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BACKGROUND: Data about vascular access (VA) use in failed kidney transplant (KT) patients returning to haemodialysis (HD) are limited. We analysed the VA profile of these patients, the factors associated with the likelihood of HD re-initiation through fistula (AVF) and the effect of VA in use at the time of KT on kidney graft (KTx) outcome. METHOD: Data from the Catalan Registry on failed KT patients restarting HD and incident HD patients with native kidney failure were examined over an 18-year period. RESULTS: The VA profile of 675 failed KT patients at HD re-initiation compared with that before KT and with 16,731 incident patients starting HD was (%): AVF 79.3 versus 88.6 and 46.2 (p = 0.001 and p < 0.001), graft AVG 4.4 versus 2.6 and 1.1 (p = 0.08 and p < 0.001), tunnelled catheter TCC 12.4 versus 5.5 and 18.0 (p = 0.001 and p < 0.001) and non-tunnelled catheter 3.9 versus 3.3 and 34.7 (p = 0.56 and p < 0.001). The likelihood of HD re-initiation by AVF was significantly lower in patients with cardiovascular disease, KT duration >5 years, dialysed through AVG or TCC before KT, and females. The analysis of Kaplan-Meier curves showed a greater KTx survival in patients dialysed through arteriovenous access than in patients using catheter just before KT (λ2 = 5.59, p = 0.0181, log-rank test). Cox regression analysis showed that patients on HD through arteriovenous access at the time of KT had lower probability of KTx loss compared to those with catheter (hazard ratio 0.71, 95% CI 0.55-0.90, p = 0.005). CONCLUSIONS: The VA profile of failed KT patients returning to HD and incident patients starting HD was different. Compared to before KT, the proportion of failed KT patients restarting HD with AVF decreased significantly at the expense of TCC. Patients on HD through arteriovenous access at the time of KT showed greater KTx survival compared with those using catheter.
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BACKGROUND: Some studies reveal that obesity is associated with a decrease in mortality in haemodialysis (HD) patients. However, few studies have addressed the association between body mass index (BMI) and peritoneal dialysis (PD) patients. METHODS: We performed this longitudinal, retrospective study to evaluate the impact of obesity on PD patients, using data from the Catalan Registry of Renal Patients from 2002 to 2015 (n = 1573). Obesity was defined as BMI ≥30; low weight: BMI <18.5; normal range: BMI = 18.5-24.99; and pre-obesity: BMI = 25-29.99 kg/m2. Variations in BMI were calculated during follow-up. The main outcomes evaluated were the technique and patient survival. RESULTS: Obesity was observed in 20% of patients starting PD. We did not find differences in sex or PD modality, with the obesity group being older (65.9% are ≥55 years versus 59% non-obese, P = 0.003) and presenting more diabetes mellitus and cardiovascular disease (CVD) (47.9% obese versus 25.1% non-obese and 41.7% versus 31.5%, respectively). We did not observe differences in haemoglobin, albumin and Kt/V in obese patients. Regarding peritonitis rate, we did not find any difference between groups, presenting more peritonitis patients on continuous ambulatory peritoneal dialysis and aged ≥65 years [sub-hazard ratio (SHR) = 1.75, P = 0.000 and SHR = 1.56, P = 0.009]. In relation to technique survival, we found higher transfer to HD in the obese group of patients in the univariate analysis, which was not confirmed in the multivariate analysis (SHR = 1.12, P = 0.4), and we did not find differences in mortality rate. In relation to being transplanted, the underweight group, elderly and patients with CVD or diabetic nephropathy presented less probability to undergo kidney transplantation (SHR = 0.65, 0.24, 0.5 and 0.54, P < 0.05). Obese patients did not present differences in survival with weight changes but in normal-weight patients, a gain of 7% of the basal weight during the first year had a protective effect on death risk (hazard ratio 0.6, P = 0.034). CONCLUSIONS: Obese and non-obese patients starting on PD had similar outcomes.
