I began my research activity at the Virgen Macarena University Hospital in Seville and continued at La Mancha-Centro Hospital, the Spanish Society of Nephrology and the Spanish Liver and Kidney Association. Principal investigator of multicenter studies and clinical trials and European coordinator. Member of the Pharmacy Commission and the Research, Teaching and Training Commission for 7 years. Resident tutor for 15 years. Author or co-author of more than 30 scientific articles published in indexed journals, 90 communications and 17 books or chapters. Editor of 6 scientific books and co-editor and reviewer of the journal of the Spanish Society of Nephrology and the digital platform Nefrología al Día. Director of final degree projects at the Faculty of Medicine of Ciudad Real. Member of the organizing committee of more than 35 scientific events. Coordinator of a research group at the Research Institute of Castilla-La Mancha (IDISCAM). Head of Nephrology Department since 2008.
EDUCATION
Graduate in Medicine (2002) in the University of Cádiz. Nephrology Specialist Physician at the Virgen Macarena University Hospital in Seville. Doctorate in Medicine (2013) from the University of Seville. Expert in Hemodialysis (2009) from the Complutense University of Madrid. Master in Research Methodology (2014) from the University of Barcelona. Master in Renal Pathology (2020) from the Rey Juan Carlos University. Certified in Management of Nephrology Services by the Andalusian School of Public Health (2022).
RESEARCH, TEACHING, or OTHER INTERESTS
Nephrology, Hepatology, Infectious Diseases
37
Scopus Publications
Scopus Publications
Genetic Characterization of Kidney Failure of Unknown Etiology in Spain: Findings From the GENSEN Study Miquel Blasco, Borja Quiroga, José M. García-Aznar, Cristina Castro-Alonso, Saulo J. Fernández-Granados, Enrique Luna, Gema Fernández Fresnedo, Marta Ossorio, María Jesús Izquierdo, Didier Sanchez-Ospina, Laura Castañeda-Infante, Ricardo Mouzo, Mercedes Cao, María L. Besada-Cerecedo, Ricardo Pan-Lizcano, Roser Torra, Alberto Ortiz, Patricia de Sequera, Victoria Eugenia García Montemayor, Mercedes Salgueira Lazo, Auxiliadora Mazuecos Blanca, Tamara Jiménez Salcedo, María José Espigares Huete, Elena Araceli Jiménez Vibora, Concepción Álamo Caballero, Eduardo J. Banegas Deras, Alejandro Alonso Bethencourt, Alejandra Rodríguez García, Saulo Fernández Granados, Gema Fernández Fresnedo, Leonardo Calle García, Jesús Martín García, Jorge Estifan Kasabji, María Jesús Izquierdo, Ricardo Mouzo Mirco, Rebeca García Agudo, Gabriel de Arriba de la Fuente, Carme Facundo Molas, Marc Xipell Font, Alejandra Yugueros González, Paula Antóns, Meritxell Ibernon Vilaro, Vanessa de la Fuente Fernández, Yussel González Galván, Antonio Cabezas, Cristina Castro Alonso, Isabel Juan García, Eduardo Garín Cascales, Josepa Sebastiá Morant, Enrique Luna Complejo, Rosa María Díaz Campillejo, Silvia González Sanchidrián, Mercedes Cao Vilariño Complejo, Milagros Sierra Carpio, Mayra Ortega Díaz, Rosa Sánchez Hernández, Marta Ossorio González, Almudena Vega Martínez, María Teresa López Picasso, Elena Goma, Martín Giorgi, Patricia Martínez Miguel, Eduardo Gutiérrez Martínez, Vicente Paraíso