Interactions Between Diet Quality and Interleukin-6 Genotypes Are Associated With Metabolic and Renal Function Parameters in Mexican Patients With Type 2 Diabetes Mellitus.

OBJECTIVE: The aim of this study was to evaluate the interaction between diet quality and interleukin (IL)-6 genotypes and its association with metabolic and renal function parameters in Mexican patients with type 2 diabetes mellitus (T2DM). DESIGN AND METHODS: Using an analytical cross-sectional design, 219 patients with T2DM (92 men; age 62 ± 10 years) were evaluated for selected metabolic and renal function parameters. Diet quality according to the Healthy Eating Index was evaluated and classified as good diet or poor diet in all patients. IL-6 serum concentrations and genotypes and haplotypes for IL6-597G > A (rs180097), -572G > C (rs180096), and -174G > C (rs180095) polymorphisms were determined. RESULTS: Eighty-two percent of patients reported having a poor diet. Carriers of alleles -572C and -174C showed higher high-density lipoprotein cholesterol levels (44 ± 12 vs. 40 ± 9 mg/dL; P = .01) and lower total cholesterol levels (184 ± 33 vs. 197 ± 42 mg/dL; P = .03) than did those homozygous for G/G. Neither IL6 genotypes nor haplotypes were significantly associated with serum concentrations of IL-6. Some significant interactions between IL6 genotypes/haplotypes and diet quality were associated with body mass index, waist circumference, high-density lipoprotein cholesterol levels, and estimated glomerular filtration rate. CONCLUSIONS: Interactions between diet quality and IL6 genotypes/haplotypes were associated with the main metabolic and renal function parameters in Mexican patients with T2DM. It will be important to consider genetic profiles in designing dietary portfolios and nutritional interventions for the management of such patients.

Circulating Levels of Soluble Klotho and Fibroblast Growth Factor 23 in Diabetic Patients and Its Association with Early Nephropathy.

INTRODUCTION: Diabetic nephropathy is a leading cause of chronic kidney disease (CKD). In diabetes, changes in serum levels of both soluble alpha Klotho (sKL) and fibroblast growth factor 23 (FGF-23) have been associated with CKD progression. OBJECTIVE: To evaluate the associations of circulating levels of sKL and FGF-23 with the presence of early nephropathy (EN) in diabetic patients. METHODS: A cross-sectional study in 136 Mexicans with type 2 diabetes mellitus (T2DM). Early nephropathy was defined as an estimated glomerular filtration rate (≥60 ml/min) and urinary albumin excretion (≥30 mg/g). Serum concentrations of sKL and FGF-23 were measured using ELISA. Associations were evaluated with multiple logistic regression. RESULTS: Fifty-two subjects had EN. Median values of sKL and FGF-23 for all individuals were 244 pg/mL (interquartile range [IQR]: 201-402) and 92 pg/mL (IQR: 39-507), respectively. A positive correlation was found between levels of sKL and FGF-23 (r = 0.38; p <0.001). FGF-23 levels correlated negatively with angiotensin-II receptor blocker therapy (ARB, r = 0.24; p <0.01). Subjects without EN were younger (59 vs. 63 years old, p = 0.02). Elevated concentrations of FGF-23 were negatively associated with EN (Odds Ratio [ORadjusted] = 0.29, 95% Confidence Interval [95% CI] = 0.13, 0.65). CONCLUSIONS: In Mexican diabetic patients, serum levels of FGF-23 were positively correlated with sKL but negatively correlated with ARB therapy. In addition, a higher concentration of FGF-23 reduced the odds of early nephropathy in patients with T2DM.

Economic impact of the chronic kidney disease: Perspective of the Instituto Mexicano del Seguro Social / Impacto económico de la enfermedad renal crónica: Perspectiva del Instituto Mexicano del Seguro Social

In Mexico, as in other parts of the world, end-stage renal disease (ESRD) constitutes a public health problem associated with high morbidity, mortality, costs and a diminished quality of life. The Instituto Mexicano del Seguro Social (IMSS) attends to, approximately, 73% of the Mexican population requiring dialysis or transplant. In 2014, the treatment of ESRD represented 15% of the total annual expenditure of IMSS major program (Disease and Maternity Security), i.e. approximately $13 250 million Mexican pesos (MP); this expense was invested in only 0.8% of patients (those with ERSD). There are few economic evaluation studies showing the real cost of kidney replacement therapies from institution's perspective. In order to reduce the global cost of ESRD, it is necessary to implement appropriate strategies of prevention, diagnosis and treatment to reduce incidence and progression of chronic kidney disease; to intensify research studies for a better understanding of etiological factors, mechanism of kidney damage progression and identification of new therapeutic agents; to create a national kidney disease registry, and to incorporate the economic evaluation methodology in the decision-making, in order to identify improved cost-benefit or cost-effective strategies.

