Pruritus in dialysis patients. Review and new perspectives.

Uremic pruritus (UP) is one of the most uncomfortable symptoms for patients in dialysis. UP has a great impact on dialysis patients' quality of life and has a great prevalence between those (28-70%). Physiopathology of UP is unknown and usually is unnoticed for most nephrologists (in more than 65% of centers is underdiagnosed). This lack of awareness drives to the unsuccessful treatment of this symptom. Moreover, the fact that most studies have been carried out on small populations and the difficulty assessing UP complicates a correct therapeutical approach. For this reason, we have designed treatment algorithms based on the efficacy of the drugs but also its safeness to avoid adverse effects.

Prurito en pacientes en diálisis. Revisión de la literatura y nuevas perspectivas / Pruritus in dialysis patients. Review and new perspectives

El prurito es uno de los síntomas más incómodos y que más impacta en la calidad de vida de los pacientes en diálisis. Su prevalencia es bastante elevada en pacientes en diálisis (28-70%). La fisiopatología del prurito urémico es desconocida, y este síntoma a menudo pasa desapercibido para el personal sanitario, siendo infradiagnosticado en más del 65% de los centros. Esta falta de reconocimiento deriva en un abordaje terapéutico ineficaz del prurito urémico. Por otro lado, la mayoría de los ensayos farmacológicos para el tratamiento del prurito urémico han sido realizados en poblaciones reducidas y están sujetos a la subjetiva medición del propio síntoma. Por este motivo, hemos propuesto algoritmos de tratamiento, teniendo en cuenta la evidencia que avala a cada fármaco y a la vez la pluripatología y la polifarmacia de cada paciente, con el fin de evitar efectos adversos. (AU)

Uremic pruritus (UP) is one of the most uncomfortable symptoms for patients in dialysis. UP has a great impact on dialysis patients’ quality of life and has a great prevalence between those (28–70%). Physiopathology of UP is unknown and usually is unnoticed for most nephrologists (in more than 65% of centers is underdiagnosed). This lack of awareness drives to the unsuccessful treatment of this symptom. Moreover, the fact that most studies have been carried out on small populations and the difficulty assessing UP complicates a correct therapeutical approach. For this reason, we have designed treatment algorithms based on the efficacy of the drugs but also its safeness to avoid adverse effects. (AU)

The Effect of Nutritional Interventions on Long-Term Patient Survival in Advanced Chronic Kidney Disease.

Patients with end-stage kidney disease (ESKD) are at high risk of malnutrition and subsequent related mortality when starting dialysis. However, there have been few clinical studies on the effect of nutritional interventions on long-term patient survival. A 2-year longitudinal study was conducted from January 2012 to December 2016. A total of 186 patients with non-dialysis ESKD started the nutritional education program (NEP), and 169 completed it. A total of 128 patients participated in a NEP over 6 months (personalized diet, education and oral supplementation, if needed). The control group (n = 45) underwent no specific nutritional intervention. The hospitalization rate was significantly lower for the patients with NEP (13.7%) compared with the control patients (26.7%) (p = 0.004). The mortality odds ratio for the patients who did not receive NEP was 2.883 (95% CI 0.993-8.3365, p = 0.051). The multivariate analysis showed an independent association between mortality and age (OR, 1.103; 95% CI 1.041-1.169; p = 0.001) and between mortality and the female sex (OR, 3.332; 95% CI 1.054-10.535; p = 0.040) but not between mortality and those with NEP (p = 0.051). Individualized nutrition education has long-term positive effects on nutritional status, reduces hospital admissions and increases survival among patients with advanced CKD who are starting dialysis programs.

Pruritus in dialysis patients. Review and new perspectives. / Prurito en pacientes en diálisis. Revisión de la literatura y nuevas perspectivas.

Uremic pruritus (UP) is one of the most uncomfortable symptoms for patients in dialysis. UP has a great impact on dialysis patients' quality of life and has a great prevalence between those (28-70%). Physiopathology of UP is unknown and usually is unnoticed for most nephrologists (in more than 65% of centers is underdiagnosed). This lack of awareness drives to the unsuccessful treatment of this symptom. Moreover, the fact that most studies have been carried out on small populations and the difficulty assessing UP complicates a correct therapeutical approach. For this reason, we have designed treatment algorithms based on the efficacy of the drugs but also its safeness to avoid adverse effects.

Hernia de Morgagni en diálisis peritoneal incremental: ¿es posible continuar con la técnica? / Morgagni hernia in incremental peritoneal dialysis: Is it possible to continue with the technique?

