Manel Vera

Hospital Clínic de Barcelona · Servicio de Nefrología y Trasplante Renal

In recent years, the meaning of adequacy in peritoneal dialysis has changed. We have witnessed a transition from an exclusive achievement of specific objectives -namely solute clearances and ultrafiltration- to a more holistic approach more focused to on the quality of life of these patients. The purpose of this document is to provide recommendatio...

Introduction: Changes in plasma sodium concentration (pNa, expressed in mEq/L) are common in hemodialysis (HD) patients. Hemodialysis monitors can estimate pNa by using an internal algorithm based on ion dialysance measurements. The present study studies the accuracy of the correlation between the pNa estimated by the dialysis monitor and that mea...

Background and Aims Chronic kidney disease (CKD) is associated with lipid metabolism disruptions and heightens cardiovascular (CV) risk. International guidelines categorize CKD patients into high CV risk (LDL target < 70 mg/dL and a reduction >50% from baseline) for CKD G3b A1, CKD G3a A2, and CKD G2 A3; and very high CV risk (LDL target < 55 mg/dL...

Atrial fibrillation is the most frequent chronic arrhythmia in patients with chronic kidney disease. Oral anticoagulation with vitamin K antagonists and now direct oral anticoagulants have been and are the fundamental pillars for the prevention of thromboembolic events. However, there are no randomized clinical trials on the risk-benefit profile of...

Introduction: New generation helixone dialyzers has recently been developed as part of the ongoing effort to improve dialyzer hemocompatibility and avoid adverse reactions to synthetic dialyzers. This study aimed to assess the performance and albumin loss of this new dialyzer series in hemodiafiltration and compare it with the previous generation...

Background New versions of the polyester polymer alloy (PEPA) membrane have appeared over the years, with increases in both the pore size and the amount of polyvinylpyrrolidone (PVP) to optimize hydrophilicity performance. This study aimed to assess the efficacy of the most recently developed PEPA dialyzer, the FDY series, in hemodialysis (HD) moda...

Introduction: The sodium gradient during hemodialysis sessions is one of the key factors in sodium balance in patients with dialysis-dependent chronic kidney disease; however, until the appearance of the new monitors with sodium modules, the differences between prescribed and measured sodium have been understudied. The present study aimed to compa...

Introduction This study aimed to evaluate the association between the use of remote patient monitoring (RPM) in patients on automated peritoneal dialysis (APD) and the Standardized Outcomes in Nephrology in peritoneal dialysis (SONG-PD) clinical outcomes. Methods A prospective and multicenter cohort study was conducted on patients with advanced ch...

Background Current guidelines establish the same hemoglobin (Hb) and iron biomarkers targets for hemodialysis (HD) and peritoneal dialysis (PD) in patients under erythropoiesis stimulating agents (ESAs) although patients in PD are usually younger, more active and less comorbid. Unfortunately, specific renal anemia (aCKD) trials, or observational st...

Background and Aims Until the advent of the new monitors with sodium modules, the differences between prescribed and actual sodium have been little studied. And most dialysis centers have a fixed sodium prescription. However, the sodium gradient during sessions is one of the key factors in its balance in hemodialysis patients. Predialysis plasma so...

Background and Aims The evidence on the management of renal anemia in peritoneal dialysis (PD) is much weaker than in hemodialysis (HD). Current guidelines establish the same haemoglobin (Hb) target for patients under eritropoietin stimulating agents (ESAs) in both dialysis techniques (PD, HD), although patients in PD are usually younger, more acti...

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....

Background A key point in dialysis treatment is the prescription of dialysate sodium (Na). This study aimed to describe the practical implementation of a new automated dialysate Na control biosensor and to assess its tolerance and the beneficial clinical effects of isonatremic dialysis. Methods A prospective study was carried out in 86 patients wh...

RESUMEN Introducción: El gradiente de sodio durante las sesiones es uno de los factores clave en el balance de este ion en los pacientes en hemodiálisis; sin embargo, hasta la aparición de los nuevos monitores con módulos de sodio, las diferencias entre el sodio prescrito y el medido han sido poco estudiadas. El objetivo del presente estudio fue co...

Background Recently, several pharmaceutical companies have developed new medium cut-off (MCO) dialyzers for expanded hemodialysis (HDx). This study aimed to compare the safety and efficacy of four MCO dialyzers between them and with high-flux hemodialysis (HD) and post-dilution hemodiafiltration (HDF). Methods A prospective study was carried out o...

Peritoneal infections still represent a most feared complication of chronic Peritoneal Dialysis, due to their high incidence and relevant clinical consequences, including direct mortality, technique failure and a significant burden for the health system. The practices for prevention and treatment of this complication show a remarkable heterogeneity...

