Más de 4.500 personas reciben tratamiento en las unidades de hemodiálisis que existen en Andalucía

Un total de 4.596 personas reciben tratamiento en las 61 unidades de hemodiálisis y 15 unidades de diálisis peritoneal hospitalaria, tres de ellas pediátricas, que existen en Andalucía. Durante 2015, estas unidades permitieron realizar más de 700.000 sesiones a pacientes (un millar fueron menores) – que precisan esta terapia por la insuficiencia renal crónica que padecen. La hemodiálisis sirve para filtrar las impurezas de la sangre y eliminar las toxinas, por lo que la máquina que realiza esta función sustituye a los riñones enfermos.

Con motivo de la celebración esta semana del Día Mundial del Riñón, la Consejería de Salud ha destacado que la prevención es la principal arma para luchar contra las patologías renales, manteniendo una dieta equilibrada, bebiendo diariamente entre 1,5 y 2 litros de agua, evitando el consumo de tabaco y alcohol y realizando ejercicio con regularidad. Tanto en personas con hipertensión arterial como en aquellas con diabetes, el buen control de la enfermedad es fundamental igualmente para prevenir el deterioro de los riñones.

Este año, la prevención desde la infancia marca el énfasis puesto durante la conmemoración del Día Mundial del Riñón, ya que la detección precoz desde la propia gestación y edades tempranas hasta el control de los factores de riesgo, permiten evitar el daño renal en la edad adulta.

Así, dado que gran parte de la enfermedad renal en adultos tiene sus raíces en la infancia, hay que insistir en la importancia de evitar la obesidad, la diabetes y la hipertensión, por sus consecuencias cardiovasculares y renales. Deben, por tanto, limitarse las dietas hipercalóricas poco saludables, el exceso de sal en comidas y aperitivos, bebidas con alto contenido en azúcar, comidas hiperprotéicas que están por encima de las necesidades reales y cambiar algunos hábitos de ocio por la realización de ejercicio físico.

Trasplante renal

A 31 de diciembre de 2015, de las 9.732 personas con tratamiento renal sustitutivo contabilizadas en Andalucía, el 47,2 % vivían gracias a la diálisis (4.184 en hemodiálisis y 412 en diálisis peritoneal), mientras que 5.136 personas (el 52,8 %) contaban con un trasplante renal funcionante. Se trata de un dato muy positivo, en cuanto a pesar de los avances médicos y tecnológicos y de la excelencia del trabajo multidisciplinar que realizan los profesionales de Nefrología, Urología, Pediatría y Enfermería en el tratamiento de la enfermedad renal, el trasplante representa, frente a la diálisis, una mayor calidad de vida para las personas con insuficiencia renal crónica, ya que los pacientes dejan de depender de una máquina, a la que se conectan durante varias horas varios días a la semana, para vivir.

Para conseguir que la cifra de personas trasplantadas sea actualmente mayor a la de personas que precisan hemodiálisis, ha sido muy importante el impulso dado desde la sanidad pública andaluza a otras modalidades de trasplante renal, como son el trasplante renal de vivo (dentro del seno familiar, cruzado o altruista), con mayor tasa de supervivencia del órgano. Los pacientes pediátricos, con prioridad en la lista de espera, se han beneficiado especialmente de estas estrategias en los últimos años.  

En 2015 se realizaron en los hospitales públicos andaluces un total de 453 trasplantes renales, de ellos 60 fueron de donante vivo. Del total de trasplantes renales, 15 fueron infantiles (4 de ellos de donante vivo). La distribución por hospitales de este tipo de trasplantes ha sido: Hospital Puerta del Mar de Cádiz (59); Hospital Reina Sofía de Córdoba (68), Hospital Virgen de las Nieves de Granada (76); Hospital Regional de Málaga (127) y Hospital Virgen del Rocío (123). Este último centro es el de referencia para realizar trasplantes renales pediátricos en la comunidad autónoma.

