31 results on '"Ortega, Mayra"'
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2. La hipomagnesemia en hemodiálisis se asocia a mayor riesgo de mortalidad: su relación con el líquido de diálisis
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Pérez-García, Rafael, Jaldo, María Teresa, Puerta, Marta, Ortega, Mayra, Corchete, Elena, de Sequera, Patricia, Martín-Navarro, Juan Antonio, Albalate, Marta, and Alcázar, Roberto
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- 2020
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3. Alta prevalencia de COVID-19 asintomático en hemodiálisis. Aprendiendo día a día el primer mes de pandemia de COVID-19
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Perez-Villar, M.I., Romero, R., Rodriguez-Suarez, E., Ramos, A., Liébana, B., Vinagre, G., Ruiz, S., Herrera, E., Quesada, M.T., Saenz, A.J., Argote, P. Diaz de, Garcia-Martinez, P., Bermejo, M.B., Sánchez-Fernandez, N., Martinez-Gonzalez, M., Cerrajero, R., Bernabé, M., Rojas, V., Martínez-Dios, I., Conejo, D., Rodriguez-Presa, P., Varona, Y., Muñoz-Blazquez, R., Sanz-Martinez, D., Montoro, J.J., Aviles, A.I., Albalate, Marta, Arribas, Patricia, Torres, Esther, Cintra, Melissa, Alcázar, Roberto, Puerta, Marta, Ortega, Mayra, Procaccini, Fabio, Martin, Juan, Jiménez, Eva, Fernandez, Inés, and de Sequera, Patricia
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- 2020
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4. El Kt/V alto, a diferencia del Kt, se asocia a mayor mortalidad: importancia de la V baja
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Pérez-García, Rafael, Jaldo, Maite, Alcázar, Roberto, de Sequera, Patricia, Albalate, Marta, Puerta, Marta, Ortega, Mayra, Ruiz, M. Caridad, and Corchete, Elena
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- 2019
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5. El líquido de diálisis con citrato no induce in vitro estrés oxidativo ni inflamación en comparación con el acetato
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Pérez-García, Rafael, Ramírez Chamond, Rafael, de Sequera Ortiz, Patricia, Albalate, Marta, Puerta Carretero, Marta, Ortega, Mayra, Ruiz Caro, M. Caridad, and Alcazar Arroyo, Roberto
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- 2017
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6. Receta para prescribir fósforo durante hemodiálisis
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Albalate, Marta, Ruiz-Alvarez, Ma Jesús, de Sequera, Patricia, Perez-Garcia, Rafael, Arribas, Patricia, Corchete, Elena, Ruiz Caro, Caridad, Talaván Zanón, Tamar, Alcazar, Roberto, Ortega, Mayra, and Puerta, Marta
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- 2017
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7. Aprender sin límites. Propuesta de innovación pedagógica, basada en la educación STEAM
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Ramírez Ortega, Mayra Alejandra
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Humanidades y ciencias sociales ,ciencias de la educación ,educación ,Educación STEAM ,creatividad ,innovación ,aprendizaje ,pensamiento creativo - Abstract
La investigación se planteó con el objetivo de diseñar una propuesta de innovación pedagógica, por medio de la implementación del método STEAM, que contribuya al desarrollo del pensamiento creativo de un niño de ocho años de una institución educativa de carácter privado. Primero, se identificaron las características del pensamiento creativo del niño participante por medio del análisis de los resultados derivados de la aplicación del test de Torrance (expresión figurada). Seguidamente, se implementaron las actividades pedagógicas basadas en la educación STEAM, y, por último, se evidenció la efectividad de la educación STEAM en el desarrollo del pensamiento creativo del caso en estudio. La pregunta problema fue: ¿Cómo la educación STEAM puede aportar en la construcción de una propuesta de innovación pedagógica que contribuya al desarrollo del pensamiento creativo de un niño de ocho años? Esta investigación se desarrolló bajo el paradigma cualitativo y con el diseño metodológico de estudio de caso, conducido a partir de tres fases para cumplir con los objetivos planteados de la propuesta investigativa. La propuesta pedagógica se consolidó por medio de seis intervenciones. Estas favorecieron los procesos de autoevaluación para entender y mejorar la práctica pedagógica. Finalmente, algunos resultados y conclusiones, fueron los siguientes: la propuesta basada en la educación STEAM realmente permitió el desarrollo del pensamiento creativo del estudiante, dado que se evidenció un avance en las características del mismo y, que planear experiencias basadas en la educación STEAM, posibilita un trabajo interdisciplinar entre las áreas a trabajar, y transversal en las dimensiones del desarrollo.
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- 2021
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8. Un curioso caso de fracaso renal agudo en tiempos del COVID-19
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Cintra, Melissa, Torres, Esther, Salazar, Danilo, Albalate, Marta, Procaccini, Fabio, Medina, Laura, Martín-Navarro, Juan Antonio, Ortega, Mayra, Puerta, Marta, Alcázar, Roberto, and De Sequera, Patricia
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- 2023
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9. Desarrollo de metodologías espectroscópicas aplicadas a la caracterización de minerales de interés arqueológico
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Manrique Ortega, Mayra Dafne and Ruvalcaba Sil, José Luis
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Ciencias Físico-Matemáticas e Ingenierías - Published
- 2019
10. Síndrome de hipersensibilidad a medicamentos con exantema, eosinofilia y síntomas sistémicos inducido por carbamazepina
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Marín, Jorge Alonso, Ortega, Mayra Alexandra, Sánchez, Isaura Pilar, and Pacheco, José Armando
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síndrome de hipersensibilidad a medicamentos ,exantema ,signs and symptoms ,carbamazepine ,Drug hypersensitivity syndrome ,anticonvulsants ,carbamazepina ,signos y síntomas ,hipersensibilidad ,hypersensitivity ,eosinophilia ,eosinofilia ,anticonvulsivos - Abstract
RESUMEN El síndrome de hipersensibilidad a medicamentos, con exantema, eosinofilia y síntomas sistémicos (Drug Rash Eosinophylia with Systemic Symptoms, DRESS) es una reacción a diferentes medicamentos, principalmente anticonvulsivos, el cual cursa con compromiso sistémico y lesiones eritematosas, al igual que ocurre en diversas dermatosis por reacción a medicamentos. Este síndrome es una condición clínica poco frecuente, cuyo diagnóstico requiere un alto grado de sospecha por parte del personal clínico. Si no se hace un diagnóstico oportuno y se suministra el tratamiento adecuado, puede confundirse con otros tipos de alergias a medicamentos que implican riesgo de muerte. Se presenta el caso de un paciente de 22 años de edad con alteración del neurodesarrollo a quien se le inició tratamiento con carbamazepina. Dos meses después consultó debido a la aparición de síntomas generales y lesiones eritematosas en la piel, inicialmente en el tronco. En la atención ambulatoria se le prescribieron antihistamínicos y antipiréticos, con los cuales no mejoró adecuadamente; su condición empeoró, con la aparición de lesiones en la piel y síntomas sistémicos propios del síndrome DRESS. Al cabo del tratamiento farmacológico administrado durante su hospitalización según los lineamientos recomendados, las manifestaciones y complicaciones asociadas con el síndrome remitieron, la administración de esteroides pudo reducirse gradualmente y, finalmente, el paciente fue dado de alta. ABSTRACT Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity reaction associated with a variety of drugs, mainly anticonvulsants, which is characterized by systemic symptoms and erythematous lesions, common to other toxicodermas. It is an uncommon clinical entity that requires a high suspicion by clinical staff given its varied initial presentation, and the fact that symptoms can overlap with those of other adverse cutaneous reactions to drugs. Without early diagnosis and appropriate treatment, mortality increases. We report the case of a 22-year-old patient with impaired neurodevelopment who received treatment with carbamazepine. Two months later he presented with general symptoms and skin erythematous lesions that began on his trunk. The patient received outpatient care with antihistamines and antipyretics without an appropriate response. His case progressed with increased skin lesions and systemic symptoms that met the diagnostic criteria for DRESS syndrome. He was hospitalized and received medical treatment according to recommended guidelines. The patient’s condition improved as his symptoms and associated complications resolved. He was discharged with gradual clearing of the steroid therapy.