En México, al igual que en otras partes del mundo, la enfermedad renal crónica terminal (ERCT) constituye un problema de salud pública asociado a elevada morbilidad, mortalidad, grandes costos y una calidad de vida disminuida. El Instituto Mexicano del Seguro Social (IMSS) atiende aproximadamente al 73% de la población mexicana que requiere diálisis o trasplante. En el año 2014, el tratamiento de la ERCT representó para el Instituto el 15% del gasto total anual de su mayor programa (Seguro de Enfermedades y Maternidad), aproximadamente $13 250 millones de pesos; este gasto se invirtió en tan solo el 0.8% de los derechohabientes (población con ERCT). Con el objetivo de disminuir la carga global de la ERCT, es necesario: 1) Implementar estrategias de prevención, diagnóstico y tratamiento de la ERC desde estadios más tempranos; 2) Fortalecer estudios de investigación dirigidos a una mejor comprensión de factores etiológicos, mecanismos de progresión de daño renal e identificar nuevos agentes terapéuticos; 3) Contar con un registro nacional de enfermedades renales; 4) Incorporar en la toma de decisiones, estudios de evaluación económica para identificar estrategias con un mayor costo-beneficio o costo-efectividad en el tratamiento de la ERC.

Model of chronic kidney disease care in primary health care / Modelo de atención de la enfermedad renal crónica en la atención primaria de la salud

Multidisciplinary attention models include the joined and coordinated participation of different professionals within the health team (physicians, nurses, social workers, dietitians, physical trainers, among others). A multidisciplinary approach facilitates and improves management of patients from early chronic kidney disease (CKD) in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients and should be adapted to the resources and health systems; its systematic implementation can help to improve patient care and prevent/slow the progression of CKD.

Los modelos de atención multidisciplinaria incluyen la participación conjunta y coordinada de diferentes profesionales miembros del equipo de salud (médicos, enfermeras, trabajadoras sociales, nutriólogas, entrenadores físicos, entre otros). Un abordaje multidisciplinario facilita y mejora el manejo de los pacientes con enfermedad renal crónica (ERC) en el primer nivel de atención médica. Este abordaje es una estrategia para mejorar el cuidado de una forma más completa, iniciando y manteniendo conductas saludables, promoviendo el trabajo en equipo, eliminando barreras para alcanzar objetivos y mejorando los procesos de la atención. Una intervención multidisciplinaria puede incluir procesos educativos guiados por profesionales, el empleo de grupos de autoayuda y el desarrollo de un plan de manejo de la ERC. La atención actual de los pacientes con ERC, fragmentada y compleja, asociada con los malos resultados frecuentemente observados, pone de manifiesto la importancia de la implementación de un abordaje multidisciplinario desde las etapas más tempranas de la enfermedad. Las estrategias multidisciplinarias deben enfocarse en las necesidades de los pacientes y deben ser adaptadas a los recursos disponibles en los sistemas de salud; su implementación sistematizada podrá ayudar a mejorar el cuidado del paciente y prevenir y/o retrasar el avance de la ERC.

Multidisciplinary strategies to promote self-care in patients with early nephropathy / Estrategias multidisciplinarias para fomentar autocuidado en pacientes con nefropatía temprana

In Mexico, there is a high prevalence of early nephropathy that usually goes unnoticed and may in part be due to the acquisition of "moderns" negative habits a lifestyle from an early age like physical inactivity, unhealthy diet, smoking and alcohol intake abuse associated with the increasing prevalence of overweight and obesity, diabetes and hypertension, leading causes of chronic kidney disease (CKD) in Mexico. These behaviors are difficult to control by medical intervention alone and may be associated with lack of resources of patients to perform self-care activities and the health care-model predominant in México also may be insufficient to generate healthy behaviors. To improve the care of patients from early stages of CKD, is necessary to implement multidisciplinary strategies to empower the patient and develop their self-efficacy to carry out self-care actions to manage their disease, control risk factors, promotion of healthy habits and modify risk behaviors. Promoting self-care is an area of opportunity with potential benefits to reduce the progression of kidney damage and complications. The aim of this article is to review the main multidisciplinary strategies to promote self-care in patients with early nephropathy in primary health-care.

