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BACKGROUND: Acute kidney failure is a serious consequence of coronavirus disease 2019 (COVID-19). OBJECTIVES: To identify the prevalence of COVID-19, kidney failure, frequency of death, and associated factors in patients receiving intensive care. DESIGN AND SETTING: Analytical cross-sectional study conducted in the intensive care unit (ICU) of a medium-sized philanthropic general hospital in center-west Minas Gerais. METHODS: Adults and older individuals who underwent real-time polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were evaluated by the nephrology team. RESULTS: Among the 176 patients, the prevalence of COVID-19 and acute kidney injury (AKI) were 103 (58.5%) and 132 (75%), respectively, and 44 (25%) had chronic kidney disease (CKD) and 16 (15,5%) were positive for SARS-CoV-2. In the Charlson index classification, which estimates the risk of death, a statistically significant difference was identified in the percentages of groups with and without COVID-19 for indices 0, 1, and 2. There was a significant association between kidney disease and ICU mortality (P < 0.05). Patients with CKD had fewer fatal outcomes (13/97, 13.4%) than those with AKI (85/97, 87.6%). CONCLUSIONS: COVID-19 rates remained high long after diagnosis and prevention of SARS-CoV-2 infection. In addition, a higher death rate among patients who developed AKI, whose prevalence was also greater than that in the national literature, regardless of the presence of COVID-19, revealed a worrying scenario and corroborated the need for early and judicious approaches to preserve the lives of patients with AKI admitted to intensive care units.

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Lesión Renal Aguda , COVID-19 , Unidades de Cuidados Intensivos , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/epidemiología , Estudios Transversales , Masculino , Femenino , Unidades de Cuidados Intensivos/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Brasil/epidemiología , Prevalencia , Adulto , SARS-CoV-2 , Mortalidad Hospitalaria , Factores de Riesgo , Anciano de 80 o más Años , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/epidemiología

RESUMEN

BACKGROUND: Vitamin D insufficiency is a prevalent issue in patients suffering from CKD. The purpose of this study was to determine whether serum 25(OH)D levels are associated with all-cause and cardiovascular mortality in patients with CKD. METHODS: To examine the associations between 25(OH)D levels and cardiovascular mortality, this retrospective cohort study used the National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI) 2007‒2018 database. A total of 2,668 eligible subjects were included in this study, with follow-up conducted until December 31, 2019. The associations were assessed using Cox proportional hazards regression, restricted cubic splines, Kaplan-Meier survival curves, and competing risks survival analysis. Furthermore, subgroup and sensitivity analyses were performed. RESULTS: During a median follow-up of 72 months in a weighted population of 11,715,452 eligible participants, there were 665 deaths from any cause, including 196 cardiovascular-related deaths. After adjusting for covariates, lower levels of 25(OH)D were significantly associated with increased risks for both all-cause mortality (HR= 0.85, 95 % CI 0.77∼0.94) and cardiovascular mortality (SHR= 0.80, 95 % CI 0.67∼0.94). Consistent results were also observed when analyzing 25(OH)D as a categorical variable (quartile). Compared to group Q1, both group Q3 (HR = 0.71, 95 % CI 0.54‒0.93) and group Q4 (HR = 0.72, 95 % CI 0.55‒0.94) exhibited a significantly reduced mortality risk. Weighted restricted cubic splines revealed an inverse J-shaped linear association between levels of 25(OH) D and all-cause mortality ((PNonliner > 0.05). Subgroup analysis and sensitivity analysis yielded similar findings. CONCLUSIONS: All-cause mortality and cardiovascular disease-related mortality were significantly increased by lower 25(OH)D levels, both as continuous and categorical variables. 25(OH)D has an inverse J-shaped linear association with all-cause and cardiovascular mortality.

Asunto(s)

Enfermedades Cardiovasculares , Causas de Muerte , Encuestas Nutricionales , Insuficiencia Renal Crónica , Vitamina D , Humanos , Vitamina D/sangre , Vitamina D/análogos & derivados , Masculino , Femenino , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/sangre , Persona de Mediana Edad , Estudios Retrospectivos , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/mortalidad , Adulto , Anciano , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/mortalidad , Deficiencia de Vitamina D/complicaciones , Factores de Riesgo , Modelos de Riesgos Proporcionales , Estimación de Kaplan-Meier

RESUMEN

INTRODUCTION: In some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the Peritoneal Equilibrium Test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007-2017 using a competing risk model. MATERIALS AND METHODS: A retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a Peritoneal Equilibration Test (PET) between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert). RESULTS: Patients were classified into four categories based on the PET result: Slow/Low transfer (16.0%), low average (35.4%), high average (32.9%), and High/Fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98-1.30) p = 0.078, high average 1.08 (95% CI 0.96-1.22) p = 0.195, low average 1.09 (95% CI 0.96-1.22) p = 0.156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98-1.52) p = 0.66, high average HR was 1.10 (95% CI 0.91-1.33) p = 0.296, low average HR of 1.03 (95% CI 0.85-1.24) p = 0.733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences. CONCLUSIONS: When evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics of peritoneal membrane transfer according to the classification given by Twardowski assessed at the start of peritoneal dialysis therapy and overall mortality or technique survival in adjusted models. The analysis will then be made from the prognostic model with the purpose of predicting the risk of mortality and survival of the technique using the risk subdistribution model (Fine & Gray).

