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Ruperto M, Barril G. Extracellular mass to body cell mass ratio as a potential index of wasting and fluid overload in hemodialysis patients. Clin Nutr 2019; 39:316-317. [PMID: 31812469 DOI: 10.1016/j.clnu.2019.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
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Londoño MC, Riveiro-Barciela M, Ahumada A, Muñoz-Gómez R, Roget M, Devesa-Medina MJ, Serra MÁ, Navascués CA, Baliellas C, Aldamiz-Echevarría T, Gutiérrez ML, Polo-Lorduy B, Carmona I, Benlloch S, Bonet L, García-Samaniego J, Jiménez-Pérez M, Morán-Sánchez S, Castro Á, Delgado M, Gea-Rodríguez F, Martín-Granizo I, Montes ML, Morano L, Castaño MA, de los Santos I, Laguno M, Losa JE, Montero-Alonso M, Rivero A, de Álvaro C, Manzanares A, Mallolas J, Barril G, González-Parra E, García-Buey L. Effectiveness, safety/tolerability of OBV/PTV/r ± DSV in patients with HCV genotype 1 or 4 with/without HIV-1 co-infection, chronic kidney disease (CKD) stage IIIb-V and dialysis in Spanish clinical practice - Vie-KinD study. PLoS One 2019; 14:e0221567. [PMID: 31550267 PMCID: PMC6759177 DOI: 10.1371/journal.pone.0221567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND AIMS Limited data are available on the effectiveness and tolerability of direct-acting antivirals (DAAs) therapies in the real world for HCV-infected patients with comorbidities. This study aimed to describe the effectiveness of OBV/PTV/r ± DSV (3D/2D regimen) with or without ribavirin (RBV) in HCV or HCV/HIV co-infected patients with GT1/GT4 and CKD (IIIb-V stages), including those under hemodialysis and peritoneal dialysis in routine clinical practice in Spain in 2015. MATERIAL AND METHODS Non-interventional, retrospective, multicenter data collection study in 31 Spanish sites. Socio-demographic, clinical variables, study treatment characteristics, effectiveness and tolerability data were collected from medical records. RESULTS Data from 135 patients with a mean age (SD) of 58.3 (11.4) years were analyzed: 92.6% GT1 (81.6% GT1b and 17.6% GT1a) and 7.4% GT4, 14 (10.4%) HIV/HCV co-infected, 19.0% with fibrosis F3 and 28.1% F4 by FibroScan®, 52.6% were previously treated with pegIFN and RBV. 11.1%, 14.8% and 74.1% of patients had CKD stage IIIb, IV and V respectively. 68.9% of patients were on hemodialysis; 8.9% on peritoneal dialysis and 38.5% had history of renal transplant. A total of 125 (96.2%) of 135 patients were treated with 3D, 10 (7.4%) with 2D and 30.4% received RBV. The overall intention-to-treat (ITT) sustained virologic response at week 12 (SVR12) was 92.6% (125/135) and the overall modified-ITT (mITT) SVR12 was 99.2% (125/126). The SVR12 rates (ITT) per sub-groups were: HCV mono-infected (91.7%), HCV/HIV co-infected (100%), GT1 (92.0%), GT4 (100%), CKD stage IIIb (86.7%), stage IV (95%) and stage V (93%). Among the 10 non-SVR there was only 1 virologic failure (0.7%); 4 patients had missing data due lost to follow up (3.0%) and 5 patients discontinued 3D/2D regimen (3.7%): 4 due to severe adverse events (including 3 deaths) and 1 patient´s decision. CONCLUSIONS These results have shown that 3D/2D regimens are effective and tolerable in patients with advanced CKD including those in dialysis with GT 1 or 4 chronic HCV mono-infection and HIV/HCV coinfection in a real-life cohort. The overall SVR12 rates were 92.6% (ITT) and 99.2% (mITT) without clinically relevant changes in eGFR until 12 weeks post-treatment. These results are consistent with those reported in clinical trials.
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Ruperto Lopez M, Barril G. MON-PO428: Extracellular Mass-to-Body Cell Mass Ratio a Nutritional-Hydration Marker is an Independent Predictor of Survival in Hemodialysis Patients. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barril G, Nogueira A, Alvarez G, Schez Tomero J. SUN-PO231: Differences in Body Composition by Segmental Multifrequency Bioimpedance Between Patients in Advanced CKD and Hemodialysis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Barril G, Nogueira A, Alvarez G, Santos B, Schez Tometo J. SUN-PO255: Importance of SMI as a Parameter of Muscle Mass in Patients with CKD. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barril G, Nogueira A, Alvarez G, Nuñez A, Sanchez C, Tomero J. SUN-PO151: Nutrition-Inflammation Markers and Survival in Patients with Chronic Advanced Kidney Disease (ACKD). Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32784-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Barril G, Nogueira A, Alvarez G, Sapiencia D, Andres N, Nuñez A, Sanchez C, Sanchez Tomero J. SUN-PO152: What is More Important in the Diagnosis of Sarcopenia Strength, Muscle Mass or Functionality? Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32785-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ruperto M, Sánchez-Muniz FJ, Barril G. Extracellular mass to body cell mass ratio as a potential index of wasting and fluid overload in hemodialysis patients. A case-control study. Clin Nutr 2019; 39:1117-1123. [PMID: 31060893 DOI: 10.1016/j.clnu.2019.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/02/2019] [Accepted: 04/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS Extracellular mass-to-body cell mass ratio (ECM/BCM ratio) which differentiates the proportion between intraextracellular compartments, could be a nutrition index of being wasted overloaded in hemodialysis (HD) patients. This study aimed to describe a cut-off point of the ECM/BCM ratio and, to find out the relationship between the nutritional-hydration status and this ratio in HD patients. METHODS A case-control study was carried out in 64 HD patients individually age-gender-matched to controls. Demographic, clinical and laboratory parameters were recorded. Bioelectrical impedance analysis was used to estimate ECM/BCM ratio as an indicator of the nutritional hydration status. Receiver operator characteristic (ROC) curve analysis was applied to determine the optimal cut-off point for identification of ECM/BCM ratio. An univariate and multivariate conditional logistic regression for the ECM/BCM ratio ≥1.20 was performed. RESULTS Median of ECM/BCM ratio was 1.50 (IQR:0.66) in HD patients, whereas 0.87 (IQR: 0.35) was found in controls (p < 0.001). HD-patients had lower body weight, serum albumin (s-albumin) and higher serum C-reactive protein (s-CRP) than controls. By ROC curve analysis, a cut-off point of 1.20 for the ECM/BCM ratio best discriminates to be wasted-overhydrated (sensitivity: 81.2%; specificity: 87.5%). Conditional logistic regression showed that for each 10%, ECM/BCM ratio increase the probability of developing fluid overload was increased 63% (OR: 1.63; 95% CI, 1.15-2.29), whereas an inverse association with s-albumin (OR: 0.15; 95% CI, 0.03-0.61) and other nutritional indicators were found. CONCLUSIONS The ECM/BCM ratio appears as a sensitive index that discriminates nutritional and/or hydration status in HD patients compared with age-gender-matched-controls. ECM/BCM ratios ≥1.20 are indicators of wasting and fluid overload in HD patients.
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Nogueira Á, Álvarez G, Russo F, San-José B, Sánchez-Tomero JA, Barril G. Is SPPB useful as a screening method of functional capacity in patients with advanced chronic kidney disease? Nefrologia 2019; 39:489-496. [PMID: 30971342 DOI: 10.1016/j.nefro.2019.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/29/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE One of the consequences of the CKD, is the deterioration of the functional capacity, being able to manifest from different stages of the disease, until renal replacement therapy. The objective of this study was to determine the functionality of patients with CKD through functional capacity test, valuing the usefulness of the SPPB as a screening test in parallel. MATERIALS AND METHODS It assessed the functional capacity of patients with CKD, using the test SPPB, 6MM, TUTG and STS. Also found the muscle strength with manual dynamometry. RESULTS Of 121 patients who came to the CKD query, 118 presented a minimum functionality to perform tests of functional capacity, a 71.2% of the patients were able to perform 4 tests, a 28.8% only could make the SPPB test. To a 71.43% of patients who presented a low score in SPPB, not could follow assessed them with the rest of the test, while the 92.31% of which had a high score, continued with the rest of the evidence. To differentiate by age ranges, the majority of young patients have minimal limitations, finding higher rates of disability in older age ranges. A good score in SPPB meant to present good functional capacity and allowed to continue evaluating the patient, obtaining better results with the rest of test and more muscle strength. A good nutritional better status and body composition was a better functionality. CONCLUSION In the absence of a consensus of what is the best method of determining the functional capacity of the kidney patient, and to assess all patients, propose to use the test SPPB as screening method, and depending on the result used as the rest of the test to more complete if it is necessary to study.
