Letter to the Editor
Hidden renal disease in the elderly is no longer buried after 10 years of follow up
Enfermedad renal «oculta» en ancianos: ¿deja de ocultarse a los 10 años de seguimiento?
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up" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "547" "paginaFinal" => "548" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Manuel Heras, María Teresa Guerrero, María José Fernández-Reyes, Angélica Muñoz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Manuel" "apellidos" => "Heras" "email" => array:1 [ 0 => "mherasb@saludcastillayleon.es" ] "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" => "María Teresa" "apellidos" => "Guerrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María José" "apellidos" => "Fernández-Reyes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Angélica" "apellidos" => "Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "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: ¿deja de ocultarse a los 10 años de seguimiento?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Occult renal disease (ORD) is defined as the presence of a glomerular filtration rate <60<span class="elsevierStyleHsp" style=""></span>ml/min, along with normal serum creatinine levels. Only few studies have been aimed to understand what is the long term outcome of patients diagnosed with ORD. Here we report our 5-year follow-up results, concluding that the serum creatinine levels remained normal with reduced glomerular filtration rate (<60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>), with no significant variations as compared with baseline.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> In this letter we analyse the results of long-term follow-up.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the study “Elderly People with Chronic Kidney Disease at Hospital General de Segovia”, which included 80 elderly patients recruited between January and April 2006. In 38 patients the serum creatinine levels was normal (≤1.1<span class="elsevierStyleHsp" style=""></span>mg/dl).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Those patients diagnosed with ORD were followed during a 10 year period.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Eighteen out of the 80 patients (22.5%), had ORD, they all were women and the mean age was 81.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6 years. Diabetics were 33.3% and 83.3%had hypertension. Twelve of these 18 patients with ORD died during follow-up. The remaining 6 patients had a mean age of 87.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6 years at 10 years. They also had no episodes of heart failure or ischaemic heart disease during the course of the study. None of the 18 patients progressed from kidney disease to end-stage kidney disease, so did not require renal replacement therapy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Baseline and 10-year laboratory test data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We consider that 10-year follow-up period is sufficient for kidney disease to manifest clinical signs; our elderly female patients who are still alive continue to present with the same characteristics as those at baseline, i.e., a glomerular filtration rate <60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, stable, as the <span class="elsevierStyleItalic">only renal manifestation</span>, with serum creatinine levels that remain normal. They do not present other manifestations of kidney disease, such as anaemia or hypocalcaemia. On the other hand, those who are still alive at 10 years have a mean age above the current life expectancy for women,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> have been asymptomatic in terms of heart disease, and have not progressed from kidney disease to end-stage kidney disease. As a result, we consider them to be an example of <span class="elsevierStyleItalic">healthy</span> people, and yet they are diagnosed as <span class="elsevierStyleItalic">sick</span> based on the ORD concept.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, our elderly patients do not have a hidden kidney disease. The ORD concept should not be used to describe a reduction of GFR in elderly women with normal serum creatinine levels.</p></span>" "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, Fernández-Reyes MJ, Muñoz A. Enfermedad renal «oculta» en ancianos: ¿deja de ocultarse a los 10 años de seguimiento? Nefrologia. 2017;37:547–548.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">NS: not significant.