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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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.
2 5Scopus© Citations 83
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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.
2 12Scopus© Citations 10
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The first report of the latin American society of nephrology and hypertension (SLANH) anemia committee in chronic hemodialysis patients
(2014)
Carlini, Raúl
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Obrador, Gregorio
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Campistrús, Nieves
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Andrade, Liliana
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Chifflet, Liliana
Background: Anemia almost invariably occurs in patients with chronic kidney disease. Limited data are available re-garding anemia management in Latin American (LA) he-modialysis (HD) patients. Objective: To evaluate the results of the first anemia survey of the Anemia Committee of the SLANH. Methods: This is a multinational, voluntary survey that collected anemia management data from adult HD patients from independent, non-chain owned HD units, between 09/2009 and 03/2010. T-test, ANOVA, chi-square test and multivariate logistic regression were used for statistical analysis.
Scopus© Citations 6 1 11
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Resumen de las Guías de práctica clínica KDIGO sobre el cuidado del receptor de trasplante renal
(Sociedad Argentina de Nefrología Argentina, 2011)
Kasiske, Bertram L.
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Zeier, Martin G.
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Chapman, Jeremy R.
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Craig, Jonathan C.
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Ekberg, Henrik
La guía de práctica clínica 2009 Enfermedad Renal: Mejorando los Resultados Globales (KDIGO, por sus siglas en inglés) sobre el control, manejo y tratamiento de receptores de un trasplante renal, está destinada a ayudar al cuidado médico de adultos y niños después de un trasplante renal. El proceso de desarrollo de la guía se ha hecho con un enfoque basado en la evidencia y las recomendaciones sobre manejo se fundamentan en revisiones sistemáticas de ensayos clínicos relevantes sobre el tratamiento. La valoración crítica de la calidad de la evidencia y la fuerza de las recomendaciones se basan en los Grados de Recomendación, Valoración, Desarrollo y Evaluación (GRADE, por sus siglas en inglés). La guía ofrece recomendaciones para la inmunosupresión y el monitoreo del injerto, así como para la prevención y el tratamiento de infecciones, enfermedades cardiovasculares, neoplasias y otras complicaciones frecuentes en el receptor de un trasplante renal, como los trastornos hematológicos y óseos. Se discuten las limitaciones de la evidencia, especialmente debidas a la falta de resultados definitivos en ensayos clínicos, y se proporcionan sugerencias para futuras investigaciones. Este resumen contiene una breve descripción de la metodología y de las recomendaciones completas de las guías, pero no contiene la justificación y las referencias de cada recomendación, las cuales han sido publicadas en otra revista. ©Revista de nefrología, diálisis y transplante, Sociedad Argentina de Nefrología Argentina.
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Anemia management in patients with chronic renal insufficiency
(2000)
Kausz, Annamaria T.
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Obrador, Gregorio
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Gutiérrez, Sebastián
The introduction of recombinant human erythropoietin (rHuEPO) more than a decade ago provided the first effective treatment for the anemia of chronic renal insufficiency (CRI). The use of rHuEPO in the treatment of anemia has been associated with partial regression of left ventricular hypertrophy among both dialysis and nondialysis patients, and has been shown to reduce the frequency of cardiac complications such as congestive heart failure and number of days of hospitalization among dialysis patients. Despite this evidence, the anemia of CRI remains highly prevalent, underrecognized, and undertreated. A number of considerations arise regarding the management of anemia among patients with CRI. In this article, we review the rationale for treatment of anemia, current management practices, proposed treatment strategies, and the economic implications of improved anemia treatment. ©American Journal of Kidney Diseases
1 15Scopus© Citations 43
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Systemic complications of chronic kidney disease: Pinpointing clinical manifestations and best management
(2002)
Obrador, Gregorio
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Pereira, Brian J. G.
The kidney plays a critical role in the maintenance of homeostasis. As kidney function diminishes, excretory, regulatory, and endocrine function is lost, and complications develop in essentially every organ system. Kidney failure is the last stage in the continuum of progressive CKD. Management of the complications associated with CKD mainly includes dietary counseling, adequate control of volume and blood pressure, and use of phosphate binders, calcitriol (Calcijex, Rocaltrol), and erythropoietin. Many of these complications can be prevented or attenuated with optimal CKD care, which involves early detection of progressive kidney disease, interventions to retard its progression, prevention of uremic complications, attenuation of comorbid conditions, adequate preparation for kidney replacement therapy, and timely initiation of dialysis (figure 2). Closer attention to CKD care is likely to be the key to improved outcomes among patients with kidney failure.
1Scopus© Citations 17 5
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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 2 37
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Mismatch Between Kidney Disease Burden and Nephrology Workforce in Mexico
(2020)
Obrador, Gregorio
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Arrigunaga, Sofía De
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Cuadra, Montserrat
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.
1 6Scopus© Citations 5
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KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary
(2010)
Kasiske, Bertram L.
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Zeier, Martin G.
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Chapman, Jeremy R.
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Craig, Jonathan C.
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Ekberg, Henrik
The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression and graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research. This summary includes a brief description of methodology and the complete guideline recommendations but does not include the rationale and references for each recommendation, which are published elsewhere. © Kidney International
Scopus© Citations 593 2 14
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Late nephrology referral and mortality among patients with end-stage renal disease: a propensity score analysis
(2004)
Kazmi, Waqar H.
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Obrador, Gregorio
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Khan, Samina S.
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Pereira, Brian J. G.
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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
Scopus© Citations 147 2 10

Obrador, Gregorio

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