Ascension Lupiañez-Barbero

Background: Patients with type 2 diabetes (T2D) on hemodialysis (HD) are at increased cardiovascular risk, where body composition and inflammation could be key modulating factors. The waist-to-height ratio (WtHR) has been proposed as a simple and effective marker of central adiposity, but its role in this population remains underexplored. AIM: To evaluate differences in body composition (BC), inflammatory and nutritional parameters between T2D and non-T2D patients on HD, and to analyze the impact of the central obesity phenotype defined by WtHR ≥0.5. Methods: Prospective, multicenter study with 455 prevalent HD patients. Demographic, clinical, nutritional, BC, and inflammatory variables were collected: neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and systemic inflammatory index (SII). Post-dialysis multifrequency bioimpedance (MF-BIA) was used to assess phase angle (PhA), extracellular water/total body water ratio (ECW/TBW-r), total body fat (PBF), and visceral fat (VFA). Abdominal obesity was defined as WtHR ≥0.5. Non-parametric tests and Chi-square tests were applied; statistical significance: p<0.05. Results: T2D patients were older [73 vs. 69 years, p=0.007], had a higher BMI [26.1 vs. 23.8 kg/m2, p<0.001], PBF [30.7% vs. 25.2%, p<0.001], VFA 96.5 vs. 71.3 cm3, p<0.001, higher SII and INL (p=0.001 and p=0.008), higher proportion with INL≥3.5 (p=0.004), lower PhA [4.7° vs. 5.1°, p<0.001, and higher ECW/TBW-r (p<0.001). Fifty-six percent of T2D patients had WtHR ≥0.5. Among T2D patients, those with WtHR ≥0.5 had higher levels of VFA, IBS, INL (p<0.05), lower PhA, and higher ECW/TBW-r. In addition, they required catheters as vascular access more frequently (CYT: 64.2% vs. 35.8%, p=0.02). In the subgroup with WtHR <0.5, T2D patients continued to have older age, higher VFA, lower PhA, and higher ECW/TBW-r than non-T2D patients, with no differences in inflammation or PBF. Conclusion: The T2D phenotype with WtHR ≥0.5 in HD is associated with greater visceral adiposity, systemic inflammation, and cellular nutritional impairment, which could reflect an increased cardiovascular risk profile. The use of WtHR as a simple tool in clinical practice may contribute to more accurate risk stratification in this vulnerable population.

Background: Given the complexity of protein energy wasting (PED) in hemodialysis (HD), prevention and treatment options are complex. There is no single treatment approach. Objective: To retrospectively evaluate the evolution of the nutritional status of HD patients. Methods: Descriptive, retrospective and multicenter study of 130 HD patients. We performed individualized nutritional intervention by Dietitians-Nutritionists (DN) integrated in a multidisciplinary team. We collected demographic, clinical, nutritional and nutritional screening variables, MIS1 and DPE2, at baseline and one-year follow-up. Parametric and non-parametric statistics for related groups. Results: Median age 75.77 years [65.43-83.83], time on HD 33.91 months [23.06-57.26], Charlson index 7 [5-9], BMI 24kg/m2 [21-27], LVEF 54.6%, DM 45.4%, diabetic nephropathy 22.3%, history of previous RF 30.8%, men 64.6%, non-EU origin 15.4%. In the annual follow-up, 82.3% of the patients remain active. A total of 5.4% were transplanted, 9.2% died and 3.1% were discharged. All patients receive dietary education (DE). Patients with moderate-severe malnutrition without improvement only with DE were added: 33.7% Oral nutritional supplementation (ONS) through hospital coordination, 16.8% intradialytic phosphosoda, 9.3% appetite stimulants, 7.5% food support by social services in coordination with the social work unit. An improvement in MIS screening scores was observed (baseline 7 [5-10] vs follow-up 5 [5-7]), especially those who received ONS (baseline 10 [7-13] vs follow-up 7 [6-9]). Even more evident in patients who received ONS during the entire period evaluated (baseline 12 [9-13] vs follow-up 7 [5-9]). A progression of malnutrition was observed and, likewise, a decrease in severe malnutrition (p ≤ 0.05). Conclusion: Individualized dietary advice in combination with different nutritional strategies from a multidisciplinary approach contributes to improve MIS scores and reverse malnutrition in more severe stages. Funding: Private Foundation Support