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1.
Esc. Anna Nery Rev. Enferm ; 25(3): e20200334, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1149298

ABSTRACT

Resumo Objetivo Compreender a aplicabilidade da Teoria Geral de Enfermagem de Orem na assistência prestada aos pacientes em diálise peritoneal domiciliar. Método Estudo de método misto. Na etapa quantitativa realizou-se uma pesquisa transversal, descritiva e exploratória, com 34 pacientes em diálise peritoneal. Aplicou-se um instrumento para caracterização sociodemográfica e clínica e a escala de avaliação da capacidade para o autocuidado - Appraisal of Self Care Agency Scale Revised. Análise dos dados por estatística descritiva. Na abordagem qualitativa, utilizou-se a Teoria Fundamentada nos Dados. Realizaram-se 23 entrevistas domiciliares com 19 participantes. Análise dos dados seguiu as codificações aberta, axial e seletiva. Resultados Dos participantes, 59% tinham capacidade para o autocuidado operacionalizado. Os pacientes em diálise peritoneal atenderam, em diferentes graus, às seis categorias de requisitos de autocuidado de desvio de saúde para a realização da terapia em domicílio. O apoio e a educação destacaram-se como modalidade de sistema de Enfermagem. Conclusão e implicação para a prática A Teoria Geral de Enfermagem de Orem se aplica na assistência de Enfermagem a pessoas em diálise peritoneal. Sugere-se sua utilização como suporte teórico para o Processo de Enfermagem.


Resumen Objetivo comprender la aplicabilidad de la teoría general de enfermería de Orem para ayudar a los pacientes en diálisis peritoneal en el hogar. Método estudio de método mixto. En la etapa cuantitativa, se realizó un estudio transversal, descriptivo y exploratorio con 34 pacientes en diálisis peritoneal. Se aplicó un instrumento para la caracterización sociodemográfica y clínica y la escala para evaluar la capacidad de autocuidado - Evaluación de la escala de la agencia de autocuidado revisada. Análisis de datos mediante estadística descriptiva. En el enfoque cualitativo, se utilizó la teoría fundamentada. Se realizaron 23 entrevistas domiciliarias con 19 participantes. El análisis de datos siguió una codificación abierta, axial y selectiva. Resultados de los participantes 59% tenían la capacidad de autocuidado operacionalizado. Los pacientes en diálisis peritoneal cumplieron, en diversos grados, las seis categorías de requisitos de autocuidado para la desviación de salud para realizar la terapia en el hogar. El apoyo y la educación se destacaron como una modalidad del sistema de enfermería. Conclusión e implicación para la práctica la teoría general de enfermería de Orem se aplica a los cuidados de enfermería para personas en diálisis peritoneal. Su uso se sugiere como soporte teórico para el Proceso de Enfermería.


Abstract Objective To understand the applicability of Orem's General Nursing Theory in assisting patients on peritoneal dialysis at home. Method Mixed method study. In the quantitative stage, a cross-sectional, descriptive and exploratory study was carried out with 34 patients on peritoneal dialysis. An instrument was applied for sociodemographic and clinical characterization and the scale for assessing the capacity for self-care - Appraisal of Self Care Agency Scale Revised. Analysis of data using descriptive statistics. In the qualitative approach, Grounded Theory was used. 23 home interviews were conducted with 19 participants. Data analysis followed open, axial and selective coding. Results 59% of the participants had the capacity for operationalized self-care. Patients on peritoneal dialysis met, to varying degrees, the six categories of self-care requirements for health deviation to perform therapy at home. Support and education stood out as a modality of the Nursing system. Conclusion and implication for practice Orem's General Nursing Theory applies to nursing care for people on peritoneal dialysis. Its use is suggested as a theoretical support for the Nursing Process.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Nursing Theory , Peritoneal Dialysis/nursing , Nursing Care , Self Care
2.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 1316-1322, jan.-dez. 2021. ilus
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1291039

ABSTRACT

Objetivo: Compreender as interlocuções entre os usuários que realizam a diálise peritoneal domiciliar e os serviços da Rede de Atenção à Saúde. Método: pesquisa qualitativa realizada com 19 pessoas em tratamento dialítico distribuídas em três grupos amostrais conforme o método da Grounded Theory. Análise através da codificação aberta, axial e seletiva. Resultado: o contexto assistencial expõe a descontinuidade do cuidado dialítico nas esferas da atenção primária e hospitalar, analisada pela categoria "Realizando a Diálise Peritoneal no domicílio, estando inserido na Rede de Atenção à Saúde". Conclusão: na ótica dos entrevistados a principal interlocução é com o serviço de terapia renal substitutiva, principal referência para o cuidado e intercorrências com a dialise domiciliar. As interlocuções com os outros pontos assistenciais da Rede visam obter serviços de apoio, não implicados com o procedimento de dialise peritoneal domiciliar


