Lavilla, F.J. (Francisco Javier)
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- Karnofsky performance score in acute renal failure as a predictor of short-term survival(Wiley-Blackwell, 2007) Perez-Valdivieso, J.R. (José Ramón); Lavilla, F.J. (Francisco Javier); Bes-Rastrollo, M. (Maira); Monedero, P. (Pablo); Irala, J. (Jokin) deKarnofsky Performance Scale Index (KPS) is a measure of functional status that allows patients to be classified according to their functional impairment. We aim to assess if the prior KPS may predict the risk of death among patients with acute renal failure (ARF). METHODS: A cohort of 668 consecutive patients who had been admitted in an university-affiliated hospital between June 2000 and June 2006, and had been diagnosed with ARF, were studied. Three hundred and eighty-six patients with ARF who matched at least one of the RIFLE (Risk, Injury, Failure, Loss and End stage) criteria on increased serum creatinine were included for subsequent analysis. The group was divided into four categories, according to different Karnofsky scores measured by a nephrologist (>or=80, 70, 60 and or=80 Karnofsky group. Adjusted odds ratios were 8.87 (95% confidence interval (CI) 3.03-25.99), 6.78 (95% CI 2.61-17.58) and 2.83 (95% CI 1.04-7.68), for Karnofsky groups of
- Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study(BioMed Central, 2007) Perez-Valdivieso, J.R. (José Ramón); Lavilla, F.J. (Francisco Javier); Bes-Rastrollo, M. (Maira); Monedero, P. (Pablo); Irala, J. (Jokin) deThe aim of this study is to evaluate the association between acute serum creatinine changes in acute renal failure (ARF), before specialized treatment begins, and in-hospital mortality, recovery of renal function, and overall mortality at 6 months, on an equal degree of ARF severity, using the RIFLE criteria, and comorbid illnesses. METHODS: Prospective cohort study of 1008 consecutive patients who had been diagnosed as having ARF, and had been admitted in an university-affiliated hospital over 10 years. Demographic, clinical information and outcomes were measured. After that, 646 patients who had presented enough increment in serum creatinine to qualify for the RIFLE criteria were included for subsequent analysis. The population was divided into two groups using the median serum creatinine change (101%) as the cut-off value. Multivariate non-conditional logistic and linear regression models were used. RESULTS: A >or= 101% increment of creatinine respect to its baseline before nephrology consultation was associated with significant increase of in-hospital mortality (35.6% vs. 22.6%, p < 0.001), with an adjusted odds ratio of 1.81 (95% CI: 1.08-3.03). Patients who required continuous renal replacement therapy in the >or= 101% increment group presented a higher increase of in-hospital mortality (62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI: 1.00-7.21). Patients in the >or= 101% increment group had a higher mean serum creatinine level with respect to their baseline level (114.72% vs. 37.96%) at hospital discharge. This was an adjusted 48.92% (95% CI: 13.05-84.79) more serum creatinine than in the < 101% increment group. CONCLUSION: In this cohort, patients who had presented an increment in serum level of creatinine of >or= 101% with respect to basal values, at the time of nephrology consultation, had increased mortality rates and were discharged from hospital with a more deteriorated renal function than those with similar Liano scoring and the same RIFLE classes, but with a < 101% increment. This finding may provide more information about the factors involved in the prognosis of ARF. Furthermore, the calculation of relative serum creatinine increase could be used as a practical tool to identify those patients at risk, and that would benefit from an intensive therapy.
- Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injury(Wiley-Blackwell, 2008) Perez-Valdivieso, J.R. (José Ramón); Lavilla, F.J. (Francisco Javier); Bes-Rastrollo, M. (Maira); Monedero, P. (Pablo); Irala, J. (Jokin) deAIM: The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor. METHODS: In this prospective study, we analysed the data gathered from a cohort of 956 patients admitted in a Spanish tertiary hospital between January 1998 and April 2006. Hazard ratios for mortality, and survival curves within 60 days were calculated. Discrimination and calibration of the model were also assessed. RESULTS: Excluding 53 patients, 903 patients were finally analysed. We classified them into groups according to the maximum RIFLE class reached during their admission. The RIFLE class was assessed by the glomerular filtration rate criterion. We found an increase in the in-hospital mortality risk. Cox proportional hazard models showed that RIFLE classes risk, injury, and failure were significant predictive factors (hazard ratios were 2.77, 3.23 and 3.52, respectively; P for trend was 0.005). The multivariate analyses from the cross-classification of the participants according to Liano score values (severity of illness) and RIFLE classes showed additive effects of the exposures on in-hospital mortality. CONCLUSION: In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system.
- Increased fibroblast growth factor 23 in heart failure: biomarker, mechanism, or both?(Elsevier, 2019) Martín, P.L. (Paloma L.); Lavilla, F.J. (Francisco Javier); Ravassa, S. (Susana); Romero-González, G. (Gregorio); Gonzalez, A. (Arantxa); Garcia-Fernandez, N. (Nuria); López, B. (Begoña); Diez, J. (Javier)
- Ejercicio físico e insuficiencia renal crónica(Universidad de Navarra, 1993) Vazquez, C. (C.); Lavilla, F.J. (Francisco Javier); Errasti, P. (Pedro); Bolaños, L. (L.); Mesa, L. (L.)Los pacientes con insuficiencia renal crónica tienen una menor capacidad física y un conjunto de alteraciones metabólicas, cardiovasculares y psicológicas. Los programas de ejercicio físico, no sólo, han demostrado ser efectivos en mejorar la capacidad física de los pacientes en hemodiálisis sino que permiten un mejor control de la hipertensión, metabolismo lipídico y glucídico, de la anemia y la depresión. Queda todavía por ser determinado si los programas de ejercicio pueden, en última instancia, reducir la morbilidad, prolongar la supervivencia y mejorar la calidad de vida de estos pacientes. De todas maneras, el ejercicio físico debe ser considerado como un importante aspecto en la rehabilitación de estos pacientes.
- Serum C-reactive protein on the prognosis of oncology patients with acute renal failure: an observational cohort study(Elsevier, 2008) Perez-Valdivieso, J.R. (José Ramón); Lopez-Olaondo, L. (Luis); Lavilla, F.J. (Francisco Javier); Bes-Rastrollo, M. (Maira); Monedero, P. (Pablo); Irala, J. (Jokin) deWe undertook this study to evaluate the significance of the C-reactive protein level (CRP) as a prognostic factor in oncology patients with acute renal failure (ARF) during nephrology consultation. METHODS: The study was comprised of a cohort of 375 consecutive oncology patients who had been admitted to a university-affiliated hospital between March 1998 and April 2006 and had been diagnosed with ARF. One hundred and fifty nine patients with ARF who matched at least one of the RIFLE criteria on increased serum creatinine were included for subsequent analysis. We used a Cox proportional hazard model. RESULTS: Clinical pathological variables were compared among patients with serum CRP levels > or =8 mg/dL (exposed group; cut-off point: median) and patients with serum CRP level <8 mg/dL (control group). In-hospital mortality rates associated with CRP levels were 53.8% for > or =8 mg/dL and 21.5% for <8 mg/dL (p <0.001). After adjusted analysis, the presence of a CRP level > or =8 mg/dL was significantly associated with an increased in-hospital mortality (HR 2.10; 95% CI: 1.17-3.78) than in those patients with similar Liano scoring, the same RIFLE classes, and the same treatment for ARF. In addition, each increment of 1 mg/dL of serum CRP was associated with an adjusted 4% increment of in-hospital mortality (HR 1.04, 95% CI: 1.01-1.06). CONCLUSIONS: CRP levels at nephrology consultation were an independent predictor of death in this cohort of oncology patients with ARF. Patients with levels > or =8 mg/dL may be considered at higher risk of death.
- Aspectos emergentes en el fracaso renal agudo(Sociedad Española de Nefrología, 2003) Lavilla, F.J. (Francisco Javier)