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Quiroga B, Ortiz A, Núñez S, Kislikova M, González Sanchidrián S, Broseta JJ, Albines ZS, Escamilla Cabrera B, Rivero Viera Y, Rodriguez Santarelli D, Salanova Villanueva L, Lopez Rodriguez F, Cancho Castellano B, Ibáñez Cerezon M, Gutierrez Rivas CP, Aresté N, Campos Gutiérrez B, Ródenas Gálvez A, Glucksmann Pizá MC, Balda Manzanos S, Soldevila A, Rodríguez Gayo L, Moral Berrio E, Ortega Diaz M, Beltrán Catalán S, Puente García A, Ángel Rojas M, Sosa Barrios RH, Santana Zapatero H, Rangel Hidalgo G, Martinez Canet AM, Díez J. Treatment of Chronic Heart Failure in Advanced Chronic Kidney Disease: The HAKA Multicenter Retrospective Real-World Study. Cardiorenal Med 2024; 14:202-214. [PMID: 38513622 DOI: 10.1159/000538030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/27/2023] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated current HF therapy in patients receiving clinical care in specialized aCKD units. METHODS The Heart And Kidney Audit (HAKA) was a cross-sectional and retrospective real-world study including outpatients with aCKD and HF from 29 Spanish centers. The objective was to evaluate how the treatment of HF in patients with aCKD complied with the recommendations of the European Society of Cardiology Guidelines for the diagnosis and treatment of HF, especially regarding the foundational drugs: renin-angiotensin system inhibitors (RASi), angiotensin receptor blocker/neprilysin inhibitors (ARNI), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). RESULTS Among 5,012 aCKD patients, 532 (13%) had a diagnosis of HF. Of them, 20% had reduced ejection fraction (HFrEF), 13% mildly reduced EF (HFmrEF), and 67% preserved EF (HFpEF). Only 9.3% of patients with HFrEF were receiving quadruple therapy with RASi/ARNI, BB, MRA, and SGLT2i, but the majority were not on the maximum recommended doses. None of the patients with HFrEF and CKD G5 received quadruple therapy. Among HFmrEF patients, approximately half and two-thirds were receiving RASi and/or BB, respectively, while less than 15% received ARNI, MRA, or SGLT2i. Less than 10% of patients with HFpEF were receiving SGLT2i. CONCLUSIONS Under real-world conditions, HF in aCKD patients is sub-optimally treated. Increased awareness of current guidelines and pragmatic trials specifically enrolling these patients represent unmet medical needs.
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Affiliation(s)
- Borja Quiroga
- Nephrology Department, IIS-La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
- RICORS2040, Madrid, Spain
| | - Alberto Ortiz
- RICORS2040, Madrid, Spain
- Nephrology Department, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Sara Núñez
- Nephrology Department, Hospital Sant Joan Despí - Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Maria Kislikova
- Nephrology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | | | - José Jesús Broseta
- Nephrology and Renal Transplantation Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Zoila Stany Albines
- Nephrology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Yaiza Rivero Viera
- Nephrology Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | - María Ibáñez Cerezon
- Nephrology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | | | - Nuria Aresté
- Nephrology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ana Ródenas Gálvez
- Nephrology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | | | - Amparo Soldevila
- Nephrology Department, Hospital Politècnic i Universitari La Fe, Valencia, Spain
| | | | - Esperanza Moral Berrio
- Nephrology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Mayra Ortega Diaz
- Nephrology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | - Miguel Ángel Rojas
- Nephrology Department, Hospital General La Mancha Centro, Ciudad Real, Spain
| | | | | | | | | | - Javier Díez
- Center of Applied Medical Research and School of Medicine, University of Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de la Enfermedades Cardiovasculares (CIBERCV), Carlos III Institute of Health, Madrid, Spain
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Aresté N, Sanchez-Alvarez JE, Prieto-Velasco M, Molina P, Esteve-Simó V, Ojeda R, Buades JM, Goicoechea M, Sanchez-Villanueva R, Bezhold GA, Pérez-Morales RE, Santos AB, Peiró-Jordan R, Arenas MD. Prevalence and severity of pruritus in Spanish patients with chronic kidney disease and impact on quality of life: a cross-sectional study. Clin Kidney J 2023; 16:1035-1037. [PMID: 37260996 PMCID: PMC10229293 DOI: 10.1093/ckj/sfac246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 06/02/2023] Open
Affiliation(s)
- Nuria Aresté
- Hospital Universitario Virgen Macarena, Department of Nephrology, Sevilla, Spain
| | | | - Mario Prieto-Velasco
- Complejo Asistencial Universitario de León, Department of Nephrology, León, Spain
| | - Pablo Molina
- Pablo Molina, Pablo; Hospital Universitario Dr Peset, Department of Nephrology, Valencia, Spain
| | | | - Raquel Ojeda
- Hospital Universitario Reina Sofia, Department of Nephrology, Córdoba, Spain
| | - Juan Manuel Buades
- Hospital Son Llatzer, Fundació Institut d'Investigació Sanitària Illes Balears, Nephrology, Palma de Mallorca, Spain
| | - Marian Goicoechea
- Hospital General Universitario Gregorio Marañón, Nephrology Unit, Madrid, Spain
| | | | | | - Rosa Elena Pérez-Morales
- Hospital Universitario Nuestra Senora de la Candelaria, Department of Nephrology, Santa Cruz de Tenerife, Spain
| | - Ana Blanco Santos
- Fresenius Medical Care Diálisis Alcobendas, Department of Nephrology, Alcobendas, Spain
| | | | - María Dolores Arenas
- Fundación Renal Íñigo Álvarez de Toledo, Department of Nephrology, Madrid, Spain
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3
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Molina P, Ojeda R, Blanco A, Alcalde G, Prieto-Velasco M, Aresté N, Buades JM, Simó VE, Goicoechea M, Pérez-Morales RE, Sánchez-Álvarez E, Sánchez-Villanueva R, Montesa M, Arenas MD. Etiopathogenesis of chronic kidney disease-associated pruritus: putting the pieces of the puzzle together. Nefrologia 2023; 43:48-62. [PMID: 37173258 DOI: 10.1016/j.nefroe.2023.03.015] [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: 03/29/2022] [Accepted: 06/28/2022] [Indexed: 05/15/2023] Open
Abstract
Defined as the unpleasant sensation that causes the desire to scratch, pruritus is the most common skin symptom associated with uremia and appears in almost half of patients with advanced chronic kidney disease (CKD). Beyond its direct impact on quality of life, CKD-associated pruritus (CKD-aP) is an independent predictor of mortality that also has a synergistic effect with other quality of life-related symptoms, such as insomnia, depression, and anxiety. Although different mechanisms have been proposed to explain the origin of Pa-ERC, its etiopathogenesis is still not fully understood. Since new therapeutic targets have been identified and several clinical trials have recently shown promising results, our current understanding of the interrelationships has expanded significantly and the pathophysiological mechanisms underlying CKD-aP are now considered to be multifactorial. The potential triggers of pruritus in patients with CKD are discussed in this review, including hypotheses about skin xerosis, accumulation of uremic toxins, dysregulation of the immune system and systemic inflammation, uremic neuropathy, and imbalances in the endogenous opioid system. Other non-uremic causes of pruritus are also discussed, with the aim of guiding the physicians to apply an adequate aetiopathogenic approach to CKD-aP in their day-to-day clinical practice.
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Affiliation(s)
- Pablo Molina
- Servicio de Nefrología, FISABIO, Hospital Universitari Dr Peset, Departamento de Medicina, Universitat de València, Valencia, Spain.
| | - Raquel Ojeda
- Servicio de Nefrología, Hospital Universitario Renia Sofía, Córdoba, Spain
| | - Ana Blanco
- Fresenius Medical Care, Centro de Diálisis Alcobendas, Madrid, Spain; Servicio de Nefrología, Hospital Quirón Ruber Juan Bravo, Madrid, Spain
| | - Guillermo Alcalde
- Servicio de Nefrología, BIOARABA, Hospital Universitario Araba, Osakidetza, Universidad del País Vasco, Vitoria-Gasteiz, Álava, Spain
| | | | - Nuria Aresté
- Servicio de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Juan Manuel Buades
- Servicio de Nefrología, Hospital Universitario Son Llàtzer, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Spain
| | - Vicent Esteve Simó
- Servicio de Nefrologia, Hospital Terrassa, Consorci Sanitari Terrassa (CST), Terrassa, Barcelona, Spain
| | - Marian Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rosa Elena Pérez-Morales
- Servicio de Nefrología. Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Emilio Sánchez-Álvarez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Red de Investigación Renal (REDINREN), Gijón, Asturias, Spain
| | | | - María Montesa
- Servicio de Nefrología, FISABIO, Hospital Universitari Dr Peset, Departamento de Medicina, Universitat de València, Valencia, Spain
