Sarcopenia and mortality in older hemodialysis patients

(1) Sarcopenia is a progressive loss of skeletal muscle mass and strength. The aim of this study was to determine the association of sarcopenia, defined according to the Working Group on Sarcopenia in Older People (EWGSOP2) diagnostic criteria, with mortality at 24 months in very elderly hemodialysis patients. (2) A prospective study was conducted in 60 patients on chronic hemodialysis who were older than 75 years. Sarcopenia was diagnosed according to EWGSOP2 criteria. Additionally, clinical, anthropometric and analytical variables and body composition by bioimpedance were assessed. The date and cause of death were recorded during 2 years of follow-up. (3) Among study participants, 41 (68%) were men, the mean age 81.85 ± 5.58 years and the dialysis vintage was 49.88 ± 40.29 months. The prevalence of probable sarcopenia was 75% to 97%, depending on the criteria employed: confirmed sarcopenia ranged from 37 to 40%, and severe sarcopenia ranged from 18 to 37%. A total of 30 (50%) patients died over 24 months. Sarcopenia probability variables were not related to mortality. In contrast, sarcopenia confirmation (appendicular skeletal muscle mass, ASM) and severity (gait speed, GS) variables were associated with mortality. In multivariate analysis, the hazard ratio (95% confidence interval) for all-cause death was 3.03 (1.14-8.08, p = 0.028) for patients fulfilling ASM sarcopenia criteria and 3.29 (1.04-10.39, p = 0.042) for patients fulfilling GS sarcopenia criteria. (4) The diagnosis of sarcopenia by EWGSOP2 criteria is associated with an increased risk of all-cause death in elderly dialysis patients. Specifically, ASM and GS criteria could be used as mortality risk markers in elderly hemodialysis patients. Future studies should address whether the early diagnosis and treatment of sarcopenia improve outcomes.This research received no external funding. E.G.-P., S.M.-F. and A.O.-A. research groups are funded by Ministerio de Economia, Industria y competitividad: FIS/Fondos FEDER (PI16/01298, PI17/00257, PI18/01386, PI19/00588, PI19/00815, PI20/00487, PI21/01430, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009) and Sociedad Española de Nefrología, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. All authors want to thank Fundación Renal Íñigo Álvarez de Toledo (FRIAT) for its support to renal research in Spain. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Financiadores Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM FRIAT Fundación Renal Íñigo Álvarez de Toledo Ministerio de Economia Sociedad Española de Nefrología Spain Federación Española de Enfermedades Raras Spain PI21/0143

Evaluation of the impact of an intradialytic exercise programme on sarcopaenia in very elderly haemodialysis patients

Sarcopaenia is a highly prevalent condition in persons on haemodialysis (HD). In stable very elderly (75-95 years old) persons on chronic HD, we prospectively studied the European Working Group on Sarcopaenia in Older People (EWGSOP2) steps stability over time in 37 controls and their response to a 12-week intradialytic lower limb exercise programme in 23 persons. Overall dropout was 15% and the main cause for dropout was death (8%). Thus 33 controls and 18 exercise participants were evaluated at 12 weeks. In controls, comorbidity, nutrition, dependency and frailty scales, anthropometric assessments, EWGSOP2 step values and the prevalence of suspected, confirmed and severe sarcopaenia as assessed by EWGSOP2 remained stable. In contrast, in persons who completed the exercise programme, a significant improvement in the five times sit-to-stand (STS-5) test was noted at the end of the 12-week exercise programme (19.2 ± 4.9-15.9 ± 5.9 seconds; P =. 001), consistent with the lower limb nature of the exercise programme, that persisted 12 weeks after completion of the programme. Exercise also improved the Fried frailty scale (1.7 ± 1.0-1.1 ± 0.6; P =. 004). In conclusion, EWGSOP2 steps remain stable in stable very elderly persons on HD and STS-5 is responsive to a short-term intradialytic lower limb exercise programme. These results may help define EWGSOP2-based primary endpoints in future large-scale clinical trials assessing exercise interventionsThe authors would like to thank FRIAT for its support to the present study. The research groups of E.G.P., S.M.F. and A.O. are funded by the Ministerio de Economia, Industria y competitividad: FIS/Fondos FEDER (PI16/01298, PI18/01386, PI19/00588, PI19/00815, PI20/00487, PI21/01240, DTS18/00032), ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009) and Sociedad Española de Nefrología, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-C

