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"apellidos" => "Rodríguez-Pérez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699512000432" "doi" => "10.3265/Nefrologia.pre2011.Nov.11114" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000432?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200043X?idApp=UINPBA000064" "url" => "/20132514/0000003200000001/v0_201502091620/X201325141200043X/v0_201502091620/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Economic impact of estimating renal function in patients with systemic lupus erythematosus" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "122" "paginaFinal" => "123" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Marco U. Martínez-Martínez, Carlos Abud-Mendoza" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Marco U." "apellidos" => "Martínez-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:4 [ "nombre" => "Carlos" "apellidos" => "Abud-Mendoza" "email" => array:1 [ 0 => "c_abud@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Unidad Regional de Reumatología y Osteoporosis, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto económico de estimar la función renal en pacientes con lupus eritematoso sistémico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11097_16025_26548_en_11097_t1.jpg" "Alto" => 262 "Ancho" => 1421 "Tamanyo" => 180286 ] ] "descripcion" => array:1 [ "en" => "Costs associated with a single estimate of GFR in Mexico" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor,</span></p><p class="elsevierStylePara">Kidney injury is one of the most important morbidity and mortality factors in patients with systemic lupus erythematosus (SLE).<span class="elsevierStyleSup">1,2 </span>Glomerular filtration rate (GFR) is the best indicator of renal function, and it is important in the diagnosis, determining the stage, gauging treatment response and dosing medications.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The National Kidney Foundation (NKF) recommends estimating GFR using creatinine-based equations.<span class="elsevierStyleSup">4,5</span> On the other hand, the European Consensus of Lupus Glomerulonephritis suggests that renal function in SLE patients should be measured either by serum creatinine levels or by estimating renal function using serum creatinine-based equations, but where GFR is higher than 60ml/min/1.73m<span class="elsevierStyleSup">2</span>, creatinine clearance should be used (CrCl).<span class="elsevierStyleSup">6</span> In a recent publication, we reported on the high frequency of inappropriate sample collection from SLE patients when CrCl is used.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">We took a survey of Mexican rheumatologists to better understand the use of NKF-recommended equations in evaluating renal function in SLE patients.</p><p class="elsevierStylePara">We used the google.com survey tool to send questionnaires to members of the Mexican College of Rheumatology in September 2010. We evaluated their demographic data, including sex, years practicing medicine, number of SLE patients evaluated per week and the rheumatologist’s method for evaluating renal function in patients with SLE.</p><p class="elsevierStylePara">We received responses from 45 rheumatologists throughout the country; the mean age of those responding was 40 years, with a mean of 9.5 years practicing medicine. Of those responding, 75.6% were male and 51.2% saw more than 10 SLE patients per week.</p><p class="elsevierStylePara">Almost half of the rheumatologists (46.7%) use CrCl in all of their patients in order to estimate GFR; 17.8% use it in two-thirds of their patients, and only 13.3% do not use it at all. Only 28.9% of those responding used equations for estimating GFR (MDRD, CKD-EPI, Cockcroft-Gault, others).</p><p class="elsevierStylePara">According to INEGI (Mexican National Institute of Statistics and Geography), nearly 112 million people lived in Mexico in 2010. As per the Peláez-Ballestas et al study, the SLE prevalence in Mexico is 0.06%.<span class="elsevierStyleSup">8 </span>We evaluated the mean cost of CrCl (serum and urinary creatinine in 24 hours) and the mean cost of measuring only serum creatinine (in order to determine GFR by means of equations) in three laboratories in central Mexico. The difference in cost between taking a single GFR measurement by one method or the other is more than 500 000 dollars if the rheumatologist uses CKD-EPI or MDRD instead of 24 hour CrCl (Table 1).