Ricardo Jauregui | Universidad Nacional de la Matanza (original) (raw)
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Papers by Ricardo Jauregui
Abstract The overall number of very elderly patients (>79 years of age) requiring renal replaceme... more Abstract The overall number of very elderly patients
(>79 years of age) requiring renal replacement therapy is
rising in the Western societies, with a choice for managing
advanced chronic renal disease among hemodialysis,
peritoneal dialysis, kidney transplant, conservative, or
palliative care. The selection of the most adequate alternatives
should be tailored to meet individual needs, considering
variables such as patient’s choice, clinical status,
and social context, analyzed from a geriatric perspective,
aiming not only to prolong patient’s life expectancy, but
also to improve the patient’s quality of life. Frailty and
sarcopenia are highly prevalent comorbidities found in
very elderly population, particularly in the end-stage
chronic renal disease population. Both comorbidities have
a strong negative impact on health general status, and specific
treatment should be provided in conjunction with the
selected management for renal replacement, except when
a palliative care has been implemented. Moreover, the
detected degree of frailty in a renal patient can have an
important influence on the decision about which modality
of renal replacement treatment will be selected. All these
alternatives and considerations are discussed in the present
review article
Human senescence induces changes in the renin-angiotensin-aldosterone system (RAAS) which consist... more Human senescence induces changes in the renin-angiotensin-aldosterone system (RAAS) which consists of a substantial decrease in its plasma activity. Consequently, the distal tubule´s capability of handling sodium and potassium is significantly reduced in the elderly, while distal tubule acidification is slightly delayed but preserved in this age group. Several studies in animal models support the hypothesis that senile renal structural changes could be induced by the local production of angiotensin II, and also that enalapril significantly decreases senile mesangial expansion, glomerulosclerosis and peritubular and medullar interstitial sclerosis. The same applies to several highly prevalent diseases in the elderly, such as hypertension, obesity, cardiac insufficiency, chronic nephropathy and dementia. In conclusion, the relationship between the RAAS and senescence is complex, since not only does aging cause many changes on this hormonal system, but also RAAS overactivity seems to be one of the main inducing mechanisms for normal senescence, and for many prevalent diseases in the elderly.
The prevalence of nutritional disorders and polypharmacy in the elderly is very high. We evaluate... more The prevalence of nutritional disorders and polypharmacy in the elderly is very high. We evaluated the occurrence of both in patients older than 80 years who were admitted in an acute patients ' hospital.
72.5% of patients who took more than 5 drugs were malnourished on admission. Even though more research is needed in this field, it seems that polypharmacy is associated to malnourishment in very old people.
Older people are high consumers of prescription drugs and are at increasing risk of polypharmacy ... more Older people are high consumers of prescription drugs and are at increasing risk of polypharmacy and adverse reactions. Pharmacokinetic and pharmacodynamic modifications due to age and co-morbidities are an important consideration, but pharmacological background evidence to guide safe and effective therapeutic approaches are often inadequate since the older population is under-represented in clinical trials. We review the pharmacokinetic and pharmacodynamic changes that are characteristic in old age and consider evidence regarding potentially safer prescription and monitoring of drugs commonly used in older patients. We also introduce the possible role of pharmacogenomics and therapeutic drug monitoring as tools to guide the individualization of drug therapy.
