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  • 1
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    Trasplante renal en pacientes con infección por virus de la inmunodeficiencia humana (VIH)
    Universidad de Alcala ; 2020
    In:  Revista de Investigación y Educación en Ciencias de la Salud (RIECS) Vol. 5, No. 2 ( 2020-11-30), p. 6-18
    Details
    In: Revista de Investigación y Educación en Ciencias de la Salud (RIECS), Universidad de Alcala, Vol. 5, No. 2 ( 2020-11-30), p. 6-18
    Abstract: INTRODUCCIÓN: el pronóstico de la infección por VIH ha mejorado tras introducir el tratamiento antirretroviral de gran actividad (TARGA), no contraindicando actualmente el trasplante renal (TR). La nefropatía asociada al VIH (HIVAN) es la principal causa de enfermedad crónica terminal (ERCT) en pacientes VIH a nivel mundial. Los criterios de inclusión para TR de pacientes VIH son multidisciplinares: no infecciones oportunistas; CD4 〉 200; carga viral indetectable. MATERIAL Y MÉTODOS: revisión de historias clínicas de 14 pacientes infectados por VIH receptores de un primer aloinjerto renal (2001-2019), seleccionados según recomendaciones de las guías españolas y americanas. La inmunosupresión se realizó según la práctica habitual en nuestro país. TARGA se inició inmediatamente tras TR. RESULTADOS: la principal causa de ERCT fue glomerulonefritis (6; 42,9%) seguida de HIVAN (4; 28,6%). 10 pacientes (71,4%) recibían hemodiálisis preTR, 7,1% se trasplantaron antes de inicar terapia renal sustitutiva. La mediana de CD4 fue 458 células/µL y todos los pacientes presentaban carga viral indetectable. 13 (92,9%) recibían TARGA preTR. 2 pacientes precisaron trasplantectomía precoz, el resto tuvieron una mediana de seguimiento de 61,0 meses. Función retrasada del injerto y rechazo agudo: 58,3% (7/12) y 33,3% (4/12) respectivamente. Mediana de creatinina a los 3 meses y en la última fecha de seguimiento: 1,3 mg/dL (RIC 0,8) y 2,1 (RIC 7,1) respectivamente. La supervivencia del injerto y del paciente a 1 (75,0%; 100%) y 3 años (67,0%; 89,0%) fue menor que en pacientes no VIH. CONCLUSIÓN: el TR es una alternativa terapéutica segura y efectiva en pacientes seleccionados con VIH.
    Type of Medium: Online Resource
    ISSN: 2530-2787
    URL: Issue
    URL: Article
    DOI: 10.37536/RIECS.2020.5.2
    DOI: 10.37536/RIECS.2020.5.2.188
    Language: Unknown
    Publisher: Universidad de Alcala
    Publication Date: 2020
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  • 2
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    Comparison of in situ preservation techniques for kidneys from donors after circulatory death: a systematic review and meta-analysis
    AME Publishing Company ; 2021
    In:  Translational Andrology and Urology Vol. 10, No. 8 ( 2021-8), p. 3286-3299
    Details
    In: Translational Andrology and Urology, AME Publishing Company, Vol. 10, No. 8 ( 2021-8), p. 3286-3299
    Type of Medium: Online Resource
    ISSN: 2223-4683 , 2223-4691
    URL: Journal
    URL: Article
    DOI: 10.21037/tau
    DOI: 10.21037/tau-21-236
    Language: Unknown
    Publisher: AME Publishing Company
    Publication Date: 2021
    detail.hit.zdb_id: 2851630-8
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  • 3
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    Percutaneous Renal Biopsy Prescreen Prior to Procedure
    Elsevier BV ; 2020
    In:  Kidney International Reports Vol. 5, No. 5 ( 2020-05), p. 731-733
    Details
    In: Kidney International Reports, Elsevier BV, Vol. 5, No. 5 ( 2020-05), p. 731-733
    Type of Medium: Online Resource
    ISSN: 2468-0249
    URL: Article
    DOI: 10.1016/j.ekir.2020.01.013
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2887223-X
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  • 4
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    Individually adjusted absolute blood volume feedback control: A promising solution for intradialytic hypotension
    Wiley ; 2023
