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Bertolotto M, Verzola D, Contini P, de Totero D, Tirandi A, Ramoni D, Ministrini S, Giacobbe DR, Bonaventura A, Vecchié A, Castellani L, Mirabella M, Arboscello E, Liberale L, Viazzi F, Bassetti M, Montecucco F, Carbone F. Osteopontin is associated with neutrophil extracellular trap formation in elderly patients with severe sepsis. Eur J Clin Invest 2024; 54:e14159. [PMID: 38264915 DOI: 10.1111/eci.14159] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024]
Affiliation(s)
- Maria Bertolotto
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Daniela Verzola
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paola Contini
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniela de Totero
- Molecular Pathology Unit IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Amedeo Tirandi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Davide Ramoni
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Stefano Ministrini
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Daniele Roberto Giacobbe
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Aldo Bonaventura
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Alessandra Vecchié
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | | | | | | | - Luca Liberale
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Genoa, Italy
| | - Francesca Viazzi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Clinic of Nephrology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Genoa, Italy
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Verzola D, Saio M, Milanesi S, Picciotto D, Frascio M, Brunori G, Laudon A, La Porta E, Rumeo N, Zanetti V, Russo E, Garibotto G, Viazzi F, Esposito P. Altered adiponectin regulation in skeletal muscle of patients with chronic kidney disease. Nephrol Dial Transplant 2024:gfae051. [PMID: 38400552 DOI: 10.1093/ndt/gfae051] [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: 02/25/2024] Open
Affiliation(s)
| | - Michela Saio
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova
| | | | - Daniela Picciotto
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova
| | - Marco Frascio
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova
| | - Giuliano Brunori
- U.O Nefrologia e Dialisi, APSS, Trento, Italy
- CISMed UniTn, Trento, G.Gaslini Children's Hospital, Dialysis Unit, Department of Pediatrics
| | | | | | - Noemi Rumeo
- Department of Internal Medicine, University of Genova
| | - Valentina Zanetti
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova
| | - Elisa Russo
- Department of Internal Medicine, University of Genova
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genova
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genova
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova
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3
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Tikhonoff V, Casiglia E, Virdis A, Grassi G, Angeli F, Arca M, Barbagallo CM, Bombelli M, Cappelli F, Cianci R, Cicero AFG, Cirillo M, Cirillo P, Dell'oro R, D'elia L, Desideri G, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Mallamaci F, Maloberti A, Masi S, Masulli M, Mazza A, Mengozzi A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti‐Trevano F, Rattazzi M, Reboldi G, Rivasi G, Russo E, Salvetti M, Temporelli PL, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C. Prognostic Value and Relative Cutoffs of Triglycerides Predicting Cardiovascular Outcome in a Large Regional-Based Italian Database. J Am Heart Assoc 2024; 13:e030319. [PMID: 38293920 PMCID: PMC11056112 DOI: 10.1161/jaha.123.030319] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Despite longstanding epidemiologic data on the association between increased serum triglycerides and cardiovascular events, the exact level at which risk begins to rise is unclear. The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension has conceived a protocol aimed at searching for the prognostic cutoff value of triglycerides in predicting cardiovascular events in a large regional-based Italian cohort. METHODS AND RESULTS Among 14 189 subjects aged 18 to 95 years followed-up for 11.2 (5.3-13.2) years, the prognostic cutoff value of triglycerides, able to discriminate combined cardiovascular events, was identified by means of receiver operating characteristic curve. The conventional (150 mg/dL) and the prognostic cutoff values of triglycerides were used as independent predictors in separate multivariable Cox regression models adjusted for age, sex, body mass index, total and high-density lipoprotein cholesterol, serum uric acid, arterial hypertension, diabetes, chronic renal disease, smoking habit, and use of antihypertensive and lipid-lowering drugs. During 139 375 person-years of follow-up, 1601 participants experienced cardiovascular events. Receiver operating characteristic curve showed that 89 mg/dL (95% CI, 75.8-103.3, sensitivity 76.6, specificity 34.1, P<0.0001) was the prognostic cutoff value for cardiovascular events. Both cutoff values of triglycerides, the conventional and the newly identified, were accepted as multivariate predictors in separate Cox analyses, the hazard ratios being 1.211 (95% CI, 1.063-1.378, P=0.004) and 1.150 (95% CI, 1.021-1.295, P=0.02), respectively. CONCLUSIONS Lower (89 mg/dL) than conventional (150 mg/dL) prognostic cutoff value of triglycerides for cardiovascular events does exist and is associated with increased cardiovascular risk in an Italian cohort.
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Affiliation(s)
- Valérie Tikhonoff
- Department of MedicineUniversità degli Studi di PadovaVia Giustiniani 8Padua35128Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of MedicineUniversità degli Studi di PadovaPaduaItaly
| | - Agostino Virdis
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Fabio Angeli
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Marcello Arca
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Carlo M. Barbagallo
- Biomedical Department of Internal Medicine and SpecialisticsUniversity of PalermoItaly
| | - Michele Bombelli
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Internal Medicine, Pio XI Hospital of Desio, ASST BrianzaDesioItaly
| | - Federica Cappelli
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Rosario Cianci
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Arrigo F. G. Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences DepartmentAlma Mater Studiorum University of BolognaBolognaItaly
- IRCCS AOU S.Orsola di BolognaBolognaItaly
| | - Massimo Cirillo
- Department of Medicine “Scuola Medica Salernitana”University of SalernoBaronissi (SA)Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation“Aldo Moro” University of BariBariItaly
| | - Raffaella Dell'oro
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Lanfranco D'elia
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | | | - Claudio Ferri
- Department of Life, Health and Environmental SciencesUniversity of L’AquilaItaly
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation“Aldo Moro” University of BariBariItaly
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” DepartmentNiguarda Ca’ Granda HospitalMilanItaly
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences“Federico II” University of NaplesNaplesItaly
| | - Francesca Mallamaci
- CNR‐IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal UnitReggio CalabriaItaly
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” DepartmentNiguarda Ca’ Granda HospitalMilanItaly
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Stefano Masi
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Maria Masulli
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | - Alberto Mazza
- Department of Internal MedicineSanta Maria della Misericordia General Hospital, AULSS 5 PolesanaRovigoItaly
| | | | | | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense OrgansUniversity of Bari Medical SchoolBariItaly
| | - Paolo Palatini
- Studium Patavinum, Department of MedicineUniversità degli Studi di PadovaPaduaItaly
| | - Gianfranco Parati
- S. Luca HospitalIstituto Auxologico Italiano and University of Milan‐BicoccaMilanItaly
| | - Roberto Pontremoli
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | | | - Marcello Rattazzi
- Department of MedicineUniversità degli Studi di PadovaVia Giustiniani 8Padua35128Italy
- Medicina Interna ICa’ Foncello University HospitalTrevisoItaly
| | - Gianpaolo Reboldi
- Department of Medical and Surgical ScienceUniversity of PerugiaItaly
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care MedicineCareggi Hospital and University of FlorenceItaly
| | - Elisa Russo
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | - Massimo Salvetti
- Department of Clinical and Experimental SciencesUniversity of BresciaItaly
| | - Pier Luigi Temporelli
- Division of Cardiac RehabilitationIstituti Clinici Scientifici Maugeri, IRCCS, Gattico‐VerunoItaly
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and PsychologyUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
| | - Andrea Ungar
- Department of Geriatric and Intensive Care MedicineCareggi Hospital and University of FlorenceItaly
| | | | - Francesca Viazzi
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and PsychologyUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
- IRCCS San Raffaele RomeRomeItaly
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences DepartmentAlma Mater Studiorum University of BolognaBolognaItaly
- IRCCS AOU S.Orsola di BolognaBolognaItaly
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4
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Massardo S, Verzola D, Alberti S, Caboni C, Santostefano M, Eugenio Verrina E, Angeletti A, Lugani F, Ghiggeri GM, Bruschi M, Candiano G, Rumeo N, Gentile M, Cravedi P, La Maestra S, Zaza G, Stallone G, Esposito P, Viazzi F, Mancianti N, La Porta E, Artini C. MicroRaman spectroscopy detects the presence of microplastics in human urine and kidney tissue. Environ Int 2024; 184:108444. [PMID: 38281449 DOI: 10.1016/j.envint.2024.108444] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
There is a growing concern within the medical community about the potential burden of microplastics on human organs and tissues. In this study, we investigated by microRaman spectroscopy the presence of microplastics in human kidneys and urine. Moreover, an open-access software was developed and validated for the project, which enabled the comparison between the investigated spectra and a self-created spectral database, thus enhancing the ability to characterize polymers and pigments in biological matrices. Healthy portions of ten kidneys obtained from nephrectomies, as well as ten urine samples from healthy donors were analyzed: 26 particles in both kidney and urine samples were identified, with sizes ranging from 3 to 13 μm in urine and from 1 to 29 μm in kidneys. The most frequently determined polymers are polyethylene and polystyrene, while the most common pigments are hematite and Cu-phthalocyanine. This preclinical study proves the presence of microplastics in renal tissues and confirms their presence in urine, providing the first evidence of kidney microplastics deposition in humans.
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Affiliation(s)
- Sara Massardo
- DCCI, Department of Chemistry and Industrial Chemistry, University of Genoa, Italy
| | - Daniela Verzola
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Stefano Alberti
- DCCI, Department of Chemistry and Industrial Chemistry, University of Genoa, Italy
| | - Claudia Caboni
- DCCI, Department of Chemistry and Industrial Chemistry, University of Genoa, Italy
| | | | - Enrico Eugenio Verrina
- UOC Nephrology IRCCS Istituto Giannina Gaslini, Genoa, Italy; UOSD Dialysis IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Angeletti
- UOC Nephrology IRCCS Istituto Giannina Gaslini, Genoa, Italy; Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Lugani
- UOC Nephrology IRCCS Istituto Giannina Gaslini, Genoa, Italy; Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Marco Ghiggeri
- UOC Nephrology IRCCS Istituto Giannina Gaslini, Genoa, Italy; Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Bruschi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Giovanni Candiano
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Noemi Rumeo
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Micaela Gentile
- Division of Nephrology, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA; UO Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Paolo Cravedi
- Division of Nephrology, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Gianluigi Zaza
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University/Hospital of Foggia, Foggia, Italy
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University/Hospital of Foggia, Foggia, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, Genoa, Italy; Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicoletta Mancianti
- Department of Emergency-Urgency and Transplantation, Nephrology, Dialysis and Transplantation Unit, University Hospital of Siena, Siena, Italy
| | - Edoardo La Porta
- UOC Nephrology IRCCS Istituto Giannina Gaslini, Genoa, Italy; UOSD Dialysis IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Cristina Artini
- DCCI, Department of Chemistry and Industrial Chemistry, University of Genoa, Italy; Institute of Condensed Matter Chemistry and Technologies for Energy, National Research Council, CNR-ICMATE, Genoa, Italy
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5
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Esposito P, Picciotto D, Verzola D, Garibotto G, Parodi EL, Sofia A, Costigliolo F, Gaggero G, Zanetti V, Saio M, Viazzi F. SA-β-Gal in Kidney Tubules as a Predictor of Renal Outcome in Patients with Chronic Kidney Disease. J Clin Med 2024; 13:322. [PMID: 38256456 PMCID: PMC10815985 DOI: 10.3390/jcm13020322] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Cellular senescence has emerged as an important driver of aging and age-related disease in the kidney. The activity of β-galactosidase at pH 6 (SA-β-Gal) is a classic maker of senescence in cellular biology; however, the predictive role of kidney tissue SA-β-Gal on eGFR loss in chronic kidney disease (CKD) is still not understood. We retrospectively studied the expression of SA-β-Gal in kidney biopsies obtained in a cohort [n = 22] of incident patients who were followed up for 3 years as standard of care. SA-β-Gal staining was approximately fourfold higher in the tubular compartment of patients with CKD vs. controls [26.0 ± 9 vs. 7.4 ± 6% positive tubuli in patients vs. controls; p < 0.025]. Tubular expressions of SA-β-Gal, but not proteinuria, at the time of biopsy correlated with eGFR loss at the follow up; moreover, SA-β-Gal expression in more than 30% of kidney tubules was associated with fast progressive kidney disease. In conclusion, our study shows that SA-β-Gal is upregulated in the kidney tubular compartment of adult patients affected by CKD and suggests that tubular SA-β-Gal is associated with accelerated loss of renal function.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (V.Z.); (F.V.)
