Diabetic kidney disease (DKD) is the leading cause of ESRD. We conducted an open-label, prospective, randomized trial to determine whether pentoxifylline (PTF), which reduces albuminuria, in addition to renin-angiotensin system (RAS) blockade, can slow progression of renal disease in patients with type 2 diabetes and stages 3-4 CKD. Participants were assigned to receive PTF (1200 mg/d) (n=82) or to a control group (n=87) for 2 years. All patients received similar doses of RAS inhibitors. At study end, eGFR had decreased by a mean6SEM of 2.160. patients with a rate of eGFR decline greater than the median rate of decline (0.16 ml/min per 1.73 m 2 per month) was lower in the PTF group than in the control group (33.3% versus 68.2%; P,0.001). Percentage change in urinary albumin excretion was 5.7% (95% CI, 20.3% to 11.1%) in the control group and 214.9% (95% CI, 220.4% to 29.4%) in the PTF group (P=0.001). Urine TNF-a decreased from a median 16 ng/g (interquartile range, 11-20.1 ng/g) to 14.3 ng/g (interquartile range, 9.2-18.4 ng/g) in the PTF group (P,0.01), with no changes in the control group. In this population, addition of PTF to RAS inhibitors resulted in a smaller decrease in eGFR and a greater reduction of residual albuminuria. 26: 220-229, 201526: 220-229, . doi: 10.1681 Diabetic kidney disease (DKD) is the most frequent cause of CKD, and ESRD in type 2 diabetes is considered a medical catastrophe. 1 Strong evidence supports the blockade of the renin-angiotensin system (RAS), most commonly with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptors blockers (ARBs), as an established standard of care in these patients to reduce the risk of developing ESRD. 2 However, these therapies do not provide complete renal protection, 3 and diabetic patients continue to show a high renal risk, which is positively associated with residual albuminuria. 4 Unfortunately, recent studies evaluating new strategies to delay the progression of diabetic nephropathy (DN) have had little success. Trials with pyridoxamine or sulodexide failed to detect a renoprotective effect in patients with type 2 diabetes and renal impairment. 5,6 Meanwhile, studies with the endothelin antagonist avosentan, 7 J Am Soc Nephrol

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Background and Aims The clinical profile and complexity of hospitalised patients from Vascular Surgery are similar to those from Nephrology. Also, the majority of patients with peripheral vascular disease has some degree of chronic kidney disease. Therefore, the collaboration of nephrologist as consultants could have a significant impact on the adequate attention of these patients. Our aim was to analyze the epidemiological and clinical characteristics of the vascular surgery patients admitted in a public university hospital of 1000 beds that were attended by a nephrologist during their hospitalization. Method Observational study of a retrospective cohort of 138 patients in a 1 year period (January 1st to December 31st 2018). The following data were considered: nature of the consultation (“Urgent” LESS THAN 24 H TO BE ATTENDER OR “Standar”), reason for consultation/nephrological diagnosis, cause of admission, follow-up period, age, sex, presence of : Diabetes Mellitus (DM), Hypertension (HT) and/or Chronic Kidney Disease (CKD) presence. Results 138 patients, Mean age was 67,8 y (range 35-92 y). 76,81% were men and 23,19% were women. Most frequent cause for consultations were: 1. Patients on Hemodialysis treatment (66 = 47,83%); 2. Exhacerbations of CKD (29 = 21,01%); 3. Acute Kidney Failure (18 = 13,04%); 4. Kidney transplantation (11 = 7,97%); 5. Ionic alterations (7 = 5,07%); 6. Advanced CKD (6=4,35%). Cause of admission: 1. Chronic lower limb ischemia (68=49,27%); 2. Problems related to arteriovenous fistula (Creation of vascular access: 10=7,25% and complications of vascular access: 16=11,59%); 3. Aneurysmatic complications (14=10,14%); 4. Diabetic foot (11=7,97%); 5. Infections (7=5,07%); 6. Deep venous thrombosis (6=4,35%). About 75.35% had DM, 91.30% were hypertensive and 62.32% had both clinical conditions. The average follow-up time was 72 days (range 1-223 days) and 92,03 % need to be follow-up more than 24 hours. About 49,27% of the consultation were urgent. Conclusion The number of patients admitted to vascular surgery department requiring nephrology attention are high and represents an important percentage of the clinical activities and resources demanding to the nephrology service. Exhacerbations of CKD, Diabetes Mellitus and Hypertension are constant clinical conditions in patients admitted to vascular surgery requiring nephrology assessment. Based on these data is important to improve the coordination between both departments and to stablish a specific training program for nephrologist and vascular surgeons in order to optimize the management of this patients.

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