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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
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Fuentes Cepeda, Alejandra de las
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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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Development and validation of a questionnaire to assess the health related Social Capital for Chronic Kidney Disease among Mexican adolescents
(Public Library of Science (PLoS), 2025)
Quiñones-Villalobos, Carolina
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Prado-Aguilar, Carlos Alberto
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Obrador, Gregorio
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Arreola-Guerra, José Manuel
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Padilla-López, Jannett
Background: Social Capital on health has been studied widely, to date there is no valid and reliable questionnaire that measure it in Chronic Kidney Disease (CKD). Objective: To develop, validate and assess the reliability of Social Capital related to CKD questionnaire for Mexican adolescents. Methods: An instrumental study was employed to validate a questionnaire that assesses the cognitive and structural domains of Social Capital related to CKD. The questionnaire was generated by operationalization of the constructs and validated by assessing the content, face validity, criteria and construct validity. Reliability was assessed through the Cronbach´s alpha. Results: The content validity of the questionnaire was confirmed through Kendall’s W of 0.925 (p = 0.01) and its face validity was evaluated by four focus groups. A principal component analysis on a sample of 281 adolescents indicated that 72.78% of the variance was explained by the cognitive domain and 83.20% by the structural domain. A confirmatory analysis returned a chi-squared value of 142.99 (p = 0.05), a CFI of 0.97, a TLI of 0.96, a RMSEA of 0.040 and a SRMR of 0.07 for the cognitive domain. Similarly, a chi-squared of 408.296 (p < 0.001), a CFI of 0.98, a TLI of 0.97, a RMSEA 0.03 and a SRMR of 0.06 were returned for the structural domain. The validity of the criteria was assessed through a Pearson’s correlation for both the cognitive and structural domains. There was a mild-to-strongly significant correlation (p ≤ 0.001) among items and dimensions within each domain, with correlation coefficients ranging from 0.23 to 0.83. As a determinant of the reliability of the questionnaire, the Cronbach’s alpha was 0.84 and 0.94 for the cognitive and structural domain, respectively. Conclusions: A valid and reliable questionnaire has been developed to measure the influence of Social Capital on health in relation to CKD among Mexican adolescents. ©The authors ©Public Library of Science (PLoS) ©PLOS One.
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Epidemiology of Kidney Disease in the Elderly
(Springer Nature Switzerland, 2024)
Obrador, Gregorio
Concomitant with population aging, kidney disease incidence and prevalence among the elderly is growing globally. The prevalence of chronic kidney disease (CKD) increases with age and is higher in women than in men. Impaired kidney function in older people is associated with adverse outcomes. Older people are more likely to die than to reach kidney replacement therapy. Discontinuation of maintenance dialysis is frequent and a leading cause of death. Kidney transplant recipients in recent years are older than in the past on average. Conservative kidney management is an alternative therapy for end-stage kidney disease, and is especially suited for older patients with multiple comorbid conditions. Elderly patients have many risk factors for developing acute kidney injury, increasing the risk of chronic kidney disease, kidney failure, and mortality. The prevalence of glomerular diseases in the elderly is growing and faces significant diagnostic and therapeutic challenges. © The author © Springer.
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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
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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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Management of Anemia in Nondialysis Chronic Kidney Disease: Current Recommendations, Real-World Practice, and Patient Perspectives
(2020)
Guedes, Murilo
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Robinson, Bruce M.
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Obrador, Gregorio
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Tong, Allison
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Pisoni, Ronald L.
In nondialysis CKD (ND-CKD), anemia is a multifactorial and complex condition in which several dysfunctions dynamically contribute to a reduction in circulating hemoglobin (Hb) levels in red blood cells. Anemia is common in CKD and represents an important and modifiable risk factor for poor clinical outcomes. Importantly, symptoms related to anemia, including reduced physical functioning and fatigue, have been identified as high priorities by patients with CKD. The current management of anemia in ND-CKD (i.e., parameters to initiate treatment, Hb and iron indexes targets, choice of therapies, and effect of treatment on clinical and patient-reported outcomes) remains controversial. In this review article, we explore the epidemiology of anemia in ND-CKD and revise current recommendations and controversies in its management. Exploring data from real-world clinical practices, particularly from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps), we highlight the current challenges to translating current recommendations to clinical practice, providing patients' perspectives of anemia and how it affects their quality of life. Finally, we summarize recent advances in the field of anemia that may change the way this condition will be managed in the future. Copyright © 2020 by the American Society of Nephrology.
Scopus© Citations 14 6 2
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The ASCEND-NHQ randomized trial found positive effects of daprodustat on hemoglobin and quality of life in patients with non-dialysis chronic kidney disease
(2023)
Johansen, Kirsten L.
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Cobitz, Alexander R.
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Singh, Ajay K.
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Macdougall, Iain C.
