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Pascual J, Marcén R, Orofino L, Quereda C, Teruel JL, Mampaso F, Liaño F, Villafruela JJ, Ortuño J. Long-term beneficial effects of azathioprine addition to ongoing cyclosporine-prednisone protocol in renal transplantation. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quereda C, Orofino L, Marcen R, Sabater J, Matesanz R, Ortuño J. Influence of Dialysate and Membrane Biocompatibility on Hemodynamic Stability in Hemodialysis. Int J Artif Organs 2018. [DOI: 10.1177/039139888801100409] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The contributions of membrane biocompatibility, dialysate temperature and sodium concentration to hemodynamic stability during hemodialysis were studied in 8 patients with a high incidence of hemodialysis-induced symptomatic hypotension. Patients were treated during 8 different periods, randomly ordered in each case, resulting from the combination of the following: the membrane, either Cuprophan or Polyacrylonitrile; the dialysate temperature, 37 or 35°C, and the sodium concentration, 133 or 139 mmol/l. The incidence of symptomatic hypotension was lower at 35°C in the entire study with either membrane and either sodium concentration. It was also lower with a sodium concentration of 139 mmol/l with either temperature and either membrane. There was a lower incidence of symptomatic hypotension when using Polyacrylonitrile, but this difference was not significant. We conclude that changes in physicochemical parameters of dialysate lead to worth-while improvement of symptomatic hypotension in hemodialysis patients, but membrane biocompatibility seems to play a minor role.
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Affiliation(s)
- C. Quereda
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - L. Orofino
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - R. Marcen
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - J. Sabater
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - R. Matesanz
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
| | - J. Ortuño
- Servicio de Nefrologia Hospital Ramon y Cajal Madrid - Spain
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Marcen R, Lamas S, Orofino L, Quereda C, Barcia F, Castro J, De Caso PA, Ortuño J. Dipyridamole Thallium-201 Perfusion Imaging for the Study of Ischemic Heart Disease in Hemodialysis Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139888901201207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To assess the usefulness of dipyridamole thallium perfusion imaging in the evaluation of myocardial perfusion in hemodialysis (HD), we studied 29 HD patients divided into three groups: A) 13 patients with clinical angina, B) 8 patients without angina but similar in age, sex, time on HD and hematocrit and C) 8 young asymptomatic patients (mean age 33 ± 9.7 years). Dipyridamole thallium-201 (TI-201) perfusion imaging revealed myocardial perfusion defects in 8 patients (61%) from group A, 4 (50%) from group B and 1 (12.5%) from group C. These defects were localized in the inferior, posterior and septal segments of the left ventricle. Abnormal myocardial perfusion was associated with age over 50 years and aortic calcifications (p < 0.05). Eight patients died within the following four years. All had aortic calcifications (p < 0.001). Our results show that myocardial perfusion defects are frequent even in non-symptomatic HD patients. This suggests that ischemic heart disease could be more frequent than estimated by clinical symptoms alone. TI-201 scintigraphy may be a useful non-invasive procedure in cardiological evaluation of HD patients
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Affiliation(s)
- R. Marcen
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
| | - S. Lamas
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
| | - L. Orofino
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
| | - C. Quereda
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
| | - F. Barcia
- Cardiology, Hospital Ramon Y Cajal, Madrid - Spain
| | - J.M. Castro
- Nuclear Medicine, Hospital Ramon Y Cajal, Madrid - Spain
| | | | - J. Ortuño
- Departments of Nephrology, Hospital Ramon Y Cajal, Madrid - Spain
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Vivancos M, Moreno A, Quereda C. Tratamiento del virus de la hepatitis C con antivirales de acción directa: Aspectos prácticos y situación actual. Rev Clin Esp 2018; 218:29-37. [DOI: 10.1016/j.rce.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/04/2017] [Accepted: 07/10/2017] [Indexed: 12/16/2022]
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Vivancos M, Moreno A, Quereda C. Treatment of hepatitis C virus with direct-acting antivirals: Practical aspects and current situation. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Myeloradiculitis is a rare neurological complication of herpes simplex type 2 (HSV-2) infection, frequently associated with a fatal outcome. Among patients with HIV infection, HSV-2 myeloradiculitis has occasionally been reported, always associated with advanced immunosuppression and AIDS. We report a patient with HIV infection but no history of previous opportunistic infections, who developed sacral myeloradiculitis immediately after an episode of genital herpes. Magnetic resonance imaging with gadolinium showed necrotizing myelitis in the conus medullaris and enhancement of sacral roots. CD4 lymphocyte count was 530/mm3. Other possible causes of myeloradiculitis in HIV-infected patients were appropriately excluded. Acyclovir therapy resulted in partial clinical improvement. This report shows that myeloradiculitis as a complication of genital herpes may occur in the early stages of HIV infection and may have a favourable outcome with antiviral treatment.
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Affiliation(s)
- I Corral
- Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain.
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Sainz-de-la-Maza S, Casado JL, Pérez-Elías MJ, Moreno A, Quereda C, Moreno S, Corral I. Incidence and prognosis of immune reconstitution inflammatory syndrome in HIV-associated progressive multifocal leucoencephalopathy. Eur J Neurol 2016; 23:919-25. [PMID: 26914970 DOI: 10.1111/ene.12963] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Progressive multifocal leucoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-IRIS) is the paradoxical worsening or unmasking of preexisting infection with JC virus attributable to a rapid recovery of the immune system after highly active antiretroviral therapy (HAART) initiation. We investigated the incidence and factors associated with PML-IRIS in HIV-infected patients. We also studied its influence on mortality of PML and the effect of corticosteroid therapy. METHODS Single-center retrospective analysis of HIV-infected patients diagnosed with PML from 1996 to 2012 who received HAART. RESULTS Among 59 PML patients treated with HAART, 18 (30.51%) developed PML-IRIS (five delayed PML-IRIS, 13 simultaneous PML-IRIS). Patients who developed IRIS had lower CD4 counts prior to treatment (102 vs. 68.5, P < 0.05) and experienced a greater decline in HIV-RNA levels in response to HAART (2.5log vs. 2.95log, P < 0.05). Gadolinium enhancement on MRI was observed in 31.25% of PML-IRIS cases versus 2.56% of PML non-IRIS (P < 0.01). Survival rates were higher in patients with PML-IRIS compared to those with PML non-IRIS. Eight patients received corticosteroids, five of which had a good outcome. Patients who died were severely ill when treatment was initiated whereas patients who survived were treated before major neurological deterioration occurred. CONCLUSIONS Nearly one-third of HIV-infected patients with PML develop IRIS after initiating HAART. Patients severely immunocompromised who experience a rapid virological response to HAART have a higher risk for PML-IRIS. There was a trend for lower mortality in patients with IRIS. Early treatment with corticosteroids might be useful.
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Affiliation(s)
- S Sainz-de-la-Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J L Casado
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M J Pérez-Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Quereda
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - S Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - I Corral
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Casado JL, Mena A, Bañón S, Castro A, Quereda C, Moreno A, Pedreira J, Moreno S. Liver toxicity and risk of discontinuation in HIV/hepatitis C virus-coinfected patients receiving an etravirine-containing antiretroviral regimen: influence of liver fibrosis. HIV Med 2015; 17:62-7. [PMID: 26122981 DOI: 10.1111/hiv.12274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the study was to establish the risk of liver toxicity in HIV/hepatitis C virus (HCV)-coinfected patients receiving etravirine, according to the degree of liver fibrosis. METHODS A prospective cohort study of 211 HIV-infected patients initiating an etravirine-containing regimen was carried out. HCV coinfection was defined as a positive HCV RNA test, and baseline liver fibrosis was assessed by transient elastography. Hepatotoxicity was defined as clinical symptoms, or an aspartate aminotransferase (AST) or alanine aminotransferase (ALT) value > 5-fold higher than the upper limit of normal if baseline values were normal, or 3.5-fold higher if values were altered at baseline. RESULTS Overall, 145 patients (69%) were HCV coinfected, with a lower nadir (165 versus 220 cells/μL, respectively; p = 0.03) and baseline (374 versus 498 cells/μL, respectively; p = 0.04) CD4 count than monoinfected patients. Etravirine was mainly used with two nucleoside reverse transcriptase inhibitors (129; 61%) or with a boosted protease inhibitor (PI) (28%), with no significant differences according to HCV serostatus. Transient elastography in 117 patients (81%) showed a median (range) stiffness value of 8.25 (3.5-69) kPa, with fibrosis stage 1 in 43 patients (37%) and fibrosis stage 4 in 28 patients (24%). During an accumulated follow-up time of 449.3 patient-years (median 548 days), only one patient with advanced fibrosis (50.8 kPa) had grade 3-4 liver toxicity (0.7%). Transaminases changed slightly, with no significant differences compared with baseline fibrosis, and nine and six patients had grade 1 and 2 transaminase increases, respectively. Also, HCV coinfection was not associated with a higher risk of discontinuation (25% discontinued versus 21% of monoinfected patients; p = 0.39, log-rank test) or virological failure (8% versus 12%, respectively; p = 0.4). CONCLUSIONS Our data suggest that etravirine is a safe option for HIV/HCV-coinfected patients, including those with significant liver fibrosis.
