Browsing by Author "Lorca, Eduardo"

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    Survival study and factors associated with mortality in Chilean patients on peritoneal dialysis infected with SARS-CoV-2
    (2022) Ortiz, Ana M.; Sepulveda Palamara, Rodrigo Andres; Torres, Ruben; Clavero, Rene; Toro, Luis; Albornoz, Miguel; Aldunate, Tatiana; Arce, Ingrid; Arevalo, Juan; Arriagada, Andres; Becker, Julieta; Gonzalez, Sonia C.; Bernales, Waldo; Briones, Eduardo; Castillo, Alvaro; Fuentes, Agustin; Gomez, Esteban; Jaramillo, Hernan; Lillo, Mario; Lorca, Eduardo; Machuca, Eduardo; Mansilla, Rodrigo; Menendez, Serwin; Moya, Carlos; Munoz, Carolina; Neilson, William; Orozco, Rodrigo; Padrino, Maria; Pais, Edgard; Ramirez, Gonzalo; Sanhueza, Maria E.; Schneider, Herman; Solis, Ruth; Troncoso, Jaime; Ursu, Marcela; Valenzuela, Marcela
    The Covid-19 pandemic has been responsible for millions of deaths worldwide. Patients with comorbidities- such as those on peritoneal dialysis (PD)- present higher morbidity and mortality than the general population. We prospectively evaluated all Chilean patients on PD (48 centres) and followed those who had Covid-19 from the beginning of the Covid-19 pandemic in Chile (March 2020) to January 2021 (start of vaccination campaign). We described demographic history, comorbidities, factors related to infection, need for hospitalisation and death due to Covid-19. During the study period, 106 adults on PD were infected by SARS-CoV-2, with a mean age of 53.1 (+/- 16.3) and of which 53.9% were female. From that group, 54.8% required hospitalisation and 24.5% (n = 26) died due to Covid-19. Most of the patients (63.4%) were infected at home and 22.8% during hospitalisation for other reasons. There was a significant association for Covid-19 mortality with: being >= 60 years old, diabetes, time on PD >= 5 years, need for hospitalisation and hospital-acquired infection. At 90 days of follow-up, all deaths associated to Covid-19 occurred before 40 days. We conclude that patients on PD without Covid-19 vaccination have a high mortality and need for hospitalisation associated to Covid-19. To avoid this negative outcome, it is necessary to intensify strategies to avoid contagion, especially in those >= 60 years old, with diabetes and/or >= 5 years spent on PD.
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    Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond
    (2023) Pedreros, Cristian; Jara Contreras, Aquiles; Lorca, Eduardo; Mezzano, Sergio; Pecoits-Filho, Roberto; Herrera, Patricia
    Dialysis treatment has improved the survival of patients with kidney failure. However, the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach that significantly improves patient outcomes by effectively eliminating medium and large uremic toxins, which explains its increasing adoption, particularly in Europe and Japan. Interest in this therapy has grown following the findings of the recently published CONVINCE study, as well as the need to understand the mechanisms behind the benefits. This comprehensive review aims to enhance the scientific understanding by explaining the underlying physiological mechanisms that contribute to the positive effects of HDF in terms of short-term benefits, like hemodynamic tolerance and cardiovascular disease. Additionally, it explores the rationale behind the medium-term clinical benefits, including phosphorus removal, the modulation of inflammation and oxidative stress, anemia management, immune response modulation, nutritional effects, the mitigation of bone disorders, neuropathy relief, and amyloidosis reduction. This review also analyzes the impact of HDF on patient-reported outcomes and mortality. Considering the importance of applying personalized uremic toxin removal strategies tailored to the unique needs of each patient, high-volume HDF appears to be the most effective treatment to date for patients with renal failure. This justifies the need to prioritize its application in clinical practice, initially focusing on the groups with the greatest potential benefits and subsequently extending its use to a larger number of patients.