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1. Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum

Author

Borja, Quiroga, María José, Soler, Alberto, Ortiz, Carlos Jesús, Jarava Mantecón, Virginia Olinda, Gomes Pérez, Antoni, Bordils, José, Lacueva, Antonio José, Marin Franco, Pablo, Delgado Conde, Patricia, Muñoz Ramos, Carmen, Calderón González, Juan Manuel, Cazorla López, Jinny, Sanchez-Rodriguez, Ana, Sánchez Horrillo, Tania Raquel, Monzón Vázquez, Alba, Leyva, José, Rojas, Ron T, Gansevoort, Patricia, de Sequera, María Teresa Jaldo, Rodríguez, Rafael Lucena, Valverde, Marta Puerta, Carretero, Mayra Ortega, Díaz, Daniel Gaitán, Tocora, Esther Rodriguez, Suárez, Alfredo José Sáenz, Santolaya, Patricia Arribas, Cobo, Tamar, Talavan, Raquel Cerrajero, Calero, Carolina, Gracia-Iguacel, Emilio, González-Parra, Mónica, Pereira, Catalina, Martin-Cleary, Ana, Ramos-Verde, Martín, Giorgi, Carmen, Sánchez, Yohana Gil, Giraldo, Ana Sánchez, Horrillo, Pablo Ruano, Suárez, Antonio Fernández, Perpén, Andrés Fernández, Ramos, Laura Salanova, Villanueva, Alejandra, Cortiñas, Pablo A Díez, Arias, Alicia Cabrera, Cárdenas, Antonio, de Santos, Almudena, Núñez, Guillermina Barril, Cuadrado, Loreto Mariscal, de Gante, Raquel, Repollet, Concepción Redondo, Polo, Francesc, Moreso, María Antonieta, Azancot, Natalia, Ramos, Oriol Bestard Nestor, Toapanta, Ignacio, Cidraque, Sheila, Bermejo, Irene, Agraz, Oreto, Prat, Carlota, Medina, Emma, Pardo, Alejandro, Saiz, Maria Antònia Munar, Vila, Secundino Cigarrán, Guldris, Nicolás Menéndez, Granados, María Jesús Corton, Cabo, Walter López, Alarcón, Soledad Pizarro, Sánchez, Simona, Alexandru, Laura García Puente, Suarez, Saul Pampa, Saico, Marisol Poma, Tapia, Rocío, Zamora, Rosa Sánchez, Hernández, Laura Rodríguez, Osorio, Nuria, García-Fernández, Paloma Leticia Martin, Moreno, Noelia Ania, González, Ana Sabalza, Ortiz, María Nieves Bastida, Iñarrea, Sagrario Soriano, Cabrera, Raquel Ojeda, López, Cayetana Moyano, Peregrí, Maria Luisa Agüera, Morales, Maria Dolores Navarro, Cabello, Auxiliadora, Mazuecos, Teresa, García, Carlos, Narváez, Cristhian, Orellana, María Gabriela Sánchez, Márquez, Carolina Lancho, Novillo, Pedro Luis Quirós, Ganga, Fernando Vallejo, Carrión, Antonio Luis García, Herrera, Natalia Blanco, Castro, Rosa María Ruiz-Calero, Cendrero, María Victoria Martín, Hidalgo-Barquero, Román Hernández, Gallego, Álvaro, Alvarez, Eva Vázquez, Leo, José Luis Pizarro, León, Manuel Antonio Martínez, García, Benaldina García, Jiménez, Virginia Olinda Gómez, Pérez, Juan, de Dios Ramiro Moya, Diana López, Espinosa, Alejandro Jiménez, Herrador, Manuel Navarro, Zurita, Leonardo Díaz, Álvarez, Álvaro González, Martínez, Sandra Báez, Arroyo, Raquel Reina, Fernández, Marlyn Janella Suárez, Vargas, Rocío Calurano, Casero, Gustavo, Useche, Amparo Bernat, García, Ana Beatriz Muñoz, Díaz, Carmen Santamaría, de Miguel, Ángel, Palacios, Brenda, Henningsmeyer, Esther Orero, Calve, José Lacueva, Moya, Yurika, Sato, Marta Serra, Marín, Sandra, Tejedor, Shaida Martínez, Vaquera, Manuel Carnerero, di Riso, Irene, Torres, Georgina, Alfaro, Olga, Halauko, Fouad E L, Rifai, Ana Dolores, Martínez, Pablo Justo, Ávila, Christian Alfaro, Sánchez, Marta