Examinando por Autor "Musso, Carlos G."
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Ítem Acute kidney injury in rural workers: An environmental-stress nephropathy(Asociación Colombiana de Nefrología e Hipertensión Arterial, 2023) Musso, Carlos G.; Aroca-Martínez, Gustavo; Avendaño-Echavez, Lil; Cadena-Bonfanti, Andrés; Castillo, Luis; González-Torres, Henry; Conde, Juan C.; Navarro-Quiroz, Elkin; Peña-Vargas, William; Hernandez, Sandra; Velez-Verbel, María de los Ángeles; Perez, Rafael; Sierra, Angélica; Rua, Zenen; Palmera, Jorge; Terrasa, SergioIntroduction: Mesoamerican nephropathy is a tubule-interstitial nephropathy whose etiology is still unknown. However, clinical cases like Mesoamerican nephropathy have been described in other geographically distant and ethnically diverse regions. Still, they all have a common factor: the intensity of heat and rural physical labor. Objective: To study whether this entity could occur among rural workers in a non-Mesoamerican region with similar climatic and working conditions, in the Colombian Caribbean countryside, and to consider how much repetitive dehydration could weigh in its pathogenesis. Methodology: An observational study was carried out, based on field work in a farm in Sitio Nuevo (Colombia) with 28 rural worker volunteers (rice fields), who were measured for weight, blood pressure, and blood and urine samples to measure electrolytes and osmolarity, at 2 times of the day (morning and evening). Results: Of the 28 young men workers evaluated, 5 (18 %) presented a significant increase in serum creatinine during the day (0.8±0.15 vs 1.2±0.17, p<0.001). The volume of water ingested by the workers was highly variable (2,861 ± 1,591 cc). There was a significant increase in serum sodium (p<0.001), and urinary osmolarity (p=0.01) values between morning and afternoon values in these 5 patients. Conclusions: Eighteen percent (18 %) of the workers evaluated developed parameters compatible with acute kidney injury and dehydration during the workday in the Colombian Caribbean countryside.Ítem Alactic base excess (ABE): a novel internal milieu parameter—its concept and clinical importance(International Urology and Nephrology, 2024) Hoque, Md; Nagourney, Jason; Pawlowski, Thomas; Cantos, Joaquin; Aroca‑Martinez, Gustavo; Huespe, Ivan; Musso, Carlos G.Inspired by the Stewart-Figge acid–base approach, Gattinoni et al. recently introduced a new internal milieu parameter known as alactic base excess (ABE). The authors defined ABE as the sum of lactate and standard base excess. In the context of sepsis, ABE has been proposed as a valuable marker to discern between metabolic acidosis resulting from the accumulation of lactate and the retention of fixed acids, which can occur in cases of renal failure. Multiple studies have demonstrated that a negative ABE value (<−3 mmol/L) represents an early marker of renal dysfunction, and significantly correlates with higher mortality rates in septic patients. In conclusion, ABE is a simple and useful parameter that can be used to better interpret a patient’s acid–base status, assess renal function, and general prognosis in sepsis. By incorporating ABE into clinical practice, healthcare professionals can enhance their understanding of the complex acid–base imbalances in their patients and tailor more individualized, effective treatment plans.Ítem Aplicación del arte a la investigación científica: fundamentos de un método original para su utilización(Sociedad Argentina de Pediatría, 2018-02) Musso, Carlos G.; Dricas, Débora; González-Torres, HenryEl arte en virtud de su poder simbólico puede funcionar como instrumento cognitivo y contribuir, incluso, al proceso de investigación científica, sobre todo, en sus etapas de generación de hipótesis y discusión de datos, debido a su capacidad inductora del pensamiento intuitivo y creativo. En el presente artículo, se propone un método para llevar a la práctica esta concepción, basado en la exposición de los científicos a actividades artísticas colectivas en ambientes protegidos, metodología diseñada a partir de experiencias relatadas por destacados artistas y científicos.