IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.03.002

Juan F. Navarro González , Alberto Ortiz , Ana Cebrián Cuenca , Marta Moreno Barón , Lluís Segú , Belén Pimentel , Unai Aranda , Blanca López-Chicheri , Margarita Capel , Elisenda Pomares Mallol , Christian Caudron , Juan José García Sánchez , Roberto Alcázar Arroyo

Background and objective

Chronic kidney disease (CKD) is a growing health problem affecting between 10% and 15% of the Spanish population. The lack of updated projections of the evolution of the disease burden hinders the development of evidence-based health policies and interventions to optimize the management of the disease and prevent its progression. The aim of this study is to project the evolution of the clinical and economic burden of CKD in Spain between 2022 and 2027.

Materials and methods

Inside CKD uses a validated microsimulation approach to project the burden of CKD. The projection is based on a virtual population according to Spanish demographics, literature, national data registries and clinical expert opinion. Costs associated with CKD management, renal replacement therapy (RRT), cardiovascular complications and arterial comorbidities were included.

Results

In Spain, an absolute increase in the prevalence of CKD of 1% (from 10.7% to 11.7%) is expected between 2022 and 2027, corresponding to an increase from 5.14 million to 5.68 million patients in 2027. However, only one third of CKD patients would be diagnosed. Of these diagnosed patients, 3.9% will require RRT in 2027, an increase of 14.7% from 2022. A total of 654,281 accumulated deaths are expected in patients with CKD diagnosed between 2022 and 2027. The economic burden of diagnosed CKD is expected to increase by 13.8% to 4.89 billion euros in 2027, representing 5.56% of total Spanish public health expenditure in 2027 (compared to 4.88% in 2022), of which 42.5% will be allocated to RRT (2.4% of public health expenditure).

Conclusions

The Inside CKD project highlights the growing clinical, economic and social burden of CKD in Spain expected by 2027. Progression to more advanced stages with the need for RRT and associated complications represent a small proportion of the total CKD population, but contribute significantly to overall costs.

背景和目标慢性肾脏病（CKD）是一个日益严重的健康问题，影响着西班牙 10%到 15%的人口。由于缺乏对疾病负担演变的最新预测，因此无法制定以证据为基础的卫生政策和干预措施，以优化疾病管理并防止其恶化。本研究的目的是预测 2022 年至 2027 年间西班牙慢性肾脏病的临床和经济负担的演变情况。材料和方法Inside CKD 采用经过验证的微观模拟方法来预测慢性肾脏病的负担。该预测是根据西班牙人口统计学、文献、国家数据登记和临床专家意见，以虚拟人群为基础进行的。结果预计在 2022 年至 2027 年期间，西班牙的 CKD 患病率将绝对增加 1%（从 10.7% 增加到 11.7%），相应地，2027 年的患者人数将从 514 万增加到 568 万。然而，只有三分之一的慢性肾脏病患者会被确诊。在这些确诊患者中，3.9% 的患者将在 2027 年需要接受 RRT 治疗，比 2022 年增加 14.7%。预计在 2022 年至 2027 年期间，确诊的慢性肾功能衰竭患者累计死亡人数将达到 654 281 人。预计到 2027 年，确诊的 CKD 患者的经济负担将增加 13.8%，达到 48.9 亿欧元，占 2027 年西班牙公共卫生总支出的 5.56%（2022 年为 4.88%），其中 42.5% 将用于 RRT（占公共卫生支出的 2.4%）。进展到需要 RRT 的晚期阶段以及相关并发症只占 CKD 总人口的一小部分，但却大大增加了总成本。

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引用次数: 0

Renata, mi nefróloga, ¿puede la literatura infantil actuar como instrumento de sensibilización y prevención de la enfermedad renal? "雷娜塔，我的肾病医生"，儿童文学能否成为提高人们对肾病的认识和预防肾病的工具？

