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Christie E, Vezza C, Pandravada A. 383. Unscheduled bleeding on hormone replacement therapy: is it a cause for concern? Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.164] [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: 11/26/2022]
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Vettoretti S, Caldiroli L, Porata G, Vezza C, Cesari M, Messa P. Frailty phenotype and multi-domain impairments in older patients with chronic kidney disease. BMC Geriatr 2020; 20:371. [PMID: 32993531 PMCID: PMC7523369 DOI: 10.1186/s12877-020-01757-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 09/08/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Older subjects with chronic kidney disease (CKD) are often affected by multiple geriatric impairments that may benefit from a comprehensive geriatric assessment (CGA). However, ordinary execution of CGA in all these individuals would be unaffordable. We evaluated if Frailty Phenotype (FP) could identify older CKD-patients that may benefit the most from a CGA. METHODS We evaluated 112 CKD patients not yet on dialysis (age ≥ 65 years, eGFR < 45 ml/min). FP was defined according to the criteria proposed by Fried and co-authors. CGA evaluated four domains (nutrition, physical performance, cognition and depression). Malnutrition was defined in accordance to Malnutrition-Inflammation Score (MIS) and/or by the presence of Protein Energy Wasting syndrome (PEW). Physical performance was evaluated using Short Physical Performance Battery (SPPB) and handgrip strength. Cognitive status was assessed by using Mini Mental State Examination (MMSE) and Clock Drawing Test. Mood was investigated with Geriatric Depression Scale (GDS). RESULTS Average age of our cohort was 80 ± 6 years and mean eGFR 24 ± 11 ml/min/1.73 m2. Prevalence of frailty was 45%. Frail patients (F-CKD) had higher prevalence of malnutrition (58 vs 29%, p = 0.0005), physical impairment (100% vs 78%; p < 0.0001), cognitive dysfunction (83% vs 37%; p < 0.0001) and depression (50% vs 21%; p < 0.001) compared to robust ones (NF-CKD). Moreover, F-CKD patients had higher probability to have > 2 impaired domains (83% sensitivity and 76% specificity) respect to NF-CKD individuals. CONCLUSIONS FP is a reliable screening tool to identify older CKD-patients that may benefit from a CGA.
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Affiliation(s)
- Simone Vettoretti
- Unit of Nephrology, Dialysis and Kidney Transplantation Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 15, 20122, Milan, Italy.
| | - Lara Caldiroli
- Unit of Nephrology, Dialysis and Kidney Transplantation Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 15, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giulia Porata
- Unit of Nephrology, Dialysis and Kidney Transplantation Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 15, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlotta Vezza
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Unit of Geriatrics Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Piergiorgio Messa
- Unit of Nephrology, Dialysis and Kidney Transplantation Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 15, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Schiara LAM, Moirano G, Grosso E, Richiardi L, Tibaldi M, Spertino E, Vezza C, Isaia GC, Massaia M, D'Amelio P. Hyponatremia, Hypokalemia, and Fragility Fractures in Old Patients: More than an Association? Calcif Tissue Int 2020; 106:599-607. [PMID: 32076748 DOI: 10.1007/s00223-020-00675-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/25/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Hyponatremia and hypokalemia are common among elderly and have been associated with osteoporosis, we evaluate the role of these electrolytes as risk for fragility fractures. METHODS This study is divided in two parts: one retrospective and one prospective. We retrospectively collected data on urgently admitted patients for femoral fragility fractures (Fx) or for acute myocardial infarction (AMI), and patients admitted for elective hip/knee replacement surgery for osteoarthrosis (OA). Age, sex, serum sodium, potassium, creatinine, and comorbidities were recorded. We enrolled prospectively in-patients from our unit: age, sex, comorbidities, drugs, and fragility fractures were recorded. Blood electrolytes were measured. Cognitive function, nutrition, muscular strength, and balance were evaluated by standard tests. The mortality rate was recorded with a follow-up after hospital discharge. RESULTS The retrospective study included 2166 subjects: 702 Fx and 1464 controls (907 AMI, 557 OA): the prevalence of hyponatremia was similar in Fx and AMI, whereas it was higher in Fx with respect to OA (p < 0.001) as well as hypokalemia (p < 0.001). Sodium decrease was associated with higher fracture risk. Among the 284 subjects included in the prospective study, 50 patients were hyponatremic, more likely malnourished, and presented a higher prevalence of fragility fractures (p = 0.008). They had a higher mortality after hospital discharge (HR = 1.80, p = 0.005), however, this association disappears after correction for confounding variables. CONCLUSIONS We suggest that hyponatremia and hypokalemia have to be considered as a marker of poor health more than an independent fracture risk.
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Affiliation(s)
- Laura Anna Maria Schiara
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit-CERMS, Department of Medical Science, University of Torino and CPO-Piemonte, Via Santena 7, 10126, Torino, Italy
| | - Elena Grosso
- Department of Orthopedics, Traumatology, City of Health and Science Hospitals, Via Zuretti 29, 10126, Torino, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit-CERMS, Department of Medical Science, University of Torino and CPO-Piemonte, Via Santena 7, 10126, Torino, Italy
| | - Michela Tibaldi
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Elena Spertino
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Carlotta Vezza
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Giovanni Carlo Isaia
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Massimiliano Massaia
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - Patrizia D'Amelio
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy.
