Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury.

BACKGROUND AND AIM: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. MATERIAL AND METHODS: This is an observational retrospective cohorts study including all in-hospital AKI episodes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ±â€¯28 months, cardiovascular events (CVE) were collected, and associated factors were analysed. RESULTS: 1255 patients were included (55% male, age 75 ±â€¯13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to VCE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. CONCLUSION: Diastolic dysfunction is an independent predictor for long-term cardiovascular events after an in-hospital acute kidney injury episode.

La disfunción diastólica es un predictor independiente de eventos cardiovasculares tras un fracaso renal agudo / Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury

Antecedente y objetivo: El desarrollo de un fracaso renal agudo (FRA) condiciona complicaciones a corto, medio y largo plazo. El objetivo de nuestro estudio fue analizar el impacto de las alteraciones cardiacas en el pronóstico cardiovascular de pacientes que presentan un episodio de FRA. Materiales y métodos: Realizamos un estudio observacional de cohortes retrospectivo incluyendo a todos los pacientes con FRA en 2013 y 2014. Basalmente recogimos variables epidemiológicas, comorbilidades y parámetros ecocardiográficos. Seguimos a los pacientes tras el ingreso durante una media de 49 ± 28 meses, recogiendo la incidencia de eventos cardiovasculares (ECV) y los factores asociados a los mismos. Resultados: Se incluyeron 1.255 pacientes (55% varones, edad 75 ± 13 años). De los 676 (54%) pacientes que disponían de un ecocardiograma previo, el 46% tenían hipertrofia de ventrículo izquierdo, el 38% hipertensión pulmonar, el 38% disfunción diastólica y el 22% disfunción sistólica. Tras la hospitalización por FRA, 484 (39%) tuvieron un ECV. Los factores asociados a presentar un ECV fueron el sexo (varón), la edad, diabetes mellitus, hipertensión arterial, dislipidemia, cardiopatía isquémica, insuficiencia cardiaca, fibrilación auricular, neoplasia previa y enfermedad renal crónica (y el filtrado glomerular estimado basal y tras el FRA). El análisis de supervivencia demostró que todos los parámetros ecocardiográficos se asociaban a ECV. Un modelo de regresión de Cox ajustado demostró que la edad (HR 1,017), la diabetes mellitus (HR 1,576) y la disfunción diastólica (HR 1,358) eran predictores independientes de ECV. Conclusiones: La disfunción diastólica es un predictor independiente de ECV a largo plazo tras un episodio hospitalario de FRA. (AU)

Background and aim: Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. Materials and methods: This is an observational retrospective cohorts study including all in-hospital AKI episoes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ± 28 months, cardiovascular events (CVEs) were collected, and associated factors were analysed. Results: 1255 patients were included (55% male, age 75 ± 13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to CVE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. Conclusion: Diastolic dysfunction is an independent predictor for long-term CVEs after an in-hospital AKI episode. (AU)

Persistent kidney dysfunction after acute kidney injury predicts short-term outpatient mortality.

BACKGROUND: Acute kidney injury (AKI) during hospitalisation is frequent and associated with adverse outcomes. AIMS: To evaluate the association between renal function recovery after AKI and short-term post-discharge mortality. METHODS: This is a retrospective study of all AKI episodes codified in the electronic records of a single centre in 2013 and 2014. Epidemiological data and comorbidities at baseline and laboratory values at admission and discharge were collected. Persistent kidney dysfunction after AKI was defined as a last serum creatinine equal or above 1.2-fold over baseline level. Patients were followed for 30 days after discharge. RESULTS: Out of 1720 evaluated patients, 1541 (89%) were analysed. Of them, 869 (56%) recovered renal function. Independent predictors of renal function recovery after AKI were lower baseline estimated glomerular filtration rate (eGFR) (P < 0.001), higher admission eGFR (P < 0.001) and haemoglobin (P = 0.016), milder AKI (P = 0.037), absence of a history of heart failure (P < 0.001) and lower admission blood pressure (P < 0.001). After discharge, 46 (3%) patients died in the first 30 days. Persistent kidney dysfunction was associated (P = 0.01) with and independently predicted (odds ratio 2.6; 95% confidence interval 1.2-5.4; P = 0.01) short-term post-discharge mortality. CONCLUSIONS: Persistent kidney dysfunction after an AKI episode is an independent predictor of 30-day post-discharge mortality. This information might help select AKI patients who require closer follow up and monitoring after discharge.

