Methotrexate nephrotoxicity in a patient with preserved renal function. Case report

Introducción: El metotrexato es un fármaco con propiedades quimioterapéuticas usa-do de forma frecuente para el tratamiento de ciertos tipos de cáncer. A continuación, se presenta un caso clínico que, a conocimiento de los autores, es el primer reporte en Colombia sobre nefrotoxicidad por este medicamento, así como sus consecuencias y el manejo que se le dio en un hospital de cuarto nivel. Presentación del caso: Hombre de 71 años con diagnóstico de linfoma no Hodgkin y función renal normal, quien se sometió a tratamiento quimioterapéutico (metotrexato a altas dosis por vía endovenosa) y desarrolló insuficiencia renal aguda estadio 3 según las guías KDIGO, la cual muy probablemente se relacionaba al consumo de metotrexato. El paciente recibió manejo con líquidos endovenosos y bicarbonato de sodio como promotores de la eliminación renal del tóxico, así como folinato cálcico oral, según el protocolo institucional, con lo cual se logró la recuperación de su función renal y que los niveles de niveles de creatinina y nitrógeno ureico mejoraran. Conclusiones: El manejo del paciente reportado demuestra que aunque la nefrotoxicidad por metotrexato es una entidad potencialmente grave, puede tener un buen pronóstico si se maneja oportunamente.Pacientes con Nefrotoxicidad por metotrexatoIntroduction: Methotrexate is a drug with chemotherapeutic properties frequently used for the treatment of certain types of cancer. The following is a clinical case which, to the best of the authors’ knowledge, is the first report in Colombia on nephrotoxicity caused by this drug and describes the consequences as well as the treatment provided at a quaternary care hospital. Case report: A 71-year-old patient with a diagnosis of non-Hodgkin’s lymphoma with normal renal function underwent chemotherapy (high-dose methotrexate intravenously) and developed stage 3 acute renal failure according to the KDIGO guidelines, which was most likely related to methotrexate intake. The patient received treatment with intravenous fluids and sodium bicarbonate as promoters of urine excretion of the toxin, and oral calcium folinate following the institutional protocol. The patient was discharged with recovery of kidney function and improved creatinine and urea nitrogen levels. Conclusion: The treatment given to the patient in this case report shows that although methotrexate nephrotoxicity is a potentially serious entity, it can have a good prognosis if treated promptly.https://orcid.org/0000-0002-2946-1877https://orcid.org/0000-0001-9852-749Xhttps://orcid.org/0000-0002-9085-1719Revista Nacional - No indexadaN

Renal compromise in tuberous sclerosis patient

La esclerosis tuberosa es una enfermedad hereditaria, autosómica dominante y multisistémica, que cursa generalmente con crisis de epilepsia, retraso mental y tumores benignos en el cerebro y en otros órganos vitales como riñones, corazón, ojos, pulmones y piel. Objetivo. Describir las características clínicas y la evolución de un paciente con esclerosis tuberosa. Diseño. Reporte de caso. Materiales y métodos. Se revisó y describió la historia clínica de un paciente que fue hospitalizado en el Hospital Universitario San Ignacio para trasplante renal de donante cadavérico con enfermedad renal estado 5, con antecedentes de esclerosis tuberosa. Posteriormente, se revisó la literatura existente acerca de «esclerosis tuberosa y trasplante renal” en PubMed, Ovid y Highwire. Conclusiones. La esclerosis tuberosa es una enfermedad poco común en nuestro medio, con compromiso renal dado por angiomiolipomas, con progresión a falla renal y estado terminal,que requiere soporte dialítico, a mediano plazo.Reporte de caso157-165PacientesTuberous sclerosis is an hereditary disease, autosomic dominant, multisystemic which appears with epileptic crisis, mental retardation, and benign tumors in brain and other vital organs such as kidneys, heart, eyes, lungs and skin. Objective. To describe the clinical characteristics and evolution of a patient with tuberous sclerosis. Design. Case report. Materials y methods. The medical record of a patient which was hospitalized at the Hospital Universitario San Ignacio for a cadaverous donor renal transplant with renal disease state 5 with tuberous sclerosis and kidney compromise was reviewed and described. Subsequently, existant literature of “tuberous sclerosis and renal transplant” in PubMed, Ovid and Highwire was reviewed. Conclusions. Tuberous sclerosis disease is not a common disease amongst us, with renal compromise given by angiomyolipomas, and progression to terminal state by renal failure, requiring dialysis support in the short term

