Pre-Transplant Assessment of Vascular Calcification as a Risk Factor of Mortality, Graft Loss, and Cardiovascular Events in Renal Transplant Recipients.

BACKGROUND: Vascular calcification (VC) is known as an independent predictor of mortality in patients undergoing hemodialysis; nevertheless, there is a lack of studies about the impact of vascular calcification in renal transplant recipients, and none of them use the Kauppila Index (KI) as a predictor of patient and graft prognosis. METHODS: We conducted an observational, retrospective study of 119 renal transplants, evaluating abdominal aortic calcifications (L4-S1) with the KI. We established 2 categories: absence (KI = 0-2) and presence (KI = 3-24) of VCs before transplantation. We analyzed the impact of calcification in graft and patient survival, new-onset diabetes mellitus, hypertension, cardiovascular events, renal function, and mineral metabolism. RESULTS: VCs were observed in 50 patients (42%) before renal transplantation. Patients with VCs were older, but no statistical differences were found in the pre-transplant study between sex, diabetes, body mass index, and cardiovascular events. We found a major patient survival (limited to first 2 years after transplantation), graft survival, and death-censored graft survival in those without VCs (P = .037, P = .015, and P = .023, respectively). In line with results, a higher incidence of major cardiovascular events (MACE) and cardiovascular death was observed in the group with preexisting calcification (P = .016/P = .019). In the multivariable analysis, VCs were not an independent predictor for graft loss, death-censored graft loss, or major cardiovascular events. CONCLUSIONS: Simple evaluation of VCs with the use of the KI at the time of transplantation relates with graft and patient survival and with MACE after renal transplantation.

[Study of immutable variables determining rHuEPO dose requirements on hemodialysis patients]. / Estudio de causas no modificables de pobre respuesta al tratamiento con eritropoyetina en pacientes en hemodiálisis.

Patients receiving recombinant human erythropoietin (rHuEPO) therapy show wide variability in their responsiveness to the drug. Variables that affect rHuEPO dose requirements can be broadly divided into modificable and immutable characteristics. Most of the scientific research on rHuEPO hyporesponsiveness has focused on modificable variables (iron status, dialysis adequacy), while immutable variables such as gender, etiology of chronic renal failure (CRF) and age have been insufficiently explored. A cross sectional study was performed in order to evaluate if immutable patient characteristics determine rHuEPO dose requirements among 215 patients (52% males; mean age 66 +/- 14 years) on hemodialysis (HD) for more than twelve months. Data were collected at 10 hemodialysis units in Aragon. Patients were divided into three groups according to their gender, their cause of CRF (diabetic nephropathy, vascular nephropathy, tubulointerstitial nephropathy and primary glomerulonephritis) and their age (younger than 60 years, from 60 to 75 years, older than 75 years). Despite a similar dose of rHuEPO, women had lower mean hemoglobin (11.1 +/- 1.5 versus 11.6 +/- 1.7 g/dl; p = 0.0258) than men. The greater hemoglobin in men than women may be attributed to greater serum albumin in men (3.5 +/- 0.3 versus 3.7 +/- 0.3 mg/dl; p = 0.0001). Requirements of rHuEPO were higher in the patients with etiology of primary glomerulonephritis compared with those with the other etiologies, even those with diabetic nephropathy (p = 0.0374). The rHuE-PO doses required to obtain similar hemoglobin levels were higher in patients younger than 60 years (p = 0.0249). We conclude that women, patients with primary glomerulonephritis as cause of CRF, and patients younger than 60 years showed the highest requirements of rHuEPO doses.

[Diagnosis and prevention of tuberculosis in hemodialysis patients. a new old problem?]. / Detección y prevención del desarrollo de tuberculosis en pacientes en hemodiálisis. Un antiguo problema actual?

Patients with chronic renal failure undergoing hemodialysis are at increased risk of developing tuberculosis because of impaired cellular immunity. Most cases are due to reactivation of disease and are known to develop the complication of extrapulmonary tuberculosis more frequently than the general population, and this makes the disease difficult to diagnose, delaying the establishment of appropiate therapy. We evaluated 39 patients undergoing hemodialysis treatment in the course of a 3 year period, therewere. Tuberculosis control program was developed to evaluate all patients newly admitted to the renal dialysis program. All of the patients were skin-tested initially with use 2 U.I. tuberculin PPD RT23, and 16 patients had positive results. Three cases of tuberculosis -registered that developed in patients, and in exposed patients, 3 patients with negative test result 2 months later had positive test. No relationship was found between the results of the tests and age, sex, renal disease, other pathologies or previous tuberculosis and albumin figures. However, positive patients had higher levels of total leukocytes. The period from undergoing hemodialysis until mantoux testing was performed was lower in those patients who resulted positive: 9.4+/-13.6 months versus 32.9+/-39 months in negative patients. The use of mantoux testing is important as a sieve system in hemodialysis patients as long as is associated with other diagnosis techniques, detecting that way those cases at risk of developing tuberculosis and latting perform further studies and isoniacida prophylaxis. Establishing isoniacida prevention in hemodialysis patients can avoid the development of tuberculosis in patients at risk as well as prompt detection makes easier the establishment of right therapy.

[Tuberculosis in hemodialysis patients and evaluation of exposures]. / Tuberculosis en hemodiálisis: casos coincidentes en el tiempo y valoración de contactos.

Three cases of tuberculosis in hemodialysis patients are described. All of them had an insidious presentation: a pulmonary form, a pleural form and a lymphadenitis form of the disease. The three cases presented risk factors associated and in two out of the three the detection of the team was achieved during the first three months of hemodialysis therapy (one had to undertake hemodialysis again, after disfunction of renal transplant). The three teams happened within two months. Owing to this, an evaluation of exposure was carried out in patients, staff and collective transport personnel making tuberculin test conversion clear in all three groups and establishing chemoprophylaxis afterward. Isoniacide prophylaxis eliminates a possible need for multidrug therapy for active tuberculosis at a future date, but decisions to institute preventive therapy are always difficult. To successfully combat the spread of tuberculosis, timely identification and treatment of high-risk populations is essential.