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Jose A Diaz-Buxo

Publications and source records attributed to Jose A Diaz-Buxo.

At least 19 recordsLinked to original sources
PubMed2006

Major difficulties the US nephrologist faces in providing adequate dialysis.

AIM: To identify the major difficulties nephrologists in the US face in providing adequate dialysis. METHODS: To identify the perceived obstacles to achieving adequate dialysis in the US, 30 clinical support specialists responsible for nursing education and training were polled. Their responses together with those found in the recent literature were summarized and analyzed. RESULTS: The obstacles identified fell into the following major categories: (1) economic; (2) personnel shortage; (3) education, and (4) cultural. The principal specific difficulties identified in providing adequate dialysis were the provision of sufficient time and frequency of dialysis, adequate volume control and vascular and peritoneal access. CONCLUSIONS: The obstacles we currently face are serious but can be conquered through better understanding of the problems and education of professionals, patients and payers. The simple improvement in two specific areas, the creation of more native arteriovenous fistulae and growth of home dialysis, are identified as the highest priorities to overcome these obstacles.

Health Care Surveys↗
PubMed2006

Standard Kt/V: comparison of calculation methods.

Standard Kt/V (stdKt/V) makes possible the comparison of the dialytic efficiency of different therapies, with different frequencies, whether intermittent, continuous or a mixture of both. To determine stdKt/V, the clearance of urea, a function of urea generation and blood concentration, is calculated over a period of one week and is normalized to total body water. For continuous processes, clearance per se is used. For intermittent therapy, two different equations have been developed by Gotch and by Leypoldt. Both equations allow the calculation of stdKt/V from the single-pool Kt/V (spKt/V). Gotch's method requires spKt/V and six other variables. Leypoldt's equation is simpler and limited to spKt/V plus two variables. The present study compared the nomograms created from both equations to determine their equivalence. The nomograms were superimposed for comparison. It also compared the stdKt/V obtained from random simulated patients with each method and the theoretic efficiency of continuous and intermittent clearances. The graphic comparison of the numeric values obtained appeared very similar in both methods, suggesting that either can be useful in clinical practice. A significant theoretic advantage was noted for continuous therapies over intermittent modalities. These results further support the use of frequent, daily, and continuous renal replacement therapies.

Blood Urea Nitrogen↗
PubMed2006

Protecting the endothelium: a new focus for management of chronic kidney disease.

It is being increasingly recognized that cardiovascular disease (CVD) and its complications are the most important cause of morbidity and mortality in patients with chronic kidney disease (CKD) and dialysis patients. If outcomes for these patients are to be improved, therapeutic strategies at all stages of CKD will have to target the etiologies and mechanisms that lead to CVD. In this review, we focus on the central role of endothelial dysfunction as the critical precursor of CVD. We argue that a better understanding of endothelial dysfunction by nephrologists and dialysis physicians is necessary if there is to be success in limiting the CVD epidemic that kills and maims our patients. The extensive studies to explain the high prevalence of vascular disease in patients with CKD have shown the close relationship among endothelial dysfunction, inflammation, and atherosclerosis. The pathogenesis starts with endothelial cell injury from any of many possible causes, and strategies to reduce the burden of CVD in uremic and dialysis patients must be directed at restoring normal endothelial function or, at the least, preventing aggravation of endothelial damage. At the center of the exploration of endothelial dysfunction and atherosclerosis are oxidative stress and inflammation. Of these, which is the chicken and which is the egg is unknown, but in the setting of uremia, endothelial injury because of free radical, oxidative stress is likely to precede inflammation. The issues raised here are highly complex and most renal practitioners may not have been adequately exposed to the background research underlying current thinking of the pathogenesis of vascular disease. Clearly, progress in management of CVD in patients with CKD will require collaboration with experts in the research and treatment of vascular disease. Nephrologists seeking optimum outcomes for patients with CKD will need to become "endotheliologists" or, at the least, subscribe to a mission "to protect the endothelium."

Atherosclerosis↗
PubMed2006

Establishing a successful home dialysis program.

The renewed interest in home dialysis therapies makes it pertinent to address the essentials of establishing and running a successful home dialysis program. The success of a home program depends on a clear understanding of the structure of the home program team, the physical plant, educational tool requirements, reimbursement sources and a business plan. A good command of the technical and economic aspects is important, but the primary drivers for the creation and growth of a home dialysis program are the confidence and commitment of the nephrological team.

Direct Service Costs↗
PubMed2006

Clinical use of and experience with neutral-pH solutions.

