The increase in the prevalence of diabetes mellitus (DM) and the secondary kidney damage produces diabetic nephropathy (DN). Early nephropathy is defined as the presence of microalbuminuria (30–300 mg/day), including normal glomerular filtration rate (GFR) or a mildly decreased GFR (60–89 mL/min/1.73 m2), with or without overt nephropathy. The earliest change caused by DN is hyperfiltration with proteinuria. The acceptable excretion rate of albumin in urine is <30 mg/day. Albuminuria represents the excretion of >300 mg/day. Chronic kidney disease (CKD) is characterized by abnormalities in renal function that persist for >3 months with health implications. Alterations in the redox state in DN are caused by the persistent state of hyperglycemia and the increase in advanced glycation end products (AGEs) with ability to affect the renin-angiotensin system and the transforming growth factor-beta (TGF-β), producing chronic inflammation and glomerular and tubular hypertrophy and favoring the appearance of oxidative stress. In DN imbalance between prooxidant/antioxidant processes exists with an increase in reactive oxygen species (ROS). The overproduction of ROS diminishes expression of the antioxidant enzymes (manganese superoxide dismutase, glutathione peroxidase, and catalase). The early detection of CKD secondary to DN and the timely identification of patients would permit decreasing its impact on health.

Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. Methods. We conducted this retrospective observational study in critically ill patients with COVID-19. Patients’ characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. Results. Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147–15.425, p = 0.030 ). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219–3.252, p = 0.006 ). Conclusion. The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.

<b><i>Background:</i></b> Based on the pathophysiology of acute kidney injury (AKI), it is plausible that certain early interventions by the nephrologist could influence its trajectory. In this study, we investigated the impact of 5 early nephrology interventions on starting kidney replacement therapy (KRT), AKI progression, and death. <b><i>Methods:</i></b> In a prospective cohort at the Hospital Civil of Guadalajara, we followed up for 10 days AKI patients in whom a nephrology consultation was requested. We analyzed 5 early interventions of the nephrology team (fluid adjustment, nephrotoxic withdrawal, antibiotic dose adjustment, nutritional adjustment, and removal of hyperchloremic solutions) after the propensity score and multivariate analysis for the risk of starting KRT (primary objective), AKI progression to stage 3, and death (secondary objectives). <b><i>Results:</i></b> From 2017 to 2020, we analyzed 288 AKI patients. The mean age was 55.3 years, 60.7% were male, AKI KDIGO stage 3 was present in 50.5% of them, sepsis was the main etiology 50.3%, and 72 (25%) patients started KRT. The overall survival was 84.4%. Fluid adjustment was the only intervention associated with a decreased risk for starting KRT (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.48–0.70, and <i>p</i> ≤ 0.001) and AKI progression to stage 3 (OR: 0.59, 95% CI: 0.49–0.71, and <i>p</i> ≤ 0.001). Receiving vasopressors and KRT were associated with mortality. None of the interventions studied was associated with reducing the risk of death. <b><i>Conclusions:</i></b> In this prospective cohort study of AKI patients, we found for the first time that early nephrologist intervention and fluid prescription adjustment were associated with lower risk of starting KRT and progression to AKI stage 3.

México es uno de los países con mayor uso de diálisis peritoneal (DP) en el mundo. Los resultados de la DP (morbimortalidad, tasa de peritonitis y supervivencia de la técnica) en México son comparables a los de otros países (1).El panel de expertos de la International Society of Renal Nutrition and Metabolism (ISRNM) propuso el término de "desgaste proteico energético" (DPE) como aquel estado que presenta un descenso tanto de los depósitos proteicos como de las reservas energéticas (esto es, una pérdida de músculo y de grasa) debido a las múltiples alteraciones nutricionales y catabólicas que ocurren en la enfermedad renal crónica2,3. Estas alteraciones incluyen: disminución en la ingestión calórico-proteica, condiciones co-mórbidas, trastornos endocrinos, aumento en la producción de citoquinas inflamatorias, toxinas urémicas, acidosis metabólica y pérdida de nutrientes durante la terapia de reemplazo renal, etc (2, 3).El término DPE es el que mejor define los síndromes relacionados al desgaste muscular, malnutrición e inflamación que ocurren en esta condición. La caquexia ocurre con poca frecuencia en la enfermedad renal y es la forma más severa de DPE, ya que este último puede referirse a grados leves de depleción de masa proteica y energética2. Por este motivo, nos ha parecido oportuno exponer los datos recientes sobre el DPE en nuestro país, para así, implementar las estrategias adecuadas para abordarlo.La prevalencia de DPE ha sido reportada en un amplio rango que va del 49-92% en la población tanto prevalente (casos ya existentes en DP) como incidente (casos nuevos en DP) en los distintos programas de DP en México (tabla 1) (4-8). Los pacientes sin seguridad social son los que presentan mayor DPE (5,7,8). Este es un grave problema debido a que el DPE se asocia con mortalidad en estos pacientes (9).