Evaluación del estado nutricional en pacientes trasplantados renales durante 5 años de seguimiento

Introducción: El aumento de peso y la malnutrición después del trasplante renal es frecuente, y el sobrepeso y la obesidad resultante se asocia con complicaciones graves de salud. Por el contrario, la prevalencia de la desnutrición en pacientes con trasplante renal y sus efectos en el resultado del trasplante de riñón se subestima. Objetivos: El objetivo de este trabajo fue evaluar el estado nutricional de pacientes trasplantados renales y determinar si en el periodo de cinco años de seguimiento, estos pacientes sufren alteraciones que sugieran deterioro nutricional. Métodos: La muestras estuvo formada por 119 pacientes trasplantados renales, que asistieron durante cinco años a la consulta postrasplante. A todos los pacientes se realizaron determinaciones de colesterol total, lipoproteínas de baja densidad (LDL), lipoproteínas de alta densidad (HDL), concentraciones de triglicéridos y ferritina (Ft), y se les efectuaron mediciones antropométricas de peso, altura e IMC. Los pacientes fueron divididos en tres grupos según la tasa de filtración glomerular : Grupo 1: < 60 mL/min, Grupo 2: 89–60 mL/min Grupo 3: ≥ 90 mL/min. Resultados: El peso e IMC tiende a disminuir en el grupo 3 mientras aumenta en el resto de grupos. Se produce una disminución de Colesterol total, HDL, LDL, Trigliceridos y Ferritina menos acusado en el grupo 3. Conclusiones: Tras cinco años se puede observar una reducción significativa de los parametros bioquímicos nutricionales en general, así mismo el estado nutricional esta estrechamente relacionado y es directamente proporcional a la función del injerto.Introduction: Weight gain and malnutrition after kidney transplantation is common and the resulting overweight and obesity is associated with serious health complications. By contrast, the prevalence of malnutrition in patients with renal transplantation and its impact on the outcome of kidney transplantation is underestimated. Objectives: The aim of this study was to evaluate the nutritional status of renal transplant patients and determine if the five-year follow-up, these patients undergo alterations that suggest nutritional deterioration. Methods: The sample consisted of 119 renal transplant patients who attended for five years post-transplant consultation. All patients measurements of total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides and ferritin (Ft) were performed. and anthropometric measurements were made of weight, height and BMI. Patients were divided into three groups according to GFR Group 1: <60 mL / min, Group 2: 89-60 mL / min Group 3: ≥ 90 mL / min. Results: The weight and BMI tended to decrease in group 3 while increasing in the other groups. A decrease in total cholesterol, HDL, LDL, Triglycerides and Ferritin less pronounced in group 3 occurs. Conclusions: After five years you can see a significant reduction in nutritional biochemical parameters in general, likewise the nutritional status is closely related, and is directly proportional to the function of the graft

Evolución del estado nutricional de pacientes en hemodiálisis

En este trabajo se hipotetiza que los pacientes con Insuficiencia Renal Crónica y Tratamiento en Hemodiálisis presentan una gran desnutrición proteico calórica que se va agravando a medida que avanza el tiempo de tratamiento, aumentando su desgaste fisico y llegando a presentar una alta morbimortalidad. Se pretende evaluar el estado nutricional de los pacientes de una unidad de hemodiálisis, determinar la frecuencia y la severidad de la malnutrición y su relación con el tratamiento en un periodo de 10 años.Tesis Univ. Granada. Programa Oficial de Doctorado en: Innovación Curricular y Orientación Educativ

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study

Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the \u2018Registro Politerapie SIMI\u2019 study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p&nbsp;=&nbsp;0.002), had a higher Short Blessed Test (SBT; p&nbsp;=&nbsp;0.022) and a lower Barthel Index (p&nbsp;=&nbsp;0.047). Polypharmacy (p&nbsp;=&nbsp;0.001), heart failure (p&nbsp;=&nbsp;0.005) and diabetes (p&nbsp;=&nbsp;0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p&nbsp;=&nbsp;0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94\u20131.00, p&nbsp;=&nbsp;0.037], diabetes (OR 0.48, 95% CI 0.26\u20130.87, p&nbsp;=&nbsp;0.016) and polypharmacy (OR 0.58, 95% CI 0.34\u20130.99, p&nbsp;=&nbsp;0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p&nbsp;=&nbsp;0.89; and 15.9 vs. 14.1%, p&nbsp;=&nbsp;0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up

Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study.

BACKGROUND: Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. AIM: The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. METHODS: We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. RESULTS: 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. CONCLUSIONS: In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen

Prevalence and Determinants of the Use of Lipid-Lowering Agents 3 in a Population of Older Hospitalized Patients: the Findings 4 from the REPOSI (REgistro POliterapie Societa` Italiana di 5 Medicina Interna) Study

Background Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. Aim The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. Methods We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della SocietA Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. Results 2171 patients aged > 65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (>= 5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. Conclusion In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen