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Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aims: Access blood flow (Qa) measurements are recommended by the current guidelines as one of the most important components in vascular access maintenance programs. This study evaluates the efficiency of Qa measurement with on-line conductivity (OLC-Qa) and blood temperature monitoring (BTM-Qa) in comparison with the gold standard saline dilution method (SDM-Qa). Subjects and Methods: 50 long-term hemodialysis patients (42 arteriovenous fistulas/8 arteriovenous grafts) were studied. Bland-Altman and Lin's coefficient (ρc) were used to study accuracy and precision. Results: Mean values were 1,021.7 ± 502.4 ml/min SDM-Qa, 832.8 ± 574.3 ml/min OLC-Qa (p = 0.007) and 1,094.9 ± 491.9 ml/min with BTM-Qa (p = NS). Biases and ρc obtained were -188.8 ml/min (ρc 0.58) OLC-Qa and 73.2 ml/min (ρc 0.89) BTM-Qa. The limits of agreement (bias ± 1.96 SD) obtained were from -1,119 to 741.3 ml/min (OLC-Qa) and -350.6 to 497.2 ml/min (BTM-Qa). Conclusions: BTM-Qa and OLC-Qa are valid noninvasive and practical methods to estimate Qa, although BTM-Qa was more accurate and had better concordance than OLC-Qa compared with SDM-Qa. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background and Objectives: The key points of a monographic vascular access (VA) consultation are an adequate preoperative assessment, as well as a correct management and optimization of waiting lists. Our main objective of present study was to evaluate the degree of exploratory-dependent concordance in outpatient clinics regarding implanted VA, between nephrology and vascular surgery., Materials and Methods: We analyzed VA created or surgically repaired between 2021 and 2022. We compared the differences in the preoperative variables between the groups in which the assessments between the two teams were coincident and non-coincident, and the primary (PP) and secondary (PS) patencies during the follow-up period (Kapplan-Meier curves and Log-rank test, and Cox regression analysis). Significant P ≤ 0.05., Results: A total of 605 VA creations or repairs were analyzed: 74 ligations (12.2%), 207 distal arterio-venous fistulaes (AVF) (34.3%), 237 proximal AVF (39.2%), 35 repairs (5.7%), 41 grafts (6.7%) and 11 others (1.9%). After an average waiting list time of 16.5 ± 11.6 days, excluding ligations, adequate 1-month maturation was observed in 87.6% of cases. A total of 158 endovascular procedures and 17 surgical repairs were performed during postoperative follow-up. Primary (PP) and secondary (PS) patencies at 6, 12 and 24 months were PP: 76.2%, 64.9%, 57.5% and PS: 86.4%, 81.2%, 74.7%, respectively. Of the total number of procedures, nephrology obtained an adequate degree of agreement in 93.6% of the cases (kappa index: 0.886). The preoperative factors associated with greater discrepancies in assessments were age (P = 0.022) and arterial diameter (P = 0.032). The subgroup of non-matched assessments between nephrology and vascular surgery (39 cases) presented a similar PP (at 2 years: 59.2% vs 41.3%, P = 0.099) but worse PS (at 2 years: 76.6% vs 55.4%, P = 0.005)., Conclusions: No significant observer-dependent differences (nephrologist vs. vascular surgeon) were observed in decision-making regarding the surgical procedure to be performed (93.6% agreement), and discordant cases presented worse secondary patency. After specific training, the nephrology coordination team can make a proper optimisation of social and health resources by reserving referrals to vascular surgery for those cases of greater complexity., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

The dialysis membrane based on a hydrophilic polymer (Hydrolink NV) was designed to enhance the movement of adsorbed water at the blood-membrane interface, aiming to achieve antithrombogenic and antifouling effects. This study aimed to assess the performance and albumin loss of the Hydrolink NV dialyzer in hemodialysis (HD) and post-dilution hemodiafiltration (HDF) with different infusion flows (Qis) and compare it with the hydrophilic FX CorAL dialyzer in post-dilution HDF. A prospective study was carried out in 20 patients. Patients underwent five dialysis sessions with the same routine dialysis parameters: four sessions with the Toraylight NV 2.1 (HD, post-dilution HDF with 50, 75 or auto-substitution Qi) and one with the FX CorAL 800 (post-dilution HDF with auto-substitution Qi). The reduction ratios' (RRs') wide range of molecular weight molecules were assessed and the dialysate albumin loss was quantified. The lowest β 2 -microglobulin, indoxyl-sulfate, and p-cresyl sulfate RR values were observed with the Toraylight NV 2.1 in HD, and they improved progressively with an increased Qi, without differences being observed between the two dialyzers in auto-substitution. A different removal profile was observed in terms of myoglobin, kFLC, prolactin, α 1 -microglobulin, α 1 -acid glycoprotein, and λFLC, whose RRs also improved progressively with an increased Qi but were significantly higher with the Toraylight NV than the CorAL in the same convective condition. There were significant differences in the albumin dialysate losses, with the highest value obtained with the Toraylight NV in auto-substitution HDF, with more than 50% of patients surpassing 5 g per session. The Toraylight NV dialyzer has great potential for efficacy but should be used at the optimal convective volume (Qi not exceeding 75 mL/min or FF not exceeding 25%) to avoid excessive albumin loss.

