Desfecho clínico de pacientes em urgência dialítica: uma revisão integrativa da literatura / Resultado clínico de pacientes en urgencia dialítica: una revisión integradora de la literatura / Clinical outcome of patients in dialysis urgency: an integrative literature review

RESUMO Objetivo : Investigar o desfecho clínico de pacientes em urgência dialítica submetidos à terapia renal substitutiva, por meio de uma revisão integrativa da literatura. Método : Revisão integrativa da literatura de estudos publicados de janeiro de 2010 a julho de 2020, na íntegra, em inglês e português, nas bases de dados: Literatura Latino Americana e do Caribe em Ciência da Saúde, Medical Literature Analysis and Retrieval System Online, Base de dados de Enfermagem e PUBMED. Foram utilizadas palavras-chave e descritores: "hemodiálise", "emergência", "diálise renal", "mortalidade, "desfecho clínico" e "urgência dialítica". Os textos foram pré-selecionados a partir da leitura dos títulos e resumos, verificando sua aderência ao tema, encontrando-se 344 artigos. A seguir, foi realizada a leitura dos resultados e considerações dos estudos. Dos 334 artigos pré-selecionados, apenas 13foram incluídos. Resultados : Há recorrência da urgência dialítica, sendo o óbito o principal desfecho clínico. Conclusão : Os estudos acerca dos desfechos clínicos de pacientes em urgência dialítica ainda são poucos se comparado à dimensão que a doença renal possui na população mundial. Conhecer esses desfechos dará subsídios para novos estudos sobre a sobrevida desses pacientes e para políticas de saúde mais eficazes.

RESUMEN Objetivo : investigar el resultado clínico de pacientes en urgencia dialítica sometidos a la terapia renal sustitutiva, por medio de una revisión integradora de la literatura. Método : revisión integradora de la literatura de estudios publicados de enero de 2010 a julio de 2020, en su totalidad, en inglés y portugués, en las bases de datos: Literatura Latino Americana e do Caribe em Ciência da Saúde, Medical Literature Analysis and Retrieval System Online, Base de dados de Enfermagem y PUBMED. Fueron utilizados los descriptores y las palabras clave en portugués: "hemodiálise", "emergência", "diálise renal", "mortalidade, "desfecho clínico" y "urgência dialítica". Los textos fueron pre-seleccionados a partir de la lectura de los títulos y resúmenes, verificando su adherencia al tema, fueron encontrados 344 artículos. A continuación, fue realizada la lectura de los resultados y las consideraciones de los estudios. De los 334 artículos pre-seleccionados, apenas 13 fueron incluidos. Resultados : hay recurrencia de la urgencia dialítica, siendo el óbito el principal resultado clínico. Conclusión: los estudios acerca de los resultados clínicos de pacientes en urgencia dialítica todavía son pocos comparados a la dimensión que la enfermedad renal posee en la población mundial. Conocer estos resultados dará herramientas para nuevos estudios respecto a la pervivencia de estos pacientes y para políticas de salud más eficaces.

ABSTRACT Objective: To investigate the clinical outcome of patients in dialysis urgency who have undergone renal replacement therapy, through an integrative literature review. Method: Integrative literature review of studies published from January 2010 to July 2020, in full, in English and Portuguese, in the databases: Latin American and Caribbean Literature in Health Science, Medical Literature Analysis and Retrieval System Online, Nursing and PUBMED database. The keywords and descriptors were used: "hemodialysis", "emergency", "renal dialysis", "mortality", "clinical outcome" and "dialysis urgency". The texts were pre-selected from reading the titles and abstracts, verifying their adherence to the theme, and 344 articles were found. Next, the results and study considerations were read. Of the 334 pre-selected articles, only 13 were included. Results: There is recurrence of dialysis urgency, with death being the main clinical outcome. Conclusion: Studies on the clinical outcomes of patients in dialysis urgency are still few compared to the dimension that kidney disease has in the world population. Knowing these outcomes will provide support for further studies on the survival of these patients and for more effective health policies.

