首页 > 最新文献

Nefrologia最新文献

英文 中文
Bone and vascular effects of magnesium supplements in CKD patients (the MagicalBone Pilot Study) 镁补充剂对慢性肾脏病患者骨骼和血管的影响(MagicalBone 试点研究)
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2024.02.003

Background and objective

The progression of chronic kidney disease (CKD) involves the development of alterations in mineral metabolism that are closely related to cardiovascular outcomes and bone disease. Hypomagnesemia is associated with more rapid progression of CKD and other comorbidities. Our objective was to analyze in CKD patients stages 3–4 the impact of the administration of magnesium (Mg) carbonate on bone mineral density (BMD) and hemodynamic changes associated with by vascular calcification (VC).

Material and methods

Patients with CKD stages 3–4 were randomized into controls (n = 12) or intervention (n = 7) group receiving 360 mg of Mg carbonate daily during a 15-month period. Parameters related to mineral metabolism, BMD, VC, and pulse wave velocity (PWV) were evaluated.

Results

Supplementation with Mg produced an increase in the urinary excretion of Mg while serum Mg levels remained stable and no episodes of hypermagnesemia were reported. In addition, no significant changes were found in the degree of VC assessed by Adragao index, however, both serum and urine Mg were significantly associated with a decrease in PWV, suggesting an increase in vascular compliance. Likewise, BMD did not change following treatment, but serum Mg significantly correlated with the levels of N-terminal propeptide of collagen alpha-1(I) chain (PINP), a marker of bone synthesis.

Conclusions

In sum, these results suggest a possible beneficial effect of Mg on vascular compliance with no detrimental effects on bone status. In addition, our results highlight the need to consider monitorization of urinary Mg status in CKD patients.