Objective: To understand the interlocutions between users who perform peritoneal dialysis at home and the services of the Health Care Network. Method: qualitative research carried out with 19 people undergoing dialysis treatment distributed in three sample groups according to the Grounded Theory method. Analysis through open, axial and selective coding. Result:the care context studied exposes the discontinuity of dialysis care in the spheres of primary and hospital care, analyzed by the category "Performing Peritoneal Dialysis at home, being inserted in the Health Care Network". Conclusion: from theinterviewees' point of view, the main dialogue is with the renal replacement therapy service, the main reference for care and complications with home dialysis. The interlocutions with the other assistance points of the Network aim to obtain support services, not involved with the peritoneal dialysis procedure at home


Objetivo: Comprender las interlocuciones entre usuarios que realizan diálisis peritoneal en el hogar y los servicios de Health Care Network. Método: investigación cualitativa realizada con 19 personas sometidas a tratamiento de diálisis distribuidas en tres grupos de muestra según el método de la teoría fundamentada. Análisis mediante codificación abierta, axial y selectiva. Resultado: el contexto de atención estudiado expone la discontinuidad de la atención de diálisis en las esferas de atención primaria y hospitalaria, analizada por la categoría "Realización de diálisis peritoneal en el hogar, que se inserta en la red de atención médica". Conclusión:Para los entrevistados, la interlocución principal es con el servicio de terapia de reemplazo renal, la principal referencia para la atención y las complicaciones con la diálisis en el hogar. Las interlocuciones con los otros puntos de asistencia de la Red apuntan a obtener servicios de apoyo, no involucrados en el procedimiento de diálisi


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Hemodialysis, Home/trends , Comprehensive Health Care , Health Services Accessibility/trends , Peritoneal Dialysis , Integrality in Health
4.
Rev. colomb. nefrol. (En línea) ; 7(2): 119-122, jul.-dic. 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1251572

ABSTRACT

Resumen La gastrostomía endoscópica percutánea (GEP), descrita por primera vez en la década de 1980, es un procedimiento universalmente utilizado para asegurar la alimentación enteral en pacientes que conservan la función del tracto digestivo, pero que por alguna condición médica o quirúrgica no pueden ingerir alimentos sólidos o líquidos. La realización de una GEP en pacientes con diálisis peritoneal (DP) sigue siendo controvertida, ya que muchos autores la consideran una contraindicación absoluta debido al alto riesgo de morbimortalidad asociada a infección intraperitoneal. Se presenta el caso de un paciente de 70 años, con antecedente de enfermedad renal crónica en estadio terminal y portador de catéter de DP, quien requirió GEP. Se socializa la estrategia utilizada en este caso particular.


Abstract Percutaneous endoscopic gastrostomy (PEG), described in the 1980s, is a procedure universally used to ensure enteral feeding in patients who retain digestive tract function, but who cannot eat solid or liquid foods due to any medical or surgical condition. The performance of PEG in patients with peritoneal dialysis (PD) remains controversial, being considered an absolute contraindication for many authors, taking into account the high risk of morbidity and mortality associated with intraperitoneal infection. We present the case of a 70-year-old patient, with a history of chronic end-stage renal disease with a peritoneal dialysis catheter, who required PEG; and we propose a management protocol for this type of patient.


Subject(s)
Humans , Male , Aged , Gastrostomy , Patients , Indicators of Morbidity and Mortality , Peritoneal Dialysis , Colombia , Renal Insufficiency, Chronic
5.
Rev. colomb. nefrol. (En línea) ; 7(2): 104-112, jul.-dic. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1251570

ABSTRACT

Resumen La anticoagulación es la terapia de elección para la mayoría de pacientes con fibrilación auricular no valvular; sin embargo, en pacientes con enfermedad renal crónica con alto riesgo de sangrado se deben considerar terapias antitrombóticas locales como el cierre percutáneo de la orejuela izquierda con dispositivo Watchman. A continuación, se reporta el primer caso de implante de este dispositivo llevado a cabo en el Hospital de San José de Bogotá, Colombia, y se hace una revisión narrativa sobre este tema. El uso del dispositivo Watchman se asocia con menos accidentes cerebrovasculares hemorrágicos (0,15 vs. 0,96 eventos / 100 pacientes-año HR=0,22; p=0,004), menos muertes cardiovasculares o inexplicadas (1,1 vs. 2,3 eventos / 100 paciente-año; HR=0,48; p=0,006) y menos casos de sangrado no asociado al procedimiento (6,0 % vs. 11,3 %; HR=0,51; p=0,006) en comparación con la warfarina.


Resumen Anticoagulation remains the therapy of choice for the majority of patients with non-valvular atrial fibrillation, however, in patients with chronic kidney disease at high risk of bleeding, local antithrombotic therapies such as the left atrial closure with Watchman device should be considered. We report the first case of implant of this type device in the Hospital de San José at the City of Bogotá, Colombia, and a narrative review of the literature is made. Watchman's use is associated with fewer hemorrhagic strokes (0.15 versus 0.96 events / 100 patients-year HR: 0.22; p = 0.004), cardiovascular death / unexplained death (1.1 vs. 2.3 events / 100 patient-year; HR: 0.48; p = 0.006), and bleeding not associated with the procedure (6.0 % vs. 11.3 %; HR: 0.51; p = 0.006) compared to warfarin.


