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Transferegravencia de teacutecnica de Diagravelisi del Pacient Renal
Aventatges i Inconvenients de les Tegravecniques de Diagravelisis en el Pacient
amb Insuficiegravencia Cardiacuteaca
Diaacutelisis Peritoneal versus Hemodiaacutelisis Perioacutedica
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria Diaacutelisis peritoneal bull Paciente con IRC terminal e ICC HD vs DP bull ICC por Fallo UF en DP Transferencia a HDP bull Conclusiones
Manejo del paciente con Insuficiencia cardiaca congestiva
3 situaciones a abordar -ICC refractaria inestabilidad hemodinaacutemica -Paciente con IRC V e ICC -ICC por Fallo UF en paciente en DP
-DP vs Teacutecnica EC -HDP vs DP -DPHD
Introduccioacuten ICC
bull 1 de la poblacioacuten mayor de 40 antildeos presenta insuficiencia cardiaca (IC)10 en mayores de 70 antildeos
bull 80000 ingresos hospitalarios por insuficiencia cardiaca cada antildeo en Espantildea
bull Causa principal de hospitalizacioacuten en mayores de 65 antildeos representando un total del 5 de todos los ingresos
bull 8 de los pacientes espantildeoles con estadio III-IV de enfermedad renal croacutenica sufren un episodio de insuficiencia cardiacuteaca clase funcional III-IV de la New York Hearth Association (NYHA) tras el antildeo de seguimiento
Ronco C et al Nat Clin Pract Nephrol 20084310-1 Ronco C et al J Am Coll Cardiol 2008521527-39 Montejo JD et al Nefrologiacutea 201030(1)21-7 De Goma E et alJ Am Coll Cardiol 2006482397 Kazory A Ross E Circulation 2008117(7)975-83
bull Reduccioacuten del gasto cardiaco
bull Congestioacuten venosaaumento presioacuten intrabdominal
bull Activacioacuten neurohormonal (SNS RAA)
bull Tratamiento farmacoloacutegico
bullICC e insuficiencia renal Patogenia
Decrease anterograde perfusion of kidneys
Venous congestion
Ronco et al Cardiorenal syndrome JACC 2008 521527-39
bullPatogenia
Datos de 1860 ya mostraron un deterioro del flujo sanguiacuteneo renal filtrado glomerular Y excrecioacuten de sodio tras la oclusioacuten parcial de la vena renal
Empeoramiento de la FR y congestioacuten persistente peor pronoacutestico
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Aventatges i Inconvenients de les Tegravecniques de Diagravelisis en el Pacient
amb Insuficiegravencia Cardiacuteaca
Diaacutelisis Peritoneal versus Hemodiaacutelisis Perioacutedica
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria Diaacutelisis peritoneal bull Paciente con IRC terminal e ICC HD vs DP bull ICC por Fallo UF en DP Transferencia a HDP bull Conclusiones
Manejo del paciente con Insuficiencia cardiaca congestiva
3 situaciones a abordar -ICC refractaria inestabilidad hemodinaacutemica -Paciente con IRC V e ICC -ICC por Fallo UF en paciente en DP
-DP vs Teacutecnica EC -HDP vs DP -DPHD
Introduccioacuten ICC
bull 1 de la poblacioacuten mayor de 40 antildeos presenta insuficiencia cardiaca (IC)10 en mayores de 70 antildeos
bull 80000 ingresos hospitalarios por insuficiencia cardiaca cada antildeo en Espantildea
bull Causa principal de hospitalizacioacuten en mayores de 65 antildeos representando un total del 5 de todos los ingresos
bull 8 de los pacientes espantildeoles con estadio III-IV de enfermedad renal croacutenica sufren un episodio de insuficiencia cardiacuteaca clase funcional III-IV de la New York Hearth Association (NYHA) tras el antildeo de seguimiento
Ronco C et al Nat Clin Pract Nephrol 20084310-1 Ronco C et al J Am Coll Cardiol 2008521527-39 Montejo JD et al Nefrologiacutea 201030(1)21-7 De Goma E et alJ Am Coll Cardiol 2006482397 Kazory A Ross E Circulation 2008117(7)975-83
bull Reduccioacuten del gasto cardiaco
bull Congestioacuten venosaaumento presioacuten intrabdominal
bull Activacioacuten neurohormonal (SNS RAA)
bull Tratamiento farmacoloacutegico
bullICC e insuficiencia renal Patogenia
Decrease anterograde perfusion of kidneys
Venous congestion
Ronco et al Cardiorenal syndrome JACC 2008 521527-39
bullPatogenia
