Subject(s)
Humans , Male , Aged , Thrombosis , Nephrotic Syndrome/complications , Antithrombins , Thrombophilia , HypertensionABSTRACT
Antecedentes y objetivo: Valorar la presión generada por una pinza ajustable en fístulas arteriovenosas (FAV) durante el proceso de hemostasia y compararla con la generada por la compresión manual. Evaluar las variaciones de la compresión manual durante el proceso de hemostasia. Métodos: Se analizaron los datos de 51 sesiones de hemodiálisis de 15 pacientes. Se utilizó la presión intraacceso como indicador indirecto de la presión generada por ambos métodos sobre la FAV. La misma se registró antes de retirar la aguja venosa (PBasal), tras retirar la aguja y colocar la pinza (P1), tras ajustar la pinza (P2), al comenzar el paciente a ejercer compresión manual (M0), a los 3min del inicio de la presión manual (M3) y a los 6min del inicio de la presión manual (M6). Resultados: La presión intraacceso fue menor al aplicar la pinza y ajustarla (P2) que al aplicar presión manual (M0), con una diferencia media de −9,43mmHg (variación −18,57%, IC95%: −14,09 a −4,77mmHg, p<0,001). La presión manual mostró una tendencia descendente durante el proceso de hemostasia (M3-M0: −8,82mmHg, p<0,001; M6-M0: −12,55mmHg, p<0,001). Conclusión: La compresión ejercida por una pinza ajustable es inferior o similar a la ejercida de forma manual por el paciente. Esta última muestra una intensidad decreciente durante el proceso de hemostasia. Estos datos sugieren que algunas de las premisas sobre las que se basan algunas de las recomendaciones presentes en las guías clínicas podrían ser imprecisas. (AU)
Background and objectives: To evaluate the pressure generated by an adjustable hemostasis clamp on arteriovenous fistulas (AVF) during the hemostasis proccess, and compare it with the direct two-finger pressure applied by the patient. To evaluate the variations of the direct two-finger pressure along the hemostasis process. Methods: We analyzed data obtained in 51 hemodialysis procedures from 15 patients. AVF intra-access pressure was used as indirect indicator of the pressure generated by both methods. It was recorded before venous needle removal (PBasal), at clamp application (P1), after clamp adjustement by a nurse (P2), at the beginning of the direct two-finger pressure by the patient (M0), after 3min of two-finger pressure (M3) and after 6min of two-finger pressure (M6). Results: Intra-access pressure was lower with the adjusted clamp (P2) than with the direct two-finger pressure by the patient (M0) (variation of −18.57%, 95%CI: −14.09 to −4.77mmHg, P<.001). Intra-access pressure generated by the direct two-finger pressure method showed a decreasing trend along the hemostasis process (M3-M0: −8.82mmHg, P<.001; M6-M0: −12.55mmHg, P<.001). Conclusion: An adjustable fistula arm clamp generates a lower pressure in AVF than the direct two-finger pressure applied by the patient. The latter showed a decreasing trend along the hemostasis process. These data suggest that some of the recommendations from clinical guidelines could be based on inaccurate premises. (AU)
Subject(s)
Humans , Hemostasis , Arteriovenous Fistula , Renal Dialysis , Cross-Sectional Studies , Epidemiology, Descriptive , Bleeding TimeABSTRACT
BACKGROUND AND OBJECTIVES: To evaluate the pressure generated by an adjustable hemostasis clamp on arteriovenous fistulas (AVF) during the hemostasis proccess, and compare it with the direct two-finger pressure applied by the patient. To evaluate the variations of the direct two-finger pressure along the hemostasis process. METHODS: We analyzed data obtained in 51 hemodialysis procedures from 15 patients. AVF intraaccess pressure was used as indirect indicator of the pressure generated by both methods. It was recorded before venous needle removal (PBasal), at clamp application (P1), after clamp adjustement by a nurse (P2), at the beginning of the direct two-finger pressure by the patient (M0), after 3â¯min of two-finger pressure (M3) and after 6â¯min of two-finger pressure (M6). RESULTS: Intra-access pressure was lower with the adjusted clamp (P2) than with the direct two-finger pressure by the patient (M0) (variation of -18.57%, 95%CI -14.09 to -4.77â¯mmHg, Pâ¯<â¯0.001). Intraaccess pressure generated by the direct two-finger pressure method showed a decreasing trend along the hemostasis process (M3-M0: -8.82â¯mmHg, Pâ¯<â¯0.001; M6-M0: -12.55â¯mmHg, Pâ¯<â¯0.001). CONCLUSION: An adjustable fistula arm clamp generates a lower pressure in AVF than the direct two-finger pressure applied by the patient. The latter showed a decreasing trend along the hemostasis process. These data suggest that some of the recommendations from clinical guidelines could be based on inaccurate premises.
Subject(s)
Arteriovenous Fistula , Arteriovenous Shunt, Surgical , Arteriovenous Shunt, Surgical/methods , Hemostasis , Humans , Renal Dialysis/methods , Upper ExtremityABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Neoplasms/epidemiology , Renal Insufficiency, Chronic/epidemiology , Antineoplastic Agents/adverse effects , Antineoplastic Agents/therapeutic use , Comorbidity , Cross-Sectional Studies , Medical Oncology/trends , Neoplasms/blood , Neoplasms/drug therapy , Nephrology/trends , Outpatients/statistics & numerical data , Prevalence , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/chemically induced , Renal Insufficiency, Chronic/diagnostic imaging , Spain/epidemiology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. Remarkably, outcomes vary across centres. In addition, the methods used have important epistemological limitations, such as ignoring significant features (e.g., quality of life) or no relevance given to the patient's perspective in the indicator's selection. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance, considering the complexity of their interactions, to facilitate a comprehensive evaluation of haemodialysis centres. METHODS: Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, using a qualitative structured analysis with pre-established criteria, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighted sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results. RESULTS: WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders. CONCLUSIONS: The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.
