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Background and Aims Impairment in the diastolic function is strongly associated with heart failure and cardiovascular disease in patients with end-stage renal disease (ESRD), with a high prevalence of 50-65% and unobvious early symptoms. Hence, it is of great importance to explore serum biomarkers for early assessment of diastolic disfunction in patients with ESRD, providing evidence for performing an early intervention. When myocardial cell membrane integrity becomes damaged, cardiac troponin is released into the circulation, inducing an elevation of serum cardiac troponin in asymptomatic patients on dialysis. We analyzed the relationship between high-sensitivity cardiac troponin I biomarker (hs-cTnI) and left ventricular diastolic dysfunction (LVDD) in a cohort of asymptomatic patients on haemodialysis at our center. Method Cross-sectional study. We include patients on haemodialysis in our center. Demographic variables (age, sex), associated comorbidity, hs-cTnI levels, and echocardiographic parameters were collected. Statistical analysis was performed with SPSS 25.0. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation, and T-student, Anova or U-mann Whitney was used to compare them. Logistic regression analysis was performed to determine independent predictors of LVDD. Statistical significance for a value of p Results 80 patients, with an average age of 67.44 ± 13 years. 57.5% were men. 86.3% had high blood pressure (HBP), 52.5% were diabetic, 75% dyslipidemic, and 51.2% had overweight/obese body mass index. 32.5% had previous history of ischemic heart disease, 41.3% had moderate/severe left ventricle hypertrophy (LVH), 8.8% left ventricular ejection fraction (LVEF) 20 (OR 4.11 95% CI 1.38-12.18 p = 0.011) are independent risk factors for LVDD. Conclusion hs-cTnI levels could be a biomarker of LVDD in asymptomatic patients on haemodialysis. New studies with a greater number of patients would increase the evidence for this claim, in order to carry out early intervention and treatment.

Background and Aims Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis. Patency of the arteriovenous access is important for effective hemodialysis. However, maintaining the patency of the AVF remains a challenge. We determined those independent prognostic factors for the patency of the AVF at the time of its creation. Method Cross-sectional study; We include all AVFs performed at the HGUCR in the last 2 decades. Demographic variables (age, sex), etiology of CKD and associated comorbidity were collected. We determine the factors involved in the primary patency of AVFs. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 test. Quantitative variables are expressed as mean ± standard deviation and the Mann Whitney Student-T/U was used to compare them. Statistical significance for a value of p Results 622 AVFs performed in 482 patients were reviewed. 86.8% were autologous. The mean age was 65.4±14 years; 66.6% were male. The most frequent etiologies of CKD were diabetic nephropathy (30.2%), unknown (18%), and glomerulonephritis (16.6%). 91.2% had arterial hypertension (HBP) and diabetes mellitus (DM) 47.9%. 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. 27% presented primary failure. The univariate analysis showed statistical significance for the qualitative variables HTA (p=0.002), treatment with statins (p Conclusion In our study, HTA and antiplatelet therapy prior to the creation of the VA behave as protective factors for primary failure, with high phosphorus levels being an independent factor for primary failure of AVFs.

