https://hdl.handle.net/10481/31037 2026-04-20T06:56:08Z https://hdl.handle.net/10481/112861 Uptake of left bundle branch area pacing for cardiac resynchronization therapy in Spain: a budget impact analysis Sánchez Moreno, José Manuel; Jiménez Jáimez, Juan; Molina Lerma, Manuel; Álvarez, Miguel; García Mochón, Leticia This study forms part of the PhD thesis submitted by José M. Sánchez-Moreno (Exp. No. 108725), University of Granada. Funding for open access charge: Universidad de Granada / CBUA. https://hdl.handle.net/10481/112847 Incremental Prognostic Value of the CONUT Score for In-Hospital Mortality and Length of Stay in Hospitalized Patients Romero Márquez, José Manuel; Novo-Rodríguez, Cristina; Hayón Ponce, María; Novo Rodríguez, María; Muñoz-Garach, Araceli; Luna López, Victoria; Tenorio-Jiménez, Carmen Background: Disease-related malnutrition is highly prevalent among hospitalized patients and is associated with increased mortality, complications, and prolonged hospital stays. Early identification of patients at nutritional risk is therefore essential to improve clinical outcomes. The Controlling Nutritional Status (CONUT) score is an objective prognostic immunometabolic marker derived from serum albumin, total cholesterol, and lymphocyte count. This study aimed to evaluate the prognostic value of the CONUT score for in-hospital mortality and length of hospital stay (LOS) in hospitalized patients with moderate-to-severe nutritional risk and to determine whether incorporating CONUT improves the predictive performance of a clinical model based on routine admission variables. Methods: A retrospective observational cohort study was conducted, including 671 adult patients admitted to a tertiary university hospital with CONUT ≥ 6. Multivariable logistic regression was used to assess predictors of in-hospital mortality, while LOS was analyzed using multivariable linear regression. Model discrimination was evaluated using receiver operating characteristic (ROC) curve analysis and comparison of the area under the curve (AUC). Results: Higher CONUT scores were independently associated with increased in-hospital mortality. Each one-point increase in CONUT was associated with 28% higher odds of death (OR 1.28; 95% CI 1.13–1.46; p < 0.001). Patients with a severe CONUT score had significantly higher mortality compared with those with a moderate CONUT score (OR 1.77; 95% CI 1.12–2.81; p = 0.004). Incorporating CONUT into the clinical prediction model significantly improved discrimination, increasing the AUC from 0.728 to 0.753 (DeLong p = 0.035). Higher CONUT values were also associated with longer hospital stays: each additional point corresponded to a 5.4% increase in LOS (p = 0.009), and a severe CONUT score was associated with a 17.6% longer stay (p = 0.027). Conclusions: the CONUT score is independently associated with in-hospital mortality and prolonged hospitalization. While its incremental discriminative improvement is modest, its automated calculation from routine laboratory data makes it a practical and scalable tool for early risk stratification. https://hdl.handle.net/10481/112803 Gut-Derived Uremic Toxins as a Risk Factor for Vascular Damage in Patients with Chronic Kidney Disease Ruiz Fuentes, María Carmen; Rashki, Mahsa; Rísquez Chica, Noelia; Clavero García, Elena; Pereira Pérez, Elisa B.; Espigares Huete, María José; Wangensteen, Rosemary Patients with chronic kidney disease (CKD) have a markedly increased cardiovascular risk that is not fully explained by traditional risk factors. Gut-derived uremic toxins, indoxyl sulfate (IS), indole-3-acetic acid (IAA), and p-cresyl sulfate (pCS), are poorly cleared by dialysis and may contribute to vascular damage. This cross-sectional observational study included 70 patients with CKD under different clinical conditions (pre-dialysis, peritoneal dialysis, hemodialysis, and kidney transplantation) and 17 healthy controls. Serum levels of IS, IAA, pCS and Klotho were measured, and vascular damage was assessed by carotid intima–media thickness (IMT) using ultrasound. CKD patients showed higher concentrations of IS, IAA, and pCS compared with controls, with the highest levels observed in hemodialysis patients. Peritoneal dialysis was associated with elevated IS and pCS, whereas in kidney transplantation, IS and IAA levels did not differ significantly from controls, and pCS remained elevated. Carotid IMT was higher in patients with diabetes and those undergoing hemodialysis. IAA correlated significantly with left/mean IMT, and mean IMT was the only parameter associated with previous cardiovascular events. These findings suggest that gut-derived uremic toxins, particularly IAA, might be associated with subclinical vascular damage in advanced CKD, although larger studies are needed to confirm these associations. https://hdl.handle.net/10481/112636 Resilience and Gender Differences in Patients with End-Stage Renal Disease Receiving Hemodialysis: A Cross-Sectional Study Zaragoza Fernández, Gloria M.; De La Flor, José C.; Fernández Abreu, Verónica; Iglesias Castellano, Elisa; Esteban de la Rosa, Rafael José; Fernández Castillo, Rafael Introduction: End-stage renal disease and hemodialysis impose substantial physical and emotional demands that compromise patients’ psychological well-being. Psychological resilience—the capacity to adapt positively to chronic adversity—plays a protective role, yet its sociodemographic and gender-related determinants remain poorly characterized in hemodialysis populations. Objective: To evaluate psychological resilience in adults receiving maintenance hemodialysis and to examine its association with gender, educational level, and clinical variables. Methods: A cross-sectional study was conducted in 55 hemodialysis patients at the Central Defense Hospital “Gómez Ulla” (Madrid, Spain). Sociodemographic and clinical data were collected, and resilience was assessed using the 14-item Resilience Scale (RS-14). Statistical analyses included independent-samples