Factores clínicos y farmacológicos relacionados con los requerimientos de fotocoagulación láser en pacientes con nefropatía diabética secundaria a diabetes mellitus tipo 2 / Clinical and pharmacological factors related to the requirements of laser photocoagulation in patients with diabetic nephropathy due to type 2 diabetes mellitus

Fundamento y objetivo: La retinopatía diabética es una complicación microvascular de la diabetes mellitus cuya prevalencia está estrechamente relacionada con la presencia de nefropatía y la hipertensión. Los objetivos fueron estudiar qué factores clínicos y farmacológicos se relacionan con una mayor necesidad de fotocoagulación láser en pacientes con nefropatía y retinopatía diabética y, en segundo lugar, determinar las características diferenciales entre ambos subgrupos de pacientes diabéticos tipo 2 según si/no hubieran recibido fotocoagulación láser. Pacientes y métodos: Estudio descriptivo transversal de 63 pacientes seguidos en consulta de Nefropatía Diabética. A los pacientes se les dividió en 2 grupos según hubiesen recibido o no previamente fotocoagulación. En cada subgrupo se estudiaron variables de tipo demográfico, antropométrico, analítico, factores de riesgo cardiovascular y tratamiento que recibían los pacientes para el control de la hipertensión arterial, diabetes u otras enfermedades asociadas. Resultados: Se observó que el grupo que había recibido fotocoagulación tenía más años de evolución de la diabetes, más antecedentes de enfermedad cardiovascular y un aclaramiento de creatinina inferior. Asimismo, el porcentaje de pacientes tratados con carvedilol era significativamente superior en el subgrupo que no había recibido fotocoagulación, mientras que el porcentaje de pacientes tratados con betabloqueantes era significativamente superior en el subgrupo que sí la había recibido, no observándose diferencias en el grado de control de la tensión arterial. Conclusiones: Los factores clínicos y farmacológicos relacionados con una mayor necesidad de fotocoagulación fueron el tiempo de evolución de la diabetes, la historia previa de enfermedad cardiovascular, el grado de insuficiencia renal y el tratamiento con betabloqueantes (AU)

Background and objetive: Diabetic retinopathy is a microvascular complication of diabetes mellitus whose prevalence is closely related to the presence of nephropathy and hypertension. The aim was to study clinical and pharmacological factors that are associated with an increased need for laser photocoagulation in patients with diabetic nephropathy and retinopathy. Patients and methods: Cross sectional study of 63 patients followed in the Diabetic Nephropathy consultation. Patients were divided into 2 groups according to whether or not previously have received photocoagulation. In each subgroup were studied demographic variables, anthropometric, laboratory, cardiovascular risk factors and treatment received by each patient for the control of hypertension, diabetes and others diseases. Results: We observed that the group had received photocoagulation had more years of diabetes evolution, more history of cardiovascular disease and a lower creatinine clearance. Similary, the percentage of patients treated with carvedilol was significantly higher in the subgroup who had not received photocoagulation while the percentage of patients treated with beta-blockers was significantly higher in the subgroup that received photocoagulation; no significant differences was observed in the degree of control blood pressure. Conclusions: Clinical and pharmacological factors related to the requirements of laser photocoagulation were years of diabetes evolution, history of cardiovascular disease, the stage of kidney disease and the treatment with beta-blokers (AU)

[Clinical and pharmacological factors related to the requirements of laser photocoagulation in patients with diabetic nephropathy due to type 2 diabetes mellitus]. / Factores clínicos y farmacológicos relacionados con los requerimientos de fotocoagulación láser en pacientes con nefropatía diabética secundaria a diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Diabetic retinopathy is a microvascular complication of diabetes mellitus whose prevalence is closely related to the presence of nephropathy and hypertension. The aim was to study clinical and pharmacological factors that are associated with an increased need for laser photocoagulation in patients with diabetic nephropathy and retinopathy. PATIENTS AND METHODS: Cross sectional study of 63 patients followed in the Diabetic Nephropathy consultation. Patients were divided into 2 groups according to whether or not previously have received photocoagulation. In each subgroup were studied demographic variables, anthropometric, laboratory, cardiovascular risk factors and treatment received by each patient for the control of hypertension, diabetes and others diseases. RESULTS: We observed that the group had received photocoagulation had more years of diabetes evolution, more history of cardiovascular disease and a lower creatinine clearance. Similarly, the percentage of patients treated with carvedilol was significantly higher in the subgroup who had not received photocoagulation while the percentage of patients treated with beta-blockers was significantly higher in the subgroup that received photocoagulation; no significant differences was observed in the degree of control blood pressure. CONCLUSIONS: Clinical and pharmacological factors related to the requirements of laser photocoagulation were years of diabetes evolution, history of cardiovascular disease, the stage of kidney disease and the treatment with beta-blockers.