Ítem Atypical Hemolytic Uremic Syndrome: A Nationwide Colombian Pediatric Series(Sage, 2024) Espitaleta, Zilac; Domínguez-Vargas, Alex; Villamizar-Martínez, Johanna; Carrascal-Guzmán, Martha; Guerrero-Tinoco, Gustavo; Pinto-Bernal, Claudia; González-Chaparro, Luz; Rojas-Rosas, Luisa; Amado-Niño, Pilar; Castillo-Arteaga, Mariángel; Alvarez-Gómez, Yeferson; Arguello-Muñoz, Laura; Morales-Camacho, William; León-Guerra, Oscar; Egea, Eduardo; Galeano-Rodríguez, Ricardo; Quintero-Gómez, Ana; Aroca-Martínez, Gustavo; Musso, Carlos G.Objectives. Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease with genetic predisposition and represents up to 10% of pediatric hemolytic uremic syndrome (HUS) cases. Few studies have evaluated aHUS in Latin American population. We studied a Colombian pediatric cohort to delineate disease presentation and outcomes. Methods. A multicenter cohort of 27 Colombian children with aHUS were included. Patients were grouped by age at onset. Clinical features were compared using analysis of variance (ANOVA) and Fisher exact tests. Renal biopsy was performed on 6 patients who were suspected of having other renal diseases before aHUS diagnosis. Results. Most patients were male (70%). The onset of aHUS occurred frequently before age 4 years (60%) and followed gastroenteritis as the main triggering event (52%). Age groups showed comparable clinical presentation, disease severity, treatment, and outcomes. Pulmonary involvement (67%) was the main extrarenal manifestation, particularly in the 1 to 7 age group (P = .01). Renal biopsies were as follows: 3 had membranoproliferative glomerulonephritis (MPGN) type I, one MPGN type III, one C3-glomerulonephritis, and one rapidly progressive GN. Genetic screening was available in 6 patients and identified 2xCFHR5, 2xMCP, 1xADAMTS13/ THBD, and 1xDGKE mutations. A total of 15 relapses were seen, of which 8 (72%) occurred in the 1 to 7 age group. The renal outcome was not significantly different regardless of age group. Conclusion. In our cohort, we observed a relatively high frequency of extrarenal involvement at first presentation represented by pulmonary manifestations. The renal prognosis at initial presentation was worse than in previous reports.Ítem Chronic kidney disease burdenin Low-Resource settings: Regional perspectives(Elsevier, 2022) Ulasi, Ifeoma I.; Awobusuyi, Olugbenga; Nayak, Saurabh; Ramachandran, Raja; Musso, Carlos G.; Depine, Santos A.; Aroca-Martínez, Gustavo; Uzoamaka Solarin, Adaobi; Macaulay, Onuigbo; Luyckx, Valerie A.; Ijoma, Chinwuba K.The burden of chronic kidney disease (CKD) has increased exponentially worldwide but more so in low- and middle-income countries. Specific risk factors in these regions expose their populations to an increased risk of CKD, such as genetic risk with APOL1 among populations of West African heritage or farmers with CKD of unknown etiology that spans various countries across several continents to immigrant/indigenous populations in both low- and high-income countries. Low- and middle-income economies also have the double burden of communicable and noncommunicable diseases, both contributing to the high prevalence of CKD. The economies are characterized by low health expenditure, sparse or nonexistent health insurance and welfare programs, and predominant out-of-pocket spending for medical care. This review highlights the challenges in populations with CKD from low-resource settings globally and explores how health systems can help ameliorate the CKD burden.Ítem Chronic Kidney Disease Stage and Cardiovascular and Mortality Events Among Older Adults: The SPRINT Trial(National Kidney Foundation, 2024) Turbay-Caballero, Valentina; Ricardo, Ana C.; Chen, Jinsong; Missikpode, Celestin; Lash, James P.; Aroca-Martinez, Gustavo; Musso, Carlos G.Rationale & Objective: The risk implications of the Kidney Disease: Improving Global Outcomes (KDIGO) CKD classification in older adults are controversial. We evaluated the risk of adverse outcomes in this population across categories of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR). Study Design: Prospective cohort. Settings & Participants: 2509 participants aged ≥75 years in the Systolic Blood Pressure Intervention Trial (SPRINT). Exposures: KDIGO eGFR and UACR categories. We combined KDIGO categories G1 and G2, G3b and G4, as well as A2 and A3. Outcomes: Primary SPRINT outcome (composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), and all-cause death. Analytical Approach: Multivariable Cox proportional hazard models. Results: Mean age was 79.8 years, 37.4% were female, mean eGFR was 64.0 ml/min/1.73 m2, and median UACR 13.1 mg/g. In multivariable Cox proportional hazard analysis, compared with participants with eGFR ≥60 ml/min/1.73 m2 and UACR <30 mg/g, there was no statistically significant difference in the risk of the primary outcome among participants with eGFR 45-59 or 15-44 ml/min/1.73 m2 and UACR <30 mg/g. However, those with eGFR 45-59 or 15-44 ml/min/1.73 m2 and UACR ≥30 mg/g had higher risk of the primary outcome (HR [95% CI], 1.97 [1.27, 3.04] and 3.32 [2.23, 4.93], respectively). The risk for all-cause death was higher for each category of abnormal eGFR and UACR, with the highest risk observed among those with eGFR 15-44 ml/min/1.73 m2 and UACR ≥30 mg/g (3.34 [2.05, 5.44]). Limitations: Individuals with diabetes and urine protein >1 g/day were excluded from SPRINT. Conclusion: Among older adults SPRINT participants, low eGFR without albuminuria was associated with higher mortality but not with increased risk of cardiovascular events. Additional studies are needed to evaluate an adapted CKD stage-based risk stratification for older adults.Ítem Comparison of histopathological findings with clinical response among patients undergoing consecutive renal biopsy for lupus nephritis in 2008-2021(Acta Scientific, 2023) Villadiego-Rojas, Rafael; Aroca-Martínez, Gustavo; Cadena-Bonfanti, Andrés; Avedaño, Lil Geraldine; García-Tolosa, Raúl; Niño-Hernández, Lucia; Vélez-Verbel, María de los Ángeles; Correa-Martínez, Lía; Rodríguez-Murgas, Javier; Musso, Carlos G.Introduction: Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease involving several systems and has a high occurrence in areas such as the kidney, central nervous system, and vascular and serous structures. Furthermore, SLE poses a significant and increased risk of infections as well as an increase in morbidity and mortality. This increase is due to the presence of risk factors such as the use of corticosteroids, immunosuppressive drugs, and cytotoxic agents; changes in renal function; leukopenia, hypoalbuminemia; and alterations in both renal function and immunological profile (complement, anti-DNA). Renal biopsy (RB) is a safe method for obtaining renal tissue for the diagnosis and prognosis of SLE. Although complications, such as hemorrhage, are rare, if they do occur, they usually do so during the first 8-24 hours of the procedure. This diagnostic method is the best tool to diagnose lupus nephritis. Hence, we conducted a study to determine the histological changes in patients with lupus nephritis who were evaluated with consecutive biopsies from 2008 to 2021. Materials and Methods: An observational, analytical, and retrospective study was conducted using information collected from the RB database. Data on SLE and/or lupus nephritis recorded in this database by Clínica de la Costa uninterruptedly from 2008 to 2021. Patients with a diagnosis of SLE were selected based on at least four diagnostic criteria of the American College of Rheumatology. Those who had undergone renal puncture biopsy according to the consensus criteria of the group of systemic autoimmune diseases of the Spanish Society of Nephrology were selected. Results: A significant increase was observed in chronicity rates. Conclusion: Consecutive renal biopsy in LN allows early identification of the progress of the histopathological lesion. In this study, 30.7% of class III patients in their first renal biopsy presented histologicalprogress toward class IV in their consecutive biopsy.Ítem Dialysis prescription in acute kidney injury: when and how much?