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El estudio DIADERM fue promovido por la Fundacion Piel Sana de la AEDV, que recibio ayuda economica de Novartis. La compania farmaceutica no participo en la recogida de datos, ni en el analisis de los datos, ni en la interpretacion de los resultados., Introducción: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales forman parte de la formación específica de los médicos especialistas en Dermatología y Venereología en España. El presente estudio pretende analizar la carga que suponen dichas patologías en la actividad dermatológica pública y privada del sistema de salud español. Material y método: Estudio observacional de corte transversal de dos períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología relacionada (36 diagnósticos codificados en los dos períodos), que se clasificó en 12 grupos. Resultados: Tan solo el 3,16% de los diagnósticos globales fueron de infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales. Los 3 grupos diagnósticos más frecuentes fueron las lesiones por virus del papiloma humano anogenital, seguido de los molluscum contagiosum y las dermatosis anogenitales inflamatorias. Con significación estadística, y comparando con el global de diagnósticos, los seleccionados constituyeron más habitualmente el motivo de consulta primario y, en el ámbito privado, fue más frecuente que viniesen derivados de otros especialistas. Conclusión: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales tienen un peso muy limitado en la asistencia dermatológica en España, a pesar de que la inclusión del diagnóstico de molluscum contagiosum sobreestima estos diagnósticos. La ausencia de inclusión de centros y consultas monográficas de ITS en la muestra aleatoria contribuye a la infrarrepresentación de estas parcelas de la especialidad. Es importante hacer un esfuerzo decidido por potenciarlas con consultas y centros monográficos., Background and objective: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methods: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. Results: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. Conclusions: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made., Fundacion Piel Sana de la AEDV

Background Although relationship between dialysate sodium concentration and hemodynamic stability has been well studied over the years, outcomes of absolute blood volume (ABV) maintenance and vascular refilling volume (Vref ) modifications were not included, as its analysis has not been easily accessible to direct investigation. However, recent studies report a simple and feasible methodology to assess ABV and Vref during hemodialysis (HD) treatments. It is the aim of this study to analyze whether sodium concentration in dialysate modifies ABV drop and Vref . Methods The study was performed in 19 patients under HD. During three different sessions, sodium concentration in dialysate was randomized to three different profiles: low sodium concentration (LNa, 138 mEq/L), neutral sodium concentration (NNa, 140 mEq/L), and high sodium concentration (HNa, 143 mEq/L). ABV and Vref were calculated using Kron et al methodology. Results Predialysis values of the measured parameters showed similar results for the three profiles. Sodium concentration showed an effect on ABV drop, Vref, and vascular refilling fraction (Fref ). Pair-wise comparison revealed mean ABV decreased 0.21 L less when using HNa profile versus LNa profile (p = 0.027), a mean Vref increase of 0.39 L (p = 0.038), and a mean Fref increase of 9.94% (p = 0.048). Conclusions This study shows that the use of HNa profiles increases Vref and Fref and reduces ABV drop during dialysis treatments when compared to LNa profiles.

BACKGROUND AND AIMS Icodextrin is a soluble glucose polymer used widely as an alternative osmotic agent to glucose-only solutions in PD patients. It provides effective net peritoneal ultrafiltration (UF) and nowadays it is only licensed for once-daily dwells. However, in selected patients it has been described its use in two daily dwells (2-ICO). Our aim was to revise our center experience with icodextrin when prescribed as 2-ICO. METHOD We retrospectively analysed all patients with a 2-ICO dwell prescription in our PD unit from January 2018 until June 2021. Clinical data, indication for prescription and outcomes were collected. RESULTS CONCLUSION In selected patients, 2-ICO dwells daily may have a clinical benefit, improving UF significantly and allowing better management of fluid overload and UF failure without relevant adverse events.

BACKGROUND AND AIMS ANCA-associated vasculitis (AAV) is an autoimmune disease that causes end-stage renal disease in ∼20%–25% of patients who develop kidney failure with progression to end-stage kidney disease with requirement of renal replacement therapy. Previous studies have found a genetic association between some major histocompatibility complex (MHC) loci, like the locus DPB1*0401, and AAV. We conducted a retrospective observational unicentric study with the objective to identify other possible loci related to AAV. METHOD As MHC determination is not usually done in patients with AAV, we looked for patients with AAV included in the kidney transplant list with a complete classic HLA allele determination registered (A, B, C, DR, and DQ). Only 14 patients with diagnosis of AAV included in the kidney transplant list from August 1993 to December 2020 in our hospital centre fulfilled this inclusion criterion. To the statistical analysis, we compared the observed proportion to the theoretical one using a normal test, since the groups in our sample included at least five subjects. We also use a continuity correction factor to approach to a binomial test. RESULTS The highest allele frequency in our cohort were the HLA B*51and the haplotype HLA DRB1*04-DQB1*03:02. We identified a B*51 frequency of 42.8% (6/14 patients) in our AAV register, while its population frequency in Spain is 15%, difference = 27.86% [Confidence interval (CI) 1.93%–53.78%] P = .01. We detected a DRB1*04 frequency of 57.1% (8/14 patients) in our cohort, while the population frequency of DRB1*04 and its associated loci DQB1*03:02 is 22%, difference = 35.14% (CI 9.22%–61.07%) P < .05. CONCLUSION HLA B*51 and the haplotype DRB1*04-DQB1*03:02 are alleles more frequent in patients with AAV than general population. This could translate a genetic predisposition of people with these alleles to develop AAV.

