Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2024.06.005
Florentina Rosique , Leonor Andúgar , Adoración Martínez-Losa , María Dolores Arenas , Diana Manzano , Fernando Hadad-Arrascue , Julio García-Puente , Daniel José Carbonell , Antonio Ocete , Esperanza Melero , José Luis Espinosa , María del Carmen Pérez , Ruth Amair , Nerea Manzanero , Hamazasp Simonyan , Norma Inés Venegas , Ebbermy Vásquez , Ana Dolores Martínez , José Luis Albero , Ramón Roca-Tey , Juan B. Cabezuelo
{"title":"Ecografía del acceso vascular en manos de los profesionales de la nefrología y de la enfermería nefrológica en las unidades de enfermedad renal crónica avanzada: una herramienta para mejorar la calidad asistencial","authors":"Florentina Rosique , Leonor Andúgar , Adoración Martínez-Losa , María Dolores Arenas , Diana Manzano , Fernando Hadad-Arrascue , Julio García-Puente , Daniel José Carbonell , Antonio Ocete , Esperanza Melero , José Luis Espinosa , María del Carmen Pérez , Ruth Amair , Nerea Manzanero , Hamazasp Simonyan , Norma Inés Venegas , Ebbermy Vásquez , Ana Dolores Martínez , José Luis Albero , Ramón Roca-Tey , Juan B. Cabezuelo","doi":"10.1016/j.nefro.2024.06.005","DOIUrl":"10.1016/j.nefro.2024.06.005","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 910-912"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141414903","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}
Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2024.04.002
Laura González-Lafuente , Elisa Mercado-García , Sara Vázquez-Sánchez , Daniel González-Moreno , Lisardo Boscá , María Fernández-Velasco , Julián Segura , Makoto Kuro-O , Luis M. Ruilope , Fernando Liaño , Gema Ruiz-Hurtado
Background and objective
In acute kidney injury (AKI), a strong inflammatory component is activated in response to the renal damage, and one of the main mediators behind this process is the pro-inflammatory interleukin 6 or IL-6. Beside to this phenomenon, there are also alterations in different components of mineral metabolism, such as those dependent on fibroblast growth factor (FGF)23 and the anti-ageing cofactor klotho. The aim of this work was to explore the association between renal function and systemic levels of IL-6, as well as FGF23 and klotho in the early stages of AKI, analysing the predictive capacity of IL-6 in early mortality associated with AKI.
Materials and methods
Plasma levels of IL-6, klotho and FGF23 were analysed in samples from 28 patients with AKI and related to renal function on hospital admission, and after 24 and 72 hours. In addition, the predictive capacity of IL-6 on AKI-associated mortality was analysed at the three study time points. In an experimental nephrotoxic -AKI mouse model, systemic IL-6 and FGF23 values were also analysed 24 and 72 hours after induction of kidney damage, as well as in mice overexpressing the anti-ageing protein, klotho.
Results
Systemic IL-6 levels increased in AKI patients, especially in hospital admission time, and decreased in parallel with improving renal function. At the same time as IL-6 values increased, there was an increase in FGF23 and a decrease in klotho levels, with a significant and positive correlation between IL-6 and FGF23 levels. In addition, we obtained that systemic IL-6 levels were a good predictor of mortality in these patients, with an area under the curve equal to one at 72 hours after AKI. In the experimental mouse AKI model, we also observed an increase in plasma levels in both IL-6 and FGF23 after 24 hours of kidney damage. Nevertheless, in transgenic mice overexpressing klotho, there was no such increase in any of them.
Conclusions
There is an association between renal damage and increased levels of IL-6 and FGF23 in patients with AKI, especially on hospital admission time. Moreover, IL-6 levels are able to predict mortality in these patients, being a promising prognostic biomarker at any study time with a strong prediction at 72 hours after patient admission. Maintaining adequate klotho levels could prevent the IL-6 mediated inflammatory response and therefore also reduce the degree and severity of renal damage after AKI.
