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Molina P, Molina MD, Carrero JJ, Escudero V, Torralba J, Castro-Alonso C, Beltrán S, Vizcaíno B, González-Moya M, Kanter J, Sancho-Calabuig A, Bover J, Górriz JL. Sevelamer Use and Mortality in People with Chronic Kidney Disease Stages 4 and 5 Not on Dialysis. J Clin Med 2023; 12:7631. [PMID: 38137700 PMCID: PMC10743559 DOI: 10.3390/jcm12247631] [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: 11/01/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Rationale and objective: Data suggest that non-calcium-based binders, and specifically sevelamer, may lead to lower rates of death when compared with calcium-based binders in end-stage renal disease (ESRD) patients. However, the association between sevelamer use and mortality for those with non-dialysis-dependent chronic kidney disease (NDD-CKD) patients has been uncertain. Study design: Our research is presented in a prospective cohort study. Setting and participants: A total of 966 participants with NDD-CKD stages 4-5 were enrolled in the PECERA study from 12 centers in Spain. Exposure: The participants were treated with sevelamer. Outcome: This study yielded all-cause and cardiovascular mortality outcomes. Analytical approach: We conducted an association analysis between mortality and sevelamer use with time-dependent Cox proportional hazards models. Results: After a median follow-up of 29 months (IQR: 13-36 months), death occurred in 181 participants (19%), with cardiovascular (n = 95, 53%) being the leading cause of death. In a multivariable model, the adjusted hazard ratios (HRs) for patients under sevelamer treatment were 0.44 (95% CI, 0.22 to 0.88) and 0.37 (95% CI, 0.18 to 0.75) for all-cause and cardiovascular mortality, respectively, compared with those of untreated patients. Limitations: Some limitations include potential confusion via indication bias; causal statements about these associations cannot be made due to the observational nature of this study. Conclusions: In this prospective NDD-CKD cohort study, the administration of sevelamer was independently associated with lower all-cause and cardiovascular mortality, suggesting that non-calcium-based phosphate binders might be the first-line therapy for phosphate lowering in this population. Further interventional studies clarifying the risks and benefits of phosphate binders in NDD-CKD are warranted.
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Affiliation(s)
- Pablo Molina
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
| | - Mariola D. Molina
- Department of Mathematics, Universidad de Alicante, 03690 Sant Vicent del Raspeig, Spain;
| | - Juan J. Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden;
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
| | - Javier Torralba
- Department of Nephrology, Hospital General Universitario, 03010 Alicante, Spain;
| | - Cristina Castro-Alonso
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
| | - Sandra Beltrán
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
| | - Belén Vizcaíno
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
| | - Mercedes González-Moya
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
| | - Julia Kanter
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
| | - Asunción Sancho-Calabuig
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - José L. Górriz
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
- Department of Nephrology, Hospital Clínico Universitario, Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana, 46010 Valencia, Spain
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Sancho A, Gavela E, Kanter J, Beltrán S, Castro C, Escudero V, Pantoja J, Molina P, Vizcaíno B, González M, Calatayud E, Avila A. Graft survival differences in kidney transplants related to recipient sex and age. Front Med (Lausanne) 2022; 9:962094. [PMID: 36226149 PMCID: PMC9548586 DOI: 10.3389/fmed.2022.962094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background In recent years, there has been increasing interest in studying differences in recipient sex in renal disease treatment, access to renal replacement therapy, and subsequent outcomes. Our aim was to find out whether there are differences in outcomes after renal transplantation between female and male kidney transplant recipients in our series, particularly in adults under 60 years of age during long-term follow-up. Methods This was a retrospective study of our kidney transplant series (n = 1,101) to compare graft survival depending on the sex of the recipient in the entire series and patients < 60 years of age (n = 687) during long-term follow-up. Results We observed no association between recipient sex and graft survival throughout the series, regardless of recipient sex. However, adult female recipients under 60 years of age had lower graft survival than male recipients (p = 0.040). Pre-transplant sensitization (HR 2.438, p = 0.002) and donor age (HR: 1.021, p = 0.017) were the independent variables associated with graft failure. Conclusion Female recipients younger than 60 years of age had lower graft survival than male recipients, although there were no gender differences in graft or patient survival in the overall study population. Recipient sex per se was not related to graft failure, but the greater immunological risk in women and more frequent use of expanded criteria donors in female recipients under 60 years of age were the main factors related to their poorer graft survival. Further studies and new strategies are needed to identify these differences and develop the best approach to address them.