Background : High-volume online hemodiafiltration (OL-HDF) has proven to be the most efficient dialysis modality and to offer better clinical outcomes in patients on hemodialysis. Longer and more frequent dialysis sessions have demonstrated clinical and survival benefits. Methods : A single-center observational study of the first one hundred patients on nocturnal every-other-day OL-HDF was conducted with the aim of reporting the experience with this treatment schedule and evaluating analytical and clinical outcomes as well as the patient and technique survival. Results : Nocturnal OL-HDF on alternate days was highly accepted, with no adverse symptoms, good clinical tolerance, and maintained active work in 62%. Kt, and the convective volume increased from 67.6 ± 12 L to 105.4 ± 11.7 L, and from 27.1 ± 4.6 L to 48.1 ± 6.4 L, respectively, from the baseline to 24 months. An improved calcium-phosphate balance and blood pressure control were observed, as the use of phosphate binders and antihypertensive medications decreased from 76.7% to 3.3% and from 56.7% to 28.3%, respectively. Furthermore, 58.3% of patients required phosphate supplementation in the dialysis fluid to prevent intradialytic hypophosphatemia. Additionally, doses of iron and erythropoiesis-stimulating agents were reduced. The global patient survival was 94% at the end of the follow-up. It was higher in those on the transplant waiting list, with 98.1% survival compared to 84.6% in non-wait-listed patients at 24 months. The main reason for treatment discontinuation was kidney transplantation, accounting for 78.4% of the 88 withdrawals, while death was the leading cause of discontinuation in non-listed patients (41.6%). Conclusions : Nocturnal every-other-day OL-HDF is a well-tolerated dialysis regimen that offers significant clinical benefits, which may positively impact morbidity and mortality. Additionally, it allows patients to integrate the treatment into their social and occupational lives.

Background: Autologous arteriovenous fistula is usually the vascular access of choice for hemodialysis in patients with chronic kidney disease. Autologous forearm loops with cephalic or basilic vein are an alternative in those cases with a suitable forearm vein but with an unsuitable radial artery; however they are rarely used and there is little reported evidence of their usefulness. Our objective is to report our results on the creation of autogenous forearm loops as vascular access for hemodialysis., Methods: We present a prospective cohort study of autogenous forearm loop arteriovenous fistula created between 2010 and 2022, in patients with stage 4-5 chronic kidney disease. Demographic data, surgical details, vein used, follow up to 24 months, maturation, utilization, primary, assisted, and secondary patency estimations with Kaplan-Meier curves, as well as complications during follow-up, were recorded., Results: During the study period, 22 autologous forearm loops were created, 14 of them with cephalic, and 8 with basilic vein. Most (59%) of the patients were men, 19 were already on dialysis and the rest started during follow-up. Sixteen patients had previous vascular accesses. One patient was lost during follow-up. Six-week maturation rate was 61.9% and utilization rate was 57.1%. 6, 12, and 24 months primary and secondary patencies were 75.4%, 59.2%, 41.5% and 85.0%, 69.5%, 56.9% respectively. In five patients an access-induced distal ischemia was diagnosed, four successfully treated and only one patient lost the access. No cases of infection or other major complications were reported., Conclusion: Autologous forearm loops have acceptable maturation (61.9%) and patency rates at follow-up (56.9% 2-years secondary patency). Although rarely used, they are a vascular access alternative that should be considered to preserve the proximal vasculature of the arm for future accesses., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Dialysis catheter-associated bacteremia in Intensive Care Units (ICUs) increases morbidity and mortality, prolongs hospital admission and increases admission costs. Taurolidine-Citrate-Heparin Locking Solution (TCHLS) is a catheter-locking solution with a broad antimicrobial activity against gram-positive and gram-negative bacteria and fungi. The aim of this study was to analyze the effect of systematic sealing of hemodialysis catheters in the ICUs of the Hospital Clínic de Barcelona on the incidence of hemodialysis catheter-related blood stream infections (CRBSI)., Material and Methods: CRBSI episodes of