Análisis de la calidad de vida en pacientes con tratamiento renal sustitutivo: influencia de los parámetros analíticos y socioclínicos / Analysis of quality of life in patients with renal replacement therapy: influence of analytical and socio-clinical parameters

Introducción: La enfermedad renal crónica es una enfermedad en crecimiento y un reto para los países desarrollados ya que produce un importante impacto en la calidad de vida de los pacientes, alterando las actividades cotidianas y provocando cambios en los aspectos físicos, emocionales y sociales. Objetivos: Evaluar la calidad de vida percibida por los pacientes con enfermedad renal crónica sometidos a tratamiento renal sustitutivo con hemodiálisis o con diálisis peritoneal, y en qué medida son influenciados por los parámetros analíticos y socioclínicos. Material y Método: Estudio transversal en un grupo de pacientes con enfermedad renal crónica en tratamiento con diálisis peritoneal y hemodiálisis, mediante la cumplimentación del cuestionario de Calidad de Vida en las Enfermedades Renales KDQOL-SF 36. Además se añadieron una serie de variables socioclínicas y parámetros de laboratorio para analizar su posible influencia en la calidad de vida. El análisis estadístico fue realizado con el software estadístico SPSS versión 22.0 para Windows. Resultados: En nuestra muestra observamos que los dominios de la calidad de vida peor valorados por los pacientes son la salud general, estrés por la enfermedad y rol físico; en cambio, los mejor valorados son el dolor corporal y la salud mental. También se halló mayor repercusión sobre algunos dominios de la calidad de vida si el paciente está en tratamiento con hemodiálisis, si dispone de fístula arteriovenosa como acceso, y cuanto más tiempo lleve en tratamiento renal sustitutivo, e incluso, si están alterados ciertos parámetros analíticos como el Ky/V, urea, potasio o hemoglobina. Conclusiones: El tratamiento renal sustitutivo con hemodiálisis o diálisis peritoneal genera un impacto enorme en la calidad de vida percibida por el paciente y se debe prestar especial atención a la idoneidad de la técnica elegida en cada momento, a la adecuación del acceso para diálisis, sin descuidar a los pacientes "veteranos" por el hecho de llevar mucho tiempo en tratamiento

Background: Chronic kidney disease is a growing disease and a challenge for developed countries, generating an important impact on the patients' quality of life, altering daily activities and causing changes in physical, emotional and social aspects. Objectives: To evaluate the quality of life perceived by patients with chronic kidney disease undergoing renal replacement therapy with hemodialysis or peritoneal dialysis, and the influence of analytical and socio-clinical parameters. Material and Method: A cross-sectional study in a group of patients with chronic kidney disease undergoing treatment with peritoneal dialysis and hemodialysis was carried out. Participants completed a Quality of Life Questionnaire on Kidney Disease (KDQOL-SF 36). In addition, several socio-clinical variables and laboratory parameters were studied to analyze their possible influence on quality of life. The statistical analysis was carried out with the statistical package SPSS v.22.0. Results: In our sample, it was observed that the worst domains of quality of life, valued by the patients, were general health, stress due to illness and physical role; on the other hand, the best valued ones were body pain and mental health. We also found greater repercussion in some domains of quality of life when the patient is in hemodialysis treatment, when the patient has arteriovenous fistula as venous access, and the longer the time of renal replacement therapy; and even if certain analytical parameters such as Kt/V, urea, potassium or hemoglobin are altered. Conclusions: Renal replacement therapy using hemodialysis or peritoneal dialysis generates a huge impact on the patient's perceived quality of life. Special attention must be paid to the suitability of the technique chosen for each moment, to the adequacy of the dialysis access, without ignoring the "veteran" patients because they have been in treatment for a long time

Unidad Nefrológica de Atención Continuada. Experiencia de un Hospital Universitario / Nephrological Unit for Continued Care. Experience of a University Hospital

