Showing papers in "Nefrologia in 2020"
TL;DR: The results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology show that age and pneumonia were independently associated with the risk of death; age and the development of pneumonia are factors associated with mortality.
Abstract: Introduction The recent appearance of the SARS-CoV-2 coronavirus pandemic has had a significant impact on the general population. Patients on renal replacement therapy (RRT) have not been unaware of this situation and due to their characteristics they are especially vulnerable. We present the results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology. Material and methods The Registry began operating on March 18th, 2020. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments and outcomes. It is an online registry. Patients were diagnosed with SARS-CoV-2 infection based on the results of the PCR of the virus, carried out both in patients who had manifested compatible symptoms or had suspicious signs, as well as in those who had undergone screening after some contact acquainted with another patient. Results As of April 11, the Registry had data on 868 patients, from all the Autonomous Communities. The most represented form of RRT is in-center hemodialysis (ICH) followed by transplant patients. Symptoms are similar to the general population. A very high percentage (85%) required hospital admission, 8% in intensive care units. The most used treatments were hydroxychloroquine, lopinavir–ritonavir, and steroids. Mortality is high and reaches 23%; deceased patients were more frequently on ICH, developed pneumonia more frequently, and received less frequently lopinavir–ritonavir and steroids. Age and pneumonia were independently associated with the risk of death. Conclusions SARS-CoV-2 infection already affects a significant number of Spanish patients on RRT, mainly those on ICH, hospitalization rates are very high and mortality is high; age and the development of pneumonia are factors associated with mortality.
101 citations
TL;DR: In this paper, the authors describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h).
Abstract: Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19.
52 citations
TL;DR: This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients.
Abstract: The SARS-CoV-2 (Covid-19) coronavirus pandemic is evolving very quickly and means a special risk for both immunosuppressed and comorbid patients. Knowledge about this growing infection is also increasing although many uncertainties remain, especially in the kidney transplant population. This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients.
51 citations
TL;DR: This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients.
Abstract: Resumen La pandemia por coronavirus SARS-CoV-2 (Covid-19) esta evolucionando de manera muy rapida y representa un riesgo especial en pacientes inmunodeprimidos y con comorbilidades anadidas. El conocimiento sobre esta infeccion emergente va tambien en aumento, si bien, aun sigue habiendo muchas incognitas, sobre todo en la poblacion con trasplante renal. Este manuscrito presenta una propuesta de actuacion con recomendaciones generales y especificas para proteger y prevenir de la infeccion a esta poblacion tan vulnerable como son los receptores de un trasplante renal.
44 citations
TL;DR: It is suggested that ferroptosis inhibitors may be explored as prophylactic agents in clinical nephrotoxicity or ischemia-reperfusion injury such as during kidney transplantation.
Abstract: Cell death is a finely regulated process occurring through different pathways Regulated cell death, either through apoptosis or regulated necrosis offers the possibility of therapeutic intervention Necroptosis and ferroptosis are among the best studied forms of regulated necrosis in the context of kidney disease We now review the current evidence supporting a role for ferroptosis in kidney disease and the implications of this knowledge for the design of novel therapeutic strategies Ferroptosis is defined functionally, as a cell modality characterized by peroxidation of certain lipids, constitutively suppressed by GPX4 and inhibited by iron chelators and lipophilic antioxidants There is functional evidence of the involvement of ferroptosis in diverse forms of kidneys disease In a well characterized nephrotoxic acute kidney injury model, ferroptosis caused an initial wave of death, triggering an inflammatory response that in turn promoted necroptotic cell death that perpetuated kidney dysfunction This suggests that ferroptosis inhibitors may be explored as prophylactic agents in clinical nephrotoxicity or ischemia-reperfusion injury such as during kidney transplantation Transplantation offers the unique opportunity of using anti-ferroptosis agent ex vivo, thus avoiding bioavailability and in vivo pharmacokinetics and pharmacodynamics issues
36 citations
TL;DR: The present findings suggest that, CA protects the kidneys against ischemia reperfusion injury via its antioxidant and anti-inflammatory effects.
