Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review.

BACKGROUND: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. OBJECTIVE: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). MATERIAL AND METHODS: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. RESULTS: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively. CONCLUSION: The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM.

Anemia at 1 year after kidney transplantation has a negative long-term impact on graft and patient outcomes.

BACKGROUND: Anemia, a common complication after kidney transplantation, has a controversial impact on graft or patient survivals or the appearance of cardiovascular disease. The present study investigated the incidence and risk factors for anemia in the first year after transplantation and its effects on graft and patient outcomes. PATIENTS AND METHODS: Among 389 patients transplanted between January 2000 and June 2008, the 331 with functioning grafts at 1 year were included in the study. The mean follow-up was 84 ± 31.8 months. Anemia was defined according to the World Health Organization as a hemoglobin < 13 g/dL in men and < 12 g/dL in women. RESULTS: The 88 patients (26.6%) with anemia included 21 (6.3%) who were receiving erythropoiesis stimulant agents. The predictive factors for anemia were: initial immunosuppression with cyclosporine (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.25-3.47; P = .005), serum creatinine (mg/dL) at discharge (OR 1.7; CI 95% 1.26-2.15 P = .000), and 1-year serum albumin (g/dL; OR 0.21; CI 95% 0.10-0.71 P = .001). Donor age in years (OR 1.02; CI 95% 1.00-1.03, P = .054) was close to significance. Cox multivariate analysis showed 1-year hemoglobin (g/dL) to be associated with graft (hazard ratio [HR] 0.81, 95% CI 0.69-0.96, P = .003) and patient survivals after adjusting for other variables (HR 0.74; 95% CI 0-59-0.96, P = .023). But it was only a cardiovascular risk factor when serum creatinine was not included in the model. CONCLUSIONS: Approximately one quarter of patients with functioning grafts show anemia at 1-year. Graft function, initial immunosuppression, serum albumin, and perhaps donor age were risk factors for anemia, which had a negative impact on graft and patient survival, and could be a risk factor for cardiovascular disease.

Utilization of elderly kidney donors (>70 years) does not affect graft survival in the medium term.

BACKGROUND: The need for organs for renal transplantation has encouraged the use of grafts from increasingly older donors. Earlier studies performed in Spain have shown the suitability of donors aged 60-65 years. In this single-center study, we evaluated our results using donors >70 years old. METHODS: We evaluated 401 primary transplantations performed from January 2000 to December 2009. Their initial immunosuppression was a tacrolimus-based (n = 324), cyclosporine-based (n = 70) or calcineurin inhibitor-free (n = 7) regimen patients. Recipients were classified according to the donors age: <50 (42.6%); 50-70 (39.7%) and >70 (17.5%) years. RESULTS: There were no differences in recipient or donor gender, time on dialysis, cold ischemia, delayed graft function, or acute rejection episodes. However, the mean age was higher among patients who received grafts from donors >70 years old; 42.5 ± 12.4 years for <50, 58.1 ± 8.2 years for 50-70, and 65.7 ± 7.2 years for >70; (P = .000). The serum creatinine at 12 months was increased according to the age of the donor; 1.4 ± 0.6, 1.8 ± 0.6, 70 and 1.7 ± 0.5 mg/dL, respectively (P = .001). The graft survival rates at 5 years were 81%, 74%, and 70%, respectively (P = .519). Upon multivariate analysis only HLA-DR mismatches, delayed graft function, and acute rejection episodes were associated with graft loss. Patient survival rates (86%) at 5 years were similar among recipients from donors aged 50-70 and >70 years, but higher (96%) for those who received a graft from a donor <50 years (P = .003). CONCLUSIONS: Nearly 20% of donors were >70 years old in our study. Their kidneys displayed excellent short-term outcomes.