patients who underwent intermittent hemodialysis (IHD) during ICU admission were reviewed. TCHLS was established as a routine dialysis catheter sealing solution in the hospital ICUs in 2015. As a control group an historic pre-TCHLS group from 2010 to 2014 was used. The post-TCHLS period comprised from 2015 to 2018., Results: A total of 243 and 266 patients required IHD in the pre- and post TCHLS periods, respectively. The number of CRBSI in the pre-TCHLS period was 18 (7.43%) as compared to 9 (3.38%) in the post-TCHLS period ( p  = 0.043). All infections were from percutaneous catheters except for three catheters that were tunneled. There was no association between the location of the catheter and the incidence of CRBSI. The most frequent isolated microorganisms were Gram positive bacteria (48.38%), with a global predominance of Staphylococcus epidermidis (32.25%). There were no significant differences in the median days from the start of hemodialysis to the onset of bacteremia (23.5 days in pre-TCHLS group vs 21 days in the post-TCHLS). There were also no significant differences between the days of ICU stay in the CRBSI in both groups or in mortality, being the overall mortality of 65.9%., Conclusions: In our population, the systematic application of TCHLS in the sealing of dialysis catheters in critically ill patients reduces the incidence of CRBSI in ICUs., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: New generation helixone dialyzers has recently been developed as part of the ongoing effort to improve dialyzer hemocompatibility and avoid adverse reactions to synthetic dialyzers. This study aimed to assess the performance and albumin loss of this new dialyzer series in hemodiafiltration and compare it with the previous generation helixone series., Material and Methods: A prospective study was conducted in 19 patients. Each patient underwent eight dialysis sessions with the same routine dialysis parameters; only the dialyzer varied: FX60 CorDiax, FX CorAL 60, FX600 CorDiax, FX CorAL 600, FX80 CorDiax, FX CorAL 80, FX800 CorDiax, and FX CorAL 800. The reduction ratios (RR) of urea, creatinine, ß 2 -microglobulin, myoglobin, kappa-free immunoglobulin light chains (κFLC), prolactin, α 1 -microglobulin, α 1 -acid glycoprotein, lambda immunoglobulin light chains (λFLC), and albumin were compared intra-individually. Dialysate albumin loss was also measured., Results: All treatments were well tolerated. The mean amount of replacement fluid ranged from 31 to 34 L. Comparison of dialysis treatments showed no differences between small molecules and even up to those the size of β2-microglobulins. Little differences were found between myoglobin, κFLC, prolactin, α 1 -microglobulin, and λFLC RRs, and only FX80 CorDiax was slightly superior to the others. Mean dialysate albumin losses were similar, with less than 2.5 g lost in each dialyzer. The FX80 CorDiax showed slightly higher global removal scores than the other dialyzers evaluated, except for FX CorAL 800., Conclusion: The new generation helixone dialyzers series has been updated to minimise the risk of adverse reactions, while maintaining the effectiveness and albumin loss achieved by the previous most advanced helixone generation., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Introduction: Changes in plasma sodium concentration ( p Na, expressed in mEq/L) are common in hemodialysis (HD) patients. Hemodialysis monitors can estimate p Na by using an internal algorithm based on ion dialysance measurements. The present study studies the accuracy of the correlation between the p Na estimated by the dialysis monitor and that measured by the biochemistry laboratory at our center., Material and Methods: A single-centre prospective observational study in patients on a chronic HD program with the 6008 CAREsystem monitor and standard sodium (138mmol/L) and bicarbonate (32mmol/L) prescriptions. Venous blood samples were drawn from each patient before and after each HD session to ensure inter- and intra-individual validity. The p Na was measured in the biochemistry laboratory using indirect potentiometry and simultaneously the estimated p Na by the HD monitor was recorded at the beginning and at the end of the HD session. For statistical analysis, a scatterplot was made, and Spearman's correlation quotient was calculated. In addition, the differences between both methods were represented as Bland-Altman diagrams., Results: The pre-dialysis p Na measured in the laboratory was 137.49±3.3, and that of the monitor, 137.96±2.91, with a correlation