Características clínicas, manejo y riesgo de complicaciones a un año en pacientes con insuficiencia cardíaca con y sin diabetes tipo 2 en España / Clinical characteristics, management, and one-year risk of complications among patients with heart failure with and without type 2 diabetes in Spain

Objetivos: Describir las características clínicas y el manejo terapéutico y determinar los eventos cardiovasculares tras un año de seguimiento en una población contemporánea con insuficiencia cardíaca (IC) con y sin diabetes tipo 2 en España. También se analizó en la población DAPA-HF (pacientes que cumplieron la mayoría de los criterios de inclusión del estudio DAPA-HF) y en los pacientes tratados basalmente con inhibidores SGLT2.Métodos: Estudio observacional, retrospectivo, poblacional, empleando la base de datos BIG-PAC. La fecha índice fue 1 de enero de 2019. Se seleccionaron sujetos≥18 años que recibieron tratamiento por IC en 2019. Se analizaron los eventos durante 2019.Resultados: Se identificaron 21.851 pacientes con IC (78±11,3 años; 53% varones; 50,9% IC con fracción de eyección reducida; 44,5% en clase funcional NYHA II). La prevalencia de IC fue del 1,88% y la incidencia 2,83 por 1.000 pacientes-año. El 66,1% tomaba inhibidores del sistema renina-angiotensina, el 69,4% betabloqueantes, el 31,2% antialdosterónicos y el 7,5% sacubitrilo/valsartán. Durante el año de seguimiento, el 29,8% fue hospitalizado por descompensación de la IC (tiempo medio primer evento 120,9±72,5 días), un 12,3% murieron, un 8,1% murieron durante la hospitalización. Los eventos fueron más frecuentes en los pacientes con diabetes tipo 2. Las hospitalizaciones por IC fueron más comunes en la población similar a DAPA-HF.Conclusiones: En España, la población con IC es anciana y tiene muchas comorbilidades. Aproximadamente la mitad de los pacientes tienen IC con fracción de eyección reducida. Existe margen de mejora en el manejo de la IC, en particular mediante el empleo de aquellos fármacos que reducen tanto la hospitalización por IC como la mortalidad, para disminuir la carga de IC (AU)

Objective: This work aims to describe the clinical characteristics and therapeutic management and to determine cardiovascular outcomes after one year of follow-up in a contemporaneous population with heart failure (HF) with and without type 2 diabetes in Spain. These factors were also analyzed in the DAPA-HF-like population (patients who met most inclusion criteria of the DAPA-HF trial) and in patients treated with SGLT2 inhibitors at baseline.Methods: This work is an observational, retrospective, population-based study using the BIG-PAC database. The index date was January 1, 2019. People aged≥18 years who received care for HF in 2019 were selected. Events that occurred in 2019 were analyzed.Results: We identified 21,851 patients with HF (age 78.0±11.3 years, 53.0% men, 50.9% with HF with reduced left ventricular ejection fraction, 44.5% in NYHA functional class II). HF prevalence was 1.88% and incidence was 2.83 per 1,000 person-years. Regarding HF treatments, 66.1% were taking renin-angiotensin system inhibitors, 69.4% beta blockers, 31.2% aldosterone antagonists, and 7.5% sacubitril/valsartan. During the year of follow-up, 29.8% had HF decompensation which led to hospitalization (mean time to first event of 120.9±72.5 days), 12.3% died, and 8.1% died during hospitalization. Events were more common among patients with type 2 diabetes. Hospitalizations for HF were more common in the DAPA-HF-like population.Conclusions: In Spain, the population with HF is elderly and has many comorbidities. Approximately half of patients have HF with reduced left ventricular ejection fraction. There is room for improvement in HF management, particularly through the use of drugs that reduce both HF hospitalization and mortality, in order to reduce the burden of HF (AU)

Clinical characteristics, management, and one-year risk of complications among patients with heart failure with and without type 2 diabetes in Spain.