Sanz, Sainz, José María Baltar, Martín, Laura, Del Río García, José Luis Pérez, Canga, Paola Milena Villabón, Ochoa, Laura Muñiz, Pacios, Lina León, Machado, Augusto Quiroz, Morales, Ignacio Manzur, Cavalotti, Itziar Navarro, Zorita, Sol Otero, López, Sara Outon, González, Carlos Soto, Montañez, Auxiliadora Bajo, Rubio, Gloria, Del Peso Gilsanz, Marta Ossorio, Gonzalez, Rafael Sánchez, Villanueva, Maria Ovidia Lopez, Oliva, Jesús Calviño, Varela, Alba García, Enríquez, Carmen Cobelo, Casas, Pablo Otero, Alonso, Lourdes González, Tabares, José María Lamas, Barreiro, Luisa Palomares, Solla, Arginino, Gándara, Walfred Nájera, de la Garza, Francisco Fernández, Fleming, María Gloria Rodríguez, Goyanes, Cintia Caramés, Feijoo, María Mercedes Moreiras, Plaza, Cristina Bayón, Juan, Gabriel de Arriba, de la Fuente, Katia Pérez, Del Valle, Francisco Javier Pérez, Contreras, Noelia Balibrea, Lara, Dioné González, Ferri, Eduardo Muñoz, de Bustillo Llorente, Enriqueta González, Rodríguez, Virginia Lopez, De La Manzanara Perez, Marta Calvo, Arevalo, Jose Antonio Herrero, Calvo, María Rosario Llópez, Carratalá, Leyre María Martin, Rodríguez, Marisa Serrano, Salazar, Begoña Bravo, Prieto, José María Portolés, Pérez, Antonio Gil, Paraíso, Emma, Huarte, M, Lanau, Rodrigo Avellaneda, Campos, José Manuel, Ubé, Isabel Berdud, Godoy, Esther Torres, Aguilera, Rolando Tello, Alea, Margie Soledad, Del Rosario Saldaña, Mercedes, Salgueira, Nuria, Aresté, María, de Los Ángeles Rodríguez, Rocío, Collantes, Ana Isabel, Martínez, María Jesús, Moyano, Elena Jiménez, Víbora, Sandra Castellano, Gash, Lara Ruíz, Martínez, María Cinta Aguilar, Cervera, María Teresa Rodrigo, De Tomas, Beatriz Azcue, Prieto, Carmen, Toyos, José Molina, Del Rio, Adriana Restrepo, Acosta, Amagoia Celayeta, Zamacona, Ma Isabel Jimeno, Martin, Saioa Bilbao, Ortega, Ma Isabel Gallardo, Ruiz, Ainhoa Hernando, Rubio, Paula Garcia, Ledesma, Alvaro Goyoaga, Alvarez, Esteban, Poch, David, Cucchiari, José Broseta, Monzo, Beatriz Escamilla, Cabrera, Aurelio Pastor Rodríguez, Hernández, María Sagrario García, Rebollo, Juana Margarita Rufino, Hernández, Alejandra Yugueros, González, Juan Carlos, Alonso, Amparo Martínez, Más, Manuel, Calvé, Marina Garces, Cardona, Vanesa Canto, Balaguer, José Ignacio Minguela, Pesquera, Eva Cotilla, de la Rosa, David Rodríguez, Santarelli, Alba Santos, Garcia, Antonio Cabezas, Martin-Caro, Inmaculada Martinez, Santamaria, Michal, Cervienka, Ana María Urraca, de la Pisa, Lidia Sendino, Monzon, Karina Ampuero, Anachuri, Esther Hernández, Garcia, Victoria Oviedo, Gomez, Raquel Santana, Estupiñán, Francisco Valga, Amado, Patricia Pérez, Borges, Marta Durán, Beloso, Fernanda Arroyo, Alonso, Noemí Pérez, Felpete, Ana Meizoso, Ameneiro, Mónica Cunha, Mera, Beatriz Gil, Casares, Sofía Zarraga, Larrondo, Naroa Maruki, Kareaga, Ainhoa Inza San Salvador, Del Valle, Ana Rosa Muñoz, García, Blanca Villacorta, Linaza, Nuria, Del Toro Espinosa, Paola Estupiñan, Perico, José Manuel Sánchez, Oliva, Joaquín, Manrique, Itziar, Castaño, Carolina, Purroi, Nerea, Gómez, Cristina, Mansilla, Ane, Utzurrum, Manuel Ramírez, de Arellano Serna, Luis Guirado, Perich, María Muñiz, Rincón, Jesús Grande, Villoria, and Alfonso Pobes Martínez, De Salinas

