Resumen La relación médico-paciente (RMP) es una relación profesional-interpersonal base para la gestión de la salud. Nuestro objetivo fue desarrollar un instrumento que permitiera evaluar la presencia de los principios bioéticos en la atención médica recibida en la consulta externa de una institución hospitalaria. El instrumento quedó constituido por 21 reactivos para evaluar su confiabilidad y consistencia. El coeficiente de correlación intraclase fue de 0,81 (p < 0,05); para el cumplimiento de los principios bioéticos, fue de 0,740 (p < 0,05). El cuestionario mostró que la autonomía fue el principio más reportado (69 %), después la dignidad (67 %) y justicia (60 %). La presencia de los principios de la bioética ampliados hace más llevadera la enfermedad.

Abstract Physician-patient relationship (PPR) is a professional-interpersonal relationship that serves as the basis for health management. We aimed to develop an instrument for patients to assess the medical attention received in the outpatient clinic. A 21 question instrument was administered to evaluate its reliability and consistency. The intraclass correlation coefficient was 0.81 (p < 0.05); to fulfill the bioethical principles, the intraclass correlation coefficient was 0.740 (p < 0.05), allowing us to get familiar with the perception of patients who attended the Nephrology Service. The survey showed autonomy as the most reported principle (69 %), followed by dignity (67 %) and justice (60 %). Courtesy, punctuality, and respect make the disease and its treatment more bearable, in addition to promoting the ethics of third parties.

Resumo A relação médico-paciente é uma relação profissional interpessoal, base para a gestão da saúde. Nosso objetivo foi desenvolver um instrumento que permitisse avaliar a presença dos princípios bioéticos na atenção médica recebida na consulta de uma instituição hospitalar. O instrumento foi constituído de 21 reativos para avaliar sua confiabilidade e consistência. O coeficiente de correlação intraclasse foi de 0,81 (p < 0,05); para o cumprimento dos princípios bioéticos, foi de 0,740 (p < 0,05). O questionário mostrou que a autonomia foi o princípio mais relatado (69%), depois da dignidade (67%) e da justiça (60%). A presença dos princípios da bioética ampliados torna a doença mais suportável.

Abstract Background: permissibility in the selection of living kidney donors (LKD) with one or more cardiometabolic risk factors (CMRFs) and/or metabolic syndrome (MS) is an increasingly frequent practice worldwide. These factors, together with kidney donation specifically, are known to be associated with an increased risk of chronic kidney disease (CKD). Methods: we analyzed the frequency of CMRFs and MS before and after kidney donation in LKD. In the secondary analysis, we associated CMRFs and MS with renal function. The SPSS V22.0 software was used. Results: we analyzed 110 LKD patients, with a mean age of 35.05 ± 10.5 years: 63 (57.3 %) men and 47 (42.7 %) women. Patients were followed for 25 ± 17.48 months after nephrectomy. Prior to donation, 62 patients (56.4 %) had MS, and the presence of one to six CMRFs was 19.1 %, 32 %, 18.2 %, 17.3 %, 3.6 %, and 0.9 %, respectively. During follow-up, in donors, the incidence of overweight increased from 48.2 % to 52.7 %, (p < 0.01); that of obesity increased from 11.8 % to 20.9 % (p < 0.01); that of hyperuricemia increased from 17.3 % to 26.4 %, (p < 0.01); that of hypercholesterolemia increased from 24.5 % to 33.6 % (p < 0.01); and that of hypertriglyceridemia increased from 47.3 % to 50.9 % (p < 0.01), while the incidence of MS decreased from 56.4 % to 51.8 % (p < 0.01). A logistic regression analysis showed that the presence of CMRFs did not show any association with glomerular filtration rates below 60 mL/min/1.73 m2. Conclusion: LKD had a high frequency of CMRFs and MS at the time of donation, and over time, the incidence of CMRFs significantly increased. Because these factors, together with kidney donation, could be associated with an increased risk of CKD, we must evaluate protocols for LKD and consider stricter criteria in the selection of LKD, with an emphasis on follow-up protocols to address CMRFs and MS.

