Nephroprotection by Hypoglycemic Agents: Do We Have Supporting Data?

Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, renin angiotensin-aldosterone system blockade and multifactorial intervention. However, the renal protection provided by these therapeutic modalities is incomplete. There is a scarcity of studies analysing the nephroprotective effect of antihyperglycaemic drugs beyond their glucose lowering effect and improved glycaemic control on the prevention and progression of diabetic nephropathy. This article analyzes the exisiting data about older and newer drugs as well as the mechanisms associated with hypoglycemic drugs, apart from their well known blood glucose lowering effect, in the prevention and progression of diabetic nephropathy. Most of them have been tested in humans, but with varying degrees of success. Although experimental data about most of antihyperglycemic drugs has shown a beneficial effect in kidney parameters, there is a lack of clinical trials that clearly prove these beneficial effects. The key question, however, is whether antihyperglycemic drugs are able to improve renal end-points beyond their antihyperglycemic effect. Existing experimental data are post hoc studies from clinical trials, and supportive of the potential renal-protective role of some of them, especially in the cases of dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors. Dedicated and adequately powered renal trials with renal outcomes are neccessary to assess the nephrotection of antihyperglycaemic drugs beyond the control of hyperglycaemia

Electronic Patient-Reported Outcomes in Nephrology: Focus on Hemodialysis

Hemodialysis; ePRO; PROMs; PREMsHemodiàlisi; ePRO; PROMs; PREMsHemodiálisis; ePRO; PROMs; PREMsThe success of hemodialysis (HD) treatments has been evaluated using objective measures of analytical parameters, or machine-measured parameters, despite having available validated instruments that assess patient perspective. There is an emerging interest regarding the use and relevance of patient-related outcomes (PROs). Electronic PROs (ePROs) involve the use of electronic technology, provide rapid access to this information, and are becoming more widely used in clinical trials and studies to evaluate efficacy and safety. Despite the scarce literature, this review suggests that ePROs are useful in providing a more customized and multidimensional approach to patient management and in making better clinical decisions in relevant aspects such as vascular access, duration and frequency of dialysis sessions, treatment of anemia, mental health, fatigue, and quality of life. The purpose of this review is to raise interest in the systematic use of ePROs in HD and to promote the development of studies in this field, which can respond to the gaps in knowledge and contribute to the implementation of the use of ePROs through new technologies, helping to improve the quality of health care

GLP-1 Receptor Agonists and Diabetic Kidney Disease: A Call of Attention to Nephrologists

Type 2 diabetes mellitus (T2DM) represents the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESKD), and diabetic kidney disease (DKD) is a major cause of morbidity and mortality in diabetes. Despite advances in the nephroprotective treatment of T2DM, DKD remains the most common complication, driving the need for renal replacement therapies (RRT) worldwide, and its incidence is increasing. Until recently, prevention of DKD progression was based around strict blood pressure (BP) control, using renin-angiotensin system blockers that simultaneously reduce BP and proteinuria, adequate glycemic control and control of cardiovascular risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are a new class of anti-hyperglycemic drugs shown to improve cardiovascular and renal events in DKD. In this regard, GLP-1RA offer the potential for adequate glycemic control in multiple stages of DKD without an increased risk of hypoglycemia, preventing the onset of macroalbuminuria and slowing the decline of glomerular filtration rate (GFR) in diabetic patients, also bringing additional benefit in weight reduction, cardiovascular and other kidney outcomes. Results from ongoing trials are pending to assess the impact of GLP-1RA treatments on primary kidney endpoints in DKD

Sodium-glucose cotransporter 2 inhibition: towards an indication to treat diabetic kidney disease

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have clearly demonstrated their beneficial effect in diabetic kidney disease (DKD) on top of the standard of care [blood glucose control, renin-angiotensin system blockade, smoking cessation and blood pressure (BP) control], even in patients with overt DKD. However, the indication of this drug class is still blood glucose lowering in type 2 diabetic patients with estimated glomerular filtration rate >45mL/min/1.73m(2). Based on the new evidence, several scientific societies have emphasized the preferential prescription of SGLT2i for patients at risk of heart failure or kidney disease, but still within the limits set by health authorities. A rapid positioning of both the European Medicines Agency and the US Food and Drug Administration will allow patients with overt DKD to benefit from SGLT2i. Clinical experience suggests that SGLT2i safety management may in part mirror renin-angiotensin blockade safety management in patients with overt DKD. This review focuses on the rationale for an indication of SGTL2i in DKD. We further propose clinical steps for maximizing the safety of SGLT2i in DKD patients on other antidiabetic, BP or diuretic medication

