Changes in cardiometabolic risk factors and metabolic syndrome over time in living kidney donors: a retrospective cohort study / Cambios en los factores de riesgo cardiometabólico y el síndrome metabólico a través del tiempo en los donantes renales vivos: estudio de cohortes retrospectivo

Background: permissibility in the selection of living kidney donors (LKD) with one or more cardiometabolic risk factors (CMRFs) and/or metabolic syndrome (MS) is an increasingly frequent practice worldwide. These factors, together with kidney donation specifically, are known to be associated with an increased risk of chronic kidney disease (CKD). Methods: we analyzed the frequency of CMRFs and MS before and after kidney donation in LKD. In the secondary analysis, we associated CMRFs and MS with renal function. The SPSS V22.0 software was used. Results: we analyzed 110 LKD patients, with a mean age of 35.05 ± 10.5 years: 63 (57.3 %) men and 47 (42.7 %) women. Patients were followed for 25 ± 17.48 months after nephrectomy. Prior to donation, 62 patients (56.4 %) had MS, and the presence of one to six CMRFs was 19.1 %, 32 %, 18.2 %, 17.3 %, 3.6 %, and 0.9 %, respectively. During follow-up, in donors, the incidence of overweight increased from 48.2 % to 52.7 %, (p < 0.01); that of obesity increased from 11.8 % to 20.9 % (p < 0.01); that of hyperuricemia increased from 17.3 % to 26.4 %, (p < 0.01); that of hypercholesterolemia increased from 24.5 % to 33.6 % (p < 0.01); and that of hypertriglyceridemia increased from 47.3 % to 50.9 % (p < 0.01), while the incidence of MS decreased from 56.4 % to 51.8 % (p < 0.01). A logistic regression analysis showed that the presence of CMRFs did not show any association with glomerular filtration rates below 60 mL/min/1.73 m2. (AU)

Introducción: la permisibilidad en la selección de los donantes renales vivos (DRV) con uno o más factores de riesgo cardiometabólico (FRCM) y/o síndrome metabólico (SM) es una práctica cada vez más frecuente en todo el mundo. Se sabe que estos factores, junto con la donación de riñón, específicamente, están asociados con un mayor riesgo de enfermedad renal crónica (ERC). Métodos: analizamos la frecuencia de los FRCM y SM antes y después de la donación renal en DRV. En el análisis secundario, asociamos los FRCM y la SM con la función renal. Se utilizó el programa SPSS V22.0. Resultados: se analizaron 110 DRV con una edad media de 35,05 ± 10,5 años: 63 (57,3 %) hombres y 47 (42,7 %) mujeres. Los pacientes fueron seguidos durante 25 ± 17,48 meses después de la nefrectomía. Antes de la donación, 62 pacientes (56,4 %) tenían SM y la presencia de uno a seis FRCM era del 19,1 %, 32 %, 18,2 %, 17,3 %, 3,6 % y 0,9 %, respectivamente. Durante el seguimiento, en los donantes, la incidencia del sobrepeso aumentó del 48,2 % al 52,7 % (p < 0,01); la de la obesidad pasó del 11,8 % al 20,9 % (p < 0,01); la de la hiperuricemia aumentó del 17,3 % al 26,4 % (p < 0,01); la de la hipercolesterolemia aumentó del 24,5 % al 33,6 % (p < 0,01); y la de la hipertrigliceridemia aumentó del 47,3 % al 50,9 % (p < 0,01), mientras que la incidencia del SM disminuyó del 56,4 % al 51,8 % (p < 0,01). El análisis de regresión logística mostró que la presencia de FRCM no presentaba ninguna asociación con las tasas de filtración glomerular por debajo de 60 ml/min/1,73 m2. (AU)

Changes in cardiometabolic risk factors and metabolic syndrome over time in living kidney donors: a retrospective cohort study.