Mycobacterium tuberculosis and Cytomegalovirus Colitis in a Renal Transplant Patient: A Case Report

Q3Q2Pacientes con trasplante de riñónPacientes con Infección por citomegalovirusPacientes con Diarrea crónicaChronic diarrhea is a common reason for consultation in renal transplant patients. Cytomegalovirus infection is the cause of chronic diarrhea of infectious origin in 50% of cases, but coinfection with tuberculosis is rare. We present the case of a renal transplant patient with chronic diarrhea, with a finding of left colon colitis and positive microbiological studies in biopsy for tuberculosis and cytomegalovirus. The patient received valganciclovir and anti-tubercular treatment with adequate evolution. Immunosuppressed patients may have diarrhea secondary to opportunistic infections; therefore, an algorithm for early diagnosis and treatment is recommended.https://orcid.org/0000-0002-8892-9652https://orcid.org/0000-0001-9852-749Xhttps://orcid.org/0000-0002-4069-3230https://orcid.org/0000-0002-6772-2943https://orcid.org/0000-0002-4100-3529Revista Internacional - IndexadaBS

A comparative study on graft and overall survival rates between diabetic and nondiabetic kidney transplant patients through survival analysis

Q3Q2Pacientes con trasplante de riñónBackground: Patients with diabetes mellitus (DM) have worse graft and overall survival, but recent evidence suggests that the difference is no longer significant. Objective: To compare the outcomes between patients with end-stage kidney disease due to DM (ESKD-DM) and ESKD due to nondiabetic etiology (ESKD-non-DM) who underwent kidney transplantation (KT) up to 10 years of follow-up. Design: Survival analysis of a retrospective cohort. Setting and Patients: All patients who underwent KT at the Hospital Universitario San Ignacio, Colombia, between 2004 and 2022. Measurements: Overall and graft survival in ESKD-DM and ESKD-non-DM who received KT. Patients who died with functional graft were censored for the calculation of kidney graft survival. Methods: Log-rank test, Cox proportional hazards model, and competing risk analysis were used to compare overall and graft survival in patients with ESKD-DM and ESKD-non-DM who underwent KT. Results: A total of 375 patients were included: 60 (16%) with ESKD-DM and 315 (84%) with ESKD-non-DM. Median follow-up was 83.3 months. Overall survival was lower in patients with ESKD-DM at 5 (75.0% vs 90.8%, P < .001) and 10 years (55.0% vs 86.7%, P < .001). Cardiovascular death was higher in patients with diabetes (27.3% vs 8.2%, P = .021). Death-censored graft survival was similar in both groups (96.7% vs 93.3% at 5 years, P = .324). On multivariate analysis, the factors associated with global survival were DM (hazard ratio [HR] = 2.11, 95% confidence interval [CI] = 1.23-3.60, P = .006), recipient age (HR = 1.05, 95% CI = 1.02-1.08, P < .001), delayed graft function (HR = 2.07, 95% CI = 1.24-3.46, P = .005), and donor age (HR = 1.03, 95% CI = 1.01-1.05, P = .002). In the competing risk analysis, DM was associated with mortality only in the cardiovascular death group (sub-hazard ratio [SHR] = 6.06, 95% CI = 1.01-36.4, P = .049). Limitations: Change in diabetes treatment received over time and adherence to glycemic targets were not considered. The sample size is relatively small, which limits the precision of our estimates. The Kidney Donor Profile Index and the occurrence of treated acute rejection were not included in the regression models. Conclusion: Overall survival is lower in patients with diabetes, possibly due to older age and cardiovascular comorbidities. Therefore, patients with diabetes should be followed more closely to control cardiovascular risk factors. However, there is no difference in graft survival.https://orcid.org/0000-0001-9852-749Xhttps://orcid.org/0000-0001-6563-2939https://orcid.org/0000-0002-5301-8381https://orcid.org/0000-0003-0077-6119https://orcid.org/0000-0001-5401-0018https://orcid.org/0000-0001-6967-3375Revista Internacional - IndexadaA2S