Subject(s)
Humans , Male , Female , Atrial Fibrillation , Patients , Peritoneal Dialysis , Colombia , Atrial Appendage , Narration
6.
Rev. enferm. UERJ ; 28: e45261, jan.-dez. 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1146354

ABSTRACT

Objetivo: identificar o conhecimento e o enfrentamento do diabetes junto a pessoas com diabetes em diálise. Método: estudo transversal, realizado com pacientes com diabetes tipo 2. Os instrumentos utilizados foram o Diabetes Knowledge Scale Questionnaire (DKN-A) e o Diabetes Attitude Questionnaire (ATT-19). Resultados: participaram 71 pacientes, com idade média de 61,81±14,93 anos. A retinopatia diabética foi a complicação prevalente (81,69%); hipertensão arterial sistêmica foi a comorbidade (83,09%). A glicemia em jejum apresentou mediana de 152 (124-228,5) mg/dl e a hemoglobina glicada de 7,5 (6,42-8,27) mg/dl. O DKN-A apresentou escore médio de 7,84±2,55 pontos; seu item com maior número de acertos foi a conduta em caso de hipoglicemia; enquanto o com menor número de acertos foi em relação à cetonúria e substituições alimentares. O instrumento ATT-19 obteve média de 50,26±11,7 pontos. Conclusão: pessoas com diabetes, em diálise, apresentam conhecimento deficiente em relação ao diabetes, assim como baixo enfrentamento da doença.


Objective: to identify knowledge of, and coping with, diabetes mellitus among diabetics undergoing dialysis. Method: in this cross-sectional study of patients with type 2 diabetes, the instruments used were the Diabetes Knowledge Scale Questionnaire (DKN-A) and Diabetes Attitude Questionnaire (ATT-19). Results: mean age of the 71 participants was 61.81 ± 14.93 years. The most prevalent complication was diabetic retinopathy (81.69%), and the most prevalent comorbidity was systemic arterial hypertension (83.09%). Median fasting glycemia and glycated hemoglobin were 152 (124-228.5) mg/dl and 7,5 (6,42-8,27) mg/dl, respectively. Average DKN-A score was 7.84 ± 2.55; the highest success rate was on how to respond to hypoglycemia; the lowest was about ketones in urine and substitute foods. Mean ATT-19 score was 50.26 ± 11.7. Conclusion: the diabetics in dialysis showed deficient knowledge of diabetes and had negative attitudes to the disease.


Objetivo: identificar el conocimiento y el afrontamiento de la diabetes mellitus entre los diabéticos en diálisis. Método: en este estudio transversal de pacientes con diabetes tipo 2, los instrumentos utilizados fueron el Diabetes Knowledge Scale Questionnaire (DKN-A) y Diabetes Attitude Questionnaire (ATT-19). Resultados: la edad media de los 71 participantes fue de 61,81 ± 14,93 años. La complicación más prevalente fue la retinopatía diabética (81,69%) y la comorbilidad más prevalente fue la hipertensión arterial sistémica (83,09%). La mediana de la glucemia en ayunas y la hemoglobina glucosilada fueron 152 (124- 228,5) mg / dl y 7,5 (6,42-8,27) mg / dl, respectivamente. La puntuación promedio de DKN-A fue de 7,84 ± 2,55; la tasa de éxito más alta fue sobre cómo responder a la hipoglucemia; el más bajo fue sobre las cetonas en la orina y los alimentos sustitutos. La puntuación media de ATT-19 fue 50,26 ± 11,7. Conclusión: los diabéticos en diálisis mostraban un conocimiento deficiente de la diabetes y actitudes negativas hacia la enfermedad.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Adaptation, Psychological , Attitude to Health , Health Knowledge, Attitudes, Practice , Peritoneal Dialysis/psychology , Diabetes Mellitus, Type 2/psychology , Renal Insufficiency, Chronic/psychology , Self Care , Socioeconomic Factors , Health Profile , Brazil/epidemiology , Health Education , Cross-Sectional Studies , Surveys and Questionnaires , Peritoneal Dialysis/nursing , Diabetes Mellitus, Type 2/nursing , Renal Insufficiency, Chronic/nursing
7.
Rev. cuba. med ; 59(4): e1346, oct.-dic. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144509