Cuevas, Rocío Echarri, Víctor Martínez, Mario Pérez Arnedo, Laura Juliana Castañeda Infante, Jose Antonio Menacho Miguel American Journal of Kidney Diseases, 2024 RATIONALE & OBJECTIVE Chronic kidney disease (CKD) of unknown etiology (CKDUE) is one of the main global causes of kidney failure. While genetic studies may identify an etiology in these patients, few studies have implemented genetic testing of CKDUE in population-based series of patients which was the focus of the GENSEN. STUDY DESIGN Case series. SETTINGS & PARTICIPANTS 818 patients aged ≤45 years at 51 Spanish centers with CKDUE, and either an estimated GFR <15 mL/min/1.73 m2 or treatment with maintenance dialysis or transplantation. OBSERVATIONS Genetic testing for 529 genes associated to inherited nephropathies using high-throughput sequencing (HTS). Pathogenic and/or likely pathogenic (P/LP) gene variants concordant with the inheritance pattern were detected in 203 (24.8%) patients. Variants in type IV collagen genes were the most frequent (COL4A5, COL4A4, COL4A3; 35% of total gene variants), followed by NPHP1, PAX2, UMOD, MUC1 and INF2 (7.3%, 5.9%, 2.5%, 2.5% and 2.5% respectively). Overall, 87 novel variants classified as P/LP were identified. The top 5 most common previously undiagnosed diseases were Alport syndrome spectrum (35% of total positive reports), genetic podocytopathies (19%), nephronophthisis (11%), autosomal dominant tubulointerstitial kidney disease (7%) and congenital anomalies of the kidney and urinary tract (CAKUT: 5%). Family history of kidney disease was reported by 191 (23.3 %) participants and by 65/203 (32.0%) patients with P/LP variants. LIMITATIONS Missing data. Selection bias resulting from voluntary enrollment. CONCLUSIONS Genomic testing with HTS identified a genetic cause of kidney disease in approximately one quarter of young patients with CKDUE and advanced kidney disease. These findings suggest that genetic studies are a potentially useful tool for the evaluation of people with CKDUE.
Eligibility test for advanced chronic kidney disease: Revision and proposal Rebeca García Agudo, Marina Méndez Molina, Sara Piqueras Sánchez, Antonio Tejera‐Muñoz Therapeutic Apheresis and Dialysis, 2024 Nowadays, chronic kidney disease (CKD) prevalence keeps increasing worldwide. The management of these patients usually requires renal replacement therapy (RRT). However, the complexity of patients' profiles comprises a great challenge to overcome. During the last decades, CKD units have been developed to offer multidisciplinary and coordinated attention to patients, helping in the decision‐making of the RRT. Nevertheless, there is a huge variability in the performance and organization of care practice, implying an existing necessity to homogenize the RRT modality chosen. We propose a test composed of two parts: one to be completed by the medical staff (to evaluate contraindications for the different RRT techniques) and another by the patient or nursing staff (to consider patients' preferences). In this sense, it would be possible to have a common and useful tool to complement patient education in RRT, as well as sharing decision‐making in the ACKD units taking into account patient preferences.
