107 results on '"Pérez-Fontán M"'
Search Results
2. Association of a single nucleotide polymorphism combination pattern of the Klotho gene with non-cardiovascular death in patients with chronic kidney disease
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Cambray S., Bermudez-Lopez M., Bozic M., Valdivielso J.M., Castro E., María V., Molí T., Vidal T., Soria M., Aladrén Regidor Ma.J., Almirall J., Ponz E., Arteaga Coloma J., Bajo Rubio Ma.A., Belart Rodríguez M., Gascón A., Bover Sanjuan J., Puigvert F., Bronsoms Artero J., Cabezuelo Romero J.B., Muray Cases S., Calviño Varela J., Caro Acevedo P., Carreras Bassa J., Cases Amenós A., Massó Jiménez E., Moreno López R., Cigarrán Guldris S., López Prieto S., Comas Mongay L., Comerma I., Compte Jové Ma.T., Cuberes Izquierdo M., de Álvaro F., Hevia Ojanguren C., de Arriba de la Fuente G., del Pino y Pino Ma.D., Diaz-Tejeiro Izquierdo R., Hormigos A., Dotori M., Duarte V., Estupiñan Torres S., Fernández Reyes Ma.J., Fernández Rodríguez Ma.L., Fernández G., Galán Serrano A., García Cantón C., García Herrera A.L., García Mena M., Gil Sacaluga L., Aguilar M., Górriz J.L., Huarte Loza E., Lerma J.L., Liebana Cañada A., Marín Álvarez J.P., Martín Alemany N., Martín García J., Martínez Castelao A., Martínez Villaescusa M., Martínez I., Moina Eguren I., Moreno Los Huertos S., Mouzo Mirco R., Munar Vila A., Muñoz Díaz A.B., Navarro González J.F., Nieto J., Carreño A., Novoa Fernández E., Ortiz A., Fernandez B., Paraíso V., Pérez Fontán M., Peris Domingo A., Piñera Haces C., Prados Garrido Ma.D., Prieto Velasco M., Puig Marí C., Rivera Gorrín M., Rubio E., Ruiz P., Salgueira Lazo M., Martínez Puerto A.I., Sánchez Tomero J.A., Sánchez J.E., Sans Lorman R., Saracho R., Sarrias M., Serón D., Soler M.J., Barrios C., Sousa F., Toran D., Tornero Molina F., Usón Carrasco J.J., Valera Cortes I., Vilaprinyo del Perugia Ma.M., Ruiz V., Pallarés V., Altozano C.S., Ródenas M.A., Sanitaria de Arán I.G.G.Á.B., Gil F.A., Criado E.G., Belinchón R.D., Fernández Toro J.Ma., and Antonio J.
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cardiovascular risk ,genetic association ,adult ,genotype ,allele ,chronic kidney failure ,cohort analysis ,major clinical study ,Klotho protein ,Article ,homozygote ,aged ,cause of death ,female ,multicenter study ,male ,priority journal ,cardiovascular mortality ,single nucleotide polymorphism ,follow up ,human ,prospective study - Abstract
Background. Chronic kidney disease (CKD) is associated with an elevated risk of all-cause mortality, with cardiovascular death being extensively investigated. However, non-cardiovascular mortality represents the biggest percentage, showing an evident increase in recent years. Klotho is a gene highly expressed in the kidney, with a clear influence on lifespan. Low levels of Klotho have been linked to CKD progression and adverse outcomes. Single nucleotide polymorphisms (SNPs) of the Klotho gene have been associated with several diseases, but studies investigating the association of Klotho SNPs with noncardiovascular death in CKD populations are lacking. Methods. The main aim of this study was to assess whether 11 Klotho SNPs were associated with non-cardiovascular death in a subpopulation of the National Observatory of Atherosclerosis in Nephrology (NEFRONA) study (n ¼ 2185 CKD patients). Results. After 48 months of follow-up, 62 cardiovascular deaths and 108 non-cardiovascular deaths were recorded. We identified a high non-cardiovascular death risk combination of SNPs corresponding to individuals carrying the most frequent allele (G) at rs562020, the rare allele (C) at rs2283368 and homozygotes for the rare allele (G) at rs2320762 (rs562020 GG/AG þ rs2283368 CC/CT þ rs2320762 GG). Among the patients with the three SNPs genotyped (n ¼ 1016), 75 (7.4%) showed this combination. Furthermore, 95 (9.3%) patients showed a low-risk combination carrying all the opposite genotypes (rs562020 AA þ rs2283368 TT þ rs2320762 GT/TT). All the other combinations [n ¼ 846 (83.3%)] were considered as normal risk. Using competing risk regression analysis, we confirmed that the proposed combinations are independently associated with a higher fhazard ratio [HR] 3.28 [confidence interval (CI) 1.51-7.12]g and lower [HR 6 × 10-6 (95% CI 3.3 × 10-7-1.1 × 10-5)] risk of suffering a non-cardiovascular death in the CKD population of the NEFRONA cohort compared with patients with the normal-risk combination. Conclusions. Determination of three SNPs of the Klotho gene could help in the prediction of non-cardiovascular death in CKD. © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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- 2020
3. P38.19 Lung Cancer in Young Adults: A Two-Center, Retrospective Study of the Clinical and Pathological Characteristics
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Guardamagna, M., Ramos, I., Perez-Fontan, M. Montero, Aguilar, M. Zalabardo, and Alba, E.
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- 2021
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4. The Modality of Dialysis Does Not Influence Atheromatous Vascular Disease Progression or Cardiovascular Outcomes in Dialysis Patients Without Previous Cardiovascular Disease
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Borràs Sans, M., primary, Pérez-Fontán, M., additional, Martinez-Alonso, M., additional, Bajo, A., additional, Betriu, À., additional, and Valdivielso, J.M., additional
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- 2018
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5. La diálisis peritoneal es la mejor alternativa coste-efectiva para la sostenibilidad del tratamiento con diálisis
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Arrieta, J., Rodríguez-Carmona, A., Remón, C., Pérez-Fontán, M., Ortega, F., Sánchez Tornero, J. A., and Selgas, R.
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- 2011
6. Plan de calidad científico-técnica y de mejora continua de calidad en diálisis peritoneal
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Bajo Rubio, María Auxiliadora, Selgas, R., Remón, C., Arrieta, J., Álvarez-Ude, F., Arenas, M.D., Borrás, M., Coronel, F., García-Ramón, R., Minguela, I., Pérez-Bañasco, V., Pérez-Contreras, J., Pérez Fontán, M., Teixidó, J., Tornero, F., and Vega, N.
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- 2010
7. Plan de calidad científico-técnica y de mejora continua de calidad en diálisis peritoneal
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Bajo Rubio,María Auxiliadora, Selgas,R., Remón,C., Arrieta,J., Álvarez-Ude,F., Arenas,M.D., Borrás,M., Coronel,F., García-Ramón,R., Minguela,I., Pérez-Bañasco,V., Pérez-Contreras,J., Pérez Fontán,M., Teixidó,J., Tornero,F., and Vega,N.
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- 2010
8. Benefits of preserving residual renal function in peritoneal dialysis
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Marrón, B., primary, Remón, C., additional, Pérez-Fontán, M., additional, Quirós, P., additional, and Ortíz, A., additional
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- 2008
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9. Agreement between two routine methods of estimation of glomerular filtration rate in patients with advanced and terminal chronic renal failure
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Garcia-Naveiro, R., primary, Rodriguez-Carmona, A., additional, and Pérez-Fontán, M., additional
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- 2005
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10. A comparative survey on the incidence of kidney graft primary vascular thrombosis among CAPD and haemodialysis patients
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Escuin, F., primary, del Peso, G., additional, Pérez Fontán, M., additional, Rodriguez Carmona, A., additional, Martínez, A., additional, Lanuza, M., additional, Hortal, L., additional, Fernández, A. M., additional, Albero, M. D., additional, Pérez Contreras, J., additional, and Selgas, R., additional
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- 1996
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11. Switching from Weekly to Every-other-week Darbepoetin Alfa Administration Maintains Hemoglobin Levels in Peritoneal Dialysis.
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Bajo, M. A., Pérez Fontán, M., Remón, C., Sánchez-Tomero, J. A., Lladós, F., and Selgas, R.
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Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2009
12. Renal allograft rupture: diagnostic role of ultrasound.
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Soler, Rafaela, Pérez Fontán, F. J., Lago, M., Moncalián, J., and Pérez-Fontán, M.
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To evaluate the diagnostic role of ultrasound in spontaneous renal allograft rupture we reviewed 18 cases observed in our centre in 10 years. Ultrasound studies were performed immediately before surgery in 15 cases. Renal allograft rupture occurred during the first 3 weeks after transplantation in 17 cases (94%). Clinical findings were consistent with previous reports. The diagnosis was confirmed by surgical exploration in 17 cases, and by necropsy in the remaining one. Nine patients were treated by corsetage and eight by graft nephrectomy, while one patient died before surgery. Acute rejection was present in nine cases, and severe acute tubular necrosis in five; no renal tissue was available for histological study in four patients. On ultrasound examination, perirenal haematoma was the most frequent finding, while subcapsular/intrarenal haematoma or findings suggesting rejection or urinary tract obstruction were less frequently observed. In six cases, disruption of the white linear echoes of the capsule of the graft could be seen; this finding has not been described previously. Ultrasound has a definite role in presurgical evaluation of suspected renal transplant rupture. [ABSTRACT FROM PUBLISHER]
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- 1992
13. Guidelines of the Spanish Society of Nephrology. Clinical practice guidelines for peritoneal dialysis,Guías Sociedad Española de Nefrología. Guías de práctica clínica en diálisis peritoneal
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Arrieta, J., Bajo, M. A., Caravaca, F., Coronel, F., García-Pérez, H., González-Parra, E., Granado, A., Martín-Govantes, J., Miguel, A., Molina, A., Montenegro, J., Pérez-Bañasco, V., Pérez-Fontán, M., César Remón-Rodríguez, Rodríguez-Palomares, J. R., Ruiz, C., Sánchez-Moreno, A., and Vega, N.
14. Relationship between the growth hormone-insulin-like growth factor I axis and serum leptin in patients with chronic renal failure
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Cordido, F., Perez-Fontán, M., Rodriguez-Carmona, A., Isidro, L., Martinez, T., Garcia-Falcón, T., and Garcia-Buela, J.
