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El estudio DIADERM fue promovido por la Fundacion Piel Sana de la AEDV, que recibio ayuda economica de Novartis. La compania farmaceutica no participo en la recogida de datos, ni en el analisis de los datos, ni en la interpretacion de los resultados., Introducción: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales forman parte de la formación específica de los médicos especialistas en Dermatología y Venereología en España. El presente estudio pretende analizar la carga que suponen dichas patologías en la actividad dermatológica pública y privada del sistema de salud español. Material y método: Estudio observacional de corte transversal de dos períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología relacionada (36 diagnósticos codificados en los dos períodos), que se clasificó en 12 grupos. Resultados: Tan solo el 3,16% de los diagnósticos globales fueron de infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales. Los 3 grupos diagnósticos más frecuentes fueron las lesiones por virus del papiloma humano anogenital, seguido de los molluscum contagiosum y las dermatosis anogenitales inflamatorias. Con significación estadística, y comparando con el global de diagnósticos, los seleccionados constituyeron más habitualmente el motivo de consulta primario y, en el ámbito privado, fue más frecuente que viniesen derivados de otros especialistas. Conclusión: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales tienen un peso muy limitado en la asistencia dermatológica en España, a pesar de que la inclusión del diagnóstico de molluscum contagiosum sobreestima estos diagnósticos. La ausencia de inclusión de centros y consultas monográficas de ITS en la muestra aleatoria contribuye a la infrarrepresentación de estas parcelas de la especialidad. Es importante hacer un esfuerzo decidido por potenciarlas con consultas y centros monográficos., Background and objective: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methods: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. Results: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. Conclusions: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made., Fundacion Piel Sana de la AEDV

Background Although relationship between dialysate sodium concentration and hemodynamic stability has been well studied over the years, outcomes of absolute blood volume (ABV) maintenance and vascular refilling volume (Vref ) modifications were not included, as its analysis has not been easily accessible to direct investigation. However, recent studies report a simple and feasible methodology to assess ABV and Vref during hemodialysis (HD) treatments. It is the aim of this study to analyze whether sodium concentration in dialysate modifies ABV drop and Vref . Methods The study was performed in 19 patients under HD. During three different sessions, sodium concentration in dialysate was randomized to three different profiles: low sodium concentration (LNa, 138 mEq/L), neutral sodium concentration (NNa, 140 mEq/L), and high sodium concentration (HNa, 143 mEq/L). ABV and Vref were calculated using Kron et al methodology. Results Predialysis values of the measured parameters showed similar results for the three profiles. Sodium concentration showed an effect on ABV drop, Vref, and vascular refilling fraction (Fref ). Pair-wise comparison revealed mean ABV decreased 0.21 L less when using HNa profile versus LNa profile (p = 0.027), a mean Vref increase of 0.39 L (p = 0.038), and a mean Fref increase of 9.94% (p = 0.048). Conclusions This study shows that the use of HNa profiles increases Vref and Fref and reduces ABV drop during dialysis treatments when compared to LNa profiles.

BACKGROUND AND AIMS Icodextrin is a soluble glucose polymer used widely as an alternative osmotic agent to glucose-only solutions in PD patients. It provides effective net peritoneal ultrafiltration (UF) and nowadays it is only licensed for once-daily dwells. However, in selected patients it has been described its use in two daily dwells (2-ICO). Our aim was to revise our center experience with icodextrin when prescribed as 2-ICO. METHOD We retrospectively analysed all patients with a 2-ICO dwell prescription in our PD unit from January 2018 until June 2021. Clinical data, indication for prescription and outcomes were collected. RESULTS CONCLUSION In selected patients, 2-ICO dwells daily may have a clinical benefit, improving UF significantly and allowing better management of fluid overload and UF failure without relevant adverse events.