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Affiliation(s)
- J L Casado
- Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain
| | - A Mena
- Department of Internal Medicine, INIBIC-Complexo Universitario Hospitalario, A Coruña, Spain
| | - S Bañón
- Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain
| | - A Castro
- Department of Internal Medicine, INIBIC-Complexo Universitario Hospitalario, A Coruña, Spain
| | - C Quereda
- Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain
| | - A Moreno
- Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain
| | - J Pedreira
- Department of Internal Medicine, INIBIC-Complexo Universitario Hospitalario, A Coruña, Spain
| | - S Moreno
- Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain
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Rivera M, Marcén R, Maciá A, Lucas MF, Quereda C, Gonzalo A, Orofino L, Ortuño J. Renal transplantation in polycystic kidney disease. Contrib Nephrol 2015; 115:144-9. [PMID: 8585903 DOI: 10.1159/000424413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M Rivera
- Hospital Ramón y Cajal, Nephrology Service, Madrid, Spain
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Oyanguren B, Esteban L, Guillán M, de Felipe A, Alonso Cánovas A, Navas E, Quereda C, Corral I. Central nervous system involvement in adult patients with invasive infection caused by Streptococcus agalactiae. Neurología (English Edition) 2015. [DOI: 10.1016/j.nrleng.2015.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Berenguer J, Zamora FX, Aldámiz-Echevarría T, Von Wichmann MA, Crespo M, López-Aldeguer J, Carrero A, Montes M, Quereda C, Téllez MJ, Galindo MJ, Sanz J, Santos I, Guardiola JM, Barros C, Ortega E, Pulido F, Rubio R, Mallolas J, Tural C, Jusdado JJ, Pérez G, Díez C, Álvarez-Pellicer J, Esteban H, Bellón JM, González-García J, Miralles P, Cosín J, López J, Padilla B, Parras F, Carrero A, Aldamiz-Echevarría T, Tejerina F, Gutiérrez I, Ramírez M, Carretero S, Bellón J, Berenguer J, Alvarez-Pellicer J, Rodríguez E, Arribas J, Montes M, Bernardino I, Pascual J, Zamora F, Peña J, Arnalich F, Díaz M, González-García J, Bustinduy M, Iribarren J, Rodríguez-Arrondo F, Von-Wichmann M, Blanes M, Cuellar S, Lacruz J, Montero M, Salavert M, López-Aldeguer J, Callau P, Miró J, Gatell J, Mallolas J, Ferrer A, Galindo M, Van den Eynde E, Pérez M, Ribera E, Crespo M, Vergas J, Téllez M, Casado J, Dronda F, Moreno A, Pérez-Elías M, Sanfrutos M, Moreno S, Quereda C, Jou A, Tural C, Arranz A, Casas E, de Miguel J, Schroeder S, Sanz J, Condés E, Barros C, Sanz J, Santos I, Hernando A, Rodríguez V, Rubio R, Pulido F, Domingo P, Guardiola J, Ortiz L, Ortega E, Torres R, Cervero M, Jusdado J, Rodríguez-Zapata M, Pérez G, Gaspar G, Barquilla E, Ramírez M, Moyano B, Aznar E, Esteban H. Comparison of the Prognostic Value of Liver Biopsy and FIB-4 Index in Patients Coinfected With HIV and Hepatitis C Virus. Clin Infect Dis 2014; 60:950-8. [DOI: 10.1093/cid/ciu939] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Francisco X. Zamora
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | - Teresa Aldámiz-Echevarría
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | | | | | | | - Ana Carrero
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Marisa Montes
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | | | | | | | - José Sanz
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares
| | | | | | | | | | - Federico Pulido
- Hospital Universitario 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre
(i+12), Madrid
| | - Rafael Rubio
- Hospital Universitario 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre
(i+12), Madrid
| | | | | | | | | | - Cristina Díez
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Julio Álvarez-Pellicer
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | | | - José M. Bellón
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Juan González-García
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
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Oyanguren B, Esteban L, Guillán M, de Felipe A, Alonso Cánovas A, Navas E, Quereda C, Corral I. Central nervous system involvement in adult patients with invasive infection caused by Streptococcus agalactiae. Neurologia 2014; 30:158-62. [PMID: 25217065 DOI: 10.1016/j.nrl.2013.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/02/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Streptococcus agalactiae is frequently an asymptomatic coloniser and a cause of neonatal and puerperal sepsis. Infections in nonpregnant adults are uncommon. The frequency of neurological complications caused by invasive infection with this microorganism in adults remains unknown. Here, we study the frequency and characteristics of central nervous system (CNS) involvement in adults with invasive S. agalactiae infection. PATIENTS AND METHODS Review of all adults with invasive S. agalactiae infection between 2003 and 2011 in a tertiary hospital. RESULTS S. agalactiae was isolated from blood, CSF or synovial fluid in 75 patients. Among them, 7 (9,3%) displayed neurological involvement: 5 men and 2 nonpregnant women, aged between 20 and 62 years. Diagnoses were spinal epidural abscess due to spondylodiscitis with spinal cord compression; acute bacterial meningitis; ischemic stroke as presentation of bacterial endocarditis (2 patients each); and meningoventriculitis after neurosurgery and ventricular shunting. One patient with endocarditis caused by S. agalactiae and S. aureus died in the acute phase, and another died 3 months later from metastatic cancer. The other patients recovered without sequelae. All patients had systemic predisposing factors for infection and 5 (71,4%) had experienced disruption of the mucocutaneous barrier as a possible origin of the infection. CONCLUSIONS CNS involvement is not uncommon in adult patients with invasive infection caused by S. agalactiae. Isolating S. agalactiae, especially in cases of meningitis, should lead doctors to search for predisposing systemic disease and causes of mucocutaneous barrier disruption.
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Affiliation(s)
- B Oyanguren
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - L Esteban
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Guillán
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A de Felipe
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Alonso Cánovas
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - E Navas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Quereda
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - I Corral
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
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Elias S, Marcen R, Jimenez S, Fernandez A, Galeano C, Quereda C. Expanded Criteria Donors Allow Successful Expansion On the Donor and Recipient Pools. A Single Centre Experience. Transplantation 2014. [DOI: 10.1097/00007890-201407151-02012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Casado JL, Quereda C, Moreno A, Pérez-Elías MJ, Martí-Belda P, Moreno S. Regression of liver fibrosis is progressive after sustained virological response to HCV therapy in patients with hepatitis C and HIV coinfection. J Viral Hepat 2013; 20:829-37. [PMID: 24304452 DOI: 10.1111/jvh.12108] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/21/2013] [Indexed: 12/17/2022]
Abstract
There are few data about the long-term histological outcome of HIV-/HCV-coinfected patients after therapy with interferon and ribavirin. We performed an observational study of 216 patients who received therapy against HCV and who had at least three successive transient elastographies (TE) during the follow-up. The primary endpoint was confirmed fibrosis regression, defined as a reduction of at least 1 point in Metavir fibrosis score, confirmed and without worsening in successive TE. At baseline, 23% had fibrosis stage 4 or cirrhosis. Overall, 82 (38%) achieved sustained virological response (SVR), without differences in baseline fibrosis or time of follow-up. Confirmed fibrosis regression was observed in 55% of patients, higher for SVR (71% vs 44%; P < 0.01), and the likelihood of achieving fibrosis regression at 3, 5 and 7 years was 0.17, 0.51 and 0.67, respectively, for SVR patients, in comparison with 0.02, 0.23 and 0.41 for no SVR patients (P < 0.01, log-rank test at any time point). Progressive regression, defined as continuous improvement in successive TE, was observed in 62% of patients with advanced liver fibrosis or cirrhosis who achieved SVR. In a Cox regression model, only SVR (HR, 4.01; 95% CI, 2.33-7.57; P < 0.01) and a younger age (HR, 1.14; 95% CI, 1.05-1.25; P < 0.01; per year) were associated with fibrosis regression. This study confirms that the rate of liver fibrosis regression increases during the follow-up after SVR to interferon therapy in HIV-/HCV-coinfected patients.
