The prevalence of Sarcopenia varies between 1.5% and 68% among patients with chronic kidney disease (CKD). This wide range is due to the different diagnostic tools and the cut-off points used. Early diagnosis and intervention of sarcopenia are essential because of its association with poorer quality of life (QoL), higher hospitalization rates, and adverse events. The "European Working Group on Sarcopenia in Older People (EWGSOP2)" consensus review suggests ultrasound as an emerging tool to quantify muscle mass. Our objective is to describe the prevalence of sarcopenia risk in peritoneal dialysis (PD) and the utility of ultrasound in our setting. We conducted an observational study in prevalent PD patients at the Puerta de Hierro University Hospital between January and October 2023. Clinical, efficacy, analytical and nutritional parameters were collected, along with functional performance measured by SPPB, frailty (FRAIL scale), risk of malnutrition (MIS scale), bioimpedance (BCM) and estimation of appendicular skeletal muscle mass using Lin's formula. Ultrasound measurement of supramuscular fat, Axes (X and Y) and the area of the rectus femoris muscle (RFM) were also included, adjusted for height and body surface area. We classified patients at risk of sarcopenia based on handgrip strength according to EWGSOP2 criteria, adjusted for sex. This study was approved by the Ethics Committee of Puerta de Hierro University Hospital (No. 16/2023). We evaluated 38 patients, with a mean age of 65.4 years (SD 14.9), 65.8% were male. 52.6% had a reduced lean tissue index (LTI) and 23.7% had a reduced fat tissue index (FTI), with a mean phase angle (PA) of 4.5 (SD 1.1). We classified 42.1% as patients at risk of sarcopenia based on handgrip strength. They were older, had more comorbidities, poorer nutrition according to the MIS scale, and showed worse scores on frailty and functional capacity. Similary, they had a lower LTI, lower appendicular skeletal muscle mass, and lower quadriceps muscle thickness (Y axis 8.5 mm (SD 2.4) vs 11.8 mm (SD 3.3) p = 0.002). Patients at risk of sarcopenic had lower phosphorus levels and higher C-reactive protein (CRP) levels. The predictive capacity of ultrasound for classifying patients at risk of sarcopenia was AUC 0.78 (0.64-0.93) for Y Axis, similar to those obtained with the LTI and PA of bioimpedance. Sarcopenia risk is highly prevalent in PD and is related to age, comorbidity, malnutrition and inflammation in patients. Ultrasound is an accessible, safe, low-cost and easy-to-use tool at the bedside. This method helps us to quantify muscle mass and assess its quality. We propose the thickness of the RFM (Y axis) as the best complementary parameter given its good correlation with bioimpedance and its diagnostic value for sarcopenic risk. Our experience will serve as a basis for future studies that allow us to define specific cut-off points in PD and design monitoring and intervention protocols.

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.

Antecedentes y objetivos Los pacientes con insuficiencia renal crónica (IRC) corren mayor riesgo de desarrollar enfermedad cardiovascular. En los pacientes con IRC, los mecanismos implicados en la disfunción endotelial y el papel de los diferentes fármacos utilizados en estos pacientes no se conocen por completo. El objetivo de este artículo es analizar el efecto de las estatinas y los antiagregantes plaquetarios (AP) sobre las microvesículas endoteliales (MVE) y otros marcadores de la disfunción endotelial. Enfoque experimental Estudio transversal con 41 pacientes con IRC 3b-4 y 8 voluntarios sanos. Se cuantificaron los niveles de MVE, factor de crecimiento vascular endotelial (FCVE) y productos avanzados de oxidación de proteínas (AOPP, por sus siglas en inglés) en la circulación y se evaluó la correlación con diferentes variables de comorbilidad y estrategias terapéuticas. Resultados: Las MVE aumentaron en pacientes con IRC al comparar los niveles con los controles (171,1 frente a 68,3/μl; p < 0,001). Se observó una correlación negativa entre la edad y las MVE. Las estatinas y los AP se asociaron con una reducción de los niveles de MVE y FCVE, independientemente de los niveles séricos de colesterol total (CT). Los niveles de AOPP y FCVE no fueron diferentes entre los pacientes con IRC y los controles. Conclusión: La IRC se asocia con un cambio de los niveles de MVE, FCVE y AOPP. El tratamiento con estatinas y AP normaliza estos valores a casi los observados en los controles y este efecto es independiente del nivel de CT predominante. Estos hallazgos explican la existencia de los efectos pleiotrópicos de las estatinas y los AP que merecen estudios adicionales. Backgrounds and purposes Patients with chronic kidney disease (CKD) have higher risk of developing cardiovascular disease. In CKD patients the mechanisms involved in, endothelial damage and the role of different drugs used on these patients are not completely understood. The aim of this work is to analyze the effect of statins and platelet antiaggregant (PA) on endothelial microvesicles (EMVs) and other markers of endothelial dysfunction. Experimental approach Cross-sectional study of 41 patients with CKD 3b-4 and 8 healthy volunteers. Circulating levels of EMVs, vascular endothelial growth factor (VEGF), and advance oxidized protein products (AOPPS) were quantified and the correlation with different comorbidity variables and therapeutic strategies were evaluated. Results: EMVs are increased in CKD patients as compared with controls (171.1 vs. 68.3/μl, P<.001). It was observed a negative correlation between age and EMVs. Statins and PA were associated with a reduction in EMVs and VEGF levels, independently of the serum total cholesterol levels (TC). The levels of AOPPS and VEGF were not different in CKD vs. controls. Conclusion: CKD is associated with a change in EMVs, VEGF and AOPP levels. The treatment with statins and PA normalizes these values to almost the observed in controls and this effect is independently of the prevailing TC level. These findings explain the existence of the pleiotropic effects of statins and PA which deserve further studies.

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.

Background/Objectives: Frailty is increasingly recognized as a major determinant of adverse outcomes in patients receiving peritoneal dialysis (PD), yet it is not routinely incorporated into clinical practice. Because PD relies heavily on patient autonomy and self-management, frailty, sarcopenia, malnutrition, and impaired quality of life may compromise both outcomes and technique retention. This study aimed to describe current clinical practices related to frailty-informed assessment in PD units participating in the GCDP network and to identify barriers to implementing a more comprehensive, patient-centered approach. Methods: We conducted a descriptive, observational, cross-sectional study based on a survey distributed to PD units belonging to the Grupo Centro de Diálisis Peritoneal (GCDP), a collaborative network of 24 hospitals across four autonomous communities in Spain. Physicians and nurses completed the questionnaire between January and February 2025. The survey explored seven domains: use of frailty scales, nutritional screening tools, dynamometry, muscle ultrasound, bioimpedance, quality of life instruments, and digital applications for patient follow-up. Results: Twenty of 24 centers completed the survey. Although all units considered frailty clinically relevant, only 11 assessed it at PD initiation and only 5 performed periodic or systematic re-evaluation. Nutritional screening tools were used in 13 centers, most commonly the Malnutrition Inflammation Score. Twelve centers had a dynamometer, though its use was not standardized. All centers used bioimpedance—primarily for hydration assessment—while muscle ultrasound was rarely applied in scheduled follow-up. Only 7 centers assessed quality of life. The main reported barriers were lack of time in routine practice and the absence of specific guidelines and training. Conclusions: Frailty-related assessment across participating GCDP units remains heterogeneous and incompletely implemented despite broad recognition of its clinical relevance. The identified gaps in standardized protocols, training, and integration of assessment tools highlight priorities for future implementation research aimed at incorporating frailty-informed, patient-centered assessment into routine PD care.