Browsing by Author "Sepúlveda Palamara, Rodrigo Andrés"
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- ItemBicarbonato de sodio intravenoso ¿Cuándo, cómo y por qué utilizarlo?(2022) Sepúlveda Palamara, Rodrigo Andrés; Juanet Lecaros, Cristián Ignacio; Sharp Segovia, Joaquín Andrés; Kattan Tala, Eduardo JoséSevere metabolic acidosis is defined by a pH < 7.2 with HCO3− < 8 mE- q/L in plasma. Its best treatment is to correct the underlying cause. However, acidemia produces multiple complications such as resistance to the action of catecholamines, pulmonary vasoconstriction, impaired cardiovascular function, hyperkalemia, immunological dysregulation, respiratory muscle fatigue, neurological impairment, cellular dysfunction, and finally, it contributes to multisystemic failure. Intravenous NaHCO3 buffers severe acidemia, preventing the associated damage and gains time while the causal disease is corrected. Its indication requires a risk-benefit assessment, considering its complications. These are hypernatremia, hypokalemia, ionic hypocalcemia, rebound alkalosis, and intracellular acidosis. For this reason, therapy must be “adapted” and administered judiciously. The patient will require monitoring with serial evaluation of the internal environment, especially arterial blood gases, plasma electrolytes, and ionized calcium. Isotonic solutions should be preferred instead of hypertonic bicarbonate. The development of hypernatremia must be prevented, calcium must be provided for hypocalcemia to improve cardiovascular function. Furthermore, in mechanically ventilated patients, a respiratory response similar to the one that would develop physiologically, must be established to be able to extract excess CO2 and thus avoid intracellular acidosis. It is possible to estimate the bicarbonate deficit, speed, and volume of its infusion. However, the calculations are only for reference. More important is to start intravenous NaHCO3 when needed, administer it judiciously, manage its side effects, and continue it to a safe goal. In this review we address all the necessary elements to consider in the administration of intravenous NaHCO3, highlighting why it is the best buffer for the management of severe metabolic acidosis.
- ItemBiocompatibility in hemodialysis: artificial membrane and human blood interactions(Springer Nature, 2025) Ávila Jiménez, Eduardo Rodolfo; Sepúlveda Palamara, Rodrigo Andrés; Retamal Montes, Jaime Alejandro; Hachim Díaz, Daniel JordiHemodialysis, a cornerstone therapy for chronic kidney disease, represented a crucial advance in the evolution of artificial organs. While its success is largely due to its efficiency in removing uremic toxins, an equally important challenge is to uphold the primum non nocere principle by minimizing the harmful effects of membrane–blood interactions. This review examines the complex mechanisms and key interactions underlying membrane biocompatibility, including complement activation, inflammation, and coagulation disturbances, paving the way for their clinical implications. We also summarize recent innovations in membrane materials and surface engineering aimed at improving hemocompatibility and promoting safer hemodialysis treatments for improved clinical outcomes. Highlights Membrane biocompatibility is essential for safe and effective hemodialysis, while bioincompatibility can trigger complement activation, inflammation, and coagulation disorders. Synthetic membranes generally demonstrate superior hemocompatibility compared with cellulose-based membranes. Adverse immune and inflammatory responses to membrane–blood interactions may contribute to oxidative stress, endothelial dysfunction, and immune exhaustion, impacting patient prognosis. Advances in membrane design and surface engineering offer promising strategies to improve safety and clinical outcomes.
- ItemClinical presentation and management of atypical hemolytic uremic syndrome in Latin America: a narrative review of the literature(2024) Sepúlveda Palamara, Rodrigo Andrés; Modelli de Andrade, Lg.; Fortunato, Rm.; Gómez, B.; Nieto-Ríos, Jf.Introduction: comprehensive information about atypical hemolytic uremic syndrome (aHUS) is rela-tively scarce outside of Europe and North America. This narrative review assembles available published data about the clinical presentation and management of aHUS in Latin America. Areas covered: A search conducted in February 2023 of the MEDLINE (from inception), Embase (frominception), and LILACS/IBECS (1950 to 2023) databases using search terms 'atypical hemolytic uremicsyndrome’ and ‘Latin America’ and their variations retrieved 51 records (full papers and conferenceabstracts) published in English, Spanish, or Portuguese. After de-duplication, manual screening of titles/abstracts and addition of author-known articles, 25 articles were included of which 17 (68%) are full papers. All articles were published during the years 2013–2022. Articles include cohort studies, a registry analysis,and case reports from Argentina, Brazil, Chile and Columbia. Overall, Latin American patients with aHUSpresent the classic epidemiological, clinical, and genetic characteristics associated with this condition asdescribed in other world regions. Depending on the country and time of reporting, aHUS in Latin Americawas treated mainly with plasma therapy and/or eculizumab. Where reported, eculizumab substantiallyimproved aHUS-related outcomes in almost all adult and pediatric patients.Expert opinion: Eculizumab has dramatically altered the natural course of aHUS, improving prognosisand patient outcomes. Addressing economic challenges and investing in healthcare infrastructure willbe essential to implement strategies for timely detection and early treatment of aHUS in Latin America.
- ItemEnfrentamiento fisiopatológico del paciente con hiponatremia. Diagnóstico diferencial y tratamiento(2025) Sepúlveda Palamara, Rodrigo Andrés; Sharp Segovia, Joaquin Andres; Juanet Lecaros, Cristian Ignacio; Avila Jimenez, Eduardo RodolfoLa hiponatremia ([Na+] plasmático <135 mEq/L) es el trastorno hidroelectrolítico más frecuente, sin embargo, no siempre traduce un estado de hipotonía del agua corporal (Osm plasmática <275 mOsm/kg). Los mecanismos subyacentes a una hiponatremia hipotónica son la sobrecarga acuosa y/o una excreción ineficiente de agua libre a nivel renal. Múltiples causas pueden provocar este trastorno, pero reconocer su etiología es un gran desafío. Se requiere una evaluación clínica completa junto a un análisis de laboratorio exhaustivo, ya que no basta un parámetro aislado. La severidad de una hiponatremia depende de la etiología, intensidad y velocidad de instauración, así, un diagnóstico inadecuado junto con una corrección apresurada pueden generar más daño. Por otro lado, existen muchas contro-versias respecto a la mejor forma de realizar un tratamiento óptimo. En esta revisión se presenta un enfoque fisiopatológico que permite interpretar los mecanismos patogénicos, diagnosticar el trastorno y sus causas específicas, corregir el estado de hipotonía y gestionar de manera adecuada y segura al paciente con hiponatremia
- ItemInsuficiencia renal aguda secundaria a rabdomiolisis como manifestación de infección por SARS-CoV-2(Sociedad Médica Santiago, 2021) Pérez, Javier; Sánchez Zagal, Sebastián Antonio; Sepúlveda Palamara, Rodrigo Andrés; Vera Alarcón, María Magdalena; Mery Ponce, Pablo Agustin; Garayar Pulgar, Bernardita; Jalil Milad, Roberto DanielSARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.
- ItemNo Need for Beef: A New Vegetarian Test to Measure Renal Functional Reserve(2023) Huidobro Espinosa, Juan Pablo; Sepúlveda Palamara, Rodrigo Andrés; Vega Stieb, Jorge Enrique
- ItemProlonged intermittent high-volume hemofiltration as kidney replacement therapy in critically ill patients(Springer Nature, 2025) Sepúlveda Palamara, Rodrigo Andrés; Huidobro Espinosa, Juan Pablo; Juanet Lecaros, Cristian Ignacio; Espinosa, María E.; González Muñoz, Loredana Elizabeth; Rot Cisternas, Ívica Damaris; Bello, Francisca; Salinas, Daniela; Hidalgo, Francisco; Delgado, Pablo; Roessler Barron, EricBackground Prolonged and intermittent high-volume hemofiltration (HVHF) can be performed in extremely critical patients for hemodynamic support. In addition, it can serve as a kidney replacement therapy, given its large ultrafiltration volume. Our objective is to characterize the depuration properties of HVHF and hemodynamic tolerance. Methods This was a retrospective cohort study. All adult critical patients who received HVHF in a university hospital during 2021 were included. Demographic variables, past medical history, pre- and post-HVHF blood tests, and hemodynamic tolerance were evaluated. Results A total of 133 HVHF sessions were performed on 74 critical patients (age 61.1 ± 14.8 years, 43.2% women, and sequential organ failure assessment (SOFA) score 15.5 ± 3.8). All HVHF sessions were performed with prefilter replacement fluid, and 83.5% without anticoagulation. Time (QT) was 337 ± 86 min, with replacement flow rate (QR) at 81 ± 21 mL/kg/h. Hypotension occurred in 19.6% of the procedures at connection and 6.8% during therapy with no precipitating factor. Norepinephrine dose decreased ≥ 20% in 47.1% of the HVHF sessions. Single-pool urea Kt/V (spKt/V) was 0.52 ± 0.17. In HVHF of QT 6–8 h, spKt/V was 0.58 ± 0.17. Higher spKt/V was associated with higher QT and high QR. Post-HVHF sodium was significantly associated with sodium in the replacement fluid. Before HVHF, 18% had hyperkalemia (5.9 ± 1.1 mEq/L). Post-therapy kalemia was 4.8 ± 0.6 mEq/L. Post-HVHF potassium was associated with QR and ultrafiltration. Conclusions Prolonged and intermittent HVHF could serve as an alternative kidney replacement therapy in critically ill patients because it provides adequate control of the internal environment, allows withdrawal anticoagulation, favors patient mobility for procedures and treatments, and provides hemodynamic support.