Asunto(s)

Diálisis Peritoneal , Insuficiencia Renal Crónica , Humanos , Colombia/epidemiología , Estudios Retrospectivos , Masculino , Femenino , Diálisis Peritoneal/mortalidad , Persona de Mediana Edad , Insuficiencia Renal Crónica/terapia , Insuficiencia Renal Crónica/mortalidad , Adulto , Factores de Tiempo , Anciano , Peritoneo/metabolismo , Tasa de Supervivencia , Soluciones para Diálisis/química

RESUMEN

BACKGROUND: On December 31, 2019, one of the most serious pandemics in recent times made its appearance. Certain health conditions, such as obesity and diabetes mellitus, have been described to be related to COVID-19 unfavorable outcomes. OBJECTIVE: To identify factors associated with mortality in patients with COVID-19. MATERIAL AND METHODS: Retrospective cohort of 998,639 patients. Patient sociodemographic and clinical characteristics were analyzed, with survivors being compared with the deceased individuals. Cox proportional hazards model was used to identify variables predictive of COVID-19-associated mortality. RESULTS: Among the deceased patients, men accounted for 64.3%, and women, for 35.7%, with the difference being statistically significant. Subjects older than 80 years had a 13-fold higher risk of dying from COVID-19 (95% CI = 12,469, 13,586), while chronic kidney disease entailed a risk 1.5 times higher (95% CI = 1,341, 1,798), and diabetes mellitus involved a risk 1.25 times higher (95% CI = 1.238,1.276). CONCLUSIONS: Age, sex, diabetes mellitus and obesity were found to be predictors of COVID-19 mortality. Further research related to chronic obstructive pulmonary disease, cardiovascular diseases, smoking and pregnancy is suggested.

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ANTECEDENTES: El 31 de diciembre de 2019, se inició una de las pandemias más graves de los últimos tiempos. Se ha descrito que ciertas condiciones de salud, como la obesidad y la diabetes mellitus, están relacionadas con desenlaces desfavorables por COVID-19. OBJETIVO: Identificar factores asociados a mortalidad en pacientes con COVID-19. MATERIAL Y MÉTODOS: Cohorte retrospectiva de 998 639 pacientes. Se analizaron las características sociodemográficas y clínicas de los pacientes, y se compararon supervivientes con fallecidos. Se utilizó el modelo de riesgos proporcionales de Cox para la identificación de variables predictivas de defunción por COVID-19. RESULTADOS: Entre los fallecidos, los hombres representaron 64.3 % y las mujeres 35.7 %, diferencia que resultó estadísticamente significativa. Las personas con más de 80 años presentaron un riesgo 13 veces mayor de morir por COVID-19 (IC 95 % = 12.469,13.586) y la enfermedad renal crónica, un riesgo de 1.5 (IC 95 % = 1.341, 1.798); la diabetes mellitus tuvo un riesgo de 1.25 (IC 95 % = 1.238,1.276). CONCLUSIONES: La edad, el sexo, la diabetes mellitus y la obesidad resultaron ser entidades predictivas de muerte por COVID-19. Se sugiere más investigación relacionada con enfermedad pulmonar obstructiva crónica, enfermedades cardiovasculares, tabaquismo y embarazo.

Asunto(s)

COVID-19 , Diabetes Mellitus , Obesidad , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , México/epidemiología , Femenino , Masculino , Estudios Retrospectivos , Factores de Riesgo , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Adulto , Obesidad/mortalidad , Obesidad/epidemiología , Obesidad/complicaciones , Diabetes Mellitus/epidemiología , Diabetes Mellitus/mortalidad , Factores de Edad , Factores Sexuales , Adulto Joven , Modelos de Riesgos Proporcionales , Adolescente , Estudios de Cohortes , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/epidemiología

RESUMEN

BACKGROUND: This study aimed to compare the diagnostic yield of the FRAIL scale with respect to the physical frailty phenotype measure and their association with mortality in non-dialysis-dependent patients. METHODS: In this prospective cohort study, non-dialysis dependent patients with chronic kidney disease (CKD) stages 3b-5 seen in the nephrology outpatient clinics of two university hospitals were included. The presence of frailty was evaluated by physical frailty phenotype measure and the FRAIL scale. Patients were evaluated for six months, and mortality was recorded. The Kappa test was used to evaluate the diagnostic properties between the methods, and logistic regression to test the association between frailty and mortality. RESULTS: One hundred fifty-three patients were evaluated; average age was 65 (56-70) years, 50.9% were women, and the all-cause mortality rate was 2.6%. Forty-six patients were classified as living with frailty according to the physical frailty phenotype while 36 patients were rated frail by the FRAIL scale. In adults < 60 years of age, the FRAIL scale showed good accuracy (84.9%) and specificity (93.2%) but had low sensitivity (41.3%) and moderate agreement (Kappa = 0.41; p < 0.001) compared to the definition of the physical frailty phenotype. The adjusted logistic regression model showed that the patients with frailty assessed by the FRAIL scale had a greater chance of mortality than the non-frail patients (OR: 6.8; CI95%:1.477-31.513; p = 0.014). CONCLUSION: Physical frailty phenotype identifies more patients as having pre-frailty and frailty in non-dialysis dependent patients as compared to the FRAIL scale. However, the FRAIL scale is a simple bedside tool that can be useful for screening for frailty and whose results were associated with mortality.

