[Prevalence of obesity and arterial hypertension and their relationship with age and gender in the city of Resistencia, Argentina, in the years 2008-2014]. / Prevalencia de obesidad e hipertensión arterial y su asociación con edad y sexo en la ciudad de Resistencia (Argentina), años 2008-2014.

INTRODUCTION: Obesity (OB) is a global pandemic, which is associated with arterial hypertension (AH). The differences in this relationship according to gender and age remain unclear. The objectives of this study were to establish the prevalence of OB and AH in an adult population, and to determine the risk of AH associated with OB in relationship to gender and age. MATERIAL AND METHODS: A cross-sectional study was performed using the database of successive cross-sectional studies carried out in 5 city squares in Resistencia (Argentina) during the years 2008-2014. The sample was randomised according to gender and age, according to the distribution of the last National Argentine Census. RESULTS: A total of 7,898 passers-by (46.8% males) with a mean age 42.74 ± 16.70 years were included. OB in men increased from 21.3% to 26.9%, and in women from 15.2% to 23%, the former having the highest prevalence between 40-49 years, and the latter between 50-59 years, and thereafter it was always higher in women. AH increased in men from 39.9% to 42.7%, and in women from 25.8% to 29.2%, the former having the highest prevalence between 60-69 years, the latter between 70-79 years. CONCLUSION: In the 7 years of the study, OB and AH prevalence increased. It was higher in men, although the risk of developing AH associated with OB was greater in older women. The highest prevalence of OB and AH appears a decade earlier in men.

Latin American Dialysis and Renal Transplant Registry: 2008 report (data 2006).

INTRODUCTION: Between 1991 and 2006, the Latin American Dialysis and Renal Transplantation Registry collected data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay). Access to RRT was universal in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay, all countries belonging to the medium-high or high income group. METHODS: Data about patients on renal replacement therapy (RRT) were supplied by national affiliates or the Registry's Coordination Committee. Transplant data were gathered and shared with the Latin American and Caribbean Society of Transplantation. RESULTS: RRT prevalence increased from 162 patients per million population (pmp) in 1991 to 478 pmp in 2005 and 473 pmp in 2006 (59.2% hemodialysis, 20.4% peritoneal dialysis and 20.4% with a functioning kidney allograft). Countries with the highest prevalence were Puerto Rico (1,148.9 pmp), Uruguay (924.5 pmp) and Chile (907.6 pmp). Latin America's (LA) incidence increased from 27.8 pmp in 1992 to 188 pmp in 2006. The LA Kidney transplant rate increased from 3.7 pmp in 1987 to 15,4 pmp in 2006, and 166 combined transplants - kidney and another organ, mainly pancreas - were performed. In the medium-high income group 2006, (Argentina, Brazil, Chile, Costa Rica, Cuba, Mexico, Panama, Uruguay, Venezuela) the prevalence rate was 534.8 pmp vs. 289.5 pmp in the middle-low income group. The transplant rate was 18.4 pmp in the medium-high income group vs. 7 pmp in the middle-low group (p < 0.01). CONCLUSIONS: RRT incidence and prevalence continue to grow steadily. Access to RRT is universal only in some countries included in the medium-high or high income group. It is imperative to accomplish the goal of making RRT available to all who need it.

[Latin-American Dialysis and Kidney Transplantation Registry: data on the treatment of end-stage renal disease in Latin America]. / Registro latino-americano di dialisi e trapianto: dati relativi al trattamento dell'insufficienza renale cronica terminale nell'America Latina.

Latin America, a region composed of a series of neighboring countries that share their history, Latin ancestry and language (Spanish or Portuguese), includes Mexico, Central America, the Spanish Caribbean islands, and South America. The Latin-American Dialysis and Kidney Transplantation Registry, which has been operative since 1991, collects data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay), where 97% of Latin Americans live. The prevalence of renal replacement therapy (RRT) has increased from 119 patients per million (pmp) in 1991 to 478.2 in 2005 (147,158 patients [57%] on chronic hemodialysis, 58,251 [23%] on peritoneal dialysis and 52,565 [20%] living with a functioning kidney graft). The incidence rate also increased from 27.8 pmp in 1992 to 167 in 2005. The increment in prevalence and incidence occurred in all Latin- American countries. The transplantation rate increased from 3,7 pmp in 1987 to 15 pmp in 2005 (7,968 kidney transplants performed this year, the cumulative number being 98,415). Access to RRT was available for every patient diagnosed with end-stage renal disease only in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay. In Latin America, the incidence and prevalence of RRT increased year by year. Only in some countries is access to RRT available to 100% of diagnosed patients. Detection and prevention programs for chronic kidney disease are needed in the region. Meanwhile, access to RRT has to be improved for everybody who needs it.

