Lavilla, J. (Javier)

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2011 - 20203

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    Timing of renal replacement therapy after cardiac surgery: a retrospective multicenter Spanish Cohort Study
    (Karger Publishers, 2011) Herreros, J. (Jesús); Perez-Valdivieso, J.R. (José Ramón); Lavilla, J. (Javier); Bes-Rastrollo, M. (Maira); Vives, M. (Marc); Monedero, P. (Pablo); Garcia-Fernandez, N. (Nuria)
    Background: The optimal time to initiate renal replacement therapy (RRT) in cardiac surgery-associated acute kidney injury (CSA-AKI) is unknown. Evidence suggests that the early use of RRT in critically ill patients is associated with improved outcomes. We studied the effects of time to initiation of RRT on outcome in patients with CSA-AKI. Methods: This was a retrospective observational multicenter study (24 Spanish hospitals). We analyzed data on 203 patients who required RRT after cardiac surgery in 2007. The cohort was divided into 2 groups based on the time at which RRT was initiated: in the early RRT group, therapy was initiated within the first 3 days after cardiac surgery; in the late group, RRT was begun after the 3rd day. Multivariate nonconditional logistic and linear regression models were used to adjust for potential confounders. Results: In-hospital mortality was significantly higher in the late RRT group compared with early RRT patients (80.4 vs. 53.2%; p < 0.001; adjusted odds ratio of 4.1, 95% CI: 1.6–10.0). Also, patients in the late RRT group had longer adjusted hospital stays by 11.6 days (95% CI: 1.4–21.9) and higher adjusted percentage increases in creatinine at discharge compared with baseline by 67.7% (95% CI: 28.5–106.4). Conclusions: Patients who undergo early initiation of RRT after CSA-AKI have improved survival rates and renal function at discharge and decreased lengths of hospital stay.
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    External validation and comparison of three scores to predict renal replacement therapy after cardiac surgery: A multicenter cohort
    (SAGE Publications, 2011) Herreros, J. (Jesús); Perez-Valdivieso, J.R. (José Ramón); Lavilla, J. (Javier); Bes-Rastrollo, M. (Maira); Vives, M. (Marc); Monedero, P. (Pablo); Garcia-Fernandez, N. (Nuria)
    Purpose: Cardiac surgery-associated acute kidney injury requiring renal replacement therapy (RRT) is independently associated with mortality. Several risk scores have been developed to predict the need for RRT after cardiac surgery. We have compared and verified the external validity of the three main available scores for RRT prediction after cardiac surgery: the Thakar score, the Mehta tool, and the Simplified Renal Index. Methods: The risk scores were calculated in a cohort of 1084 adult patients, 248 of whom required RRT, who underwent open-heart surgery in 24 Spanish hospitals in 2007. The performance of the systems was determined by examining their discrimination (areas under the receiver operating characteristic curves (aROC) and calibration (Lemeshow-Hosmer chi-square goodness-of-fit statistics). Results: The aROCs in the Thakar score, the Mehta tool, and the Simplified Renal Index were 0.82, 0.76 and 0.79, respectively. The three scoring systems were poorly calibrated and tended to underestimate the actual need for RRT. Conclusions: The Thakar score and the Simplified Renal Index discriminated well between low - and high-risk patients in our cohort, and Thakar outperformed the Mehta tool. These best-performing scores may aid in the selection of optimal therapy, facilitate the planning of hospital resource utilization, improve preoperative counseling, select participants for clinical trials of renal-protective therapies and enable an accurate comparison between different institutions or surgeons.
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    Burden and challenges of heart failure in patients with chronic kidney disease. A call to action
    (Elsevier, 2020) Martín, P.L. (Paloma L.); Moreno, M.U. (María Ujué); Ania-González, N. (Noelia); Lavilla, J. (Javier); Ravassa, S. (Susana); Beaumont, F.J. (Francisco J.); Romero-González, G. (Gregorio); Osacar, E. (Elena); De-Lorenzo, I. (Ignacio); Amézqueta, P. (Pilar); Gonzalez, A. (Arantxa); Rojas, M.A. (Miguel Angel); Garcia-Fernandez, N. (Nuria); San-Jose, G. (Gorka); García-Trigo, I. (Isabel); González, O. (Omar); López, B. (Begoña); Diez, J. (Javier)
    Patients with the dual burden of chronic kidney disease (CKD) and chronic congestive heart failure (HF) experience unacceptably high rates of symptom load, hospitalization, and mortality. Currently, concerted efforts to identify, prevent and treat HF in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this review paper endorse the need for a dedicated cardiorenal interdisciplinary team that includes nephrologists and renal nurses and jointly manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for guidelines and best clinical practice models from major cardiology and nephrology professional societies, as well as for research funding in both specialties to focus on the needs of future therapies for HF in CKD patients. The implementation of crossspecialty educational programs across all levels in cardiology and nephrology will help train future specialists and nurses who have the ability to diagnose, treat, and prevent HF in CKD patients in a precise, clinically effective, and cost-favorable manner.