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UROLOGY, NEPHROLOGY AND ANDROLOGY (155 journals)                     

Showing 1 - 155 of 155 Journals sorted alphabetically
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11)
Advances in Urology     Open Access   (Followers: 13)
African Journal of Nephrology     Open Access  
African Journal of Urology     Open Access   (Followers: 7)
AJP Renal Physiology     Hybrid Journal   (Followers: 8)
Aktuelle Urologie     Hybrid Journal   (Followers: 11)
American Journal of Kidney Diseases     Hybrid Journal   (Followers: 42)
American Journal of Men's Health     Open Access   (Followers: 9)
American Journal of Nephrology     Full-text available via subscription   (Followers: 36)
Andrologia     Hybrid Journal   (Followers: 2)
Andrology     Hybrid Journal   (Followers: 4)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Andrology and Genital Surgery     Open Access   (Followers: 7)
Andrology-Open Access     Open Access  
Annales d'Urologie     Full-text available via subscription  
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arab Journal of Urology     Open Access   (Followers: 7)
Archives of Clinical Nephrology     Open Access   (Followers: 2)
Archivio Italiano di Urologia e Andrologia     Open Access   (Followers: 1)
Archivos Españoles de Urología     Open Access  
Asian Journal of Andrology     Open Access   (Followers: 1)
Asian Journal of Urology     Open Access   (Followers: 3)
Bangladesh Journal of Urology     Open Access   (Followers: 5)
BANTAO Journal     Open Access  
Basic and Clinical Andrology     Open Access  
BJU International     Hybrid Journal   (Followers: 35)
BMC Nephrology     Open Access   (Followers: 9)
BMC Urology     Open Access   (Followers: 15)
Canadian Journal of Kidney Health and Disease     Open Access   (Followers: 6)
Canadian Urological Association Journal     Open Access   (Followers: 2)
Cancer Urology     Open Access   (Followers: 2)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Case Reports in Nephrology     Open Access   (Followers: 5)
Case Reports in Nephrology and Dialysis     Open Access   (Followers: 9)
Case Reports in Urology     Open Access   (Followers: 12)
Clinical and Experimental Nephrology     Hybrid Journal   (Followers: 4)
Clinical Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 19)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Nephrology     Full-text available via subscription   (Followers: 8)
Clinical Nephrology and Urology Science     Open Access   (Followers: 6)
Clinical Queries: Nephrology     Hybrid Journal   (Followers: 1)
Cuadernos de Cirugía     Open Access   (Followers: 3)
Current Opinion in Nephrology & Hypertension     Hybrid Journal   (Followers: 10)
Current Opinion in Urology     Hybrid Journal   (Followers: 12)
Current Urology     Open Access   (Followers: 10)
Current Urology Reports     Hybrid Journal   (Followers: 5)
Der Nephrologe     Hybrid Journal  
Der Urologe     Hybrid Journal   (Followers: 7)
EMC - Urología     Full-text available via subscription  
Enfermería Nefrológica     Open Access   (Followers: 1)
European Urology     Full-text available via subscription   (Followers: 38)
European Urology Focus     Hybrid Journal   (Followers: 6)
European Urology Supplements     Full-text available via subscription   (Followers: 15)
Forum Nefrologiczne     Full-text available via subscription  
Geriatric Nephrology and Urology     Hybrid Journal   (Followers: 7)
Giornale di Clinica Nefrologica e Dialisi     Open Access  
Herald Urology     Open Access   (Followers: 2)
Hong Kong Journal of Nephrology     Open Access   (Followers: 3)
Human Andrology     Partially Free   (Followers: 2)
IJU Case Reports     Open Access  
Indian Journal of Nephrology     Open Access   (Followers: 2)
Indian Journal of Urology     Open Access   (Followers: 5)
International Brazilian Journal of Urology     Open Access   (Followers: 5)
International Journal of Nephrology     Open Access   (Followers: 2)
International Journal of Nephrology and Renovascular Disease     Open Access   (Followers: 2)
International Journal of Urology     Hybrid Journal   (Followers: 12)
International Urology and Nephrology     Hybrid Journal   (Followers: 7)
Jornal Brasileiro de Nefrologia     Open Access  
Journal für Urologie und Urogynäkologie/Österreich     Hybrid Journal  
Journal of Clinical Nephrology     Open Access   (Followers: 1)
Journal of Clinical Urology     Hybrid Journal   (Followers: 14)
Journal of Endoluminal Endourology     Open Access  
Journal of Endourology     Hybrid Journal   (Followers: 2)
Journal of Endourology Case Reports     Hybrid Journal  
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 3)
Journal of Integrative Nephrology and Andrology     Open Access   (Followers: 2)
Journal of Kidney Cancer and VHL     Open Access  
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Nephrology     Hybrid Journal   (Followers: 4)
Journal of Nephrology Research     Open Access   (Followers: 3)
Journal of Pediatric Nephrology     Open Access   (Followers: 3)
Journal of Renal Care     Hybrid Journal   (Followers: 8)
Journal of Renal Nursing     Full-text available via subscription   (Followers: 12)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 29)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 1)
Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 27)
Journal of The Egyptian Society of Nephrology and Transplantation     Open Access  
Journal of Translational Neurosciences     Open Access  
Journal of Urology     Full-text available via subscription   (Followers: 53)
Journal of Urology & Nephrology     Open Access   (Followers: 2)
Kidney Disease and Transplantation     Open Access   (Followers: 4)
Kidney Diseases     Open Access   (Followers: 3)
Kidney International     Hybrid Journal   (Followers: 44)
Kidney International Reports     Open Access   (Followers: 3)
Kidney Medicine     Open Access  
Kidney Research Journal     Open Access   (Followers: 6)
Kidneys (Počki)     Open Access   (Followers: 1)
Nature Reviews Nephrology     Full-text available via subscription   (Followers: 19)
Nature Reviews Urology     Full-text available via subscription   (Followers: 13)
Nefrología (English Edition)     Open Access  
Nefrología (Madrid)     Open Access  
Nephro-Urology Monthly     Open Access   (Followers: 1)
Nephrology     Hybrid Journal   (Followers: 12)
Nephrology Dialysis Transplantation     Hybrid Journal   (Followers: 25)
Nephron     Hybrid Journal   (Followers: 4)
Nephron Clinical Practice     Full-text available via subscription   (Followers: 4)
Nephron Experimental Nephrology     Full-text available via subscription   (Followers: 4)
Nephron Extra     Open Access   (Followers: 1)
Nephron Physiology     Full-text available via subscription   (Followers: 4)
Neurourology and Urodynamics     Hybrid Journal   (Followers: 1)
OA Nephrology     Open Access   (Followers: 2)
Open Access Journal of Urology     Open Access   (Followers: 6)
Open Journal of Nephrology     Open Access   (Followers: 5)
Open Journal of Urology     Open Access   (Followers: 7)
Open Urology & Nephrology Journal     Open Access  
Pediatric Urology Case Reports     Open Access   (Followers: 7)
Portuguese Journal of Nephrology & Hypertension     Open Access   (Followers: 1)
Progrès en Urologie     Full-text available via subscription  
Progrès en Urologie - FMC     Full-text available via subscription  
Prostate Cancer and Prostatic Diseases     Hybrid Journal   (Followers: 6)
Renal Failure     Open Access   (Followers: 12)
Renal Replacement Therapy     Open Access   (Followers: 4)
Research and Reports in Urology     Open Access   (Followers: 4)
Revista de Nefrología, Diálisis y Trasplante     Open Access   (Followers: 1)
Revista Mexicana de Urología     Open Access   (Followers: 1)
Revista Urologia Colombiana     Open Access  
Saudi Journal of Kidney Diseases and Transplantation     Open Access   (Followers: 2)
Scandinavian Journal of Urology     Hybrid Journal   (Followers: 8)
Seminars in Nephrology     Hybrid Journal   (Followers: 11)
The Prostate     Hybrid Journal   (Followers: 8)
Therapeutic Advances in Urology     Open Access   (Followers: 4)
Trends in Urology & Men's Health     Partially Free   (Followers: 1)
Ukrainian Journal of Nephrology and Dialysis     Open Access   (Followers: 1)
Uro-News     Hybrid Journal   (Followers: 2)
Urolithiasis     Hybrid Journal   (Followers: 2)
Urologia Internationalis     Full-text available via subscription   (Followers: 2)
Urologia Journal     Hybrid Journal  
Urologic Clinics of North America     Full-text available via subscription   (Followers: 4)
Urologic Nursing     Full-text available via subscription   (Followers: 4)
Urologic Radiology     Hybrid Journal  
Urological Science     Open Access  
Urologicheskie Vedomosti     Open Access  
Urologie in der Praxis     Hybrid Journal  
Urologie Scan     Hybrid Journal  
Urology     Hybrid Journal   (Followers: 34)
Urology Annals     Open Access   (Followers: 4)
Urology Case Reports     Open Access   (Followers: 3)
Urology Practice     Full-text available via subscription   (Followers: 2)
Urology Times     Free   (Followers: 3)
Urology Video Journal     Open Access   (Followers: 1)
World Journal of Nephrology and Urology     Open Access   (Followers: 15)
World Journal of Urology     Hybrid Journal   (Followers: 12)

