Publications by authors named "Leonardo Pazarín-Villaseñor"

8 Publications

  • Page 1 of 1

Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort.

Int J Immunopathol Pharmacol 2021 Jan-Dec;35:20587384211000545

Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, México.

Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%;  < 0.05) and class II (17% vs 4%,  = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93-34.5,  = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I ( = 0.07), and 86% with DSA II ( = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2-44),  = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.
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March 2021

Loss of muscle strength in patients under hemodialysis evaluated by dynamometry in the Mexican population.

Nutr Hosp 2020 Oct;37(5):964-969

1Centro Universitario de Tonalá. Universidad de Guadalajara.

Introduction: Introduction: chronic kidney disease contributes to decreased muscle strength and physical function through a decrease in muscle mass. Current evidence suggests that hemodialysis can accentuate this complication, as well as lead to deterioration of the patient's overall health. The aim of this study is to compare muscle strength in a group of Mexican patients undergoing hemodialysis, evaluated by dynamometry, with available reference values. Materials and methods: a cross-sectional study was conducted in male and female patients between 20 and 81 years of age, with stage-5 chronic kidney disease, from the outpatient Hospital General Regional No 46 of the Mexican Social Security Institute. Muscle strength was assessed by means of a mechanical dynamometer. The average value classified by age and gender was compared with the 50th percentile of a reference study. Inter-group differences were calculated with the nonparametric Mann-Whitney U-test, and correlation using Pearson's test, logistic regression, and chi-squared test. All patients signed an informed consent form. Results: a total of 150 patients, 97 (64.7 %) men and 53 (35.3 %) women, were included in the study. The mean dynamometric value for muscle strength was 21.5 ± 10.1 kg, and a significant correlation was found with age, weight, and hemoglobin concentration. Conclusion: patients undergoing hemodialysis treatment for chronic kidney disease were found to be at the 10th percentile for muscle strength, as measured by dynamometry, thus demonstrating a marked decrease in muscle strength. This result could, however, also have been affected by different variables such as patient age, height, weight, glomerular filtration rate (GFR), hemoglobin concentration, serum creatinine, serum glucose, and the subjective global assessment, given that a significant association was also found between these and muscle strength.
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October 2020

The Role of Dietary Antioxidants on Oxidative Stress in Diabetic Nephropathy.

Iran J Kidney Dis 2020 03;14(2):81-94

Department of Physiology, University Health Sciences Center (Centro Universitario de Ciencias de la Salud), University of Guadalajara. Guadalajara, Jalisco, Mexico.

Diabetic nephropathy (ND) is the leading cause of end-stage renal disease and oxidative stress (OS) has been recognized as a key factor in the pathogenesis and progression. Hyperglycemia, reactive oxygen species, advanced glycation end products, arterial pressure, insulin resistance, decrease in nitric oxide, inflammatory markers, and cytokines, among others; are involved in the presence of OS on ND. This revision focus on diverse studies in experimental and human models with diabetes and DN that has been demonstrated beneficial effects of different dietary antioxidant as resveratrol, curcumin, selenium, soy, catechins, α-lipoic acid, coenzyme Q10, omega-3 fatty acids, zinc, vitamins E and C, on OS and the capacity for antioxidant response. Therefore, this interventions could have a positive clinical impact on DN.
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March 2020

Determinación del estado nutricional mediante el ángulo de fase en pacientes en hemodiálisis.

Gac Med Mex 2019 ;155(3):229-235

Instituto Nacional de Cardiología "Ignacio Chávez", Departamento de Endocrinología, Ciudad de México, México.

Introduction: Multi-frequency bio-impedance analysis (BIA) accurately evaluates body composition.

Objective: To assess nutritional status and its relationship with body mass index (BMI) or with BIA-obtained phase angle in patients with end-stage renal disease (ESRD) on hemodialysis.

Method: BMI, BIA and dialysis malnutrition score (DMS) were assessed in 99 patients on hemodialysis (43.6 ± 17.2 years of age, 58.8% males). Multivariate linear regression analysis was used to determine BMI and phase angle independent associations with DMS.

Results: Malnutrition risk (DMS > 13) showed a gradual increase among patients with normal BMI and phase angle (44.4%), low BMI (45.8%), low phase angle (64.0%), and in those with both parameters at abnormal ranges (68.0%). The phase angle was the only variable that was independently associated with patient nutritional status (standardized coefficient beta -0.372, p < 0.001), accounting for 13.8% of DMS variation.

