Material recomendado para tratamiento de aguas en unidades pequeñas / Recommended material for water management in small units

La calidad del agua exigible para unidades pequeñas o individuales, debe ser similar a la exigida para las unidades generales. Actualmente, para técnicas de diálisis de alto flujo e incluso para técnicas de hemodiálisis convencional, se recomienda la utilización de agua altamente purificada o ultra-pura. Tanto el diseño, como el control y mantenimiento de los sistemas de tratamiento de aguas para las unidades pequeñas, deberá ser del mismo nivel que para las unidades de hemodiálisis generales. Es muy recomendable que la producción del agua ultra-pura se realice in situ y que no se almacene. Si se produce fuera de la unidad, el circuito será lo más corto posible. Todo tratamiento de aguas, individual o general, deberá contar básicamente con un pretratamiento y un tratamiento de ósmosis inversa

The quality of the indispensable water for small or individual units must be similar to the demanded one for the general units. At the moment, for techniques of dialysis of high flow and even for techniques of conventional hemodyalisis, the water use highly purified or ultra pure is recommended. As much the design, as the control and maintenance of the systems of water treatment for the small units, will have to be of he himself level that stops the units of general hemodyalisis. He is very recommendable that the production of the ultra pure water is made “in situ” and that is not stored. If one takes place outside the unit, the circuit will be but short the possible thing. All individual or general water treatment will have to basically count on a pre-treatment and a treatment of inverse osmosis

[Guidelines for quality management of dialysis solutions]. / Guías de gestión de calidad del líquido de diálisis (LD).

A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org

Guías de Gestión de Calidad del Líquido de Diálisis (LD) / No disponible

La Sociedad Española de Nefrología ha elaborado una Guía sobre la calidad del líquido de diálisis. La guía establece recomendaciones sobre los estándares necesarios para preparar el dializado: agua, concentrado y los sistemas necesarios para su elaboración.. Esta guía se fundamenta en la Farmacopea Europea, la Real Farmacopea Española, los estándares y recomendaciones prácticas de la AAMI, las Guías Europeas para hemodiálisis (sección VI) y revisión de la literatura acompañado de su nivel de evidencia, así como la opinión del Comité de expertos que ha elaborado la guía. Se han definido dos niveles de calidad del agua: purificada y altamente purificada (ultrapura) y para el dializado: dializado estandar y dializado ultrapuro. La utilización de un dializado ultrapuro es necesario para la hemofiltración y hemodiafiltración en línea y deseable en la hemodiálisis de alto flujo para prevenir complicaciones: inflamación, malnutrición, anemia y amiloidosis. Se definen los niveles máximos de contaminantes requeridos en la calidad del agua, concentrados y dializados: químicos (1.1.2), microbiológicos y endotoxinas. Simultáneamente se especifican la frecuencia de monitorización, mantenimiento, así como los mecanismos para su corrección. En los apéndices se describen los métodos de recogida de las muestras y su análisis. Para la monitorización microbiológica se recomiendan los medios TSA o R2A, con un periodo de incubación de 5 días a una temperatura de 30-35 ºC. La calidad del dializado involucra a todo el personal de diálisis y su control requiere protocolos estrictos. Los nefrólogos encargados de la diálisis tienen la última responsabilidad en la calidad del dializado. Todas las sugerencias y preguntas relacionadas con esta guía serán atendidas en www.senefro.org (AU)

A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Espa- ñola, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is neccessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35º C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org (AU)

[Effects of a dietary intervention on the nutritional status of hemodialyzed patients: differences between men and women]. / Efectos de una intervención dietética sobre el estado nutricional de pacientes en hemodiálisis: diferencias entre varones y mujeres.

The growing interest in the nutritional status of dialyzed patients arises from the fact that it plays an important role in the evolution, morbidity and mortality of renal patients. In the current study the effects have been assessed of a dietary intervention lasting 6 months, based on a food exchange list, on the nutritional status of a group of 49 hemodialysis patients as well as the different effects between men and women. The initial and final evaluation of the nutritional status was performed by estimating energy and nutrient intake with a 24 hour recall, determination of body composition by anthropometry, bioelectrical impedance and infrared interactance and biochemical measurements related to the nutritional status of the patients undergoing hemodialysis. At the end of the study, a significant increase was seen in the energy and macronutrient intake, which was more prominent in females. The body composition analysis showed a favourable evolution as compared to other studies; which was better in women who maintained the muscle mass stable and increased fat mass. The biochemical profile showed an increase of the C3 complement, while other markers such as amino acid profile and IGF I remained unchanged at the end of the study, being both similar in males and females. The dietary intervention was found to be useful in the prevention of the progression of malnutrition in these patients, apparently with a more beneficial effect on females.

[Usefulness of preoperative location tests in primary hyperparathyroidism]. / Utilidad de las pruebas de localización preoperatoria en el hiperparatiroidismo primario.

The utility of preoperative parathyroid location in primary hyperparathyroidism (pHPT) remains controversial. In this retrospective study are analysed noninvasive techniques prior to surgical neck exploration of 11 patients with pHPT, ten adenomas and one hyperplastic parathyroid glands. Localization test were performed 24 times. Ultrasonography allowed correct localization of 5 of 7 cases, computer tomography 2 of 6, scintigraphy 2 of 4 and nuclear magnetic resonance 1 of 7. This exploration was doubtful in a patient, and two false-positive nuclear magnetic resonance were found. The low yield of these tests makes them unnecessary in the evaluation of patients undergoing surgery for pHPT, because the cost is not justified.