Social diagnosis of chronic kidney disease patients in preparation for living donor renal transplantation.

BACKGROUND: The relationship between socioeconomic status and clinical outcome in health and disease is complex and multifactorial. An association between low socioeconomic status and shorter patient survival in renal replacement therapy, dialysis, and transplantation, has been reported, implicating individual and environmental factors. We sought to analyze the socioeconomic and demographic characteristics of chronic kidney disease (CKD) patients in preparation for living kidney transplantation. METHODS: We evaluated 60 patients with CKD-V, on hemodialysis or peritoneal dialysis and who were being prepared in our public service between July 2008 and January 2010. Socioeconomic data were collected from the records. RESULTS: The mean age was 44.8 ± 13.3 years and 51% were male. Sixty-three percent were married, most of them with children, with a family size of 3.5 ± 1.45 members. They were taken a mean of 5.8 ± 2.8 drugs; only half of them were dispensed by public health insurance. Almost all--93%--did not work regularly, and the majority reported some limitation in daily activities. The mean monthly income was US $1,535.70 and 76.2% reported a monthly income ≤ US $1,810.60. The mean of school years was 7.91 ± 4.19. CONCLUSION: Low-income patients are gaining access to preparing for renal transplantation; we believe that is inherent to the universal structure of Brazil's public health system. Besides the low income, this population showed a considerable educational level, suggesting this characteristic made the patient more active to search the living transplant as an alternative for their CKD treatment. Knowledge about social status is essential for design strategies in minimizing its potential undesirable effects after transplantation.

Excessive immunosuppression in kidney transplant patients: prevalence and outcomes.

BACKGROUND: Death with a functioning graft is currently one of the main causes of kidney graft loss. A large proportion of cases is attributed to infectious complications that can be related to overimmunosuppression. We retrospectively studied 80 kidney transplant patients, grafted from January 2005 to December 2009, to assess the prevalence of excessive immunosuppression, and its possible correlation with infections and infection-related death. METHODS: Excessive immunosuppression was defined by a prescribed dosage above the expected to the time point or an elevated drug blood level according to the Kidney Disease: Improving Global Outcomes (2009) recommendations at 1, 3, 6, and 12 months, and then annually. RESULTS: Death with a functioning graft accounted for 76.5% of losses. Overall, 53.8% of deaths were from infections, and 38.5% from cardiovascular causes. Acute rejection episodes were noted in 8.8% of patients. Only 10% of patients had adequate immunosuppression throughout the follow-up. Seventy-two percent of patients showed adequate immunosuppression at least half of the 18 evaluated points, although 50% showed between 1 and 3 drugs administered above recommended dosages during the whole period. Infections were recorded in 78.8% patients, with a median of 3 episodes per patient. Any level of excessive immunosuppression was associated with infections (odds ratio, 11.2; P < .001), but not with death caused thereby. CONCLUSION: Excessive immunosuppression among this cohort was associated with a greater incidence of infections, but not with death from this cause.