Motivo de "escolha" de diálise peritoneal: exaustão de acesso vascular para hemodiálise?

Abstract

Introduction:Little is known about the prognosis of patients beginnig peritoneal dialysis (PD) as their last alternative. Objectives: To describe the clinical-demographic profile of patients switching from hemodialysis (HD) to PD, due to exhaustion of the HD vascular access, and the occurrence of peritonitis among them. Methods: Review of the medical records of all patients in the PD program of the Hospital Roberto Santos in the city of Salvador, state of Bahia, Brazil. Results: The study comprised 22 patients (median age, 47.9 years), 54.5% of whom were men, 84.2%, black or mulattoes, and 68.2% originated from the inner Bahia state. Peritoneal dialysis was the initial modality of renal substitutive therapy (RST) in only four of those patients. The remaining 18 patients began RST through HD, mainly on an emergency basis and by using double-lumen catheter (DLC). In a median of 7.7 months on HD, most patients (64.7%) used four or more DLCs. In only 7/18 (39%) patients, the switch from HD to PD was based on the patient's choice; in most cases, 11/18 (61%), the reason for switching to PD was exhaustion of HD vascular access. Peritonitis was more frequent in patients switching to PD due to exhaustion of HD vascular access than in the rest of the group. Conclusions: Initiating RST on an emergency basis through HD and using DLC may lead to a fast exhaustion of vascular access, leaving PD as the only viable option. This inadequate mode of patient "selection" for PD is associated with a higher risk for peritonitis.

Avaliação do acesso vascular para hemodiálise em crianças e adolescentes: um estudo de coorte retrospectivo de 10 anos

“…Multiple temporary catheters had to be inserted in different sites, leading to stenosis of central vessels, which precluded the use of any type of vascular access, including prostheses, and even renal transplantation. This dramatic situation is a reflex of many factors: the long period the children remain on HD, the impossibility of performing peritoneal dialysis because of repeat peritonitis, an inadequate choice of the dialysis modality, 41 the incapacity of the family to face the treatment challenges, and the delay to receive a kidney graft.…”

Translation, cultural adaptation, and validation of the Screening For Occult Renal Disease (SCORED) questionnaire to Brazilian Portuguese

“…Contudo, a TRS (diálise ou transplante) é um tratamento disponibilizado comumente nas principais cidades brasileiras e, em alguns estados, o paciente necessita viajar grandes distâncias para receber o tratamento ou, pior, migrar para os centros urbanos que oferecem o tratamento. 2 Em um país com dimensões continentais como o Brasil, o diagnóstico de falência funcional renal com indicação para TRS em algumas regiões ainda é uma sentença de morte.…”

Insuficiência renal crônica no Brasil segundo enfoque de causas múltiplas de morte

“…Como a DP pode ser realizada pelo próprio paciente, a infecção pode ocorrer por meio da realização incorreta da técnica, permitindo que bactérias tenham acesso ao peritônio por meio do cateter. Nesse sentido, destaca-se a importância do treinamento do paciente 20 , de maneira que ele aprenda a técnica asséptica de manuseio do cateter para realizar as trocas de soluções de diálise 21 .…”