Population Kidney Health. A New Paradigm for Chronic Kidney Disease Management.

Statistical data extracted from national databases demonstrate a continuous growth in the incidence and prevalence of chronic kidney disease (CKD) and the ineffectiveness of current policies and strategies based on individual risk factors to reduce them, as well as their mortality and costs. Some innovative programs, telemedicine and government interest in the prevention of CKD did not facilitate timely access to care, continuing the increased demand for dialysis and transplants, high morbidity and long-term disability. In contrast, new forms of kidney disease of unknown etiology affected populations in developing countries and underrepresented minorities, who face socioeconomic and cultural disadvantages. With this background, our objective was to analyze in the existing literature the effects of social determinants in CKD, concluding that it is necessary to strengthen current kidney health strategies, designing in a transdisciplinary way, a model that considers demographic characteristics integrated into individual risk factors and risk factors population, incorporating the population health perspective in public health policies to improve results in kidney health care, since CKD continues to be an important and growing contributor to chronic diseases.

[Chronic renal disease in Puerto Rico: incidence, prevalence, and mortality in 2000-2008]. / Enfermedad renal permanente en Puerto Rico: incidencia, prevalencia y mortalidad de 2000-2008.

BACKGROUND: End-Stage Renal Disease (ESRD) is a global public health problem. Although there are strategies for its prevention, the number of cases has increased. In order to understand current situation in Puerto Rico (PR) we review available data, which is presented in a descriptive report of the incidence, prevalence and mortality of ESRD during the period 2000-2008. In addition, we compare the incidence and prevalence rates with regard to other countries. METHODS: We used 2000-2008 USRDS statistics and the QIRN3 for patients on dialysis. Transplanted patients were excluded. Crude rates of incidence and prevalence in PR were calculated for comparison with the United States and other countries. Percentages were calculated to describe the demographic characteristics and primary diagnosis in 2008. RESULTS: During the period 2000-2008 the incidence rate increased by 21.6 percent; from 286.8 to 348.7 pmp. The prevalence rate increased by 27.3 percent; from 861.2 to 1096.2 pmp. The average annual growth in the incidence and prevalence was 2.4 percent and 3.0 percent respectively. During the same period, diabetes mellitus was the leading cause of ESRD reaching 67.4 percent of total new cases in 2008, while in the U.S. was 44.4 percent. Unadjusted mortality decreased slightly in 2008 to 18.5 percent. PR is the fifth country with the highest incidence of patient on dialysis and the first with ESRD due to diabetes mellitus. CONCLUSIONS: ESRD is becoming more common and prevalent in PR. We should be more aggressive in establishing public health strategies to reduce ESRD.

Systematic approach for the management of chronic kidney disease: moving beyond chronic kidney disease classification.

PURPOSE OF REVIEW: This review has two aims: to summarize the evolution of classification criteria for chronic kidney disease (CKD) for diagnosis, prognosis and forecasting population burden of illness; to move the discussion beyond classification to intervention by introducing an approach we describe as the 'Systematic Approach for the Management of CKD' (SAM-CKD). RECENT FINDINGS: There is now ample evidence against the use of estimated GFR (eGFR) as the sole criterion for classifying CKD for the purpose of diagnosis, risk stratification and prediction of progression. There is ample evidence that significant proteinuria is a powerful predictor of progression but even more so when combined with reduced eGFR for individual and population risk projection. Hypertension also is an important indicator in CKD progression but not in all studies. Beyond classification, there are no studies addressing standardization of management of CKD to achieve the outcomes articulated by any of the practice guidelines. SUMMARY: In this article we have moved the discussions of CKD beyond classification by introducing a clinical management tool, SAM-CKD, which couples a broader classification model with a systematic tool for management to foster standardization of CKD management for the future.

Factors associated to the prevalence of antibodies to hepatitis C virus among patients receiving hemodialysis at selected dialysis centers in Puerto Rico, 2005.

