Clinical Characteristics and Management of Patients with Secondary Hyperparathyroidism Undergoing Hemodialysis: A Feasibility Analysis of Electronic Health Records Using Natural Language Processing.

Introduction: This study aimed to assess the feasibility of applying natural language processing (NLP) to analyze real-world data (RWD) and resolve clinical problems in patients with secondary hyperparathyroidism and chronic kidney disease undergoing hemodialysis (SHPT/CKD-HD). The primary objective was to evaluate how well the guideline-recommended analytical goals are achieved in a Spanish cohort of SHPT/CKD-HD patients based on RWD. Methods: Unstructured data in the electronic health records (EHRs) from 8 hospitals were retrospectively analyzed using the EHRead® technology, based on NLP and machine learning. Variables extracted from EHRs included demographics, CKD-related clinical characteristics, comorbidities and complications, mineral and bone disorder parameter levels, and treatments at baseline, 6-month, and 12-month follow-up. Results: A total of 623 prevalent SHPT/CKD-HD patients were identified; of those, 282 fulfilled the inclusion criteria. They were predominantly elderly males with cardiovascular comorbidities, and the first cause of CKD was diabetic nephropathy. Diagnosis of SHPT was associated with an improvement in median values for PTH, calcium, and phosphate. However, the percentage of patients with normal PTH ranges remained stable during the study period (52.8-60.4%), while the percentage of patients with within-target range serum calcium or phosphate values showed an increasing trend (43.2-60% and 38.8-50%). At baseline, 74.1% of patients were using SHPT-related medication, including at least one vitamin D or analog (63.1%), phosphate binders (46.8%), and/or calcimimetics (9.6%). Conclusions: This study represents the first attempt to use clinical NLP to analyze SHPT/CKD-HD patients based on unstructured clinical data. This methodology is useful to address clinical problems based on RWD and identified a high rate of out-of-range mineral-bone analytical values in patients with HPT/CKD-HD and an increasing trend of out-of-range values for serum calcium and phosphate.

Recomendaciones para el uso de everolimus en trasplante renal de novo: falsas creencias, mitos y realidades / Recommendations for the use of everolimus in de novo kidney transplantation: False beliefs, myths and realities

La combinación inmunosupresora más utilizada en trasplante renal de novo incluye un inhibidor de calcineurina (IC), tacrolimus, un derivado del ácido micofenólico y esteroides. La evidencia que sustenta esta práctica se basa en el ensayo clínico Symphony, de evolución controlada durante un año, en el que no existía ningún grupo comparador con IC asociado a un inhibidor de mTOR. Diversos ensayos clínicos de alta calidad sustentan la indicación del uso de everolimus como inmunosupresor básico asociado a una exposición reducida de un IC en pacientes que reciben un trasplante renal. Esta combinación podría mejorar las expectativas de resultados en salud. Estas recomendaciones tratan de aportar la evidencia científica que apoya esta práctica, discuten las falsas creencias, mitos y realidades de la combinación y concretan pautas que permiten utilizarla con seguridad y evitar complicaciones (AU)

The immunosuppressive combination most commonly used in de novo kidney transplantation comprises a calcineurin inhibitor (CI), tacrolimus, a mycophenolic acid derivative and steroids. The evidence which underlies this practice is based in the Symphony trial with controlled follow-up of one year, in which no comparator group included the combination CI-mTOR inhibitor. Different high-quality clinical trials support the use of everolimus as a standard immunosuppressive drug associated with reduced exposure of a CI in kidney transplantation. This combination could improve health related outcomes in kidney transplantation recipients. The present recommendations constitute an attempt to summarise the scientific evidence supporting this practice, discuss false beliefs, myths and facts, and offer specific guidelines for safe use, avoiding complications (AU)

Recommendations for the use of everolimus in de novo kidney transplantation: False beliefs, myths and realities. / Recomendaciones para el uso de everolimus en trasplante renal de novo: falsas creencias, mitos y realidades.

The immunosuppressive combination most commonly used in de novo kidney transplantation comprises a calcineurin inhibitor (CI), tacrolimus, a mycophenolic acid derivative and steroids. The evidence which underlies this practice is based in the Symphony trial with controlled follow-up of one year, in which no comparator group included the combination CI-mTOR inhibitor. Different high-quality clinical trials support the use of everolimus as a standard immunosuppressive drug associated with reduced exposure of a CI in kidney transplantation. This combination could improve health related outcomes in kidney transplantation recipients. The present recommendations constitute an attempt to summarise the scientific evidence supporting this practice, discuss false beliefs, myths and facts, and offer specific guidelines for safe use, avoiding complications.

Bacilo Calmette-Guérin intravesical en paciente inmunodeprimido con carcinoma in situ / Intravesical Bacillus Calmette-Guérin in immunosuppressed patients with carcinoma in situ

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Los apósitos oclusivos en la ducha diaria ¿son capaces de reducir las infecciones del orificio de salida del catéter peritoneal? / Occlusive dressings in the shower — are they capable of reducing infections of the peritoneal catheter exit site?

Las infecciones del orificio de salida del catéter peritoneal son causa de una elevada morbilidad en diálisis peritoneal, llegando a condicionar el mantenimiento de la técnica. En anteriores estudios demostramos que el lavado del orificio de salida mediante agua previamente hervida, aplicada desde 1996, era capaz de disminuirlas infecciones del orificio de salida por pseudomonas. En el año 2003, añadimos a la cura del orificio de salida con agua hervida, una protección durante la ducha diaria mediante apósitos oclusivos, que excluyera el contacto del orificio de salida con el agua doméstica. Con este estudio observacional en el que analizamos la densidad de incidencias en el orificio de salida queremos mostrar los resultados respecto a las infecciones, aplicando las dos medidas profilácticas en dos grupos de pacientes. La combinación de lavado del orificio de salida con agua hervida, más los apósitos oclusivos se han mostrado efectivos en la profilaxis de las infecciones del orificio de salida (AU)

Infections of the peritoneal catheter exit site are the cause of high morbidity in peritoneal dialysis, and become a condition affecting maintenance of the technique. In previous studies we showed that washing the exit site with previously boiled water, applied since 1996, was capable of reducing exit-site infections caused by pseudomonas. In 2003, we added to the cleaning of the exit site with boiled water, protection whilst showering using occlusive dressings that excluded contact of the exit site with domestic water. With this observational study in which we analyse the density of exit-site incidents, we wish to show the results concerning infections, applying the two prophylactic measures in two groups of patients. The combination of washing the exit site with boiled water plus the occlusive dressings has been shown to be effective in preventing against infections of the exit site (AU)