Recommendations of the Spanish Society of Nephrology for the management of mineral and bone metabolism disorders in patients with chronic kidney disease: 2021 (SEN-MM).

As in 2011, when the Spanish Society of Nephrology (SEN) published the Spanish adaptation to the Kidney Disease: Improving Global Outcomes (KDIGO) universal Guideline on Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD), this document contains an update and an adaptation of the 2017 KDIGO guidelines to our setting. In this field, as in many other areas of nephrology, it has been impossible to irrefutably answer many questions, which remain pending. However, there is no doubt that the close relationship between the CKD-MBD/cardiovascular disease/morbidity and mortality complex and new randomised clinical trials in some areas and the development of new drugs have yielded significant advances in this field and created the need for this update. We would therefore highlight the slight divergences that we propose in the ideal objectives for biochemical abnormalities in the CKD-MBD complex compared to the KDIGO suggestions (for example, in relation to parathyroid hormone or phosphate), the role of native vitamin D and analogues in the control of secondary hyperparathyroidism and the contribution of new phosphate binders and calcimimetics. Attention should also be drawn to the adoption of important new developments in the diagnosis of bone abnormalities in patients with kidney disease and to the need to be more proactive in treating them. In any event, the current speed at which innovations are taking place, while perhaps slower than we might like, globally drives the need for more frequent updates (for example, through Nefrología al día).

Extracellular water/total body water ratio as predictor of mortality in hemodialysis patients.

BACKGROUND: Overhydration is a predictor of mortality in hemodialysis (HD) patients. Bioimpedance spectroscopy (BIS) is used to determine the body composition. Extracellular Water/Total Body Water (ECW/TBW) ratio has been proposed to predict mortality. METHODS: Multicenter, prospective, observational, proof-of-concept study to estimate the impact of ECW/TBW in global and cardiovascular mortality and the relationship with cardiovascular biomarkers. The study included 60 patients (mean age, 71.8 ± 11.4 years; mean time on HD, 52.3 ± 30.8 months) with a median follow-up of 30.5 months (IQ range, 17.2-34 months). RESULTS: Post-dialysis ECW/TBW was directly associated with NT-proBNP and cTnT. During the study 28 patients died, most of them (43%) due to cardiovascular events. Compared to the survivors, these subjects had a higher post-dialysis ECW/TBW ratio (p = 0.006), while for cardiovascular mortality the only significant difference was a higher pre-dialysis ECW/TBW. The ability of post-dialysis ECW/TBW ratio to predict all-cause mortality had an area under the ROC curve (AUC) of 0.71 (CI 95%, 0.57-0.81; p = 0.002), with a cutoff point of 0.5023. For cardiovascular mortality the AUC was 0.66 (CI 95%, 0.52-0.77; p = 0.045), with a cutoff point of 0.4713. CONCLUSIONS: The post-dialysis ECW/TBW ratio measured by BIS can be a predictor of all-cause and cardiovascular mortality.

How to improve adherence the captors of phosphorus on hemodialysis: Experience in real life with sucroferric oxyhydroxide / Cómo mejorar la adherencia a los captores del fosforo en hemodiálisis: experiencia en vía real con oxihidróxido sucroférrico

INTRODUCTION: The lack of adherence to phosphate -binders (PB) is the most important factor in not achieving the objectives of serum phosphorus (sP). Studies in the real-world population are needed to understand the influence of PBs on adherence and how to modify it. METHODS: Prospective study conducted during 3 months in usual clinical practice. Out of 105 hemodialysis patients, 57 were switched to SFOH and 48 maintained their baseline treatment (control group). sP levels and the percentage of patients with sP levels < 5mg/dl were compared. Adherence before and after introduction of SFOH, number of pills of PB, preferences in the administration mode and side effects were analyzed. RESULTS: The percentage of patients with controlled sP (< 5 mg/dl) increased significantly in the SFOH users' group (62.1-92.9%, p < 0.001), but not in the control group (83-83.3%, p = NS). The average of daily tablets decreased significantly in the SFOH group (7.2-2.3 comp, p < 0.001), but not in the control group (5.6-5.6, p = NS) and 100% of the patients used only one PB in SFOH group. The use of SFOH increased the adherence according to the SMAQ questionnaire (57.8-84.3%; OR 13.1, p < 0.001). The possibility to choose the preferred mode of administration (split-swallowing 89% compared to chewing 11%), improved the acceptance (44.7-78%). 14% of the patients experienced side effects and in 5.2% SFOH was discontinued for this reason. CONCLUSIONS: SFOH controlled serum sP in 93% of patients, 100% in monotherapy, and with fewer tablets. The exploration and adaptation of preferences in the mode of administration influenced the acceptance of the drug by the patient and, probably, the future adherence

