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cardiovascular disease &#40;CV&#41;&#44; CV morbidity and mortality&#44; greater cognitive deterioration and worse quality of life&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">CKD treated at early stages progresses to a lesser extent and presents with less CV complications&#46; Therefore&#44; the public health system should advocate for an early CKD detection and treatment&#46;</p><p class="elsevierStylePara">We saw World Kidney Day &#40;WKD&#41; as the perfect opportunity to assess CKD prevalence and its associated vascular risk in a non-selected population in the Galician city&#44; Ourense&#46;</p><p class="elsevierStylePara">We spontaneously studied a non-selected population that attended the WKD marquee in the city centre&#46; The following measurements were taken&#58; anthropometrics&#44; blood pressure &#40;Omron<span class="elsevierStyleSup">&#174;</span>&#41;&#44; glucose &#40;Reflotron<span class="elsevierStyleSup">&#174;</span>&#41; and creatinine &#40;Reflotron<span class="elsevierStyleSup">&#174;</span>&#41; rates&#44; intima-media thickness &#40;IMT&#41; measured by ultrasound of the supra-aortic trunks &#40;LOGIQ&#44; 12MHz probe&#41;&#44; taken from the posterior wall and from an area free from atheromatous plaques&#46; An arteriosclerosis score was used &#40;AS&#41;&#58; AS 1&#58; ITM&#60;0&#46;8&#59; AS 2&#58; ITM&#62;0&#46;8&#59; AS 3&#58; ITM&#62;&#60;0&#46;8 with plaques&#46;</p><p class="elsevierStylePara">Statistical calculations included mean&#44; standard deviation and the Pearson&#8217;s regression&#46;</p><p class="elsevierStylePara">We obtained the following results&#58; 82 people came to the marquee&#44; 75 men &#40;69&#46;66 years&#41; and 7 women &#40;67&#46;28 years&#41;&#44; see Table 1&#46; Average MDRD was 109&#46;38 &#40;12&#46;4-180&#41;&#44; the percentage of MDRD&#60;60ml&#47;min was 11&#46;9&#37;&#44; and the different degrees of arteriosclerosis are shown in Table 2&#46; AS correlated with age &#40;0&#46;000&#41;&#44; kidney function &#40;0&#46;015&#41;&#44; pulse pressure &#40;0&#46;044&#41; and BMI &#40;0&#46;069&#41;&#46;</p><p class="elsevierStylePara">When the glomerular filtration rate &#40;GFR&#41; is lower than 50ml&#47;min&#44; inflammatory response to endothelial dysfunction &#40;ED&#41; is initiated&#44; the latter being a precursor of the atherothrombotic&#47;arteriosclerotic process&#46; It is initiated by an increase in adhesion molecule expression&#44; monocyte infiltration&#44; and their activation and transformation into macrophages&#46; When the eGFR is lower than 30ml&#47;min&#44; phosphorus &#40;P&#41; &#8216;retention&#8217; is produced and fibroblast growth factor &#40;FGF 23&#41; activated&#46; Through its specific binding with a receptor and Klotho&#44; it does not only reduce the kidney&#8217;s P absorption&#44; it also inhibits 1-alpha-hydroxylase and results in lower calcitriol synthesis&#46;</p><p class="elsevierStylePara">CKD progression&#44; the decrease in FGF 23&#8217;s phosphaturic action and lower vitamin D rate produce a situation of resistance to FGF 23&#8217;s phosphaturic action&#46; As a result&#44; the P&#8217;s plasmatic rate increases&#44; which upregulates the gene that codes for PTH through a &#8220;P sensor&#8221; in the parathyroid glands&#46; Furthermore&#44; in this hyperphosphataemia situation&#44; extracellular P is transported by the cotransporter Pit-1 to the intracellular compartments&#44; and once there&#44; it acts as an indicator of an increase in mineral nucleation expression agents&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Deficiency in vitamin D contributes to this process&#44; given that Th1 lymphocyte action cannot be inhibited&#44; which continue activating and perpetuating