Role of the Nephrologist in Non-Kidney Solid Organ Transplant (NKSOT).

BACKGROUND: Chronic kidney disease (CKD) is a common complication of a non-kidney solid organ transplant (NKSOT). Identifying predisposing factors is crucial for an early approach and correct referral to nephrology. METHODS: This is a single-center retrospective observational study of a cohort of CKD patients under follow-up in the Nephrology Department between 2010 to 2020. Statistical analysis was performed between all the risk factors and four dependent variables: end-stage renal disease (ESKD); increased serum creatinine ≥50%; renal replacement therapy (RRT); and death in the pre-transplant, peri-transplant, and post-transplant periods. RESULTS: 74 patients were studied (7 heart transplants, 34 liver transplants, and 33 lung transplants). Patients who were not followed-up by a nephrologist in the pre-transplant (p < 0.027) or peri-transplant (p < 0.046) periods and those who had the longest time until an outpatient clinic follow-up (HR 1.032) were associated with a higher risk of creatinine increase ≥50%. Receiving a lung transplant conferred a higher risk than a liver or heart transplant for developing a creatinine increase ≥50% and ESKD. Peri-transplant mechanical ventilation, peri-transplant and post-transplant anticalcineurin overdose, nephrotoxicity, and the number of hospital admissions were significantly associated with a creatinine increase ≥50% and developing ESKD. CONCLUSIONS: Early and close follow-up by a nephrologist was associated with a decrease in the worsening of renal function.

Estados hipertensivos: perfil materno y papel de la matrona en el Departamento de Salud de Gandía / Hypertensive disorders of pregnancy: maternal profile and role of the midwife in the Department of Health of Gandía

Objetivos: Describir el perfil de las mujeres con estados hipertensivos del embarazo, su relación con los distintos trastornos y el papel de la matrona en el seguimiento de la presión arterial y la derivación de la gestante. Metodología: Estudio de cohortes retrospectivo, que incluye a todas las gestantes derivadas a la Unidad de Hipertensión Arterial del Hospital Francisco de Borja durante el periodo 2009-2015. Resultados: El total de participantes fue de 79. Los trastornos descritos fueron los siguientes: preeclampsia (35/79; 44,3%), hipertensión crónica (31/79; 39,2%), preeclampsia sobreañadida (8/79; 10,1%) e hipertensión gestacional (5/79; 6,3%). Los estados hipertensivos se relacionaron significativamente con el nivel de estudios (p= 0,022), los antecedentes de hipertensión (p= 0,000), obesidad (p= 0,015) y estado hipertensivo en una gestación anterior (p= 0,000). La matrona realizó 6,8 mediciones de presión arterial por gestante, derivó a urgencias a 15 mujeres y a la consulta del nefrólogo a 2. Conclusiones: El perfil de las participantes es similar al referido para las gestantes con estados hipertensivos del embarazo por otros estudios. El subgrupo de hipertensión crónica se asocia con estudios primarios, antecedentes de hipertensión arterial, obesidad y estado hipertensivo en un embarazo anterior. El subgrupo de preeclampsia sobreañadida se asocia a antecedentes de hipertensión arterial. Las primíparas presentan con más frecuencia preeclampsia y las secundíparas o multíparas hipertensión crónica. El mayor seguimiento de la presión arterial se realiza por la matrona, que es la que más deriva al servicio de urgencias y, en menor medida, a la consulta de nefrología

Objectives: To describe the profile of women with hypertensive disorders of pregnany, their relationship between the different disorders and the role of the midwife in monitoring blood pressure and the referral of the woman. Methods: Retrospective cohort study, which includes all the pregnant women referred to the Hypertension Unit of Hospital Francisco de Borja in 2009-2015. Results: The total number of participants was 79. Hypertensive disorders were preeclampsia (44.3%), chronic hypertension (39.2%), superimposed preeclampsia (10.1%) and gestational hypertension (6.3%). Level of studies (p= 0.022), history of hypertension (p= 0.000), of obesity (p= 0.015) and history of hypertensive disorder of pregnany (p= 0.000) were significantly related to the type of hypertensive disorders. The midwife performed 6.8 blood pressure measurements per pregnant woman, and referred 15 women to the emergency hospital unit and two to the nephrologist's office. Conclusions: The profile of the participants is similar to that reported for pregnant women with hypertensive disorders of pregnany by other studies. Chronic hypertension group is related to primary studies, chronic hypertension, obesity and history of hypertensive disorder. Superimposed preeclampsia group is related to history of hypertensive disorder. Primiparous women had more frequently preeclampsia, and secondary or multiparous women had more frequently chronic hypertension. The best follow-up of blood pressure is performed by the midwife, being the one that leads to the emergency unit and to a lesser extent to the nephrologist's office

Perfil perinatal asociado a los estados hipertensivos del embarazo / Perinatal profile associated with hypertensive disorders of pregnancy

