Revistas
Revista:
JOURNAL OF RENAL NUTRITION
ISSN:
1051-2276
Año:
2023
Vol.:
33
N°:
5
Págs.:
691 - 697
The coronavirus disease 2019 pandemic has exacerbated existing health disparities related to food security status. Emerging literature suggests individuals with Chronic Kidney Disease (CKD) who are also food insecure have a greater likelihood of disease progression compared to food secure individuals. However, the complex relationship between CKD and food insecurity (FI) is understudied relative to other chronic conditions. The purpose of this practical application article is to summarize the recent literature on the social-economic, nutritional, to care through which FI may negatively impact health outcomes in individuals with CKD. While several studies have reported on the cross-sectional prevalence of FI among persons with CKD, literature is lacking about the severity and duration of exposure to FI on CKD outcomes. Future research is needed to better understand how FI impairs CKD care, nutritional and structural barriers that impact disease prevention and disease progression, and effective strategies to support patients.
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN:
0066-4804
Año:
2023
Vol.:
67
N°:
1
Págs.:
e0126422
Tunneled central venous catheter (TCVC) related infection remains a challenge in the care of hemodialysis patients. We aimed to determine the best antimicrobial lock therapy (ALT) to eradicate coagulase-negative staphylococci (CoNS) biofilms. Tunneled central venous catheter (TCVC) related infection remains a challenge in the care of hemodialysis patients. We aimed to determine the best antimicrobial lock therapy (ALT) to eradicate coagulase-negative staphylococci (CoNS) biofilms. We studied the colonization status of the catheter every 30 days by quantitative blood cultures (QBC) drawn through all catheter lumens. Those patients with a significant culture (i.e.,100 to 1,000 CFU/mL) of a CoNS were classified as patients with a high risk of developing catheter-related bloodstream infections (CRBSI). They were assigned to receive daptomycin, vancomycin, teicoplanin lock solution, or the standard of care (SoC) (i.e., heparin lock). The primary endpoint was to compare eradication ability (i.e., negative QBC for 30 days after ending ALT) rates between different locks and the SoC. A second objective was to analyze the correlation between ALT exposure and isolation of CoNS with antimicrobial resistance. Daptomycin lock was associated with a significant higher eradication success than with the SoC: 85% versus 30% (relative risk [RR] = 14, 95% confidence interval [CI] = 2.4 - 82.7); followed by teicoplanin locks with a 83.3% success (RR = 11.7; 95% CI = 2 - 70.2). We observed CoNs isolates with a higher teicoplanin MIC in patients with repeated teicoplanin locks exposure (coefficient = 0.3; 95% CI = 0.11 - 0.47). However, teicoplanin MICs decreased in patients treated with vancomycin locks (coefficient = -0.56; 95% CI = -0.85 - -0.02). Methicillin-resistance decreased with accumulative ALT (RR = 0.82; 95% CI = 0.69 - 0.98). In this study, daptomycin locks achieve the highest eradication rate of CoNS from hemodialysis catheters in vivo.
Revista:
NMR IN BIOMEDICINE
ISSN:
0952-3480
Año:
2023
Vol.:
36
N°:
2
Págs.:
e4832
Monitoring renal allograft function after transplantation is key for the early detection of allograft impairment, which in turn can contribute to preventing the loss of the allograft. Multiparametric renal MRI (mpMRI) is a promising noninvasive technique to assess and characterize renal physiopathology; however, few studies have employed mpMRI in renal allografts with stable function (maintained function over a long time period). The purposes of the current study were to evaluate the reproducibility of mpMRI in transplant patients and to characterize normal values of the measured parameters, and to estimate the labeling efficiency of Pseudo-Continuous Arterial Spin Labeling (PCASL) in the infrarenal aorta using numerical simulations considering experimental measurements of aortic blood flow profiles. The subjects were 20 transplant patients with stable kidney function, maintained over 1 year. The MRI protocol consisted of PCASL, intravoxel incoherent motion, and T1 inversion recovery. Phase contrast was used to measure aortic blood flow. Renal blood flow (RBF), diffusion coefficient (D), pseudo-diffusion coefficient (D*), flowing fraction ( f$$ f $$), and T1 maps were calculated and mean values were measured in the cortex and medulla. The labeling efficiency of PCASL was estimated from simulation of Bloch equations. Reproducibility was assessed with the within-subject coefficient of variation, intraclass correlation coefficient, and Bland-Altman analysis. Correlations were evaluated using the Pearson correlation coefficient. The significance level was p less than 0.05. Cortical reproducibility was very good for T1, D, and RBF, moderate for f$$ f $$, and low for D*, while medullary reproducibility was good for T1 and D. Significant correlations in the cortex between RBF and f$$ f $$ (r = 0.66), RBF and eGFR (r = 0.64), and D* and eGFR (r = -0.57) were found. Normal values of the measured parameters employing the mpMRI protocol in kidney transplant patients with stable function were characterized and the results showed good reproducibility of the techniques.
