Obrador, Gregorio

Main Affiliation

Facultad de Ciencias de la Salud - CampCM

Preferred name

Obrador, Gregorio

Official Name

Tomás Obrador Vera, Gregorio

ORCID

0000-0003-3814-7449

Researcher ID

B-3054-2011

Scopus Author ID

6602806471

Now showing 1 - 10 of 77

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Introduction: CKD Hotspots
(2019)
Obrador, Gregorio
;
Levin, Adeera
CKD hotspots refer to countries, regions, communities, or ethnicities with a higher than average incidence of CKD. 1 Although noncommunicable diseases, such as diabetes and hypertension, are the leading causes of CKD in developed and in most developing countries, infections and CKD of unknown etiology (CKDu) are the most frequent causes in the majority of CKD hotspots. 2 , 3 The term CKDu has been used to describe CKD that is not attributable to any traditional risk factor, such as diabetes, hypertension, or human immunodeficiency virus. 4 Several potential causative factors of CKDu have been implicated, including genetic, developmental, environmental, occupational, and social factors. However, despite extensive research, the specific causes of CKDu remain unknown in most CKD hotspots. © Seminars in Nephrology
Scopus© Citations 1 2 5
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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
;
Prado-Aguilar, Carlos Alberto
;
Obrador, Gregorio
;
Arreola-Guerra, José Manuel
;
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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Prevalencia, factores de riesgo y consecuencias de la referencia tardía al nefrólogo
(2011-01)
Laris González, Almudena
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Madero, Magdalena
;
Pérez-Grovas, Héctor
;
Franco-Guevara, Martha
;
Obrador, Gregorio
Late referral of patients with chronic kidney disease (CKD) to specialized care by the nephrologist is associated with worse patient outcomes while on dialysis. To determine the prevalence, risk factors, and consequences of late nephrology referral at a Mexican tertiary care hospital. Retrospective chart review of all adult patients who began chronic hemodialysis between 2002 and 2006 at the National Institute of Cardiology "Ignacio Chavez" (NICICh), Mexico City. Timing of referral to Nephrology Department was classified as early, late or very late if the time elapsed between referral and initiation of dialysis was < 1 month, between 1-6 months or > or = 6 months, respectively. Socio-demographic, clinical, laboratory and echocardiographic characteristics were compared according to timing of referral. Eighty four out of 150 patients were included in the analysis. Of these, 56% were referred < 1 month, and an additional 15% between 1-6 months prior to the initiation of chronic hemodialysis. In univariate analysis, being referred by a relative or friend was associated with a higher risk (p = 0.04), and being employed with a lower risk of late referral (p = 0.05). Late referred patients were more likely to require emergency dialysis and hospitalization, and of not having a permanent vascular access for their first dialysis. They also had a higher prevalence of severe anemia (hematocrit < 28%) and of residual kidney function (estimated glomerular filtration rate < 5 mL/min/1.73 m2), as well as increased left ventricular mass. Late nephrology referral is highly prevalent in our population and is associated with markers of suboptimal predialysis care at the onset of chronic dialysis.
Scopus© Citations 11 1 49
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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 1 17
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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 1 13
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Patient Perspectives on the Meaning and Impact of Fatigue in Hemodialysis: A Systematic Review and Thematic Analysis of Qualitative Studies
(2019)
Jacobson, Jack
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Ju, Angela
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Baumgart, Amanda
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Unruh, Mark
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O’Donoghue, Donal
Rationale & objective: Fatigue is a highly prevalent and debilitating symptom in patients on hemodialysis therapy due to the uremic milieu, the hemodialysis treatment itself, and other comorbid conditions. However, fatigue remains underrecognized and the consequences are underappreciated because it may not be visible in clinical settings. This study aims to describe the experience that patients undergoing maintenance hemodialysis have with fatigue. Study design: Systematic review and thematic synthesis of qualitative studies. Setting & study populations: Patients undergoing hemodialysis. Search strategy & sources: MEDLINE, Embase, PsycINFO, CINAHL, reference lists, and PhD dissertations were searched from inception to October 2018. Data extraction: All text from the results/conclusion of the primary studies. Analytical approach: Thematic synthesis. Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Scopus© Citations 72 2 27