Tratamiento de la anorexia urémica con acetato de megestrol / Treatment of uremic anorexia with megestrol acetate

Introducción: La anorexia es un trastorno frecuente en el enfermo tratado con hemodiálisis periódica, y factor contribuyente de la malnutrición. El objetivo del presente trabajo es comprobar la eficacia del acetato de megestrol, un estimulador del apetito utilizado en enfermos con cáncer, como tratamiento de la anorexia del enfermo sometido a diálisis. Material y métodos: En el año 2009, 16 enfermos de nuestra unidad de hemodiálisis, tres de ellos con diabetes mellitus, fueron tratados con acetato de megestrol (160 mg/día en dosis única), por anorexia definida según una escala Likert de apetito. La pauta y la dosis de diálisis no fueron modificadas durante el estudio. Resultados: Al tercer mes de tratamiento se objetivó, en el grupo total, un aumento del peso seco (60,8 frente a 58,9 kg; p <0,01), de la concentración de albúmina (4,02 frente a 3,8 g/dl; p <0,05), de la concentración de creatinina (9,73 frente a 8,26 mg/dl; p <0,01) y de la tasa de catabolismo proteico (1,24 frente a 0,97 g/kg/día; p <0,001). No hemos constatado variaciones significativas en la concentración de hemoglobina, dosis de eritropoyetina y concentración de lípidos. En un enfermo con diabetes mellitus hubo que aumentar la dosis de insulina y en otros 2 enfermos se detectó una hiperglucemia leve. El acetato de megestrol no suprimió la secreción de hormonas sexuales hipofisarias, pero en 3 de 10 enfermos estudiados se constató una inhibición de la secreción de corticotropina. La respuesta no fue homogénea: un enfermo no respondió y disminuyó su peso seco, en cinco el incremento de peso fue discreto (inferior a 1 kg) y en los 10 restantes la respuesta fue buena, con un incremento de peso seco que osciló entre 1,5 y 5,5 kg. Conclusiones: El acetato de megestrol puede mejorar el apetito y los parámetros nutricionales en enfermos tratados con hemodiálisis periódica que refieran anorexia. El acetato de megestrol puede inducir hiperglucemia e inhibir la secreción de corticotropina en algunos pacientes. Estos efectos secundarios deben ser valorados cuando se administre este tratamiento (AU)

Background: Anorexia is a common disorder in patients treated with regular haemodialysis and is a contributing factor to malnutrition. The aim of this study was to evaluate the effectiveness of megestrol acetate, an appetite stimulant used in cancer patients, as a treatment for anorexia in dialysis patients. Material and method: In 2009, 16 patients in our haemodialysis unit, three with diabetes mellitus, were treated with megestrol (160 mg/day single dose) for anorexia defined according to a Likert scale of appetite. The schedule and dialysis dose were not changed during the study. Results: In the third month of treatment there was, in the overall group, an increase in dry weight (60.8 vs 58.9 kg, P<.01), in albumin concentration (4.02 vs 3.8 g/dl, P<.05), in creatinine concentration (9.73 vs 8.26 mg/dl, P<.01), and protein catabolic rate (1.24 vs. 0.97 g/kg/day, P<.0001). Non-significant variations in the concentration of haemoglobin, erythropoietin dose, and lipid concentrations were found. One patient with diabetes mellitus had to increase the dose of insulin and two other patients suffered mild hyperglycaemia. Megestrol acetate did not suppress the secretion of pituitary sex hormones, but in 3 of 10 patients studied inhibition of ACTH secretion was found. The response was not homogeneous: one patient did not respond and reduced his dry weight, in 5 the weight gain was minimal (less than 1 kg) and in the remaining ten the response was good, with an increase in dry weight ranging between 1.5 and 5.5 kg. Conclusions: Megestrol acetate can improve appetite and nutritional parameters in patients treated with periodic haemodialysis who report anorexia. Megestrol acetate may induce hyperglycaemia and inhibit the secretion of ACTH in some patients. These side effects should be assessed when administering this treatment (AU)

[Treatment of uraemic anorexia with megestrol acetate]. / Tratamiento de la anorexia urémica con acetato de megestrol.

