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Ítem Finerenone and Clinical Outcomes in CKD and Type 2 Diabetes by Frailty Index. FIDELITY Post Hoc Analysis(American Society of Nephrology, 2025) Rossing, Peter; Birkenfeld, Andreas L.; Fioretto, Paola; McGill, Janet B.; Anker, Stefan D.; Pitt, Bertram; Rohwedder, Katja; Scalise, Andrea; Scott, Charlie; Filippatos, Gerasimos; FIDELIO-DKD; FIGARO-DKDBackground Frailty is associated with a higher risk of adverse outcomes. It is believed that people with a higher frailty index (FI) may be less tolerant to new treatments, often leading to inappropriate prescribing. This post hoc analysis of FInerenone in chronic kiDney diseasE and type 2 diabetes: Combined FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease (FIDELIO-DKD) and FIGARO-DKD Trial program analysis, a prespecified, pooled analysis of the FIDELIO-DKD and FIGARO-DKD phase 3 clinical trials, investigated the efficacy and safety of finerenone versus placebo according to baseline FI. Methods Between September 2015 and October 2018, 12,990 people with CKD and type 2 diabetes receiving the maximum tolerated dose of a renin-angiotensin system inhibitor were randomized to receive finerenone 10 or 20 mg once daily or placebo. Baseline FI was calculated using the Rockwood cumulative deficit approach including 30 clinical characteristics. Primary efficacy outcomes included a kidney (kidney failure, sustained decrease of $57% in eGFR, or kidney-related death) and a cardiovascular (CV) composite outcome (CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure). Changes in urine albumin-to-creatinine ratio and eGFR were measured across the study period. Results Overall, kidney and CV event rates increased with increasing frailty. Finerenone reduced the risk of primary kidney and CV composite outcomes irrespective of baseline frailty (P interaction 5 0.93 and 0.35, respectively). Compared with placebo, finerenone also demonstrated significant reductions in urine albumin-to-creatinine ratio across all frailty subgroups (P , 0.01 for all visits) and significant attenuation of eGFR decline from baseline to month 48 in the three most frail quartiles (.Q1 to #Q2, P 5 0.001; .Q2 to #Q3, P , 0.001; .Q3, P , 0.001, respectively). The incidence of serious adverse events and hyperkalemia increased with increasing frailty in both treatment arms. Conclusions Finerenone reduced the risk of CV and kidney events in people with CKD and type 2 diabetes versus placebo irrespective of baseline frailty status.Ítem Oral analogues of GLP-1: perspectives on glycemic control and cardiorenal risk in patients with type 2 diabetes mellitus(Sociedad Latinoamericana de Nefrología e Hipertensión, 2024) Rico-Fontalvo, Jorge; daza arnedo, rodrigo andres; Vázquez Jiménez, Lourdes Carolina; Rodríguez-Yánez, Tomas; Raad Sarabia, Maria Isabel; TOAPANTA, NÉSTOR; Pérez, Rafael V.; Montejo-Hernández, Juan; Soler, María J.At present, type 2 diabetes mellitus (T2DM) is the leading cause of end-stage kidney disease. The management of T2DM in recent years has moved from a glucocentric approach to a global approach with the priority of introducing treatments that offer renal and cardiovascular protection. In this article, we review in depth the pharmacokinetics and pharmacodynamics of the first oral analog of glucagon-like peptide-1 (oral semaglutide) in comparison with its subcutaneous formulation. The knowledge and implementation of these drugs will be very useful in daily clinical practiceÍtem Día Mundial del Riñón 2024: promover un acceso equitativo a la atención en salud y a la medicación óptima(Sociedad Latinoamericana de Nefrología e Hipertención, 2024) Silvariño, Ricardo; Rico-Fontalvo, Jorge; Villavicencio, Vanesa; Sánchez-Polo, Vicente; Rosa-Diez, GuillermoLa enfermedad renal crónica (ERC) es una pandemia. Con variaciones regionales, afecta a 1 de cada 10 adultos (9.1-13.4%) de todo el mundo (850 millones de personas), con una prevalencia incremental cuando se analiza por décadas. Esto se adjudica a un aumento en la expectativa de vida de la población y al incremento de patologías que elevan el riesgo de ERC, principalmente hipertensión arterial, diabetes y obesidad, entre otras. La mayoría de los pacientes no necesitarán diálisis, y esto se explica (en parte) porque el desarrollo de ERC determina más probabilidad de morir a causa de una afección cardiovascular (infarto de miocardio, accidente cerebrovascular, enfermedad vascular periférica) que de ingresar a diálisis crónica. Esta mortalidad impuesta por la ERC es mundialmente reconocida. Desde 1990 es la causa de muerte por enfermedad no transmisible que más aumentó su incidencia, situándose en los primeros lugares en la tabla. Determina además elevada discapacidad. En la estimación de los años de vida ajustados a discapacidad (AVAD), es decir, el número de años perdidos por falta de salud, discapacidad o muerte prematura, para las Américas, en 2019, la ERC estaba entre las primeras causas (www.paho.org), con una tasa de AVAD de 686.1/100,000 habitantes, sin contar la carga de AVAD por enfermedad cardiovascular atribuible a la ERC.Ítem Reset osmostat(Asociación Colombiana de Nefrología e Hipertensión Arterial, 2025) Avallay, Flavia Paola; Musso Enz, Victoria Paula; Aroca-Martinez, Gustavo; Musso, CarlosIntroduction: Reset osmostat (RO) is a common syndrome, making up about 30 % of patients with hyponatremia. Objective: Conduct a comprehensive review of osmostat reset, describing its clinical, pathophy siologic, diagnostic, and therapeutic aspects. Methodology: A narrative review was conducted based on the main articles published in the medical literature. Results: Reset osmostat has a low plasma osmolality threshold, which consequently leads to an elevation in antidiuretic hormone at a lower plasma osmolarity, along with normal water load excretion and intact urine diluting ability, while maintaining normal sodium balance. Reset osmostat can be observed in pregnancy, older age, quadriplegia, psychosis, cerebral hemorrhage, encephalitis, dementia, alcoholism, malnutrition, malignancy, and particular infectious diseases. Conclusions: Reset osmostat often resets to normal if it is the consequence of a reversible cli nical setting; however, this normalization might not happen if it is secondary to an irreversible condition. In such cases, treatment is required similar to that of any hyponatremia in order to avoid its negative consequences.Ítem Análogos orales del GLP-1: perspectivas en el control glucémico y riesgo cardiorenal en pacientes con diabetes mellitus tipo 2(Sociedad Latinoamericana de Nefrología e Hipertensión, 2024) Rico-Fontalvo, Jorge; daza arnedo, rodrigo andres; Vázquez Jiménez, Lourdes Carolina; Rodríguez-Yánez, Tomas; Raad Sarabia, Maria Isabel; TOAPANTA, NÉSTOR; Pérez, Rafael V.; Montejo-Hernández, Juan; Soler, María J.La diabetes mellitus tipo 2 (DM2) es la primera causa de inicio de terapia renal sustitutiva en la actualidad. El manejo de la DM2 en los últimos años ha pasado de un abordaje glucocéntrico a un abordaje global priorizando los tratamientos que ofrecen protección renal y cardiovascular. En este artículo revisamos en profundidad la farmacocinética y farmacodinamia del primer análogo oral del péptido similar al glucagón-1 (semaglutida oral) comparado con su formulación subcutánea. El conocimiento e implementación de dichos fármacos nos serán de gran utilidad en la práctica clínica habitual.Ítem Validation of a score for the prediction of serious infection in patients with systemic lupus erythematosus: data from a latin american lupus cohort(Gladel, 2025) Quintana, Rosana; Pons-Estel, Guillermo; Roberts, Karen; Palacios Santillán, Erika; Rúa-Figueroa, Iñigo; Pego-Reigosa, José M.; Ibañez, Pablo; Berbotto, Leonel Ariel; Bertolaccini, Maria Constanza; Micelli, Marina Laura; Pisoni, Cecilia; de Souza Barbosa, Vitalina; de Ataíde Mariz, Henrique; Machado Ribeiro, Francinne; P.C. Seguro, Luciana; Inoue Sato, Emilia; Mimica Davet, Milena; Aroca-Martinez, Gustavo; Bonilla-Abadía, Fabio; Quintana-López, Gerardo; Sánchez Briones, Reyna Elizabeth; Pérez Cristóbal, Mario; Silveira, Luis H.; García-De la Torre, Ignacio; Morales Avendaño, Ivan; Gámez Siller, Pablo ; Paats Nicora, Astrid; Cieza Calderón, Jorge; Mendoza Maldonado, Andy Armando; Rebella, Martin; Silveira, Gonzalo; Jaramillo, John Fredy; Sánchez, Mónica; Sbarigia, Urbano; Orillion, Ashley; Zazzetti, Federico; Alarcón, Graciela S.; Pons-Estel, BernardoPatients with systemic lupus erythematosus (SLE) are at increased risk of serious infections, which in turn, are associated with morbidity and mortality. The Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology (RELESSER) group has developed and internally validated a tool for prediction of serious infections in SLE, with a recently improved version (SLE SI Score Revised or SLESIS-R), being an accurate and reliable instrument. SLESIS-R includes age, previous SLE-related hospitalization, previous serious infection, and glucocorticoid dose. This study aimed to validate SLESIS-R in a multi-ethnic, multi-national Latin-American (LA) SLE cohort.