Obesidad y funcion renal. Datos del estudio epidemiologico: Prevalencia de la enfermedad renal cronica en España. Estudio EPIRCE / Obesity and renal function. Data from the epidemiological study: Prevalence of chronic renal disease in Spain. EPIRCE Study

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Supervivencia en hemodiálisis vs. diálisis peritoneal y por transferencia de técnica. Experiencia en Ourense 1976-2012 / Survival for haemodialysis vs. peritoneal dialysis and technique transference. Experience in Ourense, Spain, from 1976 to 2012

Introducción: La supervivencia (SV) comparada en terapia renal sustitutiva (TRS) es dependiente de la comorbilidad previa al inicio de TRS y no de la técnica dialítica. Objetivo: Valorar la SV en nuestra población de TRS habida en el periodo 1976-2012 y asimismo la influencia por la transferencia de técnica (TTc). Material y métodos: Cohorte retrospectiva (n = 993 pacientes). Los datos fueron «censurados» por trasplante (TX), cambio de técnica, defunción o pérdida para el seguimiento. La SV por TTc se realizó en pacientes con más de 12 semanas de permanencia. Resultados: El riesgo de mortalidad ajustado por edad, sexo, técnica dialítica o diabetes mellitus (DM) mostró que el riesgo estimado de morir aumenta un 4,8% por cada año aumentado (HR=1,048, IC del 95%, 1,04-1,06, p<0,001) y este aumenta un 44% en los diabéticos con respecto a los no diabéticos (HR=1,44, IC del 95%, 1,16-1,76, p<0,01). En cuanto a la SV por TTc, los que inician HD presentan SV menor que los que inician DP y son transferidos a HD (p=0,00563). Conclusión: En nuestra experiencia, la SV en TRS es dependiente de la edad y la coexistencia de DM y sería conveniente retomar el concepto de «cuidados integrales» comenzado la TRS por DP y transferir a HD(AU)

Objective: To assess SV in our RRT population in the period 1976-2012 as well as the influence of technique transference (TT). Material and methods: The study included a retrospective cohort of 993 patients. Data were classified as transplant (Tx), change in technique, exitus or lost to follow-up. SV for TT was determined in patients with over 12 weeks of permanence. Results: The mortality risk adjusted for age, sex, dialysis technique or diabetes mellitus (DM) showed that the estimated risk of death increased by 4.8% per year increase (HR=1.048; 95% CI: 1.04-1.06; P<.001) and was 44% higher in diabetics compared to non-diabetics (HR=1.44; 95% CI 1.16-1.76; P<.01). Regarding SV for TT, patients who initiated HD had a shorter survival than those who initiated PD and transferred to HD(P=.00563). Conclusion: In our experience, SV in RRT is dependent on age and coexistence of DM. It would be beneficial to reinstate the concept of 'comprehensive care', in which RRT would start with PD and later transfer to HD (AU)

Índice hiperbárico en la prevención primaria de las complicaciones hipertensivas del embarazo de alto riesgo / Hyperbaric index in the primary prevention of hypertensive complications in high-risk pregnancy

Introducción La preeclampsia (PE) es una importante causa de morbimortalidad fetal, que en el mundo occidental afecta al 2-7% de los embarazos y es responsable de 50.000 muertes anuales. La detección precoz es prioritaria, ya que puede cambiar su curso clínico, pero no se dispone de biomarcadores ni métodos instrumentales de alta sensibilidad y especificidad, solamente el índice hiperbárico tiene una sensibilidad y una especificidad del 99% para la identificación precoz de las gestantes en riesgo de desarrollo de PE, pero está escasamente difundido. Objetivo: Valorar la utilidad del índice hiperbárico en la prevención primaria de las complicaciones hipertensivas del embarazo en un área sanitaria. Material y métodos: Estudio retrospectivo realizado entre los embarazos habidos en nuestra área durante el periodo 2007-2012 (N=11.784). El diagnóstico se estableció mediante el índice hiperbárico y las gestantes en riesgo fueron tratadas con AAS nocturno. Resultados: En las gestantes remitidas a consulta de Nefrología (38,2%), diagnosticadas de alto riesgo de PE y tratadas con AAS 100mg nocturno (desde la semana 17) se redujo la incidencia de episodios de PE un 96,94% (AU)

