Results of Salt Intake Restriction Monitored with the New Sodium Control Biosensor.

INTRODUCTION: Adherence to a low-sodium (Na) diet is crucial in patients under hemodialysis, as it improves cardiovascular outcomes and reduces thirst and interdialytic weight gain. Recommended salt intake is lower than 5 g/day. The new 6008 CAREsystem monitors incorporate a Na module that offers the advantage of estimating patients' salt intake. The objective of this study was to evaluate the effect of dietary Na restriction for 1 week, monitored with the Na biosensor. METHODS: A prospective study was conducted in 48 patients who maintained their usual dialysis parameters and were dialyzed with a 6008 CAREsystem monitor with activation of the Na module. Total Na balance, pre-/post-dialysis weight, serum Na (sNa), changes in pre- to post-dialysis sNa (ΔsNa), diffusive balance, and systolic and diastolic blood pressure were compared twice, once after 1 week of patients' usual Na diet and again after another week with more restricted Na intake. RESULTS: Restricted Na intake increased the percentage of patients on a low-Na diet (<85 Na mmol/day) from 8% to 44%. Average daily Na intake decreased from 149 ± 54 to 95 ± 49 mmol, and interdialytic weight gain was reduced by 460 ± 484 g per session. More restricted Na intake also decreased pre-dialysis sNa and increased both intradialytic diffusive balance and ΔsNa. In hypertensive patients, reducing daily Na by more than 3 g Na/day lowered their systolic blood pressure. CONCLUSIONS: The new Na module allowed objective monitoring of Na intake, which in turn could permit more precise personalized dietary recommendations in patients under hemodialysis.

Combined Liver-Kidney Transplantation in High Immunologic Risk Recipients: Kidney Graft Evolution.

BACKGROUND: Candidates for combined liver-kidney transplant frequently present pretransplant HLA sensitization in most cases related to elevated prior transfusion requirements. The urgency criterion and the evidence of the protective effect at the immunologic level of the liver graft open the possibility of carrying out the combined transplant in patients with an incompatible crossmatch. The single-center experience presented here describes the patient profile and kidney graft evolution observed in this highly sensitized group. METHODS: Descriptive study of a series of 4 cases of patients with positive crossmatch results who received a simultaneous liver-kidney transplant at our center. Demographic characteristics and clinical information were collected and detailed. RESULTS: Before the transplant, 2 patients presented HLA class I antibodies and the other 2 showed both class I and II. The post-transplant crossmatch result was negative in 2 of the 4 patients. All received induction with Thymoglobulin. In the 2 patients in whom the crossmatch remained positive, treatment with plasmapheresis, intravenous immunoglobulins and rituximab was initiated, after which the crossmatch resulted negative. During follow-up, anti-HLA antibodies were monitored, with the presence of mainly class I antibodies with variable mean fluorescence intensity being detected in all but 1 patient. Renal graft function remained stable throughout the tracing without objectifying histologic signs of rejection during the first 6 months of evolution. CONCLUSIONS: In our experience, combined liver-kidney transplant in sensitized patients with an incompatible crossmatching test has presented satisfactory outcomes. Close clinical and analytical monitoring is essential.