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Background and Aims Impairment in the diastolic function is strongly associated with heart failure and cardiovascular disease in patients with end-stage renal disease (ESRD), with a high prevalence of 50-65% and unobvious early symptoms. Hence, it is of great importance to explore serum biomarkers for early assessment of diastolic disfunction in patients with ESRD, providing evidence for performing an early intervention. When myocardial cell membrane integrity becomes damaged, cardiac troponin is released into the circulation, inducing an elevation of serum cardiac troponin in asymptomatic patients on dialysis. We analyzed the relationship between high-sensitivity cardiac troponin I biomarker (hs-cTnI) and left ventricular diastolic dysfunction (LVDD) in a cohort of asymptomatic patients on haemodialysis at our center. Method Cross-sectional study. We include patients on haemodialysis in our center. Demographic variables (age, sex), associated comorbidity, hs-cTnI levels, and echocardiographic parameters were collected. Statistical analysis was performed with SPSS 25.0. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation, and T-student, Anova or U-mann Whitney was used to compare them. Logistic regression analysis was performed to determine independent predictors of LVDD. Statistical significance for a value of p Results 80 patients, with an average age of 67.44 ± 13 years. 57.5% were men. 86.3% had high blood pressure (HBP), 52.5% were diabetic, 75% dyslipidemic, and 51.2% had overweight/obese body mass index. 32.5% had previous history of ischemic heart disease, 41.3% had moderate/severe left ventricle hypertrophy (LVH), 8.8% left ventricular ejection fraction (LVEF) 20 (OR 4.11 95% CI 1.38-12.18 p = 0.011) are independent risk factors for LVDD. Conclusion hs-cTnI levels could be a biomarker of LVDD in asymptomatic patients on haemodialysis. New studies with a greater number of patients would increase the evidence for this claim, in order to carry out early intervention and treatment.

Background and Aims The renal biopsy (RB) has been performed in the General Hospital of Ciudad Real (HGUCR) since the year 1989. It allows kidney diseases to be diagnosed and treated and pronostics to be made. We will analyse the results of these 30 years as well as the evolution of the various parameters studied. Method Descriptive study of the RB carried out in the HGUCR between 1989 and 2019. Age, sex, clinical syndrome (CS) at the time of the RB, number of glomeruli and histological diagnosis will be analysed. The patients are divided into 3 groups according to age: children (65). We will establish three periods of 10 years: period A (1989-1998), period B (1999-2008) and period C (2009-2019). The categorical variables are expressed as percentages and the quantitative variables average ± standard deviation. Statistical analysis with SPSS 25.0. Results 898 RB have been performed, average number of glomeruli 16, 70% of the RB with more than 10 glomeruli. The average age of the patients was 53±19 years old, 58% male. The most frequent CS was acute kidney failure (AKF) (35%), followed by nephrotic syndrome (NS) (30.5%), asymptomatic urinary disorders (19%), chronic kidney disease (11%), nephritic syndrome (3.6%), haematuria (0.7%) and arterial hypertension (0.7%). The most common in children were asymptomatic urinary disorders (50%), in adults NS (34%) and in the elderly AKF (55.5%). The predominant primary glomerulonephritis (GN): IgA nephropathy (IgAN) (15%), followed by membranous nephropathy (MN) (12%) and focal segmental glomerulosclerosis (FSGS) (11%). The most frequent secondary GN: vasculitis (11%) and lupus nephropathy (10%). 164 RB were performed in period A, 370 in period B and 346 in period C. In all three periods the predominant sex was male and the average age increased: 48 years old in A, 51 years old in B and 56 years old in C. Together with the increase in age, the indication of RB changes: NS in the first two periods and AKF in period C. The most frequent pathology in period A: FSGS (17%), IgAN (16%) in period B and IgAN (15%) followed by vasculitis (11%) in period C. Conclusion In the HGUCR the most common biopsied kidney pathology is IgAN, followed by MN. There has been an increase in the age of the patients as well as an increase in AKF and vasculitis. The KB constitutes a highly useful diagnostic test that allows us to establish prognostics and appropriate treatments.