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- 2017
11. Factores psicosociales y adherencia al tratamiento farmacológico en pacientes en hemodiálisis crónica
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Huertas-Vieco, María P., Pérez-García, Rafael, Albalate, Marta, Sequera, Patricia de, Ortega, Mayra, Puerta, Marta, Corchete, Elena, and Alcázar, Roberto
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Social support ,Ansiedad ,Hemodiálisis ,Cognitive impairment ,Depression ,Depresión ,Hemodialysis ,Adherence pharmacological treatment ,Anxiety ,Deterioro cognitivo ,Adherencia ,Apoyo social - Abstract
Introducción: Los pacientes en hemodiálisis (HD) son uno de los colectivos que toma mayor cantidad de comprimidos en comparación con otros enfermos crónicos. La adherencia al tratamiento prescrito tiene implicaciones en la calidad de vida, la supervivencia y el coste económico de su tratamiento, siendo este último un tema prioritario de salud pública. Objetivo: Evaluar la adherencia al tratamiento farmacológico en pacientes en HD crónica examinando, entre las posibles causas de la no adherencia, factores psicosociales como depresión, ansiedad, deterioro cognitivo y apoyo social. Material y métodos: Estudio observacional transversal llevado a cabo en treinta y cinco pacientes con enfermedad renal crónica en HD, evaluados mediante cuestionarios administrados por personal especializado. Resultados: Los pacientes no adherentes presentan índices de depresión significativamente más elevados que los adherentes al tratamiento farmacológico. La ansiedad, el deterioro cognitivo y el apoyo social no muestran relación estadísticamente significativa con el grado de cumplimiento. Conclusiones: Estos resultados sugieren que la intervención psicológica en pacientes en HD con mayores índices de depresión podría aumentar el grado de cumplimiento y bienestar general del enfermo renal. Background: The daily pill burden in hemodialysis patients is one of the highest reported to date in any chronic disease. The adherence to prescribed treatment has implications on the quality of life, the survival of patients, and the economic cost of their treatment, this being a priority public health issue. Objective: To evaluate the adherence to pharmacological treatment examining, among the possible causes of non-adherence, psychosocial factors such as depression, anxiety, cognitive impairment and social support. Method: Transversal-observational study of thirty five patients that suffer from chronic renal disease and who are on manteinance hemodialysis, evaluated by self-reported measures. Results: Non-adherent patients have significant higher depression index than adherent patients. Anxiety, cognitive impairment and social support do not show a significant relation with the degree of adherence or compliance with farmacological treatment. Conclusions: These results suggest that psychological intervention in chronic haemodialysis patients with a severe depression index could increase the degree of fulfillment and general well-being of renal patients.
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- 2014
12. Comparación de la eficacia de dos modalidades de hemodiafiltración en línea: mixta frente a posdilucional
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Sequera, Patricia de, Albalate, Marta, Pérez-García, Rafael, Corchete, Elena, Puerta, Marta, Ortega, Mayra, Alcázar, Roberto, Talaván, Tamar, and Ruiz-Álvarez, María J.
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Hemodiálisis ,Volumen convectivo ,Convective volume ,Uraemic toxins ,Beta2 microglobulina ,Toxinas urémicas ,Mixed ,Hemodiafiltración ,Posdilucional ,Haemodialysis ,Haemodiafiltration ,Beta2 microglobulin ,Mixta ,Post-dilution - Abstract
Introducción: La hemodiafiltración (HDF) con altos volúmenes de reinfusión es la técnica más eficaz en la depuración de toxinas urémicas. Existen distintas modalidades dependiendo del lugar donde se administra el volumen de sustitución en el circuito extracorpóreo: predilucional, mixta o mid-dilucional y posdilucional, en las que la infusión se realiza pre, de forma simultánea pre y pos, y posdilucional, respectivamente. Objetivo: Comparar la depuración de moléculas pequeñas, medianas y unidas a proteínas y el volumen convectivo administrado en HDF en línea (HDF-OL) con infusión posdilucional y mixta (pre-posdilucional). Material y métodos: Estudio prospectivo, aleatorizado y cruzado, comparando HDF-OL posdilucional y mixta. Los pacientes (n = 8) fueron asignados aleatoriamente para recibir 6 sesiones en cada técnica. Se realizaron 89 sesiones, de las cuales 68 fueron a tiempo programado (TP) y 21 a tiempo efectivo (TE). Se determinaron los porcentajes de reducción (RR) de distintas sustancias y los volúmenes de infusión. El estudio de los RR se realizó con TE. Resultados: El KT obtenido fue mayor con HDF-OL posdilucional [68 (8,1) frente a 64,9 (8,8) litros] (p = 0,009) cuando los pacientes se dializaron a TP. Esta diferencia desaparecía cuando la diálisis se realizaba a TE. La diferencia entre el TP-TE fue mayor en la HDF mixta con respecto a la HDF posdilucional [10,3 (7,4) frente a 6,5 (3,1) minutos, p = 0,02]. No encontramos diferencias en los RR de las sustancias analizadas. Conclusión: La HDF-OL mixta no es inferior a la posdilucional ni en la depuración de moléculas pequeñas y medianas ni en las unidas a proteínas a igual TE. Introduction: Haemodiafiltration (HDF) with high reinfusion volumes is the most effective technique for clearing uraemic toxins. There are various modalities depending on the location where the replacement volume is administered in the extracorporeal circuit: pre-dilution, mixed or mid-dilution and post-dilution, in which the infusion is carried out pre-dilution, pre- and post-dilution simultaneously and post-dilution, respectively. Objective: Compare the clearance of small, medium-sized and protein-bound molecules and the convective volume administered in online HDF (OL-HDF) in post-dilution and mixed (pre-post-dilution) infusion. Material and method: A prospective, randomised, crossover study comparing post-dilution and mixed OL-HDF. Patients (n=8) were randomly assigned to receive 6 sessions in each technique. We conducted 89 sessions, of which 68 were at a scheduled time (ST) and 21 at an effective time (ET). We determined the reduction rate (RR) percentages for various substances and the infusion volumes. The RR study was performed using ET. Results: The KT value obtained was greater with post-dilution OL-HDF [68 (8.1) compared to 64.9 (8.8) litres] (P=.009) when patients were dialysed at ST. This difference disappeared when dialysis was performed at ET. The difference between ST and ET was greater in mixed HDF than in post-dilution HDF [10.3 (7.4) compared to 6.5 (3.1) minutes, P=.02]. We found no differences in the RR of the substances analysed. Conclusion: Mixed OL-HDF is not inferior to post-dilution OL-HDF either in the clearance of small and medium-sized molecules or in the clearance of protein-bound molecules at the same ET.
