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  • 1
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    Online Resource
    Etelcalcetide and Paricalcitol in Chronic Kidney Disease: When the Target Is Inflammation
    MDPI AG ; 2022
    In:  Healthcare Vol. 11, No. 1 ( 2022-12-26), p. 72-
    Details
    In: Healthcare, MDPI AG, Vol. 11, No. 1 ( 2022-12-26), p. 72-
    Abstract: Introduction: secondary hyperparathyroidism (SHP) is frequent in patients with chronic kidney disease (CKD), particularly in those in dialysis. To treat this complication, the current options available include phosphorus restriction, phosphate binders, the inhibition of parathyroid hormone (PTH) synthesis and secretion by the supplementation of vitamin D or VDR activators, or the use of calcimimetics. Beyond the control of PTH, the effects of the treatment of SHP on other biomarkers of risk may represent an additional benefit for this population. In this study, we explore the benefits of current SHP treatment options, mainly paricalcitol and/or etelcalcetide in the inflammatory state of hemodialysis (HD) patients. Results: the study finally included 142 maintenance HD patients (5 patients were excluded) followed for 6 months (dialysis vintage 26 ± 30 months, mean age 70 years old, 73% women, 81% Spanish white, 47% diabetic). In this case, 52 patients were on regular treatment with paricalcitol for SHP and 25 patients were eligible to initiate etelcalcetide. The baseline serum levels of Ca, P, PTH, Ferritin, albumin, C-reactive protein (CRP), and other variables were measured. We found serum PTH levels showed an improvement after the treatment with etelcalcetide again paricalcitol and no treatment (p 〈 0.04). Of note, serum levels of CRP were significantly lower in a small group of patients (n = 11) receiving paricalcitol + etelcalcetide compared to paricalcitol or etelcalcetide alone. The proportion of patients with CRP within target ranges (≤1.0 mg/dL) increased significantly after combined treatment (p 〈 0.001). Conclusions: etelcalcetide proved to safely reduce the PTH levels without significant adverse events and the possibility of a synergic anti-inflammatory effect with the simultaneous use of Paricalcitol in HD patients.
    Type of Medium: Online Resource
    ISSN: 2227-9032
    URL: Article
    DOI: 10.3390/healthcare11010072
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2721009-1
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  • 2
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    Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection
    MDPI AG ; 2021
    In:  Journal of Clinical Medicine Vol. 10, No. 21 ( 2021-10-31), p. 5134-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 10, No. 21 ( 2021-10-31), p. 5134-
    Abstract: Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p 〈 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p 〈 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p 〈 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm10215134
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662592-1
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  • 3
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    ¿Cómo diseñar, aplicar y evaluar un programa de Mentoring en enfermedad renal crónica? evaluación narrativa del impacto en 6 centros asistenciales
    Elsevier BV ; 2019
    In:  Nefrología Vol. 39, No. 6 ( 2019-11), p. 603-611
    Details
    In: Nefrología, Elsevier BV, Vol. 39, No. 6 ( 2019-11), p. 603-611
    Type of Medium: Online Resource
    ISSN: 0211-6995
    URL: Article
    DOI: 10.1016/j.nefro.2019.04.002
    Language: Spanish
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 2058560-3
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  • 4
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    Desarrollo de un instrumento para la evaluación del malestar emocional para pacientes renales en diálisis
    Sociedad Espanola de Enfermeria Nefrologica ; 2016
    In:  Enfermería Nefrológica Vol. 19, No. 4 ( 2016-12-02), p. 349-357
    Details
    In: Enfermería Nefrológica, Sociedad Espanola de Enfermeria Nefrologica, Vol. 19, No. 4 ( 2016-12-02), p. 349-357
    Abstract: Objetivo: Actualmente no existen herramientas validadas para evaluar el malestar emocional en pacientes con enfermedad renal crónica, pese a su alta prevalencia en todas las etapas de la patología. Este trabajo describe el desarrollo de un instrumento breve semiestructurado para la Evaluación del malestar Emocional de los pacientes renales en Diálisis (EE-D). Método: El EE-D incluye cinco preguntas con distintos formatos de respuesta (dicotómico, Likert y preguntas abiertas) para evaluar tristeza, ansiedad, preocupaciones, recursos para afrontar la enfermedad, signos externos de malestar y observaciones. Los ítems de la primera versión se sometieron a un estudio interjueces (N= 10). Posteriormente se realizó un estudio piloto multicéntrico (N= 25 pacientes en 5 hospitales). Resultados: Tras el estudio interjueces un ítem fue eliminado, y otro añadido. Tras el piloto no hubo modificaciones. La puntuación media (sobre 10) fue 4,16 (DT: 3,41) en tristeza y 3,68 (DT: 3,48) en ansiedad. El 48% refirió preocupaciones familiares, el 44% preocupaciones sobre su estado emocional-psicológico y el 40% sobre su enfermedad/tratamientos. Los principales recursos identificados fueron la esperanza en la posibilidad de trasplante y el apoyo social. A juicio de enfermería el 24% presentan expresión facial de malestar y el 16% otros signos de malestar. Discusión: El EE-D muestra unas garantías psicométricas preliminares. Ha sido distribuido en las Unidades de Diálisis de todo el territorio nacional con el objetivo de su implementación clínica en un marco investigador, lo que permitirá el desarrollo de futuros estudios de validación multicéntricos.
