Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review.

BACKGROUND: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. OBJECTIVE: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). MATERIAL AND METHODS: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. RESULTS: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively. CONCLUSION: The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM.

Cambios inducidos por la enfermedad renal crónica en los pacientes con diabetes / Induced changes by chronic kidney disease in patients with diabetes

La nefropatía diabética afecta al 25-40% de los pacientes diabéticos y es unmarcador de morbimortalidad. Las complicaciones relacionadas con la insuficienciarenal presentes en estos pacientes se hacen más relevantes a medidaque disminuye el filtrado glomerular. La enfermedad cardiovascular es la complicacióncon más relevancia pronóstica. Ésta incluye la enfermedad coronaria,la hipertensión arterial, la hipertrofia ventricular izquierda, la insuficiencia cardiaca,las arritmias y la pericarditis. Otras complicaciones derivadas de la afectaciónrenal influirán en el pronóstico y evolución del paciente con diabetes,como la anemia, las complicaciones hemorrágicas, los fenómenos trombóticos,las alteraciones en la respuesta inmunitaria y la susceptibilidad a las infecciones.Todas las complicaciones presentes en el paciente con nefropatía diabéticaobligan a un abordaje multifactorial que incluye, en primer lugar, laprevención de la aparición/progresión de las complicaciones mediante el controlde los factores de riesgo de desarrollo de macroangiopatía y microangiopatía:control de la glucemia y de la hipertensión arterial, reducción de la proteinuria,evitación del tabaquismo, mantenimiento del peso ideal, reducción dela ingestión de sal y tratamiento con antiagregantes y estatinas, así como prevenirla nefrotoxicidad(AU)

Diabetic nephropathy affects about 25-40% of diabetic patients and is a markerof morbimortality. Complications related to kidney failure in these patientsbecome even more relevant with decreasing glomerular filtration rate.Cardiovascular disease is the most relevant complication, which include coronarydisease, arterial hypertension, left ventricular hypertrophy, congestive cardiacinsufficiency, arrhythmias and pericarditis. Other related renal complicationswill influence the prognosis and evolution of diabetic patients such asanemia, hemorrhagic complications, thrombotic phenomena, alterations of immune response and susceptibility to infections. All these complications, which are present in the patient with diabetic nephropathy, force towards a multifactor approach, which includes firstly the prevention of the appearance/progression of the complications through a control of the risk factors for macro and microangiopathyas glycemic and blood pressure control, proteinuria reduction,avoiding nicotine abuse, keeping closed to the ideal weight, salt intake reduction,antiaggregant treatment and statins therapy, as well as preventing additional renal toxicity(AU)

[Strongyloides stercoralis infection in renal transplant recipients]. / Infección por Strongyloides stercoralis en pacientes trasplantados renales.

We present two cases of strongyloides stercoralis infection in renal transplant recipients in our centre. We describe clinical presentation characteristics, treatment and resolution.

[Analysis of variability in determining intact parathyroid hormone (iPTH) according to the method used to process the sample]. / Análisis de la variabilidad en la determinación de la hormona paratiroidea (PTH-i) según el método empleado para procesar la muestra.

BACKGROUND: The measurement of i-PTH circulating is not easy due to its analytical variablity. Variability that appears in the process that goes from the sample collection to the final result determination. There are several important aspects that can influence within the pre-test variability: type of sample (serum o plasma), temperature, time elapses from blood extraction to freezing and from freezing to i-PTH quantification. Blood coming from centres far from our laboratory do not always meet the required processing conditions. Our aim was to study the stability of i-PTH with varying conditions of temperature and time until freezing in patients with chronic kidney disease (CKD). METHODS: We have analyzed 294 blood samples of 49 patients with chronic kidney disease (18 transplantated patients (36.7%) and 31 patients in haemodyalisis (63.3%)). The blood samples were collected using tubes treated with ethylenediaminotetraacetic acid (EDTA); these samples were subjected to different conditions of temperature and time before they were frozen, constituting 6 groups: blood centrifuged and plasma immediately frozen (group A or reference group); blood maintained 1 hour at room temperature and plasma stored at 2-8 masculineC during 0, 8 and 24 hours (groups B,C,D); blood maintained 3 hours at room temperature and plasma stored at 2-8 masculineC during 0 and 8 hours (groups E,F). The intact PTH (i-PTH) was measured using the immunoradiometric assay (IRMA Total Intact Scantibodies assay). We have analyzed the differences between the PTH-i mean values in the referenced groud and the others. We have applied the tests of homogeneity variance and normality and we have perform a comparation by pairs with the t-test including the Bonferroni correction. RESULTS: The mean value of intact-PTH in the referente Group was 202.5+/-199.72 pg/ml. The means values of intact-PTH in the other groups were 196 +/- 203.23 pg/ml, 202.8 +/- 200.2 pg/ml, 200.06 +/- 194.87 pg/ml, 204.08 +/- 204.073 pg/ml, 197.94 +/- 182.31 pg/ml. The results were practically identical for each group. We did not find important differences with respect to the reference group (p = 0.87, p = 0,99, p = 0,95, p = 0,96, p = 0,90 when comparing with groups 2a, 2b, 2c, 3a y 3b). CONCLUSIONS: The use of EDTA maintain the PTH stability during a longer period without the necessity of freezing the samples immediately. These results can help to state strategies to management the samples in patients with ERC.

