Nephrology Service

Buenos Aires, Argentina

Nephrology Service

Buenos Aires, Argentina

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Arias-Rodriguez M.,Hospital Universitario Marques Of Valdecilla Iidival | Fernandez-Fresnedo G.,Hospital Universitario Marques Of Valdecilla Iidival | Marin R.,Nephrology Service | Franco A.,Hospital General Of Alicante | And 5 more authors.
Journal of Hypertension | Year: 2015

Objective: Arterial hypertension is a prevalent complication that occurs in 75-90% of kidney-transplant recipients. Data about resistant arterial hypertension are scarce. The aim of this multicenter, cross-sectional, and observational study was to assess the prevalence and the clinical features of true resistant hypertension among renal-transplant patients. Methods: Eligible patients included hypertensive cadaveric kidney-transplant recipients aged below 70 years, with functioning kidney for at least 1 year, and with an estimated glomerular filtration rate at least 30 ml/min per 1.73 m2 and serum creatinine below 2.5 mg/dl. Recorded data included demographic characteristics, office blood pressure, and ambulatory blood pressure monitoring and laboratory investigations. A total of 868 patients (mean age 53.2 ± 11.6 years) were included. Results: Mean systolic and diastolic office blood pressure was 140.2 ± 18 and 80.4 ± 10 mmHg, respectively. Mean 24-h ambulatory SBP and DBP was 131.5 ± 14 and 77.4 ± 8.7 mmHg and the prevalence of true resistant hypertension was 18.9%. Those with resistant hypertension were older and men, with a worse cardiovascular risk profile and history of cardiovascular disease. Apart from this, these patients had worse graft function and treatment with steroids. Conclusions: The present study provides evidence about the prevalence of true resistant hypertension in renaltransplant patients. It also shows the very high cardiovascular risk of true resistant hypertension and the elevated association of this condition with renal failure, organ damage, and history of cardiovascular events. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Politei J.M.,Juan Fernandez Hospital | Cabrera G.,Del Viso Medical Center | Amartino H.,Austral Hospital | Valdez R.,Central Military Hospital | And 8 more authors.
International Journal of Clinical Practice | Year: 2013

Aims: Fabry disease (FD) is an X-linked inborn error of metabolism caused by alpha-galactosidase A deficiency. The Fabry Registry is an ongoing, global observational database that compiles clinical data from patients with FD. Methods: Demographic and baseline clinical characteristics of Fabry Registry patients enrolled in Argentina were analysed and compared with patients enrolled in the rest of the world (ROW). Baseline clinical parameters included chronic kidney disease (CKD) stage, urine protein-to-creatinine ratio and left ventricular posterior wall thickness. Only data from untreated patients were included. Results: As of 1 October 2010, 3752 patients were enrolled in the Registry, 70 patients from Argentina and 3682 from the ROW. Argentinean male subjects were younger than Fabry Registry male subjects enrolled in ROW: mean current age 32.5 years vs. 39.0 years for men (p = 0.0257 by t-test). The current age (mean ± standard deviation) of female subjects enrolled in Argentina was not significantly different from that of female subjects enrolled in the ROW: 40.1 ± 17.28 vs. 43.2 ±17.95 years respectively (p = 0.2967). Overall, a smaller percentage of patients from Argentina received ERT compared with patients in the ROW (54% vs. 58% respectively). When evaluated by gender, more men and fewer women in Argentina received ERT compared with ROW (85% vs. 79% for men and 27% vs. 38% for women). A larger proportion of patients in ROW had severe CKD (stage 4 or 5) compared with Argentina (9.8% vs. 0%), most likely because of the older age of the ROW population. Conclusions: The enrolment of Argentinean patients into the Fabry Registry has steadily increased, as has the inclusion of female and paediatric patients with FD. The medical community in Argentina should be aware of FD in these populations, as awareness will facilitate prompt diagnosis and initiation of treatment, thus leading to improved outcomes. © 2012 Blackwell Publishing Ltd.


