Search

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p

SARS-CoV-2 infection in transplant patients has shown greater lethality and vaccination in this group of patients has shown less information. The objective of this study is to show the statistics in Mexico of lethality in kidney recipients infected with COVID-19 in relation to vaccination and variants of the coronavirus.This is a bibliographic search of kidney transplant recipient patients since the start of the pandemic in Mexico to determine lethality after SARS-CoV-2 compared to the general population and in relation to patients, the 4 most important infectious peaks in the country due to identified variants, and also before and after vaccination.The global lethality is 26.91% from the beginning of the pandemic to April 9, 2022 in kidney recipients in Mexico (130 deaths of 483 infected kidney transplant recipients) compared to the national lethality of 5.60%. Variant B. 1.1.220 represented the highest lethality with 30.43% and the lowest lethality was Omicron with 16.41%. The lethality prior to vaccination was 30.94% and 23.46% after it.Both some variants and vaccination have influenced a lower lethality due to COVID-19 in Mexico in kidney transplant patients; It is important to consider global recommendations, such as a third or fourth dose, a combination of mRNA vaccines and vectors in order to reduce lethality in this group of patients.

Background/Aims: Vascular access (VA) is the highest risk factor for blood infections, hospitalization, and mortality of patients undergoing hemodialysis (HD). The risk of mortality while using a catheter is greater than that while using grafts. The objective of this article is to know the survival rate in relation to the type of VA. Methods: A retrospective cohort of HD patients was studied. The data gathered included age, gender, first VA at the surrogate site, days between the first and second access, number of accesses, and anatomical site of VA placement. Mean differences were estimated using χ2 or Student’s t test. Survival was calculated using the Kaplan-Meier curves and included in tables. Statistical significance was established as p < 0.05. The statistical computer software package SPSSw v25 was used for the analysis. Results: A total of 896 patients were included with a mean age of 47.88 years (SD ± 16.52), the duration of the first VA was 398.81 days (±565.79), the mean number of VAs used was 2.26 (±1.15), and the median time undergoing HD was 728.73 days. The duration of catheter placement was 330.42 days, and 728.60 days for fistula use (p = 0.001). The mean number of days of renal replacement was 611.59 days for catheter and 1,495.25 days for internal arteriovenous fistula (IAVF) patients (p = 0.001). Conclusions: The survival of the initial VA is greater for the IAVF, followed by the tunneled catheters and the lowest by the non-tunneled catheters, which continue to be frequently used in our setting.

Background Transplantation depends on a donation from a living or deceased donor, with the latter ideally involving a multiorgan transplant. The objective of this study was to determine the factors that influence the attitudes of the population in Mexico toward being a donor. Methods We conducted an observational, cross-sectional study with a survey on the attitudes toward donation in the population of Mexico. The survey had 33 items on it regarding sociodemographic aspects and people’s positions on the issues of organ and tissue donation. We used central tendency and dispersion averages and calculated the difference between groups using chi squares or the Student t test. We also used the statistical program SPSS version 25. Results The perception of respondents regarding organ and tissue donation (with 1064 people or 65.1% in favor) points to a lack of knowledge in Mexico. People do not talk about organ donation with their relatives and especially do not discuss their wishes in case of death (only 660 people indicated they had or 40.4%). There is a better attitude toward donation among younger respondents, women, single people, health personnel, people with higher incomes, Catholics, and those who do not have a hospitalized family member. Conclusions It is necessary to provide more information about organ donation to people in Mexico. The opinion toward donation is generally favorable; however, there are multiple factors that influence opinions. Family members of patients in intensive care are the least willing to donate themselves or donate a relative's organs.

Chronic kidney disease (CKD) is an important public health problem. The classification of CKD by KDOQI and KDIGO and routine reports of the estimation of the glomerular filtration rate (eGFR), have resulted in a higher frequency in the diagnosis of CKD. Identification of CKD subjects and high risk of disease progression and cardiovascular disease (CVD) development is important. In clinical practice, proteinuria is the most sensitive marker of the progression of CKD, especially when combined with eGFR, but these have limitations. Therefore, the use of other early and sensitive biomarkers is required. Promising biomarkers are now being identified for the detection of CKD progression and its associated CVD morbidity and mortality. These are sensitive biomarkers of renal function, underlying pathophysiological processes and/or cardiovascular risk.La enfermedad renal crónica (ERC) es un importante problema de salud pública. La clasificación de la ERC por KDOQI y KDIGO, y los informes rutinarios de la estimación de la tasa de filtración glomerular (eTFG), han dado lugar a una mayor frecuencia en el diagnóstico de ERC. Es importante la identificación de los pacientes con ERC y alto riesgo de progresión de la enfermedad y del desarrollo de enfermedad cardiovascular (ECV). En la práctica clínica, la proteinuria es el marcador más sensible de la progresión de la ERC, especialmente cuando se combina con eTFG, pero, aun con ello, tienen limitaciones. Por lo tanto, se requiere del uso de otros biomarcadores tempranos y sensibles. Actualmente se tienen identificados biomarcadores prometedores para la detección de la progresión de la ERC y de su morbilidad y mortalidad por ECV asociada. Estos son biomarcadores sensibles de la función renal, de los procesos fisiopatológicos subyacentes y/o del riesgo cardiovascular.

