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Escobar C, Varela L, Palacios B, Capel M, Sicras-Mainar A, Sicras-Navarro A, Hormigo A, Alcázar R, Manito N, Botana M. Características clínicas, manejo y riesgo de complicaciones a un año en pacientes con insuficiencia cardíaca con y sin diabetes tipo 2 en España. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Escobar C, Varela L, Palacios B, Capel M, Sicras-Mainar A, Sicras-Navarro A, Hormigo A, Alcázar R, Manito N, Botana M. Clinical characteristics, management, and one-year risk of complications among patients with heart failure with and without type 2 diabetes in Spain. Rev Clin Esp 2021; 222:195-204. [PMID: 34511336 DOI: 10.1016/j.rceng.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This work aims to describe the clinical characteristics and therapeutic management and to determine cardiovascular outcomes after one year of follow-up in a contemporaneous population with heart failure (HF) with and without type 2 diabetes in Spain. These factors were also analyzed in the DAPA-HF-like population (patients who met most inclusion criteria of the DAPA-HF trial) and in patients treated with SGLT2 inhibitors at baseline. METHODS This work is an observational, retrospective, population-based study using the BIG-PAC database. The index date was January 1, 2019. People aged ≥ 18 years who received care for HF in 2019 were selected. Events that occurred in 2019 were analyzed. RESULTS We identified 21,851 patients with HF (age 78.0 ± 11.3 years, 53.0% men, 50.9% with HF with reduced left ventricular ejection fraction, 44.5% in NYHA functional class II). HF prevalence was 1.88% and incidence was 2.83 per 1,000 person-years. Regarding HF treatments, 66.1% were taking renin-angiotensin system inhibitors, 69.4% beta blockers, 31.2% aldosterone antagonists, and 7.5% sacubitril/valsartan. During the year of follow-up, 29.8% had HF decompensation which led to hospitalization (mean time to first event of 120.9 ± 72.5 days), 12.3% died, and 8.1% died during hospitalization. Events were more common among patients with type 2 diabetes. Hospitalizations for HF were more common in the DAPA-HF-like population. CONCLUSIONS In Spain, the population with HF is elderly and has many comorbidities. Approximately half of patients have HF with reduced left ventricular ejection fraction. There is room for improvement in HF management, particularly through the use of drugs that reduce both HF hospitalization and mortality, in order to reduce the burden of HF.
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Affiliation(s)
- C Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - L Varela
- Departamento médico, AstraZeneca Spain
| | | | - M Capel
- Departamento médico, AstraZeneca Spain
| | - A Sicras-Mainar
- Investigación sobre economía y resultados de la salud, Atrys Health, Barcelona, Spain
| | - A Sicras-Navarro
- Investigación sobre economía y resultados de la salud, Atrys Health, Barcelona, Spain
| | - A Hormigo
- Centro de Salud de Atención Primaria Puerta Blanca, Málaga, Spain
| | - R Alcázar
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - N Manito
- Unidad de Insuficiencia Cardíaca Avanzada y Trasplante Cardíaco, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M Botana
- Servicio de Endocrinología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Albalate M, Arribas P, Torres E, Cintra M, Alcázar R, Puerta M, Ortega M, Procaccini F, Martin J, Jiménez E, Fernandez I, de Sequera P. High prevalence of asymptomatic COVID-19 in hemodialysis. Daily learning during first month of COVID-19 pandemic ☆. Nefrología (English Edition) 2020; 40. [PMCID: PMC7309939 DOI: 10.1016/j.nefroe.2020.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Dialysis patients are a risk group for SARS-CoV2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-Cov2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID19 (almost 1000 patients in 100,000 h). In the form of a diary, we present the actions undertaken, the incidence of COVID19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-Cov2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. Conclusions We detected a high prevalence of COVID19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID19.
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Affiliation(s)
- M. Albalate
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
- Corresponding author.
