Diagnósticos de enfermagem da nanda i para pessoas renais crônicas em hemodiálise: revisão de escopo / Diagnósticos de enfermería de la nanda-i para personas renales crónicas en hemodiálisis: revisión de alcance / Nanda-i nursing diagnoses for chronic kidney patients on hemodialysis: scope review

Objetivo: mapear os Diagnósticos de Enfermagem da taxonomia NANDA-I validados para pacientes renais crônicos submetidos a hemodiálise. Método: revisão de escopo registrada no Open Science Framework, guiada pelo método JBI e norteada pelo Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. As buscas foram realizadas nas bases Medical Literature Analysis and Retrievel System, Cummulative Index to Nursing and Allied Health Literature, entre outras, além da literatura cinzenta. Dados analisados descritivamente. Não houve recorte temporal ou idiomático. Resultados: identificados 12 estudos com 6 Diagnósticos de Enfermagem validados para pacientes renais crônicos submetidos a hemodiálise: volume de líquidos excessivo, proteção ineficaz, autogestão ineficaz da saúde, espiritualidade prejudicada, disposição para melhora da esperança e hipotermia. Conclusão: o mapeamento dos Diagnósticos de Enfermagem da taxonomia NANDA-I mostrou que a qualidade do processo de enfermagem tende a melhorar, quando diagnósticos de enfermagem são validados, conferindo maior confiabilidade e segurança à prática clínica.

Objetivo: mapear los Diagnósticos de Enfermería de la taxonomía NANDA-I validados para pacientes renales crónicos sometidos a hemodiálisis. Método: Revisión de ámbito registrada en el Open Science Framework, guiada por el método JBI y guiada por el Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Las búsquedas fueron realizadas en las bases Medical Literature Analysis and Retrieval System, Cumulative Index to Nursing and Allied Health Literature, entre otras, además de la literatura gris. Datos analizados descriptivamente. No hubo recorte temporal o idiomático. Resultados: identificados 12 estudios con 6 Diagnósticos de Enfermería validados para pacientes renales crónicos sometidos a hemodiálisis: volumen de líquidos excesivo, protección ineficaz, autogestión ineficaz de la salud, espiritualidad perjudicada, disposición para mejorar la esperanza y la hipotermia. Conclusión: el mapeo de los Diagnósticos de Enfermería de la taxonomía NANDA-I mostró que la calidad del proceso de enfermería tiende a mejorar, cuando diagnósticos de enfermería son validados, confiriendo mayor confiabilidad y seguridad a la práctica clínica.

Objective: to map the Nursing Diagnoses of the NANDA-I taxonomy validated for chronic kidney disease patients undergoing hemodialysis. Method: scope review recorded in the Open Science Framework, guided by the JBI method and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The searches were performed in the Medical Literature Analysis and Retrieval System, Cumulative Index to Nursing and Allied Health Literature, among others, besides the gray literature. Data analyzed descriptively. There was no temporal or idiomatic cut. Results: 12 studies were identified with 6 validated Nursing Diagnoses for chronic kidney disease patients undergoing hemodialysis: excessive volume of fluids, ineffective protection, ineffective health self-management, impaired spirituality, willingness to improve hope and hypothermia. Conclusion: the mapping of Nursing Diagnoses of the NANDA-I taxonomy showed that the quality of the nursing process tends to improve when nursing diagnoses are validated, giving greater reliability and safety to clinical practice.

Utilidad del sistema de recirculación de adsorbentes moleculares en la falla hepática: "diálisis hepática" / Usefulness of the molecular adsorbent recirculating system in liver failure: "liver dialysis"

INTRODUCCIÓN. La falla hepática ya sea aguda o crónica reagudizada representa un reto para el clínico ya que sus complicaciones conllevan una gran mortalidad, esto se ve aún más complicado ya que las opciones terapéuticas son limitadas, incluso muchas veces no se puede acceder a un programa de trasplante hepático oportuno que mejore la sobrevida de estos pacientes, es así que se ha desarrollado un sistema de "diálisis" hepática conocido como sistema de recirculación de adsorbentes moleculares el cual hace un efecto de detoxificación para eliminar sustancias que generan una noxa en el cuerpo humano. OBJETIVO. Entender la utilidad del sistema recirculante molecular adsorbente en la falla hepática, conocer sus indicaciones y complicaciones. METODOLOGÍA. Se realizó una revisión de la literatura con un enfoque descriptivo, retrospectivo cualitativo no experimental, de documentos que tratan sobre la utilización del sistema MARS para tratar la falla hepática, con evidencia desde el año 2004 hasta el 2021. La revisión bibliográfica se llevó a cabo en bases de datos como Pubmed, Embase, BVS, Google Scholar y Elsevier. RESULTADOS. Se identificaron 30 artículos que cumplieron criterios de inclusión de un grupo original de 343 artículos revisados. Se ha determinado que la evidencia sobre este sistema está compuesta sobre todo por reportes de caso y son pocos los ensayos controlados aleatorizados que empleen su uso, sin embargo, se ha podido determinar que este sistema es un puente al trasplante renal mientras se estabiliza al paciente en la Unidad de Cuidados Intensivos, disminuye los marcadores de falla hepática. CONCLUSIÓN. En Latinoamérica su uso es casi nulo de ahí la necesidad de entender el mecanismo de este novedoso sistema.

