Mediterranean Diet and Chronic Kidney Disease (CKD): A Practical Approach.

Chronic kidney disease has become a serious public health issue, as well as others health problems such as hypertension, DM, and obesity. Mediterranean diet (MD) can reduce the risk of cardiovascular disease and cancer and can lead to weight loss in obesity. There are studies that suggest that MD could be the diet of choice for patients with CKD for its influence on endothelial function, inflammation, lipid profile and blood pressure. There are few studies that tell us how to adapt MD to this group of patients. This review aims to offer a practical approach to Mediterranean diet adaptation as nutritional treatment in CKD patients.

[Immunosuppressive drugs and transplant protocols.] / Fármacos inmunosupresores y protocolos para el trasplante.

Kidney transplantation is the renal replacement therapy of choice in patients with end-stag ekidney disease. Immunosuppressive drugs are the main pillar of treatment in solid organ transplantation as they reduce rejection rates and increase graft survival. However, they can also cause significant side effects that can complicate transplant progression. The objective of this chapter is to outline the main characteristics of immunosuppressantsagents, their mechanisms of action and the side effects.

El tratamiento de elección en los pacientes con enfermedad renal avanzada es el trasplante renal. Los fármacos inmunosupresores constituyen el pilar fundamental de la terapia en el trasplante de órgano sólido, ya que permiten disminuir las tasas de rechazo y aumentar la supervivencia del injerto. Sin embargo, también pueden provocar efectos adversos que pueden complicar la evolución del trasplante. El objetivo de este capítulo es exponer las características de los principales inmunosupresores, sus mecanismos de acción y principales efectos secundarios.

Use and Safety of Remdesivir in Kidney Transplant Recipients With COVID-19.

INTRODUCTION: Remdesivir has demonstrated antiviral activity against coronavirus, shortening the time to recovery in adults hospitalized with moderate/severe COVID-19. Severe adverse events such as acute kidney injury have been reported. Scant data are available on the use and safety of remdesivir in kidney transplant recipients. METHODS: We present a multicenter cohort study of 51 kidney transplant recipients with COVID-19 treated with remdesivir. Outcomes and safety were assessed. RESULTS: Mean age at diagnosis was 60 years, with a median time since kidney transplant of 4.5 years. Mean time since admission to remdesivir was 2 days. Twenty-eight patients (54.9%) required mechanical ventilation (19 noninvasive). Mortality was 18.9% and markedly higher if aged ≥65 years (45% vs. 3.2% in younger patients). Acute kidney injury was present in 27.7% of patients, but was diagnosed in 50% before treatment. No patients required remdesivir discontinuation because of adverse events. We did not find significant hepatoxicity or systemic symptoms resulting from the drug. CONCLUSION: In our cohort of kidney transplant recipients, remdesivir was well tolerated and safe in renal and hepatic toxicity, but randomized trials are needed to assess its efficacy.

A case-control study to assess the role of polyomavirus in transplant complications: Where do we stand?

PURPOSE: The study's aim was to assess whether polyomavirus DNAemia screening was associated with different outcomes in patients with positive viremia compared with negative viremia. METHODS: Case-control retrospective study of patients with polyomavirus DNAemia (viremia > 1000 copies/mL) matched 1:1 with controls. Control group consists of the patient who received a transplant immediately before or after each identified case and did have nil viremia. FINDING: Ultimately, 120 cases of BK polyomavirus (BKPyV) were detected and matched with 130 controls. Of these, 54 were adult kidney transplant recipients (KTRs), 43 were pediatric KTRs, and 23 were undergoing hemato-oncologic therapy, of which 20 were undergoing hematopoietic stem cell transplantation. The odds ratio (OR) for overall risk of poorer outcomes in cases versus controls was 16.07 (95% CI: 5.55-46.54). The unfavorable outcome of switching the immunosuppressive drug (ISD) (14/40,35%) was no different from that of those treated with reduced ISD doses (31/71, 43.6%, P = .250). Acute rejection or graft-versus-host disease, previous transplant, and intensity of immunosuppression (4 ISDs plus induction or conditioning) were risk factors for BKPyV-DNAemia (OR: 13.96, 95% CI: 11.25-15.18, P < .001; OR: 6.14, 95% CI: 3.91-8.80, P < .001; OR: 5.53, 95% CI: 3.37-7.30, P < .001, respectively). CONCLUSIONS: Despite viremia screening, dose reduction, and change in therapeutic protocol, patients with positive BKPyV-DNAemia present poorer outcomes and unfavorable results.