INTRODUCTION: Background: permissibility in the selection of living kidney donors (LKD) with one or more cardiometabolic risk factors (CMRFs) and/or metabolic syndrome (MS) is an increasingly frequent practice worldwide. These factors, together with kidney donation specifically, are known to be associated with an increased risk of chronic kidney disease (CKD). Methods: we analyzed the frequency of CMRFs and MS before and after kidney donation in LKD. In the secondary analysis, we associated CMRFs and MS with renal function. The SPSS V22.0 software was used. Results: we analyzed 110 LKD patients, with a mean age of 35.05 ± 10.5 years: 63 (57.3 %) men and 47 (42.7 %) women. Patients were followed for 25 ± 17.48 months after nephrectomy. Prior to donation, 62 patients (56.4 %) had MS, and the presence of one to six CMRFs was 19.1 %, 32 %, 18.2 %, 17.3 %, 3.6 %, and 0.9 %, respectively. During follow-up, in donors, the incidence of overweight increased from 48.2 % to 52.7 %, (p < 0.01); that of obesity increased from 11.8 % to 20.9 % (p < 0.01); that of hyperuricemia increased from 17.3 % to 26.4 %, (p < 0.01); that of hypercholesterolemia increased from 24.5 % to 33.6 % (p < 0.01); and that of hypertriglyceridemia increased from 47.3 % to 50.9 % (p < 0.01), while the incidence of MS decreased from 56.4 % to 51.8 % (p < 0.01). A logistic regression analysis showed that the presence of CMRFs did not show any association with glomerular filtration rates below 60 mL/min/1.73 m2. Conclusion: LKD had a high frequency of CMRFs and MS at the time of donation, and over time, the incidence of CMRFs significantly increased. Because these factors, together with kidney donation, could be associated with an increased risk of CKD, we must evaluate protocols for LKD and consider stricter criteria in the selection of LKD, with an emphasis on follow-up protocols to address CMRFs and MS.

INTRODUCCIÓN: Introducción: la permisibilidad en la selección de los donantes renales vivos (DRV) con uno o más factores de riesgo cardiometabólico (FRCM) y/o síndrome metabólico (SM) es una práctica cada vez más frecuente en todo el mundo. Se sabe que estos factores, junto con la donación de riñón, específicamente, están asociados con un mayor riesgo de enfermedad renal crónica (ERC). Métodos: analizamos la frecuencia de los FRCM y SM antes y después de la donación renal en DRV. En el análisis secundario, asociamos los FRCM y la SM con la función renal. Se utilizó el programa SPSS V22.0. Resultados: se analizaron 110 DRV con una edad media de 35,05 ± 10,5 años: 63 (57,3 %) hombres y 47 (42,7 %) mujeres. Los pacientes fueron seguidos durante 25 ± 17,48 meses después de la nefrectomía. Antes de la donación, 62 pacientes (56,4 %) tenían SM y la presencia de uno a seis FRCM era del 19,1 %, 32 %, 18,2 %, 17,3 %, 3,6 % y 0,9 %, respectivamente. Durante el seguimiento, en los donantes, la incidencia del sobrepeso aumentó del 48,2 % al 52,7 % (p < 0,01); la de la obesidad pasó del 11,8 % al 20,9 % (p < 0,01); la de la hiperuricemia aumentó del 17,3 % al 26,4 % (p < 0,01); la de la hipercolesterolemia aumentó del 24,5 % al 33,6 % (p < 0,01); y la de la hipertrigliceridemia aumentó del 47,3 % al 50,9 % (p < 0,01), mientras que la incidencia del SM disminuyó del 56,4 % al 51,8 % (p < 0,01). El análisis de regresión logística mostró que la presencia de FRCM no presentaba ninguna asociación con las tasas de filtración glomerular por debajo de 60 ml/min/1,73 m2. Conclusión: los DRV tuvieron una alta frecuencia de FRCM y SM en el momento de la donación y, con el tiempo, la incidencia aumentó significativamente. Debido a que estos factores, junto con la donación de riñón, podrían estar asociados a un mayor riesgo de ERC, debemos evaluar los protocolos de los DRV y considerar criterios más estrictos en la selección de estos donantes, haciendo énfasis en los protocolos de seguimiento para tratar los FRCM y el SM.