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.02.008

M. Dolores Ojeda Ramírez , Sergio Garcia-Marcos , Paula Manso del Real , Julia Audije-Gil , M. Dolores Arenas Jiménez

引用次数: 0

Short-term effects of dapagliflozin on biomarkers of bone and mineral metabolism in patients with diabetic kidney disease: A prospective observational study 达帕格列净对糖尿病肾病患者骨和矿物质代谢生物标志物的短期影响：前瞻性观察研究

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.06.002

Tugba Islek , Safak Mirioglu , Meltem Gursu , Rumeyza Kazancioglu , Metin Demirel , Sahabettin Selek , Omer Celal Elcioglu

Background

There is still a lack of information regarding the impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on bone and mineral metabolism in patients with diabetes and chronic kidney disease (CKD). Therefore, we aimed to investigate the effects of SGLT2i in a cohort of patients suffering from diabetic kidney disease (DKD).

Methods

In this prospective observational study, patients with type 2 diabetes and biopsy-proven diabetic nephropathy or presumptive DKD with eGFR levels ≥20 ml/min/1.73m2 and 25-OH vitamin D levels ≥20 ng/dl were included. 41 used SGLT2i (study group) and 39 continued their current treatment regimens (control group). Serum FGF-23, sclerostin, osteoprotegerin (OPG), and hydroxyproline levels were measured at baseline, 1 month and 3 months after treatment.

Results

Mean age of all patients was 67 ± 9.3 years, and 48 (60%) were female. All patients in the study group used dapagliflozin. Taking into account the renal functions at the commencement of the study, the eGFR values for the study group and the control group were 51.2 ± 15.6 and 44.6 ± 16.9 ml/min/1.73m², respectively (p = 0.01). After three months, these values were observed to be 47.4 ± 16.7 and 44.3 ± 18.8 ml/min/1.73m² (p = 0.43), respectively. At baseline, OPG levels were higher in the study group (p = 0.025) but there were no differences between the groups in terms of FGF-23 and sclerostin levels (p = 0.670 and p = 0.467, respectively). Levels of OPG, FGF-23, and sclerostin significantly decreased throughout 3 months of treatment with dapagliflozin (p < 0.001 for all). Hydroxyproline levels also declined but did not reach to statistical significance (p = 0.075). Multiple linear regression models revealed that treatment with SGLT2i was associated with the change in levels of sclerostin (β=0.303, p = 0.011) and OPG (β=0.210, p = 0.010), but not with FGF-23 (β=0.089, p = 0.150).

Conclusions

FGF-23, sclerostin and OPG levels significantly declined after treatment with dapagliflozin for 3 months.

背景关于钠-葡萄糖共转运体 2 抑制剂（SGLT2i）对糖尿病和慢性肾病（CKD）患者骨质和矿物质代谢的影响，目前仍缺乏相关信息。方法在这项前瞻性观察研究中，纳入了经活检证实患有糖尿病肾病或推测患有糖尿病肾病且 eGFR 水平≥20 ml/min/1.73m2 和 25-OH 维生素 D 水平≥20 ng/dl 的 2 型糖尿病患者。41 人使用 SGLT2i（研究组），39 人继续目前的治疗方案（对照组）。结果所有患者的平均年龄为 67 ± 9.3 岁，其中 48 人（60%）为女性。研究组所有患者均使用达帕格列净。考虑到研究开始时的肾功能，研究组和对照组的 eGFR 值分别为 51.2 ± 15.6 和 44.6 ± 16.9 毫升/分钟/1.73 平方米（p = 0.01）。三个月后，观察到这些数值分别为 47.4 ± 16.7 和 44.3 ± 18.8 毫升/分钟/1.73 平方米（p = 0.43）。基线时，研究组的 OPG 水平更高（p = 0.025），但两组的 FGF-23 和硬骨素水平没有差异（分别为 p = 0.670 和 p = 0.467）。在使用达帕格列净治疗的 3 个月期间，OPG、FGF-23 和硬骨蛋白的水平显著下降（均为 p < 0.001）。羟脯氨酸水平也有所下降，但未达到统计学意义（p = 0.075）。多元线性回归模型显示，SGLT2i治疗与硬骨生成素（β=0.303，p=0.011）和OPG（β=0.210，p=0.010）水平的变化有关，但与FGF-23（β=0.089，p=0.150）无关。

