Ascensión Lupiañez-Barbero

Background and Objective: To evaluate the effectiveness and safety of intradialytic parenteral nutrition (IDPN) on different nutritional outcomes. Methods: This was a retrospective analysis for a “routinely collected data bank” in a multicenter cohort, conducted on consecutive malnourished or at-risk of malnutrition patients with chronic kidney disease on hemodialysis who underwent IDPN with a three-in-one parenteral nutrition formula for a period ≥ 2 weeks. The primary endpoint was the mean change in the malnutrition inflammation score (MIS) score between baseline and the last follow-up visit on IDPN. Results: Fifty-six patients were included. The mean age was 72.4 ± 12.0 years, and 24 (42.9%) were women. In the overall study sample, MIS significantly decreased from 16.4 (95%CI: 15.3–17.65) at baseline to 14.3 (95%CI: 12.8–15.8) at the last follow-up visit on IDPN (p = 0.0019). Fifteen (26.8%) patients achieved a MIS reduction ≥ 5 points after IDPN. As compared to baseline, IDPN significantly reduced the proportion of patients with protein-energy wasting (PEW) (89.3% versus 66.1%, respectively, p = 0.0023). Regarding analytical parameters, serum albumin (p = 0.0003) and total proteins (p = 0.0024) significantly increased after IDPN administration. Throughout the study’s follow-up period, 45 (80.4%) patients reported experiencing some type of adverse event. Conclusions: IDPN was associated with a significant improvement in the nutritional profile. Notably, our research found that the administration of IDPN over a duration > 3 months significantly improved the nutritional status of patients evaluated by the MIS test.

Abstract Background and Aims Obesity is a complex chronic multifactorial pathology characterised by an accumulation of often dysfunctional adipose tissue (AT). Leading scientific societies propose to replace the term ‘obesity’ by ‘Chronic Adipose-Based Disease’ or ‘Chronic Adipose Metabolic Disease’ to reflect the metabolic disturbances due to accumulation and dysfunction of AT. Classical techniques such as Body Mass Index (BMI) or Waist Circumference (WC) may not detect those patients with higher cardiometabolic risk phenotypes. In addition, in the nephrological setting, the assessment of obesity may be hampered by edema and hyperhydration. Aim: To determine the prevalence of obesity in haemodialysis (HD) patients according to gender and using different health indicators. Method Retrospective multicentre study of 301 HD patients. Clinical data including gender, height and dry weight (DW) will be collected. Body composition will be assessed by Inbody® S10 segmental multifrequency bioimpedance (BIA-MF) post-dialysis. BMI will be calculated based on BP and height at the time of data collection. Obesity is defined according to BMI ≥30 kg/m2 and body fat percentage (BFp) >25% men and >33% women. Visceral fat will be expressed as visceral fat area (VFA) obtained by BIA-MF considering a risk value ≥100 cm3. Risk CC cut-off point ≥102 cm men and ≥88 cm women. Kolmogorov-Smirnov test to assess normality and parametric statistics to assess difference between groups: Student's t-test and Chi-square for quantitative and categorical variables respectively. Statistical significance P < 0.05. Results Of the 301 patients, 189 (62.8%) were male with a mean age 69.3 ± 14.9 years and 112 (37.2%) were female with a mean age 66.7 ± 16.4 years (NS). The prevalence of obesity (BMI ≥30 kg/m2) was 13.2% in men and 28.6% in women (P < 0.013). According to the PGC, the obesity rate was 47.6% in men and 48.2% in women (NS). Among patients with a BMI<30 kg/m2, we observed that 34.9% of men and 23.2% of women had a PGC in the obese range (P = 0.033). In relation to the distribution of visceral adipose tissue, 38.9% had a VFA value ≥100 cm3 (29.6% of men and 54.5% of women (P < 0.001)]. 22.6% (68) of patients had elevated CC [6.6% (23) men vs. 31.2% (45) women (P < 0.001)]. We observed that 18% (56) of patients with a CC in the normal range had VFA values ≥100 cm3 [20.1% (38) men vs. 16.1% (18) women (NS)]. Conclusion In our study, a poor correlation between BMI, PGC and AGV was observed, so we conclude that both the classical indicator of BMI and CC underestimate the ‘real’ obesity rate. We believe that the assessment of HD patients should not only be multidisciplinary, but should also shift from a weight-centred approach to a body composition-based approach. This will allow us to target patients with higher cardiometabolic risk phenotypes and initiate better therapeutic strategies.

