[Therapeutic guidelines fulfillment in clinical practice in patients with chronic kidney disease (CKD)]. / Evaluación del cumplimiento de las guías terapéuticas en la práctica clínica en pacientes con enfermedad renal crónica (ERC).

OBJECTIVE: The present study was designed to determine the degree of fulfillment of the therapeutic objectives recommended in the clinical guidelines in patients with chronic kidney disease (CKD) in a nephrology outpatient clinic and the treatment that the patients were receiving to control these objectives. METHODS: A descriptive, cross-sectional study was performed in unselected patients with CKD (stages 1-5) who attended the nephrology outpatient clinic of the Hospital General Universitario Gregorio Marañón for follow up between 1st January and 1st April 2006. RESULTS: Data from 600 patients with a mean age of 62.8 years (56.5% male) were collected. The distribution of patients according to the stage (S) of CKD was as follows: S1: 11.5%, S2: 18%, S3: 36.7%, S4: 27.5% and S5: 6.3%. The target blood pressure (BP) < 130/80 mmHg was reached in 35.5%. The target diastolic blood pressure was controlled in 70%. However, systolic blood pressure increasing significantly with age and the degree of renal failure was controlled only in 42%. Total cholesterol was or=50 mg/l in 64.1% of patients. Triglyceride level was related to renal function (p=0.04). Most of the patients (94%) had hemoglobin (Hb) levels >or=11 g/dl, because of a significant increase in the percentage of patients treated with erythropoiesis-stimulating agents as the degree of renal function is reduced. Target levels of calcium-phosphorus (CaXP) product (<55 mg2/dl 2) were maintained in all the stages at the expense of decreased Ca and increased P in relation to the decrease in glomerular filtrate (p=0.001). Target Ca (8.4-9.5 mg/dl) was reached in 85% of cases (2% of patients in S3, 37% of patients in S4 and 54% in S5 were receiving calcitriol). Phosphorus levels were adequate in 80% of patients, but target levels of parathyroid hormone (PTH) were maintained only in 28.6% of patients in S3 (35-70 pg/ml), 14% of patients in S4 (70-110 pg/ml) and 28% in S-5 (115-300 pg/ml). CONCLUSIONS: Anemia is the best controlled factor of all the factors related to renal function. The degree of control of blood pressure (BP) has improved in recent years. However, it is still poor, particularly the control of systolic blood pressure getting worse with renal failure and age. It is difficult to reach the target PTH, despite adequate levels of Ca and P. Cholesterol levels, unlike triglyceride levels, do not depend on renal function and require an increase in the use and/or doses of cholesterol-lowering drugs.

Evaluación del cumplimiento de las guías terapéuticas en la práctica clínica en pacientes con enfermedad renal crónica (ERC) / therapeutic guidelines fulfilment in patients with chronic kidney disease (CKD)

Objetivo: El presente estudio se diseñó para determinar el grado de cumplimiento de los objetivos terapéuticos recomendados por las guías de actuación clínica en los pacientes con ERC en una consulta externa de nefrología y el tratamiento que recibían los pacientes para el control de los mismos. Métodos: Se realizó un estudio descriptivo y transversal con pacientes no seleccionados con ERC (estadios 1-5) que acudieron a revisión a la consulta ambulatoria de nefrología del Hospital General Universitario Gregorio Marañón entre el 1 de enero y el 1 de abril del 2006. Resultados: Se recogieron los datos de 600 pacientes con una edad media de 62,8 años (56,5% varones). La distribución de los pacientes según los estadios (E) de ERC fue: E1: 11,5%, E2: 18%, E3: 36,7%, E4: 27,5% y E5: 6,3%. El objetivo de presión arterial (PA) = 50 mg/l. El nivel de triglicéridos se relacionó con la función renal (p = 0,04). La mayor parte de los pacientes (94%) tenía cifras de Hb >= 11 g/dl, gracias a un aumento significativo en el % de pacientes tratados con agentes estimulantes de la eritropoyesis conforme disminuye el grado de función renal. El CaxP se mantuvo en cifras objetivo (< 55 mg2/dl2) en todos los estadios a expensas de disminución del Ca y aumento del P en relación con la disminución del filtrado glomerular (p = 0,001). El objetivo de Ca (entre 8,4-9,5 mg/dl) se alcanzaba en el 85% de los casos (2% de pacientes en E3, 37% de E4 y 54% de E5 recibían calcitriol). Los niveles de fósforo fueron adecuados en el 80%, pero sólo 28,6% de los pacientes en E-3 mantuvo cifras objetivo de PTH (35-70 pg/ml), 14% en E-4 (70-110 pg/ml) y 28% en E-5 (115-300 pg/ml). Conclusiones: De los factores relacionados con la función renal la anemia es el mejor controlado. El grado de control de la PA aunque ha mejorado en los últimos años, sigue siendo pobre, sobre todo de la PA sistólica que empeora con la insuficiencia renal y la edad. Es difícil alcanzar el objetivo de PTH, a pesar de cifras adecuadas de Ca y P. Los niveles de colesterol, al contrario que los niveles de triglicéridos, no dependen de la función renal y requieren incrementar el uso y/o dosis de fármacos hipocolesterolemiantes

