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Bellizzi V, Signoriello S, Minutolo R, Di Iorio B, Nazzaro P, Garofalo C, Calella P, Chiodini P, De Nicola L. No additional benefit of prescribing a very low-protein diet in patients with advanced chronic kidney disease under regular nephrology care: a pragmatic, randomized, controlled trial. Am J Clin Nutr 2022; 115:1404-1417. [PMID: 34967847 DOI: 10.1093/ajcn/nqab417] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Whether a very low-protein diet supplemented with ketoanalogues (sVLPD), compared with a standard low-protein diet (LPD), improves outcomes in patients with chronic kidney disease (CKD) under stable nephrology care is undefined. OBJECTIVES To compare the effectiveness of sVLPD compared with LPD in patients regularly seen in tertiary nephrology care. METHODS Participants were patients with CKD stages 4-5, followed for at least 6 mo, randomly allocated to receive sVLPD or LPD [0.35 or 0.60 g/kg ideal body weight (IBW)/d, respectively], stratified by center and CKD stage. The primary outcome was time to renal death, defined as the first event between end-stage renal disease (ESRD) and all-cause mortality; secondary outcomes were the single components of the primary outcome, cardiovascular outcome, and nutritional status. RESULTS We analyzed 223 patients (sVLPD, n = 107; LPD, n = 116). Mean age was 64 y, 61% were male, and 35% had diabetes. Median protein intake (PI), which was 0.8 g/kg IBW/d at baseline in both groups, was 0.83 and 0.60 g/kg IBW/d in LPD and sVLPD, respectively, during the trial with a large decrease only in sVLPD (P = 0.011). During a median of 74.2 mo, we recorded 180 renal deaths (141 dialysis and 39 deaths before dialysis). Risk of renal death did not differ in sVLPD compared with LPD (HR: 1.17; 95% CI: 0.88, 1.57; P = 0.28). No difference was observed for ESRD (HR: 1.12; 95% CI: 0.81, 1.56; P = 0.51), mortality (HR: 0.95; 95% CI: 0.62, 1.45; P = 0.82), or time to fatal/nonfatal cardiovascular events (P = 0.2, log-rank test). After 36 mo, still active patients were 45 in sVLPD and 56 in LPD. No change of nutritional status emerged during the study in any arm. CONCLUSIONS This long-term pragmatic trial found that in patients with CKD under stable nephrology care, adherence to protein restriction is low. Prescribing sVLPD compared with standard LPD is safe but does not provide additional advantage to the kidney or patient survival.
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Affiliation(s)
- Vincenzo Bellizzi
- Division of Nephrology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Simona Signoriello
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Roberto Minutolo
- Division of Nephrology, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Paola Nazzaro
- Nephrology Unit, Cardarelli Hospital, Campobasso, Italy
| | - Carlo Garofalo
- Division of Nephrology, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Patrizia Calella
- Division of Nephrology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Luca De Nicola
- Division of Nephrology, University of Campania "Luigi Vanvitelli," Naples, Italy
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Magnocavallo M, Bellasi A, Mariani MV, Fusaro M, Ravera M, Paoletti E, Di Iorio B, Barbera V, Della Rocca DG, Palumbo R, Severino P, Lavalle C, Di Lullo L. Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy. J Clin Med 2020; 10:jcm10010083. [PMID: 33379379 PMCID: PMC7796391 DOI: 10.3390/jcm10010083] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022] Open
Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.
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Affiliation(s)
- Michele Magnocavallo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.M.); (M.V.M.); (P.S.); (C.L.)
| | - Antonio Bellasi
- Department of Research, Innovation and Brand Reputation, ASST-Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.M.); (M.V.M.); (P.S.); (C.L.)
| | - Maria Fusaro
- National Council of Research, Institute of Clinical Physiology, 56124 Pisa, Italy;
| | - Maura Ravera
- Nefrologia, Dialisi e Trapianto, Policlinico San Martino, 16132 Genova, Italy; (M.R.); (E.P.)
| | - Ernesto Paoletti
- Nefrologia, Dialisi e Trapianto, Policlinico San Martino, 16132 Genova, Italy; (M.R.); (E.P.)
| | - Biagio Di Iorio
- Department of Nephrology and Dialysis, Moscati Hospital, 83100 Avellino, Italy;
| | - Vincenzo Barbera
- Department of Nephrology and Dialysis, Parodi-Delfino Hospital, 00034 Colleferro, Italy;
| | | | - Roberto Palumbo
- Department of Nephrology and Dialysis, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.M.); (M.V.M.); (P.S.); (C.L.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.M.); (M.V.M.); (P.S.); (C.L.)
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, Parodi-Delfino Hospital, 00034 Colleferro, Italy;
- Correspondence: ; Fax: +39-06-972233213
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Russo D, Tripepi R, Malberti F, Di Iorio B, Scognamiglio B, Di Lullo L, Paduano IG, Tripepi GL, Panuccio VA. Correction: Etelcalcetide in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism. Multicenter Study in "Real Life". J. Clin. Med. 2019, 8, 1066. J Clin Med 2020; 9:jcm9041224. [PMID: 32344506 PMCID: PMC7230265 DOI: 10.3390/jcm9041224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/30/2023] Open
Affiliation(s)
- Domenico Russo
- Department of Public Health, University of Naples FEDERICO II, 80131 Naples, Italy; (B.S.); (I.G.P.)
- Correspondence: ; Tel.: +39-335-738-4009
| | - Rocco Tripepi
- Institute of Clinical Physiology (IFC-CNR) Research Unit of Reggio Calabria, 89124 Reggio Calabria, Italy; (R.T.); (G.L.T.)
| | - Fabio Malberti
- Department of Nephrology Cremona Hospital, 26100 Cremona, Italy;
| | - Biagio Di Iorio
- Department of Nephrology AORN Cardarelli, 80131 Naples, Italy;
| | - Bernadette Scognamiglio
- Department of Public Health, University of Naples FEDERICO II, 80131 Naples, Italy; (B.S.); (I.G.P.)
| | - Luca Di Lullo
- Department of Nephrology Ospedale “Parodi Delfino” di Colleferro (Roma), Colleferro, 00034 Roma, Italy;
| | - Immacolata Gaia Paduano
- Department of Public Health, University of Naples FEDERICO II, 80131 Naples, Italy; (B.S.); (I.G.P.)
| | - Giovanni Luigi Tripepi
- Institute of Clinical Physiology (IFC-CNR) Research Unit of Reggio Calabria, 89124 Reggio Calabria, Italy; (R.T.); (G.L.T.)
| | - Vincenzo Antonio Panuccio
- Nephrology, Dialysis and transplantation Unit G.O.M. “Bianchi Melacrino Morelli”, 89121 Reggio Calabria, Italy;
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Fiorini F, De Pascalis A, D'Amelio A, Di Iorio B, Abaterusso C, Granata A. [Native kidney ultrasound in obstructive uropathy]. G Ital Nefrol 2020; 37:37-01-2020-4. [PMID: 32068358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The term "obstructive uropathy" refers to the complex structural and functional changes following the interruption of normal urinary runoff, which can occur at every level of the urinary tract. Depending on its origin, duration and severity, urinary tract obstructions can be acute or chronic, mono or bilateral, partial or complete. The obstruction can be localized or extended to the entire pielo-caliceal system and/or homolateral urethra. The term "hydronephrosis" indicates the dilation of the pelvis detected through imaging techniques. Among these, ultrasound is considered the gold standard in the diagnosis of obstructive uropathy: it allows to distinguish three degrees of urinary tract dilation, depending on the extent of the dilation itself and the thickness of the parenchyma. Nephrologists are confronted daily with patients who experience kidney failure and must be able to quickly distinguish between chronic and acute and, in the latter case, to discern between issues of nephrological or urological competence. This short review aims at helping them deal with this very common scenario, through the use of ultrasound.
