Estenosis arterial del injerto renal: evaluación de la incidencia mediante ecografía doppler, factores de riesgo y análisis de las complicaciones que pueden afectar a la supervivencia del injerto / Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes

Introducción y objetivos La estenosis de la arteria del injerto renal (EAR) es una complicación vascular del trasplante renal cuya incidencia estimada es del 13%, la cual puede causar hipertensión arterial refractaria, disfunción renal y muerte prematura en los receptores. Métodos Se realizó un estudio retrospectivo que incluyó a todos los pacientes sometidos a trasplante renal entre 2014 y 2020. Los pacientes fueron evaluados mediante ecografía doppler renal sistemática tras el trasplante. Para identificar los factores de riesgo independientes de la estenosis de la arteria renal tras el trasplante, realizamos un análisis multivariante. Resultados Se incluyeron 724 trasplantes renales, el 12% eran de donante vivo y el 88% de donante fallecido. La edad media en los receptores era de 54,8 años y en los donantes era de 53. Se diagnosticó estenosis de la arteria del injerto renal en 70 (10%) receptores, la mayoría durante los primeros 6 meses después de la intervención. El 51% de los pacientes con estenosis de la arteria del injerto renal se manejaron de manera conservadora. El análisis multivariante mostró que la diabetes mellitus, el rechazo del injerto, la resutura arterial y el índice de masa corporal del donante eran factores de riesgo independientes de estenosis de la arteria renal después del trasplante. La supervivencia de los injertos con estenosis de la arteria del injerto renal fue del 98% a los 6 meses y del 95% a los 2 años. Conclusiones El uso sistemático de la ecografía doppler en el período inmediatamente posterior al trasplante permitió diagnosticar un 10% de estenosis de la arteria del injerto renal en nuestra cohorte. A pesar de los factores de riesgo mencionados anteriormente, un seguimiento y tratamiento adecuados podrían reducir el riesgo de pérdida del injerto en pacientes con estenosis de la arteria del injerto renal. (AU)

Introduction and objectives Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. Methods We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. Results Seven hundred twenty-four kidney transplants were included, 12% were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. The 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. Conclusions The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis. (AU)

Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes.

INTRODUCTION AND OBJECTIVES: Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. METHODS: We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. RESULTS: Seven hundred twenty-four kidney transplants were included, 12% ​​were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. CONCLUSIONS: The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.

[Blood-glucose control in eldely patients with type 2 diabetes. Interventions to avoid risks]. / Control glucémico en pacientes diabéticos tipo 2 de edad avanzada. Intervención para evitar riesgos.

OBJECTIVE: To evaluate blood-glucose control in elderly patients with type 2 diabetes mellitus (T2DM), who are receiving various anti-diabetic treatments, and to analyse the effect of an intervention. MATERIAL AND METHODS: Cross-sectional, descriptive, and observational study of prevalence that included patients who were ≥75 years old with T2DM and being treated with two or more antidiabetic drugs. The adequacy of treatments following current recommendations for this population group was analysed, together with the prevalence of macro- and micro-vascular complications, dementia, and hypoglycaemia, the treatments used, and adherence. An intervention was carried out to optimise prescription. RESULTS: A total of 215 patients were included, of which 54.4% were women. The mean age was 82.0±4.1, and 77.2% had micro- and/or macrovascular complications, and 7.4% had dementia. Inadequacy was detected in 67.9% due to an overly intensive blood glucose control (55.6% HbA1c<7.5%), or that the dosage was not adapted to glomerular filtration (51.0%). The large majority (81.4%) were being treated with drugs with a risk of producing hypoglycaemia (2.3% had recorded episodes). The HbA1c mean was higher in non-adherent patients (8.1±1.6% vs 7.5±1.3%, P<.05). After the intervention, the intensity of hypoglycaemic treatment was reduced in 36.2% of patients, and the dosage of drugs that required adjustment was corrected in 23.1%. The percentage of overtreatment decreased to 40.0% (P<.01). CONCLUSIONS: More than half of the elderly patients with T2DM and important comorbidities had an overly strict glycaemic control. The launch of an intervention programme has allowed for an improvement in safety and for the optimisation of treatments.

[Analysis of the use of proton pump inhibitors in primary health care]. / Análisis de la utilización de inhibidores de la bomba de protones en Atención Primaria.

OBJECTIVE: The increase in the consumption of anti-ulcer drugs is accompanied by a high rate of incorrect use. The objectives of this study were to analyse the adequacy of repeat prescriptions of proton pump inhibitors (PPIs) in a Medical Centre, and to evaluate the efficacy of an improvement intervention. MATERIAL AND METHOD: A cross-sectional, descriptive and observational study of prevalence was conducted on patients in a medical centre under treatment with PPIs for at least 3consecutive months (November 2016-January 2017). An analysis was performed that included the indication, dosage and time of treatment with PPIs, drug interactions, and possible risks that could be related with their use. An intervention was carried out to optimise rational and efficient prescribing of these medicines. RESULTS: A total of 703 patients were included in the study, which is 5.4% of the total adult patients that are assigned to the centre. Adequacy criteria were not met by 436 (62.0%). Of these, 52.5% were women, 70.0% were over 65 years old, and had been on treatment for a mean of 2.7 ± 1.9 years. Interactions were observed in 48.1%, and 29.0% had some risk factors. After the intervention, the inadequate prescribing was corrected in 112 (25.7%) patients, which was a reduction of 46.1% (P<.001). CONCLUSIONS: There is a high prevalence of prescription and inadequacy of PPIs in the long term. This suggests that it is necessary to improve training of professionals to strengthen rational use and to reduce risks. The launch of an intervention programme has led to the revision and optimisation of treatments.

Influence of the number of daily pills and doses on adherence to antiretroviral treatment: a 7-year study.

WHAT IS KNOWN AND OBJECTIVE: Antiretroviral treatment (ART) is hampered by complicated regimens, high pill burden, drug-drug interactions, and frequent short- and long-term adverse effects, leading to decreased adherence. Over recent years, considerable effort has been directed at developing regimens that are less burdening. We undertook a 7-year retrospective study of the records of 264 HIV-infected subjects enrolled in a pharmaceutical care programme to document the progress made and to study the influence of the number of ART pills and doses on the level of treatment adherence. METHODS: Antiretroviral dispensing records were analysed for the number of pills and doses administered and the ART adherence rate estimated. RESULTS AND DISCUSSION: In 2005, the patients took a mean of 6·2 pills daily (CI 95%: 5·9-6·6), and 92·9% of them were on a twice-a-day (BID) dosage regimen. By 2012, the mean number of pills was reduced to 4·1 (CI 95%: 3·8-4·4), and only 50·9% were on a BID regimen. No statistically significant relation was observed between number of daily pills and doses and ART adherence reached by the patients in any of the analyses performed. WHAT IS NEW AND CONCLUSIONS: There has been a continuous reduction in the number of pills and doses of antiretrovirals taken by individual patients over the last 7 years due largely to the introduction of improved treatments and regimens. More daily pills or doses was not associated with worse ART adherence in our pharmaceutical care programme.