| | - P. Arribas
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - E. Torres
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - M. Cintra
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - R. Alcázar
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - M. Puerta
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - M. Ortega
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - F. Procaccini
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - J. Martin
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - E. Jiménez
- Medicina Preventiva y Salud Pública, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - I. Fernandez
- Medicina Preventiva y Salud Pública, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
| | - P. de Sequera
- Servicio de Nefrología, Hospital Universitario Infanta Leonor (HUIL). Madrid, Spain
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Alcázar R, Albalate M. [New methods for estimating glomerular filtration rate. Achieving more precision in diagnosing chronic kidney disease]. Nefrologia 2010; 30:143-146. [PMID: 20393616 DOI: 10.3265/nefrologia.pre2010.mar.10263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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5
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Alcázar R, Quereda C. [Digital NEFROLOGIA. A project for coming years]. Nefrologia 2010; 30:271-274. [PMID: 20514094 DOI: 10.3265/nefrologia.pre2010.apr.10406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Alcázar R, Tato A, García F, Barrios V, Quereda C. [Would prescription of erythropoiesis-stimulating agents in pre-dialysis change after results from TREAT study?]. Nefrologia 2009; 30:114-118. [PMID: 20038963 DOI: 10.3265/nefrologia.pre2009.dic.5903] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 11/29/2009] [Indexed: 05/28/2023] Open
Affiliation(s)
- R Alcázar
- Servicios de Nefrología, Hospital Infanta Leonor, Spain
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Quereda C, Alcázar R, García López F, Martín de Francisco AL, Purroy A. [Nefrología 2008-2009]. Nefrologia 2009; 29:1-5. [PMID: 19240764 DOI: 10.3265/nefrologia.2009.29.1.1.1.en.full.pdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Martínez Castelao A, Martín de Francisco A, Górriz J, Alcázar R, Orte L. [Strategies for renal health: a project of the Spanish Society of Nephrology]. Nefrologia 2009; 29:185-192. [PMID: 19554049 DOI: 10.3265/nefrologia.2009.29.3.5326.en.full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Caramelo C, Albalate M, Tejedor A, Alcázar R, Baldoví S, García Pérez A, Marín M. [Current use of acetazolamide as a diuretic: usefulness in refractory edema and in aldosterone-antagonist-related hyperkalemia]. Nefrologia 2008; 28:234-238. [PMID: 18454727] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- C Caramelo
- Servicio de Nefrología, Fundación Jiménez Díaz-Capio, Madrid
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Quereda C, Alcázar R, García-López F, Purroy A. [Goals for Nefrología in a new era]. Nefrologia 2008; 28:1-7. [PMID: 18336121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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11
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Alcázar R, Egocheaga MI, Orte L, Lobos JM, González Parra E, Alvarez Guisasola F, Górriz JL, Navarro JF, Martín de Francisco AL. [SEN-SEMFYC consensus document on chronic kidney disease]. Nefrologia 2008; 28:273-282. [PMID: 18590493] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- R Alcázar
- Sociedad Española de Nefrología, Sociedad Española de Medicina Familiar y Comunitaria.
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Lozano L, Sánchez R, Navarro J, Alcázar R. [Is chronic kidney disease (CKD) a problem of great epidemiological relevance?]. Nefrologia 2008; 28 Suppl 5:99-103. [PMID: 18847428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
In this article some of the novelties published in 2007 on epidemiological aspects of chronic kidney disease are reviewed. Specifically, some studies on the suitability of current methods for measurement of glomerular filtration rate, the estimated current prevalence of chronic kidney disease and the influence of age and NSAIDs on progression of this disease are discussed. Finally, various recent publications on the role of chronic kidney disease as a cardiovascular risk factor are summarized.
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Affiliation(s)
- L Lozano
- Servicio de Nefrologia, Hospital de Fuenlabrada, Madrid, Spain
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Alcázar R, de Francisco ALM. [Strategic action of the Spanish Society of Nephrology confronting chronic renal disease ]. Nefrologia 2006; 26:1-4. [PMID: 16649419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
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Quereda C, Pascual J, García-López F, Alcázar R, Aljama P, Amenábar JJ, Arias M, Barrio V, Fernández-Rodríguez A, Fernández Juárez G, Fernández-Lucas M, Gallego N, Hernández D, Gómez-Alamillo C, Maduell F, Martínez Castelao A, Marcén R, Matesanz R, Martín de Francisco AL, Orte L, Liaño F, Luño J, Ortuño J, Pérez García R, Praga M, Saracho R, Selgas R, Rivera M, Rodríguez Pérez JC, Teruel JL, Tato A, Torres A, Valdés F. [Clinical research based nephrology (bases for the constitution of an Evidence Based Nephrology Group in the Spanish Society of Nephrology)]. Nefrologia 2006; 26:163-72. [PMID: 16808254] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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15
