El modelo de control de anemia: ¿ayuda al nefrólogo en la decisión terapéutica para el manejo de la anemia? / The anaemia control model: Does it help nephrologists in therapeutic decision-making in the management of anaemia?

INTRODUCCIÓN: La anemia es frecuente en los pacientes en hemodiálisis, y su tratamiento con estimulantes de la eritropoyesis (AEE) resulta complejo debido a múltiples factores. OBJETIVOS: Valorar la utilidad del modelo de control de anemia (MCA) en el tratamiento de la anemia en hemodiálisis. MÉTODOS: El MCA es un software que predice la dosis óptima de darbepoetina y hierro sacarosa para alcanzar niveles de hemoglobina (Hb) y ferritina deseados, emitiendo sugerencias de prescripción. Estudio realizado en clínicas de diálisis de 18 meses de duración en dos fases de intervención (FI) con MCA (FI1, n: 213; FI2, n: 218) separadas por una fase de control (FC, n: 219). El resultado primario fue el porcentaje de Hb en rango y la mediana de dosis de AEE y los resultados secundarios fueron las transfusiones, las hospitalizaciones o los acontecimientos cardiovasculares. Análisis a nivel de clínica y de pacientes valorando la variabilidad de la Hb mediante la desviación estándar (DE) de esta. También se analizaron pacientes con la mayoría de sugerencias confirmadas (grupo MCA cumplidores) RESULTADOS: El MCA aumentó el porcentaje de Hb en rango: 80,9% FI2 frente a 72,7% en FC, y redujo el consumo de darbepoetina (FI1: 20 [70]; FC 30 [80] μg, p = 0,032) con menor fluctuación de la Hb (0,91 ± 0,49 en FC a 0,82 ± 0,37g/dl en FI2; p < 0,05) mejorando en el grupo MCA cumplidores. En cuanto a los resultados secundarios, descendieron con el uso del MCA. CONCLUSIONES: El MCA ayuda a obtener mejores resultados de anemia en los pacientes en hemodiálisis, minimizando los riesgos del tratamiento con AEE y reduciendo costes

INTRODUCTION: Anaemia is common in haemodialysis patients and treating it with erythropoiesis-stimulating agents (ESAs) is complex due to many factors. OBJECTIVES: To assess the usefulness of the Anaemia Control Model (ACM) in the treatment of anaemia in haemodialysis. METHODS: ACM is a software that predicts the optimal dose of darbepoetin and iron sucrose to achieve target haemoglobin (Hb) and ferritin levels, and makes prescription suggestions. Study conducted in dialysis clinics lasting 18months with two intervention phases (IPs) with ACM (IP1, n:213; IP2, n:218) separated by a control phase (CP, n:219). The primary outcome was the percentage of Hb in range and the median dose of ESAs, and the secondary outcomes were transfusion, hospitalisation and cardiovascular events. Clinical and patient analyses were performed. Hb variability was assessed by the standard deviation (SD) of the Hb. We also analysed the patients with most of the suggestions confirmed (ACM compliant group). RESULTS: ACM increased the percentage of Hb in range: 80.9% in IP2, compared with 72.7% in the CP and reduced the intake of darbepoetin (IP1: 20 [70]; CP 30 [80] μg P = 0.032) with less Hb fluctuation (0.91 ± 0.49 in the CP to 0.82 ± 0.37 g/dl in IP2, P < 0.05), improving in the ACM compliant group. The secondary outcomes decreased with the use of ACM. CONCLUSIONS: ACM helps to obtain better anaemia results in haemodialysis patients, minimising the risks of treatment with ESAs and red

The anaemia control model: Does it help nephrologists in therapeutic decision-making in the management of anaemia? / El modelo de control de anemia: ¿ayuda al nefrólogo en la decisión terapéutica para el manejo de la anemia?

