Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury.

BACKGROUND AND AIM: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. MATERIAL AND METHODS: This is an observational retrospective cohorts study including all in-hospital AKI episodes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ±â€¯28 months, cardiovascular events (CVE) were collected, and associated factors were analysed. RESULTS: 1255 patients were included (55% male, age 75 ±â€¯13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to VCE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. CONCLUSION: Diastolic dysfunction is an independent predictor for long-term cardiovascular events after an in-hospital acute kidney injury episode.

La disfunción diastólica es un predictor independiente de eventos cardiovasculares tras un fracaso renal agudo / Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury

Antecedente y objetivo: El desarrollo de un fracaso renal agudo (FRA) condiciona complicaciones a corto, medio y largo plazo. El objetivo de nuestro estudio fue analizar el impacto de las alteraciones cardiacas en el pronóstico cardiovascular de pacientes que presentan un episodio de FRA. Materiales y métodos: Realizamos un estudio observacional de cohortes retrospectivo incluyendo a todos los pacientes con FRA en 2013 y 2014. Basalmente recogimos variables epidemiológicas, comorbilidades y parámetros ecocardiográficos. Seguimos a los pacientes tras el ingreso durante una media de 49 ± 28 meses, recogiendo la incidencia de eventos cardiovasculares (ECV) y los factores asociados a los mismos. Resultados: Se incluyeron 1.255 pacientes (55% varones, edad 75 ± 13 años). De los 676 (54%) pacientes que disponían de un ecocardiograma previo, el 46% tenían hipertrofia de ventrículo izquierdo, el 38% hipertensión pulmonar, el 38% disfunción diastólica y el 22% disfunción sistólica. Tras la hospitalización por FRA, 484 (39%) tuvieron un ECV. Los factores asociados a presentar un ECV fueron el sexo (varón), la edad, diabetes mellitus, hipertensión arterial, dislipidemia, cardiopatía isquémica, insuficiencia cardiaca, fibrilación auricular, neoplasia previa y enfermedad renal crónica (y el filtrado glomerular estimado basal y tras el FRA). El análisis de supervivencia demostró que todos los parámetros ecocardiográficos se asociaban a ECV. Un modelo de regresión de Cox ajustado demostró que la edad (HR 1,017), la diabetes mellitus (HR 1,576) y la disfunción diastólica (HR 1,358) eran predictores independientes de ECV. Conclusiones: La disfunción diastólica es un predictor independiente de ECV a largo plazo tras un episodio hospitalario de FRA. (AU)

Background and aim: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. Materials and methods: This is an observational retrospective cohorts study including all in-hospital AKI episoes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ± 28 months, cardiovascular events (CVEs) were collected, and associated factors were analysed. Results: 1255 patients were included (55% male, age 75 ± 13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to CVE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. Conclusion: Diastolic dysfunction is an independent predictor for long-term CVEs after an in-hospital AKI episode. (AU)

Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study.

BACKGROUND: There is scarce evidence on the fourth dose of severe acute respiratory syndrome coronavirus 2 vaccines in chronic kidney disease (CKD) patients. We evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), haemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) recipients. METHODS: This is a prespecified analysis of the prospective, observational, multicentric SENCOVAC study. In patients with CKD who had received a complete initial vaccination and one or two boosters and had anti-Spike antibody determinations 6 and 12 months after the initial vaccination, we analysed factors associated with persistent negative humoral response and higher anti-Spike antibody titres as well as the efficacy of vaccination on coronavirus disease 2019 (COVID-19) severity. RESULTS: Of 2186 patients (18% KT, 8% PD, 69% HD and 5% ND-CKD), 30% had received a fourth dose. The fourth dose increased anti-Spike antibody titres in HD (P = .001) and ND-CKD (P = .014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titres at 12 months were independently associated with repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titres and not being a KT recipient. Breakthrough COVID-19 was registered in 137 (6%) patients, 5% of whom required admission. Admitted patients had prior titres <620 UI/ml and median values were lower (P = .020) than in non-admitted patients. CONCLUSIONS: A fourth vaccine dose increased anti-Spike antibody titres or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titres or KT recipients) derived the least benefit in terms of antibody titres. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titres.