COVID-19 in Patients with Glomerular Disease: Follow-Up Results from the IRoc-GN International Registry Meryl Waldman, Maria Jose Soler, Clara García-Carro, Liz Lightstone, Tabitha Turner-Stokes, Megan Griffith, Joan Torras, Laura Martinez Valenzuela, Oriol Bestard, Colin Geddes, Oliver Flossmann, Kelly L. Budge, Chiara Cantarelli, Enrico Fiaccadori, Marco Delsante, Enrique Morales, Eduardo Gutierrez, Jose A. Niño-Cruz, Armando J. Martinez-Rueda, Giorgia Comai, Claudia Bini, Gaetano La Manna, Maria F. Slon, Joaquin Manrique, Alejandro Avello, Raul Fernandez-Prado, Alberto Ortiz, Smaragdi Marinaki, Carmen Rita Martin Varas, Cristina Rabasco Ruiz, Milagros Sierra-Carpio, Rebeca García-Agudo, Gema Fernández Juárez, Alexander J. Hamilton, Annette Bruchfeld, Constantina Chrysochou, Lilian Howard, Smeeta Sinha, Tim Leach, Irene Agraz Pamplona, Umberto Maggiore, Paolo Cravedi Kidney360, 2022 Key Points Mortality and incidence of AKI do not differ between coronavirus disease 2019 (COVID-19) patients with or without glomerular diseases.The main predictor of AKI is pre-COVID-19 eGFR, independent of the presence of GN.Incomplete kidney function recovery after COVID-19-associated AKI is more common in GN patients than in controls. Background The acute and long-term effects of severe acute respiratory syndrome coronavirus 2 infection in individuals with GN are still unclear. To address this relevant issue, we created the International Registry of COVID-19 infection in GN. Methods We collected serial information on kidney-related and -unrelated outcomes from 125 GN patients (63 hospitalized and 62 outpatients) and 83 non-GN hospitalized patients with coronavirus disease 2019 (COVID-19) and a median follow-up period of 6.4 (interquartile range 2.3–9.6) months after diagnosis. We used logistic regression for the analyses of clinical outcomes and linear mixed models for the longitudinal analyses of eGFR. All multiple regression models were adjusted for age, sex, ethnicity, and renin-angiotensin-aldosterone system inhibitor use. Results After adjustment for pre-COVID-19 eGFR and other confounders, mortality and AKI did not differ between GN patients and controls (adjusted odds ratio for AKI=1.28; 95% confidence interval [CI], 0.46 to 3.60; P=0.64). The main predictor of AKI was pre-COVID-19 eGFR (adjusted odds ratio per 1 SD unit decrease in eGFR=3.04; 95% CI, 1.76 to 5.28; P<0.001). GN patients developing AKI were less likely to recover pre-COVID-19 eGFR compared with controls (adjusted 6-month post-COVID-19 eGFR=0.41; 95% CI, 0.25 to 0.56; times pre-COVID-19 eGFR). Shorter duration of GN diagnosis, higher pre-COVID-19 proteinuria, and diagnosis of focal segmental glomerulosclerosis or minimal change disease were associated with a lower post-COVID-19 eGFR. Conclusions Pre-COVID-19 eGFR is the main risk factor for AKI regardless of GN diagnosis. However, GN patients are at higher risk of impaired eGFR recovery after COVID-19-associated AKI. These patients (especially those with high baseline proteinuria or a diagnosis of focal segmental glomerulosclerosis or minimal change disease) should be closely monitored not only during the acute phases of COVID-19 but also after its resolution.
Sublingual vaccination with inactivated bacteria in recurrent urinary tract infection of nephrologic patients: experience in a center in Spain Rebeca García Agudo, Beatriz Proy Vega, Ángel Arias Arias, Nayara Panizo González, Fátima Cazalla Cadenas, Elisa Berta Pereira Pérez, Olga Redondo González Revista Colombiana De Nefrologia, 2020 Introducción: Las infecciones del tracto urinario (ITU) son frecuentes en los pacientes con enfermedad renal crónica (ERC). Una opción de tratamiento en la ITU recurrente es la vacunación bacteriana sublingual. El objetivo de este estudio fue determinar la respuesta a la vacunación en pacientes nefrológicos con ITU recurrente.
 Métodos: Estudio cuasi experimental antes-después de 15 meses en los pacientes con ITU recurrente de las consultas externas de nefrología. Tras recibir tratamiento antibiótico según antibiograma para cada ITU, tomaron un ciclo de la vacuna sublingual bacteriana Uromuneâ durante tres meses. Se recogieron datos sociodemográficos, factores de riesgo asociados, análisis de sangre y orina, episodios de ITU en los seis meses previos y posteriores, microorganismos causantes, tratamiento antibiótico concomitante, respuesta al tratamiento y resolución de la ITU.
