50 results on '"Moledous A"'
Search Results
2. Challenge of phosphorus control in hemodialysis patients: a problem of adherence?
- Author
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Arenas, Maria Dolores, Malek, Tamara, Gil, Maria Teresa, Moledous, Analía, Alvarez-Ude, Fernando, and Reig-Ferrer, Abilio
- Published
- 2010
3. Consequences of the implementation of “K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease” in a population of patients on chronic hemodialysis
- Author
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Arenas, María Dolores, Álvarez-Ude, Fernando, Torregrosa, Vicente, Gil, María Teresa, Carretón, María Antonia, Moledous, Analía, Nuñez, Carlos, Devesa, Ramón, and Albiach, Begoña
- Published
- 2007
4. Implementation of ‘K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease’ after the introduction of cinacalcet in a population of patients on chronic haemodialysis
- Author
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Arenas, Maria Dolores, Alvarez-Ude, Fernando, Gil, Maria Teresa, Moledous, Analía, Malek, Tamara, Nuñez, Carlos, Devesa, Ramón, Carretón, Maria Antonia, and Soriano, Antonio
- Published
- 2007
5. Emotional distress and health-related quality of life in patients on hemodialysis: the clinical value of COOP-WONCA charts
- Author
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Arenas, María Dolores, Álvarez-Ude, Fernando, Reig-Ferrer, Abilio, Zito, Juan Pablo, Gil, María Teresa, Carretón, María Antonia, Albiach, Begoña, and Moledous, Analía
- Published
- 2007
6. Fatal acute systemic hypersensitivity reaction during haemodialysis
- Author
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Arenas, Maria Dolores, Niveiro, Enrique, Moledous, Analía, Gil, Maria Teresa, Albiach, Begoña, and Carretón, Maria Antonia
- Published
- 2006
7. A case of endocarditis of difficult diagnosis in dialysis: could 'pest' friends be involved?
- Author
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Moledous A, T Malek-Marín, María Teresa Gil, María Dolores Arenas, Cotilla E, M Salavert-Lleti, and M Perdiguero
- Subjects
Male ,Nasal cavity ,Catheterization, Central Venous ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Asymptomatic ,Catheters, Indwelling ,Renal Dialysis ,medicine ,Animals ,Humans ,Endocarditis ,Intensive care medicine ,Dialysis ,biology ,business.industry ,Ferrets ,Achromobacter denitrificans ,Endocarditis, Bacterial ,General Medicine ,Middle Aged ,biology.organism_classification ,medicine.disease ,medicine.anatomical_structure ,Nephrology ,Catheter-Related Infections ,Etiology ,Rabbits ,Hemodialysis ,medicine.symptom ,Gram-Negative Bacterial Infections ,business - Abstract
We report a case of A. xylosoxidans endocarditis of larvate clinical presentation in a central venous catheter-dependent hemodialysis patient of difficult diagnosis and poor evolution despite a high index of suspicion and consequent assessment. A 50-year-old man on hemodialysis presented with inflammatory-malnutrition parameters during the months prior to diagnosis of endocarditis, whilst he was otherwise asymptomatic. No vegetations were detectable on his cardiac valves at repeated echocardiography until third transesophageal echocardiography was performed, and confirmed intraoperatively. On the occasion of positive peripheral blood culture for Alcaligenes (Achromobacter) xylosoxidans, the etiological diagnosis was retrospectively explained given his history of animal exposure - hunting rabbits using his pet ferrets. This bacterium is an emergent and resistant organism, mostly related to nosocomial infections and environmental water sources. Reservoirs include the microflora of the nasal cavity of rabbits and the dentogingival sulcus of ferrets. We presume that A. xylosoxidans endocarditis was transmitted from the patient's pets. It highlights the importance of early recognition of an inflammatory status and investigation of the underlying cause. Additionally, the causative bacterium emphasizes the importance of registering exposure to animals in CVC-dependent patients as well as the need for their awareness of hygienic precautions and the infectious risk associated to catheters.
- Published
- 2009
- Full Text
- View/download PDF
8. Nephrotic syndrome as paraneoplastic manifestation of a primary pulmonary lymphoepithelioma-like carcinoma
- Author
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Fernando Alvarez-Ude, María Teresa Gil, J M Arriero, Moledous A, José Farré, María Dolores Arenas, Malek T, F J Fernández Morejón, and I Aranda
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Lymphoepithelioma-like carcinoma ,Solitary pulmonary nodule ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Nephrotic Syndrome ,medicine.diagnostic_test ,Paraneoplastic Syndromes ,business.industry ,Carcinoma ,Respiratory disease ,Glomerulonephritis ,General Medicine ,Middle Aged ,medicine.disease ,Nephrology ,Biopsy ,medicine ,Humans ,Female ,business ,Nephrotic syndrome ,Kidney disease - Abstract
We present a case of nephrotic syndrome secondary to a membranous glomerulonephritis (MG), in a nonsmoking female with a solitary pulmonary nodule, which did not show growth during 2 years of followup. A biopsy by videothoracoscopy showed a granulomatous non-neoplastic process with giant multinucleated cells. The appearance of a nephrotic syndrome and its interpretation as paraneoplastic revealed the existence of a primary pulmonary lymphoepithelioma-like carcinoma (LELC), a very rare pulmonary tumor. After resection of tumor there was a complete recovery from the nephrotic syndrome. This case highlights how the investigation of paraneoplastic syndromes can help in the early diagnosis of some malignancies.
- Published
- 2009
- Full Text
- View/download PDF
9. Management of calcific uremic arteriolopathy (calciphylaxis) with a combination of treatments, including hyperbaric oxygen therapy
- Author
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Fernando Alvarez-Ude, Moledous A, A. Salinas, M. D. Gutierrez, María Dolores Arenas, Malek T, and María Teresa Gil
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medicine.medical_specialty ,medicine.medical_treatment ,Secondary infection ,Naphthalenes ,Skin Diseases, Vascular ,Lesion ,Sepsis ,Calcinosis ,medicine ,Humans ,Aged ,Gangrene ,Hyperbaric Oxygenation ,Calciphylaxis ,business.industry ,Vascular disease ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Surgery ,Nephrology ,Kidney Failure, Chronic ,Female ,Cinacalcet ,Hemodialysis ,medicine.symptom ,business - Abstract
Calcific uremic arteriolopathy (CUA) is a rare but serious complication of end-stage renal disease presenting as painful cutaneous lesions and progressing to non-healing ulcers and gangrene. This syndrome is associated with calcium and phosphorus deposits within small arteries of the skin. The pathognomonic lesion is vascular calcification with intimal arterial hypertrophy and superimposed small-vessel thrombosis. The condition is being increasingly recognized and reported as a contributing factor to death in dialysis patients, with secondary infection and sepsis as the major cause of mortality. No standard treatment has been established for this syndrome. We present the therapeutic approach employed in two patients, which successfully resulted in healing of the lesions, using a combination of measures to control the factors potentially related to development of CUA and hyperbaric oxygen therapy.
- Published
- 2008
- Full Text
- View/download PDF
10. Implementation of 'K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease' after the introduction of cinacalcet in a population of patients on chronic haemodialysis
- Author
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Malek T, Maria Antonia Carretón, María Dolores Arenas, Ramón Devesa, Carlos Nuñez, María Teresa Gil, Antonio Soriano, Fernando Alvarez-Ude, and Moledous A
- Subjects
Male ,medicine.medical_specialty ,Hypercalcaemia ,Cinacalcet ,Population ,Urology ,Parathyroid hormone ,Naphthalenes ,Sevelamer ,Bone and Bones ,Renal Dialysis ,Internal medicine ,Vitamin D and neurology ,medicine ,Humans ,Vitamin D ,education ,Transplantation ,education.field_of_study ,business.industry ,Hyperparathyroidism ,Middle Aged ,medicine.disease ,Bone Diseases, Metabolic ,Endocrinology ,Nephrology ,Chronic Disease ,Practice Guidelines as Topic ,Female ,Kidney Diseases ,Secondary hyperparathyroidism ,business ,Kidney disease ,medicine.drug - Abstract
The purpose of the present study was to evaluate the impact of cinacalcet administration on the attainment of Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation (NFK-K/DOQI) targets, in a group of dialysis patients with secondary hyperparathyroidism that were not controlled with vitamin D metabolites due to inadequate elevations in serum calcium and/or phosphorus.Twenty-eight patients undergoing haemodialysis that presented secondary hyperparathyroidism (PTH300 pg/ml) with difficulty to use vitamin D either because of hypercalcaemia (10.2 mg/dl) and/or hyperphosphoraemia (5.5 mg/dl) were included in this study. The follow-up period was 9 months before and after the introduction of cinacalcet. We started by adding 30 mg of cinacalcet orally once daily to their previous vitamin D metabolite treatment. The following variables were calculated and recorded: the mean of all measurements of serum Ca, P and parathyroid hormones (PTH), and Ca x P in each patient; calcium in dialysate (mEq/l); doses of vitamin D administered; doses of cinacalcet used, and the average prescription of calcium-based phosphate binders, sevelamer hydrochloride and aluminum binders, corresponding to two periods according to the introduction of cinacalcet. The proportions of patients with different serum Ca levels as well as serum P levels; serum PTH levels and CaxP at the beginning and at the end of the nine month period of treatment with cinacalcet were calculated.Serum PTH (826.9 +/- 325 vs 248.1 +/- 77.3, P0.001), serum calcium (9.9 +/- 0.6 vs 8.6 +/- 0.4, P0.001) and the Ca x P product (94.7 +/- 7.3 vs 43.6 +/- 8.5; P0.001) diminished significantly whereas serum phosphorus remained unchanged (4.8 +/- 1.5 vs 4.3 +/- 1.1; P = NS). Before cinacalcet, 23 patients had severe hyperparathyroidism (serum PTH500) and 15 patients hypercalcaemia (serum calcium10.2 mg/dl). After 9 months of treatment, all 28 patients showed serum PTH500 pg/ml and serum calcium10.2 mg/dl; 64.7% of the patients achieved Ca, P, Ca x P and PTH objectives simultaneously. While the mean dose of cinacalcet increased along the 9 months of treatment (P0.001), there were no significant changes in vitamin D metabolites (P = 0.5), neither in the mean doses of calcium-containing agents, nor in the mean prescribed doses of sevelamer (P0.01), and aluminium-containing agents diminished significantly (P0.05).In summary, the combination of cinacalcet and low doses of vitamin D improved significantly the control of PTH and Ca x P in patients with severe secondary hyperparathyroidism on chronic haemodialysis, without adverse effects and with lower doses of phosphate binders.