The aim of this paper was to characterize the blood pressure CR in patients with end stage chronic kidney disease (ESCKD) before and after treatment with bromocriptine compared to healthy volunteers.Fifteen patients and nine healthy volunteers were included. Both groups underwent ambulatory 24 hours blood pressure (24 h ABPM). Patients received 2.5 mg every 8 hours of bromocriptine for eight weeks, at the end of the treatment 24 h ABPM was repeated; blood pressure CR was compared before and after treatment and with healthy volunteers. The CR was identified by the method of Cosinor.64% of volunteers showed a 24 h CR, against 27% of patients (p0.05). After the treatment with bromocriptine 40% of patients showed RC 24 h. The mean arterial pressure decreased from 129 ± 1 mmHg to 106 ± 1 mmHg. A 12 h rhythm was identified in 45% of volunteers and 73% of patients before treatment (p0.05) against 60% at the end (p0.001), with no statistical difference with volunteers.The CR in blood pressure is altered in ESCKD and could be restored with bromocriptine. 12 hours rhythmicity was identified predominantly in patients with ESCKD; this rhythm was also present in the healthy volunteers.el propósito de este estudio es caracterizar el ritmo circadiano (RC) de la presión arterial en pacientes con enfermedad renal crónica terminal (ERCT) en tratamiento con diálisis peritoneal continua ambulatoria (DPCA) antes y después del tratamiento con bromocriptina (BEC) comparándolos con voluntarios sanos.se incluyeron 15 pacientes del servicio de Nefrología y 9 voluntarios sanos. Se les realizó monitoreo ambulatorio de presión arterial de 24 horas (MAPA). Los pacientes recibieron 2.5 mg de BEC cada 8 hora durante ocho semanas, al final del tratamiento se repitió el MAPA; el RC de la presión arterial se comparó antes y después del tratamiento y con los voluntarios.el 64% de los voluntarios exhibieron RC de 24 horas, frente al 27% de los pacientes (p0.05). Después del tratamiento con BEC, el 40% de pacientes mostraron RC de 24 h. El mesor de la presión arterial media disminuyó de 129 ± 1 mmHg a 106 ± 1 mmHg (p0.05). Se identificó un ritmo de 12 h en 45% de los voluntarios y en el 73% de los pacientes antes del tratamiento (p0.05) frente a 60% al final (p0.001), sin diferencia estadística con los voluntarios.el RC de la presión arterial esta alterado en la IRCT y se restableció con BEC. La ritmicidad de 12 h predominó en los pacientes con ERCT, también presente en los voluntarios sanos.

Pulmonary hypertension in chronic kidney disease is included in the group 5 of the pulmonary hypertension classification of the World Health Organization. Its mechanism is multifactorial and little known. Its importance has increased due to its impact on survival according to whether they received a kidney transplant, the greater risk of early renal graft loss and major hospital stays. In this review, we analyze the panorama of chronic renal disease in Mexico and Latin America, the epidemiology, pathophysiological mechanisms, the diagnostic process and the treatment of pulmonary hypertension in chronic kidney disease.La hipertensión pulmonar de la enfermedad renal crónica está contemplada en el grupo 5 de la clasificación de hipertensión pulmonar de la Organización Mundial de la Salud. Su mecanismo es multifactorial y poco conocido. Su importancia ha incrementado debido a su impacto en la supervivencia de acuerdo a si el paciente recibió un trasplante renal, al mayor riesgo de pérdida temprana del injerto renal y a las estancias hospitalarias mayores. En esta revisión, se analiza el panorama de la enfermedad renal crónica en México y Latinoamérica, la epidemiología, los mecanismos fisiopatológicos, el proceso diagnóstico y el tratamiento de la hipertensión pulmonar en la enfermedad renal crónica.