Ítem Consenso colombiano basado en evidencia y en la opinión de expertos para la utilización de los inhibidores del cotransportador sodio-glucosa tipo 2 (iSGLT-2) en el continuo cardiorrenal de pacientes con enfermedad renal crónica(Asociación Colombiana de Nefrología e Hipertensión Arterial, 2025) MONTEJO, JUAN DIEGO; Lopera, John Mauricio; ROSSELLI SANMARTIN, CARLOS; Ronderos Botero, Izcay; daza arnedo, rodrigo andres; Yama-Mosquera, Erica; FLECHAS, jaflechas; Contreras, Kateir; Machacón Miranda, Elkin; Henao, Carlos; ROMERO JALLER, KATHERYNE CECILIA ; Figueroa Millán , Christian Camilo; Mejia-Garcia, Carlos Hernan; Hernández Sierra, Astrid Patricia; González Sánchez, Diego Andrés; DE LA ESPRIELLA BADEL, VICTOR; Dávila Guerra, Miguel Ángel; Parra Serrano, Paola ; Guevara, Juan Guillermo; Uribe Betancur, José Mauricio; Cárdenas-Garzón, Karen; Zuluaga Peña, Julio Ricardo; Zuluaga, Juan Pablo; Rico-Fontalvo, JorgeContexto: el tratamiento de la enfermedad renal crónica (ERC) tiene como objetivo disminuir el riesgo de progresión de la enfermedad, el surgimiento de complicaciones y el riesgo de muer te, especialmente considerando el continuo cardiorrenal. Mediante diferentes ensayos clínicos realizados con personas diabéticas y no diabéticas, así como de otros grupos de riesgo como in suficiencia cardiaca y ERC, los antidiabéticos conocidos como inhibidores del cotransportador sodio-glucosa tipo 2 (iSGLT-2, según sus siglas en inglés) han demostrado efectos beneficiosos en los resultados renales y cardiovasculares. Objetivo: establecer recomendaciones para el manejo con iSGLT-2 para pacientes con ERC. Metodología: el consenso se desarrolló en las siguientes etapas: conformación del grupo desa rrollador; definición de las preguntas objeto de investigación; búsqueda, tamización, evaluación y selección de la evidencia; elaboración de síntesis y evaluación de la evidencia; discusión en paneles formales, generación de recomendaciones y juicio de expertos; y redacción, elaboración y revisión del documento del consenso. Resultados: los 22 expertos clínicos formularon un total de 15 recomendaciones para 12 pregun tas de investigación. La certeza de la evidencia varió entre moderada y alta, basada principalmente en guías de práctica clínica, revisiones sistemáticas de la literatura, ensayos clínicos y consensos de expertos. La mayoría de las recomendaciones fueron débiles a favor.Ítem Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1(Ubiquity Press, 2025) Rosende, Andres; Romero, Cesar; DiPette, Donald; Brettler, Jeffrey; Van der Stuyft, Patrick; Satheesh, Gautam; Perel, Pablo; Chapman, Niamh; Moran, Andrew; Schutte, Aletta; Sharman, James; IRAZOLA, VILMA; Huffman, Mark; Campbell, Norm; Abdul Salam, Mohammad; Lanas, Fernando; Coca, Antonio; Garcia-Zamora, Sebastian; FERREIRO, ALEJANDRO; Lopez-Jaramillo, Patricio; Rico-Fontalvo, Jorge; Ridley, Emily; Picone, Dean; Flood, David; Piñeiro, Daniel José; Neira Ojeda, Carolina; Rodriguez, Gonzalo; Wellmann, Irmgardt A.; Orias, Marcelo; Rivera, Marcela; Villatoro, Matías ; Onuma, Oyere; RAMROOP, SHAUN; Khan, Taskeen; Valdés González, Yamilé; Sebba Barroso Souza, Weimar Kunz; Plavnik, Frida; Zúñiga, Eric; Grassani, Ana María ; Tajer, Carlos; Zaidel, Ezequiel J; MARIN, MARCOS; Cyr Philbert, Shana; amorin, ignacio; Diaz-Aguilera, Miguel Angel; Bortolotto, Luiz; AVEZUM, ALVARO; Ribeiro, Antonio; Tobe, Sheldon; Aumala Viscarra, Teresa Natalia; Angell, Sonia; Lavados, Pablo; Martins, Sheila; Munera, Ana; Jaffe, Marc; Prabhakaran, Dorairaj; Parati, Gianfranco; Zhang, Xin-Hua; Rodgers, Anthony; Yusuf, Salim; Whelton, Paul; Ordunez, PedroBackground: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.0 was developed as a three-phase process to integrate evidence-based interventions into a unified care pathway, ensuring consistency across fragmented guidelines. This paper focuses on Phase 1, highlighting targeted interventions to improve and update the HEARTS Clinical Pathway. Methods: First, the coordinating group defined the project’s scope, objectives, principles, methodological