Publications by authors named "Julio Hernandez Jaras"

Background: Kidney transplantation is the therapy of choice for patients with advanced chronic kidney disease; however, predicting graft outcomes remains a significant challenge. Early identification of reliable biomarkers could enhance post-transplant management and improve long-term outcomes. This study aimed to identify metabolomic biomarkers within the first week after kidney transplantation that predict renal function at six months.

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  • The study examines the effectiveness and safety of ultrafiltration (UF) compared to traditional diuretic therapy in treating cardiac decompensation associated with cardiorenal syndrome (CRS), especially when diuretics yield poor results.
  • Analyzed data from 13 studies involving around 1,100 patients showed that UF had better trends in reducing creatinine and facilitating greater weight loss and fluid removal compared to diuretics, without impacting mortality or hospital stay durations significantly.
  • The findings suggest that UF could be a beneficial alternative for patients not responding well to diuretics, potentially lowering readmission rates, though further prospective studies are necessary to confirm these benefits.
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Worldwide, 3.9 million individuals rely on kidney replacement therapy. They experience heightened susceptibility to cardiovascular diseases and mortality, alongside an increased risk of infections and malignancies, with inflammation being key to explaining this intensified risk.

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Background: X-linked hypophosphatemia (XLH) represents the most prevalent cause of hereditary hypophosphatemia. X-linked hypophosphatemia causes an elevation of fibroblast growth factor 23 (FGF23), a hormone responsible for inducing hyperphosphaturia, and reduced active vitamin D synthesis. Challenges in diagnosis and the absence of well-defined clinical guidelines have resulted in higher rates of late diagnoses.

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Article Synopsis
  • X-linked hypophosphatemia (XLH) is a genetic disorder linked to increased levels of fibroblast growth factor 23 (FGF23) and a higher risk of early-onset hypertension, but the exact causes of hypertension in XLH patients remain unclear.
  • A multicenter study of 20 adult XLH patients found that 45% had hypertension, with significant differences in creatinine and LDL cholesterol levels compared to those without hypertension.
  • The study also identified 106 metabolites, with several showing significant differences between hypertensive and non-hypertensive patients, potentially providing insights into hypertension mechanisms in XLH and guiding future research on biomarkers and diagnostics.
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Chronic kidney disease (CKD) affects approximately 12% of the global population, posing a significant health threat. Inflammation plays a crucial role in the uremic phenotype of non-dialysis-dependent (NDD) stage 5 CKD, contributing to elevated cardiovascular and overall mortality in affected individuals. This study aimed to explore novel metabolic pathways in this population using semi-targeted metabolomics, which allowed us to quantify numerous metabolites with known identities before data acquisition through an in-house polar compound library.

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  • Acquired perforating dermatosis (APD) is a rare skin condition, occurring in about 2.5 out of 100,000 people, associated with illnesses like end-stage renal disease and diabetes mellitus.
  • The authors present three cases of APD in patients undergoing peritoneal dialysis (PD), highlighting the connection with poor management of calcium and phosphorus metabolism.
  • The findings stress the importance of recognizing APD in patients with chronic kidney disease and comorbidities to ensure timely referral to dermatology for appropriate treatment.
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Background: Chronic kidney disease (CKD) is a common complication of a non-kidney solid organ transplant (NKSOT). Identifying predisposing factors is crucial for an early approach and correct referral to nephrology.

Methods: This is a single-center retrospective observational study of a cohort of CKD patients under follow-up in the Nephrology Department between 2010 to 2020.

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  • Bicarbonate dialysate uses acetate as a buffer to prevent bicarbonate salt precipitation, but citrate is being considered as a potentially better option due to its association with improved clinical outcomes.
  • This study conducted a cross-over analysis between two dialysates, one with acetate (AD) and the other with citrate (CD), collecting blood samples at different times to explore metabolomic differences.
  • The findings indicated that citrate dialysis improved clearance of certain uremic toxins, altered lysine degradation, and significantly raised levels of branched-chain amino acids compared to acetate, suggesting new pathways to investigate the clinical benefits of citrate in future studies.
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Background: During the 1900s, tacrolimus became the mainstay immunosuppressive agent to prevent rejection after kidney transplant. Subsequently, an extended-release tacrolimus (ER-Tac) formulation was developed to improve adherence, and its generic version has been marketed over the last years. This study examines the differences in efficacy and safety between the generic ER-Tac (Conferoport) and the reference brand-name drug (Advagraf).

