Advanced hemodialysis Hemodiafiltration based on realtime individualized cardiometabolic measurements AzpirozLeehan J Morón A Cadena Méndez M Sacristán Rock E Rosas G MartínezLicona ID: 764333
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Advanced hemodialysis/ Hemodiafiltration based on real-time individualized cardiometabolic measurements Azpiroz-Leehan J., Morón A., Cadena-Méndez M., Sacristán-Rock E., Rosas G., Martínez-Licona F.CI3M, UAM Iztapalapa 4th WHO Global Forum on Medical Devices
DISCLOSURE The authors declare no conflict of interest with the material provided 4th WHO Global Forum on Medical Devices
Current Problems in HD/HDF Current needs in Mexico (250,000 patients/100,00 treated) are nor being met.Excessive death rate (up to 25%). Adverse events, complications and drugs increase (mostly out-of pocket) costs. Low quality care (over 50% of clinics deemed medium or low-quality), low quality of life. 4th WHO Global Forum on Medical Devices
Jha , V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., ... & Yang, C. W. (2013). Chronic kidney disease: global dimension and perspectives. The Lancet, 382(9888), 260-272Institute for Health Metrics and Evaluation. Mexico profile. Available at http://www.healthdata.org/mexico consulted August 8th, 2018Durán-Arenas, Luis, Ávila-Palomares, Paula D, Zendejas-Villanueva, Rodrigo, Vargas-Ruiz, María Magaly, Tirado-Gómez, Laura L, & López-Cervantes, Malaquías. (2011). Costos directos de la hemodiálisis en unidades públicas y privadas. Salud Pública de México, 53(Supl. 4), 516-524. (Note: costs were estimated at 2009 dollar value)4th WHO Global Forum on Medical Devices Chronic Kidney Disease ( CKD) is a disease that, is highly correlated with other equally disastrous diseases such as obesity and diabetes is in a state of constant expansion Efforts to control CKD are not up to the challenge that it representsThe cost-effectiveness of an intervention depends on the local gross domestic product and for this disease the intervention is not cost effective 1 According to the Institute for Health Metrics and Evaluation, from 2005 to 2016 the IRC is ranked as the third cause of death in Mexico with a percentage change in that period of 55.8% 2 The costs for hemodialysis in public health are high (In 2009, the average annual cost per patient was around $11300 USD), while the budget for renal replacement therapy is estimated to be even much higher (more than 735 million USD) 3.
To reduce the lethality rates and increase quality of life of patients undergoing hemodialysis/hemodiafiltration by using the on-line measurement of cardiometabolic variables to control the hemodialytic processes Objective: 4th WHO Global Forum on Medical Devices
Measurement of the patient's intra-dialytic hemodynamic stability, which is highly related to the occurrence of adverse events. A multi-factor control, which is adaptable to the specific needs of each patient, is applied to preserve homeostasis. Method 4th WHO Global Forum on Medical Devices Body Composition Vagal-sympathetic Index Energetic Expenditure Hemodiafiltration Exercise Utrafiltration Rate Other interventions Advanced Instrumentation Measurements Basic Hemodialysis System Advanced Hemodiafiltration System Big Data IA Information Control
Results 4th WHO Global Forum on Medical Devices Hemodialysis Research Clinic Mexican Association O n Obesity, Kidney and Nutrition Process Innovation from Hemodialysis / Hemodiafiltration
The protocols have been applied for 6 months and after more than 700 therapy sessions we have found that intradialytic monitoring heart rate variability is a predictor for hypotensive events. Other results are expected shortly. Results 4th WHO Global Forum on Medical Devices First results on hemodiafiltration showed that toxin depuration, like phosphates and beta-2 microglobulin, is possible; these are in agreement with some European results * Benefits: No diet control Lower drug needs Allows the reactivation of the productive activities of the patient Better physical, emotional, social and sexual well-being * Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, et al: High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 2013;24:487–497.
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