- Centre Hospitalier Universitaire Vaudoise (CHUV) Service de Gériatrie, Mont Paisible 16 CH, 1011, Lausanne, Switzerland.
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Guenzani D, Buoli M, Caldiroli L, Carnevali GS, Serati M, Vezza C, Armelloni S, Messa P, Vettoretti S. Malnutrition and inflammation are associated with severity of depressive and cognitive symptoms of old patients affected by chronic kidney disease. J Psychosom Res 2019; 124:109783. [PMID: 31443824 DOI: 10.1016/j.jpsychores.2019.109783] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Chronic kidney disease (CKD) is a disabling condition associated with different medical comorbidities including depression and cognitive impairment. We investigated the association between malnutrition, inflammation and depressive/cognitive symptoms in elderly subjects with advanced CKD. METHODS We evaluated cross-sectionally 132 elderly subjects (age ≥65 years) with advanced CKD (stage 4-5, non-dialytic-ND) in regular follow up at the outpatient clinic of nephrology. Blood and urinary samples were collected after an overnight fast. All patients were evaluated by Geriatric Depression Scale (GDS)-30 items for severity of depressive symptoms, Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) for cognition. Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Different linear regression models were performed to study the association between clinical variables, diet and inflammatory parameters with the above mentioned rating scale scores. A final linear regression model with only previous statistically significant variables was performed for GDS scores. RESULTS Our cohort consisted of 95 males and 37 females with a mean age of 78 ± 7. Female gender (B = 3.20, p < .01), higher MIS (B = 0.29, p = .02) and higher IL-12p70 serum levels (pg/mL) (B = 0.37, p = .03) were associated with severity of depressive symptoms. MIS was associated with the severity of cognitive impairment as assessed by MMSE (B = -0.19, p < .01) and CDT (B = 0.10, p = .03). CONCLUSION In elderly subjects affected by CKD the severity of depressive symptoms and cognitive impairment is associated with specific inflammatory and nutritional parameters. These results have to be considered as preliminary and need replication by further studies.
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Affiliation(s)
- Dalila Guenzani
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Massimiliano Buoli
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; University of Milan, Milan, Italy.
| | - Lara Caldiroli
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Greta Silvia Carnevali
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Marta Serati
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Carlotta Vezza
- University of Milan, Milan, Italy; Unit of Gerontology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Armelloni
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Piergiorgio Messa
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Simone Vettoretti
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Vettoretti S, Caldiroli L, Vezza C, Cesari M, Messa P. SP425FRAILTY INDEX PREDICTS THE PROGNOSIS OF ELDERLY PEOPLE WITH ADVANCED CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- Simone Vettoretti
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico - Clinica Mangiagalli, Milano, Italy
| | - Lara Caldiroli
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico - Clinica Mangiagalli, Milano, Italy
| | - Carlotta Vezza
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico - Clinica Mangiagalli, Milano, Italy
| | - Matteo Cesari
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico - Clinica Mangiagalli, Milano, Italy
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Vezza C, Vettoretti S, Caldiroli L, Bergamaschini L, Messa P, Cesari M. Use of the Frailty Index in Older Persons With Chronic Kidney Disease. J Am Med Dir Assoc 2019; 20:1179-1180. [PMID: 31176674 DOI: 10.1016/j.jamda.2019.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Carlotta Vezza
- Geriatric Fellowship Program, University of Milan, Milan, Italy
| | - Simone Vettoretti
- Nephrology Dialysis and Kidney Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lara Caldiroli
- Nephrology Dialysis and Kidney Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Bergamaschini
- Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | - Piergiorgio Messa
- Nephrology Dialysis and Kidney Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community, University of Milan, Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Patrizio E, Vezza C, Manzoni A, Clerici M, Mandelli C, Schinco GL, Cesari M. Acute psychosis in a patient with metabolic disorder and receiving anti‐epileptic therapy with levetiracetam. Geriatr Gerontol Int 2018; 18:1647-1648. [DOI: 10.1111/ggi.13544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Enrica Patrizio
- Specialization School in GeriatricsUniversity of Milan Milan Italy
| | - Carlotta Vezza
- Specialization School in GeriatricsUniversity of Milan Milan Italy
| | - Alice Manzoni
- Specialization School in GeriatricsUniversity of Milan Milan Italy
| | - Marta Clerici
- Specialization School in GeriatricsUniversity of Milan Milan Italy
| | - Clara Mandelli
- Geriatric UnitFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Giuseppina L Schinco
- Geriatric UnitFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Matteo Cesari
- Geriatric UnitFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community HealthUniversity of Milan Milan Italy
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Caldiroli L, Vezza C, Messa P, Cesari M, Vettoretti S. FO028FRIED’S FRAILTY SCALE IDENTIFIES THOSE ELDERLY PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE THAT MAY BENEFIT FROM A THOROUGH GERIATRIC EVALUATION. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fo028] [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: 11/12/2022] Open
Affiliation(s)
- Lara Caldiroli
- Unit of Nehrology, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Vezza
- Geriatrics Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Piergiorgio Messa
- Unit of Nephrology, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Cesari
- Unit of Geriatrics, Università degli Studi di Milano, milano, Italy
| | - Simone Vettoretti
- Unit of Nephrology, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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