[Malnutrition and dialytic adequacy in patients on peritoneal dialysis: two sides of the same coin?]

Dialysis adequacy and a state of "eunutrition" are two essential elements to consider in the evaluation of patient undergoing dialysis treatment. Dialysis inadequacy is often associated with malnutrition, and the combination of these two factors significantly worsens the prognosis. In the following monocentric and prospective study, the correlation between nutritional markers and dialytic adequacy was tested in a cohort of patients permanently followed by the peritoneal dialysis clinic, followed consistently for two years. It was therefore evaluated if modification of dialysis therapy, aimed to reach adequacy parameters, could simultaneously improve metabolic parameters. Although there were no frankly malnourished patients, the group of "inadequate" patients had a significantly lower nPCR value. In this same group, after about 6 months, therapeutic measures adopted allowed an overall improvement in Kt/V and nPCR, with other nutritional parameters (such as body weight, albumin, pre-albumin, total cholesterolemia) remaining stable. At the end of the follow-up period the Kt/V of the "inadequate" (<1.7) was higher ​​than the baseline, reaching statistical significance at the 12th and 24th months. Early identification of a dialysis inadequacy, therefore, allowed the execution of therapeutic changes necessary to achieve a lasting improvement in "adequate" replacement therapy, and a temporary improvement in the patient's nutritional status. Suddenly, despite the persistent improvement of the Kt/V there was a new reduction of the nPCR.

OCT angiography metrics predict intradialytic hypotension episodes in chronic hemodialysis patients: a pilot, prospective study.

In chronic hemodialysis (HD) patients, intradialytic hypotension (IDH) is a complication that increases mortality risk. We run a pilot study to analyzing possible relationships between optical coherence tomography angiography (OCT-A) metrics and IDH with the aim of evaluating if OCT-A could represent a useful tool to stratify the hypotensive risk in dialysis patients. A total of 35 eyes (35 patients) were analyzed. OCT-A was performed before and after a single dialysis session. We performed OCT-A 3 × 3 mm and 6 × 6 mm scanning area focused on the fovea centralis. Patients were then followed up to 30 days (10 HD sessions) and a total of 73 IDHs were recorded, with 12 patients (60%) experiencing at least one IDH. Different OCT-A parameters were reduced after dialysis: central choroid thickness (CCT), 6 × 6 mm foveal whole vessel density (VD) of superficial capillary plexus (SPC) and 6 × 6 mm foveal VD of deep capillary plexus (DCP). At logistic regression analysis, IDH was positively associated with baseline foveal VD of SCP and DCP, while an inverse association was found with the choroid. In Kaplan-Meier analyses of patients categorized according to the ROC-derived optimal thresholds, CCT, the 3 × 3 foveal VD of SCP, the 3 × 3 mm and 6 × 6 mm foveal VD of DCP and the 6 × 6 mm foveal VD of SCP were strongly associated with a higher risk of IDH over the 30-days follow-up. In HD patients, a single OCT-A measurement may represent a non-invasive, rapid tool to evaluate the compliance of vascular bed to HD stress and to stratify the risk of IDH in the short term.