BACKGROUND: Anorexia is a common disorder in patients treated with regular haemodialysis and is a contributing factor to malnutrition. The aim of this study was to evaluate the effectiveness of megestrol acetate, an appetite stimulant used in cancer patients, as a treatment for anorexia in dialysis patients. MATERIAL AND METHOD: In 2009, 16 patients in our haemodialysis unit, three with diabetes mellitus, were treated with megestrol (160 mg/day single dose) for anorexia defined according to a Likert scale of appetite. The schedule and dialysis dose were not changed during the study. RESULTS: In the third month of treatment there was, in the overall group, an increase in dry weight (60.8 vs 58.9 kg, P<.01), in albumin concentration (4.02 vs 3.8 g/dl, P<.05), in creatinine concentration (9.73 vs 8.26 mg/dl, P<.01), and protein catabolic rate (1.24 vs. 0.97 g/kg/day, P<.0001). Non-significant variations in the concentration of haemoglobin, erythropoietin dose, and lipid concentrations were found. One patient with diabetes mellitus had to increase the dose of insulin and two other patients suffered mild hyperglycaemia. Megestrol acetate did not suppress the secretion of pituitary sex hormones, but in 3 of 10 patients studied was found inhibition of ACTH secretion. The response was not homogeneous: one patient did not respond and reduced his dry weight, in 5 the weight gain was minimal (less than 1 kg) and in the remaining ten the response was good, with an increase in dry weight ranging between 1.5 and 5.5 kg. CONCLUSIONS: Megestrol acetate can improve appetite and nutritional parameters in patients treated with periodic haemodialysis who report anorexia. Megestrol acetate may induce hyperglycaemia and inhibit the secretion of ACTH in some patients. These side effects should be assessed when administering this treatment.

Cholecalciferol supplements improve vitamin D deficiency in renal transplant recipients.

Most renal transplant recipients display vitamin D deficiency or insufficiency. The KDIGO guidelines suggest that this deficit should be treated as in the general population. Since there are few studies about the effects of cholecalciferol in de novo renal transplant recipients, we sought to assess these effects in long-term kidney graft recipients. Among 37 renal transplant recipients (19 males, 18 females) at a mean of 105±82 months posttransplantation, vitamin D insufficiency or deficiency was treated with cholecalciferol (400-800 IU/d) plus calcium supplements (600-1200 mg/d of elemental calcium). These subjects were compared with 37 untreated recipients for a period between 6 and 12 months. At baseline, there were no differences between the groups in age at transplantation, sex, length of follow-up after grafting, function measured by estimated glomerular filtration rate (44.4±16.8 treated vs 42.0±15.0 mL/min/1.73 m2 untreated; P=.527); iPTH (157±103 treated vs 176±118 pg/mL untreated; P=.461); 25OHD (14.7±4.7 treated vs 15.7±9.7 ng/mL untreated; P=.584); or 1.25OHD (34.1±26.0 treated vs 34.0±13.0 pg/mL untreated; P=.950). When compared with baseline values, iPTH (157±103 vs 144±89 pg/mL; P=.11) and 1.25OHD levels at 6 months (34.1±26.0 vs 35.9±26.3 pg/mL; P=.282) showed no change but 25OHD levels (14.7±4.7 vs 22.6±7.4 ng/mL; P=.000) and phosphate tubular reabsorption (64%±17% baseline vs 69%±14% at 6 months; P=.030) were increased in the treated patients. There were no differences in the parameters studied in untreated patients. Among the 27 recipients followed at 12 months, iPTH was decreased compared with baseline values (157±103 vs 124±62 pg/mL; P=.024) and 25OHD remained stable with respect to the values at 6 months (21.1±5.3 ng/mL). No adverse effects of cholecalciferol were observed such as those to increase urinary calcium excretion. Low doses of cholecalciferol improved vitamin D status and decreased iPTH levels at 12 months. Higher doses than those used in our study are needed to increase serum 25OHD concentrations above 30 ng/mL.