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BACKGROUND: Measures of fear of progression or recurrence of illnesses have been criticized for neglecting cross-cultural validity. Therefore, we assessed the psychometric properties of the Spanish version of the Fear of Kidney Failure Questionnaire (FKFQ), to determine whether postdonation fear of kidney failure (FKF) influenced the donors' psychosocial status, and define variables that characterized donors with high FKFQ scores. METHODS: We included 492 participants (211 donors) in a multicenter, 11-year, retrospective, cross-sectional study. Donors were classified with a Latent Class Analysis of the FKFQ-item scores and characterized with a multivariable logistic regression analysis. We calculated the risk ratio based on predicted marginal probabilities. RESULTS: The Spanish version of the FKFQ showed acceptable psychometric properties. FKF was uncommon among donors, but we detected a small subgroup (n = 21, 9.9%) with high FKF (mean FKFQ score = 14.5, 3.1 SD). Compared with other donors, these donors reported higher anxiety and depression (38% and 29% of potential anxiety and depressive disorders), worse quality of life, and less satisfaction with the donation. Donors with high FKFQ scores were characterized by higher neuroticism combined with postdonation physical symptoms that interfered with daily activities. CONCLUSIONS: The FKFQ was cross-culturally valid, and thus, it may be used to assess the FKF in Spanish-speaking donors. New interventions that promote positive affectivity and evidence-based treatments for worry could be adapted for treating FKF.
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BACKGROUND: Obese kidney allograft recipients have worse results in kidney transplantation (KT). However, there is lack of information regarding the effect of body mass index (BMI) variation after KT. The objective of the study was to evaluate the effects of body weight changes in obese kidney transplant recipients. METHODS: In this study we used data from the Catalan Renal Registry that included KT recipients from 1990 to 2011 (n = 5607). The annual change in post-transplantation BMI was calculated. The main outcome variables were delayed graft function (DGF), estimated glomerular filtration rate (eGFR) and patient and graft survival. RESULTS: Obesity was observed in 609 patients (10.9%) at the time of transplantation. The incidence of DGF was significantly higher in obese patients (40.4% versus 28.3%; P < 0.001). Baseline obesity was significantly associated with worse short- and long-term graft survival (P < 0.05) and worse graft function during the follow-up (P < 0.005). BMI variations in obese patients did not improve eGFR or graft or patient survival. CONCLUSIONS: Our conclusion is that in obese patients, decreasing body weight after KT does not improve either short-term graft outcomes or long-term renal function.
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BACKGROUND: Patient survival with end-stage renal disease is longer after kidney transplantation (KT) compared with those remaining on dialysis. Nevertheless, this remains uncertain when receiving a kidney from a donor ≥80 years old. METHODS: In a longitudinal mortality study in the Catalan Renal Registry including 2585 patients ≥60 years old on dialysis and placed on the KT waiting list, 1084 received a first KT from a deceased donor aged 60 to 79 years and 128 from a deceased donor ≥80 years. We calculated adjusted risk of graft loss by means of competing-risks regression, considering patient death with functioning graft as a competing event. To assess patient survival benefit from KT, we calculated the adjusted risk of death by nonproportional hazard analysis, taking the fact of being transplanted as a time-dependent effect. Considering all KT ≥60 (n = 1212), we assessed whether the benefit of KT varied per different recipient characteristics by calculating the interaction effect between all potential mortality risk factors and the treatment group. RESULTS: Compared with kidneys from donors 60 to 79 years old, graft survival was significantly lower for kidneys from donors aged ≥80 years (subhazard ratio = 1.55; 95% confidence interval, 1.00-2.38; P = 0.048). In comparison with those who remained on dialysis, adjusted risk of death 12 months after transplantation in recipients with a kidney from donors ≥80 years was 0.54 (95% confidence interval, 0.38-0.77; P < 0.0001). CONCLUSIONS: Despite KT from octogenarian deceased donors being associated with reduced graft survival, recipients had lower mortality rates than those remaining on dialysis, even if the kidney came from an extremely aged donor.
