Utilidad del índice de masa corporal en pacientes con enfermedad renal crónica / Usefulness of body mass index in patients with chronic kidney disease

Introducción: El índice de masa corporal es un indicador que se utiliza frecuentemente para identificar el sobrepeso y la obesidad en los adultos. En la población con enfermedad renal crónica, estudios de observación han reportado resultados contradictorios acerca de la asociación entre la obesidad y la mortalidad. También, diferentes autores, han observado como aquellos que presentan un índice de masa corporal elevado, demuestran un mejor estado nutricional. Objetivo: Analizar el índice de una masa corporal de los pacientes en hemodiálisis y su relación con las complicaciones. Material y Método: Estudio observacional, analítico y longitudinal. La muestra estuvo compuesta por 170 pacientes prevalentes en tratamiento con hemodiálisis o hemodiafiltración online. Se calculó el índice de masa corporal en base al peso real y la talla del paciente en el momento de la recogida de datos. Se registraron los pacientes que causaron éxito durante el periodo de seguimiento. Resultados: Los pacientes fallecidos presentaban un índice de masa corporal menor, aunque las diferencias no resultaron estadísticamente significativas. Los pacientes que cumplieron el objetivo de índice de masa corporal, presentaron también mayores niveles de sobrehidratación, un menor índice de tejido graso, menores niveles de transferrina en sangre, un mayor Kt/ve y un mayor número de meses en terapia renal sustitutiva. Conclusiones: Un índice de masa corporal ≥ 25 kg/m² no se asoció en nuestro caso con una mayor mortalidad, aunque si se observa una tendencia en los datos en ese sentido. Los pacientes con un índice de masa corporal ≥ 25 kg/m² presentaban un mejor estado nutricional (AU)

Introduction: The body mass index is an indicator that is often used to identify overweight and obesity in adults. In the population with chronic kidney disease, observational studies have reported contradictory results regarding the association between obesity and mortality. Also, different authors have observed as those having a body mass index higher, a better nutritional status is showed. Objective: To establish a comparative study of subjects according to their body mass index. Material and Method: Observational, analytical and longitudinal study. A total of 170 prevalent patients with chronic kidney disease on treatment with hemodialysis or online hemodiafiltration were recruited. The body mass index based on actual weight and size of the patient at the time of data collection was calculated. Patients who died during the follow-up period were recorded. Results: The patients who died had a lower body mass index, although the differences were not statistically significant. Patients who met the target body mass index also had higher levels of hydration, a lower rate of fat, and lower blood levels of transferrin, a greater Kt/ve and a greater number of months in renal replacement therapy. Conclusions: A body mass index ≥ 25 kg / m² was not associated, in our case, with higher mortality, although a trend in this direction is observed. Patients with body mass index ≥ 25 kg / m² had a better nutritional status (AU)

Biomarkers associated with mortality in patients undergoing dialysis.

BACKGROUND: Survival for patients commencing renal replacement therapy is around 90% in the first year and 83% at two years after starting dialysis. The factors that appear to predict mortality are comorbidity and frailty associated with kidney disease, glomerular filtration rate, age and biochemical factors. OBJECTIVES: To analyse the condition of patients starting renal replacement therapy, based on biomarkers commonly used in clinical practice and their association with mortality, measured 6 and 12 months after initiating replacement therapy. METHODS: A one-year prospective follow-up study with 189 patients. Sociodemographic variables, aetiology of renal disease, comorbidities, prior nephrology service monitoring, prior renal transplantation and biochemical parameters at the time of initiating replacement therapy were analysed. RESULTS: The overall percentage of death during the one-year follow-up was 6.87%, with 64% of deaths occurring during the first six months. The only variable independently associated with mortality was low albumin levels. CONCLUSION: Although most patients in this centre are monitored by a nephrologist prior to starting replacement therapy, many nevertheless fail to achieve the biochemical targets recommended. One such parameter is albumin, which proved at the start of replacement therapy to be an independent predictor of mortality. Findings of this study show the need to intervene on certain biochemical parameters during the pre-dialysis stage and at the start of dialysis, in order to improve survival in this group of patients.

Depression, anxiety and health-related quality of life amongst patients who are starting dialysis treatment.

BACKGROUND: Chronic kidney disease (CKD) has a severe impact on patients' health-related quality of life (HRQL). The start of renal replacement therapy (RRT) significantly influences psychological, physical and social aspects of life. OBJECTIVES: To analyse the HRQL and psychological status (anxiety and depression) at the start of RRT. METHODS: We undertook an observational descriptive cross-sectional study. A total of 152 patients starting RRT were recruited for the study. HRQL was measured by the Kidney Disease and Quality of Life Short Form questionnaire. Levels of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale questionnaire. Comorbidities and sociodemographic and clinical factors were also evaluated. FINDINGS: HRQL in patients with end-stage kidney disease (ESKD) is significantly affected by the initiation of RRT in all respects. States of anxiety and depression were present in 26.6% and 27% of patients, respectively. These states are significantly related to the emotional component of the quality of life. CONCLUSION: The initiation of RRT has a strong impact on HRQL in comparison with a reference population and with other stages of CKD. The early detection of an altered psychological state is important, as this condition should be treated from the first stages of the disease, as it can significantly affect the subsequent development of RRT and the patient's quality of life.