t-tests, Spearman’s correlations, and multiple linear regression. Results: Patients reported moderate resilience levels (mean = 74.02, SD = 13.99). Men showed significantly higher resilience than women (77.74 vs. 67.50; p = 0.008). Educational attainment correlated positively with resilience (ρ = 0.307; p = 0.023). In the multivariate model, gender and education together explained 22% of the variance in resilience scores (R² = 0.22), while clinical variables showed no significant associations. Conclusions: This preliminary study suggests that gender and educational level may influence psychological resilience in patients undergoing hemodialysis. These associations should be interpreted with caution due to the small, single-center sample and the absence of key psychosocial and contextual variables. Larger, adequately powered multicenter studies incorporating multidimensional gender measures and broader sociodemographic indicators are needed to clarify the mechanisms shaping resilience in ESRD. Tailored psychosocial interventions may help strengthen emotional adaptation in vulnerable groups.; Introducción: La enfermedad renal terminal y la hemodiálisis imponen importantes demandas físicas y emocionales que comprometen el bienestar psicológico de los pacientes. La resiliencia psicológica —la capacidad de adaptarse positivamente ante una adversidad crónica— desempeña un papel protector; sin embargo, sus determinantes sociodemográficos y relacionados con el género siguen poco caracterizados en las poblaciones en hemodiálisis. Objetivo: Evaluar la resiliencia psicológica en adultos sometidos a hemodiálisis de mantenimiento y examinar su asociación con el género, el nivel educativo y diversas variables clínicas. Métodos: Se realizó un estudio transversal en 55 pacientes en hemodiálisis en el Hospital XXX XXX “XXX XXX” (Madrid, España). Se recogieron datos sociodemográficos y clínicos, y la resiliencia se evaluó mediante la Escala de Resiliencia de 14 ítems (RS-14). Los análisis estadísticos incluyeron pruebas t para muestras independientes, correlaciones de Spearman y regresión lineal múltiple. Resultados: Los pacientes presentaron niveles moderados de resiliencia (media = 74,02; DE = 13,99). Los hombres mostraron una resiliencia significativamente mayor que las mujeres (77,74 frente a 67,50; p = 0,008). El nivel educativo se correlacionó positivamente con la resiliencia (ρ = 0,307; p = 0,023). En el modelo multivariante, el género y la educación explicaron conjuntamente el 22% de la variabilidad en las puntuaciones de resiliencia (R² = 0,22), mientras que las variables clínicas no mostraron asociaciones significativas. Conclusiones: Este estudio preliminar sugiere que el género y el nivel educativo pueden influir en la resiliencia psicológica de los pacientes en hemodiálisis. Estas asociaciones deben interpretarse con cautela debido al tamaño muestral reducido, el diseño unicéntrico y la ausencia de variables psicosociales y contextuales relevantes. Se necesitan estudios multicéntricos, con suficiente potencia y que incorporen medidas multidimensionales de género y amplios indicadores sociodemográficos, para clarificar los mecanismos que configuran la resiliencia en la enfermedad renal terminal. Las intervenciones psicosociales personalizadas podrían contribuir a reforzar la adaptación emocional en los grupos más vulnerables. https://hdl.handle.net/10481/112615 Safety and preliminary efficacy findings from a phase 2a randomized, double-blind, placebo-controlled trial of setanaxib in patients with Alport syndrome Gale, Daniel; Agraz Pamplona, Irene; Zainab, Arslan; Esteban de la Rosa, Rafael José; Hall, Matthew; Krejci, Karel; Morales, Enrique; Safranek, Roman; Tesar, Vladimir; Torra, Roser; Lennon, Rachel The study (NCT06274489), evaluated setanaxib—a first-in-class NOX1/4 inhibitor—as a treatment to reduce fibrosis and inflammation in Alport syndrome (AS). Key Findings from the Trial 1. Safety (Primary Endpoint) The study met its primary safety objective. Setanaxib was generally well-tolerated over the 24-week period. • Adverse Events (AEs): Occurred at similar frequencies in both the setanaxib and placebo groups. • Serious Adverse Events (SAEs): One SAE (acute cholecystitis) was reported in the setanaxib group, but it was determined to be unrelated to the treatment. • Discontinuations: No patients discontinued the study due to drug-related side effects. 2. Efficacy (Secondary Endpoints) While the study was a small Phase 2a trial (N=20), it showed a positive trend in reducing proteinuria, a key marker of kidney disease progression. • UPCR Reduction: The setanaxib group showed a 15% mean reduction in the Urine Protein-Creatinine Ratio (UPCR) at 24 weeks compared to placebo. • Post-Dosing Effect: Interestingly, the reduction improved to 27% at four weeks after the treatment period ended. • Response Rate: 15.4% of patients on setanaxib achieved a \ge 25\% reduction in UPCR, whereas no patients in the placebo group reached this threshold. 3. Kidney Function (eGFR) • There was a slight mean reduction in eGFR (5% at 24 weeks) in the setanaxib group compared to placebo, which is often observed with therapies that alter glomerular hemodynamics. Study Design Overview • Participants: 20 patients (aged 12–50) with genetically confirmed Alport Syndrome and significant proteinuria (\text{UPCR} \ge 0.8 \text{ g/g}) despite being on standard-of-care ACE inhibitors or ARBs. • Regimen: Randomized 2:1 to receive either setanaxib (1200 mg or 1600 mg daily based on age) or a placebo for 24 weeks. • Mechanism: Setanaxib targets NOX1 and NOX4 enzymes, which produce reactive oxygen species (ROS) that drive the glomerular scarring and podocyte damage characteristic of Alport syndrome. Conclusion The investigators concluded that setanaxib has an acceptable safety profile and shows a clinically meaningful trend toward reducing proteinuria in Alport syndrome patients. These results support further investigation in a larger, Phase 3 clinical trial.