Objective: The present study was designed to determine the degree of fulfilment of the therapeutic objectives recommended in the clinical guidelines in patients with chronic kidney disease (CKD) in a nephrology outpatient clinic and the treatment that the patients were receiving to control these objectives. Methods: A descriptive, cross-sectional study was performed in unselected patients with CKD (stages 1-5) who attended the nephrology outpatient clinic of the Hospital General Universitario Gregorio Marañón for follow up between 1st January and 1st april 2006. Results: Data from 600 patients with a mean age of 62.8 years (56.5% male) were collected. The distribution of patients according to the stage (S) of CKD was as follows: S1: 11.5%, S2: 18%, S3: 36.7%, S4: 27.5% and S5: 6.3%. The target blood pressure (BP) = 50 mg/l in 64.1% of patients. Triglyceride level was related to renal function (p=0.04). Most of the patients (94%) had hemoglobin (Hb) levels >= 11 g/dl, because of a significant increase in the percentage of patients treated with erythropoiesis- stimulating agents as the degree of renal function is reduced. Target levels of calcium-phosphorus (CaXP) product (< 55 mg2/dl2) were maintained in all the stages at the expense of decreased Ca and increased P in relation to the decrease in glomerular filtrate (p = 0.001). Target Ca (8.4-9.5 mg/dl) was reached in 85% of cases (2% of patients in S3, 37% of patients in S4 and 54% in S5 were receiving calcitriol). Phosphorus levels were adequate in 80% of patients, but target levels of parathyroid hormone (PTH) were maintained only in 28.6% of patients in S3 (35-70 pg/ml), 14% of patients in S4 (70-110 pg/ml) and 28% in S-5 (115-300 pg/ml). Conclusions: Anemia is the best controlled factor of all the factors related to renal function. The degree of control of blood pressure (BP) has improved in recent years. However, it is still poor, particularly the control of systolic blood pressure getting worse with renal failure and age. It is difficult to reach the target PTH, despite adequate levels of Ca and P. Cholesterol levels, unlike triglyceride levels, do not depend on renal function and require an increse in the use and/or doses of cholesterol-lowering drugs

Trascendencia de un manejo ambulatorio óptimo del paciente con enfermedad renal crónica / Importance of very best outpatient management of patients with chronic renal disease

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Calidad de vida en los pacientes con insuficiencia renal crónica. Influencia de la intervención precoz del nefrólogo y de la consulta prediálisis / Quailty of life in patients with chronic renal failure. Influence of nephrologist´s early intervention and pre-dialysis clinical visit consultation

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Atención domiciliaria al paciente urémico terminal no susceptible de diálisis / Home-based care to end-stage uremic patients non susceptible for dialysis

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Evaluación de la eficacia de la darbepoetina alfa subcutánea administrada en dosis única mensual en el tratamiento de la anemia en pacientes con insuficiencia renal crónica prediálisis / Evaluation of efficacy of darbepoetin alfa administered once monthly as treatment of anemia in predialysis patients with chronic kidney disease

Introducción y objetivo: Hasta el momento se ha demostrado la eficacia de ladarbepoetina alfa en el tratamiento de la anemia asociada a la enfermedad renalcrónica (ERC) en administración subcutánea (sbc) con una frecuencia semanal oquincenal. El objetivo de este estudio es evaluar la eficacia de la darbepoetina alfasbc administrada en dosis única mensual en el tratamiento de la anemia en pacientescon insuficiencia renal crónica (IRC) avanzada (estadios IV y V) prediálisisque mantenían niveles estables de hemoglobina (Hb) con darbepoetina alfa sbcadministrada en dosis quincenal.Material y métodos: Se seleccionaron para el estudio 15 pacientes que teníanniveles de Hb > 11 g/dl y recibían desde al menos 4 meses darbepoetina alfa sbcadministrada quincenalmente. En ellos se mantuvo la dosis equivalente de darbepoetinaalfa por vía sbc pero en administración mensual durante un año, sin modificaciónde la dosis. Durante el seguimiento se perdieron 8 pacientes por diferentesmotivos, manteniéndose 12 pacientes a los 3 meses de seguimiento yquedando la muestra reducida a 7 pacientes al finalizar el estudio.Resultados: A los 3 meses de seguimiento se objetiva una disminución estadísticamentesignificativa de la Hb y el hematocrito (Hto), aunque todos los pacientesmantuvieron Hb > 11 g/dl, así como una elevación estadísticamente significativade la creatinina (Cr) y de la paratohormona (PTH) plasmáticas, permaneciendoel resto de las variables sin modificaciones. Al final del estudio, tras un año de seguimiento,no se aprecian cambios significativos en ninguna de las variables, manteniendotodos los pacientes Hb > 11 g/dl.Conclusión: La darbepoetina alfa sbc mensual es una opción eficaz en el tratamientode la anemia asociada a la IRP. La administración de una dosis de1 mcg/kg/mes permitió en todos los pacientes mantener una adecuada correcciónde la anemia según las guías clínicas (Hb > 11 g/dl)

