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Sánchez-Calavera MA, Navarro RG, Otal EA, González IB, Pardo DE, Celma LH, Lamarre M, Esteban PL, Lozano Del Hoyo ML, Mahulea L, Gallego IM, Romero-Vigara JC, Allué SS, Hueso ST, Gil FA. Prevalence and characteristics of chronic kidney disease in people with type 2 diabetes mellitus in the Autonomous Community of Aragon. Prim Care Diabetes 2024; 18:555-560. [PMID: 38991895 DOI: 10.1016/j.pcd.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/05/2024] [Accepted: 06/02/2024] [Indexed: 07/13/2024]
Abstract
AIMS The main objective in this study was to determine the prevalence of Chronic Kidney Disease (CKD) in people with Type 2 Diabetes Mellitus (T2DM) in the Autonomous Community (AC) of Aragon (Spain) and to detect whether or not there is under-registration in the patient's history. As a secundary objetive, it was proposed to study the most relevant demographic and clinical characteristics of people with CKD. METHODS Observational and retrospective real world data study of the population over 18 years of age with a diagnosis of T2DM, between January 2017 and December 2021. A descriptive analysis of qualitative and quantitative variables, and a comparison using the parametric Student's t-test or the non-parametric Mann-Whitney U-test between both groups was performed. RESULTS The prevalence of T2DM was 8.07 % and that of CKD 31.4 %, with an under-reporting of 47 %. The main risk factor associated with CKD was arterial hypertension (p<0.001), followed by dyslipidemia (p<0.001). The main treatment used for diabetes control was metformin, both in patients with and without CKD (p<0.001). A total of 56.81 % of people with T2DM and CKD did not undergo annual monitoring of their renal function (glomerular filtration rate) or determination of albuminuria. CONCLUSIONS The prevalence of CKD increases in patients with T2DM (31.4 %), and in almost half of patients the diagnosis is not registered (47 %). This under-reporting delays the implementation of measures needed to prevent CKD progression.
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Affiliation(s)
- María Antonia Sánchez-Calavera
- Health Service of Aragon, Spain; Instituto de Investigación Sanitaria de Aragón (IISA, Aragon Health Research Institute), Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Rafael Gómez Navarro
- Health Service of Aragon, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain.
| | - Elena Asso Otal
- Health Service of Aragon, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Isabel Blasco González
- Health Service of Aragon, Spain; Instituto de Investigación Sanitaria de Aragón (IISA, Aragon Health Research Institute), Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Daniel Escribano Pardo
- Health Service of Aragon, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Laia Homedes Celma
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Michelot Lamarre
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Pilar López Esteban
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - María Luisa Lozano Del Hoyo
- Health Service of Aragon, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Liliana Mahulea
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Inés Mera Gallego
- Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain; Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (Spanish Society of Clinical, Family and Community Pharmacy), Spain
| | - Juan Carlos Romero-Vigara
- Health Service of Aragon, Spain; Instituto de Investigación Sanitaria de Aragón (IISA, Aragon Health Research Institute), Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Sandra Soler Allué
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Sira Telmo Hueso
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Fran Adán Gil
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
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Chesnaye NC, Ortiz A, Zoccali C, Stel VS, Jager KJ. The impact of population ageing on the burden of chronic kidney disease. Nat Rev Nephrol 2024; 20:569-585. [PMID: 39025992 DOI: 10.1038/s41581-024-00863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/20/2024]
Abstract
The burden of chronic kidney disease (CKD) and its risk factors are projected to rise in parallel with the rapidly ageing global population. By 2050, the prevalence of CKD category G3-G5 may exceed 10% in some regions, resulting in substantial health and economic burdens that will disproportionately affect lower-income countries. The extent to which the CKD epidemic can be mitigated depends largely on the uptake of prevention efforts to address modifiable risk factors, the implementation of cost-effective screening programmes for early detection of CKD in high-risk individuals and widespread access and affordability of new-generation kidney-protective drugs to prevent the development and delay the progression of CKD. Older patients require a multidisciplinary integrated approach to manage their multimorbidity, polypharmacy, high rates of adverse outcomes, mental health, fatigue and other age-related symptoms. In those who progress to kidney failure, comprehensive conservative management should be offered as a viable option during the shared decision-making process to collaboratively determine a treatment approach that respects the values and wishes of the patient. Interventions that maintain or improve quality of life, including pain management and palliative care services when appropriate, should also be made available.
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Affiliation(s)
- Nicholas C Chesnaye
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
| | - Carmine Zoccali
- Associazione Ipertensione Nefrologia Trapianto Renale (IPNET), c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy
- Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy
- Renal Research Institute, New York, NY, USA
| | - Vianda S Stel
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
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Piqueras-Sanchez C, Esteve-Pastor MA, Moreno-Fernandez J, Soler-Espejo E, Rivera-Caravaca JM, Roldán V, Marín F. Advances in the medical treatment and diagnosis of intracranial hemorrhage associated with oral anticoagulation. Expert Rev Neurother 2024; 24:913-928. [PMID: 39039686 DOI: 10.1080/14737175.2024.2379413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION With the increasing prevalence of atrial fibrillation (AF), it entails expanding oral anticoagulants (OACs) use, carrying a higher risk of associated hemorrhagic events, including intracranial hemorrhage (ICH). Despite advances in OACs development with a better safety profile and reversal agent for these anticoagulants, there is still no consensus on the optimal management of patients with OACs-associated ICH. AREAS COVERED In this review, the authors have carried out an exhaustive search on the advances in recent years. The authors provide an update on the management of ICH in anticoagulated patients, as well as an update on the latest evidence on anticoagulation resumption, recent therapeutic strategies, and investigational drugs that could play a role in the future. EXPERT OPINION Following an ICH event in an anticoagulated patient, a comprehensive clinical evaluation is imperative. Anticoagulation should be promptly withdrawn and reversed. Once the patient is stabilized, a reintroduction of anticoagulation should be considered, typically within a timeframe of 4-8 weeks, if feasible. If re-anticoagulation is not possible, alternative options such as Left Atrial Appendage Occlusion are available.
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Affiliation(s)
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
- Instituto Murciano De Investigación Biosanitaria (IMIB- Arrixaca), Murcia, Spain
- CIBERCV, Murcia, Spain
| | - Jorge Moreno-Fernandez
- Department of Cardiology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
| | - Eva Soler-Espejo
- Instituto Murciano De Investigación Biosanitaria (IMIB- Arrixaca), Murcia, Spain
- Department of Hematology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
| | | | - Vanessa Roldán
- Instituto Murciano De Investigación Biosanitaria (IMIB- Arrixaca), Murcia, Spain
- Department of Hematology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
- Instituto Murciano De Investigación Biosanitaria (IMIB- Arrixaca), Murcia, Spain
- CIBERCV, Murcia, Spain
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Michán-Doña A, Jiménez-Varo E, Escribano-Cobalea M, Casto-Jarillo C, López-Ceres A, Campos-Dávila E, Hormigo-Pozo A, Nieto-Ordoñez C, Rodríguez-Juliá MÁ, Escribano-Serrano J. Prevalence and characteristics of anemia in patients with diabetes mellitus aged 50 or older in health unit area of Cadiz (Spain). Rev Clin Esp 2024; 224:457-465. [PMID: 38879004 DOI: 10.1016/j.rceng.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/27/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Anemia is a common comorbidity in patients with diabetes mellitus (DM), particularly in older adults. However, there is a lack of data on the prevalence and the characteristics of anemia in this population in Spain. OBJECTIVE To describe the prevalence and the characteristics of anemia in patients with DM aged 50 or older (PDM50) in a healthcare district in the province of Cádiz. METHODS A retrospective cross-sectional study was conducted that included outpatient's laboratory tests (OLT) performed over 30 months at PDM50. RESULTS The prevalence of anemia was 29.9% (95% CI: 28.7%-31.1%), predominating in women (33.3% vs 26.7%; P < 0.01), in older people stratified by decades (61.7% in 9th decade vs 12% in 5th decade; P < 0.01), and in those with kidney disease (44.7% vs 28%; P < 0.01). Most cases were mild (68.3%), normocytic (78.7%), and hypochromic (52%). Similarly, moderate-to-severe anemia was more frequent in women (39% vs 23%), their prevalence increased with age (45% in the 9th decade vs 24% in the 5th decade), and with the progression of kidney damage, either measured by a decreased glomerular filtration rate (GFR) (49% in G4 vs 25% in G1), or the presence of albuminuria (P < 0.01). No association was found between DM control, based on glycated hemoglobin (HbA1c), and anemia in either sex (P = 0.887). CONCLUSION This study describes a high prevalence of anemia in PDM50, particularly in women, in the most advantageous people and in the presence of kidney disease, even in early stages, highlighting the clinical importance of this coexistence.