Mortality in Patients With Chronic Renal Disease Without Health Insurance in Mexico: Opportunities for a National Renal Health Policy.

INTRODUCTION: Despite a systematic increase in the coverage of patients with end-stage renal disease (ESRD) who have received dialytic therapies and transplantation over the past 2 decades, the Mexican health system currently still does not have a program to provide full coverage of ESRD. Our aim was to analyze mortality in patients with ESRD without health insurance. METHODS: This was a prospective cohort study of 850 patients with advanced chronic kidney disease (CKD). Risk factors associated with death were calculated using a Cox's proportional hazards model. We used the statistical package SPSS version 22.0 for data analysis. RESULTS: The mean age of patients was 44.8 ± 17.2 years old. At the time of hospital admission, 87.6% of the population did not have a social security program to cover the cost of renal replacement treatment, and 91.3% of families had an income below US$300 per month. During the 3 years of the study, 28.8% of the cohort patients were enrolled in 1 of Mexico's social security programs. The 3-year mortality rate was of 56.7% among patients without access to health insurance, in contrast to 38.2% of patients who had access to a social security program that provided access to renal replacement therapy (P < 0.001). Risk factor analysis revealed that not having health insurance increased mortality (risk ratio: 2.64, 95% confidence intervals: 1.84-3.79; P = 0.001). CONCLUSION: Mexico needs a coordinated National Kidney Health and Treatment Program. A program of this nature should provide the basis for an appropriate educational and intervention strategy for early detection, prevention, and treatment of patients with advanced chronic kidney disease.

Sticky Platelet Syndrome: An Unrecognized Cause of Acute Thrombosis and Graft Loss.

INTRODUCTION: Sticky platelet syndrome (SPS) is a prothrombotic disease that is not well recognized and difficult to diagnose. CASE REPORT: We present a case of a 49-year-old diabetic woman on ambulatory peritoneal dialysis therapy who underwent a kidney transplant from living-related donor. The donor was her sister with whom she shared one haplotype and absence of donor specific antibodies. The posttransplant evolution was torpid, developing progressive deterioration, which made us suspect a failure in the graft. Doppler ultrasound reported renal vein thrombosis and hypoperfusion of the renal artery. Without clinical improvement, she required a reintervention that ended in graftectomy, in which the histopathological report showed negative C4d with medullary and cortical infarction. Hematological studies were negative for antibodies against phospholipids, with correct levels of proteins C and S and antithrombin. Platelet aggregometry studies were carried out, which were compatible with SPS. CONCLUSIONS: Recognition of SPS in pretransplant studies is difficult if there is no history of previous thrombotic events. However, we must consider this entity in cases of acute thrombosis and loss of the graft of uncertain origin.

Main factors affecting the loss of multi organ potential donors for transplantation.

ANTECEDENTS: In the field of organ donation and procurement, a possible donor is a patient with severe neurological damage and appropriate medical criteria for donation, and a potential donor is a patient suspected of being brain dead. OBJECTIVE: The aim of this study is to identify specific factors that cause the loss of possible multiorgan donors in an intensive care unit (ICU). METHODS: A review of cross-sectional charts of possible liver and kidney donors was done with patients admitted to the ICU with full respiratory support and Glasgow score < 8. A multiple logistical regression model was applied to identify the loss of potential donors previously considered only as possible donors. RESULTS: A total of 44 charts were reviewed, 26 were possible, and 18 were potential donors. The mean average was 46.7 and 52.8 years for possible and potential donors, respectively (p = 0.272). The potential donors experienced frequent intracranial hemorrhage (19.2 vs. 55.6) or renal injury (3.9 vs. 27.8), and fewer invasive procedures are performed (34.6 vs. 5.6) (p <0.05). Invasive procedure resulted significant (p = 0.013) when a multivariate analysis was done. DISCUSSION AND CONCLUSIONS: Patients submitted to invasive procedures have 20 times more probabilities of being lost as kidney donors even when originally considered as possible donors. Medical or surgery procedures are the leading cause for the loss of potential donors, so an opportune detection is essential.