Background: Darbepoetin alfa has demonstrated its efficacy when is administeredsubcutaneously once-weekly and once every 2 weeks as treatment of anemiain patients with chronic kidney disease (CKD). The aim of this study is to assessthe efficacy of subcutaneus darbepoetin alfa administered once monthly in patientswith progressive CKD who maintained stable levels of Hb treated on onceevery other week dosing.Methods: Patients included in the study maintained hemoglobin (Hb) > 11 g/dland were receiving darbepoetin alfa once every other week during at least 4months. We studied a frecuency interval dose change: once every other week frecuencywas converted to once monhly at equivalent dose. The study completerswere 12 patients over the third month and 7 at the end of one year evaluationperiod.Results: A statistic significant decrease in Hb and hematocrit (Hto) was observedover the third month, although all patients maintain Hb levels higher than 11g/dl. At the same time it was appreciated a statistic significant increased on creatinine(Cr) and parathyroid hormone levels (PTH). At the end of one year evaluationperiod no differences were observed in any of variables.Conclusion: Darbepoetin alfa administered once monthly is an efficacious optionas treatment of anemia for patientes with CKD. With a dose of 1 mcg/kg/month,all patientes maintain Hb > 11 g/dl

Doxazosina asociada a la combinación bloqueante del eje-renina-angiotensina y calcioantagonista en pacientes con insuficiencia renal crónica / Doxazosine associated to renin-angiotensin blockers and calcioantagonists in chronic renal failure patients

Objetivo. El estudio ZAFRA se diseñó para evaluar la seguridad de un nuevo bloqueantede los canales del calcio, lercanidipino, en la insuficiencia renal crónica, ysu posible sobre la función renal en los pacientes tratados con fármacos que bloqueanel eje renina-angiotensina. Los pacientes que no controlaron su PA con estos fármacosfueron tratados con doxazosina.Diseño y métodos. El estudio reclutó 203 pacientes con insuficiencia renal (creatinina> 1,4 mg/dl en varones o > 1,2 mg/dl en mujeres, o aclaramiento de creatinina< 80 ml/min). Todos los pacientes estaban siendo tratados con IECA o antagonistasde receptores y la medicación se mantuvo a lo largo del estudio, sin quepudieran recibir diuréticos a lo largo del seguimiento. Los pacientes eran evaluadosclínica y analíticamente 1, 3 y 6 meses después de iniciar tratamiento con lercanidipino.Aquellos pacientes que en la segunda visita no estaban controlados añadierondoxazosina GITS (4 mg en dosis única) al tratamiento.Resultados: 57 pacientes que iniciaron el estudio fueron tratados con doxazosina(edad media 64,8 ± 12,7 años, 47,4 varones y 52,6 mujeres). La PA se redujo significativamentedesde 164 ± 17/92 ± 9 hasta 135 ± 13/78 ± 8 mmHg (p < 0,001). Seprodujeron reducciones significativas de la PA en el 67,6% de los enfermos y el32,4% de los pacientes redujeron su PA hasta los límites recomendados (<130/85mmHg). Únicamente 2 (3,6) pacientes han presentado reacciones adversas. No sedetectó aumento de la incidencia de edema. La creatinina plasmática (1,9 ± 0,6mg/dl) no se había modificado al final del estudio (2,0 ± 0,8 mg/dl) ni el aclaramientode creatinina (38,7 ± 15,7 vs 38,5 ± 14,5). También se detectó un descensosignificativo del urato plasmático (7,0 ± 1,9 vs 6,7 ± 1,6 mg/dl, p < 0,05).Conclusiones: La doxazosina ha presentado un excelente perfil de seguridad enlos pacientes renales, destacando la ausencia de edemas a pesar de la insuficienciarenal de los pacientes

