Nefrologia最新文献

{"title":"Bone and vascular effects of magnesium supplements in CKD patients (the MagicalBone Pilot Study)","authors":"","doi":"10.1016/j.nefro.2024.02.003","DOIUrl":"10.1016/j.nefro.2024.02.003","url":null,"abstract":"<div><h3>Background and objective</h3><p>The progression of chronic kidney disease (CKD) involves the development of alterations in mineral metabolism that are closely related to cardiovascular outcomes and bone disease. Hypomagnesemia is associated with more rapid progression of CKD and other comorbidities. Our objective was to analyze in CKD patients stages 3–4 the impact of the administration of magnesium (Mg) carbonate on bone mineral density (BMD) and hemodynamic changes associated with by vascular calcification (VC).</p></div><div><h3>Material and methods</h3><p>Patients with CKD stages 3–4 were randomized into controls (<em>n</em> <!-->=<!--> <!-->12) or intervention (<em>n</em> <!-->=<!--> <!-->7) group receiving 360<!--> <!-->mg of Mg carbonate daily during a 15-month period. Parameters related to mineral metabolism, BMD, VC, and pulse wave velocity (PWV) were evaluated.</p></div><div><h3>Results</h3><p>Supplementation with Mg produced an increase in the urinary excretion of Mg while serum Mg levels remained stable and no episodes of hypermagnesemia were reported. In addition, no significant changes were found in the degree of VC assessed by Adragao index, however, both serum and urine Mg were significantly associated with a decrease in PWV, suggesting an increase in vascular compliance. Likewise, BMD did not change following treatment, but serum Mg significantly correlated with the levels of N-terminal propeptide of collagen alpha-1(I) chain (PINP), a marker of bone synthesis.</p></div><div><h3>Conclusions</h3><p>In sum, these results suggest a possible beneficial effect of Mg on vascular compliance with no detrimental effects on bone status. In addition, our results highlight the need to consider monitorization of urinary Mg status in CKD patients.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000146/pdfft?md5=e6982d6ea56d26286865c695a8a5b057&pid=1-s2.0-S0211699524000146-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of PD-related cardiac tamponade after cardiac surgery","authors":"","doi":"10.1016/j.nefro.2023.12.001","DOIUrl":"10.1016/j.nefro.2023.12.001","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001832/pdfft?md5=a1fe748418e1d5b4f67a89d7b67e14e0&pid=1-s2.0-S0211699523001832-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139190529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nefritis tubulointersticial aguda asociada al tratamiento con estatinas","authors":"","doi":"10.1016/j.nefro.2024.03.004","DOIUrl":"10.1016/j.nefro.2024.03.004","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000250/pdfft?md5=f3bb6fb8814e731b2245ee2cf329aedc&pid=1-s2.0-S0211699524000250-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote patient monitoring and management in nephrology: A systematic review","authors":"","doi":"10.1016/j.nefro.2024.01.005","DOIUrl":"10.1016/j.nefro.2024.01.005","url":null,"abstract":"&lt;div&gt;&lt;p&gt;Chronic kidney disease (CKD) is a global public health problem, with adverse outcomes of kidney failure, cardiovascular disease (CVD), and premature death. According to European Kidney Health Alliance (EKHA) currently, 1 in 10 Europeans has chronic kidney disease (CKD) and it is predicted to be the fifth leading cause of death worldwide by 2040. The COVID-19, pandemic has further worsened the situation, with CKD being the number one risk factor for CKD mortality, ahead of lung and heart disease. In addition to rising mortality figures, treatments for kidney disease have not improved substantially over the past 50 years, leaving too many kidney patients with a poor quality of life and reduced life expectancy. This situation is associated with staggering aggregate annual costs amounting to €140 billion per year in Europe, more than the annual healthcare costs of cancer or diabetes.&lt;/p&gt;&lt;p&gt;Many studies confirm that Information and Communication Technology intervention (ICT) in nephrology can be way to tackles this issue. The increased daily use of information and communication technologies (ICT) may lead to the need for healthcare professionals to monitoring patient remotely. Remote Patient Monitoring (RPM) have the potential to improve care for patients with kidney disease.