 Resultados: Se incluyeron 26 pacientes (80,8% mujeres) de 61,9 ± 18,4 años, 46,2% con diabetes y 147,7% con afectación de la función renal. El número de ITU fue de 3,62 ± 1,77 (1-7) antes de la vacuna y de 1,69 (0-5) después. Se recogieron 184 urocultivos: 74,9% positivos, 16,9% negativos y 8,2% contaminados. Los gérmenes más frecuentes fueron Escherichia coli (55,4%), Enterococcus faecalis (6%) y Enterobacter cloacae (2,7%). El 50% presentó síndrome miccional, que se asoció inversamente con la edad (p < 0,05). El 26,9% no volvió a tener una ITU y el 73,1% tuvo menos episodios. Los pacientes con enfermedad renal crónica avanzada (estadios 4-5) respondieron peor a la vacuna (92,9% vs 50%, p = 0,025).
 Conclusiones: La vacunación bacteriana sublingual es una buena opción de tratamiento en la ITU recurrente de los pacientes nefrológicos, siendo más eficaz en los que presentan mejor función renal.
Urinary tract infection in chronic kidney disease patients Rebeca García- Agudo, Nayara Panizo, Beatriz Proy Vega, Pedro García Martos, Ana Fernández Rodríguez Revista Colombiana De Nefrologia, 2020 Infections in chronic kidney disease patients are a major cause of morbidity and mortality. Renal patients have specific risk factors for acquiring infections, which also tend to be more severe and have a more rapid progression and slower resolution than in the healthy individuals. Urinary tract infection in renal patients is often complicated due to the presence of diabetes, multiresistant microorganisms, anatomic or functional abnormalities of the urinary tract, metabolic disturbances and the frequent use of urinary catheters. It causes one of the highest rates of hospitalization among dialysis patients and is highly prevalent in kidney transplantation. The aim of this work is to review the etiology, microbiological diagnosis and treatment of urinary tract infections in chronic kidney disease patients.
Efficacy and safety of direct-acting antiviral agents for HCV in mild-to-moderate chronic kidney disease Ezequiel Ridruejo, Rebeca Garcia-Agudo, Manuel Mendizabal, Sami Aoufi-Rabih, Vivek Dixit, Marcelo Silva, Fabrizio Fabrizi Nefrologia, 2020 Background and aims: The advent of direct-acting antiviral agents promises to change the management of hepatitis C virus infection (HCV) in patients with chronic kidney disease (CKD), a patient group in which the treatment of hepatitis C was historically challenging. We investigated the safety and efficacy of all-oral, interferon-free direct-acting antiviral agents for the treatment of hepatitis C in a 'real-world' cohort of patients with CKD. Methods: We performed an observational single-arm multi-centre study in a large (n = 198) cohort of patients with stage 1–3 CKD who underwent antiviral therapy with DAAs for the treatment of HCV. The primary end-point was sustained virologic response (serum HCV RNA <15 IU/mL, 12 weeks after treatment ended) (SVR12). We collected data on on-treatment adverse events (AEs), severe AEs, and laboratory abnormalities. Results: The average baseline eGFR (CKD-EPI equation) was 70.06 ± 20.1 mL/min/1.72 m2; the most common genotype was HCV 1b (n = 93, 51%). Advanced liver scarring was found in 58 (46%) patients by transient elastography. Five regimens were adopted: elbasvir/grazoprevir (n = 5), glecaprevir/pibrentasvir (n = 4), ritonavir-boosted paritaprevir/ombitasvir/dasabuvir (PrOD) regimen (n = 40), simeprevir ± daclatasvir (n = 2), and sofosbuvir-based combinations (n = 147). The SVR12 rate was 95.4% (95% CI, 93.8%; 96.8%). There were nine virological failures – eight being relapsers. Adverse events occurred in 30% (51/168) of patients, and were managed clinically without