Background. The Neutrophil-to-Lymphocyte Ratio (NLR) and the Platelet-to-Lymphocyte Ratio (PLR) are inflammatory biomarkers for several diseases, such as cancer and cardiovascular morbidities; however, there are currently few studies on kidney diseases. We aimed to evaluate nondialysis patients and determine the association of NLR and PLR with inflammation in these patients. Methods. A prospective cross-sectional study was conducted with 85 patients at different stages of chronic kidney disease (CKD), treated at the Kidney Disease Prevention Center of the University Hospital of the Federal University of Maranhão. This study included adult nondialysis patients diagnosed with CKD. The participants’ blood samples were collected for a high-sensitivity C-reactive protein (hs-CRP) test and blood count. They were divided into two groups according to the presence or absence of inflammation based on the hs-CRP value (<0.5 mg/dL). NLR and PLR were calculated based on the absolute number of neutrophils, lymphocytes, and platelets and were compared between them and with hs-CRP. Statistical analysis was performed using the Stata software, with the Shapiro–Wilk, Mann–Whitney, Spearman’s Correlation, and receiver operating characteristic curve tests. This study was approved by the local ethics committee. Results. The participants were categorized into two groups: with inflammation (n = 64) and without inflammation (n = 21). The mean age was 61.43 ± 14.63 y. The NLR and PLR values were significantly different between the groups with and without inflammation ( p = 0.045 and p = 0.004 , respectively). However, only PLR showed a significant positive correlation with hs-CRP ( p = 0.015 ). The best cutoff point for NLR to detect inflammation was 1.98, with 76.19% sensitivity and 48.44% specificity. For PLR, it was 116.07, with 85.71% sensitivity and 51.56% specificity. There was no significant difference between the area under the NLR and PLR curve (0.71 vs. 0.64; p = 0.186 ) for this population. Conclusions. This study showed that PLR was positively correlated with hs-CRP in nondialysis CKD patients and can be used to identify inflammation in this population.

This analysis, using data from the Brazilian kidney transplant (KT) COVID-19 study, seeks to develop a prediction score to assist in COVID-19 risk stratification in KT recipients. In this study, 1379 patients (35 sites) were enrolled, and a machine learning approach was used to fit models in a derivation cohort. A reduced Elastic Net model was selected, and the accuracy to predict the 28-day fatality after the COVID-19 diagnosis, assessed by the area under the ROC curve (AUC-ROC), was confirmed in a validation cohort. The better calibration values were used to build the applicable ImAgeS score. The 28-day fatality rate was 17% (n = 235), which was associated with increasing age, hypertension and cardiovascular disease, higher body mass index, dyspnea, and use of mycophenolate acid or azathioprine. Higher kidney graft function, longer time of symptoms until COVID-19 diagnosis, presence of anosmia or coryza, and use of mTOR inhibitor were associated with reduced risk of death. The coefficients of the best model were used to build the predictive score, which achieved an AUC-ROC of 0.767 (95% CI 0.698–0.834) in the validation cohort. In conclusion, the easily applicable predictive model could assist health care practitioners in identifying non-hospitalized kidney transplant patients that may require more intensive monitoring. Trial registration: ClinicalTrials.gov NCT04494776.

Some studies have described that when the hemoglobin levels of chronic kidney disease (CKD) patients change, especially in those taking erythropoiesis-stimulating agents (ESA), they are associated with unfavorable outcomes such as increased morbidity and mortality, mainly due to cardiovascular events. This prospective cohort study included patients with end-stage renal disease currently undergoing hemodialysis. The initial 6-month clinical evaluation provided data of the variability in hemoglobin, associated blood parameters, and the use of erythropoietin. Subsequently, the patients were followed up for 78 months to evaluate mortality-associated factors. In total, 133 patients completed the 6-month follow-up with a mean age of 47.1 (±13.2) years. The majority were women (51.9%). Six-month hemoglobin levels were as follows: always low (18.0%), intermediate/target (1.5%), always high (0.8%), low-amplitude fluctuation/Hb low (n = 37; 27.8%), low-amplitude fluctuation/Hb high (13.53%), and high-amplitude fluctuation (38.6%), among end-stage renal disease patients. At the end of 78 months, 50 (37.6%) patients died; 70% of deaths were attributed to cardiovascular etiologies. A high variability was observed in hemoglobin levels, which was not associated with mortality. Among all the variables evaluated, age, erythropoietin dose, and transferrin saturation were associated with a higher mortality. Thus, this study suggests that greater attention to erythropoietin doses and transferrin saturation levels may improve the survival of dialysis patients.