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Affiliation(s)
- Fulvio Fiorini
- UOC Nefrologia, Dialisi, AULSS5 Polesana, Rovigo. Scuola Nazionale di Ecografia Nefrologica, Società Italiana di Ultrasonologia in Medicina e Chirurgia (SIUMB), Rovigo. Commissione Didattica Iter Formativo in Ecografia Nefrologica Società Italiana di Nefrologia
| | | | - Alessandro D'Amelio
- UOS Dialisi, Gallipoli (LE). Commissione Didattica Iter Formativo in Ecografia Nefrologica Società Italiana di Nefrologia
| | | | | | - Antonio Granata
- UOC Nefrologia e Dialisi, A.O. "Cannizzaro", Catania. Scuola Nazionale di Ecografia Nefrologica, società Italiana di Ultrasonologia in Medicina e Chirurgia (SIUMB), Catania. Commissione Didattica Iter Formativo in Ecografia Nefrologica Società Italiana di Nefrologia
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Alfano G, Cappelli G, Fontana F, Di Lullo L, Di Iorio B, Bellasi A, Guaraldi G. Kidney Disease in HIV Infection. J Clin Med 2019; 8:jcm8081254. [PMID: 31430930 PMCID: PMC6722524 DOI: 10.3390/jcm8081254] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022] Open
Abstract
Antiretroviral therapy (ART) has significantly improved life expectancy of infected subjects, generating a new epidemiological setting of people aging withHuman Immunodeficiency Virus (HIV). People living with HIV (PLWH), having longer life expectancy, now face several age-related conditions as well as side effects of long-term exposure of ART. Chronic kidney disease (CKD) is a common comorbidity in this population. CKD is a relentlessly progressive disease that may evolve toward end-stage renal disease (ESRD) and significantly affect quality of life and risk of death. Herein, we review current understanding of renal involvement in PLWH, mechanisms and risk factors for CKD as well as strategies for early recognition of renal dysfunction and best care of CKD.
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Affiliation(s)
- Gaetano Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41125 Modena, Italy.
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41125 Modena, Italy.
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Francesco Fontana
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, "L. Parodi-Delfino" Hospital, 00034 Colleferro, Italy
| | - Biagio Di Iorio
- Department of Medicine, AORN "Antonio Cardarelli", 80131 Naples, Italy
| | - Antonio Bellasi
- Department of Research, Innovation, Brand Reputation, Ospedale di Bergamo, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy
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Di Iorio B. [Editorial]. G Ital Nefrol 2018; 35:35-6-2018-1. [PMID: 30550031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Biagio Di Iorio
- Unità Complessa di Nefrologia AORN Ospedale Cardarelli, Napoli
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7
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De Santo NG, Citterio F, De Santo LS, Venditti G, De Rosa G, Di Iorio B, Capasso G. [Laws regulating transplantation should express the contemporaneity. Questions to the constitutionalist Francesco Paolo Casavola and to the philosophers Remo Bodei and Aldo Masullo about the possibility deciding the destiny of one's own organs at the time one decides on how to die and on contacts between donor families and recipients.]. G Ital Nefrol 2018; 35:35-6-2018-2. [PMID: 30550032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Transplantation represents modernity thus the laws regulating the procedure should be continuously renovated and remodeled in order to take full advantage of progress. The debate is about Law no. 219, December 22, 2017 and on Law no. 222, April 1, 1999. The quests are a) about the possibility to modify the first so that people deciding on how they want to die, may also decide about their willingness to allow the removal of their organs for transplantation and b) the possibility for donor families and recipients to have contacts after transplantation in the case both sides agree. Questions were emailed to the constitutionalist Francesco Paolo Casavola, immediate Past President of the National Committee for Bioethics, and to the philosophers Remo Bodei and Aldo Masullo. Their answers received by September 16, support the idea a) to include in the Law no. 219, 2017 the possibility to decide not only on the modality one wants to die but also on the possibility to allow his own organs to be removed for transplantation and b) to liberalize contacts between donor families and recipients when both side agree. For both changes there is enough evidence of their feasibility-necessity. The answers related to contacts between donor families and recipients support the decision of the National Committee for Bioethics on September 27, 2018. Professor Casavola also suggests that contacts should organized and supervised by the ethical committees of the hospitals where the transplantation procedure is accomplished.
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Affiliation(s)
- Natale G De Santo
- Professore Emerito, Università della Campania Luigi Vanvitelli, Responsabile di Sopravvivere Non Basta
| | - Franco Citterio
- Unità di Trapianto Renale, Clinica Chirurgica, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Roma
| | | | | | - Giusy De Rosa
- Comitato Scientifico di Sopravvivere Non Basta, Istituto Comprensivo Ruggiero, Caserta
| | - Biagio Di Iorio
- Unità Complessa di Nefrologia AORN Ospedale Cardarelli, Napoli
| | - Giovambattista Capasso
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania Luigi Vanvitelli, Napoli
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Marzocco S, Fazeli G, Di Micco L, Autore G, Adesso S, Dal Piaz F, Heidland A, Di Iorio B. Supplementation of Short-Chain Fatty Acid, Sodium Propionate, in Patients on Maintenance Hemodialysis: Beneficial Effects on Inflammatory Parameters and Gut-Derived Uremic Toxins, A Pilot Study (PLAN Study). J Clin Med 2018; 7:jcm7100315. [PMID: 30274359 PMCID: PMC6210519 DOI: 10.3390/jcm7100315] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In end-stage renal disease (ESRD), gut-derived uremic toxins play a crucial role in the systemic inflammation and oxidative stress promoting the excess morbidity and mortality. The biochemical derangement is in part a consequence of an insufficient generation of short-chain fatty acids (SCFA) due to the dysbiosis of the gut and an insufficient consumption of the fermentable complex carbohydrates. AIM OF THE STUDY The primary end-point was to evaluate the potential efficacy of SCFA (specifically, sodium propionate (SP)) for patients on maintenance hemodialysis (MHD) on systemic inflammation. Secondary end-points included potential attenuation of oxidative stress markers, insulin resistance and production of gut-derived uremic toxins indoxyl sulfate and p-cresol sulfate, as well as health status after SP supplementation. STUDY DESIGN We performed a single-center non-randomized pilot study in 20 MHD patients. They received the food additive SP with a daily intake of 2 × 500 mg in the form of capsules for 12 weeks. Pre-dialysis blood samples were taken at the beginning, after six weeks and at the end of the administration period, as well as four weeks after withdrawal of the treatment. RESULTS The subjects revealed a significant decline of inflammatory parameters C-reactive protein (-46%), interleukin IL-2 (-27%) and IL-17 (-15%). The inflammatory parameters IL-6 and IFN-gamma showed a mild non-significant reduction and the anti-inflammatory cytokine IL-10 increased significantly (+71%). While the concentration of bacterial endotoxins and TNF-α remained unchanged, the gut-derived uremic toxins, indoxyl sulfate (-30%) and p-cresyl sulfate (-50%), revealed a significant decline. The SP supplementation reduced the parameters of oxidative stress malondialdehyde (-32%) and glutathione peroxidase activity (-28%). The serum insulin levels dropped by 30% and the HOMA-index by 32%. The reduction of inflammatory parameters was associated with a lowering of ferritin and a significant increase in transferrin saturation (TSAT). Four weeks after the end of the treatment phase, all improved parameters deteriorated again. Evaluation of the psycho-physical performance with the short form 36 (SF-36) questionnaire showed an enhancement in the self-reported physical functioning, general health, vitality and mental health. The SP supplementation was well tolerated and without important side effects. No patient had left the study due to intolerance to the medication. The SP supplementation in MHD patients reduced pro-inflammatory parameters and oxidative stress and improved insulin resistance and iron metabolism. Furthermore, SP effectively lowered the important gut-derived uremic toxins indoxyl and p-cresol sulfate. These improvements were associated with a better quality of life. Further controlled studies are required in a larger cohort to evaluate the clinical outcome.
