Objective To evaluate the validity of a standard information package, comprising written and audiovisual aids, for end-stage renal disease (ESRD) patients in a pre-dialysis program. Study Design A multicenter study comprising patients entering a predialysis program. Three questionnaires were developed to gather data in this study: (1) a pre-information package questionnaire that evaluates the patient's initial knowledge of ESRD and the treatment options available (pre-informed patients); (2) a post-information package questionnaire that evaluates the patient's knowledge of ESRD and treatment options after being informed according to the protocol (post-informed patients); (3) a “start of the treatment” questionnaire that deals with the patient's choice of treatment at the time of starting dialysis, as well as the reasons leading to that choice. In all three questionnaires the patient's age, gender, level of creatinine clearance (Ccr), and hematocrit were recorded. Inclusion Criteria Any patient who was on a predialysis program in the participating centers. Results Three hundred and four patients were evaluated across 14 participating centers. Initial knowledge was assessed in 216 pre-informed patients (questionnaire 1). Patients were then guided through the information package. One hundred and fifty-eight patients answered the post-information package (questionnaire 2). During the course of the study, 174 patients (of the initial 304) started renal replacement therapy. Of these, 49.4% (86 patients) had received predialysis information according to our study protocol. All the patients who received the information throughout the trial improved their knowledge of ESRD and treatment options; this improvement was statistically significant. Conclusions The treatment options least well known at the start of the study were the peritoneal dialysis techniques. After receiving the information package, patients had an equal knowledge of all the different treatments, although hemodialysis was still the most familiar. This improvement in knowledge enabled patients who started a dialysis treatment to choose a therapy according to their own preferences. Their selections were as follows: 44% of the patients chose hemodialysis, 40% chose continuous ambulatory peritoneal dialysis, and 16% chose automated peritoneal dialysis. The standard information package, used as a patient education program, effectively resulted in patients having a significantly improved level of knowledge and understanding of ESRD and the different treatment options available.

Background Clopidogrel antiplatelet effects differ according to genotypes ABCB1 and CYP2C19, establishing normal, intermediate and slow metabolizers. The intermediate and slow metabolizers and poor transporters are responsible for the poor response to the antiplatelet drug. Purpose To determine the prevalence of CYP2C19 and ABCB1 genetic polymorphism in the normal Andalusian population (control) and compare it with other populations as a step to implement this determination in clinical practise. Materials and Methods We genotyped 100 controls from the Andalusian DNA bank for CYP2C19 * 2 (rs4244285), CYP2C19 * 3 (rs4986893) and ABCB1 (rs1045642) using TaqMan probes and allelic discrimination technique. Statistical analysis for allelic and genotypic distributions was calculated by chi-squared test or Fisher’s exact test, when necessary, using the Statcalc software packages. Results Genotype frequencies CYP2C19 (*2) in the Andalusian population: *1/*1: 73%, *1/*2: 25%, *2/*2: 2%, and CYP2C19 * 3: none; the same results as in HapMap (NW European ancestry) population. ABCB1: Andalusian population: CC 36%, CT 44%, TT 20%; HapMap population CC 27%, CT 50%, TT 23%. Allelic frequencies: NW European ancestry HapMap CYP2C19 * 2: G is 85% and A is 15%, the same as our Andalusian control results. ABCB1: HapMap C allele frequency is 45% and the T is 55%, and our frequencies are 57% C and 43% T. Having made the genotype study, 59% of the controls were sensitive to clopidogrel and 41% resistant to it. Conclusions Frequencies for CYP2C19 * 2 and * 3 were similar to those reported in other studies. The frequencies for ABCB1 differed slightly It is necessary to perform this type of study in patients with acute coronary syndrome undergoing a percutaneous coronary intervention, to ensure effective treatment as it is documented that clopidogrel is not an effective drug in polymorphisms with allele CYP2C19 * 2 (*1/*2 and *2/*2) and/or ABCB1 TT. No conflict of interest.

Background Calciphylaxis (calcific uremic arteriolopathy) is the ischemic ulceration of the skin caused by the disseminated calcification of the subcutaneous tissue and small arteries as a consequence of hyperparathyroidism in uremic patients. Purpose To describe the method of preparation and checking of an injectable solution of 25% sodium thiosulfate for the treatment of intradialytic calciphylaxis in renal patients. Materials and MethodsSodium thiosulfate is an antioxidant, vasodilator and calcium chelator. The preparation process for the solution of 25% sodium thiosulfate is: Ingredients: Sodium thiosulfate pentahydrate: 25 g, water for injection (WFI): qs 100 ml. Preparation: Weigh the amount of sodium thiosulfate in a sterile beaker. Then, working in a horizontal laminar flow hood, boil WFI to eliminate CO2. Dissolve the thiosulfate in about 80 ml of boiled water. Check that the pH of the solution is between 6 and 9.5, if it is not, adjust with HCl or NaOH. Flush into a 100 ml volumetric flask and make up to volume. Filter with a double 0.22 micron philtre. Finally pack with 50 ml syringe into a sterile glass bottle and label. Results The result is a solution of 100 ml of 25% sodium thiosulfate, transparent, sterile and stable for 30 days in refrigerator. For QC a visual particulate sterility cheque is performed by sowing in aerobic and anaerobic cultures and a bubble point test to verify the integrity of the philtres. Conclusions Proper preparation and checking of the 25% solution of sodium thiosulfate has guaranteed its parenteral administration is safe. The treatment is effective and well tolerated, helping patients and improving their quality of life. No conflict of interest.