DIALYSIS DOSE ASSESSMENT DEPENDING ON THE VASCULAR ACCESS · •Permanent vascular access •Use...
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Contact: Servicio de Nefrología. Hospital Universitario Marqués de Valdecilla. Avda. Valdecilla s/n. 39008 Santander. Cantabria. Spain. @: [email protected] DIALYSIS DOSE ASSESSMENT DEPENDING ON THE VASCULAR ACCESS Marina Rojo Tordable , Raquel Pelayo Alonso, Patricia Martínez Álvarez, Mª José Cagigas Villoslada, Camino Villa Llamazares, Mª Eugenia Cuadrado Mantecón, Magdalena Gándara Revuelta . Nefrology Unit . Hospital Universitario Marqués de Valdecilla . Santander. España. The main goal of the hemodialysis (HD) patient is to achieve adequate dialysis: an effective, sufficient, well tolerated treatment that improves the patient's survival. The dialytic dose (DD) is a good marker of adequate dialysis. There are different quantitative methods to determine the DD, being the most used the Kt / V. Another factor that also influences patient survival is having good vascular access (VA). Currently, carriers of tunneled venous catheters (TVC) are on the rise. Evaluate the dialysis dose depending on the vascular access. SPSS 15.0 Windows. Descriptive analysis: half, standard deviation, median, frecuency and percentage. Hypothesis contrast: student T, statistical analysisent, chi cuadrado, ANOVA. Statistical significance p <0.05 There is no difference in DD depending on the vascular access employed. In spite of the high percentage of patients dialysed through CP, almost 80% of the sample achieved an adequate Kt / V, reaching the adequate quality standards. 1. Maduell F, Arias M. Dosis de diálisis. Nefrología 2012; 7(1):447-457. 2. Gordillo R, Fernández B, Aller C, Coca A, Vásquez D, Sanz S, et al. Relación entre acceso vascular y dosis de diálisis en una unidad de hemodiálisis. XXXIV Congreso Anual de la Sociedad Española de Diálisis y Trasplante. [Consultado 28 de marzo de 2016]. Disponible en: http://www.elsevier.es/es- revista-dialisis-trasplante-275-pdf-90128837-S300. 3. Maduell F, García M, Alcázar R. Dosificación y adecuación del tratamiento dialítico. Guías de centros de hemodiálisis. Nefrología 2006; 26(supl 8):15-21. 4. Fernández AV, Soto S, Arenas M, Sáez N, García MªM, Ortega P. Estudio comparativo de la dosis de diálisis medida por dialisancia iónica (kt) y por Kt/V. Rev Esp Enferm Nefrol 2009; 12(2):97-102 5. Daugirdas J, Depner T. KDOQUI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis 2015; 66(5): 884-930. 6. Lowrie EG, Cherton GM, Lew NL, Lazarus JM, Owen WF. The urea product (Kt) as an outcome-based measure of hemodialysis dose. Kidney Int 1999; 56: 729- 737. BACKGROUND • ≥1.3 • It increases if: • Women • Weight<50 kg • Diabetic Kt/V • Women: 40- 45L • Men: 45-50L KT OBJECTIVE BIBLIOGRAPHY CONCLUSIONS METHODS STATISTICAL ANALYSIS • Descriptive • Prospective • 45 patients • HD patients • Permanent vascular access • Use time> 1 month Sociodemographic • Dialytic parameters • KT: Ionic dialysance • Kt/V: : Daugirdas formula 2nd generation Study Inclusión Variables Dialytic dose Stratification of patients as a function of DD reached Kt LOW Kt NORMAL Kt OPTIMUM <40 L 40-45 L > 45 L <45 L 45-50 L > 50 L Kt/V ADEQUATE ≥1.3 Kt/V INADEQUATE <1.3 RESULTS 45 patients 66.78±15.86years 60% 40% 31% 69% VA DISTRIBUTION AVF TVC 13.30% 17.80% 26.70% 42.20% Distribution by sex and VA AVF TVC 2.2% 2.2% 13.3% 4.4% 8.9% 6.7% 17.8% 15.5% 11.1% 17.8% Glomerular Diabetic Vascular Insterstitial Other Nephropathy TVC AVF 6.7% 17.8% 6.7% 22.2% 35.5% 11.1% HD HDF HFR HD Technique TVC AVF AVF TVC 57.1% 38.7% 14.1% 38.7% 28.6% 22.6% Tipe of Kt according to Vascular access Optimum Normal Low p 0.063 AVF TVC 78.6% 77.4% 21.4% 22.6% Tipe of Kt/V according to Vascular access Adequate Inadequate 77.4% 77.4% 2.41% 6.24% Recirculation rate AVF TVC 371 358 Blood flow (ml/min) AVF TVC 38 40 42 44 46 48 50 Vascular Access Sex HD technique Dialyzer 49.68 46.36 42.83 42.28 47.6 48.85 48.85 48.37 48.67 KT achieved according to different criteria AVF TVC MAN WOMAN HD HDF POLYPHENYLENE POLYSULFONE POLYCARBONATE 0 0,2 0,4 0,6 0,8 1 1,2 1,4 1,6 1,8 Vascular Access Sex HD technique Dialyzer 1.51 1.66 1.41 1.38 1.56 1.5 1.66 1.75 1.39 Kt/V according to different criteria AVF TVC MAN WOMAN HD HDF POLYCARBONATE POLYSULFONE POLYPHENYLENE
Transcript of DIALYSIS DOSE ASSESSMENT DEPENDING ON THE VASCULAR ACCESS · •Permanent vascular access •Use...
