RESUMEN
In patients with chronic kidney disease (CKD), the main cause of morbidity and mortality is cardiovascular disease (CVD). Both coronary artery calcium scoring by computed tomography (CT) and optical coherence tomography (OCT) are used to identify patients at increased risk for ischemic heart disease, thereby indicating a higher cardiovascular risk profile. Our study aimed to investigate the utility of these techniques in the CKD population. In patients with CKD, OCT was used to measure the choroidal thickness (CHT) and the thickness of the peripapillary retinal nerve fiber layer (pRNFL). A total of 127 patients were included, including 70 men (55%) with an estimated glomerular filtration rate (eGFR) of 39 ± 30 mL/min/1.73 m2. Lower pRNFL thickness was found to be related to high-sensitivity troponin I (r = -0.362, p < 0.001) and total coronary calcification (r = -0.194, p = 0.032). In a multivariate analysis, pRNFL measurements remained associated with age (ß = -0.189; -0.739--0.027; p = 0.035) and high-sensitivity troponin I (ß = -0.301; -0.259--0.071; p < 0.001). Severe coronary calcification (Agatston score ≥ 400 HU) was related to a worse eGFR (p = 0.008), a higher grade of CKD (p = 0.036), and a thinner pRNFL (p = 0.011). The ROC curve confirmed that the pRNFL measurement could determine the patients with an Agatston score of ≥400 HU (AUC 0.638; 95% CI 0.525-0.750; p = 0.015). Our study concludes that measurement of pRNFL thickness using OCT is related to the markers associated with ischemic heart disease, such as coronary calcification and high-sensitivity troponin I, in the CKD population.
RESUMEN
BACKGROUND: A nondirected altruistic living kidney donor is a person who wants to donate a kidney to anyone in need. In 2010, the Spanish National Transplant Organization developed a national protocol to make the assessment of every potential nondirected living kidney donor. The aim of this study was to describe the potential donor pool and its characteristics and the overall effect of the program. MATERIAL AND METHODS: A retrospective analysis was performed using data from the Spanish National Registry of Transplant Activity, and the Nondirected Donors National Database, between 2010 and 2017. Data related to sociodemographic characteristics, main motivations toward donation, and causes of dismissal were collected from all potential donors. The assessment of each candidate was carried out in a step-by-step process based on the national protocol. RESULTS: Two hundred seventy-two people contacted us, showing interest in the nondirected kidney donation, only 203 people underwent the early triage, and 16 of them successfully completed the assessment proces s, representing 8% of the total. The main motivation toward anonymous donation (n = 161) was: social awareness (22%) and to improve the quality of life of other people (9%). One hundred eighty-two candidates did not proceed, due to medical and psychological contraindications (42%) or donor refusal after specific information about the donation process (33%). The number of utilized nondirected altruistic living donors was 13 out of 203 (6%) of the candidates who began the early triage. Twelve transplant chains and a direct donation were performed, which made 38 kidney transplants possible (2.9 transplants per nondirected donor). CONCLUSIONS: We have to continue working to optimize our program. Our next steps will be to review the evaluation process, to detect areas for improvement, to understand why we lost many possible donors, and to ascertain if any of the reasons could be avoided.