Las estrategias desarrolladas en Andalucía para favorecer los trasplantes de riñón, además de las derivadas de la donación de vivo, también incluyen el fomento de la donación en asistolia o a corazón parado y el trasplante birrenal. Todas estas medidas, han permitido reducir en un 13,24% el número de pacientes a la espera de un trasplante de riñón en los últimos cinco años e incrementar en un 281% el número de implantes de este órgano desde 1991. Desde 1978 se han realizado 522 trasplantes de donante vivo, 305 en los últimos cinco años (58,4%). Asimismo, Andalucía acumule el 26% de los trasplantes renales cruzados hechos en España desde 2009.

Desde que se hizo el primer trasplante de riñón en la comunidad en 1978, se han realizado en Andalucía más de 9.000, lo que ha permitido que alrededor de 5.000 pacientes tengan en la actualidad un riñón trasplantado funcionante.

Concretamente, en lo que se refiere al trasplante procedente de donantes en asistolia (también conocido como donantes a corazón parado), el porcentaje de donantes en Andalucía, en 2015, llegó al 21,9%, casi seis puntos por encima del porcentaje nacional (16%).

Certificación de competencias en hemodiálisis y trasplante renal

Esta misma semana, la Consejería de Salud ha abierto la posibilidad de que los profesionales de enfermería encargados de atender a personas en procesos de diálisis y trasplante renal puedan certificar sus competencias profesionales con la Agencia de Calidad Sanitaria de Andalucía (ACSA), gracias a un nuevo manual de estándares de calidad disponible en la página web de la ACSA (www.juntadeandalucia.es/agenciadecalidadsanitaria).

Para obtener la certificación de sus competencias, los profesionales de enfermería tendrán como referencia el ‘Manual de competencias profesionales del/de la Enfermero/a de Diálisis y Trasplante Renal’, que contiene un total de 32 buenas prácticas y 76 evidencias sobre las cuales deben aportar pruebas de su realización y que hacen referencia a aspectos tales como el control de dispositivos para el tratamiento renal sustitutivo, la educación para la salud, la seguridad del paciente o la personalización de los cuidados.

Study finds kidney transplant donation rates vary widely across Europe

A new Europe-wide survey shows significant country-to-country differences in rates of kidney transplant donors. The survey shows for example within the EU, there is a x5 variation in the number of kidney donors per country (per head of population). This variation is probably due to different legal and social standards across Europe.

Kidneys can fail for a variety of reasons, the most common being diabetes, high blood pressure, drug overdose, and physical injury. Kidney dialysis is often used as a treatment, but the best long-term solution is transplant, usually from a recently-deceased donor. Rates of Chronic Kidney Disease vary considerably across Europe, from 3% to 17% of the population, and are increasing. * Demand for kidneys almost always exceeds possible supply, and each country manages transplants differently. Now a new survey, being presented at the European Association of Urology congress in Munich, has shown significant differences in the number of donor kidneys available in each country.

Dr. Víctor Díez Nicolás (associated member, European Society for Transplantation in Urology, ESTU) will present the results of this ESTU-led survey on kidney donation rates and kidney transplantation rates across Europe for 2014. Comparing data from a range of registers, they found wide country to country variation. For example:

Russian Federation        3.3          All figures are deceased donors per million population

Greece                                4.2

Germany                            10.4

Switzerland                       14.3

Poland                                 15.5

The Netherlands             16.8

UK                                         20.6

Italy                                      22.7

France                                 25.3

Portugal                              27.3

Croatia                                 35.1

Spain                                    35.7                                                                      All figures are 2014 figures

Note: All- country data are in the abstract

Dr Díez Nicolás said:

“The circumstances in country are very different, but basically it depends on two factors, social sensitivity, and legislation. Most organs for transplantation are come from brain dead donors.  But each country manages organ availability differently. In Spain for example, each citizen is a potential donor unless they opt-out of the transplant scheme, whereas in Germany there is an ‘opt-in’ scheme. Some countries also allow donation from living donors, or from persons whose hearts have stopped. The number of organs from both these sources has been increasing”.