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Affiliation(s)
- J L Casado
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain
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15
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Hernandez-Novoa B, Moreno A, Perez-Elias MJ, Quereda C, Dronda F, Casado JL, Madrid-Elena N, Aguilar M, Fumero E, Molto J, Moreno S. Raltegravir pharmacokinetics in HIV/HCV-coinfected patients with advanced liver cirrhosis (Child-Pugh C). J Antimicrob Chemother 2013; 69:471-5. [DOI: 10.1093/jac/dkt386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Marcén R, Jimenez S, Fernández A, Galeano C, Villafruela JJ, Burgos FJ, Quereda C. The effects of mineral metabolism markers on renal transplant outcomes. Transplant Proc 2013; 44:2567-9. [PMID: 23146456 DOI: 10.1016/j.transproceed.2012.09.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hyperparathyroidism is a common complication of chronic renal failure. A functioning kidney graft improves hyperparathyroidism but it can persist to some degree for years. Persistent hyperparathyroidism associated with hypercalcemia and hyperphosphatemia have been associated with poor graft and patient survivals. The purpose of the present work was to assess the association between calcium/phosphate mineral metabolism markers and graft outcomes. PATIENTS AND METHODS Among 389 renal transplantations performed in our center between January 2000 and June 2008, 331 patients had functioning grafts at 12 months, the subjects of this study. Measurements of intact parathyroid hormone (iPTH), serum calcium and phosphate, tubular phosphate reabsorption, and urinary calcium excretion were performed at 1, 3, 6, and 12 months. The mean follow-up was 84.0 ± 31.8 months. RESULTS During the follow-up period, 63 grafts (19.0%) were lost, 30 patients (9.0%) died, and 80 recipients (24.2%) presented at least one cardiovascular event. Univariate Cox proportional analysis showed high iPTH levels at 1 and 12 months after transplantation to not be associated with worse patient or graft survival or an higher risk of cardiovascular events. Serum phosphate and calcium concentrations as well as calcium-phosphate products during the first year after transplantation were not associated with graft and patient outcomes or cardiovascular events. However, serum calcium at 12 months showed an inverse association with graft survival after adjusting for other variables (hazard ratio 0.61; 95% confidence interval 0.40-0.94; P = .026). CONCLUSIONS iPTH levels and serum phosphate concentrations and calcium-phosphate products during the first year after transplantation were not associated with graft outcomes. The inverse association between adjusted calcium and graft survival should be studied further.
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Affiliation(s)
- R Marcén
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
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Fujii T, Suzuki S, Shinozaki M, Tanaka H, Bell S, Cooper S, Lomonte C, Libutti P, Chimienti D, Casucci F, Bruno A, Antonelli M, Lisi P, Cocola L, Basile C, Negri A, Del Valle E, Zanchetta M, Zanchetta J, Di Vico MC, Ferraresi M, Pia A, Aroasio E, Gonella S, Mongilardi E, Clari R, Moro I, Piccoli GB, Gonzalez-Parra E, Rodriguez-Osorio L, Ortiz-Arduan A, de la Piedra C, Egido J, Perez Gomez MV, Tabikh AA, Afsar B, Kirkpantur A, Imanishi Y, Yamagata M, Nagata Y, Ohara M, Michigami T, Yukimura T, Inaba M, Bieber B, Robinson B, Mariani L, Jacobson S, Frimat L, Bommer J, Pisoni R, Tentori F, Ciceri P, Elli F, Brancaccio D, Cozzolino M, Adamczak M, Wiecek A, Kuczera P, Sezer S, Bal Z, Tutal E, Kal O, Yavuz D, Y ld r m I, Sayin B, Ozelsancak R, Ozkurt S, Turk S, Ozdemir N, Lehmann R, Roesel M, Fritz P, Braun N, Ulmer C, Steurer W, Dagmar B, Ott G, Dippon J, Alscher D, Kimmel M, Latus J, Turkvatan A, Balci M, Mandiroglu S, Seloglu B, Alkis M, Serin M, Calik Y, Erkula S, Gorboz H, Afsar B, Mandiroglu F, Kirkpantur A, Lindley E, Cruz Casal M, Rogers S, Pancirova J, Kernc J, Copley JB, Fouque D, Kiss I, Kiss Z, Szabo A, Szegedi J, Balla J, Ladanyi E, Csiky B, orkossy O, Torok M, Turi S, Ambrus C, Deak G, Tisler A, Kulcsar I, K d r V, Altuntas A, Akp nar A, Orhan H, Sezer M, Filiopoulos V, Manolios N, Arvanitis D, Pani I, Panagiotopoulos K, Vlassopoulos D, Rodriguez-Ortiz ME, Canalejo A, Herencia C, Martinez-Moreno JM, Peralta-Ramirez A, Perez-Martinez P, Navarro-Gonzalez JF, Rodriguez M, Peter M, Gundlach K, Steppan S, Passlick-Deetjen J, Munoz-Castaneda JR, Almaden Y, Munoz-Castaneda JR, Peralta-Ramirez A, Rodriguez-Ortiz M, Herencia C, Martinez-Moreno J, Lopez I, Aguilera-Tejero E, Peter M, Gundlach K, Steppan S, Passlick-Deetjen J, Rodriguez M, Almaden Y, Hanafusa N, Masakane I, Ito S, Nakai S, Maeda K, Suzuki H, Tsunoda M, Ikee R, Sasaki N, Sato M, Hashimoto N, Wang MH, Hung KY, Chiang CK, Huang JW, Lu KC, Lang CL, Okano K, Yamashita T, Tsuruta Y, Hibi A, Miwa N, Kimata N, Tsuchiya K, Nitta K, Akiba T, Sasaki N, Tsunoda M, Ikee R, Sato M, Hashimoto N, Harb L, Komaba H, Kakuta T, Suzuki H, Suga T, Fukagawa M, Kikuchi H, Shimada H, Karasawa R, Suzuki M, Zhelyazkova-Savova M, Gerova D, Paskalev D, Ikonomov V, Zortcheva R, Galunska B, Jean G, Deleaval P, Hurot JM, Lorriaux C, Mayor B, Chazot C, Vannucchi H, Vannucchi MT, Martins JC, Merino JL, Teruel JL, Fernandez-Lucas M, Villafruela JJ, Bueno B, Gomis A, Paraiso V, Quereda C, Ibrahim FH, Fadhlina NZ, Ng EK, Thong KM, Goh BL, Sulaiman DM, Fatimah DAN, Evi DO, Siti SR, Wilson RJ, Keith M, Copley JB, Gros B, Galan A, Gonzalez-Parra E, Herrero JA, Oyaguez I, Keith M, Casado MA, Lucisano S, Coppolino G, Villari A, Cernaro V, Lupica R, Trimboli D, Aloisi C, Buemi M. CKD-MBD II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Díez-Aguilar M, Ruiz-Garbajosa P, Fernández-Olmos A, Guisado P, Del Campo R, Quereda C, Cantón R, Meseguer MA. Non-diphtheriae Corynebacterium species: an emerging respiratory pathogen. Eur J Clin Microbiol Infect Dis 2012; 32:769-72. [PMID: 23271676 DOI: 10.1007/s10096-012-1805-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/11/2012] [Indexed: 11/25/2022]
Abstract
The purpose of the study was to describe the microbiological and clinical features of ten cases of lower respiratory tract infection due to Corynebacterium striatum, Corynebacterium propinquum and Corynebacterium pseudodiphtheriticum. Respiratory samples were recovered from hospitalised patients who were diagnosed of pneumonia and exacerbations of chronic respiratory infections. The samples were Gram-stained and seeded on conventional bacterial growing media. Bacteria were identified by matrix-assisted linear desorption/ionisation-time-of-flight mass spectrometry (MALDI-TOF MS). Antibiotic susceptibility was tested by the disk diffusion method. All patients presented an acute respiratory onset, most of them in the context of an underlying disease and/or immunosuppression. In all patients, the microscopical examination of Gram-stained respiratory samples showed numerous polymorphonuclear cells and Gram-positive bacilli, suggestive of the Corynebacterium morphotype. A pure culture growth of Corynebacterium was obtained in the majority (72 %) of samples. The conclusions are that non-diphtheriae Corynebacterium species are an emerging cause of respiratory infection among patients with chronic respiratory disease and/or immunosuppression, and cannot always be considered as mere colonisers. The microorganism's predominance in Gram-stained purulent respiratory samples together with abundant growth in the culture is the key for the microbiological diagnosis.