El término fragilidad ha evolucionado a lo largo del tiempo, conceptualizándolo como "riesgo" de ... more El término fragilidad ha evolucionado a lo largo del tiempo, conceptualizándolo como "riesgo" de morir, de perder funciones, de enfermar, asociado a debilidad, caídas, desnutrición. Distintas definiciones han incluido aspectos físicos, cognitivos y psicosociales. El debate acerca de la definición se centra en si deben o no asociarse factores psicosociales. La mayoría concuerda en que es un estado asociado al envejecimiento y en que, a pesar de la claridad del concepto, el mayor desafío radica en encontrar factores causales. Linda Fried publicó la definición de fragilidad como la presencia de 3 de los siguientes 5 criterios: fatiga crónica autorreferida, debilidad, inactividad, disminución de la velocidad de marcha y pérdida de peso. Este modelo fue replicado y sobre él se construyó el modelo moderno con identificación de factores causales fisiológicos, como activación del sistema de inflamación, alteración del sistema inmunitario, endocrino y musculoesquelético. También se consideran causales ciertas comorbilidades como hipertensión diastólica, ACV, cáncer y EPOC; se asoció asimismo a factores sociodemográficos entre los que se encuentran el sexo femenino y el nivel socioeducativo bajo. Por último se asoció discapacidad a fragilidad haciendo hincapié en la superposición de los conceptos discapacidad/fragilidad, dejando en claro que no son sinónimos ni son completamente excluyentes. Se concluye que la fragilidad es un síndrome multifactorial y que la detección de grupos de riesgo constituye el desafío de futuras investigaciones.
La sarcopenia se define como la pérdida progresiva y gradual de la masa, la función y la fuerza d... more La sarcopenia se define como la pérdida progresiva y gradual de la masa, la función y la fuerza del músculo esquelético que se presenta durante el proceso del envejecimiento. Todavía está en discusión hasta qué punto se puede considerar como un efecto deletéreo propio de la edad o como un síndrome geriátrico con repercusiones clínicas, daño funcional e incapacidad. Lo que es realmente fundamental es que la pérdida de la masa muscular esquelética contribuye a un mayor riesgo de discapacidad física, fragilidad, pérdida de la independencia, pobre calidad de vida, incremento en los costos para el cuidado de la salud y aumento en la tasa de mortalidad de las personas envejecidas. Su etiología es compleja y multifactorial. Recientemente diversos grupos de trabajo han centrado su interés en la investigación en el área de la sarcopenia, debido a las consecuencias que tiene en la salud y funcionalidad del adulto mayor. El objetivo de esta revisión es examinar la información disponible sobre la conceptualización, definición y métodos de diagnóstico de la sarcopenia. Se mencionan los métodos de determinación de la masa muscular esquelética por técnicas de imagen como la resonancia magnética y la absorciometría dual de energía de rayos X (DXA). Se considera su estimación a través de análisis de impedancia bioeléctrica y de ecuaciones de predicción. Se mencionan los puntos de corte que se han utilizado con mayor frecuencia para el diagnóstico de sarcopenia y, asimismo, se muestra su prevalencia en diversos estudios epidemiológicos y las propuestas de tratamientos actuales.
Objective: To describe the functional state, socio-economic status, and environmental situation o... more Objective: To describe the functional state, socio-economic status, and environmental situation of a very poor elderly (older than 65 years old) population in Argentina, and its relationship with their autonomy.
Obstructive nephropathy is the functional and /or parenchymal renal damage secondary to the urina... more Obstructive nephropathy is the functional and /or parenchymal renal damage secondary to the urinary tract occlusion at any part of it. The inducing urinary obstruction diseases can vary depending on the patient´s age and gender.
Argentina does not yet have a formal nationwide health programme for older people, so there are h... more Argentina does not yet have a formal nationwide health programme for older people, so there are huge differences in the quality and entitlement of health care for senior citizens. Academic infrastructure is also underdeveloped and this situation slows the advance of geriatrics. Teaching and research in this field is usually unpaid. However, a committed minority of teachers and health professionals are confident that their efforts are worthwhile and a new generation of geriatricians is starting to participate actively in international forums, to publish in recognized medical journals, to participate in Latin American academic forums such as ALMA (Latin American Academy of Senior Adult Medicine) and to foster geriatrics as a speciality.
Introduction: Since between 25-30% bone fractures, and 60% hip fractures in the general populatio... more Introduction: Since between 25-30% bone fractures, and 60% hip fractures in the general population are common in the subgroup which correspond to very old women. This happens due to the high predominance of primary osteoporosis and the incidence of falls which are characteristic of such group; thus, we have decided to investigate, through a systematic revision of the bibliography, the value of strontium in the prevention of bone fractures caused by falls in very old patients who suffer from primary osteoporosis.
