The Tragedy of Having ESRD in Mexico

Garcia-Garcia, Guillermo; Chávez-Íñiguez, Jonathan S

doi:10.1016/j.ekir.2018.07.018

Cited by 25 publications

(38 citation statements)

References 5 publications

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“…First, the lack of CKD surveillance in Mexico limits the potential for early diagnosis and timely referral of CKD pregnancies [45]. Similar to the report of Sato et al [10], in more than half of our cases, CKD diagnosis was made during pregnancy, mostly in the second and third trimester of gestation.…”

Section: Discussion/conclusionsupporting

confidence: 70%

Challenges in Managing Pregnancy in Underserved Women with Chronic Kidney Disease

et al. 2019

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Background: Chronic kidney disease (CKD) is a global public health problem and is linked to adverse outcomes during pregnancy; the high prevalence of CKD (3–6%) in women of childbearing age is of particular relevance in emerging countries where CKD prevalence is higher and resources are limited. Although CKD is a public health problem in Mexico, there is scant information on outcomes in pregnant CKD women in this country. We report maternal–fetal outcomes in a prospective cohort of poor, CKD pregnant women, and compare results with those of pregnant women without CKD. Methods: A prospective study of pregnant CKD women referred to a public obstetrics/nephrology clinic from July 2013 to December 2017; sociodemographic and clinical data, including complications and perinatal outcomes, were recorded. CKD was defined at referral as per KDIGO guidelines; preeclampsia and superimposed preeclampsia were defined as appearance or worsening of hypertension and proteinuria. Findings were compared to official data for Mexico and to a historic control of pregnant women without CKD who delivered at our hospital. Results: Sixty-two pregnancies in CKD patients, age 23.4 ± 5.8 years were observed; 46.8% of patients were primiparous. At referral, serum creatinine was 1.8 (1.1–3.0) mg/dL with an estimate glomerular filtration rate (eGFR) of 38.1 (21.9–68.0) mL/min/1.73 m². In half of the cases, CKD was diagnosed during pregnancy. Forty-eight pregnant women without CKD, age 27 (22–34) years, who delivered during the study period were selected as controls: 33% were primiparous, serum creatinine was 0.50 (0.4–0.6) mg/dL, and estimate glomerular filtration rate was 135 (112–174) mL/min/1.73 m². Twenty patients needed dialysis (HD-CKD): 2 were already on dialysis, and 18 began treatment during pregnancy; 42 CKD patients did not require dialysis (non-HD CKD). After delivery, 15 patients remained dialysis dependent while 5 did not. Preeclampsia was more frequent in CKD patients in comparison to controls. In total, 93% of CKD patients and 98% of controls delivered a live baby. Prematurity was more frequent in CKD patients than controls and was higher in HD-CKD than in non-HD CKD. Birth weight was lower in CKD when compared to controls. Logistic regression showed a higher risk of preeclampsia in CKD pregnancies than in controls, but it was not affected by age, parity, CKD stage, or need for dialysis during pregnancy. Conclusions: Underserved CKD Mexican women have a high rate of adverse maternal-fetal outcomes during pregnancy. The risk may be higher in patients needing dialysis during pregnancy, many of whom remained dialysis dependent after delivery.

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Section: Discussion/conclusionsupporting

confidence: 70%

Challenges in Managing Pregnancy in Underserved Women with Chronic Kidney Disease

et al. 2019

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“…Cost per year (USD) PD $6000 HD $9000 pmp: per million population, RRT: renal replacement therapy, PD: peritoneal dialysis, CAPD: continuous ambulatory peritoneal dialysis, APD: automated peritoneal dialysis, HH: home hemodialysis, VC: vascular catheter, AVF: arteriovenous fistula Source: References 1,6,7,11,12.…”

Section: Author Contributionsmentioning

confidence: 99%

“…The estimated prevalence of CKD in Mexico is 8.5% however it is important to mention that despite multiple national efforts, as of today, Mexico lacks a National CKD or Dialysis Registry. Access to RRT is limited or non-existent for the uninsured population which represents 49% of the country's population, out of this only 3% can afford private health insurance leaving the rest without access to social security benefits or private health care services 6 . Figure 1 program, 8.2% for patients that received HD only when it became an emergency (intermittent HD) and 11.4% for patients on emergency peritoneal dialysis or intermittent peritoneal dialysis (IPD).…”

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confidence: 99%

“…Although the kidney transplant rate has increased from 1.57 per million population in 1984 to 22.8 per million population in 2015, only 2939 kidney transplants were done in the country in 2019 and 17,189 patients are currently on the deceased donor list 17 . Since the cost of kidney transplantation and immunosuppressive therapy is not provided for the uninsured patients, the kidney transplantation rate is lower in patients without social security 6 . In fact, transplant rates are (72 pmp) in the insured population than non-insured population (7.5 pmp) 3 .…”

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confidence: 99%

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Global Dialysis Perspective: Mexico

Vasquez-Jimenez¹,

Madero²

2020

Kidney360

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“…Access to dialysis and kidney transplantation for this population is limited or nonexistent. 35 Action. To reduce health disparities, a constitutional reform was introduced in 1983, recognizing the right of Mexicans to access health insurance.…”

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confidence: 99%

Global case studies for chronic kidney disease/end-stage kidney disease care

Yang

Harris

Luyckx

et al. 2020

Kidney International Supplements

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T he prevalence of chronic kidney disease (CKD) and its risk factors is increasing worldwide, and there is a rapid rise in global need for the treatment of end-stage kidney disease (ESKD). The global nephrology community recognizes the need for a plan to address the growing incidence of CKD and a cohesive approach for CKD/ESKD integrated care. 1 This provides a major challenge for health systems, particularly

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The Tragedy of Having ESRD in Mexico

Cited by 25 publications

References 5 publications

Challenges in Managing Pregnancy in Underserved Women with Chronic Kidney Disease

Challenges in Managing Pregnancy in Underserved Women with Chronic Kidney Disease

Global Dialysis Perspective: Mexico

Global case studies for chronic kidney disease/end-stage kidney disease care

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