Guillermo Garcia-Garcia

Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico

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Publications (23)116.93 Total impact

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    ABSTRACT: Chronic kidney disease (CKD) is a major public health problem in Mexico. Current guidelines recommend routine CKD testing in patients at increased risk for CKD. We undertook this study to examine the diagnostic yield of targeted screening (case-finding) for CKD in high-risk populations in rural and urban communities in Jalisco, Mexico. In a cross-sectional study, we did laboratory tests searching for CKD and its risk factors and compared the characteristics of participants with those reported by the National Health and Nutrition Survey 2006 (NHNS). Individuals who were aware that they had CKD and those <18 years of age were excluded. There were 9,169 participants assessed: 28.7% were men and mean age was 55.6 ± 13.7 years. They were predominantly female (71.3 vs. 55.6% p = 0.0001) and older (55.59 ± 0.1 vs. 42.5 ± 0.3 years, p = 0.0001) than the NHNS population. Self-reported diabetes (41.9 vs. 7.3% p = 0001) and fasting blood sugar >126 mg/dl (56.1 vs. 14.4% p = 0.0001) were more prevalent among the participants; self-reported hypertension (41.9 vs. 7.3%, p = 0.0001), systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg (52.5 vs. 43.2%, p = 0.0001), and obesity (42.8. vs. 29.3%, p = 0.0001) were also more frequent among participants. There were 19.7% with proteinuria; CKD was more prevalent among the high risk participants in our study (31.3 vs. 8.0%, p = 0.0001) than in the general population. CKD was detected frequently in high-risk Mexican populations. Trials of case-finding and intervention are feasible and warranted in Mexico.
    Archives of medical research 11/2013; · 1.88 Impact Factor
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    ABSTRACT: Oxidative stress is increased in chronic kidney disease, owing to an imbalance between the oxidative and antioxidant pathways as well as a state of persistent hyperhomocysteinemia. The enzymes glutathione S-transferases (GSTs) and methylenetetrahydrofolate reductase (MTHFR) are implicated in the regulation of these pathways. This study investigates the association between polymorphisms in the Glutathione S-transferase Mu 1 (GSTM1), glutathione S-transferase theta 1 (GSTT1), and MTHFR genes and end-stage renal disease (ESRD) of unknown etiology in patients in Mexico. A Case-control study included 110 ESRD patients and 125 healthy individuals. GSTM1 and GSTT1 genotypes were determined using the multiplex polymerase chain reaction (PCR). The MTHFR C677T polymorphism was studied using a PCR/restriction fragment length polymorphism method. In ESRD patients, GSTM1 and GSTT1 null genotype frequencies were 61% and 7% respectively. GSTM1 genotype frequencies differed significantly between groups, showing that homozygous deletion of the GSTM1 gene was associated with susceptibility to ESRD of unknown etiology (P = 0.007, odds ratios = 2.05, 95% confidence interval 1.21-3.45). The MTHFR C677T polymorphism genotype and allele distributions were similar in both groups (P > 0.05), and the CT genotype was the most common genotype in both groups (45.5% and 46.6%). Our findings suggest that the GSTM1 null polymorphism appears to be associated with the ESRD of unknown etiology in patients in Mexico.
    Indian Journal of Nephrology 11/2013; 23(6):438-43.
  • Vivekanand Jha, Guillermo Garcia-Garcia
    The Lancet 10/2013; 382(9900):1244. · 39.06 Impact Factor
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    ABSTRACT: Chronic kidney disease is defined as a reduced glomerular filtration rate, increased urinary albumin excretion, or both, and is an increasing public health issue. Prevalence is estimated to be 8-16% worldwide. Complications include increased all-cause and cardiovascular mortality, kidney-disease progression, acute kidney injury, cognitive decline, anaemia, mineral and bone disorders, and fractures. Worldwide, diabetes mellitus is the most common cause of chronic kidney disease, but in some regions other causes, such as herbal and environmental toxins, are more common. The poorest populations are at the highest risk. Screening and intervention can prevent chronic kidney disease, and where management strategies have been implemented the incidence of end-stage kidney disease has been reduced. Awareness of the disorder, however, remains low in many communities and among many physicians. Strategies to reduce burden and costs related to chronic kidney disease need to be included in national programmes for non-communicable diseases.