Fragilidad: ¿Cómo podemos detectarla? / Fragility: how do we detect it?

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Valoración de la acogida de pacientes que inician terapia renal sustitutiva: nivel de satisfacción / Assessment of reception of patients initiating renal replacement therapy: level of satisfaction

Introducción: En los últimos años han cobrado especial importancia aspectos tales como la calidad de vida, la salud percibida y la satisfacción del enfermo.El objetivo de este estudio, es valorar el nivel de satisfacción de pacientes con enfermedad renal crónica con los cuidados recibidos, cuando inician por primera vez la terapia renal sustitutiva. Material y métodos: Estudio descriptivo de corte transversal, en pacientes que inician por primera vez terapia renal sustitutiva. La muestra estuvo compuesta por 83 pacientes. Se recogieron variables sociodemográficas relacionadas con la enfermedad renal y seguimientos en consulta. Para valorar la satisfacción con los cuidados recibidos, a los pacientes se les entregó el cuestionario para medir Calidad de Vida Relacionada con la Salud (KDQOL-SF), específico para pacientes renales. Dentro de este cuestionario existe un apartado que mide la satisfacción con los cuidados recibidos. Resultados: En el ítem SF23, el 62,7% de la muestra consideró que la amabilidad del personal sanitario fue la mejor posible (43,4%) o excelente (19,3%). Por otro lado, en los ítems SF24a y 24b, el 51,8% de los pacientes opinan que el personal sanitario les anima a ser independientes y el 59% considera que les apoyan a hacer frente a la enfermedad. En el modelo de regresión ordinal utilizado, SF23 y SF24 obtiene mejores puntuaciones para diálisis peritoneal cuando se controlan el resto de variables demográficas, que no son significativas (p<0,05). Conclusión: Valorando como muy positivos los resultados de satisfacción obtenidos hay que resaltar que resultan comparativamente mejores en la diálisis peritoneal (AU)

Introduction: In recent years have become very important issues such as quality of life, perceived health and patient satisfaction.The aim of this study is to assess the level of satisfaction of patients with chronic kidney disease with care received when they first start renal replacement therapy. Objective: A descriptive cross-sectional study in patients who start first renal replacement therapy. The sample consisted of 83 patients. Sociodemographic variables related to kidney disease and follow-on care clinics. To assess satisfaction with the care received, patients were given a questionnaire to measure Quality of Life Related to Health, specific for kidney patients. Within this section there is a questionnaire which measures satisfaction with the care received. Results: In item SF23, 62.7% of the sample felt that the friendliness of health workers was the best (43.4%) or excellent (19.3%). On the other hand, in SF24a and 24b items, 51.8% of patients believe that health staff encourages them to be independent and 59% think it will support coping with illness. In the ordinal regression model used, SF23 and SF24 gets top scores for PD when other demographic variables that are not significant (p <0.05) are controlled. Conclusion: Considering as positive satisfaction. results obtained should be highlighted that are comparatively better in peritoneal dialysis (AU)

Revisión de estudios sobre calidad de vida relacionada con la salud en la enfermedad renal crónica avanzada en España / Review of studies on health related quality of life in patients with advanced chronic kidney disease in Spain

Antecedentes: La enfermedad renal crónica avanzada (ERCA) tiene un gran impacto sobre la calidad de vida relacionada con la salud (CVRS). Cada vez es más frecuente el uso de esta variable en estudios en nuestro medio, aunque no se dispone de una revisión global sobre cómo se ha estudiado en población con ERCA española. Objetivos: Ofrecer una visión contrastada de los instrumentos de evaluación de la CVRS más usados en la población española con ERCA, analizando además la calidad de vida percibida por esta población. Métodos: Se llevó a cabo una revisión de la literatura publicada sobre estudios realizados en España que hubieran empleado algún instrumento para medir la CVRS, genérico o específico, en pacientes con diferentes estadios de ERCA. Se excluyeron estudios en pacientes trasplantados renales cuando eran estudiados de forma independiente. La búsqueda se realizó en CINAHL, CUIDEN, DOCUMED, EMBASE, ERIC (USDE), IME, LILACS, MEDLINE, Nursin@ovid, PubMed, Scielo, Web of Science y TESEO. Resultados: Se han incluido en esta revisión 53 artículos publicados entre el año 1995 y el mes de mayo de 2014. La terapia sustitutiva renal es la variable con mayor frecuencia asociada al estudio de la CVRS, siendo la hemodiálisis la más estudiada. La mayoría de los estudios encontrados son transversales y el Short Form-36 Health Survey es el instrumento más usado. Conclusiones: La mayoría de los estudios muestra cómo la CVRS se ve afectada de forma importante en pacientes que reciben terapia sustitutiva renal. Estos resultados se muestran independientes del instrumento usado para medir la calidad de vida relacionada con la salud y de otras variables asociadas a lo largo de los distintos estudios. La CVRS ha sido analizada especialmente en pacientes en hemodiálisis, con diseños fundamentalmente observacionales y con el Short Form-36 Health Survey. Se necesitan más estudios que aborden aspectos como la CVRS en la etapa prediálisis, así como estudios con muestras más grandes y diseños longitudinales, analíticos o experimentales (AU)

