Association between prehospital lactate categories with short- and long-term mortality: a prospective, observational multicenter study.

BACKGROUND: Lactate is an already recognized biomarker for short-term mortality in emergency medical services (EMS). However, how different levels of lactate are associated with short-, mid- and long-term outcomes should be unveiled. AIM: To determine how different categories of hyperlactatemia are associated with mortality. We also aim to clinically characterize hyperlactatemia groups. DESIGN: A multicenter, prospective, observational study performed between January 2019 and February 2022, considering 48 basic life support units and 5 advanced life support units referring to 4 tertiary care hospitals (Spain). Patients were recruited from phone requests for emergency assistance in adults, evacuated to emergency departments. The primary outcome was in-hospital mortality from any cause within the first to the 365-day period following EMS attendance. The main measures were demographical and biochemical variables, prehospital advanced life support techniques used and patient condition categorized in 24 diseases. METHODS: Univariate and Cox regression analysis. RESULTS: A total of 5072 participants fulfilled inclusion criteria. Group #1 (non-hyperlactatemia) was composed of 2389 subjects (47.1%), Group #2 (mild hyperlactatemia) of 1834 (36.1%), Group #3 (hyperlactatemia) of 333 (6.6%) and, finally, Group #4 (severe hyperlactatemia) of 516 (10.2%). The 1-day mortality was 0.2%, 1.1%, 9% and 22.3% in the four lactate groups, respectively. Long-term mortality (365 days) was 10.2%, 22.7%, 38.7% and 46.7% in the four lactate groups, respectively. Differences between patients' conditions of lactatemia groups were also found. CONCLUSIONS: Our results demonstrated that prehospital lactate categories were associated with short- and long-term outcomes in a different manner. These results will allow EMS to establish different risk states according to the prehospital lactate categories.

Eficacia del tratamiento fisioterápico en atención primaria, mediante consulta no presencial, a un paciente dado de alta de neumonía por Coronavirus / Efficacy of primary health care physical therapy treatment using telephonic remote consultation to attend a patient discharged after coronavirus pneumonia

ANTECEDENTES Y OBJETIVO: La pandemia actual por el Coronavirus SARS-Cov-2 está generando un elevado número de pacientes que necesitan ingreso hospitalario por neumonía y que, tras su alta hospitalaria, precisan de un control evolutivo por persistencia de sintomatología. Dada la poca evidencia existente sobre el abordaje fisioterápico de estos pacientes, y las restricciones de acceso al centro de salud, el objetivo es comprobar si una intervención de fisioterapia en atención primaria, realizada a un paciente a través de consulta no presencial (CNP), es eficaz. MATERIAL Y MÉTODOS: Se realizó la intervención fisioterápica: mediante CNP por vía telefónica a un paciente varón de 47 años, a los 7 días tras ser dado de alta de neumonía por Coronavirus. Se efectuó seguimiento de la disnea a través de escala de Borg modificada y la escala del Medical Research Council, pruebas de función física a través del Short Physical Performance Battery (SPPB) y de la calidad de vida relacionada con la salud mediante la encuesta EuroQol-5D, así como del control evolutivo de constantes fisiológicas (temperatura, frecuencia cardiaca y saturación de oxígeno) durante 28 días de seguimiento. La intervención consistió en un programa de educación para la salud y ejercicio terapéutico. RESULTADOS Y CONCLUSIONES: El programa de atención fisioterápica telefónica ha permitido el tratamiento y el seguimiento del paciente (variables fisiológicas, Short Physical Performance Battery, calidad de visa relacionada con la salud, en las que se ha objetivado mejoría), por lo que este tipo de intervenciones mediante CNP, para pacientes dados de alta de neumonía por Coronavirus, merecen ser estudiados en profundidad en futuros estudios

