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Background: Severity scores are useful to guarantee similar disease severity among groups in clinical trials and to enable comparison between different studies. The aim of this study was to assess the performance of the third generation models of severity scoring systems [simplified acute physiology score (SAPS) 3, acute physiology and chronic health evaluation (APACHE) IV and mortality probability model (MPM)-III] in acute kidney injury (AKI) patients in the intensive care unit (ICU)., Methods: Three hundred and sixty-six consecutive AKI critically ill patients were prospectively assessed in six ICUs of an academic tertiary care center. Scores were applied on AKI diagnosis day (DD) and on the day of nephrology consultation (NCD). Discrimination was assessed by area under the receiver operating characteristic curve (AUCROC) and calibration by Hosmer-Lemeshow (HL) goodness-of-fit test., Results: Hospital mortality rate was 67.8%. SAPS 3 general and Central and South America (CSA) customized equations presented identical good discrimination (AUCROC curve: 0.80 on NCD) and satisfactory HL tests on both analyzed days (P > 0.100). CSA SAPS 3 equation predicted mortality more accurately [standardized mortality ratio (SMR) on NCD = 1.00 (95% confidence interval (CI) 0.84-1.34)]. APACHE IV and MPM-III scores presented similar discrimination compared to SAPS 3 on both analyzed days (P > 0.05). APACHE IV presented satisfactory HL tests over time (P > 0.100) but underestimated mortality [SMR on DD = 1.92 (95% CI 1.61-2.23); SMR on NCD = 1.46 (95% CI 1.48-1.96)]. MPM-III showed unsatisfactory HL test results (P = 0.027 on DD; P = 0.045 on NCD) and underestimated mortality [SMR on NCD = 2.09 (95% CI 1.48-1.96)]., Conclusions: SAPS 3, especially the geographical customized equation, presented good discrimination and calibration performances, accurately predicting mortality in this group of AKI critically ill patients.

Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used.

Background: Anorexia is a common disorder in patients treated with regular haemodialysis and is a contributing factor to malnutrition. The aim of this study was to evaluate the effectiveness of megestrol acetate, an appetite stimulant used in cancer patients, as a treatment for anorexia in dialysis patients., Material and Method: In 2009, 16 patients in our haemodialysis unit, three with diabetes mellitus, were treated with megestrol (160 mg/day single dose) for anorexia defined according to a Likert scale of appetite. The schedule and dialysis dose were not changed during the study., Results: In the third month of treatment there was, in the overall group, an increase in dry weight (60.8 vs 58.9 kg, P<.01), in albumin concentration (4.02 vs 3.8 g/dl, P<.05), in creatinine concentration (9.73 vs 8.26 mg/dl, P<.01), and protein catabolic rate (1.24 vs. 0.97 g/kg/day, P<.0001). Non-significant variations in the concentration of haemoglobin, erythropoietin dose, and lipid concentrations were found. One patient with diabetes mellitus had to increase the dose of insulin and two other patients suffered mild hyperglycaemia. Megestrol acetate did not suppress the secretion of pituitary sex hormones, but in 3 of 10 patients studied was found inhibition of ACTH secretion. The response was not homogeneous: one patient did not respond and reduced his dry weight, in 5 the weight gain was minimal (less than 1 kg) and in the remaining ten the response was good, with an increase in dry weight ranging between 1.5 and 5.5 kg., Conclusions: Megestrol acetate can improve appetite and nutritional parameters in patients treated with periodic haemodialysis who report anorexia. Megestrol acetate may induce hyperglycaemia and inhibit the secretion of ACTH in some patients. These side effects should be assessed when administering this treatment.

