Information and consensus document for the detection and management of chronic kidney disease.

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific associations, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options. The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology. The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge.

Documento de información y consenso para la detección y manejo de la enfermedad renal crónica / Information and consensus document for the detection and management of chronic kidney disease

La enfermedad renal crónica (ERC) es un importante problema de salud pública a nivel mundial afectando a más del 10% de la población española. Se asocia a elevada comorbilidad, mal pronóstico, así como a un gran consumo de recursos en el sistema sanitario. Desde la publicación del último documento de consenso sobre ERC publicado hace siete años, han sido escasas las evidencias y los ensayos clínicos que hayan mostrado nuevas estrategias en el diagnóstico y tratamiento de la ERC, con excepción de los nuevos ensayos en la enfermedad renal diabética. Esta situación ha condicionado que no se hayan actualizado las guías internacionales específicas de ERC. Esta rigidez y actitud conservadora de las guías no debe impedir la publicación de actualizaciones en el conocimiento en algunos aspectos, que pueden ser clave en la detección y manejo del paciente con ERC. En este documento, elaborado en conjunto por diez sociedades científicas, se muestra una actualización sobre conceptos, aclaraciones, criterios diagnósticos, estrategias de remisión y nuevas opciones terapéuticas.Se han revisado las evidencias y los principales estudios publicados en estos aspectos de la ERC, considerándose más bien un documento de información sobre esta patología. El documento incluye una actualización sobre la detección de la ERC, factores de riesgo, cribado, definición de progresión renal, actualización en los criterios de remisión con nuevas sugerencias en la población anciana, monitorización y estrategias de prevención de la ERC, manejo de comorbilidades asociadas, especialmente en diabetes mellitus, funciones del médico de Atención Primaria en el manejo de la ERC y qué no hacer en Nefrología.El objetivo del documento es que sirva de ayuda en el manejo multidisciplinar del paciente con ERC basado en las recomendaciones y conocimientos actuales. (AU)

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific societies, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options.The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology.The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge. (AU)

Concordancia entre observadores en el diagnóstico electrocardiográfico de la hipertrofia ventricular izquierda en hipertensos de Andalucía. Estudio PREHVIA / Interobserver agreement on electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients in Andalusia. PREHVIA study

Objetivo: Estimar la concordancia en el diagnóstico de la hipertrofia ventricular izquierda electrocardiográfica (HVI-ECG) en sujetos hipertensos entre médicos de atención primaria (AP) y un cardiólogo experto.Diseño: Estudio transversal y multicéntrico.EmplazamientoCentros de AP de Andalucía.Participantes: 120 médicos de AP que mediante muestreo aleatorio seleccionaron a pacientes de 35 o más años con hipertensión arterial de al menos 6 meses de evolución.Mediciones principales: Se recogieron datos demográficos, de factores de riesgo y de enfermedades cardiovasculares. La HVI-ECG se evaluó aplicando los criterios de voltaje de Cornell, producto de Cornell y de Sokolow-Lyon. Los investigadores de AP realizaron una primera lectura y un cardiólogo, una segunda ciega.Resultados: Se estudió a 570 pacientes (media±desviación estándar de edad, 65±11 años; mujeres, 54,5%); la prevalencia de HVI-ECG fue del 13,7% (intervalo de confianza [IC] del 95%, 10,8-16,6; el 12,6% por Cornell y el 1,6% por Sokolow-Lyon). La concordancia en el diagnóstico de HVI-ECG entre el médico de AP y el cardiólogo fue 0,378 (IC del 95%, 0,272-0,486; desacuerdos en el 15,5% de los casos). Los investigadores de AP subestimaron levemente la prevalencia de HVI-ECG por Cornell y la sobreestimaron levemente por el criterio de Sokolow-Lyon; también fue baja la concordancia para cada uno de ellos (Cornell: κ=0,367; IC del 95%, 0,252-0,482; Sokolow-Lyon: κ=0,274; IC del 95%, 0,093-0,454).Conclusiones: La concordancia entre el diagnóstico de los médicos de AP y el cardiólogo es baja. Los resultados de este estudio indican la necesidad de mejorar la medición electrocardiográfica entre los médicos de AP; la utilización de sistemas informatizados podría ser una buena opción(AU)