Subjects
kidney transplant, Transplantation, Nephrology, SARS-CoV-2, CKD, COVID-19, dialysis, vaccines
Abstract

Background There is scarce evidence on the fourth dose of severe acute respiratory syndrome coronavirus 2 vaccines in chronic kidney disease (CKD) patients. We evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), haemodialysis (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 analysed factors associated with persistent negative humoral response and higher anti-Spike antibody titres as well as the efficacy of vaccination on coronavirus disease 2019 (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 titres in HD (P = .001) and ND-CKD (P = .014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titres at 12 months were independently associated with repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titres and not being a KT recipient. Breakthrough COVID-19 was registered in 137 (6%) patients, 5% of whom required admission. Admitted patients had prior titres Conclusions A fourth vaccine dose increased anti-Spike antibody titres or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titres or KT recipients) derived the least benefit in terms of antibody titres. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titres.

Published
2023

2. Eficacia del papel de la enfermer@ gestor@ de casos (EGC) como modelo integrador para la reducción de comorbilidades en una unidad de atención al paciente diabético crónico

Author

Juan Antonio Martinez Martinez, Carmen Toyos Ruiz, Teresa Rodrigo De Tomas, Gabriel Rivera San Martin, Victor Rodriguez Saenz De Buruaga, Alfredo Yoldi Arrieta, Jose Maria Arteche Ocasar, Ana Belastegui Duradona, and Maria Victoria Gonzalez Martin

Subjects
eficacia, diabetes, integracion, enfermera gestora de casos, outcomes, Medicine (General), R5-920
Abstract

Introducción: La U.de diabetes fue creada como modelo de integración entre los distintos niveles de salud para dar una respuesta integral al paciente diabético La componen los servicios de nefrología, endocrinología, EED, pie diabético y rehabilitación y traumatología, todo ello coordinado por una EGC. Material y métodos: Estudio realizado en las áreas de salud de la comarca de Guipúzcoa. Se crearon circuitos de derivación de interconsultas a través de “osabide global “programa que permite intercambio de archivos además de interconsultas entre distintos niveles de salud, el circuito permite también derivar entre los distintos servicios que componen la unidad. La EGC realiza un cribaje de las interconsultas según algoritmos de gravedad clasificándolas como: ü No presencial (iC contestadas de forma on line sin presencia del paciente a través del programa. ü Presenciales: pacientes que tiene que acudir al centro hospitalario, siempre citadas según criterios de gravedad. Como outcomes de comorbilidad se midieron: Primarios: ü Mejora esperada en HBAC1 ü Disminución o estabilización de la progresión de la nefropatía (albumina , proteinuria, FG) ü Disminución de amputaciones mayores Secundarios: ü Satisfacción percibida por el paciente con el servicio ü Disminución de visitas a urgencias Resultados:Desde su creación se han cribado por la EGC un total de 5269 interconsultas de las cuales han sido derivadas: 1605 pie diabético, 1169 nefrología, 1872 endocrino, 623 enfermera educadora y 43 rehabilitación. El 98% han sido contestadas dentro del periodo de respuesta pactado y el 95% citada en base a los algoritmos establecidos. 529 (10´03%) se han contestado de forma no presencial siendo la mayoría dudas de tratamiento y 4740 han sido presenciales de las cuales 1664 (35´10%) han sido vistas en más de un servicio simultáneamente. Como datos preliminares de comorbilidad han sido analizado una muestra obtenida en el periodo Enero 2015-Diciembre 2017. Amputaciones mayores se realizaron 9/ 250 pacientes en 2015, 20/362 2016 y 17/293 en 2017 Los 629 pacientes analizados en endocrino presentan HGAC1 basal media de 8´7%, 7´5% a los 3 meses 7´7 a los 6 meses y 7´6 a los 12 meses Tras analizar la muestra de los pacientes con nefropatía estos presentan cifras de progresión de la nefropatía similar a la descrita por la bibliografía en los estudios publicados. Las visitas de nuestros pacientes a urgencias se han disminuido ya que se ha creado un circuito de derivación directa a nuestra unidad. La satisfacción de nuestros pacientes medidas por nuestra unidad de calidad muestra unas buenas cifras en las encuestas realizadas. Conclusión: El papel de la EGC mejora la integración entre los distintos niveles de salud dando respuesta de forma eficaz según algoritmos de gravedad a todas la interconsultas que se realizan a través del circuito logrando una atención integral al paciente diabético y parece mejorar outcomes finales de comorbilidades este grupo de pacientes.

