Functional and Biochemical Status of Uninsured Patients Starting Kidney Replacement Therapy

Background: In Mexico, the prevalence of chronic kidney disease (CKD) reached 9,184.9 per 100,000 inhabitants in 2021. Diabetes was the primary cause, and CKD-related mortality remained high. In 2022, the National Council for the Evaluation of Social Development Policy (CONEVAL) reported that 64.7 million people lacked access to social security. This scenario leads to delayed initiation of renal replacement therapy (RRT), often under urgent circumstances, with consequences for patients’ functional and biochemical status. Methods: Objective: To assess the physical functional and biochemical status of uninsured patients at the time of late initiation of RRT. This cross-sectional study included 165 patients who began RRT via urgent dialysis. Functional assessment included bioimpedance, handgrip dynamometry, and standardized evaluations using the Katz Index, Lawton-Brody scale, and the Short Physical Performance Battery (SPPB). Results: Of the total number of patients, 85% initiated RRT with hemodialysis, (Table 1). All patients showed fluid overload, with an average extracellular water percentage of 36%. In terms of functional independence, 43% had high dependence, 20% moderate dependence, and 37% were independent based on Katz and Lawton-Brody scores. Regarding physical performance (SPPB), 42.7% demonstrated severe physical limitations (Figure 1). All patients exhibited sarcopenia according to handgrip strength criteria. The mean estimated glomerular filtration rate (eGFR) at the time of initiation was 4 mL/min/1.73 m2, and 10% of patients had severe anemia. Conclusion: Uninsured patients tend to start RRT late, often in poor general condition. The lack of timely medical care is associated with high dependency levels, sarcopenia, and severe functional impairment. These findings underscore the need for improved early detection and access to nephrological care in vulnerable populations.