BACKGROUND AND AIMS The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic has had a massive impact in health systems worldwide, taking an important toll on dialysis patients as they are more comorbid, have higher mortality and an impaired immune system. Vaccines against SARS-Cov-2 proved to reduce mortality and hospitalization, but serological response in the dialysis population is weaker. Therefore, predictors of response would be useful to assess their level of protection and evaluate the need for further booster doses of the vaccine. METHOD RESULTS CONCLUSION In our experience, PD patients have an adequate serological response to the SARS-Cov-2 vaccines, being previous COVID exposure the main predictor of a good response. Conversely, longer duration of PD treatment was a prognostic factor of seroconversion failure. We believe this should be kept in mind to assess the need for booster vaccination doses in those patients.

BACKGROUND AND AIMS Transplantation (KTx) is considered the best renal replacement therapy nephrologists can offer and improving its outcomes remains a primary challenge in our field. KTx ureteral JJ stenting has been used to prevent urological complications, but there is no consensus about its elective removal timing and literature regarding routine US imaging after EJJR to detect complications is lacking. Our aim was to define the incidence of urological complications diagnosed by routine US after EJJR in KTx, determine US utility and best time interval to perform it. METHOD We retrospectively analyzed all routine KTx US performed in our Unit from 2016 until 2020 by an experienced interventional nephrologist. US post EJJR findings were compared with previous patient US. KTx characteristics, treatment and outcomes were recorded. RESULTS CONCLUSION Routine US after EJJR allowed a timely diagnosis and early treatment of urological complications, a key factor for successful transplantation. KTx US is a cost-effective and reproducible test that provides crucial information to guide clinical decisions, being most efficient when performed 10 days post elective removal. Interventional nephrologists could do this examination promptly.

BACKGROUND AND AIMS Patients with end-stage kidney disease (ESKD) are becoming older and more comorbid. We define assisted peritoneal dialysis (aPD) as any PD treatment that needs the help of another person regardless of the age of the patient and the duration of such help. Our aim was to analyse our aPD experience. METHOD RESULTS CONCLUSION aPD should be considered not only in the elder or fragile, but also in cases of variable disability regardless of patient age. It does not imply a higher complication rate or a technique failure, and careful caregiver support should be provided to avoid exhaustion and PD abandonment.

BACKGROUND AND AIMS Total kidney volume (TKV) in patients with autosomal dominant polycystic kidney disease (ADPKD) is a known progression factor in these patients. Low levels of klotho and high levels of FGF23 in the blood of patients with ADPKD have been correlated with higher TKV even in early stages of the disease, even with glomerular filtration rate (eGFR) >90 mL/min/1.73 m2. Therefore, alterations in the levels of parathyroid hormone (PTH), vitamin D, tubular reabsorption of phosphates or urinary calcium could be correlated with the TKV and serve as an early serum biomarker of progression of kidney disease. METHOD Observational, cross-sectional, single-center study in a population of 87 patients under follow-up at our center during 2019–2020 for ADPKD. The TKV, obtained by the ellipsoid formula measured by magnetic resonance imaging (MRI) and the values of PTH, vitamin D, tubular phosphate reabsorption and urinary calcium were retrospectively collected. Subsequently, a statistical analysis of correlation between the different variables was performed. RESULTS Spearman's Rho correlation analysis obtained a positive correlation of moderate–strong intensity between the TKR of the sample and PTH levels (r = 0.638, P 90 mL/min/1.73 m2 (CKD-EPI) with an elevated PTH (> 65 pg/mL), with a median of 530 mL (interquartile range 403–1184 mL), compared with the TKV of those patients with an eGFR >90 mL/min/1.73 m2 with normal PTH, whose median was 405 mL (interquartile range 258–576 mL). Despite this trend, the Mann–Whitney U test did not show a statistically significant difference between medians in the subgroup of patients with eGFR >90 mL/min/1.73 m2. However, the comparison of medians in the subgroup of patients with eGFR CONCLUSION The increase in PTH in patients with ADPKD has a strong positive correlation with TKV. Even with normal eGFR, elevated PTH is associated with a higher TKV, which could be an early serum biomarker of kidney disease progression in this group of patients.