Prediction of onset of acute kidney injury after cardiovascular surgery at the intensive care unit of Hospital San Ignacio

Objetivo: identificar pacientes de alto riesgo de presentar injuria renal aguda en el posoperatorio de cirugía cardiovascular en la unidad de cuidados intensivos del Hospital Universitario San Ignacio. Contexto y tipo de estudio: la población de referencia estuvo conformada por aquellos pacientes atendidos en el Hospital San Ignacio de la ciudad de Bogotá, institución de IV nivel de complejidad, con una población estudio conformada por aquellos pacientes que ingresaron a la unidad de cuidados intensivos en posoperatorio inmediato de cirugía cardiovascular. Material y métodos: estudio observacional descriptivo, retrospectivo, tipo serie de casos. La información fue recolectada por los investigadores a partir de la revisión de las historias clínicas, es decir, a partir de una fuente secundaria. Dicha recolección se realizó teniendo en cuenta un formulario diseñado para ese fin, el cual incluye datos generales y datos de las variables de la escala de predicción, registrando los datos generales de cada uno de los pacientes, incluyendo antecedentes personales y las variables de la escala de predicción. Durante la recolección de información se fue conformando la base de datos, la cual fue debidamente revisada y depurada, y posteriormente analizada utilizando el programa Epi Info 2000. Resultados: se analizaron 213 pacientes que ingresaron a la unidad de cuidado intensivo del Hospital Universitario San Ignacio en el posoperatorio inmediato de CVC. Entre los pacientes analizados la incidencia de IRA fue 3.3% (n=7) los cuales fueron sometidos a TRR. Estos pacientes tuvieron una creatinina posterior al procedimiento significativamente más alta (p=0.000). Entre los pacientes que requirieron TRR se encontró una proporción significativamente mayor de casos con una FEVI menor a 40% (71.4% vs 14.1%). Otra diferencia significativa fue el porcentaje de pacientes en quienes se utilizó el balón intraaórtico, el cual fue mucho mayor entre los pacientes que recibieron TRR (p=0.000). En cuanto a la relación entre la IRA y los procedimientos realizados a los pacientes se evidenció una mayor proporción de casos manejados con CEC dentro del grupo de pacientes que requirieron TRR; así mismo, la proporción de pacientes a quienes se les colocó balón intraaórtico fue significativamente mayor (p=0.000). Al aplicar la escala de riesgo en los pacientes analizados se evidenció que existían cuatro pacientes con alto riesgo de IRA cuyo puntaje fue mayor a cuatro. De estos pacientes solamente dos (50%) terminaron en TRR. Conclusiones: la aparición de lesión renal aguda en pacientes que son llevados a cirugía cardiovascular se ha demostrado como factor independiente de mortalidad en los pacientes en las unidades de cuidado intensivo. Los modelos predictivos para determinar la aparición de IRA en el posoperatorio de CVC han facilitado la toma de decisiones y la evaluación y estratificación del riesgo, abriendo la posibilidad de realizar intervenciones más tempranas y efectivas en pro de la recuperación, disminución de complicaciones y descenso de la morbimortalidad en estos pacientesArtículo original166-174Objective: to identify patients at high risk for acute kidney injury in postoperative cardiovascular Objective: To identify patients at high risk for acute kidney injury in postoperative cardiovascular surgery in the Intensive Care Unit of Hospital Universitario San Ignacio. Context and type of study: the reference population consisted of patients treated at the Hospital San Ignacio de Bogotá, institution of IV level of complexity, with a study population comprised patients admitted to the intensive care unit in the immediate postoperative period of cardiac surgery. Materials and Methods: descriptive observational study, retrospective case series. The information was gathered by researchers from the review of medical records, that is from a secondary source. This collection is made based on a form designed for that purpose, which includes general information and data variables in the prediction, recording the general data of each patient, including personal background variables and scale prediction. During the collection of information was forming the database, which was duly revised and refined, and then analyzed using Epi Info 2000. Results: we analyzed 213 patients admitted to the Intensive Care Unit, Hospital Universitario San Ignacio in the immediate postoperative period CVC. Among the patients analyzed the incidence of ARF was 3.3% (n = 7) which were subjected to TRR. These patients had post-procedure creatinine was significantly higher (p = 0.000). Among patients requiring RRT found a significantly higher proportion of patients with an LVEF less than 40% (71.4% vs 14.1%). Another significant difference was the percentage of patients in whom intra-aortic balloon was used, which was much higher among patients who received RRT (p = 0.000). As for the relationship between the IRA and the procedures performed on patients showed a higher proportion of cases managed with CPB in the group of patients requiring RRT, likewise, the proportion of patients who were placed intra-aortic balloon was significantly higher (p = 0.000). In applying the risk score in patients analyzed showed that there were 4 patients with high risk of IRA whose score was greater than 4. Of these patients only 2 (50%) ended in TRR. Conclusions: the occurrence of acute kidney injury in patients who are taking cardiovascular surgery has been shown as independent risk factor for mortality in patients in intensive care units. Predictive models to determine the occurrence of ARF in pediatric CVC has facilitated decision making and evaluation and risk stratification, opening the possibility of early and effective interventions towards recovery, decreased complications and decreased morbidity and mortality in these patient

