Intoxicación por metanol por inhalación de disolvente / Methanol poisoning by solvent inhalation

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Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability.

AIM: The objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa. METHODS: This was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline. RESULTS: We included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months -12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P<0.0001), with an annual mean of 174.7 (88.7) international units (IU)/kg/week for epoetin versus 95.7 (43.4) (first year) and 91.4 (42.7) IU/kg/week (second year) for darbepoetin (65% and 64% reduction, respectively). The ESA resistance index decreased from 15.1 (8.5) IU/kg/week/g/dL with epoetin to 8.1 (3.9) (first year) and 7.9 (4.0) (second year) with darbepoetin (P<0.0001). The conversion rate was 354:1 in patients requiring high (>200 IU/kg/week) doses of epoetin and 291:1 in patients requiring low doses. CONCLUSION: In patients on hemodialysis receiving ESAs, conversion from epoetin alfa to darbepoetin alfa was associated with an approximate and persistent reduction of 65% of the required dose. To maintain Hb stability, a conversion rate of 300:1 seems to be appropriate for most patients receiving low doses of epoetin alfa (≤200 IU/kg/week), while 350:1 would be better for patients receiving higher doses.

La suspensión de la Diálisis en pacientes con Insuficiencia Renal Crónica Avanzada: ¿Qué opinan los enfermos? / Withdrawing dialysis in End-Stage Renal Disease: ¿What do patients think about it?

El proceso de voluntades anticipadas permite a los pacientes dar a conocer sus preferencias. Método: estudio cualitativo de subgrupos homogéneos con pacientes con enfermedad renal crónica en programa de diálisis a través de entrevistas semiestructuradas, con el objetico de conocer su deseo de participar en la toma de decisiones sanitarias, en particular las relacionadas con el final de la vida. Resultados: de mayo a diciembre de 2012 se entrevistaron a catorce pacientes, con una mediana de edad de 66 años. Creen que reciben una información adecuada, pero reconocen que no se les habla sobre el final de la vida o la retirada de diálisis. Creen que los médicos no hablan de ello porque están centrados en otras cuestiones y no quieren entristecerles. Quieren participar en la toma de decisiones y expresar sus preferencias. En caso de deterioro neurológico severo preferirían suspender la diálisis y recibir tratamiento para no tener dolor, en su casa si es posible. Sería conveniente integrar los cuidados paliativos en la asistencia de los pacientes en diálisis (AU)

Advance Care Planning (ACP) helps communicate patients’ end-of-life care, particularly for older patients. Method: prospective qualitative study carried out on selected ESRD patients from a dialysis unit. The aim was to determine what was most important to the patient, if they wanted to participate in decision-making process and what degree of functional impairment they would consider intolerable. Two semi-structured interviews with each patient were performed, including their relatives. Results: from May to December 2012 fourteen patients with an average age of 66 years were interviewed. They believe that the information process is adecuate, but there is no information about the plan of care if a trasplant is not a real option. They would like to participate in decisions concerning their care and end-of-life. They would want to keep on with dialysis treatment while their quality of life continues to be acceptable for them. Respecting end-of-life care, dying without pain and to be cared for at home are the most important points for them. Patients think that doctors don ́t speak to them about end-of-life because they are focused on other aspects of care. Conclusion: although there are great opportunities to talk with ESRD patients about end-of-life care this is often not done. In cases with severe cognitive impairment they would prefer to withdraw dialysis. Then they wish to receive care at home to relieve suffering or pain. The best way to achieve this is by integrating palliative care into dialysis units (AU)

Heterogeneity of induction therapy in Spain: changing patterns according to year, centre, indications and results.

Background. The use of induction drugs has increased markedly over the last 15 years in the USA, but there are few data about their use in other countries. Moreover, there are not enough data about when they are indicated and their long-term effects. The aim of our study was to know the rates of use and the drugs used as induction therapy, in which patients they were prescribed and the long-term graft survival effect in Spain.Methods. We conducted a retrospective cohort study with adult patients (4861) receiving a kidney allograft in Spain over four different years (1990, 1994, 1998 and 2002) with a functioning graft at the end of the first post-transplant year. Induction therapy was defined as when the patient received polyclonal antibodies, OKT3 monoclonal antibodies or anti-CD25 monoclonal antibodies.Results. From 1990 to 2002, the use of induction therapy in Spain changed, with a progressive reduction in the use of OKT3 and an increasing use of anti-CD25 antibodies. There were great differences in the rate of induction use from one centre to another, although with a common trend to greater use at each centre. Induction therapy was mainly prescribed in patients with a higher rejection risk (higher panel reactive antibody (PRA) titres and mismatches and re-transplants) and in older and diabetic recipients. Lastly, patients who were treated with induction therapy had significant higher allograft survival than those who did not (P value = 0.035).Conclusions. The use of induction therapy in Spain has changed, with an increasing use of monoclonal antibodies in recent years. Induction therapy has a protective role in long-term graft survival.