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.

The art of letting go and the mandate of going further.

THE ART OF LETTING GO AND THE MANDATE OF GOING FURTHER In rural India, people get to the hospital on foot or by bicycles, rickshaws, public transport, hitchhiking, taxis, but rarely by the public ambulance, and even more rarely, the private ambulance.1 People get help from the family, friends, compassionate lorry drivers and even empathetic complete strangers. I have seen two healthy individuals sandwich a very sick loved one between them on a motorcycle when that sick individual was no longer able to sit upright. I have met a father who walked through the night with his suddenly paralysed son in his arms, stopping only once inside the doors of the Emergency Department. While there are a lot of ways and many different people who can get you to the hospital in rural India, there is only one group of people who can take you home: your family. This reality is a mix of legal precedent and cultural tradition. When you are alive, a diversity of options listed above—some expensive, some reasonably priced, some free—are available to you. But when you die, there is no train or bus or friendly lorry driver; there is only one option. Your family must arrange a ride in a private vehicle capable of transporting a dead body. (Colleagues tell me that in some parts of India some hospitals have the capacity to transport dead bodies, but the publicly available information that I could find about transporting the dead in India relates only to air travel.2 ) Such vehicles and the rides they provide are few and far between in the central eastern states, including here in Chhattisgarh. Such transport is often prohibitively expensive.3 In a bad monsoon year, these expenses can consume an extended family’s entire savings. If this happens, sadly, it leads to a vicious cycle of food insecurity, malnutrition and further illness.

Prevalence of obesity, tobacco use, and alcohol consumption by socioeconomic status among six communities in Nicaragua / Prevalencia de la obesidad, el tabaquismo y el consumo de alcohol según la condición socioeconómica en seis comunidades de Nicaragua

Objective. To describe the prevalence of noncommunicable disease (NCD) risk factors(overweight/obesity, tobacco smoking, and alcohol consumption) and identify correlationsbetween these and sociodemographic characteristics in western and central Nicaragua.Methods. This was a cross-sectional study of 1 355 participants from six communitiesin Nicaragua conducted in September 2007–July 2009. Demographic and NCD risk-relatedhealth behavior information was collected from each individual, and their body mass index(BMI), blood pressure, diabetes status, and renal function were assessed. Data were analyzedusing descriptive statistics, bivariate analyses, and (non-stratified and stratified) logisticregression models.Results. Of the 1 355 study participants, 22.0% were obese and 55.1% were overweight/obese. Female sex, higher income, and increasing age were significantly associated with obesity.Among men, lifelong urban living correlated with obesity (Odds Ratio [OR] = 4.39,1.18–16.31). Of the total participants, 31.3% reported ever smoking tobacco and 47.7%reported ever drinking alcohol. Both tobacco smoking and alcohol consumption were strikinglymore common among men (OR = 13.0, 8.8–19.3 and 15.6, 10.7–22.6, respectively) andlifelong urban residents (OR = 2.42, 1.31–4.47 and 4.10, 2.33–7.21, respectively).Conclusions. There was a high prevalence of obesity/overweight across all income levels.Women were much more likely to be obese, but men had higher rates of tobacco and alcoholuse. The rising prevalence of NCD risk factors among even the poorest subjects suggests thatan epidemiologic transition in underway in western and central Nicaragua whereby NCDprevalence is shifting to all segments of society. Raising awareness that health clinics can beused for chronic conditions needs to be priority.

Objetivo. Describir la prevalencia de los factores de riesgo (sobrepeso/obesidad,tabaquismo y consumo de alcohol) de las enfermedades no transmisibles (ENT), ydeterminar las correlaciones entre estos y las características sociodemográficas en laszonas occidental y central de Nicaragua.Métodos. De septiembre del 2007 a julio del 2009, se llevó a cabo este estudio transversalen 1 355 participantes de seis comunidades de Nicaragua. Para cada persona,se recopiló información demográfica y sobre la conducta en materia de salud relacionadacon el riesgo de ENT, y se evaluaron el índice de masa corporal (IMC), la presiónarterial, la presencia o no de diabetes y la función renal. Se analizaron los datosmediante estadísticas descriptivas, análisis de dos variables, y modelos de regresiónlogística (análisis no estratificado y estratificado).Resultados. De los 1 355 participantes en el estudio, 22,0% eran obesos y 55,1%presentaban sobrepeso u obesidad. El sexo femenino, los ingresos más altos y la edadmás avanzada se asociaron significativamente con la obesidad. En los varones, laresidencia de por vida en un entorno urbano se correlacionó con la obesidad (razónde posibilidades [OR] = 4,39, 1,18–16,31). Del total de participantes, 31,3% habíanfumado tabaco y 47,7% habían consumido alcohol alguna vez. Tanto el tabaquismocomo el consumo de alcohol fueron considerablemente más frecuentes en los varones(OR = 13,0, 8,8–19,3 y 15,6, 10,7–22,6, respectivamente) y en los que residían de porvida en un entorno urbano (OR = 2,42, 1,31–4,47 y 4,10, 2,33–7,21, respectivamente).Conclusiones. Se observó una alta prevalencia de obesidad/sobrepeso en todos losniveles de ingresos. Las mujeres tenían muchas más probabilidades de ser obesas,pero los varones mostraban mayores tasas de tabaquismo y consumo del alcohol.