- Published
- 2007
- Full Text
- View/download PDF
11. Fatal acute systemic hypersensitivity reaction during haemodialysis
- Author
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Moledous A, Enrique Niveiro, María Dolores Arenas, María Teresa Gil, Albiach B, and Maria Antonia Carretón
- Subjects
Male ,Transplantation ,Allergy ,business.industry ,medicine.medical_treatment ,Middle Aged ,medicine.disease ,Hypersensitivity reaction ,Fatal Outcome ,Renal Dialysis ,Nephrology ,Immunopathology ,Acute Disease ,Immunology ,Hypersensitivity ,medicine ,Humans ,Eosinophilia ,Hemodialysis ,medicine.symptom ,business ,Anaphylaxis ,Kidney disease - Published
- 2006
- Full Text
- View/download PDF
12. [Dispositional optimism in patients on chronic haemodialysis and its possible influence on their clinical course]
- Author
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A I, Morales García, M D, Arenas Jiménez, A, Reig-Ferrer, F, Alvarez-Ude, T, Malek, A, Moledous, M T, Gil, and E M, Cotilla
- Subjects
Male ,Personality Inventory ,Health Status ,Comorbidity ,Middle Aged ,Prognosis ,Self Concept ,Patient Admission ,Attitude ,Renal Dialysis ,Surveys and Questionnaires ,Quality of Life ,Humans ,Kidney Failure, Chronic ,Female ,Attitude to Health ,Aged ,Follow-Up Studies ,Personality - Abstract
Dispositional optimism is a personality trait significantly associated with the use of positive adaptive coping strategies as well as with perceived psychological and physical well-being, and it appears to be an important predictor of illness.To analyse if dispositional optimism is significantly associated with the number of hospital admissions of our chronic haemodialysis patients, as well as its relationship with perceived state of health.We studied 239 patients on chronic haemodialysis. Patients were categorised into two groups according to the variables: hospital admissions/no. of admissions in the last year and dispositional optimism (DO). We used the following variables and questionnaires: 1) Dispositional O/P using the Spanish-validated cross-cultural adaptation of the revised version of the Life Orientation Test (LOT-R) (Scheier, 1994): higher scores mean a higher degree of dispositional optimism. 2) Health-related quality of life (HRQoL) using the different aspects of the COOP/WONCA (CW) charts and its total score. In this case higher scores mean lower HRQoL. 3) Modified Charlson Comorbidity Index (mCCI). 4) Age, gender, and time on dialysis.Mean age was 64.8 ± 14.3 years; median time on dialysis 2.9 years (range: 0-32); and median LOT-R 21 (range 6-30). Patients considered DO had a lower risk of hospital admissions than pessimists (DP) (OR: 0.55; IC 95%: 0.32-0.94; P.05). PD Patients that were admitted in the last year showed a significantly lower score on LOT-R (they were more pessimistic) than those that had no hospital admissions (19.4 ± 5.7 vs 22.3 ± 4.6; P=.001). We found no significant differences between admitted and not admitted patients in age, gender, time on haemodialysis and comorbidity. Admitted patients showed worse HRQoL (higher scores in total CW) than those that were not (Total CW: 22.37 vs 19.42; P.001). PD patients had significantly higher scores than OD patients in all COOP-WONCA aspects except in aspect 1 (physical fitness) and 5 (change in health).Pessimistic personality trait is significantly associated with hospital admissions in chronic haemodialysis patients, regardless of age, gender and comorbidity. Optimistic patients perceived a better state of health.
- Published
- 2011
13. Optimismo disposicional en pacientes en hemodiálisis y su influencia en el curso de la enfermedad
- Author
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Morales García,A.I., Arenas Jiménez,M.D., Reig-Ferrer,A., Álvarez-Ude,F., Malek,T., Moledous,A., Gil,M.T., and Cotilla,E.M.
- Subjects
Hemodiálisis ,Mediador pronóstico ,Ingreso hospitalario ,Optimismo disposicional - Abstract
Introducción: El optimismo disposicional es un rasgo de personalidad que se relaciona significativamente con el empleo de estrategias positivas de afrontamiento y con el grado de bienestar psicológico y físico percibidos por el paciente, y que parece ser, también, un importante predictor de enfermedad. Objetivo: Analizar si el optimismo disposicional guarda relación con el número de ingresos hospitalarios que han presentado en el último año los enfermos renales crónicos estadio Vd en nuestros centros. Material y métodos: Se estudiaron 239 pacientes en hemodiálisis que fueron categorizados en dos grupos respecto a las variables ingresos /no ingresos hospitalarios en el último año y optimismo/pesimismo disposicional. Se utilizaron los siguientes cuestionarios y variables: 1) O/P disposicional mediante el LOT-R de Scheier (1994) en su versión española: a mayor puntuación, mayor grado de optimismo disposicional. 2) Calidad de vida relacionada con la salud (CVRS) mediante las láminas COOP/WONCA: a mayor puntuación peor calidad de vida referida. 3) Índice de comorbilidad de Charlson (ICM). 4) Edad, tiempo en HD y sexo. Resultados: La edad media fue de 64,8 ± 14,3 años; la mediana de tiempo en hemodiálisis de 2,9 años (rango: 0-32), y la mediana en el LOT-R 21 (rango: 6-30). Los pacientes optimistas (OD) presentaban un menor riesgo de ser ingresados que los pesimistas (PD) (OR: 0,55; IC 95%: 0,32-0,94; p
- Published
- 2011
14. Dispositional optimism in patients on chronic haemodialysis and its possible influence on their clinical course
- Author
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Morales García, Ana Isabel, Arenas Jiménez, María Dolores, Reig Ferrer, Abilio, Álvarez Ude, Fernando, Malek, Tamara, Moledous, Analía, Gil González, María Teresa, Cotilla de la Rosa, Eva M., Universidad de Alicante. Departamento de Psicología de la Salud, and Calidad de Vida, Bienestar Psicológico y Salud
- Subjects
Haemodialysis ,Hemodiálisis ,Mediador pronóstico ,Personalidad, Evaluación y Tratamiento Psicológico ,Ingreso hospitalario ,Optimismo disposicional ,Dispositional optimism ,Hospital admissions ,Prognostic mediator - Abstract
Introducción: El optimismo disposicional es un rasgo de personalidad que se relaciona significativamente con el empleo de estrategias positivas de afrontamiento y con el grado de bienestar psicológico y físico percibidos por el paciente, y que parece ser, también, un importante predictor de enfermedad. Objetivo: Analizar si el optimismo disposicional guarda relación con el número de ingresos hospitalarios que han presentado en el último año los enfermos renales crónicos estadio Vd en nuestros centros. Material y métodos: Se estudiaron 239 pacientes en hemodiálisis que fueron categorizados en dos grupos respecto a las variables ingresos /no ingresos hospitalarios en el último año y optimismo/pesimismo disposicional. Se utilizaron los siguientes cuestionarios y variables: 1) O/P disposicional mediante el LOT-R de Scheier (1994) en su versión española: a mayor puntuación, mayor grado de optimismo disposicional. 2) Calidad de vida relacionada con la salud (CVRS) mediante las láminas COOP/WONCA: a mayor puntuación peor calidad de vida referida. 3) Índice de comorbilidad de Charlson (ICM). 4) Edad, tiempo en HD y sexo. Resultados: La edad media fue de 64,8 ± 14,3 años; la mediana de tiempo en hemodiálisis de 2,9 años (rango: 0-32), y la mediana en el LOT-R 21 (rango: 6-30). Los pacientes optimistas (OD) presentaban un menor riesgo de ser ingresados que los pesimistas (PD) (OR: 0,55; IC 95%: 0,32-0,94; p
- Published
- 2011
15. Optimismo disposicional en pacientes en hemodiálisis y su influencia en el curso de la enfermedad
- Author
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Morales García, A.I., Arenas Jiménez, M.D., Reig-Ferrer, A., Álvarez-Ude, F., Malek, T., Moledous, A., Gil, M.T., and Cotilla, E.M.