framework, and tools. Second, international experts from different disciplines proposed interventions to enhance the HEARTS Clinical Pathway. Third, the coordinating group harmonized these proposals into unique interventions. Fourth, experts appraised the appropriateness of the proposed interventions on a 1-to 9 scale using the adapted RAND/UCLA Appropriateness Method. Finally, interventions with a median score above 6 were deemed appropriate and selected as candidates to enhance the HEARTS Clinical Pathway. Results: Building on the existing HEARTS Clinical Pathway, 45 unique interventions were selected, including community-based screening, early detection and management of risk factors, lower blood pressure thresholds for diagnosing hypertension in high CVD-risk patients, reinforcement of single-pill combination therapy, inclusion of sodium-glucose cotransporter-2 inhibitors for patients with diabetes, CKD, or heart failure, expanded roles for non-physician health workers in team-based care, and strengthened clinical documentation, monitoring, and evaluation.Ítem An innovative methodology for segmenting vessel like structures using artificial intelligence and image processing(Springer Nature, 2025) Ayala Mantilla, Cristian Eduardo; Villarreal, Reynaldo; Chamorro-Solano, Sindy; Cantillo, Steffen; Pestana-Nobles, Roberto; Arquez, Sair; Vega-Sampayo, Yolanda; Pacheco-Londoño, Leonardo; Paez, Jheifer; Galan-Freyle, Nataly ; Amar, PaolaInnovation is currently driving enhanced performance and productivity across various fields through process automation. However, identifying intricate details in images can often pose challenges due to morphological variations or specific conditions. Here, artificial intelligence (AI) plays a crucial role by simplifying the segmentation of images.This is achieved by training algorithms to detect specific pixels, thereby recognizing details within images. In this study, an algorithm incorporating modules based on Efficient Sub-Pixel Convolutional Neural Network forimage super-resolution, U-Net based Neural baseline for image segmentation, and image binarization for masking was developed. The combination of these modules aimed to identify capillary structures at pixel level. The method was applied on different datasets containing images of eye fundus, citrus leaves, printed circuit boards to test how well it could segment the capillary structures. Notably, the trained model exhibited versatility in recognizing capillary structures across various image types.When tested with the Set 5 and Set 14 datasets, a PSNR of 37.92 and SSIM of 0.9219 was achieved, surpassing significantly other image superresolution methods.The enhancement module processes the image using three different varaiables in the same way, which imposes a complexity of O(n) and takes 308,734 ms to execute; the segmentation module evaluates each pixel against its neighbors to correctly segment regions of interes, generating an O(n2) quadratic complexity and taking 687,509 ms to execute; the masking module makes several runs through the whole image and in several occasions it calls processes of O(n log n) complexity at 581686 microseconds to execute, which makes it not only the most complex but also the most exhaustive part of the program. This versatility, rooted in its pixel-level operation, enables the algorithm to identify initially unnoticed details, enhancing its applicability across diverse image datasets. This innovation holds significant potential for precisely studying certain structures’ characteristics while enhancing and processing images with high fidelity through AI-driven machine learning algorithms.Ítem Impact of HbA1c reduction on major kidney outcomes in type 2 diabetes with poor glycemic control and advanced CKD(Wiley, 2025) Navarro Blackaller, Guillermo; Benitez-Renteria, A. S.; Hernández-Morales, K.; Rico-Fontalvo, Jorge; Daza-Arnedo, R.; Gómez-Ramírez, G. G.; Camacho-Guerrero, J. R.; Pérez-Venegas, M. A.; Carmona-Morales, J.; Oseguera-González, A. N.; Murguía Soto, César; Chávez-Alonso, G.; García-Peña, F.; Barrera-Torres, C. J.; Orozco-Chan, E.; Arredondo-Dubois, M.; Martínez Gallardo González, Alejandro; Gómez-Fregoso, J. A.; Rodríguez-García, F. G.; Luquin-Arellano, V. H.; Abundis-Mora, G.; Alcantar-Vallin, L.; Medina-González, R.; García-García, G.; Chávez-Iñiguez, Jonathan S.Aims: In subjects with type 