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Objective: to investigate the scientific evidence in the literature on the effects of Ascorbic Acid on biochemical outcomes such as hemoglobin, ferritin, and transferrin saturation in patients with chronic kidney disease undergoing renal replacement therapy. Methods: This is an integrative literature review study with a qualitative approach. Databases were used; Latin American Literature in Health Sciences (LILACS), Medical Literature and Retrieval System online (Medline), Excerpta Médica dataBASE (EMBASE), Cochrane Library. Eleven studies were included, only clinical trials that used ascorbic acid in hemodialysis patients and analyzed its effects. Results: The findings corroborate the efficacy of Ascorbic Acid as an adjuvant in the treatment of anemia in patients undergoing hemodialysis treatment, since it increases serum hemoglobin and reduces the need for Human Recombinant Erythropoietin. In addition, they depict a reduction in serum ferritin levels and an increase in transferrin saturation, a fact that increases its bioavailability and is useful in functional iron deficiency. Conclusion: Although studies are limited by the small number of participants, short duration of follow-up after the intervention and quality variability, Ascorbic Acid appears to be effective as an adjunct in the control of anemia. Longer-term studies are needed to confirm these results, report adverse events, and determine the impact on long-term outcomes. Objetivo: investigar la evidencia científica en la literatura sobre los efectos del Ácido Ascórbico en resultados bioquímicos como la saturación de hemoglobina, ferritina y transferrina en pacientes con enfermedad renal crónica en tratamiento de reemplazo renal. Métodos: Se trata de un estudio de Revisión Integrativa de la Literatura con enfoque cualitativo. Se utilizaron bases de datos; Literatura Latinoamericana en Ciencias de la Salud (LILACS), Literatura Médica y Sistema de Recuperación en Línea (Medline), BASE de datos Excerpta Médica (EMBASE), Biblioteca Cochrane. Se incluyeron once estudios, solo ensayos clínicos que utilizaron ácido ascórbico en pacientes en hemodiálisis y analizaron sus efectos. Resultados: Los hallazgos corroboran la eficacia del Ácido Ascórbico como adyuvante en el tratamiento de la anemia en pacientes en tratamiento de hemodiálisis, ya que aumenta la hemoglobina sérica y reduce la necesidad de Eritropoyetina Humana Recombinante. Además, muestran una reducción en los niveles de ferritina sérica y un aumento en la saturación de transferrina, hecho que aumenta su biodisponibilidad y es útil en la deficiencia funcional de hierro. Conclusión: Aunque los estudios están limitados por el pequeño número de participantes, la corta duración del seguimiento después de la intervención y la variabilidad de la calidad, el ácido ascórbico parece ser efectivo como coadyuvante en el control de la anemia. Se necesitan estudios a más largo plazo para confirmar estos resultados, informar eventos adversos y determinar el impacto en los resultados a largo plazo. Objetivo: investigar na literatura as evidências científicas sobre os efeitos do Ácido Ascórbico em desfechos bioquímicos tais como hemoglobina, ferritina e saturação de transferrina em pacientes com doença renal crônica submetidos à terapia renal substitutiva. Métodos: Trata-se de um estudo de Revisão Integrativa da Literatura com abordagem qualitativa. Utilizaram-se as bases de dados; Literatura Latino-Americana em Ciências da Saúde (LILACS), Medical Literature and Retrieval System on Line (Medline), Excerpta Médica dataBASE (EMBASE), Cochrane Library. Foram incluídos 11 estudos, apenas ensaios clínicos que utilizaram o ácido ascórbico em pacientes sob hemodiálise e analisaram seus efeitos. Resultados: Os achados corroboram para a eficácia do Ácido Ascórbico como adjuvante no tratamento da anemia em pacientes submetidos em tratamento de hemodiálise, uma vez que aumenta a hemoglobina sérica e reduz a necessidade da Eritropoetina Recombinante Humana. Alé disso, retratam a redução dos níveis de ferritina sérica e a elevação da saturação de transferrina, fato que eleva sua biodisponibilidade e ser útil na deficiência funcional de ferro. Conclusão: Embora os estudos sejam limitados pelo pequeno número de participantes, curta duração do seguimento após a intervenção e variabilidade de qualidade, o Ácido Ascórbico se apresenta como eficaz como coadjuvante no controle da anemia. Estudos mais prolongados são necessários para confirmar estes resultados, relatar eventos adversos e determinar o impacto nos desfechos a longo prazo.

RESUMEN Antecedentes: La prueba de lanzadera incremental ha sido empleada para determinar la capacidad física en pacientes con enfermedad renal crónica. Sin embargo, su aplicabilidad y reproducibilidad ha sido poco estudiada en pacientes bajo tratamiento de hemodiálisis. El objetivo de este estudio fue evaluar el rendimiento y reproducibilidad de la prueba de lanzadera incremental en pacientes con enfermedad renal crónica en hemodiálisis. Material y métodos: Se incluyeron pacientes con enfermedad renal crónica en diálisis y sujetos sin enfermedad renal crónica. Cada individuo realizó dos pruebas de lanzadera incremental con un intervalo de 30 minutos. Se registró la distancia recorrida, velocidad máxima, frecuencia cardiaca y el esfuerzo percibido. La reproducibilidad se analizó mediante el cálculo del coeficiente de correlación intraclase y el error estándar de la media. Mediante el método de Bland-Altman, se calculó la discordancia de la distancia recorrida y la frecuencia cardiaca pico. Además, se calculó el cambio mínimo detectable para todos los parámetros de la prueba de lanzadera incremental. Un valor de p=0,80). Los registros del error estándar de medición y cambio mínimo detectable para la distancia recorrida fueron de 26,0 m y 72,1 m, respectivamente. El método de Bland-Altman para la distancia recorrida mostró una diferencia media de -0,9 m con límites de concordancia entre 65,5 y -63,7 m. Conclusión: Los pacientes con enfermedad renal crónica en hemodiálisis presentan un menor rendimiento durante la prueba de lanzadera incremental comparado con individuos sin enfermedad renal crónica. Las medidas de resultado de la prueba de lanzadera incremental presentan una alta reproducibilidad test/retest a corto plazo en este grupo de pacientes. ABSTRACT Introduction: The Incremental Shuttle Walk Test has been used to determine physical capacity in patients with chronic kidney disease. However, its applicability and reproducibility have seldom been studied in hemodialysis patients. The objective of this study was to evaluate the performance and reproducibility of the incremental shuttle walk test in patients with chronic kidney disease on hemodialysis. Methods: Patients with chronic kidney disease on dialysis and subjects without chronic kidney disease were included. Each individual performed two Incremental Shuttle Walk Test with an interval of 30 minutes. We recorded the distance traveled, maximum speed, heart rate and perceived effort. Reproducibility was analyzed by calculating the intraclass correlation coefficient and the standard error of the mean. Using the Bland-Altman analysis, we calculated the discrepancy of the distance traveled and the peak heart rate. The minimum detectable change was also calculated for all parameters of the incremental shuttle walk test. A value of p=0.80). The standard error of measurement and the minimum detectable change for the distance traveled were 26.0 m and 72.1 m, respectively. The Bland-Altman analysis for the distance traveled showed a mean difference of -0.9 m with limits of agreement between 65.5 and -63.7 m. Conclusion: Patients with chronic kidney disease on hemodialysis show lower performance during the incremental shuttle walk test, compared to individuals without chronic kidney disease. The outcome measurements of the Incremental Shuttle Walk Test show high test-retest reproducibility in the short run in this group of patients.