</p>" "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">Ten 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"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">1.01<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.01<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129.00<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129.40<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">4.18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.86<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">9.56<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">9.30<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haematocrit (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.30<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="char" valign="top">39.13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " 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">56.01<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1536006.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Data at baseline and after 10 years of follow-up of 6 patients diagnosed with occult renal disease who are still alive.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad renal oculta en ancianos: ¿continua oculta a los cinco años de seguimiento?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Heras" 1 => "M.T. Guerrero" 2 => "A. Sow" 3 => "A. Muñoz" 4 => "E. Ridruejo" 5 => "M.J. Fernández-Reyes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nefro.2015.02.002" "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2015" "volumen" => "35" "paginaInicial" => "340" "paginaFinal" => "346" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26299180" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "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. 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Available from: <a href="http://www.ine.es/">http://www.ine.es</a> [accessed 15.9.16]." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000005/v2_201710131456/S2013251417301463/v2_201710131456/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000005/v2_201710131456/S2013251417301463/v2_201710131456/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301463?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 3 | 10 |
| 2024 October | 38 | 28 | 66 |
| 2024 September | 59 | 22 | 81 |
| 2024 August | 60 | 61 | 121 |
| 2024 July | 40 | 18 | 58 |
| 2024 June | 47 | 32 | 79 |
| 2024 May | 42 | 30 | 72 |
| 2024 April | 60 | 33 | 93 |
| 2024 March | 44 | 26 | 70 |
| 2024 February | 48 | 29 | 77 |
| 2024 January | 38 | 24 | 62 |
| 2023 December | 25 | 29 | 54 |
| 2023 November | 38 | 46 | 84 |
| 2023 October | 68 | 30 | 98 |
| 2023 September | 40 | 37 | 77 |
| 2023 August | 39 | 30 | 69 |
| 2023 July | 53 | 30 | 83 |
| 2023 June | 65 | 22 | 87 |
| 2023 May | 69 | 28 | 97 |
| 2023 April | 67 | 19 | 86 |
| 2023 March | 68 | 19 | 87 |
| 2023 February | 54 | 23 | 77 |
| 2023 January | 29 | 18 | 47 |
| 2022 December | 44 | 31 | 75 |
| 2022 November | 34 | 23 | 57 |
| 2022 October | 44 | 34 | 78 |
| 2022 September | 35 | 25 | 60 |
| 2022 August | 44 | 46 | 90 |
| 2022 July | 35 | 48 | 83 |
| 2022 June | 27 | 30 | 57 |
| 2022 May | 38 | 23 | 61 |
| 2022 April | 33 | 54 | 87 |
| 2022 March | 28 | 32 | 60 |
| 2022 February | 42 | 39 | 81 |
| 2022 January | 35 | 40 | 75 |
| 2021 December | 39 | 40 | 79 |
| 2021 November | 44 | 43 | 87 |
| 2021 October | 33 | 45 | 78 |
| 2021 September | 30 | 31 | 61 |
| 2021 August | 24 | 35 | 59 |
| 2021 July | 30 | 27 | 57 |
| 2021 June | 34 | 30 | 64 |
| 2021 May | 27 | 41 | 68 |
| 2021 April | 69 | 51 | 120 |
| 2021 March | 70 | 43 | 113 |
| 2021 February | 35 | 46 | 81 |
| 2021 January | 23 | 8 | 31 |
| 2020 December | 22 | 25 | 47 |
| 2020 November | 25 | 16 | 41 |
| 2020 October | 21 | 23 | 44 |
| 2020 September | 21 | 19 | 40 |
| 2020 August | 40 | 13 | 53 |
| 2020 July | 25 | 14 | 39 |
| 2020 June | 29 | 29 | 58 |
| 2020 May | 49 | 18 | 67 |
| 2020 April | 24 | 18 | 42 |
| 2020 March | 32 | 15 | 47 |
| 2020 February | 33 | 21 | 54 |
| 2020 January | 41 | 21 | 62 |
| 2019 December | 35 | 24 | 59 |
| 2019 November | 40 | 32 | 72 |
| 2019 October | 14 | 9 | 23 |
| 2019 September | 20 | 19 | 39 |
| 2019 August | 28 | 16 | 44 |
| 2019 July | 20 | 19 | 39 |
| 2019 June | 25 | 19 | 44 |
| 2019 May | 30 | 18 | 48 |
| 2019 April | 49 | 26 | 75 |
| 2019 March | 43 | 20 | 63 |
| 2019 February | 27 | 17 | 44 |
| 2019 January | 26 | 25 | 51 |
| 2018 December | 109 | 43 | 152 |
| 2018 November | 156 | 24 | 180 |
| 2018 October | 132 | 22 | 154 |
| 2018 September | 89 | 21 | 110 |
| 2018 August | 52 | 21 | 73 |
| 2018 July | 45 | 19 | 64 |
| 2018 June | 52 | 11 | 63 |
| 2018 May | 69 | 22 | 91 |
| 2018 April | 62 | 12 | 74 |
| 2018 March | 82 | 10 | 92 |
| 2018 February | 48 | 3 | 51 |
| 2018 January | 66 | 10 | 76 |
| 2017 December | 36 | 11 | 47 |
| 2017 November | 40 | 11 | 51 |
| 2017 October | 50 | 9 | 59 |
| 2017 September | 6 | 1 | 7 |
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