BACKGROUND AND AIMS ANCA-associated vasculitis (AAV) is an autoimmune disease that causes end-stage renal disease in ∼20%–25% of patients who develop kidney failure with progression to end-stage kidney disease with requirement of renal replacement therapy. Previous studies have found a genetic association between some major histocompatibility complex (MHC) loci, like the locus DPB1*0401, and AAV. We conducted a retrospective observational unicentric study with the objective to identify other possible loci related to AAV. METHOD As MHC determination is not usually done in patients with AAV, we looked for patients with AAV included in the kidney transplant list with a complete classic HLA allele determination registered (A, B, C, DR, and DQ). Only 14 patients with diagnosis of AAV included in the kidney transplant list from August 1993 to December 2020 in our hospital centre fulfilled this inclusion criterion. To the statistical analysis, we compared the observed proportion to the theoretical one using a normal test, since the groups in our sample included at least five subjects. We also use a continuity correction factor to approach to a binomial test. RESULTS The highest allele frequency in our cohort were the HLA B*51and the haplotype HLA DRB1*04-DQB1*03:02. We identified a B*51 frequency of 42.8% (6/14 patients) in our AAV register, while its population frequency in Spain is 15%, difference = 27.86% [Confidence interval (CI) 1.93%–53.78%] P = .01. We detected a DRB1*04 frequency of 57.1% (8/14 patients) in our cohort, while the population frequency of DRB1*04 and its associated loci DQB1*03:02 is 22%, difference = 35.14% (CI 9.22%–61.07%) P < .05. CONCLUSION HLA B*51 and the haplotype DRB1*04-DQB1*03:02 are alleles more frequent in patients with AAV than general population. This could translate a genetic predisposition of people with these alleles to develop AAV.

BACKGROUND AND AIMS The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic has had a massive impact in health systems worldwide, taking an important toll on dialysis patients as they are more comorbid, have higher mortality and an impaired immune system. Vaccines against SARS-Cov-2 proved to reduce mortality and hospitalization, but serological response in the dialysis population is weaker. Therefore, predictors of response would be useful to assess their level of protection and evaluate the need for further booster doses of the vaccine. METHOD RESULTS CONCLUSION In our experience, PD patients have an adequate serological response to the SARS-Cov-2 vaccines, being previous COVID exposure the main predictor of a good response. Conversely, longer duration of PD treatment was a prognostic factor of seroconversion failure. We believe this should be kept in mind to assess the need for booster vaccination doses in those patients.

BACKGROUND AND AIMS Transplantation (KTx) is considered the best renal replacement therapy nephrologists can offer and improving its outcomes remains a primary challenge in our field. KTx ureteral JJ stenting has been used to prevent urological complications, but there is no consensus about its elective removal timing and literature regarding routine US imaging after EJJR to detect complications is lacking. Our aim was to define the incidence of urological complications diagnosed by routine US after EJJR in KTx, determine US utility and best time interval to perform it. METHOD We retrospectively analyzed all routine KTx US performed in our Unit from 2016 until 2020 by an experienced interventional nephrologist. US post EJJR findings were compared with previous patient US. KTx characteristics, treatment and outcomes were recorded. RESULTS CONCLUSION Routine US after EJJR allowed a timely diagnosis and early treatment of urological complications, a key factor for successful transplantation. KTx US is a cost-effective and reproducible test that provides crucial information to guide clinical decisions, being most efficient when performed 10 days post elective removal. Interventional nephrologists could do this examination promptly.

BACKGROUND AND AIMS Patients with end-stage kidney disease (ESKD) are becoming older and more comorbid. We define assisted peritoneal dialysis (aPD) as any PD treatment that needs the help of another person regardless of the age of the patient and the duration of such help. Our aim was to analyse our aPD experience. METHOD RESULTS CONCLUSION aPD should be considered not only in the elder or fragile, but also in cases of variable disability regardless of patient age. It does not imply a higher complication rate or a technique failure, and careful caregiver support should be provided to avoid exhaustion and PD abandonment.

BACKGROUND AND AIMS Total kidney volume (TKV) in patients with autosomal dominant polycystic kidney disease (ADPKD) is a known progression factor in these patients. Low levels of klotho and high levels of FGF23 in the blood of patients with ADPKD have been correlated with higher TKV even in early stages of the disease, even with glomerular filtration rate (eGFR) >90 mL/min/1.73 m2. Therefore, alterations in the levels of parathyroid hormone (PTH), vitamin D, tubular reabsorption of phosphates or urinary calcium could be correlated with the TKV and serve as an early serum biomarker of progression of kidney disease. METHOD Observational, cross-sectional, single-center study in a population of 87 patients under follow-up at our center during 2019–2020 for ADPKD. The TKV, obtained by the ellipsoid formula measured by magnetic resonance imaging (MRI) and the values of PTH, vitamin D, tubular phosphate reabsorption and urinary calcium were retrospectively collected. Subsequently, a statistical analysis of correlation between the different variables was performed. RESULTS Spearman's Rho correlation analysis obtained a positive correlation of moderate–strong intensity between the TKR of the sample and PTH levels (r = 0.638, P 90 mL/min/1.73 m2 (CKD-EPI) with an elevated PTH (> 65 pg/mL), with a median of 530 mL (interquartile range 403–1184 mL), compared with the TKV of those patients with an eGFR >90 mL/min/1.73 m2 with normal PTH, whose median was 405 mL (interquartile range 258–576 mL). Despite this trend, the Mann–Whitney U test did not show a statistically significant difference between medians in the subgroup of patients with eGFR >90 mL/min/1.73 m2. However, the comparison of medians in the subgroup of patients with eGFR CONCLUSION The increase in PTH in patients with ADPKD has a strong positive correlation with TKV. Even with normal eGFR, elevated PTH is associated with a higher TKV, which could be an early serum biomarker of kidney disease progression in this group of patients.

