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Biomedical subjects

F Alvarez-Ude

Publications and source records attributed to F Alvarez-Ude.

At least 19 recordsLinked to original sources
PubMed2006

[Quality control systems implementation in the Spanish Dialysis Units].

OBJECTIVE: The aim of this study was to evaluate and analyze the implementation of a Quality Management Systems (QMS) and the use of Clinical Performance measures by the Nephrology Services and Hemodialysis Units in Spain. METHOD: The Quality Management Work Group of the Spanish Society of Nephrology (SEN) realized a survey that was directed to all the Spanish Nephrology Services and Hemodialysis Units. No exclusion criteria were defined for the study. The survey was based on a multichotomous self completing "Ad Hoc" questionnaire. RESULTS: The survey was answered by 46.7% of the polled centers (44.5% were public hospitals and 55.5% private centers). Of those replying the survey 70 % had a QMS, with a higher implementation in the area of Hemodialysis (HD). The ISO 9001-2000 was the prefer QMS model chosen by 76.4% of the centers. 68.6% of the centers with a QMS were certified by an external Auditing Group. 91.7% of the Nephrology Services and Hemodialysis units were using some clinical practice guideline. A high percentage of the centers had medical protocols and nursing plans (> 90%). A significantly higher implementation of QMS was observed in Private Hospitals and Hemodialysis Units (88.8 %) when compared to public Hospitals (46.1%) (X2: 31.5; p < 0.001). The ISO 9000 Standard certification was selected by 78,3% of the private centers and by 21,7% of the public centers (X2: 37.3; p < 0.001). The certification or accreditation were done by an external auditing group in 68. 1% of the private centers compared to 31.9% for the public Hospitals (X2: 24.8; p < 0.001). Although the rate of answers prevents from extracting definitive conclusions, the result seems to indicate that in the Spanish Nephrology Community a clear trend exists towards the use QMS. This tendency suggests, that in the near future, there will be a progressive implementation and routine use of QMS in the Nephrology Community in Spain.

Hemodialysis Units, Hospital↗
PubMed2006

[Functional dependency evaluation of hemodialysis patients: a multicentric study].

BACKGROUND: There has been a change in the hemodialysis population characteristics over the last years with a progressive increase in patient,s age and associated comorbility and mortality. This older hemodialysis population are more functionally and medically dependent increasing the time taken to perform nursing work. The objective of this study was to evaluate the degree of functional dependency on hemodialysis patients and the need of care by nursing workload. METHODS: A transversal descriptive study was done during 1 month (april 2005) on 586 patients from 10 HD Units in Spain. No exclusion criteria were used. The Delta Test, who was used to evaluate the patients dependency needs, is a workload measure instrument base on three subscales: dependency, Physical Deficiency and mental deficiency. The indicators are measure on a scale of one to three with each level representing an increasing demand on nursing time. The results obtained from the Delta Test were analyzed taking into account the following variables: age, average time in dialysis, Charlson comorbidity Index, geographic location and HD unit. RESULTS: 46% of the patients show some degree of dependency, of these 12.8% were moderated and 8.1% severe; the subscale analysis showed that 19.6% and 6.7% had, respectively, a moderate to severe physical and mental health deficiency. The dependency degree varied significantly between HD Units and geographic location with a range of 0% to 59.8%. The degree of dependency were statistically associated with age and CCI. The higher CCI (r: 0,21; p < 0.001) and age (r: 0,26; p < 0.001) the higher was the Delta Test Score for dependency level. Patients times of initiation on dialysis were not associated with an increase in the degree of dependency. The aspects evaluated by the Delta Test that showed a higher score were those related to patients mobility. The patients assistance requirements during the HD session are basically related to a lack of mobility due to musculoskeletal disease and to a lesser extent to behavior alterations. CONCLUSIONS: HD units are attending patients with an important degree of dependency which impose and added workload to the healthcare personnel. In occasions, it is very difficult to attend and give proper care with the current legally established nurse to patient ratio which. This suggests the need to implement a better staffing policy. The Delta Test provides an objective, adaptable and standardized instrument for measuring degree of dependency of HD patients.

Activities of Daily Living↗
PubMed2004

[Impact of a quality program in hemodialysis].

