A Case-Control Study of Cognitive Function in Patients with End-Stage Renal Disease Before and After Hemodialysis in Southern Spain

BACKGROUND: This single-center study aimed to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on modulation of thyroid hormone levels and cognition in the recovery stage of patients with cognitive dysfunction following stroke. MATERIAL AND METHODS: Seventy post-stroke patients who had cognitive impairment were randomly assigned to either the rTMS group or the control (sham) group. Both groups were administered basic treatment, with the rTMS group receiving rTMS (1 Hz, 90% MT, 1000 pulse/20 min, once a day for 5 days, for a total of 20 times), the stimulation site was the contralateral dorsolateral prefrontal cortex (DLPFC), and the sham group receiving sham stimulation which had the same stimulation parameters and site, except that the coil plane was placed perpendicular to the surface of the scalp. Cognitive function assessment and thyroid function tests were performed before and after 4 weeks of treatment. RESULTS: Serum levels of triiodothyronine (T3), free triiodothyronine (FT3), and thyroid stimulating hormone (TSH) showed a positive correlation with Montreal Cognitive Assessment (MoCA) scale score of stroke patients in the recovery phase. The post-treatment change in the scores of MoCA and Modified Barthel Index (MBI) and scores of 3 cognitive domains (visuospatial function, memory, and attention), as well as serum T3, FT3, and TSH levels, were improved more significantly in the rTMS group, and T3 and FT3 levels significantly affected the MoCA scores within the reference range. CONCLUSIONS: Serum T3, FT3, and TSH levels of stroke patients in the recovery phase were positively correlated with MoCA score. rTMS increased T3, FT3, and TSH levels and also improved MoCA and MBI of patients in the recovery phase of stroke

Baseline residual kidney function and its ensuing rate of decline interact to predict mortality of peritoneal dialysis patients

Background Baseline residual kidney function (RKF) and its rate of decline during follow-up are purported to be reliable outcome predictors of patients undergoing Peritoneal Dialysis (PD). The independent contribution of each of these factors has not been elucidated. Method We report a multicenter, longitudinal study of 493 patients incident on PD and satisfying two conditions: a glomerular filtration rate (GFR) 1 mL/minute and a daily diuresis 300 mL. The main variables were the GFR (mean of urea and creatinine clearances) at PD inception and the GFR rate of decline during follow-up. The main outcome variable was patient mortality. The secondary outcome variables were: PD technique failure and risk of peritoneal infection. The statistical analysis was based on a multivariate approach, placing an emphasis on the interactions between the two main study variables

Compared decline of residual kidney function in patients treated with automated peritoneal dialysis and continuous ambulatory peritoneal dialysis: a multicenter study

[Abstract] BACKGROUND: There is controversy concerning the compared rates of decline of residual kidney function (RKF) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). OBJECTIVES AND METHOD: Following an observational, multicenter design, we studied 493 patients initiating peritoneal dialysis (PD) in four different Spanish units. We explored the effect of the PD modality on the rate of decline of RKF and the probability of anuria during follow-up. We applied logistic regression for intention-to-treat analyses, and linear mixed models to explore time-dependent variables, excluding those affected by indication bias. MAIN RESULTS: Patients started on APD were younger and less comorbid than those initiated on CAPD. Baseline RKF was similar in both groups (p = 0.50). Eighty-seven patients changed their PD modality during follow-up. The following variables predicted a faster decline of RKF: higher (rate of decline) or lower (anuria) baseline RKF, younger age, proteinuria, nonprimary PD, use of PD solutions rich in glucose degradation products, higher blood pressure, and suffering peritonitis or cardiovascular events during follow-up. Overall, APD was not associated with a fast decline of RKF, but stratified analysis disclosed that patients with lower baseline RKF had an increased risk for this outcome when treated with this technique (HR: 2.26, 95% CI: 1.09-4.82, p = 0.023). Moreover, the probability of anuria during follow-up was overtly higher in APD patients (HR: 3.22, 95% CI: 1.25-6.69, p = 0.002). CONCLUSIONS: Starting PD patients directly on APD is associated with a faster decline of RKF and a higher risk of developing anuria than doing so on CAPD. This detrimental effect is more marked in patients initiating PD with lower levels of RKF