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Quiroga B, Soler MJ, Ortiz A, Jarava Mantecón CJ, Gomes Pérez VO, Bordils A, Lacueva J, Marin Franco AJ, Delgado Conde P, Muñoz Ramos P, Calderón González C, Cazorla López JM, Sanchez-Rodriguez J, Sánchez Horrillo A, Monzón Vázquez TR, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Rodríguez MTJ, Valverde RL, Carretero MP, Díaz MO, Tocora DG, Suárez ER, Santolaya AJS, Cobo PA, Talavan T, Calero RC, Gracia-Iguacel C, González-Parra E, Pereira M, Martin-Cleary C, Ramos-Verde A, Giorgi M, Sánchez C, Giraldo YG, Horrillo AS, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, de Gante LM, Repollet R, Polo CR, Moreso F, Azancot MA, Ramos N, Toapanta OBN, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Prat O, Saiz A, Vila MAM, Guldris SC, Granados NM, Cabo MJC, Alarcón WL, Sánchez SP, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Zamora R, Hernández RS, Osorio LR, García-Fernández N, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, Cabrera SS, López RO, Peregrí CM, Morales MLA, Cabello MDN, Mazuecos A, García T, Narváez C, Orellana C, Márquez MGS, Novillo CL, Ganga PLQ, Carrión FV, Herrera ALG, Castro NB, Cendrero RMRC, Hidalgo-Barquero MVM, Gallego RH, Alvarez Á, Leo EV, León JLP, García MAM, Jiménez BG, Pérez VOG, de Dios Ramiro Moya J, Espinosa DL, Herrador AJ, Zurita MN, Álvarez LD, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, García AB, Díaz ABM, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Sato Y, Marín MS, Tejedor S, Vaquera SM, di Riso MC, Torres I, Alfaro G, Halauko O, Rifai FEL, Martínez AD, Ávila PJ, Sánchez CA, Sainz MS, Martín JMB, del Río García L, Canga JLP, Ochoa PMV, Pacios LM, Machado LL, Morales AQ, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Rubio AB, Del Peso Gilsanz G, Gonzalez MO, Villanueva RS, Oliva MOL, Varela JC, Enríquez AG, Casas CC, Alonso PO, Tabares LG, Barreiro JML, Solla LP, Gándara A, de la Garza WN, Fleming FF, Goyanes MGR, Feijoo CC, Plaza MMM, Juan CB, de la Fuente GDA, del Valle KP, Contreras FJP, Lara NB, Ferri DG, de Bustillo Llorente EM, Rodríguez EG, De La Manzanara Perez VL, Arevalo MC, Calvo JAH, Carratalá MRL, Rodríguez LMM, Salazar MS, Prieto BB, Pérez JMP, Paraíso AG, Huarte E, Lanau M, Campos RA, Ubé JM, Godoy IB, Aguilera ET, Alea RT, Del Rosario Saldaña MS, Salgueira M, Aresté N, de los Ángeles Rodríguez M, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Gash SC, Martínez LR, Cervera MCA, De Tomas MTR, Prieto BA, Toyos C, Del Rio JM, Acosta AR, Zamacona AC, Martin MIJ, Ortega SB, Ruiz MIG, Rubio AH, Ledesma PG, Alvarez AG, Poch E, Cucchiari D, Monzo JB, Cabrera BE, Hernández APR, Rebollo MSG, Hernández JMR, González AY, Alonso JC, Más AM, Calvé M, Cardona MG, Balaguer VC, Pesquera JIM, de la Rosa EC, Santarelli DR, Garcia AS, Martin-Caro AC, Santamaria IM, Cervienka M, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Estupiñán RS, Amado FV, Borges PP, Beloso MD, Alonso FA, Felpete NP, Ameneiro AM, Mera MC, Casares BG, Larrondo SZ, Kareaga NM, del Valle AISS, García ARM, Linaza BV, del Toro Espinosa N, Perico PE, Oliva JMS, Manrique J, Castaño I, Purroi C, Gómez N, Mansilla C, Utzurrum A, de Arellano Serna MR, Perich LG, Rincón MM, De La Manzanara Perez VL, Arevalo MC, Calvo JAH, Villoria JG, De Salinas APM. Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study. Nephrol Dial Transplant 2022; 38:969-981. [PMID: 36423334 DOI: 10.1093/ndt/gfac307] [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] [Received: 09/03/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Background
There is scarce evidence on fourth doses of SARS-CoV-2 vaccines in chronic kidney disease (CKD) patients. We have evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), hemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) recipients.
Methods
This is a prespecified analysis of the prospective, observational, multicentric SENCOVAC study. In patients with CKD who had received a complete initial vaccination and one or two boosters and had anti-Spike antibody determinations 6 and 12 months after the initial vaccination, we analyzed factors associated to persistent negative humoral response and to higher anti-Spike antibody titers as well as the efficacy of vaccination on COVID-19 severity.
Results
Of 2186 patients (18% KT, 8% PD, 69% HD and 5% ND-CKD), 30% had received a fourth dose. The fourth dose increased anti-Spike antibody titers in HD (P = 0.001) and ND-CKD (P = 0.014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titers at 12 months were independently associated to repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titers and not being a KT. Breakthrough COVID-19 was registered in 137 (6%) patients, of whom 5% required admission. Admitted patients had prior titers below 620 UI/ml and median values were lower (P = 0.020) than in non-admitted patients.
