Análisis geográfico de nefropatía diabética e insuficiencia renal en el primer nivel de atención, IMSS 2019 / Geographic analysis of diabetic nephropathy and renal insufficiency in the primary care, IMSS 2019

Introducción: en un contexto donde la prevalencia de diabetes mellitus e hipertensión arterial ha aumentado significativamente en años recientes, las enfermedades renales adquieren importancia por la potencial demanda de atención especializada y de recursos en salud que requieren. Objetivo: analizar la distribución geográfica de la nefropatía diabética (ND) y la insuficiencia renal (IR) con base en las consultas otorgadas en unidades de primer nivel del Instituto Mexicano del Seguro Social (IMSS) durante 2019, para identificar las unidades médicas con mayor carga de atención. Material y métodos: estudio ecológico-exploratorio en el que se estimaron indicadores por cada mil derechohabientes en relación a las consultas otorgadas por ND e IR según la ocasión de servicio, la unidad médica familiar (UMF) de primer nivel y la representación. Se utilizó estadística espacial para analizar dichos indicadores. Resultados: el 45% de las consultas otorgadas fue por ND y el 52.4% por IR. La mayor carga por ND se registró en la UMF No. 50 de Cd. Juárez (Chihuahua) y en la No. 49 Gabino Barreda (Veracruz Sur), con 1.7 consultas de primera vez y 148.3 subsecuentes por mil derechohabientes, respectivamente. Mientras que en la UMF No. 40 Manlio Fabio Altamirano y No. 25 Cotaxtla, en Veracruz Norte, la mayor carga fue por IR, con 4.9 consultas de primera vez y 134.2 subsecuentes por mil derechohabientes, respectivamente. Conclusiones: los resultados podrían contribuir al fortalecimiento de las unidades médicas que así lo requieran y en la distribución eficiente de los recursos disponibles para atender la demanda de servicios de salud de ND e IR en el IMSS

Background: In a context where the prevalence of Diabetes Mellitus and Hypertension has increased significantly in recent years, kidney diseases become important for the potential demand for specialized health care and resources required. Objective: To analyze the geographical distribution of Diabetic Nephropathy (DN) and Renal Insufficiency (RI) based on the medical consultations given in first-level units of IMSS during 2019, to identify the medical units with the highest burden of care. Material and methods: Ecological-exploratory study in which indicators were estimated for every thousand persons in relation to medical consultations given by ND and RI according to service time, first-level medical unit (UMF) and representation to analyze the magnitude and geographic distribution at the national level. Results: 45% of medical consultations were by ND and 52.4% by RI. The highest burden per DN was registered in UMF No. 50 Cd. Juarez (Chihuahua) and No. 49 Gabino Barreda (Veracruz Sur), with 1.7 first-time medical consultations and 148.3 subsequent medical consultations per 1,000 persons, respectively. While in UMF No. 40 Manlio Fabio Altamirano and No. 25 Cotaxtla, in Veracruz Norte, the highest burden was for RI, with 4.9 first-time medical consultations and 134.2 subsequent medical consultations per 1000 persons, respectively. Conclusions: The results could contribute to strengthening of medical units where it is necessary and the efficient allocation of resources available to meet the demand for health services of ND and RI in IMSS.

Diabetes mellitus tipo 2 de inicio en paciente joven: implicancias en la población chilena / Young-onset type 2 diabetes mellitus: implications in the chilean population

La diabetes mellitus tipo 2 (DM2), habitualmente asociada a adultos en edad media y adulto mayor, ha presentado un aumento en su incidencia en pacientes menores de 40 años, lo que se conoce como DM2 de inicio en paciente joven. Varios estudios sugieren que este tipo de diabetes presenta no sólo un deterioro más rápido de las células beta-pancreáticas en comparación con la DM2 de inicio más tardío, sino que también un mayor riesgo de complicaciones que pacientes con DM Tipo1, lo que sugiere una variable independiente de los años de exposición a la enfermedad y por tanto, un fenotipo más agresivo. Por otra parte, hay evidencia que afirma que existen grupos poblacionales en mayor riesgo de desarrollar esta patología, particularmente ciertas etnias. En el presente trabajo se exponen los principales hallazgos de una reciente revisión del tema y se los compara con los datos nacionales disponibles. Dada la alta prevalencia de DM2 en la población chilena y la escasa cantidad de estudios epidemiológicos de calidad que permitan conocer nuestro panorama con mayor precisión, es que se destaca la importancia de estos últimos para poder tomar medidas de salud pública adecuadas.