Abstract: Background and aims Renal ischemia-reperfusion occurs in some clinical conditions such as kidney surgery that can leads to acute renal failure. The aim of this study was to investigate the effect of p-coumaric acid (CA) on ischemia reperfusion (I/R) injury. Methods Thirty rats were randomly divided into five groups; control, CA (100 mg/kg), I/R, propylene glycol (10%) + I/R and CA + I/R, (n = 6 each). CA and propylene glycol were administered orally for 2 weeks. Then, the rats were subjected to bilateral renal ischemia for 45 min and followed by reperfusion for 24 h. All rats were killed and kidney function tests, tissue malondialdehyde and activity of antioxidant enzymes were determined. Histopathological evaluations were also performed. In addition, renal expression of the tumor necrosis factor-α and interleukin-1β were determined using enzyme-linked immunosorbent assay and immunohistochemistry. Results CA significantly improved the Cr and BUN levels in CA + I/R group compared to I/R group (p Conclusions The present findings suggest that, CA protects the kidneys against I/R injury via its antioxidant and anti-inflammatory effects.
31 citations
TL;DR: This manuscript includes a proposal for action to prevent infection in the kidney services, and in particular in hemodialysis, with the objective of early identification of patients who meet the definition of a suspected case of infection by SARS-CoV-2.
Abstract: The current outbreak of SARS-CoV-2 represents a special risk for renal patients due to their comorbidities and advanced age. The usual performance of hemodialysis treatments in collective rooms increases the risk. The specific information at this time in this regard is very limited. This manuscript includes a proposal for action to prevent infection in the Nephrology Services, and in particular in Hemodialysis Units, with the objective of early identification of patients who meet the definition of a suspected case of infection by SARS-CoV-2 and propose circuits and mechanisms to carry out hemodialysis treatments. They are recommendations in continuous review and can be modified if the epidemiological situation, the diagnostic and therapeutic options so require.
27 citations
TL;DR: This manuscript includes a proposal for action to prevent infection in the Nephrology Services and in particular in Hemodialysis Units, with the objective of early identification of patients who meet the definition of a suspected case of infection by SARS-CoV-2 and propose circuits and mechanisms to carry out hemodialysis treatments.
Abstract: Resumen La epidemia de SARS-CoV-2 representa un riesgo especial para los pacientes renales por su condicion de personas con comorbilidades y edad avanzada, y por la realizacion del tratamiento de hemodialisis en salas colectivas. La informacion especifica en el momento actual al respecto es muy limitada. El presente manuscrito recoge una propuesta de actuacion para prevenir la infeccion en los Servicios de Nefrologia, y en particular en las unidades de hemodialisis, con el objetivo de identificar precozmente a los pacientes que cumplan con la definicion de caso sospechoso de infeccion por el SARS-CoV-2 y proponer circuitos y mecanismos para administrarles el tratamiento con hemodialisis. Son recomendaciones en continua revision y podran ser modificadas si la situacion epidemiologica y las opciones diagnostico-terapeuticas asi lo requieren.
23 citations
TL;DR: A high prevalence of COVID-19 with a high percentage being diagnosed by screening is detected and therefore it is necessary to be proactive in the diagnosis to stop the pandemic.
Abstract: Dialysis patients are at risk for SARS-CoV-2 infection and possibly with more complications than other individuals; however, the information available is scarce The objective of the present work is to describe the experience during the first month of the SARS-CoV-2 pandemic in a hemodialysis (HD) unit from a hospital in Madrid serving the 2nd district with the highest incidence of COVID-19 (almost 1,000 patients in 100,000 inhabitants) The information presented includes the actions carried out, the incidence of COVID-19 in HD patients and in health personnel, clinical characteristics and the result of a screening of all patients from the HD unit At the beginning, we had 90 HD patients: 37 (411%) had COVID-19, of which 17 (459%) were diagnosed by symptoms detected in the triage or during the HD session, and 15 (405%) were diagnosed in a subsequent screening of patients in whom the diagnostic test by PCR-SARS-CoV-2 had not been done previously The most frequent symptom was fever, 50% presented lymphopenia and in 184% the O2 saturation was Conclusions We detected a high prevalence of COVID-19 with a high percentage being diagnosed by screening and therefore it is necessary to be proactive in the diagnosis to stop the pandemic Most patients positive for COVID-19 are being managed on an outpatient basis, although severe cases may occur and the mortality so far is 162% Regarding the staff, 20% have required TSL in relation to COVID-19
22 citations
TL;DR: The N/LP ratio at ICU admission was independently associated with in-hospital mortality in septic-AKI patients, and a higher N/ LP ratio was an independent predictor of increased risk of in- Hospital Mortality in sepsis patients regardless of KDIGO stage.
