Albumin-induced apoptosis of tubular cells is modulated by BASP1.

Albuminuria promotes tubular injury and cell death, and is associated with faster progression of chronic kidney disease (CKD) to end-stage renal disease. However, the molecular mechanisms regulating tubular cell death in response to albuminuria are not fully understood. Brain abundant signal protein 1 (BASP1) was recently shown to mediate glucose-induced apoptosis in tubular cells. We have studied the role of BASP1 in albumin-induced tubular cell death. BASP1 expression was studied in experimental puromycin aminonucleoside-induced nephrotic syndrome in rats and in human nephrotic syndrome. The role of BASP1 in albumin-induced apoptosis was studied in cultured human HK2 proximal tubular epithelial cells. Puromycin aminonucleoside induced proteinuria and increased total kidney BASP1 mRNA and protein expression. Immunohistochemistry localized the increased BASP1 to tubular cells. BASP1 expression colocalized with deoxynucleotidyl-transferase-mediated dUTP nick-end labeling staining for apoptotic cells. Increased tubular BASP1 expression was observed in human proteinuric nephropathy by immunohistochemistry, providing evidence for potential clinical relevance. In cultured tubular cells, albumin induced apoptosis and increased BASP1 mRNA and protein expression at 6-48 h. Confocal microscopy localized the increased BASP1 expression in albumin-treated cells mainly to the perinuclear area. A peripheral location near the cell membrane was more conspicuous in albumin-treated apoptotic cells, where it colocalized with actin. Inhibition of BASP1 expression by a BASP1 siRNA protected from albumin-induced apoptosis. In conclusion, albumin-induced apoptosis in tubular cells is BASP1-dependent. This information may be used to design novel therapeutic approaches to slow CKD progression based on protection of tubular cells from the adverse consequences of albuminuria.

MIF, CD74 and other partners in kidney disease: tales of a promiscuous couple.

Macrophage migration inhibitory factor (MIF) is increased in kidney and urine during kidney disease. MIF binds to and activates CD74 and chemokine receptors CXCR2 and CXCR4. CD74 is a protein trafficking regulator and a cell membrane receptor for MIF, D-dopachrome tautomerase (D-DT/MIF-2) and bacterial proteins. MIF signaling through CD74 requires CD44. CD74, CD44 and CXCR4 are upregulated in renal cells in diseased kidneys and MIF activation of CD74 in kidney cells promotes an inflammatory response. MIF or CXCR2 targeting protects from experimental kidney injury, CD44 deficiency modulates kidney injury and CXCR4 activation promotes glomerular injury. However, the contribution of MIF or MIF-2 to these actions of MIF receptors has not been explored. The safety and efficacy of strategies targeting MIF, CD74, CD44 and CXCR4 are under study in humans.

La diálisis peritoneal es la mejor alternativa coste-efectiva para la sostenibilidad del tratamiento con diálisis / Peritoneal dialysis is the best cost-effective alternative for maintaining dialysis treatment

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Impact of an interdisciplinary training course on counselling and decision making support for nephrology department professionals.

A 12-hour training program was delivered to the professionals of a nephrology department. Contents of the course were about difficult communication skills in health care interactions. Counselling was the relational methodology instructed. The objective was to assess changes in attitudes in relation with bioethics principles and knowledge. Variables were measured before and after the training program. Sample was composed by 76 professionals (57% nurses, 26% auxiliary nurses y 17% nephrologists) for knowledge and 27 professionals for variable attitudes. Considering the total sample, results show changes in implication with bioethics principles (p <0.05) and knowledge (p <0.001). There are differences related to the kind of profession. Nurses benefit more from the training program attending in the variable knowledge (p <0.001).