Autores:
Quiroga, B.; Soler, M. J. (Autor de correspondencia); Ortiz, A. (Autor de correspondencia); et al.
Revista:
CLINICAL KIDNEY JOURNAL
ISSN:
2048-8505
Año:
2022
Vol.:
15
N°:
10
Págs.:
1856 - 1864
Background Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P = .001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P = .693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P = .001), lower time from booster (P = .043) and past breakthrough SARS-CoV-2 infection (P < .001). Conclusions In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection. Lay Summary Patients on hemodialysis present higher rates of complications derived from SARS-CoV-2 infections. Initial vaccination schedules have demonstrated suboptimal responses in those patients. The aim of the present study is to evaluate the time-course of the humoral response after a booster dose of SARS-CoV-2 RNA-based vaccines (BNT162b2 or mRNA-1273) in patients on hemodialysis. We included 711 patients that had received a booster dose: 545 (77%) 6 months before the initial vaccination and 166 (23%) between 6 and 9 months from the initial vaccination. After the booster, only 6 (<1%) patients presented persistent negative humoral response. During follow-up from Month 6 to Month 9, 35 patients (5%) developed a SARS-CoV-2 infection. Patients that received the booster later, breakthrough SARS-CoV-2 infection and mRNA-1273 booster were associated with higher anti-Spike titers.
Revista:
NUTRIENTS
ISSN:
2072-6643
Año:
2022
Vol.:
14
N°:
17
Págs.:
3484
Background: Matrix metalloproteinase-10 (MMP-10) levels increase progressively starting from early diabetic kidney disease (DKD) stages. Vitamin D-3 (vitD(3)) deficit is associated with a higher risk of diabetic microangiopathy. Reduced MMP-10 expression has been observed after exposure to vitD(3). Aim: to assess how vitD(3) status is related to MMP-10 levels in patients with Type 2 diabetes (T2D). Methods: 256 patients with T2D were included in this cross-sectional study. Demographic, clinical and serum MMP-10 and 25-hydroxyvitamin D-3 (25(OH)D-3) levels were collected from each patient. The association between MMP-10 and (25(OH)D-3) levels was assessed using a correlation analysis and fitting a multivariate linear regression model. Results: Serum MMP-10 levels were inversely correlated with circulating 25(OH)D-3 (rho = -0.25; p < 0.001). In the subgroup analysis this correlation was significant in patients with DKD (rho = -0.28; p = 0.001) and in subjects with vitD(3) deficit (rho = -0.24; p = 0.005). In the regression model adjusted for kidney function, body adiposity, smoking and vitD supplementation MMP-10 levels were 68.7 pg/mL lower in patients with 25(OH)D-3 > 20 ng/mL, with respect to <= 20 ng/mL (p = 0.006). Conclusions: vitD(3) repletion status is an independent predictor of MMP-10 levels in T2D patients. Perhaps, high 25(OH)D-3 values should be targeted in these patients in order to prevent vascular complications.
Revista:
ANTIBIOTICS
ISSN:
2079-6382
Año:
2022
Vol.:
11
N°:
12
Págs.:
1692
This study aimed to prove that pre-emptive antimicrobial locks in patients at risk of bacteremia decrease infection. We performed a non-randomized prospective pilot study of hemodialysis patients with tunneled central venous catheters. We drew quantitative blood cultures monthly to detect colonization. Patients with a critical catheter colonization by coagulase-negative staphylococci (defined as counts of 100-999 CFU/mL) were at high risk of developing a catheter-related bloodstream infection. We recommended antimicrobial lock for this set of patients. The nephrologist in charge of the patient decided whether to follow the recommendation or not (i.e., standard of care). We compared bloodstream infection rates between patients treated with antimicrobial lock therapy versus patients treated with the standard of care (i.e., heparin). We enrolled 149 patients and diagnosed 86 episodes of critical catheter colonization by coagulase-negative staphylococci. Patients treated with antimicrobial lock had a relative risk of bloodstream infection of 0.19 when compared with heparin lock (CI 95%, 0.11-0.33, p < 0.001) within three months of treatment. We avoided one catheter-related bloodstream infection for every ten catheter-critical colonizations treated with antimicrobial lock [number needed to treat 10, 95% CI, 5.26-100, p = 0.046]. In conclusion, pre-emptive antimicrobial locks decrease bloodstream infection rates in hemodialysis patients with critical catheter colonization.