Abstract The overall number of very elderly patients (>79 years of age) requiring renal replaceme... more Abstract The overall number of very elderly patients
(>79 years of age) requiring renal replacement therapy is
rising in the Western societies, with a choice for managing
advanced chronic renal disease among hemodialysis,
peritoneal dialysis, kidney transplant, conservative, or
palliative care. The selection of the most adequate alternatives
should be tailored to meet individual needs, considering
variables such as patient’s choice, clinical status,
and social context, analyzed from a geriatric perspective,
aiming not only to prolong patient’s life expectancy, but
also to improve the patient’s quality of life. Frailty and
sarcopenia are highly prevalent comorbidities found in
very elderly population, particularly in the end-stage
chronic renal disease population. Both comorbidities have
a strong negative impact on health general status, and specific
treatment should be provided in conjunction with the
selected management for renal replacement, except when
a palliative care has been implemented. Moreover, the
detected degree of frailty in a renal patient can have an
important influence on the decision about which modality
of renal replacement treatment will be selected. All these
alternatives and considerations are discussed in the present
review article
Human senescence induces changes in the renin-angiotensin-aldosterone system (RAAS) which consist... more Human senescence induces changes in the renin-angiotensin-aldosterone system (RAAS) which consists of a substantial decrease in its plasma activity. Consequently, the distal tubule´s capability of handling sodium and potassium is significantly reduced in the elderly, while distal tubule acidification is slightly delayed but preserved in this age group. Several studies in animal models support the hypothesis that senile renal structural changes could be induced by the local production of angiotensin II, and also that enalapril significantly decreases senile mesangial expansion, glomerulosclerosis and peritubular and medullar interstitial sclerosis. The same applies to several highly prevalent diseases in the elderly, such as hypertension, obesity, cardiac insufficiency, chronic nephropathy and dementia. In conclusion, the relationship between the RAAS and senescence is complex, since not only does aging cause many changes on this hormonal system, but also RAAS overactivity seems to be one of the main inducing mechanisms for normal senescence, and for many prevalent diseases in the elderly.
The prevalence of nutritional disorders and polypharmacy in the elderly is very high. We evaluate... more The prevalence of nutritional disorders and polypharmacy in the elderly is very high. We evaluated the occurrence of both in patients older than 80 years who were admitted in an acute patients ' hospital.
72.5% of patients who took more than 5 drugs were malnourished on admission. Even though more research is needed in this field, it seems that polypharmacy is associated to malnourishment in very old people.
Older people are high consumers of prescription drugs and are at increasing risk of polypharmacy ... more Older people are high consumers of prescription drugs and are at increasing risk of polypharmacy and adverse reactions. Pharmacokinetic and pharmacodynamic modifications due to age and co-morbidities are an important consideration, but pharmacological background evidence to guide safe and effective therapeutic approaches are often inadequate since the older population is under-represented in clinical trials. We review the pharmacokinetic and pharmacodynamic changes that are characteristic in old age and consider evidence regarding potentially safer prescription and monitoring of drugs commonly used in older patients. We also introduce the possible role of pharmacogenomics and therapeutic drug monitoring as tools to guide the individualization of drug therapy.
