Nefrologia最新文献_第10页

Hacia una disminución de la negativa de los pacientes a la realización de fístula arteriovenosa: Nuevas herramientas y nuevos actores en el equipo interdisciplinar del acceso vascular. Presentación del proyecto ERCAV 减少患者对动脉静脉瘘的拒绝：跨学科血管通路团队的新工具和新参与者。ERCAV项目介绍

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-03-01 DOI: 10.1016/j.nefro.2024.11.004

Florentina Rosique López , M. Luz Sánchez-Tocino , David Hernán Gascueña , José Luis Santos-Ascarza Bacariza , Leonor Andúgar Rocamora , Daniel Gallego Zurro , Juan Bernardo Cabezuelo Romero , Mario Prieto Velasco , Adoración Martínez Losa , Fernando Hadad-Arrascue , Laura Martínez Alarcón , Diana Manzano Sánchez , Esperanza Melero Rubio , María López Picasso , Aitana Hernández , Sandra Rubio Paez , Ramón Roca-Tey , José Ibeas López , María Dolores Arenas , Grupo Español Mutildisciplinar del Acceso Vascular (GEMAV), GTAVSEN (Grupo de Trabajo del Acceso Vascular de la S.E.N.), Grupo de Trabajo de ERCA (Grupo de Trabajo de Enfermedad Renal Crónica Avanzada), Federación ALCER (Federación Nacional de Asociaciones para la lucha contra las enfermedades del riñón)

引用次数: 0

Escombroidosis y bacteriemia por Raoultella ornithinolytica en paciente trasplantado renal: a propósito de un caso Raoultella ornithinolytica在肾移植患者中的结石和细菌性血症：一个案例

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-03-01 DOI: 10.1016/j.nefro.2024.11.005

Sofía López San Román , Eva López Melero , Ángela Rey Cárdenas , Nerea Prieto Domínguez , Enrique Gruss Vergara

引用次数: 0

Enfermedad renal diabética y polimorfismos de los genes ELMO1 y AGTR1: revisión sistemática 糖尿病肾病与ELMO1和AGTR1基因多态性：系统综述

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-03-01 DOI: 10.1016/j.nefro.2024.10.001

Yuliana Martínez-Nava , María Camila Ogaz-Escarpita , Sandra Alicia Reza-López , Irene Leal-Berumen

Background

Diabetic kidney disease (DKD) is one of the main complications of diabetes, the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. The etiopathogenesis of DKD is complex and multifactorial; recently, genetic susceptibility has gained relevance since certain ethnicities, such as Native Americans and Mexican Americans, have a higher risk of developing this disease. Numerous studies have described that single nucleotide polymorphisms (SNPs), including those for ELMO1 and AGTR1 genes, could be associated with DKD.

Objective

To carry out a systematic review of the scientific literature on the association of SNPs of the ELMO1 and AGTR1 gene with DKD in adult patients with type 2 diabetes mellitus (T2D).

Methods

Systematic review in PubMed, Google Scholar, Worldwide Science, and Science Direct databases. The selection of publications was carried out following the guidelines proposed by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses). Original articles that reported results in the adult population with T2D were included. Information about the allelic and genotypic frequencies of the SNPs and their association with DKD was obtained.

Results

The polymorphisms most frequently associated with a DKD higher risk were rs741301, rs1345365, and rs10951509 for the ELMO1 gene, whereas the rs5186 and rs388915 for the AGTR1 gene.

Conclusion

The risk of developing DKD depends on several factors, including the genetic susceptibility conferred by the ELMO1 and AGTR1 gene polymorphisms, without ignoring the patient's lifestyle and environmental factors. The studies about these polymorphisms’ association with DKD will allow a better understanding of non-modifiable risk factors for developing this disease and recognize the differences between different studied ethnicities, which would allow faster detection of patients with T2D susceptible to developing DKD, become early markers of kidney damage, as well as implementing preventive strategies on the most susceptible ethnicities.

