Incidence, factors related to presentation, course and mortality of metformin-associated lactic acidosis in the healthcare area of a tertiary hospital. / Incidencia, factores relacionados con la presentación, evolución y mortalidad de la acidosis láctica asociada a metformina en el área sanitaria de un hospital de tercer nivel.

OBJECTIVES: To determine the incidence of metformin-induced lactic acidosis during the period January 2014 to March 2017 in Aragon Healthcare Area III. To analyse the associated clinical and analytical factors and mortality. RESULTS: A total of 31 cases (61.3% males). Incidence: 79.76 cases/100,000 patients-year; mean age 75.39±9.34 years; 23 of them with levels of serum metformin (21.91±15.52 mcg/ ml); milligrams/day of metformin ingested: 1790.32±499; 96.8% of cases in the context of acute kidney failure; 11 cases with a history of chronic kidney disease (35.5%); 12 required intensive care (38.7%); 13 required purification treatment (41.9%; 3 haemodiafiltration, 10 haemodialysis). There was a significant correlation between daily milligrams of metformin ingested and drug levels; levels of metformin; and peak creatinine, pH and lactate. Mortality was 25.8%. There were only significant differences between the deceased and survivors regarding the duration of stay and final creatinine. Multivariate logistic regression did not detect any study variables associated with mortality. CONCLUSIONS: The incidence in our healthcare area is higher than in other series, with a 25.8% mortality rate. Virtually all cases were in the context of prerenal acute kidney failure. In 29% of cases, there was an overdose. Patients must be warned about the most common lactic acidosis-inducing situations, especially dehydration, if they continue taking the drug at such times.

Mioclonías asociadas al tratamiento con ciprofloxacino / Myoclonus associated with Ciprofloxacin therapy

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Enfermedad renal crónica y acromegalia: cuando las apariencias engañan / Chronic kidney disease and acromegaly: when appearances are deceptive

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Insuficiencia renal oculta y prescripción de fármacos en atención primaria / Occult renal disease and drug prescription in primary care

ObjetivoAnalizar, en pacientes ancianos, la prevalencia de insuficiencia renal crónica (IRC) (filtrado glomerular [FG]<60ml/min/1,73m2) e insuficiencia renal oculta (IRO) (coexistencia de creatinina sérica normal y FG<60), para ello se estudia, en este último grupo, la prescripción farmacéutica en atención primaria.DiseñoEstudio retrospectivo observacional.EmplazamientoCuatro centros de salud de la provincia de Huesca.Participantes4.014 pacientes mayores de 65 años seleccionados aleatoriamente.Mediciones principalesSe estimó el FG con la fórmula MDRD abreviada. Se registraron los fármacos potencialmente perjudiciales prescritos de modo agudo o crónico a los pacientes con IRO durante 12 meses.ResultadosTras las exclusiones, en 3.286 pacientes se estimó el FG (1.424 varones de 75,49±6,6 años y 1.862 mujeres de 76,29±7,04 años; p=0,001). El 21,2% de los pacientes presentaba IRC y el 10,1%, IRO (el 12,8% de las mujeres y el 6,44% de los varones). En los pacientes con IRO la media de principios activos prescritos por paciente/año fue 10,69±5,92 (varones, 9,55±5,57, y mujeres, 11,11±6; p=0,05). Un número considerable recibió tratamiento con fármacos potencialmente perjudiciales dada su función renal. Destacan los antiinflamatorios no esteroideos con 165 (61,34%) casos. El 72,5% estuvo expuesto a fármacos que pueden favorecer la hiperpotasemia.ConclusionesLa estimación del FG en los informes de los laboratorios clínicos puede contribuir a evitar el posible efecto iatrogénico derivado de una prescripción inadecuada de fármacos(AU)

ObjectiveTo study the prevalence of chronic kidney disease (CKD) [glomerular filtration rate (GFR) <60ml/min/1.73m2] and occult kidney disease (OKD) (normal serum creatinine values with GFR <60) in elderly patients.DesignRetrospective, observational study.SettingFour primary care centres in the province of Huesca, Spain.ParticipantsAbout 4014 patients older than 65 years were randomly selected.Main measurementsGFR was calculated for all subjects using the four-variable modified MDRD equation. We registered all drugs prescriptions to the patients during a period of twelve months focusing on the potential nephrotoxic drugs.ResultsAfter exclusions, GFR was estimated in 3286 patients (1424 men of 75.49±6.6 years and 1862 women of 76.29±7.04 years; P=.001). The prevalence of CKD was 21.2%. A total of 10.1% of patients (12.8% of women and 6.44% of men) had OKD. We recorded the complete drug prescription in 269 patientes. Mean of all different drugs that were prescribed by patient-year was 10.69±5.92 (men 9.55±5.57 and women 11.11±6; P=.05)]. A large number of patients were treated with potentially dangerous drugs, particularly the non-steroidal anti-inflammatory drugs with 165 cases (61.34%), and 72% were exposed to drugs that can lead to hyperkalaemia.ConclusionsWe conclude that GFR estimation by clinical laboratories in the setting of primary care can contribute to prevent the adverse effects of inappropriate drug prescriptions(AU)