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      Documento de consenso sobre el manejo de la patología renal en pacientes con infección por VIH Translated title: Consensus document on the evaluation and management of renal disease in HIV-infected patients

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      Nefrología (Madrid)

      Sociedad Española de Nefrología

      Sida, VIH, Enfermedad renal crónica, Función renal, Insuficiencia renal, Tenofovir, Toxicidad renal, Fármacos antirretrovirales, Trasplante renal, AIDS, HIV, Chronic kidney disease, Renal function, Renal failure, Tenofovir, Renal toxicity, Antiretroviral therapy, Renal transplantation

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          Abstract

          Objetivo: Actualizar las recomendaciones sobre la evaluación y el manejo de la afectación renal en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Métodos: Este documento ha sido consensuado por un panel de expertos del Grupo de Estudio de Sida (GESIDA) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), de la Sociedad Española de Nefrología (S.E.N.) y de la Sociedad Española de Química Clínica y Patología Molecular (SEQC). Para la valoración de la calidad de la evidencia y la graduación de las recomendaciones se ha utilizado el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: La evaluación renal debe incluir la medida de la concentración sérica de creatinina, la estimación del filtrado glomerular (ecuación chronic kidney disease epidemiological collaboration [CKD-EPI]), la medida del cociente proteína/creatinina en orina y un sedimento urinario. El estudio básico de la función tubular ha de incluir la concentración sérica de fosfato y la tira reactiva de orina (glucosuria). En ausencia de alteraciones, el cribado será anual. En pacientes tratados con tenofovir o con factores de riesgo para el desarrollo de enfermedad renal crónica (ERC), se recomienda una evaluación más frecuente. Se debe evitar el uso de antirretrovirales potencialmente nefrotóxicos en pacientes con ERC o factores de riesgo para evitar su progresión. En este documento se revisan las indicaciones de derivación del paciente a Nefrología y las de la biopsia renal, así como las indicaciones y la evaluación y el manejo del paciente en diálisis o del trasplante renal. Conclusiones: La función renal debe monitorizarse en todos los pacientes con infección por el VIH y este documento pretende optimizar la evaluación y el manejo de la afectación renal.

          Translated abstract

          Objective: To update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients. Methods: This document was approved by a panel of experts from the AIDS Working Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Nephrology (S.E.N.), and the Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC). The quality of evidence and the level of recommendation were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, Urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document advises on the optimal time for referral of a patient to the nephrologist and provides indications for renal biopsy. The indications for and evaluation and management of dialysis and renal transplantation are also addressed. Conclusions: Renal function should be monitored in all HIV-infected patients. The information provided in this document should enable clinicians to optimize the evaluation and management of HIV-infected patients with renal disease.

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          • Record: found
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          • Article: not found

          Rosuvastatin and cardiovascular events in patients undergoing hemodialysis.

          Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved. We conducted an international, multicenter, randomized, double-blind, prospective trial involving 2776 patients, 50 to 80 years of age, who were undergoing maintenance hemodialysis. We randomly assigned patients to receive rosuvastatin, 10 mg daily, or placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Secondary end points included death from all causes and individual cardiac and vascular events. After 3 months, the mean reduction in low-density lipoprotein (LDL) cholesterol levels was 43% in patients receiving rosuvastatin, from a mean baseline level of 100 mg per deciliter (2.6 mmol per liter). During a median follow-up period of 3.8 years, 396 patients in the rosuvastatin group and 408 patients in the placebo group reached the primary end point (9.2 and 9.5 events per 100 patient-years, respectively; hazard ratio for the combined end point in the rosuvastatin group vs. the placebo group, 0.96; 95% confidence interval [CI], 0.84 to 1.11; P=0.59). Rosuvastatin had no effect on individual components of the primary end point. There was also no significant effect on all-cause mortality (13.5 vs. 14.0 events per 100 patient-years; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.51). In patients undergoing hemodialysis, the initiation of treatment with rosuvastatin lowered the LDL cholesterol level but had no significant effect on the composite primary end point of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. (ClinicalTrials.gov number, NCT00240331.) 2009 Massachusetts Medical Society
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Dolutegravir plus abacavir-lamivudine for the treatment of HIV-1 infection.