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Alcázar R, Maduell F, Martí A. [Recognizing the different hemodialysis modalities. Hemodialysis centers guides]. Nefrologia 2006; 26 Suppl 8:22-33. [PMID: 17802666] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
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Maduell F, García M, Alcázar R. [Dosage and adaptation of dialytic treatment. Hemodialysis centers guides]. Nefrologia 2006; 26 Suppl 8:15-21. [PMID: 17806215] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
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17
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Sanchez de la Nieta MDG, Sánchez-Fructuoso AI, Alcázar R, Pérez-Contin MJ, Prats D, Grimalt J, Blanco J. Higher graft salvage rate in renal allograft rupture associated with acute tubular necrosis. Transplant Proc 2005; 36:3016-8. [PMID: 15686684 DOI: 10.1016/j.transproceed.2004.10.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Renal allograft rupture is an early postoperative complication threatening graft and patient survival. We reviewed the etiology and prognostic factors for renal allograft rupture. MATERIAL AND METHODS Among 657 renal transplants performed between 1990 and 2001, renal allograft rupture was diagnosed in 10 cases. Statistical analysis by Student t test, ANOVA, and chi-square was performed to assess donor and recipient characteristics. Multivariate logistic regression to predict renal allograft rupture used variables with P <.15 in the univariate analysis. RESULTS Patients with renal allograft rupture were mainly men and young. Renal allograft rupture incidence was higher among allografts from non-heart-beating donors, kidneys with delayed graft function, or patients with a high antibody titer. Histopathological findings revealed that six renal allograft ruptures were secondary to acute rejection, three to acute tubular rejection and one to allograft infarction. Only one of six renal allograft ruptures (17.7%) secondary to rejection was resolved by surgery; two of the three patients (66.7%) with acute tubular necrosis were successfully operated and a nephrectomy was performed for the patient with allograft infarction. By multivariate logistic regression analysis, factors shown to be predictive for renal allograft rupture were: delayed graft function, age of recipient, peak panel-reactive antibody >25%, and initial immunosuppressive treatment without antithymocyte globulin. CONCLUSIONS Higher graft salvage rates are possible in cases of graft rupture associated with acute tubular necrosis.
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Mañas MD, Vozmediano C, Alcázar R, García M. [Severe fatal calciphylaxis in a patient with kidney transplantation and previous parathyroidectomy]. Nefrologia 2005; 25:211-2. [PMID: 15912663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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Barril G, González Parra E, Alcázar R, Arenas D, Campistol JM, Caramelo C, Carrasco M, Carreño V, Espinosa M, García Valdecasas J, Górriz JL, López MD, Martín L, Ruiz P, Terruel JL. [Guidelines on hemodialysis-associated viral infections]. Nefrologia 2004; 24 Suppl 2:43-66. [PMID: 15085792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
The viric infections influence morbi-mortality in Chronic kidney Disease patients in hemodialysis therapy and can affect to the Staff of the Units. The guides considered the most relevant virus at the present moment: C Virus, B Virus and HIV. To prevent horizontal nosocomial transmission is necessary the observance always the universal precautions in the HD units, although sometimes can appeared seroconversions and epidemic bud when exist a break of these. Is analyzed different situations with special focus in units for acute patients. The following steps under the suspicious of the epidemic bud appeared in one of the annexes together with legislation according to this case. Respect to the staff in every one of the virus is shown prevention patterns, serologic markers to perform when an accident with infected blood occur, also is considered when treatment is indicated. The guides considered too the conditions necessary for include these patients on waiting list for kidney transplantation.
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Affiliation(s)
- G Barril
- Nefrólogo Hosp. Universitario de La Princesa, Madrid
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Ceres F, Rivera F, Yagüe JL, Blanco J, García-Rojo M, Sánchez de la Nieta MD, Alcázar R, de la Torre M. [Non-Hodgkin lymphoma, IgA nephropathy and renal cell carcinoma]. Nefrologia 2003; 23:554-7. [PMID: 15002792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Glomerular diseases could complicate lymphoid malignancies. We identified a patient with non-Hodgkin's lymphoma showing elevated levels of serum IgA1 paraprotein, renal infiltration by B cells, IgA nephropathy and renal cell carcinoma. It seems that there is a possible pathogenic relationship between these entities.
