ABSTRACT
ntroducción y objetivos: El hiperparatiroidismo secundario es una complicación habitual en pacientes con insuficiencia renal crónica. El tratamiento con paricalcitiol, activador selectivo del receptor de vitamina D, ha demostrado tener beneficios en el tratamiento de estos pacientes al disminuir adecuadamente la hormona paratiroidea (PTH) con mínimas variaciones del calcio y fósforo séricos. El objetivo de este estudio es evaluar la efectividad y la seguridad del paricalcitol en el tratamiento de pacientes con insuficiencia renal crónica (ERC 3 y 4). Métodos: Se llevó a cabo un análisis de datos de nuestra experiencia, en condiciones de práctica clínica habitual, en 92 pacientes de más de 18 años con diagnóstico de ERC de grado 3 y 4. Los pacientes incluidos en el mismo fueron tratados con paricalcitol y evaluados mediante controles periódicos cada tres meses. Como medida principal de efectividad se estableció la obtención de dos disminuciones en visitas consecutivas ≥ del 30% de la hormona paratiroidea intacta (PTHi) respecto a las cifras basales. Se analizaron como objetivos secundarios el cumplimiento de los objetivos de acuerdo con las guías de la Sociedad Española de Nefrología (S.E.N.) y Kidney Diseases Outcome Quality Initiatives (K/DOQI), y, también, la relación entre la efectividad del tratamiento y las diferentes variables registradas de los pacientes. La variable principal de seguridad estudiada fue la aparición de (..) (AU)
Purpose: Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease. Treatment with paricalcitol, a selective vitamin D receptor (VDR) activator, has shown benefits in these patients by adequately reducing PTH levels with minimal changes in serum calcium and phosphorus. The aim of this study was to assess the effectiveness and safety of paricalcitol in chronic renal disease patients (CKD grades 3 and 4).Methods: A study of our experience with paricalcitol was conducted in normal clinical practice in patients over 18 years diagnosed with grade 3 or 4 chronic kidney disease. Patients were periodically evaluated every 3 months. The primary endpoint of effectiveness was to obtain two consecutive decreases of ≥30% in iPTH with respect to baseline values. The secondary endpoints were fulfilment of the objectives in accordance with the Spanish (..) (AU)
Subject(s)
Humans , Renal Insufficiency, Chronic/complications , Hyperparathyroidism, Secondary/epidemiology , Vitamin D/analogs & derivatives , Vitamin D Deficiency/drug therapy , Hypercalcemia/epidemiology , Vascular Calcification/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Heart Failure/drug therapy , Diuretics/pharmacokinetics , Acute Kidney Injury/physiopathology , Cardiac OutputABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Acidosis, Renal Tubular/complications , Hearing Loss, Sensorineural/complications , Patient Dropouts , Nephrolithiasis/complications , Hypokalemic Periodic Paralysis/etiologyABSTRACT
BACKGROUND AND AIMS: There is growing evidence of the effects of immunosuppressive agents on "immune targets" in renal transplantation. Immunological monitoring could indirectly measure the suppressive effect of these drugs and guide early preventive interventions in transplant recipients. Due to the selective antiproliferative effect of mycophenolate mofetil (MMF) on lymphocytes, our goal was to determine whether MMF modulates peripheral blood lymphocyte subsets (PBLS) in kidney allograft patients. METHODS: We assessed absolute CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD19(+), CD16(+)CD3(-) PBLS counts and CD4/CD8 ratios for 12 months in three groups of kidney allograft patients stratified according to maintenance immunosuppressive regimen: group A (n = 31), which started MMF with prednisone (P) + cyclosporine A (CyA), and two control groups, B (n = 19) and C (n = 15) on P + CyA + azathioprine (Aza) and P + CyA regimens, respectively. We compared intra- and intergroup lymphocyte counts and ratios. RESULTS: Intergroup comparisons showed a significant reduction in all PBLS in group A (CD19(+) from 3 months and other subsets from 6 months), whereas there were no significant changes in PBLS in the other group analyses or comparisons. CONCLUSIONS: Our findings suggest that (1) MMF modulates all PBLS in kidney allograft patients, causing a progressive reduction occurring earlier in CD19(+), and (2) we can rule out that these changes were caused by the "natural immunological evolution" of the transplantation. These results could offer a new method for immunological monitoring of transplant patients.