Características basales de los pacientes nonagenarios ingresados por fracaso renal agudo en comparación con otros grupos etarios / Baseline characteristics of nonagenarians hospitalised due to acute kidney injury compared to other age groups

ANTECEDENTES Y OBJETIVO: El aumento en la esperanza de vida ha generado hospitalizaciones de pacientes con edades muy avanzadas. El objetivo de este trabajo es estudiar las características de la población de más de 90 años que ingresa por fracaso renal agudo (FRA) en comparación con otros grupos etarios. MATERIALES Y MÉTODOS: Estudio transversal que incluyó a todos los pacientes hospitalizados entre 2013 y 2014 cuya codificación al alta era de FRA. Recogimos características epidemiológicas, comorbilidad, medicación y datos analíticos basales. Analizamos y comparamos los datos de los mayores de 90 años con los menores de dicha edad. RESULTADOS: Se incluyeron 1.733 pacientes. Del total de pacientes, 264 (15%) tenían una edad superior a 90 años y se encontró una proporción significativamente mayor de mujeres. La causa más frecuente del FRA en los pacientes mayores de 90 años fue la funcional (81%) (p < 0,001 respecto al resto de grupos etarios). La principal causa de ingreso fue la infecciosa. En el grupo de más de 90 años, encontramos mayor prevalencia de hipertensión arterial (HTA) (p = 0,005), enfermedad renal crónica (ERC) (p = 0,014), insuficiencia cardiaca congestiva (ICC) (p = 0,006) y deterioro cognitivo (p < 0,0001). El filtrado glomerular basal por CKD-EPI fue inferior en el grupo de mayores de 90 años (p < 0,0001). Los pacientes hospitalizados por FRA menores de 90 años tenían mayor prevalencia de diabetes mellitus (p < 0,001), dislipemia (p < 0,001) y antecedente de neoplasia (p < 0,001), y un índice de Barthel superior (p < 0,0001). CONCLUSIONES: La causa más frecuente de FRA en nonagenarios es la funcional, presentando los pacientes más HTA, ERC, ICC, mayor dependencia y deterioro cognitivo frente al resto de grupos etarios

BACKGROUND: The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS: A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS: A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS: Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment

[Baseline characteristics of nonagenarians hospitalised due to acute kidney injury compared to other age groups]. / Características basales de los pacientes nonagenarios ingresados por fracaso renal agudo en comparación con otros grupos etarios.

BACKGROUND: The increase in life expectancy leads to higher hospitalisation rates in elderly patients. The aim of this work is to study the characteristics of the population over 90 years of age that are admitted due to acute kidney injury (AKI). MATERIAL AND METHODS: A cross-sectional study was conducted that included all patients admitted to hospital with AKI in the years 2013 and 2014. Epidemiological characteristics, comorbidity, medication and baseline analytical data were collected, and a comparison was made between patients with age over 90 years-old and the others. RESULTS: A total of 1733 patients were included, of whom 264 (15%) were over 90 years-old. A significantly higher proportion of these patients were women. The most frequent cause of AKI in patients older than 90 years was functional (81%) (p < 0.001 compared to other age groups). The main cause of hospital admission was infection. In the group of over 90 years of age, a higher prevalence was found for arterial hypertension (p = 0.005), chronic kidney disease (p = 0.014), congestive heart failure (p = 0.006), and cognitive impairment (p < 0.0001). The baseline glomerular filtration rate by CKD-EPI was lower in the group of patients older than 90 years (p < 0.0001). Patients under 90 years admitted to hospital due to AKI, had a higher prevalence of diabetes mellitus (p < 0.001), dyslipidaemia (p < 0.001), history of neoplasia (p < 0.001), and a higher Barthel index (p < 0.0001). CONCLUSIONS: Nonagenarians admitted due to AKI have functional aetiology as the most common factor. These patients have a higher prevalence of hypertension, heart failure, chronic kidney disease, low functional status, and more cognitive impairment.

Vascular access-related mortality in hemodialysis patients during and after hospitalization.

