Introduction and Aims: On-line dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs.This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared with a historic control group.Methods: We studied 148 long-term hemodialysis patients with arteriovenous fistulas (historical control group, n = 74) for 2 years.During the study period, the indications for vascular treatments were the Kt reduction ≥20% with respect to baseline values or Qa less than 500 mL/min (or a decrease in flow > 20%).Differences between the Qa and Kt groups were tested using Student's T-Test or the Wilcoxon test, as appropriate.The χ2 test was used to analyze the angioplasty and thrombosis rates compared with the historical control group.A P-value ≤0.05 was considered statistically significant.Results: During the study period, we detected 16 cases of significant vascular access dysfunction.The Kt value after vascular treatment was 71.1L (59L; P = 0.001) and BTM-Qa was 1218.6 mL/min (519.7 mL/min; P = 0.001).Compared with the control group, the thrombosis rate was 0.027 vs 0.148 episodes/patient-year (P = 0.009) and the total access-related cost was €22,293 vs €47,467 (P = 0.033).Conclusions: This study suggests that a combined monitoring program based on Kt and Qa-BTM represents an effective screening method that significantly reduces the thrombosis rate and economic costs of vascular treatments SP523

Introduction and Aims: Although some guidelines recommend salt restriction, few studies have examined the association between salt restriction and clinical outcomes in hemodialysis (HD) patients.Methods: We conducted a retrospective cohort study of 88,115 adult patients enrolled in the Japanese Society for Dialysis Therapy (JSDT) registry ( 2008) who had received HD for at least two years and were considered anuric.The primary outcome measure was all-cause mortality at one year, and the secondary outcome was cardiovascular (CV) mortality.Estimated salt intake was the main predictor, and was calculated from interdialytic weight gain and pre-and postdialysis serum sodium levels according to the validated method of Kimura and Ramdeen.Nonlinear logistic regression was used to determine the association of salt intake with mortality, adjusting for age, gender, body mass index, vintage of HD, dialysis time, Kt/V, protein catabolic rate normalized to body weight, comorbid conditions, type of vascular access, serum potassium, phosphate, calcium, CRP level, and endotoxin level in dialysate.Cubic splines were plotted and the reference was median salt intake.Salt consumption was categorized by intake levels of 2 g per day and the association with mortality examined.Results: Median [25th-75th percentile] salt intake at baseline was 6.4 [4.6-8.3]g per day.At one year, all-cause mortality occurred in 1,845 (2.1%) patients, including cardiovascular mortality in 821 (0.9%).We observed an association between low salt intake and clinical outcomes (all-cause and CV mortality) (Fig. 1).We observed the highest all-cause mortality in the low salt group (<6g/day) (Fig. 2), and no association between all-cause mortality and high salt intake.Further, we observed similar associations between salt intake and CV mortality.Conclusions: Low salt intake is associated with all-cause and CV mortality.These findings do not support current clinical guidelines, which recommend restricting salt intake to less than 6g per day.