Enfermedad renal crónica en Atención Primaria: prevalencia y factores modificables / Chronic renal disease in primary care: prevalence and modifiable factors

Objetivo: determinar la prevalencia diagnosticada global y por estadios de enfermedad renal crónica (ERC) en la población asignada al centro de salud (CS) urbano Casanova (Barcelona), así como explorar factores sociodemográficos y clínicos según estadios.Método: estudio descriptivo transversal. La población fueron los pacientes asignados al CS (n= 31.372). Se incluyeron pacientes adultos con diagnóstico de ERC registrado en su historia clínica electrónica. La clasificación por estadios se estableció a partir de la estimación de la tasa de filtrado glomerual (eTFG) disponible. Así mismo, se recogieron factores relacionados con la ERC: edad, sexo, índice de masa corporal, actividad física, tabaquismo, diabetes mellitus, hipertensión arterial (HTA) y dislipemia. Se realizó estadística descriptiva y análisis bivariantes en función del estadio.Resultados: la prevalencia de ERC fue de 2,9% (n= 920) y 2,1% (n= 675) con eTFG registrada. Fueron analizados 675 individuos (media 79,9 años; DE= 11,8) de los cuales el 57,6% (n= 389) fue mujer. El estadio G3a fue el más prevalente (n= 275; 40,7%). La prevalencia de los estadios G1, G2, G3b, G4 y G5 fue del 2,1% (n= 14), 19,3% (n= 130), 27,6% (n= 186), 7,8% (n= 53) y 2,5% (n= 17) respectivamente. Resultó estadísticamente significativa la asociación de los estadios de ERC con el sexo, la edad, el sobrepeso y la obesidad, y la HTA.Conclusiones: la ERC afecta a menos del 5% de los pacientes asignados en el CS, la mayoría tiene más 65 años y son mujeres. Se recomiendan estrategias de actuación preventiva centradas en población con diagnóstico de ERC en estadios centrales y enfocadas a los factores modificables de HTA, sobrepeso y obesidad.(AU)

Objective: to determine the prevalence overall and by stages of diagnosed chronic renal disease (CRD) in the population assigned to the Casanova urban Primary Care Centre (PCC) in Barcelona, as well as to explore sociodemographic and clinical factors by stages.Method: a cross-sectional descriptive study. The population consisted of those patients assigned to the PCC (n= 31,372). Adult patients with CRD diagnosis in their electronic clinical record were included. The classification by stages was determined on the basis of the estimated Glomerular Filtration Rate available. Factors associated with CRD were also collected: age, gender, body mass index, physical activity, smoking, diabetes mellitus, hypertension (HTN), and dyslipidemia. Descriptive statistics and bivariate analyses were conducted according to the stage.Results: there was a 2.9% (n= 920) prevalence of CRD, and 2.1% (n= 675) with recorded eGFR. The study included 675 individuals (mean 79.9 years of age; SD: 11.8); 57.6% (n= 389) of them were female. Stage G3a was the most prevalent (n= 275; 40.7%). The prevalence of stages G1, G2, G3b, G4 y G5 was 2.1% (n= 14), 19.3% (n= 130), 27.6% (n= 186), 7.8% (n= 53) and 2.5% (n= 17) respectively. The association between CRD stages and gender, age, excess weight and obesity, and HTN was statistically significant.Conclusions: CRD affected less than 5% of patients assigned to the PHC; the majority were over 65-years-old and female. It was recommended to implement preventive action strategies addressing the population with CRD diagnosis in central stages, and focused on the modifiable factors of HTN, excess weight and obesity.(AU)

Intervention to reduce perceived loneliness in community-dwelling older people.

AIM: We evaluated the reduction in perceived loneliness and depression and the increase in social support and quality of life in community-dwelling lonely people aged >65 years included in a community intervention compared with nonlonely controls from the same urban area. DESIGN: Randomised clinical trial without blind evaluation. LOCATION: Urban area of Barcelona. PARTICIPANTS: Community dwellers aged >65 years with loneliness identified by the primary care team. INTERVENTIONS: The primary care team together with community agents (municipal social services, community civil and religious associations) carried out 18 sessions developing activities including educational workshops, mindfulness, yoga, walking and visits to urban gardens. RESULTS: We included 55 patients (87% female, mean age 80.6 ± 6.86 years) of whom 82% had moderate and 18% severe loneliness. Six months postintervention, 48.3% of the intervention group did not feel lonely compared with 26.9% of controls (p = 0.001). Social support (DUKE-UNC-11) increased from 33.5 ± 9.3 to 41.4 ± 6.6, and mental health (SF-12) from 36 ± 610.4 to 48 ± 11.1 and depressive symptoms (Yesavage test) decreased from 9.2 ± 3.6 to 5.2 ± 5.0 in the intervention but not the control group. CONCLUSIONS: The intervention mainly reached people with moderate loneliness and significantly improved the perception of loneliness, depressive symptoms, social support and the mental health component of the quality of life. The intervention may be more suitable for people with moderate loneliness, but these types of activities may be difficult to accept by people with severe loneliness not related to the barriers to socialisation generated by ageing.