Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: renal replacement therapy and mortality. FRA-COVID SEN Registry Data.

BACKGROUND: Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI- COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed MATERIAL AND METHOD: In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality. RESULTS: Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases. The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41), and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, and shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55). CONCLUSIONS: Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as a risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.

[Anemia of chronic kidney disease: Protocol of study, management and referral to Nephrology]. / Anemia en la enfermedad renal crónica: protocolo de estudio, manejo y derivación a Nefrología.

The objective of this protocol is to know which test are needed to study an anaemia in a patient with chronic kidney disease, the differential diagnosis of renal anaemia, to know and correct other deficiency anaemias, and the criteria for referral to Nephrology or other specialties of the anaemic patient with chronic kidney disease.

[Consensus document on pneumococcal vaccination in adults at risk by age and underlying clinical conditions. 2017 Update]. / Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017.

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) represent an important health problem among aging adults and those with certain underlying pathologies and some diseases, especially immunosuppressed and some immunocompetent subjects, who are more susceptible to infections and present greater severity and worse evolution. Among the strategies to prevent IPD and PP, vaccination has its place, although vaccination coverage in this group is lower than desirable. Nowadays, there are 2 vaccines available for adults. Polysacharide vaccine (PPV23), used in patients aged 2 and older since decades ago, includes a greater number of serotypes (23), but it does not generate immune memory, antibody levels decrease with time, causes an immune tolerance phenomenon, and have no effect on nasopharyngeal colonization. PCV13 can be used from children 6 weeks of age to elderly and generates an immune response more powerful than PPV23 against most of the 13 serotypes included in it. In the year 2013 the 16 most directly related to groups of risk of presenting IPD publised a series of vaccine recommendations based on scientific evidence regarding anti-pneumococcal vaccination in adults with underlying pathologies and special conditions. A commitment was made about updating it if new scientific evidence became available. We present an exhaustive revised document focusing mainly in recommendation by age in which some more Scientific Societies have been involved.

Reincorporación laboral en pacientes con amputación traumática de extremidad superior / Return to work in traumatic upper limb amputees

Objetivo. Evaluar el retorno a la actividad laboral de pacientes amputados de extremidad superior como resultado de un accidente de trabajo. Pacientes y método. Estudio transversal y descriptivo. Variables recogidas mediante entrevista telefónica: retorno al trabajo, tipo de trabajo antes y después del accidente, protetización, uso de la prótesis, dolor. Resultados. De 65 pacientes (60 varones), con media de edad de 44,4 años, los reincorporados al trabajo (n=38) presentaban dolor con menos frecuencia (p=0,009) y menor intensidad (p=0,004) y usaban más su prótesis, aunque de forma marginalmente significativa (p=0,07). El resto de las variables no presentaban diferencias entre reincorporados y no reincorporados. Conclusiones. Desde el punto de vista clínico, la variable con más influencia en el retorno a la actividad laboral de los pacientes amputados de extremidad superior por accidente durante el trabajo fue el dolor. En el estudio no se recoge la influencia de variables socioeconómicas(AU)

Objective. To evaluate the return to the work environment of patients with upper limb amputations due to work accidents. Patients and methods. A descriptive cross-sectional study was performed. The variables evaluated were obtained by telephone interview, this being return to work, occupation after and before the amputation, prosthesis requirement, use of prosthesis and pain. Results. Sixty-five patients (60 male) mean age 44.4 years were enrolled. The subjects who returned to work (38 cases) reported pain less frequently (P=.009) and when present, the pain was less intense (P=.004). Use of prosthesis was slightly significantly higher in this group of patients (P=.07). No significant differences were found for the rest of variables between the reinstated and non-reinstated patients. Conclusions. From a clinical point of view, pain was the most important factor conditioning return to work in subjects with traumatic upper limb amputation. However, the influence of socioeconomic variables was not studied(AU)

[Outpatient surgeries of patients with arteriovenous fistulas for hemodialysis. Integrated activity in a general surgery unit]. / Cirugía sin ingreso de pacientes con fístulas arteriovenosas para hemodiálisis. Actividad integrada en un servicio de cirugía general.