           

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Nefrología (English Edition)
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2013-2514
Published by Elsevier Homepage  [3201 journals]
  • Prospective randomized multicenter study to demonstrate the benefits of
           haemodialysis without acetate (with citrate): ABC-treat Study. Acute
           effect of citrate

    • Abstract: Publication date: Available online 16 March 2019Source: Nefrología (English Edition)Author(s): Patricia de Sequera, Rafael Pérez García, Manuel Molina Nuñez, Rosa I. Muñoz González, Gracia Álvarez Fernández, Eva Mérida, M. Jesús Camba, Luís A. Blázquez, M. Paz Alcaide, Rocío Echarri, on behalf of the ABC-treat study group, Appendix A. Study group ABC-treat, P. de Sequera, R. Pérez García, M. Molina Nuñez, R.I. Muñoz González, G. Álvarez Fernández, E. Mérida, M.J. Camba, L.A. Blázquez, M.P. Alcaide, R. Echarri IntroductionDialysis fluid (DF), an essential element in hemodialysis (HD), is manufactured in situ by mixing three components: treated water, bicarbonate concentrate and acid concentrate. To avoid the precipitation of calcium and magnesium carbonate that is produced in DF by the addition of bicarbonate, it is necessary to add an acid. There are 2 acid concentrates that contain acetate (ADF) or citrate (CDF) as a stabilizer.ObjectiveTo compare the acute effect of HD with CDF vs. ADF on the metabolism of calcium, phosphorus and magnesium, acid base balance, coagulation, inflammation and hemodynamic stability.MethodsProspective, multicenter, randomized and crossed study, of 32 weeks duration, in patients in three-week HD, AK-200-Ultra-S or Artis monitor, 16 weeks with ADF SoftPac®, prepared with 3 mmol/L of acetate, and 16 weeks with CDF SelectBag Citrate®, with 1 mmol/L of citrate. Patients older than 18 years were included in HD for a minimum of 3 months by arteriovenous fistula. Epidemiological, dialysis, pre and postdialysis biochemistry, episodes of arterial hypotension, and coagulation scores were collected monthly during the 8 months of the study. Pre and post-dialysis analysis were extracted: venous blood gas, calcium (Ca), ionic calcium (Cai), phosphorus (P), magnesium (Mg) and parathyroid hormone (PTH) among others.ClinicalTrials.gov NCT03319680.ResultsWe included 56 patients, 47 (84%) men and 9 (16%) women, mean age: 65.3 (16.4) years, technique HD/HDF: 20 (35.7%)/36 (64.3%).We found differences (p 
       
  • Statins and antiplatelet agents are associated with changes in the
           circulatory markers of endothelial dysfunction in chronic kidney disease

    • Abstract: Publication date: Available online 22 January 2019Source: Nefrología (English Edition)Author(s): Estefanya García Menéndez, María Marques Vidas, Matilde Alique, Julia Carracedo, Patricia de Sequera, Elena Corchete, Rafael Pérez García, Rafael Ramírez Chamond, José M. Portolés Backgrounds and purposesPatients with chronic kidney disease (CKD) have higher risk of developing cardiovascular disease. In CKD patients the mechanisms involved in, endothelial damage and the role of different drugs used on these patients are not completely understood. The aim of this work is to analyze the effect of statins and platelet antiaggregant (PA) on endothelial microvesicles (EMVs) and other markers of endothelial dysfunction.Experimental approachCross-sectional study of 41 patients with CKD 3b-4 and 8 healthy volunteers. Circulating levels of EMVs, vascular endothelial growth factor (VEGF), and advance oxidized protein products (AOPPS) were quantified and the correlation with different comorbidity variables and therapeutic strategies were evaluated.ResultsEMVs are increased in CKD patients as compared with controls (171.1 vs. 68.3/μl, p 
       
  • Acute haemolytic pancreatitis and hepatitis secondary to percutaneous
           pharmacomechanical thrombectomy of prosthetic vascular access for
           haemodialysis

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Jessica Urdaneta, David Arroyo, Carmen Mon, José Abadal, Esther Gálvez, Milagros Ortiz, Rosa Camacho, Juan Carlos Herrero
       
  • Aldosteronism with elevated active renin concentration: Primary versus
           secondary' Importance of follow-up for the diagnosis

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): M. Heras Benito, M.J. Fernandez Reyes Luis, M.A. Rodriguez Gomez
       
  • Nephrotic syndrome in relation to treatment with ustekinumab

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): María Pérez Fernández, Ana Belén Piteiro Bermejo, Jessy Korina Peña Esparragoza, Ana Blasco Martínez, Irene Aracil Moreno, Javier Mancha Ramos, Fuensanta Moreno Barrio
       
  • Role of sustained low-efficiency dialysis in the intensive care unit

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Alícia Molina-Andújar, Miquel Blasco, Esteban Poch
       
  • A case report of cyanotic nephropathy

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Mayra Ortega-Díaz, Marta Puerta Carretero, Elena Corchete, Juan A. Martín Navarro, M. Teresa Jaldo, Marta Albalate, Patricia de Sequera, Roberto Alcázar Arroyo
       
  • Immunotherapy in cancer: Great expectations in the world of oncology, but
           a reason for renal concern

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Beatriz Redondo, Candela Moliz, Marina Alonso, Luis Paz-Ares, Manuel Praga, Enrique Morales
       
  • Potentially inappropriate prescribing in patients on dialysis using
           STOPP-START criteria

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Anunciación Gonzalez-Lopez, Alvaro Nava-Rebollo, Angel Chocarro-Martinez, Beatriz Andres-Martin, Henar Santana-Zapatero, Francisco Herrera-Gomez, Julia Diego-Martin, Cipriano Escaja-Muga, Jesús Grande-Villoria
       
  • Improvement of bilateral lower-limb muscle oxygenation by low-density
           lipoprotein apheresis in a patient with peripheral artery disease
           undergoing hemodialysis

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Kiyonori Ito, Susumu Ookawara, Yuichiro Ueda, Hideyuki Hayasaka, Masaya Kofuji, Takayuki Uchida, Harunobu Matsumoto, Atsushi Yamaguchi, Yoshiyuki Morishita
       
  • Translumbar and transhepatic haemodialysis catheters: A viable option

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Juan Rodriguez Mori, Jhony Ramirez Alguiar, Carla Postigo Oviedo, Piero Mora Munares, Manuel Llaro Sánchez, Max Caballero Linares, Manuel Castillo Zegarra
       
  • Eculizumab as a treatment for atypical hemolytic uremic syndrome secondary
           to carfilzomib

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Candela Moliz, Eduardo Gutiérrez, Teresa Cavero, Beatriz Redondo, Manuel Praga
       
  • A minimal change disease compatible with C1q nephropathy in a paediatric
           patient. Evolution and treatment of a difficult pathology

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Igor Romaniouk Jakovler, Ricardo Mouzo Javier, Carmen Perez Nieto, Antonio Romero, Fernando Simal, Beatriz Castañon
       
  • Mycophenolate mofetil-induced mouth ulcers in a kidney transplant patient:
           Case report and literature review

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Adrià Plana-Pla, Laura Cañas Solé, Aram Boada Garcia, Ricardo Lauzurica Valdemoros Mouth ulcers are a cutaneous complication that can often affect kidney transplant patients, mostly due to the effect of immunosuppressive treatment.Even so, before asserting that said complication is indeed secondary to drugs, it is very important to establish a differential diagnosis with other mouth ulcer causes, such as systemic diseases or viral infections, which are also common in these patients.ResumenLas úlceras orales son una de las complicaciones cutáneas que pueden afectar con frecuencia a los pacientes trasplantados renales, debido muchas veces al efecto del tratamiento inmunosupresor.Aun así, es importante, antes de asegurar que dicha complicación es secundaria a los fármacos, establecer el diagnóstico diferencial con otras causas de úlceras orales como pueden ser enfermedades sistémicas o infecciones virales, también frecuentes en este tipo de pacientes.
       
