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5.
Nefrología (Madrid) ; 40(3): 223-236, mayo-jun. 2020. graf, ilus, tab
Artículo en Inglés | IBECS | ID: ibc-201527

RESUMEN

Patients with the dual burden of chronic kidney disease (CKD) and chronic congestive heart failure (HF) experience unacceptably high rates of symptom load, hospitalization, and mortality. Currently, concerted efforts to identify, prevent and treat HF in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this review paper endorse the need for a dedicated cardiorenal interdisciplinary team that includes nephrologists and renal nurses and jointly manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for guidelines and best clinical practice models from major cardiology and nephrology professional societies, as well as for research funding in both specialties to focus on the needs of future therapies for HF in CKD patients. The implementation of cross-specialty educational programs across all levels in cardiology and nephrology will help train future specialists and nurses who have the ability to diagnose, treat, and prevent HF in CKD patients in a precise, clinically effective, and cost-favorable manner


Los pacientes con enfermedad renal crónica (ERC) que desarrollan insuficiencia cardíaca (IC) congestiva crónica presentan cifras inaceptablemente altas de síntomas, hospitalización y mortalidad. Actualmente, se echan en falta iniciativas institucionales dirigidas a identificar, prevenir y tratar la IC en los pacientes con ERC de manera multidisciplinar, prevaleciendo las actuaciones de las especialidades individuales. Los autores de este artículo de revisión respaldan la necesidad de crear equipos multidisciplinares cardiorrenales, en los que participen nefrólogos y enfermeras renales, que gestionen colaborativamente las intervenciones clínicas apropiadas en los entornos de pacientes con ERC e IC hospitalizados y ambulatorios. Es necesario y urgente que se elaboren guías y modelos de práctica clínica sobre la ERC con IC por parte de las sociedades profesionales de cardiología y nefrología, así como financiación para la investigación concertada entre ambas especialidades sobre la necesidad de futuros tratamientos para la IC en pacientes con ERC. La implementación de programas educativos cardiorrenales a todos los niveles en cardiología y nefrología ayudará a formar a los futuros especialistas y enfermeras para que tengan la capacidad de diagnosticar, tratar y prevenir la IC en pacientes con ERC de manera precisa, clínicamente efectiva y económicamente favorable


Asunto(s)
Humanos , Anciano , Anciano de 80 o más Años , Necesidades y Demandas de Servicios de Salud , Insuficiencia Cardíaca/epidemiología , Insuficiencia Renal Crónica/epidemiología , Instituciones de Atención Ambulatoria/organización & administración , Biomarcadores , Cardiología/educación , Fármacos Cardiovasculares/uso terapéutico , Terapia Combinada , Comorbilidad , Curriculum , Educación Médica , Educación en Enfermería , Everolimus/efectos adversos , Cardiopatías/diagnóstico , Cardiopatías/diagnóstico por imagen , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Incidencia , Guías de Práctica Clínica como Asunto , Prevalencia , Pronóstico , Investigación , Autocuidado
6.
Nefrologia (Engl Ed) ; 40(3): 223-236, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31901373

RESUMEN

Patients with the dual burden of chronic kidney disease (CKD) and chronic congestive heart failure (HF) experience unacceptably high rates of symptom load, hospitalization, and mortality. Currently, concerted efforts to identify, prevent and treat HF in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this review paper endorse the need for a dedicated cardiorenal interdisciplinary team that includes nephrologists and renal nurses and jointly manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for guidelines and best clinical practice models from major cardiology and nephrology professional societies, as well as for research funding in both specialties to focus on the needs of future therapies for HF in CKD patients. The implementation of cross-specialty educational programs across all levels in cardiology and nephrology will help train future specialists and nurses who have the ability to diagnose, treat, and prevent HF in CKD patients in a precise, clinically effective, and cost-favorable manner.


Asunto(s)
Necesidades y Demandas de Servicios de Salud , Insuficiencia Cardíaca/epidemiología , Insuficiencia Renal Crónica/epidemiología , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria/organización & administración , Biomarcadores , Cardiología/educación , Fármacos Cardiovasculares/uso terapéutico , Terapia Combinada , Comorbilidad , Curriculum , Manejo de la Enfermedad , Progresión de la Enfermedad , Diuréticos/uso terapéutico , Educación Médica , Educación en Enfermería , Everolimus/efectos adversos , Everolimus/uso terapéutico , Cardiopatías/diagnóstico , Cardiopatías/diagnóstico por imagen , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Incidencia , Guías de Práctica Clínica como Asunto , Prevalencia , Pronóstico , Insuficiencia Renal Crónica/economía , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/terapia , Terapia de Reemplazo Renal/efectos adversos , Terapia de Reemplazo Renal/métodos , Investigación , Autocuidado
8.
Ann Vasc Surg ; 27(7): 974.e1-6, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23993115

RESUMEN

In the last 20 years, endovascular procedures have radically altered the treatment of diseases of the aorta. The objective of endovascular treatment of dissections is to close the entry point to redirect blood flow toward the true lumen, thereby achieving thrombosis of the false lumen. In extensive chronic dissections that have evolved with the formation of a large aneurysm, the dissection is maintained from the end of the endoprosthesis due to multiple orifices, or reentries, that communicate with the lumens. In addition, one of the primary limitations of this technique is when the visceral arteries have disease involvement. In this report we present a case where, despite having treated the entire length of the descending thoracic aorta, the dissection was maintained distally, leading to progression of the diameter of the aneurysm. After reviewing the literature, and to the best of our knowledge, we describe the first case in which renal autotransplant was performed to allow for subsequent exclusion of the aorta at the thoracoabdominal level using a fenestrated endoprosthesis for the celiac trunk and the superior mesenteric artery.


Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Trasplante de Riñón , Anciano , Disección Aórtica/diagnóstico , Aneurisma de la Aorta Torácica/diagnóstico , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Arteria Celíaca/cirugía , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Laparoscopía , Arteria Mesentérica Superior/cirugía , Nefrectomía/métodos , Diseño de Prótesis , Reoperación , Stents , Tomografía Computarizada por Rayos X , Trasplante Autólogo , Resultado del Tratamiento
9.
Int J Artif Organs ; 34(4): 329-38, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21534243

RESUMEN

PURPOSE: Cardiac surgery-associated acute kidney injury requiring renal replacement therapy (RRT) is independently associated with mortality. Several risk scores have been developed to predict the need for RRT after cardiac surgery. We have compared and verified the external validity of the three main available scores for RRT prediction after cardiac surgery: the Thakar score, the Mehta tool, and the Simplified Renal Index. METHODS: The risk scores were calculated in a cohort of 1084 adult patients, 248 of whom required RRT, who underwent open-heart surgery in 24 Spanish hospitals in 2007. The performance of the systems was determined by examining their discrimination (areas under the receiver operating characteristic curves (aROC) and calibration (Lemeshow-Hosmer chi-square goodness-of-fit statistics). RESULTS: The aROCs in the Thakar score, the Mehta tool, and the Simplified Renal Index were 0.82, 0.76 and 0.79, respectively. The three scoring systems were poorly calibrated and tended to underestimate the actual need for RRT. CONCLUSIONS: The Thakar score and the Simplified Renal Index discriminated well between low - and high-risk patients in our cohort, and Thakar outperformed the Mehta tool. These best-performing scores may aid in the selection of optimal therapy, facilitate the planning of hospital resource utilization, improve preoperative counseling, select participants for clinical trials of renal-protective therapies and enable an accurate comparison between different institutions or surgeons.


Asunto(s)
Lesión Renal Aguda/terapia , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Indicadores de Salud , Terapia de Reemplazo Renal , Lesión Renal Aguda/etiología , Anciano , Distribución de Chi-Cuadrado , Estudios de Cohortes , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Curva ROC , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , España
10.
Blood Purif ; 32(2): 104-11, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21372568

RESUMEN

BACKGROUND: The optimal time to initiate renal replacement therapy (RRT) in cardiac surgery-associated acute kidney injury (CSA-AKI) is unknown. Evidence suggests that the early use of RRT in critically ill patients is associated with improved outcomes. We studied the effects of time to initiation of RRT on outcome in patients with CSA-AKI. METHODS: This was a retrospective observational multicenter study (24 Spanish hospitals). We analyzed data on 203 patients who required RRT after cardiac surgery in 2007. The cohort was divided into 2 groups based on the time at which RRT was initiated: in the early RRT group, therapy was initiated within the first 3 days after cardiac surgery; in the late group, RRT was begun after the 3rd day. Multivariate nonconditional logistic and linear regression models were used to adjust for potential confounders. RESULTS: In-hospital mortality was significantly higher in the late RRT group compared with early RRT patients (80.4 vs. 53.2%; p < 0.001; adjusted odds ratio of 4.1, 95% CI: 1.6-10.0). Also, patients in the late RRT group had longer adjusted hospital stays by 11.6 days (95% CI: 1.4-21.9) and higher adjusted percentage increases in creatinine at discharge compared with baseline by 67.7% (95% CI: 28.5-106.4). CONCLUSIONS: Patients who undergo early initiation of RRT after CSA-AKI have improved survival rates and renal function at discharge and decreased lengths of hospital stay.


Asunto(s)
Lesión Renal Aguda/etiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Enfermedades Cardiovasculares/cirugía , Complicaciones Posoperatorias , Terapia de Reemplazo Renal/métodos , Lesión Renal Aguda/sangre , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/terapia , Anciano , Enfermedades Cardiovasculares/patología , Creatinina/sangre , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Tasa de Supervivencia , Resultado del Tratamiento
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