Objective: To estimate the efficiency of a nurse‐led telephone program for nonadherent to treatment Type 2 diabetics with comorbid depression (TELE‐DD program).Design: Secondary analysis of cost‐consequence and budget impact, utilizing data from a randomized clinical trial conducted in the primary healthcare setting. The target population consisted of Type 2 diabetic patients with comorbid depression who were nonadherent to their pharmacological treatment.Method: The average cost per controlled patient (glycated hemoglobin < 7%) and the incremental cost‐effectiveness ratio were calculated. Similarly, the budgetary impact over 1 year of implementing this program in the region of reference of the randomized clinical trial was assessed.Results: The number of controlled patients is higher in the TELE‐DD group at 6, 12, and 18 months. The average cost per controlled patient was higher in the TELE‐DD group than in the control group at 6 months (€160.31 vs. €49.79), but lower at 12 (€150.09 vs. €179.59) and 18 months (€209.22 vs. €376.88). The incremental cost‐effectiveness ratio at 6, 12, and 18 months was €254.47, €143.65, and €177.46, respectively. The budget impact analysis revealed that implementing the TELE‐DD program would result in a reduction of €721,940.68 in expenditure for the funder in the first year of application.Conclusions: A nurse‐led telephone program for nonadherent Type 2 diabetics with comorbid depression is an efficient option in the management of healthcare resources. These results highlight the role of nursing in chronic patient management and the efficient use of healthcare resources.Trial Registration: ClinicalTrials.gov Identifier: NCT04097483.

Introduction: Different first-generation methods exist for the detection of stenosis. Objective: To determine the accuracy of first-generation methods in detecting stenosis in native arteriovenous fistulas. Method: Retrospective observational study. Sample: Patients with functioning native arteriovenous fistulas. First-generation methods include physical examination, manual tests, pulse increase test and arm elevation test, indirect methods, Kt/V, and arteriovenous fistula recirculation. The diagnosis of stenosis was confirmed by Doppler ultrasound. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of first-generation methods based on Doppler ultrasound were calculated. Results: Sample 39 patients, 79.48% male. Ultrasound detected 19 stenoses, nonsignificant. Physical examination: sensitivity 31.5%, specificity 80%, PPV 60%, NPV 55.1%, accuracy 56.4%. Pulse rise test: sensitivity 5.2%, specificity 90%, PPV 33.3%, NPV 50%, accuracy 48.7%. Arm elevation test: sensitivity 52.6%, specificity 70%, PPV 62.5%, NPV 60.8%, accuracy 61.5%. Indirect methods: sensitivity 15.7%, specificity 55%, PPV 25%, NPV 40.7%, accuracy 35.9%. Kt/V: sensitivity 10.5%, specificity 75%, PPV 28.5%, NPV 46.8%, accuracy 43.5%. AVF recirculation: sensitivity 10.5%, specificity 100%, PPV 100%, NPV 54.1%, accuracy 56.4%. Conclusions: All first-generation methods have high specificity and low sensitivity. The degree of stenosis (significant or non-significant) could influence the sensitivity of the physical examination but not the specificity. The arm elevation test is the most accurate first-generation method of detecting stenosis.

Background/Objectives: Weight gain after kidney transplantation is frequent but heterogeneous, often accompanied by changes in body composition that influence long-term outcomes. This study analysed one-year changes in body compartments and their demographic and clinical determinants. Methods: A prospective cohort of 112 adult kidney recipients transplanted between September 2020 and June 2022 at a Spanish tertiary hospital was followed. Body weight, muscle mass, fat mass, visceral fat and total body water were assessed by multi-frequency bioelectrical impedance at discharge, and at 3, 6 and 12 months. Associations with sociodemographic, clinical and comorbidity variables were examined using repeated-measures ANOVA and comparative tests. Results: At 12 months, mean weight gain was 3.6 ± 6.5 kg (5.1%). Increases were greater in men, younger patients, non-dialysis candidates, those with previous transplantation and living donor grafts. Muscle mass rose during the first three months and then stabilised, with greater gains in men and haemodialysis patients. Fat mass decreased initially and then increased, particularly in women, younger recipients and living donor transplants. Visceral fat progressively increased after three months, with higher levels in men and older patients. Total body water declined in women, younger recipients and first transplant patients. Patients with new-onset diabetes gained less weight, while smokers gained more. Conclusions: Post-transplant body composition is shaped by sex, age, BMI, comorbidities and donor type. Monitoring compartments beyond body weight may allow early detection of adverse metabolic trajectories. Tailored nutritional and lifestyle interventions are needed to optimise long-term outcomes.

