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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58; </span>La anemia representa una complicaci&#243;n frecuente en pacientes con enfermedad renal cr&#243;nica&#46; En Latinoam&#233;rica &#40;LA&#41; la prevalencia y caracter&#237;sticas de la anemia en pacientes en hemodi&#225;lisis &#40;HD&#41; no ha sido bien estudiada&#46; <span class="elsevierStyleBold">Objetivo&#58; </span>Evaluar los resultados del primer registro de anemia del Comit&#233; de Anemia de la Sociedad Latinoamericana de Nefrolog&#237;a e Hipertensi&#243;n&#46; <span class="elsevierStyleBold">M&#233;todos&#58; </span>Esta es una encuesta multinacional&#44; voluntaria&#44; que recolect&#243; datos sobre el tratamiento de la anemia en pacientes en HD de unidades independientes en LA entre septiembre de 2009 y marzo de 2010&#46; Para el an&#225;lisis estad&#237;stico se utilizaron los siguientes m&#233;todos&#58; t-test&#44; ANOVA&#44; chi<span class="elsevierStyleSup">2</span> y el an&#225;lisis de regresi&#243;n log&#237;stica multivariante&#46; <span class="elsevierStyleBold">Resultados&#58;</span> La encuesta fue respondida por 134 unidades de HD de 16 pa&#237;ses&#44; recibi&#233;ndose datos de 9025 pacientes&#46; Las medias &#177; desviaci&#243;n est&#225;ndar de Hb&#44; ferritina y del &#237;ndice de saturaci&#243;n de transferrina &#40;IST&#41; fueron respectivamente&#58; 10&#44;5 &#177; 1&#44;8 g&#47;dl&#44; 570 &#177; 539 &#181;g&#47;l y 29&#44;8&#160;&#37; &#177; 15&#46; Se administr&#243; agentes estimulantes de la eritropoyesis &#40;AEE&#41; al 84&#44;3&#160;&#37; de los pacientes y hierro intravenoso &#40;FeIV&#41; al 68&#44;3&#160;&#37;&#46; Solamente el 32&#44;7&#160;&#37; de los pacientes tuvieron una Hb blanco de 10&#44;5-12&#44;0 g&#47;dl&#46; En pacientes con Hb &#60;&#160;10&#44;5 g&#47;dl&#44; el 85&#44;2&#160;&#37; estaban recibiendo AEE y un 68&#160;&#37; FeIV&#46; Las variables independientes asociadas con nivel Hb &#60;&#160;10&#44;5 g&#47;dl fueron&#58; g&#233;nero femenino&#44; IST&#160;&#60;&#160;25&#160;&#37; y edad &#60;&#160;50 a&#241;os&#46;&#160; En la muestra de pacientes analizada&#44; a pesar del amplio uso de los AEE y FeIV&#44; casi la mitad de los pacientes no alcanz&#243; la Hb blanco&#46;</p>"
      ]
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58; </span>Anemia almost invariably occurs in patients with chronic kidney disease&#46; Limited data are available regarding anemia management in Latin American &#40;LA&#41; hemodialysis &#40;HD&#41; patients&#46; <span class="elsevierStyleBold">Objective</span>&#58; To evaluate the results of the first anemia survey of the Anemia Committee of the SLANH&#46; <span class="elsevierStyleBold">Methods&#58;</span> This is a multinational&#44; voluntary survey that collected anemia management data from adult HD patients from independent&#44; non-chain owned HD units&#44; between 09&#47;2009 and 03&#47;2010&#46; T-test&#44; ANOVA&#44; chi-square test and multivariate logistic regression were used for statistical analysis&#46; <span class="elsevierStyleBold">Results&#58; </span>The survey received responses from 134 HD units of 16 countries providing data from 9&#44;025 patients&#46; Mean values of Hb&#44; ferritin&#44; and transferrin saturation &#40;TSAT&#41; were 10&#46;5&#177;1&#46;8g&#47;dL&#44; 570&#177;539&#181;g&#47;l&#44; and 29&#46;8&#177;15&#37;&#44; respectively&#46; Only 32&#46;7&#37; of patients were within the Hb target of 10&#46;5-12&#46;0g&#47;dL &#40;46&#46;3&#37; were below and 21&#46;1&#37; above&#41;&#46; Erythropoietin-stimulating agents &#40;ESAs&#41; were administered to 84&#46;3&#37; patients and 68&#46;3&#37; received intravenous iron &#40;IV&#41;&#46; Iron deficiency &#40;TSAT&#8804;20&#37;&#41; was present in 27&#46;5&#37; patients and among those receiving erythropoietin&#44; 47&#37; did not achieve Hb target&#46; The independent variables associated with the lowest Hb level &#40;&#60;10&#46;5g&#47;dL&#41; were&#58; female gender&#44; TSAT¿25&#37; and age&#60;50 years&#46; <span class="elsevierStyleBold">Conclusions&#58; </span>According to these results&#44; nearly half of LA chronic HD patients did not achieve the recommended Hb target despite wide use of ESAs and IV iron&#46;</p>"
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                  "referenciaCompleta" => "Locatelli F, Covic A, Eckardt K-U, Wiecek A, Vanholder R, on behalf of the ERA-EDTA ERBP Advisory Board. Anaemia management in patients with chronic kidney disease: a position statement by the Anaemia Working Group of European Renal Best Practice (ERBP). Nephrol Dial Transplant 2009;24:348-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19037082" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Cusumano AM, Gonzalez Bedat MC, García-García G, Maury Fernandez S, Lugon JR, Poblete BH, et al. Latin American Dialysis and Renal Transplant Registry: 2008 Report (data 2006). Clin Nephrol 2010;74 Suppl 1:S3-8."