INTRODUCTION. Hepatic failure, whether acute or chronic, represents a challenge for the clinician since its complications entail a great mortality, this is even more complicated since the therapeutic options are limited, even many times it is not possible to access a timely liver transplant program to improve the survival of these patients, Thus, a hepatic "dialysis" system known as molecular adsorbent recirculation system has been developed, which has a detoxification effect to eliminate substances that generate a noxa in the human body. OBJECTIVE. To understand the usefulness of the molecular adsorbent recirculating system in liver failure, to know its indications and complications. METHODOLOGY. A literature review was performed with a descriptive, retrospective qualitative non-experimental qualitative approach, of papers dealing with the use of the MARS system to treat liver failure, with evidence from 2004 to 2021. The literature review was conducted in databases such as Pubmed, Embase, BVS, Google Scholar and Elsevier. RESULTS. Thirty articles were identified that met inclusion criteria from an original group of 343 articles reviewed. It has been determined that the evidence on this system is mainly composed of case reports and there are few randomized controlled trials that employ its use, however, it has been determined that this system is a bridge to renal transplantation while the patient is stabilized in the Intensive Care Unit, decreasing the markers of liver failure. CONCLUSIONS. In Latin America its use is almost null, hence the need to understand the mechanism of this novel system.

High Dialysate Calcium Concentration is Associated with Worsening Left Ventricular Function.

Dialysate calcium concentration (d[Ca]) might have a cardiovascular impact in patients on haemodialysis (HD) since a higher d[Ca] determines better hemodynamic tolerability. We have assessed the influence of d[Ca] on global longitudinal strain (GLS) by two-dimensional echocardiography using speckle-tracking imaging before and in the last hour of HD. This is an observational crossover study using d[Ca] 1.75 mmol/L and 1.25 mmol/L. Ultrafiltration was the same between interventions; patients aged 44 ± 13 years (N = 19). The 1.75 mmol/L d[Ca] was associated with lighter drop of blood pressure. Post HD serum total calcium was higher with d[Ca] 1.75 than with 1.25 mmol/L (11.5 ± 0.8 vs. 9.1 ± 0.5 mg/dL, respectively, p < 0.01). In almost all segments strain values were significantly worse in the peak HD with 1.75 mmol/L d[Ca] than with 1.25 mmol/L d[Ca]. GLS decreased from -19.8 ± 3.7% at baseline to -17.3 ± 2.9% and -16.1 ± 2.6% with 1.25 d[Ca] and 1.75 d[Ca] mmol/L, respectively (p < 0.05 for both d[Ca] vs. baseline and 1.25 d[Ca] vs. 1.75 d[Ca] mmol/L). Factors associated with a worse GLS included transferrin, C-reactive protein, weight lost, and post dialysis serum total calcium. We concluded that d[Ca] of 1.75 mmol/L was associated with higher post dialysis serum calcium, which contributed to a worse ventricular performance. Whether this finding would lead to myocardial stunning needs further investigation.

Effect of a rosmarinic acid supplemented hemodialysis fluid on inflammation of human vascular endothelial cells.

Chronic systemic inflammation and repetitive damage of vascular endothelia by incompatible dialysis system are probable causes of cardiovascular disease in patients on dialysis. The present study aimed to assess in vitro biocompatibility and anti-inflammatory effect of hemodialysis fluid supplemented with rosmarinic acid (RA) using human umbilical vein endothelial cells (HUVEC). HUVECs (5×106 cells/mL) were pre-exposed to 1 µg/mL of lipopolysaccharides (LPS) and incubated with RA-supplemented hemodialysis fluid (HDF). Cytotoxicity was assessed qualitatively by morphologic assessment and quantitatively by MTT assay. Expressions of proinflammatory mediators were assessed using quantitative real-time PCR and production of NO was quantified. Phosphorylation of AKT and nuclear localization of nuclear factor kappa B (NF-κB) were examined using western blotting. Exposure of HUVECs to RA-supplemented HDF had no influence on morphology and viability. Inhibition of proinflammatory mediator production in HUVECs by RA supplementation to HDF was significant in a dose-dependent manner. Exposure to RA-supplemented HDF resulted in a decrease in nitric oxide synthase expression and reduction of NO production in LPS-stimulated HUVECs. RA supplementation of HDF suppressed Akt activation in LPS-stimulated HUVECs. In addition, the level of cellular IκB was increased in parallel to a reduced nuclear translocation of NF-κB in LPS-induced endothelial cells. Our results suggest that RA-supplemented HDF is biocompatible and significantly suppressed inflammation induced in endothelial cells. In this respect, the use of HDF supplemented with RA could alleviate inflammation and improve long-term treatment of patients with renal failure on dialysis. Further clinical studies are required to confirm the effects.