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Barril G, Nogueira A, Ruperto López M, Castro Y, Sánchez-Tomero JA. Influence of dietary protein intake on body composition in chronic kidney disease patients in stages 3-5: A cross-sectional study. Nefrologia 2018; 38:647-654. [PMID: 30293714 DOI: 10.1016/j.nefro.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION A controlled protein intake has shown beneficial effects to preserve renal function and nutritional status in chronic kidney disease (CKD) patients. This study aimed to analyze usual dietary protein intake and its potential contribution to body composition in CKD patients in stages 3-5. METHOD Cross-sectional study in 134 CKD patients in stages 3-5 (mean e-GFR: 19.4±8.7ml/min/1.73m2; males 68.7% and primary CKD etiology was diabetes mellitus, 35.8%). Demographic, clinical and nutritional parameters were evaluated. Normalized protein nitrogen appearance (nPNA), was used as a surrogate marker of dietary protein intake. The sample was classified into three nPNA groups (Gn): G1: <0.8g/kg/day; G2: 0.8-1g/kg/day and, G3: ≥1g/kg/day. Assessment of nutritional status using the malnutrition-inflammation score (MIS), anthropometric measures and laboratory parameters. Analysis of body composition and hydration status by bioelectrical impedance analysis (BIVA-101-RJL system). Statistical analysis by SPSS v.20. RESULTS Overall mean nPNA values were 0.91±0.23g of protein/kg BW/day and only 32.1% had a dietary protein intake <0.8g of protein/kg BW/day. Most of the CKD patients (65.5%) were in stages 4 or 5. Prevalence of protein-energy-wasting (PEW) syndrome measured by MIS was 15%. By analyzing differences between nPNA groups, body weight (BW), BMI and triceps-skinfold (TSF) thickness were significantly higher in the group with nPNA ≥1g/kg BW/day (G3), whereas a significant inverse relationship was found with the percentages of body cell mass (BCM%), fat-free mass (FFM%), muscle mass (MM%) and phase angle (PA) in the group with the lowest nPNA (G1). Analysis of gender among subjects showed significant differences with BW, FFM%, TSF and mid-arm muscle circumference (MAMC%). Linear regression analysis showed that resistance, BCM%, MM%, and serum albumin were significant predictors of nPNA as a surrogate marker of daily protein intake (R=0.51; R2=0.29; R2 adjusted=0.23; p<0.001). CONCLUSION Controlled protein intake is one of the cornerstones of treatment in CKD patients. A low protein intake in patients with CKD stages 3 and 4-5 was associated with loss of muscle mass in the advanced-CKD unit. The loss of muscle mass appears as an early indicator of nutritional comprised. Factors such, elderly age and loss of eGFR, showed lower protein intake and were associated with muscle loss, especially in women. Further longitudinal studies are required to evaluate the contribution of different protein intakes to uremic symptoms, nutritional status, body composition and CKD progression.
