Efficacy and Safety Outcomes of Extended Criteria Donor Kidneys by Subtype: Subgroup Analysis of BENEFIT-EXT at 7 Years After Transplant.

The phase III Belatacept Evaluation of Nephroprotection and Efficacy as First-Line Immunosuppression Trial-Extended Criteria Donors Trial (BENEFIT-EXT) study compared more or less intensive belatacept-based immunosuppression with cyclosporine (CsA)-based immunosuppression in recipients of extended criteria donor kidneys. In this post hoc analysis, patient outcomes were assessed according to donor kidney subtype. In total, 68.9% of patients received an expanded criteria donor kidney (United Network for Organ Sharing definition), 10.1% received a donation after cardiac death kidney, and 21.0% received a kidney with an anticipated cold ischemic time ≥24 h. Over 7 years, time to death or graft loss was similar between belatacept- and CsA-based immunosuppression, regardless of donor kidney subtype. In all three donor kidney cohorts, estimated mean GFR increased over months 1-84 for belatacept-based treatment but declined for CsA-based treatment. The estimated differences in GFR significantly favored each belatacept-based regimen versus the CsA-based regimen in the three subgroups (p < 0.0001 for overall treatment effect). No differences in the safety profile of belatacept were observed by donor kidney subtype.

[Body composition in chronic kidney disease patients and haemodialysis]. / Composición corporal en pacientes con insuficiencia renal crónica y hemodiálisis.

BACKGROUND: Nutritional alterations are highly prevalent among patients with chronic kidney diseases stage 5 who receive haemodialysis therapy. Body composition alterations are directly related to an increased morbidity and mortality. Nutritional assessment represents a cardinal intervention oriented to improve the outcome and survival in chronic renal patients. OBJECTIVE: To evaluate body composition in a mexican population with chronic kidney disease stage 5 and haemodialysis therapy. METHODS: Prospective, descriptive and transversal study. Free fatty mass (FFM) and fatty mass (FM) were evaluated by means of bioelectric impedance (BIE), anthropometrics measures (MPA) and dual-energy x-ray absorptiometry (DEXA). RESULTS: 20 patients were evaluated (12 females and 8 males). Mean age was 51.9 +/- 19.3 years. Mean weight was 59.5 +/- 10.5 kg and mean body mass index was 24.9 +/- 3.1 kg/m(2). Mean FFM values were 42.4 +/- 8.6 kg (MPA), 43.6 +/- 8.9 kg (DEXA) y 42.8 +/- 10.2 kg (IBE). Mean FM values: 17.2 +/- 6.2 kg (MPA), 15.9 +/- 6.9 kg (DEXA) and 16.9 +/- 6.9 kg (IBE). Correlation coefficients between the three methods were: FFM, 0.982 (MPA vs IBE), 0.963 (MPA vs DEXA) y 0.947 (IBE vs DEXA). Fatty mass: 0.975 (MPAvs IBE), 0.925 (MPA vs DEXA) y 0.898 (IBE vs DEXA). CONCLUSION: In the studied population, fatty mass was increased and FFM was within the reference ranges. There was not evidence of protein malnutrition. MPA and BIE are practical and useful tools to evaluate body composition in mexican chronic kidney disease patients who receive haemodialysis therapy. The results obtained by means of MPA and BIE correlated with results obtained by DEXA.

Composición corporal en pacientes con insuficiencia renal crónica y hemodiálisis / Body composition in chronic kidney disease patients and haemodialysis

Antecedentes: Las alteraciones en el estado nutricio son un hallazgo frecuente en pacientes con enfermedad renal crónica en etapa 5 de la clasificación NKF K/DOQ sometidos a hemodiálisis. El impacto de la enfermedad renal sobre la composición corporal constituye por si mismo un factor de morbimortalidad en esta población, por lo que la evaluación nutricia constituye una estrategia temprana orientada a mejorar su calidad de vida y pronóstico. Objetivo: Evaluar la composición corporal mediante tres métodos en una población adulta con diagnóstico de insuficiencia renal crónica en hemodiálisis. Metodología: Estudio transversal, prospectivo y descriptivo en el que se evaluó la composición corporal por medición de panículos adiposos (MPA), impedancia bioeléctrica (IBE) y absorciometría de energía dual de rayos X (DEXA). Se calculóla masa grasa (MG) y la masa libre de grasa (MLG). Resultados: Se incluyeron 20 pacientes (12 mujeres y 8 hombres), con edad promedio de 51,9 ± 19,3 años, peso de 59,5 ± 10,5 kg. e índice de masa corporal de 24,9 ± 3,1 Kg/m2. Los valores promedio de MLG por cada uno de los métodos fueron de 42,4 ± 8,6 kg (MPA), 43,6 ± 8,9 kg (DEXA) y 42,8 ± 10,2 kg (IBE). Los valores de MG promedio fueron de 17,2 ± 6,2 kg (MPA), 15,9 ± 6,9 kg (DEXA) y 16,9 ± 6,9 kg (IBE). Existió correlación en los resultados derivados de los tres métodos utilizados. Los coeficientes de correlación fueron en MLG 0,982 (MPA vs IBE), 0,963 (MPA vs DEXA) y 0,947 (IBE vs DEXA). Y para MG, 0,975 (MPA vs IBE), 0,925 (MPA vs DEXA) y 0,898 (IBE vs DEXA). Conclusión: Se evidenció un incremento en la cantidad de MG en la población estudiada. La cantidad de MLG se encontró dentro de los rangos de referencia. No existió evidencia de desnutrición proteica. La MPA y el IBE permiten evaluar de manera confiable la composición corporal en pacientes mexicanos con enfermedad renal crónica sometidos a hemodiálisis, los resultados obtenidos son equiparables a los observados con el DEXA (AU)

Background: Nutritional alterations are highly prevalent among patients with chronic kidney diseases stage 5 who receive haemodialysis therapy. Body composition alterations are directly related to an increased morbidity and mortality. Nutritional assessment represents a cardinal intervention oriented to improve the outcome and survival in chronic renal patients. Objective: To evaluate body composition in a mexican population with chronic kidney disease stage 5 and haemodialysis therapy. Methods: Prospective, descriptive and transversal study. Free fatty mass (FFM) and fatty mass (FM) were evaluated by means of bioelectric impedance (BIE), anthropometrics measures (MPA) and dual-energy x-ray absorptiometry (DEXA). Results: 20 patients were evaluated (12 females and 8 males). Mean age was 51.9 ± 19.3 years. Mean weight was 59.5 ± 10.5 kg and mean body mass index was 24.9 ± 3.1 kg/m2. Mean FFM valueswere 42.4 ± 8.6 kg (MPA), 43.6 ± 8.9 kg (DEXA) y 42.8 ± 10.2 kg (IBE). Mean FM values: 17.2 ± 6.2 kg (MPA), 15.9 ± 6.9 kg (DEXA) and 16.9 ± 6.9 kg (IBE). Correlation coefficients between the three methods were: FFM, 0.982 (MPA vs IBE), 0.963 (MPA vs DEXA) y 0.947 (IBE vs DEXA). Fatty mass: 0.975 (MPAvs IBE), 0.925 (MPA vs DEXA) y 0.898 (IBE vs DEXA). Conclusion: In the studied population, fatty mass was increased and FFM was within the reference ranges. There was not evidence of protein malnutrition. MPA and BIE are practical and useful tools to evaluate body composition in mexican chronic kidney disease patients who receive haemodialysis therapy. The results obtained by means of MPA and BIE correlated with results obtained by DEXA (AU)