&lt;/p&gt;&lt;p&gt;RPM may provide a means to overcome some of the aforementioned barriers. RPM is a framework for monitoring patients at home by digital, wireless technology and extends the interactive contact of conventional clinical settings to include the patient's home. The hope is that these technologies would improve clinical outcomes through earlier recognition and correction of problems. Although few studies on telehealth in the dialysis population exist, studies do support its technical feasibility, which patient acceptance of this technology is very high, and that RPM may be able to improve outcomes in other co-morbid states shared by the ESKD population.&lt;/p&gt;&lt;p&gt;According to Pan American Health Organization, CKD, also called kidney failure, describes the gradual loss of kidney function and is a worldwide public health problem, with adverse outcomes of kidney failure, CVD, and premature death.&lt;/p&gt;&lt;p&gt;This study collects the papers concerning RPM and renal patient management using ICT intervention to analyze the results from considering the bioengineer's point of view. Our focus was on technology contribution.&lt;/p&gt;&lt;p&gt;The aim of this study was to review and synthesize the available literature on the role of RPM in healthcare in nephrology. This systematic review was conducted to examine the content and results of publications on using RPM to improve the health care of patients with kidney disease, available to health care professionals (HCPs) and/or patients. The literature and our results confirm that in this field, RPM can allow cost reduction, improve the efficiency of healthcare resources, reduce human error, and overall improve the quality of life of kidney patients.&lt;/p&gt;&lt;/di","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000055/pdfft?md5=57adc466e049e9af72954e126ab6cd3a&pid=1-s2.0-S0211699524000055-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139814503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediabetes and CKD: Does a causal relationship exist","authors":"","doi":"10.1016/j.nefro.2024.06.008","DOIUrl":"10.1016/j.nefro.2024.06.008","url":null,"abstract":"<div><p>The relationship between diabetes and the development of kidney complications is well known, but the understanding of prediabetes and insulin resistance with impaired kidney function has been scarcely assessed. Various factors could explain this phenomenon, from the lack of standardization in the definitions of prediabetes, to the erratic and inconsistent evidence in large-scale epidemiological and cohort studies. It seems that the pathophysiological pathway of prediabetes could be related to inflammation and neurohormonal hyperactivation, factors present even before the onset of diabetes, which might be the main drivers of glomerular hyperfiltration, albuminuria, and impaired glomerular filtration rate. It is possible that existing treatments for the management of diabetes, as metformin or SGLT2 inhibitors may also be useful in patients with prediabetes with evidence of functional and structural kidney damage. The purpose of this review is to summarize the evidence regarding the relationship between prediabetes (preDM) and the development of CKD.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000626/pdfft?md5=e3ffb5094768d5e9ef704cea8a6d93bc&pid=1-s2.0-S0211699524000626-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soluble αKlotho concentration in the inferior vena cava of patients with primary aldosteronism","authors":"","doi":"10.1016/j.nefro.2024.04.001","DOIUrl":"10.1016/j.nefro.2024.04.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Klotho, a key aging regulator, is predominantly expressed in the kidney. Various methods now enable the measurement of soluble αKlotho blood levels in humans. Limited studies have explored the renal origin of circulating αKlotho in humans.</p></div><div><h3>Methods</h3><p>Soluble αKlotho in the inferior vena cava blood was measured using an enzyme-linked immunosorbent assay kit using blood samples from patients undergoing adrenal venous catheterization for close examination of primary aldosteronism.</p></div><div><h3>Results</h3><p>The concentration at the suprarenal inferior vena cava (476<!--> <!-->±<!--> <!-->68.2) was significantly higher than that at the infrarenal inferior vena cava (434<!--> <!-->±<!--> <!-->74.8) (<em>p</em> <!-->=<!--> <!-->0.018), with a rate of change of 8.12 (2.3)%.