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

The aim of the study was to understand the experiences of patients on automated peritoneal dialysis (APD) during the period of confinement due to the COVID-19 pandemic.Qualitative exploratory study, phenomenological through semi-structured telephone interview.A priori sampling was carried out with patients on APD with remote monitoring and telephone follow-up, in 13 hospitals in Mexico.Twenty-nine informants, mean age 45.41 ± 16.93; 15 women and 14 men. The analysis revealed four categories of analysis: home isolation, clinical follow-up, socioeconomic challenges and infodemic. The experiences of these patients led them to somatize emotions, presenting symptoms such as anxiety, sadness, loneliness, sleep, eating and digestive disorders, situation that sets the tone for future research on telemedicine care models, coping styles, emotional support strategies and socioeconomic impact on patients with chronic home treatments during the pandemic.

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.

To determine the evolution, associated factors and the outcomes of transplanted people one year after the evolution of a cohort in Mexico.Kidney transplant cohort from 2013 to 2017 in Mexico. 1118 patients were analyzed. Five outcomes were studied: overall survival, kidney graft, patient survival, delayed function, and acute dysfunction. Kaplan-Meier was used for kidney graft survival. For risk, bivariate and multivariate analyzes were performed with a significant value of p0.05.Of the 1118 kidney transplant patients, 57 (5.09%) had kidney graft loss, 52 (4.65%) died during the one-year follow-up; survival of the patient of 95.35% and of the graft 90.25%.The risk factors for the outcomes were transplantation from a deceased donor, recipient over 50 years of age and use of polyclonal agents. Infections and age are related to the death of the patient.Determinar la funcionalidad del injerto renal a 1 año en una cohorte retrospectiva en México.Cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 1118 pacientes. Se estudiaron cinco desenlaces: supervivencia global, supervivencia del injerto renal, supervivencia del paciente, función retardada y disfunción aguda. Para la supervivencia del injerto renal se usó Kaplan-Meier. Para el riesgo se realizó análisis bivariado y multivariado con valor significativo p0.05.De los 1118 pacientes con trasplante renal, 57 (5.09%) tuvieron pérdida del injerto, 52 (4.65 %) fallecieron durante el año de seguimiento; la supervivencia del paciente fue del 95.35% y la supervivencia del injerto fue del 90.25%.Los factores de riesgo para los desenlaces fueron trasplante de donante fallecido, receptor mayor de 50 años y uso de agentes policlonales. Las infecciones y la edad están relacionadas con la muerte del paciente.

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.

Posttransplant anemia (PTA) in kidney recipients is a complication that has repercussions mainly of cardiovascular consequence. The objective of this study is to determine the prevalence of anemia, as well as the relationship between kidney recipient and donor sex, in the presence or absence of anemia at 12 months after kidney transplant (KT).Observational, longitudinal study of KTs made over a 5-year period, from 2013 to 2017, in a renal transplant unit from La Raza National Health Care Medical Center. Three hundred twenty-eight records were analyzed. Hemoglobin (Hb) and the presence or absence of anemia according to the definition by the World Health Organization were analyzed. The association between kidney recipient sex and donor type (living or deceased) was evaluated. Analysis of central tendency and dispersion were performed and the mean difference was established with χThe mean Hb (standard deviation) before KT was 10.38 (2.16) g/dL; Hb at 12 months was 14.47 (2.37) g/dL with an absolute increase of 4.09 g/dL. Before KT, male kidney recipients had a mean Hb of 10.54 (2.17) g/dL. At 12 months post-KT, mean Hb was 15.33 (2.25) with a change of 4.79 g/dL. Before KT, female kidney recipients had a mean Hb of 10.16 (2.13) g/dL. At 12 months post-KT, mean Hb was 13.31 (2.01) with a change of 3.15 g/dL. The difference between both sexes was 1.64 g/dL at the end of 12 months. Sixteen out of 152 (10.5%) patients had a serum creatinine (Cr) 1.2 mg/dL and anemia; 36 out of 176 (20.5%) patients had a Cr ≥ 1.2 mg/dL and anemia (P = .014). In the bivariate logistic regression with an odds ratio of 2.047 (95% confidence interval, 1027-4078; P = .042) for higher Cr levels and the presence of persistent anemia.There is a prevalence of anemia in female kidney recipients and recipients of kidneys from deceased donors. There is a higher risk of persistent anemia in the case of patients with some degree of graft failure at 12 months.