糖尿病肾病（DKD）是糖尿病的主要并发症之一，是世界范围内慢性肾脏疾病（CKD）和终末期肾脏疾病（ESRD）的主要病因。DKD的发病机制复杂，多因素；最近，遗传易感性已经获得了相关性，因为某些种族，如美洲原住民和墨西哥裔美国人，患这种疾病的风险更高。大量研究表明，包括ELMO1和AGTR1基因在内的单核苷酸多态性（snp）可能与DKD有关。目的对成人2型糖尿病（T2D）患者ELMO1和AGTR1基因snp与DKD相关性的科学文献进行系统综述。方法系统回顾PubMed、b谷歌Scholar、Worldwide Science和Science Direct数据库。出版物的选择遵循PRISMA（系统评价和Meta分析首选报告项目）提出的指南。纳入了报道成人T2D患者结果的原始文章。获得了snp的等位基因和基因型频率及其与DKD的关联信息。结果与DKD高风险相关最多的多态性是ELMO1基因的rs741301、rs1345365和rs10951509，而AGTR1基因的rss5186和rs388915。结论发生DKD的风险取决于多种因素，包括ELMO1和AGTR1基因多态性所带来的遗传易感性，但不能忽视患者的生活方式和环境因素。关于这些多态性与DKD关联的研究将使我们更好地了解发生这种疾病的不可改变的危险因素，并认识到不同研究种族之间的差异，这将使我们更快地发现易发生DKD的T2D患者，成为肾脏损害的早期标志，并对最易感的种族实施预防策略。

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引用次数: 0

Oxidative stress and inflammation on metabolic abnormalities and renal involvement in prediabetic subjects across Europe 氧化应激和炎症对欧洲糖尿病前期受试者代谢异常和肾脏受累的影响

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-03-01 DOI: 10.1016/j.nefro.2024.10.003

Sebastián Mas-Fontao , Esther Civantos , Nisa Boukichou-Abdelkader , Manuel Soto-Catalan , Marta Romeo-Colas , Arantxa Marco , Carmen Gomez-Guerrero , Juan Antonio Moreno , Jaakko Tuomilehto , Rafael Gabriel , Jesús Egido , on behalf of ePREDICE investigators

Background

Studying the mechanisms involved in the transition from prediabetes to diabetes and its associated complications, such as kidney disease, is a growing challenge. This study focuses on identifying valuable biomarkers for the early detection of kidney damage, evaluating molecules associated with oxidative stress and inflammation in prediabetic individuals across Europe.

Methods

In plasma samples from individuals with prediabetes included in the ePREDICE study, we determined molecules related to oxidative stress (advance oxidative protein products-AOPP) and inflammatory biomarkers (C-reactive protein – CRP; Interleukin 6 – IL-6), and correlated them with anthropometric and biochemical data, assessing their potential for the early diagnosis of renal involvement.

Results

Among the 967 people with prediabetes, 94 presented some sign of renal impairment such as albuminuria, hyperfiltration or hypofiltration. Significant variations were identified between oxidative stress and inflammatory biomarkers (upper and lower quartiles of AOPP, CRP and IL6), and parameters associated with blood pressure, glucose metabolism, lipid profile, and fatty liver index. In particular, both types of biomarkers were associated with components of the metabolic syndrome. There were significant associations between AOPP and CRP, and the presence of albuminuria, but not with renal function. Overall, CRP was a better biomarker than IL-6 for most of the parameters studied.

Conclusion

These results highlight the important associations of oxidative stress and inflammation with metabolic abnormalities linked to the prediabetic state and its complications such as fatty liver and renal involvement. Although these results need to be confirmed, our study suggests that AOPP and CRP could be simple biomarkers of interest in predicting the risk of loss of renal function in people with prediabetes.

研究前驱糖尿病向糖尿病及其相关并发症（如肾脏疾病）转变的机制是一个越来越大的挑战。这项研究的重点是确定早期检测肾损伤的有价值的生物标志物，评估欧洲糖尿病前期个体中与氧化应激和炎症相关的分子。方法在ePREDICE研究中纳入的糖尿病前期患者的血浆样本中，我们检测了与氧化应激相关的分子（高级氧化蛋白产物- aopp）和炎症生物标志物(c -反应蛋白- CRP；白细胞介素6 - IL-6)，并将其与人体测量和生化数据相关联，评估其早期诊断肾脏受累的潜力。结果967例糖尿病前期患者中，94例出现蛋白尿、高滤过或低滤过等肾损害征象。氧化应激和炎症生物标志物（AOPP、CRP和IL6的上下四分位数）以及与血压、葡萄糖代谢、脂质谱和脂肪肝指数相关的参数之间存在显著差异。特别是，这两种类型的生物标志物都与代谢综合征的组成部分有关。AOPP和CRP与蛋白尿存在有显著相关性，但与肾功能无显著相关性。总的来说，在研究的大多数参数中，CRP是比IL-6更好的生物标志物。结论这些结果强调了氧化应激和炎症与糖尿病前期代谢异常及其并发症（如脂肪肝和肾脏受累）的重要关联。虽然这些结果还有待证实，但我们的研究表明，AOPP和CRP可能是预测糖尿病前期患者肾功能丧失风险的简单生物标志物。