</p></div><div><h3>Conclusions</h3><p>We demonstrate a step-up in αKlotho concentration from the infrarenal to suprarenal vena cava in humans, supporting the kidney's origin of soluble αKlotho in the bloodstream.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000341/pdfft?md5=07b73de60ec3f8cc86472e231153608d&pid=1-s2.0-S0211699524000341-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arteriovenous fistula in persistent left superior vena cava scenario","authors":"","doi":"10.1016/j.nefro.2023.11.003","DOIUrl":"10.1016/j.nefro.2023.11.003","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001741/pdfft?md5=579a47acd342583d9326b821a07b74fd&pid=1-s2.0-S0211699523001741-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139298295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La hipertensión arterial intradiálisis, un diagnóstico por descubrir","authors":"","doi":"10.1016/j.nefro.2023.12.003","DOIUrl":"10.1016/j.nefro.2023.12.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Intradialytic hypertension (IDH) is a poorly understood phenomenon with no consensus on its definition, etiology, or related factors, and there is limited evidence on its consequences.</p></div><div><h3>Objective</h3><p>To determine the prevalence of IDH according to different definitions in hemodialysis (HD) units, with different clinical practices and assessment of possible events after 18 months have passed.</p></div><div><h3>Materials and methods</h3><p>A cross-sectional observational study was conducted in two HD units, including all prevalent patients from March 2021 to September 2022. We established three definitions of IDH: Def 1: Mean arterial pressure (MAP) difference pre- and pos-HD<!--> <!-->&gt;<!--> <!-->15<!--> <!-->mmHg. Def 2: Systolic blood pressure (SBP) difference pre- and pos-HD<!--> <!-->&gt;<!--> <!-->10<!--> <!-->mmHg. Def 3: SBP difference &gt;0 and ultrafiltration rate (UFR)<!--> <!-->&gt;<!--> <!-->5<!--> <!-->ml/kg/h.</p><p>IDH was considered present if the criterion was met in more than 50% of the six consecutive sessions (2 weeks) of follow-up. Personal history, medications, dialysis characteristics, and pre- and post-HD biochemical data were collected. Residual renal function (RRF) was considered as urine output &gt;250<!--> <!-->ml/24<!--> <!-->h. At 18 months, the possible events of the group were analyzed.</p></div><div><h3>Results</h3><p>We included 169 patients (68% men) with a mean age of 67.9 (14.2) years and a median HD duration of 34.5 (IQR: 17.5-67.5) months. Of these, 94 come from one unit and 75 from the other. The prevalence of IDH was 8.3% according to Def 1, 27.2% according to Def 2, and 29.6% according to Def 3. Def 2 showed an association with a history of previous hypertension, use of renin-angiotensin system inhibitors (RASIs), and furosemide, as well as with patients with RRF. Def 3 showed an association only with coronary artery disease. There was an association with different prescriptions of dialysis fluids. Catecholaminergic hormones and aldosterone did not increase in patients with hypertension during the HD session. They did not present a higher incidence of cardiovascular events or mortality at 18 months.</p></div><div><h3>Conclusions</h3><p>IDH has different prevalence rates depending on the definition used and the studied center. The future poses an important challenge: to determine which definition correlates with higher morbidity and mortality and the role of differences found in different HD units.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001856/pdfft?md5=084fda49062e59310768449524f5713b&pid=1-s2.0-S0211699523001856-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consenso Delphi multidisciplinar sobre retos y factores clave para un modelo óptimo de atención en enfermedad renal crónica","authors":"","doi":"10.1016/j.nefro.2024.01.006","DOIUrl":"10.1016/j.nefro.2024.01.006","url":null,"abstract":"<div><h3>Background and Purpose</h3><p>Chronic kidney disease (CKD) is associated with high morbidity, burden, and resource utilization, and represents a major challenge for healthcare systems. The purpose of this study was to analyse the care patterns for these patients and to reach a consensus on the key factors that should be implemented for an optimal care model in CKD, through a multidisciplinary and integrative vision.