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  1. Article ; Online: Etiopathogenesis of chronic kidney disease-associated pruritus: putting the pieces of the puzzle together.

    Molina, Pablo / Ojeda, Raquel / Blanco, Ana / Alcalde, Guillermo / Prieto-Velasco, Mario / Aresté, Nuria / Buades, Juan Manuel / Simó, Vicent Esteve / Goicoechea, Marian / Pérez-Morales, Rosa Elena / Sánchez-Álvarez, Emilio / Sánchez-Villanueva, Rafael / Montesa, María / Arenas, María Dolores

    Nefrologia

    2023  Volume 43, Issue 1, Page(s) 48–62

    Abstract: Defined as the unpleasant sensation that causes the desire to scratch, pruritus is the most common skin symptom associated with uremia and appears in almost half of patients with advanced chronic kidney disease (CKD). Beyond its direct impact on quality ... ...

    Abstract Defined as the unpleasant sensation that causes the desire to scratch, pruritus is the most common skin symptom associated with uremia and appears in almost half of patients with advanced chronic kidney disease (CKD). Beyond its direct impact on quality of life, CKD-associated pruritus (CKD-aP) is an independent predictor of mortality that also has a synergistic effect with other quality of life-related symptoms, such as insomnia, depression, and anxiety. Although different mechanisms have been proposed to explain the origin of Pa-ERC, its etiopathogenesis is still not fully understood. Since new therapeutic targets have been identified and several clinical trials have recently shown promising results, our current understanding of the interrelationships has expanded significantly and the pathophysiological mechanisms underlying CKD-aP are now considered to be multifactorial. The potential triggers of pruritus in patients with CKD are discussed in this review, including hypotheses about skin xerosis, accumulation of uremic toxins, dysregulation of the immune system and systemic inflammation, uremic neuropathy, and imbalances in the endogenous opioid system. Other non-uremic causes of pruritus are also discussed, with the aim of guiding the physicians to apply an adequate aetiopathogenic approach to CKD-aP in their day-to-day clinical practice.
    MeSH term(s) Humans ; Quality of Life ; Pruritus/etiology ; Renal Insufficiency, Chronic/complications ; Uremia/complications ; Uremia/therapy
    Language English
    Publishing date 2023-05-10
    Publishing country Spain
    Document type Journal Article ; Review
    ZDB-ID 2837917-2
    ISSN 2013-2514 ; 2013-2514
    ISSN (online) 2013-2514
    ISSN 2013-2514
    DOI 10.1016/j.nefroe.2023.03.015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Perception of Spanish nephrologists on an old unsolved problem: Pruritus associated with chronic kidney disease (CKD-aP).

    Goicoechea, Marian / Arenas-Jimenez, María Dolores / Areste, Nuria / Perez-Morales, Rosa Elena / Esteve, Vicens / Sanchez-Alvarez, Emilio / Alcalde Bezhold, Guillermo / Blanco, Ana / Sanchez-Villanueva, Rafael / Molina, Pablo / Ojeda, Raquel / Prieto-Velasco, Mario / Manuel Buades, Juan

    Nefrologia

    2023  Volume 43, Issue 1, Page(s) 102–110

    Abstract: Introduction: Pruritus associated with chronic kidney disease is defined as the sensation of itching, in people with chronic kidney disease, in a one area or all over the body that causes the need to scratch, after having ruled out other dermatological ... ...