Effects of the new immunosuppressive agents on the occurrence of malignancies after renal transplantation.

INTRODUCTION: The risk of malignancies in renal transplant recipients is considerably greater than in the general population. The purpose of the present study was to investigate the effects on the appearance of malignancies of 3 immunosuppressive periods: azathioprine (AZA), cyclosporine (CsA), and tacrolimus (TAC). PATIENTS AND METHODS: This study included 1029 first renal transplant recipients of mean age at transplantation of 44.6±14.9 years with a mean follow-up of 95.6±84.2 months. Initial immunosuppression was AZA-based (n=198), CsA-based (n=524), and TAC (n=307). A total of 280 recipients were also treated with mycophenolate mofetil or mycophenolic acid. RESULTS: There were 157 patients (15.3%) who displayed≥1 malignancy; there were 95 skin (9.2%) and 74 (7.8%) non-skin malignancies with presentations at 74±62 and 107±77 months, respectively (P=.003). The skin malignancies included squamous cell carcinomas (n=41), basal cell carcinomas (n=41), Kaposi sarcomas (n=7), and melanomas (n=4). Among the solid tumors, lymphoproliferative disorders (n=15), digestive tract (n=14), kidney and urinary tract (n=11), lung (n=10), and breast (n=3) carcinomas. The cumulative incidences at 5, 10, and 15 years were 6%, 10%, and 18% for skin and 3%, 7%, and 14% for non-skin malignancies, respectively. Multivariate analysis showed that age at transplant in years (P=.000) and male gender (P=.000) were the only variables associated with skin malignancies; age at transplant in years (P=.004) and treatment with OKT3 (P=.000) were associated with non-skin malignancies. Malignancies were the cause of death in 18% of recipients who died with functioning grafts. CONCLUSION: Malignancies are an important cause of morbidity and mortality among renal transplant recipients. The new immunosuppressive agents do not increase the risk of malignancies. Special surveillance is needed for older, male recipients.

Cambios inducidos por la enfermedad renal crónica en los pacientes con diabetes / Induced changes by chronic kidney disease in patients with diabetes

La nefropatía diabética afecta al 25-40% de los pacientes diabéticos y es unmarcador de morbimortalidad. Las complicaciones relacionadas con la insuficienciarenal presentes en estos pacientes se hacen más relevantes a medidaque disminuye el filtrado glomerular. La enfermedad cardiovascular es la complicacióncon más relevancia pronóstica. Ésta incluye la enfermedad coronaria,la hipertensión arterial, la hipertrofia ventricular izquierda, la insuficiencia cardiaca,las arritmias y la pericarditis. Otras complicaciones derivadas de la afectaciónrenal influirán en el pronóstico y evolución del paciente con diabetes,como la anemia, las complicaciones hemorrágicas, los fenómenos trombóticos,las alteraciones en la respuesta inmunitaria y la susceptibilidad a las infecciones.Todas las complicaciones presentes en el paciente con nefropatía diabéticaobligan a un abordaje multifactorial que incluye, en primer lugar, laprevención de la aparición/progresión de las complicaciones mediante el controlde los factores de riesgo de desarrollo de macroangiopatía y microangiopatía:control de la glucemia y de la hipertensión arterial, reducción de la proteinuria,evitación del tabaquismo, mantenimiento del peso ideal, reducción dela ingestión de sal y tratamiento con antiagregantes y estatinas, así como prevenirla nefrotoxicidad(AU)