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引用次数: 0

Uso de los agonistas del receptor del péptido similar al glucagón tipo 1 en pacientes trasplantados renales 胰高血糖素样肽1受体激动剂在肾移植患者中的应用

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2023.06.010

Luis Alberto Vigara , Florentino Villanego , Cristhian Orellana , Myriam Eady , María Gabriela Sánchez , Marta Alonso , María Belén García , José Manuel Amaro , Teresa García , Auxiliadora Mazuecos

Introduction

In kidney transplant (KT) recipients, diabetes mellitus (DM) are associated with an increased mortality and a poorer graft survival. Glucagon-like peptide 1 receptor agonists (GLP1-RA) have demonstrated cardiovascular and renal benefits in the general population. However, there is lacking evidence in KT recipients.

Objective

To analyze the efficacy and safety of glucagon-like peptide 1 receptor GLP1-RA in a cohort of KT recipients.

Methods

Multicenter retrospective cohort study of KT patients with DM who started subcutaneous GLP1-RA in three hospitals in the province of Cádiz between February 2016 and July 2022. Estimated glomerular filtration rate (eGFR), proteinuria, and weight at baseline and after 6 and 12 months were collected. We analyzed glycemic control, blood pressure, lipid profile, and doses and trough levels of tacrolimus. We document episodes of acute rejection (AR), de novo donor-specific antibodies (dnDSA), and adverse effects.

Results

During this period, 96 KT with DM started treatment with GLP1-RA, of which 84 had a minimum follow-up of 6 months and 61 were followed for 12 months. A significant reduction was observed in proteinuria (−19.1 mg/g, P = .000; −46.6 mg/g, P = .000), weight (−3.6 kg, P = .000; −3.6 kg, P = .000), glycosylated hemoglobin (−0.7%, P = .000; −0.9%, P = .000), systolic blood pressure (−7.5 mmHg, P = .013; −7.3 mmHg, P = .004), total cholesterol (−11.5 mg/dl, P = .001; −15.6 mg/dl, P = .002) and LDL cholesterol (−9.2 mg/dl, P = .002; −16.8 mg/dl, P = .000) at 6 months and 1 year of follow-up. The eGFR remained stable and the dose and trough levels of tacrolimus did not change. No episodes of AR or development of dnDSA were observed during follow-up.

Conclusions

GLP1-RA in KT patients can be a safe and effective option for the management of DM in KT.

导言在肾移植（KT）受者中，糖尿病（DM）与死亡率增加和移植物存活率降低有关。胰高血糖素样肽 1 受体激动剂（GLP1-RA）已在普通人群中证实对心血管和肾脏有益。方法对 2016 年 2 月至 2022 年 7 月期间在加的斯省三家医院开始皮下注射 GLP1-RA 的 KT 患者进行多中心回顾性队列研究。我们收集了基线时以及6个月和12个月后的估计肾小球滤过率（eGFR）、蛋白尿和体重。我们分析了血糖控制、血压、血脂、他克莫司的剂量和谷值水平。我们记录了急性排斥反应（AR）、新供体特异性抗体（dnDSA）和不良反应的发生情况。结果在此期间，96 名患有 DM 的 KT 开始接受 GLP1-RA 治疗，其中 84 人接受了至少 6 个月的随访，61 人接受了 12 个月的随访。蛋白尿（-19.1 mg/g，P = .000；-46.6 mg/g，P = .000）、体重（-3.6 kg，P = .000；-3.6 kg，P = .000）、糖化血红蛋白（-0.7%，P = .000；-0.9%，P = .000）、收缩压（-7.5毫米汞柱，P = .013；-7.3毫米汞柱，P = .004）、总胆固醇（-11.5毫克/分升，P = .001；-15.6毫克/分升，P = .002）和低密度脂蛋白胆固醇（-9.2毫克/分升，P = .002；-16.8毫克/分升，P = .000）。eGFR 保持稳定，他克莫司的剂量和谷值水平没有变化。结论 GLP1-RA 在 KT 患者中的应用是治疗 KT DM 的一种安全有效的选择。