Background: β-Blockers are the most frequently prescribed cardioprotective drugs in hemodialysis (HD) patients, despite their weak evidence. We sought to evaluate the effects of β-blockers on vascular refilling during HD treatments and examine whether carvedilol, for being noncardioselective and poorly dialyzable, associates more impact than others. Methods: The study was performed in a cohort of maintenance HD patients from a tertiary center. All patients had previous β-blocker prescription. We conducted a prospective crossover study and measured vascular refilling volume (Vref) and vascular refilling fraction (Fref) in 2 circumstances: under β-blocker treatment (βb profile) and without β-blocker effect (non-βb profile). Results: Twenty patients were included, 10 of whom were treated with carvedilol. Predialysis values were comparable between the 2 profiles. Although the βb profile showed lower Vref and higher ABV drop, these differences did not reach statistical significance. Data showed an increase in Fref in the non-βb profile (70.01 ± 6.80% vs. 63.14 ± 11.65%; p = 0.015). The βb profile associated a significantly higher risk of intradialytic hypotension (IDH) (risk ratio 2.40; 95% CI: 1.04–5.55). When analyzing separately the carvedilol group, patients dialyzed under drug effect experienced a significant impairment in Vref, Fref, and refilling rate. Conclusions: Administering β-blockers before HD associated a higher risk of IDH and a decrease in Fref. Patients dialyzed under carvedilol effect showed an impaired refilling, probably related to its noncardioselectivity and lower dializability.

Sin financiación No data 2021 UEM

Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system.Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups.Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians.STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Introduction and objective A significant part of a dermatologist’s activity involves the diagnosis and management of tumors.The aim of this study was to analyze the caseload at public and private dermatology outpatient clinics in Spain to determine the proportion of tumor diagnoses. Material and method Observational cross-sectional study of diagnoses made in dermatology outpatient clinics during 2 data-collection periods in the DIADERM study, an anonymous survey of a random, representative sample of dermatologists across Spain. Diagnoses made during the 2 periods were coded according to the 10th revision of the International Classification of Diseases. There were 165 tumor-related codes, classified into 24 groups. For the purpose of this study, these groups were then reduced to benign melanocytic lesions, malignant melanocytic lesions, benign nonmelanocytic lesions, and malignant nonmelanocytic lesions. Results Tumors accounted for 46.2% of all diagnoses; 18.5% of the tumors were malignant (a category that included in situ forms of keratinocyte cancers). Four of the 10 most common diagnoses were of malignant tumors: in situ keratinocyte cancers, basal cell carcinoma, melanoma, and squamous cell carcinoma. Significant differences were observed between malignant and benign tumors according to type of practice (public vs. private) and geographic region. Conclusion Skin cancer accounts for a significant part of the dermatologist’s caseload in Spain. Differences can be observed depending on the public/private healthcare setting and other factors.

