Nefrologia最新文献

{"title":"Preoperative mapping and multidisciplinary team are the key to success of arteriovenous access for hemodialysis","authors":"Bruno Fraga Dias ,&nbsp;Joana Freitas ,&nbsp;Fernanda Silva ,&nbsp;Isabel Fonseca ,&nbsp;Paulo Almeida ,&nbsp;José Queirós","doi":"10.1016/j.nefro.2023.06.008","DOIUrl":"10.1016/j.nefro.2023.06.008","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Functional and durable vascular access is needed for adequate hemodialysis. Arteriovenous fistula is preferred over prosthetic grafts or central venous catheters, but it is associated with high rates of primary failure and maturation failure.</p><p>Preoperative mapping of arm vessels with color Doppler ultrasound (CDU) has been shown to be helpful in achieving better short and long-term outcomes. Unfortunately, is more time-consuming than a physical examination and requires an experienced examiner and special equipment; some authors defend that CDU should not be part of the routine preoperative assessment.</p><p>We reported our experience in preoperative vessel mapping using color Doppler ultrasound to purpose a vascular access to the surgical team, surveillance of vascular access, and evaluation of main outcomes (primary failure, maturation failure, and patency).</p></div><div><h3>Methods</h3><p>This is a single-center retrospective study that includes patients who attended a specific appointment for vascular access planning consultation between January 2019 and December 2021. A nephrologist performed the physical exam and vascular mapping and proposed to the vascular surgeon team a specific type and location of vascular access. Patients were followed until one month after the first hemodialysis through functioning vascular access.</p></div><div><h3>Results</h3><p>In this study, 167 patients were evaluated (114 incident patients – chronic kidney disease stage 4 or 5 – and 53 prevalent patients – under hemodialysis through central venous catheter). The vascular accesses proposed by nephrologist were radial-cephalic arteriovenous fistula in 70 patients (41.9%), brachio-cephalic arteriovenous fistula in 50 patients (29.9%), brachio-basilic arteriovenous fistula in 34 patients (20.4%), arteriovenous graft in 8 patients (4.8%) and central venous catheter in 2 patients (1.2%).</p><p>Vascular access was constructed in 141 patients: distal arteriovenous fistula in 57 patients (40.4%), brachio-cephalic arteriovenous fistula in 54 patients (38.3%), brachio-basilic AVF in 27 patients (19.1%), and arteriovenous graft in 3 patients (2.1%). The created access corresponds to the proposed access in 129 patients (91.5%).</p><p>Twenty-two (15.6%) primary failures were registered. Distal arteriovenous fistulas and diabetes mellitus were associated with a higher risk of primary failure (OR<!--> <!-->=<!--> <!-->3.929 (1.485–10.392), <em>p</em> <!-->=<!--> <!-->0.004; OR<!--> <!-->=<!--> <!-->3.867 (1.235–12.113), <em>p</em> <!-->=<!--> <!-->0.014, respectively).</p><p>The incidence of maturation failure at eight weeks was 4.8%.</p><p>The primary patency at 6, 12 and 24 months was 76.3%, 70.4% and 49.2%. Primary assisted patency was 84.8% at 6 and 12 months and 81.3% at 24 months.</p></div><div><h3>Conclusions</h3><p>This study demonstrates that the study of the entire vascular territory performed with color Doppler ultras","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001005/pdfft?md5=7ae751ef8ad3a6dead6e16c0a1acbb45&pid=1-s2.0-S0211699523001005-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47638508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primera pagina","authors":"","doi":"10.1016/S0211-6995(24)00052-3","DOIUrl":"https://doi.org/10.1016/S0211-6995(24)00052-3","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000523/pdfft?md5=d6a31887cf25666411c6817e788b9716&pid=1-s2.0-S0211699524000523-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141240077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the attached letter “IgA nephropathy and hematuria after getting vaccine for SARS-CoV-2” by H. Daungsupawong and V. Wiwanitkit","authors":"Leonardo Calle Garcia","doi":"10.1016/j.nefro.2023.12.002","DOIUrl":"10.1016/j.nefro.2023.12.002","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001844/pdfft?md5=463d7628524109fd481d0af61ae16947&pid=1-s2.0-S0211699523001844-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supervivencia y su relación con el tipo de transferencia de solutos de membrana peritoneal, en pacientes con enfermedad renal crónica incidentes en terapia de diálisis peritoneal en RTS Colombia entre los años 2007-2017","authors":"Rafael Alberto Gómez ,&nbsp;Helmer de Jesús Zapata","doi":"10.1016/j.nefro.2023.06.011","DOIUrl":"10.1016/j.nefro.2023.06.011","url":null,"abstract":"<div><h3>Introduction</h3><p>In some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the peritoneal equilibrium test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007 to 2017 using a competing risk model.