UNLABELLED: One of the requirements of a health care quality management system is to be able to established clinical performance measures (CPM) for its key organisation processes. We described some of the performance measurement that has been used in our hemodialysis unit, since the implementation in the year 2001, of a Quality Management System (QMS). We analyze and compare the effect that the introduction of a ISO 9002 based QMS had in our CPM during the period 2001-2002 (post QMS) vs. the two previous years -1999-2000- (pre QMS). METHODS: We defined several CPM for assessment of hemodialysis adequacy and medical management that covered : Anemia, iron status renal osteodystrophy, hemodialysis prescription and nutritional status , follow up of the established guidelines for vascular access care and prevention of nosocomial infections water quality and general performance outcome like annual crude mortality rate and hospitalization (express as hospital days/patient year). RESULTS: No significant difference was found between both periods regarding annual crude mortality( pre QMS 8.37% vs post QMS 8.95%) or the hospitalization rate ( pre 0.47 patient-days vs. post 0.52 patient-days) . There was a significant difference after implementation of the quality system in the average hemoglobin levels (pre 11.3 +/- 1.5 vs. post 11.9+ +/- .5 p <0,001). Ferritin levels (pre 220 +/- 162 vs. post 313 +/- 373 p<0.01), albumin levels (pre 3.61 +/- 0.46 vs. post 3.82 +/- 0.56 p<0.001) and KTV>1.2 (pre 1.41 +/- 0.26 vs. post 1.50 +/- 0.33 p<0.001). The transferring saturation index (TSI) was unchanged (pre 27.98 +/- 14.39 vs.. post 29.4 +/- 16.66 p=0.11). There was a significant decrease in the average PTH levels (pre 234.9 +/- 285 vs. post 174 +/- 174 p< 0.0001) PTH>300 pg/ml (pre 23.7% vs. post 16.4% p<0.001) calcium levels (pre 10.02 +/- 0.99 vs. 9.83 +/- 0.88 p<0.001), phosphorus (pre 5.50 +/- 1.55 vs. post 5.01 +/- 1.47 p<0.001) as well as serum calcium levels >11 mg/dl (pre 14.6% vs. post 11% p<0.001) and phosphorus >6 g/dl (pre 34% post 21.5% p<0.001). Although the average serum potassium levels decrease (pre 5.51 +/- 0.85 vs. post 5.40 +/- 0.87), the percentage of patients with potassium over 6.5 meq/l was similar in both periods (pre 11.5% vs. post 10. 1%). The number of native A-V vascular access was similar in both periods and above the current DOQI Recommendations. Nevertheless, there was a gradual decrease in native A-V fistula, associated with an increase on the use of permanent catheters. The number of incident patients with a permanent catheter as the only vascular access for hemodialysis increased from 0% in the year 1999, 2000 and 2001 to 6.98% in 2002. There was no hepatitis B and C seroconversión detected in both periods. CONCLUSION: From our study we concluded that regular follow-up of quality performance measurement associated with an ongoing corrective action, promotes an improvement of the outcome measures results.

Blood Chemical Analysis↗
PubMed2002

[Acute interstitial nephritis caused by clozapine].

We are reporting a case of a 69 years old man developed acute renal failure due to interstitial nephritis during treatment with the drug clozapine, and that improve after to discontinuation of this drug. The clozapine is a new antipsychotic drug that may produce severes adverses reactions, like medullary toxicity. Recently 10 cases of clozapine-induced AIN have been reported. We want to associate to the cases publicated with a new case because it is a severe adverse reaction.

Aged↗
PubMed2002

[Minimal-change disease with mesangial IgA deposits associated with Sjogren syndrome].

Sjögren's syndrome may be accompanied by a dysregulation of IgA system implying the presence of increased serum polymeric IgA or circulating immune complexes and their consequent deposition within the kidney. In this context IgA nephropathy may only represent one of the complications brought by IgA deposition. Glomerular involvement and primary Sjögren's syndrome has been described previously only in isolated case reports, membranous nephropathy and membranoproliferative glomerulonephritis have been reported. We have not found any case of minimal change disease and glomerular IgA deposition associated with Sjögren's syndrome. In this patient nephrotic syndrome was related to serum increase of CA 19-9; this association has been reported in only three previous cases.

Adrenal Cortex Hormones↗
PubMed2001

Is the loss of health-related quality of life during renal replacement therapy lower in elderly patients than in younger patients?

