Long-term mortality and trajectory of potassium measurements following an episode of acute severe hyperkalaemia.
Abstract Background Hyperkalaemia is a common condition in patients with comorbidities such as chronic kidney disease (CKD) or congestive heart failure (HF). Moreover, severe hyperkalaemia is a potentially life-threatening condition that is associated with a higher risk of adverse clinical events such as ventricular arrhythmias and sudden cardiac death. Currently, data regarding the prognostic implications of chronic hyperkalaemia are available; however, information about the long-term clinical consequences after an episode of severe hyperkalaemia remains scarce. The objective of this study was to evaluate the association between the trajectory of potassium measurements in patients with acu…
Seguridad y efectividad del oxihidróxido sucroférrico en pacientes españoles en diálisis: subanálisis del estudio VERIFIE
Resumen Antecedentes y objetivo En este estudio presentamos los resultados del subgrupo de pacientes espanoles del estudio VERIFIE, primer estudio postautorizacion prospectivo que evalua la seguridad y efectividad a largo plazo del oxihidroxido sucroferrico (OHS) en pacientes en dialisis con hiperfosfatemia durante la practica clinica habitual. Pacientes y metodos Se incluyeron pacientes en hemodialisis y dialisis peritoneal con indicacion de tratamiento con OHS. La duracion del seguimiento fue de 12 a 36 meses desde el inicio del tratamiento con OHS. Las variables primarias de seguridad fueron la incidencia de reacciones adversas a medicamentos, eventos medicos de interes especial y variac…
Simulación clínica en pediatría y neonatología: adaptación telemática del proyecto de innovación educativa
[EN] Introduction: Framed within an educational innovation project in the nursing degree, we introduce the application of realistic scenarios, generated through the EDISON tool to deal with topics such as pediatric and neonatal CPR. Due to the COVID-19 pandemic, an adaptation of the project to the telematic modality was proposed. Methodology: Analytical exploratory study where the effectiveness of a training intervention in a confinement context was evaluated. It was based on the use of audiovisual materials created through EDISON that configured a VideoBook that was made available to students through the Virtual Platform, evaluating its effectiveness through the final exam of the subject. …
FP749The effect of short daily home hemodialysis with low-flow, lactate-buffered dialysate on nutritional status and body composition
P1082COMPARISON OF THE REMOVAL OF PROTEIN-BOUND TOXINS AND LARGE MIDDLE MOLECULES WITH HIGH-FLUX PMMA AND MEDIUM CUT-OFF DIALYZERS
Abstract Background and Aims Dialytic clearance of protein-bound toxins and large middle molecules is poor by diffusive treatment and limited by high-flux hemodialysis (HD) and on-line hemodiafiltration (OL-HDF), and only a few studies have examined how to improve their removal by other extracorporeal strategies. Since 2017, there is a new generation of polymethyl methacrylate (PMMA) membranes that suppress platelet adhesion on the membrane surface improving hemocompatibility and permeability, while also maintaining adsorption properties related to conventional PMMA membranes. Expanded HD (HDx) with medium cut-off (MCO) membranes has also recently been incorporated into clinical practice an…
Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis
Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. Materials and Methods: 612 NDD 3‒5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral r…
Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD
This is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2nd International Conference of the European Renal Nutrition working group at ERA-EDTA—“Retarding CKD progression: readily available through comprehensive nutritional management?”— and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections—basic nutritional assessment, nutritional targets, and nutritional follow-up in non-di…
P1055REMARKABLE REMOVALS OF BETA-2-MICROGLOBULIN AND PHOSPHATE WITH SHORT-DAILY HOME HEMODIALYSIS USING LOW DIALYSATE FLOW RATE