INTRODUCTION: Anaemia is common in haemodialysis patients and treating it with erythropoiesis-stimulating agents (ESAs) is complex due to many factors. OBJECTIVES: To assess the usefulness of the Anaemia Control Model (ACM) in the treatment of anaemia in haemodialysis. METHODS: ACM is a software that predicts the optimal dose of darbepoetin and iron sucrose to achieve target haemoglobin (Hb) and ferritin levels, and makes prescription suggestions. Study conducted in dialysis clinics lasting 18months with two intervention phases (IPs) with ACM (IP1, n:213; IP2, n:218) separated by a control phase (CP, n:219). The primary outcome was the percentage of Hb in range and the median dose of ESAs, and the secondary outcomes were transfusion, hospitalisation and cardiovascular events. Clinical and patient analyses were performed. Hb variability was assessed by the standard deviation (SD) of the Hb. We also analysed the patients with most of the suggestions confirmed (ACM compliant group). RESULTS: ACM increased the percentage of Hb in range: 80.9% in IP2, compared with 72.7% in the CP and reduced the intake of darbepoetin (IP1: 20 [70]; CP 30 [80] µg P=0.032) with less Hb fluctuation (0.91±0.49 in the CP to 0.82±0.37g/dl in IP2, P<0.05), improving in the ACM compliant group. The secondary outcomes decreased with the use of ACM. CONCLUSIONS: ACM helps to obtain better anaemia results in haemodialysis patients, minimising the risks of treatment with ESAs and reducing costs.

Citrate versus acetate-based dialysate in on-line haemodiafiltration. A prospective cross-over study.

BACKGROUND AND AIMS: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect and improves biocompatibility. This study examines the effect of CD on dialysis efficiency, coagulation, acid-base status, electrolytes, and inflammation in patients in on-line hemodiafiltration (OL-HDF). METHODS: 35 patients in OL-HDF were enrolled in a prospective, cross-over study for a 24-week period and two phases alternating CD and acetate dialysate fluid (AD). Parameters on study were predialysis levels of bicarbonate and ionic calcium, reactive C Protein (CRP), and beta-2 microglobulin (B2MG) and postdialysis levels of activated tromboplastine time, bicarbonate, and ionized calcium. RESULTS: No significant differences in coagulation parameters, pH, and predialysis bicarbonate were found. The postdialysis bicarbonate and postdialysis calcium were lower with CD. Dialysis efficiency was greater with CD. Regarding inflammatory parameters, both CRP and B2MG were lower using CD. CONCLUSION: The use of CD is safe and effective in OL-HDF, and it improves dialysis efficacy, postdialysis alkalosis, and inflammation.

Laboratory evaluation of the pivot-shift phenomenon with use of kinetic analysis: a preliminary study.

BACKGROUND: Currently, a suitable and reliable noninvasive method to evaluate rotational stability in vivo in anterior cruciate ligament-deficient knees, particularly during sports movements, does not exist. We speculated that if there is a rotational instability, the patient would avoid reaching a high pivoting moment during pivoting activities as a defense mechanism, and that the ground reaction moment, as registered by dynamometric platforms, would be reduced. On the basis of this hypothesis, we developed a study using kinetic analysis to evaluate rotational stability under dynamic loading. METHODS: Thirty recreationally active athletes, including fifteen healthy subjects and fifteen with an anterior cruciate ligament-deficient knee, were recruited for this study. Patients performed jumping with pivoting with internal tibial rotation and external tibial rotation on the dynamometric platform with both the healthy and the injured limb. The quantitative results were graphically plotted, and the following parameters were evaluated: loading moment, pivoting moment, torque amplitude, loading slope, pivoting slope, percentage of pivoting with load, loading impulse, pivoting impulse, and maximum body rotation angle. RESULTS: There were no significant differences between the dominant and nondominant knees in the control group during the jumping with pivoting and external tibial rotation test with regard to the pivoting moment (p = 0.805), pivoting slope (p = 0.716), pivoting impulse 2 (p = 0.858), and pivoting impulse 3 (p = 0.873). In patients with a chronic tear of the anterior cruciate ligament, there was a significant decrease of the pivoting moment (p = 0.02), pivoting slope (p = 0.005), pivoting impulse 2 (p = 0.006), and pivoting impulse 3 (p = 0.035) during the jumping with pivoting and external tibial rotation test in the anterior cruciate ligament-deficient knee compared with the healthy, contralateral knee. CONCLUSION: Kinetic analysis with use of a dynamic platform can objectively detect alterations of rotational stability in anterior cruciate ligament-deficient knees, which may allow this to be a useful research tool for evaluating treatment strategies in patients with anterior cruciate ligament injuries.