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Játiva S, Torrico S, Calle P, Poch E, Muñoz A, García M, Larque AB, Salido MTT, Hotter G. The phagocytosis dysfunction in lupus nephritis is related to monocyte/macrophage CPT1a. Immunol Lett 2024; 266:106841. [PMID: 38331259 DOI: 10.1016/j.imlet.2024.106841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/20/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024]
Abstract
Macrophages must remove apoptotic cells to shield tissues from the deleterious components of dying cells. The development of chronic inflammation and autoimmune symptoms in systemic lupus is influenced by a deficiency in phagocytosis of apoptotic cells but the underlying mechanism is still unknown. Modifications in monocyte/macrophage phenotype brought on by an increase in their inflammatory phenotype would cause them to decrease the expression of CPT1a, which would reduce their ability to phagocytose, aggravating kidney damage in lupus nephritis. We aim to demonstrate that the deficiency of CPT1A in the immunological system determines lupus. For this purpose, we will monitor CPT1a expression in blood monocytes and phagocytosis and CPT1a expression of macrophages isolated from kidneys and the inflammatory state in kidneys in two experimental models of lupus nephritis such as lupus induced pristane model and in the OVA-IC in vivo model. Additionally, we will test if reestablishing CPT1a expression in tissue macrophages restores the lost phagocytic function. We evidenced that blood monocytes and macrophages isolated from kidneys in the two in vivo models have a reduced expression of CPT1a and a reduced phagocytosis. Phagocytosis could be restored only if macrophage administration leads to an increase in CPT1a expression in kidney macrophages. A new cell therapy to reduce kidney nephritis in lupus could be developed based on these results.
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Affiliation(s)
- Soraya Játiva
- Department of Experimental Pathology, Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d' Investigacions Biomèdiques August Pi i Sunyer [IIBB-CSIC-IDIBAPS], 08036, Barcelona, Spain; M2rlab-XCELL, 28010, Madrid, Spain
| | - Selene Torrico
- Department of Experimental Pathology, Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d' Investigacions Biomèdiques August Pi i Sunyer [IIBB-CSIC-IDIBAPS], 08036, Barcelona, Spain; M2rlab-XCELL, 28010, Madrid, Spain
| | - Priscila Calle
- Department of Experimental Pathology, Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d' Investigacions Biomèdiques August Pi i Sunyer [IIBB-CSIC-IDIBAPS], 08036, Barcelona, Spain; M2rlab-XCELL, 28010, Madrid, Spain
| | - Esteban Poch
- Nefrologia i Trasplantament Renal, Hospital Clínic, IDIBAPS, Universidad de Barcelona, 08036, Barcelona, Spain
| | - Angeles Muñoz
- Department of Experimental Pathology, Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d' Investigacions Biomèdiques August Pi i Sunyer [IIBB-CSIC-IDIBAPS], 08036, Barcelona, Spain
| | - Miriam García
- Department of Experimental Pathology, Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d' Investigacions Biomèdiques August Pi i Sunyer [IIBB-CSIC-IDIBAPS], 08036, Barcelona, Spain; M2rlab-XCELL, 28010, Madrid, Spain
| | - Ana Belén Larque
- Servicio de Anatomía Patológica, CDB, Hospital Clínic, 08036 Barcelona, Spain
| | - Maria Teresa Torres Salido
- Research coordinator of the cross-sectional of Internal Medicine Department, Quironsalud del Valles Hospital, Passeig de Rubió i Ors, 23, 08203, Sabadell, Barcelona, Spain; Fundacio Catalana del lupus, 08029, Barcelona, Spain
| | - Georgina Hotter
- Department of Experimental Pathology, Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas, Institut d' Investigacions Biomèdiques August Pi i Sunyer [IIBB-CSIC-IDIBAPS], 08036, Barcelona, Spain; CIBER-BBN, Networking Center on Bioengineering, Biomaterials and Nanomedicine, 50018, Zaragoza, Spain.
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Araujo-Castro M, Ruiz-Sánchez JG, Ramírez PP, Martín Rojas-Marcos P, Aguilera-Saborido A, Gómez Cerezo JF, López Lazareno N, Torregrosa ME, Gorrín Ramos J, Oriola J, Poch E, Oliveras A, Méndez Monter JV, Gómez Muriel I, Bella-Cueto MR, Mercader Cidoncha E, Runkle I, Hanzu FA. Practical consensus for the treatment and follow-up of primary aldosteronism: a multidisciplinary consensus document. Endocrine 2024:10.1007/s12020-024-03773-9. [PMID: 38507182 DOI: 10.1007/s12020-024-03773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and is associated with a higher cardiometabolic risk than essential hypertension. The aim of this consensus is to provide practical clinical recommendations for its surgical and medical treatment, pathology study and biochemical and clinical follow-up, as well as for the approach in special situations like advanced age, pregnancy and chronic kidney disease, from a multidisciplinary perspective, in a nominal group consensus approach of experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology and Spanish Association of Surgeons (AEC).
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), University of Alcalá, Madrid, Spain.
| | - Jorge Gabriel Ruiz-Sánchez
- Endocrinology & Nutrition Department. Hospital Universitario Fundación Jiménez Díaz, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM), Madrid, Spain
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | | | | | | | | | | | - Jorge Gorrín Ramos
- Biochemical department, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - Josep Oriola
- Biochemistry and Molecular Genetics Department. CDB. Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department. Hospital Clinic. IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Anna Oliveras
- Nephrology Department, Hospital del Mar Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - María Rosa Bella-Cueto
- Pathology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA). Universitat Autònoma de Barcelona. Sabadell. ES, Barcelona, Spain
| | - Enrique Mercader Cidoncha
- General Surgery. Hospital General Universitario Gregorio Marañón, Fellow European Board of Surgery -Endocrine Surgery, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clinico San Carlos Madrid, Madrid, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department. Hospital Clinic. IDIBAPS, University of Barcelona, Barcelona, Spain.
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Araujo-Castro M, Ruiz-Sánchez JG, Parra Ramírez P, Martín Rojas-Marcos P, Aguilera-Saborido A, Gómez Cerezo JF, López Lazareno N, Torregrosa Quesada ME, Gorrin Ramos J, Oriola J, Poch E, Oliveras A, Méndez Monter JV, Gómez Muriel I, Bella-Cueto MR, Mercader Cidoncha E, Runkle I, Hanzu FA. Screening and diagnosis of primary aldosteronism. Consensus document of all the Spanish Societies involved in the management of primary aldosteronism. Endocrine 2024:10.1007/s12020-024-03751-1. [PMID: 38448679 DOI: 10.1007/s12020-024-03751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension (HT), and is associated with a higher cardiometabolic risk than essential HT. However, PA remains underdiagnosed, probably due to several difficulties clinicians usually find in performing its diagnosis and subtype classification. The aim of this consensus is to provide practical recommendations focused on the prevalence and the diagnosis of PA and the clinical implications of aldosterone excess, from a multidisciplinary perspective, in a nominal group consensus approach by experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology, Spanish Association of Surgeons (AEC).
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)., Madrid, Spain.
| | - Jorge Gabriel Ruiz-Sánchez
- Endocrinology & Nutrition Department. Hospital Universitario Fundación Jiménez Díaz, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM), Madrid, Spain
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | | | | | | | - Nieves López Lazareno
- Biochemical Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jorge Gorrin Ramos
- Biochemical department, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - Josep Oriola
- Biochemistry and Molecular Genetics Department, CDB. Hospital Clínic. University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department. Hospital Clinic, IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Anna Oliveras
- Nephrology Department. Hospital del Mar, Universitat Pompeu Fabra, Barcelona, ES, Spain
| | | | | | - María Rosa Bella-Cueto
- Pathology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA). Universitat Autònoma de Barcelona. Sabadell, Barcelona, Spain
| | - Enrique Mercader Cidoncha
- General Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Fellow European Board of Surgery -Endocrine Surgery, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic. IDIBAPS. University of Barcelona, Barcelona, Spain.
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Bover J, Romero-González G, Chávez-Iñiguez JS, Rizo-Topete L, Graterol F, Santandreu AV, Sanchez-Baya M, Díaz JM, Ortiz A, Poch E. Acute kidney injury (AKI): Spanish nomenclature also matters here. Nefrologia 2024; 44:113-115. [PMID: 38418363 DOI: 10.1016/j.nefroe.2024.02.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Affiliation(s)
- Jordi Bover
- Nephrology Department, University Hospital Germans Trias i Pujol, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain.
| | - Gregorio Romero-González
- Nephrology Department, University Hospital Germans Trias i Pujol, 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
| | - Jonathan Samuel Chávez-Iñiguez
- Nephrology Department, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico; Universidad de Guadalajara, Centro Universitario de Ciencias de la salud CUCS, Guadalajara, Jalisco, Mexico
| | - Lilia Rizo-Topete
- International Renal Research Institute of Vicenza, Vicenza, Italy; UANL, Hospital Universitario "José Eleuterio González", Monterrey, Nuevo León, Mexico; Hospital Christus Muguerza Alta Especialidad, UDEM, Monterrey, Nuevo León, Mexico
| | - Fredzzia Graterol
- Nephrology Department, University Hospital Germans Trias i Pujol, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | - Anna Vila Santandreu
- Nephrology Department, University Hospital Germans Trias i Pujol, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | - Maya Sanchez-Baya
- Nephrology Department, University Hospital Germans Trias i Pujol, Badalona, Spain; Germans Trias i Pujol Research Institute (IGTP), REMAR- IGTP Group (Kidney-affecting Diseases Research Group), Badalona, Spain
| | - Joan Manel Díaz
- Nephrology Department, Fundació Puigvert, Hospital Santa Cruz y San Pablo, Barcelona, Spain
| | - Alberto Ortiz
- Nephrology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Esteban Poch
- Nephrology Department, Hospital Clínic, Barcelona, Spain
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Molina-Andujar A, Rios J, Piñeiro GJ, Sandoval E, Ibañez C, Quintana E, Matute P, Andrea R, Lopez-Sobrino T, Mercadal J, Reverter E, Rovira I, Villar AM, Fernandez S, Castellà M, Poch E. Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury-The PrevHemAKI Randomized Controlled Trial. J Clin Med 2023; 12:7746. [PMID: 38137815 PMCID: PMC10743963 DOI: 10.3390/jcm12247746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether management with an individualized target reduces the incidence of CS-AKI. METHODS Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation. Adult patients submitted to valve replacement and/or bypass surgery with a high risk of CS-AKI evaluated by a Leicester score >30 were randomized to follow a target MPP of >75% of the calculated baseline or a standard hemodynamic management during the first postoperative 24 h. RESULTS Ninety-eight patients with an eGFR of 54 mL/min were included. There were no differences in MAP and MPP in the first 24 h between the randomized groups, although a higher use of noradrenaline was found in the intervention arm (38.78 vs. 63.27, p = 0.026). The percentage of time with MPP < 75% of measured baseline was similar in both groups (10 vs. 12.7%, p = 0.811). MAP during surgery was higher in the intervention group (73 vs. 77 mmHg, p = 0.008). The global incidence of CS-AKI was 36.7%, being 38.6% in the intervention group and 34.6% in the control group (p = 0.40). There were no differences in extrarenal complications between groups as well. CONCLUSION An individualized hemodynamic management based on MPP compared to standard treatment in cardiac surgery patients was safe but did not reduce the incidence of CS-AKI in our study.
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Affiliation(s)
- Alicia Molina-Andujar
- Nephrology and Kidney Transplantation Department, Hospital Clinic, 08036 Barcelona, Spain; (A.M.-A.); (G.J.P.)
| | - José Rios
- Department of Clinical Farmacology, Hospital Clinic and Medical Statistics Core Facility, 08036 Barcelona, Spain;
- Institut d’investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.A.); (T.L.-S.)
- Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Gaston J. Piñeiro
- Nephrology and Kidney Transplantation Department, Hospital Clinic, 08036 Barcelona, Spain; (A.M.-A.); (G.J.P.)
- Institut d’investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.A.); (T.L.-S.)
| | - Elena Sandoval
- Cardiovascular Surgery Department, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (E.Q.); (M.C.)
| | - Cristina Ibañez
- Anesthesiology Department, Hospital Clínic, 08036 Barcelona, Spain; (C.I.); (P.M.); (J.M.); (I.R.)
| | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (E.Q.); (M.C.)
| | - Purificación Matute
- Anesthesiology Department, Hospital Clínic, 08036 Barcelona, Spain; (C.I.); (P.M.); (J.M.); (I.R.)
| | - Rut Andrea
- Institut d’investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.A.); (T.L.-S.)
- Cardiology Department, Hospital Clínic, 08036 Barcelona, Spain
| | - Teresa Lopez-Sobrino
- Institut d’investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.A.); (T.L.-S.)
- Cardiology Department, Hospital Clínic, 08036 Barcelona, Spain
| | - Jordi Mercadal
- Anesthesiology Department, Hospital Clínic, 08036 Barcelona, Spain; (C.I.); (P.M.); (J.M.); (I.R.)
| | - Enric Reverter
- Liver and Digestive ICU, Liver Unit, Hospital Clínic, 08036 Barcelona, Spain;
| | - Irene Rovira
- Anesthesiology Department, Hospital Clínic, 08036 Barcelona, Spain; (C.I.); (P.M.); (J.M.); (I.R.)
| | | | - Sara Fernandez
- Medical Intensive Care Unit, Hospital Clínic, 08036 Barcelona, Spain;
| | - Manel Castellà
- Cardiovascular Surgery Department, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (E.Q.); (M.C.)
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Hospital Clinic, 08036 Barcelona, Spain; (A.M.-A.); (G.J.P.)
- Institut d’investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (R.A.); (T.L.-S.)
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Bermejo S, González E, López-Revuelta K, Ibernon M, López D, Martín-Gómez A, Garcia-Osuna R, Linares T, Díaz M, Martín N, Barros X, Marco H, Navarro MI, Esparza N, Elias S, Coloma A, Robles NR, Agraz I, Poch E, Rodas L, Lozano V, Fernández-Fernández B, Hernández E, Martínez MI, Stanescu RI, Moirón JP, García-Fernández N, Goicoechea M, Calero F, Bonet J, Liaño F, Pascual J, Bestard O, Praga M, Fulladosa X, Soler MJ. The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes. Clin Kidney J 2023; 16:1656-1663. [PMID: 37779839 PMCID: PMC10539224 DOI: 10.1093/ckj/sfad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 10/03/2023] Open
Abstract
Background Up to 50-60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR. Methods We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan-Meier and Cox regression analyses. Results Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85-3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26-2.62), P = .001]. Conclusions DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.
