{"id":1113,"date":"2020-07-23T12:26:01","date_gmt":"2020-07-23T10:26:01","guid":{"rendered":"https:\/\/fjarno.org\/revista-renal\/?p=1113"},"modified":"2020-07-27T10:09:57","modified_gmt":"2020-07-27T08:09:57","slug":"la-set-com-sobreviure-i-no-sobrebeure","status":"publish","type":"post","link":"https:\/\/fjarno.org\/revista-renal\/la-set-com-sobreviure-i-no-sobrebeure\/","title":{"rendered":"La set. Com sobreviure i no sobrebeure"},"content":{"rendered":"

Annabel Mart\u00ednez Mu\u00f1oz<\/span>
\nNutricionista-Dietista
\nCAT001373<\/span><\/p>\n

Esther Jim\u00e9nez Garriga<\/span>
\nPsic\u00f2loga sanit\u00e0ria i Psicoanalista
\nN\u00ba Col. 21600<\/span><\/p>\n

La malaltia renal cr\u00f2nica (MRC) es caracteritza per diferents estadis que depenen de la disminuci\u00f3 de la funci\u00f3 renal, motiu pel qual a mesura que s\u2019avan\u00e7a d\u2019estadi, s\u2019introdueixen canvis en el tractament m\u00e8dic, m\u00e9s restriccions diet\u00e8tiques i m\u00e9s probabilitat que apareguin s\u00edmptomes depressius i ansiosos. En el cas del tractament renal substitutiu (di\u00e0lisi), s\u2019hi ha de sumar la restricci\u00f3 de l\u00edquids<\/strong>, que \u00e9s la part que m\u00e9s dificultat ocasiona en les persones amb MRC i la que menys se segueix, la qual cosa augmenta de manera notable la dificultat d\u2019adher\u00e8ncia al tractament.<\/p>\n

La pauta[1]<\/sup><\/a> d\u2019ingesta de l\u00edquids di\u00e0ria \u00e9s de 500 ml + di\u00fcresi[2]<\/sup><\/a><\/strong> (en an\u00faria[3]<\/sup><\/a><\/strong>, 500 ml)<\/strong>, que inclou les necessitats basals corporals i el contingut h\u00eddric dels aliments.
\nLa literatura cient\u00edfica dona suport al fet que superar aquestes indicacions \u00e9s perjudicial, ja que si hi ha una hiperhidrataci\u00f3 en pacients de di\u00e0lisi, apareix augment<\/strong> de la tensi\u00f3 arterial<\/strong> i una superviv\u00e8ncia menor<\/strong>. A m\u00e9s, un augment del pes corporal provocat per una retenci\u00f3 de l\u00edquids afavoreix l\u2019aparici\u00f3 d\u2019altres complicacions m\u00e8diques, com edemes pulmonars o insufici\u00e8ncia card\u00edaca.
\n\u00c9s \u00f2ptim guanyar uns dos litres de l\u00edquid entre les sessions de di\u00e0lisi per restablir la hidrataci\u00f3 normal i, per tant, evitar complicacions. No obstant aix\u00f2, mantenir aquestes condicions \u00f2ptimes requereix acceptar la malaltia<\/strong>, molta educaci\u00f3 nutricional<\/strong> i for\u00e7a de voluntat<\/strong>, i per desgr\u00e0cia, quan es pateix set acaba sent dif\u00edcil mantenir-ho.<\/p>\n

La set \u00e9s un mecanisme fisiol\u00f2gic que regula l\u2019equilibri h\u00eddric corporal quan hi ha una deshidrataci\u00f3 o un augment de les sals minerals. En persones amb malaltia renal cr\u00f2nica, per\u00f2, la set dona compte de com la ingesta de menjar<\/strong> o aigua<\/strong> est\u00e0 desnaturalitzada<\/strong> en els humans, no funciona per pura necessitat. Aix\u00ed doncs, el cos necessita una quantitat d\u2019aigua en mesura, per\u00f2 n\u2019ingereix m\u00e9s tot i que sap i sent els efectes adversos que provoca aquest exc\u00e9s de l\u00edquid.<\/p>\n

En la restricci\u00f3 de l\u00edquids hi ha un doble paradigma: d\u2019una banda, el pacient en di\u00e0lisi s\u2019ha de protegir de quelcom que la resta de la poblaci\u00f3 utilitza com a signe de salut: beure aigua. De l\u2019altra, el fet autoterap\u00e8utic, que seria tractar la dificultat per controlar la ingesta de l\u00edquid com si es tract\u00e9s d\u2019una addicci\u00f3, \u00e9s a dir, com una depend\u00e8ncia patol\u00f2gica<\/strong>, i que es manifesta com una resposta inconscient del subjecte per fer front a la situaci\u00f3 insuportable en qu\u00e8 es troba. L\u2019autoter\u00e0pia funciona envers l\u2019elecci\u00f3 d\u2019un objecte, una subst\u00e0ncia o una situaci\u00f3, en aquest cas, l\u2019aigua, que la persona acaba assumint com una funci\u00f3 de catalitzador<\/strong> irresistible del gaudi. El subjecte \u00e9s emp\u00e8s en certs moments i de manera inexorable cap al consum de la subst\u00e0ncia o de la situaci\u00f3 que el fa gaudir[4]<\/sup><\/a> (Cosenza, 2019).<\/p>\n