            Dolutegravir (S/GSK1349572), a once-daily, unboosted integrase inhibitor, was recently approved in the United States for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in combination with other antiretroviral agents. Dolutegravir, in combination with abacavir-lamivudine, may provide a simplified regimen. We conducted a randomized, double-blind, phase 3 study involving adult participants who had not received previous therapy for HIV-1 infection and who had an HIV-1 RNA level of 1000 copies per milliliter or more. Participants were randomly assigned to dolutegravir at a dose of 50 mg plus abacavir-lamivudine once daily (DTG-ABC-3TC group) or combination therapy with efavirenz-tenofovir disoproxil fumarate (DF)-emtricitabine once daily (EFV-TDF-FTC group). The primary end point was the proportion of participants with an HIV-1 RNA level of less than 50 copies per milliliter at week 48. Secondary end points included the time to viral suppression, the change from baseline in CD4+ T-cell count, safety, and viral resistance. A total of 833 participants received at least one dose of study drug. At week 48, the proportion of participants with an HIV-1 RNA level of less than 50 copies per milliliter was significantly higher in the DTG-ABC-3TC group than in the EFV-TDF-FTC group (88% vs. 81%, P=0.003), thus meeting the criterion for superiority. The DTG-ABC-3TC group had a shorter median time to viral suppression than did the EFV-TDF-FTC group (28 vs. 84 days, P<0.001), as well as greater increases in CD4+ T-cell count (267 vs. 208 per cubic millimeter, P<0.001). The proportion of participants who discontinued therapy owing to adverse events was lower in the DTG-ABC-3TC group than in the EFV-TDF-FTC group (2% vs. 10%); rash and neuropsychiatric events (including abnormal dreams, anxiety, dizziness, and somnolence) were significantly more common in the EFV-TDF-FTC group, whereas insomnia was reported more frequently in the DTG-ABC-3TC group. No participants in the DTG-ABC-3TC group had detectable antiviral resistance; one tenofovir DF-associated mutation and four efavirenz-associated mutations were detected in participants with virologic failure in the EFV-TDF-FTC group. Dolutegravir plus abacavir-lamivudine had a better safety profile and was more effective through 48 weeks than the regimen with efavirenz-tenofovir DF-emtricitabine. (Funded by ViiV Healthcare; SINGLE ClinicalTrials.gov number, NCT01263015 .).
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease.

                (2004)
                Bookmark

                Author and article information

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                Journal
                nefrologia
                Nefrología (Madrid)
                Nefrología (Madr.)
                Sociedad Española de Nefrología (Cantabria, Santander, Spain )
                0211-6995
                1989-2284
                2014
                : 34
                : suppl 2
                : 1-81
                Affiliations
                Barcelona orgnameUniversidad Autónoma de Barcelona
                Elche orgnameHospital General Universitario de Elche
                orgnameUniversidad Miguel Hernández
                Barcelona orgnameInstitut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) orgdiv1Hospital Clinic-Universidad de Barcelona
                Cádiz orgnameHospital Universitario Puerta del Mar
                orgnameHospital de la Santa Creu i Sant Pau
                Madrid orgnameHospital Universitario de la Princesa
                orgnameHospital Universitari de Bellvitge
                Málaga orgnameHospital Universitario Virgen de la Victoria
                Valencia orgnameHospital Clínico Universitario de Valencia
                Olot orgnameHospital Sant Jaume de Olot
                Vigo orgnameHospital Universitario Xeral
                Zaragoza orgnameHospital Universitario Miguel Servet
                Madrid orgnameHospital Universitario 12 de Octubre
                Bilbao orgnameHospital de Basurto
                Sevilla orgnameHospital Universitario Virgen del Valme
                L'Hospitalet de Llobregat orgnameUniversidad de Barcelona orgdiv1Instituto de Investigación Biomédica de Bellvitge (IDIBELL)
                Barcelona orgnameHospital Universitario Nuestra Señora del Mar
                San Sebastián orgnameHospital Universitario Donostia
                Madrid orgnameHospital Universitario Ramón y Cajal orgdiv1Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)
                Madrid orgnameHospital Clínico de San Carlos
                Badalona orgnameHospital Universitario Germans Trias i Pujol
                Madrid orgnameHospital Universitario La Paz orgdiv1Instituto de Investigación Hospital Universitario La Paz (IdiPAZ)
                Valencia orgnameHospital Universitario La Fe orgdiv1Instituto de Investigación Sanitaria La Fe (IIS La Fe)
                Valencia orgnameHospital Universitario Doctor Peset
                Alcalá de Henares orgnameHospital Universitario Príncipe de Asturias
                Barcelona orgnameFundació Puigvert
                Leganés orgnameHospital Universitario Severo Ochoa
                Girona orgnameUniversitat de Girona
                Córdoba orgnameHospital Universitario Reina Sofía de Córdoba
                Article
                S0211-69952014000800001
                10.3265/Nefrologia.pre2014.Jul.12674

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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