Cuidados enfermeros en Atención Primaria ante el síndrome cardiorrenal crónico con compromiso cerebrovascular / Nursing care at primary care for chronic cardiorenal syndrome with cerebrovascular involvement

La función cardiaca y la función renal están íntimamente asociadas, ya que el corazón y los riñones llevan a cabo la regulación hemodinámica del organismo. Cuando se producen alteraciones de forma bidireccional en ambos órganos se activa una serie de mecanismos compensadores que provocan un efecto nocivo de uno de ellos sobre el otro. Es lo que se conoce como síndrome cardiorrenal. Actualmente se dispone de protocolos de Enfermería estandarizados para el manejo de la insuficiencia cardiaca y para la insuficiencia renal; no obstante, es necesario ampliar la información para entender de forma óptima la relación cardiorrenal y aplicar la mejor evidencia científica a los cuidados. Por ello se expone un caso clínico abordado desde Atención Primaria, con el desarrollo de un plan de cuidados elaborado una vez identificados los diagnósticos de Enfermería que se han derivado de la valoración enfermera siguiendo el modelo de las 14 necesidades básicas de Virginia Henderson

Cardiac function and renal function are closely related, because the heart and the kidneys carry out the hemodynamic regulation of the body. When there are bidirectional alterations in both organs, a series of compensating mechanisms are activated, which cause harmful effects of one over the other. This is known as Cardiorenal Syndrome. There are current standard Nursing protocols available for the management of heart failure and renal impairment; however, it is necessary to increase information for an optimal understanding of the cardiorenal interaction, and to apply the best scientific evidence into care. To this aim, we present a case record addressed at Primary Care, with the development of a plan of care prepared after the Nursing diagnoses were identified, derived from nursing assessment following the model of the 14 Basic Needs of Virginia Henderson

Clinical utility of biomarkers in chronic kidney disease and chronic heart failure.

Biomarkers have an increasingly important clinical role in managing patients with heart failure as well as those with kidney disease, both common conditions with generally poor prognostic outcomes and huge impacts on healthcare economics. For patients with chronic heart failure, biomarkers have become centre place in streamlining diagnostic pathways as well as identifying those with worse prognosis. There is much interest in the role for biomarkers in identifying patients at risk of acute kidney injury, although a number of these currently remain as research tools or are in the early stages of evaluation in clinical practice. Patients with cardiorenal syndrome represent a particular challenge to the clinician, and recent studies have suggested a valuable clinical role for certain biomarkers in this setting, either on their own or in combination. This paper will focus on biomarkers with a current clinical role in patients with cardiorenal disease (natriuretic peptides and neutrophil gelatinase-associated lipocalin), although brief reference will be made to other biomarkers with potential future application.

Are haemoglobin levels adequate in patients with chronic kidney disease (CKD) stage 2-4?

BACKGROUND: Anaemia often goes unrecognised in people with early chronic kidney disease (CKD) resulting in under treatment until reaching the need for dialysis. OBJECTIVES: This study aimed to determine if anaemia is adequately treated in Australians with CKD, who do not require dialysis. DESIGN AND MEASUREMENT: Haemoglobin, ferritin and transferrin saturation (TSAT) data for patients with Stage 2-4 CKD were extracted from the Renal Anaemia Management database for the period 1999-2010. The data were compared with the target levels specified in the Caring for Australasians with Renal Impairment guidelines. RESULTS: Less than 50% of the patients achieved the recommended haemoglobin levels, and even fewer patients achieved the levels recommended for ferritin and TSAT. CONCLUSION AND APPLICATION TO PRACTICE: More emphasis should be placed on detection and treatment of anaemia in earlier stages of kidney disease. Poor response to erythropoiesis stimulating agent therapy should be investigated in this group and any identified causes of poor response treated.

Cardiorenal medicine in the changing health system.

The phenomenon of Cardiorenal Syndrome is complex, well recognised and poses challenges to all levels of global healthcare. Ongoing research in this area continually manifests new ideas and theories with respect to the pathophysiology and clinical management of this condition. The 6th Cardiorenal Forum held in London on 7th October 2011 discussed some of the latest ideas and advances in this field of medicine.