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Affiliation(s)
- A Michán-Doña
- Departamento de Medicina, HU Jerez de la Frontera, AGS Norte de Cádiz, Universidad de Cádiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
| | - E Jiménez-Varo
- UGC Laboratorio Análisis Clínicos, HU la Línea de la Concepción, AGS Campo de Gibraltar Este, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - M Escribano-Cobalea
- UGC Obstetricia y Ginecología, HU Punta de Europa de Algeciras, AGS Campo de Gibraltar Oeste, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - C Casto-Jarillo
- UGC Laboratorio Análisis Clínicos, HU la Línea de la Concepción, AGS Campo de Gibraltar Este, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - A López-Ceres
- UGC Laboratorio Análisis Clínicos, HU la Línea de la Concepción, AGS Campo de Gibraltar Este, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - E Campos-Dávila
- UGC Farmacia, Hospital de la Línea de la Concepción, AGS Campo de Gibraltar Este, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - A Hormigo-Pozo
- UGC San Andrés Torcal, AGS Málaga Guadalhorce, Málaga, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - C Nieto-Ordoñez
- UGC San Roque, San Roque, AGS Campo de Gibraltar Este, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - M Á Rodríguez-Juliá
- UGC Velada, la Línea de la Concepción, AGS Campo de Gibraltar Este, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - J Escribano-Serrano
- UGC Velada, la Línea de la Concepción, AGS Campo de Gibraltar Este, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
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Nitola-Mendoza L, Sánchez-Cárdenas M, Rodriguez-Chitiva N, Mora Gutiérrez JM, Rodriguez-Pena R, Romero-González G, Bleda Pérez M, Cuenca Casbas P, Calsina-Berna A, Álvaro-Pardo M, Granados Casas V, Garrido Ballart P, Beroiz Groh P, Bover J, Miralles Basseda R, Leiva-Santos JP, Alonso-Babarro A, Julià-Torras J. Nomenclature in Palliative and Kidney Supportive Care: Not Just at the End-of-Life. Nefrologia 2024; 44:475-485. [PMID: 39127583 DOI: 10.1016/j.nefroe.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/14/2023] [Accepted: 05/19/2023] [Indexed: 08/12/2024] Open
Abstract
The multidimensional view of disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide a multidisciplinary approach tailored to the needs of each individual. Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute situations, potentially irreversible or interventions that do not improve life expectancy. To ensure excellence in care, it is important to assess indicators of palliative care and kidney support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families. Palliative and kidney care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.
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Affiliation(s)
| | | | - Néstor Rodriguez-Chitiva
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | - José María Mora Gutiérrez
- Nephrology Department, Clínica Universidad de Navarra, Pamplona, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Rosely Rodriguez-Pena
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | - Gregorio Romero-González
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain; International Renal Research Institute of Vicenza, Vicenza, Italy
| | | | | | - Agnès Calsina-Berna
- Palliative Care Department, Catalan Institute of Oncology, Badalona, Spain; Chair of Palliative Care, Medical School, Universitat de Vic-Universitat Central de Catalunya, Spain
| | | | | | | | - Patricia Beroiz Groh
- Geriatrics Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Jordi Bover
- Nephrology Department, Germans Trias i Pujol University Hospital, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | | | | | | | - Joaquim Julià-Torras
- Palliative Care Department, Catalan Institute of Oncology, Badalona, Spain; Faculty of Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
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Pintado-Outumuro E, Morin-Fraile V, Salvador-González B, Benito L, Julve-Ibáñez M, Sancho-Campos MP, Alves-Tafur C, Lumillo-Gutiérrez I. Exploring the factors influencing evidence-based approaches to advanced chronic kidney disease: a qualitative study involving nurses and physicians. BMC PRIMARY CARE 2024; 25:177. [PMID: 38773496 PMCID: PMC11107048 DOI: 10.1186/s12875-024-02418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Advanced chronic kidney disease (ACKD) is associated with a high risk of adverse cardiovascular and renal events and has a significant impact on quality of life and life expectancy. Several studies have identified areas for improvement in their management in primary care. Some professional and environmental factors can act as key barriers to appropriate care. OBJECTIVE To analyse attitudes, subjective norms, and perceived behavioural control among primary care professionals related to the implementation of an evidence-based approach for individuals with ACKD in primary care. METHODOLOGY This was a qualitative study using an interpretative phenomenological approach based on the theory of planned behaviour. Two aspects of the evidence-based approach were explored: the implementation of clinical practice guidelines and the utilisation of electronic kidney disease records within the scope of this study. Primary care nurses and physicians participated in a previous pilot interview and five focus groups. Subsequently, a thematic analysis of the gathered data was conducted. FINDINGS Thirty-three primary care professionals participated. The emerging themes included: experiences in the management of ACKD (highlighting a distinct profile of older, frail patients with comorbidities masking CKD and a CKD follow-up primarily focused on analytical monitoring and drug adjustment); factors in the professional environment influencing the use of scientific evidence (such as time constraints, excessive electronic health records, and unfamiliar reference guidelines); attitudes towards the application of recommendations on ACKD (recognising limitations of computer systems despite considering them as guidance); and capacities to implement evidence-based recommendations (acknowledging formative needs and challenges in coordinating care with nephrology services). CONCLUSIONS Several psychological elements identified through the TBP hinder the adequate implementation of an evidence-based approach for individuals with CKD. Attitudes have been identified as factors modulating the use of standardised electronic records. Instead, subjective norms (influences from the professional environment) and perceived behavioral control (perception of capabilities) acted as barriers to the proper application of clinical practice guidelines and standardised records. IMPLICATIONS FOR PRACTICE Strategies aimed at optimising the management of people with ACKD should focus not only on training but also on improving attitudes, organisational structures, IT systems and coordination between primary care and nephrology.