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Affiliation(s)
- Stefania Marzocco
- Department of Pharmacy, University of Salerno, 84084 Fisciano (SA), Italy.
| | - Gholamreza Fazeli
- Rudolf Virchow Center, University of Wuerzburg, 97080 Wuerzburg, Germany.
| | - Lucia Di Micco
- UOC Nephrology, A. Landolfi Hospital, 83029 Solofra (AV), Italy.
| | - Giuseppina Autore
- Department of Pharmacy, University of Salerno, 84084 Fisciano (SA), Italy.
| | - Simona Adesso
- Department of Pharmacy, University of Salerno, 84084 Fisciano (SA), Italy.
| | - Fabrizio Dal Piaz
- Department of Medicine and Surgery, University of Salerno, 84084 Fisciano (SA), Italy.
| | - August Heidland
- Department of Internal Medicine and KfH Kidney Center, University of Würzburg, KfH Kidney Center Würzburg, 97080 Würzburg, Germany.
| | - Biagio Di Iorio
- UOC Nephrology, A. Landolfi Hospital, 83029 Solofra (AV), Italy.
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Mangano M, Mangano S, Campana C, Ratti C, Di Iorio B, Di Lullo L, Cozzolino M, Bellasi A. FP598SECONDARY HYPERPARATHYROIDISM AND ANEMIA CORRECTION IN ESRD: DATA FROM THE OPTIMAL ESRD TREATMENT RCT. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michela Mangano
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Carlo Ratti
- Cardiology, Ospedale Ciìvile Ramazzini, Carpi, Italy
| | | | - Luca Di Lullo
- Nephrology and Dialysis, Ospedale Parodi Delfino, Colleferro, Italy
| | - Mario Cozzolino
- Department of Health Sciences, University of Milan, Milan, Italy
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Di Lullo L, Ronco C, De Pascalis A, Granata A, Cozzolino M, Russo D, Di Iorio B, Barbera V, Bellasi A. FP305RIVAROXABAN VS WARFARIN AS ORAL ANTICOAGULATION THERAPY IN CKD PATIENTS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luca Di Lullo
- Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro (Roma), Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation - S. Bortolo Hospital, International Renal Research Institute, Vicenza, Italy
| | | | - Antonio Granata
- Department of Nephrology and Dialysis, S. Giovanni Battista Hospital, Agrigento, Italy
| | - Mario Cozzolino
- Department of Health Sciences, S.Paolo Hospital, Milano, Italy
| | - Domenico Russo
- University Federico II, Nephrology Clinic, Naples, Italy
| | - Biagio Di Iorio
- Department of Nephrology and Dialysis, Landolfi Hospital, Solofra, Italy
| | - Vincenzo Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Italy
| | - Antonio Bellasi
- Department of Nephrology and Dialysis, ASST Lariana, S. Anna Hospital, Como, Italy
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11
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De Simone E, Di Micco L, La Manna G, Di Iorio B. [Protein carbamylation: what it is and why it concerns nephrologists]. G Ital Nefrol 2018; 35:2018-vol3-6. [PMID: 29786184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Spontaneous urea dissociation in water solution is a prominent source of protein carbamylation in our body. Protein carbamylation is a well-known phenomenon since early seventies. Some years ago, much interest in the diagnostic power of carbamylated protein arouse. Recently the target of the researches focused on its potential cardiovascular pathogenicity. Some authors claimed that this could be a reason for higher cardiovascular mortality in uremic patients. Nutritional therapy, amino acids supplementation and intensive dialysis regimen are some of the therapeutic tools tested to lower the carbamylation burst in this population.
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Affiliation(s)
| | | | - Gaetano La Manna
- Cattedra di Nefrologia, Università Alma Mater Studiorum - Policlinico Sant'Orsola Bologna, Italia
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12
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Di Iorio B, Di Micco L, Bruzzese D, Nardone L, Russo L, Formisano P, D'Esposito V, Russo D. Ultrapure dialysis water obtained with additional ultrafilter may reduce inflammation in patients on hemodialysis. J Nephrol 2017; 30:795-801. [PMID: 28840494 PMCID: PMC5698401 DOI: 10.1007/s40620-017-0422-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/11/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients on standard dialysis, in particular those on high-flux and high-efficiency dialysis, are exposed to hundreds of liters of dialysis-water per week. The quality of dialysis-water is a factor responsible for inflammation in dialysis patients. Inflammation is a potent trigger of atherosclerosis and a pathogenetic factor in anemia, increasing mortality and morbidity in dialysis patients. Current systems for water treatment do not completely eliminate bacteria and endotoxins. This prospective study tested whether improved dialysis-water purity by an additional ultrafilter can reduce inflammation and ameliorate hemoglobin levels, with a consequent reduction in erythropoietin-stimulating agents (ESA). METHODS An ultrafilter, composed of two serially positioned devices with polysulfone membranes of 2.0 and 1.0 m2, respectively, was positioned within the fluid pathway before the dialysis machine. Prevalent dialysis patients were assigned either to continue dialysis with conventional dialysis-water (control phase) or to initiate dialysis sessions with improved dialysis-water purity (study phase). After 6 months, patients were crossed over. Total study duration was 1 year. Routine chemistry, bacterial count, endotoxin levels in dialysis-water as well as blood levels of pro- and anti-inflammatory cytokines, human serum amyloid A, C-reactive protein and fraction 5 of complement were measured. RESULTS Thirty-two patients completed the study. Mean bacterial count was lower and endotoxin levels were absent in dialysis-water obtained with the ultrafilter. At the end of the study-phase, C-reactive protein and pro-inflammatory cytokines decreased while anti-inflammatory ones increased. Hemoglobin levels were improved with lower ESA doses. CONCLUSIONS An additional ultrafilter improved dialysis-water purity, reduced levels of inflammation markers, ameliorated hemoglobin concentration with reduced ESA doses. These results remain speculative but they may generate studies to assess whether improved dialysis-water quality with an ultrafilter can reduce inflammation and improve survival of dialysis patients.
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Affiliation(s)
- Biagio Di Iorio
- Department of Nephrology, "A. Landolfi" Hospital (Solofra, Avellino), Solofra, Italy
| | - Lucia Di Micco
- Department of Nephrology, "A. Landolfi" Hospital (Solofra, Avellino), Solofra, Italy
| | - Dario Bruzzese
- Department of Statistics, University of Naples "FEDERICO II", Naples, Italy
| | - Luca Nardone
- Department of Nephrology, "A. Landolfi" Hospital (Solofra, Avellino), Solofra, Italy
| | - Luigi Russo
- Department of Public Health, University of Naples "FEDERICO II", Naples, Italy
| | - Pietro Formisano
- Department of Genetics, University of Naples "FEDERICO II", Naples, Italy
| | | | - Domenico Russo
- Department of Public Health, University of Naples "FEDERICO II", Naples, Italy.
