Valor pronóstico de las apolipoproteínas A y B en la evolución de los pacientes con enfermedad renal crónica avanzada prediálisis / No disponible

La dislipemia es un reconocido factor de riesgo cardiovascular en la población general, pero no así en pacientes con enfermedad renal crónica (ERC). Los objetivos del presente estudio han sido determinar si las alteraciones lipídicas más comunes, así como las concentraciones de apolipoproteína (apo) A y B, son capaces de predecir la mortalidad y el desarrollo de nuevos episodios cardiovasculares (CV) en pacientes con ERC en estadios previos a la diálisis. Se trata de un estudio de observación prospectivo histórico en el que se incluyeron 331 pacientes con ERC en estadios 4-5prediálisis. Se determinaron los siguientes parámetros lipídicos: colesterol total, triglicéridos, HDL, LDL, apo A-I y apo B. Se analizó la asociación de estas variables con la mortalidad global y con el desarrollo de episodios CV. La mediana de seguimiento fue 985 días, y durante este período hubo 105 fallecimientos y 54 nuevos episodios CV. En un modelo multivariable de Cox ajustado al resto de covariables de reconocida importancia pronóstica, la razón de riesgo (RR) por cada 10 mg/dl de apo A fue de 0,915 (IC95%: 0,844 a 0,992; p = 0,031). Los pacientes con una relación apo A/apo B elevada (tercil superior, >1,42) también tuvieron una supervivencia significativamente mejor quela del resto de los pacientes estudiados (RR = 0,592, IC95%: 0,3680-0,953; p <0,05). No hubo relación significativa entre los parámetros lipídicos y el desarrollo de episodios CV. En conclusión, las concentraciones de apo A y una relación apo A/apo B elevada se asocian con un mejor pronóstico vital en pacientes con ERC prediálisis (AU)

Dyslipidemia is a well-established risk factor for cardiovascular diseases in the general population. However, this association is not observed in chronic kidney disease(CKD) patients. This study examines the association between lipid levels, including apolipoproteins A-I and B concentrations, and all-cause mortality or the development of new cardiovascular events in advanced CKD patients not yet on dialysis. This observational prospective historical study included 331 patients with CKD stage 4 or 5 not yet on dialysis. In addition to conventional clinical and biochemical data, total cholesterol, triglycerides, HDL, LDL, apolipoproteinA-I (apo A) and B (apo B) plasma concentrations were measured. Cox proportional hazard models were adjusted for age, sex, comorbidity index, residual renal function, serum albumin, C-reactive protein levels, and treatment with statins.T he median follow-up time was 985 days, and during this period 105 patients died and 54 patients had a new cardiovascular event. In fully-adjusted fixed-covariate Coxmodels, the hazard ratio for each 10 mg/dl increase of apo A concentration was 0.915 (C.I. 95% 0.844 to 0.992; p = 0,031).Patients with an apo A /apo B ratio in the upper tertile (i.e.>1.42) had a better survival than that of the rest of study patients (hazard ratio = 0.592, C.I. 95% 0.368 to 0.953,p <0.05). None of the study lipid parameters was associated with new cardiovascular events in the adjusted models. In conclusion, apo A concentrations and high apo A/apo B ratios added independent predictive information about survival of CKD patients not yet on dialysis (AU)

[Prognostic value of apolipoproteins A and B in the clinical course of patients with chronic kidney disease previous to dialysis]. / Valor pronóstico de las apolipoproteínas A y B en la evolución de los pacientes con enfermedad renal crónica avanzada prediálisis.

Dyslipidemia is a well-established risk factor for cardiovascular diseases in the general population. However, this association is not observed in chronic kidney disease (CKD) patients. This study examines the association between lipid levels, including apolipoproteins A-I and B concentrations, and all-cause mortality or the development of new cardiovascular events in advanced CKD patients not yet on dialysis. This observational prospective historical study included 331 patients with CKD stage 4 or 5 not yet on dialysis. In addition to conventional clinical and biochemical data, total cholesterol, triglycerides, HDL, LDL, apolipoprotein A-I (apo A) and B (apo B) plasma concentrations were measured. Cox proportional hazard models were adjusted for age, sex, comorbidity index, residual renal function, serum albumin, C-reactive protein levels, and treatment with statins. The median follow-up time was 985 days, and during this period 105 patients died and 54 patients had a new cardiovascular event. In fully-adjusted fixed-covariate Cox models, the hazard ratio for each 10 mg/dl increase of apo A concentration was 0.915 (C.I. 95% 0.844 to 0.992; p=0,031). Patients with an apo A /apo B ratio in the upper tertile (i.e. > 1.42) had a better survival than that of the rest of study patients (hazard ratio = 0.592, C.I. 95% 0.368 to 0.953, p<0.05). None of the study lipid parameters was associated with new cardiovascular events in the adjusted models. In conclusion, apo A concentrations and high apo A / apo B ratios added independent predictive information about survival of CKD patients not yet on dialysis.

[Growing incidence of diabetic nephropathy in the region of Badajoz during the period 1991-2006]. / Incidencia creciente de nefropatía diabética en la provincia de Badajoz durante el período 1991-2006.