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- 2000
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15. Situación de la infección por SARS-CoV-2 en pacientes en tratamiento renal sustitutivo. Informe del Registro COVID-19 de la Sociedad Espanñola de Nefrología (SEN)
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J. Emilio Sánchez-Álvarez, Miguel Pérez Fontán, Carlos Jiménez Martín, Miquel Blasco Pelícano, Carlos Jesús Cabezas Reina, Ángel M. Sevillano Prieto, Edoardo Melilli, Marta Crespo Barrios, Manuel Macía Heras, María Dolores del Pino y Pino, and [Sánchez-Álvarez,JE] Hospital Universitario de Cabueñes, Gijón, Asturias, España. [Pérez Fontán,M] Servicio de Nefrología, Complexo Hospitalario Universitario A Coruña, A Coruña, España. [Jiménez Martín,C] Servicio de Nefrología, Hospital Universitario La Paz, Madrid, España. [Blasco Pelícano,M] Servicio de Nefrología, Hospital Clínic de Barcelona, Barcelona, España. [Cabezas Reina,CJ] Servicio de Nefrología, Complejo Hospitalario de Toledo, Toledo, España. [Sevillano Prieto,MA] Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España. [Melilli,E] Servicio de Nefrología, Hospital Universitari de Bellvitge, Barcelona, España. [Crespo Barrios,M] Servicio de Nefrología, Consorci Parc de Salut Mar de Barcelona, Barcelona, España. [Macía Heras,M] Servicio de Nefrología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Canarias, España. [del Pino y Pino,MD] Servicio de Nefrología, Complejo Hospitalario Torrecárdenas, Almería, España.
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Sociedad Española de Nefrología ,Registry ,España ,030232 urology & nephrology ,Check Tags::Male [Medical Subject Headings] ,Disciplines and Occupations::Health Occupations::Medicine::Internal Medicine::Nephrology [Medical Subject Headings] ,030230 surgery ,lcsh:RC870-923 ,Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy [Medical Subject Headings] ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,03 medical and health sciences ,0302 clinical medicine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Statistical Distributions::Chi-Square Distribution [Medical Subject Headings] ,Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Hemodialysis Units, Hospital [Medical Subject Headings] ,Persons::Persons::Age Groups::Adult::Aged [Medical Subject Headings] ,Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings] ,Health Care::Health Services Administration::Organization and Administration::Records as Topic::Registries [Medical Subject Headings] ,SARS-CoV-2 ,Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Epidemiologic Factors::Age Factors [Medical Subject Headings] ,Health Care::Environment and Public Health::Public Health::Disease Outbreaks::Epidemics::Pandemics [Medical Subject Headings] ,Persons::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] ,Health Care::Health Care Economics and Organizations::Organizations::Societies::Societies, Medical [Medical Subject Headings] ,lcsh:Diseases of the genitourinary system. Urology ,Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [Medical Subject Headings] ,Spanish Society of Nephrology ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Symptom Assessment [Medical Subject Headings] ,Check Tags::Female [Medical Subject Headings] ,Nephrology ,Tratamiento renal sustitutivo ,Spain ,Renal replacement therapies ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Statistics, Nonparametric [Medical Subject Headings] ,Registro - Abstract
Introduction: The recent appearance of the SARS-CoV-2 coronavirus pandemic has had a significant impact on the general population. Patients on renal replacement therapy (RRT) have not been unaware of this situation and due to their characteristics they are especially vulnerable. We present the results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology. Material and methods: The Registry began operating on March 18th, 2020. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments and outcomes. It is an online registry. Patients were diagnosed with SARS-CoV-2 infection based on the results of the PCR of the virus, carried out both in patients who had manifested compatible symptoms or had suspicious signs, as well as in those who had undergone screening after some contact acquainted with another patient. Results: As of April 11, the Registry had data on 868 patients, from all the Autonomous Communities. The most represented form of RRT is in-center hemodialysis (ICH) followed by transplant patients. Symptoms are similar to the general population. A very high percentage (85%) required hospital admission, 8% in intensive care units. The most used treatments were hydroxychloroquine, lopinavir–ritonavir, and steroids. Mortality is high and reaches 23%; deceased patients were more frequently on ICH, developed pneumonia more frequently, and received less frequently lopinavir–ritonavir and steroids. Age and pneumonia were independently associated with the risk of death. Conclusions: SARS-CoV-2 infection already affects a significant number of Spanish patients on RRT, mainly those on ICH, hospitalization rates are very high and mortality is high; age and the development of pneumonia are factors associated with mortality. Resumen: Introducción: La reciente aparición de la pandemia por el coronavirus SARS-CoV-2 ha impactado de forma muy importante en la población general. Los pacientes en tratamiento renal sustitutivo (TRS) no han sido ajenos a esta situación y por sus características resultan especialmente vulnerables. Presentamos los resultados del análisis del Registro COVID-19 de la Sociedad Española de Nefrología. Material y métodos: EL Registro comenzó a funcionar el 18 de marzo de 2020. Recoge variables epidemiológicas, datos del contagio y diagnóstico, clínica acompañante, tratamientos y desenlace. Se trata de un registro on line. Los pacientes fueron diagnosticados de infección por SARS-CoV-2 en base a los resultados de la PCR del virus, realizada tanto en pacientes que habían manifestado clínica compatible o tenían signos sospechosos como en aquellos a los que se había hecho como cribado tras algún contacto conocido con otro enfermo. Resultados: A fecha 11 de abril el Registro disponía de datos de 868 pacientes, procedentes de todas las comunidades autónomas. La modalidad de TRS más representada es la hemodiálisis en centro (HDC) seguida de los pacientes trasplantados. La clínica de presentación es similar a la población general. Un porcentaje muy elevado (85%) requirió ingreso hospitalario, un 8% en unidades de cuidados intensivos. Los tratamientos más utilizados fueron hidroxicloroquina, lopinavir-ritonavir y esteroides. La mortalidad es elevada y alcanza el 23%: los pacientes fallecidos estaban con más frecuencia en HDC, desarrollaban más frecuentemente neumonía y recibían en menos ocasiones lopinavir-ritonavir y esteroides. La edad y la neumonía se asociaban de forma independiente al riesgo de fallecer. Conclusiones: La infección por SARS-CoV-2 afecta ya a un número importante de pacientes españoles en TRS, fundamentalmente aquellos que están en HDC, las tasas de hospitalización son muy elevadas y la mortalidad es elevada; la edad y el desarrollo de neumonía son factores asociados a mortalidad.
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- 2020
16. Clinical guideline on adequacy and prescription of peritoneal dialysis.
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Borràs Sans M, Ponz Clemente E, Rodríguez Carmona A, Vera Rivera M, Pérez Fontán M, Quereda Rodríguez-Navarro C, Bajo Rubio MA, de la Espada Piña V, Moreiras Plaza M, Pérez Contreras J, Del Peso Gilsanz G, Prieto Velasco M, Quirós Ganga P, Remón Rodríguez C, Sánchez Álvarez E, Vega Rodríguez N, Aresté Fosalba N, Benito Y, Fernández Reyes MJ, García Martínez I, Minguela Pesquera JI, Rivera Gorrín M, and Usón Nuño A
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- Humans, Peritoneal Dialysis, Continuous Ambulatory, Peritoneal Dialysis standards, Peritoneal Dialysis methods
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In recent years, the meaning of adequacy in peritoneal dialysis has changed. We have witnessed a transition from an exclusive achievement of specific objectives -namely solute clearances and ultrafiltration- to a more holistic approach more focused to on the quality of life of these patients. The purpose of this document is to provide recommendations, updated and oriented to social and health environment, for the adequacy and prescription of peritoneal dialysis. The document has been divided into three main sections: adequacy, residual kidney function and prescription of continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Recently, a guide on the same topic has been published by a Committee of Experts of the International Society of Peritoneal Dialysis (ISPD 2020). In consideration of the contributions of the group of experts and the quasi-simultaneity of the two projects, references are made to this guide in the relevant sections. We have used a systematic methodology (GRADE), which specifies the level of evidence and the strength of the proposed suggestions and recommendations, facilitating future updates of the document., (Copyright © 2024.)
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- 2024
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17. Association of urinary excretion rates of uric acid with biomarkers of kidney injury in patients with advanced chronic kidney disease.
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López Iglesias A, Blanco Pardo M, Rodríguez Magariños C, Pértega S, Sierra Castro D, García Falcón T, Rodríguez-Carmona A, and Pérez Fontán M
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- Humans, Male, Female, Middle Aged, Aged, Cross-Sectional Studies, Glomerular Filtration Rate, Disease Progression, Adult, Uric Acid blood, Uric Acid urine, Biomarkers urine, Biomarkers blood, Renal Insufficiency, Chronic urine, Renal Insufficiency, Chronic blood, Renal Insufficiency, Chronic complications
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Background: The potential influence of hyperuricemia on the genesis and progression of chronic kidney disease (CKD) remains controversial. In general, the correlation between blood levels of uric acid (UA) and the rate of progression of CKD is considered to be modest, if any, and the results of relevant trials oriented to disclose the effect of urate-lowering therapies on this outcome have been disappointing. Urinary excretion rates of UA could reflect more accurately the potential consequences of urate-related kidney injury., Method: Using a cross-sectional design, we investigated the correlation between different estimators of the rates of urinary excretion of UA (total 24-hour excretion, mean urinary concentration, renal clearance and fractional excretion)(main study variables), on one side, and urinary levels of selected biomarkers of kidney injury and CKD progression (DKK3, KIM1, NGAL, interleukin 1b and MCP)(main outcome variables), in 120 patients with advanced CKD (mean glomerular filtration rate 21.5 mL/minute). We took into consideration essential demographic, clinical and analytic variables with a potential confounding effect on the explored correlations (control variables). Spearman's rho correlation and nonlinear generalized additive regression models (GAM) with p-splines smoothers were used for statistical analysis., Main Results: Multivariate analysis disclosed independent correlations between urinary UA concentrations, clearances and fractional excretion rates (but not plasma UA or total 24-hour excretion rates of UA), on one side, and the scrutinized markers. These correlations were more consistent for DKK3 and NGAL than for the other biomarkers. Glomerular filtration rate, proteinuria and treatment with statins or RAA axis antagonists were other independent correlates of the main outcome variables., Conclusions: Our results support the hypothesis that urinary excretion rates of UA may represent a more accurate marker of UA-related kidney injury than plasma levels of this metabolite, in patients with advanced stages of CKD. Further, longitudinal studies will be necessary, to disclose the clinical significance of these findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 López Iglesias et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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18. Involvement of Mitochondrial Dysfunction in the Inflammatory Response in Human Mesothelial Cells from Peritoneal Dialysis Effluent.