Published
2019
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3. Safety and Performance of Titanium Suture Anchors Used in Knee Ligament Repair Procedures

Author

Antonio Maestro, Iván Pipa, Nicolás Rodríguez, Carmen Toyos, Marcelino Torrontegui-Duarte, and Cesar Castaño

Subjects
titanium, suture anchor, knee, ligament, anterolateral, Medicine (General), R5-920
Abstract

Injuries to the knee ligaments can be particularly disabling in young patients, given the risk of long-term disability if adequate fixation is not achieved during initial repair. The TWINFIX™ titanium (Ti) suture anchor with ULTRABRAID™ Suture (Smith and Nephew, London, UK) was designed to secure tendon and ligament reconstructions with increased boney ingrowth at the anchor site with minimal invasive technique. This retrospective analysis looked at 33 patients (41 implants) operated with this device between 2015 and 2019 at a single institution. The average age of patients was 33.18 years (standard deviation [SD], 15.26), with an average body mass index of 24.88 (SD, 3.49). The indications were lateral extra-articular tenodesis during anterior cruciate ligament reconstruction, medial patellofemoral ligament reconstruction, quadriceps or patellar tendon repair and medial collateral ligament repair. After an average follow up of 24.3 + 6.53 months, there was no reports of clinical failure or radiographic evidence of implant failure or loosening. One patient experienced a complication unrelated to the study device, requiring manipulation under anesthesia with resolution of symptoms. This case series supports the safety and performance of this implants for the knee procedures in which its use is indicated. Additional follow-up will be required to determine whether these effects are sustained at medium- and long-term durations.

Published
2021
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6. Colaboradores