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Affiliation(s)
- Sheila Bermejo
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Ester González
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Meritxell Ibernon
- Nephrology Department, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Diana López
- Nephrology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - Tania Linares
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Nàdia Martín
- Nephrology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Xoana Barros
- Nephrology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Helena Marco
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
- Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Noemí Esparza
- Nephrology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sandra Elias
- Nephrology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Coloma
- Nephrology Department, Hospital San Pedro, Logroño, Spain
- Nephrology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Irene Agraz
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Nephrology Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Víctor Lozano
- Nephrology Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Marian Goicoechea
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Josep Bonet
- Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Fernando Liaño
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Oriol Bestard
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
| | - Manuel Praga
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Xavier Fulladosa
- Nephrology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - María José Soler
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Nephrology Department, Hospital del Mar, Barcelona, Spain
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7
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Molina Andújar A, Escudero VJ, Piñeiro GJ, Lucas A, Rovira I, Matute P, Ibañez C, Blasco M, Quintana LF, Sandoval E, Sánchez MC, Quintana E, Poch E. Impact of cardiac surgery associated acute kidney injury on 1-year major adverse kidney events. Front Nephrol 2023; 3:1059668. [PMID: 37675375 PMCID: PMC10479748 DOI: 10.3389/fneph.2023.1059668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/24/2023] [Indexed: 09/08/2023]
Abstract
Background The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events (MAKE) [25% or greater decline in estimated glomerular filtration rate (eGFR), new hemodialysis, and death] after cardiac surgery in a Spanish cohort and to evaluate the utility of the score developed by Legouis D et al. (CSA-CKD score) in predicting the occurrence of MAKE. Methods This was a single-center retrospective study of patients who required cardiac surgery with cardiopulmonary bypass (CPB) during 2015, with a 1-year follow-up after the intervention. The inclusion criteria were patients over 18 years old who had undergone cardiac surgery [i.e., valve substitution (VS), coronary artery bypass graft (CABG), or a combination of both procedures]. Results The number of patients with CKD (eGFR < 60 mL/min) increased from 74 (18.3%) to 97 (24%) within 1 year after surgery. The median eGFR declined from 85 to 82 mL/min in the non-CSA-AKI patient group and from 73 to 65 mL/min in those with CSA-AKI (p = 0.024). Fifty-eight patients (1.4%) presented with MAKE at the 1-year follow-up. Multivariate logistic regression analysis showed that the only variable associated with MAKE was CSA-AKI [odds ratio (OR) 2.386 (1.31-4.35), p = 0.004]. The median CSA-CKD score was higher in the MAKE cohort [3 (2-4) vs. 2 (1-3), p < 0.001], but discrimination was poor, with a receiver operating characteristic curve (AUC) value of 0.682 (0.611-0.754). Conclusion Any-stage CSA-AKI is associated with a risk of MAKE after 1 year. Further research into new measures that identify at-risk patients is needed so that appropriate patient follow-up can be carried out.
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Affiliation(s)
- Alícia Molina Andújar
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Gaston J. Piñeiro
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d’investigacions biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alvaro Lucas
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Irene Rovira
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Anesthesiology Department, Hospital Clinic, Barcelona, Spain
| | - Purificación Matute
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Anesthesiology Department, Hospital Clinic, Barcelona, Spain
| | - Cristina Ibañez
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Anesthesiology Department, Hospital Clinic, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d’investigacions biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis F. Quintana
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d’investigacions biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Sandoval
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Cardiovascular Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Marina Chorda Sánchez
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Perfusion Department, Hospital Clinic, Barcelona, Spain
| | - Eduard Quintana
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Cardiovascular Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d’investigacions biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Salgueira M, Almenara M, Gutierrez-Pizarraya A, Belmar L, Labrador PJ, Melero R, Serrano ML, Portolés JM, Molina A, Poch E, Ramos N, Lloret MJ, Echarri R, Díaz Mancebo R, González-Lara DM, Sánchez JE, Soler MJ. [Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: Renal replacement therapy and mortality. FRA-COVID SEN Registry Data]. Nefrologia 2023:S0211-6995(23)00057-7. [PMID: 37359780 PMCID: PMC10076078 DOI: 10.1016/j.nefro.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/20/2022] [Accepted: 03/31/2023] [Indexed: 06/28/2023] Open
Abstract
Background and objectives Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed. Material and method In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality. Results Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55). Conclusions Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
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Affiliation(s)
- Mercedes Salgueira
- Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Marina Almenara
- Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Lara Belmar
- Unidad de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Pedro Jesús Labrador
- Unidad de Nefrología, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Rosa Melero
- Unidad de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Luisa Serrano
- Unidad de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - José María Portolés
- Unidad de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Alicia Molina
- Unidad de Nefrología, Hospital Clinic, Barcelona, España
| | - Esteban Poch
- Unidad de Nefrología, Hospital Clinic, Barcelona, España
| | - Natalia Ramos
- Unidad de Nefrología, Hospital Vall d'Hebron, Barcelona, España
| | | | - Rocío Echarri
- Unidad de Nefrología, Hospital Universitario Infanta Sofía, Madrid, España
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9
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Quiroga B, Soler MJ, Ortiz A, Jarava Mantecón CJ, Gomes Pérez VO, Bordils A, Lacueva J, Marin Franco AJ, Delgado Conde P, Muñoz Ramos P, Calderón González C, Cazorla López JM, Sanchez-Rodriguez J, Sánchez Horrillo A, Monzón Vázquez TR, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Rodríguez MTJ, Valverde RL, Carretero MP, Díaz MO, Tocora DG, Suárez ER, Santolaya AJS, Cobo PA, Talavan T, Calero RC, Gracia-Iguacel C, González-Parra E, Pereira M, Martin-Cleary C, Ramos-Verde A, Giorgi M, Sánchez C, Giraldo YG, Horrillo AS, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, de Gante LM, Repollet R, Polo CR, Moreso F, Azancot MA, Ramos N, Toapanta OBN, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Prat O, Saiz A, Vila MAM, Guldris SC, Granados NM, Cabo MJC, Alarcón WL, Sánchez SP, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Zamora R, Hernández RS, Osorio LR, García-Fernández N, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, Cabrera SS, López RO, Peregrí CM, Morales MLA, Cabello MDN, Mazuecos A, García T, Narváez C, Orellana C, Márquez MGS, Novillo CL, Ganga PLQ, Carrión FV, Herrera ALG, Castro NB, Cendrero RMRC, Hidalgo-Barquero MVM, Gallego RH, Alvarez Á, Leo EV, León JLP, García MAM, Jiménez BG, Pérez VOG, de Dios Ramiro Moya J, Espinosa DL, Herrador AJ, Zurita MN, Álvarez LD, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, García AB, Díaz ABM, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Sato Y, Marín MS, Tejedor S, Vaquera SM, di Riso MC, Torres I, Alfaro G, Halauko O, Rifai FEL, Martínez AD, Ávila PJ, Sánchez CA, Sainz MS, Martín JMB, del Río García L, Canga JLP, Ochoa PMV, Pacios LM, Machado LL, Morales AQ, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Rubio AB, Del Peso Gilsanz G, Gonzalez MO, Villanueva RS, Oliva MOL, Varela JC, Enríquez AG, Casas CC, Alonso PO, Tabares LG, Barreiro JML, Solla LP, Gándara A, de la Garza WN, Fleming FF, Goyanes MGR, Feijoo CC, Plaza MMM, Juan CB, de la Fuente GDA, del Valle KP, Contreras FJP, Lara NB, Ferri DG, de Bustillo Llorente EM, Rodríguez EG, De La Manzanara Perez VL, Arevalo MC, Calvo JAH, Carratalá MRL, Rodríguez LMM, Salazar MS, Prieto BB, Pérez JMP, Paraíso AG, Huarte E, Lanau M, Campos RA, Ubé JM, Godoy IB, Aguilera ET, Alea RT, Del Rosario Saldaña MS, Salgueira M, Aresté N, de los Ángeles Rodríguez M, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Gash SC, Martínez LR, Cervera MCA, De Tomas MTR, Prieto BA, Toyos C, Del Rio JM, Acosta AR, Zamacona AC, Martin MIJ, Ortega SB, Ruiz MIG, Rubio AH, Ledesma PG, Alvarez AG, Poch E, Cucchiari D, Monzo JB, Cabrera BE, Hernández APR, Rebollo MSG, Hernández JMR, González AY, Alonso JC, Más AM, Calvé M, Cardona MG, Balaguer VC, Pesquera JIM, de la Rosa EC, Santarelli DR, Garcia AS, Martin-Caro AC, Santamaria IM, Cervienka M, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Estupiñán RS, Amado FV, Borges PP, Beloso MD, Alonso FA, Felpete NP, Ameneiro AM, Mera MC, Casares BG, Larrondo SZ, Kareaga NM, del Valle AISS, García ARM, Linaza BV, del Toro Espinosa N, Perico PE, Oliva JMS, Manrique J, Castaño I, Purroi C, Gómez N, Mansilla C, Utzurrum A, de Arellano Serna MR, Perich LG, Rincón MM, De La Manzanara Perez VL, Arevalo MC, Calvo JAH, Villoria JG, De Salinas APM. Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study. Nephrol Dial Transplant 2022; 38:969-981. [PMID: 36423334 DOI: 10.1093/ndt/gfac307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Background
There is scarce evidence on fourth doses of SARS-CoV-2 vaccines in chronic kidney disease (CKD) patients. We have evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), hemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) recipients.
Methods
This is a prespecified analysis of the prospective, observational, multicentric SENCOVAC study. In patients with CKD who had received a complete initial vaccination and one or two boosters and had anti-Spike antibody determinations 6 and 12 months after the initial vaccination, we analyzed factors associated to persistent negative humoral response and to higher anti-Spike antibody titers as well as the efficacy of vaccination on COVID-19 severity.
Results
Of 2186 patients (18% KT, 8% PD, 69% HD and 5% ND-CKD), 30% had received a fourth dose. The fourth dose increased anti-Spike antibody titers in HD (P = 0.001) and ND-CKD (P = 0.014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titers at 12 months were independently associated to repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titers and not being a KT. Breakthrough COVID-19 was registered in 137 (6%) patients, of whom 5% required admission. Admitted patients had prior titers below 620 UI/ml and median values were lower (P = 0.020) than in non-admitted patients.
Conclusions
A fourth vaccine dose increased anti-Spike antibody titers or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titers or KT recipients) derived the least benefit in terms of antibody titers. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titers.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( Spain )
- RICORS2040 (Kidney Disease )
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease )
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | | | | | | | | | | | | | - Patricia Muñoz Ramos
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | | | | | - Jinny Sanchez-Rodriguez
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Ana Sánchez Horrillo
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | | | - Alba Leyva
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - José Rojas
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease )
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
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Rodríguez-Espinosa D, Broseta JJ, Bastida C, Álvarez-Mora MI, Nicolau C, Alvarez C, Agraz-Pamplona I, Sánchez-Baya M, Furlano M, Ruiz C, Quintana LF, Piñeiro GJ, Poch E, Torra-Balcells R, Blasco M. Creatine Kinase Elevation in Autosomal Dominant Polycystic Kidney Disease Patients on Tolvaptan Treatment. Nephron Clin Pract 2022; 147:152-157. [PMID: 36088902 PMCID: PMC10137304 DOI: 10.1159/000526368] [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] [Received: 01/11/2022] [Accepted: 08/03/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of end-stage kidney disease. Currently, tolvaptan is the only treatment that has proven to delay disease progression. The most notable side effect of this therapy is drug-induced liver injury; however, recently, there have been two reports of creatine kinase (CK) elevation in ADPKD patients on tolvaptan treatment. We set out to monitor and determine the actual incidence of CK elevation and evaluate its potential association with other clinical factors. <b><i>Methods:</i></b> This is an observational retrospective multicenter study performed in rapidly progressive ADPKD patients on tolvaptan treatment from Barcelona, Spain. Laboratory tests, demographics, treatment dose, and reported symptoms were collected from October 2018 to March 2021. <b><i>Results:</i></b> Ninety-five patients initiated tolvaptan treatment during follow-up. The medication had to be discontinued in 31 (32.6%) patients, primarily due to aquaretic effects (12.6%), elevated liver enzymes (8.4%), and symptomatic or persistently elevated CK levels (3.2%). Moreover, a total of 27 (28.4%) patients had elevated CK levels, with most of them being either transient (12.6%), mild and asymptomatic (4.2%), or resolved after dose reduction (3.2%) or temporary discontinuation (2.1%). <b><i>Conclusion:</i></b> We present the largest cohort that has monitored CK levels in a real-life setting, finding them elevated in 28.4% of patients. More research and monitoring will help us understand the clinical implications and the pathophysiological mechanism of CK elevation in this population.
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Affiliation(s)
- Diana Rodríguez-Espinosa
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain,
| | - José Jesús Broseta
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carla Bastida
- Department of Pharmacy, Hospital Clínic, Barcelona, Spain
| | | | - Carlos Nicolau
- Genito-urinary Department, Diagnostic Imaging Center, Hospital Clínic, Barcelona, Spain
| | - Cristina Alvarez
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Maya Sánchez-Baya
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Mónica Furlano
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - César Ruiz
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gastón J Piñeiro
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Roser Torra-Balcells
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Játiva S, Torrico S, Calle P, Muñoz Á, García M, Larque AB, Poch E, Hotter G. NGAL release from peripheral blood mononuclear cells protects against acute kidney injury and prevents AKI induced fibrosis. Biomed Pharmacother 2022; 153:113415. [DOI: 10.1016/j.biopha.2022.113415] [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] [Received: 06/13/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
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12
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Bover J, Romero-González G, Chávez-Iñiguez JS, Rizo-Topete L, Graterol F, Santandreu AV, Sanchez-Baya M, Díaz JM, Ortiz A, Poch E. AKI (Acute Kidney Injury): AQUÍ la nomenclatura también es importante. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.07.003] [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: 11/16/2022] Open
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13
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Escudero VJ, Mercadal J, Molina-Andújar A, Piñeiro GJ, Cucchiari D, Jacas A, Carramiñana A, Poch E. New Insights Into Diuretic Use to Treat Congestion in the ICU: Beyond Furosemide. Front Nephrol 2022; 2:879766. [PMID: 37675009 PMCID: PMC10479653 DOI: 10.3389/fneph.2022.879766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/30/2022] [Indexed: 09/08/2023]
Abstract
Diuretics are commonly used in critically ill patients with acute kidney injury (AKI) and fluid overload in intensive care units (ICU), furosemide being the diuretic of choice in more than 90% of the cases. Current evidence shows that other diuretics with distinct mechanisms of action could be used with good results in patients with selected profiles. From acetazolamide to tolvaptan, we will discuss recent studies and highlight how specific diuretic mechanisms could help to manage different ICU problems, such as loop diuretic resistance, hypernatremia, hyponatremia, or metabolic alkalosis. The current review tries to shed some light on the potential use of non-loop diuretics based on patient profile and give recommendations for loop diuretic treatment performance focused on what the intensivist and critical care nephrologist need to know based on the current evidence.