with R 2 value of 0.683 (p<0.001). The post-dialysis p Na measured in the laboratory was 137.08±2.23, and that of the monitor was 138.87±1.88, with an R 2 of 0.442 (p<0.001). On the Bland-Altman plots, the pre-dialysis p Na has a systematic error of 0.49, in favor of the monitor-estimated p Na, with a 95% confidence interval (CI) of (-3.24 to a 4.22). In the post-dialysis p Na, a systematic error of 1.79 with a 95% CI of (-1.64 to 5.22) was obtained., Conclusion: The correlation between the p Na estimated by Fresnius 6008 CAREsystem HD monitor and that measured by the laboratory is good, especially pre-dialysis measurements. Further studies should verify the external validity of these results., (Copyright © 2023 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The sodium gradient during hemodialysis sessions is one of the key factors in sodium balance in patients with dialysis-dependent chronic kidney disease; however, until the appearance of the new monitors with sodium modules, the differences between prescribed and measured sodium have been understudied. The present study aimed to compare the impact on the measured conductivity and the initial and final plasma sodium after changing the 5008 Cordiax to the new 6008 Cordiax monitor., Material and Methods: 106 patients on hemodialysis were included. Each patient underwent 2 dialysis sessions in which only the monitor was varied. The variables collected were dialysate, sodium and bicarbonate prescribed, real conductivity, initial and final plasma sodium measured, and the calculated sodium gradient (ΔPNa)., Results: The change of dialysis monitor showed small but statistically significant differences in the initial (138.14mmol/L with 5008 vs. 138.81mmol/L with 6008) and final plasma sodium (139.58mmol/L vs. 140.97mmol/L), as well as in the actual conductivity obtained (13.97 vs. 14.1mS/cm). The ΔPNa also increased significantly., Conclusion: The change from 5008 to 6008 monitor is associated with increased conductivity, leading the patient to end the sessions with higher plasma sodium and ΔPNa. Knowing and confirming this change will allow us to individualize the sodium prescription and avoid possible undesirable effects. It could be the preliminary study to explore the new sodium biosensor incorporated into the new generation of monitors., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Introduction: On-line haemodiafiltration (OL-HDF) is currently the most effective technique and several randomised studies and meta-analyses have seen a reduction in mortality and an association directly related with convective volume is observed. Blood flow (Qb) limits the infusion rate to 25-33 % and is the main limiting factor for reaching an optimum substitution volume. With the recent incorporation of monitors with auto-substitution systems, the aim of the study was to assess the effect of Qb variations on convective volume and purifying capacity., Material and Methods: 23 patients, 17 men and 6 women, were included, with an average age of 65.5 &plusmn;10 years, time on dialysis 292.2 &plusmn; 15 minutes, which were in the OL-HDF programme with the 5008 Cordiax monitor with auto-substitution. Each patient was analysed over 5 sessions in which only the Qb was changed (250, 300, 350, 400 and 450 ml/min). In each session the substitution volume, total convective volume and parameters of dialysis were measured. The concentration of urea (60 Da), creatinine (113 Da), &beta;2-microglobulin (11,800 Da), myoglobin (17,200 Da), prolactin (23,000 Da), &alpha;1-microglobulin (33,000 Da) and &alpha;1-acid glycoprotein (40,000 Da) in plasma was measured at the start and end of each session in order to calculate the percentage of reduction of these solutes., Results: The trans-membrane pressure was less, with Qb 250 ml/min. A significant increase in convective volume was observed with the increase in Qb, 23.7, 26.9, 30.2, 32.8 and 35.2 l/session to 250, 300, 350, 400 and 450 ml/min, respectively (P &lt; 0.001), representing a percentage of total purified blood of 33.2, 31.2, 30.2, 28.7 and 27.3 % respectively. The percentages of reduction of urea and creatine progressively increased with Qb, slight differences were observed with &beta;2-microglobulin and myoglobin, and no changes were observed in the larger molecules., Conclusion: For each 50 ml/min increase in Qb, the convective volume increased by between 8 and 12 ml/min. The auto-substitution system strengthens the lowest Qbs in the percentage of convective volume with regards to total purified blood. Qb increases the purifying capacity of small molecules, favouring that of &beta;2-microglobulin and myoglobin, and does not influence molecules of a greater molecular weight.&nbsp;