As the technology becomes more mainstream, and rates of kidney failure are increasing, the demand for organs has increased quite significantly, and there is a general need to obtain more organs. At the moment, whether you can find a donor organ largely depends on where you live. If countries want to increase transplant rates, and so increase survival from kidney failure, they might consider changing the way they source donor organs”.

Professor Arnaldo José Figueiredo (Coimbra, Portugal), chairman of the ESTU Said:

“Transplantation remains the most effective way of replacing kidney function. End stage renal failure incidence is increasing steadily in all European countries and, notwithstanding the fact that efforts should primarily be put on prevention, transplantation activity also needs be promoted, as demand clearly exceeds supply. There are significant discrepancies in transplant activity among European countries, and the ones with lower rates of transplant per capita should look at the examples of the leaders. At the same time, there are important differences where the transplanted organs come from, such as brain dead, non-heart beating and living donors, meaning there is scope for improvement in each program”.

There was no external funding for this research.

RNA sequencing opens door to accurate, highly specific test for prostate cancer‏

A study on non-coding RNA (Ribonucleic Acid) from prostate cancer patients has identified a series of new prostate cancer markers which can be found in urine. Combining these RNA markers into a single test potentially opens the door for simple, accurate non-invasive testing for prostate cancer. This work is presented at the European Association of Urology Congress in Munich.

Current tests for prostate cancer, such as the PSA and PCA3 tests, are not particularly accurate, leading to a high level of missed cancers or false positives. A test with greater specificity and accuracy may make population screening much more viable.

A group of German researchers, led by Professor Friedemann Horn (of the University of Leipzig and the Fraunhofer Institute for Cell Therapy and Immunology IZI, Leipzig) and Professor Manfred Wirth (of the University of Dresden) has taken a systematic approach to identify new biomarkers, which can offer greater prostate cancer specificity.

A particular focus is non-coding RNAs. RNA serves as part of the mechanism which regulates the production of proteins from the genetic material, but until recently most scientists had felt that the great majority of RNA (‘non-coding RNA’) had no real function, and was simply accumulated ‘clutter’. Now, greater understanding of non-coding RNAs indicates that they can regulate a number of physiological and pathological processes, including development and progression of cancer, and so might serve as markers of these processes.

The team took 64 prostate biopsy samples and read 200 million sequences from each sample. They were able to identify more than 2000 genes that showed a significant difference between tumour and control samples. Several of these showed higher specificity and sensitivity than established prostate markers. One of these non-coding RNAs, designated TAPIR (Tumour-Associated Proliferation-Inducing RNA), also showed significant promise in halting cancer cell growth, although it is too early to know if this will translate into a clinically-useful target.

These biomarkers were found in urine samples of prostate cancer patients as well, and first measurements show that they allow a precise detection of prostate cancer. Based on these results, the team is working to develop a highly specific and sensitive urine-based test for the early diagnosis of prostate cancer. This test will be based on a combination of several biomarkers, as this will give greater specificity than a single marker.

Commenting, Professor Wirth (author and EAU Treasurer) said:

“This is early work, but it is already showing results. This is a new approach to developing diagnostic tests, and comes from applying real basic science to a practical clinical problem. Given that our initial results show a high specificity for prostate cancer in urine tests, the prospects are good that we will be able to translate this into a better test for prostate cancer. We have several good candidate biomarkers, however we are aiming to design a test which utilises a combination of biomarkers. This will give significantly better specificity than existing tests. Our work on RNAs is allowing us to design a completely new kind of prostate cancer test.”

The program is part of RIBOLUTION (RIBOnucleic acid-based diagnostic soLUTIONs), a consortium funded by the Fraunhofer Future Foundation. In this interdisciplinary consortium, five Fraunhofer institutes and several universities have collaborated to identify new RNA biomarkers and to develop novel diagnostic tests.

