Documento de información y consenso para la detección y manejo de la enfermedad renal crónica

Risk-based versus GFR threshold criteria for nephrology referral in chronic kidney disease

“…Guidelines such as the National Kidney Foundation (Kidney Disease Outcomes Quality Initiative) [ 10 ], Caring for Australasians with Renal Impairment (CARI) [ 11 ], American Diabetes Association of 2022 [ 12 ] and European guidelines [ 13 , 14 ] in general recommend that patients with GFR <30 mL/min/ 1.73 m 2 (CKD Stages 4–5), regardless of the age of the patient, should be referred to a nephrologist, among other causes. French guidelines (Haute Autorité de Sante) recommend a higher cut-off value of 45 mL/min/1.73 m 2 [ 16 ].…”

“…The Belgium Centre for Evidence-Based Medicine only explicitly describes the role of general practitioners (GPs) and recommends the GP be responsible for detecting and monitoring CKD, detecting complications and treating cardiovascular risk [ 17 ]. Other recent guidelines additionally recommend referral in earlier stages of CKD (30–60 mL/min/1.73 m 2 ) if there is a confirmed progression of CKD and add special recommendations for specific populations, such as patients >80 years old [ 14 ]. Thus coexistent guidelines reflect a diversity of recommendations for GPs (Table 1 ).…”

The “FIFTY SHADOWS” of the RALES Trial: Lessons about the Potential Risk of Dietary Potassium Supplementation in Patients with Chronic Kidney Disease

“…Second, the effects of lower sodium cannot be separated from those of the higher K + delivered by the salt substitute in this study. Third, the bioavailability of inorganic K + (as provided in the SSaSS trial) is not necessarily equivalent to that of K + derived from a fruit- or vegetable-rich diet, as we already know from the strikingly different intestinal bioavailability of phosphate from inorganic (i.e., additives) versus plant-derived phosphate sources [ 19 , 58 ]. The anion linked to K + , other nutrients (e.g., magnesium, vitamin K), protein (with lower phosphate bioavailability), higher fiber content (enhancing intestinal motility and short-chain fatty acid production), or alkali (neutralising acidosis and its harmful consequences) in plant-based or adapted “healthy” diets may have contributed to the outcomes of different studies [ 25 , 59 , 60 , 61 ].…”

“…However, caution should be exerted in the contest of an increasing number of people with chronic clinical conditions such as CKD, often neglected by the patient and often treated with RAASis [ 18 ]. In this context, “occult” renal insufficiency, represented by the presence of “normal” serum creatinine but decreased glomerular filtration rate (and/or pathological albuminuria), has frequently been neglected in studies [ 14 , 15 , 19 ]. Consequently, this article offers a note of caution regarding the recent publication of the SSaSS (Salt Substitute and Stroke Study) trial [ 17 ], particularly in patients with known or “occult” CKD, those with HF, and/or those taking RAASi.…”

Comentario al artículo “Evolution of the stage of cronic kidney disease from the diagnosis of hypertension in primary care”. Limitaciones en el valor del filtrado

“…Me permito a través de estas líneas realizar un comentario general a su trabajo a manera de crítica, no tanto metodológica, sino de fondo. Siguiendo el documento de consenso recientemente publicado en la revista Nefrología sobre diagnóstico y manejo de la ERC, avalado por 9 sociedades médicas, ente las cuales está la semFYC 2 , y basándome en las recomendaciones de las guías KDIGO seguidas en nuestro país por nefrólogos y médicos de atención primaria 3 , he de comentar que para realizar el diagnóstico de ERC debemos guiarnos por 3 parámetros (cualquiera de ellos por separado, 2 o los 3): filtrado por debajo de 60 ml/min/1,73 m 2 , cociente albúmina creatinina (CAC) mayor a 30 mg/g o daño orgánico renal evidenciado, todos ellos durante 90 días y con una repercusión clínica determinada independientemente de la causa de esta.…”