Effect of a rosmarinic acid supplemented hemodialysis fluid on inflammation of human vascular endothelial cells

Chronic systemic inflammation and repetitive damage of vascular endothelia by incompatible dialysis system are probable causes of cardiovascular disease in patients on dialysis. The present study aimed to assess in vitro biocompatibility and anti-inflammatory effect of hemodialysis fluid supplemented with rosmarinic acid (RA) using human umbilical vein endothelial cells (HUVEC). HUVECs (5×106 cells/mL) were pre-exposed to 1 μg/mL of lipopolysaccharides (LPS) and incubated with RA-supplemented hemodialysis fluid (HDF). Cytotoxicity was assessed qualitatively by morphologic assessment and quantitatively by MTT assay. Expressions of proinflammatory mediators were assessed using quantitative real-time PCR and production of NO was quantified. Phosphorylation of AKT and nuclear localization of nuclear factor kappa B (NF-κB) were examined using western blotting. Exposure of HUVECs to RA-supplemented HDF had no influence on morphology and viability. Inhibition of proinflammatory mediator production in HUVECs by RA supplementation to HDF was significant in a dose-dependent manner. Exposure to RA-supplemented HDF resulted in a decrease in nitric oxide synthase expression and reduction of NO production in LPS-stimulated HUVECs. RA supplementation of HDF suppressed Akt activation in LPS-stimulated HUVECs. In addition, the level of cellular IκB was increased in parallel to a reduced nuclear translocation of NF-κB in LPS-induced endothelial cells. Our results suggest that RA-supplemented HDF is biocompatible and significantly suppressed inflammation induced in endothelial cells. In this respect, the use of HDF supplemented with RA could alleviate inflammation and improve long-term treatment of patients with renal failure on dialysis. Further clinical studies are required to confirm the effects.

Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients.

OBJECTIVE: To evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis. METHOD: This was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428. RESULTS: The most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness. CONCLUSION: The more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied.

Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients / Acurácia diagnóstica das características definidoras do diagnóstico volume de líquidos excessivo de pacientes em hemodiálise / La exactitud diagnóstica de las características definidoras del diagnóstico volumen de líquidos excesivo de pacientes en hemodiálisis

Objective: to evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis. Method: this was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428. Results: the most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness. Conclusion: the more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied.

Objetivo: avaliar a acurácia das características definidoras do diagnóstico de enfermagem volume de líquidos excessivo da NANDA Internacional, em pacientes submetidos à hemodiálise. Método: trata-se de um estudo de acurácia diagnóstica, com delineamento do tipo transversal, realizado em duas etapas. A primeira envolveu 100 pacientes de uma clínica de diálise e um hospital universitário do Nordeste do Brasil, investigando-se sobre a presença e ausência das características definidoras do volume de líquidos excessivo. Na segunda etapa, estas características foram avaliadas por enfermeiros diagnosticadores, que julgaram a presença ou ausência do diagnóstico. Para análise das medidas de acurácia foram calculados sensibilidade, especificidade e valores preditivos positivo e negativo. Aprovado pelo Comitê de Ética em Pesquisa sob o protocolo nº 148.428. Resultados: o indicador mais sensível foi o edema e os mais específicos foram congestão pulmonar, ruídos respiratórios adventícios e agitação. Conclusão: as características definidoras mais acuradas, consideradas válidas para a inferência diagnóstica do volume de líquidos excessivo em pacientes submetidos à hemodiálise são edema, congestão pulmonar, ruídos respiratórios adventícios e agitação. Assim, na presença destas, o enfermeiro poderá traçar, com segurança, a presença do diagnóstico estudado.