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Seleção do Doador/normas , Sobrevivência de Enxerto , Falência Renal Crônica/terapia , Transplante de Rim/normas , Listas de Espera/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Falência Renal Crônica/mortalidade , Transplante de Rim/efeitos adversos , Transplante de Rim/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Although kidney transplantation from the donation of a living donor is a safe treatment for end-stage renal disease, inferences about safety of living kidney donors might be biased by an informative censoring caused by the noninclusion of a substantial percentage of donors lost to follow-up. With the aim of assessing the presence of a potential informative censoring in living kidney donation outcomes of Catalan donors for a period of 12 years, 573 donors followed and lost to follow-up were compared. Losses of follow-up over time were also assessed by univariate and multivariate survival analysis, along with Cox regression. Younger and older ages, and the death of their recipient differentiated those donors who were lost to follow-up over time. The risk of dropping out from follow-up was more than twofold for the youngest and oldest donors, and almost threefold for those donors whose recipient died. Results of studies on postdonation outcomes of Catalan living kidney donors might have overlooked older and younger cases, and, remarkably, a percentage of donors whose recipient died. If these donors showed a higher incidence of psychological problems, conclusions about living donors' safety might be compromised thus emphasizing the necessity of sustained surveillance of donors and prompt identification of these cases.
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Transplante de Rim/mortalidade , Doadores Vivos/psicologia , Pacientes Desistentes do Tratamento/psicologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Análise de Sobrevida , Doadores não Relacionados/psicologiaRESUMO
INTRODUCTION: Variations in the use of healthcare services can be defined as systematic variations of adjusted rates for certain aggregation levels of the population. The study analyses how renal replacement therapy (RRT) is used, identifying RRT variability in Catalonia from 2002 to 2012. MATERIAL AND METHODS: Ecological study by health area using data from the Catalan renal registry. We present incident rates, standardised incidence ratios and prevalence, while variability was calculated through direct and indirect standardisation methods. RESULTS: From 2002 until 31/12/2012, 10,784 patients initiated RRT in Catalonia: 9,238 on haemodialysis (HD) (50 treatments per 100,000 people 2010/2012), 1,076 on peritoneal dialysis (PD) (8.2 treatments per 100,000 people 2010/2012) and 470 received an early kidney transplant (KT) (4.4 treatments per 100,000 people 2010/2012). Over the 10 years, the HD cumulative incidence rate fell (7%), while the PD and KT incidence rates increased (63% and 177%, respectively); both are higher in young patients (<45 years). 4,750 patients received a kidney transplant in this period, 49% of which were aged between 45 and 65 years. There were no significant differences in variability in HD (RV5-95=1.3; Empirical Bayes [EB]â¼ 0), or in the prevalence of KT (RV5-95=1.4; EB â¼ 0). Nevertheless, we found significant geographical variability in PD; notably in the districts of the province of Lérida, where the number of cases observed was greater than expected (RV5-95=4.01; EB=0.08). CONCLUSION: Although there was a notable rise in PD and early KT incidence rates, PD is still underused when compared to international recommendations. No territorial variability was found for HD or KT, but the use of PD was found to be higher in Lérida than in other areas. To reduce PD territorial variability and increase the uptake of this technique in the other regions, we propose 3initiatives: The development of RRT support tools for shared decision-making, the encouragement of specific PD professional training and the promotion of PD through complementary reimbursement systems.
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Terapia de Substituição Renal/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Fatores de TempoRESUMO
PURPOSE: The vascular access (VA) used at hemodialysis (HD) inception is involved in the mortality risk. We analyzed the survival of incident patients over time according to the initial VA and the VA profile of patients who died during the first year of follow-up. METHODS: Data of VA were obtained from 9956 incident HD patients from the Catalan Registry. RESULTS: Over 12 years, 47.9% of patients initiated HD with a fístula, 1.2% with a graft, 15.9% with a tunneled catheter and 35% with an untunneled catheter. Regarding fistula use, the hazard ratio of death for all-causes over time when applying a multivariate competing risk model was 1.55 [95% confidence interval (CI): 1.42-1.69] and 1.43 (95% CI: 1.33-1.54) for patients with tunneled and untunneled catheter, respectively. During the first year of follow-up, the crude all-cause mortality rate (deaths/100 patient-years) was higher during the early (first 120 days) compared to the late (121-365 days) period: 18.3 (95% CI: 16.8-19.8) versus 15.4 (95% CI: 14.5-16.5). Regarding fistula use, for patients using untunneled and tunneled catheter, the odds ratio of death in the early period for all-causes was 3.66 (95% CI: 2.80-4.81) and 2.97 (95% CI: 2.17-4.06), for cardiovascular causes it was 2.76 (95% CI: 1.90-4.01) and 1.84 (95% CI: 1.17-2.89) and for infection-related causes it was 6.62 (95% CI: 3.11-14.05) and 4.58 (95% CI: 2.00-10.52), respectively. CONCLUSIONS: Half of all incident patients in Catalonia are exposed to excessive mortality risk related to catheter and this scenario can be improved by early fistula placement.
