¿Es apropiada la aplicación de la nueva ecuación Chronic Kidney Disease Epidemiology Consortium (CKD-EPI 2021) en la población española? / Is the use of the new Chronic Kidney Disease Epidemiology Consortium (CKD-EPI 2021) formula appropriate for the Spanish population?

Introducción Las sociedades estadounidenses de nefrología recomiendan cambiar la ecuación CKD-EPI 2009 por la nueva CKD-EPI 2021, que no incluye el coeficiente de raza, para estimar la tasa de filtrado glomerular (TFGe). Se desconoce cómo podría afectar este cambio a la distribución de la enfermedad renal de la población española predominantemente caucásica. Métodos Se estudiaron dos cohortes de adultos de la provincia de Cádiz, BD-SIDICA (n=264.217 personas) y BD-PANDEMIA (n=64.217), que disponían de mediciones de creatinina plasmática entre 2017 y 2021. Se calcularon los cambios de la TFGe y la consecuente reclasificación en las diferentes categorías de la clasificación KDIGO-2012 al modificar la ecuación CKD-EPI 2009 por la de 2021. Resultados En comparación con la ecuación de 2009, CKD-EPI-21 arrojó una TFGe más alta, con una mediana de 3,8mL/min/1,73m2 (IQR: 2,98-4,48) en BD-SIDICA y de 3,89mL/min/1,73m2 (IQR: 3,05-4,55) en BD-PANDEMIA. Como primera consecuencia, del total de la población, el 15,3% en BD-SIDICA y el 15,1% en BD-PANDEMIA y el 28,1% y el 27,3%, respectivamente, de la población con enfermedad renal (G3-G5), se reclasificó a una categoría de TFGe más alta y ningún sujeto a una más grave. Como segunda consecuencia, la prevalencia de la enfermedad renal disminuyó del 9% al 7,5% en ambas cohortes. Conclusiones Implementar la ecuación CKD-EPI-21 en la población española, predominantemente caucásica, aumentaría la TFGe en una cantidad modesta (mayor en hombres y con mayor edad o TFG) y una proporción importante de la población se clasificaría en una categoría de TFGe superior, con la consiguiente disminución de la prevalencia de la enfermedad renal (AU)

Introduction United States nephrology societies recommend changing from the CKD-EPI 2009 equation to the new CKD-EPI 2021 equation, which does not include the race coefficient, for calculating estimated glomerular filtration rate (eGFR). It is unknown how this change might affect the distribution of kidney disease in the predominantly Caucasian Spanish population. Methods Two databases of adults from the province of Cádiz, DB-SIDICA (n=264,217) and BD-PANDEMIC (n=64,217), that had plasma creatinine measurements recorded between 2017 and 2021 were studied. Changes in eGFR and the consequent reclassification into different categories of the KDIGO2012 classification resulting from substituting the CKD-EPI 2009 equation for the 2021 equation were calculated. Results Compared to the 2009 equation, CKD-EPI 2021 yielded a higher eGFR, with a median of 3.8mL/min/1.73m2 (IQR: 2.98-4.48) in DB-SIDICA and 3.89mL/min/1.73m2 (IQR: 3.05-4.55) in DB-PANDEMIA. The first consequence was that 15.3% of the total population in DB-SIDICA and 15.1% of the total population in DB-PANDEMIA were reclassified into a higher category of eGFR, as were 28.1% and 27.3%, respectively, of the population with CKD (G3-G5); no subjects were classified into the more severe category. The second consequence was that the prevalence of kidney disease decreased from 9% to 7.5% in both cohorts. Conclusions Implementing the CKD-EPI 2021 equation in the Spanish population, which is predominantly Caucasian, would increase eGFR by a modest amount (greater in men and those who are older or have a higher GFR). A significant proportion of the population would be classified into a higher eGFR category, with a consequent decrease in the prevalence of kidney disease (AU)

Is the use of the new Chronic Kidney Disease Epidemiology Consortium (CKD-EPI 2021) formula appropriate for the Spanish population?

INTRODUCTION: United States nephrology societies recommend changing from the CKD-EPI 2009 equation to the new CKD-EPI 2021 equation, which does not include the race coefficient, for calculating estimated glomerular filtration rate (eGFR). It is unknown how this change might affect the distribution of kidney disease in the predominantly Caucasian Spanish population. METHODS: Two databases of adults from the province of Cádiz, DB-SIDICA (N=264,217) and DB-PANDEMIA (N=64,217), that had plasma creatinine measurements recorded between 2017 and 2021 were studied. Changes in eGFR and the consequent reclassification into different categories of the KDIGO 2012 classification resulting from substituting the CKD-EPI 2009 equation for the 2021 equation were calculated. RESULTS: Compared to the 2009 equation, CKD-EPI 2021 yielded a higher eGFR, with a median of 3.8mL/min/1.73m2 (IQR 2.98-4.48) in DB-SIDICA and 3.89mL/min/1.73m2 (IQR 3.05-4.55) in DB-PANDEMIA. The first consequence was that 15.3% of the total population in DB-SIDICA and 15.1% of the total population in DB-PANDEMIA were reclassified into a higher category of eGFR, as were 28.1% and 27.3%, respectively, of the population with CKD (G3-G5); no subjects were classified into the more severe category. The second consequence was that the prevalence of kidney disease decreased from 9% to 7.5% in both cohorts. CONCLUSIONS: Implementing the CKD-EPI 2021 equation in the Spanish population, which is predominantly Caucasian, would increase eGFR by a modest amount (greater in men and those who are older or have a higher GFR). A significant proportion of the population would be classified into a higher eGFR category, with a consequent decrease in the prevalence of kidney disease.

Prevención y tratamiento de la enfermedad infecciosa en personas con diabetes / Prevention and treatment of infectious diseases in diabetic patients

Es conocida la relación bidireccional entre enfermedades infecciosas y diabetes. Las personas con diabetes tienen mayor riesgo de presentar enfermedades infecciosas, pudiendo ser estas de mayor severidad; y por otro lado, las enfermedades infecciosas desestabilizan el control metabólico de las personas con diabetes. El envejecimiento importante de la población es debido en parte al aumento de la supervivencia de pacientes con enfermedades crónicas, entre ellas la diabetes. Mejorar la prevención de enfermedades infecciosas en este grupo de población podría disminuir las complicaciones de estas enfermedades, así como las consecuencias de la desestabilización de la enfermedad de base (morbilidad, discapacidad, ingresos hospitalarios, costes sanitarios, tasas de mortalidad), mejorando además la calidad de vida de las personas con diabetes. La presente revisión expone el tratamiento de las enfermedades infecciosas en personas con diabetes y el abordaje de las enfermedades inmunoprevenibles con las vacunas recomendadas en la actualidad

The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations

[Prevention and treatment of infectious diseases in diabetic patients]. / Prevención y tratamiento de la enfermedad infecciosa en personas con diabetes.

The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations.

Recomendaciones de buena práctica en el tratamiento de la dislipemia en la diabetes / Consensus document on the treatment of dyslipidemia in diabetes

Las personas con diabetes mellitus tipo 2 tienen un riesgo de desarrollar enfermedad cardiovascular de 2 a 4 veces superior al observado en la población general de similar edad y sexo. Este riesgo se mantiene después de ajustar para otros factores clásicos de riesgo cardiovascular. La dislipidemia asociada a la diabetes mellitus tipo 2 se encuentra presente en hasta un 60% de las personas con diabetes y contribuye en gran medida al incremento de riesgo cardiovascular y de morbimortalidad que presentan estos pacientes. La dislipidemia diabética es una alteración del metabolismo lipídico que se caracteriza por un exceso de triglicéridos, un déficit del colesterol HDL y una alteración de la composición de las lipoproteínas que consiste sobre todo en un exceso de partículas LDL pequeñas y densas. Múltiples ensayos clínicos han demostrado los beneficios del tratamiento farmacológico de la dislipidemia (principalmente estatinas), para prevenir eventos cardiovasculares y mortalidad en personas con diabetes tanto en prevención primaria como secundaria. El presente documento de consenso elaborado por médicos de familia, integrantes del Grupo de Diabetes de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), pretende servir de ayuda en el manejo de las personas con diabetes y dislipidemia a la vista de las recomendaciones más actualizadas (AU)