Introduction: Preeclampsia (PE) is a major cause of fetal morbidity and mortality. In the Western World, PE affects 2-7% of pregnancies and is responsible for 50,000 deaths annually. Early detection is a priority as it can change the clinical course, but there are no biomarkers or instrumental methods with high sensitivity and specificity. Only the hyperbaric index has a sensitivity and specificity of 99% for early identification of pregnant women at risk of developing PE, but its use is not widespread. Objective: To assess the usefulness of the hyperbaric index in the primary prevention of hypertensive pregnancy complications in a public healthcare area. Material and methods: This is a retrospective study of pregnancies that occurred in our area during the period 2007-2012 (N=11,784). The diagnosis was established by the hyperbaric index and pregnant women at risk were treated with ASA at night. Results: In pregnant patients referred to the nephrology clinic (38.2%), diagnosed as high-risk for PE, and treated with 100mg ASA/night (from week 17), the incidence of PE episodes was reduced by 96.94% (AU)

Survival for haemodialysis vs. peritoneal dialysis and technique transference. Experience in Ourense, Spain, from 1976 to 2012.

OBJECTIVE: To assess SV in our RRT population in the period 1976-2012 as well as the influence of technique transference (TT). MATERIAL AND METHODS: The study included a retrospective cohort of 993 patients. Data were classified as transplant (Tx), change in technique, exitus or lost to follow-up. SV for TT was determined in patients with over 12 weeks of permanence. RESULTS: The mortality risk adjusted for age, sex, dialysis technique or diabetes mellitus (DM) showed that the estimated risk of death increased by 4.8% per year increase (HR=1.048; 95% CI: 1.04-1.06; P<.001) and was 44% higher in diabetics compared to non-diabetics (HR=1.44; 95% CI 1.16-1.76; P<.01). Regarding SV for TT, patients who initiated HD had a shorter survival than those who initiated PD and transferred to HD (P=.00563). CONCLUSION: In our experience, SV in RRT is dependent on age and coexistence of DM. It would be beneficial to reinstate the concept of "comprehensive care", in which RRT would start with PD and later transfer to HD.

Hyperbaric index in the primary prevention of hypertensive complications in high-risk pregnancy.

INTRODUCTION: Preeclampsia (PE) is a major cause of fetal morbidity and mortality. In the Western World, PE affects 2-7% of pregnancies and is responsible for 50,000 deaths annually. Early detection is a priority as it can change the clinical course, but there are no biomarkers or instrumental methods with high sensitivity and specificity. Only the hyperbaric index has a sensitivity and specificity of 99% for early identification of pregnant women at risk of developing PE, but its use is not widespread. OBJECTIVE: To assess the usefulness of the hyperbaric index in the primary prevention of hypertensive pregnancy complications in a public healthcare area. MATERIAL AND METHODS: This is a retrospective study of pregnancies that occurred in our area during the period 2007-2012 (N=11,784). The diagnosis was established by the hyperbaric index and pregnant women at risk were treated with ASA at night. RESULTS: In pregnant patients referred to the nephrology clinic (38.2%), diagnosed as high-risk for PE, and treated with 100mg ASA/night (from week 17), the incidence of PE episodes was reduced by 96.94.

Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study.

BACKGROUND: Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. METHODS: It included 2459 adults (range 20-92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. RESULTS: In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. CONCLUSIONS: The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women.

Strategy to estimate risk progression of chronic kidney disease, cardiovascular risk, and referral to nephrology: the EPIRCE Study

Background: Although the prevalence of chronic kidney disease (CKD) is 10-14%, several prospective studies note a low rate of progression to end-stage renal disease (ESRD) in stages 3 and 4. A correct classification of risk of progression, based on demonstrated predictive factors, would allow better management of CKD. Recent studies have demonstrated the high predictive value of a classification that combines estimated (e) glomerular filtration rate (GFR) and urine albumin-creatinine ratio (ACR). We estimated the clinical risk of progression to ESRD and cardiovascular mortality predicted by the combined variable of eGFR and ACR in the Spanish general population. Materials and Methods: This study was a cross-sectional evaluation in the Epirce sample, representative of Spanish population older than 20 years. GFR was estimated using MDRD and CKD-EPI formulas; microalbuminuria was considered to be an ACR 20-200 mg/g (men) or 30-300 mg/g (women) and macroalbuminuria was indicated beyond these limits. Population-weighted prevalence of risk (..) (AU)