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Fragilidad , Insuficiencia Renal Crónica , Humanos , Femenino , Masculino , Anciano , Fragilidad/diagnóstico , Fragilidad/mortalidad , Persona de Mediana Edad , Estudios Prospectivos , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/complicaciones , Valor Predictivo de las Pruebas , Evaluación Geriátrica/métodos , Modelos Logísticos , Anciano Frágil , Factores de Riesgo , Fenotipo , Pronóstico

RESUMEN

Introducción: La enfermedad renal crónica es una de las principales causas de mortalidad en todo el mundo. La estratificación del riesgo a través del análisis de factores pronósticos podría generar un cambio de paradigma. Objetivo: Analizar los factores pronósticos de mortalidad en los pacientes con enfermedad renal crónica en hemodiálisis. Métodos: Se realizó un estudio no experimental, longitudinal de cohorte retrospectivo en los pacientes con enfermedad renal crónica en hemodiálisis en el Hospital General Docente: Dr. Ernesto Guevara de la Serna durante el período del 1 de enero de 2017 al 31 de diciembre de 2021. En general, se analizaron los factores pronósticos de mortalidad mediante el análisis multivariado de regresión logística binaria y se determinó el porcentaje correcto de clasificación del modelo de regresión. Resultados: Se analizaron como variables pronosticas de mortalidad la enfermedad cardiovascular [B = 3,831; p = 0,000; Exp (B) = 46,118], Albúmina 17 mmol/L [B = 1,326; p = 0,027; Exp (B) = 3,767], glucemia < 4 mmol/L [B = 1,600; p = 0,015; Exp (B) = 4,955] y ganancia de peso interdialítica excesiva [B = 2,243; p = 0,001; Exp (B) = 9,420]. El porcentaje global de clasificación del modelo de regresión logística binaria fue de 89,5 por ciento. Conclusiones: Se analizó el modelo predictivo de regresión logística que presentó una buena precisión con los factores de pronósticos asociados a la mortalidad en los pacientes en hemodiálisis(AU)

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Introduction: Chronic kidney disease is one of the main causes of mortality worldwide. Risk stratification through the analysis of prognostic factors could generate a paradigm shift. Objective: To analyze the prognostic factors of mortality in patients with chronic kidney disease on hemodialysis. Methods: A non-experimental, longitudinal retrospective cohort study was carried out on patients with chronic kidney disease on hemodialysis at Dr. Ernesto Guevara de la Serna General Teaching Hospital from January 2017 to December 31, 2021. The prognostic factors of mortality were analyzed using multivariate binary logistic regression analysis and the correct percentage of classification of the regression model was determined. Results: Prognostic variables of mortality were analyzed, such as cardiovascular disease [B = 3.831; p = 0.000; Exp (B) = 46.118], albumin 17 mmol/L [B = 1.326; p = 0.027; Exp (B) = 3.767], blood glucose < 4 mmol/L [B = 1.600; p = 0.015; Exp (B) = 4.955] and excessive interdialytic weight gain [B = 2.243; p = 0.001; Exp(B) = 9.420]. The overall classification percentage of the binary logistic regression model was 89.5percent. Conclusions: The logistic regression predictive model was analyzed, which showed good precision with the prognostic factors associated with mortality in hemodialysis patients(AU)

Asunto(s)

Humanos , Masculino , Femenino , Pronóstico , Diálisis Renal/métodos , Insuficiencia Renal Crónica/mortalidad , Estudios Retrospectivos , Estudios Longitudinales

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OBJECTIVE: To analyze chronic kidney disease mortality in Brazil according to sex, age group and region of residence, from 2009 to 2020. METHODS: This was a time series study having deaths as its unit of analysis, based on Mortality Information System data. The mortality rate was standardized using the direct method and the temporal trend was analyzed using the Prais-Winsten method. RESULTS: There was a rising trend in chronic kidney disease mortality, ranging from 2.82, in 2009, to 3.24 in 2020 (average annual increase 1.29%; 95%CI 0.73;1.85), with a greater increase in males (1.14% per year; 95%CI 0.52;1.76), those aged 75 years and over (2.23% per year; 95%CI 1.87; 2.60) and in the Northern Region (3.86% per year; 95%CI 1.86;5.90) and Northeast Region (3.36% per year; 95%CI 2.24;4.50). CONCLUSION: Chronic kidney disease mortality showed a rising trend in the period, with sociodemographic disparities. MAIN RESULTS: A rising mortality trend was found for both sexes, with a greater increase in males, those aged over 75 years and in the North and Northeast regions of Brazil; mortality was highest in the Midwest region throughout the entire period. IMPLICATIONS FOR SERVICES: The results point to the need to implement public policies with guidelines for addressing chronic kidney disease, focused on strengthening Primary Health Care (PHC). PERSPECTIVES: Expanding access to health services, health education and integration between PHC, health surveillance and specialized care are strategies that would possibly prove to be efficient in managing this chronic health condition.

Asunto(s)

Mortalidad , Insuficiencia Renal Crónica , Femenino , Humanos , Masculino , Brasil/epidemiología , Sistemas de Información , Insuficiencia Renal Crónica/mortalidad , Mortalidad/tendencias

RESUMEN

Introducción: La infección por SARS-CoV-2 en pacientes con enfermedad renal crónica se asocia a larga estadía hospitalaria, aparición de complicaciones y mortalidad. Objetivo: Describir el caso clínico de un paciente con enfermedad renal crónica agudizada como causa de mortalidad en presencia de la infección por la COVID-19. Presentación del caso: Paciente masculino de 69 años con antecedentes de enfermedad renal crónica estadio 3a que ingresó a la institución hospitalaria con diagnóstico de COVID-19 y que durante su estadía presentó cifras elevadas de creatinina sérica con el consiguiente desarrollo de injuria renal aguda. Después de cinco sesiones de hemodiálisis mejoró el estado general del paciente y las cifras de creatinina disminuyeron parcialmente. A pesar de la mejoría clínica, el paciente progresó hacia el último estadio de la enfermedad renal crónica. Luego de tres semanas bajo terapia hemodialítica crónica falleció a causa de síndrome coronario agudo con elevación del segmento ST. Conclusiones: El pronóstico de los pacientes con daño renal que desarrollan la COVID-19 es desfavorable. La infección por SARS-CoV-2 favorece la progresión hacia los estadios finales de la enfermedad renal crónica con riesgo incrementado de la mortalidad(AU)