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Affiliation(s)
- Victor Joaquin Escudero
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jordi Mercadal
- Surgical Intensive Care Unit, Anesthesiology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Univesitat de Barcelona, Barcelona, Spain
| | - Alícia Molina-Andújar
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Gaston J. Piñeiro
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - David Cucchiari
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Adriana Jacas
- Surgical Intensive Care Unit, Anesthesiology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Univesitat de Barcelona, Barcelona, Spain
| | - Albert Carramiñana
- Surgical Intensive Care Unit, Anesthesiology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Univesitat de Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Poch E, Molina A, Piñeiro G. Syndrome of inappropriate antidiuretic hormone secretion. Med Clin (Barc) 2022; 159:139-146. [PMID: 35659417 DOI: 10.1016/j.medcli.2022.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/05/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
Abstract
Hyponatremia is the most frequent electrolytic disorder in hospitalized patients, and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), the most frequent cause of hiponatremia with clinically normal extracellular volume. It consists of a disorder of the regulation of body water that obeys to different causes, mainly cancer, pulmonary illnesses, disorders of the central nervous system and diverse drugs. As in any hiponatremia it a physiological knowledge of the regulation of body water and sodium is essential as well as the application of precise diagnostic criteria in order to manage the problem with an effective treatment. The available data until the moment show that the clinical diagnosis of SIADH made by professionals is mainly not supported on the established criteria drawn by experts and this lack of accuracy probably hits in the therapeutic result. The basis of the treatment of the SIADH is to correct its cause, water restriction, solutes (sodium chloride) and the use of vaptans in case of failure of the previous measures.
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Affiliation(s)
- Esteban Poch
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España; IDIBAPS; Departamento de Medicina, Universidad de Barcelona, Barcelona, España.
| | - Alicia Molina
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Gastón Piñeiro
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
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Molina Andujar A, Joaquin Escudero V, Blasco M, Piñeiro G, Poch E. MO315: Risk Factors for CSA-AKI and Performance of Leicester Score in a Spanish Cohort. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac068.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30% and it places patients at an increased risk of death. Leicester score (LS) is a new score designed by Birnie et al. [1] and validated in 2014 in a British Cohort. It predicts CSA-AKI at any stage with better discrimination compared with the Clevaland Clinic Score (CCS) and Euroscore II. The aim of this study was to identify risk factors for CSA-AKI and to assess the performance of LS in a Spanish cohort.
METHOD
A unicentric retrospective study of patients that required cardiac surgery with cardio-pulmonary bypass (CPB) during 2015 in the Hospital Clinic de Barcelona. The inclusion criteria were patients >18 years old who were operated on for cardiac surgery [valve substitution (VS), coronary artery bypass graft (CABG) or a combination of both procedures] with the need of CPB. CSA-AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria.
RESULTS
A total of 444 patients were included, of which 171 (38.5%) developed CSA-AKI. The most frequent form of AKI was mild AKI (AKI stage 1), which was present in 105 patients (61.4%). AKI stage 3 was developed in 26 patients, 15 of which required RRT. A total of 66.7% of AKI cases met criteria in the first 24 h and the median duration until total recovery was 3 days. In the multivariate analysis, hypertension (OR 1.883), EGFR < 60 mL/min (OR 2.365) and peripheral vascular disease (OR 4.66) were associated with CSA-AKI. Either discrimination or calibration were better with LS compared with CCS and Euroscore II, with an AUC of 0.721 versus 0.595 and 0.662, respectively (Fig. 1).
CONCLUSION
Preoperative hypertension in patients with CKD with or without peripheral vasculopathy can identify patients at risk of CSA-AKI. LS has proved to be a valid score that could be used to identify patients at risk who could benefit in intervention studies.
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16
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Ventura-Aguiar P, Bayés-Genís B, Amor AJ, Cuatrecasas M, Diekmann F, Esmatjes E, Ferrer-Fàbrega J, García-Criado Á, Musquera M, Olivella S, Palou E, Paredes D, Perea S, Perez A, Poch E, Romano B, Escarrabill J. Patient Experience in Pancreas-Kidney Transplantation-A Methodological Approach Towards Innovation in an Established Program. Transpl Int 2022; 35:10223. [PMID: 35497883 PMCID: PMC9047730 DOI: 10.3389/ti.2022.10223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
Simultaneous pancreas-kidney transplantation (SPKT) leads to increased survival and quality of life, and is an alternative treatment for insulin-dependent diabetes mellitus and end-stage kidney disease. Due to the particularities of this population (often with multiple comorbidities) and of the surgery (only performed in a few centers), a comprehensive analysis of patients' experience along the SPKT process is crucial to improve patient care and add value to this procedure. Therefore, we applied a systematic and iterative methodology with the participation of both patients and professional teams working together to explore and identify unmet needs and value-adding steps along the transplant patient journey at an established pancreas transplant program. Four main steps (to comprehend, to explore, to experiment and to assess) led to several interventions around three major areas: Administration and logistics, information and communication, and perceived quality of assistance. As a result, both displacements to the hospital for diagnostic purposes and the time delay involved in joining the patient waiting list for transplantation were reduced in parallel to the administrative procedures. In conclusion, the methodological implementation of key organizational changes has great impact on overall patient experience. Further quantitative analysis from the patient's perspective will consolidate our program and may add new prototype service design components.
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Affiliation(s)
- Pedro Ventura-Aguiar
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Beatriu Bayés-Genís
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Antonio J Amor
- Endocrinology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center for Biomedical Diagnosis, Hospital Clinic Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament, Fundació Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Enric Esmatjes
- Endocrinology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Joana Ferrer-Fàbrega
- Hepato-Bilio-Pancreatic Surgery and Digestive Transplant Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Ángeles García-Criado
- Radiology Department, Center for Imaging Diagnosis, Hospital Clinic Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Urology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Silvia Olivella
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Palou
- Patient Experience, Hospital Clinic Barcelona, Barcelona, Spain
| | - David Paredes
- Transplant Coordination Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sonia Perea
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Anna Perez
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Barbara Romano
- Nephrology and Kidney Transplant Department, Hospital Clinic Barcelona, Barcelona, Spain
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17
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Rodríguez Espinosa D, Jesus Broseta Monzo J, Cuadrado E, Fernando Quintana Porras L, Poch E, Piñeiro G, Agraz I, Sánchez-Baya M, Furlano M, Ruiz C, Torra R, Blasco M. MO009: Creatine-Kinase Elevation in Autosomal Dominant Polycystic Kidney Disease Patients on Tolvaptan Treatment. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac061.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of end-stage kidney disease. Currently, tolvaptan is the only treatment that has proven to delay disease progression. The most notable side-effect of this therapy is drug-induced liver injury; however, recently, there have been two reports of creatine kinase (CK) elevation in ADPKD patients on tolvaptan treatment. We set out to monitor and determine the actual incidence of CK elevation and evaluate its potential association with other clinical factors.
METHOD
This is an observational prospective multicenter study performed in rapidly progressive ADPKD patients on tolvaptan treatment from Barcelona, Spain. Laboratory tests, demographics, treatment dose and reported symptoms were collected from October 2018 to March 2021.
RESULTS
Ninety-five patients initiated tolvaptan treatment during follow-up. The medication had to be discontinued in 31 (32.6%) patients, primarily due to aquaretic effects (12.6%), elevated liver enzymes (8.4%) and symptomatic or persistently elevated CK levels (3.2%). Moreover, a total of 27 (28.4%) patients elevated CK levels, with most of them being either transient (12.6%), mild and asymptomatic (4.2%), or resolved after dose reduction (3.2%) or temporary discontinuation (2.1%).
CONCLUSION
We present the largest cohort that has monitored CK levels in a real-life setting, finding them elevated in 28.4% of patients. More research and monitoring will help us understand the clinical implications and the pathophysiological mechanism of CK elevation in this population.
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Affiliation(s)
| | | | | | | | | | | | - Irene Agraz
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
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18
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Del Risco Zevallos J, Molina-Andujar A, Piñeiro G, Fernando Quintana Porras L, Blasco M, Morata L, Soriano A, Poch E. MO783: Reduction of the Incidence of Dialysis Catheter-Associated Bacteraemia in Intensive Care Units after Systematic Application of Taurolock in the Sealing of the Catheter. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac080.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Dialysis catheter-associated bacteraemia in Intensive Care Units (ICUs) increases morbidity and mortality, prolongs hospital admission and increases admission costs. TauroLock™ is a lock solution containing (cyclo)-taurolidine (1.35%) and citrate (4%). (Cyclo)-taurolidine has broad antimicrobial activity against gram-positive and gram-negative bacteria and fungi. The objective of this study was to analyse the effect of systematic sealing of haemodialysis catheters in the ICUs of the Hospital Clínic de Barcelona on the incidence of bacteraemia associated with haemodialysis catheters (BACH).
METHOD
BACH episodes of patients who underwent intermittent haemodialysis (IHD) during ICU admission were reviewed. The period analysed as pre-Taurolock™ was from 2010 to 2014 and post-TauroLock™ from 2015 to 2018. Patients who only received renal replacement therapy with continuous techniques were excluded.
RESULTS
A total of 279 patients received IHD in the pre-TauroLock™ period and 331 in the post-TauroLock™ period. The number of BACH in the pre-TauroLock™ period was 18 (6.45%) and 9 (2.72%) in the post-TauroLock™ period. All infections were from percutaneous catheters (acute patients) except three catheters that were tunnelled. In the pre-TauroLock™ period, femoral catheters predominated (61.1%) while in the post-TauroLock they were jugular (66.7%). There was no association between the location of the catheter and the incidence of BACH. Of the 27 patients with BACH, 14 (51.8%) were men with a mean age of 63 years, with no significant differences between the two groups. The most frequent reasons for admission to the ICU in the pre-TauroLock™ period were post-cardiac surgery, cardiogenic, septic or hypovolemic shock and acute myocardial infarction (3 patients per group) and in the post-TauroLock™ period, septic shock and pancreatitis (3 and 2 patients respectively). The most frequent isolated bacteria were Gram-positive (in total 48.38%: pre-TauroLock™ 47.61% and post-TauroLock™ 50%), with a global predominance of staphylococcus epidermidis (32.25%) (Table). There were no significant differences in the median days from the start of haemodialysis to bacteraemia (23.5 pre-TauroLock™ versus 21 post-TauroLock™). There were also no significant differences between the days of ICU stay in the BACH in both groups or in mortality, being the overall mortality of 70.4%.
CONCLUSION
In our cohort, the systematic application of TauroLock™ in the sealing of dialysis catheters in critically ill patients reduces the incidence of BACH in ICUs.
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Affiliation(s)
| | - Alicia Molina-Andujar
- Hospital Clínic de Barcelona, Nephrology and Kidney Transplantation Department, Barcelona, Spain
| | - Gaston Piñeiro
- Hospital Clínic de Barcelona, Nephrology and Kidney Transplantation Department, Barcelona, Spain
| | | | - Miquel Blasco
- Hospital Clínic de Barcelona, Nephrology and Kidney Transplantation Department, Barcelona, Spain
| | - Laura Morata
- Hospital Clínic de Barcelona, Infectious Diseases Department, Barcelona, Spain
| | - Alex Soriano
- Hospital Clínic de Barcelona, Infectious Diseases Department, Barcelona, Spain
| | - Esteban Poch
- Hospital Clínic de Barcelona, Nephrology and Kidney Transplantation Department, Barcelona, Spain
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19
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Rodríguez-Espinosa D, Montagud-Marrahi E, Cacho J, Arana C, Taurizano N, Hermida E, Del Risco-Zevallos J, Casals J, Rosario A, Cuadrado-Payán E, Molina-Andújar A, Rodríguez N, Vilella A, Bodro M, Ventura-Aguiar P, Revuelta I, Cofàn F, Poch E, Oppenheimer F, Vera M, Rodas LM, Cases A, Bayés B, Diekmann F, Maduell F, Broseta JJ, Cucchiari D. Incidence of severe breakthrough SARS-CoV-2 infections in vaccinated kidney transplant and haemodialysis patients. J Nephrol 2022; 35:769-778. [PMID: 35191008 PMCID: PMC8860282 DOI: 10.1007/s40620-022-01257-5] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 12/28/2022]
Abstract
Introduction Given the increased COVID-19 observed in kidney transplant recipients (KTRs) and haemodialysis patients, several studies have tried to establish the efficacy of mRNA vaccines in these populations by evaluating their humoral and cellular responses. However, there is currently no information on clinical protection (deaths and hospitalizations), a gap that this study aims to fill. Methods Observational prospective study involving 1,336 KTRs and haemodialysis patients from three dialysis units affiliated to Hospital Clínic of Barcelona, Spain, vaccinated with two doses of mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 mRNA vaccines. The outcomes measured were SARS-CoV-2 infection diagnosed by a positive RT-PCR fourteen days after the second vaccine dose, hospital admissions derived from infection, and a severe COVID-19 composite outcome, defined as either ICU admission, invasive and non-invasive mechanical ventilation, or death. Results Six per cent (18/302) of patients on haemodialysis were infected, of whom four required hospital admission (1.3%), only one (0.3%) had severe COVID-19, and none of them died. In contrast, 4.3% (44/1034) of KTRs were infected, and presented more hospital admissions (26 patients, 2.5%), severe COVID-19 (11 patients, 1.1%) or death (4 patients, 0.4%). KTRs had a significantly higher risk of hospital admission than HD patients, and this risk increased with age and male sex (HR 3.37 and 4.74, respectively). Conclusions The study highlights the need for booster doses in KTRs. In contrast, the haemodialysis population appears to have an adequate clinical response to vaccination, at least up to four months from its administration. Graphical abstract ![]()
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Affiliation(s)
- Diana Rodríguez-Espinosa
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Enrique Montagud-Marrahi
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Judit Cacho
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Carolt Arana
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Natalia Taurizano
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Evelyn Hermida
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Fresenius Medical Care, Barcelona, Spain
| | - Jimena Del Risco-Zevallos
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Joaquim Casals
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Anney Rosario
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Elena Cuadrado-Payán
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alicia Molina-Andújar
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | | | - Anna Vilella
- Department of Preventive Medicine and Epidemiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ignacio Revuelta
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Frederic Cofàn
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Frederic Oppenheimer
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Manel Vera
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Lida M Rodas
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Aleix Cases
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Beatriu Bayés
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Francisco Maduell
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José Jesús Broseta
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - David Cucchiari
- Department of Nephrology and Kidney, Renal Transplantation, Hospital Clínic of Barcelona, Villarroel 170, 08036, Barcelona, Spain. .,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
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20
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Del Risco-Zevallos J, Andújar AM, Piñeiro G, Reverter E, Toapanta ND, Sanz M, Blasco M, Fernández J, Poch E. Management of acute renal replacement therapy in critically ill cirrhotic patients. Clin Kidney J 2022; 15:1060-1070. [PMID: 35664279 PMCID: PMC9155212 DOI: 10.1093/ckj/sfac025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Indexed: 02/07/2023] Open
Abstract
Renal replacement therapy (RRT) in cirrhotic patients encompasses a number of issues related to the particular characteristics of this population, especially in the intensive care unit (ICU) setting. The short-term prognosis of cirrhotic patients with acute kidney injury is poor, with a mortality rate higher than 65% in patients with RRT requirement, raising questions about the futility of its initiation. Regarding the management of the RRT itself, there is still no consensus with respect to the modality (continuous versus intermittent) or the anticoagulation required to improve the circuit life, which is shorter than similar at-risk populations, despite the altered haemostasis in traditional coagulation tests frequently found in these patients. Furthermore, volume management is one of the most complex issues in this cohort, where tools used for ambulatory dialysis have not yet been successfully reproducible in the ICU setting. This review attempts to shed light on the management of acute RRT in the critically ill cirrhotic population based on the current evidence and the newly available tools. We will discuss the timing of RRT initiation and cessation, the modality, anticoagulation and fluid management, as well as the outcomes of the RRT in this population, and provide a brief review of the albumin extracorporeal dialysis from the point of view of a nephrologist.
