Utilidad de las técnicas de imagen y biomarcadores en la predicción del riesgo cardiovascular en pacientes con enfermedad renal crónica en España: Proyecto NEFRONA* / Usefulness of imaging techniques and novel biomarkers in the prediction of cardiovascular risk in patients with chronic kidney disease in Spain: The NEFRONA project

Justificación: La enfermedad cardiovascular (ECV) es la primera causa de mortalidad en pacientes con enfermedad renal crónica (ERC). La valoración del riesgo cardiovascular a partir de los factores tradicionales es poco útil en esta población debido al fenómeno de «reverse epidemiology» y a la existencia de factores específicos derivados de la uremia. En este trabajo presentamos el protocolo del proyecto NEFRONA, un estudio prospectivo con el objetivo de evaluar la utilidad de técnicas de imagen y biomarcadores en la predicción de la ECV en la ERC. Métodos: A partir de noviembre 2009 se reclutarán 2.661adultos asintomáticos con ERC (estadios 3-5D) procedentes de consultas ambulatorias de nefrología y centros de diálisis distribuidos a lo largo del territorio español. Asimismo, se incluirán843 participantes sin ERC (grupo control). Además, semestralmente se registrará la aparición de acontecimientos cardiovasculares y mortalidad. Un equipo itinerante realizará una ecografía carotíde a para valorar el grosor íntima-media y la presencia de placas, y determinará el índice tobillo-brazo para la clasificación de la enfermedad ateromatosa. Para el estudio de las calcificaciones vasculares se utilizará un score basado en la presencia de calcificaciones en las arterias carótidas, femorales y braquiales, y en las válvulas cardíacas, mediante ecografía. Finalmente, se recogerán muestras de sangre para la determinación de biomarcadores. Discusión: El proyecto NEFRONA nos permitirá evaluar la utilidad de las técnicas de imagen y biomarcadores en la valoración de la enfermedad ateromatosa y su valor predictivo en la población española con ERC (AU)

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease(CKD). Cardiovascular risk assessment in this population is hampered by the failure of traditional risk factors to fully account for the elevated CVD risk, mainly due to the reverse epidemiology effect, and the presence of risk factors specifically related to uremia. Hereby, we present the protocol of a prospective study aimed to assess the predictive value of imaging techniques and biomarkers for CVD in patients with CKD. Methods: From November 2009, 2.661asymptomatic adult patients with stages 3-5D CKD will be recruited from nephrology services and dialysis units throughout Spain. Eighthundred forty-three participants without CKD (control group) will be also recruited. During the follow-up, CVD events and mortality will be recorded from all CKD patients. One trained itinerant team will carry out a carotid ultrasound to assess intima-media thickness and presence of plaques. A composite atherosclerosis score will be constructed based on carotid ultrasound data and ankle-brachialindex. Presence and type of calcifications will be assessed in carotid, femoral and brachial arteries, and in cardiac valves, by ultrasound. Finally, blood samples will be collected from all participants to study biomarkers. Discussion: The NEFRONA study will allow us to examine the usefulness of imaging techniques and biomarkers to assess atherosclerosis development and their predictive value in a Spanish population with CKD (AU)

[Usefulness of imaging techniques and novel biomarkers in the prediction of cardiovascular risk in patients with chronic kidney disease in Spain: the NEFRONA project]. / Utilidad de las técnicas de imagen y biomarcadores en la predicción del riesgo cardiovascular en pacientes con enfermedad renal crónica en España: Proyecto NEFRONA.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Cardiovascular risk assessment in this population is hampered by the failure of traditional risk factors to fully account for the elevated CVD risk, mainly due to the reverse epidemiology effect, and the presence of risk factors specifically related to uremia. Hereby, we present the protocol of a prospective study aimed to assess the predictive value of imaging techniques and biomarkers for CVD in patients with CKD. METHODS: From November 2009, 2.661 asymptomatic adult patients with stages 3-5D CKD will be recruited from nephrology services and dialysis units throughout Spain. Eight hundred forty-three participants without CKD (control group) will be also recruited. During the follow-up, CVD events and mortality will be recorded from all CKD patients. One trained itinerant team will carry out a carotid ultrasound to assess intima-media thickness and presence of plaques. A composite atherosclerosis score will be constructed based on carotid ultrasound data and ankle-brachial index. Presence and type of calcifications will be assessed in carotid, femoral and brachial arteries, and in cardiac valves, by ultrasound. Finally, blood samples will be collected from all participants to study biomarkers. DISCUSSION: The NEFRONA study will allow us to examine the usefulness of imaging techniques and biomarkers to assess atherosclerosis development and their predictive value in a Spanish population with CKD.