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Pérez Á, Álvarez G, Tomero J, Barril G. Body mass index(BMI), visceral adiposity index (VAI), and concicity index (CI) as predictors of cardiovascular risk. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Barril G, Nogueira A, Garcia N, Giorgi M, Caro P, Puchulu B, Sanz P, Blazquez L, Sanchez Tomero J, Aguilera A. Sarcopenia in hd patients. multicenter study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Furaz K, Gruss E, Barril G, Pérez E, De La Flor J, Benavides N, Mendez A, Martin R. SP54744 HOURS AMBULATORY BLOOD PRESSURE MONITORING CHARACTERISTICS AND CORRELATION WITH HEMODIALYSIS BLOOD PRESSURES MEASURES. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Albalate Ramón M, Martínez Miguel P, Bohorquez L, de Sequera P, Bouarich H, Pérez-García R, Rodríguez Puyol D, Barril G, Sánchez Tomero JA, Giorgi M, Ramirez Chamond MR. Asymmetric cellulose triacetate is a safe and effective alternative for online haemodiafiltration. Nefrologia 2018; 38:315-320. [PMID: 29454540 DOI: 10.1016/j.nefro.2017.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/04/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In post-dilution haemodiafiltration only synthetic membranes have been used to date. Asymmetric cellulose triacetate (ATA™) is now available, whose characteristics are suitable for this technique. OBJECTIVES To describe the in vivo performance and behaviour of this membrane, to identify its depurative effectiveness, use in clinical practice and its biocompatibility, both acute and after one month of treatment. METHODS Observational prospective study of 23 patients who were dialysed for 4 weeks using an ATA™ membrane and who maintained their prior regimen. RESULTS A total of 287 sessions were performed and 264 complete sessions were collected. With an effective time of 243.7 (17.6) min and a mean blood flow of 371.7 (23) ml/min, an average Kt of 56.3 (5.3) l was observed, as well as a convection volume of 27.1 (4.2) l, a filtration fraction of 29.9 (3.7) %, a urea reduction ratio (RR) of 81 (5.2) %, a creatinine RR of 74.7 (4.6) %, a β2-microglobulin RR of 76.5 (4.8) % and a retinol binding protein RR of 18.6 (7.6) %. There were no technical problems or alarms. Changing the heparin dosage was not necessary. No increases in C3a or C5a concentrations or leukopenia were observed in the first 30min of the session. Neither the monocyte subpopulations nor IL-β1 or IL-6 were significantly altered after one month of treatment. CONCLUSIONS The new ATA™ membrane achieves adequate Kt and convection volume, without technical problems and with good biocompatibility and inflammatory profiles. It is therefore a valid option for post-dilution haemodiafiltration, particularly in patients allergic to synthetic membranes.
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Barril G, Nogueira A, Russo F, Nuñez A, Sanchez C, Sanchez Tomero JA. SP413INFLUENCE OF HYDRATION STATUS AND FAT MASS ON BMI IN CKD PATIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx148.sp413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Barril G, Nogueira A, Giorgi M, Nuñez A, Russo F, Saharaui Y, Santos A, Sanchez Tomero JA. MP461UTILITY MALNUTRITION-INFLAMMATION SCORE IN CKD AND HD PATIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx172.mp461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Molina P, Vizcaíno B, Beltrán S, Montomoli M, Ávila A, Kanter J, Barril G, Fernández-Giráldez E, Pallardó LM, Górriz JL. FP365PREDICTIVE VALUE OF ABDOMINAL FAT DEPOSITION FOR PROGRESSION, HOSPITALIZATION AND MORTALITY IN NON-DIALYSIS CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv175.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Górriz JL, Molina P, Cerverón MJ, Vila R, Bover J, Nieto J, Barril G, Martínez-Castelao A, Fernández E, Escudero V, Piñera C, Adragao T, Navarro-Gonzalez JF, Molinero LM, Castro-Alonso C, Pallardó LM, Jamal SA. Vascular calcification in patients with nondialysis CKD over 3 years. Clin J Am Soc Nephrol 2015; 10:654-66. [PMID: 25770175 DOI: 10.2215/cjn.07450714] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/16/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3-5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop >30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models. RESULTS VC was present in 79% of patients and prominent in 47% (AS≥3 or KS>6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P<0.001), phosphorous (OR, 1.68; 95% CI, 1.28 to 2.20; P<0.001), and diabetes (OR, 2.11; 95% CI, 1.32 to 3.35; P=0.002) were independently related to AS≥3. After a median follow-up of 35 months (interquartile range=17-36), there were 70 deaths (10%). After multivariate adjustment for age, smoking, diabetes, comorbidity, renal function, and level of phosphorous, AS≥3 but not KS>6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event-free period (HR, 1.14; 95% CI, 1.06 to 1.22; P<0.001). VC did not predict renal progression. CONCLUSIONS VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful index to identify patients with CKD at high risk of death and morbidity as previously reported in patients on dialysis.