BACKGROUND AND OBJECTIVE: The current SARS-Cov-2 Coronavirus pandemic is resulting in a high number of patients who need hospital admission for pneumonia and in many cases subsequent follow-up due to persistent symptoms after discharge. Since there is little existing evidence on the physiotherapy treatment approach, and there are restrictions to usual consultation, the aim is to check whether Physical Therapy Primary Care (PTPC) intervention through remote consultation is effective. MATERIAL AND METHODS: A 47-year-old male patient with Coronavirus pneumonia underwent a physiotherapy intervention through remote consultation (RC) over the phone 7 days after being discharged. On the one hand, dyspnoea was followed up by employing the modified Borg scale and modified Medical Research Council scale (mMRC), where physical function is assessed through the Short Physical Performance Battery (SPPB). On the other hand, the Health Related Quality of Life (HRQL) was assessed through the EuroQol-5D questionnaire, and vital signs (temperature, heart rate and oxygen pressure) were monitored for 28 days. The intervention consisted of an educational programme for health and exercise therapy. RESULTS AND CONCLUSIONS: The physiotherapy phone consultation programme allowed the treatment and follow up of this patient (physiological variables, SPPB and HRQL) which resulted in improvement. Therefore, we suggest future trials are worth undertaking to study in-depth interventions based on remote consultation directed at these patients with Coronavirus pneumonia after discharge

A General Protocol for Cu-Mediated Fluoro-deamination: Sandmeyer Fluorination of Diverse Aromatic Substrates.

A Cu(I)-mediated fluoro-deamination method for nucleophilic radiofluorination was devised. The method affords fluorinated aromatic products directly from anilines under both no-carrier added and stoichiometric conditions. Isolated radiochemical yields range from 11% to 81% with high radiochemical purities and a molar activity of 58 MBq/nmol. The reaction conditions were implemented successfully in an automated process for production of (S)-4[18F]fluorogluthetimide on a radiosynthesis module.

Programa multifactorial para la prevención de caídas: un proyecto multifactorial en el ámbito rural / Multifactorial program for the prevention of falls: a multifactorial proyect in the rural area

No disponible

Cumulative iron dose and resistance to erythropoietin.

INTRODUCTION: Optimizing anemia treatment in hemodialysis (HD) patients remains a priority worldwide as it has significant health and financial implications. Our aim was to evaluate in a large cohort of chronic HD patients in Fresenius Medical Care centers in Spain the value of cumulative iron (Fe) dose monitoring for the management of iron therapy in erythropoiesis-stimulating agent (ESA)-treated patients, and the relationship between cumulative iron dose and risk of hospitalization. METHODS: Demographic, clinical and laboratory parameters from EuCliD(®) (European Clinical Dialysis Database) on 3,591 patients were recorded including ESA dose (UI/kg/week), erythropoietin resistance index (ERI) [U.I weekly/kg/gr hemoglobin (Hb)] and hospitalizations. Moreover the cumulative Fe dose (mg/kg of bodyweight) administered over the last 2 years was calculated. Univariate and multivariate analyses were performed to identify the main predictors of ESA resistance and risk of hospitalization. Patients belonging to the 4th quartile of ERI were defined as hypo-responders. RESULTS: The 2-year iron cumulative dose was significantly higher in the 4th quartile of ERI. In hypo-responders, 2-year cumulative iron dose was the only iron marker associated with ESA resistance. At case-mix adjusted multivariate analysis, 2-year iron cumulative dose was an independent predictor of hospitalization risk. DISCUSSION: In ESA-treated patients cumulative Fe dose could be a useful tool to monitor the appropriateness of Fe therapy and to prevent iron overload. To establish whether the associations between cumulative iron dose, ERI and hospitalization risk are causal or attributable to selection bias by indication, clinical trials are necessary.

Risk in dosing regimens for 25-OH vitamin D supplementation in chronic haemodialysis patients.

INTRODUCTION: 25-OH vitamin D (25-OHvitD) insufficiency or deficiency should be treated in haemodialysis (HD) patients, although the 25-OHvitD target, drug or dosing regimens are unclear. AIMS: To describe factors associated with 25-OHvitD levels in HD patients and to assess the effect of three dosing regimens to supplement 25-OHvitD (calcifediol) on serum calcium (Ca), phosphate (P), parathyroid hormone (PTH), 25-OHvitD and 1,25-OHvitD. METHODS: Two hundred and seventeen patients from three HD units were studied. Demographic and biochemical data were collected at baseline. Two different 25-OHvitD assays were used. One hundred and sixty-seven patients were treated with various calcifediol dosing regimens. The same biochemical determinations were repeated after 3 months of treatment. RESULTS: At baseline, 12.9% of patients had 25-OHvitD <10 ng/ml. In multivariate linear regression, the season (lower in winter) and the assay method were determinants of 25-OHvitD concentration. Following calcifediol supplementation, 25-OHvitD, calcium and phosphate increased, while PTH diminished with statistical significance. After treatment, there were positive correlations between 25-OHvitD and Ca (r = 0.28, p < 0.0001) or 1,25-OHvitD (r = 0.75, p < 0.0001) that were not observed in the baseline dataset. High concentrations of post-treatment 25-OHvitD were associated with higher 1,25-OHvitD levels. Calcemia increased more in those treated with concomitant active vitamin D or those having suppressed baseline PTH, while PTH decreased more in those having above-target PTH levels. CONCLUSIONS: Standardisation of methods to determine 25-OHvitD blood levels is needed. In HD patients, calcifediol increased 25-OHvitD, calcemia and phosphatemia and lowered PTH. Caution should be exercised with the higher calcifediol dosing regimens, especially in patients with suppressed PTH or on vitamin D receptor activators.

