Unmet Needs of CKD in Latin America: A Review from Expert Virtual Working Group.

Chronic kidney disease (CKD) represents a major challenge for Latin American (LatAm) because of its epidemic proportions. Therefore, the current status and knowledge of CKD in Latin America is not clearly understood. Moreover, there is a paucity of epidemiologic studies that makes the comparison across the countries even more difficult. To address these gaps, a virtual kidney expert opinion meeting of 14 key opinion leaders from Argentina, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Guatemala, Mexico, and Panama was held in January 2022 to review and discuss the status of CKD in various LatAm regions. The meeting discussed the following: (i) epidemiology, diagnosis, and treatment of CKD, (ii) detection and prevention programs, (iii) clinical guidelines, (iv) state of public policies about diagnosis and management of chronic kidney disease, and (v) role of innovative therapies in the management of CKD. The expert panel emphasized that efforts should be made to implement timely detection programs and early evaluation of kidney function parameters to prevent the development or progression of CKD. Furthermore, the panel discussed the importance of raising awareness among health care professionals; disseminating knowledge to the authorities, the medical community, and the general population about the kidney and cardiovascular benefits of novel therapies; and the need for timely updating of clinical practice guidelines, regulatory policies, and protocols across the region.

Primeras recomendaciones de consenso SLANH - COLABIOCLI / Primeiras Recomendações de Consenso SLANH - COLABIOCLI / (Sociedad Latinoamericana de Nefrología e Hipertensión - Confederación Latinoamericana de Bioquímica Clínica) / Informe de la tasa de filtración glomerular estimada junto a la determinación de la creatininemia en población adulta / First SLANH-COLABIOCLI Consensus Recommendations

Resumen La enfermedad renal crónica (ERC) es de alta prevalencia en América Latina y en todo el mundo. Se estima que entre 10 y 20% de la población adulta es portadora de ERC y su prevalencia va en aumento. La ERC progresa en forma silenciosa. Su diagnóstico temprano y oportuno permite iniciar un tratamiento efectivo, en la mayoría de los casos, para detener la enfermedad. Desde hace mucho tiempo, el análisis de la creatininemia es la principal prueba utilizada para valorar la función renal, pero su confiabilidad es limitada. De acuerdo con las recomendaciones de las GUIAS KDOQI del año 2002 la tasa de filtración glomerular estimada (TFGe) obtenida a través de fórmulas, se estableció como una de las herramientas principales para detectar la enfermedad renal de manera precoz, ya que alerta de forma precisa al médico y al equipo de salud sobre el nivel de función renal del paciente. La detección de una TFGe disminuida (menor de 60 mL/min/1,73 m2) es clínicamente relevante, ya que permite establecer el diagnóstico de enfermedad renal en adultos. En el año 2022, en una encuesta realizada por SLANH y COLABIOCLI dirigida a los laboratorios de análisis clínicos de América Latina (n: 237), el 49% de los mismos no informaban la TFGe rutinariamente. En base a esta realidad SLANH y COLABIOCLI elaboraron estas recomendaciones de consenso en referencia al uso de la TFGe.

Abstract Chronic kidney disease (CKD) has a high prevalence worldwide and in Latin America (10 to 20% of the adult population) and is increasing. CKD progresses silently. Opportune diagnosis and treatment are effective in most cases to improve outcomes. Serum creatinine was the main test to assess kidney function, but its reliability is limited. Through the KDOQI Guidelines 2002, the estimated glomerular filtration rate (eGFR) obtained from equations was established as one of the main tools for the early detection of kidney disease in clinical practice. The detection of a decreased eGFR (less than 60 mL/min/1.73 m2) is clinically relevant. This cut-off level establishes the diagnosis of kidney disease in adults. In 2022 SLANH and COLABIOCLI conducted a survey among the clinical laboratories from Latin America. The survey included 237 laboratories, 49% of which did not routinely report the eGFR. Based on this situation, SLANH and COLABIOCLI have elaborated the following consensus recommendations regarding the use of eGFR.