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Gorriz JL, Gutiérrez F, Trullàs JC, Arazo P, Arribas JR, Barril G, Cervero M, Cofán F, Domingo P, Estrada V, Fulladosa X, Galindo MJ, Gràcia S, Iribarren JA, Knobel H, López-Aldeguer J, Lozano F, Martínez-Castelao A, Martínez E, Mazuecos MA, Miralles C, Montañés R, Negredo E, Palacios R, Pérez-Elías MJ, Portilla J, Praga M, Quereda C, Rivero A, Santamaría JM, Sanz J, Sanz J, Miró JM. [Executive summary of the recommendations on the evaluation and management of renal disease in human immunodeficiency virus-infected patients]. Enferm Infecc Microbiol Clin 2014; 32:583-97. [PMID: 25303781 DOI: 10.1016/j.eimc.2014.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in human immunodeficiency virus (HIV)-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glycosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir, or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.
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Gutiérrez F, Fulladosa X, Barril G, Domingo P. Renal tubular transporter-mediated interactions of HIV drugs: implications for patient management. AIDS Rev 2014; 16:199-212. [PMID: 25350530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Interactions of drugs with renal transporters can reduce the tubular secretion of endogenous products and affect drug pharmacokinetics, efficacy, and toxicity. This review aims to understand the clinical implications of renal transporter-mediated interactions of HIV drugs. These interactions have been fully investigated for nucleoside/nucleotide reverse transcriptase inhibitors, particularly tenofovir disoproxil fumarate, and for some of the newer agents, such as rilpivirine, dolutegravir, and cobicistat. Interactions may include competition, inhibition, or induction of transporters, and interference with renal active secretion of creatinine, the most commonly used marker of renal function. Drug-drug interactions may result in an increased risk of drug toxicity. This interaction is more likely to occur with the protease inhibitors, particularly ritonavir, due to the inhibitory effects of these drugs on specific transporters involved in renal excretion of other drugs. Interactions with the transport of creatinine have been identified with rilpivirine, dolutegravir, and cobicistat. While rilpivirine and dolutegravir inhibit mainly the renal transporter OCT2 in the basolateral membrane of the proximal tubular cell, cobicistat predominantly inhibits the renal transporter MATE1 in the luminal membrane. These interactions can cause mild-to-moderate increases in serum creatinine concentrations and moderate reductions in estimated glomerular filtration rate that do not translate into real decreases in glomerular filtration. To use these drugs safely, clinicians must correctly interpret changes upon initiation of therapy to differentiate these spurious elevations in serum creatinine from clinically significant toxicity. In this article we propose a set of recommendations for clinical use of antiretroviral drugs that interfere with creatinine renal transporters.
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Ruperto M, Barril G, Sánchez-Muniz FJ. Conicity index as a contributor marker of inflammation in haemodialysis patients. NUTR HOSP 2014; 28:1688-95. [PMID: 24160234 DOI: 10.3305/nh.2013.28.5.6626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Abdominal fat mass is an important risk factor of inflammation in the general population as it is in haemodialysis (HD) patients. The aim of this study was to investigate the association of adiposity using the conicity index (Ci) with nutritional-inflammatory markers and to analyse whether these factors were related with the clinical outcome in HD patients. METHODS A cross-sectional study in 80 HD patients (men, 65%; aged 68.2 ± 14.2) was carried out. Abdominal fat deposition was evaluated by Ci median with regard to baseline inflammatory, anthropomorphic, and nutritional markers. Linear regression analysis was applied to identify whether serum C-reactive protein (CRP), as an inflammatory biomarker, was an independent predictor of Ci in HD patients. RESULTS Mean Ci was significantly greater in men (p = 0.001). Significant positive correlations were observed between Ci and serum triglycerides (r = 0.23; p < 0.05) and Ln of serum CRP (r = 0.27; p < 0.01). A significantly higher median Ci (men ≥ 1.39 and women ≥ 1.33) was observed in inflammated overweight patients by multivariate analysis (p < 0.05). Serum CRP, as an inflammatory biomarker, was a significant predictor (p = 0.021) of Ci, but its predictive value disappeared after median Ci adjustment of linear regression analysis. CONCLUSION Abdominal fat mass, measured by Ci, appears directly linked to inflammation in dialysis. Results support the hypothesis that inflammation in HD patients has pleiotropic effects depending on abdominal body adiposity.
