Adhesión al tratamiento, estado emocional y calidad de vida en pacientes con insuficiencia renal crónica en tratamiento con diálisis

A low rate of adherence to treatment is a widespread problem of great clinical relevance among dialysis patients. The objective of the present study is to determine the relationship between adherence, emotional state (depression, anxiety, and perceived stress), and healthrelated quality of life (HRQOL) in renal patients undergoing dialysis. Method: Two patient groups (30 in hemodialysis and 31 in peritoneal dialysis) participated in this study. We evaluated aspects of adherence, depression, anxiety, perceived stress, and HRQOL with self-report and standardized instruments. Results: Peritoneal dialysis patients reported signifi cantly higher levels of adherence to treatment and better HRQOL in Physical Function and Bodily Pain domains. Depression level is associated with HRQOL indicators. We did not fi nd any differences regarding specifi c adherence to antihypertensive and phosphate binder drugs or in psychological variables depending on the modality of dialysis. Patients with adherence to antihypertensive drugs show better physical HRQOL. The predictors of HRQOL in dialysis patients were: work, gender and depression. Conclusions: Our results suggest that the modality of dialysis does not differentially affect the emotional state or specifi c adherence to drugs, but it is nevertheless related to their overall adherence to treatment and to their HRQOLAdhesión al tratamiento, estado emocional y calidad de vida en pacientes con insufi ciencia renal crónica en tratamiento con diálisis. Antecedentes: la escasa adhesión al tratamiento y un estado psicológico negativo constituyen potenciales factores de riesgo para la calidad de vida relacionada con la salud (CVRS) de los pacientes en diálisis. El objetivo del presente trabajo fue estudiar las relaciones entre adhesión, estado emocional (depresión, ansiedad y estrés percibido) y CVRS en pacientes en hemodiálisis y diálisis peritoneal. Método: participaron dos grupos de pacientes (30 en hemodiálisis y 31 en diálisis peritoneal). Evaluación mediante autoinformes e instrumentos estandarizados. Resultados: los pacientes en diálisis peritoneal informaron de niveles signifi cativamente más altos de adhesión y mejor CVRS en función física y dolor corporal. La depresión se relaciona de manera signifi cativa con la CVRS. No encontramos diferencias en adhesión específi ca a fármacos hipotensores y quelantes del fósforo ni en las variables psicológicas en función de la modalidad de diálisis. Al analizar la muestra en conjunto los pacientes adherentes a los hipotensores tienen mejor CVRS física. Los predictores de CVRS en pacientes en diálisis fueron: trabajo, género y depresión. Conclusiones: nuestros resultados sugieren que la modalidad de diálisis no afecta al estado emocional ni a la adhesión específi ca a fármacos, pero sí está asociada al grado de adhesión global al tratamiento y CVR

Giant Bilateral Renal Angiomyolipomas and Lymphangioleiomyomatosis Presenting after Two Successive Pregnancies Successfully Treated with Surgery and Rapamycin

We report the case of a 25-year-old woman who presented with abdominal and flank pain with two successive pregnancies and was diagnosed of giant bilateral renal AMLs and pulmonary LAM associated with TSC in the post-partum of her second pregnancy. This case illustrates that in women with TSC rapid growth from renal AMLs and development of LAM may occur with successive pregnancies. It also stresses the potential for preservation of renal function despite successive bilateral renal surgery of giant AMLs. Moreover, the treatment with a low-dose rapamycin may be an option for LAM treatment. Finally, a low-dose rapamycin may be considered as an adjuvant treatment together to kidney-sparing conservative surgery for renal AMLs

Alginate and its vast range of industrial usages

El alginato es un biopolímero no tóxico, biodegradable, biocompatible, soluble en agua y renovable, extraído habitualmente de algas pardas o producido mediante cultivo microbiano. Este biomaterial está aprobado por la Food and Drug Administration (FDA) de Estados Unidos para su uso en humanos en ciertas aplicaciones biomédicas. Además, existe una amplia gama de tipos de alginato diseñados con propiedades diversas según la aplicación específica. En el presente trabajo de revisión se pretende mostrar las inmensas aplicaciones que ofrece este biopolímero y que siguen en crecimiento exponencial debido a sus excelentes propiedades químicas, físicas y biológicas. De este modo, se presentan aplicaciones actuales en áreas importantes como la industria farmacéutica, la industria química y textil, la industria gastronómica y de la congelación, la inmovilización biotecnológica de células y enzimas, la liberación controlada de biomoléculas, la industria biomédica y finalmente el análisis de su creciente uso en la bioimpresión 3D.Alginate is a non-toxic, biodegradable, biocompatible, water-soluble and renewable biopolymer, usually extracted from brown algae or produced by microbial culture. This biomaterial has been approved by the Food and Drug Administration (FDA) for human use in certain biomedical applications. In addition, there is a wide range of alginate types designed with different properties depending on the specific application. This review aims to show the multiple applications of this biopolymer, which continues to grow exponentially due to its excellent chemical, physical and biological properties. Thus, current applications are present in important areas such as the pharmaceutical industry, chemical and textile industry, gastronomic and freezing industry, biotechnological immobilization of cells and enzymes, controlled release of biomolecules and biomedical industry. Finally, we will discuss its increasing use in 3D bioprinting applications.Ciencias Experimentale