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Affiliation(s)
- Asuncion Sancho
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- *Correspondence: Asuncion Sancho,
| | - Eva Gavela
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Julia Kanter
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Sandra Beltrán
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Cristina Castro
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Jonay Pantoja
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Belen Vizcaíno
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Mercedes González
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Emma Calatayud
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Ana Avila
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
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Carpeño J, Insa A, Collado R, Escudero V, Martínez A, Fernandez E, Sullivan I, Crama L, Arrabal N, Carcedo D, Manzaneque A. EP04.01-002 Costs of Locoregional and Metastatic Recurrences in Patients with Resectable Stage II-III NSCLC in Spain. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Goicoechea M, Álvarez V, Segarra A, Polaina M, Martín-Reyes G, Robles NR, Escudero V, Orellana C, Bea Granell S, de Juan-Ribera J, Fernández Lucas M, Graña JM, Reque J, Sánchez Hernández R, Villamayor S, Górriz JL. Lipid profile of patients treated with evolocumab in Spanish hospital nephrology units (RETOSS NEFRO). Nefrologia 2022; 42:301-310. [PMID: 36210619 DOI: 10.1016/j.nefroe.2022.05.005] [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: 11/13/2020] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To describe the clinical characteristics, the reasons for initiating therapy and the effects of treatment in the initial phase of evolocumab availability in the Nephrology Units of Spain. MATERIAL AND METHODS Retrospective, observational and multicentric study that included patients initiating treatment with evolocumab (from February 2016 to August 2018), in 15 Nephrology Units in Spain. The demographic and clinical characteristics of the patients, the lipid lowering treatment and the evolution of the lipid profiles between 24 weeks pre-initiation and 12±4 weeks post-initiation of evolocumab were reviewed. RESULTS 60 patients were enrolled: 53.3% women; mean (SD) age, 56.9 (12.8) years, 45.0% with familial hypercholesterolemia (FH) (5.0% homozygous and 40.0% heterozygous) and 65.0% with atherosclerotic cardiovascular disease. The mean (SD) eGFR was 62.6 (30.0) ml/min/1.73m2 (51.7% of patients had eGFR <60ml/min/1.73m2 [CKD stage>2]), 50.0% had proteinuria (>300mg/g) and 10.0% had nephrotic syndrome. Other CV risk factors were hypertension (75.0%), diabetes (25.0%), and smoking (21.7%). A 40.0% of patients were statin intolerant. At evolocumab initiation, 41.7% of patients were on a high intensity statin, 18.3% on moderate intensity statin and 50.0% were receiving ezetimibe. Mean (SD) LDL-c at evolocumab initiation was 179.7 (62.9) mg/dL (53.4% of patients with LDL-c ≥160mg/dL and 29.3% ≥190mg/dL). After 12 weeks, evolocumab resulted in LDL-c reductions of 60.1%. At week 12, 90.0% of patients reached LDL-c levels <100mg/dL, 70.0% <70mg/dL, and 55.0% <55mg/dL, while mean eGFR levels and statin use remained stable. CONCLUSION In Nephrology Units of Spain, evolocumab was predominantly prescribed in patients with FH, chronic renal disease (CRD>2) and secondary prevention, with LDL-c levels above those recommended by the guidelines. Evolocumab used in clinical practice significantly reduced the LDL-c levels in all patients included in the study.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Vicente Álvarez
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Alfonso Segarra
- Servicio de Nefrología, Hospital Arnau de Vilanova, Lérida, Spain
| | - Manuel Polaina
- Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Guillermo Martín-Reyes
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario, Universidad de Málaga, Málaga, Spain; Servicio de Nefrología, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain
| | | | - Verónica Escudero
- Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Cristhian Orellana
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Sergio Bea Granell
- Servicio de Nefrología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Jose Maria Graña
- Servicio de Nefrología, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | - Javier Reque
- Servicio de Nefrología, Hospital Rey Don Jaime, Castellón, Spain
| | - Rosa Sánchez Hernández
- Servicio de Nefrología, Hospital Universitario General de Villalba, Villalba, Madrid, Spain
| | | | - Jose Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain
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Goicoechea M, Álvarez V, Segarra A, Polaina M, Martín-Reyes G, Robles NR, Escudero V, Orellana C, Bea Granell S, de Juan-Ribera J, Fernández Lucas M, Graña JM, Reque J, Sánchez Hernández R, Villamayor S, Górriz JL. Lipid profile of patients treated with evolocumab in Spanish hospital nephrology units (RETOSS NEFRO). Nefrologia 2021; 42:S0211-6995(21)00133-8. [PMID: 34389184 DOI: 10.1016/j.nefro.2021.06.004] [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: 11/13/2020] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To describe the clinical characteristics, the reasons for initiating therapy and the effects of treatment in the initial phase of evolocumab availability in the Nephrology Units of Spain. MATERIAL AND METHODS Retrospective, observational and multicentric study that included patients initiating treatment with evolocumab (from February 2016 to August 2018), in 15 Nephrology Units in Spain. The demographic and clinical characteristics of the patients, the lipid lowering treatment and the evolution of the lipid profiles between 24 weeks pre-initiation and 12±4 weeks post-initiation of evolocumab were reviewed. RESULTS Sixty patients were enrolled: 53.3% women; mean (SD) age, 56.9 (12.8) years, 45.0% with familial hypercholesterolemia (FH) (5.0% homozygous and 40.0% heterozygous) and 65.0% with atherosclerotic cardiovascular (CV) disease. The mean (SD) eGFR was 62.6 (30.0)ml/min/1.73m2 (51.7% of patients had eGFR<60ml/min/1.73m2 [CKD stage>2]), 50.0% had proteinuria (>300mg/g) and 10.0% had nephrotic syndrome. Other CV risk factors were hypertension (75.0%), diabetes (25.0%), and smoking (21.7%). A 40.0% of patients were statin intolerant. At evolocumab initiation, 41.7% of patients were on a high-intensity statin, 18.3% on moderate intensity statin and 50.0% were receiving ezetimibe. Mean (SD) LDL-c at evolocumab initiation was 179.7 (62.9)mg/dL (53.4% of patients with LDL-c≥160mg/dL and 29.3%≥190mg/dL). After 12 weeks, evolocumab resulted in LDL-c reductions of 60.1%. At week 12, 90.0% of patients reached LDL-c levels <100mg/dL, 70.0% <70mg/dL, and 55.0% <55mg/dL, while mean eGFR levels and statin use were remained stable. CONCLUSION In Nephrology Units of Spain, evolocumab was predominantly prescribed in patients with FH, chronic renal disease (CRD>2) and secondary prevention, with LDL-c levels above those recommended by the guidelines. Evolocumab used in clinical practice significantly reduced the LDL-c levels in all patients included in the study.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Vicente Álvarez
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España
| | - Alfonso Segarra
- Servicio de Nefrología, Hospital Arnau de Vilanova, Lérida, España
| | - Manuel Polaina
- Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, España
| | - Guillermo Martín-Reyes
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario, Universidad de Málaga, Málaga, España; Servicio de Nefrología, IBIMA, REDinREN (RD16/0009/0006), Málaga, España
| | | | - Verónica Escudero
- Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, España
| | - Cristhian Orellana
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Sergio Bea Granell
- Servicio de Nefrología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | | | | | - Jose Maria Graña
- Servicio de Nefrología, Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Javier Reque
- Servicio de Nefrología, Hospital Rey Don Jaime, Castellón, España
| | - Rosa Sánchez Hernández
- Servicio de Nefrología, Hospital Universitario General de Villalba, Villalba, Madrid, España
| | | | - Jose Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, España
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Gorriz JL, D'Marco L, Pastor-González A, Molina P, Gonzalez-Rico M, Puchades MJ, Sanchis I, Escudero V, Estañ N, de la Espriella R, Nuñez E, Pallardó L, Núñez J. LONG-TERM MORTALITY AND TRAJECTORY OF POTASSIUM MEASUREMENTS FOLLOWING AN EPISODE OF ACUTE SEVERE HYPERKALEMIA. Nephrol Dial Transplant 2021; 37:522-530. [PMID: 33508124 PMCID: PMC8875445 DOI: 10.1093/ndt/gfab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hyperkalemia is a common condition in patients with comorbidities such as chronic kidney disease (CKD) or congestive heart failure. Moreover, severe hyperkalemia is a potentially life-threatening condition that is associated with a higher risk of adverse clinical events such as ventricular arrhythmias and sudden cardiac death. Currently, data regarding the prognostic implications of chronic hyperkalemia are available; however, the information about the long-term clinical consequences after an episode of severe hyperkalemia remains scarce. The objective of the study was to evaluate the association between the trajectory of potassium measurements in patients with acute hyperkalemia and long-term all-cause mortality. METHODS This is a retrospective observational study that included patients with acute severe hyperkalemia (K > 6 mEq/L) without hemolysis in the emergency room of Dr. Peset University Hospital in Valencia, Spain searching the lab database from January 2016 to March 2017. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modelling. RESULTS We found 172 episodes of acute hyperkalemia in 160 patients in the emergency room. The mean age of the sample was 77 ± 12 years and 60.5% were males. The most frequent comorbidities were CKD (71.2%), heart failure (35%) and diabetes mellitus (56.9%). Only 11.9% of the patients were on chronic dialysis. A quarter of the patients did not have previous CKD making hyperkalemia as an unpredictable life-threatening complication. During the acute episode, mean potassium and eGFR were 6.6 ± 0.6 (range: 6,1-9,2), and eGFR: 23 ± 16 (r : 2-84). After a median follow-up of 17.3 (IQR: 2.2-23.7) months, 68 patients died (42.5%). Recurrences of hyperkalemia (K > 5.5 mEq/L) were detected in 39.5%% of the patients who were monitored during follow-up. We found that previous potassium levels during an acute severe hyperkalemia episode were not predictors of mortality. Conversely, the post-discharge longitudinal trajectories of potassium were able to predict all-cause mortality (overall p-value = 0.0015). The effect of transitioning from hyperkalemia to normokalaemia (K > 5.5 to K ≤ 5.5 after the acute episode was significant and inversely associated with the risk of mortality. CONCLUSION The potassium levels prior to a severe hyperkalemic event do not predict mortality. Conversely, following an episode of acute severe hyperkalemia, serial kinetic of potassium trajectories predicts the risk of death. Further evidence is needed to confirm these findings and clarify the optimal long-term management of these patients.
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Affiliation(s)
- José Luis Gorriz
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Luis D'Marco
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Anna Pastor-González
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Pablo Molina
- Department of Nephrology, Hospital Universitario Dr Peset. Universitat de València, . Valencia, Spain
| | - Miguel Gonzalez-Rico
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - María Jesús Puchades
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Irina Sanchis
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitario Dr Peset. Universitat de València, . Valencia, Spain
| | - Nuria Estañ
- Clinical Analysis Service, Dr Peset University Hospital
| | - Rafael de la Espriella
- Department of Cardiology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Eduardo Nuñez
- Department of Cardiology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Luis Pallardó
- Department of Nephrology, Hospital Universitario Dr Peset. Universitat de València, . Valencia, Spain
| | - Julio Núñez
- Department of Cardiology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
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Molina P, Molina MD, Pallardó LM, Torralba J, Escudero V, Álvarez L, Peris A, Sánchez-Pérez P, González-Rico M, Puchades MJ, Fernández-Nájera JE, Giménez-Civera E, D'Marco L, Carrero JJ, Górriz JL. Disorders in bone-mineral parameters and the risk of death in persons with chronic kidney disease stages 4 and 5: the PECERA study. J Nephrol 2021; 34:1189-1199. [PMID: 33394344 DOI: 10.1007/s40620-020-00916-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/06/2020] [Accepted: 11/11/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD). METHODS PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicenter, open-cohort study of 966 adult patients with non-dialyzed CKD stages 4-5 enrolled from 12 centers in Spain. Associations between levels of serum calcium (Ca) (corrected for albumin), phosphate (P), and intact parathyroid hormone (iPTH) with all-cause mortality (primary outcome) and cardiovascular mortality (secondary outcome) were examined using time-dependent Cox proportional hazards models and penalized splines analysis adjusted by demographics and comorbidities, treatments and biochemical values collected every 6 months for 3 years. RESULTS After a median follow-up of 29 months (IQR: 13-36 months) there were 181 deaths (19%). The association of calcium with all-cause mortality was J-shaped, with an increased risk for all-cause mortality at levels > 10.5 mg/dL. For phosphate and iPTH levels, the association was U-shaped. The serum values associated with the minimum risk of mortality were 3.8 mg/dL for phosphate and 70 pg/mL for iPTH, being the lowest risk ranges between 2.8 and 5.0 mg/dL, and between 38 and 112 pg/mL for phosphate and iPTH, respectively. CONCLUSIONS Our study provides evidence on the non-linear association of serum calcium, phosphate and iPTH levels with mortality in stage 4 and 5 CKD patients, and suggests potential survival benefits for controlling bone mineral parameters in this population, as previously reported for dialysis patients.
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Affiliation(s)
- Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain.
