Garcia-Agudo Rebeca
@nefrologiamanchacentro.es
Nephrology Department
SESCAM
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
Scopus Publications
Scopus Publications
Rebeca García Agudo, Marina Méndez Molina, Sara Piqueras Sánchez, and Antonio Tejera‐Muñoz
Wiley
AbstractNowadays, 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.
Rebeca García-Agudo, Miguel Ángel Rojas-Fernández, Elizabeth Canllavi-Fiel, Beatriz Proy-Vega, and Antonio Tejera-Muñoz
Elsevier BV
Meryl Waldman, Maria Jose Soler, Clara García-Carro, Liz Lightstone, Tabitha Turner-Stokes, Megan Griffith, Joan Torras, Laura Martinez Valenzuela, Oriol Bestard, Colin Geddes,et al.
Ovid Technologies (Wolters Kluwer Health)
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.
Fabrizio Fabrizi, Roberta Cerutti, Rebeca Garcia-Agudo, Cecilia Bellincioni, Giulia Porata, Giulia Frontini, Sami Aoufi-Rabih, and Piergiorgio Messa
Elsevier BV
Ezequiel Ridruejo, Rebeca Garcia-Agudo, Manuel Mendizabal, Sami Aoufi-Rabih, Vivek Dixit, Marcelo Silva, and Fabrizio Fabrizi
Elsevier BV
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, and Ana Fernández Rodríguez
Elsevier BV
M.A. Martín-Gómez, R. García Agudo, and M.D. Arenas Jiménez
Elsevier BV
Rebeca García-Agudo, Sami Aoufi-Rabih, Mercedes Salgueira-Lazo, Carmen González-Corvillo, and Fabrizio Fabrizi
SAGE Publications
Background and Aims: The advent of direct-acting antiviral agents promises to change the management of hepatitis C in patients with end-stage renal disease, a patient group where 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’ group of patients with end-stage renal disease. Methods: We performed a single-arm, multi-centre study in a cohort (n=30) of patients with advanced chronic kidney disease (mostly on dialysis) who underwent antiviral therapy with direct-acting antiviral agents. The primary end-point was sustained virologic response (serum hepatitis C virus RNA < 15 mIU/mL, 12 weeks after treatment ended). We collected data on on-treatment adverse events, serious adverse events and laboratory abnormalities. Results: In total, 23 (77%) and 7 (23%) patients underwent regular dialysis and had chronic kidney disease at pre-dialysis stage, respectively. Six regimens were adopted: elbasvir/grazoprevir ( n = 6), ledipasvir/sofosbuvir ± ribavirin ( n = 4), PrOD regimens ± ribavirin ( n = 10), simeprevir + daclatasvir ( n = 3), sofosbuvir + daclatasvir ± ribavirin ( n = 3), sofosbuvir + ribavirin ( n = 4). The SVR12 rate was 90% (95% confidence interval, 74%; 96%). A total of 27 (90%) patients achieved SVR12; there were three virologic failures – two were non-responders and one had a viral breakthrough while on therapy. Adverse events occurred in 53% (16/30) (95% confidence interval, 0.39; 0.73) of patients and were managed clinically without discontinuation of therapy or hospitalization. The most common adverse event was anaemia ( n = 12) that required blood transfusions in seven individuals; deterioration of kidney function occurred in one (14%). Conclusion: All-oral, interferon-free therapy with direct-acting antiviral agents for chronic hepatitis C virus in advanced chronic kidney disease was effective and well tolerated in a ‘real-life’ clinical setting. Careful monitoring of haemoglobin and serum creatinine during therapy with direct-acting antiviral agents is suggested. Studies are under way to address whether sustained viral response translates into better survival in this population.
Sami Aoufi-Rabih, , Rebeca García-Agudo, María-Carlota Londoño, María-Dolores Fraga-Fuentes, and Guillermina Barril-Cuadrado
Springer Science and Business Media LLC
Rebeca García Agudo, Sami Aoufi Rabih, Guillermina Barril Cuadrado, Beatriz Proy Vega, Ángel Arias Arias, and José Antonio Herruzo Gallego
Elsevier BV
Rebeca García Agudo, Sami Aoufi Rabih, Guillermina Barril Cuadrado, Beatriz Proy Vega, Ángel Arias Arias, and José Antonio Herruzo Gallego
Elsevier BV
Guillermina Barril, Juan A. Quiroga, María Dolores Arenas, Mario Espinosa, Nuria García-Fernández, Secundino Cigarrán, José A. Herrero, Gloria del Peso, Pilar Caro, Rebeca García-Agudo,et al.