背景和目的慢性肾脏病(CKD)的进展涉及矿物质代谢的改变,而矿物质代谢的改变与心血管疾病和骨病密切相关。低镁血症与 CKD 的快速进展及其他合并症有关。我们的目的是分析 CKD 3-4 期患者服用碳酸镁对骨矿物质密度(BMD)和与血管钙化(VC)相关的血液动力学变化的影响。结果补充镁后,镁的尿排泄量增加,而血清镁的水平保持稳定,没有出现高镁血症。此外,用阿德拉高指数评估的血管顺应性程度未发现明显变化,但血清和尿液中的镁与脉搏波速度的下降有明显相关性,表明血管顺应性增加。总之,这些结果表明,镁可能对血管顺应性产生有益影响,但对骨质状况没有不利影响。总之,这些结果表明,镁可能对血管顺应性产生有益影响,但不会对骨骼状况产生不利影响。此外,我们的研究结果还强调,有必要考虑对慢性肾脏病患者的尿镁状况进行监测。
{"title":"Bone and vascular effects of magnesium supplements in CKD patients (the MagicalBone Pilot Study)","authors":"","doi":"10.1016/j.nefro.2024.02.003","DOIUrl":"10.1016/j.nefro.2024.02.003","url":null,"abstract":"<div><h3>Background and objective</h3><p>The progression of chronic kidney disease (CKD) involves the development of alterations in mineral metabolism that are closely related to cardiovascular outcomes and bone disease. Hypomagnesemia is associated with more rapid progression of CKD and other comorbidities. Our objective was to analyze in CKD patients stages 3–4 the impact of the administration of magnesium (Mg) carbonate on bone mineral density (BMD) and hemodynamic changes associated with by vascular calcification (VC).</p></div><div><h3>Material and methods</h3><p>Patients with CKD stages 3–4 were randomized into controls (<em>n</em> <!-->=<!--> <!-->12) or intervention (<em>n</em> <!-->=<!--> <!-->7) group receiving 360<!--> <!-->mg of Mg carbonate daily during a 15-month period. Parameters related to mineral metabolism, BMD, VC, and pulse wave velocity (PWV) were evaluated.</p></div><div><h3>Results</h3><p>Supplementation with Mg produced an increase in the urinary excretion of Mg while serum Mg levels remained stable and no episodes of hypermagnesemia were reported. In addition, no significant changes were found in the degree of VC assessed by Adragao index, however, both serum and urine Mg were significantly associated with a decrease in PWV, suggesting an increase in vascular compliance. Likewise, BMD did not change following treatment, but serum Mg significantly correlated with the levels of N-terminal propeptide of collagen alpha-1(I) chain (PINP), a marker of bone synthesis.</p></div><div><h3>Conclusions</h3><p>In sum, these results suggest a possible beneficial effect of Mg on vascular compliance with no detrimental effects on bone status. In addition, our results highlight the need to consider monitorization of urinary Mg status in CKD patients.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 721-730"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000146/pdfft?md5=e6982d6ea56d26286865c695a8a5b057&pid=1-s2.0-S0211699524000146-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467356","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
El Día Mundial del Riñón: una oportunidad para visibilizar la salud renal y la Nefrología 世界肾脏日:提升肾脏健康和肾脏病学形象的契机
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2024.05.004
{"title":"El Día Mundial del Riñón: una oportunidad para visibilizar la salud renal y la Nefrología","authors":"","doi":"10.1016/j.nefro.2024.05.004","DOIUrl":"10.1016/j.nefro.2024.05.004","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 615-618"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000390/pdfft?md5=f29f69c427819f75316a6ba0b3956d94&pid=1-s2.0-S0211699524000390-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035077","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
A rare case of PD-related cardiac tamponade after cardiac surgery 一例罕见的心脏手术后 PD 相关性心脏填塞病例
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2023.12.001
{"title":"A rare case of PD-related cardiac tamponade after cardiac surgery","authors":"","doi":"10.1016/j.nefro.2023.12.001","DOIUrl":"10.1016/j.nefro.2023.12.001","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 759-760"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001832/pdfft?md5=a1fe748418e1d5b4f67a89d7b67e14e0&pid=1-s2.0-S0211699523001832-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139190529","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
Remote patient monitoring and management in nephrology: A systematic review 肾脏病学中的远程患者监护与管理:系统回顾
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2024.01.005
<div><p>Chronic kidney disease (CKD) is a global public health problem, with adverse outcomes of kidney failure, cardiovascular disease (CVD), and premature death. According to European Kidney Health Alliance (EKHA) currently, 1 in 10 Europeans has chronic kidney disease (CKD) and it is predicted to be the fifth leading cause of death worldwide by 2040. The COVID-19, pandemic has further worsened the situation, with CKD being the number one risk factor for CKD mortality, ahead of lung and heart disease. In addition to rising mortality figures, treatments for kidney disease have not improved substantially over the past 50 years, leaving too many kidney patients with a poor quality of life and reduced life expectancy. This situation is associated with staggering aggregate annual costs amounting to €140 billion per year in Europe, more than the annual healthcare costs of cancer or diabetes.</p><p>Many studies confirm that Information and Communication Technology intervention (ICT) in nephrology can be way to tackles this issue. The increased daily use of information and communication technologies (ICT) may lead to the need for healthcare professionals to monitoring patient remotely. Remote Patient Monitoring (RPM) have the potential to improve care for patients with kidney disease.</p><p>RPM may provide a means to overcome some of the aforementioned barriers. RPM is a framework for monitoring patients at home by digital, wireless technology and extends the interactive contact of conventional clinical settings to include the patient's home. The hope is that these technologies would improve clinical outcomes through earlier recognition and correction of problems. Although few studies on telehealth in the dialysis population exist, studies do support its technical feasibility, which patient acceptance of this technology is very high, and that RPM may be able to improve outcomes in other co-morbid states shared by the ESKD population.