- Subjects
Haemodialysis ,Hemodiálisis ,Mediador pronóstico ,Ingreso hospitalario ,Optimismo disposicional ,Dispositional optimism ,Hospital admissions ,Prognostic mediator - Abstract
Introducción: El optimismo disposicional es un rasgo de personalidad que se relaciona significativamente con el empleo de estrategias positivas de afrontamiento y con el grado de bienestar psicológico y físico percibidos por el paciente, y que parece ser, también, un importante predictor de enfermedad. Objetivo: Analizar si el optimismo disposicional guarda relación con el número de ingresos hospitalarios que han presentado en el último año los enfermos renales crónicos estadio Vd en nuestros centros. Material y métodos: Se estudiaron 239 pacientes en hemodiálisis que fueron categorizados en dos grupos respecto a las variables ingresos /no ingresos hospitalarios en el último año y optimismo/pesimismo disposicional. Se utilizaron los siguientes cuestionarios y variables: 1) O/P disposicional mediante el LOT-R de Scheier (1994) en su versión española: a mayor puntuación, mayor grado de optimismo disposicional. 2) Calidad de vida relacionada con la salud (CVRS) mediante las láminas COOP/WONCA: a mayor puntuación peor calidad de vida referida. 3) Índice de comorbilidad de Charlson (ICM). 4) Edad, tiempo en HD y sexo. Resultados: La edad media fue de 64,8 ± 14,3 años; la mediana de tiempo en hemodiálisis de 2,9 años (rango: 0-32), y la mediana en el LOT-R 21 (rango: 6-30). Los pacientes optimistas (OD) presentaban un menor riesgo de ser ingresados que los pesimistas (PD) (OR: 0,55; IC 95%: 0,32-0,94; p
- Published
- 2011
16. Spontaneous retroperitoneal hemorrhage in dialysis: a presentation of 5 cases and review of the literature
- Author
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D Arenas, T Gil, J J Arenas, T Malek-Marín, A Morales, M Okubo, Cotilla E, and Moledous A
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Adult ,Male ,medicine.medical_specialty ,Pediatrics ,medicine.medical_treatment ,Population ,Hemorrhage ,Peritoneal dialysis ,End stage renal disease ,Renal Dialysis ,Risk Factors ,medicine ,Humans ,Retroperitoneal Space ,Retroperitoneal hemorrhage ,education ,Dialysis ,Aged ,education.field_of_study ,business.industry ,Mortality rate ,Incidence ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Nephrology ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business ,Kidney disease - Abstract
Background: Spontaneous retroperitoneal hemorrhage (SRH) is a rare but potentially fatal entity. Despite published case reports of SRH in dialysis, little systematic information is available. Methods: Report of 5 cases and review of MEDLINE database from 1971 until 2008. Results: Incidence of SRH in our unit was 0.86 cases per 100 patients; annual incidence rate 8/ 10,000 patients. We identified 34 publications, comprising 55 cases. The existing cases and the 5 reported were analyzed: 74.5 % male, average age 53.3 years (range 27 - 78), average time on dialysis 7.1 years (range 3 weeks ― 27.5 years), 95% on hemodialysis and 5% on peritoneal dialysis. There was significant heterogeneity in clinical presentation. The kidney was the most commonly reported origin (87.8%), and acquired cystic kidney disease (ACKD) was the most frequent underlying cause. 91.8% received some kind of anticoagulation. Treatment was conservative, included angioembolization or surgery in 33.3%, 17.6% and 49% of the cases respectively. Mortality rate was 18.3%. Conclusions: More than 85% of SRH in dialysis had a renal cause, ACKD being predominant. The complication occurs mainly in the HD modality, possibly in relation to anticoagulation. There is no evidence that screening of ACKD is of benefit predicting SRH. Therefore, awareness of ACKD as a manifestation of ESRD patients and its risk of bleeding is necessary. Because of the summation of risk factors that appears in the population on dialysis, SRH should be considered in the differential diagnosis of unexplained pain before drop in blood pressure or hematocrit occurs.
- Published
- 2010
17. [Phosphorus binders: preferences of patients on haemodialysis and its impact on treatment compliance and phosphorus control]
- Author
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M D, Arenas, T, Malek, F, Álvarez-Ude, M T, Gil, A, Moledous, and A, Reig-Ferrer
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,Aluminum Hydroxide ,Patient Preference ,Phosphorus ,Sevelamer ,Acetates ,Calcium Compounds ,Middle Aged ,Chelation Therapy ,Cohort Studies ,Cross-Sectional Studies ,Lanthanum ,Renal Dialysis ,Surveys and Questionnaires ,Taste ,Polyamines ,Humans ,Patient Compliance ,Female ,Dyspepsia ,Aged ,Chelating Agents ,Tablets - Abstract
Non-adherence to phosphate binding (PB) medication may play a role in the difficulty in achieving the targets for phosphorus. We have a wide armamentarium of PB but preferences of patients are poorly understood.to study the patients' preferences and beliefs regarding PB and their influence on adherence and serum phosphate.A cross-sectional cohort study was performed. A total of 121 hemodialysis patients answered a specific questionnaire in which they were questioned about adherence, the type of PB they preferred and the reasons for their choice. All patients questioned tasted two or three PB. The consequence of non-adherence to PB was estimated indirectly by determination of serum phosphorus.Specific noncompliance with PB medication was recognized by 21.4% of patients. Patients non-adherent specifically to PB were more likely to have P levels5.5 mg/dl (χ(2): 4.7; 95% CI 1.07-6.5; p = 0.03). Paradoxically, patients non-adherent showed greater knowledge of the use (χ(2): 17.3; 95% CI -2.2-10.1; p0.0001) and importance of the drug (χ(2): 10.4; 95% CI -1.5-6.6; p = 0.001). The percentage of patients prescribed binders they did not like was 54.5%. Patients who were taking PB they did not like had a greater risk of having P levels5.5 mg/dl) (χ(2): 13.3; 95% CI -1.1-1.5; p = 0.0001). Calcium acetate was the preferred PB in 47.1% of patients, lanthanum carbonate in 40%, sevelamer in 20.6% and aluminum hydroxide in 19.4%. The reasons claimed by patients for their negative ratings of PB were the type of dosage form, the taste, the number of tablets and gastric intolerance. Gastric intolerance and bad taste were more frequent in aluminum hydroxide patients (19.4% and 22.2%, respectively). Sevelamer received complaints about its dosage form because the tablets were too large and a large number of tablets were required (27.2%). 17.7% of patient who were taking lanthanum carbonate did not like the chewable tablets.patients who were taking binders that they did not like had worse serum P levels and were prescribed higher doses of binders. Knowing patients' preferences about the drugs prescribed may be a key factor in achieving adequate adherence to treatment.
- Published
- 2010
18. Captores del fósforo: preferencias de los pacientes en hemodiálisis y su repercusión sobre el cumplimiento del tratamiento y el control del fósforo
- Author
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Arenas, M. D., Malek, T., Álvarez-Ude, F., Gil, M. T., Moledous, A., and Reig-Ferrer, A.
- Subjects
Hemodiálisis ,Cumplimiento del tratamiento ,Preferencias ,Phosphate binders ,Preferences ,Hemodialysis ,Captores del fósforo ,Adherence to treatment - Abstract
Introducción: En la actualidad disponemos de un amplio abanico de captores del fósforo (CF), pero sabemos poco acerca de las preferencias de los pacientes y de su repercusión sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Objetivo: Estudiar las preferencias y creencias de los pacientes respecto a los CF, y su influencia sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Pacientes y métodos: Estudio observacional transversal. Se incluyeron 121 pacientes que respondieron un cuestionario genérico de cumplimiento del tratamiento (SMAQ) y a un cuestionario específico sobre cumplimiento del tratamiento con CF, tipo de CF preferido y razones de dicha preferencia. Todos los pacientes entrevistados habían probado dos o tres CF. Las consecuencias de la falta de cumplimiento del tratamiento con CF se estimaron indirectamente analizando los valores promedio de fósforo sérico. Resultados: El 40% de los pacientes era incumplidor según el cuestionario SMAQ; se encontró una asociación estadísticamente significativa entre la falta de cumplimiento en general y no alcanzar el objetivo de fósforo sérico promedio 5,5 mg/dl (OR = 4,7; IC 95%, 1,1-6,5; p = 0,03). Un 43,8% de los pacientes no refirió tener preferencias entre los diferentes tipos de CF; para el resto de pacientes, el CF preferido fue Royen®, seguido de Fosrenol®, Renagel® y Pepsamar®. Las razones expresadas para el desagrado con el Renagel® fueron las siguientes: incomodidad en la toma por su gran tamaño (28,8%), necesidad de tomar muchos comprimidos y gran consumo de agua (57,7%) e intolerancia gástrica (13,3%). En el caso del Fosrenol®: incómodo de tomar (72,7%) e intolerancia gástrica (27,2%); para el Pepsamar®: mal sabor (54,5%) e intolerancia gástrica (45,4%). Sólo al 9,4% no le gustaba el Royen®. Al analizar los conocimientos de los pacientes respecto a la utilidad de los CF, un 42% sabía que servían para controlar el fósforo; un 52% no lo sabía y un 6% tenía ideas equivocadas. En cuanto a su importancia: un 47% no conocía por qué son importantes; un 2% tenía ideas erróneas; un 9% creía que era beneficioso para la salud; un 11% creía que era bueno "porque lo dice el medico"; un 26% porque controla el fósforo y un 5% lo relacionaba con el hueso. Ningún paciente relacionó los CF con la enfermedad cardiovascular. Un 24,4% no se llevaba los CF cuando salía fuera de casa o estaba con los amigos; eran pacientes más jóvenes a quienes se les habían prescrito un mayor número de comprimidos de CF y que presentaban un mayor riesgo de no cumplir el objetivo de fósforo (OR = 10,5; IC 95%, -1,8 a -16,4; p 5,5 mg/dl (OR = 13.3; IC 95%, 1,1-1,5; p = 0,0001). Paradójicamente, los pacientes que no cumplían con el tratamiento demostraban un mejor conocimiento de su uso (OR = 17,3; IC 95%, 2,2-10,1; p 5.5 mg/dl (χ²: 4.7; 95% CI 1.07-6.5; p = 0.03). Paradoxically, non-adherent patients showed greater knowledge of the use (χ²: 17.3; 95% CI -2.2-10.1; p 5.5 mg/dl) (χ²: 13.3; 95% CI -1.1-1.5; p = 0.0001). Calcium acetate was the prefered PB in 47.1% of patients, lanthanum carbonate in 40%, sevelamer in 20.6% and aluminum hydroxide in 19.4%. The reasons claimed by patients for their negative ratings of PB were the type of dosage form, the taste, the number of tablets and gastric intolerance. Gastric intolerance and bad taste were more frequent in aluminum hydroxide patients (19.4% and 22.2%, respectively). Sevelamer received complaints about its dosage form because the tablets were too large and a large number of tablets were required (27.2%). 17.7% of patient who were taking lanthanum carbonate did not like the chewable tablets. Conclusion: patients who were taking binders that they did not like had worse serum P levels and were prescribed higher doses of binders. Knowing patients' preferences about the drugs prescribed may be a key factor in achieving adequate adherence to treatment.