Introducción: Los hospitales de día suponen una alternativa asistencial a la hospitalización convencional mejorando la eficacia de la asistencia sanitaria. Desde nuestro punto de vista, la nefrología se beneficiaria de esta modalidad de atención, ya que el paciente con enfermedad renal crónica tiene unas necesidades concretas de cuidado que conllevan al profesional de enfermería a generar una atención integral e individualizada. Por este motivo surge en nuestro servicio la creación de la Unidad Nefrológica de Atención Continuada. Objetivo: Presentar nuestra experiencia en la implantación y desarrollo de la Unidad Nefrológica de Atención Continuada en el Hospital Universitario del Henares. Material y Método: Estudio descriptivo retrospectivo de la actividad realizada en la Unidad Nefrológica de Atención Continuada entre enero-junio de 2017. Desarrollo y puesta en marcha de las distintas funciones y competencias profesionales. Resultados: En este periodo se asistieron a un total de 874 pacientes, con una media de 145,6 visitas/mes. De todas estas visitas, se atendieron 474 pacientes en programa de Diálisis Peritoneal (55% del volumen total), 149 pacientes con enfermedad renal crónica (16%), 245 pacientes con enfermedad renal crónica avanzada (18%) y 11 pacientes en tratamiento conservador (1%). Se realizaron diferentes técnicas, bien programadas en la agenda electrónica o a demanda. Conclusiones: La implantación de la Unidad Nefrológica de Atención Continuada, de forma estructurada y planificada, es una alternativa válida y necesaria en nuestro sistema sanitario. Permite aseguramos un abordaje integral de los pacientes renales y alcanzar una continuidad de cuidados con menor coste sanitario

Introduction: The daytime hospitals are an alternative to conventional hospitalization and improve the effectiveness of healthcare. From our point of view, nephrology is a specialty that should be able to benefit from this type of care, because chronic kidney disease (CKD) patients have specific care needs that lead to the nursing professional to generate comprehensive and individualized care. For this reason, the creation of the Nephrological Unit for Continued Care (NUCA) arises in our service. Aim: To present our experience in the implantation and development of a NUCA in the University Hospital of Henares. Material and Method: Retrospective descriptive study of the activity carried out at NUCA between January 1, 2017 and June 30, 2017. Development and implementation of different functions and professional competencies. Results: In this period, a total of 804 patients were attended, with an average of 145.6 visits per month. Of all these visits, 474 patients undergoing Peritoneal Dialysis (55% of total volume), 149 patients with CKD (16%), 245 patients with advanced CKD (18%) and 11 patients in conservative treatment (1%). Different techniques were carried out, either programmed by electronic agenda or by demand. Conclusions: The implantation of the NUCA, in a structured and planned way, is a valid and necessary alternative in our health system. It allows to ensure an integral approach to renal patients and achieve a continuity of care with lower healthcare costs

Continuous venovenous renal replacement therapy in critically ill patients: A work load analysis.

OBJECTIVES: To evaluate the nursing workload related to two techniques of continuous renal replacement therapy. RESEARCH METHODOLOGY: We analysed retrospectively the nursing work load caused directly by continuous renal replacement therapy in a cohort of patients admitted consecutively over 10 months. Two types of continuous renal replacement therapy have been compared: dialysis with regional citrate anticoagulation and haemodiafiltration with systemic heparin coagulation. SETTING: Academic Hospital Intensive Care Unit. MAIN OUTCOME MEASURES: The nursing workload was defined by the time spent in the management of continuous renal replacement therapy, including preparation of the circuit and related biological controls. RESULTS: 60 patients underwent a total of 202 sessions of continuous renal replacement therapy. The nursing workload as expressed as % time of nursing care was similar (12.3 [9.4-18.8] vs 13.4 [11.7-17.0] %, for haemodiafiltration and dialysis respectively, P=0.06). However, the distribution of the nursing workload is different: the bigger proportion of care is circuit preparation in haemodiafiltration and biology control in dialysis. CONCLUSIONS: Nursing time dedicated to continuous renal replacement therapy is similar whatever the renal replacement therapy technique. However, a longer duration of the filter and a better circuit predictability with dialysis and citrate anticoagulation are potential benefits for nursing workload.