En México, existe una alta prevalencia de nefropatía temprana que puede pasar desapercibida y deberse a los "modernos" hábitos negativos de un estilo de vida; la inactividad física, la dieta poco saludable, el tabaquismo y el abuso en el consumo de alcohol, asociados al incremento de la prevalencia de sobrepeso y obesidad, diabetes e hipertensión arterial, son las principales causas de enfermedad renal crónica (ERC) en nuestro país. Para mejorar la atención de los pacientes desde los estadios tempranos de la ERC, es necesario implementar estrategias multidisciplinarias para empoderar al paciente y desarrollar su autoeficacia para llevar a cabo acciones de autocuidado para el manejo de su enfermedad, control de factores de riesgo, promoción de hábitos saludables y modificar conductas de riesgo. Fomentar el autocuidado constituye un área de oportunidad con potenciales beneficios para reducir la progresión del daño renal y sus complicaciones. El objetivo de este artículo es revisar las principales estrategias multidisciplinarias para fomentar el autocuidado en pacientes con nefropatía temprana en atención primaria.

[Socioeconomic, demographic and family dysfunction related to obesity in 6 to 9 year-old children]. / Obesidad en niños de 6 a 9 años. Factores socioeconómicos, demográficos y disfunción familiar.

OBJECTIVE: To identify the association between family dysfunction and obesity in children six to nine year-old. METHODS: A case-control study that included children with obesity (cases, n = 64) with body mass index (BMI) > 95th percentile and triceps skinfold (TSF) > 90th percentile; and a control group (n = 120) with BMI < 85th percentile and TSF < 90th percentile was performed. Anthropometric measurements were made and a questionnaire assessing eight areas of family dynamics was applied. We compared the frequency of family dysfunction among cases and controls with the χ² test and its association with obesity through the odds ratio. RESULTS: The average score of the questionnaire was 80.8 ± 11.3 with no differences between groups. The categories "probably dysfunctional" and "dysfunctional" were more common in the obese group but the differences were not significant. The score of the areas "dynamics of parents as a couple" (p = 0.053) and "structure of authority in the family" (p = 0.061) was higher in the control group. CONCLUSIONS: Although no association was seen between family dysfunction and obesity, we found a tendency toward obesity in dysfunctional families.

[The peritoneal transport type might be distinctive among different Mexican populations on CAPD]. / El tipo de transporte peritoneal puede ser diferente en las distintas poblaciones de pacientes en diálisis peritoneal de México.

INTRODUCTION: The peritoneal equilibration test (PET), standardized by Twardowski et al. more than 20 years ago, is the most common test to classify peritoneal transport. Some reference values from Mexican population were established in the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) 10 years ago. The aims of this study were to evaluate the peritoneal transport in a population from the west of Mexico, and compare results with those obtained in the studies of Twardowski and the INCMNSZ. MATERIAL AND METHODS: Cross-sectional study, performed in 156 patients. All consecutive CAPD patients to whom a PET was performed between January 2000 and January 2004 were included. Each patient had a standard PET consistent on infusion of a freshly 2L dialysis exchange at 2.5% after drainage of the previous nocturnal exchange; 3 dialysis aliquots at 0, 2 and 4 hours, and a blood sample at 2 hours, are obtained after infusion. Results were compared to those reported by Twardowski and INCMNSZ. RESULTS: From the total of patients, 48% were diabetics and 62% were men. Mean age was 46 +/- 16 years and body surface area was 1.70 +/- 0.23 m2. There were no differences between groups regarding diabetes and peritonitis. Time on dialysis was shorter in our study than in the INCMNSZ (14.6 +/- 17.8 vs. 20.8 +/- 21.4 months; p < 0.05). Compared to those from Twardowski and INCMNSZ, creatinine D/P ratios at 0, 2 and 4 h of our study were higher, whereas D/D0 ratios at 2 and 4 h, and PET drained volume, were lower. Using reference values obtained in the present study, high transport (H) was present in 18%, high average (HA) in 33%, low average (LA) in 34% and low (L) in 15%, whereas employing the INCMNSZ reference values, H was present in 23%, HA in 36%, LA in 33% and L in 8%. CONCLUSIONS: Patients from this studied population had mean peritoneal transport values higher than those obtained in other studies, including Mexican values. Ideally, it is recommendable to determine reference values in all peritoneal dialysis centers, as extrapolating results from other regions may lead to errors in diagnosing the peritoneal transport type.