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引用次数: 0

Clinicopathological characteristics and outcomes of patients with unexplained renal impairment: A single center study 不明原因肾损害患者的临床病理特征和预后：单中心研究

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-03-01 DOI: 10.1016/j.nefro.2024.10.006

Radwa A. Ellisy , Effat A. Tony , Wesam Ismail , Rabab Radi , Mohamed Ismail Seddik , Essam M. Abdel Aziz

Background

Chronic kidney disease (CKD) is a growing health problem. About 20% of CKD patients have undetermined causes. Data describing histopathological patterns of unexplained impaired kidney functions in Egypt are lacking. We aimed to identify the clinicopathological characteristics and short-term outcomes of adult cases with unexplained impaired kidney functions.

Methods

We conducted a prospective study in Assiut University Hospital from August 2018 to May 2022. It included patients with unexplained elevated serum creatinine (serum creatinine > 115 μmol/L) who underwent renal biopsies. Descriptive statistics were used to summarize data on patient demographics, histopathological patterns, and outcomes after three months. Clinical trial registration number: NCT03586531.

Results

Overall, 210 native renal biopsies were included in the analysis. Glomerular diseases were the most common pathological finding (n = 88, 44.9%), amyloidosis and FSGS were the most prevalent glomerular pathology (15.2%, 14.3%, respectively). Chronic kidney disease of unknown etiology (CKDu) was diagnosed in 8.1% of the cases; histology suggestive of genetic origin was found in 2.5%, and LECT amyloidosis was found in 3.8% of the cases. Poor outcomes were observed in 43.6% of the patients i.e., renal replacement therapy or death. Treatment strategies were changed based on the biopsy findings in 86 patients (40%).

Conclusion

Amyloidosis and FSGS were the most common causes of unexplained renal impairment. CKDu is not uncommon in Egypt, and more preventive measures are needed. This study supports the irreplaceable role of renal biopsy in disease diagnosis, treatment decisions, and predicting prognosis even in advanced stages.

慢性肾脏疾病（CKD）是一个日益严重的健康问题。大约20%的CKD患者病因不明。缺乏描述埃及不明原因肾功能受损的组织病理学模式的数据。我们的目的是确定临床病理特征和短期预后的成人病例不明原因的肾功能受损。方法于2018年8月至2022年5月在阿西尤特大学医院进行前瞻性研究。其中包括原因不明的血清肌酐升高(血清肌酐>；115 μmol/L)，行肾活检。描述性统计用于总结三个月后患者人口统计学、组织病理学模式和结果的数据。临床试验注册号：NCT03586531。结果总共有210例本地肾活检纳入分析。肾小球疾病是最常见的病理表现（n = 88, 44.9%），淀粉样变和FSGS是最常见的肾小球病理（分别为15.2%,14.3%）。8.1%的病例诊断为病因不明的慢性肾病（CKDu）；2.5%的组织学提示遗传起源，3.8%的病例发现LECT淀粉样变。43.6%的患者预后不良，即肾替代治疗或死亡。根据86例（40%）患者的活检结果改变治疗策略。结论淀粉样变和FSGS是导致不明原因肾功能损害最常见的原因。CKDu在埃及并不罕见，需要更多的预防措施。本研究支持肾活检在疾病诊断、治疗决策和预测晚期预后中不可替代的作用。

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引用次数: 0

Evidence for the use of a nonsteroidal mineralocorticoid receptor antagonist for the treatment of chronic kidney disease 使用非甾体矿皮质激素受体拮抗剂治疗慢性肾病的证据

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-03-01 DOI: 10.1016/j.nefro.2024.10.004

Mariana Morais David Pliças , Bernardo Marques da Silva , Edgar Avito Fernandes de Almeida

Introduction and objectives

Chronic kidney disease morbimortality drives the development of new drugs. This work summarizes the evidence on the use of non-steroidal mineralocorticoid receptor antagonists on chronic kidney disease.

