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Palomo-Piñón S, Antonio-Villa NE, García-Cortés LR, Moreno-Noguez M, Alcocer L, Álvarez-López H, Cardona-Muñoz EG, Chávez-Mendoza A, Díaz-Díaz E, Enciso-Muñoz JM, Galván-Oseguera H, Rosas-Peralta M. Patients Living With Arterial Hypertension in Mexico: First Insights of The Mexican Registry of Arterial Hypertension (RIHTA Study). Am J Hypertens 2024; 37:503-513. [PMID: 38466237 PMCID: PMC11176274 DOI: 10.1093/ajh/hpae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Arterial hypertension is a significant cause of morbidity and mortality in Mexico. However, there is limited evidence to understand blood pressure management and cardiometabolic profiles. Here, we aim to assess the prevalence of controlled and uncontrolled blood pressure, as well as the prevalence of cardiometabolic risk factors among patients from the Mexican Registry of Arterial Hypertension (RIHTA). METHODS We conducted a cross-sectional analysis of participants living with arterial hypertension registered on RIHTA between December 2021 and April 2023. We used both the 2017 ACC/AHA and 2018 ESC/ESH thresholds to define controlled and uncontrolled arterial hypertension. We considered eleven cardiometabolic risk factors, which include overweight, obesity, central obesity, insulin resistance, diabetes, hypercholesterolemia, hypertriglyceridemia, low HDL-C, high LDL-C, low-eGFR, and high cardiovascular disease (CVD) risk. RESULTS In a sample of 5,590 participants (female: 61%, n = 3,393; median age: 64 [IQR: 56-72] years), the prevalence of uncontrolled hypertension varied significantly, depending on the definition (2017 ACC/AHA: 59.9%, 95% CI: 58.6-61.2 and 2018 ESC/ESH: 20.1%, 95% CI: 19.0-21.2). In the sample, 40.43% exhibited at least 5-6 risk factors, and 32.4% had 3-4 risk factors, chiefly abdominal obesity (83.4%, 95% CI: 82.4-84.4), high LDL-C (59.6%, 95% CI: 58.3-60.9), high CVD risk (57.9%, 95% CI: 56.6-59.2), high triglycerides (56.2%, 95% CI: 54.9-57.5), and low HDL-C (42.2%, 95% CI: 40.9-43.5). CONCLUSIONS There is a high prevalence of uncontrolled hypertension interlinked with a high burden of cardiometabolic comorbidities in Mexican adults living with arterial hypertension, underscoring the urgent need for targeted interventions and better healthcare policies to reduce the burden of the disease in our country.
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Affiliation(s)
- Silvia Palomo-Piñón
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Ciudad de México, México
| | | | - Luis Rey García-Cortés
- Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Instituto Mexicano del Seguro Social, Estado de México, Oriente, México
| | - Moises Moreno-Noguez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar No. 55 Zumpango, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Estado de México, México
| | - Luis Alcocer
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Ángeles del Pedregal, Ciudad de México, México
| | - Humberto Álvarez-López
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Puerta de Hierro Andares, Zapopan, Jalisco, México
| | - Ernesto G Cardona-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Adolfo Chávez-Mendoza
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Enrique Díaz-Díaz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Manuel Enciso-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital General Zacatecas "Luz González Cosio", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Zacatecas, Zacatecas, México
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
| | - Héctor Galván-Oseguera
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Martín Rosas-Peralta
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Titular Academia Nacional de Medicina, Ciudad de México, México
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Rivera-Paredez B, Argoty-Pantoja AD, Velázquez-Cruz R, Salmerón J, Jiménez-Corona A, González-Villalpando C, Lajous M, Tamayo J, Catzin-Kuhlmann A, Nelson R, Correa-Rotter R, Denova-Gutiérrez E. Dietary inflammatory index and lower glomerular filtration rate in Mexican adults. Nutr Res 2024; 127:53-62. [PMID: 38876039 DOI: 10.1016/j.nutres.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 06/16/2024]
Abstract
We hypothesized that higher scores on the dietary inflammatory index (DII) would be associated with a lower glomerular filtration rate (GFR). This cross-sectional study included 2098 participants from Mexican Teachers Cohort Study, the Health Workers Cohort Study, and the Comitán Study belonging to the RenMex consortium. Energy-adjusted DII scores were estimated using a semi-quantitative food frequency questionnaire (FFQ). eGFR was estimated by the CKD Epidemiology Collaboration equation. Quantile regression models and ordered regression models were estimated to assess the associations of interest. Median age of study participants was 47 years, median eGFR was 102.9 mL/min/1.73m2, and the median energy-adjusted DII was 0.89 (range, -2.25, +4.86). The median eGFR was lower in participants in the highest percentile of DII compared to those in the lowest percentile (103.8 vs 101.4). We found that continuous and categorical energy-adjusted DII scores were associated with lower eGFR, especially at the lower percentiles. In adjusted ordered logistic regression, we found that the highest DII category was associated with 1.80 times the odds of belonging to the mildly decreased eGFR category or moderately decreased eGFR category compared lowest DII category (OR: 1.80, 95%CI 1.35, 2.40). A high DII score was associated with a lower eGFR among the Mexican population. Additional studies are crucial to validate these findings and explore potential strategies to reduce the consumption of pro-inflammatory foods as a preventive approach for chronic kidney disease (CKD).
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Affiliation(s)
- Berenice Rivera-Paredez
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous, University of Mexico (UNAM), Mexico City, Mexico
| | - Anna D Argoty-Pantoja
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous, University of Mexico (UNAM), Mexico City, Mexico
| | - Rafael Velázquez-Cruz
- Genomics of Bone Metabolism Laboratory, National Institute of Genomic Medicine, Mexico City, Mexico
| | - Jorge Salmerón
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous, University of Mexico (UNAM), Mexico City, Mexico
| | - Aida Jiménez-Corona
- Department of Ocular Epidemiology and Visual Health, Instituto de Oftalmología Conde de, Valenciana, Mexico City, Mexico
| | | | - Martin Lajous
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Andrés Catzin-Kuhlmann
- Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Robert Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney, Diseases, Phoenix, Arizona
| | - Ricardo Correa-Rotter
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Edgar Denova-Gutiérrez
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
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Garduño-Alanis A, Contreras-Manzano A, Salgado JC, Lamadrid-Figueroa H, Curi-Quinto K, Barquera S. A high density of ultra-processed food, alcohol & tobacco retail stores, and social inequalities are associated with higher mortality rates of non-communicable diseases in Mexican adults: 2005 to 2021. PLoS One 2024; 19:e0301387. [PMID: 38598474 PMCID: PMC11006154 DOI: 10.1371/journal.pone.0301387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading causes of mortality in Mexico. Factors contributing to NCDs-related deaths may vary across small geographic areas such as municipalities. We aimed to predict municipal-level factors associated with NCD mortality in Mexican adults from 2005 to 2021 using the small-area analysis (SSA) approach. METHODS We gathered data on population sociodemographic, access to healthcare services, and mortality records at the municipal-level from census and public institutions from 2005 to 2021. We identified municipal predictors of NCDs mortality rates (MR) using negative binomial regression models. RESULTS A total of 584,052 observations of Mexican adults were analyzed. The national expected NCDs MR per 100,000 inhabitants was 210.7 (95%CI: 196.1-226.7) in 2005 and increased to 322.4 (95%CI: 300.3-346.4) by 2021. Predictors of NCDs mortality (quintile 5 vs. quintile 1) included; indigeneity (IRR = 1.15, 95%CI: 1.12-1.19), poverty (IRR = 1.14, 95%CI: 1.13-1.15), affiliation with Mexican Social Security Institute (IRR = 1.11, 95%CI: 1.09-1.14), households with television (IRR = 1.14, 95%CI: 1.11-1.17), and high density of ultra-processed food, alcohol & tobacco retail stores (IRR = 1.15, 95%CI: 1.13-1.17). The greatest increases in MR were observed in municipalities from Oaxaca (>200% increments). CONCLUSION There was an overall increase in NCDs MR from 2005 to 2021, with a significant geographic variation among Mexican municipalities. The results of this study highlight the importance of identifying priority areas in the country that urgently require public policies focused on local factors associated with deaths from NCDs, such as the regulation of the ultra-processed food, alcohol & tobacco retail stores, and efforts to reduce social inequalities.
