Alteraciones neuropsicológicas en pacientes en tratamiento con diálisis peritoneal / Neuropsychological impairments in patients undergoing peritoneal dialysis treatment

Objetivo: Los pacientes con enfermedad renal crónica (ERC) en hemodiálisis (HD) suelen presentar déficits cognitivos. Sin embargo, existen pocos estudios que hayan examinado el funcionamiento neuropsicológico de aquellos que reciben diálisis peritoneal (DP). Método: Se evaluaron las funciones ejecutivas, la velocidad de procesamiento y la memoria verbal en 27 pacientes en DP, 42 en HD y 42 participantes sanos (PS). La presión sanguínea sistólica y el tiempo total en terapia renal sustitutiva (TRS) se controlaron estadísticamente. Las asociaciones entre el rendimiento y los factores clínicos se analizaron mediante correlaciones y regresión múltiple. Resultados: El grupo DP presentó mejor ejecución respecto al HD en fluidez verbal, memoria de trabajo, flexibilidad cognitiva, planificación y toma de decisiones. El grupo DP mostró peor ejecución que el grupo PS en inhibición y memoria verbal. Las puntuaciones en las funciones ejecutivas se asociaron positivamente con los meses totales en DP, en TRS, en HD, la albúmina, el colesterol total y el fósforo, y de forma negativa con la ferritina. Conclusión: El funcionamiento ejecutivo global fue mejor en los pacientes en DP que en aquellos en HD. Los resultados muestran el efecto positivo de la DP sobre las funciones ejecutivas, lo que debe tenerse en cuenta a la hora de la elección de la TRS. Las asociaciones observadas entre los factores bioquímicos y el rendimiento muestran la importancia de mantener un adecuado estado nutricional en estos pacientes.(AU)

Background: Patients with chronic kidney disease on hemodialysis (HD) often have cognitive deficits. However, there are few studies that have examined the neuropsychological impairments of patients receiving peritoneal dialysis (PD). Methods: Executive functions, processing speed and verbal memory were assessed in 27 PD patients, 42 HD patients, and 42 healthy participants (HP). Systolic blood pressure and total time on renal replacement therapy (RRT) were controlled statistically. Associations between performance and clinical factors were analyzed using correlations and multiple regression. Results: The DP group showed better performance compared to the HD group in verbal fluency, working memory, cognitive flexibility, planning and decision making. The DP group showed worse execution than the HP group in verbal inhibition and memory. Executive function scores were positively associated with total months on PD, total months on RRT, total months on HD, albumin, total cholesterol, and phosphorus, and negatively with ferritin. Conclusion: Global executive functioning was more optimal in PD patients than in HD patients. The results show the positive effect of PD on executive functions, which must be taken into account when choosing the TRS. The associations observed between biochemical factors and performance show the importance of maintaining an adequate nutritional status in these patients.(AU)

Neuropsychological impairments in patients undergoing peritoneal dialysis treatment. / Alteraciones neuropsicológicas en pacientes en tratamiento con diálisis peritoneal.

BACKGROUND: Patients with chronic kidney disease on hemodialysis (HD) often have cognitive deficits. However, there are few studies that have examined the neuropsychological impairments of patients receiving peritoneal dialysis (PD). METHODS: Executive functions, processing speed and verbal memory were assessed in 27 PD patients, 42 HD patients, and 42 healthy participants (HP). Systolic blood pressure and total time on renal replacement therapy (RRT) were controlled statistically. Associations between performance and clinical factors were analyzed using correlations and multiple regression. RESULTS: The DP group showed better performance compared to the HD group in verbal fluency, working memory, cognitive flexibility, planning and decision making. The DP group showed worse execution than the HP group in verbal inhibition and memory. Executive function scores were positively associated with total months on PD, total months on RRT, total months on HD, albumin, total cholesterol, and phosphorus, and negatively with ferritin. CONCLUSION: Global executive functioning was more optimal in PD patients than in HD patients. The results show the positive effect of PD on executive functions, which must be taken into account when choosing the TRS. The associations observed between biochemical factors and performance show the importance of maintaining an adequate nutritional status in these patients.

A Case-Control Study of Cognitive Function in Patients with End-Stage Renal Disease Before and After Hemodialysis in Southern Spain.

BACKGROUND Cognitive problems are frequent in patients with end-stage renal disease (ESRD) treated with hemodialysis. However, previous studies used only a single cognitive screening test or a small number of cognitive indices, which is inadequate for an exhaustive evaluation of cognitive deficits. This case-control study aimed to evaluate cognitive function in patients with ESRD before and after hemodialysis at centers in southern Spain, and included analysis of associations between cognitive function and duration of hemodialysis, biochemistry, body composition, and treatment variables. MATERIAL AND METHODS Cognitive performance was evaluated in 42 healthy participants (HPs) and in 43 ESRD patients, before and after hemodialysis. The tests measured verbal and visual memory, sustained/selective attention, and processing speed. The diagnostic criterion for ESRD was a glomerular filtration rate.

Diagnostic and Interventional Nephrology in Spain: A snapshot of current situation.