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Grants
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
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Affiliation(s)
- Elena Pintado-Outumuro
- Primary Care Center El Pla. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, 08980, Spain
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain
| | - Victoria Morin-Fraile
- Department of Public Health, Mental Health and Maternal and Child Health Nursing. Faculty of Nursing, University of Barcelona. Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- Research Group On Environments and Materials for Learning, Universitat de Barcelona, Barcelona, Spain
| | - Betlem Salvador-González
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain
| | - Llúcia Benito
- Fundamental and Clinic Nursing Department, Faculty of Nursing, University of Barcelona, Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- IDIBELL, Bellvitge Biomedical Research Institute, Avinguda de la Gran Via, 199, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
| | - Maricel Julve-Ibáñez
- Primary Care Center El Castell, Servei d'Atenció Primària Delta del Llobregat, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Castelldefels, 08860, Barcelona, Spain
| | - M-Pilar Sancho-Campos
- Primary Care Center Sant Ildefons. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, Barcelona, 08940, Spain
| | - Carolina Alves-Tafur
- Primary Care Center Montclar and Primary Care Center Camps Blancs. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, 08830, Spain
| | - Iris Lumillo-Gutiérrez
- Department of Public Health, Mental Health and Maternal and Child Health Nursing. Faculty of Nursing, University of Barcelona. Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain.
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain.
- Research Group On Environments and Materials for Learning, Universitat de Barcelona, Barcelona, Spain.
- Chronicity and Complexity Care Unit (UTACC) Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, 08940, Spain.
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7
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Gippini A, Prado A. Earlier onset of treatment improves the nephroprotective effect of dapagliflozin. Nefrologia 2024; 44:431-433. [PMID: 39002997 DOI: 10.1016/j.nefroe.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 07/15/2024] Open
Affiliation(s)
- Antonio Gippini
- Endocrinologist, Endocrinology Service, Hospitalary Complex Ourense, National Health System, Spain.
| | - Alberto Prado
- Pharmacist, Master in Statistics, Cardiovascular Renal Metabolism (CVRM), Medical Department, AstraZeneca, Spain
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8
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Górriz JL, García Maset R. Response to the letter: "Preeclampsia: a relevant chronic kidney disease risk factor frequently and unfortunately forgotten". Nefrologia 2024; 44:454-455. [PMID: 38937159 DOI: 10.1016/j.nefroe.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 06/29/2024] Open
Affiliation(s)
- Jose Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, Universidad de Valencia, Valencia, Spain.
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DaSilva Santos I, Ricart Calleja M, Piccoli GB. Pre-eclampsia: An important risk factor for chronic kidney disease frequently and unfortunately forgotten. Nefrologia 2024; 44:453-454. [PMID: 38960782 DOI: 10.1016/j.nefroe.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2024] Open
Affiliation(s)
- Iara DaSilva Santos
- Servicio de Nefrología, Unidad Multidisciplinar de Alto Riesgo Nefro-Obstétrico, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Marta Ricart Calleja
- Servicio de Ginecología y Obstetricia, Unidad Multidisciplinarde Alto Riesgo Nefro-Obstétrico, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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10
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Salar Ibáñez L, Espejo Guerrero J, Satué E, Pérez León N, Martínez-Berganza Asensio ML. [Screening for Chronic Kidney Disease in the Community Pharmacy. CRIERFAC Study: Description of the Methodology]. FARMACEUTICOS COMUNITARIOS 2024; 16:5-13. [PMID: 39156030 PMCID: PMC11328524 DOI: 10.33620/fc.2173-9218.(2024).12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 08/20/2024]
Abstract
Abstract Chronic kidney disease (CKD) is the existence of abnormalities in renal structure or function with an impact on health. This is usually considered when estimated glomerular filtration (eGF) falls under 60 mL/min/1.73m2. Its clinical course leads to renal replacement therapy (dialysis or transplant) when eGF falls under 15 mL/min/1.73m2. Screening in at risk populations has been proven to be cost-effective. The aim of this work is to perform CKD screening in the community pharmacy. In this publication we report and justify the methodology in detail. Methodology Pharmacists from the community pharmacies taking part selected patients who complied with inclusion and not exclusion criteria. Creatinine was measured by means of a finger prick and eGF calculated with the formula CKD-EPI. If this is lower than a set value, which depends on age, referral to the general practitioner takes place. Results A total of 141 out of 200 pharmacies took part in the study. In all 2116 patients were recruited and 116 patients were lost. The final sample size was 2000 patients. Discussion The protocol was successfully implemented by community pharmacists and was extremely well received by community pharmacy users. The age adjustment for eGF thresholds provides a novel additional filter. The aim is not to overburden primary care centres with potential referrals of false positives. Confirmation of the diagnosis is subject to voluntary communication by the patient to the pharmacist.
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Affiliation(s)
- Luis Salar Ibáñez
- Doctor en farmacia, Director de ‘Farmacéuticos Comunitarios’, Profesor asociado Universidad Cardenal Herrera – CEU, Farmacéutico comunitario en Valencia Universidad Cardenal HerreraEspaña
| | | | | | - Noemí Pérez León
- Médico. Centro de Atención Primaria Gran Sol. Badalona. Barcelona Centro de Atención Primaria Gran Sol.España
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11
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Goicochea-Rios EDS, Chian-García AM, Yupari-Azabache IL, Gómez Goicochea NI. Factors Associated with the Development of Chronic Kidney Disease in Patients with Arterial Hypertension. Int J Nephrol Renovasc Dis 2024; 17:113-123. [PMID: 38566818 PMCID: PMC10986410 DOI: 10.2147/ijnrd.s448986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Chronic kidney disease affects a large part of the population with hypertension, diabetes mellitus as well as those over 50 years of age. Research reported that male sex and other comorbidities such as obesity and anemia are more frequent in Chronic kidney disease, as well as uncontrolled diabetes mellitus or hypertension. Objective To determine the risk factors associated with the development of chronic kidney disease in adults with arterial hypertension. Material and Methods Retrospective cohort study of 455 patients with hypertension treated in a primary health care hospital. Medical records and laboratory information were reviewed for the diagnosis of chronic kidney disease and its staging. Patients aged 40 years and older, of both sexes and evaluated between the years 2015 -2017 were included. Logistic regression analysis allowed the identification of risk factors associated with the development of chronic kidney disease. Results 63.7% were female and 36.3% male. The average age for 2015 was 69.79 ± 9.03, more than half of participants had diabetes mellitus and controlled hypertension and the predominant nephroprotection was with Losartan (53%) that year. Male sex (OR 1.68, CI 1.03-2,76), age: 60 years or older (OR 6.38, CI 2.65-15,37) and anemia (OR 1.71, CI 1.03-2,85), were risk factors for the development of chronic kidney disease (p < 0.05), whereas nephroprotection (OR 0.39, CI 0.18-0,88) and controlled diabetes mellitus (OR: 0.18, CI 0.07-0,47) were shown to be protective factors (p < 0.05). The prevalence of chronic kidney disease between 2015 and 2017 was 19% and 45%, respectively, with predominance of category G2. The comparison group is the same cohort analyzed in each year under study. Conclusion Male sex, age over 60 years, and anemia are risk factors for chronic kidney disease. Nephroprotection, controlled diabetes mellitus, and patient follow-up are factors that prevent its development.