Background and Aims Consensus document of the Spanish Society of Nephrology and many Primary Care (PC) related societies for chronic kidney disease (CKD) detection and management provides to the PC doctor referral criteria (RC) to nephrology clinic. The aim of the study is to describe the referrals to our center nephrology clinic and evaluate the influencing factors for RC adequacy. Method Retrospective observational study. We included the referred patients to our nephrology clinic from October 2019 to May 2020. We recollected demographic variables, as well as comorbidity, renal function, RC adequacy and follow-up. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation and compared using t-student test. Cox regression was performed to determine independent predictors for RC adequacy. Statistical significance for a value of p< 0,05 or CI 95%. Statistical analysis was performed with SPSS 25.0. Results 238 patients, 55.5% male. Average age 63 ± 17 years, being 34% older than 75 years. 67.6% had at least 3 cardiovascular risk factors. 85.3% were referred from PC with 57.1% of them from a rural center. There was adequation to the RC on 55%. The most frequent RC was CKD progression (37.4%). Mean serum creatinine at the time of referring was 1.91 ± 0.59 mg/dl with a glomerular filtration rate 34 ± 11 ml/min/1.73m2 and 329.43 ± 992.01 mg/g or mg/24h of albuminuria. From the 45% of those who did not had RC adequacy 51.4% had CKD III stage and 21.5% had false refractory hypertension (controlled or under-treated). Mean time of follow-up was 5 ± 1.7 months. RC adequacy was related with being referred from PC (59.6% vs 28.6% p=0.001), smoking (65.9% vs 49% p=0.012), time of referring creatinine (1.54 ± 0.86 vs 1.18 ± 0.39 p=0.001) and albuminuria (43406 ± 1009.7 vs 136.13 ± 637.16 p=0.019) and end of follow-up albuminuria (265.84 ± 516.82 vs 81.67 ± 250.7 p=0.007). RC adequacy was associated with receiving follow-up on nephrology clinic (80.2% vs 19.8% p=0.001). Logistic regression showed that being referred from PC (OR 3.64 IC 95% 1.03-12.8 p=0.044) and a worse renal function at the referring (OR 2.49 IC 95% 1.19-5.24 p=0.015) were associated with RC adequacy. Conclusion The experience in our center shows that there is not an adequacy on the current RC from the Spanish Society of Nephrology in almost half of the patients. That proportion decreases when patients are referred from PC close to 40%. CKD progression is the main reason for referral with most of patients being elderly and with a high cardiovascular risk. The need for greater dissemination of RC can be inferred from the significant number of inappropriate referrals, encouraging us to propose their review.

Background and Aims Dialysis patients constitute a risk group for coronavirus infection due to their immunosuppressed condition, with the increased risk of morbidity and mortality that this entails. We analyzed the factors associated with mortality from coronavirus infection in a cohort of patients undergoing renal replacement therapy at our center. Method Transversal study. We included patients in renal replacement therapy (RRT) in our center. Demographic variables (age, sex), associated comorbidity, RRT technique, clinical and laboratory parameters were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed in percentages and are compared using the Chi2 test. The quantitative variables are expressed as mean ± standard deviation and compared using Student's T-test. Statistical significance p Results 38 patients, mean age 66 ± 18 years, 51.4% men. 92.1% had arterial hypertension, 39.5% diabetes mellitus (DM). 63.2% on hemodialysis, 2.6% peritoneal dialysis, 34.2% transplanted. 84.2% presented fever, 63.2% cough, 73.7% pneumonia, 34.2% dyspnea, 15.8% digestive symptoms. 21.1% leukopenia, 73.7% lymphopenia, money D 1509 ± 1351, CRP 12.45 ± 19.47, sodium 136 ± 5.5. 81.% were admitted to hospitalization, of which 2.6% required admission to the ICU. 44% died. Mortality was statistically significantly related to DM (56.3% vs 43.8% p = 0.05), and with the need for hospitalization (93.8 vs 6.3% p = 0.054). Conclusion In our experience, DM patients and those who required hospitalization had a higher risk of mortality.