{"title":"Interleuquina-6 como marcador pronóstico en el fracaso renal agudo y su regulación dependiente de klotho","authors":"Laura González-Lafuente , Elisa Mercado-García , Sara Vázquez-Sánchez , Daniel González-Moreno , Lisardo Boscá , María Fernández-Velasco , Julián Segura , Makoto Kuro-O , Luis M. Ruilope , Fernando Liaño , Gema Ruiz-Hurtado","doi":"10.1016/j.nefro.2024.04.002","DOIUrl":"10.1016/j.nefro.2024.04.002","url":null,"abstract":"<div><h3>Background and objective</h3><div>In acute kidney injury (AKI), a strong inflammatory component is activated in response to the renal damage, and one of the main mediators behind this process is the pro-inflammatory interleukin 6 or IL-6. Beside to this phenomenon, there are also alterations in different components of mineral metabolism, such as those dependent on fibroblast growth factor (FGF)23 and the anti-ageing cofactor klotho. The aim of this work was to explore the association between renal function and systemic levels of IL-6, as well as FGF23 and klotho in the early stages of AKI, analysing the predictive capacity of IL-6 in early mortality associated with AKI.</div></div><div><h3>Materials and methods</h3><div>Plasma levels of IL-6, klotho and FGF23 were analysed in samples from 28 patients with AKI and related to renal function on hospital admission, and after 24 and 72<!--> <!-->hours. In addition, the predictive capacity of IL-6 on AKI-associated mortality was analysed at the three study time points. In an experimental nephrotoxic -AKI mouse model, systemic IL-6 and FGF23 values were also analysed 24 and 72<!--> <!-->hours after induction of kidney damage, as well as in mice overexpressing the anti-ageing protein, klotho.</div></div><div><h3>Results</h3><div>Systemic IL-6 levels increased in AKI patients, especially in hospital admission time, and decreased in parallel with improving renal function. At the same time as IL-6 values increased, there was an increase in FGF23 and a decrease in klotho levels, with a significant and positive correlation between IL-6 and FGF23 levels. In addition, we obtained that systemic IL-6 levels were a good predictor of mortality in these patients, with an area under the curve equal to one at 72<!--> <!-->hours after AKI. In the experimental mouse AKI model, we also observed an increase in plasma levels in both IL-6 and FGF23 after 24<!--> <!-->hours of kidney damage. Nevertheless, in transgenic mice overexpressing klotho, there was no such increase in any of them.</div></div><div><h3>Conclusions</h3><div>There is an association between renal damage and increased levels of IL-6 and FGF23 in patients with AKI, especially on hospital admission time. Moreover, IL-6 levels are able to predict mortality in these patients, being a promising prognostic biomarker at any study time with a strong prediction at 72<!--> <!-->hours after patient admission. Maintaining adequate klotho levels could prevent the IL-6 mediated inflammatory response and therefore also reduce the degree and severity of renal damage after AKI.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 818-829"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142661950","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}
Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2024.05.006
Zoila Stany Albines Fiestas , María Victoria Rubio Rubio , José Antonio Gimeno Orna , Ana Belén Mañas Martínez , Virginia Arroyo Espallargas , Jordi Bosch Melguizo , Beatriz María Rojas Pérez-Ezquerra , Carmen Criado Mainar , Fernando Anaya-Fernández Lomana , Pablo Iñigo Gil
