[The Evolution of Hemodialysis in Chile: Is Hemodiafiltration the Next Step?] / Evolución de la hemodiálisis en Chile: ¿La hemodiafiltración es el siguiente eslabón?

Hemodialysis began in Chile during the latter half of the 20th century, primarily targeting individuals with acute renal failure. With time, dialysis facilities emerged across diverse regions of the nation, covering hospitals and private centers. This expansion widened dialysis access to chronic patients, culminating in universal coverage through the AUGE plan. Ongoing technological improvements and the integration of pharmaceutical interventions for chronic kidney disease-related complications have notably enhanced survival rates. Nonetheless, dialysis recipients continue to confront significantly elevated mortality risks in comparison to the general population. Despite advancements, complications linked to dialysis persist, significantly affecting patients' overall quality of life. Heightened rates of hospitalization and mortality are, in part, ascribed to the inherent technical limitations of hemodialysis in efficiently clearing uremic toxins. Therefore, superior purification modalities such as high-volume hemodiafiltration need to be progressively adopted to effectively address the persistent clinical needs in the care of dialysis patients within the Chilean context.

[Use of cinacalcet in secondary hyperparathyroidism: assessment of nutritional, lipid and inflammatory status in chronic kidney disease]. / Uso de cinacalcet en hiperparatiroidismo secundario: evaluación del estado nutricional, lipídico e inflamatorio en enfermedad renal crónica.

Introduction: Introduction: observations in cell lines suggest that the use of cinacalcet could be associated with increase in body fat, inflammatory state, and alteration in lipid metabolism. However, when scaling the model to the clinical level, the occurrence of these effects is unknown. Objectives: to analyze the effect of cinacalcet therapy on anthropometric, inflammatory and lipid parameters in renal patients with secondary hyperparathyroidism (SHPT). Methods: observational study with two approaches. The retrospective study included 89 patients who started cinacalcet treatment since 2018 with a maximum follow-up of 36 months. Body mass index (BMI) variables, waist circumference, tricipital skinfold, parathyroid hormone (PTH), and biochemical profile were analyzed. The prospective study included 52 patients who started cinacalcet treatment since 2020 with a 12-month follow-up. BMI, PTH, lipid profile, and PCR variables were analyzed. Results: in the retrospective study, BMI was 27 kg/m2, with 62 % overweight and 65 % of patients with high cardiovascular risk. Cinacalcet reduced PTH by 12 % after six months (p < 0.01) and serum calcium decreased by 3.4 % at the end of follow-up (p = 0.04). According to the prospective study, BMI was 26.8 kg/m2, with 60 % overweight. PTH decreased by 8.4 % after six months. Total cholesterol, LDL cholesterol, and triglycerides decreased by 6.8 %, 12.5 %, and 5.5 %, respectively, at the end of follow-up. Conclusions: the prevalent nutritional status is excess weight. In patients with SHPT, cinacalcet improves PTH control without causing changes in anthropometric, lipid, and inflammatory parameters.

Introducción: Introducción: observaciones en líneas celulares sugieren que el uso de cinacalcet podría asociarse con un aumento de grasa corporal y del estado inflamatorio y una alteración del metabolismo lipídico. Sin embargo, al escalar el modelo a nivel clínico se desconoce la ocurrencia de estos efectos. Objetivos: analizar el efecto de la terapia con cinacalcet sobre parámetros antropométricos, inflamatorios y lipídicos en pacientes renales con hiperparatiroidismo secundario (HPT2). Métodos: estudio observacional con dos aproximaciones. El estudio retrospectivo incluyó 89 pacientes que iniciaron tratamiento de cinacalcet desde el año 2018 con un seguimiento máximo de 36 meses. Se analizaron variables de índice de masa corporal (IMC), circunferencia de cintura, pliegue tricipital, paratohormona (PTH) y perfil bioquímico. El estudio prospectivo incluyó 52 pacientes que iniciaron tratamiento con cinacalcet desde el año 2020 con un seguimiento de 12 meses. Se analizaron variables de IMC, PTH, perfil lipídico y proteína C reactiva (PCR). Resultados: en el estudio retrospectivo, el IMC fue de 27 kg/m2, con un 62 % de exceso de peso y un 65 % de los pacientes con riesgo cardiovascular elevado. Cinacalcet redujo la PTH un 12 % luego de seis meses (p < 0,01) y el calcio sérico disminuyó un 3,4 % al final del seguimiento (p = 0,04). En el estudio prospectivo, el IMC fue de 26,8 kg/m2, con un 60 % de exceso de peso. La PTH disminuyó un 8,4 % luego de seis meses. El colesterol total, el colesterol LDL y los triglicéridos disminuyeron en un 6,8 %, 12,5 % y 5,5 %, respectivamente, al finalizar el seguimiento. Conclusiones: el estado nutricional prevalente es el exceso de peso. En pacientes con HPT2 cinacalcet mejora el control de la PTH sin provocar cambios en parámetros antropométricos, lipídicos e inflamatorios.

Farmacocinética y aclaramiento de ciprofloxacina y amikacina en hemodiálisis continua / Pharmacokinetics and clearence of ciprofloxacin and amikacin during continuous hemodialysis

We studied the pharmacokinetics and clearence of a 200 mg ciprofloxacin and a 500 mg amikacin intravenous dose during 5 continuous hemodialysis procedures in 5 patients with acute oliguric renal failure. Hourly blood and ultrafiltrate drug concentrations were measured during 8 hours. Dialysate flux (Qd) was 16.6 ml/min during the first hours and 33.2 ml/min thereafter. For each Qd, total ciprofloxacin clearence was 1.13ñ0.99 and 2.8ñ1.71 ml/min (p<0.001), diffusive clearence was 0.96ñ0.87 and 2.47ñ1.56 ml/min (p<0.005) and convective clearence was 0.16ñ0.17 and 0.33ñ0.2 ml/min (p<0.05). Likewise, total amikacin clearence was 3.47ñ1.31 and 4.18ñ0.53 ml/min (p<0.001), diffusive clearence was 2.97ñ1.24 and 3.86ñ0.52 ml/min and convective clearence was 0.50ñ0.47 and 0.32ñ0.29 ml/min (p=NS). Protein binding was 84 percent for ciprofloxacin and 77 percent for amikacin. It is concluded that during continuous hemodialysis with cuprofan membrane, the main transport mechanism of ciprofloxacin and amikacin is diffusive. Very low amounts of ciprofloxacin are depurated by the dialyser. Likewise, the shortening of amikacin half life suggest the presence of other elimination pathway and the need to use suplementary doses every 24 hours