Progresión de la enfermedad renal crónica en pacientes con hipertensión resistente sometidos a 2 estrategias terapéuticas: intensificación con diuréticos de asa vs. antagonistas de la aldosterona / Chronic kidney disease progression in patients with resistant hypertension subject to 2 therapeutic strategies: Intensification with loop diuretics vs aldosterone antagonists

INTRODUCCIÓN: En la actualidad, existen pocos datos sobre la evolución de la función renal en pacientes con hipertensión arterial (HTA) resistente y enfermedad renal crónica (ERC), así como de la influencia de diferentes tipos de tratamiento en dicha progresión. OBJETIVO: Evaluar la progresión de la ERC en pacientes con ERC e HTA resistente tratados mediante 2 estrategias terapéuticas diferentes: tratamiento con espironolactona vs. furosemida. MÉTODOS: Incluimos a 30 pacientes (21 H, 9M) con una edad media de 66,3 ± 9,1 años, FGe 55,8 ± 16,5 ml/min/1,73 m2, PAS 162,8 ± 8,2 y PAD 90,2 ± 6,2 mmHg: 15 tratados con espironolactona y 15 con furosemida, seguidos durante un tiempo medio de 32 meses (28-41). RESULTADOS: El descenso medio anual del FGe fue de -2,8 ± 5,4 ml/min/1,73 m2. En el grupo de espironolactona fue de -2,1 ± 4,8ml/min/1,73 m2 y en el de furosemida -3,2 ± 5,6 ml/min/1,73 m2, p < 0,01. En los pacientes con espironolactona la PAS disminuyó 23 ± 9 mmHg vs. 16 ± 3mmHg en el grupo de furosemida (p < 0,01). La PAD se redujo 10 ± 8 mmHg y 6 ± 2 mmHg, respectivamente (p < 0,01). El tratamiento con espironolactona redujo la albuminuria de una mediana de 210 (121-385) mg/g a 65 (45-120) mg/g al final del seguimiento, p < 0,01. En el grupo de furosemida la albuminuria no descendió. La progresión más lenta en la enfermedad renal se asoció con una menor PAS (p = 0,04), mayor FGe basal (p = 0,01), menor albuminuria (p = 0,01), no tener diabetes mellitus (p = 0,01) y recibir tratamiento con espironolactona (p = 0,02). El tratamiento con espironolactona (OR 2,13; IC 1,89-2,29) y la menor albuminuria (OR 0,98; IC 0,97-0,99) mantienen su poder predictivo independiente en un modelo multivariante. CONCLUSIONES: El tratamiento con espironolactona reduce más la presión arterial y la albuminuria en pacientes con HTA resistente comparado con la furosemida y esto se asocia con una progresión más lenta de la ERC a largo plazo

INTRODUCTION: Actualy, there are few data about glomerular filtration rate (eGFR) drop in patients with resistant hypertension and how diferent therapies can modify chronic kidney disease progression (CKD). OBJECTIVE: To evaluate CKD progression in patients with resistant hypertension undergoing 2 diferent therapies: treatment with spironolactone or furosemide. METHODS: We included 30 patients (21 M, 9 W) with a mean age of 66.3 ± 9.1 years, eGFR 55.8 ± 16.5 ml/min/1.73 m2, SBP 162.8 ± 8.2 and DBP 90.2 ± 6.2 mmHg: 15 patients received spironolactone and 15 furosemide and we followed up them a median of 32 months (28-41). RESULTS: The mean annual eGFR decrease was -2.8 ± 5.4 ml/min/1.73 m2. In spironolactone group was -2.1 ± 4.8 ml/min/1.73 m2 and in furosemide group was -3.2 ± 5.6 ml/min/1.73 m2, P < 0.01. In patients received spironolactone, SBP decreased 23 ± 9 mmHg and in furosemide group decreased 16 ± 3 mmHg, P<.01. DBP decreased 10 ± 8 mmHg and 6 ± 2mmHg, respectively (P<.01). Treatment with spironolactone reduced albuminuria from a serum albumin/creatine ratio of 210 (121-385) mg/g to 65 (45-120) mg/g at the end of follow-up, P<.01. There were no significant changes in the albumin/creatinine ratio in the furosemide group. The slower drop in kidney function was associated with lower SBP (P=.04), higher GFR (P=.01), lower albuminuria (P=.01), not diabetes mellitus (P=.01) and treatment with spironolactone (P=.02). Treatment with spironolactone (OR 2.13, IC 1.89-2.29) and lower albuminuria (OR 0.98, CI 0.97-0.99) maintain their independent predictive power in a multivariate model. CONCLUSION: Treatment with spironolactone is more effective reducing BP and albuminuria in patients with resistant hypertension compared with furosemide and it is associated with a slower progression of CKD in the long term follow up