Almost 1/3 of infertile men at increased risk of metabolic diseases as they age

Men with fertility problems are at increased risk of metabolic diseases as they age, according to work being presented at the European Association of Urology conference in Munich(* see publication details, below).

Around fifteen percent of all couples experience infertility, and in around half of these cases this is due to male infertility. Men with poor semen quality have been shown to have a decreased life expectancy, but the cause are unknown and no biochemical markers or prevention strategies have been developed. Now a group of Swedish researchers have measured the levels of sex hormones and other biochemical parameters in infertile men, and have shown that many of them are at risk of hypogonadism (low levels of sex hormones) as well as signs of metabolic disease and osteoporosis.

The group took 192 men with a low sperm count, who were attending the Reproductive Medicine Centre at Skåne University Hospital, Malmö, and compared them with 199 age-matched controls. They compared sex hormone  levels between the groups, as well as other markers such as bone mineral density (which indicates risk of osteoporosis) and HbA1c (a biomarker for diabetes).

They found that one third of men under 50 with fertility problems, had biochemical signs of low sex hormone levels (e.g. low testosterone), which is known as hypogonadism.  This was 7 times as common as amongst controls. These men also had low bone density – especially in men with low testosterone - leaving them at increased risk of fractures and osteoporosis. Hypogonadal men also showed biochemical signs of elevated glucose (with elevated HbA1c), and greater signs of insulin resistance – indicating a tendency towards diabetes.

According to study leader Dr Aleksander Giwercman (Skåne University Hospital, and Lund University, Malmö, Sweden):

“We found that a significant proportion of men from infertile couples show biochemical signs of hypogonadism. This may be affecting their fertility, but they can also serve as early warning signs for metabolic diseases in later life, such as osteoporosis or diabetes. We would recommend that levels of reproductive hormones should be checked in all men seeking advice for fertility problems. Those at risk of serious disease should be followed after the completion of fertility treatment. ”

Commenting, Professor Jens Sønksen (Copenhagen) of the European Association of Urology Scientific Congress Office said

“This study is very interesting, as is the question it poses; whether infertility in men below the age of 50 years might be used as a predictor for development of metabolic diseases including diabetes and osteoporosis later in life. There is a significant need for more studies in this field”.

How a bad night’s sleep might worsen cancer development

Recent studies have indicated that patients with sleep apnea may be associated with worse cancer outcomes. Now a new animal study, presented at the European Association of Urology Congress in Munich, uncovers a possible mechanism which may underlie this link.

Hypoxia is where a tissue or organ does not get enough oxygen. It is one of the consequences of sleep apnea, which is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Sleep apnea has been associated with increases in the risk of several conditions, such as high blood pressure or stroke.  Recently some evidence has also linked it to worse cancer outcomes, although there is some conflicting evidence on this. The possible mechanism linking apnea to worse outcomes is not known, although it is known that patients suffering from obstructive apnea usually suffer from intermittent hypoxia.

Now a group of Spanish-US researchers have used a mouse model to show that intermittent hypoxia promotes the formation of blood vessels within tumours, probably due to an increased production of Vascular endothelial growth factor (VEGF). VEGF is known to promote blood vessels formation.

A team led by Dr Antoni Vilaseca (Hospital Clínic De Barcelona, Spain) took 12 experimental and 12 control mice with kidney tumours and subjected them to varying oxygen levels to mimic intermittent hypoxia. They found that the mice which had been subjected to intermittent hypoxia showed increases in vascular progenitor cells (6,1 ± 0,76 vs 4,5±1,1; p=0,001) and endothelial cells (4±0,8 vs 2,5±1; p=0,013) within the tumours; these cells may later mature to form blood vessels in the tumours. Circulating VEGF was also increased in the mice which had undergone hypoxia (306±93 vs 204±45 pg/mL; p=0,001), although other factors such as tumour growth, were not affected.