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Di Lullo L, Mangano M, Ronco C, Barbera V, De Pascalis A, Bellasi A, Russo D, Di Iorio B, Cozzolino M. The treatment of type 2 diabetes mellitus in patients with chronic kidney disease: What to expect from new oral hypoglycemic agents. Diabetes Metab Syndr 2017; 11 Suppl 1:S295-S305. [PMID: 28292575 DOI: 10.1016/j.dsx.2017.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/03/2017] [Indexed: 02/06/2023]
Abstract
Worldwide, an estimated 200 million people have chronic kidney disease (CKD), whose most common causes include hypertension, arteriosclerosis, and diabetes. About 40% of patients with diabetes develop CKD and intensive blood glucose control through pharmacological intervention can delay CKD progression. Standard therapies for the treatment of type 2 diabetes mellitus include metformin, sulfonylureas, meglitinides, thiazolidinediones, and insulin. While these drugs have an important role in the management of type 2 diabetes, only the thiazolidinedione pioglitazone can be used across the spectrum of CKD (stages 2-5) and without dose adjustment. Newer therapies, particularly dipeptidyl peptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors, are increasingly being used in the treatment of type 2 diabetes; however, a major consideration is whether these newer therapies can also be used safely and effectively across the spectrum of renal impairment.
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Affiliation(s)
- Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Italy.
| | - Michela Mangano
- Department of Health Sciences, S. Paolo Hospital, University of Milan, Italy
| | - Claudio Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
| | - Vincenzo Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Italy
| | | | - Antonio Bellasi
- Department of Nephrology and Dialysis, ASST Lariana, S. Anna Hospital, Como, Italy
| | - Domenico Russo
- Clinical Nephrology, University Federico II°, Naples, Italy
| | - Biagio Di Iorio
- Department of Nephrology and Dialysis, Landolfi Hospital, Solofra, Italy
| | - Mario Cozzolino
- Department of Health Sciences, S. Paolo Hospital, University of Milan, Italy
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De Santo N, de Pascale C, Di Iorio B. MP868CARMELO GIORDANO (1930-2016): A FOUNDER OF A SCHOOL OF RENAL NUTRITIONIST. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx112.mp868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Di Lullo L, Bellasi A, De Pascalis A, Barbera V, Cozzolino M, Russo D, Di Iorio B, Ronco C. SP034INCIDENTAL FABRY DISEASE DIAGNOSIS IN NEPHROLOGY UNIT. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx138.sp034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Iorio B. [Liquid society and ethical relativism]. G Ital Nefrol 2017; 34:4-7. [PMID: 28682559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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De Santo N, De Pascale C, Quarto E, Phillips ME, Di Iorio B. Carmelo Giordano (1930-2016): a giant in Nephrology. G Ital Nefrol 2017; 34:165-187. [PMID: 28682572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Carmelo Giordano (Carmine, Louis, Joseph Giordano) was born in Naples on August 23, 1930 in the house of Rafael and Anna Tirone He received the MD cum laude in 1954. He was Fellow and assistant to Professor Flaviano Magrassi and studied nephrology at the Peter Bent Brigham Hospital, University of Harvard in Boston, under the guidance of John P. Merrill (1958-1960). He was nominated Professor of Nephrology at the University Federico II, Naples in 1975 and Professor of Medicine at the Second University of Naples (1986-2002). The National Institutes of Health of the United States in Bethesda financed his research for more than 20 years. He started low protein alimentation (Giordano-Giovannetti diet according to Geoffrey M. Berlyne) with or without addition of amino acids and ketoacids and devised formula diets for CKD infants and children. He demonstrated that 85% of CKD patients receiving a 25 g protein diet were in positive nitrogen balance. Later he introduced the concept of energy load from dialysate in CAPD and the assessment of amino acid losses during hemodialysis and peritoneal dialysis. He also researched the minimum protein requirement under CAPD regimens. He synthesized, with Professor Renato Esposito, oxystarch and oycellulose and introduced the use of carbon at low temperature and its regeneration at 90°C. He introduced wearable and portable artificial kidneys. He died in Naples on May 12, 2016.
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Affiliation(s)
- Natale De Santo
- Department of Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Carlo De Pascale
- Retired Physician in Chief, Renal Unit Cotugno Hospital, Naples, Italy
| | - Ernesto Quarto
- Retired Professor of Bioengineering, University Federico II, Naples, Italy
| | - Malcolm E Phillips
- Retired Nephrologist and Medical Director of Charing Cross and Hammersmith Hospitals Trust London, UK
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Sirico ML, De Blasio A, De Simone E, Di Micco L, Nardone L, Di Iorio B. [Sudden cardiac death in patient with CKD]. G Ital Nefrol 2017; 34:49-58. [PMID: 28682029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite significant improvements in technology of dialysis delivery, cardiovascular disease remains the mayor cause of death in dialysis patients. Individuals with End Stage Renal Disease (ESRD( present an high incidence of coronary artery disease, arrhythmia and sudden cardiac death (SCD). This review summarizes the current available literature regarding the physiopathology, the risk factors and potential interventions to reduce the risk of SCD in dialysis patients, including medical therapy or defibrillators.
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Affiliation(s)
| | | | | | - Lucia Di Micco
- UOC di Nefrologia, PO Landolfi, Solofra, Avellino, Italy
| | - Luca Nardone
- UOC di Nefrologia, PO Landolfi, Solofra, Avellino, Italy
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Bellasi A, Di Micco L, Santoro D, Marzocco S, De Simone E, Cozzolino M, Di Lullo L, Guastaferro P, Di Iorio B. Correction of metabolic acidosis improves insulin resistance in chronic kidney disease. BMC Nephrol 2016; 17:158. [PMID: 27770799 PMCID: PMC5075179 DOI: 10.1186/s12882-016-0372-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/12/2016] [Indexed: 01/12/2023] Open
Abstract
Background Correction of metabolic acidosis (MA) with nutritional therapy or bicarbonate administration is widely used in chronic kidney disease (CKD) patients. However, it is unknown whether these interventions reduce insulin resistance (IR) in diabetic patients with CKD. We sought to evaluate the effect of MA correction on endogenous insulin action in diabetic type 2 (DM2) CKD patients. Methods A total of 145 CKD subjects (83 men e 62 women) with DM2 treated with oral antidiabetic drugs were included in the study and followed up to 1 year. All patients were randomly assigned 1:1 to either open-label (A) oral bicarbonate to achieve serum bicarbonate levels of 24–28 mmol/L (treatment group) or (B) no treatment (control group). The Homeostatic model assessment (HOMA) index was used to evaluate IR at study inception and conclusion. Parametric and non-parametric tests as well as linear regression were used. Results At baseline no differences in demographic and clinical characteristics between the two groups was observed. Average dose of bicarbonate in the treatment group was 0.7 ± 0.2 mmol/kg. Treated patients showed a better metabolic control as confirmed by lower insulin levels (13.4 ± 5.2 vs 19.9 ± 6.3; for treated and control subjects respectively; p < 0.001), Homa-IR (5.9[5.0-7.0] vs 6.3[5.3–8.2]; p = 0.01) and need for oral antidiabetic drugs. The serum bicarbonate and HOMA-IR relationship was non-linear and the largest HOMA-IR reduction was noted for serum bicarbonate levels between 24 and 28 mmol/l. Adjustment for confounders, suggests that serum bicarbonate rather than treatment drives the effect on HOMA-IR. Conclusions Serum bicarbonate is related to IR and the largest HOMA-IR reduction is noted for serum bicarbonate between 24 and 28 mmol/l. Treatment with bicarbonate influences IR. However, changes in serum bicarbonate explains the effect of treatment on HOMA index. Future efforts are required to validate these results in diabetic and non-diabetic CKD patients. Trial registration The trial was registered at www.clinicaltrial.gov (Use of Bicarbonate in Chronic Renal Insufficiency (UBI) study - NCT01640119)
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Affiliation(s)
- Antonio Bellasi
- Department of Nephrology and Dialysis, ASST-Lariana, Ospedale Sant' Anna, Como, (CO), Italy
| | - Lucia Di Micco
- Department of Nephrology and Dialysis, UOC Nefrologia, PO "A Landolfi", Via Melito, snc, I-83029, Solofra, (AV), Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Unit of Nephrology, University of Messina, Messina, Italy
| | - Stefania Marzocco
- Department of Pharmacy, School of Pharmacy, University of Salerno, Fisciano, (SA), Italy
| | - Emanuele De Simone
- Department of Nephrology and Dialysis, UOC Nefrologia, PO "A Landolfi", Via Melito, snc, I-83029, Solofra, (AV), Italy
| | - Mario Cozzolino
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, Ospedale Parodi, Delfino, Colleferro, (Rome), Italy
| | | | - Biagio Di Iorio
- Department of Nephrology and Dialysis, UOC Nefrologia, PO "A Landolfi", Via Melito, snc, I-83029, Solofra, (AV), Italy.