2 diabetes (DM), poor glycemic control, and advanced chronic kidney disease (CKD), the kidney beneft of the reduction of glycated hemoglobin (HbA1c) is not well established. Methods: In a retrospective cohort, we included patients with DM, CKD grade 3b-5, and HbA1c > 9% to evaluate the risk of developing major adverse kidney events (MAKE) defned as the start of kidney replacement therapy (KRT), ≥ 25% or ≥ 40% decline in the glomerular fltration rate (eGFR) from baseline, and death; patients were divided according to the HbA1c levels at the end of the follow-up into the following groups: > 75 mmol/mol (≥ 9.0%), 74–64 mmol/mol (8.9%–8.0%), 64–53 mmol/mol (7.9%–7.0%), and < 52 mmol/mol (< 7.0%). We described their characteristics and analyzed their risks, adjusting for confounding variables. Results: From 2015 to 2023, 111 patients were included. In 46 patients (41.4%), the HbA1c at the end of follow-up (60 months) was still > 75 mmol/mol (≥ 9%), and each patient had a mean of 4.9 HbA1c measurements. Te mean age was 59 years, and 46% were male; the baseline eGFR was 25 mL/min/1.73 m2 . MAKE occurred in 67% of cases. In a multivariate analysis, the risk of MAKE was not associated with the HbA1c groups, nor was it associated with any of the MAKE components individually, nor in certain subgroups. When evaluating the magnitude of percentage changes in HbA1 with the initiation of KRT, we did not fnd any association. Conclusions: With advanced CKD and poor glycemic control, changes in HbA1c during long follow-up are not associated with MAKE or its individual components.Ítem Kidney health programs in Latin America: Results of the SLANH survey 2024(Elsevier, 2025) Cueto-Manzano, Alfonso; Carlino-Bauza, María C.; Ríos-Sarro, Pablo G.; Vallejos, Augusto; Zúñiga-San Martín, Carlos A.; Zúñiga-Saravia, Eric A.; Bravo Zúñiga, Jessica Ivonne; Alles-Gamberale, Alberto M.; Solá-Schnir, Laura; Sánchez-Polo, Vicente; Robayo, Adriana; Rico-Fontalvo, Jorge; Álvarez-Estévez, Guillermo; Comité de Salud Renal; Sociedad Latinoamericana de Nefrología e HipertensiónChronic kidney disease (CKD) is a health problem worldwide, but it is overexpressed in Latin America. With the aim of understanding the status of kidney health programs (KHP) and provide information to help create or direct kidney health policies, the Kidney Health Committee of the Latin American Society of Nephrology and Hypertension (SLANH) developed an electronic survey that was sent (February 1–May 30, 2024) to the national nephrology society, the Ministry of Health or a policymaker, and a recognized local nephrology leader of all SLANH member countries. Thirteen of 20 (65%) member countries had a KHP. Although with variability, most covers individuals with and without social security, targeting people with risk factors with or without CKD (61%) or general population (39%). In all but two countries with KHP, it is integrated into another noncommunicable disease program (diabetes, hypertension, obesity, and/or cardiovascular disease), and the national nephrology society is involved (except in three). Virtually all countries perform educative interventions for multidisciplinary health professionals and general population, the latter mainly in connection with World Kidney Day. Only eight (40%) countries have a registry of CKD stage 1-4 (seven of them had a KHP), and nine (45%) have a kidney health law, which was not different between countries with or without KHP. Only 25% of countries have active patient participation in kidney issues, regardless of the country having KHP or not. The SLANH-KHP survey showed heterogeneity in the way Latin American countries address kidney health. These findings could guide the implementation of strategies aimed at reducing the burden of CKD toward equitable and sustainable kidney disease care.