    In:  Hemodialysis International Vol. 27, No. 2 ( 2023-04), p. 184-192
    Details
    In: Hemodialysis International, Wiley, Vol. 27, No. 2 ( 2023-04), p. 184-192
    Abstract: Intradialytic hypotension (IDH) remains one of the most frequent complications associated to hemodialysis (HD), frequently triggered by a reduction in absolute blood volume (ABV) not compensated by vascular refilling. A recently developed dilutional method allows routinary measurement of ABV and, by a simple algorithm, may turn blood volume monitor (BVM) guided UF (ultrafiltration) biofeedback into an ABV control, automatically adjusting UF rate to maintain ABV above a preset threshold. The aim of this study is to identify an individual critical ABV threshold and test the ability of an ABV feedback control to avoid IDH. Methods We studied 24 patients throughout three consecutive midweek HD treatments. ABV and blood pressure (BP) were measured every 30 min and anytime the patient referred any symptoms to identify each patient's critical ABV (ABV at the time of hypotension). A fixed bolus dilution approach at the start of HD was used to calculate ABV. Then, patients were followed through three additional HD treatments and IDH development was analyzed. Findings Seventy‐one treatments performed in 24 patients. ABV monitoring showed a constant decrease as HD treatment progressed. Thirteen IDH events were observed in eight different patients, with a mean systolic BP drop in IDH treatments of 37.38 ± 4.31 mmHg and a mean adjusted ABV at hypotension of 71.07 ± 14.88 mL/kg. Critical ABV was individually set in patients prone to IDH. As expected, ABV feedback control successfully maintained ABV over preset critical ABV. IDH events were avoided in 21 out of 22 treatments performed. ABV drop was successfully reduced, as well as SBP drop (despite similar UF than prior to ABV feedback control implementation). Discussion ABV feedback control avoided IDH in 21 out of 22 treatments performed by maintaining blood volume above critical ABV, significantly reducing ABV variations without compromising prescribed UF.
    Type of Medium: Online Resource
    ISSN: 1492-7535 , 1542-4758
    URL: Issue
    URL: Article
    DOI: 10.1111/hdi.v27.2
    DOI: 10.1111/hdi.13074
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2103570-2
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  • 5
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    Absolute blood volume variations during hemodialysis: Does dialysate temperature play a role?
    Wiley ; 2021
    In:  Seminars in Dialysis Vol. 34, No. 4 ( 2021-07), p. 309-314
    Details
    In: Seminars in Dialysis, Wiley, Vol. 34, No. 4 ( 2021-07), p. 309-314
    Abstract: Vascular refilling occurs to preserve hemodynamic stability during hemodialysis (HD). Recent studies report a feasible and noninvasive method to determine absolute blood volume (ABV), and estimate vascular refilling during HD. The objective of this study is to analyze if lowering dialysate temperature modifies variations in ABV during HD. Methods The study was performed in 50 patients under HD. During two different sessions, relative blood volume was assessed using dialysate temperatures of 35.5°C (cool dialysate) and 36.5°C (neutral dialysate). ABV and vascular refilling were calculated using Kron et al methodology. Results Thirty‐nine intradialytic morbid events (IMEs) were observed in 30 patients, 14 under cool dialysate and 25 during neutral dialysate. We did not found statistically differences in ABV or in refilling volume between cool and neutral temperature. When analyzing apart only those patients who presented IME, we observed lower drop in ABV in the 35.5°C dialysate treatments (0.57 L) versus 36.5°C dialysate treatments (0.71 L). When cool dialysate was used, the vascular refilling fraction tended to be higher, but data did not turn statistically significant. Conclusions In selected groups of patients the use of cool dialysate induces lower ABV variations that could improve hemodynamic stability during HD treatments.