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Ruperto M, Sánchez-Muniz FJ, Barril G. Predictors of protein-energy wasting in haemodialysis patients: a cross-sectional study. J Hum Nutr Diet 2014; 29:38-47. [DOI: 10.1111/jhn.12276] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Turin TC, Matsushita K, Coresh J, Arima H, Chadban SJ, Cirillo M, Djurdjev O, Green JA, Irie F, Ix JH, Kovesdy CP, Ohkubo T, Shankar A, Wen CP, De Jong PE, Iseki K, Stengel B, Gansevoort RT, De Nicola L, Donfrancesco C, Minutolo R, Iacoviello L, Zoccali C, Gesualdo L, Conte G, Vanuzzo D, Giampaoli S, Gorriz JL, Molina-Vila P, Nieto J, Bover J, Martinez-Castelao A, Martinde Francisco AL, Barril G, Del Pino MD, Escudero V, Coresh J, Matsushita K, Sang Y, Ballew SH, Appel LJ, Green JA, Heine GH, Inker LA, Ishani A, Marks A, Shalev V, Turin TC, Iseki K, Levey AS, Sedaghat S, Mattace-Raso FUS, Uitterlinden AG, Hoorn EJ, Hofman A, Ikram MA, Franco OH, Dehghan A. CKD EPIDEMIOLOGY. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ruperto M, Sánchez-Muniz FJ, Barril G. A clinical approach to the nutritional care process in protein-energy wasting hemodialysis patients. NUTR HOSP 2014; 29:735-50. [PMID: 24679014 DOI: 10.3305/nh.2014.29.4.7222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Malnutrition/wasting/cachexia are complex-disease conditions that frequently remain undiagnosed and/or untreated in up to 75% of prevalent hemodialysis (HD) patients. The nutrition care process (NCP) based on assessment, diagnosis, intervention and monitoring of nutritional status is a systematic method that nutrition professionals use to make decisions in clinical practice. OBJECTIVE This review examines from a clinical-nutritional practice point of view: a) nutritional status as a mortality causative factor; b) phenotypic characteristics of malnutrition/wasting/cachexia, and c) current trends of NCP with special emphasis on nutritional support and novel nutrient and pharmacologic adjunctive therapies in HD patients. METHOD A literature review was conducted using the Pubmed, Science Direct, Scielo, Scopus, and Medline electronic scientific basis. Studies which assessing nutritional status and nutritional support published from 1990 to 2013 in HD patients were included and discussed. RESULTS From all the epidemiological data analyzed, NCP was the suggested method for identifying malnutrition/ wasting or cachexia in clinical practice. Nutrition support as an unimodal therapy was not completely able to reverse wasting in HD patients. Novel experimental therapeutic strategies including the use of appetite stimulants, ghrelin agonist, MC4-R antagonists, anabolic steroids, anti-inflammatory drugs, cholecalciferol, and other components are still under clinical evaluation. CONCLUSION Nutritional status is a strong predictor of morbidity and mortality in HD patients. The terms called malnutrition, wasting and cachexia have different nutritional therapeutics implications. The NCP is a necessary tool for assessing and monitoring nutritional status in the current clinical practice. Novel pharmacological therapies or specific nutrient supplementation interventions studies are required.