Background: β-Blockers are the most frequently prescribed cardioprotective drugs in hemodialysis (HD) patients, despite their weak evidence. We sought to evaluate the effects of β-blockers on vascular refilling during HD treatments and examine whether carvedilol, for being noncardioselective and poorly dialyzable, associates more impact than others. Methods: The study was performed in a cohort of maintenance HD patients from a tertiary center. All patients had previous β-blocker prescription. We conducted a prospective crossover study and measured vascular refilling volume (Vref) and vascular refilling fraction (Fref) in 2 circumstances: under β-blocker treatment (βb profile) and without β-blocker effect (non-βb profile). Results: Twenty patients were included, 10 of whom were treated with carvedilol. Predialysis values were comparable between the 2 profiles. Although the βb profile showed lower Vref and higher ABV drop, these differences did not reach statistical significance. Data showed an increase in Fref in the non-βb profile (70.01 ± 6.80% vs. 63.14 ± 11.65%; p = 0.015). The βb profile associated a significantly higher risk of intradialytic hypotension (IDH) (risk ratio 2.40; 95% CI: 1.04–5.55). When analyzing separately the carvedilol group, patients dialyzed under drug effect experienced a significant impairment in Vref, Fref, and refilling rate. Conclusions: Administering β-blockers before HD associated a higher risk of IDH and a decrease in Fref. Patients dialyzed under carvedilol effect showed an impaired refilling, probably related to its noncardioselectivity and lower dializability.

Sin financiación No data 2021 UEM

Resumen Antecedentes El conocimiento de las variaciones de las enfermedades dermatologicas a lo largo del ano podria ser util para la planificacion en salud y el manejo de las enfermedades. Sin embargo, existe escasa informacion acerca de la variacion de los diagnosticos dermatologicos en diferentes epocas del ano en una muestra nacional representativa. Objetivos Evaluar si existe variacion en los diagnosticos clinicos dermatologicos entre la temporada de frio y calor en Espana. Material y metodos Los datos se han obtenido mediante una encuesta anonima realizada a una muestra aleatoria y representativa de dermatologos espanoles estratificados por area. Cada uno de los participantes recogio todos los diagnosticos clinicos durante 6 dias de consulta en 2016 (3 en la temporada de frio y 3 en la temporada de calor). Los diagnosticos se codificaron segun la CIE-10. Resultados Con una proporcion de respuesta de 62%, se recolectaron 11.223 diagnosticos clinicos. Los grupos diagnostico CIE-10 que mostraron variaciones entre temporadas fueron: otras neoplasias benignas de la piel (D23), rosacea (L71) y otros trastornos foliculares (L73), los cuales fueron mas frecuentes en la temporada de calor, y acne (L70) el cual fue mas frecuente en la temporada de frio. Ademas, describimos las diferencias en la poblacion pediatrica y segun el tipo de asistencia publica frente a privada. Algunas de estas diferencias podrian estar relacionadas con diferencias en la poblacion que consulta en las distintas temporadas. Conclusiones La frecuencia de la mayoria de los diagnosticos clinicos realizados por dermatologos no sufre variaciones a lo largo del ano. Solo algunos de los diagnosticos clinicos muestran variaciones entre la temporada de frio frente a calor. Estas variaciones observadas pueden estar en relacion con las propias enfermedades o pueden ser debidas a cambios estacionales en la demanda de consultas dermatologicas.

Background and objective Skin lesions are a common reason for consulting a primary care physician. Current legislation in Spain states that purely aesthetic skin problems that do not pose a health problem are not to be treated within the National Health Service. The aim of this study was to estimate the proportion of referrals from primary care physicians to dermatologists that were for cystic lesions or benign tumors and could potentially have been avoided. Material and methods We consulted cases registered in the DIADERM study dataset, which is representative of dermatology practice in Spain, and collected the main diagnoses given on referring patients from primary care. A referral diagnosis was classified as potentially avoidable if it corresponded to one of the primary care discharge diagnoses listed in a consensus paper of the Andalusian section of the Spanish Academy of Dermatology and Venereology (AEDV). Results We collected 2171 main reasons for first-visit referrals to dermatologists; 686 of them (31.6%) were for cystic lesions or benign tumors and classified as potentially avoidable. In 478 cases (22%) the patients were discharged on the first visit. The most frequent diagnoses in such cases were seborrheic keratosis (9.3%) and melanocytic nevus (8.6%). Conclusions Nearly a third of referrals from primary care to a dermatologist were for cystic lesions and benign tumors and could have been avoided. A clearer understanding of our caseload can be useful for improving planning, training, and health care system management.