El estudio DIADERM fue promovido por la Fundación Piel Sanade la Academia Espa˜nola de Dermatología y Venereología,que recibió ayuda económica de Novartis. La compa˜nía far-macéutica no participó en la recogida de datos, ni en elanálisis de estos, ni en la interpretación de los resultados., Introducción y objetivo: La patología tumoral conforma una parte esencial de la actividad dermatológica. El presente estudio pretende analizar la carga de los tumores cutáneos en la actividad dermatológica pública y privada del sistema de salud espa˜nol. Material y método: Estudio observacional de corte transversal de 2 períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología tumoral (165 diagnósticos codificados en los 2 períodos), que se clasificó en 24 grupos, posteriormente subclasificada en patología benigna y maligna, melanocítica y no melanocítica. cutáneasResultados: El 46,2% de los diagnósticos fueron de patología tumoral. El 18,5% de los diagnós-ticos globales se debió a tumores malignos (incluyendo entre estos diagnósticos los tumoresqueratinocíticos in situ). De los primeros 10 diagnósticos de patología tumoral en frecuen-cia, 4 eran malignos: tumores queratinocíticos in situ, carcinoma basocelular, melanoma ycarcinoma espinocelular. Se encontraron algunas diferencias significativas entre tumores benig-nos y malignos atendiendo al ámbito de su asistencia (público/privado), así como a factoresgeográficos.Conclusión: El cáncer cutáneo tiene un peso importante en la asistencia dermatológicaen Espa˜na. Se pueden observar algunas diferencias en función del ámbito de atenciónpúblico/privado y de otros factores., Introduction and objective: A significant part of a dermatologist’s activity involves the diagno-sis and management of tumors. The aim of this study was to analyze the caseload at public andprivate dermatology outpatient clinics in Spain to determine the proportion of tumor diagnoses.Material and method: Observational cross-sectional study of diagnoses made in dermatologyoutpatient clinics during 2 data-collection periods in the DIADERM study, an anonymous surveyof a random, representative sample of dermatologists across Spain. Diagnoses made during the2 periods were coded according to the CIE-10. There were 165 tumor-related codes, classifiedinto 24 groups. For the purpose of this study, these groups were then reduced to benign mela-nocytic lesions, malignant melanocytic lesions, benign nonmelanocytic lesions, and malignantnonmelanocytic lesions.Results: Tumors accounted for 46.2% of all diagnoses; 18.5% of the tumors were malignant (acategory that included in situ forms of keratinocyte cancers). Four of the 10 most commondiagnoses were of malignant tumors: in situ keratinocyte cancers, basal cell carcinoma, mela-noma, and squamous cell carcinoma. Significant differences were observed between malignantand benign tumors according to type of practice (public vs. private) and geographic region.Conclusion: Skin cancer accounts for a significant part of the dermatologist’s caseload in Spain.Differences can be observed depending on the public/private healthcare setting and other factors., Novartis

The imbalance between ultrafiltration volume (UF) and vascular refilling is considered a major cause for intradialytic hypotension. Recent studies report a noninvasive method to estimate vascular refilling (VREF ) by determining absolute blood volume (ABV). It was the aim of the study to analyze variations in ABV in a group of hemodialysis (HD) patients and examine VREF . Thirty one stable chronic HD patients were studied, aged 71.07 ± 13.31 years. Dialysis duration and UF requirements were based on physician prescription. VREF was calculated as: VREF = VUF - ΔV where ΔV is ABV variation during dialysis treatment. ABV at the beginning of the dialysis was 6.00 ± 2.39 L (92.82 ± 33.17 ml/kg) and at the end 5.38 ± 2.32 L (82.07 ± 31.41 ml/kg). Prescribed UF was 2.64 ± 0.83 L. Mean VREF was 2.05 ± 0.80 L, with a refilling fraction of 75.75 ± 12.79%. VREF was strongly correlated with UF volume (r2 0.877), and with pre-dialysis volume overload (r2 0.617). Patients under beta-blocker treatment showed significantly lower FREF . ABV measurement is an easy and noninvasive method that allows us to study VREF during HD. We found a strong correlation between VREF and UF.

BACKGROUND Vascular refilling occurs to preserve hemodynamic stability during hemodialysis (HD). Recent studies report a feasible and noninvasive method to determine absolute blood volume (ABV), and estimate vascular refilling during HD. The objective of this study is to analyze if lowering dialysate temperature modifies variations in ABV during HD. METHODS The study was performed in 50 patients under HD. During two different sessions, relative blood volume was assessed using dialysate temperatures of 35.5°C (cool dialysate) and 36.5°C (neutral dialysate). ABV and vascular refilling were calculated using Kron et al methodology. RESULTS Thirty-nine intradialytic morbid events (IMEs) were observed in 30 patients, 14 under cool dialysate and 25 during neutral dialysate. We did not found statistically differences in ABV or in refilling volume between cool and neutral temperature. When analyzing apart only those patients who presented IME, we observed lower drop in ABV in the 35.5°C dialysate treatments (0.57 L) versus 36.5°C dialysate treatments (0.71 L). When cool dialysate was used, the vascular refilling fraction tended to be higher, but data did not turn statistically significant. CONCLUSIONS In selected groups of patients the use of cool dialysate induces lower ABV variations that could improve hemodynamic stability during HD treatments.