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Affiliation(s)
| | | | - Gastón Piñeiro
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona. University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Enric Reverter
- Liver and Digestive ICU, Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Néstor David Toapanta
- Liver and Digestive ICU, Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Miquel Sanz
- Liver and Digestive ICU, Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona. University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Javier Fernández
- Liver and Digestive ICU, Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
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21
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Rodas L, Barnadas E, Pereira A, Castrejon N, Saurina A, Calls J, Calzada Y, Madrid Á, Blasco M, Poch E, García-Herrera A, Quintana LF. The density of renal lymphatics correlates with clinical outcomes in IgA nephropathy. Kidney Int Rep 2022; 7:823-830. [PMID: 35497787 PMCID: PMC9039908 DOI: 10.1016/j.ekir.2021.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction IgA nephropathy (IgAN) is the most common primary glomerulonephritis (GN) worldwide. The disease course fluctuates, and the most important challenge is the considerable variation in the time lag between diagnosis and the development of a hard clinical end point, such as end-stage kidney disease (ESKD). The reaction of renal tissue to damage resembles the common wound-healing response. One part of this repair in IgAN is the expansion of lymphatic vessels known as lymphangiogenesis. The aim of this work was to establish the prognostic value of the density of lymphatic vessels in the renal biopsy at the time of diagnosis, for predicting the risk of ESKD in a Spanish cohort of patients with IgAN. Methods We performed a retrospective multicenter study of 76 patients with IgAN. The end point of the study was progression to ESKD. The morphometric analysis of lymphatic vessels was performed on tissue sections stained with antipodoplanin antibody. Results Density of lymphatic vessels was significantly higher in patients with IgAN with mesangial hypercellularity >50%, segmental sclerosis, higher degrees of interstitial fibrosis, and tubular atrophy. Patients with more lymphatic vessels had significantly higher values of proteinuria and lower estimated glomerular filtration rate (eGFR). A density of lymphatic vessels ≥8 per mm2 was associated with a significantly higher rate of progression to ESKD at 3 years from biopsy. After adjustment for the International IgAN prediction score, at the multivariate logistic regression, high density of lymphatic vessels (≥8 per mm2) remained significantly associated with a higher rate of early progression to ESKD. Conclusion This study contributes to the understanding of the natural history of the progression to ESKD in patients with IgAN revealing the density of lymphatics vessels may optimize the prognostic value of the International IgA predicting tool to calculate the risk of ESKD, favoring the evaluation of new targeted therapies.
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22
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Del Risco J, Casals J, Hermida-Lama E, Quintana LF, Blasco M, Piñeiro G, Poch E, Molina Andujar A. MO393ACUTE RENAL REPLACEMENT THERAPY IN CRITICAL ILL OCTOGENARIAN OR OLDER PATIENTS: PROGNOSTIC FACTORS AND RENAL OUTCOMES. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab082.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
a growing number of octogenarians or older patients are being admitted to the intensive care unit (ICU). The aim of this study was to assess factors associated with acute renal replacement therapy (ARRT) requirement in these patients and the impact of ARRT on the 90-day ICU mortality. Also we aimed to identify prognostic factors associated with mortality risk in the group of patients that required ARRT.
Method
retrospective study of octogenarian or older patients admitted to the ICUs of Hospital Clínic de Barcelona from June 2007 to April 2019. Patients on chronic dialysis treatment or kidney transplant, and patients with limitation of therapeutic support or admitted for less than 48 hours were excluded.
Results
217 patients were included in the study, of which 36.4% required ARRT. Use of vasoactive drugs and Sequential Organ Failure Assessment (SOFA) score on admission were higher in ARRT patients (p=0.009 and <0.001). Basal estimated glomerular filtration rate (eGFR) was lower in the ARRT cohort (p<0.001). Hospital and ICU length of stay were longer in the ARRT cohort (p<0.001). Ninety-day mortality was 58.2% in the ARRT cohort and 55.8% in the control cohort, without statistical differences. In the survival analysis, only female sex and non-renal SOFA ≥6.5 were significantly associated with mortality (p= 0.005 and 0.002 respectively) in the ARRT cohort.
Conclusion
mortality was not significatively increased in the octogenarian population that required and got ARRT respect to those who did not require it. Scores like SOFA can help in the process of decision making about initiation of ARRT.
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Affiliation(s)
| | - Joaquim Casals
- Hospital Clínic de Barcelona, Nephrology, Barcelona, Spain
| | | | | | - Miquel Blasco
- Hospital Clínic de Barcelona, Nephrology, Barcelona, Spain
| | - Gaston Piñeiro
- Hospital Clínic de Barcelona, Nephrology, Barcelona, Spain
| | - Esteban Poch
- Hospital Clínic de Barcelona, Nephrology, Barcelona, Spain
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23
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Lucas A, Molina Andujar A, Quintana E, Piñeiro G, Poch E. MO405RISC FACTORS FOR CARDIAC SURGERY-ASSOCIATED ACUTE KIDNEY INJURY IN A TERTIARY REFERRAL HOSPITAL. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab082.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
cardiac surgery-associated acute kidney injury (CS-AKI) is a frequent complication that confers significant increase in morbility and mortality. It is still unclear how to identify patients at high risk to develop it, in order to apply to them early preventive strategies to avoid AKI. The study aimed to explore risk factors associated to CS-AKI.
Method
to analyze the association between demographic, pre-operative and intraoperative variables with all grades-AKI, we collected baseline characteristics, type of surgery, aortic time of clampage and extracorporeal circulation time, hemodinamic variables during surgery, Euroscore II, Clevelant Clinic Score and Leicester cardiosurgery score. The post-operative variables included monitorization of the first 24 h in the Intensive Care Units (ICU), consistent in: use of vasoactive drugs, total diuresis, use of furosemide, need of transfusions and need and duration of renal replacement therapy (RRT). Creatinine was collected for all the admision days in order to calculate the incidence of AKI. Also mortality and need of RRT at 30 th day was assessed.
The inclusion criteria were: patients over 18 years old who underwent cardiac surgery with extracorporeal circulation. Only valve substitution (VS), Coronary Artery Bypass Graft (CABG) or a combination of both procedures (not including endocarditis surgery) were included. Patients who were already in dialysis or suffered an AKI just before the surgery were not included in the study.
Results
we included 130 patients who underwent heart surgery intervention in Hospital Clínic de Barcelona from 1st January to 31 st March 2015. 61,5% were men and the majority of them was 60 - 75 years old (46.9%), with hypertension (80.8%), without diabetes (68.5%), with stage 2-Chronic Kidney Disease (53.1%). Main surgical procedure was CABG (50.8%), followed by valve substitution (36.1%) and combination of both (13.1%). 73,1% of the procedures were done electively and 26.9% urgently. Out of the 130 patients, 60 (46.2%) suffered an AKI (36 AKIN 1, 16 AKIN 2 and 8 AKIN3). The majority of the episodes (55.2%) started between 24 and 48 hours after the intervention and 7 patients required RRT. AKI was not associated with mortality or need of renal replacement therapy at 30 days (OR 1.853, p= 0.397).
Regarding risk factors for CS-AKI, basal eGFR <60 ml/min, history of hypertension, age and the clevelant/leicester and euroscore were preoperative risk factors associated with CS-AKI in our cohort (OR 5.571 p=<0.001; OR 2.621 p=0.043; OR 1.036 p<0.001; OR 1.453 p=0.045; OR 1.062 p<0.001; OR 1.351 p=0.006 respectively). Leicester cardiosurgery score >30 was the score who showed the best association with AKI (OR 5.167, p<0.001). Intraoperative significant risk factors that were identified were: ischaemia time over 70 minutes (OR 2.876, p=0.004), and the need to use phenylephrine (3.064, p=0.015); whereas the need to use nitroglycerin was identified as a protector (OR 0.441, p=0.031).
Conclusion
previous eGFR<60 ml/min, age, hypertension, use of phenylephrine during surgery and long ischaemia time are the main factors associated with CS-AKI. Scores like Leicester score can help physicians to identify people at risk and apply preventive strategies.
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Revuelta I, Santos-Arteaga FJ, Montagud-Marrahi E, Ventura-Aguiar P, Di Caprio D, Cofan F, Cucchiari D, Torregrosa V, Piñeiro GJ, Esforzado N, Bodro M, Ugalde-Altamirano J, Moreno A, Campistol JM, Alcaraz A, Bayès B, Poch E, Oppenheimer F, Diekmann F. A hybrid data envelopment analysis-artificial neural network prediction model for COVID-19 severity in transplant recipients. Artif Intell Rev 2021; 54:4653-4684. [PMID: 33907345 PMCID: PMC8062617 DOI: 10.1007/s10462-021-10008-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 01/08/2023]
Abstract
In an overwhelming demand scenario, such as the SARS-CoV-2 pandemic, pressure over health systems may outburst their predicted capacity to deal with such extreme situations. Therefore, in order to successfully face a health emergency, scientific evidence and validated models are needed to provide real-time information that could be applied by any health center, especially for high-risk populations, such as transplant recipients. We have developed a hybrid prediction model whose accuracy relative to several alternative configurations has been validated through a battery of clustering techniques. Using hospital admission data from a cohort of hospitalized transplant patients, our hybrid Data Envelopment Analysis (DEA)—Artificial Neural Network (ANN) model extrapolates the progression towards severe COVID-19 disease with an accuracy of 96.3%, outperforming any competing model, such as logistic regression (65.5%) and random forest (44.8%). In this regard, DEA-ANN allows us to categorize the evolution of patients through the values of the analyses performed at hospital admission. Our prediction model may help guiding COVID-19 management through the identification of key predictors that permit a sustainable management of resources in a patient-centered model.
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Affiliation(s)
- Ignacio Revuelta
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Francisco J Santos-Arteaga
- Faculty of Economics and Management, Free University of Bolzano, Piazza Università 1, 39100 Bolzano, Italy
| | - Enrique Montagud-Marrahi
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Debora Di Caprio
- Department of Economics and Management, University of Trento, Trento, Italy
| | - Frederic Cofan
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - David Cucchiari
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Vicens Torregrosa
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Gaston Julio Piñeiro
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Nuria Esforzado
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Marta Bodro
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Department of Infectious Diseases, Hospital Clinic Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jessica Ugalde-Altamirano
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Asuncion Moreno
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Department of Infectious Diseases, Hospital Clinic Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep M Campistol
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Antonio Alcaraz
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Urology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Beatriu Bayès
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Federico Oppenheimer
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Fritz Diekmann
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Villarroel 170 (Escala 10 - Planta 5), 08036 Barcelona, Spain.,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Red de Investigación Renal (REDINREN), Madrid, Spain
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Molina-Andújar A, Casals J, Del Risco-Zevallos J, Hermida E, Quintana LF, Blasco M, Piñeiro G, Poch E. Acute renal replacement therapy in critically ill octogenarian or older patients: prognostic factors and renal outcomes. J Nephrol 2021; 34:1531-1536. [PMID: 33818745 DOI: 10.1007/s40620-021-01034-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/27/2020] [Accepted: 03/18/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The number of octogenarians or older patients admitted to the intensive care unit (ICU) has been growing over the past several years. The aim of this study is to assess factors associated with acute renal replacement therapy (ARRT) requirement in these patients and the impact of this therapy on 90-day mortality. We also aimed to identify prognostic factors associated with mortality risk in the group of patients that required ARRT. METHODS Retrospective study of octogenarian or older patients admitted to the ICU at Hospital Clínic de Barcelona from June 2007 to April 2019. Patients on chronic dialysis treatment or with a kidney transplant, and patients with limitation of therapeutic support or admitted for less than 48 h were excluded. RESULTS 217 patients were included in the study, of whom 36.4% required ARRT. Use of vasoactive drugs (VAD) and Sequential Organ Failure Assessment (SOFA) score on admission were higher in ARRT patients (P = 0.009 and < 0.001, respectively). Basal estimated glomerular filtration rate (eGFR) was lower in the ARRT cohort (P < 0.001). Hospital and ICU length of stay were longer in the ARRT cohort (P < 0.001). Ninety-day mortality was 58.2% in the ARRT cohort compared to 55.8% in the non-ARRT control cohort (P = NS). In the survival analysis, only female sex, sepsis and non-renal SOFA ≥ 6.5 were significantly associated with mortality (P = 0.002, 0.028 and 0.009, respectively) in the ARRT cohort. CONCLUSION Mortality was not significantly increased in the octogenarian or older population that required and received ARRT compared to control patients who did not require it. Severity scores like SOFA could help in the process of decision making about initiation of ARRT in this population.
