Background Recently, the concept of the metabolic syndrome (MS) has emerged in an effort to group and study as a whole several cardiovascular risk factors. The definition of the metabolic syndrome requires the presence of 3 or more of the following parameters: high blood pressure (≥30/85), waist circumference >102 cm in men and >88 cm in women, HDL<50 mg/dL in men and <40 mg/dL in women, serum triglycerides >150 mg/dL and fasting blood glucose ≥110 mg/dL. Objectives: To investigate the prevalence of the MS and the specific patient characteristics in a cohort of hemodialysis patients. Mterials and Methods 102 stable patients on maintenance hemodialysis (63 male/39 female with a mean time on dialysis of 57.19 ± 47.16 months) were studied for 12 months. Results The prevalence of the MS is high (56.25%) during the first year on dialysis and gradually declines (44.8% from 2–5 years and 29.7% for >5 years). In total 41/102 patients had MS (40.19%); 28/41 were men (68.29%) and 13/41 women (31.7%). The prevalence of MS in males was 44.4% (28/63) and 33.3% (13/39) in females, while the most frequent combination of risk factors in MS patients was high blood pressure-high waist circumference-high levels of serum triglycerides (36.58%). Serum triglycerides >150 mg/dL is the most frequent component of the MS both in well-nourished patients and according to the duration of dialysis (58.53% for 0–5 years and 19.51% for >5 years on dialysis). MS patients had a better nutritional status and were on dialysis for less time than their non-MS (NMS) counterparts. Actual or anamnestic cardiovascular events and infections did not differ between the 2 groups. Conclusions Our study provides new data concerning the prevalence of the MS and the specific patient characteristics in a hemodialysis population. The prevalence of MS in hemodialysis patients is high (40.19%) and seems to reflect a state of good nutrition compared to patients without the MS. Furthermore, the MS is more common in the first years of dialysis (42.46±34.29 months) than later on (67.25±52.15 months) probably reflecting the long term consequences of the hemodialysis treatment. Our results also indicate that although patients in the MS group were well-nourished and for a shorter time on dialysis, they were not protected from cardiovascular disease and infections. Our study provides new data concerning both the prevalence of the MS and a variety of patient characteristics in a hemodialysis population. Further research and a larger number of patients are required in order to clarify the precise role of this syndrome in patients on MHD.

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Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound systems by clinicians at a patient’s bedside for diagnostic and therapeutic purposes. It is not a substitute but rather a complement to clinical examination, and contrary to the classic ultrasound examination performed by radiologists, POCUS is not a detailed morphologic examination but focuses on answering specific clinical questions in an effort to reduce time to diagnosis and treatment, improve patient safety and decrease complication rates. In this article, we present the POCUS in hemodialysis units for and beyond vascular-access purposes, arguing that its implementation will help the practicing nephrologist who is treating hemodialysis patients on a daily basis to rapidly and efficiently answer several clinical questions that are common to dialysis patients, such as vascular-access assessment and cannulation, and assessment of volume status. POCUS aims to answer specific clinical questions, so a question-answer format is used. This review is divided in two parts. In the first part we will answer specific clinical questions exclusively concerning vascular access. The second part is dedicated to the use of POCUS for the assessment of volume status and dry-weight determination.

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Background: Monitoring of vascular access outflow (VAO) in dialysis is based on the indicator dilution method by ultrasound (UD). The role of arterial needle orientation in VAO measurement is not clear. We compared the impact of the retrograde (RET) versus the antegrade orientation (ANT) in terms of (a) VAO (UD) and (b) dialysis adequacy. Moreover, we compared VAO (UD ANT and RET orientation) with VAO measured by Doppler ultrasound. Methods: 22 patients participated in the study. Inclusion criteria: Dialysis > 6 months with a functioning AVF, no stenosis, no active infection, EF > 45% and informed consent. 4 flow measurements were taken on the same dialysis day (4 consecutive weeks). To account for blood pressure variation, we “corrected” VAO for a mean arterial pressure of 100 mmHg. Doppler VAO was measured just before dialysis. Means were compared by the paired t-test. For correlation and agreement, linear regression and Bland-Altman analysis were performed respectively. Results: Mean VAO (UD) was higher in the (ANT) versus the (RET) orientation: 1286.17 mL/min (SD = 455.78, 95%CI = 1084–1488) versus 1189.96 mL/min (SD = 401.05, 95%CI = 1012–1368) (p = 0.013) with a mean difference of 96.21 mL/min (5.66%). Mean Kt/V (RET orientation) was 1.57 (SD = 0.10, 95%CI = 1.52–1.61) versus 1,55 (SD = 0.10, 95%CI = 1.50–1.60) (ANT) orientation (p = 0.062). Recirculation was always 0%. The mean VAO (Doppler) was 1079.54 mL/min (SD = 356.04, 95%CI = 922–1237), 16% lower than VAO measured by UD with (ANT) orientation (p = 0.009) and 9.3% lower than the VAO in the (RET) orientation (p = 0.113). Linear regression analysis showed that VA flows (ANT versus RET) orientation of the needle correlates well between them (r = 0.93, p < 0.001) but show poor agreement (Bland–Altman analysis). Conclusion: VAO (UD) in the RET orientation was significantly lower than VAO in the ANT orientation and more consistent with VAO assessed by Doppler without influencing dialysis adequacy. Therefore, when using UD for VAO surveillance, the RET orientation should be used.

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