[Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes]. / Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2). PATIENTS AND METHOD: Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (< 60 ml/min/1,73 m(2)). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation. RESULTS: The sample consisted of 3,197 patients, the mean age was 67.7 years (SD = 11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n = 532), of which 60.3% (n = 321) corresponded to occult CKD. 6.6% (n = 211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR = 2.7; CI 95% = 1,83-3,99). Occult CKD was associated with age, blood pressure higher than 150/100 mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia. CONCLUSIONS: The prevalence of CKD is 16.6%, of which 60.3% (n = 321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD.

[Cost relation between severity of Alzheimer's disease and cognitive and functional impairment]. / Análisis de los costes de la enfermedad de Alzheimer en función del deterioro cognitivo y funcional.

BACKGROUND AND OBJECTIVE: This study aims to identify the relationship between costs of medical and social attention in patients with dementia of Alzheimer disease (AD) type and clinical and sociodemographic data of patients and their caregivers. PATIENTS AND METHOD: It was an analytic observational study in a cohort of patients diagnosed with Alzheimer's disease who received ambulatory attention. Information about the use of health-related resources was collected and costs were estimated from a societal perspective. Indirect costs were calculated using a replacement cost approach. Patients and caregivers were examined with the Mini-Mental State Examination (MMSE), the Rapid Disability Rating Scale (RDRS-2), the Neuropsychiatric Inventory (NPI), the Burden Interview (BI) and the Resource Utilization in Dementia (RUD). Patients were grouped taking into account the score obtained in the MMSE. RESULTS: A cohort of 417 patients, mean age (SD) 75.2 (6.6) years, 71% females, was studied. Disease severity levels were distributed as follows: MMSE, 26% for MMSE > 19, 66% for MMSE = 19-11, and 8% for MMSE < 11. 69% of caregivers were women, with a mean age of 57.1 (15.8) years. The cost per patient and per month was estimated to be 419.3 Euro for MMSE > 19, 641.9 Euro for MMSE = 19-11, and 1150.6 Euro for MMSE < 11. CONCLUSIONS: The societal cost of AD increases dramatically with increasing disease severity. Caregiver burden and sex as well as the marital status of patients are associated with the cost of the disease.

Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil or galantamine.

BACKGROUND: few studies have analysed the effect of the long-term use of cholinesterase inhibitors (ChEIs) on mortality. OBJECTIVE: to compare the long-term effects of galantamine and donepezil treatment on the mortality rate in Alzheimer's disease (AD) patients. DESIGN: a retrospective cohort study. SETTING AND SUBJECTS: 404 patients referred by primary care centres to a Memory Clinic who were diagnosed with probable AD and who were prescribed treatment with donepezil or galantamine. METHODS: standardised review of the patient's medical records. RESULTS: 14.5% of the patients showed intolerance to the treatment with ChEIs during the first 15 days. Of those patients who initially tolerated the treatment, 18.5% gave it up after a mean duration of 13.36 months and a mean dose of 7.5 mg/day of donepezil or 14.3 mg/day of galantamine. The mean duration of the treatment in patients who did not abandon the treatment was 25.4 months and the mean dose was 8.1 mg/day of donepezil or 20.0 mg/day of galantamine. There were no differences in the mortality rate between patients treated with donepezil or galantamine (13.7 versus 12.2; P = 0.75). The multivariate analysis through binary logistic regression showed that the variables associated with mortality were male gender, older age, heart failure, treatment with antipsychotic drugs and a high score on the Global Deterioration Scale. CONCLUSIONS: the duration and the dose of donepezil or galantamine are not related to an increase in mortality. The related variables were advanced age, the severity of the dementia, being male, heart failure and treatment with antipsychotic drugs.

Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2 / Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes

Fundamento y objetivo: Determinar la prevalencia de insuficiencia renal crónica (IRC) oculta y las variables clínicas asociadas en pacientes con diabetes mellitus de tipo 2 (DM2). Pacientes y método: Estudio observacional, analítico y transversal en pacientes con DM2 ambulatorios de atención primaria. De la historia clínica electrónica se registraron datos demográficos y antropométricos, antecedentes patológicos y medidas de riesgo cardiovascular y de función renal. Se determinó la prevalencia de IRC oculta, definida en pacientes con valores de creatinina (Cr) plasmática normales (Cr ≤1,4mg/dl en las mujeres y Cr ≤1,5mg/dl en los varones), y la estimación del filtrado glomerular (eFG) reducida (<60ml/min/1,73m2). La eFG se determinó mediante la fórmula Modification of Diet in Renal Disease (MDRD). Resultados: La muestra estuvo formada por 3.197 pacientes, con una media (DE) de edad de 67,7 años (11,7); el 53,9% eran varones. La prevalencia de IRC según los valores de la MDRD fue del 16,6% (n=532), de los que el 60,3% (n=321) fue IRC oculta. El 6,6% (n=211) de los sujetos presentó IRC con valores de Cr elevados. El análisis multivariante mostró una asociación del sexo femenino con la IRC oculta (odds ratio: 2,7; intervalo de confianza del 95%: 1,83–3,99). La IRC se asoció a la edad, a la presión arterial superior a 150/100mmHg, a la dislipidemia y a los antecedentes de cardiopatía isquémica, insuficiencia cardíaca y arteriopatía periférica. Conclusión: La prevalencia de IRC según la fórmula MDRD fue del 16,6%, del que el 60,3% presentaba IRC oculta. El sexo femenino se asoció directamente a la presencia de IRC oculta (AU)

Background and objective: To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2). Patients and method: Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (<60ml/min/1,73m2). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation. Results: The sample consisted of 3,197 patients, the mean age was 67.7 years (SD=11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n=532), of which 60.3% (n=321) corresponded to occult CKD. 6.6% (n=211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR=2.7; CI 95%=1,83–3,99). Occult CKD was associated with age, blood pressure higher than 150/100mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia. Conclusions: The prevalence of CKD is 16.6%, of which 60.3% (n=321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD (AU)