Ítem Lymphoid peritoneal fluid as a variant of chylous-like effluent in peritoneal dialysis: proposal for a new diagnostic term(Società Italiana di Nefrologia, 2024) Fernández Claros, Nigel; Ocampo, María L.; Musso, Carlos G.; Cristiano, Fabrizio; Aroca Martinez, Gustavo; Giordani, María C.The cloudy bag in peritoneal dialysis is generally associated with infectious peritonitis and non-infectious etiologies. These cloudy bags may have increased cellularity or low/acellular counts. In the case of low cell count, the concomitant detection of fibrin or fat can provide guidance on its etiology. The cloudy peritoneal bag with a whitish appearance is usually due to its high fat content (chyloperitoneum). The etiologies include pharmacological, traumatic or inflammatory causes. The elevated fatty component in chyloperitoneum may be triglycerides (chylous), cholesterol (pseudochylous) or lymph. We present the case of a patient with stage 5 chronic kidney disease (CKD). He starts continuous ambulatory peritoneal dialysis and presents turbid but acellular peritoneal effluent with chylous appearance, negative cultures, and low levels of triglycerides and cholesterol on physicochemical evaluation. It doesn’t meet the criteria for chylous or pseudochylous fluid, which is why the term lymphoid fluid is here proposed to describe it, because of its resemblance to lymphatic fluid in color. To our knowledge, this is the first case in the literature to report this effluent (milky-looking fluid without high levels of triglycerides or cholesterol) and to propose a specific term to describe it.Ítem La relación médico-paciente en el contexto de las investigaciones clínicas: ¿asegura formas relacionales efectivas?(Asociación Colombiana de Nefrología e Hipertensión Arterial, 2025) Depine, Santos; Aroca-Martinez, GustavoIntroducción: el artículo explora la dinámica histórica de la relación médico-paciente, destacan do la importancia del diálogo y la escucha activa desde las civilizaciones antiguas, destacando su importancia en el contexto de las investigaciones clínicas. Se introduce el concepto de "modelo mental", enfatizando cómo las interpretaciones individuales del médico y el paciente influyen en la interacción. Además, se plantean los desafíos actuales, como la sobrecarga de información, la medicina defensiva y las barreras de acceso a la atención médica, así como los cambios surgidos a raíz de la pandemia de COVID-19 y la influencia de la tecnología. Se subraya la relevancia de los códigos de ética para prevenir malas prácticas médicas. Contenidos: se describen los cuatro componentes del modelo mental: biología, historia personal, cultura y expresión inconsciente, subrayando la necesidad de una relación basada en empatía y respeto. Se analizan los modelos bio-médico y bio-psico-social, y la importancia de integrar ambos enfoques. Se examina el impacto de la tecnología y la globalización en la práctica médica, incluyendo la telemedicina y la medicina de precisión. Se discute el papel del consentimiento informado y la participación activa del paciente en la toma de decisiones, incluyendo su participación en las investigaciones clínicas. Se plantea la importancia de ampliar el concepto a una relación entre el consultante y el equipo de salud, y se aborda el problema de la falta de personal médico y la precarización de la profesión.Ítem Situation of chronic kidney disease in Latin America, with emphasis on diabetic kidney disease: difficulties and challenges(Sociedad Latinoamericana de Nefrología e Hipertensión, 2025) Rico-Fontalvo, Jorge; Elbert, Alicia; lorca, eduardo; daza arnedo, rodrigo andres; Castellaro, Carlos; Villavicencio, Vanessa; Rosa Diez, Guillermo Javier; Bonanno-Hidalgo, Carlos; Sánchez-Polo, Vicente; Correa-Rotter, RicardoChronic kidney disease (CKD) is a serious public health problem worldwide, with a high prevalence in the adult population and often lately diagnosed. A meeting of experts in nephrology, with participants from Argentina, Brazil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Mexico, Nicaragua, and the Dominican Republic, was held with the aim of generating pro posals and a call to action on how to deal with CKD and cardio-renal-metabolic syndrome. Based on a review of the best available evidence and from the perspective of experience in daily practice about the difficulties and opportunities for opti mizing early diagnosis and treatment of CKD, with emphasis on diabetic kidney disease, a description of the current scenario, the challenges and proposals for improving this situation in the region are presentedÍtem On World Kidney Day: from early detection to access to kidney disease treatment(Sociedad Latinoamericana de Nefrología e Hipertensión, 2025) Sánchez-Polo, Vicente; daza arnedo, rodrigo andres; Villavicencio Ceron, Vanessa; Álvarez-Estévez, Guillermo; Rico-Fontalvo, JorgeAs every year, World Kidney Day will be celebrated on March 13th, prompting educational campaigns worldwide