Improvement in Nutritional Status in Patients With Chronic Kidney Disease-4 by a Nutrition Education Program With No Impact on Renal Function and Determined by Male Sex.

OBJECTIVE: Protein-energy wasting (PEW) is associated with increased morbidity and mortality and a rapid deterioration of kidney function in patients with chronic kidney disease (CKD). However, there is little information regarding the effect of nutrition intervention. The aims of this study were to evaluate the efficacy and safety of a nutrition education program (NEP) in patients with nondialysis dependent CKD (NDD-CKD), based on the diagnostic criteria for PEW proposed by the International Society of Renal Nutrition and Metabolism. The design of the study was a 6-month longitudinal, prospective, and interventional study. The study was conducted from March 2008 to September 2011 in the Nephrology Department of La Paz University Hospital in Madrid, Spain. SUBJECTS: A total of 160 patients with NDD-CKD started the NEP, and 128 finished it. INTERVENTION: The 6-month NEP consisted of designing an individualized diet plan based on the patient's initial nutritional status, and 4 nutrition education sessions. MAIN OUTCOME MEASURES: Changes in nutritional status (PEW) and biochemical, anthropometric and body composition parameters. RESULTS: After 6 months of intervention, potassium and inflammation levels decreased, and an improved lipid profile was found. Body mass index lowered, with increased muscle mass and a stable fat mass. Men showed increased levels of albumin and prealbumin, and women showed decreased proteinuria levels. The prevalence of PEW decreased globally (27.3%-10.9%; P = .000), but differently in men (29.5%-6.5%; P = .000) and in women (25.4%-14.9%; P = .070), 3 of the women having worsened. Kidney function was preserved, despite increased protein intake. CONCLUSION: The NEP in NDD-CKD generally improved nutritional status as measured by PEW parameters, but individual poorer results indicated the need to pay special attention to female sex and low body mass index at the start of the program.

Validación de un método cromatográfico para la determinación de cafeína en muestras acuosas de la Industria Farmacéutica / Validation of a chromatographic method for determination of caffeine content in aqueous samples of the drug industry

Introducción: la cafeína es una sustancia que se encuentra en algunas plantas como el café, el té, el cacao, además es un ingrediente de algunos medicamentos como los analgésicos, es estimulante metabólico y del sistema nervioso central. Su consumo agudo o crónico puede dar lugar a una variedad de efectos adversos. Debido a su uso en la industria farmacéutica su determinación adquiere gran importancia. La validación de un método analítico demuestra científicamente que es adecuado para una aplicación específica, como la determinación de ingredientes farmacéuticos activos en disoluciones acuosas. Objetivo: validar un método analítico para la cuantificación por Cromatografía Líquida de Alta Resolución de la cafeína presente en disoluciones acuosas y la determinación de su contenido en muestras residuales acuosas de un laboratorio farmacéutico productor de medicamentos. Métodos: la validación del método cromatográfico se llevó a cabo empleando una columna RP-18 de 250 × 4,6 mm, 5 µm; Fase móvil: agua­CH3OH (70/30); flujo: 1,0 mL/min y un detector ultravioleta visible a 254 nm. La determinación de la cafeína se efectuó por el método validado según las regulaciones internacionales vigentes. Resultados: el método resultó selectivo frente a los productos de ozonización, lineal (r= 0,999 y r2= 0,999), preciso, exacto, robusto y sensible, en el intervalo de 1 × 10-4 mol/L a 2 × 10-3 mol ̸ L. Se evaluó la estabilidad del analito en las condiciones de análisis. El contenido de cafeína en aguas residuales de la industria farmacéutica productora del medicamento fue determinado en concentraciones inferiores a 3 × 10-4 mol/L. Conclusiones: el método validado fue selectivo, lineal, preciso, exacto y robusto en el intervalo de concentraciones analizado y permite la determinación de cafeína y del analito en disolución acuosa en muestras residuales acuosas del laboratorio farmacéutico productor del medicamento en Cuba(AU)