Introduction Classic post-transplant complications are highly studied and monitored; however, other unusual complications may occur due to immunosuppression. The objective of this study is to show these rare complications in a kidney transplant center. Material and Methods Retrospective, observational, longitudinal study of renal transplants carried out from 2013 to 2017 in the Renal Transplant Unit of the National Medical Center Siglo XXI. A total of 790 transplants were performed, with surveillance for 1 year and rare events described. An analysis of frequencies and percentages of the events was performed using the statistical package SPSS version 25. Results Of the 790 patients, 110 (13.92%) experienced rare events, classified into 9 types of complications. Discussion and Conclusions Complications exist in renal transplantation that are often ignored or minimized. A considerable number have been observed in this study, 110 events (13.92%); this result allows us to consider multiple possibilities in a kidney transplant program, especially infectious complications (34 patients) and surgical complications (29 cases). With the increase in diabetic receptor transplantation, metabolic complications will surely increase in the coming years.

Objectives The biochemical conditions in which patients arrive before renal transplantation (RT) are rarely evaluated; examples of them are found in the Dialysis Outcomes and Practice Patterns Study (DOPPS). The objective of our study was to ascertain the fulfillment of biochemical goals for patients on renal replacement therapy before RT. Material and Methods Observational, retrospective study of patients who were on a RT protocol between 2012 and 2017 in 2 RT centers in Mexico. The records of 1188 patients with a history of RT and their lab results before transplantation were analyzed. Anthropometric values including hemoglobin, iron levels, calcium, phosphorus, parathyroid hormone, urea, creatinine, uric acid, and left ventricular ejection fraction were studied. All values were categorized as low, optimal, or high levels. Results The fulfillment of pretransplant biochemical objectives for elimination of azotemia (urea and creatinine) was achieved in 60% of the patients. Optimal values for calcium were found in 715 (64%) patients and optimal values for albumin were found in 690 (61.8%) patients. In the case of phosphorus, hemoglobin, uric acid, and parathyroid hormone, the optimal values were below 50%. Conclusions It is essential to improve compliance with biochemical and clinical objectives for patients on renal replacement therapy (dialysis, hemodialysis) before RT. Only half of the variables were within the optimal range before surgical intervention took place.

There are very few data on analytical biomarker levels in children with congenital heart disease (CHD) before and after cardiopulmonary bypass surgery. We conducted a preliminary study in the Pediatric Hospital of Medical Center IMSS Mexico, to evaluate plasma levels of endothelin-1 (ET-1) and circulating endothelial progenitor cells (CPEC) before and after correction surgery. 56 patients were included: 41 with CHD that required CPB and 15 controls with surgery other than CPB, which were stratified by age (infants, preschool-age-children, and school-age-children). Samples of peripheral blood were taken 24h before and 48h after surgery, cytokine levels (TNF/IL-1β/IL-6/IL-8/IL-10 and IL-12p70) and brachial-artery-flow-mediated dilation (BAFMD) were explored too. Demographic and clinical data were collected. BAFMD was evaluated by-Doppler-ultrasound, the percentage (%) and absolute number (N) of CPEC [CEC and EPC], ET-1 and cytokines concentrations were measured by flow-cytometry, radioimmunoassay and a Bead-Array-cytometric-system, respectively. The% and N of CEC[CD34 + / CD146 + / VEGFR2 + / CD133−] increased in infants versus their control group; and EPC[CD34 + / CD146 + / VEGFR2 + / CD133 +] were higher in the control group of infants versus patients. ET-1 levels were higher in patients than in controls (p = 0.002). N-CEC showed differences between 24 and 48 hours; BAFMD in CPB-preschool at 24H and 48H showed a significant difference. Higher levels of IL-6 and IL-8 were detected in CPB-school-age at 48H. This pilot study observed a significant increase in the levels of CEC and ET-1. To validate these data, subsequent studies should increase the sample size.