American Society for Microbiology
ABSTRACT Amplification of hepatitis C virus (HCV) RNA from blood detected occult HCV infections in 30.9% of 210 HCV-seronegative dialysis patients with abnormal liver enzyme levels that had evaded standard HCV testing practices. Isolated HCV core-specific antibody detection identified three additional anti-HCV screening-negative patients lacking HCV RNA amplification in blood who were considered potentially infectious. Together, these findings may affect management of the dialysis setting.
Sami Aoufi Rabih, Rebeca García Agudo, María Luisa Legaz Huidobro, Marina Ynfante Ferrús, Pedro González Carro, Francisco Roldán Pérez, Francisco Ruiz Carrillo, and José María Tenías Burillo
Ovid Technologies (Wolters Kluwer Health)
Objectives The aims of this study were to determine the prevalence of exocrine pancreatic insufficiency (EPI) and chronic pancreatitis (CP) in patients with chronic alcoholic liver disease and to analyze the possible associated factors. Methods This is an analytical observational study of cases and controls for a sample of patients with chronic alcoholic and nonalcoholic liver disease. Exocrine pancreatic insufficiency was diagnosed using the 13C mixed-triglyceride breath test. Patients with abdominal pain underwent endoscopic ultrasonography for CP evaluation using the Wiersema criteria. Results A total of 154 patients were included, 129 with alcoholic liver disease (83 with cirrhosis) and 25 with nonalcoholic liver disease. Exocrine pancreatic insufficiency was found in 55.2% versus 16.7% (P < 0.001), 70% of patients without cirrhosis compared with 46.2% of patients with cirrhosis had pancreatic insufficiency (P = 0.017), and 82.7% of patients with alcoholic liver disease and abdominal pain had CP (P < 0.001). Exocrine pancreatic insufficiency was associated with the male sex, alcohol intake, abdominal pain, degree of liver failure, and the absence of portal hypertension. Chronic pancreatitis was correlated with age younger than 55 years and abdominal pain. Conclusions Patients with alcoholic liver disease had a high prevalence of EPI and CP; this prevalence was even higher in patients who have not yet developed cirrhosis with liver failure or portal hypertension.
O. Fikri-Benbrahim, F. Rivera-Hernández, Alberto Martínez-Calero, F. Cazalla-Cadenas, R. García-Agudo and Javier Mancha-Ramos
Rheumatological diseases and, firstly, rheumatoid arthritis (RA) remain a major cause of secondary amyloidosis. The emergence of biological agents such as adalimumab in the early treatment of RA can be an effective alternative to stop the development and progression of secondary amyloidosis. Not all patients will respond the same way to treatment; we must consider associated comorbidity, the poor prognosis factors for predicting therapeutic response and possible adverse effects. In the adverse effects of biological therapies, there has been an increase in the rate of lethal infections and congestive heart failure. We present two cases with renal amyloidosis secondary to RA who had a different clinical course: our 1st case had a good response to Adalimumab while the 2nd case evolved unfavourably after treatment, and died from cardiovascular complications.
R. García-Agudo, Sami Aoufi-Rabih and Guillermina Barril-Cuadrado
La hepatitis C cronica en pacientes en dialisis
es mayor que en la poblacion general. El estudio SHECTS tie-
ne como objetivos analizar el nivel de estudio y seguimien-
to de los pacientes con infeccion cronica por el virus de la
hepatitis C (VHC) en hemodialisis y determinar su prevalen-
cia actual.
Metodo:
Estudio de cohorte multicentrico na-
cional, realizado entre septiembre de 2010 y septiembre de
2011. Se envio un cuaderno de recogida de datos a todas las
unidades de hemodialisis de Espana para incluir informacion
de la unidad y de la situacion nefrologica y hepatologica de
sus pacientes VHC-positivos.