RESUMEN: La Enfermedad Renal Crónica sigue siendo uno de los problemas de salud que más afecta a la población a nivel mundial, cambiando drásticamente la vida de las personas que la padecen. Debido a esto, es conveniente analizar el rol de Enfermería relacionado con esta enfermedad, conociendo la patología, las distintas modalidades terapéuticas y los distintos cuidados inherentes a nuestra profesión. En el capítulo 1 se tratará acerca de la enfermedad, explicando la epidemiología, su clasificación y los principales factores de riesgo. En el capítulo 2 se discurrirá acerca de las distintas modalidades terapéuticas, con la Hemodiálisis, Diálisis Peritoneal y el Trasplante Renal. El capítulo 3 se ocupará del mejor acceso vascular para la Hemodiálisis, las Fístulas Arteriovenosas Internas. Para finalizar, en el capítulo 4 se va a conferir sobre lo más importante de la profesión enfermera, los cuidados de Enfermería. Al final de esta búsqueda bibliográfica relacionada con las Fistulas Arteriovenosas Internas quedará demostrado el hecho de que son necesarios unos cuidados fundamentales por parte del profesional enfermero, junto con una participación del paciente. ABSTRACT: Chronic Kidney Disease is still one of the health problems that affects the population globally, changing drastically the life of the people who suffer it. Because of this, its likely to analize the nursing role with this disease by its study, knowing the different therapies and understanding the Nursing Cares for it. Chapter 1 will discuss about the disease, explainig the epidemiology, classification and main risk factors to develop it. Chapter 2 will analize the main therapies, being them the Hemodyalisis, the Peritoneal Dyalisis and the kidney transplant. chapter 3 will engage on the best vascular access for Hemodyalisis, being the Arteriovenous Fistula. Finally, chapter 4 will talk about the most important matter of the nurse profesión, the Nursing Cares. At the end of this bibliographical research related to the Arteriovenous Fistulas it will remain demonstrated that the Nursing Cares are fundamental for their sustaint, as it is also included the patient involvement. Grado en Enfermería

End-stage renal disease (ESRD) patients undergoing hemodialysis (HD) are at high risk of arrhythmias and sudden cardiac death as a result of blood potassium con-centration ([K+]) changes.The aim of this study is to investigate if dw, a time-warping-based electrocardiogram (ECG) biomarker of T-wave morphology changes,reflects [K+] evolution in HD patients, facilitating non-invasive [K+] monitoring and avoiding in-hospital blood tests analysis. 48-hour ECGs and a set of hourly collected blood samples from 12 ESRD patients were acquired and analyzed. dw was calculated between a reference T-wave,measured at the end of the HD session, and the T-waves corresponding to each hour along the whole HD session,when [K+] was measured from blood samples. The values of dw correlated with the relative variations in [K+] with respect to the reference value (end of HD,¿[K+]), with a median (interquartile) correlation coefficient of 0.90(0.30), evidencing a strong relation between them. Our findings support the use of dw as a surrogate of¿[K+],suggesting a potential use of dw for non-invasive hyperkalemia monitoring both in hospital and ambulatory settings.