Materials and methods

A search was performed on PubMed and ClinicalTrials.gov using relevant keywords for clinical trials and observational studies, finished or ongoing, from 2019 to 2023.

Results

Finerenone is currently approved for diabetic kidney disease with albuminuria, with results from two phase three trials, presenting satisfactory results on renal and cardiovascular outcomes and an appropriate safety profile, namely regarding potassium balance. Regarding nondiabetic kidney disease, combining sodium glucose transport protein-2 inhibitors and finerenone points toward reliable results, although these came from non-placebo-controlled trials. An ongoing phase three trial is assessing finerenone efficacy and safety on nondiabetic chronic kidney disease. Esaxerenone is approved for diabetic nephropathies and hypertension in Japan, based on two phase three clinical trials. These trials’ external validity is compromised, as they were only developed in Japan. Ocedurenone presents results from a phase two trial on managing refractory hypertension on chronic kidney disease. Apararenone is being investigated for diabetic kidney disease, with results from a phase two study, limited for only including Japanese patients.

Conclusions

With this review we provide a global perspective on the available clinical results for these drugs to improve its evidence-based use.

慢性肾脏疾病的发病率和死亡率推动着新药的开发。本工作总结了非甾体矿皮质激素受体拮抗剂治疗慢性肾脏疾病的证据。材料和方法在PubMed和ClinicalTrials.gov上检索2019年至2023年已完成或正在进行的临床试验和观察性研究的相关关键词。finerenone目前被批准用于糖尿病肾病伴蛋白尿，两项三期试验的结果显示，在肾脏和心血管结局方面取得了令人满意的结果，并具有适当的安全性，即钾平衡。对于非糖尿病肾病，联合使用葡萄糖转运蛋白-2抑制剂钠和芬烯酮可获得可靠的结果，尽管这些结果来自非安慰剂对照试验。一项正在进行的三期试验正在评估芬尼酮对非糖尿病性慢性肾脏疾病的疗效和安全性。基于两项三期临床试验，Esaxerenone在日本被批准用于糖尿病肾病和高血压。这些试验的外部有效性受到了损害，因为它们只是在日本开发的。奥克都列酮在治疗难治性高血压合并慢性肾脏疾病的ii期临床试验结果。Apararenone正在研究用于糖尿病肾病的治疗，其结果来自一项ii期研究，仅限于日本患者。结论通过这篇综述，我们对这些药物的现有临床结果提供了一个全球视角，以改善其循证应用。

{"title":"Evidence for the use of a nonsteroidal mineralocorticoid receptor antagonist for the treatment of chronic kidney disease","authors":"Mariana Morais David Pliças , Bernardo Marques da Silva , Edgar Avito Fernandes de Almeida","doi":"10.1016/j.nefro.2024.10.004","DOIUrl":"10.1016/j.nefro.2024.10.004","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Chronic kidney disease morbimortality drives the development of new drugs. This work summarizes the evidence on the use of non-steroidal mineralocorticoid receptor antagonists on chronic kidney disease.</div></div><div><h3>Materials and methods</h3><div>A search was performed on PubMed and ClinicalTrials.gov using relevant keywords for clinical trials and observational studies, finished or ongoing, from 2019 to 2023.</div></div><div><h3>Results</h3><div>Finerenone is currently approved for diabetic kidney disease with albuminuria, with results from two phase three trials, presenting satisfactory results on renal and cardiovascular outcomes and an appropriate safety profile, namely regarding potassium balance. Regarding nondiabetic kidney disease, combining sodium glucose transport protein-2 inhibitors and finerenone points toward reliable results, although these came from non-placebo-controlled trials. An ongoing phase three trial is assessing finerenone efficacy and safety on nondiabetic chronic kidney disease. Esaxerenone is approved for diabetic nephropathies and hypertension in Japan, based on two phase three clinical trials. These trials’ external validity is compromised, as they were only developed in Japan. Ocedurenone presents results from a phase two trial on managing refractory hypertension on chronic kidney disease. Apararenone is being investigated for diabetic kidney disease, with results from a phase two study, limited for only including Japanese patients.</div></div><div><h3>Conclusions</h3><div>With this review we provide a global perspective on the available clinical results for these drugs to improve its evidence-based use.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 3","pages":"Pages 214-227"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528951","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

