Hypocitraturia is present when renal function is impaired in diverse nephropathies and is not related with serum bicarbonate levels.

BACKGROUND: In autosomal dominant polycystic kidney disease (ADPKD) it is frequently found a reduction in urinary citrate of unknown origin. It has been suggested that it could be a marker of acid retention in chronic kidney disease. Our aim was to compare urinary citrate in ADPKD with other nephropathies and to show its relation with serum bicarbonate. METHODS: We determined urinary citrate in patients with several nephropathies and varied renal function. We included 291 patients, 119 with glomerular diseases, 116 with ADPKD, 21 with other nephropathies, and 35 patients with normal renal function. RESULTS: Urinary citrate was higher in women and in patients with normal renal function. ADPKD patients showed similar values of urinary citrate to patients with glomerular diseases and with other nephropathies. We observed a progressive reduction in urinary citrate with renal impairment, in a comparable way among patients with ADPKD and glomerular diseases. We did not observe a relationship with serum bicarbonate. Serum uric acid levels were significantly higher in patients with glomerular diseases than in ADPKD patients, even after correction with the degree of renal function. CONCLUSIONS: Hypocitraturia is not specific of ADPKD but it is also present in all tested nephropathies and is related with renal impairment and not with serum bicarbonate. It could be interesting to study urinary citrate as a marker of renal function and as a prognostic factor.

Nefropatía IgA: efectos a corto plazo del tratamiento con prednisona sobre la proteinuria, función renal y relación con la clasificación de Oxford / IgA nephropathy: Short term effects of prednisone treatment on proteinuria, renal function and relation with Oxford classification

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Atrial fibrillation in incident dialysis patients.

Despite the importance of cardiovascular disease in dialysis patients, the frequency of atrial fibrillation in incident dialysis patients has not been determined. We analyzed the prevalence of atrial fibrillation in patients starting dialysis over a 4-year period, its occurrence over the course of dialysis, and its influence on ischemic stroke and mortality. Factors predisposing to atrial fibrillation were noted, as was the influence of arrhythmia on mortality and presentation of ischemic stroke. Of the 256 patients studied, 31 had atrial fibrillation at the start of dialysis. Increased age, larger left atrium, and female gender were independently related to the presence of atrial fibrillation at dialysis inception. Of the 225 patients who were in sinus rhythm at the start of dialysis, 28 developed atrial fibrillation during a mean follow-up time of 2 years. The presence of valvular calcifications, bundle branch block, previous ischemic stroke, lower ejection fraction, higher pulse pressure, and lower hemoglobin concentration were predictors of the clinical evolution of atrial fibrillation. Overall, atrial fibrillation increased mortality risk 1.72-fold and ischemic stroke risk 9.8-fold. Therefore, it appears that atrial fibrillation is quite prevalent and its presence is associated with significant risk.

[Incidence of atrial fibrillation in hemodialysis patients. A prospective long-term follow-up study]. / Incidencia de la fibrilación auricular en los pacientes en hemodiálisis. Estudio prospectivo a largo plazo.

INTRODUCTION AND OBJECTIVES: Although atrial fibrillation (AF) is the most commonly occurring arrhythmia in the general population and is a serious health problem, its incidence in patients on hemodialysis is unknown. Our objectives were to determine the incidence of AF in our hemodialysis patients, to investigate factors that predispose to its occurrence, and to assess the clinical implications of AF. METHODS: In total, 164 patients in sinus rhythm (SR) were followed for seven years. The occurrence of AF and its influence on mortality and on the occurrence of thromboembolic events were recorded. RESULTS: In a mean follow-up period of 47 (29.5) months (i.e., 643.2 patient-years), 20 patients developed AF (3.1 per 100 patient-years). It was not possible to identify factors that predisposed to the arrhythmia. In patients aged > or =65 years, 1-year and 2-year mortality rates following the occurrence of AF were 38% and 53%, respectively, whereas the rates in those who remained in SR were 14% and 31%, respectively (P=NS). The development of AF was not found to be an independent predictor of mortality. Five patients in the AF group experienced six thromboembolic episodes in a follow-up period of 23.6 (21.4) months (i.e., 15 episodes per 100 patient-years), compared with three episodes per 100 patient-years in the SR group (relative risk=5.2; 95% CI, 2.1-12.4). CONCLUSIONS: Each year, three in every 100 patients in our dialysis unit developed AF. The occurrence of AF increased the risk of a thromboembolic complication five-fold. The use of anticoagulant treatment in these patients should be carefully evaluated.

