Nefrología Vol. 29 Issue Year 2009
Este artículo no dispone de la versión en español
Nefrologia (English Version) 2009;29 Supl 1:38-43 | doi: 10.3265/Nefrologia.2009.29.S.1.5636.en.full

EVALUATING RENAL FUNCTION AND INDICATIONS FOR STARTING DIALYSIS

Valoración de la función renal e indicaciones para el inicio de diálisis


a Servicio de Nefrolog??a, Hospital Ram??n y Cajal, Madrid, Madrid, Espa??a,
b Servicio de Nefrolog??a, Hospital Cl??nico San Carlos, Madrid, Madrid, Espa??a,
c Servicio de Nefrolog??a, Hospital de la Defensa, Madrid, Madrid, Espa??a,
d Servicio de Nefrolog??a, Hospital de Cruces, Barakaldo, Bilbao, Espa??a,
Resumen

VALORACIÓN DE LA FUNCIÓN RENAL
- Para el seguimiento de la función del injerto renal, debe medirse el filtrado glomerular (FG) mediante fórmulas que utilizan la concentración sérica de creatinina. La ecuación más utilizada es la fórmula abreviada MDRD (Modification of Diet in Renal Disease).
- Todos los enfermos trasplantados deben incluirse en el grupo de enfermedad renal crónica (ERC), aunque el FG sea normal y no haya evidencia de daño renal.
- Las medidas de intervención propuestas en la clasificación de la enfermedad renal crónica para su instauración progresiva en los estadios 1 a 3 de entrada deben aplicarse a todos los enfermos trasplantados.
COMIENZO DE DIÁLISIS
- A pesar de recibir atención nefrológica a lo largo de toda la evolución, los enfermos con disfunción crónica del injerto que reanudan tratamiento con diálisis lo hacen de forma más tardía y con más complicaciones relacionadas con la uremia que los enfermos que se dializan por primera vez.
- Para invertir esta tendencia, hay que considerar el tratamiento con diálisis cuando el FG sea inferior a 15 ml/min/1,73 m2. En el momento en que aparezca cualquier complicación relacionada con la uremia que no responda al tratamiento conservador, el inicio de la diálisis es mandatorio.
INICIO PROGRAMADO DE LA DIÁLISIS
- La reanudación de diálisis de forma no programada en el enfermo trasplantado es difícil de justificar si tenemos en cuenta que ha recibido atención nefrológica a lo largo de toda su evolución.
- La realización de un nuevo acceso vascular en estos enfermos puede ser problemática, dependiendo de los antecedentes de fístulas trombosadas. Es importante una valoración precoz por el Servicio de Cirugía Vascular.
- Como norma general, debe seguirse el mismo criterio aconsejado para el enfermo no trasplantado: el acceso vascular debe plantearse cuando el FG sea inferior a 20 ml/min/1,73 m2.
- El enfermo que vaya a ser tratado con diálisis peritoneal precisa un seguimiento muy estrecho, para poder programar la colocación del catéter peritoneal con un mínimo de 15 días antes de comenzar el entrenamiento.

Abstract

EVALUATION OF THE RENAL FUNCTION
- For the follow-up of the graft renal function it must be measured the glomerular filtration rate by means of formulae that use the serum creatinine. The most used equation is the brief formula MDRD.
- All patients transplanted must be included in the group of Renal Chronic Disease though the glomerular filtration rate is normal and there is no evidence of renal damage.
- The measures of intervention proposed in the classification of the Renal Chronic Disease for its progressive stablishment in the stage 1 to 3, must be applied to all the transplanted patients.
THE BEGINNING OF DIALYSIS
- In spite of receiving attention of Nephrologists along the whole evolution, the patients with chronic dysfunction of the graft that need treatment with dialysis start later and with more uremic complications that the patients who start dialysis for the first time.
- To change this trend, it is necessary to consider the treatment with dialysis when the glomerular filtration rate is lower than 15 ml/min/1,73 m2. If there appears any complication related to the uremia that cannot be handled by conservative treatment, the beginning of the dialysis is necessary.
THE BEGINNING OF THE DIALYSIS OF PROGRAMMED FORM
- The beginning of the dialysis of not programmed form in transplanted patients is difficult to justify if we take into account that such patients, have received nephrological attention along all their evolution.
- To get a new vascular access in these patients can be difficult depending on the previous trombosis of arteriovenous fistulas. Therefore, it must be realized a prompt evaluation for de department of vascular surgery to guarantee a suitable vascular access.
- As general norm, one must follow the same criterion advised for the not transplanted patient: the vascular access must be considered when the glomerular filtration rate is lower than 20 m/min/1,73 m2.
- The patient who is going to be treated by dialysis peritoneal precise a very narrow follow-up to be able to programme the placement of the catheter peritoneal with a minimum of 15 days before beginning the training.

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