ABSTRACT

Introducción: La peritonitis fúngica es una complicación infrecuente pero grave para un paciente en diálisis peritoneal domiciliaria. Objetivo: Describir un caso de peritonitis fúngica en un paciente en diálisis peritoneal continua ambulatoria (DPCA). Métodos: Se presenta un paciente masculino de 53 años de edad, con antecedentes de hipertensión arterial, 9 años en diálisis peritoneal continua ambulatoria, con una desnutrición proteico energética moderada. Durante su tratamiento presentó varios episodios de peritonitis bacterianas, infecciones del orificio de salida y una recolocación de catéter peritoneal con cuff extruido. Se trabajó con sus antecedentes, cuadro clínico, agente etiológico y tratamiento. El diagnóstico se estableció por la presencia de líquido peritoneal turbio, conteo celular con más de 100 leucocitos/ul y cultivo con la presencia del hongo filamentoso. Resultados: En diciembre de 2017 se le diagnostica una peritonitis por fusarium, sin leucocitosis ni anemia, sí presentaba una hipoalbuminemia, se cultiva además pared de la habitación donde el paciente se realizaba los intercambios y se encuentra hongo filamentoso. En principio se comienza tratamiento con vancomicina y ceftacidima, posteriormente se cambia la ceftazidima por amikacina y finalmente, al tener resultado de cultivo y se muestra el patógeno, se inicia tratamiento con itraconazol, lamentablemente el paciente fallece a los 20 días. Conclusiones: Con esta investigación se analizan aspectos clínicos y microbiológicos de la peritonitis por fusarium, los cuales son poco conocidos en diálisis peritoneal domiciliaria(AU)


Introduction: Fungal peritonitis is an infrequent but serious complication for a patient on home peritoneal dialysis. Objective: To describe a case of fungal peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). Methods: A 53-year-old male patient is reported, with a history of arterial hypertension, 9 years on continuous outpatient peritoneal dialysis, moderate protein-energy malnutrition. During his treatment, he had several episodes of bacterial peritonitis, exit-site infections, and repositioning of a peritoneal catheter with an extruded cuff. We worked with his antecedents, clinical status, etiological agent and treatment. The diagnosis was established by the presence of cloudy peritoneal fluid, cell count higher than 100 leukocytes / ul, and culture with the presence of the filamentous fungus. Results: In December 2017, he was diagnosed with fusarium peritonitis, with no leukocytosis or anemia, he did present hypoalbuminemia. A culture was performed on the wall of the room where the patient had his exchanges and filamentous fungus was found. Initially, treatment started with vancomycin and ceftazidime, followed by amikacin. Finally, after having a culture showed the pathogen, treatment with itraconazole started. Unfortunately the patient died 20 days later. Conclusions: This research analyzes clinical and microbiological aspects of fusarium peritonitis, which are poorly understood in home peritoneal dialysis(AU)


Subject(s)
Humans , Male , Middle Aged , Peritonitis/mortality , Peritoneal Dialysis/adverse effects , Fusariosis/mortality
8.
Rev. Assoc. Med. Bras. (1992) ; 66(9): 1229-1234, Sept. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136367

ABSTRACT

SUMMARY OBJECTIVE: To evaluate the effects of hemodialysis, peritoneal dialysis, and renal transplantation on the quality of life of patients with end-stage renal disease (ESRD) and analyze the influencing factors. METHODS: A total of 162 ESRD patients who received maintenance hemodialysis, continuous ambulatory peritoneal dialysis, and renal transplantation from February 2017 to March 2018 in our hospital were divided into a hemodialysis group, a peritoneal dialysis group, and a renal transplantation group. The baseline clinical data, serum indices, as well as environmental factors such as education level, marital status, work, residential pattern, household income, and expenditure were recorded. The quality of life was assessed using the short-form 36-item (SF-36) scale reflecting the Physical Component Summary (PCS) and the Mental Component Summary (MCS). One-way analysis of variance and logistic stepwise multiple regression analysis were performed to analyze the factors influencing the quality of life. RESULTS: The renal transplantation group had the highest average scores for all dimensions of the SF-36 scale. The PCS and MCS scores of this group were higher than those of the hemodialysis and peritoneal dialysis groups. The peritoneal dialysis group had higher scores for physical functioning, physical role, bodily pain, general health, mental health, PCS, and MCS than those of the hemodialysis group. Age, HGB, GLU, and ALP were the main factors influencing PCS. Age, education level, residential pattern, medication expenditure, and monthly per capita income mainly affected MCS. CONCLUSION: In terms of quality of life, renal transplantation is superior to peritoneal dialysis and hemodialysis.


RESUMO OBJETIVO: Avaliar os efeitos da hemodiálise, diálise peritoneal e transplante renal na qualidade de vida de pacientes na última fase da doença renal terminal (ESRD), bem como analisar os fatores influentes. MÉTODOS: Um total de 162 pacientes de ESRD receberam hemodiálise de manutenção, diálise peritoneal ambulatorial contínua e transplante renal de fevereiro de 2017 a março de 2018 em nosso hospital. Eles foram divididos em grupo de hemodiálise, grupo de diálise peritoneal e grupo de transplante renal. Foram analisados os dados clínicos de base, índices-chave e os fatores ambientais, como nível educacional, estado civil, emprego, padrão residencial, renda e gasto familiar. A qualidade de vida foi avaliada pelo uso da escala de forma reduzida de 36 itens (SF-36), que reflete o Resumo da Escala Física (PCS) e o Resumo dos Componentes Mentais (PCS). Análise unidirecional de variações e análise de regressão logística múltipla foram realizadas para analisar os fatores que influenciam a qualidade de vida. RESULTADOS: O grupo de transplante renal teve os maiores pontos médios em todas as dimensões da escala SF-36. Os pontos PCS e MCS desse grupo foram mais altos que os dos grupos de hemodiálise e diálise peritoneal. Além disso, o grupo de diálise peritoneal teve pontos mais altos em funcionamento físico, função física, dor corporal, saúde geral, saúde mental, PCS e MCS do que os do grupo de hemodiálise. Idade, HGB, GLU e ALP foram os principais fatores que influenciaram a PCS. Idade, nível educacional, padrão residencial, gastos em medicamentos e renda mensal per capita afetaram principalmente o MCS. CONCLUSÃO: Quanto à qualidade de vida, o transplante renal é melhor que a diálise peritoneal e a hemodiálise.


