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Non-traditional barriers to participation in pharmacologic chronic kidney disease clinical trials
(Springer Science and Business Media LLC, 2025)
Cojuc-Konigsberg, Gabriel
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Braverman-Poyastro, Alan
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Canaviri-Flores, Vianca Anabel
;
Fuentes Cepeda, Alejandra de las
;
Rodríguez-Paniagua, Briana Mariette
Background: The Agenda for Sustainable Development agenda prioritizes access to care for non-communicable diseases, including chronic kidney disease (CKD), and sustainable cities and communities. City-level health may impact local research capacity and subsequent participation in randomized controlled trials (RCTs). We identified city-level barriers to CKD RCT participation in the cities from the Global Observatory of Healthy and Sustainable Cities (GOHSC). Methods: We conducted a cross-sectional study of 214 drug CKD RCTs (2003–2023) with participants spanning 146 GOHSC sites. We queried open datasets to retrieve relevant financial, urban, healthcare, and nephrology-related indicators. We designed a CKD research capacity scale incorporating six variables: population-weighted RCTs, sites per sqkm, funding, site span, facility type, RCTs per site. We classified research capacity as absent (0–1 points), insufficient (2–4), fair (6–7), good (7–8), or excellent (9–10) and compared indicators between research capacity categories. Results: Of the included cities, Odense had the highest population-weighted RCT count (7.01 RCTs per 100,000 population), and Mexico City had the lowest (0.06 RCTs per 100,000 population). Cities with good or excellent research capacity had higher health expenditures, nephrologists, and dialysis centers per million population than cities with absent or insufficient research capacity. In cities with good or excellent research capacity, the most prevalent type of insurance coverage for CKD was public, whereas mixed financing was the most frequent type in cities with absent or insufficient research capacity. Among the identified non-traditional barriers to CKD RCT participation, daily living score, access to public transport, access to open spaces, and access to a fresh food market were higher in cities with good or excellent research capacity, compared to those with lower research capacity scores. Conclusions: We found differences in CKD research capacity across the cities included in the GOHSC Study Collaboration, which may be affected by financial, socio-demographic, healthcare, and nephrology-related barriers. Local, regional, and international initiatives should address distinctive local variations to enhance CKD research capacity. ©The authors ©Springer
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The impact of externalized pancreatic stents in our practice: A comparison of outcomes after pancreaticoduodenectomy in two time periods
(Elsevier, 2025)
Arias-Espinosa, Luis
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Nordmann-Gomes, Alberto
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Zorrilla-Villalobos, A.
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Vargas-España Andres
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Malcher, Flavio
Background: Postoperative pancreatic fistula is a severe complication of pancreaticoduodenectomy. Using an externalized pancreatic stent is a potential mitigation strategy not previously studied in Latin America. Methods: Pancreaticoduodenectomies performed in a single center between 2006 and 2019 were retrospectively analyzed. Clinical variables were collected with a 90-day follow-up according to stent intervention: externalized stent (ES), internal stent (IS), or no stent. Before and after ES implementation (2016) periods were also compared. ©The authors ©The American Journal of Surgery (AJS) © Elsevier.
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Urine epidermal growth factor as a biomarker for kidney function recovery and prognosis in glomerulonephritis with severe kidney function impairment
(Springer, 2024)
Hernández-Andrade, Adriana
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Nordmann-Gomes, Alberto
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Juárez-Cuevas, Bernardo
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Zavala-Miranda, Maria Fernanda
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Cruz, Cristino
Background: Prognostication in glomerulonephritis with severe kidney function impairment is critical for evaluating the benefit-to-risk ratio of immunosuppression. We hypothesized that the urine biomarker epidermal growth factor (EGF) could have good discrimination power to identify subjects who might ultimately recover kidney function. Methods: We included 82 subjects with glomerulonephritis and severe kidney function impairment at admission (estimated glomerular filtration rate [eGFR] ≤ 30 mL/min/1.73m2): 58 with lupus nephritis (LN) and 24 with ANCA-associated vasculitis (AAV). Thirty-five subjects required kidney replacement therapy (KRT) at presentation. Urine epidermal growth factor was measured and corrected by urine creatinine (uEGF/Cr) and the population was analyzed by uEGF/Cr tertiles. The primary outcome was time to recovery of eGFR ≥ 30 mL/min/1.73m2 and time to recovery of kidney function with dialysis independence in those with initial KRT. ©The authors ©Journal of Nephrology © Springer.
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