Obrador, Gregorio
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Preferred name
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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Patients with Fabry disease on dialysis in the United States

2002 , Thadhani, Ravi , Wolf, Myles , West, Michael L. , Tonelli, Marcello , Ruthazer, Robin , Pastores, Gregory M. , Obrador, Gregorio

Background: Fabry disease results from an X-linked deficiency of lysosomal alpha-galactosidase A and is a rare cause of end-stage renal disease. Little is known about the characteristics of patients with Fabry disease that initiate dialysis in the United States, although data from Europe suggests these individuals have a poor survival. Methods: Using the United States Renal Disease System database, we first studied in detail 42 Fabry patients who initiated dialysis between April 1995 (following the introduction of the new detailed HCFA 2728 form) and July 1998. To examine crude survival in a larger cohort, 95 Fabry patients were studied who initiated dialysis between 1985 and 1993, similar to the European Registry. Diabetic and non-diabetic controls matched by age, gender, race, year of dialysis initiation, and initial dialysis modality were examined for comparison. ©Copyright © Elsevier Inc.,

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Prevalencia de enfermedad renal en niños aparentemente sanos con antecedente familiar de terapia de reemplazo renal

2015 , Medeiros, Mara , Andrade Veneros, Gioconda Daniela , Toussaint Martínez de Castro, Georgina , Ortiz Vásquez, Lourdes , Hernández Sánchez, Ana María , Olvera, Nadia , Obrador, Gregorio , Velásquez Jones, Luis

Introducción: Se ha mencionado que tener un familiar directo con enfermedad renal es un factor de riesgo para el padecimiento. El objetivo del estudio fue conocer la prevalencia de enfermedad renal temprana en niños familiares de pacientes con enfermedad renal crónica terminal (ERCT). Métodos: Se realizó un estudio de tamiz en niños aparentemente sanos, familiares en primer o segundo grado de pacientes con ERCT en programa reemplazo renal (hemodiálisis o trasplante renal). Previa firma de consentimiento informado se realizó el examen físico completo. Se tomó una muestra de sangre para la determinación de creatinina y electrolitos séricos, así como examen general de orina.

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Prevalence of Malnutrition in Low-Income Mexican CAPD Patients

2003 , García-García, Guillermo , Nuñez-Martinez, Maria Guadalupe , Obrador, Gregorio

Malnutrition is a common finding in continuous ambulatory peritoneal dialysis (CAPD) patients (1-6) and has been shown to be associated with increased morbidity and mortality (5). Identified risk factors are diabetes mellitus and female gender, nutritional status at the start of therapy, length of time on dialysis, age, and residual renal function (1,4,7,8). The reported prevalence in developed countries varies from 18% to 55% (1-3,5,6). In Mexico, it has been reported that 82% of CAPD patients show some degree of malnutrition (4). Socioeconomic factors and diabetes mellitus might contribute to the problem, since reduced income limits the availability of food. Our program provides CAPD to patients from the lowest social strata in Mexico. The average annual income in our state is US$1,775 and the prevalence of malnutrition is 25% (9). Our patients’ annual income per capita ranges between US$30 and US$430. (10). Diabetes mellitus is the main cause of end-stage renal disease (ESRD) in our state, representing 40% of our prevalent CAPD population (11). In this study, we report the prevalence of malnutrition among low-income Mexican CAPD patients and compare results with other series. Copyright © by International Society for Peritoneal Dialysis

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Daprodustat for the Treatment of Anemia in Patients Not Undergoing Dialysis

2021 , Singh, Ajay K. , Carroll, Kevin , McMurray, John J. V. , Solomon, Scott , Jha, Vivekanand , Johansen, Kirsten L. , Lopes, Renato D. , Macdougall, Iain C. , Obrador, Gregorio , Waikar, Sushrut S. , Wanner, Christoph , Wheeler, David C. , Więcek, Andrzej , Blackorby, Allison , Cizman, Borut , Cobitz, Alexander R. , Davies, Rich , DiMino, Tara L. , Kler, Lata , Meadowcroft, Amy M. , Taft, Lin , Perkovic, Vlado