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Affiliation(s)
- Adriana Garduño-Alanis
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- National Council of Humanities, Science and Technology, Mexico
- Autonomous University of the State of Mexico, Toluca, State of Mexico, Mexico
| | - Alejandra Contreras-Manzano
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- National Council of Humanities, Science and Technology, Mexico
| | - Juan Carlos Salgado
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- National Council of Humanities, Science and Technology, Mexico
| | - Héctor Lamadrid-Figueroa
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Holliday MW, Majeti RN, Sheikh-Hamad D. Chronic Interstitial Nephritis in Agricultural Communities: Observational and Mechanistic Evidence Supporting the Role of Nephrotoxic Agrochemicals. Clin J Am Soc Nephrol 2024; 19:538-545. [PMID: 37678249 PMCID: PMC11020436 DOI: 10.2215/cjn.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
Chronic interstitial nephritis in agricultural communities (CINAC) is an epidemic of kidney disease affecting specific tropical and subtropical regions worldwide and is characterized by progressive CKD in the absence of traditional risk factors, such as hypertension and diabetes. CINAC prevalence is higher among young, male agricultural workers, but it also affects women, children, and nonagricultural workers in affected areas. Biopsies from patients with CINAC across regions commonly demonstrate tubular injury with lysosomal aggregates, tubulointerstitial inflammation, and fibrosis and variable glomerular changes. Each endemic area holds environmental risk factors and patient/genetic milieus, resulting in uncertainty about the cause(s) of the disease. Currently, there is no specific treatment available for CINAC. We highlight survey findings of Houston-based migrant workers with CINAC and draw similarities between kidney injury phenotype of patients with CINAC and mice treated chronically with paraquat, an herbicide used worldwide. We propose potential pathways and mechanisms for kidney injury in patients with CINAC, which may offer clues for potential therapies.
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Affiliation(s)
- Michael W. Holliday
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
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Dávila-Cervantes CA, Agudelo-Botero M. Young-onset chronic kidney disease in Mexico: Secondary analysis of global burden of disease study, 1990-2019. Prev Med 2024; 181:107901. [PMID: 38387518 DOI: 10.1016/j.ypmed.2024.107901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To report the burden of young-onset chronic kidney disease (CKD) in Mexico from 1990 to 2019, and to assess the association between young-onset CKD burden with the Socio-Demographic Index (SDI), and the Healthcare Access and Quality Index (HAQ). METHODS Secondary analysis of data using the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) by sex, age groups, states, and subcauses. Mortality, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY), were obtained. RESULTS Between 1990 and 2019, the young-onset CKD mortality rate increased by 87.3% (126.3% for men and 48.1% for women). In 2019, this rate was highest in Tlaxcala, Estado de México, Puebla, Veracruz, Jalisco, and Guanajuato (all above 8 deaths per 100,000 inhabitants); Sinaloa and Quintana Roo had the lowest mortality rates (under 3.5 deaths per 100,000 inhabitants). While men had a higher rate of YLL, women were more likely to present YLD due to CKD. In 1990 there was a negative and statistically significant correlation between the HAQ Index and the young-onset CKD DALY rate. CONCLUSIONS In the last 30 years, the burden of early-onset chronic CKD has had an unprecedented increase among the Mexican population, compromising the fulfillment of the Sustainable Development Goals. This will be unattainable if actions to promote healthy lifestyles and prevent kidney disease are not immediately established and articulated, starting with the youngest age groups.
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Affiliation(s)
| | - Marcela Agudelo-Botero
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Rivera-Paredez B, Morales M, Velázquez-Cruz R, Salmerón J, Jiménez-Corona A, Balderas-Arteaga N, González-Villalpando C, Tamayo J, Lajous M, Catzin-Kuhlmann A, Nelson R, Correa-Rotter R, Denova-Gutierréz E. Association between soft drinks intake and low glomerular filtration rate in Mexican adults: Results from RenMex. Clin Nutr 2024; 43:1062-1069. [PMID: 38547595 DOI: 10.1016/j.clnu.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS To evaluate the association between soft drinks (SDs) consumption and estimated glomerular filtration rate (eGFR) in a Mexican adult population. METHODS We used data from the RenMex consortium (n = 2095) that included the Mexican Teachers Cohort Study (34-65 years), the Health Workers Cohort Study (18-90 years), and the Comitán Study (19-91 years). In this cross-sectional study, we assessed SDs consumption (cola and flavored soda) using a food frequency questionnaire (FFQ) and estimated eGFR using the CKD Epidemiology Collaboration equation. Quantile regression was used to assess the association between SDs consumption and eGFR with eGFR as a continuous variable. Multinomial logistic regression models were used for eGFR categories derived from quantile regression (mildly decreased eGFR, ≥72.9-87.9 mL/min/1.73 m2 and moderately decreased eGFR, <72.9 mL/min/1.73 m2). RESULTS Mean age of study participants was 47.2 years, 67.5% were women, and 12.2% had diabetes. eGFR was <60 mL/min/1.73 m2 in 3.7% of study participants. Mildly decreased eGFR was present in 14.8%, and moderately decreased eGFR was present in 10.1% of study participants. Quantile regression results showed that SDs consumption was associated with lower eGFR at the 10th, 25th, 50th and 75th percentile. Based on the final adjusted multinomial model, ≥7 servings/week was positively associated with moderately decreased eGFR relative to <1 serving/week (Relative Risk Ratio = 1.95; 95% CI: 1.07-3.57). CONCLUSION Our results suggest that higher SDs consumption is associated with lower eGFR. Encouraging healthy dietary choices should be part of the management and prevention of CKD.
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Affiliation(s)
- Berenice Rivera-Paredez
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Mariluz Morales
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Rafael Velázquez-Cruz
- Genomics of Bone Metabolism Laboratory, National Institute of Genomic Medicine, Mexico City, Mexico
| | - Jorge Salmerón
- Research Center in Policies, Population and Health, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Aida Jiménez-Corona
- Department of Ocular Epidemiology and Visual Health, Instituto de Oftalmología Conde de Valenciana, Mexico City, Mexico
| | - Nydia Balderas-Arteaga
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | - Martin Lajous
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Andrés Catzin-Kuhlmann
- Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Robert Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Ricardo Correa-Rotter
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Edgar Denova-Gutierréz
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
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Sammut-Powell C, Sisk R, Silva-Tinoco R, de la Pena G, Almeda-Valdes P, Juarez Comboni SC, Goncalves S, Cameron R. External validation of a minimal-resource model to predict reduced estimated glomerular filtration rate in people with type 2 diabetes without diagnosis of chronic kidney disease in Mexico: a comparison between country-level and regional performance. Front Endocrinol (Lausanne) 2024; 15:1253492. [PMID: 38586458 PMCID: PMC10998449 DOI: 10.3389/fendo.2024.1253492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/19/2024] [Indexed: 04/09/2024] Open
Abstract
Background Patients with type 2 diabetes are at an increased risk of chronic kidney disease (CKD) hence it is recommended that they receive annual CKD screening. The huge burden of diabetes in Mexico and limited screening resource mean that CKD screening is underperformed. Consequently, patients often have a late diagnosis of CKD. A regional minimal-resource model to support risk-tailored CKD screening in patients with type 2 diabetes has been developed and globally validated. However, population heath and care services between countries within a region are expected to differ. The aim of this study was to evaluate the performance of the model within Mexico and compare this with the performance demonstrated within the Americas in the global validation. Methods We performed a retrospective observational study with data from primary care (Clinic Specialized in Diabetes Management in Mexico City), tertiary care (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán) and the Mexican national survey of health and nutrition (ENSANUT-MC 2016). We applied the minimal-resource model across the datasets and evaluated model performance metrics, with the primary interest in the sensitivity and increase in the positive predictive value (PPV) compared to a screen-everyone approach. Results The model was evaluated on 2510 patients from Mexico (primary care: 1358, tertiary care: 735, ENSANUT-MC: 417). Across the Mexico data, the sensitivity was 0.730 (95% CI: 0.689 - 0.779) and the relative increase in PPV was 61.0% (95% CI: 52.1% - 70.8%). These were not statistically different to the regional performance metrics for the Americas (sensitivity: p=0.964; relative improvement: p=0.132), however considerable variability was observed across the data sources. Conclusion The minimal-resource model performs consistently in a representative Mexican population sample compared with the Americas regional performance. In primary care settings where screening is underperformed and access to laboratory testing is limited, the model can act as a risk-tailored CKD screening solution, directing screening resources to patients who are at highest risk.