Type 2 diabetes mellitus type 2 (T2DM), commonly associated with the middle to old aged adults group, has shown an increase in incidence in patients younger than 40 years old, which is known as young-onset type 2 diabetes mellitus. Several studies suggest that this type of diabetes not only exhibits a faster deterioration of the beta-pancreatic cells in comparison with type 1 diabetes mellitus patients, but also a greater risk of complications not regarding the time of exposure to the disease, therefore a more aggressive phenotype. Otherwise, there is evidence which asserts that some population groups are in mayor risk of developing this disease, especially certain ethnics. In this work it is exposed the main findings of a recent review of the subject and it is contrasted with available national data. Given the high prevalence of T2DM in the chilean population and the little amount of epidemiological high-quality studies that allows us to know our outlook with greater precision, it is highlighted the need for them in order to make adequate public health decisions.

Brazilian chronic dialysis survey 2017 / Inquérito Brasileiro de Diálise Crônica 2017

Abstract Introduction: Having national data on chronic dialysis is essential in treatment planning. Objective: To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017. Methods: Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units. Results: Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%). Conclusion: The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.

Resumo Introdução: Dados nacionais sobre diálise crônica são fundamentais no planejamento do tratamento. Objetivo: Apresentar dados do inquérito da Sociedade Brasileira de Nefrologia sobre os pacientes com doença renal crônica em tratamento dialítico em julho de 2017. Métodos: Levantamento de dados de unidades de diálise do país. A coleta de dados foi feita utilizando questionário preenchido on-line pelas unidades de diálise. Resultados: 291 (38,4%) centros responderam ao questionário. Em julho de 2017, o número total estimado de pacientes em diálise foi de 126.583. As estimativas nacionais das taxas de prevalência e de incidência de pacientes em tratamento dialítico por milhão da população (pmp) foram 610 (variação: 473 na região Norte e 710 no Centro-Oeste) e 194, respectivamente. A taxa de incidência de novos pacientes em diálise com diagnóstico de nefropatia diabética foi de 77 pmp. A taxa anual de mortalidade bruta foi de 19,9%. Dos pacientes prevalentes, 93,1% estavam em hemodiálise e 6,9% em diálise peritoneal, com 31.226 (24%) em fila de espera para transplante. Cateter venoso era usado como acesso em 22,6% dos pacientes em hemodiálise. A taxa de prevalência de sorologia positiva para hepatite C continua a mostrar tendência para redução (3,3%). Conclusão: O número absoluto de pacientes e as taxas de incidência e prevalência em diálise continuam a aumentar; a taxa de mortalidade tendeu a elevar-se. Há discrepâncias regionais e estaduais evidentes nessas taxas.

Marcadores de funcionamiento renal en pacientes diabéticos tipo 2. Policlínico "Milanés". Municipio Matanzas / Renal function markers type 2 diabet ic patients. Polyclinic "José J. Milanés". Municipality of Matanzas

Introducción: la nefropatía diabética, es un trastorno metabólico en el que la hiperglucemia induce disfunción en diversos tipos de células del riñón, que deriva en insuficiencia renal progresiva. Objetivo: describir el comportamiento de variables de funcionamiento renal en pacientes diabéticos tipo 2 en tres consultorio médicos de la familia del Policlínico Comunitario "José J. Milanés", Municipio de Matanzas, entre mayo del 2013 y mayo del 2014. Materiales y métodos: se realizó un estudio descriptivo transversal en un universo conformado por 129 pacientes con diabetes mellitus tipo 2. La muestra fueron 85 pacientes seleccionados por muestreo aleatorio simple. Variables objeto de estudio: tiempo de evolución de la enfermedad, glucemia, creatinina, microalbuminuria y filtrado glomerular. Resultados: 39 pacientes se encontraban con un período de diagnóstico entre 6 y 10 años, correspondiendo a esta etapa el mayor por ciento (45.9 %). 74 pacientes (87 %) presentó hiperglicemia y el 76,9 % (30 pacientes) presentaron cifras elevadas de creatinina. Para el filtrado glomerular predominaron los pacientes que se encuentran en el estadio II con un 43.6 % y tiempo de evolución entre los 6 y los 10 años, en la microalbuminuria, se destaca que el 42,1 % de los pacientes con menos de 5 años de evolución de la enfermedad presentaban cifras de microalbuminuria por encima de 30 mg/l). Conclusiones: predominaron los pacientes con tiempo de evolución entre los 6 a 10 años, grupo con los mayores porcentaje de pacientes con glucemia, creatinina, filtrado glomerular y microalbuminuria elevados. EL total de pacientes con más de 16 años de evolución de la enfermedad tenían cifras elevadas de filtrado glomerular y microalbuminuria (AU).