Impacto de un curso interdisciplinar de formación en Counselling y apoyo en la toma de decisiones a profesionales de un servicio de nefrología / Impact of an interdisciplinary training program in Counselling and decision-making process in a nephrology department

Los profesionales sanitarios del servicio de nefrología de un hospital de tercer nivel recibieron entrenamiento en comunicación terapéutica mediante un curso de 12 horas centrado en el instrumento terapéutico conocido como Counselling. El objetivo fue evaluar cambios en actitudes en relación con los principios bioéticos y en conocimientos sobre comunicación y gestión emocional. Las variables evaluadas se midieron antes y después de la implantación del curso. La muestra estaba formada por 76 profesionales (un 57% profesionales de enfermería, un 26% auxiliares y un 17% médicos especialistas en nefrología) para la variable conocimientos y por 27 profesionales para la variable de actitudes. Considerando la muestra total, en los resultados se observan cambios en implicación con los principios bioéticos (p <0,05) y conocimientos (p <0,001). Se observan diferencias en función de la profesión y son los profesionales de enfermería quienes más se benefician del curso en el área de conocimientos (p <0,001) (AU)

A 12-hour training program was delivered to the professionals of a nephrology department. Contents of the course were about difficult communication skills in health care interactions. Counselling was the relational methodology instructed. The objective was to assess changes in attitudes in relation with bioethics principles and knowledge. Variables were measured before and after the training program. Sample was composed by 76 professionals (57% nurses, 26% auxiliary nurses y 17% nephrologists) for knowledge and 27 professionals for variable attitudes. Considering the total sample, results show changes in implication with bioethics principles (p <0.05) and knowledge (p <0.001). There are differences related to the kind of profession. Nurses benefit more from the training program attending in the variable knowledge (p <0.001) (AU)

[Co-inheritance of autosomal dominant polycystic kidney disease and sickle cell trait in African Americans]. / Co-herencia de poliquistosis renal autosómica dominante y hemoglobina con rasgo falciforme en afroamericanos.

BACKGROUND: Macroscopic haematuria secondary to renal cyst rupture is a frequent complication in autosomal dominant polycystic kidney disease (ADPKD). Sickle-cell disease is an autosomal recessive haemoglobinopathy that involves a qualitative anomaly of haemoglobin due to substitution of valine for the glutamic acid in the sixth position of 3-globin gene on the short arm of chromosome 11. For the full disease to be manifested, this mutation must be present on both inherited alleles. The severity of the disease is proportional to the quantity of haemoglobin S (Hb S) in the red cells; sickle-cell trait (Hb S <50%) and homozygous sickle-cell disease (Hb S >75%). In sickle-cell disease, the abnormal Hb S loses its rheological characteristics and is responsible of the various systemic manifestations including those of the kidney, such as macroscopic haematuria secondary to papilar necrosis. Despite the generally benign nature of the sickle-cell trait, several potentially serious complications have been described. Metabolic or environmental changes such as hypoxia, acidosis, dehydration, hyperosmolality or hyperthermia may transform silent sickle-cell trait into a syndrome resembling sickle-cell disease with vaso-occlusive crisis due to an accumulation of low deformable red blood cells in the microcirculation originating haematuria from papilar necrosis. On the other hand, it has been demonstrated an earlier onset of end-stage renal disease (ESRD), in blacks with ADPKD and sickle-cell trait when compared with blacks with ADPKD without the trait. PATIENTS AND METHODS: We studied 2 african-american families (4 patients) which presented with both ADPKD and sickle-cell trait (Hb S <50%). The diagnosis of sickle-cell trait was confirmed by haemoglobin electrophoresis. The renal volume was measured by magnetic resonance imaging (MRI). RESULTS: The proband subject in family 1 presented frequent haematuria episodes, associated to increase of renal volume, developed very early ESRD and was dialyzed at the age of 39 years. The other 3 patients in family 2 presented different degree of renal function. CONCLUSIONS: The presence of sickle haemoglobin should be determined in african-american and west-african patients with ADPKD because it is an important prognostic factor. Coherence of sickle-cell trait may have influence on ADPKD evolution to ESRD and other complications, such as cystic haemorrhages. MRI can identify intracystic haemorrhage and permit renal volume measure.