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Ramil-Gómez O, López-Pardo M, Fernández-Rodríguez JA, Rodríguez-Carmona A, Pérez-López T, Vaamonde-García C, Pérez-Fontán M, and López-Armada MJ
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Recent studies have related mitochondrial impairment with peritoneal membrane damage during peritoneal dialysis (PD) therapy. Here, we assessed the involvement of mitochondrial dysfunction in the inflammatory response in human mesothelial cells, a hallmark in the pathogenesis of PD-related peritoneal membrane damage. Our ex vivo studies showed that IL-1β causes a drop in the mitochondrial membrane potential in cells from peritoneal effluent. Moreover, when mitochondrial damage was induced by inhibitors of mitochondrial function, a low-grade inflammatory response was generated. Interestingly, mitochondrial damage sensitized mesothelial cells, causing a significant increase in the inflammatory response induced by cytokines, in which ROS generation and NF-κB activation appear to be involved, since inflammation was counteracted by both mitoTEMPO (mitochondrial ROS scavenger) and BAY-117085 (NF-κB inhibitor). Furthermore, the natural anti-inflammatory antioxidant resveratrol significantly attenuated the inflammatory response, by reversing the decline in mitochondrial membrane potential and decreasing the expression of IL-8, COX-2 and PGE
2 caused by IL-1β. These findings suggest that IL-1β regulates mitochondrial function in mesothelial cells and that mitochondrial dysfunction could induce an inflammatory scenario that sensitizes these cells, causing significant amplification of the inflammatory response induced by cytokines. Resveratrol may represent a promising strategy in controlling the mesothelial inflammatory response to PD.- Published
- 2022
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19. Mitochondrial Dysfunction Plays a Relevant Role in Pathophysiology of Peritoneal Membrane Damage Induced by Peritoneal Dialysis.
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Ramil-Gómez O, Rodríguez-Carmona A, Fernández-Rodríguez JA, Pérez-Fontán M, Ferreiro-Hermida T, López-Pardo M, Pérez-López T, and López-Armada MJ
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Preservation of the peritoneal membrane is an essential determinant of the long-term outcome of peritoneal dialysis (PD). Epithelial-to-mesenchymal transition (EMT) plays a central role in the pathogenesis of PD-related peritoneal membrane injury. We hypothesized that mitochondria may be implicated in the mechanisms that initiate and sustain peritoneal membrane damage in this setting. Hence, we carried out ex vivo studies of effluent-derived human mesothelial cells, which disclosed a significant increase in mitochondrial reactive oxygen species (mtROS) production and a loss of mitochondrial membrane potential in mesothelial cells with a fibroblast phenotype, compared to those preserving an epithelial morphology. In addition, in vitro studies of omentum-derived mesothelial cells identified mtROS as mediators of the EMT process as mitoTEMPO, a selective mtROS scavenger, reduced fibronectin protein expression induced by TGF-ß1. Moreover, we quantified mitochondrial DNA (mtDNA) levels in the supernatant of effluent PD solutions, disclosing a direct correlation with small solute transport characteristics (as estimated from the ratio dialysate/plasma of creatinine at 240 min), and an inverse correlation with peritoneal ultrafiltration. These results suggest that mitochondria are involved in the EMT that human peritoneal mesothelial cells suffer in the course of PD therapy. The level of mtDNA in the effluent dialysate of PD patients could perform as a biomarker of PD-induced damage to the peritoneal membrane.
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- 2021
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20. Does Prior Abdominal Surgery Influence Peritoneal Transport Characteristics or Technique Survival of Peritoneal Dialysis Patients?
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Dias da Silva A, García Gago L, Rodríguez Magariños C, Astudillo Jarrín D, Rodríguez-Carmona A, García Falcón T, and Pérez Fontán M
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- Adult, Aged, Aged, 80 and over, Biological Transport, Female, Humans, Male, Middle Aged, Peritoneum surgery, Retrospective Studies, Young Adult, Abdomen surgery, Peritoneal Dialysis methods, Peritoneum metabolism
- Abstract
Introduction: Prior abdominal surgery may result in peritoneal membrane adhesions and fibrosis, compromising the success of peritoneal dialysis (PD). The impact of this factor on peritoneal membrane function and PD technique survival has not been adequately investigated., Methods: Following an observational, retrospective design, we studied 171 incident PD patients, with the main objective of analyzing the influence of prior abdominal surgical procedures (main study variable) on baseline and evolutionary peritoneal transport characteristics (main outcome) and PD patient and technique survival (secondary outcomes). Abdominal surgeries were categorized according to the degree of presumed injury to the peritoneal membrane. We also considered the additive effect of aggressions to the membrane during the first year on PD therapy., Results: All patients had a baseline peritoneal equilibration test with complete drainage at 60', and 113 patients had a second study at the end of the first year. Sixty-one patients (35.7%) had a record of prior abdominal surgery, including 29 patients with at least one major intraperitoneal surgery, 22 having undergone minor intraperitoneal procedures, and 21 with a background of major abdominopelvic extraperitoneal surgery. We did not observe differences, at baseline or after 1 year, among patients with or without previous abdominal procedures regarding small solute transport, overall capacity of ultrafiltration, free water transport, small pore ultrafiltration, or peritoneal protein excretion. Stratified analysis, considering prior and first-year-on-PD peritoneal aggressions, did not reveal any differences, although in this case our analysis was hampered by a limited statistical power. Abdominal surgical events did not influence patient or PD technique survival., Conclusion: Prior abdominal surgical procedures do not appear to compromise peritoneal membrane function or technique survival in patients successfully started on PD., (© 2020 S. Karger AG, Basel.)
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- 2021
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21. Long-term trends in the incidence of peritoneal dialysis-related peritonitis disclose an increasing relevance of streptococcal infections: A longitudinal study.
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Santos JE, Rodríguez Magariños C, García Gago L, Astudillo Jarrín D, Pértega S, Rodríguez-Carmona A, García Falcón T, and Pérez Fontán M
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- Adult, Aged, Anti-Bacterial Agents therapeutic use, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Peritoneal Dialysis trends, Peritonitis microbiology, Proportional Hazards Models, Retrospective Studies, Risk Factors, Streptococcal Infections drug therapy, Streptococcal Infections epidemiology, Streptococcus, Peritoneal Dialysis adverse effects, Peritonitis epidemiology, Peritonitis etiology
- Abstract
Background: The selective impact of strategies for prevention of PD-related peritonitis (PDrP) may have modified, in the long term, the causal spectrum, clinical presentation and outcomes of these infections., Objectives: To compare trends in the incidence of PDrP by different microorganisms during a 30-year period, with a particular focus on streptococcal infections. To analyze the clinical presentation and outcomes of these infections. Secondarily, to investigate how the isolation of different species of streptococci can influence the clinical course of PDrP by this genus of bacteria., Method: Following a retrospective, observational design we investigated 1061 PDrP (1990-2019). We used joinpoint regression analysis to explore trends in the incidence of PDrP by different microorganisms, and compared the risk profile (Cox), clinical presentation and outcomes (logistic regression) of these infections., Main Results: Our data showed a progressive decline in the incidence of PDrP by staphylococci and Gram negative bacteria, while the absolute rates of streptococcal (average annual percent change +1.6%, 95% CI -0.1/+3.2) and polymicrobial (+1.8%, +0.1/+3.5) infections tended to increase, during the same period. Remarkably, streptococci were isolated in 58.6% of polymicrobial infections, and patients who suffered a streptococcal PDrP had a 35.8% chance of presenting at least one other infection by the same genus. The risk profile for streptococcal infections was comparable to that observed for PDrP overall. Streptococcal PDrP were associated with a severe initial inflammatory response, but their clinical course was generally nonaggressive thereafter. We did not observe a differential effect of different groups of streptococci on the clinical presentation or outcome of PDrP., Conclusions: Time trends in the incidence of PDrP by different microorganisms have granted streptococci an increasing relevance as causative agents of these infections, during the last three decades. This behaviour suggests that current measures of prevention of PDrP may not be sufficiently effective, in the case of this genus of microorganisms., Competing Interests: The authors have declared that no competing interests exist.
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- 2020
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22. [SARS-CoV-2 infection in patients on renal replacement therapy. Report of the COVID-19 Registry of the Spanish Society of Nephrology (SEN)].
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Sánchez-Álvarez JE, Pérez Fontán M, Jiménez Martín C, Blasco Pelícano M, Cabezas Reina CJ, Sevillano Prieto ÁM, Melilli E, Crespo Barrios M, Macía Heras M, and Del Pino Y Pino MD
- Subjects
- Age Factors, Aged, COVID-19, Chi-Square Distribution, Coronavirus Infections drug therapy, Coronavirus Infections mortality, Female, Hemodialysis Units, Hospital statistics & numerical data, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Pneumonia, Viral drug therapy, Pneumonia, Viral mortality, SARS-CoV-2, Societies, Medical, Spain epidemiology, Statistics, Nonparametric, Symptom Assessment statistics & numerical data, Transplant Recipients statistics & numerical data, Betacoronavirus, Coronavirus Infections epidemiology, Nephrology statistics & numerical data, Pandemics, Pneumonia, Viral epidemiology, Registries statistics & numerical data, Renal Replacement Therapy statistics & numerical data
- Abstract
Introduction: The recent appearance of the SARS-CoV-2 coronavirus pandemic has had a significant impact on the general population. Patients on renal replacement therapy (RRT) have not been unaware of this situation and due to their characteristics they are especially vulnerable. We present the results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology., Material and Methods: The Registry began operating on March 18th, 2020. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments and outcomes. It is an online registry. Patients were diagnosed with SARS-CoV-2 infection based on the results of the PCR of the virus, carried out both in patients who had manifested compatible symptoms or had suspicious signs, as well as in those who had undergone screening after some contact acquainted with another patient., Results: As of April 11, the Registry had data on 868 patients, from all the Autonomous Communities. The most represented form of RRT is in-center hemodialysis (ICH) followed by transplant patients. Symptoms are similar to the general population. A very high percentage (85%) required hospital admission, 8% in intensive care units. The most used treatments were hydroxychloroquine, lopinavir-ritonavir, and steroids. Mortality is high and reaches 23%; deceased patients were more frequently on ICH, developed pneumonia more frequently, and received less frequently lopinavir-ritonavir and steroids. Age and pneumonia were independently associated with the risk of death., Conclusions: SARS-CoV-2 infection already affects a significant number of Spanish patients on RRT, mainly those on ICH, hospitalization rates are very high and mortality is high; age and the development of pneumonia are factors associated with mortality., (Copyright © 2020 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2020
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23. Analysis of Factors Influencing the Prognostic Significance of Hyponatremia in Peritoneal Dialysis Patients.
