Search

Background The number of frail patients of advanced age with end-stage kidney disease (ESKD) undergoing hemodialysis is increasing globally. Here we evaluated a frailty screening program of ESKD patients starting hemodialysis, and subsequent multidisciplinary interventions. Methods This was a prospective observational study of ESKD patients in a hemodialysis program. Patients were evaluated for frailty (Fried frail phenotype) before and after a 12-month period. Patients followed standard clinical practice at our hospital, which included assessment and multidisciplinary interventions for nutritional (malnutrition-inflammation score, protein-energy wasting), physical [short physical performance battery (SPPB)] and psychological status. Results A total of 167 patients (mean ± standard deviation age 67.8 ± 15.4 years) were screened for frailty, and 108 completed the program. At screening, 27.9% of the patients were frail, 40.0% pre-frail and 32.1% non-frail. Nutritional interventions (enrichment, oral nutritional supplements, intradialytic parenteral nutrition) resulted in stable nutritional status for most frail and pre-frail patients after 12 months. Patients following recommendations for intradialytic, home-based or combined physical exercise presented improved or stable in SPPB scores after 12 months, compared with those that did not follow recommendations, especially in the frail and pre-frail population (P  = .025). A rate of 0.05 falls/patient/year was observed. More than 60% of frail patients presented high scores of sadness and anxiety. Conclusions Frailty screening, together with coordinated interventions by nutritionists, physiotherapists, psychologists and nurses, preserved the health status of ESKD patients starting hemodialysis. Frailty assessment helped in advising patients on individual nutritional, physical or psychological needs. [ABSTRACT FROM AUTHOR]

Introduction: chronic kidney disease (CKD) is characterized by its high prevalence of malnutrition, difficult to detect as it is underestimated by the usual tools. There is no valid or hospital-level nutritional screening tool in Spanish to identify patients with CKD at risk of malnutrition. Objective: to translate and accomplish the transcultural adaptation of Jackson‘s questionnaire (Renal Inpatient Nutrition Screening Tool [Renal iNUT]) to Spanish, which detects the risk of malnutrition in CKD inpatients and compares it with other nutritional tools. Methods: phase 1: translation, back-translation and transcultural adaptation of the questionnaire from the English to the Spanish version. A pilot test was carried out by nursing staff together with a satisfaction questionnaire. Phase 2: comparison of Renal iNUT with Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA). Results: phase 1: the nursing staff’s perception was highly favorable. They found it easy or very easy to use and 90 % of them did it in a maximum of ten minutes. Phase 2: from 48 patients included, Renal iNUT detected 44 % at low risk of malnutrition, 28 % at intermediate risk and 28 % at high risk. Increased sensitivity of Renal iNUT (p < 0.007) vs MUST (62.5 vs 33.3 %) and similar specificity (87.1 vs 90.6 %) were found, together with an acceptable correlation compared to SGA (r = 0.75, 95 % CI: 0.67 to 0.83). Conclusions: the Spanish version of Renal iNUT is a useful and easy-to-understand tool for health professionals. We also confirm its good correlation with SGA, with greater sensitivity than MUST for the risk of malnutrition detection in CKD inpatients. [ABSTRACT FROM AUTHOR]

Abstract: Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease and frequently persists after kidney transplantation. Paricalcitol, a selective vitamin D receptor activator, is indicated in the management of this disorder and recent evidences have suggested that this drug has other beneficial effects. Aiming to elucidate these effects, our study included 52 stable kidney transplant recipients randomized 2:1 to treatment with paricalcitol or to no treatment. Bone mineral parameters, kidney function and inflammatory status were assessed at baseline, at 3 and at 12 months. Moreover, a proteomic approach, based on magnetic beads technology coupled to MALDI-TOF mass spectrometry readout, was used to determine changes in patients' plasma peptidome. Patients treated with paricalcitol showed a significant decrease in parathyroid hormone and alkaline phosphatase levels, and an increase of bone mineral density and glomerular filtration rate. The proteomic analysis revealed a decrease in bradykinin after paricalcitol treatment, whereas 2 peptides identified as fragments of the complement factor C4 decreased only in those patients not treated with paricalcitol. These findings suggest that paricalcitol may offer additional benefits due to immunomodulatory effects via the kallikrein-kinin and complement systems. [Copyright &y& Elsevier]

Introduction: The growing numbers of People with Complex Chronic Conditions (PCCC) has been leading to a challenge of adaptation of the care providers' response to the high needs presented by individuals. Short description of practice change implemented: The creation of a Chronic Care Management Team (CCMT) supported an innovative strategy focused on reaching a more integrated model of care. A community-based care programme was developed based on: a. International evidence (reviewed by two CCMT experts); b. A consensus reached by clinical leaders involved on care (in a local task force group with 60 members from primary and secondary care); c. The inclusion of people experience (by two focus groups with patients, and home interviews to carers and members of community institutions). It led to a new organisational and governance model for the whole territory. An IT tools adaptation was required to support the CCMT task on monitoring the care process and outcome indicators. Aim and theory of change: In order to improve the quality of the care process and to obtain patientcentred outcomes in an efficient way, it was urged to change the usual model, to a new multidisciplinary, multidimensional, patient-centred provision of integrated care focused in the community, with the central role of expert Primary Care teams. Targeted population and stakeholders: PCCC including those with advanced illnesses. Stakeholders: several units from the Catalan Health Institute in Badalona area, North of Barcelona, as a territorial public provider of primary care and hospital care, which collaborate with other social care and intermediate care providers in the area. Timeline: Phase 1: development of theory for change (2018); Phase 2: implementation of the new model of care (2018-2019); Phase 3: evaluation of the model (2019). Highlights (innovation, Impact and outcomes) People-centred integrated care ongoing project at meso level as a response to high needs of PCCC in an urban territory in the Catalan public health system. Definition of the care model by people involved on care (patients, carers and staff). Functional integration of clinicians from the institution. CCMT led the integration by: defining and monitoring the quality of the care process, planning the adaptation of resources, and evaluating people-centred outcomes. Comments on sustainability: High sustainability expected due to the pragmatic approach. Comments on transferability: High transferability expected due to the position of our institution in the health system. Conclusions (comprising key findings): Our project was created based on a need to deepen on integrated care provision. Preliminary results on the quality of the care process have been evaluated. Preliminary results centred on people have been evaluated. Discussion: It is a huge opportunity for our system to develop and evaluate an integrated care strategy at a meso level, following the Catalan Government integrated care strategy. Lessons learned: Adapting the theoretical model to real world required a strong leadership, clear governance, time for change and the alignment of all the actors. The consensus reached, based on people experience and views, was a strong element for change. [ABSTRACT FROM AUTHOR]