BACKGROUND: Limited information about the epidemiology of hepatitis C virus (HCV) infection is available in hemodialysis patients in Puerto Rico. We assessed the factors associated to the prevalence of antibodies to HCV (anti-HCV) among patients receiving hemodialysis in eight dialysis centers in Puerto Rico. METHODS: A systematic sampling design was employed to select a sample of 150 hemodialysis patients (30 anti-HCV+ and 120 anti-HCV-) 21 years and older during 2005. A total of 110 (81.5%) from 135 eligible patients completed a face-to-face interview that gathered data on demographics, and self-reported risk behaviors followed by a clinical record review. Variables that were marginally or significantly associated with the prevalence of anti-HCV (p < 0.10) in the bivariate analyses were considered for inclusion into the multiple logistic regression model to estimate the adjusted prevalence odds ratio (POR). RESULTS: Bivariate analysis revealed that age (POR(C) = 3.65, p = 0.05), blood transfusions prior to 1992 (POR(C) = 5.13, p = 0.05), tattooing practices (POR(C) = 13.29, p = 0.04), and illegal drug use (POR(C) = 4.53, p = 0.01) were associated with anti-HCV. Multivariate analysis revealed that blood transfusions prior to 1992 (POR(A) = 11.05; p = 0.04) remained significantly associated with anti-HCV after adjusting for age, tattooing practices, illegal drug use and dialysis center. Age (POR(A) = 5.40; p = 0.06) was marginally associated with anti-HCV after adjusting for blood transfusions prior to 1992, tattooing practices, illegal drug use and dialysis center. CONCLUSIONS: The present study showed that the profile of risk factors for the hemodialysis population was similar to the profile of risk factors reported in the general population.

La nefrología en latinoamérica : estado actual pautas para su desarrollo

Nefrología

Enfermo renal

Enfermedad renal permanente en Puerto Rico, tendencia de morbilidad y mortalidad 1970-1994 / Permanent renal disease in Puerto Rico, morbidity and mortality trends 1970-1994

To describe the characteristics and trends of the incidence and mortality of End-Stage Renal Diseases (ESRD) in Puerto Rico, a descriptive analysis of the data of all patients treated with dialysis between 1970 through 1994 was conducted. A total of 7,256 patients received dialysis treatment for ESRD in Puerto Rico. Of these, 61 percent were males and 39 percent were females. Diabetes (41.7 percent) and glomerulonephritis (18.3 percent) accounted for the largest number of cases followed by circulatory problems(8.3 percent). Hemodialysis was the predominant treatment modality (76 percent). The incidence trend was significant for the predictor variable period of time after adjusting by age and gender (Poisson). The mortality trend was significant for the predictor variables, period of time, gender and age (Poisson). A substantial increment in the incidence and mortality of persons receiving dialysis was found, particularly in the diabetics, males and elderly persons. The casual explanations of these findings requires further study

Incidence and prevalence of HIV-positive patients on chronic hemodialysis at the university and San Juan Hospital

There is controversy on whether or not patients with End Stage Renal Disease (ESRD) on chronic hemodialysis (HD) should be routinely tested for the prsence of HIV-antibody (HIV-Ab) in their blood. Several reports have appeared in the literature reporting incidence from 0 to 11%. A total of 227 patients receiving chronic HD; at the University and San Juan City Hospital, from January to December 1987 were screened for the presence of HIV-Ab by the ELISA method. Those reported as positive were confirmed by the Western Blot method. HIV-Ab presence was reported and confirmed in 9 patients (4%). Five of these patients (2%) were IV drug abusers, 2 (0.9%) homosexual, 1 (0.4%) had history of sexual promiscuity and 1 (0.4%) had been exposed to multiple blood transfusion (MBT) prior to HIV testing of blood. Our prevalence was 7%. However when risk factors other than MBT were excluded the prevalence was 0.4%. The incidence and prevalence of HIV positive cases in our hemodialysis populations is comparable to that previously reported