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Abstract Teicoplanin is a glycopeptide antibiotic commonly used to treat Gram-positive bacterial infections in the clinic. The aim of this study was to provide a therapeutic reference for the clinical application and dosage regimen adjustment of teicoplanin by identifying factors associated with its plasma trough concentration (Ctrough). A retrospective study was performed on patients with suspected or documented Gram-positive infections who were hospitalized from November 2017 to January 2020 and treated with teicoplanin while undergoing routine therapeutic drug monitoring (TDM). A total of 112 Ctrough trough measurements were obtained from 72 patients were included in this study. SPSS software was used for correlation analysis and receiver operator characteristic curve (ROC) analysis. The Ctrough for teicoplanin showed statistically significant relationships (P<0.05) with PLT, Scr, CLcr, eGFR, BUN and Cys-C. ROC curve analysis revealed that CLcr and eGFR were more sensitive and specific for Ctrough compared to the other factors. These findings should be considered in the clinical application of teicoplanin and for its dosage adjustment.

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BACKGROUND: Because the consequences of the lifestyle changes in older adults associated with the social isolation imposed in response to the COVID-19 pandemic are not fully understood, here, we investigated the effects of one year of social isolation imposed by COVID-19 on the metabolic parameters and functional physical capacity of older women who regularly practiced physical exercises before the pandemic. METHODS: Systemic lipid and protein profiles, estimated creatinine clearance (ECC), and functional physical capacity (FPC) were assessed before (January-February 2020) and 12 months after social isolation in 30 older women (mean age 73.77 ± 6.22) who were engaged in a combined-exercise training program for at least 3 years before the COVID-19 pandemic. RESULTS: In this group, we observed increased plasma levels of triglycerides and creatinine, an increase in the time necessary to perform gait speed and time-up-and-go tests, and reduced muscle strength assessed by the handgrip test and ECC post-COVID-19 pandemic relative to values recorded pre-pandemic. In addition, we observed significant correlations (both negative and positive) between anthropometric, some metabolic parameters, and physical tests. CONCLUSION: One year of interruption of physical exercise practice imposed in response to the COVID-19 pandemic significantly altered some systemic metabolic parameters and worsened ECC and FPC in older women.

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Diagnosticar, clasificar y estadificar la enfermedad renal en pacientes con diabetes mellitus (DM) es un desafío tanto para los médicos de atención primaria como para los especialistas, porque no existe método en la práctica clínica que evalúe la tasa de filtrado glomerular (TFG) en forma precisa. Para evaluar la función renal en enfermedad renal crónica (ERC) con menos de 60 ml/min/1.73m2 , correspondiente a los estadios 3, 4 y 5 de la clasificación actual, los métodos disponibles en los laboratorios clínicos son de limitada exactitud. En este trabajo se desarrollarán las condiciones que debería cumplir un marcador ideal, las dificultades que ofrece la evaluación de la creatinina, la medición de la TFG, así como las ventajas y limitaciones de las recomendaciones del uso de fórmulas para su determinación, y el algoritmo actual para estimar función renal. Conclusiones: actualmente, a pesar de las limitaciones, se recomienda el empleo de fórmulas para la estimación de la TFG, sobre todo en TFG menor a 60 ml/min/1.73 m2. Es un desafío, para un futuro mediato, desarrollar mejores recursos para su evaluación.

To diagnose,classify and stage diabetic kidney disease in patients with diabetes mellitus is a challenge in clinical practice for both primary care physicians and specialists because there is no method in clinical practice that evaluates accurately the glomerular filtration rate (GFR). This challenge is due to difficulties in evaluating kidney function in stages of chronic kidney disease (CKD) below 60 ml/min/1.73m2 corresponding to stages 3, 4 and 5 of the classification, because the available tools in clinical laboratories are of limited accuracy. This work explores the conditions that an ideal marker should meet, the difficulties offered by the evaluation of serum creatinine, the measurement of the glomerular filtration rate (GFR) as well as the advantages and limitations of the recommendations of the use of formulas for its determination and the current algorithm to estimate renal function. Conclusions: currently, despite the limitations, the use of formulas for the diagnosis of renal function is recommended, especially in GFR below 60 ml/min/1.73 m2. It is a challenge for the near future to develop better tools for the evaluation of TGF.

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The objective was to evaluate the influence of diets on lambs using different levels of peach palm meal as a replacement for maize (0, 10, 40, 60, and 85% of diet dry matter) on the endogenous creatinine clearance (CC), urine concentration ratio of purine derivatives to creatinine (PDC index), and daily creatinine excretion (DCE) as a marker to estimate purine derivatives (PD) excretion from urinary spot samples collected at different time points (4, 8, 12, 16, 20, 24 h after morning feeding) compared to 24-h total urine collection. The measured parameters were voluntary intake, urinary volume, CC, DCE, the concentration of plasma creatinine, and PD and purine derivatives' excretion (PDE). Five lambs were allocated to metabolic cages and distributed in a 5 × 5 Latin square. Urine collection was taken daily on days 16 to 19 of each experimental period. The inclusion of peach palm meal linearly reduced the intake of dry matter (g kg BW−0.75, p = 0.005), crude protein (g kg BW−0.75, p = 0.010), metabolizable energy (MJ kg BW−0.75, p = 0.010) and CC (p < 0.0001). It also quadratically affected the urinary volume (p = 0.008) and DCE (p = 0.004). There was a linear decrease for PDC index (p = 0.032) and PDE (p < 0.0001) measured in the 24-h total urine with peach palm meal levels. The different times of spot urine sampling did not affect (p > 0.05) the PDC index and PDE. Peach palm meal decreases the CC thereby compromising the use of a mean value of DCE as a PDE marker in spot urine samples. There is greater accuracy when using different values of DCE obtained for each diet as markers for the PDE in spot urine samples. Unconventional foodstuffs of low palatability affecting the voluntary intake of feed change the renal function.