{"title":"Aféresis terapéutica en gestante con hipercolesterolemia familiar heterocigota","authors":"Zoila Stany Albines Fiestas , María Victoria Rubio Rubio , José Antonio Gimeno Orna , Ana Belén Mañas Martínez , Virginia Arroyo Espallargas , Jordi Bosch Melguizo , Beatriz María Rojas Pérez-Ezquerra , Carmen Criado Mainar , Fernando Anaya-Fernández Lomana , Pablo Iñigo Gil","doi":"10.1016/j.nefro.2024.05.006","DOIUrl":"10.1016/j.nefro.2024.05.006","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 899-901"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030399","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}
Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2024.06.004
Emilio Guirao-Arrabal , Ana Delgado-Ureña , Elena Borrego-García , Rosa Ríos-Pelegrina
{"title":"Q fever as a cause of fever of unknown origin in a patient on hemodialysis","authors":"Emilio Guirao-Arrabal , Ana Delgado-Ureña , Elena Borrego-García , Rosa Ríos-Pelegrina","doi":"10.1016/j.nefro.2024.06.004","DOIUrl":"10.1016/j.nefro.2024.06.004","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 906-910"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141399028","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}
Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2024.07.003
Borja Quiroga , Juan José Gorgojo , Jesús Ignacio Diago , Pedro Ruiz , CARABELA-CKD Scientific Committee
{"title":"Toward optimization and excellence via a multidisciplinary care model for patients with chronic kidney disease in Spain: The CARABELA-CKD initiative","authors":"Borja Quiroga , Juan José Gorgojo , Jesús Ignacio Diago , Pedro Ruiz , CARABELA-CKD Scientific Committee","doi":"10.1016/j.nefro.2024.07.003","DOIUrl":"10.1016/j.nefro.2024.07.003","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 912-915"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845754","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}
Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2023.06.001
Enrique Calvo-Aranda , Laura Barrio-Nogal , Boris A. Blanco-Caceres , Diana Peiteado , Marta Novella-Navarro , Eugenio De Miguel , Jaime Arroyo Palomo , Roberto Alcázar Arroyo , Juan Antonio Martín Navarro , Milagros Fernandez Lucas , Martha Elizabeth Diaz Dominguez , Marco Antonio Vaca Gallardo , Elda Besada Estevez , Leticia Lojo Oliveira
<div><h3>Background</h3><div>One in 10 patients with hyperuricemia may develop gout over time, with urate deposition sometimes asymptomatic. Recent reviews and guidelines support ultrasound (US) to assess asymptomatic hyperuricemic (AH) patients to detect gout lesions, showing double contour (DC) and tophus the highest specificities and positive predictive values. Hyperuricemia and gout are common in chronic kidney disease (CKD), especially with glomerular filtration rate (GFR) <60, and both are associated with worse prognosis, although treatment of AH in CKD is not yet recommended in all guidelines. US gout lesions have been found more frequently in AH (up to 35%) than in normouricemic (NU) patients, but evidence is scarce in CKD.</div></div><div><h3>Objectives</h3><div>To assess the prevalence of urate deposit in stages 3–5 CKD detected by US, and to investigate if there are differences between AH and NU patients.