The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study

Background

Data on female gender differences on clinical prognosis after coronary artery bypass grafting (CABG) are still controversial. We evaluated retrospectively the impact of women patients in comparison with men undergoing CABG on mid-term outcome.

Methods

Between December 2014 and March 2022, 1,044 consecutive patients (162 females, 15.5%, 882 males, 84.5%) underwent isolated CABG. The mean follow-up was 40±27 (median 38) months. Logistic and Cox model analysis regressions were used to assess the risk of female gender and other variables, Kaplan-Meier estimates to assess survival rates.

Results

Women did not have a significant higher operative mortality than men (3.09% vs. 1.93%; P=0.37). There was no difference in the use of left internal mammary artery (97.5% vs. 94.9%; P=0.85). Independent predictors of early mortality were emergency CABG (P<0.0001), percutaneous coronary intervention (PCI) within 30 days (P=0.0026), and higher EuroSCORE II (P=0.0155). At 7.5 years, actuarial survival was 87%±3.6% for female gender vs. 88%±1.9% in male gender (P=0.41), freedom from cardiac death 97%±1.8% vs. 96.6%±1.0% (P=0.6), freedom from major adverse cardiac events (MACE) 87%±6.2% vs. 89.7%±2.5% (P=0.96). Independent predictor of all-causes death and cardiac death was the advanced age (74 years in dead patients vs. 67 years in survivors) (P<0.0001). Female gender was not a predictor of either operative mortality (P=0.34) or worse mid-term outcome (P=0.41).

Conclusions

Women undergoing CABG with the same surgical techniques currently adopted for men, do not appear to be associated with worse early prognosis. Freedom from late all-causes mortality, cardiac death and adverse cardiac events are comparable and equally satisfactory, highlighting the positive protective effect of CABG over time also in women.

Early-Staged Carotid Artery Stenting Prior to Coronary Artery Bypass Grafting: Analysis of the Early and Mid-Term Results in Comparison with a Consecutive Cohort of Isolated Coronary Artery Surgery Patients

AIM

The aim of the present study was to analyze retrospectively the results of patients who underwent early-staged, i.e., within 24-48 h, carotid artery stenting (e-s CAS) before coronary artery bypass grafting (CABG).

METHODS

Between December 2014 and December 2022, 1046 consecutive patients underwent CABG; 31 of these patients (3%) were subjected to e-s CAS prior to CABG (e-s CAS + CABG group). Preoperative and intraoperative variables and early and mid-term results of the e-s CAS + CABG group were compared with those of patients who underwent isolated CABG (CABG group).

RESULTS

As compared with the CABG group, the e-s CAS + CABG group showed a worse clinical risk profile due to higher Euroscore-2 values and incidence of obstructive pulmonary disease and bilateral carotid artery and peripheral artery diseases (p < 0.05, for all comparisons). The combined end point of operative mortality, periprocedural myocardial infarction, and stroke was 3.2% (0%/0%/3.2%) in the e-s CAS + CABG group vs. 5.9% (2.2%/2.8%/0.9%) in the CABG group (p > 0.5, for all measurements). At 5 years, actuarial survival was 74% ± 16% in the e-s CAS + CABG group vs. 93% ± 4.0% in the CABG group, freedom from cardiac death was 100% vs. 98% ± 1.0% (p = 0.6), and freedom from MACCEs was 85% ± 15% vs. 97% ± 2.5% (p > 0.1, for all comparisons). Independent predictors of all-causes death were advanced age at the operation (p < 0.0001), a lower value for left ventricular ejection fraction (p = 0.05), and a high Euroscore-2 (p = 0.04).

CONCLUSIONS

CABG preceded by e-s CAS appears to be associated with satisfactory early outcomes while limiting the risk of myocardial infarction to a very short time interval between the two procedures. Freedom from late all-causes death, cardiac death, and MACCEs were comparable and equally satisfactory, underscoring the positive protective effects of CAS and CABG on the carotid and coronary territories over time.

Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis

Aim: To analyze early and mid-term outcomes of the Bentall operation. Methods: Two hundred and seventeen patients (mean age 65.6 ± 15.9 years, males/females 172/45) underwent Bentall operation in a 7-year period (January 2015−December 2021), on average, 30 Bentall operations occurred per year, using biological (n = 104) or mechanical (n = 113) valved conduits for the treatment of ascending aorta−aortic root aneurysms. Associate procedures were performed in 58 patients (26.7%); coronary artery bypass grafting (CABG) in 35 (16%). Mean follow-up was 55.2 ± 24 (median 60.2) months. Cox model analysis was used to assess risk factors, Kaplan−Meier and log-rank tests were used to assess different survival rates. Results: Operative mortality was 1.38%. At 7 years, survival, freedom from cardiac death, and event-free survival were 93% ± 2%, 99% ± 1%, and 81% ± 5%. NYHA class (p < 0.0001), trans-aortic valve mean (p < 0.0001) and maximum (p < 0.000) gradients, left ventricular hypertrophy (p < 0.05), and pulmonary arterial pressure (p = 0.002) significantly improved vs. preoperative values. Concomitant CABG during Bentall operation independently affected late outcomes (HR 1.9−2.3; p-values < 0.05). Late survival was affected by concomitant CABG (84% ± 8% vs. 95% ± 2%, p = 0.04), preoperative myocardial infarction (91% ± 9% vs. 97% ± 2%, p = 0.02), and biological vs. mechanical prostheses valved conduits (91% ± 9% vs. 95% ± 3%, p = 0.02). Event-free survival also was affected by concomitant CABG (62% ± 14% vs. 85% ± 5%, p = 0.005) and biological prostheses (78% ± 8% vs. 84% ± 6%, p = 0.06). Freedom from endocarditis−redo operation was 83% ± 9% for biological prostheses vs. 89% ± 6% for mechanical prostheses (p = 0.49). Conclusions: Low rates of operative mortality and late complications make Bentall operation the gold standard for the treatment of ascending aorta−aortic root aneurysms. Coronary ischemic disease affects late outcomes. Biological prostheses should be preferred for the elderly.

Circulating Levels of Ferritin, RDW, PTLs as Predictive Biomarkers of Postoperative Atrial Fibrillation Risk after Cardiac Surgery in Extracorporeal Circulation

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery in conventional extracorporeal circulation (CECC), with an incidence of 15-50%. The POAF pathophysiology is not known, and no blood biomarkers exist. However, an association between increased ferritin levels and increased AF risk, has been demonstrated. Based on such evidence, here, we evaluated the effectiveness of ferritin and other haematological parameters as POAF risk biomarkers in patients subjected to cardiac surgery. We enrolled 105 patients (mean age = 70.1 ± 7.1 years; 70 men and 35 females) with diverse heart pathologies and who were subjected to cardiothoracic surgery. Their blood samples were collected and used to determine hematological parameters. Electrocardiographic and echocardiographic parameters were also evaluated. The data obtained demonstrated significantly higher levels of serum ferritin, red cell distribution width (RDW), and platelets (PLTs) in POAF patients. However, the serum ferritin resulted to be the independent factor associated with the onset POAF risk. Thus, we detected the ferritin cut-off value, which, when ≥148.5 ng/mL, identifies the subjects at the highest POAF risk, and with abnormal ECG atrial parameters, such as PW indices, and altered structural heart disease variables. Serum ferritin, RDW, and PTLs represent predictive biomarkers of POAF after cardiothoracic surgery in CECC; particularly, serum ferritin combined with anormal PW indices and structural heart disease variables can represent an optimal tool for predicting not only POAF, but also the eventual stroke onset.

The Endothelial Transcription Factor ERG Mediates a Differential Role in the Aneurysmatic Ascending Aorta with Bicuspid or Tricuspid Aorta Valve: A Preliminary Study

The pathobiology of ascending aorta aneurysms (AAA) onset and progression is not well understood and only partially characterized. AAA are also complicated in case of bicuspid aorta valve (BAV) anatomy. There is emerging evidence about the crucial role of endothelium-related pathways, which show in AAA an altered expression and function. Here, we examined the involvement of ERG-related pathways in the differential progression of disease in aortic tissues from patients having a BAV or tricuspid aorta valve (TAV) with or without AAA. Our findings identified ERG as a novel endothelial-specific regulator of TGF-β-SMAD, Notch, and NO pathways, by modulating a differential fibrotic or calcified AAA progression in BAV and TAV aortas. We provided evidence that calcification is correlated to different ERG expression (as gene and protein), which appears to be under control of Notch signaling. The latter, when increased, associated with an early calcification in aortas with BAV valve and aneurysmatic, was demonstrated to favor the progression versus severe complications, i.e., dissection or rupture. In TAV aneurysmatic aortas, ERG appeared to modulate fibrosis. Therefore, we proposed that ERG may represent a sensitive tissue biomarker to monitor AAA progression and a target to develop therapeutic strategies and influence surgical procedures.

