Association of the rs5186 polymorphism of the AGTR1 gene with decreased eGFR in patients with type 2 diabetes from Mexico City.

BACKGROUND: Early biomarkers search for Diabetic Kidney Disease (DKD) in patients with Type 2 Diabetes Mellitus (T2DM), as genetic markers to identify vulnerable carriers of the disease even before Glomerular Filtration Rate (GFR) decline or microalbuminuria development, has been relevant during the last few years. The rs5186 (A116C) polymorphism of the Angiotensin II Receptor Type I gene (AGTR1), has been associated to multiple effects of renal injury risk, commonly detected in patients with Diabetes Mellitus (DM). It has been described that rs5186 could have an effect in stability proteins that assemble Angiotensin II Receptor Type I (AT1), modifying its action, which is why it should be considered as a risk factor for Chronic Kidney Disease (CKD), characterized by a GFR progressive reduction. Even though, the association between rs5186 AGTR1 gene polymorphism and DKD in patients with T2DM has been controversial, inconclusive, and even absent. This disputable issue might be as a result of association studies in which many and varied clinical phenotypes included are contemplated as CKD inductors and enhancers. Although, the sample sizes studied in patients with T2DM are undersized and did not have a strict inclusion criteria, lacking of biochemical markers or KDOQI classification, which have hindered its examination. OBJECTIVE: The aim of our study was to establish an association between rs5186 AGTR1 gene polymorphism and GFR depletion, assessed as a risk factor to DKD development in patients with T2DM. METHODS: We analyzed 297 not related patients with T2DM, divided into 221 controls (KDOQI 1) and 76 cases (KDOQI 2). Arterial pressure, anthropometric and biochemical parameters were measured. rs5186 of AGTR1 genotyping was performed by TaqMan assay real-time PCR method. Allele and genotype frequencies, and Hardy-Weinberg equilibrium were measured. Normality test for data distribution was analyzed by Shapiro-Wilk test, variable comparison by Student's t-test for continuous variables, and Chi-squared test for categorical variables; ANOVA test was used for mean comparison of more than two groups. Effect of rs5186 to DKD was estimated by multiple heritability adjustment models for risk variables of DKD. Statistical significance was indicated by p<0.05. Data was analyzed using Statistical Package STATA v11 software. RESULTS: Dominant and Over-dominant models showed a likelihood ratio to GFR depletion of 1.89 (1.05-3.39, p=0.031) and 2.01 (1.08-3.73, p=0.023) in patients with T2DM. Risk factor increased to 2.54 (1.10-5.89) in women in Over-dominant model. CONCLUSION: In clinical practice, most of nephropathies progress at a slow pace into a total breakdown of renal function, even asymptomatic. This is the first study, reporting that rs5186 polymorphism of AGTR1 gene contribution to GFR depletion, and this could be evaluated as a predisposing factor for DKD in patients with T2DM.

Remote Healthcare Program in Mexico in the Context of the COVID-19 Pandemic.

OBJECTIVES: Given the challenge of limiting the transmission of coronavirus disease 2019 while simultaneously continuing to provide medical care for other chronic and degenerative diseases and monitor therapy, a remote medical advice and guidance program was created to help individuals receive health services at their homes. METHODS: A descriptive, cross-sectional, and observational study was performed from April 13, 2020 to April 19, 2021 among Petroleos Mexicanos (PEMEX) health services beneficiaries. Mobile text messages were used to assign patients throughout Mexico to a doctor, who coordinated a video call with the nursing service for advice and remote care. RESULTS: In total, 17,472 calls were registered, with an average duration of 10.28 minutes. Almost half (49.4%) of the people who requested attention through the remote program were workers, 31.5% were workers' relatives, and 19.1% were retired workers. The average age of the program users was 50.66 ± 18.02 years. A total of 144 doctors from 28 different specialties participated. In this program, 7,163 calls were made because of respiratory symptoms, 1,514 for therapeutic monitoring (prescriptions), and 8,183 because of other diseases, including mental health. CONCLUSIONS: Remote healthcare programs have shown the potential to support the health system. This program is the first to deploy real-time video calls with a health team utilizing institutional electronic clinical records in Mexico. The implementation of this pandemic management program impacted the number of consultations given remotely, resulting in effective triage.