Enfermedad linfoproliferativa en el injerto renal. Reporte de un caso y revisión de la literatura

Los desórdenes linfoproliferativos postrasplante (PTLD por sus siglas en inglés: Posttransplant Lymphoproliferative disorders) se presentan en 3 a 10% de adultos con trasplante de órgano sólido (TOS). Se ha asociado a infección por Virus Epstein Barr (VEB). Es difícil diferenciar PTLD de rechazo o infección viral, porque los hallazgos clínicos e histopatológicos son muy similares. Presentamos el caso de un paciente con enfermedad renal crónica (ERC) secundaria a glomerulonefritis IgM, con trasplante renal de donante cadavérico, quien presentó pro-teinuria y disminucuón de la función renal, se le documentó una masa en el injerto renal compatible con desorden linfoproliferativo pos-trasplante renal de tipo polimórfico (PTLD), VEB positivo y CD 20 positivo. El tratamiento consistió en rituximab 375 mg/m2 semanales, cuatro dosis, se realizó control con imágenes y se adicionó el esquema CHOP (ciclofosfamida, vincristina, doxorubicina). El paciente toleró de manera adecuada la quimioterapia, no requirió radioterapia, ni trasplantectomía y después del R-CHOP la masa disminuyó de manera significativa hasta desaparecer al año de seguimiento manteniendo función óptima del injerto renal.Reporte de caso210-216Posttransplant Lymphoproliferative Disorders (PTLDs) occur in 3 to 10% of adults with solid organ transplant (SOT). It has been associa-ted with Epstein Barr Virus (EBV) infection. Differential diagnostics of PTLD from rejection or viral infection is difficult when the tumor infiltrates the graft, because the clinical and histopathological findings are similar. We report a case of patient with chronic kidney disease due to Ig M glomerulonephritis with cadaveric donor kidney transplantation who presented proteinuria and decreased glomerular filtration rate, with a solid mass at renal graft and confirmatory histology of polymorphic renal transplant lymphoproliferative disorder (PTLD), VEB positive, and CD 20 positive. The patient was treated with rituximab 375 mg / m2 weekly, four doses, followed by chemotherapy with ciclophosphamide, vincristine and doxorubicin. He didn’t need radiotherapy or graft nephrectomy, with complete remission at one year of follow-up and optimal graft function

Clinical characteristics of the intensive care patients at the Hospital Universitario de San Ignacio with acute renal failure and factors associated with mortality