New peritoneal dialysis solutions with neutral pH and lactate bicarbonate, or combinations of both buffer bases, have been clinically tested in various countries. The experience is most encouraging and consistent with the laboratory data generated in animals and tissue cultures. The available studies suggest improvement in cellular function and viability and better biocompatibility. However the reported studies do not define the specific contributions of neutral pH per se versus those of bicarbonate or reduction in glucose degradation products. Studies designed to address this important question are required.

Bicarbonates↗
PubMed2005

Beyond thrice-weekly hemodialysis.

The frequency, length, and dose of hemodialysis (HD) have empirically evolved during the past four decades. The relationships among these variables and their influence on clinical outcomes are complex. Despite the lack of controlled studies and the selection bias inherent to cohorts studied with enhanced or intensified HD prescriptions, this review explores the impact of frequency, length, and dose of HD on clinical outcomes. The experiences with frequent HD make a formidable case for frequent therapies. The data show that quotidian regimens are associated with the best biochemical profiles, volume and hypertension control, and nutritional status, but do not provide the evidence for superior survival when compared to long nocturnal thrice-weekly or every-other-day conventional HD. The correlation between frequency and clinical outcomes seems evident, but not likely to be linear. Perhaps the greatest benefits are achieved from the simple avoidance of 48 hr without dialysis. Considering the additional cost and patient involvement with daily dialysis compared to every-other-day dialysis, it is logical to include the latter in future controlled studies on the benefits of frequent HD.

Humans↗
PubMed2005

Access and continuous flow peritoneal dialysis.

Continuous flow peritoneal dialysis (CFPD) presents many potential advantages over any conventional peritoneal dialysis modality. Foremost are the impressive clearances achieved by CFPD in clinical studies, approaching those of quotidian hemodialysis. The principal limitation of CFPD is its inability to provide adequate and consistent ultrafiltration in clinical practice, contrary to the high ultrafiltration predicted by theoretical models. There is a good possibility that this discrepancy is due to poor mixing, streaming, and recirculation of dialysate related to inadequate peritoneal access. Novel access designs are encouraging but await longitudinal clinical testing to prove their superiority.

Equipment Design↗
PubMed2005

Impact of peritoneal dialysis technology on patient care.

Technologic advances in peritoneal dialysis (PD) have a significant impact on patient care. Here, we review recent technology with special emphasis on connectology, equipment, PD solutions, new modalities, patient management programs, and pharmaceuticals proposed for membrane preservation. Some of these advances and practices are in their early experimental stages (for example, continuous-flow PD) and others are limited to a few geographic areas (for example, biocompatible PD solutions). Thus, the impact on PD growth and patient care varies from country to country.

Hemodialysis Solutions↗
PubMed2005

Bicarbonate solutions: update.

The use of lactate-based peritoneal dialysis solutions (PDFs) requires hepatic metabolism to convert lactate to bicarbonate. Pure bicarbonate solutions are particularly useful in the setting of hepatic dysfunction and whenever a high risk of lactate accumulation in the blood exists. This article reviews the recent literature related to laboratory findings and clinical experiences with bicarbonate-containing PDFs. The data suggest that bicarbonate-based solutions are safe and well tolerated and that, among patients with severe metabolic acidosis, they provide better correction of that acidosis than do lactate-containing PDFs. In addition, use of bicarbonate solution seems to be associated with improved nutrition, better growth rate in children with end-stage renal disease, better preservation of residual renal function, and, possibly, higher peritoneal ultrafiltration and a lower peritonitis rate. More experience with these solutions and more prospective controlled studies should be encouraged to further characterize the potential benefits of bicarbonate solutions.

Acidosis↗
PubMed2004

Continuous-flow peritoneal dialysis: update.

The theoretical constructs of and limited clinical experiments with, continuous flow peritoneal dialysis (CFPD) are very promising. Specifically, removal of small molecular solutes has been shown to approximate that with quotidian hemodialysis. However progress has been slow because of the lack of an adequate peritoneal access device and the high cost of peritoneal dialysis (PD) solution generation. Several novel designs for CFPD catheters have been introduced during the past year. Those designs may solve some of the problems of fluid mixing and recirculation. This review of the past and latest developments in CFPD identifies the factors that limit the widespread use of this promising therapy.

Catheters, Indwelling↗
PubMed2004

Maximizing biocompatibility: what is on the horizon?

The development of biocompatible peritoneal dialysis fluids (PDFs) is one of the most significant improvements in the field. The evolution of PDFs can be divided into three phases: (1) identification of the problems; (2) basic laboratory studies and formulation of alternative solutions; and (3) clinical testing of the new alternatives. A summary of representative work for each of these phases, together with insights into future developments, is provided.