    The Lancet 05/2013; · 39.06 Impact Factor
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    ABSTRACT: Little is known about the prevalence of chronic kidney disease (CKD) among the homeless in Mexico. The role of substance abuse, alcoholism, and homelessness in CKD has not been properly evaluated. We screened 260 homeless individuals in the state of Jalisco, Mexico, for the presence of CKD and its risk factors, and compared their characteristics with those from a separate cohort of poor Jalisco residents and with a survey of the general Mexican population. CKD was more prevalent among the homeless than among the poor Jalisco population (22% vs. 15.8%, P=0.0001); 16.5% had stage 3, 4.3% stage 4, and 1.2% stage 5. All were unaware of having CKD. Only 5.8% knew they had diabetes, but 19% had fasting blood sugar >126 mg/dl; 3.5% knew they were hypertensive but 31% had systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg. Alcoholism was less common than in the poor Jalisco population (23.5% vs. 32.3%, P=0.002), but tobacco smoking (34.6% vs. 21.5%, P=0.0001) and substance abuse (18% vs. 1.1%, P=0.0001) were more prevalent among the homeless. Likewise, chronic viral infections such as HIV (4.5% vs. 0.3%, P=0.0001) and HCV (7.7% vs. 1.4%, P=0.0001) were also significantly higher among the homeless than in the general population. In conclusion, CKD and its risk factors are highly prevalent among the homeless individuals in Jalisco, Mexico. Lack of awareness of having diabetes and hypertension is highly common, as is substance abuse. Programs aiming to prevent CKD and its risk factors in Mexico should specifically target this high-risk population.
    Kidney International Supplements. 05/2013; 3(2):250-253.
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    ABSTRACT: Coordinated multidisciplinary care (MDC) could improve management and outcomes of patients with chronic kidney disease (CKD). We opened a nurse-led, MDC CKD clinic in Guadalajara, Mexico. We report the clinic's results between March 2008 and July 2011. The records of 353 patients with CKD stage 3 and 4 were reviewed. Data were collected prospectively. Mean age was 59.1±15.5 years; 54.4% were female and 63.7% were diabetic. We observed significant changes in the quality of care between baseline and follow-up. Compliance with practice guidelines for angiotensin II receptor blockers (ARB) and beta blockers increased from 30.6% to 46.6%, and from 11% to 19%, respectively; for statins from 41.4% to 80.3%; for erythropoietin and calcium binders from 10.5% to 23.4%, and from 41.9 to 82.6%, respectively. At last visit, 90% of patients were on ACE inhibitors/ARB. Blood pressure <130/80 mm Hg increased from 23% to 38%. Serum glucose 130 mg/dl increased from 54.4% to 67.7%. Serum cholesterol >160 mg/dl decreased from 64.8% to 60.3%. At last visit, 70% of the patients had a serum Hgb 11.0 g/dl, and 80.1% and 65.1% had a normal serum calcium and serum phosphate, respectively. In conclusion, we observed a trend in the improvement of quality of care of CKD patients similar to those reported by other MDC programs in the developed world. Our study demonstrated that a nurse-led MDC program could be successfully implemented in developing countries.
    Kidney International Supplements. 05/2013; 3(2):178-183.
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    ABSTRACT: Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.
    PLoS ONE 01/2013; 8(1):e54380. · 3.73 Impact Factor
  • Guillermo Garcia-Garcia, Paul Harden, Jeremy Chapman
    Nephrology 03/2012; 17(3):199-203. · 1.69 Impact Factor
  • G Garcia-Garcia, P Harden, J Chapman
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    ABSTRACT: World Kidney Day on 8 March 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end-stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatments by transplantation. The barriers to universal transplantation as the therapy for end-stage kidney disease include the economic limitations which, in some countries, place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation, and vaccination. Even in high-income countries, the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical, surgical, and nursing workforces with the required expertise. These problems have solutions which involve the full range of societal, professional, governmental, and political environments. World Kidney Day is a call to deliver transplantation therapy to the 1 million people a year who have a right to benefit.
    Indian Journal of Nephrology 03/2012; 22(2):77-82.
  • Guillermo García-García, Paul Harden, Jeremy Chapman
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    ABSTRACT: World Kidney Day on March 8th 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatment by transplantation. The barriers to universal transplantation as the therapy for end stage kidney disease include the economic limitations which, in some countries place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation and vaccination. Even in high income countries the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical, surgical and nursing workforces with the required expertise. These problems have solutions which involve the full range of societal, professional, governmental and political environments. World Kidney Day is a call to deliver transplantation therapy to the one million people a year who have a right to benefit.
