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OBJECTIVE: There is evidence of cognitive impairment in patients with end-stage renal disease in hemodialysis (ESRD-HD). However, few studies have exhaustively analyzed executive functions (EFs) in this population, especially considering the influence of a wide range of clinical variables. This study analyzes performance in different EF components in ESRD-HD patients compared to a group of healthy controls (HCs), in addition to the acute effects of HD and the associations of cognitive performance with clinical variables. METHOD: EFs were evaluated pre- and post-HD in 43 ESRD-HD patients and 42 HCs, using a battery of tests designed to assess EF domains. Age, schooling, mood and blood pressure were statistically controlled. Associations between performance and clinical factors were computed by correlations and hierarchical multiple regression analyses. RESULTS: The performance of the ESRD-HD patients was significantly lower than that of HCs in all the EF domains except for planning. Group differences were marginally significant for reasoning. HD produced no acute changes in global performance, with improvements see only in inhibition and working memory. EF scores were positively associated with total number of months previously transplanted, body mass index (BMI), dry weight, and levels of hemoglobin, albumin, ferritin, calcium, phosphorus, sodium, urea, and creatinine. CONCLUSIONS: Global EF functioning was lower in ESRD-HD patients than in HCs. No major acute HD-related EF changes were detected. These findings underline the importance of an adequate nutritional status for maintaining executive functioning in ESRD-HD patients.

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OBJECTIVE: To analyse the presence of VC at the start of dialysis and its relationship with events and/or death from cardiovascular causes in the course of follow-up. METHODS: In the study, we included patients who started dialysis between November 2003 and September 2007. In the first month of treatment, we assessed the presence of VC by Doppler echocardiography, along with demographic factors and risk factors for cardiovascular disease, coronary artery disease, stroke, atrial fibrillation (AF), and cardiac dimensional and functional electrocardiographic and echocardiographic parameters. The biochemistry values assessed were: haemoglobin, calcium/phosphorous/iPTH metabolism, cholesterol and fractions, triglycerides, troponin I, albumin, CRP and glycosylated haemoglobin. We analysed the association between VC and the presence of myocardial infarction (MI), stroke and/or death from cardiovascular causes up to transplantation, death or the end of the study (December 2012). RESULTS: Of 256 enrolled patients (83% haemodialysis, 17% peritoneal dialysis), 128 (50%) had VC (mitral: 39, aortic: 20, both: 69). In the multivariate analysis, VC was associated with older age (OR: 1.110; 95% CI: 1.073-1.148; p = 0.000) and lower albumin levels (OR: 0.29; 95% CI: 0.14-0.61; p = 0.001). In a follow-up lasting 42.1 ± 30.2 months (898.1 patient-years), 68 patients suffered MI, stroke and/or died from cardiovascular causes. In the Cox regression analysis, older age (HR: 1.028; 95% CI: 1.002-1.055; p = 0.037), coronary artery disease and/or stroke (HR: 1.979; 95% CI: 1.111-3.527; p = 0.021), AF (HR: 2.474; 95% CI: 1.331-4.602; p = 0.004), and the presence of VC at the start of dialysis (HR: 1.996; 95% CI: 1.077-3.700; p = 0.028) were the predictor variables for the occurrence of the analysed events. CONCLUSIONS: The prevalence of VC at the start of dialysis is high and its presence predicts the occurrence of events and/or cardiovascular death in the course of follow-up.

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La calcificación valvular (CV) en la enfermedad renal crónica es frecuente, aunque la mayor parte de la información procede de pacientes prevalentes en diálisis. Son pocos los estudios que analicen la CV en los pacientes que inician diálisis. Objetivo: Analizar la presencia de CV al inicio de diálisis y su relación con eventos y/o muerte cardiovascular en la evolución. Métodos: Incluimos en el estudio los pacientes incidentes en diálisis entre nov/03 y sept/07. En el 1o mes de tratamiento analizamos la presencia de CV mediante Ecocardiograma-doppler, junto a factores demográficos y de riesgo cardiovascular, enfermedad coronaria, accidente cerebrovascular (ACV), fibrilación auricular (FA) y parámetros de electro y ecocardiográficos dimensionales y funcionales cardiacos. Los valores bioquímicos analizados fueron: hemoglobina, metabolismo calcio/fósforo/iPTH, colesterol y fracciones, triglicéridos, troponina I, albúmina, PCR y hemoglobina glicosilada. Analizamos la asociación de la CV con la presentación de infarto de miocardio (IAM), ACV y/o muerte cardiovascular hasta el trasplante, muerte, o fin del estudio (dic/2012). Resultados: De 256 pacientes incluidos (83% hemodiálisis, 17% diálisis peritoneal), 128 (50%) presentaban CV (mitral: 39, aórtica: 20, ambas: 69). En el análisis multivariante la CV se asoció a mayor edad (OR: 1,110; IC 95%: 1,073-1,148; p = 0,000) y menor albúmina (OR: 0,29; IC 95%: 0,14-0,61; p = 0,001). En un seguimiento de 42,1 ± 30,2 meses (898,1 pacientesaño), 68 pacientes presentaron IAM, ACV y/o murieron por causa cardiovascular. En el análisis de regresión de Cox, la mayor edad (HR: 1,028; IC 95%: 1,002-1,055; p = 0,037), la enfermedad coronaria y/o ACV (HR: 1,979; IC95%: 1,111-3,527; p = 0,021), la FA (HR: 2,474; IC 95%: 1,331-4,602; p = 0,004) y la presencia de CV antes de entrar en diálisis (HR: 1,996; IC 95%: 1,077-3,700; p = 0,028), fueron predictores independientes de la presentación de los eventos analizados. Conclusiones: La prevalencia de CV en el momento de iniciar diálisis es alta y su presencia predice la presentación de eventos y/o muerte cardiovascular en la evolución (AU)