Lead researcher Dr Vilaseca said:

“Patients suffering from obstructive sleep apnea usually suffer from intermittent hypoxia at night. This work shows that intermittent hypoxia has the potential to promote the formation of blood vessels within tumours, meaning that the tumours have access to more nutrients”.

He continued

“This is of course an early animal study, so we need to be cautious in applying this to humans. Nevertheless, this work indicates a plausible mechanism for just why conditions which restrict oxygen flow to tissues, like sleep apnea, may promote cancers”.

Commenting, Professor Arnulf Stenzl (Tübingen), Chair of the EAU Congress Committee, said:

“Although this is an experimental study, it is remarkable, because it demonstrates the influence of oxygen deficiency on the growth of renal cell carcinoma tissue (both primary tumour as well as metastases). It may be postulated that increased oxygenation of the blood may be the underlying mechanism why not smoking or giving up smoking, regular sport activity (especially endurance type sports), reducing the body mass index and other life style changes that increase tissue oxygenation have a supportive beneficial effect on better outcomes in renal cell cancer as well as other tumour types”.

Can we predict aggressiveness of prostate cancer before surgery with a blood test?

Prostate cancer is the most common male cancer, with 400,000 new cases every year in Europe. The success of surgery depends on a variety of factors.  Now a new study from scientists in Milan has shown that for local prostate cancers treated with radical prostatectomy, you can preoperatively predict the aggressiveness of the prostatic disease, via a simple blood test. 

When describing prostate cancer, urologists normally use the Gleason pattern, where a tissue sample from a biopsy is analysed to show much of the sample has been taken over by tumour cells. Gleason pattern 1 means that the cells in the tissue are normal, whereas Gleason pattern 5 (the highest score) indicates that the tissue is largely taken over by tumour cells. If a patient has Gleason pattern 5, then the predicted outcomes are poor.

Now a group of Italian researchers have been able to show that hypogonadism (which is low levels of the sex hormone testosterone) predicts that the patient will have a high Gleason score – which indicates a poor outcome after treatment.

A group led by Dr Marco Moschini (San Raffaele Hospital, Milan) retrospectively correlated hormone levels and Gleason scores in 1017 patients who underwent radical prostatectomy surgery at the San Raffaele hospital in Milan. 118 of the patients showed Gleason pattern 5. After adjusting for age, they found that the hypogonadism status and levels of sex-hormone-binding globulin (SHBG) was able to predict patients with Gleason pattern 5(OR 1.79, p=0.025).

According to Marco Moschini

“We found that hypogonadism, and the levels of SHBG, were able to predict whether or not patients had Gleason factor 5, which is the worst Gleason score. This association will allow us to predict what the outcome will be before we decide to treat a patient with surgery. Potentially this can be helpful to identify patients with the most aggressive prostate cancer before surgery.

There is an urgent need for new research to uncover the role which hormones play in prostate cancer development.

What we don’t yet know is if this is an association, or if hypogonadism in some way increases the risk of developing high-grade prostate cancer. If this is the case, then it may be that treating the hypogonadism can lessen this risk, but we need more work before we can be sure of that”.

Commenting Professor Alexandre de la Taille (Paris) member of EAU Scientific Congress Committee, said: “Several reports in the literature mention that low serum testosterone level is associated with prostate cancer aggressiveness. This study highlights the fact that SHBG is also linked to high Gleason score. These cancers, developed in this special hormonal environment, are probably due to different molecular pathways and represent a new field to explore.”

(Note: the overall Gleason score is arrived at by adding together 2 samples to give a total score. In the worst case, Gleason 5 plus Gleason 5 would give an overall score of 10)

There was no external funding for this research. 