Antecedentes: Si bien la prevalencia de la enfermedad renal crónica (ERC) es del 10-14 %, diversos estudios prospectivos indican que en las fases 3 y 4 existe una tasa baja de progresión hacia enfermedad renal terminal (ERT). Una clasificación correcta del riesgo de progresión basada en factores predictivos demostrados permitiría un mejor manejo de la ERC. Estudios recientes han demostrado el elevado valor predictivo de la clasificación que combina el valor estimado (e) de la tasa de filtrado glomerular (FG) con la ratio albúmina-creatinina (RAC) en orina. Realizamos una estimación del riesgo clínico de una progresión hacia una ERT y de mortalidad cardiovascular existente en la población general española basando la predicción en el uso combinado de las variables tasa (e) de FG y RAC. Materiales y métodos: Evaluación cruzada en la muestra Epirce, que era representativa de la población española mayor de 20 años. Para la estimación del FG se emplearon las fórmulas MDRD y CKD-EPI; se consideraba la existencia de microalbuminuria cuando los valores de RAC oscilaban entre 20-200 mg/g (hombres) o entre 30-300 mg/g (mujeres) y de macroalbuminuria cuando los valores superaban dichos límites. Se realizó una estimación de la prevalencia ponderada poblacionalmente del riesgo de progresión de ERC hacia ERT. Resultados: Con MDRD, el 1,4 % de la población (..) (AU)

Strategy to estimate risk progression of chronic kidney disease, cardiovascular risk, and referral to nephrology: the EPIRCE Study.

BACKGROUND: Although the prevalence of chronic kidney disease (CKD) is 10­14%, several prospective studies note a low rate of progression to end-stage renal disease (ESRD) in stages 3 and 4. A correct classification of risk of progression, based on demonstrated predictive factors, would allow better management of CKD. Recent studies have demonstrated the high predictive value of a classification that combines estimated (e) glomerular filtration rate (GFR) and urine albumin­creatinine ratio (ACR). We estimated the clinical risk of progression to ESRD and cardiovascular mortality predicted by the combined variable of eGFR and ACR in the Spanish general population. MATERIALS AND METHODS: This study was a cross-sectional evaluation in the Epirce sample, representative of Spanish population older than 20 years. GFR was estimated using MDRD and CKD-EPI formulas; microalbuminuria was considered to be an ACR 20­200 mg/g (men) or 30­300 mg/g (women) and macroalbuminuria was indicated beyond these limits. Population-weighted prevalence of risk of progression of CKD to ESRD was estimated. RESULTS: With MDRD, 1.4% of the adult Spanish population was at moderate risk of progression to ESRD, 0.1% at high risk, and 12.3% at low risk. With CKD-EPI, the moderate risk ratio rose to 1.7% and low risk to 12.6%, but high risk remained stable. CONCLUSIONS: The addition of ACR to eGFR best classifies the population at risk for renal impairment relative to Kidney/Disease Outcomes Quality Initiative grades 3 and 4. Estimating GFR with CKD-EPI modifies the distribution of low and moderate risk.

Troponina I cardíaca y creatina cinasa MB en pacientes con insuficiencia renal crónica / Cardiac troponin I and creatine kinase MB isoenzyme in patients with chronic renal failure

Objetivo: Evaluar valores de corte (VC) para el diagnóstico del síndrome coronario agudo (SCA) en pacientes con insuficiencia renal crónica (IRC) para los biomarcadores cardíacos troponina I cardíaca (TnIc) y creatina cinasa MB (CK-MB) diferentes a los recomendados por los fabricantes de los reactivos y utilizados habitualmente en los laboratorios. Métodos: Realizamos un estudio prospectivo de pruebas diagnósticas en pacientes con IRC con una tasa de filtración glomerular estimada con la ecuación MDRD4 < 60 ml/min ingresados por sospecha de SCA según la historia clínica, la exploración física y el electrocardiograma. Se evaluó la concentración de TnIc y CK-MB al ingreso hospitalario y a los seis meses, utilizando dos sistemas analíticos diferentes (para TnIc, los analizadores Access® y Vidas®, y para CK-MB, los analizadores Access® y Vitros®). Resultados: Durante el período de estudio, se incluyeron 484 pacientes con IRC y sospecha de SCA. Se diagnosticó SCA en el 12 % de los pacientes (58/484), mientras que se encontraron otras patologías cardíacas en (..) (AU)