Triglycerides-glucose index and the risk of cardiovascular events in persons with non-diabetic chronic kidney disease.

Background: Chronic kidney disease (CKD) is associated with high rates of cardiovascular events. We here explored whether the recently described triglycerides-glucose index (TyG) predicted the incidence of major adverse cardiovascular events (MACE) in these patients. Methods: This observationa study was undertaken of 1142 persons with CKD and free from diabetes and 460 controls from the prospective NEFRONA study. The study exposure was the TyG index at cohort inclusion. The study outcome was MACE (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and hospitalization for unstable angina). Covariates included demographics, comorbidities, lipid profile, renal function and glycaemic control. Cox regression models evaluated the association between TyG index and 4-point MACE in patients with CKD. Results: TyG was higher [median 8.63 (interquartile range 8.32-8.95)] in patients with CKD compared with controls (P < 0.001). TyG increased across albuminuria categories but was similar for glomerular filtration rate categories among patients with CKD stages 3-5. During 46 ± 13 months of follow-up, 49 (4.3%) MACE were registered. TyG predicted the occurrence of MACE {hazard ratio (HR) 1.95 [95% confidence interval (CI) 1.11-3.40] per TyG unit increase; and HR 2.29 (95% CI 1.24-4.20] for TyG values above the median of 8.63 units}. Sensitivity analysis for subgroups of participants according to age, kidney function, body mass index and imaging evidence of atherosclerosis yielded similar results, as did adjusted analysis. Neither triglycerides nor glucose alone was associated with MACE. Conclusions: The TyG index is associated with the occurrence of major cardiovascular events in persons free from diabetes with non-dialysis dependent CKD.

Persistent kidney dysfunction after acute kidney injury predicts short-term outpatient mortality.

BACKGROUND: Acute kidney injury (AKI) during hospitalisation is frequent and associated with adverse outcomes. AIMS: To evaluate the association between renal function recovery after AKI and short-term post-discharge mortality. METHODS: This is a retrospective study of all AKI episodes codified in the electronic records of a single centre in 2013 and 2014. Epidemiological data and comorbidities at baseline and laboratory values at admission and discharge were collected. Persistent kidney dysfunction after AKI was defined as a last serum creatinine equal or above 1.2-fold over baseline level. Patients were followed for 30 days after discharge. RESULTS: Out of 1720 evaluated patients, 1541 (89%) were analysed. Of them, 869 (56%) recovered renal function. Independent predictors of renal function recovery after AKI were lower baseline estimated glomerular filtration rate (eGFR) (P < 0.001), higher admission eGFR (P < 0.001) and haemoglobin (P = 0.016), milder AKI (P = 0.037), absence of a history of heart failure (P < 0.001) and lower admission blood pressure (P < 0.001). After discharge, 46 (3%) patients died in the first 30 days. Persistent kidney dysfunction was associated (P = 0.01) with and independently predicted (odds ratio 2.6; 95% confidence interval 1.2-5.4; P = 0.01) short-term post-discharge mortality. CONCLUSIONS: Persistent kidney dysfunction after an AKI episode is an independent predictor of 30-day post-discharge mortality. This information might help select AKI patients who require closer follow up and monitoring after discharge.

Safety and immediate humoral response of COVID-19 vaccines in chronic kidney disease patients: the SENCOVAC study.

