Introduction: Social disparities in chronic kidney disease are a reality. Low socioeconomic status is associated with increased incidence of chronic kidney disease and overall worse outcomes. In Portugal, similarly to many European countries, a National Health System was established to provide equity in healthcare access, but its impact in specialized chronic kidney disease care is unclear. This study aims to compare the effects of economic insufficiency in referral and overall specialized kidney care in a Portuguese center. Subjects and Methods: Retrospective cohort study evaluating maintenance hemodialysis patients of a Public Portuguese Nephrology Center from 2017 through 2021. Medical records were compared for presence of low-income status, with primary outcome as baseline estimated glomerular filtration rate at Nephrology referral and secondary outcomes as presence of kidney replacement therapy options appointment, timely vascular access assessment and time to dialysis from referral. Results: A total of 212 participants were evaluated, 96 with low-income status. This group presented higher serum creatinine and lower estimated glomerular filtration rate at referral (2.35 vs. 3.29 mg/dl, p<0.001; 27.63 vs. 18.47 ml/min/1.73 m2, p<0.001; respectively). Low-income status associated with absence of kidney replacement therapy options appointment (OR 2.7, 95% CI: 1.44-5.08; p=0.003) and late vascular access evaluation (OR 2.77, 95% CI: 1.55-4.98, p=0.001). Dialysis-free survival analysis revealed shorter time to dialysis in the low-income status group (15.77 vs. 20.71 months, p<0.001) with a higher cumulative incidence in dialysis at 24 months (HR: 2.11, 95% CI: 1.39-3.21, p < 0.001), a difference that was not verified after adjusting for estimated glomerular filtration rate at referral (HR: 1.16, 95 % CI: 0.74 – 1.80, p = 0.53). Conclusion: Low-Income chronic kidney disease Portuguese patients are at risk for late Nephrology referral, an established factor for adverse outcomes. Shorter time to dialysis appears significative in reducing adequate kidney care access, which can be attenuated through education of primary care providers and general population for chronic kidney disease.

Background and Aims It is known that maintenance hemodialysis (MHD) patients have a high risk of initial mortality from COVID-19. Concurrently, the Post-COVID-19 Syndrome also appears to be highly prevalent between them. However, in the general population, it looks like the probability of having long covid symptoms has been decreasing after covid-19 vaccination. As the number of vaccinated MHD patients against SARS-CoV-2 is currently extremely high in Portugal, with this study we aimed to investigate the current prevalence of long-COVID in our MHD patients and to identify if their baseline characteristics served as a predictor to this syndrome. Method In this retrospective single center study, we questioned 71 MHD patients regarding the history of COVID-19, its symptoms when it first appeared, and the symptoms that persisted at least 12 weeks after the onset of the disease. All patients were in our MHD program for at least 3 months before SARS-CoV-2 infection. Patients with COVID-19 were divided between those with and without long-COVID (long-COVID was defined as the existence of symptoms that persisted for more than 12 weeks). Baseline characteristics (sex, age, Chalson Comorbidity Index (CCI), time since the beginning of dialysis, diabetes, hypertension, hospitalization, the use of corticosteroids and the number of vaccines taken) and analytical values (hemoglobin, ferritin, phosphorus and albumin) were statistically evaluated. Results From the 71 analyzed MHD patients of the program of Centro Hospitalar do Médio Tejo - Portugal, 27 had a positive Polymerase Chain Reaction (PCR) test for COVID-19. Of those, the mean age was 73,81 years old (±11,08), 63% (n=17) were male and they were on a MHD program for an average of 36,48 (±32,1) months. 25,0% (n=7) of the COVID-19 patients suffered from long-COVID and 48,1% (n=13) had three doses of a vaccine against SARS-CoV-2 at the time of diagnosis. The mean follow up time was 12,59 (±7,11). The most common symptoms were asthenia, cough and sicca syndrome (all present in 14,8% of long-COVID patients), followed by arthralgias and anxiety (both present in 11,1% of the patients). A Receiver Operating Characteristic (ROC) curve was generated plotting sensitivity (y- axis) as a function of 1-specificity (x-axis), which allowed us to conclude that patients didn't have any analytic change that was predictor of long covid when compared to patients without long covid (p values all &gt; 0,05). Regarding to the baseline characteristics of the patients, there was no correlation between sex, age, CCI, time since the beginning of dialysis, diabetes, hypertension, hospitalization, the use of corticosteroids, the number of vaccines taken and the manifestation of long COVID (according to Fisher's Exact test). There was a statistically significant association with the presence of long covid and the initial symptoms of COVID-19 disease (with a p value of 0,01 and with a moderate strength - Cramer's V of 0,57). Conclusion Our study showed a moderate prevalence of COVID-19 infection and a low prevalence of long COVID in MHD patients. Besides there was no correlation between the number of vaccine doses and the presence of long COVID, one can only assume that the low incidence of post-COVID-19 syndrome is due to the vaccination. Even so, more studies with a higher number of patients and without memory bias are needed to prove a lower incidence of this syndrome after the massive vaccination. The fact that the higher number of initial symptoms correlate with long-COVID also leads to state that very symptomatic patients must remain under close monitoring.

Introduction: Erythropoietin-stimulating agents hyporesponsiveness is common among hemodialysis patients. The aim was to analyze factors predictive of Erythropoietin-stimulating agent resistance and its association with mortality. Subjects and methods: Retrospective analysis of prevalent hemodialysis patients. Dose–response effect of Erythropoietin-stimulating agent therapy was evaluated using Erythropoietin-stimulating agent resistance index (ERI). Patients were classified in groups (ERI≤10 and ERI>10). All-cause mortality was assessed using standard survival methods. Results: Among 59 patients, 24 had ERI>10. Patients with ERI >10 had more central venous catheters, higher C-reactive protein levels, lower body mass index, serum iron, transferrin saturation, albumin and intact parathormone levels. Hyporesponsive patients had an increased risk of one-year mortality. Discussion and conclusion: Our study confirmed that malnutrition, inflammation, and iron deficiency are the main causes of Erythropoietin-stimulating agent hyporesponsiveness, and intact parathormone levels and central venous catheter use may also play a role. Erythropoietin-stimulating agent resistance appear to be associated with an increased mortality risk among prevalent hemodialysis patients.

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