</p><p>According to Pan American Health Organization, CKD, also called kidney failure, describes the gradual loss of kidney function and is a worldwide public health problem, with adverse outcomes of kidney failure, CVD, and premature death.</p><p>This study collects the papers concerning RPM and renal patient management using ICT intervention to analyze the results from considering the bioengineer's point of view. Our focus was on technology contribution.</p><p>The aim of this study was to review and synthesize the available literature on the role of RPM in healthcare in nephrology. This systematic review was conducted to examine the content and results of publications on using RPM to improve the health care of patients with kidney disease, available to health care professionals (HCPs) and/or patients. The literature and our results confirm that in this field, RPM can allow cost reduction, improve the efficiency of healthcare resources, reduce human error, and overall improve the quality of life of kidney patients.</p></di
慢性肾脏病(CKD)是一个全球性的公共卫生问题,其不良后果包括肾衰竭、心血管疾病(CVD)和过早死亡。根据欧洲肾脏健康联盟(EKHA)的数据,目前每 10 个欧洲人中就有 1 人患有慢性肾脏病(CKD),预计到 2040 年,慢性肾脏病将成为全球第五大死因。COVID-19 大流行使情况进一步恶化,CKD 已成为导致 CKD 死亡的头号风险因素,超过了肺病和心脏病。除了死亡率上升之外,肾脏疾病的治疗方法在过去 50 年中也没有得到实质性的改善,导致太多的肾脏病患者生活质量低下,预期寿命缩短。许多研究证实,信息和通信技术(ICT)在肾脏病学中的应用可以解决这一问题。信息和通信技术(ICT)的日常使用日益增多,可能导致医护人员需要对病人进行远程监控。远程患者监护(RPM)有可能改善肾病患者的护理。RPM 是一种通过数字、无线技术在家中对患者进行监测的框架,它将传统临床环境中的互动接触扩展到了患者家中。人们希望这些技术能通过及早识别和纠正问题来改善临床效果。虽然有关透析人群远程医疗的研究很少,但研究确实支持其技术可行性,患者对该技术的接受度非常高,而且远程医疗可能能够改善 ESKD 患者的其他并发症的治疗效果。泛美卫生组织称,CKD 又称肾衰竭,是指肾功能逐渐丧失,是一个世界性的公共卫生问题,其不良后果包括肾衰竭、心血管疾病和过早死亡。我们的重点是技术贡献。本研究的目的是回顾和综合现有文献,了解 RPM 在肾脏病学医疗保健中的作用。本系统性综述旨在研究有关使用 RPM 改善肾病患者医疗保健的出版物的内容和结果,这些出版物可供医疗保健专业人员(HCP)和/或患者使用。文献和我们的研究结果证实,在这一领域,RPM 可以降低成本,提高医疗资源的效率,减少人为错误,并从整体上提高肾病患者的生活质量。
{"title":"Remote patient monitoring and management in nephrology: A systematic review","authors":"","doi":"10.1016/j.nefro.2024.01.005","DOIUrl":"10.1016/j.nefro.2024.01.005","url":null,"abstract":"&lt;div&gt;&lt;p&gt;Chronic kidney disease (CKD) is a global public health problem, with adverse outcomes of kidney failure, cardiovascular disease (CVD), and premature death. According to European Kidney Health Alliance (EKHA) currently, 1 in 10 Europeans has chronic kidney disease (CKD) and it is predicted to be the fifth leading cause of death worldwide by 2040. The COVID-19, pandemic has further worsened the situation, with CKD being the number one risk factor for CKD mortality, ahead of lung and heart disease. In addition to rising mortality figures, treatments for kidney disease have not improved substantially over the past 50 years, leaving too many kidney patients with a poor quality of life and reduced life expectancy. This situation is associated with staggering aggregate annual costs amounting to €140 billion per year in Europe, more than the annual healthcare costs of cancer or diabetes.&lt;/p&gt;&lt;p&gt;Many studies confirm that Information and Communication Technology intervention (ICT) in nephrology can be way to tackles this issue. The increased daily use of information and communication technologies (ICT) may lead to the need for healthcare professionals to monitoring patient remotely. Remote Patient Monitoring (RPM) have the potential to improve care for patients with kidney disease.&lt;/p&gt;&lt;p&gt;RPM may provide a means to overcome some of the aforementioned barriers. RPM is a framework for monitoring patients at home by digital, wireless technology and extends the interactive contact of conventional clinical settings to include the patient's home. The hope is that these technologies would improve clinical outcomes through earlier recognition and correction of problems. Although few studies on telehealth in the dialysis population exist, studies do support its technical feasibility, which patient acceptance of this technology is very high, and that RPM may be able to improve outcomes in other co-morbid states shared by the ESKD population.&lt;/p&gt;&lt;p&gt;According to Pan American Health Organization, CKD, also called kidney failure, describes the gradual loss of kidney function and is a worldwide public health problem, with adverse outcomes of kidney failure, CVD, and premature death.&lt;/p&gt;&lt;p&gt;This study collects the papers concerning RPM and renal patient management using ICT intervention to analyze the results from considering the bioengineer's point of view. Our focus was on technology contribution.&lt;/p&gt;&lt;p&gt;The aim of this study was to review and synthesize the available literature on the role of RPM in healthcare in nephrology. This systematic review was conducted to examine the content and results of publications on using RPM to improve the health care of patients with kidney disease, available to health care professionals (HCPs) and/or patients. The literature and our results confirm that in this field, RPM can allow cost reduction, improve the efficiency of healthcare resources, reduce human error, and overall improve the quality of life of kidney patients.&lt;/p&gt;&lt;/di","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 639-667"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000055/pdfft?md5=57adc466e049e9af72954e126ab6cd3a&pid=1-s2.0-S0211699524000055-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139814503","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
Nefritis tubulointersticial aguda asociada al tratamiento con estatinas 与他汀类药物治疗相关的急性肾小管间质性肾炎
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2024.03.004
{"title":"Nefritis tubulointersticial aguda asociada al tratamiento con estatinas","authors":"","doi":"10.1016/j.nefro.2024.03.004","DOIUrl":"10.1016/j.nefro.2024.03.004","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 745-747"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000250/pdfft?md5=f3bb6fb8814e731b2245ee2cf329aedc&pid=1-s2.0-S0211699524000250-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279351","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
Soluble αKlotho concentration in the inferior vena cava of patients with primary aldosteronism 原发性醛固酮增多症患者下腔静脉中的可溶性αKlotho浓度
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2024.04.001

