[Dialysis and transplant. Spain in 2005]. / Informe de Situación de Diálisis y Trasplante en España, 2005.

In 2005, renal replace treatment (dialysis and transplant) was necessary for about 40,000 people, without being known the number accurate and either their basic characteristics, such as: time in treatment, modality or treatment changes. The presented data cover the 76% of the Spanish population and are the result of the cooperation among technicians of registries, nephrologists and transplant coordinations. 4,125 people started RRT in 2005, the total estimated acceptance rate for renal replacement therapy in adults in Spain was 126 pmp and regarding other European countries it locates us in an intermediate area. The incidence rate seems to keep stable in the last years although there were some differences among communities (from 104 pmp in Castile and Leon to 186 pmp in Canary Islands). Diabetes Mellitus is the most diagnosed cause of renal failure in 2005, more than 20% of patients, followed by vascular diseases. The estimated prevalence of renal replacement therapy in Spain at the end of 2005 was 903 pmp, with important variations among communities (from 806 pmp in Cantabria to 1056 pmp in Valencia Region). The 47% of prevalent RRT patients had a functioning transplant. Mortality on haemodialysis and peritoneal dialysis was 13.7% and 10.8% respectively. Mortality on transplant was 1.3%, one of the lowest values registered so far. Mortality on renal replacement therapy was around 5% among patients from 45 to 64 years, 11% between 65 and 74 years and 19% among the patients older than 75 years.

Síndrome metabólico en pacientes en hemodiálisis / Metabolic syndrome in patients on hemodialysis

La morbimortalidad por problemas cardiovasculares en pacientes en programas de hemodiálisis periódica es mayor que en la población general, coincidiendo a la vez más de un factor de riesgo, entre los que destacan la hipertensión arterial, dislipidemia o alteraciones de los hidratos de carbono, entre otros. Siguiendo los criterios de la ATP III (Adult Treatment Panel), se han estudiado los pacientes que se engloban en el síndrome metabólico valorando los factores de riesgo más frecuentes que lo constituyen. La obesidad, tanto medida por el índice de masa corporal (IMC) como por la circunferencia de cintura, es el factor que se ha observado con mayor incidencia. La resistencia a la insulina, medida por el test de HOMA, se ha incluido igualmente en el estudio por sus implicaciones en esta patología

Cardiovascular disease morbidity-mortality is higher in patients on periodic dialysis than in the general population, there being more than one risk factor at the same time. Among these, hypertension, dyslipidemia and carbohydrate alterations stand out. Following the ATP III (Adult Treatment Panel) criteria, patients included under the metabolic syndrome have been studied, evaluating the most important risk factors that make it up. Obesity, measured with body mass index (BMI) or with the waist circumference, is the factor observed with the greatest incidence. In addition, insulin resistance measured by the HOMA test has been included due to its relevant implications in this disease

Informe de situación de diálisis y trasplante en España, 2004 / Dialysis and transplant situation, Spain 2004

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Informe de diálisis y trasplante correspondiente al año 2002 de la Sociedad Española de Nefrología y Registros Autonómicos / The year 2002 Spanish Nephrology Society Report on Dialysis and Transplantation and Autonomic Registries

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Importancia del tratamiento de agua para hemodiálisis. ¿Nefrólogos o servicios de mantenimiento? / Importance of water treatment for haemodialysis: nephrologists or maintenance service?

La técnica de hemodiálisis, especialmente "on-line" que utiliza membranas de alta permeabilidad, necesita la producción de un líquido de agua ultrapura, por lo que el agua de la red debe someterse a un tratamiento, desinfección y controles periódicos que garanticen su idoneidad. La presencia de contaminantes químicos puede producir una sintomatología muy variada, tanto aguda como crónica y los bacteriológicos, en especial los pirógenos, dificultan la eficacia de la diálisis sometiendo a los pacientes a un estado inflamatorio crónico con diversa patología. La responsabilidad última de este tratamiento debe ser del nefrólogo quien deberá considerar al agua de diálisis como un fármaco más (AU)

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Informe de diálisis y trasplante de la Sociedad Española de Nefrología y Registros Autonómicos, año 2000 / Rapport of the dialysis and transplant registry in Spain. The Spanish Society of Nephrology and Regional Registries

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Decreased excretion of nitrate and nitrite in essential hypertensives with renal vasoconstriction.

