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Solis Sánchez G, Alcalde Bezhold G, Alfonso Farnós I. Research ethics: From principles to practical aspects. An Pediatr (Barc) 2023; 99:195-202. [PMID: 37598083 DOI: 10.1016/j.anpede.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 08/21/2023] Open
Abstract
Any research conducted on human beings or human biological samples requires a prior ethical assessment to avoid risks and problems for all involved parties. The legislation in this regard is very broad and emphasizes the safeguarding of patient rights in relation to the universal principles of autonomy, beneficence and justice. The present article reviews the regulations applicable to clinical trials, observational studies with drugs, biobank projects or any other type of study that may be conducted in the health care field. It also addresses the role of research ethics committees, data protection and the foundations of scientific integrity.
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Affiliation(s)
- Gonzalo Solis Sánchez
- Hospital Universitario Central de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain.
| | - Guillermo Alcalde Bezhold
- CEI OSI Araba, Universidad del País Vasco, Servicio de Nefrología, Hospital Universitario Araba, Vitoria, Vizcaya, Spain
| | - Iciar Alfonso Farnós
- Comité de Ética de la Investigación de Euskadi, Asociación Nacional de Comités de Ética en Investigación, Vitoria, Vizcaya, Spain
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Esteve-Simó V, Perez-Morales R, Buades-Fuster JM, Arenas Jimenez MD, Areste-Fosalba N, Alcalde Bezhold G, Blanco Santos A, Sanchez Álvarez E, Sanchez Villanueva R, Molina P, Ojeda R, Prieto-Velasco M, Goicoechea M. Chronic Kidney Disease-Associated Pruritus and Quality of Life: Learning from Our Patients. J Clin Med 2023; 12:4505. [PMID: 37445539 DOI: 10.3390/jcm12134505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Chronic kidney disease-associated pruritus is itching directly related to kidney disease that cannot be explained by any other condition. Despite technological advances in the different aspects of dialysis sessions and the best treatment for chronic kidney disease patients, it is still a common problem in our patients. The many complex physiological mechanisms involved, the different hypotheses made over the years on the aetiology of the condition, and the great clinical variability may partially explain the limited knowledge about this problem and the difficulties in treating it. The presence of all these factors leads to the persistence of unpleasant symptoms, which must affect the disease burden and quality of life of kidney patients. Through the presentation of an illustrative clinical case, the aim of this review article is to highlight the need for adequate diagnosis and an improved approach to all aspects of chronic kidney disease-associated pruritus, in view of the heavy burden of the disease and the huge impact on the patient's quality of life.
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Affiliation(s)
- Vicent Esteve-Simó
- Nephrology Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain
| | - Rosa Perez-Morales
- Nephrology Department, Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - Juan Manuel Buades-Fuster
- Nephrology Department, Hospital Son Llatzer, Fundació Institut d'Investigació Sanitària Illes Balears, 07120 Palma, Spain
| | | | - Nuria Areste-Fosalba
- Nephrology Department, Hospital Universitario Virgen de la Macarena, 41009 Sevilla, Spain
| | | | - Ana Blanco Santos
- Fresenius Medical Care, Dialysis Center Alcobendas, Complejo Hospitalario Ruber Juan Bravo, 28006 Madrid, Spain
| | | | | | - Pablo Molina
- Nephrology Department, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Hospital Universitari Dr. Peset, Universitat de València, 46017 Valencia, Spain
| | - Raquel Ojeda
- Nephrology Department, Hospital Universitario Reina Sofia, 14004 Córdoba, Spain
| | | | - Marian Goicoechea
- Nephrology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
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Aresté N, Sanchez-Alvarez JE, Prieto-Velasco M, Molina P, Esteve-Simó V, Ojeda R, Buades JM, Goicoechea M, Sanchez-Villanueva R, Bezhold GA, Pérez-Morales RE, Santos AB, Peiró-Jordan R, Arenas MD. Prevalence and severity of pruritus in Spanish patients with chronic kidney disease and impact on quality of life: a cross-sectional study. Clin Kidney J 2023; 16:1035-1037. [PMID: 37260996 PMCID: PMC10229293 DOI: 10.1093/ckj/sfac246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 06/02/2023] Open
Affiliation(s)
- Nuria Aresté
- Hospital Universitario Virgen Macarena, Department of Nephrology, Sevilla, Spain
| | | | - Mario Prieto-Velasco
- Complejo Asistencial Universitario de León, Department of Nephrology, León, Spain
| | - Pablo Molina
- Pablo Molina, Pablo; Hospital Universitario Dr Peset, Department of Nephrology, Valencia, Spain
| | | | - Raquel Ojeda
- Hospital Universitario Reina Sofia, Department of Nephrology, Córdoba, Spain
| | - Juan Manuel Buades
- Hospital Son Llatzer, Fundació Institut d'Investigació Sanitària Illes Balears, Nephrology, Palma de Mallorca, Spain
| | - Marian Goicoechea
- Hospital General Universitario Gregorio Marañón, Nephrology Unit, Madrid, Spain
| | | | | | - Rosa Elena Pérez-Morales
- Hospital Universitario Nuestra Senora de la Candelaria, Department of Nephrology, Santa Cruz de Tenerife, Spain
| | - Ana Blanco Santos
- Fresenius Medical Care Diálisis Alcobendas, Department of Nephrology, Alcobendas, Spain
| | | | - María Dolores Arenas
- Fundación Renal Íñigo Álvarez de Toledo, Department of Nephrology, Madrid, Spain