    Abstract Introduction: Pruritus associated with chronic kidney disease is defined as the sensation of itching, in people with chronic kidney disease, in a one area or all over the body that causes the need to scratch, after having ruled out other dermatological or systemic causes. It is an old and known problem whose prevalence has been able to decrease with the improvement of dialytic techniques but which still persists and is underdiagnosed.
    Objectives: The objective of this study was to analyse the current perception of nephrologists about this problem that influences the quality of life of people with chronic kidney disease through a survey.
    Results: 135 nephrologists, most of them engaged in haemodialysis, participated. 86% considered that pruritus associated with chronic kidney disease is still a problem today that affects the quality of life. Most nephrologists believe that the main pathophysiological cause is uremic toxins (60%) and only 16% believe that it is due to the dysregulation of the opioid system/endorphins-dynorphins. Only 16% comment that the prevalence of pruritus in their centre is greater than 20%. 40% believe that the diagnosis is made because it is manifested by the patient and only 27% because it is asked by the doctor. Moreover, it is not usual to use scales to measure it or the codification in the medical records. The main treatment used is antihistamines (96%), followed by moisturizers/anaesthetics (93%) and modification of the dialysis regimen (70%).
    Conclusions: Pruritus associated with chronic kidney disease is still a current problem, it is underdiagnosed, not codified and with a lack of indicated, effective and safe treatments. Nephrologists do not know its real prevalence and the different pathophysiological mechanisms involved in its development. Many therapeutic options are used with very variable results, ignoring their efficacy and applicability at the present time. The new emerging kappa-opioid-receptor agonist agents offer us an opportunity to reevaluate this age-old problem and improve the quality of life for our patients with chronic kidney disease.
    MeSH term(s) Humans ; Nephrologists ; Quality of Life ; Analgesics, Opioid/therapeutic use ; Renal Insufficiency, Chronic/complications ; Pruritus/etiology ; Perception
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-04-15
    Publishing country Spain
    Document type Journal Article
    ZDB-ID 2837917-2
    ISSN 2013-2514 ; 2013-2514
    ISSN (online) 2013-2514
    ISSN 2013-2514
    DOI 10.1016/j.nefroe.2023.03.012
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Prevalence and severity of pruritus in Spanish patients with chronic kidney disease and impact on quality of life: a cross-sectional study.

    Aresté, Nuria / Sanchez-Alvarez, J Emilio / Prieto-Velasco, Mario / Molina, Pablo / Esteve-Simó, Vicent / Ojeda, Raquel / Buades, Juan Manuel / Goicoechea, Marian / Sanchez-Villanueva, Rafael / Bezhold, Guillermo Alcalde / Pérez-Morales, Rosa Elena / Santos, Ana Blanco / Peiró-Jordan, Roser / Arenas, María Dolores

    Clinical kidney journal

    2023  Volume 16, Issue 6, Page(s) 1035–1037

    Language English
    Publishing date 2023-03-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfac246
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 6587: Show issues Location:
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  4. Article ; Online: Treatment of Chronic Heart Failure in Advanced Chronic Kidney Disease: The HAKA Multicenter Retrospective Real-World Study.

    Quiroga, Borja / Ortiz, Alberto / Núñez, Sara / Kislikova, Maria / González Sanchidrián, Silvia / Broseta, José Jesús / Albines, Zoila Stany / Escamilla Cabrera, Beatriz / Rivero Viera, Yaiza / Rodriguez Santarelli, David / Salanova Villanueva, Laura / Lopez Rodriguez, Francisca / Cancho Castellano, Barbara / Ibáñez Cerezon, María / Gutierrez Rivas, Carmen Patricia / Aresté, Nuria / Campos Gutiérrez, Belén / Ródenas Gálvez, Ana / Glucksmann Pizá, Maria Constanza /
    Balda Manzanos, Sagrario / Soldevila, Amparo / Rodríguez Gayo, Lucía / Moral Berrio, Esperanza / Ortega Diaz, Mayra / Beltrán Catalán, Sandra / Puente García, Adriana / Ángel Rojas, Miguel / Sosa Barrios, R Haridian / Santana Zapatero, Henar / Rangel Hidalgo, Gema / Martinez Canet, Ana Maria / Díez, Javier

    Cardiorenal medicine

    2024  Volume 14, Issue 1, Page(s) 202–214

    Abstract: Introduction: Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated ... ...