  • A comparison of effects induced on urinary calcium by thiazides and
           different doses of salt in the diet: Implications in clinical practice

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): María Martínez García, Pablo Trincado Aznar, Leticia Pérez Fernández, Isabel Azcona Monreal, María Elena López Alaminos, Javier Acha Pérez, Ramón Albero Gamboa IntroductionBoth dietary restriction of sodium chloride (NaCl) and treatment with thiazides have been used in hypercalciuric patients.ObjectivesTo calculate regular salt intake and investigate the correlation between natriuresis and urinary calcium with usual diet (B) and after changing the amount of NaCl intake and administration of thiazides.Material and methodsNineteen healthy young individuals had their diet replaced by 2 l of Nutrison® Low Sodium (500 mg sodium/day) daily for two days. Then, 5 g of NaCl were added every two days (“5”, “10” and “15”), administering 50 mg (H50) and 100 mg (H100) of Higroton® on the last two days. Blood sodium, plasma renin activity (PRA) and aldosterone were determined in venous blood samples, as were urinary sodium and calcium. Statistical analysis: Wilcoxon t-test and the Pearson linear correlation were calculated.ResultsUrinary Na (mEq/24 h): 210.3 ± 87.6 (“B”); 42.7 ± 20.4 (“5”); 135.5 ± 50.6 (“10”); 225.5 ± 56.7 (“15”). Urinary calcium (mg/24 h): 207.8 ± 93.6 (“B”); 172.8 ± 63.1 (“5”); 206.2 ± 87.7 (“10”); 227.4 ± 84.1 (“15”). A positive correlation was observed between natriuresis and urinary calcium in “10” (r = 0.47) and “15” (r = 0.67). After Higroton®, natriuresis: 232.3 ± 50.7; 377 ± 4 (H50); 341.1 ± 68.4 (H100); Ca in urine: 209.8 ± 57.4; 213.2 ± 67.6 (H50); 159.1 ± 52.2 (H100).ConclusionsSalt intake in the population studied was estimated to be 14.9 ± 4.9 g/day with a positive correlation found between sodium and calcium urine output with daily intakes of 11.25 and 16.25 g of salt. With the usual intake, for each gram of salt, urinary calcium increased by 5.46 mg/24 h and with 100 mg of Higroton® it decreased by 50.7 mg/24 h. These data could be useful for the management of patients with excretory hypercalciuria or hypoparathyroidism.ResumenIntroducciónLa restricción de ClNa en la dieta y el tratamiento con tiazidas han sido utilizados en pacientes hipercalciúricos.ObjetivosConocer la ingesta habitual de sal y la correlación entre natriuria y calciuria con la dieta habitual (B) y tras la modificación de la cantidad de ClNa y la administración de tiazidas.Material y métodosDiecinueve jóvenes sanos, a los que se les sustituyó su dieta por 2 l diarios de Nutrison® Low Sodium (500 mg de Na) durante 2 días. Posteriormente se añadieron cada 2 días 5 g de ClNa («5», «10» y «15») y durante los 2 últimos días 50 y 100 mg de Higrotona® (H50) y (H100). Se determinaron iones, ARP y aldosterona en sangre venosa, así como la natriuria y calciuria. Valoración estadística: se calcula la t de Wilcoxon y la correlación lineal de Pearson.ResultadosNatriuria (mEq/24 h): 210,3 ± 87,6 («B»); 42,7 ± 20,4 («5»); 135,5 ± 50,6 («10»); 225,5 ± 56,7 («15»). Calciuria (mg/24 h): 207,8 ± 93,6 («B»); 172,8 ± 63,1 («5»); 206,2 ± 87,7 («10»); 227,4 ± 84,1 («15»). Correlación positiva entre natriuria y calciuria en «10» (r = 0,47) y en «15» (r = 0,67). Tras Higrotona®, natriuria: 232,3 ± 50,7; 377 ± 4 (H50); 341,1 ± 68,4 (H100); Ca en orina: 209,8 ± 57,4; 213,2 ± 67,6 (H50); 159,1 ± 52,2 (H100).ConclusionesLa ingesta de sal en la población estudiada es de 14,9 ± 4,9 g/día. Encontramos correlación entre natriuria y calciuria con ingestas de 11,25 y 16,25 g de sal. Con la ingesta habitual, por cada gramo de sal aumenta la calciuria 5,46 mg y con 100 mg de Higrotona®, la calciuria disminuye 50,7 mg/24 h. Los datos podrían ser de utilidad para el manejo de pacientes con hipercalciuria excretora o hipoparatiroidismo.
       
  • The value of ABPM and subclinical target organ damage parameters in
           diagnosis of resistant hypertension

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): M. Inmaculada Poveda García, M. Dolores del Pino y Pino, Raquel Alarcón Rodriguez, Cristian Rodelo-Haad, Tesifón Parrón Carreño IntroductionWe aimed to assess the effectiveness of ambulatory blood pressure monitoring (ABPM) and subclinical target organ damage parameters for diagnosis of resistant hypertension (RH).MethodsWe assessed demographic and anthropometric variables, the incidence of cardiovascular events and subclinical target organ damage (n = 112). We also studied the relationship between these variables and the ABPM results.ResultsOf the 112 patients referred from primary care with a diagnosis of RH, 69 (61.6%) were confirmed by ABPM. We found statistically significant differences (p 
       
  • Unlike Kt, high Kt/V is associated with greater mortality: The importance
           of low V