The environmental impact of human activity has considerably grown, particularly from the 20th century. Citizens, plus different social, scientific, business and political groups, are becoming aware and getting organised to improve this matter by warning about the very high environmental and life style cost due to our lifestyle. So behaviour compatible with environmental conservation and improvement is expected of companies and organisations. In relation to this thesis, its importance in the health sector, specifically haemodialysis, is not questioned, but the natural resources haemodialysis employs, and the production and suitable management of the waste it generates, are generally ill-known, many of which are classified as hazardous (drugs, chemicals, radioactive and infectious products). Hence such products have a highly negative environmental influence if not responsibly processed. Indeed, we do not think of health organisations as advanced institutions that play a role in improving and respecting the environment and environmental health, which is paradoxical. Thus safe, sustainable health waste management is vital, but poorly known and recognised by citizens and health professionals. Its improvement can be promoted through environmental management systems that go beyond regulations, protocols and policies to improve this management, helped by good individual, social and institutional environmental practices. Environmental management systems (EMS) are solutions that help combine socio-economic success and preserve natural resources which might be applied in any organisation that wishes to improve the internal management of its environmental problems. Two international standards stand out: ISO 14001, introduced by 1996 by ISO – International Organization for Standardization; EMAS (European Commission - The European Eco-Management and Audit Scheme), launched by the European Commission in 1993, and improved in 2001 by incorporating ISO 14001 requirements. Assessing the current status of environmental systems in the healthcare sector of the Valencian Community and Spain, and knowing their implementation to obtain reference organisations specifically in hospital/outpatient haemodialysis services that are stressed for their outstanding implication in hazardous waste generation given the increased incidence of chronic kidney failure worldwide, could be a starting point to raise awareness and improve environmental action as key factors in the daily activities of both health professionals and citizens and public/private health institutions. All this could be backed by evaluating hazardous waste generation in haemodialysis, which the scientific literature has barely covered, and even less so in our domain as no public registers on this matter exist. This would, therefore, become a reference that health professionals could use and learn about health institutions with outstanding daily environmental management practices, and become aware of the need to improve the environmental influence in their personal/professional lives. All this would take the healthcare/socio-health sector to social leadership in environmental care. --- El impacto ambiental de la actividad humana se ha incrementado notablemente y especialmente a partir del pasado siglo XX. La ciudadanía junto con diversos colectivos sociales, científicos, empresariales y políticos se está concienciando y organizando para mejorar este asunto, advirtiendo que estamos pagando un precio ambiental y vital muy elevado por nuestro estilo de vida. Por ello se está exigiendo a las organizaciones y empresas un comportamiento compatible con la preservación y mejora del medio ambiente. Con la referencia para esta tesis del sector sanitario y en concreto de la hemodiálisis, su importancia no se discute pero poco se conoce en líneas generales sobre su consumo de recursos naturales y sobre la producción y gestión adecuada de los residuos que genera, con un alto porcentaje de ellos catalogados como peligrosos (farmacéuticos, químicos, radiactivos, infecciosos) y por ello con un elevado riesgo de influencia ambiental negativa si no son tratados de forma responsable. De hecho, en líneas generales se podría decir que no pensamos en las organizaciones sanitarias como instituciones avanzadas en su papel para mejorar y cuidar el medio ambiente y la salud ambiental, hecho que resulta incluso paradójico. Por ello la gestión segura y sostenible de los residuos sanitarios es vital pero poco conocida y reconocida por la ciudadanía y por los profesionales sanitarios. Su mejora se puede impulsar a través de sistemas de gestión medioambiental más allá de normativas, protocolos y políticas de mejora de su manejo, con el apoyo de las buenas prácticas medioambientales en el ámbito individual, social e institucional. Los sistemas de gestión ambiental son soluciones aportadas para intentar combinar el éxito social y económico con la preservación de los recursos naturales, siendo potencialmente aplicables en cualquier organización que quiera mejorar la gestión interna de su problemática ambiental. Destacan dos normas internacionales: ISO 14001, introducida en 1996 por la ISO – International Organization for Standardization y, EMAS (European Commission - The European Eco-Management and Audit Scheme), lanzada por la Comisión Europea en 1993 y mejorada en 2001 al incorporar requisitos de la ISO 14001. Valorar la situación actual de los sistemas medioambientales en el ámbito sanitario de la Comunidad Valenciana y, España, conociendo su implantación para disponer de organizaciones referentes y concretamente en la actividad de hemodiálisis hospitalaria y ambulatoria, por su destacada implicación en la generación de residuos peligrosos dado el aumento de la incidencia de la insuficiencia renal crónica a nivel global, puede ser un punto de partida para concienciar y mejorar la acción ambiental como factor clave en la actividad diaria tanto de los profesionales sanitarios y la ciudadanía como de las instituciones sanitarias, públicas y privadas. Todo ello apoyado con la evaluación de la generación de residuos peligrosos en hemodiálisis, asunto muy escasamente tratado en la literatura científica y aún con menor intensidad en nuestro medio, sin que existan registros públicos al respecto. Se conforma por tanto un referente al que las y los profesionales sanitarios puedan acudir y conocer las instituciones del sector salud con prácticas ambientales destacadas en su gestión diaria, concienciándose a la vez de la necesidad de la mejora de la influencia ambiental de su vida personal y profesional, conduciendo al sector sanitario y sociosanitario hacia el liderazgo social en el cuidado medioambiental., Site web (free access): http://hdl.handle.net/10550/59159

Introducción: el balance redox alterado en el curso de la insuficiencia renal crónica ha sido considerado un factor contribuyente a la morbilidad y mortalidad de la enfermedad y un factor asociado a la progresión de la infección por sida. Objetivo: valorar el estado redox en pacientes infectados por VIH con insuficiencia renal crónica que requirieron hemodiálisis. Métodos: se realizó un estudio de casos y controles en 20 pacientes VIH/sida con insuficiencia renal crónica y 40 individuos aparentemente sanos. Se realizaron determinaciones de malonildialdehído, glutatión, superóxido dismutasa, catalasa, productos avanzados de la oxidación de proteínas, hidroperóxidos y potencial de peroxidación, conjuntamente con los marcadores de progresión: conteo de linfocitos T CD4+ y carga viral y una serie de determinaciones hemoquímicas y hematológicas. El análisis se realizó antes, a los 30 min y a los 240 min del tratamiento dialítico. Estadísticamente se verificaron los supuestos de igualdad de varianza y normalidad de las variables, y en dependencia se aplicó una prueba paramétrica o no paramétrica. El resultado fue significativo para p< 0,05. Resultados: los indicadores del estado redox se encontraron alterados en los pacientes estudiados con respecto al grupo supuestamente sano antes de la hemodiálisis. Se mostró un valor mayor significativo (p< 0,05) de los índices malonildialdehído, productos avanzados de la oxidación de proteínas, superóxido dismutasa, y un valor menor de catalasa y glutatión a los 240 min de realizada la diálisis, con la excepción de los hidroperóxidos que no mostraron cambios. La carga viral plasmática disminuyó de manera significativa en el proceso. Conclusiones: los resultados sugieren que el proceso dialítico en este tipo de pacientes favorece el estrés oxidativo, conjuntamente con una disminución de la carga viral plasmática. El estudio aporta valor metodológico en el manejo de estos pacientes y en la búsqueda por mejorar su calidad de vida.Introduction: the altered redox balance in chronic renal failure has been considered a contributing factor to morbidity and mortality from this disease and as an AIDS progression-associated factor. Objective: to assess the redox state in HIV patients suffering chronic renal failure that requires haemodialysis. Methods: a case-control study was conducted in 20 HIV/AIDS patients with chronic renal failure and in 40 apparently healthy individuals. Estimations of malonildialdehyde, gluthatione, superoxide dismutase, catalase, advanced products from protein oxidation, hydroperoxides and peroxidation potentials, as well as progression markers such as T CD4+ lymphocyte count, viral load and a series of hemochemical and hematological determinations were all made. The analysis was made before, 30 minutes and 240 min after the dialysis. The assumptions of variance equality and variable normality were verified, and accordingly, a parametric or non-parametric test was applied. The result was significant for p< 0,05. Results: the redox state indicators were found to be altered in the studied patients when they were compared to the supposedly healthy group before hemodialysis. It was shown that the values of malondialdehyde, advanced products from protein oxidation, superoxide dismutase were high and significant whereas catalase and gluthatione had lower values after 240 minutes of dialysis, except for hydroperoxides that did not change. The plasma viral load decreased significantly in this process. Conclusions: the results suggested that the dialysis in this type of patients favors the oxidative stress, together with the reduction of the plasma viral load. The study grants some methodological value to the management of these patients and to the search for a better quality of life.