Subject(s)
Ambulatory Care Facilities/standards , Attitude of Health Personnel , Quality Assurance, Health Care/methods , Renal Dialysis , Stakeholder Participation , Consensus , Decision Making , Humans , Quality of Life , Social ValuesABSTRACT
No disponible
Subject(s)
Humans , Aged , Decision Making , Chronic Disease/epidemiology , Kidney Diseases/epidemiology , Primary Health Care , Frail ElderlySubject(s)
Neoplasms/epidemiology , Renal Insufficiency, Chronic/epidemiology , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/adverse effects , Antineoplastic Agents/therapeutic use , Comorbidity , Cross-Sectional Studies , Female , Humans , Male , Medical Oncology/trends , Middle Aged , Neoplasms/blood , Neoplasms/drug therapy , Nephrology/trends , Outpatients/statistics & numerical data , Prevalence , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/chemically induced , Renal Insufficiency, Chronic/diagnostic imaging , Spain/epidemiology , Tomography, X-Ray Computed , Young AdultABSTRACT
La enfermedad renal crónica es frecuente en personas >65años. El desarrollo y el perfeccionamiento de técnicas de diálisis ha permitido su generalización a toda la población cuando se llega a una situación de nefropatía terminal, sin existir límite de uso por la edad cronológica. La toma de decisiones en ancianos con enfermedad renal crónica avanzada es compleja: además de parámetros renales se debe considerar la comorbilidad, así como la presencia de síndromes geriátricos. En esta revisión se aborda la gestión de la información, la toma de decisión de diferentes modalidades de tratamiento que se pueden ofertar a estos pacientes y el momento de inicio y/o retirada de diálisis
Chronic kidney disease is common in people >65years of age. The development and improvement of dialysis techniques has allowed its generalisation to the entire population, when there is a situation of terminal nephropathy, without limit of use due to chronological age. Decision making in elderly patients with advanced chronic kidney disease is complex: in addition to renal parameters, both comorbidity and the presence of geriatric syndromes must be considered. This review addresses the management of information, the decision making of different treatment modalities that can be offered to these patients, and the time of initiation and/or withdrawal of dialysis
Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Renal Insufficiency, Chronic/epidemiology , Decision Making , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Information Management , Cognitive Dysfunction/complications , Survival Analysis , Quality of Life , Patient Education as Topic , Palliative CareABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Hyperaldosteronism/blood , Hyperaldosteronism/diagnosis , Renin/blood , Follow-Up StudiesSubject(s)
Hyperaldosteronism/diagnosis , Antihypertensive Agents/adverse effects , Antihypertensive Agents/therapeutic use , Captopril/adverse effects , Captopril/therapeutic use , Diuretics/therapeutic use , Female , Humans , Hyperaldosteronism/blood , Hyperaldosteronism/drug therapy , Hypertension/drug therapy , Hypotension/chemically induced , Middle Aged , Renin/blood , Spironolactone/therapeutic useABSTRACT
Chronic kidney disease is common in people >65years of age. The development and improvement of dialysis techniques has allowed its generalisation to the entire population, when there is a situation of terminal nephropathy, without limit of use due to chronological age. Decision making in elderly patients with advanced chronic kidney disease is complex: in addition to renal parameters, both comorbidity and the presence of geriatric syndromes must be considered. This review addresses the management of information, the decision making of different treatment modalities that can be offered to these patients, and the time of initiation and/or withdrawal of dialysis.
Subject(s)
Clinical Decision-Making , Decision Making, Shared , Renal Dialysis , Renal Insufficiency, Chronic/therapy , Aged , Aged, 80 and over , Disease Progression , Frailty , Humans , Palliative Care , Patient Education as Topic , Patient Preference , Physical Functional Performance , Quality of Life , Renal Insufficiency, Chronic/mortality , Withholding TreatmentSubject(s)
Cathartics/adverse effects , Colonoscopy , Kidney Diseases/chemically induced , Phosphates/adverse effects , Administration, Oral , Aged , Aged, 80 and over , Cathartics/administration & dosage , Female , Humans , Kidney Diseases/diagnosis , Male , Middle Aged , Phosphates/administration & dosage , Preoperative CareABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Crohn Disease/drug therapy , Adalimumab/therapeutic use , Risk FactorsABSTRACT
Describimos el caso de una mujer joven, que fue diagnosticada de insuficiencia renal avanzada, con un hallazgo casual de una nefrocalcinosis sin una etiología clara, al haberse encontrado asintomática a lo largo de su vida. El estudio genético por paneles de genes conocidos asociados a enfermedad tubulointersticial permitió descubrir una acidosis tubular renal distal autosómica dominante, asociada a una mutación de novo en el exón 14 del gen SLC4A1, que hubiera sido imposible diagnosticar clínicamente por lo avanzado de la enfermedad renal cuando fue descubierta (AU)
We describe the case of a young woman who was diagnosed with advanced kidney disease, with an incidental finding of nephrocalcinosis of unknown aetiology, having been found asymptomatic throughout her life. The genetic study by panels of known genes associated with tubulointerstitial disease allowed us to discover autosomal dominant distal renal tubular acidosis associated with a de novo mutation in exon 14 of the SLC4A1 gene, which would have been impossible to diagnose clinically due to the advanced nature of the kidney disease when it was discovered (AU)