Chronic kidney disease progression in patients with resistant hypertension subject to 2 therapeutic strategies: Intensification with loop diuretics vs aldosterone antagonists. / Progresión de la enfermedad renal crónica en pacientes con hipertensión resistente sometidos a 2 estrategias terapéuticas: intensificación con diuréticos de asa vs. antagonistas de la aldosterona.

INTRODUCTION: Actualy, there are few data about glomerular filtration rate (eGFR) drop in patients with resistant hypertension and how diferent therapies can modify chronic kidney disease progression (CKD). OBJECTIVE: To evaluate CKD progression in patients with resistant hypertension undergoing 2diferent therapies: treatment with spironolactone or furosemide. METHODS: We included 30 patients (21M, 9W) with a mean age of 66.3±9.1 years, eGFR 55.8±16.5ml/min/1.73 m2, SBP 162.8±8.2 and DBP 90.2±6.2mmHg: 15 patients received spironolactone and 15 furosemide and we followed up them a median of 32 months (28-41). RESULTS: The mean annual eGFR decrease was -2.8±5.4ml/min/1.73 m2. In spironolactone group was -2.1±4.8ml/min/1.73 m2 and in furosemide group was -3.2±5.6ml/min/1.73 m2, P<0.01. In patients received spironolactone, SBP decreased 23±9mmHg and in furosemide group decreased 16±3mmHg, P<.01. DBP decreased 10±8mmHg and 6±2mmHg, respectively (P<.01). Treatment with spironolactone reduced albuminuria from a serum albumin/creatine ratio of 210 (121-385) mg/g to 65 (45-120) mg/g at the end of follow-up, P<.01. There were no significant changes in the albumin/creatinine ratio in the furosemide group. The slower drop in kidney function was associated with lower SBP (P=.04), higher GFR (P=.01), lower albuminuria (P=.01), not diabetes mellitus (P=.01) and treatment with spironolactone (P=.02). Treatment with spironolactone (OR 2.13, IC 1.89-2.29) and lower albuminuria (OR 0.98, CI 0.97-0.99) maintain their independent predictive power in a multivariate model. CONCLUSION: Treatment with spironolactone is more effective reducing BP and albuminuria in patients with resistant hypertension compared with furosemide and it is associated with a slower progression of CKD in the long term follow up.

Daño renal en pacientes con síndrome metabólico que consultan en atención primaria / Renal damage in primary care patients with metabolic syndrome

Introducción. Estudiar en condiciones de práctica clínica real el daño renal, la prevalencia y grado de control de los factores de riesgo cardiovascular en pacientes con síndrome metabólico atendidos en atención primaria. Material y método. Estudio observacional realizado a pacientes con síndrome metabólico (criterios ATP III). Realizado en centros de atención primaria de la Región de Murcia y Asturias. Se incluyó a 485 pacientes. Los datos recogidos fueron edad, sexo, índice de masa corporal (IMC), presión arterial, presión de pulso, glucosa, hemoglobina glucosilada, perfil lipídico, factores de riesgo cardiovascular, tratamiento, componentes de síndrome metabólico y datos de afectación renal. Resultados. De los 458 pacientes, el filtrado glomerular es < 90ml/min en 375 (77,5%). La microalbuminuria ha sido positiva en 94 pacientes (22%). Las cifras medias de presión arterial fueron 143,6±16,0mm de Hg para la sistólica y 82,8±10,2mm de Hg para la diastólica. El LDL colesterol (LDLc) medio fue de 129,88±36,77mg/dl y la hemoglobina glucosilada, de 6,47±1,45g/dl. El fármaco más utilizado para el control de la diabetes fue la metformina en el 33,6% de los diabéticos. Respecto a la hipertensión arterial (HTA) los fármacos más utilizados fueron los bloqueantes del sistema renina angiotensina en el 41,1% de los hipertensos y para el control lipídico fueron las estatinas en el 63,1% de los dislipidémicos. Conclusiones. Se detecta afectación renal en un alto porcentaje de los pacientes. Es necesario lograr un alto grado de control de los factores de riesgo cardiovascular en estos pacientes (AU)