Introducción: la insuficiencia renal aguda (IRA) es una de las complicaciones más frecuentes en las Unidades de Cuidado Intensivo (UCI), por lo cual, la identificación de los factores de riesgo y su manejo temprano y oportuno, implicarían optimización de recursos, mejoría en la calidad de la atención y disminución de complicaciones y morbimortalidad. Objetivo: describir las características clínicas de los pacientes que ingresaron a la unidad de cuidados intensivos del Hospital Universitario San Ignacio (HUSI) con IRA y cuáles podrían ser los factores de riesgo asociados a mortalidad. Materiales y métodos: se realizó un estudio prospectivo de una serie de casos, de una muestra por conveniencia de todos los pacientes mayores de 15 años que ingresaron a la UCI del HUSI de Bogotá y desarrollaron IRA. Se definió IRA como: niveles de creatinina sérica mayor de 1.4 mg/dL (hombre) y mayor de 1.2 mg/dL (mujer) o cuando desarrollaron oliguria; gasto urinario menor de 400 cc en 24 horas, o aumento del 50% de la creatinina con respecto a su ingreso. Las variables incluidas al ingreso de los pacientes fueron: edad, sexo, Apache, TISS, SOFA, indicación de UCI, morbilidades asociadas o presentes, infección, sitio de infección, valores de azoados, electrolitos: sodio y potasio, gases arteriales (pH y bicarbonato), relación entre la presión arterial de oxígeno y la fracción inspirada de oxígeno, uso de vasopresores: (dopamina dosis > de 5 µg/kg/min, noradrenalina dosis > 0.1 µg/kg/min) y cuantificación de diuresis. Resultados: entre junio 1o. y diciembre 1o. de 2006 se estudiaron 253 pacientes que ingresaron a la UCI que luego desarrollaron IRA, de los cuales el 56% fueron hombres y 60.3% requirió soporte vasopresor. Los diagnósticos de ingreso más frecuentes fueron choque séptico y síndrome coronario agudo en 35 pacientes (13.83%) en cada patología. La mortalidad fue de 13.4% en este grupo. El análisis exploratorio de las variables al ingreso a UCI mostró aumento de la mortalidad por la presencia de soporte ventilatorio, infección pulmonar, uso de vasopresores, específicamente noradrenalina, alteraciones en los niveles de sodio y potasio, niveles de APACHE mayores de 20 y de SOFA mayor de seis, así como la presencia de morbilidades asociadas. Conclusiones: después de ajustar un modelo de regresión logística controlado por otras variables independientes, las únicas variables asociadas con mortalidad fueron: necesidad de ventilación mecánica, Apache mayor de 20, SOFA mayor de 6 y anormalidades en sodio.Introduction: acute renal failure (ARF) is one of the most frequent complications found in the Intensive Care Unit (ICU). In order to optimize resources, to improve the quality of patient care, and to reduce complications and morbidity-mortality, it is therefore important to identify risk factors and to implement early and timely management measures. Objective: to identify the clinical characteristics of patients admitted to the ICU of Hospital Universitario de San Ignacio (HUSI) with ARF, as well as the risk factors possibly associated with mortality. Materials and methods: a prospective study of a convenience sample of all patients aged 15 years or older admitted to the ICU of HUSI who developed ARF. ARF was defined as serum creatinin levels greater than 1.4 mg/dL (male) or greater than 1.2 mg/dL (female), or when the patient developed oliguria (urine output less than 400 ml in 24 hours), or a 50% increase in creatinin levels with respect to admission. The variables included at the moment of admission were: age, sex, APACHE, TISS, SOFA, indication for admission to ICU, comorbidities, infection, site of infection, azotemia values, electrolytes (sodium and potassium), arterial blood gases (pH and bicarbonate), relationship between PaO2 and FiO2, use of vasopressors (dopamine > 5 µg/kg/min, noradrenalin > 0.1 µg/kg/min), and urine output. Results: during the period from June 1 to December 1 2006, 253 patients admitted to the ICU who afterwards developed ARF were studied. 56% were males and 60.3% required vasopressors. The most frequent diagnoses on admission were septic shock and acute coronary syndrome, with 35 patients each (13.83%). Mortality was 13.4% in this group. Exploratory analysis of the variables on admission to the ICU showed increased mortality associated with mechanical ventilation, pulmonary infection, use of vasopressors (specifically noradrenalin), altered sodium and potassium levels, APACHE scores greater than 20 and SOFA greater than 6, as well as comorbidities. Conclusions: after adjusting a logistic regression model controlled by other independent variables, the only variables found to be associated with mortality were: need for mechanical ventilation, APACHE score greater than 20, SOFA score greater than 6, and abnormal sodium levels.https://orcid.org/0000-0003-2023-785Xhttps://orcid.org/0000-0001-9852-749XN/