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Diagnosticar, clasificar y estadificar la enfermedad renal en pacientes con diabetes mellitus (DM) es un desafío tanto para los médicos de atención primaria como para los especialistas, porque no existe método en la práctica clínica que evalúe la tasa de filtrado glomerular (TFG) en forma precisa. Para evaluar la función renal en enfermedad renal crónica (ERC) con menos de 60 ml/min/1.73m., correspondiente a los estadios 3, 4 y 5 de la clasificación actual, los métodos disponibles en los laboratorios clínicos son de limitada exactitud. En este trabajo se desarrollarán las condiciones que debería cumplir un marcador ideal, las dificultades que ofrece la evaluación de la creatinina, la medición de la TFG, así como las ventajas y limitaciones de las recomendaciones del uso de fórmulas para su determinación, y el algoritmo actual para estimar función renal. Conclusiones: actualmente, a pesar de las limitaciones, se recomienda el empleo de fórmulas para la estimación de la TFG, sobre todo en TFG menor a 60 ml/min/1.73 m.. Es un desafío, para un futuro mediato, desarrollar mejores recursos para su evaluación.

To diagnose,classify and stage diabetic kidney disease in patients with diabetes mellitus is a challenge in clinical practice for both primary care physicians and specialists because there is no method in clinical practice that evaluates accurately the glomerular filtration rate (GFR). This challenge is due to difficulties in evaluating kidney function in stages of chronic kidney disease (CKD) below 60 ml/min/1.73m. corresponding to stages 3, 4 and 5 of the classification, because the available tools in clinical laboratories are of limited accuracy. This work explores the conditions that an ideal marker should meet, the difficulties offered by the evaluation of serum creatinine, the measurement of the glomerular filtration rate (GFR) as well as the advantages and limitations of the recommendations of the use of formulas for its determination and the current algorithm to estimate renal function. Conclusions: currently, despite the limitations, the use of formulas for the diagnosis of renal function is recommended, especially in GFR below 60 ml/min/1.73 m2. It is a challenge for the near future to develop better tools for the evaluation of TGF. Key words: renal function; glomerular filtration rate; creatinine; creatinine clearance.

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The prevalence of chronic kidney disease (CKD) continues to increase worldwide, as well as the associated morbidity and mortality and the consequences on the patients' quality of life and countries' economies. CKD often evolves without being recognized by patients and physicians, although the diagnosis is based on two simple laboratory data: the estimated glomerular filtration rate (eGFR) and urine analysis. To measure GFR, the knowledge about the physiologic processes at the nephron level, the concept of clearance, and the identification of creatinine as a suitable endogenous marker for measuring the creatinine clearance (CrCl) had to be previously developed. On those bases, different equations to calculate CrCl (Cockcroft and Gault, 1976), or estimated GFR (four variables MDRD, 1999; CKD-Epi, 2009, among others) were generated. They all include creatinine and some demographic data, such as sex and age. However, to compare results throughout life or among laboratories, the creatinine determination must be standardized. In addition, the accuracy of these equations remains controversial in certain subgroups of patients. For these reasons, other mathematical models to improve CrCl estimation have been developed, such as when urine cannot be collected, in debilitated elderly patients and patients with trauma, diabetes, or obesity. Currently, eGFR in adults can be measured and reported immediately, using isotope dilution mass spectrometry traceable creatinine-based equations. In conclusion, based on knowledge obtained from renal physiology, eGFR can be used in the clinic for the diagnosis and early treatment of CKD, as well as a public instrument to estimate the prevalence.

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Although some investigations have been performed to determine the effects of transfusion load and suction pressure on renal function during intraoperative salvage autotransfusion, the precise threshold is still undetermined. A total of 625 patients undergoing surgery with the Continuous AutoTransfusion System (CATSplus) were enrolled and divided into groups according to the utilized suction pressure and transfusion volume. Plasma free hemoglobin (FHB) and creatinine clearance (CCr) were assayed to indicate the renal function. Both 0.03 MPa suction (≥4-unit load) and >5 units transfusion changed the levels of FHB and CCr significantly when measured 24 h post-operation compared to pre-operation. Under 0.02 MPa suction (≥4-unit load), the alteration of FHB and CCr returned to normal after 24 h. Under 3 units transfusion, the levels of FHB and CCr at 6 and 12 h post-operation changed significantly compared to pre-operation (P<0.05 or P<0.01, respectively), and this alteration could be restored to normal at 72 h post-operation. After an exhaustive investigation, less than 4 units transfusion and less than 0.03 MPa suction pressure are recommended for intraoperative salvage autotransfusion.