</div></div><div><h3>Methods</h3><div>Multicenter cross-sectional study, recruiting patients aged ≥18 years with AH and stages 3–5 CKD in four hospitals. A comparator group of NU patients with stages 3–5 CKD was included. Exclusion criteria: previous diagnosis of gout, tophi. Hyperuricemia was defined as serum uric acid (sUA) >7 mg/dl, documented at least twice during the last 12 months. A standardized US exam of the knees and bilateral first metatarsophalangeal joints was performed to assess patients for DC/tophus as defined by OMERACT. Demographic, clinical and laboratory data were recorded. A descriptive analysis was performed using SPSS. Pre-clinical gout (PCG: DC and/or tophus) was considered as outcome variable. Chi-square and Fisher's exact test were used for qualitative variables, and Mann–Whitney <em>U</em> test for quantitative variables; significant threshold <em>p</em><span><</span>0.05.</div></div><div><h3>Results</h3><div>Fifty-three patients with stages 3–5 CKD (59.6% stage 3, 19.1% stage 4, 21.3% stage 5) were recruited, 38 AH (71.7%) and 15 NU. A higher prevalence of US findings was observed in HU patients compared to NU patients (DC 23.7% vs. 13.3%, tophus 31.6% vs. 26.7%, PCG 39.5% vs. 33.3%), although the differences were not statistically significant. NU patients had CKD of longer duration than HU patients [11 (7.2–13.5) vs. 6 (2–9.2) years; <em>p</em> = 0.02], with no differences in sex, age, comorbidities, or urate-lowering therapy (ULT) (66.7% vs. 44.7%; <em>p</em> = 0.05) and other treatments. Seventy percent of NU patients with TRU had AH before starting treatment. In patients with tophi, we observed a trend towards shorter duration of CKD and shorter duration of treatment with ULT compared to those without tophi [3.5 (2–6.7) vs. 7 (3–12) years; <em>p</em> = 0.05] and [22 (12–44) vs. 39 (29–73) months; <em>p</em> = 0.08], respectively. This trend was also observed in PCG, but not in DC, first US sign to disappear after initiation of ULT. Ninety percent of patients (100% in non-dialyzed patients) with
背景每10名高尿酸血症患者中就有1人可能在一段时间后发展为痛风，尿酸盐沉积有时无症状。最近的评论和指南支持用超声波（US）评估无症状的高尿酸血症（AH）患者，以检测痛风病变，其中双轮廓（DC）和topphus的特异性和阳性预测值最高。高尿酸血症和痛风在慢性肾脏病（CKD）中很常见，尤其是在肾小球滤过率（GFR）大于60的情况下，两者都与预后恶化有关，尽管目前还没有所有指南推荐治疗CKD中的高尿酸血症。方法：多中心横断面研究，在四家医院招募年龄≥18 岁的 AH 和 3-5 期 CKD 患者。对比组包括 3-5 期 CKD 的 NU 患者。排除标准：既往诊断为痛风、结核。高尿酸血症的定义是血清尿酸（sUA）达到 7 mg/dl，且在过去 12 个月中至少有两次记录在案。对膝关节和双侧第一跖趾关节进行标准化的 US 检查，以评估患者是否患有 OMERACT 所定义的 DC/趾关节炎。此外，还记录了人口统计学、临床和实验室数据。使用 SPSS 进行了描述性分析。结果变量为临床前痛风（PCG：DC和/或Tophus）。定性变量采用卡方检验和费雪精确检验，定量变量采用 Mann-Whitney U 检验；显著性临界值 p<0.05。与 NU 患者相比，HU 患者的 US 发现率较高（DC 23.7% 对 13.3%，topphus 31.6% 对 26.7%，PCG 39.5% 对 33.3%），但差异无统计学意义。NU 患者的 CKD 病程比 HU 患者长[11 (7.2-13.5) 年 vs. 6 (2-9.2) 年；p = 0.02]，在性别、年龄、合并症、降尿酸治疗 (ULT) (66.7% vs. 44.7%；p = 0.05) 和其他治疗方面没有差异。70%的NU TRU患者在开始治疗前患有AH。我们观察到，与没有结核病灶的患者相比，有结核病灶的患者的 CKD 病程和 ULT 治疗时间有缩短的趋势，分别为[3.5 (2-6.7) 年 vs. 7 (3-12) 年；p = 0.05]和[22 (12-44) 个月 vs. 39 (29-73) 个月；p = 0.08]。在 PCG 中也观察到这一趋势，但在 DC 中未观察到这一趋势。结论：我们发现在 3-5 期 CKD 患者中，无症状尿酸盐沉积的发生率很高，大多数患者在过去 12 个月中尿酸血症中位数≥5 mg/dl。通过肌肉骨骼 US 对慢性肾脏病患者 PCG 的早期诊断，可使超低密度脂蛋白胆固醇治疗更早开始并得到优化。这很可能有助于减缓这一病症的进展，因此促进肾脏病学和风湿病学之间的合作至关重要。
{"title":"La gota preclínica es frecuente en el paciente con enfermedad renal crónica estadio 3-5. Relevancia de la ecografía articular","authors":"Enrique Calvo-Aranda , Laura Barrio-Nogal , Boris A. Blanco-Caceres , Diana Peiteado , Marta Novella-Navarro , Eugenio De Miguel , Jaime Arroyo Palomo , Roberto Alcázar Arroyo , Juan Antonio Martín Navarro , Milagros Fernandez Lucas , Martha Elizabeth Diaz Dominguez , Marco Antonio Vaca Gallardo , Elda Besada Estevez , Leticia Lojo Oliveira","doi":"10.1016/j.nefro.2023.06.001","DOIUrl":"10.1016/j.nefro.2023.06.001","url":null,"abstract":"<div><h3>Background</h3><div>One in 10 patients with hyperuricemia may develop gout over time, with urate deposition sometimes asymptomatic. Recent reviews and guidelines support ultrasound (US) to assess asymptomatic hyperuricemic (AH) patients to detect gout lesions, showing double contour (DC) and tophus the highest specificities and positive predictive values. Hyperuricemia and gout are common in chronic kidney disease (CKD), especially with glomerular filtration rate (GFR) <60, and both are associated with worse prognosis, although treatment of AH in CKD is not yet recommended in all guidelines. US gout lesions have been found more frequently in AH (up to 35%) than in normouricemic (NU) patients, but evidence is scarce in CKD.