Energy supplementation in chronic hemodialysis patients with moderate and severe malnutrition.

OBJECTIVE: Prospectively evaluate the effect on the nutritional status of a glucose polymer as energy supplementation alone in chronic hemodialysis patients with moderate and severe malnutrition. MATERIAL AND METHODS: The nutritional status of 55 hemodialysis patients was assessed by using a score that included Iron binding capacity, albumin, cholesterol, body mass index, mid brachial circumference, arm muscle area, triceps skinfold, and clinical impression. Twenty-two of 27 patients (14 men and 8 women, mean age 43 +/- 15 years, time on dialysis 65 +/- 49 months) were classified as moderately or severely malnourished and were supplemented for 6 months with 100 g of glucose polymers per day (equivalent to 380 kcal or 1590 kJ) added to the usual food intake. The patients were reevaluated at 3 and 6 months. RESULTS: Only body weight, body mass index, triceps skinfold, and brachial circumference and clinical impression increased significantly at the end of the third month (P < .05) in the 22 patients. These results were confirmed at 6 months in 18 patients that completed the study. Mean body weight increase was 2.4 kg (range, .2 to 6.3 kg). The nutritional status, evaluated through the score, improved in only 4 patients at the end of the study. Few gastrointestinal side effects were observed. Triglycerides increased from 136 +/- 40 mg/dL to 235 +/- 120 mg/dL. Follow-up of the patients showed that fat mass (assessed by anthropometry) was maintained for 6 months after supplementation was discontinued. CONCLUSION: Energy supplementation alone in patients with moderate and severe malnutrition on chronic hemodialysis resulted in an increase in body weight, owing to an increase in body fat, but the nutritional status did not improve.

[Outcome of diabetic patients on chronic hemodialysis. Comparative analysis of survival and morbidity of polycystic and elderly patients]. / Evolución de pacientes diabéticos en hemodiálisis crónica. Analisis comparativo de sobrevida y morbilidad con pacientes poliquísticos y mayores de 60 años.

We analyzed retrospectively the outcome of 169 patients in chronic hemodialysis (CHD), divided into four groups: 1) 24 patients with diabetic nephropathy (age 53.7 +/- 11 years); 2) 19 with polycystic kidney disease (age 55.3 +/- 9 years) 3) 43 patients older than 60 when starting chronic hemodialysis with etiologies different from diabetes and polycystic kidney disease (age 69.2 +/- 5.8 years) and 4) 83 patients younger than 60 with diverse etiologies (age 42.8 +/- 12.4 years). In groups 1, 2 and 3 serum creatinine, arterial hypertension at the beginning, morbility, mortality and its causes were registered. In group 1, the prevalence of severe diabetic retinopathy and cardiovascular disease at the beginning were also analyzed. In all groups survival was determined. Of the diabetics, 92% presented severe diabetic retinopathy and 88% cardiovascular disease. The prevalence of hypertension was 100, 74 and 67% in groups 1, 2 and 3, respectively (p = 0.13). Twelve diabetics died before the first year of treatment; there was no difference in creatinine, age, cardiovascular disease, severe retinopathy and hypertension with those who lived more than one year. The percentage of time in risk hospitalized and the days/patients/year hospitalized were significantly different between group 1 and 3 and group 2 (p < 0.001). Patients were hospitalized for similar causes in groups 1 and 3: the initiation of CHD, cardiovascular and neurological diseases. The main causes of death in groups 1 and 3 were: cardiovascular disease and sudden death at home. Survival was better in group 2 compared with group 1 (p = 0.0014) but was similar between groups 1 and 3 (p = 0.21) even though there was a difference of 15 years between them. The Cox's proportional hazard model identified as risk factors diabetes, age, year of starting chronic hemodialysis and hospitalization episodes, adjusted for covariates. The outcome of diabetic patients in chronic hemodialysis showed high morbidity and mortality and was quite similar to that of elderly patients.

Latin American Registry of dialysis and renal transplantation: 1993 annual dialysis data report.

