Early detection is a key strategy to prevent kidney disease, its progression and related complications, but numerous studies show that awareness of kidney disease at the population level is low. Therefore, increasing knowledge and implementing sustainable solutions for early detection of kidney disease are public health priorities. Economic and epidemiological data underscore why kidney disease should be placed on the global public health agenda - kidney disease prevalence is increasing globally and it is now the seventh leading risk factor for mortality worldwide. Moreover, demographic trends, the obesity epidemic and the sequelae of climate change are all likely to increase kidney disease prevalence further, with serious implications for survival, quality of life and health care spending worldwide. Importantly, the burden of kidney disease is highest among historically disadvantaged populations that often have limited access to optimal kidney disease therapies, which greatly contributes to current socioeconomic disparities in health outcomes. This joint statement from the International Society of Nephrology, European Renal Association and American Society of Nephrology, supported by three other regional nephrology societies, advocates for the inclusion of kidney disease in the current WHO statement on major non-communicable disease drivers of premature mortality.
RESUMEN El camino para llegar a la diálisis peritoneal (DP) como tratamiento de la enfermedad renal crónica (ERC) avanzada estuvo jalonado por hitos a lo largo de la historia. Los conocimientos sobre la anatomía del peritoneo fueron aportados por los embalsamadores egipcios, Galeno (siglo II), y Vesalio (siglo XVI). Recién en 1628 Asellius Gaselli describe los capilares linfáticos abdominales. El siglo XIX fue rico en avances: se identificarn la célula como unidad de los seres vivos y el fenómeno de ósmosis (Dutrochet, 1828), los cristaloides y coloides y su pasaje o no a través de una membrana (Graham T, 1850), el flujo de solutos y partículas a través de la membrana peritoneal (v.Recklinghausen, 1863), la absorción de sustancias hipotónicas y el aumento del efluente con las hipertónicas (Wegner G, 1877), y experimentos en animales confirmaron que la remoción de fluidos y otras sustancias ocurría primariamente a través de vasos sanguíneos (Starling & Tubby, 1894). Pero recién en el siglo 20 se utilizó la DP como tratamiento. El primer intento de utilizar el peritoneo para tratar la uremia lo realizó Georg Ganter en 1923, primero en animales con ligadura de uréteres y luego en dos pacientes. Recién en 1937 se publicó el primer caso que sobrevivió a un "lavaje "peritoneal (Wear y col), pero fueron Fine, Frank y Seligman quienes inicialmente en perros nefrectomizados y luego en pacientes con injuria renal aguda (IRA) demostraron que el método no sólo era viable, sino también efectivo. Luego continuaron los progresos, sobre todo para pacientes con IRA, pero también en algunos casos con ERC avanzada: el doble frasco colgante (Maxwell M, 1959), la diálisis crónica intrahospitalaria con cicladora (Tenckoff y col, 1965), las bolsas plásticas para DP, hasta que en 1975 Moncrief y col pusieron en marcha la DP continua ambulatoria, y en 1981 se introdujo la DP automatizada. Los años noventa fueron de expansión de la DP, hoy instalada como una de las alternativas de tratamiento de la ERC avanzada.
ABSTRACT Milestones throughout history marked the path to reach peritoneal dialysis (PD) as a treatment for advanced chronic kidney disease (CKD). The Egyptian embalmers, Galen (2nd century) and Vesalius (16th century) provided knowledge about the anatomy of the peritoneum. It was not until 1628 that Asellius Gaselli described the abdominal lymphatic capillaries. The 19th century was rich in advances: the cell was identified as the unit of living beings and the phenomenon of osmosis (Dutrochet, 1828), crystalloids and colloids and their passage or not through a membrane (Graham T, 1850), the flow of solutes and particles through the peritoneal membrane (Recklinghausen, 1863), the absorption of hypotonic substances and the increase in effluent with hypertonic ones (Wegner G, 1877), and animal experiments confirmed that fluid removal and other substances occurred primarily through blood vessels (Starling & Tubby, 1894). But it was not until the 20th century that PD was applied as treatment. The first attempt to use the peritoneum to treat uremia was made by Georg Ganter in 1923, first in animals with ureteral ligation and then in two patients. It was not until 1937 that the first case that survived a peritoneal "lavage" was published (Wear et al), but it was Fine, Frank and Seligman who initially in nephrectomized dogs and later in patients with acute kidney injury (ARI) demonstrated that the method was not only viable, but also succesful. Then progress continued, especially for patients with ARI, but also in some cases with advanced CKD: the double hanging bottle (Maxwell M, 1959), chronic intrahospital dialysis with a cycler (Tenckoff et al, 1965), plastic bags for PD, until 1975 when Moncrief et al launched continuous ambulatory PD, and in 1981 automated PD was introduced. The 1990s saw the expansion of PD, to date installed as one of treatment alternatives for advanced CKD.
Chronic kidney disease (CKD) represents a major challenge for Latin American (LatAm) because of its epidemic proportions. Therefore, the current status and knowledge of CKD in Latin America is not clearly understood. Moreover, there is a paucity of epidemiologic studies that makes the comparison across the countries even more difficult. To address these gaps, a virtual kidney expert opinion meeting of 14 key opinion leaders from Argentina, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Guatemala, Mexico, and Panama was held in January 2022 to review and discuss the status of CKD in various LatAm regions. The meeting discussed the following: (i) epidemiology, diagnosis, and treatment of CKD, (ii) detection and prevention programs, (iii) clinical guidelines, (iv) state of public policies about diagnosis and management of chronic kidney disease, and (v) role of innovative therapies in the management of CKD. The expert panel emphasized that efforts should be made to implement timely detection programs and early evaluation of kidney function parameters to prevent the development or progression of CKD. Furthermore, the panel discussed the importance of raising awareness among health care professionals; disseminating knowledge to the authorities, the medical community, and the general population about the kidney and cardiovascular benefits of novel therapies; and the need for timely updating of clinical practice guidelines, regulatory policies, and protocols across the region.