INTRODUCTION: The increase of prevalent haemodialysis patients is a challenge for surgery units. Vascular access related complications are the main cause of hospital admissions in many dialysis units. Outpatient surgery could decrease waiting lists, cost related and complications associated to vascular access. MATERIAL AND METHODS: We have performed a prospective study of the vascular access related surgery in a ten years period. Outpatient surgery was included with the rest of the activity in a general surgery unit and was performed by not exclusive dedicated surgeons. RESULTS: Since 1998 to December 2009 we performed 2,413 surgical interventions for creating and repairing arteriovenous fistula in 1,229 patients, including elective and emergency surgery (74.8% and 25.2% respectively). Outpatient procedures were performed in 82% of cases (89% in elective and 60% in emergency surgery). There were unexpected admissions secondary to surgical complications in 6% of patients. There wasn't postoperative mortality. The rate of admissions were 0,09 episodes and 0,2 days per patient/year. CONCLUSIONS: Outpatient surgery is possible in a high percentage of patients to perform or to repair an arteriovenous fistula, including emergency surgery. Vascular access surgery can be included in ordinary activity of a surgical unit. Outpatient vascular access surgery decreases unnecessary hospital admissions, reduces costs and nosocomial complications.

Reproducibilidad de la medida de la fuerza muscular de la rodilla mediante dinamometría manual en pacientes con gonartrosis grave / Reliability of knee muscle strength measurement with manual dynamometry in patients with severe knee arthritis

Introducción. El objetivo fue valorar la reproducibilidadde la dinamometría manual para medir lafuerza muscular de la rodilla en pacientes con gonalgia porgonartrosis grave, con el dinamómetro Nicholas ManualMuscle Tester (NMMT).Métodos. Se reclutaron los pacientes antes de realizaruna artroplastia total de rodilla. Se midió la fuerza muscularde los flexores y los extensores de la rodilla (FR, ER) con eldinamómetro NMMT, mediante un protocolo estándar, conuna prueba isométrica y un diseño test-retest. Se calcularonlos coeficientes de correlación intraclases (CCI) y elerror técnico de medida (ETM), y se realizó una prueba devarianza para descartar un sesgo entre los observadores.Resultados. El CCI inter-observador (n = 20) fue 0,85 (intervalode confianza [IC] 95 % 0,66-0,94) para ER, y 0,90(IC 95 % 0,68-0,96) para FR. El CCI intra-observador(n = 13) fue 0,99 (IC 95 % 0,97-0,99) para ER, y 0,95 (IC 95 %0,84-0,98) para FR. El ETM fue 1,487 kg para ER, y 1,153 kgpara FR. Se encontró una diferencia significativa entre lasfuerzas medidas por los dos exploradores de una media de1,0 kg para la fuerza de los FR (p = 0,01, IC 95 % 0,28-1,78).Conclusiones. La reproducibilidad inter-observador de ladinamometría manual fue entre moderada y alta, mientrasque la reproducibilidad intra-observador fue alta(AU)

Background. The aim of the study was to determinethe reliability of the knee muscle strength measurementwith the Nicholas Manual Muscle Tester (NMMT) dynamometerin patients with pain due to severe knee arthritis.Methods. Patients were recruited before a total knee arthroplasty.The flexor and extensor knee muscle strength wasmeasured with the NMMT using a standardised protocol forisometric “make” tests, and a test-retest design was done. Theintra-class correlation coefficients (ICC), and the technical errorof measurement (TEM) were determined. A paired samplet-test was performed to detect any possible rater bias.Results. The inter-rater ICC (n = 20) was 0.85 (95 % CI0.66-0.94) for knee extensor force (KEF), while it was 0.90(95 % CI 0.68-0.96) for knee flexor force (KFF). The intra-rater ICC (n = 13) for KEF was 0.99 (95 % CI 0.97-0.99),whereas for KFF it was 0.95 (95 % CI 0.84-0.98). The TEMwas 1.487 kg for KEF, and 1.153 kg for KFF. The paired samplet-test showed a significant difference of an average of1.0 kg between the two raters in the KFF measurement(p = 0.01, 95 % CI 0.28-1.78).Conclusions. With this protocol, dynamometry was reliablefor patients with knee pain, achieving moderate to highinter-rater reliability for KFF and KEF, and high intra-raterreliability for both KFF and KEF(AU)