Results of the cooperative study of Spanish peritoneal dialysis registries: analysis of 12 years of follow-up

[Resumen] Introducción y objetivos: Actualmente no existe un registro que muestre en su conjunto y globalidad la realidad de la diálisis peritoneal (DP) en España. Sin embargo, para distintos congresos y reuniones se ha elaborado durante varios años un informe sobre la DP en España a partir de datos comunicados por cada uno de los registros de las comunidades autónomas y regiones. El objetivo fundamental del presente trabajo es analizar todos estos datos en forma agrupada y comparativa, con objeto de conseguir una muestra representativa de la población española en DP en los últimos años, para su análisis y resultados en cuanto a datos demográficos, penetración de la técnica, diferencias geográficas, incidencia y prevalencia, aspectos técnicos, indicadores intermedios, comorbilidad y resultados finales como supervivencia del paciente y de la técnica puedan ser extrapolables a todo el territorio nacional. Diseño, material y métodos: Estudio observacional de cohortes de registros autonómicos de DP, abarcando el mayor porcentaje posible de la población española adulta (mayores de 14 años) en DP, al menos en la última década (1999-2010), y en la mayor área geográfica que nos ha sido posible reclutar. Se ha seguido una estrategia precisa de recogida de información de cada registro autonómico. Una vez recibida la información y depurada, se integran como datos agregados, para su estudio estadístico. Resultados: Los registros autonómicos que han participado representan un área geográfica total que engloba a 32 853 251 habitantes mayores de 14 años, el 84 % de la población española total a partir de esa edad. La tasa anual media de incidentes por millón de habitantes (ppm) es variable (entre los 17,81 ppm de Andalucía y los 29,90 ppm del País Vasco), observándose en los últimos años un discreto y permanente aumento de la incidencia global en la DP en España. La prevalencia media anual por millón de población (ppm) es muy heterogénea (desde 42 a 99 ppm). Se observa un aumento progresivo medio en el uso de la diálisis peritoneal automática (DPA). La tasa de peritonitis es de aproximadamente un episodio cada 25-30 meses/paciente, observándose una ligera disminución en los años más recientes. Las causas de salida del programa de DP se distribuyen, de forma bastante homogénea entre las distintas comunidades, prácticamente en un tercio por muerte del paciente (media 28 %), un tercio por trasplante renal (media 39 %) y un tercio pasan a hemodiálisis (fracaso de la técnica: media 32 %). Las principales comorbilidades fueron la enfermedad cardiovascular (30,2 %) y la diabetes mellitus (24,2 %). La supervivencia global media acumulada ha sido del 92,2 %, 82,8 %, 74,2 %, 64,8 % y 57 %, al año, dos, tres, cuatro y cinco años, respectivamente. Proporcionaron de forma significativa e independiente una peor supervivencia para el paciente una mayor edad, la enfermedad cardiovascular, la diabetes mellitus, la técnica de diálisis peritoneal continua ambulatoria (frente a DPA), el inicio de la DP antes de 2004 (analizado en Andalucía y Cataluña) y la menor función renal residual al inicio de la DP (analizado en el registro de Levante). De igual forma, actualmente ha mejorado la supervivencia de la técnica, presentando unas cifras promedio superiores al 50 % a los 5 años Conclusiones: La incidencia y la prevalencia de la DP en España están creciendo moderadamente de forma generalizada, si bien siguen manteniendo una distribución por comunidades autónomas irregular. Tanto la supervivencia del paciente como de la técnica es superior al 50 % a los 5 años, habiendo mejorado en los últimos años, y siendo comparable a los países de mejores resultados en este tratamiento.[Abstract] Introduction and objectives: There is currently no registry that gives a complete and overall view of the peritoneal dialysis (PD) situation in Spain. However, a report on PD in Spain was developed for various conferences and meetings over several years from data provided by each registry in the autonomous communities and regions. The main objective of this study is to analyse this data in aggregate and comparatively to obtain a representative sample of the Spanish population on PD in recent years, in order that analysis and results in terms of demographic data, penetration of the technique, geographical differences, incidence and prevalence, technical aspects, intermediate indicators, comorbidity, and outcomes such as patient and technique survival may be extrapolated to the whole country Design, material and method: Observational cohort study of autonomous PD registries, covering the largest possible percentage of the adult Spanish population (over 14 years of age) on PD, at least in the last decade (1999-2010), and in the largest possible geographical area in which we were able to recruit. A precise data collection strategy was followed for each regional registry. Once the information was received and clarified, they were added as aggregate data for statistical study Results: The regional registries that participated represent a total geographical area that encompasses 32,853,251 inhabitants over 14 years of age, 84% of the total Spanish population older than that age. The mean annual rate of incidents per million inhabitants (ppm) was variable (between 17.81ppm in Andalusia and 29.90ppm in the Basque Country), with a discrete and permanent increase in the overall PD incidence in Spain being observed in recent years. The mean annual prevalence per million population (ppm) was very heterogeneous (from 42 to 99ppm). A mean progressive increase in the use of automated peritoneal dialysis (APD) was observed. The peritonitis rate was approximately one episode every 25-30 months/patient, with a slight decrease being observed in recent years. The causes of discontinuing PD were distributed fairly evenly between communities; almost a third was due to patient death (mean 28%), a third was due to renal transplantation (mean 39%) and a third was due to transfer to haemodialysis (technique failure: mean 32%). The main comorbidities were cardiovascular disease (30.2%) and diabetes mellitus (24.2%). The overall accumulated mean survival was 92.2%, 82.8%, 74.2%, 64.8% and 57% after one, two, three, four and five years respectively. There was significantly and independently worse survival for older patients and those with cardiovascular disease, patients with diabetes mellitus, those on continuous ambulatory peritoneal dialysis (vs. APD), those who started PD before 2004 (analysed in Andalusia and Catalonia), and patients with lower residual renal function at the start of PD (analysed in the Levante registry). Similarly, the technique survival has improved, showing a mean figure above 50% after 5 years. Conclusions: The incidence and prevalence of PD in Spain are growing moderately and in a generalised manner and continue to maintain an irregular distribution by autonomous community. Both patient and technique survival were greater than 50% after 5 years, with an improvement being observed in recent years, and are comparable to countries with better results in this treatment

