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4th WHO Global Forum on Medical Devices

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.

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4th WHO Global Forum on Medical Devices

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  1. Advanced hemodialysis/Hemodiafiltration based on real-time individualized cardiometabolic measurements Azpiroz-LeehanJ., Morón A., Cadena-Méndez M., Sacristán-Rock E., Rosas G., Martínez-LiconaF. CI3M, UAM Iztapalapa 4th WHO Global Forum on Medical Devices

  2. DISCLOSURE The authors declare no conflict of interest with the material provided 4th WHO Global Forum on Medical Devices

  3. 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

  4. 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 represents • The 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. 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), 260-272 Institute for Health Metrics and Evaluation. Mexico profile. Available at http://www.healthdata.org/mexico consulted August 8th, 2018 Durán-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

  5. Objective: To reduce the lethality rates and increase quality of life of patients undergoing hemodialysis/hemodiafiltrationby using the on-line measurement of cardiometabolic variables to control the hemodialyticprocesses 4th WHO Global Forum on Medical Devices

  6. Method 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. Basic Hemodialysis System • Body Composition • Vagal-sympathetic Index • Energetic Expenditure • Hemodiafiltration • Exercise • Utrafiltration Rate • Other interventions Advanced Instrumentation Measurements Advanced Hemodiafiltration System • Big Data • IA Information Control 4th WHO Global Forum on Medical Devices

  7. Results Mexican Association On Obesity, Kidney and Nutrition Hemodialysis Research Clinic Process Innovation from Hemodialysis / Hemodiafiltration 4th WHO Global Forum on Medical Devices

  8. Results • 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 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. * 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. 4th WHO Global Forum on Medical Devices

  9. ci3m.mx Thank you 4th WHO Global Forum on Medical Devices

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