Association of Variants of the NFE2L2 Gene with Metabolic and Kidney Function Parameters in Patients with Diabetes and/or Hypertension.

Background: Type 2 diabetes mellitus (T2DM) and high blood pressure (HBP) are the main risk factors for chronic kidney disease (CKD). Relationships between variants within the NFE2L2 gene and the presence of environmental risk factors for CKD, such as HBP and hyperglycemia have been suggested; however, their interactions remains unclear. Aim: To analyze the association of NFE2L2 variants with metabolic and kidney parameters. Materials and Methods: Six-hundred and fifty-one patients grouped according to the diagnosis of T2DM (n =166), T2DM+HBP (n =348) and HBP (n =137) were included. Metabolic characteristics were evaluated to identify risk factors and presence of CKD. Genotyping was performed by polymerase chain reaction (PCR) using two pairs primers for rs35652124 and rs6721961 and by real-time PCR for rs2364723. Logistic regression analyses, adjusted for confounding factors and correction for multiple tests were performed. Results: Significant associations between decreased risk for presenting with CKD and the rs35652124 (A allele) and the rs2364723 (G allele) variants were detected. Other variables consistently associated with these alleles were HBP, BMI, waist circumference, uric acid and triglycerides. Haplotypes AAC and GCG (loci order: rs35652124-rs6721961-rs2364723) showed similar trends. After adjustment for age and sex and correction for multiple tests, only rs35652124 (Odds Ratio [OR] = 0.5; Confidence Interval at 95% (CI95%), 0.3-0.9; p = 0.04) and rs2364723 (OR = 0.3; CI95%, 0.1-0.8; p = 0.009) variants remained associated with deceased risk for CKD in T2DM patients. Conclusion: This study showed for the first time that NFE2L2 variants are associated with decreased risk for CKD in the presence of environmental/metabolic risk factors related to kidney damage, including HBP, hyperuricemia and albuminuria in Mexican patients with diabetes.

Prevalence of Pica in Patients on Dialysis and its Association With Nutritional Status.

OBJECTIVE: Pica could be strongly implicated in nutritional status of patients on dialysis; however, very scarce data are currently available. The objective of this study was to evaluate the prevalence of pica and its association with nutritional status in dialysis patients. DESIGN AND METHODS: This is a cross-sectional study in a tertiary care teaching hospital. Four-hundred patients on dialysis, without previous pica diagnosis or transplant, pregnancy, mental illness, or infection, were included in the study. Pica, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was classified as no pica, ice pica, or hard pica. Dialysis Malnutrition Score, 24-hour dietary recall, and biochemical measurements were obtained from patients. As part of statistical analysis, point prevalence and 95% confidence interval of pica were calculated. Comparisons between groups were performed by means of analysis of variance, Kruskal-Wallis test, χ2, or Fisher exact tests, as appropriate. A multivariate analysis was performed by multinomial logistic regression. RESULTS: Prevalence of pica was 42% (ice pica, 46%; soil, 29%; two substances, 14%; red brick, 5%; paper, 3%; soap, 2%; and cattle pasture, 1%). Comparing patients with pica (hard pica and ice pica) versus no pica, subjects with pica were of younger age (25 ± 7, 27 ± 9, 30 ± 11 years, respectively), were more frequently educated <9 years (57%, 46%, 30%, respectively), and had longer dialysis duration (36 ± 19, 32 ± 18, 27 ± 16 months, respectively). Patients with pica achieved the recommended calorie and macronutrients intake target less frequently than those without pica (40-64% vs. 66-77%, P <.05). Malnutrition was present in 74% of the whole sample: (1) 67% in no pica group, (2) 80% in ice pica group, and (3) 89% in hard pica group (P = .001). In the multivariate analysis (R2, 0.27; P < .0001), malnutrition, C-reactive protein, and lower educational level significantly predicted both ice and hard pica. CONCLUSIONS: A worse nutritional status was observed in patients with pica, who additionally were younger, had lower educational level, longer dialysis duration, and worse macronutrient intake routine than patients without pica. Malnutrition, C-reactive protein, and lower educational level significantly predicted both ice and hard pica.

