Pneumocystis pneumonia in HIV-positive patients in Spain: epidemiology and environmental risk factors.

INTRODUCTION: Specific environmental factors may play a role in the development of Pneumocystis pneumonia (PCP) in HIV-positive patients. The aim of this study was to estimate the PCP incidence and mortality in hospitalized HIV-positive patients in Spain during the combination antiretroviral therapy (cART) era (1997 to 2011), as well as to analyze the climatological factors and air pollution levels in relation to hospital admissions and deaths. METHODS: We carried out a retrospective study. Data were collected from the National Hospital Discharge Database and the State Meteorological Agency of Spain. A case-crossover analysis was applied to identify environmental risk factors related to hospitalizations and deaths. For each patient, climatic factors and pollution levels were assigned based on readings from the nearest meteorological station to his or her postal code. RESULTS: There were 13,139 new PCP diagnoses and 1754 deaths in hospitalized HIV-positive patients from 1997 to 2011. The PCP incidence (events per 1000 person-years) dropped from 11.6 in 1997 to 2000, to 5.4 in 2004 to 2011 (p<0.001). The mortality (events per 10,000 person-years) also decreased from 14.3 in 1997 to 2000, to 7.5 in 2004 to 2011 (p<0.001). Most hospital admissions and deaths occurred in the winter season and the fewest occurred in the summer, overlapping respectively with the lowest and highest temperatures of the year in Spain. Moreover, lower temperatures prior to PCP admission, as well as higher concentrations of NO2 and particulate matter up to 10 m in size (PM10) at the time of admission were associated with higher likelihoods of hospital admission due to PCP when two weeks, one month, 1.5 months or two months were used as controls (p<0.01). Furthermore, higher concentrations of ozone at one month (p=0.007), 1.5 months (p<0.001) and two months (p=0.006) prior to admission were associated with higher likelihoods of hospital admission with PCP. For PCP-related deaths, lower temperatures prior to admission and higher concentrations of atmospheric PM10 at the time of admission were related to higher likelihood of death when two weeks, one month and 1.5 months were used as controls (p<0.05). CONCLUSIONS: PCP was a significant health problem in the cART era (1997 to 2011), and PCP epidemiology was adversely influenced by colder climatological factors and higher ambient air pollution levels.

[New reliable methods for the diagnose of protein-energy wasting in hemodialysis patients]. / Nuevos métodos fiables para diagnosticar la depleción proteico-calórica en los pacientes en hemodiálisis.

BACKGROUND: Protein-energy wasting (PEW), defined as the body loss of muscle mass and fat, is an important cardiovascular risk factor in dialysis patients. Diagnosing this condition requires the presence of three characteristics: biochemical (low albumine, prealbumine or cholesterol), body mass reduction (body mass index, weight loss or fat loss) and muscle mass reduction (measured by means of creatinine or arm muscle area). This study aimed at demonstrating that the lean tissue index (LTI) calculated by spectroscopic bioimpedance (SBI) is a valid parameter for the diagnostic of protein-energy wasting. METHODS: Cross-sectional study including 1369 patients with two BCM measurements on a six-month delay, analyzing analytic and spectroscopic bioimpedance parameters. RESULTS: The lean tissue index from the BCM (Body Composition Monitor) quantifies the patient's lean mass and it is matched against traditional parameters (plasma albumine) and non-traditional parameters (IRE and PCR) for protein-energy wasting with no alterations from the patient's hydration level. CONCLUSIONS: LTI is an easy to obtain parameter of lean mass which can be followed and monitored in order to diagnose risk situations of our patients as it is the protein- energy wasting.

Introducción: La depleción proteico-calórica (protein- energy wasting, PEW) definida como pérdida de masa muscular y grasa del organismo, supone un importante factor de riesgo cardiovascular en los pacientes en diálisis. Para su diagnóstico se requiere de la presencia de tres características: bioquímicas (albúmina, prealbúmina o colesterol bajos), descenso de masa corporal (índice de masa corporal, pérdida de peso o de grasa) y reducción de masa muscular (evaluada mediante creatinina o área muscular del brazo). El Objetivo del presente estudio es demostrar que el índice de tejido magro (LTI) obtenido por bioimpedancia espectroscópica (BIS) es un parámetro válido para el diagnóstico de depleción proteico- calórica. Métodos: Estudio transversal de 1369 pacientes con dos mediciones de BCM entre las que transcurren seis meses, en los que analizamos parámetros analíticos y de bioimpedancia espectroscópica . Resultados: El índice de tejido magro aportado por el BCM (Body Composition Monitor) cuantifica la masa magra del paciente y se correlaciona con parámetros tradicionales (albúmina plasmática) y no-tradicionales (IRE y PCR) de depleción proteico-calórica sin verse alterado por la situación hídrica del paciente. Conclusiones: El LTI es un parámetro de masa magra fácil de obtener cuyo seguimiento y monitorización nos puede ayudar a diagnosticar situaciones de riesgo para nuestros pacientes como la depleción proteico-calórica.