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Rafael Perez-Garcia, Maite Jaldo, Roberto Alcázar, Patricia de Sequera, Marta Albalate, Marta Puerta, Mayra Ortega, M. Caridad Ruiz, Elena Corchete IntroductionKt/V has been used as a synonym for hemodialysis dose. Patient survival improved with a Kt/V > 1; this target was subsequently increased to 1.2 and 1.3. The HEMO study revealed no significant relationship between Kt/V and mortality. The relationship between Kt/V and mortality often shows a J-shaped curve. Is V the confounding factor in this relationship' The objective of this study is to determine the relationship between mortality and Kt/V, Kt and body water content (V) and lean mass (bioimpedance).MethodsWe studied a cohort of 127 prevalent hemodialysis patients, who we followed-up for an average of 36 months. Kt was determined by ionic dialysance, and V and nutrition parameters by bioimpedance. Kt/V, Kt corrected for body surface area (Kt/BSA) and target Kt/BSA were calculated. The mean data from 18,998 sessions were used as hemodialysis parameters, with a mean of 155 sessions per patient.ResultsMean age was 70.4 ± 15.3 years and 61% were male; 76 were dialyzed via an arteriovenous fistula and 65 were on online hemodiafiltration. Weight was 70.6 (16.8) kg; BSA 1.8 (0.25) m2; total body water (V) 32.2 (7.41) l and lean mass index (LMI) 11.1 (2.7) kg/m2. Mean Kt/V was 1.84 (0.44); Kt 56.1(7) l and Kt/BSA 52.8 (10.4) l. The mean target Kt/BSA was 49.7 (4.5) l. Mean Kt/BSA − target Kt/BSA + 6.4 (7.0) l. Patients with a higher Kt/V had worse survival rates than others; with Kt this is not the case. Higher Kt/V values are due to a lower V, with poorer nutrition parameters. LMI and serum albumin were the parameters that best independently predicted the risk of death and are lower in patients with a higher Kt/V and lower V.ConclusionKt/V is not useful for determining dialysis doses in patients with low or reduced body water. Kt or the Kt/BSA are proposed as an alternative.ResumenIntroducciónEl Kt/V se ha usado como sinónimo de dosis de hemodiálisis. La supervivencia de los pacientes mejoraba con un Kt/V > 1; este objetivo posteriormente fue elevado a 1,2 y a 1,3. En el estudio HEMO no se demostró una relación significativa entre Kt/V y la mortalidad. La relación Kt/V y mortalidad con frecuencia es una curva en «J». ¿Es la V el factor de confusión de esa relación' El objetivo de este estudio es buscar la relación de la mortalidad con el Kt/V, Kt y con el contenido de agua corporal (V) y masa magra (bioimpedancia).MétodosSe ha estudiado una cohorte de 127 pacientes prevalentes en hemodiálisis seguidos durante una media de 36 meses. Se determinó el Kt por dialisancia iónica y la V y parámetros de nutrición mediante bioimpedancia. Se ha calculado el Kt/V y el Kt alcanzado corregido para superficie corporal (Ktsc) y el Ktsc objetivo. Como parámetros de hemodiálisis se ha utilizado la media de los datos de 18.998 sesiones, con una media de 155 sesiones por paciente.ResultadosLa edad media fue 70,4 (15,3) años y un 61% eran hombres; 76 se dializaban mediante fístula arteriovenosa y 65 estaban en HDF-OL. Peso: 70,6 (16,8) kg; superficie corporal: 1,8 (0,25) m2; agua corporal total: 32,2 (7,4) l; índice de masa magra (LTI): 11,1 (2,7) kg/m2. El Kt/V medio fue 1,84 (0,44); Kt: 56,1 (7) l, y el Ktsc, 52,8 (10,4) l. El Ktsc objetivo medio era de 49,7 (4,5) l. La media del Ktsc – Ktsc objetivo: +6,4 (7,0) l. Los pacientes con un Kt/V mayor tienen peor supervivencia que el resto. Con el Kt no existe esta relación. Los Kt/V mayores se deben a una V menor, con peores parámetros de nutrición. La albúmina sérica y el LTI son los parámetros que se relacionan con el riesgo de muerte de forma independiente y son menores en los pacientes con mayor Kt/V y menor V.ConclusiónEl Kt/V no es útil para determinar la dosis de diálisis en pacientes con un agua corporal pequeña o disminuida. Se propone el Kt o el Ktsc como alternativa.
       
  • Gastrointestinal lesions in chronic kidney disease patients with anemia

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Rebeca García Agudo, Sami Aoufi Rabih, Pedro González Carro, Francisco Pérez Roldán, Beatriz Proy Vega, Ángel Arias Arias, Fátima Cazalla Cadenas, José María Tenías Burillo, Ana Fernández Rodríguez IntroductionDespite the frequency with which anemia is present in patients with chronic kidney disease (CKD), its relationship with gastrointestinal lesions has not been studied.MethodA cross-sectional, analytical, observational study involving one year of recruitment was carried out to determine the prevalence of endoscopic gastrointestinal lesions and associated risk factors in asymptomatic patients with chronic kidney disease stages 1–5 and anemia who had a positive qualitative immunochemical fecal occult blood test.ResultsA total of 9658 patients with CKD were analyzed, of which 286 (2.9%) had anemia; 198 had a positive fecal occult blood test (47% male, 71.1 ± 11.8 years). The endoscopic study revealed 255 lesions, with at least one lesion in 68.2% of patients, with the most prevalent being: adenomatous colorectal polyps (39.6%), acute lesions of the gastric mucosa (22.6%), neoplastic lesions 15.1%), angiodysplasia (14.4%), oesophagitis (8.4%), inflammatory bowel disease (4.8%) and ischemic colitis (3.1%). Uremia and acetylsalicylic acid were identified as risk factors for acute gastric mucosal lesions. Angiodysplasia was associated with alcoholism, a more advanced stage of chronic kidney disease, anemia, and lack of response to erythropoiesis-stimulating agents. Age and refractory anemia were risk factors for adenomatous polyps and colorectal cancer.ConclusionRenal patients with anemia could benefit from an endoscopic study due to their high prevalence of gastrointestinal lesions, particularly adenomatous polyps and colorectal cancer, which are more common in those over 50 years of age with CKD stages 3–5.ResumenIntroducciónA pesar de la frecuencia con que la anemia está presente en los pacientes con enfermedad renal crónica (ERC), su relación con lesiones gastrointestinales no ha sido estudiada.MétodoEstudio observacional analítico transversal de un año de reclutamiento para determinar la prevalencia de lesiones gastrointestinales endoscópicas y los factores de riesgo asociados en pacientes asintomáticos con ERC estadios 1-5 y anemia que presentaban un test inmunoquímico cualitativo de sangre oculta en heces positivo.ResultadosSe analizaron 9.658 pacientes con ERC, de los que 286 (2,9%) presentaban anemia; 198 tuvieron un test de sangre oculta en heces positivo (47% varones, 71,1 ± 11,8 años). El estudio endoscópico reveló 255 lesiones, con al menos una lesión en el 68,2%, siendo las más prevalentes: pólipos colorrectales adenomatosos (39,6%), lesiones agudas de la mucosa gástrica (22,6%), lesiones neoplásicas (15,1%), angiodisplasias (14,4%), esofagitis (8,4%), enfermedad inflamatoria intestinal (4,8%) y colitis isquémica (3,1%). La uremia y el ácido acetilsalicílico fueron identificados como factores de riesgo de lesiones agudas de la mucosa gástrica. Las angiodisplasias se relacionaron con el enolismo, el mayor estadio de ERC, la anemia y la ausencia de respuesta a agentes estimulantes de la eritropoyesis. La edad y la anemia refractaria constituyeron factores de riesgo de pólipos adenomatosos y cáncer colorrectal.ConclusiónLos pacientes renales con anemia podrían beneficiarse de un estudio endoscópico debido a la alta prevalencia de lesiones gastrointestinales que presentan, particularmente pólipos adenomatosos y cáncer colorrectal, más frecuentes en los mayores de 50 años con ERC estadios 3-5.
       
  • Influence of calcium concentration in haemodialysis fluid on blood
           pressure control

