Background: Increased oxidative stress is a hallmark of end-stage renal disease. Hemodialysis (HD) patients lacking glutathione transferase M1 (GSTM1) enzyme activity exhibit enhanced oxidative DNA damage and higher mortality rate than those with active GSTM1 enzyme. To our knowledge, this is the first study to use the vitamin E-bonded membranes (VEM) in patients with homozygous GSTM1 gene deletion, and we aimed to determine the effect of VEM on oxidative and inflammatory status in HD patients with homozygous GSTM1 gene deletion. Methods: GSTM1 genotypes were determined by polymerase chain reaction (PCR) in 170 chronic HD patients. Those with GSTM1-null genotype were randomized and 80 were included in the study. Forty of them were dialyzed for three months with VEM, while the other forty were dialyzed with high-flux same-surface polysulfone dialyzers. Markers of protein and lipid oxidative damage and inflammation (thiol groups, malondialdehyde (MDA), Interleukin-6 (IL-6)), together with plasma antioxidant activity (glutathione peroxidase (GPX), superoxide dismutase (SOD)) were determined. Results: Seventy-five patients finished the study. There were no differences at baseline in markers of protein and lipid oxidative damage, inflammation and plasma antioxidant activity. After three months of therapy, GPX, MDA, and thiol groups increased significantly in both groups, but without statistical significance between groups. SOD and C reactive protein (CRP) did not change significantly during the three-month period. IL-6 increased in the control group, and at the same time, decreased in the VEM group, but without statistical significance. Hemoglobin (Hb) value, red blood cells, erythropoiesis resistance index (ERI), serum ferritin and iron did not change significantly within or between groups. Regarding other laboratory parameters, proteins, albumins, triglycerides, serum phosphorus, serum bicarbonate and Kt/V showed significant improvements within groups but with no significant difference between groups. Conclusions: Our data shows that therapy with VEM over three months had no benefit over standard polysulfone membrane in decreasing by-products of oxidative stress and inflammation in dialysis patients lacking GSTM1 enzyme activity.

Glycemic assessment in patients with chronic kidney disease (CKD) Stage V on hemodialysis (HD) is limited by the inaccuracy of hemoglobin A1c (HbA1c), mainly due to anemia, shortened erythrocyte lifespan, and erythropoiesis-stimulating agent (ESA) therapy. Glycated albumin (GA), independent of erythrocyte turnover, may better reflect glycemic exposure. We evaluated the diagnostic performance and clinical utility of GA as a biomarker of poor glycemic control and cardiovascular risk in patients with diabetes mellitus (DM). A cross-sectional analysis and five-year prospective follow-up were conducted in three subgroups: HD+DM+ (n = 40), HD- DM+ (n = 15), and HD+DM– (n = 22). Glycemic markers (mean plasma glucose over 3 months (PG₃m), GA, and HbA1c) were compared between groups. GA levels were significantly higher in HD+DM+ patients (p < 0.001) and showed the strongest correlation with PG₃m. GA independently predicted poor glycemic control (OR 3.23; 95% CI 1.54–6.77; p = 0.002) and demonstrated high diagnostic accuracy (AUC 0.873; optimal cut-off 10%). During the five-year follow-up, CV mortality was 35%, and 85% of deceased patients had GA > 10%. Although Cox regression did not reach statistical significance, GA showed a consistent trend toward higher CV mortality risk after adjustment for age and HD duration (HR 2.56; 95% CI 0.57–11.44; p = 0.21), whereas HbA1c was not prognostic (HR 1.39; 95% CI 0.49–3.91; p = 0.28). GA appears to be a clinically useful marker of glycemic control in diabetic patients with CKD Stage V receiving maintenance hemodialysis. In this cohort, GA showed high diagnostic accuracy and a more balanced sensitivity/specificity profile compared with HbA1c, with a consistent trend toward association with cardiovascular mortality. In this regard, the wider use of this marker in clinical practice is worth considering. Nevertheless, larger prospective studies are warranted to validate these observations.

Background: Obesity has reached epidemic proportions and represents a challenge in selecting the optimal renal replacement therapy for patients with end-stage renal disease (ESRD). This study aimed to evaluate the outcomes of peritoneal dialysis (PD) patients according to baseline body mass index (BMI) and to assess the impact of BMI changes during follow-up on PD-related complications and patient outcomes. Methods: This retrospective, single-center study included 53 incident PD patients treated between June 2006 and August 2015. Based on baseline BMI, patients were classified as normal weight (18.5–24.9 kg/m²; n = 17), overweight (25.0–29.9 kg/m²; n = 25), or obese (≥30.0 kg/m²; n = 11). PD adequacy, mechanical and infectious complications, technique survival, and patient survival were assessed over a 48-month follow-up. The effect of BMI changes during follow-up was also analyzed. Results: At PD initiation, total weekly Kt/V was significantly lower in the obese compared with the normal-weight patients (2.0 ± 0.4 vs. 2.3 ± 0.5; p = 0.038), although values remained within the ISPD targets. The normal-weight patients had lower urine output compared with the overweight patients (p = 0.038). Exit-site infections were the most frequent, whereas peritonitis incidence was the lowest in the obese patients, without statistically significant differences. The obese patients demonstrated poorer technique survival and overall survival, again without statistical significance. Mean BMI change after one year was 1.65 ± 2.08 kg/m², and after 4 years, it was 2.07 ± 3.18 kg/m². The BMI change was not associated with complications or survival. Conclusions: No significant association during the 48-month follow-up period was observed between baseline nutritional status or weight gain assessed by body mass index and adverse peritoneal dialysis outcomes; therefore, overweight and obese patients can achieve adequate PD performance and may defer or avoid transition to hemodialysis.