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12
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Escamilla-Cabrera B, Luis-Lima S, Gallego-Valcarce E, Sánchez-Dorta NV, Negrín-Mena N, Díaz-Martín L, Cruz-Perera C, Hernández-Valles AM, González-Rinne F, Rodríguez-Gamboa MJ, Estupiñán-Torres S, Miquel-Rodríguez R, Cobo-Caso MÁ, Delgado-Mallén P, Fernández-Suárez G, González-Rinne A, Hernández-Barroso G, González-Delgado A, Torres-Ramírez A, Jiménez-Sosa A, Ortiz A, Gaspari F, Hernández-Marrero D, Porrini EL. The error of estimated GFR in predialysis care. Sci Rep 2024; 14:5219. [PMID: 38433228 PMCID: PMC10909958 DOI: 10.1038/s41598-024-55022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
The error of estimated glomerular filtration rate (eGFR) and its consequences in predialysis are unknown. In this prospective multicentre study, 315 predialysis patients underwent measured GFR (mGFR) by the clearance of iohexol and eGFR by 52 formulas. Agreement between eGFR and mGFR was evaluated by concordance correlation coefficient (CCC), total deviation index (TDI) and coverage probability (CP). In a sub-analysis we assessed the impact of eGFR error on decision-making as (i) initiating dialysis, (ii) preparation for renal replacement therapy (RRT) and (iii) continuing clinical follow-up. For this sub-analysis, patients who started RRT due to clinical indications (uremia, fluid overload, etc.) were excluded. eGFR had scarce precision and accuracy in reflecting mGFR (average CCC 0.6, TDI 70% and cp 22%) both in creatinine- and cystatin-based formulas. Variations -larger than 10 ml/min- between mGFR and eGFR were frequent. The error of formulas would have suggested (a) premature preparation for RTT in 14% of stable patients evaluated by mGFR; (b) to continue clinical follow-up in 59% of subjects with indication for RTT preparation due to low GFRm and (c) to delay dialysis in all asymptomatic patients (n = 6) in whom RRT was indicated based on very low mGFR. The error of formulas in predialysis was frequent and large and may have consequences in clinical care.
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Affiliation(s)
- Beatriz Escamilla-Cabrera
- Nephrology Department, Complejo Hospitalario Universitario de Canarias, La Laguna, Spain
- Facultad de Medicina, Universidad de La Laguna, La Laguna, Spain
| | - Sergio Luis-Lima
- Department of Laboratory Medicine, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
- Laboratory of Renal Function (LFR), Faculty of Medicine, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain
| | | | | | - Natalia Negrín-Mena
- Laboratory of Renal Function (LFR), Faculty of Medicine, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain
| | - Laura Díaz-Martín
- Laboratory of Renal Function (LFR), Faculty of Medicine, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain
| | - Coriolano Cruz-Perera
- Laboratory of Renal Function (LFR), Faculty of Medicine, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain
| | | | - Federico González-Rinne
- Laboratory of Renal Function (LFR), Faculty of Medicine, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain
| | | | - Sara Estupiñán-Torres
- Nephrology Department, Complejo Hospitalario Universitario de Canarias, La Laguna, Spain
| | - Rosa Miquel-Rodríguez
- Nephrology Department, Complejo Hospitalario Universitario de Canarias, La Laguna, Spain
| | | | | | | | - Ana González-Rinne
- Nephrology Department, Complejo Hospitalario Universitario de Canarias, La Laguna, Spain
| | | | | | - Armando Torres-Ramírez
- Nephrology Department, Complejo Hospitalario Universitario de Canarias, La Laguna, Spain
- Facultad de Medicina, Universidad de La Laguna, La Laguna, Spain
| | | | - Alberto Ortiz
- Faculty of Medicine, Universidad Autónoma de Madrid. IIS-Fundación Jiménez Díaz. RICORS, Madrid, Spain
| | - Flavio Gaspari
- Laboratory of Renal Function (LFR), Faculty of Medicine, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain
| | - Domingo Hernández-Marrero
- Nephrology Department, Complejo Hospitalario Universitario de Canarias, La Laguna, Spain
- Instituto de Tecnologías Biomédicas (ITB), Faculty of Medicine, University of La Laguna, La Laguna, Spain
- Facultad de Medicina, Universidad de La Laguna, La Laguna, Spain
| | - Esteban Luis Porrini
- Laboratory of Renal Function (LFR), Faculty of Medicine, Complejo Hospitalario Universitario de Canarias, University of La Laguna, La Laguna, Spain.
- Instituto de Tecnologías Biomédicas (ITB), Faculty of Medicine, University of La Laguna, La Laguna, Spain.
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13
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Bover J, Gómez-Alonso C, Casado E, Rodríguez-García M, Lloret MJ, Castro-Alonso C, Gifre L, Henríquez-Palop F, Prior-Español Á, López de la Manzanara V, Láiz AM, Martínez-Ferrer À, Torregrosa JV, Cigarrán S, Górriz JL, Montomoli M, Panizo N, Costa E, Martínez-Laguna D, Rodríguez M, Navarro-González JF. Osteoporosis management in patients with chronic kidney disease (ERCOS Study): A challenge in nephrological care. Nefrologia 2024; 44:241-250. [PMID: 38531765 DOI: 10.1016/j.nefroe.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/07/2023] [Indexed: 03/28/2024] Open
Abstract
Fracture risk assessment in patients with chronic kidney disease (CKD) has been included in the CKD-MBD ("Chronic Kidney Disease-Mineral and Bone Disorders") complex in international and national nephrology guidelines, suggesting for the first time the assessment of bone mineral density (BMD) if the results can influence therapeutic decision-making. However, there is very little information on actual clinical practice in this population. The main objective of the ERCOS (ERC-Osteoporosis) study is to describe the profile of patients with CKD G3-5D with osteoporosis (OP) and/or fragility fractures treated in specialized nephrology, rheumatology and internal medicine clinics in Spain. Fifteen centers participated and 162 patients (mostly women [71.2%] postmenopausal [98.3%]) with a median age of 77 years were included. Mean estimated glomerular filtration rate (eGFR) was 36 mL/min/1.73 m2 and 38% of the included patients were on dialysis. We highlight the high frequency of prevalent fragility fractures [37.7%), mainly vertebral (52.5%) and hip (24.6%)], the disproportionate history of patients with glomerular disease compared to purely nephrological series (corticosteroids) and undertreatment for fracture prevention, especially in nephrology consultations. This study is an immediate call to action with the dissemination of the new, more proactive, clinical guidelines, and underlines the need to standardize a coordinated and multidisciplinary care/therapeutic approach to these patients in an efficient way to avoid current discrepancies and therapeutic nihilism.
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Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, REMAR-IGTP Group, Can Ruti Campus, Badalona, Barcelona, Spain.
| | - Carlos Gómez-Alonso
- Unidad de Gestión Clínica de Metabolismo Óseo y Mineral, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Enrique Casado
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Minerva Rodríguez-García
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Jesús Lloret
- Servicio de Nefrología, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Cristina Castro-Alonso
- Servicio de Nefrología, Hospital Universitario Doctor Peset, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Laia Gifre
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Águeda Prior-Español
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Ana María Láiz
- Servicio de Reumatología, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Marco Montomoli
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Nayara Panizo
- Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Ester Costa
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Mariano Rodríguez
- Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan F Navarro-González
- Unidad de Investigación y Servicio de Nefrología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Islas Canarias, Spain
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14
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Sánchez-Fernández MDM, Reyes Del Paso GA, Quirós-Ganga PL, Moreno-Salazar AS, Fernández-Serrano MJ. [Neuropsychological impairments in patients undergoing peritoneal dialysis treatment]. Med Clin (Barc) 2024; 162:147-156. [PMID: 38007389 DOI: 10.1016/j.medcli.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Patients with chronic kidney disease on hemodialysis (HD) often have cognitive deficits. However, there are few studies that have examined the neuropsychological impairments of patients receiving peritoneal dialysis (PD). METHODS Executive functions, processing speed and verbal memory were assessed in 27 PD patients, 42 HD patients, and 42 healthy participants (HP). Systolic blood pressure and total time on renal replacement therapy (RRT) were controlled statistically. Associations between performance and clinical factors were analyzed using correlations and multiple regression. RESULTS The DP group showed better performance compared to the HD group in verbal fluency, working memory, cognitive flexibility, planning and decision making. The DP group showed worse execution than the HP group in verbal inhibition and memory. Executive function scores were positively associated with total months on PD, total months on RRT, total months on HD, albumin, total cholesterol, and phosphorus, and negatively with ferritin. CONCLUSION Global executive functioning was more optimal in PD patients than in HD patients. The results show the positive effect of PD on executive functions, which must be taken into account when choosing the TRS. The associations observed between biochemical factors and performance show the importance of maintaining an adequate nutritional status in these patients.