Background: The estimated prevalence of protein energy wasting (PEW) in haemodialysis (HD) is between 28-54%, and may be even higher1. Different nutritional strategies are available: dietary advice by a Dietitian-Nutritionist (DN), oral nutrition (ONS) or Intradialytic parenteral nutrition (IDPN), among others2. The economic cost or the lack of DN in dialysis units are barriers that limit its use. Objective: To determine the prevalence of HD patients who are potential candidates for IDPN. Methods: Descriptive, retrospective and multicentre study of 3544 patients who responded to the KDQOL-SFTMV1.3 surveys during 2022. We analysed the generic part (SF-36), the Summative Physical (ISF) and Mental Index (ISM)3. We collected demographic and clinical data, used the DPE scale4 and the expert consensus5 as screening for PIND. We assessed normality and performed non-parametric statistics. Results: 62.4% male, 73 years, BMI 25.8kg/m2 , albumin 3.93g/dl, creatinine 6.5mg/dl , CRPn 0.98 g/kg/d, FSI 49.14 [39.58-55.69], MSI 34.88 [27.75-42.55]. 45.4% had DM, 60.9% were on dialysis with AVF and 35 months on HD [15-67]. According to DPE screening components: 33% albumin <3.8g/dl; 4.1% creatinine <3.8mg/dl; 26.3% BMI <23kg/m2; 20.8% nCRP <0.8g/kg/d. 59.2% had some degree of malnutrition. 21.3% could be candidates for NPID due to moderate-severe malnutrition. According to expert consensus: 27.4% albumin <3.8g/dl plus creatinine <8mg/dl; 3% BMI <18.5kg/m2; 14.4% CRPn <0.75g/kg/d; 0.6% weight loss> 10% in the last 6 months. Only 0.23% met at least 3 of these criteria and would be candidates for NPID. We observed association between nutritional status and quality of life (QoL) (table 1). Conclusion: We found huge discrepancy in the prevalence of patients who were candidates for NPID according to the criteria used. The decision to provide NPID not only impacts on the clinical prognosis and QoL of the patient, but also entails relevant costs that could be avoided. Funding: Private Foundation Support

Abstract Background and Aims Studies have shown that poorer quality of life (QoL) is associated with higher mortality and hospitalisation in dialysis patients. Measuring QoL in this patient population is a key indicator for assessing the impact of treatment and the effectiveness of medical interventions. Aim: To analyse the results of the baseline and 2-year survey to identify improvements and areas of opportunity in the care of haemodialysis (HD) patients in outpatient centres. Method Observational, retrospective, multi-centre study analysing QoL surveys applied to prevalent eligible patients on HD (&amp;gt;3 months) in 2022 and 2024, using the KDQOL-SF36 instrument, in 49 HD centres. The different areas of the generic and the CKD-specific part were assessed. Descriptive analysis was performed to compare the composite scores in these categories and to determine significant variations between groups and over time. Variables are measured in absolute survey scores. Results Of the completed surveys analysed: 3,157 in 2022 and 3,789 in 2024, results show an overall trend of improvement in perceived QoL: Significant improvements in the domains of sexual function (+1.46 points), work status (+1.37 points), pain (+1.17 points) and energy/fatigue (+0.87 points). Perception of the effect of kidney disease increased by 1.07 points. Satisfaction with the dialysis team remained high (100% at the median), with a slight increase in the mean score (+0.41 points). Moderate improvements in disease-associated symptoms (+0.35 points) and in physical and emotional limitations (+0.30 and +0.23 points, respectively). Conclusion The results suggest a positive evolution in the quality of life of haemodialysis patients between 2022 and 2024, highlighting improvements in physical well-being, adaptation to the disease and satisfaction with the care received. These results reinforce the importance of continuing to invest in strategies for a holistic approach to the patient and in measurement tools to assess and continuously improve the quality of life of this population and therefore medical outcomes.