Co–herencia de poliquistosis renal autosómica dominante y hemoglobina con rasgo falciforme en afroamericanos / Co–inheritance of autosomal dominant polycystic kidney disease and sickle cell trait in African Americans

Antecedentes: La hematuria macroscópica derivada de la rotura de quistes renales es una manifestación habitual en la poliquistosis renal autosómica dominante (PQRAD). La enfermedad por células falciformes es una anomalía de la hemoglobina, que se hereda con carácter autosómico recesivo, consistente en la sustitución de la valina por el ácido glutámico en la posición 6 del gen de la 3–globina en el brazo corto del cromosoma 11. La gravedad de la enfermedad es proporcional a la cantidad de hemoglobina S (Hb S) en los hematíes: los heterocigotos con hemoglobina con rasgo falciforme (Hb S <50%) y los homocigotos con enfermedad por células falciformes (Hb S >75%). La presencia de hemoglobina con rasgo falciforme (Hb AS) se acompaña de manifestaciones renales, especialmente hematuria, y la necrosis papilar es la causa más frecuente de hematuria macroscópica en los pacientes heterocigotos portadores de esta hemoglobinopatía. La asociación de estas dos enfermedades hereditarias, PQRAD y hemoglobina con rasgo falciforme, se ha comunicado raramente. Se ha sugerido que los pacientes con PQRAD y hemoglobina con rasgo falciforme podían desarrollar precozmente insuficiencia renal crónica (IRC). Recientemente, se ha comunicado que la hemoglobina con rasgo falciforme es un factor de riesgo predisponente para el desarrollo de enfermedad renal crónica en afroamericanos. Pacientes y métodos: Se estudiaron 2 familias de origen afroamericano (4 pacientes) que co–heredaron la PQRAD y la hemoglobina con rasgo falciforme (heterocigotos). El diagnóstico de hemoglobina falciforme (Hb S) se realizó por electroforesis de la hemoglobina. El volumen renal se midió mediante resonancia magnética (RM). Resultados: La paciente índice, perteneciente a una de las familias, presentó episodios de hematuria macroscópica recidivantes, asociados (..) (AU)

Background: Macroscopic haematuria secondary to renal cyst rupture is a frequent complication in autosomal dominant polycystic kidney disease (ADPKD). Sickle–cell disease is an autosomal recessive haemoglobinopathy that involves a qualitative anomaly of haemoglobin due to substitution of valine for the glutamic acid in the sixth position of 3–globin gene on the short arm of chromosome 11. For the full disease to be manifested, this mutation must be present on both inherited alleles. The severity of the disease is proportional to the quantity of haemoglobin S (Hb S) in the red cells; sickle–cell trait (Hb S <50%) and homozygous sickle–cell disease (Hb S >75%). In sickle–cell disease, the abnormal Hb S loses its rheological characteristics and is responsible of the various systemic manifestations including those of the kidney, such as macroscopic haematuria secondary to papilar necrosis. Despite the generally benign nature of the sickle–cell trait, several potentially serious complications have been described. Metabolic or environmental changes such as hypoxia, acidosis, dehydration, hyperosmolality or hyperthermia may transform silent sickle–cell trait into a syndrome resembling sickle–cell disease with vaso–occlusive crisis due to an accumulation of low deformable red blood cells in the microcirculation originating haematuria from papilar necrosis. On the other hand, it has been demonstrated an earlier onset of end–stage renal disease (ESRD), in blacks with ADPKD and sickle–cell trait when compared with blacks with ADPKD without the trait. Patients and methods: We studied 2 african–american families (4 patients) which presented with both ADPKD and sickle–cell trait (Hb S <50%). The diagnosis of sickle–cell trait was confirmed by haemoglobin electrophoresis. The renal volume was measured by magnetic resonance imaging (..) (AU)