the ED process&#46;</p><p class="elsevierStylePara">To conclude&#44; there is a high prevalence of CKD in a non-selected and spontaneous population&#46; Arteriosclerotic disease is not only related to kidney function&#44; but also to age and pulse pressure&#46; Pathogenic mechanisms are well known&#44; meaning that a change is needed&#46; Nephrology departments&#44; in collaboration with primary care centres should create programmes for detecting CKD and incipient vascular lesions early&#44; so as to reduce CKD progression and cardiovascular morbidity and mortality&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10788&#95;108&#95;17663&#95;en&#95;t1&#46;10788&#46;jpg" class="elsevierStyleCrossRefs"><img src="10788_108_17663_en_t1.10788.jpg" alt="Descriptive"></img></a></p><p class="elsevierStylePara">Table 1&#46; Descriptive</p><p class="elsevierStylePara"><a href="grande&#47;10788&#95;108&#95;17664&#95;en&#95;t2&#46;10788&#46;jpg" class="elsevierStyleCrossRefs"><img src="10788_108_17664_en_t2.10788.jpg"></img></a></p><p class="elsevierStylePara">Table 2&#46; </p>"
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Prevalence of chronic kidney disease and arteriosclerosis in a non-selected population. World Kidney Day
Prevalencia de enfermedad renal crónica y arteriosclerosis en una población no seleccionada. Día Mundial del Riñón
C.. Pereira Feijooa, V.E.. Martínez Maestroa, N.. Bretaña Vilanovaa, L.. Queija Martíneza, A.. Otero Gonzálezb
a Servicio de Nefrología, Fundación Renal Íñigo Álvarez de Toledo, Ourense,
b Servicio de Nefrología, Complejo Hospitalario de Ourense,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Chronic kidney disease &#40;CKD&#41; is an important issue for public health&#44; given its high incidence&#44; prevalence&#44; morbidity and mortality&#44; and socio-economic cost&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">In Spain&#44;<span class="elsevierStyleSup">2</span> the prevalence of replacement renal therapy is 986 patients per million population &#40;pmp&#41;&#44; which means that approximately 45&#160;000 people need extrarenal clearance or have received a kidney transplant&#46; CKD is much more prevalent in earlier stages&#44; and is associated with a poor prognosis&#44; given the increased risk of premature death caused by cardiovascular disorders and the risk of kidney disease progressing&#46; If this were to occur&#44; replacement renal treatment is needed&#46;</p><p class="elsevierStylePara">The prevalence of CKD at stages 3b and 4 is 1&#46;38&#37;&#44;<span class="elsevierStyleSup">3</span> presenting a greater risk of death&#44; cardiovascular disease &#40;CV&#41;&#44; CV morbidity and mortality&#44; greater cognitive deterioration and worse quality of life&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">CKD treated at early stages progresses to a lesser extent and presents with less CV complications&#46; Therefore&#44; the public health system should advocate for an early CKD detection and treatment&#46;</p><p class="elsevierStylePara">We saw World Kidney Day &#40;WKD&#41; as the perfect opportunity to assess CKD prevalence and its associated vascular risk in a non-selected population in the Galician city&#44; Ourense&#46;</p><p class="elsevierStylePara">We spontaneously studied a non-selected population that attended the WKD marquee in the city centre&#46; The following measurements were taken&#58; anthropometrics&#44; blood pressure &#40;Omron<span class="elsevierStyleSup">&#174;</span>&#41;&#44; glucose &#40;Reflotron<span class="elsevierStyleSup">&#174;</span>&#41; and creatinine &#40;Reflotron<span class="elsevierStyleSup">&#174;</span>&#41; rates&#44; intima-media thickness &#40;IMT&#41; measured by ultrasound of the supra-aortic trunks &#40;LOGIQ&#44; 12MHz probe&#41;&#44; taken