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      Emergencia pandemia COVID-19: recomendaciones nutricionales para pacientes en tratamiento sustitutivo renal modalidad hemodiálisis Translated title: COVID-19 pandemic emergency: recommendations for patients in renal replacement treatment, hemodialysis modality

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          Abstract

          Resumen Las personas portadoras de enfermedad renal crónica (ERC) se hallan en mayor riesgo de complicaciones graves si sufren infección por COVID-19, y en el caso particular de los pacientes en tratamiento sustitutivo renal, modalidad hemodiálisis (HD), se suman las complejidades de atención y bioseguridad en el entorno específico común de un centro de diálisis. Ante la actual situación de emergencia sanitaria mundial debido a la infección por COVID-19, se prevé que en Argentina se desarrolle un plan de contingencia en el cual se disminuyan las horas semanales y/o la frecuencia de tratamiento dialítico. Es por ello que el Grupo de estudio de Nutrición y Riñón de AADYND consideró fundamental adaptar las recomendaciones nutricionales a este cambio en la modalidad de tratamiento, con el objetivo de garantizar el control metabólico adecuado combinando una carga menor de toxinas que permitiría disminuir la frecuencia de diálisis por un tiempo determinado y manteniendo un adecuado estado nutricional.

          Translated abstract

          Abstract People with chronic kidney disease (CKD) are at greater risk of serious complications if they suffer from COVID-19 infection, and in the particular case of patients undergoing renal replacement therapy, hemodialysis (HD) modality, there are also complexities of care and biosecurity in the specific common environment of a dialysis center. Given the current global health emergency situation due to COVID-19 infection, it is expected that in Argentina a contingency plan will be developed in which the weekly hours and/or the frequency of dialysis treatment will be reduced. That is why the AADYND Nutrition and Kidney Study Group considers it essential to adapt the nutritional recommendations to this change in the treatment modality, with the aim of guaranteeing adequate metabolic control by combining a lower toxin load that would reduce the frequency of dialysis for a specified time and maintaining an adequate nutritional status.

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          Most cited references29

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          EBPG guideline on nutrition.

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            Chronic Fluid Overload and Mortality in ESRD.

            Sustained fluid overload (FO) is considered a major cause of hypertension, heart failure, and mortality in patients with ESRD on maintenance hemodialysis. However, there has not been a cohort study investigating the relationship between chronic exposure to FO and mortality in this population. We studied the relationship of baseline and cumulative FO exposure over 1 year with mortality in 39,566 patients with incident ESRD in a large dialysis network in 26 countries using whole-body bioimpedance spectroscopy to assess fluid status. Analyses were applied across three discrete systolic BP (syst-BP) categories ( 160 mmHg), with nonoverhydrated patients with syst-BP=130-160 mmHg as the reference category; >200,000 FO measurements were performed over follow-up. Baseline FO value predicted excess risk of mortality across syst-BP categories ( 160 mmHg: HR, 1.30; 95% CI, 1.19 to 1.42; all P 160 mmHg: HR, 1.62; 95% CI, 1.39 to 1.90). In conclusion, chronic exposure to FO in ESRD is a strong risk factor for death across discrete BP categories. Whether treatment policies that account for fluid status monitoring are preferable to policies that account solely for predialysis BP measurements remains to be tested in a clinical trial.
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              Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres

              Abstract COVID-19, a disease caused by a novel coronavirus, is a major global human threat that has turned into a pandemic. This novel coronavirus has specifically high morbidity in the elderly and in comorbid populations. Uraemic patients on dialysis combine an intrinsic fragility and a very frequent burden of comorbidities with a specific setting in which many patients are repeatedly treated in the same area (haemodialysis centres). Moreover, if infected, the intensity of dialysis requiring specialized resources and staff is further complicated by requirements for isolation, control and prevention, putting healthcare systems under exceptional additional strain. Therefore, all measures to slow if not to eradicate the pandemic and to control unmanageably high incidence rates must be taken very seriously. The aim of the present review of the European Dialysis (EUDIAL) Working Group of ERA-EDTA is to provide recommendations for the prevention, mitigation and containment in haemodialysis centres of the emerging COVID-19 pandemic. The management of patients on dialysis affected by COVID-19 must be carried out according to strict protocols to minimize the risk for other patients and personnel taking care of these patients. Measures of prevention, protection, screening, isolation and distribution have been shown to be efficient in similar settings. They are essential in the management of the pandemic and should be taken in the early stages of the disease.
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                Author and article information

                Journal
                diaeta
                Diaeta
                Diaeta
                Asociación Argentina de Dietistas y Nutricionistas Dietista (Ciudad Autónoma de Buenos Aires, , Argentina )
                1852-7337
                May 2020
                : 38
                : 171
                : 56-64
                Article
                S1852-73372020000200056 S1852-7337(20)03817100056
                89270e55-7ddd-4f34-8f06-f427ad03cdbf

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 15 May 2020
                : 15 May 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 29, Pages: 9
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                SciELO Argentina

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                Artículos originales

                nutritional status.,COVID-19,hemodiálisis,recomendaciones,proteínas,energía,estado nutricional.,COVID-19-,hemodialysis,recommendations,proteins,energy

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