aimed at raising awareness among the general population about kidney care. Given that chronic kidney disease (CKD) has a significant impact on quality of life, morbidity, and mortality, it is crucial to use this opportunity to raise its visibility among the public. It is estimated that approximately 10% of the global population suffers from some form of CKD, with 78% residing in low- or middle-income countries. These regions also face challenges such as malnutrition, infection risks, low birth weight, environmental factors, and limited access to healthcare servicesÍtem May Measurement Month 2022: an analysis of blood pressure screening results from Colombia(European Society of Cardiology, 2025) Lopez-Lopez, Jose P.; Otero, Johanna; urbina, zulma; sanchez-vallejo, gregorio; Narvaez, Claudia; Camacho, Paul Anthony; Urina, Miguel; Quintero, Adalberto; Aroca-Martinez, Gustavo; Campos, Alfonso; Arcos, Edgar; Perez-Mayorga, Maritza; Mosquera, Walter; Garcia, Luis; Beaney, Thomas; Kerr, Gabriele; Poulter, Neil; Lopez-Jaramillo, PatricioThe May Measurement Month (MMM) campaign was carried out in Colombia in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report on the findings of the campaign. Adults aged ≥ 18 years were recruited opportunistically at healthcare and public facilities in eleven departments. Three seated BP readings were taken for each participant, along with completion of a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Controlled BP was defined as being on antihypertensive medication with a BP <140/90 mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 38 924 were screened, with a mean age of 46.3 years and 52.9% of whom were female. Of all participants, 10 738 (27.6%) had hypertension, of whom 7058 (65.7%) were aware, and 6925 (64.5%) were on antihypertensive medication. Of those on antihypertensive medication, 4600 (66.4%) had controlled BP, and of all participants with hypertension, 42.8% had controlled BP. However, those under 50 years had lower hypertension control (<30%). Women had a higher BP control than men (49.5 vs 36.3%). High education was associated with lower systolic BP (-2.37 mmHg). The MMM campaign in Colombia identified significant numbers of participants with either untreated or inadequately treated hypertension. MMM22 results point to the need to continue improving awareness and seek a broader implementation of strategies with proven efficacy in controlling hypertension.Ítem Overlap syndrome in late-onset systemic lupus erythematosus with lupus nephritis and MPO-ANCA pauci-immune glomerulonephritis and tuberculosis: an uncommon association(Wiley, 2025) Dulce Muñoz, Jaime Arturo; Aroca-Martinez, Gustavo; Seni, Christian ; Perea Rojas, Diana Marcela; CABARCAS BARBOSA, OMAR; Niño Hernández, Lucia Mercedes; Gaivao Arciniegas, Dario Jose; García Jarava, Camila Maria ; Olivares Olmos, Marianela ; Seni Hernandez, Sebastian Andre; Pérez Jiménez, Valentina; Rojas-Torres, Indiana-LuzSystemic lupus erythematosus is a systemic autoimmune pathology that generally presents in young people and manifests acutely, while its late presentation in people over 50 years of age is rare and insidious. Vasculitis is a pathology that afects any vessel producing fbrinoid necrosis, and presents with a positive antineutrophil cytoplasmic antibody. Te concomitance of these two entities is rare and leads to worse clinical outcomes. We present a 73-year-old female patient who presented with rapidly progressive glomerulonephritis requiring renal replacement therapy, pulmonary tuberculosis, late-onset lupus erythematosus with lupus nephritis, and a positive result for neutrophil cytoplasmic antibody. An immune-mediated extracapillary proliferative glomerulonephritis was found when the biopsy was performed, with obvious signs of vasculitis, an overlap syndrome was found between these entities. She was initially treated with antituberculosis therapy, boluses of methylprednisolone and continued with intermittent renal replacement therapy; however, due to the severity of his pathologies, she had a fatal outcome. Te concomitance between these autoimmune pathologies is unusual; there is a late-onset overlap syndrome between lupus nephritis accompanied by myeloperoxidase-antineutrophil cytoplasmic antibody and pauci-immune glomerulonephritis. Te dual presentation es tablishes clinical challeng.