La evidencia cualitativa y el cuidado del paciente en diálisis peritoneal / The qualitative evidence and the care of patients in Peritoneal dialysis

Introducción: La atención de enfermería como relación entre un sujeto de cuidado y un profesional con capacidad para hacerlo requiere que éste último comprenda las vivencias que la enfermedad y los tratamientos generan en la persona. Objetivo: Establecer interrelación entre las evidencias cualitativas disponibles en la literatura científica cualitativa publicada entre 1997-2014 respecto al cuidado de enfermería a pacientes en Diálisis Peritoneal con las taxonomías enfermeras. Material y Métodos: Estudio cualitativo en el cuál, previa autorización del comité de ética e investigación, se realizó revisión sistemática de estudios cualitativos en tres etapas: 1. Búsqueda en las bases de datos: PubMed, Embase, CUIDEN, CINAHL, Dialnet, Scielo, Biblioteca Virtual en Salud y Web of Science. 2. Evaluación de calidad metodológica por pares independientes utilizando el Critical Appraisal Skills Programme, en español; 3. Síntesis de evidencias cualitativas, que se interrelacionaron con las taxonomías Nursing Diagnoses: definitions and classification, y Nursing Intervention Classification. Resultados: Se incluyeron 19 estudios que permitieron, desde la voz de los sujetos de investigación reportadas por los autores y homologadas con las características definitorias, formular diagnósticos y determinar intervenciones de enfermería enmarcadas en los 13 dominios establecidos por la Nursing Diagnoses: definitions and classification. Algunos resultados y conclusiones en sí mismos son evidencias cualitativas del cuidado que requieren las personas en diálisis peritoneal. Discusión y conclusiones: La diálisis peritoneal interfiere en todos los dominios, afectando al sujeto, su familia y su entorno. En general requiere de educación y apoyo permanente para lograr adherencia (AU)

Introduction: Nursing care as a relationship between a subject of care and professional ability to do so requires that the latter understand the experiences that the disease and the treatments generate in the person. Objective: To establish the qualitative relationship between the qualitative evidence available in scientific literature published between 1997-2014, related to nursing care in patients with peritoneal dialysis nurses taxonomies. Material and methods: Qualitative study in which with prior authorization from the ethics and research committees, systematic review of qualitative studies was conducted in three stages: 1. Search databases: PubMed, Embase, CUIDEN, CINAHL, Dialnet, Scielo Virtual Library Health and Web of Science. 2. Assessment of methodological quality conducted by independent peers using the Critical Appraisal Skills Programme, in Spanish; 3. Summary of qualitative evidence, which is interrelated with the taxonomies Nursing Diagnoses: Definitions and classification, and Nursing Intervention Classification. Results: The research paper is based on 19 studies that, using the voice of research subjects reported by the authors and approved with the defining characteristics, allowed the formulation of diagnoses and the determination of the necessary nursing interventions framed in the 13 domains established by the Nursing Diagnoses: definitions and classification. Some of the results and conclusions themselves are qualitative evidence of the care required by people on peritoneal dialysis. Discussion and conclusions: Peritoneal dialysis interferes in all domains, which goes beyond the subject, affecting their family and environment. Generally it requires lifelong support to achieve adhesion (AU)

The impact of "early" versus "late" initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis.

BACKGROUND: The optimal timing of initiating renal replacement therapy (RRT) in critical illness complicated by acute kidney injury (AKI) is not clearly established. Trials completed on this topic have been marked by contradictory findings as well as quality and heterogeneity issues. Our goal was to perform a synthesis of the evidence regarding the impact of "early" versus "late" RRT in critically ill patients with AKI, focusing on the highest-quality research on this topic. METHODS: A literature search using the PubMed and Embase databases was completed to identify studies involving critically ill adult patients with AKI who received hemodialysis according to "early" versus "late"/"standard" criteria. The highest-quality studies were selected for meta-analysis. The primary outcome of interest was mortality at 1 month (composite of 28- and 30-day mortality). Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (LOS). RESULTS: Thirty-six studies (seven randomized controlled trials, ten prospective cohorts, and nineteen retrospective cohorts) were identified for detailed evaluation. Nine studies involving 1042 patients were considered to be of high quality and were included for quantitative analysis. No survival advantage was found with "early" RRT among high-quality studies with an OR of 0.665 (95 % CI 0.384-1.153, p = 0.146). Subgroup analysis by reason for ICU admission (surgical/medical) or definition of "early" (time/biochemical) showed no evidence of survival advantage. No significant differences were observed in ICU or hospital LOS among high-quality studies. CONCLUSIONS: Our conclusion based on this evidence synthesis is that "early" initiation of RRT in critical illness complicated by AKI does not improve patient survival or confer reductions in ICU or hospital LOS.