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Cupisti A, D'Alessandro C, Di Iorio B, Bottai A, Zullo C, Giannese D, Barsotti M, Egidi MF. Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach. BMC Nephrol 2016; 17:124. [PMID: 27600818 PMCID: PMC5012117 DOI: 10.1186/s12882-016-0342-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/29/2016] [Indexed: 01/16/2023] Open
Abstract
Background Dietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care. Methods This is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG). In the NTG patients the dietary interventions were assigned in order to prevent or correct abnormalities and to maintain a good nutritional status. They included manipulation of sodium, phosphate, energy and protein dietary intakes while paying special attention to each patient’s dietary habits. Results Phosphate and BUN levels were lower in the NTG than in the CG, especially in stage 4 and 5. The prevalence of hyperphosphatemia was lower in the NTG than in CG in stage 5 (13.3 % vs 53.3 %, p < 001, respectively), in stage 4 (4.1 % vs 18.3 % vs, p < 0.001) and stage 3b (2.8 % vs 9.5 % p < 0.05). Serum albumin was higher in NTG than in CG especially in stage 5 . The use of calcium-free intestinal phosphate binders was significantly lower in NTG than in CG (11 % vs 19 % p < 0.01), as well as that of Erythropoiesis stimulating agents (11 % vs 19 %, p < 0.01), and active Vitamin D preparations (13 % vs 21 %, p < 0.01). Conclusions This case-control study shows the usefulness of a nutritional support in addition to the pharmacological good practice in CKD patients on tertiary care. Lower phosphate and BUN levels are obtained together with maintenance of serum albumin levels. In addition, a lower need of erythropoiesis stimulating agents, phosphate binders and active Vitamin D preparations was detected in NTG. This study suggests that a nutritional support may be useful in the management of the world-wide growing CKD burden.
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Affiliation(s)
- Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Biagio Di Iorio
- U.O.C. di Nefrologia, PO "A. Landolfi", PO di Solofra (AV), Solofra, Italy
| | - Anna Bottai
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Claudia Zullo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Domenico Giannese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Massimiliano Barsotti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Maria Francesca Egidi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
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Bellasi A, Di Lullo L, Melfa G, Minoretti C, Ratti C, Campana C, Volpi M, Mangano S, Di Iorio B, Cozzolino M. [New oral anticoagulants (NOAC) in nephrology]. G Ital Nefrol 2016; 33:gin/00244.12. [PMID: 27545637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The new or direct oral anticoagulants [new oral anticoagulants (NOAC) or direct oral anticoagulants (DOAC)] were launched in the Italian market in 2013. Although these compounds share common pharmacological indications with vitamin K antagonists (warfarin or acenocumarol), they have different mechanisms of action, do not require a constant anticoagulant monitoring but are more efficacious and safer than vitamin K antagonists. The use of these molecules (Dabigatran, Apixaban, Rivaroxaban, Betrixaban, Edoxaban) is constantly rising in daily practice. However, while available data suggest that NOAC/DOAC use is safe, dosage should be adjusted based on renal or liver function. It should be acknowledged that commonly available blood tests [Prothrombin Time (PT) and partial thromboplastin time (PTT)] are not indicated to monitor the anticoagulant activity of these compounds. With the exception of dabigatran, we currently lack of an antidote to reverse the anticoagulant effect of NOAC/DOAC. We herein review available evidence on NOAC/DOAC pharmacokinetic, risk factors for bleeding, interventions to reverse the anticoagulant activity in case of hemorrhages or need of urgent surgery and/or NOAC/DOAC overdose or side effects.
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Basile C, Vigo V, Di Micco L, Libutti P, Lisi P, Vernaglione L, Donadio C, Di Iorio B, Rossi L, Lomonte C. MP478DRY WEIGHT AND BIOIMPEDANCE: NEW SOLUTIONS TO OLD PROBLEMS - THE RESISTANCE STABILIZATION TEST. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw194.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Di Iorio B, Rollino C. [Not Available]. G Ital Nefrol 2015; 32:gin/32.6.14. [PMID: 27265906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Di Micco L, Marzocco S, Adesso S, De Blasio A, Autore G, Sirico ML, Di Iorio B. Muscle stimulation in elderly patients with CKD and sarcopenia. G Ital Nefrol 2015; 32:gin/00220.13. [PMID: 26480263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Aim of our study was to assess the potential effects of high-tone external muscle stimulation (HTEMS) on improvement of endothelial dysfunction (ED) and kidney damage in elderly patients with chronic kidney disease (CKD), sarcopenia and/or serious physical disability with a high Multidisciplinary Prognostic Index (MPI). METHODS We enrolled 12 consecutive CKD patients with MPI > 0,66 from January 1st, 2008 to December 31st, 2014. Six patients underwent a 2-hours HTEMS during the first day (group A) and the other six patients (group B) underwent a sham experiment with HTEMS without power supply. After 24 hours, patients of group A were shifted to group B and vice-versa. Nitrite/nitrate (NOx), endotheline-1 (ET-1) and urine creatinine concentration were measured in all patients. RESULTS During HTEMS urine amount increased by 22% (p=0.049), so did urine creatinine that increased by 40%, (p=0.034) and creatinine clearance that increased by 26% (p=0.041). There was no statistical difference in urine nitrogen (that raised by 11%, p=0.526), urine sodium (that reduced by 42%, p=0.121) and urine potassium levels (p=0,491). At the same time, NOx changed from 44.15.1 to 38.45.3 M/L after 1 hour, to 36.44.8 M/L after 2 hours, to 41.15.7 M/L after 3 hours and to 46,95.0 M/L after 4 hours (p=0.008) during HTEMS, while it did not vary during the sham section of the experiment, respectively 43.66.1 M/L , 436.4 M/L, 42.85.5 M/L, 434.7 M/L, and 42.85.8 M/L (p=0.992). CONCLUSION Our study showed that HTEMS may improve microcirculation and, through this mechanism, may reduce kidney damage in elderly patients with CKD and severe muscle atrophy.