Filiació URV: SIInclòs a la memòria: SITítol en castellà: [Valoración de la calidad de vida relacionada con la salud en la enfermedad renal crónica terminal mediante un cuestionario de resultados percibidos por los pacientes] Objective: Evaluate the health-related quality of life for patiens with end-stage renal disease and identify the most significant differences depending on gender and treatment received. Methods and Materials: Observational, analytical and cross-sectional study (second semester 2014) carried out on patiens having high-flux hemodialysis or On-line hemodiafiltration treatment. We did descriptive and inferential statistics and the results with signification grades equal or less than 5% (p

Introducción: La enfermedad renal crónica (ERC) es un problema de salud pública en crecimiento, que genera gran morbilidad y mortalidad, se estima que en Colombia hay 38000 personas con ERC y la principal causa de muerte es la enfermedad cardiovascular. La presión de pulso y el índice tobillo brazo son dos herramientas estudiadas en muchas poblaciones que han mostrado ser útiles para predecir eventos y mortalidad cardiovascular, adicionalmente se perfila el índice de presión de pulso como el indicador más útil de la relación entre las propiedades de los vasos y el volumen de eyección. Objetivo: Estimar el poder predictivo a los 6 meses del índice tobillo brazo (ITB) y el índice de presión de pulso (IPP) para eventos y muerte cardiovascular en pacientes con enfermedad renal crónica en hemodiálisis. Metodología: Se realizó un estudio de prueba pronóstica en una cohorte dinámica tomando pacientes de una unidad renal de Bogotá, a quienes se midió en el primer contacto ITB antes de sesión de hemodiálisis e IPP al terminar la sesión; posteriormente se hizo seguimiento a los 6 meses a través de visita a unidad renal, visita a domicilio y/o contacto telefónico; se revisaron las historias clínicas y certificados de defunción de los pacientes que tuvieron algún desenlace. Resultados: Se analizaron datos de 104 pacientes. Se encontró ITB promedio 1.12 +/- 0,26 (0,58-1,79) e IPP promedio 0,45 +/- 0,08 (0,31-0,66). La incidencia de mortalidad por todas las causas fue 6,7 casos /100 personas, mortalidad cardiovascular 3,8 casos/100 personas y eventos cardiovasculares 9,6 casos/100 personas. El tamaño de la muestra y el tiempo de seguimiento aún es insuficiente para demostrar relación de alguno de los indices con los desenlaces estimados. Se encontró que ambos indices tienen coeficientes de correlación de concordancia de LIN muy favorables que indican buena reproducibilidad para mediciones de un mismo día y de días diferentes. Abstract. Introduction: Chronic kidney disease (CKD) is a public health issue in growth that produce high morbility and mortality. There are an estimated of 38000 people with CKD in Colombia and the main cause of death is the cardiovascular disease. The pulse pressure and the ankle brachial index are two studied tools in different populations than have proven be useful, predicting cardiovascular events and mortality.; the pulse pressure index is emerging as a more helpful indicator of the relationship between the properties of the vessels and stroke volumen. Objectives: to estimate the predictive power at 6 months of the pulse pressure index (PPI) and ankle brachial index (ABI) for cardiovascular events and death, in patients with chronic kidney disease on hemodyalisis. Methodology: A prospective study taking patients from one dyalisis unit in Bogota, in the first visit we will measure ABI before dyalisis and PPI at the end of the session, then tey were followed at 6 months through visit to renal unit, home visit and telephone contact, the medical records and death certificates were reviewed in the outcomes. Results: 104 patients were analyzed. We found mean ABI 1.12 +/- 0,26 (0,58-1,79) and mean PPI 0,45 +/- 0,08 (0,31-0,66). The incidence of all cause mortality was 6,7 cases /100 people, cardiovascular mortality 3,8 cases/100 people and cardiovascular events 9,6 cases/100 people. The sample size and the follow up time are still insufficient to prove relation of any of the index with the estimated outcomes. It was found that both index have good Lin’s concordance correlation coefficient, which indicate good reproducibility for each day and different days. Otra

Introduction. Renal cell carcinoma (RCC) is derived from renal tubular epithelial cells and represents approximately 3.8% of all malignancies in adults. The incidence of renal cell carcinoma has been growing steadily and ranging from 0.6 to 14.7 for every 100,000 inhabitants. Patients with end-stage renal disease and acquired cystic kidney disease are at increased risk of developing RCC while undergoing dialysis treatment or after renal transplantation. Case report. We presented 3 patients undergoing hemodialysis, with acquired cystic kidney disease accompanied by the development of RCC. In all the patients tumor was asymptomatic and discovered through ultrasound screening in 2 patients and in 1 of the patients by post-surgery pathohistological analysis of the tissue of the kidney excised using nephrectomy. All the three patients had organ-limited disease at the time of the diagnosis and they did not require additional therapy after surgical treatment. During the follow- up after nephrectomy from 6 months to 7 years, local recurrence or metastasis of RCC were not diagnosed. Conclusion. Acquired cystic kidney disease represents a predisposing factor for the development of renal cell carcinoma in dialysis patients and requires regular ultrasound examinations of the abdomen aimed at early diagnosis of malignancies. Prognosis for patients with endstage renal disease and RCC is mostly good because these tumors are usually of indolent course.