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Peritonitis esclerosante encapsulante asociada a la diálisis peritoneal. Una revisión y una iniciativa unitaria europea para abordar el cuidado de una enfermedad rara / ncapsulating Peritoneal Sclerosis in Peritoneal Dialysis. A review and European initiative for approaching a serious and rare disease

La peritonitis esclerosante encapsulante (EPS) representa una complicación rara de la diálisis peritoneal (DP) con una alta mortalidad. Se caracteriza por la fibrosis difusa de la membrana peritoneal que progresa a encapsulamiento y se manifiesta con signos y síntomas de obstrucción intestinal. Su incidencia varía desde el 0,7 al 3,3 %. El factor de riesgo más importante en su desarrollo es el tiempo de exposición a las soluciones de DP, aunque posiblemente la edad joven y los episodios de peritonitis puedan contribuir. Su etiopatogenia no está claramente dilucidada y se cree que, sobre una membrana peritoneal lesionada, un segundo estímulo (second hit) como las peritonitis, hemoperitoneos, cirugías, predisposición genética, etc., puedan desencadenar el desarrollo de EPS. Algunos casos aparecen tras la transferencia a hemodiálisis o tras el trasplante, lo que quizá tenga relación con el uso de inhibidores de la calcineurina. La presencia de síntomas y signos de obstrucción intestinal, junto con los hallazgos radiológicos y/o anatómicos compatibles, permiten confirmar el diagnóstico. Su detección precoz es imprescindible, aunque en la actualidad no existen marcadores clínicos ni bioquímicos capaces de predecir su aparición. En el manejo terapéutico se emplean inmunosupresores como los esteroides y el tamoxifeno, la nutrición y, en casos más avanzados, la cirugía de adhesiolisis, con resultados variables. En esta revisión se discute el diagnóstico y tratamiento de la EPS, se promueve la participación en el Registro Europeo y se aboga por la necesidad de centralizar el manejo de esta complicación (AU)

Encapsulating peritoneal sclerosis (EPS) represents a rare complication in peritoneal dialysis (PD) with high mortality. It is characterised by diffuse peritoneal membrane fibrosis, which develops into encapsulation and manifests as clinical signs and symptoms of intestinal obstruction. Its incidence varies from 0.7%to 3.3%. The most significant risk factor in its development is exposure time to PD solutions, although young age and peritonitis episodes can also contribute. Its aetiopathogeny has not been clearly explained and it is thought that a second hit like peritonitis, hemoperitoneum, surgery, genetic predisposition, etc on an already damaged peritoneal membrane, could also trigger the development of EPS. Some cases appear after transfer to haemodialysis or after transplant. In these cases, the use of calcineurin inhibitors is believed to be related. The presence of clinical symptoms and signs of intestinal obstruction, along with compatible radiological and/or anatomical findings could also confirm the diagnosis. At present there are no clinical or biochemical markers capable of predicting its onset. Therapeutic management comprises the use of immunosuppressors like steroids and tamoxifen, nutritional management and even surgery in advanced cases, all of which provide varying results. This article discusses the diagnosis and treatment of EPS, it encourages the participation in the European Registry and it advocates the need to centralise the management of this medical complication (AU)

Encapsulating peritoneal sclerosis in peritoneal dialysis. a review and European initiative for approaching a serious and rare disease.

Encapsulating peritoneal sclerosis (EPS) represents a rare complication in peritoneal dialysis (PD) with high mortality. It is characterised by diffuse peritoneal membrane fibrosis, which develops into encapsulation and manifests as clinical signs and symptoms of intestinal obstruction. Its incidence varies from 0.7%to 3.3%. The most significant risk factor in its development is exposure time to PD solutions, although young age and peritonitis episodes can also contribute. Its aetiopathogeny has not been clearly explained and it is thought that a second hit like peritonitis, hemoperitoneum, surgery, genetic predisposition, etc on an already damaged peritoneal membrane, could also trigger the development of EPS. Some cases appear after transfer to haemodialysis or after transplant. In these cases, the use of calcineurin inhibitors is believed to be related. The presence of clinical symptoms and signs of intestinal obstruction, along with compatible radiological and/or anatomical findings could also confirm the diagnosis. At present there are no clinical or biochemical markers capable of predicting its onset. Therapeutic management comprises the use of immunosuppressors like steroids and tamoxifen, nutritional management and even surgery in advanced cases, all of which provide varying results. This article discusses the diagnosis and treatment of EPS, it encourages the participation in the European Registry and it advocates the need to centralise the management of this medical complication.

Experiencia en la administración de quimioterapia intraperitoneal en una unidad de diálisis peritoneal / No disponible

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