Conclusions
A fourth vaccine dose increased anti-Spike antibody titers or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titers or KT recipients) derived the least benefit in terms of antibody titers. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titers.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( Spain )
- RICORS2040 (Kidney Disease )
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease )
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | | | | | | | | | | | | | - Patricia Muñoz Ramos
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | | | | | - Jinny Sanchez-Rodriguez
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Ana Sánchez Horrillo
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | | | - Alba Leyva
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - José Rojas
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease )
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
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5
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Quiroga B, Soler MJ, Ortiz A, Mantecón CJJ, Pérez NN, Martín MS, Sato Y, Franco AJM, Zambrano DFP, Valverde RL, Diaz MO, González CC, López JMC, Pereira M, Parra EG, Horrillo AS, González CS, Toapanta N, Guldris SC, Hernández RS, Sánchez SP, Rincón MM, Garcia-Fernandez N, Castro NB, Mateo RC, Morales MAQ, Escamilla-Cabrera B, Godoy IB, Casanova BGC, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Carretero MP, Tocora DG, Rodríguez MTJ, Zanón TT, Suárez ER, Santolaya AJS, Calero RC, Cobo PA, Ramos PM, Gracia-Iguacel C, Martin-Cleary C, Sánchez-Rodríguez J, Ramos-Verde A, Giraldo YG, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, Repollet R, Moreso F, Azancot MA, Ramos N, Bestard O, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Saiz A, Granados NM, Cabo MJC, Alarcón WL, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Osorio LR, Zamora R, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, García T, Narváez C, Orellana C, León JLP, García MAM, Jiménez BG, Moya JDDR, Espinosa DL, Herrador AJ, Zurita MN, Díaz Álvarez L, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Gash SC, Martínez LR, Perez VLDLM, Arevalo MC, Calvo JAH, Salgueira M, Aresté N, Rodríguez MDLÁ, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Hernández APR, Rebollo MSG, Hernández JMR, Aguilera ET, Alea RT, Saldaña MSDR, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Serna MRDA, Perich LG, de la Rosa EC. Anti-Spike antibodies three months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study. Clin Kidney J 2022; 15:1856-1864. [PMID: 36147708 PMCID: PMC9384616 DOI: 10.1093/ckj/sfac169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Patients on hemodialysis are at high-risk for complications derived from coronavirus disease-19 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity three months after the booster dose.
Methods
This is a multicentric and prospective study assessing IgG anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed.
Results
A total of 711 patients (67% male, 67 [20-89] years) were included. Of which, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, p = 0.001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, p = 0.693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated to mRNA-1273 booster (p = 0.001), lower time from booster (p = 0.043) and past breakthrough SARS-CoV-2 infection (p<0.001).
Conclusions
In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated to mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( Spain )
- RICORS2040 (Kidney Disease)
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease)
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | | | | | | | | | | | | | - Rafael Lucena Valverde
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | - Mayra Ortega Diaz
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | | | | | - Mónica Pereira
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Emilio González Parra
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Ana Sánchez Horrillo
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - Carmen Sánchez González
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - Néstor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( Spain )
| | | | | | | | | | | | | | | | | | | | | | | | - Alba Leyva
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - José Rojas
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease)
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
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Quiroga B, Soler MJ, Ortiz A, Bernat A, Díaz ABM, Mantecón CJJ, Pérez VOG, González CC, Cervienka M, Mazuecos A, Cazorla JM, Riso MCD, Martínez S, Diaz MO, Valverde RL, Márquez MGS, Novillo CL, Parra EG, Gracia-Iguacel C, De Tomas MTR, Cervera MCA, Giorgi M, Ramos PM, Carmona NM, Toapanta N, Guldris SC, Millán JCRS, Estupiñán RS, Crespo M, Linaza BV, Martín MIJ, Jiménez LRO, Soriano S, Ferri DG, Sánchez MSP, Yugueros A, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Carretero MP, Tocora DG, Rodríguez MJ, Zanón TT, Suárez ER, Santolaya AJS, Calero RC, Cobo PA, Martin-Cleary C, Sánchez-Rodríguez J, Pereira M, Ramos-Verde A, Sánchez C, Giraldo YG, Horrillo AS, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, Repollet R, Moreso F, Azancot MA, Ramos N, Bestard O, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Saiz A, Vila MAM, Granados NM, Cabo MJC, Alarcón WL, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Hernández RS, García-Fernández N, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, López RO, Peregrí CM, Morales MLA, Cabello MDN, Ribera AMT, Valcarce EG, Vergara EG, García T, Narváez C, Orellana C, Ganga PLQ, Carrión