Autores:
Bajo, M. A. (Autor de correspondencia); Ríos Moreno, F.; Arenas, M. D.; et al.
Revista:
NEFROLOGIA
ISSN:
2013-2514
Año:
2022
Vol.:
42
N°:
5
Págs.:
594 - 606
Background and aims: In this study, we show the results of the subset of Spanish patients of the VERIFIE study, the first post-marketing study assessing the long-term safety and effectiveness of sucroferric oxyhydroxide (SFOH) in patients with hyperphosphatemia undergoing dialysis during clinical practice.
Patients and methods: Patients undergoing hemodialysis and peritoneal dialysis with indication of SFOH treatment were included. Follow-up duration was 12-36 months after SFOH initiation. Primary safety variables were the incidence of adverse drug reactions (ADRs), medical events of special interest (MESIs), and variations in iron-related parameters. SFOH effectiveness was evaluated by the change in serum phosphorus levels.
Results: A total of 286 patients were recruited and data from 282 were analyzed. Among those 282 patients, 161 (57.1%) withdrew the study prematurely and 52.5% received concomitant treatment with other phosphate binders. ADRs were observed in 35.1% of patients, the most common of which were gastrointestinal disorders (77.1%) and mild/moderate in severity (83.7%). MESIs were reported in 14.2% of patients, and 93.7% were mild/moderate. An increase in ferritin (386.66ng/mL vs 447.55ng/mL; p=0.0013) and transferrin saturation (28.07% vs 30.34%; p=0.043) was observed from baseline to the last visit (p=0.0013). Serum phosphorus levels progressively decreased from 5.69mg/dL at baseline to 4.84mg/dL at the last visit (p<0.0001), increasing by 32.2% the proportion of patients who achieved serum phosphorus levels ¿5.5mg/dL, with a mean daily SFOH dose of 1.98 pills/day.
Conclusions: SFOH showed a favorable effectiveness profile, a similar safety profile to that observed in the international study with most adverse events of mild/moderate severity, and a low daily pill burden in Spanish patients in dialysis.
Revista:
MAGNETIC RESONANCE IN MEDICINE
ISSN:
0740-3194
Año:
2021
Vol.:
85
N°:
3
Págs.:
1507 - 1521
Purpose To evaluate labeling efficiency of pseudo-continuous arterial spin labeling (PCASL) and to find the gradient parameters that increase PCASL robustness for renal perfusion measurements. Methods Aortic blood flow was characterized in 3 groups: young healthy volunteers (YHV1), chronic kidney disease (CKD) patients (CKDP), and healthy controls (HCO). PCASL inversion efficiency was evaluated through numeric simulations considering the measured pulsatile flow velocity profiles and off-resonance effects for a wide range of gradient parameters, and the results were assessed in vivo. The most robust PCASL implementation was used to measure renal blood flow (RBF) in CKDP and HCO. Results Aortic blood velocities reached peak values of 120 cm/s in YHV1, whereas for elderly subjects values were lower by approximately a factor of 2. Simulations and experiments showed that by reducing the gradient average (G(ave)) and the selective to average gradient ratio (G(max)/G(ave)), labeling efficiency was maximized and PCASL robustness to off-resonance was improved. The study in CKDP and HCO showed significant differences in RBF between groups. Conclusion An efficient and robust PCASL scheme for renal applications requires aG(max)/G(ave)ratio of 6-7 and aG(ave)value that depends on the aortic blood flow velocities (0.5 mT/m being appropriate for CKDP and HCO).