The prevalence of chronic kidney disease (CKD) continues to increase worldwide, as well as the associated morbidity and mortality and the consequences on the patients' quality of life and countries' economies. CKD often evolves without being recognized by patients and physicians, although the diagnosis is based on two simple laboratory data: the estimated glomerular filtration rate (eGFR) and urine analysis. To measure GFR, the knowledge about the physiologic processes at the nephron level, the concept of clearance, and the identification of creatinine as a suitable endogenous marker for measuring the creatinine clearance (CrCl) had to be previously developed. On those bases, different equations to calculate CrCl (Cockcroft and Gault, 1976), or estimated GFR (four variables MDRD, 1999; CKD-Epi, 2009, among others) were generated. They all include creatinine and some demographic data, such as sex and age. However, to compare results throughout life or among laboratories, the creatinine determination must be standardized. In addition, the accuracy of these equations remains controversial in certain subgroups of patients. For these reasons, other mathematical models to improve CrCl estimation have been developed, such as when urine cannot be collected, in debilitated elderly patients and patients with trauma, diabetes, or obesity. Currently, eGFR in adults can be measured and reported immediately, using isotope dilution mass spectrometry traceable creatinine-based equations. In conclusion, based on knowledge obtained from renal physiology, eGFR can be used in the clinic for the diagnosis and early treatment of CKD, as well as a public instrument to estimate the prevalence.
Introducción: el ejercicio de la enfermería requiere conocimiento integral del funcionamiento del cuerpo humano, por lo cual es imprescindible el aprendizaje de fisiología humana dentro del proceso formativo de grado. El proceso enfermero, herramienta para la práctica profesional sistemática, dinámica y oportuna basado en el método científico, constituye el eje organizador del currículo de la Licenciatura en Enfermería en la Universidad Nacional del Nordeste (Corrientes, Argentina). Objetivo:Identificar la percepción que estudiantes y docentes de asignaturas troncales de Enfermería tenían sobre la aplicación o no de conocimientos fisiológicos desarrollados en los trabajos prácticos de la asignatura Fisiología en las distintas etapas del proceso enfermero. Metodología: Se realizó un estudio descriptivo, observacional y transversal, cuestionario anónimo distribuido al azar a estudiantes y docentes, consistente en una tabla de doble entrada que describe los contenidos de cada trabajo práctico, por un lado, y las fases del proceso enfermero, por el otro. Resultados: respondieron 24 docentes (39 %) y 38 estudiantes (61 %). Las fases en que más reconocieron aplicar conocimientos de fisiología en el proceso enfermero fueron, en ambos grupos, valoración y diagnóstico; en cada trabajo práctico fue percibido diferente por docentes y estudiantes, siendo mayor el reconocimiento del uso de fisiología en el proceso enfermero por parte de docentes. Conclusiones: vertebrar la actividad práctica de fisiología alrededor del proceso enfermero parece constituir una estrategia didáctica válida, dado que docentes y estudiantes perciben, en mayor o menor medida, que aplican conocimientos trabajados en la asignatura en las distintas etapas del proceso enfermero, particularmente en la valoración y el diagnóstico. La percepción fue mayor en herramienta para la práctica profesional sistemática, dinámica y oportuna basado en el método científico, constituye el eje organizador del currículo de la Licenciatura en Enfermería en la Universidad Nacional del Nordeste (Corrientes, Argentina). Objetivo: I d e n t i f i c a r l a percepción que estudiantes y docentes de asignaturas troncales de Enfermería tenían sobre la aplicación o no de conocimientos fisiológicos desarrollados en los trabajos prácticos de la asignatura Fisiología en lasdistintas etapas del proceso enfermero. Metodología: Se realizó un estudio descriptivo, observacional y transversal, cuestionario anónimo distribuido al azar a estudiantes y docentes, consistente en una tabla de doble entrada que describe los contenidos de cada trabajo práctico, por un lado, y las fases del proceso enfermero, por el otro. Resultados: respondieron 24 docentes (39 %) y 38 estudiantes (61 %). Las fases en que más reconocieron aplicar conocimientos de fisiología en el proceso enfermero fueron, en ambos grupos, valoración y diagnóstico; en cada trabajo práctico fue percibido diferente por docentes y estudiantes, siendo mayor el reconocimiento del uso de fisiología en el proceso enfermero por parte de docentes. Conclusiones: vertebrar la actividad práctica de fisiología alrededor del proceso enfermero parece constituir una estrategia didáctica válida, dado que docentes y estudiantes perciben, en mayor o menor medida, que aplican conocimientos trabajados en la asignatura en las distintas etapas del proceso enfermero, particularmente en la valoración y el diagnóstico. La percepción fue mayor en docentes, lo cual evidencia mejor manejo del proceso enfermero, por tener mayor nivel de conocimientos y práctica profesional.