(Springer, 2020) Badel, Juan C.; Garcia, Lautaro A.; Soto‑Doria, Manuel J.; Musso, Carlos G.Acute kidney injury (AKI) constitutes a serious public health problem because of its very high cost and mortality rate, with an increasing incidence, phenomenon which is explained by the increasingly number of older patients suffering from several comorbidities admitted in the intensive care units. Despite the new AKI definition and classification, the use of novel AKI biomarkers and modern technologies, as an attempt to achieve an early AKI detection and treatment, and consequently to better clinical outcomes, AKI mortality particularly in ICU patients remains persistently high. In the present article, the currently accepted concepts regarding dose and time of hemodialysis and peritoneal dialysis prescription in AKI patients have been reviewed.Ítem Effectiveness of native vitamin D therapy in patients with chronic kidney disease stage 3 and hypovitaminosis D in Colombia, South America(Dovepress, 2019) Restrepo Valencia, Cesar A.; Aguirre Arango, Jose V.; Musso, Carlos G.In a high percentage of patients with chronic kidney disease (CKD) low levels of vitamin D are detected. The purpose of this study was to evaluate if the native vitamin D therapy (cholecalciferol) in the patients with stage 3 and hypovitaminosis D allows to modify markers of bone and mineral metabolism once normal serum levels have been achieved.Ítem The fourth wave in chronic kidney disease (CKD) classification: taking into account the aging kidney(Springer Nature, 2023) Musso, Carlos G.; Ricardo, Ana C.; Aroca‑Martínez, GustavoCKD affects more than 10% of the population worldwide, is strongly associated with accelerated cardiovascular morbimortality, and its prevalence is exponentially higher among older individuals, although this prevalence is just based on estimated GFR (eGFR) and albuminuria [1]. The first CKD classification (2002) was proposed by the KDOQI group; it divided CKD into five categories based on eGFR. This classification was subsequently endorsed by the KDIGO organization. The second CKD classification (2008) subdivided stage 3 into stages 3a and 3b (45–59 and 30–44 ml/ min/1.73 m2, respectively), and incorporated the presence or absence of albuminuria [2]. The third and currently used KDIGO CKD classification (2012) added the albuminuria level: normal (A1), moderate (A2), and severe (A3) [3]. The positive impact that implementation of the current classification has had is not debatable, however it does not take into consideration the age of the patient. Experts in nephrogeriatrics have long suggested that eGFR declines as we age.Ítem Glomerular Diseases in the Colombian Caribbean: Data from the Colombian Nephropathy Registry (NEFRORED®)(Wolters Kluwer, 2022) Aroca-Martínez, Gustavo; González-Torres, Henry J.; Domínguez-Vargas, Alex; García- Tolosa, Raúl; Castillo-Parodi, Luis; Conde-Manotas, Juan; Navarro-Quiroz, Elkin; Acuña- Freyte, Andersson; Depine, Santos Ángel; Cadena-Bonfanti, Andrés; Musso, Carlos G.Our study aimed to describe the glomerular diseases, both primary glomerular disease (PGD) and secondary glomerular disease (SGD) in the Colombian Caribbean based on the first regional Colombian Nephropathy Registry (NEFRORED®). A descriptive and retrospective study of adult patients with glomerular diseases from the Colombian Caribbean region was made. All diagnoses by renal biopsy with light microscopy and immunofluorescence obtained between January 2008 and June 2018 were recorded. Eight hundred and seventy-one renal biopsies were obtained. The main clinical indication for biopsy was nephritic syndrome (36%). SGD was more frequent than PGD (55% vs. 45%). Within SGD group, lupus nephritis (LN) was the most frequent etiology (83%). Within PGD group, membranous nephropathy (33%) and focal segmental glomerulosclerosis (FSGS) (19%) were the most common glomerular diseases. At a 24-month follow-up, the patients with FSGS and paraproteinemia-mediated glomerular disease had the worst renal survival prognosis. This is the first Colombian Nephropathy Registry in a Caribbean population, demonstrating a high predominance of SGD due to LN.