Clinical application of Ultracontrol®: infusion volume and use with different dialyzers.

INTRODUCTION: Recent studies indicate that the survival benefit with post-dilution on line hemodiafiltration (OL-HDF-post) are achieved if the infusion volume (Vinf) is greater than 20L per session, a goal that is not easily achieved due to hemoconcentration problems. Today we have automated techniques to achieve higher performance minimizing the number of alarms as Ultracontrol® (Ultrac). The objective in the first part of study was to evaluate the UltraC performance (expressed as the filtration fraction (FF) and Vinf) and which problems it presents, and in the second part, to study its performance with four different dialyzers. MATERIAL AND METHODS: 1st period. Nine patients were transferred to OL-HDF-post with UltraC. The first 3 months on OL-HDF all sessions were recorded and compared with hemodialysis sessions in the previous month. 2nd part: 18 patients on chronic OL-HDF-post were dialyzed for a week with each of these dialyser: FX1000, FX800, Elisio210H and Polyflux210. RESULTS: 1st period: In 3 patients, problems associated with inappropriate pressures emerged. In 3 patients there were problems associated with inadequate PTM and Psist that resolved changing to pressure control. Mean values were: maximum Qb 441 (21) (range 350-490) ml/min, Vinf 26.3 (3.3) l/session, FF 30.6 (2.5)%, KT 59.9 (5) l/session. KT increase of 12% compared to HD. 2nd part: Polyflux210 required less UltraC withdrawals than the others. Different PTM or Psist were found and determined the need for removal of the system. The KT was adequate. a) The UltraC system reaches FF of 30% with minimal alarms and Vinf higher than 20 l. b) Structural characteristics of dialysers can limit their use with UltraC although they managed to desirable KT and Vinf in a manual way.

Sistema Ultracontrol® en la clínica diaria de la hemodiafiltración en línea posdilucional: volumen de infusión alcanzado y aplicabilidad con distintos dializadores / Clinical application of Ultracontrol®: infusion volume and use with different dialyzers

Introducción: Estudios recientes indican que los beneficios en la supervivencia con hemodiafiltración en línea posdilucional (HDFOL-post) se logran si el volumen de infusión (Vinf) es superior a 20 l por sesión, cifra que no es fácil lograr por los problemas que genera la hemoconcentración. Hoy día contamos con técnicas automáticas que logran un mayor rendimiento minimizando el número de alarmas como el Ultracontrol® (UltraC). Objetivo: El objetivo ha sido, en una primera parte, evaluar el UltraC para conocer qué rendimiento logra (expresado como la fracción de filtración [FF] y el Vinf) y los problemas que presenta y, en una segunda parte, estudiar su funcionamiento con cuatro dializadores diferentes. Material y métodos: Primera parte. Nueve pacientes fueron transferidos a HDFOL-post con UltraC. Se recogieron todas las sesiones correspondientes a los tres primeros meses con HDF-OL y al mes previo en HD. Segunda parte. 18 pacientes en tratamiento crónico con HDFOL-post fueron sometidos a diálisis una semana con cada uno de estos dializadores: FX1000, FX800, Polyflux210 y Elisio 210H. Resultados: Primera parte. En 3 pacientes surgieron problemas asociados a PTM y Psist inadecuadas que se (..) (AU)