    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 01/2012; 32(1):1-6. · 1.27 Impact Factor
  • D Pugsley, K C Norris, G García-García
    Clinical nephrology 11/2010; 74 Suppl 1:S1-2. · 1.29 Impact Factor
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    ABSTRACT: The National Kidney Foundation Kidney Early Evaluation Program (KEEP) is a free community screening program aimed at early detection of kidney disease among high-risk individuals. A pilot phase of KEEP México began in 2008 in México City and Jalisco State. Adults with diabetes, hypertension, or family history of diabetes, hypertension, or chronic kidney disease (CKD) were invited to participate through advertising campaigns. All participants completed a questionnaire. Blood pressure, weight, and height were measured; blood and urine tests included albuminuria and serum creatinine to estimate glomerular filtration rate using the Modification of Diet in Renal Disease Study equation. Mean age of KEEP México City and KEEP Jalisco participants was 46 and 53 years, respectively; >70% were women. CKD prevalence was 22% in KEEP México City and 33% in KEEP Jalisco, not significantly different from reported KEEP US prevalence of 26%. CKD stages 1 and 2 were more frequent in KEEP México and stage 3 in KEEP US. In KEEP México City, CKD prevalence was higher than the overall prevalence among participants with diabetes (38%) or diabetes and hypertension (42%). Most KEEP México participants were unaware of the CKD diagnosis, despite that 71% in KEEP México City had seen a doctor in the previous year. CKD is highly prevalent, underdiagnosed, and underrecognized among high-risk individuals in México. KEEP is an effective screening program that can successfully be adapted for use in México.
    Kidney international. Supplement 03/2010;
  • Guillermo Garcia-Garcia, Karina Renoirte-Lopez, Isela Marquez-Magaña
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    ABSTRACT: End-stage renal disease represents a serious public health problem in Mexico. Close to 9% of the Mexican population has chronic kidney disease (CKD) and 40,000 patients are on dialysis. However, the fragmentation of our health care system has resulted in unequal access to renal replacement therapy. In addition, poor patients in Jalisco with kidney failure have very advanced disease at the time of dialysis initiation, suggesting lack of access to predialysis care. To address these issues, a number of strategies have been implemented. Among them a renal replacement therapy program for which the cost of treatment is shared by government, patients, industry, and charitable organizations; the implementation of a state-funded hemodialysis program that provides free dialysis for the poor; the establishment of a university-sponsored residency program in nephrology and a postgraduate training in nephrology nursing; and a screening program for early detection and control of CKD. In conclusion, access to renal care is unequal. The extension of the Seguro Popular to cover end-stage renal disease treatment nationwide and the implementation of community screening programs for the detection and control of CKD offers an opportunity to correct the existing disparities in renal care in Jalisco and perhaps in other regions of Mexico.
    Seminars in Nephrology 01/2010; 30(1):3-7. · 2.83 Impact Factor
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    ABSTRACT: Chronic kidney disease (CKD) is a major cause of morbidity and mortality in Mexico. However, many residents of underserved areas may be unaware that they potentially are affected. In an observational cross-sectional study, we examined the diagnostic yield of screening for CKD and cardiovascular disease risk factors using mobile units that traveled to poor communities in Jalisco, Mexico. We excluded individuals who were aware that they had CKD and those < 18 years of age. Glomerular filtration rate, cardiovascular risk. Demographic data, socioeconomic status, blood pressure, fasting glucose, and dipstick urinalysis. 3,734 participants; 29.3% men and mean age of 57.4 +/- 13.0 years. Most (99.7%) had no history of cardiovascular disease; however, 43.5% had a history of diabetes, 11.4% had dipstick-positive proteinuria, 62.0% had blood pressure in the hypertensive range, and 15.8% had an estimated glomerular filtration rate compatible with stages 3-5 CKD. In patients with no history of cardiovascular disease, proportions with predicted 5-year risks of new cardiovascular events <5%, 5%-10%, 10.1%-20%, 20.1%-30%, and >30% were 10.0%, 11.7%, 26.6%, 20.7%, and 30.9%, respectively. Screening 18 participants aged < 40 years would be expected to detect 6 new cases of hypertension or 2 new cases of diabetes. Data may not be generalizable to all low-income settings or other regions of Mexico. Impaired kidney function, proteinuria, and cardiovascular risk factors were detected frequently when mobile units were used to perform screening in poor areas of Jalisco, Mexico. This suggests that trials of targeted screening and intervention are feasible and warranted.