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15
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Ortiz A, Galán CDA, Carlos Fernández-García J, Cerezo JG, Ochoa RI, Núñez J, Gutiérrez FP, Navarro-González JF. Consensus document on the management of hyperkalemia. Nefrologia 2023; 43:765-782. [PMID: 38169239 DOI: 10.1016/j.nefroe.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 01/05/2024] Open
Abstract
Hyperkalaemia is a common electrolyte imbalance with potentially serious short-, medium- and long-term consequences on morbidity and mortality rates and the use of national health service resources. The fact that different medical specialities can manage hyperkalaemia makes it important to have a unified approach, and the recent availability of new specific drug treatments means that the approach needs to be updated. This consensus document from the scientific societies most directly involved in the management of hyperkalaemia (Sociedad Española de Cardiología [Spanish Society of Cardiology], Sociedad Española de Endocrinología y Nutrición [Spanish Society of Endocrinology and Nutrition], Sociedad Española de Medicina Interna [Spanish Society of Internal Medicine], Sociedad Española de Medicina de Urgencias y Emergencias [Spanish Society of Accident and Emergency Medicine] and Sociedad Española de Nefrología [Spanish Society of Nephrology]) first of all reviews basic aspects of potassium balance and blood potassium. Then it goes on to focus on the concept, epidemiology, pathophysiology and diagnostic and therapeutic approaches to hyperkalaemia. The available evidence and the main published studies have been reviewed with the aim of providing a useful tool in the multidisciplinary approach to patients with hyperkalaemia.
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Affiliation(s)
| | | | | | | | - Rosa Ibán Ochoa
- Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Spain
| | - Julio Núñez
- Sociedad Española de Cardiología (SEC), Spain
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16
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Escribá-Martí G, Cámara-Ramos I, Climent-Catalá MT, Escudero-Quesada V, Salar-Ibáñez L. [Detection of nephrotoxics and dose adjustment in patients with low glomerular filtration rate in community pharmacy: methodology]. FARMACEUTICOS COMUNITARIOS 2023; 15:37-44. [PMID: 39156982 PMCID: PMC11326692 DOI: 10.33620/fc.2173-9218.(2023).29] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/30/2023] [Indexed: 08/20/2024]
Abstract
Abstract Chronic kidney disease is a prevalent problem without specific treatment. Early detection is important and estimated glomerular filtration rate (eGFR) is a very affordable test that can be performed in community pharmacies. If present, it is very important not to further damage the kidney by avoiding the use of nephrotoxic drugs and adjusting the doses of other renal elimination drugs and the community pharmacy is very well positioned to do this. Objective To describe the methodology used to detect nephrotoxic drugs and adjust doses of other drugs in community pharmacies for subsequent referral to primary care. Method Multicentre experimental multicentre uncontrolled follow-up study carried out in community pharmacies in 4 autonomous communities in Spain. Patients who met the inclusion criteria and signed the informed consent form were included. Those with eGFR <60 ml/min/1.73m2 were studied and their medication was analysed using the BOT Plus and 4 other sources of information. Result 670 patients were included, 215 of them with eGFR<60ml/min/1.73m2. Of these 90 (41.9%) needed some type of adjustment in the pharmacist's judgement. Of these 90, 43.3% (39) had some kind of change after the pharmacist's intervention. Conclusion In patients with low glomerular filtration rate, with the appropriate methodology, the community pharmacist is able to detect the use of nephrotoxic drugs or the use of drugs at doses higher than those recommended according to their renal status.
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Affiliation(s)
| | | | | | - Verónica Escudero-Quesada
- Nefróloga. Servicio de Nefrología del Hospital Universitario Dr. Peset (Valencia). Hospital Universitario Dr. PesetEspaña
| | - Luis Salar-Ibáñez
- Farmacéutico comunitario en Valencia. Profesor asociado Universidad Cardenal Herrera - CEU. Universidad Cardenal HerreraEspaña
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17
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Flores E, Salinas JM, Blasco Á, López-Garrigós M, Torreblanca R, Carbonell R, Martínez-Racaj L, Salinas M. Clinical Decision Support systems: A step forward in establishing the clinical laboratory as a decision maker hubA CDS system protocol implementation in the clinical laboratory. Comput Struct Biotechnol J 2023; 22:27-31. [PMID: 37661968 PMCID: PMC10474568 DOI: 10.1016/j.csbj.2023.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
Background New tools for health information technology have been developed in recent times, such as Clinical Decision Support (CDS) systems, which are any digital solutions designed to help healthcare professionals when making clinical decisions. The study aimed to show how we have adopted a CDS system in the San Juan de Alicante Clinical Laboratory and facilitate the implementation of our protocol in other clinical laboratories. We have user experience and the motivation to improve healthcare tools. The improvement, measurement, and monitoring of interventions and laboratory tests has been our motto for years. Materials and methods A descriptive research was conducted. All stages in the design of the project are as follows: 1. Set up a multidisciplinary workgroup. 2. Review patients' data. 3. Identify relevant data from main sources. 4. Design the likely outcomes. 5. Define a complete integration scenario. 6. Monitor and track the impact. To set up this protocol, two new software systems were implemented in our laboratory: AlinIQ CDS v8.2 as Rule Engine, and AlinIQ AIP Integrated Platform v1.6 as Business Intelligence (BI) tool. Results Our protocol shows the workflow and actions that can be done with a CDS system and also how it could be integrated with other monitoring systems, as well as some examples of KPIs and their outcomes. Conclusions CDS could be a great strategic asset for clinical laboratories to improve the integration of care, optimize the use of laboratory tests, and add more clinical value to physicians in the interpretation of results.