Introduction: Recent studies indicate that the survival benefit with post-dilution on line hemodiafiltration (OL-HDF-post) are achieved if the infusion volume (Vinf) is greater than 20L per session, a goal that is not easily achieved due to hemoconcentration problems. Today we have automated techniques to achieve higher performance minimizing the number of alarms as Ultracontrol® (Ultrac). The objective in the first part of study was to evaluate the UltraC performance (expressed as the filtration fraction (FF) and Vinf) and which problems it presents, and in the second part, to study its performance with four different dialyzers. Material and methods: 1st period. Nine patients were transferred to OL-HDF-post with UltraC. The first 3 months on OL-HDF all sessions were recorded and compared with hemodialysis sessions in the previous month. 2nd part: 18 patients on chronic OL-HDF-post were dialyzed for a week with each of these dialyser: FX1000, FX800, Elisio210H and Polyflux210. Results: 1st period: In 3 patients, problems associated with inappropriate pressures emerged. In 3 patients there (..) (AU)

¿Hemos olvidado lo más importante para prevenir las bacteriemias en pacientes portadores de catéteres para hemodiálisis? / Have we forgotten the most important thing to prevent bacteremias associated with tunneled hemodialysis catheters?

La bacteriemia relacionada con el catéter (BRC) en pacientes en hemodiálisis (HD) es una complicación grave. Existen múltiples publicaciones que abogan por el uso de diferentes medidas farmacológicas para su prevención, pero muy pocas sobre la importancia de las medidas de precaución universal . El objetivo de este trabajo es mostrar la baja tasa de incidencia de BRC obtenida con la aplicación estricta de un protocolo de cuidados de catéter tunelizado (CT) por un personal bien entrenado en una nueva unidad de HD. Durante20 meses se aplicó un protocolo de manejo de CT por personal de enfermería cual i f i cado. Se ut i l izaron un total de 42 CT en 32 pacientes . El tiempo total de seguimiento fue de 8.372 días en los que ocurrieron dos episodios de BRC: 0,24 eventos /1.000 días - catéter. El trabajo muestra cómo sólo con medidas de precaución universal pueden lograr se tasas de BRC dentro de la excelencia (AU)

Bacteremia associated with tunneled central venous catheters (CVC) is a major complication in hemodialysis patients. Strategies that aim to prevent catheter-related bacteremia (CRB),ranging from the application of topical antibiotics to the use of different catheter-lock solutions, have been studied, but limited interest has been shown about following standardization of aseptic care and maintenance of CVC by experienced staff. This study reports CRB incidence obtained with astrict infection prophylaxis protocol based on universal precautions against infection adopted in our Unit by qualified nursing hemodialysis staff. During a period of 20 months, 32 patients received 42 CVC. There were 2 CRB, with an incidence of 0.24CRB/1000 days-catheter. This study shows that an optimal catheter-use management reduces the incidence of CRB to excellent rates. The use of a protocol directed to vigorously protect the catheter at the time of usage by specialized teams is critically important and is highly recommended (AU)

[Have we forgotten the most important thing to prevent bacteremias associated with tunneled hemodialysis catheters?]. / ¿Hemos olvidado lo más importante para prevenirlas bacteriemias en pacientes portadores de catéterespara hemodiálisis?

Bacteremia associated with tunneled central venous catheters (CVC) is a major complication in hemodialysis patients. Strategies that aim to prevent catheter-related bacteremia (CRB), ranging from the application of topical antibiotics to the use of different catheter-lock solutions, have been studied, but limited interest has been shown about following standardization of aseptic care and maintenance of CVC by experienced staff. This study reports CRB incidence obtained with a strict infection prophylaxis protocol based on universal precautions against infection adopted in our Unit by qualified nursing hemodialysis staff. During a period of 20 months, 32 patients received 42 CVC. There were 2 CRB, with an incidence of 0.24 CRB/1000 days-catheter. This study shows that an optimal catheter-use management reduces the incidence of CRB to excellent rates. The use of a protocol directed to vigorously protect the catheter at the time of usage by specialized teams is critically important and is highly recommended.

[Acetate-free on-line PHF: how to improve hyperacetatemia and haemodynamic tolerance]. / PHF on-line sin acetato: cómo mejorar la hiperacetatemia y la tolerancia hemodinámica.