Abstract: Background AKI is frequent in critically ill patients, in whom the leading cause of AKI is sepsis. The role of intrarenal and systemic inflammation appears to be significant in the pathophysiology of septic-AKI. The neutrophils to lymphocytes and platelets (N/LP) ratio is an indirect marker of inflammation. The aim of this study was to evaluate the prognostic ability of N/LP ratio at admission in septic-AKI patients admitted to an intensive care unit (ICU). Methods This is a retrospective analysis of 399 septic-AKI patients admitted to the Division of Intensive Medicine of the Centro Hospitalar Universitario Lisboa Norte between January 2008 and December 2014. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. N/LP ratio was calculated as: (Neutrophil count × 100)/(Lymphocyte count × Platelet count). Results Fifty-two percent of patients were KDIGO stage 3, 25.8% KDIGO stage 2 and 22.3% KDIGO stage 1. A higher N/LP ratio was an independent predictor of increased risk of in-hospital mortality in septic-AKI patients regardless of KDIGO stage (31.59 ± 126.8 vs 13.66 ± 22.64, p = 0.028; unadjusted OR 1.01 (95% CI 1.00–1.02), p = 0.027; adjusted OR 1.01 (95% CI 1.00–1.02), p = 0.015). The AUC for mortality prediction in septic-AKI was of 0.565 (95% CI (0.515–0.615), p = 0.034). Conclusions The N/LP ratio at ICU admission was independently associated with in-hospital mortality in septic-AKI patients.
22 citations
TL;DR: Detailed measures that can be implemented in every country to promote and advance CKD prevention are outlined, including blood pressure optimization and glycemic control, and political efforts are needed to proliferate the preventive approach.
Abstract: The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. Crucially, however, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be it primary, secondary or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers.
TL;DR: The pandemic has clearly impacted clinical activity in Spanish Nephrology departments, reducing elective activity and kidney transplants, and modifying activity in outpatient clinics, and a restructuring and implementation plan in Nephrology focused on telemedicine and/or virtual medicine would seem to be both necessary and very useful in the near future.
Abstract: Resumen La pandemia de la infeccion por el coronavirus tipo 2 del sindrome respiratorio agudo grave o SARS-CoV-2, causante de la enfermedad por coronavirus de 2019 (COVID-19), ha precisado una transformacion drastica de los hospitales y, por consiguiente, de los servicios de Nefrologia de Espana. Desde la Sociedad Espanola de Nefrologia se ha realizado una encuesta a los jefes de servicios de Nefrologia de Espana abordando la reorganizacion de los servicios de Nefrologia y la actividad en la epoca de mayor afectacion por COVID-19. Hemos preguntado por la integracion de los nefrologos en equipos COVID-19, la actividad asistencial de hospitalizacion de Nefrologia (ingresos programados, biopsias renales), la realizacion de cirugias programadas como los accesos vasculares o la implantacion de cateteres peritoneales, la suspension o no del programa de trasplante renal y la transformacion de las consultas externas de Nefrologia. En el trabajo actual se detallan la adaptacion y la transformacion de los servicios de Nefrologia en la pandemia COVID-19 en Espana. Durante dicho periodo se han suspendido los ingresos programados en los servicios de Nefrologia, la realizacion de cirugias/biopsias programadas y ha disminuido en mas de un 75% el programa de trasplante renal. Es de interes mencionar que las consultas externas de Nefrologia se han realizado mayoritariamente telefonicamente. En conclusion, la pandemia ha impactado claramente en la actividad clinica en los servicios de Nefrologia espanoles disminuyendo la actividad programada y los trasplantes renales y modificando la actividad en consultas externas. Un plan de transformacion asistencial e implementacion de telemedicina en Nefrologia parece necesario y de gran utilidad en un futuro proximo.