ANTECEDENTES: En el campo de la donación y la procuración renal, un posible donador es un paciente con daño neurológico grave y que cubre los criterios médicos para la donación; un potencial donador es el paciente que, además, cuenta con la sospecha de tener muerte cerebral. OBJETIVO: Identificar los factores específicos que causan la pérdida de posibles donadores multiorgánicos en una unidad de terapia intensiva. METODOLOGÍA: Se realizó un estudio retrospectivo transversal de los expedientes de los posibles donadores de riñón e hígado admitidos a la unidad de terapia intensiva con soporte respiratorio total y escala de Glasgow < 8. Se aplicó un modelo de regresión logística para identificar los casos perdidos de potenciales donadores previamente considerados solo como posibles donadores. RESULTADOS: Se revisaron 44 casos, 26 de posibles y 18 de potenciales donadores. La edad promedio fue de 46.7 y 52.8 años para los posibles y potenciales donadores, respectivamente (p = 0.272). Los potenciales donadores experimentaron con más frecuencia hemorragia intracraneal (19.2 vs. 55.6) o lesión renal (3.9 vs. 27.8), y fueron sometidos a menos procedimientos médicos (34.6 vs. 5.6) (p < 0.05). En el análisis multivariado, la realización de algún procedimiento invasivo fue significativa entre los dos grupos (p = 0.013). DISCUSIÓN Y CONCLUSIONES: Los pacientes sometidos a un procedimiento invasivo tienen 20 veces más probabilidades de perderse como donadores renales aun siendo considerados de manera original como posibles donadores. Los procedimientos médicos o quirúrgicos son la principal causa de pérdida de potenciales donadores, por lo que es esencial una detección precoz y oportuna de los mismos.

De novo development of heart valve calcification in incident peritoneal dialysis patients.

BACKGROUND AND AIMS: Cardiac valve calcification (VC) is a frequent complication in chronic kidney disease and is considered a risk factor for all-cause and cardiovascular mortality. However, little is known about the pathophysiology mechanisms that originate it and the factors associated with its development. We undertook this study to analyze the frequency and factors related to de novo development of mitral valve calcification (MVC) and aortic valve calcifications (AVC) in incident peritoneal dialysis (PD) patients. METHODS: A prospective cohort of 124 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1 year of follow-up for calcium, phosphorus, glucose, urea, creatinine, cholesterol, triglycerides by spectrophotometry assay; high-sensitivity C-reactive protein (CRP) by immunoturbidimetric ultrasensitive assay, intact parathormone (iPTH) and osteocalcin by electrochemiluminescence, fetuin-A and osteoprotegerin by EDI-ELISA. Valve calcification was evaluated by M-mode bidimensional echocardiogram. RESULTS: Sixty eight percent of patients were male, ages 43 ± 13 years; 51% were diabetic with 1.4 ± 1 months on PD. After 12.3 ± 1 months, 57 patients (46%) developed VC: AVC in 33 (57.8%), MVC in 15 (26.3%) and 9 (15.8%) patients in both valves. There was no correlation between AVC and MCV. In univariate logistic regression analysis, age, diabetes and elevated concentrations of OPG, iPTH and CRP were risk factors for development MVC. In multivariate analysis, only iPTH remained an independent risk factor as was also the case in AVC. CONCLUSIONS: Age, diabetes, osteoprotegerin, parathormone and C-reactive protein are risk factors related to de novo development of MVC and iPTH for AVC in incident dialysis patients.