    Abstract Introduction: Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated current HF therapy in patients receiving clinical care in specialized aCKD units.
    Methods: The Heart And Kidney Audit (HAKA) was a cross-sectional and retrospective real-world study including outpatients with aCKD and HF from 29 Spanish centers. The objective was to evaluate how the treatment of HF in patients with aCKD complied with the recommendations of the European Society of Cardiology Guidelines for the diagnosis and treatment of HF, especially regarding the foundational drugs: renin-angiotensin system inhibitors (RASi), angiotensin receptor blocker/neprilysin inhibitors (ARNI), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i).
    Results: Among 5,012 aCKD patients, 532 (13%) had a diagnosis of HF. Of them, 20% had reduced ejection fraction (HFrEF), 13% mildly reduced EF (HFmrEF), and 67% preserved EF (HFpEF). Only 9.3% of patients with HFrEF were receiving quadruple therapy with RASi/ARNI, BB, MRA, and SGLT2i, but the majority were not on the maximum recommended doses. None of the patients with HFrEF and CKD G5 received quadruple therapy. Among HFmrEF patients, approximately half and two-thirds were receiving RASi and/or BB, respectively, while less than 15% received ARNI, MRA, or SGLT2i. Less than 10% of patients with HFpEF were receiving SGLT2i.
    Conclusions: Under real-world conditions, HF in aCKD patients is sub-optimally treated. Increased awareness of current guidelines and pragmatic trials specifically enrolling these patients represent unmet medical needs.
    MeSH term(s) Humans ; Heart Failure/complications ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Retrospective Studies ; Male ; Female ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/physiopathology ; Aged ; Cross-Sectional Studies ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Angiotensin Receptor Antagonists/therapeutic use ; Adrenergic beta-Antagonists/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Stroke Volume/physiology ; Middle Aged ; Spain/epidemiology ; Guideline Adherence ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Aged, 80 and over
    Chemical Substances Mineralocorticoid Receptor Antagonists ; Angiotensin Receptor Antagonists ; Adrenergic beta-Antagonists ; Sodium-Glucose Transporter 2 Inhibitors ; Angiotensin-Converting Enzyme Inhibitors
    Language English
    Publishing date 2024-04-03
    Publishing country Switzerland
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2595659-0
    ISSN 1664-5502 ; 1664-3828
    ISSN (online) 1664-5502
    ISSN 1664-3828
    DOI 10.1159/000538030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Vascular calcification in the uremic patient: a cardiovascular risk?

    Salgueira, Mercedes / del Toro, Nuria / Moreno-Alba, Rafael / Jiménez, Elena / Aresté, Nuria / Palma, Alfonso

    Kidney international. Supplement

    2003  , Issue 85, Page(s) S119–21

    Abstract: Background: Several factors suggest that the presence of vascular calcification (VC) is associated with a high risk of cardiac events in uremic patients. The aim of this study was to analyze the influence of VC on cardiac morbidity and mortality in our ... ...

    Abstract Background: Several factors suggest that the presence of vascular calcification (VC) is associated with a high risk of cardiac events in uremic patients. The aim of this study was to analyze the influence of VC on cardiac morbidity and mortality in our hemodialysis (HD) patients.
    Methods: We studied 79 patients on HD: 43 males, mean age 48 +/- 15 years old, mean time on HD 83 +/- 63 months. The presence of VC was evaluated by radiologic series. Other cardiovascular risk factors analyzed were arterial hypertension, diabetes mellitus, obesity, cigarette smoking, anemia, and dyslipidemia. All patients underwent M-mode, two-dimensional, Doppler echocardiography. Patients were followed for two years. During this time, clinical information collected included predialysis blood pressure, incidence of ischemic heart disease, episodes of congestive heart failure, and mortality due to cardiovascular event.
    Results: VC was observed in 55.7% of patients. Left ventricular hypertrophy, diastolic dysfunction, and cardiac valve calcification were significantly associated with VC. Ischemic heart disease (71.4% vs. 28.6%) and episodes of cardiac failure (0.41 vs. 0.18 per year; P < 0.05) appeared more frequently in the patient group with VC. VC was present in 80.6% of patients who developed episodes of heart failure. Eight patients died from cardiac disease; each of them had VC.
    Conclusion: The presence of VC can help to identify those HD patients with a higher cardiovascular risk.
    MeSH term(s) Aged ; Calcinosis/complications ; Calcinosis/diagnostic imaging ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/mortality ; Echocardiography ; Female ; Heart Failure/complications ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/diagnostic imaging ; Male ; Middle Aged ; Prospective Studies ; Radiography ; Renal Dialysis/adverse effects ; Risk Factors ; Treatment Outcome ; Vascular Diseases/complications ; Vascular Diseases/diagnostic imaging
    Language English
    Publishing date 2003-06
    Publishing country United States
    Document type Clinical Trial ; Journal Article
    ZDB-ID 193442-9
    ISSN 2157-1716 ; 0098-6577 ; 2157-1724
    ISSN (online) 2157-1716
    ISSN 0098-6577 ; 2157-1724
    DOI 10.1046/j.1523-1755.63.s85.28.x
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 797 -Suppl.-: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  6. Article ; Online: Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe: prevalence and survival--an analysis of data from the ERA-EDTA Registry.