- Department of Medicine, Universitat de València, Valencia, Spain.
| | - Mariola D Molina
- Department of Mathematics, Universidad de Alicante, Alicante, Spain
| | - Luis M Pallardó
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Javier Torralba
- Department of Nephrology, Hospital General Universitario, Alicante, Spain
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Luis Álvarez
- Section of Nephrology, Hospital Virgen de Los Lirios, Alcoi, Spain
| | - Ana Peris
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Sánchez-Pérez
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Miguel González-Rico
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - María J Puchades
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | | | - Elena Giménez-Civera
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Luis D'Marco
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - José L Górriz
- Department of Medicine, Universitat de València, Valencia, Spain
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
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Castro-Alonso C, D’Marco L, Pomes J, Del Amo Conill M, García-Diez AI, Molina P, Puchades MJ, Valdivielso JM, Escudero V, Bover J, Navarro-González J, Ribas B, Pallardo LM, Gorriz JL. Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis. J Clin Med 2020; 9:jcm9051604. [PMID: 32466297 PMCID: PMC7291319 DOI: 10.3390/jcm9051604] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022] Open
Abstract
Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. Materials and Methods: 612 NDD 3‒5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. Results: VF were detected in 110 patients (18%). Serum phosphate levels (OR 0.719, 95% CI 0.532 to 0.972, p = 0.032), ankle-brachial index < 0.9 (OR 1.694, 95% CI 1.056‒2.717, p = 0.029) and treatment with bisphosphonates (OR 5.636, 95% CI 1.876‒16.930, p = 0.002) were independently related to the presence of VF. After a median follow-up of 35 months (IQR: 17‒37 months), 62 patients (10%) died. The causes of death were cardiovascular (n = 21, 34%) and infectious (n = 11, 18%). In the crude analysis, fractured patients group had poorer survival (log-rank test, p = 0.02). After multivariate adjustment for age, MDRD, albumin, diabetes mellitus, comorbidity, Adragao Score > 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009‒3.898, p = 0.047) were an independent predictor of all-cause mortality. Conclusions: In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3‒5 NDD-CKD patients. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis.
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Affiliation(s)
- Cristina Castro-Alonso
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46017 Valencia, Spain; (C.C.-A.); (P.M.); (V.E.); (L.M.P.)
| | - Luis D’Marco
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.D.M.); (M.J.P.)
| | - Jaume Pomes
- Department of Radiology, Hospital Clínic, 08036 Barcelona, Spain; (J.P.); (M.D.A.C.); (A.I.G.-D.)
| | - Monserrat Del Amo Conill
- Department of Radiology, Hospital Clínic, 08036 Barcelona, Spain; (J.P.); (M.D.A.C.); (A.I.G.-D.)
| | - Ana Isabel García-Diez
- Department of Radiology, Hospital Clínic, 08036 Barcelona, Spain; (J.P.); (M.D.A.C.); (A.I.G.-D.)
| | - Pablo Molina
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46017 Valencia, Spain; (C.C.-A.); (P.M.); (V.E.); (L.M.P.)
| | - María Jesús Puchades
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.D.M.); (M.J.P.)
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, IRBLleida, RedinRen-ISCIII, 25198 Lleida, Spain;
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46017 Valencia, Spain; (C.C.-A.); (P.M.); (V.E.); (L.M.P.)
| | - Jordi Bover
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, RedinRen, 08025 Barcelona, Spain;
| | - Juan Navarro-González
- Research Unit and Nephrology Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife and Instituto de Tecnologías Biomédicas, Universidad de La Laguna, 38010 Tenerife, GEENDIAB REDINREN, Spain;
| | - Begoña Ribas
- Department of Nephrology, Hospital La Paz, 28046 Madrid, Spain;
| | - Luis Manuel Pallardo
- Department of Nephrology, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46017 Valencia, Spain; (C.C.-A.); (P.M.); (V.E.); (L.M.P.)
| | - José Luis Gorriz
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.D.M.); (M.J.P.)