Vascular calcification and 25-hydroxyvitamin D levels in non-dialysis patients with chronic kidney disease stages 4 and 5.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death among chronic kidney disease (CKD) patients. Vascular calcification is highly prevalent in this population and is an independent predictor of cardiovascular mortality. Vascular calcification in uraemic patients is known to be an active and regulated process subject to the action of many promoting and inhibitory factors. The role of vitamin D in this process remains controversial. We evaluated the relationship between serum levels of 25-hydroxyvitamin D (25(OH)D) and vascular calcification evaluated by plain X-ray images, in predialysis patients with CKD stages 4 and 5. METHODS: We performed a cross-sectional study with 210 CKD patients stages 4 and 5 managed at our predialysis unit. Patients were 63.5 ± 13 years of age, 60.5% males, 64.8% diabetics and 47.1% with a history of CVD. Plain X-ray images of pelvis, hands and lateral lumbar spine from all subjects were studied for calculation of semiquantitative vascular calcification scores as described by Adragao and Kauppila. RESULTS: We found a high prevalence of vascular calcification in our population. Adragao scores revealed only 47 patients (22.4%) without vascular calcification and 120 (57.1%) with scores higher than 3. Kauppila scores revealed only 29 patients (13.8%) without aortic calcifications and 114 patients (54.3%) with scores higher than 7. Higher vascular calcification scores were related to older age, diabetes, history of CVD and lower levels of 25(OH)D. Only 18.5% of patients had adequate levels of 25(OH)D (> 30 ng/mL), 53.7% of them had insufficient levels (15-30 ng/mL) and 27.8% had deficient levels (< 15 ng/mL). Multivariate analysis showed that age, diabetes and CVD were directly associated and 25(OH)D levels were inversely associated with vascular calcifications. CONCLUSIONS: Our results show an independent and negative association between serum levels of 25(OH)D and vascular calcification. Further and larger prospective studies are needed to clarify the possible role of vitamin D deficiency in the development of vascular calcification in CKD patients.

Hypercalcemia secondary to persistent hyperparathyroidism in kidney transplant patients: analysis after a year with cinacalcet.

INTRODUCTION: The most common cause of hypercalcemia in patients with transplanted kidneys is persistent hyperparathyroidism, which presents in 10%-30% of patients with functioning renal grafts. In these patients, the treatment of vitamin D-resistant hyperparathyroidism traditionally required parathyroidectomy. Calcimimetic agents represent a new therapeutic alternative; they inhibit parathyroid hormone (PTH) secretion, increasing the sensitivity of the calcium-sensitive receptor in the parathyroid gland. The objective of this study is to evaluate the efficacy of cinacalcet in renal transplant patients with persistent hyperparathyroidism. METHODS: Cinacalcet 30 mg/day was prescribed to 17 renal transplant patients (6 women, 11 men) with a mean age of 49 years and hypercalcemia secondary to persistent hyperparathyroidism. The treatment started 58.17 ± 35.16 months posttransplant, with 1 year of follow-up. RESULTS: Calcium in serum fell from 10.5 ± 0.74 to 9.4 ± 0.84 mg/dL (p<0.001), whereas phosphorous levels were not significantly altered. The fall in PTH was from 204.79 ± 78 to 148.55 ± 56 pg/mL (p<0.011). Kidney function remained stable, and immunosuppressant drug levels remained unchanged. The dose of cinacalcet was increased to 60 mg in 2 patients. No significant adverse effects were described, and none of the patients had to suspend the treatment. CONCLUSIONS: Calcimimetic agents represent a therapeutic alternative in transplant patients with persistent hyperparathyroidism, as they correct hypercalcemia and reduce PTH levels with no adverse effects on kidney function. Prospective, controlled studies should be designed to evaluate the long-term effects and evolution after suspension of the treatment.