Nuevos métodos fiables para diagnosticar la depleción proteico-calórica en los pacientes en hemodiálisis / New reliable methods for the diagnose of protein-energy wasting in hemodialysis patients

Introducción: La depleción proteico-calórica (protein-energy wasting, PEW) definida como pérdida de masa muscular y grasa del organismo, supone un importante factor de riesgo cardiovascular en los pacientes en diálisis. Para su diagnóstico se requiere de la presencia de tres características: bioquímicas (albúmina, prealbúmina o colesterol bajos), descenso de masa corporal (índice de masa corporal, pérdida de peso o de grasa) y reducción de masa muscular (evaluada mediante creatinina o área muscular del brazo). El Objetivo del presente estudio es demostrar que el índice de tejido magro (LTI) obtenido por bioimpedancia espectroscópica (BIS) es un parámetro válido para el diagnóstico de depleción proteico-calórica. Métodos: Estudio transversal de 1369 pacientes con dos mediciones de BCM entre las que transcurren seis meses, en los que analizamos parámetros analíticos y de bioimpedancia espectroscópica . Resultados: El índice de tejido magro aportado por el BCM (Body Composition Monitor) cuantifica la masa magra del paciente y se correlaciona con parámetros tradicionales (albúmina plasmática) y no-tradicionales (IRE y PCR) de depleción proteico-calórica sin verse alterado por la situación hídrica del paciente. Conclusiones: El LTI es un parámetro de masa magra fácil de obtener cuyo seguimiento y monitorización nos puede ayudar a diagnosticar situaciones de riesgo para nuestros pacientes como la depleción proteico-calórica (AU)

Background: Protein-energy wasting (PEW), defined as the body loss of muscle mass and fat, is an important cardiovascular risk factor in dialysis patients. Diagnosing this condition requires the presence of three characteristics: biochemical (low albumine, prealbumine or cholesterol), body mass reduction (body mass index, weight loss or fat loss) and muscle mass reduction (measured by means of creatinine or arm muscle area). This study aimed at demonstrating that the lean tissue index (LTI) calculated by spectroscopic bioimpedance (SBI) is a valid parameter for the diagnostic of protein-energy wasting. Methods: Cross-sectional study including 1369 patients with two BCM measurements on a six-month delay, analyzing analytic and spectroscopic bioimpedance parameters. Results: The lean tissue index from the BCM (Body Composition Monitor) quantifies the patient’s lean mass and it is matched against traditional parameters (plasma albumine) and non-traditional parameters (IRE and PCR) for protein-energy wasting with no alterations from the patient’s hydration level. Conclusions: LTI is an easy to obtain parameter of lean mass which can be followed and monitored in order to diagnose risk situations of our patients as it is the protein-energy wasting (AU)

Epidemiological study of 7316 patients on haemodialysis treated in FME clinics in Spain, using data from the EuCliD® database: results from years 2009-2010.

Observational study of patients on hemodialysis (HD) in FMC® Spain clinics over the years 2009 and 2010. The data were collected from the EuClid® database, implemented in the clinics of FMC®, which complies with the following feature: record online, compulsory, conducted in patients incidents and that it covers the entire population on HD in these clinics. Its aim is to understand the characteristics of patients and treatment patterns, comparing them with other studies described in the literature and in order to improve their prognosis and quality of life. Include 2637 incidents patients and 4679 prevalent, which makes a total of 7316 patients. In prevalent patients: 24.4% were diabetic; 76.3% had cardio-vascular disease (CVD) and 13.4% cancer. Among the incidents, these percentages were: 33.5% diabetic; 80.6% had CVD and 12.6% cancer. The prevalent patients had such as vascular access: FAV 68.5%, prosthesis 5.6%, permanent catheter 23.7% and 2.3% temporary catheter. The average of the duration of the sessions of HD was 230 minutes. 23.2% of the prevalent patients were on on-line hemodiafiltration. These patients hospitalization rates were 0.46 hospitalizations per incident patient per year and 0.52 per prevalent patient per year. The annual gross mortality rate was 12%. The mortality of the patients in this study HD is smaller than these of the Spanish Registry of Dialysis and Transplant (GRER). The result of morbidity and mortality of the FMC clinics of Spain can, therefore, be as good compared with these of the GRER and other international series. That does not mean that there are not areas of improvement as the increase in the time of dialysis, the percentage of patients on on-line hemodiafiltration convective techniques and the percentage of FAV.