Author

Montaño, Mario Abarca, Diezhandino, Ana Abarquero, Maestro, Ignacio Aguado, Bonus, Antonio Agulló, Albareda, Jorge Cruz Albareda, Orduña, Francisco Aliaga, Ramos, Jorge Amestoy, Baile, Ainhoa Arias, Martín, Francisco Arias, Díaz, Montserrat Arjona, Martín, Ismael Auñón, López, Cristina Ávila, Dapía, Galo Azuara, Martí, Albert Baduell, Castro, Mariano Balaguer, Nieto, Larraitz Bergara, Rubio, Nieves Blanco, Gustems, Nuria Boó, Net, Rosa Busquets, Doussoux, Pedro Caba, Castellà, Josep Maria Cabestany, Perich, Bernat Cabestany, Tapies, Jorge Rafael Calvo, González, Mercedes Campoamor, Porras, Juan Ramón Cano, Martín, Miguel Cañones, Laso, Esther Carbó, Bencano, Andrés Carranza, Oñate, Ana Castel, Peris, Vicente J. Climent, Leal, Alexandre Coelho, Escudero, Carlos A. Collado, Sáenz, Fernando Collado, Aleu, Andrés Combalia, Ampuero, José Cordero, Hernández, Pablo Crespo, Ocaña, Encarnación Cruz, Cantón, Manuel Cuervas-Mons, Nogales, Jaime Dalla Rosa, Coll, Antonio Dalmau, Sánchez-Minguet, Antonio Darder, Escuredo, Basilio J. de la Torre, Serrano, Mariano de Prado, Martínez, Alberto D. Delgado, Fernández, Rodrigo Díaz, Sevilla, Alejandro Domínguez, Llado, Gemma Duarri, Serrano, María Durán, Hernández, Óscar Fernández, Reinales, Álvaro Fernández, Sánchez, José Antonio Fernández-Dívar, Laborde, Jenaro Ángel Fernández-Valencia, Tarragó, Joan Ferràs, Manzanal, Francisco Ferrero, Alonso, Manuel García, Cepeda, Ignacio García, Elvira, Rubén García, Guirao, Antonio Jesús García, Oltra, Ester García, Rey, Eduardo García, Vázquez, Diego García-Germán, Garay, Enrique Gil, Cespedosa, Albert Ginés, Izquierdo, Manuel Godino, Barrena, Enrique Gómez, Vallejo, Jesús Gómez, Álvarez, Juan José González, Quevedo, David González de, Fernández, Enrique González, Montané, José Luis González, Checa, Daniel Grau, Llopis, Enrique Grau, Parra, Enrique Guerado, Vicente, Isabel Guillén, Castanedo, Gustavo Gutiérrez, Navarte, Francisco de Borja Gutiérrez, Domenech, David Guzmán, García, Samuel Hernández, Hermoso, José Antonio Hernández, Pérez, Mario Herrera, Sierra, Virginia Herrero, Gómez, Pedro Hinarejos, León, Miguel Salvador Hirschfeld, Marco, Sergio Hortelano, Malvestiti, Maximiliano Ibáñez, Sánchez, Carlos Kalbakdij, Muñoz, Vicente J. León, Utrilla, Alejandro Lizaur, Capdevila, M.ª Eulalia López, González, Francisco José Madera, Fernández, Antonio Maestro, Peña, Oliver Marín, Hernández, Carlos Martín, Vélez, Pablo Martín, Torrente, Pilar Martínez de Albornoz, Mozos, José Luis Martínez de los, García, Carmen Martínez, Giménez, Enrique Martínez, Martínez, Francisco Martínez, Municio, Gonzalo Martínez, Pastor, Juan Carlos Martínez, Martínez, Jesús Más, Díaz, José Antonio Matas, Romero, M.ª Ángela Mellado, Barrio, Ricardo Mencía, Solana, Guillermo Menéndez, Rueda, Luis Rodrigo Merino, Muñoz, Francisco Antonio Miralles, Gómez, Ignacio Miranda, García, Joan C. Monllau, Rosa, Manuel Monteagudo de la, Avalos, Rodolfo Morales, Suárez, Jesús Moreta, Mahamud, Ernesto Muñoz, Asensio, Antonio Murcia, Faubel, Enrique Navarrete, Mont, Ramón Navarro, Jiménez, Jorge Ojeda, Thies, Cristina Ojeda, González, Carlos Olaya, Cruz, Eduardo José Ortiz, López, Francisco Javier Pascual, Rodríguez, Jorge Payo, Pensado, Manuel Peleteiro, Andrada, Pablo Peñalver, Carro, Luis Pérez, Núñez, M.ª Isabel Pérez, Pinto, Leonardo E., Muñiz, Iván Pipa, Cano, Daniel Poggio, Roldán, Alicia Ramírez, González, Laura Ramos, Pascua, Luis R. Ramos, Díaz, Diego Rendón, Ferrer, Pablo Renovell, García, Nicolás Rodríguez, Añón, Alejandro Roselló, Naranjo, Antonio Miguel Royo, Lozano, Matías Ruiz, Martos, Marta Sabater, Navarro, Iván Sáenz, Gilabert, José Eduardo Salinas, Font, Andrea Sallent, Solís, Gonzalo Samitier, González, María Sánchez, Lázaro, Jaime Sánchez, Morata, Enrique J. Sánchez, Siles, Juan Manuel Sánchez, Alfonso, Vicente Sanchis, Fumas, Alejandro Santamaría, Medina, Fernando Santonja, Ruiz, Pablo Sanz, Muñoz, Antonio Silvestre, Suárez, Miguel Ángel Suárez, Mariño, Iskandar Tamimi, García, Sergio Tejero, Pons, Marc Tey, Dacasa, Eduardo Tornero, Campos, Antonio Torres, Eguía, Raúl Torres, Munárriz, Carmen Toyos, Cubillas, Ana Rosa Trapote, Sánchez, Elena Vacas, Martín, Javier Vaquero, Egocheaga, José Ramón Varela, Román, Carmen M.ª Verdú, Cés, Miquel Videla, Rico, Jesús Vilá y, Voegeli, Antonio Viladot, Carsí, Vicente Vincent, and Navas, Plácido Zamora