BACKGROUND: Chronic kidney disease (CKD) patients are at high-risk for severe coronavirus disease 2019 (COVID-19). The multicentric, observational and prospective SENCOVAC study aims to describe the humoral response and safety of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in CKD patients. Safety and immediate humoral response results are reported here. METHODS: Four cohorts of patients were included: kidney transplant (KT) recipients, and haemodialysis (HD), peritoneal dialysis (PD) and non-dialysis CKD patients from 50 Spanish centres. Adverse events after vaccine doses were recorded. At baseline and on Day 28 after the last vaccine dose, anti-Spike antibodies were measured and compared between cohorts. Factors associated with development of anti-Spike antibodies were analysed. RESULTS: A total of 1746 participants were recruited: 1116 HD, 171 PD, 176 non-dialysis CKD patients and 283 KT recipients. Most patients (98%) received mRNA vaccines. At least one vaccine reaction developed after the first dose in 763 (53.5%) and after the second dose in 741 (54.5%) of patients. Anti-Spike antibodies were measured in the first 301 patients. At 28 days, 95% of patients had developed antibodies: 79% of KT, 98% of HD, 99% of PD and 100% of non-dialysis CKD patients (P < 0.001). In a multivariate adjusted analysis, absence of an antibody response was independently associated with KT (odds ratio 20.56, P = 0.001) and with BNT162b2 vaccine (odds ratio 6.03, P = 0.023). CONCLUSION: The rate of anti-Spike antibody development after vaccination in KT patients was low but in other CKD patients it approached 100%, suggesting that KT patients require persistent isolation measures and booster doses of a COVID-19 vaccine. Potential differences between COVID-19 vaccines should be explored in prospective controlled studies.

Nefropatía endémica mesoamericana: una enfermedad renal crónica de origen no tan desconocido / Mesoamerican nephropathy: A not so unknown chronic kidney disease

Desde el año 2000, la región de Mesoamérica ha presentado una elevada incidencia de casos de enfermedad renal crónica de origen desconocido. Bajo el nombre de nefropatía endémica mesoamericana (NeM) han concurrido numerosas hipótesis incluyendo la deshidratación, el estrés por calor, la exposición a contaminantes ambientales e incluso determinadas infecciones, sin que actualmente exista unanimidad en la etiología de dicha patología. La NeM afecta principalmente a varones jóvenes dedicados a actividades agrícolas con antecedente de exposición a temperaturas especialmente elevadas. Clínicamente cursa con síntomas inespecíficos como febrícula y disuria y, analíticamente, con deterioro de la función renal y alteraciones hidroelectrolíticas. El diagnóstico exige de la realización de una biopsia renal que muestra invariablemente datos de nefritis tubulointersticial, principalmente crónica. A pesar de que la NeM condiciona una elevada morbimortalidad en las regiones endémicas, no existe un tratamiento específico, por lo que la prevención, basada en disminuir la exposición a elevadas temperaturas y asegurar el correcto estado de hidratación son de gran importancia. En la presente revisión, y basándonos en un caso clínico, actualizamos la evidencia disponible sobre un problema de salud pública con relevantes consecuencias renales. (AU)

From 2000, Mesoamerican region has reached an important rate of chronic kidney disease of unknown etiology. Under the name of Meroamerican Nephropathy (MeN) several hypotheses (including dehydration, heat stress, environmental or toxic exposure or even infections) have tried to explain the etiology this new disease. MeN affects young men, agricultural workers exposed to high temperatures. MeN courses with unspecific symptoms as low-grade fever and dysuria and progressive kidney disease with impaired renal function and hydroelectrolyte disturbances. The diagnosis requires kidney biopsy showing tubule-interstitial nephritis (usually at chronic stage). Although MeN conditions a high morbi-mortality in endemic regions, there is a lack of specific treatment and only preventive measures have demonstrated some effect of prognosis (avoid heat stress, constant hydration). In this review we aim to summarize the available information of MeN, illustrating the information in a case report. (AU)

Proteinuria-Lowering Effects of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Chronic Kidney Disease Patients: A Real-World Multicentric Study.

