Enrique Rojas-Campos

Introduction: Treatment conditions and progression of chronic kidney disease (CKD) are factors for work incapacity, related with physical limitations and social and emotional distress, affecting quality of life (QOL). Methods: In a cross-sectional study, 343 patients with CKD were included: chronic kidney disease non-dialysis (CKD G3-G5ND) (n = 98), hemodialysis (HD) (n = 95), peritoneal dialysis (PD) (n = 96), and kidney transplant (KT) (n = 54). A clinical and nutritional assessment was carried out using the Subjective Global Assessment instrument. QOL was assessed using the Kidney Disease Quality of Life Short Form instrument. Results: Employed patients (44%) were younger (40 ± 14 vs. 51 ± 16 years, p < 0.0001), had >9 years of schooling (49 vs. 29%, p < 0.0001), lower diabetes frequency (21 vs. 47%, p < 0.0001), hypertension (71 vs. 87%, p < 0.0001), cardiovascular disease (5 vs. 16%, p = 0.002), and better nutritional status score (6 ± 1 vs. 5 ± 1, p < 0.0001) than unemployed. Employed patients with KT had better QOL than employed patients on CKD G3-G5ND, HD, and PD (76 ± 6, 68 ± 13, 68 ± 12, and 67 ± 7, respectively, p < 0.05). In multivariate analysis, employment predicted QOL in all kidney replacement therapies (KRTs): HD (B = 10.1, 95% CI: 5.5–14.6), PD (B = 4.5, 95% CI: 0.08–8.9) and KT (B = 13.3, 95% CI: 6.1–20.5). Nutritional status predicted QOL in all groups: CKD G3-G5ND (B = 3.6, 95% CI: 1.24–5.97), HD (B = 2.44, 95% CI: 0.4–4.4), PD (B = 3.73, 95% CI: 2.1–5.3), and KT (B = 4.4, 95% CI: 0.05–8.8). Conclusion: Only 44% of patients had employment. Employed patients had better QOL, were younger, more educated, had fewer comorbidities and better nutritional status than unemployed patients. Employment predicted QOL in all three KRTs but not in CKD G3-G5ND patients, and nutritional status was a predictor QOL in all groups.

Bioelectrical impedance permits the measurement of variables related to morbidity and mortality in cardiac surgery patients. The preoperative phase angle (PhA) is one of the variables associated with increased mortality, prolonged duration of invasive mechanical ventilation, and prolonged hospital stay. However, its relationship with acute kidney injury (AKI) is unknown. A prospective cohort study measured the PhA 24 hours before surgery, and the standardized phase angle (SPhA) was calculated from data from the reference population. The incidence and severity of AKI were determined over 7 days after surgery. Multivariate analysis was performed to determine the relationships between PhA or SPhA and the incidence and severity of AKI after cardiac surgery. A total of 120 patients were recruited. The incidence of AKI during the 7 days after cardiac surgery was 37%, 70% of which were classified as Kidney Disease Improving Global Outcomes (KDIGO) 1, 19% as KDIGO 2, and 11% as KDIGO 3. SPhA > −0.54 was associated with a lower incidence of AKI at 21% and lower AKI KDIGO 1 at 8% (2/24 patients) than SPhA ≤ −0.54 was associated with an AKI incidence of 40% ( P = .072) and AKI KDIGO 1 incidence of 30% (29/96 patients) ( P = .029). There were no differences in the incidence of AKI classified as KDIGO 2–3. According to the multivariate analysis, an SPhA > −0.54 was a protective factor (RR 0.254, CI 0.074–0.870, P = .029). A high SPhA (>−0.54) serves as a protective factor against AKI, particularly against AKI classified as KDIGO 1.