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Bravo González-Blas L, García-Gago L, Astudillo-Jarrín D, Rodríguez-Magariños C, López-Iglesias A, García Falcón T, Rodríguez-Carmona A, and Pérez Fontán M
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- Adult, Aged, Female, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Hyponatremia mortality, Peritoneal Dialysis mortality
- Abstract
Background: The evidence linking low serum sodium levels with the risk of mortality in peritoneal dialysis (PD) patients is controversial. Considering the different mechanisms contributing to hyponatremia in these patients, it is conceivable that the prognostic significance of this factor may vary, according to the clinical setting., Methods: Following a retrospective, observational design, we analyzed the association between hyponatremia and mortality in 748 patients incident on PD. We applied multivariate strategies of analysis, with the main objective of identifying subgroups of patients in whom hyponatremia could sustain different degrees of association with mortality (main outcome variable). For this purpose, we performed preliminary analyses to: (1) disclose predictors of serum sodium levels before and after (mean of first 3 months) initiation of PD (main study variable) and (2) investigate the overall prognostic significance of hyponatremia, in our patients., Results: Comorbidity, hypoalbuminemia, and lower glomerular filtration rate (GFR) were main predictors of hyponatremia. Use of icodextrin was another inverse correlate of serum sodium, and the only consistent predictor of a decline of natremia, once PD was started. Multivariate analysis confirmed early hyponatremia as an independent marker of survival. However, stratified analyses showed that this association was most apparent in specific subsets, namely, hypoalbuminemic, more anemic patients with higher baseline levels of GFR and C-reactive protein and faster peritoneal solute transport rates. Other factors potentially reinforcing the prognostic significance of hyponatremia included lower lean body mass levels, nonprescription of renin-angiotensin-aldosterone system antagonists, and use of icodextrin-based PD solution. On the contrary, baseline overhydration or categorization by classic predictors of mortality (age, comorbidity, diabetes) did not appear to influence the risk pattern associated with lower serum sodium levels., Conclusions: Our results suggest that hyponatremia performs as a consistent correlate of the risk of mortality mainly in PD patients manifesting direct or indirect signs of inflammation and wasting, while this association is not apparently linked to the presence of overhydration or nominal, preexisting comorbid conditions., (© 2019 S. Karger AG, Basel.)
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- 2020
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24. Persistent overhydration is associated with a significant risk of peritoneal infection by enteric pathogens in patients treated with peritoneal dialysis.
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Carvalho Fiel D, Pérez-Fontán M, López Iglesias A, Bravo González-Blas L, García Gago L, García Falcón T, and Rodríguez-Carmona A
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Assessment, Bacterial Infections epidemiology, Bacterial Infections etiology, Peritoneal Dialysis adverse effects, Peritonitis epidemiology, Peritonitis etiology, Water-Electrolyte Imbalance complications
- Abstract
Background: Overhydration (OH) complicates frequently the clinical course of Peritoneal Dialysis (PD) patients, and keeps a controversial association with the risk of peritoneal infection. The main objective of this study was to disclose an association between persistent OH and the risk of enteric peritonitis in a relatively large sample of patients undergoing PD., Method: Following a prospective design, we monitorized systematically body composition of patients treated with PD in our unit (2011-2016), searching for a correlation with the ensuing risk of peritonitis, with an emphasis on the association between persistent OH (main study variable) and the risk of infection by enteric pathogens (main outcome). Essential demographic, clinical and laboratory variables with a potential influence on the risk of peritonitis were recorded. We used multivariate survival analysis to clarify the specific effect of different body composition parameters on the main outcome., Main Results: We included 139 patients for analysis (mean follow-up 24 months). Sixty-three patients suffered at least one peritonitis, and 17 had at least one diagnosis of enteric peritonitis. Univariate analysis disclosed a general trend to an increased risk of enteric peritonitis in overhydrated patients, as evidenced by associations of this outcome with mean extracellular water/intracellular water (ECW/ICW) (p=.007), OH/ECW (p=.033) and ECW/total body water (ECW/TBW) (p=.004) ratios, but not with absolute OH values. Multivariate analysis confirmed similar associations or trends (RR: 3.48, 95% CI: 1.03-14.59; p=.046, highest versus lowest tertile of ECW/ICW, RR: 2.31, 95% CI: 0.98-6.56; p=.061, highest versus lowest tertile of OH/ECW, and RR: 6.33, 95% CI: 1.37-19.37; p=.011, highest versus lowest tertile of ECW/TBW). On the contrary, no apparent association was detected between OH and the overall risk of peritoneal infection., Conclusion: Persistent overhydration portends a significant risk of peritoneal infection by enteric pathogens, among patients undergoing chronic PD., (Copyright © 2019 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2019
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25. High rates of protein intake are associated with an accelerated rate of decline of residual kidney function in incident peritoneal dialysis patients.
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Otero Alonso P, Pérez Fontán M, López Iglesias A, García Falcón T, and Rodríguez-Carmona A
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- Adult, Aged, Disease Progression, Female, Humans, Kidney Failure, Chronic physiopathology, Kidney Function Tests, Kinetics, Male, Middle Aged, Multivariate Analysis, Nitrogen analysis, Nutritional Status, Odds Ratio, Probability, Retrospective Studies, Treatment Outcome, Urea analysis, Diet, Dietary Proteins adverse effects, Glomerular Filtration Rate, Kidney Failure, Chronic therapy, Peritoneal Dialysis adverse effects
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Background: Preservation of residual kidney function (RKF) is a relevant objective in peritoneal dialysis (PD) patients. The influence of dietary protein intake (PI) on this variable has not been adequately investigated., Methods: Following an observational design, we studied 336 patients incident on PD, with a minimum follow-up of 6 months. The main study variable was the mean PI [normalized rate of protein nitrogen appearance (nPNA)] during the first 4 months on PD. The main outcome variables were the absolute rate of decline of RKF and the proportion of patients presenting a >50% decay of their RKF during the first year of follow-up. We applied univariate and multivariate strategies of analysis, taking into consideration the main control variables bearing a correlation with nPNA and/or RKF., Results: Mean nPNA (first 4 months) was 1.23 ± 0.33 g/kg/day, while the overall rate of decline of RKF was -0.13 ± 0.29 mL/min/month; 69 patients (25.1%) had lost >50% of their initial RKF by the end of the first year. Univariate analysis disclosed consistent associations between the main study variable on one hand and baseline RKF (r = 0.32, P < 0.0005) and its rate of decline (r = -0.23, P < 0.0005) on the other. The latter two variables were also significantly correlated (r = -0.36, P < 0.0005). Multivariate analysis identified mean nPNA as an independent predictor of the rate of decline of RKF [odds ratio 1.09 per 0.10 g/kg/day, 95% confidence interval (CI) 0.99-1.19, P = 0.058] and, in particular, of the probability of losing >50% of the baseline RKF during the first year of treatment (odds ratio 1.15 per 0.10 g/kg/day, 95% CI 1.04-1.27, P = 0.006)., Conclusion: Higher rates of PI during the first months of therapy are associated with a faster decline of RKF among patients incident on PD. Our results underline the convenience of keeping an adequate balance between sufficient protein ingestion, to prevent malnutrition and wasting, and sensible restriction in stable, adequately nourished individuals with rates of intake in the higher range or above-recommended allowances., (© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
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- 2019
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26. The Spanish Society of Nephrology (SENEFRO) commentary to the Spain GBD 2016 report: Keeping chronic kidney disease out of sight of health authorities will only magnify the problem.
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Ortiz A, Sanchez-Niño MD, Crespo-Barrio M, De-Sequera-Ortiz P, Fernández-Giráldez E, García-Maset R, Macía-Heras M, Pérez-Fontán M, Rodríguez-Portillo M, Salgueira-Lazo M, Sánchez-Álvarez E, Santamaría-Olmo R, Simal-Blanco F, and Pino-Pino MD
- Subjects
- Alzheimer Disease epidemiology, Cause of Death, Humans, Nephrology, Quality-Adjusted Life Years, Renal Insufficiency, Chronic epidemiology, Societies, Medical, Spain epidemiology, Global Burden of Disease statistics & numerical data, Renal Insufficiency, Chronic mortality
- Abstract
The Global Burden of Disease (GBD) study measures the health of populations worldwide and by country on an annual basis and aims at helping guide public policy on health issues. The GBD estimates for Spain in 2016 and recent trends in mortality and morbidity from 2006 to 2016 were recently published. According to these estimates, chronic kidney disease was the 8th cause of death in Spain in 2016. Among the top ten causes of death, chronic kidney disease was the fastest growing from 2006 to 2016, after Alzheimer disease. At the current pace of growth, chronic kidney disease is set to become the second cause of death in Spain, after Alzheimer disease, by 2100. Additionally, among major causes of death, chronic kidney disease also ranked second only to Alzheimer as the fastest growing cause of Years Lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs). Public resources devoted to prevention, care and research on kidney disease should be in line with both its current and future burden., (Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2019
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27. Peritoneal Dialysis Is an Independent Factor Associated to Lower Intima Media Thickness in Dialysis Patients Free From Previous Cardiovascular Disease.
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Borràs M, Cambray S, Crespo-Masip M, Pérez-Fontán M, Bozic M, Bermudez-López M, Fernández E, Betriu À, and Valdivielso JM
- Abstract
Carotid intima media thickness (cIMT) displays prognostic value as a marker of cardiovascular risk in dialysis patients. However, few data are available regarding the impact of dialysis modality on cIMT. The aim of this study is to determine whether the modality of dialysis influences cIMT values. We compared 237 peritoneal dialysis (PD) and 451 hemodialysis (HD) patients without previous cardiovascular disease included in NEFRONA, a prospective, observational and multicenter study. This cross sectional study included the determination of cIMT in 6 carotid territories by arterial ultrasound. cIMT was determined in territories without atheroma plaque and averaged. A second analysis was performed using all territories, giving a truncated cIMT value of 1,5 mm to territories presenting with atheroma plaque. Age and plaque presence at baseline were the clinical variables more closely associated to cIMT in dialysis patients. The evaluation of the impact of the modality of dialysis on cIMT showed that PD patients had lower cIMT than HD patients, both in territories with no plaques and when using truncated cIMT values. No differences were found between right and left sides, neither in cIMT or truncated cIMT values. Lineal multivariate analysis adjusted by several clinical variables showed a statistically significant association of PD with a lower cIMT (slope -0.036; SD 0.010). These results were also confirmed when truncated cIMT values were used. We conclude that the modality of dialysis has an impact on cITM. HD patients have greater global cIMT than PD patients, and PD is and independent factor associated with a lower cIMT.
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- 2018
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28. Correction: The modality of dialysis does not influence atheromatous vascular disease progression or cardiovascular outcomes in dialysis patients without previous cardiovascular disease.