Continuous Renal Replacement Therapy (CRRT) practices in Canadian hospitals: Where are we now?

BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill patients. Renal replacement therapy is prescribed for as many as 70% of critically ill patients in AKI and may be provided in the form of intermittent or continuous dialysis including intermittent hemodialysis, sustained low-efficiency dialysis, and continuous renal replacement therapy (CR RT). CRRT is commonly used for unstable critically ill patients, as it involves a slow continuous process. The nursing work involved with CR RT is highly complex and the learning requirements are challenging; therefore, it is important to identify nursing practices. PURPOSE: A national survey was conducted to gain insight into CRRT nursing practices. METHODS: T he design for this study was descriptive using a survey The target population for this survey was ICU nurse educators at Canadian teaching and community hospitals. Topics in the survey included staff education, CRRT ordering and initiation practices, vascular access, filters and filter life, fluids used, anticoagulation methods, adverse events, and greatest concerns. FINDINGS: One hundred and twenty-nine surveys were sent out and 73 were returned for a response rate of 57%. Thirty-six hospitals used CRRT and of these, 73% had used CR RT for more than eight years. The findings revealed that educators identified achieving and maintaining competence as their greatest concern related to CRRT practices. CONCLUSION: The fndings of this research revealed that consistent training programs were not the norm. The complexity of caring for patients on CRRT requires consideration of when to introduce to staff the technology and care of patients on CRRT and how to sustain their competence.

Development of Online Learning Modules as an Adjunct to Skills Fairs and Lectures to Maintain Nurses' Competency and Comfort Level When Caring for Pediatric Patients Requiring Continuous Renal Replacement Therapy (CRRT).

Continuous renal replacement therapy (CRRT) for pediatric patients is an extremely specialized therapy requiring knowledge of the patient's diagnosis, understanding of the principles of the therapy, astute patient assessment, and proficiency with complicated equipment. The complexity of CRRT is compounded by its relatively rare occurrence, in the pediatric population. Maintaining staff competency with this high-risk/low-volume therapy is extremely difficult. This article discusses the development and implementation of a structured system and set of resources to support routine education, and the development of two online, interactive learning modules to provide additional exposure to GRRT throughout the year. The modules are an efficient, effective, and inexpensive way to provide additional education and information to large groups of staff.

Using High-Fidelity Simulation to Assess Knowledge, Skills, and Attitudes in Nurses Performing CRRT.

Continuous renal replacement therapy (CRRT) is an acute therapy for critically ill patients. There are many life-threatening complications that can occur; therefore, it is imperative that nurses are highly trained in the use and troubleshooting of CRRT. A structured simulation exercise was added to an existing CRRT education program by developing and implementing an annual assessment of knowledge, skills, and attitudes (KSAs) using high-fidelity simulation. The use of high-fidelity simulation as an intervention during annual evaluation of KSAs was shown to be effective in increasing nurse satisfaction, understanding of CRRT principles, and critical thinking skills with the operation of CRRT.

[The impact of continuous renal replacement therapy training on nursing competence]. / Impact d'une formation en épuration extrarénale continue sur la compétence infirmière.

Specific training adapted to the needs of caregivers in intensive care enables professional competence and quality of care to be developed in continuous renal replacement therapy. In addition, it contributes to reducing the stress felt by caregivers and the costs of this technique.

Continuing education: preparing patients to choose a renal replacement therapy.

BACKGROUND: Patients with progressive chronic kidney disease face a series of treatment decisions that will impact the quality of life of themselves and their family. Renal replacement therapy option education (RRTOE), generally provided by nurses, is recommended by international guidelines OBJECTIVES: To provide nurses with advice and guidance on running RRTOE. DESIGN: A consensus conference. PARTICIPANTS: Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 European countries) from units that had extensive experience in RRTOE or were performing research in this field. APPROACH: Experts brainstormed and discussed quality standards for the education team, processes, content/topics, media/material/funding and quality measurements for RRTOE. RESULTS: Conclusions and recommendations from these discussions that are particularly pertinent to nurses are presented in this paper. CONCLUSIONS: Through careful planning and smooth interdisciplinary cooperation, it is possible to implement an education and support programme that helps patients choose a form of RRT that is most suited to their needs. This may result in benefits in quality of life and clinical outcomes. APPLICATION TO PRACTICE: There are large differences between renal units in terms of resources available and the demographics of the catchment area. Therefore, nurses should carefully consider how best to adapt the advice offered here to their own situation. Throughout this process, it is crucial to keep in mind the ultimate goal - providing patients with the knowledge and skill to make a modality choice that will enhance their quality of life to the greatest degree.

