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Vol. 42. Issue. 3.May - June 2022
Pages 223-362
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Vol. 42. Issue. 3.May - June 2022
Pages 223-362
Letter to the Editor
Open Access
Morbidity, mortality, and renal replacement therapy for chronic kidney disease in Mexico between 2016 and 2018
Morbilidad, mortalidad y terapia de reemplazo renal por enfermedad renal crónica en México entre 2016 y 2018
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Luis Alberto Dorantes-Carrilloa, Martha Medina-Escobedob, Yaseth Aridai Cobá-Cantoc, Alberto Alvarez-Baezac, Nina Méndez Domínguezb,
Corresponding author
nina.mendez@salud.gob.mx

Corresponding author.
a Universidad Autonoma de Yucatan, Facultad de Medicina, Merida, Mexico
b Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, Mexico
c Universidad Marista de Merida, Escuela de Medicina, Merida, Mexico
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Tables (1)
Table 1. Hospitalizations, in-hospital deaths, and general mortality due to CKD in Mexico between 2016 and 2018.
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Dear Editor:

Due to the availability, access, and the administration of specialised health services for chronic illnesses in Mexico, the clinical epidemiology of risk factors associated to Chronic Kidney Disease (CKD)1 is not homogenous throughout the country; the state of Yucatan in Mexico, according to the National Health and Nutrition Survey in 2016 and 2018,2 has the highest prevalence of obesity and diabetes, while leading the rate of urolithiasis hospitalizations and hospitalizations due to urinary tract stones that far exceeds that of other states of Mexico,3 which implies that the burden of CKD in the state of Yucatan could also exceed proportionally the trends at the national level. The objective of the present study is to describe the epidemiology of CKD in Mexico, during the years 2016, 2017 and 2018, with emphasis on Yucatan, with respect to hospitalizations, in-hospital deaths, general deaths, and Renal Replacement Therapy (RRT).

The present is a retrospective cross-sectional, descriptive study with a focus on clinical epidemiology of chronic kidney disease in Mexico, based on Open Access Datasets from the General Directorate of Health Information,4 the National Institute of Statistics and Geography5, and the National Centre of Transplants6 corresponding to the period between January 2016 and December 2018 The analyses were conducted using Stata 15® software.

Hospitalizations due to CKD, stage of CKD, in-hospital deaths, and general mortality

A total of 350, 997 hospital discharges due to CKD were recorded in Mexico during the period studied, with 2017 exhibiting the greatest number of discharges (n=120,746), compared to years 2016 (n=116, 218) and 2018 (n=114, 033); with 7646 aged <15 years.

Both, at the national level (71.84%; n=249,130) and in Yucatan (91.17%; n=3832), in most discharges, the stage of CKD was not specified or recorded in the adult population. Among the records of patients admitted with a first-time diagnosis, women experienced greater hospital mortality (8.38%; n=212) (p=<0.01).

In general, 28,783 deaths due to CKD took place in Mexico in the studied period (2135<15 years of age) mortality rate from this cause was 23 per 100,000 inhabitants at the national level and 25 per 100,000 in Yucatan. 82.77% (n=23, 349) of the national deaths and 86.50% (n=487) of those that occurred in Yucatan were not classified by stage of CKD. In Yucatan, there were a proportionally greater mortality among patients <15 years (Table 1).

Table 1.

Hospitalizations, in-hospital deaths, and general mortality due to CKD in Mexico between 2016 and 2018.