Oftalmólogos especialistas en cirugía analizan en el Hospital Santa Clotilde las nuevas tecnologías aplicadas a la corrección del astigmatismo

Especialistas en oftalmología y cirugía ocular de diferentes centros de la Comunidad Autónoma se han dado cita en el Hospital Santa Clotilde de Santander que ha organizado una jornada -en colaboración con Alcon- sobre "Nuevas tecnologías  aplicadas a la corrección del astigmatismo". El objetivo del encuentro ha sido analizar las últimas novedades en sistemas de guiado intraoperatorio, que permiten al cirujano  conocer en tiempo real  la situación  de la cirugía  refractiva de cataratas, y los avances en la corrección del astigmatismo durante la intervención quirúrgica.

En este sentido, los expertos reunidos en el encuentro han destacado los grandes avances tecnológicos en el campo de la cirugía de cristalino. Entre ellas, la cirugía de cataratas, una de las intervenciones quirúrgicas más comunes con casi 7.000 intervenciones anuales en Cantabria.

Para el Dr. Álvaro Rodríguez Ratón, “las tecnologías han mejorado notablemente. La mayor fiabilidad de los métodos de cálculo de las lentes intraoculares, los nuevos diseños de lentes multifocales-tóricasy la constante evolución de la tecnología de los aparatos de facoemulsificación hacen que el procedimiento quirúrgico sea más seguro”.

Durante la sesión se ha destacado el papel de los últimos sistemas de guiado  intraoperatorio que proporcionan medidas clave utilizando la aberrometría, para mejorar  la precisión de implantes de lentes intraoculares. El  Dr. Rodríguez ha explicado que “los sistemas en la aberrometríaintraoperatoria han demostrado ser mejor que los sistemas habituales  de  cálculo de lente para ojos que han sido intervenidos previamente por la cirugía refractiva”, y ha añadido que “mejoran la previsión  de la refracción postoperatoria”.

Los especialistas también han compartido las últimas novedades en la corrección de los defectos refractivos a través de la cirugía corneal. Así, se han revisado las últimas técnicas y dispositivos para la cirugía refractiva como los avances en la tecnología del láser excimer, que mejoran la trayectoria del haz y reducen la sensibilidad a los movimientos del paciente, entre otros.

El ‘Quirófano inteligente’ del Hospital Santa Clotilde, completado en su dotación con un equipo de última generación -láser excimer- permitirá a la Unidad de cirugía refractiva y cataratas ofrecer en sus intervenciones una mayor seguridad, fiabilidad y rapidez. Las ventajas serán no solo quirúrgicas, sino también para detectar previamente posibles patologías. Además,  se podrá ampliar el rango de tratamiento -número de dioptrías susceptibles de ser operadas- y el tiempo en la eliminación de cada dioptría a poco más de un segundo.

La corrección del astigmatismo en la cirugía de cataratas

El astigmatismo es un defecto refractivo que provoca visión borrosa y distorsionada, y afecta hasta al 26% de la población cántabra. Éste se debe, con mayor frecuencia, a una curvatura irregular de la córnea y tiene como principal consecuencia la disminución la agudeza visual en objetos próximos y lejanos.

En el caso de los pacientes que se someten a una cirugía de cataratas, la incidencia del astigmatismo superior a 1,5 dioptrías llega hasta el 30%. En palabras del  Dr. Rodríguez “un astigmatismo de más de una dioptría ya tiene importancia, y por encima de 1,5 empieza a afectar a la calidad de visión en términos legales”, como por ejemplo para la conducción de vehículos. Por ello, el experto recordó que “la operación es recomendable a partir de 0,75 dioptrías para pacientes de lentes multifocales y a partir de una dioptría o 1,5 para el resto de la población”.

Por su parte, el Dr. Xavier Puig, Director Médico de Alcon añadió que “la participación de Alcon en este encuentro supone una muestra más "del firme  compromiso por fomentar  el intercambio del conocimiento y experiencias entre los profesionales sanitarios involucrados en el manejo de las patologías de la visión, así como dar a conocer aquellas innovaciones tecnológicas que facilitan la labor de los profesionales y mejoran la calidad de vida de los pacientes".