Objective: To assess the agreement between Primary Care (PC) doctors and a cardiology specialist in diagnosing left ventricular hypertrophy in the electrocardiograph (LVH-ECG) in hypertensive patients.Design: Cross-sectional, multicentre study.Setting: Andalusian Primary Care Centres.Participants: A total of 120 PC doctors who using a random sample selected patients of 35 years or more with AHT of at least 6 months of progression.Primary variables: Demographic data, risk factors and cardiovascular diseases were recorded. The LVH-ECG was evaluated by applying Cornell voltage criteria, Cornell and Sokolow-Lyon product. The PC researchers read the ECG first and the cardiologist made a second reading blind.Results: A total of 570 patients (mean±SD of age, 65±11 years; 54.5% females); the LVH-ECG prevalence was 13.7% (95% CI, 10.8-16.6; 12.6% by Cornell and 1.6% by Sokolow-Lyon). The agreement in the diagnosis between the PC doctors and the cardiologist was 0.378 (95% CI, 0.272-0.486; disagreements in 15.5% of cases). The PC doctors slightly underestimated the LVH-ECG prevalence by Cornell and slightly overestimated it by the Sokolow-Lyon criteria. The agreement was also low for all of them (κ=0.367; 95% CI, 0.252-0.482, for Cornell, and κ=0.274; 95% CI: 0.093-0.454 for Sokolow-Lyon).Conclusions: The agreement between the diagnosis by the PC doctors and the cardiologist was low. The implications of this study suggest the need to improve the reading of ECG among PC doctors. The use of computerised systems could be a good option(AU)

[Interobserver agreement on electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients in Andalusia. PREHVIA study]. / Concordancia entre observadores en el diagnóstico electrocardiográfico de la hipertrofia ventricular izquierda en hipertensos de Andalucía. Estudio PREHVIA.

OBJECTIVE: To assess the agreement between Primary Care (PC) doctors and a cardiology specialist in diagnosing left ventricular hypertrophy in the electrocardiograph (LVH-ECG) in hypertensive patients. DESIGN: Cross-sectional, multicentre study. SETTING: Andalusian Primary Care Centres. PARTICIPANTS: A total of 120 PC doctors who using a random sample selected patients of 35 years or more with AHT of at least 6 months of progression. PRIMARY VARIABLES: Demographic data, risk factors and cardiovascular diseases were recorded. The LVH-ECG was evaluated by applying Cornell voltage criteria, Cornell and Sokolow-Lyon product. The PC researchers read the ECG first and the cardiologist made a second reading blind. RESULTS: A total of 570 patients (mean +/- SD of age, 65 +/- 11 years; 54.5% females); the LVH-ECG prevalence was 13.7% (95% CI, 10.8-16.6; 12.6% by Cornell and 1.6% by Sokolow-Lyon). The agreement in the diagnosis between the PC doctors and the cardiologist was 0.378 (95% CI, 0.272-0.486; disagreements in 15.5% of cases). The PC doctors slightly underestimated the LVH-ECG prevalence by Cornell and slightly overestimated it by the Sokolow-Lyon criteria. The agreement was also low for all of them (kappa = 0.367; 95% CI, 0.252-0.482, for Cornell, and kappa = 0.274; 95% CI: 0.093-0.454 for Sokolow-Lyon). CONCLUSIONS: The agreement between the diagnosis by the PC doctors and the cardiologist was low. The implications of this study suggest the need to improve the reading of ECG among PC doctors. The use of computerised systems could be a good option.

[Prevalence of left ventricular hypertrophy, atrial fibrillation and cardiovascular disease in hypertensive patients of Andalusia, Spain. PREHVIA study]. / Prevalencia de hipertrofia ventricular izquierda, fibrilación auricular y enfermedad cardiovascular en hipertensos de Andalucía. Estudio PREHVIA.

OBJECTIVES: The objective of the PREHVIA study was to assess the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) and of atrial fibrillation (AF) among Andalusian hypertensive patients, and the relationship of this complications with cardiovascular disease (CVD). PATIENTS AND METHODS: Cross-sectional study with selection of study centres following the distribution of the Andalusian population by provinces and habitat, and randomization of patients included in the sample. Personal history was recorded, and ECG-LVH was assessed using the Cornell (voltage and product) and Sokolow-Lyon criteria, applied by the participant physicians and by an expert cardiologist. The association with ECG-HVH or CVD was studied by logistic regression models. RESULTS: In 570 patients (mean age 65 years, 54.5% women, 50.6% with obesity, 28,2% with diabetes), the prevalence of ECG-LVH was 13.7% (95% confidence interval [CI], 10.8-16.6%). Cornell criterion was fulfilled by 12.6% and Sokolow-Lyon by 1.6%. The prevalence of AF was 5.1% (95% CI, 3.9-7.5%) and 22.1% (95% CI, 18.4-25.4%) had established CVD. In the multivariate analysis, ECG-LVH was associated with female gender (odds ratio=5.10; 95% CI, 2.44-10.64) and with the presence of CVD (odds ratio=2.18; 95% CI, 1.09-4.12). The antecedent of CVD was independently associated with an advanced age, male gender, AF and, less strongly, with low glomerular filtration rate and diabetes mellitus. CONCLUSIONS: In Andalusian hypertensives, the prevalence of ECG-LVH was significantly lower than that found in other studies, greater in women and at the expense of the Cornell criterion, the prevalence of AF was 5.1% and it was 22.1% for CVD with independent associations between ECG-LVH and between CVD and AF.

Prevalencia de hipertrofia ventricular izquierda, fibrilación auricular y enfermedad cardiovascular en hipertensos de Andalucía. Estudio PREHVIA / Prevalence of left ventricular hypertrophy, atrial fibrillation and cardiovascular disease in hypertensive patients of Andalusia, Spain. PREHVIA study

Objetivos: el objetivo del estudio PREHVIA ha sido estimar la prevalencia de hipertrofia ventricular izquierda evidenciada en el electrocardiograma (HVI-ECG) y de fibrilación auricular (FA) en pacientes con hipertensión arterial (HTA) de Andalucía, y evaluar la relación de estas variables con la enfermedad cardiovascular (ECV).Pacientes y métodos se realizó un estudio transversal con selección de centros de salud según la distribución de la población andaluza por provincias y hábitat, y selección aleatoria de pacientes incluidos en la muestra. Se recogieron los antecedentes y los médicos participantes y un cardiólogo experto valoraron la HVI-ECG aplicando los criterios de Cornell (voltaje y producto) y de Sokolow-Lyon. Se valoró la asociación con la HVI o la ECV mediante modelos de regresión logística. Resultados: en 570 pacientes (edad media de 65 años, un 54,5% de mujeres, un 50,6% con obesidad y un 28,2% con diabetes), la prevalencia de HVI-ECG fue del 13,7% (intervalo de confianza [IC] del 95%, 10,8–16,6%). El 12,6% cumplió el criterio de Cornell y el 1,6% el de Sokolow-Lyon. Un 5,1% presentó FA (IC del 95%, 3,9–7,5%) y el 22,1% (IC del 95%, 18,4–25,4%) tenía antecedente de ECV. En el análisis multivariante, la HVI-ECG se relacionó con el sexo femenino (odds ratio=5,10; IC del 95%, 2,44–10,64) y la presencia de ECV (odds ratio=2,18; IC del 95%, 1,09–4,12). La ECV se relacionó independientemente con la edad avanzada, el sexo masculino y la FA, y con menos fuerza con un filtrado glomerular bajo y la diabetes mellitus. Conclusiones: en hipertensos de Andalucía la prevalencia de HVI-ECG es considerablemente inferior a la hallada en otros estudios, mucho mayor en mujeres y a expensas principalmente del criterio de Cornell. La prevalencia de FA es del 5,1% y la de ECV similar a la de estudios previos. Se observa una asociación independiente entre HVI-ECG y ECV, y entre ECV y FA (AU)

Objectives: The objective of the PREHVIA study was to assess the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) and of atrial fibrillation (AF) among Andalusian hypertensive patients, and the relationship of this complications with cardiovascular disease (CVD).Patients and methods Cross-sectional study with selection of study centres following the distribution of the Andalusian population by provinces and habitat, and randomization of patients included in the sample. Personal history was recorded, and ECG-LVH was assessed using the Cornell (voltage and product) and Sokolow-Lyon criteria, applied by the participant physicians and by an expert cardiologist. The association with ECG-HVH or CVD was studied by logistic regression models. Results: In 570 patients (mean age 65 years, 54.5% women, 50.6% with obesity, 28,2% with diabetes), the prevalence of ECG-LVH was 13.7% (95% confidence interval [CI], 10.8–16.6%). Cornell criterion was fulfilled by 12.6% and Sokolow-Lyon by 1.6%. The prevalence of AF was 5.1% (95% CI, 3.9–7.5%) and 22.1% (95% CI, 18.4–25.4%) had established CVD. In the multivariate analysis, ECG-LVH was associated with female gender (odds ratio=5.10; 95% CI, 2.44–10.64) and with the presence of CVD (odds ratio=2.18; 95% CI, 1.09–4.12). The antecedent of CVD was independently associated with an advanced age, male gender, AF and, less strongly, with low glomerular filtration rate and diabetes mellitus. Conclusions: In Andalusian hypertensives, the prevalence of ECG-LVH was significantly lower than that found in other studies, greater in women and at the expense of the Cornell criterion, the prevalence of AF was 5.1% and it was 22.1% for CVD with independent associations between ECG-LVH and between CVD and AF (AU)