Objective. To evaluate the safety and effectiveness of the alfa-blocker doxazosinGITS in CRF patients.Design and methods. The study recruited 203 CRF patients (creatinine > 1,4mg/dl for males, creatinine > 1,2 mg/dl for females, or creatinine clearance < 80ml/min). All patients were receiving ACE inhibitores (63.4%) or angiotensin II antagonist(36.6%) therapy but they had higher blood pressure than recommended forCRF (130/85 mmHg). Patients were clinically evaluated 1, 3 and 6 moths after startingtreatment with lercanidipine (10 mg once daily). Patients with high blood pressurein spite of combined therapy with two drugs added doxazosin GITS 4-8 mgonce daily to treatment.Result: 57 patients rendered evaluable for the study (age 64.8 ± 12.7 years,47.4% males and 52.6 females). BP significantly decrease from 164 ± 17/92 ± 9mmHg to 135 ± 13/78 ± 8 mmHg. 67.6% patients showed a significant BP reductionand 32.4% gets optimal BP control (< 130/85 mmHg). Two patients (3.6%)showed untoward effects. No biochemical changes were detected.Conclusions: Doxazosin showed a good antihypertensive effect in CRF patientswhen used as third drug in resistant severe hypertension. It has a good tolerabilityprofile and showed a neutral profile on biochemical parameters

[Doxazosine associated to renin-angiotensin blockers and calcioantagonists in chronic renal failure patients]. / Doxazosina asociada a la combinación bloqueante del eje-renina-angiotensina y calcioantagonista en pacientes con insuficiencia renal crónica.

OBJECTIVE: To evaluate the safety and effectiveness of the alfa-blocker doxazosin GITS in CRF patients. DESIGN AND METHODS: The study recruited 203 CRF patients (creatinine > 1,4 mg/dl for males, creatinine > 1,2 mg/dl for females, or creatinine clearance < 80 ml/min). All patients were receiving ACE inhibitores (63.4%) or angiotensin II antagonist (36.6%) therapy but they had higher blood pressure than recommended for CRF (130/85 mmHg). Patients were clinically evaluated 1, 3 and 6 moths after starting treatment with lercanidipine (10 mg once daily). Patients with high blood pressure in spite of combined therapy with two drugs added doxazosin GITS 4-8 mg once daily to treatment. RESULT: 57 patients rendered evaluable for the study (age 64.8 +/- 12.7 years, 47.4% males and 52.6 females). BP significantly decrease from 164 +/- 17/92 +/- 9 mmHg to 135 +/- 13/78 +/- 8 mmHg. 67.6% patients showed a significant BP reduction and 32.4% gets optimal BP control (< 130/85 mmHg). Two patients (3.6%) showed untoward effects. No biochemical changes were detected. CONCLUSIONS: Doxazosin showed a good antihypertensive effect in CRF patients when used as third drug in resistant severe hypertension. It has a good tolerability profile and showed a neutral profile on biochemical parameters.

[Evaluation of efficacy of darbepoetin alfa administered once monthly as treatment of anemia in predialysis patients with chronic kidney disease]. / Evaluación de la eficacia de la darbepoetina alfa subcutánea administrada en dosis única mensual en el tratamiento de la anemia en pacientes con insuficiencia renal crónica prediálisis.

BACKGROUND: Darbepoetin alfa has demonstrated its efficacy when is administered subcutaneously once-weekly and once every 2 weeks as treatment of anemia in patients with chronic kidney disease (CKD). The aim of this study is to assess the efficacy of subcutaneus darbepoetin alfa administered once monthly in patients with progressive CKD who maintained stable levels of Hb treated on once every other week dosing. METHODS: Patients included in the study maintained hemoglobin (Hb) > 11 g/dl and were receiving darbepoetin alfa once every other week during at least 4 months. We studied a frequency interval dose change: once every other week frequency was converted to once monthly at equivalent dose. The study completers were 12 patients over the third month and 7 at the end of one year evaluation period. RESULTS: A statistic significant decrease in Hb and hematocrit (Hto) was observed over the third month, although all patients maintain Hb levels higher than 11 g/dl. At the same time it was appreciated a statistic significant increased on creatinine (Cr) and parathyroid hormone levels (PTH). At the end of one year evaluation period no differences were observed in any of variables. CONCLUSION: Darbepoetin alfa administered once monthly is an efficacious option as treatment of anemia for patientes with CKD. With a dose of 1 mcg/kg/month, all patientes maintain Hb > 11 g/dl.

Es posible una nefrología ambulatoria diferente y eficiente? / No disponible

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