Clasificación preliminar de especies de jardín según sus requerimientos hídricos en la región de Murcia

El desarrollo económico y social de la Región de Murcia ha conllevado desde la década de los 80 un considerable aumento de la superficie ajardinada, tanto de carácter público como privado. Esta circunstancia, unida a los graves problemas de escasez de agua, pone de manifiesto la importancia del establecimiento de jardines de bajo consumo hídrico.Este trabajo forma parte del proyecto de investigación regional PR02-03-2 financiado por la Dirección General de Investigación y Transferencia Tecnológica

Modeling photosynthetically active radiation from satellite-derived estimations over mainland Spain

A model based on the known high correlation between photosynthetically active radiation (PAR) and global horizontal irradiance (GHI) was implemented to estimate PAR from GHI measurements in this present study. The model has been developed using satellite-derived GHI and PAR estimations. Both variables can be estimated using Kato bands, provided by Satellite Application Facility on Climate Monitoring (CM-SAF), and its ratio may be used as the variable of interest in order to obtain the model. The study area, which was located in mainland Spain, has been split by cluster analysis into regions with similar behavior, according to this ratio. In each of these regions, a regression model estimating PAR from GHI has been developed. According to the analysis, two regions are distinguished in the study area. These regions belong to the two climates dominating the territory: an Oceanic climate on the northern edge; and a Mediterranean climate with hot summer in the rest of the study area. The models obtained for each region have been checked against the ground measurements, providing correlograms with determination coefficients higher than 0.99This work was supported by the Spanish Ministry of Economy, Industry and Competitiveness (MINECO) [Project CGL2016-79284-P AEI/FEDER/UE]S

Air and wet bulb temperature lapse rates and their impact on snowmaking in a Pyrenean ski resort

A set of 17 air temperature and relative humidity sensors were used to analyze the temporal variability of surface air temperature (Tair), wet bulb temperature (Twb), and daily snowmaking hours (SM, number of hours per day with Twb < − 2 °C), lapse rates, and the occurrence of thermal inversions at the Formigal ski resort (Spanish Pyrenees) from December to March during three consecutive ski seasons (2012–2013, 2013–2014, and 2014–2015). The Tair and Twb lapse rates showed strong hourly and daily variability, with both exhibiting almost identical temporal fluctuations. The Twb exhibited average lapse rates that were slightly steeper (− 5.2 °C/km) than those observed for Tair (− 4.9 °C/km). The less steep lapse rates and most thermal inversions were observed in December. Days having less (more) steep Tair and Twb lapse rates were observed under low (high) wind speeds and high (low) relative humidity and air pressure. The temporal dynamics of the SM lapse rates was more complex, as this involved consideration of the average Tair in the ski resort, in addition to the driving factors of the spatio-temporal variability of Twb. Thus, on a number of cold (warm) days, snowmaking was feasible at all elevations at the ski resort, independently of the slopes of the lapse rates. The SM exhibited an average daily lapse rate of 8.2 h/km, with a progressive trend of increase from December to March. Weather types over the Iberian Peninsula tightly control the driving factors of the Tair, Twb, and SM lapse rates (wind speed, relative humidity, and Tair), so the slopes of the lapse rates and the frequency of inversions in relation to elevation for the three variables are very dependent on the occurrence of specific weather types. The less steep lapse rates occurred associated with advections from the southeast, although low lapse rates also occurred during advections from the east and south, and under anticyclonic conditions. The steepest Tair and Twb lapse rates were observed during north and northwest advections, while the steepest rates for SM were observed during days of cyclonic circulation and advections from the northeast.This study was funded by the research project CGL2014-52599-P "Estudio del manto de nieve en la montaña española y su respuesta a la variabilidad y cambio climatico" (Ministry of Economy and Development, MINECO)