Objetivo: evaluar la exactitud de las características definidoras del diagnóstico de enfermería volumen de líquidos excesivo, de la NANDA Internacional, en pacientes sometidos a hemodiálisis. Método: se trata de un estudio de exactitud diagnóstica, con diseño de tipo transversal, realizado en dos etapas. En la primera participaron 100 pacientes de una clínica de diálisis y un hospital universitario del Noreste de Brasil; se investigó la presencia y ausencia de las características definidoras del volumen de líquidos excesivo. En la segunda etapa, estas características fueron evaluadas por enfermeros diagnosticadores, los que juzgaron la presencia o ausencia del diagnóstico. Para analizar las medidas de exactitud fueron calculados: sensibilidad, especificidad y, valores predictivos positivo y negativo. Estudio aprobado por el Comité de Ética en Investigación con el protocolo nº 148.428. Resultados: el indicador más sensible fue el edema y los más específicos fueron: congestión pulmonar, ruidos respiratorios agregados y agitación. Conclusión: las características definidoras más exactas, consideradas válidas para la inferencia diagnóstica del volumen de líquidos excesivo, en pacientes sometidos a hemodiálisis fueron: edema, congestión pulmonar, ruidos respiratorios agregados y agitación. Así, en la presencia de estas características, el enfermero podrá detectar, con seguridad, la presencia del diagnóstico estudiado.

Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia.

OBJECTIVE: To compare the occurrence of hypoglycemia during hemodialysis in chronic kidney disease diabetic patients who present different levels of pre-dialysis glycemia both when using dialysis solutions with and without glucose. SUBJECTS AND METHODS: Twenty type 2 diabetic patients in maintenance hemodialysis were submitted to three dialysis sessions (at a 7-day interval each) with dialysis solutions without glucose, with glucose at 55 mg/dL, and at 90 mg/dL subsequently. Blood glucose levels were measured immediately pre-dialysis and at 4 moments during the session, and values under 70 mg/dL were considered as hypoglycemia. RESULTS: Average pre-dialysis glycemia was lower in those who presented intra-dialytic hypoglycemia than in those who did not, both in glucose-free (140.4 ± 50.7 vs. 277.7 ± 91.0 mg/dL; p = 0.005; 95%CI: 46.4 to 228.1) and in glucose 55 mg/dL (89.5 ± 10.6 vs. 229.7 ± 105.0 mg/dL; p < 0.05; 95%CI: 9.8 to 270.5). In patients with pre-dialysis glycemia under 140 mg/dL, average intradialytic glycemia was significantly lower than pre-dialysis glycemia only when using glucose-free dialysate (p < 0.0001; 95%CI: 29.9 to 56.0 - t-test). Hypoglycemia during dialysis was observed only when using glucose-free or glucose-poor dialysis solutions. CONCLUSIONS: The use of glucose-free or glucose-poor dialysis solution presents a high risk of intradialytic hypoglycemia in diabetic renal patients, especially in those with presumed better glycemic control.

Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia

Objective To compare the occurrence of hypoglycemia during hemodialysis in chronic kidney disease diabetic patients who present different levels of pre-dialysis glycemia both when using dialysis solutions with and without glucose. Subjects and methods Twenty type 2 diabetic patients in maintenance hemodialysis were submitted to three dialysis sessions (at a 7-day interval each) with dialysis solutions without glucose, with glucose at 55 mg/dL, and at 90 mg/dL subsequently. Blood glucose levels were measured immediately pre-dialysis and at 4 moments during the session, and values under 70 mg/dL were considered as hypoglycemia. Results Average pre-dialysis glycemia was lower in those who presented intra-dialytic hypoglycemia than in those who did not, both in glucose-free (140.4 ± 50.7 vs. 277.7 ± 91.0 mg/dL; p = 0.005; 95%CI: 46.4 to 228.1) and in glucose 55 mg/dL (89.5 ± 10.6 vs. 229.7 ± 105.0 mg/dL; p < 0.05; 95%CI: 9.8 to 270.5). In patients with pre-dialysis glycemia under 140 mg/dL, average intradialytic glycemia was significantly lower than pre-dialysis glycemia only when using glucose-free dialysate (p < 0.0001; 95%CI: 29.9 to 56.0 - t-test). Hypoglycemia during dialysis was observed only when using glucose-free or glucose-poor dialysis solutions. Conclusions The use of glucose-free or glucose-poor dialysis solution presents a high risk of intradialytic hypoglycemia in diabetic renal patients, especially in those with presumed better glycemic control. .

