Evaluation of dialysis centres: values and criteria of the stakeholders.

Background: Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. Remarkably, outcomes vary across centres. In addition, the methods used have important epistemological limitations, such as ignoring significant features (e.

Disability in instrumental activities of daily living in hemodialysis patients: Influence on quality of life related to health.

Introduction: Instrumental Activities of Daily Life (IADL) requires a higher level of personal autonomy and interaction with the environment than the basic activities of daily life (BADL). Few studies analyze the deficit on IADL. Early detection is important because an early action can delay the evolution of the dependency process.

Strategies to increase patient safety in Hemodialysis: Application of the modal analysis system of errors and effects (FEMA system).

Background: Haemodialysis (HD) patients are a high-risk population group. For these patients, an error could have catastrophic consequences. Therefore, systems that ensure the safety of these patients in an environment with high technology and great interaction of the human factor is a requirement.

Assessing value-based health care delivery for haemodialysis.

Rationale, Aims And Objectives: Disparities in haemodialysis outcomes among centres have been well-documented. Besides, attempts to assess haemodialysis results have been based on non-comprehensive methodologies. This study aimed to develop a comprehensive methodology for assessing haemodialysis centres, based on the value of health care.

Outcomes weighting for comprehensive haemodialysis centre assessment.

Background: At present, there is no adequate system available for evaluating dialysis centres.

Objectives: To construct an overall haemodialysis results weighting system, acceptable to the different stakeholders involved which allows the comparison of centres using a compound marker.

Method: The Quality Management Work Group of the Spanish Society of Nephrology (WG) established a set of preselected indicators.

Elderly patients with chronic kidney disease: outcomes after 5 years of follow-up.

Introduction: In recent years, chronic kidney disease (CKD) has come to be considered an epidemic problem, and there is considerable interest in early diagnosis in order to slow its progression to end-stage renal disease (ESRD) and prepare patients for dialysis and transplantation programmes. Many elderly patients are labelled as having CKD based solely on having a glomerular filtration rate (GFR) of <60 ml/min.

Objective: Monitor renal function (RF) and outcomes associated with CKD (morbidity, mortality and progress to ESRD) in an elderly cohort.

Serum uric acid as a marker of all-cause mortality in an elderly patient cohort.

Introduction: There is growing evidence of the role of serum uric acid (SUA) as a risk factor for cardiovascular and renal disease. We analysed the association between baseline SUA and overall mortality in a cohort of elderly patients followed prospectively for 5 years.

Patients And Methods: Eighty clinically stable patients, median age 83 years (range 69-97), 31.

Renal supportive care and palliative care: revision and proposal in kidney replacement therapy.

Patients with chronic kidney disease may receive sustained renal supportive care and renal palliative care (RPC) starting with the diagnosis of the disease, throughout the various stages of renal replacement therapy (RRT), the cessation of the RRT, and in the decision of whether to provide conservative treatment or non-initiation of RRT. This article reviews the literature on the development of renal palliative care and proposed RPC models. We describe the progression of disease in organ failure, which is very different from other areas of palliative care (PC).

Multicentre study of haemodialysis costs.

Background: Previous studies to determine the cost of haemodialysis (HD) in Spain have significant limitations: they are outdated or used indirect methods. There is also a lack of analysis performed simultaneously on Public centres (PC), with direct HD services, and partially state-subsidised centres (SC). This is an important issue since the two systems coexist in Spain.

[Dispositional optimism in patients on chronic haemodialysis and its possible influence on their clinical course].

Introduction: Dispositional optimism is a personality trait significantly associated with the use of positive adaptive coping strategies as well as with perceived psychological and physical well-being, and it appears to be an important predictor of illness.

Objectives: To analyse if dispositional optimism is significantly associated with the number of hospital admissions of our chronic haemodialysis patients, as well as its relationship with perceived state of health.

Methods: We studied 239 patients on chronic haemodialysis.

[Renal biopsy in patients aged 65 years or older: are there differences in the indication and histopathology compared to other patients?].

Background: Renal biopsy (RB) represents the gold standard for diagnosis of kidney diseases. In this paper we analyse whether the indication of RB and histopathology in patients 65 years or older is different from the other patients.

Material And Methods: Retrospective study of 93 native renal biopsies performed in the General Hospital of Segovia in the period 2004-2008.

Acute responses of gastrointestinal hormones to both oral and parenteral intradialytic nutrition.

Introduction: Intradialytic nutrition (IDN) has been used to improve the nutritional status of malnourished hemodialysis (HD) patients.

Objective: To evaluate the different effects of parenteral IDN (IDPN) and oral IDN (IDON) on nutrition-related gastrointestinal hormones.

Patients And Methods: Seven clinically stable HD patients with malnutrition were included.

[Phosphorus binders: preferences of patients on haemodialysis and its impact on treatment compliance and phosphorus control].

Introduction: Non-adherence to phosphate binding (PB) medication may play a role in the difficulty in achieving the targets for phosphorus. We have a wide armamentarium of PB but preferences of patients are poorly understood.

Objective: to study the patients' preferences and beliefs regarding PB and their influence on adherence and serum phosphate.

A comparative study of 2 new phosphate binders (sevelamer and lanthanum carbonate) in routine clinical practice.

Introduction: Lack of adherence may influence the efficiency of phosphate binders. Our clinical hypothesis was that if lanthanum carbonate (LC) might offer some advantage over sevelamer (S), that that would be in those patients in whom serum phosphate (P) levels were not controlled by S or in those requiring high doses of it, presuming that therapeutic compliance with S could be inadequate. The aim of this study was to compare the cost-consequences of changing from S to LC.

[Estimation of glomerular filtration rate in persons aged 69 years or older: agreement between distinct calculation methods].

Material: Estimation of glomerular filtration rate (eGFR) is the most widely accepted marker of renal function. Precise calculation is not routinely performed in clinical practice. Several methods have been developed for eGFR: creatinine clearance (CCr) calculation or the use of formulae derived from serum creatinine (sCr).

Challenge of phosphorus control in hemodialysis patients: a problem of adherence?

Objective: Few studies have investigated nonadherence to phosphate binders. The aim of this study was to evaluate the degree of adherence of our hemodialysis (HD) patients to phosphate binders and to determine which variables were related to nonadherence to treatment.

Methods: In 165 HD patients, the degree of adherence to the drugs prescribed was studied using the Simplified Medication Adherence Questionnaire.

Nephrotic syndrome as paraneoplastic manifestation of a primary pulmonary lymphoepithelioma-like carcinoma.

We present a case of nephrotic syndrome secondary to a membranous glomerulonephritis (MG), in a nonsmoking female with a solitary pulmonary nodule, which did not show growth during 2 years of followup. A biopsy by videothoracoscopy showed a granulomatous non-neoplastic process with giant multinucleated cells. The appearance of a nephrotic syndrome and its interpretation as paraneoplastic revealed the existence of a primary pulmonary lymphoepithelioma-like carcinoma (LELC), a very rare pulmonary tumor.