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Rombolà G, Quintaliani G, Di Iorio B. [Patients, nephrology and Balduzzi decree]. G Ital Nefrol 2015; 32:gin/00208.26. [PMID: 26093143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Battaglia Y, Forcellini S, Cojocaru E, Fiorini F, Granata A, Morrone L, Di Iorio B, Russo L, Storari A, Russo D. FP097ANTHROPOMETRIC INDICATORS AND HYPERTENSION IN ITALIAN YOUNG ADULTS FROM THE WORD KIDNEY DAYS 2010 - 2011. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv169.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nazha M, D’Alessandro C, Ferraresi M, Capizzi I, Marxia S, Loi V, Vigotti FN, Cabiddu G, Di Iorio B, Piccoli G, Cupisti A. SP369DIETARY SATISFACTION IN CKD PATIENTS ON LOW PROTEIN DIETS FOR AT LEAST 6 MONTHS: A MULTICENTRIC STUDY (THE TOPI STUDY). Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv192.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Santo NG, Bisaccia C, Anastasio P, Ricciardi B, Di Iorio B, Aliotta G, Ongaro G. SuO012NEPHROLOGY IN DE MEDICINA METHODICA LIBRI TREDECIM (1611) OF PROSPERO ALPINI READER AND OSTENSOR IN SIMPLEX AND PREFECT OF THE BOTANICAL GARDEN AT THE UNIVERSITY OF PADUA IN THE YEAS 1593-1616. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv157.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bellizzi V, Signoriello S, Minutolo R, Di Iorio B, Nazzaro P, Conte G, Chiodini P, De Nicola L. SP292EFFECT OF VERY LOW-PROTEIN DIET VERSUS STANDARD LOW-PROTEIN DIET ON RENAL DEATH IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A PRAGMATIC, RANDOMIZED, CONTROLLED, MULTICENTER TRIAL. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv191.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bellasi A, Cozzolino M, Russo D, Molony DA, Di Iorio B. SP635CINACALCET BUT NOT VITAMIN D USE MODULATES THE SURVIVAL BENEFIT ASSOCIATED WITH SEVELAMER IN THE INDEPENDENT STUDY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv199.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Battaglia Y, Fiorini S, Cojocaru E, Fiorini F, Granata A, Morrone L, Di Iorio B, Russo L, Storari A, Russo D. SP281ASSOCIATION BETWEEN URINARY ABNORMALITIES AND ANTHROPOMETRIC INDICATORS IN ITALIAN YOUNG PEOPLE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv191.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bellasi A, Cozzolino M, Russo D, Molony DA, Di Iorio B. SP575PREDICTIVE VALUE OF MEASURES OF VASCULAR CALCIFICATION FOR RISK OF DEATH IN INCIDENT DIALYSIS PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv197.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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D'Avanzo E, Musto LA, Di Iorio B. [Mystery diagnosis: "the Rolling Stones' syndrome"]. G Ital Nefrol 2014; 31:gin/00196.14. [PMID: 25315731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present an unusual case of a young patient regularly followed in our Chronic Renal Insufficiency ambulatory with the periodicity of 2-3 visits per year--with stabilization of his residual renal function. The patient came to the emergency department declaring abdominal pain but make a diagnosis turned out to be more complicated than we expected.
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Ruggeri M, Cipriani F, Bellasi A, Russo D, Di Iorio B. Sevelamer is cost-saving vs. calcium carbonate in non-dialysis-dependent CKD patients in italy: a patient-level cost-effectiveness analysis of the INDEPENDENT study. Blood Purif 2014; 37:316-24. [PMID: 25171148 DOI: 10.1159/000365746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/06/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To conduct a cost-effectiveness analysis of sevelamer versus calcium carbonate in patients with non-dialysis-dependent CKD (NDD-CKD) from the Italian NHS perspective using patient-level data from the INDEPENDENT-CKD study. METHODS Patient-level data on all-cause mortality, dialysis inception and phosphate binder dose were obtained for all 107 sevelamer and 105 calcium carbonate patients from the INDEPENDENT-CKD study. Hospitalization and frequency of dialysis data were collected post hoc for all patients via a retrospective chart review. Phosphate binder, hospitalization, and dialysis costs were expressed in 2012 euros using hospital pharmacy, Italian diagnosis-related group and ambulatory tariffs, respectively. Total life years (LYs) and costs per treatment group were calculated for the 3-year period of the study. Bootstrapping was used to estimate confidence intervals around outcomes, costs, and cost-effectiveness and to calculate the cost-effectiveness acceptability curve. A subgroup analysis of patients who did not initiate dialysis during the INDEPENDENT-CKD study was also conducted. RESULTS Sevelamer was associated with 0.06 additional LYs (95% CI -0.04 to 0.16) and cost savings of EUR -5,615 (95% CI -10,066 to -1,164) per patient compared with calcium carbonate. On the basis of the bootstrap analysis, sevelamer was dominant compared to calcium carbonate in 87.1% of 10,000 bootstrap replicates. Similar results were observed in the subgroup analysis. RESULTS were driven by a significant reduction in all-cause mortality and significantly fewer hospitalizations in the sevelamer group, which offset the higher acquisition cost for sevelamer. CONCLUSIONS Sevelamer provides more LYs and is less costly than calcium carbonate in patients with NDD-CKD in Italy.
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Affiliation(s)
- Matteo Ruggeri
- Faculty of Economics, Università Cattolica del Sacro Cuore, Rome, Italy
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Basile C, Lomonte C, Lisi P, Karohl C, Di Iorio B, Bellasi A. Physical activity in chronic kidney disease: a plausible approach to vascular calcification? Kidney Blood Press Res 2014; 39:154-63. [PMID: 25117909 DOI: 10.1159/000355791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
Vascular calcification (VC) is a prominent feature that affects up to 40 to 80% of Chronic Kidney Disease (CKD) patients depending on the degree of renal impairment. Though etiology and pathogenesis of the different types of VC are far from being elucidated, it is conceivable that an imbalance between promoters and inhibitors represents the condition that triggers VC deposition and progression. In addition to traditional cardiovascular risk factors, several lines of evidence suggest that specific factors may affect the arterial system and prognosis in CKD. Over the last decade, a few pharmacological strategies aimed at controlling different selected risk factors for VC have been investigated yielding conflicting results. In light of the complicated interplay between inhibitors and promoters as well as the fact that VC represents the result of cumulative and prolonged exposure to multiple risk factors, a more comprehensive risk modification approach such as lifestyle modification or physical activity (PA) may represent a valid strategy to attenuate VC deposition and progression.We herein aim at reviewing the rationale and current evidence on the potential for lifestyle modification with a specific focus on PA as a cost-effective strategy for VC treatment.
