Sociedad Espanola de Nefrologia

Sociedad, Spain

Sociedad Espanola de Nefrologia

Sociedad, Spain
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Royo-Bordonada M.A.,Institute Salud Carlos III | Bejarano J.M.L.,Sociedad Espanola de Medicina de Familia y Comunitaria | Alvarez F.V.,Sociedad Espanola de Arteriosclerosis | Sans S.,Sociedad Espanola de Salud Publica y Administracion Sanitaria | And 16 more authors.
Revista Espanola de Salud Publica | Year: 2013

Based on the two main frameworks for evaluating scientific evidence SEC and GRADE European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of populationbased and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions, led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions-such as smoking ban in public areas or the elimination of trans fatty acids from the food chain are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure (BP) within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.


Royo-Bordonada M.A.,Institute Salud Carlos III | Lobos Bejarano J.M.,Sociedad Espanola de Medicina de Familia y Comunitaria | Villar Alvarez F.,Sociedad Espanola de Arteriosclerosis | Sans S.,Sociedad Espanola de Salud Publica y Administracion Sanitaria | And 17 more authors.
Hipertension y Riesgo Vascular | Year: 2013

Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85. mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses. © 2013 SEHLELHA.


Martin Escobar E.,Organizacion Nacional de Trasplantes | Duran B.M.,Organizacion Nacional de Trasplantes | Emilio Sanchez J.,Sociedad Espanola de Nefrologia | Rotaeche R.S.,Sociedad Espanola de Nefrologia | And 30 more authors.
Nefrologia | Year: 2016

The purpose of the study is to show the evolution of renal replacement therapy (RRT) in Spain from 2007 to 2013.Aggregated data and individual patient records were used from participating regional renal disease registries and that National Transplant Organisation registry. The reference population was the official population on January 1st of each year studied. Data on incidence and prevalence were based on aggregated data, while the survival analysis was calculated from individual patient records. The study period was 2007 to 2013 for prevalence, incidence and transplantation, and survival was analysed for 2004-2012. The population covered by the registry was a minimum of 95.3% to 100% of the Spanish population for aggregated data. The EU27 age and gender distributions of the European population for 2005 were used to adjust incidence and prevalence for age and gender. Survival probabilities were calculated for incident patients between the years 2004 and 2013 using the Kaplan-Meier method to calculate unadjusted patient survival probability. The log rank test was applied to compare survival curves according to some risk factors. Cox proportional hazards model was created to study the potential predictors of survival.In 2013, the total number of patients in Spain that started RRT was 5,705 for 95.3% of the total Spanish population, with an unadjusted rate of 127.1 pmp. The evolution from 2007 to 2013 showed a gradual decline from 127.4 pmp in 2007 to 120.4 pmp in 2012, with a small upturn to 127.1 in 2013. The adjusted incidence rate for the year 2013 was 121.5 pmp for the total population, 158.7 pmp for males and 83.1 pmp for females. The most frequent cause of primary renal disease in incident was diabetes mellitus: 20.4% in 2007, which increased to 24.6% in 2013. The percentage of transplant as first RRT increased from 1.7% in 2007 to 4.2% in 2013. The total number of patients in RRT for 95.3% of the population in 2013 was 50,567, with an unadjusted prevalent rate of 1,125.7 pmp. The adjusted prevalence rate for 2013 was 1,087.5 pmp (1,360.7 pmp for males and 809.8 pmp for females). The percentage of diabetes mellitus in prevalent patients evolved from 13.9% in 2007 to 14.9% (168 pmp) in 2013. The percentage of transplanted prevalent patients with functioning grafts evolved from 49.3% in 2007 to 51.5% in 2013. The number of transplantations performed each year increased from 2,211 (48.9 pmp) in 2007 (6.2% living donor transplants) to 2,552 (54.2 pmp) in 2013 (15.0% living donor transplants).40,394 patients from 12 regions of Spain who began RRT between 2004 and 2012 were included in the survival analysis (87% Spanish population coverage). Unadjusted patient survival probabilities after one, 2 and 5 years were 91, 81 and 57%, respectively. In the univariate analysis, better survival was found for non-diabetic patients, women, age below 45, peritoneal dialysis as first RRT and patients who had received at least one transplant. © 2015 Sociedad Española de Nefrología.


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 | Year: 2014

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.


Portoles-Perez J.,Hospital Universitario Puerta Of Hierro Redinren Isciii | Marques-Vidas M.,Hospital Universitario Puerta Of Hierro Redinren Isciii | Picazo J.J.,Sociedad Espanola de Quimioterapia | Gonzalez-Romo F.,Sociedad Espanola de Quimioterapia | And 15 more authors.
Nefrologia | Year: 2014

Invasive pneumococcal disease (IPD) is a serious problem in some risk groups: patients with stage 4 and 5 chronic kidney disease, stage 3 CKD undergoing immunosuppressive treatment, nephrotic syndrome or diabetes. These individuals are more susceptible to acquire the infection and more prone to suffering more severe episodes with worse outcome. Vaccination is one of the strategies for preventing IPD, although vaccination coverage in this group at present is lower than desired. Currently, there are two vaccinations available for adults. The polysaccharide vaccine (PPSV23), used for decades in patients over the age of 2, includes higher number of serotypes (23), but it does not generate immune memory, causing an immune tolerance phenomenon and it does not act on nasopharyngeal colonization. The conjugate vaccine (VNC13) can be used from infancy until adulthood (advice in patients over 18 years old received approval from the European Medicines Agency in July 2013) and generates a more powerful immune response than PPSV23 against the majority of the 13 serotypes that are included. The 16 scientific societies most directly involved with the groups at risk of IPD have discussed and drafted a series of vaccination recommendations based on scientific evidence related to pneumococcal vaccination in adults with underlying conditions and pathologies, which are the subject of the document "Consensus: Pneumococcal vaccination in adults with underlying pathology". This text sets out the vaccination recommendations for the chronic kidney disease population. © 2014 Revista Nefrología.

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