Resumo A doença renal crônica (DRC) é altamente prevalente na América Latina e em todo o mundo. Estima-se que entre 10 e 20% da população adulta seja portadora de DRC e sua prevalência esteja aumentando. A DRC progride silenciosamente. Seu diagnóstico precoce e oportuno permite iniciar um tratamento eficaz, na maioria dos casos, para estancar a doença. Faz muito tempo, a análise da creatinina tem sido o principal teste usado para avaliar a função renal mas sua confiabilidade é limitada. De acordo com as recomendações dos GUIAS KDOQI do ano de 2002, a estimativa da taxa de filtração glomerular (eGFR), obtida por meio de fórmulas, consolidou-se como uma das principais ferramentas para a detecção precoce da doença renal, visto que alerta com precisão ao médico e ao equipe de saúde sobre o nível de função renal do paciente. A detecção de uma eGFR diminuída (inferior a 60 mL/min/1,73 m2) é clinicamente relevante, pois permite estabelecer o diagnóstico de doença renal em adultos. No ano de 2022, em pesquisa realizada pela SLANH e COLABIOCLI dirigida a laboratórios de análises clínicas da América Latina (n: 237), 49% deles não relataram rotineiramente eGFR. Com base nessa realidade, SLANH e COLABIOCLI prepararam essas recomendações de consenso sobre o uso de eGFR.

COVID-19 among Chronic Dialysis Patients after First Year of Pandemic, Argentina.

We performed a descriptive study to characterize effects from COVID-19 among chronic dialysis patients compared with the general population in Argentina during March 2020-February 2021. COVID-19 case-fatality rate of chronic dialysis patients was 10 times the national rate; the age-standardized mortality ratio was 6.8 (95% CI 6.3-7.3).

Cuarta Encuesta Nacional de Factores de Riesgo. Visión Nefrológica de los Principales Resultados / Fourth National Survey of Risk Factors. Analysis of the Main Results From a Nephrological Point of View

Resumen La vigilancia epidemiológica constituye una herramienta fundamental de la salud pública, dado que proporciona información confiable y en el momento oportuno para planificar, aplicar y evaluar políticas sanitarias, a nivel local, regional y nacional. El Sistema Nacional de Vigilancia en Salud está desarrollado tanto para enfermedades transmisibles como para enfermedades no transmisibles, dentro del cual se encuentran los sistemas de vigilancia de enfermedades crónicas. La Encuesta Nacional de Factores de Riesgo forma parte del Sistema de Vigilancia de Enfermedades no Transmisibles y del Sistema Integrado de Encuestas a Hogares, proporcionando información válida, confiable y oportuna sobre factores de riesgo (consumo de tabaco, alcohol, alimentación, actividad física, etc.), procesos de atención en el sistema de salud, y principales enfermedades no transmisibles en la población argentina (hipertensión, diabetes y obesidad, entre otras).

Abstract Epidemiologic surveillance constitutes a fundamental tool for public health, given it provides reliable information at the right time to plan, implement and evaluate health policies at a local level as well as at a regional/national one. The National Health Surveillance System was developed both for communicable diseases and non-communicable diseases; the latter fall within the scope of chronic disease surveillance systems. The National Survey of Risk Factors, which is part of the Non-communicable Diseases Surveillance System and the Household Survey Integrated System, provides timely, reliable, valid information about risk factors (e.g. smoking, alcohol, diet, physical activity); attention processes in the health system and main NCD in the argentine population (hypertension, diabetes, obesity, among others).

Dialysis for acute kidney injury associated with influenza a (H1N1) infection.

In June 2009, the World Health Organization declared a novel influenza A, S-OIV (H1N1), pandemic. We observed 44 consecutive patients during the "first wave" of the pandemic. 70.5% of them showed co-morbidities (hypertension, obesity, chronic respiratory diseases, chronic renal disease, diabetes, pregnancy). Serious cases were admitted to the intensive care unit (ICU), particularly those with severe acute respiratory failure. Some of them developed acute kidney injury (AKI) and required renal replacement therapy (RRT). The average time between admission to the ICU and initiation of RRT was 3.16 ± 2.6 days. At initiation of RRT, most patients required mechanical ventilation. No relationship was found with creatinine-kinase levels. Seventy-five percent of the cases were observed during a 3-week period and mortality, related to respiratory failure, doubling of alanine amino transferase and use of inotropics was 81.8%. In conclusion, the H1N1-infected patients who developed RRT-requiring AKI, in the context of multi-organ failure, showed a high mortality rate. Thus, it is mandatory that elaborate strategies aimed at anticipating potential renal complications associated to future pandemics are implemented.

