Letter to the Editor – Brief papers about basic research or clinical experiences
“Masked” renal disease in the elderly: Still “masked” after a 5-year follow-up?
Enfermedad renal “oculta” en ancianos: ¿continúa “oculta” a los 5 años de seguimiento?
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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "344" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Manuel Heras, Maria Teresa Guerrero, Assyatou Sow, Angelica Muñoz, Elena Ridruejo, Maria José Fernández-Reyes" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Manuel" "apellidos" => "Heras" "email" => array:2 [ 0 => "mherasb@saludcastillayleon.es" 1 => "manuhebe@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Maria Teresa" "apellidos" => "Guerrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Assyatou" "apellidos" => "Sow" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Angelica" "apellidos" => "Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Elena" "apellidos" => "Ridruejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Maria José" "apellidos" => "Fernández-Reyes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Geriatría, Hospital General de Segovia, Segovia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad renal “oculta” en ancianos: ¿continúa “oculta” a los 5 años de seguimiento?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">“Hidden” renal disease (HRD) is defined by an UF <60<span class="elsevierStyleHsp" style=""></span>ml/min associated to normal range SCR. In Primary Care several trials have been performed in order to know HRD prevalence; Labrador et al. performed 13,784 SCR measurements in patients over the age of 18. Findings were the following: UF <60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> in 1042 patients, out of which 418 resulted in normal range SCR, all of them female with an average age of 76.5.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> A newly published Nephrology trial was performed on a total of 183 subjects (64.5% female) with an average age of 59.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.2 years. 21.4<span class="elsevierStyleHsp" style=""></span>% or 25<span class="elsevierStyleHsp" style=""></span>% of them would have HRD if MDRD-4 or Cockroft-Gault equations respectively were applied.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Notwithstanding, only a few trials have focused on knowing what was the outcome of those patients diagnosed of HRD over the course of time. In this study, both the clinical and analytical evolutions of patients with HRD were assessed over a period of five years.</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to “Ancianos con Enfermedad Renal Crónica del Hospital General de Segovia” (Elderly people with Chronic Renal Disease at the Segovia General Hospital), which included 80 elderly people recruited between January and April 2006, normal SCR range (≤1.1<span class="elsevierStyleHsp" style=""></span>mg/dl) was found in 38 patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Of those, baseline characteristics and five-year follow up were analyzed in patients diagnosed with HRD.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Out of the 80 patients, 18 (22.5%) could be considered as carriers of HRD; all were female and their average age was 81.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6 years. 33.3% were diabetic and 83.3% were diagnosed of hypertension. For baseline treatments, 66.7% were on diuretics and 38.9% were on ACE inhibitors. During the five-year clinical evolution, 1 of them (5.6%) presented de novo ischaemic cardiopathy and 3 (16.7%) had cardiac failure episodes; 8 (44.4%) patients died during that period. No patient evolved to end-stage nephropathy or needed renal replacement therapy. Baseline and post-five-year analytical data are showed in the table below (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Our study found that around one-quarter of the analysed population could be considered as HRD carriers, all of were female. Our findings are similar to those of Pérez-Durillo et al. which analysed a younger population, and to those of Labrador et al. where HRD was registered in female patients. Another contribution of our study was the evolution over time of these patients; there was a slow decrease of GFR values, without typical manifestations of renal failure (such as anaemia or hypocalcaemia) or progression of renal failure to end-stage nephropathy. Therefore, the term “hidden” in elderly female patients with HRD might refer to the “physiological” GFR drop associated with age. Our study confirmed a drop of about 1.1<span class="elsevierStyleHsp" style=""></span>ml/min/yr while patients still kept their SCR levels within normal range without typical manifestations of renal failure.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Conclusion</span>: the term HRD should be avoided in elderly people. In those female patients whose SCR range remains normal over time, the drop of UF might correspond to “physiological” renal ageing and not to a “pathological” process.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Heras M, Guerrero MT, Sow A, Muñoz A, Ridruejo E, Fernández-Reyes MJ. Enfermedad renal “oculta” en ancianos: ¿continúa “oculta” a los cinco años de seguimiento? Nefrologia. 2015. . 2015;35:343–344.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">5 Years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">A \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Creatinine, mg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.14<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.051 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Uric acid (mg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.92<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.45<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Potassium mmol/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Calcium mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.45<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Haematocrits (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.44<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.88<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Urine protein (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MDRD (ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.50<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.71<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.063 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab942096.