Importancia sanitaria de Pseudomonas aeruginosa en agua de hemodiálisis y su desinfección / Health importance of Pseudomonas aeruginosa in hemodyalisis water and its disinfection

Introducción: la contaminación microbiológica de los sistemas de tratamiento de agua para hemodiálisis es un problema actual, sobre todo, por la persistencia de determinados microorganismos en la formación del biofilm, entre ellos Pseudomonas aeruginosa. Objetivo: actualizar los conocimientos sobre la importancia sanitaria de Pseudomonas aeruginosa y su desinfección en agua de hemodiálisis, que aporten criterios para la toma de decisiones adecuadas. Métodos: los datos se obtuvieron de organismos internacionales como son la Asociación para el Avance de Instrumentos Médicos y la Organización Internacional de Normalización, de criterios de expertos y de resultados de laboratorio y guías de trabajo. Síntesis de la información: existen diferentes manera de actuar sobre la contaminación bacteriana, uno de ellos es evitarla, que se puede lograr si ciertos elementos del sistema son mejorados para crear finalmente un flujo turbulento y evitar la presencia de biofilm, también puede lograrse con calor o con productos químicos desinfectantes que deben estar validados. Sin embargo, para evitar la presencia de Pseudomonas aeruginosa y otros microorganismos, hay que poner énfasis en la limpieza y desinfección de forma regular y preventiva de todas las partes de los sistemas de tratamiento y de distribución de agua y de las máquinas de hemodiálisis. Conclusiones: el proceso de desinfección en el caso de contaminación por Pseudomonas aeruginosa en una planta de tratamiento es casuístico, teniendo en cuenta la diversidad de sistemas de tratamiento de agua, sistemas de distribución, su tiempo de explotación y la necesidad de tomar medidas puntuales para cada una de estos(AU)

Introduction: microbiological contamination of the hemodialysis water treatment is a present problem mainly because of the persistence of certain microorganisms in the biofilm formation, such as the case of Pseudomonas aeruginosa. Objective: to update the knowledge on the health importance of Pseudomonas aeruginosa and their disinfection in hemodialysis water for adequate decision-making. Methods: data were taken from international bodies such as the Association for the Advancement of Medical Instruments, the International Standardization Organization, expert criteria and lab results as well as work guidelines. Information synthesis: there are different ways of acting upon the bacterial contamination; one of them is to prevent it. This can be accomplished if certain elements of the system are improved to create a turbulent flow that prevents the presence of biofilm; it may also be attained by using heat or disinfectant chemical products that should be validated. However, for the purpose of preventing the presence of Pseudomonas aeruginosa and other microorganisms, emphasis must be made on regular and preventive cleaning and disinfection of all the parts of the water treatment and distribution systems and of the hemodialysis equipment. Conclusions: the process of disinfection of Pseudomonas aeruginosa in a water treatment plant is casuistic, taking into account the diversity of water treatment systems, distribution systems, operating time and need of taking point measures aimed at each of them(AU)

Importancia sanitaria de Pseudomonas aeruginosa en agua de hemodiálisis y su desinfección / Health importance of Pseudomonas aeruginosa in hemodyalisis water and its disinfection

Introducción: la contaminación microbiológica de los sistemas de tratamiento de agua para hemodiálisis es un problema actual, sobre todo, por la persistencia de determinados microorganismos en la formación del biofilm, entre ellos Pseudomonas aeruginosa. Objetivo: actualizar los conocimientos sobre la importancia sanitaria de Pseudomonas aeruginosa y su desinfección en agua de hemodiálisis, que aporten criterios para la toma de decisiones adecuadas. Métodos: los datos se obtuvieron de organismos internacionales como son la Asociación para el Avance de Instrumentos Médicos y la Organización Internacional de Normalización, de criterios de expertos y de resultados de laboratorio y guías de trabajo. Síntesis de la información: existen diferentes manera de actuar sobre la contaminación bacteriana, uno de ellos es evitarla, que se puede lograr si ciertos elementos del sistema son mejorados para crear finalmente un flujo turbulento y evitar la presencia de biofilm, también puede lograrse con calor o con productos químicos desinfectantes que deben estar validados. Sin embargo, para evitar la presencia de Pseudomonas aeruginosa y otros microorganismos, hay que poner énfasis en la limpieza y desinfección de forma regular y preventiva de todas las partes de los sistemas de tratamiento y de distribución de agua y de las máquinas de hemodiálisis. Conclusiones: el proceso de desinfección en el caso de contaminación por Pseudomonas aeruginosa en una planta de tratamiento es casuístico, teniendo en cuenta la diversidad de sistemas de tratamiento de agua, sistemas de distribución, su tiempo de explotación y la necesidad de tomar medidas puntuales para cada una de estos(AU)