Hospitalizationsa due to Chronic Kidney Disease in Mexico and Yucatan, by age groups (N=350,997).
Variables  ≥15<15
  Mean±SDP value  Mean±SDP value 
  Mexico (n=339,154)  Yucatan (n=3975)    Mexico (n=7418)  Yucatan (n=228)   
Age (years)  45.36±17.31  53.88±14.08  <0.001  10.20±3.93  9.05±3.93  <0.001 
Length of hospitaliaation (days)  1.69±7.13  4.81±7.34  <0.001  2.64±7.62  4.37±6.82  <0.001 
  % (n)  % (n) 
Gender (male)  37.31 (183,899)  54.22 (1483)  <0.001  54.12 (4014)  57.46 (131)  0.319 
First-time hospitalizations  36.34 (123,242)  63.72 (2533)  <0.001  15.72 (1166)  71.93 (164)  <0.001 
Inhospital infection  0.5 (1681)  0.53 (21)  0.771  0.42 (31)  0.44 (1)  0.962 
In-hospital mortality  1.92 (6504)  5.72 (227)  <0.001  1.29 (96)  2.19 (5)  0.242 
Stage at first hospitalization  General≥15<15
  Mexico (n=346,794)  Yucatan (n=4203)  Mexico (n=339,154)  Yucatán (n=3975)  Nacional (n=7418)  Yucatan (n=228) 
  % (n)
Stage 3  0.15 (512)  0.36 (15)  0.15 (500)  0.38 (15)  0.16 (12)  – 
Stage 4  0.26 (910)  0.33 (14)  0.26 (892)  0.30 (12)  0.24 (18)  0.88 (2) 
Stage 5  27.75 (96,242)  8.14 (342)  26.87 (91,132)  8.1 (322)  65.92 (4890)  8.77 (20) 
Unclassified Stage  71.84 (249,130)  91.17 (3832)  72.72 (246,630)  91.22 (3626)  33.67 (2499)  90.35 (206) 
General deaths due to CKD in Mexico and in Yucatan, by age group and stage (N=28,773)
Variables  ≥15 (N=26,638)<15 (N=2135)
  Mexico (n=26,118)  Yucatan (n=520)  P value  Mexico (n=2092)  Yucatan (n=43)  P value 
  Mean±SD      Mean±SD     
Age (years)  65.74±19.91  69.11±16.39  <0.001  5.77±3.06  4.79±2.90  0.037 
  % (n)% (n)
Gender (male)  57.37 (14,985)  51.73 (269)  0.01  57.46 (1202)  41.86 (18)  0.041 
Rural community  21.41 (5503)  15.34 (86)  <0.001  19.46 (400)  17.07 (7)  0.703 
Medical assistance at death  94.17 (23,435)  96.80 (491)  0.016  95.74 (1908)  100 (37)  0.199 
Affiliation to Health Servicesa  86.77 (20,844)  95.25 (461)  <0.001  88.87 (1741)  97.44 (38)  0.09 
CKD stage at death  General≥15<15
  Mexico (n=28,220)  Yucatan (n=563)  Mexico (n=26,118)  Yucatan (n=520)  Mexico (n=2092)  Yucatan (n=43) 
  % (n)
Stage 3  0.17 (47)  0.18 (1)  0.16 (43)  0.19 (1)  0.19 (4)  – 
Stage 4  0.41 (117)  0.53 (3)  0.41 (106)  0.58 (3)  0.48 (10)  – 
Stage 5  16.68 (4707)  12.79 (72)  16.34 (4268)  12.88 (67)  20.94 (438)  11.63 (5) 
Unclassified stage  82.74 (23,349)  86.50 (487)  83.09 (21,701)  86.35 (449)  78.39 (1640)  88.37 (38) 
a

Hospitalization data refers only to public hospitals.

Hospital procedures and renal replacement therapy (RRT)

In Mexico, 9316 kidney transplants were recorded, the modal year was 2017 during the study period, at a national level, but in Yucatan there was a decrease in transplants between 2016 and 2018. For receivers of age ≥15, the percentage of live donors was significantly greater. The transplant rate per 1,000,000 inhabitants was 74 at the national level and 41 in Yucatan. In the state of Yucatan, a progressive decrease in the proportion of cadaver donors per year (50%–23%), whilst the live donors were observed to be increasing (50%–77%) (Table 2). A total of 516,287 dialysis procedures were recorded during the period, of these, the Haemodialysis (HD) was the most common RRT (79.65%, n=411,222), whilst Peritoneal Dialysis (PD) was less common (20.35%, n=105,065), as shown in Table 2.