Control of dyslipidemia in chronic kidney disease (CKD) is not always guaranteed with statins and/or ezetimibe. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have opened up a new era in lipid control, but their effect on renal function and proteinuria in real life have not yet been evaluated. The aim of the present study was to analyze the evolution of renal function and proteinuria in a cohort of CKD patients treated with PCSK9i. This retrospective multicentric cohort study included CKD patients treated with PCSK9i. Baseline epidemiological data, comorbidities and laboratory findings (including estimated glomerular filtration rate [eGFR], proteinuria and lipid profile) were collected. The evolution of renal function, proteinuria and lipid profile was analyzed during the 1-year follow-up. The cohort included 76 patients (68% male, mean age 66 ± 10 years). The mean baseline creatinine was 1.55 ± 0.77 mg/dL, and the mean eGFR was 52 ± 22 mL/min/1.73 m2. Reductions in LDL-cholesterol, total cholesterol and triglycerides during the first month were 51 ± 25%, 32 ± 25% and 11 ± 40%, respectively, levels that remained stable throughout the first year (p < 0.001 for LDL-cholesterol and total cholesterol trends and p = 0.002 for triglyceride trend). During follow-up, proteinuria improved from 57 (9-481) to 30 (7-520) mg/g (p = 0.021). In addition, eGFR remained stable, and no adverse events were reported. In our cohort, dyslipidemia treatment with PCSK9i was associated with decreased proteinuria in CKD patients, an effect that might be due to reduced lipid nephrotoxicity. Clinical trials are needed to further investigate whether this impact on proteinuria can significantly slow CKD progression in the long term.

Effectiveness of biosimilar drugs in the treatment of renal anemia: A case series. / Efectividad del uso de biosimilares en el tratamiento de la anemia en pacientes con enfermedad renal crónica: serie de casos.

INTRODUCTION: Patients with chronic kidney disease usually have anemia secondary to an erythropoietin deficit. The emergence of biosimilar drugs of erythro-poiesis-stimulating agents ensures broader access to these treatments. OBJECTIVE: This study analyzes the effectiveness of an epoetin α biosimilar drug in chronic kidney disease patients with anemia. METHODS: This observational retrospective study enrolled 111 consecutive outpatients with chronic kidney disease and anemia and criteria for using eryth-ropoietin-stimulating agents. We collected baseline epidemiological and comorbidity data, as well as hematological and renal function infor-mation. We analyzed the effectiveness of the biosimilar agent in naïve patients and those who already had other erythropoiesis-stimulating agents. RESULTS: The 111 included patients had a mean age of 83 ± 8 years, and 54% were males. We found that patients who previously received erythropoiesis-stimulating agents, maintained hemoglobin values at two months of treatment with the biosimilar, while the naïve group significantly raised their hemoglobin values (P < 0.001). Renal function remained stable within the whole sample. The cost of using erythropoiesis-stimulating agents was reduced by a mean of 82 ± 17% with the biosimilar drug. CONCLUSION: Using a biosimilar of epoetin α is effective in patients with chronic kidney disease and anemia and significantly reduces costs.

INTRODUCCIÓN: Los pacientes con enfermedad renal crónica presentan anemia que, en gran parte, se debe a un defecto en la producción de eritropoyetina. La aparición de fármacos biosimilares de agentes estimulantes de la eritropoyesis garantiza un acceso más generalizado a dichos fármacos. OBJETIVO: Los pacientes con enfermedad renal crónica presentan anemia que, en gran parte, se debe a un defecto en la producción de eritropoyetina. MÉTODO: Se trata de un estudio observacional retrospectivo, en el que analizamos datos de 111 pacientes consecutivos de las consultas de nefrología con enfermedad renal crónica, anemia y con criterios de uso de agentes estimulantes de la eritropoyesis. Recogimos datos basales epidemiológicos y de comorbilidad, así como hematológicos y de función renal. Analizamos la efectividad del fármaco en aquellos pacientes naïve así como en aquellos que ya tenían otros agentes estimulantes de la eritropoyesis, y que habían iniciado tratamiento con el biosimilar. RESULTADOS: De los 111 pacientes incluidos, el 54% eran varones y la edad media se situó en 83 ± 8 años. En los pacientes que ya estaban en tratamiento con agentes estimulantes de la eritropoyesis, el uso del biosimilar mantuvo los valores de hemoglobina a los dos meses de tratamiento, mientras que en el grupo naïve se produjo un ascenso significativo de los mismos (p < 0,001). No hubo cambios en la función renal en ninguno de los grupos. El costo del uso de agentes estimulantes de la eritropoyesis se redujo una media de 82 ± 17% con el uso del biosimilar. CONCLUSIONES: El uso de un biosimilar de epoetina αα es efectivo en pacientes con enfermedad renal crónica y genera una importante reducción de costos.

