UNIT

Dialysis

"The correct choice of renal replacement therapy for each patient is facilitated by a good follow-up program in the advanced chronic renal disease practice. In these consultations it is defined in a shared way which is the therapy that offers better quality of life for each patient".

DR. NURIA GARCÍA FERNÁNDEZ
PERSON IN CHARGE. DIALYSIS UNIT

At the Clinica Universidad de Navarra we have a Hemodialysis Unit composed of a team of multidisciplinary professionals specialized in this treatment: nephrologists, nurses, nutritionists, etc.

After inclusion in hemodialysis, each patient is assigned a reference nurse who will work with the doctor to provide the follow-up and care required. The nurse, in particular, will accompany both the patient and his or her family, developing a program of education for self-care, nutritional support and healthy lifestyle.

As for the medical follow-up by the nephrologist, he or she will make the individualized hemodialysis prescriptions for each patient, review the analyses and routine complementary examinations, adjust the medical treatment and also pay special attention and care to the cardiac pathology that accompanies the chronic renal patient and has a special impact on the morbidity and mortality of these patients. In fact, the choice of the vascular access to do hemodialysis will be determined after a study of the cardiac outcome through clinical history and echocardiogram. And being already on dialysis, periodically, a follow-up will be done.

On the other hand, upon your arrival for each session, a nurse and a nursing assistant will receive you and will be responsible for your care during the whole process of that day. In addition, the Unit's nephrologist will be at your disposal for anything you may need.

During the hemodialysis session, which lasts approximately 4 hours, the patient will be seated in a recliner. During that time, besides being able to sleep, listen to the radio, read or talk, he or she can connect to the Internet via wifi or watch television. You will also have breakfast, lunch or an afternoon snack, depending on the time, as long as your tolerance to dialysis is adequate.

As in any other dialysis center, through the Association of Renal Patients in Spain (ALCER), you will be able to arrange for hemodialysis to be carried out at your vacation destination. Our Unit also has a post for patients who have to travel to Navarra for various reasons, including vacations, provided that this is done with sufficient notice and with the corresponding complete medical report.

In addition to our hemodialysis program for patients with chronic renal disease, we have dialysis modalities that support the treatment of certain groups of patients with other diseases such as heart failure, liver failure, multiple myeloma, etc

Imagen del icono de la consulta de Segunda Opinión. Clínica Universidad de Navarra

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Special indications

In recent years important advances have been developed in dialysis techniques that allow it to be an aid in the treatment of other diseases.

90% of hospital admissions in patients with heart failure are due to fluid overload that further destabilizes the heart, sometimes compromising other organs such as the lung and kidney, and increasing the risk of mortality.

The pharmacological treatment indicated in these cases may not be sufficient, especially when they do not respond well to diuretic treatment.

In these cases, we have what is known as ultrafiltration, a treatment which, through a venous access, allows the blood to be extracted and a volume of water to be removed from it through an external filter.

This technique offers a series of advantages with respect to pharmacological treatment: controlled and adjustable volume and speed of liquid extraction, it does not have an effective negative effect on the levels of electrolytes in the blood, it has been shown to improve that of heart failure and to achieve more or less prolonged hemodynamic stability in the majority of these patients.

Indications:

  • Heart failure with demonstrated resistance to diuretics.
  • Acute heart failure with oligoanuric renal dysfunction (reduced urine volume).
  • Bridge treatment to heart transplantation.

Liver failure and/or cholestatic itch are two processes that in certain situations become severe or refractory to usual medical treatment.

Liver failure can be acute, due to viruses, drugs or toxins that cause acute damage to the liver, or as a result of acute chronic liver failure in a patient with known liver disease.

When the liver loses its functions, due to failure or major resection in case of tumors, a large amount of toxic substances such as bile acids, conjugated bilirubin, amino acids, etc., accumulate in the body, which can cause a severe generalized toxicity picture compromising life.

In these situations and while waiting for the definitive treatment such as liver transplantation or the regeneration of the residual tissue at resection, we have a liver dialysis system called MARS. Both studies on MARS and the results of our experience show how this system provides clinical stability, with usual hemodynamic and neurological improvement and, as a consequence, it can prolong the survival time while waiting for liver transplantation or tissue regeneration.

Regarding the indications of cholestatic refractory pruritus, they are usually minor, and the aim is to reduce it after several consecutive sessions for a more or less long time. It is postulated that substances responsible for the patient's pruritus are eliminated.

Indications:

  • Acute decompensation of chronic liver failure.
  • Acute hepatic dysfunction caused by viruses, toxins, drugs, etc.
  • Initial hepatic dysfunction of liver transplantation from treatable cause such as hepatotoxicity, etc.
  • Liver dysfunction after liver resection surgery.
  • Pruritus (itching) that does not respond to treatment in chronic cholestatic syndromes such as primary biliary cirrhosis, sclerosing cholangitis, etc.

Although sufficient data have long been available to state that the use of MARS can stabilize the liver function of patients with acute liver failure or acute chronic liver disease, its final impact on the mortality of these patients is not yet clear.

Multiple myeloma is a tumorous disease of the bone marrow that consists of an atypical proliferation of plasma cells.

Plasma cells come from B lymphocytes and under normal conditions are responsible for the production of immunoglobulins, blood proteins with an important defense function against infection.

These atypical cells produce and secrete an abnormal immunoglobulin into the blood which produces an excess of light chains that the kidney is unable to eliminate effectively and which can cause irreversible damage to kidney function.

The simultaneous application of a chemotherapy treatment to reduce the plasma cells that produce these light chains and another treatment that allows the effective elimination of these very high chains in the blood and toxic to the kidney, increases the possibilities of a better recovery of the renal function.