Introduction: diabetic nephropathy is a metabolic disturbance in which hyperglycemia induces dysfunction in different kinds of kidneys cells. It derives in progressive renal insufficiency. Objective: to describe the behaviour of renal function variables in type 2 diabetic patients in three family physician consultation (CMF, abbreviation in Spanish) of the Community Polyclinic "José J. Milanés", municipality of Matanzas in the period May 2013-May 2014. Materials and methods: descriptive, transversal study in a universe of 129 patients with type 2 diabetes mellitus. Simply randomized sample composed by 85 patients. The studied variables were time of disease evolution, glycemia, creatinine, microalbuminuria and glomerular filtration. Results: 39 patients were found in a diagnostic period between 6 and 10 years, the biggest percent (45.9 %) corresponding to this stage. 74 patients (87 %) presented hyperglycemia and 30 patients (76.9 %) showed high quantitites of creatinine. Patients that were in the II stage for 43.6 % and evolution time between 6 and 10 years predominated in the glomerular filtration; 42.1 % of the patients with less than 5 years of the disease evolution showed amounts of microalbuminuria of over 30 mg/l. Conclusions: it was found the predomination of patients with 6-10 years of evolution time, the group with the highest percent of patients with increased glycemia, creatinine, glomerular filtration and microalbuminuria. The total of the patients with more than 16 years of disease evolution had high amounts of glomerular filtrate and microalbuminuria (AU).

Fisiopatología de la nefropatía diabética: una revisión de la literatura / Pathophysiology of diabetic nephropathy: a literature review

La enfermedad renal crónica es una complicación frecuente en la diabetes mellitus. Su importancia radica en la alta prevalencia y la proyección a futuro que ésta tiene. Se asocia a altos gastos en salud y además a deterioro cardiovascular global. La fisiopatología del desarrollo de esta enfermedad está siendo estudiada y se sabe que en ella participan una serie de vías moleculares complejas que determinan una enfermedad microvascular. En esta revisión se intenta abordar las vías conocidas en el desarrollo de nefropatía diabética, con el fin de comprender mejor posibles blancos terapéuticos que se podrían desarrollar.

Chronic kidney disease is a common complication of diabetes. Its importance lies in its high prevalence and future projection. It is associated with high health costs and global cardiovascular deterioration as well. The development of this disease pathophysiology is being studied and it is known that a series of complex molecular pathways determining a microvascular disease are involved. This review addresses the known pathways in the development of diabetic nephropathy aiming to improve the understanding of potential therapeutic targets that could be developed in the future.

The Association Between Smoking Tobacco After a Diagnosis of Diabetes and the Prevalence of Diabetic Nephropathy in the Korean Male Population / 예방의학회지

OBJECTIVES: Smoking is known to be associated with nephropathy in patients with diabetes. The distinct effects of smoking before and after diabetes has been diagnosed, however, are not well characterized. We evaluated the association of cigarette smoking before and after a diagnosis of diabetes with the presence of diabetic nephropathy. METHODS: We analyzed data from the 2011-2013 editions of the Korea National Health and Nutrition Examination Survey. A total of 629 male patients diagnosed with diabetes were classified as non-smokers (90 patients), former smokers (225 patients), or continuing smokers (314 patients). A "former smoker" was a patient who smoked only before receiving his diagnosis of diabetes. A "continuing smoker" was a patient who smoked at any time after his diabetes had been diagnosed. Diabetic nephropathy was defined as the presence of albuminuria (spot urine albumin/creatinine ratio ≥30 mg/g) or low estimated glomerular filtration rate (<60 mL/min/1.73 m2). Multiple logistic regression models were used to assess the independent association after adjusting for age, duration of diabetes, hemoglobin A1c, body mass index, systolic blood pressure, medication for hypertension, and medication for dyslipidemia. Female patients were excluded from the study due to the small proportion of females in the survey who smoked. RESULTS: Compared to non-smokers, continuing smokers had significantly higher odds ratio ([OR], 2.17; 95% confidence interval [CI], 1.23 to 3.83) of suffering from diabetic nephropathy. The corresponding OR (95% CI) for former smokers was 1.26 (0.70 to 2.29). CONCLUSIONS: Smoking after diagnosis of diabetes is significantly associated with the presence of diabetic nephropathy in the Korean male population.