Introduction: To study, under routine clinical practice conditions, renal damage, prevalence and control of cardiovascular risk factors in patients with metabolic syndrome treated in Primary Care centres in Spain. Material and methods: An observational study in patients with metabolic syndrome (ATP III criteria) was conducted in Primary Care Centres in Murcia and Asturias. A total of 485 patients were included. The data collected were: age, sex, body mass index, blood pressure, pulse pressure, glucose, glycosylated haemoglobin, lipid profile, cardiovascular risk factors, treatment, components of metabolic syndrome and data on renal involvement. Results: Of the 485 patients, 375 (77.5%) had a glomerular filtration rate of < 90 ml/min. Microalbuminuria was positive in 94 patients (22%). The means of blood pressure were 143.6±16.0 mmHg for systolic, and 82.8±10.2 mmHg for diastolic. The mean LDL cholesterol was 129.88±36.97 mg/dL and for glycosylated haemoglobin it was 6.47±1.45 g/dL. The drug most used for the control of the diabetes was metformin in 33.6% of the diabetics. With respect to hypertension the drugs more used were the renin-angiotensin system blockers in 41.1% of the hypertensive patients. Statins were used for lipid control in 63.1% of the patients. Conclusions: Renal damage was detected in a high percentage of the patients. An increased level of control of cardiovascular risk factors is required in these patients (AU)

Factores de progresión de la enfermedad renalcrónica. Prevención secundaria / No disponible

La historia natural de la mayoría de las enfermedades renales crónicas (ERC) indica que el filtrado glomerular va disminuyendo a lo largo del tiempo, progresando hacia estadios más avanzados de insuficiencia renal. Desde la publicación de los primeros trabajos del grupo de estudio sobre modificaciones de la dieta en la enfermedad renal(MDRD), se han identificado múltiples factores que pueden acelerar esta evolución. Algunos son dependientes dela etiología pero otros son comunes a todas ellas, y que (..) (AU)

The natural history of most chronic kidney diseases (CKD) indicates that glomerular filtration gradually declines over time, progressing to more advanced stages of kidney failure. Since the publication of the first studies by the Modification of Diet in Renal Disease (MDRD) Study Group, numerous factors have been identified that can accelerate this progression. Some are dependent on the etiology, but other are common (..)(AU)

[Progression factors for chronic kidney disease. Secondary prevention]. / Factores de progresion de la enfermedad renal cronica. Prevencion secundaria.

The natural history of most chronic kidney diseases (CKD) indicates that glomerular filtration gradually declines over time, progressing to more advanced stages of kidney failure. Since the publication of the first studies by the Modification of Diet in Renal Disease (MDRD) Study Group, numerous factors have been identified that can accelerate this progression. Some are dependent on the etiology, but other are common to all and may accelerate progression of kidney disease: Non-modifiable progression factors for CKD: - Etiology of kidney disease - Degree of initial kidney function - Gender - Age - Ethnicity/Other genetic factors - Birth weight Modifiable progression factors for CKD: - Proteinuria - High blood pressure - Poor glycemic control in diabetes - Smoking - Obesity - Metabolic syndrome/Insulin resistance - Dyslipidemia - Anemia - Metabolic factors (Ca/P, uric acid) - Use of nephrotoxic drugs. Therapeutic intervention on these factors has shown that it reduce the rate of progression of CKD (Strength of Recommendation A).There is no clear evidence that correction of these factors slows CKD (Strength of Recommendation C), although it has been shown to have a beneficial effect on cardiovascular risk at other levels.

[Calciphylaxis: fatal complication of cardiometabolic syndrome in patients with end stage kidney disease]. / Calcifilaxis: complicación grave del síndrome cardio-metabólico en pacientes con enfermedad renal crónica terminal (ERCT).