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Affiliation(s)
- M Díez-Aguilar
- Department of Clinical Microbiology, Ramón y Cajal University Hospital, Madrid, Spain.
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Marcén R, Galeano C, Fernandez-Rodriguez A, Jiménez S, Teruel JL, Burgos FJ, Quereda C. Anemia at 1 year after kidney transplantation has a negative long-term impact on graft and patient outcomes. Transplant Proc 2012; 44:2593-5. [PMID: 23146465 DOI: 10.1016/j.transproceed.2012.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- R Marcén
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
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Miyazaki N, Matsumoto J, Alberici F, Palmisano A, Maritati F, Oliva E, Buzio C, Vaglio A, Mjoen G, Norby GE, Vikse BE, Svarstad E, Rune B, Knut A, Szymczak M, Kuzniar J, Kopec W, Marchewka Z, Klinger M, Arrizabalaga P, Silvarino R, Sant F, Espinosa G, Sole M, Cervera R, Gude D, Chennamsetty S, Demin A, Kozlov V, Lisukov I, Kotova O, Sizikov A, Sergeevicheva V, Demina L, Borjesson O, Wendt M, Avik A, Qureshi AR, Bratt J, Miller EJ, Gunnarsson I, Bruchfeld A, Sugiyama K, Hasegawa M, Yamamoto K, Hayashi H, Koide S, Murakami K, Tomita M, Yoshida S, Yuzawa Y, Yew S, Jayne D, Westman K, Hoglund P, Flossman O, Mahr A, Luqmani R, Robson J, Thervet E, Levi C, Guiard E, Roland M, Nochy D, Daniliuc C, Guillevin L, Mouthon L, Jacquot C, Karras A, Kimura Y, Morita H, Debiec H, Yamada H, Miura N, Banno S, Ronco P, Imai H, Shin DH, Famee D, Koo HM, Han SH, Choi KH, Yoo TH, Kang SW, Fofi C, Fofi C, Scabbia L, Festuccia F, Stoppacciaro A, Mene' P, Shimizu A, Fukui M, MII A, Kaneko T, Masuda Y, Iino Y, Katayama Y, Fukuda Y, Kuroki A, Matsumoto K, Akizawa T, Jurubita R, Ismail G, Bobeica R, Rusu E, Zilisteanu D, Andronesi A, Motoi O, Ditoiu V, Copaci I, Voiculescu M, Irazabal MV, Eirin A, Lieske JC, Beck LH, Dillon JJ, Nachman PH, Sethi S, Erickson SB, Cattran DC, Fervenza FC, Svobodova B, Hruskova Z, Janatkova I, Jancova E, Tesar V, Seo MS, Kwon SH, Lee EB, You JY, Hyun YK, Woo SA, Park MY, Choi SJ, Jeon JS, Noh H, Kim JG, Han DC, Hwang SD, Choi TY, Jin SY, Kwon SH, Loiacono E, Loiacono E, Defedele D, Puccinelli MP, Camilla R, Gallo R, Peruzzi L, Rollino C, Beltrame G, Ferro M, Vergano L, Campolo F, Amore A, Coppo R, Knoop T, Vikse BE, Svarstad E, Bostad L, Leivestad T, Bjorneklett R, Teranishi J, Yamamoto R, Nagasawa Y, Shoji T, Iwatani H, Okada N, Moriyama T, Yamauchi A, Tsubakihara Y, Imai E, Rakugi H, Isaka Y, Koo HM, Doh FM, Kim SJ, Kang SW, Choi KH, Han DS, Han SH, Suzuki Y, Matsuzaki K, Suzuki H, Okazaki K, Yanagawa H, Maiguma M, Muto M, Sato T, Horikoshi S, Novak J, Hotta O, Tomino Y, Gutierrez* E, Zamora I, Ballarin J, Arce Y, Jimenez S, Quereda C, Olea T, Martinez-Ara J, Segarra A, Bernis C, Garcia A, Goicoechea M, Garcia de Vinuesa S, Rojas J, Praga M, Ristovska V, Petrushevska G, Grcevska L, Knoop T, Vikse BE, Svarstad E, Bostad L, Leivestad T, Bjorneklett R, Satake K, Shimizu Y, Mugitani N, Suzuki H, Suzuki Y, Horikoshi S, Honda S, Shibuya K, Shibuya A, Tomino Y, Papale M, Rocchetti MT, DI Paolo S, Suriano IV, D'apollo A, Vocino G, Montemurno E, Varraso L, Grandaliano G, Gesualdo L, Huerta A, Bomback AS, Canetta PA, Radhakrishnan J, Herlitz L, Stokes B, D'agati V, Markowitz G, Appel GB, Ristovska V, Grcevska L, Mouna H, Nasr BD, Mrabet I, Ahmed L, Sabra A, Mohamed Ammeur F, Mezri E, Habib S, Innocenti M, Pasquariello A, Pasquariello G, Mattei P, Bottai A, Fumagalli G, Bozzoli L, Samoni S, Cupisti A, Caldin B, Hung J, Repizo L, Malheiros DM, Barros R, Woronik V, Giammarresi C, Bono L, Ferrantelli A, Tortorici C, Licavoli G, Rotolo U, Huang X, Wang Q, Shi M, Chen W, Liu Z, Scarpioni R, Cantarini L, Lazzaro A, Ricardi M, Albertazzi V, Melfa L, Concesi C, Vallisa D, Cavanna L, Gungor G, Ataseven H, Demir A, Solak Y, Biyik M, Ozturk B, Polat I, Kiyici A, Ozer Cakir O, Polat H, Martinez-Ara J, Castillo I, Carreno V, Aguilar A, Madero R, Hernandez E, Bernis C, Bartolome J, Gea F, Selgas R, El Aggan HAM, El Banawy HS, Wagdy E, Tchebotareva N, LI O, Bobkova I, Kozlovskaya L, Varshavskiy V, Golicina E, Chen Y, Gong Z, Chen X, Tang L, Zhou J, Cao X, Wei R, Koo EH, Koo EH, Park JH, Kim HK, Kim MS, Jang HR, Lee JE, Huh W, Kim DJ, Oh HY, Kim YG, Tchebotareva N, Bobkova I, Kozlovskaya L, LI O, Eskova O, Shvetsov M, Golytsina E, Varshavskiy V, Popova O, Quaglia M, Monti S, Fenoglio R, Menegotto A, Airoldi A, Izzo C, Rizzo MA, Dianzani U, Stratta P, Vaglio A, Vaglio A, Alberici F, Gianfreda D, Buzio C. Primary and secondary glomerulonephritis I. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Donadio C, Kanaki A, Martin-Gomez A, Garcia S, Palacios-Gomez M, Donadio C, Calia D, Colombini E, DI Francesco F, Ghimenti S, Kanaki A, Onor M, Tognotti D, Fuoco R, Marka-Castro E, Torres Zamora MI, Giron-Mino J, Jaime-Solis MA, Arteaga LM, Romero H, Marka-Castro E, Akonur A, Leypoldt K, Asola M, Culleton B, Eloot S, Glorieux G, Nathalie N, Vanholder R, Perez de Jose A, Verdalles Guzman U, Abad Esttebanez S, Vega Martinez A, Barraca D, Yuste C, Bucalo L, Rincon A, Lopez-Gomez JM, Bataille P, Celine P, Raymond A, Francois G, Herve L, Michel D, Jean Louis R, Zhu F, Kotanko P, Thijssen S, Levin NW, Papamichail N, Bougiakli M, Gouva C, Antoniou S, Gianitsi S, Vlachopanou A, Chachalos S, Naka K, Kaarsavvidou D, Katopodis K, Michalis L, Sasaki K, Yasuda K, Yamato M, Surace A, Rovatti P, Steckiph D, Bandini R, Severi S, Dellacasa Bellingegni A, Santoro A, Arias