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引用次数: 0

Evaluación de eventos clínicos y costes asociados a la adición de dapagliflozina al tratamiento de la enfermedad renal crónica: análisis de compensación de costes 评估在慢性肾病治疗中添加达帕格列净的相关临床事件和成本：成本权衡分析

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.05.010

Juan Francisco Navarro-González , Alberto Ortiz , Ana Cebrián Cuenca , Lluís Segú , Belén Pimentel , Unai Aranda , Blanca Lopez-Chicheri , Margarita Capel , Elisenda Pomares Mallol , Christian Caudron , Juan José García Sánchez , Roberto Alcázar Arroyo

Background and objectives

Chronic kidney disease (CKD) is a serious health problem with an increasing clinical, social and economic impact in advanced stages. Dapagliflozin is a sodium-glucose cotransporter-2 inhibitor that reduces the risk of CKD progression, in addition to provide cardiovascular benefits and reduce all-cause mortality. The aim of this study was to determine the short-term clinical and economic impact of dapagliflozin as an add-on to renin-angiotensin-aldosterone system inhibitors (RAASi) standard therapy for CKD in Spain.

Materials and methods

A cost-offset model was used to compare the costs of clinical events and pharmacological per 100,000 CKD patients in a virtual cohort treated with dapagliflozin added to RAASi standard therapy versus RAASi standard therapy alone. Renal (progression to renal failure and acute kidney injury), cardiovascular (hospitalisation for heart failure [HF]), and all-cause mortality events were assessed. The incidence of clinical events by treatment arm was obtained from the DAPA-CKD study, and costs were obtained from national databases and the literature.

Results

Over 3 years, treatment with dapagliflozin would reduce progression to renal failure (−33%; 7,221 vs. 10,767), hospitalisation for HF (−49%; 2,370 vs. 4,683) and acute kidney injury (−29%; 4,110 vs. 5,819). The savings associated with this reduction in events was €258 million per 100,000 patients, of which 63.4% is due to the avoidance of dialysis for renal failure. Considering the event and pharmacological treatment costs, the total net savings were estimated at €158 million per 100,000 patients.

Conclusions

Delaying progression of CKD and reducing the incidence of clinical events thanks to the treatment with dapagliflozin could generate savings for the Spanish National Health System, even when pharmacological costs are taken into account.

背景和目的慢性肾脏病（CKD）是一个严重的健康问题，晚期患者的临床、社会和经济影响越来越大。达帕格列净是一种钠-葡萄糖共转运体-2抑制剂，可降低慢性肾脏病进展的风险，此外还可为心血管带来益处并降低全因死亡率。本研究旨在确定达帕格列净作为肾素-血管紧张素-醛固酮系统抑制剂（RAASi）标准疗法的附加疗法对西班牙 CKD 患者的短期临床和经济影响。材料和方法采用成本抵消模型，比较虚拟队列中每 10 万名接受达帕格列净附加 RAASi 标准疗法与单独 RAASi 标准疗法治疗的 CKD 患者的临床事件和药物治疗成本。对肾脏（进展为肾衰竭和急性肾损伤）、心血管（因心衰 [HF] 而住院）和全因死亡率事件进行了评估。各治疗组的临床事件发生率来自 DAPA-CKD 研究，费用来自国家数据库和文献。结果在 3 年内，使用达帕格列净治疗可减少肾衰竭进展（-33%；7221 对 10767）、心力衰竭住院（-49%；2370 对 4683）和急性肾损伤（-29%；4110 对 5819）。每 10 万名患者中，因事件减少而节省的费用为 2.58 亿欧元，其中 63.4% 是由于避免了因肾衰竭而进行透析。结论达帕格列净治疗可延缓慢性肾脏病的进展并降低临床事件的发生率，即使考虑到药物治疗成本，也可为西班牙国家卫生系统节省开支。