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Borràs Sans M, Pérez-Fontán M, Martinez-Alonso M, Bajo A, Betriu À, Valdivielso JM, and Fernández E
- Abstract
[This corrects the article DOI: 10.1371/journal.pone.0186921.].
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- 2018
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29. Comprehensive Approach to Peritoneal Dialysis-Related Peritonitis by Enteric Microorganisms. Comparison Between Single Organism and Polymicrobial Infections.
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Ribera-Sánchez R, Pérez-Fontán M, López-Iglesias A, García-Enríquez A, and Rodríguez-Carmona A
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- Aged, Anti-Bacterial Agents therapeutic use, Female, Hospitalization, Humans, Male, Middle Aged, Peritonitis prevention & control, Retrospective Studies, Coinfection microbiology, Enterococcaceae, Kidney Failure, Chronic therapy, Peritoneal Dialysis adverse effects, Peritonitis microbiology
- Abstract
Background: Peritoneal infections of enteric origin (EntP) have been classically investigated using partial strategies, focused on particular subgroups of microorganisms. A more comprehensive approach may facilitate the definition of the nomenclature and clinical presentation of these infections., Objectives: To investigate the clinical presentation and outcomes of a full spectrum of EntP, with a particular interest in the comparison between single-organism and polymicrobial infections., Method: Following an observational design, we investigated 165 single-organism and 83 polymicrobial peritonitis episodes with isolation of at least 1 enteric bacteria ( Enterobacteriaceae , Enterococcus spp. and/or intestinal anaerobics). We compared the risk of treatment failure for these 2 types of infection and explored the significance of the isolation of specific microorganisms and of their antibacterial susceptibility patterns., Results: Polymicrobial EntP was associated with higher rates of hospitalization, more changes to initial antibiotic therapy, more surgical explorations, and higher mortality and treatment failure rates than monobacterial EntP. However, stratified and multivariate analyses revealed that the burden of these differences rested on the isolation of intestinal anaerobics (odds ratio [OR] 12.05, 95% confidence interval [CI] 2.53-31.09, p < 0.001) and/or Enterococcus faecium (OR 3.37, 95% CI 1.02-11.30, p = 0.046), while other polymicrobial infections were more comparable with single-organism peritonitis, except for even higher mortality rates in the former group. Lower antibiotic susceptibility of the isolations (OR 1.18, 95% CI 0.51-2.70, p = 0.70) did not perform as a predictor of treatment failure., Conclusion: A comprehensive approach to peritoneal infections by intestinal microorganisms may provide a focused perspective of the clinical presentation and outcomes of these complications of peritoneal dialysis., (Copyright © 2018 International Society for Peritoneal Dialysis.)
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- 2018
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30. The modality of dialysis does not influence atheromatous vascular disease progression or cardiovascular outcomes in dialysis patients without previous cardiovascular disease.
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Borràs Sans M, Pérez-Fontán M, Martinez-Alonso M, Bajo A, Betriu À, Valdivielso JM, and Fernández E
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- Adult, Carotid Arteries diagnostic imaging, Disease Progression, Female, Humans, Male, Middle Aged, Prospective Studies, Survival Analysis, Atherosclerosis pathology, Cardiovascular Diseases pathology, Renal Dialysis methods
- Abstract
Background: There is limited and inconclusive information regarding the influence of the modality of renal replacement therapy on the atherosclerotic burden of patients on dialysis. The aim of this study was to compare the prevalence of asymptomatic atheromatous carotid disease, as also its rate of progression and cardiovascular outcomes, in two matched populations of patients treated with hemodialysis (HD) and peritoneal dialysis (PD)., Methods: Following a prospective, observational and multicenter design, we compared 237 PD and 237 HD patients without previous cardiovascular disease, included in the NEFRONA study, and matched for age, sex, diabetes and time on dialysis. Carotid ultrasound study was performed at baseline and after two years of follow-up in 6 carotid territories. Atheromatous vascular disease (AVD) progression was defined as any increase in the number of territories with plaques after 2 years. Fatal and non fatal cardiovascular events were also recorded during 36-month of follow-up., Main Results: At baseline, PD patients presented a worse general cardiovascular risk profile than HD patients. On the contrary, some markers of prevalent atherosclerotic disease (common carotid intima-media thickness and ankle-brachial index) were more favorable in PD patients. During follow-up, we observed no differences either in the rate of progression of atheromatous vascular disease (OR 1.78, 95% CI 0.80-4.06, p = 0.161) or in the incidence of cardiovascular events (OR 1.51, 95% CI 0.85-2.66, p = 0.159), according to the modality of dialysis., Conclusion: Dialysis modality did not impact on atherosclerotic carotid disease progression or cardiovascular outcomes, in two groups of patients treated with PD or HD.
- Published
- 2017
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31. Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study.
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Fernandes A, Ribera-Sanchez R, Rodríguez-Carmona A, López-Iglesias A, Leite-Costa N, and Pérez Fontán M
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- Adult, Aged, Biological Transport, Creatinine blood, Cross-Sectional Studies, Diabetic Nephropathies blood, Diabetic Nephropathies therapy, Female, Glucose metabolism, Hemodialysis Solutions chemistry, Humans, Kidney Failure, Chronic blood, Kidney Failure, Chronic therapy, Longitudinal Studies, Male, Middle Aged, Sodium blood, Sodium metabolism, Diabetic Nephropathies metabolism, Hemodiafiltration statistics & numerical data, Kidney Failure, Chronic metabolism, Peritoneal Dialysis statistics & numerical data, Peritoneum metabolism, Water metabolism
- Abstract
Background: Volume overload is frequent in diabetics undergoing peritoneal dialysis (PD), and may play a significant role in the excess mortality observed in these patients. The characteristics of peritoneal water transport in this population have not been studied sufficiently., Method: Following a prospective, single-center design we made cross-sectional and longitudinal comparisons of peritoneal water transport in 2 relatively large samples of diabetic and nondiabetic PD patients. We used 3.86/4.25% glucose-based peritoneal equilibration tests (PET) with complete drainage at 60 min, for these purposes., Main Results: We scrutinized 59 diabetic and 120 nondiabetic PD patients. Both samples showed relatively similar characteristics, although diabetics were significantly more overhydrated than nondiabetics. The baseline PET disclosed lower ultrafiltration (mean 439 mL diabetics vs. 532 mL nondiabetics, p = 0.033) and sodium removal (41 vs. 53 mM, p = 0.014) rates in diabetics. One hundred and nine patients (36 diabetics) underwent a second PET after 12 months, and 45 (14 diabetics) underwent a third one after 24 months. Longitudinal analyses disclosed an essential stability of water transport in both groups, although nondiabetic patients showed a trend where an increase in free water transport (p = 0.033) was observed, which was not the case in diabetics., Conclusions: Diabetic patients undergoing PD present lower capacities of ultrafiltration and sodium removal than their nondiabetic counterparts. Longitudinal analyses disclose an essential stability of water transport capacities, both in diabetics and nondiabetics. The clinical significance of these differences deserves further analysis., (© 2017 S. Karger AG, Basel.)
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- 2017
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32. Low Serum Levels of Vitamin D are Associated with Progression of Subclinical Atherosclerotic Vascular Disease in Peritoneal Dialysis Patients: A Prospective, Multicenter Study.
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Pérez Fontán M, Borràs Sans M, Bajo Rubio MA, Rodriguez-Carmona A, Betriu A, Valdivielso JM, and Fernández E
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- Adult, Aged, Biomarkers blood, Disease Progression, End Stage Liver Disease complications, End Stage Liver Disease therapy, Female, Humans, Longitudinal Studies, Male, Middle Aged, Plaque, Atherosclerotic blood, Prospective Studies, Ultrasonography, Vitamin D blood, Vitamin D Deficiency blood, Peritoneal Dialysis adverse effects, Plaque, Atherosclerotic complications, Vitamin D Deficiency complications
- Abstract
Background: The prevalence of subclinical atherosclerosis and the main predictors of progression of this condition in patients undergoing peritoneal dialysis (PD) have been insufficiently investigated., Objectives and Method: Following a prospective, multicenter, observational design, we studied 237 patients who were treated with PD for ≥3 months, without any clinical background of cardiovascular (CV) disease. Our objectives were the following: (1) to investigate the prevalence of subclinical atherosclerosis, as compared to a control group of age- and sex-matched healthy individuals, and (2) to disclose PD technique-related predictors of progression of disease during a 24-month follow-up period. We used vascular ultrasound for characterization of subclinical atherosclerotic disease., Main Results: A total of 123 patients (51.9%) vs. 79 controls (33.5%) presented ≥1 carotid plaque, and 114 patients (48.3%) vs. 72 controls (30.5%) ≥1 femoral plaque, at baseline evaluation (p < 0.0005). Progression of disease, either in clinical or ultrasound (new plaques) terms, affected 62.6% of patients. Multivariate analysis identified age, carotid intima-media thickness, presence of ≥1 carotid plaque, and serum levels of 25OH vitamin D and C-reactive protein (CRP) at baseline as independent correlates of progression of atherosclerotic disease. On the contrary, PD technique-related variables did not show any association with this outcome., Conclusions: Atherosclerotic vascular disease is frequent among asymptomatic patients undergoing PD. Older age, pre-existent disease (assessed by vascular ultrasound), and serum levels of 25OH vitamin D and CRP are independent markers of the progression of this condition. These findings may contribute to improve identification of subpopulations with a high risk of CV events, deserving intensified measures of prevention., (© 2017 S. Karger AG, Basel.)
- Published
- 2017
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33. Serum levels of the adipomyokine irisin in patients with chronic kidney disease.