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Introduction: SARS-CoV-2 infection in patients with chronic kidney disease is associated with a long hospital stay, the appearance of complications and mortality. Objective: To describe the clinical case of a patient with exacerbated chronic kidney disease as a cause of mortality in the presence of COVID-19 infection. Clinical case: A 69-year-old male patient with a history of stage 3a chronic kidney disease who was admitted to a hospital with a diagnosis of COVID-19 and who during his stay presented elevated serum creatinine levels with the subsequent development of acute kidney injury. After five hemodialysis sessions, the patient's general condition improved and the creatinine levels partially decreased. Despite clinical improvement, the patient progressed to the last stage of chronic kidney disease. After three weeks under chronic hemodialytic therapy, the patient died due to ST-segment elevation acute coronary syndrome. Conclusions: The prognosis of patients with kidney damage who develop COVID-19 is unfavorable. SARS-CoV-2 infection favors progression to the final stages of chronic kidney disease with an increased risk of mortality(AU)

Asunto(s)

Humanos , Masculino , Anciano , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/epidemiología , COVID-19/complicaciones

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Introducción: La enfermedad renal crónica (ERC) es una afección persistente en la función y estructura renal. La prevalencia de ERC varía mundialmente, siendo más común en personas con diabetes e hipertensión. Además, la tasa de mortalidad por ERC ha disminuido en Chile en los últimos años. Objetivo general: describir las defunciones por ERC en Chile según sexo, grupo etario y región, entre los años 2021 y 2022. Metodología: estudio observacional descriptivo transversal. Se obstuvieron datos sobre ERC según sexo, grupo etario y región desde el Departamento de Estadística e Información en Salud (DEIS). Se utilizó estadística descriptiva y se calculó la tasa de mortalidad. Para el análisis estadístico se utilizó el programa Microsoft Excel. Este estudio no requirió revisión por comité de ética y no existen conflictos de interés. Resultados: Durante 2021-2022 se estudiaron 2478 defunciones por enfermedad renal crónica (ERC). Hubo un aumento del 15.85% en el número total de defunciones. La tasa de mortalidad general fue de 12.54 por cada 100.000 habitantes. Ambos sexos tuvieron tasas de mortalidad similares. El grupo etario de 81-90 años tuvo la mayor cantidad de muertes. La Región Metropolitana registró la mayoría de las defunciones. Discusión: La tasa de mortalidad en Chile es similar a países desarrollados, con tendencia al aumento en ambos sexos. El mayor número de defunciones en mayores de 61 años y la variación de las tasas de mortalidad por región podrían deberse a factores de riesgo cardiovascular. El enfrentamiento de la ERC debe enfocarse en estrategias de prevención y diagnóstico precoz.

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Introduction: Chronic Kidney Disease (CKD) is a persistent condition affecting renal function and structure. The prevalence of CKD varies worldwide, with a higher incidence among individuals with diabetes and hypertension. Moreover, the mortality rate due to CKD has decreased in recent years in Chile. General objective: To describe CKD-related deaths in Chile according to sex, age group, and region between 2021 and 2022. Materials and methods: A descriptive cross-sectional observational study was conducted using data obtained from the Department of Health Statistics and Information (DEIS). Descriptive statistics were used and the mortality rate was calculated. Microsoft Excel was used for the statistical analysis. This study did not require ethical committee review, and there are no conflicts of interest. Results: A total of 2478 deaths due to CKD were studied during 2021-2022, with a 15.85% increase in the overall number of deaths. The general mortality rate was 12.54 per 100,000 inhabitants. Both sexes had similar mortality rates, and the 81-90 age group had the highest number of deaths. The Metropolitan Region registered the majority of the deaths. Discussion: The mortality rate in Chile is comparable to developed countries, with an increasing trend in both sexes. The higher number of deaths among individuals over 61 years old and the variation in mortality rates by region may be attributed to cardiovascular risk factors. Addressing CKD requires a focus on prevention and early diagnosis strategies.

Asunto(s)

Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/epidemiología , Chile/epidemiología , Salud Pública , Distribución por Edad y Sexo

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Background and Objectives: Chronic kidney disease (CKD) is one of the main complications resulting from arterial hypertension, and a recent increase in the incidence and prevalence of the disease has been reported, which can lead to an increase in mortality and complications resulting from the disease. Thus, the objective of study is to describe the variations in mortality from CKD secondary to arterial hypertension, in Brazil, between the years 1990 to 2019. Methods: Epidemiological study, with a quantitative approach and descriptive character, which analyzed data from the "Global Burden of Disease Study" (GBD) tool. Results: In all of Brazil's federative units, the estimate of deaths from CKD secondary to hypertension increased, with the Southeast region having the highest estimates. The States of Rio de Janeiro, Rio Grande do Sul, and Paraíba lead with the highest mortality rates. Regarding sex, in all years, higher rates were observed in males, however, over the years, this difference has been reduced. The age group of ≥70 years was the most affected, standing out with the highest death rates. Conclusion: the burden of CKD in Brazil has increased in the last 30 years; among the regions of the country, the Southeast recorded the highest estimates of deaths in all the years analyzed, being mainly higher among men.(AU)

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Justificativa e objetivos: A doença renal crônica (DRC) é uma das principais complicações decorrentes da hipertensão arterial. Nos últimos anos, tem sido relatado um aumento na incidência e prevalência da doença, o que pode levar ao aumento da mortalidade e das complicações decorrentes da doença. Assim, o objetivo deste estudo foi descrever as variações da mortalidade por DRC secundária à hipertensão arterial no Brasil entre 1990 e 2019. Métodos: Trata-se de um estudo epidemiológico, de abordagem quantitativa e caráter descritivo, que analisou dados da ferramenta Global Burden of Disease Study (GBD). Resultados: Em todas as unidades da federação, a estimativa de mortes por DRC secundária à hipertensão apresentou aumento, a região Sudeste apresentando as maiores estimativas. Os estados do Rio de Janeiro, Rio Grande do Sul e Paraíba lideram as pesquisas com as maiores taxas de mortalidade. No que diz respeito ao sexo, em todos os anos foram observadas maiores taxas de DRC em indivíduos do sexo masculino; contudo, nota-se que tem ocorrido uma redução dessa diferença. A faixa etária de ≥70 anos foi a mais acometida, destacando-se com as maiores taxas de mortes. Conclusão: a carga de DRC no Brasil aumentou nos últimos 30 anos. Entre as regiões do país, o Sudeste registrou as maiores estimativas de mortes em todos os anos analisados, principalmente de homens.(AU)

