Publication: El uso del citrato con respecto al acetato y sus beneficios clínicos
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2020-06-01
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Abstract
El uso del citrato en el líquido de diálisis (LD) puede contribuir significativamente a mejorar la hemodiálisis (HD), la eficacia dialítica, el estado ácido-base, la situación hemodinámica y la calidad de vida del paciente.
Se ha llevado a cabo una búsqueda bibliográfica con inclusión de artículos de diferentes revistas, años y países, para encontrar cuando y como utilizar el citrato y el acetato, diferencias entre ambos, relación con efectos/beneficios a largo plazo, menor trombogenicidad e inflamación, aumento en el aclaramiento y mejora de la nutrición. El uso de Citrato puede cambiar los parámetros fisicoquímicos del dializado, permitiendo una mejora importante de la hipotensión sintomática en pacientes con tratamiento de HD.
Los profesionales de enfermería suponen un gran potencial en las intervenciones a los pacientes, familia y entorno. La Educación Sanitaria, englobando información correcta y formación en conocimientos y habilidades, resulta fundamental en la resolución de problemas y en la toma de decisiones. La corrección de hábitos poco saludables que influyan en una mejora del estado nutricional, la calidad de vida y la disminución de factores de riesgo requieren de una atención sanitaria excelente basada en la mejor evidencia científica.
Actualmente, no hay grandes efectos adversos relacionados con el uso del citrato en pacientes con tratamiento de HD, pero son necesarios más estudios prospectivos y cruzados sobre la eficacia del uso de este acidificante en el tratamiento para justificar el cambio completo por el acetato.
The citrate dialysate can significantly contribute to improve hemodialysis and it ́s efficiency, acid-base status and hemodynamic, as well as the low quality of life. We have carried out a bibliographic search in which we have included articles from different journals, years and countries to found differences between when the situation in which they used a dialysate with citrate and the one in which they used, like a lower thrombogenicity, inflammation, improvement in clearance and nutrition. Citrate could change physicochemical parameters of dialysate, allowing an important improvement of symptomatic hypotension in hemodialysis patients. Nurses have a great potential to intervene on the patients, informing them correctly, clarifying their doubts, and supporting them in decision-making, in order to provoke a correction if an unhealthy dietary habit to improve their nutritional status, increase the quality of life and decrease the risk of death. To do this, we must find the best treatment to avoid secondary effects and allow the nurse to improve her care and the clinical practice guideline. Currently, there are no several adverse effects related to the use of citrate in patients with hemodialysis, but we need more prospective and cross-over studies on the efficiency of the use of this treatment to justify it ́s the change by acetate.
The citrate dialysate can significantly contribute to improve hemodialysis and it ́s efficiency, acid-base status and hemodynamic, as well as the low quality of life. We have carried out a bibliographic search in which we have included articles from different journals, years and countries to found differences between when the situation in which they used a dialysate with citrate and the one in which they used, like a lower thrombogenicity, inflammation, improvement in clearance and nutrition. Citrate could change physicochemical parameters of dialysate, allowing an important improvement of symptomatic hypotension in hemodialysis patients. Nurses have a great potential to intervene on the patients, informing them correctly, clarifying their doubts, and supporting them in decision-making, in order to provoke a correction if an unhealthy dietary habit to improve their nutritional status, increase the quality of life and decrease the risk of death. To do this, we must find the best treatment to avoid secondary effects and allow the nurse to improve her care and the clinical practice guideline. Currently, there are no several adverse effects related to the use of citrate in patients with hemodialysis, but we need more prospective and cross-over studies on the efficiency of the use of this treatment to justify it ́s the change by acetate.