Validación multicéntrica de la fórmula Kidney Failure Risk Equation (KFRE) en pacientes españoles con enfermedad renal crónica avanzada 西班牙晚期慢性肾病患者肾脏失败风险方程式（KFRE）的多中心验证

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-03-01 DOI: 10.1016/j.nefro.2025.02.004

Beatriz Escamilla-Cabrera , Marco Montomoli , Maria Kislikova , Verónica de la Espada , Alazne Olarte-García , Ana María García-Prieto , Sara Piqueras-Sánchez , Álvaro Álvarez López , Lucía Rodríguez-Gayo , Javier Centellas-Pérez , Hilda Villafuerte , Pedro Barrera Baena

Introduction

Chronic kidney disease (CKD) is a prevalent condition that requires reliable tools to predict its progression to end-stage renal disease (ESRD). The KFRE equation, internationally validated, allows for estimating the risk of progression at 2 and 5 years. However, it has not been validated in the Spanish population. This study aims to evaluate the predictive capacity of the KFRE in a cohort of Spanish patients.

Methods

This is a multicenter, observational, and retrospective study conducted in patients with an estimated glomerular filtration rate (eGFR) < 30 ml/min who were followed in nephrology clinics between January 2016 and 2021. A total of 602 patients with clinical and demographic data were included. The predictive capacity of the KFRE, in its 4-variable and 8-variable versions, was evaluated using Cox regression analysis and ROC curves.

Results

Of the 602 patients included, 60% were male. Diabetes was the main etiology. Among the patients who started renal replacement therapy (RRT), 37% did so within two years, and 70% began with hemodialysis. Patients who initiated RRT (50.6%) were younger, had a lower eGFR, and exhibited higher baseline albuminuria. The 4-variable KFRE equation showed an AUC of 0.7639 (95% CI: 0.71-0.81) and demonstrated superior accuracy compared to the 8-variable model.

Conclusions

The KFRE equation, particularly in its 4-variable version, proves to be useful in predicting the progression to ESRD in the Spanish population. However, recalibration is necessary to improve its accuracy in this context.

慢性肾脏疾病（CKD）是一种普遍的疾病，需要可靠的工具来预测其进展到终末期肾脏疾病（ESRD）。国际认可的KFRE方程可以估计2年和5年的进展风险。然而，它尚未在西班牙人群中得到验证。本研究旨在评估KFRE在西班牙患者队列中的预测能力。方法：这是一项多中心、观察性和回顾性研究，研究对象是肾小球滤过率（eGFR）和lt；2016年1月至2021年1月在肾脏病诊所随访30 ml/min。共纳入602例具有临床和人口统计学资料的患者。采用Cox回归分析和ROC曲线对4变量和8变量版本的KFRE的预测能力进行评估。结果602例患者中，男性占60%。糖尿病是主要病因。在开始肾脏替代治疗（RRT）的患者中，37%的患者在两年内进行了治疗，70%的患者开始进行血液透析。开始RRT的患者（50.6%）较年轻，eGFR较低，基线蛋白尿较高。4变量KFRE方程的AUC为0.7639 (95% CI: 0.71-0.81)，与8变量模型相比，显示出更高的准确性。结论KFRE方程，特别是它的4变量版本，在预测西班牙人群的ESRD进展方面被证明是有用的。然而，在这种情况下，重新校准是必要的，以提高其准确性。

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引用次数: 0

Enfermedad glomerular en enfermedad injerto versus huésped crónica 移植物性疾病与慢性宿主性疾病的肾小球病

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-03-01 DOI: 10.1016/j.nefro.2025.02.002

Leticia Peluffo , Lucía Barceló , Gabriela Otatti , Andrés Urrestarazu , Ruben Coitiño , Cecilia Baccino , Sofía San Román , Agustín Noboa , Jimena Cabrera , Haydee Aunchaunya , Fernanda Varela , Cecilia Coelho , Lucía Santini , Eliana Cabrera , Paula Gauronas , Santiago Acle , Oscar Noboa , Ricardo Silvariño

Introduction

Allogeneic hematopoietic progenitor cell transplantation is a widely used procedure, and graft-versus-host disease (GVHD) is a common complication. Glomerular involvement due to GVHD is exceptional.

