LOPEZ HERNANDEZ, RENE RAMON

Preferred name
LOPEZ HERNANDEZ, RENE RAMON
Main Affiliation
Email
lrene@udd.cl
ORCID
0000-0003-4026-6367
Scopus Author ID
57194425118

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    Switching Stable Kidney Transplant Recipients to a Generic Tacrolimus Is Feasible and Safe, but It Must Be Monitored
    (2017)
    Fernando González  
    ;
    Elizabeth Arriagada
    ;
    René López  
    ;
    René Carrasco
    ;
    NATALIA BERNARDITA GALLARDO CHAPARRO
    <jats:p><jats:italic>Background</jats:italic>. Tacrolimus is the primary immunosuppressive drug used in kidney transplant patients. Replacing brand name products with generics is a controversial issue that we studied after a Chilean Ministry of Health mandate to implement such a switch.<jats:italic>Methods</jats:italic>. Forty-one stable Prograf (Astellas) receiving kidney transplant patients were switched to a generic tacrolimus (Sandoz) in a 1 : 1 dose ratio and were followed up for up to 8 months. All other drugs were maintained as per normal practice.<jats:italic>Results</jats:italic>. Neither tacrolimus doses nor their trough blood levels changed significantly after the switch, but serum creatinine did:<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mn fontstyle="italic">1.62</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">0.90</mml:mn></mml:math>versus<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mn fontstyle="italic">1.75</mml:mn><mml:mo>±</mml:mo><mml:mn fontstyle="italic">0.92</mml:mn></mml:math> mg/dL (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>p</mml:mi><mml:mo>&lt;</mml:mo><mml:mn fontstyle="italic">0.001</mml:mn></mml:math>). At the same time, five graft biopsies were performed, and two of them showed cellular acute rejection. There were nine infectious episodes treated satisfactorily with proper therapies. No patient or graft was lost during the follow-up time period.<jats:italic>Conclusion</jats:italic>. Switching from brand name tacrolimus to a generic tacrolimus (Sandoz) is feasible and appears to be safe, but it must be monitored carefully by treating physicians.</jats:p>
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    Survival of Critically Ill Oncologic Patients Requiring Invasive Ventilatory Support: A Prospective Comparative Cohort Study With Nononcologic Patients
    (2019)
    Rene López  
    ;
    Suraj Rajesh Samtani
    ;
    Jose Miguel Montes
    ;
    PEREZ ARAOS, RODRIGO ALEJANDRO  
    ;
    Maria Jose Martin
    <jats:sec><jats:title>PURPOSE</jats:title><jats:p> Cancer is in the process of changing to become a chronic disease; therefore, an increasing number of oncologic patients (OPs) are being admitted to intensive care units (ICUs) for supportive care of disease or therapy-related complications. We compare the short- and long-term outcomes of critically ill mechanically ventilated OPs with those of their nononcologic counterparts. </jats:p></jats:sec><jats:sec><jats:title>PATIENTS AND METHODS</jats:title><jats:p> We performed a prospective study of patients admitted to our ICU between October 2017 and February 2019. Demographic, physiologic, laboratory, clinical, and treatment data were obtained. The primary outcome was survival at 28 days and at the end of the follow-up period. Secondary outcomes were survival according to acute severity scoring (Acute Physiology and Chronic Health Evaluation II score), Eastern Cooperative Oncology Group (ECOG) performance status, and Charlson comorbidity index. </jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p> A total of 1,490 patients were admitted during the study period; 358 patients (24%) were OPs, and 100 of these OPs were supported with mechanical ventilation. Seventy-three percent of OPs had an ECOG performances status of 0 or 1, and 90% had solid tumors. Reason for admission to the ICU was postoperative admission in 44 patients and neutropenic infection in 10 patients. The follow-up period was 148 days (range, 42 to 363 days). Survival at 28 days was similar between OPs and nononcologic patients and associated with the Acute Physiology and Chronic Health Evaluation II score. However, long-term survival was lower in OPs compared with nononcologic patients (52% v 76%, respectively; P &lt; .001) and associated with poor ECOG performance status. </jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p> Short-term survival of critically ill, mechanically ventilated OPs is similar to that of their nononcologic counterparts and is determined by the severity of the critical illness. </jats:p></jats:sec>
      2Scopus© Citations 2
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    Association between phase angle and daily creatinine excretion changes in critically ill patients: an approach to muscle mass
    (Frontiers Media SA, 2025-01-07)
    Patricio Vargas-Errázuriz
    ;
    Natalia Dreyse
    ;
    LOPEZ HERNANDEZ, RENE RAMON  
    ;
    Marcelo Cano-Cappellacci
    ;
    Julia Guerrero
    Assessing muscle mass in critically ill patients remains challenging. This retrospective cohort study explores the potential of phase angle (PA°) derived from bioelectrical impedance analysis (BIA) as a surrogate marker for muscle mass monitoring by associating it with daily creatinine excretion (DCE), a structural and metabolic muscle mass marker. In 20 ICU patients, we observed a linear relationship between PA° and DCE at initial (S1) and follow-up (S2) points, with Rho values of 0.78 and 0.65, respectively, as well as between their percentage changes (Rho = 0.80). Multivariate analysis confirmed a strong association between changes in PA° and DCE (adjusted R<jats:sup>2</jats:sup> of 0.73), while changes in the extracellular water to total body water (ECW/TBW) ratio showed no significant association. This study establishes a relationship between a BIA-derived independent-weight parameter and DCE, highlighting the potential of PA° for muscle mass monitoring during acute changes, such as those seen in ICU settings. Integrating PA° into clinical practice could provide a non-invasive and reliable tool to enhance muscle assessment and support targeted interventions in critically ill patients.