{"title":"Evaluación de eventos clínicos y costes asociados a la adición de dapagliflozina al tratamiento de la enfermedad renal crónica: análisis de compensación de costes","authors":"Juan Francisco Navarro-González , Alberto Ortiz , Ana Cebrián Cuenca , Lluís Segú , Belén Pimentel , Unai Aranda , Blanca Lopez-Chicheri , Margarita Capel , Elisenda Pomares Mallol , Christian Caudron , Juan José García Sánchez , Roberto Alcázar Arroyo","doi":"10.1016/j.nefro.2024.05.010","DOIUrl":"10.1016/j.nefro.2024.05.010","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Chronic kidney disease (CKD) is a serious health problem with an increasing clinical, social and economic impact in advanced stages. Dapagliflozin is a sodium-glucose cotransporter-2 inhibitor that reduces the risk of CKD progression, in addition to provide cardiovascular benefits and reduce all-cause mortality. The aim of this study was to determine the short-term clinical and economic impact of dapagliflozin as an add-on to renin-angiotensin-aldosterone system inhibitors (RAASi) standard therapy for CKD in Spain.</div></div><div><h3>Materials and methods</h3><div>A cost-offset model was used to compare the costs of clinical events and pharmacological per 100,000 CKD patients in a virtual cohort treated with dapagliflozin added to RAASi standard therapy versus RAASi standard therapy alone. Renal (progression to renal failure and acute kidney injury), cardiovascular (hospitalisation for heart failure [HF]), and all-cause mortality events were assessed. The incidence of clinical events by treatment arm was obtained from the DAPA-CKD study, and costs were obtained from national databases and the literature.</div></div><div><h3>Results</h3><div>Over 3 years, treatment with dapagliflozin would reduce progression to renal failure (−33%; 7,221 vs. 10,767), hospitalisation for HF (−49%; 2,370 vs. 4,683) and acute kidney injury (−29%; 4,110 vs. 5,819). The savings associated with this reduction in events was €258 million per 100,000 patients, of which 63.4% is due to the avoidance of dialysis for renal failure. Considering the event and pharmacological treatment costs, the total net savings were estimated at €158 million per 100,000 patients.</div></div><div><h3>Conclusions</h3><div>Delaying progression of CKD and reducing the incidence of clinical events thanks to the treatment with dapagliflozin could generate savings for the Spanish National Health System, even when pharmacological costs are taken into account.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 857-867"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141135946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectivity and safety profile of tenapanor, a sodium-hydrogen exchanger isoform 3 inhibitor, as an innovative treatment for hyperphosphatemia in chronic kidney disease: A systematic review of clinical studies 钠-氢交换机同工酶 3 抑制剂 Tenapanor 作为慢性肾病高磷血症创新疗法的有效性和安全性概况：临床研究系统回顾

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.06.007

William Suciangto , Haerani Rasyid , Anastasya Angelica Vicente , Winny Suciangto

Background

Chronic kidney disease (CKD) is a major global health problem. Hyperphosphatemia is frequent in CKD and a reason for increased morbidity and mortality as it generates hyperparathyroidism, high fibroblast growth factor 23 (FGF23), and hypocalcemia. Available hyperphosphatemia therapies still have limitations, including risk of metal overload, cardiovascular calcification, and systemic adverse effects (AEs). Tenapanor is a new hyperphosphatemia treatment in CKD with sodium-hydrogen exchanger isoform 3 (NHE3) inhibition mechanism and low systemic AEs.

Objectives

Discovering the effectivity and safety of tenapanor as hyperphosphatemia management in CKD.

Method

Literature searching is performed by using “pubmed” and “science direct” with “tenapanor”, “chronic kidney disease”, and “hyperphosphatemia” as keywords. The literatures were selected using PRISMA algorithm version 2020. Literature was screened based on Population, Intervention, Comparison, and Outcome (PICO) criteria which are: CKD patients requiring dialysis as population, tenapanor or its combination with dialysis or phosphate binders as intervention, placebo or other phosphate binders without tenapanor as comparison, and serum phosphate, safety profile, and other pleiotropic benefits related to hyperphosphatemia management as the outcome. The included studies then assessed for risk of bias and qualitatively reviewed.