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Derivação Arteriovenosa Cirúrgica/mortalidade , Implante de Prótese Vascular/mortalidade , Cateterismo Venoso Central/mortalidade , Diálise Renal/mortalidade , Adolescente , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Distribuição de Qui-Quadrado , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Sistema de Registros , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004-2011 (period of use of highly active antiretroviral therapy [HAART] in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1,000 patients on RRT (95% confidence interval [CI] 4.4-5.8. Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95% CI 1.74 - 2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95% CI 1.10 - 2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95% CI: 0.10-0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.
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Infecções por HIV/complicações , Insuficiência Renal Crônica/complicações , Terapia de Substituição Renal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Antirretroviral de Alta Atividade , Comorbidade , Nefropatias Diabéticas/complicações , Progressão da Doença , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Incidência , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Espanha , Adulto JovemRESUMO
PURPOSE: Arteriovenous fístula is the best vascular access (VA) for hemodialysis. We analyzed the VA used at first session and the factors associated with the likelihood to start hemodialysis by fistula in 2000-2011. METHODS: Data of VA type were obtained in 9,956 incident hemodialysis patients from the Catalan Registry. RESULTS: Overall, 47.9% of patients initiated hemodialysis with a fistula, 1.2% with a graft, 15.9% with a tunneled catheter and 35% with an untunneled catheter. The percentage of incident patients with fistula and catheter has remained stable at around 50% over the years. The likelihood to start hemodialysis with fistula was significantly lower in females [adjusted odds ratio: 0.69, 95% confidence interval (CI): 0.61-0.75], patients aged 18-44 years (0.78, 95% CI: 0.64-0.94), patients with comorbidity (0.67, 95% CI: 0.60-0.75) and tended to be lower in patients aged over 74 years (0.89, 95% CI: 0.78-1.01). The probability to use fistula was significantly higher in patients with polycystic kidney disease (2.08, 95% CI: 1.63-2.67), predialysis nephrology care longer than 2 years (4.14, 95% CI: 3.63-4.73) and steady chronic kidney disease (CKD) progression (10.97, 95% CI: 8.41-14.32). During 1 year of follow-up, 67.2% and 59.6% of patients using untunneled and tunneled catheter changed to fistula, respectively. CONCLUSIONS: Starting hemodialysis by fistula was related with nonmodifiable patient characteristics and modifiable CKD practice processes, such as predialysis care duration. Half of the incident patients were exposed annually in Catalonia to potential catheter complications. This scenario can be improved by optimizing the processes of CKD care.
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Derivação Arteriovenosa Cirúrgica/tendências , Implante de Prótese Vascular/tendências , Cateterismo Venoso Central/tendências , Padrões de Prática Médica/tendências , Diálise Renal/tendências , Insuficiência Renal Crônica/terapia , Adolescente , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Seleção de Pacientes , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Sistema de Registros , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The obesity paradox of hemodialysis patients (the association between obesity and survival) could be modified by age. We hypothesize that whereas obesity associates with survival in elderly patients, it behaves as a mortality risk marker in younger individuals. METHODS: Retrospective study of 2002-2010 adult incident hemodialysis to analyze the relationship between body mass index (BMI) and annual body weight changes with mortality in different age strata. RESULTS: Included in the study were 6,290 individuals. A progressive decrease in mortality was associated with increasing BMI ranges. Both annual body weight gains and losses were associated with mortality. Similar results were observed in elderly individuals, but in the BMI values of young patients, there were no significant differences in mortality. CONCLUSION: There is a survival benefit with increasing BMI in patients overall. However, while these results persist in patients >65 years, in young people there are no changes in mortality. Patients with the highest inter-annual variability in weight have an increased risk.