</div></div><div><h3>Objectives</h3><div>To assess the prevalence of urate deposit in stages 3–5 CKD detected by US, and to investigate if there are differences between AH and NU patients.</div></div><div><h3>Methods</h3><div>Multicenter cross-sectional study, recruiting patients aged ≥18 years with AH and stages 3–5 CKD in four hospitals. A comparator group of NU patients with stages 3–5 CKD was included. Exclusion criteria: previous diagnosis of gout, tophi. Hyperuricemia was defined as serum uric acid (sUA) >7 mg/dl, documented at least twice during the last 12 months. A standardized US exam of the knees and bilateral first metatarsophalangeal joints was performed to assess patients for DC/tophus as defined by OMERACT. Demographic, clinical and laboratory data were recorded. A descriptive analysis was performed using SPSS. Pre-clinical gout (PCG: DC and/or tophus) was considered as outcome variable. Chi-square and Fisher's exact test were used for qualitative variables, and Mann–Whitney <em>U</em> test for quantitative variables; significant threshold <em>p</em><span><</span>0.05.</div></div><div><h3>Results</h3><div>Fifty-three patients with stages 3–5 CKD (59.6% stage 3, 19.1% stage 4, 21.3% stage 5) were recruited, 38 AH (71.7%) and 15 NU. A higher prevalence of US findings was observed in HU patients compared to NU patients (DC 23.7% vs. 13.3%, tophus 31.6% vs. 26.7%, PCG 39.5% vs. 33.3%), although the differences were not statistically significant. NU patients had CKD of longer duration than HU patients [11 (7.2–13.5) vs. 6 (2–9.2) years; <em>p</em> = 0.02], with no differences in sex, age, comorbidities, or urate-lowering therapy (ULT) (66.7% vs. 44.7%; <em>p</em> = 0.05) and other treatments. Seventy percent of NU patients with TRU had AH before starting treatment. In patients with tophi, we observed a trend towards shorter duration of CKD and shorter duration of treatment with ULT compared to those without tophi [3.5 (2–6.7) vs. 7 (3–12) years; <em>p</em> = 0.05] and [22 (12–44) vs. 39 (29–73) months; <em>p</em> = 0.08], respectively. This trend was also observed in PCG, but not in DC, first US sign to disappear after initiation of ULT. Ninety percent of patients (100% in non-dialyzed patients) with ","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 877-884"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47042140","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}
Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2024.05.009
María Ángeles Fernández Rojo , Rafael Díaz-Tejeiro Izquierdo , Mario Vaquero Alonso , Dabaiba Regidor Rodríguez , Laura Cueto Bravo , Iván Carmena Rodríguez , David Carro Herrero , Carlos Jesús Cabezas Reina , Francisco Javier Ahijado Hormigos
Introduction
Adequate control of patient blood volume in hemodialysis (HD) is essential as a modifiable risk factor for morbidity and mortality. In this study, we propose continuous non-invasive hemodynamic monitoring using bioreactance (Starling™ SV. Baxter) and real-time characterization of cardiac preload data to aid in the accurate assessment of volume status and improvement of tolerance in HD.
