Background and Aims: Anemia is a common complication of heart failure and chronic kidney disease (CKD). Sacubitril-valsartan is a novel therapy for the treatment of chronic heart failure with a reduced ejection fraction (HFrEF). We have evaluated the short-term effects of sacubitril-valsartan on the anemia of CRS. Methods: The study group comprised 39 patients with HFrEF, who were followed-up for three months. The study is a retrospective analysis of clinical data. Data of 3 months’ visit and baseline visit were recorded including: plasmatic creatinine, glomerular filtration rate, cystatin C, kaliemia, haemoglobin, pro-BNP and albuminuria. Results: In all, 34 patients ended the follow-up. Mean sacubitril-valsartan dosage at baseline was 101±62 mg/day and 126±59 mg/day at end. Mean hemoglobin increased from 12.2±1.1 g/dl at baseline to 12.9±1.0 g/dl (p = 0.001,). Prevalence of anemia was 64.7% (95%CI,47.9-78.5%) at baseline and 38.4 (95%CI,23.9-55.0%) after the follow-up (p = 0.016). Serum cystatin C levels decreased from 2.71±1.0 to 2.48±1.0 mg/l (p = 0.028). Serum K levels remained unchanged (baseline 4.94±0.60, three months visit 4.94±0.61 mmol/l, p = 0.998). Conclusions: Sacubitril-valsartan improves anemia in CRS patients. An improvement of serum cystatin levels was observed. Few untoward effects were detected. These findings should be confirmed in wider clinical trials.

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Background and Aims : Secondary hyperparathyroidism (HPT) is a frequent complication in hemodialysis (HD) patients. Until now we had oral Vit / D analogues and oral Cinacalcet for treatment. The appearance of Etelcalcetide brings new treatment possibilities. Apart from clinical trials there are few long-term results in usual practice. Our goal is to evaluate results with the use of Etelcalcetide after more than a year of treatment in clinical practice of HD. Method We carry out a prospective descriptive study for 15 months with patients with HPT-HD, the ones who were with Cinacalcet and had not responded or had intolerance were changed to Etelcalcetide. Patients without prior treatment with calcimimetics were also included. Treatment with Vit D analogues and phosphate binders is treated according to usual clinical practice. Results We studied 25 HD patients, 12 men and 13 women with a mean age of 59.5 ± 13.6 years, 11 began de novo calcimimetic treatment and in 14 Cinacalcet was modified to Etelcalcetide due to lack of response or poor oral tolerance. Starting dose 2.5 mg post-dialysis, mean final dose 7.5 mg. We observed a reduction of PTH ≥30% in 80% of patients and a decrease ≥50% in 52%, Figure 1 shows the decrease over 15 months. The calcium corrected to albumine (Cac) decreased 4.8% ± 8 compared to baseline. The majority of patients present mild hypocalcemia (Cac between 7.5 and 8.3 mg / dl) and asymptomatic. There are no differences with P. Patients with PTH in range according to KDIGO went from 8% to 63%. No serious clinical manifestations of hypocalcemia or symptoms of digestive intolerance or other side effects appeared.  Conclusion Etelcalcetide in the long term significantly improves the control of HPT in HD with a high safety profile. IV administration facilitates compliance without having followed serious side effects in 15 months of follow-up.

Background and Aims Haemodialysis is the most commoly used replacement therapy for chronic kidney disease. We are looking for new solutions to remove solutes in the middle to high molecular weight range. Our objective is to evaluate and compare the purification of small and middle to high molecular weight between 15-45 KDa with Haemodyafiltration On Line postdilutional (HDF-OL-post) technique, Haemodialysis High-Flux (HD-HF) and Haemodialysis Expanded (HDx) using specific high permeability membranes: in the first two techniques polyphenylene membranes (1.7m2) and in the HDx technique cut point membranes PAEs/PVP (1.7 m2). Method 10 chronic prevalent patients on haemodialysis, older than 18 years, without diuresis and stable, 60% males. Mean age 65.3±17.47 years. Time in HD, mean 49.5 months. Etiologies: 20% NAE, 30% ND, 10 % Glomerulopathies, 40% unaffiliated. Vascular Accesses: 50% FAVn, 20% FAVp, 30% CVC-T. They were evaluated for three consecutive weeks with analytics in the intermediate session, modifying the technique and the membrane, keeping the dialysis patient stable. Post-dialysis concentrations of solutes in the middle to high molecular weight range were corrected in relation to haemoconcentration. A comparison of the reduction percentages (RP%) of various molecules was performed. The possible normal distribution was studied in the continuous variables with the Shapiro-Wilk test and the comparison of means using the t-Student or Wilconson test as the most appropriate. SPSS statistical program 17.0. Results No serious adverse events or allergies were recorded. The comparative results between the three techniques are shown in the figure 1. Conclusion The mean reduction of medium molecules (β2-microglobulin, cystatin-C) was not lower in HDx compared to HDF-OL-post. From 20 KDa there is no greater capacity to reduce solutes in HDx in our sample than in the other techniques. Between the three techniques, the HDF-Ol-post is the one that shows a higher percentage of mean reduction of α1-acid glycoprotein and albumin.

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