Mismatch Between Kidney Disease Burden and Nephrology Workforce in Mexico

Obrador, Gregorio T.; Arrigunaga, Sofía De; Cuadra, M.; Villa, Antonio

doi:10.1016/j.ekir.2020.04.028

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…In respect to our secondary outcomes, Beberashvili et al [18,19] studied geriatric patients to find an association between UA and nutritional status. In contrast, we studied a relatively young population (median age was 40 (29-52) years) and found similar results; in our country, a dialysis registry is lacking but the mean age of people with CKD is 44.8 ± 17.2 years old [45,46]. In our population, the main etiology of CKD was unknown, contrary to that described in the studies by Abbas et al [47] and Hsu et al [48], in which the main causes were diabetic nephropathy and arterial hypertension.…”

Section: Discussionsupporting

confidence: 60%

Association between Serum Uric Acid Levels, Nutritional and Antioxidant Status in Patients on Hemodialysis

et al. 2020

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Purpose: To determine the relationship between uric acid (UA) and nutritional and antioxidant status in hemodialysis (HD) patients, given that hyperuricemia could be an indicator of good nutritional status possibly because of the antioxidant properties of UA. Methods: Cross-sectional study with 93 patients on HD. Hyperuricemia was considered as UA ≥6.0 mg/dL in females and ≥7.0 mg/dL in males. Nutritional variables were registered. Blood samples were taken before the dialysis session to determine oxidative damage as plasma malondialdehyde (MDA) content, and antioxidant capacity measuring 2,2-diphenyl-piclrylhidrazil radical (DPPH●) scavenging activity and oxygen radical absorbance capacity (ORAC) value. Results: Patients with hyperuricemia had higher creatinine (11.9 vs. 10.5 mg/dL; p = 0.004), potassium (5.5 vs. 5.0 mg/dL; p = 0.014) levels; phase angle (5.8 vs. 4.9; p = 0.005), protein consumption (normalized protein nitrogen appearance, nPNA, 1.03 vs. 0.83; p = 0.013) than normouricemic patients. DPPH● scavenging activity was higher in hyperuricemic subjects (1.139 vs. 1.049 mM Trolox equivalents; p = 0.007); likewise, hyperuricemic subjects had less oxidant damage measured by MDA (10.6 vs. 12.7 nmol/mL; p = 0.020). Subjects with normouricemia were at higher risk of having a reactance to height (Xc/H) ratio less than 35 (OR 2.79; 95% CI, 1.1–7.017, p = 0.028); nPNA < 1.0 (OR 3.78; 95% CI, 1.4–10.2, p = 0.007), diagnosis of cachexia (OR 2.95; 95% CI, 1156–7.518, p = 0.021), potassium levels <5 (OR 2.97; 95% CI, 1.136–7.772, p = 0.023) and PA < 5.5° (OR 3.38; 95% CI, 1.309–8.749, p = 0.012.) Conclusions: Patients with hyperuricemia had higher antioxidant capacity and better nutritional status. Purines and protein restrictions in HD patients with hyperuricemia need to be reviewed individually for each patient. More studies are needed to stablish a cut point of UA levels in renal population.

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Section: Discussionsupporting

confidence: 60%

Association between Serum Uric Acid Levels, Nutritional and Antioxidant Status in Patients on Hemodialysis

et al. 2020

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“…Assessing workforce adequacy and identifying the optimal capacity are crucial for efficient and equitable allocation of the nephrology workforce. However, there is no standardized framework to assess workforce adequacy, and limited literature has focused on nephrology workforce size recommendations due to data constraints [ 6 , 34 ]. Specifically, for accurate evaluation of the optimal capacity of a nephrology workforce for a given region, an understanding of the heterogeneity in healthcare needs and the establishment of minimum baselines for nephrologists to guide workforce development are needed.…”

Section: Discussionmentioning

confidence: 99%

Nephrology workforce in China: describing current status and evaluating the optimal capacity based on real-world data