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Resumen OBJETIVO: Determinar y comparar el aclaramiento de creatinina de largo plazo con el inicial en pacientes con hemorragia obstétrica. MATERIALES Y MÉTODOS: Estudio observacional, longitudinal, retrospectivo, comparativo y analítico llevado a cabo en una serie de pacientes con hemorragia obstétrica (pérdida ≥ 1000 mL) hospitalizadas en la unidad de cuidados intensivos. El aclaramiento de la creatinina se calculó con la fórmula CKD-EPI en dos momentos: al ingreso a cuidados intensivos durante el puerperio inmediato, complicado por hemorragia (medición inicial) y de su última consulta médica registrada (medición de largo plazo). Se utilizó estadística descriptiva y la prueba t de Student con el programa SPSS versión 20. Se consideró significativo el valor de p < 0.05. RESULTADOS: Se estudiaron 49 pacientes con media de edad de 30.48 ± 6.06 años y 32.20 ± 8.24 semanas de embarazo. En 39 de 49 se practicó cesárea, 5 de 49 tuvieron parto, 4 de 49 requirieron histerotomía y solo 1 legrado instrumental. La media de sangrado estimado fue de 2744.89 ± 1474.65 mL. Para su control se requirió cirugía en 13 de 49, dos intervenciones en 21 de 49 y tres operaciones en 15 de 49. Aclaramiento de la creatinina: medición inicial 159.09 ± 46.62 y de largo plazo (22.27 ± 1.55 meses después) 112.23 ± 30.91 mL de min de 1.73 m2 de superficie corporal. La diferencia fue significativa (p = 0.002). En la medición de largo plazo se encontró enfermedad renal crónica en 1 de las 49 pacientes. CONCLUSIONES: El aclaramiento de la creatinina de largo plazo resultó menor, quizá por la regresión de los cambios gestacionales al paso del tiempo, pero sin deterioro funcional importante, salvo un caso con enfermedad renal crónica encontrado como un hallazgo no necesariamente relacionado con la hemorragia obstétrica.

Abstract OBJECTIVE: To determine and compare long-term creatinine clearance with baseline creatinine clearance in patients with obstetric hemorrhage. MATERIALS AND METHODS: Observational, longitudinal, retrospective, comparative and analytical study carried out in a series of patients with obstetric hemorrhage (loss ≥ 1000 mL) hospitalized in the intensive care unit. Creatinine clearance was calculated with the CKD-EPI formula at two time points: on admission to intensive care after the end of pregnancy complicated by hemorrhage (baseline measurement) and from their last recorded medical consultation (long-term measurement). Descriptive statistics and Student's t-test were used with SPSS version 20, p < 0.05 was considered significant. RESULTS: Forty-nine patients with mean age of 30.48 ± 6.06 years and 32.20 ± 8.24 weeks of pregnancy were studied. Cesarean section was performed in 39 of 49, 5 of 49 delivered, 4 of 49 required hysterotomy and only one required instrumental curettage. The mean estimated bleeding was 2744.89 ± 1474.65 mL. Creatinine clearance: initial measurement 159.09 ± 46.62 and long-term (22.27 ± 1.55 months later) 112.23 ± 30.91 mL of min of 1.73 m2 body surface area. The difference was significant (p = 0.002). On long-term measurement, chronic kidney disease was found in 1 of the 49 patients. CONCLUSIONS: Long-term creatinine clearance resulted lower, perhaps due to regression of gestational changes over time, but without significant functional impairment, except for one case with chronic kidney disease found as a finding not necessarily related to obstetric hemorrhage.

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ABSTRACT Background: Thrombocytopenia (TP) is the major event associated with linezolid (LZD) therapy. We investigated the incidence and risk factors for thrombocytopenia in hospitalized adults who received LZD (1200 mg/day) between 2015 and 2017. HIV-positive, death during follow-up and those with a baseline platelet count ≤100 × 103/mm3 were excluded. Method: TP was defined as a decrease in platelet count of ≥20% from the baseline level at the initiation of linezolid therapy and a final count of <100 × 103/mm3. The odds ratios (OR) for thrombocytopenia were obtained using multivariate stepwise logistic regression analysis. Main results: A total of 66 patients were included (mean age [SD] 62 [18], male gender [%], 37 [56]). LZD-associated TP was identified in 12 patients (18.2%). For TP, the adjusted OR [95% CI] of the platelet count ≤200 × 103/mm3, serum creatinine and renal impairment at baseline were 5.66 [1.15-27.9], 4.57 [1.26-16.5] and 9.41 [1.09-80.54], respectively. Male gender and dosage per weight per day (DPWD) >20 mg/kg/day were not risk factors. Conclusion: The results showed that the incidence of linezolid-induced thrombocytopenia was lower in patients with normal renal function and higher in those with platelet counts ≤200 × 103/mm3 or serum creatinine >1.5 mg/dL at the start of the treatment.

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BACKGROUND: Thrombocytopenia (TP) is the major event associated with linezolid (LZD) therapy. We investigated the incidence and risk factors for thrombocytopenia in hospitalized adults who received LZD (1200mg/day) between 2015 and 2017. HIV-positive, death during follow-up and those with a baseline platelet count ≤100×103/mm3 were excluded. METHOD: TP was defined as a decrease in platelet count of ≥20% from the baseline level at the initiation of linezolid therapy and a final count of <100×103/mm3. The odds ratios (OR) for thrombocytopenia were obtained using multivariate stepwise logistic regression analysis. MAIN RESULTS: A total of 66 patients were included (mean age [SD] 62 [18], male gender [%], 37 [56]). LZD-associated TP was identified in 12 patients (18.2%). For TP, the adjusted OR [95% CI] of the platelet count ≤200×103/mm3, serum creatinine and renal impairment at baseline were 5.66 [1.15-27.9], 4.57 [1.26-16.5] and 9.41 [1.09-80.54], respectively. Male gender and dosage per weight per day (DPWD) >20mg/kg/day were not risk factors. CONCLUSION: The results showed that the incidence of linezolid-induced thrombocytopenia was lower in patients with normal renal function and higher in those with platelet counts ≤200×103/mm3 or serum creatinine >1.5mg/dL at the start of the treatment.