Resultados:
Participaron en el
estudio 187 unidades de hemodialisis (71 hospitalarias). La
prevalencia del VHC se estimo en el 5,6 %. La causa mas fre-
cuente de enfermedad renal cronica fue la glomerular (25
%); del 72,1% de los pacientes que se habia sometido a una
biopsia renal, el 23,2 % presentaba una glomerulonefritis
que podia estar asociada al VHC. No se disponia del genoti-
po en el 64 %, ecografia hepatica en el 61,3 %, biopsia
hepatica en el 87,7 %. Un tercio era seguido por un digesto-
logo. El 26,6 % habia recibido tratamiento antiviral, con res-
puesta viral sostenida en el 35,3 % y suspension del trata-
miento en el 67,4 %.
Conclusion:
La prevalencia del VHC en
hemodialisis en Espana ha disminuido notablemente en la
ultima decada hasta igualarse a la de paises del entorno. Es-
tos pacientes tienen un estudio incompleto de su hepatopa-
tia y los tributarios de tratamiento antiviral y no tratados
constituyen un numero considerable, a pesar de tener car-
gas virales bajas y ser candidatos a trasplante renal.
R. García-Agudo, S. Aoufi Rabih, P. Araque Torres, M. Dolores Fraga Fuentes, J. Carlos Valenzuela Gámez, J. Mancha Ramos, and J. María Tenías Burillo
Elsevier BV
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,et al.
Elsevier BV
R. Garcia-Agudo, R. Manzano, E. Camacho, and S. Aoufi
Oxford University Press (OUP)
A 50-year-old gypsy woman presented with intense pruritus and skin lesions. She had controlled hypertension and Stage-4 chronic kidney disease with no hyperparathyroidism. No cholestatic disorder was observed. Physical examination revealed a papulonodular eruption on the limbs and the trunk and important lesions due to scratching. We consulted the dermatologist who prescribed sulpiride and a betamethasone and gentamicin cream in 10-day cycles. The lesions disappeared after 2 months of treatment. Sometimes new lesions appeared after a period of rubbing and scratching.
Prurigo nodularis is a dermatosis originating from pruritus and the persistence and progression of skin lesions are strictly correlated to scratching and rubbing. The skin between the lesions is usually normal but can be xerotic or lichenified. It is more frequent in middle aged women. The clinical feature is a papulonodular eruption with a few to hundreds of lesions that range from several millimetres to 2 cm in diameter. There is a tendency for symmetrical distribution with a predilection for extensor surfaces of the limbs and the trunk. The face and the palms are seldom affected. Prominent features include crusting and excoriations with postinflammatory hyperpigmented and hypopigmented macules (Figure 1).
A variety of systemic conditions have been reported to be associated with prurigo nodularis: chronic kidney disease, cholestatic disorders, Hodgkin’s lymphoma, hyperthyroidism, polycythaemia rubra vera and gluten-sensitive enteropathy. The clinical features are usually sufficient for diagnosing the disorder. The first step is to exclude any underlying disease and then to address the causes of general pruritus, which can be monitored by laboratory tests. Computerized tomography scan and chest X-rays are performed in the case of suspicion of lymphoma. Once the general causes have been excluded, the most common dermatologic differential diagnoses for prurigo nodularis are hypertrofic lichen planus, multiple keratoacanthoma and pemphigoid nodularis. If there are few lesions also nodular scabies can be considered.
It is the repetitive rubbing, scratching and picking of the skin that perpetuates the disease. In the absence of any clear underlying association, prurigo nodularis is highly resistant to therapy. Potent topical glucocorticoids such as triamcinolone acetonide are often successfully employed. Topical capsaicin can be effective in the very early manifestations. Ultraviolet-based therapy is useful in diffuse and/or resistant forms of prurigo nodularis. In resistant forms, cyclosporine reduces the severity of pruritus. Thalidomide and naltrexone can also be effective in recalcitrant diffuse forms. Psychosomatic interventions can be suggested.
Fig. 1.
Patient’s back. Excoriations with postinflammatory hyperpigmented and hypopigmented macules.