Outcome

Tenapanor was able to reduce serum phosphate, generally in a dose-dependent manner. Tenapanor also suppressed FGF23 and parathyroid hormone, probably due to decreased serum phosphate. The frequent AEs were transient mild-to-moderate diarrhea in a dose-dependent manner. Tenapanor was generally well-tolerated with low systemic AEs due to its non-calcium, metal-free, and low-absorbed properties.

Conclusion

Tenapanor is an effective and safe option for hyperphosphatemia management in CKD.

背景慢性肾脏病（CKD）是全球主要的健康问题。高磷血症是慢性肾脏病的常见病，也是发病率和死亡率增加的原因之一，因为它会导致甲状旁腺功能亢进、高成纤维细胞生长因子 23 (FGF23) 和低钙血症。现有的高磷血症疗法仍有其局限性，包括金属超载风险、心血管钙化和全身不良反应（AEs）。方法以 "tenapanor"、"慢性肾脏病 "和 "高磷血症 "为关键词，通过 "pubmed "和 "science direct "进行文献检索。采用 2020 版 PRISMA 算法筛选文献。根据人群、干预、比较和结果（PICO）标准对文献进行筛选：需要透析的 CKD 患者为研究对象，替那帕诺或其与透析或磷酸盐结合剂的组合为干预措施，安慰剂或其他磷酸盐结合剂（不含替那帕诺）为对比措施，血清磷酸盐、安全性以及与高磷酸盐血症治疗相关的其他多效应为研究结果。然后对纳入的研究进行了偏倚风险评估和定性审查。结果替那帕诺能降低血清磷酸盐，一般呈剂量依赖性。特纳帕诺还能抑制 FGF23 和甲状旁腺激素，这可能是由于血清磷酸盐降低所致。常见的不良反应是一过性轻度至中度腹泻，与剂量有关。由于特纳帕诺不含钙、不含金属且吸收率低，因此总体上耐受性良好，全身AEs较低。

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引用次数: 0

El aluvión migratorio en hemodiálisis 血液透析中的迁徙洪流

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.05.003

Claudia Yuste Lozano

引用次数: 0

¿Es útil medir el grosor de la grasa peri-pararrenal mediante ultrasonografía como marcador de riesgo cardiovascular en pacientes obesos con enfermedad renal crónica? 用超声波测量肥胖慢性肾病患者肾周围脂肪厚度作为心血管风险的标志有用吗？

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.08.001

José C. De La Flor Merino , Carlos Narváez Mejía , Adriana Puente García , Jonay Pantoja Pérez , Michael Cieza Terrones , Maite Rivera Gorrín

引用次数: 0

La definición del síndrome cardiovascular-reno-metabólico (cardiovascular-kidney-metabolic syndrome) y su papel en la prevención, estatificación del riesgo y tratamiento. Una oportunidad para la Nefrología 心血管-肾脏-代谢综合征的定义及其在预防、风险统计和治疗中的作用。肾脏病学的机遇

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.05.001

Aleix Cases , Jose Jesus Broseta , Maria Marqués , Secundino Cigarrán , Juan Carlos Julián , Roberto Alcázar , Alberto Ortiz

The recent conceptualization of the cardiovascular-kidney-metabolic (CKM) syndrome by the American Heart Association (AHA) opens an opportunity for a multidisciplinary and lifelong approach in the risk stratification, early prevention, and treatment of the vicious circle generated by the interaction of cardiovascular, renal and metabolic risk factors and aggravated by the development of cardiovascular diseases (including their full spectrum: heart failure, atrial fibrillation, coronary heart disease, stroke, and peripheral arterial disease), chronic kidney disease or type 2 diabetes mellitus, with the excess or dysfunctional adiposity as the trigger. Three publications offer the rational basis of a conceptual decalogue and action plan and a new cardiovascular risk stratification equation since the age of 30 that includes measures of renal function/damage, among others, to promote effective cardiovascular, renal, and metabolic prevention. In Spain, we must leverage this momentum to adapt these new concepts to our reality with greater and improved collaboration between primary care and the specialties involved in CKM syndrome, including the formation of multidisciplinary units for the optimal management using a patient-centred approach.

