Compliance With Biochemical Objectives in Patients on Renal Replacement Therapy Before Kidney Transplantation in Mexico.

OBJECTIVES: The biochemical conditions in which patients arrive before renal transplantation (RT) are rarely evaluated; examples of them are found in the Dialysis Outcomes and Practice Patterns Study (DOPPS). The objective of our study was to ascertain the fulfillment of biochemical goals for patients on renal replacement therapy before RT. MATERIAL AND METHODS: Observational, retrospective study of patients who were on a RT protocol between 2012 and 2017 in 2 RT centers in Mexico. The records of 1188 patients with a history of RT and their lab results before transplantation were analyzed. Anthropometric values including hemoglobin, iron levels, calcium, phosphorus, parathyroid hormone, urea, creatinine, uric acid, and left ventricular ejection fraction were studied. All values were categorized as low, optimal, or high levels. RESULTS: The fulfillment of pretransplant biochemical objectives for elimination of azotemia (urea and creatinine) was achieved in 60% of the patients. Optimal values for calcium were found in 715 (64%) patients and optimal values for albumin were found in 690 (61.8%) patients. In the case of phosphorus, hemoglobin, uric acid, and parathyroid hormone, the optimal values were below 50%. CONCLUSIONS: It is essential to improve compliance with biochemical and clinical objectives for patients on renal replacement therapy (dialysis, hemodialysis) before RT. Only half of the variables were within the optimal range before surgical intervention took place.

Holter heart rhythm disorders in patients with acute kidney injury during hemodialysis / Trastornos del ritmo cardiaco por Holter en pacientes con lesión renal aguda durante hemodiálisis

BACKGROUND: The presence of acute renal injury has been associated with increased cardiovascular morbidity and mortality (sudden death and arrhythmias). OBJECTIVE: To know the frequency of heart rhythm disorders documented by Holter in patients in need of intermittent hemodialysis due to acute renal injury. MATERIAL AND METHODS: A prospective observational study was conducted including patients with a diagnosis of acute renal injury who received intermittent hemodialysis; demographic, clinical and laboratory data were collected from 28 patients. Monitoring was carried out through Holter before, during and after the hemodialysis session. Nonparametric statistics were used, with a significant value of p < 0.05. Risks were established with logistic regression. RESULTS: There was a significant difference in supraventricular extra systoles (82.1% vs. 57.1%), ventricular extra systoles (26.7% vs. 3.6%), and supraventricular tachycardia (6.7% vs. 3.6%). The rest of the rhythm alterations without significance. CONCLUSIONS: Intermittent hemodialysis is a factor associated with the appearance of heart rhythm disorders. The death of patients with acute renal injury and substitution was related to ventricular extra systole detected by transhemodialysis Holter.

INTRODUCCIÓN: La presencia de lesión renal aguda se ha asociado a unas mayores morbilidad y mortalidad de causa cardiovascular (muerte súbita y arritmias). OBJETIVO: Conocer la frecuencia de trastornos del ritmo cardiaco documentado por Holter en pacientes con necesidad de hemodiálisis intermitente por lesión renal aguda. MATERIAL Y MÉTODOS: Se realizó un estudio observacional, prospectivo, en pacientes con diagnóstico de lesión renal aguda que recibieron hemodiálisis intermitente; se recabaron datos demográficos, clínicos y de laboratorio de 28 pacientes. Se realizó monitoreo mediante Holter, previo, durante y posterior a la sesión de hemodiálisis. Se utilizó estadística no paramétrica, con un valor significativo de p < 0.05. Se establecieron riesgos con regresión logística. RESULTADOS: Hubo diferencia significativa en extrasístoles supraventriculares (82.1% frente a 57.1%), extrasístoles ventriculares (26.7% frente a 3.6%) y taquicardia supraventricular (6.7% frente a 3.6%). El resto de las alteraciones del ritmo no mostraron significancia. CONCLUSIONES: La hemodiálisis intermitente es un factor asociado a la aparición de trastornos del ritmo cardiaco. La muerte de los pacientes con lesión renal aguda y sustitución estuvo relacionada con la extrasístole ventricular detectada por Holter transhemodiálisis.

COVID-19 pandemic in Mexico: surveillance protocol in intrahospital hemodialysis units. / Pandemia COVID-19 en México: protocolo de vigilancia en unidades de hemodiálisis intrahospitalarias.

On January 30 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as epidemiological emergency. Globally, various guidelines have been published for the safety of patients with chronic kidney disease (CKD) and health personnel working in hemodialysis centers. In Mexico, the prevalence of CKD is 12.2% and 60,000 patients receive some modality of renal replacement therapy at the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security). This proposal for action is made in the face of suspected and confirmed cases of COVID-19 in intrahospital hemodialysis units.

El 30 de enero de 2020, la Organización Mundial de la Salud (OMS) declaró el brote de COVID-19 como emergencia epidemiológica. A nivel mundial han surgido diversos lineamientos para la seguridad de los pacientes que padecen enfermedad renal crónica (ERC) y el personal de salud que labora en centros de hemodiálisis. En México, la prevalencia de ERC es de 12.2% y 60 000 enfermos reciben alguna modalidad de terapia de reemplazo renal en el Instituto Mexicano del Seguro Social (IMSS). Se realiza esta propuesta de actuación ante casos sospechosos y confirmados de COVID-19 en unidades de hemodiálisis intrahospitalaria.