    Type of Medium: Online Resource
    ISSN: 2255-3517 , 2254-2884
    URL: Article
    DOI: 10.4321/S2254-28842016000400006
    Language: Unknown
    Publisher: Sociedad Espanola de Enfermeria Nefrologica
    Publication Date: 2016
    detail.hit.zdb_id: 2739231-4
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  • 5
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    Online Resource
    Increased Response to Subcutaneous Erythropoietin on Type I Diabetic Patients on CAPD: Is There a Synergistic Effect with Insulin?
    SAGE Publications ; 1995
    In:  Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis Vol. 15, No. 3 ( 1995-07), p. 231-235
    Details
    In: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, SAGE Publications, Vol. 15, No. 3 ( 1995-07), p. 231-235
    Abstract: To evaluate the effect of subcutaneous erythropoietin (SC EPO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Design A resistance index was designed for measuring the relative EPO response, dividing EPO dose (U/kg/ week) by the hemoglobin (Hb) increment with respect to the basallevel. Patients Eleven nonselected type I diabetic patients using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy. Results The two groups showed similar mean baseline hemoglobin levels (7.4 D- l and 7.7 non-D, g/dL). There was a statistically significant lower resistance index for diabetics (13.8±9.7 U/kg/g Hb increment) compared to nondiabetic (55.8±128, p 〈 0.001). Multivariate analysis confirmed an independent association between diabetes and resistance index. The response to EPO was slightly better among those diabetic patients with lower levels of serum parathyroid hormone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p 〈 0.05). No other differences, apart from the use of subcutaneous insulin, were found between diabetics and controls. Although diabetic patients had an increased response to EPO, they had no more frequent side effects than nondiabetics. Conclusions According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.
    Type of Medium: Online Resource
    ISSN: 0896-8608 , 1718-4304
    URL: Article
    DOI: 10.1177/089686089501500310
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1995
    detail.hit.zdb_id: 2075957-5
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  • 6
    Online Resource
    Online Resource
    Increased Response to Subcutaneous Erythropoietin on Type I Diabetic Patients on Capd: Is There a Synergistic Effect with Insulin?
    SAGE Publications ; 1995
    In:  Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis Vol. 15, No. 6_suppl ( 1995-07), p. 231-235
    Details
    In: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, SAGE Publications, Vol. 15, No. 6_suppl ( 1995-07), p. 231-235
    Abstract: To evaluate the effect of subcutaneous erythropoietin (SC EPO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Design A resistance index was designed for measuring the relative EPO response, dividing EPO dose (U/kg/ week) by the hemoglobin (Hb) increment with respect to the basallevel. Patients Eleven nonselected type I diabetic patients using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy. Results The two groups showed similar mean baseline hemoglobin levels (7.4 D- l and 7.7 non-D, g/dL). There was a statistically significant lower resistance index for diabetics (13.8±9.7 U/kg/g Hb increment) compared to nondiabetic (55.8±128, p 〈 0.001). Multivariate analysis confirmed an independent association between diabetes and resistance index. The response to EPO was slightly better among those diabetic patients with lower levels of serum parathyroid hormone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p 〈 0.05). No other differences, apart from the use of subcutaneous insulin, were found between diabetics and controls. Although diabetic patients had an increased response to EPO, they had no more frequent side effects than nondiabetics. Conclusions According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.
    Type of Medium: Online Resource
    ISSN: 0896-8608 , 1718-4304
    URL: Article
    DOI: 10.1177/089686089501506S06
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1995
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  • 7
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    Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres
    Oxford University Press (OUP) ; 2022
    In:  Clinical Kidney Journal Vol. 15, No. 7 ( 2022-06-23), p. 1340-1347
    Details
    In: Clinical Kidney Journal, Oxford University Press (OUP), Vol. 15, No. 7 ( 2022-06-23), p. 1340-1347
    Abstract: The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods We compared retrospectively two periods of time: the pre-COVID (1 January 2019–11 March 2020) and the COVID era (12 March 2020–30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt ( & gt;45) as a marker of HD adequacy. Results A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients ( & gt;75 and & gt;85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P & lt; 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P & lt; 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt & gt; 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.