Mesoamerican nephropathy: A not so unknown chronic kidney disease. / Nefropatía endémica mesoamericana: una enfermedad renal crónica de origen no tan desconocido.

From 2000, Mesoamerican region has reached an important rate of chronic kidney disease of unknown etiology. Under the name of Meroamerican Nephropathy (MeN) several hypotheses (including dehydration, heat stress, environmental or toxic exposure or even infections) have tried to explain the etiology this new disease. MeN affects young men, agricultural workers exposed to high temperatures. MeN courses with unspecific symptoms as low-grade fever and dysuria and progressive kidney disease with impaired renal function and hydroelectrolyte disturbances. The diagnosis requires kidney biopsy showing tubule-interstitial nephritis (usually at chronic stage). Although MeN conditions a high morbi-mortality in endemic regions, there is a lack of specific treatment and only preventive measures have demonstrated some effect of prognosis (avoid heat stress, constant hydration). In this review we aim to summarize the available information of MeN, illustrating the information in a case report.

Dynamic assessment of interleukin-6 during hemodialysis and mortality in coronavirus disease-19.

The impact of the newly discovered severe acute respiratory syndrome coronavirus 2 causing coronavirus disease-19 (COVID-19) in hemodialysis patients remains poorly characterized. Some hemodialysis techniques reduce systemic inflammation but their impact on COVID-19 has not been addressed. The aim of this prospective study was to evaluate factors associated with mortality in COVID-19 hemodialysis patients, including the impact of reducing interleukin-6 using a cytokine adsorbent filter. This is a prospective single-center study including 16 hemodialysis patients with COVID-19. All were dialyzed using a polymethyl methacrylate (PMMA) filter. Interleukin-6 levels were obtained before and after the first admission hemodialysis session and at 1 week. Baseline comorbidities, laboratory values, chest X-ray, and treatments were recorded and compared between survivors and non-survivors. Out of 16 patients (13 males, mean age 72 ± 15 years), 4 (25%) died. Factors associated with mortality were dialysis vintage (P = 0.01), chest X-ray infiltrates (P = 0.032), serum C-reactive protein (P = 0.05), and lactate dehydrogenase (P = 0.02) at 1 week, oxygen therapy requirement (P = 0.02) and anticoagulation (P < 0.01). At admission, non-survivors had higher predialysis and postdialysis interleukin-6 levels (P = 0.02 for both) and did not present the reduction of interleukin-6 levels during the dialysis session with PMMA filter that was observed in survivors (survivors vs. non-survivors: 25.0 [17.5-53.2]% vs. -2.8 [-109.4-12.8]% reduction, P = 0.04). A positive balance of interleukin-6 during the admission dialysis was associated with mortality (P = 0.008). In conclusion, in hemodialysis COVID-19 patients, a positive interleukin-6 balance during the admission hemodialysis session was associated with higher mortality.

Mesoamerican nephropathy: A not so unknown chronic kidney disease.

