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Xochitl B Trigueros-Flores,1 Gabriela Luna-Hernández,2 María F Santos-Lopez,1 Lucía Pérez-Galván,1 Karen J Flores-Camacho,1 Laura M Díaz-Canchola,3 Alfonso M Cueto-Manzano,1 Hugo E Chávez-Chávez,3 Jose I Cerrillos-Gutiérrez,4 Enrique Rojas-Campos,1 Fabiola Martín-del-Campo1 1Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades CMNO, IMSS, Guadalajara, Jalisco, México; 2Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México; 3División de Medicina Interna, Hospital General Regional 180, IMSS, Guadalajara, Jalisco, México; 4División de Nefrología y Trasplantes, Hospital de Especialidades CMNO, IMSS, Guadalajara, Jalisco, MéxicoCorrespondence: Fabiola Martín-del-Campo, Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Belisario Domínguez No. 1000, Col. Independencia, Guadalajara, Jalisco, CP 44320, México, Tel +52 (33)1071-1190, Email fabi_mc@hotmail.comPurpose: A healthy diet plays an important role for chronic kidney disease (CKD) treatment, but adherence to nutritional recommendations is frequently low. The aim of the present study was to describe barriers and facilitators to adherence to a healthy diet in people with CKD.Patients and Methods: Cross-sectional study; 80 predialysis (n=20), hemodialysis (n=20), peritoneal dialysis (n=20) and transplant (n=20) patients matched by age and sex, were included. Nutritional evaluation included subjective global assessment, anthropometry, quality of food consumption (Mini-ECCA v.2), self-perception about diet and willingness to change. Barriers and facilitators were evaluated with a qualitative approach (semi-structured interviews). Concepts were converted into “in vivo” and “theoretical” codes, then, grouped into categories. A second analysis was performed with the ATLAS.ti software.Results: Frequency of malnutrition was 50% in people receiving dialysis. Quality of food consumption was healthier on people with CKD stages 3b-5 (40%) and people with kidney transplant (65%) compared to peritoneal dialysis (25%) and hemodialysis (0%). The main themes influencing adherence to a healthy diet were: need for nutritional guidance, economy, dietary restrictions, willingness to change, relationship with consequences in disease control and health status, aversion for healthy foods, bad and good self-perception, family support, feelings and emotions, environment, eating habits and CKD itself. Lack of time, work, economy, food preferences and cravings were the main barriers in people with CKD stage 3b-5 and transplant, while low willingness to eat healthy foods and dietary restrictions were the main barriers in people receiving dialysis.Conclusion: Personal, environmental, health professional-related, CKD related as well as feelings and emotions aspects that people with CKD face in a daily basis, act as barriers or facilitators when trying to follow a healthy diet. Individualizing nutritional treatment taking into account people with CKD perspectives and situations is of utmost importance to improve adherence to nutritional treatment.Plain summary: In this article, the authors discuss the main barriers and facilitators that people with kidney disease face when trying to follow a healthy diet (from the people with CKD perspective). A healthy diet has been associated with lower progression of kidney disease and helps to prevent complications; however, adherence to nutritional recommendations is frequently low. People on dialysis had the unhealthier diet compared to people on predialysis or kidney transplant. People perceived dietary restrictions, lack of nutritional counseling and knowledge, economic constraints, lack of social and family support, negative effects of food on their health, dislike or aversion to healthy foods, lack of time and environment limitations as the main barriers to adhere to a healthy diet.Additionally, since diets are considered complicated (especially renal diets), strategies to improve willingness to eat healthy, counseling about food variety and preparation, some liberalization of dietary restrictions (when possible) and considering family support could help people with CKD to increase skills to adhere to a healthier diet. Considering people with CKD perspectives is of utmost importance when planning nutritional treatment and counseling, to improve adherence and therefore, clinical outcomes.Keywords: healthy diet, treatment adherence, qualitative research, chronic renal insufficiency

