Outcomes of Frail Patients While Waiting for Kidney Transplantation : Differences between Physical Frailty Phenotype and FRAIL Scale

Frailty is associated with poorer outcomes among patients waiting for kidney transplantation (KT). Several different tools to measure frailty have been used; however, their predictive value is unknown. This is a prospective longitudinal study of 449 KT candidates evaluated for frailty by the Physical Frailty Phenotype (PFP) and the FRAIL scale. During the study period, 296 patients received a KT, while 153 remained listed. Patients who did not get receive a transplant were more frequently frail according to PFP (16.3 vs. 7.4%, p = 0.013). Robust patients had fewer hospital admissions during the 1st year after listing (20.8% if PFP = 0 vs. 43.4% if ≥1, and 27.1% if FRAIL = 0 vs. 48.9% if ≥1) and fewer cardiovascular events (than FRAIL ≥ 1) or major infectious events (than PFP ≥ 1). According to PFP, scoring 1 point had an impact on patient survival and chance of transplantation in the univariate analysis. The multivariable analysis corroborated the result, as candidates with PFP ≥ 3 had less likelihood of transplantation (HR 0.45 [0.26-0.77]). The FRAIL scale did not associate with any of these outcomes. In KT candidates, pre-frailty and frailty according to both the PFP and the FRAIL scale were associated with poorer results while listed. The PFP detected that frail patients were less likely to receive a KT, while the FRAIL scale did not

Increased mortality after kidney transplantation in mildly frail recipients

Physical Frailty Phenotype (PFP) is the most used frailty instrument among kidney transplant recipients, classifying patients as pre-frail if they have 1-2 criteria and as frail if they have ≥3. However, different definitions of robustness have been used among renal patients, including only those who have 0 criteria, or those with 0-1 criteria. Our aim was to determine the impact of one PFP criterion on transplant outcomes. We undertook a retrospective study of 296 kidney transplant recipients who had been evaluated for frailty by PFP at the time of evaluating for transplantation. Only 30.4% of patients had 0 criteria, and an additional 42.9% showed one PFP criterion. As PFP score increased, a higher percentage of women and cerebrovascular disease were found. Recipients with 0-1 criteria had lower 1-year mortality after transplant than those with ≥2 (1.8% vs 10.1%), but this difference was already present when we only considered those who scored 0 (mortality 1.1%) and 1 (mortality 2.4%) separately. The multivariable analysis confirmed that one PFP criterion was associated to a higher risk of patient death after kidney transplantation [hazard ratio 3.52 (95% confidence interval 1.03-15.9)]. Listed kidney transplant candidates frequently show only one PFP frailty criterion. This has an independent impact on patient survival after transplantation

Hemodiálisis a un paciente en tratamiento con yodo radioactivo I-131

El Yodo 131 es un isotopo radiactivo que se usa con fines médicos, y se ingiere en forma de líquido o cápsula. Su absorción se produce en el tracto gastrointestinal, pasa al torrente sanguíneo y se concentra finalmente en la glándula del tiroides destruyendo sus células1,2. Es un tratamiento de elección en pacientes que estén afectados por un cáncer de tiroides o sufran de un hipertiroidismo1,2,3. En el cáncer de tiroides se administran dosis muy altas de este radiofármaco (del orden de 100 mCi de actividad)1,2, por lo cual el paciente precisa de ingreso hospitalario y medidas de protección radiológicas estrictas, tales como habitación plomada, visitas controladas, etc2,4. En el tratamiento del hipertiroidismo se administran unas dosis bajas de radioyodo (aproximadamente 10 mCi de actividad) por vía oral en capsulas1,2,3. La máxima captación en la glándula tiroides se produce las primeras 48 horas y la eliminación de la actividad radioactiva remanente es por medio del propio decaimiento físico del isotopo, y a través de orina, heces, sudor y saliva. Es un tratamiento que se administra de forma ambulatoria, aunque el paciente debe seguir una serie de recomendaciones de protección radiológica ya que, debido a la incorporación del radioisótopo, pasa a ser un emisor de radiación1,4

{'en_US': 'Transfer to hemodialysis after a fungal peritonitis. Is it the definitive choice?', 'es_ES': 'La transferencia a hemodiálisis tras una peritonitis fúngica.¿Es la opción definitiva?'}

La peritonitis es una de las complicaciones más graves y frecuentes en los pacientes en tratamiento renal sustitutivo mediante diálisis peritoneal (DP), especialmente en la modalidad de diálisis peritoneal continua ambulatoria (DPCA)1. La etiología bacteriana es la responsable de los episodios de peritonitis en el 80% de los casos, pero en cambio, la infección fúngica solo en el 4,6%, aunque presenta peor pronóstico ya que se asocia con una alta morbi-mortalidad2. Las guías de la Sociedad Española de Nefrología4 (SEN) recomiendan la retirada del catéter de forma inmediata, con la imposibilidad de continuar en el programa de DP. Los agentes patógenos más habituales en la peritonitis bacteriana son: Staphylococcus coagulasa negativa y Staphylococcus aureus. En cambio, en la peritonitis fúngica, el patógeno habitual es la Candida albacans, aunque actualmente se ha observado mayor incidencia de Candida parapsilosis2. Los factores de riesgo más habituales son episodios previos de peritonitis bacteriana y el tratamiento con antibióticos de alto espectro1,2. A continuación describiremos nuestra experiencia en un caso de peritonitis fúngica, cuya singularidad radica en su resolución; a pesar de la gravedad del caso y las complicaciones surgidas tras la trasferencia a Hemodiálisis (HD), la paciente pudo volver a DP