Introdução: a prática da enfermagem requer conhecimento abrangente do funcionamento do corpo humano, razão pela qual é essencial o aprendizado da fisiologia humana na graduação. O processo de enfermagem, ferramenta para a prática profissional sistemática, dinâmica e oportuna baseada no método científico, é o eixo organizador do currículo da Licenciatura em Enfermagem da Universidade Nacional do Nordeste (Corrientes, Argentina). Objetivo: Identificar a percepção que alunos e professores das disciplinas nucleares de Enfermagem têm sobre a aplicação ou não dos conhecimentos fisiológicos desenvolvidos nos trabalhos práticos da disciplina de Fisiologia nas diferentes etapas do processo de enfermagem. Metodologia: Foi realizado um estudo descritivo, observacional e transversal, com questionário anônimo distribuído aleatoriamente aos alunos e professores, constituído por uma tabela de dupla entrada que descreve o conteúdo de cada trabalho prático, por um lado, e as fases do processo de enfermagem, de outro. Resultados: Responderam 24 professores (39%) e 38 alunos (61%). As fases em que mais reconheceram a aplicação dos conhecimentos da fisiologia no processo de enfermagem foram, nos dois grupos, avaliação e diagnóstico; em cada trabalho prático foi percebido de forma diferente por professores e alunos, havendo maior reconhecimento da utilização da fisiologia no processo de enfermagem pelos professores. Conclusões: estruturar a atividade prática da fisiologia em torno do processo de enfermagem parece constituir uma estratégia didática válida, uma vez que professores y alunos percebem, em maior ou menor grau, que aplicam os conhecimentos trabalhados na disciplina nas diferentes etapas do processo de enfermagem, particularmente no processo de enfermagem avaliação e diagnóstico. A percepção foi maior nos professores, o que evidencia melhor gerenciamento do processo de enfermagem, por possuírem maior nível de conhecimento e prática profissional.
Introduction: Nursing practice requires comprehensive knowledge of the human body's functioning, so learning human physiology is essential during the undergraduate educational process. The nursing process, a tool for systematic, dynamic, and timely professional practice, based on the scientific method, constitutes the organizing axis of the curriculum of the bachelor's degree in nursing at the Universidad Nacional del Nordeste (Corrientes, Argentina). Objective: To identify the perception that students and teachers of core nursing courses had about applying or not physiological knowledge gained during practical work in the Physiology class, in different stages of the nursing process. Method: A d e s c r i p t i ve , observational, cross-sectional study was conducted. An anonymous questionnaire was randomly administered to students and teachers, which consisted of a double-entry table describing the contents of each practical work, on the one hand, and the phases of the nursing process, on the other. Results: T h e questionnaire was answered by 24 teachers (39%) and 38 students (61%). The phases in which they most admitted applying physiology knowledge in the nursing process were assessment and diagnosis in both groups. In each practical work, the application of physiological knowledge was perceived differently by teachers and students, and teachers recognized more the use of physiology in the nursing process. Conclusions: Structuring practical physiology activities around the nursing process seems to be a valid didactic strategy, considering that teachers and students perceive, to a greater or lesser extent, that they apply the knowledge gained during the course in the different stages of the nursing process, particularly in the assessment and diagnosis stages. The perception was higher in teachers, which evidences a better management of the nursing process due to a higher level of knowledge and professional practice.
Physiology , Nurse's Role , Education , Nursing Process , Nursing
Resumen Introducción: Varios estudios han demostrado en poblaciones indígenas alta prevalencia de obesidad, diabetes mellitus, hipertensión arterial, proteinuria y enfermedad renal crónica. Objetivo: Detectar factores de riesgo cardiovascular y renal, hipertensión arterial, sobrepeso y obesidad, obesidad central, diabetes y proteinuria, y evaluar nivel educativo, situación laboral, nivel socioeconómico y cobertura de salud en sujetos de la etnia wichi, habitantes de "El Impenetrable" chaqueño. Material y métodos: Se realizó un estudio descriptivo observacional, de corte transversal, con muestra aleatoria de sujetos mayores de 18 años. La encuesta semiestructurada, y traducida a lengua wichi, incluyó: edad, sexo, sedentarismo, tabaquismo, nivel educativo, situación laboral, cobertura de salud y nivel socioeconómico. Se midió peso, talla, circunferencia de cintura, presión arterial sistólica y diastólica, glucemia y proteinuria. Se calculó el índice de masa corporal. Resultados: Se evaluaron 156 personas (el 58,3% varones, edad 34 ± 12 años). El índice de masa corporal fue de 27,9 ± 5,3, sin diferencia entre sexos. Presentó hipertensión arterial el 10,8%, sobrepeso el 34,0%, obesidad el 30,9%, obesidad central el 40,1% (mayor en mujeres, p= 0,03), tabaquismo el 17,4%, sedentarismo el 83,3%, y proteinuria el 14,5%. Se registró un único caso de diabetes. Solo 6,4% refirió trabajar, el 49,3% no había finalizado estudios primarios, el 61,7% calificó como marginal en el nivel socioeconómico, y solo el 3,8% tenía cobertura de salud. Conclusión: Este grupo poblacional evidencia un alto grado de vulnerabilidad alimentaria, educativa, laboral, social y sanitaria, reflejado en la alta prevalencia de factores de riesgo cardiovascular y renal (en particular exceso de peso y obesidad central), en el bajo nivel educativo, laboral y socioeconómico, y en la falta de cobertura de salud.