Background: Daprodustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor. In patients with chronic kidney disease (CKD) who are not undergoing dialysis, the efficacy and safety of daprodustat, as compared with the conventional erythropoiesis-stimulating agent darbepoetin alfa, are unknown. Methods: In this randomized, open-label, phase 3 trial with blinded adjudication of cardiovascular outcomes, we compared daprodustat with darbepoetin alfa for the treatment of anemia in patients with CKD who were not undergoing dialysis. The primary outcomes were the mean change in the hemoglobin level from baseline to weeks 28 through 52 and the first occurrence of a major adverse cardiovascular event (MACE; a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke). Copyright © 2021 Massachusetts Medical Society.

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Mortality in Patients With Chronic Renal Disease Without Health Insurance in Mexico: Opportunities for a National Renal Health Policy

2018 , Valdez-Ortiz, Rafael , Navarro-Reynoso, Francisco , Olvera-Soto, Guadalupe , Martin-Alemañy, Geovana , Rodríguez-Matías, Adrian , Hernández-Arciniega, Clara Rocío , Cortes-Pérez, Mario , Chávez-López, Ernesto , García-Villalobos, Gloria , Hinojosa-Heredia, Héctor , Camacho-Aguirre, Ana Yetzin , Valdez-Ortiz, Ángel , Cantú Quintanilla, Guillermo Rafael , Gómez-Guerrero, Irma , Reding, Arturo , Pérez-Navarro, Monserrat , Obrador, Gregorio , Correa-Rotter, Ricardo

Despite a systematic increase in the coverage of patients with end-stage renal disease (ESRD) who have received dialytic therapies and transplantation over the past 2 decades, the Mexican health system currently still does not have a program to provide full coverage of ESRD. Our aim was to analyze mortality in patients with ESRD without health insurance.

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Regional Variation of Erythropoiesis-Stimulating Agent Hyporesponsiveness in the Global Daprodustat Dialysis Study (ASCEND-D)

2023 , Macdougall, Iain C. , Meadowcroft, Amy M. , Blackorby, Allison , Cizman, Borut , Cobitz, Alexander R. , Godoy, Sergio , Jha, Vivekanand , Johansen, Kirsten L. , McMahon, Gearoid , Obrador, Gregorio , Wong, Muh Geot , Singh, Ajay K.

Introduction: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) affects 10-15% of the chronic dialysis population. We explored baseline characteristics and predictors of ESA hyporesponsiveness in a global randomized cardiovascular outcomes study comparing an investigational hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), daprodustat, with conventional ESA treatment. Methods: ASCEND-D (NCT02879305) recruited 2,964 chronic dialysis patients receiving ESA treatment (standardized to weekly intravenous [IV] epoetin) who were iron replete at baseline. The primary ESA hyporesponsiveness definition was an ESA Resistance Index (ERI, ESA units/kg/week/hemoglobin g/L) ≥2 or IV standardized ESA dose ≥450 units/kg/week. Predictors of ESA hyporesponsiveness were determined using a multivariable regression model. Alternative hyporesponder definitions were explored. The Author(s). Published by S. Karger AG, Basel.

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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. , Levin, Adeera , Moss, Alvin H. , Jha, Vivekanand , Brown, Edwina A. , Brennan, Frank , Murtagh, Fliss E.M. , Naicker, Saraladevi , Germain, Michael J. , O'Donoghue, Donal J. , Morton, Rachael L. , Obrador, Gregorio

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

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Mismatch Between Kidney Disease Burden and Nephrology Workforce in Mexico

2020 , Obrador, Gregorio , Arrigunaga, Sofía De , Cuadra, Montserrat , Villa Romero, Antonio Rafael

End-stage kidney disease (ESKD) is highly prevalent worldwide and is associated with high mortality, morbidity, and cost. It has been estimated that, in 2010, a total of 2.6 million people received kidney replacement therapy (KRT) globally, and that between 4.9 and 9.7 million patients needed KRT. For the Latin American and Caribbean regions, the number of patients receiving versus needing KRT was 373,000 versus 626,000. 1 Although a national dialysis registry is lacking in Mexico, in 2005, it was estimated that there were approximately 130,000 patients with ESKD and that only half of them had access to KRT. 2 Furthermore, the burden of disease attributed to chronic kidney disease (CKD) has increased dramatically. Among all diseases, CKD went from being ranked #16 in 1990 to #2 in 2013 for years of life lost due to premature death.© 2020 International Society of Nephrology. Published by Elsevier Inc.

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Prevalence of chronic kidney disease in the Kidney Early Evaluation Program (KEEP) México and comparison with KEEP US

2010 , Obrador, Gregorio , García-García, Guillermo , Villa, Antonio R. , Rubilar, Ximena , Olvera, Nadia , Ferreira, Evangelina , Virgen, Margarita , Gutiérrez-Padilla, José Alfonso , Plascencia-Alonso, Melissa , Mendoza-García, Martha , Plascencia-Pérez, Salvador

The National Kidney Foundation Kidney Early Evaluation Program (KEEP) is a free community screening program aimed at early detection of kidney disease among high-risk individuals. A pilot phase of KEEP México began in 2008 in México City and Jalisco State. Adults with diabetes, hypertension, or family history of diabetes, hypertension, or chronic kidney disease (CKD) were invited to participate through advertising campaigns. All participants completed a questionnaire. Blood pressure, weight, and height were measured; blood and urine tests included albuminuria and serum creatinine to estimate glomerular filtration rate using the Modification of Diet in Renal Disease Study equation. Mean age of KEEP México City and KEEP Jalisco participants was 46 and 53 years, respectively; >70% were women. CKD prevalence was 22% in KEEP México City and 33% in KEEP Jalisco, not significantly different from reported KEEP US prevalence of 26%. CKD stages 1 and 2 were more frequent in KEEP México and stage 3 in KEEP US. In KEEP México City, CKD prevalence was higher than the overall prevalence among participants with diabetes (38%) or diabetes and hypertension (42%). Most KEEP México participants were unaware of the CKD diagnosis, despite that 71% in KEEP México City had seen a doctor in the previous year. CKD is highly prevalent, underdiagnosed, and underrecognized among high-risk individuals in México. KEEP is an effective screening program that can successfully be adapted for use in México.

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Kidney disease: Improving global outcomes (KDIGO) anemia work group. KDIGO clinical practice guideline for anemia in chronic kidney disease

2012 , McMurray, John J. V. , Parfrey, Patrick S. , Adamson, John W. , Aljama, Pedro , Berns, Jeffrey S. , Bohlius, Julia , Drüeke, Tilman B. , Finkelstein, Fredric O. , Fishbane, Steven , Ganz, Tomas , Macdougall, Iain C. , McDonald, Ruth A. , McMahon, Lawrence P. , Obrador, Gregorio , Strippoli, Giovanni F. M . , Weiss, Günter , Wiecek, Andrzej

The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Anemia in Chronic Kidney Disease aims to provide guidance on diagnosis, evaluation, management and treatment for all CKD patients (non-dialysis, dialysis, kidney transplant recipients and children) at risk of or with anemia. Guideline development followed an explicit process of evidence review and appraisal. The guideline contains chapters addressing diagnosis and evaluation of anemia in CKD and the use of various therapeutic agents (iron, ESAs and other agents) and red cell transfusion as means of treatment. Treatment approaches are addressed in each chapter and guideline recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the GRADE approach. Ongoing areas of controversies and limitations of the evidence are discussed and additional suggestions are also provided for future research.

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