Aneurisma de arteria renal como causa de hipertensión arterial en paciente joven

Renal artery aneurysms are a rare cause of arterial hypertension. The diagnosis is made usually with imaging techniques during the evaluation of secondary hypertension. Their resolution, by percutaneous procedures or surgery, drives mostly to remission of hypertension.Los aneurismas de arteria renal son una causa poco frecuente de hipertensión arterial. Se diagnostican mediante pruebas de imagen durante el cribado de hipertensión arterial secundaria. Su reparación, tanto por vía percutánea como quirúrgica, conduce en la mayoría de los casos a la resolución de la hipertensión arterial

Propiedades psicométricas preliminares de un cuestionario multidimensional de adaptación a la enfermedad para pacientes onco-hematológicos (Cmae-Oh) adaptado a pacientes renales en diálisis (Cmae-Rd)

Este trabajo tiene como objetivo la adaptación de un cuestionario empleado para la evaluación de necesidades y recursos en pacientes con enfermedad onco-hematológica, el CMAE-OH de Arranz y Ulla (2008) a pacientes renales en diálisis. Para ello realizamos tres estudios secuenciales. El primero de ellos es un estudio interjueces, para determinar la validez del cuestionario. El segundo es un estudio piloto para poner a prueba su funcionamiento en pacientes renales. El tercer estudio, consistirá en el empleo de la herramienta en una muestra mayor para determinar las propiedades psicométricas del instrumento. Tras la adaptación del cuestionario, concluimos que la herramienta es útil y adecuada para la evaluación de necesidades y recursos en los pacientes renales en diálisis, así como lo era para el caso de los pacientes oncológicos. Partimos de la adaptación de esta herramienta para iniciar una reflexión acerca de la cercanía, más que el distanciamiento, entre la psicooncología y otras subdisciplinas del ámbito de la Psicología de la Salud como la psiconefrologíaThe aim of this research is to adapt a questionnaire designed for the assessment of needs and resources in patients with onco-haematological diseases – the CMAE-OH- to renal patients under dialysis treatment. We have conducted three different studies. The first one is an inter-judges study to determine the face validity of the tool. The second is a pilot study, to know how the designed tool works when used in renal patients under dialysis. The third study consists of the usage of the questionnaire in a biggest sample to determine the psychometric properties of the tool. After the adaptation of the tool we conclude that the questionnaire we have adapt it is useful to assess needs and resources in renal patients under dialysis, as well as CMAE-OH was when used with oncological patients. On the basis of our study, we reflexionate about the closeness between psychooncology and other subdisciplines in the area of health psychology like psychonephrolog

Effect of self-administered intraperitoneal bemiparin on peritoneal transport and ultrafiltration capacity in peritoneal dialysis patients with membrane dysfunction: a randomized, multi-centre open clinical trial

Randomized controlled trial[Abstract] Background: Progressive peritoneal membrane injury and dysfunction are feared repercussions of peritoneal dialysis (PD), and may compromise the long-term feasibility of this therapy. Different strategies have been attempted to prevent or reverse this complication with limited success. Methods: We performed a randomized, open multi-centre trial, aimed at scrutinizing the efficacy of self-administered intraperitoneal (i.p.) bemiparin (BM) to modulate peritoneal membrane dysfunction. The main outcome variables were peritoneal creatinine transport and the ultrafiltration (UF) capacity, estimated during consecutive peritoneal equilibration tests. The trial included a control group who did not undergo intervention. The treatment phase lasted 16 weeks with a post-study follow-up of 8 weeks. Results: Intraperitoneal BM did not significantly improve creatinine transport or the UF capacity, when the whole group was considered. However, we observed a time-limited improvement in the UF capacity for the subgroup of patients with overt UF failure, which was not observed in the control group. Intraperitoneal injection of BM did not carry an increased risk of peritoneal infection or major haemorrhagic complications. Conclusions: Our data do not support the systematic use of BM for management of peritoneal membrane dysfunction in PD patients. Further studies on the usefulness of this approach in patients with overt UF failure are warranted. Intraperitoneal administration of BM is safe in PD patients, provided regulated procedures are respected

How a bottom-up multi-stakeholder initiative helped transform the renal replacement therapy landscape in Spain