美国心脏协会（AHA）最近提出了心血管-肾脏-代谢综合征（CKM）的概念，这为采取多学科和终生方法进行风险分层、早期预防和治疗提供了机会，这种恶性循环是由心血管、肾脏和代谢风险因素相互作用产生的，并因心血管疾病（包括各种心血管疾病：心力衰竭、心房颤动、冠心病、中风和外周动脉疾病）的发展而加剧：心力衰竭、心房颤动、冠心病、中风和外周动脉疾病）、慢性肾病或 2 型糖尿病，脂肪过多或功能失调是其诱因。三份出版物为概念性十诫和行动计划提供了合理依据，并提出了自 30 岁起的心血管风险分层新方程，其中包括肾功能/肾损伤等指标，以促进心血管、肾脏和新陈代谢的有效预防。在西班牙，我们必须利用这一势头，将这些新概念与我们的现实情况相结合，加强和改善初级保健与 CKM 综合征相关专科之间的合作，包括组建多学科小组，采用以患者为中心的方法进行优化管理。

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引用次数: 0

Estudio de la asociación de marcadores de rigidez arterial central y periférica con la función renal en pacientes con hipertensión arterial, diabetes mellitus y enfermedad renal crónica 研究高血压、糖尿病和慢性肾病患者中央和外周动脉僵化指标与肾功能的关系。

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2024-11-01 DOI: 10.1016/j.nefro.2024.05.005

Jary Perelló Martínez , Alfredo Michán Doña , Rafael Santamaría Olmo , Juan Carlos Hidalgo Santiago , Josefina Gálvez Moral , Pablo Gómez-Fernández

<div><h3>Rationale and objectives</h3><div>Increased aortic or central arterial stiffness (CAS) is a major factor in cardiovascular morbidity and mortality in patients with vascular risk factors. Decreased glomerular filtration rate (GFR) and increased urinary albumin excretion (uALB) are associated with lethal and non-lethal cardiovascular events. The pathophysiological mechanisms of this association are not fully defined.</div><div>The aim of this study was: 1.- To analyze the CAS, comparing several markers, in subjects with arterial hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD) and their combination. 2.- To study the possible association of CAS with renal dysfunction (decrease in GFR and increase in uALB).</div></div><div><h3>Material and methods</h3><div>A total of 286 subjects were included, divided into several groups: Control (n: 38); HTN (n:51); DM without CKD (n:26); CKD without DM (n:77); CKD with DM (n:94). Several indices obtained by applanation tonometry were used to determine the CAS: carotid-femoral pulse velocity (VP<sub><strong>c-f</strong></sub>); central pulse pressure (cPP); augmentation index standardized to a cardiac frequency of 75 l/min (IA<sub><strong>75</strong></sub>); peripheral / aortic arterial stiffness gradient (ASG<sub>p-a</sub>). As a marker of peripheral arterial stiffness, the carotid-radial pulse velocity (PV<sub>c-r</sub>) was determined. The ASG<sub>p-a</sub> was calculated from the PV<sub>c-r</sub> /PV<sub>c-f</sub> ratio. The subendocardial viability index (iBuckberg) was obtained from the aortic pulse wave.</div><div>Multiple regression, binary logistic regression, and multinomial regression were used to study the association between arterial stiffness markers and renal function.</div></div><div><h3>Results</h3><div>The adjusted values of the PV<sub>c-f</sub> [(median (interquartile range) (m/sec)] were significantly higher in subjects with DM [(9 (1.2)], CKD [(9.4 (0.7)] and DM with CKD [(10.9 (0.7)] than in the control group [(8.2 (1.3)] and group with HTN [(8.3 (0.9)], (p:0.001). Patients with DM with CKD had higher PV<sub><strong>c-f</strong></sub> values than all other groups (p: 0.001). The ASG<sub><strong>p-a</strong></sub> of the patients was significantly lower than that of the controls, and the group with DM with CKD had significantly lower values than the other groups. The cPP in the DM with CKD group was significantly higher than in the other groups. All patients had an AI<sub>75</sub> higher than the control group.</div><div>When all aortic stiffness markers were introduced together in the regression, PV <sub><strong>c-f</strong></sub> was the only one that, after multivariate adjustment, was independently and inversely associated with GFR (β; –4, p:0.001) and predicted the presence of GFR decrease (< 60mL/min/1.73 m<sup>2</sup>), [(OR (95%CI): 1.50 (1.17-1.92; p:0.001]. The PV<sub><strong>c-f</strong></sub> was the only index directly associated with