BACKGROUND: Previous studies have reported that elderly (aged 65 years or over) end-stage renal disease (ESRD) patients have poorer health-related quality of life (HRQOL) than both younger patients and healthy subjects of the same age. The aim of present study was to evaluate the effect of ESRD and its treatment on the HRQOL, and to determine the effects of age and gender. METHODS: A cross-sectional multicentric study was carried out with 485 haemodialysis and renal-transplant patients, using the SF-36 Health Survey to evaluate their HRQOL. SF-36 scores were standardized by age and gender using Spanish normative data. Karnofsky scale score (KS), socio-demographic, and clinical data were also collected. RESULTS: In renal-replacement therapy (RRT), chronic haemodialysis, and renal-transplant patients, SF-36 standardized scores of elderly patients were higher than in younger patients. Therefore the reduction in HRQOL of elderly patients, in relationship with that of the general population of the same age and gender, was lower than in younger patients. In the case of renal-transplant patients, standardized scores in elderly patients were higher than in the general population for all parameters. CONCLUSIONS: Using standardized scores, elderly patients on renal replacement therapy (haemodialysis and kidney transplant) had relatively better HRQOL than younger patients, and in the case of transplant patients, they had even better HRQOL than in the general population of the same age and gender.

Adult↗
PubMed2000

Health related quality of life (HRQOL) of kidney transplanted patients: variables that influence it.

UNLABELLED: The incidence and prevalence of patients on renal replacement therapy (RRT) who receive a renal transplant are continuously increasing in Spain. At the moment, they are the main group of end-stage renal disease (ESRD) patients in our region (60% of total RRT patients). The aim of the present study was to assess the health related quality of life (HRQOL) of kidney transplanted patients of our region, and to identify socio-demographic and clinical variables that influence it. The intention was also to compare the HRQOL of these patients with that of chronic haemodialysis (HD) patients and of the general population. METHODS: Two hundred and ten kidney transplanted patients and 170 HD patients were evaluated using the Karnofsky performance scale (KPS), sickness impact profile (SIP), and SF-36 Health Survey (SF-36). Socio-demographic and clinical data, including a comorbidity index (CI), were also collected. To compare our patients with the general population we used SF-36 mean scores from an aleatory sample taken from our region. RESULTS: Transplant patients had lower mean scores on SIP dimensions and higher scores on SF-36 dimensions than chronic HD patients. In transplant patients, we found significant differences on SIP and SF-36 scores in gender, educational level, haematocrite and haemoglobin, CI, time since transplantation, and KPS. CONCLUSIONS: The HRQOL of transplant patients is clearly better than that of chronic HD patients and similar to that of the general population. Differences in the HRQOL within transplant patients did not appear to be as a result of patient's age, but rather it would appear to be a consequence of gender, analytic figures, CI, KPS score, time with transplant, and educational level.

Adult↗
PubMed1998

Health-related quality of life (HRQOL) in end stage renal disease (ESRD) patients over 65 years.

OBJECTIVES: The aim of the study was to assess Health Related Quality of Life (HRQOL) of elderly patients on renal replacement therapy (RRT) of our region, and to identify socio-demographic and clinical variables which influence it. We also attempted to compare HRQOL of transplant patients, with that of chronic hemodialysis patients. DESIGN: Cross-sectional study. SETTING: Institutional Hospital Nephrology Unit. PATIENTS: All patients from 9 of the 10 hemodialysis centres in our region, aged 65 years or more, who had been on RRT (chronic hemodialysis and kidney transplantation) for at least three months, showing no cognitive problems, were included. The sample included 124 patients. INTERVENTIONS: These patients participated in a structured interview using two generic HRQOL questionnaires: Sickness Impact Profile and SF-36 Health Survey. Karnofsky Scale, Comorbidity Index, socio-demographic and clinical data, were also collected. RESULTS: The median age was 71 years (range 65-75); 55.6% of the patients were male; 19.8% of the sample were transplant patients and 80.2%, hemodialysis patients (only 2% on renal transplant waiting list); 69.2% had a low-intermediate socio-economic level, 52.9% had elementary studies, and 10.6% lived alone. Transplant patients had higher HRQOL than hemodialysis patients. Women had lower HRQOL than men. A higher economic level, higher educational level, higher Karnofsky Performance Scale, and lower Comorbidity Index score, were associated with higher HRQOL. CONCLUSIONS: The good HRQOL of elderly transplant patients, in comparison with hemodialysis patients, is an important reason for advising kidney transplants in elderly patients. Economic and educational levels, functional status and comorbidity are variables which influence the HRQOL of these patients.