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- 2013
13. Primer episodio de infección peritoneal: descripción y factores pronósticos
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Portolés, José, Janeiro, Darío, Lou-Arnal, Luis M., López-Sánchez, Paula, Ortega, Mayra, Peso, Gloria del, Felipe, Carmen, Tato, Ana M., Velo, Mercedes, Castellano, Inés, and Pérez-Díaz, Vicente
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Prognostic factor ,Risk factors ,Primera peritonitis ,Peritoneal dialysis ,Diálisis peritoneal ,First peritonitis ,Factor pronóstico ,Factores de riesgo - Abstract
Introducción: La peritonitis es una de las complicaciones más frecuentes y graves asociadas a la diálisis peritoneal (DP), siendo la primera causa de pérdida de catéter y de finalización de la técnica. La incidencia y etiología de cada episodio varía en función de cada región y evoluciona a lo largo del tiempo. Por esta razón, es de vital importancia conocer los factores de riesgo y pronósticos de peritonitis en cada momento. Métodos: Se realizó un estudio observacional de cohorte, multicéntrico, prospectivo, con un seguimiento máximo de 7 años (2003-2010) que incluyó 1177 pacientes, con 476 episodios de primera peritonitis (total: 1091 peritonitis). Resultados: Se presenta la descripción de las características del primer episodio de peritonitis en una serie amplia y actual. Los factores que se asociaron a un menor tiempo hasta la primera peritonitis en análisis multivariante fueron la comorbilidad cardiovascular previa (hazard ratio [HR] 1,25 [1,04-1,58]), la procedencia de hemodiálisis (HR 1,39 [1,10-1,76]) o trasplante renal previo (HR 1,38 [1,10-1,93]), iniciar DP con técnica manual (HR 1,39 [1,13-1,73]) y la edad de inicio > 70 años (HR 1,53 [1,23-1,90]). El primer episodio de peritonitis presenta una tasa de recidiva del 7,8 %, retirada de catéter del 11,7 % y una mortalidad en el primer mes tras el episodio del 1,3 %. La evolución de la peritonitis depende fundamentalmente del tipo de germen. Se estima un riesgo mayor para gramnegativos (odds ratio [OR] 5,31 [2,26-12,48]) y el agregado de peritonitis polimicrobianas, por hongos o por micobacterias (OR 38,24 [13,84-105,63]), comparados con la referencia de grampositivos. Conclusión: El desarrollo del primer episodio de peritonitis depende de las características del paciente al inicio de diálisis, la comorbilidad y la técnica utilizada. Los pacientes que presentan mayor riesgo deben recibir una atención especial en los procesos de entrenamiento y seguimiento. Introduction: Peritonitis is one of the most common and severe complications associated with peritoneal dialysis (PD), constituting the primary cause of catheter loss and exit from the dialysis technique. The incidence and aetiology of peritonitis episodes vary based on geographical region, and change over time. For this reason, it is vital to maintain an updated understanding of the current risk factors and prognostic factors associated with peritonitis. Method: We performed an observational, multi-centre, prospective cohort study with a maximum follow-up period of 7 years (2003-2010), which included 1177 patients and a total of 476 first episodes of peritonitis (total: 1091 cases of peritonitis). Results: We describe the characteristics of the first episode of peritonitis from a large and current study sample. The factors associated with a shorter interval until the first episode of peritonitis as selected by the multivariate analysis included prior cardiovascular comorbidity (Hazard Ratio [HR]: 1.25 [1.04-1.58]), having previously received haemodialysis (HR: 1.39 [1.10-1.76]) or a kidney transplant (HR: 1.38 [1.10-1.93]), having started PD on a manual modality (HR: 1.39 [1.13-1.73]), and initial age >70 years (HR: 1.53 [1.23-1.90]). The first episode of peritonitis was associated with a 7.8% rate of recurrence, an 11.7% rate of catheter removal, and a mortality rate within one month of the episode of 1.3%. The progression of peritonitis infections depended on the type of causal microorganism. We calculated a greater risk for gram-negative bacterial infections (Odds Ratio [OR]: 5.31 [2.26-12.48]) and the aggregate group of infections caused by multiple microorganisms, fungal infections, and mycobacterial infections (OR: 38.24 [13.84-105.63]), as compared to gram-positive bacterial infections. Conclusion: The development of a first case of peritonitis depends on the characteristics of the patient starting dialysis, comorbidities present, and the technique used. Patients at a greater risk for peritonitis must receive special care during training and follow-up.