SUMMARY BACKGROUND: The small quantity of acetate present in the dialysis fluid exposes patient's blood to an acetate concentration 30-40 times the physiological levels. This amount is even greater in hemodiafiltration on-line. Our purpose was to evaluate the clinical-analytical effects using three different dialysis techniques in the same patient. METHODS: 35 patients on hemodialysis were included. All patients were treated with conventional bicarbonate dialysate for 3 months, after randomization were switched to first be treated with PHF online with standard bicarbonate dialysate for 6 months and then switched to PHF on-line acetate-free dialysate for the other 6 months or to invert the two last periods. Blood samples were drawn monthly throughout the study and clinical data were obtained. RESULTS: Postdialysis blood acetate levels were higher in patients treated with conventional bicarbonate dialysate with respect to the period of PHF with free-acetate dialysate. Moreover, the percentage of patients with postdialysis blood acetate levels in the pathologic range was higher in patients treated with conventional bicarbonate dialysate respect to PHF on-line acetate-free dialysate period (61% vs. 30%). Serum concentrations of chloride postdialysis were higher and serum concentrations of bicarbonate pre and posthemodialysis were lower in the PHF free-acetate period. The incidence of hypotensive episodes was significantly lower in the PHF on-line with conventional dialysate. CONCLUSIONS: PHF on-line with free-acetate dialysate allows that most of patients finished hemodialysis with blood acetate levels in the physiologic ranges. PHF on-line is a predilutional hemodiafiltration treatment with better tolerance than hemodialysis with standard bicarbonate dialysate.

PHF on-line sin acetato: cómo mejorar la hiperacetatemia y la tolerancia hemodinámica / No disponible

Antecedentes: la presencia de acético en el Líquido de Diálisis (LD) expone al paciente a una concentración de acetato 30-40 veces superior a la normal. Dicha exposición aumenta en técnicas de Hemodiafiltración (HDF) online. El objetivo de dicho estudio fue evaluar los cambios clínico-analíticos al usar tres técnicas de Hemodiálisis(HD) diferentes. Métodos: se reclutaron 35 pacientes en HD estable. Se dializaron tres meses con HD convencional y luego fueron aleatorizados para pasar a una técnica de PHF on-line con concentrado convencional seis meses, y después pasaron a PHF on-line sin acetato otros seis meses. El otro grupo invertía estos dos períodos. Se obtuvieron análisis de sangre y datos clínicos de HD. Resultados: las medias de los acetatos posdiálisis fueron significativamente superiores durante los períodos de tratamiento con acético respecto al período sin acetato. El porcentaje de valores patológicos de acetato posdiálisis fue significativamente superior durante los períodos de tratamiento con acético (61 respecto al 30%). Las concentraciones de cloro pos-HD fueron superiores y las de bicarbonato pre y pos-HD fueron menores durante el período sin acético. El número de hipotensiones fue significativamente inferior en el período de PHF on-line con LD estándar respecto a los otros períodos. Conclusiones: la técnica de PHF on-line sin acetato disminuye la exposición a concentraciones elevadas de acetato y consigue que la mayoría de pacientes termine la HD con una acetatemia en el rango fisiológico. La PHF on-line es un tratamiento de HDF predilucional con mejor tolerancia que la HD estándar con bicarbonato (AU)

Summary Background: the small quantity of acetate present in the dialysis fluid exposes patient’s blood to an acetate concentration 30-40 times the physiological levels. This amountis even greater in hemodiafiltration on-line. Our purpose was to evaluate the clinical-analytical effects using three different dialysis techniques in the same patient. Methods: 35 patients on hemodialysis were included. All patients were treated with conventional bicarbonate dialysate for 3 months, after randomization were switched to first be treated with PHF online with standard bicarbonate dialysate for 6 months and then switched to PHF on-line acetate-free dialysate for the other 6months or to invert the two last periods. Blood samples were drawn monthly throughout the study and clinical data were obtained. Results: Posdialysis blood acetate levels were higher in patients treated with conventional bicarbonate dialysate with respect to the period of PHF with free-acetate dialysate. Moreover, the percentage of patients with posdialysis blood acetate levels in the pathologic range was higher in patients treated with conventional bicarbonate dialysate respect to PHF on-line acetate-free dialysate period (61% vs. 30%). Serum concentrations of chloride posdialysis were higher and serum concentrations of bicarbonate pre and poshemodialysis were lower in the PHF free-acetate period. The incidence of hypotensive episodes was significantly lower in the PHF on-line with conventional dialysate. Conclusions: PHF on-line with free-acetate dialysate allows that most of patients finished hemodialysis with blood acetate levels in the physiologic ranges. PHF on-line is a predilutional hemodiafiltration treatment with better tolerance than hemodialysis with standard bicarbonate dialysate (AU)

