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Vol. 33. Núm. 5.Septiembre 2013
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Vol. 33. Núm. 5.Septiembre 2013
Páginas 623-868
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Factores relacionados con la progresión de la enfermedad renal crónica
Factors related with the progression of chronic kidney disease
Visitas
...
Claudia Yustea, Daniel Barracaa, Inés Aragoncillo-Saucob, ines Aragoncillo Saucoa, Almudena Vega-Martínezb, Almudena Vega Martíneza, Soraya Abada, Úrsula Verdalles-Guzmánb, Ursula Verdalles Guzmána, Caridad Ruiz-Caroa, Jara Ampueroa, Juan M. López-Gómezb, Juan Manuel López-Gómeza
a Department of Nephrology, Gregorio Mara????n University General Hospital, Madrid, Madrid, Spain,
b Department of Nephrology, Gregorio Mara????n University General Hospital, Madrid,
Información del artículo

Antecedentes: Nuestro propósito era determinar el índice de progresión de la enfermedad renal crónica (ERC) e identificar predictores, con especial énfasis en el metabolismo mineral y óseo. Métodos: Estudio retrospectivo y de observación que incluye a 300 pacientes con ERC avanzada (61,2 % varones, 33,1 % diabéticos; edad 65,6 ± 14 años). El tiempo medio de seguimiento fue de 19,4 ± 10,1 meses. El índice de filtración glomerular estimado (FGe) de referencia (MDRD-4) fue de 22,5 ± 7,18 ml/min. Para calcular la tasa de reducción en el IFGe, utilizamos la pendiente de la línea de regresión entre todas las determinaciones de IFGe y el tiempo de seguimiento. Calculamos los valores medios de proteinuria y fosfato sérico, calcio, ácido úrico y hormona paratiroidea (PTH), así como la excreción urinaria de 24 horas de nitrógeno ureico de cada paciente. El seguimiento fue, como mínimo, de 6 meses e incluyó al menos 4 mediciones de FGe. Resultados: La tasa media de reducción de FGe (–1,64 ml/min/1,73 m2/año) estaba inversamente correlacionada con los niveles de fosfato sérico (4,3 ± 2,1 mg/dl, p < 0,001), PTH (256,3 ± 193,7 mg/l, p < 0,001) y proteinuria (0,84 ± 1,31 g/día, p = 0,004) y directamente correlacionada con el calcio sérico medio (p < 0,001) y la presencia de hipertensión (p < 0,02). Sin embargo, únicamente el fosfato sérico, la PTH sérica y la proteinuria persistieron como predictores en el análisis multivariable. Los pacientes con IFG estable (pendiente positiva) eran mayores (p = 0,041) y presentaban niveles más bajos de fosfato sérico y PTH (p < 0,01 y p < 0,01, respectivamente), y proteinuria más baja (p < 0,01). Conclusiones: La tasa de reducción en el FGe estaba correlacionada con los niveles de fosfato sérico y PTH y la proteinuria. Todos estos factores pueden modificarse con el tratamiento adecuado.

Palabras clave:
Progresión de insuficiencia renal
Palabras clave:
Metabolismo óseo
Palabras clave:
Enfermedad renal crónica
Palabras clave:
Proteinuria
Palabras clave:
Hormona paratiroidea (PTH)
Palabras clave:
Fosfato sérico

Background: Our aims were to determine the rate of progression of chronic kidney disease (CKD) and to identify predictors, with particular emphasis on bone and mineral metabolism. Methods: Retrospective and observational study including 300 patients with advanced CKD (61.2% males, 33.1% diabetics; age 65.6±14 years). Mean follow-up time was19.4±10.1 months. Baseline estimated glomerular filtration rate (eGFR) (MDRD-4) was 22.5±7.18mL/min. To calculate the rate of decline in eGFR, we used the slope of the regression line between all determinations of eGFR and follow-up time. We calculated the mean values for proteinuria and serum phosphate, calcium, uric acid, and PTH, as well as 24-hour urinary excretion of urea nitrogen over time for each patient. Follow-up was at least 6 months and included at least 4 measurements of eGFR. Results: The mean rate of decline eGFR (–1.64 mL/min/1.73m2/year) was inversely correlated with serum phosphate levels (4.3±2.1 mg/dL, p<.001), PTH (256.3±193.7ng/L, p<.001) and proteinuria (0.84±1.31g/day, p=.004) and directly correlated with mean serum calcium (p<.001) and the presence of hypertension (p<.02). However, only serum phosphate, serum PTH, and proteinuria persisted as predictors in the multivariate analysis. Stable-GFR patients (positive slope) were older (p=.041) and had lower serum phosphate and PTH levels (p<.01 and p<.01 respectively) and lower proteinuria (p<.01). Conclusions: The rate of decrease in eGFR was correlated with serum phosphate and PTH levels and proteinuria. All of these factors can be modified with an adequate treatment.

Keywords:
Progression of renal insufficiency
Keywords:
Bone metabolism
Keywords:
Chronic kidne disease
Keywords:
Proteinuria
Keywords:
Parathyroid hormone (PTH)
Keywords:
Serum phosphate
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