Revista de nefrología y terapéutica

Background: Traditional socio-economic status (SES) factors that have been associated with access to renal transplantation include race, gender and income. However, these traditional factors are neither specific nor sensitive for ‘at risk’ status. There are now new and comprehensive SES assessment tools like the Social adaptability index (SAI) that provide an accurate and reliable estimate of an individual’s social adaptability, and have been shown to predict graft failure and access to renal transplantation. Summary: In this review we describe the various SES factors that have been shown to be associated with graft failure and access to renal transplantation. We also describe novel methods to quantify SES like the SAI. We also discuss, based on literature review, potential interventions to improve access to renal transplantation in individuals with lower SES. Conclusion: There are several SES factors associated with access to renal transplantation. Quantifying SES through tools like SAI can aid in identifying at risk patients, and thereby, can assist in targeting interventions towards patients most likely to benefit from them and reducing disparities in access to renal transplantation.

Background: The first cloned long pentraxin is Pentraxin 3(PTX3) and C-reactive protein is a human short pentraxin. Pentraxin 3 has a bigger molecular size (40.6 kDA) compared to CRP (21.5 kDa).The long PTX3 is produced by diverse cell types in response to primary inflammatory signals and specific neutrophil granules store PTX3. Aim: Evaluate serum levels of long pentraxin 3 and high sensitivity C-reactive protein in patients with chronic kidney disease treated with or without hemodialysis. The study included 75 subjects, 25 heathy controls (group 1), 50 patients without cardiovascular disease subdivided into: 25 patients with chronic kidney disease (CKD) on conservative therapy (group 2a) and 25CKD patients on maintenance hemodialysis (group 2b). To all studied subjects the following was done: electocardiography, carotid intima media thickness, fasting serum glucose, renal, liver and lipid profiles, high- sensitivity C-reactive protein (hsCRP) and PTX3by ELISA. Results: There was a significant decrease in the mean levels of albumin in all the studied chronic renal failure patients when compared to controls. Hypoalbuminemia is due to malnutrition and inflammation in CKD patients. There was a significant increase in hsCRP in patients on hemodialysis therapy when compared to both controls and patients on non-dialytic therapy. The circulating value of CRP reflects ongoing inflammation and/or tissue damage. There was a significant increase in PTX3 in patients on hemodialysis therapy as compared to controls. PTX3 levels may directly reflect the inflammatory status. Since a state of persistant low-grade inflammation is a common feature in hemodialysis patients so PTX3 increased in such patients. There were no correlations between PTX3 and hsCRP in the studied groups. By drawing the ROC curve for hsCRP and PTX3 in patients on non-dialytic therapy (group 2a), the area under the curve was 0.545 (p=0.594) and 0.653 (p=0.073) respectively. In patients on hemodialysis therapy (group 2b), the area under the curve was 0.735 (p=0.006) for hsCRP and 0.765 (p=0.002) for PTX3. By using the best cut off values, it was found that high sensitivity C-reactive protein showed a better specificity and positive predictive value than PTX3 while PTX3 showed a better sensitivity than hsCRP in the studied two groups of patients. Conclusion: It could be concluded that using both hsCRP and PTX3 complement each other to give better specificity and sensitivity as predictors of inflammation in chronic kidney disease patients. Recommendation: Study of PTX3 and hsCRP on a large number of chronic kidney disease patients with cardiovascular disease.

Adiponectin is an inflammatory cytokine produced by adipose tissue and its protective role has been recognized in the pathogenesis of obesity. A lower concentration in obesity patients is noted, in conditions of resistance to insulin, diabetes mellitus, and CKD. Patients with type 2 diabetes mellitus have a potential risk of atherosclerosis, while low concentrations of adiponectin are considered as predictor for the occurrence of complications in patients with type 2 diabetes. The aim of this study was to investigate in patients with type 2 diabetes mellitus with and without diabetic nephropathy the correlation of adiponectin levels and CKD stage or degree of albuminuria. We studied 119 patients with type 2 diabetes mellitus with different stage of renal function, the levels of plasma adiponectin, and the BMI. A statistically significant difference of plasma adiponectin levels was noted between the initial and end stages of CKD, the highest levels seen in ESKD patients. Also, the levels of adiponectin were elevated in patients with greater albuminuria (statistically significant difference between groups 1 and 3, p=0.05). The levels of adiponectin were found to decrease with increasing the stage of obesity (ANOVA, p<0.05). Finally, the group of patients receiving glitazones had higher plasma adiponectin levels compared to those not receiving. It concluded that the levels of adiponectin increase with the deterioration of renal function and with enhancement of albuminuria, while decreasing as the stage of obesity worsens. The administration of glitazones was associated with increased plasma levels of adiponectin.

