Prevalence by health areas of chronic kidney disease in the diabetic population of Extremadura in 2012, 2013 and 2014. An observational study.

BACKGROUND AND OBJECTIVE: Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in our country. The objective was to estimate the global prevalence and by health areas of CKD in the diabetic population of Extremadura. METHODS: Observational, longitudinal retrospective study in the diabetic population attended in the Extremadura Health System in 2012-2014. A total of 90,709 patients ≥18 years old were studied. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). The presence of CKD was was defined as follows: an eGFR <60ml/min/1.73m2 in a time period≥of three months or the presence of renal damage, as evaluated by an urine albumin-creatinine ratio (UACR) ≥30mg/g, with or without reduced eGFR, also in a time period ≥ of three months. RESULTS: The overall prevalence of CKD was 15.6% (17.5% in women and 13.7% in men) and it was higher in the province of Cáceres (17.0%) than in Badajoz (14.8%, p<0.001), with the lowest prevalence in the Navalmoral de la Mata health area (13.0%) and the highest in Plasencia (17.8%, p<0.001). The prevalence of CKD defined without the need for confirmation of the sustainability of kidney damage or decreased eGFR was 26.1% (29.3% in women and 22.9% in men), which represents an overestimation of the prevalence of 67%. CONCLUSIONS: The prevalence of CKD in Extremadura's diabetic population is lower than usually referred to and differs significantly between its health areas.

[Active Smoking and Coronary Risk in a Population of a Spanish Health-Care Centre: An Observational Cohort Study]. / Tabaquismo y riesgo coronario en la población de un centro de salud. Estudio de cohortes retrospectivo.

OBJECTIVE: Smoking is a major risk factor for multiple chronic diseases, such as cardiovascular diseases and cancer, and an established risk factor for premature death .The objective was to analyze the association between smoking and total coronary risk (incidence of lethal and non-lethal coronary events) in a cohort of 35-74 years old patients followed for 10 years. METHODS: Longitudinal, observational study of a retrospective cohort followed for ten years in primary care practices in Badajoz (Spain). 1011 patients (mean 55.7 year-old; 56.0% women) without evidence of cardiovascular disease was studied. Multivariate analysis was performed using a binary logistic regression model, introducing as the dependent variable the presence of total coronary events during the follow-up period. RESULTS: 29.1% of the patients were smokers. Smokers were younger (52.1 vs 57.2 years, p smaller than 0.001), with less prevalence of arterial hypertension (46.9% vs 61.5%, p smaller than 0.01), obesity (25.5% vs 31.8%, p=0,055) and lower HDL-cholesterol (45.7 vs 54.0 mg/dl, p smaller than 0.001). During the follow-up, they presented a higher mortality (11.2% vs 6.7%, p smaller than 0.05) and higher incidence of total coronary events (14.3% vs 9.2%, p smaller than 0.05). The final model of the logistic regression multivariate analysis revealed that only smoking and age are predictor variables of total coronary events, the greater odds ratio (OR) corresponding to smoking [OR: 2.33; 95% confidence interval (CI):1.31-4.16; p smaller than 0.01]. CONCLUSIONS: In patients aged 35-74 years followed during 10 years, smoking doubles the risk of total coronary events.

OBJETIVO: El tabaquismo es un importante factor de riesgo para múltiples enfermedades crónicas, tales como enfermedades cardiovasculares y cáncer, y también de muerte prematura. El objetivo fue valorar la relación entre tabaquismo y riesgo coronario total en una cohorte de pacientes de 35 a 74 años de edad. METODOS: Estudio observacional de una cohorte retrospectiva de 1.011 personas (edad media 55,7 años, 56,0% mujeres) sin antecedentes de enfermedades cardiovasculares, seguidas durante 10 años en un centro de salud de Badajoz (Extremadura, España). Se realizó un análisis multivariante mediante regresión logística binaria, incluyéndose como variable dependiente la incidencia de eventos coronarios durante el periodo de seguimiento. RESULTADOS: El 29,1% de la población era fumadora, con menor edad (52,1 vs 57,2 años, p menor que 0,001), menores cifras de colesterol-HDL (45,7 vs 54,0 mg/dl, p menor que 0,001), menor prevalencia de hipertensión arterial (46,9% vs 61,5%, p menor que 0,01) y obesidad (25,5% vs 31,8%, p=0,055) que los pacientes no fumadores. Sin embargo, durante el seguimiento presentaron mayores tasas de mortalidad (11,2% vs 6,7%, p menor que 0,05) e incidencia de eventos coronarios totales (14,3% vs 9,2%, p menor que 0,05). En el análisis multivariante solamente la edad y el tabaquismo se comportaron como variables predictoras de eventos coronarios totales, correspondiendo al tabaquismo las mayores odds ratio (OR: 2,33; IC95%:1,31-4,16; p menor que 0,01). CONCLUSIONES: En personas de 35 a 74 años seguidos durante 10 años el consumo de tabaco duplica el riesgo de eventos coronarios.