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Affiliation(s)
- Alícia Molina-Andújar
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Joaquim Casals
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Jimena Del Risco-Zevallos
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Evelyn Hermida
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Gaston Piñeiro
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Blasco M, Guillén E, Quintana LF, Garcia-Herrera A, Piñeiro G, Poch E, Carreras E, Campistol JM, Diaz-Ricart M, Palomo M. Thrombotic microangiopathies assessment: mind the complement. Clin Kidney J 2021; 14:1055-1066. [PMID: 33841853 PMCID: PMC8023218 DOI: 10.1093/ckj/sfaa195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
When faced with microangiopathic haemolytic anaemia, thrombocytopenia and organ dysfunction, clinicians should suspect thrombotic microangiopathy (TMA). The endothelial damage that leads to this histological lesion can be triggered by several conditions or diseases, hindering an early diagnosis and aetiological treatment. However, due to systemic involvement in TMA and its low incidence, an accurate early diagnosis is often troublesome. In the last few decades, major improvements have been made in the pathophysiological knowledge of TMAs such as thrombotic thrombocytopenic purpura [TTP, caused by ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin Type 1 motif, member 13) deficiency] and atypical haemolytic uraemic syndrome (aHUS, associated with dysregulation of the alternative complement pathway), together with enhancements in patient management due to new diagnostic tools and treatments. However, diagnosis of aHUS requires the exclusion of all the other entities that can cause TMA, delaying the introduction of terminal complement blockers, which have shown high efficacy in haemolysis control and especially in avoiding organ damage if used early. Importantly, there is increasing evidence that other forms of TMA could present overactivation of the complement system, worsening their clinical progression. This review addresses the diagnostic and therapeutic approach when there is clinical suspicion of TMA, emphasizing complement evaluation as a potential tool for the inclusive diagnosis of aHUS, as well as for the improvement of current knowledge of its pathophysiological involvement in other TMAs. The development of both new complement activation biomarkers and inhibitory treatments will probably improve the management of TMA patients in the near future, reducing response times and improving patient outcomes.
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Affiliation(s)
- Miquel Blasco
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties Nefro-Urològiques i Trasplantament Renal, Barcelona, Spain
| | - Elena Guillén
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), University of Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties Nefro-Urològiques i Trasplantament Renal, Barcelona, Spain
| | | | - Gastón Piñeiro
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties Nefro-Urològiques i Trasplantament Renal, Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties Nefro-Urològiques i Trasplantament Renal, Barcelona, Spain
| | - Enric Carreras
- Josep Carreras Leukaemia Research Institute, Hospital Clinic/University of Barcelona Campus, Barcelona, Spain
- Barcelona Endothelium Team, Barcelona, Spain
| | - Josep M Campistol
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), University of Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties Nefro-Urològiques i Trasplantament Renal, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Barcelona Endothelium Team, Barcelona, Spain
- Department of Pathology, Hematopathology Unit, Hospital Clínic of Barcelona, Biomedical Diagnosis Centre (CDB), Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marta Palomo
- Josep Carreras Leukaemia Research Institute, Hospital Clinic/University of Barcelona Campus, Barcelona, Spain
- Barcelona Endothelium Team, Barcelona, Spain
- Department of Pathology, Hematopathology Unit, Hospital Clínic of Barcelona, Biomedical Diagnosis Centre (CDB), Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Piñeiro GJ, Molina-Andújar A, Hermida E, Blasco M, Quintana LF, Rojas GM, Mercadal J, Castro P, Sandoval E, Andrea R, Fernández J, Badia JR, Soriano A, Poch E. Severe acute kidney injury in critically ill COVID-19 patients. J Nephrol 2021; 34:285-293. [PMID: 33387345 PMCID: PMC7776310 DOI: 10.1007/s40620-020-00918-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is frequent in Coronavirus Infection Disease 2019 (COVID-19) patients. Factors associated with AKI in COVID-19 intensive care unit (ICU) patients and their outcomes have not been previously explored. METHODS Prospective observational study of COVID-19 patients admitted to the ICUs of the Hospital Clínic of Barcelona (Spain), from March 25th to April 21st, 2020, who developed AKI stage 2 or higher (AKIN classification). The primary goal was to describe the characteristics of moderate-severe AKI of COVID-19 patients in an ICU context. As a secondary goal, we aimed to find independent predictors of AKI progression, Renal Replacement Therapy (RRT) requirement and mortality among these patients. RESULTS During the study period, 52 out of 237 ICU patients, developed AKIN stage 2 or higher and were included in the study. A Sequential Organ Failure Assessment (SOFA) score at AKI diagnosis of 8 or higher was associated with RRT, OR 5.2, p 0.032. At the time of AKI diagnosis, patients had a worse liver profile and higher inflammation markers than at admission. Fifty per cent of the patients presented AKI progression from AKIN 2 to 3 and 28.85% required RRT. The use of corticosteroids in 69.2% of patients was associated with a reduced requirement of RRT, OR 0.13 (CI 95% 0.02-0.89), p 0.037. AKI was associated with high mortality (50%) and a longer hospital stay, median 35 vs 18 days (p 0.024). CONCLUSIONS The prevalence of moderate/severe AKI in COVID-19 patients admitted to the ICU is high and has a strong correlation with mortality and length of hospital stay.
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Affiliation(s)
- Gaston J Piñeiro
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain.
| | - Alicia Molina-Andújar
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain
| | - Evelyn Hermida
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain
| | - Guido Muñoz Rojas
- Surgical Intensive Care Unit, Anesthesiology Department, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain
| | - Jordi Mercadal
- Surgical Intensive Care Unit, Anesthesiology Department, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain
| | - Pedro Castro
- Intensive Care Unit, Internal Medicine Department, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Cardiovascular Intensive Care Unit, Cardiovascular Surgery Department, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain
| | - Rut Andrea
- Acute Cardiac Care Unit, Cardiology Department, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain
| | - Javier Fernández
- Intensive Care Unit, Hepatology Department, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain
| | - Joan Ramon Badia
- Respiratory Institute, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic, IDIBAPS, Univesitat de Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona and REDinREN, Villarroel 170, 08036, Barcelona, Spain
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Sebastià C, Páez-Carpio A, Guillen E, Paño B, Garcia-Cinca D, Poch E, Oleaga L, Nicolau C. Oral hydration compared to intravenous hydration in the prevention of post-contrast acute kidney injury in patients with chronic kidney disease stage IIIb: A phase III non-inferiority study (NICIR study). Eur J Radiol 2021; 136:109509. [PMID: 33516141 DOI: 10.1016/j.ejrad.2020.109509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/02/2020] [Revised: 12/03/2020] [Accepted: 12/28/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the non-inferiority of oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in patients with stage IIIb chronic kidney disease (CKD) referred for an elective contrast-enhanced computed tomography (CE-CT). MATERIAL AND METHODS This is a prospective, randomized, phase 3, parallel-group, open-label, non-inferiority trial. Patients were randomly assigned 1:1 to receive prophylaxis against PC-AKI either with oral hydration: 500 mL of water two hours before and 2000 mL during the 24 h after performing CE-CT or i.v. hydration: sodium bicarbonate (166 mmol/L) 3 mL/kg/h starting one hour before and sodium bicarbonate (166 mmol/L) 1 mL/kg/h during the first hour after CE-CT. 100 mL of non-ionic iodinated contrast was administered in all cases. The primary outcome was the proportion of PC-AKI in the first 48-72 h after CE-CT. Secondary outcomes were persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis. RESULTS Of 264 patients randomized between January 2018 and January 2019, 114 received oral hydration, and 114 received i.v. hydration and were evaluable. No significant differences were found (p > 0.05) between arms in clinical characteristics or risk factors. PC-AKI rate was 4.4 % (95 %CI: 1.4-9.9 %) in the oral hydration arm and 5.3 % (95 %CI: 2.0-11.1%) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8 % (95 %CI: 0.2-6.2 %) in both arms. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. CONCLUSION In those with stage IIIb CKD referred for an elective CE-CT, we provide evidence of non-inferiority of oral hydration compared to i.v. hydration in the prevention of PC-AKI.
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Affiliation(s)
- Carmen Sebastià
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | | | - Elena Guillen
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Blanca Paño
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Esteban Poch
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain; Universitat de Barcelona, Campus Clínic, Barcelona, Spain
| | - Carlos Nicolau
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain; Universitat de Barcelona, Campus Clínic, Barcelona, Spain
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Jiménez Hernández M, Soriano A, Filella X, Calvo M, Coll E, Rebled JM, Poch E, Graterol F, Compte MT, Maduell F, Fontsere N. Impact of locking solutions on conditioning biofilm formation in tunnelled haemodialysis catheters and inflammatory response activation. J Vasc Access 2020; 22:370-379. [PMID: 32691665 DOI: 10.1177/1129729820942040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The surface of tunnelled cuffed catheters provides an optimal environment for the development of biofilms, which have recently been described as conditioning films because of the presence of adherent biological materials. These biofilms are associated with infection and thrombosis and potentially increase patients' inflammatory response. These complications could be reduced by the use of locking solutions. OBJECTIVE To analyse biofilm formation, using confocal and electron microscopy, in tunnelled cuffed catheters locked with three different solutions and to determine the relationship between these solutions and inflammatory response. STUDY DESIGN This prospective study included 35 haemodialysis patients with tunnelled cuffed catheter removal for non-infection-related reasons. The participants were divided into three groups according to the lock solution used: (1) heparin 1: 5000 IU; (2) citrate 4%; and (3) taurolidine 1.35%, citrate 4% and heparin 500 IU (taurolock); in the latter group, 25,000 IU taurolidine-urokinase was used in the last weekly session. All tunnelled cuffed catheters were cultured, and the inner surface was evaluated with confocal and electron microscopy. The inflammatory profile of included patients was determined at tunnelled cuffed catheter removal. RESULTS There were no differences in clinical or demographic variables between the three subgroups. Biofilm thickness was lower in the taurolidine group than in the citrate 4% and heparin groups (28.85 ± 6.86 vs 49.99 ± 16.56 vs 56.2 ± 15.67 µm, respectively; p < 0.001), as was biofilm volume (1.01 ±1.18 vs 3.7 ± 2.15 vs 5.55 ±2.44, µm3, respectively; p < 0.001). The mean interleukin-6 value was 39%, which was 50% lower than in the citrate and heparin groups, but without significance differences. CONCLUSION Our results show that biofilms were found in all tunnelled cuffed catheters, but the thickness and volume were significantly lower in tunnelled cuffed catheters locked with taurolidine solution. Therefore, the type of locking solution used in tunnelled cuffed catheters should maintain tunnelled cuffed catheter sterility and prevent catheter-related bloodstream infections. No significant difference was observed in the inflammatory profile according to the type of locking solution.
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Affiliation(s)
- Mario Jiménez Hernández
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain.,School of Medicine, Universidad de las Americas Puebla, San Andrés Cholula, Puebla, Mexico
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Filella
- Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Calvo
- Advanced Optical Microscopy Unit, Scientific and Technological Centers of the University of Barcelona, Barcelona, Spain
| | - Elisenda Coll
- Advanced Optical Microscopy Unit, Scientific and Technological Centers of the University of Barcelona, Barcelona, Spain
| | - Josep M Rebled
- Unitat de Microscòpia Electrònica (TEM/SEM), Centres Científics i Tecnològics, Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Fredzia Graterol
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Francisco Maduell
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Néstor Fontsere
- Department of Nephrology, Hospital Clínic de Barcelona, Barcelona, Spain.,Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Pappaccogli M, Prejbisz A, Ciurică S, Bruno RM, Aniszczuk-Hybiak A, Bracalente I, De Backer T, Debiève F, Delmotte P, Di Monaco S, Jarraya F, Gordin D, Kosiński P, Kroon AA, Maas AHEM, Marcon D, Minuz P, Montagud-Marrahi E, Pasquet A, Poch E, Rabbia F, Stergiou GS, Tikkanen I, Toubiana L, Vinck W, Warchoł-Celińska E, Van der Niepen P, de Leeuw P, Januszewicz A, Persu A. Pregnancy-Related Complications in Patients With Fibromuscular Dysplasia: A Report From the European/International Fibromuscular Dysplasia Registry. Hypertension 2020; 76:545-553. [PMID: 32639884 DOI: 10.1161/hypertensionaha.120.15349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Current literature suggests a higher risk of pregnancy-related complications in patients with renal fibromuscular dysplasia (FMD). The aim of our study was to assess the nature and prevalence of pregnancy-related complications in patients subsequently diagnosed with FMD. A call for participation was sent to centers contributing to the European/International FMD Registry. Patients with at least 1 pregnancy were included. Data on pregnancy were collected through medical files and FMD characteristics through the European/International FMD Registry. Data from 534 pregnancies were obtained in 237 patients. Despite the fact that, in 96% of cases, FMD was not diagnosed before pregnancy, 40% of women (n=93) experienced pregnancy-related complications, mostly gestational hypertension (25%) and preterm birth (20%), while preeclampsia was reported in only 7.5%. Only 1 patient experienced arterial dissection and another patient an aneurysm rupture. When compared with patients without pregnancy-related complications, patients with complicated pregnancies were younger at FMD diagnosis (43 versus 51 years old; P<0.001) and had a lower prevalence of cerebrovascular FMD (30% versus 52%; P=0.003) but underwent more often renal revascularization (63% versus 40%, P<0.001). In conclusion, the prevalence of pregnancy-related complications such as gestational hypertension and preterm birth was high in patients with FMD, probably related to the severity of renal FMD. However, the prevalence of preeclampsia and arterial complications was low/moderate. These findings emphasize the need to screen hypertensive women for FMD to ensure revascularization before pregnancy if indicated and appropriate follow-up during pregnancy, without discouraging patients with FMD from considering pregnancy.