Introduction: microbiological contamination of the hemodialysis water treatment is a present problem mainly because of the persistence of certain microorganisms in the biofilm formation, such as the case of Pseudomonas aeruginosa. Objective: to update the knowledge on the health importance of Pseudomonas aeruginosa and their disinfection in hemodialysis water for adequate decision-making. Methods: data were taken from international bodies such as the Association for the Advancement of Medical Instruments, the International Standardization Organization, expert criteria and lab results as well as work guidelines. Information synthesis: there are different ways of acting upon the bacterial contamination; one of them is to prevent it. This can be accomplished if certain elements of the system are improved to create a turbulent flow that prevents the presence of biofilm; it may also be attained by using heat or disinfectant chemical products that should be validated. However, for the purpose of preventing the presence of Pseudomonas aeruginosa and other microorganisms, emphasis must be made on regular and preventive cleaning and disinfection of all the parts of the water treatment and distribution systems and of the hemodialysis equipment. Conclusions: the process of disinfection of Pseudomonas aeruginosa in a water treatment plant is casuistic, taking into account the diversity of water treatment systems, distribution systems, operating time and need of taking point measures aimed at each of them(AU)

A green and efficient procedure for the preconcentration and determination of cadmium, nickel and zinc from freshwater, hemodialysis solutions and tuna fish samples by cloud point extraction and flame atomic absorption spectrometry.

Cloud point extraction (CPE) was used to simultaneously preconcentrate trace-level cadmium, nickel and zinc for determination by flame atomic absorption spectrometry (FAAS). 1-(2-Pyridilazo)-2-naphthol (PAN) was used as a complexing agent, and the metal complexes were extracted from the aqueous phase by the surfactant Triton X-114 ((1,1,3,3-tetramethylbutyl)phenyl-polyethylene glycol). Under optimized complexation and extraction conditions, the limits of detection were 0.37µgL(-1) (Cd), 2.6µgL(-1) (Ni) and 2.3µgL(-1) (Zn). This extraction was quantitative with a preconcentration factor of 30 and enrichment factor estimated to be 42, 40 and 43, respectively. The method was applied to different complex samples, and the accuracy was evaluated by analyzing a water standard reference material (NIST SRM 1643e), yielding results in agreement with the certified values.

Desempeño analítico de los métodos de control de calidad de una solución concentrada para hemodiálisis / Analytical performance of the quality control methods in a concentrated solution for hemodialysis

Objetivo: evaluar el desempeño de los métodos de cuantificación de los iones sodio, potasio, cloruro, calcio y magnesio en una solución concentrada para hemodiálisis con bicarbonato. Métodos: los cinco métodos aparecen informados en la farmacopea británica. Para la verificación del desempeño, se utilizaron los parámetros, linealidad, exactitud y precisión. Se empleó el método de placebo enriquecido utilizando niveles de 60 a 140 por ciento de la concentración nominal de cada ion. Resultados: los cinco métodos resultaron lineales en el intervalo de concentraciones evaluadas, fueron precisos y exactos, con coeficientes de variación global menor que 1,75 por ciento, y una recuperación entre 100 ± 3 por ciento. Conclusiones: los métodos de cuantificación de los iones presentes en la solución concentrada para hemodiálisis con bicarbonato, permiten obtener resultados fiables en las condiciones analíticas practicadas en esta investigación(AU)

Objective: to evaluate the analytical performance of the sodium, potassium, chloride, calcium and magnesium ions quantification methods, in a concentrated solution with bicarbonate for hemodyalisis. Methods: the five analytical methods are reported on the official British pharmacopeia. The performance evaluation was made by verifying linearity, accuracy and precision. In all cases, the enriched placebo method was used, with concentration levels from 60 to 140 percent of the standard concentration value of each ion. Results: the five methods showed linearity in the evaluated concentration range; they were accurate and precise with global variation coefficients lower than 1.75 percent, and a recovery rate of 100 ± 3 percent. Conclusions: the quantification methods for the ions present in concentrated solution with bicarbonate for hemodialysis, allows obtaining reliable results under the analytical conditions used in this research(AU)

Factors determining a low dose of haemodialysis as measured by ionic dialysance in critical patients with acute kidney injury.