- Published
- 2010
19. Captores del fósforo: preferencias de los pacientes en hemodiálisis y su repercusión sobre el cumplimiento del tratamiento y el control del fósforo
- Author
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Arenas Jiménez, María Dolores, Malek, Tamara, Álvarez Ude, Fernando, Gil González, María Teresa, Moledous, Analía, Reig Ferrer, Abilio, Calidad de Vida, Bienestar Psicológico y Salud, and Universidad de Alicante. Departamento de Psicología de la Salud
- Subjects
Hemodiálisis ,Cumplimiento del tratamiento ,Preferencias ,Phosphate binders ,Preferences ,Hemodialysis ,Personalidad, Evaluación y Tratamiento Psicológico ,Captores del fósforo ,Adherence to treatment - Abstract
Introducción: En la actualidad disponemos de un amplio abanico de captores del fósforo (CF), pero sabemos poco acerca de las preferencias de los pacientes y de su repercusión sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Objetivo: Estudiar las preferencias y creencias de los pacientes respecto a los CF, y su influencia sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Pacientes y métodos: Estudio observacional transversal. Se incluyeron 121 pacientes que respondieron un cuestionario genérico de cumplimiento del tratamiento (SMAQ) y a un cuestionario específico sobre cumplimiento del tratamiento con CF, tipo de CF preferido y razones de dicha preferencia. Todos los pacientes entrevistados habían probado dos o tres CF. Las consecuencias de la falta de cumplimiento del tratamiento con CF se estimaron indirectamente analizando los valores promedio de fósforo sérico. Resultados: El 40% de los pacientes era incumplidor según el cuestionario SMAQ; se encontró una asociación estadísticamente significativa entre la falta de cumplimiento en general y no alcanzar el objetivo de fósforo sérico promedio 5,5 mg/dl (OR = 4,7; IC 95%, 1,1-6,5; p = 0,03). Un 43,8% de los pacientes no refirió tener preferencias entre los diferentes tipos de CF; para el resto de pacientes, el CF preferido fue Royen®, seguido de Fosrenol®, Renagel® y Pepsamar®. Las razones expresadas para el desagrado con el Renagel® fueron las siguientes: incomodidad en la toma por su gran tamaño (28,8%), necesidad de tomar muchos comprimidos y gran consumo de agua (57,7%) e intolerancia gástrica (13,3%). En el caso del Fosrenol®: incómodo de tomar (72,7%) e intolerancia gástrica (27,2%); para el Pepsamar®: mal sabor (54,5%) e intolerancia gástrica (45,4%). Sólo al 9,4% no le gustaba el Royen®. Al analizar los conocimientos de los pacientes respecto a la utilidad de los CF, un 42% sabía que servían para controlar el fósforo; un 52% no lo sabía y un 6% tenía ideas equivocadas. En cuanto a su importancia: un 47% no conocía por qué son importantes; un 2% tenía ideas erróneas; un 9% creía que era beneficioso para la salud; un 11% creía que era bueno «porque lo dice el medico»; un 26% porque controla el fósforo y un 5% lo relacionaba con el hueso. Ningún paciente relacionó los CF con la enfermedad cardiovascular. Un 24,4% no se llevaba los CF cuando salía fuera de casa o estaba con los amigos; eran pacientes más jóvenes a quienes se les habían prescrito un mayor número de comprimidos de CF y que presentaban un mayor riesgo de no cumplir el objetivo de fósforo (OR = 10,5; IC 95%, —1,8 a —16,4; p 5,5 mg/dl (OR = 13.3; IC 95%, 1,1-1,5; p = 0,0001). Paradójicamente, los pacientes que no cumplían con el tratamiento demostraban un mejor conocimiento de su uso (OR = 17,3; IC 95%, 2,2-10,1; p 5.5 mg/dl (χ2: 4.7; 95% CI 1.07-6.5; p = 0.03). Paradoxically, non-adherent patients showed greater knowledge of the use (χ2: 17.3; 95% CI -2.2-10.1; p 5.5 mg/dl) (χ2: 13.3; 95% CI -1.1-1.5; p = 0.0001). Calcium acetate was the prefered PB in 47.1% of patients, lanthanum carbonate in 40%, sevelamer in 20.6% and aluminum hydroxide in 19.4%. The reasons claimed by patients for their negative ratings of PB were the type of dosage form, the taste, the number of tablets and gastric intolerance. Gastric intolerance and bad taste were more frequent in aluminum hydroxide patients (19.4% and 22.2%, respectively). Sevelamer received complaints about its dosage form because the tablets were too large and a large number of tablets were required (27.2%). 17.7% of patient who were taking lanthanum carbonate did not like the chewable tablets. Conclusion: patients who were taking binders that they did not like had worse serum P levels and were prescribed higher doses of binders. Knowing patients’ preferences about the drugs prescribed may be a key factor in achieving adequate adherence to treatment.
- Published
- 2010
20. [Operation to remove tunnelled venous catheters in a dialysis unit. Is it possible to reverse the trend in their growing use?]
- Author
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M D, Arenas, T, Malek, M, López-Collado, M T, Gil, A, Moledous, A, Morales, E, Cotilla, and F, Alvarez-Ude
- Subjects
Male ,Renal Dialysis ,Humans ,Female ,Aged ,Catheterization - Abstract
Introduction In an attempt to reduce unnecessary central venous catheters (CVC) dependence in prevalent population, a "CVC removal" programme was initiated in our unit. The objective was to diminish the number of CVC and to analyze the causes of their insertion and maintenance. On 09/01/07, 38 out of 173 prevalent patients on hemodialysis. Methods were CVC dependant (21.9%): 16 incident patients (42,1%) and 22 (57,8%) prevalent patients. All of them were re-evaluated for permanent vascular access utilization, included those previously rejected for surgery. Physical, psychical and vascular aspects regarding each patient were taken into consideration. The following variables were age, Body mass index, time on hemodialysis, Charlson analyzed comorbidity index, DM or vascular comorbidities and number of vascular accesses created prior to CVC placement. In those patients in whom AVF creation was feasible, the following were registered after 18 months of 1.Primary failure rate. 2. Related complications. 3. up follow Percentage of usable AVF or AVG. 4. Percentage of removed CVC. 5. Mortality and hospitalization. The decision of no realization of a new vascular access and? Results maintenance of TVC was performed in 21 patients (55.2%). In 9 of them was decision of the nephrologists and the family. In 11 patients was decision of vascular surgeon due to vascular bed exhaustion. A permanent VA was achieved in 17 patients (44.7%), 50% of them was incident patients and 45% prevalent patients. The primary failure rate was 0%. The TVC was withdrawn in 11/17 (64.7%). Only 4 patients remain without TVC after 18 months of follow-up: 5 patients died (4 with a AVF functioning and 1 VA closure due to steal syndrome) and in 8 patients was mandatory to reintroduce the TVC again. Immediate complications after the surgery were: 1 severe haematoma, 2 infections and 2 severe sequestrations. 3 patients required hospital admission following complications directly related to VA. Mean time of free of TVC was 5.2 months (range: 0.7- 14.3 months). The mortality was 29,4% (5/17) in the group of patients with a new VA and 9,5% (2/21) in the other group(RR 3,19; IC 95%: 0,68-13,98; p: 0,11). No significant differences were observed between patients who transitioned to a permanent vascular access and those who remained TVC dependant in regards to age, gender, BMI, time on dialysis, DM, comorbidity or number of previous VA, Transition from CVC use to hospitalizations or mortality. Conclusions permanent vascular access is possible in prevalent patients in dialysis. Improvement was achieved by a modest amount, and after a prolonged process with gravel complications, some of which proved severe. Need for CVC dependence is confirmed in a high percentage of prevalent patients on dialysis. Comorbidity might have influenced the results. The quality standard should be adequate to reality of current population on hemodialysis.
- Published
- 2009
21. [Superficialization of autologous vascular access: an alternative to the use of vascular prostheses and permanent catheters]
- Author
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M D, Arenas, M T, Gil, T, Malek, A, Moledous, C, Nuñez, and M, López-Collado
- Subjects
Male ,Catheters, Indwelling ,Renal Dialysis ,Humans ,Female ,Aged ,Blood Vessel Prosthesis ,Retrospective Studies ,Veins - Abstract
We review our experience with autologous veins Superficialization (Spf), to establish the actual possibilities of this kind of vascular access in our area.Between January/2001 and January/2008, Spf was performed in 48 patients. Mean follow-up time was 18.8 (0.2-75.7) months. Primary failure rate was recorded; primary and secondary survival were estimated using the Kaplan-Meier method; and its possible associations with several variables were analyzed.the maturity rate was 97.9%; and the rate of primary failure 2.0%. After Spf, mean time of primary and secondary survival were 65 months and 67 months, respectively. Four vascular thromboses were observed. None of the presurgery variables analyzed (age; sex; diabetes mellitus; ipsilateral central catheter; the number of previous VA attempts; and obesity) were significantly associated with maturity rate, primary or secondary survivals.the Spf can be a good option alternative to the use of prosthetic grafts or permanent central vascular catheters.
- Published
- 2009
22. [Changes in vascular access in a dialysis unit in recent years: planning problems, change in preferences, or demographic change?]
- Author
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T, Malek, F, Alvarez-Ude, M T, Gil, A, Moledous, M, López-Collado, C, Núñez, and M D, Arenas
- Subjects
Male ,Catheters, Indwelling ,Time Factors ,Renal Dialysis ,Humans ,Female ,Middle Aged ,Aged - Abstract
Evidence on the reasons for the general and discouraging overutilization of catheters in DOPPS countries is lacking.We analysed the changes in distribution of the different types of vascular access in all 398 patients ongoing hemodialysis at our unit, from January 2000 until December 2005, as well as patients' characteristics. Secondly, risk factors associated with the use of permanent catheters were evaluated in all 95 patients who used that kind of vascular access from January 1997 until April 2006.The percentage of fistulas in prevalent patients diminished from year 2000 until year 2005 (from 95% to 77.9%); concurrently there was an increase in the use of permanent catheters (from 4.2% to 21.5%). The percentage of incident patients having a usable fistula or graft at the beginning of hemodialysis diminished progressively (83.4% in 2000; 69.3% in 2005), and there was a significant increase in the percentage of incident patients using a permanent catheter (from 0 to 23%). Coincidentally, there was a change in patients characteristics: increasing age (71.3 vs. 60.5 years); greater diabetes percentage (7.1% vs. 18.5%) and less time on dialysis (93.2 vs 37 months; p0.03). Causes of permanent catheter insertion varied, exhaustion of all other arteriovenous options being the most frequent in the first period of the study and the presence of an unsuitable vascular anatomy in the second.Despite our policy favoring arteriovenous angioaccess, our results with regards to vascular access worsened in both prevalent and incident patients, coinciding with a change in patients' characteristics. We believe that reversing this trend may become more complicated as the population on dialysis grows older and becomes more prone to diabetes.