Datos de 1860 ya mostraron un deterioro del flujo sanguiacuteneo renal filtrado glomerular Y excrecioacuten de sodio tras la oclusioacuten parcial de la vena renal
Empeoramiento de la FR y congestioacuten persistente peor pronoacutestico
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria Diaacutelisis peritoneal bull Paciente con IRC terminal e ICC HD vs DP bull ICC por Fallo UF en DP Transferencia a HDP bull Conclusiones
Manejo del paciente con Insuficiencia cardiaca congestiva
3 situaciones a abordar -ICC refractaria inestabilidad hemodinaacutemica -Paciente con IRC V e ICC -ICC por Fallo UF en paciente en DP
-DP vs Teacutecnica EC -HDP vs DP -DPHD
Introduccioacuten ICC
bull 1 de la poblacioacuten mayor de 40 antildeos presenta insuficiencia cardiaca (IC)10 en mayores de 70 antildeos
bull 80000 ingresos hospitalarios por insuficiencia cardiaca cada antildeo en Espantildea
bull Causa principal de hospitalizacioacuten en mayores de 65 antildeos representando un total del 5 de todos los ingresos
bull 8 de los pacientes espantildeoles con estadio III-IV de enfermedad renal croacutenica sufren un episodio de insuficiencia cardiacuteaca clase funcional III-IV de la New York Hearth Association (NYHA) tras el antildeo de seguimiento
Ronco C et al Nat Clin Pract Nephrol 20084310-1 Ronco C et al J Am Coll Cardiol 2008521527-39 Montejo JD et al Nefrologiacutea 201030(1)21-7 De Goma E et alJ Am Coll Cardiol 2006482397 Kazory A Ross E Circulation 2008117(7)975-83
bull Reduccioacuten del gasto cardiaco
bull Congestioacuten venosaaumento presioacuten intrabdominal
bull Activacioacuten neurohormonal (SNS RAA)
bull Tratamiento farmacoloacutegico
bullICC e insuficiencia renal Patogenia
Decrease anterograde perfusion of kidneys
Venous congestion
Ronco et al Cardiorenal syndrome JACC 2008 521527-39
bullPatogenia
Datos de 1860 ya mostraron un deterioro del flujo sanguiacuteneo renal filtrado glomerular Y excrecioacuten de sodio tras la oclusioacuten parcial de la vena renal
Empeoramiento de la FR y congestioacuten persistente peor pronoacutestico
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Manejo del paciente con Insuficiencia cardiaca congestiva
3 situaciones a abordar -ICC refractaria inestabilidad hemodinaacutemica -Paciente con IRC V e ICC -ICC por Fallo UF en paciente en DP
-DP vs Teacutecnica EC -HDP vs DP -DPHD
Introduccioacuten ICC
bull 1 de la poblacioacuten mayor de 40 antildeos presenta insuficiencia cardiaca (IC)10 en mayores de 70 antildeos
bull 80000 ingresos hospitalarios por insuficiencia cardiaca cada antildeo en Espantildea
bull Causa principal de hospitalizacioacuten en mayores de 65 antildeos representando un total del 5 de todos los ingresos
bull 8 de los pacientes espantildeoles con estadio III-IV de enfermedad renal croacutenica sufren un episodio de insuficiencia cardiacuteaca clase funcional III-IV de la New York Hearth Association (NYHA) tras el antildeo de seguimiento
Ronco C et al Nat Clin Pract Nephrol 20084310-1 Ronco C et al J Am Coll Cardiol 2008521527-39 Montejo JD et al Nefrologiacutea 201030(1)21-7 De Goma E et alJ Am Coll Cardiol 2006482397 Kazory A Ross E Circulation 2008117(7)975-83
bull Reduccioacuten del gasto cardiaco
bull Congestioacuten venosaaumento presioacuten intrabdominal
bull Activacioacuten neurohormonal (SNS RAA)
bull Tratamiento farmacoloacutegico
bullICC e insuficiencia renal Patogenia
Decrease anterograde perfusion of kidneys
Venous congestion
Ronco et al Cardiorenal syndrome JACC 2008 521527-39
bullPatogenia
Datos de 1860 ya mostraron un deterioro del flujo sanguiacuteneo renal filtrado glomerular Y excrecioacuten de sodio tras la oclusioacuten parcial de la vena renal
Empeoramiento de la FR y congestioacuten persistente peor pronoacutestico
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Introduccioacuten ICC
bull 1 de la poblacioacuten mayor de 40 antildeos presenta insuficiencia cardiaca (IC)10 en mayores de 70 antildeos
bull 80000 ingresos hospitalarios por insuficiencia cardiaca cada antildeo en Espantildea