- Published
- 2013
14. La hemodiafiltración en línea mejora la respuesta al tratamiento con calcifediol
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Pérez-García, Rafael, Albalate, Marta, Sequera, Patricia de, Alcázar, Roberto, Puerta, Marta, Ortega, Mayra, and Corchete, Elena
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Hyperphosphataemia ,Haemodialysis ,Online hemodiafiltration (OL-HDF) ,Hemodiálisis ,Vitamina d ,Hemodiafiltración en línea (HDF-OL) ,Hiperfosfatemia ,Vitamin D ,Calcifediol - Abstract
Introducción: Los niveles en sangre de 25-hidroxi-vitamina D (25-OH-vitD) se relacionan con múltiples patologías. Acordes al riesgo cardiovascular, se han definido los valores considerados «normales» y con ese dintel los pacientes con enfermedad renal crónica tienen muy frecuentemente déficit de dicha vitamina. Su reposición en hemodiálisis (HD), con dosis todavía no claramente establecidas, comienza a ser una constante en la práctica habitual. Objetivo: Valorar si la técnica de diálisis influye en la concentración basal de 25-OH-vitD y en la respuesta a su suplementación. Métodos: Estudio observacional prospectivo de dos cohortes de pacientes tratados y no tratados con calcifediol. Se determinaron Ca, P, hormona paratiroidea (PTH) y 25-OH-vitD en 59 pacientes prevalentes en HD (35 eran varones; edad media: 65,2 [15,7] años) en noviembre de 2010. De ellos, 36 pacientes (con 25-OH-vitD < 10 ng/ml) se trataron con calcifediol semanal (Hidroferol®, 1 ampolla: 266 µg) administrado pos-HD por una enfermera a partir de enero de 2011. Recibieron 6 dosis y se determinaron de nuevo los niveles en marzo. Se comparó la respuesta en función de la técnica de HD. Los 22 restantes no fueron tratados y se consideran como un grupo control. Resultados: Medias basales (n = 59): 25-OH-vitD: 9,8 (7,0) ng/ml; Ca: 9,3 (0,5) mg/dl; P: 4,5 (1,4) mg/dl, y PTH intacta: 299 (224) pg/ml. No existían diferencias por edad, sexo, ni técnica (HD vs. hemodiafiltración en línea [HDF-OL]).Tratados (n = 36): Los niveles de 25-OH-vitD pasaron de 6,2 (3,4) a 51 (22,9) ng/ml, p < 0,0001, sin cambios significativos en el Ca. La fosfatemia se incrementó como media en 0,6 (1,4) mg/dl, de 4,4 a 5 mg/dl, (p = 0,015). La PTH disminuyó como media en 85 (208) pg/ml, p = 0,023. En estos pacientes la indicación de captores del P se incrementó en una dosis media equivalente de 0,47 (0,82), p < 0,001. Los 13 pacientes en tratamiento con HDF-OL alcanzaron unos niveles de 25-OH-vitD significativamente mayores que los 23 tratados con HD: 63 (21) vs. 43 (21) ng/ml, p = 0,011. El tratamiento doble con vitamina D nativa y activa se asoció de forma significativa al aumento de los niveles de P, p = 0,043.No tratados (n = 23): Los niveles de 25-OH-vitD bajaron de 15,3 (7,5) en noviembre a 11,1 (6,8) ng/ml en marzo, p < 0,01, sin cambios significativos en el P ni la PTH y sin que encontráramos diferencias según la edad. La disminución se produjo en los pacientes en HD, n = 15, y no en los que estaban en HDF-OL, n = 8. Comentario: Los niveles séricos basales de 25-OH-vitD en pacientes en HD son bajos o muy bajos. La respuesta al tratamiento con calcifediol es buena, más marcada en los pacientes en HDF-OL; mientras, en los pacientes no tratados los niveles bajan probablemente en relación con el período invernal. Algunos pacientes incrementan la fosfatemia a pesar de aumentar la cantidad de captores de P, fundamentalmente aquellos que estaban en tratamiento con vitamina D activa. Introduction: 25-hydroxy vitamin D (25-OH-vit D) levels in the blood are associated with multiple pathologies. "Normal" values have been defined based on cardiovascular risk, and under this framework, patients with chronic kidney disease often have a deficit. 25-OH-vit D replacement in patients on haemodialysis (HD), in which dosage has not yet been clearly established, is becoming a constant in our daily practice. Objective: To assess whether dialysis technique influences the baseline concentration of 25-OH-vitamin D and the response to supplements. Method: Prospective observational study of two cohorts of patients, those patients treated with calcifediol and those untreated (controls). Blood levels of Ca, P, PTH, and 25-OH-vit D were measured in 59 prevalent patients on HD (35 male; mean age: 65.2 (15.7) years) in November 2010. Thirty-six patients with 25-OH-vit D
- Published
- 2012
15. El siglo de oro vuelve a nacer
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Ortega, Mayra
- Published
- 2000
16. Implementacion de un sistema de control predictivo multivariable en un horno
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Gómez Ortega, Mayra Alejandra and Correa Cely, Carlos Rodrigo
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hornos ,Estructuras ,simulación dinámica ,Química ,Control predictivo basado en modelos - Abstract
El presente artículo describe la aplicación de una estrategia de control predictivo basado en modelo (MPC). El controlador se diseñó y sintonizó a partir de información obtenida de una simulación dinámica rigurosa de un horno de precalentamiento de crudo ya existente. Se encontró que el esquema de control MPC es superior y comanda de mejor manera la operación del horno con respecto a la configuración de control básica constituida por PIDs. En las simulaciones se observó que el MPC garantiza además de que las variables controladas se encuentren dentro de los límites operacionales, que la planta siga un objetivo económico potencial dado por la maximización de la carga y la disminución del fenómeno de coquización. La implementación de la estrategia de control predictivo en el modelo, permitió incrementar la eficiencia, mantener estable la operación, ampliar el tiempo de corrida de la unidad, aumentar la carga total y prolongar de esta manera la vida útil media de los tubos.
- Published
- 2009
17. El balance de calcio es menor con un líquido de diálisis con citrato que con acetato
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Pérez-García, Rafael, Albalate, Marta, Sequera, Patricia, and Ortega, Mayra
- Published
- 2017
- Full Text
- View/download PDF
18. Propuesta de un protocolo para el entrenamiento muscular respiratorio al interior de las unidades de cuidado intensivo fase I
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Alejo De Paula, Luz Ángela, Morelos Páez, Omar Ramiro [Coautor], León Almanza, Daiver [Coautor], Castillo Cruz, Camila [Coautor], Caro Pinilla, Viviana [Coautor], Ortega, Mayra [Coautor], Vanegas Ovalle, Viviana [Coautor], Yepes, Marleinis [Coautor], and Corporación Universitaria Iberoamericana
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Ventilación mecánica ,Protocolo ,Entrenamiento muscular respiratorio ,Fuerza de resistencia muscular respiratoria ,Destete ventilatorio ,UCI (unidad de cuidado crítico intensivo) ,Paciente critico ,Fuerza máxima - Abstract
63 h. El presente proyecto tiene como objetivo diseñar un protocolo para el entrenamiento muscular respiratorio al interior de las Unidades de Cuidado intensivo con un nivel de calidad óptimo siguiendo las recomendaciones de la Guía Metodológica para la Elaboración de Protocolos Basados en la Evidencia, así como las propuestas del instrumento AGREE y del Nacional Institute of Clinical Excelence Introducción.-- 1. Descripción general del proyecto.-- Justificación.-- Problema de Investigación.-- Objetivo General.-- Objetivos específicos.-- 2. Marco de referencia.-- 3. Marco metodológico.-- Fase de prediseño.-- Fase de diseño.-- Fase de evaluación y revisión.-- 4. Resultados.-- Discusión y Conclusiones.-- Referencias Bibliográficas.