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Rodríguez-Carmona A, Pérez Fontán M, Sangiao Alvarellos S, García Falcón T, Pena Bello ML, López Muñiz A, and Cordido F
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- Adult, Aged, Case-Control Studies, Cross-Sectional Studies, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Peritoneal Dialysis, Renal Dialysis, Fibronectins blood, Renal Insufficiency, Chronic blood
- Abstract
Background: Irisin is an adipomyokine with claimed anti-obesity and anti-diabetic effects. This hormone has been insufficiently studied in patients with advanced chronic kidney disease (CKD)., Objective: To perform an exploratory analysis of serum irisin levels in patients undergoing different CKD treatments., Method: Following a cross-sectional design, we estimated serum levels of irisin in 95 patients with CKD managed conservatively (advanced CKD), with peritoneal dialysis (PD) or with haemodialysis, and compared our findings with a control group of 40 healthy individuals. We investigated the correlations between serum irisin and demographic, clinical, body composition and metabolic variables., Results: Irisin levels were lower in all the CKD groups than in the control group. The univariate analysis revealed limited correlations between irisin, on the one hand, and fat (but not lean) mass, glomerular filtration rate (GFR) and plasma albumin and bicarbonate, on the other. The multivariate analysis confirmed that advanced CKD patients managed conservatively (difference 111.1ng/ml), with PD (25.9ng/ml) or haemodialysis (61.4ng/ml) (all P<.0005) presented lower irisin levels than the control group. Furthermore, PD patients presented higher serum levels of irisin than those on haemodialysis (difference 39.4ng/ml, P=.002) or those managed conservatively (24.4 ng/ml, P=.036). The multivariate analysis also identified plasma bicarbonate (B=3.90 per mM/l, P=.001) and GFR (B=1.89 per ml/minute, P=.003) as independent predictors of irisin levels. Conversely, no adjusted correlation between irisin and body composition markers was found., Conclusions: Serum irisin levels are low in patients with CKD and show a consistent correlation with GFR and plasma bicarbonate levels. PD patients present higher levels of irisin than those managed conservatively or with haemodialysis. Our study confirms a general inconsistency of the association between serum irisin levels, on the one hand, and body composition and metabolic markers, on the other., (Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2016
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34. Circulating Levels of Irisin in Hypopituitary and Normal Subjects.
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Pena-Bello L, Pértega-Diaz S, Sangiao-Alvarellos S, Outeiriño-Blanco E, Eiras-Leal R, Varela-Rodriguez B, Juiz-Valiña P, Pérez-Fontán M, Cordido M, and Cordido F
- Subjects
- Adult, Case-Control Studies, Female, Humans, Male, Middle Aged, Muscle, Skeletal metabolism, Fibronectins blood, Hypopituitarism blood
- Abstract
Context: The recently identified myokine irisin conveys some of the benefits of exercise. Hypopituitarism with adult growth hormone deficiency (HP) is a situation characterized by decreased GH secretion and an altered body composition., Objective: Our aim was to study the skeletal muscle hormone irisin in HP, and compare the results with a similar group of normal subjects., Participants and Methods: Seventeen HP patients and fifty-one normal subjects of similar age and sex were studied. The diagnosis of GH deficiency was confirmed by the presence of pituitary disease and a peak GH secretion below 3 μg/L after an insulin tolerance test. The patients were adequately treated for all pituitary hormone deficits, except for GH. Fasting serum irisin was measured with an enzyme immunoassay, and HOMA-IR, QUICKI and HOMA-β were calculated., Results: Fasting irisin levels (ng/ml) were similar in normal [208.42 (168.44-249.23)] and HP patients [195.13 (178.44-241.44)]. In the control group there were moderate significant positive correlations between irisin and BMI, waist circumference, leptin, fasting insulin, HOMA-IR, HOMA-β, triglycerides, and cholesterol. In the control group there were moderate significant negative correlations between irisin and IGF-I and QUICKI. In the hypopituitary group there were moderate significant positive correlations between irisin and body fat and HOMA-β., Conclusions: We found similar irisin levels in GH deficiency hypopituitary patients when compared with normal subjects. The correlation between irisin and adiposity related factors suggests that that in the case of this clinical model, irisin is regulated by adiposity and not by GH.
- Published
- 2016
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35. Baseline Residual Kidney Function and Its Ensuing Rate of Decline Interact to Predict Mortality of Peritoneal Dialysis Patients.
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Pérez Fontán M, Remón Rodríguez C, da Cunha Naveira M, Borràs Sans M, Rodríguez Suárez C, Quirós Ganga P, Sánchez Alvarez E, and Rodríguez-Carmona A
- Subjects
- Adult, Aged, Female, Humans, Kidney pathology, Kidney Function Tests, Longitudinal Studies, Male, Middle Aged, Peritonitis pathology, Glomerular Filtration Rate physiology, Kidney physiopathology, Peritoneal Dialysis, Peritonitis mortality, Peritonitis therapy
- Abstract
Background: Baseline residual kidney function (RKF) and its rate of decline during follow-up are purported to be reliable outcome predictors of patients undergoing Peritoneal Dialysis (PD). The independent contribution of each of these factors has not been elucidated., Method: We report a multicenter, longitudinal study of 493 patients incident on PD and satisfying two conditions: a glomerular filtration rate (GFR) ≥1 mL/minute and a daily diuresis ≥300 mL. The main variables were the GFR (mean of urea and creatinine clearances) at PD inception and the GFR rate of decline during follow-up. The main outcome variable was patient mortality. The secondary outcome variables were: PD technique failure and risk of peritoneal infection. The statistical analysis was based on a multivariate approach, placing an emphasis on the interactions between the two main study variables., Main Results: Baseline GFR and its rate of decline performed well as independent predictors of both patient mortality and risk of peritoneal infection. These two main study variables maintained a moderate correlation with each other (r2 = 0.12, p<0.0005), and interacted clearly, as predictors of patient mortality. A low baseline GFR followed by a fast decline portended the worst survival outcome (adjusted HR 3.84, 95%CI 1.81-8.14, p<0.0005)(Ref. baseline GFR above median plus rate of decline below median). In general, the rate of decline of RKF had a greater effect on mortality than baseline GFR, which had no detectable effect on survival when the decline of RKF was slow (HR 1.17, 95% CI 0.81-2.22, p = 0.22). Conversely, a relatively high GFR at the start of PD still carried a significant risk of mortality, when RKF declined rapidly (HR 1.89, 95% CI 1.05-3.72, p = 0.028)., Conclusion: The risk-benefit balance of an early versus late start of PD cannot be evaluated without taking into consideration the rate of decline of RKF. This circumstance may contribute to explain the controversial results observed at the time of evaluating the potential benefits of an early initiation of PD.
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- 2016
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36. Identification of Targets for Prevention of Peritoneal Catheter Tunnel and Exit-Site Infections in Low Incidence Settings.
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Santos C, Pérez-Fontán M, Rodríguez-Carmona A, Calvo-Rodríguez M, López-Muñiz A, López-Calviño B, and García-Falcón T
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Catheter-Related Infections prevention & control, Catheters, Indwelling adverse effects, Peritoneal Dialysis, Staphylococcal Infections prevention & control
- Abstract
Unlabelled: ♦, Background: Peritoneal catheter tunnel and exit-site infection (TESI) complicates the clinical course of peritoneal dialysis (PD) patients. Adherence to recommendations for catheter insertion, exit-site care, and management of Staphylococcus aureus (SAu) carriage reduces, but does not abrogate the risk of these infections. ♦, Objective: To reappraise the risk profile for TESI in an experienced center with a long-term focus on management of SAu carriage and a low incidence of these infections. ♦, Method: Following a retrospective, observational design, we investigated 665 patients incident on PD. The main study variable was survival to the first episode of TESI. We considered selected demographic, clinical, and technical variables, applying multivariate strategies of analysis. ♦, Main Results: The overall incidence of TESI was 1 episode/68.5 patient-months. Staphylococcus aureus carriage disclosed at inception of PD (but not if observed sporadically during follow-up) (hazard ratio [HR] 1.53, p = 0.009), PD started shortly after catheter insertion (HR 0.98 per day, p = 0.011), PD after kidney transplant failure (HR 2.18, p = 0.017), lower hemoglobin levels (HR 0.88 per g/dL, p = 0.013) and fast peritoneal transport rates (HR 2.92, p = 0.03) portended an increased risk of TESI. Delaying PD ≥ 30 days after catheter insertion markedly improved the probability of TESI. Carriage of methicillin-resistant SAu since the start of PD was associated with a high incidence of TESI by these bacteria. On the contrary, resistance to mupirocin did not predict such a risk, probably due to the use of an alternative regime in affected patients. ♦, Conclusions: Adherence to current recommendations results in a low incidence of TESI in PD patients. Interventions on specific risk subsets have a potential to bring incidence close to negligible levels. Despite systematic screening and management, SAu carriage is still a predictor of TESI. Antibiotic susceptibility patterns may help to refine stratification of the risk of TESI by these bacteria. Early insertion of the peritoneal catheter should be considered whenever possible, to reduce the risk of later TESI., (Copyright © 2016 International Society for Peritoneal Dialysis.)
- Published
- 2016
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37. Correlation between glycemic control and the incidence of peritoneal and catheter tunnel and exit-site infections in diabetic patients undergoing peritoneal dialysis.
- Author
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Rodríguez-Carmona A, Pérez-Fontán M, López-Muñiz A, Ferreiro-Hermida T, and García-Falcón T
- Subjects
- Age Distribution, Aged, Catheter-Related Infections etiology, Catheters, Indwelling adverse effects, Cohort Studies, Diabetes Mellitus diagnosis, Female, Follow-Up Studies, Glycemic Index, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Peritoneal Dialysis methods, Peritonitis etiology, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Sex Distribution, Statistics, Nonparametric, Blood Glucose analysis, Catheter-Related Infections epidemiology, Diabetes Mellitus therapy, Glycated Hemoglobin analysis, Peritoneal Dialysis adverse effects, Peritonitis epidemiology
- Abstract
Background: Diabetes mellitus, especially if complicated by poor glycemic control, portends an increased risk of infection. The significance of this association in the case of diabetic patients undergoing peritoneal dialysis (PD) has not been assessed., Methods: Using a retrospective observational design, we analyzed the association between glycemic control at the start of PD (estimated from glycosylated hemoglobin levels) and the risk of peritoneal and catheter tunnel and exit-site infections during follow-up in 183 incident patients on PD. We used the median value of glycosylated hemoglobin to classify patients into good (group A) or poor (group B) glycemic control groups. We applied multivariate strategies of analysis to control for other potential predictors of PD-related infection., Results: Groups A and B differed significantly in age, dialysis vintage, use of insulin, and rate of Staphylococcus aureus carriage. Neither the incidence (0.60 episodes in group A vs 0.56 episodes in group B per patient-year) nor the time to a first peritoneal infection (median: 42 months vs 38 months) differed significantly between the study groups. In contrast, group B had a significantly higher incidence of catheter tunnel and exit-site infections (0.23 episodes vs 0.12 episodes per patient-year) and shorter time to a first infection episode (64 months vs 76 months, p = 0.004). The difference persisted in multivariate analysis (adjusted hazard ratio: 2.65; 95% confidence interval: 1.13 to 6.05; p = 0.013). We observed no differences between the study groups in the spectrum of causative organisms or in the outcomes of PD-related infections., Conclusions: Poor glycemic control is a consistent predictor of subsequent risk of catheter tunnel and exit-site infection, but not of peritoneal infection, among diabetic patients starting PD therapy., (Copyright © 2014 International Society for Peritoneal Dialysis.)
- Published
- 2014
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38. Compared decline of residual kidney function in patients treated with automated peritoneal dialysis and continuous ambulatory peritoneal dialysis: a multicenter study.
