Background and Aims Overhydration (OH) is an independent predictor of mortality on hemodialysis (HD). The gold standard to assess OH is BCM monitor from Fresenius®, however BCM is a hospital hold device limiting its use. New smart scales have emerged as household devices reporting daily body composition data. Objective To determine if Renpho ES-CS20M® could be useful on a 52 HD patient to estimate body composition data. Method 72 body composition assessments (BCA) during mid-week HD session were performed. Each BCA included: (1) Predialysis Renpho measurement, (2) Predialysis BCM monitor measurement, (3) Postdialysis Renpho measurement. To track the fluid balance during the HD session: (1) we recorded ultrafiltration, (2) food or fluid intake was not allowed, and (3) none of the HD patients urinated during the HD session. If any intravenous fluids were needed during the HD session, we subtracted them off from UF. Results Data from 52 HD patients were studied (age 58.8 ± 16.8 years, 56.9 % males, 14.7% diabetics), with a mean pre-HD weight of 70.0 ± 13. 4 Kg, overhydration of 1.7 ± 1.5 L and urea distribution volume of 31.7 ± 5.7 L. The mean ultrafiltration during HD session was -1.8 ± 0.9 L. Renpho estimated a Pre – HD hydration of 34.25 ± 6.02 Kg vs 33.4 ± 5.7 Kg by BCM, showing a good concordance between methods (ICC 0.788 [0.67-0.86], B -0.58, p <0.01). Renpho poorly estimated pre – HD lean tissue mass at 45.4 ± 6.9 Kg compared with 33.8 ± 8.0 Kg by BCM. Although Renpho was able to provide a moderate concordant estimation of fat tissue mass (33.8 ± 8.0 % with Renpho vs 34.7 ± 9.6%), the bias proportion was unacceptable. Post- HD hydration by Renpho was not able to reproduce the ultrafiltracion achieved during the HD session (pre-HD 34.25 ± 6.02 Kg vs post-HD 34.08 ± 6.00 Kg). Conclusion Renpho has a proportional bias estimating predialysis hydration compared with BCM monitor, but is not able to assess changes produced with ultrafiltration or other parameters of body composition (as lean or fat tissue mass). Although smart scales are unacurate to assess body composition on HD patients, they could be useful on the follow up of them changing the accuracy for frequency.

Background and Aims Longer survival in renal transplantation means an increase in the number of patients who return to dialysis after graft loss. There is little literature about the management of immunosupression(IS) in these patients and the complications derived from its maintenance and its withdrawal/reduction. Method We conducted a retrospective study involving a cohort of patients who returned to dialysis after graft failure at Doce de Octubre Hospital from 2015 to 2022. We analyzed baseline characteristics, IS withdrawal scheme, and the complications derived in the 27 months following the restart of dialysis. Results A total of 50 patients were enrolled in the study: 58% male, 86% hypertensive, 30% diabetic and 52% with heart disease. The median age at transplant was 41.5 (33.7-53.2). 70% of donations were in brain death, 18% asystole and 10% alive. The duration of the graft was 8.5 years (5,14), 96% of patients developed anti-HLA antibodies and 40% suffered active rejection. Upon restarting dialysis, all the patients were receiving IS: 84% calcineurin inhibitors (CNI) (tacrolimus, cyclosporine), 58% antimetabolites (mycophenolate, azathioprine), and 10% mTOR inhibitors (everolimus). Haemodialysis was performed in 70% of patients through central venous catheterization in 68.6%. The median time to stop IS was 10 months (6,19). Between the first and the third month, imTOR [0(0.4)] and antimetabolite [1(0.3)] were finalized. Discontinuance of CNI and steroids was at 2 months (1,8) and 8 months (3,15.7) respectively. As complications derived of IS, 64% of patients developed serious infection and 12% were diagnosticated of neoplasms. On the other hand, eighteen patients presented immunological intolerance to the graft, 100% requiring an increase of steroids, 72.2% percutaneous embolization and finally 50% require a transplantectomy. The rate of immunological intolerance, embolization and transplantectomy was higher in patients with withdrawal IS during the first year. Patients on haemodialysis (HD) had higher rate of graft intolerance compared to peritoneal dialysis (PD) (40.5% vs 23%), attributable to early suspension of IS (62% before the first year), but similar rate of infection (61.5%PD, 64.8%HD). At 27 months (14.5,44.2) of follow-up after returning dialysis, 64% of patients remained on dialysis (30% on waiting list for a second kidney transplantation), 28% were retransplanted, and 8% were died. Conclusion Most of transplant recipients returned to haemodialysis through a venous catheter. Withdrawal of immunosuppression was performed on a median of 10 months, faster in mTOR and antimetabolites, and more progressive in CNI and steroids. Stop IS before the first year is more common in haemodialysis group and it is associated with a higher rate of graft intolerance. Finally we want to highlight the significant percentage of embolizations in our hospital, that let us avoid a 12.2% of the transplantectomies.