理由和目标主动脉或中心动脉僵化（CAS）增加是有血管风险因素的患者心血管发病率和死亡率的主要因素。肾小球滤过率（GFR）降低和尿白蛋白排泄量（uALB）增加与致命性和非致命性心血管事件有关。本研究的目的是：1.- 通过比较动脉高血压（HTN）、糖尿病（DM）、慢性肾脏病（CKD）及其合并症受试者的几种标志物，分析 CAS。2.- 研究 CAS 与肾功能障碍（GFR 下降和 uALB 升高）之间可能存在的关联：对照组（38 人）；高血压组（51 人）；无 CKD 的 DM 组（26 人）；无 DM 的 CKD 组（77 人）；有 DM 的 CKD 组（94 人）。通过眼压测量法获得的几项指数用于确定 CAS：颈动脉-股动脉脉搏速度（VPc-f）；中心脉压（cPP）；以 75 升/分钟的心率为标准的增强指数（IA75）；外周/主动脉动脉僵化梯度（ASGp-a）。作为外周动脉僵化的标志，颈动脉-桡动脉脉搏速度（PVc-r）被测定出来。根据 PVc-r /PVc-f 的比率计算 ASGp-a。多元回归、二元逻辑回归和多项式回归用于研究动脉僵化指标与肾功能之间的关系。结果 DM患者[（9（1.2）]、CKD患者[（9.4（0.7）]和DM伴CKD患者[（10.9（0.7）]的PVc-f调整值[（中位数（四分位距）（米/秒）]明显高于对照组[（8.2（1.3）]和HTN组[（8.3（0.9）]，（P：0.001）。糖尿病合并慢性肾脏病患者的 PVc-f 值高于所有其他组别（P：0.001）。患者的 ASGp-a 值明显低于对照组，DM 伴 CKD 组的 ASGp-a 值明显低于其他组。糖尿病合并慢性肾脏病组的 cPP 明显高于其他组。所有患者的 AI75 均高于对照组。当所有主动脉僵化指标一起引入回归时，PV c-f 是唯一一个经多变量调整后与 GFR 呈独立反相关的指标（β; -4, p:0.001），并可预测 GFR 是否下降（< 60 mL/min/1.73 m2），[（OR (95%CI): 1.50 (1.17-1.92; p:0.001]。PVc-f 是唯一与白蛋白尿直接相关的指数（β：0.15，p：0.02），并可预测是否存在异常白蛋白尿（> 30 mg/g）[（OR；1.66（1.25-2.20），p：0.001）]。多项式回归证实，PVc-f 是 GFR 和 uALB 的重要决定因素。多项式回归证实，PVc-f 是 GFR 和 uALB 的重要决定因素。另一方面，PVc-f 的增加和 DM 的存在对白蛋白尿的程度有显著影响。当糖尿病和慢性肾脏病同时存在时，主动脉僵硬度增加的幅度更大。主动脉僵硬度的增加与肾小球滤过率成反比，与尿量胆固醇直接相关，并可预测肾小球滤过率下降和尿量胆固醇异常。VPc-f 是主动脉僵化参数中与肾功能异常关系最密切的参数。主动脉僵化增加可能是肾功能不全与心血管事件相关联的病理机制之一。

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