Aged↗
PubMed1992

Adequacy of peritoneal dialysis: does kt/v have the same predictive value as in HD? A multicenter study.

Urea kinetics and the use of KT/V has become a useful tool for assessing adequacy of small solute removal in HD. Clinical data supporting the benefit of urea kinetic analysis in CAPD patients had been lacking. Using the standards of KT/V for hemodialysis, many CAPD patients would be underdialyzed but, most studies show no significant difference in morbidity or mortality between CAPD and HD patients. We studied retrospectively, 102 patients (48 M, 54 F), aged 54.6 +/- 14.8 (range 14-82), on CAPD 24.4 +/- 23.9 months (0-120) from 6 hospitals. Clinical and biochemical parameters, co-morbidity, mortality, and hospital admission rate were registered. During the follow-up (1 year), a significant decrease of residual renal function (Kr) from 1.74 +/- 1.86 to 1.31 +/- 1.67 (p < 0.01) was noticed. The KT/V also decreased from 2.00 +/- 0.47 to 1.89 +/- 0.36 (p < 0.01) without change in BUN or plasma creatinine levels. The normalized protein catabolic rate (NPCR) decreased from 0.98 +/- 0.28 to 0.93 +/- 0.30 (p < 0.05) and serum albumin from 3.7 +/- 0.5 to 3.5 +/- 0.6 (p < 0.001). There was a positive correlation between NPCR and KT/V (r = 0.44, p < 0.05) and between NPCR with serum BUN (r = 0.27, p < 0.05). There was no correlation between KT/V and NPCR neither with hospitalization rate nor clinical symptoms index. The latter, however, showed a positive correlation with the co-morbidity index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

Function of the hypothalamo-hypophysial-thyroid axis in chronic renal failure.

Hypothalamo-hypophysial-thyroid function has been studied in twenty-five patients with chronic renal failure. Eight were receiving conservative treatment, nine peritoneal dialysis and eight haemodialysis. All were clinically euthyroid. Total thyroxine (T4) and triiodothyronine (T3) levels were reduced but free T4 levels were normal, while free T3 was reduced in patients with the most severe renal failure. It is suggested that the binding of thyroid hormones by the transport proteins is reduced and that peripheral conversion of T4 to T3 is impaired in renal failure. The thyrotrophin response to thyrotrophin-releasing hormone (TRH) is reduced in renal failure but this reduction is probably independent of alterations in thyroid hormone metabolism. Growth hormone was released by TRH in seven of the patients studied, possibly as a result of protein malnutrition.

Adolescent↗
PubMed1978

Determination of serum ionised calcium by ion-exchange electrode in normal subjects.

Serum ionised calcium concentration [Ca2+] was measured with a calcium selective electrode in 65 normal people. A mean value of 1.06 mmol/l (+/- 0.04 S.D.) with an actual range of 0.97 to 1.13 mmol/l was obtained. Serum samples refrigerated at 4 degrees C for 24 h were satisfactory for analysis. Storage of whole blood samples for 6 h at room temperature before separation caused a very small error (+0.04 mmol/l). Mean results and ranges were similar in males and females and there was no significant correlation with age. No significant change in serum [Ca2+] was found following a normal meal. Serum [Ca2+] and total serum calcium showed a very slight correlation (r = 0.35). The method is reproducible and sensitive.

Age Factors↗
PubMed1978

Hemodialysis bone disease: correlation between clinical, histologic, and other findings.

This paper explores in patients with dialysis osteodystrophy the relationship between clinical features and histological, radiological, and biochemical findings. Eighty-five patients treated by hemodialysis for more than 6 months were studied. The following conclusions were drawn: 1) Bone pain in patients on regular hemodialysis is usually a symptom of developing osteomalacia but not of hyperparathyroidism or osteoporosis. 2) Many patients with histological osteomalacia and radiological features of osteomalacia, such as fractures or Looser zones, have no symptoms. 3)In dialysis patients, biochemical and radiological abnormalities are not a reliable means of predicting the presence of osteomalacia, but a raised serum alkaline phosphatase is a good indicator of the presence of osteitis fibrosa. For early detection of osteomalacia, bone biopsy in necessary. 4)A number of our dialysis patients develop an unusual form of osteomalacia characterized by absent or minimal histological osteitis fibrosa, a normal serum alkaline phosphatase, and a high incidence of myopathy and fractures.

Adolescent↗