El término fragilidad ha evolucionado a lo largo del tiempo, conceptualizándolo como "riesgo" de ... more El término fragilidad ha evolucionado a lo largo del tiempo, conceptualizándolo como "riesgo" de morir, de perder funciones, de enfermar, asociado a debilidad, caídas, desnutrición. Distintas definiciones han incluido aspectos físicos, cognitivos y psicosociales. El debate acerca de la definición se centra en si deben o no asociarse factores psicosociales. La mayoría concuerda en que es un estado asociado al envejecimiento y en que, a pesar de la claridad del concepto, el mayor desafío radica en encontrar factores causales. Linda Fried publicó la definición de fragilidad como la presencia de 3 de los siguientes 5 criterios: fatiga crónica autorreferida, debilidad, inactividad, disminución de la velocidad de marcha y pérdida de peso. Este modelo fue replicado y sobre él se construyó el modelo moderno con identificación de factores causales fisiológicos, como activación del sistema de inflamación, alteración del sistema inmunitario, endocrino y musculoesquelético. También se consideran causales ciertas comorbilidades como hipertensión diastólica, ACV, cáncer y EPOC; se asoció asimismo a factores sociodemográficos entre los que se encuentran el sexo femenino y el nivel socioeducativo bajo. Por último se asoció discapacidad a fragilidad haciendo hincapié en la superposición de los conceptos discapacidad/fragilidad, dejando en claro que no son sinónimos ni son completamente excluyentes. Se concluye que la fragilidad es un síndrome multifactorial y que la detección de grupos de riesgo constituye el desafío de futuras investigaciones.
La sarcopenia se define como la pérdida progresiva y gradual de la masa, la función y la fuerza d... more La sarcopenia se define como la pérdida progresiva y gradual de la masa, la función y la fuerza del músculo esquelético que se presenta durante el proceso del envejecimiento. Todavía está en discusión hasta qué punto se puede considerar como un efecto deletéreo propio de la edad o como un síndrome geriátrico con repercusiones clínicas, daño funcional e incapacidad. Lo que es realmente fundamental es que la pérdida de la masa muscular esquelética contribuye a un mayor riesgo de discapacidad física, fragilidad, pérdida de la independencia, pobre calidad de vida, incremento en los costos para el cuidado de la salud y aumento en la tasa de mortalidad de las personas envejecidas. Su etiología es compleja y multifactorial. Recientemente diversos grupos de trabajo han centrado su interés en la investigación en el área de la sarcopenia, debido a las consecuencias que tiene en la salud y funcionalidad del adulto mayor. El objetivo de esta revisión es examinar la información disponible sobre la conceptualización, definición y métodos de diagnóstico de la sarcopenia. Se mencionan los métodos de determinación de la masa muscular esquelética por técnicas de imagen como la resonancia magnética y la absorciometría dual de energía de rayos X (DXA). Se considera su estimación a través de análisis de impedancia bioeléctrica y de ecuaciones de predicción. Se mencionan los puntos de corte que se han utilizado con mayor frecuencia para el diagnóstico de sarcopenia y, asimismo, se muestra su prevalencia en diversos estudios epidemiológicos y las propuestas de tratamientos actuales.
Objective: To describe the functional state, socio-economic status, and environmental situation o... more Objective: To describe the functional state, socio-economic status, and environmental situation of a very poor elderly (older than 65 years old) population in Argentina, and its relationship with their autonomy.
Obstructive nephropathy is the functional and /or parenchymal renal damage secondary to the urina... more Obstructive nephropathy is the functional and /or parenchymal renal damage secondary to the urinary tract occlusion at any part of it. The inducing urinary obstruction diseases can vary depending on the patient´s age and gender.
Argentina does not yet have a formal nationwide health programme for older people, so there are h... more Argentina does not yet have a formal nationwide health programme for older people, so there are huge differences in the quality and entitlement of health care for senior citizens. Academic infrastructure is also underdeveloped and this situation slows the advance of geriatrics. Teaching and research in this field is usually unpaid. However, a committed minority of teachers and health professionals are confident that their efforts are worthwhile and a new generation of geriatricians is starting to participate actively in international forums, to publish in recognized medical journals, to participate in Latin American academic forums such as ALMA (Latin American Academy of Senior Adult Medicine) and to foster geriatrics as a speciality.
Introduction: Since between 25-30% bone fractures, and 60% hip fractures in the general populatio... more Introduction: Since between 25-30% bone fractures, and 60% hip fractures in the general population are common in the subgroup which correspond to very old women. This happens due to the high predominance of primary osteoporosis and the incidence of falls which are characteristic of such group; thus, we have decided to investigate, through a systematic revision of the bibliography, the value of strontium in the prevention of bone fractures caused by falls in very old patients who suffer from primary osteoporosis.