Attributable causes of chronic kidney disease in adults: a five-year retrospective study in a tertiary-care hospital in the northeast of the Malaysian Peninsula / Causas imputáveis da doença renal crônica em adultos: um estudo retrospectivo de cinco anos de um Hospital de Assistência Terciária no nordeste do Península da Malásia

ABSTRACT CONTEXT AND OBJECTIVE: Chronic kidney disease (CKD) is an escalating medical and socioeconomic problem worldwide. Information concerning the causes of CKD, which is a prerequisite for reducing the disease burden, is sparse in Malaysia. Therefore, this study aimed to evaluate the attributable causes of CKD in an adult population at a tertiary referral hospital. DESIGN AND SETTING: Retrospective study at Hospital Universiti Sains Malaysia (HUSM). METHODS: This was an analysis based on medical records of adult patients at HUSM. Data regarding demographics, laboratory investigations, attributable causes and CKD stage were gathered. RESULTS: A total of 851 eligible cases were included. The patients' mean age was 61.18 ± 13.37 years. CKD stage V was found in 333 cases (39.1%) whereas stages IV, IIIb, IIIa, and II were seen in 240 (28.2%), 186 (21.9%), 74 (8.7%) and 18 (2.1%), respectively. The percentage of CKD stage V patients receiving renal replacement therapy was 15.6%. The foremost attributable causes of CKD were diabetic nephropathy (DN) (44.9%), hypertension (HPT) (24.2%) and obstructive uropathy (9.2%). The difference in the prevalence of CKD due to DN, HPT and glomerulonephritis between patients ≤ 50 and > 50 years old was statistically significant. CONCLUSION: Our results suggest that DN and HPT are the major attributable causes of CKD among patients at a Malaysian tertiary-care hospital. Furthermore, the results draw attention to the possibility that greater emphasis on primary prevention of diabetes and hypertension will have a great impact on reduction of hospital admissions due to CKD in Malaysia.

RESUMO CONTEXTO E OBJETIVO: Doença renal crônica (DRC) é um problema médico e socioeconômico crescente. As informações relativas às causas da DRC são pré-requisito para reduzir a carga da doença, e são escassas na Malásia. Este estudo tem como objetivo avaliar as causas atribuíveis à DRC na população adulta de um hospital de referência terciária. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado no Hospital Universiti Sains Malaysia (HUSM). MÉTODOS: Análise de prontuários de pacientes adultos de HUSM. Foram obtidos dados demográficos, exames laboratoriais, causas atribuíveis e estágio da DRC. RESULTADOS: Um total de 851 casos elegíveis foi incluído. A idade média dos pacientes foi de 61,18 ± 13,37 anos. DRC fase V foi contabilizada em 333 casos (39,1%), enquanto casos de estágio IV, IIIb, IIIa e II foram 240 (28,2%), 186 (21,9%), 74 (8,7%) e 18 (2,1%), respectivamente. A porcentagem de pacientes com DRC estágio V recebendo a terapia de substituição renal foi 15,6%. As causas atribuíveis mais importantes da DRC foram nefropatia diabética (ND) (44,9%), hipertensão (24,2%) e uropatia obstrutiva (9,2%). A diferença na prevalência da DRC devido à ND, hipertensão e glomerulonefrite entre pacientes ≤ 50 anos e > 50 anos de idade foi estatisticamente significativa. CONCLUSÃO: Nossos resultados sugerem que a ND e a hipertensão são as principais causas atribuíveis da DRC em pacientes sob cuidados terciários na Malásia. Os resultados apontam para a possibilidade de maior ênfase na prevenção primária da diabetes e hipertensão como impactante na redução das internações hospitalares devidas a DRC na Malásia.

Vascular endothelial growth factor insertion/deletion gene polymorphism in West Indian patients of type 2 diabetes and diabetic nephropathy.

Diabetic nephropathy (DN) is a major cause of morbidity and mortality in diabetes. Vascular endothelial growth factor (VEGF) is a potent multi-functional cytokine which plays a key role in the pathogenesis of DN. In this study, we evaluated the possible association of the VEGF gene (I/D) polymorphisms with DN in type 2 diabetes patients in West Indian population. Genotyping (I/D) of the VEGF gene polymorphism was done by the polymerase chain reaction. A total of 103 patients with type 2 diabetes, 102 patients with DN, 108 patients with non-diabetic nephropathy and 143 healthy controls were genotyped. The frequency of VEGF genotype distribution and biochemical parameters like creatinine and HbA1c were compared in diabetic, diabetic nephropathy, non diabetic nephropathy and control groups. We found significant difference in creatinine level in DN and NDN groups on comparison with control group. Our study suggests that I/D polymorphism in the promoter region of the VEGF gene is not associated with DN in type 2 diabetes patients, but might have a role in development of non-diabetic nephropathy.