Objective: The aim of our study was to evaluate cut-off values for acute the cardiac biomarkers cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) in patients with chronic renal failure (CRF) different to the cut-off values proposed by the manufacturers and frequently used at the laboratory. Method: We performed a prospective study in patients with CRF with a glomerular filtration rate estimated by the MDRD-4 equation <60mL/min admitted with suspected acute coronary syndrome (ACS) by history, physical examination, and electrocardiography. cTnI and CK-MB measurements were assessed at admission and six months later by using two different analytical methods (for cTnI: Access® and Vidas® analysers, and for CK-MB: Access® and Vitros® analysers). Results: During the study period, 484 patients with CRF and suspected ACS were included. ACS was diagnosed in (..) (AU)

Cardiac troponin I and creatine kinase MB isoenzyme in patients with chronic renal failure.

OBJECTIVE: The aim of our study was to evaluate cut-off values for acute coronary syndrome (ACS) diagnosis in patients with chronic renal failure (CRF) for the cardiac biomarkers cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) as compared to the cut-off values proposed by the manufacturers and those frequently used in the laboratory. METHOD: We performed a prospective study in patients with CRF with a glomerular filtration rate estimated by the MDRD-4 equation <60 mL/min and admitted with suspected acute coronary syndrome due to clinical history, physical examination, and electrocardiography. cTnI and CK-MB measurements were assessed upon hospitalisation and six months later using two different analytical methods (for cTnI: Access® and Vidas® analysers, and for CK-MB: Access® and Vitros® analysers). RESULTS: During the study period, 484 patients with CRF and suspected ACS were assessed. ACS was diagnosed in 12% of patients (58/484), while we found other cardiac pathologies (OCP) in 29% of patients (140/484) and other non-cardiac pathologies (ONCP) in 59% of patients (286/484). For cTnI assessed using the Access® analyser with the usual cut-off value (≥ 0.5 ng/mL), sensitivity was 43% and specificity was 94%, while for the proposed cut-off value (≥ 0.11 ng/mL), the values were 68% and 83%, respectively. For cTnI assessed using the Vidas® analyser with the usual cut-off value (≥ 0.11 ng/mL), sensitivity was 64% and specificity was 87%, while for the proposed cut-off value (≥ 0.06 ng/mL), the values were 75% and 79%, respectively. The sensitivity and specificity for both CK-MB were lower compared with cTnI. CONCLUSION: The cut-off values proposed in this study for both cTnI in patients with CRF (stage 3 to 5) to diagnose ACS are significantly different from that of the general population.

Insulin resistance index (HOMA-IR) levels in a general adult population: curves percentile by gender and age. The EPIRCE study.

AIMS: To describe the distribution of HOMA-IR levels in a general nondiabetic population and its relationships with metabolic and lifestyles characteristics. METHODS: Cross-sectional study. Data from 2246 nondiabetic adults in a random Spanish population sample, stratified by age and gender, were analyzed. Assessments included a structured interview, physical examination, and blood sampling. Generalized additive models (GAMs) were used to assess the effect of lifestyle habits and clinical and demographic measurements on HOMA-IR. Multivariate GAMs and quantile regression analyses of HOMA-IR were carried out separately in men and women. RESULTS: This study shows refined estimations of HOMA-IR levels by age, body mass index, and waist circumference in men and women. HOMA-IR levels were higher in men (2.06) than women (1.95) (P=0.047). In women, but not men, HOMA-IR and age showed a significant nonlinear association (P=0.006), with increased levels above fifty years of age. We estimated HOMA-IR curves percentile in men and women. CONCLUSIONS: Age- and gender-adjusted HOMA-IR levels are reported in a representative Spanish adult non-diabetic population. There are gender-specific differences, with increased levels in women over fifty years of age that may be related with changes in body fat distribution after menopause.