Papel fundamental del Sistema de Tratamiento del Agua (STA)en la calidad del agua parahemodiálisis / No disponible

No disponible

Hemodiafiltración en línea secuencial (HDF-OL-S): una nueva opción terapéutica / No disponible

La hemodiafiltración en línea proporciona una alta eficacia depurativa de moléculas de mediano y gran peso molecular. Existe consenso sobre la necesidad de conseguir al menos 20 L de ultrafiltración en postdilución y tasas de reducción de B2-microglobulina mayores del 70%. Desafortunadamente muchos pacientes tienen un acceso vascular inadecuado siendo muy difícil lograr esos volúmenes de ultrafiltración sin complicaciones clínicas. El objetivo de este trabajo fue conseguir un volumen de ultrafiltración equivalente a 20 L en postdilucional, mediante la técnica «Secuencial» (HDF-OL-S) que comienza siendo postdilucional y cuando la PTM alcanza los 250 mmHg se trasforma en predilucional. Se realizó una sesión de hemodiálisis de alto flujo (HD-HF), una de hemodiafiltración postdilucional (HDF-OL-P) y otra sesión en modo secuencial a 16 pacientes durante 3 semanas consecutivas, en la sesión de mitad de semana. Se compararon los rendimientos de eliminación de pequeñas y medianas moléculas entre las diferentes técnicas. Se midió la presión prefiltro (PPF) mediante manómetro predializador. No encontramos diferencias en el Kt/V, tasa de reducción de urea y de creatinina entre las3 técnicas. La tasa de reducción de B2-microglobulina y mioglobina fue significativamente mayor tanto en HDFOL-P como en HDF-OL-S con respecto a la HD-HF, no habiendo diferencias entre ambas técnicas de HDF. Existió una correlación directa entre PTM y PPF a lo largo de la sesión en todas las técnicas. La PPF horaria se correlacionaba mejor que PTM con los niveles basales de albúmina sérica, hematocrito y porcentaje de hemoconcentración al final de la diálisis. La HDF-OL-S es una técnica de hemodiálisis con los mismos beneficios de la postdilucional que permite lograr volúmenes de ultrafiltración dentro de los objetivos planteados. Creemos podría ser útil en pacientes con flujos sanguíneos limitados para lo cual habría que diseñar nuevos estudios. La PPF aporta información complementaria a la PTM (AU)

Background: On line haemodiafiltration provides the greatest clearance for low and high-molecular weight uremic toxins, which is associated with a lower risk of mortality in our patients. Nowadays, there’s increasing evidence about the need of achieving at least 20 litters ultrafiltration in postdilution mode and70% reduction of beta-2-microglobulin (B2M), however it requires a vascular access’s high blood flow. Unfortunately, we do not succeed in these objectives because of our patients being older, diabetic and with poor vascular access; in this situation highblood flows are more difficult to get at the expense of lower postdilution exchange volumes. The aim of this study was to assess the efficiency of OL-S-HDF to obtain an equivalent ultrafiltration volume as 20 L in OL-postdilution-HDF (OL-P-HDF). OL-SHD Finitially begins in postdilution mode changing to predilution once the transmembrane pressure (TMP) reached 250 mmHg. Methods: We performed one high-flux HD session (HF-HD), one OL-P-HDF session and one OL-S-HDF session in each of the 16adult patients who participated during 3 consecutive weeks. We compared the clearance rates of low and middle molecules such asurea, creatinine, B2M, myoglobulin and levels of albumin and haematocrit between the 3 different techniques. We measured the pre-filter pressure (PFP) by a manometer set before the dialyzer. Results: The main characteristics of the sessions are described in table Nº1. There wasn¿t significant difference in Kt/V, urea and creatinine removal between the three techniques. B2M and myoglobulin¿s clearance rates were significantly higher in both hemodiafiltration modes than in HF-HD (p = 0.000), however we didn¿t find differences between OL-P-HDF and OL-S-HDF. There was a direct correlation between PFP and TMP along the sessions in every technique (p < 0.05). We found that PFP was better than TMP to correlate with pre-dialysis levels of albumin and haematocrit and also with the haemoconcentration percentage at the end of the sessions. Conclusions: This study confirms that OL-S-HDF is as good as OL-P-HDF and it could be a useful technique to treat patients with suboptimal access¿s blood flow to get to achieve ultrafiltration volumes within the objectives. PFP could offer extra information than TMP (AU)

[Peripheral vascular disease: prevalence, mortality and relationship with inflammation in hemodialysis]. / Enfermedad Vascular Periférica: Prevalencia, Mortalidad y Asociación con Inflamación en Hemodiálisis.