Diabetic nephropathy affects about 25-40% of diabetic patients and is a markerof morbimortality. Complications related to kidney failure in these patientsbecome even more relevant with decreasing glomerular filtration rate.Cardiovascular disease is the most relevant complication, which include coronarydisease, arterial hypertension, left ventricular hypertrophy, congestive cardiacinsufficiency, arrhythmias and pericarditis. Other related renal complicationswill influence the prognosis and evolution of diabetic patients such asanemia, hemorrhagic complications, thrombotic phenomena, alterations of immune response and susceptibility to infections. All these complications, which are present in the patient with diabetic nephropathy, force towards a multifactor approach, which includes firstly the prevention of the appearance/progression of the complications through a control of the risk factors for macro and microangiopathyas glycemic and blood pressure control, proteinuria reduction,avoiding nicotine abuse, keeping closed to the ideal weight, salt intake reduction,antiaggregant treatment and statins therapy, as well as preventing additional renal toxicity(AU)

[Strongyloides stercoralis infection in renal transplant recipients]. / Infección por Strongyloides stercoralis en pacientes trasplantados renales.

We present two cases of strongyloides stercoralis infection in renal transplant recipients in our centre. We describe clinical presentation characteristics, treatment and resolution.

Evolution of rejection rates and kidney graft survival: a historical analysis.

INTRODUCTION: New immunosuppressive regimens have dramatically reduced rejection rates but this positive effect has not been followed by an improvement in long-term graft outcomes. The aim of the present work was to investigate the incidence of graft rejection and graft outcomes with various immunosuppressive protocols. PATIENTS AND METHODS: Included in our study were 1029 first renal transplantations performed at our unit between November 1979 and December 2007. Basal immunosuppression included azathioprine (AZA) in 198 recipients, cyclosporine (CsA) in 524 recipients, and tacrolimus (TAC) in 307 recipients. RESULTS: Recipient and donor ages increased progressively from the AZA to the TAC era. Delayed graft function was less frequent among AZA than CsA and TAC recipients (29.8 vs 39.3% vs 42.0%; P = .014). The incidence of acute rejection episodes was 68.7% on AZA, 38.2% on CsA, and 11.4% on TAC (P = .000). Graft survival rates at 1, 5, and 10 years were 69%, 56%, and 46% on AZA, 82%, 69%, and 54% on CsA, and 88%, 77%, and 60% on TAC, respectively (P = .001). However, the differences disappeared when only grafts surviving >12 months were analyzed. On multivariate analysis, the variables associated with worse graft outcomes after 12 months were older recipient age, male gender, longer time on dialysis, lower body weight, and higher serum creatinine level at 6 months. CONCLUSIONS: New immunosuppressants have decreased the incidence of acute rejection. But this was not followed by a significant improvement in graft outcomes after 12 months. The beneficial effects on rejection are possibly affected by the older age of donor and recipient and the worse early graft function.

Vitamin D deficiency in kidney transplant recipients: risk factors and effects of vitamin D3 supplements.

INTRODUCTION: The Kidney Disease Outcome Quality Initiative (K/DOQI) clinical practice guidelines in chronic kidney disease (CKD) give some recommendations about diagnosis and treatment of vitamin D deficiency. These guidelines may also be applied to renal transplant recipients. The aim of the present study was to assess the vitamin D status and the effects of vitamin D3 supplements among a cohort of kidney graft recipients. PATIENTS AND METHODS: Five hundred nine renal transplant recipients with a follow-up of more than 12 months were included in this retrospective cross-sectional study. A total of 189 patients were treated with vitamin D3 supplements, 171 with calcitriol (0.25 or 0.5 microg x 3 weekly) and 18 with cholecalciferol (400 IU/d). RESULTS: 25OHD deficiency was present in 38.3% of patients, insufficiency in 46.9%, and normal levels in 14.7%. There were no differences in the prevalence of deficiency or insufficiency between patients who were not treated or those who were treated with vitamin D3 supplements. Upon multivariate analysis, 25OHD concentrations correlated with gender, length of follow-up, season of 25OHD determination, iPTH and 1.25OHD concentrations, and treatment with ACEI/ARB (R(2) = 0.17; P = .000). CONCLUSIONS: 25OHD deficiency or insufficiency is frequent after renal transplantation even in sunny regions. The clinical significance of such a high prevalence of apparent 25OHD deficiency/insufficiency is unclear and requires further study.