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                  "referenciaCompleta" => "Sesso R, Lopes AA, Thomé FS, Bevilacqua JL, Romão JE Junior, Lugon J. Brazilian Dialysis Census Report 2008. J Bras Nefrol 2008;30(4):233-8."
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                  "referenciaCompleta" => "Gurgel TC, Cherchiglia ML, Acurcio F de A, Szuster DA, Campos DA, Gomes IC, et al. Erythropoietin use by incident HD patients in the Brazilian Unified National Health System, 2002-2003. Cad Saude Publica 2012;28(5):856-68."
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                  "referenciaCompleta" => "González C, Ferreiro A, Schwedt E, Pinato M. 2009 Uruguayan Register Dialysis. Available at: http://www.nefrouruguay.com/"
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                  "referenciaCompleta" => "Poblete H. Chilenan Nephrology Society. Dialysis Register 2010. Available at: http://www.nefro.cl/registros/registro-de-hemodialisis.html"
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                  "referenciaCompleta" => "Tsubakihara Y, Nishi S, Akiba T, Hirakata H, Iseki K, Kubota M, et al. 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial 2010;14(3):240-75. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20609178" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "National Institute for Health and Clinical Excellence (NICE). Anaemia management in people with chronic kidney disease. (CG114). 2011. Available at: http://guidance.nice.org.uk/CG114"
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                  "referenciaCompleta" => "Gilg J, Webb L, Feest T, Fogarty D. UK Renal Registry 13th Annual Report (December 2010): Chapter 9, haemoglobin, ferritin and erythropoietin amongst UK adult dialysis patients in 2009: national and center-specific analyses. Nephron Clin Pract 2011;119 Suppl 2:c149-77. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21894032" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "US Renal Data System, USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2012. Available at: http://www.usrds.org/atlas.aspxcion"
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                  "referenciaCompleta" => "Hasegawa T, Bragg-Gresham JL, Pisoni RL, Robinson BM, Fukuhara S, Akiba T, et al. Changes in anemia management and hemoglobin levels following revision of a bundling policy to incorporate recombinant human erythropoietin. Kidney Int 2011;79(3):340-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20962740" target="_blank">[Pubmed]</a>"
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Información de la revista
Vol. 34. Núm. 1.enero 2014
Páginas 0-138
Vol. 34. Núm. 1.enero 2014
Páginas 0-138
Acceso a texto completo
Primer Informe del Comité de Anemia en Pacientes en Hemodiálisis Crónica de la Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH)
The First Report of The Latin American Society of Nephrology and Hypertension (SLANH) Anemia Committee in Chronic Hemodialysis Patients
Visitas
14377
Raúl Carlinia, Raul Carlinia, Gregorio Obradorb, Nieves Campistrúsc, Liliana Andraded, Liliana Chifflete, Rachel Bregmanf, Alberto Locatellig, Ricardo Correa-Rotterh, Hugo Pobletei
a Division of Nephrology, University Hospital of Caracas, Caracas, Venezuela,
b School of Medicine, Panamerican University, Ciudad City, México,
c Dialysis Center Uruguayana, Montevideo, Uruguay,
d Hospital Policial Medical Complex Churruca-Visca, Buenos Aires, Argentina,
e Division of Dialysis, San José Medical Association, San José de Mayo, Uruguay,
f Rio de Janeiro State University, Rio de Janeiro, Brazil,
g Nefronosa Service SA, Buenos Aires,
h Department of Nephrology and Mineral Metabolism, Institute of Nutrition, Salvador Zubirán, Mexico City, Mexico,
i Dialysis Center Sermedial, Valparaíso, Chile,
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Estadísticas

Antecedentes: La anemia representa una complicación frecuente en pacientes con enfermedad renal crónica. En Latinoamérica (LA) la prevalencia y características de la anemia en pacientes en hemodiálisis (HD) no ha sido bien estudiada. Objetivo: Evaluar los resultados del primer registro de anemia del Comité de Anemia de la Sociedad Latinoamericana de Nefrología e Hipertensión. Métodos: Esta es una encuesta multinacional, voluntaria, que recolectó datos sobre el tratamiento de la anemia en pacientes en HD de unidades independientes en LA entre septiembre de 2009 y marzo de 2010. Para el análisis estadístico se utilizaron los siguientes métodos: t-test, ANOVA, chi2 y el análisis de regresión logística multivariante. Resultados: La encuesta fue respondida por 134 unidades de HD de 16 países, recibiéndose datos de 9025 pacientes. Las medias ± desviación estándar de Hb, ferritina y del índice de saturación de transferrina (IST) fueron respectivamente: 10,5 ± 1,8 g/dl, 570 ± 539 µg/l y 29,8 % ± 15. Se administró agentes estimulantes de la eritropoyesis (AEE) al 84,3 % de los pacientes y hierro intravenoso (FeIV) al 68,3 %. Solamente el 32,7 % de los pacientes tuvieron una Hb blanco de 10,5-12,0 g/dl. En pacientes con Hb < 10,5 g/dl, el 85,2 % estaban recibiendo AEE y un 68 % FeIV. Las variables independientes asociadas con nivel Hb < 10,5 g/dl fueron: género femenino, IST < 25 % y edad < 50 años.  En la muestra de pacientes analizada, a pesar del amplio uso de los AEE y FeIV, casi la mitad de los pacientes no alcanzó la Hb blanco.