A Insuficiência Renal Crônica é um importante problema de Saúde Pública. O tratamento dialítico, na espera pelo transplante renal, constitui-se numa expectativa de melhoria da qualidade de vida. Este estudo qualitativo, realizado em Rio Grande-RS, objetivou conhecer as percepções dos pacientes com Insuficiência Renal Crônica acerca das mudanças ocorridas em sua rotina de vida, decorrentes do tratamento de hemodiálise, identificando os elementos que influenciam a sua qualidade de vida. Os resultados evidenciaram que os sentimentos iniciais de indignação e negação se modificam, enquanto os pacientes se fortalecem para o enfrentamento da doença. Restrições dos hábitos alimentares e hídricos, incapacidade ou limitação das atividades físicas, profissionais e de lazer foram as principais dificuldades identificadas. O apoio dos familiares e dos profissionais da saúde pode contribuir para a superação dessas limitações e adaptação ao novo estilo de vida. Chronicle Renal Failure is considered a major problem in Public Health. The dyalitic treatment while waiting for the renal transplant means a boost on quality of life. This qualitative study, carried out in Rio Grande-RS, aimed at knowing the perceptions of patients with Chronicle Renal Failure, identifying the elements that influence their quality of life. The results highlighted that the initial feelings of indignation and denial change as they strengthen themselves to face the disease. Restrictions of fluid and eating habits, inability to perform or limitation in activities, professional and leisure, were the main difficulties identified. The support from family members and from health professionals may help to overcome these limitations and adaptation to a new lifestyle. La Insuficiencia Renal Crónica es un importante problema para la Salud Pública. El tratamiento dialítico, en la espera por el trasplante renal, se constituye en una expectativa de mejoría de la calidad de vida. Este estudio cualitativo, realizado en Rio Grande-RS, tuvo por objetivo conocer las percepciones de los enfermos con Insuficiencia Renal Crónica sobre los cambios ocurridos en su rutina de vida que derivan del tratamiento de hemodiálisis, identificando los elementos que influencian su calidad de vida. Los resultados evidenciaron que los primeros sentimientos de indignación y negación se modifican a la medida que se fortalecen para enfrentar a la enfermedad. Restricciones de los hábitos alimentares e hídricos, incapacidad o limitación de las actividades físicas, profesionales y de ocio fueran las principales dificultades identificadas. El apoyo de los parientes y de los profesionales de la salud puede contribuir para la superación de esas limitaciones y adaptaciones al nuevo estilo de vida.

Project: Oxidative stress (OS) is enhanced in hemodialysis (HD) patients. Lipid peroxidation and oxidative damage to glycids, proteins and nucleic acids are the main consequences of OS and are associated with increased cardiovascular risk. Vitamin E and glutathione peroxidase (GSH-Px) represent the main antioxidant systems in human cells. Selenium (Se), bound to the active sites of GSH-Pxs, plays a critical role in this antioxidant defence system. Statins are widely used and extensively investigated in the prevention of cardiovascular disease, notably in high-risk subjects. Several studies show antioxidant effects of statins not related to their lipid-lowering action. Our study aimed to compare serum Se concentration in ESRD patients on maintenance HD and in homogeneous healthy subjects and to investigate whether chronic treatment with statins may interfere with serum Se concentration in HD patients. Procedure: A total of 103 HD patients and 69 healthy subjects were enrolled; HD patients were divided into patients who were not treated with statins (group A) and patients who assumed statins since 6 months at least (group B). Serum Se was determined by atomic absorption spectrometry. Results: Serum Se was significantly lower in HD patients of group A compared with healthy subjects (81.65719.66 Vs. 96.47715.62 mcg/L, po0.0040). However, in HD patients who assumed statins serum, Se was significantly higher than in HD patients who did not (111.83718.82 vs. 81.65719.66 mcg/L, po0.0001). Conclusions: Our results suggest that in HD patients chronic treatment with statins is related to higherserum Se concentration.

La enfermedad renal crónica (ERC) es una situación clínica cada vez más prevalente. Esto se debe en gran medida al aumento de la esperanza de vida y al incremento de la incidencia de la diabetes mellitus (DM) y la hipertensión arterial (HTA). Estos pacientes requieren un manejo cuidadoso de la analgesia postoperatoria. El fentanilo es un fármaco cuya farmacocinética encaja en el manejo del dolor en la ERC. Sus diferentes presentaciones comerciales permiten elaborar estrategias adecuadas para brindarles una analgesia postoperatoria de gran calidad. Presentamos el esquema de analgesia postoperatoria de un paciente en fallo renal severo sometido a artroplastia de cadera: metamizol (6 gramos/24 horas) en perfusión durante 48 horas, fentanilo transcutáneo TTS 25 microgramos/hora durante 48 horas y fentanilo oral transmucosa 200 microgramos en caso de exacerbación del dolor. Este tratamiento analgésico permitió el control satisfactorio del dolor sin que se presentaran vómitos, prurito ni estreñimiento; la calidad del sueño y el descanso nocturno fueron buenos. Chronic kidney failure (CKF) is a clinical situation with an increasing prevalence due to the high incidence of hypertension and diabetes both of them considered as risk factors, and also due to the rise on life expectancy. These patients need a carefully anaesthetic management in order not to aggravate their renal function. Postoperative analgesia becomes a key point at this end. Fentanyl's pharmacokinetic totally fits in handling pain in CKF's patients. Thanks to the great commercial display on fentanyl's presentation we are able to develop suitable strategies to offer high quality postoperative analgesia. We describe a case of a severe CKD patient undergoing hip arthroplasty following this analgesia plan during the first 48 hours postoperative: Continuous infusion of metamizol (6 g/24 hours) + transdermal fentanyl (25 µg/h) + transmucosal fentanyl (200 µg) if necessary. With this analgesia approach we obtained a satisfactory pain control without vomits, itching or constipation; the patient had a proper rest at night.