Published
2022
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7. Prediction at First Year of Incident New-Onset Diabetes After Kidney Transplantation by Risk Prediction Models

Author

Carlos Gómez-Alamillo, Lidia Santos, Natalia Allende, Celestino Piñera, Juan Carlos Ruiz San Millán, Emilio Rodrigo, Manuel Arias, Carmen Toyos, and Maria Estrella Quintela

Subjects
Advanced and Specialized Nursing, Research design, medicine.medical_specialty, Percentile, Framingham Risk Score, Receiver operating characteristic, business.industry, Endocrinology, Diabetes and Metabolism, Hazard ratio, Clinical Care/Education/Nutrition/Psychosocial Research, medicine.disease, Kidney Transplantation, Transplantation, Risk Factors, Diabetes mellitus, Internal medicine, Diabetes Mellitus, Internal Medicine, medicine, Humans, Intensive care medicine, business, Kidney transplantation, Original Research
Abstract

OBJECTIVE Our aim was to analyze the performance of two scores developed for predicting diabetes in nontransplant populations for identifying kidney transplant recipients with a higher new-onset diabetes mellitus after transplantation (NODAT) risk beyond the first year after transplantation. RESEARCH DESIGN AND METHODS We analyzed 191 kidney transplants, which had at least 1-year follow-up posttransplant. First-year posttransplant variables were collected to estimate the San Antonio Diabetes Prediction Model (SADPM) and Framingham Offspring Study–Diabetes Mellitus (FOS-DM) algorithm. RESULTS Areas under the receiver operating characteristic curve of FOS-DM and SADPM scores to predict NODAT were 0.756 and 0.807 (P < 0.001), respectively. FOS-DM and SADPM scores over 75 percentile (hazard ratio 5.074 and 8.179, respectively, P < 0.001) were associated with NODAT. CONCLUSIONS Both scores can be used to identify kidney recipients at higher risk for NODAT beyond the first year. SADPM score detects some 25% of kidney transplant patients with an eightfold risk for NODAT.

Published
2012

8. Clinical characteristics of resistant hypertension in renal transplant patients

Author

Carlos Gómez-Alamillo, Gema Fernández-Fresnedo, Emilio Rodrigo, María Gago, Carmen Toyos, Natalia Allende, and Manuel Arias

Subjects
Transplantation, medicine.medical_specialty, education.field_of_study, business.industry, Population, Drug Resistance, medicine.disease, Kidney Transplantation, Blood pressure, Nephrology, Internal medicine, Diabetes mellitus, Hypertension, medicine, Humans, Risk factor, Complication, Intensive care medicine, business, Adverse effect, education, Antihypertensive Agents, Kidney disease
Abstract

Hypertension is a prevalent complication that occurs in 80-85% of all kidney transplant recipients. The pathogenesis of post-transplant hypertension is multifactorial and includes pre-transplant hypertension, donor hypertension, renin secretion from the native kidney, graft dysfunction, recurrent disease and immunosuppressive treatment. Hypertension negatively affects transplant and patient survival outcomes; cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic renal disease and after successful renal transplantation. Hypertension is a well-known risk factor for CVD and it is frequently associated with other CVD risk factors. Despite increased awareness of the adverse effects of hypertension in both graft and patient survival, long-term studies have shown that arterial hypertension in the transplant population has not been adequately controlled. Resistant hypertension (RH) is defined as office blood pressure (oBP) that remains above goal (oBP ≥ 140/90 or 130/80 mmHg) in patients with diabetes or chronic kidney disease despite the concurrent use of three antihypertensive agents, at full doses, one of them being a diuretic. Despite studies in the general population and the high prevalence of hypertension in renal transplant patients, data about RH are very scarce and the prevalence of RH in renal transplant patients is unknown and could be associated with a worse prognosis.