Introduction: The medium cut-off Elisio HX dialyzer by Nipro became commercially available in Europe in 2021, but there are still no reports of in vivo data. This study aimed to evaluate the safety and efficacy of it compared with previously evaluated hemodialysis (HD), expanded HD (HDx), and postdilution hemodiafiltration (HDF) treatments. Metho...

BACKGROUND AND AIMS The use of remote monitoring programs in peritoneal dialysis (RMAPD) has been related to favorable clinical events, as well as possible reductions in healthcare costs, although the medical literature is scarce. METHOD Prospective, multicenter, longitudinal 2-year study of cohorts to evaluate the number of significant interventi...

BACKGROUND AND AIMS Telemonitoring (RM), applied in automated peritoneal dialysis (APD), has shown both clinical and quality of life (QoL) benefits, although current evidence is limited. The aim of this study is to analyse the number of significant interventions in a 3-month period (unscheduled consultations and teleconsultations, ) as well as clin...

Introduction: Given the increased COVID-19 observed in kidney transplant recipients (KTRs) and haemodialysis patients, several studies have tried to establish the efficacy of mRNA vaccines in these populations by evaluating their humoral and cellular responses. However, there is currently no information on clinical protection (deaths and hospitali...

ere, we report a case of a patient with cloudy effluent that was initially diagnosed as bacterial peritonitis. The persistence of a cloudy effluent despite antibiotic therapy led to an extensive peritoneal dialysis (PD) effluent analysis, with the final diagnosis being high-grade B-cell lymphoma. This case will increase the awareness of this rare p...

Here, we report a case of a patient with cloudy effluent that was initially diagnosed as bacterial peritonitis. The persistence of a cloudy effluent despite antibiotic therapy led to an extensive peritoneal dialysis (PD) effluent analysis, with the final diagnosis being high-grade B-cell lymphoma. This case will increase the awareness of this rare...

Resumen Las infecciones peritoneales siguen constituyendo una complicación muy relevante de la diálisis peritoneal, por su incidencia todavía elevada y por sus importantes consecuencias clínicas, en términos de mortalidad, fracaso de la técnica y costes para el sistema sanitario. Las prácticas de prevención y tratamiento de esta complicación muestr...

Objective: The nutritional status of patients on peritoneal dialysis (PD) is influenced by patient- and disease-related factors and lifestyle. This analysis evaluated the association of PD prescription with body composition and patient outcomes in the prospective incident Initiative for Patient Outcomes in Dialysis–Peritoneal Dialysis (IPOD-PD) pat...

Norovirus is the common cause of gastroenteritis in humans. There is no report of liver dysfunction in children caused by norovirus infection. Baclofen has been used mainly to treat spasticity in children with cerebral palsy. Hepatotoxicity of baclofen has not been previously described in children. This report describes the case of acute liver dysf...

Adapted automated peritoneal dialysis (aAPD), comprising a sequence of dwells with different durations and fill volumes, has been shown to enhance both ultrafiltration and solute clearance compared to standard peritoneal dialysis with constant time and volume dwells. The aim of this non-interventional study was to describe the different prescriptio...

PurposeChronic kidney disease (CKD) associates with inflammatory and prothrombotic phenotypes, resulting in higher cardiovascular risk. Factor Xa displays functions beyond coagulation, exhibiting proinflammatory effects. The aim of the present study was to investigate whether a direct FXa inhibitor protects from the endothelial dysfunction (ED) cau...

The Clearum dialyzer, built by Medtronic, became commercially available in several European countries in 2020 but there are still no reports of in vivo data. The aim of this study was to evaluate the efficacy and risk of hypoalbuminemia of this dialyzer compared with previously evaluated hemodialysis (HD), expanded hemodialysis (HDx) and postdiluti...

Introduction Patients undergoing hemodialysis (HD) are characterized by a poor physical condition and a substantial sedentary profile. The implementation of physical exercise programs in the hemodialysis units is usually limited by the inherent safeness and the lack of appropriate resources. Objectives We aimed to evaluate the impact and safety ou...

Resumen Introducción Los pacientes en hemodiálisis (HD) suelen tener una condición física mermada y elevado sedentarismo. La consolidación de programas de ejercicio físico en las unidades de diálisis está limitada por barreras como la seguridad inherente a estos programas y la falta de recursos. Objetivos Evaluar la eficacia y seguridad en la imp...

Toray has created a new generation of dialyzers, the polysulphone (TS) UL series, and polymethylmethacrylate (PMMA) NF‐U series, which offer enhanced efficacy over the previous TS‐S series and NF‐H series. The aim of this study was to evaluate the safety and efficacy of these dialyzer series versus contrasted expanded hemodialysis (HDx) and postdil...

A patient with a previously failed kidney transplant (on low-dose immunosuppressors), and currently on thrice-weekly in-center hemodialysis, had an initial asymptomatic SARS-CoV-2 infection with a transient positive IgG presence on immunoassays, was re-infected three months later presenting a more severe disease and ultimately fatal clinical outcom...