Long-Term Follow-Up of Device-Assisted Clampless Off-Pump Coronary Artery Bypass Grafting Compared with Conventional On-Pump Technique

STUDY OBJECTIVE

To evaluate the long-term outcomes of clampless off-pump coronary artery bypass grafting (C-OPCAB) compared with conventional on-pump double clamping coronary artery bypass grafting (C-CABG).

METHODS

From October 2006 to December 2011, 366 patients underwent isolated coronary artery bypass grafting. After propensity score matching of preoperative variables, 143 pairs were selected who received C-OPCAB with the use of device-assisted PAS-Port proximal venous graft anastomoses or C-CABG, performed by the same surgeon experienced in both techniques. Data of the two groups of patients were retrospectively analyzed up to 14 years of follow-up.

RESULTS

As compared with C-OPCAB, in the C-CABG patients, the performed number of grafts per patient was higher (2.9 ± 0.5 vs. 2.6 ± 0.6, p-value 0.0001). At 14 years, overall survival, including in-hospital death, was 64 ± 4.7% for the C-OPCAB vs. 55 ± 5.5% for the C-CABG, freedom from overall MACCEs 51 ± 6.2% vs. 41 ± 7.7%, and from late cardiac death 94 ± 2.4% vs. 96 ± 2.2% (p-value not significant, for all comparisons). No significant statistical differences were observed in the actual rates of adverse events during follow-up. Independent predictors of survival were advanced age at operation (p-value 0.001) and a lower mean value of preoperative left ventricular ejection fraction (p-value 0.015).

CONCLUSIONS

Our single-center study analysis suggests that clampless OPCAB using device-assisted proximal anastomoses proved to be not inferior to double-clamping CABG in the long-term follow-up, provided that involved surgeons are familiar with both techniques. These conclusions are supported by a large and long-term follow-up period, eliminating potential bias, i.e., by means of the propensity score matching and analyzing single-surgeon experience.

Role of Cachexia and Fragility in the Patient Candidate for Cardiac Surgery

Frailty is the major expression of accelerated aging and describes a decreased resistance to stressors, and consequently an increased vulnerability to additional diseases in elderly people. The vascular aging related to frail phenotype reflects the high susceptibility for cardiovascular diseases and negative postoperative outcomes after cardiac surgery. Sarcopenia can be considered a biological substrate of physical frailty. Malnutrition and physical inactivity play a key role in the pathogenesis of sarcopenia. We searched on Medline (PubMed) and Scopus for relevant literature published over the last 10 years and analyzed the strong correlation between frailty, sarcopenia and cardiovascular diseases in elderly patient. In our opinion, a right food intake and moderate intensity resistance exercise are mandatory in order to better prepare patients undergoing cardiac operation.

Imaging and monitoring in minimally invasive valve surgery using an intra-aortic occlusion device: a single center experience

Background

Minimally invasive approach through a right mini-thoracotomy is a world-wide used procedure for mitral valve surgery. We performed a retrospective analysis based on our center experience in order to propose an effective, safe and reproducible method using an intra-aortic occlusion device.

Methods

This is a retrospective analysis on 48 consecutive patients undergoing mitral valve surgery through a right anterolateral mini-thoracotomy in our center. An intra-aortic occlusion device was used for aortic clamping and cardioplegia delivery. Simultaneous multi-plane three-dimensional echocardiography imaging was acquired to detect the venous cannulas position, the intra-aortic device location in the ascending aorta, the balloon inflation, the complete occlusion of the aorta, the cardioplegia delivery, the origin and the blood flow in the right coronary artery. Aortic root pressure was measured by the tip of the intra-aortic occlusion device. A bilateral upper extremity invasive arterial pressure monitoring was detected. Neuromonitoring was performed through bilateral cerebral oximetry.

Results

The analysis has shown no aortic dissection, neurological damage type 1 and myocardial ischemia in the study population. In 3 cases a distal displacement of the intra-aortic occlusion device was promptly detected by the combined use of echocardiographic imaging and by a drop of the right cerebral oximetry saturation and of the right radial artery pressure.

Conclusions

The combined use of transesophageal simultaneous multi-plane three- dimensional echocardiography imaging, bilateral upper extremity invasive arterial pressure monitoring, aortic root pressure and cerebral oximetry is an effective, safe and reproducible method in patients undergoing minimally invasive valve surgery using an intra-aortic occlusion device.

