Lara Belmar

Effect of calcium acetate/magnesium carbonate in the treatment of hyperphosphataemia in dialysis patients in real clinical practice: one year follow up

BACKGROUND This observational study was conducted to investigate the use and effectiveness of calcium acetate/magnesium carbonate (CaMg) in the treatment of hyperphosphataemia in dialysis patients in real-world clinical practice. METHODS 120 adult CKD patients on dialysis who received CaMg alone or in combination with other phosphate binders were followed-up for 3-12 months. Serum phosphorus, calcium, magnesium, parathyroid hormone and albumin concentration was measured at baseline and after 3, 6 and 12 months respectively. In addition, CaMg dosage, use of concurrent phosphate binders, vitamin D and cinacalcet was documented. Patients were evaluated in 2 subgroups – CaMg alone (n=79) vs. CaMg + concurrent phosphate binder (n=41). RESULTS In both subgroups serum phosphorus levels decreased significantly from baseline at 3, 6 and 12 months of CaMg treatment. The percentage achievement of recommended serum phosphorus targets improved after CaMg initiation. At month 6, a total of 78% were within the Kidney Disease Outcomes Quality Initiative (K/DOQI) target range. Total corrected serum calcium increased during CaMg treatment, but mildly exceeded the upper limit of normal in three patients only. Asymptomatic significant increases in magnesium (p<0.001) were observed in the monotherapy group at 3, 6 and 12 months. A total of 80 patients (67%) experienced episodes of mild hypermagnesaemia (>2.6mg/mL, 1.05mmol/L). CONCLUSIONS This analysis of current clinical practice shows that – consistent with findings from a randomised controlled trial – CaMg treatment leads to marked improvement in serum phosphorus levels, helping patients in trying to achieve K/DOQI and KDIGO (Kidney Disease Improving Global Outcome) targets.

The Coefficient of Variability is the Same in the mTOR-inhibitors?

Background Intrapatient trough levels variability of immunosuppressive drugs must be considered as a prognostic factor. Many studies demonstrate the relationship between the high intrapatient variability of calcineurin inhibitors (CNI) levels and poor long-term renal graft outcome. Recent studies suggest a lower variability when using once-daily tacrolimus compared to the classical twice-daily formulation. Our objective is to analyze the intrapatient variability observed in the blood levels of mTOR-inhibitors (mTORi) and to compared the variability of sirolimus (SRL) with that of everolimus (EVL) in transplant patients converted to an iMTORi. Methods We analyzed 256 adult renal transplant patients converted to an mTORi between Jan-2009 and Dec-2015 in two Spanish transplant centers. The mean post-transplant conversion time was 51,6 months. One hundred and seventeen werw converted to SRL and 139 to EVL. Coefficient of variation (CV) was calculated using at least 3 blood trough levels between 3 and 18 months postconversion. Conversions in the first postransplant year (121) and later (135) were analized separatedly. CV was correlated with graft evolution (graft survival and/or renal function). Results The mean and median CV of the entire group was 25,6∓13,0% and 23,7∓12,1%. SRL and EVL mean CV was 23,8% and 27,1% (p=0,04). Inthe subgroup of late conversions (>1 y) SRL and EVL-CV was 23,0% and 29,0% (p=0,008). 59,8% vs 41,7% of patients converted to SRL and EVL respectively had a CV below the median (p=0,004). No differences in graft evolution could be demonstrated between patients with high and low CV at a mean follow-up of 58,5∓21,4 months. Conclusions We suggest that SRL has a lower CV than EVL. This difference should probably have a prognostic significance but we have not found differences in the long-term follow-up. This might probably be a consequence of that most patients were converted in the stable postransplant phase.

Elimination of hepatitis C virus infection from a hemodialysis unit and impact of treatment on the control of anemia

INTRODUCTION In the interferon era, the treatment of hepatitis C virus (HCV) infection in patients on haemodialysis (HD) was limited due to the significant number of treatment-related adverse events (AEs). Direct-acting antivirals (DAAs) have demonstrated their efficacy and safety in the treatment of HCV in patients with advanced chronic kidney disease on haemodialysis. The objective of the study was to evaluate the success in eliminating HCV infection from our dialysis unit using DAAs, and to assess the impact of HCV elimination on clinical and analytical outcomes. PATIENTS AND METHODS This is a prospective, interventional, single-center study at Hospital Clínic de Barcelona. All HCV-RNA positive patients who received antiviral therapy with DAAs within a 3-year period (2014-2017) were analyzed (n=20). Data on virologic response, adverse events, and biochemical and hematological parameters during and after DAA therapy were analyzed. RESULTS All patients achieved sustained virologic response (SVR) and only 40% of patients presented with mild AEs. None of the patients presented with HCV reinfection after a 1-year follow-up period, and thus HCV was eliminated from our HD unit. SVR was associated with a significant increase in hemoglobin and hematocrit, and a tendency toward the need for lower doses of iron supplementation with no changes in darbepoetin dose. CONCLUSION HCV infection can be safely eliminated from HD units with the use of DAAs, preventing new infections in patients and healthcare staff. In the short term, the achievement of SVR is associated with an improvement in the control of anemia.