Revista:
SCIENTIFIC REPORTS
ISSN:
2045-2322
Matrix metalloproteinases have been implicated in diabetic microvascular complications. However, little is known about the pathophysiological links between MMP-10 and the renin-angiotensin system (RAS) in diabetic kidney disease (DKD). We tested the hypothesis that MMP-10 may be up-regulated in early stage DKD, and could be down-regulated by angiotensin II receptor blockade (telmisartan). Serum MMP-10 and TIMP-1 levels were measured in 268 type 2 diabetic subjects and 111 controls. Furthermore, histological and molecular analyses were performed to evaluate the renal expression of Mmp10 and Timp1 in a murine model of early type 2 DKD (db/db) after telmisartan treatment. MMP-10 (473¿±¿274¿pg/ml vs. 332¿±¿151; p¿=¿0.02) and TIMP-1 (573¿±¿296¿ng/ml vs. 375¿±¿317; p¿<¿0.001) levels were significantly increased in diabetic patients as compared to controls. An early increase in MMP-10 and TIMP-1 was observed and a further progressive elevation was found as DKD progressed to end-stage renal disease. Diabetic mice had 4-fold greater glomerular Mmp10 expression and significant albuminuria compared to wild-type, which was prevented by telmisartan. MMP-10 and TIMP-1 are increased from the early stages of type 2 diabetes. Prevention of MMP-10 upregulation observed in diabetic mice could be another protective mechanism of RAS blockade in DKD.
Autores:
Bermejo, S.; Gonzalez, E.; Lopez-Revuelta, K.; et al.
Revista:
CLINICAL KIDNEY JOURNAL
ISSN:
2048-8505
Año:
2020
Vol.:
13
N°:
3
Págs.:
380 - 388
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 61.7612.8 years, creatinine was 2.862.2 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.
Revista:
EUROPEAN JOURNAL OF HOSPITAL PHARMACY - SCIENCE AND PRACTICE
ISSN:
2047-9956
Año:
2019
Vol.:
26
N°:
1
Págs.:
33 - 38
Objective Electronic alert systems have shown their capacity for improving the detection of acute kidney injury (AKI). The aim of this study was to design and implement a clinical decision support system (CDSS) for improving drug selection and reducing nephrotoxic drug use in patients with AKI.
Methods The study was designed as an intervention study comparing a pre and post cohort of patients admitted during April 2014 and April 2015, respectively (phase I and phase II). The intervention was a CDSS which provided kidney function and nephrotoxic drug information. Furthermore, an interruptive alert was designed to detect patients suffering an AKI event while taking a nephrotoxic drug and to see if the dose was then reduced or the drug was discontinued by the physicians.
Results One-third of the inpatients were included in the analysis because they met the inclusion criteria (1004 and 1002 patients in phases I and II, respectively). 735 and 761 of them received at least one nephrotoxic alert (73% vs 76%; p=0.763). 65 and 88 patients suffered AKI during admission (6.5% vs 8.8%; p=0.051). In phase I, patients received 384 nephrotoxic alerts (55%) with 78 (20%) of them provoking a change or discontinuation of the nephrotoxic drug. In phase II this value increased to 154 out of 526 (29%) after implementation of the CDSS (p<0.01).
Conclusions A CDSS with interruptive alerts that inform of the development of AKI in real time in patients with nephrotoxic drug prescription has a positive impact on the judicious use of these drugs.
Revista:
AMERICAN JOURNAL OF HYPERTENSION
ISSN:
0895-7061
Año:
2019
Vol.:
32
N°:
1
Págs.:
15 - 17
Revista:
CARDIOVASCULAR RESEARCH
ISSN:
0008-6363
Año:
2019
Vol.:
115
N°:
4
Págs.:
696 - 698
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2018
Vol.:
41
N°:
1
Págs.:
135 - 136
Autores:
Selby, N. M. (Autor de correspondencia); Blankestijn, P. J.; Boor, P. ; et al.
Revista:
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN:
0931-0509
Año:
2018
Vol.:
33
N°:
Supl.2
Págs.:
II4 - II14
Functional renal magnetic resonance imaging (MRI) has seen a number of recent advances, and techniques are now available that can generate quantitative imaging biomarkers with the potential to improve the management of kidney disease. Such biomarkers are sensitive to changes in renal blood flow, tissue perfusion, oxygenation and microstructure (including inflammation and fibrosis), processes that are important in a range of renal diseases including chronic kidney disease. However, several challenges remain to move these techniques towards clinical adoption, from technical validation through biological and clinical validation, to demonstration of cost-effectiveness and regulatory qualification. To address these challenges, the European Cooperation in Science and Technology Action PARENCHIMA was initiated in early 2017. PARENCHIMA is a multidisciplinary pan-European network with an overarching aim of eliminating the main barriers to the broader evaluation, commercial exploitation and clinical use of renal MRI biomarkers. This position paper lays out PARENCHIMA's vision on key clinical questions that MRI must address to become more widely used in patients with kidney disease, first within research settings and ultimately in clinical practice. We then present a series of practical recommendations to accelerate the study and translation of these techniques.