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Affiliation(s)
- Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti (BA), Italy
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Russo D, Morrone L, Di Iorio B, Andreucci M, De Gregorio MG, Errichiello C, Russo L, Locatelli F. Parathyroid hormone may be an early predictor of low serum hemoglobin concentration in patients with not advanced stages of chronic kidney disease. J Nephrol 2014; 28:701-8. [PMID: 25113067 PMCID: PMC4605967 DOI: 10.1007/s40620-014-0129-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/05/2014] [Indexed: 11/24/2022]
Abstract
Background Parathyroid hormone (PTH) has been associated with anemia only in dialysis patients with severe hyperparathyroidism. Whether an association between PTH and hemoglobin also exists in patients with chronic kidney disease not on dialysis (CKD-patients) is still unclear. In this study we evaluated the association between PTH and hemoglobin in CKD-patients without severe secondary hyperparathyroidism. Methods Hospitalized patients and outpatients (N = 979) were retrospectively evaluated and categorized according to PTH quartile and serum hemoglobin (<12.0, <11.0, <10.0 g/dl). Gender, diabetes, glomerular filtration rate (GFR), hemoglobin, PTH, markers of mineral metabolism, inflammation, iron status and nutrition were variables of adjustment in univariate and multivariate analysis. Results An inverse association (p = 0.001) was observed between PTH and hemoglobin in patients as a whole, in diabetics, and in patients with GFR ≤60 ml/min. PTH was the single predictor of low hemoglobin in patients as a whole (unstandardized beta −2.12; p = 0.005), in diabetics (unstandardized beta −8.86; p = 0.007) and in patients with GFR ≤60 ml/min (unstandardized beta −2.52; p = 0.006). For each increase of quartile of PTH the risk of having hemoglobin level <10.0 mg/dl was more than doubled [hazard ratio (HR) 2.79, 95 % confidence interval (CI) 2.00–3.88; p = 0.001]. The receiver operating characteristic curve showed that PTH ≥122 pg/ml had 67 % sensitivity and 75 % specificity in predicting hemoglobin level <10.0 g/dl with area under the curve of 0.758 (95 % CI 0.73–0.78). Conclusions This study shows a significant inverse association between PTH and hemoglobin levels across the whole spectrum of non-dialysis CKD and a doubled risk of having serum hemoglobin <10.0 mg/dl in the absence of severely deranged PTH concentration. These findings may have clinical relevance in ascertaining the cause of unexplained low hemoglobin levels in CKD-patients.
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Affiliation(s)
- Domenico Russo
- Department of Nephrology, University of Naples "FEDERICO II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Luigi Morrone
- Department of Nephrology, "G. RUMMO" Hospital, Benevento, Italy.
| | - Biagio Di Iorio
- Department of Nephrology, "A. LANDOLFI" Hospital, Solofra, Avellino, Italy
| | - Michele Andreucci
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Maria Grazia De Gregorio
- Department of Nephrology, University of Naples "FEDERICO II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Carmela Errichiello
- Department of Nephrology, University of Naples "FEDERICO II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Luigi Russo
- Department of Nephrology, University of Naples "FEDERICO II", Via S. Pansini, 5, 80131, Naples, Italy
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Bellizzi V, Chiodini P, Cupisti A, Viola BF, Pezzotta M, De Nicola L, Minutolo R, Barsotti G, Piccoli GB, Di Iorio B. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrol Dial Transplant 2014; 30:71-7. [PMID: 25082793 DOI: 10.1093/ndt/gfu251] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Very low-protein intake during chronic kidney disease (CKD) improves metabolic disorders and may delay dialysis start without compromising nutritional status, but concerns have been raised on a possible negative effect on survival during dialysis. This study aimed at evaluating whether a very low-protein diet during CKD is associated with a greater risk of death while on dialysis treatment. METHODS This is an historical, cohort, controlled study, enrolling patients at dialysis start previously treated in a tertiary nephrology clinic with a very low-protein diet supplemented with amino acids and ketoacids (s-VLPD group, n = 184) or without s-VLPD [tertiary nephrology care (TNC) group, n = 334] and unselected patients [control (CON) group, n = 9.092]. The major outcome was survival rate during end-stage renal disease associated to s-VLPD treatment during CKD. The propensity score methods and Cox regression model were used to match groups at the start of dialysis to perform survival analysis and estimate adjusted hazard ratio (HR). RESULTS In s-VLPD, TNC and CON groups, average age was 67.5, 66.0 and 66.3 years, respectively (P = 0.521) and male prevalence was 55, 55 and 62%, respectively (P = 0.004). Diabetes prevalence differed in the three groups (P < 0.001), being 18, 17 and 31% in s-VLPD, CON and TNC, respectively. A different prevalence of cardiovascular (CV) disease was found (P < 0.001), being similar in TNC and CON (31 and 25%) and higher in s-VLPD (41%). Median follow-up during renal replacement therapy (RRT) was 36, 32 and 36 months in the three groups. Adjusted HR estimated on matched propensity patients was 0.59 (0.45-0.78) for s-VLPD versus CON. Subgroup analysis showed a lower mortality risk in s-VLPD versus matched-CON in younger patients (<70 years) and those without CV disease. No significant difference in HRs was found between s-VLPD and TNC. CONCLUSION s-VLPD during CKD does not increase mortality in the subsequent RRT period.
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Affiliation(s)
- Vincenzo Bellizzi
- Division of Nephrology, Dialysis and Renal Transplantation, 'San Giovanni di Dio e Ruggi d'Aragona' University Hospital of Salerno, Salerno, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Napoli, Napoli, Italy
| | - Adamasco Cupisti
- Nephrology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Mauro Pezzotta
- Nephrology Unit, A.O. Spedali Civili, University of Brescia, Brescia, Italy
| | - Luca De Nicola
- Nephrology Unit, Med School, Second University of Naples, Napoli, Italy
| | - Roberto Minutolo
- Nephrology Unit, Med School, Second University of Naples, Napoli, Italy
| | - Giuliano Barsotti
- Nephrology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Biagio Di Iorio
- Nephrology Unit, Landolfi' Hospital, Solofra, Avellino, Italy
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Ruggeri M, Bellasi A, Cipriani F, Molony D, Bell C, Russo D, Di Iorio B. Sevelamer is cost effective versus calcium carbonate for the first-line treatment of hyperphosphatemia in new patients to hemodialysis: a patient-level economic evaluation of the INDEPENDENT-HD study. J Nephrol 2014; 28:593-602. [DOI: 10.1007/s40620-014-0122-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/09/2014] [Indexed: 01/24/2023]
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Di Micco L, D'Avanzo E, De Blasio A, Sirico ML, Musto LA, Di Iorio B. [The devil teaches us his tricks... and also how to hide them]. G Ital Nefrol 2014; 31:gin/00194.5. [PMID: 25098460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Spontaneous ureteric ruptures is a rare condition [1]and bilateral ureteric rupture is even more uncommon. Few cases are described in the literature in which bilateral ureteric rupture is associated to dermatomyositis [2]or to intra-arterial contrast medium application for infrarenal aortic stent placement [3]. We discuss here a case of bilateral ureteric rupture in a 74-year-old man with bladder cancer, presenting oliguric acute kidney failure and a light abdominal pain.
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Sirico ML, D'Avanzo E, De Blasio A, De Piano G, Lomazzo N, Di Micco L, Musto LA, Di Iorio B. [An unusual case of acute kidney insufficiency]. G Ital Nefrol 2014; 31:gin/00189.11. [PMID: 25030014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Acute aortic dissection (AAD) is a life-threatening condition with high morbidity and mortality, that involves renal arteries in at least 5-10% so leading to renal ischemia and insufficiency. AAD presenting with anuria and the necessity of renal replacement therapy occurs rarely. Here we describe a case of a hypertensive and obese patient presenting with anuria and acute kidney injury, who underwent to hemodialysis and later was diagnosed with aortic dissection. Through this case, we underline the importance of considering AAD as an important differential in patients with a long history of uncontrolled hypertension presenting with anuria.