- Published
- 2017
19. A curious case of acute kidney failure in times of COVID-19.
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Cintra M, Torres E, Salazar D, Albalate M, Procaccini F, Medina L, Martín-Navarro JA, Ortega M, Puerta M, Alcázar R, and De Sequera P
- Published
- 2021
- Full Text
- View/download PDF
20. Haemodialysis patients have worse postural balance with an associated risk of falls.
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Pérez-Gurbindo I, Angulo Carrere MT, Arribas Cobo P, Puerta M, Ortega M, Jaldo MT, de Sequera P, Alcázar R, Pérez-García R, and Álvarez-Méndez AM
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- Accidental Falls prevention & control, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Incidence, Male, Middle Aged, Prospective Studies, Sensation Disorders diagnosis, Sensation Disorders physiopathology, Accidental Falls statistics & numerical data, Postural Balance drug effects, Postural Balance physiology, Renal Dialysis, Sensation Disorders complications
- Abstract
Introduction: Postural balance is the result of a complex interaction of sensory input which keeps us upright. Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Our objective was to analyse postural stability and its relationship with the risk of falls in haemodialysis patients using a force platform., Material and Methods: This was a prospective cross-sectional study. Postural balance was recorded using a force platform in prevalent haemodialysis patients. We collected epidemiological, dialysis, analytical and treatment data. The incidence of falls was recorded over the 6 months following the tests. The postural stability analysis was performed with a portable strain gauge platform (AMTI AccuGait®) and a specific software unit for stabilometry (Balance Trainer® program). We measured 31 balance parameters; the balance variables used were: Area95; AreaEffect; VyMax; Xrange and Yrange. The stabilometry studies were performed in 3 situations: with eyes open; with eyes closed; and with the patient performing a simultaneous task. We performed one study at the start of the dialysis session, and a second study at the end. Stabilometry was measured in a control group under similar conditions., Results: We studied 32 patients with a mean age of 68 years old; of this group, 20 subjects were male and 12 were female. Their mean weight was 74kg, with a mean BMI of 27.6kg/m
2 . In the controls, there were no significant differences in the stabilometry between the 3 situations studied. Both pre- and post-haemodialysis, patients with closed eyes showed greater imbalance, and there were significant differences with the other situations and controls. We found a significant increase in instability after the haemodialysis session, and greater instability in the 13 patients with diabetes (P<.05). The 4 patients with hyponatraemia (Na<136mmol/l) had worse balance in the simultaneous task situation (P=.038). Various drugs, such as insulin (P=.022), antiplatelet agents (P=.036) and beta-blockers (P=.029), were associated with imbalance. The 10 patients who suffered falls had greater imbalance, Yrange, Xrange, Area95 and AreaEffect, both pre- and post-haemodialysis (P<.05) than those without falls., Conclusions: Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Prevention programmes which include specific exercises to improve balance could be beneficial in reducing the risk of falls in this population., (Copyright © 2020 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2020
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21. Hypomagnesaemia in haemodialysis is associated with increased mortality risk: its relationship with dialysis fluid.
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Pérez-García R, Jaldo MT, Puerta M, Ortega M, Corchete E, de Sequera P, Martín-Navarro JA, Albalate M, and Alcázar R
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Kidney Failure, Chronic therapy, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Dialysis Solutions, Kidney Failure, Chronic blood, Kidney Failure, Chronic mortality, Magnesium blood, Renal Dialysis
- Abstract
Hypomagnesaemia in haemodialysis (HD) is associated with increased mortality risk: its relationship with dialysis fluid (DF)., Introduction: Low concentrations of magnesium (Mg) in blood have been linked to the development of diabetes, hypertension, arrhythmias, vascular calcifications and an increased risk of death in the general population and in haemodialysis patients. The composition of the dialysis fluid in terms of its magnesium concentration is one of the main determinants of magnesium in haemodialysis patients., Objective: To study magnesium concentrations in haemodialysis patients, their predictive mortality rate and what factors are associated with hypomagnesaemia and mortality in haemodialysis., Methods: Retrospective study of a cohort of prevalent haemodialysis patients followed up for two years. Serum magnesium was measured every six months. The analysis used the initial and average magnesium values for each patient, comparing patients with magnesium below the mean (2.1mg/dl) with those with magnesium above the mean. During the follow-up, three types of dialysis fluid were used: type 1, magnesium 0.5 mmol/l; type 3, magnesium 0.37 mmol/l (both with acetate); and type 2, magnesium 0.5 mmol/l with citrate., Results: We included 137 haemodialysis patients in the study, of which 72 were male and 65 were female, with a mean age of 67 (15) [26-95] years old. Of this group, 57 patients were diabetic, 70 were on online haemodiafiltration (OL-HDF) and 67 were on high-flow haemodialysis (HF-HD). The mean magnesium of the 93 patients with dialysis fluid type 1 was 2.18 (0.37) mg/dl. In the 27 patients with dialysis fluid type 3 it was 2.02 (0.42) mg/dl. And in the 17 with dialysis fluid type 2 it was 1.84 (0.24) mg/dl (p=.01). There was a pronounced direct relationship between Mg and P and albumin. After a mean follow-up of 16.6 (8.9) [3-24] months, 77 remained active, 24 had died and 36 had been transplanted or transferred. Patients with magnesium above than 2.1mg/dl had a longer survival (p=.008). The survival of patients with the three types of dialysis fluid did not differ significantly (Log-Rank, p=.424). Corrected for blood magnesium, patients with dialysis fluid with citrate have better survival (p=.009). The COX regression analysis shows how age, serum albumin, magnesium, dialysis technique and type of dialysis fluid have an independent predictive mortality rate., Conclusions: Low serum magnesium levels have a greater association with an increased risk of mortality compared to high levels. The type of dialysis fluid affects the magnesium concentration and the risk of death., (Copyright © 2020 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2020
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22. [High prevalence of asymptomatic COVID-19 in haemodialysis: learning day by day in the first month of the COVID-19 pandemic].