Revista:
EUROPEAN JOURNAL OF ANAESTHESIOLOGY
ISSN:
0265-0215
Año:
2018
Vol.:
35
N°:
1
Págs.:
65 - 66
BACKGROUND Four predictive models for acute kidney injury associated with cardiac surgery were developed by Demirjian in the United States in 2012. However, the usefulness of these models in clinical practice needs to be established in different populations independent of that used to develop the models. OBJECTIVES Our aim was to evaluate the predictive performance of these models in a Spanish population. DESIGN A multicentre, prospective observational study. DATA SOURCES Twenty-three Spanish hospitals in 2012 and 2013. ELIGIBILITY CRITERIA Of 1067 consecutive cardiac patients recruited for the study, 1014 patients remained suitable for the final analysis. MAIN OUTCOME MEASURES Dialysis therapy, and a composite outcome of either a doubling of the serum creatinine level or dialysis therapy, in the 2 weeks (or until discharge, if sooner) after cardiac surgery. RESULTS Of the 1014 patients analysed, 34 (3.4%) required dialysis and 95 (9.4%) had either dialysis or doubled their serum creatinine level. The areas under the receiver operating characteristic curves of the two predictive models for dialysis therapy, which include either presurgical variables only, or combined presurgical and intrasurgical variables, were 0.79 and 0.80, respectively. The model for the composite endpoint that combined presurgical and intrasurgical variables showed better discriminatory ability than the model that included only presurgical variables: the areas under the receiver operating characteristic
Revista:
HYPERTENSION
ISSN:
0194-911X
Año:
2018
Vol.:
72
N°:
2
Págs.:
277 - 278
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2017
Vol.:
40
N°:
1
Págs.:
77 - 84
Background. The aim of this study was to describe the efficacy, security and viability of an anticoagulation system with continuous infusion of unfractionated heparin (UFH) versus one without any type of anticoagulant using 0.9% physiological saline washings, in critically ill patients with continuous renal replacement therapy (CRRT) and different risks of bleeding. Methods. From October 2013 to April 2015 we conducted an observational prospective study in the intensive care unit (ICU). Sixty-one patients with acute kidney injury (AKI) and requiring CRRT were included, with 122 filters. Patients and filters were divided in two groups: anticoagulated (AC) and not anticoagulated (No AC). The main outcome measure was filter life span. Different analytical parameters were also collected at the beginning of treatment and at the moment of circuit coagulation Results. The number of patients was similar in both groups. We did not find statistically significant differences between the two groups in filter life span (30.5 hours AC vs 34.9 hours No AC). Patients with increased morbidity (severe thrombocytopenia, coagulopathy, etc.) were included in the group that did not received anticoagulation but saline flushes. Conclusions. CRRT without anticoagulation with saline flushes is a viable, safe and effective strategy in critically ill patients with high risk of bleeding. This approach achieves a circuit life span similar to that observed in anticoagulated patients with UFH; avoiding the risks and costs associated with anticoagulation.
Revista:
JOURNAL OF MAGNETIC RESONANCE IMAGING
ISSN:
1053-1807
Año:
2017
Vol.:
46
N°:
6
Págs.:
1810 - 1817
To investigate whether arterial spin labeling (ASL) MRI could detect renal hemodynamic impairment in diabetes mellitus (DM) along different stages of chronic kidney disease (CKD).