Methodology
Observational and prospective study on the relationship between cardiac preload data and intradialytic hemodynamic instability. Forty-six stable HD patients were recruited. Clinical, analytical, and dialysis data were collected from all participants. The protocol included bioimpedance (BIVA), pre- and post-dialysis echocardiography and tissue Doppler, and monitoring of hemodynamic parameters during the session.
Results
According to the Fall20 definition, 24 patients (51.19%) experienced intradialytic hypotension (IDH). We found no relationship between IDH and analytical, echocardiographic, BIVA parameters, or relative blood volume measurement (BVM) values. Regarding hemodynamic monitoring, indexed systolic volume (ISV) was lower in patients with IDH (38.2 ± 0.9 vs. 39.2 ± 1.9; P<.001). Indexed systolic volume variation (ISVV) and heart rate (HR) were higher in the IDH group (14.1 ± 0.7 vs. 13.5 ± 0.7; P<.0001), (70.01 ± 2.1 vs. 68.97 ± 1.1; P<.0001), respectively. Indexed cardiac output (ICO) and indexed peripheral resistances (IPR) were also lower in the IDH group (2.62 ± 0.09 vs. 2.65 ± 0.13; P<.05) and (3201 ± 325 vs. 3432 ± 231; P<.05), respectively. Patients who started the session with lower preload (ΔSV after infusion of 250 cc ≥ 10%) more frequently developed IDH (P<.001).
Conclusions
Non-invasive hemodynamic monitoring and preload data may constitute a valid tool in managing the volume status of HD patients and preventing IDH.
导言：血液透析（HD）过程中对患者血容量的适当控制是至关重要的，因为它是导致发病率和死亡率的一个可改变的风险因素。在这项研究中，我们建议使用生物反应（Starling™ SV. Baxter）进行连续无创血流动力学监测，并对心脏前负荷数据进行实时分析，以帮助准确评估血容量状态并改善血液透析患者的耐受性。方法：对心脏前负荷数据与透析内血流动力学不稳定性之间的关系进行观察性和前瞻性研究。招募了 46 名病情稳定的 HD 患者。收集了所有参与者的临床、分析和透析数据。方案包括生物阻抗（BIVA）、透析前后超声心动图和组织多普勒以及透析过程中的血流动力学参数监测。结果根据Fall20的定义，24名患者（51.19%）出现了渠内低血压（IDH）。我们发现 IDH 与分析、超声心动图、BIVA 参数或相对血容量测量 (BVM) 值之间没有关系。在血液动力学监测方面，IDH 患者的指数收缩容积（ISV）较低（38.2 ± 0.9 vs. 39.2 ± 1.9; P<.001）。IDH组的指数收缩容积变化（ISVV）和心率（HR）分别较高（14.1 ± 0.7 vs. 13.5 ± 0.7; P<.0001）和（70.01 ± 2.1 vs. 68.97 ± 1.1; P<.0001）。IDH组的指数心输出量（ICO）和指数外周阻力（IPR）也分别较低（2.62 ± 0.09 vs. 2.65 ± 0.13; P<.05）和（3201 ± 325 vs. 3432 ± 231; P<.05）。结论无创血液动力学监测和前负荷数据可能是管理 HD 患者容量状态和预防 IDH 的有效工具。
{"title":"Monitorización hemodinámica no invasiva intradiálisis: utilidad de los valores de precarga cardiaca en la predicción de la inestabilidad hemodinámica","authors":"María Ángeles Fernández Rojo , Rafael Díaz-Tejeiro Izquierdo , Mario Vaquero Alonso , Dabaiba Regidor Rodríguez , Laura Cueto Bravo , Iván Carmena Rodríguez , David Carro Herrero , Carlos Jesús Cabezas Reina , Francisco Javier Ahijado Hormigos","doi":"10.1016/j.nefro.2024.05.009","DOIUrl":"10.1016/j.nefro.2024.05.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Adequate control of patient blood volume in hemodialysis (HD) is essential as a modifiable risk factor for morbidity and mortality. In this study, we propose continuous non-invasive hemodynamic monitoring using bioreactance (Starling™ SV. Baxter) and real-time characterization of cardiac preload data to aid in the accurate assessment of volume status and improvement of tolerance in HD.