    Scopus© Citations 1  1
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    Fluid removal improves muscle performance and weakness in critically ill patients: a pilot study
    (Springer Science and Business Media LLC, 2025-11-24)
    Nicolás Arancibia
    ;
    LOPEZ HERNANDEZ, RENE RAMON  
    <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Fluid overload in critically ill patients has been associated with muscle edema, decreased tissue quality, and the development of intensive care unit-acquired weakness (ICU-AW). Continuous renal replacement therapy (CRRT) with ultrafiltration (UF) contributes to removing excess extracellular fluid. This study aimed to evaluate whether UF is associated with changes in muscle ultrasound parameters and strength in critically ill patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Critically ill patients with resolved hypoperfusion undergoing CRRT with fluid removal via UF were prospectively enrolled and compared with a control group without UF. Muscle ultrasound assessments included rectus femoris and vastus intermedius thickness, echogenicity, and subcutaneous tissue. Global muscle strength was assessed using the Medical Research Council Sum Score (MRC-SS). Assessments were performed at CRRT initiation (T1) and again 36 h later (T2).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p> Twenty-eight patients were enrolled, 18 in the UF group and 10 patients in the control group. All ultrasonographic variables measured were different between the UF and control groups. In the UF group, median rectus femoris thickness decreased from 1.74 to 1.57 cm ( <jats:italic>p</jats:italic>  = 0.03), vastus intermedius from 1.14 to 0.95 cm ( <jats:italic>p</jats:italic>  &lt; 0.01), echogenicity from 91.7 to 78.3 grayscale units ( <jats:italic>p</jats:italic>  &lt; 0.01), and subcutaneous tissue thickness from 1.98 to 1.79 cm ( <jats:italic>p</jats:italic>  &lt; 0.01). MRC-SS increased from 45.0 to 49.0 points ( <jats:italic>p</jats:italic>  = 0.05). A positive correlation was found between UF volume (mL/kg) and MRC-SS at T2 ( <jats:italic>ρ</jats:italic>  = 0.71, <jats:italic>p</jats:italic>  &lt; 0.01), and a negative correlation between UF volume and change in muscle echogenicity ( <jats:italic>ρ</jats:italic>  = − 0.49, <jats:italic>p</jats:italic>  = 0.039). ROC curve analysis identified that a UF volume ≥ 82 mL/kg was associated with MRC-SS &gt; 48 points obtaining an AUC of 0.982 (95% CI: 0.928–1.000), sensitivity 92.9%, and specificity 100%. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Ultrafiltration was associated with changes in muscle echogenicity and subcutaneous tissue as well as an increase in MRC scoring at follow-up. These results suggest a potential relationship between fluid balance and muscle ultrasound parameters. No causal inferences can be drawn; therefore, further studies are needed.</jats:p> </jats:sec>
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    Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
    (2021)
    LOPEZ HERNANDEZ, RENE RAMON  
    ;
    Rodrigo Pérez-Araos
    ;
    Fernanda Baus
    ;
    Camila Moscoso
    ;
    Álvaro Salazar
    <jats:p>The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, <jats:italic>p</jats:italic> = 0.013) and associated with lower survival (65.4% vs. 85.7%, <jats:italic>p</jats:italic> = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998–24.731], <jats:italic>p</jats:italic> = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402–5.160], <jats:italic>p</jats:italic> = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.</jats:p>
      1Scopus© Citations 19
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    Hantavirus in humans: a review of clinical aspects and management
    (2023)
    Pablo A Vial
    ;
    Marcela Ferrés
    ;
    VIAL COX, MARIA CECILIA  
    ;
    Jonas Klingström
    ;
    Clas Ahlm
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