Published
2012

9. Double treatment with paricalcitol-associated calcifediol and cardiovascular risk biomarkers in haemodialysis

Author

Celestino, Piñera-Haces, María J, Izquierdo-Ortiz, Ángel L, Martín-de Francisco, M Teresa, García-Unzueta, Marcos, López-Hoyos, Carmen, Toyos, Natalia, Allende, Estrella, Quintela, and Manuel, Arias

Subjects
Male, Bone Density Conservation Agents, Phosphorus, Middle Aged, Cardiovascular Diseases, Renal Dialysis, Risk Factors, Ergocalciferols, Humans, Drug Therapy, Combination, Female, Prospective Studies, Vitamin D, Biomarkers, Aged, Calcifediol
Abstract

The deficit of 25-hydroxyvitamin D (25OHD) associated with secondary hyperparathyroidism (SHPT) is a frequent finding in chronic kidney disease (CKD) patients on haemodialysis (HD). These events are associated with increased morbidity and mortality rates of cardiovascular (CV) origin. Adequate 25OHD serum levels as well as the use of selective vitamin D receptor activators (VDRA) have been shown to have beneficial and independent effects on bone mineral metabolism and cardiovascular risk. Currently, there is still controversy regarding the type of supplementation needed by CKD patients on HD.The aim of our study was to evaluate whether there is a benefit of combination therapy with 25OHD, calcifediol and a VDRA, oral paricalcitol, on bone-mineral metabolism and inflammatory markers, compared to single treatment with each of these in a group of patients on HD.We performed a prospective study of 6 months, involving 26 patients in our HD unit. We randomised patients into two groups: group 1 (G1) received oral paricalcitol treatment at doses of 1 mcg/day. Group 2 (G2) was treated with 1 ampoule calcifediol/wk (0.266 mg/wk=16 000U) orally. After 3 months of treatment, calcifediol and paricalcitol were added to the G1 and G2 respectively at the same doses, keeping these treatments together for 3 months to complete the 6 months of follow-up. Laboratory tests were performed at months 0, 3 and 6, measuring in all patients serum markers of 25OHD, calcium (Ca), phosphorus (P) and PTH. Bone turnover markers measured were: alkaline phosphatase (AP), aminoterminal propeptide of procollagen type 1 (Pinp1) and carboxyl-terminal telopeptide of type I collagen (CrossLaps), and inflammatory markers: IL-8. We also collected data on levels of insulin, glucose, haemoglobin, erythropoiesis-stimulating agents (ESAs) and rates of resistance to EPO and HOMA (homeostasis model assessment).We detected a deficit of 25-hydroxyvitamin D in all patients studied, with a mean of 13.67 ± 4.81 ng/ml. Supplementation with oral calcifediol significantly corrects this deficit without evidence of toxicity (35.36 ± 33.68 ng/ml in G1 at 6 months and 59.21 ± 26.50 ng/ml in G2 at 3 months). Paricalcitol treatment significantly reduces PTH levels in G1 at 3 months (P.039). We also noted a decrease in bone marker Pinp1 with paricalcitol, pointing to a possible direct effect on bone cells (P.001). Both treatment with paricalcitol and with calcifediol produced a significant decrease in levels of IL-8 (P.001), a known inflammatory marker, drawing attention to a trend towards better response to erythropoiesis-stimulating agents (ESAs), possibly related to the decrease in inflammation. The HOMA index did not change significantly.Based on our results, we cannot conclude that the association of calcifediol and paricalcitol produces advantages over the effect of each drug separately. In addition, Paricalcitol by itself appears to have a direct effect on cellular bone remodelling.

Published
2012

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