Bao

et al. 2023

Hum Resour Health

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Objective This study aims to characterize the current status of the nephrology workforce in China and evaluate its optimal capacity based on real-world patient mobility data. Methods Data on nephrologists in China were collected from two prominent online healthcare platforms using web crawlers and natural language processing techniques. Hospitalization records of patients with chronic kidney disease (CKD) from January 2014 to December 2018 were extracted from a national administrative database in China. City-level paths of patient mobility were identified. Effects of nephrology workforce on patient mobility were analyzed using multivariate Poisson regression models. Results Altogether 9.13 nephrologists per million population (pmp) were in practice, with substantial city-level variations ranging from 0.16 to 88.79. The ratio of nephrologists to the estimated CKD population was 84.57 pmp. Among 6 415 559 hospitalizations of patients with CKD, 21.3% were cross-city hospitalizations and 7441 city-level paths of patient mobility with more than five hospitalizations were identified. After making adjustment for healthcare capacity, healthcare insurance, economic status, and travel characteristics, the Poisson regression models revealed that the number of nephrologists in both the source city (incidence rate ratio [IRR] 0.99, per 1 pmp increase) and destination city (IRR 1.07, per 1 pmp increase) were independently associated with patient mobility. An IRR plateau was observed when the number of nephrologists exceeded 12 pmp in the source city, while a rapidly increasing IRR was observed beyond 20 pmp in the destination city. Conclusions The nephrology workforce in China exhibits significant geographic variations. Based on local healthcare needs, an optimal range of 12–20 nephrologists pmp is suggested.

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“…In South Asia, there are only 1.2 nephrologists per million population (pmp), in comparison to 19.5 in North and East Asia [106]. In the Latin American region, there is again a striking disparity between countries with 45.2 nephrologists pmp in Cuba, and as low as 1–5 in Nicaragua, and 6–10 in El Salvador [107]. Access to tertiary care centres and dialysis is limited, and the cost of treatment poses a disproportionate burden on the already vulnerable population in these countries.…”

Section: Methodsmentioning

confidence: 99%

Chronic kidney disease of unknown aetiology: A comprehensive review of a global public health problem

Rao,

Bangera,

Nagaraju

et al. 2023

Tropical Med Int Health

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The term chronic kidney disease of unknown aetiology (CKDu) refers to chronic kidney disease (CKD) in the absence of diabetes, long-standing hypertension, glomerulonephritis, obstructive uropathy or other apparent causes. An increasing number of CKDu cases have been reported from Latin America, Sri Lanka, India and others over the last two decades. These regional nephropathies share the following common attributes: (a) they affect low-to-middle income countries with tropical climates, (b) involve predominantly rural agricultural communities, (c) male predilection, (d) absence of significant proteinuria and hypertension, and (e) chronic tubulointerstitial nephritis on kidney biopsy. The current body of literature suggests that CKDu may be caused by heat stress, agrochemicals, contaminated drinking water or heavy metals; however, considerable regional disparities in CKDu research make it difficult to establish a common causal link. In the absence of a definite aetiology, specific preventive and therapeutic interventions are lacking. Improvement of working conditions of farmers and labourers, provision of safe drinking water and changes in agricultural practices are some of the measures that have been implemented; however, there is lack of data to assess their impact on the incidence and progression of CKDu. There is a need for a concerted global effort to address the current knowledge gaps, and to develop effective and sustainable strategies to tackle this devastating disease.K E Y W O R D S agrochemicals, chronic kidney disease of uncertain aetiology, chronic renal insufficiency, endemic nephropathy, epidemiology, groundwater, interstitial nephritis, public health measures, risk factors Indu Ramachandra Rao and Ashika Bangera contributed equally to this work.

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Mismatch Between Kidney Disease Burden and Nephrology Workforce in Mexico

Cited by 3 publications

References 6 publications

Association between Serum Uric Acid Levels, Nutritional and Antioxidant Status in Patients on Hemodialysis

Association between Serum Uric Acid Levels, Nutritional and Antioxidant Status in Patients on Hemodialysis

Nephrology workforce in China: describing current status and evaluating the optimal capacity based on real-world data

Chronic kidney disease of unknown aetiology: A comprehensive review of a global public health problem

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