Kidney transplantation reduces the risk of chronic limb threatening ischemia and amputation among patients with end-stage renal disease on hemodialysis.

OBJECTIVE: This study aimed to analyze the risk of chronic limb threatening ischemia (CLTI) or amputation among patients with end-stage renal disease (ESRD) entering a hemodialysis (HD) program and to evaluate the protective effect associated with kidney transplantation (KT). DESIGN, MATERIAL AND METHODS: Retrospective cohort of all consecutive ESRD patients entering into a HD program at our institution between 2000 and 2010. Collected variables included baseline characteristics (pre-entry in hemodialysis), time on HD program, KT and the composite outcome of chronic limb threatening ischemia or need for any amputation (CLTI/AMP). Patients with previous symptomatic peripheral arterial disease or amputation were excluded. RESULTS: The study group included 336 patients (mean age 63 years, 66% male). The mean follow up was 6.7 years with an average time on HD of 4.2 years. Ninety two patients (27.4 %) underwent transplantation. CLTI free survival rates were 90.3 % and 82.6 % at 5 and 10 years, respectively. The episodes of CLT involved 28 revascularization procedures (17 endovascular and 11 open surgeries), 18 minor amputations and 20 major amputations. KT was associated with a protective effect over the development of CLTI (HR: 0.065; CI 95% 0.02-0.21) after adjustment for confounding factors. The long-term survival of non-transplanted patients was 45 % and 15 % at 5 and 10 years, respectively and the long-term survival in transplanted patients was 89% and 80% at 5 and 10 years, respectively; but decreased to 47 % at 1 year and 18.2 % at 5 years once CLTI occurred. CONCLUSION: Patients on HD program show a notorious risk of chronic limb threatening ischemia or amputation over time. Once this complication occurs, patient's survival is markedly reduced. Transplantation confers an independent protective effect over the development of chronic limb threatening ischemia or amputation.

[Monitoring and telematic control of people with kidney transplant and suspected COVID-19 infection.] / Seguimiento y control telemático a personas con trasplante renal y sospecha de infección por COVID-19.

OBJECTIVE: People with Kidney Transplantation require immunosuppressant treatments and this classifies them as a population at risk for virus and/or bacterial infections. The objective of the study was to describe the follow-up of transplanted people with suspected COVID19 infection. METHODS: Descriptive, cross-sectional, observational study with prospective follow-up carried out between March and June 2020. Sociodemographic and clinical data were recorded for the assessment, control and follow-up of the cases. The results were expressed with means and standard deviation, median and interquartile range, or frequencies and percentages. The chi-square test was used to compare qualitative variables and the Student's T test to compare quantitative variables with normal distribution. If they did not follow a normal distribution, the Mann Whitney U test was used. The level of statistical significance was established at p<0.05. RESULTS: A total of 56 patients were included, with a mean of 62.73±13.01 years and a median of 39.5 [7.5; 93] months transplanted. 2.48±2.69 calls/patient were made during a period of 3.46±4.41 days. Virtual follow-up was performed with 100% (n=56) and 71.43% (n=40) required hospital admission at some point. 28.57% (n=16) of the people evaluated were managed at home. The PCR test was performed on 85.71% (n=48) of the study population, being positive in 48.21% (n=27). 29.62% (n=8) of the positive cases required invasive mechanical ventilation and 33.33% (n=9) died. The mortality rate in the study population is 4.17 times higher than that presented in the data from the registries in the general population. CONCLUSIONS: According to the mortality data, it is essential to maintain close contact with the main objective of referring the case to the hospital system at the slightest suspicion of complication. Remote monitoring is offered as a positive opportunity for the control of transplant recipients who require close monitoring by the nursing team.

OBJETIVO: Las personas con Trasplante Renal requieren tratamientos con inmunosupresores y esto los clasifica como población de riesgo para infecciones de virus y/o bacterias. El objetivo del estudio fue describir el seguimiento a personas trasplantadas con sospecha de infección por COVID-19. METODOS: Estudio observacional descriptivo de corte transversal con seguimiento prospectivo llevado a cabo entre marzo y junio de 2020. Se registraron datos sociodemográficos y clínicos para la valoración, control y seguimiento de los casos. Los resultados se expresaron con medias y desviación estándar, mediana y rango intercuartílico o frecuencias y porcentajes Se utilizó el test de chi-cuadrado para comparar variables cualitativas y la prueba T de student para comparar variables cuantitativas con distribución normal. Si no seguían una distribución normal se utilizó el test U de Mann Whitney. Se estableció el nivel de significación estadística en p<0,05. RESULTADOS: Se incluyó a un total de 56 pacientes con una media de 62,73± 13,01 años y una mediana de 39,5 [7,5; 93] meses trasplantados. Se realizaron 2,48±2,69 llamadas/paciente durante un periodo de 3,46±4,41 días. Se realizó seguimiento virtual con el 100% (n=56) y el 71,43% (n=40) requirió ingreso hospitalario en algún momento. El 28,57% (n=16) de las personas valoradas se logró controlar en domicilio. Se realizó el test PCR al 85,71% (n=48) de la población estudiada, siendo positivo en el 48,21% (n=27). El 29,62% (n=8) de los casos positivos requirió de ventilación mecánica invasiva y el 33,33% (n=9) falleció. La tasa de mortalidad en la población estudiada es 4,17 veces superior a la presentada en los datos de los registros en población general. CONCLUSIONES: Según el dato de mortalidad, se hace indispensable mantener el contacto estrecho con el objetivo principal de derivar el caso al sistema hospitalario a la menor sospecha de complicación. El seguimiento a distancia se ofrece como una oportunidad positiva para el control de las personas trasplantadas que requieran un seguimiento estrecho por parte del equipo de enfermería.

Acute renal failure and severe thrombocytopenia associated with metamizole.

Metamizole or dipyrone is a pyrazolone derivative that belongs to the non-steroidal anti-inflammatory drugs. Its main side-effect is hematological toxicity. Thrombocytopenia due to metamizole is rare and is usually associated with the involvement of the two other blood series. Drug-induced thrombocytopenia is more frequently related to immune mechanisms, and the diagnosis is still largely made by exclusion of other causes and by correlation of timing of thrombocytopenia with the administration of drug. Metamizole may cause acute renal failure due to hemodynamic renal failure/acute tubular necrosis and/or acute tubulointerstitial nephritis. We report a case of acute renal failure and severe thrombocytopenia after metamizole. As far as we know, this combination of adverse effects from this drug has not been reported previously.