Resumen Introducción: la permisibilidad en la selección de los donantes renales vivos (DRV) con uno o más factores de riesgo cardiometabólico (FRCM) y/o síndrome metabólico (SM) es una práctica cada vez más frecuente en todo el mundo. Se sabe que estos factores, junto con la donación de riñón, específicamente, están asociados con un mayor riesgo de enfermedad renal crónica (ERC). Métodos: analizamos la frecuencia de los FRCM y SM antes y después de la donación renal en DRV. En el análisis secundario, asociamos los FRCM y la SM con la función renal. Se utilizó el programa SPSS V22.0. Resultados: se analizaron 110 DRV con una edad media de 35,05 ± 10,5 años: 63 (57,3 %) hombres y 47 (42,7 %) mujeres. Los pacientes fueron seguidos durante 25 ± 17,48 meses después de la nefrectomía. Antes de la donación, 62 pacientes (56,4 %) tenían SM y la presencia de uno a seis FRCM era del 19,1 %, 32 %, 18,2 %, 17,3 %, 3,6 % y 0,9 %, respectivamente. Durante el seguimiento, en los donantes, la incidencia del sobrepeso aumentó del 48,2 % al 52,7 % (p < 0,01); la de la obesidad pasó del 11,8 % al 20,9 % (p < 0,01); la de la hiperuricemia aumentó del 17,3 % al 26,4 % (p < 0,01); la de la hipercolesterolemia aumentó del 24,5 % al 33,6 % (p < 0,01); y la de la hipertrigliceridemia aumentó del 47,3 % al 50,9 % (p < 0,01), mientras que la incidencia del SM disminuyó del 56,4 % al 51,8 % (p < 0,01). El análisis de regresión logística mostró que la presencia de FRCM no presentaba ninguna asociación con las tasas de filtración glomerular por debajo de 60 ml/min/1,73 m2. Conclusión: los DRV tuvieron una alta frecuencia de FRCM y SM en el momento de la donación y, con el tiempo, la incidencia aumentó significativamente. Debido a que estos factores, junto con la donación de riñón, podrían estar asociados a un mayor riesgo de ERC, debemos evaluar los protocolos de los DRV y considerar criterios más estrictos en la selección de estos donantes, haciendo énfasis en los protocolos de seguimiento para tratar los FRCM y el SM.

Abstract: Introduction: Information regarding severity of uremic pruritus, impact on sleep quality in patients with end stage renal disease (ESRD) in renal replacement therapy (RRT) is scarce in Mexico. Objective: To correlate clinical and biochemical features, body mass index (BMI), sleep quality impairment with severity of uremic pruritus in patients with ESRD in RRT. Material and methods: Cross sectional study with patients of “Hospital General de México” from August through September 2018. Clinical, biochemical and sleep quality variables were collected. Characteristics of pruritus four weeks before assessment was obtained. A descriptive analysis and multivariate logistic regression for severe pruritus [visual analogue scale (VAS) of > 6 points] were analyzed. Results: Data from 99 patients was included. 60.6% male, age 44.9 ± 4.2 years. Patients with severe pruritus were older (42.4 vs 49.7 years p = 0.021), had higher BMI (23.8 vs 25.9 kg/m2, p = 0.019). Other associations identified were BMI ≥ 24 kg/m2 [OR = 3.37 (95% CI 1.008-11.29, p = 0.049)], disseminated pruritus [OR = 17.2 (95% CI 1.039-286.6, p = 0.047)]; awakenings OR = 10.9 (95% CI 2.21-53.87, p = 0.003). No association was observed for biochemical variables or TRR modality. Conclusions: Severe uremic pruritus was associated with higher BMI, older age, disseminated affection and awakenings.

Resumen: Introducción: Se desconocen los factores asociados a prurito urémico grave y el impacto sobre la calidad del sueño en pacientes con enfermedad renal crónica (ERC) en terapia de reemplazo renal (TRR) en México. Objetivo: Correlacionar características clínicas y bioquímicas con la gravedad del prurito urémico en pacientes con ERC en TRR. Material y métodos: Estudio descriptivo, transversal en el Hospital General de México de agosto a septiembre de 2018. Incluimos variables demográficas, bioquímicas y características del prurito urémico cuatro semanas previas a la evaluación. Se realizó estadística descriptiva y regresión logística binaria multivariada para identificar factores de riesgo para prurito grave, definido con escala visual análoga (EVA) > 6 puntos. Resultados: Se incluyeron 99 pacientes, 60.6% varones, edad promedio 44.9 ± 4.2. Variables asociadas a prurito grave: edad (42.4 vs 49.7, p = 0.021), IMC (23.8 vs 25.9 kg/m2, p = 0.019). Los factores asociados a prurito grave obtenidos en el análisis de regresión multivariado fueron IMC ≥ 24 (OR = 3.37 [IC95% 1.008-11.29, p = 0.049]), prurito diseminado (OR = 17.2 [IC95% 1.039-286.6, p = 0.047]), despertares (OR = 10.9 [IC95% 2.21-53.87, p = 0.003]). No se observó asociación con variables bioquímicas ni modalidad de TRR. Conclusiones: El prurito urémico grave tuvo asociación con mayor IMC, edad, presentación diseminada y despertares.