Palabras clave:
Encuesta
Palabras clave:
Hemodiálisis
Palabras clave:
Latinoamérica
Palabras clave:
Anemia

Background: Anemia almost invariably occurs in patients with chronic kidney disease. Limited data are available regarding anemia management in Latin American (LA) hemodialysis (HD) patients. Objective: To evaluate the results of the first anemia survey of the Anemia Committee of the SLANH. Methods: This is a multinational, voluntary survey that collected anemia management data from adult HD patients from independent, non-chain owned HD units, between 09/2009 and 03/2010. T-test, ANOVA, chi-square test and multivariate logistic regression were used for statistical analysis. Results: The survey received responses from 134 HD units of 16 countries providing data from 9,025 patients. Mean values of Hb, ferritin, and transferrin saturation (TSAT) were 10.5±1.8g/dL, 570±539µg/l, and 29.8±15%, respectively. Only 32.7% of patients were within the Hb target of 10.5-12.0g/dL (46.3% were below and 21.1% above). Erythropoietin-stimulating agents (ESAs) were administered to 84.3% patients and 68.3% received intravenous iron (IV). Iron deficiency (TSAT≤20%) was present in 27.5% patients and among those receiving erythropoietin, 47% did not achieve Hb target. The independent variables associated with the lowest Hb level (<10.5g/dL) were: female gender, TSAT¿25% and age<50 years. Conclusions: According to these results, nearly half of LA chronic HD patients did not achieve the recommended Hb target despite wide use of ESAs and IV iron.

Keywords:
Survey
Keywords:
Hemodialysis
Keywords:
Latin America
Keywords:
Anemia
El Texto completo está disponible en PDF
Bibliografía
[1]
Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. for the CHOIR Investigators. Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease. N Engl J Med 2006;355:2085-98. [Pubmed]
[2]
Drüeke TB, Locatelli F, Clyne N, Eckardt K-U, Macdougall IC, Tsakiris D, et al. for the CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071-84. [Pubmed]
[3]
Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU et al.; TREAT Investigators. A trial of darbepoetinalfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009;361(21):2019-32. [Pubmed]
[4]
Coyne DW. The health-related quality of life was not improved by targeting higher hemoglobin in the Normal Hematocrit Trial. Kidney Int 2012;82:235-41. [Pubmed]
[5]
KDOQI clinical practice guideline and clinical practice recommendations for anemia in chronic kidney disease, 2007 update of hemoglobin target. Am J Kidney Dis 2007;50(3):471-530. [Pubmed]
[6]
Locatelli F, Covic A, Eckardt K-U, Wiecek A, Vanholder R, on behalf of the ERA-EDTA ERBP Advisory Board. Anaemia management in patients with chronic kidney disease: a position statement by the Anaemia Working Group of European Renal Best Practice (ERBP). Nephrol Dial Transplant 2009;24:348-54. [Pubmed]
[7]
Carlini R, Campistrús N, Andrade L, Bregman R, Chifflet L, Correa-Rotter R, et al. Recommendations for the clinical practice of the Latino American Society of Nephrology and Hypertension (SLANH) for the treatment of anemia in patients with chronic renal disease (RPCA-ERC/SLANH). Nefrología Latinoamericana 2009;13:1-30.
[8]
KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl 2012;(2):S299-310.
[9]
Cusumano AM, Gonzalez Bedat MC, García-García G, Maury Fernandez S, Lugon JR, Poblete BH, et al. Latin American Dialysis and Renal Transplant Registry: 2008 Report (data 2006). Clin Nephrol 2010;74 Suppl 1:S3-8.
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