- Published
- 2008
23. [Is Cinacalcet a cost-effective treatment in severe secondary hyperparathyroidism in patients on hemodialysis?]
- Author
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M D, Arenas, P, Rebollo, F, Alvarez-Ude, L, Prieto, M T, Gil, T, Malek, A, Moledous, and C, Núñez
- Subjects
Male ,Renal Dialysis ,Cost-Benefit Analysis ,Humans ,Female ,Hyperparathyroidism, Secondary ,Cinacalcet ,Prospective Studies ,Middle Aged ,Naphthalenes ,Severity of Illness Index - Abstract
A previous study using cinacalcet, as compared to vitamin D alone, showed a better reduction response of PTH levels and a significant diminution of secondary effects. The objective of present study was to evaluate the additional cost of adding cinacalcet to the standard treatment of patients with severe secondary hyperparathyroidism (SHPT) taking into account the treatment goals achieved.12 month prospective study of 23 patients with severe SHPT. Two treatment regimens were considered: standard treatment (m 0) and standard treatment plus cinacalcet (m 12). Four consequences of inadequate control of SHPT were registered: parathiroid hormone (PTH), Calcium (Ca), Phosphorus (P) and the Ca x P product serum levels. Treatment effectiveness was measured as percentage of patients who achieved treatment goal according to each indicator: PTH800 pg/mL, PTH between 150 and 300 pg/mL, Calcium9.5 mg/dL, Phosphorus5.5 mg/dL, and Ca x P product55. Annual and monthly costs were calculated for both treatment regimens using Spanish 2007 tariffs, and taking into account the dose reduction in some other treatments. Results are presented as incremental costs and cost per patient who achieved treatment goal.At 12 month it was observed a higher percentage of patients who achieved simultaneously the 4 therapeutic goals with respect to basal moment, from 0% to 52.1%. Cinacalcet allowed to save costs in concomitant drugs, achieving a total saving of 149 euros per patient and month. At 12 month, Cinacalcet achieved a reduction of percentage of patients with PTH800 pgr/mL with half of costs than standard treatment (651.35 euros vs 1363.68 euros). It was not possible to calculate the cost for PTH indicator since at the study onset, there was no patient who achieved a level between 150 and 300 pg/mL. Cinacalcet allowed reaching treatment goals in Calcium, Phosphorus and Ca x P product in a more cost-effective way (2164.2 euros vs 2684.8 euros).Although Cinacalcet is expensive,p atients treated with Cinacalcet showed a minor cost per patient who achieved treatment goal than patients without Cinacalcet. The ability of cinacalcet to reduce PTH secretion, along with the reductions in the serum Ca, P, and Ca x P product, provides an alternative to the traditional treatment paradigm, and should be a welcomed addition in the management of SHPT.
- Published
- 2008
24. [Use of the aluminum phosphate-binders in hemodialysis in the ultrapure water era]
- Author
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Maria D, Arenas, T, Malek, M T, Gil, A, Moledous, C, Núñez, and F, Alvarez-Ude
- Subjects
Hyperphosphatemia ,Male ,Renal Dialysis ,Humans ,Aluminum Hydroxide ,Female ,Aged ,Chelating Agents ,Phosphates - Abstract
Aluminium binder has been ill-advised, but his use remain applicable in the clinique practice in very seleccionated and particular patients. The repercussion of prolonged treatment with low doses of aluminium phosphate-binders in haemodialysis was studied. The haemodialysis unit had a double osmosis inverse and the aluminium levels in haemodialysis liquid was less than 2 micrograms/liter.41 patients of the 295 on haemodialysis received aluminium phosphate-binders since the 2005 January to the 2007 November. The mean time of treatment was 17.8 months, and the doses was 3.9 tablets day (mean of 463 grams in the studied period). The association of low doses of aluminium phosphate-binders permitted a better control of phosphorus (6.8 to 4.8 mg/dl; p0.0001), with a reduction of the others phosphate-binders: sevelamer (10.4 a 8 tablets/day; p0.0001) and calcium phosphate-binders (4.6 to 3.1 tablets/day; p0.0001). The serum aluminium increased after the aluminium treatment (6.8 to 13.8 mcg/l; p0.0001), and no toxicity indirect signs were observed on CMV, haemoglobin, none PTH. Five patients (12.1%) reached aluminium serum levels higher 20 mcg/l, and none reached the 40 mcg/l.The aluminium phosphate-binders were effective, economical and, now, with an apparent better security profile than in a previous time, but it is very important to be careful with this use and to follow a vigilance strict on patients and haemodialysis liquid.
- Published
- 2008
25. [Adverse reactions to polysulphone membrane dialyzers durind hemodialysis]
- Author
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M D, Arenas, M T, Gil, M A, Carretón, A, Moledous, and B, Albiach
- Subjects
Male ,Polymers ,Renal Dialysis ,Hypersensitivity ,Humans ,Membranes, Artificial ,Sulfones ,Middle Aged - Abstract
The majority of severe hypersensitivity reactions in hemodialysis (HD) patients has been due to sensitization to ethylene oxide or to non-biocompatible membrane dialyzers like cupramonium membrane. However could be the possibility of adverse reactions with other hemodialysis substances. Adverse reactions with biocompatible polisulphone membranes are not frequent, but some authors described anaphilactoid reactions related to them. Any severe clinical syndrome of broncoespasm during hemodialysis with several biocompatible polysulphone membranes made by different manufacturers and with a variety of sterilization methods is presented here. The following day he was dialyzed on an cellulose triacetate dialyzer and the hemodialysis treatment was uneventful. This cas report demonstrates the complex nature involving a hypersensitivity reaction to HD.
- Published
- 2007
26. Consequences of the implementation of K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease in a population of patients on chronic hemodialysis
- Author
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María D, Arenas, Fernando, Alvarez-Ude, Vicente, Torregrosa, María T, Gil, María A, Carretón, Analía, Moledous, Carlos, Nuñez, Ramón, Devesa, and Begoña, Albiach
- Subjects
Chronic Kidney Disease-Mineral and Bone Disorder ,Male ,Phosphorus ,Sevelamer ,Middle Aged ,Bone and Bones ,Parathyroid Hormone ,Renal Dialysis ,Practice Guidelines as Topic ,Polyamines ,Humans ,Kidney Failure, Chronic ,Calcium ,Female ,Vitamin D ,Aged ,Chelating Agents ,Retrospective Studies - Abstract
After application of K/DOQI recommendations, a large proportion of our patients failed to reach the proposed targets. This study examined the causes of these findings.Patients (n=163) were compared in 2 periods (8 months before and after application of K/DOQI guidelines). Serum calcium (Ca), phosphorus (P), parathyroid hormone (PTH) and calcium x phosphate product (Ca x P); mean dialysate Ca content; mean doses of vitamin D; and average prescription of Ca-based phosphate binders and sevelamer in both periods were analyzed.Prescription of Ca salts as phosphate-binding agents decreased and prescription of sevelamer increased in an attempt to maintain serum Ca levels between 8.4 and 9.5 mg/dL post-K/DOQI. Increased serum PTH levels were associated with decreased serum Ca levels (relative risk [RR] = 41.1, p0.001) and increased serum P levels (RR=6.81, p0.01). Use of dialysis fluids with Ca content of 2.5 mEq/L was associated with an increased risk of having PTH levels300 pg/mL (RR=11.4, p0.003). Vitamin D metabolites had to be discontinued in 26 patients (37.1% of those receiving them from study start) due to hyperphosphoremia or hypercalcemia post-K/DOQI; and serum PTH significantly increased (445.8 +/- 238.2 pg/mL vs. 715.2 +/- 549.5 pg/mL; p0.001). Ninety-three patients (57%) did not receive vitamin D at study start; in 20 of those (21.5%), vitamin D had to be started post-K/DOQI.Clinical guidelines do not appear to be sufficient to overcome all difficulties arising in daily management of these patients.
- Published
- 2007
27. Emotional distress and health-related quality of life in patients on hemodialysis: the clinical value of COOP-WONCA charts
- Author
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Arenas Jiménez, María Dolores, Álvarez-Ude Cotera, Fernando, Reig Ferrer, Abilio, Zito, Juan Pablo, Gil González, María Teresa, Carretón, María Antonia, Albiach, Begoña, Moledous, Analía, Universidad de Alicante. Departamento de Psicología de la Salud, Hospital Perpetuo Socorro (Alicante), Hospital General de Segovia, and Calidad de Vida, Bienestar Psicológico y Salud
- Subjects
Depression ,COOP-WOCA charts ,Hemodialysis ,Health-related quality of life ,Personalidad, Evaluación y Tratamiento Psicológico ,mental disorders ,Anxiety ,behavioral disciplines and activities - Abstract
Background: A significant percentage of patients on hemodialysis (HD) present with affective disorders such as anxiety and/or depression. The purpose of this study was to explore adaptive mixed affective disorders of patients on HD and to analyze the clinical value of a brief health-related quality-of-life (HRQoL) instrument, the COOP-WONCA charts, in our population of HD patient. Methods: Seventy-five patients (mean age 49.2 years; range 20.1-64.9), who had been on HD for a mean 110 months (range 6.1-364.5 months) were studied. The Beck Depression Inventory (BDI), Hamilton Scale of Depression (HDRS) and Hamilton Scale of Anxiety (HARS) were used. To evaluate patient HRQoL, we used the validated Spanish version of the COOPWONCA charts. Results: Of the 75 patients studied, 44.0% (BDI) and 53.4% (HDRS) had some depressive symptoms which were moderatesevere in 14.7% (BDI) and in 22.7% (HDRS). Anxiety symptoms were observed in 46.6% of the patients (13.3% were of moderate- severe degree). There was a high level of association between both depression scales (BDI and HDRS) (r=0.70; p18), with a sensitivity of 96.8% and a specificity of 75% for this cutoff point. Conclusions: A high percentage of patients on HD present with mixed emotional disorders (anxiety and/or depression); a good correlation is observed between HRQoL and the levels of anxiety and depression in these patients; and measuring HRQoL with the COOP-WONCA charts may help diagnose such problems.