Incidencia de la fibrilación auricular en los pacientes en hemodiálisis. Estudio prospectivo a largo plazo / Incidence of Atrial Fibrillation in Hemodialysis Patients. A Prospective Long-Term Follow-Up Study

Introducción y objetivos. Aunque la fibrilación auricular (FA) es la arritmia más frecuente en la población y constituye un relevante problema social y sanitario, su incidencia en los pacientes en hemodiálisis es desconocida. El objetivo es determinar la incidencia de FA en nuestra población en hemodiálisis, analizar los factores que condicionan su aparición y su influencia en la evolución clínica. Métodos. Seguimos, durante 7 años, a 164 pacientes que se encontraban en ritmo sinusal (RS). Determinamos la aparición de FA y su influencia en la mortalidad y en la aparición de fenómenos tromboembólicos. Resultados. Durante un seguimiento medio de 47 ± 29,5 meses (643,2 pacientes-año), 20 pacientes desarrollaron FA (3,1/100 pacientes-año), sin que se identificaran los factores que condicionaron la aparición de la arritmia. En el grupo ≥ 65 años, la mortalidad al primer y segundo año tras la aparición de FA fue del 38 y el 53%, respectivamente, mientras que en los pacientes que mantuvieron el RS fue del 14 y el 31% (p = NS); el desarrollo de FA no se mostró como factor predictor independiente de mortalidad. Cinco pacientes del grupo de FA desarrollaron 6 episodios tromboembólicos durante un seguimiento de 23,6 ± 21,4 meses (15 episodios/100 pacientes-año), mientras que el grupo que mantuvo el RS presentó 3 episodios/100 pacientes-año (riesgo relativo [RR] = 5,2; intervalo de confianza [IC] del 95%, 2,1-12,4). Conclusiones. Tres de cada 100 pacientes desarrollaron, cada año, FA en nuestra unidad de diálisis. La aparición de FA incrementó en 5 veces el riesgo de presentar una complicación tromboembólica. La utilización del tratamiento anticoagulante en estos pacientes necesita ser cuidadosamente evaluada (AU)

Introduction and objectives. Although atrial fibrillation (AF) is the most commonly occurring arrhythmia in the general population and is a serious health problem, its incidence in patients on hemodialysis is unknown. Our objectives were to determine the incidence of AF in our hemodialysis patients, to investigate factors that predispose to its occurrence, and to assess the clinical implications of AF. Methods. In total, 164 patients in sinus rhythm (SR) were followed for seven years. The occurrence of AF and its influence on mortality and on the occurrence of thromboembolic events were recorded. Results. In a mean follow-up period of 47 (29.5) months (i.e., 643.2 patient-years), 20 patients developed AF (3.1 per 100 patient-years). It was not possible to identify factors that predisposed to the arrhythmia. In patients aged ≥65 years, 1-year and 2-year mortality rates following the occurrence of AF were 38% and 53%, respectively, whereas the rates in those who remained in SR were 14% and 31%, respectively (P=NS). The development of AF was not found to be an independent predictor of mortality. Five patients in the AF group experienced six thromboembolic episodes in a follow-up period of 23.6 (21.4) months (i.e., 15 episodes per 100 patient-years), compared with three episodes per 100 patient-years in the SR group (relative risk=5.2; 95% CI, 2.1-12.4). Conclusions. Each year, three in every 100 patients in our dialysis unit developed AF. The occurrence of AF increased the risk of a thromboembolic complication five- fold. The use of anticoagulant treatment in these patients should be carefully evaluated (AU)