Ítem Impacto de la fragilidad y la carga viral en la lesión renal aguda en los pacientes afectados por Covid-19(Ediciones Universidad Simón Bolívar, 2022) Avendaño Echávez, Lil Geraldine; Aroca Martinez, Gustavo; Musso, Carlos G.El COVID-19 puede afectar muchos otros órganos además del sistema respiratorio, particularmente en el riñón, el corazón, el tracto digestivo, la sangre y el sistema nervioso. En cuanto a las alteraciones renales, los informes preliminares indicaron una incidencia del 3% al 9% y cada vez hay más pruebas de que la lesión renal aguda (IRA) es frecuente en la infección por SARS-CoV-2, con una incidencia informada de 8-17%, llegando al 35% en pacientes críticos, y que esta condición se considera un factor de mal pronóstico. En este sentido, el desarrollo de IRA en el contexto de la COVID-19 tiene una mortalidad asociada del 91,7%.Ítem Kidney-gut crosstalk in renal disease(Springer Nature, 2020) Colombo, Iara; Aiello-Battan, Florencia; Rosario Elena; Ruiz, Agustina; Petraglia, Lucas; Musso, Carlos G.Introduction The colon has an important role in managing nitrogenous waste products, electrolytes, and mineral balance during kidney diseases. However, colonic microbiota produces uremic toxins, such as indoxyl sulfate and p-cresyl sulfate, in chronic kidney disease (CKD) patients, which due to their proinflammatory properties contribute to CKD progression. Conversely, in acute renal injury patients, intestinal microbiota could reduce inflammation by secreting short-chain fatty acids and inducing a renal protective immune response. However, since the intestines are the most frequently affected organ in advanced sepsis, colonic microbiota can also represent a negative factor for kidney health in this scenario. Conclusion In the present review, the main characteristics of kidney-gut crosstalk are described.Ítem Medicina biosemiótica: de una medicina de efectos a una medicina de procesos(Sociedad Argentina de Pediatría, 2020) Musso, Carlos G.La medicina contemporánea se caracteriza por una creciente subespecialización, así como por la adquisición de un mayor conocimiento respecto de la interacción entre las distintas estructuras del organismo (biosemiótica) tanto en estado de salud como de enfermedad. Se propone, en este artículo, una nueva conceptualización del organismo basada en la perspectiva de considerarlo conformado por un espacio biológico (células, tejidos y órganos) y un espacio biosemiótico (intercambio de señales entre ellos). Su desarrollo daría lugar a una nueva subespecialidad dedicada al estudio e interferencia de la biosemiótica de la enfermedad (medicina biosemiótica), lo que propiciaría el desarrollo de una medicina de procesos, tendiente al diagnóstico y tratamiento temprano de las enfermedades.Ítem Mortality rate and acute kidney injury prevalence reduction in COVID‑19 critical patients treated with hemoperfusion(Wolters Kluwer, 2024) Barriga‑Moreno, Adriana P.; Lozano‑Sánchez, Marcela; Barón‑Álvarez, Rafael A.; Cordoba, Juan P.; Aroca‑Martínez, Gustavo; Dianda, Daniela; Gonzalez‑Torres, Henry; Musso, Carlos G.Introduction: Coronavirus disease 2019 (COVID‑19) induces organic damage mainly through the patient’s immune overreaction. Hemoperfusion (HPF) can remove infl ammatory cytokines and can reduce the negative effects of cytokine storm in COVID‑19. We compared the mortality rate, infl ammatory response, and acute kidney injury (AKI) prevalence among patients suffering from respiratory insufficiency secondary to COVID‑19 treated with and without HPF with HA330 cartridge. Methods: Mortality rate, serum creatinine, and ferritin values were compared between patients suffering from respiratory insufficiency secondary to COVID‑19 who received conventional treatment and another group of patients who additionally received four sessions of HPF with HA330. Results: Of 116 patients suffering from acute respiratory insufficiency secondary to severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), one group (n: 84) received support treatment and the other group (n: 32) additionally received HPF with HA330 cartridge. Both groups had no renal disease and similar age and comorbidities at admission, except for obesity and mechanical ventilation requirement, which were significantly higher in the HPF group. Mortality rate (61% vs. 31%, P: 0.008), serum creatinine (1.4 vs. 0.5 mg/dl, P < 0.001), and post‑HPF serum ferritin (2868 vs. 1675, P < 0.001) were significantly lower in the HPF group. Conclusion: Mortality rate, serum ferritin, and AKI were significantly reduced in critical COVID‑19 patients who received HPF with HA330 cartridge than in those who did not receive it. These results were obtained despite the HPF group risk factors, such as obesity and mechanical ventilation, worsening its prognosis.