INTRODUCCIÓN: La falta de adherencia a los captores del fósforo es el factor más importante para no lograr los objetivos del fósforo sérico (Ps). Se necesitan estudios en la población del mundo real para comprender la influencia de los CP sobre la adherencia y como modificarla. OBJETIVOS: Evaluar la eficacia y la adherencia de un nuevo CP, oxihidróxido sucroférrico (OHSF) en pacientes en hemodiálisis y la influencia de un cambio en el modo de administración del fármaco sobre la aceptación del mismo. MÉTODOS: Estudio prospectivo realizado durante 3 meses en práctica clínica habitual. De 105 pacientes de hemodiálisis, 57 pacientes con P mal controlado (p < 5 mg/dl) fueron cambiados a OHSF y 48 mantuvieron su tratamiento inicial (grupo control). Se compararon los niveles de Ps y el porcentaje de pacientes con niveles de Ps < 5 mg/dl. Se analizó la adherencia antes y después de la introducción de OHSF, el número de comprimidos de captores del P, los efectos secundarios y el grado de aceptación del fármaco tras ofrecer varias alternativas en el modo de administración. RESULTADOS: El porcentaje de pacientes con P controlado (< 5 mg/dl) aumentó significativamente a los 3 meses de seguimiento en el grupo de pacientes con OHSF (62,1 al 92,9%; p < 0,001), pero no en el grupo de control (83 al 83,3%; p = NS). El promedio de comprimidos diarios disminuyó significativamente en el grupo OHSF (7,2 a 2,3 comprimidos; p < 0,001), pero no en el grupo control (5,6 a 5,6; p = NS) y todos los pacientes en tratamiento con OHSF se controlaron con monoterapia. El uso de OHSF aumentó la adherencia según el cuestionario SMAQ (57,8 al 84,3%; OR: 13,1; p < 0,001). La posibilidad de elegir el modo de administración preferido (cortar-tragar 89% en comparación con masticar 11%) mejoró la aceptación (44,7 al 78%) de los pacientes. El 14% de los pacientes experimentaron efectos secundarios y en 5,2% se suspendió el OHSF por esta razón. CONCLUSIONES: OHSF controló el P sérico en el 93% de los pacientes, siendo la totalidad de ellos en monoterapia, y con menor número de comprimidos a corto plazo. La exploración y adaptación de las preferencias en el modo de administración influyó en la aceptación del fármaco por parte del paciente y, probablemente en la adherencia futura

Nueva información sobre interacciones de captores de fósforo con la vitamina K / New information on phosphate binder interactions with vitamin K

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How to improve adherence the captors of phosphorus on hemodialysis: Experience in real life with sucroferric oxyhydroxide.

INTRODUCTION: The lack of adherence to phosphate -binders (PB) is the most important factor in not achieving the objectives of serum phosphorus (sP). Studies in the real-world population are needed to understand the influence of PBs on adherence and how to modify it. METHODS: Prospective study conducted during 3 months in usual clinical practice. Out of 105 hemodialysis patients, 57 were switched to SFOH and 48 maintained their baseline treatment (control group). sP levels and the percentage of patients with sP levels <5mg/dl were compared. Adherence before and after introduction of SFOH, number of pills of PB, preferences in the administration mode and side effects were analyzed. RESULTS: The percentage of patients with controlled sP (<5mg/dl) increased significantly in the SFOH users' group (62.1-92.9%, p<0.001), but not in the control group (83-83.3%, p=NS). The average of daily tablets decreased significantly in the SFOH group (7.2-2.3 comp, p<0.001), but not in the control group (5.6-5.6, p=NS) and 100% of the patients used only one PB in SFOH group. The use of SFOH increased the adherence according to the SMAQ questionnaire (57.8-84.3%; OR 13.1, p<0.001). The possibility to choose the preferred mode of administration (split-swallowing 89% compared to chewing 11%), improved the acceptance (44.7-78%). 14% of the patients experienced side effects and in 5.2% SFOH was discontinued for this reason. CONCLUSIONS: SFOH controlled serum sP in 93% of patients, 100% in monotherapy, and with fewer tablets. The exploration and adaptation of preferences in the mode of administration influenced the acceptance of the drug by the patient and, probably, the future adherence.

Interacciones farmacológicas de los captores del fósforo / Pharmacological interactions of phosphate binders

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