OBJECTIVE: This work aims to describe the clinical characteristics and therapeutic management and to determine cardiovascular outcomes after one year of follow-up in a contemporaneous population with heart failure (HF) with and without type 2 diabetes in Spain. These factors were also analyzed in the DAPA-HF-like population (patients who met most inclusion criteria of the DAPA-HF trial) and in patients treated with SGLT2 inhibitors at baseline. METHODS: This work is an observational, retrospective, population-based study using the BIG-PAC database. The index date was January 1, 2019. People aged ≥ 18 years who received care for HF in 2019 were selected. Events that occurred in 2019 were analyzed. RESULTS: We identified 21,851 patients with HF (age 78.0 ± 11.3 years, 53.0% men, 50.9% with HF with reduced left ventricular ejection fraction, 44.5% in NYHA functional class II). HF prevalence was 1.88% and incidence was 2.83 per 1,000 person-years. Regarding HF treatments, 66.1% were taking renin-angiotensin system inhibitors, 69.4% beta blockers, 31.2% aldosterone antagonists, and 7.5% sacubitril/valsartan. During the year of follow-up, 29.8% had HF decompensation which led to hospitalization (mean time to first event of 120.9 ± 72.5 days), 12.3% died, and 8.1% died during hospitalization. Events were more common among patients with type 2 diabetes. Hospitalizations for HF were more common in the DAPA-HF-like population. CONCLUSIONS: In Spain, the population with HF is elderly and has many comorbidities. Approximately half of patients have HF with reduced left ventricular ejection fraction. There is room for improvement in HF management, particularly through the use of drugs that reduce both HF hospitalization and mortality, in order to reduce the burden of HF.

Alta prevalencia de covid19 asintomático en hemodiálisis. Aprendiendo dia a dia el primer mes de pandemia de covid19 / High prevalence of asymptomatic COVID-19 in haemodialysis: learning day by day in the first month of the COVID-19 pandemic

Los pacientes en diálisis son un grupo de riesgo de sufrir la infección por el SARS-CoV2 y posiblemente de tener más complicaciones, pero la información con la que contamos es escasa. El objetivo de este trabajo es describir la experiencia del primer mes de pandemia por SARS-Cov2 en una unidad hospitalaria de hemodiálisis (HD) que atiende al 2º distrito madrileño con más en incidencia de COVID19 (casi 1000 pacientes en 100000 h). Se presenta mediante un diario las acciones llevadas a cabo, la incidencia de COVID19 en pacientes y en el personal sanitario, algunas características clínicas y el resultado de un cribado entre todos los pacientes de la unidad. Al inicio, teníamos 90 pacientes en HD: 37(41,1%) han tenido COVID19, de los que 17 (45,9%) fueron diagnosticado spor síntomas detectados en el triaje o durante la sesión y 15 (40,5%) en un cribado realizado a posteriori en los que no se había hecho test diagnóstico por PCR-SARS-Cov2 hasta ese momento. El síntoma más frecuente fue la fiebre, el 50% presentó linfopenia y el 18,4% saturación de O2 < 95%. Precisaron ingreso hospitalario 16 (43,2%) y 6 fallecieron (16,2%). Encontramos un agrupamiento de contagio por turnos y también en aquellos que usaban transporte colectivo. En cuanto al personal, de las 44 personas involucradas, 15 (34%) presentaron sintomatología compatible y 4 (9%) tuvieron PCR SARS-Cov-2 positiva determinada por Salud Laboral y 9 (20%) precisaron algún periodo de Incapacidad Laboral Transitoria (ILT), y 5 fueron considerados casos probables

Dialysis patients are a risk group for SARS-CoV2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-Cov2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID19 (almost 1000 patients in 100000 h). In the form of a diary, we present the actions undertaken, the incidence of COVID19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit.We started with 90 patients on HD: 37 (41.1%) had COVID19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% < 95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-Cov2 PCR cases by occupational health,9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID19 with a high percentage detected byscreening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID19

[Comparison of surgical techniques for rotator cuff injury: cost-result]. / Comparación de técnicas quirúrgicas para la lesión del manguito de los rotadores: costo-resultado.