    Type of Medium: Online Resource
    ISSN: 2048-8505 , 2048-8513
    URL: Article
    DOI: 10.1093/ckj/sfac094
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2656786-6
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  • 8
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    Online Resource
    Impact of the COVID-19 Pandemic in Spain in the Successive Pandemic Waves on Hemodialysis Patients and Healthcare Personnel
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 13 ( 2023-06-28), p. 4337-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 13 ( 2023-06-28), p. 4337-
    Abstract: (1) Background: The impact of SARS-CoV-2 has been variable over the time course of the pandemic and in different populations. The aim was to analyze the impact of COVID-19 infection in a known population of hemodialysis (HD) patients and professionals in Spain at different times of the pandemic. (2) Methods: We conducted an observational, descriptive study with a follow-up from 3 March 2020 to 23 April 2022 (776 days), using in average of 414 professionals and 1381 patients from 18 HD units in Spain. The data from the positive PCR or the rapid antigen detection test (RADT) subject were analyzed and segmented into six periods (waves). (3) Results: Of 703 positive COVID-19 tests, 524 were HD patients (74.5%), and 179 were HD professionals (25.5%). Overall, 38% of staff and 43% of patients were affected. Differences were observed in regard to incidence (21% vs. 13%), mortality (3.5% vs. 0%), and symptomatology between the patients and professionals and throughout the pandemic. (4) Conclusions: COVID-19 severity varied during different pandemic waves, with a greater impact seen in the first wave. HD professionals and patients had similar infection rates, but patients had higher mortality rates. Community transmission was the primary route of infection.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12134337
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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  • 9
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    Increased mortality after kidney transplantation in mildly frail recipients
    Oxford University Press (OUP) ; 2022
    In:  Clinical Kidney Journal Vol. 15, No. 11 ( 2022-10-28), p. 2089-2096
    Details
    In: Clinical Kidney Journal, Oxford University Press (OUP), Vol. 15, No. 11 ( 2022-10-28), p. 2089-2096
    Abstract: Physical Frailty Phenotype (PFP) is the most used frailty instrument among kidney transplant recipients, classifying patients as pre-frail if they have 1–2 criteria and as frail if they have ≥3. However, different definitions of robustness have been used among renal patients, including only those who have 0 criteria, or those with 0–1 criteria. Our aim was to determine the impact of one PFP criterion on transplant outcomes. Methods We undertook a retrospective study of 296 kidney transplant recipients who had been evaluated for frailty by PFP at the time of evaluating for transplantation. Results Only 30.4% of patients had 0 criteria, and an additional 42.9% showed one PFP criterion. As PFP score increased, a higher percentage of women and cerebrovascular disease were found. Recipients with 0–1 criteria had lower 1-year mortality after transplant than those with ≥2 (1.8% vs 10.1%), but this difference was already present when we only considered those who scored 0 (mortality 1.1%) and 1 (mortality 2.4%) separately. The multivariable analysis confirmed that one PFP criterion was associated to a higher risk of patient death after kidney transplantation [hazard ratio 3.52 (95% confidence interval 1.03–15.9)]. Conclusions Listed kidney transplant candidates frequently show only one PFP frailty criterion. This has an independent impact on patient survival after transplantation.
    Type of Medium: Online Resource
    ISSN: 2048-8505 , 2048-8513
    URL: Article
    DOI: 10.1093/ckj/sfac159
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2656786-6
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  • 10
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    La programación neurolingüística, una posible heramienta de abordaje en la gestión de conflictos para la supervisión de enfermería en la unidad de diálisis
    Sociedad Espanola de Enfermeria Nefrologica ; 2023
    In:  Enfermería Nefrológica Vol. 26, No. 1 ( 2023-3-30), p. 7-8
    Details
    In: Enfermería Nefrológica, Sociedad Espanola de Enfermeria Nefrologica, Vol. 26, No. 1 ( 2023-3-30), p. 7-8
    Abstract: La enfermera que asume la responsabilidad de la supervisión de una unidad de diálisis debería saber, que se enfrentará a lo largo de su ejercicio profesional con múltiples conflictos, que podríamos incluso considerar arquetípicos. A la supervisión se le exige como requisitos de formación complementaria la gestión por procesos, liderazgo y desarrollo de personas y resolución de conflictos.  En los conflictos considero que las características más importantes a destacar es que son inevitables, siempre gestionables e imprescindibles para crecer en un equipo.  El rol principal de la supervisión de enfermería en la gestión de conflictos, es conseguir resolverlo de forma funcional, lo que significa, que la resolución ayuda a caminar hacia la maduración del equipo, a fomentar el análisis crítico y a promover el cambio y la creatividad. La supervisión es el agente activo en habilidades de gestión que deberá evitar una resolución disfuncional que mantiene la tensión, los comportamientos negativos, la posible distorsión de la realidad y la reducción de la colaboración. Convertirse en este agente activo implica realizar una formación proactiva, consciente y continua. Significa “me responsabilizo de atender mi desarrollo” y “me dedico respetuosamente a transformarme”. La programación neurolingüística aglutina estrategias para el desarrollo personal con un enfoque eminentemente práctico.
    Type of Medium: Online Resource
    ISSN: 2255-3517 , 2254-2884
    URL: Journal
    URL: Article
    DOI: 10.37551/S2254-2884
    DOI: 10.37551/S2254-28842023001
    Language: Spanish
    Publisher: Sociedad Espanola de Enfermeria Nefrologica
    Publication Date: 2023
    detail.hit.zdb_id: 2739231-4
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