BackgroundIn dialysis patients, on the one hand unwillingness to change negative lifestyle patterns is associated with worse nutritional status and unhealthy lifestyle, whereas on the other, pica may be highly prevalent. However, it is not known whether pica is associated with unwillingness to change negative lifestyle behaviors, as well as with consumption of different types of foods. This study aimed to investigate this issue.MethodsThis is a cross-sectional study in dialysis patients. Lifestyle was assessed using the self-administered Instrument to Measure Lifestyle Questionnaire (IMEVID). Pica diagnosis was established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A food frequency questionnaire was performed and self-reported willingness to change was determined by a trans-theoretical model staging inventory.ResultsCompared with patients without pica, those with pica (particularly hard pica) had lower willingness to change unhealthy behavior in the case of diet (22% vs. 46% in precontemplation/contemplation stages, respectively) and exercise (43% vs. 62% in precontemplation/contemplation stages, respectively). Patients with hard pica had significantly (p < 0.05) lower scores in almost all dimensions of the lifestyle questionnaire than those in the no pica group: diet (23.9 vs. 26.8, respectively), physical activity (5.5 vs. 7, respectively), knowledge of disease (5.7 vs. 6.4, respectively), emotion management (6.6 vs. 8, respectively) and adherence to treatment (13.4 vs. 14.7, respectively), but not in the consumption of tobacco and alcohol. Compared to patients with no pica, those with hard pica ate vegetables and fruits less frequently, and dairy products, fried foods and soda more frequently.ConclusionsPica was more frequently observed in patients with lower willingness to change negative habits of diet and exercise, in those who had more unhealthy behaviors in diet, exercise and emotion management dimensions and adherence to treatment, as well as in those who ate less frequently healthful foods and more frequently unhealthy foods.

Mineral bone disease (MBD) is common in dialysis patients. Genetics and the hormonal environment influence the clinical picture and outcomes of women. This study aimed to determine how these factors affect mortality. In 234 female dialysis patients on Continuous Ambulatory (48%) or Automated (29%) Peritoneal Dialysis or Hemodialysis (23%), MBD biochemical variables, as well as bone density and genetic Bsm1 polymorphism of vitamin D receptor (VDR) were performed at baseline. The cohort was followed-up by 17 (IQ range 15–31) months. According to VDR polymorphism, the distribution of patients was bb: 64% and BB+Bb: 36%. Fifty-five patients died from all-cause mortality; the hs-C-reactive protein level was the most significant risk in multivariate Cox analysis. Nineteen died from cardiovascular mortality. None of the variables were significant for cardiovascular mortality. Patients with bb plus inflammation had the highest risk in the analysis; the significance persisted after adjustment for age, diabetes, and parathyroid hormone levels HR 2.33 (95% CI, 1.01–8.33) and after further adjustment for time on dialysis, albumin, and Osteoprotegerin levels HR 3.49 (95% CI, 1.20–10.9). The presence of the bb genotype from VDR and inflammation had the highest risk of death from all-cause mortality in females on CAPD, APD, and HD patient.

La enfermedad renal crónica (ERC) es silenciosa y se caracteriza por su elevada prevalencia, alta morbimortalidad, sobre todo cardiovascular, y altos costos en salud. En Latinoamérica la falta de recursos y la baja conciencia de la enfermedad, no solo en la población sino también en los equipos asistenciales, dificulta el diagnóstico temprano y el tratamiento oportuno. Para revertir esta realidad es necesario contar con programas de salud renal (PSR), diseñados e implementados por los nefrólogos de cada país, enfocados en mejorar las condiciones de salud de los pacientes con riesgo o portadores de ERC. En el presente artículo se exponen estrategias y experiencias latinoamericanas en la prevención de la enfermedad renal recogidas por el Comité de Salud Renal de la Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH) y se delinean pasos fundamentales para la implementación de un programa de salud renal que deberán ser adaptados a las realidades y recursos de cada país. Se plantea la necesidad de generar políticas de prevención, establecer un fuerte componente educativo, gestar programas eficientes de detección de la ERC y lograr el acceso oportuno y universal al tratamiento.

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle-income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.

Abstract To evaluate individual and combined effect of captopril and telmisartan on systemic inflammation markers of hemodialysis (HD) patients. Randomized, double-blinded, controlled clinical trial. Patients on HD at least 2 months, with arteriovenous fistula, were randomly allocated to groups: (1) captopril/placebo (N 13); (2) telmisartan/placebo (N 13); (3) captopril + telmisartan (N 12); or (4) placebo/placebo (N 12). During 3 months, patients received oral drugs as follows: captopril 50 mg/day, telmisartan 80 mg/day or placebo. Patients excluded if they had conditions or were on drugs potentially influencing on inflammation. Clinical and biochemical evaluations were performed monthly. Serum tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6), and C-reactive protein (CRP) were measured at 0, 1 and 3 months. Baseline, demographic, clinical and biochemical variables were comparable between groups. Baseline versus final inflammatory markers were: captopril/placebo TNFα, 2.47 (0.1–4.5) versus 1.73 (0.3–3.8) pg/ml; IL-6, 17.03 (7.2–23) versus 7.90 (0.7–19) pg/ml; CRP, 4.21 (1.6–18) versus 5.9 (3.0–28) mg/l; telmisartan/placebo TNFα, 3.03 (2.3–4.6) versus 1.70 (1.2–2.0) pg/ml; IL-6, 14.10 (5.5–23) versus 9.85 (6.2–13) pg/ml; CRP, 5.74 (2.1–13) versus 10.60 (1.5–27) mg/l; captopril + telmisartan TNFα, 1.43 (0.7–5.4) versus 0.40 (0.1–2.1) pg/ml; IL-6, 10.05 (4.9–23) versus 4.00 (0.7–7.7) pg/ml (p