Análisis de los pacientes con diabetes controlados a nivel primaria en el Servicio de Salud Concepción / Analysis of diabetic patients controlled at primary level in Concepcion Health Service

To evaluate diabetic patients in control in Concepcion Health Service, evaluating coverage, metabolic control and complications. Material: A retrospective analysis of the statistical record of 2011 (REM) using the CIE-10 classification was done. Estimation is performed with the National Health Survey of 2010. Results: 26,638 patients are controlled, achieving a 67.9 percent coverage (point estimate based on the National Health Survey of 2010), being lower in the group between 15 and 44 years old (34 percent). 38.4 percent had good metabolic control (HbA1C less than 7) and 20.8 percent poor control (HbA1C greater than 9). According to age, the group over 65 had better control and the group between 15 and 44 years worse control. The complication described was diabetic foot (51.9 percent), retinopathy (5 percent) and nephropathy (4.6 percent). Discussion: The prevalence of diabetes is increasing every year in Chile. There is acceptable coverage and early diagnosis, but still are poorly controlled cases and require a multifactorial management that begins with a self-care of their diabetes...

Small ubiquitin-like modifier 4 M55V polymorphism is not associated with diabetic nephropathy in Iranian type 2 diabetes patients.

INTRODUCTION: We studied the impact of small ubiquitin-like modifier 4 (SUMO4) M55V polymorphism on susceptibility to diabetic nephropathy in Iranian type 2 diabetes patients. MATERIALS AND METHODS: The patient group consisted of 50 Iranian type 2 diabetes patients with nephropathy, and the control group consisted of 50 Iranian type 2 diabetes patients without nephropathy. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism method for the M55V. RESULTS: The frequency of SUMO4 AA, AG, and GG genotypes were 23%, 18%, and 9% in the patient group and 10%, 22%, and 18% in the control group. There was no significant difference in frequency of SUMO4 genotypes in patients compared to controls. CONCLUSION: These findings indicate that SUMO4 M55V polymorphism is not associated with diabetic nephropathy in Iranian type 2 diabetes patients.

Nephropathy following Type 2 diabetes mellitus in Tunisian population / Nefropatía tras la diabetes mellitus tipo 2 en la población Tunesina

OBJECTIVE: The purpose was to compare the characteristics of Tunisians with Type 2 diabetes mellitus (Type 2 DM) and nephropathy with those without nephropathy. This study assessed whether or not phenotypic characteristics can predict nephropathy development in Type 2 DM. The prevalence of nephropathy in Tunisian Type 2 DM patients, and their relationship with clinical and biochemical factors as well as chronic complications of the disease were determined. METHODS: This was a cross-sectional study of patients with diabetes diagnosed between January 2008 and December 2010. Altogether, 73 Type 2 DM and 42 healthy volunteers from the Basic Health Group of Sousse, were targeted for the study. Clinical, biochemical data, as well as complications of diabetes were collected. Kidney malfunction was defined by glomerular filtration rate (GFR). RESULTS: Diabetic patients were older. Diabetic women were more likely to have higher body mass index than men (p = 0.004). Obesity was more in women than men (60/23%). Complications including hypertension and dyslipidaemia were co-associated in women. Urinary creatinine clearance in Type 2 DM patients without nephropathy was significantly lower than in healthy participants (p < 0.0001). Microalbuminuria and urinary creatinine clearance were associated only in women with Type 2 DM with nephropathy (R² = 0.95); 1.5% of Type 2 DM patients without nephropathy had GFR < 60 mL/min/1.73m² and 76% had a GFR between 60 and 89 mL/min/1.73m². Glomerular filtration rate difference between Type 2 DM patients with/without nephropathy, as well as between Type 2 DM patients with nephropathy/Type 2 DM without nephropathy, and with retinopathy was not significant. CONCLUSIONS: By analysing factors associated with nephropathy in Type 2 DM Tunisian patients, this study demonstrated their susceptibility to nephropathy. In addition, retinopathy is potentially associated with incipient nephropathy in Type 2 DM Tunisian patients.

