Manual de accesos vasculares para hemodiálisis
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La diálisis ha incrementado la supervivencia del paciente de enfermedad renal crónica y le proporciona buena calidad de vida en espera de la solución definitiva: el trasplante renal. Existen dos tipos de diálisis: la diálisis peritoneal y la hemodiálisis. La primera utiliza el propio peritoneo del paciente como membrana y precisa un catéter intraperitoneal.La segunda es una técnica de depuración extracorpórea, con extracción de sangre del paciente que, a través de un circuito externo, se enfrenta a un lÃquido de diálisis isoosmótico para la depuración de toxinas. Esta función necesita un flujo de sangre elevado que no se consigue mediante la punción de una vena normal, mientras que la frecuencia de la hemodiálisis precisa de un vaso venoso con una pared resistente a las punciones. Ello ha llevado a localizar un acceso adecuado, representado por la fÃstula arteriovenosa de Cimino-Brescia.La hemodiálisis a través de un acceso vascular antólogo, que se asocia a una mayor supervivencia de la técnica y del paciente, requiere la colaboración del nefrólogo con cirujanos vasculares, a los que se han de sumar angioradiólogos, radiólogos y especialistas en medicina nuclear.La medicina precisa esta coordinación multidisciplinar y la Fundación Española de Diálisis ha considerado necesario que este tratado vea la luz, coordinado por la Dra. M.a Teresa González, especialista en NefrologÃa del Hospital Universitari de Bellvitge y presidenta de la Fundación Española de Diálisis, y el Dr. Román MartÃnez Cercós, especialista en CirugÃa vascular del Hospital del Mar, con la colaboración de los más destacados especialistas en diálisis, con el fin de promover la formación de nuevas generaciones de expertos y el avance de la medicina.
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