Introduction

Klotho, a key aging regulator, is predominantly expressed in the kidney. Various methods now enable the measurement of soluble αKlotho blood levels in humans. Limited studies have explored the renal origin of circulating αKlotho in humans.

Methods

Soluble αKlotho in the inferior vena cava blood was measured using an enzyme-linked immunosorbent assay kit using blood samples from patients undergoing adrenal venous catheterization for close examination of primary aldosteronism.

Results

The concentration at the suprarenal inferior vena cava (476 ± 68.2) was significantly higher than that at the infrarenal inferior vena cava (434 ± 74.8) (p = 0.018), with a rate of change of 8.12 (2.3)%.

Conclusions

We demonstrate a step-up in αKlotho concentration from the infrarenal to suprarenal vena cava in humans, supporting the kidney's origin of soluble αKlotho in the bloodstream.

导言Klotho是一种关键的衰老调节因子,主要在肾脏中表达。目前有多种方法可以测量人体血液中的可溶性αKlotho水平。方法使用酶联免疫吸附测定试剂盒测量下腔静脉血中可溶性αKlotho的含量,采用的血液样本来自接受肾上腺静脉导管插入术以仔细检查原发性醛固酮增多症的患者。2)明显高于肾下腔静脉(434 ± 74.8)(p = 0.018),变化率为 8.12 (2.3)%。结论我们证明了人体αKlotho浓度从肾下腔静脉到肾上腔静脉呈阶梯式上升,支持肾脏是血液中可溶性αKlotho的来源。
{"title":"Soluble αKlotho concentration in the inferior vena cava of patients with primary aldosteronism","authors":"","doi":"10.1016/j.nefro.2024.04.001","DOIUrl":"10.1016/j.nefro.2024.04.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Klotho, a key aging regulator, is predominantly expressed in the kidney. Various methods now enable the measurement of soluble αKlotho blood levels in humans. Limited studies have explored the renal origin of circulating αKlotho in humans.</p></div><div><h3>Methods</h3><p>Soluble αKlotho in the inferior vena cava blood was measured using an enzyme-linked immunosorbent assay kit using blood samples from patients undergoing adrenal venous catheterization for close examination of primary aldosteronism.</p></div><div><h3>Results</h3><p>The concentration at the suprarenal inferior vena cava (476<!--> <!-->±<!--> <!-->68.2) was significantly higher than that at the infrarenal inferior vena cava (434<!--> <!-->±<!--> <!-->74.8) (<em>p</em> <!-->=<!--> <!-->0.018), with a rate of change of 8.12 (2.3)%.</p></div><div><h3>Conclusions</h3><p>We demonstrate a step-up in αKlotho concentration from the infrarenal to suprarenal vena cava in humans, supporting the kidney's origin of soluble αKlotho in the bloodstream.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 623-627"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000341/pdfft?md5=07b73de60ec3f8cc86472e231153608d&pid=1-s2.0-S0211699524000341-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796642","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
Prediabetes and CKD: Does a causal relationship exist 糖尿病前期与慢性肾脏病:是否存在因果关系
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2024.06.008
Jorge Rico Fontalvo , María José Soler , Rodrigo Daza Arnedo , Guillermo Navarro-Blackaller , Ramón Medina-González , Tomas Rodríguez Yánez , Maria Cardona-Blanco , Jose Cabrales-Juan , Isabella Uparrela-Gulfo , Jonathan S. Chávez-Iñiguez