Luis D.,Karolinska Institutet | Luis D.,Hospital Universitario Nuestra Senora Of Candelaria | Zlatkis K.,Patient Association Enfermos Renales de Tenerife ERTE | Comenge B.,Patient Association Enfermos Renales de Tenerife ERTE | And 4 more authors.
Journal of Renal Nutrition | Year: 2016

Background: The multiple dietary restrictions recommended to hemodialysis patients may be difficult to achieve and, at the same time, may result in nutritional deficiencies rendering a poor dietary quality. We here assess the dietary quality and adherence to renal-specific guideline recommendations among hemodialysis patients from a single center in Canary Islands, Spain. Methods: Cross-sectional study, including 91 patients undergoing maintenance hemodialysis. Clinical data and 3-day dietary records were collected. We compared patient's reported nutrients intake with guideline recommendations. We also evaluated their alignment with current American Heart Association dietary guidelines for cardiovascular prevention. Results: Seventy-seven percent and 50% of patients consumed less than the recommended daily energy and protein, respectively. Although half of the patients met the recommendations for dietary fat intake, this was accounted by an excess of saturated fat in 92% of them. Only 22% consumed sufficient fiber. A very small proportion of patients (less than 50%) met the requirements for vitamins and other micronutrients. Insufficient dietary intake was observed in most patients for all vitamins except for cobalamin. Similarly, inadequate dietary intake was observed for many minerals, by both excess (phosphorus, calcium, sodium, and potassium) and defect (magnesium). Most patients met the recommendations for iron and zinc in their diets. Conclusions: A large proportion of hemodialysis patients at our center did not meet current renal-specific dietary recommendations. The quality of the diet was considered poor and proatherogenic according to American Heart Association guidelines. © 2016 National Kidney Foundation, Inc..


PubMed | Karolinska Institutet, Hospital Universitario Nuestra Senora Of Candelaria, Hospital Universitario Of Canarias And Hospiten Tamaragua, Nephrology Service and Patient Association Enfermos Renales de Tenerife ERTE
Type: Journal Article | Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation | Year: 2016

The multiple dietary restrictions recommended to hemodialysis patients may be difficult to achieve and, at the same time, may result in nutritional deficiencies rendering a poor dietary quality. We here assess the dietary quality and adherence to renal-specific guideline recommendations among hemodialysis patients from a single center in Canary Islands, Spain.Cross-sectional study, including 91 patients undergoing maintenance hemodialysis. Clinical data and 3-day dietary records were collected. We compared patients reported nutrients intake with guideline recommendations. We also evaluated their alignment with current American Heart Association dietary guidelines for cardiovascular prevention.Seventy-seven percent and 50% of patients consumed less than the recommended daily energy and protein, respectively. Although half of the patients met the recommendations for dietary fat intake, this was accounted by an excess of saturated fat in 92% of them. Only 22% consumed sufficient fiber. A very small proportion of patients (less than 50%) met the requirements for vitamins and other micronutrients. Insufficient dietary intake was observed in most patients for all vitamins except for cobalamin. Similarly, inadequate dietary intake was observed for many minerals, by both excess (phosphorus, calcium, sodium, and potassium) and defect (magnesium). Most patients met the recommendations for iron and zinc in their diets.A large proportion of hemodialysis patients at our center did not meet current renal-specific dietary recommendations. The quality of the diet was considered poor and proatherogenic according to American Heart Association guidelines.


Antunes S.A.,Federal University of São Paulo | Vilela R.Q.,Federal University of Alagoas | Vaz J.D.,Nephrology Service | Canziani M.E.F.,Federal University of São Paulo
International Journal of Artificial Organs | Year: 2014

Introduction: Anemia is a frequent condition in patients with chronic kidney disease due to a reduction in the production of erythropoietin. Patients with inflammation respond less well to treatment with erythropoietin, possibly because the increased production of hepcidin reduces the availability of iron for hematopoiesis. Some studies suggest that pentoxifylline has anti-inflammatory properties and could be used as adjuvant therapy in the treatment of anemia. Objective: The aim of this study was to analyze the effect of pentoxifylline on serum hepcidin in chronic hemodialysis patients with inflammation. Methods: 71 adult patients on hemodialysis with C-reactive protein (CRP) ≥0.5 mg/dl in screening tests; patients were randomized to the treatment group (oral pentoxifylline 400 mg/thrice-weekly) or the control group for 3 months follow-up. Results: During the study, a decrease in hemoglobin, transferrin saturation, and hepcidin was observed in both groups. However, these reductions were related to the time and not to the drug. There was no difference in the concentrations of CRP, ferritin, and albumin over time in either group. Conclusions: The use of this amount of pentoxifylline did not modify the serum levels of hepcidin in this population. © 2014 Wichtig Publishing.