Objective

to describe the clinical and histopathological presentation of patients with glomerular disease secondary to GVHD.

Materials and methods

A retrospective review of the Uruguayan registry of glomerulopathies was conducted to identify renal biopsies from patients with confirmed GVHD.

Results

Seven patients were identified, 4 male, with a median age of 41 years (range 8–58). The most common clinical and analytical presentation was nephrotic syndrome. Histopathological findings included membranous glomerulonephritis (4), segmental and focal sclerohyalinosis (1), membranoproliferative glomerulonephritis (1), and thrombotic microangiopathy (1). All patients were treated with corticosteroids in combination with immunosuppressors, most frequently mycophenolate mofetil and rituximab. Five patients achieved complete remission, one had partial remission, and one did not respond. The combination of corticosteroids with rituximab showed a good response rate in those presenting with podocytopathy in the renal biopsy.

同种异体造血祖细胞移植是一种广泛应用的手术，移植物抗宿主病（GVHD）是一种常见的并发症。GVHD累及肾小球是罕见的。目的探讨GVHD继发肾小球疾病的临床和组织病理学表现。材料和方法对乌拉圭肾小球病变登记进行回顾性审查，以确定确诊GVHD患者的肾脏活检。结果7例患者，男性4例，中位年龄41岁（范围8-58岁）。最常见的临床和分析表现为肾病综合征。组织病理学结果包括膜性肾小球肾炎(4)、节段性和局灶性硬化性肾小球肾炎(1)、膜性增生性肾小球肾炎(1)和血栓性微血管病(1)。所有患者均接受皮质类固醇联合免疫抑制剂治疗，最常见的是霉酚酸酯和利妥昔单抗。5例患者完全缓解，1例部分缓解，1例无反应。在肾活检中出现足细胞病的患者中，糖皮质激素联合利妥昔单抗显示出良好的反应率。

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引用次数: 0

Mejora en la detección, diagnóstico y tratamiento temprano de la enfermedad renal crónica en España. Proyecto IntERKit 改善西班牙慢性肾脏疾病的检测、诊断和早期治疗。IntERKit项目

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-02-28 DOI: 10.1016/j.nefro.2025.02.001

José Luis Górriz , Fran Adán Gil , Manuel A. Botana López , Antonio Buño Soto , Francisco José Campos Cabrera , Angeles Cisneros , Silvia Cobo Guerrero , María Dolores Conejos , Isabel Egocheaga Cabello , M. Concepción Fernández Planelles , Lisardo García-Matarín , Natalia Jiménez , Juan Carlos Julián Mauro , David León Jiménez , Daniel Martínez Gamote , Pilar Mazón Ramos , Alberto Ortiz , Gemma Palau , Julia Quevedo Rivera , J. Emilio Sánchez-Álvarez , Roser Vallés Fernández

Chronic kidney disease (CKD) is a real public health problem. It is estimated that by 2040, approximately one in 5 adults will develop CKD, and by 2050 it will be the third cause of death in Spain. However, CKD is clearly underdiagnosed, with low screening figures in the population at risk, often delaying its identification to advanced stages of the disease, which worsens the prognosis of patients and increases the associated costs. In addition, drugs are now available that have been shown to reduce the progression of CKD and the risk of developing vascular complications. In this context, the early detection, diagnosis and initial management of CKD by health organizations should become a priority, as it would reduce the burden of the disease substantially. The IntERKit project arises with the aim of improving the early detection, diagnosis and initial management of CKD by promoting collaboration with health organizations, through tools easily implemented by these organizations. Since this pathology is oligo or paucisymptomatic in early stages, a proactive attitude is required from the health professional to detect, diagnose and treat this pathology early. Several publications have shown that, to date, both the detection of CKD and its initial management are not optimal. The IntERKit project provides healthcare organizations with a structured framework to optimize the early approach of CKD efficiently, achieving a real, measurable, sustainable and scalable impact, which can evolve depending on the results obtained.