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Jara Ampuero Mencía, Almudena Vega, Soraya Abad, Caridad Ruiz Caro, Úrsula Verdalles, Juan Manuel López Gómez BackgroundHypertension is a highly prevalent disorder among patients undergoing haemodialysis. It contributes to greater cardiovascular risk and must be controlled. However, despite dietary measures, haemodialysis regimen optimization and pharmacological treatment, some patients in our units continue to maintain high blood pressure levels. The objective of the study is to demonstrate that reducing calcium in dialysis fluid can help treat hypertension patients undergoing haemodialysis.Material and methodsWe selected all of the hypertensive patients from our haemodialysis unit. We checked their normovolemic status by means of bioimpedance spectroscopy, decreasing the haemodialysis fluid's calcium concentration to 2.5 mEq/L, with a follow-up period of 12 months.ResultsA total of 24 patients met the non-volume dependent hypertension criteria (age 61 ± 15 years, males 48%, diabetes 43%). A significant systolic and diastolic blood pressure decrease was observed at 6 and 12 months as a result of reducing the dialysis calcium concentration; this was not accompanied by greater hemodynamic instability (baseline systolic blood pressure: 162 ± 14 mmHg; at 6 months: 146 ± 18 mmHg; at 12 months: 141 ± 21 mmHg; p = 0.001) (baseline diastolic blood pressure: 76 ± 14 mmHg; at 6 months: 70 ± 12 mmHg; at 12 months: 65 ± 11 mmHg; p = 0.005). A non-significant increase in plasma parathyroid hormone levels was also found. No side effects were observed.ConclusionsAdding 2.5 mEq/L of calcium to dialysis fluid is a safe and effective therapeutic alternative to control hard-to-manage hypertension among haemodialysis patients.ResumenIntroducciónLa hipertensión arterial es altamente prevalente en los pacientes en hemodiálisis. Implica un mayor riesgo cardiovascular y es fundamental su control. A pesar de medidas dietéticas, optimización de la pauta de hemodiálisis y tratamiento farmacológico, existe un porcentaje de pacientes en nuestras unidades que continúan hipertensos. Es por ello que nos planteamos que la reducción de calcio en el líquido de diálisis puede ayudar al manejo de los pacientes hipertensos en hemodiálisis.Material y métodosSe seleccionaron todos los pacientes hipertensos de nuestra unidad de hemodiálisis. Se comprobó estado de normovolemia mediante bioimpedancia espectroscópica y se disminuyó la concentración de calcio del líquido de hemodiálisis a 2,5 mEq/l, con un seguimiento de 12 meses.ResultadosCumplieron criterios de hipertensión arterial no volumen-dependiente 24 pacientes (edad 61 ± 15 años, varones el 48%, diabetes el 43%). Se observó una disminución significativa en la tensión arterial sistólica y diastólica a los 6 y 12 meses de la reducción de la concentración del calcio de diálisis, sin acompañarse de mayor inestabilidad hemodinámica (tensión arterial sistólica basal 162 ± 14; a los 6 meses 146 ± 18; a los 12 meses 141 ± 21 mmHg; p = 0,001) (tensión arterial diastólica basal 76 ± 14; a los 6 meses 70 ± 12; a los 12 meses 65 ± 11 mmHg; p = 0,005) Existió un aumento de los niveles plasmáticos de PTH de forma no significativa. No se evidenciaron efectos secundarios.ConclusionesLa hemodiálisis con calcio en el líquido de 2,5 mEq/l es una alternativa terapéutica eficaz y segura para el control de hipertensión arterial de difícil manejo en los pacientes de hemodiálisis.
       
  • Native vitamin D in pre-dialysis chronic kidney disease

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Mariana P. Cardoso, Luciano A.L. Pereira Chronic kidney disease patients have a high prevalence of vitamin D insufficiency/deficiency. Vitamin D deficiency has been associated with a variety of bone, metabolic and cardiovascular disorders. However, the role of native vitamin D supplementation (ergocalciferol, cholecalciferol or calcifediol) remains unclear in chronic kidney disease (CKD), particularly in the pre-dialytic phase. Several international guidelines have been developed on CKD–Mineral and Bone Disorder, but the optimal strategy for native vitamin D supplementation and its clinical benefit remains a subject of debate in the scientific community. This paper aims to review the available literature, including randomized clinical trials that evaluated the effects of native vitamin D supplementation on pre-dialysis CKD on biochemical and clinically relevant outcomes.ResumenLos pacientes renales crónicos tienen una elevada prevalencia de insuficiencia/deficiencia de vitamina D. El déficit de vitamina D se ha asociado con una serie de cambios óseos, metabólicos y cardiovasculares. Sin embargo, continúa por aclarar el papel de la suplementación con vitamina D nativa (ergocalciferol, colecalciferol o calcifediol) en la enfermedad renal crónica (ERC), especialmente en la fase pre-dialítica. Varias pautas internacionales se han desarrollado sobre la enfermedad mineral y ósea relacionada con la ERC, pero la estrategia ideal de suplementación con vitamina D nativa y su beneficio clínico continúan siendo objeto de debate en la comunidad científica. Este trabajo pretende revisar la literatura disponible, incluyendo ensayos clínicos aleatorizados que evaluaron los efectos de la suplementación con vitamina D nativa en la ERC pre-diálisis en resultados bioquímicos y clínicamente relevantes.
       
  • The role of women throughout the history of Nephrology

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): M.A. Martín-Gómez, R. García Agudo, M.D. Arenas Jiménez
       
  • Rewards to increase living kidney donation: The state of the art

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Sara Querido, André Weigert, Teresa Adragão, Domingos Machado, Diogo Pais
       
  • Will the new hypoglycaemic agents be effective on renal and cardiovascular
           protection in diabetes and renal diabetic disease'

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Alberto Martinez-Castelao, M. José Soler, Juan F. Navarro-González, José Luis Górriz
       
  • Adenovirus infection—A rare cause of interstitial nephritis in
           kidney transplant

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Carla L. Moreira, Joana Rocha, Margarida Silva, Joana Silva, Manuela Almeida, Sofia Pedroso, Ramon Vizcaíno, La Salete Martins, Leonídio Dias, António Castro Henriques, António Cabrita
       
  • Novel nonsense mutation in the SLC12A3 gene in a Spanish case of
           Gitelman syndrome

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): Lourdes Roca-Argente, Angel Zúñiga, Jose Luis Moll-Guillem, Julio Hernández-Jaras
       
  • Erratum to “Spanish Clinical Guidelines on Vascular Access for
           Haemodialysis”

    • Abstract: Publication date: January–February 2019Source: Nefrología (English Edition), Volume 39, Issue 1Author(s): José Ibeas, Ramon Roca-Tey, Joaquín Vallespín, Teresa Moreno, Guillermo Moñux, Anna Martí-Monrós, José Luis del Pozo, Enrique Gruss, Manel Ramírez de Arellano, Néstor Fontseré, María Dolores Arenas, José Luis Merino, José García-Revillo, Pilar Caro, Cristina López-Espada, Antonio Giménez-Gaibar, Milagros Fernández-Lucas, Pablo Valdés, Fidel Fernández-Quesada, Natalia de la Fuente
       
  • A light in the control of secondary hyperparathyroidism. Etelcalcetide IV
           in haemodialysis

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Paola Villabón Ochoa, Marta Sánchez Heras, Andrea Zapata Balcázar, Patricia Sánchez Escudero, Jose R. Rodríguez Palomares, Gabriel de Arriba de la Fuente
       
  • Podocytopathy as the onset of systemic lupus erythematosus

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Salomé Muray Cases, María Teresa Herranz Marín, Concepción Alcázar Fajardo, Alberto Javier Andreu Muñoz, Juan B. Cabezuelo Romero
       
  • Transplantation of hepatitis C infected kidneys into uninfected
           recipients. Why not'

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Antonio Franco, Noelia Balibrea, Angelina Gimeno, Esperanza Merino, Maria Isabel Lopez, Carlos Santiago, Francisco Perez Contreras
       
  • Successful treatment of chronic hepatitis C in a kidney transplant patient
           with only 2 weeks of direct-acting antiviral therapy

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Sofia de Sá Guimarães Cerqueira, Mónica Dinis Mesquita, Rui Arlindo Castro, Paulo Carrola, Teresa Margarida Pinto Ribeiro Morgado, Paula Marques
       
  • IgA-dominant infection-related glomerulonephritis

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Yoshinosuke Shimamura, Takuto Maeda, Yufu Gocho, Yayoi Ogawa, Hideki Takizawa
       
  • Triple functioning renal allograft after repeated liver–kidney
           transplantation due to liver failure

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Andrés Tapias, Nuria Sánchez, José V. Torregrosa, David Fuster, Pilar Perlaza, Francisco Lomeña
       
  • Guillian-Barre syndrome secondary to tacrolimus in a patient with
           corticoresistant nephrotic syndrome secondary to focal and segmental
           glomerulonephritis and a coexisting IgA nephropathy

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Igor Romaniouk Jakovler, Carmen Perez Nieto, Marco Romero Antonio, Fernando Simal Blanco, Ricardo Mouzo Javier
       
  • Acute renal failure due to rhabdomyolysis. Renal replacement therapy with
           intermediate cut-off membranes (EMIC2)

