Obrador, Gregorio
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Obrador, Gregorio
Official Name
Tomás Obrador Vera, Gregorio
Alternative Name
gobrador
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ORCID
Scopus Author ID
6602806471
Researcher ID
B-3054-2011

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Nephrology in Mexico

2021 , García-García, Guillermo , Chávez-Iñiguez, Jonathan Samuel , Vázquez-Rangel, Armando , Cervantes-Sánchez, Cynthia Gabriela , Paniagua, Ramón , Valdez-Ortiz, Rafael , Reyes-Acevedo, Rafael , Medeiros, Mara , Aguilar-Kitsu, Maria Alejandra , Muñoz-Arizpe, Ricardo , Obrador, Gregorio , Rubilar-Araya, Ximena

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

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Patient-Reported Outcome Measures for Fatigue in Patients on Hemodialysis: A Systematic Review

2018 , Ju, Angela , Unruh, Mark , Davison, Sara N. , Dapueto, Juan , Dew, Mary Amanda , Fluck, Richard , Germain, Michael , Jassal, Sarbjit Vanita , Obrador, Gregorio , O’Donoghue, Donal , Tugwell, Peter , Craig, Jonathan C. , Ralph, Angelique F. , Howell, Martin , Tong, Allison

Background: Fatigue is a prevalent and debilitating symptom in patients receiving hemodialysis. We aimed to identify and evaluate the characteristics and psychometric properties of patient-reported outcome measures for fatigue in patients receiving hemodialysis, to inform the selection of a robust and feasible measure for use in randomized trials in hemodialysis. Study Design: Systematic review of outcome measures for fatigue. Setting & Population: Patients receiving hemodialysis. Search Strategy & Sources: MEDLINE, Embase, PsycINFO, and CINAHL from inception to April 2017 were searched for all studies that reported fatigue in patients receiving hemodialysis. Analytical Approach: With a focus on addressing methods, items (individual questions) from all measures were categorized into content and measurement dimensions of fatigue. We assessed the general characteristics (eg, number of items and cost) and psychometric properties of all measures. © American Journal of Kidney Diseases

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Late nephrology referral and mortality among patients with end-stage renal disease: a propensity score analysis

2004 , Kazmi, Waqar H. , Obrador, Gregorio , Khan, Samina S. , Pereira, Brian J. G. , Kausz, Annamaria T.

Background: Late nephrology referral has been associated with adverse outcomes among patients with end-stage renal disease; however, its relationship to mortality is unclear. We examined the impact of timing of nephrology care relative to initiation of dialysis on mortality after initiation of dialysis. Methods: Data from the Dialysis Morbidity and Mortality Study - Wave II, a prospective study of incident dialysis patients, were used. Late referral (LR) was defined as first nephrology visit <4 months and early referral (ER) as first nephrology visit >or=4 months prior to initiation of dialysis. Propensity scores (PS) were estimated using logistic regression to predict the probability that a given patient was LR. A Cox proportional hazards model was built to examine the association between timing of nephrology referral and mortality. © Nephrology Dialysis Transplantation

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