    Type of Medium: Online Resource
    ISSN: 0894-0959 , 1525-139X
    URL: Issue
    URL: Article
    DOI: 10.1111/sdi.v34.4
    DOI: 10.1111/sdi.12958
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2010756-0
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  • 6
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    Absolute blood volume variations and vascular refilling in hemodialysis patients
    Wiley ; 2021
    In:  Seminars in Dialysis Vol. 34, No. 3 ( 2021-05), p. 229-234
    Details
    In: Seminars in Dialysis, Wiley, Vol. 34, No. 3 ( 2021-05), p. 229-234
    Abstract: The imbalance between ultrafiltration volume (UF) and vascular refilling is considered a major cause for intradialytic hypotension. Recent studies report a noninvasive method to estimate vascular refilling (V REF ) by determining absolute blood volume (ABV). It was the aim of the study to analyze variations in ABV in a group of hemodialysis (HD) patients and examine V REF . Thirty one stable chronic HD patients were studied, aged 71.07 ± 13.31 years. Dialysis duration and UF requirements were based on physician prescription. V REF was calculated as: V REF  = V UF  − ΔV where ΔV is ABV variation during dialysis treatment. ABV at the beginning of the dialysis was 6.00 ± 2.39 L (92.82 ± 33.17 ml/kg) and at the end 5.38 ± 2.32 L (82.07 ± 31.41 ml/kg). Prescribed UF was 2.64 ± 0.83 L. Mean V REF was 2.05 ± 0.80 L, with a refilling fraction of 75.75 ± 12.79%. V REF was strongly correlated with UF volume (r 2 0.877), and with pre‐dialysis volume overload (r 2 0.617). Patients under beta‐blocker treatment showed significantly lower F REF . ABV measurement is an easy and noninvasive method that allows us to study V REF during HD. We found a strong correlation between V REF and UF.
    Type of Medium: Online Resource
    ISSN: 0894-0959 , 1525-139X
    URL: Issue
    URL: Article
    DOI: 10.1111/sdi.v34.3
    DOI: 10.1111/sdi.12952
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2010756-0
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  • 7
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    MO172HYPONATREMIA IN PATIENTS WITH COVID19
    Oxford University Press (OUP) ; 2021
    In:  Nephrology Dialysis Transplantation Vol. 36, No. Supplement_1 ( 2021-05-29)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 36, No. Supplement_1 ( 2021-05-29)
    Abstract: Among laboratory abnormalities described in the context of SARS-COV-2 infection, hyponatremia seem to be the most common. The mechanism of this sodium disbalance is not well known. Aims Characterize the incidence, etiology and prognostic value of sodium disbalance in patients with COVID19. Method Observational pilot study with 37 patients admitted to Hospital Ramon y Cajal in Madrid, Spain, between March and April 2020, with a confirmed diagnosis of COVID19. Patients were followed until discharge or death. Clinical and laboratory data were collected at admission and before the clinical outcome. Variables were analyzed comparing hyponatremic vs eunatremic patients. Results Distribution of patients according to their serum sodium was as follows: 16 patients with hyponatremia (44%), 19 with normal serum sodium (51%) and 2 with hypernatremia (5%). The average sodium level in hyponatremic patients was 130 ±3.2 mmol/l, median urine sodium was 36 ±3.2 mmol/l (only 6 urine sample available). Hyponatremia was associated with dyspnea at admission and with higher levels of LDH, neutrophil cells account and C reactive protein. However, no worse prognostic was associated with lower serum sodium. All patients recover sodium levels at discharge treated with salt supplementation and free water intake. Conclusion mild hyponatremia is a common electrolyte disorder associated with COVID19. Sing as low urine sodium and recover with water and salt ingestion, point toward hydrosaline dehydration instead of SIADH as most common origin of hyponatremia.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfab092.0050
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 1465709-0
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  • 8
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    Online Resource
    P1243ABSOLUTE BLOOD VOLUME VARIATIONS INFLUENCED BY DIALYSATE TEMPERATURE DURING HAEMODIALYSIS
    Oxford University Press (OUP) ; 2020
    In:  Nephrology Dialysis Transplantation Vol. 35, No. Supplement_3 ( 2020-06-01)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 35, No. Supplement_3 ( 2020-06-01)