Introducción: La enfermedad renal crónica (ERC) es un problema de salud pública en crecimiento que genera gran morbilidad y mortalidad. Se estima que en Colombia hay 38000 personas con ERC, y su principal causa de muerte es la enfermedad cardiovascular. La presión de pulso y el índice tobillo brazo son dos herramientas estudiadas en diferentes poblaciones que han mostrado ser útiles para predecir eventos y mortalidad cardiovascular; el índice de presión de pulso se perfila como el indicador más útil de la relación entre las propiedades de los vasos y el volumen de eyección. Objetivos: Estimar el poder predictivo a los 6 y 12 meses del índice tobillo brazo (ITB) y el índice de presión de pulso (IPP) para eventos y muerte cardiovascular, en pacientes con enfermedad renal crónica en hemodiálisis. Metodología: Se realizará un estudio de cohorte prospectivo tomando pacientes de dos unidades renales de Bogotá, a quienes mediremos en el primer contacto ITB antes de sesión de hemodiálisis e IPP al terminar la sesión; posteriormente se hará seguimiento a los 6 y 12 meses a través de visita a unidad renal, visita a domicilio y/o contacto telefónico; de ser necesario se revisarán las historias clínicas y certificados de defunción. Resultados esperados: Se espera que tener una disminución del ITB y el aumento del IPP se asociarán con aumento de los eventos y la mortalidad cardiovascular a 6 meses y 1 año en la población en estudio. Abstract Introduction: Chronic kidney disease (CKD) is a public health issue in growth that produce high morbility and mortality. There are an estimated of 38000 people with CKD in Colombia and the main cause of death is the cardiovascular disease. The pulse pressure and the ankle brachial index are two studied tools in different populations than have proven be useful, predicting cardiovascular events and mortality.; the pulse pressure index is emerging as a more helpful indicator of the relationship between the properties of the vessels and stroke volumen. Objectives: to estimate the predictive power at 6 and 12 months of the pulse pressure index (PPI) and ankle brachial index (ABI) for cardiovascular events and death, in patients with chronic kidney disease on hemodyalisis. Methodology: A prospective study taking patients from two dyalisis units in Bogota, in the first visit we will measure ABI before dyalisis and PPI at the end of the session, then we will follow at 6 and 12 months through visit to renal unit, home visit and telephone contact, if is necesary we will review medical records and death certificates. Expected results: We expect than the patients with low ABI and those with high PPI, will present increased in cardiovascular events and mortality at 6 and 12 months. Otra

Proyecto de investigación para Trabajo Fin de Máster. Planteamiento de una intervención no farmacológica en pacientes en hemodiálisis(grupo control/grupo experimental) en el HUCA durante 2 meses, la cual una vez finalizada se analizará la calidad de sueño en estos pacientes.

Os autores deste artigo desenvolvem algumas reflexões sobre o aspecto da comunicação, na prática do profissional enfermeiro junto ao paciente renal crônico, em programa de hemodiálise, cujo tratamento propicia uma relação prolongada e, muitas vezes, mais profunda. Analisa e exemplifica a necessidade de usarmos, de f orma consciente, alguns modos de comunicação verbal e o não-verbal para que possamos estabelecer uma interação terapêutica para o cuidar desses pacientes. This article makes considerations about the communication in the nursing assistence to the chronic renal patient, submitted to hemodyalisis, which tratment is characterized by a frequent relation and sometimes a "closed" prof issional relation between nurse and patient. The object of this article is to analyse and give examples of the way to use consciently the verbal and nonverbal communication in order to stablish a therapeutic interaction of these patients.

Introduction Accumulation of trace elements occurs in conditions of decreased kidney function. In some conditions, increased trace elements can have toxic features. On the other hand, studies are showing that concentration of some trace elements could be decreased in ERSD patients as well. The most important factor affecting trace element concentration in ERSD patients is the degree of renal failure and the usage of replacement therapy. Materials and methods We analyzed the trace elements' (boron, aluminum, vanadium, chromium, manganese, cobalt, nickel, copper, zinc, arsenic, selenium, rubidium, strontium, cadmium, cesium, barium and lead) concentration in the whole blood of 41 ESRD patients who were treated with hemodialysis and hemodiafiltration and also of 61 healthy blood donors. In addition, comparison of trace element blood levels of patients receiving hemodialysis and hemofiltration was carried out. Whole blood trace element concentration was determined using inductive coupled plasma mass-spectrometry (ICPMS). Results Levels of boron, aluminum, vanadium, chromium, manganese, zinc, strontium, cadmium, barium and lead were significantly increased in ESRD patients. Significantly decreased levels were observed for nickel, arsenic, selenium and rubidium. Blood levels of cobalt, copper, cadmium and lead in hemodialysis patients were significantly higher compared to patients receiving hemodiafiltration. Conclusions ESRD is accompanied with serious and multidirectional changes of trace element blood levels. The highest degree of blood level increases were observed for nonessential and toxic trace elements. Disorders of essential trace elements were manifested in a minor degree. Besides this, there were observed differences of trace element concentrations between ESRD patients receiving hemodialysis and hemo-diafiltration.