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Palmer S, Ruospo M, Pellgrini F, Strippoli GFM, Palmer S, Ruospo M, Natale P, Saglimbene V, Pellegrini F, Craig JC, Hegbrant J, Strippoli GFM, Ferraresi M, Pereno A, Castelluccia N, Clari R, Moro I, Colombi N, Di Giorgio G, Barbero S, Piccoli GB, Krishnan M, Bond TC, Brunelli S, Nissenson A, Kara B, Palmer S, Wong G, Craig JC, Strippoli GFM, Hanafusa N, Wakai K, Iseki K, Tsubakihara Y, Ogata S, Bikbov B, Tomilina N, Suleymanlar G, Altiparmak MR, Seyahi N, Trabulus S, Serdengecti K, Huang ST, Shu KH, Kao CH, Palmer S, Ruospo M, Natale P, Johnson DW, Craig JC, Gargano L, Saglimbene V, Pellegrini F, Strippoli GFM, Bernasconi AR, Waisman R, Lapidus A, Montoya P, Heguilen R, Suzuki A, Shoji T, Tsubakihara Y, Hayashi T, Tomida K, Guinsburg A, Thijssen S, Usvyat L, Xiao Q, van der Sande F, Marelli C, Etter M, Marcelli D, Levin N, Wang Y, Kotanko P, Kooman J, Schiller A, Schiller O, Andrei C, Mihaescu A, Olariu N, Anton C, Ivacson Z, Roman V, Berca S, Bansal V, Hwang SJ, Lee JJ, Lin MY, Chang JS, Okamura K, Kishi T, Miyazono M, Ikeda Y, Fukumitsu T, Sanai T, Reyes-Bahamonde J, Raimann J, Usvyat LA, Thijssen S, Van der Sande F, Kooman J, Levin N, Kotanko P, Allehbi AM, Bunani AD, Noor A, Laplante S, Rutherford P, Kulcsar I, Szegedi J, Ladanyi E, Torok M, Reusz G, Kiss I, Sparacino V, Agnello V, Di Gaetano P, Guaiana V, Almasio P, Rainone F, Merlino L, Ritchie JP, Marcatti M, Kalra PA, Toprak O, Quintaliani G, Ranocchia D, Germini F, Notargiacomo A, Ariete ML, Palmer S, Ruospo M, Pellegrini F, Strippoli GFM, Bunani AD, Bunani ED, Herrero Berron JC, Mon C, Ortiz M, Hinostroza J, Cobo G, Gallar P, Ortega O, Rodriguez Villarreal I, Oliet A, Digiogia C, Vigil A, Trigka K, Douzdampanis P, Aggelakou-Vaitsi M, Vaitsis N, Fourtounas K, Vigotti FN, Apostu AL, Boscolo M, Chegui LK, Ferrero S, Gallicchio M, Garassino G, Ionescu A, Portonero I, Tarea CA, Valentino E, Piccoli GB, Sikole A, Trajceska L, Gelev S, Dzekova P, Selim G, Amitov V, Borg Cauchi A, Buhagiar L, Calleja N, Demarco D, Nikitidou O, Liakopoulos V, Michalaki A, Demirtzi P, Christidou F, Papagianni A, Daskalopoulou E, Nikolaidis P, Dombros N, Vassallo DM, Chinnadurai R, Robinson H, Middleton R, Donne R, Saralegui I, Garcia O, Robledo C, Gabilondo E, Ortalda VVO, Tomei PPT, Yabarek TTY, Spatola LLS, Dalla Gassa AADG, Lupo AAL, Barril G, Quiroga JA, Arenas D, Cigarran S, Garcia N, Glez Parra E, Martin A, Bartolome J, Castillo I, Carreno V, Baamonde E, Bosch E, Perez G, Ramirez I, Checa MD, Palmer S, Ruospo M, Pellegrini F, Strippoli GFM, Shifris I, Dudar I, Rudenko A, Gonchar I, Mademtzoglou S, Tsikliras NC, Balaskas EV, Montalto G, Lupica R, Fazio MR, Aloisi C, Donato V, Lucisano S, Buemi M, Trimboli D, Cernaro V, Donia A, Denewar A, Khil M, Dudar I, Khil V, Shifris I. Epidemiology CKD 5D - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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