</div></div><div><h3>Methodology</h3><div>Observational and prospective study on the relationship between cardiac preload data and intradialytic hemodynamic instability. Forty-six stable HD patients were recruited. Clinical, analytical, and dialysis data were collected from all participants. The protocol included bioimpedance (BIVA), pre- and post-dialysis echocardiography and tissue Doppler, and monitoring of hemodynamic parameters during the session.</div></div><div><h3>Results</h3><div>According to the Fall20 definition, 24 patients (51.19%) experienced intradialytic hypotension (IDH). We found no relationship between IDH and analytical, echocardiographic, BIVA parameters, or relative blood volume measurement (BVM) values. Regarding hemodynamic monitoring, indexed systolic volume (ISV) was lower in patients with IDH (38.2<!--> <!-->±<!--> <!-->0.9 vs. 39.2<!--> <!-->±<!--> <!-->1.9; <em>P</em><.001). Indexed systolic volume variation (ISVV) and heart rate (HR) were higher in the IDH group (14.1<!--> <!-->±<!--> <!-->0.7 vs. 13.5<!--> <!-->±<!--> <!-->0.7; <em>P</em><.0001), (70.01<!--> <!-->±<!--> <!-->2.1 vs. 68.97<!--> <!-->±<!--> <!-->1.1; <em>P</em><.0001), respectively. Indexed cardiac output (ICO) and indexed peripheral resistances (IPR) were also lower in the IDH group (2.62<!--> <!-->±<!--> <!-->0.09 vs. 2.65<!--> <!-->±<!--> <!-->0.13; <em>P</em><.05) and (3201<!--> <!-->±<!--> <!-->325 vs. 3432<!--> <!-->±<!--> <!-->231; <em>P</em><.05), respectively. Patients who started the session with lower preload (ΔSV after infusion of 250 cc ≥ 10%) more frequently developed IDH (<em>P</em><.001).</div></div><div><h3>Conclusions</h3><div>Non-invasive hemodynamic monitoring and preload data may constitute a valid tool in managing the volume status of HD patients and preventing IDH.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 846-856"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133366","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}
Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2024.05.008
Gerry George Mathew , Sharmila Ganesan
{"title":"Isolated postpartum central diabetes insipidus in a primi mother with postpartum preeclampsia","authors":"Gerry George Mathew , Sharmila Ganesan","doi":"10.1016/j.nefro.2024.05.008","DOIUrl":"10.1016/j.nefro.2024.05.008","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 902-904"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130134","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}
Pub Date : 2024-11-01DOI: 10.1016/j.nefro.2024.05.011
Cristina Hernández Tejedor , Yolanda Romero Salas , María Dolores Miramar Gallart , Alberto José Bríngola Moñux , María José Sánchez Malo , José Luis Peña Segura
{"title":"A propósito de un caso de exceso aparente de mineralocorticoides, con clínica nefrológica y neurológica desde el nacimiento, y con nueva variante probablemente patogénica en gen HSD11B2","authors":"Cristina Hernández Tejedor , Yolanda Romero Salas , María Dolores Miramar Gallart , Alberto José Bríngola Moñux , María José Sánchez Malo , José Luis Peña Segura","doi":"10.1016/j.nefro.2024.05.011","DOIUrl":"10.1016/j.nefro.2024.05.011","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 6","pages":"Pages 904-906"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130979","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}
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