Most hypertensive patients exhibit increased renal vascular resistance (RVR). This study was designed to investigate whether there exists any relationship between RVR and the production of nitric oxide (NO) in patients with essential hypertension. The study was performed in 49 non-treated patients with mild-to-moderate essential hypertension, and 20 age- and sex-matched normotensive subjects on a controlled sodium diet. Renal hemodynamics was measured in terms of the clearance of para-aminohippuric acid and inulin. Urinary excretion of nitrate and nitrite (NO3- plus NO2-) was determined as an index of NO production. As compared with normotensives, hypertensive patients exhibited higher (P < 0.001) RVR and lower (P < 0.05) urinary excretion of NO3- plus NO2-. With the 100% confidence (upper) limit of the normotensive population as a cut-off point, a subgroup of 30 hypertensives had an abnormally high RVR. The excretion of NO3- plus NO2- was lower (P < 0.005) in hypertensives with high RVR than in normotensives and the remaining hypertensives. No differences were found in the urinary excretion of NO3- plus NO2- between normotensives and hypertensives with normal RVR. Statistically significant associations were seen between diastolic blood pressure and RVR (r = 0.341, P < 0.05) and urinary excretion of NO3- plus NO2- (r = -0.387, P < 0.01) in all hypertensives. These results indicate that there is a subgroup (61%) of hypertensive patients with diminished urine levels of NO3- plus NO2- in which RVR is abnormally increased. Thus, it is suggested that in essential hypertension a diminished renal ability to produce NO by the endothelium may be involved in exaggerated renal vasoconstriction.

Vasoconstriction of the afferent arteriole and defective renal synthesis of nitric oxide in essential hypertension.

This study was designed to investigate whether some relation exists between afferent arteriolar resistance (AAR) and the renal production of nitric oxide (NO) and prostacyclin (PGI2) in 21 patients with untreated essential hypertension and 20 normotensive controls. All subjects were studied in conditions of an unlimited Na+ diet both basally and after a four-hour amino acid infusion. AAR was calculated using Gomez's equations. Renal production of NO and PGI2 were assessed by radioimmunoassay of the urinary excretion of cGMP and 6-keto-PGF1 alpha, respectively. Baseline AAR was higher (P < 0.01) in hypertensives than in normotensives. The baseline urinary excretion of 6-keto-PGF1 alpha and cGMP were similar in the two groups of subjects. AAR diminished (P < 0.005) in normotensives and remained unchanged in hypertensives after amino acid infusion. Urinary excretion of 6-keto-PGF1 alpha was increased similarly in the two groups of subjects after infusion. Urinary excretion of cGMP remained unchanged in normotensives and decreased by 31% in hypertensives after infusion. These findings suggest that afferent vasoconstriction present in hypertensive patients is unresponsive to the vasodilatory manoeuvre of amino acid infusion. This lack of response may be due to a defective renal synthesis of NO in these patients.

[Initial response to treatment with erythropoietin in anemia caused by chronic renal insufficiency]. / Respuesta inicial al tratamiento con eritropoyetina en la anemia de la insuficiencia renal crónica.

The achievement of recombinant human erythropoietin (r-HuEpo) supposed an important advance in the treatment of the anaemia of chronic renal failure. The results achieved with r-HuEpo in seven patients with chronic renal failure subjected to haemodialysis who required repeated blood transfusions are reported. The duration of treatment was 12 weeks at an initial doses of 50 U/Kg. A significant increase of haematocrit, red-cell count, haemoglobin, reticulocytes and platelets was attained. The decrease of serum iron, transferrin saturation index and ferritin in spite of oral iron therapy was striking. None of the patients required blood transfusion during the period of study, and all but one referred subjective improvement. No severe adverse effects were observed, except for one case of thrombosis of arteriovenous fistula, whose relation with this treatment is dubious. Although this is a short-term preliminary study, it can be inferred that r-HuEpo treatment is effective and free of major risks for the anaemia of chronic renal failure.