Journal Article•
TL;DR: The SARS-CoV-2 (Covid-19) coronavirus pandemic is evolving very quickly and means a special risk for both immunosuppressed and comorbid patients as mentioned in this paper.
Abstract: The SARS-CoV-2 (Covid-19) coronavirus pandemic is evolving very quickly and means a special risk for both immunosuppressed and comorbid patients. Knowledge about this growing infection is also increasing although many uncertainties remain, especially in the kidney transplant population. This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients.
TL;DR: The comprehensive nephroprotection and safer profile suggests the melatonin to be a useful adjunct to improve the safety of nephrotoxic drugs.
Abstract: Background Drug-induced nephrotoxicity is a frequent adverse event that can lead to acute or chronic kidney disease and increase the healthcare expenditure. It has high morbidity and mortality incidence in 40–70% of renal injuries and accounts for 66% cases of renal failure in elderly population. Objective Amelioration of drug-induced nephrotoxicity has been long soughed to improve the effectiveness of therapeutic drugs. This study was conducted to review the melatonin potential to prevent the pathogenesis of nephrotoxicity induced by important nephrotoxic drugs. Methods We analyzed the relevant studies indexed in Pubmed, Medline, Scielo and Web of science to explain the molecular improvements following melatonin co-administration with special attention to oxidative stress, inflammation and apoptosis as key players of drug-induced nephrotoxicity. Results A robust consensus among researchers of these studies suggested that melatonin efficiently eradicate the chain reaction of free radical production and induced the endogenous antioxidant enzymes which attenuate the lipid peroxidation of cellular membranes and subcellular oxidative stress in drug-induced nephrotoxicity. This agreement was further supported by the melatonin role in disintegration of inflammatory process through inhibition of principle pro-inflammatory or apoptotic cytokines such as TNF-α and NF-κB. These studies highlighted that alleviation of drug-induced renal toxicity is a function of melatonin potential to down regulate the cellular inflammatory and oxidative injury process and to stimulate the cellular repair or defensive mechanisms. Conclusion The comprehensive nephroprotection and safer profile suggests the melatonin to be a useful adjunct to improve the safety of nephrotoxic drugs.
TL;DR: The objective of this study is to review the clinical trials on physical exercise in patients with CKD and describe its effect on the progression of kidney disease and other factors associated.
Abstract: Physical exercise may offer multiple benefits to patients with chronic kidney disease (CKD). However, it was not traditionally recommended because of the possibility of impairing renal function and increasing proteinuria. The objective of this study is to review the clinical trials on physical exercise in patients with CKD and describe its effect on the progression of kidney disease and other factors associated. Randomized clinical trials (RCT) comparing an intervention that included an exercise component with a control group without physical exercise in non-dialysis patients with CKD from 2007 to 2018 in English and Spanish were included. PubMed, Scopus, Embase, Ovid (Medline) and PEDro databases were used for the search. Effects of physical exercise were summarized by the standardized mean difference (SMD). No differences were found in glomerular filtration rate or proteinuria between the intervention group and the control group: SMD -0.3 (P=.81); SMD 26.6 (P=.82). Positive effects were obtained on peak oxygen consumption: SMD 2.5 (P<.001), functional capacity: SMD 56.6 (P<.001), upper limb strength: SMD 6.8 (P<.001) and hemoglobin: SMD 0.3 (P=.003). An improvement on the quality of life was also evident using the KDQOL-36 survey: SMD 3.56 (P=.02) and the SF-36 survey: SMD 6.66 (P=.02). In conclusion, the practice of low-intensity physical exercise routinely has no negative impact on renal function. On the contrary, it improves aerobic and functional capacity, impacting positively on the quality of life.