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Affiliation(s)
- F Ceres
- Sección de Nefrología, Hospital Alarcos, Ciudad Real
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Sánchez de la Nieta MD, Arias LF, Alcázar R, de la Torre M, González L, Rivera F, Blanco J, Ferreras I. [Familial focal and segmentary hyalinosis]. Nefrologia 2003; 23:172-6. [PMID: 12778884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Focal segmental glomerulosclerosis represents a finding in several renal disorders, characterized by proteinuria and sometimes by arterial hypertension and progressive decline in renal function. There are primary (idiopathic and familial) and secundary forms. In the last 20 years several familial cases has been reported, with a great genetic heterogeneity (dominant and recessive forms) and with multiple associations with particular MHC class-I and class-II gene loci, being Al, DR3 o DR7 the most frequently reported. We described three members of same family with focal segmental hyalinosis that shared the HLA haplotype A31 B61 DR13. This association has not been described previously. We highlight that genetic and acquired factors (obesity, hypertension...) could have importance in the development of progressive renal failure in these patients.
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Sánchez de la Nieta MD, de la Torre M, Alcázar R, Rivera F. [Acute renal failure caused by dihydroergotamine]. Nefrologia 2003; 22:293. [PMID: 12123131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Alcázar R, Ruiz-Ortega M, Egido J. [Angiotensin II : a key peptide in vascular and renal failure]. Nefrologia 2003; 23 Suppl 4:27-35. [PMID: 14626811] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- R Alcázar
- Servicio de Nefrología, Hospital Virgen de Alarcos, Ciudad Real
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Alcázar R. [Do Spanish nephrologists take full advantage of medical informatics?]. Nefrologia 2002; 22:108-10. [PMID: 12085412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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de la Torre M, Alcázar R, Sánchez de la Nieta D, Nieto J, Ferreras I, Urra JM. Lupus relapse after prostaglandin E(1) administration: activation of a cytokine cascade? Ann Rheum Dis 2002; 61:91-2. [PMID: 11779776 PMCID: PMC1753874 DOI: 10.1136/ard.61.1.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ortega-Carnicer J, de la Nieta DS, Alcázar R. Acute myocardial injury caused presumably by coronary spasm after magnesium fluoro-silicate ingestion. J Electrocardiol 2001; 34:335-7. [PMID: 11590575 DOI: 10.1054/jelc.2001.27928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A patient who developed magnesium fluoro-silicate poisoning is described. This condition was manifest by the findings of acute chest pain, dysphagia, diarrhea, metabolic acidosis, hypocalcemia and hypomagnesemia and was complicated by acute myocardial injury-a phenomenon not previously described. Coronary cineangiography showed normal coronary arteries. The physiopathologic mechanisms of this electrocardiographic finding are discussed.
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Affiliation(s)
- J Ortega-Carnicer
- Coronary Care Unit, Hospital Alarcos, Los Alisos 10, 13002-Ciudad Real, Spain.
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Ortega-Carnicer J, Porras L, Alcázar R, Sánchez de la Nieta D. Silent transmural myocardial ischemia during septic shock in a patient with normal coronary arteries. Intensive Care Med 2001; 27:1098-9. [PMID: 11497148 DOI: 10.1007/s001340100944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ortega-Carnicer J, Alcázar R, Ambrós A, Gómez-Grande ML. Acute postrenal failure and pseudomyocardial infarction after spontaneous bladder rupture. Intensive Care Med 2000; 26:353-4. [PMID: 10823396 DOI: 10.1007/s001340051163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De La Torre M, Alcázar R, Urra JM, Caparrós G, Alegre R, Blanco J, Nieto J, Ferreras I. Monthly cyclophosphamide pulses in the treatment of crescentic glomerulonephritis. Transplant Proc 1998; 30:3952-4. [PMID: 9865259 DOI: 10.1016/s0041-1345(98)01302-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M De La Torre
- Service of Nephrology, Hospital Alarcos, Ciudad Real, Spain
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Urra JM, de la Torre M, Alcázar R, Peces R, Ferreras I, García-Chico P. Variable in vitro inhibition of HLA-specific alloantibody-mediated cytotoxicity by intravenous human immunoglobulin. Transplant Proc 1998; 30:4177-9. [PMID: 9865338 DOI: 10.1016/s0041-1345(98)01383-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J M Urra
- Laboratory of Immunology, Complejo Hospitalario de Ciudad Real, Spain
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De la Torre M, Alcázar R, Aguirre M, Ferreras I. The dialysis patient with headache and sudden hypotension: consider pituitary apoplexy. Nephrol Dial Transplant 1998; 13:787-8. [PMID: 9550672 DOI: 10.1093/ndt/13.3.787] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- M De la Torre
- Nephrology Unit, Complejo Hospitalario Ciudad Real, Spain
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Peces R, de la Torre M, Alcázar R, Tejada F, Gago E. Genitourinary tuberculosis as the cause of unexplained hypercalcaemia in a patient with pre-end-stage renal failure. Nephrol Dial Transplant 1998; 13:488-90. [PMID: 9509470 DOI: 10.1093/oxfordjournals.ndt.a027854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- R Peces
- Service of Nephrology, Hospital Alarcos, Oviedo, Spain
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Abstract
Unexplained sudden deaths following use of pentavalent antimonial drugs have been described, presumably owing to ventricular arrhythmias. A patient is reported with QT interval prolongation and syncopal episodes related to torsade de pointes following treatment of visceral leishmaniasis with meglumine antimoniate. This is the first reported case of documented torsade de pointes following treatment with pentavalent antimonial drugs.