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Resumen Introducción: La estimación de la función renal es un componente importante de laatención hospitalaria. Para ello, habitualmente, se utilizan estimaciones basadas en las cifras de creatinina sérica. Las fórmulas más utilizadas son la MDRD y Cockcroft-Gault.Objetivo:Evaluar la correlación de las ecuaciones de Cockcroft-Gault y MDRD con el valor de depuración de creatinina, basada en la recolección de orina de 24 horas. Material y métodos:Para realizar el estudio se utilizaron los registros del Servicio de Patología Clínica del HospitalNacional Hipólito Unanue, un hospital de referencia en Lima, Perú. La creatinina sérica se realizó mediante el método de Jaffe. La depuración de creatinina se llevó a cabo mediante las determinaciones simultáneas de creatinina sérica y creatinina urinaria, obtenida a través de la recolección de orina de 24 horas. Se calcularon las correlaciones utilizando el coeficiente de Pearson, considerando significativos valores de p<0.05. Resultados:Se incluyeron 426 pacientes. La edad promedio de la población estudiada fue de 58.36 +/- 16.21 años, con un mínimo de 15 años y un máximo de 91 años. Hubo un discreto predominio del género femenino (51.2%).La correlación entre la depuración de creatinina y aquella estimada por la ecuación MDRD fue de 0.57 (p<0.001); al restringir el análisis a aquellos pacientes con valores de depuración menores a 60 ml/min, la correlación fue de 0.55 (p<0.001). La correlación entre la depuración de creatinina y la estimada por la ecuación de Cockcroft-Gault fue de 0.53 (p<0.001); al restringir el análisis a pacientes con valores de depuración menores a 60 ml/min, la correlación fue de 0.55 (p<0.001). La correlación entre las fórmulas de Cockcroft-Gault y MDRD fue de 0.84 (p<0.01). En pacientes con depuraciones por debajo de 60, fue de 0.87 (p<0.01). Los resultados no mostraron diferencias al restringir las observaciones a pacientes menores de 70 años.Conclusión:Aunque las ecuaciones de Cockcroft-Gault y MDRD guardan una buena correlación entre ellas, se correlacionan de manera subóptima con la depuración de creatinina realizada mediante la recolección de 24 horas, bajo condiciones clínicas habituales.

Abstract Introduction: The estimation of renal function is an important component of hospital care. To do this, estimates are usually used, based on serum creatinine levels. The most widely used equations are MDRD and Cockcroft-Gault. Objective: To evaluate the correlation of the Cockcroft-Gault and MDRD equations with the creatinine clearance value, based on 24-hour urine collection. Methods: In order to carry out this study, the records of the Clinical Pathology Service of Hospital Nacional HipólitoUnanue, a reference hospital in Lima (Peru), were used. Serum creatinine was measured using the Jaffe's method. Creatinine clearance was performed by simultaneous determinations of serum creatinine and urinary creatinine, obtained through 24-hour urine collection. Correlations were calculated using Pearson coefficient, considering significant values ​​of p<0.05. Results: 426 patients were included. The average age was 58.36 +/- 16.21 years, with a minimum age of 15 and a maximum of 91. There was a slight female predominance (51.2%). The correlation between creatinine clearance and that estimated by the MDRD equation was 0.57 (p<0.001); when restricting the analysis to those patients with clearance values ​​lower than 60 ml/min, the correlation was 0.55 (p <0.001). The correlation between creatinine clearance and that estimated by the Cockcroft-Gault equation was 0.53 (p<0.001); when the analysis was limited to patients with purification values ​​lower than 60 ml/min, the correlation was 0.55 (p <0.001). The correlation between Cockcroft-Gault and MDRD equations was 0.84 (p<0.01). In patients with purifications below 60, it was 0.87 (p<0.01). The results showed no differences when restricting observations to patients under 70. Conclusion: Although Cockcroft-Gault and MDRD equations keep a good correlation between them, this correlation is suboptimal with creatinine clearance performed through 24-hour collection, under usual clinical conditions.