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy; (D.P.); (A.S.); (F.C.); (M.S.)
| | - Daniela Picciotto
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy; (D.P.); (A.S.); (F.C.); (M.S.)
| | - Daniela Verzola
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (V.Z.); (F.V.)
| | - Giacomo Garibotto
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (V.Z.); (F.V.)
| | - Emanuele Luigi Parodi
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (V.Z.); (F.V.)
| | - Antonella Sofia
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy; (D.P.); (A.S.); (F.C.); (M.S.)
| | - Francesca Costigliolo
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy; (D.P.); (A.S.); (F.C.); (M.S.)
| | - Gabriele Gaggero
- UO Anatomia Patologica, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy;
| | - Valentina Zanetti
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (V.Z.); (F.V.)
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy; (D.P.); (A.S.); (F.C.); (M.S.)
| | - Michela Saio
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy; (D.P.); (A.S.); (F.C.); (M.S.)
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (V.Z.); (F.V.)
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16142 Genova, Italy; (D.P.); (A.S.); (F.C.); (M.S.)
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6
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Esposito P, Caputo C, Repetto M, Somaschini A, Pietro B, Colomba P, Zizzo C, Parodi A, Zanetti V, Canepa M, Eustachi V, Sanguineri F, Mandich P, Viazzi F. Diagnosing Fabry nephropathy: the challenge of multiple kidney disease. BMC Nephrol 2023; 24:344. [PMID: 37990184 PMCID: PMC10664682 DOI: 10.1186/s12882-023-03388-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
Fabry disease (FD) is an X-linked inherited lysosomal disorder due to a deficiency of the enzyme alpha-galactosidase A (α-gla) due to mutations in the GLA gene. These mutations result in plasma and lysosome accumulation of glycosphingolipids, leading to progressive organ damage and reduced life expectancy. Due to the availability of specific disease-modifying treatments, proper and timely diagnosis and therapy are essential to prevent irreversible complications. However, diagnosis of FD is often delayed because of the wide clinical heterogeneity of the disease and multiple organ involvement developing in variable temporal sequences. This observation is also valid for renal involvement, which may manifest with non-specific signs, such as proteinuria and chronic kidney disease, which are also common in many other nephropathies. Moreover, an additional confounding factor is the possibility of the coexistence of FD with other kidney disorders. Thus, suspecting and diagnosing FD nephropathy in patients with signs of kidney disease may be challenging for the clinical nephrologist. Herein, also through the presentation of a unique case of co-occurrence of autosomal dominant polycystic kidney disease and FD, we review the available literature on cases of coexistence of FD and other renal diseases and discuss the implications of these conditions. Moreover, we highlight the clinical, laboratory, and histological elements that may suggest clinical suspicion and address a proper diagnosis of Fabry nephropathy.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genoa, Genoa, Italy.
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Carmela Caputo
- Unit of Nephrology and Dialysis, Ospedale San Paolo, Savona, Italy
| | - Monica Repetto
- Unit of Nephrology and Dialysis, Ospedale San Paolo, Savona, Italy
| | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, Ospedale San Paolo, Savona, Italy
| | - Bellone Pietro
- Division of Cardiology and Cardiac Intensive Care Unit, Ospedale San Paolo, Savona, Italy
| | - Paolo Colomba
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Carmela Zizzo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Angelica Parodi
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Zanetti
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Virginia Eustachi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Sanguineri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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7
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Esposito P, Bottini A, Lecini E, Cappadona F, Piaggio M, Macciò L, Genova C, Viazzi F. Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports. Front Oncol 2023; 13:1221135. [PMID: 37936605 PMCID: PMC10627243 DOI: 10.3389/fonc.2023.1221135] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/12/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Acute kidney injury (AKI) in cancer patients receiving immune checkpoint inhibitors (ICIs) may recognize multiple causes. Here, we reviewed cases of biopsy-proven acute tubulointerstitial nephritis (ATIN) to describe the clinical characteristics and outcomes of this condition. Method We conducted a pooled analysis of clinical cases of ICI-related biopsy-proven ATIN up to 1 May 2022. We collected data on clinical characteristics, AKI, biopsy findings, laboratory examinations, and renal outcomes. Results Eighty-five patients (61.4 ± 19 years, 56 male) were evaluated. Melanoma was the most prevalent diagnosis (51%), followed by non-small cell lung cancer (30%). ICI treatment consisted of PD-1, PDL-1 (nivolumab, pembrolizumab, atezolizumab), and CTLA-4 inhibitors (i) (ipilimumab) or combination PD-1i+CTLA4i. Renal toxicity developed after a median of four cycles of therapy. Fifty-one patients (65.5%) developed the most severe form of AKI- stage 3, including five patients requiring dialysis. All the 19 patients treated with dual ICI blockade developed AKI-stage 3, compared with 29 patients out of the 60 receiving a single agent (p<0.001). Most events were managed with corticosteroids associated with ICI withdrawal. In 15 patients ICI was restarted, but in six (40%) AKI recurred. Overall, 32 patients (40%) presented a complete renal recovery, which chance was inversely associated with dual ICI blockade (OR 0.15, 95CI 0.03-0.7, p=0.01). Conclusion ICI-related ATIN may develop late after the therapy initiation, presenting as severe AKI, particularly in patients with dual ICI blockade. Although this complication may be partially reversible, concerns remain about the renal function sequelae and the possibility of restarting ICI treatment.
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Affiliation(s)
- Pasquale Esposito
- Nephrology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Annarita Bottini
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Elvina Lecini
- Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Michela Piaggio
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Lucia Macciò
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Carlo Genova
- Department of Internal Medicine, University of Genova, Genova, Italy
- UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Viazzi
- Nephrology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
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8
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Esposito P, Picciotto D, Cappadona F, Costigliolo F, Russo E, Macciò L, Viazzi F. Multifaceted relationship between diabetes and kidney diseases: Beyond diabetes. World J Diabetes 2023; 14:1450-1462. [PMID: 37970131 PMCID: PMC10642421 DOI: 10.4239/wjd.v14.i10.1450] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 10/09/2023] Open
Abstract
Diabetes mellitus is one of the most common causes of chronic kidney disease. Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney failure. The development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments, such as the vascular system and glomeruli. Glomerular alterations include thickening of the glomerular basement membrane, loss of podocytes, and segmental mesangiolysis, which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson nodules. Beyond lesions directly related to diabetes, awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is increasing. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, and other primary or secondary renal disorders. Differential diagnosis of these conditions is crucial in guiding clinical management and therapeutic approaches. However, the relationship between diabetes and the kidney is bidirectional; thus, new-onset diabetes may also occur as a complication of the treatment in patients with renal diseases. Here, we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course, differential diagnosis, and therapeutic oppor-tunities offered by novel drugs.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Daniela Picciotto
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Francesca Cappadona
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Francesca Costigliolo
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Elisa Russo
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Lucia Macciò
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
| | - Francesca Viazzi
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
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9
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La Porta E, Exacoustos O, Lugani F, Angeletti A, Chiarenza DS, Bigatti C, Spinelli S, Kajana X, Garbarino A, Bruschi M, Candiano G, Caridi G, Mancianti N, Calatroni M, Verzola D, Esposito P, Viazzi F, Verrina E, Ghiggeri GM. Microplastics and Kidneys: An Update on the Evidence for Deposition of Plastic Microparticles in Human Organs, Tissues and Fluids and Renal Toxicity Concern. Int J Mol Sci 2023; 24:14391. [PMID: 37762695 PMCID: PMC10531672 DOI: 10.3390/ijms241814391] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/17/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Plastic pollution became a main challenge for human beings as demonstrated by the increasing dispersion of plastic waste into the environment. Microplastics (MPs) have become ubiquitous and humans are exposed daily to inhalation or ingestion of plastic microparticles. Recent studies performed using mainly spectroscopy or spectrometry-based techniques have shown astounding evidence for the presence of MPs in human tissues, organs and fluids. The placenta, meconium, breast milk, lung, intestine, liver, heart and cardiovascular system, blood, urine and cerebrovascular liquid are afflicted by MPs' presence and deposition. On the whole, obtained data underline a great heterogeneity among different tissue and organs of the polymers characterized and the microparticles' dimension, even if most of them seem to be below 50-100 µm. Evidence for the possible contribution of MPs in human diseases is still limited and this field of study in medicine is in an initial state. However, increasing studies on their toxicity in vitro and in vivo suggest worrying effects on human cells mainly mediated by oxidative stress, inflammation and fibrosis. Nephrological studies are insufficient and evidence for the presence of MPs in human kidneys is still lacking, but the little evidence present in the literature has demonstrated histological and functional alteration of kidneys in animal models and cytotoxicity through apoptosis, autophagy, oxidative stress and inflammation in kidney cells. Overall, the manuscript we report in this review recommends urgent further study to analyze potential correlations between kidney disease and MPs' exposure in human.
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Affiliation(s)
- Edoardo La Porta
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (E.L.P.); (O.E.); (F.L.); (A.A.); (D.S.C.); (C.B.); (E.V.)
- UOSD Dialysis IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (G.C.); (G.C.)
| | - Ottavia Exacoustos
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (E.L.P.); (O.E.); (F.L.); (A.A.); (D.S.C.); (C.B.); (E.V.)
| | - Francesca Lugani
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (E.L.P.); (O.E.); (F.L.); (A.A.); (D.S.C.); (C.B.); (E.V.)
| | - Andrea Angeletti
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (E.L.P.); (O.E.); (F.L.); (A.A.); (D.S.C.); (C.B.); (E.V.)
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.S.); (X.K.); (A.G.); (M.B.)
| | - Decimo Silvio Chiarenza
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (E.L.P.); (O.E.); (F.L.); (A.A.); (D.S.C.); (C.B.); (E.V.)
| | - Carolina Bigatti
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (E.L.P.); (O.E.); (F.L.); (A.A.); (D.S.C.); (C.B.); (E.V.)
| | - Sonia Spinelli
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.S.); (X.K.); (A.G.); (M.B.)
| | - Xhuliana Kajana
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.S.); (X.K.); (A.G.); (M.B.)
| | - Andrea Garbarino
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.S.); (X.K.); (A.G.); (M.B.)
| | - Maurizio Bruschi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.S.); (X.K.); (A.G.); (M.B.)
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
| | - Giovanni Candiano
- UOSD Dialysis IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (G.C.); (G.C.)
| | - Gianluca Caridi
- UOSD Dialysis IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (G.C.); (G.C.)
| | - Nicoletta Mancianti
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency-Urgency and Transplantation, University Hospital of Siena, 53100 Siena, Italy;
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Daniela Verzola
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (P.E.); (F.V.)
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (P.E.); (F.V.)
- Division of Nephrology, Dialysis and Transplantation IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (P.E.); (F.V.)
- Division of Nephrology, Dialysis and Transplantation IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Enrico Verrina
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (E.L.P.); (O.E.); (F.L.); (A.A.); (D.S.C.); (C.B.); (E.V.)
- UOSD Dialysis IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (G.C.); (G.C.)
| | - Gian Marco Ghiggeri
- UO Nephrology Dialysis and Transplant, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (E.L.P.); (O.E.); (F.L.); (A.A.); (D.S.C.); (C.B.); (E.V.)
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.S.); (X.K.); (A.G.); (M.B.)
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10
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Maloberti A, Mengozzi A, Russo E, Cicero AFG, Angeli F, Agabiti Rosei E, Barbagallo CM, Bernardino B, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cirillo M, Cirillo P, Desideri G, D'Elia L, Dell'Oro R, Facchetti R, Ferri C, Galletti F, Giannattasio C, Gesualdo L, Iaccarino G, Lippa L, Mallamaci F, Masi S, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Parati G, Palatini P, Pauletto P, Pontremoli R, Pugliese NR, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Virdis A, Grassi G, Borghi C. The Results of the URRAH (Uric Acid Right for Heart Health) Project: A Focus on Hyperuricemia in Relation to Cardiovascular and Kidney Disease and its Role in Metabolic Dysregulation. High Blood Press Cardiovasc Prev 2023; 30:411-425. [PMID: 37792253 PMCID: PMC10600296 DOI: 10.1007/s40292-023-00602-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
The relationship between Serum Uric Acid (UA) and Cardiovascular (CV) diseases has already been extensively evaluated, and it was found to be an independent predictor of all-cause and cardiovascular mortality but also acute coronary syndrome, stroke and heart failure. Similarly, also many papers have been published on the association between UA and kidney function, while less is known on the role of UA in metabolic derangement and, particularly, in metabolic syndrome. Despite the substantial number of publications on the topic, there are still some elements of doubt: (1) the better cut-off to be used to refine CV risk (also called CV cut-off); (2) the needing for a correction of UA values for kidney function; and (3) the better definition of its role in metabolic syndrome: is UA simply a marker, a bystander or a key pathological element of metabolic dysregulation?. The Uric acid Right for heArt Health (URRAH) project was designed by the Working Group on uric acid and CV risk of the Italian Society of Hypertension to answer the first question. After the first papers that individuates specific cut-off for different CV disease, subsequent articles have been published responding to the other relevant questions. This review will summarise most of the results obtained so far from the URRAH research project.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, University of Zurich, Schlieren, Switzerland
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Bruno Bernardino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Bombelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Internal Medicine, Pio XI Hospital of Desio, ASST Brianza, Desio, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Rosario Cianci
- Department of Translational and Precision Medicine, University of Rome La Sapienza, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Massimo Cirillo
- Department of Public Health, ''Federico II'' University of Naples, Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Raffaella Dell'Oro
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Rita Facchetti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, ''Federico II'' University of Naples, Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - Francesca Mallamaci
- Reggio Cal Unit, Clinical Epidemiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Masulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Gianfranco Parati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Palatini
- Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Pauletto
- Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | | | - Fosca Quarti-Trevano
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | | | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100, Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- IRCCS San Raffaele, Rome, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy
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11
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Esposito P, Picciotto D, Costigliolo F, Russo E, Macciò L, Cenacchi G, Cagnetta A, Cea M, Lemoli RM, Viazzi F. Daratumumab in the treatment of C3 glomerulopathy with monoclonal gammopathy: a case report and literature review. Front Med (Lausanne) 2023; 10:1266172. [PMID: 37724175 PMCID: PMC10505429 DOI: 10.3389/fmed.2023.1266172] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023] Open
Abstract
Although rare, C3 glomerulopathy (C3G) is increasingly recognized thanks to the currently available diagnostic skills. C3G is not a single disease but a group of disorders with distinct pathogenesis and progression. Thus, an essential step for its management remains an in-depth characterization of the specific form and the identification of underlying conditions, which may also impact treatment choices as well. Among these entities, an emerging condition is the association of C3G with monoclonal gammopathy, which confers poor outcomes. Overall, diagnosis of C3G remains challenging, and determining the appropriate treatment remains unclear. Conventional immunosuppressive therapy has proven ineffective in such cases, while clone-directed therapies have shown promising results in small interventional studies and case series. Here, we report a case of a patient affected by C3G with monoclonal gammopathy of renal significance who experienced rapid deterioration of kidney function requiring replacement therapy. After the failure of first-line treatment, a switch to the anti-CD38 therapy with daratumumab resulted in the progressive improvement of the patient's kidney function, leading to the discontinuation of hemodialysis after approximately 10 months. Serial renal biopsies were also performed to study the disease's evolution in response to the treatment. Based on the description of this single case, we have comprehensively reviewed available studies on daratumumab use in patients with C3G associated with monoclonal gammopathy to provide insights for the design of prospective studies which aim to enhance the management of such poor prognosis disease.
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Affiliation(s)
- Pasquale Esposito
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Daniela Picciotto
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Costigliolo
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Russo
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Lucia Macciò
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Giovanna Cenacchi
- Biotechnology and Methods in Laboratory Medicine, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Antonia Cagnetta
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Clinic of Hematology, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Michele Cea
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Clinic of Hematology, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Roberto M. Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Clinic of Hematology, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Francesca Viazzi
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
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12
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Ceriello A, Lucisano G, Prattichizzo F, La Grotta R, Frigé C, De Cosmo S, Di Bartolo P, Di Cianni G, Fioretto P, Giorda CB, Pontremoli R, Russo G, Viazzi F, Nicolucci A. The legacy effect of hyperglycemia and early use of SGLT-2 inhibitors: a cohort study with newly-diagnosed people with type 2 diabetes. Lancet Reg Health Eur 2023; 31:100666. [PMID: 37547276 PMCID: PMC10398589 DOI: 10.1016/j.lanepe.2023.100666] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 08/08/2023]
Abstract
Background A delay in reaching HbA1c targets in patients with newly-diagnosed type 2 diabetes (T2D) is associated with an increased long-term risk of developing cardiovascular diseases (CVD), a phenomenon referred to as legacy effect. Whether an early introduction of glucose-lowering drugs with proven benefit on CVD can attenuate this phenomenon is unknown. Methods Using data derived from a large Italian clinical registry, i.e. the AMD Annals, we identified 251,339 subjects with newly-diagnosed T2D and without CVD at baseline. Through Cox regressions adjusted for multiple risk factors, we examined the association between having a mean HbA1c between 7.1 and 8% or >8%, compared with ≤7%, for various periods of early exposure (0-1, 0-2, 0-3 years) and the development of later (mean subsequent follow-up 4.6 ± 2.9 years) CVD, evaluated as a composite of myocardial infarction, stroke, coronary or peripheral revascularization, and coronary or peripheral bypass. We performed this analysis in the overall cohort and then splitting the population in two groups of patients: those that introduced sodium-glucose transport protein 2 inhibitors (SGLT-2i) during the exposure phase and those not treated with these drugs. Findings Considering the whole cohort, subjects with both a mean HbA1c between 7.1 and 8% and >8%, compared with patients attaining a mean HbA1c ≤ 7%, showed an increased risk of developing the outcome in all the three early exposure periods assessed, with the highest risk observed in patients with mean HbA1c > 8% in the 3 years exposure period (hazard ratio [HR]1.33; 95% confidence interval [CI] 1.063-1.365). The introduction of SGLT-2i during the exposure periods of 0-1 and 0-2 years eliminated the association between poor glycemic control and the outcome (p for interaction 0.006 and 0.003, respectively, vs. patients with the same degree of glycemic control but not treated with these drugs). Interpretation Among patients with newly diagnosed T2D and free of CVD at baseline, a poor glycemic control in the first three years after diagnosis is associated with an increased subsequent risk of CVD. This association is no longer evident when SGLT-2i are introduced in the first two years, suggesting that these drugs attenuate the phenomenon of legacy effect. An early treatment with these drugs might thus promote a long-lasting benefit in patients not attaining proper glycemic control after T2D diagnosis. Funding This work was supported, in part, by the Italian Ministry of Health (Ricerca Corrente) to IRCCS MultiMedica.
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Affiliation(s)
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | | | | | - Salvatore De Cosmo
- Department of Medical Sciences, Scientific Institute “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, FG, Italy
| | - Paolo Di Bartolo
- Ravenna Diabetes Center, Department of Specialist Medicine, Romagna Local Health Authority, Italy
| | | | - Paola Fioretto
- Department of Medicine, University of Padua, Unit of Medical Clinic 3, Hospital of Padua, Padua, Italy
| | | | - Roberto Pontremoli
- IRCCS Ospedale Policlinico San Martino; Dipartimento di Medicina Interna, Università degli studi di Genova, Genoa, Italy
| | - Giuseppina Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Viazzi
- IRCCS Ospedale Policlinico San Martino; Dipartimento di Medicina Interna, Università degli studi di Genova, Genoa, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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13
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Esposito P, Verzola D, Saio M, Picciotto D, Frascio M, Laudon A, Zanetti V, Brunori G, Garibotto G, Viazzi F. The Contribution of Muscle Innate Immunity to Uremic Cachexia. Nutrients 2023; 15:2832. [PMID: 37447158 DOI: 10.3390/nu15132832] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Protein energy wasting (PEW) is a common complication both in chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Of note, PEW is one of the stronger predictors of morbidity and mortality in this patient population. The pathogenesis of PEW involves several mechanisms, including anorexia, insulin resistance, acidosis and low-grade inflammation. In addition, "sterile" muscle inflammation contributes to PEW at an advanced CKD stage. Both immune and resident muscle cells can activate innate immunity; thus, they have critical roles in triggering "sterile" tissue inflammation. Toll-like receptor 4 (TLR4) can detect endogenous danger-associated molecular patterns generated or retained in blood in uremia and induce a sterile muscle inflammatory response via NF-κB in myocytes. In addition, TLR4, though the activation of the NLRP3 inflammasome, links the sensing of metabolic uremic stress in muscle to the activation of pro-inflammatory cascades, which lead to the production of IL-1β and IL-18. Finally, uremia-induced accelerated cell senescence is associated with a secretory phenotype that favors fibrosis in muscle. Targeting these innate immune pathways could lead to novel therapies for CKD-related PEW.
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Affiliation(s)
- Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Daniela Verzola
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Michela Saio
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Daniela Picciotto
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Marco Frascio
- Division of Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, 16132 Genova, Italy
| | | | - Valentina Zanetti
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Giuliano Brunori
- Division of Nephrology, Ospedale Santa Chiara, 38122 Trento, Italy
| | - Giacomo Garibotto
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Francesca Viazzi
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
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14
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Russo E, Bussalino E, Macciò L, Verzola D, Saio M, Esposito P, Leoncini G, Pontremoli R, Viazzi F. Non-Haemodynamic Mechanisms Underlying Hypertension-Associated Damage in Target Kidney Components. Int J Mol Sci 2023; 24:ijms24119422. [PMID: 37298378 DOI: 10.3390/ijms24119422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/30/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Arterial hypertension (AH) is a global challenge that greatly impacts cardiovascular morbidity and mortality worldwide. AH is a major risk factor for the development and progression of kidney disease. Several antihypertensive treatment options are already available to counteract the progression of kidney disease. Despite the implementation of the clinical use of renin-angiotensin aldosterone system (RAAS) inhibitors, gliflozins, endothelin receptor antagonists, and their combination, the kidney damage associated with AH is far from being resolved. Fortunately, recent studies on the molecular mechanisms of AH-induced kidney damage have identified novel potential therapeutic targets. Several pathophysiologic pathways have been shown to play a key role in AH-induced kidney damage, including inappropriate tissue activation of the RAAS and immunity system, leading to oxidative stress and inflammation. Moreover, the intracellular effects of increased uric acid and cell phenotype transition showed their link with changes in kidney structure in the early phase of AH. Emerging therapies targeting novel disease mechanisms could provide powerful approaches for hypertensive nephropathy management in the future. In this review, we would like to focus on the interactions of pathways linking the molecular consequences of AH to kidney damage, suggesting how old and new therapies could aim to protect the kidney.
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Affiliation(s)
- Elisa Russo
- U.O.C. Nefrologia e Dialisi, Ospedale San Luca, 55100 Lucca, Italy
| | - Elisabetta Bussalino
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Lucia Macciò
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Michela Saio
- S.S.D. Nefrologia e Dialisi, Ospedale di Sestri Levante, 16124 Genova, Italy
| | - Pasquale Esposito
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Giovanna Leoncini
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Roberto Pontremoli
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Francesca Viazzi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
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15
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Esposito P, Cappadona F, Sangregorio F, Costa E, Mallia L, Zanetti V, Nescis L, Bianzina S, Ferrari F, Patroniti NA, Traverso GB, Viazzi F. Combined extracorporeal CO2 removal and renal replacement therapy in a pregnant patient with COVID-19: a case report. G Ital Nefrol 2023; 40:40-02-2023-06. [PMID: 37179478] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background. Pregnant women are at high risk of Coronavirus disease 2019 (COVID-19) complications, including acute respiratory distress syndrome. Currently, one of the cornerstones in the treatment of this condition is lung-protective ventilation (LPV) with low tidal volumes. However, the occurrence of hypercapnia may limit this ventilatory strategy. So, different extracorporeal CO2 removal (ECCO2R) procedures have been developed. ECCO2R comprises a variety of techniques, including low-flow and high-flow systems, that may be performed with dedicated devices or combined with continuous renal replacement therapy (CRRT). Case description. Here, we report a unique case of a pregnant patient affected by COVID-19 who required extracorporeal support for multiorgan failure. While on LPV, because of the concomitant hypercapnia and acute kidney injury, the patient was treated with an ECCO2R membrane inserted in series after a hemofilter in a CRRT platform. This combined treatment reducing hypercapnia allowed LPV maintenance at the same time while providing kidney replacement and ensuring maternal and fetal hemodynamic stability. Adverse effects consisted of minor bleeding episodes due to the anticoagulation required to maintain the extracorporeal circuit patency. The patient's pulmonary and kidney function progressively recovered, permitting the withdrawal of any extracorporeal treatment. At the 25th gestational week, the patient underwent spontaneous premature vaginal delivery because of placental abruption. She gave birth to an 800-gram female baby, who three days later died because of multiorgan failure related to extreme prematurity. Conclusions. This case supports using ECCO2R-CRRT combined treatment as a suitable approach in the management of complex conditions, such as pregnancy, even in the case of severe COVID-19.
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Affiliation(s)
- Pasquale Esposito
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Cappadona
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Filippo Sangregorio
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Costa
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Mallia
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Zanetti
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorenzo Nescis
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Bianzina
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Fiorenza Ferrari
- Department of Anesthesia and Intensive Care Unit, I.R.C.C.S., San Matteo Hospital and University of Pavia, Pavia, Italy
| | - Nicolò Antonino Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics [DISC], University of Genoa, Genoa, Italy
| | - Giovanni Battista Traverso
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Viazzi
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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16
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Garibotto G, Picciotto D, Verzola D, Valli A, Sofia A, Costigliolo F, Saio M, Viazzi F, Esposito P. Homocysteine exchange across skeletal muscle in patients with chronic kidney disease. Physiol Rep 2023; 11:e15573. [PMID: 36945836 PMCID: PMC10031238 DOI: 10.14814/phy2.15573] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 03/23/2023] Open
Abstract
Sites and mechanisms regulating the supply of homocysteine (Hcy) to the circulation are unexplored in humans. We studied the exchange of Hcy across the forearm in CKD patients (n = 17, eGFR 20 ± 2 ml/min), in hemodialysis (HD)-treated patients (n = 14) and controls (n = 9). Arterial Hcy was ~ 2.5 folds increased in CKD and HD patients (p < 0.05-0.03 vs. controls). Both in controls and in patients Hcy levels in the deep forearm vein were consistently greater (+~7%, p < 0.05-0.01) than the corresponding arterial levels, indicating the occurrence of Hcy release from muscle. The release of Hcy from the forearm was similar among groups. In all groups arterial Hcy varied with its release from muscle (p < 0.03-0.02), suggesting that muscle plays an important role on plasma Hcy levels. Forearm Hcy release was inversely related to folate plasma level in all study groups but neither to vitamin B12 and IL-6 levels nor to muscle protein net balance. These data indicate that the release of Hcy from peripheral tissue metabolism plays a major role in influencing its Hcy plasma levels in humans and patients with CKD, and that folate is a major determinant of Hcy release.
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Affiliation(s)
| | - Daniela Picciotto
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Daniela Verzola
- Department of Internal MedicineUniversity of GenovaGenovaItaly
| | - Alessando Valli
- Department of Internal MedicineUniversity of GenovaGenovaItaly
| | - Antonella Sofia
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Francesca Costigliolo
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Michela Saio
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Francesca Viazzi
- Department of Internal MedicineUniversity of GenovaGenovaItaly
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Pasquale Esposito
- Department of Internal MedicineUniversity of GenovaGenovaItaly
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San MartinoGenoaItaly
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17
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Esposito P, Nescis L, Viazzi F. Future directions of maintenance therapy in ANCA-associated vasculitis. Curr Med Chem 2023; 30:3052-3059. [PMID: 36825698 DOI: 10.2174/0929867330666230220101730] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Pasquale Esposito
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine, University of Genoa, Italy
| | - Lorenzo Nescis
- Department of Internal Medicine, University of Genoa, Italy
| | - Francesca Viazzi
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine, University of Genoa, Italy
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18
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Mengozzi A, Pugliese NR, Desideri G, Masi S, Angeli F, Barbagallo CM, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cicero AFG, Cirillo M, Cirillo P, Dell’Oro R, D’Elia L, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Grassi G, Iaccarino G, Lippa L, Mallamaci F, Maloberti A, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Russo E, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C, Virdis A. Serum Uric Acid Predicts All-Cause and Cardiovascular Mortality Independently of Hypertriglyceridemia in Cardiometabolic Patients without Established CV Disease: A Sub-Analysis of the URic acid Right for heArt Health (URRAH) Study. Metabolites 2023; 13:metabo13020244. [PMID: 36837863 PMCID: PMC9959524 DOI: 10.3390/metabo13020244] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
High serum uric acid (SUA) and triglyceride (TG) levels might promote high-cardiovascular risk phenotypes across the cardiometabolic spectrum. However, SUA predictive power in the presence of normal and high TG levels has never been investigated. We included 8124 patients from the URic acid Right for heArt Health (URRAH) study cohort who were followed for over 20 years and had no established cardiovascular disease or uncontrolled metabolic disease. All-cause mortality (ACM) and cardiovascular mortality (CVM) were explored by the Kaplan-Meier estimator and Cox multivariable regression, adopting recently defined SUA cut-offs for ACM (≥4.7 mg/dL) and CVM (≥5.6 mg/dL). Exploratory analysis across cardiometabolic subgroups and a sensitivity analysis using SUA/serum creatinine were performed as validation. SUA predicted ACM (HR 1.25 [1.12-1.40], p < 0.001) and CVM (1.31 [1.11-1.74], p < 0.001) in the whole study population, and according to TG strata: ACM in normotriglyceridemia (HR 1.26 [1.12-1.43], p < 0.001) and hypertriglyceridemia (1.31 [1.02-1.68], p = 0.033), and CVM in normotriglyceridemia (HR 1.46 [1.23-1.73], p < 0.001) and hypertriglyceridemia (HR 1.31 [0.99-1.64], p = 0.060). Exploratory and sensitivity analyses confirmed our findings, suggesting a substantial role of SUA in normotriglyceridemia and hypertriglyceridemia. In conclusion, we report that SUA can predict ACM and CVM in cardiometabolic patients without established cardiovascular disease, independent of TG levels.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, 8952 Schlieren, Switzerland
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence: or or ; Tel.:+39-05-099-2558
| | | | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, 21100 Varese, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, 90100 Palermo, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Michele Ciccarelli
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80133 Naples, Italy
| | - Arrigo F. G. Cicero
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Heart-Chest-Vascular Department, IRCCS AOU of Bologna, 40126 Bologna, Italy
| | - Massimo Cirillo
- Department of Public Health, “Federico II” University of Naples, 80133 Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
| | - Raffaella Dell’Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Lanfranco D’Elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80133 Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), 67051 Avezzano, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, 89124 Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria Della Misericordia General Hospital, AULSS 5 Polesana, 45100 Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | - Pietro Nazzaro
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Neurosciences and Sense Organs, University of Bari Medical School, 70122 Bari, Italy
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
| | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, 20126 Milan, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, Medicina Interna 1°, Ca’ Foncello University Hospital, 31100 Treviso, Italy
| | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100 Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | | | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00185 Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00185 Rome, Italy
| | - Claudio Borghi
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Heart-Chest-Vascular Department, IRCCS AOU of Bologna, 40126 Bologna, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Palatini P, Virdis A, Masi S, Mengozzi A, Casiglia E, Tikhonoff V, Cicero AFG, Ungar A, Parati G, Rivasi G, Salvetti M, Barbagallo CM, Bombelli M, Dell'Oro R, Bruno B, Lippa L, D'Elia L, Masulli M, Verdecchia P, Reboldi G, Angeli F, Mallamaci F, Cirillo M, Rattazzi M, Cirillo P, Gesualdo L, Mazza A, Giannattasio C, Maloberti A, Volpe M, Tocci G, Iaccarino G, Nazzaro P, Galletti F, Ferri C, Desideri G, Viazzi F, Pontremoli R, Muiesan ML, Grassi G, Borghi C. Hyperuricemia increases the risk of cardiovascular mortality associated with very high HdL-cholesterol level. Nutr Metab Cardiovasc Dis 2023; 33:323-330. [PMID: 36642602 DOI: 10.1016/j.numecd.2022.11.024] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Whether the association between very high HDL-cholesterol levels and cardiovascular mortality (CVM) is modulated by some facilitating factors is unclear. Aim of the study was to investigate whether the risk of CVM associated with very high HDL-cholesterol is increased in subjects with hyperuricemia. METHODS AND RESULTS Multivariable Cox analyses were made in 18,072 participants from the multicentre URRAH study stratified by sex and HDL-cholesterol category. During a median follow-up of 11.4 years there were 1307 cases of CVM. In multivariable Cox models a J-shaped association was found in the whole population, with the highest risk being present in the high HDL-cholesterol group [>80 mg/dL, adjusted hazard ratio (HR), 1.28; 95%CI, 1.02-1.61; p = 0.031)]. However, a sex-specific analysis revealed that this association was present only in women (HR, 1.34; 95%CI, 1.02-1.77; p = 0.034) but not in men. The risk of CVM related to high HDL-cholesterol was much greater in the women with high uric acid (>0.30 mmol/L, HR 1.61; 95%CI, 1.08-2.39) than in those with low uric acid (HR, 1.17; 95%CI, 0.80-1.72, p for interaction = 0.016). In women older than 70 years with hyperuricemia the risk related to high HDL-cholesterol was 1.83 (95%CI, 1.19-2.80, p < 0.005). Inclusion of BMI in the models weakened the strength of the associations. CONCLUSION Our data indicate that very high HDL-cholesterol levels in women are associated with CVM in a J-shaped fashion. The risk of CVM is increased by concomitant hyperuricemia suggesting that a proinflammatory/oxidative state can enhance the detrimental cardiovascular effects associated with high HDL-cholesterol.
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Affiliation(s)
- Paolo Palatini
- Department of Medicine, Studium Patavinum, University of Padova, Padua, Italy.
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | | | | | | | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy
| | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, Milan, Italy
| | - Giulia Rivasi
- Department of Medical and Surgical Science, University of Perugia, Perugia, Italy; Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Carlo M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Michele Bombelli
- Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaella Dell'Oro
- Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Berardino Bruno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | | | - Gianpaolo Reboldi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation. Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy
| | - Massimo Cirillo
- Department of Public Health, "Federico II" University of Naples, Napoli, Italy
| | - Marcello Rattazzi
- Department of Medicine - DIMED, University of Padova, Medicina Interna 1, Ca' Foncello University Hospital, Treviso, Italy
| | - Pietro Cirillo
- Department of Emergency and Organ Transplantation - Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation - Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
| | - Cristina Giannattasio
- Cardiology IV, 'A. De Gasperis' Department, Niguarda Ca' Granda Hospital, Health Science Department, Milano-Bicocca University, Milano, Italy
| | - Alessandro Maloberti
- Cardiology IV, 'A. De Gasperis' Department, Niguarda Ca' Granda Hospital, Health Science Department, Milano-Bicocca University, Milano, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Napoli, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy
| | | | - Guido Grassi
- Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Claudio Borghi
- Alma Mater Studiorum University of Bologna, Bologna, Italy
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20
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Casiglia E, Tikhonoff V, Virdis A, Grassi G, Angeli F, Barbagallo CM, Bombelli M, Cicero AF, Cirillo M, Cirillo P, Dell’Oro R, D’elia L, Desideri G, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Lippa L, Mallamaci F, Masi S, Maloberti A, Masulli M, Mazza A, Mengozzi A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C. Serum uric acid / serum creatinine ratio as a predictor of cardiovascular events. Detection of prognostic cardiovascular cut-off values. J Hypertens 2023; 41:180-186. [PMID: 36453660 PMCID: PMC9794153 DOI: 10.1097/hjh.0000000000003319] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE In the frame of the Uric Acid Right for Heart Health (URRAH) study, a nationwide multicenter study involving adult participants recruited on a regional community basis from all the territory of Italy under the patronage of the Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension, we searched for the cut-off values of the ratio between serum uric acid (SUA) and serum creatinine (sCr) able to predict cardiovascular (CV) events. METHODS Among 20 724 participants followed-up for 126 ± 64 months, after detecting cut-off by the receiver operating characteristic curves, we calculated by Cox models adjusted for confounders having CV events as dependent variable the hazard ratio (HR) of SUA/sCr > cut-off. We also verified if the role of cut-off varied with increasing SUA/sCr. RESULTS A plausible prognostic cut-off of SUA/sCr was found and was the same in the whole database, in men and in women (>5.35). The HR of SUA/sCr > cut-off was 1.159 (95% confidence interval [CI] 1.092-1.131, P < 0.03) in all, 1.161 (95% CI 1.021-1.335, P < 0.02) in men, and 1.444 (95% CI 1.012-1.113, P < 0.03) in women. In increasing quintiles of SUA/sCr the cut-offs were >3.08, >4.87, >5.35, >6.22 and >7.58, respectively. The HRs significantly increased from the 3rd to the 5th quintile (1.21, 95% CI 1.032-1.467, P = 0.018; 1.294, 95% CI 1.101-1.521, P = 0.002; and 1.642, 95% CI 1.405-1.919, P < 0.0001; respectively), that is, over 5.35, whereas the 2nd quintile was not significantly different from the 1st (reference). CONCLUSION Having SUA/sCr >5.35 is an independent CV risk indicator both in men and women. The cut-off is dynamic and significantly increases with increasing SUA/sCr.
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Affiliation(s)
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese
| | - Carlo M. Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna
| | - Massimo Cirillo
- Department of Public Health, “Federico II” University of Naples, Naples
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, Bari
| | - Raffaella Dell’Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Lanfranco D’elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, Naples
| | | | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, Naples
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, Bari
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi's” Department, Niguarda Ca’ Granda Hospital, Milan
- School of Medicine and Surgery, Milano-Bicocca University, Milan
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Naples
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L’Aquila
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi's” Department, Niguarda Ca’ Granda Hospital, Milan
- School of Medicine and Surgery, Milano-Bicocca University, Milan
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, Naples
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo
| | | | | | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari
| | | | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, Milan
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa, and Policlinico San Martino, Genoa
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Marcello Rattazzi
- Department of Medicine, University of Padua, Padua
- Medicina Interna I, Ca’ Foncello University Hospital, Treviso
| | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, Perugia
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, and Policlinico San Martino, Genoa
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome
| | - Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna
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21
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Muacevic A, Adler JR, Viazzi F, Paoletti E, Esposito P. Kidney Transplantation in a Patient Affected by Sickle Cell Trait: A Case Report and State-of-the-Art Review. Cureus 2023; 15:e33400. [PMID: 36751159 PMCID: PMC9899094 DOI: 10.7759/cureus.33400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Chronic kidney disease (CKD) is a common feature of sickle cell disease (SCD). The awareness of the clinical presentation and renal involvement in patients affected by hemoglobinopathies is greatly needed. Patient management is particularly complex, especially with kidney transplantation. We, therefore, report the case of a 56-year-old patient affected by sickle cell trait who underwent kidney transplantation. This case will underline all the various challenges the nephrologist must face in this clinical setting and their management.
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22
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Carbone F, Elia E, Casula M, Bonaventura A, Bertolotto M, Minetti S, Artom N, Camici GG, Contini P, Pontremoli R, Viazzi F, Bertolini S, Pende A, Pisciotta L, Montecucco F, Liberale L. Among biomarkers of neutrophil activity, matrix metalloproteinases 8 independently predicts remission of metabolic syndrome. Nutr Metab Cardiovasc Dis 2023; 33:185-193. [PMID: 36411219 DOI: 10.1016/j.numecd.2022.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/10/2022] [Revised: 09/24/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Inflammation due to the excess of nutrient intake plays an important role in the pathophysiology of metabolic syndrome (MetS). Here, the potential influence of neutrophils and their degranulation markers on MetS improvement upon dietary and behavioral counselling, has been investigated. Specifically, we aimed at investigating their role as potential predictors of metabolic syndrome improvements. METHODS AND RESULTS patients with MetS (n = 127) received behavioral and dietary recommendations before follow-up at 6 months. Serum levels of matrix metalloproteinases (MMP)8, MMP9, myeloperoxidase (MPO), tissue inhibitor of MMP (TIMP)-1, TIMP-2, TIMP-3 and resistin were tested at baseline. In the whole cohort, baseline levels of proinflammatory MMP8, MMP9 and MPO increased together with the number of MetS criteria. Seventy-three (57%) patients experienced a reduction in MetS-defining criteria at follow-up. With respect to those with no improvement, such individuals showed lower weight and waist circumference at enrolment, less frequent smoking habits, higher levels of triglycerides and lower circulating MMP8. At logistic regression analysis, baseline MMP8 showed negative predictive ability (odds ratio (OR) 0.979 [0.961-0.997]; p = 0.025) against MetS improvement. Such findings hold true even when included in the backward stepwise logistic regression model confirming MMP8 as an independent predictor (OR 0.970 [0.949-0.993]; p = 0.009). Receiver operating characteristic (ROC) curve confirmed the predictive ability of MMP8 combined in a model including baseline MetS criteria and waist circumference. Bootstrap resampling analysis internally validated our findings. CONCLUSION Improvement of MetS is independently associated with baseline low MMP-8 levels, suggesting a pivotal role for inflammation in metabolic alteration.
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Affiliation(s)
- Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy
| | - Edoardo Elia
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Matteo Casula
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Aldo Bonaventura
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Maria Bertolotto
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Silvia Minetti
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Nathan Artom
- Department of Internal Medicine, Ospedale S. Paolo di Savona, 30 via Genova, 17110 Savona, Italy
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Paola Contini
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Stefano Bertolini
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Aldo Pende
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy; First Clinic of Internal Medicine, Department of Internal Medicine, and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, 10 Largo Benzi, 16132 Genoa, Italy.
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23
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Esposito P, Garbarino S, Fenoglio D, Cama I, Cipriani L, Campi C, Parodi A, Vigo T, Franciotta D, Altosole T, Grosjean F, Viazzi F, Filaci G, Piana M. Longitudinal Cluster Analysis of Hemodialysis Patients with COVID-19 in the Pre-Vaccination Era. Life (Basel) 2022; 12:1702. [PMID: 36362858 PMCID: PMC9695171 DOI: 10.3390/life12111702] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/22/2022] [Accepted: 10/23/2022] [Indexed: 08/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) in hemodialysis patients (HD) is characterized by heterogeneity of clinical presentation and outcomes. To stratify patients, we collected clinical and laboratory data in two cohorts of HD patients at COVID-19 diagnosis and during the following 4 weeks. Baseline and longitudinal values were used to build a linear mixed effect model (LME) and define different clusters. The development of the LME model in the derivation cohort of 17 HD patients (66.7 ± 12.3 years, eight males) allowed the characterization of two clusters (cl1 and cl2). Patients in cl1 presented a prevalence of females, higher lymphocyte count, and lower levels of lactate dehydrogenase, C-reactive protein, and CD8 + T memory stem cells as a possible result of a milder inflammation. Then, this model was tested in an independent validation cohort of 30 HD patients (73.3 ± 16.3 years, 16 males) assigned to cl1 or cl2 (16 and 14 patients, respectively). The cluster comparison confirmed that cl1 presented a milder form of COVID-19 associated with reduced disease activity, hospitalization, mortality rate, and oxygen requirement. Clustering analysis on longitudinal data allowed patient stratification and identification of the patients at high risk of complications. This strategy could be suitable in different clinical settings.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Sara Garbarino
- Dipartimento di Matematica (MIDA), Università di Genova, 16132 Genova, Italy
| | - Daniela Fenoglio
- Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine-Centre of Excellence for Biomedical Research, University of Genova, 16132 Genova, Italy
| | - Isabella Cama
- Dipartimento di Matematica (MIDA), Università di Genova, 16132 Genova, Italy
| | - Leda Cipriani
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy
| | - Cristina Campi
- Dipartimento di Matematica (MIDA), Università di Genova, 16132 Genova, Italy
| | - Alessia Parodi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Tiziana Vigo
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Tiziana Altosole
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Fabrizio Grosjean
- Department of Internal Medicine-Centre of Excellence for Biomedical Research, University of Genova, 16132 Genova, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, 16132 Genova, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Gilberto Filaci
- Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine-Centre of Excellence for Biomedical Research, University of Genova, 16132 Genova, Italy
| | - Michele Piana
- Dipartimento di Matematica (MIDA), Università di Genova, 16132 Genova, Italy
- Life Science Computational Laboratory (LISCOMP), IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
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24
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Russo GT, Giandalia A, Ceriello A, Di Bartolo P, Di Cianni G, Fioretto P, Giorda CB, Manicardi V, Pontremoli R, Viazzi F, Lucisano G, Nicolucci A, De Cosmo S. A prediction model to assess the risk of egfr loss in patients with type 2 diabetes and preserved kidney function: The amd annals initiative. Diabetes Res Clin Pract 2022; 192:110092. [PMID: 36167264 DOI: 10.1016/j.diabres.2022.110092] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/05/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop and validate a model for predicting 5-year eGFR-loss in type 2 diabetes mellitus (T2DM) patients with preserved renal function at baseline. RESEARCH DESIGN AND METHODS A cohort of 504.532 T2DM outpatients participating to the Medical Associations of Diabetologists (AMD) Annals Initiative was splitted into the Learning and Validation cohorts, in which the predictive model was respectively developed and validated. A multivariate Cox proportional hazard regression model including all baseline characteristics was performed to identify predictors of eGFR-loss. A weight derived from regression coefficients was assigned to each variable and the overall sum of weights determined the 0 to 8-risk score. RESULTS A set of demographic, clinical and laboratory parameters entered the final model. The eGFR-loss score showed a good performance in the Validation cohort. Increasing score values progressively identified a higher risk of GFR loss: a score ≥ 8 was associated with a HR of 13.48 (12.96-14.01) in the Learning and a HR of 13.45 (12.93-13.99) in the Validation cohort. The 5 years-probability of developing the study outcome was 55.9% higher in subjects with a score ≥ 8. CONCLUSIONS In the large AMD Annals Initiative cohort, we developed and validated an eGFR-loss prediction model to identify T2DM patients at risk of developing clinically meaningful renal complications within a 5-years time frame.
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Affiliation(s)
- G T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - A Ceriello
- Department of Cardiovascular and Metabolic Diseases, IRCCS Gruppo Multimedica, MI, Italy.
| | | | - G Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy.
| | - P Fioretto
- Department of Medicine, University of Padua, Unit of Medical Clinic 3, Hospital of Padua, Padua, Italy.
| | - C B Giorda
- Diabetes and Metabolism Unit ASL Turin 5 Chieri (TO), Italy.
| | - V Manicardi
- Diabetes Consultant, Salus Hospital, Reggio Emilia, Italy.
| | - R Pontremoli
- Università degli Studi and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - F Viazzi
- Università degli Studi and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy.
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy.
| | - S De Cosmo
- Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG), Italy.
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25
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Esposito P, Picciotto D, Cappadona F, Russo E, Falqui V, Conti NE, Parodi A, Mallia L, Cavagnaro S, Battaglia Y, Viazzi F. The Evolving Scenario of COVID-19 in Hemodialysis Patients. Int J Environ Res Public Health 2022; 19:10836. [PMID: 36078552 PMCID: PMC9518574 DOI: 10.3390/ijerph191710836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a rapidly changing disease. Therefore, in this study, to evaluate the evolution of COVID-19 in hemodialysis patients, we retrospectively compared patients affected by COVID-19 during the first pandemic waves of 2020 (from March to December 2020-Group 1) with patients with COVID-19 from September 2021 to February 2022 (Group 2) after the full completion of vaccination. Group 1 was constituted of 44 patients (69.3 ± 14.6 years), and Group 2 of 55 patients (67.4 ± 15.3 years). Among Group 2, 52 patients (95%) were vaccinated. Patients of Group 2, compared with Group 1, were more often asymptomatic (38 vs. 10%, p = 0.002) and reported less frequent fever and pulmonary involvement. At diagnosis, Group 2 showed a significantly higher number of lymphocytes and lower levels of circulating IL-6 (16 ± 13.3 vs. 41 ± 39.4 pg/mL, p = 0.002). Moreover, in Group 2, inflammatory parameters significantly improved after a few days from diagnosis. Patients of Group 2 presented a lower hospitalization rate (12.7 vs. 38%, p = 0.004), illness duration (18.8 ± 7.7 vs. 29.2 ± 19.5 days, p = 0.005), and mortality rate (5.4 vs. 25%, p = 0.008). Finally, responders to the vaccination (80% of vaccinated patients) compared with nonresponders showed a reduction in infection duration and hospitalization (5 vs. 40%, p = 0.018). In conclusion, we found that COVID-19 presentation and course in hemodialysis patients have improved over time after the implementation of vaccine campaigns. However, due to the evolving nature of the disease, active surveillance is necessary.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Unit of Nephrology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Daniela Picciotto
- Unit of Nephrology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Francesca Cappadona
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Unit of Nephrology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
| | - Valeria Falqui
- Unit of Nephrology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Angelica Parodi
- Unit of Nephrology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Laura Mallia
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
| | - Sara Cavagnaro
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
| | - Yuri Battaglia
- Department of Medicine, University of Verona, 37129 Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, 37019 Peschiera del Garda, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Unit of Nephrology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
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26
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Genovesi S, Montelisciani L, Viazzi F, Giussani M, Lieti G, Patti I, Orlando A, Antolini L, Salvi P, Parati G. Uric acid and arterial stiffness in children and adolescents: Role of insulin resistance and blood pressure. Front Cardiovasc Med 2022; 9:978366. [PMID: 36035959 PMCID: PMC9403185 DOI: 10.3389/fcvm.2022.978366] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022] Open
Abstract
Several studies describe the association between serum uric acid (SUA) and arterial stiffness in adults. Uric acid contributes through several mechanisms to the increase in blood pressure (BP) and adversely affects the insulin signaling pathway. Moreover, SUA predict the development of hypertension and insulin resistance up to type 2 diabetes. Early arterial stiffening, estimated by carotid-femoral pulse wave velocity (PWV), may already be present in pediatric age. Aim of our study was to investigate the relationship between SUA and PWV in a pediatric population and its interaction with insulin resistance and BP. In 322 children and adolescents (56.2% male, mean age 11.3 [SD 2.8] years), we measured weight, height, waist circumference, BP and PWV. We also assayed SUA and estimated glomerular filtration rate (eGFR) and calculated HOMA-index as a marker of insulin resistance. Simple and multiple regression analyses were performed to assess variables associated with PWV. Mediation models were applied to identify the direct and indirect effects of individual variables on PWV. On univariate analysis, age (p < 0.001), waist circumference-to-height ratio (p = 0.036), systolic and diastolic BP (SBP and DBP) z-score (p < 0.001), heart rate (p = 0.028), SUA (p = 0.002), HOMA-index (p < 0.001), and eGFR (p = 0.014) were significantly associated with PWV. The multiple regression model showed that only age (p = 0.028), SBP z-score (p = 0.006), and heart rate (p = 0.001) were significantly associated with PWV. The results were superimposable when the DBP z-score replaced the SBP z-score in the model. Mediation models showed that the effect of eGFR on PWV was fully mediated by SUA (p = 0.015) and that the effect of SUA on PWV was totally mediated by HOMA-index (p < 0.001). Both SUA (p < 0.01) and HOMA-index (p < 0.01) had a significant association with higher SBP (DBP) z-scores. The double mediation model including both BP and HOMA-index showed that the SUA effect on PWV was totally mediated by both variables (p = 0.005, for HOMA-index, p = 0.004, for SBP z-score and p = 0.007, for combined effect). The results were superimposable when the DBP z-score replaced the SBP z-score in the model. In conclusion, insulin resistance and BP are both important mediators of the association between SUA and vascular stiffness in pediatric age.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy,*Correspondence: Simonetta Genovesi
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Study and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Giussani
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giulia Lieti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ilenia Patti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonina Orlando
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Salvi
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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27
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De Luca L, Cappadona F, Temporelli PL, Gonzini L, Ledda A, Raisaro A, Viazzi F, Gabrielli D, Colivicchi F, Gulizia MM, Pontremoli R. Impact of eGFR rate on 1-year all-cause mortality in patients with stable coronary artery disease. Eur J Intern Med 2022; 101:98-105. [PMID: 35513990 DOI: 10.1016/j.ejim.2022.04.021] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of mortality and is often complicated by chronic kidney disease. We sought to investigate the prevalence of different degree of estimated glomerular filtration rate (eGFR) reduction, the clinical and bio-humoral correlates, its relationship with therapeutic management, and its predictive role on 1-year all-cause mortality, in patients with stable CAD. METHODS We studied 4,130 patients with stable CAD recruited in a prospective, observational, nationwide study (START, STable coronary Artery diseases RegisTry) in Italy. Baseline clinical characteristics, pharmacological treatment, and all-cause 1-year mortality were evaluated according to groups of eGFR (<30; 30-59; 60-89; ≥90 ml/min/1.73 m2) at baseline. RESULTS The presence and the degree of chronic kidney disease entailed an unfavorable risk profile, since it was gradually associated with more comorbidities. Furthermore, progressively lower eGFR values were associated to lower diastolic blood pressure and hemoglobin values. As eGFR lowers, optimal medical treatment and its persistence overtime is reduced. Multivariate analysis showed that progressively lower eGFR significantly correlated with all-cause 1-year mortality [hazard ratio (HR): 1.02; 95% confidence intervals (CI): 1.01-1-03; p = 0.0001]. CONCLUSIONS Low eGFR is associated with an increasing risk of all-cause mortality in patients with stable CAD. Chronic kidney disease may hamper the optimization of treatment limiting the use of drugs which may favorably impact cardiovascular and renal outcomes.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Division of Cardiology, A.O. San Camillo-Forlanini, Circonvallazione Gianicolense, 87, Roma 00152, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | - Francesca Cappadona
- Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Novara, Gattico-Veruno, Italy
| | - Lucio Gonzini
- Heart Care Foundation ANMCO Research Center, Florence, Italy
| | | | - Arturo Raisaro
- Division of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Domenico Gabrielli
- Department of Cardiosciences, Division of Cardiology, A.O. San Camillo-Forlanini, Circonvallazione Gianicolense, 87, Roma 00152, Italy
| | | | - Michele Massimo Gulizia
- Heart Care Foundation ANMCO Research Center, Florence, Italy; Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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28
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Cremonini AL, Pasta A, Carbone F, Visconti L, Casula M, Elia E, Bonaventura A, Liberale L, Bertolotto M, Artom N, Minetti S, Contini P, Verzola D, Pontremoli R, Viazzi F, Viviani GL, Bertolini S, Pende A, Montecucco F, Pisciotta L. Lipoprotein(a) Modulates Carotid Atherosclerosis in Metabolic Syndrome. Front Mol Biosci 2022; 9:854624. [PMID: 35755826 PMCID: PMC9214261 DOI: 10.3389/fmolb.2022.854624] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Aim: High lipoprotein(a) [Lp(a)] is a well-established cardiovascular (CV) risk factor, but the effect of mildly elevated Lp(a) on CV health is largely unknown. Our aim was to evaluate if Lp(a) is associated with the severity of carotid atherosclerosis (CA) in the specific subset of metabolic syndrome (MetS). Patients and Methods: Subjects with diagnosed MetS and ultrasound-assessed CA were enrolled. Those patients were categorized according to the severity of CA (moderate vs. severe), and the circulating levels of Lp(a) alongside with clinical, anthropometric, and biochemical data were collected. Results: Sixty-five patients were finally included: twenty-five with moderate and forty with severe CA (all with asymptomatic disease). Intergroup comparison showed Lp(a) as the only significantly different variable [6 (2–12) mg/dl vs. 11.5 (6–29.5) mg/dl; p = 0.018]. Circulating levels of Lp(a) were also confirmed as the only variable independently associated with severity of CA at logistic regression analysis [OR 2.9 (95% CI 1.1–7.8); p = 0.040]. ROC curve analysis for Lp(a) confirmed a serum level of 10 mg/dl as the best cut-off value [AUC 0.675 (95% CI 0.548–0.786)]. Although sensitivity and specificity were suboptimal (69.0 and 70.4%, respectively)—likely due to the small sample size—this result is in line with those previously reported in the literature. Conclusion: Lp(a) is independently associated with severity of CA in the subgroup of MetS patients.
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Affiliation(s)
- Anna Laura Cremonini
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Visconti
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Matteo Casula
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edoardo Elia
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Aldo Bonaventura
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,Internal Medicine Department Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Luca Liberale
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Bertolotto
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Nathan Artom
- Department of Internal Medicine, Ospedale S. Paolo di Savona, Savona, Italy
| | - Silvia Minetti
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paola Contini
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniela Verzola
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Aldo Pende
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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29
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Picciotto D, Frascio M, Laudon A, Macciò L, Bui F, Zanetti V, Viazzi F, Garibotto G, Brunori G, Verzola D, Esposito P. MO582: Impaired HIF-1 Regulation in Skeletal Muscle of Patients With Advanced-Stage Chronic Kidney Disease. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac074.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Tiredness and fatigue are common symptoms in patients with chronic kidney disease (CKD), but their underlying mechanisms are unknown and treatments unavailable. Patients with CKD display abnormalities along the entire oxygen cascade, with impaired diffusive and convective oxygen transport, thus contributing to a reduced tissue oxygen supply. Hypoxic adaptation is largely regulated by hypoxia-inducible factor 1 (HIF-1α), encoded by the HIF-1Α gene [1], and peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1α). In response to hypoxia or anemia, the muscle HIF-1α target genes increase oxygen transport through angiogenesis, responsiveness to insulin, cell proliferation and apoptosis/survival [2]. PGC-1α controls the expression of genes involved in mitochondrial biogenesis, energy homeostasis and glucose metabolism. PGC-1α is correlated with a total-body aerobic capacity [3], and its decrease has been detected in muscles of elderly persons and type 2 diabetes patients [3,4]. We hypothesized that desensitization of the HIF-1α driven oxygen-sensing mechanisms occurs in CKD patients.
METHOD
HIF-1α, PGC1α gene and protein expression, studied by Rt–PCR and immunohistochemistry, were assessed in the rectus abdominis muscle biopsies from 31 CKD patients with non-dialysis CKD 5 (18 M/13 F, eGFR 8 ± 1 mL/min) and were compared with those obtained in 10 subjects with normal renal function (7M/3F).
HIF-1α, PGC1α expression was studied also in C2C12 myotubes exposed to 10% normal serum or uremic serum (US) for 48 h. In addition, mitofusin-2 (MFN2), nuclear factor erythroid 2-related factor 2 (NRF2), and oxidative phosphorylation (OXPHOS) related to mitochondria integrity were monitored by Rt–PCR and/or western blot. Changes in the membrane potential were quantified by JC1 staining and fluorimeter analysis.
RESULTS
Despite anemia (Hb 9.5 ± 1 g/dL), HIF-1α mRNA was severely blunted in the muscle of CKD patients, as well as PGC1α that resulted down-regulated in 62.5% of them (P < 0.05) (Fig. 1). Log HIF-1α mRNA was directly related to log eGFR (r = 0.632, P < 0.02), suggesting that the hypoxic response in muscle progressively down-regulates as the renal function declines. In cultured myotubes, US decreases PGC1α, HIF1α, MFN2, NRF2 and OXPHOS and membrane potential (P < 0.05–0.01).
CONCLUSION
In patients with non-dialysis CKD, PGC1α and HIF1α are down-regulated, as well as in an in vitro model that resembles the uremic milieu. On the one hand, these findings are in keeping with impaired oxidative metabolism in the advanced stage of CKD, while on the other hand, they may account for the fatigue often referred by these patients. Moreover, our study suggests that the HIF prolyl hydroxylase inhibitor (HIF-PHIs), currently in clinical development, might be targeted on muscle metabolism and function and tested in the treatment of myopathy and fatigue in CKD.
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Affiliation(s)
- Daniela Picciotto
- IRCCS Ospedale Policlinico San Martino and University of Genova, Italy, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | - Marco Frascio
- IRCCS Ospedale Policlinico San Martino and Universtity of Genova, Italy, Surgical Sciences and Integrated Diagnostics, Genoa, Italy
| | - Alessandro Laudon
- Ospedale Santa Chiara, Trento, Italy, Division of Nephrology and Dialysis, Trento, Italy
| | - Lucia Macciò
- IRCCS Ospedale Policlinico San Martino and University of Genova, Italy, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | - Federica Bui
- IRCCS Ospedale Policlinico San Martino and University of Genova, Italy, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | - Valentina Zanetti
- IRCCS Ospedale Policlinico San Martino and University of Genova, Italy, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | - Francesca Viazzi
- IRCCS Ospedale Policlinico San Martino and University of Genova, Italy, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | | | - Giuliano Brunori
- Ospedale Santa Chiara, Trento, Italy, Division of Nephrology and Dialysis, Trento, Italy
| | | | - Pasquale Esposito
- IRCCS Ospedale Policlinico San Martino and University of Genova, Italy, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
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30
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Russo E, Tagliafico A, Signori A, Brigati F, Cappadona F, Derchi L, Martinoli C, Viazzi F. MO330: AKI and Renal Parenchyma Attenuation in Hospitalized Patients With COVID-19. Nephrol Dial Transplant 2022. [PMCID: PMC9383847 DOI: 10.1093/ndt/gfac068.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIMS Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a worldwide spread since early 2020 and a lot of studies concerning the diagnostic and prognostic role of chest computed tomography (CT) on coronavirus disease (COVID-19) has been published. Renal involvement might be present in up to 75% of cases, significantly impacting on the prognosis. The aim of this study is to clarify the role of opportunistic kidney assessment on non-enhanced chest CT and to evaluate if radiological findings could be associated with relevant clinical information regarding kidney function and patient's prognosis in hospitalized patients with COVID-19. METHOD We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution who underwent chest CT. The standard chest CT-scan acquired in full inspiration include large part of both kidneys as per protocol. Three regions of interest (ROI) of 0.5–0.7 cm2 were positioned in every kidney, right and left to include both the cortex and the medulla. The mean values of attenuation of kidney regions were analysed. The primary and secondary outcomes were the occurrence of acute kidney injury (AKI), in-hospital and 9 months of death for all causes. RESULTS A total of 86 patients with COVID-19 and unenhanced chest CT were analyzed splitting the cohort into CT renal parenchyma attenuation (RPA) quartiles. Patients with a CT RPA below 24 Hounsfield unit (HU) were more likely to develop AKI when compared with other patients (×2 = 2.77, P = .014). An AKI-specific cut-off point of RPA was identified by performing a survival receiver operating characteristic (ROC) curve. At multivariate logistic regression analysis, being in the first quartile of CT RPA was associated with a four-times higher risk of AKI (Table 1) after adjustment for age, gender, hypertension, kidney function at admission and other comorbidities. During a mean 22 ± 15 days of admission, 32 patients died (37.2%). Patients with lower values of RPA at CT (first quartile, <24 HU) were not at a higher risk of death compared with patients with RPA ≥ 24 HU, as shown by Kaplan Maier curve (Fig. 1) and by multivariate Cox regression analysis [HR 1.84 (95% CI 0.82–4.13); P = .14]. CONCLUSION The association between AKI and RPA < 24 HU was independent of age, gender, creatinine and comorbidities. RPA values seemed to be predictive of AKI development in COVID-19 patients who underwent chest CT, suggesting RPA values could significantly improve patients’ care. The opportunistic measure of RPA could help physicians identifying patients with a higher risk of AKI, and this increased awareness could guide choices for diagnostic and therapeutic procedures.
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Affiliation(s)
- Elisa Russo
- Ospedale San Luca, Nephrologic Clinic, Lucca, Italy
| | | | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genova, Italy
| | | | | | - Lorenzo Derchi
- Department of Experimental Medicine, University of Genoa, Genova, Italy
| | - Carlo Martinoli
- Department of Experimental Medicine, University of Genoa, Genova, Italy
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31
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Verzola D, Russo E, Bianca Bertolotto M, Zanetti V, Picciotto D, Cappadona F, Esposito P, Carbone F, Montecucco F, Viazzi F. FC027: Uric Acid Stimulates Cytoskeleton Pathways in Vascular Smooth Muscle Cells Through F-ACTIN Polymerization and Atrogin, Αsma and SM22 up Regulation. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac100.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Hyperuricaemia (HU) has been identified as a risk factor for hypertension and renal disease. The most widely documented pathogenetic mechanisms for the uric acid (UA) mediated vascular and renal damage are vascular inflammation and remodeling.
Vascular smooth muscle cells (VSMCs) possess a distinctive property of plasticity that allows the phenotypic transition and contributes to vascular remodeling. The aim of this study was to investigate UA effects on VSMC cell line, focusing on phenotypic transition and searching for possible signals involved in this process.
METHOD
MOVAS, a mouse VSMC cell line, was exposed for short (0–6 h) or long time (24–48 h) to 0 (No Treated cells: NT), 6, 9 and 12 mg/dL of UA, respectively. We evaluated cell viability by MTT test, migration property in a 48-well microchemotaxis chamber (using an 8 μm pore size, polycarbonate polyvinylpyrrolidone-free filters) and by phalloidin staining. Changes in cytoskeleton proteins [Smoothelin (SMT), alpha-Smooth Muscle Actin (αSMA), Smooth Muscle 22 Alpha (SM 22α)] were detected by real time polymerase chain reaction (rt-PCR) and Western blot. In addition, we evaluated angiotensin receptor 1 (AT1) and atrogin 1 expression by rt-PCR and Map kinase activation (Erk 1,2) by western blot. Lastly, we tested the UA effects on cellular changes through a prior treatment with angiotensin receptor blockers, Valsartan (V) and Losartan (L) 10 µmol.