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Affiliation(s)
- Marco Pappaccogli
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (M.P., S.D.M., F.R.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu)
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A. Prejbisz, A.A.-H., E.W.-C., A.J.)
| | - Simina Ciurică
- Cardiology Department, Marie Curie Civil Hospital, CHU Charleroi, Lodelinsart, Belgium (S.C.)
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine University of Pisa, Italy (R.M.B., I.B.).,INSERM U970 Team 7, Paris Cardiovascular Research Centre - PARCC & Université de Paris, Paris, France (R.M.B.)
| | - Anna Aniszczuk-Hybiak
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A. Prejbisz, A.A.-H., E.W.-C., A.J.)
| | - Irene Bracalente
- Department of Clinical and Experimental Medicine University of Pisa, Italy (R.M.B., I.B.)
| | - Tine De Backer
- Department of Cardiovascular Diseases, University Hospital Ghent, Belgium (T.D.B.)
| | - Frédéric Debiève
- Obstetrics Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium (F.D.)
| | | | - Silvia Di Monaco
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (M.P., S.D.M., F.R.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu)
| | - Faiçal Jarraya
- Service de Néphrologie, CHU Hédi Chaker, Sfax, Tunisie/Unité de Recherche 12ES14 Pathologie rénale, Faculté de medicine, Sfax (F.J.)
| | - Daniel Gordin
- Helsinki Hypertension Centre of Excellence (D.G., I.T.), University of Helsinki, Helsinki University Hospital, Finland.,Abdominal Center Nephrology (D.G., I.T.), University of Helsinki, Helsinki University Hospital, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland (D.G.)
| | - Przemysław Kosiński
- Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland (P.K.)
| | - Abraham A Kroon
- Department of Internal Medicine, Division of General Internal Medicine, Section Vascular Medicine (A.A.K., P.d.L.), Maastricht University Medical Centre, Maastricht University, the Netherlands.,CARIM School for Cardiovascular Diseases (A.A.K., P.d.L.), Maastricht University Medical Centre, Maastricht University, the Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (A.H.E.M.M.)
| | - Denise Marcon
- Department of Medicine, Unit of General Medicine and Hypertension, University of Verona, Italy (D.M., P.M.)
| | - Pietro Minuz
- Department of Medicine, Unit of General Medicine and Hypertension, University of Verona, Italy (D.M., P.M.)
| | | | - Agnès Pasquet
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu)
| | - Esteban Poch
- Service de Cardiologie, CHU Ambroise Paré, Mons, Belgium (P.D.)
| | - Franco Rabbia
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (M.P., S.D.M., F.R.)
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Greece (G.S.S.)
| | - Ilkka Tikkanen
- Helsinki Hypertension Centre of Excellence (D.G., I.T.), University of Helsinki, Helsinki University Hospital, Finland.,Abdominal Center Nephrology (D.G., I.T.), University of Helsinki, Helsinki University Hospital, Finland.,Minerva Institute for Medical Research, Helsinki, Finland (I.T.)
| | - Laurent Toubiana
- Sorbonne Université, Université Paris 13, Sorbonne Paris Cité, INSERM, UMR_S1142, LIMICS, IRSAN, France (L.T.)
| | - Wouter Vinck
- Endocrinology Department, Saint-Augustinus Hospital, Wilrijk, Belgium (W.V.)
| | - Ewa Warchoł-Celińska
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A. Prejbisz, A.A.-H., E.W.-C., A.J.)
| | - Patricia Van der Niepen
- Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium (P.V.d.N.)
| | - Peter de Leeuw
- Department of Internal Medicine, Division of General Internal Medicine, Section Vascular Medicine (A.A.K., P.d.L.), Maastricht University Medical Centre, Maastricht University, the Netherlands.,CARIM School for Cardiovascular Diseases (A.A.K., P.d.L.), Maastricht University Medical Centre, Maastricht University, the Netherlands
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A. Prejbisz, A.A.-H., E.W.-C., A.J.)
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (M.P., S.D.M., A. Pasquet, A. Persu)
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Sebastià C, Nicolau C, Martín de Francisco Á, Poch E, Oleaga L. Prophylaxis against postcontrast acute kidney injury (PC-AKI): Updates in the ESUR guidelines 10.0 and critical review. Radiología (English Edition) 2020. [DOI: 10.1016/j.rxeng.2019.12.004] [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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32
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Sebastià C, Nicolau C, Martín de Francisco Á, Poch E, Oleaga L. Profilaxis de la lesión renal aguda poscontraste (LRA-PC). Actualización según la guía clínica ESUR 10.0 y revisión crítica. Radiología 2020; 62:292-297. [DOI: 10.1016/j.rx.2019.12.005] [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] [Received: 02/05/2019] [Revised: 11/12/2019] [Accepted: 12/11/2019] [Indexed: 12/09/2022]
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Bassegoda O, Huelin P, Ariza X, Solé C, Juanola A, Gratacós-Ginès J, Carol M, Graupera I, Pose E, Napoleone L, Albertos S, de Prada G, Cervera M, Fernández J, Fabrellas N, Poch E, Solà E, Ginès P. Development of chronic kidney disease after acute kidney injury in patients with cirrhosis is common and impairs clinical outcomes. J Hepatol 2020; 72:1132-1139. [PMID: 31953138 DOI: 10.1016/j.jhep.2019.12.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 02/19/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Acute kidney injury (AKI) is common in cirrhosis and is associated with poor prognosis. In patients who survive after AKI, it is not known whether the acute injury leads to chronic impairment of kidney function (chronic kidney disease [CKD]). The aim of the study was to determine the frequency of CKD at 3 months after an AKI episode and its effects on patient outcomes. METHODS Patients admitted for complications of cirrhosis during a 6.5-year period were evaluated using the same protocol, with assessment of kidney function at regular intervals during and after hospitalization. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 at 3 months after AKI. RESULTS A total of 409 patients (168 with AKI and 241 without AKI) were included. After 3 months, 97 patients with AKI and 188 patients without AKI had survived. Of the 97 patients with AKI, 24 had developed CKD at 3 months compared to only 2 of the 188 patients without AKI (25% vs. 1%, odds ratio 31; p <0.0001). Risk factors independently associated with CKD were nosocomial AKI and severity of AKI (stage ≥1B). At diagnosis of CKD, all patients had stage 3A CKD and one-quarter of them progressed to stages 3B and 4 after 1 year. The transition from AKI to CKD was associated with an increased rate of 3-month hospital readmission, increased frequency of AKI, bacterial infections, ascites, and refractory ascites and a trend towards a higher need for liver transplantation. Transplant-free survival was not impaired. CONCLUSIONS CKD frequently develops in patients with cirrhosis who survive AKI and has a negative impact on relevant clinical outcomes. The transition from AKI to CKD is common and should be considered a high-risk condition in patients with cirrhosis. LAY SUMMARY Episodes of acute impairment of kidney function are common in patients with cirrhosis. This study shows that the development of chronic impairment of kidney function is frequent in patients surviving these acute episodes and that it is associated with a higher risk of developing other complications of cirrhosis and to a higher rate of 3-month hospital readmissions.
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Affiliation(s)
- Octavi Bassegoda
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Patricia Huelin
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Xavier Ariza
- Digestive Diseases Unit, Hospital Moisès Broggi, Sant Joan Despí, Catalonia, Spain
| | - Cristina Solé
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Adrià Juanola
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Marta Carol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Laura Napoleone
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Sonia Albertos
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Gloria de Prada
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Marta Cervera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Javier Fernández
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Esteban Poch
- Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Nephrology Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Elsa Solà
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, University of Barcelona, Barcelona, Catalonia, Spain.
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Hermida-Lama E, Rodríguez D, Cucchiari D, Blasco M, Piñeiro G, Poch E, Lozano M, Cid J, Ruiz-Ortiz E, García-Herrera A, Quintana LF, Molina Andãºjar A. P0485ASSOCIATION BETWEEN ANTI-GBM TITERS AND KIDNEY INFLAMMATION MEASURED BY A NEW ACTIVITY SCORE. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Anti-glomerular basement membrane (anti-GBM) disease is an aggressive and rare glomerulopathy characterized by rapidly progressive loss of kidney function, leading to end stage kidney disease (ESKD) in a significant amount of cases. The main objective of our study was to determine whether anti-GBM titer correlated with the rate of activity in renal biopsy and long-term kidney survival in patients with anti-GBM, hence identifying patients who would potentially benefit from more intensive treatments.
Method
A retrospective analysis was performed on the cases of anti-GBM from our center that had both a positive biopsy and serology, from 2007 to 2019. Epidemiological data, anti-GBM levels on admission, kidney function at admission, discharge and follow-up, treatment and kidney biopsy findings were collected. All biopsies were reevaluated by a single, blinded pathologist and nephrologist. Based on a recent study by van Daalen et al, a chronicity and activity histopathological score was developed. The score was divided in glomerular and interstitial sections. In the glomerular section, a sclerotic pattern (>50% of glomeruli) was given 0 points in activity and 3 in chronicity, a mixed pattern was given 1 point in activity and chronicity, and a crescentic pattern (>50% with cellular crescents) was given 3 points in activity and 0 in chronicity. In the interstitial section, the presence of fibrosis and atrophy was given between 0 and 3 points in chronicity and the presence of tubulitis or interstitial infiltrate were given points in activity (0 to 1 and 0 to 3 respectively). The presence of neutrophils in the infiltrate was given one extra point in activity. Spearman correlation was performed between anti-GBM levels and our biopsy score.
Results
Twelve cases were identified, with a median Anti-GBM titer at admission of 292 U/mL (IQR 40-1517). Ten patients were treated with cyclophosphamide, 1 with rituximab plus cyclophosphamide and 1 with only rituximab. All patients received treatment with metilprednisona and plasma exchange with a median number of sessions of 8 (range: 6-12). Only one patient was not in ESKD during follow-up (35 months), so correlation with long-term kidney survival could not be performed. On the other hand, high antibody titers correlated with more activity on biopsy (correlation coefficient 0.592, p= 0.042) and less chronicity (correlation coefficient -0.657, p= 0.02).
Conclusion
These results suggest that patients who present with higher titers have more acute inflammation and less chronicity in renal parenchima, and therefore could benefit from more intensive treatment that changes the natural history of this aggressive disease. It would be interesting to study this score in larger and multicentric cohorts in order to produce more definitive conclusions.
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Affiliation(s)
- Evelyn Hermida-Lama
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
| | - Diana Rodríguez
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
| | - David Cucchiari
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
| | - Miquel Blasco
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
| | - Gaston Piñeiro
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
| | - Esteban Poch
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
| | - Miquel Lozano
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
| | - Joan Cid
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
| | | | | | - Luis F Quintana
- Hospital Clínic de Barcelona, Nephrology and Renal Transplant Unit, Barcelona, Spain
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Blasco M, Martínez-Roca A, Rodríguez-Lobato LG, Garcia-Herrera A, Rosiñol L, Castro P, Fernández S, Quintana LF, Cibeira MT, Bladé J, Fernández de Larrea C, Tovar N, Jimenez R, Poch E, Guillen E, Campistol JM, Carreras E, Diaz-Ricart M, Palomo M. Complement as the enabler of carfilzomib-induced thrombotic microangiopathy. Br J Haematol 2020; 193:181-187. [PMID: 32469083 DOI: 10.1111/bjh.16796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/16/2020] [Accepted: 05/05/2020] [Indexed: 01/07/2023]
Abstract
Carfilzomib has been associated with the development of thrombotic microangiopathy (TMA) in relapsed/refractory multiple myeloma patients, a severe disease with no currently available aetiological treatment. We evaluated the potential role of terminal complement pathway in four patients with carfilzomib-induced TMA. Membrane attack complex (C5b-9) deposition on endothelial cells in culture exposed to plasma from patients during the acute phase of the disease suggests complement overactivation as a mechanism of potential endothelial damage in three out of four patients. If confirmed in larger cohorts, C5b-9 evaluation will allow early identification of patients who could benefit from complement blockade and treatment monitoring.
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Affiliation(s)
- Miquel Blasco
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties nefro-urològiques i Trasplantament Renal, Barcelona, Spain
| | - Alexandra Martínez-Roca
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Luis G Rodríguez-Lobato
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | | | - Laura Rosiñol
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Sara Fernández
- Medical Intensive Care Unit, Hospital Clínic, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties nefro-urològiques i Trasplantament Renal, Barcelona, Spain
| | - María T Cibeira
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Joan Bladé
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Natalia Tovar
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Raquel Jimenez
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties nefro-urològiques i Trasplantament Renal, Barcelona, Spain
| | - Elena Guillen
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep M Campistol
- Nephrology and Kidney Transplantation Department, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIPABS), Malalties nefro-urològiques i Trasplantament Renal, Barcelona, Spain
| | - Enric Carreras
- Josep Carreras Leukaemia Research Institute, Hospital Clinic/University of Barcelona Campus, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Barcelona Endothelium Team, Barcelona, Spain.,Department of Hematopathology, Biomedical Diagnosis Center (CDB), Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Marta Palomo
- Josep Carreras Leukaemia Research Institute, Hospital Clinic/University of Barcelona Campus, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain.,Department of Hematopathology, Biomedical Diagnosis Center (CDB), Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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Cuadrado-Payán E, Montagud-Marrahi E, Torres-Elorza M, Bodro M, Blasco M, Poch E, Soriano A, Piñeiro GJ. SARS-CoV-2 and influenza virus co-infection. Lancet 2020; 395:e84. [PMID: 32423586 PMCID: PMC7200126 DOI: 10.1016/s0140-6736(20)31052-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | | | | | - Marta Bodro
- Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Miquel Blasco
- Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Esteban Poch
- Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Alex Soriano
- Hospital Clinic of Barcelona, Barcelona 08036, Spain
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Pappaccogli M, Di Monaco S, Warchoł-Celińska E, Lorthioir A, Amar L, Aparicio LS, Beauloye C, Bruno RM, Chenu P, de Leeuw P, De Backer T, Delmotte P, Dika Z, Gordin D, Heuten H, Iwashima Y, Krzesinski JM, Kroon AA, Mazzolai L, Poch E, Sarafidis P, Seinturier C, Spiering W, Toubiana L, Van der Niepen P, van Twist D, Visonà A, Wautrecht JC, Witowicz H, Xu J, Prejbisz A, Januszewicz A, Azizi M, Persu A. The European/International Fibromuscular Dysplasia Registry and Initiative (FEIRI)-clinical phenotypes and their predictors based on a cohort of 1000 patients. Cardiovasc Res 2020; 117:950-959. [PMID: 32282921 DOI: 10.1093/cvr/cvaa102] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 02/10/2020] [Revised: 02/27/2020] [Accepted: 04/07/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Since December 2015, the European/International Fibromuscular Dysplasia (FMD) Registry enrolled 1022 patients from 22 countries. We present their characteristics according to disease subtype, age and gender, as well as predictors of widespread disease, aneurysms and dissections. METHODS AND RESULTS All patients diagnosed with FMD (string-of-beads or focal stenosis in at least one vascular bed) based on computed tomography angiography, magnetic resonance angiography, and/or catheter-based angiography were eligible. Patients were predominantly women (82%) and Caucasians (88%). Age at diagnosis was 46 ± 16 years (12% ≥65 years old), 86% were hypertensive, 72% had multifocal, and 57% multivessel FMD. Compared to patients with multifocal FMD, patients with focal FMD were younger, more often men, had less often multivessel FMD but more revascularizations. Compared to women with FMD, men were younger, had more often focal FMD and arterial dissections. Compared to younger patients with FMD, patients ≥65 years old had more often multifocal FMD, lower estimated glomerular filtration rate and more atherosclerotic lesions. Independent predictors of multivessel FMD were age at FMD diagnosis, stroke, multifocal subtype, presence of aneurysm or dissection, and family history of FMD. Predictors of aneurysms were multivessel and multifocal FMD. Predictors of dissections were age at FMD diagnosis, male gender, stroke, and multivessel FMD. CONCLUSIONS The European/International FMD Registry allowed large-scale characterization of distinct profiles of patients with FMD and, more importantly, identification of a unique set of independent predictors of widespread disease, aneurysms and dissections, paving the way for targeted screening, management, and follow-up of FMD.