Introduction: caffeine is a substance located in some plants like coffee, tea, cocoa; it is also an ingredient of some drugs such as analgesics, a metabolic and central nervous system stimulant. The consumption of caffeine either acute or chronic may give rise to a variety of adverse effects. Due to its use in the drug industry, it is vitally important to determine it. The validation of an analytical method scientifically proves that it is adequate for a particular application as in the case of determination of active ingredients in aqueous solutions. Objective: to validate an analytical method for the quantitation by means of high performance liquid chromatography of the caffeine content in aqueous solutions and in wastewater samples from a drug manufacturing laboratory. Methods: the validation of the chromatographic method was performed by using a RP­18 de 250 x 4,6 mm, 5 µm column, a mobile phase: water/ CH3OH (70/30); Flow: 1,0 mL/min and an ultraviolet detector at 254 nm. The caffeine content was estimated by the high performance liquid chromatograpy following the international regulations in force. Results: the method was selective against the ozonization products, linear r = 0.999 y r2 = 0.999), precise, accurate, robust and sensitive in the 1x10-4mol/L to 2x10-3mol/L interval. The analyte stability was also evaluated under the analysis conditions. The caffeine content in wastewaters of the drug manufacturing industry was determined at concentrations lower than 3x10-4 mol/L. Conclusions: the validated method was selective, linear, precise, accurate and robust in the analyzed interval of concentrations and allows estimating the caffeine content in aqueous solutions and of the analyte in wastewater samples from a pharmaceutical laboratory that produces the drug in Cuba(AU)

[Bioimpedance vector analysis as a tool for the determination and adjustment of dry weight in patients undergoing hemodialysis]. / VECTORES DE IMPEDANCIA BIOELÉCTRICA COMO HERRAMIENTA PARA LA DETERMINACIÓN Y AJUSTE DEL PESO SECO EN PACIENTES SOMETIDOS A HEMODIÁLISIS.

BACKGROUND AND OBJECTIVE: Overhydration in hemodialysis patients is associated with cardiovascular mortality. Adequate removal of liquids and achievement of dry weight is one of the main goals of therapy. So far there are no clinical or laboratory parameters that are reliable, simple and affordable for its determination. The bioelectrical impedance vector analysis (BIVE) is a tool that allows identifying and monitoring hydration status, so the aim of this study was to use BIVE to adjust the intensity of ultrafiltration and achieve dry weight in hemodialysis patients. METHODS: We studied 26 patients on hemodialysis, which were performed monthly measurements of bioelectrical impedance for four months. Corresponding vectors were plotted to know in an individual way the state of hydration, according to which the dry weight was adjusted when necessary. RESULTS: Dry weight adjustment was performed in 13 patients, 7 of which required increase and 6 decrease of dry weight. The displacement of vectors on the ellipses corresponded to the type of intervention made. Dry weight was reached in 84.6% of patients at the end of the study with a significant decrease in mean arterial blood pressure and an increase in phase angle in the group of decrease of dry weight. CONCLUSIONS: Bioelectrical impedance vector analysis is an useful tool for adjusting the dry weight in patients undergoing hemodialysis.

Antecedentes y objetivo: La sobrehidratación en los pacientes en hemodiálisis se asocia con mortalidad cardiovascular, por lo que la adecuada remoción de líquidos y el logro del peso seco es uno de los principales objetivos de la terapia. Hasta el momento no hay parámetros clínicos ni de laboratorio que sean confiables, sencillos y accesibles para su determinación. El análisis de vectores de impedancia (VIBE) es una herramienta que permite identificar y monitorizar el estado de hidratación, por lo que el objetivo de este estudio fue usar el VIBE para ajustar la intensidad del ultrafiltrado y alcanzar el peso seco en pacientes en hemodiálisis. Material y método: Se estudiaron 26 pacientes en hemodiálisis a los cuales se les realizaron medidas mensuales de impedancia bioeléctrica durante cuatro meses. Se graficaron los vectores correspondientes para conocer de manera individual el estado de hidratación, de acuerdo con lo cual se ajustó el peso seco en los casos necesarios. Resultados: Se realizó ajuste de peso seco en 13 pacientes, 7 de ellos necesitaron aumento de peso y 6 disminución del mismo. El desplazamiento de los vectores sobre las elipses correspondió al tipo de intervención realizada. Se logró alcanzar el peso seco en el 84.6% de los pacientes al final del estudio, con una disminución significativa de la presión arterial media y aumento del ángulo de fase en el grupo de disminución de peso seco. Conclusiones: El análisis de vectores de impedancia es útil para el ajuste del peso seco en los pacientes sometidos a hemodiálisis.

Focal segmental glomerulosclerosis due to a relapsing non-Hodgkin's lymphoma diagnosed by positron emission tomography.

Glomerulonephritis rarely appears associated with Hodgkin's disease or non-Hodgkin's lymphoma (NHL). We present a patient with a relapse of a non-Hodgkin's lymphoma which first presented as nephrotic syndrome due to focal segmental glomerulosclerosis (FSGS). This case report discusses the unusual association of non-Hodgkin's lymphoma and focal segmental glomerulosclerosis, as well as the crucial role of positron emission tomography in detecting the relapsing lymphoma.