Introducción: Los estados hipertensivos del embarazo son un conjunto de trastornos que acontecen en gestantes, siendo una de las principales causas de morbimortalidad materna y perinatal. Se clasifican en: hipertensión crónica, hipertensión gestacional, preeclampsia e hipertensión crónica con preclampsia sobreañadida. El adecuado control de la presión arterial es clave para su seguimiento. Objetivos: describir el perfil de los recién nacidos fruto de una gestación con estados hipertensivos y estudiar si existe relación con el tipo de alteración hipertensiva de la madre. Pacientes y Método: estudio de cohortes retrospectivo, que incluye a recién nacidos de gestantes con estados hipertensivos, seguidas en la unidad de hipertensión arterial, y que naciesen entre el 1 de enero de 2009 y el 31 de diciembre de 2015. Resultados: la muestra estuvo formada por 84 sujetos. La edad gestacional fue de 37,1 y el peso al nacer fue de 2.782,7 g. Las menores edades gestacionales y peso al nacer fueron en hijos de gestantes con preeclampsia o hipertensión crónica con preeclampsia sobreañadida (p<0,05). El Apgar y el sexo del RN no fue diferente en función del estado hipertensivo materno. Conclusiones: el perfil es el de un recién nacido con edad gestacional de 37,1 semanas, peso medio de 2.782,7 g, y Apgar al minuto de nacer de 8,6, y a los 5 minutos de 9,7. El peso al nacer y la edad gestacional se relacionaron significativamente con el tipo de estado hipertensivo de la madre, describiéndose peores resultados en hijos de gestantes con preeclampsia sola o sobreañadida. número de sesiones de entrenamiento (10 sesiones vs 8,7 sesiones; p=0,048)

Introduction: Pregnant women can be affected with a group of disorders called hypertensive disorders of pregnancy. These are classified as follows: chronic hypertension, gestational hypertension, mild preeclampsia, severe preeclampsia and chronic hypertension with superimposed preeclampsia. Hypertensive disorders of pregnancy are among the leading causes of maternal and perinatal morbidity and mortality. An adequate blood pressure monitoring is essential for the follow-up of this risk group. Objective: To describe a profile for new-borns delivered in pregnancies with hypertensive disorders of pregnancy, and to determine whether the profile is related to the different types of disorders. Patients and Method: Retrospective cohort study, which includes new-borns of pregnant women with hypertensive states, followed in the hypertension unit, and born between January 1, 2009 and December 31, 2015. Results: The sample consisted of 84 subjects. The gestational age was 37.1 and the birth weight was 2,782.7 g. The lowest gestational ages and birth weight were in children of pregnant women with preeclampsia or chronic hypertension with superimposed preeclampsia (p<0.05). The Apgar test and the sex of the RN was not different based on the maternal hypertensive state. Conclusions: The profile was a newborn with a gestational age of 37.1 weeks, average weight of 2,782.7 g, and an Apgar test at birth of 8.6, and at 5 minutes of 9.7. Birth weight and gestational age were significantly related to the type of hypertensive state of the mother, with worse results being reported in children of pregnant women with preeclampsia alone or in addition

Marked improvement in bone metabolism parameters after increasing the dialysate calcium concentration from 2.5 to 3 mEq/L in nonhypercalcemic hemodialysis patients.

The optimal dialysate calcium (Ca) concentration for hemodialysis (HD) patients is set at 2.5 mEq/L according to Kidney Disease Outcomes Quality Initiative (K-DOQI) guidelines. This recommendation is opinion-based and could negatively affect secondary hyperparathyroidism. Studies have suggested that a dialysate Ca of 3.0 mEq/L is a compromise between bone protection and cardiovascular risk. The aim of our study was to investigate the effect on bone metabolism parameters after increasing the dialysate Ca concentration from 2.5 to 3.0 mEq/L. The dialysate Ca concentration in our patients was increased from 2.5 to 3.0 mEq/L. Patients with hypercalcemia, normal-high Ca levels with a high Ca-Phosphorus product (Ca x P), excessively suppressed parathyroid hormone (PTH), or a past medical history of calciphylaxis were excluded. Twenty-two patients were studied over 20 weeks. Parathyroid hormone levels decreased significantly (442 +/- 254 vs. 255 +/- 226 pg/mL; p=0.000), without significant changes in serum Ca, P, and Ca x P levels at any sampling point. Better control of secondary hyperparathyroidism allowed us to decrease the paracalcitol dosage in 6 of the 12 patients who had been treated with this drug at the beginning of the study. Other potential factors involved in PTH secretion were not modified. A significant improvement in the rate of patients with 3 or more K-DOQI parameters within the target ranges (8 [36%] vs. 12 [55%]; p=0.026) was observed. In the absence of hypercalcemia or excessively suppressed PTH, an increase from 2.5 mEq to 3.0 mEq/L in dialysate Ca concentration resulted in better control of secondary hyperparathyroidism without affecting Ca, P, and Ca x P levels, thus enabling us to reduce the dosage of vitamin D metabolites.