Hipertensión endocraneal como presentación de una neurobrucellosis en un paciente de hemodiálisis / No disponible

No disponible

Mineral metabolism influences pulse pressure increase provoked by chronic kidney disease.

BACKGROUND: Pulse pressure (PP) increase has been associated with hypertension, ageing and chronic kidney disease. Although hyperparathyroidism and phosphate imbalance have been suspect in PP increase in hemodialysis patients, the link between these parameters and pulse pressure, in renal disease before dialysis, has not been established. METHODS AND PATIENTS: 1966 chronic kidney disease (CKD) patients. STATISTICS: ANOVA, Student's t-and Chi-square, rank correlations (Spearman) and multivariate analysis, with PP as the dependent variable, while adjusting for other covariables. RESULTS: There was an increase of pulse pressure parallel to renal function deterioration, and a significant influence of age, diabetes, hypertension, phosphate and PTH on pulse pressure in the whole population, as well as in patients with glomerular filtration rate < 60 ml/min. The impact of phosphate was particularly high after the age of 50. CONCLUSION: PP increase present in renal disease patients might be primarily due to the underlying mineral metabolism disturbances.

[MIBI and parathyroid gland function in secondary hyperparathyroidism]. / MIBI y funcionalismo de las glándulas paratiroideas en el hiperparatiroidismo secundario.

The role of the double phase parathyroid scintigraphy with MIBI in the primary hyperparathyroidism has been well studied. The present work analyzes the benefit of this image technique in the diagnosis and therapeutic approach to uremia associated hyperparathyroidism. We studied 18 dialysis patients with clinical and analytical data of hyperparathyroidism. All of them were receiving treatment with i.v. vitamin D. We carried out two scintigraphic studies, the first under basal conditions (without changes in treatment) and the second one, a week later after the stimulation of the parathyroid gland through the cessation of the treatment with vitamin D and phosphorus binders, and the use of a low-calcium dialysate. In the basal study, fourteen patients had a positive uptake test in at least one of the four glands. These patients had significantly higher PTHi levels than those with a negative scintigraphic study. After the stimulation test, we found a statistically significative rise in PHTi (644 vs 979 p < 0.001) and phosphorus levels (5.8 vs 7.3; p < 0.01), a slight fall in calcium levels (p = NS) and a statistically significative increment in the score of scintigraphic captation (5.5 +/- 4.5 vs 6.8 +/- 5; p < 0.05). We found a statistically significative correlation between the PTHi level and the score of scintigraphic uptake, in the basal study (r = 0.6, p < 0.01) and after stimulation (r = 0.6, p < 0.01). The only variable associated with the scintigraphic uptake was PTHi, justifying 31.1% of the variance in the first study and 32.7% in the second. In conclusion, the MIBI scintigraphic is a useful exploration in the uremic patient with hyperparathyroidism, as it predicts the functional state of the parathyroid glands according to uptake intensity. The stimulation test could be useful in planning therapy, but some of its characteristics need to be established, such as the precise time to reach the maximum level of parathyroid stimulation.

Láminas COOP/WONCA: ¿un instrumento válido para determinar la CVRS en el paciente en diálisis?

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Distribución de los genotipos del virus C en la población de hemodiálisis de la provincia de Alicante / Hepatitis c virus genotype distribution in the hemodialysis population from Alicante