[How to carry out the search of kidney disease in patients with cardiovascular disease?]. / Cómo realizar la búsqueda de enfermedad renal en pacientes con enfermedad cardiovascular?

Patients with chronic kidney disease are at high risk of cardiovascular disease and should receive intensive risk-reduction therapy. Early detection of albuminuria and chronic kidney disease can identify individuals at increased risk of adverse clinical events and therefore may have a better opportunity to improve their outcomes. The determination of serum creatinine should not be the only parameter used to as renal function. The evaluation of the renal involvement in patients with cardiovascular disease should be done using the determination of albumin in a urine spot test and estimating glomerular filtration from predictive equations derived from creatinine. The MDRD equation is of choice but alternatively the Cockcroft-Gault formula can also be used.

Impacto socio sanitario de la enfermedad renal crónica avanzada / No disponible

La prevalencia de ERC en España es del 11%, con una tasa elevada de factores de riesgo vascular asociados y el progresivo incremento del número de pacientes subsidiarios de depuración extrarrenal, estimado en un 5-8% anual, ha convertido a esta enfermedad en un problema sanitario, social y económico de primer orden para todos los sistemas sanitarios de los países desarrollados. La terapia renal sustitutiva, aunque es adecuada, no es óptima para (..) (AU)

The prevalence of CKD in Spain is 11%, with a high rate of associated vascular risk factors and a progressive increase in the number of patients requiring kidney replacement therapy, estimated at 5-8% annually. This has made CKD one of the leading health, social and economic problems for the health care systems of all developed countries. Kidney replacement therapy, although adequate, is not optimal for solving this clinical (..) (AU)

[Social and health impact of advanced chronic kidney disease]. / Impacto socio sanitario de la enfermedad renal cronica avanzada.

The prevalence of CKD in Spain is 11%, with a high rate of associated vascular risk factors and a progressive increase in the number of patients requiring kidney replacement therapy, estimated at 5-8% annually. This has made CKD one of the leading health, social and economic problems for the health care systems of all developed countries. Kidney replacement therapy, although adequate, is not optimal for solving this clinical problem. The key aspects of the problem are: The increase in the number of patients with CKD due to: Early vascular injury as a result of the inflammatory process associated with CKD. Aging of the population, although CKD may be more dependent on comorbidities than age "per se", and prevalence may therefore not have the expected increase. The epidemic of type 2 diabetes mellitus. CKD is the major vascular risk factor both in the general and hypertensive population or patients with established vascular injury. The estimated cost of care of stage 1-4 CKD per year can be 1.6-2.4 times more than kidney replacement therapy. The approach to this serious social and health problem is based on: Early detection and diagnosis of CKD by estimation of glomerular filtration rate and assessment of associated risk factors. Establishment of treatment goals for control of cardiovascular risk factors (blood pressure, dyslipidemia, diabetes mellitus,) and albuminuria to reduce the rate of progression of kidney disease. Joint approach to problem by primary care physicians and other specialists caring for patients at high cardiovascular risk. Establishment of criteria for referral to nephrology departments.

Tratamiento de la trombosis de los injertos de PTFE para hemodiálisis mediante trombectomís percutanea. Estudio prospectivo / Treatment of ptfe haemodialysis graft thrombosis by percutaneous thrombectomy. A prospective study

Objetivos. Las guías actuales (DOQI) recomiendan una permeabilidad primaria a los tres meses del 40 por ciento en el tratamiento percutáneo de las trombosis de las prótesis de PTFE para hemodiálisis. El objetivo de nuestro estudio es valorar prospectivamente la eficacia de la trombectomía mecánica en el tratamiento de esta complicación de las prótesis para hemodiálisis. Pacientes y métodos. Hemos analizado prospectivamente 107 trombectomías percutáneas consecutivas de prótesis de PTFE para hemodiálisis realizadas en 75 pacientes con técnica hidrodinámica (Hydrolyserâ) en los primeros 35 casos (33 por ciento) y con técnica mecánica simple utilizando un balón de angioplastia en los últimos 72 casos (67 por ciento). Las lesiones subyacentes fueron diagnosticadas mediante fistulografía, tratándose mediante angioplastia cuando era necesario. Se analizó el éxito anatómico, el éxito clínico, las lesiones subyacentes, las trombosis precoces (72 horas), la permeabilidad y las complicaciones. Resultados. El éxito anatómico se ha conseguido en 103 casos (96,2 por ciento) y el clínico en 101 (94,4 por ciento). La tasa de trombosis precoz ha sido del 17,3 por ciento. En 68 casos (90,6 por ciento) se han detectado estenosis asociadas, que han sido tratadas con ATP. A los 3, 6 y 12 meses, la permeabilidad primaria ha sido de 50, 39 y 30 por ciento, y la secundaria de 62, 49 y 40 por ciento. Se han producido dos complicaciones mayores (1,86 por ciento). Conclusiones. La trombectomía mecánica es segura y eficaz en el tratamiento de las trombosis de las prótesis de PTFE para hemodiálisis. Las recomendaciones del DOQI se cumplen completamente con esta técnica (AU)