Factors Contributing to Negative Outcomes Associated with Medications and Drug-Related Problems in Kidney Replacement Therapy-A Hospital-Based Prospective Observational Study.

BACKGROUND: Negative outcomes associated with medications (NOM) and drug-related problems (DRP) significantly impact individuals with kidney replacement therapy (KRT) given the complexities of managing kidney disease and associated comorbidities. The present study aims to assess the frequency of NOMs/DRPs among KRT patients and identify contributing factors. METHODS: A cross-sectional study was conducted at Virgen de las Nieves University Hospital (Granada, Spain), involving 117 outpatient adults with KRT. Data were collected from February 2021 to July 2023 using electronic records, semi-structured interviews (Dáder Method), and discussions with nephrology specialists. NOMs/DRPs were identified following treatment guidelines. Binary logistic regression was used to determine associated factors (p-value < 0.05). RESULTS: Across 117 patients, 2436 NOMs and 3303 DRPs were identified, averaging 20.82 NOMs and 28.23 DRPs per patient. Prevalent NOMs included untreated conditions (58.95%), quantitative ineffectiveness (35.43%), and non-quantitative safety problems (5.13%). Dominant DRPs were undertreated conditions (37.63%), wrong dose/posology/length (33.00%), risk of adverse drug reactions (ADR) (16.14%), and non-adherence (6.87%). Patients with ADR, undertreated conditions, and anemia were associated with quantitative ineffectiveness. Risk of ADR and vitamin D deficiency/insufficiency correlated with non-quantitative safety problems. CONCLUSIONS: KRT patients exhibited a substantial prevalence of NOMs/DRPs. Further research is needed to deepen our understanding of these complexities for improved patient care.

Síndrome hemofagocítico en hemodiálisis / No disponible

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Estudio de la función renal a largo plazo en 53 pacientes con nefrectomía por diversas causas / Assessment of long-term renal function after nephrectomy. Study of 53 patients

Fundamento y objetivo: En pacientes con nefrectomía quirúrgica, la función renal se mantiene conservada durante largo tiempo, habiéndose descrito fundamentalmente en donantes sanos. Planteamos este estudio para conocer la evolución y los factores favorecedores de insuficiencia renal en nuestra población monorrena. Pacientes y método: En 53 monorrenos a quienes se había practicado una nefrectomía más de 5 años antes, se determinó el aclaramiento de creatinina, el aclaramiento por la fórmula de Cockcroft, la microalbuminuria y la proteinuria. Se recogieron factores de riesgo como diabetes, hipertensión, tratamiento con inhibidores de la enzima conversiva de la angiotensina y antagonistas del receptor de la angiotensina de tipo II, tabaquismo y obesidad. Incluimos los valores de creatinina, aclaramiento, Cockcroft y proteinuria de los últimos 5 años de seguimiento y se calculó la velocidad de pérdida de aclaramiento anual. Establecimos dos grupos de pacientes: grupo I, con función renal normal o leve insuficiencia (aclaramiento > 50 ml/min y/o creatinina < 1,4), y grupo II, con insuficiencia renal moderada o grave (aclaramiento < 50 ml/min). Resultados: La edad media fue de 60 años, al realizar la nefrectomía era de 37 años. La velocidad de disminución del filtrado glomerular fue de 1 ml/min/año. El 35,8% de los pacientes tenían insuficiencia renal; el 32%, proteinuria, y el 56,6%, microalbuminuria elevada. En el análisis de factores de riesgo para insuficiencia renal resultaron significativas la edad actual, la edad cuando se practicó la nefrectomía, microalbuminuria y proteinuria previas elevadas, e hipertensión arterial. Respecto a la velocidad de progresión, fueron factores de riesgo la microalbuminuria final e inicial y la proteinuria final. En el análisis multivariante fueron significativas para la insuficiencia renal la edad actual y la proteinuria final. Conclusiones: Se observa un porcentaje elevado de insuficiencia renal en monorrenos, que se relaciona fundamentalmente con la edad y con la proteinuria. La velocidad de pérdida de filtrado glomerular es lenta y está influida por la microalbuminuria

Background and objective: Patients with unilateral nephrectomy maintain the remaining kidney function over time, as it has been described in healthy kidney donors. Patients and method: We performed a cross-sectional study of 53 patients who were followed 5 or more years after nephrectomy. Serum creatinine, BUN, Glomerular Filtration Rate (GFR) (24 hours urine collection and Cockcroft formula), microalbuminuria, proteinuria, Body Mass Index and the annual loss rate of renal function were measured or calculated over the follow-up period. We retrospectively considered the presence of risk factors like diabetes, hypertension, microalbuminuria, dyslipemia, smoking habit, obesity and ACE inhibitors or angiotensin-receptor antagonists treatment. We divided our patients into two groups: group I (normal or mild renal failure: GFR > 50 cc/min and or serum creatinine < 1.4 mg/dL) and group II (moderate or severe renal failure). Results: The main cause of nephrectomy was renal tuberculosis, followed by lithiasis and pyonephrosis. In addition, 7.5% of patients were kidney donors. At the time of study, 22.7% had diabetes, 60.4% hypertension and 39.6% were obese. The mean age was 60 years (37 years at the moment of nephrectomy). The GFR final mean was 53.6 cc/min (58.8 cc/min by Cockcroft formula). The mean renal function loss rate was 1 cc/min/year. 35% of the patients had moderate or severe kidney failure and were included in group II; 32% had proteinuria and 56.6% had abnormal microalbuminuria. The univariate risk factors analysis for the development of renal failure showed inter-group statistical significative differences in current age, nephrectomy age, microalbuminuria, proteinuria, and hypertension prevalence (p = 0.008). With regard to the progression rate, we found a significant correlation with final microalbuminuria (r = 0.358, p = 0.03). Current age and final proteinuria were found to be significant risk factors in the multivariate analysis. Conclusions: A high prevalence of renal insufficiency was found among patients with unilateral nephrectomy, which is mainly related to age and proteinuria. The renal–function loss rate is slow and is influenced by microalbuminuria