- Published
- 2007
28. Optimismo disposicional en pacientes en hemodiálisis y su influencia en el curso de la enfermedad
- Author
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Universidad de Alicante. Departamento de Psicología de la Salud, Morales García, Ana Isabel, Arenas Jiménez, María Dolores, Reig-Ferrer, Abilio, Álvarez Ude, Fernando, Malek, Tamara, Moledous, Analía, Gil González, María Teresa, Cotilla de la Rosa, Eva M., Universidad de Alicante. Departamento de Psicología de la Salud, Morales García, Ana Isabel, Arenas Jiménez, María Dolores, Reig-Ferrer, Abilio, Álvarez Ude, Fernando, Malek, Tamara, Moledous, Analía, Gil González, María Teresa, and Cotilla de la Rosa, Eva M.
- Abstract
Introducción: El optimismo disposicional es un rasgo de personalidad que se relaciona significativamente con el empleo de estrategias positivas de afrontamiento y con el grado de bienestar psicológico y físico percibidos por el paciente, y que parece ser, también, un importante predictor de enfermedad. Objetivo: Analizar si el optimismo disposicional guarda relación con el número de ingresos hospitalarios que han presentado en el último año los enfermos renales crónicos estadio Vd en nuestros centros. Material y métodos: Se estudiaron 239 pacientes en hemodiálisis que fueron categorizados en dos grupos respecto a las variables ingresos /no ingresos hospitalarios en el último año y optimismo/pesimismo disposicional. Se utilizaron los siguientes cuestionarios y variables: 1) O/P disposicional mediante el LOT-R de Scheier (1994) en su versión española: a mayor puntuación, mayor grado de optimismo disposicional. 2) Calidad de vida relacionada con la salud (CVRS) mediante las láminas COOP/WONCA: a mayor puntuación peor calidad de vida referida. 3) Índice de comorbilidad de Charlson (ICM). 4) Edad, tiempo en HD y sexo. Resultados: La edad media fue de 64,8 ± 14,3 años; la mediana de tiempo en hemodiálisis de 2,9 años (rango: 0-32), y la mediana en el LOT-R 21 (rango: 6-30). Los pacientes optimistas (OD) presentaban un menor riesgo de ser ingresados que los pesimistas (PD) (OR: 0,55; IC 95%: 0,32-0,94; p <0,05) y los pacientes con ingresos hospitalarios mostraron una puntuación en el LOT-R significativamente menor que los que no ingresaron (19,4 ± 5,7 frente a 22,3 ± 4,6; p = 0,001). No se encontraron diferencias significativas en cuanto a edad, tiempo en hemodiálisis, e índice de comorbilidad de Charlson entre los pacientes que ingresaron y los que no ingresaron. Los pacientes que ingresaron mostraban peor calidad de vida relacionada con la salud que los pacientes que no ingresaron (CW total: 22,37 frente a 19,42; p <0,001). Los pacientes PD puntuaban significativamente m, Introduction: Dispositional optimism is a personality trait significantly associated with the use of positive adaptive coping strategies as well as with perceived psychological and physical well-being, and it appears to be an important predictor of illness. Objectives: To analyse if dispositional optimism is significantly associated with the number of hospital admissions of our chronic haemodialysis patients, as well as its relationship with perceived state of health. Methods: We studied 239 patients on chronic haemodialysis. Patients were categorised into two groups according to the variables: hospital admissions/no. of admissions in the last year and dispositional optimism (DO). We used the following variables and questionnaires: 1) Dispositional O/P using the Spanish-validated cross-cultural adaptation of the revised version of the Life Orientation Test (LOT-R) (Scheier, 1994): higher scores mean a higher degree of dispositional optimism. 2) Health-related quality of life (HRQoL) using the different aspects of the COOP/WONCA (CW) charts and its total score. In this case higher scores mean lower HRQoL. 3) Modified Charlson Comorbidity Index (mCCI). 4) Age, gender, and time on dialysis. Results: Mean age was 64.8±14.3 years; median time on dialysis 2.9 years (range: 0-32); and median LOT-R 21 (range 6-30). Patients considered DO had a lower risk of hospital admissions than pessimists (DP) (OR: 0.55; IC 95%: 0.32-0.94; P<.05). PD Patients that were admitted in the last year showed a significantly lower score on LOT-R (they were more pessimistic) than those that had no hospital admissions (19.4±5.7 vs 22.3±4.6; P=.001). We found no significant differences between admitted and not admitted patients in age, gender, time on haemodialysis and comorbidity. Admitted patients showed worse HRQoL (higher scores in total CW) than those that were not (Total CW: 22.37 vs 19.42; P<.001). PD patients had significantly higher scores than OD patients in all COOP-WONCA aspects except
- Published
- 2011
29. Emotional distress and health-related quality of life in patients on hemodialysis: the clinical value of COOP-WONCA charts
- Author
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Universidad de Alicante. Departamento de Psicología de la Salud, Hospital Perpetuo Socorro (Alicante), Hospital General de Segovia, Arenas Jiménez, María Dolores, Álvarez-Ude Cotera, Fernando, Reig-Ferrer, Abilio, Zito, Juan Pablo, Gil González, María Teresa, Carretón, María Antonia, Albiach, Begoña, Moledous, Analía, Universidad de Alicante. Departamento de Psicología de la Salud, Hospital Perpetuo Socorro (Alicante), Hospital General de Segovia, Arenas Jiménez, María Dolores, Álvarez-Ude Cotera, Fernando, Reig-Ferrer, Abilio, Zito, Juan Pablo, Gil González, María Teresa, Carretón, María Antonia, Albiach, Begoña, and Moledous, Analía
- Abstract
Background: A significant percentage of patients on hemodialysis (HD) present with affective disorders such as anxiety and/or depression. The purpose of this study was to explore adaptive mixed affective disorders of patients on HD and to analyze the clinical value of a brief health-related quality-of-life (HRQoL) instrument, the COOP-WONCA charts, in our population of HD patient. Methods: Seventy-five patients (mean age 49.2 years; range 20.1-64.9), who had been on HD for a mean 110 months (range 6.1-364.5 months) were studied. The Beck Depression Inventory (BDI), Hamilton Scale of Depression (HDRS) and Hamilton Scale of Anxiety (HARS) were used. To evaluate patient HRQoL, we used the validated Spanish version of the COOPWONCA charts. Results: Of the 75 patients studied, 44.0% (BDI) and 53.4% (HDRS) had some depressive symptoms which were moderatesevere in 14.7% (BDI) and in 22.7% (HDRS). Anxiety symptoms were observed in 46.6% of the patients (13.3% were of moderate- severe degree). There was a high level of association between both depression scales (BDI and HDRS) (r=0.70; p<0.001), as well as between both scales and the HARS (HDRS, r=0.82; p<0.001; BDI, r=0.53; p<0.001). The most affected dimensions of the COOP-WONCA charts were “Physical fitness” and “Overall health,” whereas the least affected were “Social activities” and “Daily activities.” The global score of the COOP-WONCA charts was associated with the presence of depressive (BDI, r=0.64, and HDRS, r=0.75; p<0.001) and anxiety symptoms (HARS, r=0.52; p<0.001). A score of ≥3 corresponding to the dimension “Feelings” on the COOP-WONCA charts allowed the detection of 81.8% of the patients with clinically significant depressive symptoms (BDI >18), with a sensitivity of 96.8% and a specificity of 75% for this cutoff point. Conclusions: A high percentage of patients on HD present with mixed emotional disorders (anxiety and/or depression); a good correlation is observed between HRQoL and the levels of anxiety and
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- 2007
30. Erratum in: “A comparative study of 2 new phosphate binders (sevelamer and lanthanum carbonate) in routine clinical practice”, by Arenas MD et al, J Nephrol 2010; 23(6): 683-692
- Author
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Arenas, María Dolores, primary, Rebollo, Pablo, additional, Malek, Tamara, additional, Moledous, Analia, additional, Gil, Teresa, additional, Alvarez-Ude, Fernando, additional, Morales, Ana, additional, and Cotilla, Eva, additional
- Published
- 2012
- Full Text
- View/download PDF
31. Erratum in: 'A comparative study of 2 new phosphate binders (sevelamer and lanthanum carbonate) in routine clinical practice', by Arenas MD et al, J Nephrol 2010; 23(6): 683-692
- Author
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Teresa Gil, Fernando Alvarez-Ude, María Dolores Arenas, Malek T, Pablo Rebollo, Ana Morales, Moledous A, and Eva Cotilla
- Subjects
medicine.medical_specialty ,chemistry.chemical_compound ,Lanthanum carbonate ,chemistry ,Nephrology ,business.industry ,medicine ,Urology ,Routine clinical practice ,Sevelamer ,business ,Phosphate ,medicine.drug - Published
- 2012
- Full Text
- View/download PDF
32. Spontaneous retroperitoneal hemorrhage in dialysis: a presentation of 5 cases and review of the literature
- Author
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Malek-Marín, T., primary, Arenas, D., additional, Gil, T., additional, Moledous, A., additional, Okubo, M., additional, Arenas, J.J., additional, Morales, A., additional, and Cotilla, E., additional
- Published
- 2010
- Full Text
- View/download PDF
33. A case of endocarditis of difficult diagnosis in dialysis: could “pest” friends be involved?
- Author
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Malek-Marín, T., primary, Arenas, M.D., additional, Perdiguero, M., additional, Salavert-Lleti, M., additional, Moledous, A., additional, Cotilla, E., additional, and Gil, M.T., additional
- Published
- 2009
- Full Text
- View/download PDF
34. Nephrotic syndrome as paraneoplastic manifestation of a primary pulmonary lymphoepithelioma-like carcinoma
- Author
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Arenas, M.D., primary, Gil, M.T., additional, Malek, T., additional, Farré, J., additional, Morejón, F.J. Fernández, additional, Arriero, J.M., additional, Aranda, I., additional, Moledous, A., additional, and Álvarez-Ude, F., additional
- Published
- 2009
- Full Text
- View/download PDF
35. Management of calcific uremic arteriolopathy (calciphylaxis) with a combination of treatments, including hyperbaric oxygen therapy
- Author
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Arenas, M.D., primary, Gil, M.T., additional, Gutiérrez, M.D., additional, Malek, T., additional, Moledous, A., additional, Salinas, A., additional, and Alvarez-Ude, F., additional
- Published
- 2008
- Full Text
- View/download PDF
36. Fatal acute systemic hypersensitivity reaction during haemodialysis
- Author
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Dolores Arenas, Maria, primary, Niveiro, Enrique, additional, Moledous, Analía, additional, Gil, Maria Teresa, additional, Albiach, Begoña, additional, and Carretón, Maria Antonia, additional
- Published
- 2006
- Full Text
- View/download PDF
37. Dispositional optimism in patients on chronic haemodialysis and its possible influence on their clinical course.
- Author
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Morales García, A. I., Arenas Jiménez, M. D., Reig-Ferrer, A., Álvarez-Ude, F., Malek, T., Moledous, A., Gil, M. T., and Cotilla, E. M.