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Affiliation(s)
- Emilio Flores
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, Crta. Nacional 332 s/n, 03550, San Juan de Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernández, Crta. Nacional N-332 s/n, 03550, San Juan de Alicante, Spain
| | - José María Salinas
- Informatics Technology and Communication Department, University Hospital Sant Joan d'Alacant, Crta. Nacional 332 s/n, 03550 San Juan de Alicante, Spain
| | - Álvaro Blasco
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, Crta. Nacional 332 s/n, 03550, San Juan de Alicante, Spain
| | - Maite López-Garrigós
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, Crta. Nacional 332 s/n, 03550, San Juan de Alicante, Spain
| | - Ruth Torreblanca
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, Crta. Nacional 332 s/n, 03550, San Juan de Alicante, Spain
| | - Rosa Carbonell
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, Crta. Nacional 332 s/n, 03550, San Juan de Alicante, Spain
| | - Laura Martínez-Racaj
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, Crta. Nacional 332 s/n, 03550, San Juan de Alicante, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Av. de Cataluña 21, 46020, Valencia, Spain
| | - Maria Salinas
- Clinical Laboratory, University Hospital Sant Joan d'Alacant, Crta. Nacional 332 s/n, 03550, San Juan de Alicante, Spain
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Tablado MAM. Importance of gender in KDIGO guideline recommendations. Diabetes and CKD. Nefrologia 2023; 43:512-513. [PMID: 37666715 DOI: 10.1016/j.nefroe.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/28/2022] [Indexed: 09/06/2023] Open
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19
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Gippini A, Prado A. Cardiorenal prevention as the key player in the reduction of all-cause mortality. Nefrologia 2023; 43:514-515. [PMID: 36564232 DOI: 10.1016/j.nefroe.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 06/17/2023] Open
Affiliation(s)
- Antonio Gippini
- Endocrinology Service, Hospitalary Complex Ourense, National Health System, Spain.
| | - Alberto Prado
- Cardiovascular Renal Metabolism (CVRM), Medical Department, AstraZeneca, Spain
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20
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Fernández López P, Romero Lerma Á. [Key guidelines on the Spanish multi-society consensus on chronic kidney disease]. Semergen 2023; 49 Suppl 1:102017. [PMID: 37355298 DOI: 10.1016/j.semerg.2023.102017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
Chronic kidney disease (CKD) is a global health problem and affects approximately 15.1% of the general population in Spain (IBERICAN and ENRCA studies), although most of the literature agrees that there is an underdiagnosis that would further increase this prevalence. This article from the CKD monograph aims to summarize the main consensus guidelines for the management of CKD, highlighting the most important and novel aspects, as well as recently updated terminology and concepts. Sections addressing specific populations and prevention strategies are also included. As the family doctor (MAP) plays a fundamental role in the detection of CKD, recommendations on the multidisciplinary approach to CKD are collected.
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Affiliation(s)
- P Fernández López
- Centro de Salud de Huétor Vega, Granada. Grupo de trabajo de Nefro-urología de SEMERGEN, España.
| | - Á Romero Lerma
- Medicina Familar y Comunitaria Centro de Salud de Almuñecar, Granada. Grupo de trabajo de Nefro-urología de SEMERGEN, España
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21
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Górriz JL, Górriz-Zambrano C, Pallarés-Carratalá V. [Renal pathophysiology and pharmacological mechanisms of nephroprotection]. Semergen 2023; 49 Suppl 1:102021. [PMID: 37355300 DOI: 10.1016/j.semerg.2023.102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 06/26/2023]
Abstract
Several risk factors may affect the progression of chronic kidney disease (CKD). Arterial hypertension, proteinuria, obesity, intraglomerular hypertension, smoking and metabolic control in diabetes mellitus are the main modifiable risk factors for progression. The progression of CKD involves many cellular processes that originate in specific compartments of the kidney, the vascular compartment with nephroangiosclerosis and the tubulointerstitial compartment with fibrosis and tubulointerstitial atrophy, and there may be overlap between both mechanisms. Given the involvement of so many risk factors and so many pathogenic pathways in the progression of CKD, the best hope for delaying or preventing the progression of CKD lies in a combined and multidisciplinary therapeutic approach, based on the existing evidence and acting on all these processes and pathways from the mechanistic point of view, and on a global process that is cardiovascular and renal risk to improve the prognosis of patients.
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Affiliation(s)
- J L Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, Valencia. INCLIVA, Universitat de València, Valencia, España.
| | | | - V Pallarés-Carratalá
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón. Departamento de Medicina, Universitat Jaume I, Castellón, España
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22
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Castillo Moraga MJ, Turégano-Yedro M, Pallarés-Carratala V. [Clinical and practical management of sodium-glucose cotransporter type 2 inhibitors in patients with chronic kidney disease]. Semergen 2023; 49 Suppl 1:102020. [PMID: 37355299 DOI: 10.1016/j.semerg.2023.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 06/26/2023]
Abstract
The discovery of the nephroprotective role of sodium-glucose cotransporter type 2 (iSGLT2) inhibitor drugs in people with type 2 diabetes mellitus (DM 2) following the results obtained in the respective cardiovascular safety trials led to a change in the approach to diabetic kidney disease in recent years, positioning this group in the first step in the treatment of this comorbidity. The publication of the results of the DAPA-CKD study with dapagliflozin, demonstrating its benefit in slowing the progression of chronic kidney disease (CKD) in patients with and without DM, has opened a new age in the management of this pathology. These drugs are also safe and easy to use for the clinician. This article reviews the management of iSGLT2 in patients with diabetic and non-diabetic CKD.
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Affiliation(s)
| | | | - V Pallarés-Carratala
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Departamento de Medicina, Universitat Jaume I. Castellón, Castellón, España
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Bover J, García-Maset R. On the wide campaign and authorship matters of «kidneys also speak Spanish». Nefrologia 2023; 43:144-145. [PMID: 36997469 DOI: 10.1016/j.nefroe.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 06/12/2023] Open
Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, Badalona (Barcelona), Spain.
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24
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[Response to the reflections raised in «Impact of diabetes and hypertension training on chronic kidney disease. Determinants of renal function loss» on «Impact of training in in patients with diabetes and/or hypertension for the prevention of renal and cardiovascular disease in primary care»]. Semergen 2023; 49:101827. [PMID: 36162329 DOI: 10.1016/j.semerg.2022.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023]
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25
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Vázquez-Atanacio MJ, Bautista M, González-Cortazar M, Romero-Estrada A, De la O-Arciniega M, Castañeda-Ovando A, Sosa-Gutiérrez CG, Ojeda-Ramírez D. Nephroprotective Activity of Papaloquelite ( Porophyllum ruderale) in Thioacetamide-Induced Injury Model. PLANTS (BASEL, SWITZERLAND) 2022; 11:3460. [PMID: 36559573 PMCID: PMC9784717 DOI: 10.3390/plants11243460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Acute kidney injury and impaired kidney function is associated with reduced survival and increased morbidity. Porophyllum ruderale is an edible plant endemic to Mexico used in Mexican traditional medicine. The aim of this study was to evaluate the nephroprotective effect of a hydroalcoholic extract (MeOH:water 70:30, v/v) from the aerial parts of P. ruderale (HEPr). Firstly, in vitro the antioxidant and anti-inflammatory activity of HEPr was determined; after the in vivo nephroprotective activity of HEPr was evaluated using a thioacetamide-induced injury model in rats. HEPr showed a slight effect on LPS-NO production in macrophages (15% INO at 40 µg/mL) and high antioxidant activity in the ferric reducing antioxidant power (FRAP) test, followed by the activity on DPPH and ABTS radicals test (69.04, 63.06 and 32.96% of inhibition, respectively). In addition, values of kidney injury biomarkers in urine (urobilinogen, hemoglobin, bilirubin, ketones, glucose, protein, pH, nitrites, leukocytes, specific gravity, and the microalbumin/creatinine) and serum (creatinine, urea, and urea nitrogen) of rats treated with HEPr were maintained in normal ranges. Finally, 5-O-caffeoylquinic, 4-O-caffeoylquinic and ferulic acids; as well as 3-O-quercetin glucoside and 3-O-kaempferol glucoside were identified by HPLC as major components of HEPr. In conclusion, Porophyllum ruderale constitutes a source of compounds for the treatment of acute kidney injury.