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Rafael Díaz-Tejeiro, Dabaiba Regidor, Jorge Morales, Mayte Padrón, Laura Cueto, Miguel Angel Muñoz, Marta Torres, Francisco Javier Ahijado, Jose Eugenio García Díaz
       
  • Hemodialysis catheter colonised by Pandoraea spotorum

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Tania Monzón, Francisco Valga, Jorge Reichert, Celia López
       
  • Mortality from chronic kidney disease in the elderly Peruvians, 2009-2013

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Guido Bendezu-Quispe, Diego Azañedo, Akram Hernández-Vásquez
       
  • Distal renal tubular acidosis in two children with acquired hypothyroidism

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Norma E. Guerra-Hernández, Karen V. Ordaz-López, Rosa Vargas-Poussou, Laura Escobar-Pérez, Víctor M. García-Nieto Two cases of children diagnosed with renal tubular acidosis (RTA) associated with autoimmune hypothyroidism are presented.Case 1 developed an intestinal ileus at the age of five in the context of a respiratory problem. The tests performed confirmed metabolic acidosis, hyperchloraemia, hypokalaemia and nephrocalcinosis. Case 2 was diagnosed with hypothyroidism at the age of 11, and with RTA two years later.In both patients, the diagnosis of RTA was verified when decreased maximum urinary pCO2 was found. In case 2, a proximal bicarbonate leak (type 3 RTA) was also confirmed. This was the first case to be published on the topic.The causes of RTA in patients with hypothyroidism are reviewed. The deleterious effect on the kidneys may be due to the absence of thyroid hormone and/or autoantibodies in the cases of autoimmune hypothyroidism.ResumenSe presentan dos casos en edad pediátrica diagnosticados de acidosis tubular renal (ATR) asociada a hipotiroidismo de causa autoinmune.El caso 1 desarrolló un íleo intestinal a los 5 años de edad en el seno de un problema respiratorio. En los exámenes realizados se constató acidosis metabólica, hipercloremia, hipopotasemia y nefrocalcinosis. El caso 2 fue diagnosticado de hipotiroidismo a los 11 años de edad y 2 años después, de ATR.En ambos pacientes, se comprobó el diagnóstico de ATR al observarse una pCO2 urinaria máxima reducida. En el caso 2 se constató, además, una fuga proximal de bicarbonato (ATR tipo 3), que constituye el primer caso publicado sobre el tema.Se revisan las causas de ATR en pacientes con hipotiroidismo. El efecto deletéreo sobre el riñón puede ser debido a la propia ausencia de hormona tiroidea y/o a los autoanticuerpos en los casos de hipotiroidismo autoinmune.
       
  • Curcumin intake in haemodialysis patients

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Tania Monzón, Francisco Valga, Fernando Henriquez
       
  • Contribution of uremic toxins to the vascular fibrosis associated with
           chronic kidney disease

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Marco Hatem-Vaquero, Sergio de Frutos, Alicia Luengo, Alba González Abajo, Mercedes Griera, Manuel Rodríguez-Puyol, Diego Rodríguez-Puyol, Laura Calleros BackgroundPatients with chronic kidney disease present with an accumulation of uremic toxins, which have been identified as pathogenic agents associated with cardiovascular mortality, which is very high is this patient group. A phenomenon common to the progressive renal dysfunction and associated vascular damage, is the abnormal accumulation of extracellular matrix (ECM) proteins in the renal or vascular structures.ObjectiveTo determine the contribution of uremia or the uremic toxins to the production of cytokinins and ECM in aortas of uremic animals or human aortic smooth muscle cells (HASMCs).Materials and methodsMice were used with uremia induced by a diet rich in adenine (0.2%) for 2, 4 or 6 weeks. Kidney function was evaluated by means of urine volume, plasma levels of creatinine, urea, fractional excretion of sodium, and vascular damage using histology, as well as protein expression using RT-qPCR. The HASMCs were incubated in vitro with uremic toxins: p-cresol 10–100 (μg/ml) and indoxyl-sulphate 25–100 (μg/ml) alone or simultaneously. The protein expression was evaluated using Western blot and confocal microscopy.ResultsThe administration of adenine produced progressive kidney damage in the mice, thickening of the aortic wall, and increasing the expression of TGF-β1 and ECM proteins. The toxins at high doses and combined also induced the expression of TGF-β1 and ECM proteins by the HASMCs.ConclusionsThe uremia produced by an adenine rich diet or high doses of uremic toxins induced the abnormal deposit of ECM proteins in the vascular wall or its production by HASMCs. The understanding of the mechanisms that underlie this pathophysiological process may be useful in the prevention of cardiovascular damage associated with the progress of chronic kidney disease, a disease, at the moment that is irreversible and occasional silent until its diagnosis in advanced stages.ResumenAntecedentesLos pacientes con enfermedad renal crónica presentan una acumulación de toxinas urémicas, las cuales han sido identificadas como agentes patogénicos asociados con la mortalidad cardiovascular, muy elevada en este grupo de enfermos. Un fenómeno común a la disfunción renal progresiva y al daño vascular asociado es la acumulación anormal de proteínas de la matriz extracelular (MEC) en las estructuras renales o vasculares.ObjetivoEstudiar la contribución de la uremia o las toxinas urémicas a la producción de citocinas y MEC en aortas de animales urémicos o células de músculo liso de aorta humana (HAOSMC).Materiales y métodosSe utilizaron ratones con uremia inducida por una dieta rica en adenina (0,2%) durante 2, 4 o 6 semanas. Se evaluó la función renal mediante la diuresis, los niveles plasmáticos de creatinina y nitrógeno ureico plasmático, y la excreción fraccional de sodio y el daño vascular mediante histología y expresión proteica por RT-qPCR. In vitro, las HAOSMC se incubaron con toxinas urémicas: p-cresol 10-100 (μg/ml) e indoxil-sulfato 25-100 (μg/ml), solas o simultáneamente. La expresión proteica se evaluó por Western blot y microscopia confocal.ResultadosLa administración de adenina produjo un progresivo daño renal en los ratones, un engrosamiento de la pared aórtica y un incremento de la expresión de TGF-β1 y proteínas de MEC. Las toxinas a dosis altas y combinadas también indujeron expresión de TGF-β1 y proteínas de MEC por las células HAOSMC.ConclusionesLa uremia producida por una dieta rica en adenina o las dosis altas de toxinas urémicas indujeron el depósito anormal de proteínas de MEC en las paredes vasculares o su producción por HAOSMC. La comprensión de los mecanismos que subyacen a este proceso fisiopatológico puede resultar de utilidad en la prevención del daño cardiovascular asociado a la progresión de la enfermedad renal crónica, una dolencia, de momento, irreversible y, en ocasiones, silenciosa hasta su diagnóstico en etapas avanzadas.
       
  • Rationale and design of DiPPI: A randomized controlled trial to evaluate
           the safety and effectiveness of progressive hemodialysis in incident
           patients