BACKGROUND: Estimating the dialysis dose is a requirement commonly used to assess the quality of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD). In patients with acute kidney injury (AKI), this value is not always evaluated and it has been estimated that the prescribed dose is seldom obtained. Reports addressing this issue in AKI individuals are scarce and most have not included an adequate number of patients or treatments, nor were patients treated with extended therapies. Kt values obtained by the ionic dialysance method have been validated for the evaluation of the dialysis dose and it has also been shown that, compared with Kt/V, this is the most sensitive strategy for revealing inadequate dialysis treatment in critically ill AKI individuals. The main aim of this study was to assess the difference between the prescribed and the administered dialysis dose in critically ill AKI patients, and to evaluate what factors determine this gap using Kt values assessed through ionic dialisance. MATERIAL AND METHOD: Data from 394 sessions of renal replacement therapy in 105 adult haemodialysis (HD) patients with oliguric acute kidney injury and admitted to ICU were included in this analysis. RRT was carried out with Fresenius 4008E dialysis machines equipped with on-line clearance monitoring (OCM® Fresenius), which use non-invasive techniques to monitor the effective ionic dialysance, equivalent to urea clearance. The baseline characteristics of the study population as well as the prescription and outcome of RRT were analysed. These variables were included in a multivariate model in which the dependent variable was the failure to obtain the threshold dose (TD). RESULTS: The main baseline characteristics of the study population/treatments were: age 66 ± 15 years, 37% female, most frequent cause of AKI: sepsis (70%). Low BP and/or vasoactive drug requirement (71%), mechanical ventilation (70%) and average individual severity index: 0.7 ± 0.26. Two hundred and one intermittent HD (IHD) and 193 extended HD (EHD) sessions were performed; the most frequently used temporary vascular access was the femoral vein catheter (79%). Prescribed Kt was 53.5 ± 14L and 21% of prescriptions fell below the TD. Sixty-one percent of treatments did not fulfill the TD (31 ± 8L) compared with 56 ± 12L obtained in the subgroup that achieved the target. Compared to IHD, EHD provided a significantly larger Kt (46 ± 16L vs 33L ± 9L). Univariate analysis showed that inadequate compliance was associated with age (>65y), male gender, intra-dialytic hypotension, low Qb, catheter line reversal, and IHD. The same variables with the exception of age and gender were independently associated in the multivariate analysis. CONCLUSIONS: The dialysis dose obtained was significantly lower than that prescribed. EHD achieved values closer to the prescribed KT and significantly higher than in IHD. Ionic Kt measurement facilitates monitoring and allows HD treatments to be extended based upon a previously established TD. Besides the chosen strategy to dispense the dose of dialysis, a well-functioning vascular access allowing for optimal blood flow and other approaches aimed at avoiding hemodynamic instability during RRT are the most important factors to achieve TD, mainly in elderly male patients. The dialysis dose should be prescribed and monitored for all critically ill AKI patients.

Calculation of Kt/V in haemodialysis: a comparison between the formulas.

INTRODUCTION: The quality of delivered dialysis can be measured by the Kt/V ratio, which can be calculated in various ways. OBJECTIVE: To compare the Kt/V ratio obtained with the formulas of Lowrie (L) and Daugirdas (D) with the results measured by an Online Clearance Monitor (OCM). METHOD: Observational, cross-sectional study of 59 patients on hemodialysis (HD). Data were collected in the same dialysis session (predialysis and postdialysis urea) and Kt/V was calculated by the OCM of the Fresenius 4008S machine (Fresenius Medical Care AG, Bad Homburg, Germany). RESULTS: A total of 95 sessions were assessed, with a predominance of males 56% (33), and a sample mean age of 57 + 14 years. Hypertension (42%; n = 25), diabetes (12%; n = 7) and glomerulonephritides (8%; n = 5) were the most frequent causes of chronic kidney disease (CKD). Mean Kt/V values obtained with the L and D formulas and the OCM were 1.31, 1.41 and 1.32, respectively. Comparison between the L and D formulas showed a statistically significant difference (p = 0.008), with a Pearson's correlation of 0.950. The difference between the D formula and the OCM was also significant (p = 0.011 and r = 0.346), probably due to convective loss, estimated by the D formula but not by the OCM and L formula. The difference between the L formula and the OCM was not significant (p = 0.999 and r = 0.577). CONCLUSION: These data suggest that the OCM can be used as a guide to the real-time adjustment of the dialysis dose.

Cálculo de Kt/V em hemodiálise: comparação entre fórmulas / Calculation of Kt/V in haemodialysis: a comparison between the formulas

INTRODUÇÃO: A qualidade da diálise oferecida aos pacientes em diálise pode ser mensurada pelo Kt/V, o qual pode ser calculado de diversas maneiras. OBJETIVO: Comparar os resultados de Kt/V obtidos por meio das fórmulas de Lowrie (L) e de Daugirdas (D) com os resultados mensurados pelo monitor de clearence on-line - Online Clearence Monitor (OCM). MÉTODO: Estudo observacional transversal com 59 pacientes em hemodiálise (HD). Os dados foram coletados na mesma sessão de diálise: (ureia pré-diálise e pós-diálise) e o resultado de Kt/V foi obtido pelo OCM da máquina Fresenius 4008S (Fresenius Medical Care AG, Bad Homburg, Alemanha). RESULTADO: Foram analisadas 95 sessões, em que prevaleceu o sexo masculino, 56% (33), com idade média de 57 + 14 anos. A hipertensão arterial com 42% (25), diabetes com 12% (7) e glomerulonefrite com 8% (5) foram as causas mais frequentes da doença renal crônica (DRC). O Kt/V médio obtido pela fórmula de L, de D e pelo OCM foi de 1,31; 1,41 e 1,32, respectivamente. A comparação entre as fórmulas de L e D mostra que há diferença estatística p = 0,008 com a correlação de Pearson de 0,950. Entre D e OCM a diferença também é significativa: p = 0,011 e r = 0,346, provavelmente devido a perda convectiva, avaliada pela equação de D e não observadas por OCM e L. A comparação entre L e OCM não foi significativa p = 0,999 e r = 0,577. CONCLUSÃO: Os dados sugerem que o OCM pode ser utilizado como um norteador para ajuste da dose de diálise em tempo real.