- Correspondence:
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Molina P, Durbá A, Calatayud E, Pérez-Zafra E, Vizcaíno B, González-Moya M, Beltrán S, Mora A, Escudero V, Estañ N, Pallardó LM. SP489The role of CA125 as a volume marker before and after hemodialysis session. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp489] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pablo Molina
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | - Alba Durbá
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | - Emma Calatayud
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | - Erika Pérez-Zafra
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | - Belén Vizcaíno
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | | | - Sandra Beltrán
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | - Antonio Mora
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | - Verónica Escudero
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | - Nuria Estañ
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
| | - Luis M Pallardó
- Hospital Universitari Dr Peset. Universitat de València, Valencia, Spain
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Welmers-van de Poll MJ, Roest JJ, van der Stouwe T, van den Akker AL, Stams GJJM, Escudero V, Overbeek GJ, de Swart JJW. Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis. Clin Child Fam Psychol Rev 2018; 21:146-170. [PMID: 29218565 PMCID: PMC5899120 DOI: 10.1007/s10567-017-0249-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Alliance has been shown to predict treatment outcome in family-involved treatment for youth problems in several studies. However, meta-analytic research on alliance in family-involved treatment is scarce, and to date, no meta-analytic study on the alliance-outcome association in this field has paid attention to moderating variables. We included 28 studies reporting on the alliance-outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems (N = 2126 families, M age youth ranging from 10.6 to 16.1). We performed three multilevel meta-analyses of the associations between three types of alliance processes and treatment outcome, and of several moderator variables. The quality of the alliance was significantly associated with treatment outcome (r = .183, p < .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seeking rather than receiving mandated care and when studies included younger children. The correlation between alliance improvement and treatment outcome just failed to reached significance (r = .281, p = .067), and no significant correlation was found between split alliances and treatment outcome (r = .106, p = .343). However, the number of included studies reporting on alliance change scores or split alliances was small. Our findings demonstrate that alliance plays a small but significant role in the effectiveness of family-involved treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families.
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Affiliation(s)
- M J Welmers-van de Poll
- Research Centre Youth Care, Windesheim University of Applied Sciences, Postbus 10090, 8000 GB, Zwolle, The Netherlands.
- Child and Youth Care Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands.
| | - J J Roest
- Youth Expert Centre, Leiden University of Applied Sciences, Zernikedreef 11, Postbus 382, 2300 AJ, Leiden, The Netherlands
| | - T van der Stouwe
- Child and Youth Care Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - A L van den Akker
- Child and Youth Care Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - G J J M Stams
- Child and Youth Care Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - V Escudero
- Department of Psychology, University of A Coruña, Elviña, 15071, A Coruña, Spain
| | - G J Overbeek
- Child and Youth Care Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - J J W de Swart
- Research Group Social Work, Saxion University of Applied Sciences, Postbus 70.000, 7500 KB, Enschede, The Netherlands
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Molina P, González-Moya M, Vizcaíno B, Beltrán S, Molina M, Sanchis I, Sargsyan M, Mora A, Pantoja J, Escudero V, Estañ N, Pallardó L. SP470RELATIONSHIP BETWEEN PREDICTIVE KT/V AND CALCULATED KT/V ACHIEVED WITH NXSTAGE CYCLER IN SHORT-DAILY HOME HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp470] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pablo Molina
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Mercedes González-Moya
- Department of Medicine, Universitat de València, Valencia, Spain
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
| | - Belén Vizcaíno
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Sandra Beltrán
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
| | - Mariola Molina
- Departament of Mathematics, Univesitad de Alicante, San Vicente del Raspeig, Spain
| | - Irina Sanchis
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
| | - Mari Sargsyan
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
| | - Antonio Mora
- Department of Clinical Analysis, Hospital Universitari Dr Peset, Valencia, Spain
| | - Jonay Pantoja
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
| | - Verónica Escudero
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
| | - Nuria Estañ
- Department of Clinical Analysis, Hospital Universitari Dr Peset, Valencia, Spain
| | - Luis Pallardó
- Department of Medicine, Universitat de València, Valencia, Spain
- Department of Nephrology. FISABIO, Hospital Universitari Dr Peset, Valencia, Spain
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Artigas L, Mateu C, Vilaregut A, Feixas G, Escudero V. Couple Therapy for Depression: Exploring How the Dyadic Adjustment Determines the Therapeutic Alliance in Two Contrasting Cases. Contemp Fam Ther 2017. [DOI: 10.1007/s10591-017-9420-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Tovar M, Escudero V, Ribed A, Ortega C, Herranz A, Sanjurjo M. CP-006 Ketoconazole and performance status as predictive factors of response to abiraterone in metastasic prostate cancer in real life conditions. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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14