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Acetate is widely used as a dialysate buffer to avoid the precipitation of bicarbonate salts. However, even at low concentrations that wouldn't surpass the metabolic capacity of the Krebs tricarboxylic acid (TCA) cycle, other metabolic routes are activated, leading to undesirable clinical consequences by poorly understood mechanisms. This study aims to add information that could biologically explain the clinical improvements found in patients using citrate dialysate.

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Patients on peritoneal dialysis (PD) have an increased risk of cardiovascular disease (CVD) and an atherogenic lipid profile generated by exposure to high glucose dialysis solutions. In the general population, the reduction of classic lipids biomarkers is associated with improved clinical outcomes; however, the same results have not been seen in PD population, a lack of data this study aims to fulfill. Single-center prospective observational study of a cohort of CKD patients who started renal replacement therapy with continuous ambulatory peritoneal dialysis.

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Background: SARS-CoV-2 infection has had a major impact on kidney transplant patients. Recent evidence suggests that solid organ transplant recipients who received mRNA vaccines reach low immunization rates. There are only few reports about the risk factors and severity of COVID-19 in these patients.

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Introduction: The composition of the dialysate is a crucial feature in the dialysis treatment. Two of its most debated elements are the optimal calcium concentration and the use of acetate as a buffer. Moreover, among the different alternatives to achieve acetate-free dialysis, the use of citrate is postulated as the most suitable option.

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Rare diseases are heterogeneous life-threatening or seriously debilitating conditions that affect < 1 in 2000 individuals, and most have a genetic component. The diagnostic process is usually based on classic clinical practices, such as physical examination, personal and family history (inheritance pattern), laboratory tests and image studies, but diagnosis can be delayed several years after the initiation of symptoms. The advances in molecular genetics that have taken place in recent years have led to an important shift in medical practice and in its approach to the diagnosis and treatment of many rare diseases.

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X-linked hypophosphataemic rickets (XLH) is the main form of hereditary rickets caused by mutation of the PHEX gene and occurs mainly in childhood. Clinically, it causes growth retardation and bone deformities; however, there are atypical forms of presentation that make diagnosis difficult. We present a case of XLH of late diagnosis and paucisymptomatic form with multiple fractures and greatly affecting quality of life, under treatment with traditional therapy for this disease.

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Objective: To report on 2 patients with alcoholic cirrhosis who were treated with transjugular intrahepatic portosystemic shunt (TIPS) placement.

Clinical Presentation And Intervention: The 2 patients had a history of alcoholic cirrhosis, and TIPS surgery was performed on them. In both cases, 4 months after TIPS placement, proteinuria was observed along with histological alterations characteristic of immune complex membranoproliferative glomerulonephritis (MPGN).

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Levamisole is illicitly employed as a cocaine adulterant. The consumption of levamisole-adulterated cocaine can provoke anti-neutrophil cytoplasmic antibody (ANCA)-associated syndromes. Patients carrying an HLAB27 allele are known to be at higher risk of developing agranulocytosis when treated with levamisole.

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Metabolic acidosis correction is achieved by the transfer of bicarbonate and other buffer anions in dialysis. The aim of this study was to evaluate changes in the main anions of intermediary metabolism on standard hemodiafiltration (HDF) and on acetate-free biofiltration (AFB). A prospective, in-center, crossover study was carried out with 22 patients on maintenance dialysis.

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Objective: To investigate the effects of an alternative peritoneal dialysis (PD) solution composed of a lactate/ bicarbonate (Lac/Bic) mixture (35/2 mmol/L), pH 7.0, on the appearance of cancer antigen 125 (CA125) in the peritoneal effluent.

Methods: Eight stable PD patients received a conventional solution containing 35 mmol/L lactate (Lac) for 11.

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