Revista de Nefrología, Diálisis y Trasplante

THE PASSAGE OF THE SWALLOWS (ON THE OCCASION OF WORLD KIDNEY DAY 2025)

Cristian Krämer — Thu, 22 May 2025 02:12:07 +0000

ARE YOUR KIDNEYS OK? DETECT EARLY TO PROTECT KIDNEY HEALTH

Thu, 22 May 2025 00:00:00 +0000

Early identification of kidney disease can protect kidney health, prevent kidney disease progression and related complications, reduce cardiovascular disease risk and decrease mortality. We must ask “Are your kidneys ok?” using serum creatinine to estimate kidney function and urine albumin to assess for kidney and endothelial damage. Evaluation for causes and risk factors for chronic kidney disease (CKD) includes testing for diabetes and measurement of blood pressure and body mass index. This World Kidney Day we assert that case-finding in high-risk populations, or even population level screening, can decrease the burden of kidney disease globally. Early-stage CKD is asymptomatic, simple to test for and recent paradigm shifting CKD treatments such as sodium glucose co-transporter-2 inhibitors dramatically improve outcomes and favor the cost-benefit analysis for screening or case-finding programs. Despite this, numerous barriers exist, including resource allocation, healthcare funding, healthcare infrastructure and healthcare-professional and population awareness of kidney disease. Coordinated efforts by major kidney non-governmental organizations to prioritise the kidney health agenda for governments and aligning early detection efforts with other current programs will maximise efficiencies.

Using AI tools to predict arterial stiffness in populations with cardiovascular risk factors

Fri, 23 May 2025 00:00:00 +0000

Introduction: Smoking is a well-established cardiovascular risk factor that contributes to arterial stiffness, accelerating processes such as atherosclerosis. Pulse wave velocity (PWV) is a noninvasive measure that reflects vascular health and helps to detect subclinical damage. Objectives: To describe the variables associated with PWV in the study population, evaluate its association with smoking and ex-smoking, and use machine learning (ML) techniques to identify complex associations not evident in conventional statistical analyses. Materials and Methods: A descriptive cross-sectional study was conducted in the vascular age and smoking cessation clinic of Santojanni Hospital. PWV was measured in 136 patients, analyzing clinical and demographic variables, emphasizing current or past smoking history. Results: PWV showed a positive correlation mainly with age, chronic kidney disease (CKD), and arterial hypertension (AH). Although no significant differences were found between smokers and non-smokers initially, when excluding comorbidities such as hypertension and CKD, smokers and ex-smokers were found to have significantly higher PWV. The use of machine learning identified that, although hypertension and CKD are important factors, the number of pack years and age influenced arterial stiffness more. Conclusions: The study highlights the detrimental effects of smoking on vascular health and the usefulness of PWV in assessing cardiovascular risk. ML techniques allowed the identification of complex interactions, revealing that smoking amplifies the impact of other risk factors. Smoking cessation could improve PWV, reinforcing the importance of continuous monitoring to prevent cardiovascular events.

PRIMARY GLOMERULOPATHIES: LIMA 2006-2015

Fri, 23 May 2025 00:00:00 +0000

Introduction: Primary glomerulopathies (GPs) constitute a heterogeneous group of renal diseases that mainly affect the glomeruli without identifiable etiologic cause. They present clinically with a broad spectrum of manifestations, from proteinuria, hematuria, and nephrotic syndrome to acute or chronic renal failure. The epidemiology of GP varies geographically; in Peru, focal segmental glomerulosclerosis (FSGS) has increased significantly, becoming the most prevalent form. Materials and Methods: A retrospective study was performed using renal biopsies from a referral center in Lima between 2006 and 2015. Patients older than 18 years with a biopsy-confirmed diagnosis of GP were included. Samples were processed for light microscopy and immunofluorescence, classifying glomerular lesions according to their morphological pattern and type of immune deposits. Results: Of the 1259 GP biopsies, 960 met the inclusion criteria. FSGS was the most frequent form (67%), followed by membranous glomerulopathy (MG) (21%) and glomerulopathy with membranoproliferative pattern (MPG) (7%). The annual rate of GPs was 13.2 patients per million population. Conclusion: The prevalence of FSGS has doubled in the last decade, displacing MPG, suggesting an epidemiological change in the Peruvian population.

HEALTH FUNDER AS A PREDICTOR OF MORTALITY IN HEMODIALYSIS AT A SINGLE CENTER IN ARGENTINA

Natalia Boccia, Anabel Abib, Jenny Guzman, Gustavo Laham — Fri, 23 May 2025 00:00:00 +0000

Introduction: Several factors influence mortality in dialysis patients; however, the influence of the healthcare system on survival in this group is unknown. We aimed to assess the influence of the healthcare system on end-stage renal disease patients starting hemodialysis and its impact on mortality. Materials and Methods: We evaluated 503 patients admitted to hemodialysis at CEMIC between January 1995 and June 2020. Considering the healthcare system, the patients were divided into two groups: private (PHC n=360) and government (GHC n=143). Results: The median follow-up time was 30.9 months (12.9-50). In the GHC group, patients were older (66.5 vs. 58.8 years p<0.0001), admitted with a lower percentage of AVF/prosthesis (44.1 vs. 55.3% p < 0.029), phosphorus (5.5 vs. 6 mg /dl p<0.009) and lower albumin (3.7 vs. 3.8 g/dl p<0.038) with mean glomerular filtration rate estimated by CKD-EPI without significant difference with the PHC group (PHC 7.9 ± 3 .8, GHC 7.7 ± 3.8, p 0.613). The proportion of transplanted patients was higher in the PHC group, 40.6 vs 14.7% in the GHC group(p<0.0001), and this group had a higher survival rate (Log-Rank test p <0.021). In multivariate analysis, GHC was one of the predictors of mortality (OR 1.384, 95% CI 1.015-1.888, p 0.040), showing this factor's influence on dialysis patients' survival. Conclusions: Starting hemodialysis with GHC was associated with higher mortality. This patient's group had less access to kidney transplantation.