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Miguel A. Suárez, Emilio García-Cabrera, Antonio Gascón, Francisca López, Eduardo Torregrosa, Giannina E. García, Jorge Huertas, José C. de la Flor, Suleyka Puello, Jonathan Gómez-Raja, Jesús Grande, José L. Lerma, Carlos Corradino, Manuel Ramos, Jesús Martín, Carlo Basile, Francesco G. Casino, Javier Deira IntroductionProgressive haemodialysis (HD) is a starting regime for renal replacement therapy (RRT) adapted to each patient's necessities. It is mainly conditioned by the residual renal function (RRF). The frequency of sessions with which patients start HD (one or two sessions per week), is lower than that for conventional HD (three times per week). Such frequency is increased (from one to two sessions, and from two to three sessions) as the RRF declines.Methodology/DesignIHDIP is a multicentre randomized experimental open trial. It is randomized in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 patients older than 18 years with chronic renal disease stage 5 and start HD as RRT, with an RRF of ≥4 ml/min/1.73 m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with one session of HD per week (progressive HD). The control group includes 76 patients who will start with three sessions per week (conventional HD). The primary purpose is assessing the survival rate, while the secondary purposes are the morbidity rate (hospital admissions), the clinical parameters, the quality of life and the efficiency.DiscussionThis study will enable us to know, with the highest level of scientific evidence, the number of sessions a patient should receive when starting the HD treatment, depending on his/her RRF.Trial registrationRegistered at the U.S. National Institutes of Health, ClinicalTrials.gov under the number NCT03239808.ResumenIntroducciónLa hemodiálisis (HD) progresiva es una modalidad de inicio del tratamiento renal sustitutivo adaptada a las necesidades individuales de cada paciente. Está condicionada fundamentalmente por la función renal residual (FRR). En ella, la frecuencia de sesiones con las que el paciente inicia HD (una o 2 sesiones por semana) es menor que en la HD convencional (3 por semana). Dicha frecuencia aumenta (de una a 2, y de 2 a 3) con el declinar de la FRR.Metodología/diseñoDiPPI es un estudio abierto, multicéntrico, experimental, aleatorizado 1:1 y controlado con procedimiento de práctica clínica habitual, de bajo nivel de intervención y no comercial. Incluye 152 pacientes mayores de 18 años, con enfermedad renal crónica estadio 5, que inician HD como tratamiento renal sustitutivo; y la FRR, medida por aclaramiento renal de urea (KrU) es ≥4 ml/min/1,73 m2. El estudio se basa en un grupo de intervención con 76 pacientes que iniciarán HD con una sola sesión por semana (modalidad progresiva) y un grupo control con 76 pacientes que comenzarán con 3 sesiones por semana. El objetivo primario es evaluar la supervivencia y los objetivos secundarios son la morbilidad (hospitalizaciones), los parámetros clínicos habituales, la calidad de vida y la eficiencia.DiscusiónEste estudio permitirá conocer, con la máxima evidencia científica, cuántas sesiones debe recibir un paciente al inicio del tratamiento con HD, dependiendo de su FRR.RegistroRegistrado en U.S. National Institutes of Health, ClinicalTrials.gov con número NCT03239808.
       
  • Analysis of emergency Department Frequentation among patients with
           advanced CKD (chronic kidney disease): Lessons to optimize scheduled renal
           replacement therapy initiation

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Víctor Lorenzo Sellarés The decision to initiate renal replacement therapy (RRT) implies a wide margin of uncertainty. Glomerular filtration rate (GFR) tells us the magnitude of renal damage. Proteinuria indicates the speed of progression. However, nowadays more than 50% of patients are still initiating RRT hastily, and it is life threatening.HypothesisBy analysing Emergency Department (ED) frequentation and causes of a hurried initiation, we can better schedule the timing of the start of RRT.MethodRetrospective and observational study of all CKD patients in our outpatient clinic. ED frequentation and hospitalization (Hos) time were reviewed during a 12-month period. We analyzed: (1) time at risk, purpose (modality of RRT), previous comorbidity; (2) causes of ED frequentation and Hos; (3) type of initiation: “scheduled” vs. “non-scheduled”, and within these “non-planned” vs. “potentially planned”.ResultsOf a total of 267 patients (time at risk 63.987 days, 70 ± 13 years, 67% males, 38% diabetics), 68 (25%) patients came to hospital on 97 occasions: 39 only ED, 46 ED + Hos and 12 only Hos. ED frequentation was one patient every 4.3 days, and bed occupation was almost 3 per day. Main causes: 47% cardiopulmonary (1/3 heart failure), 11% vascular peripheral + cerebral, 11% gastrointestinal: 8/11 due to bleeding (all with anticoagulants/antiplatelet agents). Thirty-one (12%) patients initiated RRT: of these, 14 (45%) were scheduled (6 PD, 6 HD, and 2 living donor RTx), and 17 (55%) were not scheduled or were rushed, all with venous central catheter. Following the objectives of this study, the non-scheduled group were itemized into 2 groups: 9 non-planned (initial indication of conservative management or patient's refusal to undergo dialysis, and diverse social circumstances not controllable by the nephrologist) and 8 were considered potentially planned (6 heart failure, one gastrointestinal bleeding and one peripheral vascular complication). This last group (potentially planned), when compared with the 14 patients who started treatment in a scheduled manner, had significant differences in that they were older, with more previous cardiac events, and GFR almost double that of the other group. All of them started treatment in the ED.ConclusionThis analysis provides us with knowledge on those patients who may benefit from an earlier preparation in RRT. We suggest that patients with previous cardiac events, especially with a risk of gastrointestinal bleeding, should start the preparation for RRT even with GFR rates of 20–25 ml/min. In spite of the retrospective nature of this study, and taking into account the difficulties of carrying out clinical trials in this population, we propose this suggestion as complementary to the current recommendations for a scheduled start using this technique.ResumenLa decisión de empezar tratamiento renal sustitutivo (TRS) conlleva un amplio margen de incertidumbre. El filtrado glomerular (FG) nos dice la magnitud del daño. La proteinuria, la velocidad de progresión. A pesar de estas premisas, más del 50% de los pacientes continúan iniciando TRS de forma precipitada y con riesgo vital.HipótesisAnalizando la frecuentación de Urgencias (Urg) y las causas determinantes de un inicio precipitado, podremos programar mejor el momento de iniciar un TRS.MétodoEstudio retrospectivo, observacional, de la frecuentación de Urg y del tiempo de hospitalización (Hos) de todos los pacientes de la consulta ERCA, durante un período de 12 meses. Se analizó: 1) tiempo en riesgo, destino (modalidad de TRS), comorbilidad previa. 2) Causas de frecuentación de Urg y Hos. 3) Tipo de inicio: «programado» vs. «no programado» y, dentro de estos, «no planificables» vs. «potencialmente planificables».ResultadosDe 267 pacientes (con un tiempo en riesgo de 63.987 días; 70 ± 13 años; 67% varones; 38% diabéticos), 68 (25%) pacientes acudieron al hospital en 97 ocasiones: 39 solo Urg, 46 Urg + Hos y 12 solo Hos. La frecuentación de Urg fue de un paciente cada 4,3 días y la ocupación de camas fue de casi 3 diarias. Causas predominantes: 47% cardiopulmonar (1/3 insuficiencia cardíaca), 11% vascular periférico + cerebral, 11% digestivo: 8/11 por sangrado (todos con anticoagulantes/antiagregantes). Iniciaron TRS: 31 (12%): de estos, 14 (45%) de forma programada (6 DP, 6 HD y 2 TxR de donante vivo); 17 (55%) no programados o precipitados, todos con catéter venoso. Siguiendo los objetivos del estudio, estos últimos se desglosaron en 2 grupos: 9 no planificables (indicación inicial de manejo conservador o negativa del paciente a dializarse, y circunstancias sociales diversas no controlables por el nefrólogo) y 8 que consideramos potencialmente planificables (6 con fallo cardíaco, uno con hemorragia digestiva y uno vascular periférico). Estos últimos (potencialmente planificables), comparados con los 14 que iniciaron de forma programada, tenían significativamente mayor edad, más eventos cardíacos previos y el FG casi duplicaba al del otro grupo; todos entraron por Urg.ConclusiónEste análisis nos aporta conocimiento sobre aquellos pacientes que pueden beneficiarse de una preparación más precoz en TRS: proponemos que en los enfermos con eventos cardíacos previos, especia...
       