</p></div><div><h3>Materials and methods</h3><p>A retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a PET between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert).</p></div><div><h3>Results</h3><p>Patients were classified into four categories based on the PET result: slow/low transfer (16.0%), low average (35.4%), high average (32.9%), and high/fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98–1.30) <em>P</em> = .078, high average 1.08 (95% CI 0.96–1.22) <em>P</em> = .195, low average 1.09 (95% CI 0.96–1.22) <em>P</em> = .156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98–1.52) <em>P</em> = .66, high average HR was 1.10 (95% CI 0.91–1.33) <em>P</em> = .296, low average HR of 1.03 (95% CI 0.85–1.24) <em>P</em> = .733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences.</p></div><div><h3>Conclusions</h3><p>When evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics ","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001054/pdfft?md5=06010577642ba6c2cd9b05057b72629b&pid=1-s2.0-S0211699523001054-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46404884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparación de la eficacia y seguridad de la nueva generación dializadores de helixona","authors":"Francisco Maduell ,&nbsp;José Jesús Broseta ,&nbsp;Diana Rodríguez-Espinosa ,&nbsp;Lida María Rodas ,&nbsp;Miquel Gómez ,&nbsp;Marta Arias-Guillén ,&nbsp;Néstor Fontseré ,&nbsp;Manel Vera ,&nbsp;Maria del Carmen Salgado ,&nbsp;Nayra Rico ,&nbsp;Rosa Ramos","doi":"10.1016/j.nefro.2024.02.005","DOIUrl":"10.1016/j.nefro.2024.02.005","url":null,"abstract":"<div><h3>Introduction</h3><p>New generation helixone dialyzers has recently been developed as part of the ongoing effort to improve dialyzer hemocompatibility and avoid adverse reactions to synthetic dialyzers. This study aimed to assess the performance and albumin loss of this new dialyzer series in hemodiafiltration and compare it with the previous generation helixone series.</p></div><div><h3>Material and methods</h3><p>A prospective study was conducted in 19 patients. Each patient underwent eight dialysis sessions with the same routine dialysis parameters; only the dialyzer varied: FX60 CorDiax, FX CorAL 60, FX600 CorDiax, FX CorAL 600, FX80 CorDiax, FX CorAL 80, FX800 CorDiax, and FX CorAL 800. The reduction ratios (RR) of urea, creatinine, β₂-microglobulin, myoglobin, kappa-free immunoglobulin light chains (κFLC), prolactin, α₁-microglobulin, α₁-acid glycoprotein, lambda immunoglobulin light chains (λFLC), and albumin were compared intra-individually. Dialysate albumin loss was also measured.</p></div><div><h3>Results</h3><p>All treatments were well tolerated. The mean amount of replacement fluid ranged from 31 to 34<!--> <!-->litres. Comparison of dialysis treatments showed no differences between small molecules and even up to those the size of β₂-microglobulins. Little differences were found between myoglobin, κFLC, prolactin, α₁-microglobulin, and λFLC RRs, and only FX80 CorDiax was slightly superior to the others. Mean dialysate albumin losses were similar, with less than 2.5<!--> <!-->grams lost in each dialyzer. The FX80 CorDiax showed slightly higher global removal scores than the other dialyzers evaluated, except for FX CorAL 800.</p></div><div><h3>Conclusion</h3><p>The new generation helixone dialyzers series has been updated to minimise the risk of adverse reactions, while maintaining the effectiveness and albumin loss achieved by the previous most advanced helixone generation.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S021169952400016X/pdfft?md5=2e453e9cfb8175b9515cc67280765dbe&pid=1-s2.0-S021169952400016X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140086915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activación y control de enfermedad de pacientes en tratamiento crónico con hemodiálisis: un estudio observacional","authors":"Sara Ramírez-Sánchez ,&nbsp;María Jesús Soriano-Munuera ,&nbsp;Elena Lucía Gras-Colomer ,&nbsp;Alicia Cana-Poyatos ,&nbsp;Teresa García-Martínez ,&nbsp;Rafael Ortiz-Ramón ,&nbsp;Sara Linares-Aguayo ,&nbsp;Alicia García-Testal","doi":"10.1016/j.nefro.2023.05.009","DOIUrl":"10.1016/j.nefro.2023.05.009","url":null,"abstract":"<div><h3>Background and objective</h3><p>Patient activation is a concept that refers to the willingness to manage one's health and medical care. To assess it, a patient activation measure (PAM) has been developed and validated. Several studies report low activation in patients with chronic diseases. However, information on activation in hemodialysis patients is scarce. The aim of the present study is to describe the activation level of patients on chronic treatment in an HD unit and its relationship with disease control parameters.