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Di Iorio B, Cucciniello E, Aucella F, Guastaferro P, di Gianni A, Chiuchiulo L, Tedesco V, Migliorati M, de Simone W, Zito B, d'Avanzo E, Bortone S, Nargi P, Iannaccone FS, Veniero P, Capuano M, Genualdo R, Lorenzo M, Santoro D, Avella F, Morrone L, Martignetti V, Piscopo C, Matarese D, Vigilante D, Aquino A, Martino R, Struzziero G, Frallicciardi A, Tortoriello R. Does Vascular Calcification Correlate with Pulse Wave Velocity in Hemodialysis Patients? ACTA ACUST UNITED AC 2014. [DOI: 10.4081/nr.2009.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vascular calcifications have been previously shown to be an independent predictor of mortality in dialysis patients and a similar association has been shown for arterial stiffness. Nonetheless, the relationship between vascular calcifications and pulse wave velocity (PWV) have so far been little explored. The goal of this study is to verify the correlation among vascular calcifications and rigidity of arterial wall in patients at dialysis start. Accordingly, we investigated the association between aortic PWV and coronary calcification measured by computed tomography (TC-score) in 105 adult incident hemodialysis patients. PWV resulted increased in patients with the higher TC-score values; indeed, at univariate analysis PWV directly correlated with age (p=0.016), presence of diabetes (p<0.0001), serum phosphorus (p=0.0066), C-reactive protein (CRP) (p=0.046), LDL-cholesterol (p=0.043), TC-score (p<0.0001), and inversely correlated with systolic blood pressure (p=0.036). At multivariate analysis, age, diabetes, serum phosphorus, CRP, LDL-cholesterol and vascular calcifications were determinants of arterial stiffening. Using the table “two for two”, we showed 6 false negative patients (high TC-score and low PWV) and 12 false positive patients (low TC-score and high PWV). The sensibility was 76% and the specificity 85%; the accuracy was 83%, the predictor positive value was 61% and the predictor negative value was 92%. Overall, a strong association between TC-score and PWV was seen.
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Guaraldi G, Dolci G, Bellasi A, Di Iorio B. [Inhibition of the renin-angiotensin system in HIV nephropathy]. G Ital Nefrol 2014; 31:gin/00103.14. [PMID: 24671847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It is estimated that 1-2 % of patients starting dialysis suffers from kidney disease associated with HIV infection. HIV-associated nephropathy ( HIVAN ) develops in about 10% of people living with HIV , with different preference for Blacks and Hispanics . Since the beginning of large-scale use of antiretroviral therapy (ART), the HIVAN has been characterized by a rapid decline in renal function , with progression to ESRD ( End - Stage Renal Disease ). Aside from HIV direct damage to the nephron, numerous experimental observations support the argument that the agiotensina II contributes to the podocytes damage. Treatment with ACE - inhibitors (ACE - Is) , as well as the one with angiotensin receptor blockers ( ARBs), may attenuate the decline in renal function in HIVAN . However, clinical data on the effects of these antihypertensive agents in HIV-infected individuals are still scarce and doubts have yet to be adequately addressed. In the following, we analyze the studies that have investigated the use of ACE -Is and ARBs in the treatment of hypertension and albuminuria in patients with HIVAN.
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Di Iorio B. In reply to 'The change history of the INDEPENDENT Study in the ClinicalTrials.gov database'. Am J Kidney Dis 2014; 63:164-5. [PMID: 24377649 DOI: 10.1053/j.ajkd.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 11/11/2022]
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Quintaliani G, Conte F, Di Iorio B. [Change the country so that we don't have to change country]. G Ital Nefrol 2014; 31:gin/31.1.18. [PMID: 24945043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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De Santo NG, Aliotta G, Bisaccia C, Di Iorio B, Cirillo M, Ricciardi B, Savica V, Ongaro G. De Medicina Aegyptiorum by Prospero Alpini (Venice, Franciscus de Franciscis, 1591). J Nephrol 2013; 26:117-123. [PMID: 24375355 DOI: 10.5301/jn.5000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 11/20/2022]
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Di Iorio B, De Santo NG, Anastasio P, Perna A, Pollastro MR, Di Micco L, Cirillo M. The Giordano-Giovannetti diet. J Nephrol 2013; 26:143-152. [PMID: 24375359 DOI: 10.5301/jn.5000367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 11/20/2022]
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Mezzogiorno A, De Santo NG, Bisaccia C, Di Iorio B, Cirillo M, Savica V, Ricciardi B, Menditti D, Richet G. Exupère-Joseph Bertin (1712-1781) and his description of the "petits siphons recourbez" (Henle's loops, a century earlier). J Nephrol 2013; 26:93-98. [PMID: 24375350 DOI: 10.5301/jn.5000374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 11/20/2022]
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De Santo NG, Di Iorio B, Diamandopoulos AA, Bellinghieri G, Rutkowski B. Timeline for a humanistic nephrology. J Nephrol 2013; 26:1-5. [PMID: 24375333 DOI: 10.5301/jn.5000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 06/03/2023]
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Di Iorio B, Di Micco L. [Phosphate control in end stage renal disease: barriers and opportunities. Malnutrition: yes or not?]. G Ital Nefrol 2013; 30:gin/00101.14. [PMID: 24402667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The fear of malnutrition, caused by the low-protein diet, conditions in an inappropriate use of a useful nutrition therapy in Chronic Kidney Disease. Often malnutrition is due to reduced intake of energy, because a low (or very low) protein proper diet with adequate amount of calories (30-35 cal/kg bw/day). We analyze the positive aspects of the low-protein diet for optimal control of hypertension, hyperphosphatemia, anemia, and proteinuria that is the goal of pharmacological management Chronic Kidney Disease patients.
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De Blasio A, Sirico M, Di Micco L, Di Iorio B. [Hemodialysis improves the subendocardial viability ratio]. G Ital Nefrol 2013; 30:gin/00101.11. [PMID: 24402665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The subendocardial viability ratio (SEVR), a parameter introduced by Buckberg, represents a non-invasive measure of myocardial perfusion related to left ventricular work. AIM. The aim of this study was to verify if dialysis may determine modifications of SEVR and how these modifications are modulated in the 2-day interdialytic period. METHODS.We studied 54 subjects of mean age 6314 years and receiving dialysis for 3215 months. Exclusion criteria were diabetes, resistant hypertension and peripheral vascular diseases and intradialytic hypotension evidenced during the study dialysis session. Pulse wave velocity and SEVR assessments were performed during the third dialysis session of the week, before (pre-HD) and after (post-HD) dialysis, in 2-day interdialytic period after and at the beginning of the following dialysis session. RESULTS.Dialysis reduces PWV, in particular the tertile with the lowest PWV presents the highest percentage reduction (-26%) compared with the second and the third tertiles. In the same way, dialysis leads to an increase of SEVR and patients in the tertile with the highest SEVR values maintain high SEVR values during dialysis and in the interdialytic period. Patients with severe vascular calcifications present higher PWV value and lower SEVR value. CONCLUSIONS.The results of present study demonstrate that ultrafiltration improves PWV (with a mean reduction of 16%) and SEVR (increase of 13%) and that the severity of vascular calcifications influences the effect of ultrafiltration on these two parameters. More studies are certainly necessary to verify our findings. Considered the higher mortality of patients with higher SEVR, it would be important to understand if new dialytic strategies are needed in patients with higher PVW and lower SEVR values.
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