Relationship between leptin and all–cause and cardiovascular mortality in chronic hemodialysis patients

Background: We aimed to evaluate the relationship between serum leptin and the leptin/body mass index (BMI) ratio with prevalent cardiovascular disease (CVD), and their influence on all–cause and CVD–related mortality in patients on hemodialysis (HD). Methods: 118 stable HD patients (50 women, median [interquartile range] age, 65.1 [54.7–72.2] years) were studied. All patients had baseline measurement of serum leptin concentrations. Relationships between leptin and all–cause and CVD mortality were studied by means of survival analysis and Cox regression analysis. Results: The leptin/BMI ratio was similar in patients with and without CVD at baseline (0.65 [0.29–2.23] vs. 0.68 [0.29–1.49] ng·m2/ml·kg, respectively, NS). Multiple logistic regression analysis showed that there was not an independent association between leptin/BMI ratio and prevalent CVD. During the follow–up time, 52 (44.1%) patients died. CVD was the cause of death in 27 out of 52 (51.9%) deceased patients. Survival analysis and Cox proportional multivariate regression analysis showed that there were no significant relationships between leptin levels or the leptin/BMI ratio and all–cause and CVD–related mortality. Conclusion: These results do not support that, in stable HD patients, serum leptin concentrations and the leptin/BMI ratio are related with prevalent CVD. Leptin/BMI ratio seems not to be a risk factor for mortality in these patients (AU)

Introducción: El objetivo del presente estudio ha sido evaluar la relación entre la leptina sérica y el cociente leptina/índice de masa corporal (IMC) con la enfermedad cardiovascular (ECV) prevalente y su influencia en la mortalidad global y en la mortalidad por ECV en pacientes en hemodiálisis (HD). Métodos: Se estudiaron 118 pacientes estables en HD (50 mujeres, edad mediana [recorrido intercuartílico], 65,1 [54,7–72,2] años). En todos los pacientes se cuantificó la concentración basal de leptina. La relación entre leptina y la mortalidad se evaluó mediante análisis de supervivencia y análisis de regresión de Cox. Resultados: El cociente leptina/IMC fue similar en pacientes con y sin ECV prevalente (0,65 [0,29–2,23] frente a 0,68 [0,29–1,49] ng·m2/ml·kg, respectivamente, NS). El análisis de regresión logística mostró que no existía una asociación independiente entre el cociente leptina/IMC y la enfermedad cardiovascular prevalente. Durante el seguimiento 52 pacientes fallecieron (44,1%). La ECV fue causa de muerte en 27 de 52 pacientes fallecidos (51,9%). El análisis de supervivencia y el análisis multivariante de Cox mostraron que no hubo relación significativa entre los niveles de leptina o el cociente leptina/IMC y la mortalidad global o por causa de ECV. Conclusión: Estos resultados no apoyan la hipótesis de que, en pacientes estables en HD, las concentraciones de leptina y el cociente leptina/IMC estén relacionados con la ECV prevalente. Más aún, el cociente leptina/IMC no parece ser un factor de riesgo de mortalidad en estos pacientes (AU)

[Incorporation of a psychologist into a nephrology service: criteria and process]. / Incorporación de un psicólogo en un servicio de nefrología: criterios y proceso.

Chronic kidney disease is associated with a wide range of stressful situations causing important physical and psychological repercussions. It is not usual that psychology professionals are active members of the nephrology teams. In consequence, these alterations are not properly assisted. Our aim is to present the introduction process of a psychologist in a nephrology department and its preliminary results. We designed a clearly defined introduction process, starting with a therapeutic communication training program for all the staff. In the model we have priorized pre-emptive interventions in order to promote the adaptation process, far from simple psychological symptom control. It is assumed the binomial patient-family as the major objective for care, choosing an interdisciplinary approach. We worked more from a health psychology perspective than from a mental health perspective. Over the year 2008 the number of patients assisted by the psychologist were 571 (mean 48 patients/month). The total number of interventions was 1,022. Majority of cases (45.2%) were derived from the advanced chronic kidney disease program, mostly related to demands about emotional impact of renal replacement therapy commencement. Others were: suspect of depression episode, adherence, primary caregiver emotional overwhelming, bereavement, anxiety and support in decision making process. This experience is a stimulus for the integral approach of the renal patient.

