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Santa Cruz de Tenerife, Spain

Robaina J.C.G.,University Hospital Nuestra Senora Of Candelaria | Sanchez C.P.,Merck S.L. | Perez E.E.,Merck S.L.
ClinicoEconomics and Outcomes Research

Objectives: To quantify the cost difference between conventional symptomatic treatment of mite allergy and specific subcutaneous immunotherapy (SCIT). Methods: Observational, retrospective, and multicenter study was carried out in Spain in 2013. The medical records of 419 patients diagnosed with rhinitis and/or bronchial asthma for mite allergy were retrieved. Mean age was 24.9 years (standard deviation 14.4). The use of symptomatic medication (rescue and daily), diagnostic tests, unscheduled medical care, and sick leave days associated with SCIT treatment versus no-SCIT treatment was compared. Also measured was the SCIT treatment to no-SCIT treatment costs ratio: used resources (symptomatic medication, unscheduled medical care, diagnostic tests, and 3 years SCIT treatment and sick leave days) were quantified in euros. Efficacy (decreased resource usage) of first-year treatment was assumed during the remaining 2 years and also during the 3-year follow-up period. Results: After a single year of SCIT, all quantified resources diminished significantly (P<0.05) from baseline. Estimated reduction in cost items included hospital resources (100% in hospitalizations, 82% in visits to the allergist, and 79% in emergency room visits), therapies (56% in rescue medication and 63% in daily medication), diagnostic tests (77%), and sick leave days (94%). Ratio of comparative calculation described as SCIT treatment versus non-SCIT treatment (or conventional symptomatic treatment) is 0.8. Conclusion: Direct costs are reduced by 64% and indirect costs by 94%. SCIT of hypoallergenic preparation of dust mite (Acaroid®) allows cost savings versus conventional treatment. Estimated savings for the public National Health System are 5.7 times the cost of immunotherapy. © 2016 García Robaina et al. Source

Navarro-Gonzalez J.F.,University Hospital Nuestra Senora Of Candelaria | Mora-Fernandez C.,University Hospital Nuestra Senora Of Candelaria
Contributions to Nephrology

Diabetes mellitus and its complications have become one of the most important health problems in the world. Nowadays, diabetic nephropathy is the main cause of end-stage renal failure and need for renal substitutive therapy. The exact mechanisms leading to the development and progression of renal damage in diabetes are not yet completely known. Growing evidence indicates that activation of innate immunity with the development of a chronic low-grade inflammatory response is a recognized factor in the pathogenesis of this disease. Inflammatory molecules and pathways, including metabolic routes, oxidative stress, growth factors, chemokines, adhesion molecules and inflammatory cytokines, interact in manifold ways leading to renal injury responsible for the development and progression of this complication. The increasing knowledge and understanding of the role of these inflammatory mechanisms, with an integrative comprehension of this network, will facilitate the identification of new therapeutic targets and the development of new strategies that can be translated successfully into clinical applications. Copyright © 2011 S. Karger AG, Basel. Source

Mora-Fernandez C.,University Hospital Nuestra Senora Of Candelaria | Dominguez-Pimentel V.,University Hospital Nuestra Senora Of Candelaria | de Fuentes M.M.,Sociedad Espanola de Nefrologia | de Fuentes M.M.,University Hospital Nuestra Senora Of Candelaria | And 5 more authors.
Journal of Physiology

Diabetic kidney disease (DKD) defines the functional, structural and clinical abnormalities of the kidneys that are caused by diabetes. This complication has become the single most frequent cause of end-stage renal disease. The pathophysiology of DKD comprises the interaction of both genetic and environmental determinants that trigger a complex network of pathophysiological events, which leads to the damage of the glomerular filtration barrier, a highly specialized structure formed by the fenestrated endothelium, the glomerular basement membrane and the epithelial podocytes, that permits a highly selective ultrafiltration of the blood plasma. DKD evolves gradually over years through five progressive stages. Briefly they are: reversible glomerular hyperfiltration, normal glomerular filtration and normoalbuminuria, normal glomerular filtration and microalbuminuria, macroalbuminuria, and renal failure. Approximately 20-40% of diabetic patients develop microalbuminuria within 10-15 years of the diagnosis of diabetes, and about 80-90% of those with microalbuminuria progress to more advanced stages. Thus, after 15-20 years, macroalbuminuria occurs approximately in 20-40% of patients, and around half of them will present renal insufficiency within 5 years. The screening and early diagnosis of DKD is based on the measurement of urinary albumin excretion and the detection of microalbuminuria, the first clinical sign of DKD. The management of DKD is based on the general recommendations in the treatment of patients with diabetes, including optimal glycaemic and blood pressure control, adequate lipid management and abolishing smoking, in addition to the lowering of albuminuria. © 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society. Source

