[Control of phosphorus and treatment with vitamin D in chronic kidney disease prior to the start of dialysis]. / Control del fósforo y tratamiento con vitamina D en Enfermedad Renal Crónica antes del inicio de diálisis.

Hyperphosphatemia is a complication that appears in the early stages of chronic kidney disease (CKD) and that has been shown to have serious consequences in kidney disease patients. New phosphate regulators are currently being studied such as FGF- 23, a counter-regulatory phosphaturic hormone for vitamin D, and klotho, a cofactor necessary for activation of FGF-23. The main consequences of hyperphosphatemia described in CKD patients not on dialysis are ectopic calcification, increased mortality and more rapid progression of CKD. All this indicates the need for strict control of Pi. The two most currently used drugs for this purpose are lanthanum carbonate and sevelamer. Although there are no studies specifically designed for this predialysis population, these drugs appear to be effective and safe. Another complication of CKD is vitamin D deficiency which, according to recently published studies, is more prevalent and appears in earlier stages of the disease than was initially thought. There is wide debate on the need to administer vitamin D supplements systematically due to the pleiotropic effects of this hormone and which are unrelated to development of renal bone disease. Because of these doubts, there is no agreement on routine administration, although there is consensus on the need to measure 1,25-dihydroxyvitamin D and 25-hydroxyvitamin D values and to wait for the result of numerous studies that are being carried out on the impact of vitamin D on progression of cardiovascular risk factors in CKD and the possible consequences of its indiscriminate administration.

Efficacy of cinacalcet administered with the first meal after dialysis: the SENSOR Study.

BACKGROUND: Cinacalcet, a novel calcimimetic, simultaneously lowers parathyroid hormone (PTH), phosphorus (P), calcium (Ca) and Ca x P in patients who are on dialysis with secondary hyperparathyroidism (sHPT) associated with CKD. Previous studies have required cinacalcet to be administered during the dialysis session and at the same time on non-dialysis days. The aim of the SENSOR study was to demonstrate that cinacalcet given in a more clinically practical manner with the first major meal after dialysis is noninferior to cinacalcet given with food during the dialysis session. METHODS: In this open-label study dialysis patients with poorly controlled sHPT (intact PTH (iPTH) (3) 300 pg/ml) were randomized to receive cinacalcet either daily with their post-dialysis meal (n = 337) or with food during the dialysis session (n = 336). The primary endpoint was the proportions of patients with mean iPTH pound 300 pg/ml ( pound 31.8 pmol/l) at Weeks 11 and 13 of a 21-week treatment period. Secondary endpoints included the proportion of patients with Ca x P < 55 mg2/dl2 (< 4.44 mmol2/l2) at Weeks 11 and 13 and patients who discontinued the study due to nausea or vomiting. RESULTS: Comparable proportions of patients in the cinacalcet "during dialysis" and "post-dialysis meal" groups had a mean iPTH pound 300 pg/ml (54 vs. 57%, respectively, 95% confidence interval (CI) difference -4, +10%) and Ca x P < 55 mg2/dl2 (78 vs. 73%, respectively, 95% CI difference -11, +2%) at Weeks 11 and 13. The groups were also comparable at Week 21. Cinacalcet was well tolerated, with < 3% of patients in both groups discontinuing due to nausea or vomiting. A combined post-hoc analysis of both groups showed the incidence of nausea and vomiting was lower if cinacalcet was administered during the evening. CONCLUSIONS: Administering cinacalcet with the first main meal after dialysis was as effective as administration with food during the dialysis session. Cinacalcet was well tolerated. The incidence of gastrointestinal adverse events appeared to be lower when cinacalcet was administered in the evening.

Avances en vacunas contra la malaria / Advances in vaccines against malaria

Los últimos avances en el desarrollo de una vacuna contra la malaria van encaminados a conseguir que ésta sea a la vez segura e inmunógena. Actualmente existen diversos tipos de vacunas en estudio, dirigidas hacia las distintas fases del ciclo vital del Plasmodium. De esta manera se han desarrollado vacunas que actúan en la fase asexual (pre y eritrocítica) y en la fase sexual (bloqueo de la transmisión) del parásito. Hemos revisado los últimos datos obtenidos sobre estas líneas de investigación y las dificultades que se presentan para la obtención de una vacuna eficaz

The last advances in the development against malaria vaccines are going to get a safe and immunogenic vaccines. At the moment there are several types of vaccines in investigation, they are directed at the different phases of the vital cycle of Plasmodium. So vaccines have been developed to actuating in the asexual phase (pre and erytrocytic vaccines) and in the sexual phase (transmission block vaccines) parasite. We have reviewed the last studies and the problems to achieve an efficient vaccine