    Spithoven, Edwin M / Kramer, Anneke / Meijer, Esther / Orskov, Bjarne / Wanner, Christoph / Abad, Jose M / Aresté, Nuria / de la Torre, Ramón Alonso / Caskey, Fergus / Couchoud, Cécile / Finne, Patrik / Heaf, James / Hoitsma, Andries / de Meester, Johan / Pascual, Julio / Postorino, Maurizio / Ravani, Pietro / Zurriaga, Oscar / Jager, Kitty J /
    Gansevoort, Ron T

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2014  Volume 29 Suppl 4, Page(s) iv15–25

    Abstract: Background: Autosomal dominant polycystic kidney disease (ADPKD) is the fourth most common renal disease requiring renal replacement therapy (RRT). Still, there are few epidemiological data on the prevalence of, and survival on RRT for ADPKD.: Methods! ...

    Abstract Background: Autosomal dominant polycystic kidney disease (ADPKD) is the fourth most common renal disease requiring renal replacement therapy (RRT). Still, there are few epidemiological data on the prevalence of, and survival on RRT for ADPKD.
    Methods: This study used data from the ERA-EDTA Registry on RRT prevalence and survival on RRT in 12 European countries with 208 million inhabitants. We studied four 5-year periods (1991-2010). Survival analysis was performed by the Kaplan-Meier method and by Cox proportional hazards regression.
    Results: From the first to the last study period, the prevalence of RRT for ADPKD increased from 56.8 to 91.1 per million population (pmp). The percentage of prevalent RRT patients with ADPKD remained fairly stable at 9.8%. Two-year survival of ADPKD patients on RRT (adjusted for age, sex and country) increased significantly from 89.0 to 92.8%, and was higher than for non-ADPKD subjects. Improved survival was noted for all RRT modalities: haemodialysis [adjusted hazard ratio for mortality during the last versus first time period 0.75 (95% confidence interval 0.61-0.91), peritoneal dialysis 0.55 (0.38-0.80) and transplantation 0.52 (0.32-0.74)]. Cardiovascular mortality as a proportion of total mortality on RRT decreased more in ADPKD patients (from 53 to 29%), than in non-ADPKD patients (from 44 to 35%). Of note, the incidence rate of RRT for ADPKD remained relatively stable at 7.6 versus 8.3 pmp from the first to the last study period, which will be discussed in detail in a separate study.
    Conclusions: In ADPKD patients on RRT, survival has improved markedly, especially due to a decrease in cardiovascular mortality. This has led to a considerable increase in the number of ADPKD patients being treated with RRT.
    MeSH term(s) Aged ; Europe/epidemiology ; Female ; Humans ; Male ; Middle Aged ; Polycystic Kidney, Autosomal Dominant/mortality ; Polycystic Kidney, Autosomal Dominant/therapy ; Prevalence ; Registries/statistics & numerical data ; Renal Dialysis/mortality ; Renal Replacement Therapy/mortality ; Survival Rate ; Time Factors
    Language English
    Publishing date 2014-08-26
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfu017
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2198: Show issues Location:
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    Zs.MO 329: Show issues

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