Relación entre la morfología y la función peritoneal en pacientes tratados con diálisis peritoneal con soluciones convencionales: análisis del impacto que tienen la duración de la técnicas y el uso de soluciones más biocompatibles

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 30-10-201

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

The effect of paricalcitolon dialysate protein loss in peritoneal dialysis patients

Ever since peritoneal dialysis (PD) has been used in the treatment of chronic kidney disease (CKD), high peritoneal protein loss has been observed on each PD exchange. In adult patients, the loss has been estimated at 6 to 13 g daily. Paricalcitol, a selective activator of vitamin D receptors (VDR), is successfully used as a treatment of hyperparathyroidism secondary to CKD. In addition, it has been proposed for reducing proteinuria in patients with CKD. Nonetheless, little is known about its effect on peritoneal protein loss (PPL) in patients on PD, namely after the identification of VDRon the peritoneal membrane. The aim of this study wasto examine the effect of paricalcitol on PPL in PD patients

Beneficio de la realización de un taller en gestión emocional para enfermería nefrológica

Los profesionales de enfermería del servicio de nefrología recibieron entrenamiento en gestión emocional mediante un taller de 12 horas centrado en la tecnología relacional de Counselling de amplia aplicabilidad en entornos sanitarios. El objetivo fue evaluar cambios en actitudes en relación a los principios bioéticos y en conocimientos sobre comunicación y gestión emocional antes y después de la implantación del taller. La muestra estaba formada por 63 profesionales del ámbito de la enfermería nefrológica (43 enfermeras y 20 auxiliares de enfermería) para la variable conocimientos y por 23 profesionales para la variable de actitudes (18 enfermeras y 5 auxiliares). Los resultados muestran cambios en implicación con los principios bioéticos (p<0,05) y conocimientos (p<0,001) en la muestr

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

Tamoxifen ameliorates peritoneal membrane damage by blocking mesothelial to mesenchymal transition in peritoneal dialysis

Mesothelial-to-mesenchymal transition (MMT) is an auto-regulated physiological process of tissue repair that in uncontrolled conditions such as peritoneal dialysis (PD) can lead to peritoneal fibrosis. The maximum expression of peritoneal fibrosis induced by PD fluids and other peritoneal processes is the encapsulating peritoneal sclerosis (EPS) for which no specific treatment exists. Tamoxifen, a synthetic estrogen, has successfully been used to treat retroperitoneal fibrosis and EPS associated with PD. Hence, we used in vitro and animal model approaches to evaluate the efficacy of Tamoxifen to inhibit the MMT as a trigger of peritoneal fibrosis. In vitro studies were carried out using omentum-derived mesothelial cells (MCs) and effluent-derived MCs. Tamoxifen blocked the MMT induced by transforming growth factor (TGF)-β1, as it preserved the expression of E-cadherin and reduced the expression of mesenchymal-associated molecules such as snail, fibronectin, collagen-I, α-smooth muscle actin, and matrix metalloproteinse-2. Tamoxifen-treatment preserved the fibrinolytic capacity of MCs treated with TGF-β1 and decreased their migration capacity. Tamoxifen did not reverse the MMT of non-epitheliod MCs from effluents, but it reduced the expression of some mesenchymal molecules. In mice PD model, we demonstrated that MMT progressed in parallel with peritoneal membrane thickness. In addition, we observed that Tamoxifen significantly reduced peritoneal thickness, angiogenesis, invasion of the compact zone by mesenchymal MCs and improved peritoneal function. Tamoxifen also reduced the effluent levels of vascular endothelial growth factor and leptin. These results demonstrate that Tamoxifen is a therapeutic option to treat peritoneal fibrosis, and that its protective effect is mediated via modulation of the MMT processThis work was supported by grant SAF2010-21249 from the ‘‘Ministerio de Economia y Competitividad’’ to MLC and by grant S2010/BMD-2321 from ‘‘Comunidad Autónoma de Madrid’’ to MLC and RS. This work was also partially supported by grants PI 09/0776 from ‘‘Fondo de Investigaciones Sanitarias’’ to AA, and RETICS 06/0016 (REDinREN, Fondos FEDER, EU) to R

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).