Incorporación de un psicólogo en un servicio de nefrología: criterios y proceso / Incorporation of a psychologist into a nephrology service: criteria and process

La insuficiencia renal es una enfermedad que genera un amplio rango de situaciones estresantes, que ocasionan trastornos tanto de tipo físico como psicológico. Es anecdótico que profesionales de la psicología sean miembros activos de los equipos de nefrología, por lo que dichas necesidades pueden no ser atendidas adecuadamente. Nos proponemos describir el proceso de incorporación de este profesional en un servicio de nefrología y presentar resultados preliminares de su actividad. El proceso se inició con un programa formativo en comunicación difícil. En el modelo elegido se prioriza el trabajo preventivo; se trata de facilitar los procesos de adaptación más allá del mero control de síntomas psicológicos; se asume como prioridad asistencial el binomio paciente familia y se opta por un estilo de relación sinérgica interdisciplinaria. Se trabaja más desde la perspectiva de la psicología de la salud que desde la óptica de la salud mental. A lo largo del año 2008 el número de pacientes atendidos por el psicólogo ha sido de 571 (media de 48pacientes al mes). El número total de intervenciones fue de 1.022. La mayoría de los casos atendidos en consulta(45,2%) procedían de la consulta de enfermedad renal crónica avanzada (ERCA). Otros motivos de derivación fueron: sospecha de depresión, cumplimiento, sobrecarga del cuidador principal, duelo, ansiedad y apoyo en la toma de decisiones. Este tipo de experiencias son un estímulo para el abordaje integral del paciente con enfermedad renal (AU)

Chronic kidney disease is associated with a wide range of stressful situations causing important physical and psychological repercussions. It is not usual that psychology professionals are active members of the nephrology teams. Inconsequence, these alterations are not properly assisted. Our aim is to present the introduction process of a psychologist in a nephrology department and its preliminary results. We designed a clearly defined introduction process, starting with a therapeutic communication training program for all the staff. In the model we have priorized pre-emptive interventions in order to promote the adaptation process, far from simple psychological symptom control. It is assumed the binomial patient-family as the major objective for care, choosing an interdisciplinary approach. We worked more from a health psychology perspective than from a mental health perspective. Over the year 2008 the number of patients assisted by the psychologist were 571 (mean 48 patients/month). The total number of interventions was 1,022. Majority of cases (45.2%)were derived from the advanced chronic kidney disease program, mostly related to demands about emotional impact of renal replacement therapy commencement. Others were: suspect of depression episode, adherence, primary caregiver emotional overwhelming, bereavement, anxiety and support in decision making process. This experience is a stimulus for the integral approach of the renal patient (AU)

Las recomendaciones clínicas: una oportunidad para la trasladar la investigación desde las redes de investigación a través de las Sociedades científicas / No disponible

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[The peritoneal kinetic study performed with hypertonic glucose permits better evaluation of UF capacity and determination of sieving of sodium]. / Las cinéticas con glucosa hipertónica permiten identificar mejor el fallo de ultrafiltración. ¿Qué aporta el cribado de sodio?

INTRODUCTION: The use of solutions containing hypertonic glucose (3.86%/4.25%) has been postulated as the method of choice for study the peritoneal function, and permits a better evaluation of the ultrafiltration (UF) capacity. OBJECTIVE: The aim of our study was to analyze the UF capacity and its relation with the peritoneal permeability and sieving of sodium, performing the peritoneal kinetic study with hypertonic glucose solutions. PATIENTS AND METHODS: We performed 184 peritoneal kinetic studies with hypertonic glucose solutions in stable patients on peritoneal dialysis (PD), with a mean time on PD of 16 +/- 22 months. We measured the mass transfer coefficient of creatinine (CrMTC), dialysate to plasma ratio of creatinine (D/PCr), UF capacity and sieving of sodium at 60 minutes (difNa60). RESULTS: The mean values were: CrMTC: 9.1 +/- 4.5 ml/min, D/PCr: 0.71 +/- 0.09, UF 759 +/- 233 ml/4 h and difNa60: 4.7 +/- 2.3. The best multivariate model that predicts the UF capacity included: difNa60, CrMTC, age and time on PD (r = 0.57; p > 0.0001). In patients with UF lower than 600 ml/4 h (Percentil 25) the correlation between UF and CrMTC was lost, but remains the correlation with difNa60 (r = 0.48). The patients with previous peritonitis (n = 38) showed no differences in UF, CrMTC or D/Pcr, but the had lower difNa60 (3.7 +/- 2.8 vs. 4.9 +/- 2.1; p = 0.002) than the remaining patients. CONCLUSIONS: The peritoneal kinetic study performed with hypertonic glucose allows to standardize the UF capacity and by determination of sieving of sodium, the early detection of water transport alterations, before the UF capacity and small solutes permeability alteration develops.

Las cinéticas con glucosa hipertónica permiten identificar mejor el fallo de ultrafiltración. ¿Qué aporta el cribado de sodio? / Kinetic studies with hypertonic glucose permit better identification of ultrafiltration failure. What is the contribution of sodium sieving?

Introducción: La utilización de soluciones con glucosa al3,86%/4,25% se ha postulado como el método ideal para estudiar la función peritoneal, ya que permite evaluar mejor la capacidad de ultrafiltración (UF). Objetivo: El objetivo del estudio es analizar la UF y sus relaciones con la permeabilidad peritoneal y el cribado de sodio mediante la realización de cinéticas peritoneales con glucosa hipertónica. Pacientes y métodos: Realizamos 184 cinéticas con glucosa hipertónica en pacientes estables en diálisis peritoneal (DP), con un tiempo medio en DP de 16 ± 22 meses. Se midieron el coeficiente de transferencia de masa de creatinina (MTCcr), el cociente dializado/plasma de creatinina (D/Pcr),la UF y el cribado de sodio a los 60 minutos (difNa60). Resultados: Los valores medios fueron: MTC-Cr: 9,1 ± 4,5 ml/min, D/Pcr: 0,71 ± 0,09, UF 759 ± 233 ml/4 h y difNa60: 4,7 ± 2,3.El modelo que mejor explica la UF es el que incluye difNa60,MTCcr, edad y tiempo en DP (r = 0,57; p >0,0001). En los pacientes con UF menor de 600 ml (percentil 25) se pierde la correlación entre la UF y el MTCcr, pero se mantiene condifNa60 (r = 0,48). Los 38 pacientes con antecedentes de peritonitisno presentaron diferencias en UF, MTCcr o D/Pcr, pero tienen menor difNa60 (3,7 ± 2,8 frente a 4,9 ± 2,1; p = 0,002)que el resto de pacientes. Conclusiones: La cinética peritoneal realizada con glucosa hipertónica permite no sólo haceruna medida estandarizada de la UF sino también determinar el cribado de sodio, que es el parámetro más sensible para detectar alteraciones del transporte de agua (AU)