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Peces R, de la Torre M, Alcázar R, Urra JM. Prospective analysis of the factors influencing the antibody response to hepatitis B vaccine in hemodialysis patients. Am J Kidney Dis 1997; 29:239-45. [PMID: 9016896 DOI: 10.1016/s0272-6386(97)90036-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hepatitis B vaccine is effective in producing protection against hepatitis B virus (HBV) infection in hemodialysis (HD) patients, but the antibody response is variable. To identify those factors implicated in the vaccine response, in a prospective study over a 24-month period, we vaccinated 80 seronegative patients on HD (group A) and monitored clinical, biochemical, and immunologic parameters. The protective immunity acquired by vaccination was compared with that developed through HBV infection in 22 age-matched HD patients (group B). The anti-HBs antibody-seronegative patients followed a four-dose vaccination schedule (0, 1, 2, and 6 months) with 40 microg DNA-recombinant hepatitis B vaccine. One month after vaccination, 77.5% of the patients had seroconverted, and 72.5% achieved high antibody response, whereas 22.5% were nonresponders. Patients aged younger than 40 years seroconverted 100%; those aged 40 to 60 years, 75% (P < 0.01); and patients older than 60 years, 74% (P < 0.001). No differences between responders and nonresponders concerning sex, time on HD, HD dose, nutritional status, hemoglobin level, HD membrane, iPTH level, calcitriol treatment, or number of transfusions during vaccination were found. The presence of other factors, such as recombinant human erythropoietin (rHuEPO) therapy or hepatitis C virus (HCV) infection, did not significantly influence antibody responses to hepatitis B immunization. A greater frequency of DR3 (53.8% v 25.7%, P < 0.05), DR7 (53.8% v 18.6%, P < 0.01), and DQ2 (76.9% v 44.1%, P < 0.05), and a lesser frequency of A2 (7.7% v 37.2%, P < 0.05) were found in nonresponders compared with responders. Eighteen months after vaccination, the analysis showed similar antibody titers but lower seroconversion rates in group A as compared with group B. In conclusion, unresponsiveness to hepatitis B vaccine in HD patients was related to factors such as older age, the presence of DR3, DR7, and DQ2, and the absence of A2 alleles. Although the seroprotection produced by the vaccine was less than that achieved through natural HBV infection, our protocol of vaccination was sufficiently immunogenic and provided lasting protection.
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Affiliation(s)
- R Peces
- Services of Nephrology and Immunology, Hospital Alarcos, Ciudad Real, Spain
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35
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Alcázar R, de la Torre M, Peces R. Symptomatic intrarenal arteriovenous fistula detected 25 years after percutaneous renal biopsy. Nephrol Dial Transplant 1996. [PMID: 8672036 DOI: 10.1093/ndt/11.7.1346] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- R Alcázar
- Service of Nephrology, Hospital Alarcos, Ciudad Real, Spain
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37
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Affiliation(s)
- R Peces
- Service of Nephrology, Hospital Alarcos, Ciudad Real, Spain
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Albalate M, Alcázar R, Ortiz A, Reyero AM, Casado S, Caramelo C. Acute pneumoperitoneum in a patient on nocturnal intermittent peritoneal dialysis. Nephron Clin Pract 1996; 72:358. [PMID: 8684571 DOI: 10.1159/000188886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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40
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Alcázar R, Rey M, de Sequera P, Alegre R, Rovira A, Caramelo C. [The reversibility of pulmonary hypertension associated with autoimmune hyperthyroidism]. Rev Esp Cardiol 1995; 48:142-4. [PMID: 7886265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report the case of a 28-year-old woman in a chronic hemodialysis program, who developed moderate pulmonary hypertension (eco-Doppler assumed pulmonary systolic pressure of 62 mmHg), with right ventricular dilatation (49 mm) in coincidence with a fully symptomatic autoimmune hyperthyroidism. The improvement of thyroid function resulted in a significant regression of pulmonary hypertension (45 mmHg) and normalization of right ventricular size (35 mm). The appearance and reversibility of pulmonary hypertension associated to autoimmune hyperthyroidism have not been described before and, in our patient, it is probably facilitated by other coincident factors that increase cardiac output and, subsequently, pulmonary flow, i.e. anemia and the arteriovenous fístula for hemodialysis.