INTRODUCTION: The quality of delivered dialysis can be measured by the Kt/V ratio, which can be calculated in various ways. OBJECTIVE: To compare the Kt/V ratio obtained with the formulas of Lowrie (L) and Daugirdas (D) with the results measured by an Online Clearance Monitor (OCM). Method: Observational, cross-sectional study of 59 patients on hemodialysis (HD). Data were collected in the same dialysis session (predialysis and postdialysis urea) and Kt/V was calculated by the OCM of the Fresenius 4008S machine (Fresenius Medical Care AG, Bad Homburg, Germany). RESULTS: A total of 95 sessions were assessed, with a predominance of males 56% (33), and a sample mean age of 57 + 14 years. Hypertension (42%; n = 25), diabetes (12%; n = 7) and glomerulonephritides (8%; n = 5) were the most frequent causes of chronic kidney disease (CKD). Mean Kt/V values obtained with the L and D formulas and the OCM were 1.31, 1.41 and 1.32, respectively. Comparison between the L and D formulas showed a statistically significant difference (p = 0.008), with a Pearson's correlation of 0.950. The difference between the D formula and the OCM was also significant (p = 0.011 and r = 0.346), probably due to convective loss, estimated by the D formula but not by the OCM and L formula. The difference between the L formula and the OCM was not significant (p = 0.999 and r = 0.577). CONCLUSION: These data suggest that the OCM can be used as a guide to the real-time adjustment of the dialysis dose.

Candida parapsilosis complex water isolates from a haemodialysis unit: biofilm production and in vitro evaluation of the use of clinical antifungals.

Candida parapsilosis, currently divided into three distinct species, proliferates in glucose-rich solutions and has been associated with infections resulting from the use of medical devices made of plastic, an environment common in dialysis centres. The aims of this study were (i) to screen for Candida orthopsilosis and Candida metapsilosis (100 environmental isolates previously identified as C. parapsilosis), (ii) to test the ability of these isolates to form biofilm and (iii) to investigate the in vitro susceptibility of Candida spp biofilms to the antifungal agents, fluconazole (FLC) and amphotericin B (AMB). Isolates were obtained from a hydraulic circuit collected from a haemodialysis unit. Based on molecular criteria, 47 strains were re-identified as C. orthopsilosis and 53 as C. parapsilosis. Analyses using a formazan salt reduction assay and total viable count, together with microscopy studies, revealed that 72 strains were able to form biofilm that was structurally similar, but with minor differences in morphology. A microtitre-based colorimetric assay used to test the susceptibility of fungal biofilms to AMB and FLC demonstrated that the C. parapsilosis complex displayed an increased resistance to these antifungal agents. The results from these analyses may provide a basis for implementing quality controls and monitoring to ensure the microbiological purity of dialysis water, including the presence of yeast.

Candida parapsilosis complex water isolates from a haemodialysis unit: biofilm production and in vitro evaluation of the use of clinical antifungals

Candida parapsilosis, currently divided into three distinct species, proliferates in glucose-rich solutions and has been associated with infections resulting from the use of medical devices made of plastic, an environment common in dialysis centres. The aims of this study were (i) to screen for Candida orthopsilosis and Candida metapsilosis (100 environmental isolates previously identified as C. parapsilosis), (ii) to test the ability of these isolates to form biofilm and (iii) to investigate the in vitro susceptibility of Candida spp biofilms to the antifungal agents, fluconazole (FLC) and amphotericin B (AMB). Isolates were obtained from a hydraulic circuit collected from a haemodialysis unit. Based on molecular criteria, 47 strains were re-identified as C. orthopsilosis and 53 as C. parapsilosis. Analyses using a formazan salt reduction assay and total viable count, together with microscopy studies, revealed that 72 strains were able to form biofilm that was structurally similar, but with minor differences in morphology. A microtitre-based colorimetric assay used to test the susceptibility of fungal biofilms to AMB and FLC demonstrated that the C. parapsilosis complex displayed an increased resistance to these antifungal agents. The results from these analyses may provide a basis for implementing quality controls and monitoring to ensure the microbiological purity of dialysis water, including the presence of yeast.