UNLABELLED: Calciphylaxis characterized by schemic skin ulceration due to subcutaneous small arterioles calcification, is a rare disease but usually fatal. Disorders of calcium metabolism and vascular calcifications are common in dialysis patients but calciphylaxis prevalence is low in patients with end stage renal disease. So we proposed other emergent factors implicated in calciphylaxis development. METHODS: We studied retrospective 8 patients who developed calciphylaxis in our service from january 2001 to december 2006. RESULTS: All patients were female with mean age at diagnosis 68.5+/-6.7 years. All patients were receiving hemodialysis therapy and 6 patients had been receiving hemodialysis less than four months. Six patients had diabetes mellitus type II and all patients were obese (BMI >25 kg/m2). All patients had metabolic syndrome (APTIII) with bad control hypertension and 6 (75%) were receiving anticoagulation therapy with warfarin. Patients didn t have severe alterations of calcium metabolism, all had product calcium-phosphorus <55. All patients developed low blood pressure at the beginning of dialysis treatment (98.3+/-22.7/60+/-18,29 mmHg). 7 patients present proximal lesions in fatty regions like abdomen and thighs. Histopathologic examination reveals calcium deposits in arteriole-sized and small vessels with vascular thrombosis. Prognosis was poor, seven patients died secondary to a sepsis originated in infected cutaneous ulcers. CONCLUSIONS: calciphylaxis is a disease with poor prognosis and high mortality, without specific treatment actually. Female gender, obesity associated with diabetes mellitus and cardiometabolic syndrome, anticoagulant therapy with warfarin and low blood pressure associated with hemodialysis therapy, are risk factors to develop calciphylaxis, in absence of severe disorders of calcium metabolism. In these patients is important to avoid hypotension episodes during dialysis, dialysis hypotension appears to be an important risk factor who promotes ischemia of subcutaneous adipose tissue.

Calcifilaxis: complicación grave del síndrome cardio-metabólico en pacientes con enfermedad renal crónica terminal (ERCT) / Calciphylaxis: fatal complication of cardio-metabolic syndrome in patients with end stage kidney disease

La calcifilaxis, caracterizada por la ulceración isquémica de la piel secundaria a la calcificación de las pequeñas arteriolas subcutáneas, es una enfermedad poco frecuente pero con mal pronóstico. Los pacientes con ERCT tienen un riesgo alto de calcificaciones patológicas debido a las alteraciones del metabolismo calcio-fósforo, pero solo un pequeño número desarrollan esta enfermedad. Por ello es lógico pensar que hay otros factores que condicionan el desarrollo de la calcifilaxis. Métodos: Con el fin de identificar estos posibles factores implicados en su génesis, hemos analizado de forma retrospectiva las características de los 8 pacientes con ERCT que presentaron calcifilaxis en nuestro hospital entre de enero 2001 a diciembre 2006. Resultados: Los 8 pacientes eran mujeres con edad media de 68,5 ± 6,7 años. Todas presentaban ERCT en hemodiálisis periódica (HD) y en 6 casos la cacifilaxis apareció en los primeros 4 meses del inicio del tratamiento con HD. Seis de las pacientes eran diabéticas tipo 2 y todas eran obesas (IMC > 25 kg/m2), 3 con obesidad grado 4 o mórbida. Todas cumplían criterios de síndrome metabólico (APT III), habían sido hipertensas mal controladas y en un 75% de los casos recibían tratamiento con anticoagulantes cumarínicos por distintas causas. No presentaban alteraciones severas del metabolismo calcio-fósforo: todas tenían un producto CaxP < 55. En todos los casos se controló estrictamente la Presión arterial (PA) con el tratamiento con HD manteniendo cifras medias de PA de 98,3 ± 22,7/60 ± 18,29 mmHg en el momento de la aparición de los síntomas. La mayoría de las pacientes (7/8), presentaron las lesiones a nivel proximal en las zonas con mayor depósito graso como muslos y abdomen. El estudio histológico de las lesiones en todos los casos demostró calcificación de pequeñas arteriolas subcutáneas asociada a paniculitis y trombosis de pequeños vasos. La evolución clínica fue mala ya que siete de las ocho pacientes murieron como consecuencia de una sepsis de origen cutáneo. La exéresis quirúrgica de los nódulos no modificó la mala evolución. En conclusión: La paniculitis calcificante en pacientes con ERCT es una enfermedad rara pero de mal pronóstico y elevada mortalidad. El sexo mujer, la obesidad asociada a Diabetes y Síndrome metabólico, el tratamiento anticoagulante y el excesivo control de la presión arterial al inicio del tratamiento con HD pueden favorecer su aparición incluso en ausencia de alteraciones relevantes del metabolismo Ca-P-PTH. Debido a la epidemia actual de DM, obesidad y síndrome metabólico es de esperar que el número de pacientes con estas características que desarrollen ERCT y calcifilaxis vaya en aumento (AU)