FV, Herrera ALG, Chamoun B, Barbosa F, Faura A, Pachón DR, Castro NB, Cendrero RMRC, Hidalgo-Barquero MVM, Gallego RH, Alvarez Á, Leo EV, León JLP, García MAM, Jiménez BG, Moya JDDR, Espinosa DL, Herrador AJ, Zurita MN, Álvarez LD, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Sato Y, Marín MS, Torres I, Conde PD, Alfaro G, Halauko O, Rifai FEL, Martínez AD, Ávila PJ, Franco AM, Sainz MS, Martín JMB, García LDR, Canga JLP, Ochoa PMV, Pacios LM, Machado LL, Morales AQ, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Rubio AB, Gilsanz GDP, Gonzalez MO, Villanueva RS, Oliva MOL, Varela JC, Enríquez AG, Casas CC, Alonso PO, Tabares LG, Barreiro JML, Solla LP, Gándara A, de la Garza WN, Fleming FF, Goyanes MGR, Feijoo CC, Plaza MMM, Juan CB, Cecilio RVS, Haces CP, Kislikova M, Rodrigo E, Contreras FJP, Lara NB, Llorente EMDB, Díaz LS, Bustamante AMC, Ruiz JM, Rodríguez EG, Perez VLDLM, Arevalo MC, Calvo JAH, Carratalá MRL, Rodríguez LMM, Salazar MS, Prieto BB, Pérez JMP, Rueda DA, Ferrero MLR, Martínez AV, Estébanez SA, Paraíso AG, Huarte E, Lanau M, Campos RA, Ubé JM, Pérez PS, Godoy IB, Aguilera ET, Alea RT, Saldaña MSDR, Salvetti ML, Valmajor MC, Sánchez MP, Barragán ML, Aunatell LR, Salgueira M, Aresté N, de Los Ángeles Rodríguez M, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Gash SC, Martínez LR, Prieto BA, Toyos C, Rio JM, Acosta AR, Zamacona AC, Ortega SB, Ruiz MIG, Rubio AH, Ledesma PG, Alvarez AG, de Briñas EPL, Cucchiari D, Monzo JB, Cabrera BE, Hernández APR, Rebollo MSG, Hernández JMR, Alonso JC, Más AM, Calvé M, Cardona MG, Balaguer VC, Pesquera JIM, Serrano AG, Simó PT, Mancilla HDR, Gómez MP, Gumpert JV, de la Fuente GDA, Del Valle KP, de la Rosa EC, Santarelli DR, Garcia AS, Martin-Caro AC, Santamaria IM, Umpierrez AM, Ruiz EH, Corbella AM, Perdomo KT, Martín YM, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Amado FV, Borges PP, Vázquez RM, Beloso MD, Alonso FA, Felpete NP, Ameneiro AM, Mera MC, Casares BG, Larrondo SZ, Kareaga NM, Del Valle AISS, García ARM, Del Toro Espinosa N, Perico PE, Oliva JMS, Manrique J, Castaño I, Purroi C, Gómez N, Mansilla C, Utzurrum A. Loss of humoral response 3 months after SARS-CoV-2 vaccination in the CKD spectrum: the multicentric SENCOVAC study. Nephrol Dial Transplant 2022; 37:994-999. [PMID: 35022757 PMCID: PMC9383183 DOI: 10.1093/ndt/gfac007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain.,RICORS2040 (Kidney Disease)
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease).,IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Mayra Ortega Diaz
- Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
| | - Rafael Lucena Valverde
- Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
| | | | | | - Emilio González Parra
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Carolina Gracia-Iguacel
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | - Martín Giorgi
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Néstor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | | | - Raquel Santana Estupiñán
- Nephrology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | | | | | | | | | - Alejandra Yugueros
- Nephrology Department, Hospital Lluis Alcanyis De Xátiva, Valencia, Spain
| | - Alba Leyva
- R&D Department, VIRCELL SL, Granada, Spain
| | - José Rojas
- R&D Department, VIRCELL SL, Granada, Spain
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease).,Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
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Spithoven EM, Kramer A, Meijer E, Orskov B, Wanner C, Abad JM, Aresté N, de la Torre RA, Caskey F, Couchoud C, Finne P, Heaf J, Hoitsma A, de Meester J, Pascual J, Postorino M, Ravani P, Zurriaga O, Jager KJ, Gansevoort RT. Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe: prevalence and survival--an analysis of data from the ERA-EDTA Registry. Nephrol Dial Transplant 2014; 29 Suppl 4:iv15-25. [PMID: 25165182 DOI: 10.1093/ndt/gfu017] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the fourth most common renal disease requiring renal replacement therapy (RRT). Still, there are few epidemiological data on the prevalence of, and survival on RRT for ADPKD. METHODS This study used data from the ERA-EDTA Registry on RRT prevalence and survival on RRT in 12 European countries with 208 million inhabitants. We studied four 5-year periods (1991-2010). Survival analysis was performed by the Kaplan-Meier method and by Cox proportional hazards regression. RESULTS From the first to the last study period, the prevalence of RRT for ADPKD increased from 56.8 to 91.1 per million population (pmp). The percentage of prevalent RRT patients with ADPKD remained fairly stable at 9.8%. Two-year survival of ADPKD patients on RRT (adjusted for age, sex and country) increased significantly from 89.0 to 92.8%, and was higher than for non-ADPKD subjects. Improved survival was noted for all RRT modalities: haemodialysis [adjusted hazard ratio for mortality during the last versus first time period 0.75 (95% confidence interval 0.61-0.91), peritoneal dialysis 0.55 (0.38-0.80) and transplantation 0.52 (0.32-0.74)]. Cardiovascular mortality as a proportion of total mortality on RRT decreased more in ADPKD patients (from 53 to 29%), than in non-ADPKD patients (from 44 to 35%). Of note, the incidence rate of RRT for ADPKD remained relatively stable at 7.6 versus 8.3 pmp from the first to the last study period, which will be discussed in detail in a separate study. CONCLUSIONS In ADPKD patients on RRT, survival has improved markedly, especially due to a decrease in cardiovascular mortality. This has led to a considerable increase in the number of ADPKD patients being treated with RRT.