The relationship between diabetes and the development of kidney complications is well known, but the understanding of prediabetes and insulin resistance with impaired kidney function has been scarcely assessed. Various factors could explain this phenomenon, from the lack of standardization in the definitions of prediabetes, to the erratic and inconsistent evidence in large-scale epidemiological and cohort studies. It seems that the pathophysiological pathway of prediabetes could be related to inflammation and neurohormonal hyperactivation, factors present even before the onset of diabetes, which might be the main drivers of glomerular hyperfiltration, albuminuria, and impaired glomerular filtration rate. It is possible that existing treatments for the management of diabetes, as metformin or SGLT2 inhibitors may also be useful in patients with prediabetes with evidence of functional and structural kidney damage. The purpose of this review is to summarize the evidence regarding the relationship between prediabetes (preDM) and the development of CKD.

糖尿病与肾脏并发症之间的关系众所周知,但人们对糖尿病前期和胰岛素抵抗与肾功能受损之间的关系却知之甚少。从糖尿病前期定义缺乏标准化,到大规模流行病学和队列研究中证据的不稳定和不一致,各种因素都可以解释这一现象。糖尿病前期的病理生理途径似乎与炎症和神经激素亢进有关,这些因素甚至在糖尿病发病前就已存在,可能是导致肾小球滤过功能亢进、白蛋白尿和肾小球滤过率受损的主要原因。现有的糖尿病治疗方法,如二甲双胍或 SGLT2 抑制剂,可能也适用于有功能性和结构性肾损害证据的糖尿病前期患者。本综述旨在总结有关糖尿病前期(preDM)与慢性肾脏病发展之间关系的证据。
{"title":"Prediabetes and CKD: Does a causal relationship exist","authors":"Jorge Rico Fontalvo ,&nbsp;María José Soler ,&nbsp;Rodrigo Daza Arnedo ,&nbsp;Guillermo Navarro-Blackaller ,&nbsp;Ramón Medina-González ,&nbsp;Tomas Rodríguez Yánez ,&nbsp;Maria Cardona-Blanco ,&nbsp;Jose Cabrales-Juan ,&nbsp;Isabella Uparrela-Gulfo ,&nbsp;Jonathan S. Chávez-Iñiguez","doi":"10.1016/j.nefro.2024.06.008","DOIUrl":"10.1016/j.nefro.2024.06.008","url":null,"abstract":"<div><p>The relationship between diabetes and the development of kidney complications is well known, but the understanding of prediabetes and insulin resistance with impaired kidney function has been scarcely assessed. Various factors could explain this phenomenon, from the lack of standardization in the definitions of prediabetes, to the erratic and inconsistent evidence in large-scale epidemiological and cohort studies. It seems that the pathophysiological pathway of prediabetes could be related to inflammation and neurohormonal hyperactivation, factors present even before the onset of diabetes, which might be the main drivers of glomerular hyperfiltration, albuminuria, and impaired glomerular filtration rate. It is possible that existing treatments for the management of diabetes, as metformin or SGLT2 inhibitors may also be useful in patients with prediabetes with evidence of functional and structural kidney damage. The purpose of this review is to summarize the evidence regarding the relationship between prediabetes (preDM) and the development of CKD.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 628-638"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000626/pdfft?md5=e3ffb5094768d5e9ef704cea8a6d93bc&pid=1-s2.0-S0211699524000626-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164141","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
Consenso Delphi multidisciplinar sobre retos y factores clave para un modelo óptimo de atención en enfermedad renal crónica 关于慢性肾病护理最佳模式的挑战和关键因素的多学科德尔菲共识
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2024.01.006

Background and Purpose

Chronic kidney disease (CKD) is associated with high morbidity, burden, and resource utilization, and represents a major challenge for healthcare systems. The purpose of this study was to analyse the care patterns for these patients and to reach a consensus on the key factors that should be implemented for an optimal care model in CKD, through a multidisciplinary and integrative vision.