Impact of immunosuppression regimen on COVID-19 mortality in kidney transplant recipients: Analysis from a Colombian transplantation centers registry

Introducción: El impacto de los diferentes esquemas de inmunosupresión en receptores de trasplante de órganos sólidos es desconocido. El conocimiento del comportamiento de la enfermedad bajo diferentes esquemas de inmunosupresión es escaso. Nuestra experiencia intenta determinar el riesgo de muerte en receptores de trasplante renal con COVID-19 bajo dos esquemas diferentes de inmunosupresión. Métodos: Describimos la experiencia en receptores de trasplante renal con infección por SARS-CoV-2 en siete centros de trasplante renal en la ciudad de Bogotá, durante el primer año de pandemia y previo al inicio de los programas de vacunación. Las características demográficas, la presentación clínica, los esquemas de inmunosupresión y las estrategias de tratamiento fueron comparadas entre pacientes recuperados y fallecidos, un análisis de sobrevida fue llevado a cabo entre esquemas basados en inhibidores de calcineurina y esquemas libres de inhibidores de calcineurina. Resultados: Entre los 165 casos confirmados, 28 murieron (17%), los factores de riesgo identificados para mortalidad en el análisis univariado fueron: edad mayor de 60 años, diabetes, un esquema de inmunosupresión basado en inhibidores de calcineurina y pacientes recibiendo esteroides en el momento del diagnóstico. En el análisis multivariado, la presencia de hipoxemia en el momento del diagnóstico (p = 0,000) y un esquema de inmunosupresión basado en inhibidores de calcineurina (p = 0,002) fueron predictores independientes de mortalidad. El análisis de sobrevida encontró un riesgo mayor de mortalidad en pacientes bajo esquemas de inmunosupresión con inhibidores de calcineurina vs. aquellos libres de inhibidores de calcineurina, con tasas de mortalidad respectivas en 21,7 y 8,5% (p = 0,036). Conclusiones: Nuestros resultados sugieren que los inhibidores de calcineurina no aportan mayor protección en pacientes con trasplante renal y COVID-19 en comparación con esquemas libres de inhibidores de calcineurina, siendo necesario realizar análisis que permitan evaluar los desenlaces con diferentes esquemas de inmunosupresión en receptores de trasplante renal con infección por SARS-CoV-2.Q2Q3Receptores de trasplante renal con infección por SARS-CoV-2Background: The impact of immunosuppression in solid organ transplant recipients with SARS-CoV-2 infection is unknown. The knowledge about the behavior of different immunosuppression schemes in clinical outcomes is scarce. This study aimed to determine the risk of death in kidney transplant recipients with COVID-19 under two different schemes of immunosuppression. Methods: We describe our experience in kidney transplant recipients with SARS-CoV-2 infection in seven transplant centers during the first year of the pandemic before starting the vaccination programs in the city of Bogotá. Demographic characteristics, clinical presentation, immunosuppression schemes at presentation, and global treatment strategies were compared between recovered and dead patients; survival analysis was carried out between calcineurin inhibitors based regimen and free calcineurin inhibitors regimen. Results: Among 165 confirmed cases, 28 died (17%); the risk factors for mortality identified in univariate analysis were age older than 60 years (p = .003) diabetes (p = .001), immunosuppression based on calcineurin inhibitors (CNI) (p = .025) and patients receiving steroids (p = .041). In multivariable analysis, hypoxemia (p = .000) and calcineurin inhibitors regimen (p = .002) were predictors of death. Survival analysis showed increased mortality risk in patients receiving CNI based immunosuppression regimen vs. CNI free regimens mortality rates were, respectively, 21.7% and 8.5% (p = .036). Conclusions: Our results suggest that the calcineurin inhibitors probably do not provide greater protection compared to calcineurin inhibitor free schemes being necessary to carry out analyzes that allow us to evaluate the outcomes with different immunosuppression schemes in solid organ transplant recipients with SARS-CoV-2 infection.https://orcid.org/0000-0001-9852-749Xhttps://orcid.org/0000-0003-0960-9480Revista Internacional - IndexadaN