Ítem A propósito del Día Mundial del Riñón: de la detección temprana al acceso al tratamiento de la enfermedad renal(Sociedad Latinoamericana de Nefrología e Hipertensión, 2025) Sánchez-Polo, Vicente; Daza-Arnedo, Rodrigo; Villavicencio-Cerón, Vanessa; Álvarez-Estévez, Guillermo; Rico-Fontalvo, JorgeComo todos los años, el próximo 13 de marzo se celebra el Día Mundial del Riñón, por lo que en todo el mundo se hacen campañas educativas que buscan impactar en la población en general con relación al cuidado de los riñones. Por ser la enfermedad renal crónica (ERC) una afección de alto impacto en térmi nos de calidad de vida, morbilidad y mortalidad, es fundamental aprovechar esta oportunidad para hacerla visible dentro de la población. Se estima que aproxi madamente un 10% de la población mundial cursa con alguna forma de ERC, y que el 78% residen en países de medio o bajo ingreso económico, teniendo por con texto, además, la malnutrición, el riesgo de infecciones, el bajo peso al nacer, factores ambientales y la falta de acceso a los servicios de saludÍtem Efficacy and safety of obinutuzumab in active lupus nephritis(Massachusetts Medical Society, 2025) Furie, R.A.; Rovin, B.H.; Garg, J.P.; Santiago, M.B.; Aroca Martínez, G.; Zuta Santillán, A.E.; Álvarez, D.; Navarro Sandoval, C.; Lila, A.M.; Tumlin, J.A.; Saxena, A.; Irazoque Palazuelos, F.; Raghu, H.; Yoo, B.; Hassan, I.; Martins, E.; Sehgal, H.; Kirchner, P.; Ross Terres, J.; Omachi, T.A.; Schindler, T.; Pendergraft, W.F.; Malvar, A.Obinutuzumab, a humanized type II anti-CD20 monoclonal antibody, provided sig nificantly better renal responses than placebo in a phase 2 trial involving patients with lupus nephritis receiving standard therapy. METHODS In a phase 3, randomized, controlled trial, we assigned adults with biopsy-proven active lupus nephritis in a 1:1 ratio to receive obinutuzumab in one of two dose schedules (1000 mg on day 1 and at weeks 2, 24, 26, and 52, with or without a dose at week 50) or placebo. All patients received standard therapy with mycophen olate mofetil, along with oral prednisone at a target dose of 7.5 mg per day by week 12 and 5 mg per day by week 24. The primary end point was a complete renal response at week 76, defined by a urinary protein-to-creatinine ratio of less than 0.5 (with protein and creatinine both measured in milligrams), an estimated glo merular filtration rate of at least 85% of the baseline value, and no intercurrent event (i.e., rescue therapy, treatment failure, death, or early trial withdrawal). Key secondary end points at week 76 included a complete renal response with a pred nisone dose of 7.5 mg per day or lower between weeks 64 and 76 and a urinary protein-to-creatinine ratio lower than 0.8 without an intercurrent event.Ítem Results from the regency trial assessing efficacy and safety of obinutuzumab in active lupus nephritis(International Society of Nephrology (ISN), 2025) Rovin, Brad; Furie, Richard; Garg, JayIntroduction: Obinutuzumab, a humanized type II anti-CD20 mono clonal antibody, is approved for B-cell malignancies. In the Phase II NOBILITY trial of patients with active lupus nephritis (LN;NCT02550652), study participants receiving obinutuzumab in addition to standard therapy were significantly more likely to achieve complete renal response than those receiving placebo in addition to standard therapy. The results of the Phase III REGENCY trial (NCT04221477), performed to verify NOBILITY, are presented here. Methods: REGENCY, a Phase III, double-blind placebo-controlled trial, randomized adults with biopsy-proven active proliferative LN 1:1 to placebo or one of two intravenous obinutuzumab dosing schedules (1000 mg: Day 1, Weeks 2, 24, 26, 50 and 52) in addition to standard therapy. The primary endpoint was complete renal response (CRR, defined as urine protein-to-creatinine ratio [UPCR] <0.5 g/g, estimated glomerular filtration rate [eGFR] $85% of baseline and no intercurrent events of rescue therapy, treatment failure, death or early study withdrawal) at Week 76 and assessed in the intention-to-treat population. Key secondary endpoints included CRR at Week 76 with successful prednisone taper to #7.5 mg/day between Weeks 64 and 76, and UPCR <0.8 g/g at Week 76 with no intercurrent events, change in eGFR from baseline to Week 76 and renal-related events or death through Week 76. Incidence and severity of adverse events through Week 76 were compiled