Renal involvement in multiple myeloma is one of the most frequent complications (50% of cases). Renal failure is the main cause of morbidity and mortality in myeloma patients. Clinical research indicates that reducing the period of exposure of the kidney to light chains to toxic levels reduces the risk of developing permanent kidney failure.

Indication:

  • Patients diagnosed with multiple myeloma with excess free light chains and associated renal failure, attributable to that cause, who have been scheduled for chemotherapy treatment for myeloma.

The Nephrology Service, in close collaboration with the Haematology Service, carries out this type of haemodialysis as a coadjuvant treatment in chemotherapy in those patients with multiple myeloma who meet the inclusion criteria.

Radioactive iodine is administered as a complementary treatment to surgery for differentiated thyroid carcinoma.

This iodine is mainly eliminated through the urine so, in those patients with renal failure, hemodialysis is strictly necessary to decrease the radiation to the rest of their body.

Otherwise, the treatment with radioactive iodine could not be carried out since the risk of diminishing blood cells (myelosuppression) and irradiation of other organs such as salivary glands, digestive system, etc., would be very high.

The hemodialysis procedure is carried out in a special isolation room that the patients occupy during the treatment with radioactive iodine. It is performed by means of a conventional hemodialysis monitor reserved for these treatments and with a standard and equivalent guideline to that performed in your usual center.

Before and after each session, radiopharmaceutical levels are taken to determine the duration and number of sessions required. Under all the radioactive protection measures, the nurse connects you to the dialysis and to the monitor for taking constants and then monitors the dialysis from outside the room through a video-camera system.

Every time you see abnormal indicators on the dialysis or constants monitor, you will enter with the protective measures and solve the problem.

The Nephrology service of the Clinica Universidad de Navarra has this office which facilitates the decision making process in the choice of each patient for renal replacement therapy.

It is protocolized according to defined standards and implies a special role of the nurse with the medical team in the whole process of information and eligibility of the technique according to the characteristics of the patient and thinking about the best quality of life. 

The informative process includes a first stage that is the one of knowledge in depth of the values or priorities of life of the patient, an informative phase on the different options of therapy (home dialysis, hospital dialysis, renal transplant of alive donor and of dead donor and conservative treatment), a shared reinforcement on the knowledge of the therapies and a test of eligibility on which is the most suitable in that moment for the patient.

We have the hospital hemodialysis, the traplant and the conservative treatment for those patients that the renal substitutive therapy will not give more time or quality of life. However, if the best option for a patient was the home dialysis, we have the possibility of referring patients from the Navarre health system to another center for such therapies.

Program of the consultation:

The Advanced Chronic Kidney Disease Consultation requires at least two visits separated in time to guarantee the correct choice of therapy for the future, the patient's knowledge and the deliberation of the therapy with an intermediate time at home to review the information provided about it.

Nevertheless, due to the peculiarities of our center, where many people from other places consult for a second opinion, an approximation can be made, as long as the patient provides sufficient data from the professionals who take him/her to his/her city of residence.

In these cases, we recommend that the patient go to the previously scheduled consultation on an empty stomach and with complete medical reports.

Your nutritional status impacts your present and future health situation. For that reason, caring for your nutritional status is a priority in our Hemodialysis Unit from the moment you start therapy and in continuity with your ERCA consultation. Eating the right foods in quantity and species can improve your dialysis results and overall health.

Because you belong to a regular hemodialysis program, you will need to carefully monitor your fluid, sodium, potassium and phosphorus intake. However, your nutrition will be prioritized over excessive restrictions.

We have in the Unit of Nephrology nurses with Master in Nutrition or accredited courses, who with the specialist doctor, will help you to develop an individualized plan of feeding, and will make a simple monthly follow-up (analytical and corporal composition) and complete four-monthly follow-up (analytical, anthropometry, tests of functionality and corporal composition). The indications will be according to your tastes and eating habits promoting health.

In certain situations of state of malnutrition, technically called "energetic protein depletion" it may be indicated to evaluate the prescription of some oral supplement or even parenteral nutrition intradialysis.

We offer you some information to facilitate and improve the access to the Hemodialysis Unit of the Nephrology Service.

If you come as a private patient:

Please send the following documents directly by fax (948 296 500) or e-mail (nefrologiacun@unav.es), for the attention of the Secretary of the Nephrology Service

  • Dates in which you request the hemodialysis sessions.
  • Complete medical report, including current hemodialysis schedule and last month's anti-HBV, anti-HBV, hepatitis B virus antigens, hepatitis C virus serology and HIV serology for the last month. In addition, in our center we demand that you provide the result of the HBV and HCV viral load.
  • Telephone and / or mail contact.

Within 48 hours (excluding national and local holidays), you will receive a response to your request.

If the application is viable, you should contact the Admission Service (948 255 400) to register all your details and be able to complete the process.

If you are referred by the Social Security:

You must contact ALCER NAVARRA directly (948 278 005 - www.alcernavarra.com). They will inform you about all the procedures that you have to do.

In case of conformity, ALCER will send the SIFCO report by fax (948 296 500) to the Admission Service of the Clinica Universidad de Navarra.

Remember that you will not receive confirmation of your place until this procedure has been completed.

Additional Information

  • Upon arrival at the Clinic, whether private or not, you must go to the Coordination Units on the first floor to open the assistance and check your data.
  • Afterwards, you must go to the Hemodialysis Unit of the Nephrology Service, located on the 8th floor of the consultation building.
  • If you are referred by the Social Security, it is convenient that you bring, from your center of reference, the medication to be administered during the sessions, since otherwise you will have to pay for it or you will not be able to administer it.

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