Materials and Methods

A multidisciplinary panel of professionals with experience in the field of CKD was formed, composed of an advisory committee of 15 experts and an additional panel of 44 experts. Challenges and areas for improvement across the continuum of care were identified through review of scientific evidence and individual interviews with the advisory committee. Key factors for an optimal model of care in CKD were agreed and assessed using the Rand/UCLA consensus methodology (adapted Delphi), evaluating their appropriateness and necessity.

Results

38 key factors were identified for an optimal CKD patient care model, organised into four challenges: 1) Development of CKD management models and increased visibility of the disease, 2) Prevention, optimisation of screening, early diagnosis and registration of CKD at all levels of care, 3) Comprehensive, multidisciplinary and coordinated monitoring, ensuring therapeutic optimisation and continuity of care, and 4) Reinforcement of CKD training for health care professionals and patients. 35 key factors were assessed by the panel as adequate and clearly necessary, and of these, 14 were considered highly imperative.

Conclusions

There is consensus on the need to prioritise CKD care at both institutional and societal levels, moving towards optimal models of CKD care based on prevention and early detection of the disease, as well as comprehensive and coordinated patient monitoring and training and awareness-raising at all levels. The key factors identified constitute a roadmap that can be implemented in the different Autonomous Communities and contribute to a significant improvement in the patient's care.

背景和目的 慢性肾脏病(CKD)与高发病率、高负担和高资源利用率有关,是医疗保健系统面临的一项重大挑战。本研究旨在分析这些患者的护理模式,并通过多学科综合视角就 CKD 最佳护理模式应实施的关键因素达成共识。通过对科学证据的审查和与咨询委员会的个别访谈,确定了整个护理过程中面临的挑战和需要改进的地方。采用兰德/加州大学洛杉矶分校的共识方法(改编的德尔菲法),对 CKD 最佳护理模式的关键因素进行了商定和评估,并对其适当性和必要性进行了评价。结果确定了 CKD 患者最佳护理模式的 38 个关键因素,分为四个挑战:1) 发展 CKD 管理模式并提高该疾病的知名度;2) 在各级医疗机构预防、优化筛查、早期诊断和登记 CKD;3) 全面、多学科和协调的监测,确保治疗的优化和护理的连续性;4) 加强对医护人员和患者的 CKD 培训。35个关键因素被专家小组评定为充分且明显必要,其中14个因素被认为非常必要。结论:人们一致认为,有必要在机构和社会层面优先考虑慢性肾脏病护理,在疾病的预防和早期发现、全面协调的患者监测以及各级培训和提高认识的基础上,逐步实现慢性肾脏病护理的最佳模式。所确定的关键因素构成了一个路线图,可在各自治区实施,并有助于显著改善患者护理。
{"title":"Consenso Delphi multidisciplinar sobre retos y factores clave para un modelo óptimo de atención en enfermedad renal crónica","authors":"","doi":"10.1016/j.nefro.2024.01.006","DOIUrl":"10.1016/j.nefro.2024.01.006","url":null,"abstract":"<div><h3>Background and Purpose</h3><p>Chronic kidney disease (CKD) is associated with high morbidity, burden, and resource utilization, and represents a major challenge for healthcare systems. The purpose of this study was to analyse the care patterns for these patients and to reach a consensus on the key factors that should be implemented for an optimal care model in CKD, through a multidisciplinary and integrative vision.</p></div><div><h3>Materials and Methods</h3><p>A multidisciplinary panel of professionals with experience in the field of CKD was formed, composed of an advisory committee of 15 experts and an additional panel of 44 experts. Challenges and areas for improvement across the continuum of care were identified through review of scientific evidence and individual interviews with the advisory committee. Key factors for an optimal model of care in CKD were agreed and assessed using the Rand/UCLA consensus methodology (adapted Delphi), evaluating their appropriateness and necessity.</p></div><div><h3>Results</h3><p>38 key factors were identified for an optimal CKD patient care model, organised into four challenges: 1) Development of CKD management models and increased visibility of the disease, 2) Prevention, optimisation of screening, early diagnosis and registration of CKD at all levels of care, 3) Comprehensive, multidisciplinary and coordinated monitoring, ensuring therapeutic optimisation and continuity of care, and 4) Reinforcement of CKD training for health care professionals and patients. 35 key factors were assessed by the panel as adequate and clearly necessary, and of these, 14 were considered highly imperative.</p></div><div><h3>Conclusions</h3><p>There is consensus on the need to prioritise CKD care at both institutional and societal levels, moving towards optimal models of CKD care based on prevention and early detection of the disease, as well as comprehensive and coordinated patient monitoring and training and awareness-raising at all levels. The key factors identified constitute a roadmap that can be implemented in the different Autonomous Communities and contribute to a significant improvement in the patient's care.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 678-688"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699524000067/pdfft?md5=df26a8e2d7c49604d62335c13096b2e0&pid=1-s2.0-S0211699524000067-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139892594","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
La hipertensión arterial intradiálisis, un diagnóstico por descubrir 椎管内动脉高血压,一种尚未发现的诊断方法
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2023.12.003