Background: Diabetic nephropathy, characterized by albuminuria, is a severe complication of diabetes mellitus, leading cause of end-stage renal disease. The aim of the present study was to evaluate the efficacy and safety of sulodexide, alone or in combination with captopril, versus captopril alone in consecutive adult patients with diabetic nephropathy. Methods: Patients aged ≥ 18 years, with type 1 or type 2 diabetes mellitus and albumin excretion rate (AER) ≥ 30 mg/24 h, without severe renal insufficiency, cardiac or hepatic insufficiency, or haematuria, were enrolled. Patients were treated with captopril 25 mg twice daily, sulodexide 25 mg twice daily, or a combination of captopril 25 mg twice daily + sulodexide 25 mg twice daily for 6 months. The primary endpoint was the evaluation of AER. Secondary endpoints included evaluation of arterial blood pressure, fasting glucose, HbA1c, serum creatinine and uricemia and safety. Results: Globally, 123 patients were enrolled and treated with captopril alone (n=42), sulodexide alone (n=53) or sulodexide plus captopril (n=28). After adjustment for initial albuminuria, the AER reduction at T3 and T6 versus T0, although highly significant in all treatment groups, was higher in patients treated with the combination or with sulodexide alone than in patients given captopril alone (further decrease of 17.6% and 18.2% at T3 and of 29.3% and 19.8% at T6, respectively). In the whole population, serum creatinine and uric acid levels increased during the study, HbA1c and fasting glucose levels increased from T0 to T3 and remained stable thereafter, while blood pressure was constant throughout the study. Sulodexide was well tolerated. Conclusions: Long term administration of sulodexide 50 mg/day, both in monotherapy or in combination with captopril, is effective and well tolerated in reducing proteinuria in diabetic patients and can be considered a valid therapeutical option in order to prevent major complications and reduce morbidity and mortality in this population.

Introducción: Las complicaciones cardiovasculares son la principal causa de morbilidad y mortalidad en los pacientes con enfermedad renal terminal que requieren hemodiálisis. La mayoría de estos pacientes padecen hipertensión y el control adecuado de la presión arterial es un desafío en estos pacientes debido a la etiología multifactorial y los cambios farmacocinéticos complicados en estos pacientes. El presente estudio tiene como objetivo encontrar el mejor fármaco o combinación de fármacos posible que pueda proporcionar un mejor control de la presión arterial y mejorar la calidad de vida de estos pacientes. Metodología: Se realizó un estudio retrospectivo de los pacientes que asistieron a la unidad de hemodiálisis del hospital Hakeem Abdul Hamid Centenary desde julio de 2015 hasta junio de 2016 (un año), se registraron y analizaron los datos sobre los fármacos antihipertensivos y el control de la presión arterial (prediálisis y posdiálisis). Resultado: El 68,75% de los pacientes en hemodiálisis padecían hipertensión y tomaban medicación antihipertensiva. Una combinación de amlodipino y clonidina fueron los agentes antihipertensivos prescritos con mayor frecuencia. Los calambres musculares, un aumento agudo de la presión arterial y la hipotensión fueron las complicaciones intradialíticas más frecuentes en estos pacientes. Conclusión: Aunque la combinación de amlodipino y clonidina fue la medicación antihipertensiva prescrita con más frecuencia en estos pacientes, estos fármacos se asociaron con complicaciones intradialíticas como calambres musculares e hipotensión. El amlodipino con un bloqueador de los receptores beta-adrenérgicos (metoprolol o bisoprolol) proporcionó el mejor control de la presión arterial en estos pacientes con menos complicaciones intradialíticas.