Quan parlem de di\u00e0lisi, aquest consum queda restringit i s\u2019han de tenir en compte no nom\u00e9s les begudes, sin\u00f3 tamb\u00e9 altres aliments amb textura o contingut elevats en aigua:<\/p>\n

\"Aliments<\/p>\n

No obstant aix\u00f2, no n\u2019hi ha prou de comptar amb aquests coneixements, perqu\u00e8 controlar la restricci\u00f3 de l\u00edquids \u00e9s un proc\u00e9s ple de daltabaixos, motiu pel qual s\u2019ha realitzat una petita recollida de trucs i idees que utilitzen les persones que fan hemodi\u00e0lisi o di\u00e0lisi peritoneal per afrontar la set.<\/p>\n

Tanmateix, des del vessant de la psiconutrici\u00f3, \u00e9s important potenciar una atenci\u00f3 nutricional individualitzada i totalment adaptada a cada cas en particular i en qu\u00e8 l\u2019acompanyament psicol\u00f2gic permet analitzar i, per tant, desconstruir les in\u00e8rcies adherides a les conductes pulsionals.<\/p>\n

\"Els\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \"Disposes<\/div>\n
<\/div>\n
<\/div>\n

Agra\u00efments a <\/strong>Carmen Hidalgo, Juan Jos\u00e9 Gasco, Yassy Vega, Ignacio Gracia i Marisol Robles per la seva col\u00b7laboraci\u00f3.<\/p>\n

 <\/p>\n

[1]<\/sup><\/a> En di\u00e0lisi peritoneal, la ingesta de l\u00edquid pot ser m\u00e9s elevada que en hemodi\u00e0lisi i adaptar-se a les concentracions del l\u00edquid de di\u00e0lisi.<\/p>\n

[2]<\/sup><\/a> La di\u00fcresi \u00e9s la secreci\u00f3 d\u2019orina.<\/p>\n

[3]<\/sup><\/a> L\u2019an\u00faria \u00e9s la suspensi\u00f3 en la secreci\u00f3 d\u2019orina.<\/p>\n

[4]<\/sup><\/a> En psicoan\u00e0lisi, el terme gaudi<\/em> \u00e9s un dels m\u00e9s amplis i complexos. No es refereix al plaer, sin\u00f3 m\u00e9s aviat a la satisfacci\u00f3 de la insatisfacci\u00f3.<\/p>\n

\nBIBLIOGRAFIA<\/strong><\/p>\n
    \n
  1. Carmelo Iborra-Molt\u00f3 S, L\u00f3pez-Roig MAP (2012). Prevalencia de la adhesi\u00f3n a la restricci\u00f3n de l\u00edquidos en pacientes renales en hemodi\u00e1lisis: indicador objetivo y adhesi\u00f3n percibida. Nefrologia 2012;32(4):477-85.<\/li>\n
  2. Huarte-Loza E (coord.), Barril-Cuadrado G, Cebollada-Muro J, Cerezo-Morales S, Coronel-D\u00edaz F, Do\u00f1ate-Cubells T et al. Grupo de Consenso de la Sociedad Espa\u00f1ola de Di\u00e1lisis y Trasplante. Nutrici\u00f3n en pacientes en di\u00e1lisis. Consenso SEDYT. Dial Traspl2006;27(4):138-61.<\/li>\n
  3. Crist\u00f3v\u00e3o AF. Dificultades y estrategias en el manejo del r\u00e9gimen terap\u00e9utico en el paciente renal cr\u00f3nico en hemodi\u00e1lisis. Enferm Nefrol. 2013;16(4):247-55.<\/li>\n
  4. Ruiz Vaca AM, Mu\u00f1oz Garc\u00eda VE, Garc\u00eda Vega JL, Maanan NM, Garc\u00eda Criado J, Bagdad Abselam A. Rasgos de personalidad, edad, cultura y restricciones h\u00eddricas y diet\u00e9ticas en pacientes en hemodi\u00e1lisis. Rev Soc Esp Enferm Nefrol [Internet]. Juny de 2011 [citat el 5 de juny de 2020];14(2).<\/li>\n
  5. Consenza D. (2019). La comida y el inconsciente. Psicoan\u00e1lisis y los trastornos alimentarios<\/em>. Espa\u00f1a: Ned Ediciones.<\/li>\n
  6. Luis Rom\u00e1n D, Bustamante J. Aspectos nutricionales en la insuficiencia renal. Nefrolog\u00eda [1 jul 2008]; 28(3):333-42.<\/li>\n<\/ol>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Annabel Mart\u00ednez Mu\u00f1oz Nutricionista-Dietista CAT001373 Esther Jim\u00e9nez Garriga Psic\u00f2loga sanit\u00e0ria i Psicoanalista N\u00ba Col. 21600 La malaltia renal cr\u00f2nica (MRC) es caracteritza per diferents estadis que depenen de la disminuci\u00f3 de la funci\u00f3 renal, motiu pel qual a mesura que s\u2019avan\u00e7a d\u2019estadi, s\u2019introdueixen canvis en el tractament m\u00e8dic, m\u00e9s restriccions diet\u00e8tiques i m\u00e9s probabilitat que […]<\/p>\n","protected":false},"author":3,"featured_media":1115,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[25,30],"tags":[32],"class_list":{"0":"post-1113","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-frja","8":"category-psiconutricio","9":"tag-numero-3"},"yoast_head":"\nLa set. 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