Secondary hyperparathyroidism after kidney transplantation: a cross-sectional study.

INTRODUCTION: The purpose of the present study was to investigate the prevalence of hyperparathyroidism among a population of kidney graft recipients. PATIENTS AND METHODS: We investigated biochemical bone parameters of 509 renal transplant recipients with a mean follow-up of 113 +/- 76 months. Among these patients, 257 patients were treated with either vitamin D or calcium supplements or both. RESULTS: The mean estimated glomerular filtration rate (eGFR) was 47.2 +/- 18.4 mL/min/1.73 m(2) and the mean intact parathyroid hormone (iPTH) level was 144 +/- 149 pg/mL. A total of 70 patients (13.7%) had hypercalcemia defined by a corrected serum calcium >10.2 mg/dL. When the patients were classified according to iPTH concentrations following the Kidney Disease Outcome Quality Initiative (K/DOQI) clinical practice guidelines: 22.4% had iPTH <70 pg/mL; 30.8% between 70 and 110 pg/mL; 16.5% between 110 and 150 pg/mL; 24.3% between 150 and 300 pg/mL; and 6.9% >300 pg/mL. There were no differences in biochemical bone parameters between those that were or were not on calcium and vitamin D supplements, but there was a higher percentage of patients with normal iPTH among the treated group (28.0% vs 16.7%; P = 0.003). In patients not receiving calcium and/or vitamin D supplements, multiple linear regression demonstrated that only time on dialysis, eGFR, and serum 25-hydroxyvitamin D (25OHD) levels were significantly predictive of iPTH concentrations (R(2) = 0.21; P = .000). CONCLUSIONS: About 80% of patients displayed high iPTH concentrations. The persistence of hyperparathyroidism was associated with graft dysfunction, longer time on dialysis, and low concentrations of 25OHD. Treatment with vitamin D produced a slight improvement in the prevalence of hyperparathyroidism.

Management of chronic kidney disease after renal transplantation: is it different from nontransplant patients?

BACKGROUND: The Kidney Disease Quality Initiative (K/DOQI) of the National Kidney Foundation has published guidelines for the diagnosis and management of chronic kidney disease (CKD). Renal transplant recipients frequently have CKD and complications similar to native kidney disease patients. The purpose of the present study was to compare the management of CKD complications of transplant recipients and nontransplant patients. PATIENTS AND METHODS: Eighty three renal transplant recipients with CKD stages 4T and 5T were compared with 83 nontransplant CKD patients matched by CKD stage. RESULTS: There were no differences between the groups in serum hemoglobin, prevalence of anemia, and percentage of patients treated with erythropoiesis-stimulating agents, but serum ferritin levels were higher among recipients (186.3 +/- 161.3 vs 119.1 +/- 113.4 ng/mL; P = .003). Mean blood pressure (BP) was similar in both groups but a systolic BP > 130 mm Hg was more frequent among recipients (83.3% vs 72.6%). More recipients were treated with either angiotensin-converting enzyme (ACE)-inhibitors or angiotensin receptor antagonist (43.3% vs 8.4%; P < .001). Low-density lipoprotein cholesterol was lower in recipients (108.9 +/- 30.3 vs 120.8 +/- 39.5 mg/dL; P = .033) and a higher percentage was on statin treatment (44.6% vs 28.9%; P = .053). Serum calcium was higher in transplant recipients (9.5 +/- 0.8 vs 8.9 +/- 0.7 mg/dL; P < .005) and phosphate was lower (3.9 +/- 0.9 vs 4.2 +/- 1.1; P = .043); there were no differences in intact parathyroid hormone blood levels. CONCLUSIONS: The management of renal transplant recipients is no worse than that of nontransplant patients. However, in both populations, some parameters are far from the target recommended by the guidelines.