    American Journal of Kidney Diseases 10/2009; 55(3):474-84. · 5.29 Impact Factor
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    ABSTRACT: World Kidney Day (WKD) is intended to raise awareness and increase detection of chronic kidney disease (CKD), but most emphasis is placed on adults rather than children. We examined yield of screening for CKD and hypertension among poor children in Mexico. On WKD (2006, 2007), children (age < 18 years) without known CKD were invited to participate at two screening stations. We measured body mass index (BMI), blood pressure, and serum creatinine, and performed dipstick urinalysis. The Schwartz equation was used to estimate glomerular filtration rate (GFR; reduced GFR defined as < 60 ml/min per 1.73 m(2)). Proteinuria and hematuria were defined by a reading of >or= 1+ protein or blood on dipstick. Hypertension was defined by gender, age, and height-specific norms. In total, 240 children were screened (mean age 8.9 +/- 4.1 years; 44.2% male). Proteinuria and hematuria were detected in 38 (16.1%) and 41 (17.5%), respectively; 15% had BMI > 95th percentile for age. Reduced GFR was detected in four (1.7%) individuals. Systolic hypertension was more prevalent in younger children (age 0-8 years, 19.6%; age 9-13 years, 7.1%; age 14-17 years, 5.3%) suggesting a possible white-coat effect. Hematuria, proteinuria, hypertension and obesity were frequently detected among children in a community based screening program in Mexico. This form of screening might be useful in identifying children with CKD and hypertension in developing nations.
    Pediatric Nephrology 03/2009; 24(6):1219-25. · 2.94 Impact Factor
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    David Pugsley, Keith C Norris, Guillermo Garcia-Garcia, Lawrence Agodoa
    Ethnicity & disease 02/2009; 19(1 Suppl 1):S1-1-2. · 1.12 Impact Factor
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    ABSTRACT: ESRD is a serious public health problem in the state of Jalisco, Mexico. This study evaluated mortality in poor patients who initiated dialysis at the Jalisco Health Secretariat, compared with Hispanic patients without medical insurance who initiated dialysis in the United States. All patients who received a diagnosis with ESRD between February 1 and December 31, 2003, were studied prospectively at a single institution that provides care to the poor of Jalisco. Data from an American national dialysis registry and Cox proportional hazards models were used to compare the adjusted survival among Jalisco patients with that of a contemporaneous group of incident Hispanic patients who did not have Medicare or private insurance cover and who initiated peritoneal dialysis in the United States. Of 274 consecutive patients who presented with a clinical diagnosis of ESRD in Jalisco, mean estimated GFR at dialysis initiation was very low (3.9 +/- 2.4 ml/min per 1.73 m(2)), and <10% were previously known to a nephrologist. Of the 274 patients, 102 (37.2%) did not initiate dialysis therapy, 71 (69.6%) of whom died during follow-up. The majority (n = 49) of such deaths occurred in-hospital before dialysis initiation. Of 172 patients who initiated dialysis, 36 (20.9%) died within the first 90 d of renal replacement therapy. An additional 31 (18.0%) patients died during a median follow-up of 186 d. When all 274 Jalisco patients who presented with ESRD were considered, survival was 49.6% at the end of follow-up. Unadjusted mortality rates among those who survived at least 90 d after dialysis initiation were 19.2 (95% confidence interval [CI] 13.5 to 27.3) and 5.9 (95% CI 4.6 to 7.7) per 100 patient-years in Jalisco and American patients, respectively. After adjustment, the risk for death remained nearly three-fold higher in Jalisco patients (hazard ratio 2.7; 95% CI 1.5 to 4.7). Poor patients with kidney failure in Jalisco have very advanced disease at the time of first nephrologic contact and have exceedingly high rates of mortality after dialysis initiation. Our findings demonstrate a tremendous opportunity to reduce morbidity and mortality from kidney disease in Jalisco and perhaps other regions of Mexico.