Background Residual renal function (RRF) has been identified as the most important component in dialysis adequacy and has a strong effect on clinical outcomes. This justifies any effort in understanding the mechanism behind the preservation or decline in RRF. The aim of this study was to analyze the possible association of components of cardio-renal syndrome with the rate of decline in RRF. Methods A retrospective cohort study was performed in a group of prevalent adult patients on continuous ambulatory peritoneal dialysis (CAPD). Patients were analyzed at baseline and after a 30-month follow-up. Evaluations included measurements of residual renal function, dialysis adequacy parameters, cardiovascular comorbidity, and measurements of biochemical markers of cardiovascular disease (CVD) and inflammation, as well as resting electrocardiography. Results We included 129 patients in the study who were divided into groups according to loss of RRF, considering the cut-off point as 100 mL/day of 24 h urine volume. At baseline, there were no differences between groups: patients who lost RRF showed low values of 24 h urine volume, higher levels of systolic blood pressure, N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), IL-6, and low values of serum albumin. In the multivariate analysis, age, albumin, CRP, and NT-proBNP were significant risk factors for the loss of RRF. Conclusions Data indicate a close relationship between heart and kidney function where chronic kidney disease (CKD) affects and is an effect of, heart function, indicative of a bi-directional influence that leads to a vicious cycle, promoting deleterious effects on both systems.

Systemic arterial hypertension (SAH) is a progressive cardiovascular syndrome caused by complex and interrelated causes. The early markers of this syndrome are often present even before the blood pressure (BP) elevation; therefore, SAH cannot only be classified by the BP elevation threshold, which sometimes is discreet. Its progression is strongly associated with structural and functional cardiovascular abnormalities, which lead to end-organ damage (heart, kidney, brain, blood vessels and other organs), and cause premature morbidity and death. In this sense, the BP is only a biomarker of this cardiovascular syndrome, which is why it is more useful to consider individual BP patterns of the ill patient rather than a single BP threshold. The study and treatment of hypertension in chronic kidney disease (CKD) has made some progresses, especially in patients requiring dialysis. The use of non-invasive technology to register the BP has reconfigured health care of patients in regards to the diagnosis, circadian pattern, clinical surveillance, pharmacological prescription, prognosis, and risk of cardiovascular events (as well as mortality). The opportunity in the diagnosis and treatment means a delay in the onset of complications and, also, of dialysis. The blockade of the renin-aldotensin-aldosterone system (RAAS), a regular monitoring of the dry weight of the population in dialysis, and non-pharmacological interventions to modify lifestyle are the maneuvers with greater impact on the morbidity and mortality of patients.La hipertensión arterial (HTA) es un síndrome cardiovascular progresivo que es ocasionado por etiologías complejas e interrelacionadas. Los marcadores tempranos del síndrome frecuentemente están presentes antes de que se eleve la presión arterial (PA); por lo tanto, la HTA no puede ser solamente clasificada por el umbral de elevación de la PA. Su progresión está fuertemente asociada con anormalidades estructurales y funcionales de la función cardiaca y vascular que dañan el corazón, el riñón, el cerebro, los vasos sanguíneos y otros órganos, y provocan morbilidad y muerte prematuras. Así, la PA es solamente un biomarcador de este síndrome cardiovascular, por lo que es de mayor utilidad considerar los patrones individuales de PA del enfermo en vez de un umbral de PA único. El estudio y tratamiento de la HTA en la enfermedad renal crónica (ERC) ha tenido avances, sobre todo en la población en diálisis. El uso de tecnología no invasiva para registrar la PA ha permitido reformar la atención médica de los enfermos en cuanto al diagnóstico, patrón circadiano, vigilancia clínica, prescripción farmacológica, pronóstico y riesgo de eventos cardiovasculares. La oportunidad en el diagnóstico y tratamiento supone un retardo en la aparición de complicaciones y en el inicio de la diálisis. El bloqueo del sistema renina-angiotensina-aldosterona (SRAA), la vigilancia periódica del peso seco en la población en diálisis y las intervenciones para modificar el estilo de vida son las maniobras con mayor impacto en la morbimortalidad de los enfermos.

This Consenso Nacional de Hipertensión Arterial Sistémica (National Consensus on Systemic Arterial Hypertension) brings together experiences and joint work of 79 specialists who have been in contact with the patient affected by systemic arterial hypertension. All concepts here presented were outlined on the basis of the real world practice of Mexican hypertensive population. The consensus was developed under strict methodological guidelines. The Delphi technique was applied in two rounds for the development of an appropriate statistical analysis of the concepts exposed by all the specialists, who posed key questions, later developed by the panel of experts of the Hospital de Cardiología, and specialists from the Centro Médico Nacional. Several angles of this illness are shown: detection, diagnosis, pathophysiology, classification, treatment and prevention. The evidence analysis was carried out using PRISMA method. More than 600 articles were reviewed, leaving only the most representative in the references. This document concludes with practical and useful recommendations for the three levels of health care of our country.Este Consenso Nacional de Hipertensión Arterial Sistémica reúne las experiencias y el trabajo conjunto de 79 especialistas que han estado en contacto con el paciente que padece hipertensión arterial sistémica. Todos los conceptos aquí presentados se plantearon con base en la práctica del mundo real de la población hipertensa de México. El consenso se desarrolló bajo lineamientos metodológicos estrictos. La técnica de Delphi se aplicó en dos vueltas para el desarrollo de un análisis estadístico apropiado de los conceptos vertidos por todos los especialistas con preguntas clave que desarrolló el panel de expertos del Hospital de Cardiología y especialistas del Centro Médico Nacional. Se presentan los aspectos de detección, diagnóstico, fisiopatología, clasificación, tratamiento y prevención. El análisis de la evidencia en la literatura se hizo utilizando el método de PRISMA para análisis de evidencia. Se revisaron más de 600 artículos y se dejaron en la bibliografía solo los más representativos. Este documento concluye con recomendaciones prácticas y de utilidad para los tres niveles de atención en salud de nuestro país.