Prevalence and risk factors of chronic kidney disease in the comprehensive care program DiabetIMSS / Prevalencia de enfermedad renal crónica y factores de riesgo en el programa de atención DiabetIMSS

BACKGROUND: The aim of this paper is to determine prevalence and risk factors of chronic kidney disease (CKD) in the comprehensive care program DiabetIMSS. METHODS: Cross-sectional study in 488 patients with type 2 diabetes mellitus (DM2) included in the program DiabetIMSS. Sociodemographic, clinical, biochemical, and kidney function variables were collected. RESULTS: Prevalence of CKD was 32% [early nephropathy (EN) 19% and overt nephropathy (ON) 13%]. Patients with more severe nephropathy significantly (p < 0.05) had: older age [normal kidney function (NKF) 54±11, EN 54±10, ON 63±9, years)], cardiovascular disease (NKF 1%, EN 5%, ON 11%), hypertension (NKF 65%, EN 63%, ON 85%), longer duration of DM2 (NKF 5%, EN 5%, ON 9%,) and of hypertension (NKF 5%, EN 6%, ON 9%), glycemic lack of control (NKF 46%, EN 62%, ON 60%), hyperuricemia (NKF 7%, EN 13%, ON 23%), anemia (NKF 1%, EN 4%, ON 10%) and metabolic syndrome (NKF 79%, EN 82%, ON 93%). Uncontrolled hypertension and DM2, cardiovascular disease and hyperuricemia significantly predicted the presence of nephropathy CONCLUSIONS: A third of patients attending to DiabetIMSS had CKD and has not been previously diagnosed. Multiple risk factors are present in this high-risk population; their identification and control are extraordinarily important. Moreover, educative interventions for primary health-care professionals to improve health of this kind of patients are needed.

INTRODUCCIÓN: el objetivo de este trabajo es determinar la prevalencia de enfermedad renal crónica (ERC) e identificar factores de riesgo para nefropatía en el programa DiabetIMSS. MÉTODOS: estudio transversal analítico en 488 pacientes con diabetes mellitus tipo 2 (DM2) atendidos en el programa de atención integral DiabetIMSS. Se recolectaron variables sociodemográficas, clínicas, bioquímicas y de función renal. RESULTADOS: la prevalencia de ERC fue 32% [nefropatía temprana (NT) 19% y nefropatía establecida (NE) 13%]. A nefropatía más avanzada, los pacientes tenían significativamente (p < 0.05): mayor edad [función renal normal (FRN) 54 ± 11, NT 54 ± 10, NE 63 ± 9 años)], enfermedad cardiovascular (FRN 1%, NT 5%, NE 11%), hipertensión (FRN 65%, NT 63%, NE 85%), mayor evolución de DM2 (FRN 5%, NT 5%, NE 9%,) y de hipertensión (FRN 5%, NT 6%, NE 9%), descontrol glucémico (FRN 46%, NT 62%, NE 60%), hiperuricemia (FRN 7%, NT 13%, NE 23%), anemia (FRN 1%, NT 4%, NE 10%) y síndrome metabólico (FRN 79%, NT 82%, NE 93%). La hipertensión y DM2 descontroladas, la enfermedad cardiovascular y la hiperuricemia predijeron significativamente la presencia de nefropatía. CONCLUSIONES: un tercio de los pacientes atendidos en DiabetIMSS tenían ERC y no habían sido identificados. Múltiples factores de riesgo están presentes en esta población de alto riesgo; su identificación y control son de extraordinaria importancia. Son necesarias, además, intervenciones educativas para el personal del primer nivel de atención médica para mejorar la salud de este tipo de pacientes.