Los genotipos del virus de la hepatitis C (VHC) se distribuyen irregularmente según las áreas geográficas y los diferentes grupos de riesgo. Objetivo: Conocer la prevalencia y distribución de los genotipos y subtipos del VHC en los pacientes de hemodiálisis (HD) de la provincia de Alicante, analizando la distribución por áreas y su asociación con algunas características como la edad y el tiempo en hemodiálisis. Métodos: Se estudiaron 640 pacientes en HD y se determinó el RNA-VHC y sus genotipos en los 120 pacientes con anticuerpos frente al VHC (Ac-VHC) positivos. Se comparó con un grupo control de 1.355 pacientes de otros grupos de riesgo de la misma área geográfica. Resultados: La prevalencia del VHC en HD fue del 20%. En el 15% (18/120)de los pacientes en HD con Ac-VHC no se detectó el RNA-VHC en suero. Los genotipos de los 102 pacientes con RNA viral positivo (85%) mostraron las siguientes prevalencias: 1b: 56,8% (58/102), 1a: 19,6% (20/102), 3: 17% (17/102),2a-2c: 1,9% (2/102), 2b: 0,9% (1/102), 4: 2,9% (3/102), 5: 0,9% (1/102).Conclusiones: Los genotipos más frecuentes en hemodiálisis en la provincia de (..) (AU)

Hepatitis C virus (HCV) genotypes are irregularly distributed among the different geographic area and groups at risk. Objective: To study the different HCV genotypes and subtypes of hemodialyzed patients from Alicante. Methods: We studied 640 patients on haemodialysis (HD) and we determined the RNA-HCV and the genotypes in the 120 patients with antibodies against HCV(HCV-Ab). We compared the results with the genotypes of 1,370 patients from other groups at risk in the same geographic area. Results: RNA-HCV was not found in the serum in 15% (18/120) of the patients on HD who were HCV-Ab positive. Prevalence of the different genotypes in the102 patients with positive viral RNA was the following: 1b: 56.8% (58/102), 1a:19.6% (20/102), 3: 17% (17/102), 2a-2c: 1.9 (2/102), 2b: 0.9% (1/102) 4: 2.9(3/102), 5: 0.9% (1/102). In conclusion, the genotype 1b was the most frequent in the patients studied in all these areas, and was the same as in the rest of the country. This genotype has been associated with the most severe hepatic disease and poor response to treatment, affecting the prognosis of these patients. The most frequent genotypes in HD in Alicante were 1b, 3 and 1a. HCV genotypes (AU)

Transmisión nosocomial del virus de la hepatitis C en hemodiálisis: ¿monitores, personal o ambos? / Nosocomial transmission of hepatitis c virus: Dialysis machines, staff or both?

La infección por el virus de la hepatitis C (VHC) es la causa más frecuente de enfermedad hepática en la población de hemodiálisis. Numerosos estudios sugieren que la transmisión nosocomial es la principal vía de infección, aunque no está bien definido el papel que juegan las máquinas y el personal en esta transmisión. Objetivo: El objetivo de nuestro estudio fue analizar el papel de las posibles vías de transmisión implicadas (monitores y contaminación directa paciente a paciente a través del contagio en la sala de diálisis) utilizando métodos epidemiológicos y la identificación de los genotipos del VHC. Métodos: En 50 pacientes de una unidad de hemodiálisis se determinó el RNAVHC mediante la técnica de reacción en cadena de la polimerasa (PCR) y los genotipos por un test de hibridación inversa y se analizó la distribución de los diferentes genotipos por turnos y monitores de hemodiálisis y la asociación temporal en la aparición de casos. Se determinó la PCR-RNA en el ultrafiltrado del líquido de diálisis en los 19 pacientes con RNA viral en sangre. Resultados: 21 pacientes presentaban anticuerpos frente al VHC (Ac-VHC)(21/50:42%) y en el 90% de estos se detectó el RNA viral en suero (19/21). En ninguno de los pacientes con Ac-VHC negativos fue posible detectar el virus en la sangre. Los genotipos del VHC se distribuyeron de la siguiente manera: El (..) (AU)

Background: The Hepatitis C virus (HCV) infection is the most frequent cause of hepatic disease in the dialysis population. Many observations suggest that nosocomial transmission is the principal way of infection. Objective: The aim of this study was to investigate HCV outbreak in a hemodialysis (HD) unit, using epidemiological and molecular methods. Methods: 50 patients in a HD unit were tested for HCV-RNA by reverse transcription-polymerase chain reaction (PCR), and the hepatitis C genotype determination (reverse hybridization assay). We analyzed the distribution of different genotypes by shifts and dialysis machines and the temporal association in the appearance of the HCV cases. Results: 21 of 50 patients (42%) showed detectable anti-HCV antibodies (..) (AU)

Utilidad del sildenafilo en el tratamiento de la disfunción eréctil del varón en hemodiálisis / No disponible

No disponible

Utilidad del sildenafilo en el tratamiento de la disfunción eréctil del varón en hemodiálisis / No disponible

No disponible

[Distribution of hepatitis C virus genotypes among the hemodialysis population in the province of Alicante]. / Distribución de los genotipos del virus C en la población de hemodiálisis de la provincia de Alicante.