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Affiliation(s)
- Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy.,Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, 1200 Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Silvia Di Monaco
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Aurélien Lorthioir
- Hypertension Unit and DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Laurence Amar
- Hypertension Unit and DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, CIC1418, INSERM, Paris, France
| | - Lucas S Aparicio
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Christophe Beauloye
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, 1200 Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,INSERM U970 and Université de Paris, Paris, France
| | - Patrick Chenu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, 1200 Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Peter de Leeuw
- Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tine De Backer
- Department of Cardiovascular Diseases, University Hospital Ghent, Ghent, Belgium
| | - Philippe Delmotte
- Hypertension Excellence Centre, Department of Cardiology, Ambroise Paré University Hospital, Mons, Belgium
| | - Zivka Dika
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Daniel Gordin
- Helsinki Hypertension Centre of Excellence, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Helsinki, Finland
| | - Hilde Heuten
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
| | - Yoshio Iwashima
- Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi, Japan
| | - Jean-Marie Krzesinski
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium.,Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Abraham A Kroon
- Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital-CHUV, Centre of Rare Vascular Diseases and RAVAD Registry, Lausanne, Switzerland
| | - Esteban Poch
- Department of Nephrology and Kidney Transplantation, Hospital Clínic of Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christophe Seinturier
- Department of Cardiovascular Disease, Competence Center for Rare Vascular Diseases, European Center of Excellence in Arterial Hypertension, Grenoble-Alpes University Hospital, CS Grenoble Cedex 9, France
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laurent Toubiana
- Sorbonne Université, Université Paris 13, Sorbonne Paris Cité, INSERM, UMR_S1142, LIMICS, IRSAN, Paris, France
| | - Patricia Van der Niepen
- Department of Nephrology & Hypertension, Universitair Ziekenhuis Brussel , Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Daan van Twist
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Adriana Visonà
- Angiology Unit, Azienda ULSS 2 Marca Trevigiana, Castelfranco Veneto, Italy.,ESVM Board Member
| | | | - Helena Witowicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Jianzhong Xu
- Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Michel Azizi
- Hypertension Unit and DMU CARTE, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, CIC1418, INSERM, Paris, France
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, 1200 Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium
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Molina-Andújar A, Robles P, Cibeira MT, Montagud-Marrahi E, Guillen E, Xipell M, Blasco M, Poch E, Rosiñol L, Bladé J, Quintana LF. The renal range of the κ/λ sFLC ratio: best strategy to evaluate multiple myeloma in patients with chronic kidney disease. BMC Nephrol 2020; 21:111. [PMID: 32234026 PMCID: PMC7110749 DOI: 10.1186/s12882-020-01771-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/19/2020] [Indexed: 11/30/2022] Open
Abstract
Background Monoclonal serum free light chains (sFLC) are a well-known cause of renal impairment (RI) in patients with multiple myeloma (MM). As an indicator of monoclonality, sFLC ratio has acquired a key role in the diagnosis and monitorization of the disease. However, its interpretation is altered in patients with chronic kidney disease (CKD). This study aims to evaluate the modification of the sFLC ratio reference range in patients with CKD, and propose an optimal range for patients with CKD. Methods Serum FLC κ/λ ratio and estimated glomerular filtration rate (eGFR) were retrospectively analyzed in 113 control patients (without hematologic disease), 63 patients with MM in complete remission and 347 patients with active MM. The three groups included patients with CKD (eGFR < 90). Results In the group of patients without active MM (n = 176), the sFLC ratio increased at different stages of CKD without pathological significance, with an increase in the number of false positives specially when eGFR is ≤55 ml/min. An optimal range was established for patients with eGFR ≤55 ml/min/1.73 m2: 0.82–3,6 with maximum sensitivity + specificity for that group with an improvement in the Area under the curve (AUC), 0.91 (0.84–0.97) compared with the current ranges proposed by Katzmann and Hutchinson. Conclusions This study confirms the influence of eGFR on the interpretation of the sFLC ratio, showing a decreasing specificity in progressive CKD stages when using the reference sFLC range (Katzmann), especially in patients with eFGR ≤55. According to our results, we suggest a modified optimal range (0.82–3,6) for eGFR ≤55 ml/min/1.73 m2. It is necessary to validate this modified range in larger and prospective studies.
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Affiliation(s)
- Alícia Molina-Andújar
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Pau Robles
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria T Cibeira
- Haematology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Amyloidosis and Myeloma Unit.Hospital Clínic de Barcelona, Barcelona, Spain
| | - Enrique Montagud-Marrahi
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Guillen
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Xipell
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
| | - Esteban Poch
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
| | - Laura Rosiñol
- Haematology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Amyloidosis and Myeloma Unit.Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Bladé
- Haematology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Amyloidosis and Myeloma Unit.Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. .,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. .,Amyloidosis and Myeloma Unit.Hospital Clínic de Barcelona, Barcelona, Spain. .,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain.
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Montagud-Marrahi E, Revuelta I, Cucchiari D, Piñeiro GJ, Ventura-Aguiar P, Lozano M, Cid J, Martorell J, Solé M, Quintana LF, Oppenheimer F, Diekmann F, Poch E, Campistol JM, Blasco M. Successful use of nonantigen-specific immunoadsorption with antihuman Ig-columns in kidney graft antibody-mediated rejection. J Clin Apher 2020; 35:188-199. [PMID: 32219886 DOI: 10.1002/jca.21779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/04/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Nonantigen-specific immunoadsorption (IA) has proven to be effective in acute antibody-mediated rejection (aAMR). However, there is a lack of solid studies evaluating the safety and efficacy of IA with antihuman Ig-columns in aAMR. For chronic-active AMR (cAMR), no studies have evaluated the efficacy of nonantingen-specific IA with antihuman Ig-columns. The purpose of this study was to evaluate the role of nonantigen-specific IA with antihuman Ig-columns in the treatment of both aAMR and cAMR in kidney transplantation. MATERIAL AND METHODS In retrospective and observational study, kidney graft and recipient survival rates were assessed after treatment of aAMR and cAMR with nonantigen-specific IA with Ig-Flex columns (Therasorb) between January 2012 and May 2018. Protocols included nonantigen-specific IA, rituximab, intravenous immunoglobulin, and rescue plasma exchange, if necessary. RESULTS The study included 14 patients with AMR (acute in 9, chronic active in 5). For aAMR, mean follow-up was 13 ± 6 months, and patient and graft survival were, respectively, of 100% and 83%, with a mean increase in estimated glomerular filtration rate (eGFR) of 7.98 ± 12.96, 10.18 ± 16.71, and 11.43 ± 13.85 mL/min/1.72 m2 (P > .05) at 3, 12 months after treatment, and at the end of follow-up, respectively. For cAMR, mean follow-up was 14 ± 8 months, and patient and graft survival were, respectively, of 100% and 60%, with an average increase in eGFR of 4.30 ± 7.86, 5.64 ± 10.47, and 14.5 ± 7.86 mL/min/m2 (P > .05) at 3, 12 months after IA treatment, and at the end of the follow-up, respectively, although 40% did not respond and required chronic hemodialysis. CONCLUSION Nonantigen-specific IA with Ig-Flex columns was safe and effective for aAMR treatment in kidney transplantation. In cAMR, IA with Ig-Flex columns was associated with a satisfactory kidney graft survival, suggesting that IA could potentially offer some benefits supporting its indication in cAMR.
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Affiliation(s)
- Enrique Montagud-Marrahi
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Ignacio Revuelta
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - David Cucchiari
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Gaston J Piñeiro
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Joan Cid
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jaume Martorell
- Immunology Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Manel Solé
- Pathology Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Federico Oppenheimer
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep M Campistol
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Rodas LM, Ruiz-Ortiz E, Garcia-Herrera A, Pereira A, Blasco M, Ventura-Aguiar P, Viñas Gomis O, Egri N, De Sousa E, Palou E, Diekmann F, Poch E, Campistol JM, Quintana LF. IgA Nephropathy Recurrence after Kidney Transplantation: Role of Recipient Age and Human Leukocyte Antigen-B Mismatch. Am J Nephrol 2020; 51:357-365. [PMID: 32187607 DOI: 10.1159/000506853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recurrence of immunoglobulin (Ig)A nephropathy (rIgAN) is a growing cause of kidney allograft dysfunction. This study was aimed at investigating factors associated with rIgAN and the subsequent progression to end-stage renal disease (ESRD). METHODS Retrospective study including consecutive patients with IgA nephropathy (IgAN) who received a kidney transplant in our center between 1992 and 2016 and had a renal biopsy by clinical indication. The date of detection of chronic kidney disease (CKD) 5 was used as renal outcome. RESULTS Eighty-six kidney transplants were performed in patients with IgAN, 38 (44%) were from living donors (related n = 26). rIgAN was diagnosed in 23 allografts (27%). Renal function and proteinuria at the end of the follow-up period were worst in the rIgAN patients compared to those without rIgAN (2.2 vs. 1.4 mg/dL, p = 0.014, and 1.16 vs. 0.49 g/day, p = 0.005, respectively). Risk of rIgAN and progression to CKD 5 decreased with patient's age (hazard ratio [HR] 0.95, 95% CI 0.92-0.98, p = 0.002, and HR 0.97, 95% CI 0.83-0.97, p = 0.008 per year, respectively). Patients with rIgAN had a higher risk of progression to CKD 5 (HR 6.7, 95% CI 1.3-35.7, p = 0.025). Full donor-recipient mismatch in the human leukocyte antigen (HLA)-B loci decreased the risk of rIgAN (HR 0.22, 95% CI 0.06-0.76, p = 0.017). CONCLUSIONS rIgAN was an independent risk factor for ESRD after renal allograft. Younger age increased the risk of rIgAN and CKD 5. Conversely, HLA-B mismatching was a potential protective factor for rIgAN of this glomerular disease.
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Affiliation(s)
- Lida M Rodas
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain,
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain,
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain,
| | | | - Adriana Garcia-Herrera
- Department of Pathology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
| | - Arturo Pereira
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Miquel Blasco
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | | | - Natalia Egri
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Erika De Sousa
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Eduard Palou
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Josep M Campistol
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Luis Fernando Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
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Bermejo S, González E, López-Revuelta K, Ibernon M, López D, Martín-Gómez A, Garcia-Osuna R, Linares T, Díaz M, Martín N, Barros X, Marco H, Navarro MI, Esparza N, Elias S, Coloma A, Robles NR, Agraz I, Poch E, Rodas L, Lozano V, Fernández B, Hernández E, Martínez MI, Stanescu RI, Moirón JP, García N, Goicoechea M, Calero F, Bonet J, Galceran JM, Liaño F, Pascual J, Praga M, Fulladosa X, Soler MJ. Risk factors for non-diabetic renal disease in diabetic patients. Clin Kidney J 2020; 13:380-388. [PMID: 32699618 PMCID: PMC7367112 DOI: 10.1093/ckj/sfz177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/15/2019] [Indexed: 11/28/2022] Open
Abstract
Background Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 ± 12.8 years, creatinine was 2.8 ± 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n = 329) of patients had DN, 49.6% (n = 413) NDRD and 10.8% (n = 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n = 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) = 1.03, 95% CI: 1.02–1.05, P < 0.001], microhaematuria (OR = 1.51, 95% CI: 1.03–2.21, P = 0.033) and absence of diabetic retinopathy (DR) (OR = 0.28, 95% CI: 0.19–0.42, P < 0.001) were independently associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P = 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P = 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P = 0.002), higher creatinine (P = 0.01) and DN (P = 0.015) were independent risk factors for mortality. Conclusions The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis.