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Affiliation(s)
- María José Vázquez-Atanacio
- Área Académica de Medicina Veterinaria y Zootecnia, Instituto de Ciencias Agropecuarias, Universidad Autónoma del Estado de Hidalgo, Av. Universidad Km 1, Ex-Hda. de Aquetzalpa, Tulancingo 43600, Hidalgo, Mexico
- Área Académica de Farmacia, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex Hacienda la Concepción s/n, San Agustín Tlaxiaca 42160, Hidalgo, Mexico
| | - Mirandeli Bautista
- Área Académica de Farmacia, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex Hacienda la Concepción s/n, San Agustín Tlaxiaca 42160, Hidalgo, Mexico
| | - Manasés González-Cortazar
- Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social, Argentina No. 1., Centro, Xochitepec 62790, Morelos, Mexico
| | - Antonio Romero-Estrada
- Departamento de Madera, Celulosa y Papel, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Km 15.5 Carretera Guadalajara-Nogales, Col. Las Agujas, Zapopan 45100, Jalisco, Mexico
| | - Minarda De la O-Arciniega
- Área Académica de Farmacia, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex Hacienda la Concepción s/n, San Agustín Tlaxiaca 42160, Hidalgo, Mexico
| | - Araceli Castañeda-Ovando
- Área Académica de Química, Instituto de Ciencias Básicas e Ingeniería, Universidad Autónoma del Estado de Hidalgo, Pachuca-Tulancingo km 4.5 Carboneras, Mineral de la Reforma 42184, Hidalgo, Mexico
| | - Carolina G. Sosa-Gutiérrez
- Área Académica de Medicina Veterinaria y Zootecnia, Instituto de Ciencias Agropecuarias, Universidad Autónoma del Estado de Hidalgo, Av. Universidad Km 1, Ex-Hda. de Aquetzalpa, Tulancingo 43600, Hidalgo, Mexico
| | - Deyanira Ojeda-Ramírez
- Área Académica de Medicina Veterinaria y Zootecnia, Instituto de Ciencias Agropecuarias, Universidad Autónoma del Estado de Hidalgo, Av. Universidad Km 1, Ex-Hda. de Aquetzalpa, Tulancingo 43600, Hidalgo, Mexico
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Maria Tablado MA. Accuracy in the diagnosis of hypertension and CKD is key to determine their possible association. Endocrine 2022; 78:642-643. [PMID: 35869973 DOI: 10.1007/s12020-022-03149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022]
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Oliva-Damaso N, Delanaye P, Oliva-Damaso E, Payan J, Glassock RJ. Risk-based versus GFR threshold criteria for nephrology referral in chronic kidney disease. Clin Kidney J 2022; 15:1996-2005. [PMID: 36325015 PMCID: PMC9613424 DOI: 10.1093/ckj/sfac104] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 02/22/2024] Open
Abstract
Chronic kidney disease (CKD) and kidney failure are global health problems associated with morbidity, mortality and healthcare costs, with unequal access to kidney replacement therapy between countries. The diversity of guidelines concerning referral from primary care to a specialist nephrologist determines different outcomes around the world among patients with CKD where several guidelines recommend referral when the glomerular filtration rate (GFR) is <30 mL/min/1.73 m2 regardless of age. Additionally, fixed non-age-adapted diagnostic criteria for CKD that do not distinguish correctly between normal kidney senescence and true kidney disease can lead to overdiagnosis of CKD in the elderly and underdiagnosis of CKD in young patients and contributes to the unfair referral of CKD patients to a kidney specialist. Non-age-adapted recommendations contribute to unnecessary referral in the very elderly with a mild disease where the risk of death consistently exceeds the risk of progression to kidney failure and ignore the possibility of effective interventions of a young patient with long life expectancy. The opportunity of mitigating CKD progression and cardiovascular complications in young patients with early stages of CKD is a task entrusted to primary care providers who are possibly unable to optimally accomplish guideline-directed medical therapy for this purpose. The shortage in the nephrology workforce has classically led to focused referral on advanced CKD stages preparing for kidney replacement, but the need for hasty referral to a nephrologist because of the urgent requirement for kidney replacement therapy in advanced CKD is still observed and changes are required to move toward reducing the kidney failure burden. The Kidney Failure Risk Equation (KFRE) is a novel tool that can guide wiser nephrology referrals and impact patients.
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Affiliation(s)
- Nestor Oliva-Damaso
- Department of Medicine, Division of Nephrology, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liege, Centre Hospitalier Universitaire Sart Tilman, ULgCHU, Liege, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Elena Oliva-Damaso
- Department of Medicine, Division of Nephrology, Hospital Universitario Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | - Juan Payan
- Department of Medicine, Division of Nephrology, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - Richard J Glassock
- Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ruiz-Garcia A, Arranz-Martínez E, Iturmendi-Martínez N, Fernández-Vicente T, Rivera-Teijido M, García-Álvarez JC. Tasas de prevalencia de enfermedad renal crónica y su asociación con factores cardiometabólicos y enfermedades cardiovasculares. Estudio SIMETAP-ERC. CLÍNICA E INVESTIGACIÓN EN ARTERIOSCLEROSIS 2022; 35:64-74. [PMID: 35945036 DOI: 10.1016/j.arteri.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease (ACVD). The aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors. METHODS Cross-sectional observational study conducted in primary care setting. Population-based random sample: 6,588 people between 18 and 102 years old (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate according to CKD-EPI, and their associations with cardiometabolic factors and ACVD were determined. RESULTS The crude prevalence of CKD was 11.48% (95%CI: 10.72-12.27%), without significant difference between men (11.64% [95%CI: 10.49-12.86%]) and women (11.35% [95%CI: 10.34-12.41%]). The age- and sex-adjusted prevalence rate of CKD was 9.16% (men: 8.61%; women: 9.69%). The prevalence of low estimated glomerular filtration rate (<60mL/min/1.73m2) and albuminuria (≥30mg/g) were 7.95% (95%CI: 7.30-8.61) and 5.98% (95%CI: 5.41-6.55), respectively. Hypertension, diabetes, prediabetes, increased waist-to-height ratio, heart failure, atrial fibrillation, and ACVD were independently associated with CKD (P<.001). Very high cardiovascular risk according to SCORE was found in 77.51% (95%CI: 74.54-80.49) of the population with CKD. CONCLUSIONS The adjusted prevalence of CKD was 9.2% (low estimated glomerular filtration rate: 8.0%; albuminuria: 6.0%). Most of the patients with CKD had very high cardiovascular risk. Hypertension, diabetes, prediabetes, increased waist-to-height ratio and ACVD were independently associated with CKD.
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Romero-González G, Bover J, Arrieta J, Salera D, Troya M, Graterol F, Ureña-Torres P, Cozzolino M, Di Lullo L, Cippà PE, Urrutia M, Paúl-Martinez J, Boixeda R, Górriz JL, Ara J, Bayés-Genís A, Bellasi A, Ronco C. The "FIFTY SHADOWS" of the RALES Trial: Lessons about the Potential Risk of Dietary Potassium Supplementation in Patients with Chronic Kidney Disease. J Clin Med 2022; 11:3970. [PMID: 35887733 PMCID: PMC9318835 DOI: 10.3390/jcm11143970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Hyperkalaemia (HK) is one of the most common electrolyte disorders and a frequent reason for nephrological consultations. High serum potassium (K+) levels are associated with elevated morbidity and mortality, mainly due to life-threatening arrhythmias. In the majority of cases, HK is associated with chronic kidney disease (CKD), or with the use of renin-angiotensin-aldosterone system inhibitors (RAASis) and/or mineral corticoid antagonists (MRAs). These drugs represent the mainstays of treatment in CKD, HF, diabetes, hypertension, and even glomerular diseases, in consideration of their beneficial effect on hard outcomes related to cardiovascular events and CKD progression. However, experiences in relation to the Randomised Aldactone Evaluation Study (RALES) cast a long shadow that extends to the present day, since the increased risk for HK remains a major concern. In this article, we summarise the physiology of K+ homeostasis, and we review the effects of dietary K+ on blood pressure and cardiovascular risk in the general population and in patients with early CKD, who are often not aware of this disease. We conclude with a note of caution regarding the recent publication of the SSaSS trial and the use of salt substitutes, particularly in patients with a limited capacity to increase K+ secretion in response to an exogenous load, particularly in the context of "occult" CKD, HF, and in patients taking RAASis and/or MRAs.