Historia natural del paciente isquémico sometido a una amputación infracondílea: un largo camino hacia la deambulación autónoma / The natural history of ischaemic patients who undergo below-knee amputation: a long way to autonomus walking

Objetivo. Conocer la historia natural del paciente sometido a una amputación infracondílea (AIC), analizandolos factores pronósticos de reamputación precoz, protetización, supervivencia y deambulación al año. Pacientesy métodos. 140 amputaciones consecutivas en 124 pacientes (edad media 70,2, varones 64%), intervenidos entre 1995y 2004 por isquemia aguda (6%), crítica (86%) o infección (exclusiva 8%; concomitante 59%); practicándose una AIC(57% transversal, 43% sagital). Estadístico: regresión logística, Kaplan-Meier invertido, Cox. Resultados. Supervivencia:inmediata (< 30 días/alta) del 87,6% y al año del 67%, disminuyendo significativamente la primera con antecedentede enfermedad pulmonar obstructiva crónica (odds ratio, OR = 2,698; p = 0,087), y la segunda si accidentevascular cerebral (AVC) (OR = 2,86; p = 0,039) o edad > 80 años (OR = 2,94; p = 0,049). Evolución del muñón: 20reamputaciones proximales (14%) precoces, asociándose a antecedentes de AVC (OR = 3,675; p = 0,021), edad 60-69años (OR = 3,337; p = 0,027) e isquemia aguda (OR = 5,097; p = 0,051). El porcentaje acumulado de cicatrización delas restantes 120 fue a 30/60/90 días de 44/84/91%, respectivamente (mediana 47 días), siendo menor con antecedentede diabetes (OR = 1,654; p = 0,020). Protetización: 56/140 (40%) pacientes (a 90/180/365 días: 19/38/55%), siendomenor si antecedente de insuficiencia cardíaca congestiva (OR = 0,245; p = 0,002), AVC (OR = 0,217; p = 0,035)y deambulación limitada (OR = 0,154, p = 0,002) o nula (OR = 0,191, p = 0,085) previas. Deambulación al año:41/124 pacientes (35%: limitada = 37%, normal = 63%), siendo menor si antecedente de edad > 70 años (OR = 0,169;p = 0,006), insuficiencia renal crónica (OR = 0,035; p = 0,001), AVC (OR = 0,000; p = 0,998), deambulación limitada(OR = 0,154, p = 0,002) o nula (OR = 0,191, p = 0,085) previas. Conclusiones. A pesar de nuestra tendencia optimistaal indicar una AIC, el número de pacientes que llegan al final del camino es modesto y depende de factores quevan mucho más allá de que el paciente tenga nivel clínico para esta intervención. El conocimiento de estos factorespuede contribuir a un mejor proceso de selección, evitando expectativas, a veces, poco realistas

Aim. To determine the natural history of patients who undergo below-knee amputation (BKA) by analysingthe prognostic factors of early reamputation, prosthetics surgery, survival and walking at one year. Patients and methods.Our sample included 140 consecutive amputations in 124 patients (mean age 70.2; 64% males) who, between 1995 and2004, underwent surgery involving BKA (57% transversal, 43% sagittal) as a result of acute ischaemia (6%), criticalischaemia (86%) or infection (exclusive 8%; concomitant 59%). Statistics: logistic regression, inverted Kaplan-Meier,Cox. Results. Survival: immediate (< 30 days/discharge) 87.6% and at one year 67%; the former dropped significantlywith a history of chronic obstructive pulmonary disease (odds ratio, OR = 2.698; p = 0.087) while the latter decreasedwith cerebrovascular accident (CVA) (OR = 2.86; p = 0.039) or age > 80 years (OR = 2.94; p = 0.049). Progression ofthe residual limb: 20 early proximal reamputations (14%), which were associated with a history of CVA (OR = 3.675; p =0.021), an age of 60-69 years (OR = 3.337; p = 0.027) and acute ischaemia (OR = 5.097; p = 0.051). The accumulatedpercentage of scarring in the other 120 was 44/84/91% at 30/60/90 days, respectively (mean 47 days), and was lowerwith a history of diabetes (OR = 1.654; p = 0.020). Prosthetics surgery: 56/140 (40%) patients (at 90/180/365 days:19/38/55%), which was lower with a history of congestive heart failure (OR = 0.245; p = 0.002), CVA (OR = 0.217; p =0.035) and previous limited (OR = 0.154; p = 0.002) or null walking ability (OR = 0.191; p = 0.085). Walking at one year: 41/124 patients (35%: limited = 37%, normal = 63%), which were lower with a history of an age > 70 years (OR= 0.169; p = 0.006), chronic renal failure (OR = 0.035; p = 0.001), CVA (OR = 0.000; p = 0.998), previous limited(OR = 0.154; p = 0.002) or null walking ability (OR = 0.191; p = 0.085). Conclusions. Despite our tendency to beoptimistic when indicating a BKA, a relatively small number of patients reach the end of the way and the figure dependson factors that go far beyond the patient's having the clinical level required for this procedure. Knowledge of thesefactors can help improve the selection process and avoid what are sometimes unrealistic expectations