Gamondi C.,Instituto Oncologico della Svizzera Italiana | Galli N.,University of Lugano | Schonholzer C.,Nephrology Service | Marone C.,Nephrology Service | And 6 more authors.
Swiss Medical Weekly | Year: 2013

Question Under Study: Data on pain management in haemodialysis patients with end-stage renal disease are scanty. Our study aimed to collect information on the frequency and severity of pain and symptom distress among long-term dialysis patients in southern Switzerland. METHODS: Patients with chronic kidney disease stage 5, on dialysis, treated in five nephrology units in southern Switzerland, who had given informed consent and were able to complete the survey, were interviewed to assess pain and correlated symptoms using a Visual Analogue Scale (VAS), the Brief Pain Inventory and the Edmonton Symptom Assessment System. To evaluate the impact of symptoms, the Instrumental Activities of Daily Living questionnaire was used. RESULTS: One hundred and twenty-three patients, aged 36-90 years and with a mean time on dialysis of 3.5 years, were interviewed. Pain was experienced by 81 patients during the 4 weeks before the interview: 68 had chronic pain; 66 reported pain intensity higher than 5 on the VAS; 35 identified musculoskeletal pain as the most disturbing pain. Five patients used drugs to cope with pain during the night. Asthenia and fatigue were prevalent concomitant symptoms. Asthenia, fatigue, sleep disturbances, dyspnoea, loss of appetite, nausea/vomiting and anxiety were correlated with pain. The majority of the patients reported that their pain limited their daily life activities. CONCLUSIONS: Pain severity and symptom distress in dialysis patients are important, but underestimated and undertreated. They interfere with sleep quality and daily living. Routine assessment of pain burden, pain management similar to that used in palliative care, and adequate analgesic use to treat specific dialysis-associated pain syndromes should be considered in guidelines.


Marquez D.,Nephrology Service
Jornal brasileiro de nefrologia : 'orgão oficial de Sociedades Brasileira e Latino-Americana de Nefrologia | Year: 2012

Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS). Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) Excessive sedation was common with gabapentin. Desloratadine was well tolerated. Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.


PubMed | University Hospital Nuestra Senora Of Candelaria and Nephrology Service.
Type: Journal Article | Journal: Journal of the American Society of Nephrology : JASN | Year: 2015

Diabetic kidney disease (DKD) is the leading cause of ESRD. We conducted an open-label, prospective, randomized trial to determine whether pentoxifylline (PTF), which reduces albuminuria, in addition to renin-angiotensin system (RAS) blockade, can slow progression of renal disease in patients with type 2 diabetes and stages 3-4 CKD. Participants were assigned to receive PTF (1200 mg/d) (n=82) or to a control group (n=87) for 2 years. All patients received similar doses of RAS inhibitors. At study end, eGFR had decreased by a meanSEM of 2.10.4 ml/min per 1.73 m(2) in the PTF group compared with 6.50.4 ml/min per 1.73 m(2) in the control group, with a between-group difference of 4.3 ml/min per 1.73 m(2) (95% confidence interval [95% CI], 3.1 to 5.5 ml/min per 1.73 m(2); P<0.001) in favor of PTF. The proportion of patients with a rate of eGFR decline greater than the median rate of decline (0.16 ml/min per 1.73 m(2) per month) was lower in the PTF group than in the control group (33.3% versus 68.2%; P<0.001). Percentage change in urinary albumin excretion was 5.7% (95% CI, -0.3% to 11.1%) in the control group and -14.9% (95% CI, -20.4% to -9.4%) in the PTF group (P=0.001). Urine TNF- decreased from a median 16 ng/g (interquartile range, 11-20.1 ng/g) to 14.3 ng/g (interquartile range, 9.2-18.4 ng/g) in the PTF group (P<0.01), with no changes in the control group. In this population, addition of PTF to RAS inhibitors resulted in a smaller decrease in eGFR and a greater reduction of residual albuminuria.


Peixoto A.J.,VA Connecticut Healthcare System | Peixoto A.J.,Yale University | Orias M.,Nephrology Service | Desir G.V.,VA Connecticut Healthcare System | Desir G.V.,Yale University
Current Hypertension Reports | Year: 2013

Hypertension complicates most cases of chronic kidney disease. While the prevalence and severity of hypertension increase as glomerular filtration rate falls, hypertension is often observed in patients with structural kidney disease while renal function is normal, in particular those with polycystic kidney disease or proteinuric glomerular diseases. On the other hand, even severe reductions in renal function may not result in hypertension, especially if there is effective control of extracellular fluid volume. Recent clinical and experimental data indicate that proteinuria may mediate sodium retention and hypertension via plasmin-mediated activation of the epithelial sodium channel. Current evidence supports the notion that chronic kidney disease is a cause of chronic hypertension, even in the absence of detectable changes in glomerular filtration rate. © 2013 Springer Science+Business Media New York (outside the USA).

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