Objectives: Sleep disorders in patients on hemodialysis are frequent, but few studies correlate these disorders with autonomic dysfunction in these patients. This study aimed to verify whether clinical and laboratory variables and heart rate variability are associated with worse sleep quality verified by the Pittsburg subjective scale in patients on hemodialysis. Material and Methods: A cross-sectional study was performed on forty-eight patients. Epidemiological, clinical, and laboratory data were collected. After were performed by recording the heart rate variability and applied Pittsburg questionnaires, Beck anxiety index (BAI), and Beck depression index (BDI). The global PSQI score >5 indicates that a person is a poor sleeper, the patients were divided according to the scores in the Pittsburg questionnaire into good and poor sleepers and the differences between all variables were analyzed. Results: Forty-eight patients were evaluated and the prevalence of 68.7% (n=33) of poor sleep quality was verified. From the depression and anxiety questionnaires, it was found that only 18.7% (n=9) had criteria for depression. In the analysis of the sympathetic dysfunction parameters, it was found that in the group with good sleep quality in the frequency domain (HFm2) and the LFnu in the group with worse sleep quality. There was a positive correlation between sleep quality scores the anxiety and depression scores. It is also verified that the variables LFnu had a positive correlation with higher scores of quality of sleep and HFnu had a negative correlation with the highest scores of quality of sleep. Conclusion: In patients undergoing hemodialysis, the poorest quality of sleep is correlated with worse cardiac autonomic modulation as well as higher scores on the depression and anxiety scales.

Introduction: Chronic kidney disease (CKD) and metabolic syndrome (MS) are recognized as public health problems which are related to overweight and cardiometabolic factors. The aim of this study was to develop a model to predict MS in people with CKD.

Introduction: Chronic kidney disease (CKD) is a public health issue, with an estimated prevalence of 10% in Brazil, possibly underestimated due to regional inequalities and diagnostic limitations. The EPI-CKD Brazil study aimed to estimate the prevalence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 in adults with risk factor for CKD, using point-of-care creatinine testing (POCTcr) during World Kidney Day 2025, and to assess regional variations and associated predictors. Methods: We conducted a multicenter cross-sectional study across 20 state chapters of the Brazilian Society of Nephrology, including individuals ≥ 18 years with at least one CKD risk factor (age > 60 years, hypertension [HTN], diabetes mellitus [DM], cardiovascular disease, obesity, chronic use of nonsteroidal anti-inflammatory drugs, history of acute kidney injury, bilateral kidney stones, or family history of CKD). Renal function was assessed using a rapid creatinine test (NovaMaxPro®–eGFR CKD-EPI 2021). Reduced eGFR was defined as < 60 mL/min/1.73 m2. Results: We analyzed 8,374 participants (66.9% women; median age, 58 years; BMI, 28.3 kg/m2; 46.2% mixed race). The frequency of reduced eGFR was 40.2% (n = 3,370), of whom 36% were in stages G3b–G5. Only 35.2% were aware of CKD risk factors. Significant regional differences were observed (ranging from 27.9% [Bahia] to 55.2% [Paraná]; p < 0.001). Independent predictors included age (OR = 1.032; 95%CI: 1.028–1.035), HTN (OR = 1.27; 95%CI: 1.15–1.40), and indigenous ethnicity as a protective factor (OR = 0.40; 95%CI: 0.20–0.89; p < 0.05). Risk increased by 23% for each additional risk factor. Conclusion: A high frequency of reduced eGFR and low awareness of CKD risk factors were observed. The study demonstrates the feasibility of POCTcr in screening strategies and reinforces the need for public policies to expand early diagnosis and strengthen primary care.