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The pathophysiology of renal failure in septic shock is complex. Although microvascular dysfunction has been proposed as a mechanism, there are controversial findings about the characteristics of microvascular redistribution and the effects of resuscitation. Our hypothesis was that the normalization of systemic hemodynamics with fluids and norepinephrine fails to improve acute kidney injury. To test this hypothesis, we assessed systemic and renal hemodynamics and oxygen metabolism in 24 anesthetized and mechanically ventilated sheep. Renal cortical microcirculation was evaluated by SDF-videomicroscopy. Shock (n = 12) was induced by intravenous administration of endotoxin. After 60 min of shock, 30 mL/kg of saline solution was infused and norepinephrine was titrated to reach a mean blood pressure of 70 mmHg for 2 h. These animals were compared with a sham group (n = 12). After endotoxin administration, mean blood pressure, cardiac index, and systemic O2 transport and consumption decreased (P < 0.05 for all). Resuscitation improved these variables. Endotoxin shock also reduced renal blood flow and O2 transport and consumption (205[157-293] vs. 131 [99-185], 28.4[19.0-38.2] vs. 15.8[13.5-23.2], and 5.4[4.0-8.8] vs. 3.7[3.3-4.5] mL·min-1·100 g-1, respectively); cortical perfused capillary density (23.8[23.5-25.9] vs. 17.5[15.1-19.0] mm/mm2); and creatinine clearance (62.4[39.2-99.4] vs. 10.7[4.4-23.5] mL/min). After 2 h of resuscitation, these variables did not improve (174[91-186], 20.5[10.8-22.7], and 3.8[1.9-4.8] mL·min-1·100 g-1, 19.9[18.6-22.1] mm/mm2, and 5.9[1.0-11.9] mL/min). In conclusion, endotoxin shock induced severe renal failure associated with decreased renal flow, O2 transport and consumption, and cortical microcirculation. Normalization of systemic hemodynamics with fluids and norepinephrine failed to improve renal perfusion, oxygenation, and function.NEW & NOTEWORTHY This experimental model of endotoxin shock induced severe renal failure, which was associated with abnormalities in renal regional blood flow, microcirculation, and oxygenation. Derangements included the compromise of peritubular microvascular perfusion. Improvements in systemic hemodynamics through fluids and norepinephrine were unable to correct these abnormalities.

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INTRODUCTION: The management of kidney transplant recipients requires glomerular filtration rate (GFR) monitoring, which is an indicator of graft primary function and patient survival. OBJECTIVE: To evaluate the performance of different creatinine or cystatin-based formulas in the estimation of glomerular filtration rate in Mexican patients receiving kidney transplantation. METHOD: 30 transplant recipients were included, in whom the glomerular filtration rate was measured by means of iothalamate, and was also calculated using seven equations based on cystatin or creatinine. RESULTS: The formula with the best performance was the one proposed by the chronic kidney disease epidemiology collaboration (CKD-EPI), with a bias of -2.4 mL/min/1.73 m2 and an accuracy of 9.6; 96.7 % of patients were within 30 % of the measured GFR. The second best formula was the modification of diet in renal disease (MDRD) equation. Cystatin-based equations showed a poor performance. CONCLUSIONS: Our study suggests that, in Mexican patients receiving kidney transplantations, the best equations to estimate GFR are the CKD-EPI and MDRD equations.

INTRODUCCIÓN: El manejo de los pacientes receptores de trasplante renal requiere vigilancia de la tasa de filtrado glomerular (TFG), la cual es un indicador de la función primaria del injerto y de la supervivencia del paciente. OBJETIVO: Evaluar el rendimiento en la estimación de la función renal de diferentes fórmulas basadas en creatinina o cistatina en pacientes mexicanos receptores de trasplante renal. MÉTODO: Se incluyeron 30 pacientes receptores de trasplante renal en quienes se midió tasa de filtrado glomerular por iodotalamato, la cual también se calculó por siete ecuaciones basadas en cistatina o creatinina. RESULTADOS: La fórmula con mejor desempeño fue la propuesta por CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), con un sesgo de −2.4 mL/minuto/1.73 m2 y precisión de 9.6; 96.7 % estaba dentro de 30 % de la tasa de filtrado glomerular medida. La segunda mejor ecuación fue la MDRD (Modification of Diet in Renal Disease). Las ecuaciones basadas en cistatina mostraron pobre desempeño. CONCLUSIONES: Nuestro estudio sugiere que en pacientes mexicanos receptores de trasplante renal las mejores ecuaciones para estimar la TFG son CKD y MDRD.

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Abstract Introduction: The management of kidney transplant recipients requires glomerular filtration rate (GFR) monitoring, which is an indicator of graft primary function and patient survival. Objective: To evaluate the performance of different creatinine or cystatin-based formulas in the estimation of glomerular filtration rate in Mexican patients receiving kidney transplantation. Method: 30 transplant recipients were included, in whom the glomerular filtration rate was measured by means of iothalamate, and was also calculated using seven equations based on cystatin or creatinine. Results: The formula with the best performance was the one proposed by the chronic kidney disease epidemiology collaboration (CKD-EPI), with a bias of −2.4 mL/min/1.73 m2: and an accuracy of 9.6; 96.7 % of patients were within 30 % of the measured GFR. The second best formula was the modification of diet in renal disease (MDRD) equation. Cystatin-based equations showed a poor performance. Conclusions: Our study suggests that, in Mexican patients receiving kidney transplantations, the best equations to estimate GFR are the CKD-EPI and MDRD equations.

