Niveles de 25 hidroxivitamina D y riesgo cardiovascular en una cohorte de pacientes con enfermedad renal crónica avanzada / 25 hydroxyvitamin D levels and cardiovascular risk in a cohort of patients with chronic kidney disease

Introducción: Los niveles bajos de 25 hidroxivitamina D han sido relacionados con un aumento de la morbimortalidad de origen cardiovascular en la población general y en pacientes con enfermedad renal crónica. Objetivo: Nuestro objetivo fue estudiar los niveles de 25 hidroxivitamina D en un grupo de pacientes con enfermedad renal crónica estadios 4 y 5 prediálisis, y relacionarlos con los antecedentes de enferme- dad cardiovascular y con factores conocidos de riesgo cardiovascular. Material y métodos: Se trata de un estudio observacional transversal de una cohorte de 171 pacientes seguidos en la consulta prediálisis de nuestro hospital, me- dia de edad 64,16 ± 13 años, el 59,6% hombres, el 64,3% diabéticos, el 47,3% obesos y el 46,8% con antecedentes de enfermedad cardiovascular. A todos los pacientes se les mi- dieron los niveles séricos de 25 hidroxivitamina D y de 1-25 dihidroxivitamina D, se recogieron datos clínicos y analíticos de función renal, anemia, perfil lipídico y metabolismo óseo-mineral; también se evaluó la presión arterial mediante registro ambulatorio de 24 horas (MAPA) y se realizó estudio ecocardiográfico. Resultados: La media de los niveles de 25 hidroxivitamina D fue de 22,1 ± 13 ng/ml, sólo un 18,7% de los pacientes presentaban niveles normales, un 58,5% presentaban niveles insuficientes o bajos y un 22,8% niveles deficientes o muy bajos. Las variables que se asociaron con los niveles bajos de vitamina D fueron la edad, la diabetes, el sexo femenino, la obesidad, el filtrado glomerular y el antecedente de enfermedad cardiovascular. Dentro de los parámetros asociados a la presión arterial, la presión del pulso fue la que más se relacionó con los niveles de vitamina D. No se encontró asociación entre los niveles de 25 hidroxivitamina D con otros parámetros del metabolismo óseo mineral ni con los valores ecográficos de hipertrofia ventricular izquierda. En el análisis multivariante las variables que más se asociaron al déficit de 25 hidroxivitamina D fueron el sexo femenino, el antecedente de enfermedad cardiovascular, el filtrado glomerular y la presión del pulso del MAPA. Conclusiones: Nuestro estudio confirma una alta prevalencia de insuficiencia y deficiencia de 25 hidroxivitamina D en la población con enfermedad renal crónica avanzada; este déficit se asocia con la presencia de factores de riesgo cardiovascular y con el antecedente de enfermedad cardiovascular. Sin embargo, no se encontró ninguna asociación con uno de los principales predictores de eventos cardiovasculares como es la hipertrofia ventricular izquierda (AU)

Background: Decreased 25 hydroxyvitamin D serum levels have been related to an increase in cardiovascular morbility and mortality in both general population and chronic kidney disease patients. The aim of this study was to evaluate the relationship between 25 hydroxy vitamin D serum level, cardiovascular risk factors and previouses tablished cardiovascular disease in a group of patients with advanced chronic kidney disease. Material and methods: We performed a cross-sectional observational study in a cohort of 171 stage 4 and 5 chronic kidney disease out patients seen in our predialysis clinic, mean age64.16 ± 13 years, 59.6% were men, 64.3% had diabetes,47.3% had obesity, 46.8% had previous cardiovascular disease. 25 hydroxy vitamin D and 1-25 dihydroxy vitamin D were measured, we also determine other routine biochemical parameters. All subjects underwent anechocardiogram and 24 hours ambulatory blood pressure monitoring was also performed. Results: Mean 25hydroxyvitamin D levels were 22.1 ± 13 ng/ml, only 18.7%of the patients had adecuate levels, levels were insufficient in 58.5% of the patients and deficient in 22.8% of them. Low 25 hydroxyvitamin D levels were significatively related with age, diabetes, female gender, obesity, MDRD glomerular filtration rate and previous cardiovascular disease. Pulse pressure was the Ambulatory Blood Pressure Monitoring parameter that was better correlated with 25 hydroxyvitamin D levels. We could not find any association between vitamin D levels and other bone and mineral metabolism parameters. No relationship was seen between low vitamin D levels and left ventricular hypertrophy. On multivariate analysis lower levels of 25 hydroxyvitamin D were independently associated with female gender, previous cardiovascular disease, MDRD4-GFR and higher pulse pressure. Conclusions: Our study confirm a high prevalence of 25 hydroxyvitamin D insufficiency and deficiency in advanced chronic kidney disease patiens, this was associated with the presence of cardiovascular risk markers and previous established cardiovascular disease. However we could not see any relationship with left ventricular hypertrophy which is an known predictor of future cardiovascular events in this population (AU)