- Abstract
Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2011
- Full Text
- View/download PDF
38. Phosphorus binders: preferences of patients on haemodialysis and its impact on treatment compliance and phosphorus control.
- Author
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Arenas, M. D., Malek, T., Álvarez-Ude, F., Gil, M. T., Moledous, A., and Reig-Ferrer, A.
- Abstract
Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2010
- Full Text
- View/download PDF
39. Operación retirada de catéteres venosos tunelizados en una unidad de diálisis. ¿Es posible cambiar la tendencia en el uso creciente de éstos?
- Author
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Arenas, M. D., Malek, T., López-Collado, M., Gil, M. T., Moledous, A., Morales, A., Cotilla, E., and Álvarez-Ude, F.
- Abstract
Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2009
40. Fatal acute systemic hypersensitivity reaction during haemodialysis.
- Author
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Maria Dolores Arenas, Enrique Niveiro, Analía Moledous, Maria Teresa Gil, Begoña Albiach, and Maria Antonia Carretón
- Published
- 2006
- Full Text
- View/download PDF
41. Alergia al látex y trombosis repetida de accesos vasculares para hemodiálisis.
- Author
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Arenas, M. D., López-Collado, M., Niveiro, E., Cotilla de la Rosa, E., Morales, A., Moledous, A., Malek, T., and M. T. Gil
- Published
- 2009
42. Implementation of K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease after the introduction of cinacalcet in a population of patients on chronic haemodialysis.
- Author
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Maria Dolores Arenas, Fernando Alvarez-Ude, Maria Teresa Gil, AnalÃa Moledous, Tamara Malek, Carlos Nuñez, Ramón Devesa, Maria Antonia Carretón, and Antonio Soriano
- Subjects
KIDNEY diseases ,HYPERPARATHYROIDISM ,VITAMIN D ,DIALYSIS (Chemistry) - Abstract
Background. The purpose of the present study was to evaluate the impact of cinacalcet administration on the attainment of Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation (NFK-K/DOQI) targets, in a group of dialysis patients with secondary hyperparathyroidism that were not controlled with vitamin D metabolites due to inadequate elevations in serum calcium and/or phosphorus. Methods. Twenty-eight patients undergoing haemodialysis that presented secondary hyperparathyroidism (PTHâ>â300âpg/ml) with difficulty to use vitamin D either because of hypercalcaemia (>10.2âmg/dl) and/or hyperphosphoraemia (>5.5âmg/dl) were included in this study. The follow-up period was 9 months before and after the introduction of cinacalcet. We started by adding 30âmg of cinacalcet orally once daily to their previous vitamin D metabolite treatment. The following variables were calculated and recorded: the mean of all measurements of serum Ca, P and parathyroid hormones (PTH), and CaâÃâP in each patient; calcium in dialysate (mEq/l); doses of vitamin D administered; doses of cinacalcet used, and the average prescription of calciumâbased phosphate binders, sevelamer hydrochloride and aluminum binders, corresponding to two periods according to the introduction of cinacalcet. The proportions of patients with different serum Ca levels as well as serum P levels; serum PTH levels and CaxP at the beginning and at the end of the nine month period of treatment with cinacalcet were calculated. Results. Serum PTH (826.9â±â325 vs 248.1â±â77.3, Pâvs 8.6â±â0.4, Pâvs 43.6â±â8.5; Pâvs 4.3â±â1.1; Pâ=âNS). Before cinacalcet, 23 patients had severe hyperparathiroidism (serum PTHâ>â500) and 15 patients hypercalcaemia (serum calcium >10.2âmg/dl). After 9 months of treatment, all 28 patients showed serum PTHâPâPâ=â0.5), neither in the mean doses of calcium-containing agents, nor in the mean prescribed doses of sevelamer (PâPâConclusions. In summary, the combination of cinacalcet and low doses of vitamin D improved significantly the control of PTH and CaâÃâP in patients with severe secondary hyperparathiroidism on chronic haemodialysis, without adverse effects and with lower doses of phosphate binders. [ABSTRACT FROM AUTHOR]
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- 2007
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43. [Allergy to latex and repeated vascular access thrombosis in haemodialysis].
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Arenas MD, López-Collado M, Niveiro E, Cotilla de la Rosa E, Morales A, Moledous A, Malek T, and Gil MT
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- Humans, Male, Recurrence, Young Adult, Catheters, Indwelling adverse effects, Latex Hypersensitivity etiology, Renal Dialysis instrumentation, Thrombosis etiology
- Published
- 2009
- Full Text
- View/download PDF
44. [Superficialization of autologous vascular access: an alternative to the use of vascular prostheses and permanent catheters].
- Author
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Arenas MD, Gil MT, Malek T, Moledous A, Nuñez C, and López-Collado M
- Subjects
- Aged, Blood Vessel Prosthesis, Catheters, Indwelling, Female, Humans, Male, Retrospective Studies, Renal Dialysis, Veins transplantation
- Abstract
Introduction: We review our experience with autologous veins Superficialization (Spf), to establish the actual possibilities of this kind of vascular access in our area., Methods: Between January/2001 and January/2008, Spf was performed in 48 patients. Mean follow-up time was 18.8 (0.2-75.7) months. Primary failure rate was recorded; primary and secondary survival were estimated using the Kaplan-Meier method; and its possible associations with several variables were analyzed., Results: the maturity rate was 97.9%; and the rate of primary failure 2.0%. After Spf, mean time of primary and secondary survival were 65 months and 67 months, respectively. Four vascular thromboses were observed. None of the presurgery variables analyzed (age; sex; diabetes mellitus; ipsilateral central catheter; the number of previous VA attempts; and obesity) were significantly associated with maturity rate, primary or secondary survivals., Conclusion: the Spf can be a good option alternative to the use of prosthetic grafts or permanent central vascular catheters.
- Published
- 2009
- Full Text
- View/download PDF
45. [Operation to remove tunnelled venous catheters in a dialysis unit. Is it possible to reverse the trend in their growing use?].
- Author
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Arenas MD, Malek T, López-Collado M, Gil MT, Moledous A, Morales A, Cotilla E, and Alvarez-Ude F
- Subjects
- Aged, Female, Humans, Male, Catheterization statistics & numerical data, Catheterization trends, Renal Dialysis instrumentation
- Abstract
Introduction: Introduction In an attempt to reduce unnecessary central venous catheters (CVC) dependence in prevalent population, a "CVC removal" programme was initiated in our unit. The objective was to diminish the number of CVC and to analyze the causes of their insertion and maintenance. On 09/01/07, 38 out of 173 prevalent patients on hemodialysis. Methods were CVC dependant (21.9%): 16 incident patients (42,1%) and 22 (57,8%) prevalent patients. All of them were re-evaluated for permanent vascular access utilization, included those previously rejected for surgery. Physical, psychical and vascular aspects regarding each patient were taken into consideration. The following variables were age, Body mass index, time on hemodialysis, Charlson analyzed comorbidity index, DM or vascular comorbidities and number of vascular accesses created prior to CVC placement. In those patients in whom AVF creation was feasible, the following were registered after 18 months of 1.Primary failure rate. 2. Related complications. 3. up follow Percentage of usable AVF or AVG. 4. Percentage of removed CVC. 5. Mortality and hospitalization. The decision of no realization of a new vascular access and? Results maintenance of TVC was performed in 21 patients (55.2%). In 9 of them was decision of the nephrologists and the family. In 11 patients was decision of vascular surgeon due to vascular bed exhaustion. A permanent VA was achieved in 17 patients (44.7%), 50% of them was incident patients and 45% prevalent patients. The primary failure rate was 0%. The TVC was withdrawn in 11/17 (64.7%). Only 4 patients remain without TVC after 18 months of follow-up: 5 patients died (4 with a AVF functioning and 1 VA closure due to steal syndrome) and in 8 patients was mandatory to reintroduce the TVC again. Immediate complications after the surgery were: 1 severe haematoma, 2 infections and 2 severe sequestrations. 3 patients required hospital admission following complications directly related to VA. Mean time of free of TVC was 5.2 months (range: 0.7- 14.3 months). The mortality was 29,4% (5/17) in the group of patients with a new VA and 9,5% (2/21) in the other group(RR 3,19; IC 95%: 0,68-13,98; p: 0,11). No significant differences were observed between patients who transitioned to a permanent vascular access and those who remained TVC dependant in regards to age, gender, BMI, time on dialysis, DM, comorbidity or number of previous VA, Transition from CVC use to hospitalizations or mortality. Conclusions permanent vascular access is possible in prevalent patients in dialysis. Improvement was achieved by a modest amount, and after a prolonged process with gravel complications, some of which proved severe. Need for CVC dependence is confirmed in a high percentage of prevalent patients on dialysis. Comorbidity might have influenced the results. The quality standard should be adequate to reality of current population on hemodialysis.
- Published
- 2009
- Full Text
- View/download PDF
46. [Can we improve our results in hemodialysis? Setting quality objectives, feedback, and benchmarking].