Biomechanical properties and histomorphometric features of aortic tissue in patients with or without bicuspid aortic valve

Background

We sought to investigate and compare biomechanical properties and histomorphometric findings of thoracic ascending aorta aneurysm (TAA) tissue from patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in order to clarify mechanisms underlying differences in the clinical course.

Methods

Circumferential sections of TAA tissue in patients with BAV (BAV-TAA) and TAV (TAV-TAA) were obtained during surgery and used for biomechanical tests and histomorphometrical analysis.

Results

In BAV-TAA, we observed biomechanical higher peak stress and lower Young modulus values compared with TAV-TAA wall. The right lateral longitudinal region seemed to be the most fragile zone of the TAA wall. Mechanical stress-induced rupture of BAV-TAA tissue was sudden and uniform in all aortic wall layers, whereas a gradual and progressive aortic wall breakage was described in TAV-TAA. Histomorphometric analysis revealed higher amount of collagen but not elastin in BAV-TAA tunica media.

Conclusions

The higher deformability of BAV-TAA tissue supports the hypothesis that increased wall shear stress doesn’t explain the increased risk of sudden onset of rupture and dissection; other mechanisms, likely related to alteration of specific genetic pathways and epigenetic signals, could be investigated to explain differences in aortic dissection and rupture in BAV patients.

Factors Affecting Npcr in Hemodialysed Patients

The determination of dialysis adequacy is difficult and definitions are in a state of flux (Lindsay). In fact, after fifteen years from the introduction of urea kinetics into clinical practice, nephrologists still do not agree on recognizing the real utility of it. Gotch and Sargent in their mechanistic analysis of the NCDS indicated that the dose of small molecules removal could be defined by Kt/V urea. The results of the NCDS were depicted in a three-variable plot in which six domains could be seen. Several reports have documented malnutrition as being frequently present in patients on maintenance hemodialysis. It is generally accepted that a suboptimal nutritional status is associated with an increased morbidity and may adversely affect rehabilitation and the quality of life. In 1989 Lindsay et al showed that low levels of Kt/V corresponded with low levels of nPCR and found a direct correlation between the two parameters. On this basis, they suggested the hypothesis of nPCR dependence on Kt/V. The Authors showed a good correlation (r=0.73) between nPCR and Kt/V in 55 patients. This work aims to evaluate the correlation between Kt/V and nPCR, real age and dialytic age in a dialytic population in Southern Italy, during a long period of observation (six years, follow up 2,692 months). One hundred and thirty-four patients were studied in six years of observation. Follow up: 2692 months. Twenty-six patients died during the observation period. The simple regression analysis of nPCR vs. Kt/V, real age and dialytic age was performed in 63 anuric patients. nPCR showed a statistical difference (p<0.01) versus reall age, but no difference versus dialytic age and Kt/V. Our research data show that increasing Kt/V administration does not modify the nPCR of patients with initial and steady low protein intake over a medium time of observation. The same happens in patients with initial and steady high protein intake, when decreasing Kt/V administration in a short period of observation. We confirm that nPCR and Kt/V do not show any mathematical correlation in short and medium times of observation. It is also stressed by the simple regression analysis of data for a selected population of anuric uremics on dialysis thrice weekly for long observation times (between three and six years). Variance analysis (in 8 patients who had used all the membranes) showed differences between Kt/V and dialytic age, but not nPCR and real age. Kt/V and biocompatibility do not appear to be correlated directly with nPCR, because other factors are important in determining the general well-being in uremic patients. Such factors have to be considered when prescribing the dialytic “dose” and in clinically evaluating a uremic patient.

Proteolytic activity of molds and their metabiotic association with Salmonella in a model system

The aim of this study was to investigate the proteolytic ability of some strains of aspergilli, fusaria, and penicillia and the metabiotic effect of Fusarium oxysporum and Penicillium expansum on Salmonella. The proteolytic activity of the target molds was determined on tomato juice agar and tomato juice, whereas the metabiotic effect of F. oxysporum and P. expansum on Salmonella was assessed in a model system consisting of tryptone soy broth with different amounts of tomato juice added. Fusaria, some aspergilli, and one strain of penicillium showed a proteolytic activity on tomato juice agar. In addition, Salmonella survival was enhanced in tryptone soy broth plus 20 or 50% tomato juice in the model system previously inoculated with F. oxysporum.

Suitability of bifidobacteria and thymol as biopreservatives in extending the shelf life of fresh packed plaice fillets

AIMS

The present study was aimed to evaluate the microbiological and sensory characteristics of biopreserved packed fresh plaice (Pleuronectes platessa), during storage.