Revista:
EUROPEAN JOURNAL OF ANAESTHESIOLOGY
ISSN:
0265-0215
Año:
2017
Vol.:
34
N°:
2
Págs.:
81 - 88
BACKGROUND Four predictive models for acute kidney injury associated with cardiac surgery were developed by Demirjian in the United States in 2012. However, the usefulness of these models in clinical practice needs to be established in different populations independent of that used to develop the models. OBJECTIVES Our aim was to evaluate the predictive performance of these models in a Spanish population. DESIGN A multicentre, prospective observational study. DATA SOURCES Twenty-three Spanish hospitals in 2012 and 2013. ELIGIBILITY CRITERIA Of 1067 consecutive cardiac patients recruited for the study, 1014 patients remained suitable for the final analysis. MAIN OUTCOME MEASURES Dialysis therapy, and a composite outcome of either a doubling of the serum creatinine level or dialysis therapy, in the 2 weeks (or until discharge, if sooner) after cardiac surgery. RESULTS Of the 1014 patients analysed, 34 (3.4%) required dialysis and 95 (9.4%) had either dialysis or doubled their serum creatinine level. The areas under the receiver operating characteristic curves of the two predictive models for dialysis therapy, which include either presurgical variables only, or combined presurgical and intrasurgical variables, were 0.79 and 0.80, respectively. The model for the composite endpoint that combined presurgical and intrasurgical variables showed better discriminatory ability than the model that included only presurgical variables: the areas under the receiver operating characteristic curves were 0.76 and 0.70, respectively. All four models lacked calibration for their respective outcomes in our Spanish population. CONCLUSION Overall, the lack of calibration of these models and the difficulty in using the models clinically because of the large number of variables limit their applicability.
Revista:
TRANSPLANTATION PROCEEDINGS
ISSN:
0041-1345
Año:
2016
Vol.:
48
N°:
9
Págs.:
2891-2894
The Kidney Transplant Program started at the Clinica Universidad de Navarra (Pamplona, Spain) in September of 1969. The 1000th kidney transplant was performed in September 2015. Data from kidney transplants have been included in the Collaborative Transplant Study since 1983.
Revista:
TRANSPLANTATION PROCEEDINGS
ISSN:
0041-1345
Año:
2016
Vol.:
48
N°:
9
Págs.:
2906-2909
The results of kidney transplantation have improved significantly in the last decade with patient and graft survival rates that range from 92% to 95%.
Our observations suggest great improvement of early results of renal transplantation in recent years, including complex cases. In this 3-year period we had a patient survival rate of 98% and a graft survival rate of 96% of cases. Further dedicated prospective studies that aim to evaluate or to propose possible recipient-related predictors for kidney transplantation outcomes in different
Revista:
THE NEPHRON JOURNALS
ISSN:
1660-8151
Año:
2015
Vol.:
131
N°:
1
Págs.:
51 - 58
We evaluated the effectiveness of oral sodium citrate versus intravenous (IV) sodium bicarbonate for CI-AKI prophylaxis as well as their influence on kidney injury biomarkers. Material and Methods: A randomized, controlled, single-center study including 130 hospitalized patients (62.3% men), who were randomized to receive sodium bicarbonate (1/6 men, 3 ml/kg/h for 1 h; n = 43), oral sodium citrate (75 ml/10 kg divided into 4 doses; n = 43) or nonspecific hydration (n = 44) before contrast administration, was conducted. Serum creatinine and kidney injury biomarkers (cystatin C, neutrophil gelatinase-associated lipocalin, interleukin-8, F2-isoprostanes and cardiotrophin-1 [CT-1]) were assessed. Results: Incidence of CI-AKI was 9.2% with no differences found between hydration groups: 7.0% in sodium bicarbonate group, 11.6% in oral sodium citrate group and 9.1% in the nonspecific hydration group. Urinary creatinine and urinary CT-1/creatinine ratio decreased 4 h after contrast infusion (p < 0.001), but none of the biomarkers assessed were affected by the treatments. Conclusions: There were no differences in hydration with oral sodium citrate and IV sodium bicarbonate for the prophylaxis of CI-AKI. Therefore, oral hydration represents a safe, inexpensive and practical method for preventing CI-AKI in low-risk patients. No effect on biomarkers for kidney injury could be demonstrated.
Autores:
Barril G; Quiroga JA; Arenas MD; et al.
Revista:
JOURNAL OF CLINICAL MICROBIOLOGY
ISSN:
0095-1137
Año:
2014
Vol.:
52
N°:
8
Págs.:
3053-56
Amplification of hepatitis C virus (HCV) RNA from blood detected occult HCV infections in 30.9% of 210 HCV-seronegative dialysis patients with abnormal liver enzyme levels that had evaded standard HCV testing practices. Isolated HCV core-specific antibody detection identified three additional anti-HCV screening-negative patients lacking HCV RNA amplification in blood who were considered potentially infectious. Together, these findings may affect management of the dialysis setting.
Revista:
NEFROLOGIA
ISSN:
0211-6995
Año:
2013
Vol.:
33
N°:
4
Págs.:
524-31.