- Author
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Albalate M, Arribas P, Torres E, Cintra M, Alcázar R, Puerta M, Ortega M, Procaccini F, Martin J, Jiménez E, Fernandez I, and de Sequera P
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, COVID-19, Clinical Protocols, Coronavirus Infections diagnosis, Coronavirus Infections drug therapy, Female, Health Personnel organization & administration, Hemodialysis Units, Hospital organization & administration, Humans, Incidence, Lymphopenia epidemiology, Male, Middle Aged, Pneumonia, Viral diagnosis, Pneumonia, Viral drug therapy, Prevalence, SARS-CoV-2, Spain epidemiology, Symptom Assessment, Time Factors, Triage methods, Young Adult, Asymptomatic Infections epidemiology, Betacoronavirus, Coronavirus Infections epidemiology, Health Personnel statistics & numerical data, Hemodialysis Units, Hospital statistics & numerical data, Pandemics, Pneumonia, Viral epidemiology
- Abstract
Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O
2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19., (Copyright © 2020 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2020
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23. Unlike Kt, high Kt/V is associated with greater mortality: The importance of low V.
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Pérez-García R, Jaldo M, Alcázar R, de Sequera P, Albalate M, Puerta M, Ortega M, Ruiz MC, and Corchete E
- Subjects
- Adult, Aged, Aged, 80 and over, Body Surface Area, Electric Impedance, Female, Follow-Up Studies, Humans, Hyponatremia mortality, Male, Middle Aged, Renal Dialysis methods, Renal Dialysis statistics & numerical data, Retrospective Studies, Time Factors, Young Adult, Body Water, Renal Dialysis mortality, Urea blood
- Abstract
Introduction: Kt/V has been used as a synonym for haemodialysis dose. Patient survival improved with a Kt/V>1; this target was subsequently increased to 1.2 and 1.3. The HEMO study revealed no significant relationship between Kt/V and mortality. The relationship between Kt/V and mortality often shows a J-shaped curve. Is V the confounding factor in this relationship? The objective of this study is to determine the relationship between mortality and Kt/V, Kt and body water content (V) and lean mass (bioimpedance)., Methods: We studied a cohort of 127 prevalent haemodialysis patients, who we followed-up for an average of 36 months. Kt was determined by ionic dialysance, and V and nutrition parameters by bioimpedance. Kt/V, Kt corrected for body surface area (Kt/BSA) and target Kt/BSA were calculated. The mean data from 18,998 sessions were used as haemodialysis parameters, with a mean of 155 sessions per patient., Results: Mean age was 70.4±15.3 years and 61% were male; 76 were dialysed via an arteriovenous fistula and 65 were on online haemodiafiltration. Weight was 70.6 (16.8)kg; BSA 1.8 (0.25) m
2 ; total body water (V) 32.2 (7.41) l and lean mass index (LMI) 11.1 (2.7)kg/m2 . Mean Kt/V was 1.84 (0.44); Kt 56.1 (7)l and Kt/BSA 52.8 (10.4)l. The mean target Kt/BSA was 49.7 (4.5)l. Mean Kt/BSA-target Kt/BSA +6.4 (7.0)l. Patients with a higher Kt/V had worse survival rates than others; with Kt this is not the case. Higher Kt/V values are due to a lower V, with poorer nutrition parameters. LMI and serum albumin were the parameters that best independently predicted the risk of death and are lower in patients with a higher Kt/V and lower V., Conclusion: Kt/V is not useful for determining dialysis doses in patients with low or reduced body water. Kt or the Kt/BSA are proposed as an alternative., (Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2019
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24. Citrate dialysate does not induce oxidative stress or inflammation in vitro as compared to acetate dialysate.
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Pérez-García R, Ramírez Chamond R, de Sequera Ortiz P, Albalate M, Puerta Carretero M, Ortega M, Ruiz Caro MC, and Alcazar Arroyo R
- Subjects
- Acetates adverse effects, Cell-Derived Microparticles drug effects, Cells, Cultured, Dialysis Solutions adverse effects, Dose-Response Relationship, Drug, Humans, Immunocompetence, In Vitro Techniques, Inflammation, Intercellular Adhesion Molecule-1 biosynthesis, Intercellular Adhesion Molecule-1 blood, Leukocytes, Mononuclear metabolism, Monocytes metabolism, Reactive Oxygen Species blood, Renal Dialysis, THP-1 Cells, Uremia blood, Uremia immunology, Uremia therapy, Acetates pharmacology, Citrates pharmacology, Dialysis Solutions pharmacology, Leukocytes, Mononuclear drug effects, Monocytes drug effects, Oxidative Stress drug effects
- Abstract
Increased acetataemia during haemodialysis sessions has been associated with a number of abnormalities, including increased oxidative stress, pro-inflammatory cytokines and nitric oxide synthesis. However, citric acid may play an alternative role to acetate as a dialysate stabiliser given that the effect of citrate on complement and leukocyte activation is different to that of acetate. The purpose of this study was to compare the inflammatory effect in immunocompetent blood cells of acetate dialysate and citrate dialysate., Material and Methods: The effect of acetate and/or citrate was investigated in the whole blood of uraemic patients and in healthy in vitro samples. Four types of dialysate were tested: dialysate 1, acetate-free with 1mmol/L of citrate; dialysate 2, with 0.8mmol/L of citrate and 0.3mmol/L of acetate; dialysate 3, citrate-free with 3mmol/L of acetate; and dialysate 4, citrate-free with 4mmol/L of acetate. The cell types used were: human monocyte culture (THP-1); and peripheral blood mononuclear cells (PBMCs) from healthy subjects and uraemic patients on haemodialysis. ICAM-1 was determined and levels of reactive oxygen species and total microvesicles were quantified., Results: Unlike the citrate dialysates, the dialysates with acetate (dialysate 3 and dialysate 4) induced increased ICAM-1 expression density in THP-1 cells; an increase in ICAM-1 expression was observed in the immunocompetent cells of healthy subjects with acetate dialysate (dialysate 3 and dialysate 4) but not with citrate dialysate (dialysate 1 and dialysate 2). No significant ICAM-1 differences were found between the different dialysates in the cells of haemodialysed patients. Reactive oxygen species expression and the number of microvesicles increased significantly with acetate dialysate but not with citrate dialysate in the cells of both healthy subjects and haemodialysed patients., Conclusions: At the concentrations in which it is generally used in clinical practice, acetate-based dialysate increases oxidative stress and the total number of microvesicles and may induce other pro-inflammatory stimuli typical of uraemic patients on haemodialysis. Citrate dialysates do not induce this activation, which could make them a suitable alternative in clinical practice., (Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2017
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25. [Drug rash with eosinophilia and systemic symptoms syndrome induced by carbamazepine: Case report].
- Author
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Marín JA, Ortega MA, Sánchez IP, and Pacheco JA
- Subjects
- Carbamazepine chemistry, Humans, Male, Syndrome, Anticonvulsants adverse effects, Carbamazepine adverse effects, Drug Eruptions etiology, Eosinophilia chemically induced, Exanthema chemically induced, Fever chemically induced
- Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity reaction associated with a variety of drugs, mainly anticonvulsants, which is characterized by systemic symptoms and erythematous lesions, common to other toxicodermas. It is an uncommon clinical entity that requires a high suspicion by clinical staff given its varied initial presentation, and the fact that symptoms can overlap with those of other adverse cutaneous reactions to drugs. Without early diagnosis and appropriate treatment, mortality increases.We report the case of a 22-year-old patient with impaired neurodevelopment who received treatment with carbamazepine. Two months later he presented with general symptoms and skin erythematous lesions that began on his trunk. The patient received outpatient care with antihistamines and antipyretics without an appropriate response. His case progressed with increased skin lesions and systemic symptoms that met the diagnostic criteria for DRESS syndrome. He was hospitalized and received medical treatment according to recommended guidelines. The patient's condition improved as his symptoms and associated complications resolved. He was discharged with gradual clearing of the steroid therapy.
- Published
- 2017
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26. Follow a recipe to prescribe phosphate during hemodialysis.
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Albalate M, Ruiz-Alvarez MJ, de Sequera P, Perez-Garcia R, Arribas P, Corchete E, Ruiz Caro C, Talaván Zanón T, Alcazar R, Ortega M, and Puerta M
- Subjects
- Algorithms, Enema, Humans, Hypophosphatemia therapy, Phosphates analysis, Solutions chemistry, Hemodialysis Solutions chemistry, Phosphates administration & dosage, Renal Dialysis
- Abstract
The addition of phosphorus (P) to the dialysate (LD) in the form of enema Casen® is common practice in patients with hypophosphatemia. The estimation of the amount to be used and the identification of the problems that may can occur are not well defined. As a result of our work we propose a practical approach of how to proceed to increase phosphate concentration in the hemodialysate. We present a reasoned formula to calculate how much enema has to be added and the problems that may arise., (Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2017
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27. Calcium mass balance with citrate dialysate is lower than with acetate.
- Author
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Pérez-García R, Albalate M, Sequera P, and Ortega M
- Subjects
- Acetates administration & dosage, Citrates administration & dosage, Humans, Hypercalcemia etiology, Acetates pharmacology, Calcium metabolism, Citrates pharmacology, Hemodialysis Solutions pharmacology, Hypercalcemia prevention & control, Renal Dialysis
- Published
- 2017
- Full Text
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28. Psychosocial factors and adherence to drug treatment in patients on chronic haemodialysis.
- Author
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Huertas-Vieco MP, Pérez-García R, Albalate M, de Sequera P, Ortega M, Puerta M, Corchete E, and Alcázar R
- Subjects
- Anxiety etiology, Cognition Disorders etiology, Comorbidity, Cross-Sectional Studies, Depression etiology, Diabetic Nephropathies drug therapy, Diabetic Nephropathies psychology, Diabetic Nephropathies therapy, Humans, Kidney Failure, Chronic drug therapy, Kidney Failure, Chronic therapy, Polypharmacy, Psychology, Quality of Life, Self Report, Severity of Illness Index, Social Support, Spain, Kidney Failure, Chronic psychology, Medication Adherence, Renal Dialysis psychology
- Abstract
Background: The daily pill burden in hemodialysis patients is one of the highest reported to date in any chronic disease. The adherence to prescribed treatment has implications on the quality of life, the survival of patients, and the economic cost of their treatment, this being a priority public health issue., Objective: To evaluate the adherence to pharmacological treatment examining, among the possible causes of non-adherence, psychosocial factors such as depression, anxiety, cognitive impairment and social support., Method: Transversal-observational study of thirty five patients that suffer from chronic renal disease and who are on manteinance hemodialysis, evaluated by self-reported measures., Results: Non-adherent patients have significant higher depression index than adherent patients. Anxiety, cognitive impairment and social support do not show a significant relation with the degree of adherence or compliance with farmacological treatment., Conclusions: These results suggest that psychological intervention in chronic haemodialysis patients with a severe depression index could increase the degree of fulfillment and general well-being of renal patients.
- Published
- 2014
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29. A comparison of the effectiveness of two online haemodiafiltration modalities: mixed versus post-dilution.
- Author
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de Sequera P, Albalate M, Pérez-García R, Corchete E, Puerta M, Ortega M, Alcázar R, Talaván T, and Ruiz-Álvarez MJ
- Subjects
- Adult, Aged, Aged, 80 and over, Albumins analysis, Blood Pressure, Blood Proteins analysis, Convection, Cross-Over Studies, Dialysis Solutions chemistry, Female, Hematocrit, Humans, Male, Middle Aged, Molecular Weight, Nephelometry and Turbidimetry, Prospective Studies, Renal Insufficiency, Chronic blood, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic therapy, Retinol-Binding Proteins analysis, Uremia blood, Uremia etiology, beta 2-Microglobulin analysis, Hemodiafiltration methods, Uremia therapy
- Abstract
Introduction: Haemodiafiltration (HDF) with high reinfusion volumes is the most effective technique for clearing uraemic toxins. There are various modalities depending on the location where the replacement volume is administered in the extracorporeal circuit: pre-dilution, mixed or mid-dilution and post-dilution, in which the infusion is carried out pre-dilution, pre- and post-dilution simultaneously and post-dilution, respectively., Objective: Compare the clearance of small, medium-sized and protein-bound molecules and the convective volume administered in online HDF (OL-HDF) in post-dilution and mixed (pre-post-dilution) infusion., Material and Method: A prospective, randomised, crossover study comparing post-dilution and mixed OL-HDF. Patients (n=8) were randomly assigned to receive 6 sessions in each technique. We conducted 89 sessions, of which 68 were at a scheduled time (ST) and 21 at an effective time (ET). We determined the reduction rate (RR) percentages for various substances and the infusion volumes. The RR study was performed using ET., Results: The KT value obtained was greater with post-dilution OL-HDF [68 (8.1) compared to 64.9 (8.8) litres] (P=.009) when patients were dialysed at ST. This difference disappeared when dialysis was performed at ET. The difference between ST and ET was greater in mixed HDF than in post-dilution HDF [10.3 (7.4) compared to 6.5 (3.1) minutes, P=.02]. We found no differences in the RR of the substances analysed., Conclusion: Mixed OL-HDF is not inferior to post-dilution OL-HDF either in the clearance of small and medium-sized molecules or in the clearance of protein-bound molecules at the same ET.
