Recomendaciones para el uso racional de la prueba 25-hidroxivitamina D Resumen de política

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The exponential increase in the request for laboratory tests of 25-Hydroxyvitamin D or [25 (OH) D has ignited the alarms and generated a strong call for attention, since it may reflect deficiencies in the standardization of clinical practice and in the use non-systematic scientific evidence for decision-making in real life, which allows to analyze the indications of the test, its frequency, interpretation and even to assess the impact for health systems, especially when contrasted with the minimum or almost. No effects of the strategy of screening or supplying indiscriminately to the general population, without considering a comprehensive clinical assessment of risks and needs of people. From a purely public health impact point of view, the consequence of massive and unspecified requests is affecting most of the health systems and institutions at the global level. The primary studies that determined average population intake values have been widely used in the formulation of recommendations in Clinical Practice Guidelines, but unfortunately misinterpreted as cut points to diagnose disease and allow the exaggerated prescription of nutritional substitution. The coefficient of variation in routine tests to measure blood levels of 25 (OH) D is high (28%), decreasing the overall accuracy of the test and simultaneously, increasing both the falsely high and falsely low values. The most recent scientific evidence analyzes and seriously questions the usefulness and the real effect of the massive and indiscriminate practice of prescribing vitamin D without an exhaustive risk analysis. The available evidence is insufficient to recommend a general substitution of vitamin D to prevent fractures, falls, changes in bone mineral density, incidence of cardiovascular diseases, cerebrovascular disease, neoplasms and also to modify the growth curve of mothers' children. They received vitamin D as a substitute during pregnancy. The recommendations presented in the document are based on the critical analysis of current evidence and the principles of good clinical practice and invite to consider a rational use of 25 (OH) D tests in the context of a clinical practice focused on people and a comprehensive assessment of needs and risks. The principles of good practice suggest that clinicians may be able to justify that the results of the 25 (OH) D test strongly influence and define clinical practice and modify the outcomes that interest people and impact their health and wellness. Currently there is no clarity on how to interpret the results, and the relationship between symptoms and 25 (OH) D levels, which may not be consistent with the high prevalence of vitamin D deficiency reported. For this reason, it is suggested to review the rationale of the request for tests for systematic monitoring of levels of 25 (OH) D or in all cases where substitution is performed. Consider the use of 25 (OH) D tests within the comprehensive evaluation of people with suspicion or confirmation of the following conditions: rickets, osteomalacia, osteoporosis, hyper or hypoparathyroidism, malabsorption syndromes, sarcopenia, metabolic bone disease.

Programa de prevención de la enfermedad renal crónica basado en redes integradas de servicios en Colombia / Program for the prevention of chronic kidney disease based on integrated service networks in Colombia

RESUMEN Objetivo Los programas de prevención de la Enfermedad Renal Crónica (ERC) permiten controlar la morbimortalidad y/o retrasar el ingreso a terapia de reemplazo renal. Se documenta el diseño de un programa de prevención de la ERC y se describe cómo se integran los niveles primario y secundario de atención mediante la caracterización de una población admitida para prevención secundaria. Métodos La descripción del programa se realizó con base en una revisión documental. Para la caracterización de los pacientes participantes en el programa se utilizaron herramientas de estadística descriptiva. Resultados El diseño e implementación del programa de prevención se basó en la integración de redes de servicios y niveles de atención. Se detallan las actividades fundamentales del programa según el nivel de atención en el que se realizan. Un total de 3 487 pacientes fueron admitidos para control en el segundo nivel de atención por presentar tasa de filtración glomerular estimada <60 mil/min; 87,81 % de los pacientes ingresó en estadio 3 de la ERC con mediana de Tasa de Filtración Glomerular de 46,21mil/min; las principales causas de ERC fueron la hipertensión arterial y la diabetes. Al ingreso, 2 129 pacientes (61.05 %) tuvieron tensión arterial sistólica <140 mmHg y 3 091(88,64 %) diastólica <90mmHg; de 620 diabéticos con hemoglobina glicosilada, 357 (57,58 %) tuvieron valores <7,5 %. Conclusión Se diseñó e implementó un programa de prevención que permitió la integración de los niveles de atención para una intervención multidisciplinaria que logró la captación oportuna de pacientes y la continuidad en la atención para el mejor control de la ERC.(AU)