from the posterior wall and from an area free from atheromatous plaques&#46; An arteriosclerosis score was used &#40;AS&#41;&#58; AS 1&#58; ITM&#60;0&#46;8&#59; AS 2&#58; ITM&#62;0&#46;8&#59; AS 3&#58; ITM&#62;&#60;0&#46;8 with plaques&#46;</p><p class="elsevierStylePara">Statistical calculations included mean&#44; standard deviation and the Pearson&#8217;s regression&#46;</p><p class="elsevierStylePara">We obtained the following results&#58; 82 people came to the marquee&#44; 75 men &#40;69&#46;66 years&#41; and 7 women &#40;67&#46;28 years&#41;&#44; see Table 1&#46; Average MDRD was 109&#46;38 &#40;12&#46;4-180&#41;&#44; the percentage of MDRD&#60;60ml&#47;min was 11&#46;9&#37;&#44; and the different degrees of arteriosclerosis are shown in Table 2&#46; AS correlated with age &#40;0&#46;000&#41;&#44; kidney function &#40;0&#46;015&#41;&#44; pulse pressure &#40;0&#46;044&#41; and BMI &#40;0&#46;069&#41;&#46;</p><p class="elsevierStylePara">When the glomerular filtration rate &#40;GFR&#41; is lower than 50ml&#47;min&#44; inflammatory response to endothelial dysfunction &#40;ED&#41; is initiated&#44; the latter being a precursor of the atherothrombotic&#47;arteriosclerotic process&#46; It is initiated by an increase in adhesion molecule expression&#44; monocyte infiltration&#44; and their activation and transformation into macrophages&#46; When the eGFR is lower than 30ml&#47;min&#44; phosphorus &#40;P&#41; &#8216;retention&#8217; is produced and fibroblast growth factor &#40;FGF 23&#41; activated&#46; Through its specific binding with a receptor and Klotho&#44; it does not only reduce the kidney&#8217;s P absorption&#44; it also inhibits 1-alpha-hydroxylase and results in lower calcitriol synthesis&#46;</p><p class="elsevierStylePara">CKD progression&#44; the decrease in FGF 23&#8217;s phosphaturic action and lower vitamin D rate produce a situation of resistance to FGF 23&#8217;s phosphaturic action&#46; As a result&#44; the P&#8217;s plasmatic rate increases&#44; which upregulates the gene that codes for PTH through a &#8220;P sensor&#8221; in the parathyroid glands&#46; Furthermore&#44; in this hyperphosphataemia situation&#44; extracellular P is transported by the cotransporter Pit-1 to the intracellular compartments&#44; and once there&#44; it acts as an indicator of an increase in mineral nucleation expression agents&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Deficiency in vitamin D contributes to this process&#44; given that Th1 lymphocyte action cannot be inhibited&#44; which continue activating and perpetuating the ED process&#46;</p><p class="elsevierStylePara">To conclude&#44; there is a high prevalence of CKD in a non-selected and spontaneous population&#46; Arteriosclerotic disease is not only related to kidney function&#44; but also to age and pulse pressure&#46; Pathogenic mechanisms are well known&#44; meaning that a change is needed&#46; Nephrology departments&#44; in collaboration with primary care centres should create programmes for detecting CKD and incipient vascular lesions early&#44; so as to reduce CKD progression and cardiovascular morbidity and mortality&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10788&#95;108&#95;17663&#95;en&#95;t1&#46;10788&#46;jpg" class="elsevierStyleCrossRefs"><img src="10788_108_17663_en_t1.10788.jpg" alt="Descriptive"></img></a></p><p class="elsevierStylePara">Table 1&#46; Descriptive</p><p class="elsevierStylePara"><a href="grande&#47;10788&#95;108&#95;17664&#95;en&#95;t2&#46;10788&#46;jpg" class="elsevierStyleCrossRefs"><img src="10788_108_17664_en_t2.10788.jpg"></img></a></p><p class="elsevierStylePara">Table 2&#46; </p>"
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ISSN: 20132514
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Nefrología (English Edition)