UNLABELLED: Hepatitis C virus (HCV) genotypes are irregularly distributed among the different geographic area and groups at risk. OBJECTIVE: To study the different HCV genotypes and subtypes of hemodialyzed patients from Alicante. METHODS: We studied 640 patients on haemodialysis (HD) and we determined the RNA-HCV and the genotypes in the 120 patients with antibodies against HCV (HCV-Ab). We compared the results with the genotypes of 1,370 patients from other groups at risk in the same geographic area. RESULTS: RNA-HCV was not found in the serum in 15% (18/120) of the patients on HD who were HCV-Ab positive. Prevalence of the different genotypes in the 102 patients with positive viral RNA was the following: 1b: 56.8% (58/102), 1a: 19.6% (20/102), 3: 17% (17/102), 2a-2c: 1.9 (2/102), 2b: 0.9% (1/102) 4: 2.9 (3/102), 5: 0.9% (1/102). In conclusion, the genotype 1b was the most frequent in the patients studied in all these areas, and was the same as in the rest of the country. This genotype has been associated with the most severe hepatic disease and poor response to treatment, affecting the prognosis of these patients. The most frequent genotypes in HD in Alicante were 1b, 3 and 1a. HCV genotypes distribution among the HD units was not uniform in the different geographic areas. HCV genotypes distribution in the HD population is similar to other groups at risk from the same geographic area.

[Nosocomial transmission of the hepatitis C virus in hemodialysis: monitors, personnel, or both?]. / Transmisión nosocomial del virus de la hepatitis C en hemodiálisis: monitores, personal o ambos?

BACKGROUND: The Hepatitis C virus (HCV) infection is the most frequent cause of hepatic disease in the dialysis population. Many observations suggest that nosocomial transmission is the principal way of infection. OBJECTIVE: The aim of this study was to investigate HCV outbreak in a hemodialysis (HD) unit, using epidemiological and molecular methods. METHODS: 50 patients in a HD unit were tested for HCV-RNA by reverse transcription-polymerase chain reaction (PCR), and the hepatitis C genotype determination (reverse hybridization assay). We analyzed the distribution of different genotypes by shifts and dialysis machines and the temporal association in the appearance of the HCV cases. RESULTS: 21 of 50 patients (42%) showed detectable anti-HCV antibodies (HCV-Ab) in serum. The prevalence of HCV RNA positivity was 90.4% (19/21) among these patients. None of the HCV-Ab negative patients detectable HCV virus in thein blood. The PCR genotyping of HCV RNA was performed in 19 patients. It detected the presence of HCV subtype 1b in 10 out of 19 viremic patients (52.6%), HCV-subtype I a in 31.5% of the patients (6/19) and genotype 3 in 15.7% (3/19) of the viremic patients. All patients had been infected by only one genotype. We found epidemiological correlation and temporal association between the genotypes 1b (p < 0.05) and 3 (p < 0.05) with the shifts. The HCV genotype 1a shows statistical association with the machine 1 (p < 0.05) but not temporal association. CONCLUSIONS: HCV genotype 1b was dominant in our cohort of HCV-infected patients. There was a high level of agreement between the PCR detection of HCV RNA and the detection of antibodies against the HCV genome. Genotyping and epidemiological analysis suggest that horizontal nosocomial patient to patient transmission plays an important role in the epidemiology of HCV in dialysis patients. There is a need for stringent implementation and regular auditi of infection control measures.