Background: Advanced chronic kidney disease (ACKD) has a great impact on health-related quality of life (HRQL). The use of this variable in studies in our field is becoming more frequent, although there has been no comprehensive review of how Spaniards with ACKD are assessed. Aims: To offer a contrasted vision of the HRQL assessment tools that are most often used on Spanish ACKD population, also analysing how this population perceive their quality of life. Method: A review was carried out on literature published on studies undertaken in Spain that had used some kind of instrument, either generic or specific, in order to measure HRQL in patients with different stages of ACKD. Studies in kidney transplant patients were excluded when they were independently reviewed. The research was carried out in CINAHL, CUIDEN, DOCUMED, EMBASE, ERIC (USDE), IME, LILACS, MEDLINE, Nursin@ovid, PubMed, Scielo, Web of Science and TESEO. Results: 53 articles published between 1995 and May 2014 have been included in this review. Renal replacement therapy is the variable that is most often associated with the study of HRQL, with haemodialysis being the most studied. Most of the studies found are cross-sectional and the Short Form-36 Health Survey is the most used instrument. Conclusions: The majority of the studies show how HRQL is significantly affected in patients who receive renal replacement therapy. These results are independent from the instrument used to measure health-related quality of life and other associated variables throughout the various studies. HRQL has been particularly analysed in patients on haemodialysis, using mainly observational methods and the Short Form-36 Health Survey. There is a need for more studies that address aspects such as HRQL in the pre-dialysis phase, as well as studies with larger samples and longitudinal, analytical and experimental designs (AU)

Review of studies on health related quality of life in patients with advanced chronic kidney disease in Spain.

BACKGROUND: Advanced chronic kidney disease (ACKD) has a great impact on health-related quality of life (HRQL). The use of this variable in studies in our field is becoming more frequent, although there has been no comprehensive review of how Spaniards with ACKD are assessed. AIMS: To offer a contrasted vision of the HRQL assessment tools that are most often used on Spanish ACKD population, also analysing how this population perceive their quality of life. METHOD: A review was carried out on literature published on studies undertaken in Spain that had used some kind of instrument, either generic or specific, in order to measure HRQL in patients with different stages of ACKD. Studies in kidney transplant patients were excluded when they were independently reviewed. The research was carried out in CINAHL, CUIDEN, DOCUMED, EMBASE, ERIC (USDE), IME, LILACS, MEDLINE, Nursin@ovid, PubMed, Scielo, Web of Science and TESEO. RESULTS: 53 articles published between 1995 and May 2014 have been included in this review. Renal replacement therapy is the variable that is most often associated with the study of HRQL, with haemodialysis being the most studied. Most of the studies found are cross-sectional and the Short Form-36 Health Survey is the most used instrument. CONCLUSIONS: The majority of the studies show how HRQL is significantly affected in patients who receive renal replacement therapy. These results are independent from the instrument used to measure health-related quality of life and other associated variables throughout the various studies. HRQL has been particularly analysed in patients on haemodialysis, using mainly observational methods and the Short Form-36 Health Survey. There is a need for more studies that address aspects such as HRQL in the pre-dialysis phase, as well as studies with larger samples and longitudinal, analytical and experimental designs.