Background and Aims Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD). CVD is in turn related to endothelial dysfunction, endothelial dysfunction, and degradation of the endothelial glycocalyx (EG), releasing its components into the bloodstream. The EG consists of glycosaminoglycans and proteoglycans, such as Perlecan. The aim of the study is to analyse the levels of perlecan in plasma in different stages of CKD, and to relate them to age and inflammatory monocytes, as well as their adhesion capacity (CD54/ICAM-1). Method An observational cross-sectional study was carried out. 56 patients were included: advanced chronic kidney disease (ACKD) (n=13), haemodialysis (HD) (n=13), peritoneal dialysis (PD) (n=15) and transplant recipients (TX) (n=15). Thirteen healthy subjects (CT) were analysed. Plasma perlecan levels were quantified using ELISA and phenotyping of monocyte subpopulations (classical (CD14++CD16-), intermediate (CD14+CD16+) and non-classical (CD14+CD16++)), as well as CD54 (ICAM-1) expression by flow cytometry. Statistical analysis: ANOVA and Spearman correlation. Results Patients with CKD had higher plasma levels of perlecan than healthy participants (p-value = 0.044 vs ACKD, 0.028 vs HD and 0.002 vs PD) (Fig. 1). These levels were associated with higher percentage of classical monocytes (p=0,011) intermediate monocytes (p=0,009) and non-classical monocytes (p=0,003) expressing ICAM-1 but not with a higher expression of ICAM-1 per monocyte. Perlecan levels correlate negatively with age (p=0,03) (Table 1). Conclusion Patients with ACKD, HD and PD have elevated plasma perlecan levels compared to CT and TX. Elevated perlecan concentrations are associated with increased ICAM-1 expression on monocytes, which is important for its possible role in the development of atherosclerosis. Perlecan may be postulated as a molecule of interest to assess endothelial and cardiovascular damage in CKD patients.

Background and Aims Changes on body composition have an impact on the survival of haemodialysis (HD) patients. The aim of the study was to determine the impact of the reduction of physical activity due to COVID19 lockdown on body composition in HD patients. Method Retrospective and observational study including 149 HD patients. Nutritional and Bioimpedance spectroscopy (BIS) data were recorded before and after COVID19 lockdown (mean of 148 ± 20 days between determinations). Results Over the 49 days of COVID19 lockdown, we observed a decrease in normohydrated weight (NHW) of 1.01 ± 3.59 kg mainly secondary to a reduction on total body water (TBW) 0.95 ± 3.78 L (extracellular water 0.45 ± 1.58 L and intracellular water 0.41 ± 2.36 L). There was also a small loss on lean tissue index (LTI) of 0.28 ± 2.42 kg/m2, with an increase of fat tissue index (FTI) 0f 0.02 ± 2.82 kg/m2. Twenty-three patients presented COVID19 infection, of which 21 required admission (median of 10 [4-16] days). Patients who presented COVID19 were older (70.7 ± 12.0 vs 64.9 ± 16.6 years, NS) with higher Charlson index (7.48 ± 2.77 vs 6.33 ± 2.65, p = 0.07). Patients with COVID19 infection presented a greater loss on LTI (-1.18 ± 3.15 bs -0.16 ± 2.30 kg/m2; p = 0.22), FTI (-0.41 ± 3.38 vs 0.06 ± 2.74 kg/m2; p = 0.54); BMI (-1.49 ± 2.14 vs -0.25 ± 0.96 kg/m2; p = < 0.01) and NHW (-4.00 ± 6.33 vs -0.62 ± 2.90 kg; p = < 0.01) compared to patients without COVID19 infection. The length of