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Índice de Massa Corporal , Falência Renal Crônica/mortalidade , Obesidade/mortalidade , Diálise Renal/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/patologia , Obesidade/terapia , Modelos de Riscos Proporcionais , Fatores de Proteção , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Aumento de PesoRESUMO
BACKGROUND: Kidney transplantation from deceased donors aged 65 years or older is associated with suboptimal patient and graft survival. In large registries, survival is longer after kidney transplantation than when remaining on dialysis. However, whether recipients of these old grafts survive longer than their dialysis counterparts is unknown. METHODS: We retrospectively assessed the outcomes of 5,230 recipients of first deceased donor grafts transplanted during the period of 1990 to 2010 in Catalonia, 915 of whom received grafts from donors 65 years or older. In a match-pair analysis, we aimed to pair each of 915 eligible cases with one control (1:1 ratio). Each pair had the same characteristics at the time of entering dialysis program: age, sex, primary renal disease, period of dialysis onset, and cardiovascular comorbidities. We found 823 pairs. RESULTS: Patient survival of 823 recipients of elderly donors was significantly higher than that of their 823 matched dialysis waitlisted nontransplanted partners (91.6%, 74.5%, and 55.5% vs. 88.8%, 44.2%, and 18.1%, respectively at 1, 5, and 10 years; P<0.001). The probability of death after the first year was similar (8.1% transplant vs 10.3% dialysis; P=0.137); however, analyzing the whole period, the adjusted proportional risk of death was 2.66 (95% confidence interval, 2.21-3.20) times higher for patients remaining on dialysis than for transplanted patients (P<0.001). CONCLUSION: Our study demonstrates that despite the fact that kidney transplantation from elderly deceased donors is associated with reduced graft and patient survival, their paired counterpart patients remaining on dialysis have a risk of death 2.66 times higher.
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Transplante de Rim/mortalidade , Diálise Renal/mortalidade , Doadores de Tecidos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de SobrevidaRESUMO
BACKGROUND: Some 7-10% of patients on replacement renal therapy (RRT) are receiving it because of autosomal dominant polycystic kidney disease (ADPKD). The age at initiation of RRT is expected to increase over time. METHODS: Clinical data of 1,586 patients (7.9%) with ADPKD and 18,447 (92.1%) patients with other nephropathies were analysed from 1984 through 2009 (1984-1991, 1992-1999 and 2000-2009). RESULTS: The age at initiation of RRT remained stable over the three periods in the ADPKD group (56.7 ± 10.9 (mean ± SD) vs 57.5 ± 12.1 vs 57.8 ± 13.3 years), whereas it increased significantly in the non-ADPKD group (from 54.8 ± 16.8 to 63.9 ± 16.3 years, p < 0.001). The ratio of males to females was higher for non-ADPKD than for ADPKD patients (1.6-1.8 vs 1.1-1.2). The prevalence of diabetes was significantly lower in the ADPKD group (6.76% vs 11.89%, p < 0.001), as were most of the co-morbidities studied, with the exception of hypertension. The survival rate of the ADPKD patients on RRT was higher than that of the non-ADPKD patients (p < 0.001). CONCLUSIONS: Over time neither changes in age nor alterations in male to female ratio have occurred among ADPKD patients who have started RRT, probably because of the impact of unmodifiable genetic factors in the absence of a specific treatment.