Navarro-Gonzalez J.F.,El Rosario University | Navarro-Gonzalez J.F.,University Hospital Nuestra Senora Of Candelaria | Muros M.,University Hospital Nuestra Senora Of Candelaria | Mora-Fernandez C.,University Hospital Nuestra Senora Of Candelaria | And 3 more authors.
Journal of Diabetes and its Complications

Statements of the Problem: Diabetic nephropathy (DN) is the main cause of end-stage renal disease (ESRD). Renin-angiotensin system (RAS) blockade is the standard of care; however, a significant proportion of patients progress to ESRD. Pentoxifylline (PTF) possesses properties suggesting potential renoprotective efficacy. The aim of the Pentoxifylline for Renoprotection in Diabetic Nephropathy (PREDIAN) study is to test the efficacy of PTF addition to RAS blockade on the progression of DN. Here we report the study design and the baseline patient characteristics. Methods: This is an investigator-initiated, single-center, prospective, randomized, controlled, clinical trial without any commercial interest, funded by the Spanish Ministry of Science and Innovation. One hundred and sixty-nine type 2 diabetic patients with Stage 3 and 4 chronic kidney disease (CKD) were randomized to a control group (n=87) or an active group (n=82), which will receive PTF (1200 mg/day) for 24 months. The primary outcome measure is the difference in estimated glomerular filtration rate (eGFR) between the groups at the end of the study. Results: The baseline characteristics of the subjects are as follows: 116 patients (68.6%) with Stage 3 CKD and 53 (31.3%) Stage 4 CKD, age 69±9 years, duration of diabetes 15±3 years, eGFR 37±12 ml/min per 1.73 m 2, albuminuria 1.39±1.16 g/day, blood pressure 142±8/86±8 mmHg. Inflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-10) and polymorphisms of the coding genes for these molecules are studied. Conclusions: The PREDIAN study will provide evidence on the renoprotective benefit of PTF in addition to interventions of proven efficacy (RAS blockade) in DN. © 2011 Elsevier Inc. Source

Donate-Correa J.,University Hospital Nuestra Senora Of Candelaria | Donate-Correa J.,Institute Salud Carlos III | De Fuentes M.M.,University Hospital Nuestra Senora Of Candelaria | De Fuentes M.M.,Institute Salud Carlos III | And 4 more authors.
Clinical Chemistry

BACKGROUND: Fibroblast growth factor-23 (FGF-23) and Klotho constitute the main regulatory system of phosphorus homeostasis. Beyond this physiological role, there is growing evidence suggesting that this system has relevant pathophysiological implications in different clinical processes. CONTENT: In this review we discuss the pathophysiological implications of the FGF-23/Klotho system and the potential utility that measurements of its components may have as clinical biomarkers in different clinical settings, such as progression of chronic kidney disease, acute renal failure, and secondary hyperparathyroidism, as well as vascular dysfunction, atherosclerosis, and cardiovascular morbidity and mortality. We outline and discuss the current commercially available assays for determination of FGF-23 and Klotho and the assay limitations that must be overcome to translate these biomarkers into reliable indicators in clinical practice. SUMMARY: In addition to its physiological role, the FGF-23/Klotho system appears to provide important information regarding the pathophysiology of several clinical conditions. Although there has been increasing study of the components of this new biological system and their potential use as clinical biomarkers, the ultimate value of this system in clinical practice will not be known until remaining assay limitations can be overcome and adequately designed studies have been conducted to demonstrate its clinical utility. © 2013 American Association for Clinical Chemistry. Source

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