The relationship between serum dentin matrix Acidic Phosphoprotein-1, Sortilin levels and arterial stiffness in hemodialysis patients

Fri, 23 May 2025 00:49:55 +0000

Introduction: The most important cause of death in hemodialysis (HD) patients is cardiovascular system disease. Dentin Matrix Acidic Phosphoprotein-1 (DMP-1) and sortilin are two molecules associated with cardiovascular events; their significance in HD patients is unknown. In this study, we aimed to investigate the relationship between serum DMP-1 and sortilin levels and arterial stiffness in HD patients. Materials and Methods: A total of 80 individuals, 60 HD patients, and 20 healthy controls were included in the study. Arterial stiffness measurements were performed non-invasively with the Mobil-O-Graph device. Serum DMP-1 and sortilin were measured using the ELISA method in blood samples taken before dialysis. Results: DMP-1 was higher in HD patients than in the healthy controls. Patients with a Pulse Wave Velocity (PWV) value ≥10 were considered to have increased arterial stiffness. Patients with increased arterial stiffness were older, had higher body mass index (BMI) and systolic blood pressure (SBP), and lower creatinine and DMP-1. In the correlation analysis, PWV was positively correlated with age, BMI, and SBP and inversely correlated with creatinine and DMP-1. DMP-1 was negatively correlated with age and C-reactive protein (CRP). In the regression analysis, SBP and DMP-1 were found to be factors affecting PWV. Conclusion: Our study is the first to investigate the relationship between serum DMP-1 and arterial stiffness in HD patients. As a result of our study, we found that serum DMP-1 was inversely related to arterial stiffness in HD patients, and serum sortilin was unrelated.

PREVALENCE OF SODIUM INTAKE IN THE OUTPATIENT POPULATION ATTENDING FOLLOW-UP AT HOSPITAL CARLOS G. DURAND: ASSOCIATION WITH OTHER CARDIOVASCULAR PROGNOSTIC VARIABLES

Sebastián Boubee — Fri, 23 May 2025 00:50:57 +0000

Introduction: Patients with excessive salt intake have a higher cardiovascular risk compared to the general population. Sodium and potassium intake are modifiable risk factors for arterial hypertension. The World Health Organization (WHO) recommends a salt intake target of less than 5 grams per day, regardless of hypertensive status. Objectives: To determine the prevalence of salt intake in the outpatient population attending Hospital Durand. To demonstrate the association between high sodium intake and proteinuria. Materials and Methods: This is an observational, cross-sectional, and analytical study of outpatients attending the Nephrology Department at Hospital Carlos G. Durand with an estimated glomerular filtration rate (eGFR) greater than 60 ml/min and a 24-hour urinary sodium measurement. Results: The median sodium intake was 7.98 grams (IQR 5.84–9.91 grams). Excessive salt intake was observed in 76.10% of the study population. A positive and statistically significant association was found between sodium intake and proteinuria (p = 0.001). Conclusion: Seventy-six percent of patients consume more than 6 grams of salt per day. No statistically significant differences in salt intake were found when comparing hypertensive and diabetic patients, nationality, or current residence. However, higher salt intake was observed in males (p = 0.001).

HISTORICAL DEVELOPMENT OF THE CONCEPT OF CARDIOVASCULAR AND RENAL RISK FACTOR

Ana María Cusumano, María Eugenia Victoria Bianchi — Fri, 23 May 2025 00:43:28 +0000

At the beginning of the 20th century, infectious diseases were the leading cause of death, but with advances in medicine and greater access to healthcare, mortality from these diseases decreased; by 1940, cardiovascular diseases (CVD) were the leading causes of death. In 1947, the Framingham Study began, focusing on the main causes of CVD (atherosclerotic and high blood pressure (HBP). In the 1950s, the causes of coronary heart disease were hypertension, high cholesterol, smoking, and diabetes (DBT). In 1961, the concept of "risk factor" (RF) was coined, recognizing that a combination of factors increased risk. In 1998, the Framingham Score became a key tool in the prevention, diagnosis, and treatment of CVD. In 2000, CVD was recognized as the leading cause of death in patients with CKD, and similar strategies should be used to prevent both CVD and CKD, given the common RFs (diabetes, hypertension, low HDL cholesterol). Albuminuria was identified as a marker and predictor of CKD and CVD progression. Non-traditional RFs for CVD in CKD were later recognized: chronic inflammation, oxidative stress, and altered phosphocalcic metabolism. Subsequently, low birth weight (LBW) was associated with an increased risk of chronic non-communicable diseases, including CVD and CKD (Barker hypothesis); renal studies confirmed a reduction in the number of nephrons in newborns with LBW.