BACKGROUND:: Diagnostic and Interventional Nephrology has been a rising field in recent years worldwide. Catheter insertion, renal biopsy, renal ultrasound, and peritoneal dialysis catheter or permanent dialysis catheter insertion are vital to our specialty. At present, many of these procedures are delegated to other specialties, generating long waiting lists and limiting diagnosis and treatment. METHODS:: An online survey was emailed to all Nephrology departments in Spain. One survey response was allowed per center. RESULTS:: Of 195 Nephrology departments, 70 responded (35.8%). Of them, 72.3% (52) had ultrasound equipment, 77.1% insert temporary jugular catheters, and 92.8% femoral. Up to 75.7% (53 centers) perform native renal biopsies, of which 35.8% (19) are real-time ultrasound guided by nephrologists. Transplant kidney biopsies are done in 26 centers, of which 46.1% (12) by nephrologists. Tunneled hemodialysis catheters are inserted in 27 centers (38.5%), peritoneal catheter insertion in 18 (31.6%), and only 2 centers (2.8%) perform arteriovenous fistulae angioplasty. In terms of ultrasound imaging, 20 centers (28.5%) do native renal ultrasound and 16 (22.8%) transplanted kidneys. Of all units 71.4% offer carotid ultrasound to evaluate cardiovascular risk, only in 15 centers (21%) by nephrologists. AVF ultrasound scanning is done in 55.7% (39). CONCLUSION:: Diagnostic and Interventional Nephrology is slowly spreading in Spain. It includes basic techniques to our specialty, allowing nephrologists to be more independent, efficient, and reducing waiting times and costs, overall improving patient care. Nowadays, more nephrologists aim to perform them. Therefore, appropriate training on different techniques should be warranted, implementing an official certification and teaching programs.

Situación de la nefrología diagnóstica e intervencionista en España / Performance of diagnostic and interventional nephrology in Spain

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La diálisis peritoneal permite el trasplante cardíaco con éxito en paciente con insuficiencia cardíaca refractaria / Peritoneal dialysis allows successful cardiac transplantation in patients with refractory heart failure

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Logrando mejores resultados para la diálisis peritoneal en los últimos años / Achieving better results for peritoneal dialysis in recent years

Introducción: La supervivencia entre la hemodiálisis (HD) y la diálisis peritoneal (DP) son equivalentes, siendo los factores de comorbilidad asociados los que ejercen más influencia sobre la mortalidad. En los más recientes estudios, el pronóstico de la DP peritoneal ha mejorado proporcionalmente más que el de la HD, aunque esto no ha significado un aumento en la utilización de este tratamiento. Objetivos: Conocer si la DP en nuestro medio ha mejorado en el tiempo con respecto a sus resultados. Conocer la influencia de la comorbilidad y las características del tratamiento en los resultados finales. Métodos: Pacientes incidentes en DP en Andalucía entre 1999 y 2010. La cohorte se ha dividido en dos grupos: antes y después de 2004. Estadística: medias ± desviación estándar, frecuencias, test (..) (AU)

Introduction: Survival rates between haemodialysis (HD) and peritoneal dialysis (PD) are the same but the associated comorbidity factors have a great impact on mortality. In the most recent studies the prognosis for PD has improved more than that for HD, although this has not meant an increase in the use of this treatment. Objectives: To determine whether the PD has improved over time with respect to its outcomes in our community, and determine the influence of comorbidity and treatment characteristics on the final results. Methods: Incident patients undergoing DP in Andalusia between 1999 and (..) (AU)

Achieving better results for peritoneal dialysis in recent years.

INTRODUCTION: Survival rates between haemodialysis (HD) and peritoneal dialysis (PD) are the same but the associated comorbidity factors have a great impact on mortality. In the most recent studies the prognosis for PD has improved more than that for HD, although this has not meant an increase in the use of this treatment. OBJECTIVES: To determine whether the PD has improved over time with respect to its outcomes in our community, and determine the influence of comorbidity and treatment characteristics on the final results. METHODS: Incident patients undergoing DP in Andalusia between 1999 and 2010. The cohort was divided into two groups: before and after 2004. STATISTICS: mean ± standard deviation, frequency, chi-square test, Student's t-test, risk determination (95% confidence interval), Kaplan-Meyer, log-rank and multivariate Cox proportional hazards models. RESULTS: 1464 incident patients undergoing DP, 537 before 2004 and 927 after 2004. The baseline characteristics of both groups (age, diabetes) were similar, although the first group had more severe cardiovascular disease and higher Charlson comorbidity index. In the second period, more automatic PD and solutions of bicarbonate and icodextrin were used. The overall survival rate for patients was 55 months median and 65 mean. Within all subgroups (age, diabetes, cardiovascular disease, technique type) there was a greater tendency towards survival in the second period (the technique type, age and diabetes were found to be statistically significant variables). Age, cardiovascular disease, diabetes mellitus and incident cases before 2004 were all independent risk factors. This latter variable lost significance as bicarbonate or icodextrin-based solutions were introduced, which were independent risk factors. Technique survival showed a median of 68 months and a mean of 73 months. Dialysis solutions and the period when the DP was initiated were independent risk factors for the technique. CONCLUSIONS: DP has shown improved results in recent years; probably the new solutions are having a positive influence. As such PD should be implemented applying the criteria of effectiveness, free choice, efficiency and PD units should be fully developed within Nephrology Departments.