M, Arias M, Sentis A, Perez N, Fontsere N, Vera M, Rodriguez N, Arcal C, Ortega N, Uriza F, Cases A, Maduell F, Abbas SR, Abbas SR, Zhu F, Kotanko P, Levin NW, Georgianos P, Sarafidis P, Nikolaidis P, Lasaridis A, Ahmed A, Ahmed A, Kaoutar H, Mohammed B, Zouhir O, Balter P, Ginsberg N, Taylor P, Sullivan T, Usvyat LA, Levin NW, Kotanko P, Zabetakis P, Moissl U, Ferrario M, Garzotto F, Wabel P, Cruz D, Tetta C, Signorini MG, Cerutti S, Brendolan A, Ronco C, Heaf J, Axelsen M, Pedersen RS, Ahmed A, Ahmed A, Amine H, Oualim Z, Ammirati AL, Guimaraes de Souza NK, Nemoto Matsui T, Luiz Vieira M, Alves de Oliveira WA, Fischer CH, Dias Carneiro F, Iizuka IJ, Aparecida de Souza M, Mallet AC, Cruz Andreoli MC, Cardoso Dos Santos BF, Rosales L, Dou Y, Carter M, Thijssen S, Kotanko P, Testa A, Sottini L, Giacon B, Prati E, Loschiavo C, Brognoli M, Marseglia C, Tommasi A, Sereni L, Palladino G, Bove S, Bosticardo G, Schillaci E, Detoma P, Bergia R, Park JW, Moon SJ, Choi HY, Ha SK, Park HC, Liao Y, Zhang L, Fu P, Igarashi H, Suzuki N, Esashi S, Masakane I, Panichi V, De Ferrari G, Saffiotti S, Sidoti A, Biagioli M, Bianchi S, Imperiali P, Gabrielli C, Conti P, Patrone P, Rombola G, Falqui V, Mura C, Icardi A, Rosati A, Santori F, Mannarino A, Bertucci A, Steckiph D, Jeong J, Jeong J, Kim OK, Kim NH, Bots M, Den Hoedt C, Grooteman MP, Van der Weerd NC, Mazairac AHA, Levesque R, Ter Wee PM, Nube MJ, Blankestijn P, Van den Dorpel MA, Park Y, Jeon J, Tessitore N, Tessitore N, Bedogna V, Girelli D, Corazza L, Jacky P, Guillaume Q, Julien B, Marcinkowski W, Drozdz M, Milkowski A, Rydzynska T, Prystacki T, August R, Benedyk-Lorens E, Bladek K, Cina J, Janiszewska G, Kaczmarek A, Lewinska T, Mendel M, Paszkot M, Trafidlo E, Trzciniecka-Kloczkowska M, Vasilevsky A, Konoplev G, Lopatenko O, Komashnya A, Visnevsky K, Gerasimchuk R, Neivelt I, Frorip A, Vostry M, Racek J, Rajdl D, Eiselt J, Malanova L, Pechter U, Selart A, Ots-Rosenberg M, Krieter DH, Seidel S, Merget K, Lemke HD, Wanner C, Krieter DH, Canaud B, Lemke HD, Rodriguez A, Morgenroth A, Von Appen K, Dragoun GP, Wanner C, Fluck R, Fouque D, Lockridge R, Motomiya Y, Uji Y, Hiramatsu T, Ando Y, Furuta M, Furuta M, Kuragano T, Kida A, Yahiro M, Otaki Y, Hasuike Y, Nonoguchi H, Nakanishi T, Sain M, Sain M, Kovacic V, Ljutic D, Radic J, Jelicic I, Yalin SF, Yalin SF, Trabulus S, Yalin AS, Altiparmak MR, Serdengecti K, Ohtsuka A, Fukami K, Ishikawa K, Ando R, Kaida Y, Adachi T, Sugi K, Okuda S, Nesterova OB, Nesterova OB, Suglobova ED, Golubev RV, Vasiliev AN, Lazeba VA, Smirnov AV, Arita K, Kihara E, Maeda K, Oda H, Doi S, Masaki T, Hidaka S, Ishioka K, Oka M, Moriya H, Ohtake T, Nomura S, Kobayashi S, Wagner S, Gmerek A, Wagner J, Wizemann V, Eftimovska - Otovic N, Spaseska-Gjurovska K, Bogdanovska S, Babalj - Banskolieva E, Milovanceva M, Grozdanovski R, Pisani A, Riccio E, Mancini A, Ambuhl P, Astrid S, Ivana P, Martin H, Thomas K, Hans-Rudolf R, Daniel A, Denes K, Marco M, Wuthrich RP, Andreas S, Andrulli S, Altieri P, Sau G, Bolasco P, Pedrini LA, Basile C, David S, Feriani M, Nebiolo PE, Ferrara R, Casu D, Logias F, Tarchini R, Cadinu F, Passaghe M, Fundoni G, Villa G, DI Iorio BR, Zoccali C, Locatelli F, Kihara E, Arita K, Hamamoto M, Maeda K, Oda H, Doi S, Masaki T, Lee DY, Kim B, Moon KH, LI Z, Fu P, Ahrenholz P, Ahrenholz P, Winkler RE, Waitz G, Wolf H, Grundstrom G, Alquist M, Holmquist M, Christensson A, Bjork P, Abdgawad M, Ekholm L, Segelmark M, Corsi C, Santoro A, De Bie J, Mambelli E, Mortara D, Santoro A, Severi S, Arroyo D, Arroyo D, Panizo N, Quiroga B, Reque J, Melero R, Rodriguez-Ferrero M, Rodriguez-Benitez P, Anaya F, Luno J, Ragon A, James A, Brunet P, Ribeiro S, Faria MS, Rocha S, Rodrigues S, Catarino C, Reis F, Nascimento H, Fernandes J, Miranda V, Quintanilha A, Belo L, Costa E, Santos-Silva A, Arund J, Tanner R, Fridolin I, Luman M, Clajus C, Clajus C, Kielstein JT, Haller H, David S, Basile C, Basile C, Libutti P, Lisi P, Vernaglione L, Casucci F, Losurdo N, Teutonico A, Lomonte C, Krisp C, Gmerek A, Wagner J, Wolters DA, Pedrini LA, Matsuyama M, Tomo T, Ishida K, Matsuyama K, Nakata T, Kadota J, Caiazzo M, Monari E, Cuoghi A, Bellei E, Bergamini S, Palladino G, Tomasi A, Baranger T, Seniuta P, Berge F, Drouillat V, Frangie C, Rosier E, Labonia W, Lescano A, Rubio D, Von der Lippe N, Jorgensen JA, Osthus TB, Waldum B, Os I, Bossola M, DI Stasio E, Antocicco M, Tazza L, Griveas I, Karameris A, Pasadakis P, Savica V, Santoro D, Saitta S, Tigano V, Bellinghieri G, Gangemi S, Daniela R, Checherita IA, Ciocalteu A, Vacaroiu IA, Niculae A, Bladek K, Stefaniak E, Pietrzak I, Krupa D, Garred L, Santoro A, Mancini E, Corrazza L, Atti M, Afsar B, Stamopoulos D, Mpakirtzi N, Gogola B, Zeibekis M, Stivarou D, Panagiotou M, Grapsa E, Vega Vega O, Barraca Nunez D, Abad Esttebanez S, Bucalo L, Yuste C, Lopez-Gomez JM, Fernandez-Lucas M, Gomis A, Teruel JL, Elias S, Quereda C, Hignell L, Humphrey S, Pacy N, Stamopoulos D, Mpakirtzi N, Afentakis N, Grapsa E. Extracorporeal dialysis: techniques and adequacy. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ruiz-Irastorza G, Espinosa G, Frutos MA, Jiménez Alonso J, Praga M, Pallarés L, Rivera F, Robles Marhuenda Á, Segarra A, Quereda C. [Diagnosis and treatment of lupus nephritis]. Rev Clin Esp 2012; 212:147.e1-30. [PMID: 22361331 DOI: 10.1016/j.rce.2012.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- G Ruiz-Irastorza
- Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Bizkaia, España.
