Análisis de la retirada del catéter peritoneal después del trasplante renal en población adulta

Introducción: Las personas con enfermedad renal crónica dializadas demandan mayor cuidado por el manejo complejo de su condición, las múltiples complicaciones asociadas al tratamiento y la necesidad de asumir estilos de vida saludables, para garantizar la efectividad y seguridad de las terapias. Objetivos: Determinar la competencia para el autocuidado de las personas en diálisis, así como su relación con las características sociodemográficas y clínicas. Metodología: Se realizó un estudio observacional descriptivo de corte transversal, en una unidad renal del sur de Colombia. Instrumentos utilizados: Encuesta de caracterización para el cuidado de la persona con enfermedad crónica, Formulario de características clínicas y Cuestionario de Competencia para el cuidado versión-paciente. Resultados: Se incluyeron un total de 200 personas dializadas, con una edad media de 59±13,89 años, el 50,5% mujeres, con pareja estable, apoyo para su cuidado, grado educativo primario, dedicados a labores del hogar, y nivel socioeconómico bajo. El 47,5% evidenció alta competencia para su autocuidado, el 42% una competencia media y el 10,5% baja. Se identificaron asociaciones estadísticamente significativas de la competencia para el autocuidado con las variables asistencia puntual a terapia (p=0,024) y adherencia farmacológica (p=0,001). Conclusiones: La población abordada se caracterizó por vivir en condiciones socioeconómicas que aumentan la vulnerabilidad de la persona dializada, en su mayoría contó con soporte para el cuidado, presentó nivel de competencia para el autocuidado entre alto y medio, relacionado con asistencia puntual a terapia y cumplimiento en adherencia farmacológica.

A Retrospective Survey of Attitudes toward Acceptance of Peritoneal Dialysis in Chinese End-Stage Renal Failure Patients in Hong Kong—From a Cultural Point of View

Objective

We undertook to study the attitudes toward dialysis of patients approaching end-stage renal failure and to analyze those attitudes from a cultural perspective.

Setting

The study was performed in the pre-dialysis clinic of a tertiary referral renal center.

Patients

All patients of Chinese ethnic origin seen in the pre-dialysis clinic from 1995 to 2000 for assessment of dialysis therapy were included.

Method

We performed a retrospective analysis of patient records with regard to attitudes of the patients toward dialysis, reasons for those attitudes, and factors that could lead to a subsequent change in attitude.

Results

We assessed 462 patients over the 6-year period. Their mean age was 65.5 ± 13.3 years, and 43.9% of the patients had diabetes. Peritoneal dialysis (PD) was offered to 74% of the patients, and hemodialysis (HD) to 3.9%. Among the patients offered PD, only 44% accepted dialysis. After counselling, 54% of the patients who originally declined PD ultimately accepted it. The major reasons for refusing PD were the ideas of “having lived long enough” and “lack of family support.” Most other reasons could be overcome by counselling. Only a minority of patients demanded hemodialysis.

Conclusions

Declining an offer of dialysis was common. Counselling helped patients to accept PD. Certain cultural elements that hindered acceptance of dialysis were involved in the ideas of “having lived long enough” and “lack of family support.” Those cultural elements should be tackled more specifically during counselling.

Technical Aspects in Studying Peritoneal Morphology in Animal Models of Peritoneal Dialysis

Objective

Peritoneal biopsies are considered useful for gaining a better understanding of the pathophysiology of the peritoneum during experimental peritoneal dialysis (PD). Different peritoneal tissue samples (i.e., abdominal wall, liver, diaphragm, intestine, and omentum) may be used, but there can be artifacts due to peritoneal tissue processing.

Aim

To investigate differences in peritoneal membranes from different parts of the peritoneum, and also 2 different fixatives, in experimental PD and a peritonitis model in rats.

Methods

Peritoneal tissues from the anterior abdominal wall, liver, omentum, and intestine were taken from each of 3 groups of animals: sham, experimental PD, and peritonitis model. Tissue samples were immediately fixed with 4% formaldehyde and routinely processed for histological examination. Two parietal peritoneal tissue samples according to longitudinal and horizontal sections of anterior wall inner abdominal muscle were also taken. All samples were immediately fixed with 4% formaldehyde and B5 fixative (B5), and then routinely processed for histological examination.

Results

In all groups, histopathological findings were more commonly seen in the abdominal wall samples. There were no changes observed in peritoneal membranes other than those of anterior abdominal wall samples from both sham and PD model rats. However, there was a significant difference between anterior and posterior facets of liver in the peritonitis model. Furthermore, the antimesenteric site of intestinal peritoneum was less affected than the mesenteric site. There were no significant histopathological differences between B5 and 4% formaldehyde fixation ( p > 0.05).

Conclusion

Our results suggest that peritoneum obtained from the anterior abdominal wall is the most affected area and therefore the most suitable site to investigate peritoneal changes in the experimental rat PD model. There were no significant differences between fixation with 4% formaldehyde and B5 solution. Abdominal wall samples should be of the same direction of inner abdominal muscle, that is, horizontal sectioning should be used for measurements of the submesothelial area.