INTRODUCTION: Currently, to manage rotator cuff injury (RCI), there is a tendency to replace mini-open (MO) surgery with arthroscopy, but results and costs are controversial. OBJECTIVE: To analyze the cost-result of surgical techniques for RCI. MATERIAL AND METHODS: A partial economic evaluation of cost-result type was performed on 113 patients with RCI surgically operated by mini-open technique (n = 6), or arthroscopy (n = 91), or both (n = 16). Direct costs included: hospital stay, days of work disability, surgery, implants (anchors), medical assessments, laboratory and imaging. One-year shoulder functionality was evaluated with Constant-Murley scale (EscC-M). RESULTS: The MO technique was the most economical (X = $42,950.60 MXN) and the most expensive was the arthroscopy + MO with anchors (X = $89,594.80 MXN); with a non-significant difference in shoulder functionality (EscC-M = 56.33 ± 7.0 vs. 64.25 ± 9.0 points, respectively) (p 0.05; Kruskal-Wallis; post hoc Mann-Whitney). Difference of $46,644.1 MXN between techniques corresponded to 7.92 points. There was a mild relationship between the technique and the functionality of shoulder (rs = 0.26; p = 0.005; Spearman). CONCLUSION: The mini-open technique showed best cost-result, with similar functionality in shoulder to that obtained with the more expensive technique.

INTRODUCCIÓN: Actualmente, para manejar la ruptura del manguito de los rotadores (LMR), se prefiere la artroscopía sobre técnicas abiertas (mini-open [MO]), con resultados y costos controversiales. OBJETIVO: Analizar el costo-resultado de las técnicas quirúrgicas para la LMR. MATERIAL Y MÉTODOS: Se realizó una evaluación económica parcial de tipo costo-resultado a 113 pacientes con LMR intervenidos mediante técnica mini-open (n = 6) o artroscopía (n = 91) o ambas (n = 16). Los costos directos incluyeron: estancia, días de incapacidad laboral, cirugía, implantes (anclas), valoraciones médicas, laboratorio e imagen. Se evaluó la funcionalidad del hombro a un año mediante la escala de Constant-Murley (EscC-M). RESULTADOS: La técnica MO fue la más económica (X = $42,950.60 MXN) y la más costosa fue la artroscopía + MO con anclas (X = $89,594.80 MXN); con una diferencia no significativa en la funcionalidad del hombro (EscC-M = 56.33 ± 7 vs 64.25 ± 9 puntos, respectivamente) (p 0.05; Kruskal-Wallis; post hoc Mann-Whitney). Una diferencia de $46,644.10 MXN entre técnicas correspondió a 7.92 puntos. Hubo relación leve entre la técnica y la funcionalidad del hombro (rs = 0.26; p = 0.005; Spearman). CONCLUSIÓN: La técnica mini-open mostró mejor costo-resultado, con una ganancia en la funcionalidad de hombro similar a la que se obtiene con la técnica más costosa.

Economic impact of vitamin D treatment on chronic kidney disease patients.

During recent years, increasing recognition has been given to the endocrine action that vitamin D has on the extraskeletal system, and its deep involvement in CKD. This has meant that many vitamin D compounds (both nutritional and active) have been made available, with an important cost reduction. This review looks at the evidence available regarding the usefulness of different types of vitamin D (nutritional and active) for patients with stage 3-5 CKD and those undergoing dialysis. Emphasis is given to its usefulness to control hyperparathyroidism and its impact on morbidity and mortality. We also analysed pharmacoeconomic studies that have been published which compare active vitamin D metabolites. From this review, we are able to conclude that there is still not enough scientific evidence to be able to prefer one active vitamin D over another. In the meantime, doctors should follow the recommendations given in clinical practice guidelines, always taking into account their personal experience with patients. Furthermore, they must consider the economic impact that their treatment decisions may have.

Impacto económico del tratamiento con vitamina D en pacientes con enfermedad renal crónica / Economic impact of vitamin D treatment on chronic kidney disease patients