People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations (AU)

[Consensus document on the treatment of dyslipidemia in diabetes]. / Recomendaciones de buena práctica en el tratamiento de la dislipemia en la diabetes.

People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations.

[Use of glucose-lowering drugs in a primary care setting in Malaga during the years 2008-2012]. / Utilización de fármacos hipoglucemiantes en el ámbito de la atención primaria de Málaga durante los años 2008-2012.

INTRODUCTION: The aim of the study is to describe the pattern of use of hypoglycemic agents in a primary health care district of Málaga between the years 2008-2012. MATERIAL AND METHOD: Cross-sectional descriptive study. Málaga health district. Population of 609,781 inhabitants; 42,060 people in the diabetes process. Therapeutic sub-group A10 (drugs used in diabetes). Data is presented as defined daily dose (DDD). Years 2008-2012. Measures of frequency. RESULTS: The population grew by 0.4% and the people included in the diabetes process, by 19%. The hypoglycemic agents have increased from 12,453,443 to 14,144,817 DDD (13.5%). Oral antidiabetics increased by 13.8% and insulin by 9.7%. Metformin is the most used oral antidiabetic (6,655,923 DDD) and the iDDP4 was the one that had increased more (from 63,882 DDD to 1,482,574). The growth in insulin use was mainly due to the long-acting (38%) and the shorter-acting one (40%). The most used insulin doses are the long-acting ones, followed by the pre-mixed. The proportion of insulin use as regards the use of ADOs has remained stable (31%)., Long-acting (36%) insulin has become the most used, followed by pre-mixed (34%), shorter-acting (16%), and the intermediate-acting (12%). CONCLUSIONS: There is an increase in the use of hypoglycemic agents., Metformin and iDPP4 are the antidiabetics oral with the greatest growth., There is an increase in shorter-acting and long-acting insulins with a decrease in intermediate-acting and pre-mixed., The proportion of oral antidiabetics/insulins has remained stable.

[A retrospective evaluation of the behaviour of groups under out-patient care at a health center]. / Evaluación retrospectiva del comportamiento de los grupos de cuidados ambulatorios en un centro de salud.

OBJECTIVES: To study and analyse the Out-Patient Care Groups (OCGs), and evaluate how they affect use of health resources. DESIGN: An observational, retrospective study. SETTING: Ciudad Jardín Health Centre, Málaga. PARTICIPANTS: 2999 patients with a clinical history opened before 31.12.95, chosen from 5 of the 17 medical lists at the Health Centre, were included. RESULTS: The statistical analysis was performed with the SPSS software package of the Calculation Centre at Málaga University. A descriptive test produced the following results: 33% of the patients were classified in OCG 41 (combination of 2 or 3 out-patient diagnosis groups in people over 34); 19% belonged to groups of stable or unstable chronic illnesses (OCGs 8, 9 and 10); and 9% had acute children's diseases. Then multiple regression constructed a model with the OCGs as independent variable and annual visits, further tests performed and referral to specialists as dependent variables. In this model the OCGs were able to explain 20.3% of resource consumption. CONCLUSIONS: In the retrospective study and with a limited sample of 2999 patients, the OCGs are able to explain 20.3% of resource consumption. However, it does seem a valid model for discriminating between normal and over-using patients.