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Affiliation(s)
| | - Rose Sisk
- Gendius Ltd, Alderley Edge, United Kingdom
| | - Ruben Silva-Tinoco
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Public Health Services of the Mexico City Government, Mexico, City, Mexico
| | - Gustavo de la Pena
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
- Metabolic Diseases Research, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Agudelo-Botero M, Aguilar-González A, Vergara-Jiménez I, Pizzolato E, Giraldo-Rodríguez L. Achievements and challenges in the health of Mexican women, 1990 and 2019: ecological analysis based on the global burden of disease data. Public Health 2024; 228:8-17. [PMID: 38246129 DOI: 10.1016/j.puhe.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/17/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To describe the burden and causes of disease in Mexican women in 1990 and 2019, based on the data disaggregation by age groups and states. Also, to evaluate the relationship of years of healthy life lost with the Socio-demographic Index (SDI) and with the Healthcare Access and Quality (HAQ) Index. STUDY DESIGN This was an ecological descriptive study. METHODS Based on the Global Burden of Disease, Injuries, and Risk Factors Study study, the age-standardized and age-specific rates for mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) were reported. RESULTS At the national level, the all-cause age-standardized rates for Mexican women decreased in mortality -28.8%; YLLs -39.8%; YLDs -1.3%; and DALYs -26.2%. For 2019, the indicators analyzed had the worst performances in Chiapas and Chihuahua, while women in Sinaloa had the lowest age-standardized rates. In 1990, it is worth noting that there was a remarkable presence of CDs, mainly in YLLs. In all age groups, diabetes mellitus was the leading cause of DALYs in Mexico's 32 states, followed by CKD (in 24 states), and ischemic heart disease (in 18 states). In both 1990 and 2019, a negative and statistically significant correlation between DALYs and the HAQ Index was evident. The correlation between DALYs and the SDI was only significant in 1990. CONCLUSION In the last 30 years, the burden of disease on Mexican women has undergone substantial changes that reflect progress in the improvement of their health conditions. However, the current scenario is complex because the convergence of communicable diseases, non-communicable diseases, and injuries is evident, which implies important challenges that must be addressed as soon as possible.
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Affiliation(s)
- M Agudelo-Botero
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - A Aguilar-González
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - I Vergara-Jiménez
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - E Pizzolato
- Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
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9
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Kierans C, Padilla-Altamira C. Failing kidneys: Hotspots, blind spots and biopolitics of indifference. Med Anthropol Q 2024; 38:24-39. [PMID: 37853527 DOI: 10.1111/maq.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/07/2023] [Indexed: 10/20/2023]
Abstract
Chronic kidney disease of non-traditional cause (CKDnt) is commonly associated with monocropping agriculture, heat stress and impoverished working conditions, referred to as CKDnt "hotspots." The condition is also emerging in various sites of environmental contamination, raising questions as to whether multiple variants of the condition exist as a result of different ecologies and different human-environment interactions. This paper examines the emergence of CKDnt around Lake Chapala in Mexico, where we document local efforts to gain recognition and reparation for CKDnt. We follow the ways patients, families and activists have mobilized specific and interlocking infrastructural failures to enact complaint and confront state inaction and neglect of their bodies, communities, and environments. Though their labors have formally achieved little, we discuss how they make visible a biopolitics of indifference, one bound to the production of structural "blindspots."
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Affiliation(s)
- Ciara Kierans
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
| | - César Padilla-Altamira
- Centre for Research and Higher Studies in Social Anthropology (CIESAS), Unidad Occidente, Guadalajara, Mexico
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Rashidi MM, Saeedi Moghaddam S, Azadnajafabad S, Heidari-Foroozan M, Haddadi M, Sharifnejad Tehrani Y, Keykhaei M, Ghasemi E, Mohammadi E, Ahmadi N, Malekpour MR, Mohammadi Fateh S, Rezaei N, Mehrazma M, Larijani B, Farzadfar F. Burden and quality of care index of chronic kidney disease: Global Burden of Disease analysis for 1990-2019. Nephrol Dial Transplant 2024; 39:317-327. [PMID: 37587021 DOI: 10.1093/ndt/gfad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) imposes a heavy obscure burden on individuals and health systems. Besides its burden, the quality of care of CKD is less well investigated. In this study, we aimed to explore the global, regional and national trends of CKD burden and quality of care. METHODS The Global Burden of Disease Study 2019 data were used. Trends of incidence, prevalence, deaths and disability-adjusted life years were studied for the 1990-2019 period in the global aspect. By generating four secondary indices to assess different aspects of quality of care the quality of care index (QCI) was developed to explore the care provided for CKD. Inequities and disparities between various geographic, socio-demographic and age stratifications, and sex were studied using the QCI values. RESULTS In 2019, there were 18 986 903 (95% uncertainty interval 17 556 535 to 20 518 156) incident cases of CKD, globally. The overall global QCI score had increased slightly from 78.4 in 1990 to 81.6 in 2019, and it was marginally better in males (QCI score 83.5) than in females (80.3). The highest QCI score was observed in the European region with a score of 92.5, while the African region displayed the lowest QCI with 61.7. Among the age groups, the highest QCI was for children aged between 5 and 9 years old (92.0), and the lowest was in the age group of 20-24 year olds (65.5). CONCLUSIONS This study revealed that significant disparities remain regarding the quality of care of CKD, and to reach better care for CKD, attention to and care of minorities should be reconsidered. The evidence presented in this study would benefit health policymakers toward better and more efficient control of CKD burden alongside improving the care of this condition.
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Affiliation(s)
- Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Heidari-Foroozan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Center Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Haddadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Sharifnejad Tehrani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, IL, USA
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Mehrazma
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Méndez-García SR, Cano-Europa E, Ocotitla-Hernández J, Franco-Colín M, Florencio-Santiago OI, Torres-SanMiguel CR. Experimental Lab Tests on Rabbits for the Optimization and Redesign of Low-Cost Equipment for Automated Peritoneal Dialysis. Bioengineering (Basel) 2024; 11:114. [PMID: 38391600 PMCID: PMC10886354 DOI: 10.3390/bioengineering11020114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 02/24/2024] Open
Abstract
This work shows the experiences acquired by the experimental test performed to validate an automated peritoneal dialysis machine using rabbits with kidney damage to find improvements that can be made for future advances. These are listed to understand the direction of the development of the machine. The article shows the device's background and previous tests using a testbed. The rabbit anatomy was prepared for nephrectomy surgery. The tests were practiced by checking all of the APD machine's subsystems. The data were analyzed to develop improvements in the process. The results indicate the importance of the DPA machine as an alternative by implementing peristaltic pumps to substitute disposable cassettes. The identified improvements are the main objectives for research to continue improving the technology.
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Affiliation(s)
- Sergio Rodrigo Méndez-García
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Nacional Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de México 07738, Mexico
| | - Edgar Cano-Europa
- Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas Unidad Zacatenco, Ciudad de México 07738, Mexico
| | - José Ocotitla-Hernández
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Dirección de alta Especialidad, Ciudad de México 14070, Mexico
| | - Margarita Franco-Colín
- Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas Unidad Zacatenco, Ciudad de México 07738, Mexico
| | - Oscar Iván Florencio-Santiago
- Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas Unidad Zacatenco, Ciudad de México 07738, Mexico
| | - Christopher René Torres-SanMiguel
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Nacional Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de México 07738, Mexico
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12
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Palomo-Piñón S, Enciso-Muñoz JM, Meaney E, Díaz-Domínguez E, Cardona-Muller D, Pérez FP, Cantoral-Farfán E, Anda-Garay JC, Mijangos-Chavez J, Antonio-Villa NE. Strategies to prevent, diagnose and treat kidney disease related to systemic arterial hypertension: a narrative review from the Mexican Group of Experts on Arterial Hypertension. BMC Nephrol 2024; 25:24. [PMID: 38238661 PMCID: PMC10797813 DOI: 10.1186/s12882-023-03450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024] Open
Abstract
This narrative review highlights strategies proposed by the Mexican Group of Experts on Arterial Hypertension endorsed to prevent, diagnose, and treat chronic kidney disease (CKD) related to systemic arterial hypertension (SAH). Given the growing prevalence of CKD in Mexico and Latin America caused by SAH, there is a need for context-specific approaches to address the effects of SAH, given the diverse population and unique challenges faced by the region. This narrative review provides clinical strategies for healthcare providers on preventing, diagnosing, and treating kidney disease related to SAH, focusing on primary prevention, early detection, evidence-based diagnostic approaches, and selecting pharmacological treatments. Key-strategies are focused on six fundamental areas: 1) Strategies to mitigate kidney disease in SAH, 2) early detection of CKD in SAH, 3) diagnosis and monitoring of SAH, 4) blood pressure targets in patients living with CKD, 5) hypertensive treatment in patients with CKD and 6) diuretics and Non-Steroidal Mineralocorticoid Receptor Inhibitors in Patients with CKD. This review aims to provide relevant strategies for the Mexican and Latin American clinical context, highlight the importance of a multidisciplinary approach to managing SAH, and the role of community-based programs in improving the quality of life for affected individuals. This position paper seeks to contribute to reducing the burden of SAH-related CKD and its complications in Mexico and Latin America.
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Affiliation(s)
- Silvia Palomo-Piñón
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México.
- Colaborador Externo, Unidad de Investigación Médica en Enfermedades Nefrológicas Siglo XXI (UIMENSXII), UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Ciudad de México, México.
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Calle Retorno del Escorial #13, Col. El Dorado, Tlanepantla de Baz, Estado de México, 54020, México.
| | - José Manuel Enciso-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones A.C, Ciudad de México, México
| | - Eduardo Meaney
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Escuela Superior de Medicina, Instituto Politecnico Nacional, Ciudad de México, México
| | - Ernesto Díaz-Domínguez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - David Cardona-Muller
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Fabiola Pazos Pérez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Emilia Cantoral-Farfán
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Jefatura de Nefrología, Hospital General De Zona Médico Familiar No. 8 Gilberto Flores Izquierdo, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Juan Carlos Anda-Garay
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Janet Mijangos-Chavez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Jefatura de Cardiología, UMAE Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Neftali Eduardo Antonio-Villa
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Departamento de Endocrinologia, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, Morales-Buenrostro LE, Gracia-Ramos AE, Aguilar-Salinas CA, Castillo-Martínez L. Prevalence of Chronic Kidney Disease in Individuals With Type 2 Diabetes Within Primary Care: A Cross-Sectional Study. J Prim Care Community Health 2024; 15:21501319241259325. [PMID: 38840565 PMCID: PMC11155365 DOI: 10.1177/21501319241259325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024] Open
Abstract
AIMS To assess the prevalence and risk factors for chronic kidney disease (CKD) among adults with type 2 diabetes within primary care. METHODS This cross-sectional study evaluated 1319 individuals receiving standard care across 26 primary units from July 2017 to January 2023. The estimated glomerular filtration rate (eGFR) and albuminuria were used for the diagnosis of CKD. CKD was defined by eGFR values of <60 mL/min/1.73 m2 and/or albumin-to-creatine ratio ≥30 mg/g. Logistic regression was applied to identify factors associated with CKD and study variables. RESULTS The median age of participants (60.6% females) was 55 years and the median diabetes duration was 10 years. The overall CKD prevalence in the study population was 39.2%. Within the CKD group, the prevalence rates of albuminuria, albuminuria coupled with low eGFR and isolated low eGFR were 72.1%, 19%, and 8.9%, respectively. The prevalence of CKD was 30.6% among participants under 40 years old and a higher value was observed in middle-aged adults with early-onset diabetes (at age <40 years) compared with the later-onset group. Multivariable analyses identified associations between CKD and factors such as age, the male sex, diabetes duration, hypertension, retinopathy, and metformin use. CONCLUSION A relatively high prevalence of CKD, especially in non-elderly adults, was revealed in this primary care study. Early recognition strategies for CKD are crucial for timely prevention within primary care.
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Affiliation(s)
- Ruben Silva-Tinoco
- Clinic Specialized in the Diabetes Management in Mexico City, IMSS-Bienestar Public Health Services, Ciudad de México, México
| | - Teresa Cuatecontzi-Xochitiotzi
- Clinic Specialized in the Diabetes Management in Mexico City, IMSS-Bienestar Public Health Services, Ciudad de México, México
| | - Luis E. Morales-Buenrostro
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Abraham Edgar Gracia-Ramos
- Departamento de Medicina Interna, Hospital General, Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carlos A. Aguilar-Salinas
- Dirección de Investigación y Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Lilia Castillo-Martínez
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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14
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García-Yañez JC, Serrano-Gavuzzo CA, Arvizu-Hernandez M, Moguel-González B, Bravo E. Evaluation of hemodialysis vascular access. Perspective from Mexico. FRONTIERS IN NEPHROLOGY 2023; 3:1084188. [PMID: 37675383 PMCID: PMC10479673 DOI: 10.3389/fneph.2023.1084188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/26/2023] [Indexed: 09/08/2023]
Abstract
Chronic kidney disease (CKD) has become a global health problem. In 2019, it was related to 2.53% of general global mortality (2.35-2.66%); in the same year, in Latin America, mortality related to CKD reached 5.25% (4.92-5.49%), with an annual increase of 3.37%, proving increased mortality of 102% between 1990 and 2017. A nephrology specialty in Mexico recently fulfilled its first 50 years. Despite being relatively young, nephrologists are interested in "new" sub-specialties of nephrology and learning novel techniques and problem-solving skills. Our group is the first in our country to focus solely and exclusively on comprehensive VA care and we want to position ourselves as the first Mexican interdisciplinary group focused on vascular access (GIMEXAV).
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Affiliation(s)
- Juan C. García-Yañez
- Department of Nephrology and Urology, High Specialty Regional Hospital of Bajio, León, Guanajuato, Mexico
- Department of Nephrology, Aranda de la Parra Hospital, Leon, Guanajuato, Mexico
- Department of Medicine and Nutrition, University of Guanajuato, Leon, Guanajuato, Mexico
| | - Carlos A. Serrano-Gavuzzo
- Department of Vascular Surgery, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | - Mauricio Arvizu-Hernandez
- Department of Nephrology and Mineral Metabolism, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
- Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Mexico City, Mexico
| | | | - Erick Bravo
- Department of Vascular Surgery, Guadalupe Hospital, Celaya, Guanajuato, Mexico
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15
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Ekrikpo U, Obiagwu P, Chika-Onu U, Yadla M, Karam S, Tannor EK, Bello AK, Okpechi IG. Epidemiology and Outcomes of Glomerular Diseases in Low- and Middle-Income Countries. Semin Nephrol 2023; 42:151316. [PMID: 36773418 DOI: 10.1016/j.semnephrol.2023.151316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Glomerular diseases account for a significant proportion of chronic kidney disease in low-income and middle-income countries (LMICs). The epidemiology of glomerulonephritis is characterized inadequately in LMICs, largely owing to unavailable nephropathology services or uncertainty of the safety of the kidney biopsy procedure. In contrast to high-income countries where IgA nephropathy is the dominant primary glomerular disease, focal segmental glomerulosclerosis is common in large populations across Latin America, Africa, Middle East, and South East Asia, while IgA nephropathy is common in Chinese populations. Despite having a high prevalence of known genetic and viral risk factors that trigger focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis also is common in adults and children in some African countries. Treatment of glomerular diseases in adults and children in LMICs largely is dependent on corticosteroids in combination with other immunosuppressive therapy, which often is cyclophosphamide because of its ready availability and low cost of treatment, despite significant adverse effects. Partial and/or complete remission status reported from studies of glomerular disease subtypes vary across LMIC regions, with high rates of kidney failure, mortality, and disease, and treatment complications often reported. Improving the availability of nephropathology services and ensuring availability of specific therapies are key measures to improving glomerular disease outcomes in LMICs.
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Affiliation(s)
- Udeme Ekrikpo
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Patience Obiagwu
- Department of Paediatrics, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ugochi Chika-Onu
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Manjusha Yadla
- Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India
| | - Sabine Karam
- Division of Nephrology, University of Minnesota, Minnesota, MN; Division of Nephrology, Faculty of Medicine and Medical Sciences, University of Balamand, Balamand, Lebanon
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Canada; Division of Nephrology, University of Cape Town, Cape Town, South Africa.
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Colli VA, González-Rocha A, Canales D, Hernández-Alcáraz C, Pedroza A, Pérez-Chan M, Barquera S, Denova-Gutierrez E. Chronic kidney disease risk prediction scores assessment and development in Mexican adult population. Front Med (Lausanne) 2022; 9:903090. [PMID: 36341240 PMCID: PMC9631933 DOI: 10.3389/fmed.2022.903090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a major public health problem, with considerable growth in prevalence and mortality in recent years. Screening of CKD at primary care is crucial for the implementation of prevention strategies. The aims of this study are to assess CKD risk prediction scores and to develop a risk prediction score for the Mexican adult population. Methods Data from the Mexican National Health and Nutrition Survey 2016 was utilized and 3463 participants ≥ 20 years old were included. Reduced renal function with Glomerular filtration rate and/or the presence of albuminuria was defined as CKD. Multiple logistic regression models were performed for the creation of a training and validation model. Additionally, several models were validated in our Mexican population. Results The developed training model included sex, age, body mass index, fast plasma glucose, systolic blood pressure, and triglycerides, as did the validation model. The area under the curve (AUC) was 0.78 (95% CI: 0.72, 0.79) for training model, and 0.76 (95% CI: 0.71, 0.80) in validation model for Mexican adult population. Age, female gender, presence of diabetes and hypertension, elevated systolic and diastolic blood pressure, serum and urinary creatinine, and higher HbA1c were significantly associated with the prevalent chronic kidney disease. Previous CKD risk predictive models were evaluated with a representative sample of the Mexican adult population, their AUC was between 0.61 and 0.78. Conclusion The designed CKD risk predictive model satisfactorily predicts using simple and common variables in primary medical care. This model could have multiple benefits; such as, the identification of the population at risk, and prevention of CKD.
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Affiliation(s)
- Victor A. Colli
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Alejandra González-Rocha
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - David Canales
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Cesar Hernández-Alcáraz
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Andrea Pedroza
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Manuel Pérez-Chan
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Edgar Denova-Gutierrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- *Correspondence: Edgar Denova-Gutierrez,
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Hockham C, Schanschieff F, Woodward M. Sex Differences in CKD-Associated Mortality From 1990 to 2019: Data From the Global Burden of Disease Study. Kidney Med 2022; 4:100535. [PMID: 36159166 PMCID: PMC9490202 DOI: 10.1016/j.xkme.2022.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rationale & Objective Previous studies have shown chronic kidney disease (CKD) mortality rates to be lower among females than males. We aimed to examine the extent to which sex differences vary over time, among countries, and with age, using Global Burden of Disease (GBD) Study data. Study Design Observational epidemiological study. Setting & Participants GBD Study, which used published literature, vital registration systems, kidney replacement therapy registries, and household surveys. Exposures Sex. Outcomes CKD-associated mortality rate (per 100,000 population). Analytical Approach Changes in CKD mortality between 1990 and 2019 were compared between sexes, globally, and separately for the 50 most populous countries. For 2019 only, sex differences in age-standardized and age-specific mortality were compared between countries. Results There was no change in global age-standardized mortality for either sex between 1990 and 2019, with female mortality consistently 30% lower than male mortality. Percentage changes were less favorable among females than males in two-thirds of the 50 countries examined, with the greatest change disparities observed in Egypt, Thailand, and Malaysia. Although Mexico exhibited the greatest overall percentage increase, the increase was smaller in females (81% vs 138%). In 2019, female mortality varied between 47% lower and 60% higher than male mortality (in Angola and Egypt, respectively). In most countries, female mortality was lower across all age groups, with no narrowing of sex differences with age. Limitations We were not able to assess the sex differences according to CKD stage and we did not explore other disease metrics (eg, disability-adjusted life years). Conclusions Percentage changes in age-standardized CKD mortality have tended to be less favorable among females than males, with notable exceptions. Similarly, although female mortality is generally lower than male mortality, there are multiple examples of the opposite. Country-specific assessments of sex differences in CKD-associated outcomes are essential for equitable care.
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Murillo-Zamora E, Trujillo X, Huerta M, Riós-Silva M, Guzmán-Esquivel J, Bricio-Barrios JA, Mendoza-Cano O, Lugo-Radillo A. COVID-19 Pneumonia in Fully Vaccinated Adults during the Dominance of the Omicron Sublineages BA.1.1 and BA.2 in Mexico. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081127. [PMID: 36013594 PMCID: PMC9412276 DOI: 10.3390/medicina58081127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
Background and Objectives: A nationwide retrospective cohort study was conducted to evaluate the factors associated with the risk of laboratory-confirmed coronavirus disease 2019 (COVID-19)-related pneumonia in fully vaccinated adults during the dominance of the Omicron sublineages in Mexico. Materials and Methods: Fully COVID-19-vaccinated adults with laboratory-positive illness and symptom onset from April to mid-June 2022 were eligible. We computed the eta-squared (η2) to evaluate the effect size of the study sample. The characteristics predicting pneumonia were evaluated through risk ratios (RRs), and the 95% confidence intervals (CIs) were computed through generalized linear models. Results: The data from 35,561 participants were evaluated, and the overall risk of pneumonia was 0.5%. In multiple analyses, patients aged ≥ 60 years old were at increased risk of developing pneumonia (vs. 20−39 years old: RR = 1.031, 95% CI = 1.027−1.034). Chronic pulmonary obstructive disease, type 2 diabetes mellitus, arterial hypertension, chronic kidney disease (any stage), and immunosuppression (any cause) were also associated with a higher pneumonia risk. The η2 of all the variables included in the multiple models was <0.06. Conclusions: Our study suggests that, even when fully COVID-19-vaccinated, older adults and those with chronic conditions were at increased risk of pneumonia during the dominance of the Omicron sublineages BA.1.1 and BA.2.
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Affiliation(s)
- Efrén Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Av. Javier Mina 301, Col. Centro, Colima 28000, Mexico
- Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las Víboras, Colima 28040, Mexico
| | - Xóchitl Trujillo
- Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Av. 25 de julio 965, Col. Villas San Sebastián, Colima 28045, Mexico
| | - Miguel Huerta
- Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Av. 25 de julio 965, Col. Villas San Sebastián, Colima 28045, Mexico
| | - Mónica Riós-Silva
- Centro Universitario de Investigaciones Biomédicas, Universidad de Colima-CONACyT, Av. 25 de julio 965, Col. Villas de San Sebastián, Colima 28045, Mexico
| | - José Guzmán-Esquivel
- Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las Víboras, Colima 28040, Mexico
- Unidad de Investigación en Epidemiología Clínica, Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Av. Lapislázuli 250, Col. El Haya, Villa de Álvarez, Colima 28984, Mexico
| | | | - Oliver Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, km. 9 Carretera Colima-Coquimatlán, Coquimatlán, Colima 28400, Mexico
- Correspondence: (O.M.-C.); (A.L.-R.); Tel.: +52-312-316-1167 (O.M.-C.)
| | - Agustin Lugo-Radillo
- CONACYT—Faculty of Medicine and Surgery, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca 68020, Mexico
- Correspondence: (O.M.-C.); (A.L.-R.); Tel.: +52-312-316-1167 (O.M.-C.)
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Rodrigues AS, de Abreu LC, Morais MJDD, Leitao FNC, do Amaral GLG, de Sousa Santos EF, do Souto RP. Temporal trend of mortality and hospitalization for chronic kidney disease in adults from Northern Brazil. Medicine (Baltimore) 2022; 101:e29702. [PMID: 35777060 PMCID: PMC9239633 DOI: 10.1097/md.0000000000029702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/22/2022] [Indexed: 01/05/2023] Open
Abstract
We aimed to evaluate mortality and hospital admissions for chronic kidney disease in young adults according to sex and state in the northern region of Brazil, between 1996 and 2017. A population-based time series study using official data on mortality and hospital admissions due to chronic kidney disease in individuals aged 20 to 49 years old, residents of the northern region of Brazil, in the periods 1996-2017 and to 2008-2017, respectively. Chronic kidney disease was defined according to the International Classification of Diseases, 10th revision (N18). The evolution of mortality from chronic kidney disease decreased by 0.881% per year over the period (1996-2017). In the states of Acre and Amapá, there was a reduction of 5.85% and -5.68% per year, respectively, and in Tocantins, an increase of 4.16% per year. The incidence of hospitalization did not vary between 2008 and 2017. However, 2 states showed an increase in hospitalization rates: Acre (6.08% per year) and Pará (2.83% per year), and 2 states showed a reduction: Amazonas (5.09% per year) and Tocantins (6.23% per year). In general, there was decrease in mortality rate overtime. However, rate of mortality due to chronic kidney disease increased in the state of Tocantins. The evolution of hospitalization due to chronic kidney disease in a population of young adults remained stationary.
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Affiliation(s)
- Alliny Sales Rodrigues
- Centro Universitário FMABC, Santo André, Sao Paulo, Brazil
- Acre State Health Secretariat (SESACRE), Rio Branco, Acre, Brazil
- Multidisciplinary Laboratory for Studies and Scientific Writing in Health Sciences (LaMEECCS), Federal University of Acre (UFAC), Rio Branco, Acre, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
| | - Luiz Carlos de Abreu
- Centro Universitário FMABC, Santo André, Sao Paulo, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
| | - Mauro Jose de Deus Morais
- Multidisciplinary Laboratory for Studies and Scientific Writing in Health Sciences (LaMEECCS), Federal University of Acre (UFAC), Rio Branco, Acre, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
- Federal University of Acre (UFAC), Cruzeiro do Sul, Acre, Brazil
| | - Francisco Naildo Cardoso Leitao
- Centro Universitário FMABC, Santo André, Sao Paulo, Brazil
- Multidisciplinary Laboratory for Studies and Scientific Writing in Health Sciences (LaMEECCS), Federal University of Acre (UFAC), Rio Branco, Acre, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
| | | | - Edige Felipe de Sousa Santos
- Centro Universitário FMABC, Santo André, Sao Paulo, Brazil
- Laboratory of Study Design and Scientific Writing (LaDEEC/FMABC), Santo Andre, Sao Paulo, Brazil
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20
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Valdez Ortiz R, Escorza-Valdivia S, Benitez-Renteria S, Lopez-Alvarenga JC, Pérez Navarro LM. Factors of Poor Prognosis Associated with Chronic Kidney Disease by Stage in Ambulatory Patients: A Cross-sectional Study. Arch Med Res 2022; 53:524-532. [DOI: 10.1016/j.arcmed.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
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21
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Rivero-Urzua S, Paredes-Rojas JC, Méndez-García SR, Ortiz-Hernández FE, Oropeza-Osornio A, Torres-SanMiguel CR. 3D Low-Cost Equipment for Automated Peritoneal Dialysis Therapy. Healthcare (Basel) 2022; 10:healthcare10030564. [PMID: 35327042 PMCID: PMC8950556 DOI: 10.3390/healthcare10030564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
Abstract
A breakthrough in peritoneal dialysis (PD) therapy occurred in 1977 with the development of continuous ambulatory peritoneal dialysis (CAPD). Its simplicity, low cost, and ease with which CAPD could be performed on patients at home contributed to the popularity of this procedure. However, there is a need for continuous improvement in building optimal systems for incident chronic kidney disease (CKD) patients. This research showed the design and construction of a simplified prototype of low-cost automated peritoneal dialysis (APD) equipment that meets international standards to automatically regulate infusion and fluid drainage in and out of a patient with low margins of error. Experimental tests allowed the adjustment of the RPM values concerning the flow rate provided. In addition, thanks to the pressure sensor, it was possible to observe a fluctuation ranging from 9 to 13 kPa, which is within the permissible average specified in the catalogs of medical instruments and equipment. Furthermore, a turbidity sensor was added to decrease the possibility of presenting peritonitis. The results showed absolute values of flow, angular velocity, and pressure that it could deliver for use in APD therapies. Finally, the construction of the APD equipment is presented generally, showing the electronic and mechanical components that constitute it.
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Affiliation(s)
- Samuel Rivero-Urzua
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de Mexico 07738, Mexico; (S.R.-U.); (S.R.M.-G.)
| | - Juan Carlos Paredes-Rojas
- Instituto Politécnico Nacional, Centro Mexicano para la Producción más Limpia, Acueducto de Guadalupe S/N, La laguna Ticomán, Ciudad de Mexico 07340, Mexico;
| | - Sergio Rodrigo Méndez-García
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de Mexico 07738, Mexico; (S.R.-U.); (S.R.M.-G.)
| | - Fernando Eli Ortiz-Hernández
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Unidad Culhuacán, Ciudad de Mexico 04260, Mexico;
| | - Armando Oropeza-Osornio
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Unidad Ticomán, Ciudad de Mexico 07340, Mexico;
| | - Christopher René Torres-SanMiguel
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de Mexico 07738, Mexico; (S.R.-U.); (S.R.M.-G.)
- Correspondence:
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22
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García GG, Iyengar A, Kaze F, Kierans C, Padilla-Altamira C, Luyckx VA. Sex and gender differences in chronic kidney disease and access to care around the globe. Semin Nephrol 2022; 42:101-113. [PMID: 35718358 DOI: 10.1016/j.semnephrol.2022.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The difference between sex, the biological construct, and gender, the social construct, may be most evident in settings of vulnerability. Globally, chronic kidney disease is more prevalent among women, but the prevalence of end-stage kidney failure, and especially receipt of kidney replacement therapy, is higher in men. These differences likely reflect a combination of physiological and social/structural risk factors that independently modulate kidney disease and/or its progression. The distribution of the most common risk factors such as hypertension and obesity differ between men and women and may impact disease risk differentially. Social and structural gender-related inequities remain stark across the globe. More women live in poverty, receive less education, and are more dependent on others for health care decision making, but men may have a higher risk of injury, occupational exposures, and less access to screening, prevention, and primary care. In this article, we explore how social determinants of health affect kidney disease risk and access to care differentially across genders, and differently across the globe. We also describe specific challenges experienced by boys and girls with kidney disease, how culture and geography may impact kidney care in places where resources are particularly limited such as sub-Saharan Africa, and give examples of social and structural circumstances that place young men and women at high risk of kidney disease in Mexico and Central America, illustrated by case vignettes. The coronavirus disease-2019 pandemic has raised awareness of pervasive gender-based inequities within all societies. This applies to kidney disease and is not new. The nephrology community must add its voice to the calls for action, for a more just society overall, and for the recognition of the roles of sex and gender as modulators of kidney disease risk and access to care.
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Affiliation(s)
- Guillermo García García
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde," University of Guadalajara Health Sciences Center (Centro Universitario de Ciencias de la Salud), Guadalajara, Jalisco, Mexico
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India
| | - François Kaze
- Faculty of Medicine and Biomedical Sciences, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Ciara Kierans
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Cesar Padilla-Altamira
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom; Center for Research and Higher Studies in Social Anthropology, Guadalajara, Jalisco, Mexico
| | - Valerie A Luyckx
- Department of Nephrology, University Children's Hospital University of Zurich, Zurich, Switzerland,; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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23
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Prevalence, incidence and years of life adjusted for disability due to depressive disorders in Mexico: Results of the Global Burden of Disease Study 2019. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Villalvazo P, Carriazo S, Martin-Cleary C, Ortiz A. Aguascalientes: one of the hottest chronic kidney disease (CKD) hotspots in Mexico and a CKD of unknown aetiology mystery to be solved. Clin Kidney J 2021; 14:2285-2294. [PMID: 34754425 PMCID: PMC8573004 DOI: 10.1093/ckj/sfab136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/05/2023] Open
Abstract
In a recent issue of Clinical Kidney Journal (CKJ), Gutierrez-Peña et al. reported a high incidence and prevalence of advanced chronic kidney disease (CKD) in Aguascalientes, Mexico. This contradicts Global Burden of Disease estimates, which should be updated. A key component of this high burden of CKD relates to young people ages 20-40 years in whom the cause of CKD was unknown [CKD of unknown aetiology (CKDu)]. The incidence of kidney replacement therapy in this age group in Aguascalientes is among the highest in the world, second only to Taiwan. However, high-altitude Aguascalientes, with a year-round average temperature of 19°C, does not fit the geography of other CKDu hotspots. Furthermore, kidney biopsies in young people showed a high prevalence of focal segmental glomerulosclerosis. Potential causes of CKDu in Aguascalientes include the genetic background (no evidence, although podocytopathy genes should be explored) and environmental factors. The highest prevalence of CKD was found in Calvillo, known for guava farming. Thus guava itself, known to contain bioactive, potentially nephrotoxic molecules and pesticides, should be explored. Additionally, there are reports of water sources in Aguascalientes contaminated with heavy metals and/or pesticides. These include fluoride (increased levels found in Calvillo drinking water) as well as naturally occurring arsenic, among others. Fluoride may accumulate in bone and cause kidney disease years later, and maternal exposure to excess fluoride may cause kidney disease in offspring. We propose a research agenda to clarify the cause of CKDu in Aguascalientes that should involve international funders. The need for urgent action to identify and stem the cause of the high incidence of CKD extends to other CKD hotspots in Mexico, including Tierra Blanca in Veracruz and Poncitlan in Jalisco.
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Affiliation(s)
| | - Sol Carriazo
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
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25
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Changes in cardiometabolic risk factors and metabolic syndrome over time in living kidney donors: a retrospective cohort study. NUTR HOSP 2021; 38:1002-1008. [PMID: 34304575 DOI: 10.20960/nh.03646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND permissibility in the selection of living kidney donors (LKD) with one or more cardiometabolic risk factors (CMRFs) and/or metabolic syndrome (MS) is an increasingly frequent practice worldwide. These factors, together with kidney donation specifically, are known to be associated with an increased risk of chronic kidney disease (CKD). METHODS we analyzed the frequency of CMRFs and MS before and after kidney donation in LKD. In the secondary analysis, we associated CMRFs and MS with renal function. The SPSS V22.0 software was used. RESULTS we analyzed 110 LKD patients, with a mean age of 35.05 ± 10.5 years: 63 (57.3 %) men and 47 (42.7 %) women. Patients were followed for 25 ± 17.48 months after nephrectomy. Prior to donation, 62 patients (56.4 %) had MS, and the presence of one to six CMRFs was 19.1 %, 32 %, 18.2 %, 17.3 %, 3.6 %, and 0.9 %, respectively. During follow-up, in donors, the incidence of overweight increased from 48.2 % to 52.7 %, (p < 0.01); that of obesity increased from 11.8 % to 20.9 % (p < 0.01); that of hyperuricemia increased from 17.3 % to 26.4 %, (p < 0.01); that of hypercholesterolemia increased from 24.5 % to 33.6 % (p < 0.01); and that of hypertriglyceridemia increased from 47.3 % to 50.9 % (p < 0.01), while the incidence of MS decreased from 56.4 % to 51.8 % (p < 0.01). A logistic regression analysis showed that the presence of CMRFs did not show any association with glomerular filtration rates below 60 mL/min/1.73 m2. CONCLUSION LKD had a high frequency of CMRFs and MS at the time of donation, and over time, the incidence of CMRFs significantly increased. Because these factors, together with kidney donation, could be associated with an increased risk of CKD, we must evaluate protocols for LKD and consider stricter criteria in the selection of LKD, with an emphasis on follow-up protocols to address CMRFs and MS.
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26
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Vera-Zertuche JM, Mancilla-Galindo J, Tlalpa-Prisco M, Aguilar-Alonso P, Aguirre-García MM, Segura-Badilla O, Lazcano-Hernández M, Rocha-González HI, Navarro-Cruz AR, Kammar-García A, Vidal-Mayo JDJ. Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study. Epidemiol Infect 2021; 149:e109. [PMID: 33913410 PMCID: PMC8134888 DOI: 10.1017/s0950268821001023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/03/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
Conflicting results have been obtained through meta-analyses for the role of obesity as a risk factor for adverse outcomes in patients with coronavirus disease-2019 (COVID-19), possibly due to the inclusion of predominantly multimorbid patients with severe COVID-19. Here, we aimed to study obesity alone or in combination with other comorbidities as a risk factor for short-term all-cause mortality and other adverse outcomes in Mexican patients evaluated for suspected COVID-19 in ambulatory units and hospitals in Mexico. We performed a retrospective observational analysis in a national cohort of 71 103 patients from all 32 states of Mexico from the National COVID-19 Epidemiological Surveillance Study. Two statistical models were applied through Cox regression to create survival models and logistic regression models to determine risk of death, hospitalisation, invasive mechanical ventilation, pneumonia and admission to an intensive care unit, conferred by obesity and other comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, immunosuppression, hypertension, cardiovascular disease and chronic kidney disease). Models were adjusted for other risk factors. From 24 February to 26 April 2020, 71 103 patients were evaluated for suspected COVID-19; 15 529 (21.8%) had a positive test for SARS-CoV-2; 46 960 (66.1%), negative and 8614 (12.1%), pending results. Obesity alone increased adjusted mortality risk in positive patients (hazard ratio (HR) = 2.7, 95% confidence interval (CI) 2.04-2.98), but not in negative and pending-result patients. Obesity combined with other comorbidities further increased risk of death (DM: HR = 2.79, 95% CI 2.04-3.80; immunosuppression: HR = 5.06, 95% CI 2.26-11.41; hypertension: HR = 2.30, 95% CI 1.77-3.01) and other adverse outcomes. In conclusion, obesity is a strong risk factor for short-term mortality and critical illness in Mexican patients with COVID-19; risk increases when obesity is present with other comorbidities.
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Affiliation(s)
- J. M. Vera-Zertuche
- Endocrinology Department, Obesity Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J. Mancilla-Galindo
- Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - M. Tlalpa-Prisco
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - P. Aguilar-Alonso
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - M. M. Aguirre-García
- Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - O. Segura-Badilla
- Facultad de Ciencias de la Salud y de los Alimentos, Departamento de Nutrición y Salud Pública, Programa UBB Saludable, Universidad del Bío-Bío, Bío-Bío, Chile
| | - M. Lazcano-Hernández
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - H. I. Rocha-González
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - A. R. Navarro-Cruz
- Facultad de Ciencias Químicas, Departamento de Bioquímica y Alimentos, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - A. Kammar-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J. de J. Vidal-Mayo
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Ibarra-Nava I, Flores-Rodriguez KG, Ruiz-Herrera V, Ochoa-Bayona HC, Salinas-Zertuche A, Padilla-Orozco M, Salazar-Montalvo RG. Ethnic disparities in COVID-19 mortality in Mexico: A cross-sectional study based on national data. PLoS One 2021; 16:e0239168. [PMID: 33690607 PMCID: PMC7946310 DOI: 10.1371/journal.pone.0239168] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/13/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Across the world, the COVID-19 pandemic has disproportionately affected racial and ethnic minorities. How ethnicity affects Indigenous peoples in Mexico is unclear. The aim of this cross-sectional study was to determine the mortality associated with ethnicity, particularly of Indigenous peoples, in a large sample of patients with COVID-19 in Mexico. METHODS We used open access data from the Mexican Ministry of Health, which includes data of all confirmed COVID-19 cases in the country. We used descriptive statistics to compare differences among different groups of patients. Logistic regression was used to calculate odds ratios while adjusting for confounders. RESULTS From February 28 to August 3, 2020, a total of 416546 adult patients were diagnosed with COVID-19. Among these, 4178 were Indigenous peoples. Among all patients with COVID-19, whether hospitalized or not, a higher proportion of Indigenous peoples died compared to non-Indigenous people (16.5% vs 11.1%, respectively). Among hospitalized patients, a higher proportion of Indigenous peoples died (37.1%) compared to non-Indigenous peoples (36.3%). Deaths outside the hospital were also higher among Indigenous peoples (3.7% vs 1.7%). A higher proportion of Indigenous peoples died in both the private and public health care sectors. The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was 1.13 (95% confidence interval 1.03 to 1.24). The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was higher among those who received only ambulatory care (1.55, 95% confidence interval 1.24 to 1.92). DISCUSSION In this large sample of patients with COVID-19, the findings suggest that Indigenous peoples in Mexico have a higher risk of death from COVID-19, especially outside the hospital. These findings suggest Indigenous peoples lack access to care more so than non-Indigenous people during the COVID-19 pandemic in Mexico.
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Affiliation(s)
- Ismael Ibarra-Nava
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Kathia G. Flores-Rodriguez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Violeta Ruiz-Herrera
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Hilda C. Ochoa-Bayona
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Alfonso Salinas-Zertuche
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Magaly Padilla-Orozco
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Raul G. Salazar-Montalvo
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
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28
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Parra-Bracamonte GM, Parra-Bracamonte FE, Lopez-Villalobos N, Lara-Rivera AL. Chronic kidney disease is a very significant comorbidity for high risk of death in patients with COVID-19 in Mexico. Nephrology (Carlton) 2020; 26:248-251. [PMID: 33184959 DOI: 10.1111/nep.13827] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
Chronic kidney disease (CKD) is a recognized public health problem and key determinant of poor health outcomes. In Mexico, this condition has been associated with high and significant risk of death in COVID-19 patients; however, not enough attention has been given to the vulnerable population as the increasing numbers and fatality rates suggest. This study evaluated the effect of interaction between CKD condition and other risk factors (sex, diabetes, hypertension and obesity) on the survival rate of positive patients for COVID-19 in Mexico. The results from this study support that CKD patients is a population at high risk for mortality for COVID-19 and that COVID-19 positive inpatients with CKD and diabetes are highly vulnerable to death.
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Abstract
Podcast
This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_06_25_K3602020000091.mp3
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Affiliation(s)
- Enzo Vasquez-Jimenez
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Magdalena Madero
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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30
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Agudelo-Botero M, González-Robledo MC, Reyes-Morales H, Giraldo-Rodríguez L, Rojas-Russell M, Mino-León D, Ocampo-Morales DI, Valdez-Ortiz R. Health care trajectories and barriers to treatment for patients with end-stage renal disease without health insurance in Mexico: a mixed methods approach. Int J Equity Health 2020; 19:90. [PMID: 32513177 PMCID: PMC7282114 DOI: 10.1186/s12939-020-01205-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 05/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background Mexico has the sixth-highest premature death rate from chronic kidney disease (CKD) in the world. From 1990 to 2017, the age-standardized CKD mortality rate jumped from 28.7 to 58.1 per 100,000 inhabitants, making it the second-leading cause of death that year. Medical care for the disease is inequitable, as those without health insurance have limited access to renal replacement therapy (RRT). The objective of this study is to describe the healthcare trajectories of patients with end-stage renal disease (ESRD) in a public hospital in Mexico City and the barriers they face in receiving peritoneal dialysis and haemodialysis. Methods This study uses a convergent mixed methods approach and is predominantly qualitative. Patients completed 199 surveys, and 42 semi-structured interviews with patients having ESRD and their families were conducted. The quantitative data were analysed using descriptive statistics, and the qualitative data were processed using a phenomenological approach. Results It was found that 76.9% of the patients received peritoneal dialysis or haemodialysis as their first RRT. Over 30% began their treatment at least a month after a health professional prescribed it. Almost 50% had been hospitalized for complications related to the disease in the previous year, and 36% had uncertainties about their treatment. Close to 64% of the haemodialysis patients received treatment intermittently. Barriers to accessing treatment, information, contact with health services, and treatment availability were identified. Patients and their families encountered economic and emotional difficulties at every phase of their search for medical care and treatment. Conclusion Mexico urgently needs to implement public policies related to CKD that are primarily directed at its prevention but should also implement policies directed at slowing its progression, reducing its complications, and providing funding for uninsured patients who require RRT. These policies must be based on the perspectives of human rights and equality, and the perspectives of patients, their families and the general population should be included in the policy creation process.
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Affiliation(s)
- Marcela Agudelo-Botero
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Liliana Giraldo-Rodríguez
- Department of Demographic Epidemiology and Social Determinants, National Institute of Geriatrics, Mexico City, Mexico
| | - Mario Rojas-Russell
- Faculty of Higher Studies Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
| | - Dolores Mino-León
- Research Unit in Clinical Epidemiology. Specialty Hospital of the 21st Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Dayan Irene Ocampo-Morales
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rafael Valdez-Ortiz
- Nephrology Services, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.
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