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Hipertensão/mortalidade , Rim Policístico Autossômico Dominante/mortalidade , Rim Policístico Autossômico Dominante/reabilitação , Sistema de Registros , Terapia de Substituição Renal/mortalidade , Distribuição por Idade , Comorbidade , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Espanha/epidemiologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The survival after renal transplantation of patients with antineutrophil cytoplasmic antibody (ANCA)-associated to systemic vasculitis is as good as in other diseases, although most of the reports are based on small numbers of patients. Furthermore, it is not known whether comorbidities (cardiovascular [CV] disease and cancer) are more frequent than in general population. We report our experience and the analysis of the published data on this topic. The outcome after transplantation in 49 patients with ANCA-associated small vessel vasculitis was compared with a control group. The relapse rate of vasculitis was 0.01 per patient per year. Comparison with the control patients revealed no difference in long-term outcome, CV mortality or incidence of malignancies. In the published literature, patients with ANCA at transplantation and with Wegener's granulomatosis are at greater risk of relapse. Taking our own results together with the review of the literature, we conclude that patient and graft survival rates compare favorably with those in control group that the recurrence rate is very low and that there is no increase in the incidence of cancer or in CV mortality. Patients with ANCA at transplantation and with Wegener's granulomatosis have a higher relapse rate.
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Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/etiologia , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Nefropatias/complicações , Transplante de Rim/efeitos adversos , Adolescente , Adulto , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Estudos de Casos e Controles , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Nefropatias/mortalidade , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Fatores de Risco , Taxa de Sobrevida , Adulto JovemRESUMO
BACKGROUND: Chronic kidney disease due to diabetes (DCKD) is the main known cause of renal replacement therapy (RRT) initiation. A Centers for Disease Control and Prevention study showed that the rate of DCKD cases initiating RRT among the overall DM population has dropped in the USA. Our main objective was to analyse this rate in Catalonia in 1994, 2002, 2006 and 2010. Cardiovascular risk factors (CVRF) in the diabetic population and characteristics and survival of DCKD patients on RRT were also evaluated. METHODS: Data from the Catalan Renal Registry was used to learn the number of DCKD cases on RRT together with their characteristics and survival rates. Data from the Catalonia Health Survey established the diabetic population and also the prevalence of CVRF in this population. RESULTS: The adjusted rate (95% CI) of patients initiating RRT with DCKD was 509.1 (484.6-533.7) pmp in 1994, 645.3 (621.6-669.0) in 2002, 602.6 (581.4-623.9) in 2006 and 600.0 (578.4-621.6) in 2010. Survival of DCKD patients in the 4th year of RRT had increased progressively from 35.9% for DCKD cases versus 64.9% for CKD cases due to other causes in 1994, to 39.9% versus 58.3% in 2002 and to 59.9% versus 65.9% in 2006. CONCLUSIONS: Since 2002, the rates of patients with DCKD initiating RRT among the overall DM population decreased slightly in Catalonia. Survival in these cases has increased progressively and in 2006 is similar to the CKD patients due to other causes. This figure suggests a better overall management, especially of CVRF.
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Doenças Cardiovasculares/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/fisiopatologia , Falência Renal Crônica/epidemiologia , Terapia de Substituição Renal/mortalidade , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Complicações do Diabetes/etiologia , Complicações do Diabetes/mortalidade , Complicações do Diabetes/terapia , Feminino , Seguimentos , Humanos , Incidência , Falência Renal Crônica/etiologia , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida , Adulto JovemRESUMO
BACKGROUND: Pulse pressure is an important cardiovascular risk factor, particularly in the elderly and in patients with isolated systolic hypertension. The differential impact of antihypertensive agents on pulse pressure is not known. OBJECTIVE: To assess the antihypertensive effect of treatment with the angiotensin II receptor blocker eprosartan on pulse pressure, and the factors influencing this effect. METHODS: The present study was an observational study of 4067 patients (55% women, mean age 67 years) with essential hypertension, newly diagnosed or unresponsive to current treatment, in which 3133 patients received 12 weeks of treatment with eprosartan 600 mg/day (87% monotherapy) in primary care centres. Blood pressure was measured using a validated oscillometric device (Omron 705CP, Omron Healthcare Inc, USA). RESULTS: Eprosartan significantly reduced pulse pressure at 12 weeks (13.5 mmHg, P<0.001). The reductions in systolic, diastolic and mean blood pressures were also statistically significant (26.0 mmHg, 12.6 mmHg and 17.1 mmHg, respectively). After correcting the pulse pressure for hypertension severity (pulse pressure/mean blood pressure ratio), this index was reduced from 62% to 58% with eprosartan, suggesting a 4% reduction in the pulsatile component. This reduction was more pronounced in patients over 60 years of age, those with a higher index at baseline and those with hypertensive cardiovascular complications. Adverse drug reactions occurred in 1.5% of patients. CONCLUSION: Eprosartan is an effective, well tolerated antihypertensive drug that reduces pulse pressure. This reduction is partially independent of the severity of high blood pressure, which may be important for both safety and target organ protection.