[Analysis of variability in determining intact parathyroid hormone (iPTH) according to the method used to process the sample]. / Análisis de la variabilidad en la determinación de la hormona paratiroidea (PTH-i) según el método empleado para procesar la muestra.

BACKGROUND: The measurement of i-PTH circulating is not easy due to its analytical variablity. Variability that appears in the process that goes from the sample collection to the final result determination. There are several important aspects that can influence within the pre-test variability: type of sample (serum o plasma), temperature, time elapses from blood extraction to freezing and from freezing to i-PTH quantification. Blood coming from centres far from our laboratory do not always meet the required processing conditions. Our aim was to study the stability of i-PTH with varying conditions of temperature and time until freezing in patients with chronic kidney disease (CKD). METHODS: We have analyzed 294 blood samples of 49 patients with chronic kidney disease (18 transplantated patients (36.7%) and 31 patients in haemodyalisis (63.3%)). The blood samples were collected using tubes treated with ethylenediaminotetraacetic acid (EDTA); these samples were subjected to different conditions of temperature and time before they were frozen, constituting 6 groups: blood centrifuged and plasma immediately frozen (group A or reference group); blood maintained 1 hour at room temperature and plasma stored at 2-8 masculineC during 0, 8 and 24 hours (groups B,C,D); blood maintained 3 hours at room temperature and plasma stored at 2-8 masculineC during 0 and 8 hours (groups E,F). The intact PTH (i-PTH) was measured using the immunoradiometric assay (IRMA Total Intact Scantibodies assay). We have analyzed the differences between the PTH-i mean values in the referenced groud and the others. We have applied the tests of homogeneity variance and normality and we have perform a comparation by pairs with the t-test including the Bonferroni correction. RESULTS: The mean value of intact-PTH in the referente Group was 202.5+/-199.72 pg/ml. The means values of intact-PTH in the other groups were 196 +/- 203.23 pg/ml, 202.8 +/- 200.2 pg/ml, 200.06 +/- 194.87 pg/ml, 204.08 +/- 204.073 pg/ml, 197.94 +/- 182.31 pg/ml. The results were practically identical for each group. We did not find important differences with respect to the reference group (p = 0.87, p = 0,99, p = 0,95, p = 0,96, p = 0,90 when comparing with groups 2a, 2b, 2c, 3a y 3b). CONCLUSIONS: The use of EDTA maintain the PTH stability during a longer period without the necessity of freezing the samples immediately. These results can help to state strategies to management the samples in patients with ERC.

[How to carry out the search of kidney disease in patients with cardiovascular disease?]. / Cómo realizar la búsqueda de enfermedad renal en pacientes con enfermedad cardiovascular?

Patients with chronic kidney disease are at high risk of cardiovascular disease and should receive intensive risk-reduction therapy. Early detection of albuminuria and chronic kidney disease can identify individuals at increased risk of adverse clinical events and therefore may have a better opportunity to improve their outcomes. The determination of serum creatinine should not be the only parameter used to as renal function. The evaluation of the renal involvement in patients with cardiovascular disease should be done using the determination of albumin in a urine spot test and estimating glomerular filtration from predictive equations derived from creatinine. The MDRD equation is of choice but alternatively the Cockcroft-Gault formula can also be used.