</p></div><div><h3>Materials and methods</h3><p>Cross-sectional observational study in patients with advanced chronic kidney disease on chronic HD treatment. Ninety-six patients were included. Activation was measured with the PAM-13 questionnaire. Its relationship with descriptive variables (age, sex, comorbidity, studies, habitat) and disease control variables (vascular access, blood flow, potassaemia, phosphataemia, interdialytic gain) was studied. For this purpose, Spearman's correlation test, multiple linear regression model and logistic model were used as statistical methods.</p></div><div><h3>Results</h3><p>The mean (SD) PAM-13 score was 63.19 (15.21). Activation was significantly associated with vascular access (<em>P</em> = .003), blood flow (<em>P</em> = .024), and interdialytic gain of patients (<em>P</em> = .008).</p></div><div><h3>Conclusions</h3><p>Activation in patients on chronic hemodialysis treatment is low. Higher activation is related having an arteriovenous fistula, higher blood flow and lower interdialytic gain. Future studies are needed to confirm and apply our results.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000784/pdfft?md5=839865158b5e701caffe892fd17553f1&pid=1-s2.0-S0211699523000784-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43064090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Encefalopatía inducida por contraste en pacientes con enfermedad renal crónica avanzada: aquello que el nefrólogo necesita saber","authors":"Víctor Joaquín Escudero-Saiz ,&nbsp;Nathalie Melissa Romani ,&nbsp;Pastora Rodríguez ,&nbsp;Laura Morantes ,&nbsp;Jimena Del Risco-Zevallos ,&nbsp;Joaquim Casals ,&nbsp;Marc Xipell ,&nbsp;Elena Guillén ,&nbsp;Gastón J. Piñeiro ,&nbsp;Miguel Blasco ,&nbsp;Lida M. Rodas ,&nbsp;Luis F. Quintana ,&nbsp;Esteban Poch ,&nbsp;Daniel Santana ,&nbsp;Alicia Molina Andújar","doi":"10.1016/j.nefro.2023.05.007","DOIUrl":"10.1016/j.nefro.2023.05.007","url":null,"abstract":"<div><p>Contrast-induced encephalopathy is a neurological complication related to contrast used in endovascular procedures or computed tomography (CT). The main risk factors are arterial hypertension, diabetes mellitus, chronic kidney disease (CKD), hyperosmolar contrasts, the amount of infused contrast and its direct infusion in the posterior cerebral territory, or pathologies with blood–brain barrier damage. Symptomatology is non-specific and may present as altered level of consciousness, neurological focality or seizures. Diagnosis is done by exclusion after ischemic or hemorrhagic stroke has been ruled out; CT or MRI are useful for differentiation. Generally, it appears shortly after exposure and the symptoms lasts 48–72 h with complete recovery, although cases with persistence of symptoms or longer duration have been described. Treatment consists of monitoring, supportive measures and renal replacement therapy (RRT) with hemodialysis (HD) in patients in chronic RRT program. It is important for the nephrologist to be aware of this entity given the susceptibility of the patient on HD as well as its potential therapeutic role in these patients.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000760/pdfft?md5=d4f2d5f9c0d722d391f758ba09ca00eb&pid=1-s2.0-S0211699523000760-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46353774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiencia en vida real con terapias frente a COVID-19 leve-moderada en trasplantados renales: ¿cómo tratar a partir de ahora a los pacientes con enfermedad renal crónica?","authors":"Marta Alonso ,&nbsp;Florentino Villanego ,&nbsp;Luis Alberto Vigara ,&nbsp;María Eugenia Rodríguez ,&nbsp;Myriam Eady ,&nbsp;Ana García ,&nbsp;María Carmen Mínguez ,&nbsp;María Elisa Montero ,&nbsp;Óscar Segurado ,&nbsp;Teresa García ,&nbsp;Auxiliadora Mazuecos","doi":"10.1016/j.nefro.2023.06.007","DOIUrl":"10.1016/j.nefro.2023.06.007","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10045895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efecto de un equipo multidisciplinar en el manejo del acceso vascular para hemodiálisis","authors":"Israel Leblic Ramírez ,&nbsp;Luis Riera del Moral ,&nbsp;Rafael Sánchez Villanueva ,&nbsp;Stefan Stefanov Kiuri ,&nbsp;Laura Álvarez García ,&nbsp;Rocío Echarri Carrillo ,&nbsp;Ángel Gallegos Villalobos ,&nbsp;Álvaro Fernandez Heredero","doi":"10.1016/j.nefro.2023.06.003","DOIUrl":"10.1016/j.nefro.2023.06.003","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000954/pdfft?md5=379aadba751c448a3889c828f6afe040&pid=1-s2.0-S0211699523000954-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43989777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respuesta a la carta: «Preeclampsia: un importante factor de riesgo de enfermedad renal crónica frecuente y desafortunadamente olvidado»","authors":"Jose Luis Górriz ,&nbsp;Rafael García Maset ,&nbsp;en nombre de los autores del documento de información y consenso para la detección y manejo de la ERC","doi":"10.1016/j.nefro.2024.02.002","DOIUrl":"10.1016/j.nefro.2024.02.002","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000080/pdfft?md5=d7a6b8872e954263d69a7331e5245fc4&pid=1-s2.0-S0211699524000080-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139872207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}