Introduction: COVID-19 is a highly contagious disease that has easily spread worldwide. Outpatient maintenance hemodialysis seems to entail an increased risk of contagion, and previous reports inform of increased mortality among this population. Methods: We retrospectively analyzed clinical and laboratory parameters, outcomes, and management onc...

Chronic kidney disease (CKD) patients have an accelerated atherosclerosis, increased risk of thrombotic-ischemic complications, and excessive mortality rates when compared with the general population. There is also evidence of an endothelial damage in which the proinflammatory state, the enhanced oxidative stress, or the accumulation of toxins due...

Background and Aims The ratio D/P-Creatinine (DP-Cr) obtained by the peritoneal equilibrium test (PET) is the most widely used parameter to characterize the type of peritoneal membrane transport, and it is used to determine the dialysis regimen for ultrafiltration (UF). It has been suggested that net UF influences the final clearance of solutes, so...

Background: Metabolic acidosis is a common problem in haemodialysis patients, but acidosis overcorrection has been associated with higher mortality. There is no clear definition of the optimal serum bicarbonate target or dialysate bicarbonate. This study analysed the impact of reducing dialysate bicarbonate from 35 to 32 mEq/L on plasma bicarbonate...

The aim of the study was to compare expanded hemodialysis (HDx) with hemodiafiltration (HDF) at different infusion flows to identify the main determinants, namely blood flow (Qb), replacement volume, infusion flow (Qi), ultrafiltration flow (Quf), filtration fraction (FF), and the point at which the effectiveness of HDF equals or exceeds that of HD...

Background: The biocompatibility of dialysis membranes is a determining factor in avoiding chronic microinflammation in patients under haemodialysis. Lower biocompatibility has been related to increased inflammatory status, which is known to be associated with cardiovascular events. Classically, cellulose membranes have been considered bioincompat...

Endothelial dysfunction is an earlier contributor to the development of atherosclerosis in chronic kidney disease (CKD), in which the role of epigenetic triggers cannot be ruled out. Endothelial protective strategies, such as defibrotide (DF), may be useful in this scenario. We evaluated changes induced by CKD on endothelial cell proteome and explo...

Introduction: Recently, a new class of dialyzers, medium cut-off membranes (MCO), designed to improve the permeability, which could provide an efficacy similar to hemodiafiltration, have been incorporated into our therapeutic possibilities. To increase the knowledge about its use, the objective of the study was to evaluate the effect of the surface...

Blood flow (Qb) is one of the dialysis parameters most strongly influencing the performance of dialysis modalities. However, few studies have compared different dialysis modalities in patients with low Qb. We conducted a prospective, single-center study in 21 patients. Each patient underwent four dialysis sessions with routine dialysis parameters:...

Bioelectrical impedance analysis (BIA) has increasingly been incorporated into hemodialysis units (HD) as a useful, non‐invasive technique for evaluating overall fluid status. The aims of this study were to verify whether the information obtained from two different BIA (spectroscopy bioimpedance‐BCM‐ and single‐frequency bioelectric impedance vecto...

INTRODUCTION: Recently, mediumcut-off (MCO) dialyzers, a new class of membranes, designed to improve the permeability, which could provide an efficacy similar to hemodiafiltration, have been incorporated into our therapeutic arsenal. To increase the knowledge about its use, we conducted this study that with the aim to evaluate the effect of the mem...

SP469- STUDY OF BIOCOMPATIBILITY OF MEMBRANES IN HEMODIAFILTRATION ON- LINE Raquel Ojeda, M. Arias-Guillén, M. Gómez, Manel Vera, Néstor Fontseré, Lm Rodas, Xavier Filella, JC. Reverter, F. Lozano, N. Villamor, FranciscoMaduell ABSTRACT Introduction and Aims: The biocompatibility of dialysis membranes is a determining factor in avoiding chronic mi...

INTRODUCTION: Medium cut-off (MCO) dialyzers, a novel class of membranes that have recently been designed, are suggested to achieve interesting removal capacities for middle and large middle molecules in hemodialysis (HD) treatments. The few studies published until now have reported contradictory results regarding middle-sized molecules when compar...

Resumen: Introducción: Recientemente, se ha incorporado a nuestras posibilidades terapéuticas una nueva clase de dializadores, las membranas de medio cut-off (MCO), diseñadas para mejorar la permeabilidad y que podrían alcanzar una eficacia similar a la hemodiafiltración. Para aumentar el conocimiento sobre su uso, el objetivo del estudio fue valor...

Most high‐flux dialyzers can be used in both hemodialysis (HD) and online hemodiafiltration (OL‐HDF). However, some of these dialyzers have higher permeability and should not be prescribed for OL‐HDF to avoid high albumin losses. The aim of this study was to compare the safety and efficacy of a currently used dialyzer in HD and OL‐HDF with those of...