Evolución de pacientes con diálisis aguda asociada a infección por Influenza A (H1N1) pandémica en 2009 / Evolution of patients with acute dialysis associated to Influenza A pandemic infection (H1N1) in 2009

En junio de 2009 la OMS declaró la pandemia por un nuevo virus de la Influenza A, S-OIV (H1N1). Casos severos fueron hospitalizados en UTI con falla respiratoria aguda. Alguno de estos casos desarrollaron injuria renal aguda y requirieron terapias de reemplazo renal (TRR). Durante el período de mayor incidencia observamos 44 casos consecutivos. 70,5% de estos presentaron comorbilidades (hipertensión, obesidad, enfermedades respiratorias crónicas, enfermedad renal crónica, diabetes, embarazo, otras). El tiempo promedio desde el ingreso a UTI y el comienzo de la TRR fue 3.16 +- 2.6 días. Al inicio de la TRR la mayoría de los pacientes presentaban SOFA score > - 10, presentando fallas cardiovascular y respiratoria. No hubo correlación con los niveles de CK. El 75% de los casos se observaron en un período de tres semanas de pandemia y un porcentaje alto presentaban aumento de enzimas hepáticas, necesidad de inotrópicos, ventilación mecánica y la mortalidad fue superior al 80%. En resumen, los pacientes infectados con S-OIV (H1N1) que requirieron TRR en contexto de falla multiparenquimatosa, presentaron una alta tasa de mortalidad. La experiencia dejada puede ayudarnos a desarrollar estrategias para anticipar potenciales complicaciones renales en futuras pandemias.

Recomendaciones prácticas sobre tratamiento antiagregante y anticoagulante en pacientes en diálisis / Practical recommendations about anti-aggregant and anticoagulant treatment in dialysis patients

La terapéutica antiagregante plaquetaria ha demostrado ser de utilidad tanto en la prevención primaria como en la secundaria de los eventos cardiovasculares y cerebrovasculares en los pacientes con IRC en diálisis. No hay estudios que puedan determinar la utilidad en el tratamiento de la enfermedad vascular periférica pero extrapolando los resultados obtenidos en la población no renal, se asume que son de utilidad.

Resistive index and chronic allograft nephropathy evaluated in protocol biopsies as predictors of graft outcome.

INTRODUCTION: The presence of chronic allograft nephropathy (CAN) in protocol biopsies is negatively associated with graft survival. Although recent studies have indicated that the resistive index (RI) is a predictor of graft failure, it does not correlate with CAN in stable grafts. We therefore studied the relationship between RI and CAN and examined the predictive value of both parameters on graft outcome. METHODS: Included were patients transplanted between 1997 and 2002 and who had protocol biopsies and RI determinations. Renal lesions were blindly evaluated according to Banff 97 criteria. Mean glomerular volume, cortical interstitial volume fraction and intimal arterial volume fraction were estimated using a point counting technique. RI was determined before biopsy in at least two different renal locations. The outcome variable was defined as graft failure or a 30% serum creatinine increase between protocol biopsy and last follow-up. RESULTS: Eighty-seven patients were included. RI correlated with recipient age (R = 0.52, P < 0.0001), diastolic blood pressure (R = -0.36, P = 0.0006), pulse pressure index (R = 0.27, P = 0.009) and g-score for histological glomerulitis (rho = 0.30, P = 0.0054), but there were no correlations between RI and chronic Banff scores or any morphometric parameter. The presence of CAN (relative risk, 3.5; 95% confidence interval 1.2-10.2; P = 0.02) but not RI was associated with the outcome variable. CONCLUSION: RI was associated with surrogate measures of vascular compliance such as recipient age and pulse pressure index but not with chronic allograft damage, even when it was evaluated by histomorphometry. Our results indicate that histology may be superior to RI in predicting graft function deterioration, at least in patients with stable renal function.