Introduction: The use of solutions containing hypertonic glucose(3.86%/4.25%) has been postulated as the method of choice for study the peritoneal function, and permits a better evaluation of the ultrafiltration (UF) capacity. Objective: The aim of our study was to analyze the UF capacity and its relation with the peritoneal permeability and sieving of sodium, performing the peritoneal kinetic study with hypertonic glucose solutions. Patients and methods: We performed 184 peritoneal kinetic studies with hypertonic glucose solutions in stable patients on peritoneal dialysis (PD), with a meantime on PD of 16 ± 22 months. We measured the mass transfer coefficient of creatinine (CrMTC), dialysate to plasma ratio of creatinine (D/PCr), UF capacity and sieving of sodium at 60 minutes(difNa60). Results: The mean values were: CrMTC: 9.1 ± 4.5 ml/min, D/PCr: 0.71 ± 0.09, UF 759 ± 233 ml/4 h and difNa60: 4.7 ± 2.3. The best multivariate model that predicts the UF capacity included: difNa60,CrMTC, age and time on PD (r = 0.57; p >0.0001). In patients with U Flower than 600 ml/4 h (Percentil 25) the correlation between UF and CrMTC was lost, but remains the correlation with difNa60 (r = 0.48).The patients with previous peritonitis (n = 38) showed no differences in UF, CrMTC or D/Pcr, but the had lower difNa60 (3.7 ± 2.8 vs.4.9 ± 2.1; p = 0.002) than the remaning patients. Conclusions: The peritoneal kinetic study performed with hypertonic glucose allows to standarize the UF capacity and by determination of sieving of sodium, the early detection of water transport alterations, before the UF capacity and small solutes permeability alteration develops (AU)

Are low concentrations of serum triiodothyronine a good marker for long-term mortality in hemodialysis patients?

INTRODUCTION: Low serum free triiodothyronine (FT3) concentrations have been reported in a high percentage of chronic renal failure patients and have been considered as an independent predictor of mortality in dialysis patients. OBJECTIVE: Our aim has been to evaluate the prognostic value of FT3 levels for long-term mortality in stable hemodialysis patients surviving at least 12 months. PATIENTS AND MEASUREMENTS: We retrospectively analyzed 89 stable hemodialysis patients (50 males; mean age 67.9 +/- 11.8 years). All patients had a baseline clinical and analytical evaluation. We analyzed the relationship between baseline FT3 and mortality by means of survival analysis (Kaplan-Meier) and Cox regression analysis. RESULTS: Mean values of thyroid function test were: thyrotropin (TSH) 2.02 +/- 1.5 microU/ml, free thyroxine (FT4) 1.26 +/- 0.23 ng/dl, and FT3 2.7 +/- 0.4 pg/ml. During a median follow-up time of 33.6 +/- 14.9 (12 - 62) months, 41 patients died. FT3 was similar in patients who died or survived (2.6 +/- 0.5 vs. 2.7 +/- 0.4 pg/ml ns). Kaplan-Meier analysis did not show significant differences in mean survival according to tertiles of FT3. In multivariate Cox regression analysis, FT3 was not a predictor of mortality (RR 0,001; 95% CI; 0.000 to 1.73). CONCLUSIONS: These data suggest that low FT3 levels are not predictive for mortality in a subgroup of stable HD patients who could survive more than 12 months.

Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardíaca refractaria / Role played by peritoneal dialysis in treating refractory heart failure

Las patologías renal y cardíaca asociadas son de alta prevalencia en la población en diferentes contextos clínicos: fracaso renal agudo en el contexto de insuficiencia cardíaca (IC) descompensada, pacientes con IC que desarrollan enfermedad renal crónica (ERC) o pacientes con ERC que desarrollan IC. En los últimos años se ha descrito el síndrome cardior renal (SCR) como el deterioro de la función renal en el contexto de IC. Sin embargo, existen otras situaciones clínicas en las que la Nefrología puede aportar su conocimiento como parte de la estrategia de tratamiento integral, como es el caso de la IC refractaria (ICR). Todas estas situaciones obligan a un trabajo conjunto interdisciplinario entre cardiólogos y nefrólogos con el fin de proporcionar un tratamiento integral. Este documento pretende hacer una revisión del papel del nefrólogo en el tratamiento de la IC haciendo hincapié en el subgrupo de pacientes con ICR y la evidencia actual de la utilidad de la diálisis peritoneal(DP) como tratamiento crónico coadyuvante (AU)