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Lopes, Renato D.
The ASCEND-NHQ trial evaluated the effects of daprodustat on hemoglobin and the Medical Outcomes Study 36-item Short Form Survey (SF-36) Vitality score (fatigue) in a multicenter, randomized, double-blind, placebo-controlled trial. Adults with chronic kidney disease (CKD) stages 3-5, hemoglobin 8.5-10.0 g/dl, transferrin saturation 15% or more, and ferritin 50 ng/ml or more without recent erythropoiesis-stimulating agent use were randomized (1:1) to oral daprodustat or placebo to achieve and maintain target hemoglobin of 11-12 g/dl over 28 weeks. The primary endpoint was the mean change in hemoglobin between baseline and the evaluation period (Weeks 24-28). Principal secondary endpoints were proportion of participants with a 1 g/dl or more increase in hemoglobin and mean change in the Vitality score between baseline and Week 28. Outcome superiority was tested (1-sided alpha level of 0.025). Overall, 614 participants with non-dialysis-dependent CKD were randomized. The adjusted mean change in hemoglobin from baseline to the evaluation period was greater with daprodustat (1.58 vs 0.19 g/dl). The adjusted mean treatment difference (AMD) was significant at 1.40 g/dl (95% confidence interval 1.23, 1.56). A significantly greater proportion of participants receiving daprodustat showed a 1 g/dl or greater increase in hemoglobin from baseline (77% vs 18%). The mean SF-36 Vitality score increased by 7.3 and 1.9 points with daprodustat and placebo, respectively; a clinically and statistically significant 5.4 point Week 28 AMD increase. Adverse event rates were similar (69% vs 71%); relative risk 0.98, (95% confidence interval 0.88, 1.09). Thus, in participants with CKD stages 3-5, daprodustat resulted in a significant increase in hemoglobin and improvement in fatigue without an increase in the overall frequency of adverse events. Copyright © 2023 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
Scopus© Citations 16 11 1
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Longitudinal Analysis of Participants in The KEEP Mexico's Chronic Kidney Disease Screening Program
(2013)
Obrador, Gregorio
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Olvera, Nadia
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Gutiérrez, Verónica
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Contreras, Daniela
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Reyes, Rebeca
Background and aims: The Kidney Early Evaluation Program (KEEP) is a free screening and educational program aimed at detecting chronic kidney disease (CKD) among adult individuals who are at high-risk (those with diabetes, hypertension, or family history of these conditions or CKD). Confirmation of CKD diagnosis requires persistence of albuminuria or estimated GFR <60 mL/min for at least 3 months. We undertook this study to determine in a follow-up KEEP done at least 1 year after a baseline KEEP the following: 1) CKD incidence among individuals who initially tested negative for CKD, 2) transitions between CKD stages among individuals who initially tested positive for CKD. Methods: A random sample of KEEP participants was invited to participate in a follow-up KEEP between 2008 and 2010. Paired analyses were conducted to compare CKD stages between baseline and follow-up KEEP. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.
Scopus© Citations 10 49 2
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Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care
(2015)
Davison, Sara N.
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Levin, Adeera
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Moss, Alvin H.
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Jha, Vivekanand
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Brown, Edwina A.
Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable. Copyright © Elsevier B.V., its licensors, and contributors
Scopus© Citations 424 13 1
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Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference
(2016)
Macdougall, Iain C.
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Bircher, Andreas J.
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Eckardt, Kai-uwe
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Obrador, Gregorio
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Pollock, Carol A.
Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in recent years. The safety of various iron compounds has been of theoretical concern due to their potential to induce iron overload, oxidative stress, hypersensitivity reactions, and a permissive environment for infectious processes. Therefore, an expert group was convened to assess the benefits and risks of parenteral iron, and to provide strategies for its optimal use while mitigating the risk for acute reactions and other adverse effects. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
Scopus© Citations 214 19 2
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Genetic and environmental risk factors for chronic kidney disease
(2017)
Obrador, Gregorio
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Schultheiss, Ulla T.
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Kretzler, Matthias
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Langham, Robyn G.
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Nangaku, Masaomi
In order to change the current state of chronic kidney disease knowledge and therapeutics, a fundamental improvement in the understanding of genetic and environmental causes of chronic kidney disease is essential. This article first provides an overview of the existing knowledge gaps in our understanding of the genetic and environmental causes of chronic kidney disease, as well as their interactions. The second part of the article formulates goals that should be achieved in order to close these gaps, along with suggested timelines and stakeholders that are to be involved. A better understanding of genetic and environmental factors and their interactions that influence kidney function in healthy and diseased conditions can provide novel insights into renal physiology and pathophysiology and result in the identification of novel therapeutic or preventive targets to tackle the global public health care problem of chronic kidney disease. © Kidney International Supplements.
Scopus© Citations 60 10 2

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