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Affiliation(s)
- Edwin M Spithoven
- Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Esther Meijer
- Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Bjarne Orskov
- Division of Nephrology, Copenhagen University Hospital, Roskilde, Denmark
| | - Christoph Wanner
- Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany
| | - Jose M Abad
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
| | - Nuria Aresté
- Department of Nephrology, University Hospital Virgen Macarena, Seville, Spain
| | | | | | - Cécile Couchoud
- REIN Registry, Agence de la Biomedecine, Saint Denis La Plaine, France
| | - Patrik Finne
- Finnish Registry of Kidney Diseases, Helsinki, Finland
| | - James Heaf
- Department of Nephrology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Andries Hoitsma
- Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Johan de Meester
- Department of Nephrology, Dialysis and Hypertension, Nederlandstalige Belgische Vereniging voor Nefrologie (Dutch Speaking Belgium Renal Registry)-NBVN, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Maurizio Postorino
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, U.O.C. Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera di Reggio Calabria and CNR-IBIM, Reggio Calabria, Italy
| | - Pietro Ravani
- Department of Medicine and Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oscar Zurriaga
- Subirección General de Epidemiología y Vigilancia de la Salud, Conselleria de Sanitat, Generalitat C. Valenciana, Valencia, Spain Spanish Consortium of Epidemiology and Public Health Research (CIBERESP), Spain
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
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Moyano MJ, Salgueira M, Aresté N, Escalera B, del Toro N, Jiménez-Víbora E, Martínez-Puerto AI, Molas JR, Palma A. [Comparative study of PTFE grafts in forearm vs cuffed permanent catheters]. Nefrologia 2006; 26:594-9. [PMID: 17117903] [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: 05/12/2023] Open
Abstract
INTRODUCTION As is universally accepted the best form of permanent vascular access for haemodialysis is the native arteriovenous fistula. A second and third options are the politetrafluoroethylene (PTFE) AV grafts and the cuffed, tunneled, internal catheters. The overall performance and complications of catheters is clearly inferior to AV fistula. There are not many studies that compare permanent catheters to grafts in terms of functionality, survival and complications. METHODS We analyzed 81 vascular accesses carried out from october 99 to december 03 in 59 patients and during a follow-up period of 35 months. Two groups were considered. Group 1, catheters (n 42) and group 2, grafts (n 39). Clinical aspects, comorbidity index (Wright and Kanh), dialysis dose and complications and survival of the access were registered. RESULTS Both groups were similar in age, sex, time on haemodialysis, number of previous accesses and hospitalization days. Cardiovascular morbidity and comorbidity index were significantly higher in patients with catheter. While blood flow during dialysis was higher in grafts both groups showed no significant differences in parameters of efficacy of dialysis (Kt/V, TAC BUN and PCRn). Serum albumin was lower in patients with catheter. The number of accesses that failed was higher in the graft group being thrombosis the main complication followed by infection. Kaplan-Meier curves showed better accumulated survival of permanent catheters versus grafts (61,4% vs 9,8% at 35 months). The most frequent complication of catheter was infection while in the case of grafts it was thrombosis followed by infection. CONCLUSIONS Although they were placed in patients with higher comorbidity, cuffed, tunneled catheters showed less number of complications and better survival than PTFE grafts in our patients in haemodialysis. The main cause of failure of both vascular access was thrombosis followed by infection. The dose of dialysis obtained was no different in both groups. Cuffed, tunneled permanent catheters are a very interesting option in a number of patients in haemodialysis and they can be an option to consider in those patients with vascular difficulties and higher comorbidities.