Introduction

Intradialytic hypertension (IDH) is a poorly understood phenomenon with no consensus on its definition, etiology, or related factors, and there is limited evidence on its consequences.

Objective

To determine the prevalence of IDH according to different definitions in hemodialysis (HD) units, with different clinical practices and assessment of possible events after 18 months have passed.

Materials and methods

A cross-sectional observational study was conducted in two HD units, including all prevalent patients from March 2021 to September 2022. We established three definitions of IDH: Def 1: Mean arterial pressure (MAP) difference pre- and pos-HD > 15 mmHg. Def 2: Systolic blood pressure (SBP) difference pre- and pos-HD > 10 mmHg. Def 3: SBP difference >0 and ultrafiltration rate (UFR) > 5 ml/kg/h.

IDH was considered present if the criterion was met in more than 50% of the six consecutive sessions (2 weeks) of follow-up. Personal history, medications, dialysis characteristics, and pre- and post-HD biochemical data were collected. Residual renal function (RRF) was considered as urine output >250 ml/24 h. At 18 months, the possible events of the group were analyzed.

Results

We included 169 patients (68% men) with a mean age of 67.9 (14.2) years and a median HD duration of 34.5 (IQR: 17.5-67.5) months. Of these, 94 come from one unit and 75 from the other. The prevalence of IDH was 8.3% according to Def 1, 27.2% according to Def 2, and 29.6% according to Def 3. Def 2 showed an association with a history of previous hypertension, use of renin-angiotensin system inhibitors (RASIs), and furosemide, as well as with patients with RRF. Def 3 showed an association only with coronary artery disease. There was an association with different prescriptions of dialysis fluids. Catecholaminergic hormones and aldosterone did not increase in patients with hypertension during the HD session. They did not present a higher incidence of cardiovascular events or mortality at 18 months.

Conclusions

IDH has different prevalence rates depending on the definition used and the studied center. The future poses an important challenge: to determine which definition correlates with higher morbidity and mortality and the role of differences found in different HD units.

