Unidad de enfermedad renal crónica avanzada (ERCA).Concepto de una unidad multidisciplinaria. Objetivos de la consulta de ERCA / No disponible

• Un asistencia óptima en la fase de ERC avanzada (ERCA),antes del inicio de la diálisis, debe contemplar:– detección precoz de la enfermedad renal progresiva,– intervenciones para retardar su progresión– prevenir las complicaciones urémicas– atenuar las condiciones comórbidas asociadas– adecuar la preparación para el TRS e iniciarlo en el momento adecuado de forma programada.– La alternativa de futuro son los equipos multidisciplinarios(EMD) de manejo de la ERC avanzada y deberá de disponer de recursos humanos y materiales especificos (AU)

• Optimal care of patients with advanced CKD (ACKD) before the initiation of dialysis should include:– Early detection of progressive kidney disease– Interventions to delay its progression– Prevention of uremic complications– Reduction of associated comorbid conditions– Appropriate preparation and scheduled initiation of KRT.– Multidisciplinary teams (MDT) are the future alternative for management of advanced CKD and they should have specific human and material resources (AU)

Guía de nutrición en Enfermedad Renal Crónica Avanzada (ERCA) / No disponible

• La prescripción de la ingesta proteica en ERC es compleja por los conflictos potenciales existentes para retrasarla progresión de la ERC y preservar el estado nutricional. Proporcionar alrededor de 0,75 g proteínas/ kg/ día parece razonable en pacientes con FG > 30 mL (ERC estadios1-3). En estadios 4, 5 es recomendable proporcionar alrededor de 0,6 g/kg/día. Para frenar la progresión y minimizar la acumulación de toxinas urémicas.• Mantener una adecuada ingesta energética es esencial en todos los estadios de ERC.• La valoración del estado nutricional en ERC requiere de la utilización de múltiples marcadores, para valorar el estatus proteico, los depósitos de grasa, la composición corporal y la ingesta energética y proteica.• La Malnutrición Proteico Energética (MPE) puede ser considerada como una indicación para el inicio en terapia renal sustitutiva. Si la MPE se desarrolla o persiste a pesar de intentar optimizar la ingesta y no existe otra causa de malnutrición que la ingesta o anorexia urémica está indicada la iniciación de diálisis o el trasplante renal en pacientes con FG > 15 mL/ min.• El tratamiento nutricional para pacientes con ERC debería incluir valoración nutricional, educación y una planificación y seguimiento nutricional (AU)

• Prescription of protein intake in CKD is complicated by potential conflicts between goals to delay progression of CKD and preserve nutritional status. Providing a protein intake of about 0.75 g/kg/day appears reasonable in patients with GRF > 30 mL (CKD stages 1-3). In CKD stage 4 and 5, it is recommended to provide a protein intake of about0.6 g/kg/day to slow progression and minimize accumulation of uremic toxins.• Maintaining adequate energy intake is essential in all stages of CKD.• Assessment of nutritional status in CKD requires multiple markers to assess protein status, fat stores, body composition, and protein and energy intake.• PEM can be considered as an indication for the initiation of kidney replacement therapy. If PEM develops or persists despite attempts to optimize intake, and there is no apparent cause for malnutrition other than intake or anorexia, initiation of dialysis or kidney transplant is indicated in patients with GFR> 15 mL/min.• Nutritional treatment for patients with CKD should include nutritional assessment and education and nutritional planning and follow-up (AU)

[Advanced chronic kidney disease unit. Concept of a multidisciplinary unit. Objectives of the CKD unit]. / Unidad de enfermedad renal cronica avanzada. Concepto de una unidad multidisciplinaria. Objetivos de la consulta de ERC.

Optimal care of patients with advanced CKD (ACKD) before the initiation of dialysis should include: Early detection of progressive kidney disease Interventions to delay its progression Prevention of uremic complications Reduction of associated comorbid conditions Appropriate preparation and scheduled initiation of KRT. Multidisciplinary teams (MDT) are the future alternative for management of advanced CKD and they should have specific human and material resources.

[Nutrition guidelines for advanced chronic kidney disease (ACKD)]. / Guia de nutricion en enfermedad renal cronica avanzada (ERCA).

Prescription of protein intake in CKD is complicated by potential conflicts between goals to delay progression of CKD and preserve nutritional status. Providing a protein intake of about 0.75 g/kg/day appears reasonable in patients with GRF > 30 mL (CKD stages 1-3). In CKD stage 4 and 5, it is recommended to provide a protein intake of about 0.6 g/kg/day to slow progression and minimize accumulation of uremic toxins. - Maintaining adequate energy intake is essential in all stages of CKD. - Assessment of nutritional status in CKD requires multiple markers to assess protein status, fat stores, body composition, and protein and energy intake. - PEM can be considered as an indication for the initiation of kidney replacement therapy. If PEM develops or persists despite attempts to optimize intake, and there is no apparent cause for malnutrition other than intake or anorexia, initiation of dialysis or kidney transplant is indicated in patients with GFR > 15 mL/min. - Nutritional treatment for patients with CKD should include nutritional assessment and education and nutritional planning and follow-up.