Conclusion: Phase angle is inversely and independently associated with malnutrition risk in patients with ESRD, which suggests that BIA-assessed body composition might be better than BMI in the clinical assessment of patients with ESRD.
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January 2020

Uremic cardiomyopathy and peritoneal transport in incident peritoneal dialysis patients in the west of Mexico.

Nefrologia 2017 Sep - Oct;37(5):541-544

Servicio de Nefrología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca». Guadalajara, Jalisco, México.

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October 2018

Oxidative Stress in Diabetic Nephropathy with Early Chronic Kidney Disease.

J Diabetes Res 2016 20;2016:7047238. Epub 2016 Jul 20.

Nephrology Service, Civil Hospital of Guadalajara "Dr. Juan I. Menchaca", Guadalajara, JAL, Mexico.

The increase in the prevalence of diabetes mellitus (DM) and the secondary kidney damage produces diabetic nephropathy (DN). Early nephropathy is defined as the presence of microalbuminuria (30-300 mg/day), including normal glomerular filtration rate (GFR) or a mildly decreased GFR (60-89 mL/min/1.73 m(2)), with or without overt nephropathy. The earliest change caused by DN is hyperfiltration with proteinuria. The acceptable excretion rate of albumin in urine is <30 mg/day. Albuminuria represents the excretion of >300 mg/day. Chronic kidney disease (CKD) is characterized by abnormalities in renal function that persist for >3 months with health implications. Alterations in the redox state in DN are caused by the persistent state of hyperglycemia and the increase in advanced glycation end products (AGEs) with ability to affect the renin-angiotensin system and the transforming growth factor-beta (TGF-β), producing chronic inflammation and glomerular and tubular hypertrophy and favoring the appearance of oxidative stress. In DN imbalance between prooxidant/antioxidant processes exists with an increase in reactive oxygen species (ROS). The overproduction of ROS diminishes expression of the antioxidant enzymes (manganese superoxide dismutase, glutathione peroxidase, and catalase). The early detection of CKD secondary to DN and the timely identification of patients would permit decreasing its impact on health.
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June 2017


Nutr Hosp 2015 Dec 1;32(6):2887-92. Epub 2015 Dec 1.

Servicio de Cirugía Nutrición Clínica, Hospital Civil de Guadalajara Dr. Juan I Menchaca. Guadalajara, Jalisco, México..

Introduction: serum albumin the biomarker most frequently used as one of three biochemical criteria for diagnosis of protein energy wasting (PEW). However, as a nutritional parameter it's unreliable in chronic kidney disease (CKD). The subjective global assessment (SGA) has been recommended for nutritional evaluation and the PEW in CKD.

Objective: determine association between the levels of serum albumin and SGA in patients with end stage renal disease (ESRD) who started peritoneal dialysis (PD).

Methods: a cross-sectional study in patients with ESRD were evaluated prior to starting PD. Levels of serum albumin were determined and nutritional assessment was performed by SGA.

Results: 69 patients, 46 (67%) men and 23 (33%) women, average age 39.97 ± 18.30 years old, serum albumin 2.75 ± 0.65 g/dl, creatinine 18.91 ± 10.98 mg/dl, urea 314.80 ± 152.74 mg/dl and BMI 23.37 ± 3.79 kg/m2, median of GFR 3 (1-12) mL/min/1.73m2. The SGA showed that 34.8% was well nourished, 40.6% had risk of moderate PEW and the 24.6% had severe PEW. There was no association (p = ns) between the levels of serum albumin and SGA.

Conclusion: the present study shows hypoalbuminemia and PEW are very frequent. The identification of levels of serum albumin and SGA at the beginning of PD in our population could be predictors of mortality. Serum albumin is not a useful tool for nutritional assessment in patients with ERSD who initiate PD.
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December 2015

Comparison of direct medical costs between automated and continuous ambulatory peritoneal dialysis.

Perit Dial Int 2013 Nov-Dec;33(6):679-86. Epub 2013 Apr 1.

Unidad de Investigación Médica en Enfermedades Renales,1 Hospital de Especialidades, CMNO, and Coordinación de Salud Pública,2 Delegación Jalisco, IMSS, Guadalajara;

Objective: We set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated.

Methods: Our retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries.

Results: No baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more (p = 0.001) in APD (US$7 084) than in CAPD (US$6 071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% - 20% increase for each component--except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008.

Conclusions: The annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were attributable to the dialysis procedure, hospitalizations, and medications. In a multivariate analysis, no independent variable significantly predicted a higher DMC.
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September 2014