Abstract Introduction: Several studies have shown a high prevalence of obesity, diabetes mellitus, hypertension, proteinuria and chronic kidney disease in indigenous populations. Aim: To detect cardiovascular and renal risk factors, hypertension, overweight and obesity, truncal obesity, diabetes and proteinuria, and to evaluate educational level, employment situation, socioeconomic level and health care coverage in subjects from the Wichi ethnic group who inhabit in "El Impenetrable" in Chaco. Methods: An observational, descriptive, cross-sectional study was carried out, with a random sample of subjects over 18 years of age. The semi-structured survey, translated into the Wichi language, included: age, sex, sedentary lifestyle, smoking habit, educational level, employment situation, health care coverage and socioeconomic level. Weight, height, waist circumference, systolic and diastolic blood pressure, blood glucose and proteinuria were measured. Body mass index was calculated. Results: 156 people were evaluated (58.3% men; age: 34 ± 12 years). The body mass index was 27.9 ± 5.3, with no difference between the sexes. Hypertension was present in 10.8% of individuals; overweight in 34.0%; obesity in 30.9%; truncal obesity in 40.1% (higher in women, p = 0.03); smoking habit in 17.4%; sedentary lifestyle in 83.3%, and proteinuria in 14.5%. A single case of diabetes was registered. Only 6.4% reported having a job, 49.3% had not completed primary studies, 61.7% qualified as marginal in terms of socioeconomic status, and only 3.8% had health care coverage. Conclusion: This population group shows a high degree of food, educational, occupational, social and health vulnerability, reflected in the high prevalence of cardiovascular and renal risk factors (particularly excess weight and truncal obesity), in the low educational, employment and socioeconomic levels, and in the lack of health coverage.
Resumen La hemodiálisis, como tratamiento de la insuficiencia renal crónica extrema, comenzó en la Argentina casi simultáneamente con el trasplante renal y la especialidad de nefrología. En 1957 se realizó el primer trasplante renal, en 1958, la primera hemodiálisis y, en 1960 se creó la Sociedad Argentina de Nefrología. Inicialmente fue importante la fabricación local de riñones, como aquel con el que se realizó la primera hemodiálisis, construido por el Dr. Alfonso Ruiz Guiñazú y varios artesanos, basándose en apuntes y fotos traídas del exterior y en el modelo tipo Kiil, confeccionado por el Dr. Manuel Calvo, luego modificado por el Dr. Manuel Arce. La hemodiálisis, inicialmente, se usó en el país para tratar la insuficiencia renal aguda o como preparación para el trasplante. En 1964 se constituyó el primer Servicio de Hemodiálisis Crónica del Hospital Italiano de Buenos Aires, seguido, en 1965, por el Servicio de Nefrología del Instituto de Cardiología de la Fundación Pombo, dirigido por el Dr. Víctor Raúl Miatello. La expansión de la hemodiálisis crónica en todo el país ocurrió durante los años ochenta, lo que posibilitó su desarrollo fue la universalización de la cobertura de salud para pacientes que necesitaran hemodiálisis crónica, en agosto de 1975, la Ley Nacional de Trasplante 21.541 de 1977 y, en el mismo año, la inclusión de la hemodiálisis en la cobertura de salud de los sistemas de aseguramiento privados. En 1983, la Ley 22.853 normatiza la organización y funcionamiento de las instituciones de diálisis. La Ley 21.541 creó el CUCAI, Centro Único Coordinador de Ablación e Implante, hoy instituto nacional (INCUCAI), que realiza el registro de la insuficiencia renal crónica y de su tratamiento sustitutivo.
Abstract In Argentina, hemodialysis, as a treatment for acute chronic kidney disease, started almost simultaneously with renal transplantation and nephrology. In 1957, the first renal transplantation was performed; in 1958, the first hemodialysis treatment took place, and in 1960 the Argentine Society of Nephrology was created. At first, local manufacture of kidneys was important; for example, Dr. Alfonso Ruiz Guiñazú and other artisans made the one used for the first hemodialysis session, based on notes and photographs from abroad and on the Kiil model made by Dr. Manuel Calvo and later modified by Dr. Manuel Arce. Hemodialysis was first used in our country to treat acute kidney disease or to prepare the patient for transplantation. In 1964, the first chronic hemodialysis unit was established at Hospital Italiano de Buenos Aires (Italian Hospital of Buenos Aires), followed by another at the Servicio de Nefrología del Instituto de Cardiología de la Fundación Pombo (Pombo Foundation Cardiology Institute), led by Dr. Víctor Raúl Miatello. The spread of this practice to the whole country took place in the 80s; its development was fostered by the following: the universalization of health care coverage for chronic hemodialysis patients (August 1975); the National Law 21.541 on organ transplantation in 1977, and the inclusion of hemodialysis in private health insurance plans the same year. In 1983, Law 22.853 regulated the organization and running of dialysis institutions. The Unique Central Coordinator of Ablation and Implant (CUCAI in Spanish) was created under Law 21.541 of 1977; this institution, nowadays a national institute (INCUCAI), keeps an important record of chronic kidney disease and its replacement therapy.
RESUMEN La hemodiálisis (HD), como tratamiento de la insuficiencia renal (IR), y la nefrología, como especialidad, surgieron casi simultáneamente. La primera HD exitosa en humanos ocurrió en Holanda, en 1945, con un riñón diseñado por Wilhem Kolff. La primera sociedad científica se fundó en Francia, en 1949 (Société de Pathologie Rénale), y la segunda en 1950, en el Reino Unido (Renal Association). Varios intentos precedieron a la primera HD exitosa. En el ámbito experimental, se dializaron perros nefrectomizados John J. Abel, Leonard G. Rowntree y Benjamin B. Turner (1913, Estados Unidos), George Hass (1914, Alemania) y Henry Necheles (1923, China). Las primeras HD en humanos las realizó Hass, entre 1924 y 1927: hemodializó seis pacientes, de 15 a 30 minutos, dado que su objetivo era de probar la seguridad del método. Si bien Kolff realizó la primera HD exitosa, otros autores, como Nils Alwall (Suecia) y Gordon Murray (Canadá), durante los años cuarenta, publicaron experiencias exitosas con otros modelos de riñones. A mediados de los años cuarenta, la HD se había inventado, simultánea e independientemente, en Holanda, Suecia y Canadá, si bien aún con dudas sobre su aplicación y eficacia. Utilizada inicialmente solo para pacientes agudos, la HD se convirtió en un tratamiento posible en la insuficiencia renal crónica (IRC) gracias a que Belding Scribner y Wayne Quinton, en 1960, y Michael J. Brescia y James E. Cimino, en 1966, desarrollaron el shunt semipermanente y la fístula arteriovenosa permanente, respectivamente. Esto posibilitó en el mundo el sostenimiento de la vida de millones de personas con IRC y el desarrollo del trasplante renal como una alternativa terapéutica más.