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Pérez Fontán M, Remón Rodríguez C, Borràs Sans M, Sánchez Álvarez E, da Cunha Naveira M, Quirós Ganga P, López-Calviño B, Rodríguez Suárez C, and Rodriguez-Carmona A
- Subjects
- Female, Humans, Kidney Function Tests, Male, Middle Aged, Peritoneal Dialysis, Continuous Ambulatory, Spain, Treatment Outcome, Kidney Diseases physiopathology, Kidney Diseases therapy, Peritoneal Dialysis methods
- Abstract
Background: There is controversy concerning the compared rates of decline of residual kidney function (RKF) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD)., Objectives and Method: Following an observational, multicenter design, we studied 493 patients initiating peritoneal dialysis (PD) in four different Spanish units. We explored the effect of the PD modality on the rate of decline of RKF and the probability of anuria during follow-up. We applied logistic regression for intention-to-treat analyses, and linear mixed models to explore time-dependent variables, excluding those affected by indication bias., Main Results: Patients started on APD were younger and less comorbid than those initiated on CAPD. Baseline RKF was similar in both groups (p = 0.50). Eighty-seven patients changed their PD modality during follow-up. The following variables predicted a faster decline of RKF: higher (rate of decline) or lower (anuria) baseline RKF, younger age, proteinuria, nonprimary PD, use of PD solutions rich in glucose degradation products, higher blood pressure, and suffering peritonitis or cardiovascular events during follow-up. Overall, APD was not associated with a fast decline of RKF, but stratified analysis disclosed that patients with lower baseline RKF had an increased risk for this outcome when treated with this technique (HR: 2.26, 95% CI: 1.09-4.82, p = 0.023). Moreover, the probability of anuria during follow-up was overtly higher in APD patients (HR: 3.22, 95% CI: 1.25-6.69, p = 0.002)., Conclusions: Starting PD patients directly on APD is associated with a faster decline of RKF and a higher risk of developing anuria than doing so on CAPD. This detrimental effect is more marked in patients initiating PD with lower levels of RKF., (© 2015 S. Karger AG, Basel.)
- Published
- 2014
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39. [Results of the cooperative study of Spanish peritoneal dialysis registries: analysis of 12 years of follow-up].
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Remón-Rodríguez C, Quirós-Ganga P, Portolés-Pérez J, Gómez-Roldán C, Miguel-Carrasco A, Borràs-Sans M, Rodríguez-Carmona A, Pérez-Fontán M, Sánchez-Álvarez JE, and Rodríguez Suárez C
- Subjects
- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Spain, Time Factors, Young Adult, Peritoneal Dialysis statistics & numerical data, Registries
- Abstract
Introduction and Objectives: There is currently no registry that gives a complete and overall view of the peritoneal dialysis (PD) situation in Spain. However, a report on PD in Spain was developed for various conferences and meetings over several years from data provided by each registry in the autonomous communities and regions. The main objective of this study is to analyse this data in aggregate and comparatively to obtain a representative sample of the Spanish population on PD in recent years, in order that analysis and results in terms of demographic data, penetration of the technique, geographical differences, incidence and prevalence, technical aspects, intermediate indicators, comorbidity, and outcomes such as patient and technique survival may be extrapolated to the whole country. DESIGN, MATERIAL AND METHOD: Observational cohort study of autonomous PD registries, covering the largest possible percentage of the adult Spanish population (over 14 years of age) on PD, at least in the last decade (1999-2010), and in the largest possible geographical area in which we were able to recruit. A precise data collection strategy was followed for each regional registry. Once the information was received and clarified, they were added as aggregate data for statistical study., Results: The regional registries that participated represent a total geographical area that encompasses 32,853,251 inhabitants over 14 years of age, 84% of the total Spanish population older than that age. The mean annual rate of incidents per million inhabitants (ppm) was variable (between 17.81 ppm in Andalusia and 29.90 ppm in the Basque Country), with a discrete and permanent increase in the overall PD incidence in Spain being observed in recent years. The mean annual prevalence per million population (ppm) was very heterogeneous (from 42 to 99 ppm). A mean progressive increase in the use of automated peritoneal dialysis (APD) was observed. The peritonitis rate was approximately one episode every 25-30 months/patient, with a slight decrease being observed in recent years. The causes of discontinuing PD were distributed fairly evenly between communities; almost a third was due to patient death (mean 28%), a third was due to renal transplantation (mean 39%) and a third was due to transfer to haemodialysis (technique failure: mean 32%). The main comorbidities were cardiovascular disease (30.2%) and diabetes mellitus (24.2%). The overall accumulated mean survival was 92.2%, 82.8%, 74.2%, 64.8% and 57% after one, two, three, four and five years respectively. There was significantly and independently worse survival for older patients and those with cardiovascular disease, patients with diabetes mellitus, those on continuous ambulatory peritoneal dialysis (vs. APD), those who started PD before 2004 (analysed in Andalusia and Catalonia), and patients with lower residual renal function at the start of PD (analysed in the Levante registry). Similarly, the technique survival has improved, showing a mean figure above 50% after 5 years., Conclusions: The incidence and prevalence of PD in Spain are growing moderately and in a generalised manner and continue to maintain an irregular distribution by autonomous community. Both patient and technique survival were greater than 50% after 5 years, with an improvement being observed in recent years, and are comparable to countries with better results in this treatment.
- Published
- 2014
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40. Activation of vitamin D receptors in the optimization of hyperparathyroidism secondary to dialysis.
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Herrero JA, López-Gómez JM, Maduell F, Martín-de Francisco ÁL, Martín-Malo A, Martínez-Castelao A, Navarro-González JF, Pérez-Fontán M, Pérez J, Selgas R, and Solozabal C
- Subjects
- Humans, Hyperparathyroidism, Secondary drug therapy, Receptors, Calcitriol drug effects, Receptors, Calcitriol physiology, Renal Dialysis
- Published
- 2013
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41. Is peritoneal kinetics useful in clinical practice? Against.
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Rodríguez-Carmona A and Pérez-Fontán M
- Subjects
- Hemodialysis Solutions pharmacokinetics, Humans, Practice Guidelines as Topic, Peritoneal Dialysis methods, Peritoneum metabolism
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- 2013
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42. Effect of low-GDP bicarbonate-lactate-buffered peritoneal dialysis solutions on plasma levels of adipokines and gut appetite-regulatory peptides. A randomized crossover study.
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Rodríguez-Carmona A, Pérez-Fontán M, Guitián A, Peteiro J, García-Falcón T, López-Muñiz A, García-Buela J, and Cordido F
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Buffers, Creatinine blood, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Intestinal Mucosa metabolism, Intestines pathology, Male, Middle Aged, Prognosis, Prospective Studies, Young Adult, Adipokines blood, Bicarbonates pharmacology, Dialysis Solutions, Ghrelin blood, Lactates pharmacology, Peptide Fragments blood, Peritoneal Dialysis
- Abstract
Background: Malnutrition is common in patients treated with peritoneal dialysis (PD). Previous studies have disclosed disturbances in the hormonal axes regulating appetite in these patients. The effect of newer biocompatible PD solutions on these disorders is undetermined., Methods: Using a crossover randomized design, 21 patients stable on PD underwent 5 weeks of therapy with each of classic glucose degradation product (GDP)-rich lactate-buffered PD solutions (L) and newer low-GDP bicarbonate-lactate-buffered PD solutions (BL). At the end of each phase, we scrutinized patients for adequacy markers, peritoneal transport (peritoneal equilibration test with 3.86% glucose-based solutions), general biochemical markers and, more specifically, cytokines, adipokines (leptin and adiponectin) and selected gastrointestinal peptides which regulate appetite in the short term [ghrelin, peptide YY, cholecystokinin, glucagon-like peptide 1 (GLP1)]. For plasma GLP1 levels, we analysed a group of healthy, sex-, age- and body mass index-matched controls., Results: Use of BL solutions was associated with higher plasma levels of acylated (but not total) ghrelin (median 243 BL versus 141 pg/mL L, P = 0.05), adiponectin (median 20.2 BL versus 17.6 mcg/mL L, P = 0.008) and growth hormone (median 1.8 BL versus 1.0 ng/mL L, P = 0.013), without significant differences for the other cytokines, leptin or gut peptides scrutinized. We did not observe significant differences between L and BL solutions concerning estimations of adequacy, peritoneal transport or general biochemical markers., Conclusions: Use of GDP-free, neutral-pH, bicarbonate-lactate-buffered PD solutions is associated with higher plasma levels of acylated ghrelin and adiponectin than classic solutions. These findings may contribute to explaining improved appetite scores and overall survival rates reported with the use of so-called biocompatible PD solutions.
- Published
- 2012
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43. Effect of dialysis modality and other prescription factors on peritoneal protein excretion in peritoneal dialysis.
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Rodríguez-Carmona A, Pérez-Fontán M, Pértega-Díaz S, López-Calviño B, López-Muñiz A, and García-Falcón T
- Subjects
- Female, Humans, Male, Middle Aged, Peritoneal Dialysis, Continuous Ambulatory, Prospective Studies, Peritoneal Dialysis methods, Peritoneum metabolism, Protein Transport
- Abstract
Background: There is a deficit of information regarding the factors that influence peritoneal protein excretion (PPE) during PD therapy. In particular, the effects of the modality of PD and other conditions of the dialysis prescription remain unclear., Method: This prospective, observational study analysed the effects of prescription characteristics on 24-hour PPE (study variable) in a cohort of patients starting PD. Our statistical analysis included a multi-level mixed model and standardised estimations of peritoneal protein transport during serial four-hour peritoneal equilibrium tests in order to control for disparities in the characteristics of patients managed on different regimens., Results: We evaluated 284 patients, 197 on CAPD and 87 on automated PD (APD), at the start of PD treatment. The two groups differed in terms of clinical characteristics and peritoneal function. Univariate, serial estimates of 24-hour PPE were marginally higher in CAPD patients, and remained essentially stable over time in both groups. Multivariate analyses identified CAPD (B=888.5mg, 95% CI: 327.5/1448.6), total dialysate volume infused per day (B=275.9 mg/Ll; 153.9/397.9) and ultrafiltration (B=0.41 mg/mL; 0.02/0.80) as independent predictors of 24-hour PPE. The model also revealed a minor trend for a lower 24-hour PPE as time on PD increases., Conclusions: The individual characteristics of peritoneal protein transport are the major determinants of 24-hour PPE. The use of CAPD as the dialysis modality is associated with higher PPE rates than the APD technique, although this difference is counterbalanced by a direct correlation between PPE and the volume of dialysate infused per day. Ultrafiltration and time on dialysis also act as minor independent predictors of PPE during PD therapy.