Biocompatible Materials↗
PubMed2002

Streaming, mixing, and recirculation: role of the peritoneal access in continuous flow peritoneal dialysis (clinical considerations).

Continuous flow peritoneal dialysis (CFPD) is a very promising modality of PD in terms of high rates of solute removal and ultrafiltration (UF). The published clinical data are characterized by marked variability in terms of clearances and UF. Analysis of those data suggest significant streaming and recirculation with the available double-lumen catheters. A new double lumen catheter is described. It has wide separation between the limbs to minimize streaming and recirculation, and a novel geometric configuration to maximize internal cross-sectional luminal area with the lowest external diameter. Preliminary in vitro studies have shown flow rates consistent with those required for CFPD, satisfactory mixing of the fluid, and minimal streaming and recirculation. Clinical validation with long-term studies are needed to assess the viability of CFPD as a chronic renal replacement therapy.

Catheters, Indwelling↗
PubMed2002

Peritonitis in continuous cycling peritoneal dialysis.

The increased use of automated peritoneal dialysis (APD) has generated interest in potential differences in the incidence and causes of peritonitis between APD and continuous ambulatory peritoneal dialysis (CAPD). Several seldom-considered factors may influence peritonitis rates in those patient groups. Patient selection and sequence of therapies, reuse practices, effect of solutions on host defenses, and promptness of diagnosis may have an effect on peritonitis rates. Those factors are reviewed in light of recent literature and technologic advances.

Humans↗
PubMedDate not supplied

The future of APD.

The future of automated peritoneal dialysis (APD) greatly depends on its ability to provide optimal clearances and volume control, preserve peritoneal transport, maintain adequate peritoneal access, and offer flexibility of prescription at a reasonable and competitive cost. Each of these aspects are discussed in the light of recent technologic advances and clinical experiences in order to project a vision of the potential future of APD.

Algorithms↗
PubMedDate not supplied

The Fresenius Medical Care home hemodialysis system.

The Fresenius Medical Care home dialysis system consists of a newly designed machine, a central monitoring system, a state-of-the-art reverse osmosis module, ultrapure water, and all the services associated with a successful implementation. The 2008K@home hemodialysis machine has the flexibility to accommodate the changing needs of the home hemodialysis patient and is well suited to deliver short daily or prolonged nocturnal dialysis using a broad range of dialysate flows and concentrates. The intuitive design, large graphic illustrations, and step-by-step tutorial make this equipment very user friendly. Patient safety is assured by the use of hydraulic systems with a long history of reliability, smart alarm algorithms, and advanced electronic monitoring. To further patient comfort with their safety at home, the 2008K@home is enabled to communicate with the newly designed iCare remote monitoring system. The Aquaboss Smart reverse osmosis (RO) system is compact, quiet, highly efficient, and offers an improved hygienic design. The RO module reduces water consumption by monitoring the water flow of the dialysis system and adjusting water production accordingly. The Diasafe Plus filter provides ultrapure water, known for its long-term benefits. This comprehensive approach includes planning, installation, technical and clinical support, and customer service.

Equipment Design↗
PubMedDate not supplied

Improving outcomes in CKD and ESRD patients: carrying the torch from training to practice.

Practicing nephrologists are spending more time caring for end-stage renal disease (ESRD) and chronic kidney disease (CKD) patients. Despite this focus, and considerable advances in the understanding of those aspects of care that impact on clinical outcomes, morbidity, mortality, and quality of life for these patients has not improved substantially over the past decade. One of the possible explanations for this lack of progress is the structure of current nephrology training programs, where ESRD and CKD patient care is not emphasized. To address this issue, we developed a short preceptorship for second-year nephrology fellows, including didactic lectures and workshops. Of 67 participating fellows, 50% were from programs offering 3 or fewer months of exposure to outpatient hemodialysis, and 25% reported no exposure to peritoneal dialysis. Of more concern, 25% reported no "official rounds" with an attending nephrologist on dialysis patients. If nephrologists are to take their appropriate place as leaders of the care delivery team, nephrology fellowships must be restructured with appropriate emphasis placed on the comprehensive care of ESRD and CKD patients.

Attitude of Health Personnel↗
PubMedDate not supplied

Comparison of peritoneal dialysis solutions.

The composition of peritoneal dialysis solutions to a great extent, determine their effectiveness and safety. Many of the factors that determine the bioincompatibility of peritoneal dialysis fluids have been recently identified. This knowledge is essential to modify the manufacturing processes and in the quest for more biocompatible solutions. A description of the available peritoneal dialysis fluids in the United States and a comparison of their formulations are provided.

Biocompatible Materials↗