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Berenguer J, von Wichmann MA, Quereda C, Miralles P, Mallolas J, Lopez-Aldeguer J, Alvarez-Pellicer J, De Miguel J, Crespo M, Guardiola JM, Tellez MJ, Galindo MJ, Arponen S, Barquilla E, Bellon JM, Gonzalez-Garcia J, Miralles P, Cosin J, Lopez JC, Padilla B, Sanchez Conde M, Bellon JM, Gutierrez I, Ramirez M, Carretero S, Aldamiz-Echevarria T, Tejerina F, Berenguer J, Alvarez-Pellicer J, Rodriguez E, Arribas JR, Montes ML, Bernardino I, Pascual JF, Zamora F, Pena JM, Arnalich F, Gonzalez-Garcia J, Bustinduy MJ, Iribarren JA, Rodriguez-Arrondo F, Von-Wichmann MA, Blanes M, Cuellar S, Lacruz J, Montero M, Salavert M, Lopez-Aldeguer J, Callau P, Miro JM, Gatell JM, Mallolas J, Ferrer A, Galindo MJ, Van den Eynde E, Perez M, Ribera E, Crespo M, Vergas J, Tellez MJ, Casado JL, Dronda F, Moreno A, Perez-Elias MJ, Sanfrutos MA, Moreno S, Quereda C, Jou A, Tural C, Arranz A, Casas E, de Miguel J, Schroeder S, Sanz J, Condes E, Barros C, Sanz J, Santos I, Hernando A, Rodriguez V, Rubio R, Pulido F, Domingo P, Guardiola JM, Ortiz L, Ortega E, Torres L:R, Cervero M, Jusdado JJ, Montes ML, Perez G, Gaspar G, Barquilla E, Mahillo B, Moyano B, Cotarelo M, Aznar E, Esteban H. Effect of accompanying antiretroviral drugs on virological response to pegylated interferon and ribavirin in patients co-infected with HIV and hepatitis C virus. J Antimicrob Chemother 2011; 66:2843-9. [DOI: 10.1093/jac/dkr362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Galeano C, Marcén R, Jimenez S, Fernández Rodríguez A, Sosa H, Villafruela JJ, Teruel JL, Burgos FJ, Quereda C. Utilization of elderly kidney donors (>70 years) does not affect graft survival in the medium term. Transplant Proc 2011; 42:3935-7. [PMID: 21168591 DOI: 10.1016/j.transproceed.2010.08.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 08/30/2010] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- C Galeano
- Nephrology Department, Hospital Ramón y Cajal, Madrid, Spain.
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Marcén R, Galeano C, Fernández-Rodriguez A, Jiménez-Alvaro S, Teruel JL, Rivera M, Burgos FJ, Quereda C. Effects of the new immunosuppressive agents on the occurrence of malignancies after renal transplantation. Transplant Proc 2011; 42:3055-7. [PMID: 20970609 DOI: 10.1016/j.transproceed.2010.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- R Marcén
- Department of Nephrology, University of Alcalá de Henares, Hospital Ramón y Cajal, Madrid, Spain.
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Jiménez Álvaro S, Marcén R, Villacorta J, Fernández-Rodríguez A, Galeano C, Villafruela J, Teruel J, Burgos F, Quereda C. Cholecalciferol Supplements Improve Vitamin D Deficiency in Renal Transplant Recipients. Transplant Proc 2010; 42:2921-3. [DOI: 10.1016/j.transproceed.2010.07.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Merino JL, Galeano C, Espejo B, Rivera M, Fernandez-Lucas M, Caldes S, Plana MN, Letosa M, Teruel JL, Quereda C, Ortuno J. A retrospective study on outcome of microscopic polyangiitis in chronic renal replacement therapy. Nephrol Dial Transplant 2010; 26:1360-6. [DOI: 10.1093/ndt/gfq523] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Caldes S, Rivera M, Merino J, Amezquita Y, Blazquez J, Quereda C. Retroperitoneal Hematoma in a Peritoneal Dialysis Patient on Oral Anticoagulant Treatment Editor. Perit Dial Int 2010; 30:581-3. [DOI: 10.3747/pdi.2010.00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Caldes
- Nephrology Department, Hospital Ramón y Cajal Madrid, Spain
| | - M. Rivera
- Nephrology Department, Hospital Ramón y Cajal Madrid, Spain
| | - J.L. Merino
- Hospital Ramón y Cajal Nephrology, Hospital Ramón y Cajal Madrid, Spain
| | - Y. Amezquita
- Nephrology Department, Hospital Ramón y Cajal Madrid, Spain
| | - J. Blazquez
- Hospital Del Henares Interventional Radiology, Hospital Ramón y Cajal Madrid, Spain
| | - C. Quereda
- Nephrology Department, Hospital Ramón y Cajal Madrid, Spain
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Marcén R, Jimenez S, Fernández A, Galeano C, Villacorta J, Villafruela JJ, Teruel JL, Burgos FJ, Quereda C, Chan L. CHOLECALCIFEROL SUPPLEMENTS IMPROVE VITAMIN D DEFICIENCY IN RENAL TRANSPLANT RECIPIENTS. DEPARTMENTS OF NEPHROLOGY AND *UROLOGY. HOSPITAL RAMóN Y CAJAL. MADRID,. Transplantation 2010. [DOI: 10.1097/00007890-201007272-01895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alcázar R, Quereda C. [Digital NEFROLOGIA. A project for coming years]. Nefrologia 2010; 30:271-274. [PMID: 20514094 DOI: 10.3265/nefrologia.pre2010.apr.10406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Alcázar R, Tato A, García F, Barrios V, Quereda C. [Would prescription of erythropoiesis-stimulating agents in pre-dialysis change after results from TREAT study?]. Nefrologia 2009; 30:114-118. [PMID: 20038963 DOI: 10.3265/nefrologia.pre2009.dic.5903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 11/29/2009] [Indexed: 05/28/2023] Open
Affiliation(s)
- R Alcázar
- Servicios de Nefrología, Hospital Infanta Leonor, Spain
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Berenguer J, González-García J, López-Aldeguer J, Von-Wichmann MA, Quereda C, Hernando A, Sanz J, Tural C, Ortega E, Mallolas J, Santos I, Miralles P, Montes ML, Bellón JM, Esteban H. Pegylated interferon {alpha}2a plus ribavirin versus pegylated interferon {alpha}2b plus ribavirin for the treatment of chronic hepatitis C in HIV-infected patients. J Antimicrob Chemother 2009; 63:1256-63. [PMID: 19363085 DOI: 10.1093/jac/dkp106] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The two currently available types of pegylated interferon (peg-IFN) used to treat hepatitis C have different pharmacokinetic properties. It is unclear how these differences affect response to therapy. We compared the effectiveness and safety of peg-IFN-alpha2a and peg-IFN-alpha2b, both with ribavirin, against chronic hepatitis C virus (HCV) infection in HIV-infected patients. METHODS From the GESIDA HIV/HCV cohort, we analysed patients treated with peg-IFN-alpha2a (n = 315) or peg-IFN-alpha2b (n = 242). The primary endpoint was a sustained virological response (SVR). RESULTS Both groups were well matched in baseline characteristics except for a higher frequency of injection drug users in the peg-IFN-alpha2b group than in the peg-IFN-alpha2a group (85% versus 76%; P = 0.01) and a higher frequency of bridging fibrosis and cirrhosis (F3-F4) in the peg-IFN-alpha2b group than in the peg-IFN-alpha2a group (42% versus 33%; P = 0.04). End-of-treatment response was significantly lower among patients treated with peg-IFN-alpha2b [40% versus 52%; odds ratio (OR), 1.63; 95% confidence interval (95% CI), 1.16-2.29; P < 0.01]. However, no significant differences were found in SVR between patients treated with peg-IFN-alpha2b and those treated with peg-IFN-alpha2a (31% versus 33%; OR, 1.09; 95% CI, 0.75-1.59; P = 0.655). Therapy was interrupted due to adverse events in 33 (14%) patients treated with peg-IFN-alpha2b and 47 (15%) patients treated with peg-IFN-alpha2a. CONCLUSIONS No differences in effectiveness and safety were found between peg-IFN-alpha2b and peg-IFN-alpha2a for the treatment of chronic HCV infection in HIV-infected patients.
