Description of a disease management model in patients undergoing dialysis in Colombia
PDF (Español)


Cardiovascular risk factors
terminal chronic renal disease
management of disease

How to Cite

Bunch A, Tamer L, Ardila F, Laganis S, Castaño R, Vesga J, López P, Sanabria RM. Description of a disease management model in patients undergoing dialysis in Colombia. Rev. Colomb. Nefrol. [Internet]. 2016 Jul. 11 [cited 2024 Apr. 20];3(1):5-13. Available from:


Introduction: Management Models of Disease (MMD) allows one to identify risks and prioritize interven-tions to achieve better clinical outcomes. This work aims to describe a MMD designed for a population on dialysis and identify the cardiovascular risk factors and metabolic diseases in this population.

Methods: MMD described. We included patients older than 18 years, receiving dialysis between March 1stand  August 31st2013; demographic variables were assessed and baseline clinical and risk factors werei-dentified according to the presence of diabetes. For the analysisdescriptive statistics in Stata® 12 was used.

Results: 2219 patients were analyzed, 1004 (45.24%) of them were diabetic, 624 (28.1%) had a history of cardiovascular disease, 990 (94.37%) reported some alteration in the echocardiogram, being the most frequent the hypertensive cardiopathy in the 58.63%. As a result, the total number of patients on hemodialy-sis was 271 (13%), and on peritoneal dialysis112 (5%) had poor control of blood volume, high CRP in the 64.4% and TSH >10 IU/ml in 12.1% of the subjects. The ankle-brachial index (ITB) was found altered in 37.5% of diabetics, versus 21.8% in non-diabetics (p<0.001); differences were observed for the overweight population; 40.03% vs. 26.91%, in diabetics and non-diabetics, respectively.

Conclusions: This disease management model is based on agency of cases and integration of networks of services may be a high impact response to populations in dialysis with important comorbidity.
PDF (Español)


1. Levey AS, Beto JA, Coronado BE, Eknoyan G, Foley RN, Kasiske BL, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease. Am J Kidney Dis. 1998; 32(5): 853-906.

2. Longenecker JC, Coresh J, Powe NR, Levey AS, Fink NE, Martin A et al. Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: the CHOICE Study. Clin J Am Soc Nephrol. 2002; 13(7): 1918-27.

3. Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2008; 52(3): 519-30.

4. Kalantar K, Regidor D, Kovesdy C, Van D, Horwich T, Fonarrow G. Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation 2009; 119: 671-9.

5. Zoccali C, Mallamaci F, Tripepi G. Traditional and emerging cardiovascular risk factors in end-stage renal disease. Kidney Int Suppl. 2003; 63: S105-S10.

6. Becker BN, Himmelfarb J, Henrich WL, Hakim RM. Reassessing the cardiac risk profile in chronic hemodialysis patients: A hypothesis on the role of oxidant stress and other non-traditional cardiac risk factors. Clin J Am Soc Nephrol.1997; 8(3): 475-86.

7. Stenvinkel P, Carrero JJ, Axelsson J, Lindholm B, Heimbürger O, Massy Z. Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle? Clin J Am Soc Nephrol. 2008; 3(2): 505-21.

8. Bazeley J, Bieber B, Li Y, Morgenstern H, de Sequera P, Combe C, et al. C-reactive protein and prediction of 1-year mortality in prevalent hemodialysis patients. Clin J Am Soc Nephrol. 2011; 6(10): 2452-61.

9. Mourad JJ, Cacoub P, Collet JP, Becker F, Pinel JF, Huet D, et al. Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD. J Vasc Surg. 2009; 50(3): 572-80.

10. Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, et al. Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality. JAMA. 2008; 300(2): 197-208.

11. Collins AJ, Foley RN, Gilbertson DT, Chen SC. The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol. 2009; 4(suppl1): S5-S11.

12. Rayner HC, Pisoni RL, Bommer J, Canaud B, Hecking E, Locatelli F, et al. Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2009; 19(1): 108-20.

13. López K, Lorenzo S, Gruss E, Garrido MV, Moreno JA. Aplicación de la gestión por procesos en Nefrología. Gestión del proceso de hemodiálisis. Nefrología. 2002; 22(4): 329-39.

14. Nissenson AR, Rettig RA. Medicare's end-stage renal disease program: current status and future prospects. Health Aff. 1999;18(1): 161-79.

15. Anand S, Nissenson AR. Utilizing a disease management approach to improve ESRD patient outcomes. Semin Dial. 2002;15(1):38-40.

16. Ministerio de la Protección Social, Colombia. Guía De Instrucción Para El Diseño De Programas De Gestión De Enfermedades Crónicas. Observatorio de la Calidad de la Atención en Salud. Dirección General de Calidad. [Internet]. [Consultado julio de 2014]. Disponible en:

17. López P, Alonso L, García AJ, Fernández IE. Presencia de los atributos para la integración de las redes de servicios de salud. Rev Cubana de Medicina General Integral. 2009; 25(4): 86-97.

18. Norfolk E, Hartle J. Nephrology Care in a Fully Integrated Care Model: Lessons from the Geisinger Health System. Clin J Am Soc Nephrol. 2013; 8(4): 687-93.

19. Batres JP, Alvarez M, Gallardo P. De la precisión de cuidados a los cuidados imprescindibles. Las enfermeras gestoras de casos en Andalucía: la enfermera comunitaria de enlace. Rev Adm Sanit. 2009; 7(2): 313-22.

20. López T, Amoedo MªL, Navarro R, Guerrero M. Modelo de gestión de casos en el paciente renal hospitalizado con síndrome sociosanitario. Comunicaciones Presentadas al XXXIII Congreso Nacional.2008. SEDEN. [Internet]. [consultado octubre 2014]. Disponible en:[2].pdf

21. Cuenta de Alto Costo. Situación de la enfermedad renal crónica en Colombia 2014. [Internet]. [Consultado octubre 2014]. Disponible en:

22. Chantrel F, Enache I, Bouiller M, Kolb I, Kunz K, Petitjean P, et al. Abysmal prognosis of patients with type 2 diabetes entering dialysis. Nephrol Dial Transplant. 1999; 14(1): 129-36.

23. Margolis KL, O’Connor PJ, Morgan TM, Buse JB, Cohen RM, Cushman WC, et al. Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes: The ACCORD randomized trial. Diabetes care. 2014; 37(6): 1721-8.

24. Gæde P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med.2008; 358(6): 580-91.

25. Lepäntalo M, Fiengo L, Biancari F. Peripheral arterial disease in diabetic patients with renal insufficiency: a review. Diabetes Metab Res Rev. 2012; 28(S1): 40-5.

26. Cappola AR, Fried LP, Arnold AM, Danese MD, Kuller LH, Burke GL, et al.Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006; 295(9): 1033-41.

27. U.S. Renal Data System, USRDS 2005 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. 2005. [internet]. [Consultado octubre 2014]. Disponible en:

28. Cheung AK, Sarnak MJ, Yan G, Berkoben M, Heyka R, Kaufman A. et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney int. 2004; 65(6): 2380-9.
No national or foreign publication may partially or totally reproduce or translate Revista Colombiana de Nefrología articles or abstracts without prior written permission from the journal’s Editorial Board.




Download data is not yet available.