- Published
- 2012
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44. Getting the right patient on the right renal replacement therapy.
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Pérez Fontán M, Rodríguez-Carmona A, López-Muñiz A, and García-Falcón T
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- Contraindications, Humans, Peritoneal Dialysis methods, Renal Dialysis methods, Renal Replacement Therapy methods
- Abstract
Adequate selection of the modality of renal replacement therapy (RRT), ideally based on well-planned predialysis care, informed decision by the patient and timely initiation of dialysis, is essential to optimize the outcome of patients with chronic kidney disease. However, there are important practical limitations to the success of this process. A major consequence is the underutilization of home-based dialysis therapies, including peritoneal dialysis (PD). A wide array of medical and social factors have been invoked as contraindications to PD, but well-designed studies have shown that most patients (probably >70%) starting dialysis are suitable for this technique. PD is feasible and may be preferred by a significant proportion of patients in many claimed unfavorable settings. The practicing nephrologist should be able to: disclose which are insurmountable barriers to PD, clarify the significance of relative contraindications in individual cases, and identify favorable and unfavorable settings for home dialysis. These abilities will permit quality education, justified advice, well-targeted informed decision and, predictably, successful selection of the modality of RRT. This article provides some clues to approach these issues in three different settings: planned start of RRT after predialysis care, unplanned start of dialysis and programmed changes of modality during follow-up., (Copyright © 2012 S. Karger AG, Basel.)
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- 2012
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45. Cost comparison between haemodialysis and peritoneal dialysis outsourcing agreements.
- Author
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Arrieta J, Rodríguez-Carmona A, Remón C, Pérez-Fontán M, Ortega F, Sánchez-Tomero JA, and Selgas R
- Subjects
- Humans, Outsourced Services economics, Peritoneal Dialysis economics, Renal Dialysis economics
- Published
- 2012
- Full Text
- View/download PDF
46. Enterococcal peritonitis in peritoneal dialysis patients: last name matters.
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Pérez-Fontán M, Rodríguez-Carmona A, and Rodríguez-Mayo M
- Subjects
- Female, Humans, Male, Peritoneal Dialysis adverse effects, Peritonitis microbiology
- Published
- 2011
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47. Peritoneal dialysis is the best cost-effective alternative for maintaining dialysis treatment.
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Arrieta J, Rodríguez-Carmona A, Remón C, Pérez-Fontán M, Ortega F, Sánchez Tomero JA, and Selgas R
- Subjects
- Cost Savings, Cost of Illness, Cost-Benefit Analysis, Health Care Costs, Health Resources economics, Health Resources supply & distribution, Health Services Accessibility economics, Humans, Kidney Failure, Chronic therapy, National Health Programs economics, Peritoneal Dialysis, Continuous Ambulatory economics, Quality of Life, Renal Replacement Therapy economics, Spain, Survival Analysis, Kidney Failure, Chronic economics, Peritoneal Dialysis economics
- Published
- 2011
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48. Peritoneal total protein transport assessed from peritoneal equilibration tests using different dialysate glucose concentrations.
- Author
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Gomes AM, Pérez-Fontán M, Rodríguez-Carmona A, López-Muñiz A, Fernández-Villar M, Peteiro-Cartelle J, and García-Falcón T
- Subjects
- Acid-Base Equilibrium physiology, Adult, Aged, Analysis of Variance, Biomarkers analysis, Chi-Square Distribution, Cohort Studies, Female, Humans, Male, Middle Aged, Multivariate Analysis, Peritoneal Dialysis adverse effects, Prospective Studies, Sensitivity and Specificity, Clinical Chemistry Tests methods, Dialysis Solutions analysis, Dialysis Solutions metabolism, Glucose isolation & purification, Peritoneal Dialysis methods, Peritoneum metabolism, Protein Transport physiology
- Abstract
Background: The peritoneal equilibration test (PET) permits assessment of peritoneal protein transport, but this potential marker of outcome in peritoneal dialysis (PD) patients lacks adequate standardization. ♢, Objectives: To assess various approaches for estimation of peritoneal protein transport in PD patients during 2.27% and 3.86% glucose-based PETs, and to uncover the demographic, clinical, and biochemical correlates of this phenomenon. ♢, Patients and Methods: We studied 90 PD patients who underwent 2.27% and 3.86% PETs in random order, and we used multivariate analysis to compare assessments of peritoneal protein transport in both tests, searching for correlations between D₂₄₀' - D₀' protein concentration (PETΔPConc), total peritoneal protein excretion (PET-PPE), or total protein clearance (PET-PC) on the one hand (the main study variables), and PET-derived markers of peritoneal function and selected demographic, clinical, and biochemical variables on the other. ♢, Results: The PETΔPConc was higher during the 2.27% PET (mean: 45.2 mg/dL vs 37.0 mg/dL for the 3.86% test; p = 0.003); the PET-PPE and PET-PC were comparable (1121.8 mg vs 1168.9 mg, p = 0.52, and 17.1 mL vs 17.8 mL, p = 0.66, respectively). All three variables sustained a significant, yet moderate correlation (all r² values < 0.30) with the 24-hour PPE rate. Multivariate analysis identified dialysate-to-plasma ratio (D/P₂₄₀') of creatinine, end-to-initial dialysate ratio (D₂₄₀'/D₀') of glucose, current daily peritoneal glucose load, ultrafiltration during PET, systolic blood pressure, and previous cardiovascular events (3.86% test only) as independent predictors of protein transport during PET. ♢, Conclusions: Either PET-PPE or PET-PC seems preferable to PETΔPConc for characterization of peritoneal protein transport. Small-solute transport characteristics, ultrafiltration, and current peritoneal glucose load sustain independent correlations with peritoneal protein transport. The latter variable shows also a moderate association with markers of cardiovascular disease in PD patients.
- Published
- 2010
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49. Peritoneal protein transport during the baseline peritoneal equilibration test is an accurate predictor of the outcome of peritoneal dialysis patients.
- Author
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Pérez-Fontán M, Rodríguez-Carmona A, Barreda D, López-Muñiz A, Blanco-Castro N, and García-Falcón T
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Biomarkers metabolism, Cardiovascular Diseases diagnosis, Cardiovascular Diseases etiology, Cardiovascular Diseases metabolism, Child, Cohort Studies, Diagnostic Tests, Routine methods, Female, Follow-Up Studies, Humans, Male, Middle Aged, Peritonitis diagnosis, Peritonitis etiology, Peritonitis metabolism, Predictive Value of Tests, Protein Transport physiology, Treatment Outcome, Young Adult, Diagnostic Tests, Routine standards, Peritoneal Dialysis adverse effects, Peritoneum metabolism
- Abstract
Background: Peritoneal protein excretion (PPE) is a potential marker of the outcome in peritoneal dialysis (PD) patients., Method: Observational study of a cohort of 269 patients starting PD in a single unit., Study Variables: total PPE during a baseline peritoneal equilibration test (PET; PET-PPE) and 24-hour PPE. Control variables: essential baseline demographic, laboratory and adequacy markers., Main Outcomes: mortality, cardiovascular events and risk of peritonitis. We applied univariate and multivariate strategies of survival analysis., Main Results: PET-PPE sustained a significant, yet limited correlation with 24-hour PPE (r = 0.46, p < 0.0005). At baseline, the main study variables showed an independent correlation with peritoneal transport characteristics (D/P(240') creatinine) and cardiovascular comorbidity. PET-PPE (p < 0.0005, model global χ(2) 59.4) was a more accurate predictor of overall mortality than 24-hour PPE (p = 0.04, χ(2) 50.5). Moreover, PPE during PET, but not 24-hour PPE, was an independent predictor of the risks of cardiovascular and infectious mortality, and of peritonitis., Conclusions: Baseline PPE represents a strong independent marker of survival of PD patients. Estimation of PPE during PET is more accurate than 24-hour PPE for this purpose, sustains a definite independent association with cardiovascular and infectious mortality, and shows a significant correlation with the risk of peritonitis., (Copyright © 2010 S. Karger AG, Basel.)
- Published
- 2010
- Full Text
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50. [Changing the frequency of administration of darbepoetin alfa (from weekly to fortnightly) maintains the haemoglobin levels in patients undergoing peritoneal dialysis].
- Author
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Bajo MA, Pérez Fontán M, Remón C, Sánchez-Tomero JA, Lladós F, and Selgas R
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anemia blood, Anemia etiology, Darbepoetin alfa, Drug Administration Schedule, Erythropoietin administration & dosage, Erythropoietin adverse effects, Erythropoietin therapeutic use, Female, Humans, Injections, Subcutaneous, Kidney Failure, Chronic complications, Kidney Failure, Chronic therapy, Male, Middle Aged, Polycythemia chemically induced, Prospective Studies, Young Adult, Anemia drug therapy, Erythropoietin analogs & derivatives, Hemoglobins analysis, Peritoneal Dialysis
- Abstract
Summary Background: Less frequent dosing regimens during anemia treatment could benefit Peritoneal Dialysis (PD) patients. We investigated the effectiveness of darbepoetin alfa dosed every-other-week (Q2W) for maintaining hemoglobin (Hb) levels (11-13 g/dL)., Patients and Methods: One hundred and nine PD patients from 14 centers participated in an 8-month observational, prospective study. Patients (Hb 11-13 g/dL) receiving weekly (QW) darbepoetin alfa switched to Q2W dosing at the investigator's discretion. Doses were adjusted according to published guidelines., Results: Sixty-nine percent (75 out of 109) of patients switched to Q2W dosing. Thirty-three percent maintained the g/week, equivalent to twice the previous mean weekly dose (26.1-25.8 g/week, QW dose). Forty-seven percent received a dose reduction (35.8-20.2 equivalent to the previous QW dose). More patients in the maintenance dose group 11 g/dL than those receiving a reduced weekly dose (80% vs. had Hb levels 51.4%, respectively, p = 0.0236). During the Q2W phase, the mean Hb level ranged from 12.0-12.5 g/dL for the maintenance dose group and 11.5-12.0 g/dL for the reduced dose group. From the switch to the end of the study, the mean (SD) change in Hb was -0.7 g/dL (0.98 g/dL, p = 0.0557) and -0.6 g/dL (1.6 g/dL, p = 0.1296) for the maintenance and reduced dose groups, respectively. The Q2W darbepoetin alfa was well tolerated. Only a single treatment-related adverse event (polycythemia) occurred., Conclusion: The majority of PD patients receiving QW darbepoetin alfa can be effectively switched to Q2W and still maintain their Hb level.
- Published
- 2009
- Full Text
- View/download PDF
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