bull Causa principal de hospitalizacioacuten en mayores de 65 antildeos representando un total del 5 de todos los ingresos
bull 8 de los pacientes espantildeoles con estadio III-IV de enfermedad renal croacutenica sufren un episodio de insuficiencia cardiacuteaca clase funcional III-IV de la New York Hearth Association (NYHA) tras el antildeo de seguimiento
Ronco C et al Nat Clin Pract Nephrol 20084310-1 Ronco C et al J Am Coll Cardiol 2008521527-39 Montejo JD et al Nefrologiacutea 201030(1)21-7 De Goma E et alJ Am Coll Cardiol 2006482397 Kazory A Ross E Circulation 2008117(7)975-83
bull Reduccioacuten del gasto cardiaco
bull Congestioacuten venosaaumento presioacuten intrabdominal
bull Activacioacuten neurohormonal (SNS RAA)
bull Tratamiento farmacoloacutegico
bullICC e insuficiencia renal Patogenia
Decrease anterograde perfusion of kidneys
Venous congestion
Ronco et al Cardiorenal syndrome JACC 2008 521527-39
bullPatogenia
Datos de 1860 ya mostraron un deterioro del flujo sanguiacuteneo renal filtrado glomerular Y excrecioacuten de sodio tras la oclusioacuten parcial de la vena renal
Empeoramiento de la FR y congestioacuten persistente peor pronoacutestico
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
bull Reduccioacuten del gasto cardiaco
bull Congestioacuten venosaaumento presioacuten intrabdominal
bull Activacioacuten neurohormonal (SNS RAA)
bull Tratamiento farmacoloacutegico
bullICC e insuficiencia renal Patogenia
Decrease anterograde perfusion of kidneys
Venous congestion
Ronco et al Cardiorenal syndrome JACC 2008 521527-39
bullPatogenia
Datos de 1860 ya mostraron un deterioro del flujo sanguiacuteneo renal filtrado glomerular Y excrecioacuten de sodio tras la oclusioacuten parcial de la vena renal
Empeoramiento de la FR y congestioacuten persistente peor pronoacutestico
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
bullPatogenia
Datos de 1860 ya mostraron un deterioro del flujo sanguiacuteneo renal filtrado glomerular Y excrecioacuten de sodio tras la oclusioacuten parcial de la vena renal
Empeoramiento de la FR y congestioacuten persistente peor pronoacutestico
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Empeoramiento de la FR y congestioacuten persistente peor pronoacutestico
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Diureacuteticos ESCAPE Predictor de Mortalidad Dosis Dependiente
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Tratamiento ICC refractaria TRS UF
bull En casos refractarios son de gran intereacutes las teacutecnicas de ultrafiltracioacuten
bull El papel de la ultrafiltracioacuten complementaria (DP o extracorpoacuterea) estaacute destinada a los pacientes afectos de siacutendrome cardiorrenal tipo 2 resistente a diureacuteticos
bull Las terapias continuas de reemplazo renal como la hemofiltracioacuten venovenosa continua o UF se han utilizado para resolver situaciones agudas de sobrecarga de volumen en pacientes oliguacutericos
Kagan A Rapoport J Nephrol Dial Transplant 2005 2028-31 Khalifeh N et al Kidney Int Suppl 2006(103)S72-5 Diacuteez Ojea B et al Perit Dial Int 200929116-8 Saacutenchez JE et al Nephrol Dial Transplant 201025605-10
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Since this is a chronic conditionhellip Why not to consider a chronic ultrafiltration modality
Ultrafiltration
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Evidencia UF en IC
peso
reingresos
Peso y creat
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
CARRESS End Point Primario Cambio de peso y creatinina a las 96h
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
bull La descongestioacuten es una diana terapeacuteutica clave en IC con valor pronoacutestico
bull Las alternativas actuales no tienen soacutelida evidencia bull Los resultados continuacutean siendo inaceptablemente
malos bull Necesidad de explorar nuevas alternativas
Tratamiento ICC refractaria UF
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Rev Clin Esp 1975 May 15137(3)247-52