Aporte de calcio en la insuficiencia renal crónica / No disponible

No disponible

Impacto socio sanitario de la enfermedad renal crónica avanzada / No disponible

La prevalencia de ERC en España es del 11%, con una tasa elevada de factores de riesgo vascular asociados y el progresivo incremento del número de pacientes subsidiarios de depuración extrarrenal, estimado en un 5-8% anual, ha convertido a esta enfermedad en un problema sanitario, social y económico de primer orden para todos los sistemas sanitarios de los países desarrollados. La terapia renal sustitutiva, aunque es adecuada, no es óptima para (..) (AU)

The prevalence of CKD in Spain is 11%, with a high rate of associated vascular risk factors and a progressive increase in the number of patients requiring kidney replacement therapy, estimated at 5-8% annually. This has made CKD one of the leading health, social and economic problems for the health care systems of all developed countries. Kidney replacement therapy, although adequate, is not optimal for solving this clinical (..) (AU)

Calendario de vacunas en la enfermedad renal crónica avanzada / No disponible

1. VACUNACIÓN PARA LA HEPATITIS Ba) Todos los pacientes con enfermedad renal crónica avanzada cuya serología sea negativa para el HBsAg y el an-tiHBs serán vacunados contra la hepatitis B (Nivel de evidencia: B).b) Para las vacunas clásicas (Engerix B y HBVAxpro) la dosis de la vacuna en adultos es de 40 mcg (20 mcg en población pediátrica). Hay dos pautas de administración según la especialidad farmacéutica empleada: 0,1 y 6 meses con HBVAxpro y 0, 1, 2 y 6 meses con En-gerix B. Con la nueva vacuna Fendrix, la dosis es de 20mcg y la pauta de 0, 1, 2 y 6 meses (Nivel de evidencia: C).c) El título de antiHBs será determinado 1-2 meses después de administrar la última dosis. En los enfermos en los que el título de anticuerpos sea inferior a 10mUI/ml, se puede suministrar una dosis de refuerzo y comprobar la respuesta o realizar una segunda vacunación completa (Nivel de evidencia: B).d) En los enfermos respondedores, el nivel de anticuerpos (..) (AU)

1. VACCINATION AGAINST HEPATITIS Ba) All patients with chronic advanced renal disease and negative serology for HBsAg and antiHBs are to be vaccinated agains thepatitis B (Evidence level: B).b) For classic vaccines (Engerix B and HBVAxpro) the adult vaccine dose is 40 mcg (20 mcg in the paediatric population).There are two dose regimens based on the medicinal productused: 0, 1 and 6 months with HBVAxpro and 0, 1, 2 and6 months with Engerix B. With the new vaccine Fendrix, the dose is 20 mcg and the schedule 0, 1, 2 and 6 months (Evidence level: C).c) The antiHBs titre is to be measured 1-2 months after administration of the last dose. In patients whose antibody titres are below 10 mIU/mL, a booster may be administered, checking (..) (AU)

[Social and health impact of advanced chronic kidney disease]. / Impacto socio sanitario de la enfermedad renal cronica avanzada.

The prevalence of CKD in Spain is 11%, with a high rate of associated vascular risk factors and a progressive increase in the number of patients requiring kidney replacement therapy, estimated at 5-8% annually. This has made CKD one of the leading health, social and economic problems for the health care systems of all developed countries. Kidney replacement therapy, although adequate, is not optimal for solving this clinical problem. The key aspects of the problem are: The increase in the number of patients with CKD due to: Early vascular injury as a result of the inflammatory process associated with CKD. Aging of the population, although CKD may be more dependent on comorbidities than age "per se", and prevalence may therefore not have the expected increase. The epidemic of type 2 diabetes mellitus. CKD is the major vascular risk factor both in the general and hypertensive population or patients with established vascular injury. The estimated cost of care of stage 1-4 CKD per year can be 1.6-2.4 times more than kidney replacement therapy. The approach to this serious social and health problem is based on: Early detection and diagnosis of CKD by estimation of glomerular filtration rate and assessment of associated risk factors. Establishment of treatment goals for control of cardiovascular risk factors (blood pressure, dyslipidemia, diabetes mellitus,) and albuminuria to reduce the rate of progression of kidney disease. Joint approach to problem by primary care physicians and other specialists caring for patients at high cardiovascular risk. Establishment of criteria for referral to nephrology departments.