hospitalization was associated with greater loss of BMI and NHW, resulting, therefore, in overhydration. There also had lower serum phosphorus (3.6 ± 0.8 vs 5.2 ± 0.8 mg/dl; p = 0.01) and serum albumin (3.5 ± 0.4 vs 4.0 ± 0.1 g/dl; p = 0.01). Seven patients died during hospitalization. Deceased patients were older (78.4 ± 6.6 vs 67.4 ± 12.4 years; p = 0.01), presented higher comorbidity (estimated by Charlson index 10.0 [8.0-11.0] vs 6.5 [4.3-8.0]; p = 0.02) and were more overhydrated (3.4 ± 3.6 vs 1.9 ± 1.9; p = 0.34). Although not statistically different, they had lower LTI (10.4 ± 2.1 vs 12.0 ± 3.4 kg/m2; p = 0.18) and lower serum albumin (3.4 ± 0.6 vs 3.9 ± 0.4 g/dl; p = 0.08) compared to survivors. Patients who survived COVID19 infection had longer hospitalization (57% were discharged between twelfth and forty third day; mean hospitalization 14.6 ± 11.5 days). Deceased patients died within the first 12 days of hospitalization (6.8 ± 4.1 days). Conclusion COVID19 lockdown induced a weight reduction on HD patients due to decrease in total body water. COVID19 infection increased this reduction, inducing greater loss on lean and fat tissue composition. Moreover, COVID19 impact on body composition was magnified with the length of hospitalization.

Background and Aims Peritoneal dialysis (PD) fluids used colloid or crystalloid solutions to achieve ultrafiltration. Here we presented our clinical experience with the intraperitoneal (IP) use of mixed solutions (MS) (crystalloid plus colloid) to treat overhydration. Method We studied the kinetics of 4-hour single-dwell exchange using 2L MS in 3 different sessions. We analysed IP fluids and IP pressure at 0,30,60,120 and 240 min plus blood samples at 0, 120 and 240 min. MS kinetics were compared with standard 4-hour 3.86 % glucose (GS) exchange. MS composition. We modified a single-dwell exchange of 2L Icodextrin (Extraneal, Baxter®) by adding a continuous 50% glucose infusion (50g Glucose per 100mL) in an aseptic technique through infusion pump (42 ml/h) over 4 hours. Results MS exchange induced a progressive increase in IP pressure with an inverse decrease in IP sodium, without significant changes in IP glucose or osmolarity. MS exchanges were well tolerated without side effects (total 25 sessions). We did not observe any remarkable change in bloods samples during the MS exchange. The combination fluid enhanced net ultrafiltration (mean 1030 ml) compared with GS (650 ml). Although the net glucose dispensed was slightly higher with MS (79 g MS vs 77.2 g GS), similar net glucose absorption was observed (49.8 g MS vs 49.9g GS) and smaller maximum intraperitoneal glucose levels (1739 mg/dL at 120 min with MS vs 2695 mg/dL with GS at 0 min). GS induced a faster initial reduction in dialysate sodium concentration while MS maintained the sodium sieving over 4-hour dwell enhancing net ultrafiltration due to sustained IP glucose concentration. Conclusion The combination fluid could be a new strategy to enhance ultrafiltration in PD patients, leaded by colloid osmosis at the beginning of PD exchange maintained by crystalloid osmosis. Figure (A) Intraperitoneal kinetics of MIXED SOLUTION for IP sodium (Na+ PF), Osmolarity PF and intraperitoneal pressure. (B, C, D) Comparison between MIXED SOLUTIONS (black line) vs Glucose solution 3,86 % (gray line) intraperitoneal kinetcs for sodium (B), intraperitoneal pressure (C) and glucose (D).