Effect of Nutritional Intervention Through Teleconsultation on Glomerular Filtration Rate and Glycated Hemoglobin A1c in Patients With Diabetic Kidney Disease in Stage G3a, G3b and G4.

Chronic kidney disease (CKD) is the result of various chronic-degenerative diseases, including diabetes mellitus. In Mexico, it is considered a catastrophic disease due to the increasing number of cases, high investment costs and human resources, limited infrastructure, late detection of the disease, and high rates of morbidity and mortality in substitution programs.

So far, there is no record of patients with CKD in Mexico, so the precise number of patients in any of their stages is unknown. International databases, estimate an incidence of 421 patients with terminal CKD treated per million of population per year in our country (represented by the state of Jalisco), and a prevalence of 1,568 cases per million of population; figures that are considered the highest in the world.

Currently our country lives an extraordinarily complex scenario, has shown the highest rate of incidence of terminal kidney disease in recent years, which may be related, at least in part, to the increase in the prevalence of risk factors and the incongruence between needs of patients and the health care system, largely designed for the management of acute diseases. The CKD is among the first 10 causes of general mortality in Mexico, with a survival calculated in average months, from the entrance to a substitution therapy, of 30.6 months. The medical expense provided by the Mexican Institute of Social Security (an public agency that provides coverage to 66% of Mexicans with social security), for the treatment of terminal CKD in 2007, was estimated at $ 4 billion pesos, equivalent 60% of the total medical expense; and it is estimated that, due to the high incidence rates, in 2043 the investment costs will reach 20 billion pesos, figures that can not be paid.

The dimensions of chronic kidney disease show it as a public health problem that requires the creation of new intervention and education programs focused on the prevention of kidney disease and its causes. Currently, doctors have serious difficulties in providing optimal management. It is common for patients during the early stages of CKD not to comply with recommendations for effective control. They usually present negative life habits, difficult to change only with medical intervention. Many of the risk factors for both the onset and progression of CKD are related to unhealthy eating habits. It is widely known that, optimizing the quality of diet and lifestyles, in individuals with CKD at early stages have substantial benefits in terms of preventing the incidence and progression of the disease, as well as in the mortality of this population. Interventions based on multidisciplinary models, developed in populations at risk and in early stages of kidney disease have proven useful for delaying progression and postponing patients' admission to substitution therapy.

As the CKD progresses, the risk of presenting complications such as malnutrition, hyperphosphatemia and hyperkalemia increases significantly, which increases the risk of morbidity and mortality, especially in more advanced stages of the disease. Nutrition interventions to control and modify these risk behaviors become key points for the management of patients with CKD.