OBJETIVO: El propósito fue comparar las características de los tunesinos con diabetes mellitus tipo 2 (DMT2) y nefropatía, con aquéllos que no padecen nefropatía. Este estudio evaluó la posibilidad de saber si las características fenotípicas pueden predecir el desarrollo de una nefropatía en pacientes de DMT2. Se determinó la prevalencia de la nefropatía en los pacientes tunesinos con DMT2, y su relación con factores clínicos y bioquímicos, así como las complicaciones crónicas de la enfermedad. MÉTODOS: Se realizó un estudio transversal de pacientes con diabetes diagnosticada entre enero de 2008 y diciembre de 2010. En total, 73 voluntarios con DMT2 y 42 saludables del Grupo Básico de Salud de Sousse, fueron escogidos para el estudio. Se recogieron los datos clínicos y bioquímicos, así como las complicaciones por diabetes. El grado de mal funcionamiento renal fue determinado por la tasa de filtrado glomerular (GFR). RESULTADOS: Los pacientes diabéticos tenían más edad. Las mujeres diabéticas presentaban una mayor probabilidad de tener un índice de masa corporal más alto que los hombres (p = 0.004). Hubo mayor obesidad en las mujeres que en los hombres (60/23%). Las complicaciones - incluyendo hipertensión y dislipidemia - estuvieron co-asociadas en las mujeres. La depuración de la creatinina urinaria en los pacientes de DMT2 sin nefropatía fue significativamente más baja (p < 0.0001) que en los participantes saludables. La microalbuminuria y la depuración de la creatinina urinaria estuvieron asociadas en las mujeres con DMT2 con nefropatía (R² = 0.95); 1.5% de los pacientes con DMT2 sin nefropatía, tuvo una tasa GFR < 60 mL/min/1.73m² y 76% tuvo una GFR entre 60 y 89 mL/min/1.73m². La diferencia de la tasa de filtrado glomerular entre los pacientes de DMT2 con/sin nefropatía, así como entre los pacientes de DMT2 con nefropatía/DMT2 sin nefropatía, y con retinopatía, no fue significativa. CONCLUSIONES: Analizando factores asociados con la nefropatía en pacientes tunesinos con DMT2, este estudio demostró que estos últimos son susceptibles a la nefropatía. Además, la retinopatía se halla potencialmente asociada con la nefropatía incipiente en los pacientes tunesinos que padecen DMT2.

Risk factors associated with the development of overt nephropathy in type 2 diabetes patients: A 12 years observational study.

Background & objectives: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal disease in developing countries. Early detection and risk reduction measures can prevent DN. The aim of the study was to determine the risk factors for the development of proteinuria over a period of 12 years of follow up in normoalbuminuric type 2 diabetes patients attending a specialized centre. Methods: Of the 2630 type 2 diabetes subjects newly registered in 1996, 152 (M:F;92:60) normoalbuminuric subjects had baseline and subsequent measurements of anthropometric, haemodynamic and biochemical details spanning 12 years. The subjects were divided into 2 groups based on the renal status during follow up visits. Group 1 (non-progressors) had persistent normoalbuminuria and group 2 (progressors) had persistent proteinuria. Presence of other diabetic complications during follow up and details on antidiabetic and antihypertensive agents were noted. Results: During median follow up of 11 years in subjects with normal renal function at baseline, 44.1 per cent developed proteinuria at follow up. Glucose levels, HbA1c, systolic blood pressure (SBP), triglycerides, and urea levels were significantly higher at baseline among progressors than non-progressors. Progressors had a longer duration of diabetes and significant fall in estimated glomerular filtration rate (eGFR) levels at follow up. In Cox's regression analysis, baseline age, duration of diabetes, baseline HbA1c and mean values of HbA1c, triglycerides, SBP and presence of retinopathy showed significant association with the development of macroalbuminuria. Interpretation & conclusions: Type 2 diabetes patients with uncontrolled diabetes and increase in blood pressure are at high risk of developing nephropathy. Age, long duration of diabetes, elevated BP, poor glycaemic control and presence of retinopathy were significantly associated with the progression of diabetic nephropathy.

Prevalência de diabetes mellitus em pacientes renais crônicos sob hemodiálise em Porto Alegre, Brasil / Prevalence of diabetes mellitus in chronic renal failure patients under haemodialysis in Porto Alegre, Brazil

INTRODUÇÃO: A causa mais frequente de insuficiência renal crônica (IRC) nos pacientes iniciando tratamento dialítico nos países desenvolvidos é o diabetes mellitus (DM), com índices crescentes e que hoje se aproximam de 50%. No Brasil, os dados disponíveis indicam que essa prevalência é inferior, em torno de 27%, embora venha aumentando. OBJETIVOS: Estimar a prevalência de DM na população adulta de pacientes em tratamento hemodialítico por IRC em Porto Alegre, Brasil. MÉTODOS: Estudo transversal descritivo, quantitativo e analítico, com inquérito sobre a prevalência de DM entre os 1.288 pacientes em tratamento por hemodiálise (HD) crônica nas 15 clínicas do município nos meses de junho e julho de 2009. Resultados: 488 pacientes diabéticos foram identificados, uma prevalência de 37,9%, variando de 21 - 75% nas diferentes clínicas da cidade. CONCLUSÕES: A prevalência de DM entre pacientes em HD crônica em Porto Alegre é muito superior ao que tem sido atribuído como causa de IRC no país, o que indica a possibilidade de que essa etiologia de IRC possa estar sendo subestimada.

