The SEN proposes specific consultations of advanced chronic kidney disease to slow the progression and preparing patients for renal replacement therapy

Seville, 2011-October in Spain near 2.200.000 people living with kidney disease. Despite the high number of transplants performed on patients with this disease, the prevalence of patients treated in dialysis programs has continued to grow, due to the existence of a greater number of elderly patients, many of which are not candidates for kidney transplantation.

Dialysis is, therefore, the treatment Renal Sustitutivo (TRS) most important for kidney diseases; for which there are basically two types: the hemodialysis (HD) and Peritoneal Dialysis (DP). The use of the latter continues to be minority with respect to the HD.

Unlike hemodialysis, the DP is a home-based treatment modality that eliminates toxic substances through the peritoneal membrane of the patient; It can be either manual or automated.

According to Dr. José Antonio Milan Martin, co-President of the Organizing Committee of the Congress, both hemodialysis and peritoneal dialysis are good techniques of renal replacement therapy. There is no doubt that the transplant is the best, but not everyone can be transplanted. What if it is is true that between 30 and 70% of patients starting renal replacement therapy could do with peritoneal dialysis. Peritoneal dialysis is indicated as a first start of TSR technique by its lower cost and health results, at least equal to the hemodialysis centers-based techniques ”.

Also, experts point out that the important thing is the patient who is going to start dialysis treatment to know all the possibilities and choose which best fits your situation, habit of life and personal preferences.

The Spanish society of Nephrology (SEN) proposes a comprehensive care of TSR (renal replacement therapy) with advanced chronic kidney disease specific consultations to halt progression, deal with the consequences, and prepare patients for the TSR; gain efficiency and equity in the assisted selection of the TSR; bring the TSR to the patient (household techniques) and provide adequate training of health staff, patients and the general population.

In this sense, the question does the same meaning prognosis kidney function at the beginning of DP and HD? It is a subject of debate in the Conference national from the society Spanish of Nephrology, that brings together various experts these days in Seville.

Aim: to try to slow the loss of residual renal function

Peritoneal dialysis at home provides higher quality of life, freedom and privacy in treatment; its most important benefits compared with hemodialysis are flexibility and better maintenance of residual kidney function.

In this sense, the preservation of residual kidney function (RRF) is an important factor to take into account in dialysis patients. Although it is not possible to prevent the loss of Residual Renal function (RRF), are obliged, at least to try to endentecer her ”, points out Dr. Nicanor Vega. Optional area specialist responsible for the unity of Peritoneal Dialysis in the University Hospital of Gran Canaria Dr. Negrín.

There are common to both modes that can promote the loss of kidney function and factors specific to each of them; acknowledging them and acting on them can take steps to preserve the (RRF). According to Dr. Vega, should be considered that the RRF: 1) it is important in both types of dialysis and that has the same clinically and prognosis; (2) that it should be considered an intermediate objective that will allow us to achieve ultimate objectives; (and 3) that both modalities are complementary in function inclusive of these ultimate objectives, facilitate optimum TSR and improve the survival of the patient ”.

However, even if the peritoneal dialysis is better preserved residual renal function, the goal is to preserve also in hemodialysis patients so that they can have the same benefits as patients in DP.

Modern hemodialysis therapies can contribute to a better preservation of the RRF in patients and providing the benefits referred to peritoneal dialysis. This can add techniques (e.g. bioimpedancia) that allow a better definition of the State of hydration of the patient, keeping them with his tight weight and in situation of euvolemia, for both technical ”, concludes Dr. Vega.

Biotechnology and bioengineering in hemodialysis

Also, during the Congress, experts address the hemodialysis treatment from the perspective of the biomedical engineering. To do this, carried out a review of the major milestones in the history of hemodialysis and its relationship with the bioengineering.

The DRA. Laura Roa, responsible for the biomedical engineering of the University of Seville-CIBER BBN group, explains as information and communication technologies can contribute to a better follow-up of the evolution of the disease, and therefore an improvement in the quality of life of patients ”.

All this allows us to, on the one hand, to highlight as the artificial kidney and hemodialysis are a key research field in bioengineering, and on the other hand, the present and future need for collaboration among Nephrologists and bioengineers, before the new paradigms in health care, and therefore of the Nephrology in an environment of sustainability ”, concludes the DRA. ROA.

The Spanish society of Nephrology

The Spanish society of Nephrology is a scientific society whose objectives are to promote and disseminate scientific and advances clinical in the field of specialty, covering fields as diverse as high blood pressure, kidney disease, the progression of renal insufficiency, or renal dialysis (hemodialysis or peritoneal dialysis) or kidney transplant replacement therapy when the renal function does not allow the survival of the patient. It also promotes research on extra kidney complications of kidney disease (anemia, bone disorders, cardiovascular complications, etc.). It currently has 1,700 members between researchers and clinical Nephrologists on topics related to the specialty. This company organizes a Conference, as well as several refresher courses throughout the year, both for specialists and resident doctors. The programme of activities can be consulted at: www.senefro.org/congreso2011