Resumen Antecedentes y objetivo Las lesiones cutaneas constituyen un motivo de consulta frecuente en Atencion Primaria (AP). Aquellas que no supongan un problema de salud, sino una cuestion estetica, no deben ser tratadas en el Sistema Nacional de Salud, segun la legislacion vigente. El objetivo de este trabajo es estimar que porcentaje de derivaciones remitidas desde AP a Dermatologia por lesiones quisticas o tumores benignos corresponde a lesiones que podriamos considerar potencialmente evitables. Material y metodo Utilizamos los diagnosticos principales de los pacientes derivados de AP, recogidos en el estudio representativo nacional DIADERM. Cada uno de los diagnosticos derivados fue clasificado como potencialmente evitable si se correspondia con alguno de los diagnosticos con criterio de alta desde AP, establecidos en el documento de consenso propuesto por la seccion territorial andaluza de la Academia Espanola de Dermatologia y Venereologia. Resultados Se recogieron datos de 2.171 motivos principales de consulta derivados de AP como primeras consultas. De estos, 686 (31,6%) son diagnosticos que podrian corresponderse con derivaciones potencialmente evitables por lesiones quisticas o tumorales benignas. Un 22% (478) del total de las consultas fueron dadas de alta en la primera visita. Los diagnosticos mas frecuentes entre estos fueron las queratosis seborreicas (9,3%) y los nevus melanociticos (8,6%). Conclusiones La proporcion de derivaciones potencialmente evitables a Dermatologia desde AP por lesiones quisticas y tumorales benignas supone casi un tercio de las consultas. El conocimiento de la realidad asistencial de nuestro entorno puede ser util para mejorar la planificacion, la formacion y la gestion sanitaria.

Background and objectives Understanding the origin and referral routes of patients seen in teledermatology and in-person dermatology consultations in Spain is of interest from the perspective of health care management. The objective of this study was to describe the referral routes and the frequency and characteristics of teledermatology consultations in Spain. Material and methods We performed a descriptive cross-sectional study of data collected over 6 days from the DIADERM study sample, which included the outpatients diagnosed by 80 Spanish dermatologists, selected by means of stratified random sampling. We studied the source and destination of patients based on funding, type of consultation, and age of the patients. We reported the frequency of teledermatology consultations, their origin and destination, type of funding, age of the patients, and most common diagnoses, and compared them with the same characteristics for in-person consultations. Results In private consultations, most patients were direct clients, whereas the most frequent source in public consultations was primary care and the dermatologist. Sixty-six percent of patients were referred to dermatology and 27% were discharged. No differences in these percentages were found between public and private consultations. The ratio of follow-up to initial visits was 0.8 for public consultations and 0.2 for private consultations. Teledermatology accounts for 1% of consultations. Eighty percent of these come from primary care and 17% are direct visits. Thirty-three percent of these visits are referred to primary care —a greater proportion than in in-person consultations. Galicia, Andalusia, and Catalonia are the regions with the highest percentage of consultations. Conclusions The results suggest that dermatologists in Spain have a considerable ability to resolve cases. Teledermatology accounts for a small percentage of consultations and access to these consultations is direct in a large percentage of cases.

Resumen Antecedentes y objetivos El conocimiento de las rutas de origen y derivacion de los pacientes atendidos en consulta dermatologica presencial y de teledermatologia en Espana tiene interes desde el punto de vista de la gestion sanitaria. El objetivo de este estudio es describir las rutas de derivacion y la frecuencia y caracteristicas de la teledermatologia en Espana. Material y metodos Estudio transversal descriptivo sobre la muestra del estudio DIADERM, que recogio la actividad de 80 dermatologos espanoles, seleccionados mediante muestreo aleatorio estratificado, durante 6 dias. Se estudiaron el origen y destino de los pacientes en funcion de la financiacion, el tipo de consulta y la edad de los pacientes. Se describio la frecuencia de las consultas por teledermatologia, su origen y destino, el tipo de financiacion, la edad de los pacientes y los diagnosticos mas frecuentes, comparandolos con la consulta presencial. Resultados El origen mas frecuente en la consulta privada es el directo, mientras que en la publica es la atencion primaria y el propio dermatologo. Un 66% de los pacientes se derivan a dermatologia y un 27% son dados de alta. No existen diferencias en estos porcentajes entre consulta publica y privada. El indice sucesivas/primeras fue de 0,8 para la consulta publica y de 0,2 para la privada. La teledermatologia representa un 1% de las consultas. El 80% procede de atencion primaria y el 17% tiene origen directo. Se deriva a atencion primaria el 33%, en mayor proporcion que en consulta presencial. Galicia, Andalucia y Cataluna son las regiones donde representa un mayor porcentaje de consultas. Conclusiones Los resultados sugieren una alta capacidad resolutiva de las consultas de dermatologia en Espana. La teledermatologia representa un porcentaje pequeno de las consultas, y el acceso a ella se da en un porcentaje relevante de pacientes por via directa.

Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.