Table 2.

Clinical epidemiology of Renal Replacement Therapy in Mexico between 2016 and 2018.

Percentage of kidney transplants, according to the type of donor, by year in Mexico and Yucatan (N=9316)
Year  Mexico (n=9225)Yucatan (n=91)
  Cadaveric donor  Living donor  Cadaveric donor  Living donor 
  % (n)
2016 (n=3037)  28% (n=848)  72 (2155)  50% (n=17)  50% (n=17) 
2017 (n=3168)  29% (n=923)  71% (n=2219)  46% (n=12)  54% (n=14) 
2018 (n=3111)  32% (n=977)  68% (n=2103)  23% (n=7)  77% (n=24) 
Kidney transplant in patients ≥15 years old in Mexico and Yucatan (N=8880)
Variable  Mexico (n=8790)  Yucatan (n=90)  Difference  P value 
  Mean±SD   
Age (years)  35.15±13.44  36.62±13.37  1.48  0.297 
Time elapsed until transplant  315.09±654.12  289.50±478.49  25.59  0.711 
  % (n)
Gender (male)  63.90 (5617)  58.89 (53)  0.05  0.325 
Cadaveric donor  28.96 (2546)  38.89 (35)  0.1  0.039 
Therapeutic procedures of hemodialysis and peritoneal dialysis in Mexico 2016–2018 (N=516,287)
Year  Hemodialysis (n=411,222)  Peritoneal dialysis (n=105,065) 
  % (n)
2016  80.37 (135,849)  19.63 (33,171) 
2017  79.51 (134,033)  20.49 (34,532) 
2018  79.09 (141,340)  20.91 (37,363) 

We have presented the epidemiological panorama of CKD in México, with emphasis on the state of Yucatán. The frequency of intrahospital infections was increased as the days of hospitalization also increased, which is consistent with what has been reported in other studies7,8; additionally, the hospital infection was most frequent among those that were discharged due to death.

Mexico ranks second place in Latin American countries in respect to the number of patients that are using PD modality. However, it has been reported that the access to RRT, is unequal in the population due to their affiliation with the health services, A large part of the population is affiliated with public services; however, medical coverage is limited in these patients, because CKD and RRT translates to a large economic burden for the patients and struggle to comply with the expenses for the adequate care necessary for disease management.9,10 Finally, it is important to mention that the current surveillance system of CKD in Mexico does not include patient-centred statistics, follow ups nor a record of patients that have PD at home. New efforts are needed to improve monitoring of patients since their diagnosis, this could orient on progression timing, survival and other indicators that could be sensible to change along with new health approaches and therapeutic innovations and permit contrasting the Mexican trends in CKD with those from around the world. Improving health care and timely diagnosis in Mexico, particularly in the states with higher prevalence of obesity, diabetes, and hypertension, such as Yucatan may be considered as essential for the well being and prognosis of patients.

References
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H.S. Lastiri.
La Enfermedad Renal Crónica en México: una política nacional de salud todavía pendiente.
La ERC en México. Hacia una política Nacional para enfrentarla, pp. 2-16
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Clinical epidemiology of infectious disease among patients with chronic kidney disease.
Clin Exp Nephrol, 23 (2019), pp. 437-447
[8]
C.H. Chang, P.C. Fan, G. Kuo, Y.S. Lin, T.Y. Tsai, S.W. Chang, et al.
Infection in advanced chronic kidney disease and subsequent adverse outcomes after dialysis initiation: a nationwide cohort study.
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R. Valdez-Ortiz, F. Navarro-Reynoso, M.G. Olvera-Soto, G. Martin-Alemañy, A. Rodríguez-Matías, C.R. Hernández-Arciniega, et al.
Mortality in patients with chronic renal disease without health insurance in Mexico: opportunities for a National Renal Health Policy.
Kidney Int Rep, 3 (2018), pp. 1171-1182
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G. Garcia-Garcia, K. Renoirte-Lopez, I. Marquez-Magaña.
Disparities in renal care in Jalisco, Mexico.
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