Purpose: A healthy diet plays an important role for chronic kidney disease (CKD) treatment, but adherence to nutritional recommendations is frequently low. The aim of the present study was to describe barriers and facilitators to adherence to a healthy diet in people with CKD. Patients and Methods: Cross-sectional study; 80 predialysis (n=20), hemodialysis (n=20), peritoneal dialysis (n=20) and transplant (n=20) patients matched by age and sex, were included. Nutritional evaluation included subjective global assessment, anthropometry, quality of food consumption (Mini-ECCA v.2), self-perception about diet and willingness to change. Barriers and facilitators were evaluated with a qualitative approach (semi-structured interviews). Concepts were converted into “in vivo” and “theoretical” codes, then, grouped into categories. A second analysis was performed with the ATLAS.ti software. Results: Frequency of malnutrition was 50% in people receiving dialysis. Quality of food consumption was healthier on people with CKD stages 3b-5 (40%) and people with kidney transplant (65%) compared to peritoneal dialysis (25%) and hemodialysis (0%). The main themes influencing adherence to a healthy diet were: need for nutritional guidance, economy, dietary restrictions, willingness to change, relationship with consequences in disease control and health status, aversion for healthy foods, bad and good self-perception, family support, feelings and emotions, environment, eating habits and CKD itself. Lack of time, work, economy, food preferences and cravings were the main barriers in people with CKD stage 3b-5 and transplant, while low willingness to eat healthy foods and dietary restrictions were the main barriers in people receiving dialysis. Conclusion: Personal, environmental, health professional-related, CKD related as well as feelings and emotions aspects that people with CKD face in a daily basis, act as barriers or facilitators when trying to follow a healthy diet. Individualizing nutritional treatment taking into account people with CKD perspectives and situations is of utmost importance to improve adherence to nutritional treatment. Plain summary: In this article, the authors discuss the main barriers and facilitators that people with kidney disease face when trying to follow a healthy diet (from the people with CKD perspective). A healthy diet has been associated with lower progression of kidney disease and helps to prevent complications; however, adherence to nutritional recommendations is frequently low. People on dialysis had the unhealthier diet compared to people on predialysis or kidney transplant. People perceived dietary restrictions, lack of nutritional counseling and knowledge, economic constraints, lack of social and family support, negative effects of food on their health, dislike or aversion to healthy foods, lack of time and environment limitations as the main barriers to adhere to a healthy diet. Additionally, since diets are considered complicated (especially renal diets), strategies to improve willingness to eat healthy, counseling about food variety and preparation, some liberalization of dietary restrictions (when possible) and considering family support could help people with CKD to increase skills to adhere to a healthier diet. Considering people with CKD perspectives is of utmost importance when planning nutritional treatment and counseling, to improve adherence and therefore, clinical outcomes.

Gut microbiota disturbances may influence cognitive function, increasing uremic toxins and inflammation in dialysis patients; therefore, we aimed to evaluate the association of the gut microbiota profile with cognitive impairment (CI) in patients on automated peritoneal dialysis (APD). In a cross-sectional study, cognitive function was evaluated using the Montreal Cognitive Assessment in 39 APD patients and classified as normal cognitive function and CI. The gut microbiota was analyzed using the 16S rRNA gene sequencing approach. All patients had clinical, biochemical and urea clearance evaluations. Eighty-two percent of patients were men, with a mean age of 47 ± 24 years and 11 (7–48) months on PD therapy; 64% had mild CI. Patients with CI were older (53 ± 16 vs. 38 ± 14, p = 0.006) and had a higher frequency of diabetes mellitus (56% vs. 21%, p = 0.04) and constipation (7% vs. 48%, p = 0.04) and lower creatinine concentrations (11.3 ± 3.7 vs. 14.9 ± 5.4, p = 0.02) compared to normal cognitive function patients. Patients with CI showed a preponderance of S24_7, Rikenellaceae, Odoribacteraceae, Odoribacter and Anaerotruncus, while patients without CI had a greater abundance of Dorea, Ruminococcus, Sutterella and Fusobacteria (LDA score (Log₁₀) > 2.5; p < 0.05). After glucose and age adjustment, Odoribacter was still associated with CI. In conclusion, patients with CI had a different gut microbiota characterized by the higher abundance of indole-producing and mucin-fermenting bacteria compared to normal cognitive function patients.

Antecedentes: La enfermedad renal crónica (ERC), tiene muchos retos: el diagnóstico temprano, atención especializada, aspectos económicos, sin embargo el aspecto nutricional es de la misma relevancia. No se conoce el número de especialistas en nutrición renal en muchos países (entre ellos México). El derecho a la salud, a la nutrición y a la nutrición clínica son reconocidos internacionalmente; sin embargo, no se tiene la certeza que en la ERC se goce de ellos. La adecuada evaluación nutricional contempla evaluaciones antropométrica, bioquímica, clínica, dietética y de estilo de vida; pero evaluar el sentido del gusto no se hace de manera regular. Objetivo y Resultados: análisis bibliográfico sobre el derecho a la evaluación nutricional adecuada, optima y completa en la ERC. La alta prevalencia tanto de ERC como de desnutrición de pacientes en diálisis predice los resultados clínicos y de sobrevida de los pacientes; aunque el número de nutriólogos en algunos países es mayor que en otros, el número de especialistas en nutrición renal no parece haberse alcanzado. No se puede confirmar que los pacientes con ERC gozan del derecho a la nutrición clínica, incluso no hay evaluaciones tan importantes como la del sentido del gusto de manera habitual. Conclusiones: aunque existe el derecho a la salud, a la nutrición y a la nutrición clínica, se debe asegurar que se lleve a cabo por un especialista en nutrición renal y que abarque la evaluación del sentido de gusto, hecha por profesionales de la nutrición entrenados que puedan interpretar los resultados de la misma.

Evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) for renal transplantation (RT) is still limited, but maintaining a dose of vs 2 g of MMF. A prospective cohort study was performed with a 12-month follow-up of recipients of RT from living donors with low (1.5 g/day) or standard (2 g/day) doses of MMF. The association between adverse effects and complications and doses of MMF was examined using Cox proportional hazard models, and survival free of AR, infectious diseases, and noninfectious complications was evaluated using the Kaplan–Meier test. At the end of the follow-up, the incidence of infectious diseases was 52% versus 50% (P = .71) and AR was 5% versus 5% (P = .86), respectively. The survival rate free of gastrointestinal (GI) complications requiring medical attention was higher in the low-dose group than in the standard-dose dose (88% vs 45%, respectively; P < .001). The use of 1.5 g/day of MMF confers a reduction in GI complications without an increase in infectious diseases or the risk of AR.

Background: The evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) in renal transplant (RT) is still limited but maintaining the dose of less than 2g could result in worse clinical outcomes in terms of acute rejection (AR). Research Question: This study’s aim was to determine the association between AR, infectious and non-infectious complications after RT with the dose of 1.5g vs . 2g of MMF. Design: A prospective cohort was performed with a 12-month follow-up in recipients of RT from living donors with low doses of MMF (1.5 g/day) or use of standard dosage (2 g/day). The association between adverse effects and complications and doses of MMF were examined in Cox proportional hazard models and survival free of AR, infectious diseases, and non-infectious complications was evaluated by the Kaplan-Meier test. Results: At the end of the follow-up, the incidence of infectious diseases was 52% vs . 50% ( p =0.71) and AR was 5% vs . 5% ( p =0.86), respectively. Survival free of GI complications requiring medical attention was higher in the low dose group compared to the standard dose (88% vs . 45%, respectively; p <0.001). Discussion: The use of 1.5 g/day of MMF is safe in Mexican population with RT from living donors without increasing the risk of AR, and it confers a reduction of adverse events.

Background. Acute kidney injury (AKI) is associated with poor outcomes in patients infected with SARS‐CoV‐2. Sepsis, direct injury to kidney cells by the virus, and severe systemic inflammation are mechanisms implicated in its development. We investigated the association between inflammatory markers (C‐reactive protein, procalcitonin, D‐dimer, lactate dehydrogenase, and ferritin) in patients infected with SARS‐CoV‐2 and the development of AKI. Methods. A prospective cohort study performed at the Civil Hospital (Dr. Juan I. Menchaca) Guadalajara, Mexico, included patients aged >18 years with a diagnosis of SARS‐CoV‐2 pneumonia confirmed by RT‐PCR and who did or did not present with AKI (KDIGO) while hospitalized. Biomarkers of inflammation were recorded, and kidney function was estimated using the CKD‐EPI formula. Results. 291 patients were included (68% males; average age, 57 years). The incidence of AKI was 40.5% (118 patients); 21% developed stage 1 AKI, 6% developed stage 2 AKI, and 14% developed stage 3 AKI. The development of AKI was associated with higher phosphate (p = 0.002) (RR 1.39, CI 95% 1.13–1.72), high procalcitonin levels at hospital admission (p = 0.005) (RR 2.09, CI 95% 1.26–3.50), and high APACHE scores (p = 0.011) (RR 2.0, CI 95% 1.17–3.40). The survival analysis free of AKI according to procalcitonin levels and APACHE scores demonstrated a lower survival in patients with procalcitonin >0.5 ng/ml (p = 0.001) and APACHE >15 points (p = 0.004). Conclusions. Phosphate, high procalcitonin levels, and APACHE levels >15 were predictors of AKI development in patients hospitalized with COVID‐19.