Background and Aims Gait speed is a predictor of disability, mobility limitation and mortality. Buchner et al. the first to observe a non-linear relationship between leg strength and normal gait speed. This relationship was explained as small changes in physiological capacity. The objective of this study is to assess the relationship between gait speed and body composition in haemodialysis. Method Cross-sectional study in 40 subjects with CKD in hospital haemodialysis, 70.5±13.03 years, 62.5% male. 40% Diabetic Nephropathy, 10% Glomerulopathies, 7.5% Nephroangiosclerosis, 2.5% Chronic Tubule-Interstitial Nephropathies, 32.5% Unknown, 2.5% Others. 35% arteriovenous fistula, 10% arteriovenous graft, 55% central venous catheter. Haemodialysis type: 40% High Flux, 45% Online postdilutional Haemodiafiltration, 10% Acetate Free Biofiltration. Gait seed was measured on the middle day of the week, predialysis. Body composition was estimated by monofrecuency bioimpedance measurement (50 KHz) on the middle day of the week, posthemodiálisis. Statistical analysis was performed with SPSS 13.0. Results Average gait speed 0.6±0.38 m/s, median 0.65 (IQR 0.18) m/s, range (0, 1.23) m/s. The prevalence of a gait speed less than or equal to 0.8 m/s was 67.5%, while 32.5% of the patients presented a gait speed less than or equal to 0.8 m/s. Gait speed was lower among diabetics (0.77±0.3 vs 0.46±0.39, p=0.0074). A positive and significant correlation was observed between gait speed and phase angle. No correlation was observed between gait speed and body fat. A positive linear relationship or dependence was observed between gait speed and muscle mass and cell mass. In relation to body water, a negative linear relationship is observed with the EW/IW ratio. Table 1. Conclusion There is a dependent relationship between gait speed and diabetes in haemodialysis patients. The decrease of the phase angle, the increase of the ratio EW/IW changes with the decrease the cell mass index are inversely related to the gait speed in haemodialysis patients. These items and the gait speed, which provide information on the state of vulnerability of the patient, could be markers of frailty.

Background and Aims Hemodialysis patients are high-risk patients for severe forms of SARS-Cov 2. Extremadura has two provinces Badajoz(B) and Caceres(C) with one million of people. The incidence was small in the first part of the pandemic (2,6%) compared with the national incidence, and it was higher in C than in B (5,6% vs 1,1%) The aim of this study was to estimate the incidence of COVID-19 disease in the population of Extremadura's hemodialysis patients and to study the clinical evolution, treatment and mortality in patients with confirmed infection with Polymerase chain reaction(PCR) during the second wave. Method Multicenter, retrospective, observational study of hemodialysis patients with COVID-19 disease between August and December of 2020. There were 683 hemodialysis patients in this period distributed in 5 hospital units and 7 out of hospital Units. Results Incidence: 6,8% (46 infected of SARS-Cov 2), with almost one patient in each center (the highest with 16,1%) and higher incidence in B than in C (8,1% vs 4,1%). Males (58,7%), media age, (69,3±11,9) and median renal replacement therapy time 29 months (RIC 47,4). The most frequent CKD was diabetic nephropathy (16%), but 35% of the patients have diabetes, 86% hypertension and 56% cardiovascular illness. Treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers 40% and with vitamin D 62,8%. There were 42% patients who had contacted with positive people of hemodialysis unit and 37% with positive people outside. 67% have symptoms: the most frequent cough and fever (46%). Hospitalized patients: 41,6%, all of them with bilateral pneumonia. All had lymphocytopenia and high acute phase reactants: D -dimer 1195 ng/ml (RIC 1545), Ferritin 950,12ng/ml (RIC 533,6) IL-6 30,11pg/ml (RIC 41,13) C-reactive protein 28 mg/l (RIC 62,10) Procalcitonin 0,42 ng/ml (RIC 0,44), all increased in the hospitalized period without significant differences. Median hospitalized time was 10 days (RIC 11). Nine patients died (19,5%), 3 of them in intensive unit care with 15 days median. Most of them needed antibiotic therapy, steroids and anticoagulation, 5 convalescent plasma and 5 tocilizumab. We stopped isolated room dialysis when they had negative PCR (56%) or IgG positive (54%), median insulation 17 days (RIC 7). We haven´t found differences in hospitalized vs no hospitalized patients in age, gender, renal replacement therapy time, etiology, DM, hypertension or cardiovascular illness and treatment, nor in relation with mortality. Conclusion We have observed an increase in the incidence of infection in this period compared with the first period of the pandemic, parallel to the increases in the incidence of the general population in Extremadura (more in B than in C). The mortality is high but similar to other publications. We have to do screening due to the possibility of asymptomatic patients that could have contributed to expand the infection. The high number of hospitalized patients and the need of isolated rooms dialysis for infections patients is a challenge for the organization of hemodialysis units but having positive serologic reduce the isolation time.

Background and Aims Frailty is known as a biological syndrome of decreased reserves and resistance to stress, with a decline of multiple physiological systems, causing vulnerability. Its prevalence ranges from 10-80 %. The etiopathogenesis is multifactorial, based on the loss of muscle mass associated with aging or sarcopenia. Chronic Kidney Disease (CKD) is a model of accelerated aging, with impaired physical function, frailty and cognitive decline. The main theorical frameworks on frailty are the one advocated by Linda Fried, in which she develops a phenotype as a risk situation for developing disability and one advocated by Kennet Rockwood which establishes that frailty consists of addition of various health conditions including comorbidity and disability. Our objective was to evaluate frailty in stage 5 CKD in haemodialysis, measured by clinical scale and to relate it to the body composition measured by bioimpedance. Method Cross-sectional study in 40 subjects with CKD in hospital haemodialysis, 70.5±13.03 years, 62.5% male. 40% Diabetic Nephropathy, 10% Glomerulopathies, 7.5% Nephroangiosclerosis, 2.5% Chronic Tubule-Interstitial Nephropathies, 32.5% Unknow, 2.5% Others. 35% arteriovenous fistula, 10% arteriovenous graft, 55% central venous catheter. Hemodialysis type: 40% High Flux, 45% Online postdilutional Haemodiafiltration, 10% Acetate Free Biofiltration. Fragility was measured by the Rockwood clinical scale: not fragile (1-4), moderately fragile (5-6) and severely fragile (7-9). Body composition was estimated by monofrequency bioimpedance measurement. Chi-Cuadrado was used to study differences between dichotomous variables and ANOVA for continuous variables. Spearman correlation´s was used to examinate the intensity of association between two quantitative variables. Statistical analysis was performed with SPSS 13.0. Results 42.5% of the subjects presented a degree of fragility ≥5, severely fragile 27.5%. The results are shown in the Tables 1 and 2. Conclusion The degree of frailty is greater in the elderly. Measurement of body composition by bioimpedance can be useful to indirectly asses frailty. The phase angle could be an indicator of fragility, since in more fragile subjects its value decreases, its physiological role remains to be elucidated. There is a positive trend to an increase in extracellular water in more fragile subjects, keeping the subjects in their dry weight, so it will be necessary to evaluate what is due.

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.