A terapia renal substitutiva contínua (TRSC) é amplamente utilizada em pacientes criticamente enfermos com insuficiência renal aguda (IRA). O meropenem é um carbapenêmico usado em pacientes críticos que tem uma atividade antibacteriana dependente do tempo. O objetivo do estudo foi avaliar a farmacocinética do meropenem infundido em três horas em pacientes submetidos à TRSC. Estudamos as concentrações plasmáticas e de efluente em cinco pacientes submetidos à TRSC. As amostras foram coletadas em momentos 0, 30 min, e 1, 2, 4, 6 e 8 horas após o início de uma infusão de 3 horas. As determinações de meropenem foram feitas por cromatografia líquida de alta eficiência. Quatro pacientes do sexo masculino e um feminino, idade de 53,0 ± 19,7 (23 a 80 anos), 62,1 ± 10,6 kg, foram estudados. Parâmetros farmacocinéticos apresentados em mediana (amplitude): concentrações plasmáticas, 34.86mg / L (10,08-139,27); tempo de meia vida (t ½), 1,8 h (1,4-3,0); volume de distribuição (Vd), 8,29 L (5,8-15,3); depuração total (Dept ) 3,98 L / h (2,51-4,35); concentração máxima (Cmax) 48,5 mg/L (37,0-105,8); concentração mínima (Cmin) 20,1 mg / L (14,0-16,6); constante de eliminação (Kel), 0,38 (0,34-0,43); área sob a curva de concentração versus tempo (AUC 0 a 8 h), 251,1 mg / Lh (229,7-398,4); (AUC de 0a∞), 275,1 mg /Lh (263,8-453,6).A depuração total pela TRSC variou de 8,46 a 18,33 ml/min. No efluente as concentrações máximas foram 24,35 e 74,81 mg /L. A eliminação de meropenem por TRSC é semelhante ao que é relatado pelo rim normal, quando é infundido por 3 horas a cada 8 h. Os níveis plasmáticos foram sempre acima do MIC necessário. Podemos concluir que não houve necessidade de ajuste de dose do meropenem com a dose de TRSC prescrita. Continuous renal replacement therapy (CRRT) is widely used in critically ill patients with acute kidney injury (AKI). Meropenem is a carbapenem used in critically ill patients, which has a time dependent antibacterial activity. The aim of the study was to assess the pharmacokinetics of meropenem on a 3-hour infusion in patients undergoing CRRT due to AKI. We studied the plasmatic and effluent concentrations in five patients undergoing CRRT. The samples were collected at moments 0, 30 minutes, and 1, 2, 4, 6 and 8 hours after the beginning of the 3-hour infusion. The meropenem determinations were made through high performace efficiency liquid chromatography (HPLC). Four male patients and one female patient, with a mean age of 53,0 ± 19,7 (23 to 80 years), weighing 62,1 ± 10,6 kgs were studied. Pharmacokinetic parameters presented in medians (range): plasmatic concentrations, 34.86mg / L (10,08-139,27); half-life (t ½), 1,8 h (1,4-3,0); volume of distribution (Vd), 8,29 L (5,8-15,3); total clearance (CLT) 3,98 L / h (2,51-4,35); (Cmax) (maximum plasma concentration), 48,5 mg / L (37,0-105,8); Cmin (minimum plasma concentration)20,1 mg / L (14,0-16,6); elimination constant (Kel), 0,38 (0,34-0,43); area under the concentration versus time curve (AUC 0 a 8 h), 251,1 mg / Lh (229,7-398,4); (AUC 0 a ∞) 275,1 mg / Lh (263,8-453,6). In the effluent, the maximum concentrations varied from 24,35 to 74,81 mg/L, and the clearance from the therapy varied from 8,46 to 18,33 ml/min. The elimination of meropenem through CRRT is similar to that of a normal kidney, given a 3-hour infusion every 8 hours. Plasmatic levels were always above the necessary MICs. We can conclude there was no need for dose adjustment of meropenem with the prescribed CRRT dose.

Objetivo: describir la prevalencia de calcificaciones de aorta abdominal y factores de riesgo relacionados de pacientes en hemodiálisis en una unidad renal de la ciudad de Cali. Introducción: las calcificaciones vasculares son prevalentes en pacientes con enfermedad renal crónica (ERC). Los pacientes en hemodiálisis presentan mayor riesgo de mortalidad cardiovascular y factores como la edad, enfermedades asociadas y algunas alteraciones metabólicas incrementan el riesgo de calcificaciones vasculares. Material y métodos: se incluyeron 47 pacientes en hemodiálisis mayores de 18 años y con más de tres meses en hemodiálisis. La radiografía lumbar lateral fue usada para evaluar las calcificaciones de los segmentos L1 a L4 utilizando un puntaje para su cuantificación y un único observador entrenado. Se realizaron mediciones de calcio, fósforo, PTH, colesterol, triglicéridos en sangre y tensión arterial. Fue utilizado análisis de regresión para determinar asociaciones entre las calcificaciones de aorta abdominal y las características de los pacientes. Resultados: se encontró que la edad promedio fue de 60,8 años (rango 25-84), el 57.4% fueron mujeres, el tiempo promedio en hemodiálisis 44.6 meses (rango 3-156). El 63.8% de los pacientes presentaron calcificaciones en algún segmento de la aorta abdominal. Se encontró que a mayor edad (P = 0.0006) y menor tensión arterial diastólica (TAD) (P = 0.036), el riesgo de prevalencia de calcificación es mayor. Conclusiones: la calcificación de aorta abdominal es prevalente en los pacientes con ERC en hemodiálisis. Factores como la edad y la disminución de la TAD se encontraron asociadas al grupo de calcificaciones. La radiografía lumbar lateral es una herramienta ampliamente disponible y menos costosa que puede ser tenida en cuenta en el tratamiento y evaluación de riesgo cardiovascular en los pacientes en hemodiálisis y como predictor de complicaciones. (Acta Med Colom 2012; 37: 14-20). Objective: to describe the prevalence of abdominal aortic calcifications and risk factors in patients on hemodialysis in the renal unit Imbanaco Medical Center in the city of Cali. Background: vascular calcification is prevalent in patients with chronic kidney disease. Hemodialysis (HD) patients are at increased risk of cardiovascular mortality and factors such as age, associated diseases and some metabolic abnormalities increase the risk of vascular calcification. Material and methods: we included 47 hemodialysis patients over 18 years and more than three months in dialysis. The lateral lumbar radiography was used to assess the calcification of the segments L1 to L4 using a score for quantification and a single trained observer. Regression analysis was used to determine associations between AAC and patient characteristics. Results: median age of patients was 60.8 years (range 25-84), 57.4% were female, median duration of HD 44.6 months (range 3-156). We found that in 63.8% of patients had calcifications in any segment of the abdominal aorta. We found that older age (P = 0.0006) and lower diastolic blood pressure (DBP) (P = 0.036) the risk is greater prevalence of calcification. Conclusions: abdominal aortic calcification is prevalent in patients with CKD on hemodialysis. Factors such as age and decreased DBP were associated with the group of calcifications.The lateral lumbar radiograph is a tool widely available and less expensive than can be taken into account in the assessment of cardiovascular risk in hemodialysis patients and as a predictor of complications. (Acta Med Colom 2012; 37: 14-20).