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Goicoechea M, Arenas-Jimenez MD, Areste N, Perez-Morales RE, Esteve V, Sanchez-Alvarez E, Alcalde Bezhold G, Blanco A, Sanchez-Villanueva R, Molina P, Ojeda R, Prieto-Velasco M, Manuel Buades J. Perception of Spanish nephrologists on an old unsolved problem: Pruritus associated with chronic kidney disease (CKD-aP). Nefrologia 2023; 43:102-110. [PMID: 37069038 DOI: 10.1016/j.nefroe.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/22/2022] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Pruritus associated with chronic kidney disease is defined as the sensation of itching, in people with chronic kidney disease, in a one area or all over the body that causes the need to scratch, after having ruled out other dermatological or systemic causes. It is an old and known problem whose prevalence has been able to decrease with the improvement of dialytic techniques but which still persists and is underdiagnosed. OBJECTIVES The objective of this study was to analyse the current perception of nephrologists about this problem that influences the quality of life of people with chronic kidney disease through a survey. RESULTS 135 nephrologists, most of them engaged in haemodialysis, participated. 86% considered that pruritus associated with chronic kidney disease is still a problem today that affects the quality of life. Most nephrologists believe that the main pathophysiological cause is uremic toxins (60%) and only 16% believe that it is due to the dysregulation of the opioid system/endorphins-dynorphins. Only 16% comment that the prevalence of pruritus in their centre is greater than 20%. 40% believe that the diagnosis is made because it is manifested by the patient and only 27% because it is asked by the doctor. Moreover, it is not usual to use scales to measure it or the codification in the medical records. The main treatment used is antihistamines (96%), followed by moisturizers/anaesthetics (93%) and modification of the dialysis regimen (70%). CONCLUSIONS Pruritus associated with chronic kidney disease is still a current problem, it is underdiagnosed, not codified and with a lack of indicated, effective and safe treatments. Nephrologists do not know its real prevalence and the different pathophysiological mechanisms involved in its development. Many therapeutic options are used with very variable results, ignoring their efficacy and applicability at the present time. The new emerging kappa-opioid-receptor agonist agents offer us an opportunity to reevaluate this age-old problem and improve the quality of life for our patients with chronic kidney disease.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
| | | | - Nuria Areste
- Servicio de Nefrología, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Rosa Elena Perez-Morales
- Servicio de Nefrología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Vicens Esteve
- Servicio de Nefrología, Consorci Sanitari de Tarrasa, Terrasa, Spain
| | | | | | - Ana Blanco
- Fresenius Medical Care, Centro de Dialisis Alcobendas, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
| | | | - Pablo Molina
- Servicio de Nefrología, FISABIO, Hospital Universitari Dr Peset, Universitat de València, Valencia, Spain
| | - Raquel Ojeda
- Servicio de Nefrología, Hospital Universitario Reina Sofia, Córdoba, Spain
| | | | - Juan Manuel Buades
- Servicio de Nefrologia, Hospital Son Llatzer, Fundació Institut d'Investigació Sanitària Illes Balears, Palma, Spain
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Alfonso Farnós I, Alcalde Bezhold G. Clinical research in rare diseases: New challenges, opportunities and ethical issues. An Pediatr (Barc) 2020; 93:219-221. [PMID: 34092333 DOI: 10.1016/j.anpede.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Iciar Alfonso Farnós
- Comité de Ética de la Investigación con medicamentos de Euskadi, Vitoria-Gasteiz, Spain.
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Alfonso Farnós I, Alcalde Bezhold G. [Clinical research in rare diseases: new challenges, opportunities and ethical issues]. An Pediatr (Barc) 2020; 93:219-221. [PMID: 32921623 DOI: 10.1016/j.anpedi.2020.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Iciar Alfonso Farnós
- Comité de Ética de la Investigación con medicamentos de Euskadi, Vitoria-Gasteiz, España.
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Alcalde Bezhold G, Alfonso Farnós I. [Accessing medical records for research purposes]. Rev Derecho Genoma Hum 2013:137-172. [PMID: 24868961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Organic Law 15/1999 of 13 December on the Protection of Personal Data and the Law 41/2002 of 14 November regulating patient autonomy and rights and obligations of information and clinical documentation are the basic rules which govern the medical history in Spain. However, the lack of development of these laws regarding data protection in clinical research, particularly in terms of access to the medical history, repeatedly causes doubts about its construction by the Research Ethics Committees. Therefore, the aim of this paper is to analyze the rules which govern the access to the medical history for research purposes, with particular emphasis on the common problems that arise in the Committees for the ethical evaluation of these projects and finally setting a series of recommendations. The use for research purpose of genetic personal data contained in the medical history is also addressed in this paper. In this sense, a key contribution of the Law on Biomedical Research is relating to the specific regulation of the genetic personal data, both with respect to their production and access to the data as a support and regarding to its use for research purpose.
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