ABSTRACT Background: Cardiometabolic risk factors (CMRFs) appear decades before developing chronic kidney disease (CKD) in adulthood. Objective: The objective of the study was to identify the prevalence and association between CMRFs and kidney function in apparently healthy young adults (18-25 years old). Methods: We included 5531 freshman year students. Data collected on CMRFs included central obesity, high body mass index (hBMI >25), blood pressure, glycemia, lipids, uric acid (UA >6.8 mg/dL), and insulin. Glomerular filtration rate (GFR) was estimated by CKD-Epidemiology Collaboration formula. We used logistic regression and a log linear for odds ratio (OR) (95% confidence level) and probabilities. Results: The presence of any CMRF was observed in 78% (4312) of individuals; GFR ≥120/130 mL/min/1.73 m2sc was found in 33%, GFR <90 mL/min/1.73 m2sc in 3%, and proteinuria in 3%. Factors associated with high GFR were hBMI (OR 1.3 [1.14, 1.47]), UA (OR 0.2 [0.15, 0.26]), high-density lipoprotein (HDL) (OR 1.4 [1.2, 1.6]), and insulin resistance (OR 1.3 [1.05, 1.7]). CMRF associated with low GFR was UA (OR 1.8 [1.3, 2.6]), low-density lipoprotein cholesterol (OR 1.66 [1.05, 2.6]), and proteinuria (OR 3.4 [2.07, 5.7]). Proteinuria was associated with high UA (OR 1.59 [1.01, 2.5]) and hypercholesterolemia (OR 1.8 [1.03, 3.18]). The sole presence of hBMI+UA predicted low GFR with p = 0.6 and hBMI+UA+low HDL predicted proteinuria with p = 0.55. Conclusions: CMRFs were highly prevalent among this freshman student population and were associated with proteinuria and GFR abnormalities. Future studies should focus on public health programs to prevent or delay the development of CKD.

RESUMO Objetivo: Determinar a prevalência de doença renal crônica (DRC) e os fatores epidemiológicos, clínicos e laboratoriais associados à DRC em pacientes mexicanos infectados pelo HIV. Métodos: Estudo transversal. Incluímos 274 pacientes com HIV/AIDS. A DRC foi definida pela taxa de filtração glomerular estimada (TFGe < 60 mL/min/1,73 m2, avaliada pelo CKD-EPI) e pelos critérios de albuminúria das diretrizes do KDIGO. As características clínicas, epidemiológicas e laboratoriais foram comparadas entre pacientes com e sem DRC. Os fatores associados à DRC foram avaliados por análise de regressão logística. Resultados: A média da idade foi de 41 ± 11 anos e 72,3% dos pacientes eram homens. A prevalência global de DRC foi de 11,7% (n = 32); 7,2% (n = 20) foram definidos pelo critério TFGe; 7,6% (n = 21), pelo critério da albuminúria; e 3,2% (n = 9), pelos dois critérios para DRC. Os estágios mais frequentemente observados da DRC foram o estágio KDIGO G3A1 com 4,7% (n = 13); estágio KDIGO G1A2 com 3,6% (n = 10) e estágio KDIGO G3A2 com 1,7% (n = 5). Os fatores associados à DRC foram o uso de abacavir/lamivudina (OR 3,2; IC95% 1,1-8,9; p = 0,03), contagem de linfócitos CD4 < 400 células/µL (OR 2,6; 95% 1,03-6,4, p = 0,04), idade (OR 1,1; IC95% 1,04-1,2, p = 0,001) e albuminúria (OR 19,98; IC95%: 5,5-72,2; p < 0,001). Conclusões: A DRC foi uma complicação frequente em pacientes infectados pelo HIV. Esses achados confirmam a importância do rastreamento e da detecção precoce da DRC, bem como a importância de identificar e tratar os fatores de risco tradicionais e não tradicionais associados à DRC.

ABSTRACT Aim: To determine the prevalence of chronic kidney disease (CKD) and the epidemiological, clinical, and laboratory factors associated with CKD in Mexican HIV-infected patients. Methods: Cross-sectional study. We included 274 patients with HIV/AIDS. CKD was defined by the estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2 assessed by CKD-EPI) and albuminuria criteria from KDIGO guidelines. Clinical, epidemiological, and laboratory characteristics were compared between patients with and without CKD. The factors associated with CKD were assessed by logistic regression analysis. Results: The mean age was 41±11 years, and 72.3% of the patients were men. The global prevalence of CKD was 11.7% (n = 32); 7.2% (n = 20) were defined by eGFR criterion; 7.6% (n = 21), by the albuminuria criterion; and 3.2% (n = 9), by both CKD criteria. The most frequently observed stages of CKD were KDIGO G3A1 stage with 4.7% (n = 13), KDIGO G1A2 stage with 3.6% (n = 10) and KDIGO G3A2 stage with 1.7% (n = 5). The factors associated with CKD were use of abacavir/lamivudine (OR 3.2; 95% CI 1.1-8.9; p = 0.03), a CD4 lymphocyte count < 400 cells/µL (OR 2.6; 95% 1.03-6.4, p = 0.04), age (OR 1.1; 95% CI 1.04-1.2, p = 0.001) and albuminuria (OR 19.98; 95% CI: 5.5-72.2; p < 0.001). Conclusions: CKD was a frequent complication in HIV-infected patients. These findings confirm the importance of screening and the early detection of CKD, as well as the importance of identifying and treating traditional and non-traditional risk factors associated with CKD.