Residual renal function (RRF) contributes to the quality of life of patients on dialysis. The preservation of RRF is associated with higher patient survival in peritoneal dialysis (PD), and is now accepted that RRF and peritoneal clearance are not of equal value in patient survival. The aim of this study is to know the factors related to RRF loss in prevalent patients in continuous ambulatory peritoneal dialysis (CAPD).This is an analysis of secondary outcomes. Forty-three adult patients with type 2 diabetes were included. They had RRF preserved. Clinical and laboratory assessments were done in each visit during a year.The male gender (p = 0.042), systolic (p = 0.009) and diastolic (p = 0.006) blood pressure (BP), hemoglobin (p = 0.008), peritoneal creatinine clearance (p = 0.014), peritoneal ultrafiltration (p = 0.017) and levels of tumor necrosis factor-alpha (TNF-alpha) in plasma (p = 0.022) and dialysate (p = 0.008) were related with RRF loss.It is important to understand the factors associated with RRF loss in our patients to prevent the gradual loss and its implications on the mortality and quality of life.Introducción: la conservación de la función renal residual (FRR) en los pacientes en diálisis peritoneal (DP) tiene una clara influencia sobre la calidad de vida, independientemente de que su preservación ha demostrado influir en la mayor supervivencia de los pacientes. El objetivo del presente estudio fue conocer los factores relacionados con pérdida de la FRR en un grupo de pacientes prevalentes en diálisis peritoneal continua ambulatoria (DPCA). Métodos: se trata de un estudio de análisis de resultados secundarios. Se incluyeron 43 adultos con diabetes tipo 2 (DT2), con FRR conservada, a quienes se les dio seguimiento durante un año. Resultados: los factores relacionados con la pérdida de la FRR fueron: género masculino (p = 0.042), presión arterial sistólica (p = 0.009) y diastólica (p = 0.006), hemoglobina (p = 0.008), aclaramiento peritoneal de creatinina (p = 0.014), ultrafiltración (p = 0.017), niveles de factor de necrosis tumoral alfa (FNT–alfa) en plasma (p = 0.022) y dializado (p = 0.008). Conclusiones: es importante conocer los factores relacionados con pérdida de la FRR en nuestros pacientes para evitar la pérdida gradual de la misma y sus implicaciones sobre la mortalidad y calidad de vida.

To evaluate the association of hypomagnesemia with prehypertension (preHTN) and hypertension in children.A total of 3954 apparently healthy Mexican children were enrolled in a cross-sectional study. Exclusion criteria were type 2 diabetes; hepatic, renal, or endocrine disease; impaired fasting glucose; chronic diarrhea; and intake of vitamins or magnesium supplements in the previous 6 months. preHTN was defined by systolic and/or diastolic blood pressure ≥90th to95th percentile and hypertension by systolic and/or diastolic blood pressure ≥95th percentile, according to age, sex, and height percentile. Hypomagnesemia was defined by serum magnesium concentration1.8 mg/dL (0.74 mmol/L). To control for potential sources of bias related to age, participants were allocated into 2 groups, aged 6-10 years and 11-15 years.The prevalence of preHTN and hypertension was 12.2% and 6.4%, respectively, in children aged 6-10 years and 13.9% and 10.6% in those aged 11-15 years. Hypomagnesemia was identified in 59 children with preHTN (27.3%) and 52 (45.6%) with hypertension in the 6-10 year age group, and in 115 children with preHTN (36.0%) and 109 (49.6%) with hypertension in the 11-15 year age group. Adjusted multiple logistic regression analysis showed that in children in both age groups, hypomagnesemia was associated with both preHTN (6-10 years: OR, 2.18, P .0005; 11-15 years: OR, 1.38, P = .018) and hypertension (6-10 years: OR, 4.87, P .0005; 11-15 years: OR, 1.83, P = .0002).Our results indicate that serum magnesium level1.8 mg/dL is significantly associated with preHTN and hypertension in apparently healthy children.