Subject(s)
Humans , Kidney Transplantation , Peritoneal Dialysis , Kidney Failure, Chronic/therapy , Quality of Life , Renal Dialysis
9.
Rev. enferm. Inst. Mex. Seguro Soc ; 28(3): 159-169, Jul-sept 2020. tab
Article in Spanish | LILACS, BDENF | ID: biblio-1343059

ABSTRACT

Introducción: la depresión en personas con enfermedad renal crónica (ERC) tiene efectos en el cumplimiento y aceptación del régimen terapéutico empleado. Objetivo: evaluar la eficacia de una intervención psicoeducativa de enfermería en la disminución de los síntomas de depresión en pacientes adscritos al Programa de Diálisis Peritoneal del Hospital General de Zona No.32 de Minatitlán, Veracruz. Metodología: estudio cuasi experimental; la muestra se integró con 8 pacientes y el muestreo se estableció por conveniencia. Se utilizó el inventario de depresión de Beck II y se aplicó una intervención de enfermería. Resultados: participaron más mujeres (75%), con 50% que utiliza DPA y 50% DPCA. La depresión mínima (37.5%) y la depresión leve (37.5%) predominaron antes de la intervención; luego de la intervención predominó el grado de depresión mínima (87.5%). La media fue de 14.88 en la prueba preliminar y 5.88 en la posterior (p = 0.007). Conclusiones: la intervención de enfermería mostró eficacia al disminuir los grados de depresión en los pacientes con ERC.


Introduction: Depression in a person with chronic kidney disease (CKD), has an impact on the fulfillment and acceptance of the therapeutic regimen used. Objective: To evaluate the efficacy of a psychoeducational nursing intervention to reduce depression symptoms in patients assigned to the peritoneal dialysis program of the General Hospital of Zone No.32 of Minatitlán, Ver. Methods: Quasi-experimental, study. Sample was 8 patients. Sampling was by Convenience. The Beck-II Depression Inventory was used; a nursing psychoeducational intervention was applied. Results: Most of the participants were women (75%); 50% uses DPA and 50% DPCA. Minimum depression (37.5%) and mild depression (37.5%) predominated before the intervention; after intervention, the minimum depression level predominated (87.5%). The average in the Pretest was 14.88 and 5.88 in the Posttest (p = .007). Conclusion: The nursing psychoeducational intervention showed efficacy to decrease depression levels in the group of CKD patients studied.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Peritoneal Dialysis/nursing , Depression/prevention & control , Renal Insufficiency, Chronic/nursing , Renal Insufficiency, Chronic/psychology , Nursing Care , Psychotherapy, Group/methods , Socioeconomic Factors , Longitudinal Studies , Hospitals, General , Hospitals, Public , Mexico
10.
Rev. chil. pediatr ; 91(2): 265-274, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1098902

ABSTRACT

Resumen: La enfermedad renal crónica terminal (ERCT) tiene una incidencia de 5,5 a 9 ppm, y una prevalencia de 23 a 65 ppm en menores de 15 años. La diálisis peritoneal (DP) crónica representa en pediatría la terapia de reemplazo renal más usada, previo al trasplante renal. Existen 2 tipos de DP crónicas, manual (DPCA) y automatizada (DPA), cuya elección se basa en las características del peritoneo eva luado mediante el test de equilibrio peritoneal (PET), que divide a los pacientes en transportadores altos (intercambio rápido), promedio alto, promedio bajo, y bajos (intercambio lento). Este test eva lúa básicamente el transporte de solutos, al cual se ha sumado el MiniPET, que evalúa el transporte peritoneal de agua libre. Se debe igualmente determinar la cuantía de diálisis (Kt/V), que representa la dosis de diálisis aplicada, con un valor mínimo sugerido de 1,7, relacionado a la morbimortalidad. Estos parámetros deben ser evaluados periódicamente para ajustar la DP, y cada vez que se sospeche una depuración o ultrafiltración inadecuadas. El objetivo de esta revisión es entregar conceptos bási cos sobre fisiología del transporte peritoneal, modalidades de DP, evaluación del transporte de agua y solutos peritoneal, y el cálculo de la dosis de diálisis para una diálisis ajustada a las necesidades de cada paciente, como también revisar los mecanismos de corrección y ajuste del procedimiento cada vez que se requiera.


