Monitoring haemodialysis in the Cabueñes Hospital
Monitorización en hemodiálisis en el Hospital de Cabueñes
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This produced a total of 77 patients; of them, 31 were included in the study over the course of the year, yielding a final prevalence of 47 patients. The mean age was 68.07 years, 69% were male, and the treatment administered was primarily conventional haemodialysis with biocompatible filters. The distribution of renal diseases was similar to rates in previous studies, with a higher frequency of nephroangiosclerosis, diabetic nephropathy, and of an unknown aetiology, with similar percentages. We analysed the standard demographic and biological indicators related to dialysis treatment, anaemia, iron parameters, renal osteodystrophy, etc. We would also like to highlight certain characteristics of the patients who passed away, given their homogeneity.</p><p class="elsevierStylePara">The prevalence during 2011 is summarised in Table 1.</p><p class="elsevierStylePara">Some 30% of both prevalent and incident patients were diabetic, and 36% had a Charlson index >7. Only 3 patients underwent dialysis treatment more than 3 days per week, and none underwent less than 3 sessions per week. Gross mortality was 11.68%, with normal hospitalisation rates and duration of hospital stay. We observed positive results with permanent catheters: Kt/V (1.37)<span class="elsevierStyleSup">6</span> (Table 2) was similar to rates with fistulas. Furthermore, there was a very low rate of infections (1 bacteraemia in 22 permanent catheters in place for at least 3 months). Values for renal osteodystrophy were acceptable,<span class="elsevierStyleSup">7</span> with <span class="elsevierStyleItalic">P</span><55 in 70%, CaxP<55 in 73%, and parathyroid hormone (PTH) <300 in 70%. There were no cases of PTH>800 + CaxP>55, thus no need for parathyroidectomy. All parameters for treated water and vaccinations were fulfilled without exception.<span class="elsevierStyleSup">8</span> We were satisfied that 80% of the patients starting dialysis treatment were referred from specialists and only 20% from emergency departments (pericarditis, uraemic coma, etc., and some patients that abandoned regular visits). However, we were unable to reach adequate Hb levels (11-13g/dl) in 90% of patients, as is suggested by standard guidelines. We only reached adequate Hb levels in 55% of cases. Furthermore, despite having a predialysis unit for patients with renal failure, a catheter was needed in the first session in approximately 50% of patients, not always due to the lack of an established vascular access, but rather inadequate performance by the already created vascular access in elderly patients. We also failed to comply with the recommended fistula:catheter ratio, resulting in a 3/1 value.</p><p class="elsevierStylePara">The most interesting results were those aspects that deviated from guideline objectives: the only patients that died were older than 80 years (mean: 85 years); except for one case, none responded to vaccination; and in more than half of all deaths, the patient left treatment several days or weeks before dying, rather than prolonging regressive situations without recourse. However, the mean duration on haemodialysis in these patients that died was 21 months, which should be taken into account when evaluating patient age upon inclusion in the programme.</p><p class="elsevierStylePara">No patients included in the treatment programme produced unexpected emergencies, although 2 cases occurred in patients in predialysis (pulmonary oedema) and 4 life-threatening situations were produced in previously unknown patients.</p><p class="elsevierStylePara">To conclude: in our experience, the positive results in permanent catheters are due to the total freedom in our unit for inserting, removing, replacing, and choosing catheters, for which we owe eternal thanks to Dr Forascepi; there is nothing like working closely with the patient to improve our results. Secondly, the few emergencies that were produced in prevalent dialysis patients were closely related to the referral of cardiologically unstable patients to peritoneal dialysis (essential collaboration from the Hospital Central de Asturias), and in some cases due to administering extra scheduled dialysis. Finally, avoiding unnecessarily prolonged treatment in certain patients with very low life expectancy and poor quality of life is an obvious goal, and we are focused on avoiding unnecessary suffering and ethical issues, etc., for heavily burdened families. In our opinion, senile patients with an acceptable quality of life should be included in this treatment programme. We need to improve many aspects of the treatment that we provide, but always with the patient’s needs in mind.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article.