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Affiliation(s)
- R Alcázar
- Servicio de Nefrología, Fundación Jiménez Díaz, Madrid
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Ruíz-Ortega M, Gómez-Garre D, Alcázar R, Palacios I, Bustos C, González S, Plaza JJ, González E, Egido J. Involvement of angiotensin II and endothelin in matrix protein production and renal sclerosis. J Hypertens Suppl 1994; 12:S51-8. [PMID: 7965275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To review the evidence that links angiotensin II and endothelin as growth factors and as modifiers of extracellular matrix synthesis in renal cells, with particular reference to the effects of angiotensin converting enzyme (ACE) inhibition in models of renal injury. IN VITRO STUDIES In cultured mesangial cells, both angiotensin II and endothelin promote contraction, proliferation/hypertrophy, signal transduction pathways, the activation of early growth genes, and the generation of inflammatory mediators, cytokines and growth factors. Both hormones have been shown to promote the synthesis of fibronectin and collagen in a dose-dependent manner. ACE inhibition attenuates the effect of endothelin-1, one of three isoforms of endothelin. ANIMAL STUDIES In experimental models of renal injury, chiefly in those characterized by increased intraglomerular pressure, ACE inhibition has reduced proteinuria and glomerular and interstitial sclerosis. HUMAN STUDIES ACE inhibition has been shown to have major beneficial effects in patients with diabetic nephropathy, even in those with normal blood pressure. CONCLUSIONS Although the renal-protective effects of ACE inhibitors in experimental and human renal injury may reflect systemic and/or local hemodynamic effects of these drugs, their modulatory actions on extracellular matrix synthesis and proteinuria may contribute to the benefit of ACE-inhibitor therapy.
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Affiliation(s)
- M Ruíz-Ortega
- Jiménez Díaz Foundation, Autónoma University, Madrid, Spain
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Caramelo C, Alcázar R, Gallar P, Teruel JL, Velo M, Ortega O, Galera A, Da Silva M. Choice of dialysis membrane does not influence the outcome of residual renal function in haemodialysis patients. Nephrol Dial Transplant 1994; 9:675-7. [PMID: 7970095 DOI: 10.1093/ndt/9.6.675] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
It has been recently proposed that haemodialysis membrane choice may influence the maintenance of residual renal function. The aim of the present study was to prospectively analyse the effect of membrane choice on the outcome of renal function in patients entering a chronic haemodialysis programme. Twenty-two patients from four hospitals have been randomly assigned to be dialysed with either polysulphone (PSF)/polyacrylonitrile (PAN) (group A; n = 9), or cuprophane membranes (group B; n = 13). Basal and monthly serum biochemistry, residual creatinine clearance (Ccr) and urine volume (Vu), pharmacological and dialytic treatment, diet, and haemodialysis-related complications were recorded. A significant decrease was observed in the two most relevant variables, i.e. remnant Ccr and Vu, within 3 months of starting haemodialysis, with stabilization during the further follow-up. Such decrease was similar (P NS) for both groups A and B throughout the 9-month observation period. In conclusion, our results suggest that the choice of haemodialysis membrane does not influence the outcome of the residual renal function. Renal function decreased significantly within 3 months on haemodialysis, independently of the type of dialyser membrane.
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Affiliation(s)
- C Caramelo
- Laboratorio de Nefrología, Fundación Jiménez Díaz, Madrid, Spain
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González Parra E, Alberola ML, Alcázar R, de la Piedra C, Barat A, Caramelo C. [Calciphylaxis in chronic renal failure]. Rev Clin Esp 1993; 193:17-9. [PMID: 8337454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Three cases of calciphylaxis in patients with terminal renal insufficiency are discussed. The existence of metastatic calcifications, mainly vascular, in patients with chronic renal insufficiency is frequent. However calciphylaxis is a process which is rarely found in these patients. This entity is characterized by the obliteration of small vessels with ischemia and necrosis. The exceptionality of the disease, its difficult treatment and poor evolution make calciphylaxis a bad prognostic complication which should be considered in the differential diagnosis of cutaneous lesions in patients with chronic renal insufficiency.
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