Hemodialysis vascular access flow measurements by the novel DMed NephroFlow® device: A comparative study with Transonic®.

INTRODUCTION: The current Spanish Clinical Guidelines on Vascular Access for Hemodialysis support the need for surveillance and monitoring of vascular access (VA) to avoid complications. Ultrasound dilution (UD) methods are accepted for the evaluation of VA flow and Transonic® has established the gold standard method for the measurement. The DMed NephroFlow (NIPRO®) device, based on UD method has recently been incorporated. We report a comparative study between the classic Transonic® versus the new NephroFlow® device. MATERIAL AND METHODS: For two consecutive months, measurements of VA flow using both referred systems were performed in patients with a native arteriovenous fistula (AVF) or a graft (AVG) on hemodialysis (HD) in our unit. Both studies were undertaken according to the usual recommendations: VA flow of 250 ml/min, ultrafiltration rate without modifications, both needles in the same vein, and always in the first hour of the HD session. RESULTS: Forty-five patients were included: 17 women and 28 men, mean age of 67 ± 12 years. Thirty patients were diabetic. The baseline meantime on HD was 51 ± 39 months (range: 3-163). Type of VA was: 17 patients radio-cephalic AVF, 17 brachiocephalic AVF, 7 brachiobasilic AVF, and 3 with a graft. The mean flow estimated by the Transonic® was 1222 ± 805 ml/min and the estimated flow by the NephroFlow® device was 1252 ± 975 ml/min. Good reliability between Transonic® and NephroFlow® was observed, with a reliability index of Cronbach's Alpha of 0.927 and an Intraclass Correlation Index of 0.928. CONCLUSIONS: The NephroFlow® device seems comparable with the accepted gold standard UD method for estimating VA flow. More studies must be performed to verify these results. However, they should be considered for the surveillance and monitoring of VA flow, in agreement with the Spanish Guidelines.

Fat tissue and inflammation in patients undergoing peritoneal dialysis.

BACKGROUND: Body weight has been increasing in the general population and is an established risk factor for hypertension, diabetes, and all-cause and cardiovascular mortality. Patients undergoing peritoneal dialysis (PD) gain weight, mainly during the first months of treatment. The aim of this study was to assess the relationship between body composition and metabolic and inflammatory status in patients undergoing PD. METHODS: This was a prospective, non-interventional study of prevalent patients receiving PD. Body composition was studied every 3 months using bioelectrical impedance (BCM(®)). We performed linear regression for each patient, including all BCM(®) measurements, to calculate annual changes in body composition. Thirty-one patients in our PD unit met the inclusion criteria. RESULTS: Median follow-up was 26 (range 17-27) months. Mean increase in weight was 1.8 ± 2.8 kg/year. However, BCM(®) analysis revealed a mean increase in fat mass of 3.0 ± 3.2 kg/year with a loss of lean mass of 2.3 ± 4.1 kg/year during follow-up. The increase in fat mass was associated with the conicity index, suggesting that increases in fat mass are based mainly on abdominal adipose tissue. Changes in fat mass were directly associated with inflammation parameters such as C-reactive protein (r = 0.382, P = 0.045) and inversely associated with high-density lipoprotein cholesterol (r=-0.50, P = 0.008). CONCLUSIONS: Follow-up of weight and body mass index can underestimate the fat mass increase and miss lean mass loss. The increase in fat mass is associated with proinflammatory state and alteration in lipid profile.

Citrate versus acetate-based dialysate in on-line haemodiafiltration. A prospective cross-over study.

BACKGROUND AND AIMS: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect and improves biocompatibility. This study examines the effect of CD on dialysis efficiency, coagulation, acid-base status, electrolytes, and inflammation in patients in on-line hemodiafiltration (OL-HDF). METHODS: 35 patients in OL-HDF were enrolled in a prospective, cross-over study for a 24-week period and two phases alternating CD and acetate dialysate fluid (AD). Parameters on study were predialysis levels of bicarbonate and ionic calcium, reactive C Protein (CRP), and beta-2 microglobulin (B2MG) and postdialysis levels of activated tromboplastine time, bicarbonate, and ionized calcium. RESULTS: No significant differences in coagulation parameters, pH, and predialysis bicarbonate were found. The postdialysis bicarbonate and postdialysis calcium were lower with CD. Dialysis efficiency was greater with CD. Regarding inflammatory parameters, both CRP and B2MG were lower using CD. CONCLUSION: The use of CD is safe and effective in OL-HDF, and it improves dialysis efficacy, postdialysis alkalosis, and inflammation.