INTRODUCTION: The most common cause of chronic renal failure (CRF) among patients who are starting on dialysis in developed countries is diabetes mellitus (DM), with growing rates approaching 50%. In Brazil, the available data indicate a lower prevalence, around 27%, even though it is also increasing. OBJECTIVES: To estimate the prevalence of DM in the adult population of patients on hemodialysis for CRF in Porto Alegre, Brazil. METHODS: Cross-sectional, descriptive, quantitative and analytical survey study on the prevalence of DM among the 1,288 patients on hemodialysis (HD) in all the 15 clinics in the city from June to July, 2009. RESULTS: 488 diabetic patients were identified, a prevalence of 37.9%, ranging from 21 - 75% in the different clinics of the city. CONCLUSIONS: The prevalence of DM among chronic HD patients in Porto Alegre is higher than what was previously published as a cause of CRF in the country, which indicates the possibility that this etiology of CRF may have been underestimated.

Acido úrico, aterosclerosis y calcificaciones vasculares en enfermedad renal crónica / Uric acid, atherosclerosis and vascular calcifications in chronic kidney disease

Estudios clínicos y epidemiológicos han demostrado que la enfermedad cardiovascular está relacionada con un aumento en la tasa de mortalidad en los pacientes con enfermedad renal crónica (ERC). Las complicaciones vasculares son principalmente secundarias a calcificaciones y ateroesclerosis. En los últimos años se ha renovado el interés por la asociación entre niveles de ácido úrico y riesgo cardiovascular. El objetivo de esta investigación fue relacionar la presencia de calcificaciones vasculares (CV) y aterosclerosis, evaluadas mediante ecografía carotídea, con niveles de ácido úrico en pacientes con ERC estadio 5 en diálisis. Se observaron CV en 56% de los pacientes; 46% tuvo criterios ecográficos para aterosclerosis con un promedio general de 0,89 mm (DE: ± 0,28), siendo mayor en los pacientes con hipertensión arterial y diabetes mellitus; este grupo también mostró mayor predisposición para CV (p= 0,01). Los niveles de urea (141,3 mg/dL) (p= 0,01) y ácido úrico (6,9 mg/dL) (p= 0,04) mostraron asociación estadísticamente significativa con la presencia de CV. Los eventos cardiovasculares adversos predominaron en los pacientes con aterosclerosis y CV (p= 0,01). Esta investigación demostró que un incremento en los niveles de ácido úrico por encima de 6 mg/L está relacionado con mayor riesgo de presentar calcificaciones y eventos cardiovasculares adversos en pacientes con ERC.

Epidemiological and clinical studies have shown that cardiovascular disease is associated with an increase in mortality in patients with chronic kidney disease (CKD). Vascular complications are mainly secondary to calcification and atherosclerosis. Interest in the association between uric acid levels and cardiovascular risk has been renewed in recent years. The objective of this research was to determine the relation between vascular calcification (VC) and atherosclerosis, through carotid ultrasound, with uric acid levels in patients with CKD in dialysis. VCs were observed in 56% of patients, 46% had ultrasound criteria for atherosclerosis with an overall average of 0.89 mm (SD ± 0.28), being higher in patients with hypertension and diabetes; this group also showed increased susceptibility to VC (p= 0.01). The levels of urea (141.3 mg/dL) (p= 0.01) and uric acid (6.9 mg/dL) (p= 0.04) showed significant association with the presence of VC. Adverse cardiovascular events were observed mainly in patients with atherosclerosis and VC (p= 0.01). This investigation showed that an increase in uric acid levels above 6 mg/dL is associated with an increased risk of calcification and cardiovascular adverse events in CKD patients in dialysis.

Prevalencia y clasificación de enfermedad renal crónica en pacientes con diabetes mellitus tipo 2 en el centro comunitario de salud familiar Pantanosa, Frutillar / Frequency of chronic kidney disease among ambulatory patients with type 2 diabetes

Background: Type 2 diabetes mellitus is the main cause of chronic kidney disease in developed countries. Aim: To study the prevalence of chronic kidney disease among adults with diabetes mellitus attended at a public primary health care clinic in southern Chile. Material and Methods: One hundred patients with type 2 diabetes mellitus, aged more than 15 years participated in this cross sectional study. Chronic kidney disease was defined as the presence of a urine albumin/creatinine ratio over 30 mg/g or an estimated glomerular filtration rate of less than 60 mL/min/1,73 m², detected in at least two opportunities, separated at least by three months. Results: Thirty four percent of participants had chronic kidney disease (17% stage 1 or 2 and 17% stage 3). Thirty percent of participants had an abnormal urinary albumin/creatinine ratio. Halfof the patients with an estimated glomerular filtration rate below 60 mL/min/1,73 m², had a normal urinary albumin/creatinine ratio. Conclusions: The rates of chronic kidney disease in this group of diabetic patients are very similar to those reported elsewhere.

