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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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.
;
Cobitz, Alexander R.
;
Singh, Ajay K.
;
Macdougall, Iain C.
;
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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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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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
2 5Scopus© Citations 1
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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
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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.
1 49Scopus© Citations 11
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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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Reaching Targets for Mineral Metabolism Clinical Practice Guidelines and Its Impact on Outcomes Among Mexican Chronic Dialysis Patients
(2013)
Paniagua, Ramón
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Ventura, María-de-Jesús
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Ávila-Díaz, Marcela
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Hinojosa-Heredia, Héctor
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Méndez-Duran, Antonio
Background and aims: An increasing number of studies have been published concerning meeting targets of clinical guidelines for different aspects of the diagnosis and treatment of patients with end-stage renal disease. Most of these studies have shown that guideline recommendations are not always satisfied, and results outside target limits have been associated with high rates of mortality and morbidity. The objective of this study was to analyze the frequency of reaching mineral and bone metabolism-related guideline targets and its impact on clinical outcomes in Mexican chronic dialysis patients. Methods: A cohort of prevalent peritoneal dialysis (PD) and hemodialysis (HD) patients were analyzed at baseline and followed for at least 16 months. Patients were on continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), and HD and contracted HD modalities where patients received HD sessions outside institution facilities. Results: We studied 753 patients. The percentage of patients within target limits for phosphorus was 35%, for calcium 32%, and for PTH 12%. The most frequent pattern was hyperphosphatamia, hypercalcemia, and low PTH. This was even more frequent in CAPD patients, probably due to the high percentage of diabetic patients. Hypercalcemia was found as an independent risk factor for mortality.
Scopus© Citations 12 2 7
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Percepción de maltrato durante la residencia médica en México: medición y análisis bioético
(Universidad Nacional Autónoma de México, Facultad de Medicina, 2018)
Derive, Stéphanie
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Casas-Martínez, María-de-la-Luz
;
Obrador, Gregorio
;
Villa, Antonio R.
;
Contreras, Daniela
Introducción: Entre los múltiples retos que enfrenta un residente se encuentran las relaciones intrahospitalarias. En estas relaciones se han identificado maltratos hacia el residente que interfieren con su aprendizaje. Sin embargo, se conoce poco sobre este fenómeno en México. Objetivo: Medir la percepción de diferentes tipos de maltrato en residentes y hacer un análisis bioético de los resultados. Método: Se aplicó una encuesta electrónica de 107 preguntas a residentes del Estado de México para medir la percepción de maltratos psicológicos, físicos, académicos y sexuales. Se preguntó sobre quiénes ejercían los maltratos y sus consecuencias. El análisis estadístico incluyó la descripción de maltrato y sus tipos específicos, así como la frecuencia de variables sociodemográficas. Se realizó regresión logística para estimar la probabilidad de maltrato en función de variables de riesgo. Resultados: Se obtuvieron 143 respuestas (tasa de respuesta: 8.2%), 84% de los residentes refirió haber sufrido maltratos, siendo el más frecuente el psicológico (humillaciones en el 78%), seguido por el académico (guardias de castigo en 50% y negación de la enseñanza en 40%) y por el físico (16% recibieron golpes, 35% fueron privados de alimentación y 1% de ir al baño durante sus guardias, como castigo). Además 21% fue presionado a consumir alcohol contra su voluntad. Los maltratos psicológicos y físicos fueron más frecuentes en especialidades quirúrgicas que médicas. Como consecuencia de los maltratos, el 89% de los residentes reportaron burnout, 71% depresión, 78% ansiedad y 58% mala atención a sus pacientes. Los principales responsables de los maltratos fueron residentes de jerarquía superior y médicos de base. Conclusiones: Los maltratos durante la residencia son muy frecuentes y afectan los derechos humanos y la dignidad de los residentes. También reducen la capacidad de aprendizaje y la eficiencia de la educación médica de especialidad, en un país con alta demanda de atención de salud que requiere optimizar recursos económicos y humanos. © Los autores © Investigación en Educación Médica © Universidad Nacional Autónoma de México, Facultad de Medicina
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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.
;
Jha, Vivekanand
;
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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Associations of Haemoglobin Values and Rate of Changes With MACE in the ASCEND-ND Randomised Clinical Trial
(2022)
Singh, Ajay K.
;
Macdougall, Iain C.
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Johansen, Kirsten
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Jha, Vivekanand
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Correa-Rotter, Ricardo
Background and aims: Rapid changes in haemoglobin (Hb) following treatment with erythropoiesis-stimulating agents (ESAs) in patients with anaemia of chronic kidney disease (CKD) have been suggested to be associated with adverse outcomes [1–3]. This exploratory post-hoc analysis was performed to investigate the association between absolute Hb values or Hb changes over a 4-week period and the occurrence of first adjudicated major adverse cardiovascular event (MACE) in CKD patients not on dialysis who were treated with either daprodustat or darbepoetin. Method: ASCEND-ND was an event driven, cardiovascular outcomes trial conducted in over 30 countries that randomized 3872 CKD patients not on dialysis with baseline Hb of 8–10 g/dL if not on a prior ESA, or 8–11 g/dL if receiving an ESA, to receive either oral, once-daily daprodustat (1937 patients) or subcutaneous darbepoetin (1935 patients). Available doses were daprodustat 1–24 mg once-daily and darbepoetin 20–400 µg total 4-weekly dose. The study was recently reported to have met the co-primary endpoints of non-inferiority for first occurrence of adjudicated MACE and mean Hb change from baseline to weeks 28 through 52 [4]. MACE was a composite of death from any cause, non-fatal myocardial infarction or non-fatal stroke, and events were adjudicated by an independent clinical events committee blinded to treatment assignment. In this exploratory post-hoc analysis, we examined the associations of post-randomization absolute Hb values and Hb changes categorized into quintiles (see Table 1) with first adjudicated MACE. Each patient's time in the study, prior to a first MACE or end of follow-up, was divided into distinct 4-week intervals, with each interval associated with a particular post-randomization Hb value and rate of change. Separately for each treatment group, these 4-week periods were grouped according to quintiles of Hb values, and MACE rates were calculated for each quintile. This analysis was repeated using quintiles derived from Hb rate of decrease and increase. MACEs that occurred prior to Week 4, the first scheduled post-randomization Hb collection, were not included in the analysis. Copyright © Oxford University Press
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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

Obrador, Gregorio

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