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Affiliation(s)
- M J Moyano
- Servicio de Nefrología, Hospital Universitario Virgen Macarena, Avda Foctor Drediani, Sevilla
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9
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Jiménez Víbora E, Aresté N, Salgueira M, del Toro N, Jiménez García A, Villar JL, Palma A. [Renal hyperparathyroidism's control after subtotal parathyroidectomy]. Nefrologia 2005; 25:416-21. [PMID: 16231509] [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: 05/04/2023] Open
Abstract
UNLABELLED Parathyroidectomy, in any of its forms, is considered an effective short-term treatment of renal hyperparathyroidism in patients who are not being controlled with drugs. Nevertheless, the outcome in the medium and long term of the various surgical procedures is still unclear and seems a controversial issue. We conducted a prospective study of 15 patients undergoing subtotal parathyroidectomy who were followed up for a period of 48 months after surgery. All patients were included in hemodialysis programmes. Elevated levels of parathyroid hormone which did not decrease with drug therapy recommended parathyroidectomy. The aim of our study is to determine whether subtotal parathyroidectomy is an effective technique in the medium and long term. As regards the results obtained, the levels of parathyroid hormone and calcemia remarkably decreased during the follow-up period, if compared to pre-surgery levels. The level of alkaline phosphatase also showed a reduction and the "hungry bone effect" was observed. The phosphorus and Ca-P product levels only showed a significant reduction immediately after surgery but showed an increment from the first year after surgery onwards. Hemoglobin levels did not show any alteration after parathyroidectomy. In two patients we observed a relapse of hyperparathyroidism. The anatomopathological examination revealed nodular hyperplasia in most of the cases, including the two relapses. CONCLUSION Subtotal parathyroidectomy is an effective surgical procedure in the medium-term treatment of renal hyperparathyroidism.
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Affiliation(s)
- E Jiménez Víbora
- Servicios de Nefrología, Cirugía General, Hospital Universitario Virgen Macarena, Sevilla
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Aresté N, Moyano MJ, Naranjo D, Marcos F. [Endovascular treatment with "covered stent" of arteriovenous fistula secondary to percutaneous renal biopsy]. Nefrologia 2005; 25:449-50. [PMID: 16231517] [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: 05/04/2023] Open
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11
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Salgueira M, Milan JA, Moreno Alba R, Amor J, Aresté N, Jiménez E, Palma A. [Cardiac failure and diastolic disfunction in hemodialysis patients: associated factors]. Nefrologia 2005; 25:668-77. [PMID: 16514908] [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: 05/06/2023] Open
Abstract
UNLABELLED Heart failure (CHF) and diastolic dysfuction (DD) relationship has received poor attention in hemodialysis patients (HD). OBJECTIVE To analyse the incidence of CHF in our HD patients, the relationship with DD and impact on mortality. METHODS We studied 79 patients: 48 +/- 15 years old, mean time on HD 83 +/- 63 months. Vascular calcification (PVC) was evaluated by radiologic series (55.7%). We analyzed the presence of clinical and analytical cardiovascular factors. All patients underwent M-mode, two-dimensional, Doppler echocardiography. Patients were followed for two years. Clinical information collected: incidence of ischemic heart disease (IHD), CHF, and mortality due to cardiovascular events. RESULTS Most frequent finding was Left Ventricular Hypertrophy (LVH) (93%), followed by DD (63.5% had anormal LV relaxation) (ALVR). Incidence of CHF was 38.3%; and was significantly associated with higher: time on HD (130/72 months), Ca x P (74/65), PTH (677/376), bone alkaline phosphatase (27/16), and systolic BP (145 vs 130 mmHg); IHD, PVC, valvular calcification (VC), LVH and ALVR (p < 0.01). Systolic function was normal in both groups (with/without CHF). Logistic regression identified as risk factors for CHF: ALVR (OR: 9.5), IHD (OR: 15) and systolic BP (OR: 2.2). ALVR was associated with greater age (55/37), longer time on HD (76/60), PVC and VC (p < 0.001). Predictor factors identified were age (OR: 2.13) and PVC (OR: 3.9). CONCLUSIONS HD patients showed a high incidence of CHF. IHD, systolic BP and DD (ALVR) have behave as risk factors for CHF. Vascular calcifications were intimately related to these findings and, therefore, they contribute to the greater mortality of these patients.
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Affiliation(s)
- M Salgueira
- Servicio de Nefrología, Hospital Universitario Virgen Macarena, Sevilla.
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12
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Aresté N, Amor J, Cambil T, Salgueira M, Sánchez-Palencia R, Páez C, Gómez O, Palma A. [Early treatment of secondary hyperparathyroidism in moderate renal insufficiency: low-phosphorus diet versus calcium carbonate]. Nefrologia 2003; 23 Suppl 2:64-8. [PMID: 12778857] [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
Calcitriol deficiency and phosphorus retention are mechanisms involved in the pathogenesis of renal hyperparathyroidism. The aim of this study was to evaluate the effect of dietary phosphorus restriction versus calcium carbonate treatment for one month on PTH and calcitriol levels in patients with mild renal failure. We studied two groups of patients: Group I: 21 patients (14M/7F); mean age 61 years old; mean glomerular filtration rate 51 ml/min. Their diet contained phosphorus 700 mg/day. Group II: 30 patients (21M/9F); mean age 58; mean glomerular rate 56 ml/min. They were divided in two subgroups: 18 patients treated with calcium carbonate 2.5 g/day and 12 patients with 5 g/day. Serum PTH, calcitriol, 25(OH)D3, calcium, phosphorus and urinary excretion of calcium and phosphorus were measured before and after a 30 day period. The low phosphorus diet (Group I) resulted in a significant decrease in PTH levels (81.3 +/- 35 vs 71 +/- 39 pg/ml, p < 0.05) and significant increase in calcitriol levels (22.4 +/- 4.4 vs 33.4 +/- 7.5 pg/ml, p < 0.05). In our study calcium carbonate treatment (Group II) had no effect on PTH and calcitriol levels.
