Patient experience in automated peritoneal dialysis with telemedicine monitoring during the COVID-19 pandemic in Mexico: Qualitative study.

AIM: The aim of the study was to understand the experiences of patients on automated peritoneal dialysis (APD) during the period of confinement due to the COVID-19 pandemic. DESIGN: Qualitative exploratory study, phenomenological through semi-structured telephone interview. METHOD: A priori sampling was carried out with patients on APD with remote monitoring and telephone follow-up, in 13 hospitals in Mexico. RESULTS: Twenty-nine informants, mean age 45.41 ± 16.93; 15 women and 14 men. The analysis revealed four categories of analysis: home isolation, clinical follow-up, socioeconomic challenges and infodemic. The experiences of these patients led them to somatize emotions, presenting symptoms such as anxiety, sadness, loneliness, sleep, eating and digestive disorders, situation that sets the tone for future research on telemedicine care models, coping styles, emotional support strategies and socioeconomic impact on patients with chronic home treatments during the pandemic.

Relationship Between the Gut Microbiota and Alzheimer's Disease: A Systematic Review.

BACKGROUND: In recent years, scientific research on the gut microbiota and their relationship with some diseases, including neurological ones, has notably increased. As a result of these investigations, the so-called gut-brain axis arises. Despite its influence on the evolution and development of cognitive impairment, the gut-brain axis is little defined and demonstrated. OBJECTIVE: To provide the best scientific evidence available on the relationship between the gut microbiota and Alzheimer's disease. METHOD: Systematic and narrative review of the information generated in the last 5 years in national and international databases, in English and Spanish. RESULTS: Eight observational studies were selected, carried out in humans and, therefore, suitable for inclusion in this review. CONCLUSION: The results of these studies support the hypothesis that there is a relationship between the gut microbiota and cognitive disorders through the gut-brain axis. However, today, there is a substantial lack of human studies, especially clinical trials, which makes it difficult to formulate clinical recommendations on this topic.

Compliance With Biochemical Objectives in Patients on Renal Replacement Therapy Before Kidney Transplantation in Mexico.

OBJECTIVES: The biochemical conditions in which patients arrive before renal transplantation (RT) are rarely evaluated; examples of them are found in the Dialysis Outcomes and Practice Patterns Study (DOPPS). The objective of our study was to ascertain the fulfillment of biochemical goals for patients on renal replacement therapy before RT. MATERIAL AND METHODS: Observational, retrospective study of patients who were on a RT protocol between 2012 and 2017 in 2 RT centers in Mexico. The records of 1188 patients with a history of RT and their lab results before transplantation were analyzed. Anthropometric values including hemoglobin, iron levels, calcium, phosphorus, parathyroid hormone, urea, creatinine, uric acid, and left ventricular ejection fraction were studied. All values were categorized as low, optimal, or high levels. RESULTS: The fulfillment of pretransplant biochemical objectives for elimination of azotemia (urea and creatinine) was achieved in 60% of the patients. Optimal values for calcium were found in 715 (64%) patients and optimal values for albumin were found in 690 (61.8%) patients. In the case of phosphorus, hemoglobin, uric acid, and parathyroid hormone, the optimal values were below 50%. CONCLUSIONS: It is essential to improve compliance with biochemical and clinical objectives for patients on renal replacement therapy (dialysis, hemodialysis) before RT. Only half of the variables were within the optimal range before surgical intervention took place.

Desenlaces obstétricos en mujeres embarazadas con enfermedad renal crónica y factores asociados / Obstetric outcomes in pregnant women with chronic kidney disease and associated factors

Resumen OBJETIVO: Identificar los factores asociados con los desenlaces fetales, maternos y renales en embarazadas con enfermedad renal crónica. MATERIALES Y MÉTODOS: Estudio observacional y prospectivo llevado a cabo en el Hospital de Ginecoobstetricia 4 del IMSS de 2016 a 2018 en pacientes embarazadas con enfermedad renal crónica, con parámetros bioquímicos (creatinina, urea) y desenlaces obstétricos; se excluyeron los casos incompletos. Por el tipo de población se usó estadística no paramétrica con mediana (tendencia central) y rango intercuartilar (dispersión). Para la comparación de medias se utilizó t de Student y Kruskal Wallis; los valores de p < 0.05 se consideraron estadísticamente significativos. Para establecer el riesgo se efectuó análisis bivariado. Se utilizó el programa estadístico SPSS 25. RESULTADOS: Se estudiaron 48 pacientes; de éstas 16 cursaron con preeclampsia. La cesárea fue la vía de finalización del embarazo más común en 32 de los 48 casos. En relación con los recién nacidos: 41 supervivieron, 22 de 41 fueron prematuros, 19 de 41 nacieron a término, 29 de 41 recién nacidos no experimentaron complicaciones. Se registró elevación de la creatinina de 0.28 mg/dL y descenso de la tasa de filtración glomerular de 9.67 mL/min. CONCLUSIONES: Se identificaron 4 factores. La maduración pulmonar y las enfermedades crónico-degenerativas representaron riesgo de prematurez. Los factores contibuyentes para el embarazo de término fueron: no cursar con preeclampsia y no tener eventos de hospitalización o infección. La enfermedad renal crónica influye de forma directa en desenlaces adversos para la madre y el feto; el embarazo influye en mayor deterioro renal.

Abstract OBJECTIVE: To know the factors associated with fetal, maternal and renal outcomes in known pregnant women with chronic kidney disease. MATERIALS AND METHODS: An observational, prospective study at the IMSS Hospital of Gynecobstetrics No. 4 from 2016 to 2018 of pregnant women with chronic kidney disease with biochemical parameters (creatinine, urea) and obstetric outcomes; Incomplete cases were excluded. For the type of population, non-parametric statistics were used with median (central tendency), interquartile range (dispersion), for the comparison of means, a student's "t" was used, with a significance of p < 0.05 and Kruskal Wallis. To establish risk, a bivariate analysis is performed. SPSS 25 statistical program. RESULTS: The obstetric results obtained were: 16/48 of the women with preeclampsia, caesarean section was the most common resolution in 32/48 cases. In relation to newborns, 41 survived, 22/41 with prematurity, 19/41 were full term, 29/41 newborns without complications. There was an elevation of 0.28 mg/dL creatinine and a decrease in the glomerular filtration rate of 9.67 mL/min. CONCLUSIONS: 4 factors were identified. Pulmonary maturation and chronic-degenerative diseases represented a risk for prematurity; Two influential factors for the termination of pregnancy were: not taking preeclampsia and having no hospitalization and/or infection events. chronic kidney disease directly influences both maternal and fetal adverse outcomes, and pregnancy also has an influence on greater renal impairment.