Seroconversión tardía por el virus de la hepatitis C en un paciente en hemodiálisis / Late virus C seroconversion in a patient on hemodialysis

Presentamos un caso de seroconversión excepcionalmente tardía al VHC en un paciente en hemodiálisis. El caso clínico ilustra la dificultad que existe en aislar adecuada y prontamente a un paciente infectado por el VHC, y demuestra la necesidad de considerar a todos los pacientes en diálisis como potencialmente infecciosos. la aplicación de las precauciones estándar en hemodiálisis ha de hacerse de forma rutinaria con todos los pacientes, por que el diagnóstico de infección por VHC es muchas veces tardío y, en ocasiones existe dificultad en interpretar correctamente los tests diagnósticos disponibles (AU)

[Late hepatitis C virus seroconversion in a patient on hemodialysis]. / Seroconversión tardía por el virus de la hepatitis C en un paciente en hemodiálisis.

We present a case of an exceptionally late HCV seroconversion in a hemodialysis patient. The clinical case illustrates the difficulty of appropriately and quickly isolating a HCV infected patient, and it demonstrates the necessity to consider all the dialysis patients as potentially infectious patients. The standard precautions in hemodialysis must be applied routinely to all the patients, because the diagnosis of the HCV infection is very often late, and on some occasions it is difficult to interpret correctly the results of the available diagnostic tests.

[Efficacy and duration of effect of two delayed-action preparations of gallopamil in patients with exercise angina]. / Efficacia e durata di effetto di due formulazioni di gallopamil, pronta e ritardo, in pazienti con angina da sforzo.

In 15 subjects (13 male, 2 female) with reproducible threshold ischaemic effort angina, the efficacy and the duration of the effect of two different formulations of gallopamil in equal doses were evaluated. One of these was gallopamil slow release administered twice daily (at 7.00 a.m. and 6.00 p.m.) in doses of 100 mg. The other was action gallopamil immediate release administered four times daily (at 7.00 a.m., 1.00 p.m., 6.00 p.m., 11.00 p.m.) in doses of 50 mg. The double-blind study followed the cross-over model. After one week of run-in with placebo and two-weeks of treatment with active preparations, the patients underwent a clinical examination, an ambulatory electrocardiogram monitoring for 24 hours and two cycloergometric effort tests. The ergometric tests were carried out at 10.00 a.m. and at 5.00 p.m. on the same day so that there was a three-hour interval between the administration of both preparations (slow release and immediate release) and the morning test. The ergometric test which was carried out at 5.00 p.m. was at a ten-hour interval from the administration of slow release and at a four-hour interval from the administration of immediate release. For each period of treatment the gallopamil plasma concentrations were dosed during the ergometric test. In both these tests, the two preparations significantly increased the duration of the exercise compared to the basal values with placebo (7.9 +/- 2.3 minutes with placebo, 9.2 +/- 2.0 minutes with slow release.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative evaluation of 3 calcium antagonist drugs in patients with stable angina of effort. Double-blind placebo-controlled randomized study]. / Valutazione comparative di tre farmaci calcioantagonisti in pazienti con angina da sforzo stabile. Studio randomizzato in doppio cieco con placebo.

A study was undertaken in order to compare the effects of Diltiazem, Nifedipine and Verapamil on 11 male adults (aged 44 to 70 yrs: mean age 60 yrs) affected by effort angina with a stable exercise threshold. The study was carried out according to a 4 week double-blind randomized protocol. Diltiazem (300 mg/die), Nifedipine (50 mg/die), Verapamil (400 mg/die) and placebo were administered each for 7 day periods. An ergometric test was performed on the last of each therapeutic cycle in order to evaluate the effects of the treatments. The three active drugs globally provoked an increased tolerance to physical effort with respect to placebo (p less than 0.01); no significant differences, as regards physical performance, could be detected among the three drugs. Treatment with Nifedipine significantly increased heart rate at rest (p less than 0.05), under submaximal (p less than 0.05) and maximal load (p less than 0.05), with respect to treatment with Diltiazem and Verapamil. Systolic and diastolic arterial blood pressure did not vary significantly with any of the three drugs. Rate pressure product under submaximal load (p less than 0.05) and at the end of the exercise (p less than 0.05) was higher with Nifedipine than with the other two drugs. These results show that patient response to Nifedipine is different from that to Verapamil and Diltiazem and suggest that the three drugs exert their anti ischemic effect through different mechanisms. The evaluation of individual response revealed that only one patient showed no increased tolerance to physical effort with any of the drugs.(ABSTRACT TRUNCATED AT 250 WORDS)