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[25 hydroxyvitamin D levels and cardiovascular risk in a cohort of patients with advanced chronic kidney disease]. / Niveles de 25 hidroxivitamina D y riesgo cardiovascular en una cohorte de pacientes con enfermedad renal crónica avanzada.

BACKGROUND: Decreased 25 hydroxyvitamin D serum levels have been related to an increase in cardiovascular morbility and mortality in both general population and chronic kidney disease patients. The aim of this study was to evaluate the relationship between 25 hydroxyvitamin D serum level, cardiovascular risk factors and previous established cardiovascular disease in a group of patients with advanced chronic kidney disease. MATERIAL AND METHODS: We performed a cross-sectional observational study in a cohort of 171 stage 4 and 5 chronic kidney disease outpatients seen in our predialysis clinic, mean age 64.16 +/- 13 years, 59.6% were men, 64.3% had diabetes, 47.3% had obesity, 46.8% had previous cardiovascular disease. 25 hydroxyvitamin D and 1-25 dihydroxyvitamin D were measured, we also determined other routine biochemical parameters. All subjects underwent an echocardiogram and 24 hours ambulatory blood pressure monitoring was also performed. RESULTS: Mean 25 hydroxyvitamin D levels were 22.1 +/- 13 ng/mL, only 18.7% of the patients had adequate levels, levels were insufficient in 58.5% of the patients and deficient in 22.8% of them. Low 25 hydroxyvitamin D levels were significantly related with age, diabetes, female gender, obesity, MDRD glomerular filtration rate and previous cardiovascular disease. Pulse pressure was the Ambulatory Blood Pressure Monitoring parameter that was better correlated with 25 hydroxyvitamin D levels. We could not find any association between vitamin D levels and other bone and mineral metabolism parameters. No relationship was seen between low vitamin D levels and left ventricular hypertrophy. On multivariate analysis lower levels of 25 hydroxyvitamin D were independently associated with female gender, previous cardiovascular disease, MDRD4-GFR and higher pulse pressure. CONCLUSIONS: Our study confirm a high prevalence of 25 hydroxyvitamin D insufficiency and deficiency in advanced chronic kidney disease patients, this was associated with the presence of cardiovascular risk markers and previous established cardiovascular disease. However we could not see any relationship with left ventricular hypertrophy which is a known predictor of future cardiovascular events in this population.

Conjuntivitis hemorrágica epidémica. Estudio casuístico en la provincia de Matanzas / Epidemic hemorrhagic conjunctivitis. Casuistical study in Matanzas Province

Se realiza un trabajo sobre la epidemia de CHE en la provincia de Matanzas. Se consideran los principales parámetros demográficos con respecto a la incidencia, magnitud de la propagación, complicaciones, tratamiento y consideraciones comparativas con las epidemias oculares en el mundo desde la primera vez que se informó en 1969. Este trabajo no constituye un estudio definitivo, sino más bien una forma preliminar, abierta y general, que posibilitará elementos importantes para su continuidad a lo largo del estudio del problema; por lo cual esperamos obtener desde este punto de partida elementos que particularicen clínica y epidemiológicamente las características de la CHE en nuestro medio (AU)