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Justificación y objetivos: La enfermedad renal crónica (ERC) es una de las principales complicaciones derivadas de la hipertensión arterial, y en los últimos años se ha reportado un aumento en la incidencia y prevalencia de la enfermedad, lo que puede conducir a un aumento de la mortalidad y de las complicaciones derivadas de esta, por lo tanto, el objetivo del estudio es describir las variaciones en la mortalidad por ERC secundaria a la hipertensión arterial en Brasil entre los años 1990 a 2019. Métodos: Estudio epidemiológico, con enfoque cuantitativo y carácter descriptivo, que analizó datos de la herramienta Global Burden of Disease Study (GBD). Resultados: En todas las unidades de la federación, aumentó la estimación de muertes por ERC secundaria a la hipertensión arterial, con la región Sudeste presentando las estimaciones más altas. Los estados de Rio de Janeiro, Rio Grande do Sul y Paraíba lideran con las tasas de mortalidad más altas. Con respecto al sexo, en todos los años se observaron mayores tasas en los varones, sin embargo, con el paso de los años, esta diferencia se ha ido reduciendo. El grupo de edad de ≥70 años fue el más afectado, destacándose con las tasas de mortalidad más altas. Conclusión: la carga de ERC en Brasil ha aumentado en los últimos 30 años; de las regiones del país, el Sudeste registró las mayores estimaciones de muertes en todos los años registrados entre los analizados, siendo principalmente mayor entre los hombres.(AU)

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Humanos , Insuficiencia Renal Crónica/mortalidad , Carga Global de Enfermedades , Hipertensión/complicaciones , Estudios Epidemiológicos , Epidemiología

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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Alopurinol/efectos adversos , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/tratamiento farmacológico , Gota/mortalidad , Gota/tratamiento farmacológico , Supresores de la Gota/efectos adversos , Resultado del Tratamiento , Insuficiencia Renal Crónica/complicaciones , Gota/complicaciones

RESUMEN

Introducción: La morbimortalidad por enfermedad renal crónica (ERC) ha presentado en las dos últimas décadas un incremento desconcertante. En Cuba, aunque la mortalidad por esta causa ha tenido un comportamiento estable, la incidencia y la prevalencia se mantienen elevadas. Objetivo: Caracterizar los pacientes fallecidos con ERC según variables demográficas, causas de muerte y otras variables seleccionadas. Material y Métodos: Estudio descriptivo, transversal. El universo de estudio estuvo constituido por todos los fallecidos del país en el período, en cuyos certificados de defunción se incluyó entre una de las causas, la ERC. La información fue obtenida de las bases de datos de mortalidad de la Dirección Nacional de Registros Médicos y Estadísticos de Salud del MINSAP. Procesamiento de forma automatizada (SPSS versión 22.0). Fueron calculadas las frecuencias absolutas y relativas. Resultados: La frecuencia global de pacientes fallecidos se incrementó de forma mantenida y resultó mayor en la provincia La Habana (23,6 por ciento). La media de la edad fue de 70 años. Prevaleció el sexo masculino, el color de piel blanco y el grupo de edad de 80 años y más. Los porcentajes más altos según la causa básica de muerte correspondieron a enfermedad renal hipertensiva y Diabetes Mellitus. Conclusiones: Los fallecidos con ERC son mayormente hombres, de piel blanca, y con edades avanzadas. Las principales causas de muerte son la enfermedad hipertensiva y la Diabetes Mellitus(AU)

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Introduction: Chronic kidney disease (CKD) has increased at an alarming rate worldwide over the last two decades. Although mortality due to CKD has registered stable behavior in Cuba, its prevalence and incidence are showing higher rates. Objective: To describe the main demographic features of deceased patients with CKD in Cuba, the causes of death and other variables during the period 2011-2016. Material and Methods: A descriptive cross-sectional study was conducted. The study universe included all deceased patients in Cuba during the period mentioned. CKD was listed on their death certificates as one of the causes of death. The information used was obtained from the mortality database available on the National Directorate of Medical Records and Health Statistics of the Cuban Ministry of Public Health. Data was processed using SPSS version 22.0. Absolute and relative frequencies were calculated. Results: The global frequency of deceased patients showed a steady increase. Havana was the city that presented the highest percentage (23,6 percent). Nonetheless, the rest of the cities showed an increased frequency rate. The median age was 70 years. The male gender prevailed over the female one as well as white ethnicity and the 80 years and over age group. Regarding the cause of death, the highest percentages corresponded to hypertensive kidney disease and Diabetes Mellitus. Conclusions: Most of the deceased patients with CKD are male, white and at advanced ages. The main causes of death are hypertensive disease and Diabetes Mellitus(AU)

Asunto(s)

Humanos , Masculino , Femenino , Anciano , Indicadores de Morbimortalidad , Causas de Muerte/tendencias , Insuficiencia Renal Crónica/mortalidad , Enfermedades Renales , Estadísticas de Salud , Epidemiología Descriptiva , Estudios Transversales , Cuba , Complicaciones de la Diabetes/mortalidad