Early mobility activities during continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is a therapeutic technique used to support critically ill patients with acute renal failure in intensive care units. CRRT is preferred over hemodialysis for patients who cannot tolerate the rapid fluid and electrolyte shifts associated with hemodialysis because of their tenuous hemodynamic state. Traditionally, such patients have not been candidates for mobilization and have remained on strict bed rest. Mobilization is now being initiated on patients undergoing CRRT in intensive care units. This case study chronicles the successful mobilization of a patient undergoing CRRT. This experience suggests that CRRT patients who are appropriate candidates may be mobilized safely and therefore should not automatically be excluded from mobilization therapies.

[Psychological experiences and coping strategies of children and adolescents with chronic kidney disease on renal replacement therapy]. / Psychische Belastungen und Coping- Strategien von niereninsuffizienten Kindern und Jugendlichen unter Nierenersatztherapie.

Children, adolescents and young adults with end-stage renal disease need a renal replacement therapy (dialysis) or a renal transplant to survive. The dialysis is related to a very complex care, which includes invasive and painful procedures. Chronic diseases have a strong influence not only on the physical but also on the psychological development of children and adolescents. The most important psychological consequences include social isolation, differences in body image, limited lifestyle, as well as the changed personal relationships with family and friends. Therefore, caregivers should also have knowledge about the psychological consequences, being able to provide adequate help and support to children, adolescents and young adults.

Self-management programmes in stages 1-4 chronic kidney disease: a literature review.

BACKGROUND: Chronic kidney disease (CKD) is a complex health problem, which requires individuals to invest considerable time and energy in managing their health and adhering to multifaceted treatment regimens. OBJECTIVES: To review studies delivering self-management interventions to people with CKD (Stages 1-4) and assess whether these interventions improve patient outcomes. DESIGN: Systematic review. METHODS: Nine electronic databases (MedLine, CINAHL, EMBASE, ProQuest Health & Medical Complete, ProQuest Nursing & Allied Health, The Cochrane Library, The Joanna Briggs Institute EBP Database, Web of Science and PsycINFO) were searched using relevant terms for papers published between January 2003 and February 2013. RESULTS: The search strategy identified 2,051 papers, of which 34 were retrieved in full with only 5 studies involving 274 patients meeting the inclusion criteria. Three studies were randomised controlled trials, a variety of methods were used to measure outcomes, and four studies included a nurse on the self-management intervention team. There was little consistency in the delivery, intensity, duration and format of the self-management programmes. There is some evidence that knowledge- and health-related quality of life improved. Generally, small effects were observed for levels of adherence and progression of CKD according to physiologic measures. CONCLUSION: The effectiveness of self-management programmes in CKD (Stages 1-4) cannot be conclusively ascertained, and further research is required. It is desirable that individuals with CKD are supported to effectively self-manage day-to-day aspects of their health.

Comparison of circuit patency and exchange rates between 2 different continuous renal replacement therapy machines.

BACKGROUND: Continuous renal replacement therapy (CRRT) is an important tool in the care of critically ill patients. However, the impact of a specific CRRT machine type on the successful delivery of CRRT is unclear. The purpose of this study was to evaluate the effectiveness of CRRT delivery with an intensive care unit (ICU) bedside nurse delivery model for CRRT while comparing circuit patency and circuit exchange rates in 2 Food and Drug Administration-approved CRRT devices. This article presents the data comparing circuit exchange rates for 2 different CRRT machines. MATERIALS AND METHODS: A group of ICU nurses were selected to undergo expanded training in CRRT operation and empowered to deliver all aspects of CRRT. The ICU nurses then provided all aspects of CRRT on 2 Food and Drug Administration-approved CRRT devices for 6 months. Each device was used exclusively in the designated ICU for a 2-week run-in period followed by 3-month data collection period. The primary end point for the study was the differences in average number of filter exchanges per day during each CRRT event. RESULTS: A total of 45 unique patients who underwent 64 separate CRRT treatment periods were included. Four CRRT events were excluded (see text for details). Twenty-eight CRRT events occurred in the NxStage System One arm (NxStage Medical, Lawrence, Mass) and 32 events in the Gambro Prismaflex arm (Gambro Renal Products, Boulder, Colo). Average (SD) filter exchanges per day was 0.443 (0.60) for the NxStage System One machine and 0.553 (0.65) for Gambro Prismaflex machine (P = .09). CONCLUSIONS: There was no demonstrable difference in circuit patency as defined by the rate of filter exchanges per day of CRRT therapy.