Valoración del estado nutricional en pacientes en hemodiálisis / Assessment of nutritional status in haemodialysis patients

La malnutrición es un problema frecuente y un factor de riesgo de mortalidad en pacientes en hemodiálisis. Sin embargo, no existe un consenso para evaluarla. Objetivo: Evaluar la relación entre el estado nutricional medido por bioimpedancia espectroscópica (BIS) y los parámetros analíticos nutricionales, así como la evolución nutricional, valorada como sus modificaciones, en un año. Métodos: Estudio prospectivo observacional de 124 pacientes en hemodiálisis (edad 61,2 [±15,8] años, varones 62,9 %, diabéticos 33,1 %). Los parámetros analíticos nutricionales y la BIS se realizaron basalmente y al año. Resultados: El índice de masa magra (IMM) basal (medio 13,3 ± 3,6 kg/m2) se correlaciona de forma directa con el sexo masculino (p =0,01) e inversamente con la edad (p = 0,006). Basalmente el índice de masa grasa (IMG) (medio 11,2 ± 6,1 kg/m2)se correlaciona de forma directa con el índice de masa corporal (p < 0,001) y el sexo femenino (p = 0,004). No encontramos asociación con la comorbilidad o los parámetros inflamatorios. No observamos correlación entre las modificaciones de masa magra o masa grasa con las modificaciones de parámetros nutricionales. Los pacientes con ganancia de IMM (> 0 kg/m2) presentan albúmina sérica basal más baja (p = 0,017), menor IMM basal (p < 0,001) y mayor IMG basal (p = 0,027). Los pacientes con pérdida de IMG (< 0 kg/m2) presentan menores cifras de tensión arterial sistólica(p = 0,04). Conclusión: La valoración del estado nutricional mediante parámetros analíticos no presenta una buena relación con los parámetros de composición corporal ni con sus modificaciones (AU)

Malnutrition is a common problem and a risk factor of mortality in haemodialysis patients. However, there is no consensus for its assessment. Objective: To assess the relationship between nutritional status, measured by bioimpedance spectrometry (BIS), and laboratory markers of nutritional status, as well as nutritional evolution and its changes after 1 year. Methods: We performed an observational prospective study on 124 haemodialysis patients (aged 61.2 [±15.8] years, 2.9% were males, 33.1% were diabetic. Laboratory markers of nutritional status and BIS were implemented at baseline and after one year. Results: At baseline, lean mass index (LMI) (13.3 [±3.6] Kg/m2) was inversely correlated with age (P=.006), and directly with male gender (P=.01). At baseline, the fat mass index (FMI) (mean 11.2 ± 6.1kg/m2) correlates directly with the body mass index (P<.001) and the female gender (P=.004). We found no association with comorbidity or inflammatory markers. We did not observe any correlation between lean mass or fat mass modifications and nutritional marker modifications. Patients with LMI gain (>0kg/m2) have lower baseline serum albumin (P=.017), lower baseline LMI (P<.001) and higher baseline FMI (P=.027). Patients with FMI loss (<0kg/m2) have lower systolic blood pressure (P=.04). Conclusions: Assessment of nutritional status through laboratory parameters does not have a good correlation with body composition parameters or with their modifications (AU)

Assessment of nutritional status in haemodialysis patients.

BACKGROUND: Malnutrition is a common problem and a risk factor of mortality in haemodialysis patients. However, there is no consensus for its assessment. OBJECTIVE: To assess the relationship between nutritional status, measured by bioimpedance spectrometry (BIS), and laboratory markers of nutritional status, as well as nutritional evolution and its changes after 1 year. METHODS: We performed an observational prospective study on 124 haemodialysis patients (aged 61.2 ±[15.8] years, 62.9% were males, 33.1% were diabetic. Laboratory markers of nutritional status and BIS were implemented at baseline and after one year. RESULTS: At baseline, lean mass index (LMI) (13.3 [3.6] Kg/m2) was inversely correlated with age (P=.006), and directly with male gender (P=.01). At baseline, the fat mass index (FMI) (mean 11.2 & 6.1kg/m2) correlates directly with the body mass index (P<.001) and the female gender (P=.004). We found no association with comorbidity or inflammatory markers. We did not observe any correlation between lean mass or fat mass modifications and nutritional marker modifications. Patients with LMI gain (>0kg/m2) have lower baseline serum albumin (P=.017), lower baseline LMI (P<.001) and higher baseline FMI (P=.027). Patients with FMI loss (<0kg/m2) have lower systolic blood pressure (P=.04). CONCLUSIONS: Assessment of nutritional status through laboratory parameters does not have a good correlation with body composition parameters or with their modifications.