Se estudiaron los expedientes clínicos de los 22 pacientes incluidos en el plan de enfermos crónicos del Servicio de Hemodiálisis de nuestro hospital en el 2005. Diez de estos pacientes tenían como acceso vascular temporal para hemodiálisis un catéter venoso central percutáneo (45,5 %) y en ellos se registraron 26 procesos infecciosos relacionados con el cateterismo −algunos de ellos presentaron más de un episodio de infección relacionado con el catéter. Los catéteres utilizados fueron colocados por vía percutánea en las venas subclavia, femoral y yugular interna. Los catéteres insertados en la vena femoral presentaron el mayor número de complicaciones infecciosas. El hemocultivo fue positivo para el mismo germen en 14 casos del total de pacientes infectados, lo que evidenció que 53,8 % de los pacientes desarrollaron una infección asociada al uso del catéter. Los gérmenes que predominaron fueron los grampositivos (53,7 %), representados mayoritariamente por el estafilococo coagulasa-negativo. Las sepsis sistémicas predominaron en el estudio y todos los pacientes desarrollaron manifestaciones clínicas. En nuestro servicio la tasa estimada de sepsis por catéter para hemodiálisis fue de 18,1 %.The medical histories of the 22 patients from the chronically-ill patient program of Hemodyalisis Service at our hospital were studied in 2005. Ten of them had a central percutaneous venous catheter as a temporary vascular access for hemodyalisis (45,5%), but they also suffered 26 catheter-related infectious processes, some of them even more than one episode of infection. The used catheters were percutaneously placed in subclavian, femoral and internal jugular veins. Those catheters inserted into the femoral vein exhibited the highest number of infectious complications. Hemoculture was positive to the same germ in 14 cases of the total number of infected patients, which proved that 53,8% of patients developed catheter-related infection. Predominant germs were Gram-positve (53,7%) mostly Coagulase-negative Staphylococcus. Systemic sepsis prevailed in the study and all the patients had clinical manifestations. The estimated rate of catheter-associated sepsis in hemodyalisis was 18,1%.

Objetivo: Determinar la frecuencia de marcadores de hepatitis viral B (VHB) y C (VHC) en pacientes con Insuficiencia renal crónica terminal (IRC-T) antes de ingresar a un programa de hemodiálisis crónica (HDC) y evaluar la relación temporal de la infección con antecedentes epidemiológicos. Materiales y métodos: Se realizó un estudio de serie de casos prospectivo y analítico. La población se conformó por la totalidad de pacientes nuevos con IRC-T que ingresaron por primera vez al programa de HDC del HNCH-Lima, desde Junio del 2002 hasta Setiembre del 2003, se evaluaron los marcadores HBsAg y anti-HBcTotal del VHB y anti-VHC del VHC. Resultados: Se estudiaron 86 pacientes, 45 (52.3%) fueron mujeres y 41 (47.7%) varones. En el periodo de estudio se halló una frecuencia total de marcadores de VHB del 20.9%, siendo 2.3% HBsAg(+) y 18.7% sólo anti-HBcT(+). En tanto la frecuencia de anti-VHC fue de 4.65%. Los factores relacionados para ser portador de sólo anti-HBcT(+) fueron: edad avanzada, relaciones sexuales con prostitutas OR=6.1(1.5-25.3), ingerir alimentos en restaurantes OR=5.2(1.6-16.4) y haber nacido en la Selva OR=6.7(1.5-30.5). En el análisis multivariado solo la edad avanzada OR=1.03(1.00-1.06), haber nacido en la Selva OR=13.1(1.8-91.1) e ingerir alimentos en restaurantes OR=5.0(1.4-18.0), se relacionaron con la presencia de anti-HBcTotal. Conclusión: Los resultados de este estudio sugieren baja frecuencia de los marcadores serológicos de VHB y VHC en pacientes con IRCT que ingresan por primera vez al tratamiento de HDC en el HNCH. Purpose: Determine the rate of markers of hepatitis B (HBV) and C (HCV) viruses in patients with terminal chronic kidney failure (TCKF) prior to the start of a chronic hemodyalisis program (CHD), and assess the time relation between infection and epidemiological history. Materials and Methods: This was a prospective and analytical study. The study population was composed of the entire group of TCKF patients using the CHD program for the first time at the HNCH, Lima, from June 2002 to September 2003. HbsAg and HBV Anti-HBc, and HCV anti-VHC markers were assessed. Results: 86 patients were studied, 45 female (52.3%) and 41 male (47.7%). During the study, the total rate of HBV markers was 20.9%, HBsAg(+) was 2.3%, and anti-HBcT(+) was only 18.7%. Anti-HCV rate was 4.65%. Related factors for potential carriers of only anti-HBcT(+) were: elder age, sexual intercourse with prostitutes OR=6.1 (1.5-25.3), food consumption at restaurants OR=5.2 (1.6-16.4), or being born in the jungle area OR=6.7 (1.5-30.5). Multi-variance analysis showed that only elder age OR=1.03 (1.00-1.06), being born in the jungle area OR=13.1 (1.8-91.1), and food consumption in restaurants OR=5.0 (1.4-18.0) were related to total anti-HBc count. Conclusions: The study results suggest a low rate of serological markers of HBV and HCV in TCKF patients using chronic hemodyalisis treatment for the first time at HNCH.

An automatic flow injection procedure for spectrophotometric aluminium determination in purified water and solutions containing high salts concentrations used for hemodyalisis treatment was developed. The method was base on reaction of Al3+ with cianine eriochrome R (ECR) after preconcentration using the AG50W-X8 cationic-exchange resin. Elution was carried out using a 1 % (m/v) calcium chloride solution. The manifold comprised an automatic proporcional injector controlled by a computer equipped with an eletronic interface and software written in QuicBASIC 4.5 with facilities to control the injector and perform data acquisition. Samples with concentration ranging from 4.96 to 19.90 µg L-1 Al were analyzed and recoveries between 88 and 113% were obtained by using the standard addition method. Other profitable analytical characteristics such as a relative standard deviation 1.3 % (n = 10) for a typical sample 14.5 µg L-1 Al, a linear response ranging up to 60.0 µg L-1Al, and a sampling throughput of 10 determinations per hour were achieved. A detection limit of 4.2 µg L-1 Al was estimated as suggested by IUPAC.

Filiació URV: SIInclòs a la memòria: SITítol en castellà: [Valoración de la calidad de vida relacionada con la salud en la enfermedad renal crónica terminal mediante un cuestionario de resultados percibidos por los pacientes] Objective: Evaluate the health-related quality of life for patiens with end-stage renal disease and identify the most significant differences depending on gender and treatment received. Methods and Materials: Observational, analytical and cross-sectional study (second semester 2014) carried out on patiens having high-flux hemodialysis or On-line hemodiafiltration treatment. We did descriptive and inferential statistics and the results with signification grades equal or less than 5% (p