Impact of Remote Monitoring on Standardized Outcomes in Nephrology-Peritoneal Dialysis

Introduction: This study aimed to evaluate the association between the use of remote patient monitoring (RPM) in patients on automated peritoneal dialysis (APD) and the Standardized Outcomes in Nephrology in peritoneal dialysis (SONG-PD) clinical outcomes. Methods: A prospective and multicenter cohort study was conducted on patients with advanced chronic kidney disease on APD, recruited at 16 Spanish Hospitals, between June 1 and December 31, 2021. Patients were divided into 2 cohorts, namely patients on APD with RPM (APD-RPM) and patients on APD without RPM. The primary endpoints were the standardized outcomes of the SONG-PD clinical outcomes: PD-associated infection, cardiovascular disease (CVD), mortality rate, technique survival, and life participation (assessed as health-related quality of life [QoL]). Propensity score matching (PSM) was used to evaluate the association of RPM exposure with the clinical outcomes. Results: A total of 232 patients were included, 176 (75.9%) in the APD-RPM group and 56 (24.1%) in the APD-without-RPM group. The mean patient follow-up time was significantly longer in the APD-RPM group than in the APD-without-RPM group (10.4 ± 2.8 vs. 9.4 ± 3.1 months, respectively; P = 0.02). In the overall study sample, the APD-RPM group was associated with a lower mortality rate (hazard ratio [HR]: 0.08; 95% confidence interval [CI]: 0.01 to 0.69; P = 0.020) and greater technique survival rate (HR: 0.25; 95% CI: 0.11 to 0.59; P = 0.001). After PSM, APD-RPM continued to be associated with better technique survival (HR: 0.23; 95% CI: 0.06 to 0.83; P = 0.024). Conclusion: The use of RPM programs in patients on APD was associated with better survival of the technique and lower mortality rates. However, after PSM, only technique survival was significant

