The ERA Registry Annual Report 2021: a summary.

Background: The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities. Methods: Data was collected from 54 national and regional registries from 36 countries, of which 35 registries from 18 countries contributed individual patient data and 19 registries from 19 countries contributed aggregated data. Using this data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities and expected remaining lifetimes were calculated. Result: In 2021, 533.2 million people in the general population were covered by the ERA Registry. The incidence of KRT was 145 per million population (pmp). In incident patients, 55% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes (22%). The prevalence of KRT was 1040 pmp. In prevalent patients, 47% were 65 years or older, 62% were male, and the most common PRDs were diabetes and glomerulonephritis/sclerosis (both 16%). On 31 December 2021, 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. The kidney transplantation rate in 2021 was 37 pmp, a majority coming from deceased donors (66%). For patients initiating KRT between 2012-2016, 5-year survival probability was 52%. Compared to the general population, life expectancy was 65% and 68% shorter for males and females receiving dialysis, and 40% and 43% shorter for males and females living with a functioning graft.

Gut microbiota in chronic kidney disease. / Microbiota intestinal en la enfermedad renal crónica.

The intestinal microflora maintains a symbiotic relationship with the host under normal conditions, but its imbalance has recently been associated with several diseases. In chronic kidney disease (CKD), dysbiotic intestinal microflora has been reported with an increase in pathogenic flora compared to symbiotic flora. An enhanced permeability of the intestinal barrier, allowing the passage of endotoxins and other bacterial products to the blood, has also been shown in CKD. By fermenting undigested products that reach the colon, the intestinal microflora produce indoles, phenols and amines, among others, that are absorbed by the host, accumulate in CKD and have harmful effects on the body. These gut-derived uraemic toxins and the increased permeability of the intestinal barrier in CKD have been associated with increased inflammation and oxidative stress and have been involved in various CKD-related complications, including cardiovascular disease, anaemia, mineral metabolism disorders or the progression of CKD. The use of prebiotics, probiotics or synbiotics, among other approaches, could improve the dysbiosis and/or the increased permeability of the intestinal barrier in CKD. This article describes the situation of the intestinal microflora in CKD, the alteration of the intestinal barrier and its clinical consequences, the harmful effects of intestinal flora-derived uraemic toxins, and possible therapeutic options to improve this dysbiosis and reduce CKD-related complications.

Heart failure in patients with kidney disease and iron deficiency; the role of iron therapy. / Insuficiencia cardíaca en la enfermedad renal y déficit de hierro: importancia de la ferroterapia.

Chronic kidney disease and anaemia are common in heart failure (HF) and are associated with a worse prognosis in these patients. Iron deficiency is also common in patients with HF and increases the risk of morbidity and mortality, regardless of the presence or absence of anaemia. While the treatment of anaemia with erythropoiesis-stimulating agents in patients with HF have failed to show a benefit in terms of morbidity and mortality, treatment with IV iron in patients with HF and reduced ejection fraction and iron deficiency is associated with clinical improvement. In a posthoc analysis of a clinical trial, iron therapy improved kidney function in patients with HF and iron deficiency. In fact, the European Society of Cardiology's recent clinical guidelines on HF suggest that in symptomatic patients with reduced ejection fraction and iron deficiency, treatment with IV ferric carboxymaltose should be considered to improve symptoms, the ability to exercise and quality of life. Iron plays a key role in oxygen storage (myoglobin) and in energy metabolism, and there are pathophysiological bases that explain the beneficial effect of IV iron therapy in patients with HF. All these aspects are reviewed in this article.

Consensus on the Statin of Choice in Patients with Impaired Glucose Metabolism: Results of the DIANA Study.

INTRODUCTION AND OBJECTIVES: Despite the recognized clinical benefit of statins on cardiovascular prevention, providing correct management of hypercholesterolaemia, possible adverse effects of their use cannot be disregarded. Previously published data shows that there is a risk of developing diabetes mellitus or experiencing changes in glucose metabolism in statin-treated patients. The possible determining factors are the drug characteristics (potency, dose), patient characteristics (kidney function, age, cardiovascular risk and polypharmacy because of multiple disorders) and the pre-diabetic state. METHODS: In order to ascertain the opinion of the experts (primary care physicians and other specialists with experience in the management of this type of patient) we conducted a Delphi study to evaluate the consensus rate on diverse aspects related to the diabetogenicity of different statins, and the factors that influence their choice. RESULTS: Consensus was highly significant concerning aspects such as the varying diabetogenicity profiles of different statins, as some of them do not significantly worsen glucose metabolism. There was an almost unanimous consensus that pitavastatin is the safest statin in this regard. CONCLUSIONS: Factors to consider in the choice of a statin regarding its diabetogenicity are the dose and patient-related factors: age, cardiovascular risk, diabetes risk and baseline metabolic parameters (which must be monitored during the treatment), as well as kidney function.

Delphi consensus on the diagnosis and management of dyslipidaemia in chronic kidney disease patients: A post hoc analysis of the DIANA study. / Consenso Delphi sobre el diagnóstico y manejo de la dislipidemia en pacientes con enfermedad renal crónica: análisis post-hoc del estudio DIANA.

BACKGROUND AND OBJECTIVES: This post hoc study analysed the perception of the relevance of chronic kidney disease (CKD) in dyslipidaemia screening and the choice of statin among primary care physicians (PCPs) and other specialists through a Delphi questionnaire. METHODS: The questionnaire included 4blocks of questions concerning dyslipidaemic patients with impaired carbohydrate metabolism. This study presents the results of the impact of CKD on screening and the choice of statin. RESULTS: Of the 497 experts included, 58% were PCPs and 42% were specialists (35, 7% were nephrologists). There was consensus by both PCPs and specialists, with no difference between PCPs and specialists, that CKD patients should undergo a dyslipidaemia screening and that the screening should be part of routine clinical practice. However, there was no consensus in considering the estimated glomerular filtration rate (eGFR) (although there was consensus among PCPs and nephrologists), or considering albuminuria when selecting a statin, or in determining albuminuria during follow-up after having initiated treatment with statins (although there was consensus among the nephrologists). CONCLUSIONS: The consensus to analyse the lipid profile in CKD patients suggests acknowledgment of the high cardiovascular risk of this condition. However, the lack of consensus in considering renal function or albuminuria, both when selecting a statin and during follow-up, suggests a limited knowledge of the differences between statins in relation to CKD. Thus, it would be advisable to develop a guideline/consensus document on the use of statins in CKD.

Prevalence of anaemia and its clinical management in patients with stages 3-5 chronic kidney disease not on dialysis in Catalonia: MICENAS I study.

INTRODUCTION: Anaemia is a common complication of chronic kidney disease (CKD). The aim of this study was to determine the prevalence and clinical management of anaemia in patients with stages 3-5 CKD not on dialysis treated in outpatient Nephrology clinics (OC) in Catalonia. METHODS: Epidemiological, cross-sectional cohort, multicentre study under routine clinical practice conditions. Data collection by electronic data collection log-book (e-DCL) including personal information and data related to anaemia (haemoglobin, iron status, treatment with erythropoiesis-stimulating agents [ESA] and other anaemia treatments). Anaemia was defined as haemoglobin levels <13.5 g/dL in males or <12 g/dL in females or patients who receive treatment with ESA. RESULTS: We included 504 patients (56.4% male, mean age of 67.8 ± 15.5 years): 61.5% had stage 3 CKD, 30.2% stage 4 and 8.3% stage 5. The main causes of CKD were vascular and diabetic nephropathy. The prevalence of anaemia was 58.5% (n=295), however, only 14.9% of patients had haemoglobin levels <11 g/dL. Mean haemoglobin levels decreased and ESA treatment was more common as CKD progressed, but no significant differences were observed regarding the prescription of iron, according to CKD stages. ESA and intervals most frequently prescribed were darbepoetin alfa with a median dose of 40 µg/biweekly, followed by C.E.R.A. with a median dose of 75 µg/month and epoetin beta with a median dose of 5,000 IU/week. Among the patients with anaemia (n=295), 36.3% (n=107) had iron deficiency and only 53.3% of these patients were treated with iron supplements. CONCLUSIONS: This study demonstrates the high prevalence of anaemia, which increases as the disease progresses and its good control in a CKD patient population treated in Nephrology outpatient clinics in Catalonia. This control is achieved with moderate doses of ESA and iron supplements prescribed in more than 50% of anaemic CKD patients.

Level of dependence in patients on haemodialysis in Catalonia and evolution of mortality rates.

INTRODUCTION: Age and the comorbidities associated with ESRD impair the functional autonomy of patients on haemodialysis (HD). Our objectives were to assess the level of dependence in patients on HD and their mortality rates after three years of treatment. To do so, we followed the criteria established by the "Ley de Promoción de la Autonomía Personal y Atención a las Personas en situación de dependencia", the Spanish Law of Dependence (LD). METHODS: We carried out a cross-sectional descriptive study between October 2007 and January 2008. From 3702 patients in 40 dialysis units in Catalonia, 806 were selected as potential dependent individuals according to the criteria of their healthcare providers. Variables studied included: level of dependence according to the LD criteria, age, time on HD, associated pathology, treatment characteristics, family circumstances, and survival from 2009 to 2011. RESULTS: According to the LD, 137 were not dependent, 350 had a grade 1 dependence level, 237 grade 2, and 82 grade 3. In addition, 121 were living in an institution. The mean age was 74.9 ± 18.2 years and the median time on HD was 36 months. The prevalence of common pathologies was: diabetes (35.7%) and cardiovascular disease (29.1%). Musculoskeletal alterations (87%) and neurological disorders (38%) were the main causes of dependence. 64.2% of patients had a catheter as a vascular access. 34.9% of patients survived after three years, and these had a lower level of dependence when compared to those patients who had died, with no statistically significant differences within those three years. CONCLUSIONS: According to the LD, the prevalence of dependent patients in Catalonia is substantial (18.07%). These patients have a high mortality rate after three years.

Prevalence of chronic kidney disease in patients with or at a high risk of cardiovascular disease.

This secondary analysis of data from the MULTIRISC study investigated the prevalence of chronic kidney disease (CKD) in patients who either had or were at a high risk of cardiovascular disease. The original, epidemiological, cross-sectional, multicenter study was carried out in outpatient clinics belonging to cardiology, internal medicine and endocrinology departments. It included patients aged > or = 18 years with a high cardiovascular risk (i.e., a SCORE [Systematic Coronary Risk Evaluation] risk >5% or diabetes mellitus or associated clinical disease). The definition of CKD was an estimated glomerular filtration rate (Modification of Diet in Renal Disease formula) <60 mL/min per 1.73 m2. Established CKD was regarded as present when, in addition, the serum creatinine level was > or = 1.3 mg/dL in men or > or = 1.2 mg/dL in women, and occult CKD as present when the creatinine level was lower. In total, 2608 patients were included. Some 62.7% did not have CKD, 18.9% had established CKD and 18.4% had occult CKD. In summary, CKD was highly prevalent in patients with a high risk of cardiovascular disease.