[Treatment of cardiac failure refractary to conventional therapy using peritoneal dialysis]
Alarcoacuten Zurita A Torre Carballada MA Martiacuten Jadraque L Rivero Sanchez M Montero Garciacutea A Sanz Guajardo A Sanchez Sicilia L
PMID 1144854 [PubMed - indexed for MEDLINE]
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Tratamiento de la DP en pacientes con insuficiencia cardiaca severa puede llevar a impresionantes mejoras a corto plazo en diuresis residual
Tratamiento ICC refractaria TRS DP
Brown EA Johansson L Nephron Clin Pract 2011 119 Ruhi Ccedil A et al Int Urol Nephrol 2012 Prochnicka A et al Kardiol Pol 2013 71 393 -395 Ishimoto Y Mise N Tanaka M et al Perit Dial Int 2013 33 582 -583
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Evolution of NYHA functional class in the first line are reported the NYHA functional status of the patients before PD treatment in the second one the NYHA functional status of the patients after PD treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
bull dibujo
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Eleccioacuten controvertida DP 1 preserva FRR 2 UF continua 3 Ausencia FAVi 4 Mejoriacutea paraacutemetros IFM
HD 1 Mejor control Navolumen 2 Mejor perfil lipiacutedico
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Variables asociadas con mayor riesgo M
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Comparacioacuten riesgo de desarrollar CVD seguacuten la modalidad de Diaacutelisis
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
bull DP ventaja supervivencia en los dos primeros antildeos bull Aumento riesgo mortalidad en DP en ancianos y alta
comorbilidad bull Mayor riesgo cardiovascular en HDP por ganancia fluido
intradiaacutelisis trastorno HDN mayor y circulacioacuten hiperdinaacutemica (UF raacutepida+FAVi)
bull DP menor riesgo CV 1) HDN y 2)preservacioacuten DRR
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
bull Estudio reciente bull Modelo con 45000 pacientes bull Mutivariados modelos ajustados y anaacutelisis de
propensioacuten bull Limitacionesbmi fumadorhellipno se recogioacute bull Hb albuacutemina tampoco ni FRR ni ktv
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Abstract Background The purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) Methods From a Taiwanese universal insurance claims database we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010 Using the propensity score matching method we included 6516 patients in HD and PD groups respectively All patients were followed up until the end of 2011 The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease and congestive heart failure (CHF) Results No difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD adjusted hazard ratio [HR] 103 95 confidence interval [CI] 086ndash122) However HD was associated with a higher risk of de novo CHF (adjusted HR 129 95 CI 113ndash147) than PD was The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients compared to PD patients Conclusions No difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients However HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Iacutendice
bull Introduccioacuten bull Tratamiento ICC refractaria TRS Teacutecnicas
extracorpoacutereas bull Tratamiento ICC refractaria TRS Diaacutelisis
peritoneal bull Paciente con IRC estadiacuteo V e ICC HD vs DP bull Fallo UF Transferencia a HDP bull Conclusiones
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal
Conclusiones
bullTratamiento ICC refractaria TRS Teacutecnicas extracorpoacutereas Estudios negativos bullTratamiento ICC refractaria TRS Diaacutelisis peritoneal En pacientes con insuficiencia cardiaca congestiva avanzada y disfuncioacuten renal concomitante la diaacutelisis peritoneal podriacutea asociarse con una mejoriacutea a largo plazo en los resultados cliacutenicos bullPaciente con IRC estadiacuteo V e ICC HD vs DP Resultados controvertidos bullFallo UF Transferencia a HDP Soluciones biocompatibles amp valorar descanso peritoneal