</p></div><div><h3>Materials and Methods</h3><p>A multidisciplinary panel of professionals with experience in the field of CKD was formed, composed of an advisory committee of 15 experts and an additional panel of 44 experts. Challenges and areas for improvement across the continuum of care were identified through review of scientific evidence and individual interviews with the advisory committee. Key factors for an optimal model of care in CKD were agreed and assessed using the Rand/UCLA consensus methodology (adapted Delphi), evaluating their appropriateness and necessity.</p></div><div><h3>Results</h3><p>38 key factors were identified for an optimal CKD patient care model, organised into four challenges: 1) Development of CKD management models and increased visibility of the disease, 2) Prevention, optimisation of screening, early diagnosis and registration of CKD at all levels of care, 3) Comprehensive, multidisciplinary and coordinated monitoring, ensuring therapeutic optimisation and continuity of care, and 4) Reinforcement of CKD training for health care professionals and patients. 35 key factors were assessed by the panel as adequate and clearly necessary, and of these, 14 were considered highly imperative.</p></div><div><h3>Conclusions</h3><p>There is consensus on the need to prioritise CKD care at both institutional and societal levels, moving towards optimal models of CKD care based on prevention and early detection of the disease, as well as comprehensive and coordinated patient monitoring and training and awareness-raising at all levels. The key factors identified constitute a roadmap that can be implemented in the different Autonomous Communities and contribute to a significant improvement in the patient's care.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000067/pdfft?md5=df26a8e2d7c49604d62335c13096b2e0&pid=1-s2.0-S0211699524000067-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139892594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coste-efectividad del ciclosilicato de sodio y zirconio para el tratamiento de la hiperpotasemia en pacientes con enfermedad renal crónica o insuficiencia cardiaca en España","authors":"","doi":"10.1016/j.nefro.2024.02.006","DOIUrl":"10.1016/j.nefro.2024.02.006","url":null,"abstract":"<div><h3>Background and objective</h3><p>Hyperkalemia (HK) is an electrolyte disturbance in the concentration of potassium ions (K⁺), whose risk increases in patients with chronic kidney disease (CKD) or heart failure (HF) and/or in patients being treated with renin-angiotensin-aldosterone system inhibitors (RAASi). The new oral K⁺ chelators offer a safe and effective treatment to maintain normokalemia in these patients. The objective of the analysis is to estimate the cost-effectiveness of sodium zirconium cyclosilicate (SZC) for the treatment of chronic HK in patients with CKD or HF versus standard treatment (calcium polystyrene sulfonate and lifestyle modifications) from the perspective of the Spanish National Health System.</p></div><div><h3>Materials and methods</h3><p>Two microsimulation models reflecting the natural history of CKD and HF were used. In both models, K⁺ levels were simulated individually. Based on efficacy (reduction of K⁺ levels), quality of life of patients (utilities according to health states, and disutilities of events derived from each pathology and adverse events [AEs] of treatment) and costs considered (cost of treatment for HK, of RAASi treatment and its modification, health states, management of events derived from each pathology, HK episodes, and AEs treatment) (€, 2022), clinical benefit (quality-adjusted life years [QALYs]) and cost results were obtained. A time horizon of the patient's lifetime was used and a discount rate of 3% was applied for costs and outcomes.</p></div><div><h3>Results</h3><p>SZC is a more effective option in both pathologies, with a difference in QALYs of 0.476 in CKD and 0.978 in HF compared to standard treatment, and it represents an incremental cost of € 3,616 and € 14,749, respectively, obtaining an incremental cost-utility ratio of € 7,605 /QALY in CKD and € 15,078 /QALY in HF.</p></div><div><h3>Conclusions</h3><p>SZC is a cost-effective alternative for the treatment of HK in patients with CKD or HF, taking into account the reference efficiency values commonly used in Spain.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000171/pdfft?md5=313960772570e6858aa49f0328ecbc74&pid=1-s2.0-S0211699524000171-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140092850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}