Peripheral vascular disease (PVD) is a common disease among patients undergoing hemodialysis leading to increase morbidity and mortality with a high risk of inflammation and sepsis. The aim of the present study was to determinate PVD prevalence in our hemodialysis population and association with inflammation. The study sample consisted of 220 patients prevalents in hemodialysis. A basal study was made in 2001 and a follow up for 47 months. Data were collected retrospectively. PVD diagnosis was made attending to limb pulses and doppler in revisions. Diagnosis was classified as rest pain, ischemic ulceration and gangrene. Among a total of 220 patients, 89 had prevalent PVD. Thirty per cent had rest pain, 6,5% had ischemic ulceration and 3% had gangrene. Ninety five per cent underwent medical treatment, 0,5% were treated by percutaneous transluminal angioplasty (PTA), 2% were treated with surgical revascularization and 2,5% were treated with amputation. Patients with PVD were older, with higher Charlson index, diabetes, they hay higher CRP and fibrinogen serum levels; and lower albumin and prealbumine serum levels. Survival PVD was decreased in Kaplan-Meier (log rank =12,4; p<0,000). Adjusted Cox regression analysis revealed that PVD (p =0,034; OR =2,10; IC [1,06 ; 4,23]) ; age (p =0,001; OR =1,06; IC [1,03 ; 1,09]) and low serum albumin levels (p =0,012; OR =0,93; IC [0,89 ; 0,98]) predicted significantly the risk of mortality. PVD is an independent mortality risk factor in hemodialysis patients. An early diagnosis and treatment are able with examination and doppler. In our sample, a few patients are treated with PTA or surgical revascularization. There is an association between PVD and inflammation.

Enfermedad vascular periférica: prevalencia, mortalidad y asociación con inflamación enhemodiálisis / Peripheral vascular disease: prevalence, mortality and association with inflammation in haemodialysis

La enfermedad vascular periférica es una complicación frecuente en la población en hemodiálisis que contribuye a aumentar su morbi-mortalidad, al favorecer el estado inflamatorio, la malnutrición y las complicaciones severas como la isquemia y la sepsis secundaria. El objetivo del estudio fue analizar la prevalencia de enfermedad vascular periférica en nuestra población en hemodiálisis, su repercusión en la mortalidad y su asociación con parámetros de inflamación y malnutrición. Fueron incluidos 220 pacientes prevalentes en hemodiálisis, del área perteneciente a nuestro centro hospitalario. Se realizó un estudio basal en el año 2001 y se siguieron durante 48 (..) (AU)

Peripheral vascular disease (PVD) is a common disease among patients undergoing hemodialysis leading to increase morbidity and mortality with a high risk of inflammation and sepsis. The aim of the present study was to determinate PVD prevalence in our hemodialysis population and association with inflammation. The study sample consisted of 220 patients prevalents in hemodialysis. A basal study was made in 2001 and a follow up for 47months. Data were collected retrospectively. PVD diagnosis was made attending to limb pulses and doppler in revisions. Diagnosis was classified as rest pain, ischemic ulceration and gangrene. Among a total of 220 patients, 89 had prevalent PVD. Thirty percent had rest pain, 6,5% had ischemic ulceration and 3% had gangrene. Ninety five per cent underwent medical treatment,0,5% were treated by per cutaneous transluminal angioplasty(PTA), 2% were treated with surgical revascularization and 2,5%were treated with amputation. Patients with PVD were older, with higher Charlson index, diabetes, they hay higher CRP and fibrinogen serum levels; and lower albumin and prealbumineserum levels. Survival PVD was decreased in Kaplan-Meier (logrank 012,4; p < 0,000). Adjusted Cox regression analysis revealed that PVD (p = 0,034; OR = 2,10; IC [1,06; 4,23]) ; age (p =0,001; OR = 1,06; IC [1,03; 1,09]) and low serum albumin levels(p = 0,012; OR = 0,93; IC [0,89; 0,98]) predicted significantly the risk of mortality. PVD is an independent mortality risk factor inhemodialysis patients. An early diagnosis and treatment are able with examination and doppler. In our sample, a few patients are treated with PTA or surgical revascularization. There is an association between PVD and inflammation (AU)