From 2000, Mesoamerican region has reached an important rate of chronic kidney disease of unknown etiology. Under the name of Meroamerican Nephropathy (MeN) several hypotheses (including dehydration, heat stress, environmental or toxic exposure or even infections) have tried to explain the etiology this new disease. MeN affects young men, agricultural workers exposed to high temperatures. MeN courses with unspecific symptoms as low-grade fever and dysuria and progressive kidney disease with impaired renal function and hydroelectrolyte disturbances. The diagnosis requires kidney biopsy showing tubule-interstitial nephritis (usually at chronic stage). Although MeN conditions a high morbi-mortality in endemic regions, there is a lack of specific treatment and only preventive measures have demonstrated some effect of prognosis (avoid heat stress, constant hydration). In this review we aim to summarize the available information of MeN, illustrating the information in a case report.

Características basales de los pacientes nonagenarios ingresados por fracaso renal agudo en comparación con otros grupos etarios / Baseline characteristics of nonagenarians hospitalised due to acute kidney injury compared to other age groups

ANTECEDENTES Y OBJETIVO: El aumento en la esperanza de vida ha generado hospitalizaciones de pacientes con edades muy avanzadas. El objetivo de este trabajo es estudiar las características de la población de más de 90 años que ingresa por fracaso renal agudo (FRA) en comparación con otros grupos etarios. MATERIALES Y MÉTODOS: Estudio transversal que incluyó a todos los pacientes hospitalizados entre 2013 y 2014 cuya codificación al alta era de FRA. Recogimos características epidemiológicas, comorbilidad, medicación y datos analíticos basales. Analizamos y comparamos los datos de los mayores de 90 años con los menores de dicha edad. RESULTADOS: Se incluyeron 1.733 pacientes. Del total de pacientes, 264 (15%) tenían una edad superior a 90 años y se encontró una proporción significativamente mayor de mujeres. La causa más frecuente del FRA en los pacientes mayores de 90 años fue la funcional (81%) (p < 0,001 respecto al resto de grupos etarios). La principal causa de ingreso fue la infecciosa. En el grupo de más de 90 años, encontramos mayor prevalencia de hipertensión arterial (HTA) (p = 0,005), enfermedad renal crónica (ERC) (p = 0,014), insuficiencia cardiaca congestiva (ICC) (p = 0,006) y deterioro cognitivo (p < 0,0001). El filtrado glomerular basal por CKD-EPI fue inferior en el grupo de mayores de 90 años (p < 0,0001). Los pacientes hospitalizados por FRA menores de 90 años tenían mayor prevalencia de diabetes mellitus (p < 0,001), dislipemia (p < 0,001) y antecedente de neoplasia (p < 0,001), y un índice de Barthel superior (p < 0,0001). CONCLUSIONES: La causa más frecuente de FRA en nonagenarios es la funcional, presentando los pacientes más HTA, ERC, ICC, mayor dependencia y deterioro cognitivo frente al resto de grupos etarios

BACKGROUND: The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS: A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS: A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS: Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment

Efectividad y seguridad del uso de inhibidores de PCSK9 en el tratamiento de la dislipidemia en el paciente con insuficiencia renal / Efficacy and safety of the PCSK9 inhibitors in the treatment of dyslipidemia in chronic kidney disease

El uso de fármacos inhibidores de la proprotein convertase subtilisin/kexin type 9 (iPCSK9) ha supuesto un cambio en el tratamiento de la dislipidemia en sus efectos sobre los eventos cardiovasculares. Actualmente, disponemos de 2principios activos comercializados (evolocumab y alirocumab) que tienen indicación en los pacientes que no alcanzan unos valores de lipoproteína de baja densidad (LDL) inferior a 100mg/dl habiendo presentado un evento cardiovascular previo y con dosis máximas o intolerancia a las estatinas. Los ensayos clínicos con iPCSK9 han incluido a pacientes con enfermedad renal, aunque con límites en el filtrado glomerular de hasta 20ml/min/1,73 m2 en el menos restrictivo de ellos. Los subanálisis de estos ensayos clínicos han demostrado eficacia en los pacientes con insuficiencia renal, tanto en la mejoría del perfil lipídico como en la reducción de eventos cardiovasculares. Derivado de su intenso efecto en la reducción de colesterol LDL han surgido algunas dudas sobre su seguridad que actualmente están resueltas y que confieren a los iPCSK9 un evidente beneficio cardiovascular también pacientes con enfermedad renal

