[Conservative management in elderly patients with advanced chronic kidney disease].

The poor health outcomes of Renal Replacement Therapy (RRT) in the elderly has promoted Conservative Management (CM) as a therapeutic option in advanced chronic kidney disease. However, there is still a lack of evidence about prognosis of these patients; thus, the aim was to analyze the survival rate of elderly patients under CM and RRT and evaluate the variables related to the initiation of such treatments in clinical practice. METHODS: Prospective cohort study of RRT and CM patients >75años. Renal function parameters and geriatric assessments were carried out. This evaluation included: analysis of comorbidity, functional, cognitive, frailty, nutritional and socio-family status. RESULTS: Cohort of 37 RRT and 82 CM patients. CM patients were significantly older, with more frequency of history of vascular event, more comorbility (Charlson), worse functional situation (Barthel), higher risks of cognitive impairment (Pfeiffer) and malnutrition (MNA-SF), and higher frailty and socio-familiar impairment. Mortality rate was lower in RRT patients (8.72 vs. 3/1,000 patients/month; HR= 0.37, p=0.018), but survival advantage reduced drastically after adjustment for the different geriatric syndromes analyzed. CONCLUSIONS: Charlson's comorbidity was found to be an independent mortality predictor in elderly patients with advanced chronic kidney disease. Dialysis did not improve survival with respect to conservative treatment in patients with Charlson higher than 8 points.

Pre-Transplant Assessment of Vascular Calcification as a Risk Factor of Mortality, Graft Loss, and Cardiovascular Events in Renal Transplant Recipients.

BACKGROUND: Vascular calcification (VC) is known as an independent predictor of mortality in patients undergoing hemodialysis; nevertheless, there is a lack of studies about the impact of vascular calcification in renal transplant recipients, and none of them use the Kauppila Index (KI) as a predictor of patient and graft prognosis. METHODS: We conducted an observational, retrospective study of 119 renal transplants, evaluating abdominal aortic calcifications (L4-S1) with the KI. We established 2 categories: absence (KI = 0-2) and presence (KI = 3-24) of VCs before transplantation. We analyzed the impact of calcification in graft and patient survival, new-onset diabetes mellitus, hypertension, cardiovascular events, renal function, and mineral metabolism. RESULTS: VCs were observed in 50 patients (42%) before renal transplantation. Patients with VCs were older, but no statistical differences were found in the pre-transplant study between sex, diabetes, body mass index, and cardiovascular events. We found a major patient survival (limited to first 2 years after transplantation), graft survival, and death-censored graft survival in those without VCs (P = .037, P = .015, and P = .023, respectively). In line with results, a higher incidence of major cardiovascular events (MACE) and cardiovascular death was observed in the group with preexisting calcification (P = .016/P = .019). In the multivariable analysis, VCs were not an independent predictor for graft loss, death-censored graft loss, or major cardiovascular events. CONCLUSIONS: Simple evaluation of VCs with the use of the KI at the time of transplantation relates with graft and patient survival and with MACE after renal transplantation.