RESUMEN

Patients with type 2 diabetes (T2D) and Latin American subjects in particular are at an increased risk of developing severe COVID-19 and mortality. Altered renal function and lower magnesium levels have been reported to play important roles in the pathophysiology of T2D. The aim of the study was to investigate the relationship between renal function, serum magnesium levels and mortality in T2D patients with COVID-19. In this retrospective study, we characterized 118 T2D and non-diabetic subjects hospitalized with COVID-19. Patients were clinically characterized and electrolyte, renal function and inflammatory markers were evaluated. Patients were grouped according to their estimated glomerular filtration rate (eGFR <60 mL/min per 1.73 m2). T2D patients had lower eGFR and serum magnesium levels when compared to non-diabetics (59.7 ± 32.8 vs. 78.4 ± 33.8 mL/min per 1.73 m2, P = 0.008 and 1.9 ± 0.3 vs. 2.1 ± 0.3 mEq/L, P = 0.012). Survival was worse in T2D patients with eGFR levels less than 60 mL/min per 1.73 m2 as estimated by Kaplan-Meier analyses (log-rank test <0.0001). The Cox model for T2D patients showed that eGFR (HR 0.970, 95% CI 0.949 to 0.991, P = 0.005) and magnesium (HR 8.025, 95% CI 1.226 to 52.512, P = 0.030) were associated with significantly increased risk of death. Reduced eGFR and magnesium levels were associated with increased mortality in our population. These results suggest that early assessment of kidney function, including magnesium levels, may assist in developing effective treatment strategies to reduce morbidity and mortality among Latin American COVID-19 patients with T2D.

Asunto(s)

COVID-19 , Diabetes Mellitus Tipo 2 , Riñón/fisiopatología , Magnesio/sangre , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , COVID-19/sangre , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/mortalidad , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/mortalidad , Femenino , Tasa de Filtración Glomerular/fisiología , Mortalidad Hospitalaria , Humanos , Riñón/metabolismo , Masculino , Persona de Mediana Edad , Pronóstico , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/mortalidad , Estudios Retrospectivos , SARS-CoV-2/fisiología , Análisis de Supervivencia

RESUMEN

Introducción: La enfermedad renal crónica constituye un gran problema de salud en el mundo y en Cuba. Para el año 2040 puede convertirse en la quinta causa más común de años de vida potencialmente perdidos a nivel mundial y es una importante causa de gastos para la salud, la economía y el seguro social de los países. Objetivo: Caracterizar la mortalidad en pacientes renales crónicos en edad laboral en Cuba, en los años 2011-2017, según variables sociodemográficas seleccionadas. Métodos: Investigación transversal descriptiva. El universo estuvo constituido por los 5 716 fallecidos con enfermedad renal crónica. La información fue tomada de las bases de datos de mortalidad de la Dirección Nacional de Estadísticas, del Ministerio de Salud Pública. Se estudiaron las variables: edad, sexo, ocupación y principales causas de muerte. Se calcularon tasas brutas, así como tasas de mortalidad específicas. Resultados: En la edad laboral la mortalidad por enfermedad renal crónica presentó oscilaciones del año 2011 al 2017. La edad media al morir fue 53.7 años, los mayores de 61 años, hombres, presentaron el mayor riesgo (16 por 10 000 habitantes). La tasa en la población económicamente activa desocupada fue de 33 por 10 000 habitantes. El riesgo fue mayor en las ocupaciones elementales (9 por 10 000 habitantes). La enfermedad renal hipertensiva fue la principal causa de muerte (17 por 100 000 habitantes). Conclusiones: Existe ligero incremento de la mortalidad, en hombres el riesgo es mayor, la tasa más alta es en población económicamente activa desocupada y en las ocupaciones elementales. La principal causa de muerte es la enfermedad renal hipertensiva(AU)

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Introduction: Chronic kidney disease constitutes a major health problem in Cuba and worldwide. By 2040 it may become the fifth most common cause of years of life potentially lost, worldwide, and a major cause of health expenses, economy and social security. Objective: To describe mortality in chronic kidney patients of working ages in Cuba, from 2011to 2017, according to selected sociodemographic variables. Methods: This is descriptive cross-sectional research. The universe consisted of 5,716 deceased subjects with chronic kidney disease. The information was taken from the mortality databases of the National Directorate of Statistics, from the Ministry of Public Health. The variables were studied age, sex, occupation and main causes of death. Gross and specific mortality rates were calculated. Results: In working age, mortality from chronic kidney disease fluctuated from 2011 to 2017. The mean age at death was 53.7 years, those over 61 years of age, men, had the highest risk (16 per 10,000 inhabitants). The rate in the economically active unemployed population was 33 per 10,000 inhabitants. The risk was higher in basic occupations (9 per 10,000 inhabitants). Hypertensive kidney disease was the leading cause of death (17 per 100,000 population). Conclusions: There is a slight increase in mortality, the risk is higher in men, the highest rate is in the economically active unemployed population and in basic occupations. The leading cause of death is hypertensive kidney disease(AU)

Asunto(s)

Humanos , Trabajo , Diabetes Mellitus/epidemiología , Insuficiencia Renal Crónica/mortalidad , Hipertensión/epidemiología , Epidemiología Descriptiva , Estudios Transversales , Ausencia por Enfermedad , Cuba