  • Chronic kidney disease in Spain: Prevalence and impact of accumulation of
           cardiovascular risk factors

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Manuel Gorostidi, Mercedes Sánchez-Martínez, Luis M. Ruilope, Auxiliadora Graciani, Juan J. de la Cruz, Rafael Santamaría, María D. del Pino, Pilar Guallar-Castillón, Fernando de Álvaro, Fernando Rodríguez-Artalejo, José R. Banegas BackgroundChronic kidney disease (CKD) is a public health problem worldwide. We aimed to estimate the CKD prevalence in Spain and to examine the impact of the accumulation of cardiovascular risk factors (CVRF).Material and methodsWe performed a nationwide, population-based survey evaluating 11,505 individuals representative of the Spanish adult population. Information was collected through standardized questionnaires, physical examination, and analysis of blood and urine samples in a central laboratory. CKD was graded according to current KDIGO definitions. The relationship between CKD and 10 CVRF was assessed (age, hypertension, general obesity, abdominal obesity, smoking, high LDL-cholesterol, low HDL-cholesterol, hypertriglyceridemia, diabetes and sedentary lifestyle).ResultsPrevalence of CKD was 15.1% (95% CI: 14.3–16.0%). CKD was more common in men (23.1% vs. 7.3% in women), increased with age (4.8% in 18–44 age group, 17.4% in 45–64 age group, and 37.3% in ≥65), and was more common in those with than those without cardiovascular disease (39.8% vs. 14.6%); all P 
       
  • Estimated glomerular filtration rate is an early biomarker of cardiac
           surgery-associated acute kidney injury

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Ángel Candela-Toha, María Carmen Pardo, Teresa Pérez, Alfonso Muriel, Javier Zamora BackgroundAcute kidney injury (AKI) diagnosis is still based on serum creatinine and diuresis. However, increases in creatinine are typically delayed 48 h or longer after injury. Our aim was to determine the utility of routine postoperative renal function blood tests, to predict AKI one or 2 days in advance in a cohort of cardiac surgery patients.Patients and methodsUsing a prospective database, we selected a sample of patients who had undergone major cardiac surgery between January 2002 and December 2013. The ability of the parameters to predict AKI was based on Acute Kidney Injury Network serum creatinine criteria. A cohort of 3962 cases was divided into 2 groups of similar size, one being exploratory and the other a validation sample. The exploratory group was used to show primary objectives and the validation group to confirm results. The ability to predict AKI of several kidney function parameters measured in routine postoperative blood tests, was measured with time-dependent ROC curves. The primary endpoint was time from measurement to AKI diagnosis.ResultsAKI developed in 610 (30.8%) and 623 (31.4%) patients in the exploratory and validation samples, respectively. Estimated glomerular filtration rate using the MDRD-4 equation showed the best AKI prediction capacity, with values for the AUC ROC curves between 0.700 and 0.946. We obtained different cut-off values for estimated glomerular filtration rate depending on the degree of AKI severity and on the time elapsed between surgery and parameter measurement. Results were confirmed in the validation sample.ConclusionsPostoperative estimated glomerular filtration rate using the MDRD-4 equation showed good ability to predict AKI following cardiac surgery one or 2 days in advance.ResumenAntecedentes y objetivoEl diagnóstico de insuficiencia renal aguda (IRA) todavía se basa en la creatinina sérica y la diuresis. Sin embargo, el incremento de la creatinina a menudo se retrasa 48 h o más con respecto al momento de la lesión. El objetivo de este estudio es determinar la utilidad de las pruebas analíticas de función renal habituales en el postoperatorio, para predecir la IRA con uno o 2 días de antelación, en una cohorte de pacientes intervenidos mediante cirugía cardíaca.Pacientes y métodosA partir de una base de datos prospectiva, se seleccionó una muestra de pacientes operados de cirugía cardíaca mayor, entre enero de 2002 y diciembre de 2013. La definición de IRA se basó en el criterio de la creatinina sérica utilizado por la Acute Kidney Injury Network. La cohorte de 3.962 casos se dividió en 2 grupos de tamaño similar, uno exploratorio y otro de validación. El grupo exploratorio se utilizó para demostrar los objetivos principales y el de validación para confirmar los resultados. La capacidad de predicción de la IRA, de varios parámetros de función renal medidos en la analítica postoperatoria habitual, se evaluó utilizando curvas ROC tiempo-dependientes. Como variable principal se consideró el tiempo transcurrido desde la medida del marcador hasta el diagnóstico de la IRA.ResultadosSe observaron 610 (30,8%) y 623 (31,4%) episodios de IRA en los grupos exploratorio y de validación, respectivamente. La tasa de filtrado glomerular estimada por la ecuación MDRD-4 demostró la mejor capacidad predictiva de IRA, con valores del área bajo la curva ROC entre 0,700 y 0,946. Se calcularon distintos puntos de corte para dicho parámetro, en función de la gravedad de la IRA y del tiempo transcurrido entre la cirugía y su medición. Los resultados obtenidos se confirmaron en el grupo de validación.ConclusiónLa tasa de filtrado glomerular postoperatoria, estimada por la ecuación MDRD-4, mostró una alta capacidad de predicción de IRA con uno o 2 días de antelación, en pacientes operados de cirugía cardíaca.
       
  • Calciphylaxis in patients with chronic kidney disease: A disease which is
           still bewildering and potentially fatal

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): David Cucchiari, Jose-Vicente Torregrosa Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare syndrome that typically causes skin necrosis and usually affects dialysis patients. Its pathogenesis is multifactorial and is the consequence of many factors causing ectopic calcifications in patients with chronic kidney disease, such as calcium-phosphate metabolism disorders, hyper- or hypo-parathyroidism, diabetes, obesity, systemic inflammation and the use of vitamin K antagonists, among others. From a clinical point of view, calciphylaxis may progress from painful purpura to extensive areas of skin necrosis that can potentially lead to superinfection and the death of the patient due to sepsis. Treatment is primarily based on managing the wounds, eliminating all the possible precipitating factors of ectopic calcification and administering agents which are capable of inhibiting the process of calcification.ResumenLa calcifilaxis, también denominada arteriolopatía urémica calcificante, es un síndrome raro que causa típicamente necrosis cutánea y que afecta principalmente a los pacientes en diálisis. La patogénesis es multifactorial y depende de la suma de todos los factores que producen calcificaciones ectópicas en el paciente con enfermedad renal crónica, como las alteraciones del metabolismo calcio-fósforo, el hiper o el hipoparatiroidismo, la diabetes, la obesidad, la inflamación sistémica y el uso de inhibidores de vitamina K, entre otros. Desde un punto de vista clínico, la calcifilaxis puede evolucionar desde una púrpura dolorosa hasta extensas áreas de necrosis cutánea que pueden sobreinfectarse y llegar a causar el fallecimiento del paciente por sepsis. El tratamiento se basa fundamentalmente en el manejo de las heridas, la eliminación de todos los elementos que puedan precipitar la calcificación ectópica y el uso de agentes inhibidores del proceso de calcificación.
       
  • Pharmacological interactions of phosphate binders

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Jordi Bover Sanjuán, Juan Francisco Navarro-González, M. Dolores Arenas, José-Vicente Torregrosa, Juan Tamargo Menéndez, Angel Luis Martín de Francisco, Emilio González-Parra, M. Jesús Lloret Cora, J. Emilio Sánchez Álvarez, Alejandro Martín-Malo, Pablo Molina Vila, M. Auxiliadora Bajo, Iara DaSilva Santos
       
  • Methanol poisoning caused by inhalation of solvent

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Carmen Robledo, Ramón Saracho
       
  • Influence of dietary protein intake on body composition in chronic kidney
           disease patients in stages 3–5: A cross-sectional study

    • Abstract: Publication date: November–December 2018Source: Nefrología (English Edition), Volume 38, Issue 6Author(s): Guillermina Barril, Angel Nogueira, Mar Ruperto López, Yone Castro, José Antonio Sánchez-Tomero IntroductionA controlled protein intake has shown beneficial effects to preserve renal function and nutritional status in chronic kidney disease (CKD) patients. This study aimed to analyze usual dietary protein intake and its potential contribution to body composition in CKD patients in stages 3–5.MethodCross-sectional study in 134 CKD patients in stages 3–5 (mean e-GFR: 19.4 ± 8.7 ml/min/1.73 m2; males 68.7% and primary CKD etiology was diabetes mellitus, 35.8%). Demographic, clinical and nutritional parameters were evaluated. Normalized protein nitrogen appearance (nPNA), was used as a surrogate marker of dietary protein intake. The sample was classified into three nPNA groups (Gn): G1:
       
 
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