ABSTRACT Hemodialysis (HD), as a treatment for renal failure (RF), and nephrology, as a specialty, arose almost simultaneously. The first successful HD in humans occurred in the Netherlands, in 1945, with a kidney designed by Wilhem Kolff. The first scientific society was founded in France in 1949 (Société de Pathologie Rénale), and the second in 1950, in the United Kingdom (Renal Association). Several attempts preceded the first successful HD. In the experimental setting, John J. Abel, Leonard G. Rowntree and Benjamin B. Turner (1913, United States), George Haas (1914, Germany) and Henry Necheles (1923, China) dialyzed nephrectomized dogs. The first HD in humans were performed by Haas, between 1924 and 1927: he hemodialyzed six patients, from 15 to 30 minutes, since his objective was to test the safety of the method. Although Kolff performed the first successful HD, other authors, such as Nils Alwall (Sweden) and Gordon Murray (Canada), during the 1940s, published successful experiences with other kidney models. By the mid-1940s, HD had been invented, simultaneously and independently, in the Netherlands, Sweden and Canada, although still with doubts about its application and effectiveness. Initially used only for acute patients, HD became a possible treatment for chronic kidney disease (CKD) thanks to the development of the semi-permanent shunt by Belding Scribner and Wayne Quinton in 1960 and the permanent arteriovenous fistula by Michael J. Brescia and James E. Cimino in 1966. This enabled the life support of millions of people with CKD in the world and the development of kidney transplantation as one more therapeutic alternative.
INTRODUCTION: Little information is available regarding the evaluation of renal volume in healthy Latin-American children of different ages. The objective of this work was to establish a predictive model of renal size (volume and length) and develop a web-based calculator. MATERIALS AND METHODS: A selective and representative sample was obtained randomly from the database of healthy children living in Resistencia city, Chaco, Argentina: a) the National Health Program for children under 6 years old; b) school children until 18 years old (primary and middle education). Renal dimensions were obtained by ultrasonography via a single experienced operator at the indicated site (schools or primary health care centers). Renal volume was calculated using Dinkel's formula. A multiple linear regression model was applied using potential predictors. The final model was implemented in a free web-based application. RESULTS: Random selection was made from the database to include 882 subjects with ages between 0.03 and 230.63 months. The data was divided into two sets (one for training and the other for model testing). The training set (423) included 212 (50%) females. Significant predictors included age, height, current weight and birth weight, and the interaction between age and present weight. Using the test dataset, both renal volume and length root mean square errors were 5.06 cm3 and 0.59 cm. CONCLUSION: The prediction model was accurate and allowed for the development a freely-available web app: Renal size prediction (https://porbm28.shinyapps.io/RenalVolume/). Once the models are validated by additional studies, the app could be a useful tool to predict renal volume and length in pediatric clinical practice.
Kidney/anatomy & histology , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Kidney/diagnostic imaging , Linear Models , Male , Organ Size , Ultrasonography
INTRODUCCIÓN: El trastorno del metabolismo óseo y mineral constituye una grave complicación de la IRC. Respecto al fósforo, las nuevas Guías KDIGO sugieren disminuirla hiperfosfatemia, sin recomendar un valor determinado. Sin embargo, en Argentina se continúa utilizando como indicador de calidad dialítica (IndCalDial) un valor de fósforo igual o inferior a 5 mg.dl. Nuestro objetivo fue evaluar si un valor fijo de fosfatemia es válido como IndCalDial. MATERIAL Y MÉTODOS: Se realizó un estudio multicéntrico, de corte transversal. Se incluyeron pacientes mayores de 18 años, con más de 90 días en hemodiálisis crónica. Se tabularon datos demográficos y de laboratorio. Según el reactivo empleado en la determinación de fósforo, en 4 centros el límite superior de referencia fue 4.5 mg.dl (Grupo F4.5) y en tres 5.6 mg.dl (Grupo F5.6). RESULTADOS: Se incluyeron 334 pacientes. Edad, sexo, porcentaje con FAV, diabéticos, tiempo en diálisis, Kt/V, Hemoglobina y Albúmina, resultaron semejantes a los del Registro Nacional de Diálisis. La mediana de fosfatemia fue 5.2 mg.dl, (rango: 2.3 a 10.6). Los pacientes hiperfosfatémicos fueron más jóvenes y presentaron mejores niveles de Albúmina. De considerarse como IndCalDial: Fósforo menor a 5 mg.dl, 21 pacientes del Grupo F4.5 (n=154) con fosfatemia entre 4.5 y 5.0 mg.dl no recibirían tratamiento, mientras que en el Grupo F5.6 (n=180), 32 pacientes con fosfatemia entre 5.1 y 5.6 mg.dl deberían recibir tratamiento, a pesar de presentar normofosfatemia. CONCLUSIONES: Debería estandarizarse la determinación de fosfatemia, previo a utilizar un valor fijo como IndCalDial
Humans , Renal Dialysis , Hyperphosphatemia , Phosphorus/analysis , Phosphorus/metabolism , Quality Indicators, Health Care
Introducción: El trastorno del metabolismo óseo y mineral constituye una grave complicación de la insuficiencia renal crónica. Respecto al fósforo, las nuevas Guías KDIGO sugieren disminuir la hiperfosfatemia, sin recomendar un valor determinado. Sin embargo, en Argentina se utiliza como indicador de calidad dialítica (IndCalDial) un valor de fósforo igual o inferior a 5 mg/dL. Nuestro objetivo fue evaluar si dicho objetivo es actualmente válido como IndCalDial. Material y métodos: Estudio multicéntrico, de corte transversal. Se incluyeron pacientes mayores de 18 años, con más de 90 días en hemodiálisis. Se tabularon datos demográficos y de laboratorio, comparándose normofosfatémicos contra hiperfosfatémicos. Según el método, en 3 centros el límite superior de referencia fue 4.5 mg/dL y en cuatro 5.6 mg/dL, éstos últimos se analizaron como grupo separado F 5.6. Resultados: Se incluyeron 333 pacientes. Edad, sexo, porcentaje FAV, diabéticos, tiempo en diálisis, Kt/V, Hemoglobina y Albumina, fueron semejantes a los datos del registro. La mediana de fosfatemia fue 5.2 mg/dL, (rango: 2.3 a 10.6). Los pacientes hiperfosfatémicos presentaron menor edad, menos tiempo en diálisis y cifras mayores de hemoglobina y Albumina. En el grupo F 5.6 (n = 203), según KDIGO sólo el 33.7 % necesitaría tratamiento. De aplicarse el IndCalDial (fósforo menor a 5 mg/dL), el porcentaje sería de 55%, es decir, un 21.3% de pacientes normofosfatémicos deberían ser tratados. Conclusiones: Debería estandarizarse la determinación de fosfatemia, previo a utilizar un valor fijo como IndCalDial.
