Resultados de la aplicación del plan de calidad científico-técnica y de mejora continua de calidad en diálisis peritoneal / No disponible

Introducción: en los últimos años se ha intentado homogeneizar la actividad clínica y facilitar la toma de decisiones. En el campo de la Nefrología, la SEN ha elaborado diferentes guías de práctica clínica que han conseguido una mejora de la monitorización de los pacientes. Por ello, se ha creado un grupo de trabajo sobre Gestión de la Calidad en Nefrología cuyo ámbito fundamental ha sido la hemodiálisis, aunque su colaboración con un grupo de expertos de Diálisis Peritoneal (DP) ha permitido la elaboración del Plan de Calidad Científico-técnica y de Mejora Continua de Calidad en DP. El objetivo de nuestro trabajo fue evaluar la situación de la Unidad de DP de nuestro centro respecto a dicho plan de calidad valorando cada uno de los indicadores propuestos y compararlos con los estándares recomendados. Material y métodos: revisamos las historias clínicas de todos los pacientes que realizaron DP durante el año 2008 en nuestra Unidad, valorando todos los indicadores de calidad descritos en el Plan de Calidad Científico-técnica y de Mejora Continua de Calidad en DP. Resultados: durante el año 2008, 41 pacientes realizaron DP en nuestro centro; el 43,9% eran mujeres, con una incidencia de 14 (51,8%), y el 21,4% eran diabéticos. Ningún paciente procedía de trasplante y 2 de HD (7,1%). La edad media de la población incidente fue de 60 ± 13 años, y la de la prevalente fue de 53,9 ± 14,4 años, con tiempo medio en DP de 25,9 ± 19,9 meses. La mediana del índice de comorbilidad de Charlson modificado en incidentes fue 6 y en prevalentes 5. El 70,7% estaba incluido en programa de trasplante y se trasplantaron 3 (10,3%). Hubo 19 ingresos (0,46 por paciente/año en riesgo), con estancia media de 7,3 días (3,4 días por paciente/año en riesgo). A lo largo del año abandonaron el tratamiento 6 pacientes (2 transferencias a HD, 3 trasplantes y 1 exitus). Hubo 16 peritonitis (1 episodio cada 24 meses-paciente) y 23 infecciones del OS (1 episodio cada 18 meses-paciente). El Kt/V medio fue de 2,4 ± 0,06, con el 92,7% dentro del objetivo. El 100% de los pacientes no anúricos tenían medida FRR; sólo 1 paciente no alcanzaba el objetivo de eliminación de líquido >1.000 ml/día; en ningún caso se utilizaban bolsas de 3,86-4,25%. Se alcanzaron los estándares de los indicadores analíticos en lo que respecta a índice de resistencia a eritropoyetina, LDL-colesterol, fósforo, producto calcio-fósforo y PTH intacta. Conclusiones: la aplicación del Plan de Calidad Científico-técnica y de Mejora Continua de Calidad en Diálisis Peritoneal nos ha permitido conocer la situación actual de nuestra Unidad y plantearnos aquellas cuestiones en las que es preciso incidir para conseguir una mejor calidad en la asistencia que prestamos (AU)