Background/Objectives: Individuals with chronic kidney disease often face significant physical and clinical challenges, such as muscle weakness, fatigue, and reduced cardiorespiratory capacity, that impact their quality of life. Physical activity has emerged as an effective intervention to counteract these effects, with clinical guidelines recommending exercise as a standard treatment for kidney transplant recipients. The aim of this study was to assess pretransplant physical activity levels in a cohort of transplant patients and analyze their relationships with cardiovascular risk factors. Methods: A cross-sectional, analytical, and correlational study was conducted from September 2020 to June 2022 with a sample of 122 kidney transplant recipients assessed before kidney transplantation. Sociodemographic data, anthropometric data, comorbidities, renal replacement therapy types, and clinical and analytical data were collected from the patients’ clinical records. Physical activity was assessed via the International Physical Activity Questionnaire. Results: The average time spent waiting for transplantation was 423 ± 405 days, which was longer (387 ± 524) in the group of those under 65 years than in those over 65 years (194 ± 256) (p = 0.010). The median energy expenditure was 1742 (IQR = 1719) METs. In addition, 15.6% of the participants reported inactivity. Men reported higher physical activity levels (median: 2076 METs/week; IQR: 2037) than women did (median: 1386 METs/week; IQR: 1238). A higher level of physical activity was found in non-dialysis patients, overweight patients, and those with a history of stroke. A significant positive correlation was found between physical activity levels and serum urea. Conclusions: Increased physical activity levels were observed in men and in participants under 65 years of age. Patients with cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, overweight and obesity, reported lower activity levels, whereas those with a prior history of cerebrovascular accidents engaged in more physical activity. This study highlights the importance of assessing physical activity and promoting exercise for chronic kidney disease patients awaiting kidney transplantation. Further research is needed to explore the evolution of physical activity in this population and its impact post-transplantation.

Objective: To determine the preoperative and postoperative inflammatory, biochemical, and haematological factors that influence the maturation of native arteriovenous fistulas. Material and Method: We conducted a retrospective observational study. Two blood tests were performed—pre- and postoperative—analysing biochemical, haematological, and inflammatory parameters. Statistical analysis included descriptive statistics, Student’s t test, Mann–Whitney U test, chi-square test, Wilcoxon test, and binomial logistic regression. Results: The sample comprised 130 patients with a mean age of 68.3 years; 75.3% were men. Overall, 75.3% of fistulas matured. When comparing mature versus non-mature fistulas, the following findings were observed: Preoperative analysis: albumin (p=0.012) and PO2 (p=0.007) were significantly higher, and C-reactive protein (CRP) (p=0.006) was significantly lower in mature fistulas. Postoperative analysis: CRP (p=0.004) and creatinine (p=0.002) were significantly lower in mature fistulas. Paired-sample analysis: in mature fistulas, there was a significant postoperative increase in PO2 (p=0.049), leukocytes (p=0.021), and neutrophils (p=0.011), and a significant postoperative decrease in PCO2 (p=0.042) and creatinine (p<0.001). In non-mature fistulas, a significant decrease in preoperative albumin was observed (p<0.001). Logistic regression: higher preoperative albumin (OR, 0.15; p=0.003) and PO2 (OR, 0.54; p=0.002) were associated with a lower risk of maturation failure. Higher preoperative uric acid (OR, 1.58; p=0.005), and higher postoperative CRP (OR, 1.31; p=0.047) and creatinine (OR, 1.22; p=0.006) were associated with a greater risk of maturation failure. Conclusions: Elevated uric acid, creatinine, and CRP levels increase the risk of fistula maturation failure, whereas higher preoperative albumin and PO2 reduce this risk.

Introduction: Postoperative isometric exercises promote the maturation of native arteriovenous fistulas.Objective: To determine whether the use of a handgrip influences arteriovenous fistula maturation and to analyse its relationship with sex.Material and Method: Prospective observational study. Population: patients with mature radiocephalic fistulas who performed handgrip exercises. Exercise protocol: initiation 15 days after surgery. A total of 20 repetitions were performed 5 times per day with progressive increase in resistance every 15 days. Ultrasound measurements: at 30 and 75 days.Results: The sample included a total of 21 patients, 66.7% men. Men achieved significantly higher radial artery peak systolic velocity and venous diameter in all ultrasound measurements (P<0.05). At 75 days, those who used a maximum resistance of 40 kg showed greater radial artery peak systolic velocity (114.1 vs 85.3; P=0.049), venous diameter (6.87 vs 5.83; P=0.021), and vascular access flow (1465 vs 795; P=0.002) vs those who used 24 kg. In addition, they showed greater radial artery peak systolic velocity (114.1 vs 98.2; P=0.032) and venous diameter (6.87 vs 6.24; P=0.046) vs those who used 32 kg. The maximum resistance used was significantly correlated with radial artery peak systolic velocity (r=0.5; P=0.004), venous diameter (r= 0.57; P=0.006), and vascular access flow (r=0.58; P=0.027). When stratified by sex, a significant correlation was observed only in men.Conclusions: Men use higher resistance levels than women in handgrip isometric exercises. Furthermore, men achieve better morphological and haemodynamic parameters in all ultrasound measurements.