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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: 117] [Impact Index Per Article: 13.0] [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: 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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Affiliation(s)
- José L Górriz
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Pablo Molina
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - M Jesús Cerverón
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Rocío Vila
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jordi Bover
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Javier Nieto
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Guillermina Barril
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alberto Martínez-Castelao
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Elvira Fernández
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Verónica Escudero
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Celestino Piñera
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Teresa Adragao
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Juan F Navarro-Gonzalez
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Luis M Molinero
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Cristina Castro-Alonso
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Luis M Pallardó
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sophie A Jamal
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Vega A, Abad S, Verdalles U, Aragoncillo I, Velazquez K, Quiroga B, Escudero V, López-Gómez JM. Dose equivalence between continuous erythropoietin receptor activator (CERA), Darbepoetin and Epoetin in patients with advanced chronic kidney disease. Hippokratia 2014; 18:315-318. [PMID: 26052197 PMCID: PMC4453804] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Anemia is a prevalent situation in patients with chronic kidney disease (CKD) and can be well managed with erythropoiesis-stimulating agents (ESAs). Continuous erythropoietin receptor activator (CERA) has a long half-life that allows to be administered once monthly. The lowest recommended dose for patients with non dialysis CKD is 120 μg per month. The objectives were to assess the efficacy of subcutaneous monthly dosing of CERA in CKD stages 4 and 5 not on dialysis, and to determine the equivalent dose to epoetin β and darbepoetin α. METHODS This is a cohort study. A 30-patient group that ESAs was changed to CERA (μg/month) was used as treatment group. We used the following clinically-based equivalent dosing: epoetin β (IU/week) and darbepoetin α (μg/week): 3000/15= 50; 4000/20=75; 6000/30=100; 8000/40=150. Another group of 30 patients with similar characteristics was used as control group and received the same epoetin β and darbepoetin α doses. RESULTS The mean CERA initial dose and at 6 months was 81.9 ± 35.2 and 82.0 ± 37.82 μg/month (p=0.37). The mean erythropoietin resistance index (ERI) and hemoglobin at baseline and at 6 months in the CERA group and in the control group were not statistically significant. CONCLUSION Monthly dosing treatment with CERA is safe and effective. A dose of 75-100 μg/month is enough to maintain stable levels of hemoglobin. Hippokratia 2014; 18 (4): 315-318.
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Affiliation(s)
- A Vega
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - S Abad
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - U Verdalles
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Aragoncillo
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - K Velazquez
- Internal Medicine, St Columciles Hospital, Dublin, Ireland
| | - B Quiroga
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - V Escudero
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J M López-Gómez
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Molina P, Gorriz JL, Molina MD, Peris A, Beltran S, Kanter J, Escudero V, Romero R, Pallardo LM. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant 2013; 29:97-109. [DOI: 10.1093/ndt/gft360] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Escudero V, Mihaela Ciorba I, Viroles Torrent G, León Carmona E. [Subdural block and Horner's syndrome]. ACTA ACUST UNITED AC 2013; 61:415. [PMID: 23871441 DOI: 10.1016/j.redar.2013.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/14/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Affiliation(s)
- V Escudero
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España
| | - I Mihaela Ciorba
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España.
| | - G Viroles Torrent
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España
| | - E León Carmona
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España
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Félix-Redondo F, Consuegra-Sánchez L, Ramírez-Moreno J, Lozano L, Escudero V, Fernández-Bergés D. Ischemic stroke mortality tendency (2000–2009) and prognostic factors. ICTUS Study-Extremadura (Spain). Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Félix-Redondo F, Consuegra-Sánchez L, Ramírez-Moreno J, Lozano L, Escudero V, Fernández-Bergés D. Tendencia de la mortalidad por ictus isquémico (2000-2009) y factores pronósticos. Estudio ICTUS-Extremadura. Rev Clin Esp 2013; 213:177-85. [DOI: 10.1016/j.rce.2013.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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Alañón E, Escudero V, Ramírez E, Trovato N, Bellin MJ, Morell A, Sanjurjo M. DGI-011 Anti-Tumor Necrosis Factor Real-World Doses: Four-Year Retrospective Study in Rheumatoid Arthritis Patients in Two Hospitals in Spain: Abstract DGI-011 Table 1. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Valenzuela B, Rebollo J, Escudero V, Martinez-Navarro E, Gonzalez R. Multivariate analysis of pharmacokinetics (PK) and pharmacogenetics (PG) factors following irinotecan (CPT) treatment and the risk of developing neutropenia or diarrhea. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Valenzuela B, Nalda R, Duart M, Escudero V, Perez-Ruixo J, Martinez-Navarro E, Rebollo J, Gonzalez R, Brugarolas A. UGT1A1,A7 and A9 genotyping and pharmacokinetics of irinotecan-containing chemotherapy in patients with advanced cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e14563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14563 Background: To the best of our knowledge only one previous report in asian lung cancer patients (pts) assesed UGT1A1, A7 and A9 genotypes along with irinotecan pharmacokinetics (Han et al. JCO 2006; 24: 2237–44). We set out to evaluate UGT1A1, A7 and A9 genotypes in caucasian cancer patients and their relationship with both irinotecan toxicity and irinotecan pharmacokinetics. Methods: UGT1A1, A7 and A9 genotypes were obtained from blood genomic DNA by direct sequencing. The area under the time-concentration curve (AUC) of SN-38 and SN-38G were calculated. The ratio between these AUCs (AUC SN-38G /AUC SN-38) was also calculated. Associations between pharmacokinetics parameters and the UGT1A genotypes were assessed by univariate analysis. Toxicity was collected using standard NCI grading criteria. Statistical correlation between presence of grade III and IV toxicity and UGT1A1,A7 and A9 genotypes was done by Pearson's Chi square. At least 80 patients (with both genotype and pharmacokinetics) are needed to achieve enough statistical power. Results: At the time of writing this abstract, complete genotyping and toxicity data from 59 patients were available. Sex (females 17, males 42). Median age 60 (range 25–88). Pathology (no. pts): lung (26), colon (17), others (16). 21 pts. (35.59%) had received previous chemotherapy. All but 5 pts received doses of irinotecan between 120 and 150 mg/m2. Median no. of cycles 6 (range 1–15). The frequencies of the different UGT1A1, A7 and A9 genotypes are similar to those previously reported. At least one episode of grade III or IV leukopenia was present in 19 pts. (32.2%), and grade III diarrea in 11 pts (18.6%). No statistically significant correlation was found between presence of leukopenia grades III and IV, and the genotypes UGT1A1,A7, and A9 (P=0.687, P=0.156 and P=0.476, respectively). Diarrea grade III was not statistically significantly associated with UGT1A1 (P=0.318), A7 (P=0.318) and A9 (P=0.158). 21 out of 59 pts. had pharmacokinetics (PK) data available. In genotype-PK association analysis, UGT1A1,A7 and A9 were not statistically associated with AUC SN-38G / AUC SN-38 ratios (P=0.844, P=0.911, P=0.431, respectively). Conclusions: Patients are still being accrued to achieve the targeted size. No significant financial relationships to disclose.
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Affiliation(s)
| | - R. Nalda
- USP Hospital San Jaime, Torrevieja, Spain
| | - M. Duart
- USP Hospital San Jaime, Torrevieja, Spain
| | | | | | | | - J. Rebollo
- USP Hospital San Jaime, Torrevieja, Spain
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Abstract
INTRODUCTION Among graft failures beyond months, we performed progressive reduction and complete withdrawal of immunosuppressive drugs and steroids over a period of 6 months. PATIENTS AND METHODS We analyzed the treatment and complications associated with all late allograft failures in 34 patients (8.19%) out of 415 patients transplanted from November 1996 to November 2006. RESULTS In 21 patients (61.8%), the progressive reduction of immunosuppressive treatment was effective and well tolerated; however, in 13 patients (38.2%) there was rejection of the allograft at 10.74 +/- 8.95 months (0.77-34.80) after the failure. With the reintroduction of these drugs, the rejection was controlled in seven patients, but in the other six we had to embolize the allograft, which had to be repeated in one case. Embolization was well tolerated, but in one case there was migration of one coil to the femoral artery. One patient treated with drug withdrawal experienced emphysematous pyelonephritis after repeated urinary infections, requiring a nephrectomy. Thirteen (38.2%) of the patients with late failures have been admitted for a second transplant; five of them showed HLA sensitization. CONCLUSIONS Conservative treatment with progressive withdrawal of immunosuppression was effective and well tolerated in two-thirds of the patients with late renal allograft failure, but one-third of the patients rejected the graft and needed allograft embolization. Infection of the graft and HLA sensitization can complicate the course of these patients.
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Affiliation(s)
- A Morales
- Service de Nefrología, Hospital Universitario Dr Peset, Valencia, Spain.
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Gonzalez MS, Rebollo J, Escudero V, Valenzuela B, Nalda R, Duart M, Brugarolas A. Pharmacokinetic (pk) guide for dose adjustments in cancer patients (pts) treated with 5-fluoruracil (5-fu) infusions. Preliminary results. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.13550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pérez Castrillón JL, Cruz JM, Escudero V, Benítez JA, Ostos A, Caballero V. [Chronic pericardial effusion due to Toxoplasma gondii in a patient with a myelodysplastic syndrome]. Rev Clin Esp 1990; 187:310-1. [PMID: 2091101] [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: 12/30/2022]
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García Monzón C, Noguerado A, Hidalgo S, Escudero V. [Cholestatic hepatitis caused by erythromycin estolate]. Rev Clin Esp 1985; 177:420-1. [PMID: 3836470] [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: 01/07/2023]
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