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Challenges for sustainable end-stage kidney disease care in low-middle-income countries: the problem of the workforce
(2020)
Swanepoel, Charles R.
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McCulloch, Mignon I.
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Abraham, Georgi
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Donner, Jo-Ann
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Alrukhaimi, Mona N.
Prevention and early detection of kidney diseases in adults and children should be a priority for any government health department. This is particularly pertinent in the low-middle-income countries, mostly in Asia, Africa, Latin America, and the Caribbean, where up to 7 million people die because of lack of end-stage kidney disease treatment. The nephrology workforce (nurses, technicians, and doctors) is limited in these countries and expanding the size and expertise of the workforce is essential to permit expansion of treatment for both chronic kidney disease and end-stage kidney disease. To achieve this will require sustained action and commitment from governments, academic medical centers, local nephrology societies, and the international nephrology community. © 2020 International Society of Nephrology
1 11Scopus© Citations 21
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Supportive care for end-stage kidney disease: an integral part of kidney services across a range of income settings around the world
(2020)
Hole, Barnaby
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Hemmelgarn, Brenda
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Brown, Edwina
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Brown, Mark
;
McCulloch, Mignon I.
A key component of treatment for all people with advanced kidney disease is supportive care, which aims to improve quality of life and can be provided alongside therapies intended to prolong life, such as dialysis. This article addresses the key considerations of supportive care as part of integrated end-stage kidney disease care, with particular attention paid to programs in low- and middle-income countries. Supportive care should be an integrated component of care for patients with advanced chronic kidney disease, patients receiving kidney replacement therapy (KRT), and patients receiving non-KRT conservative care. Five themes are identified: improving information on prognosis and support, developing context-specific evidence, establishing appropriate metrics for monitoring care, clearly communicating the role of supportive care, and integrating supportive care into existing health care infrastructures. This report explores some general aspects of these 5 domains, before exploring their consequences in 4 health care situations/settings: in people approaching end-stage kidney disease in high-income countries and in low- and middle-income countries, and in people discontinuing KRT in high-income countries and in low- and middle-income countries. ©2020 International Society of Nephrology
1 6Scopus© Citations 54
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Anemia of chronic kidney disease and end-stage renal disease: Are there unique issues in disadvantaged populations?
(2009-03)
Obrador, Gregorio
Several sources of data indicate that there are racial and ethnic disparities in the management of anemia of chronic kidney disease and end-stage renal disease. In this article, I present evidence documenting these disparities and discuss possible factors that may explain the suboptimal anemia management. I also provide recommendations to improve anemia management in disadvantaged populations.
Scopus© Citations 2 1 27
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Decreased kidney function and agricultural work: a cross-sectional study in middle-aged adults from Tierra Blanca, Mexico
(2020)
Aguilar-Ramirez, Diego
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Raña-Custodio, Alejandro
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Olvera, Nadia
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Rubilar, Ximena
;
Escobar, Alejandro
Background: We aimed to determine the prevalence of decreased kidney function in a potential chronic kidney disease (KD) of unknown aetiology hotspot in Mexico, assess its distribution across occupations and examine the associated risk factors. Methods: A cross-sectional study collected sociodemographic, occupational, medical and biometric data from 616 men and women aged 20-60 years who were residents of three communities within the Tierra Blanca region in Mexico. Kidney function was assessed by standardized serum creatinine and estimated glomerular filtration rate (eGFR) and semi-quantitative albumin-to-creatinine ratio (ACR). To examine the distribution of decreased kidney function within the population, age- and sex-adjusted prevalence of low eGFR (≤60 mL/min/1.73 m2) was estimated for all participants and across occupations. Multivariable logistic regression was used to assess the association of occupation with having low eGFR.
Scopus© Citations 16 1 22

Obrador, Gregorio

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