El Juego y la Comprensión Oral y Escrita como Actividades Rectoras en el Área de lenguaje para el Nivel de Educación Inicial

The objective of the work was to systematize information through a bibliographic review about the use of the game for oral and written comprehension in initial education students. The approach used was the qualitative descriptive type. For the acquisition of information, a review of the literature on the subject was used. The instrument applied for each of the categories was the documentary analysis guide. The main findings reveal that it is currently necessary to continue research on this subject, since there is little information both from documentary review and from practical experience of the teaching-learning process; the game, as time has advanced, is viewed positively for oral and written comprehension; there is little information on the complete process, how the game could be applied with the students.El objetivo del trabajo fue sistematizar información mediante revisión bibliográfica sobre el uso del juego para la comprensión oral y escrita en los estudiantes de educación inicial. El enfoque empleado fue el cualitativo de tipo descriptivo. Para la adquisición de la información se hizo uso de la revisión de la literatura sobre la temática. El instrumento aplicado para cada una de las categorías fue la guía del análisis documental. Los principales hallazgos dan a conocer que actualmente es necesario seguir investigando sobre esta temática, puesto que existe escasa información tanto de revisión documental como de experiencia práctica del proceso de enseñanza-aprendizaje; el juego, conforme ha avanzado el tiempo, es visto de manera positiva para la comprensión oral y escrita; es escasa la información del proceso completo como se podría aplicar el juego con los educandos

Sarcopenia assessed by 4-step EWGSOP2 in elderly hemodialysis patients: Feasibility and limitations

In 2019, EWGSOP2 proposed 4 steps to diagnose and assess sarcopenia. We aimed to quantify the prevalence of sarcopenia according to the EWGSOP2 diagnostic algorithm and to assess its applicability in elderly patients on hemodialysis. Methods, Prospective study of 60 outpatients on chronic hemodialysis aged 75- to 95-years, sarcopenia was assessed according to the 4-step EWGSOP2: Find: Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F); Assess: grip strength by dynamometry (GSD) and sit to stand to sit 5 (STS5); Confirm: appendicular skeletal muscle mass (ASM) by bioimpedance; Severity: gait speed (GS), Timed-Up and Go (TUG), and Short Physical Performance Battery (SPPB). Results, The sequential four steps resulted in a prevalence of confirmed or severe sarcopenia of 20%. Most (97%) patients fulfilled at least one criterion for probable sarcopenia. The sensitivity of SARC-F for confirmed sarcopenia was low (46%). Skipping the SARC-F step increased the prevalence of confirmed and severe sarcopenia to 40% and 37%, respectively. However, 78% of all patients had evidence of dynapenia consistent with severe sarcopenia. Muscle mass (ASM) was normal in 60% of patients, while only 25% had normal muscle strength values (GSD). Conclusions According to the 4-step EWGSOP2, the prevalence of confirmed or severe sarcopenia was low in elderly hemodialysis patients. The diagnosis of confirmed sarcopenia underestimated the prevalence of dynapenia consistent with severe sarcopenia. Future studies should address whether a 2-step EWGSOP2 assessment (Assess-Severity) is simpler to apply and may provide better prognostic information than 4-step EWGSOP2 in elderly persons on hemodialysisThis research received no external funding. EGP, SM and AO research groups are funded by Ministerio de Economia, Industria y competitividad: FIS/Fondos FEDER (PI16/01298, PI17/00257, PI18/01386, PI19/00588, PI19/00815, PI20/00487, PI21/01430, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009), and Sociedad Española de Nefrología, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. All authors want to thank Fundación Renal Íñigo Álvarez de Toledo (FRIAT) for it support to renal research in Spain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip

Impact of the COVID-19 pandemic in Spain in the successive pandemic waves on hemodialysis patients and healthcare personnel

(1) Background: The impact of SARS-CoV-2 has been variable over the time course of the pandemic and in different populations. The aim was to analyze the impact of COVID-19 infection in a known population of hemodialysis (HD) patients and professionals in Spain at different times of the pandemic. (2) Methods: We conducted an observational, descriptive study with a follow-up from 3 March 2020 to 23 April 2022 (776 days), using in average of 414 professionals and 1381 patients from 18 HD units in Spain. The data from the positive PCR or the rapid antigen detection test (RADT) subject were analyzed and segmented into six periods (waves). (3) Results: Of 703 positive COVID-19 tests, 524 were HD patients (74.5%), and 179 were HD professionals (25.5%). Overall, 38% of staff and 43% of patients were affected. Differences were observed in regard to incidence (21% vs. 13%), mortality (3.5% vs. 0%), and symptomatology between the patients and professionals and throughout the pandemic. (4) Conclusions: COVID-19 severity varied during different pandemic waves, with a greater impact seen in the first wave. HD professionals and patients had similar infection rates, but patients had higher mortality rates. Community transmission was the primary route of infection.This research received was founded by Fundación Renal Íñigo Álvarez de Toledo (FRIAT). The research groups of S.M.-F. and E.G.-P. are funded by the Ministerio de Economia, Industria y competitividad: FIS/Fondos FEDER (PI20/00487; PI21/01430). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Financiadores Fundación Renal Íñigo Álvarez de Toledo Ministerio de Economia Federación Española de Enfermedades Raras Spain PI21/0143

7th Drug hypersensitivity meeting: part two

No abstract availabl

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Influencia sobre la función renal de una infusión endovenosa de aminoácidos en personas sanas, en enfermos renales y en pacientes con hipertensión arterial esencial

Tesis doctoral original inédita leída en la Universidad de Autónoma de Madrid, Facultad de Medicina. Fecha de lectura: 17 de abril de 198

{'en_US': 'Reactogenicity and immunogenicity after inoculation of SAR-CoV-2 vaccine in dialysis care workers', 'es_ES': 'Reactogenicidad e inmunogenicidad tras la inoculación de vacuna frente a SAR-CoV-2 en personal de diálisis'}

Introducción: Ser personal sanitario en activo supone un factor de riesgo elevado para contraer la infección por SAR-CoV-2. La realización de programas de vacunación es la mejor herramienta disponible para enfrentar este problema. En España, los profesionales sanitarios han sido vacunados de manera prioritaria. Objetivo: Evaluar, a través del recuento de anticuerpos en sangre, la inmunogenicidad de las vacunas frente a SARS-CoV-2 en personal de diálisis y los factores relacionados con ella. Material y Método: Estudio observacional descriptivo de corte trasversal, multicéntrico. Se realizó una determinación serológica del recuento de anticuerpos totales anti-proteína “S” en las 12 semanas posteriores a la vacunación. La recogida de datos se realizó a través de un cuestionario ad-hoc, online, anónimo y voluntario. Resultados: 167 participantes, todos vacunados con vacunas ARN. EL 15% había pasado previamente la infección. El 96,4% han desarrollado anticuerpos (media de 15.776±13.640 AU/ml); aquellos profesionales que han pasado previamente la infección tienen un número promedio de anticuerpos significativamente mayor que los que no (23.532 vs 14.381 AU/ml) (p=0,05). La presencia de síntomas como cansancio, cefalea, fiebre y mialgias se asocia, también, a una reactividad significativamente mayor (p=0,004). No existe relación significativa entre la reactividad y sexo, edad, índice de masa corporal (IMC) o lugar de trabajo. Conclusiones: La inmunogenicidad provocada por las vacunas ARN administradas a personal de diálisis ha sido casi total. Padecer efectos adversos post vacunación, como cansancio, cefaleas, fiebre, náuseas y dolores, y haber pasado previamente la infección se asocia con mayor reactivida