[Guidelines for quality management of dialysis solutions]. / Guías de gestión de calidad del líquido de diálisis (LD).

A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org

[Effects of a dietary intervention on the nutritional status of hemodialyzed patients: differences between men and women]. / Efectos de una intervención dietética sobre el estado nutricional de pacientes en hemodiálisis: diferencias entre varones y mujeres.

The growing interest in the nutritional status of dialyzed patients arises from the fact that it plays an important role in the evolution, morbidity and mortality of renal patients. In the current study the effects have been assessed of a dietary intervention lasting 6 months, based on a food exchange list, on the nutritional status of a group of 49 hemodialysis patients as well as the different effects between men and women. The initial and final evaluation of the nutritional status was performed by estimating energy and nutrient intake with a 24 hour recall, determination of body composition by anthropometry, bioelectrical impedance and infrared interactance and biochemical measurements related to the nutritional status of the patients undergoing hemodialysis. At the end of the study, a significant increase was seen in the energy and macronutrient intake, which was more prominent in females. The body composition analysis showed a favourable evolution as compared to other studies; which was better in women who maintained the muscle mass stable and increased fat mass. The biochemical profile showed an increase of the C3 complement, while other markers such as amino acid profile and IGF I remained unchanged at the end of the study, being both similar in males and females. The dietary intervention was found to be useful in the prevention of the progression of malnutrition in these patients, apparently with a more beneficial effect on females.

[Usefulness of preoperative location tests in primary hyperparathyroidism]. / Utilidad de las pruebas de localización preoperatoria en el hiperparatiroidismo primario.

The utility of preoperative parathyroid location in primary hyperparathyroidism (pHPT) remains controversial. In this retrospective study are analysed noninvasive techniques prior to surgical neck exploration of 11 patients with pHPT, ten adenomas and one hyperplastic parathyroid glands. Localization test were performed 24 times. Ultrasonography allowed correct localization of 5 of 7 cases, computer tomography 2 of 6, scintigraphy 2 of 4 and nuclear magnetic resonance 1 of 7. This exploration was doubtful in a patient, and two false-positive nuclear magnetic resonance were found. The low yield of these tests makes them unnecessary in the evaluation of patients undergoing surgery for pHPT, because the cost is not justified.