Associated renal and cardiac diseases have a high prevalence among the population in several clinical contexts: acute renal failure in the context of decompensated heart failure (HF), HF patients who develop chronic kidney disease (CKD) and patients with CKD who develop HF. In recent years, cardiorenal syndrome has been described as deteriorating kidney function in the context of HF. However, there are other clinical situations for which nephrologists can contribute their knowledge as a part of an integral treatment strategy, as is the case with refractory HF (RHF). All of these situations require an interdisciplinary cooperative effort between cardiologists and nephrologists with the aim of providing integral treatment. This article aims to review the role of the nephrologist in HF treatment, with an emphasis on the subgroup of patients with RHF and current evidence regarding the usefulness of peritoneal dialysis (PD) as a chronic coadjuvant treatment (AU)

Tratamiento con hemoperfusión prolongada en la intoxicación aguda por carbamazepina / Extended hemoperfusion in the treatment of acute carbamazepine intoxication

La intoxicación aguda por carbamazepina en los intentosautolíticos es un problema clínico bastante común que puede dar lugar a coma, depresión respiratoria, arritmias, inestabilidad hemodinámica y muerte. El fármaco tiene un peso molecular relativamente elevado, un volumen de distribución moderadamente grande y una intensa fijación a las proteínas. En caso de sobredosis, estas características farmacocinéticas hacen su eliminación extracorpórea difícil, por lo que la experiencia publicada con hemoperfusión o hemodiálisis presenta resultados variables. Se presenta un caso de intoxicación aguda por carbamazepina que fue tratado exitosamente con medidas de soporte general y una sesión de hemoperfusión con carbón activado. Esta técnica produjo una extracción considerable del fármaco, mejorando rápidamente los signos clínicos de intoxicación. Basados en la experiencia con esta paciente y en la revisión de otros casos publicados, concluimos que en la intoxicación aguda por carbamazepina el tratamiento precoz con hemoperfusión prolongada debe considerarse de elección (AU)

Carbamazepine is used in the treatment of epilepsy, and also prescribed in neuralgic pain syndromes, and certain affective disorders. Carbamazepine intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, arrhythmia, hemodynamic instability and death. The drug's relatively high molecular weight, elevated volume of distribution and intense protein-binding render it difficult to extracorporeal removal, but published experience with hemoperfusion or hemodialysis present variable results. We describe a case report involving carbamazepine intoxication who was successfully treated with charcoal hemoperfusion. With this treatment the half-life of carbamazepine was reduced with rapid lowering of carbamazepine levels and clinical improvement. Based on our experience in this patient and a review of previously reported cases, extended charcoal hemoperfusion should be considered for serious carbamazepine intoxication because free as well as bound drug fractions are eliminated via this technique (AU)

[Role played by peritoneal dialysis in treating refractory heart failure]. / Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardíaca refractaria.

Associated renal and cardiac diseases have a high prevalence among the population in several clinical contexts: acute renal failure in the context of decompensated heart failure (HF), HF patients who develop chronic kidney disease (CKD) and patients with CKD who develop HF. In recent years, cardiorenal syndrome has been described as deteriorating kidney function in the context of HF. However, there are other clinical situations for which nephrologists can contribute their knowledge as a part of an integral treatment strategy, as is the case with refractory HF (RHF). All of these situations require an interdisciplinary cooperative effort between cardiologists and nephrologists with the aim of providing integral treatment. This article aims to review the role of the nephrologist in HF treatment, with an emphasis on the subgroup of patients with RHF and current evidence regarding the usefulness of peritoneal dialysis (PD) as a chronic coadjuvant treatment.