Introduction: In 2007 the Scientific Quality-technical and Improvement of Quality in Peritoneal Dialysis was edited. It includes several quality indicators. As far as we know, only some groups of work had evaluated these indicators, with inconclusive results., Aim: To study the evolution and impact of guidelines in Peritoneal Dialysis., Methods: Prospective cohort study of each incident of patients in Peritoneal Dialysis, in a regional public health care system (2003-2006). We prospectively collected baseline clinical and analytical data, technical efficacy, cardiovascular risk, events and deaths, hospital admissions and also prescription data was collected every 6 months., Results: Over a period of 3 years, 490 patients (53.58 years of age; 61.6% males.) Causes of ERC: glomerular 25.5%, diabetes 16%, vascular 12.4%, and interstitial 13.3%. 26.48% were on the list for transplant. Dialysis efficacy: Of the first available results, the residual renal function was 6.37 ml/min, achieving 67.6% of all the objectives K/DOQI. 38.6% remained within the range during the entire first year. Anaemia: 79.3% received erythropoietic stimulating agents and maintained an average Hb of 12.1 g/dl. The percentage of patients in the range (Hb: 11-13 g/dl) improved after a year (58.4% vs 56.3% keeping in the range during this time of 25.6%). Evolution: it has been estimated that per patient-year the risk of: 1) mortality is 0.06 IC 95% [0.04-0.08]; 2) admissions 0.65 [0.58-0.72]; 3) peritoneal infections 0.5 [0.44-0.56]., Conclusion: Diabetes Mellitus patients had a higher cardiovascular risk and prevalence of events. The degrees of control during the follow-up in many topics of peritoneal dialysis improve each year; however they are far from the recommended guidelines, especially if they are evaluated throughout the whole study.

General and specific severity scores for patients with acute kidney injury have significant limitations due in part to the diversity of methods that have been used. Here we prospectively validated five general (APACHE II, SAPS II, SOFA, LODS, and OSF) and three specific (SHARF, Liaño, and Mehta) scoring systems in 366 critically ill patients who developed acute kidney injury in the intensive care unit. Sequential scores in each system were determined on the day that acute kidney injury was diagnosed, on the day when acute kidney injury-specific score criteria were achieved, and on the day of initial nephrology consultation. Acute kidney injury, defined as an increase of 50% or more in the baseline serum creatinine, was mainly due to sepsis, and had an incidence of 19% and an overall 68% mortality. A progressive improvement in score performance was found. On the day of initial nephrology consultation, most scores showed a good performance and two indices (SAPS II and SHARF) achieved an area under the receiver operating characteristic curve above 0.80. Calibration was good on all three defining days, except for OSF when score criteria were achieved, and Mehta at the time of nephrology consultation. Our study shows that early and sequential evaluation is a better approach for prognostic scoring in critically ill patients who develop acute kidney injury.

In Spain and in each of its autonomous communities, the dialysis treatment of chronic renal disease stage 5 is totally covered by public health. Peritoneal dialysis, in any of its modalities, is established as the preferred home dialysis technique and is chosen by high percentage of patients as their choice in dialysis treatment. The Spanish Society of Nephrology has promoted a project of creation of performance guides in the field of peritoneal dialysis, entrusting a work group composed of members of the Spanish Society of Nephrology a with the development of these guides. The information offered is based on levels of evidence, opinion and clinical experience of the most relevant publications of the topic. In these guides, after defining the concept of << peritoneal dialysis>>, the obligations and responsibilities of the sanitation team of the peritoneal dialysis unit are determined, and protocols and performance procedures that try to include all the aspects that concern the patient with chronic renal disease in substitute treatment with this technique are developed. They propose prescription objectives based on available clinical evidence and, lacking this, on the consensus of the experts' opinions. The final aim is to improve the care and quality of the of the patient in peritoneal dialysis, optimizing in this way the survival of the patient and of the technique. In Spain, as in other neighbouring countries, peritoneal dialysis has an incidence and prevalence that is much lower than that of hemodialysis, ranging in the last evaluation by the Spanish Society of Nephrology between 5 and 24% in the different autonomous communities. The great majority of peritoneal dialysis units form part of the public network of the Spanish state, with special representation as a Satellite Unit or Concerted Center related to the public hospital of reference, on which it must depend.