Introduction: In last time it was tried to homogenize the clinical activity and to make the decisions easier. In the field of Nephrology, the Spanish Society of Nephrology has developed different guidelines that have managed an improvement in patient´s monitoring. That is the reason why the Quality Working Group in Nephrology was created, whose basic working field was haemodialysis, although its collaboration with an expert group in peritoneal dialysis (PD) has allowed the developement of a Scientific Technical Quality Programme and Constant Quality Improvement in PD. Material and methods:We checked the clinical histories of all the patients in PD in the course of 2008 in the Peritoneal Dialysis Unit at our institution and we evaluated all the quality indicators that were described in the Scientific Technical Quality Programme and of Constant Quality Improvement in PD. Results: During 2008 a total of 41 patients were treated in the Peritoneal Dialysis Unit at our institution, 43.9% women. Incidence was 14 (51.8%) and 21.4% were diabetics. No patients cames from transplant unit and 2 came from haemodilalysis unit (7.1%). Mean age in incident population was 60 ± 13 years and in prevalent population was 53.9 ± 14.4 years. Mean follow-up in PD was 25.9 ± 19.9 months. Modified Charlson comorbility index average in incident patients was 6 and in prevalent patients was 5. 70.7% were included in transplant programme and 3 were transplanted in the year´s course (10.3%). There were 19 hospital admissions (rate: 0.46 admission per patient/year in risk) with a mean stay of 7.3 days (rate: 3.4 days per patient/year in risk). During 2008 6 patients leaved PD (2 transfers to haemodialysis, 3 transplants and 1 death). 16 infective peritonitis (overall rate:1 episode every 24 months) and 23 exit side infections were reported (rate: 1 episode every 18 months). Mean Kt/V was 2,4 ± 0.06 (92.7% of patients achieved the stablished standards). All non-anuric patients had measured residual renal function and only 1 patient did not achieve the goal of fluid output > 1000 ml/day. No patient used 3.86-4.25% bags. Stablished standards were achieve by analitic indicators with regard to epoetin resistence index, LDL- cholesterol, phosphate, calcium-phosphate product and PTH.Conclusions: The application of the Scientific Technical Quality Programme and of Constant Quality Improvement in PD has made possible to know the current situation of our unit and to raise some matters when it is necessary to insist to get a better quality in our assistance (AU)

Situación actual del acceso vascular en la provincia de Cáceres / No disponible

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[Vancomycin dosing in hemodialysis patients]. / Dosificación de vancomicina en pacientes en hemodiálisis.

UNLABELLED: Vancomycin is widely used in haemodialysis (HD) patients for treating infections of vascular access due to St. Aureus. To avoid subtherapeutic levels it is important to know the adequate dosing in patients undergoing haemodialysis with high flux membranes. OBJECTIVE: The aim of this study was to evaluate whether HD patients treated with 1 g intravenous (IV) vancomycin reached optimum plasma levels. MATERIAL AND METHODS: In a crossover design we studied 28 chronic HD patients, 3 times a week, treated with vancomycin between 15/2/2006 and 14/2/2007. Antibiotic was given at dose of 1 g during the last hour of dialysis session. Plasma levels of vancomycin were measured immediately before next HD (preHD1) and after (postHD1), and prior to the beginning of the second next session (preHD2). We evaluated age, sex, dry height, week Kt/V and the type of membrane used. RESULTS: Of 28 patients, 5 were analysed 3 times, 2 were analysed twice and 9 were analysed once . There were 43 samples, 19 men (44,2%) and 24 women (55,8%), with a mean age of 70 +/- 8,4 years. 1 g dose is equivalent to > 15 mg/kg in 31 patients (72,1%) and < 15 mg/kg in 12 (27,9%). The type of membrane used was high flux polyetersulfone (PES-AP) (44,2%), eval (7%), medium-low polyetersulfone (PES-BP) (32,5%) and polyacrylonitrile (16,3%). PreHD1 mean concentration results for the total population was 7,06 mg/ml, being 16,3% bellow optimum levels. There were not difference between patients treated with dose > 15 mg/kg (7,5 mg/ml) and < 15 mg/kg (6 m/ml). When the dose administered was > 15 mg/kg, 6,45% results were subtherapeutic, whereas if the dose was < 15 mg/kg, 41,67% values were bellow optimum levels (p<0,05). With regard to the dialyzers used, the lowest concentrations were observed with PES-AP (5,95 mg/ml) and the highest values were observed with PES-BP (7,27 mg/ml) (p no significance). No patient using PES-BP versus 31,58% patients using PES-AP showed suboptimum values (p> or =0,07). All postHD1 and preHD2 results were in subtherapeutic range (mean values, dose > and < 15 mg/kg and all types of membrane). CONCLUSIONS: Based on the above results, the vancomycin dosing schedule of 1 g IV every 5-7 days is not recommended for patients undergoing haemodialysis with high flux membranes. Since there are not guidelines for handling this antibiotic in these patients our findings suggest that it may be necessary to monitorize predialysis plasma levels to avoid subtherapeutic values.

¿Es el momento de aplicar las nuevas Tecnologías de la Información y Comunicación a la Nefrología? / No disponible

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