Background and Aims Consensus document of the Spanish Society of Nephrology and many Primary Care (PC) related societies for chronic kidney disease (CKD) detection and management provides to the PC doctor referral criteria (RC) to nephrology clinic. The aim of the study is to describe the referrals to our center nephrology clinic and evaluate the influencing factors for RC adequacy. Method Retrospective observational study. We included the referred patients to our nephrology clinic from October 2019 to May 2020. We recollected demographic variables, as well as comorbidity, renal function, RC adequacy and follow-up. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation and compared using t-student test. Cox regression was performed to determine independent predictors for RC adequacy. Statistical significance for a value of p< 0,05 or CI 95%. Statistical analysis was performed with SPSS 25.0. Results 238 patients, 55.5% male. Average age 63 ± 17 years, being 34% older than 75 years. 67.6% had at least 3 cardiovascular risk factors. 85.3% were referred from PC with 57.1% of them from a rural center. There was adequation to the RC on 55%. The most frequent RC was CKD progression (37.4%). Mean serum creatinine at the time of referring was 1.91 ± 0.59 mg/dl with a glomerular filtration rate 34 ± 11 ml/min/1.73m2 and 329.43 ± 992.01 mg/g or mg/24h of albuminuria. From the 45% of those who did not had RC adequacy 51.4% had CKD III stage and 21.5% had false refractory hypertension (controlled or under-treated). Mean time of follow-up was 5 ± 1.7 months. RC adequacy was related with being referred from PC (59.6% vs 28.6% p=0.001), smoking (65.9% vs 49% p=0.012), time of referring creatinine (1.54 ± 0.86 vs 1.18 ± 0.39 p=0.001) and albuminuria (43406 ± 1009.7 vs 136.13 ± 637.16 p=0.019) and end of follow-up albuminuria (265.84 ± 516.82 vs 81.67 ± 250.7 p=0.007). RC adequacy was associated with receiving follow-up on nephrology clinic (80.2% vs 19.8% p=0.001). Logistic regression showed that being referred from PC (OR 3.64 IC 95% 1.03-12.8 p=0.044) and a worse renal function at the referring (OR 2.49 IC 95% 1.19-5.24 p=0.015) were associated with RC adequacy. Conclusion The experience in our center shows that there is not an adequacy on the current RC from the Spanish Society of Nephrology in almost half of the patients. That proportion decreases when patients are referred from PC close to 40%. CKD progression is the main reason for referral with most of patients being elderly and with a high cardiovascular risk. The need for greater dissemination of RC can be inferred from the significant number of inappropriate referrals, encouraging us to propose their review.

Background and Aims Dialysis patients constitute a risk group for coronavirus infection due to their immunosuppressed condition, with the increased risk of morbidity and mortality that this entails. We analyzed the factors associated with mortality from coronavirus infection in a cohort of patients undergoing renal replacement therapy at our center. Method Transversal study. We included patients in renal replacement therapy (RRT) in our center. Demographic variables (age, sex), associated comorbidity, RRT technique, clinical and laboratory parameters were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed in percentages and are compared using the Chi2 test. The quantitative variables are expressed as mean ± standard deviation and compared using Student's T-test. Statistical significance p Results 38 patients, mean age 66 ± 18 years, 51.4% men. 92.1% had arterial hypertension, 39.5% diabetes mellitus (DM). 63.2% on hemodialysis, 2.6% peritoneal dialysis, 34.2% transplanted. 84.2% presented fever, 63.2% cough, 73.7% pneumonia, 34.2% dyspnea, 15.8% digestive symptoms. 21.1% leukopenia, 73.7% lymphopenia, money D 1509 ± 1351, CRP 12.45 ± 19.47, sodium 136 ± 5.5. 81.% were admitted to hospitalization, of which 2.6% required admission to the ICU. 44% died. Mortality was statistically significantly related to DM (56.3% vs 43.8% p = 0.05), and with the need for hospitalization (93.8 vs 6.3% p = 0.054). Conclusion In our experience, DM patients and those who required hospitalization had a higher risk of mortality.

