[Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection]. / Consenso multidisciplinar sobre la valoración y el tratamiento nutricional y dietético en pacientes con enfermedad renal crónica e infección por SARS-CoV-2. Consenso de nutrición en enfermedad renal crónica e infección por SARS-CoV-2.

The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection.The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST.It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values.In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass.Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea.Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.

Impacto del consumo de alimentos ultraprocesados en la enfermedad renal crónica / Association between ultrapocessed food and chronic kidney disease

La alimentación moderna está estrechamente vinculada al consumo de alimentos procesados, originando un aumento en la ingesta de sal, azúcares simples, fósforo y potasio añadidos. Este aporte excesivo se asocia a un mayor riesgo de obesidad, diabetes, hipertensión y enfermedad renal crónica (ERC). La ERC, que según datos del estudio ENRICA afecta al 15% de la población, magnifica su repercusión por la mayor prevalencia de diabetes e hipertensión y por las limitaciones en el manejo del sodio y del fósforo. La ingesta de estos productos supera ampliamente las recomendaciones establecidas, suponiendo un 72% del sodio total, un 25-35% del fósforo, un 12-18% de potasio y más del 10% del aporte calórico en azúcares simples. Son necesarias medidas para disminuir su aporte a través de consejo nutricional, revisión del etiquetado, campañas de educación en hábitos saludables, tasas y actuaciones institucionales que impliquen a las agencias de seguridad alimentaria, industria, distribución y sociedades científicas. (AU)

The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25-35% of phosphorus, 12-18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies. (AU)

Enfermedad renal crónica avanzada en ancianos en tratamiento renal sustitutivo y tratamiento conservador. Estudio comparativo de supervivencia y síntomas / Advanced chronic kidney disease in elderly under renal replacement therapy and conservative treatment. Comparative survival and symptoms study

Resumen Introducción: A pesar de la elevada prevalencia de la enfermedad renal crónica avanzada en ancianos, sigue siendo incierto el beneficio en términos de supervivencia y control de los síntomas del tratamiento renal sustitutivo frente al tratamiento renal conservador en esta población. Analizamos estos dos objetivos en ambas modalidades de tratamiento. Material y métodos: Estudio de cohortes prospectivo de pacientes mayores de 75 años en tratamiento renal sustitutivo y tratamiento renal conservador. Se realizaron un análisis de supervivencia y una valoración de la sintomatología utilizando la escala POS-S Renal en consulta multidisciplinar de tratamiento renal sustitutivo y en unidades de tratamiento renal sustitutivo. Resultados: Analizamos 82 pacientes en tratamiento renal sustitutivo y 37 pacientes en TRS. Los pacientes en tratamiento renal sustitutivo tuvieron mayor comorbilidad (Charlson) y peor situación funcional (Karnofsky). La mediana de supervivencia en el grupo de tratamiento renal sustitutivo fue de 26,9 meses (IC95% 19,6-34,2) frente a una media de 30,5 meses (IC95% 27,46-33,67) en el grupo tratamiento renal sustitutivo (p=0,014 a favor de diálisis). Los dos grupos presentaron gran variedad de síntomas, siendo la debilidad el más prevalente e intenso en ambos (97% tratamiento renal sustitutivo y 98% tratamiento renal conservador). La valoración a los 0,12 y 24 meses mostró que el número e intensidad de los síntomas se mantuvo estable en ambas terapias, sin diferencias clínicas. Conclusiones: El tratamiento renal sustitutivo se asocia a mayor supervivencia que el tratamiento renal conservador, sin embargo, los síntomas percibidos en enfermedad renal crónica avanzada son muy prevalentes y no apreciamos diferencias al comparar ambos tratamientos. La evaluación regular de los síntomas mediante un equipo multidisciplinar es útil en el manejo clínico de pacientes en ambas terapias.

Abstract Introduction: Despite the high prevalence of advanced chronic kidney disease for elderly, survival and symptom burden are uncertain for patients commencing renal replacement therapy versus patients managed with supportive care without dialysis (RSC-NFD). We examined these outcomes in both treatment modalities. Methods: Prospective cohort study of RSC-NFD and renal replacement therapy patients older than 75-years-old. A survival analysis and Symptoms were measured using POS-S Renal Scale in a multidisciplinary RSC-NFD clinic and in renal replacement therapy units. Results: 82 RSC-NFD patients and 37 renal replacement therapy patients were included in the study. RSC-NFD patients presented significant comorbidity (Charlson) and worse functional situation (Karnofsky). Median survival in the RSC-NFD treatment was 26.9 months (95%CI 19.6-34.2) vs mean 30.5 months (95% CI 27.46-33.67) in renal replacement therapy group (p 0.014 in favour of dialysis). Both treatments presented a wide variety of symptoms, being weakness the most prevalent and intense in both groups (97% renal replacement therapy and 98% RSC-NFD). The evaluation at 0,12 and 24 months showed that the number and intensity of symptoms remained stable in both therapies and there were no clinical differences. Conclusions: Dialysis is associated with a survival advantage from RSC-NFD. However, the perceived symptoms in advanced chronic kidney disease are highly prevalent and we didn`t appreciate differences comparing both treatments. Routine symptom assessment by a multidisciplinary team can be useful in clinical practice of patients in renal replacement therapy and RSC-NFD.

Consenso multidisciplinar sobre la valoración y el tratamiento nutricional y dietético en pacientes con enfermedad renal crónica e infección por SARS-CoV-2. Consenso de nutrición en enfermedad renal crónica e infección por SARS-CoV-2 / Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection

La presencia de malnutrición en pacientes con enfermedad renal crónica (ERC) es elevada, puede agravarse por la infección por SARS-CoV-2. La valoración nutricional se debe adaptar para minimizar contagios, recomendando monitorizar: porcentaje de pérdida de peso, índice de masa corporal (IMC), pérdida de apetito, parámetros analíticos y capacidad funcional mediante dinamometría. Así como valorar la sarcopenia mediante la escala SCARF, y la posibilidad de utilizar los criterios GLIM en aquellos pacientes que el cribado MUST ha dado positivo. Es importante adaptar las recomendaciones nutricionales en ingesta calórica y proteica, al estadio de la ERC y a la fase de infección por SARS-CoV-2. En pacientes hipercatabólicos priorizar preservar estado nutricional (35kcal/kg peso/día, proteínas hasta 1,5g/kg/día). El resto de nutrientes se adaptarán a estadio de ERC y valores analíticos. En la etapa postinfección, se recomienda realizar valoración nutricional completa, incluyendo sarcopenia. Los requerimientos energéticos y proteicos en esta fase se adaptarán a la afectación del estado nutricional, con especial atención a la pérdida de masa muscular. Es necesario adaptar las recomendaciones dietéticas a efectos secundarios de la infección por SARS-CoV-2: anorexia, disfagia, disgeusiay diarrea. La anorexia y el hipercatabolismo dificulta el cumplimiento de los requerimientos a través de la alimentación, por lo que se recomienda la utilización de soporte nutricional oral y en las fases severas la nutrición enteral o la parenteral. (AU)

The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection. The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST. It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35kcal/kg weight/day, proteins up to 1.5g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values. In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass. Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea. Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases. (AU)

Estudio de efectividad y seguridad de los agentes estimulantes de la eritropoyesis en el tratamiento de la anemia asociada a enfermedad renal crónica. Análisis de los factores que influyen en la respuesta / Effectiveness and Safety Study of the Stimulating Agents of Erythropoyesis in the Treatment of Anemia Associated with Chronic Kidney Disease. Analysis of the Factors that Influence the Response

Objetivos: Evaluar la efectividad y seguridad de darbepoetina α y epoetina β en la anemia asociada a ERC y estudiar los factores que influyen en la respuesta.Métodos: Estudio observacional, de cohortes, retrospectivo. Pacientes ≥18 años con ERC que inicia-ron tratamiento con AEE entre el 1 de enero 2014 y el 31 de diciembre 2015. Periodo máximo de seguimiento: 24 meses. Variables sociodemográficas, analíticas; de efectividad y relacionadas con la causa de fin de seguimiento. Análisis estadístico: modelos de regresión logística multivariante, regresión lineal múltiple. El estudio obtuvo dictamen favorable del Comité Ético de Investigación Clínica de Aragón (CEICA). Resultados: 198 pacientes: 59,1% varones, edad media: 75,3±12,4 años, 60% ERC estadio 4, Hb me-dia basal: 10,2±1,3 g/dL. El 71,2% inició darbepoetina α (dosis mediana: 18,7 (4,7-100,0) μg/semanal), el 28,8% epoetina β (6000,0 (466,7-20.000,0) UI/semanal). Los pacientes tratados con darbepoetina α presentaban estadios de ERC más avanzados (p<0,001); los que recibieron epoetina β más insuficiencia cardíaca (IC) (p=0,002) y cardiopatía isquémica (p=0,028). El 54,5% de los pacientes alcanzó el objetivo terapéutico a los 3 meses. El tratamiento con estatinas (OR:0,4 (IC95%: 0,174-0,996)) e insulina (OR:2,6 (IC95%:1,1-5,2)) se relacionaron con alcanzar la respuesta terapéutica. La Hb basal (Hb_b) y el Fe basal (Fe_b) influyeron en el ΔHb (%) (p<0,001 y 0,007 respectivamente). El 2,5% presentó un acci-dente cerebrovascular (ACV) isquémico en los 24 meses de seguimiento. El 35,9% (n=71) continuaba tratamiento con AEE a los 24 meses: 40,4% con darbepoetina α vs 24,6% con epoetina β (p=0,001). Conclusiones: Los AEE corrigen y mantienen la concentración de Hb de forma segura con dosis moderadas de AEE.(AU)

Objective: To evaluate the effectiveness and safety of darbepoetin α and epoetin β in anemia associat-ed with CKD and to study the factors that influence the response.Methods: It was carried out an observational, group and retrospective study. Patients ≥18 years of age with CKD who started treatment with ESA between January 1, 2014 and December 31, 2015. Maximum period of follow-up: 24 months. Sociodemographic, analytical, effectiveness and related to the cause of end of follow-up variables. Statistical analysis: multivariate logistic regression models, multiple linear regression. The study obtained a favorable opinion from the Aragón Clinical Research Ethics Committee (CEICA).Results: 198 patients: 59.1% men, mean age: 75.3 ± 12.4 years, 60% stage 4 CKD, mean baseline Hb: 10.2 ± 1.3 g / dL. 71.2% started darbepoetin α (median dose: 18.7 (4.7-100.0) μg / weekly), 28.8% epoetin β (6000.0 (466.7-20,000.0) IU /weekly). The patients treated with darbepoetin α had more advanced stages of CKD (p <0.001); those who re-ceived epoetin β plus heart failure (HF) (p = 0.002) and ischemic heart disease (p = 0.028). 54.5% of the patients reached the therapeutic objective at 3 months. Treatment with statins (OR: 0.4 (95% CI: 0.174-0.996)) and insulin (OR: 2.6 (95% CI: 1.1-5.2)) were related to achieving the therapeutic response. Baseline Hb (Hb_b) and basal Fe (Fe_b) influenced ΔHb (%) (p <0.001 and 0.007, respectively. 2.5% had an ischemic cerebrovascular accident (CVA) in the 24-month follow-up. 35.9% (n = 71) continued treat-ment with ESA at 24 months: 40.4% with darbepoe-tin α vs 24.6% with epoetin β (p = 0.001). Conclusions: ESAs safely correct and maintain Hb levels with moderate doses of ESAs.(AU)

Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection.

The presence of malnutrition in patients with Chronic Kidney Disease (CKD) is high, it can be made worse by SARS-CoV2 infection. The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST. It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values. In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass. Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea. Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.

Association between ultrapocessed food and chronic kidney disease.

The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25%-35% of phosphorus, 12%-18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies.

Supervivencia y calidad de vida en pacientes ancianos en tratamiento renal conservador / Survival and quality of life in elderly patients in conservative management

Introducción: El tratamiento renal conservador (TRC) se ha convertido en una opción terapéutica en la enfermedad renal crónica avanzada en ancianos. Se sabe poco sobre la evolución pronóstica de estos pacientes en términos de supervivencia y calidad de vida relacionada con la salud (CVRS). Objetivo: Establecer variables predictivas de mortalidad y analizar la CVRS en los pacientes en TRC. Pacientes y métodos: Estudio de cohortes prospectivo. Se realizó una valoración de parámetros de función renal y evaluación geriátrica integral: análisis de comorbilidad, situación funcional, cognitiva, fragilidad, nutricional, social y CVRS. Resultados: Se evaluaron 82 pacientes, con una edad media de 84 años e importante pluripatología: el 56% tenía antecedentes de evento vascular y Charlson > 8. La tasa de mortalidad fue de 23/1.000 pacientes-mes, con un ritmo de mortalidad homogéneo a partir de los 6 meses. La supervivencia difirió significativamente si presentaban evento vascular previo (36,7 vs. 14,8; p = 0,028), Charlson ≥10 (42 vs. 17; p = 0,002), grado de dependencia (48,4 vs. 19; p = 0,002) y fragilidad (27 vs. 10; p = 0,05). Fueron predictores de mortalidad: eFG y proteinuria, presencia de evento vascular previo, comorbilidad de Charlson, parámetros de malnutrición-inflamación (albúmina y puntuación MNA), grado de dependencia, CVRS física y aumento de PTH. La presencia de evento vascular previo, comorbilidad, albúmina descendida y elevación de PTH fueron predictores independientes de mortalidad. La CVRS se mantuvo estable y no se produjo empeoramiento significativo durante el tratamiento. Conclusiones: El conocimiento de los factores asociados con mortalidad y la evaluación de la CVRS puede ser útil como herramienta en la toma de decisiones en TRC. La presencia de evento vascular previo, comorbilidad, albúmina disminuida y el aumento de PTH fueron predictores independientes de mortalidad

Introduction: Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL). Objective: Establish predictive variables associated with mortality and analyse HRQoL in CM patients. Patients and methods: Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status. Results: 82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson > 8. The mortality rate was 23/1,000 patients per month, with a homogeneous mortality rate after 6 months. Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p = 0.028), Charlson score ≥10 (42 vs. 17; p = 0.002), functional status (48.4 vs. 19; p = 0.002) and fragility (27 vs. 10; p = 0.05). Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment. Conclusions: Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality

Survival and quality of life in elderly patients in conservative management. / Supervivencia y calidad de vida en pacientes ancianos en tratamiento renal conservador.

INTRODUCTION: Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL). OBJECTIVE: Establish predictive variables associated with mortality and analyse HRQoL in CM patients. PATIENTS AND METHODS: Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status. RESULTS: 82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson >8. The mortality rate was 23/1,000 patients per month, with a homogeneous mortality rate after 6 months. Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p=0.028), Charlson score ≥10 (42 vs. 17; p=0.002), functional status (48.4 vs. 19; p=0.002) and fragility (27 vs. 10; p=0.05). Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment. CONCLUSIONS: Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality.

Utilidad de un programa de calidad asistencial para la gestión clínica de las enfermedades nefrológicas en Aragón / The use of a quality care program for the management of renal disease in the Aragon region

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Riesgo de mortalidad asociado a enfermedad renal crónica en pacientes con diabetes tipo 2 durante un seguimiento de 13 años / Risk of mortality associated to chronic kidney disease in patients with type 2 diabetes mellitus: A 13-year follow-up

Objetivos: Nuestro objetivo fue evaluar la influencia de la tasa de filtración glomerular (TFG) y de la excreción de albúmina urinaria (EAU) sobre el riesgo de mortalidad en pacientes con diabetes mellitus tipo 2 (DM2). Material y métodos: Estudio de cohortes prospectivo con inclusión de pacientes con DM2. El punto final clínico fue mortalidad total. La TFG se midió en ml/min/1,73 m2 con estratificación en 3 categorías (≥60; 45-59; <45) y la EAU en mg/24h con estratificación también en 3 categorías (<30; 30-300; >300). Se evaluaron las tasas de mortalidad por cada 1.000 pacientes/año y, mediante regresión de Cox, el riesgo de mortalidad asociado con las categorías de TFG y EAU. El poder predictivo se midió con el estadístico C de Harrell. Resultados: Se incluyó a 453 pacientes (39,3% varones, edad 64,9 [DE 9,3] años y evolución de DM2 10,4 [DE 7,5] años). Durante una mediana de 13 años de seguimiento, la tasa de mortalidad total fue de 39,5/1.000, con incremento progresivo ante descenso de la TFG y aumento de la EAU (p < 0,001). En análisis multivariante la EAU (HR30-300 = 1,02 y HR>300 = 2,83; chi2 = 11,6; p = 0,003) y la TFG (HR45-59 = 1,34 y HR<45= 1,84; chi2 = 6,4; p = 0,041) fueron predictores independientes de mortalidad sin interacción significativa. La inclusión de TFG y EAU mejoró la capacidad predictiva de los modelos (C de Harrell 0,741 vs. 0,726; p = 0,045). Conclusiones: La TFG y la EAU son predictores independientes de mortalidad en pacientes con DM2, sin interacción significativa (AU)

Objective: Our aim was to assess the usefulness of glomerular filtration rate (GFR) and urinary albumin excretion (UAE) to predict the risk of mortality in patients with type 2 diabetes mellitus. Material and methods: This is a prospective cohort study in patients with type 2 diabetes mellitus. Clinical end-point was mortality rate. GFR was measured in ml/min/1.73 m2 and stratified in 3 categories (≥60; 45-59; <45); UAE was measured in mg/24 hours and was also stratified in 3 categories (<30; 30-300; >300). Mortality rates were reported per 1000 patient years. Cox regression models were used to predict mortality risk associated with combined GFR and UAE. The predictive power was estimated with C-Harrell statistic. Results: A total of 453 patients (39.3% males), aged 64.9 (SD 9.3) years were included; mean diabetes duration was 10.4 (SD 7.5) years. Median follow-up was 13 years. Total mortality rate was 39.5/1000. The progressive increase in mortality in the successive categories of GFR and UAE was statistically significant (P<.001). In a multivariable analysis, UAE (HR30- 300 = 1.02 and HR> 300 = 2.83; X2 = 11.6; P =.003) and GFR (HR45-59 = 1.34 and HR< 45=1.84; X2 = 6.4; P =.041) were independent predictors for mortality, with no significant interaction. Simultaneous inclusion of GFR and UAE improved the predictive power of models (C-Harrell 0.741 vs. 0.726; P =.045). Conclusions: GFR and UAE are independent predictors for mortality in type 2 diabetic patients and do not show a statistically significant interaction (AU)

Risk of mortality associated to chronic kidney disease in patients with type 2 diabetes mellitus: a 13-year follow-up.

OBJECTIVE: Our aim was to assess the usefulness of glomerular filtration rate (GFR) and urinary albumin excretion (UAE) to predict the risk of mortality in patients with type 2 diabetes mellitus. MATERIAL AND METHODS: This is a prospective cohort study in patients with type 2 diabetes mellitus. Clinical end-point was mortality rate. GFR was measured in ml/min/1.73 m2 and stratified in 3 categories (≥60; 45-59; <45); UAE was measured in mg/24hours and was also stratified in 3 categories (<30; 30-300; >300). Mortality rates were reported per 1000 patient-years. Cox regression models were used to predict mortality risk associated with combined GFR and UAE. The predictive power was estimated with C-Harrell statistic. RESULTS: A total of 453 patients (39.3% males), aged 64.9 (SD 9.3) years were included; mean diabetes duration was 10.4 (SD 7.5) years. Median follow-up was 13 years. Total mortality rate was 39.5/1000. The progressive increase in mortality in the successive categories of GFR and UAE was statistically significant (P<.001). In a multivariable analysis, UAE (HR30-300=1.02 and HR>300=2.83; X2=11.6; P =.003) and GFR (HR45-59=1.34 and HR<45=1.84; X2=6.4; P =.041) were independent predictors for mortality, with no significant interaction. Simultaneous inclusion of GFR and UAE improved the predictive power of models (C-Harrell 0.741 vs. 0.726; P =.045). CONCLUSIONS: GFR and UAE are independent predictors for mortality in type 2 diabetic patients and do not show a statistically significant interaction.

Riesgo de morbimortalidad cardiovascular según el tiempo de evolución de la diabetes tipo 2 / Morbidity and mortality cardiovascular risk in dependence of type 2 diabetes duration

Introducción: Nuestro objetivo fue evaluar si el tiempo de evolución de la enfermedad puede ayudar a discriminar el riesgo vascular en la diabetes tipo 2 (DM2). Métodos: Estudio de cohortes prospectivo con inclusión de pacientes con DM2. Se siguieron hasta la aparición de un episodio de enfermedad cardiovascular (ECV), hasta su fallecimiento o hasta la fecha de cierre en 2012. Los pacientes se clasificaron en 5 grupos: grupo 1: ≤ 5 años de evolución sin ECV inicial; grupo 2: 6-10 años sin ECV; grupo 3: 11-15 años sin ECV; grupo 4: > 15 años sin ECV; grupo 5: cualquier tiempo de evolución con ECV inicial. Las tasas se expresan por cada 1.000 pacientes-año. La comparación de tasas se realizó mediante análisis de Kaplan-Meier y Log Rank Test. La contribución del tiempo de evolución se evaluó mediante regresión de Cox. Resultados: Se incluyeron 457 pacientes (38,9% varones), con edad media de 64,9 (DE 9,3) años y tiempo de evolución de la DM2 de 10,5 (DE 7,6) años. Se produjeron 125 episodios durante una mediana de seguimiento de 12,3 años. Hubo un incremento progresivo de las tasas de ECV desde los grupos 1 al 5 (grupo 1: 14,1; grupo 2: 18,3; grupo 3: 19,6; grupo 4: 32,9; grupo 5: 53,5; p < 0,0001, tendencia lineal). Una duración de la DM2 > 15 años duplicó el riesgo de ECV (HR = 1,97; IC 95%: 1,23-3,15; p = 0,004). Conclusiones: Consideramos útil tener en cuenta la duración conocida de la enfermedad a la hora de estratificar el riesgo vascular de los pacientes con DM

Introduction: This study was aimed to assess the prognostic importance of diabetes duration to predict cardiovascular risk in type 2 diabetic patients. Methods: Prospective cohort study with inclusion of type 2 diabetic patients. Follow-up lasted until the appearance of a cardiovascular event, until death or until 2012. Patients were classified into 5 groups in accordance to diabetes duration and baseline cardiovascular disease (CVD): group 1: ≤ 5 years without CVD; group 2: 6-10 years without CVD; group 3: 11-15 years without CVD; group 4: > 15 years without CVD; group 5: baseline CVD independently of diabetes duration. CVD rates were expressed per 1000 patients-year and compared by Kaplan-Meier analysis and Log Rank Test. The predictive power of diabetes duration was evaluated by Cox regression. Results: 457 patients, aged 64.9 (DE 9.3) years (38.9% males), were included. Diabetes duration in order to stratify cardiovascular risk of type2 diabetic patients

[Morbidity and mortality cardiovascular risk in dependence of type 2 diabetes duration]. / Riesgo de morbimortalidad cardiovascular según el tiempo de evolución de la diabetes tipo 2.

INTRODUCTION: This study was aimed to assess the prognostic importance of diabetes duration to predict cardiovascular risk in type 2 diabetic patients. METHODS: Prospective cohort study with inclusion of type 2 diabetic patients. Follow-up lasted until the appearance of a cardiovascular event, until death or until 2012. Patients were classified into 5 groups in accordance to diabetes duration and baseline cardiovascular disease (CVD): group 1: ≤ 5 years without CVD; group 2: 6-10 years without CVD; group 3: 11-15 years without CVD; group 4: >15 years without CVD; group 5: baseline CVD independently of diabetes duration. CVD rates were expressed per 1000 patients-year and compared by Kaplan-Meier analysis and Log Rank Test. The predictive power of diabetes duration was evaluated by Cox regression. RESULTS: 457 patients, aged 64.9 (DE 9.3) years (38.9% males), were included. Diabetes duration was 10.5 (DE 7.6) years. 125 cardiovascular events occurred during 12.3 years follow-up. Cardiovascular event rates were progressively increased from groups 1 to 5 (group 1: 14.1; group 2: 18.3; group 3: 19.6; group 4: 32.9; group 5: 53.5; p<0.0001, linear tendency). Diabetes duration superior to 15 years significantly increased cardiovascular risk of the patients (HR=1.97; 95%CI: 1.23-3.15; P=.004). CONCLUSIONS: It could be useful to consider diabetes duration in order to stratify cardiovascular risk of type 2 diabetic patients.

Utilidad de la encuesta dietética cualitativa en los pacientes en hemodiálisis periódica / Usefulness of the qualitative dietetic questionnaire in patients undergoing periodic haemodialysis

Introducción y objetivos: La desnutrición es frecuente en pacientes con insuficiencia renal crónica en hemodiálisis periódica (HDP), dentro de su origen multifactorial la ingesta insuficiente es una causa importante. Esta desnutrición produce una mala calidad de vida y un aumento de mortalidad en nuestros pacientes. El objetivo de nuestro trabajo es valorar la información que nos aporta una encuesta cualitativa frente a la cuantitativa realizadas ambas simultáneamente. Material y métodos: Se realiza el estudio con 20 pacientes de nuestra unidad de diálisis, en los que se determina la edad, parámetros de calidad de diálisis y parámetros nutricionales bioquímicos y antropométricos. Se realizan dos tipos de encuesta dietética: cualitativa y cuantitativa. En la encuesta cuantitativa se recoge un registro alimentario de dos días en el que se valora la ingesta calórica y proteica mediante tablas de composición de alimentos. En la encuesta dietética cualitativa se puntúan de 1 a 3 siete variables subjetivas de la dieta: el apetito, los cambios de apetito, descripción de la cantidad de ingesta, dificultad para seguir una dieta, las tomas principales, otras tomas, y los indicadores seleccionados de ingesta proteica. Resultados: Al contrastar los datos obtenidos en ambas encuestas, se detecta que los pacientes con una puntuación superior a 17 en la encuesta cualitativa tienen una mejor ingesta calórica y proteica que los pacientes con una puntuación inferior a 17 (1,44 versus 1,08 gr/Kg/día de proteínas y 32,01 versus 27,8 Kcal/Kg/día de calorías; p< 0,05). Conclusión: La encuesta cualitativa es más sencilla de realizar que la cuantitativa y se puede incluir en el trabajo cotidiano de enfermería nefrológica pudiendo detectar así de forma precoz los déficit de ingesta, evitando el desarrollo de malnutrición (AU)

Malnutrition is often observed in patients with chronic renal insufficiency (CRI) under periodic haemodialysis (PH). This malnutrition leads to poor quality of life and an increase in the mortality rate. The aim of our study was to compare the information provided by a qualitative dietetic questionnaire with a quantitative one. The study was performed with 20 patients from our dialysis Unit. We recorded the following data: age, dialysis quality parameters and biochemical and nutritional parameters. We performed two dietetic questionnaires: qualitative and quantitative. In the quantitative questionnaire we recorded the dietary intake for two days based on dietetic tables. In the qualitative questionnaire we scored from 1 to 3 seven subjective items: appetite, appetite changes, intake quantity, difficulties in following the diet, main intakes, and other items of protein intake. When data from the two questionnaires are compared we observe that in patients with a score over 17 from the quantitative questionnaire, a better protein and caloric intake than patients under 17. (1.44 vs. 1.08 gr protein/Kg/day, and 32.01 vs 27.8 Kcal/Kg/day, p<0.05). In conclusion, the qualitative questionnaire is easier to perform than the quantitative one, and can be used by nursing staff to detect malnutrition promptly (AU)