SGLT-2i are the new standard of care for diabetic kidney disease (DKD), but previous studies have not included patients on kidney replacement therapy (KRT). Due to their high risk of cardiovascular, renal complications, and mortality, these patients would benefit the most from this therapy. Residual kidney function (RKF) conveys a survival benefit and cardiovascular health among hemodialysis (HD) patients, especially those on incremental hemodialysis (iHD). We retrospectively describe the safety and efficacy of SGLT2i regarding RKF preservation in seven diabetic patients with different clinical backgrounds who underwent iHD (one or two sessions per week) during a 12-month follow-up. All patients preserved RKF, measured as residual kidney urea clearance (KrU) in 24 h after the introduction of SGLT2i. KrU levels improved significantly from 4.91 ± 1.14 mL/min to 7.28 ± 1.68 mL/min at 12 months (p = 0.028). Pre-hemodialysis blood pressure improved 9.95% in mean systolic blood pressure (SBP) (p = 0.015) and 10.95% in mean diastolic blood pressure (DBP) (p = 0.041); as a result, antihypertensive medication was modified. Improvements in blood uric acid, hemoglobin A1c, urine albumin/creatinine ratio (UACR), and 24 h proteinuria were also significant. Regarding side effects, two patients developed uncomplicated urinary tract infections that were resolved. No other complications were reported. The use of SGLT2i in our sample of DKD patients starting iHD on a 1–2 weekly regimen appears to be safe and effective in preserving RKF.

Background and Objectives: Peritoneal dialysis (PD) is a renal replacement therapy modality in which the dialysis dose can be individually adapted according to the patients’ residual kidney function (RKF). RKF is a crucial factor for technique and patient survival. Pharmacological strategies aimed at slowing the loss of RKF in patients on PD are limited. Therefore, we aimed to assess the potential effects and safety of sodium–glucose cotransporter 2 (SGLT-2) inhibitors on the preservation of RKF in patients with and without type 2 diabetes mellitus (T2DM) on PD during an average follow-up of 6 months. Materials and Methods: In this retrospective observational, single-center study on real-world data, we included patients from the Peritoneal Dialysis Unit of the Hospital General Universitario de Ciudad Real, who started treatment with SGLT-2 inhibitors during the period from December 2022 to December 2023. Data on analytical and clinical parameters, RKF, and peritoneal membrane transport function were retrospectively collected at months 0, 3, and 6. Results: Out of 31 patients in our unit, 16 prevalent patients initiated treatment with SGLT-2 inhibitors (13 empagliflozin and 3 dapagliflozin). A total of 62.5% were male and the mean age was 67.3 years. The baseline peritoneal ultrafiltration was higher in the non-diabetic patient (NDMP) group than in the diabetic patient (DMP) group. However, the residual diuresis volume, 24 h residual renal clearance rate of urea in urine, and 24 h proteinuria were higher in the DMP group than in the NDMP group. At the sixth month, patients in both groups preserved RKF and diuresis, with a trend towards a non-significant reduction in proteinuria and blood pressure. Only two patients of the DMP group presented adverse effects. Conclusions: The use of SGLT-2 inhibitors in our sample of patients with and without T2DM on PD appears to be safe and effective to preserve RKF.

Background and Objectives: Sodium glucose cotransporter-2 (SGLT-2) inhibitors have emerged as integral therapeutic tools in the management of patients with cardiovascular–kidney–metabolic (CKM) syndrome. In addition to their well-documented effects on lowering glucose levels and cardiovascular- and reno-protective actions, SGLT-2 inhibitors, through a reduction in body weight (BW), generate changes in the body composition and volume status that have not been clearly studied. Materials and Methods: This retrospective, observational longitudinal cohort, single-center study analyzed and compared body composition and fluid status measured by bioelectrical impedance analysis (BIA) from weeks 0 to 12 after the initiation of the cardiac rehabilitation (CR) program for coronary artery disease and heart failure in 59 patients who started treatment with SGLT-2 inhibitors (SGLT-2iG) and 112 patients without SGLT-2 inhibitors (non-SGLT-2iG). Results: Changes between the baseline and week 12 in the SGLT-2iG and non-SGLT-2iG were −0.3 L (p = 0.003) and −0.03 L (p = 0.82) in extracellular water (ECW) (p = 0.05), −0.39 L (p < 0.001) and −0.14 L (p = 0.33) in intracellular water (ICW) (p = 0.12), −0.69 (p < 0.001) and −0.16 (p = 0.52) in total body water (TBW) (p = 0.08), and −0.01 (p = 0.37) and −0.001 (p = 0.25) in the ECW/TBW ratio, respectively. After 3 months of exercise therapy in the CR program, patients in the SGLT-2iG showed a greater decrease than the non-SGLT-2iG in weight (−1.34 kg, p < 0.001 vs. −0.99, p = 0.02), body mass index (BMI) (−0.45 kg/m², p < 0.001 vs. −0.38, p = 0.004), arm circumference (−0.57 cm, p = 0.008 vs. −0.12 cm, p = 0.21), waist circumference (−1.5 cm, p = 0.04 vs. −0.11 cm, p = 0.83), systolic blood pressure (SBP) (−8.9 mmHg, p = 0.049 vs. −4.19, p = 0.08), and diastolic blood pressure (DBP) (−5.15, p = 0.03 vs. −2.85, p = 0.01). The bioelectrical impedance analysis (BIA) revealed a significant decrease in body fat mass (BFM) and visceral fat area, without a loss of lean body mass (LBM) or skeletal muscle mass in the SGLT-2iG. Conclusions: SGLT-2 inhibitors exert beneficial effects on body compartments and volume status. Although they induce modest weight loss, this appears to be mainly directed at ECW, BFM, and visceral fat, without a loss of LBM nor skeletal muscle mass, which could contribute to the observed CKM benefits.

Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition and sarcopenia, and to compare its utility with established tools such as bioimpedance analysis (BIA), biochemical markers, handgrip strength (HGS), and functional performance tests. Materials and Methods: A cross-sectional study was conducted in 74 stable MHD patients. Clinical, analytical, anthropometric, BIA, NUS, and functional parameters were collected, along with validated nutritional and frailty scales. NUS was used to assess the quadriceps rectus femoris (QRF) and preperitoneal visceral fat (PPVF), measuring Y-axis, Y-axis/height, cross-sectional muscle area rectus femoris (CS-MARF), muscle area rectus femoris index adjusted to height (MARFI_h), and supramuscular fat (SMF). Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Results: The prevalence of risk, confirmed, and severe sarcopenia was 24.3%, 40.5%, and 20.3%, respectively. Severe-to-moderate protein-energy wasting (PEW) affected 44.6% of patients. Compared to non-sarcopenic individuals, sarcopenic patients had lower values of HGS, prealbumin, lean body mass, and phase angle. NUS-derived cut-off values for sarcopenia were Y-axis ≤ 8 mm, Y-axis/height ≤ 2.9 mm/m², CS-MARF ≤ 2.4 cm², and MARFIh ≤ 0.9 cm²/m². The most discriminative NUS parameters were Y-axis and SMF (AUC 0.67), followed by Y-axis/height (AUC 0.65) and MARFI_h (AUC 0.63). NUS measurements correlated significantly with ASMI, phase angle, HGS, and SPPB scores. Conclusions: Nutritional ultrasonography is a feasible, reproducible, and clinically valuable tool for assessing muscle mass and quality in MHD patients. Its incorporation into routine practice may enhance early detection of malnutrition and sarcopenia, thereby facilitating timely, individualized nutritional interventions.

Cryoglobulins are immunoglobulins that precipitate at temperatures below 37 °C and dissolve upon reheating. They can induce small-vessel vasculitis with renal involvement. Cryoglobulinemic glomerulonephritis is a rare manifestation that occurs in patients with monoclonal gammopathy, specifically Waldenström’s macroglobulinemia. We present the case of a 52-year-old patient with a history of cutaneous vasculitis and hypothyroidism, who presented with generalized edema, moderate anemia, hypercholesterolemia, nephrotic range proteinuria of 12.69 g/day, microhematuria, arterial hypertension, and hypocomplementemia via the classical pathway, without acute kidney injury and with negative serological studies and positive cryoglobulins in the second determination. Serum and urine protein electrophoresis and immunofixation studies showed a monoclonal band of IgM and kappa light chain. Renal biopsy was consistent with cryoglobulinemic glomerulonephritis. In the context of dysproteinemia and cryoglobulinemic glomerulonephritis, bone-marrow aspiration and biopsy were performed, leading to the diagnosis of Waldenström’s macroglobulinemia. Monoclonal gammopathies have been described in association with type I cryoglobulinemias. This described association is uncommon, which is why we present this case, along with a review of the literature.

Background and Objectives: Nutritional status is essential for outcomes in hemodialysis (HD) patients. Incremental HD (iHD) may help preserve residual renal function, but its effect on nutrition and body composition is unclear. Nutritional ultrasound (NUS) offers a non-invasive way to assess muscle and fat, complementing methods like BIA. This study compared nutritional status using morphofunctional assessment in patients on iHD versus conventional HD (cHD). Material and Methods: This single-center observational cross-sectional study included 74 stable adult HD patients (>3 months). Patients were stratified into iHD (n = 13; 1–2 sessions/week) and cHD (n = 61; 3 sessions/week). Evaluations included clinical and biochemical parameters, BIA, handgrip strength, nutritional scores and NUS assessed mass muscle of anterior quadriceps rectus femoris (QRF), supramuscular fat (SMF), subcutaneous adipose tissue (SAT), and preperitoneal visceral fat (PPVF). Results: Patients on iHD exhibited a more favorable nutritional and inflammatory profile, with a lower risk of malnutrition and a reduced prevalence of protein-energy wasting (PEW) syndrome. Although BIA failed to clearly differentiate between groups, NUS identified better preservation of SMF in iHD patients (8.3 ± 2.5 vs. 6.6 ± 2 mm; p = 0.009), as well as higher preperitoneal visceral fat thickness (1.9 ± 4.9 vs. 0.6 ± 0.3 cm; p = 0.04). There was also a trend toward greater muscle thickness in the iHD group, such as the Y-axis (9.5 ± 2 vs. 8.5 ± 2.3 mm; p = 0.17) and cross-sectional area muscle of rectus femoris (CS-MARF in cm²) (2.9 ± 0.6 vs. 2.6 ± 0.8 mm; p = 0.1) of anterior QRF, although without reaching statistical significance. Conclusions: These results highlight the value of NUS as a sensitive method for assessing nutritional status in HD patients, particularly within individualized strategies such as iHD, where it may provide key complementary information not captured by conventional methods.