discontinuation of therapy or hospitalization. One of the most common AEs was anaemia (n = 12), which required discontinuation or dose reduction of ribavirin in some cases (n = 6); deterioration of kidney function occurred in three (1.7%). Conclusions: All-oral, interferon-free therapy with DAAs for chronic HCV in mild-to-moderate CKD was effective and well-tolerated in a 'real–world' clinical setting. Studies are in progress to address whether sustained viral response translates into better survival in this population. Resumen: Antecedentes y objetivos: La aparición de los antivíricos de acción directa (AAD) promete cambiar el tratamiento de la infección por el virus de la hepatitis C (VHC) en los pacientes con nefropatía crónica (NC), un grupo de pacientes en el que el tratamiento de la hepatitis C siempre supuso una dificultad. Se investiga la seguridad y la eficacia de los antivíricos de acción directa, sin interferones orales, en todos los casos para el tratamiento de la hepatitis C en una cohorte en condiciones reales de pacientes con NC. Métodos: Se llevó a cabo un estudio multicéntrico, de un solo grupo y observacional en una cohorte amplia (n = 198) de pacientes con NC en estadio 1-3 a los que se administró tratamiento antivírico con AAD para el VHC. El criterio principal de valoración fue la respuesta virológica sostenida (ARN sérico del VHC < 15 UI/ml, 12 semanas después de la finalización del tratamiento) (RVS12). Se recogieron los datos sobre acontecimientos adversos (AA) surgidos durante el tratamiento, AA graves y anomalías analíticas. Resultados: La FGe inicial media (ecuación de CKD-EPI) fue de 70,06 ± 20,1 ml/min/1,72 m2; el genotipo más frecuente fue VHC 1b (n = 93; 51%). Se observó cicatrización hepática avanzada en 58 (46%) pacientes mediante elastografía transitoria. Se adoptaron 5 pautas: elbasvir/grazoprevir (n = 5), glecaprevir/pibrentasvir (n = 4), pauta de paritaprevir/ombitasvir/dasabuvir (PrOD) potenciada con ritonavir (n = 40), simeprevir ± daclatasvir (n = 2) y combinaciones basadas en sofosbuvir (n = 147). La tasa de RVS12 fue del 95,4% (IC del 95%: 93,8; 96,8%). Hubo 9 fracasos virológicos, 8 de ellos recidivantes. Se produjeron acontecimientos adversos en el 30% (51/168) de los pacientes, que se trataron clínicamente sin suspensión del tratamiento ni hospitalización. Uno de los AA más frecuentes fue la anemia (n = 12), que precisó la suspensión o la reducción de la dosis de ribavirina en algunos casos (n = 6); se produjo deterioro de la función renal en 3 casos (1,7%). Conclusiones: El tratamiento sin interferón oral en todos los casos con AAD para el VHC crónico en la NC de leve a moderada fue eficaz y bien tolerado en un contexto de la práctica clínica real. Hay estudios en curso para abordar si la respuesta viral sostenida se traduce en una mejor supervivencia en esta población. Keywords: Adverse effects, Antiviral agents, Hepatitis C, Kidney failure, Sustained virologic response, Palabras clave: Efectos adversos, Antivíricos, Hepatitis C, Insuficiencia renal, Respuesta virológica sostenida
Gastrointestinal lesions in chronic kidney disease patients with anemia Rebeca García Agudo, Sami Aoufi Rabih, Pedro González Carro, Francisco Pérez Roldán, Beatriz Proy Vega, Ángel Arias Arias, Fátima Cazalla Cadenas, José María Tenías Burillo, Ana Fernández Rodríguez Nefrologia, 2019 Introduction: Despite the frequency with which anemia is present in patients with chronic kidney disease (CKD), its relationship with gastrointestinal lesions has not been studied. Method: A cross-sectional, analytical, observational study involving one year of recruitment was carried out to determine the prevalence of endoscopic