Ítem Nephrotic Syndrome Secondary to Podocytopathy in SARS-COV2 Infection(Asociación Colombiana de Nefrología e Hipertensión Arterial, 2023) Aroca-Martínez, Gustavo; Cadena-Bonfanti, Andrés; Avendaño-Echavez, Lil; Conde-Manotas, Juan C.; Pérez, Rafael; García, Raúl; Orozco, Carlos; Musso, Carlos G.Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterized by pulmonary involvement. However, there are reports on patients also suffering from concomitant renal involvement, with clinical manifestations such as hematuria, proteinuria, elevated nitrogen levels and acute kidney injury. Objective: The present study reports two clinical cases of nephrotic syndrome associated with coronavirus disease (COVID-19). Clinical case presentation: Histological imaging by electron microscopy showed, in one case, evidence of minimal changes and fusion of podocytes pedicels, and in the other one, podocytopathy with pedicels loss (70 %) and focal sclerosis of capillary loops. Discussion: Proteinuria in COVID-19 can be secondary to glomerular and acute tubular lesions, with a multifactorial origin: Hemodynamic factors, cytokine storms, secondary infections, druginduced nephrotoxicity and direct viral infection (proximal tubule cells and podocytes). The latter mechanisms could be explained by SARS-CoV2 renal tropism. Conclusion: The present report presents two cases of nephrotic syndrome secondary to podocytopathy in patients suffering from acute COVID-19 infection.Ítem Nocturia: its characteristics, diagnostic algorithm and treatment(Springer, 2022) Aucar, Nahir; Fagalde, Ines; Zanella, Akemi; Capalbo, Olivia; Aroca‑Martínez, Gustavo; Favre, Gabriel; Musso, Carlos G.Nocturia is the complaint that an individual has to wake up at night one or more times to urinate. It is a frequent condition among older adults and entails detrimental effects with regard to sleeping, sexual activity, comfort, depression, mental function and vitality. It is clinically important to distinguish it from global polyuria, defined as a urinary rate ≥ 125 ml/h (3000 ml/day), as well as from nocturnal polyuria, which is an abnormally large volume of urine during sleep associated with a decreased daytime urine production. A Frequency Volume Chart (FVC), overnight water deprivation test with renal concentrating capacity test, and the nocturnal bladder capacity index are some of the methods that help establish the underlying pathology of this condition and hence define an adequate treatment plan.Ítem Obesity and glomerular filtration rate(Springer Nature, 2023) Schwartz, Paula; Capotondo, Maria M.; Quaintenne, Miranda; Musso‑Enz, Guido M.; Aroca‑Martinez, Gustavo; Musso, Carlos G.Obesity has received considerable attention in general medicine and nephrology over the last few years. This condition increases the risk of metabolic syndrome, diabetes mellitus, hypertension, and dyslipidemia, which are the main risk factors for developing chronic kidney disease (CKD). Kidney damage caused by obesity can be explained by many mechanisms, such as sympathetic nervous and renin-angiotensin-aldosterone systems activation, mechanical stress, hormonal unbalance, as well as inflammatory cytokines production. Even though creatinine-based glomerular filtration rate (GFR) equations in obese individuals have been validated (Salazar-Corcoran and CKD-MCQ), changes in body weight after bariatric surgery (BS) leads to changes in creatininemia, affecting its reliability. Thus, an average between creatine and cystatin-based GFR equations would be more appropriate in this setting. Bariatric surgery can reverse diabetes mellitus and improve hypertension, which are the main causes of CKD. Conclusion: GFR can be affected by obesity and BS, and its value should be cautiously evaluated in this setting.