Abstract: End-stage renal disease (ESRD) has an incidence of 5.5 to 9 pmp, and a prevalence of 23 to 65 pmp in children under 15 years of age. Chronic peritoneal dialysis (PD) represents the most widely used renal replacement therapy in children before kidney transplantation. There are two PD modalities, the manual one (CAPD) and the automated one (APD). The choice is based on the peritoneum characteristics, evaluated through the peritoneal equilibrium test (PET), which divides patients into high transporters (rapid exchange membrane), high average, low average, and low transporters (slow exchange membrane). This test basically evaluates the solutes transport rate, and the MiniPET has been added which evaluates peritoneal free water transport. The amount of dialysis (Kt/V), which represents the dose of dialysis administered also must be evaluated to assure a minimal value of 1.7 related to morbidity and mortality. These parameters should be evaluated periodically to ad just the PD and whenever suspected an inadequate clearance or ultrafiltration. The objective of this review is to provide basic concepts on peritoneal transport physiology, PD modalities, free water transport and peritoneal solute transport evaluation, and the dialysis dose to be applied according to the patient's needs, as well as reviewing the correction mechanisms and procedure adjustment whenever required.


Subject(s)
Humans , Child , Peritoneal Dialysis/methods , Kidney Failure, Chronic/therapy , Pediatrics , Treatment Outcome , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/physiopathology
11.
Arch. argent. pediatr ; 118(2): e178-e182, abr. 2020. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1100431

ABSTRACT

La enfermedad de jarabe de arce es una entidad autosómica recesiva producida por un error congénito en el metabolismo de tres aminoácidos esenciales de cadena ramificada: valina, leucina e isoleucina. La forma neonatal de esta enfermedad se manifiesta por un cuadro de compromiso neurológico grave y progresivo, asociado a un olor peculiar de la orina, consecuencia de la eliminación del exceso de estos aminoácidos. Este olor a azúcar quemada remeda a la melaza obtenida de los arces, lo que da nombre a esta enfermedad. El mejor método para eliminar estos tóxicos es la hemodiafiltración, pero, en los centros en los que esta práctica no es posible, la diálisis peritoneal constituye una alternativa.Se presenta a un recién nacido con leucinosis, con compromiso grave del sistema nervioso central, en quien la diálisis peritoneal fue de utilidad para superar la descompensación metabólica.


Maple syrup disease is an autosomal recessive entity caused by a congenital error in the metabolism of three essential branched-chain amino acids: valine, leucine and isoleucine. The neonatal form of this disease is expressed by a severe and progressive neurological compromise, associated with a peculiar smell of urine, a consequence of the elimination of the excess of these amino acids. This smell of burnt sugar mimics the molasses obtained from maples, which gives its name to this disease. The best method to eliminate these toxins is hemodiafiltration, but in centers where this practice is not possible, peritoneal dialysis is an alternative.We present a newborn with leukinosis with severe central nervous system involvement in whom peritoneal dialysis was useful to overcome metabolic decompensation.


Subject(s)
Humans , Male , Infant, Newborn , Peritoneal Dialysis , Maple Syrup Urine Disease/diagnosis , Urine/chemistry , Weight Loss , Maple Syrup Urine Disease/therapy
12.
Saude e pesqui. (Impr.) ; 13(1): 63-72, jan/mar 2020. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1052900

ABSTRACT

O objetivo deste estudo foi avaliar o consumo alimentar e fatores associados de pacientes com Doença Renal Crônica em terapia renal substitutiva do tipo diálise peritoneal. Trata-se de um estudo transversal que avaliou dados sociodemográficos, hábitos de vida, estado nutricional e condição clínica com o consumo alimentar destes pacientes. Dos indivíduos avaliados, 73,5% (n=25) apresentaram consumo fora do recomendado de calorias e carboidratos, 76,5% (n=32) de proteína e 52,95% (n=18) de lipídios. Encontraram-se altas prevalências de inadequação para o consumo de cálcio, ferro, zinco e fósforo. Foi associado à maior inadequação no consumo de carboidratos o fato do paciente ser aposentado/afastado (p=0,025) e ser desnutrido/eutrófico (p=0,003). O consumo lipídico inadequado foi mais presente nos homens (61,01%, p=0,045) e o consumo adequado associou-se aos aposentados/afastados (p=0,026) e aos eutróficos (p=0,023). Foi identificado consumo abaixo do recomendado de calorias, carboidrato e proteína e acima do recomendado para lipídios.