Introduction: Bone and mineral metabolism disorder is a serious complication of Chronic Kidney Disease. Concerning phosphorus, the new KDIGO Guidelines suggest a reduction of hyperphosphatemia, but they do not recommend a specific value. However, in Argentina, a phosphorus value of 5 mg/dL or less is used as a dialysis quality indicator (DiaQualInd). Our objective was to evaluate whether this goal is currently valid as a DiaQualInd. Methods: A multicentric, cross-sectional study was conducted. Patients older than 18 were included, with more than 90 days undergoing hemodialysis. Demographic and laboratory data were tabulated, comparing normophosphatemic with hyperphosphatemic values. According to this method, in 3 centers the upper reference limit was 4.5 mg/dL and in 4 centers it was 5.6 mg/dL. The latter were analyzed as a separate group (F 5.6). Results: There were 333 patients included in this study. Age, sex, AVF percentage, diabetes, time on dialysis, Kt/V, hemoglobin and albumin were similar to the registry data. The median phosphatemia was 5.2 mg/dL, (range: 2.3 to 10.6). The hyperphosphatemic patients were the youngest, spent less time on dialysis and showed higher hemoglobin and albumin values. In group F 5.6 (n = 203), according to KDIGO only 33.7% would need treatment. If this DiaQualInd were to be applied (phosphorus lower than 5 mg/dL), the percentage would be 55%, that is, 21.3% of normophosphatemic patients should be treated. Conclusions: Phosphatemia determination should be standardized before using a fixed value such as DiaQualInd
INTRODUCCIÓN: Se carece de datos sobre situación nutricional y factores de riesgo cardiovascular y renal en pediatría en la provincia del Chaco, una de las más pobres y con mayor población pediátrica de Argentina. OBJETIVO: Determinar la prevalencia de factores de riesgo nutricionales (bajo peso/talla, baja talla/edad, bajo peso y sobrepeso), factores de riesgo perinatales (edad materna y edad gestacional al nacimiento), cardiovasculares y renales (sobrepeso, hipertensión arterial y proteinuria), correlacionados con el peso al nacer, en población de un mes a 18 años del conglomerado urbano del Gran Resistencia, provincia del Chaco. MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo observacional de corte transversal. Los participantes se seleccionaron por muestreo probabilístico por conglomerados según peso de la población en cada estrato, de escuelas para niños de 6 a 18 años y de centros de salud para menores de 6.RESULTADOS: Se estudiaron 850 niños. La prevalencia de factores de riesgo fue: 24% alto riesgo por edad materna; 21% nacidos pre-término; 7,2% bajo peso al nacer; 9,1% baja talla/edad; 4,2% bajo peso/talla; 11,8% alto peso/talla; 6,3% bajo peso/edad; 2,4% proteinuria; y 6,8% hipertensión arterial. En menores de 6 años con bajo peso al nacer comparados con nacidos con peso normal, la odd ratio para presentar bajo peso/talla fue de 6,15, y para bajo peso/edad de 5,02; para nacidos con alto peso comparados con nacidos con peso normal, la odd ratio para sobrepeso fue 3,07. CONCLUSIONES: La población pediátrica estudiada presenta una situación de alto riesgo nutricional que correlaciona con el peso al nacer. La prevalencia de proteinuria e hipertensión arterial no se asociaron al peso al nacer
INTRODUCTION: There is a lack of data on nutritional status and cardiovascular and renal risk factors in pediatrics in the province of Chaco, one of the poorest provinces and with the largest pediatric population in Argentina. OBJECTIVE: To determine the prevalence of these risk factors: nutritional (low weight/height, low height/age, low weight and overweight); perinatal (maternal age and gestational age at birth), as well as cardiovascular and renal (overweight, hypertension and proteinuria), correlated with birth weight, in population from one month old to 18 years old in the urban agglomeration of Gran Resistencia, province of Chaco. MATERIAL AND METHODS: An observational descriptive cross-sectional study was conducted. Participants were selected by probabilistic sampling through agglomerations according to population weight in each strata, taken from schools for 6-18 year-old children and from health centers for children under 6. RESULTS: A total of 850 children were studied. The prevalence of risk factors was: 24% with high risk for maternal age, 21% with preterm birth, 