Ítem Optimizing dialysis dose in the context of frailty: an exploratory study(Springer Nature, 2020) Hernandez‑Agudelo, Sandra Y.; Musso, Carlos G.; González‑Torres, Henry J.; Castro‑Hernández, Christian; Maya‑Altamiranda, Lina P.; Quintero‑Cruz, María V.; Corradino, Claudio; Terrasa, Sergio A.; Aroca‑Martínez, Gustavo J.; Cadena‑Bonfanti, AndrésIntroduction Frailty is a multicausal syndrome characterized by a decrease in strength, resistance and physiological function, which makes the individual vulnerable and dependent, and increases his/her mortality. This syndrome is more prevalent among older individuals, and chronic kidney disease patients, particularly those on dialysis. Dialysis dose is currently standardized for hemodialysis (HD) patients regardless of their age and functional status. However, it has been postulated that the dialysis dose required in older patients, especially frail ones, should be lower, since it could increase their degree of frailty. Then, the purpose of this study was to evaluate if there would be a correlation between the dose of Kt/V and the degree of frailty in a population of adult patients on HD. Materials and methods A cross-sectional study with 82 patients on HD in Barranquilla (Colombia) and Lobos (Argentina) was conducted. Socio-demographic and laboratory data, as well as dialysis doses (Kt/V) were recorded and scales of fragility, physical activity, gait and grip strength were applied. Then these data were correlated by a Spearman’s correlation and a logistic regression. Results CFS, social isolation, physical activity, gait speed, and prehensile strength tests were outside the reference ranges in the studied group. No significant correlation was found between dialysis dose and all the above mentioned functional tests. However, a significant and inverse correlation between physical activity and CFS was documented (score − 1.41 (CI − 2.1 to − 0.7). Conclusion No significant correlation was documented between Kt/V value and different parameters of the frailty status, but this status correlated significantly and inversely with physical activity in this group. Frailty status in hemodialysis patients was significantly higher in older individuals, although young individuals were not exempt from it.Ítem Osmotic diuresis in chronic kidney disease: its significance and clinical utility(Springer, 2019-06) Musso, Carlos G.; Juarez, Rossina; Terrasa, Sergio; Gonzalez‑Torres, Henry; Aroca‑Martinez, GustavoIntroduction The kidneys contribute to maintain plasma osmolality in normal range by achieving the adequate daily osmolar urine excretion (DOUE). An equation has been described for estimating the expected daily urine volume necessary to excrete the osmolar load required to keep serum osmolality in normal range. According to this equation, a difference between real and expected daily osmolar diuresis (DOD) can be obtained, being normally this difference value zero (± 500 cc). However, a positive DOD difference signifies a reduced urine concentration capability, while a negative DOD difference signifies a reduced urine dilution capability. Therefore, we decided to originally investigate how DOUE, and DOD difference are modified through the different stages of CKD. Materials and methods 61 patients suffering from CKD (stages I–V) secondary to glomerulopathies were studied. Creatinine clearance (CrCl), DOUE, and difference between real and expected DOD were obtained from each patient. Besides, correlation (Spearman) between CrCl and DOUE, and between CrCl and real–expected DOD difference were also obtained. Results Spearman correlation between CrCl and DOUE was positive and significant (Spearman’s ρ = 0.63, p < 0.0001). In addition, CKD patients who were not able to achieve the minimal DOUE required (600 mOsm/day) were mostly those with CrCl < 40 mL/min. Spearman correlation between CrCl and real–expected DOD difference was negative and significant (Spearman’s ρ = − 0.4, p < 0.0013). Additionally, abnormal DOD difference (> 500 cc) was found in CKD patients with CrCl < 80 mL/min/1.73 m2. Conclusion Daily osmolar urine excretion, and difference between real and expected daily osmolar diuresis are simple and significant clinical parameter which can be useful to easily evaluate urine concentration–dilution capability (tubular function) in CKD patients.