</p><p class="elsevierStylePara">Despite the evidence suggesting a high frequency of inappropriate sample collecting and the recommendation made by the NKF, Mexican rheumatologists continue to use CrCl to estimate GFR. The importance of disseminating studies in other diseases, in addition to the NKF guidelines, is firstly due to the fact that the methods mentioned above do not require 24 hour urine collection and that health care systems would save thousands of dollars if this practice were generalised (worldwide); considering that a number of controlled international clinical trials use CrCl to estimate GFR.<span class="elsevierStyleSup">9,10</span></p><p class="elsevierStylePara">These findings show that although the guidelines suggest the use of more exact, less expensive methods, Mexican rheumatologists continue to use methods that are both more expensive and less reflective of true GFR. We must promote studies among doctors showing the benefits for patients in terms of both economic sustainability and reproducibility. If our results among Mexican rheumatologists were similar on a global level, the savings incurred by using better estimation methods could amount to millions of dollars.</p><p class="elsevierStylePara"><a href="grande/11097_16025_26548_en_11097_t1.jpg" class="elsevierStyleCrossRefs"><img src="11097_16025_26548_en_11097_t1.jpg" alt="Costs associated with a single estimate of GFR in Mexico"></img></a></p><p class="elsevierStylePara">Table 1. Costs associated with a single estimate of GFR in Mexico</p>" "pdfFichero" => "P1-E532-S3402-A11097-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11097_16025_26548_en_11097_t1.jpg" "Alto" => 262 "Ancho" => 1421 "Tamanyo" => 180286 ] ] "descripcion" => array:1 [ "en" => "Costs associated with a single estimate of GFR in Mexico" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cervera R, Khamashta MA, Font J,\u{A0}Sebastiani GD, Gil A, Lavilla P, et al. 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2021 February | 34 | 15 | 49 |
2021 January | 33 | 22 | 55 |
2020 December | 26 | 13 | 39 |
2020 November | 19 | 14 | 33 |
2020 October | 13 | 13 | 26 |
2020 September | 19 | 3 | 22 |
2020 August | 39 | 13 | 52 |
2020 July | 22 | 11 | 33 |
2020 June | 23 | 22 | 45 |
2020 May | 35 | 15 | 50 |
2020 April | 33 | 13 | 46 |
2020 March | 31 | 15 | 46 |
2020 February | 20 | 22 | 42 |
2020 January | 40 | 18 | 58 |
2019 December | 45 | 16 | 61 |
2019 November | 37 | 14 | 51 |
2019 October | 7 | 15 | 22 |
2019 September | 16 | 32 | 48 |
2019 August | 13 | 7 | 20 |
2019 July | 16 | 21 | 37 |
2019 June | 24 | 23 | 47 |
2019 May | 16 | 36 | 52 |
2019 April | 39 | 42 | 81 |
2019 March | 26 | 19 | 45 |
2019 February | 20 | 22 | 42 |
2019 January | 21 | 18 | 39 |
2018 December | 74 | 38 | 112 |
2018 November | 95 | 21 | 116 |
2018 October | 79 | 22 | 101 |
2018 September | 73 | 29 | 102 |
2018 August | 46 | 20 | 66 |
2018 July | 48 | 20 | 68 |
2018 June | 60 | 13 | 73 |
2018 May | 59 | 18 | 77 |
2018 April | 66 | 15 | 81 |
2018 March | 70 | 10 | 80 |
2018 February | 46 | 7 | 53 |
2018 January | 65 | 7 | 72 |
2017 December | 56 | 10 | 66 |
2017 November | 53 | 9 | 62 |
2017 October | 41 | 11 | 52 |
2017 September | 45 | 9 | 54 |
2017 August | 62 | 11 | 73 |
2017 July | 80 | 11 | 91 |
2017 June | 51 | 15 | 66 |
2017 May | 68 | 23 | 91 |
2017 April | 54 | 16 | 70 |
2017 March | 47 | 12 | 59 |
2017 February | 23 | 4 | 27 |
2017 January | 20 | 12 | 32 |
2016 December | 48 | 5 | 53 |
2016 November | 49 | 9 | 58 |
2016 October | 69 | 16 | 85 |
2016 September | 114 | 5 | 119 |
2016 August | 162 | 7 | 169 |
2016 July | 143 | 8 | 151 |
2016 June | 105 | 0 | 105 |
2016 May | 126 | 0 | 126 |
2016 April | 86 | 0 | 86 |
2016 March | 75 | 0 | 75 |
2016 February | 108 | 0 | 108 |
2016 January | 107 | 0 | 107 |
2015 December | 116 | 0 | 116 |
2015 November | 92 | 0 | 92 |
2015 October | 103 | 0 | 103 |
2015 September | 64 | 0 | 64 |
2015 August | 66 | 0 | 66 |
2015 July | 52 | 0 | 52 |
2015 June | 43 | 0 | 43 |
2015 May | 66 | 0 | 66 |
2015 April | 10 | 0 | 10 |