RESUMEN

Abstract Background Cardiovascular disease (CVD) is commonly associated with chronic kidney disease (CKD). These diseases have a significant impact on life expectancy. Individuals with CKD are more likely to die from CVD than to progress to end-stage kidney disease. Objective To assess cardiovascular risk factors of patients with CKD under conservative treatment. Methods This was an observational, cross-sectional study. Socioeconomic, anthropometric, biochemical, and physical inactivity data were assessed, and 10-year risk for CVD were estimated using the Framingham Score in patients with CKD under conservative treatment. For statistical analysis, the Student's t-test and Pearson's chi-square test were performed. Results A total of 172 individuals were evaluated, 57% of whom were male, with an average age of 68.85 ± 11.41 years. The prevalence of hypertension and diabetes were 87.2% and 53.5%, respectively; 62.2% were physically inactive; 9.9% of men were smokers and 12.8% consumed alcohol. According to BMI, 82.4% of adults <60 years old and 60.6% of those older than 60 years were overweight. High waist circumference and a high waist-hip ratio were highly prevalent in females (91.9% and 83.8%, respectively) and males (64.3% and 39.8%, respectively); 92.4% had a high body fat percentage and 73.3% high uric acid levels. According to the Framingham score, 57% have a medium or high risk of developing CVD in 10 years. Conclusion There was a high prevalence of cardiovascular risk factors in the population studied. The assessment of cardiovascular risk factors in patients with CKD makes it possible to guide the conduct of health professionals to prevent mortality from cardiovascular causes. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/complicaciones , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo de Enfermedad Cardiaca , Enfermedades Cardiovasculares/mortalidad , Estudios Transversales , Diabetes Mellitus , Insuficiencia Renal Crónica/mortalidad , Hipertensión

RESUMEN

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG), known to regulate bone mass by inhibiting osteoclast differentiation and activation, might also play a role in vascular calcification. Increased circulating OPG levels in patients with CKD are associated with aortic calcification and increased mortality. We assessed the predictive role of OPG for all-cause and cardiovascular mortality in patients with CKD stages 3-5 over a 5-year follow-up period. We evaluated the relationship between OPG and all-cause and cardiovascular mortality in 145 CKD patients (stages 3-5) in a prospective observational follow-up study. Inflammation markers, including high-sensitivity C-reactive protein, standard echocardiography, and estimation of intima-media thickness in the common carotid artery, were assessed at baseline, and correlations with OPG levels were determined. The cutoff values for OPG were defined using ROC curves for cardiovascular mortality. Survival was assessed during follow up lasting for up to 5.5 years using Fine and Gray model. A total of 145 (89 men; age 58.9 ± 15.0 years) were followed up. The cutoff value for OPG determined using ROC was 10 pmol/L for general causes mortality and 10.08 pmol/L for CV causes mortality. Patients with higher serum OPG levels presented with higher mortality rates compared to patients with lower levels. Aalen-Johansen cumulative incidence curve analysis demonstrated significantly worse survival rates in individuals with higher baseline OPG levels for all-cause and cardiovascular mortality (p < 0.001). In multivariate analysis, OPG was a marker of general and cardiovascular mortality independent of sex, age, CVD, diabetes, and CRP levels. When CKD stages were included in the multivariate analysis, OPG was an independent marker of all-cause mortality but not cardiovascular mortality. Elevated serum OPG levels were associated with higher all-cause and cardiovascular mortality risk, independent of age, CVD, diabetes, and inflammatory markers, in patients with CKD.

Asunto(s)

Enfermedades Cardiovasculares , Osteoprotegerina/sangre , Insuficiencia Renal Crónica , Anciano , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/mortalidad

RESUMEN

BACKGROUND: optimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority. METHODS: we performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox's proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values. RESULTS: Data from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39-5.12), serum iron (HR = 8.396, 95% CI: 2.02-34.96), serum calcium (HR = 4.102, 95% CI: 1.35-12.46) and serum protein (HR = 4.630, 95% CI: 2.07-10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01-0.74), high ferritin values (HR = 0.392, 95% CI: 0.19-0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19-0.61) and serum albumin (HR = 0.230, 95% CI: 0.10-0.54) were less risk to die. CONCLUSION: survival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

Asunto(s)

Fallo Renal Crónico/mortalidad , Terapia de Reemplazo Renal , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Proteínas Sanguíneas/análisis , Calcio/sangre , Femenino , Humanos , Hierro/sangre , Estimación de Kaplan-Meier , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Fósforo/sangre , Pronóstico , Modelos de Riesgos Proporcionales , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/terapia , Estudios Retrospectivos , Factores de Riesgo , Albúmina Sérica , Tasa de Supervivencia

RESUMEN

BACKGROUND: Renal replacement therapy (RRT) is usually indicated for patients with chronic kidney disease (CKD) with glomerular filtration rate below 10 ml/ml/min/1.73m2. However, the need for RRT and timing of dialysis initiation are debatable for patients aged 70 years or older. We here describe the study design and methodology of the Aging Nephropathy Study (AGNES) protocol that aims at evaluating to what extent geriatric-related conditions such as frailty, cognitive dysfunction, and presence of comorbidities have an impact on survival and RRT initiation in this group of patients. In this manuscript we provide detailed information about the AGNES study design and methodology. METHODS: AGNES is a prospective observational cohort that aim to investigate clinical, biochemical and demographic factors associated with RRT initiation and mortality of patients with CKD stage 4 or 5 who are aged 70 years and older. We plan to include 200 patients over 5 years. Clinically stable outpatients on conservative management for at least 6 months will be recruited from the Nephrogeriatric Clinic at the Hospital das Clinicas da Universidade de Sao Paulo, Brazil. Eligible patients are submitted to a full clinical examination, geriatric assessment, and blood test at baseline. Following the baseline visit the patients are being monitored during an observational follow up period of at least 12 months during which patients will be contacted in the clinic at their regular follow up or by phone until either RRT initiation or death occurs. This cohort includes evaluation of cognition by the education-adjusted 10-point Cognitive Screener (10-CS), frailty by Fried index score, a complete nutritional assessment (by body composition assessment, global subjective assessment and dietary intake), comorbidities by Charlson comorbidity index and biochemical markers including FGF-23 and Klotho. DISCUSSION: The AGNES cohort, a real-world study of current clinical practice in elderly patients with advanced CKD prior to dialysis initiation, will shed light into progression of CKD and its complications, indications of RRT and factors determining survival. This investigation will elucidate to what extent geriatric conditions, nutritional status and clinical factors are associated with survival, quality of life and RRT initiation in elderly CKD patients not yet on dialysis. TRIAL REGISTRATION: Registered on ClinicalTrials.gov on 18 October 2019 ( NCT04132492 ).