ABSTRACT Objective Chronic Kidney Disease (CKD) prevention programs allow to control morbidity and/or delay renal replacement therapy. The design of a CKD prevention program is described, including highlights on how the primary and secondary levels of care interact with each other through the characterization of the population admitted for secondary prevention. Methods The description of the program was based on a literature review. Descriptive statistics were used to characterize the patients participating in the program. Results The design and implementation of the prevention program was based on the integration of service networks and care levels. The main activities for the program were detailed according to the care level in which they performed. 3 487 patients in total were admitted for control at the second care level due to an estimated glomerular filtration rate of <60 mil/min; 87.81% of the patients were admitted with CKD stage 3 and a median glomerular filtration rate of 46.21mil/min. The main causes of CKD were hypertension and diabetes. On admission, 2 129 patients (61.05 %) had systolic blood pressure <140 mmHg and 3 091 (88.64 %) had diastolic blood pressure <90 mmHg; 357 (57.58 %), out of 620, diabetic patients with glycosylated hemoglobin presented values <7.5 %. Conclusion A prevention program was designed and implemented to allow the integration of care levels oriented to a multidisciplinary intervention, which ultimately managed to recognize patients and to give continuity to care provision for a better control of CKD.(AU)

[Program for the prevention of chronic kidney disease based on integrated service networks in Colombia]. / Programa de prevención de la enfermedad renal crónica basado en redes integradas de servicios en Colombia.

OBJECTIVE: Chronic Kidney Disease (CKD) prevention programs allow to control morbidity and/or delay renal replacement therapy. The design of a CKD prevention program is described, including highlights on how the primary and secondary levels of care interact with each other through the characterization of the population admitted for secondary prevention. METHODS: The description of the program was based on a literature review. Descriptive statistics were used to characterize the patients participating in the program. RESULTS: The design and implementation of the prevention program was based on the integration of service networks and care levels. The main activities for the program were detailed according to the care level in which they performed. 3 487 patients in total were admitted for control at the second care level due to an estimated glomerular filtration rate of <60 mil/min; 87.81% of the patients were admitted with CKD stage 3 and a median glomerular filtration rate of 46.21mil/min. The main causes of CKD were hypertension and diabetes. On admission, 2 129 patients (61.05 %) had systolic blood pressure <140 mmHg and 3 091 (88.64 %) had diastolic blood pressure <90 mmHg; 357 (57.58 %), out of 620, diabetic patients with glycosylated hemoglobin presented values <7.5 %. CONCLUSION: A prevention program was designed and implemented to allow the integration of care levels oriented to a multidisciplinary intervention, which ultimately managed to recognize patients and to give continuity to care provision for a better control of CKD.

OBJETIVO: Los programas de prevención de la Enfermedad Renal Crónica (ERC) permiten controlar la morbimortalidad y/o retrasar el ingreso a terapia de reemplazo renal. Se documenta el diseño de un programa de prevención de la ERC y se describe cómo se integran los niveles primario y secundario de atención mediante la caracterización de una población admitida para prevención secundaria. MÉTODOS: La descripción del programa se realizó con base en una revisión documental. Para la caracterización de los pacientes participantes en el programa se utilizaron herramientas de estadística descriptiva. RESULTADOS: El diseño e implementación del programa de prevención se basó en la integración de redes de servicios y niveles de atención. Se detallan las actividades fundamentales del programa según el nivel de atención en el que se realizan. Un total de 3 487 pacientes fueron admitidos para control en el segundo nivel de atención por presentar tasa de filtración glomerular estimada <60 mil/min; 87,81 % de los pacientes ingresó en estadio 3 de la ERC con mediana de Tasa de Filtración Glomerular de 46,21mil/min; las principales causas de ERC fueron la hipertensión arterial y la diabetes. Al ingreso, 2 129 pacientes (61.05 %) tuvieron tensión arterial sistólica <140 mmHg y 3 091(88,64 %) diastólica <90mmHg; de 620 diabéticos con hemoglobina glicosilada, 357 (57,58 %) tuvieron valores <7,5 %. CONCLUSIÓN: Se diseñó e implementó un programa de prevención que permitió la integración de los niveles de atención para una intervención multidisciplinaria que logró la captación oportuna de pacientes y la continuidad en la atención para el mejor control de la ERC.

Articulación de actores institucionales en el marco de los procesos de municipalización y aseguramiento en salud en siete municipios colombianos / Organization of institutional actors en the context of the processes of countries and insurance in health in seven colombian countries

En la década de los ochenta se transfirieron a los municipios responsabilidades que antes eran de la Nación, los recursos para asumirlas y el poder político, mediante la elección popular de los alcaldes y de los gobernadores. Se dio curso a la descentralización de funciones, asumiendo el municipio la inversión en infraestructura en los puestos, centros de salud y hospitales locales, con recursos procedentes de las transferencias nacionales