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Martínez Castelao A, Carratalà J, Fernández Fresnedo G, Fulladosa Oliveras X, Górriz JL, Portolés JM, Quereda C, Hernández RS. [The influenza virus A/H1N1 in the nephrological patient. The pandemic that has put us on alert]. Nefrologia 2009; 29:503-505. [PMID: 19935993 DOI: 10.3265/nefrologia.2009.29.6.5861.en.full] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Quereda C, Alcázar R, García López F, Martín de Francisco AL, Purroy A. [Nefrología 2008-2009]. Nefrologia 2009; 29:1-5. [PMID: 19240764 DOI: 10.3265/nefrologia.2009.29.1.1.1.en.full.pdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Quereda C, Alcázar R, García-López F, Purroy A. [Goals for Nefrología in a new era]. Nefrologia 2008; 28:1-7. [PMID: 18336121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Galeano C, Quereda C. [Is the failure rate in remission induction lower with mycophenolate mofetil than with cyclophosphamide in lupus nephritis?]. Nefrologia 2008; 28 Suppl 2:4-5. [PMID: 18457545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- C Galeano
- Servicio de Nefrología, Hospital Ramón Y Cajal, Madrid, Spain
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Barrio V, Quereda C. [Is therapy with intermittent hemodialysis better than using continuous techniques in acute renal failure in adult patients?]. Nefrologia 2008; 28 Suppl 2:22-23. [PMID: 18457553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- V Barrio
- Servicio de Nefrología, Hospital Infanta Sofia, Madrid, Spain
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Tural C, Solà R, Rubio R, Santín M, Planas R, Quereda C, Berenguer J, Montes-Ramírez M, Clotet B. Safety and efficacy of an induction dose of pegylated interferon alpha-2a on early hepatitis C virus kinetics in HIV/HCV co-infected patients: the CORAL-1 multicentre pilot study. J Viral Hepat 2007; 14:704-13. [PMID: 17875005 DOI: 10.1111/j.1365-2893.2007.00860.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
To evaluate the safety and efficacy of an induction dose of pegylated interferon alpha 2a (IFN-alpha2a) on the 12-week hepatitis C virus (HCV) kinetics in human immunodeficiency virus (HIV) patients co-infected with HCV. One hundred sixteen HIV/HCV co-infected patients from nine hospitals in Spain were randomized to receive 270 microg/week of pegylated IFN-alpha2a for 4 weeks followed by 180 microg/week for 8 weeks or 180 microg/week for 12 weeks. Ribavirin was given at a daily dose of 1000 or 1200 mg. The main outcome measure was the percentage of patients achieving an HCV-RNA below 50 IU/mL or a decrease of 2 or more log(10) at week 12 (early virologic response, EVR). HCV-RNA was measured at baseline, weekly, for the first 4 weeks and monthly thereafter. We observed no difference in the percentage of patients achieving an EVR between arms (on-treatment, 74% in both arms; intention-to-treat, 70% in the induction arm and 67% in the control arm), nor were there differences in the percentage achieving an undetectable HCV qualitative polymerase chain reaction at any time points or in the decrease in HCV-RNA from baseline. No differences were found between arms in the percentage of dropouts (8% in the whole study population). Our study failed to find a benefit of an induction dose of 270 microg/week of pegylated IFN-alpha2a for 4 weeks on the EVR in co-infected patients who are treatment naive. Despite the lack of benefit with this regimen, induction therapy with this schedule was safe and well tolerated in co-infected patients.
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Affiliation(s)
- C Tural
- HIV Clinical Unit, Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Merino JL, Cobo J, Innerarity J, Diz S, Quereda C. [The figure of Chief of Residents in the Residencing training: establishment and development in a Spanish hospital]. Rev Clin Esp 2007; 207:79-82. [PMID: 17397568 DOI: 10.1157/13100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Training qualified medical specialists is one of the great supports of the Spanish health care system. The teaching structure of the hospital is essential for the correct development of this training. The figure of the chief resident (CR) is widely developed in the USA and Canada, but not in our country. Including this figure in the teaching organigram of our hospital has meant one more advance in the search for improving our teaching capacity. In the following, we explain our experience during the introduction and later development of the figure of CR, stressing its theoretical functions, the notification mechanism, constitution of the Residents' Committee and later development of activities and tasks conducted. After three years, our experience is favorable, subject to modifications, but adaptable to the idiosyncrasy of each site.
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Affiliation(s)
- J L Merino
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
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Quereda C, Ballarín J, Galeano C, García López F, Praga M. [Immunosuppressive therapy of primary focal sclerosing glomerulonephritis in the adult: a systematic review]. Nefrologia 2007; 27:249-60. [PMID: 17725445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Affiliation(s)
- C Quereda
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
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Barrio V, Quereda C, Zamora J, García López F. [Does continuous veno-venous hemodiafiltration therapy reduce mortality due to acute renal failure as compared to intermittent hemodialysis?]. Nefrologia 2007; 27 Suppl 1:42-8. [PMID: 17763635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To estimate whether continuous veno-venous hemodiafiltration (CVVHDF) is superior to intermittent hemodialysis (IHD) in terms of survival of adult patients with acute renal failure (ARF) admitted to the Intensive Care Unit. SELECTION OF STUDIES Controlled clinical trials (CCT) and systematic reviews comparing CWHDF and IHD for managing ARF in adult patients (age > 19 years). Observational and case series were excluded. SEARCH SOURCES: The basic syntax <<hemodiafiltration OR continuous hemodi* OR continuous dialysis) and acute renal failure and acute renal insuficiency>> was used to search Pub Med and Ovid System databases. A manual search was done by reviewing the references in the corresponding topic of UpToDate. ANALYSIS Data were extracted by two author and their methodological quality was assessed according to the Cochrane Renal Group recommendations that include the procedure for assigning, blinding, intention to treat analysis, and follow-up. OUTCOMES VARIABLES: All data relating to mortality were extracted, specifying the time of collection, time and circumstances (mortality in the ICU or hospitalization). Values gathered are expressed as mortality rates in both the experimental group (CVVHDF) and the control group (IHD), indicating the absolute risk reduction (ARR) and its 95% confidence interval. OUTCOMES AGGREGATION: Studies meeting clinical and methodological homogeneity criteria were combined with the fix effect model by using the Review Manager tool from Cochrane Collaboration. Methodological heterogeneity was analyzed by using the chi-squared test for n-1 freedom degrees, with an alpha value of 0.05. A sensitivity analysis was done adjusting for methodological quality to confirm the results obtained. RESULTS Seven clinical trials directly comparing the survival of severe ARF patients in a prospective, randomized, and controlled way were identifiec. Almost all published estudies have quality problems because of being too small to study survival rates, treatment allocation problems and high numbers of loss to follow-up, differences in initial severity levels, or to premature study closure. When combining the results, it was observed that mortality was 64% for IHD and 65% for CVVHDF, with a relative risk of 0.98 (95% CI 0.89-1.07), p = 0.65, with no statistically significant heterogeneity between studies included. When excluding from the analysis the most questionable study due to selection bias, high loss to follow-up (21%), and baseline differences in co-variables influencing the study outcomes, the results are not changed, the observed mortality was 67% for extra-renal intermittent depurative techniques versus 65% for continous ones, with a relative risk of 1.03 (95% CI 0.94-1.14), p = 0.54, again with no statistically significant heterogeneity between studies included. CONCLUSION CVVHDF does not offer any benefit as compared to IHD in terms of survival and according to available data from the literature. However, continuous techniques bring other potential benefits such as hemodynamic stability, better tolerability of ultrafiltration, and depuration of solutes, which merit a systematic review to estimate and quantify their magnitude, and which would allow for better defining their place in the therapeutic armamentarium available for this high-mortality condition.
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Affiliation(s)
- V Barrio
- Unidad de Nefrología, Fundación Hospital de Alcorcón
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García López F, Quereda C. [Notes for the reading of a systematic review]. Nefrologia 2007; 27:417-24. [PMID: 17944578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- F García López
- Grupo de Nefrología Basada en la Evidencia de la Sociedad Española de Nefrología, Unidad de Epidemiología Clínica, Hospital Universitario Puerta de Hierro, Madrid
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Moreno A, Bárcena R, García-Garzón S, Moreno L, Quereda C, Muriel A, Zamora J, Mateos ML, Pérez-Elías MJ, Antela A, Diz S, Moreno A, Moreno S. Viral kinetics and early prediction of nonresponse to peg-IFN-alpha-2b plus ribavirin in HCV genotypes 1/4 according to HIV serostatus. J Viral Hepat 2006; 13:466-73. [PMID: 16792540 DOI: 10.1111/j.1365-2893.2005.00710.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
To evaluate, among 70 hepatitis C virus (HCV)-monoinfected and 36 human immunodeficiency virus (HIV)-coinfected naïve patients with genotypes 1/4 receiving weight-adjusted pegylated interferon-alpha-2b/ribavirin, viral kinetics and the feasibility to predict treatment failure measuring early HCV-RNA decreases. HCV-RNA was assessed at baseline, weeks 4, 12 and 24. Receiver operating characteristic (ROC) curves were calculated to determine the most sensitive cut-off values of viral decrease at week 4 predicting treatment failure. Baseline predictors of failure were evaluated by univariate and multivariate analyses. Despite similar baseline HCV-RNA (5.75 vs 5.72 log(10)IU/ml, P = 0.6), HCV monoinfection led to significantly lower HCV-RNA values at weeks 4 (3.7 vs 4.3 log(10)IU/ml, P = 0.01), 12 (2.3 vs 3.5 log(10)IU/ml, P = 0.01) and 24 (1.4 vs 3.3 log(10)IU/ml, P = 0.001) and a higher rates of viral clearance at weeks 24 (60%vs 36%, P = 0.02), 48 (46%vs 25%, P = 0.03) and 72 (37%vs 17%). The lack of achieving an HCV-RNA decrease of at least 1 log(10) at week 4 was highly predictive of treatment failure for HCV-monoinfected patients (Se 100%, Sp 50%, positive predictive value (PPV) 57%, negative predictive value (NPV) 100%, ROC curve area, 0.86 [95% confidence interval (CI) 0.77-0.95], but not for HCV/HIV-coinfected patients (cut-off, 0 log(10), Se 100%, Sp 27%, PPV 21%, NPV 100%, ROC curve area, 0.71 (95% CI 0.49-0.93). HIV coinfection was independently associated with failure (odds ratio 2.95, 95% CI 1.08-8.04, P = 0.01). Thus the magnitude of HCV-RNA decreases at week 4 correlated with treatment response. Significant differences in viral kinetics and cut-off values predicting nonresponse suggest a slower HCV clearance rate in HIV coinfection, which was independently associated with treatment failure.