导言血液透析高血压(IDH)是一种鲜为人知的现象,其定义、病因或相关因素尚未达成共识,有关其后果的证据也很有限。目的根据血液透析(HD)单位的不同定义确定 IDH 的患病率,并在 18 个月后对可能发生的事件进行评估。我们确定了三种 IDH 定义:定义 1:HD 前和 HD 后的平均动脉压(MAP)差值为 15 mmHg。定义 2:收缩压(SBP)差值为 10 mmHg。定义 3:SBP 差值为 0,超滤率(UFR)为 5 毫升/千克/小时。如果在连续六次(2 周)随访中,有 50% 以上的时间符合标准,则认为存在 IDH。研究人员收集了个人病史、用药情况、透析特点以及血液透析前后的生化数据。18 个月后,对该组患者可能发生的事件进行了分析。结果 我们纳入了 169 名患者(68% 为男性),平均年龄为 67.9(14.2)岁,中位透析时间为 34.5(IQR:17.5-67.5)个月。其中 94 人来自一个单位,75 人来自另一个单位。根据 Def 1,IDH 患病率为 8.3%;根据 Def 2,患病率为 27.2%;根据 Def 3,患病率为 29.6%。Def 2 与既往高血压病史、使用肾素-血管紧张素系统抑制剂(RASIs)和呋塞米以及 RRF 患者有关。Def 3 仅显示与冠状动脉疾病有关。与不同的透析液处方有关。在血液透析过程中,高血压患者体内的儿茶酚胺激素和醛固酮没有增加。结论 高血压的发病率因所使用的定义和研究中心而异。未来面临的一个重要挑战是:确定哪种定义与较高的发病率和死亡率相关,以及不同 HD 单位的差异所起的作用。
{"title":"La hipertensión arterial intradiálisis, un diagnóstico por descubrir","authors":"","doi":"10.1016/j.nefro.2023.12.003","DOIUrl":"10.1016/j.nefro.2023.12.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Intradialytic hypertension (IDH) is a poorly understood phenomenon with no consensus on its definition, etiology, or related factors, and there is limited evidence on its consequences.</p></div><div><h3>Objective</h3><p>To determine the prevalence of IDH according to different definitions in hemodialysis (HD) units, with different clinical practices and assessment of possible events after 18 months have passed.</p></div><div><h3>Materials and methods</h3><p>A cross-sectional observational study was conducted in two HD units, including all prevalent patients from March 2021 to September 2022. We established three definitions of IDH: Def 1: Mean arterial pressure (MAP) difference pre- and pos-HD<!--> <!-->&gt;<!--> <!-->15<!--> <!-->mmHg. Def 2: Systolic blood pressure (SBP) difference pre- and pos-HD<!--> <!-->&gt;<!--> <!-->10<!--> <!-->mmHg. Def 3: SBP difference &gt;0 and ultrafiltration rate (UFR)<!--> <!-->&gt;<!--> <!-->5<!--> <!-->ml/kg/h.</p><p>IDH was considered present if the criterion was met in more than 50% of the six consecutive sessions (2 weeks) of follow-up. Personal history, medications, dialysis characteristics, and pre- and post-HD biochemical data were collected. Residual renal function (RRF) was considered as urine output &gt;250<!--> <!-->ml/24<!--> <!-->h. At 18 months, the possible events of the group were analyzed.</p></div><div><h3>Results</h3><p>We included 169 patients (68% men) with a mean age of 67.9 (14.2) years and a median HD duration of 34.5 (IQR: 17.5-67.5) months. Of these, 94 come from one unit and 75 from the other. The prevalence of IDH was 8.3% according to Def 1, 27.2% according to Def 2, and 29.6% according to Def 3. Def 2 showed an association with a history of previous hypertension, use of renin-angiotensin system inhibitors (RASIs), and furosemide, as well as with patients with RRF. Def 3 showed an association only with coronary artery disease. There was an association with different prescriptions of dialysis fluids. Catecholaminergic hormones and aldosterone did not increase in patients with hypertension during the HD session. They did not present a higher incidence of cardiovascular events or mortality at 18 months.</p></div><div><h3>Conclusions</h3><p>IDH has different prevalence rates depending on the definition used and the studied center. The future poses an important challenge: to determine which definition correlates with higher morbidity and mortality and the role of differences found in different HD units.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 668-677"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001856/pdfft?md5=084fda49062e59310768449524f5713b&pid=1-s2.0-S0211699523001856-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139195967","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
Arteriovenous fistula in persistent left superior vena cava scenario 左上腔静脉持续存在情况下的动静脉瘘
IF 2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.nefro.2023.11.003
{"title":"Arteriovenous fistula in persistent left superior vena cava scenario","authors":"","doi":"10.1016/j.nefro.2023.11.003","DOIUrl":"10.1016/j.nefro.2023.11.003","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 5","pages":"Pages 757-759"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001741/pdfft?md5=579a47acd342583d9326b821a07b74fd&pid=1-s2.0-S0211699523001741-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139298295","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
期刊
Nefrologia
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1