TL;DR: This review of literature discusses kidney injury associated with the use of AAS and ADE, highlighting the mechanisms of acute and chronic renal lesion, such as direct renal toxicity, glomerular hyperfiltration and hypercalcemia.
Abstract: The excessive chase for beauty standards and the rise of muscle dysmorphia have ultimately led to an increase in androgenic-anabolic steroids (AAS) and intramuscular injections of vitamins A, D and E (ADE) abuse, which is associated with several adverse effects and has become a public health issue. This review of literature discusses kidney injury associated with the use of AAS and ADE, highlighting the mechanisms of acute and chronic renal lesion, such as direct renal toxicity, glomerular hyperfiltration and hypercalcemia. Future perspectives regarding evaluation and early diagnosis of kidney injury in these patients are also discussed.
TL;DR: There is a critical need for guidelines and best clinical practice models from major cardiology and nephrology professional societies, as well as for research funding in both specialties to focus on the needs of future therapies for HF in CKD patients.
Abstract: Patients with the dual burden of chronic kidney disease (CKD) and chronic congestive heart failure (HF) experience unacceptably high rates of symptom load, hospitalization, and mortality. Currently, concerted efforts to identify, prevent and treat HF in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this review paper endorse the need for a dedicated cardiorenal interdisciplinary team that includes nephrologists and renal nurses and jointly manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for guidelines and best clinical practice models from major cardiology and nephrology professional societies, as well as for research funding in both specialties to focus on the needs of future therapies for HF in CKD patients. The implementation of cross-specialty educational programs across all levels in cardiology and nephrology will help train future specialists and nurses who have the ability to diagnose, treat, and prevent HF in CKD patients in a precise, clinically effective, and cost-favorable manner.
TL;DR: El objetivo del estudio es revisar los ensayos sobre ejercicio en pacientes con ERC y describir su impacto sobre the progresion of the enfermedad renal y otros factores asociados.
Abstract: Resumen El ejercicio fisico podria ofrecer multiples beneficios al paciente con enfermedad renal cronica (ERC). No obstante, tradicionalmente no se recomendaba por la posibilidad de deteriorar la funcion renal y aumentar la proteinuria. El objetivo del estudio es revisar los ensayos sobre ejercicio en pacientes con ERC y describir su impacto sobre la progresion de la enfermedad renal y otros factores asociados. Se seleccionaron ensayos clinicos aleatorizados desde 2007 a 2018, en ingles y en espanol, que compararan un grupo intervencion con un componente de ejercicio con un grupo control sin ejercicio fisico en pacientes con ERC en predialisis. Para la busqueda se emplearon las bases de datos PubMed, Scopus, Embase, Ovid (Medline) y PEDro. Los efectos del ejercicio sobre las variables analizadas se resumieron calculando la diferencia de medias estandarizada (DME). No se encontraron diferencias en el filtrado glomerular ni en la proteinuria entre el grupo intervencion y el grupo control (DME: −0,3; p = 0,81; DME: 26,6; p = 0,82). Se obtuvieron efectos positivos sobre el consumo pico de oxigeno (DME: 2,5; p
Journal Article•
TL;DR: This manuscript includes a proposal for action to prevent infection in the Nephrology Services, and in particular in Hemodialysis Units, with the objective of early identification of patients who meet the definition of a suspected case of infection by SARS-CoV-2 and propose circuits and mechanisms to carry out hemodialysis treatments.
Abstract: The current outbreak of SARS-CoV-2 represents a special risk for renal patients due to their comorbidities and advanced age. The usual performance of hemodialysis treatments in collective rooms increases the risk. The specific information at this time in this regard is very limited. This manuscript includes a proposal for action to prevent infection in the Nephrology Services, and in particular in Hemodialysis Units, with the objective of early identification of patients who meet the definition of a suspected case of infection by SARS-CoV-2 and propose circuits and mechanisms to carry out hemodialysis treatments. They are recommendations in continuous review and can be modified if the epidemiological situation, the diagnostic and therapeutic options so require.