- Published
- 2013
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30. First episodes of peritoneal infection: description and prognostic factors.
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Portolés J, Janeiro D, Lou-Arnal LM, López-Sánchez P, Ortega M, del Peso G, Felipe C, Tato AM, Velo M, Castellano I, and Pérez-Díaz V
- Subjects
- Female, Humans, Male, Middle Aged, Peritonitis epidemiology, Prognosis, Prospective Studies, Renal Dialysis, Risk Factors, Survival Rate, Peritonitis diagnosis, Peritonitis microbiology
- Abstract
Introduction: Peritonitis is one of the most common and severe complications associated with peritoneal dialysis (PD), constituting the primary cause of catheter loss and exit from the dialysis technique. The incidence and aetiology of peritonitis episodes vary based on geographical region, and change over time. For this reason, it is vital to maintain an updated understanding of the current risk factors and prognostic factors associated with peritonitis., Method: We performed an observational, multi-centre, prospective cohort study with a maximum follow-up period of 7 years (2003-2010), which included 1177 patients and a total of 476 first episodes of peritonitis (total: 1091 cases of peritonitis)., Results: We describe the characteristics of the first episode of peritonitis from a large and current study sample. The factors associated with a shorter interval until the first episode of peritonitis as selected by the multivariate analysis included prior cardiovascular comorbidity (Hazard Ratio [HR]: 1.25 [1.04-1.58]), having previously received haemodialysis (HR: 1.39 [1.10-1.76]) or a kidney transplant (HR: 1.38 [1.10-1.93]), having started PD on a manual modality (HR: 1.39 [1.13-1.73]), and initial age >70 years (HR: 1.53 [1.23-1.90]). The first episode of peritonitis was associated with a 7.8% rate of recurrence, an 11.7% rate of catheter removal, and a mortality rate within one month of the episode of 1.3%. The progression of peritonitis infections depended on the type of causal microorganism. We calculated a greater risk for gram-negative bacterial infections (Odds Ratio [OR]: 5.31 [2.26-12.48]) and the aggregate group of infections caused by multiple microorganisms, fungal infections, and mycobacterial infections (OR: 38.24 [13.84-105.63]), as compared to gram-positive bacterial infections., Conclusion: The development of a first case of peritonitis depends on the characteristics of the patient upon starting dialysis, comorbidities present, and the technique used. Patients at a greater risk for peritonitis must receive special care during training and follow-up.
- Published
- 2013
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31. On-line haemodiafiltration improves response to calcifediol treatment.
- Author
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Pérez-García R, Albalate M, de Sequera P, Alcázar R, Puerta M, Ortega M, and Corchete E
- Subjects
- Aged, Calcifediol adverse effects, Calcifediol blood, Calcium blood, Cohort Studies, Diabetic Nephropathies complications, Female, Humans, Hypercalcemia chemically induced, Kidney Failure, Chronic blood, Kidney Failure, Chronic complications, Male, Middle Aged, Parathyroid Hormone blood, Phosphorus blood, Prospective Studies, Vitamin D Deficiency blood, Vitamin D Deficiency complications, Calcifediol therapeutic use, Hemodiafiltration, Kidney Failure, Chronic therapy, Vitamin D Deficiency drug therapy
- Abstract
Introduction: 25-hydroxy vitamin D (25-OH-vit D) levels in the blood are associated with multiple pathologies. "Normal" values have been defined based on cardiovascular risk, and under this framework, patients with chronic kidney disease often have a deficit. 25-OH-vit D replacement in patients on haemodialysis (HD), in which dosage has not yet been clearly established, is becoming a constant in our daily practice., Objective: To assess whether dialysis technique influences the baseline concentration of 25-OH-vitamin D and the response to supplements., Method: Prospective observational study of two cohorts of patients, those patients treated with calcifediol and those untreated (controls). Blood levels of Ca, P, PTH, and 25-OH-vit D were measured in 59 prevalent patients on HD (35 male; mean age: 65.2 (15.7) years) in November 2010. Thirty-six patients with 25-OH-vit D<10 ng/ml were treated with weekly calcifediol (Hidroferol®, 1 ampoule: 266 μg) since January 2011, which was administered after HD by a nurse. They received 6 doses, and blood levels were measured again in March 2011. We compared the response based on the technique of HD (online haemodiafiltration [OL-HDF] vs HD)., Results: Mean baseline values (n=59): 25-OH-vit D: 9.8 (7.0)ng/ml, Ca: 9.3 (0.5)mg/dl, P: 4.5 (1.4)mg/dl, and iPTH: 299 (224)pg/ml. There were no differences by age, sex, or dialysis technique (HD vs OL-HDF). Treated patients (n=36): 25-OH-vit D levels rose from 6.2 (3.4)ng/ml to 51 (22.9)ng/ml (P<.0001), without significant changes in Ca. Serum phosphate increased an average of 0.6 (1.4)mg/dl, from 4.4 mg/dl to 5mg/dl, (P=.015). PTH decreased an average of 85 (208)pg/ml (P=.023). In these patients, the indication for phosphate binders increased by an average dose equivalent of 0.47 (0.82)mg/dl (P<.001). The 13 patients under treatment with OL-HDF reached 25-OH-vit D levels significantly higher than the 23 treated on HD: 63 (21)ng/ml vs 43 (21)ng/ml (P=.011). Dual treatment with native and active Vit D was associated with significantly increased levels of P (P=.043). Untreated patients (n=23): 25-OH-vit D levels decreased from 15.3 (7.5)ng/ml in November to 11.1 (6.8)ng/ml in March (P<.01), without significant changes in P or PTH and without differences according to age. 25-OH-vit D levels declined in patients on HD (15) but not in patients on OL-HDF., Conclusion: The patients on haemodialysis have low or very low baseline values for 25-OH-vit D. The response to treatment with calcifediol is good, with the most marked improvement occurring in patients on OL-HDF. Furthermore, 25-OH-vit D levels decreased in untreated patients, which was probably correlated with the lower sun exposure in winter. Some patients experienced an increase in phosphataemia despite increasing the dosage of phosphate binders, mainly in those receiving treatment with active vitamin D.
- Published
- 2012
- Full Text
- View/download PDF
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