Abstract Background and Aims Short-daily hemodialysis (HD) with low-dialysate volume is an appealing portable dialysis approach for home use. Although this type of HD has proved being effective for the volume control and the clearance of low molecular-weight uremic toxins, limited data are available on the impact on the removal rates of other uremic toxins like β2-microglobulin (β2M) or phosphate (P), whose clearance is limited by sequestration into compartments, poor diffusion, high time-dependency, or protein binding. We evaluated the impact of short-daily HD with slow dialysate flow rate on the removal of solutes of different molecular weights and distribution volumes. Method Single-sess…
SP470RELATIONSHIP BETWEEN PREDICTIVE KT/V AND CALCULATED KT/V ACHIEVED WITH NXSTAGE CYCLER IN SHORT-DAILY HOME HEMODIALYSIS PATIENTS
SP489The role of CA125 as a volume marker before and after hemodialysis session
Experience in Spain with the first patients in home hemodialysis treated with low-flow dialysate monitors
Resumen La hemodialisis domiciliaria (HDD) con monitores de bajo flujo de liquido de dialisis ha ganado popularidad en los ultimos anos gracias a su sencillez de diseno, portabilidad y capacidad de desplazamiento. No obstante, existen dudas respecto a la adecuacion que este tipo de tecnica ofrece, pues utiliza monitores con bano a flujos bajos y lactato. El objetivo de este estudio fue demostrar los beneficios clinicos de la HDD con el monitor NxStage System One® introducido recientemente en Espana. Presentamos los resultados de un estudio observacional, retrospectivo que incluyo de manera no seleccionada a los primeros pacientes con HDD corta mediante este monitor en 12 centros en Espana. …
SP660HIGH-VOLUME ON-LINE HEMODIAFILTRATION MAY PREVENT PROTEIN-ENERGY WASTING IN HEMODIALYSIS PATIENTS: A 1-YEAR PROSPECTIVE CONTROLLED STUDY
Interacciones farmacológicas de los captores del fósforo
The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study.
Background. Growing evidence indicates that vitamin D receptor activation may have antiproteinuric effects. We aimed to evaluate whether vitamin D supplementation with daily cholecalciferol could reduce albuminuria in proteinuric chronic kidney disease (CKD) patients. Methods. This 6-month prospective, controlled, intervention study enrolled 101 non-dialysis CKD patients with albuminuria. Patients with low 25(OH) vitamin D [25(OH)D] and high parathyroid hormone (PTH) levels (n = 50; 49%) received oral cholecalciferol (666 IU/day), whereas those without hyperparathyroidism (n = 51; 51%), independent of their vitamin D status, did not receive any cholecalciferol, and were considered as the co…
Feasible Low-Phosphorus Dietary Patterns in Maintenance Hemodialysis Patients: Need for Original Research
Introduction The standard low-phosphorus diet restricts pulses, nuts, and whole grains and other high phosphorus foods to control hyperphosphatemia. We conducted a randomized controlled trial to evaluate the effectiveness, safety, and tolerability of the modified diet, which introduced some pulses and nuts, increased the use of whole grains, increased focus on the avoidance of phosphate additives, and introduced the prescription of low-biological-value protein such as bread. Methods We conducted a multicenter, pragmatic, parallel-arm, open-label, randomized controlled trial of modified versus standard diet in 74 adults on hemodialysis with hyperphosphatemia over 1 month. Biochemistry was as…
Clinical Approach to Vascular Calcification in Patients With Non-dialysis Dependent Chronic Kidney Disease: Mineral-Bone Disorder-Related Aspects
Chronic kidney disease (CKD) is associated with a very high morbimortality, mainly from cardiovascular origin, and CKD is currently considered in the high- or very high risk- cardiovascular risk category. CKD-mineral and bone disorders (CKD-MBDs), including vascular and/or valvular calcifications, are also associated with these poor outcomes. Vascular calcification (VC) is very prevalent (both intimal and medial), even in non-dialysis dependent patients, with a greater severity and more rapid progression. Simple X-ray based-scores such as Adragão's (AS) are useful prognostic tools and AS (even AS based on hand-X-ray only) may be superior to the classic Kauppila's score when evaluating non-d…
Nephroprotection by Hypoglycemic Agents: Do We Have Supporting Data?
Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, renin angiotensin-aldosterone system blockade and multifactorial intervention. However, the renal protection provided by these therapeutic modalities is incomplete. There is a scarcity of studies analysing the nephroprotective effect of antihyperglycaemic drugs beyond their glucose lowering effect and improved glycaemic control on the prevention and progression of diabetic nephropathy. This article analyzes the exisiting data about older and newer drugs as well as the mechanisms associated with hypoglycemic drugs, apart from their well known blood gluc…
Prevención de úlceras por presión en neonatos con ventilación mecánica no invasiva
espanolRESUMEN Objetivo: Determinar el aposito con mayor efectividad (hidrocoloide o espuma de poliuretano) en neonatos ingresados en las unidades de cuidados intensivos neonatal y pediatrica del Hospital Clinico Universitario de Valencia, sometidos a ventilacion mecanica no invasiva para la prevencion de ulceras por presion nasales y/o faciales. Material y metodos: Proyecto de investigacion de tipo observacional, prospectivo y analitico cuya muestra estaba formada por 13 neonatos con ventilacion mecanica no invasiva, hospitalizados en la unidad de cuidados intensivos neonatales y pediatrica. Los neonatos fueron divididos en dos grupos: en el grupo A (7 pacientes) se empleo el aposito de es…
FP116TRAJECTORY OF POTASSIUM MEASUREMENTS IN PATIENTS WITH ACUTE SEVERE HYPERKALEMIA AND LONG-TERM ALL-CAUSE MORTALITY
Efectividad de las medidas y estrategias de prevención de úlceras por presión en neonatos
espanolRESUMEN Objetivos: Analizar la efectividad, en terminos de disminucion de la incidencia de ulceras por presion (UPP), de las medidas y estrategias preventivas de UPP en neonatos hospitalizados. Metodo: La recuperacion de estudios se realizo a traves de tres bases de datos (Medline a traves de PubMed, Scopus y Science Direct) y a partir de un experto. Solamente se incluyeron en esta revision los estudios publicados del 2007 al 2017 en espanol o ingles, que de forma directa o indirecta valoraran la efectividad de una medida o estrategia preventiva de UPP en neonatos hospitalizados y que en cuanto al diseno fueran o estudios clinicos controlados o cuasiexperimentales. Resultados: De 100…
SP619The effect of etelcalcetide in hemodialysis patients with secondary hyperparathyroidism in daily clinical practice. A prospective multicenter study
P0877ASSOCIATIONS OF DISORDERS IN BONE MINERAL PARAMETERS WITH MORTALITY IN STAGE 4 AND 5 CKD: INSIGHTS FROM THE PECERA STUDY
Abstract Background and Aims Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD). Method PECERA (Collaborative Study Project in Patients with Advanced Chronic Kidney Disease) is a 3-year, multicentre, open-cohort, prospective study carried out in 995 adult patients with CKD stages 4-5 not on dialysis enrolled in 2007-09 from 12 centres in Spain. Associations between levels of serum calcium (corrected for serum albumin), phosphate, and intact parathyroid hormone (iPTH) and all-cause mortality were examined u…
The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study
Background Compared with conventional haemodialysis (HD), online haemodiafiltration (OL-HDF) achieves a more efficient removal of uraemic toxins and reduces inflammation, which could favourably affect nutritional status. We evaluate the effect of OL-HDF on body composition and nutritional status in prevalent high-flux HD (HF-HD) patients. Methods In all, 33 adults with chronic kidney disease (CKD) Stage 5 undergoing maintenance HF-HD were assigned to post-dilution OL-HDF (n = 17) or to remain on HF-HD (n = 16, control group) for 12 months. The primary outcome was the change in lean tissue mass (LTM), intracellular water (ICW) and body cell mass (BCM) assessed by multifrequency bioimpedance …
SARS-CoV-2 vs. Hepatitis Virus Infection Risk in the Hemodialysis Population: What Should We Expect?
Since the dramatic rise of the coronavirus infection disease 2019 (COVID-19) pandemic, patients receiving dialysis have emerged as especially susceptible to this infection because of their impaired immunologic state, chronic inflammation and the high incidence of comorbidities. Although several strategies have thus been implemented to minimize the risk of transmission and acquisition in this population worldwide, the reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence varies across studies but is higher than in the general population. On the contrary, the screening for hepatitis viruses (HBV and HCV) has seen significant improvements in recent years, with va…