TL;DR: This manuscript contains a proposal for action to prevent infection of professionals in the Nephrology Services, one of the most valuable assets at the present time.
Abstract: The COVID-19 epidemic represents a special risk for kidney patients due to their comorbidities and advanced age, and the need for hemodialysis treatment in group rooms. It also represents a risk for professionals responsible for their attention. This manuscript contains a proposal for action to prevent infection of professionals in the Nephrology Services, one of the most valuable assets at the present time.
TL;DR: The capacity of olfactory perception is affected in patients with chronic kidney disease, and whether these alterations improve after dialysis is disputed, and one important consequence of such impairment is the potential impact on the patient's nutritional status.
Abstract: Alterations in the sense of smell (dysosmia, anosmia, hyposmia) are frequently experienced by patients with chronic kidney disease. However, currently, the aetiology and consequences are poorly understood, with no effective treatments available to address such impairment. In general, the capacity of olfactory perception is affected in patients with chronic kidney disease (even in those who have not undergone dialysis therapy), and whether these alterations improve after dialysis is disputed. Patients in peritoneal dialysis and haemodialysis have the same olfactory perception defects. Kidney transplantation improves olfactory perception, and one important consequence of such impairment is the potential impact on the patient's nutritional status.
Journal Article•
TL;DR: The experience of the first month of the SARS-Cov2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID19 is described, with some clinical characteristics and the results of screening all the patients in the unit.
Abstract: Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O2 saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19.
TL;DR: Determinar los datos clinicos y analiticos predictores de ND, y elaborar un modelo predictivo (score) para confirmar o descartar ND y enfermedad renal no diabetica (ERND) y conclusiones la ERND es frecuente en pacientes con DM.
Abstract: Resumen Introduccion La nefropatia diabetica (ND) es una complicacion frecuente de la diabetes mellitus (DM), y su diagnostico suele ser clinico. Sin embargo, en numerosas ocasiones la enfermedad renal que presentan los pacientes diabeticos es debida a otras causas cuyo diagnostico es histologico. El objetivo del estudio fue determinar los datos clinicos y analiticos predictores de ND y enfermedad renal no diabetica (ERND), y elaborar un modelo predictivo (score) para confirmar o descartar ND. Material y metodos Estudio observacional, transversal y retrospectivo de biopsias renales realizadas en pacientes diabeticos tipo 2 entre 2000 y 2018. Resultados Se incluyeron 207 pacientes diabeticos con una edad media de 64,5 ± 10,6 anos; el 74% eran varones. La biopsia mostro ND en 126 (61%) y en 81 ERND (39%). La retinopatia diabetica estaba presente en el 58% de los pacientes con ND y en el 6% del grupo con ERND (p 3 era tenian ND, y el 94% de los casos con score ≤ 1 punto fueron ERND. Conclusiones La ERND es frecuente en pacientes con DM (39%). La etiologia mas frecuente son las glomerulonefritis primarias. La ausencia de retinopatia y la presencia de microhematuria son altamente sugestivas de ERND. La utilizacion de un sistema de puntuacion facilita la indicacion de biopsia renal en pacientes diabeticos.
TL;DR: The pandemic has clearly impacted clinical activity in Spanish Nephrology departments, reducing elective activity and kidney transplants, and modifying activity in outpatient clinics, and a restructuring and implementation plan in Nephrology focused on telemedicine and/or virtual medicine would seem to be both necessary and very useful in the near future.
Abstract: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has required a rapid and drastic transformation of hospitals, and consequently also of Spanish Nephrology Units, to respond to the critical situation. The Spanish Society of Nephrology conducted a survey directed to the Heads of Nephrology Departments in Spain that addressed the reorganisation of Nephrology departments and activity during the peak of COVID-19 pandemic. The survey focused on the integration of nephrologists in COVID-19 teams, nephrology inpatient care activities (elective admissions, kidney biopsies), the performance of elective surgeries such as vascular accesses or implantation of peritoneal catheters, the suspension of kidney transplantation programmes and the transformation of nephrology outpatient clinics. This work details the adaptation and transformation of nephrology services during the COVID-19 pandemic in Spain. During this period, elective admissions to Nephrology Services, elective surgeries and biopsies were suspended, and the kidney transplant programme was scaled back by more than 75%. It is worth noting that outpatient nephrology consultations were carried out largely by telephone. In conclusion, the pandemic has clearly impacted clinical activity in Spanish Nephrology departments, reducing elective activity and kidney transplants, and modifying activity in outpatient clinics. A restructuring and implementation plan in Nephrology focused on telemedicine and/or virtual medicine would seem to be both necessary and very useful in the near future.
TL;DR: Paricalcitol treatment might be profitable in regulating inflammatory and anticalcificant parameters, unmodified calcium or phosphorus seric levels and preserving kidney function in renal patients with no dialysis.
Abstract: Resumen Antecedentes La principal causa de morbimortalidad en el paciente con enfermedad renal cronica (ERC) es la cardiovascular. La inflamacion y las alteraciones en el metabolismo oseo-mineral en estos pacientes conllevan aumento del riesgo cardiovascular. Objetivos Valorar el papel de paricalcitol sobre distintos parametros sericos relacionados con inflamacion, fibrosis y enfermedad oseo-mineral en la ERC. Material y metodos Estudio prospectivo, no controlado en 46 pacientes con ERC estadios III-V sin dialisis, con niveles elevados de paratohormona, segun su estadio de ERC, por lo que se introdujo tratamiento con el analogo de vitamina D paricalcitol. Durante 4 meses de tratamiento valoramos los parametros clasicos y novedosos del metabolismo oseo-mineral en suero (calcio, fosforo, paratohormona, factor de crecimiento fibroblastico-23 [FGF-23], Klotho y calcidiol) y parametros relacionados con el proceso de inflamacion-fibrosis y anticalcificantes (interleucina-6 y 10, factor de necrosis tumoral alfa [TNF-a], factor de crecimiento transformante beta [TGF-b], proteina osea morfogenica-7 [BMP-7], y fetuina-A). Resultados Tras el uso de paricalcitol los niveles de Klotho aumentaron (p = 0,001) y los de FGF-23 se mantuvieron estables al igual que los de calcio y fosforo; calcidiol aumento de forma significativa (p = 0,010) y paratohormona descendio (p = 0,002). Los parametros de inflamacion, fibrosis y calcificacion mostraron una regulacion benigna con descenso significativo de interleucina-6 (p = 0,001), TNF-α (p = 0,005) y TGF-β (p = 0,001) y aumento de BMP-7 (p = 0,001), fetuina-A (p = 0,001) e interleucina-10 (p = 0,001). El filtrado glomerular y la proteinuria se mantuvieron estables. Conclusiones El tratamiento con paricalcitol en el paciente renal sin dialisis parece ser beneficioso en la regulacion de los parametros inflamatorios y anticalcificantes, preservando la funcion renal y el eje oseo-mineral. Los marcadores elegidos en nuestro estudio podrian indicarnos un efecto positivo de paricalcitol a nivel vascular.
TL;DR: The joint application of measures, including patient screening, the early investigation of possible cases, the isolation of confirmed, investigational or contact cases, as well as the use of individual protection measures, has enabled the COVID-19 epidemic to be controlled.
Abstract: The experience of a tertiary hospital and four hemodialysis centers attached to it during the COVID-19 epidemic is described. The organization of care that has been carried out and the clinical course of the 16cases of COVID-19 in hemodialysis patients are summarized. The joint application of measures, including patient screening, the early investigation of possible cases, the isolation of confirmed, investigational or contact cases, as well as the use of individual protection measures, has enabled the epidemic to be controlled. The clinical course of these 16patients is compared with the series published by the Wuhan University Hospital and with the data from the COVID-19 infection registry of the Spanish Society of Nephrology. In our experience, and unlike what was reported by the Wuhan Center, COVID-19 disease in hemodialysis patients is severe in a significant percentage of cases, and high lethality is mostly caused by the infection itself. Measures to contain the epidemic are effective.