Our aim was to study the potential effect of PTX on anaemia in haemodialysis patients. Patients and method: Retrospective observational case-control study on 18 patients (treated with PTX) and 18 controls (without PTX matched by age and sex) on HD (Clínica Universidad de Navarra). Four patients received PTX due to vascular disease and 14 due to refractory anaemia (which was defined as haemoglobin [Hb] <11g/dl in the last three months despite high doses of ESA and transferrin saturation of >20%). Hb, MIRCERA® dose and C-reactive protein were recorded before starting PTX treatment (baseline), at 3 months and at the end of the study. Results: In patients who received PTX, there was an increase in Hb (P<.001) over three months and a decrease in the ESA dose at the end of the study (P=.002). The baseline differences in Hb between groups (lowest of all cases) (P<.001) and ESA dose (highest of all cases) (P=.006), disappeared at 3 months. At the end of the study, 11/18 (61.1%) of patients treated with PTX had adequate Hb levels and received doses of ESA comparable with those of the controls. Conclusions: In HD patients, PTX in doses of 800mg/day improves Hb significantly and in the short term (3 months) in HD patients (around 61% response) and allows the required ESA dose to be reduced in the medium-long term. This effect is sustained over time and treatment is tolerated well.
Revista:
REVISTA ESPAÑOLA DE ANESTESIOLOGIA Y REANIMACION
ISSN:
0034-9356
Año:
2013
Vol.:
60
N°:
2
Págs.:
79-86.
To assess the correlation between intraoperative packed red blood cells transfusion and adverse outcome in a Spanish cohort of cardiac surgery patients. METHODS: Retrospective observational multicentre study. An analysis was performed on the data from 927 cardiac surgery patients treated in 24 Spanish hospitals in 2007. Patients who received intraoperative transfusions were compared with non-transfused patients. Multivariate analyses were performed (including, among others, several items from the Euroscore, surgery type, basal renal status and haemoglobin levels, and Thakar score).
RESULTS: Every transfusion of packed red cells was associated with increased postoperative risk of acute kidney damage at 72 hours after surgery, prolonged mechanical ventilation, and need for haemodynamic support. Moreover, transfused patients showed an increased in-hospital mortality rates (Adjusted OR: 1.30; 95% CI: 1.19-1.42), as well as longer hospital stays (almost 4 days).
CONCLUSIONS: In this cohort of patients, intraoperative transfusion might independently predict higher risk of early acute kidney damage, prolonged postoperative mechanical ventilation, and a need for haemodynamic support, and reduced short term survival (adjusted OR for mortality: 1.30; 95% CI: 1.19-1.42), and longer hospital stays (4 days longer).
Revista:
INTERNATIONAL JOURNAL OF CLINICAL PRACTICE
ISSN:
1368-5031
Año:
2012
Vol.:
66
N°:
3
Págs.:
305 -308
DPT lock therapy demonstrated good in vivo efficacy in LT-CRBI caused by coagulase negative staphylococci and Enterococcus species.
Revista:
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
ISSN:
0190-9622
Año:
2012
Vol.:
67
N°:
4
Págs.:
e152 - e154
Case report of uncommon presentation of calciphylaxis
Revista:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2011
Vol.:
10
N°:
79
Págs.:
5364 - 5369
Revista:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2011
Vol.:
Serie 10
N°:
79
Págs.:
5370 - 5377
Revista:
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
ISSN:
0391-3988
Año:
2011
Vol.:
34
N°:
4
Págs.:
329 - 338
Revista:
REVISTA ESPAÑOLA DE ANESTESIOLOGIA Y REANIMACION
ISSN:
0034-9356
Año:
2011
Vol.:
58
N°:
6
Págs.:
365 - 374
Early detection of AKI is necessary for preventing progression and starting renal replacement therapy at adjusted doses that reflect metabolic requirements..
