Correlation between functional capacity and oxidative stress and inflammation in hemodialysis patients.

INTRODUCTION: Patients with chronic kidney disease (CKD) may present impaired functional capacity due to peripheral muscle involvement. Oxidative stress and inflammation are probably involved in this pathophysiology. This study aimed to evaluate the association between functional capacity and biomarkers of oxidative stress as well as biomarkers of inflammation in patients under chronic hemodialysis therapy. METHOD: Cross-sectional study including 41 patients from a single hemodialysis center. Functional capacity was assessed through the 6-min walk test (6MWT). The assessed blood biomarkers were: malondialdehyde (MDA) (oxidative stress, TBARS method) and angiopoietin-2 (Ang-2) (inflammation, ELISA). The influence of gender on impairment of functional capacity was further explored. RESULTS: There was an inversely proportional correlation between the 6MWD and MDA (r = -,322 and p = 0.040) and Ang-2 (r = -, 376 and p = 0.016) values. 6MWD was 370.9 ± 101.2 m and 391.4 ± 108.2 m in women and men, respectively (p < 0.001), which means 29.3% and 34.3% reduction of the expected values for healthy individuals from the same age range. CONCLUSION: Patients with CKD under hemodialysis, regardless of gender, presented impaired performance in 6MWT and this impairment was associated with oxidative stress and inflammation.

Reasons for Disparities in Access to Kidney Transplantation.

Clinical Background: Kidney transplantation (KT) is the best treatment for most patients with end-stage kidney disease (ESKD), providing better survival and quality of life and lower cost when compared to dialysis. Epidemiology: Despite robust evidence showing the superiority of KT over dialysis, a significant percentage of ESKD patients worldwide do not access this treatment. Challenges: Barriers resulting in inequalities and inequities in access to KT involves chronic kidney disease (CKD) diagnosis and management, including difficulties in accessing dialysis therapy before KT; suboptimal referral and enlistment to KT; and imbalance between supply and demand for organs. Low socioeconomic status has an important role in that scenario. Prevention and Treatment: Strategies to minimize disparities in access to KT involve public policies to ensure access to CKD diagnosis and treatment, health education, continuous training of health providers, infrastructure, and allocation policies.

Clinical Characteristics and Outcomes of Kidney Transplantation under Urgency Priority Condition.

BACKGROUND: In several countries, patients with end-stage renal disease who are ineligible for dialysis are considered urgency priority (UP) for kidney transplantation (KT) through distinct allocation rules. There are scarce published data on clinical features and outcomes after KT of these patients. METHODS: We retrospectively reviewed and compared demographic and clinical pretransplant characteristics and outcomes after KT of all patients transplanted under UP allocation in a single Brazilian transplant center from January 10 to March 16 (n = 74) and 1: 1 patients transplanted under standard allocation in the same period (n = 74). A propensity score (PS) matching analysis was performed to evaluate risk factors for death-censored graft loss. RESULTS: UP KT group presented higher percentage of women (58.1 vs. 33.8%, p = 0.005), higher class I (22.2 ± 32.9 vs. 13.1 ± 25.3%, p = 0.027) and class II panel reactive antibodies (11.5 ± 24 vs. 5.2 ± 19.1%, p = 0.002), higher HLA mismatches (4.9 ± 0.9 vs. 3.7 ± 1.2, p < 0.001), higher percentage of retransplants (27 vs. 4.1%, p < 0.001), and spent longer time on dialysis off the waiting list (WL; 54.5 ± 52.5 vs. 31.2 ± 29.0 months, p = 0.03). After transplantation, UP KT patients presented longer hospital stay (29.3 ± 35.7 vs. 18.5 ± 19.5 days, p = 0.003) and inferior death-censored graft survival at 3 years (82 vs. 95.8%, log rank = 0.016), with 33.3% of graft losses due to vascular thrombosis. In PS-matched multivariable analysis, UP status hazard ratios (HR 4.791, 95% CI 1.052-21.722, p = 0.042) and donor age (HR 1.071, 95% CI 1.003-1.145, p = 0.041) were independent risk factors for death-censored graft loss. CONCLUSION: Patients transplanted under UP status remained a longer time on dialysis off the WL, suggesting that long-term dialysis led to exhaustion of accesses. After transplantation, outcomes are inferior and UP status was a risk factor for graft loss. These results point to the need for local policies to encourage and monitor the early referral to KT.