7.2% with low birth weight, 9.1% with low height/age, 4.2% with low weight/height, 11.8% with high weight/height, 6.3% with low weight/age, 2.4% with proteinuria and 6.8% with high blood pressure. In children under 6 years of age with low birth weight, compared to those with normal birth weight, the odd ratio for low weight/height was 6.15, and for low weight/age it was 5.02; for those born with a high weight compared to those born with normal weight, the odd ratio for overweight was 3.07. CONCLUSIONS: the pediatric population which was studied presents a situation of high nutritional risk that correlates with birth weight. The prevalence of proteinuria and high blood pressure were not associated with birth weight
Humans , Child , Proteinuria , Birth Weight , Nutritional Status , Pediatrics , Argentina , Cardiovascular Diseases , Risk Factors , Hypertension
BACKGROUND: In incident hemodialysis (HD) patients, the use of catheters is associated with a worse prognosis when compared with those with an arteriovenous fistula, but the role of vascular access (VA) type in the morbidity and mortality of patients returning to HD with a failing renal allograft is unknown. We aimed to determine the associations between the type of VA and mortality in this population. METHODS: This was a retrospective observational cohort study of 138 patients who initiated dialysis after kidney transplant failure between 1995 and 2014. We recorded access type, laboratory values at entry, stratified patients per risk, and determined the effect on mortality of programmed VA (PVA), (arteriovenous fistula or PTFE graft) and nonprogrammed VA (UPVA) (tunneled or nontunneled catheters) at the initiation of HD. RESULTS: Eighty-five (61.6%) and 53 (38.4%) patients initiated therapy with PVA and UPVA, respectively. Overall mortality was 14.6% at 1 year. Patients using catheters had greater mortality than those with a PVA (log rank P <0.0001). At 24 months, 7 patients died in PVA group versus 22 in UPVA group. Multivariate Cox analysis showed that initiation of HD with a catheter (hazard ratio, 5.90; 95%, confidence interval, 2.83-12.31) was independently associated with greater mortality after adjusting for confounders. CONCLUSIONS: Nonprogrammed VA with a catheter predicted all-cause mortality among patients with transplant failure reentering HD.
Graft Rejection/therapy , Kidney Failure, Chronic/surgery , Kidney Transplantation , Renal Dialysis/methods , Vascular Access Devices , Adult , Argentina/epidemiology , Female , Follow-Up Studies , Graft Rejection/mortality , Humans , Kidney Failure, Chronic/mortality , Male , Middle Aged , Retrospective Studies , Risk Factors , Survival Rate/trends , Time Factors
In 2015, 634387 million people (9% of the world's population) resided in Latin America (LA), with half of those populating Brazil and Mexico. The LA Dialysis and Transplant Registry was initiated in 1991, with the aim of collecting data on renal replacement therapy (RRT) from the 20 LA-affiliated countries. Since then, the Registry has revealed a trend of increasing prevalence and incidence of end-stage kidney disease on RRT, which is ongoing and is correlated with gross national income, life expectancy at birth, and percentage of population that is older than 65 years. In addition, the rate of kidney transplantation has increased yearly, with > 70% being performed from deceased donors. According to the numbers reported for 2013, the rates of prevalence, incidence and transplantation were (in patients per million population) 669, 149 and 19.4, respectively. Hemodialysis was the treatment of choice (90%), and 43% of the patients undergoing this treatment was located in Brazil; in contrast, peritoneal dialysis prevailed in Costa Rica, El Salvador and Guatemala. To date, the Registry remains the only source of RRT data available to healthcare authorities in many LA countries. It not only serves to promote knowledge regarding epidemiology of end-stage renal disease and the related RRT but also for training of nephrologists and renal researchers, to improve understanding and clinical application of dialysis and transplantation services. In LA, accessibility to RRT is still limited and it remains necessary to develop effective programs that will reduce risk factors, promote early diagnosis and treatment of chronic kidney disease, and strengthen transplantation programs.