Food intake by chronic kidney patients and associated factors in substitute kidney therapy, such as peritoneal dialysis, are evaluated by a transversal study that evaluated sociodemographic data, life style, nutritional status and clinical conditions with the patients´ food intake. Twenty-five (73.5%) patients consumed food with less calories and carbohydrates; 76.5% (n=32) with less protein and 52.95% (n=18) with excess lipid. There were also high amounts of calcium, iron, zinc and phosphorus. The fact that the patient was retired (p=0.025) and undernourished/eutrophic (p=0.003) was a compounding factor to carbohydrate intake. Inadequate lipids intake was more pronounced in males (61.01%, p=0.045) and inadequate intake was associated with retirement (p=0.026) and eutrophic conditions (p=0.023). Results show low intake of calories, carbohydrates and protein and excess in lipids.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Socioeconomic Factors , Eating , Peritoneal Dialysis , Renal Insufficiency, Chronic
13.
Rev. cuba. med ; 59(1): e174, ene.-mar. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139043

ABSTRACT

La esclerosis peritoneal encapsulante es una complicación poco común, pero muy grave, de la diálisis peritoneal. Esta complicación está asociada con altas tasas de morbilidad y mortalidad. El diagnóstico clínico requiere la presencia de obstrucción intestinal o función gastrointestinal alterada con signos patológicos y radiológicos de encapsulamiento intestinal. El diagnóstico patognomónico es solo con la realización de una biopsia peritoneal. El mecanismo patogénico exacto de esta entidad sigue siendo desconocido, aunque se asocia firmemente con el tiempo de duración del paciente en el tratamiento con diálisis peritoneal. Se presenta un caso clínico de esclerosis peritoneal encapsulante y se analizan las manifestaciones clínicas, diagnóstico, tratamiento, pronóstico y prevención(AU)


Encapsulating peritoneal sclerosis is a rare but very serious complication of peritoneal dialysis. This complication is associated with high morbidity and mortality rates. Clinical diagnosis is based on the presence of intestinal obstruction or altered gastrointestinal function with pathological and radiological signs of intestinal encapsulation. The pathognomonic diagnosis is achieved only by performing peritoneal biopsy. The exact pathogenic mechanism of this entity remains unknown, although it is strongly associated with the duration of the patient with peritoneal dialysis. We report a clinical case of encapsulating peritoneal sclerosis and the clinical manifestations, diagnosis, treatment, prognosis and prevention are analyzed(AU)


Subject(s)
Humans , Male , Adult , Peritoneal Dialysis/adverse effects , Peritoneal Fibrosis/complications , Peritoneal Fibrosis/pathology
14.
Int. braz. j. urol ; 46(4): 538-544, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134207

ABSTRACT

ABSTRACT The indication for simultaneous bilateral native nephrectomy and the choice of surgical technique is of key importance, as these patients are burdened with a large comorbidity. The paper reports our experience of seven successful and completed simultaneous bilateral native nephrectomy procedures with retroperitoneal approach in the patient's flank position. Seven patients (mean age 34), were indicated for the removal of both kidneys before the planned transplant. Six patients underwent haemodialysis from 48 to 84 months, and one underwent peritoneal dialysis for 60 months. Two patients had undergone graftectomy. The indications were chronic infection or hypertension. The length of the kidneys ranged from 5.8 to 10cm. All procedures were performed by the laparoscopic technique with retroperitoneal approach, with the patient in the flank position. Three trocars were used on each side. The retroperitoneal space created did not require balloon dilatation. The kidneys were removed through the 10mm trocar hole after splitting. The duration of the procedure ranged from 150 to 240 minutes, average 139 minutes and blood loss ranged from100 to 250mL, average 142mL. There were no complications. In 6 patients, the postoperative dialysis was performed at zero-day. One patient continued peritoneal dialysis. Patients were discharged on the 2nd day, except one with peritoneal dialysis, who was discharged on the 3rd day. Retroperitoneal laparoscopic bilateral native nephrectomy is a safe and effective technique, and it can be considered as an ideal approach for native nephrectomy. It allows for the preservation of peritoneal integrity and vessels for future vascular access.


Subject(s)
Humans , Male , Female , Adult , Aged , Nephrectomy , Retroperitoneal Space/surgery , Kidney Transplantation , Peritoneal Dialysis , Laparoscopy
15.
Rev. Assoc. Med. Bras. (1992) ; 66(supl.1): s37-s44, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057099

ABSTRACT

SUMMARY Peritoneal dialysis (PD) is a renal replacement therapy based on infusing a sterile solution into the peritoneal cavity through a catheter and provides for the removal of solutes and water using the peritoneal membrane as the exchange surface. This solution, which is in close contact with the capillaries in the peritoneum, allows diffusion solute transport and osmotic ultrafiltration water loss since it is hyperosmolar to plasma due to the addition of osmotic agents (most commonly glucose). Infusion and drainage of the solution into the peritoneal cavity can be performed in two ways: manually (continuous ambulatory PD), in which the patient usually goes through four solution changes throughout the day, or machine-assisted PD (automated PD), in which dialysis is performed with the aid of a cycling machine that allows changes to be made overnight while the patient is sleeping. Prescription and follow-up of PD involve characterizing the type of peritoneal transport and assessing the offered dialysis dose (solute clearance) as well as diagnosing and treating possible method-related complications (infectious and non-infectious).