A menudo, los pacientes con un mismo problema de salud reciben diferentes formas de evaluación o tratamiento que no siempre son claramente justificadas, lo que con frecuencia conduce a discrepancias en los resultados clínicos de los pacientes y a variabilidad significativa en los costos. La estandarización de procesos en salud es la especificación y comunicación de un proceso con suficiente detalle para permitir de forma consistente y verificable su implementación por diferentes operadores, a diferentes tiempos y en diferentes ambientes. En este manuscrito se abordan los procesos estandarizados con especial énfasis en la salud renal, algunos de sus beneficios, incluyendo los costos, así como algunos puntos importantes para implementar estos procesos en la práctica clínica.

La enfermedad renal crónica (ERC) es de alta prevalencia en América Latina y en todo el mundo. Se estima que entre el 10 y 20% de la población adulta es portadora de ERC y su prevalencia va en aumento. La ERC progresa en forma silenciosa. Su diagnóstico temprano y oportuno permite iniciar un tratamiento efectivo, en la mayoría de los casos, para detener la enfermedad. Desde hace mucho tiempo, el análisis de la creatininemia es la principal prueba utilizada para valorar la función renal; pero su confiabilidad es limitada. De acuerdo con las recomendaciones de las Guías KDOQI del año 2002, la tasa de filtración glomerular estimada (TFGe) obtenida por medio de fórmulas se estableció como una de las herramientas principales para detectar la enfermedad renal de manera precoz, ya que alerta de forma precisa al médico y al equipo de salud sobre el nivel de función renal del paciente. La detección de una TFGe disminuida (menor de 60 ml/min/1.73 m2) es clínicamente relevante, ya que permite establecer el diagnóstico de enfermedad renal en adultos. En el año 2022, en una encuesta realizada por la Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH) y la Confederación Latinoamericana de Bioquímica Clínica (COLABIOCLI) dirigida a los laboratorios de análisis clínicos de América Latina (237), el 49% de estos no informaban la TFGe de forma sistemática. Con base en esta realidad, la SLANH y la COLABIOCLI presentan las siguientes recomendaciones de consenso en referencia al uso de la TFGe.

BackgroundThere are many clinical practice guidelines (CPGs) in Nephrology; however, there is no evidence that their availability has improved the clinical competence of physicians or the outcome of patients with chronic kidney disease (CKD). This study was aimed to evaluate the effect of implementation of CPGs for early CKD on family physicians (FP) clinical competence and subsequently on kidney function preservation of type 2 diabetes mellitus (DM2) patients at a primary healthcare setting.MethodsA prospective educative intervention (40-h) based on CPGs for Prevention, Diagnosis and Treatment of Early CKD was applied to FP; a questionnaire to evaluate clinical competence was applied at the beginning and end of the educative intervention (0 and 2 months), and 12 months afterwards. DM2 patients with CKD were evaluated during 1-year of follow-up with estimated glomerular filtration rate (eGFR) and albuminuria.ResultsAfter educative intervention, there was a significant increase in FP clinical competence compared to baseline; although it was reduced after 1 year, it remained higher compared to baseline. One-hundred thirteen patients with early nephropathy (58 stage 1, 55 stage 2) and 28 with overt nephropathy (23 stage 3, 5 stage 4) were studied. At final evaluation, both groups maintained eGFR [(mean change) early 0.20 ± 19 pNS; overt 0.51 ± 13 mL/min pNS], whereas albuminuria/creatinuria (early −67 ± 155 p < 0.0001; overt −301 ± 596 mg/g p < 0.0001), systolic blood pressure (early −10 ± 18 p < 0.05; overt −8 ± 20 mmHg p < 0.05), and total cholesterol (early −11 ± 31 p < 0.05; overt −17 ± 38 mg/dL p < 0.05) decreased. Diastolic blood pressure, waist circumference and LDL-cholesterol were also controlled in early nephropathy patients.ConclusionsCPGs for Prevention, Diagnosis and Treatment of CKD, by means of an educative intervention increases FP clinical competence and improves renal function in DM2 patients with CKD.

