Prevalence of chronic kidney disease of non-traditional causes in patients on hemodialysis in southwest Guatemala.

Objective To document the prevalence of patients on hemodialysis in southwestern Guatemala who have chronic kidney disease (CKD) of non-traditional causes (CKDnt). Methods This cross-sectional descriptive study interviewed patients on hemodialysis at the Instituto Guatemalteco de Seguridad Social on their health and occupational history. Laboratory serum, urine and vital sign data at the initiation of hemodialysis were obtained from chart reviews. Patients were classified according to whether they had hypertension or obesity or neither. The proportion of patients with and without these traditional CKD risk factors was recorded and the association between demographic and occupational factors and a lack of traditional CKD risk factors analyzed using multivariate logistic regression. Results Of 242 total patients (including 171 non-diabetics) enrolled in hemodialysis in southwestern Guatemala, 45 (18.6% of total patients and 26.3% of non-diabetics) lacked traditional CKD risk factors. While agricultural work history was common, only travel time greater than 30 minutes and age less than 50 years old were significantly associated with CKD in the absence of traditional risk factors. Individuals without such risk factors lived throughout southwestern Guatemala's five departments. Conclusions The prevalence of CKDnT appears to be much lower in this sample of patients receiving hemodialysis in Southwestern Guatemala than in hospitalized patients in El Salvador. It has yet to be determined whether the prevalence is higher in the general population and in patients on peritoneal dialysis.

Coronavirus Disease 2019 in Patients With End-Stage Kidney Disease on Hemodialysis in Guatemala.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is public health concern across the world. Data on the epidemiology among patients on hemodialysis in Latin America and low- and middle-income countries are limited. METHODS: Using electronic medical records from the second largest dialysis network in Guatemala, we performed a retrospective analysis of all adult patients on hemodialysis with the diagnosis of COVID-19 to estimate incidence of infection and to describe the demographics, comorbidities, and outcomes. We stratified incidence rate by region. We reviewed data from May 1 to July 31, 2020, with outcome data ascertained up to August 28, 2020. RESULTS: Of 3201 patients undergoing hemodialysis, 325 patients were diagnosed with COVID-19 (incidence rate 102/1000 patients on hemodialysis, compared with 3/1000 in the general population). Incidence was higher in the Central region (207/1000) and lowest in the Southeast region (33/1000), and unlike in the general population, the incidence was lower in Guatemala City. The mean age of patients diagnosed with COVID-19 was 51.1 years (standard deviation [SD] 14.8 years), and 84 (25.8%) were female. The median length of hospital stay was 12 days (interquartile range [IQR] 10-16 days). Two hundred twenty-nine (69.8%) of the patients recovered, 90 patients died (27.7%), and 6 (1.8%) patients were still in the hospital at the time of last follow-up. CONCLUSION: The incidence of diagnosed COVID-19 in Guatemalan patients on hemodialysis was much higher than reported in the general population, with outcomes similar to those described in high-income countries. Rural regions had higher incidence rates than the major metropolitan area.

Prevalence of chronic kidney disease of non-traditional causes in patients on hemodialysis in southwest Guatemala / Prevalencia de enfermedad renal crónica por causas no tradicionales en pacientes en hemodiálisis en el sudoeste de Guatemala

ABSTRACT Objective To document the prevalence of patients on hemodialysis in southwestern Guatemala who have chronic kidney disease (CKD) of non-traditional causes (CKDnt). Methods This cross-sectional descriptive study interviewed patients on hemodialysis at the Instituto Guatemalteco de Seguridad Social on their health and occupational history. Laboratory serum, urine and vital sign data at the initiation of hemodialysis were obtained from chart reviews. Patients were classified according to whether they had hypertension or obesity or neither. The proportion of patients with and without these traditional CKD risk factors was recorded and the association between demographic and occupational factors and a lack of traditional CKD risk factors analyzed using multivariate logistic regression. Results Of 242 total patients (including 171 non-diabetics) enrolled in hemodialysis in southwestern Guatemala, 45 (18.6% of total patients and 26.3% of non-diabetics) lacked traditional CKD risk factors. While agricultural work history was common, only travel time greater than 30 minutes and age less than 50 years old were significantly associated with CKD in the absence of traditional risk factors. Individuals without such risk factors lived throughout southwestern Guatemala’s five departments. Conclusions The prevalence of CKDnT appears to be much lower in this sample of patients receiving hemodialysis in Southwestern Guatemala than in hospitalized patients in El Salvador. It has yet to be determined whether the prevalence is higher in the general population and in patients on peritoneal dialysis.

RESUMEN Objetivo Documentar la prevalencia de enfermedad renal crónica por causas no tradicionales en los pacientes en hemodiálisis en el sudoeste de Guatemala. Métodos En este estudio descriptivo y transversal se entrevistó a pacientes en hemodiálisis en el Instituto Guatemalteco de Seguridad Social para obtener datos sobre su salud y antecedentes ocupacionales. Los datos de las pruebas de laboratorio séricas y de orina y los signos vitales al inicio de la hemodiálisis se extrajeron de los expedientes clínicos. Para clasificar a los pacientes se tomó en cuenta si eran hipertensos u obesos, o ninguna de las dos cosas. Se registró la proporción de pacientes con estos factores de riesgo tradicionales de enfermedad renal crónica y sin ellos, y se analizó la asociación entre los factores demográficos y ocupacionales y la falta de factores de riesgo tradicionales utilizando métodos de regresión logística multifactorial. Resultados De un total de 242 pacientes que recibían hemodiálisis en el sudoeste de Guatemala (incluidos 171 que no eran diabéticos), 45 carecían de factores de riesgo tradicionales de enfermedad renal crónica (18,6% del total de pacientes y 26,3% de pacientes sin diabetes). A pesar de que los antecedentes de trabajo agrícola eran comunes, solo el tiempo de viaje superior a 30 minutos y la edad inferior a los 50 años se asociaron significativamente con enfermedad renal crónica cuando estaban ausentes los factores de riesgo tradicionales. Las personas en las que no se detectaron estos factores de riesgo tradicionales vivían en cinco departamentos del sudoeste de Guatemala. Conclusiones La prevalencia de enfermedad renal crónica por causas no tradicionales aparentemente es muy inferior en esta muestra de pacientes que reciben hemodiálisis en el sudoeste de Guatemala que en los pacientes hospitalizados en El Salvador. Todavía no se ha determinado si la prevalencia es mayor en la población general y en los pacientes que reciben diálisis peritoneal.