¿Cuál es el papel de la hemodiálisis extendida en el tratamiento renal sustitutivo en 2020?

Pérez‐García, Rafael; Alcázar-Arroyo, Roberto; Sequera-Ortiz, Patricia de

doi:10.1016/j.nefro.2020.11.007

Cited by 3 publications

(4 citation statements)

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“…Table 3; for all online suppl. material, see www.karger.com/doi/10.1159/000520891 ), the HD techniques recommended were HDx and OL-HDF [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Effect of Expanded Hemodialysis with Theranova® in Patients with COVID-19

Salazar¹,

Pórtoles²,

Recio³

et al. 2022

Blood Purif

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Introduction: Cytokine storm control is the main target for improving severe COVID-19 by using immunosuppressive treatment. Effective renal replacement therapy (RRT) could give us an advantage removing cytokines in patients with RRT requirements superimposed on COVID-19. Methods: This is a prospective observational study in COVID-19 patients who required hemodialysis (HD). Patients were assigned to online hemodiafiltration (OL-HDF) and expanded HD (HDx) according to Brescia group recommendations. We measured several cytokines, β2 microglobulin and albumin levels pre/post-dialysis and on 1st–2nd week. We compared levels among both techniques and control group (HD without COVID-19). Results: We included 26 patients: 18 with COVID-19 on RRT (5 of them had acute kidney injury [AKI]) and 8 controls. We confirm higher cytokine levels in COVID-19 patients than controls and even higher in patients with AKI than in those with chronic kidney disease. Most cytokines raised during HD session, except IL-10 and TNFα. IL-10 was eliminated by any dialysis technique, while clearance of TNFα was higher in the HDx group. HDx achieved a deeper normalization of cytokines and β2 microglobulin reduction. Mortality was higher in the OL-HDF group than the HDx group. Discussion: Not all cytokines behave equally along HD session. The following characteristics should be taken into account, such as intrinsic kinetic profile during a HD session. HDx seems to get better performance, probably due to the combination of different factors; however, we did not reach statistical significance due to the small sample size, dropout, and reduction of AKI incidence during the 2nd pandemic wave. Conclusion: HDx appears to provide better clearance for TNFα and β2 microglobulin during HD session and associates lower mortality. We propose the HDx technique for COVID-19 patients with RRT requirements since it seems to be safe and more effective than OL-HDF. Further studies are still needed, but we hope that our preliminary data may help us in future pandemic waves of SARS-CoV-2 or other viruses still to come.

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“…Table 3; for all online suppl. material, see www.karger.com/doi/10.1159/000520891 ), the HD techniques recommended were HDx and OL-HDF [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The main objective of this study was to describe changes in cytokine activation, and to compare responses and clinical outcomes among OL-HDF and HDx. We are not aware of any prospective longitudinal study that compares both techniques, due to difficulty to develop successful clinical trials in this area [ 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Expanded Hemodialysis with Theranova® in Patients with COVID-19

Salazar¹,

Pórtoles²,

Recio³

et al. 2022

Blood Purif

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“…La HDD, no solamente consigue, mejoría en términos de calidad de vida [39][40][41] , al poderse realizar en casa del paciente, evitando así los desplazamientos a los centros de HD asistida, sino que también, al poderse efectuar en forma más frecuente permitiría mejorías en términos clínicos, con mejoría sobre el control de la anemia con menores dosis de estimulantes eritropoyéticos 42 , mejoría en el control de las alteraciones óseo minerales asociadas a la ERC con menores dosis de quelantes del fósforo 43,44 , mejoría en parámetros nutricionales 45 , mejoría en el control de la presión arterial con menores dosis de fármacos hipotensores y mejoría en la hipertrofia ventricular izquierda 46,47 .…”

Section: Beneficios Clínicos Hemodiálisis Domiciliariaunclassified

“…En referencia a los niveles de beta-2-microglobulina, los valores fueron menores en el grupo de HDD con respecto al grupo de HDC, alcanzando significación estadística. La beta-2-microglobulina es una molécula de unos 12000 daltons de peso molecular, y por tanto está en el límite de lo que la hemodiálisis convencional con filtros de alta permeabilidad elimina con facilidad 44 . Sus valores en sangre son muy dependientes de la función renal residual y son marcadores de morbi-mortalidad en pacientes en hemodiálisis 45 , al incrementar la frecuencia aumentamos la capacidad depurativa de esta sustancia, que puede ser bien utilizada como determinante de una mayor dosis de HD administrada 46 , como la que obtenemos con la HD de más frecuencia.…”

Section: Morbilidadunclassified

Desarrollo y optimización de programas de hemodiálisis domiciliaria basados en modelos TIC

Alba¹

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The research work carried out within this PhD aims to discuss the possibilities that the Information and Communication Technologies (ICT) bring to the development of Home Hemodialysis programs (HDD) optimizing their medical outcomes. After a first approach to the state of the art of kidney substitution treatments, and in particular of the HDD, and the description of the first application of ICT based solutions to a kidney treatment in the year 2017, starting date of this research work, a mobile application, called Dialapp, was developed with the cooperation of the Nephrology Department and the Computing Department of the Hospital General de Castellón (Spain).This application allowed the physician to prescribe the HD session while patients can transmit their HD sessions' parameters manually through the application. The application also allowed two-way communication between patients and the medical team involved in their treatment. After some initial problems of data privacy, the application was launched in May 2019. At that moment, the HDD service providers started to launch two other telemonitoring remote systems. The first system used a direct online connection between the home HD session in the patient's home and the server in the hospital.This system automatically uploaded data in the hospital management server and created a dump

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