RESUMEN
Diabetic kidney disease (DKD) is the leading cause of ESRD. We conducted an open-label, prospective, randomized trial to determine whether pentoxifylline (PTF), which reduces albuminuria, in addition to renin-angiotensin system (RAS) blockade, can slow progression of renal disease in patients with type 2 diabetes and stages 3-4 CKD. Participants were assigned to receive PTF (1200 mg/d) (n=82) or to a control group (n=87) for 2 years. All patients received similar doses of RAS inhibitors. At study end, eGFR had decreased by a mean±SEM of 2.1±0.4 ml/min per 1.73 m(2) in the PTF group compared with 6.5±0.4 ml/min per 1.73 m(2) in the control group, with a between-group difference of 4.3 ml/min per 1.73 m(2) (95% confidence interval [95% CI], 3.1 to 5.5 ml/min per 1.73 m(2); P<0.001) in favor of PTF. The proportion of patients with a rate of eGFR decline greater than the median rate of decline (0.16 ml/min per 1.73 m(2) per month) was lower in the PTF group than in the control group (33.3% versus 68.2%; P<0.001). Percentage change in urinary albumin excretion was 5.7% (95% CI, -0.3% to 11.1%) in the control group and -14.9% (95% CI, -20.4% to -9.4%) in the PTF group (P=0.001). Urine TNF-α decreased from a median 16 ng/g (interquartile range, 11-20.1 ng/g) to 14.3 ng/g (interquartile range, 9.2-18.4 ng/g) in the PTF group (P<0.01), with no changes in the control group. In this population, addition of PTF to RAS inhibitors resulted in a smaller decrease in eGFR and a greater reduction of residual albuminuria.
Asunto(s)
Albúminas/análisis , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/orina , Riñón/efectos de los fármacos , Pentoxifilina/uso terapéutico , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Progresión de la Enfermedad , Femenino , Tasa de Filtración Glomerular , Humanos , Inflamación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proyectos de Investigación , Resultado del TratamientoRESUMEN
Infectious spondylodiscitis is an infection seen with increasing frequency in patients receiving chronic hemodialysis. Often accompanied by bacteremia, it is associated with the use of central venous catheters for hemodialysis access. Initial symptoms can be relatively insidious and nonspecific. Therefore, the clinician must have a low threshold for diagnostic testing that goes beyond blood cultures. This, in addition to early empiric antibiotic therapy, may improve the outcome of this potentially catastrophic infection.