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Affiliation(s)
- Gregorio Romero-González
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
- REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916 Barcelona, Spain
- International Renal Research Institute of Vicenza, 36100 Vicenza, Italy;
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
- REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916 Barcelona, Spain
| | - Javier Arrieta
- Nephrology Department, University Hospital Basurto, 48013 Bilbao, Spain;
| | - Davide Salera
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (D.S.); (P.E.C.); (A.B.)
| | - Maribel Troya
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Fredzzia Graterol
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Pablo Ureña-Torres
- AURA Nord Saint Ouen Dialysis Service, 93400 Saint Ouen, France;
- Service d’Explorations Fonctionnelles Rénales, Hôpital Necker, Université Paris V, René Descartes, 75006 Paris, France
| | - Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy;
| | - Luca Di Lullo
- Nephrology Department, Parodi-Delfino Hospital, 00034 Colleferro, Italy;
| | - Pietro E. Cippà
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (D.S.); (P.E.C.); (A.B.)
| | - Marina Urrutia
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Javier Paúl-Martinez
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Ramón Boixeda
- Internal Medicine Department, Mataró Hospital, 08304 Mataró, Spain;
| | - José Luis Górriz
- Department of Nephrology, Clínico University Hospital, INCLIVA, Universitat de València, 46010 Valencia, Spain;
| | - Jordi Ara
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Antoni Bayés-Genís
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol (HGTiP), 08916 Badalona, Spain;
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Antonio Bellasi
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (D.S.); (P.E.C.); (A.B.)
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, 36100 Vicenza, Italy;
- Department of Nephrology, DIMED–University of Padova, 35122 Padova, Italy
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Tablado MAM. Importancia del género en las recomendaciones de las guías KDIGO. Diabetes y ERC. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Martínez-Urbano J, Rodríguez-Durán A, Parra-Martos L, Crespo-Montero R. Análisis del tratamiento conservador en el paciente con enfermedad renal crónica terminal. Revisión sistemática. ENFERMERÍA NEFROLÓGICA 2022. [DOI: 10.37551/2254-28842022012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: Desde hace unos años, debido a la inclusión de pacientes con enfermedad renal crónica cada vez más mayores en tratamiento renal sustitutivo, se viene ofreciendo como otra opción, tratamiento renal conservador, con resultados similares en algunas series al tratamiento dialítico.Objetivo: Revisar la literatura científica existente sobre el tratamiento renal conservador en pacientes con enfermedad renal crónica, su supervivencia y calidad de vida.Metodología: Se ha llevado a cabo una revisión sistemática. Se realizó una búsqueda en las bases de datos PubMed, ProQuest, Scielo y Scopus. Se incluyeron artículos científicos en español e inglés, y texto completo disponible. Se analizaron aquellos artículos que trataban sobre pacientes renales en estadío final de la enfermedad renal crónica terminal, tratados con tratamiento paliativo únicamente o en comparación con el tratamiento renal sustitutivo.Resultados: Se han incluido 15 artículos publicados entre los años 2010 y 2020. La enfermedad renal crónica es un problema de alta prevalencia en nuestra población, lo cual condiciona los tratamientos sustitutivos de la función renal. El tratamiento renal conservador surge como opción al sustitutivo, en aquellos pacientes mayores o con una corta expectativa de vida. Como factores más importantes a tener en cuenta surgen la supervivencia y la calidad de vida.Conclusiones: En el paciente con enfermedad renal crónica en tratamiento renal sustitutivo la supervivencia es mayor, aunque con peor calidad de vida, mientras que en el caso del tratamiento renal conservador suele ser al contrario. En pacientes mayores de 75-80 años la supervivencia se iguala, siendo necesario potenciar la calidad de vida y paliar los síntomas de la enfermedad
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Affiliation(s)
- Julia Martínez-Urbano
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Ana Rodríguez-Durán
- Servicio de Nefrología. Hospital Universitario Reina Sofía de Córdoba. España
| | - Lucía Parra-Martos
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España
| | - Rodolfo Crespo-Montero
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. España. Servicio de Nefrología. Hospital Universitario Reina Sofía de Córdoba. España. Instituto Maimónides de Investigación Biomédica de Córdoba. España
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Gippini A, Prado A. Cardiorenal prevention as the key player in the reduction of all-cause mortality. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bover J, García-Maset R. Sobre la amplia difusión y autoría de «los riñones también hablan español». Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bover J, Bosch R, Górriz JL, Ureña P, Ortiz A, daSilva I, García-Trabanino RA, Hueso M, Trinidad P, Jara A, Furlano M, Gelpi R, Vila-Santandreu A, Restrepo CA, Sánchez-Baya M, Arana C, Goicoechea M, Coll V, Segura J, Gutiérrez O, Kalantar-Zadeh K, Sánchez E, Ferreiro A, García-Maset R. Kidneys also speak Spanish: Initiatives towards standardisation of our nephrology nomenclature. Nefrologia 2021; 42:S0211-6995(21)00157-0. [PMID: 34452777 DOI: 10.1016/j.nefro.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España.
| | - Ricardo Bosch
- Departamento de Biología de Sistemas, Unidad de Fisiología, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario. INCLIVA. Universidad de Valencia, Valencia, España
| | - Pablo Ureña
- AURA Nord Saint Ouen. Saint Ouen, Francia y Department of Renal Physiology. Necker Hospital, University of Paris Descartes, París, Francia
| | - Alberto Ortiz
- Servicio de Nefrología e Hipertensión. IIS-Fundación Jiménez Díaz-UAM, Madrid, España
| | - Iara daSilva
- Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma, Badalona, España
| | - Ramón A García-Trabanino
- Centro de Hemodiálisis de San Salvador, Fondo Social de Emergencia para la Salud de Tierra Blanca, El Salvador, España
| | - Miguel Hueso
- Servicio de Nefrología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Grupo de trabajo sobre BigData e Inteligencia Artificial (BigSEN) de la Sociedad Española de Nefrología, Barcelona, España
| | - Pedro Trinidad
- Departamento de Nefrología, HECMN siglo XXI. IMSS, Ciudad de México, México
| | - Aquiles Jara
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mónica Furlano
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Rosana Gelpi
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Hospital de Caldas, Universidad de Caldas, Manizales, Colombia
| | - Ana Vila-Santandreu
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España
| | - César A Restrepo
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Maya Sánchez-Baya
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Carolt Arana
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Marián Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Verónica Coll
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Julián Segura
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Orlando Gutiérrez
- Division of Nephrology, Department of Medicine. University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension and Kidney Transplantation, Orange. University of California Los Angeles, Los Angeles, California, USA
| | - Emilio Sánchez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, España
| | - Alejandro Ferreiro
- Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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