R. G. Agudo, S. A. Rabih, F. P. Roldán, F. G. Ames, P. G. Carro, F. R. Carrillo and R. Domínguez
S. Aoufi Rabih and R. García Agudo
The prevalence of chronic infection with the hepatitis C virus (HCV) in patients with chronic kidney disease is higher than in the general population. The estimated prevalence is 13% in haemodialysis, with wide variations geographically and between units in the same country. A liver biopsy is a useful tool for deciding whether to start antiviral therapy and to exclude concomitant causes of liver dysfunction. Examples of this include non-alcoholic fatty liver disease, whose incidence is on the rise, and haemosiderosis, which may affect the progression of the disease and determine the response to antiviral therapy. In addition, the transjugular approach can be used to measure the hepatic venous pressure gradient and confirm the existence of portal hypertension. Chronic hepatitis due to HCV has been shown to reduce survival in haemodialysis, renal transplantation and graft survival. It is the fourth leading cause of death and the leading cause of post-renal transplantation liver dysfunction. HCV behaves as an independent risk factor for the occurrence of proteinuria; it increases the risk of developing diabetes mellitus, de novo glomerulonephritis and chronic allograft nephropathy; it leads to a deterioration in liver disease and causes a greater number of infections. An increased frequency of fibrosing cholestatic hepatitis has also been described which, together with the rapid evolution to cirrhosis, can significantly increase morbidity and mortality and lead to the need for liver transplantation. In addition, immunosuppression in renal transplantation predisposes a reactivation of HCV. However, as the pharmacokinetics of interferon and ribavirin is impaired in kidney failure and their use has adverse effects on function and graft survival, a combination therapy must be limited to non-transplanted individuals with an estimated glomerular filtration rate greater than 50ml/min, and with the interferon being used as monotherapy in dialysis. The fact that a quarter of HCV-positive patients evaluated for a renal transplant have bridging fibrosis or cirrhosis in the liver biopsy may renew renal pre-transplant treatment planning.
O. Fikri Benbrahim, R. García Agudo, F. Cazalla Cadenas, A. Martínez Calero and J. González-Spínola
R. García-Agudo and P. García-Martos
Peritonitis is one of the most serious complications of peritoneal dialysis. Pathogenic bacteria cause the majority of cases of peritonitis. Fungal infection is rare but it is associated with high morbidity, the inability to continue on the dialysis program and important mortality. Its incidence varies from 4% to 10% of all peritonitis episodes in children and from 1% to 23% in adults. Its clinical presentation is similar to bacterial peritonitis. Until now, predisposing factors of fungal peritonitis have not been clearly established; history of bacterial peritonitis episodes and treatment with broad-spectrum antibiotics have been often reported in the literature. Candida species were the most common pathogens and Candida albicans was the most frequent, but high prevalence of Candida parapsilosis has been observed in the last decade. Microbiological findings are essential to to determine the etiology of peritonitis. Successful management of fungal peritonitis requires antifungal therapy, the removal of peritoneal catheter and the subsequent transfer to hemodialysis. Fluconazole and amphotericin B are recommended as antifungal agents. New drugs as voriconazole and caspofungin are very effective. The aim of this systematic review has been to analyse the clinical and microbiological aspects of fungal peritonitis, as they are not well known and have changed in the last few years.
P. García-Martos, F. GildeSola, P. Marín, L. García-Agudo, R. García-Agudo, F. Tejuca and L. Calle
BACKGROUND
Fungal peritonitis is a rare but serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
METHODS
During a ten-year period (1999-2008), from a total of 175 patients with chronic renal failure undergoing CAPD, we retrospectively studied 10 cases of fungal peritonitis analyzing the predisposing factors, clinical aspects, etiological agents and treatment. Diagnosis was based on elevated CAPD effluent count (>100/microl) and isolation of fungi on culture.
RESULTS
Fungal peritonitis represented 3.6% of all peritonitis episodes. Nine patients had a history of previous bacterial peritonitis and all of them were under antibiotic therapy. Other common findings were: age higher than 70 years old (50%) and diabetes mellitus (40%). Direct microscopic examination of the peritoneal fluid was useful for the suspicion of fungal infection in six patients (60%). The responsible agents for peritonitis were: Candida parapsilosis (4), Candida albicans (2), Candida tropicales (1), Candida glabrata (1), Candida famata (1) and Fusarium oxysporum (1). Intraperitoneal and oral fluconazole, intravenous and oral voriconazole and intravenous amphotericin B were the antifungal agents used in the treatment. As a result of fungal infection, eight patients were transferred to hemodialysis. One patient died before the diagnosis and three other during the episode of peritonitis.
CONCLUSIONS
Patients with previous bacterial peritonitis and antibiotic treatment were at greater risk of developing fungal peritonitis. Candida parapsilosis was the most common pathogen. For the successful management of fungal peritonitis besides the antifungal therapy, peritoneal catheter removal was necessary in 60% of patients.