The estimated frequency of cardiac valvular calcification (VC) in patients on dialysis is high, although the majority of studies published to date regarding the rate of VC have dealt with prevalent patients in dialysis. There are few studies of VC at the commencement of dialysis and its relationship to future events or cardiovascular mortality. Objective: To establish the prevalence of VC at the start of dialysis and the relationship between VC and the presentation of composite endpoints of acute myocardial infarction (MI), stroke or death from cardiovascular causes in the follow-up of incident dialysis patients. Methods: We conducted an analysis of dialysis patients (haemodialysis or peritoneal dialysis) who commenced dialysis between November 03 and September 07. VC was assessed by Doppler-echocardiography and its association with MI, stroke or cardiovascular mortality in the follow-up until death, transplant, or study end in December 2012 was analysed. Other variables assessed in the first month of dialysis were ECG, age, gender, smoking habit, diabetes, hypertension, previous ischemic stroke, coronary arterial disease and atrial fibrillation. Biochemical analyses included: haemoglobin, urea, creatinine, lipids, calcium, phosphorus, parathyroid hormone, albumin, troponin I, glycosylated haemoglobin and C-reactive protein. Results: Of 256 enrolled patients (83% Haemodialysis, 17% Peritoneal dialysis), 128 (50%) had VC at the commencement of dialysis (aortic 20, mitral 39, both 69). VC was associated with older age (OR: 1.110; CI 95%: 1.073-1.148; P=.000) and lower albumin levels (OR: 0.29; CI 95%: 0.14-0.61; P=.001). In a follow-up lasting a mean of 42.1±30.2 months (898.1 patient-years), 68 patients suffered an MI, a stroke or died from cardiovascular causes. The factors that predicted the presentation of the endpoint (Cox regression analysis) were older age (HR: 1.028; CI 95%: 1.002-1.055; P=.037), previous coronary arterial disease or stroke (HR: 1.979; CI 95%: 1.111-3.527; P=.021), atrial fibrillation (HR: 2.474; CI 95%: 1.331-4.602; P=.004) and VC at the start of dialysis (HR: 1.996; CI 95%: 1.077-3.700; P=.028). Conclusions: The prevalence of VC at the commencement of dialysis is very high and its presence is an independent predictor of event and cardiovascular mortality presentation in the course of follow-up (AU)

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Los pacientes con insuficiencia renal crónica en diálisis peritoneal con frecuencia están mal nutridos o en riesgo de desnutrición, por sus especiales características y favorecido por múltiples factores, como otras patologías asociadas, diálisis inadecuada, estado inflamatorio, pérdida de nutrientes por el dializado, etc. Se han descrito numerosos métodos para evaluar el estado nutricional, siendo las medidas antropométricas y determinaciones de laboratorio las más utilizadas, pero cuando las aplicamos a pacientes renales los resultados obtenidos son muy variables, además algunos de ellos plantean problemas a la hora de su aplicación, por las especiales características de los pacientes en diálisis. Una forma de prevenir la malnutrición es identificar a aquellos pacientes en riesgo de desnutrición y evitar su deterioro progresivo. Nuestro objetivo, es evaluar el estado nutricional de los pacientes en diálisis peritoneal con hipoalbuminemia. Hemos seleccionado 21 pacientes con más de 3 meses en diálisis peritoneal y con tendencia a tener hipoalbuminemia < 3,6 g/ dl. Hemos evaluado su estado nutricional mediante la escala de evaluación global subjetiva y escala de malnutrición-inflamación. Hemos encontrado que la mayoría de los pacientes presentan bajo riesgo de malnutrición estimado tanto por la evaluación global subjetiva donde el 85,7% tienen bajo riesgo de malnutrición o estado de nutrición normal y por la escala de malnutrición-inflamación igualmente el 85% tienen un estado de nutrición normal. Por tanto, debemos utilizar la combinación de varios métodos para evaluar adecuadamente el estado nutricional e identificar aquellos con riesgo de malnutrición (AU)

Patients with chronic renal deficiency on peritoneal dialysis are often poorly nourished or at risk of malnutrition due to their special characteristics, and this is exacerbated by a range of factors, including other associated pathologies, unsuitable dialysis, inflammatory state, loss of nutrients due to the dialysate, etc. Numerous methods for assessing nutritional status have been described, among which anthropometric measurements and laboratory determinations are the most widely-used. However, when these are applied to renal patients the results obtained are highly variable, and moreover problems arise with putting some of them into practice, due to the special features of dialysis patients. One way of preventing malnutrition is to identify the patients at risk and avoid their gradual deterioration. The aim here is to assess the nutritional status of patients on peritoneal dialysis with hypoalbuminaemia. We selected 21 patients with over 3 months on peritoneal dialysis and with a tendency to suffer hypoalbuminaemia < 3.6g/dl. We appraised their nutritional status using the subjective overall assessment scale and the malnutritioninflammation scale. We found that most patients had a low estimated risk of malnutrition according to both the subjective global assessment where 85.7% had a low risk of malnutrition or a normal nutritional status and the malnutrition-inflammation scale, which likewise gave 85% with a normal nutritional status. We must therefore use a combination of different methods to properly assess nutritional status and identify those at risk of malnutrition (AU)

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