Grado de satisfacción y mejoría clínica subjetiva tras la rehabilitación en el tratamiento de la incontinencia urinaria / Satisfaction grade and subjective clinical improvement grade after rehabilitation in the treatment of urinary incontinence

Objetivos. Averiguar la mejoría clínica subjetiva y el grado de satisfacción de pacientes con incontinencia urinaria (IU) después de seguir tratamiento rehabilitador, así como determinar la relación entre dicha mejoría clínica subjetiva y el cumplimiento posterior en el entrenamiento del suelo pélvico en el domicilio. Pacientes y método. Estudio descriptivo transversal: 100 mujeres con IU que siguen tratamiento rehabilitador. Las principales variables recogidas fueron: edad, tiempo de evolución, factores desencadenantes, número de partos vaginales, tipo de incontinencia, grado de IU, tratamientos previos, mejoría al finalizar la terapia, mejoría clínica actual, cumplimiento del tratamiento en el domicilio y grado de satisfacción actual. Resultados. Cincuenta y ocho mujeres con IU de esfuerzo (IUE) y 42 con IU mixta (IUM). Más del 85 % de las pacientes estaban satisfechas con el tratamiento independientemente del tipo y del grado de incontinencia. Más del 75 % de las pacientes con IU grado I manifiestaban mejoría clínica de su sintomatología (p = 0,035), independientemente de cual fuera el tipo de IU. Las pacientes que continuaron haciendo los ejercicios en el domicilio fueron las que, inicialmente habían presentado mejor respuesta clínica al tratamiento (p = 0,01), en el momento del estudio estaban mejor que antes del tratamiento (p < 0,001) y las que presentaban un mayor grado de satisfacción (p < 0,001). Conclusiones. Las pacientes con IUE o IUM que reciben tratamiento rehabilitador manifiestan una mejoría clínica y refieren un alto grado de satisfacción, especialmente en las IU de grado I. La continuidad del entrenamiento en el domicilio está relacionado con el grado de mejoría clínica subjetiva y con el grado de satisfacción

Objectives. Ascertain subjective clinical improvement and satisfaction grade of patients with urinary incontinence (UI) after following rehabilitation treatment and determine the relationship between this subjective clinical improvement and subsequent fulfillment of pelvic floor training at home. Patients and method. Descriptive cross-sectional study: 100 women with UI who follow rehabilitation treatment. The main variables used were: age, course time, precipitating factors, number of vaginal deliveries, type of incontinence, UI grade, previous treatments, improvement at end of therapy, current clinical improvement, fulfillment of treatment at home and current satisfaction grade. Results. 58 women with stress UI (SUI) and 42 with mixed IU (MUI). More than 85 % of the patients were satisfied with the treatment independently of incontinence type and grade. More than 75 % of the patients with grade I IU manifested clinical improvement of their symptoms (p = 0,035), independently of which type of UI they had. Patients who continued doing the exercises at home were those who initially had presented better clinical response to the treatment (p = 0.01), were better at the time of the study than before the treatment (p < 0.001) and those who had a better satisfaction grade (p < 0.001). Conclusions. Patients with SUI or MUI who receive rehabilitation treatment manifest clinical improvement and report high satisfaction grade, especially in the grade I UI. Continuing training at home is related with grade of subjective clinical improvement and satisfaction grade