Background and Aims The population with chronic kidney disease (CKD) presents an increased risk of infection by hepatitis B virus (HBV). Usually, the protective immunological response rate (considering HBV titer > 10 mIU/mL) is 90–95% after the 4th dose of vaccine; In CKD the immune response is lower and correlates with the degree of CKD. In dialysis, this response is variable, less than 50% with three-dose regimens and higher with four doses. Cardiovascular risk factors have been implicated in the response rate to vaccination. The objective of this work is to analyze the efficacy of the HBV vaccine in hemodialysis patients and to identify cardiovascular factors as predictors of response. Method Retrospective observational study. We evaluated the response to a 4-dose vaccination protocol (0-1-2-6 months), determining the levels of HBVA 3 months after the last dose. Demographic variables (age, sex), associated comorbidity, etiology of CKD, among others, were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and have been compared using the Chi2 test. The quantitative variables are expressed as mean +/- standard deviation and the T-student was used to compare them. Statistical significance for a value of p Results 89 patients were included; 68.5% are male, with an average age of 65 years. 85.4% had arterial hypertension, and 39.3 were diabetic, the most frequent cause of CKD being renal vascular disease (20.8%), diabetic nephropathy (26.4%) and interstitial (9%). The immune response to HBV vaccination was 79.2%. When making statistical comparisons between the qualitative variables, we have not observed differences between serological response and DM or sex; We did find a trend towards significance when comparing the serological response with the variable HT and etiology of CKD (polycystic kidney disease), pNS. The comparison of means between quantitative variables when performing the Student's T-test did not show differences for any of the study variables. Conclusion In our center, HBV vaccination on dialysis achieves a response rate of 79.2%. HT may condition the immune response to vaccination in HD patients, although significance was not reached. Hereditary pathology has been the one that has shown the best serological response with respect to the rest of etiologies, perhaps associated with greater residual renal function.

Background and Aims Management of ANCA-Associated Vasculitis (AAV) is in constant update. The aim of the study is to describe our experience as a territorial reference center with this systemic disease and to analyze which factors have a significant influence on the development of end-stage renal disease (ESRD). Method Retrospective observational study. All the patients who developed AAV in our center between 2010 and 2019 were included. Demographic variables (age, sex), renal function, other vasculitis related symptoms, induction and maintenance therapy, response degree and follow-up were collected. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation and compared using Mann-Whitney U test. Cox regression was performed to determine independent predictors of ESRD. Kaplan-Meier was used to estimate ESRD-free survival. Statistical significance for a value of p< 0,05. Statistical analysis was performed with SPSS 25.0. Results 45 patients were analyzed, with an average age of 70 ± 11 years. 62.2% were men. Mean time of follow-up 36 ± 31.6 months. 37.8% presented c-ANCA autoantibodies and 57.8% p-ANCA. Mean baseline serum creatinine level was 5.51 ± 3.65 mg/dl and proteinuria 2.82 ± 2.48 g/24h. 77.8% received cyclophosphamide as induction immunosuppressive treatment whereas 13.3% rituximab. 50% received azathioprine, 36.1% mycophenolate and 13.9% rituximab as maintenance treatment. 37.8% patients underwent plasma exchange therapy and 44.4% hemodialysis. Complete remission was achieved by 13.3% of patients, while 57.8% partial remission. 28.9% had absence of remission. 28.9% achieved ESRD. ESRD was associated with undergoing hemodialysis (69.2% vs 30.8% p=0.033), to the type of response (complete 7.7% vs partial 23.1% vs no response 69.2%), baseline creatinine level (8.36 ± 5.44 vs 4.35 ± 1.64 mg/dl p=0.011), creatinine 6 months after induction treatment (4.3 ± 2.05 vs 2.04 ± 0.77 mg/dl p=0.001) and at the end of follow-up (6.33 ± 2.47 mg/dl vs 2.2 ± 1.29 mg/dl p=0.001) and also to baseline proteinuria (4.21 ± 3.12 vs 2.25 ± 1.96 p=0.003), proteinuria 6 months after induction treatment (1.4 ± 1.46 vs 0.58 ± 0.73 g/24h p=0.014) and at the end of follow-up (2.48 ± 1.9 vs 1.12 ± 1.64 p=0.001). Logistic regression only showed end of follow up serum creatinine level as an independent risk factor of ESRD (OR3.74 IC 95% 1.01-13.75 p=0.047). ESRD-free survival chance after 5 of follow-up was 67%. Conclusion Only serum creatinine level at the end of follow-up could be found as an associated factor with ESRD. Greater number of patients would be needed in order to obtain other factors leading to ESRD in patients with AAV.