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Affiliation(s)
- A Moreno
- Service of Infectious Diseases, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain.
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García AM, Corral I, Cobo J, Quereda C. [Pure alexia secondary to progressive multifocal leukoencephalopathy as first manifestation of HIV infection]. Neurologia 2006; 21:213-7. [PMID: 16832778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Pure alexia, or alexia without agraphia, is usually caused by disconnection between the gyrus angularis and visual areas of both hemispheres. Cerebrovascular disease is the most frequent cause of this syndrome. CLINICAL CASE We report the first case of a patient with pure alexia secondary to progressive multifocal leukoencephalopathy (PML) as the first manifestation of Human Immunodeficiency Virus (HIV) infection. Polymerase chain reaction in cerebrospinal fluid was positive for JC virus. Despite favorable immunological and virological response to highly active antiretroviral therapy, neurological symptoms and demyelinating lesions progressed during the first months, and right homonyous hemianopsia, acalculia, and color anomia were noted. In magnetic resonance imaging (MRI) demyelinating lesions involved white matter of both occipital lobes, with left predominance, forceps major and splenium of the corpus callosum, together with white matter of the left temporal lobe and both hippocampal regions. During the following months, coinciding cidofovir treatment, the patient had partial clinical improvement, but neurological deficits persisted. The size of MRI lesions significantly improved. CONCLUSIONS PML is frequently the first manifestation of AIDS (acquired immunodeficiency syndrome). It should be considered as a possible diagnosis of pure alexia.
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Affiliation(s)
- A M García
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid.
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Pascual Santos J, Quereda C, Zamora J. Steroid avoidance or withdrawal for kidney transplant recipients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [DOI: 10.1002/14651858.cd005632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Quereda C, Pascual J, García-López F, Alcázar R, Aljama P, Amenábar JJ, Arias M, Barrio V, Fernández-Rodríguez A, Fernández Juárez G, Fernández-Lucas M, Gallego N, Hernández D, Gómez-Alamillo C, Maduell F, Martínez Castelao A, Marcén R, Matesanz R, Martín de Francisco AL, Orte L, Liaño F, Luño J, Ortuño J, Pérez García R, Praga M, Saracho R, Selgas R, Rivera M, Rodríguez Pérez JC, Teruel JL, Tato A, Torres A, Valdés F. [Clinical research based nephrology (bases for the constitution of an Evidence Based Nephrology Group in the Spanish Society of Nephrology)]. Nefrologia 2006; 26:163-72. [PMID: 16808254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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Teruel JL, Martins J, Merino JL, Fernández Lucas M, Rivera M, Marcén R, Quereda C, Ortuño J. [Temperature dialysate and hemodialysis tolerance]. Nefrologia 2006; 26:461-8. [PMID: 17058858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
In this study, the effect of dialysate temperature on hemodynamic stability, patients' perception of dialysis discomfort and postdialysis fatigue were assessed. Thirty-one patients of the morning shift were eligible to participate in the study. Three patients refused. Patients were assessed during 6 dialysis sessions: in three sessions the dialysate temperature was normal (37 degrees C) and in other three sessions the dialysate temperature was low (35.5 degrees C). To evaluate the symptoms along the dialysis procedure and the postdialysis fatigue, specific scale questionnaires were administered in each dialysis session and respective scores were elaborated. Low temperature dialysate was associated with higher postdialysis systolic blood pressure (122 +/- 24 vs. 126 +/- 27 mmHg, p < 0.05), and lower postdialysis heart rate (82 +/- 13 vs. 78 +/- 9 beats/min, p < 0.05) with the same ultrafiltration rate. Dialysis symptoms score and postdialysis fatigue score were better with the low dialysate temperature (0.7 +/- 0.9 vs. 0.4 +/- 1 vs. p < 0.05, and 1.3 +/- 1 vs. 1 +/- 0.9 p < 0.05, respectively). Furthermore, low temperature dialysate shortened the post-dialysis fatigue period (5.4 +/- 6.3 vs. 3.1 +/- 3.3 vs. hours, p < 0.05). The clinical improvement experimented with the low temperature dialysate was not universal. A beneficial effect was exclusively observed in the patients with higher dialysis symptoms and postdialysis fatigue scores or having more than one episode of hypotension in a week. The patients were asked about their temperature preference, 7 patients (23%) request a dialysate at 37 degrees C, 19 patients (61%) prefered to be dialysed with the low temperature dialysate, and 5 patients (16%) were indifferent. The later two groups of the patients continued with the low temperature dialysate during other 4 weeks. At the end of that period, the clinical improvement remained unchanged. In summary, low temperature dialysate is particularly beneficial for highly symptomatic patients.
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Affiliation(s)
- J L Teruel
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid
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Hernández D, Marrero-Miranda D, González-Posada JM, Pascual J, Quereda C. [New evidences in renal transplantation bibliography]. Nefrologia 2006; 26:304-14, 316. [PMID: 16892818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Affiliation(s)
- D Hernández
- Servicio de Nefrología, Hospital Universitario de Canarias, Tenerife.
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Pascual J, Quereda C, Zamora J, Hernández D. Updated Metaanalysis of Steroid Withdrawal in Renal Transplant Patients on Calcineurin Inhibitor and Mycophenolate Mofetil. Transplant Proc 2005; 37:3746-8. [PMID: 16386525 DOI: 10.1016/j.transproceed.2005.09.177] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
During the 1990s two metaanalysis of randomized clinical trials of steroid withdrawal after renal transplantation showed significant increases in acute rejection episodes and graft failure rates. A recently published metaanalysis of steroid withdrawal in patients on a calcineurin inhibitor and MMF included randomized clinical trials. We have updated this study, searching more publications during the last 2 years. Finally, the same six trials were included, four in patients receiving cyclosporine and two tacrolimus. Risk ratio (RR) for acute rejection was 2.28 [95%CI 1.65-3.16, P < .00001], and pooled risk difference (RD) was 0.08 [0.05-0.11, P < .001], indicating that the proportion of patients with acute rejection episodes after prednisone withdrawal was significantly higher compared with controls. RR for graft failure was 0.73 [0.42-1.28, P = .27], and RD was -0.01 [-0.03-0.01, P = .28], indicating that the proportion of patients with graft failure after withdrawal was not significantly different from that of controls. Total cholesterol was significantly lower after steroid withdrawal (weighted mean difference -0.53 mumol/L [-0.70--0.36, P < .0001]). Renal allograft recipients on triple therapy with a calcineurin inhibitor, MMF, and steroids are at low but significant risk of acute rejection after steroid withdrawal, but do not suffer an increased risk of early graft failure. It is necessary to extend controlled follow-up to confirm graft function stabilization.
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Affiliation(s)
- J Pascual
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain
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Fernández Lucas M, Teruel JL, Quereda C, Orte LM, Marcén R, Ortuño J. [Predialysis arterial hypertension: risk factor for cardiovascular mortality during hemodialysis treatment]. Nefrologia 2005; 25 Suppl 4:23-7. [PMID: 16392320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
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