Asunto(s)

Insuficiencia Renal Crónica/mortalidad , Factores de Edad , Anciano , Envejecimiento , Trastornos del Conocimiento/complicaciones , Comorbilidad , Complicaciones de la Diabetes , Factor-23 de Crecimiento de Fibroblastos , Fragilidad/complicaciones , Insuficiencia Cardíaca/complicaciones , Humanos , Estudios Prospectivos , Insuficiencia Renal Crónica/complicaciones , Proyectos de Investigación , Factores de Riesgo , Trastornos del Sueño-Vigilia/complicaciones

RESUMEN

La insuficiencia renal representa alta morbilidad y mortalidad. La complejidad de su prevención radica en el número de factores de riesgo implicados. Para describir el comportamiento de la insuficiencia renal crónica en el área de salud René Vallejo Ortíz, se realizó un estudio observacional descriptivo, en pacientes sometidos a pesquisa de enfermedad renal crónica atendidos en el Consultorio 27 del Policlínico René Vallejo Ortíz de Bayamo, en el período comprendido desde abril a julio de 2019. La edad media de los pacientes fue 68 años, la incidencia de la insuficiencia renal de un 49.01 por ciento. La incidencia de la insuficiencia renal fue superior a las tasas nacionales e internacionales. El grupo de edad predominante fue de 60 a 79 años. La patología con mayor incidencia fue la HTA. El estadio 3 a de la insuficiencia renal fue el que predominó(AU)

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Renal failure represents high morbidity and mortality. The complexity of its prevention lies in the number of risk factors involved. To describe the behavior of chronic kidney failure in the health area René Vallejo Ortíz, a descriptive observational study was carried out in patients undergoing a chronic kidney disease investigation treated at Office 27 of the René Vallejo Ortíz Polyclinic in Bayamo, in the period from April to July 2019. The mean age of the patients was 68 years, the incidence of renal failure 49.01 percent. The incidence of kidney failure was higher than national and international rates. The predominant age group was 60 to 79 years. The pathology with the highest incidence was hypertension. Stage 3a of renal failure was the one that predominated(EU)

Asunto(s)

Humanos , Anciano , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/mortalidad , Hipertensión/prevención & control , Epidemiología Descriptiva , Factores de Riesgo

RESUMEN

BACKGROUND: Patients with both diabetes mellitus (DM) and chronic kidney disease (CKD) are a subpopulation characterized by ultrahigh ischemic and bleeding risk after percutaneous coronary intervention. There are limited data on the impact of ticagrelor monotherapy among these patients. METHODS: In this post hoc analysis of the GLOBAL-LEADERS trial, the treatment effects of the experimental (one-month dual-antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) versus the reference regimen (12-month DAPT followed by 12-month aspirin alone) were analyzed according to DM/CKD status. The primary endpoint was a composite endpoint of all-cause death or new Q-wave myocardial infarction at 2-years. The patient-oriented composite endpoint (POCE) was defined as the composite of all-cause death, any stroke, site-reported MI and any revascularization, whereas net adverse clinical events (NACE) combined POCE with BARC type 3 or 5 bleeding events. RESULTS: At 2 years, the DM + /CKD + patients had significantly higher incidences of the primary endpoint (9.5% versus 3.1%, adjusted HR 2.16; 95% CI [1.66-2.80], p < 0.001), BARC type 3 or 5 bleeding events, stroke, site-reported myocardial infraction, all revascularization, POCE, and NACE, compared with the DM-/CKD- patients. Among the DM + /CKD + patients, after adjustment, there were no significant differences in the primary endpoints between the experimental and reference regimen; however, the experimental regimen was associated with lower rates of POCE (20.6% versus 25.9%, HR 0.74; 95% CI [0.55-0.99], p = 0.043, pinteraction = 0.155) and NACE (22.7% versus 28.3%, HR 0.75; 95% CI [0.56-0.99], p = 0.044, pinteraction = 0.310), which was mainly driven by a lower rate of all revascularization, as compared with the reference regimen. The landmark analysis showed that while the experimental and reference regimen had similar rates of all the clinical endpoints during the first year, the experimental regimen was associated with significantly lower rates of POCE (5.8% versus 11.0%, HR 0.49; 95% CI [0.29-0.82], p = 0.007, pinteraction = 0.040) and NACE (5.8% versus 11.2%, HR 0.48; 95% CI [0.29-0.82], p = 0.007, pinteraction = 0.013) in the second year. CONCLUSION: Among patients with both DM and CKD, ticagrelor monotherapy was not associated with lower rates of all-cause death or new Q-wave, or major bleeding complications; however, it was associated with lower rates of POCE and NACE. These findings should be interpreted as hypothesis-generating. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT01813435).

Asunto(s)

Enfermedad de la Arteria Coronaria/terapia , Diabetes Mellitus , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/uso terapéutico , Insuficiencia Renal Crónica , Ticagrelor/uso terapéutico , Anciano , Anciano de 80 o más Años , Asia , Australia , Brasil , Canadá , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Stents Liberadores de Fármacos , Europa (Continente) , Femenino , Hemorragia/inducido químicamente , Hemorragia/mortalidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/mortalidad , Inhibidores de Agregación Plaquetaria/efectos adversos , Prevalencia , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/mortalidad , Medición de Riesgo , Factores de Riesgo , Prevención Secundaria , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & control , Ticagrelor/efectos adversos , Factores de Tiempo , Resultado del Tratamiento