Revista:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2011
Vol.:
10
N°:
79
Págs.:
5390 - 5392
Revista:
BLOOD PURIFICATION
ISSN:
0253-5068
Año:
2011
Vol.:
32
N°:
2
Págs.:
104 - 111
Patients who undergo early initiation of RRT after CSA-AKI have improved survival rates and renal function at discharge and decreased lengths of hospital stay
Revista:
NEPHROLOGY
ISSN:
1320-5358
Año:
2010
Vol.:
15
N°:
2
Págs.:
178 - 183
Nacionales y Regionales
Título:
Renal MRI standardization to improve personalised management of CKD patients (RESPECT)
Código de expediente:
0011-2750-2020-000001
Investigador principal:
María Asunción Fernández Seara
Financiador:
GOBIERNO DE NAVARRA
Convocatoria:
ERA PerMed JTC2020
Fecha de inicio:
01/06/2021
Fecha fin:
31/10/2024
Importe concedido:
242.284,00€
Otros fondos:
-
Título:
Estudio genómico para la personalización del diagnóstico y el tratamiento de los pacientes con insuficiencia Cardíaca crónica y enfermedad renal crónica (Medicina cardIoreNal pERsonalizada en NaVArra)-II (MINERVA-II)
Código de expediente:
0011-1411-2021-000094
Investigador principal:
Juan José Gavira Gómez
Financiador:
GOBIERNO DE NAVARRA
Convocatoria:
2021 GN PROYECTOS ESTRATEGICOS DE I+D 2021-2024
Fecha de inicio:
01/05/2021
Fecha fin:
31/12/2023
Importe concedido:
100.748,76€
Otros fondos:
-
Título:
Creación de una plataforma para el desarrollo de vectores de terapia génica con tropismo renal (DRONES GÉNICOS)
Código de expediente:
0011-1411-2019-000048
Investigador principal:
Nuria García Fernández
Financiador:
GOBIERNO DE NAVARRA
Convocatoria:
2019 GN PROYECTOS ESTRATEGICOS DE I+D 2019-2021
Fecha de inicio:
01/04/2019
Fecha fin:
30/11/2021
Importe concedido:
64.625,00€
Otros fondos:
-
Título:
Estudio genómico para la personalización del diagnóstico y el tratamiento de los pacientes con insuficiencia cardiaca crónica y enfermedad renal crónica (Medicina cardIoreNal pERsonalizada en NaVArra) (MINERVA)
Código de expediente:
0011-1411-2018-000036
Investigador principal:
Juan José Gavira Gómez
Financiador:
GOBIERNO DE NAVARRA
Convocatoria:
2018 GN PROYECTOS ESTRATEGICOS DE I+D 2018-2020
Fecha de inicio:
01/04/2018
Fecha fin:
30/11/2020
Importe concedido:
97.237,60€
Otros fondos:
-
Título:
Papel de la MMP-10 y la perfusión tisular en el diagnóstico y seguimiento de la nefropatía y patología cardiovascular de pacientes con diabetes mellitus tipo 2.
Código de expediente:
PI20/01678
Investigador principal:
Nuria García Fernández
Financiador:
INSTITUTO DE SALUD CARLOS III
Convocatoria:
2020 AES Proyectos de investigación
Fecha de inicio:
01/01/2021
Fecha fin:
31/12/2023
Importe concedido:
102.608,00€
Otros fondos:
Fondos FEDER
Título:
Desarrollo y evaluación de una técnica de imagen por resonancia magnética multiparamétrica para predecir de forma precoz la disfunción del injerto renal tras el trasplante,. RM-RENAL.
Código de expediente:
0011-1383-2020-000010 PC181 RM-RENAL
Investigador principal:
Paloma Leticia Martín Moreno, María Asunción Fernández Seara
Financiador:
GOBIERNO DE NAVARRA
Convocatoria:
2020 GN Proyectos Colaborativos
Fecha de inicio:
01/01/2020
Fecha fin:
30/11/2022
Importe concedido:
164.349,50€
Otros fondos:
-
Título:
ELABORACIÓN E IMPLEMENTACIÓN DE HERRAMIENTAS DE ESTRATIFICACIÓN DE RIESGOS EN PACIENTES CRÓNICOS COMPLEJOS (Stratistics)
Código de expediente:
RTC-2016-5418-1
Investigador principal:
Francisco Javier Escalada San Martín
Financiador:
MINISTERIO DE CIENCIA E INNOVACIÓN
Convocatoria:
2016 MINECO RETOS-COLABORACION
Fecha de inicio:
01/01/2017
Fecha fin:
31/12/2018
Importe concedido:
99.541,25€
Otros fondos:
-
Título:
Estudio clínico y experimental del papel de la MMP-10 en la nefropatía diabética tipo 2
Código de expediente:
PI15/02111
Investigador principal:
Nuria García Fernández
Financiador:
INSTITUTO DE SALUD CARLOS III
Convocatoria:
2015 AES PROYECTOS DE INVESTIGACIÓN
Fecha de inicio:
01/01/2016
Fecha fin:
30/11/2020
Importe concedido:
116.765,00€
Otros fondos:
Fondos FEDER