The 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 psychonephrologyEste 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 psiconefrología

Preliminary psychometric properties of a multidimensional questionnaire to assess adaptation to illness in onco-haematological patients (CMAE-OH) adapted to renal patients undergoing dialysis (CMAE-RD)

The 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

Abnormalities in Glucose Metabolism, Appetite-Related Peptide Release, and Pro-inflammatory Cytokines Play a Central Role in Appetite Disorders in Peritoneal Dialysis

Background: Appetite disorders are frequent and scantly studied in peritoneal dialysis (PD) patients and are associated with malnutrition and cardiovascular complications.Objective: We investigated the relationship between uremic insulin resistance, pro-inflammatory cytokines, and appetite-related peptides release (ARPr) with eating-behavior disorders in PD patients.Methods: We included 42 PD patients (12 suffering anorexia, 12 obese with high food-intake, and 18 asymptomatic) and 10 controls. We measured blood levels of ARPr including orexigens [neuropeptide-Y (NPY), ghrelin, and nitric-oxide], anorexigens [cholecystokinin, insulin, corticotropin-releasing factor, leptin, and adiponectin (Ad)], and cytokines (TNF-α, sTNFα-R2, and IL-6) both at baseline and after administering a standard-food stimulus (SFS). We also measured the expression of TNF-α, leptin and Ad-encoding mRNAs in abdominal adipose tissue. We compared these markers with eating motivation measured by a Visual Analog Scale (VAS).Results: Anorexics showed both little appetite, measured by a VAS, and low levels of orexigens that remained constant after SFS, coupled with high levels of anorexigens at baseline and after SFS. Obeses showed higher appetite, increased baseline levels of orexigens, lower baseline levels of anorexigens and cytokines and two peaks of NPY after SFS. The different patterns of ARPr and cytokines pointed to a close relationship with uremic insulin resistance. In fact, the euglycemic–hyperglycemic clamp reproduced these disorders. In anorexics, TNF-α fat expression was increased. In obese patients, leptin expression in fat tissue was down-regulated and showed correlation with the appetite.Conclusion: In PD, appetite is governed by substances that are altered at baseline and abnormally released. Such modulators are controlled by insulin metabolism and cytokines and, while anorexics display inflammatory predominance, obese patients predominantly display insulin resistance

TWEAK promotes peritoneal inflammation

Peritoneal dialysis (PD) is complicated by peritonitis episodes that cause loss of mesothelium and eventually sclerosing peritonitis. An improved understanding of the molecular contributors to peritoneal injury and defense may increase the therapeutic armamentarium to optimize peritoneal defenses while minimizing peritoneal injury. There is no information on the expression and function of the cytokine TWEAK and its receptor Fn14 during peritoneal injury. Fn14 expression and soluble TWEAK levels were measured in human PD peritoneal effluent cells or fluids with or without peritonitis. Fn14 expression was also analyzed in peritoneal biopsies from PD patients. Actions of intraperitoneal TWEAK were studied in mice in vivo. sTWEAK levels were increased in peritoneal effluent in PD peritonitis. Effluent sTWEAK levels correlated with the number of peritoneal macrophages (r = 0.491, p = 0.002). Potential TWEAK targets that express the receptor Fn14 include mesothelial cells and macrophages, as demonstrated by flow cytometry of peritoneal effluents and by analysis of peritoneal biopsies. Peritoneal biopsy Fn14 correlated with mesothelial injury, fibrosis and inflammation, suggesting a potential deleterious effect of TWEAK/Fn14. In this regard, intraperitoneal TWEAK administration to mice promoted peritoneal inflammation characterized by increased peritoneal effluent MCP-1, Fn14 and Gr1+ macrophages, increased mesothelial Fn14, MCP-1 and CCL21 expression and submesothelial tissue macrophage recruitment. Taken together these data suggest that the TWEAK/Fn14 system may promote inflammation and tissue injury during peritonitis and PD.This work was supported by FIS PS09/00447, PI08/1564, PI10/00234, MS12/03262, FEDER funds ISCIII-RETIC REDinREN/RD06/0016, RD12/0021, Comunidad de Madrid (Fibroteam S2010/BMD-2321, S2010/BMD-2378). Programa Intensificación Actividad Investigadora (ISCIII/Agencia Laı´n-Entralgo/CM) to AO, Programa Estabilizacio´n Investigadores to LB-C, Miguel Servet to ABS, Sara Borrell to BS, MDSN. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript