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Nephrology in Mexico
(2021)
García-García, Guillermo
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Chávez-Iñiguez, Jonathan Samuel
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Vázquez-Rangel, Armando
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Cervantes-Sánchez, Cynthia Gabriela
;
Paniagua, Ramón
Nephrology in Mexico started in 1955 with the opening of the nephrology department at Mexico’s National Heart Institute, where the first nephrology training program began in 1958. Pediatric nephrology care was first offered at Mexico’s Federico Gomez Children’s Hospital in 1953, among the first pediatric nephrology programs in the world. Kidney transplantation began in 1963 at the IMSS General Hospital. The Sociedad Mexicana de Nefrologia, the first Mexican nephrology society, was established in 1967, followed by the publication of Nefrologia Mexicana, its official journal, in 1980. Chronic kidney disease has emerged as a public health problem in Mexico. However, the fragmentation of the health system has resulted in unequal access to renal replacement therapy. Seguro Popular, a public health-care insurance for the poor, does not cover renal replacement therapy. As a consequence, many uninsured patients refuse dialysis, eventually abandon their treatment, or lose their kidney grafts because sustaining dialysis or immunosuppression becomes unaffordable. The lack of a national dialysis registry results in a vacuum of information on the burden of treated end-stage renal disease and its outcomes. In addition to the high burden of traditional risk factors (i.e., diabetes mellitus), a number of “hotspots” of chronic kidney disease of unknown origin have been recently described in the country. Despite the increased burden of chronic kidney disease, strategies to prevent chronic kidney disease have not been part of the nation’s noncommunicable disease health policies. Chronic kidney disease screening is not part of the National Health Surveys. Peritoneal dialysis continues to be the dialysis modality of choice, although a significant shift to hemodialysis has been observed over the last two decades. The number of nephrologists (9.1 per million population) is insufficient to match the demand imposed by the burden of chronic kidney disease. In conclusion, after 65 years of the beginning of nephrology in Mexico, kidney disease care remains unjust, unequal, and below the quality of international standards. The current infrastructure and resources are insufficient to satisfy the demand of renal care in our society. Therefore, it is important to consider it as a public health priority and to implement a comprehensive program for the prevention and control of this illness. The establishment of a national public policy for the prevention and treatment of chronic kidney disease is urgently needed. © Springer Nature
Scopus© Citations 2 15 2
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Prevalence of Malnutrition in Low-Income Mexican CAPD Patients
(2003)
García-García, Guillermo
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Nuñez-Martinez, Maria Guadalupe
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Obrador, Gregorio
Malnutrition is a common finding in continuous ambulatory peritoneal dialysis (CAPD) patients (1-6) and has been shown to be associated with increased morbidity and mortality (5). Identified risk factors are diabetes mellitus and female gender, nutritional status at the start of therapy, length of time on dialysis, age, and residual renal function (1,4,7,8). The reported prevalence in developed countries varies from 18% to 55% (1-3,5,6). In Mexico, it has been reported that 82% of CAPD patients show some degree of malnutrition (4). Socioeconomic factors and diabetes mellitus might contribute to the problem, since reduced income limits the availability of food. Our program provides CAPD to patients from the lowest social strata in Mexico. The average annual income in our state is US$1,775 and the prevalence of malnutrition is 25% (9). Our patients’ annual income per capita ranges between US$30 and US$430. (10). Diabetes mellitus is the main cause of end-stage renal disease (ESRD) in our state, representing 40% of our prevalent CAPD population (11). In this study, we report the prevalence of malnutrition among low-income Mexican CAPD patients and compare results with other series. Copyright © by International Society for Peritoneal Dialysis
Scopus© Citations 7 26 2
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Prevalence of chronic kidney disease in the Kidney Early Evaluation Program (KEEP) México and comparison with KEEP US
(2010)
Obrador, Gregorio
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García-García, Guillermo
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Villa, Antonio R.
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Rubilar, Ximena
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Olvera, Nadia
The National Kidney Foundation Kidney Early Evaluation Program (KEEP) is a free community screening program aimed at early detection of kidney disease among high-risk individuals. A pilot phase of KEEP México began in 2008 in México City and Jalisco State. Adults with diabetes, hypertension, or family history of diabetes, hypertension, or chronic kidney disease (CKD) were invited to participate through advertising campaigns. All participants completed a questionnaire. Blood pressure, weight, and height were measured; blood and urine tests included albuminuria and serum creatinine to estimate glomerular filtration rate using the Modification of Diet in Renal Disease Study equation. Mean age of KEEP México City and KEEP Jalisco participants was 46 and 53 years, respectively; >70% were women. CKD prevalence was 22% in KEEP México City and 33% in KEEP Jalisco, not significantly different from reported KEEP US prevalence of 26%. CKD stages 1 and 2 were more frequent in KEEP México and stage 3 in KEEP US. In KEEP México City, CKD prevalence was higher than the overall prevalence among participants with diabetes (38%) or diabetes and hypertension (42%). Most KEEP México participants were unaware of the CKD diagnosis, despite that 71% in KEEP México City had seen a doctor in the previous year. CKD is highly prevalent, underdiagnosed, and underrecognized among high-risk individuals in México. KEEP is an effective screening program that can successfully be adapted for use in México.
Scopus© Citations 107 24 2

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