Reaching targets for mineral metabolism clinical practice guidelines and its impact on outcomes among Mexican chronic dialysis patients.

BACKGROUND AND AIMS: An increasing number of studies have been published concerning meeting targets of clinical guidelines for different aspects of the diagnosis and treatment of patients with end-stage renal disease. Most of these studies have shown that guideline recommendations are not always satisfied, and results outside target limits have been associated with high rates of mortality and morbidity. The objective of this study was to analyze the frequency of reaching mineral and bone metabolism-related guideline targets and its impact on clinical outcomes in Mexican chronic dialysis patients. METHODS: A cohort of prevalent peritoneal dialysis (PD) and hemodialysis (HD) patients were analyzed at baseline and followed for at least 16 months. Patients were on continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), and HD and contracted HD modalities where patients received HD sessions outside institution facilities. RESULTS: We studied 753 patients. The percentage of patients within target limits for phosphorus was 35%, for calcium 32%, and for PTH 12%. The most frequent pattern was hyperphosphatamia, hypercalcemia, and low PTH. This was even more frequent in CAPD patients, probably due to the high percentage of diabetic patients. Hypercalcemia was found as an independent risk factor for mortality. CONCLUSIONS: The most important results suggest that guideline recommendations are not usually satisfied and that hypercalcemia, in addition to other traditional risk factors, is associated with high mortality rates. The study also detected some opportunities to improve the quality of treatment by reducing the calcium content of dialysis solutions and reducing the use of calcium carbonate as a phosphate binder.

NT-proBNP, fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients.

BACKGROUND: N-terminal fragment of B-type natriuretic peptide (NT-proBNP) is a marker of both fluid volume overload and myocardial damage, and it has been useful as a predictor of mortality in patients with end-stage renal disease (ESRD). It has been suggested that continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and haemodialysis (HD) may have different effects on fluid volume and blood pressure control; however, whether the independent predictive value of NT-proBNP for mortality is preserved when analysed in conjunction with fluid overload and dialysis modality is not clear. METHODS: A prospective multicentre cohort of 753 prevalent adult patients on CAPD, APD and HD was followed up for 16 months. Plasmatic levels of NT-proBNP, extracellular fluid volume/total body water ratio (ECFv/TBW) and traditional clinical and biochemical markers for cardiovascular damage risk were measured, and their role as predictors of all-cause and cardiovascular mortality was analysed. RESULTS: NT-proBNP level, ECFv/TBW and other cardiovascular damage risk factors were not evenly distributed among the different dialysis modalities. NT-proBNP levels and ECFv/TBW were correlated with several inflammation, malnutrition and myocardial damage markers. Multivariate analysis showed that NT-proBNP levels and ECFv/TBW were predictors of both all-cause and cardiovascular mortality, independently of dialysis modality and the presence of other known clinical and biochemical risk factors. CONCLUSIONS: NT-proBNP is a reliable predictor of death risk independently of the effect of dialysis modality on fluid volume control, and the presence of other clinical and biochemical markers recognized as risk factors for all-cause and cardiovascular mortality. NT-pro-BNP is a good predictor of mortality independently of fluid volume overload and dialysis modality.

Resultados de la encuesta aplicada en el Hospital Universitario San Ignacio de Bogotá, Colombia. Estudio piloto que utiliza la metodología del Estudio Internacional de Sibilancias en Lactante / Results of a questionnaire conducted in University Hospital San Ignacio, Bogotá, Colombia A pilot study using methodology of the International Study of Wheezing in Infants

Utilizando metodología del Estudio Internacional de Sibilancias en Lactantes (EISL), se diligencian 283 encuestas en el Hospital Universitario San Ignacio de Bogotá, Colombia, en niños de 12 a 15 meses de edad, durante enero de 2006 a diciembre de 2007. Como estudio piloto tiene limitaciones en la discusión y conclusiones pero, contribuye de manera importante a considerar aspectos de prevalencia y diferentes características asociadas con la enfermedad.