RESUMO A diálise peritoneal (DP) é uma terapia renal substitutiva baseada na infusão de uma solução estéril na cavidade peritoneal através de um cateter, proporcionando a remoção de solutos e água usando a membrana peritoneal como superfície de troca. Essa solução, em contato com os capilares do peritônio, permite o transporte difuso de solutos e a perda de água por ultrafiltração osmótica, uma vez que é hiperosmolar ao plasma devido à adição de agentes osmóticos (normalmente, a glicose). A infusão e drenagem da solução dentro da cavidade peritoneal pode ser realizada de duas maneiras: manualmente (DP ambulatorial contínua), em que o paciente, geralmente, passa por quatro trocas de solução durante o dia, ou por DP mecânica (automatizada), em que a diálise é realizada com o auxílio de uma máquina de diálise que permite que as trocas sejam feitas durante a noite, enquanto o paciente está dormindo. A prescrição e o acompanhamento da DP envolvem a caracterização do tipo de transporte peritoneal e a avaliação da dose de diálise oferecida (depuração do soluto), bem como o diagnóstico e tratamento de possíveis complicações relacionadas ao método (infecciosas e não infecciosas).


Subject(s)
Humans , Peritoneal Dialysis/methods , Kidney Failure, Chronic/therapy , Dialysis Solutions/therapeutic use , Peritoneal Dialysis, Continuous Ambulatory , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/classification
16.
Article in Chinese | WPRIM | ID: wpr-880805

ABSTRACT

OBJECTIVE@#To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis.@*METHODS@#The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (< 36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events.@*RESULTS@#A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred (@*CONCLUSIONS@#Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.


Subject(s)
Humans , Kidney Failure, Chronic/therapy , Peritoneal Dialysis/adverse effects , Peritonitis/etiology , Retrospective Studies , Treatment Outcome
17.
Article in English | WPRIM | ID: wpr-880613

ABSTRACT

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis. A total of 50% of the patients died within 12 months after being diagnosed. There are no obvious clinical symptoms in the early stage of EPS, which is easy to be missed. And there are few case reports of EPS in early stage. On December 22, 2018, a 70-year-old male patient undergoing peritoneal dialysis for 17 months, who was diagnosed as EPS, was admitted to the Department of Nephrology, the Third Xiangya Hospital, Central South University. The patient's peritoneal dialysis catheter was obstructed after peritonitis. The peritoneal dialysis fluid couldn't be drain in and out of the abdominal cavity. Therefore, the laparoscopy was performed to repair the catheter. The operation in progress showed that the peritoneum was slightly thickened and the ileocecal intestinal tube was closely adhered to the parietal peritoneum where the catheter was wrapped, indicating the early stage of EPS. Peritoneal relaxation was performed. The patient's catheter was normal after adhesiolysis. He underwent hemodialysis, nutritional supporting as well as peritoneal dialysis transition, etc. The peritonitis was controlled after 10 days and the peritoneal dialysis was resumed. After discharge from hospital, the patient took moxifloxacin for 2 more weeks. We followed up the patient for 6 months. The automated peritoneal dialysis is maintained, and everything remains normal. Clinicians need to improve understanding of EPS. Early diagnosis and laparoscopic adhesiolysis is helpful to continue peritoneal dialysis treatment.


Subject(s)
Aged , Early Diagnosis , Humans , Male , Peritoneal Dialysis/adverse effects , Peritoneal Fibrosis/pathology , Peritoneum , Peritonitis/pathology , Sclerosis/pathology
20.
Article in English | WPRIM | ID: wpr-762455

ABSTRACT

BACKGROUND: Anti-carbohydrate antibody responses, including those of anti-blood group ABO antibodies, are yet to be thoroughly studied in humans. Because anti-ABO antibody-mediated rejection is a key hurdle in ABO-incompatible transplantation, it is important to understand the cellular mechanism of anti-ABO responses. We aimed to identify the main human B cell subsets that produce anti-ABO antibodies by analyzing the correlation between B cell subsets and anti-ABO antibody titers. METHODS: Blood group A-binding B cells were analyzed in peritoneal fluid and peripheral blood samples from 43 patients undergoing peritoneal dialysis and 18 healthy volunteers with blood group B or O. The correlation between each blood group A-specific B cell subset and anti-A antibody titer was then analyzed using Pearson's correlation analysis. RESULTS: Blood group A-binding B cells were enriched in CD27⁺CD43⁺CD1c− B1, CD5⁺ B1, CD11b⁺ B1, and CD27⁺CD43⁺CD1c+ marginal zone-B1 cells in peripheral blood. Blood group A-specific B1 cells (P=0.029 and R=0.356 for IgM; P=0.049 and R=0.325 for IgG) and marginal zone-B1 cells (P=0.011 and R=0.410 for IgM) were positively correlated with anti-A antibody titer. Further analysis of peritoneal B cells confirmed B1 cell enrichment in the peritoneal cavity but showed no difference in blood group A-specific B1 cell enrichment between the peritoneal cavity and peripheral blood. CONCLUSIONS: Human B1 cells are the key blood group A-specific B cells that have a moderate correlation with anti-A antibody titer and therefore constitute a potential therapeutic target for successful ABO-incompatible transplantation.


Subject(s)
Antibodies , Antibody Formation , Ascitic Fluid , B-Lymphocyte Subsets , B-Lymphocytes , Healthy Volunteers , Humans , Immunoglobulin M , Peritoneal Cavity , Peritoneal Dialysis
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