Descripción de la calidad de vida percibida en pacientes con insuficiencia renal crónica en tres modalidades de tratamiento sustitutivo renal, en el estado de Guanajuato / Description of the perceived quality of life in patients with chronic renal failure in three modes of renal replacement therapy in the state of Guanajuato, México", "_i": "

Introducción: La evaluación de la calidad de vida del paciente representa un impacto percibido que una enfermedad y su consecuente tratamiento tienen en el bienestar del mismo. Objetivo: Describir la calidad de vida percibida por los pacientes con insuficiencia renal crónica en etapa avanzada y en tres modalidades de tratamiento sustitutivo renal. Material y métodos: Es un estudio descriptivo transversal de 30 pacientes adultos, en tres modalidades diferentes de tratamiento sustitutivo renal, tratados en una clínica del estado de Guanajuato. Se utilizó el cuestionario SF-36 para medición subjetiva de calidad de vida en ocho diferentes dominios y PASW statistics 18 para el análisis estadístico. Resultados: En la escala del 1 al 100 los pacientes reportaron los puntajes: función física 37.6, rol físico 35.8, dolor corporal 64.7, salud general 58.5, vitalidad 59, función social 86.7, rol emocional 68.9 y salud mental 77.2. Se observa una tendencia a percibir una mejor calidad de vida en diálisis peritoneal automatizada, que con la diálisis peritoneal continúa ambulatoria y hemodiálisis. Conclusión: La calidad de vida del paciente en diálisis se reporta afectada principalmente en su función física. Conocer el estado general de la salud que el paciente percibe, informa sobre la eficacia del tratamiento y proporciona una guía para diseñar estrategias de cuidado de enfermería con enfoque holístico.

Introduction: Quality of life assessment represents the perceived impact of the disease and the consequent treatment on patient wellness. Objective: To describe the quality of life perceived by patients with end stage renal disease. Material and methods: This is a cross-sectional descriptive study on 30 adult patients in three different renal replacement therapies attending to a dialysis clinic located in Guanajuato state. SF-36 questionnaire was used to measure quality of life through eight different domains. PASW statistics 18 was used for statistical analysis. Results: In a 1 to 100 scale, the scores per domain were: physical function 37.6, physical role 35.8, pain 64.7, general health 58.5, vitality 59, social function 86.7, emotional role 68.9 and mental health 77.2. There is a trend to perceive a better quality of life in automated peritoneal dialysis compared with continued ambulatory peritoneal dialysis and hemodialysis. Conclusion: The quality of life from renal disease patients was most affected with respect to physical function. To know the perceived general health status of patients reported on the effectiveness of treatment and provides guidance for designing strategies for nursing care with a holistic approach.

Actualización en técnicas continuas de reemplazo renal / Update in continuous renal replacement techniques

El fracaso renal agudo afecta a un 25% de los pacientes hospitalizados en las unidades de cuidados intensivos. A pesar de los avances tecnológicos, la mortalidad de estos pacientes sigue siendo elevada debido a las complicaciones asociadas. Uno de los tratamientos del fracaso renal agudo son las técnicas continuas de reemplazo renal ya que permiten tratar las complicaciones y disminuir la mortalidad. El conocimiento y la habilidad de la enfermera en relación con estas técnicas serán decisivos para el éxito de la terapia. Para ello, la formación y la experiencia de la enfermera son el componente clave. El presente artículo tiene como objetivo actualizar los conocimientos sobre las técnicas continuas de reemplazo renal. Para ello, se realiza una revisión de los principios físico-químicos, como la difusión y la convección, entre otros, una descripción de las modalidades de las técnicas continuas de reemplazo renal, una presentación de los principales accesos vasculares y una descripción de los cuidados enfermeros y de las complicaciones relacionadas con las técnicas utilizadas