BACKGROUND: The Latin American Registry of Dialysis and Transplantation was created in October 1991 and comprises the National Societies of Nephrology from 21 countries with a total population of 468.56 million inhabitants. METHODS: This report includes data from 21,181 patients from Argentina, Brazil, Chile, El Salvador, Panama, Paraguay, Peru, Puerto Rico, Uruguay, and Venezuela who were receiving chronic dialysis treatment during 1993. Data was collected by individual patient questionnaires except from Chile and Brazil where the data was obtained from a local centre questionnaire. RESULTS: The prevalence rate averaged 131.1 per million population. The mean age of the 8972 incident patients was 50.5 years, with 58.2% males. The more frequent causes of renal failure were glomerulopathies (22.6%), vascular nephropathy (20.9%) and diabetes (16.9%). Haemodialysis was the most used treatment (88.3%). Gross mortality was 21.1% and the more frequent causes of death were cardiac complications and infections. The analysis of mortality risk factors using a logistic regression model showed that diabetics patients older than 65 years had the highest probability of death (43.0%) and patients with glomerulonephritis, younger than 65 years had the lowest (8.0%). The adjusted mortality rate was 241 deaths/1000 patient-years at risk when the USRDS 1987-1989 white mortality rate by age groups and primary diseases was used as standard. CONCLUSION: In spite of the economic difficulties, very important efforts have been made to treat ESRD patients and gross mortality statistics in some countries are similar to those reported by other regional registries.

[Incidence, etiology and prognostic value of persistent significant proteinuria in kidney transplants]. / Incidencia, etiología y pronóstico de la proteinuria persistente significativa en el trasplante renal.

We investigated persistent significant proteinuria (PSP), defined as proteinuria > 1 gr/24 hours on three consecutive months, in renal allograft recipients. The clinical records of 273 patients (288 grafts) were reviewed and 236 grafts (178 live related, 58 cadaver donor) that functioned for at least 4 months (230 patients, 148 men and 82 women) were selected for analysis. The histological diagnoses of 226 grafts and 35 native kidneys were also reviewed. PSP was present in 67 grafts (28.4%); 43 of these grafts were studied histologically (transplant glomerulopathy (TxGPT) 19, idiopathic glomerulopathy (GP) 13, and chronic rejection 11). Patients with an idiopathic GP in the graft usually presented with the nephrotic syndrome (65%); this presentation was infrequent in patients with chronic rejection. The appearance of proteinuria was strongly associated with functional deterioration in grafts with chronic rejection and TxGPT; in grafts with PSP and a histological diagnosis of idiopathic GP, renal function was usually normal. Within grafts with PSP no statistically significant differences in actuarial survival (AS) could be established when the time of appearance or magnitude of PSP, the presence or absence of arterial hypertension, the immunosuppressive regimen, and the histological diagnosis were considered. Contrariwise, the difference in AS was highly significant (p < 0.0001) when grafts with and without PSP were compared. The former had an AS at 5 and 10 years of 74.6% and 55.7%, while in the case of the latter AS was 57.3% and 32.1%, respectively. In conclusion, in the present series 28.4% of grafts that functioned 4 months or more presented PSP. The most frequent glomerular lesion was TxGPT. The presence of PSP was a marker for poorer prognosis, since AS at 5 and 10 years was significantly less in this group.

Epidemiology and prevention of diabetic nephropathy.

Diabetes mellitus is the leading underlying cause of end-stage renal disease in the USA. To develop preventive strategies aimed at combatting diabetic end-stage renal disease, three steps are required: first, the delineation of the natural history of diabetic nephropathy; second, the identification of modifiable risk factors for the development and progression of diabetic nephropathy; and third, the demonstration that manipulation of these factors does indeed reduce risk. A review of the literature regarding the epidemiology and prevention of diabetic renal disease in humans published during the past year revealed a wealth of data which may guide preventive efforts. Prospective cohort studies confirmed that microalbuminuria is a strong predictor of nephropathy and that blood pressure is an important modifiable risk factor for the progression of diabetic renal disease. In addition, observational studies identified several novel factors which might also increase risk. Randomized controlled trials provided convincing evidence that strict glycemic control reduces the risk of progression to diabetic nephropathy by 50%. Data from trials also demonstrated that angiotensin-converting enzyme inhibitors slow the progression of renal disease beyond their effect on blood pressure alone. Future research should further evaluate novel modifiable risk factors, define optimal treatment strategies for the use of angiotensin-converting enzyme inhibitors and antihypertensive agents, and develop methods to translate these findings into practice for the general population.