Background and Aims Management of ANCA-Associated Vasculitis (AAV) is in constant update. The aim of the study is to describe our experience as a territorial reference center with this systemic disease and to analyze which factors have a significant influence on the development of end-stage renal disease (ESRD). Method Retrospective observational study. All the patients who developed AAV in our center between 2010 and 2019 were included. Demographic variables (age, sex), renal function, other vasculitis related symptoms, induction and maintenance therapy, response degree and follow-up were collected. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation and compared using Mann-Whitney U test. Cox regression was performed to determine independent predictors of ESRD. Kaplan-Meier was used to estimate ESRD-free survival. Statistical significance for a value of p< 0,05. Statistical analysis was performed with SPSS 25.0. Results 45 patients were analyzed, with an average age of 70 ± 11 years. 62.2% were men. Mean time of follow-up 36 ± 31.6 months. 37.8% presented c-ANCA autoantibodies and 57.8% p-ANCA. Mean baseline serum creatinine level was 5.51 ± 3.65 mg/dl and proteinuria 2.82 ± 2.48 g/24h. 77.8% received cyclophosphamide as induction immunosuppressive treatment whereas 13.3% rituximab. 50% received azathioprine, 36.1% mycophenolate and 13.9% rituximab as maintenance treatment. 37.8% patients underwent plasma exchange therapy and 44.4% hemodialysis. Complete remission was achieved by 13.3% of patients, while 57.8% partial remission. 28.9% had absence of remission. 28.9% achieved ESRD. ESRD was associated with undergoing hemodialysis (69.2% vs 30.8% p=0.033), to the type of response (complete 7.7% vs partial 23.1% vs no response 69.2%), baseline creatinine level (8.36 ± 5.44 vs 4.35 ± 1.64 mg/dl p=0.011), creatinine 6 months after induction treatment (4.3 ± 2.05 vs 2.04 ± 0.77 mg/dl p=0.001) and at the end of follow-up (6.33 ± 2.47 mg/dl vs 2.2 ± 1.29 mg/dl p=0.001) and also to baseline proteinuria (4.21 ± 3.12 vs 2.25 ± 1.96 p=0.003), proteinuria 6 months after induction treatment (1.4 ± 1.46 vs 0.58 ± 0.73 g/24h p=0.014) and at the end of follow-up (2.48 ± 1.9 vs 1.12 ± 1.64 p=0.001). Logistic regression only showed end of follow up serum creatinine level as an independent risk factor of ESRD (OR3.74 IC 95% 1.01-13.75 p=0.047). ESRD-free survival chance after 5 of follow-up was 67%. Conclusion Only serum creatinine level at the end of follow-up could be found as an associated factor with ESRD. Greater number of patients would be needed in order to obtain other factors leading to ESRD in patients with AAV.

Resumen Antecedentes: Los registros de biopsias renales permiten la recogida de datos histopatológicos que, puestos en su conjunto, ayudan a comprender enfermedades y su historia natural. Objetivos: Analizar los datos del Registro de Glomerulonefritis de Castilla-La Mancha (GLOMANCHA) y la evolución de las diferentes enfermedades biopsiadas (1994-2008). Métodos: Se recogieron las 6 enfermedades biopsiadas más prevalentes durante los 14 años (941 biopsias) en 5 hospitales de la comunidad autónoma. En 2008 se evaluó la situación vital y renal de los pacientes y se analizaron los factores asociados a dicha situación en cada enfermedad. Resultados: De las 941 biopsias, el 59% fueron de varones con una edad media de 48 ± 18 años. En el momento de la biopsia la mediana de filtrado glomerular (FG) era de 50,3 (25,5-76,3) ml/min/1,73 m2 y la de proteinuria de 3,4 (1,5-6,4) g al día. La enfermedad más frecuente fue la nefropatía lúpica, seguida de la glomeruloesclerosis focal y segmentaria, y de la membranosa. El mejor pronóstico renal durante el seguimiento (media 7,3 ± 4,8 años) fue el de la nefropatía lúpica y la nefropatía por cambios mínimos; la glomeruloesclerosis focal y segmentaria y las glomerulonefritis rápidamente progresivas de tipo 3 tuvieron el peor pronóstico renal. Esta última, además, tuvo el peor pronóstico vital. Conclusiones: GLOMANCHA demuestra el mal pronóstico de las glomerulonefritis rápidamente progresivas de tipo 3, a diferencia de la nefropatía por cambios mínimos y lúpica. La función renal es un predictor independiente de supervivencia renal y de mortalidad en nuestra población. Abstract Background: Renal biopsy registries allow histopathological data to be collected to improve knowledge of different pathologies and their natural history. Aim: To analyse the data of the Castilla La Mancha Glomerulonephritis Registry (GLOMANCHA) and the evolution of the different biopsy-proven pathologies between 1994 and 2008. Methods: The 6 most common biopsy-proven pathologies were collected during the 14 years of the study (941 biopsies) in the 5 participant centres of the autonomous community. In 2008, we assessed patient renal survival and mortality and we evaluated associated factors to each situation for each pathology. Results: Of the 941 biopsies, 59% belonged to men, with a mean age of 48 ± 18 years. At the time of the biopsy, the median glomerular filtration rate was 50.3 (25.5-76.3) ml/min/1,73 m2 and median proteinuria was 3.4 (1.5-6.4) grams per day. The most common pathology were lupus nephropathy, followed by focal segmental glomerulosclerosis and membranous nephropathy. Lupus nephropathy and minimal change disease achieved the best renal prognosis during follow-up (mean 7.3 ± 4.8 years). Rapidly progressive glomerulonephritis type 3 and focal segmental glomerulosclerosis had the worst renal prognosis. In addition, rapidly progressive glomerulonephritis type 3 presented the worst vital prognosis. Conclusions: In GLOMANCHA, we demonstrate the poor prognosis of rapidly progressive glomerulonephritis type 3, in contrast to minimal change disease or lupus nephropathy. Renal function is an independent predictor of renal survival and mortality in this study.