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Affiliation(s)
- Sheila Bermejo
- Nephrology Department, Hospital del Mar, Barcelona, Spain.,Nephrology Department, Fundació Althaia, Manresa, Spain
| | - Ester González
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Meritxell Ibernon
- Nephrology Department, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Diana López
- Nephrology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | | | | | - Tania Linares
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Nàdia Martín
- Nephrology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Xoana Barros
- Nephrology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Helena Marco
- Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Noemí Esparza
- Nephrology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Sandra Elias
- Nephrology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Coloma
- Nephrology Department, Hospital San Pedro, Logroño, Spain
| | | | - Irene Agraz
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department, Hospital Clínic, Barcelona, Spain.,IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Nephrology Department, Hospital Clínic, Barcelona, Spain.,IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Víctor Lozano
- Nephrology Department, Hospital Clínic, Barcelona, Spain.,IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | - José Pelayo Moirón
- Nephrology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Núria García
- Nephrology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Marian Goicoechea
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Josep Bonet
- Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Fernando Liaño
- Nephrology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Manuel Praga
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Xavier Fulladosa
- Nephrology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Spanish Group for the Study of Glomerular Diseases (GLOSEN), Grup de Treball de Malalties Glomerulars de la Societat Catalana de. Nefrologia (GlomCAT), and Grupo Español de Estudio de Nefropatía Diabética (GEENDIAB)
| | - María José Soler
- Nephrology Department, Hospital del Mar, Barcelona, Spain.,Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
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42
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Palomo M, Blasco M, Molina P, Lozano M, Praga M, Torramade-Moix S, Martinez-Sanchez J, Cid J, Escolar G, Carreras E, Paules C, Crispi F, Quintana LF, Poch E, Rodas L, Goma E, Morelle J, Espinosa M, Morales E, Avila A, Cabello V, Ariceta G, Chocron S, Manrique J, Barros X, Martin N, Huerta A, Fraga-Rodriguez GM, Cao M, Martin M, Romera AM, Moreso F, Manonelles A, Gratacos E, Pereira A, Campistol JM, Diaz-Ricart M. Complement Activation and Thrombotic Microangiopathies. Clin J Am Soc Nephrol 2019; 14:1719-1732. [PMID: 31694864 PMCID: PMC6895490 DOI: 10.2215/cjn.05830519] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 05/13/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Atypical hemolytic uremic syndrome is a form of thrombotic microangiopathy caused by dysregulation of the alternative complement pathway. There is evidence showing complement activation in other thrombotic microangiopathies. The aim of this study was to evaluate complement activation in different thrombotic microangiopathies and to monitor treatment response. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Complement activation was assessed by exposing endothelial cells to sera or activated-patient plasma-citrated plasma mixed with a control sera pool (1:1)-to analyze C5b-9 deposits by immunofluorescence. Patients with atypical hemolytic uremic syndrome (n=34) at different stages of the disease, HELLP syndrome (a pregnancy complication characterized by hemolysis, elevated liver enzymes, and low platelet count) or severe preeclampsia (n=10), and malignant hypertension (n=5) were included. RESULTS Acute phase atypical hemolytic uremic syndrome-activated plasma induced an increased C5b-9 deposition on endothelial cells. Standard and lower doses of eculizumab inhibited C5b-9 deposition in all patients with atypical hemolytic uremic syndrome, except in two who showed partial remission and clinical relapse. Significant fibrin formation was observed together with C5b-9 deposition. Results obtained using activated-plasma samples were more marked and reproducible than those obtained with sera. C5b-9 deposition was also increased with samples from patients with HELLP (all cases) and preeclampsia (90%) at disease onset. This increase was sustained in those with HELLP after 40 days, and levels normalized in patients with both HELLP and preeclampsia after 6-9 months. Complement activation in those with malignant hypertension was at control levels. CONCLUSIONS The proposed methodology identifies complement overactivation in patients with atypical hemolytic uremic syndrome at acute phase and in other diseases such as HELLP syndrome and preeclampsia. Moreover, it is sensitive enough to individually assess the efficiency of the C5 inhibition treatment.
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Affiliation(s)
- Marta Palomo
- Josep Carreras Leukaemia Research Institute; .,Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain
| | - Miquel Blasco
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain.,Group of nephro-urological diseases and renal transplantation (IDIBAPS), Barcelona, Spain
| | - Patricia Molina
- Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Institut Clinic de Malalties Hematologiques i Oncologiques (ICMHO), IDIBAPS, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario 12 de Octubre and Research Institute i+12, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Sergi Torramade-Moix
- Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Julia Martinez-Sanchez
- Josep Carreras Leukaemia Research Institute.,Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain
| | - Joan Cid
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Institut Clinic de Malalties Hematologiques i Oncologiques (ICMHO), IDIBAPS, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Gines Escolar
- Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Enric Carreras
- Josep Carreras Leukaemia Research Institute.,Barcelona Endothelium Team, Barcelona, Spain
| | - Cristina Paules
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic de Barcelona and Hospital Sant Joan de Deu), ICGON, IDIBAPS, Universitat de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Barcelona, Spain
| | - Fatima Crispi
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic de Barcelona and Hospital Sant Joan de Deu), ICGON, IDIBAPS, Universitat de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain.,Group of nephro-urological diseases and renal transplantation (IDIBAPS), Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain.,Group of nephro-urological diseases and renal transplantation (IDIBAPS), Barcelona, Spain
| | - Lida Rodas
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Emma Goma
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Mario Espinosa
- Department of Nephrology, Hospital Universitario Reina Sofía e Instituto Maimonides de Investigaciones Biológicas de Córdoba (IMIBIC), Córdoba, Spain
| | - Enrique Morales
- Department of Nephrology, Hospital Universitario 12 de Octubre and Research Institute i+12, Madrid, Spain
| | - Ana Avila
- Department of Nephrology and Renal Transplantation, Hospital Universitario Dr Peset, Valencia, Spain
| | - Virginia Cabello
- Department of Nephrology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Materno-Infantil, Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sara Chocron
- Department of Pediatric Nephrology, Hospital Materno-Infantil, Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joaquin Manrique
- Department of Nephrology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitari Josep Trueta, Girona, Spain
| | - Nadia Martin
- Department of Nephrology, Hospital Universitari Josep Trueta, Girona, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Gloria M Fraga-Rodriguez
- Department of Pediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mercedes Cao
- Department of Nephrology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Marisa Martin
- Department of Nephrology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Ana Maria Romera
- Department of Nephrology, Hospital General Universitario, Ciudad Real, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Anna Manonelles
- Kidney Transplant Unit, Department of Nephrology, Hospital de Bellvitge, Universitat de Barcelona, Barcelona, Spain; and
| | - Eduard Gratacos
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic de Barcelona and Hospital Sant Joan de Deu), ICGON, IDIBAPS, Universitat de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Barcelona, Spain
| | | | - Josep M Campistol
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Maribel Diaz-Ricart
- Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain
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43
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Huelin P, Solà E, Elia C, Solé C, Risso A, Moreira R, Carol M, Fabrellas N, Bassegoda O, Juanola A, de Prada G, Albertos S, Piano S, Graupera I, Ariza X, Napoleone L, Pose E, Filella X, Morales-Ruiz M, Rios J, Fernández J, Jiménez W, Poch E, Torres F, Ginès P. Neutrophil Gelatinase-Associated Lipocalin for Assessment of Acute Kidney Injury in Cirrhosis: A Prospective Study. Hepatology 2019; 70:319-333. [PMID: 30810244 DOI: 10.1002/hep.30592] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/12/2019] [Indexed: 12/14/2022]
Abstract
Kidney biomarkers appear to be useful in differential diagnosis between acute tubular necrosis (ATN) and other types of acute kidney injury (AKI) in cirrhosis, particularly hepatorenal syndrome (HRS-AKI). Distinction is important because treatment is different. However, kidney biomarkers are still not used in clinical practice. The aim of the current study was to investigate the accuracy of several biomarkers in differential diagnosis of AKI and in predicting kidney outcome and patient survival. This was a prospective study of 320 consecutive cases of AKI in patients hospitalized for decompensated cirrhosis. Evaluation of AKI was made with a diagnostic algorithm that included identification and removal/treatment of precipitating factors and albumin administration (1 g/kg for 2 days) to patients with AKI stage 1B or greater. Urinary neutrophil gelatinase-associated lipocalin (NGAL), monomeric NGAL (mNGAL), interleukin-18, and standard biomarkers were measured at diagnosis and on days 3, 7, and 14. Of the 320 cases, 153 were hypovolemia-induced AKI (48%), 93 were HRS-AKI (29%), 39 were ATN (12%), and 35 were due to miscellaneous causes (11%). Among all biomarkers, urinary NGAL measured at day 3 had the greatest accuracy for differential diagnosis between ATN and other types of AKI (area under the receiver operating characteristic curve, 0.87; 95% confidence interval, 0.78-0.95). The cutoff with the best predictive accuracy for ATN diagnosis was 220 µg/g creatinine. Progression of AKI during hospitalization was associated with persistently high NGAL levels, and NGAL was an independent predictive factor of AKI progression. Likewise, NGAL was also an independent predictive factor of 28-day mortality together with Model for End-Stage Liver Disease score. Conclusion: These results support the use of NGAL in clinical practice within the context of a diagnostic algorithm for differential diagnosis of AKI and outcome prediction in cirrhosis.
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Affiliation(s)
- Patricia Huelin
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Elsa Solà
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Chiara Elia
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Cristina Solé
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Alessandro Risso
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Rebeca Moreira
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Marta Carol
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Octavi Bassegoda
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | - Adrià Juanola
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | - Gloria de Prada
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Sonia Albertos
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Salvatore Piano
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Isabel Graupera
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Xavier Ariza
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Laura Napoleone
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Xavier Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Manuel Morales-Ruiz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - José Rios
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Catalonia, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Javier Fernández
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Wladimiro Jiménez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Esteban Poch
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Servei de Nefrologia, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Catalonia, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
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44
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Bermejo S, Gonzalez E, Martin N, Garcia R, Linares T, Poch E, Esparza N, Díaz-Encarnación M, Irene A, Navarro MI, Lopez K, Ibernon M, Garcia N, Lopez D, Martin-Gómez A, Praga M, Galceran JM, Pascual J, Fulladosa X, Soler Romeo MJ. SaO011BIOPSY-PROVEN DIABETIC NEPHROPATHY WORSENS RENAL PROGNOSIS IN DIABETIC PATIENT: RESULTS MULTICENTER STUDY BIODIAB-GLOSEN-GEENDIAB. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz101.sao011] [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: 11/14/2022] Open
Affiliation(s)
- Sheila Bermejo
- Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain, Manresa, Spain
| | | | - Nadia Martin
- Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | | | | | | | - Noemí Esparza
- Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Agraz Irene
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Katia Lopez
- Fundación Hospital Alcorcón, Alcorcón, Spain
| | | | | | - Diana Lopez
- Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Manuel Praga
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Josep Mª Galceran
- Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain, Manresa, Spain
| | | | - Xavier Fulladosa
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria Jose Soler Romeo
- Hospital del Mar. Hospital Universitari del Vall d´Hebron. pi17/00257. redinren., Barcelona, Spain
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Molina A, Guillen E, Montagud E, Quintana LF, Blasco M, Arrizabalaga P, Campistol JM, Botey A, Poch E. SP059FIBROMUSCULAR DYSPLASIA: 40 YEARS OF EXPERIENCE IN A TERTIARY REFERRAL HOSPITAL. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp059] [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: 11/13/2022] Open
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Molina A, Santiago P, Blasco M, Maduell F, Poch E. SP479IMPACT OF THE INTENSITY OF INTERMITTENT RENAL REPLACEMENT THERAPY IN THE CRITICAL ILL PATIENTS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp479] [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: 11/14/2022] Open
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Arrizabalaga P, Gómez M, Menacho I, Pallisa L, Jorge V, Poch E. La contribución de la nefrología extrahospitalaria al control de la demanda: análisis del Área Integral de Salud Barcelona Esquerra (AISBE). Nefrologia 2019; 39:192-197. [DOI: 10.1016/j.nefro.2018.07.011] [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] [Received: 10/23/2017] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 11/26/2022] Open
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Abstract
Tolvaptan is an orally active antagonist of vasopressin (antidiuretic hormone [ADH]) V2 receptors. By blocking water reabsorption in kidney collecting ducts, it prompts renal free-water excretion and has been used for the treatment of hyponatremia, both euvolemic due to the syndrome of inappropriate ADH secretion, and hypervolemic due to liver cirrhosis and congestive heart failure. In the past few years, it has been shown that vasopressin and its second messenger cyclic adenosine monophosphate (cAMP) play an important role in the pathogenesis of autosomal dominant polycystic kidney disease (ADPKD). This has been the rationale for the use of tolvaptan to halt the progression of ADPKD, mainly through slowing kidney growth and decline in renal function. Two major randomized clinical trials have demonstrated the benefits of tolvaptan in slowing the progression of ADPKD in terms of kidney growth and decline in renal function at 1 and 3 years (REPRISE and TEMPO). However, the long-term effectiveness of treatment with tolvaptan remains to be determined.
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Affiliation(s)
- E Poch
- Department of Nephrology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - L Rodas
- Department of Nephrology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Blasco
- Department of Nephrology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Molina
- Department of Nephrology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - L Quintana
- Department of Nephrology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Cucchiari D, Reverter E, Blasco M, Molina-Andujar A, Carpio A, Sanz M, Escorsell A, Fernández J, Poch E. High cut-off membrane for in-vivo dialysis of free plasma hemoglobin in a patient with massive hemolysis. BMC Nephrol 2018; 19:250. [PMID: 30286730 PMCID: PMC6172805 DOI: 10.1186/s12882-018-1051-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background The possibility of clearing Cell-free Plasma Hemoglobin (CPH) from human plasma may appear attractive, especially when considering the noxious effects that CPH has on the immune function and the renal damage caused by its filtration. The existence of the so-called High Cut-Off (HCO) filters, possessing pores as big as 60 kDa, could potentially allow the clearance of the αβ dimers (31.3 kDa), the form in which the α2β2 hemoglobin tetramers (62.6 kDa) physiologically dissociate in plasma. We present herein the first reported case in which such an attempt was made. Case presentation The patient was a 51-year-old man with hemolytic crisis due to glucose-6-phosphate dehydrogenase deficiency, further complicated by pigment-induced nephropathy. He underwent a 48-h CVVHD session, in which a HCO filter was used. The Sieving Coefficient (SC) for CPH was initially 0.08 and decreased to 0.02 after 24 h. This unexpected low SC was due to the initial high concentration of CPH (4.24 g/L). At such concentrations, the α2β2 tetramer poorly dissociates into the αβ dimer; but increases exponentially at concentrations lower than 1 g/L. Conclusions Clearance of CPH through a HCO filter is technically feasible but its performance markedly relies on the initial concentration of CPH. Critically ill patients with smoldering hemolysis, as it happens during septic shock or ECMO treatment, may benefit the most from the use of this membrane in order to clear CPH.
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Affiliation(s)
- David Cucchiari
- Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain.
| | - Enric Reverter
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain
| | - Alicia Molina-Andujar
- Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain
| | - Adriá Carpio
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Miquel Sanz
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Angels Escorsell
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Javier Fernández
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain
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Molina-Andújar A, Blasco M, Poch E. Role of sustained low efficiency dialysis in the intensive care unit. Nefrologia 2018; 39:98-99. [PMID: 30077424 DOI: 10.1016/j.nefro.2018.06.002] [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] [Received: 04/11/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Alícia Molina-Andújar
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España.
| | - Miquel Blasco
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
| | - Esteban Poch
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, España
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