METHODS AND RESULTS

Fish samples were treated with a Bifidobacterium bifidum strain and thymol as preservatives, stored at different temperatures (4 and 12 degrees C) and package atmospheres (in air, under vacuum, modified atmosphere). Data about the total viable count (TVC) were used to predict the shelf life of the fish fillets as affected by the preservatives used and the storage conditions. Data obtained revealed that B. bifidum could perform an efficient synergy with thymol, in controlling the hygiene biological markers. Besides, the tested bifidobacterial species, combined with low storage temperature and anoxia/hypoxia, showed a great efficacy against the main fresh packaged fish spoilage species (Pseudomonas spp., Photobacterium phosphoreum).

CONCLUSIONS

The studied technique could be considered effective in fresh fish spoilage control.

SIGNIFICANCE AND IMPACT OF THE STUDY

Great interest is developing on food biopreservation, because of the ever increasing needs to protect consumers' and environment's health, and to revalorize some important food characteristics, such as naturalness and authenticity, without leaving the safety aside.

Use of Chitosan to Prolong Mozzarella Cheese Shelf Life

This study was undertaken to evaluate the feasibility of using chitosan, a natural antimicrobial substance, to improve the preservation of a very perishable cheese. The effectiveness of chitosan to inhibit the growth of spoilage microorganisms in Mozzarella cheese was studied during refrigerated storage. A lactic acid/chitosan solution was added directly to the starter used for Mozzarella cheese manufacturing. Mozzarella cheese samples were stored at 4 degrees C for about 10 d and microbial populations as well as the pH were monitored. Results demonstrated that chitosan inhibited the growth of some spoilage microorganisms such as coliforms, whereas it did not influence the growth of other microorganisms, such as Micrococcaceae, and lightly stimulated lactic acid bacteria.

Development of a structured model for batch cultures of lactic acid bacteria

A combined stochastic-deterministic model able to predict the growth curve of microorganisms, from inoculation to death, is presented. The proposed model is based on the assumption that microorganisms can experience two different physiological states: non-proliferating and proliferating. The former being the physiological state of the cells right after their inoculation into the new extracellular environment; the latter the state of microorganisms after adaptation to the new medium. To validate the model, a Lactobacillus bulgaricus strain was tested in a medium at pH 4.6 at two different temperatures (42 degrees C and 35 degrees C). Curves representing the bacterial growth cycle were satisfactorily fitted by means of the proposed model. Moreover, due to the mechanistic structure of the proposed model, valuable quantitative information on the following was obtained: rate of conversion of non-proliferating cells into proliferating cells, growth and death rate of proliferating cells, and rate of nutrient consumption.

Evaluation of recovery methods to detect faecal streptococci in polluted waters

AIMS

This paper compares the faecal streptococci count on 25 samples of polluted waters obtained with three techniques: most probable number (MPN), membrane filtration (MF) and pour plate (PP) methods. Although the PP method is a simple technique, familiar to water bacteriologists, it is not recommended in the international methods.

METHODS AND RESULTS

For the MPN method, azide dextrose broth and ethyl violet azide broth were employed. For the MF technique, Millipore filters were placed onto azide maltose agar (KF agar), while for the PP method, 1 ml of a decimal water dilution was added to (Kennel Faecal) KF medium. Regression analysis and Friedman's ANOVA were performed to determine the relationship between faecal streptococci counts obtained with the three techniques. Statistical analysis of the results showed that the MPN, MF and PP techniques were equally valid with respect to faecal streptococci enumeration in polluted waters.

CONCLUSION

Since the PP method was found to be as good as the other techniques, it may be preferred in polluted waters. It is more economical in terms of both time and materials than the MPN count, and it is as accurate as the MF count.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study indicates that the PP method, although not recommended internationally, is a reliable alternative to MF and MPN.

The occurrence of Aeromonas spp. in natural mineral water and well water

The presence of motile Aeromonas spp. in natural mineral water (NMW) and drinking well water in the area of Lecce (Italy) was investigated. Aeromonas spp. were not detected in any of the 60 NMW samples either by the direct and enrichment method. From a total of 20 wells, five were found to contain Aeromonas species with cell number ranging from 26 to 1609 250 ml(-1). In two wells the presence of Aeromonas spp. was not associated to the presence of faecal indicators, i.e. coliforms and faecal coliforms. Sixty-five Aeromonas spp. strains isolated in this survey were identified at species level and some were examined for haemolysis, Voges Proskauer reaction, lysine decarboxylase and sorbitol fermentation, tests which had been previously shown to correlate with production of enterotoxin/cytotoxin. Isolates identified as A. hydrophila and A. sobria showed potentially virulent properties.