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BACKGROUND: The prospective, observational XANTUS study demonstrated low rates of stroke and major bleeding in real-world rivaroxaban-treated patients with non-valvular atrial fibrillation (NVAF) from Western Europe, Canada and Israel. XANTUS-EL is a component of the overall XANTUS programme and enrolled patients with NVAF treated with rivaroxaban from Eastern Europe, the Middle East and Africa (EEMEA) and Latin America. METHODS: Patients with NVAF starting rivaroxaban for stroke prevention were consecutively recruited and followed for 1 year, at approximately 3-month intervals, or for ≥30 days after permanent rivaroxaban discontinuation. Primary outcomes were major bleeding, adverse events (AEs), serious AEs and all-cause mortality. Secondary outcomes included stroke, non-central nervous system systemic embolism (non-CNS SE), transient ischaemic attack (TIA), myocardial infarction (MI) and non-major bleeding. All major outcomes were centrally adjudicated. RESULTS: Overall, 2064 patients were enrolled; mean age ±â€¯standard deviation was 67.1 ±â€¯11.32 years; 49.3% were male. Co-morbidities included heart failure (30.9%), hypertension (84.2%), diabetes mellitus (26.5%), prior stroke/non-CNS SE/TIA (16.2%) and prior MI (10.7%). Mean CHADS2, CHA2DS2-VASc and HAS-BLED scores were 2.0, 3.6 and 1.6, respectively. Treatment-emergent event rates were (events/100 patient-years, [95% confidence interval]): major bleeding 0.9 (0.5-1.4); all-cause mortality 1.7 (1.2-2.4); stroke/non-CNS SE 0.7 (0.4-1.2); any AE 18.1 (16.2-20.1) and any serious AE 8.3 (7.0-9.7). One-year treatment persistence was 81.9%. CONCLUSIONS: XANTUS-EL confirmed low stroke and major bleeding rates in patients with NVAF from EEMEA and Latin America. The population was younger but with more heart failure and hypertension than XANTUS; stroke/SE rate was similar but major bleeding lower.

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OBJECTIVE: To evaluate the impact of advanced age on rocuronium kinetic disposition in ASA I-III patients undergoing elective surgeries. METHODS: Young adult (20-50 years, n = 15) and elderly patients (65-85 years, n = 14) submitted to surgery under general anaesthesia were investigated. All patients were induced with individual intravenous doses of midazolam, rocuronium, fentanyl and propofol. Rocuronium-induced neuromuscular block was monitored by train of four stimulations of the adductor muscle of the thumb on the ulnar nerve. The pharmacokinetic parameters were calculated by non-compartmental analysis. The relationship between rocuronium plasma concentration and the neuromuscular blockade was described by a sigmoidal Emax model. KEY-FINDINGS: Elderly patients presented decreased Cl (2.1 ml/kg per min vs 2.8 ml/kg per min; P = 0.0123); increased AUC/dose (507.8 µg min/ml (mg/kg) vs 392.2 µg min/ml/(mg/kg); P = 0.0168) and reduced volume of distribution (285.4 ml/kg vs 435.6 ml/kg, P = 0.0434) compared to young adults. The concentrations required to achieve 50% of maximum neuromuscular block (EC50) were similar for young adult (338.8 ng/ml) and elderly (462.7 ng/ml) patients (P > 0.05). CONCLUSIONS: Elderly patients showed increased AUC/D and reduced total Cl compared to young adult patients due to the age-related reduced renal function. Differences in the PK-PD properties of rocuronium in elderly population are due to changes in drug disposition rather than to alterations in the sensitivity to the drug.

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La filtración glomerular se calcula por la depuración de creatinina endógena (DCE) en orina de 24 horas, con limitaciones en su recolección y dificultades para los pacientes. Sin embargo, existen fórmulas propuestas para estimar esta función renal. Objetivo. Aplicar la fórmula Cockcroft-Gault de filtración glomerular y compararla con método químico colorimétrico en gestantes. Diseño. Estudio observacional, correlacional, prospectivo y transversal. Lugar. Laboratorio central, Hospital Nacional Sergio Bernales de Lima, Perú. Participantes. Mujeres gestantes. Métodos. Previo consentimiento informado, se procesaron muestras de sangre y orina de 24 horas de 92 gestantes, entre noviembre 2015 y enero 2016. Se utilizó el coeficiente de correlación de Pearson entre los resultados DCE de la fórmula Cockcroft-Gault y la obtenida en suero-orina de 24 horas. Resultados. La muestra tuvo una distribución normal analizada por el estimador Smirnov-Kolmogorov. El promedio de la DCE en orina de 24 horas fue 73,65 ± 19,85 mL/min, la obtenida por la fórmula Cockcroft-Gault fue 99,82 ± 18,75 mL/min, con diferencia significativa a la prueba t para muestras relacionadas (p < 0,000), y la correlación entre dichos métodos de laboratorio fue baja (r=0,561) en todas las gestantes y por trimestre, mostrando falta de correlación con la prueba coeficiente de correlación-concordancia de Lin (ccc) (p < 0,01). La sensibilidad (S) fue 0,50; especificidad (E) 0,591, el valor predictivo positivo (VPP) 0,212 y el negativo (VPN) 0,881. Conclusiones. La DCE obtenida por fórmula Cockcroft­ Gault con la DCE suero-orina de 24 horas en gestantes tuvo baja correlación (r =[0,4 a 0,67]), con niveles bajos de S, E VPP y VPN, por lo que no es recomendable su uso en gestantes.