    Journal of the American Society of Nephrology 06/2007; 18(6):1922-7. · 8.99 Impact Factor
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    ABSTRACT: Continuous ambulatory peritoneal dialysis is the first-choice treatment for ESRD in Mexico. Peritonitis is the most frequent cause of morbidity and is among the leading causes of technique failure in our country. Our objective was to compare the efficacy of the standard and double-bag disconnect systems for the prevention of peritonitis in a high-risk population with poor living standards, and high prevalence of malnutrition and diabetes rates. Episodes of peritonitis registered between July 1989 and June 2003 were included. Patients were divided in conventional and double-bag groups. Between July 1989 and May 1999, all patients used the conventional system. From May 1999, all incident patients were placed on a double-bag disconnect system. Six-hundred and forty-seven patients started dialysis in the study period, 383 in the conventional group, and 264 in the double-bag. The peritonitis rate observed was 1 episode per 7.2 patient-months in the conventional group, and 1 episode per 25.1 patient-months in the double-bag system (p < 0.001). Cumulative peritonitis-free survival rate at 6 (50 vs. 82%), 12 (27 vs. 69%) and 24 (12 vs. 45%) months, respectively, was significantly lower in the conventional group (p < 0.001). Technique survival at 1 (75 vs. 85%), 2 (68 vs. 80%), and 3 years (50 vs. 80%), was worse in the conventional group (p < 0.001). By multivariate analysis, the only factor associated with peritonitis was the connecting system. We conclude that switching from a standard to a double-bag system using electrolytically produced sodium hypochlorite disinfectant markedly decreased the peritonitis rate, even in a high-risk population like ours.
    Contributions to nephrology 02/2007; 154:145-52. · 1.49 Impact Factor
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    ABSTRACT: Chronic degenerative disorders have become a major health problem in Mexico. Cardiovascular diseases represent the first cause of death in our country. Diabetes mellitus (DM) has emerged as the main health problem in Mexico. Its prevalence doubled from < 3% in the 1960s to 6% in the 1980s. Between 1993 and 2000, diabetes mellitus increased from 6.7% to 8.2%, a 22% growth over a seven-year period. In 1995, the cost of the treatment of DM represented 15.48% of the health budget and 0.79% of the GDP. The prevalence of hypertension (HTN) increased from 10% in 1933 to 20% in 1990 and from 23.8% to 30.7% between 1993 and 2000. The expenditures from HTN in 1999 corresponded to 13.9% of the health budget, and 0.71% of GDP. Dyslipidemias are very common. Close to 40% of the population has levels of HDL cholesterol < 35 mg/dL, 24.3% has fasting triglycerides > 200 mg/dL, and 10% has hypercholesterolemia. The prevalence of obesity increased from 21.4% in 1993, to 23.7% in the year 2000. Eight percent of the population has a glomerular filtration rate < 60 mL/min, and 9.1% has proteinuria. Twenty-four percent uses tobacco regularly, and 13% had the habit in the past. Smoking is more frequent among diabetics (34%).In conclusion, cardiovascular risks factors are highly common among the Mexican population and increasing at alarming rates. Preventive programs targeted to decrease their prevalence are urgently needed in Mexico and should become a national priority.
    Renal Failure 02/2006; 28(8):677-87. · 0.94 Impact Factor
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    ABSTRACT: Chronic kidney disease is a worldwide public health problem. More than one million individuals in the world are on maintenance dialysis, a number that is estimated to double in the next decade. Access to dialysis is significantly different between developed and developing nations. Close to 80% of the world dialysis population is treated in Europe, North America, and Japan, representing 12% of the world's population. The remaining dialysis patients are treated in the developing world. This disparity is likely due to the high cost and complexity of renal replacement therapy (RRT). Dialysis is so costly that is out of reach for low-income countries, which are struggling to provide preventive and therapeutic measures for communicable diseases and other basic needs. Providing renal care to all developing nations, although a difficult task, is not impossible. A number of strategies are proposed. These include the prevention of kidney disease, as well as dialysis and transplantation. Dialysis programs should be decentralized, and kidney transplantation should be promoted as the treatment of choice. The use of generic immunosuppressive drugs can make this therapy more affordable. Peritoneal dialysis seems a good, affordable, therapy for patients living in areas where hemodialysis is not available. Governments should provide funds not only for RRT but also for the prevention of kidney failure. The provision of tax incentives and reaching a critical number of patients on RRT could be incentives for industry to lower the cost of dialysis. The challenges are enormous, but renal care for all could be achieved through a concerted effort between nephrologists, governments, patients, charitable organizations, and industry.
    Ethnicity & disease 02/2006; 16(2 Suppl 2):S2-70-2. · 1.12 Impact Factor

Publication Stats

116 Citations
116.93 Total Impact Points

Institutions

  • 2005–2013
    • Hospital Civil de Guadalajara
      Guadalajara, Jalisco, Mexico
  • 2010
    • University of Adelaide
      Tarndarnya, South Australia, Australia