Contact: Servicio de Nefrología. Hospital Universitario Marqués de Valdecilla.
Avda. Valdecilla s/n. 39008 Santander. Cantabria. Spain. @: [email protected]
DIALYSIS DOSE ASSESSMENT DEPENDING ON THE VASCULAR ACCESS
Marina Rojo Tordable, Raquel Pelayo Alonso, Patricia Martínez Álvarez, Mª José Cagigas Villoslada, Camino Villa Llamazares, Mª Eugenia Cuadrado Mantecón, Magdalena Gándara Revuelta .
Nefrology Unit. Hospital Universitario Marqués de Valdecilla. Santander. España.
The main goal of the hemodialysis (HD) patient is to achieve adequate dialysis: an effective, sufficient, well tolerated treatment that improves the patient's survival.
The dialytic dose (DD) is a good marker of adequate dialysis.
There are different
quantitative methods to determine the DD, being the most used the Kt / V.
Another factor that also influences patient survival is having good vascular access (VA).
Currently, carriers of tunneled venous catheters (TVC) are on the rise.
Evaluate the dialysis dose depending on the vascular access.
SPSS 15.0 Windows.
Descriptive analysis: half, standard deviation, median,
frecuency and percentage.
Hypothesis contrast: studentT, statistical analysisent, chi cuadrado, ANOVA.
Statistical significance p <0.05
There is no difference in DD depending on the vascular access employed.
In spite of the high percentage of patients dialysed through CP, almost 80% of the sample achieved an adequate Kt / V, reaching the adequate quality standards.
1. Maduell F, Arias M. Dosis de diálisis. Nefrología 2012; 7(1):447-457.2. Gordillo R, Fernández B, Aller C, Coca A, Vásquez D, Sanz S, et al. Relación entre acceso vascular y dosis de diálisis en una unidad de hemodiálisis. XXXIV Congreso Anual de la Sociedad Española de Diálisis y Trasplante. [Consultado 28 de marzo de 2016]. Disponible en: http://www.elsevier.es/es-revista-dialisis-trasplante-275-pdf-90128837-S300.3. Maduell F, García M, Alcázar R. Dosificación y adecuación del tratamiento dialítico. Guías de centros de hemodiálisis. Nefrología 2006; 26(supl8):15-21.4. Fernández AV, Soto S, Arenas M, Sáez N, García MªM, Ortega P. Estudio comparativo de la dosis de diálisis medida por dialisancia iónica (kt) y por Kt/V. Rev Esp Enferm Nefrol 2009; 12(2):97-1025. Daugirdas J, Depner T. KDOQUI clinical practiceguideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis 2015; 66(5): 884-930.6. Lowrie EG, Cherton GM, Lew NL, Lazarus JM, Owen WF. The urea product (Kt) as an outcome-basedmeasure of hemodialysis dose. Kidney Int 1999; 56: 729-737.
BACKGROUND
• ≥1.3
• It increases if:
• Women
• Weight<50 kg
• Diabetic
Kt/V
• Women: 40-45L
• Men: 45-50L
KT
OBJECTIVE
BIBLIOGRAPHY
CONCLUSIONS
METHODS STATISTICAL ANALYSIS
• Descriptive
• Prospective
• 45 patients
• HD patients
• Permanent vascular access
• Use time> 1 month
Sociodemographic
• Dialytic parameters
• KT: Ionic dialysance
• Kt/V: : Daugirdasformula 2nd generation
StudyInclusión Variables
Dialytic dose
Stratification of patients as a function of DD reached
KtLOW
KtNORMAL
KtOPTIMUM
<40 L 40-45 L > 45 L
<45 L 45-50 L > 50 L
Kt/VADEQUATE
≥1.3
Kt/V INADEQUATE
<1.3
RESULTS
45 patients66.78±15.86years
60%40% 31%
69%
VA DISTRIBUTION
AVF TVC
13.30%
17.80%
26.70%
42.20%
Distribution by sex and VA
AVF TVC
2.2%
2.2%
13.3%
4.4%
8.9%
6.7%
17.8%
15.5%
11.1%
17.8%
Glomerular
Diabetic
Vascular
Insterstitial
Other
Nephropathy
TVC AVF
6.7%
17.8%
6.7%
22.2%
35.5%
11.1%
HD
HDF
HFR
HD Technique
TVC AVF
AVF TVC
57
.1%
38
.7%
14
.1%
38
.7%
28
.6%
22
.6%
Tipe of Kt according to Vascular access
Optimum
Normal
Low
p 0.063
AVF TVC
78
.6%
77
.4%
21
.4%
22
.6%
Tipe of Kt/V according to Vascular access
Adequate
Inadequate
77.4%
77.4%
2.41%6.24%
Recirculation rate
AVF
TVC
371 358
Blood flow (ml/min)
AVF
TVC
38
40
42
44
46
48
50
Vascular Access Sex HD technique Dialyzer
49
.68
46
.36
42
.83
42
.28
47
.6
48
.85
48
.85
48
.37
48
.67
KT achieved according to different criteria
AV
F
TVC
MA
N
WO
MA
N
HD H
DF
PO
LYP
HEN
YLE
NE
PO
LYSU
LFO
NE
PO
LYC
AR
BO
NA
TE
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
Vascular Access Sex HD technique Dialyzer
1.5
1
1.6
6
1.4
1
1.3
8
1.5
6
1.5 1.6
6
1.7
5
1.3
9
Kt/V according to different criteria
AV
F
TVC MA
N
WO
MA
N
HD
HD
F
PO
LYC
AR
BO
NA
TE
PO
LYSU
LFO
NE
PO
LYP
HEN
YLE
NE