Glomerular filtration rate (GFR) is calculated by the endogenous creatinine clearance (DCE) in 24-hour urine, with limited collection and difficulties for patients. There are formulas proposed to estimate renal function. Objective. To use the Cockcroft-Gaul formula of glomerular filtration and to compare it with the chemical colorimetric method in pregnant women. Design. Observational, correlational, prospective and transversal study. Setting. Central Laboratory, Sergio Bernales National Hospital, Lima, Peru. Participants. Pregnant women. Methods. Using prior informed consent blood samples and 24-hour urine of 92 pregnant women between November 2015 and January 2016 were processed. The Pearson correlation coefficient was used to compare the DCE results obtained with the Cockcroft­ Gault formula and the serum-24 hours urine. Results. The sample had a normal distribution analyzed by Kolmogorov-Smirnov estimator. The average DCE in 24 hours urine was 73.65 ± 19.85 mL /min, and that obtained by the Cockcroft-Gault formula was 99.82 ± 18.75 mL/min, with t test significant difference in related samples (p <0.000); the correlation between these laboratory methods was low (r = 0.561) in all pregnant women and by trimesters, showing lack of correlation with the coefficient of the Lin correlation-matching (ccc) (p <001) Sensitivity (S) was 0.50, specificity (Sp) 0.591, positive predictive value (PPV) 0.212 and negative predictive value (NPV) 0.881. Conclusions. The DCE obtained by Cockcroft-Gault with the DCE serum-24 hours urine in pregnant women had low correlation (r = [OA to 0.67]) with low levels of S, Sp, PPV and NPV, so it is not recommended for use in pregnant women.

RESUMO

La cuantificación de la proteinuria en orina de 24 horas se utiliza con frecuencia para el diagnóstico y la terapéutica en pacientes con enfermedad renal crónica (ERC). Sin embargo, muchas veces se pierde precisión debido a lo complicado que resulta para el paciente la recolección de la muestra. Se ha desarrollado el cociente proteína/creatinina (P/C) en orina esporádica como alternativa diagnóstica, razón por la cual el objetivo del presente estudio fue determinar si el cociente P/C se correlaciona con la proteinuria en 24 horas (ProtU24h), en pacientes con ERC que asistieron al Centro UNILIME UC, Valencia-Venezuela. El estudio fue correlacional, de campo y transversal. La muestra fue de tipo intencional, no probabilística, constituida por 120 pacientes que cumplieron con los criterios de inclusión, a quienes se les determinó la depuración de creatinina, proteinuria en orina de 24 horas y el índice P/C en la segunda orina, entre los meses de abril y septiembre de 2013. Se establecieron correlaciones entre las variables. La ProtU24h correlacionó significativamente con el cociente P/C (r=0,855; p=0,000) en proteinurias menores de 3500 mg/24 horas, y adicionalmente dicho cociente tiene la capacidad de detectar elevadas concentraciones de ProtU24h. El presente estudio demuestra que el cociente P/C en orina esporádica es útil en proteinurias inferiores al rango nefrótico, lo que supone simplificación de la recolección de la muestra y podría suponer una disminución del gasto sanitario.(AU)

Quantification of proteinuria in 24-hour urine is frequently used for diagnosis and therapy in patients with chronic kidney disease (CKD); however, accuracy is often lost due to how complicated it is for the patient to collect the sample. Researchers have developed the protein/creatinine ratio (P/C) in sporadic urine as a diagnostic alternative. The objective of this study was to determine if the P/C correlates with proteinuria in 24 hours (ProtU24h) in CKD patients who attended UNILIME UC Center, Valencia-Venezuela. This was a correlational field study. The sample was not probabilistic; it was constituted by 120 patients who met the inclusion criteria and were determined creatinine clearance and proteinuria in 24-hour urine, and P/C ratio in the second urine sample,from April to September 2013. Correlations between variables were established. The ProtU24h correlated significantly with the P/C (r=0.855 ; p=0.000) in proteinuria lower than 3500 mg/24 hours. Additionally, said quotient has the ability to detect high concentrations of ProtU24h. The present study shows that the P/C in sporadic urine is useful in proteinuria lower than the nephrotic range, which simplifies collection of the sample and could lead to a reduction in health expenditure.(AU)

A quantificaþÒo da proteinúria na urina de 24 horas é frequentemente utilizada para diagnóstico e terapia em pacientes com doenþa renal cr¶nica (DRC). Porém, muitas vezes, é perdida a precisÒo devido a que, para o paciente, é difícil a coleta da amostra de urina. Foi desenvolvido o quociente proteína / creatinina (P/C) na urina esporádica como um diagnóstico alternativo, razÒo pela qual o objetivo desse estudo foi determinar se o quociente P/C se correlaciona com a proteinúria em 24 horas (ProtU24h), em pacientes com DRC que frequentaram o Centro de UNILIME UC, Valencia-Venezuela. O estudo foi correlacional, de campo e transversal. A amostra foi de tipo intencional, nÒo probabilística, composta de 120 pacientes que cumpriram os critérios de inclusÒo, aos quais lhes determinaram a depuraþÒo da creatinina, proteinúria em urina de 24 horas e o índice P/C na segunda urina, entre abril e setembro de 2013. As correlaþ§es entre as variáveis foram estabelecidas. A ProtU24h se correlacionou significativamente com o quociente P/C (r=0,855; p=0,000) em proteinúrias menores de 3500 mg/24 horas, e além disso tal quociente tem a capacidade de detectar concentraþ§es elevadas de ProtU24h. O estudo presente demonstra que o quociente P/C na urina esporádica é útil em proteinúrias inferiores ao intervalo nefrótico, representando simplificaþÒo da coleta da amostra e poderia fazer supor uma reduþÒo das despesas em saúde.(AU)