慢性肾脏疾病（CKD）是一个真正的公共卫生问题。据估计，到2040年，大约五分之一的成年人将患上慢性肾病，到2050年，它将成为西班牙第三大死因。然而，CKD显然未被充分诊断，在高危人群中筛查率较低，往往将其识别延迟到疾病的晚期，从而恶化了患者的预后并增加了相关费用。此外，目前已有的药物已被证明可以减少CKD的进展和发生血管并发症的风险。在这种情况下，卫生组织对慢性肾病的早期发现、诊断和初步管理应成为一个优先事项，因为这将大大减轻疾病的负担。IntERKit项目的目的是通过促进与卫生组织的合作，通过这些组织易于实施的工具，改善慢性肾病的早期发现、诊断和初步管理。由于这种病理在早期是少症状或无症状的，因此需要卫生专业人员采取积极的态度，及早发现、诊断和治疗这种病理。一些出版物表明，到目前为止，CKD的检测和初始治疗都不是最佳的。IntERKit项目为医疗保健组织提供了一个结构化的框架，以有效地优化CKD的早期方法，实现真正的、可衡量的、可持续的和可扩展的影响，这种影响可以根据所获得的结果而发展。

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引用次数: 0

Etelcalcetide: What we know eight years since its approval 艾替卡肽：我们所知道的，自从它被批准以来已经八年了

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-02-01 DOI: 10.1016/j.nefro.2024.09.004

Pedro Freitas , Luciano Pereira

Introduction and objectives

The impact of etelcalcetide on patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) has been studied since its introduction in 2016/2017. However, only a handful of studies reported clinically relevant outcomes. This narrative review aims to summarize the published data about etelcalcetide, focusing on biochemical, cardiovascular (CV) and bone endpoints, as well as adverse effects and all-cause mortality.

Materials and methods

A literature review of the use of etelcalcetide in hemodialysis patients with SHPT was conducted. Several sources were used, such as PubMed, Google Scholar and Cochrane Library.

Results

Regarding bone and mineral metabolism, etelcalcetide is effective in reducing serum levels of parathormone (PTH), calcium, phosphate and fibroblast growth factor 23 (FGF23). Preliminary data have highlighted its role in reducing bone turnover and improving mineralization and preservation of bone structure, indicating a possible positive impact on renal osteodystrophy. From a CV perspective, etelcalcetide is associated with a significant reduction in left ventricular hypertrophy. In addition, etelcalcetide reduces FGF23 and increases sclerostin serum levels. This data suggests a possible CV beneficial effect.

Conclusions

Etelcalcetide is effective in controlling SHPT. Promising data is available for some bone and surrogate cardiovascular endpoints, suggesting a possible beneficial effect. There is a lack of studies specifically designed to evaluate its role in reducing fractures, CV and all-cause mortality.

自2016/2017年etelcalcetide引入以来，一直在研究其对慢性肾脏疾病（CKD）和继发性甲状旁腺功能亢进（SHPT）患者的影响。然而，只有少数研究报告了临床相关的结果。这篇叙述性综述旨在总结已发表的关于依替卡肽的数据，重点是生化、心血管（CV）和骨骼终点，以及不良反应和全因死亡率。材料与方法回顾性分析了依替卡肽在血液透析合并SHPT患者中的应用。使用了几个来源，如PubMed，谷歌Scholar和Cochrane Library。结果在骨和矿物质代谢方面，依替卡尔肽能有效降低血清甲状旁腺激素（PTH）、钙、磷酸盐和成纤维细胞生长因子23 （FGF23）水平。初步数据强调了其在减少骨转换和改善矿化和骨结构保存方面的作用，表明其可能对肾性骨营养不良有积极影响。从心血管的角度来看，依替卡肽与左心室肥厚的显著减少有关。此外，依替卡尔肽降低FGF23并增加血清硬化蛋白水平。这一数据表明可能存在CV有益效应。结论塞替卡肽能有效控制SHPT。有希望的数据可用于一些骨骼和替代心血管终点，表明可能有益的效果。缺乏专门设计的研究来评估其在降低骨折、心血管疾病和全因死亡率方面的作用。

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