- ItemProlonged intermittent high-volume hemofiltration as kidney replacement therapy in critically ill patients(2025) Sepúlveda Palamara, Rodrigo Andrés; Huidobro Espinosa Juan Pablo; Juanet Lecaros, Cristián Ignacio; Espinosa Sánchez, María Constanza; González Muñoz, Loredana Elizabeth; Rot Cisternas, Ivica Damaris; Francisca Bello; Daniela Salinas; Francisco Hidalgo; Pablo Delgado; Roessler, Barron EricBackground Prolonged and intermittent high-volume hemofltration (HVHF) can be performed in extremely critical patients for hemodynamic support. In addition, it can serve as a kidney replacement therapy, given its large ultrafltration volume. Our objective is to characterize the depuration properties of HVHF and hemodynamic tolerance. Methods This was a retrospective cohort study. All adult critical patients who received HVHF in a university hospital during 2021 were included. Demographic variables, past medical history, pre- and post-HVHF blood tests, and hemodynamic tolerance were evaluated. Results A total of 133 HVHF sessions were performed on 74 critical patients (age 61.1±14.8 years, 43.2% women, and sequential organ failure assessment (SOFA) score 15.5±3.8). All HVHF sessions were performed with preflter replacement fuid, and 83.5% without anticoagulation. Time (QT) was 337±86 min, with replacement fow rate (QR) at 81±21 mL/kg/h. Hypotension occurred in 19.6% of the procedures at connection and 6.8% during therapy with no precipitating factor. Norepinephrine dose decreased≥20% in 47.1% of the HVHF sessions. Single-pool urea Kt/V (spKt/V) was 0.52±0.17. In HVHF of QT 6–8 h, spKt/V was 0.58±0.17. Higher spKt/V was associated with higher QT and high QR. Post-HVHF sodium was signifcantly associated with sodium in the replacement fuid. Before HVHF, 18% had hyperkalemia (5.9±1.1 mEq/L). Post-therapy kalemia was 4.8±0.6 mEq/L. Post-HVHF potassium was associatedwith QR and ultrafltration. Conclusions Prolonged and intermittent HVHF could serve as an alternative kidney replacement therapy in critically ill patients because it provides adequate control of the internal environment, allows withdrawal anticoagulation, favors patient mobility for procedures and treatments, and provides hemodynamic support.
- ItemSuccessful Kidney Transplant in a Patient with Overlap C3 Glomerulonephritis and Thrombotic Microangiopathy Treated with Ravulizumab(2023) Huidobro Espinosa, Juan Pablo; Sepúlveda Palamara, Rodrigo Andrés; Carpio, Daniel; Majerson Grinberg, Alejandro; Jara Contreras, Aquiles
- ItemWCN25-1962 USE OF HEMODIALYSIS FOR THE CORRECTION OF EXTREME METABOLIC ALKALOSIS(2025) Medina Pedraza, Álvaro Ignacio; Sepúlveda Palamara, Rodrigo Andrés; Avila Jiménez, Eduardo Rodolfo
- ItemWCN25-743 Fibromuscular dysplasia involving renal arteries, case report(2025) Medina Pedraza, Álvaro Ignacio; Sepúlveda Palamara, Rodrigo Andrés