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Baseline data and five-year evolution data for patients diagnosed with HRD.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insuficiencia renal oculta en atención primaria. ¿Un problema exclusivo de mujeres?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.J. Labrador" 1 => "T. Mengotti" 2 => "M. Jiménez" 3 => "M. Macías" 4 => "F. Vicente" 5 => "J. Labrador" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nefrología" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "716" "paginaFinal" => "720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18336101" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad renal oculta a través de las ecuaciones de filtrado glomerular en Atención Primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.T. Perez-Durillo" 1 => "A.B. Villarejo Villar" 2 => "J. Perez-Durillo" 3 => "A.I. Ribes-Bautista" 4 => "C. Macias Ortiz de Galistea" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2014.Jun.12620" "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "676" "paginaFinal" => "678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25259823" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ancianos con enfermedad renal crónica: ¿qué ocurre a los cinco años de seguimiento?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Heras" 1 => "M.J. Fernández-Reyes" 2 => "R. Sánchez" 3 => "M.T. Guerrero" 4 => "A. Molina" 5 => "M.A. Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2012.Jan.10994" "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "300" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22508140" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003500000003/v4_201511060045/S2013251415000218/v4_201511060045/en/main.assets" "Apartado" => array:4 [ "identificador" => "35438" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003500000003/v4_201511060045/S2013251415000218/v4_201511060045/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000218?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 5 | 9 |
| 2024 October | 38 | 36 | 74 |
| 2024 September | 39 | 18 | 57 |
| 2024 August | 51 | 65 | 116 |
| 2024 July | 35 | 20 | 55 |
| 2024 June | 46 | 39 | 85 |
| 2024 May | 47 | 32 | 79 |
| 2024 April | 49 | 28 | 77 |
| 2024 March | 61 | 29 | 90 |
| 2024 February | 32 | 30 | 62 |
| 2024 January | 36 | 22 | 58 |
| 2023 December | 27 | 24 | 51 |
| 2023 November | 41 | 32 | 73 |
| 2023 October | 45 | 22 | 67 |
| 2023 September | 37 | 30 | 67 |
| 2023 August | 37 | 32 | 69 |
| 2023 July | 46 | 23 | 69 |
| 2023 June | 95 | 20 | 115 |
| 2023 May | 88 | 31 | 119 |
| 2023 April | 81 | 13 | 94 |
| 2023 March | 99 | 16 | 115 |
| 2023 February | 83 | 14 | 97 |
| 2023 January | 32 | 28 | 60 |
| 2022 December | 47 | 30 | 77 |
| 2022 November | 41 | 33 | 74 |
| 2022 October | 49 | 46 | 95 |
| 2022 September | 36 | 39 | 75 |
| 2022 August | 34 | 33 | 67 |
| 2022 July | 37 | 44 | 81 |
| 2022 June | 37 | 47 | 84 |
| 2022 May | 27 | 21 | 48 |
| 2022 April | 26 | 32 | 58 |
| 2022 March | 43 | 43 | 86 |
| 2022 February | 27 | 44 | 71 |
| 2022 January | 44 | 33 | 77 |
| 2021 December | 43 | 38 | 81 |
| 2021 November | 32 | 36 | 68 |
| 2021 October | 40 | 50 | 90 |
| 2021 September | 22 | 31 | 53 |
| 2021 August | 27 | 37 | 64 |
| 2021 July | 30 | 23 | 53 |
| 2021 June | 24 | 20 | 44 |
| 2021 May | 32 | 30 | 62 |
| 2021 April | 70 | 26 | 96 |
| 2021 March | 40 | 22 | 62 |
| 2021 February | 28 | 15 | 43 |
| 2021 January | 37 | 17 | 54 |
| 2020 December | 20 | 12 | 32 |
| 2020 November | 32 | 10 | 42 |
| 2020 October | 17 | 11 | 28 |
| 2020 September | 23 | 9 | 32 |
| 2020 August | 37 | 10 | 47 |
| 2020 July | 42 | 5 | 47 |
| 2020 June | 18 | 12 | 30 |
| 2020 May | 51 | 11 | 62 |
| 2020 April | 25 | 12 | 37 |
| 2020 March | 37 | 14 | 51 |
| 2020 February | 23 | 16 | 39 |
| 2020 January | 30 | 21 | 51 |
| 2019 December | 39 | 22 | 61 |
| 2019 November | 25 | 20 | 45 |
| 2019 October | 15 | 10 | 25 |
| 2019 September | 21 | 19 | 40 |
| 2019 August | 16 | 18 | 34 |
| 2019 July | 17 | 26 | 43 |
| 2019 June | 22 | 8 | 30 |
| 2019 May | 17 | 22 | 39 |
| 2019 April | 43 | 23 | 66 |
| 2019 March | 24 | 13 | 37 |
| 2019 February | 15 | 12 | 27 |
| 2019 January | 28 | 13 | 41 |
| 2018 December | 55 | 35 | 90 |
| 2018 November | 89 | 17 | 106 |
| 2018 October | 64 | 14 | 78 |
| 2018 September | 34 | 8 | 42 |
| 2018 August | 29 | 11 | 40 |
| 2018 July | 28 | 9 | 37 |
| 2018 June | 26 | 9 | 35 |
| 2018 May | 30 | 11 | 41 |
| 2018 April | 39 | 5 | 44 |
| 2018 March | 29 | 4 | 33 |
| 2018 February | 29 | 7 | 36 |
| 2018 January | 31 | 5 | 36 |
| 2017 December | 28 | 6 | 34 |
| 2017 November | 32 | 7 | 39 |
| 2017 October | 42 | 7 | 49 |
| 2017 September | 31 | 12 | 43 |
| 2017 August | 37 | 8 | 45 |
| 2017 July | 31 | 9 | 40 |
| 2017 June | 50 | 4 | 54 |
| 2017 May | 38 | 8 | 46 |
| 2017 April | 34 | 5 | 39 |
| 2017 March | 27 | 19 | 46 |
| 2017 February | 37 | 6 | 43 |
| 2017 January | 21 | 6 | 27 |
| 2016 December | 44 | 7 | 51 |
| 2016 November | 65 | 10 | 75 |
| 2016 October | 100 | 6 | 106 |
| 2016 September | 131 | 5 | 136 |
| 2016 August | 157 | 6 | 163 |
| 2016 July | 159 | 4 | 163 |
| 2016 June | 117 | 0 | 117 |
| 2016 May | 118 | 0 | 118 |
| 2016 April | 96 | 0 | 96 |
| 2016 March | 82 | 0 | 82 |
| 2016 February | 91 | 0 | 91 |
| 2016 January | 87 | 0 | 87 |
| 2015 December | 95 | 0 | 95 |
| 2015 November | 97 | 0 | 97 |
| 2015 October | 119 | 0 | 119 |
| 2015 September | 126 | 0 | 126 |
| 2015 August | 128 | 0 | 128 |
| 2015 July | 6 | 0 | 6 |
Show all