Influencia de la consulta de enfermería de enfermedad renal crónica avanzada en pacientes que inician tratamiento renal sustitutivo / Influence of nursing consultation for advanced chronic kidney disease in patients starting renal replacement treatment

La remisión precoz del paciente con enfermedad renal crónica avanzada al especialista y una atención nefrológica integrada y especializada en la etapa prediálisis, proporcionada por un equipo multidisciplinar, ha demostrado tener importantes beneficios sobre pacientes en fase avanzada de la enfermedad renal que inician tratamiento renal sustitutivo. Objetivo: determinar si existe riesgo de alteraciones a nivel físico, psicológico o de la calidad de vida en pacientes que inician terapia sustitutiva renal en función de si han tenido seguimiento nefrológico multidisciplinar en la etapa prediálisis. Material y métodos: estudio observacional trasversal analítico sobre una muestra de 90 pacientes que inician terapia sustitutiva renal. Resultados: El 86,5% de los pacientes estudiados fue seguido por el nefrólogo en la etapa prediálisis, solo el 37,8% de los pacientes fue atendido por la enfermera. El 27,8% de los pacientes mostraban elevados niveles de ansiedad al iniciar diálisis. No se encontraron diferencias en la calidad de vida relacionado con la salud entre pacientes seguidos o no por la enfermera en la etapa prediálisis. Conclusiones: Un porcentaje muy bajo de pacientes son seguidos en la consulta de enfermería prediálisis, no existiendo diferencias significativas en la calidad de vida relacionada con la salud entre ambos grupos. Si se encontraron diferencias significativas en cuanto a la ansiedad; el grupo de pacientes atendidos por la enfermera en la etapa prediálisis presentan mayores niveles de ansiedad que los no atendido (AU)

Early referral of patients with advanced specialist care and nephrology integrated and specialized in predialysis stage, provided by a multidisciplinary team chronic kidney disease, has been shown to have significant benefits for patients with advanced stage renal disease who initiate renal replacement therapy. Objective: To determine if there is risk of changes to physical, psychological or quality of life in patients starting renal replacement therapy depending on whether they have been tracking nephrology multidisciplinary predialysis stage. Methods: Observational analytical study on a sample of 90 patients starting renal replacement therapy. Results: 86.5% of the patients studied was followed by the nephrologist in the predialysis stage, only 37.8% of patients was treated by the nurse. 27.8% of patients showed elevated levels of anxiety when starting dialysis. No differences in quality of life associated with health among patients followed or not by the nurse in the predialysis phase were found. Conclusions: A very small percentage of patients are followed in predialysis nurses, with no significant differences in quality of life related to health between the two groups. If significant differences were found with regard to anxiety; the group of patients seen by the nurse in the predialysis stage have higher levels of anxiety that unattended (AU)

Análisis de la discapacidad en el paciente crónico mediante la herramienta WHODAS II / Analysis of disability in chronic patients, using the WHODAS II tool

La Dependencia Funcional se define como la pérdida de autonomía física, psíquica o intelectual a causa de procesos relacionados con la salud del individuo. La discapacidades un atributo inseparable de la dependencia, pero no recíproco. La dependencia funcional es el resultado de una discapacidad, pero no todos los discapacitados tienen dependencia funcional puesto que no precisan ayuda de terceros. El objetivo del estudio es valorarla discapacidad y dependencia funcional y comparar los resultados obtenidos mediante el Índice de Barthel, con los obtenidos según el World Health Organization Disability Schedule versión 2 y relacionarlos con una variable predictora de dependencia funcional como el Índice de Comorbilidad de Charlson modificado por edad para evaluar la congruencia de ambas medidas. Material y método: Estudio epidemiológico de corte trasversal. Resultados: Analizando conjuntamente los valores de Índicede Barthel y World Health Organization Disability Schedule versión 2 con el Índice de Comorbilidad deCharlson modificado por edad obtuvimos que si bien ambas correlacionan significativamente con la comorbilidad (p<0,05), parece que la dependencia funcional lo hace con mayor fuerza que la discapacidad. Conclusiones: La medida de la discapacidad y su adscripción y tabulación en una clasificación como la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud nos permite identificar de forma precoz áreas de discapacidad física, psíquica o relacional que en un futuro pudieran abocarse a dependencia funcional (AU)

Functional dependency is defined as the loss of physical, mental or intellectual autonomy due to health related factors. Disability is an inseparable but not reciprocal attribute of dependency. Functional dependency is therefore a consequence of a disability but not all persons with disabilities are functionally dependents as they may not require any help from others. The objective of the study is to evaluate disability and functional dependency comparing the scores obtained using the Barthel Index and the World Health Organization Disability Assessment Schedule version 2 and relate these scores to the age adjusted - functional dependency predictor Charlson Comorbidity Index to assess the consistency of all these methods. Material and method: Cross - sectional epidemiological study. Result: Significant comorbidity correlation (p<0,05) between the Barthel Index and the World Health Organization Disability Assessment Schedule version 2 scores and the age adjusted Charlson Comorbidity Index was found by analyzing together all the values but functional dependency correlation seems to be stronger than disability’s. Conclusions: The evaluation of disability and its ascription and tabulation in the frame of a classification such as the International Functionality, Disability and Health Classification allow us to early identify physical, mental or relational disability areas that may evolve to a functional dependency (AU)