Assuntos
Acrilatos/administração & dosagem , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Imidazóis/administração & dosagem , Tiofenos/administração & dosagem , Acrilatos/efeitos adversos , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Canadá , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Imidazóis/efeitos adversos , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Probabilidade , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Tiofenos/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Systolic blood pressure (SBP) and pulse pressure (PP) are accurate predictors of cardiovascular events in the elderly population. In these patients, isolated systolic hypertension (ISH) is an important risk factor for cardiovascular morbidity and mortality. STUDY DESIGN: A multicentre, observational, prospective study, evaluated the effects of 16 weeks of eprosartan treatment on PP and other blood pressure (BP) parameters. Data from a subgroup of patients from this study, who had ISH, are presented here. RESULTS: Eprosartan monotherapy reduced SBP, PP and mean blood pressure (MBP) over the duration of treatment, whereas diastolic blood pressure (DBP) remained unchanged. There was no difference in the reductions of these parameters between eprosartan monotherapy and combination therapy. In addition, a high proportion of patients responded to eprosartan therapy. The response to eprosartan therapy was significantly influenced by family history of early cardiovascular disease, but not by gender, body mass index (BMI), raised low-density lipoprotein (LDL)-cholesterol, smoking, left ventricular hypertrophy, or previous history of cardiovascular disease. Patients aged > or =70 years had a decreased reduction in DBP and MBP components. Eprosartan therapy was well tolerated, with only 1% of patients reporting an adverse event. CONCLUSIONS: Eprosartan is an effective and well-tolerated antihypertensive therapy for elderly patients with ISH.
Assuntos
Acrilatos/uso terapêutico , Pressão Sanguínea , Hipertensão/tratamento farmacológico , Hipertensão/patologia , Imidazóis/uso terapêutico , Tiofenos/uso terapêutico , Idoso , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/métodos , Índice de Massa Corporal , Doenças Cardiovasculares/patologia , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Fatores de TempoRESUMO
BACKGROUND: Pulse pressure (difference between systolic and diastolic pressure) is an important prognostic factor for cardiovascular mortality and morbidity in elderly hypertensives. However, data regarding the effect of antihypertensive treatment on pulse pressure (PP) are scarce. In the present study, we evaluate the effect of six classes of antihypertensive drugs on PP in an elderly hypertensive cohort. PATIENTS AND METHOD: It was an open, prospective and multicenter study performed by primary care physicians. 857 hypertensive patients (54% women) with a mean age of 68 years were included. Antihypertensive treatment (any antihypertensive drug used in monotherapy) was freely assigned by investigators and then grouped in classes for analysis. Blood pressure was measured by a validated oscillometric device using a standardized protocol. RESULTS: ACE inhibitors were the mostly used class of antihypertensive drugs (27.8%). We found no differences between drug classes in PP reduction. Likewise, no differences were observed regarding the effect on systolic, diastolic, and mean blood pressure. The percentage of adverse reactions was low (6.3%). When effects on PP reduction and adverse reactions were pooled together, angiotensin receptor blockers emerged as the antihypertensive drug class with the best profile. CONCLUSIONS: Antihypertensive drugs do not differ substantially in their ability to reduce PP. Although PP is considered as an important prognostic factor for cardiovascular mortality and morbidity, the present results do not strengthen its usefulness as a distinctive marker of antihypertensive drug classes.