Non-diabetic renal disease in type II diabetes mellitus patients in Mohammed V military hospital, Rabat, Morocco

The distinction between diabetic nephropathy lesions and non-diabetic renal lesions is not always obvious and is often based on renal biopsy. This study evaluated the prevalence and predictors of nondiabetic renal disease in people with type 2 diabetes. The study was conducted between January 2008 and October 2010 in the nephrology department of the military hospital in Rabat. The study included 16 patients with type 2 diabetes in whom renal biopsy was indicated. Non-diabetic renal disease was found in 6 of the patients [37.5%]; IgA nephropathy was the most frequent non-diabetic renal disease [half of non-diabetic renal diseases]. Hypertension was significantly less frequent in the non-diabetic renal disease group than the diabetic nephropathy group [16.7% versus 80.0%, P = 0024], duration of diabetes was a shorter [4.5 versus 15.5 years, P = 0.022] and diabetic retinopathy was absent [100% versus 40%, P = 0.026]. There were no statistically significant differences between the 2 groups in relation to age, sex, creatinine level, 24-hour proteinuria, nephritic syndrome and microscopic haematuria

Referral pattern of patients with end-stage renal disease at a public sector hospital and its impact on outcome.

Background. Late referral of patients with chronic kidney disease (CKD) to a nephrologist has been shown to be associated with greater morbidity and adverse clinical outcomes. Methods. We did a prospective cross-sectional study of 2490 consecutive, newly diagnosed patients with end-stage renal disease (ESRD) referred to the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh over 2 years. The referral pattern was classified on the basis of the interval between first visit to a nephrologist and initiation of renal replacement therapy (RRT). If the patient reported later to a nephrologist, the disease would have progressed more, and the time interval to initiation of RRT would thus be shorter. A time interval of <3 months was classified as late referral (LR), 3–12 months as intermediate referral (IR) and >12 months as early referral (ER). The demographic and clinical characteristics and co-morbid conditions were compared, and factors associated with LR and outcomes were evaluated. Results. About 75% of patients were referred late. Poor socioeconomic status, low level of education and reduced access to reimbursement of treatment costs contributed to LR. The aetiology of ESRD could not be established in a larger number of LR patients as compared to the other groups. LR patients had a higher prevalence of uraemic complications and required emergency dialysis more frequently. A higher proportion of LR patients were lost to follow up because they could not afford to continue dialysis. Early mortality was higher in the ER group than in the other groups. ER patients were older, more likely to have diabetic nephropathy and a higher burden of co-morbid conditions. They were also more likely to choose continuous ambulatory peritoneal dialysis or undergo transplantation. Only 28% of all patients continued RRT beyond 3 months. Conclusion. A large majority of patients with ESRD in India seek medical attention late, usually in advanced stages of CKD with uraemic complications. LR is more frequent in younger patients and those with non-diabetic kidney disease, and is associated with poor socioeconomic status, lack of education and poor outcomes.

Null association between ACE gene I/D polymorphism and diabetic nephropathy among multiethnic Malaysian subjects.

BACKGROUND: Wide inter-ethnic allelic variations of the Angiotensin Converting Enzyme (ACE) i nsertion-deletion (I/D) gene polymorphism were thought to be responsible for the conflicting gene–diabetic nephropathy disease association worldwide. We have investigated the genetic susceptibility of the ACE gene to diabetic nephropathy in the multiethnic Malaysian population. MATERIALS AND METHODS: A total of 137 healthy (control) and 256 diabetic subjects were recruited. The diabetic subjects were further subdivided according to their nephropathy status based on urinary albumin-creatinine ratio (ACR) and glomerular filtration rate (GFR). Triple primer polymerase chain reaction (PCR) was used for ACE I/D genotyping. Subsequently, populationwide genetic analysis and gene-disease association studies were performed. RESULTS: The genotype frequencies in all subgroups were in Hardy-Weinberg equilibrium. Similar allelic and genotypic frequency of ACE I/D gene polymorphism was observed between healthy controls versus pooled type 2 diabetes mellitus (T2DM) subjects, and normoalbuminuria versus microalbuminuria, macroalbuminuria and End Stage Renal Failure (ESRF) (P > 0.05). Neither ethnicity nor gender exerted any influence on the ACE I/D gene polymorphism (P > 0.05), with the exception of the Chinese ethnic group which exhibited a higher frequency of ID genotype (P = 0.042). A multinomial logistic regression model showed that predictive factors including age, systolic blood pressure (SBP), high density lipoprotein (HDL) and glycosylated hemoglobin (HbA1C) were independently associated with diabetic nephropathy, in that order. CONCLUSION: The I/D polymorphism of the ACE gene is not significantly associated with both T2DM and/or diabetic nephropathy in this Malaysian population regardless of ethnicity and gender.