- Author
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Arenas MD, Alvarez-Ude F, Moledous A, Malek T, Gil MT, Soriano A, and Núñez C
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- Aged, Benchmarking, Feedback, Humans, Middle Aged, Renal Dialysis standards
- Abstract
Unlabelled: To diminish inter centres variability in applied medical treatments, as well as in the results obtained with them, is one of the main challenges that Nephrology faces now a days. The systematic and planned use of Clinical Performance Measures (CPMs), Feedback and Benchmarking are tools that can help clinicians to reach such an objective. In this study we evaluate the consequences of applying those techniques in the results obtained in three haemodialysis units., Methods: we analyzed the results obtained in 311 patients dialyzed in the three units during the period 2006-2007. Established and evaluated objectives were as follows: 1.- To increase the percentage of patients with a serum calcium below 9,5 mg/dl over 70%; 2.- To increase the percentage of patients with a serum phosphorus under 5,5 mg/dl over 80%; 3.- To increase the percentage of patients with a serum PTH in between 150-300 pg/ml over 40%; 4.- To diminish the percentage of patients with a serum ferritine below 100 ng/ml under 10%, in one of the units that at the beginning of the study was not accomplishing that objective. Every three months each unit received their own results as well as the results of the two other units., Results: the percentage of patients with serum calcium below 9,5 mg/dl increased significantly in the three units (54,6%, 56,1% and 55,6% at the beginning; 87,7%, 82.9% and 75,1% at the end of the study, respectively; p<0,001). The same was observed for the percentage of patients with a serum phosphorus below 5,5 mg/dl (77,9%, 73,6% and 66,0% at the beginning; 81,7%, 78,0% and 85.9% at the end, respectively; p: not significant), and for the percentage of patients with PTH between 150-300 pg/ml (32,9%, 43,1% and 26,4% versus 47,5%, 41,4% and 39.5%, respectively; p: not significant). The percentage of patients with a serum ferritin below 100 ng/ml in unit B diminished from 30% to 5,3% (p<0,001), reaching results similar the the two other units. Mean erythropoietin (EPO) consumption during the year 2005 was 145,5+/-13,2 U/kg/week in unit A; 226,2+/-39,8 U/kg/week in unit B, and 175,5+/-13,9 U/kg/week in unit C. At the end of year 2007, mean EPO consumption was significantly lower in unit B (144,2+/-15 U/kg/week), and similar to the other two units (140+/-14,2 in unit A and 135,1+/-13,8 in unit C)., Conclusion: The results of this study permit to conclude that the use of QPM's and quality targets, combined with feedback and benchmarking, allows for the improvement of clinical results. Each centre should establish their own objectives, independently of the defined quality standards, so as to reach such standards or even to improve them. In this study, the three units showed a general improvement in their results, tending towards similar outcomes for the same clinical processes.
- Published
- 2008
47. [Use of the aluminum phosphate-binders in hemodialysis in the ultrapure water era].
- Author
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Arenas MD, Malek T, Gil MT, Moledous A, Núñez C, and Alvarez-Ude F
- Subjects
- Aged, Female, Humans, Hyperphosphatemia etiology, Male, Aluminum Hydroxide therapeutic use, Chelating Agents therapeutic use, Hyperphosphatemia prevention & control, Phosphates metabolism, Renal Dialysis adverse effects
- Abstract
Introduction: Aluminium binder has been ill-advised, but his use remain applicable in the clinique practice in very seleccionated and particular patients. The repercussion of prolonged treatment with low doses of aluminium phosphate-binders in haemodialysis was studied. The haemodialysis unit had a double osmosis inverse and the aluminium levels in haemodialysis liquid was less than 2 micrograms/liter., Methods: 41 patients of the 295 on haemodialysis received aluminium phosphate-binders since the 2005 January to the 2007 November. The mean time of treatment was 17.8 months, and the doses was 3.9 tablets day (mean of 463 grams in the studied period). The association of low doses of aluminium phosphate-binders permitted a better control of phosphorus (6.8 to 4.8 mg/dl; p<0.0001), with a reduction of the others phosphate-binders: sevelamer (10.4 a 8 tablets/day; p<0.0001) and calcium phosphate-binders (4.6 to 3.1 tablets/day; p<0.0001). The serum aluminium increased after the aluminium treatment (6.8 to 13.8 mcg/l; p<0.0001), and no toxicity indirect signs were observed on CMV, haemoglobin, none PTH. Five patients (12.1%) reached aluminium serum levels higher 20 mcg/l, and none reached the 40 mcg/l., Conclusions: The aluminium phosphate-binders were effective, economical and, now, with an apparent better security profile than in a previous time, but it is very important to be careful with this use and to follow a vigilance strict on patients and haemodialysis liquid.
- Published
- 2008
48. [Changes in vascular access in a dialysis unit in recent years: planning problems, change in preferences, or demographic change?].
- Author
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Malek T, Alvarez-Ude F, Gil MT, Moledous A, López-Collado M, Núñez C, and Arenas MD
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Time Factors, Catheters, Indwelling statistics & numerical data, Catheters, Indwelling trends, Renal Dialysis
- Abstract
Background: Evidence on the reasons for the general and discouraging overutilization of catheters in DOPPS countries is lacking., Methods: We analysed the changes in distribution of the different types of vascular access in all 398 patients ongoing hemodialysis at our unit, from January 2000 until December 2005, as well as patients' characteristics. Secondly, risk factors associated with the use of permanent catheters were evaluated in all 95 patients who used that kind of vascular access from January 1997 until April 2006., Results: The percentage of fistulas in prevalent patients diminished from year 2000 until year 2005 (from 95% to 77.9%); concurrently there was an increase in the use of permanent catheters (from 4.2% to 21.5%). The percentage of incident patients having a usable fistula or graft at the beginning of hemodialysis diminished progressively (83.4% in 2000; 69.3% in 2005), and there was a significant increase in the percentage of incident patients using a permanent catheter (from 0 to 23%). Coincidentally, there was a change in patients characteristics: increasing age (71.3 vs. 60.5 years); greater diabetes percentage (7.1% vs. 18.5%) and less time on dialysis (93.2 vs 37 months; p < 0.03). Causes of permanent catheter insertion varied, exhaustion of all other arteriovenous options being the most frequent in the first period of the study and the presence of an unsuitable vascular anatomy in the second., Conclusions: Despite our policy favoring arteriovenous angioaccess, our results with regards to vascular access worsened in both prevalent and incident patients, coinciding with a change in patients' characteristics. We believe that reversing this trend may become more complicated as the population on dialysis grows older and becomes more prone to diabetes.
- Published
- 2008
49. [Is Cinacalcet a cost-effective treatment in severe secondary hyperparathyroidism in patients on hemodialysis?].
- Author
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Arenas MD, Rebollo P, Alvarez-Ude F, Prieto L, Gil MT, Malek T, Moledous A, and Núñez C
- Subjects
- Cinacalcet, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Hyperparathyroidism, Secondary drug therapy, Hyperparathyroidism, Secondary economics, Naphthalenes economics, Naphthalenes therapeutic use, Renal Dialysis
- Abstract
Background: A previous study using cinacalcet, as compared to vitamin D alone, showed a better reduction response of PTH levels and a significant diminution of secondary effects. The objective of present study was to evaluate the additional cost of adding cinacalcet to the standard treatment of patients with severe secondary hyperparathyroidism (SHPT) taking into account the treatment goals achieved., Methods: 12 month prospective study of 23 patients with severe SHPT. Two treatment regimens were considered: standard treatment (m 0) and standard treatment plus cinacalcet (m 12). Four consequences of inadequate control of SHPT were registered: parathiroid hormone (PTH), Calcium (Ca), Phosphorus (P) and the Ca x P product serum levels. Treatment effectiveness was measured as percentage of patients who achieved treatment goal according to each indicator: PTH < 800 pg/mL, PTH between 150 and 300 pg/mL, Calcium < 9.5 mg/dL, Phosphorus < 5.5 mg/dL, and Ca x P product < 55. Annual and monthly costs were calculated for both treatment regimens using Spanish 2007 tariffs, and taking into account the dose reduction in some other treatments. Results are presented as incremental costs and cost per patient who achieved treatment goal., Results: At 12 month it was observed a higher percentage of patients who achieved simultaneously the 4 therapeutic goals with respect to basal moment, from 0% to 52.1%. Cinacalcet allowed to save costs in concomitant drugs, achieving a total saving of 149 euros per patient and month. At 12 month, Cinacalcet achieved a reduction of percentage of patients with PTH > 800 pgr/mL with half of costs than standard treatment (651.35 euros vs 1363.68 euros). It was not possible to calculate the cost for PTH indicator since at the study onset, there was no patient who achieved a level between 150 and 300 pg/mL. Cinacalcet allowed reaching treatment goals in Calcium, Phosphorus and Ca x P product in a more cost-effective way (2164.2 euros vs 2684.8 euros)., Conclusions: Although Cinacalcet is expensive,p atients treated with Cinacalcet showed a minor cost per patient who achieved treatment goal than patients without Cinacalcet. The ability of cinacalcet to reduce PTH secretion, along with the reductions in the serum Ca, P, and Ca x P product, provides an alternative to the traditional treatment paradigm, and should be a welcomed addition in the management of SHPT.
- Published
- 2008
50. [Adverse reactions to polysulphone membrane dialyzers durind hemodialysis].
- Author
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Arenas MD, Gil MT, Carretón MA, Moledous A, and Albiach B
- Subjects
- Humans, Male, Middle Aged, Hypersensitivity etiology, Membranes, Artificial, Polymers adverse effects, Renal Dialysis, Sulfones adverse effects
- Abstract
The majority of severe hypersensitivity reactions in hemodialysis (HD) patients has been due to sensitization to ethylene oxide or to non-biocompatible membrane dialyzers like cupramonium membrane. However could be the possibility of adverse reactions with other hemodialysis substances. Adverse reactions with biocompatible polisulphone membranes are not frequent, but some authors described anaphilactoid reactions related to them. Any severe clinical syndrome of broncoespasm during hemodialysis with several biocompatible polysulphone membranes made by different manufacturers and with a variety of sterilization methods is presented here. The following day he was dialyzed on an cellulose triacetate dialyzer and the hemodialysis treatment was uneventful. This cas report demonstrates the complex nature involving a hypersensitivity reaction to HD.
- Published
- 2007
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