gastrointestinal lesions and associated risk factors in asymptomatic patients with chronic kidney disease stages 1–5 and anemia who had a positive qualitative immunochemical fecal occult blood test. Results: A total of 9658 patients with CKD were analyzed, of which 286 (2.9%) had anemia; 198 had a positive fecal occult blood test (47% male, 71.1 ± 11.8 years). The endoscopic study revealed 255 lesions, with at least one lesion in 68.2% of patients, with the most prevalent being: adenomatous colorectal polyps (39.6%), acute lesions of the gastric mucosa (22.6%), neoplastic lesions 15.1%), angiodysplasia (14.4%), oesophagitis (8.4%), inflammatory bowel disease (4.8%) and ischemic colitis (3.1%). Uremia and acetylsalicylic acid were identified as risk factors for acute gastric mucosal lesions. Angiodysplasia was associated with alcoholism, a more advanced stage of chronic kidney disease, anemia, and lack of response to erythropoiesis-stimulating agents. Age and refractory anemia were risk factors for adenomatous polyps and colorectal cancer. Conclusion: Renal patients with anemia could benefit from an endoscopic study due to their high prevalence of gastrointestinal lesions, particularly adenomatous polyps and colorectal cancer, which are more common in those over 50 years of age with CKD stages 3–5. Resumen: Introducción: A pesar de la frecuencia con que la anemia está presente en los pacientes con enfermedad renal crónica (ERC), su relación con lesiones gastrointestinales no ha sido estudiada. Método: Estudio observacional analítico transversal de un año de reclutamiento para determinar la prevalencia de lesiones gastrointestinales endoscópicas y los factores de riesgo asociados en pacientes asintomáticos con ERC estadios 1-5 y anemia que presentaban un test inmunoquímico cualitativo de sangre oculta en heces positivo. Resultados: Se analizaron 9.658 pacientes con ERC, de los que 286 (2,9%) presentaban anemia; 198 tuvieron un test de sangre oculta en heces positivo (47% varones, 71,1 ± 11,8 años). El estudio endoscópico reveló 255 lesiones, con al menos una lesión en el 68,2%, siendo las más prevalentes: pólipos colorrectales adenomatosos (39,6%), lesiones agudas de la mucosa gástrica (22,6%), lesiones neoplásicas (15,1%), angiodisplasias (14,4%), esofagitis (8,4%), enfermedad inflamatoria intestinal (4,8%) y colitis isquémica (3,1%). La uremia y el ácido acetilsalicílico fueron identificados como factores de riesgo de lesiones agudas de la mucosa gástrica. Las angiodisplasias se relacionaron con el enolismo, el mayor estadio de ERC, la anemia y la ausencia de respuesta a agentes estimulantes de la eritropoyesis. La edad y la anemia refractaria constituyeron factores de riesgo de pólipos adenomatosos y cáncer colorrectal. Conclusión: Los pacientes renales con anemia podrían beneficiarse de un estudio endoscópico debido a la alta prevalencia de lesiones gastrointestinales que presentan, particularmente pólipos adenomatosos y cáncer colorrectal, más frecuentes en los mayores de 50 años con ERC estadios 3-5. Keywords: Chronic kidney disease, Anemia, Colorectal cancer, Adenomatous polyps, Acute lesions of the gastric mucosa, Palabras clave: Enfermedad renal crónica, Anemia, Cáncer colorrectal, Pólipos adenomatosos, Lesiones agudas de la mucosa gástrica
Microalbuminuria and renal insufficiency in chronic hepatitis C virus infection Sami Aoufi Rabih, Rebeca García Agudo, José María Tenías Burillo, Francisco Ruiz Carrillo, Pedro González Carro, Francisco Pérez Roldán, Marina Ynfante Ferrús, Esther Bernardos Martín, Óscar Roncero García-Escribano, María Luisa Legaz Huidobro, Natividad Sánchez-Manjavacas Gastroenterologia Y Hepatologia, 2012