[Abstract] Healthcare reforms aim to change certain parts of the health system to improve quality of care, access, or financial sustainability. Traditionally, healthcare reform is understood as an action undertaken by a government at a national or local level. However, bottom-up changes can also lead to improvements in the health system. This paper describes the efforts of a coordinated multi-stakeholder advocacy group in Spain to promote a more cost-effective and patient-centred treatment for people receiving renal replacement therapy and assesses the outcomes of their advocacy for health system financing and patient satisfaction. It concludes that bottom-up initiatives do indeed have the power to change health policy and that policy makers should pay attention to their arguments

Validación de un Cuestionario Multidimensional de Adaptación a la Enfermedad para Pacientes Renales en Diálisis (CMAE-RD) diseñado a partir de un cuestionario para pacientes oncohematológicos

Objectives: The present study aims to explore the psychometric properties of a multidimensional questionnaire to assess adaptation to illness in patients with end stage renal disease under hemodialysis (CMAE-RD for its Spanish acronym). Methods: This instrument was developed to be administered by a psychologist as a semi structured interview and it was adapted from a previous questionnaire for patients with oncohaematologic diseases. A total of 113 patients receiving hemodialysis treatment were interviewed with the CMAE-RD and completed two additional questionnaires with validation purposes: the HADS (to assess anxiety and depression) and the CDRISC-2 (to assess resilience). Results: Internal consistency scores for the areas of the CMAE-RD was comprised between.53 and.70. Evidences of validity related to an external criterion and concurrent validity were obtained for the areas which assess the level of information of the patient and their emotional state. Conclusions: We conclude that the CMAE-RD shows adequate levels of reliability and validity, being a useful measurement tool from the standpoint of health care, as it allows psychologist the needs and resources of renal patients, providing guidance for psychological intervention.Objetivos: El objetivo de este trabajo es estudiar las propiedades psicométricas de un cuestionario multidimensional de adaptación a la enfermedad para pacientes con enfermedad renal en diálisis (CMAE-RD). Métodos: Esta herramienta está diseñada para ser administrada por un profesional de la psicología en forma de entrevista semiestructurada y fue diseñado a partir de un cuestionario previo para pacientes oncohematológicos. Un total de 113 pacientes en hemodiálisis fueron entrevistados mediante el CMAE-RD y completaron dos cuestionarios adicionales con propósitos de validación: el HADS (para evaluar ansiedad y depresión) y el CDRISC-2 (para evaluar resiliencia). Resultados: La consistencia interna para las áreas del CMAE-RD estuvo comprendida entre 0,53 y 0,70, y se obtuvieron evidencias de validez relacionada con un criterio externo y concurrente especialmente para las áreas que evaluaban el grado en que el paciente está informado y su estado de ánimo. Conclusiones: CMAE-RD presenta niveles adecuados de fiabilidad y validez, siendo una herramienta útil desde el punto de vista clínico, pues permite evaluar las necesidades y recursos de los pacientes, guiando la intervención psicológic

Severe congenital nephrogenic diabetes insipidus in a compound heterozygote with a new large deletion of the AQP2 gene: A case report

Background: Congenital nephrogenic diabetes insipidus (NDI) is a rare condition characterized by severe polyuria, due to the inability of the kidneys to concentrate urine in response to arginine vasopressin (AVP). In the majority of the cases, the disease shows an X‐linked inherited pattern, although an autosomal recessive inheritance was also observed. Methods: We report a patient with a severe NDI diagnosed during the neonatal period. Because the patient was female without a family history of congenital NDI, her disease was thought to exhibit an autosomal recessive form. Results: A full mutation analysis of AVP receptor 2 (AVPR2; MIM#300538) gene showed no mutations. However, direct Sanger sequencing of the aquaporin 2 (AQP2) revealed an apparently homozygous mutation at nucleotide position NM_000486.5:c.374C>T (p.Thr125Met) in exon 2. Further customized multiplex ligation‐dependent probe amplification (MLPA), single‐nucleotide polymorphism (SNP) array analysis, and long‐range polymerase chain reaction (PCR) followed by Sanger sequencing showed a heterozygous exonic deletion comprising exons 2, 3, and partially 4 of AQP2. Conclusion: This is the first case of a compound heterozygote patient with a missense mutation involving NM_000486.5:exon2:c.374C>T (p.Thr125Met) and a gross deletion of at least exons 2, 3, and partially 4 on the AQP2 to present with a severe NDI phenotypeThis study was supported in part by grants from the Research Activity Intensification Program (Programa Intensificación Actividad Investigadora) (IdiPAZ and Agencia Laín‐Entralgo/CM) to R.P. ISCIII RETIC REDINREN RD16/0009 FEDER FUNDS, and (Programa Intensificación Actividad Investigadora) (IdiPAZ and FIBHULP) to J.N