</p><p class="elsevierStylePara"><a href="grande/11397_16025_30585_en_t1_611397.jpg" class="elsevierStyleCrossRefs"><img src="11397_16025_30585_en_t1_611397.jpg" alt="Prevalence during 2011"></img></a></p><p class="elsevierStylePara">Table 1. Prevalence during 2011</p><p class="elsevierStylePara"><a href="grande/11397_16025_30586_en_t2_611397.jpg" class="elsevierStyleCrossRefs"><img src="11397_16025_30586_en_t2_611397.jpg" alt="Vascular access and Kt/V"></img></a></p><p class="elsevierStylePara">Table 2. Vascular access and Kt/V</p>" "pdfFichero" => "P1-E536-S3516-A11397-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11397_16025_30585_en_t1_611397.jpg" "Alto" => 384 "Ancho" => 1440 "Tamanyo" => 182074 ] ] "descripcion" => array:1 [ "en" => "Prevalence during 2011" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11397_16025_30586_en_t2_611397.jpg" "Alto" => 251 "Ancho" => 1440 "Tamanyo" => 138447 ] ] "descripcion" => array:1 [ "en" => "Vascular access and Kt/V" ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001141/v0_201502091614/en/main.assets" "Apartado" => array:4 [ "identificador" => "35438" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000003/v0_201502091613/X2013251412001141/v0_201502091614/en/P1-E536-S3516-A11397-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001141?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 11 | 14 |
| 2024 October | 35 | 27 | 62 |
| 2024 September | 41 | 28 | 69 |
| 2024 August | 51 | 55 | 106 |
| 2024 July | 39 | 32 | 71 |
| 2024 June | 44 | 30 | 74 |
| 2024 May | 45 | 34 | 79 |
| 2024 April | 46 | 31 | 77 |
| 2024 March | 39 | 36 | 75 |
| 2024 February | 53 | 36 | 89 |
| 2024 January | 33 | 24 | 57 |
| 2023 December | 35 | 28 | 63 |
| 2023 November | 58 | 38 | 96 |
| 2023 October | 45 | 27 | 72 |
| 2023 September | 49 | 32 | 81 |
| 2023 August | 34 | 24 | 58 |
| 2023 July | 41 | 30 | 71 |
| 2023 June | 25 | 30 | 55 |
| 2023 May | 49 | 35 | 84 |
| 2023 April | 13 | 20 | 33 |
| 2023 March | 33 | 30 | 63 |
| 2023 February | 24 | 21 | 45 |
| 2023 January | 21 | 23 | 44 |
| 2022 December | 41 | 21 | 62 |
| 2022 November | 38 | 22 | 60 |
| 2022 October | 29 | 34 | 63 |
| 2022 September | 32 | 22 | 54 |
| 2022 August | 28 | 38 | 66 |
| 2022 July | 25 | 37 | 62 |
| 2022 June | 21 | 24 | 45 |
| 2022 May | 33 | 30 | 63 |
| 2022 April | 38 | 46 | 84 |
| 2022 March | 35 | 43 | 78 |
| 2022 February | 28 | 37 | 65 |
| 2022 January | 24 | 35 | 59 |
| 2021 December | 28 | 41 | 69 |
| 2021 November | 36 | 37 | 73 |
| 2021 October | 46 | 24 | 70 |
| 2021 September | 30 | 35 | 65 |
| 2021 August | 36 | 37 | 73 |
| 2021 July | 76 | 42 | 118 |
| 2021 June | 30 | 15 | 45 |
| 2021 May | 27 | 33 | 60 |
| 2021 April | 49 | 48 | 97 |
| 2021 March | 52 | 36 | 88 |
| 2021 February | 36 | 24 | 60 |
| 2021 January | 30 | 16 | 46 |
| 2020 December | 36 | 20 | 56 |
| 2020 November | 23 | 7 | 30 |
| 2020 October | 21 | 16 | 37 |
| 2020 September | 14 | 13 | 27 |
| 2020 August | 26 | 12 | 38 |
| 2020 July | 22 | 7 | 29 |
| 2020 June | 29 | 11 | 40 |
| 2020 May | 27 | 8 | 35 |
| 2020 April | 24 | 14 | 38 |
| 2020 March | 19 | 9 | 28 |
| 2020 February | 27 | 22 | 49 |
| 2020 January | 22 | 15 | 37 |
| 2019 December | 31 | 17 | 48 |
| 2019 November | 19 | 23 | 42 |
| 2019 October | 11 | 9 | 20 |
| 2019 September | 11 | 24 | 35 |
| 2019 August | 6 | 5 | 11 |
| 2019 July | 10 | 25 | 35 |
| 2019 June | 16 | 16 | 32 |
| 2019 May | 15 | 17 | 32 |
| 2019 April | 32 | 21 | 53 |
| 2019 March | 19 | 26 | 45 |
| 2019 February | 15 | 18 | 33 |
| 2019 January | 20 | 21 | 41 |
| 2018 December | 61 | 39 | 100 |
| 2018 November | 87 | 22 | 109 |
| 2018 October | 78 | 19 | 97 |
| 2018 September | 63 | 15 | 78 |
| 2018 August | 36 | 21 | 57 |
| 2018 July | 32 | 11 | 43 |
| 2018 June | 53 | 20 | 73 |
| 2018 May | 40 | 10 | 50 |
| 2018 April | 63 | 10 | 73 |
| 2018 March | 48 | 13 | 61 |
| 2018 February | 55 | 9 | 64 |
| 2018 January | 47 | 9 | 56 |
| 2017 December | 64 | 13 | 77 |
| 2017 November | 55 | 17 | 72 |
| 2017 October | 43 | 12 | 55 |
| 2017 September | 42 | 14 | 56 |
| 2017 August | 43 | 13 | 56 |
| 2017 July | 32 | 16 | 48 |
| 2017 June | 44 | 9 | 53 |
| 2017 May | 42 | 15 | 57 |
| 2017 April | 30 | 12 | 42 |
| 2017 March | 37 | 22 | 59 |
| 2017 February | 36 | 8 | 44 |
| 2017 January | 26 | 15 | 41 |
| 2016 December | 40 | 5 | 45 |
| 2016 November | 62 | 24 | 86 |
| 2016 October | 79 | 18 | 97 |
| 2016 September | 87 | 7 | 94 |
| 2016 August | 150 | 11 | 161 |
| 2016 July | 195 | 20 | 215 |
| 2016 June | 128 | 0 | 128 |
| 2016 May | 145 | 0 | 145 |
| 2016 April | 93 | 0 | 93 |
| 2016 March | 97 | 0 | 97 |
| 2016 February | 97 | 0 | 97 |
| 2016 January | 118 | 0 | 118 |
| 2015 December | 115 | 0 | 115 |
| 2015 November | 91 | 0 | 91 |
| 2015 October | 82 | 0 | 82 |
| 2015 September | 62 | 0 | 62 |
| 2015 August | 83 | 0 | 83 |
| 2015 July | 62 | 0 | 62 |
| 2015 June | 34 | 0 | 34 |
| 2015 May | 59 | 0 | 59 |
| 2015 April | 11 | 0 | 11 |
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