Clinical guide of the Spanish Society of Nephrology on the prevention and treatment of peritoneal infection in peritoneal dialysis

[Resumen] Las infecciones peritoneales siguen constituyendo una complicación muy relevante de la diálisis peritoneal, por su incidencia todavía elevada y por sus importantes consecuencias clínicas, en términos de mortalidad, fracaso de la técnica y costes para el sistema sanitario. Las prácticas de prevención y tratamiento de esta complicación muestran una notable heterogeneidad derivada, entre otros factores, de la complejidad del problema y de la escasez de evidencia clínica que permitan responder de manera clara a muchas de las dudas planteadas. El propósito de este documento es proporcionar una revisión completa y actualizada de los métodos de diagnóstico, prevención y tratamiento de estas infecciones. El documento se ha elaborado tomando como referencia de partida la guía más reciente de la Sociedad Internacional de Diálisis Peritoneal (2016). Mientras que para el capítulo diagnóstico se ha adoptado una estructura más narrativa, el análisis de las medidas de prevención y tratamiento ha seguido una metodología sistemática (Grading of Recommendations, Assessment, Development and Evaluation [GRADE]), que especifica el nivel de evidencia y la fuerza de las sugerencias y recomendaciones propuestas, y facilita actualizaciones futuras de la guía. La gran extensión y numerosas recomendaciones o sugerencias emanadas de la revisión ponen de manifiesto la complejidad y gran número de facetas a tener en cuenta para un adecuado abordaje de esta importante complicación de la diálisis peritoneal.[Abstract] Peritoneal infections still represent a most feared complication of chronic peritoneal dialysis, due to their high incidence and relevant clinical consequences, including direct mortality, technique failure and a significant burden for the health system. The practices for prevention and treatment of this complication show a remarkable heterogeneity emerging, among other factors, from the complexity of the problem and from a paucity of quality evidence which could permit to respond clearly to many of the raised questions. The purpose of this document is to provide a complete and updated review of the main methods of diagnosis, prevention and treatment of these infections. The document has been elaborated taking as a reference the most recent guidelines of the International Society of Peritoneal Dialysis (2016). The diagnostic considerations are presented in a narrative style while, for prevention and therapy, we have used a systematic methodology (Grading of Recommendations, Assessment, Development and Evaluation [GRADE]), which specifies the level of evidence and the strength of the proposed suggestions and recommendations and facilitates future updates of the document. The length of the document and the many suggestions and recommendations coming out of the review underline the large number and the complexity of the factors to be taken into consideration for an adequate approach to this complication of peritoneal dialysis

Enfermedad renal crónica : ¿qué tratamiento me conviene? : herramienta de ayuda para la toma de decisiones

YesLa Consejería de Salud de la Junta de Andalucía, con la colaboración de un grupo de profesionales liderado por la Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA, ha elaborado esta guía para que sirva como “Herramienta de ayuda a la toma de decisiones en la enfermedad renal crónica avanzada” (ERCA). La guía pretende que los pacientes atendidos en las consultas de pre-diálisis de los diferentes Servicios de Nefrología de los hospitales andaluces tengan la información suficiente que les facilite la trascendente decisión de elegir la modalidad de tratamiento que le resulte más conveniente

Patient survival according to tertiles of the rate of decline of GFR during follow-up.

<p>Kaplan Meier plot (log rank).</p