En los últimos años se está reconociendo la importancia de las acciones extraesqueléticas de la actividad endocrina de la vitamina D y su profunda interacción con la ERC. Ello ha facilitado el que se pueda disponer de muchos compuestos de vitamina D, tanto nutricional, como activa, con importantes diferencias en su coste económico. En esta revisión se repasa la evidencia disponible sobre la utilidad de los distintos tipos de vitamina D, tanto nutricional como activa, en pacientes con enfermedad renal crónica, tanto en estadios 3-4 como en diálisis, con especial énfasis tanto en su utilidad para el control del hiperparatiroidismo como en su efecto sobre la morbimortalidad. También se analizan los estudios farmacoeconómicos que se han publicado y que comparan entre sí algunos metabolitos activos de la vitamina D. De esta revisión puede concluirse que en el momento actual no existe todavía una base científica suficiente como para preferir la utilización de una vitamina D activa respecto a otra. Mientras no disponga de más datos, el clínico debe seguir las recomendaciones de las guías de práctica clínica, matizadas por la experiencia adquirida con sus pacientes y siempre teniendo en cuenta las implicaciones económicas de sus decisiones terapéuticas (AU)

During recent years, increasing recognition has been given to the endocrine action that vitamin D has on the extraskeletal system, and its deep involvement in CKD. This has meant that many vitamin D compounds (both nutritional and active) have been made available, with an important cost reduction. This review looks at the evidence available regarding the usefulness of different types of vitamin D (nutritional and active) for patients with stage 3-4 CKD and those under-going dialysis. Emphasis is given to its usefulness to control hyperparathyroidism and its impact on morbidity and mortality. We also analysed pharmacoeconomic studies that have been published which compare active vitamin D metabolites. From this review, we are able to conclude that there is still not enough scientific evidence to be able to prefer one active vitamin D over another. In the meantime, doctors should follow the recommendations given in clinical practice guidelines, always taking into account their personal experience with patients. Furthermore, they must consider the economic impact that their treatment decisions may have (AU)

¿Hemos olvidado lo más importante para prevenir las bacteriemias en pacientes portadores de catéteres para hemodiálisis? / Have we forgotten the most important thing to prevent bacteremias associated with tunneled hemodialysis catheters?

La bacteriemia relacionada con el catéter (BRC) en pacientes en hemodiálisis (HD) es una complicación grave. Existen múltiples publicaciones que abogan por el uso de diferentes medidas farmacológicas para su prevención, pero muy pocas sobre la importancia de las medidas de precaución universal . El objetivo de este trabajo es mostrar la baja tasa de incidencia de BRC obtenida con la aplicación estricta de un protocolo de cuidados de catéter tunelizado (CT) por un personal bien entrenado en una nueva unidad de HD. Durante20 meses se aplicó un protocolo de manejo de CT por personal de enfermería cual i f i cado. Se ut i l izaron un total de 42 CT en 32 pacientes . El tiempo total de seguimiento fue de 8.372 días en los que ocurrieron dos episodios de BRC: 0,24 eventos /1.000 días - catéter. El trabajo muestra cómo sólo con medidas de precaución universal pueden lograr se tasas de BRC dentro de la excelencia (AU)

Bacteremia associated with tunneled central venous catheters (CVC) is a major complication in hemodialysis patients. Strategies that aim to prevent catheter-related bacteremia (CRB),ranging from the application of topical antibiotics to the use of different catheter-lock solutions, have been studied, but limited interest has been shown about following standardization of aseptic care and maintenance of CVC by experienced staff. This study reports CRB incidence obtained with astrict infection prophylaxis protocol based on universal precautions against infection adopted in our Unit by qualified nursing hemodialysis staff. During a period of 20 months, 32 patients received 42 CVC. There were 2 CRB, with an incidence of 0.24CRB/1000 days-catheter. This study shows that an optimal catheter-use management reduces the incidence of CRB to excellent rates. The use of a protocol directed to vigorously protect the catheter at the time of usage by specialized teams is critically important and is highly recommended (AU)

[Have we forgotten the most important thing to prevent bacteremias associated with tunneled hemodialysis catheters?]. / ¿Hemos olvidado lo más importante para prevenirlas bacteriemias en pacientes portadores de catéterespara hemodiálisis?

Bacteremia associated with tunneled central venous catheters (CVC) is a major complication in hemodialysis patients. Strategies that aim to prevent catheter-related bacteremia (CRB), ranging from the application of topical antibiotics to the use of different catheter-lock solutions, have been studied, but limited interest has been shown about following standardization of aseptic care and maintenance of CVC by experienced staff. This study reports CRB incidence obtained with a strict infection prophylaxis protocol based on universal precautions against infection adopted in our Unit by qualified nursing hemodialysis staff. During a period of 20 months, 32 patients received 42 CVC. There were 2 CRB, with an incidence of 0.24 CRB/1000 days-catheter. This study shows that an optimal catheter-use management reduces the incidence of CRB to excellent rates. The use of a protocol directed to vigorously protect the catheter at the time of usage by specialized teams is critically important and is highly recommended.

NEFROLOGIA digital. Un proyecto para los próximos años / No disponible

No disponible

Nuevas fórmulas para estimar el filtrado glomerular. Hacia una mayor precisión en el diagnóstico de la enfermedad renal crónica / No disponible

No disponible

¿Cambiará la prescripción de agentes estimulantes de la eritropoyesis en prediálisis tras los resultados del estudio TREAT? / No disponible

No disponible

Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis.

UNLABELLED: Systematic review of adherence to bisphosphonates for the treatment of osteoporosis finds suboptimal levels of persistence and compliance. Poor bisphosphonate compliance increases fracture risk. INTRODUCTION: The objectives of the study were to measure the persistence and compliance with bisphosphonates for the treatment of osteoporotic patients, and to estimate the influence of compliance on fracture risk. METHODS: A systematic review of bisphosphonate adherence in clinical practise provided new evidence to perform a meta-analysis of the means of bisphosphonate persistence and compliance, with a subsequent meta-analysis of fracture risk comparing poorly versus highly compliant patients. RESULTS: Fifteen articles, totalling 704,134 patients, met our inclusion criteria. Most of the patients were postmenopausal women treated with bisphosphonates. The 3.95% of the patients received hormone replacement therapy, but the rest received bisphosphonates. The meta-analysis of five articles totalling 236,540 patients, who were followed for 1 year, provided a pooled persistence mean of 184.09 days. The meta-analysis of five articles, totalling 234,737 patients, who were also followed for 1 year, provided a pooled medication possession ratio mean of 66.93%. The meta-analysis of six articles, totalling 171,063 patients, who were followed for varying periods of time between 1 and 2.5 years, provided a pooled 46% increased fracture risk in non-compliant patients versus compliant patients. The increased fracture risk was lower for non-vertebral (16%) and hip (28%) than for clinical vertebral fractures (43%). CONCLUSIONS: Persistence and compliance are suboptimal for postmenopausal women undergoing bisphosphonate therapy for osteoporosis. The clinical consequence of this low compliance is an increased risk of fracture, which is lower for non-vertebral than for clinical vertebral fractures.

Nefrología 2008-2009 / No disponible

No disponible

Severe cardiac phenotype of Berardinelli-Seip congenital lipodystrophy in an infant with homozygous E189X BSCL2 mutation.

Berardinelli-Seip congenital lipodystrophy (BSCL) is a rare autosomal recessive condition associating insulin resistance, absence of subcutaneous fat and muscular hypertrophy. Disease-causing mutations have been described in AGPAT2 and BSCL2 genes. Hypertrophic cardiomyopathy is a classical late (third decade) complication which has only been occasionally described in childhood. We report on a 4-month-old Chinese male infant who presented with a severe BSCL "cardiac" phenotype comprising heart failure, hypertension and hypertrophic cardiomyopathy.

¿Es la Enfermedad Renal Crónica (ERC) un problemade gran relevancia epidemiológica? / No disponible

Se revisan en este artículo algunas novedades publicadas durante el año 2007 sobre aspectos epidemiológicos de la Enfermedad Renal Crónica. Se comentan, en concreto, algunos trabajos que versan sobre la idoneidad de los métodos actuales de medida del Filtrado glomerular, sobre la estimación de la prevalencia actual de la Enfermedad Renal Crónica y sobre la influencia de la edad y de los AINEs en la progresión de dicha patología. Por último se resumen varias publicaciones recientes sobre el papel de la Enfermedad Renal Crónica como factor de riesgo cardiovascular (AU)

In this article some of the novelties published in 2007 on epidemiological aspects of chronic kidney disease are reviewed. Specifically, some studies on the suitability of current methods for measurement of glomerular filtration rate, the estimated current prevalence of chronic kidney disease and the influence of age and NSAIDs on progression of this disease are discussed. Finally, various recent publications on the role of chronic kidney disease as a cardiovascular risk factor are summarized (AU)