Mineral bone disease (MBD) is common in dialysis patients. Genetics and the hormonal environment influence the clinical picture and outcomes of women. This study aimed to determine how these factors affect mortality. In 234 female dialysis patients on Continuous Ambulatory (48%) or Automated (29%) Peritoneal Dialysis or Hemodialysis (23%), MBD biochemical variables, as well as bone density and genetic Bsm1 polymorphism of vitamin D receptor (VDR) were performed at baseline. The cohort was followed-up by 17 (IQ range 15–31) months. According to VDR polymorphism, the distribution of patients was bb: 64% and BB+Bb: 36%. Fifty-five patients died from all-cause mortality; the hs-C-reactive protein level was the most significant risk in multivariate Cox analysis. Nineteen died from cardiovascular mortality. None of the variables were significant for cardiovascular mortality. Patients with bb plus inflammation had the highest risk in the analysis; the significance persisted after adjustment for age, diabetes, and parathyroid hormone levels HR 2.33 (95% CI, 1.01–8.33) and after further adjustment for time on dialysis, albumin, and Osteoprotegerin levels HR 3.49 (95% CI, 1.20–10.9). The presence of the bb genotype from VDR and inflammation had the highest risk of death from all-cause mortality in females on CAPD, APD, and HD patient. [ABSTRACT FROM AUTHOR]

The aim of the present study was to develop and validate a test to evaluate dietitian's clinical competence (CC) about nutritional care in patients with early chronic kidney disease (CKD). The study was conducted through five steps: (1) CC and its dimensions were defined; (2) test items were elaborated, and choice of response format and scoring system was selected; (3) content and face validity were established; (4) test was subjected to a pilot test and those items with inadequate performance were removed; (5) criterion validity and internal consistency for final validation were established. A 120-items test was developed and applied to 207 dietitians for validation. Dietitians with previous CKD training obtained higher scores than those with no training, confirming the test validity criterion. According to item analysis, Cronbach's α was 0⋅85, difficulty index 0⋅61 ± 0⋅22, discrimination index 0⋅26 ± 0⋅15 and inter-item correlation 0⋅19 ± 0⋅11, displaying adequate internal consistency.

Gut microbiota disturbances may influence cognitive function, increasing uremic toxins and inflammation in dialysis patients; therefore, we aimed to evaluate the association of the gut microbiota profile with cognitive impairment (CI) in patients on automated peritoneal dialysis (APD). In a cross-sectional study, cognitive function was evaluated using the Montreal Cognitive Assessment in 39 APD patients and classified as normal cognitive function and CI. The gut microbiota was analyzed using the 16S rRNA gene sequencing approach. All patients had clinical, biochemical and urea clearance evaluations. Eighty-two percent of patients were men, with a mean age of 47 ± 24 years and 11 (7–48) months on PD therapy; 64% had mild CI. Patients with CI were older (53 ± 16 vs. 38 ± 14, p = 0.006) and had a higher frequency of diabetes mellitus (56% vs. 21%, p = 0.04) and constipation (7% vs. 48%, p = 0.04) and lower creatinine concentrations (11.3 ± 3.7 vs. 14.9 ± 5.4, p = 0.02) compared to normal cognitive function patients. Patients with CI showed a preponderance of S24_7, Rikenellaceae, Odoribacteraceae, Odoribacter and Anaerotruncus, while patients without CI had a greater abundance of Dorea, Ruminococcus, Sutterella and Fusobacteria (LDA score (Log10) > 2.5; p < 0.05). After glucose and age adjustment, Odoribacter was still associated with CI. In conclusion, patients with CI had a different gut microbiota characterized by the higher abundance of indole-producing and mucin-fermenting bacteria compared to normal cognitive function patients. [ABSTRACT FROM AUTHOR]

Objective To describe mortality of in-hospital patients with COVID-19 and compare risk factors between survivors and non-survivors.Design Prospective cohort of adult inpatients.Setting Tertiary healthcare teaching hospital in Guadalajara, Mexico.Participants All patients with confirmed COVID-19 hospitalised from 25 March to 7 September 2020 were included. End of study: 7 November 2020.Primary outcome measures Patient survival analysed by the Kaplan-Meier method and comparison of factors by the log-rank test. Mortality risk factors analysed by multivariate Cox’s proportional-hazard model.Results One thousand ten patients included: 386 (38%) died, 618 (61%) alive at discharge and six (0.6%) remained hospitalised. There was predominance of men (63%) and high frequency of overweight–obesity (71%); hypertension (54%); diabetes (40%); and lung (9%), cardiovascular (8%) and kidney diseases (11%); all of them significantly more frequent in non-survivors. Overweight–obesity was not different between groups, but severity of disease (Manchester Triage System and quick Sequential Organ Failure Assessment) was significantly worse in non-survivors, who were also significantly older (65 vs 45 years, respectively) and had haematological, biochemical, coagulation and inflammatory biomarkers more altered than survivors. Mortality predictors were invasive mechanical ventilation (IMV; OR 3.31, p