End-stage renal disease (ESRD) patients have an elevated risk of cardiovascular (CV) complications including acute myocardial infarction (AMI); endothelial dysfunction and accumulation of uremic toxins have been associated with such CV-events. To explore which molecular pathways are involved in this CV-complication and the effects of the uremic serum on gene expression, an endothelial dysfunction model was studied through microarrays and pathway analysis. mRNA was isolated of human coronary arterial endothelial cells (HCAEC) primary cultures supplemented with 20% uremic serum from two groups of patients, USI: ESRD-patients; UCI: ESRD-AMI-patients. Affymetrix GeneChip® microarray and the LIMMA-package (Linear Models for Microarray Data) of the Bioconductor sofware17 was implemented to identify relevant DEGs between the two groups of uremic patients. Protein-protein interaction networks and pathway analysis were made to analyze the interaction and expression tendency of differentially expressed genes. 100 differentially expressed genes were identified from two data sets triggered by uremic state using bioinformatics, from 16,607. After in a new cohort, 30 genes were overexpressed in UCI group, which we identified 500 ontological genetic terms and one KEGG-pathway with p < 0.05. The metabolic pathway significantly represented was the MAPK signaling pathway. Network analysis showed six genes (PTGS2, SELE, ICAM1, HMOX1, EGR1, and TLR2) that represent potential markers for ESRD with AMI, as an approximation to their underlying mechanisms. The results obtained suggest that uremic toxins in patients with ESRD can alter HCAEC and modify the gene expression profile, which could have an impact on the development of cardiovascular complications in these patients.

BACKGROUND The presence of acute renal injury has been associated with increased cardiovascular morbidity and mortality (sudden death and arrhythmias). OBJECTIVE To know the frequency of heart rhythm disorders documented by Holter in patients in need of intermittent hemodialysis due to acute renal injury. MATERIAL AND METHODS A prospective observational study was conducted including patients with a diagnosis of acute renal injury who received intermittent hemodialysis; demographic, clinical and laboratory data were collected from 28 patients. Monitoring was carried out through Holter before, during and after the hemodialysis session. Nonparametric statistics were used, with a significant value of p < 0.05. Risks were established with logistic regression. RESULTS There was a significant difference in supraventricular extra systoles (82.1% vs. 57.1%), ventricular extra systoles (26.7% vs. 3.6%), and supraventricular tachycardia (6.7% vs. 3.6%). The rest of the rhythm alterations without significance. CONCLUSIONS Intermittent hemodialysis is a factor associated with the appearance of heart rhythm disorders. The death of patients with acute renal injury and substitution was related to ventricular extra systole detected by transhemodialysis Holter.

The presence of acute renal injury has been associated with increased cardiovascular morbidity and mortality (sudden death and arrhythmias).To know the frequency of heart rhythm disorders documented by Holter in patients in need of intermittent hemodialysis due to acute renal injury.A prospective observational study was conducted including patients with a diagnosis of acute renal injury who received intermittent hemodialysis; demographic, clinical and laboratory data were collected from 28 patients. Monitoring was carried out through Holter before, during and after the hemodialysis session. Nonparametric statistics were used, with a significant value of p0.05. Risks were established with logistic regression.There was a significant difference in supraventricular extra systoles (82.1% vs. 57.1%), ventricular extra systoles (26.7% vs. 3.6%), and supraventricular tachycardia (6.7% vs. 3.6%). The rest of the rhythm alterations without significance.Intermittent hemodialysis is a factor associated with the appearance of heart rhythm disorders. The death of patients with acute renal injury and substitution was related to ventricular extra systole detected by transhemodialysis Holter.La presencia de lesión renal aguda se ha asociado a unas mayores morbilidad y mortalidad de causa cardiovascular (muerte súbita y arritmias).Conocer la frecuencia de trastornos del ritmo cardiaco documentado por Holter en pacientes con necesidad de hemodiálisis intermitente por lesión renal aguda.Se realizó un estudio observacional, prospectivo, en pacientes con diagnóstico de lesión renal aguda que recibieron hemodiálisis intermitente; se recabaron datos demográficos, clínicos y de laboratorio de 28 pacientes. Se realizó monitoreo mediante Holter, previo, durante y posterior a la sesión de hemodiálisis. Se utilizó estadística no paramétrica, con un valor significativo de p0.05. Se establecieron riesgos con regresión logística.Hubo diferencia significativa en extrasístoles supraventriculares (82.1% frente a 57.1%), extrasístoles ventriculares (26.7% frente a 3.6%) y taquicardia supraventricular (6.7% frente a 3.6%). El resto de las alteraciones del ritmo no mostraron significancia.La hemodiálisis intermitente es un factor asociado a la aparición de trastornos del ritmo cardiaco. La muerte de los pacientes con lesión renal aguda y sustitución estuvo relacionada con la extrasístole ventricular detectada por Holter transhemodiálisis.

Resumen Introduccion y objetivos El trastorno neuroagresivo irreductible (TNI) es una entidad bien descrita asociada con comportamiento impulsivo y agresivo. Es un dilema tanto para el tratamiento farmacologico como para el no farmacologico en la psiquiatria moderna, implicando un riesgo individual y social importante. A pesar de los avances en la terapia estereotactica dirigida para TNI persiste una ausencia de informacion cuando se compara la eficacia de los diferentes blancos anatomicos validados. En el presente trabajo se describen los resultados quirurgicos de los pacientes con TNI tratados con cirugia estereotactica ablativa, con enfoque en los criterios de seleccion y metodos utilizados en nuestra institucion. El objetivo es analizar la eficacia y seguridad de los diferentes blancos estereotacticos mas utilizados para agresividad irreductible en ninos. Materiales y metodos Seleccionamos a 8 pacientes pediatricos con TNI bajo un estricto protocolo. Se les realizo electroencefalograma, videoelectroencefalograma y resonancia magnetica previo a la cirugia. El sintoma neuroagresivo irreductible fue tratado con cirugia estereotactica hacia los blancos cerebrales mas descritos para agresividad, y posteriormente evaluado mediante la Overt Agressive Scale en el prequirurgico y a los 6 meses de seguimiento, usando el test de Wilcoxon para el analisis estadistico. Resultados y conclusiones La edad promedio de los pacientes fue de 13 anos y 2 meses, 7 de los 8 pacientes incluidos tenian discapacidad intelectual, un paciente tenia secuelas neurologicas por sindrome de Dandy Walker y 7 pacientes no tenian alteraciones anatomicas preoperatorias. Despues de la cirugia los pacientes mostraron mejoria en la escala Overt Agressive Scale con un promedio de 39,29% (p = 0,0156), lo cual se encuentra dentro del rango descrito para TNI en adultos. Los resultados mas satisfactorios tuvieron en comun la inclusion del complejo nuclear amigdalino dentro de los blancos quirurgicos. No hubo muertes ni secuelas permanentes atribuibles al procedimiento. La presente serie es la mas grande descrita en la literatura hasta el momento para pacientes pediatricos con TNI tratados con ablacion estereotactica.

Background Bone mineral disease after transplantation persists and is an issue that must be addressed owing to the cardiovascular impact it presents. The objective of this study is to present the behavior of calcium, phosphorus, and parathormone (PTH) before renal transplantation (RT) and throughout the 12 months after transplant surgery. Methods A longitudinal observational study of RT patients was performed from 2013 to 2017 in 2 renal transplant units in Mexico. In total, 1009 records of patients with RT were analyzed. Calcium, phosphorus, and PTH levels were studied before transplantation and for 12 months after. Central tendency and dispersion were measured, the difference of means was established with chi square or student t tests, and the significant value of P was set at Results Phosphorus had a median pre-RT of 5.73, which decreased to 2.8 in the first month post-transplant and then increased to 3.41 at 12 months post-RT. The median PTH, on the other hand, started at 420.60 and decreased to 67.45. Calcium began at 9.04 and hit a plateau of 9.58 during month 12 after the surgical event. Conclusions Of the 3 biochemical parameters evaluated, phosphorus was the one that most corrected itself after transplantation. Despite a tendency toward hypophosphatemia in the first month after transplantation, it began to normalize from month 6 on. Meanwhile, calcium was the biochemical value that changed the least after transplantation.

Introduction: The infection with SARS-CoV-2 that affects the entire world has been shown to be more severe in patients with comorbidities The object of this study was to know the survival of renal transplant patients infected with this coronavirus Material and methods: Eligible were renal transplant patients with SARS-CoV-2 infection requiring hospitalization (moderate and severe degree) from the start of the pandemic to September 28, 2020 Survival analysis was performed with Kaplan-Meier tables in days, using statistical package SPSSw v25 Results: Data was collected for 66 patients from 4 renal transplant facilities;the mean age was 39 5 years (IQR 30 0-49 5);global survival was 59 10% Difference of 67 50% vs 46 15% was observed between receivers from living and dead donors respectively (without Log Rank significance of 0 068);70 25% survival in patients with low immunological risk and 44 82% for high risk (Log Rank 0 034) Conclusions: Comorbidities and immunosuppression greatly influence mortality in renal transplant patients immunological risk presents an important determinant of patient survival [ABSTRACT FROM AUTHOR] Copyright of Trends in Transplantation is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Introduction Renal transplantation (RT) has evolved to improve its functionality. Some factors have been little studied, one of which is hyperuricemia and its impact on renal graft function. The objective of this study is to determine the prevalence of complications of renal transplantation and its influence on hyperuricemia values in the first year of evolution. Material and Methods The authors completed a retrospective, observational study of 2 RT units in Mexico from January 2013 to December 2017. In total, 1009 files met the inclusion criteria; the levels of uric acid (UA) and creatinine (Cr) were determined before transplantation and in months 1, 3, 6, 9, and 12 after transplantation. Descriptive analysis was performed with measures of central tendency, measures of dispersion, difference of means with Student t test, and SPSS version 25 (IBM, Armonk, NY, United States). Results The mean pretransplant UA was 6.24 mg/dL (standard deviation [SD] 1.97); per month was 4.73 mg/dL (SD 1.49). There is a difference in means between categorized groups of UA in the 5 post-RT moments (1, 3, 6, 9, and 12 months). A positive correlation of 0.41 to 0.47 was found with Spearman’s test. The delayed function of the graft influenced in the first month after transplant in presenting hyperuricemia and acute dysfunction in month 6 showed that the rejection had no significance at any time. Conclusions The relationship between the values of UA and Cr in the RT represents a moderate positive correlation; delayed graft function in the first month impacts the presence of hyperuricemia, as well as acute dysfunction at month 6 after transplantation.

Background Dyslipidemia represents a trigger for cardiovascular complications, being in minimized renal transplantation (RT) or most of the occasions associated as something secondary to immunosuppression. The objective is to determine the pattern of cholesterol and triglyceride behavior in the first 12 months of post-transplant evolution and its relationship with age, sex of the recipient, and type of renal donor. Materials and Methods An observational, longitudinal study of RT carried out from 2013 to 2017 at the National Medical Center La Raza. In total, 328 records of patients with RT were analyzed. Cholesterol and triglyceride levels were studied over 12 months after renal transplantation; the association with sex, age of the renal recipient, and type of donor (live or deceased) was determined. Measures of central tendency and dispersion were made; the difference of means was established with a χ2 or Student t test. For risk, a bivariate analysis was performed with a significant value of P Results The mean pretransplant cholesterol was within normal values (176.32, standard deviation [SD] 40.15 mg/dL), but triglycerides were not (158.36, SD 36.60 mg/dL). The pattern in both cases increased the values the first month after transplant to reach similar pretransplant levels in month 12. Cholesterol showed differences for month 12 in the group over 50 years (P = .022); like triglycerides in the 9th and 12th months (P = .026 and .003, respectively), values were higher in those over 50 years. Discussion and Conclusions The pattern of cholesterol and triglyceride behavior is similar, even without understanding the reasons for the immediate post-transplant increase in month 1. There is no influence on the sex of the renal recipient nor on the type of donor. Only the age in recipients older than 50 years has a ratio of higher triglyceride values in months 9 and 12 and in cholesterol in the 12 months post-transplant.

Introduction Renal transplantation presents multiple complications after its completion, some of them related to the behavior of hemoglobin levels. The objective of this study is to determine the behavior and prevalence of anemia and erythrocytosis in the first year after renal transplantation. Material and Methods A retrospective, observational study was conducted of a cohort of patients of the 21st Century National Medical Center in Mexico of transplants performed from January 1, 2013 to December 31, 2017. A total of 649 met the inclusion criteria. Pre-transplant hemoglobin (Hb) levels were determined, as well as levels 1 month, 3, 6, 9, and 12 months after transplantation, and the prevalence of anemia and erythrocytosis was determined in each month. Descriptive analysis was performed with measures of central tendency and measures of dispersion. The statistical program SPSS version 25 was used. Results The mean pre-transplant Hb was 10.69 g/dL (standard deviation [SD] 2.04). One year after the renal transplant, Hb averaged 14.45 g/dL (SD 2.30), which meant an increase over the first year after renal transplantation of 3.76 g/dL. Pre-transplant anemia occurred in 73.1% of patients, and erythrocytosis in 0.1%; 12.9% of patients and 5.9% in erythrocytosis continued with anemia for a year. Conclusions Renal transplantation allows Hb levels to recover in a multifactorial way; however, the persistence of anemia and erythrocytes creates a study challenge in any transplant unit, due to their prevalence of 12.9 and 5.9% respectively

espanolIntroduccion: La enfermedad renal cronica representa parte del gasto en salud en general; una potencial etiologia es la relacionada con variaciones, ausencia o presencia de algunos alelos del human leucocyte antigen (HLA). Metodo: Se realizo el analisis de 1965 reportes de HLA sin etiologia determinada y de 1361 donadores renales. Se llevo a cabo tecnologia Luminex con base en fluorimetria de flujo celular para los locus A, B, DRB1 y DQA. Se realizo analisis con tablas de contingencia para determinar razon de momios (RM) e intervalos de confianza (IC). Se efectuo analisis cuantitativo. Resultados: De 101 alelos encontrados, 13 presentaron asociacion, siete con riesgo para enfermedad renal cronica, de los cuales el mas significativo fue HLA-DR17, con RM = 3.91 (IC 95 % = 2.96-5.17), y el de mayor significacion de proteccion fue HLA-DR9, con RM = 0.043 (IC 95 % = 0.005-0.3224). Conclusiones: Es necesario entender que las enfermedades renales pueden estar ligadas a procesos inmunologicos, en los que se tiene que conocer la asociacion de la ausencia o presencia de algun alelo. EnglishIntroduction: Chronic kidney disease accounts for part of overall health expenditure; a potential etiology is related to variations, absence or presence of some human leukocyte antigen (HLA) alleles. Method: An analysis of HLA reports of 1965 kidney recipients with no determined etiology, and 1361 kidney donors was performed. It was carried out with Luminex based in cell flow fluorometry for the A, B, DRB1 and DQA loci. An analysis was performed with contingency tables in order to determine the odds ratio (OR) and confidence intervals (CI). Quantitative analysis was also carried out. Results: Of the 101 alleles found, 13 showed association, 7 with risk for chronic kidney disease, with the most significant being HLA-DR17 with an OR of 3.91 (95 % CI = 2.96-5.17) and the one with the highest significance for protection being HLA-DR9, with an OR of 0.043 (95 % CI = 0.005-0.3224). Conclusions: It is necessary to understand that kidney diseases can be associated with yet unknown immune processes, where the association of the absence or presence of any allele should be known.

Kidney transplantation presents a susceptible point, and is related to infections; tuberculosis is a common and endemic etiology in a country like Mexico, where the most frequent presentation is the respiratory condition, the extrapulmonary is extremely rare and it is derived from immunosuppression conditions.33-year-old man with kidney disease of undetermined etiology, kidney transplant in 2003 (donor mother) with adequate evolution; presented with chronic graft nephropathy, with baseline creatinine of 1.8 mg / dL, immunosuppression with prednisone 10 mg every 24 hours, mycophenolate mofetil 500 mg every 8 hours and ciclosporin 100 mg every 12 hours; surgical intervention was performed due to acute abdomen, appendectomy and omentectomy with histopathological finding of tuberculosis, Dotbal, antiproliferative in suspension was started and decrease of calcineurin inhibitor. Adequate kidney function was recovered and maintained as well as control of the infectious disease during the maintenance period.The management of immunosuppression is vital to find the right dose to avoid rejection and allow an immune response to infection, together with antimicrobial treatment.el trasplante renal presenta un punto susceptible y está relacionado con las infecciones; siendo la tuberculosis una etiología común y más en un país endémico como lo es México, siendo la forma de presentación más frecuente la afección respiratoria, lo extrapulmonar es sumamente raro derivado de condiciones de inmunosupresión.hombre de 33 años de edad, con enfermedad renal de etiología no determinada, trasplantado renal en el año 2003 (madre donadora) con adecuada evolución; se presentó con nefropatía crónica del injerto, con creatinina basal de 1.8 mg/dL, inmunosupresión con prednisona 10 mg cada 24 horas, micofenolato de mofetilo 500 mg cada 8 horas y ciclosporina 100 mg cada 12 horas; se intervino quirúrgicamente por cuadro de abdomen agudo, se realizó apendicetomía y omentectomía con hallazgo histopatológico de tuberculosis, se inició Dotbal, antiproliferativo en suspensión y disminución del inhibidor de calcineurina. Se recuperó y mantuvo adecuada función renal y control del cuadro infeccioso, en periodo de mantenimiento.el manejo de la inmunosupresión es vital para encontrar la dosis adecuada evitando rechazo, así como permitir una respuesta inmunológica ante la infección, junto con el tratamiento antimicrobiano.

Cardiovascular diseases occur 75 to 80% as causes of morbidity and mortality in patients with chronic kidney disease. In epidemiological studies the causes of cardiovascular deaths are sudden death, arrhythmias, heart failure, coronary arteries disease and myocardial infarction. Heart failure and cardiac arrhythmias are caused mainly by left ventricular hypertrophy and cardiac fibrosis. Pathophysiological factors involved in left ventricular hypertrophy ventricular hypertrophy have been divided into 3 categories: related to afterload, related to preload and not related to afterload or preload. Myocardial hypertrophy induces the activation of cellular apoptosis signals and activates metabolic pathways able to increase extracellular matrix production up to fibrosis. Fibrosis leads to progressive impairment in contractility with stiffening of myocardial wall, diastolic and systolic dysfunction and finally dilated cardiomyopathy with congestive heart failure. The main of this review is to understand the pathophysiology of left ventricular hypertrophy, cardiac fibrosis and diastolic dysfunction.Las enfermedades cardiovasculares se presentan del 75al 80% como causas de morbimortalidad en pacientes con enfermedad renal crónica. En estudios epidemiológicos, las causas más frecuentes de muerte cardiovascular son: muerte súbita, arritmias, falla cardiaca, enfermedad arterial coronaria e infarto del miocardio. La insuficiencia cardiaca y las arritmias cardiacas son causadas por la hipertrofia del ventrículo izquierdo y la fibrosis cardiaca. Los factores fisiopatológicos involucrados en la hipertrofia del ventrículo izquierdo se dividen en 3 categorías: relacionado a la poscarga, relacionado a la precarga y los no relacionados ni a la poscarga, ni a la precarga. La hipertrofia miocárdica induce la activación de señales de apoptosis celular y activa las vías metabólicas capaces de aumentar la producción de matriz extracelular hasta fibrosis. La fibrosis conduce al deterioro progresivo de la contractilidad y al engrosamiento de la pared del miocardio, causando disfunción diastólica, sistólica y miocardiopatía dilatada con insuficiencia cardiaca congestiva. El objetivo de esta revisión es conocer la fisiopatología de la hipertrofia del ventrículo izquierdo, de la fibrosis cardiaca y de la disfunción diastólica en la enfermedad renal crónica.

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.

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.

Cardiovascular diseases are the leading cause of death in people with chronic kidney disease (CKD). These involve the whole structure and function of the heart, so the clinical presentation varies from chronic heart failure to arrhythmias and even sudden death, having a significant impact on the patient’s quality of life and a high cost for health services. The origin of these cardiovascular alterations is ample, involving the traditional and non-traditional cardiovascular risk factors, as well as systemic changes that cause the progressive loss of the glomerular filtration rate. The identification of cardiovascular alterations during the course of the CKD has become important in the clinical setting, and there is a wide field of research regarding treatment interventions, many of which have not been fully established up to date.La principal causa de muerte en la población con enfermedad renal crónica (ERC) se debe a causas cardiovasculares; estas alteraciones involucran a toda la estructura y función del corazón, de tal forma que la presentación clínica varía desde un cuadro de insuficiencia cardiaca crónica, hasta arritmias y muerte súbita, con un impacto significativo en la calidad de vida del enfermo y un alto costo para los servicios de salud. El origen de estas alteraciones es basto e intervienen en su generación los factores tradicionales y no tradicionales de riesgo cardiovascular, así como los cambios sistémicos que ocasiona la pérdida progresiva de la tasa de filtración glomerular. La identificación de las alteraciones cardiovasculares durante el transcurso de la ERC ha tomado importancia en la atención clínica del enfermo, y existe un amplio campo de investigación en lo que se refiere a las intervenciones de tratamiento, muchas de las cuales, al momento actual, no se encuentran totalmente establecidas.

The irreducible neuroaggressive disorder (IND) is a well-described entity known to be associated with impulsive and aggressive behavior. While various studies have assessed available pharmacological and non-pharmacological treatment regimens, patients with IND continue to pose a major threat to themselves and society. While targeted stereotactic therapy for IND has gained traction in recent years, there is a paucity of information describing comparative effectiveness of different validated anatomic regions. In this paper, we discuss the surgical results for patients with IND following targeted lesional therapy with a special focus on selection criteria and operative methods. The objective is to analyze the efficacy and safety of the different described targets for this disorder in pediatric patients.Eight pediatric patients met strict criteria for IND and were enrolled in this study. Electroencephalography (EEG), video electroencephalography (VEEG) and magnetic resonance imaging (MRI) were performed in all patients prior to surgery. Irreducible neuroagressive symptom was approached by lesional therapy based on most described targets for this disorder and assessed by The Overt Agressive Scale (OAS) pre-operatively and 6 months following surgery, using Wilcoxon test for statistical analysis.The average patient age was 13 years 2 months. 7 of the 8 patients enrolled had intellectual disabilities, 1 patient suffered neurologic sequelae referable to Dandy Walker syndrome and 7 patients had no preoperative anatomical alterations. Following surgery, patients with IND noted improvement in their OAS. On average, the OAS improved by 39.29% (P=.0156), a figure similar in comparison to studies assessing treatment of IND in adult patients. The most satisfactory results were achieved in patients whose ablative therapy involved the Amygdala in their targets. There were no deaths or permanent neurological deficits attributable to procedure. To the author's knowledge, this is the largest series described in the literature for pediatric patients with IND treated with lesional stereotactic therapy.

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.

"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."

OBJETIVO: Evaluar las características de la atención del paciente hipertenso, y su relación con el descontrol de la presión arterial, en una unidad de medicina familiar. MATERIAL Y MÉTODOS: Diseño: estudio transversal. Se revisó la mitad de 8 080 (4 040) expedientes. Se registraron las características de los pacientes, los médicos tratantes y la unidad de atención. RESULTADOS: Se encontraron como factores asociados a la hipertensión descontrolada la edad (RM, 1.43; IC95%: 1.015-1.030), IMC (RM, 1.03; IC95%: 1.02-1.05), creatinina (RM, 1.16; IC95%: 1.03-1.30), tomar tres o más fármacos antihipertensivos (RM, 1.48; IC95%: 1.31-1.07), ser atendido por un médico con más de 20 años de antigüedad (RM, 1.21; IC95%: 1.06-1.39), sin especialidad (RM, 1.43; IC95%: 1.20-1.71) y ser atendido en el turno matutino (RM, 1.21; IC95%: 1.07-1.56). CONCLUSIONES: La presión arterial está bien controlada en la mayoría de los pacientes. En el descontrol de la presión arterial intervienen factores relacionados con el paciente mismo, pero las características del sistema de salud también tienen un papel significativo.OBJECTIVE: To assess health care characteristics for hypertensive patients and their association with uncontrolled hypertension in a primary care outpatient clinic. MATERIAL AND METHODS: Design: cross-sectional.A review was conducted of 50% of 8080 (n= 4040) files. Patient, physician and primary health care clinic characteristics were recorded. RESULTS: The factors associated with uncontrolled hypertension were: age (OR, 1.43; CI95% : 1.015-1.030), BMI (OR, 1.03; CI95%: 1.02-1.05), creatinine serum levels (OR, 1.16; CI95%: 1.03-1.30), three or more different antihypertensive drugs (OR, 1.48; CI95%: 1.31-1.07), to be treated by a physician with more than 20 years of medical practice (OR, 1.21; CI95%; 1.06-1.39) or by a non-specialist physician (OR, 1.43; CI95%: 1.20-1.71) and to be treated in the morningshift (OR, 1.21; CI95%: 1.07- 1.56). CONCLUSIONS: Hypertension is well-controlled in the majority of patients. Patient-related factors are important in uncontrolled hypertension; however, health care system characteristics also play an important role.

Objetivo. Evaluar las características de la atención del paciente hipertenso, y su relación con el descontrol de la presión arterial, en una unidad de medicina familiar. Material y métodos. Diseño: estudio transversal. Se revisó la mitad de 8 080 (4 040) expedientes. Se registraron las características de los pacientes, los médicos tratantes y la unidad de atención. Resultados. Se encontraron como factores asociados a la hipertensión descontrolada la edad (RM, 1.43; IC95%: 1.015-1.030), IMC (RM, 1.03; IC95%: 1.02-1.05), creatinina (RM, 1.16; IC95%: 1.03-1.30), tomar tres o más fármacos antihipertensivos (RM, 1.48; IC95%: 1.31-1.07), ser atendido por un médico con más de 20 años de antigüedad (RM, 1.21; IC95%: 1.06-1.39), sin especialidad (RM, 1.43; IC95%: 1.20-1.71) y ser atendido en el turno matutino (RM, 1.21; IC95%: 1.07-1.56). Conclusiones. La presión arterial está bien controlada en la mayoría de los pacientes. En el descontrol de la presión arterial intervienen factores relacionados con el paciente mismo, pero las características del sistema de salud también tienen un papel significativo.