In vitro survival of Listeria monocytogenes in human amniotic fluid

A Listeria monocytogenes strain (CA01/93), haemolytic and virulent in mice, was inoculated in 16 samples of sterile human amniotic fluid to study the growth curves and to provide more information about the pathophysiology of the microorganism in pregnancy. A control test for every analysis was performed with an Escherichia coli strain (CN 02/95). Regardless of the amniotic fluid samples were taken at 34th-39th week of gestation, when it expresses maximum ability to inhibit growth of E. coli, the growth curves of L. monocytogenes do not show any bactericidal (only bacteriostatic) activity of the amniotic fluids against the tested strain. This gives an interesting result about the pathogenesis of the infection in pregnancy and about the potential environmental contamination due to long surviving times of the microorganism in-amniotic fluid.

Fate of Escherichia coli O157:H7 in unpasteurized milk stored at 8 degrees C

Escherichia coli O157:H7 and verocytotoxins were not found in any of 100 unpasteurized milk samples obtained from the bulk tanks of eight dairy farms located in the Puglia and Basilicata areas. Seven E. coli O157:H7 (EHEC) strains were inoculated separately into raw milk samples and then examined periodically to determine the fate of EHEC as influenced by the storage temperature (8 degrees C) and time. There was essentially no change in the viable population of three EHEC strains for up to 14 d. The remaining four strains showed an increase in population from < 2 log to 3 log cfu ml-1 in a time period of between 9 and 17 d. The results indicate good survival or even multiplication of E. coli O157:H7 in raw milk when stored at 8 degrees C and reaffirm the need for pasteurization and holding the milk at < or = 5 degrees C.

Survival of Escherichia coli O157:H7 in yoghurt during preparation and storage at 4 degrees C

Cow's milk was inoculated with ca 10(3) and 10(7) cfu ml-1 Escherichia coli O157:H7. After fermentation at 42 degrees C for 0-5 h, the yoghurt was stored at 4 degrees C. Two kinds of yoghurt were used: traditional yoghurt (TY), made with Streptococcus thermophilus and Lactobacillus bulgaricus starter cultures, and 'bifido' yoghurt (BY), made with the two starter cultures plus Bifidobacterium bifidum. After 7 d E. coli O157:H7 decreased from 3.52 to 2.72 log10 cfu ml-1 and from 7.08 to 5.32 log10 cfu ml-1 in TY, and from 3.49 to 2.73 log10 cfu ml-1 and from 7.38 to 5.41 log10 cfu ml-1 in BY. The pH values of yoghurt dropped from 6.6 to 4.5 and 4.4 in TY (for low and high pathogen inocula, respectively), and from 6.6 to 4.6 and 4.5 in BY (for low and high pathogen inocula, respectively).

Factors affecting nPCR in hemodialysed patients

The determination of dialysis adequacy is difficult and definitions are in a state of flux (Lindsay). In fact, after fifteen years from the introduction of urea kinetics into clinical practice, nephrologists still do not agree on recognizing the real utility of it. Gotch and Sargent in their mechanistic analysis of the NCDS indicated that the dose of small molecules removal could be defined by Kt/V urea. The results of the NCDS were depicted in a three-variable plot in which six domains could be seen. Several reports have documented malnutrition as being frequently present in patients on maintenance hemodialysis. It is generally accepted that a suboptimal nutritional status is associated with an increased morbidity and may adversely affect rehabilitation and the quality of life. In 1989 Lindsay et al showed that low levels of Kt/V corresponded with low levels of nPCR and found a direct correlation between the two parameters. On this basis, they suggested the hypothesis of nPCR dependence on Kt/V. The Authors showed a good correlation (r = 0.73) between nPCR and Kt/V in 55 patients. This work aims to evaluate the correlation between Kt/V and nPCR, real age and dialytic age in a dialytic population in Southern Italy, during a long period of observation (six years, follow up 2,692 months). One hundred and thirty-four patients were studied in six years of observation. Follow up: 2,692 months. Twenty-six patients died during the observation period. The simple regression analysis of nPCR vs. Kt/V, real age and dialytic age was performed in 63 anuric patients.(ABSTRACT TRUNCATED AT 250 WORDS)