BACKGROUND: A novel class of membranes, medium cut-off (MCO) membranes, has recently been designed to achieve interesting removal capacities for middle and large middle molecules in hemodialysis (HD) treatments. The few studies published to date have reported contradictory results regarding middle-sized molecules when comparing MCO dialyzers versus...

Background: Etelcalcetide is a novel second-generation calcimimetic that, because of its intravenous administration, could improve treatment adherence in secondary hyperparathyroidism (SHPT). The aim of this study was to evaluate the effectiveness of etelcalcetide compared with that of cinacalcet in controlling SHPT in patients under hemodialysis....

Background/Aims: Accelerated atherosclerosis in chronic kidney disease (CKD) is preceded by endothelial dysfunction (ED), which exhibits a proinflammatory and prothrombotic phenotype and enhanced oxidative stress. In this study, the effect of several compounds with anti-inflammatory and/or antioxidant properties on uremia-induced endothelial dysfun...

Objectives: To evaluate whether body composition monitor (BCM) could be a practical instrument for nephrologists to assess nutritional status in patients on hemodialysis (HD) and whether it is more effective in identifying patients at highest risk of developing protein-energy wasting (PEW) alone or in combination with other tools currently used fo...

Introduction: Online haemodiafiltration (OL-HDF) has been associated with increased survival. To date, the influence of the inner diameter of the hollow fibres of the dialyser on convective volume has not been well established. The objective of the study was to evaluate the effect of increasing the inner diameter of the dialyser on the convective...

Anemia is common in chronic kidney disease (CKD) and has been associated with reduced quality of life, the need for red blood cell transfusions and poor outcomes. The main cause of anemia in CKD is an inadequate renal production of erythropoietin (EPO). Treatment with erythropoiesis-stimulating agents (ESAs) and iron are currently the mainstays of...

Evaluation of inner diameter of hollow fibers dialyzer in on-line hemodiafiltration. ABSTRACT Introduction: On-line hemodiafiltration (OL-HDF) has been associated with increased survival. It is not well established the influence of inner diameter of hollow fibers dialyzer on the convective volume. The objective of the study was to evaluate the ef...

Background: Online haemodiafiltration (OL-HDF) is currently the most effective dialysis technique that also improves survival. To date, high permeability membranes with low albumin loss, such as polysulfone, polyamide and polyacrylonitrile membranes have been the most widely used. However, the initially restricted use of cellulose triacetate (CTA)...

Background Online haemodiafiltration (OL-HDF) is currently the most effective dialysis technique that also improves survival. To date, high permeability membranes with low albumin loss, such as polysulfone, polyamide and polyacrylonitrile membranes have been the most widely used. However, the initially restricted use of cellulose triacetate (CTA) m...

Background: New haemodialysis therapeutic regimens are required to improve patient survival. Longer and more frequent dialysis sessions have produced excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment. Methods: In this single-centre observational study, 57 p...

Accelerated atherosclerosis in chronic kidney disease (CKD) is preceded by the development of endothelial dysfunction (ED), with development of a proinflammatory and prothrombotic phenotype and enhanced oxidative stress. The effect of anti-inflammatory and antioxidant strategies on the endothelium has been evaluated in an in vitro model of ED in ur...

Introduction: Currently, on-line hemodiafiltration (HDF-OL) is the most effective technique. Several randomized studies and meta-analyses have shown a reduced mortality and a direct association with convective volume has been reported. At present, it has not been established if an increased dialysate flow (Qd) results in improved results in terms...

Introducción: La hemodiafiltración on-line (HDF-OL) es actualmente la técnica más efectiva. Varios estudios aleatorizados y metaanálisis han observado una reducción de la mortalidad, objetivándose una asociación en relación directa con el volumen convectivo. En el momento presente no está bien establecido si el aumento de superficie del dializador...

Introduction: On-line haemodiafiltration (OL-HDF) is currently the most effective technique and several randomised studies and meta-analyses have seen a reduction in mortality and an association directly related with convective volume is observed. Blood flow (Qb) limits the infusion rate to 25-33 % and is the main limiting factor for reaching an o...

Background The increased cardiovascular risk present in chronic kidney disease (CKD) is related to the development of endothelial dysfunction, whose mechanisms are still unclear. Accumulation of toxins and proinflammatory cytokines may constitute danger associated molecular patterns (DAMP) to which endothelial cells are continuously exposed. Potent...

El objetivo del trabajo es analizar los resultados obtenidos tras la introducción de la modalidad de diálisis peritoneal automática adaptada, usando bicarbonato puro como agente tampón, en un grupo de pacientes en programa de diálisis peritoneal automática convencional. Estudio de diseño cuasi experimental, que se realizó entre los meses de febrero...