El presente artículo intentará demostrar por qué es necesario mejorar el control de calidad de los laboratorios clínicos y avanzar hacia la estandarización de la creatininemia para contribuir a mejorar el diagnóstico clínico y epidemiológico de la Enfermedad Renal Crónica especialmente en América Latina. El rol del laboratorio de análisis clínico es brindar información útil, confiable y reproducible para la práctica clínica de la medicina, cualquiera sea la metodología empleada y el laboratorio interviniente. Para ello se implementó calidad para mejorar los errores sistemático y aleatorio en las determinaciones de los laboratorios clínicos. Los programas de estandarización se ponen en marcha en el año 2006. Por otra parte se fue incorporando la creatinina sérica y el clearance de creatinina a la clínica, hasta arribarse a un hito histórico que fue la determinación de la Tasa Filtrado Glomerular estimada (TFGe) a partir de fórmulas (MDRD y CKD-EPI). La necesidad de la estandarización de la determinación de la creatinina fue establecida en la Guía 4, KDOQUI en el año 2002. Respecto a la determinación de la creatinina sérica para la estimación del TFGe, un largo camino se ha recorrido desde la identificación del concepto de clearance, su aplicación a la determinación de la función renal, su utilización en la clínica para el diagnóstico, la progresión y el pronóstico, la identificación de la misma como un indicador epidemiológico a la hora de establecer riesgo poblacional. En ese marco, se manifiesta la necesidad de promover su estandarización
This article attempts to show why it is necessary to improve quality control of clinical laboratories and move toward standardization of serum creatinine to help improve clinical and epidemiological diagnosis of chronic kidney disease especially in Latin America. The role of clinical laboratory is to provide useful, reliable and reproducible information to be used in clinical practice, regardless of the methodology used and the intervening laboratory. For this, quality was implemented to improve the systematic and random errors in the determinations of clinical laboratories. Standardization programs are launched in 2006.Moreover serum creatinine and creatinine clearance joined the clinic, to be arrived at a milestone that was the determination of the estimated Glomerular Filtration Rate (eGFR) from formulas (MDRD and CKD-EPI). The need for standardization of the determination of creatinine was established in the Guide 4 KDOQUI in 2002. Regarding the determination of serum creatinine for estimating eGFR, a long way has come: from identification of the concept of clearance, its application to the determination of renal function, its use in the clinic for diagnosis, progression and prognosis, identifying it as an epidemiological indicator in population risk setting. In this context the need for standardization is established
Humans , Clinical Laboratory Techniques , Creatinine , Glomerular Filtration Rate , Reference Standards , Renal Insufficiency, Chronic
INTRODUCTION: Chronic kidney disease (CKD) represents a major challenge for Latin America (LA), due to its epidemic proportions and high burden to the population affected and to public health systems. METHODS: Our methods have been reported previously: This paper shows the data for the last 10 years until 2010, from the Latin American Dialysis and Renal Transplantation Registry (RLADTR). RESULTS: 20 countries participated in the surveys, covering 99% of Latin America (LA). The prevalence of end-stage renal disease (ESRD) under renal replacement therapy (RRT) in LA increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (hemodialysis (HD) 413 pmp, peritoneal dialysis (PD) 135 pmp, and LFG 111 pmp). HD proportionally increased more than PD and transplant and continues to be the treatment of choice in the region (75%). The kidney transplant rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of transplants in 2010 was 10,397, with 58% being deceased donors. The total RRT prevalence correlated positively with gross national income (GNI) (r = 0.86; p < 0.05) and life expectancy at birth (r = 0.58; p < 0.05). The global incidence rate correlated significantly only with GNI (r = 0.56; p < 0.05). Diabetes remained the leading cause of ESRD. CONCLUSION: The prevalence and incidence of RRT continues to increase. In countries with 100% public health or insurance coverage for RRT the rates are comparable to those displayed by developed countries with better GNI. PD is still an underutilized strategy for RRT in the region. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost effective forms of RRT are needed in the region.
Cost of Illness , Forecasting , Kidney Failure, Chronic/economics , Kidney Failure, Chronic/epidemiology , Registries , Female , Humans , Incidence , Latin America/epidemiology , Male , Prevalence , Retrospective Studies
Se define sarcopenia como la pérdida de masa y función musculares, no sólo por disminución del tamaño sino también del número de fibras musculares. Altamente prevalente en el adulto mayor, aparece también en pacientes con enfermedades crónicas. En la insuficiencia renal crónica (IRC) contribuyen a su aparición la enfermedad crónica per se, la edad avanzada, el sedentarismo habitual, sumado a múltiples factores que deterioran el estado nutricional, tales como reducción de la ingesta asociada o no a drogas anorexígenas, inflamación crónica, déficit de hormonas anabólicas, bajos niveles de vitamina D, resistencia insulínica y disminución de gelsolina (proteína clave en el ensamblaje y desensamblaje de filamentos de actina). La presencia de sarcopenia correlaciona con mayor mortalidad, discapacidad y aumento del riesgo de caídas. El diagnóstico se basa en medir la fuerza muscular y el rendimiento físico; para lo primero se utiliza el dinamómetro, y para lo segundo la medida de la velocidad de la marcha (registra el tiempo necesario para caminar una distancia determinada) y el test ôTime Up and Goõ (evalúa el tiempo para levantarse, recorrer 3 metros y volver a sentarse). En pacientes con IRC, una adecuada ingesta proteica, sumado a actividad física (particularmente ejercicios de resistencia) mejoran el rendimiento físico, la aptitud respiratoria y la sobrevida en general, y reducen la mortalidad cardiovascular. Asimismo, el ejercicio aumenta elcontenido muscular de IGF-1, y del ARNm para factor de crecimiento tipo insulina II, la capacidad oxidativa muscular y el número de células satélites necesarias para regenerar las fibras musculares.
Sarcopenia is defined as the loss of muscle mass and function, not only due to muscle fiber decrease in size but also in number. Highly prevalent in older adults, it also appears in patients with chronic diseases. In the chronic renal failure (CRF), the facts that contribute to its appearance are: chronic disease per se, advanced age, sedentary lifestyle, added to multiple factors which deteriorate the nutritional status such as reduction of in-take associated or not to anorexic drugs, chronic inflammation, anabolic hormone deficit, vitamin D low levels, insulin resistance and gelsolin decrease ( key protein in the assembly and disassembly of actin filaments). Presence of sarcopenia correlates with greater mortality, disability and falls risk increase. Diagnosis is based on measuring muscle strength and physical performance, for the first one a dynamometer is used, and for the second one: walking speed measurement (records the needed period of time to walk a determined distance) and the test ôTime Up and Goõ (which evaluates the needed period of time to stand up, walk 3 meters and sit down again). In patients with CRF, an appropriate protein ingestion, added to physical activity, (specially resistance exercises) improve physical performance, respiratory aptitude and survival in general, and reduce cardiovascular mortality. Additionally, exercise increases IGF-1 muscle content, as well as the mRNA for insulin-like growth factor type II, muscle oxidative capacity and the number of required satellite cells to regenerate muscle fibers.
Male , Female , Humans , Aged , Aged, 80 and over , Exercise , Muscle Strength , Renal Insufficiency, Chronic , Muscular Diseases/diagnosis , Muscular Diseases/therapy