OBJECTIVE: Diabetic nephropathy is the most common cause for starting renal repacement therapy in Spain with a steady incidence since 1997. Data on incidence of diabetic nephropathy previously to dialysis are scanty because they are not registries similar to those used for renal replacement therapy. DESIGN AND METHODS: It have been retrospectively studied the records of our hospital Nephrology outward from January, 1991 to December, 2006. Diagnosis was commonly made using clinical criteria (proteinuria plus diabetic retinopathy). There were 21 cases which did not meet theses criteria and so renal biopsy was performed. RESULTS: During this time 478 (49.7 pmp) patients were diagnosed of diabetic nephropathy (mean age 61.2 years, 50.4% women). Incidence increased from 33.3 pmp (1991) to 76.2 pmp (2006). There were not significant changes in the age of patients along the time. Other common diagnosis in diabetic patients were nefroangiosclerosis (129) and glomerulonefritis (n = 103). Survival until renal replacement therapy was 87.5% at one year and 48% at five years of follow up. CONCLUSIONS: Incidence of diabetic nephropathy seems to have increase last years specially in the patients aged 70 or older. In spite of therapeutic improvements the prognosis is still unfavourable. Less rectricted age criteria for submitting patients may have influenced these results.

Incidencia creciente de nefropatía diabética en la provincia de Badajoz durante el período 1991-2006 / No disponible

Objetivo: la nefropatía diabética es la causa más común de entrada en tratamiento renal sustitutivo en España, con una incidencia que parece estable desde 1997. Los datos sobre incidencia de nefropatía diabética en consulta son escasos al no existir registros similares a los usados en el tratamiento renal sustitutivo. Diseño y métodos: se ha revisado retrospectivamente la base de datos de la consulta de Nefrología de nuestro hospital entre enero de 1991 y diciembre de 2006. El diagnóstico se hizo en la mayor parte de los casos por criterios clínicos (proteinuria asociada a retinopatía diabética). En 21 casos se realizó biopsia renal por incumplimiento de estos criterios. Resultados: durante ese tiempo, 478 (49,7 pmp) pacientes fueron diagnosticados de nefropatía diabética (edad media 61,2 años, 50,4% mujeres). Se aprecia una tendencia progresiva de crecimiento desde 33,3 pmp en 1991 hasta 76,2 pmp en 2006. No se han producido variaciones significativas en la edad media de los incidentes. Ciento seis pacientes (22,1%) han iniciado tratamiento renal sustitutivo. En el resto de los casos, el diagnóstico más frecuente fue nefroangiosclerosis (129) y glomerulonefritis (n = 103). La supervivencia estimada antes de llegar a tratamiento renal sustitutivo fue del 87,5% al año y del 48% a los cinco años de seguimiento. Conclusiones: la incidencia de nefropatía diabética parece tender a crecer significativamente en los últimos años, sobre todo en el grupo de edad mayor de 70 años. A pesar del perfeccionamiento de los tratamientos, el pronóstico sigue siendo desfavorable. La mayor permisividad en la edad para la derivación puede haber influido en estos resultados (AU)

Objective: Diabetic nephropathy is the most common cause for starting renal repacement therapy in Spain with a steady incidence since 1997. Data on incidence of diabetic nephropathy previously to dialysis are scanty because they are not registries similar to those used for renal replacement therapy. Design and methods: It have been retrospectively studied the records of our hospital Nephrology outward from January, 1991 to December, 2006. Diagnosis was commonly made using clinical criteria (proteinuria plus diabetic retinopathy). There were 21 cases which did not meet theses criteria and so renal biopsy was performed. Results: During this time 478 (49.7 pmp) patients were diagnosed of diabetic nephropathy (mean age 61.2 years, 50.4% women). Incidence increased from 33.3 pmp (1991) to 76.2 pmp (2006). There were not significant changes in the age of patients along the time. Other common diagnosis in diabetic patients were nefroangiosclerosis (129) and glomerulonefritis (n = 103). Survival until renal replacement therapy was 87.5% at one year and 48% at five years of follow up. Conclusions: Incidence of diabetic nephropathy seems to have increase last years specially in the patients aged 70 or older. In spite of therapeutic improvements the prognosis is still unfavourable. Less rectricted age criteria for submitting patients may have influenced these results (AU)

Long-term antiproteinuric effect of dual renin-angiotensin system blockade.

We evaluated the long-term changes on overt proteinuria induced by dual blockade of the renin-angiotensin system (RAS). Dual blockade was produced by adding an angiotensin II receptor blocker (ARB) to treatment with maximal recommended doses of an angiotensin converting enzyme (ACE) inhibitor in proteinuric patients. A total of 28 patients (19 men and 9 women) with proteinuria higher than 1 g/24 h were enrolled in this trial of treatment with the ARB candesartan (from 4 up to 32 mg daily) added to existing treatment with an ACE inhibitor. At 6, 12, 24, and 36 months, we evaluated proteinuria in 24-h urinary collections, office blood pressure (BP), plasmatic creatinine (Cr), serum potassium (K), and 24 h urine collection creatinine clearance (CrC). During monoblockade of the RAS by ACE inhibitor treatment, albuminuria was 2.94 +/- 1.92 mg/24 h; BP was 137/76 mmHg; K+ was 4.8 +/- 0.5 mmol/l, Cr was 1.76 +/- 0.67 mg/dL, and CrC was 62 +/- 31.9 mL/min. After 6 months, dual blockade of the RAS albuminuria was 2.18 +/- 2.29 mg/24 h (P < 0.01 vs. baseline) and BP was 133/75 mmHg (not significant). At 36 months, albuminuria was 2.21 +/- 2.20 mg/24 h (P < 0.05 vs. baseline); BP was 133/73 mmHg (not significant). CrC was not changed along the follow up. A small increment of Cr was detected at 24 months (2.11 +/- 1.06 mg/mL, P < 0.05). The antiproteinuric effect of dual renin-angiotensin system blockade combining candesartan and ACE inhibitors remain after 36 months without losing its initial effect. Blood pressure changes seem not to explain this long-term antiproteinuric effect.