A prospective randomised European multicentre study of medium-long run mortality and morbidity comparing acetate-free biofiltration and bicarbonate dialysis.

In recent years, the progressive increase in the mean age of the population entering chronic dialysis treatment has been responsible, on the one hand, for the growing number of patients undergoing regular dialysis, and on the other, for the high number of "critical" patients, both as a result of their age and the presence of concomitant morbidity. Thus, dialysis treatment today is not only aimed at waste removal and water-electrolyte homeostasis, but also at a reduction in morbidity and mortality, and at improving the patients' quality of life, thanks to the use of biocompatible materials and the achievement of good cardiovascular tolerance to treatment. Consequently, diffusive-convective dialysis procedures have been on the increase, since they combine better depuration with the use of biocompatible high-flux membranes. Acetate-free biofiltration (AFB) is a diffusive-convective dialysis procedure which utilises a high-flux membrane, AN69, post-dilution infusion of a sodium bicarbonate solution (NaHCO3), and a dialysate which is completely free of any buffer, and thus also free of acetate, which may have various negative effects on the patient. A number of studies have already shown the better hemodynamic stability and the reduction of intradialytic side-effects during AFB. All these, however, were short-term studies. To verify the beneficial effects of AFB in the long run, a three year multicentre randomised European trial has been proposed to compare bicarbonate hemodialysis (BD), a technique used in nearly 80% of the world's dialysis population, and AFB. The specific aim of the investigation is to verify, in a large number of patients, the results of hemodialysis treatment in terms of morbidity, mortality and quality of life. The study involves 80 hemodialysis units across Italy, France, Germany, Spain, Slovenia and Croatia, with enrollment of about 400 patients considered "critical" for at least one of the following reasons: age, diabetes, dialysis cardiovascular instability. Fifty percent of the patients are to undergo AFB with the AN69 membrane and bicarbonate solution infusion (NaHCO3 145 or 167 mEq/lt), and the other fifty percent are to be treated by BD, with any membrane except the nonmodified cellulosic one. Biochemical, cardiological, and nutritional parameters will be considered throughout the study. Mortality, morbidity both in terms of intra- and interdialysis symptoms - and hospitalisation rate, as well as the patients' quality of life, evaluated by the SF36 questionnaire, will be analysed.

Nutrición del anciano y protesis dentales / Nutrition of the aged and dental prosthesis

El anciano tiene una fisiología diferente de la del adulto; ha perdido una parte de sus reservas y de su capacidad de adaptación, es más vulnerable a la agresión del medio y la reducción de su plasticidade le vuelve frágil. La asistencia a ancianos expuestos al riesgo de malnutrición o desnutrición en principio debe ser preventiva. Las alteraciones nutricionales en el anciano con frecuencia se encuentran ligadas a deficiencias bucodentales, como parodontopatías, desdentación y prótesis defectuosas; por esta causa el geriatra debe establecer una estrecha colaboración con el estomatólogo con el fin de encontrar un tratamiento adecuado para el paciente anciano con desequilibrio nutricional. Además, las enfermedades agudas exponen al anciano a una desnutrición rápida, por lo que es necesario evaluar el estado de nutrición anterior del paciente y proporcionarle en forma precoz los medios fisiológicos y la realimentación adecuados para corregir las anomalías observadas