Acute renal failure affects 25% of patients hospitalized in intensive care units. Despite technological advances, the mortality of these patients is still high due to its associated complications. Continuous renal replacement techniques are one of the treatments for acute renal failure because they make it possible to treat the complications and decrease mortality. The nurse's knowledge and skills regarding these techniques will be decisive for the success of the therapy. Consequently, the nurse's experience and training are key components. The objective of this article is to update the knowledge on continuous renal replacement techniques. Keeping this in mind, a review has been made of the physical and chemical principles such as diffusion and convection, among others. A description of the different continuous renal replacement techniques, a presentation of the main vascular access, and a description of the nursing cares and complications related to techniques used have also been provide

Cuidados de enfermería en la terapia de depuración extrarrenal / Nursing cares in extrarenal depuration therapy

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Comparación del nivel de cumplimiento del proceso de hemodiafiltración en línea posterior a un programa de capacitación / Comparison of the compliance level in the process of online hemofiltration after a training program", "_i": "

Introducción: Dada la importancia del tratamiento de hemodiafiltración en línea es necesario estandarizar la eficiencia del procedimiento realizado por el personal de enfermería e implementar, cuando sea necesario, acciones para mejorar la calidad de atención. Objetivo: Comparar las escalas de cumplimiento del procedimiento HDFL antes y después de un programa de capacitación. Material y métodos: Estudio comparativo, prospectivo y longitudinal desde mayo del 2008 a octubre del 2011. Muestra por conveniencia de 60 procedimientos realizados por profesionales de enfermería. Se diseñó una cédula de auditoría con 23 elementos con respuestas dicotómicas, otorgando 0 al procedimiento realizado parcialmente o no aplicado y de 1 a 3 a la actividad realizada al 100%. Se determinaron las escalas de cumplimiento de la siguiente manera: 91 a 100% nivel de excelencia, 85-90% significativo, entre 75 y 84% cumplimiento mínimo y menor de 70% nivel de no cumplimiento. Se analizaron los datos con frecuencias, porcentajes, asociación de Pearson (categoría laboral), t de Student (turno y años) y ANOVA de una vía para categoría laboral, considerándose estadísticamente significativo p ‹ 0.05. Resultados: El índice de cumplimiento antes y después de la capacitación fue de excelencia (97.15 ± 2.70 versus 97.70± 2.4) sin ser estadísticamente significativa (t = 0.840, gl = 58, p = 0.404). Las enfermeras generales tienen el mejor índice de cumplimiento. Conclusiones: A pesar de obtener índice global de excelencia, existen oportunidades de mejora, lo que demuestra que se tiene que reforzar el procedimiento en actividades donde se obtuvieron puntuaciones bajas.

Introduction: Given the importance of the treatment of hemodiafiltration on-line it is necessary to have a standard that assess the efficiency of the process carried out by nursing and allow, if necessary, implement improvement actions focused on raising the quality of care. Objective: To compare the level of compliance of the HDFL process before and after a training program. Material and methods: longitudinal, prospective and comparative study of May 2008 to October 2011. Displays for convenience of 60 procedures performed by nurses. A certificate of audit was designed with 23 items with dichotomous responses, giving 0 to the procedure carried out partially or not implemented, and 1 to 3 to the activity carried out at 100%. The level was determined in accordance with the following scale: 91 to 100% level of excellence; 85-90%, significant; between 75 and 84%, minimum compliance; and less than 70%, level of non-compliance. We analysed the data frequencies, percentages, Pearson (labour category) Association, (turn to years) Student’s t and ANOVA of a pathway for category work, statistically significant p < 0.05. Results: The level of compliance before and after the training was excellent (97. 15 + 2. 70 versus 97. 70 + 2. 4) without being statistically significant (t = 0.840, gl = 58, p = 0.404). General nurses who have a better level of compliance. Conclusions: Despite get global index of excellence, there are opportunities for improvement, which shows that you have to strengthen the procedure in activities where low scores were obtained.