Background and Aims Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis and are associated with a lower incidence of morbidity and mortality. However, primary vascular access (AV) failure is not uncommon. Low-grade inflammation is present in ERCT. We identify the inflammatory parameters that influence the primary permeability of vascular access for hemodialysis. Method Cross-sectional study; We include all the AVs performed in the HGUCR. We evaluate the initial operation after the creation of the AV. Demographic variables (age, sex), aetiology of CKD and associated comorbidity were collected. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 Test. Quantitative variables are expressed as mean ± standard deviation and the t-student was used to compare them. We performed a multivariate analysis to determine those factors involved in the primary failure of the VA. Statistical significance for a value of p Results 600 VA performed on 466 patients were reviewed between October 2009 and December 2019. 492 autologous VA (86.8%) and 75 prosthetic VA (13.2%) were performed. The mean age of the patients was 65.3 ± 14.2 years and 66.2% were male. The most frequent etiology of CKD was diabetic nephropathy (29.9%), followed by non-affiliated (18%) and glomerulonephritis (16.5%). 90.8% of the patients had arterial hypertension (HT), diabetes mellitus (DM) 48%. 77.2% of AV presented primary permeability. In the univariate analysis using Chi2 and T student, statistical age (p = 0.017), HT (p = 0.002), statin treatment (p = 0.002), antiplatelet therapy (p = 0.001), low ferritin levels (p = 0.011) and PCR (p = 0.019). When performing a multivariate analysis, the high CRP figures (OR: 0.64 95% CI 0.42-0.98 p = 0.043) and ferritinemia (OR: 1.04 95% CI 1.01-1.06 p = 0.013) are predictive factors of primary AV failure. Conclusion In our study, high CRP decreases the probability of primary functioning of AVFs by 36% and elevated ferritin levels are predictors of primary failure after adjusting for age and sex in the multivariate model.

Background and Aims Elderly patients and comorbidity present more frequently deterioration of their cognitive and / or functional capacity, and consequently worse quality of life related to health and the need for help to perform their basic activities. It has been described in the literature that peritoneal dialysis (PD) is a protective factor in the patient's survival against hemodialysis (HD). Quality of life is an important parameter in patients undergoing renal replacement therapy, which influences the choice of dialysis modality. We analyzed and compared the degree of functional dependence of patients on PD versus HD. Method Descriptive and cross-sectional study. A total of 84 patients belonging to the General University Hospital of Ciudad Real were included. Demographic variables (age, sex), associated comorbidity, etiology of CKD, among others, were collected. To assess the degree of dependence, the Barthel index and Lawton and Brody were performed. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and have been compared using the Chi2 test. Quantitative variables are expressed as mean +/- standard deviation, and the T-student was used to compare them. Statistical significance for a value of p Results Of the 84 patients, 40.5% received PD and 59.5% HD. 60.7% were male and 39.3% female, with an average age of 60.90 years. 75% were hypertensive, 38.1% diabetic, 61.9% dyslipidemic, 27.4% obese and 61.9% had peripheral vasculopathy. The most frequent causes of CKD were diabetic nephropathy (22.6%), glomerular etiology (21.4%), unfiltered (20.2%) and nephroangiosclerosis (14.3%), among others. The degree of functional dependence according to the Barthel index was 63.1.9% for total independence, 29.8% mild dependence, 4.8% moderate dependence and 1.2% total dependence; and for the Lawton and Brody index, 42.9% total independence, 14.3% mild dependence, 27.4% moderate dependence, 11.9% severe dependence and 3.6% total dependence. When comparing the degree of functional dependence between both dialysis techniques, we observed that patients in PD had a lower degree of functional dependence compared to patients in HD, these differences being statistically significant (Lawton and Brody 73.5% in PD vs. 22% in HD, p Conclusion In our experience, the degree of functional dependence in patients in PD is lower compared to patients in HD with less comorbidity, being able to condition the choice of the technique of renal replacement therapy.