    Abstract: Intradialytic hypotension is a common complication in haemodialysis. Vascular refilling occurs to preserve haemodynamic stability. Recent studies report a feasible and noninvasive method to determine absolute blood volume, which would allow us to estimate vascular refilling during haemodialysis. During years, it has been proposed that lowering the dialysate temperature could improve intradialytic hypotension outcomes in patients undergoing chronic haemodialysis. The objective of this study is to analyze if lowering dialysate temperature modifies variations in absolute blood volume during haemodialysis. Method The study was performed in 51 patients under haemodialysis treatment. During two different sessions, relative blood volume was assessed using dialysate temperatures of 35.5ºC (cool dialysate) and 36.5ºC (neutral dialysate). Absolute blood volume and vascular refilling were calculated using Kron et al methodology (Hemodial Int. 2016;20(3):484–91). Intradialytic hypotension was defined as a systolic blood pressure below 85 mmHg or a drop of pressure above 20 mmHg accompanied by symptoms. Statistical analysis was performed using paired t-Test or Wilcoxon rank sum. Results 31 episodes of intradialytic hypotension were observed, 14 under cool dialysate and 26 during neutral dialysate. We did not found statistically differences in absolute blood volume or in refilling volume between cool and warm dialysate temperature. In the group of patients with intradialytic hypotension (Table 1) we observed lower drop in absolute blood volume in the 35.5ºC dialysate group (0.59 L) versus 36.5ºC group (0.72 L). Although no statistically significant differences were found in vascular refilling volumes, when cool dialysate was used refilling tended to be higher. Conclusion It seems that in selected groups of patients the use of cool dialysate could improve absolute blood volume stability during HD treatments, although further studies are needed.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfaa142.P1243
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 1465709-0
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  • 9
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    Effect of Beta-Blocker Cardioselectivity on Vascular Refilling in Hemodialysis Patients
    S. Karger AG ; 2021
    In:  Cardiorenal Medicine Vol. 11, No. 5-6 ( 2021), p. 237-242
    Details
    In: Cardiorenal Medicine, S. Karger AG, Vol. 11, No. 5-6 ( 2021), p. 237-242
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 β-Blockers are the most frequently prescribed cardioprotective drugs in hemodialysis (HD) patients, despite their weak evidence. We sought to evaluate the effects of β-blockers on vascular refilling during HD treatments and examine whether carvedilol, for being noncardioselective and poorly dialyzable, associates more impact than others. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 The study was performed in a cohort of maintenance HD patients from a tertiary center. All patients had previous β-blocker prescription. We conducted a prospective crossover study and measured vascular refilling volume ( 〈 i 〉 V 〈 /i 〉 〈 sub 〉 ref 〈 /sub 〉 ) and vascular refilling fraction ( 〈 i 〉 F 〈 /i 〉 〈 sub 〉 ref 〈 /sub 〉 ) in 2 circumstances: under β-blocker treatment (βb profile) and without β-blocker effect (non-βb profile). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Twenty patients were included, 10 of whom were treated with carvedilol. Predialysis values were comparable between the 2 profiles. Although the βb profile showed lower 〈 i 〉 V 〈 /i 〉 〈 sub 〉 ref 〈 /sub 〉 and higher ABV drop, these differences did not reach statistical significance. Data showed an increase in 〈 i 〉 F 〈 /i 〉 〈 sub 〉 ref 〈 /sub 〉 in the non-βb profile (70.01 ± 6.80% vs. 63.14 ± 11.65%; 〈 i 〉 p 〈 /i 〉 = 0.015). The βb profile associated a significantly higher risk of intradialytic hypotension (IDH) (risk ratio 2.40; 95% CI: 1.04–5.55). When analyzing separately the carvedilol group, patients dialyzed under drug effect experienced a significant impairment in 〈 i 〉 V 〈 /i 〉 〈 sub 〉 ref 〈 /sub 〉 , 〈 i 〉 F 〈 /i 〉 〈 sub 〉 ref 〈 /sub 〉 , and refilling rate. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Administering β-blockers before HD associated a higher risk of IDH and a decrease in 〈 i 〉 F 〈 /i 〉 〈 sub 〉 ref 〈 /sub 〉 . Patients dialyzed under carvedilol effect showed an impaired refilling, probably related to its noncardioselectivity and lower dializability.
    Type of Medium: Online Resource
    ISSN: 1664-3828 , 1664-5502
    URL: Article
    DOI: 10.1159/000519661
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 2595659-0
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  • 10
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    SP535CARDIORENAL SYNDROME AND PERITONEAL DIALYSIS: OUR EXPERIENCE
    Oxford University Press (OUP) ; 2019
    In:  Nephrology Dialysis Transplantation Vol. 34, No. Supplement_1 ( 2019-06-01)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 34, No. Supplement_1 ( 2019-06-01)
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfz103.SP535
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 1465709-0
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