Muñoz-Menjivar Cristhian, Reyes-Sánchez Ivonne, Aguilar-Martínez Carolina, Rodríguez-Rodríguez Arturo, Mendoza-Gómez Jenner Leobardo, Guerrero-Soto Joseph, Lizardi-Gómez Luis Fernando, Venegas-Vera Angel Verner, Hernández-Rivera Juan Carlos H, Ramos-Sánchez Alfonso, Paniagua Ramón
Nephrology Service, Hospital de Especialidades, Centro Médico Nacional La Raza, Mexico City, Mexico,
Nephrology Service, Hospital de Especialidades, Centro Médico Nacional La Raza, Mexico City, Mexico.
Blood Purif. 2021;50(1):93-101. doi: 10.1159/000508410. Epub 2020 Jun 30.
For the majority of renal replacement therapy history, the main treatment option for patients with end-stage renal disease (ESRD) in Mexico has been peritoneal dialysis. However, the use of hemodialysis is overwhelmingly increasing, driving public health care institutions to subrogate this service. Even when the actual hiring model for subrogation is accurate, there is a lack of quality control points in the hemodialysis prescription, poor adherence to clinical practice guidelines, and a few or no record of outcomes in hemodialysis patients of these subrogated services. The objective of this work is to fill this information gap to allow for uniform and safe hemodialysis for patients of Mexico.
An observational and cross-sectional study was performed, including all patients receiving chronic hemodialysis treatment in subrogated units of Mexican Social Security Institute (IMSS) in the northern region of Mexico City. Clinical and biochemical data as well as hemodialysis dose by Kt/V and urea reduction rate were collected and evaluated. To determine distribution, mean or median and SD or interquartile range were used; for nominal variables, the difference in proportions was estimated using the χ2 test; proportions were analyzed for biochemical values using the statistical package SPSS version 25.
In our study, >60% (485) of the patients were anemic with an average hemoglobin of 9.39 mg/dL (SD ± 1.83); serum calcium was found below 8.4 mg/dL in 51.3% (383) of patients, and only in 45.8% (342) was at an optimal level of this parameter. Only 33.5% of patients have arteriovenous fistula for dialysis access. The hemodialysis dose was optimal in >75% of patients.
It is necessary to enhance and monitor treatment of comorbidities in patients with ESRD in subrogated hemodialysis units in México. We observed adequate prescription of hemodialysis in a majority of patients, achieving quality control points for removal of nitrogen products. Yet, there is a lack of quality control of comorbidities; therefore, we should aim to optimize treatment for mineral-bone disorder, anemia, and nutritional status.
在肾脏替代治疗的大部分历史中，墨西哥终末期肾病（ESRD）患者的主要治疗选择一直是腹膜透析。然而，血液透析的使用正在压倒性地增加，促使公共医疗机构替代这项服务。即使实际的替代雇佣模式是准确的，但血液透析处方中仍缺乏质量控制点，对临床实践指南的遵循性较差，并且这些替代服务的血液透析患者的结局记录很少或没有记录。这项工作的目的是填补这一信息空白，以便为墨西哥患者提供统一且安全的血液透析。
进行了一项观察性横断面研究，纳入了墨西哥城北部地区墨西哥社会保障局（IMSS）替代单位中所有接受慢性血液透析治疗的患者。收集并评估了临床和生化数据以及通过Kt/V和尿素清除率计算的血液透析剂量。为确定分布情况，使用了均值或中位数以及标准差或四分位间距；对于名义变量，使用χ2检验估计比例差异；使用统计软件包SPSS 25对生化值的比例进行分析。
在我们的研究中，超过60%（485例）的患者贫血，平均血红蛋白为9.39mg/dL（标准差±1.83）；51.3%（383例）的患者血清钙低于8.4mg/dL，只有45.8%（342例）的患者该参数处于最佳水平。只有33.5%的患者有动静脉内瘘用于透析通路。超过75%的患者血液透析剂量是最佳的。
有必要加强并监测墨西哥替代血液透析单位中ESRD患者的合并症治疗。我们观察到大多数患者的血液透析处方是合适的，达到了清除氮产物的质量控制点。然而，合并症缺乏质量控制；因此，我们应致力于优化矿物质 - 骨代谢紊乱、贫血和营养状况的治疗。