Long-term prognosis is poorer in hemodialysis patients wearing a permanent catheter than in those with a fistula; however, few data are available regarding the survival of hospitalized patients according to their vascular access. The aim of the present study is to analyze the influence of vascular access in the prognosis of hemodialysis patients during hospitalization. A prospective observational study was conducted, including 100 consecutive hemodialysis patients that were hospitalized for any cause. At baseline, we collected epidemiological data, comorbidities, and variables related to the hospitalization (analytical values, reason for admission, and type of vascular access). We divided the whole sample into two groups regarding the vascular access (fistula or catheter), and compared associated variables and short-term survival. We analyzed mortality during hospitalization and during follow-up. Of the 100 patients studied, 71 (71%) were male, with a mean age of 71 ± 12 years. Fifty patients (50%) had fistulae as vascular access. Mean dialysis vintage was 60 ± 47 months. Eighteen patients (18%) died during the hospitalization and 27 (27%) at the end of the follow-up (median 144 [47-269] months). Variables associated to survival during hospitalization were vascular access, personal history of heart failure, dialysis vintage, and analytical values at admission such as low hemoglobin, high lactic acid, and low albumin. A regression model demonstrated that vascular access was an independent predictor of survival during hospitalization and, also, during the follow-up. Permanent catheters should be avoided as they are independent predictors of mortality in hospitalized hemodialysis patients.

Cytomegalovirus encephalitis in a hemodialysis patient: a rare association.

Haemodialysis patients are at greater risk of infections than individuals not on dialysis due to their immunosuppressive state caused by several factors (uraemia, vascular access, inflammation, malnutrition). However, infections affecting the central nervous system are not frequent in this population. We present the case of a 77-year-old man with end-stage renal disease who was admitted to the emergency department for a decreased level of consciousness and fever. Although the initial clinical suspicion oriented to a urinary infection, the lack of improvement forced us to perform a lumbar puncture. Five days after cerebrospinal fluid was cultured, cytomegalovirus was isolated and ganciclovir initiated.

[FGF-23: just a phosphate metabolism regulator or something else?]. / FGF-23: ¿solo regulador del metabolismo del fósforo o algo más?

Endocrine communication between the bone, kidney, and the intestine is involved in maintaining appropriate serum phosphate concentrations, which is critical for the maintenance of skeletal integrity and is central to signal transduction and cell metabolism. In addition, hyperphosphatemia is statistically associated with vascular calcification, increased morbidity and mortality; because of this, phosphate regulation has become an important field of research. In this sense, fibroblast growth factor 23 (FGF-23) has been identified as a new hormone involved in phosphate regulation through feedback mechanisms involving parathyroid hormone and vitamin D. Given what the kidney is the primary site for regulation of phosphate levels and the principal target for FGF-23, its discovery has changed the understanding of disordered mineral metabolism in chronic kidney disease, especially now, since there is clinical evidence in favor of FGF-23 playing a central role for the pathogenesis of sHPT.

FGF-23: ¿solo regulador del metabolismo del fósforo o algo más? / FGF-23: just a phosphate metabolism regulator or something else?

En el organismo, la regulación de los niveles adecuados de fósforo se debe a la coordinación entre el esqueleto, el riñón y el intestino. El fósforo es un elemento crítico para el mantenimiento de la integridad del esqueleto, así como para la comunicación de numerosos procesos celulares. Además, la hiperfosfatemia ha sido estadísticamente asociada con calcificación vascular e incremento de la morbimortalidad, por lo que el control del fósforo se ha convertido en un importante campo de investigación. En este sentido, el factor de crecimiento fibroblástico 23 (FGF-23) ha aparecido como la nueva hormona implicada en la regulación del fósforo. Dado que el riñón es el principal órgano de regulación de los niveles de fósforo y el principal órgano diana de FGF-23, este factor ha suscitado un gran interés en el campo de la nefrología, especialmente al ser reconocido como el factor central del desarrollo del hiperparatiroidismo secundario (AU)

Endocrine communication between the bone, kidney, and the intestine is involved in maintaining appropriate serum phosphate concentrations, which is critical for the maintenance of skeletal integrity and is central to signal transduction and cell metabolism. In addition, hyperphosphatemia is statistically associated with vascular calcification, increased morbidity and mortality; because of this, phosphate regulation has become an important field of research. In this sense, fibroblast growth factor 23 (FGF-23) has been identified as a new hormone involved in phosphate regulation through feedback mechanisms involving parathyroid hormone and vitamin D. Given what the kidney is the primary site for regulation of phosphate levels and the principal target for FGF-23, its discovery has changed the understanding of disordered mineral metabolism in chronic kidney disease, especially now, since there is clinical evidence in favor of FGF-23 playing a central role for the pathogenesis of sHPT (AU)

Mental health care of Western expatriates in Tokyo.

This paper describes the current state of mental health care for Western expatriates in Tokyo, Japan. Types of therapists, patient demographics, illness breakdown, and psychiatric medications in Japan are discussed and problems in the system and potential remedies are presented.