The use of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has changed the clinical practice of dyslipidemia and their effects in cardiovascular events. Nowadays 2active principles have been commercialized (evolocumab and alircumab) with indication in patients with low-density lipoprotein (LDL) cholesterol over 100mg/dl, history of cardiovascular events and higher statins doses prescribed. Clinical trials with PCSK9i have included chronic kidney disease (CKD) patients, although glomerular filtration rate has been limited up to 20ml/min/1,73m2 or higher. The published sub-analysis of them have demonstrated at least the same efficacy (in reduction of LDL and cardiovascular events) and safety in patients with CKD. However, as these drugs are very powerful in reducing LDL cholesterol, some safety concerns appeared in the past. Once safety is probed, we conclude that PCSK9i are beneficial for CKD patients

[Baseline characteristics of nonagenarians hospitalised due to acute kidney injury compared to other age groups]. / Características basales de los pacientes nonagenarios ingresados por fracaso renal agudo en comparación con otros grupos etarios.

BACKGROUND: The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS: A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS: A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS: Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment.

Efficacy and safety of the PCSK9 inhibitors in the treatment of dyslipidemia in chronic kidney disease. / Efectividad y seguridad del uso de inhibidores de PCSK9 en el tratamiento de la dislipidemia en el paciente con insuficiencia renal.

The use of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has changed the clinical practice of dyslipidemia and their effects in cardiovascular events. Nowadays 2active principles have been commercialized (evolocumab and alircumab) with indication in patients with low-density lipoprotein (LDL) cholesterol over 100mg/dl, history of cardiovascular events and higher statins doses prescribed. Clinical trials with PCSK9i have included chronic kidney disease (CKD) patients, although glomerular filtration rate has been limited up to 20ml/min/1,73m2 or higher. The published sub-analysis of them have demonstrated at least the same efficacy (in reduction of LDL and cardiovascular events) and safety in patients with CKD. However, as these drugs are very powerful in reducing LDL cholesterol, some safety concerns appeared in the past. Once safety is probed, we conclude that PCSK9i are beneficial for CKD patients.

Vascular access-related mortality in hemodialysis patients during and after hospitalization.

Long-term prognosis is poorer in hemodialysis patients wearing a permanent catheter than in those with a fistula; however, few data are available regarding the survival of hospitalized patients according to their vascular access. The aim of the present study is to analyze the influence of vascular access in the prognosis of hemodialysis patients during hospitalization. A prospective observational study was conducted, including 100 consecutive hemodialysis patients that were hospitalized for any cause. At baseline, we collected epidemiological data, comorbidities, and variables related to the hospitalization (analytical values, reason for admission, and type of vascular access). We divided the whole sample into two groups regarding the vascular access (fistula or catheter), and compared associated variables and short-term survival. We analyzed mortality during hospitalization and during follow-up. Of the 100 patients studied, 71 (71%) were male, with a mean age of 71 ± 12 years. Fifty patients (50%) had fistulae as vascular access. Mean dialysis vintage was 60 ± 47 months. Eighteen patients (18%) died during the hospitalization and 27 (27%) at the end of the follow-up (median 144 [47-269] months). Variables associated to survival during hospitalization were vascular access, personal history of heart failure, dialysis vintage, and analytical values at admission such as low hemoglobin, high lactic acid, and low albumin. A regression model demonstrated that vascular access was an independent predictor of survival during hospitalization and, also, during the follow-up. Permanent catheters should be avoided as they are independent predictors of mortality in hospitalized hemodialysis patients.