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MESH Headings
- Aged
- Calcifediol/blood
- Calcitriol/blood
- Calcium/blood
- Calcium Carbonate/therapeutic use
- Calcium, Dietary/administration & dosage
- Chelating Agents/therapeutic use
- Chelation Therapy
- Creatinine/urine
- Female
- Humans
- Hyperparathyroidism, Secondary/blood
- Hyperparathyroidism, Secondary/diet therapy
- Hyperparathyroidism, Secondary/drug therapy
- Hyperparathyroidism, Secondary/etiology
- Hyperparathyroidism, Secondary/therapy
- Kidney Failure, Chronic/blood
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/diet therapy
- Kidney Failure, Chronic/drug therapy
- Male
- Middle Aged
- Parathyroid Hormone/blood
- Phosphorus/blood
- Phosphorus, Dietary/administration & dosage
- Treatment Outcome
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Affiliation(s)
- N Aresté
- Servicio de Nefrología, Hospital Universitario Virgen Macarena Avda. Dr. Fedriani, s/n 41071 Sevilla
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Salgueira M, del Toro N, Moreno-Alba R, Jiménez E, Aresté N, Palma A. Vascular calcification in the uremic patient: a cardiovascular risk? Kidney Int Suppl 2003:S119-21. [PMID: 12753281 DOI: 10.1046/j.1523-1755.63.s85.28.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several factors suggest that the presence of vascular calcification (VC) is associated with a high risk of cardiac events in uremic patients. The aim of this study was to analyze the influence of VC on cardiac morbidity and mortality in our hemodialysis (HD) patients. METHODS We studied 79 patients on HD: 43 males, mean age 48 +/- 15 years old, mean time on HD 83 +/- 63 months. The presence of VC was evaluated by radiologic series. Other cardiovascular risk factors analyzed were arterial hypertension, diabetes mellitus, obesity, cigarette smoking, anemia, and dyslipidemia. All patients underwent M-mode, two-dimensional, Doppler echocardiography. Patients were followed for two years. During this time, clinical information collected included predialysis blood pressure, incidence of ischemic heart disease, episodes of congestive heart failure, and mortality due to cardiovascular event. RESULTS VC was observed in 55.7% of patients. Left ventricular hypertrophy, diastolic dysfunction, and cardiac valve calcification were significantly associated with VC. Ischemic heart disease (71.4% vs. 28.6%) and episodes of cardiac failure (0.41 vs. 0.18 per year; P < 0.05) appeared more frequently in the patient group with VC. VC was present in 80.6% of patients who developed episodes of heart failure. Eight patients died from cardiac disease; each of them had VC. CONCLUSION The presence of VC can help to identify those HD patients with a higher cardiovascular risk.
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Affiliation(s)
- Mercedes Salgueira
- Nephrology and Cardiology Services, Virgen Macarena University Hospital, Sevilla, Spain.
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Amor J, Aresté N, Cambil T, de la Prada F, Jarava C, Salgueira M, Páez MC, Sánchez-Palencia R, Palma A. [Effects of dietary phosphorus restriction on the production of 1,25(OH)2D3 (calcitriol) in patients with moderated renal failure]. Nefrologia 2000; 20:158-63. [PMID: 10853197] [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: 02/16/2023] Open
Abstract
UNLABELLED Calcitriol deficiency and phosphate retention are two main factors in the pathogenesis of renal hyperparathyroidism. In spite of normal serum levels, phosphate may have an important role even in moderate RI. The aim of this study was to evaluate the effect of dietary phosphorus restriction on serum levels of calcitriol in patients with moderate RI. We studied 21 patients (7 F/14 M); mean age 61.7 +/- 15 years old; corrected creatinine clearance 51.4 +/- 14 ml/m. Serum PTH, calcitriol 25(OH)D3, calcium, phosphorus and urinary excretion of calcium and phosphorus were measured before and after 30 days on phosphorus restricted diet (700 mg/day). RESULTS [table: see text] CONCLUSIONS Our patients with moderate RI have elevated serum levels of PTH while calcitriol was in the lower normal range. Dietary phosphorus restriction resulted in a significant decrease in PTH levels and a significant increase in serum calcitriol concentrations. The levels of 25(OH)D3 did not change in this study.
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Affiliation(s)
- J Amor
- Servicio de Nefrología, Hospital Universitario Virgen Macarena, Sevilla
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