RESUMO

BACKGROUND: Obesity is a risk factor for renal damage. This study aimed to determine the relationship between body fat percent and creatinine clearance in adult patients with and without type 2 diabetes mellitus (T2DM). METHODS: An observational prospective cross-correlation study was carried out among adults with and without T2DM between 18 and 60 years of age. It was determined the time of evolution with T2DM, as well as fat percentage (FP), body mass index (BMI), creatinine clearance (Cockroft-Gault [CrCCG]), glycemia and micro/macroalbuminuria. The correlation between CrCCG and FP was determined by Spearman's test. RESULTS: 174 subjects were included in this study. Obesity by BMI and FP in subjects with and without T2DM was similar. Of the studied subjects, 12.6 % didn't have kidney damage and 50.7 % had increased risk of renal disease; the frequencies for stages 1-4 of kidney damage were 12.0, 20.1, 4.0 and 0.6 %, respectively. Spearman's test showed a direct relationship between FP and CrCCG, higher in diabetics (r = 0.418, p < 0.0001) than in non-diabetics (p = 0.327, p < 0.0001). CONCLUSIONS: The FP was correlated directly with the CrCCG in subjects with and without T2DM; therefore, we can conclude that the greater the kidney damage, the smaller the fat porcentage in the study sample.

Introducción: la obesidad es un factor de riesgo para daño renal. El objetivo del estudio fue conocer la relación entre el porcentaje de grasa corporal (PG) y la depuración de creatinina en pacientes adultos con y sin diabetes mellitus 2 (DM2). Métodos: estudio observacional, prospectivo, transversal de correlación. Se evaluaron adultos entre 18 y 60 años, con y sin DM2. Se determinó el tiempo de evolución con DM2, el PG, el índice de masa corporal (IMC), la depuración de creatinina (Cockroft-Gault [DCrCG]), la glicemia y la micro/macroalbuminuria. Mediante la prueba de Spearman se determinó la correlación entre DCrCG y PG. Resultados: se incluyeron 174 sujetos. La frecuencia de obesidad por IMC y PG en sujetos con y sin DM2 fue similar. El 12.6 % no tuvo daño renal y el 50.7 % tuvo riesgo aumentado de enfermedad renal. Las frecuencias para los estadios 1 a 4 fueron 12.0, 20.1, 4.0 y 0.6 %, de forma respectiva. La prueba de Spearman mostró relación directa entre PG y DCrCG, mayor en diabéticos (r = 0.418 frente a r = 0.327, p < 0.0001). Conclusiones: el PG corporal se correlacionó en forma directa con la DCrCG en sujetos con y sin DM2; se infiere que a mayor daño renal, menor grasa tiene la población evaluada.

Assuntos

RESUMO

Introducción: la identificación temprana de los pacientes con enfermedad renal permite realizar tratamientos que limitan la progresión del daño de este órgano y modificar los factores de riesgo asociados que contribuyen al aumento de su morbilidad. Objetivos: determinar la prevalencia de la Enfermedad renal crónica oculta (ERCO) en la población del Bañado Sur y sus factores de riesgo. Metodología: estudio descriptivo transversal realizado en hombres y mujeres mayores de 18 años de edad del Barrio Bañado Sur, Asunción, Paraguay. La toma de muestras se realizó en forma aleatoria, recorriendo casa por casa para determinar variables demográficas, clínicas y laboratoriales. Se determinó el filtrado glomerular aplicando la fórmula de MDRD-4 y se clasificaron los pacientes según el filtrado glomerular (FG), en estadios 1 a 5. Resultados: se estudiaron 75 personas con edad media 39 años±17 años, predominio del sexo femenino (66%). La creatinina sérica media fue 0,97 0,4 mg/dL, la glicemia media fue 109± 54 mg/dL, la FG media por MDRD-4 fue 90,32 ± 37,55 mL/min. Los pacientes se encontraban con distintos grados de función renal de acuerdo a los valores de FG. Se encontraron 34 personas en el estadio 1 (45%), 28 personas en el estadio 2 (37%), 10 personas en el estadio 3 (13%), 3 personas en el estadio 4 (4%) y ninguna persona en estadio 5. De ahí que 13 sujetos (17%) ya se hallaban con ERCO. Conclusión: la prevalencia de ERCO fue 17%. Es recomendable utilizar el filtrado glomerular por la fórmula MDRD-4 para evaluar la función renal en pacientes con factores de riesgo como obesidad, hipertensión arterial y diabetes mellitus.

Introduction: The early identification of renal disease patients allow treatments that limit the evolution of kidney damage and modify associated risk factors that contribute to the increase of morbidity. Objectives: To determine the prevalence of the occult chronic kidney disease (OCKD) in the population of the South Wetland (Bañado Sur) and their risk factors. Methodology: Cross-sectional descriptive study performed in men and women older than 18 years old in the South Wetland neighborhood of Asunción, Paraguay. Sample collection was made randomly, visiting house per house to determine demographic, clinical and laboratory variables. Glomerular filtration was determined using the MDRD-4 formula and patients were classified in 1 to 5 stages using the glomerular filtration rate (GFR). Results: Seventy people were studied, the mean age was 39±17 years old and there was a predominance of women (66%). The mean serum creatinine was 0.97±0.4 mg/dL, the mean glycemia was 109±54 mg/dL, and the mean GF by MDRD-4 was 90.32±37.55 mL/min. The patients were in different stages of renal function according to the GF. Thirty four people were in stage 1 (45%), 28 people in stage 2 (37%), 10 people in stage 3 (13%), 3 people in stage 4 (4%) and none was in stage 5. Thirteen (17%) subjects had already OCKD. Conclusion: The prevalence of OCKD was 17%. It is recommended to use glomerular filtration by MDRD-4 formula to evaluate the renal function in patients with risk factors such as obesity, arterial hypertension and diabetes mellitus.