Introduction: On-line haemodiafiltration (OL-HDF) is based on the controlled administration of large volumes of replacement ultrapure dialysate to the extracorporeal blood circuit of dialysis. It is currently the most effective technique for eliminating small and large uraemic toxins. Recent studies have observed a direct association between a decrease in mortality and the received convective volume. The latest Fresenius 5008 (5008 CorDiax) monitor software update enables the automation of the replacement volume without requiring total protein and haematocrit values, with the aim of maximising convection., Objective: The study&rsquo;s objective was to evaluate the recent version of the 5008 monitor software, compared to the previous version, on the impact on total convective volume., Material and Method: We included 63 patients (44 males and 19 females), with a mean age of 65.2&nbsp;&plusmn;&nbsp;15 years, on OL-HDF. Each patient was analysed in 6 sessions; 3 with the 5008 monitor and 3 with the 5008 CorDiax monitor. The replacement volume, total convective volume and dialysis parameters were determined in each session., Results: No significant differences were observed in blood, venous or transmembrane pressure, nor was there an increase in the number of alarms or coagulation of lines or dialysers. A significant increase of replacement fluid volume, from 27.2 to 31.2&nbsp;L/session, was observed using the CorDiax software. Total convective volume increased from 29.5 to 33.3 L/session, representing an effective convective volume increase from 26&nbsp;% to 29.6&nbsp;% of total filtered blood., Conclusion: The 5008 dialysis monitor software update has meant a 13&nbsp;% increase of total convective volume and a 3.5&nbsp;% increase of total filtered blood.

Unlabelled: Calcium is one of the key elements to consider in patients on dialysis due to its relationship with cardiovascular risk. The introduction of non-calcium-based phosphate binders and calcimimetics has changed the setting for pre-dialysis serum calcium in recent years from 9.5-10.5mg/dl to 8.5-9.5mg/dl. To assess more accurately the changes in calcium (Ca) during haemodialysis sessions and to individualise prescriptions, the aim of this study was to assess the intradialytic changes of two different dialysate Ca concentrations before and after hemodialysis and their implications in controlling calcium-phosphate metabolism., Patients and Method: We analysed 98 patients with a mean age of 59.3 ± 15 years, 68 of which were men and 30 women. Each patient received two HD sessions with two different dialysate Ca concentrations: 2.5 mEq/l (Ca25 group) or 3.0 mEq/l (Ca30 group). Pre- and post-dialysis Ca, phosphorus (P) and PTH were determined, and associated medications were recorded. For a more individualised analysis, patients were divided into four subgroups of Ca<8.5mg/dl, 8.5-9.0mg/dl, 9.0-9.5mg/dl, and >9.5mg/dl, according to pre-dialysis serum calcium levels., Results: There were no differences in pre-dialysis values of Ca: 8.81 ± 0.65 (CA25) and 8.88 ± 0.61 (CA30), P: 4.01 ± 1.3 (CA25) and 4.19 ± 1.2 (CA30), or PTH: 352 ± 288 (CA25) and 369 ± 310 (CA30). Post-dialysis Ca and PTH did not change significantly with CA25 dialysate, although there was a significant post-dialysis Ca increase to 10.2 ± 0.6 (P<.001) accompanied by a decrease in post-dialysis PTH (181 ± 227, P<.001) with CA30. However, with CA25 dialysate, when different subgroups of pre-dialysis Ca were analysed: <8.5mg/dl (30.6%), 8.5-9.0mg/dl (31.6%), 9.1-9.5mg/dl (23.5%) and >9.5mg/dl (14.3%) we observed a Ca increase during the session in the <8.5 (P<.001) and 8.5-9.0 (P<.01) subgroups. Ca was unchanged in the 9.1-9.5 group and Ca decreased when the initial Ca values were >9.5mg/dL (P<.01). A Ca increase (P<.001) and a decrease in PTH (P<.01) were observed in all subgroups with CA30 dialysate. A total of 42% of patients were taking calcimimetics, 47% paricalcitol, and 32% calcium-based phosphate binders, although these drugs were not linked with pre- or post-dialysis Ca levels in or dialysate treatment., Conclusion: We concluded that the prescription of Ca dialysate needs to be individualised based on pre- and post-dialysis Ca values and the need for an increase, decrease, or no changes in post-dialysis calcium in relation to the clinical condition of the patient's phosphorous-calcium metabolism.