Calciphylaxis characterized by schemic skin ulceration due to subcutaneous small arterioles calcification, is a rare disease but usually fatal. Disorders of calcium metabolism and vascular calcifications are common in dialysis patients but calciphylaxis prevalence is low in patients with end stage renal disease. So we proposed other emergent factors implicated in calciphylaxis development. Methods: We studied retrospective 8 patients who developed calciphylaxis in our service from january 2001 to december 2006. Results: All patients were female with mean age at diagnosis 68.5 ± 6.7 years. All patients were receiving hemodialysis therapy and 6 patients had been receiving hemodialysis less than four months. Six patients had diabetes mellitus type II and all patients were obese (BMI > 25 kg/m2). All patients had metabolic syndrome (APTIII) with bad control hypertension and 6 (75%) were receiving anticoagulation therapy with warfarin. Patients didn´t have severe alterations of calcium metabolism, all had product calcium-phosphorus < 55. All patients developed low blood pressure at the beginning of dialysis treatment (98.3 ± 22.7/60 ± 18,29 mmHg). 7 patients present proximal lesions in fatty regions like abdomen and thighs. Histopathologic examination reveals calcium deposits in arteriole-sized and small vessels with vascular thrombosis. Prognosis was poor, seven patients died secondary to a sepsis originated in infected cutaneous ulcers. Conclusions: calciphylaxis is a disease with poor prognosis and high mortality, without specific treatment actually. Female gender, obesity associated with diabetes mellitus and cardiometabolic syndrome, anticoagulant therapy with warfarin and low blood pressure associated with hemodialysis therapy, are risk factors to develop calciphylaxis, in absence of severe disorders of calcium metabolism. In these patients is important to avoid hypotension episodes during dialysis, dialysis hypotension appears to be an important risk factor who promotes ischemia of subcutaneous adipose tissue (AU)

[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

Catéter temporal al inicio de diálisis: indicador de calidad en los cuidados pre-diálisis / Temporary catheter at dialysis onset: quality indicator of pre-dialysis care

No disponible

No disponible

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

[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.

¿Qué características tienen los pacientes que acuden por primera vez a consultas externas de nefrología? / No disponible

No disponible

Riesgo de enfermedad cardiovascular asociado a la enfermedad renal crónica. Prevalencia y grado de control de los factores de riesgos clásicos / No disponible

No disponible

Vasculitis asociadas a ANCA en los ancianos / No disponible

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[Renal and cardiovascular protection associated to antihypertensive treatment in the elderly]. / Protección cardiovascular y renal asociada al tratamiento antihipertensivo en el anciano.

The incidence of arterial hypertension increases with age in such a way that by the age of 60 the incidence is greater than 50% in men and women. This increase is particularly relevant if we consider the changes in systolic blood pressure (increase) and diastolic blood pressure (decrease) in relation to age and as a consequence in the reduction of vascular compliance which is common in men and women over the age of 60. These disorders are associated to artheriosclerosis and the corresponding increase in pulse pressure. It is for these reasons that the most common form of hypertension is isolated systolic hypertension (SBP > 140 mmHg and SBP < 90 mmHg), which represents 50% of hypertensive patients in the elderly population. Isolated systolic hypertension is also associated to an increase in cardiovascular disease (MI, stroke), increasing the risk of mortality four times. In elderly people, hypertension and isolated systolic hypertension are risk factors that can be managed. Today there is sufficient evidence from clinical trials that show a clear benefit in the reduction of the cardiovascular and renal risk associated to the antihypertensive treatment in the elderly, at least when the blood pressure is greater than 160/90 mmHg. The target blood pressure figures to control in the elderly person, probably below 160/90 mmHg, still need to be determined.