Repetición de la medición de creatinina sérica en atención primaria: no todos tienen insuficiencia renal crónica

ResumenObjetivoEvaluar la prevalencia de la insuficiencia renal en los pacientes de un centro médico de un área básica de salud que disponen de determinaciones analíticas de creatinina sérica.DiseñoEstudio descriptivo observacional transversal.Fuentes de datosÁrea básica de salud con 23.807 usuarios de ≥18 años de edad.ResultadosLa prevalencia de la insuficiencia renal entre los 17.240 pacientes que disponían de, al menos, una analítica fue del 8,5%, con una media de edad de 77,6±12,05 años. Un 33,2% de los afectados presentaba una insuficiencia renal oculta, siendo un 98,8% mujeres.La prevalencia de la insuficiencia renal crónica entre los 10.011 pacientes que disponían de al menos 2 analíticas separadas por ≥ de 3 meses fue del 5,5%, siendo su media de edad de 80,1±10,0 años (el grupo más afectado fue el de 75 a 84 años), un 59,7% hombres, y un 76,3% de los casos con estadio 3. Un 5,3% de los afectados presentaban una insuficiencia renal oculta, el 86,2% de estos eran mujeres (se calculaba un filtrado glomerular < 60ml/min ya con niveles de creatinina plasmática de 0,9mg/dl).ConclusionesLa comparación de los resultados actuales con los previos reportados pone de manifiesto la necesidad de realizar nuevos estudios de prevalencia de la insuficiencia renal global, crónica y oculta en España para poder valorar el alcance real de la enfermedad. El médico de atención primaria juega un papel fundamental en la detección, tratamiento, control y registro de la enfermedad (en la historia clínica). La fórmula MDRD resulta útil y práctica para estimar el filtrado glomerular.AbstractObjectiveTo assess the prevalence of kidney failure in patients from a primary care centre in a basic healthcare district with laboratory availability allowing serum creatinine measurements.DesignAn observational descriptive cross-sectional study.Data sourcesA basic healthcare district serving 23,807 people aged ≥ 18 years.ResultsPrevalence of kidney failure among 17,240 patients having at least one laboratory measurement available was 8.5% (mean age 77.6±12.05 years). In 33.2% of such patients an occult kidney failure was found (98.8% were women).Prevalence of chronic kidney failure among 10,011 patients having at least 2 laboratory measurements available (≥ 3 months apart) was 5.5% with mean age being 80.1±10.0 years (most severely affected patients were those aged 75 to 84); 59.7% were men and 76.3% of cases were in stage 3. An occult kidney failure was found in 5.3% of patients with women being 86.2% of them (a glomerular filtration rate<60ml/min was estimated for plasma creatinine levels of 0.9mg/dl or higher).ConclusionsComparison of present findings to those previously reported demonstrates the need for further studies on the prevalence of overall (chronic and acute) kidney failure in Spain in order to estimate the real scope of the disease. Primary care physicians play a critical role in disease detection, therapy, control and recording (in medical records). MDRD equation is useful and practical to estimate glomerular filtration rate

Evaluación de la aorta infrarenal y cribado del aneurisma de aorta abdominal mediante la ecocardiografía transtorácica en pacientes visitados en cardiología

La creciente incidencia del aneurisma de aorta abdominal (AAA) y su mortalidad del 85-90%, en caso de rotura, justifican el realizar un diagnóstico y tratamiento reparador precoces. Este estudio incluyó a 687 pacientes consecutivos estudiados mediante ecocardiografía transtorácica (ETT), por cualquier causa, en el servicio de cardiología. Se detectó un AAA en 28 pacientes (4,2%), siendo sus factores de riesgo el ser fumador o ex fumador, la edad, el presentar un soplo femoral y las mayores dimensiones de la aorta suprarenal y del cayado. Conclusiones: el completar la ETT convencional con el estudio de la aorta infrarenal es factible y útil para realizar cribado del AAA en los pacientes visitados en cardiología. El cribado debería realizarse principalmente en pacientes con factores de riesgo para desarrollar un AAA (especialmente si son ³ 55 años) y en aquellos con una alta puntuación en los índices de riesgo del AAA calculados.The increasing incidence of abdominal aortic aneurysm (AAA) and its mortality of 85- 90% in the event of rupture justify opting for early diagnosis and elective treatment to repair it. So, this study included 687 patients consecutively assessed by transthoracic echocardiography (TTE) for any reason in a cardiology department. An AAA was detected in 28 patients (4,2%), and the risk factors associated were to current and former smoking, age, presence of femoral murmur and a largest suprarenal aorta and aortic arch dimensions . Conclusions: It is feasible and useful to complement conventional TTE with the study of the infrarenal aorta for AAA screening in patients visited at the department of cardiology. This study should be performed mainly in patients with risk factors to develop an AAA (specially if they are ³ 55 years old) and in patients with a high punctuation in the calculated risk scores of AA

Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment : Study of a Population Cohort ≥65 Years of Age

To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline. It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated. The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19. Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive statu

Blood-biomarkers and devices for atrial fibrillation screening : Lessons learned from the AFRICAT (Atrial Fibrillation Research In CATalonia) study

AFRICAT is a prospective cohort study intending to develop an atrial fibrillation (AF) screening program through the combination of blood markers, rhythm detection devices, and long-term monitoring in our community. In particular, we aimed to validate the use of NT-proBNP, and identify new blood biomarkers associated with AF. Also, we aimed to compare AF detection using various wearables and long-term Holter monitoring. 359 subjects aged 65-75 years with hypertension and diabetes were included in two phases: Phase I (n = 100) and Phase II (n = 259). AF diagnosis was performed by baseline 12-lead ECG, 4 weeks of Holter monitoring (Nuubo TM), and/or medical history. An aptamer array including 1310 proteins was measured in the blood of 26 patients. Candidates were selected according to p-value, logFC and biological function to be tested in verification and validation phases. Several screening devices were tested and compared: AliveCor, Watch BP, MyDiagnostick and Fibricheck. AF was present in 34 subjects (9.47%). The aptamer array revealed 41 proteins with differential expression in AF individuals. TIMP-2 and ST-2 were the most promising candidates in the verification analysis, but none of them was further validated. NT-proBNP (log-transformed) (OR = 1.934; p<0.001) was the only independent biomarker to detect AF in the whole cohort. Compared to an ECG, WatchBP had the highest sensitivity (84.6%) and AUC (0.895 [0.780-1]), while MyDiagnostick showed the highest specificity (97.10%). The inclusion and monitoring of a cohort of primary care patients for AF detection, together with the testing of biomarkers and screening devices provided useful lessons about AF screening in our community. An AF screening strategy using rhythm detection devices and short monitoring periods among high-risk patients with high NT-proBNP levels could be feasible

Lipid-lowering drugs in ischaemic heart disease : a quasi-experimental uncontrolled before-and-after study of the effectiveness of clinical practice guidelines

Background: Cardiovascular diseases(CVD), specifically ischaemic heart disease(IHD), are the main causes of death in industrialized countries. Statins are not usually prescribed in the most appropriate way. To ensure the correct prescription of these drugs, it is necessary to develop, disseminate and implement clinical practice guidelines(CPGs), and subsequently evaluate them. The main objective of this study is to evaluate the effectiveness of the implementation of consensual Lipid-lowering drugs (LLD) prescription guidelines in hospital and primary care settings, to improve the control of Low-Density Lipoprotein Cholesterol (LDL-C) levels in patients with IHD in the Terres de l'Ebre region covered by the Catalonian Health Institute. Secondary bjectives are to assess the improvement of the prescription profile of these LLDs, to assess cardiovascular morbimortality and the professional profile and participant centre characteristics that govern the control of LDL-C. Methods/Design Design: Quasi-experimental uncontrolled before and after study. The intervention consists of the delivery of training strategies for guideline implementation (classroom clinical sessions and on-line courses) aimed at primary care and hospital physicians. The improvement in the control of LDL-C levels in the 3,402 patients with IHD in our territory is then assessed. Scope: Primary care physicians from 11 basic health areas(BHAs) and two hospital services (internal medicine and cardiology). Sample: 3,402 patients registered with IHD in the database of the Catalan Institute of Health(E-cap) before December 2008 and patients newly diagnosed during 2009-2010. Variables: Percentage of patients achieving good control of LDL-C, measured in milligrams per decilitre. The aim of the intervention is to achieve levels of LDL-C < 100 mg/dl in patients with IHD. Secondary variables measure type and time of diagnosis of IHD, type and dose of prescribed cholesterol-lowering drugs, level of physician participation in training activities and their professional profile. Discussion: The development of prescription guidelines previously agreed by various medical specialists involved in treating IHD patients have usually improved drug prescription. The guideline presented in this study aims to improve the control of LDL-C by training physicians through presential and on-line courses on the dissemination of this guideline, and by providing feedback on their personal results a year after this training intervention

Top table of the differential expressed proteins between AF and no AF

S1 Table: Top table of the differential expressed proteins between AF and no AF. Results from the discovery study.Results from the discovery study. Proteins selected to be verified in the whole Phase 1 are highlighted in grey. Proteins in bold but not highlighted were already tested in the whole phase 1 as part of a previous published work.Peer reviewe