Association of Race and Ethnicity With Prescription of SGLT2 Inhibitors and GLP1 Receptor Agonists Among Patients With Type 2 Diabetes in the Veterans Health Administration System

Q1Q1Pacientes con Diabetes tipo 2Importance: Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney disease progression. The equitability of these agents’ prescription across racial and ethnic groups has not been well-evaluated. Objective : To investigate differences in the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with type 2 diabetes by racial and ethnic groups. Design, Setting, and Participants: Cross-sectional analysis of data from the US Veterans Health Administration’s Corporate Data Warehouse. The sample included adult patients with type 2 diabetes and at least 2 primary care clinic visits from January 1, 2019, to December 31, 2020. Exposures Self-identified race and self-identified ethnicity: Main Outcomes and Measures The primary outcomes were prevalent SGLT2i or GLP-1 RA prescription, defined as any active prescription during the study period. Results: Among 1 197 914 patients (mean age, 68 years; 96% men; 1% American Indian or Alaska Native, 2% Asian, Native Hawaiian, or Other Pacific Islander, 20% Black or African American, 71% White, and 7% of Hispanic or Latino ethnicity), 10.7% and 7.7% were prescribed an SGLT2i or a GLP-1 RA, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 8.4% among American Indian or Alaska Native patients; 11.8% and 8% among Asian, Native Hawaiian, or Other Pacific Islander patients; 8.8% and 6.1% among Black or African American patients; and 11.3% and 8.2% among White patients, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 7.1% among Hispanic or Latino patients and 10.7% and 7.8% among non-Hispanic or Latino patients. After accounting for patient- and system-level factors, all racial groups had significantly lower odds of SGLT2i and GLP-1 RA prescription compared with White patients. Black patients had the lowest odds of prescription compared with White patients (adjusted odds ratio, 0.72 [95% CI, 0.71-0.74] for SGLT2i and 0.64 [95% CI, 0.63-0.66] for GLP-1 RA). Patients of Hispanic or Latino ethnicity had significantly lower odds of prescription (0.90 [95% CI, 0.88-0.93] for SGLT2i and 0.88 [95% CI, 0.85-0.91] for GLP-1 RA) compared with non-Hispanic or Latino patients. Conclusions and Relevance: Among patients with type 2 diabetes in the Veterans Health Administration system during 2019 and 2020, prescription rates of SGLT2i and GLP-1 RA medications were low, and individuals of several different racial groups and those of Hispanic ethnicity had statistically significantly lower odds of receiving prescriptions for these medications compared with individuals of White race and non-Hispanic ethnicity. Further research is needed to understand the mechanisms underlying these differences in rates of prescribing and the potential relationship with differences in clinical outcomes.https://orcid.org/0000-0001-9852-749XRevista Internacional - IndexadaA1N

Colombian Nephrology Schools’ Consensus Statement on Ecographical Guidance for Hemodialysis Catheters

En el presente consenso, los coordinadores de los posgrados de nefrología de Colombia planteamos posición y recomendaciones para promover el uso de ecografía para incrementar la seguridad de los implantes de catéteres de hemodiálisis y para aumentar su uso como herramienta diagnóstica en nefrología crítica y clínica.Dialysis catheters are mandatory in clinical practice of nephrology. Being a complex and potentially associated to complications procedure, it is pertinent to use strategies focused to increase safety of the patient. In the present consensus, the coordinators from nephrology postgraduate schools in Colombia make our statement and recommendations about the use of Ultrasound guidance to insertion of hemodialysis catheters and developing fields to its use in clinical nephrology.https://orcid.org/0000-0001-9852-749XRevista Internacional - No indexadaN