Monitorización de la calidad del agua tratada «on line» y del líquido de diálisis (LD) / No disponible

Introducción: Los tratamientos de agua «on line», están diseñados para obtener agua de gran calidad, condición indispensable, aunque no única, para conseguir LD ultrapuro. Para mantener ésta calidad es precisa la monitorización continua de la calidad del tratamiento del agua, del LD y de los monitores de diálisis. Método: Tras la instalación de un tratamiento de agua con estas características, implementamos un sistema de monitorización que incluía:a) Análisis microbiológicos, endotoxinas y químicos (analíticos y colorimétricos) en el agua en sus diferentes estadios(antes de ser tratada, en diferentes fases del tratamiento y en la red de distribución).b) Control de los parámetros mecánicos de funcionamiento del tratamiento.c) Análisis microbiológico y de endotoxinas del LD.d) Control y mantenimiento de los diferentes monitores de hemodiálisis, según las indicaciones técnicas de los mismos. Resultados: Tras cinco años de funcionamiento se ha evaluado su eficacia y la utilidad de las modificaciones introducidas a lo largo del tiempo. En este periodo no se han registrado contaminación global o parcial del agua después de ser tratada. Los incidentes registrados no han supuesto cortes de suministro o merma de la calidad que haya supuesto la paralización de la unidad de hemodiálisis, pese a los problemas derivados de las malas condiciones en que en ocasiones se encuentra el agua antes de ser tratada. Solo se registró una contaminación persistente en un monitor, que con gran certeza venía originada por el propio puerto para toma de muestras. Conclusiones: Los tratamientos de agua ¿on line¿ para hemodiálisis son los más adecuados para obtener agua de gran calidad. Han de ir acompañados de una monitorización basada en estrictos protocolos de seguimiento creados específicamente para evaluar las características del agua a tratar y tratada (AU)

Introduction: On line-treated water has been designed to obtain ultrapure water. This quality of water is obviously necessary to obtain ultrapure dialysate, although this is not the only condition. To keep the quality of the process, is necessary the continuous monitoring of the water treatment, dialysate and haemodialysis machines. Method: After the installation of a water treatment with these characteristics, we developed a protocol to follow up its quality. The measures included in the protocol were: a. - Microbiologic, endotoxin and chemical controls of the water on different stage: before and at the end of the treatment, pre-treatment and network of distribution. The chemical analysis included analytical and colorimetric measures. b. - Control of specific mechanical functions of the facilities. c. - Microbiologic and endotoxin analysis of the dialysate produced by haemodialysis machines. d. - Control and maintenance of haemodialysis machines, according to the technical indications. Results: We analyse the initial five years of water treatment with the aim to evaluate quality parameters and efficiency. We explain the reasons of the modifications introduced in the system. During this period we have not any episodes of global or partial contamination. We refer here some incidents related with the quality of raw water supply before the treatment, but in any case it was necessary neither to stop the water supply or to reduce the water quality. We observed a persistent contamination of one haemodialysis monitor due to the port used to get the samples. Conclusions: On line-treated water is at present the most appropriate system to obtain high quality water for haemodialysis. The process must be continuously monitored through specific protocols developed to evaluate the raw water's characteristics and the treated water (AU)

[Monitoring on-line treated water and dialysate quality]. / Monitorización de la calidad del agua tratada <> y del líquido de diálisis (LD).

INTRODUCTION: On line-treated water has been designed to obtain ultrapure water. This quality of water is obviously necessary to obtain ultrapure dialysate, although this is not the only condition. To keep the quality of the process, is necessary the continuous monitoring of the water treatment, dialysate and haemodialysis machines. METHOD: After the installation of a water treatment with these characteristics, we developed a protocol to follow up its quality. The measures included in the protocol were: a) Microbiologic, endotoxin and chemical controls of the water on different stage: before and at the end of the treatment, pre-treatment and network of distribution. The chemical analysis included analytical and colorimetric measures. b) Control of specific mechanical functions of the facilities. c) Microbiologic and endotoxin analysis of the dialysate produced by haemodialysis machines. d) Control and maintenance of haemodialysis machines, according to the technical indications. RESULTS: We analyse the initial five years of water treatment with the aim to evaluate quality parameters and efficiency. We explain the reasons of the modifications introduced in the system. During this period we have not any episodes of global or partial contamination. We refer here some incidents related with the quality of raw water supply before the treatment, but in any case it was necessary neither to stop the water supply or to reduce the water quality. We observed a persistent contamination of one haemodialysis monitor due to the port used to get the samples. CONCLUSIONS: On line-treated water is at present the most appropriate system to obtain high quality water for haemodialysis. The process must be continuously monitored through specific protocols developed to evaluate the raw water's characteristics and the treated water.

[Effect of family environment on adaptation to the hemodialysis program in patients with chronic renal insufficiency]. / Influencia del clima familiar en la adaptación al programa de hemodiálisis en pacientes con insuficiencia renal crónica.

In our study we have analyzed the influence of family environment on adjustment of renal patients to the HD as well as on the attitude towards kidney transplantation. The study included 57 patients (34 M, 23 F), mean age 52.3 years, and they had been on dialysis for an average of 34.5 months. We obtained information about adaptation and behavior in the care unit, and attitude and motivation towards renal transplantation. Biochemical variables were used to register disruption of medical compliance or dietetic transgression (K, PRC, BUN, weight gain, etc.). The patient's family climate was assessed through use of the Family Environment Scale (FES, Moos and Moos, 1981). The results showed that patients with aggressiveness and noncompliance during HD sessions tended to have high family conflict in family members. The most positive attitudes towards renal transplantation were found in the patients that came from families with the greatest degree of cohesion and expressiveness. In summary, family social climate is a variable influencing outcome of these patients. Its routine assessment would permit the prediction of adaptation to the therapeutic program as much as better efficacy of HD treatment.