Cambios clínicos y analíticos al sustituir el líquido de diálisis convencional por uno sin acetato / Clinical and analytical changes in hemodialysis without acetate

Introducción: El objetivo de dicho estudio fue evaluar los cambios en la acetatemia durante la hemodiálisis (HD) en pacientes con líquido de diálisis (LD) convencional con acetato y en pacientes con LD con clorhídrico (HCl) y analizar sus efectos sobre la clínica y sobre distintos parámetros analíticos. Material y métodos: 14 pacientes en programa de HD estable (11 hombres) de 61 ± 15 años de edad fuerondializados durante 1 mes con el LD convencional con acetato y durante el segundo mes con el LD con HCl (sin acetato). Se obtuvieron análisis pre y post-diálisisla tercera sesión de las semanas 1 y 4 en cada uno de los períodos (con y sin acetato).Resultados: Las medias de los acetatos pre-diálisis fueron similares en ambos grupos, mientras que las medias de los acetatos post-diálisis fueron significativamente superiores en el grupo tratado con el LD convencional (0,48 ± 0,64 vs 0,18 ±0,23 mmol/L, p = 0,024). Tampoco hallamos diferencias significativas entre los 2 grupos en cuanto a la presencia de valores de acetato pre-diálisis patológicos, mientras sí hallamos un mayor porcentaje valores patológicos de acetato post-diálisis enel grupo tratado con LD convencional respecto al grupo del HCl (67% vs 21%, p = 0,001). Los niveles plasmáticos de IL-6 fueron significativamente superiores en el periodo de diálisis con acetato (31,7 ± 24,7 vs 18,7 ± 10,3 pg/ml, p = 0,014), aunque no se acompañaron de un aumento de otros marcadores inflamatorios como la LBP,el TNF-alfa o la PCR dializante el mismo periodo. No hallamos diferencias estadísticamente significativas en los otros parámetros evaluados excepto en la variación de las concentraciones de sodio, cloro y bicarbonato. Conclusiones: El LD sin acetato no expone a los pacientes a concentraciones elevadas de acetato consiguiendo que la mayoría de pacientes (79%) termine la HD con una acetatemia dentro del rango fisiológico.El uso de LD sin acetato es seguro y bien tolerado por los pacientes en hemodiálisis, aunque su traducción clínica debe ser evaluada en estudios prospectivosa más largo plazo (AU)

Background: the purpose of this study was to evaluate blood acetate levels and its correlation with clinical and analytical changes in hemodialysis patients treated with standard bicarbonate dialysate compared to treatment with acetate-free bicarbonate dialysate. Methods: Fourteen patients on hemodialysis (11 male) with mean age of 61 ± 15 years were treated with conventional bicarbonate dialysate for 1 month andthen switched to acetate-free bicarbonate dialysate for another month. Blood samples were drawn at the third session of first and fourth week of each type of dialysis.Results: Pre-dialysis blood acetate levels were similar in both groups, whereas postdialysis blood acetate levels were higher in patients treated with conventional bicarbonate dialysate (0.48 ± 0.64 vs 0.18 ± 0.23 mmol/L, p = 0.024). Moreover, both periods had similar percentage of patients with pre-dialysis blood acetate levels in the pathologic range, whereas this percentage was higher in post-dialysis samples from patients treated with conventional bicarbonate dialysate respect to acetate-free dialysate (67% vs 21%, p = 0.001). Serum levels of interleukin-6 were statistically higher in the period with conventional bicarbonate dialysate (31.7 ± 24.7 vs 18,7 ± 10,3 pg/ml, p = 0,014), even though other inflammatory markers such as LBP, TNF-alfa and CRP failed to increase in the same period. We didn’t found significant differences in the other parameters studied except for the changes in serum concentrationsof sodium, chloride and bicarbonate. Conclusions: Acetate-free bicarbonate dialysate does not expose patients to a big amount of acetate and allows that the majority of patients finished hemodialysis with blood acetate levels in the physiologic ranges. Acetate-free dialysate was safe and well tolerated by our hemodialysis patients, although clinical advantages derived from its use should be evaluated in long-termprospective studies (AU)