RESULTS
A small increment in cell proliferation was observed at 24 h (+11%–15%; P < 0.05). UA promoted an increased migratory rate in UA treated VSMCs at 24 and 48 h respect to untreated cells (P < 0.001). These results were confirmed by F-actin intracellular distribution: the AlexaFluor 594-conjugate-phalloidin staining revealed a compact polymerization of F-actin in stress fibers along the major cell axis in untreated cells, while a re-arrangement in thinner and poorly oriented fibers localized at cortical level were found in UA treated cells (Fig. 1). When we evaluated cytoskeleton components, we found out that 24 h UA exposition rose up, SMT (2.5–3.4-fold; P < 0.05), αSMA (1.3–1.5-fold; P < 0.05) and SM 22α levels (1.3–2.5-fold P < 0.05). Conversely, we found a 48 h UA treatment caused them to drop (SMT = –20%–40%, P < 0.05; αSMA = –20%–40%, P < 0.05; SM 22α = –30%–43%, P < 0.05). Atrogin-1 was 2-fold up regulated at 48 h in UA treated VMSCs compared with NT (P = 0.04), suggesting a possible role for UA in cytoskeleton remodeling (Fig. 2). Furthermore, we observed a significant increase in VSMC area (+30%; P < 0.001) regardless of UA concentration and time exposition. Supposing a key role of Angiotensin involvement in UA induced VSMCs changes, AT1 expression was assessed. We found AT1 was up regulated in UA treated VSMCs compared with NT (P = 0.04). As expected, V and L had inhibitory effects on AT1 upregulation. Moreover, the two angiotensin receptors blockers inhibited all the phenotypic changes induced by UA. Lastly, UA induced a time dependent Erk 1, 2 phosphorylation (1.5–2.5-fold versus T0; P < 0.05–0.01), which was reversed by both L and V.
CONCLUSION
The results of this study show for the first time as UA-induced cytoskeletal changes involve polymerization of F-actin, Atrogin, αSMA and up-regulation of SM22.These results reveal the pathways by which UA induces an increase in VSMC area and in migratory rate, suggesting UA as a key player in vascular remodeling.
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Affiliation(s)
| | - Elisa Russo
- Nephrologic Clinic, Ospedale San Luca, Lucca, Italy
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Cappadona F, Sangregorio F, Costa E, Zanetti V, Tugnoli E, Ball L, Battista Traverso G, Viazzi F, Esposito P. MO292: Clinical Characteristics, Management and Outcomes of Critically ill COVID-19 Patients Undergoing CRRT: Comparison Between the First Two Pandemic Waves. Nephrol Dial Transplant 2022. [PMCID: PMC9383911 DOI: 10.1093/ndt/gfac068.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Acute kidney injury (AKI) is a common complication of coronavirus disease-19 (COVID-19), which, particularly in critically ill patients requiring continuous renal replacement therapy (CRRT), is associated with an elevated mortality risk [1, 2]. However, knowledge about COVID-19 pathogenesis and management is evolving, and clinical practice is changing rapidly. Here, we evaluated if this process had an impact on the management and outcome of AKI patients.
METHODS
We performed a retrospective observational study on critically ill adult COVID-19 patients who received CRRT in the intensive care unit (ICU) during the first two pandemic waves before the availability of COVID-19 vaccines: the first one from March to August 2020 (first) and the second one (second) from September to December 2020.
RESULTS
Overall, we considered 63 patients, aged 65 (60–69) years, 76.2% males. The main comorbidities were diabetes (DM), cardiovascular disease (CVD) and chronic kidney disease (CKD). Among them, 28 (44%) were in the first group and 35 (66%) in the second group. There were no significant differences in general characteristics, such as in comorbidities, except for a higher prevalence of CVD in the first group (Fig. 1). Lab examinations at ICU admission, including serum creatinine level (sCr), were not different between the two groups. While all patients required respiratory support, non-invasive ventilation was more prevalent in the second wave. Notably, during this period, decapneization combined with CRRT was introduced. Regarding drugs, we found that in the second group, hydroxychloroquine was abandoned, tocilizumab use was reduced and heparin administration significantly increased. The AKI time course was similar between the patients of the two waves (Fig. 2). There were no significant differences in CRRT techniques. However, in the second, the use of additional CRRT-devices, in particular adsorption-based filters, significantly increased. In most cases, citrate anticoagulation was used in both groups. Looking at the outcomes, we found no significant difference between the two waves. Indeed, 17 (60.2%) and 22 (62.8%) patients died in the ICU in the first and second groups, respectively. The length of ICU hospitalization, days on CRRT, invasive ventilation and DM were significantly related to overall mortality; time of ICU hospitalization was the only remaining significant at multivariate Cox regression. Overall, 21 (33%) patients survived hospitalization. At the 6 months after the discharge, 3 of them died, 3 were on HD and 15 were dialysis-free, even if 6 of them presented CKD.
CONCLUSION
Our data confirm the high complexity and mortality of COVID-19 patients undergoing CRRT. Comparing the first two pandemic waves, we found that the patients also presented similar characteristics in terms of renal function and AKI time course. Regarding treatments, we observed some significant modifications in the management of ventilation, drug administration and dialysis membranes, mainly because of the results of ongoing clinical trials. However, these changes did not impact patients’ outcomes.
These data support the view that only game-change strategies, such as vaccination or infection-specific drugs, may impact the presentation and outcome of COVID-19 patients undergoing CRRT.
Finally, patients surviving this condition deserve special attention in the follow-up.
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Affiliation(s)
- Francesca Cappadona
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Filippo Sangregorio
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Internal Medicine, Universtity of Genova, Genoa, Italy
| | - Elisa Costa
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Internal Medicine, Universtity of Genova, Genoa, Italy
| | - Valentina Zanetti
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Internal Medicine, Universtity of Genova, Genoa, Italy
| | - Erica Tugnoli
- Internal Medicine, Universtity of Genova, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, Universtity of Genova, Genoa, Italy
| | | | - Francesca Viazzi
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Internal Medicine, Universtity of Genova, Genoa, Italy
| | - Pasquale Esposito
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Internal Medicine, Universtity of Genova, Genoa, Italy
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Esposito P, Russo E, Picciotto D, Cappadona F, Battaglia Y, Battista Traverso G, Viazzi F. MO342: Impact of COVID-19 Pandemic on In-Hospital Acute Kidney Injury Epidemiology and Outcomes: A Retrospective Cohort Study. Nephrol Dial Transplant 2022. [PMCID: PMC9383883 DOI: 10.1093/ndt/gfac068.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Acute kidney injury (AKI) is a common complication in patients affected by coronavirus disease-19 (COVID-19) and its development is associated with high mortality [1]. However, it is also clear that the COVID-19 pandemic has effects on the management of diseases not directly related to COVID-19 [2]. In this study, we investigated the impact of the COVID-19 pandemic on general intrahospital AKI incidence and outcomes.
METHOD
We performed a retrospective cohort study comparing data on AKI epidemiology and outcomes of patients hospitalized from January 2016 to December 2019 (pre-COVID-19 period) and from January to December 2020 (COVID-19 period, including both SARS-CoV-2 negative and positive patients). AKI was defined and classified by evaluating the kinetics of intra-hospital creatinine (comparing the peak to the minimum serum creatinine level, considered as the basal value) [3]. The prevalence of chronic kidney disease (CKD) (i.e. eGFR < 60 mL/min) was calculated in patients with previous creatinine values available. Patients with CKD stage 4–5 (i.e. eGFR < 30 mL/min/1.73 m2) and with a length of hospital stay > 30 days were excluded.
RESULTS
A total of 51 681 patients during the pre-COVID-19 period and 10 ,062 during the COVID-19 period (9026 SARS-CoV-2 negative and 1036 SARS-CoV-2 positive patients) were analysed. Patients admitted in the COVID-19 period were significantly older, with a higher prevalence of males and a reduced prevalence of chronic conditions. In-hospital AKI incidence was 31.7% during the COVID-19 period (30.5% in SARS-CoV-2 negative patients and 42.2% in SARS-CoV-2 positive ones) as compared with 25.9% during the pre-COVID-19 period (P < .0001) (Fig. 1). Similarly, the COVID-19 period showed an increase in AKI stage 2–3 incidence both for AKI on CKD and for ‘de novo AKI’. In multivariate analysis, demographic characteristics, length of hospital stay, ICU admission, main comorbidities, basal sCr, admission period (pre-COVID-19 or COVID-19) and SARS-CoV-2 infection were significantly associated with the risk of AKI. In particular, the admission in the COVID-19 period increased the risk of AKI [OR 1.18, 95% confidence interval (95% CI) 1.12–2.25] regardless of SARS-CoV-2 infection. Moreover, we found that in the COVID-19 period, there was an increased number of patients admitted to ICU, accompanied by a significant increase in the length of hospital stay and intrahospital mortality. In the multivariate analysis, development of AKI, admission in the COVID-19 period and active SARS-CoV-2 infection remained significantly and independently associated with mortality risk (Fig. 2).
CONCLUSION
Overall, we found that AKI was more common and severe in the COVID-19 period, regardless of SARS-CoV-2 infection, when compared with patients admitted to the same hospital during the four years before the pandemic. So, we provide evidence that the COVID-19 pandemic has changed general in-hospital AKI epidemiology. These findings call attention to the need to adapt the resources dedicated to the prevention and management of the intra-hospital AKI in response to health emergencies.
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Affiliation(s)
- Pasquale Esposito
- IRCCS Ospedale Policlinico San Martino and Universtity of Genova, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | - Elisa Russo
- IRCCS Ospedale Policlinico San Martino and Universtity of Genova, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | - Daniela Picciotto
- IRCCS Ospedale Policlinico San Martino and Universtity of Genova, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | - Francesca Cappadona
- IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, Ferrara, Italy
| | | | - Francesca Viazzi
- IRCCS Ospedale Policlinico San Martino and Universtity of Genova, Internal Medicine, Clinica Nefrologica, Dialisi e Trapianto, Genoa, Italy
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Masulli M, D'Elia L, Angeli F, Barbagallo CM, Bilancio G, Bombelli M, Bruno B, Casiglia E, Cianci R, Cicero AFG, Cirillo M, Cirillo P, Dell'Oro R, Desideri G, Ferri C, Gesualdo L, Giannattasio C, Grassi G, Iaccarino G, Lippa L, Mallamaci F, Maloberti A, Masi S, Mazza A, Mengozzi A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Virdis A, Volpe M, Borghi C, Galletti F. Serum uric acid levels threshold for mortality in diabetic individuals: The URic acid Right for heArt Health (URRAH) project. Nutr Metab Cardiovasc Dis 2022; 32:1245-1252. [PMID: 35282979 DOI: 10.1016/j.numecd.2022.01.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/16/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM The URRAH (URic acid Right for heArt Health) Study has identified cut-off values of serum uric acid (SUA) predictive of total mortality at 4.7 mg/dl, and cardiovascular (CV) mortality at 5.6 mg/dl. Our aim was to validate these SUA thresholds in people with diabetes. METHODS AND RESULTS The URRAH subpopulation of people with diabetes was studied. All-cause and CV deaths were evaluated at the end of follow-up. A total of 2570 diabetic subjects were studied. During a median follow-up of 107 months, 744 deaths occurred. In the multivariate Cox regression analyses adjusted for several confounders, subjects with SUA ≥5.6 mg/dl had higher risk of total (HR: 1.23, 95%CI: 1.04-1.47) and CV mortality (HR:1.31, 95%CI:1.03-1.66), than those with SUA <5.6 mg/dl. Increased all-cause mortality risk was shown in participants with SUA ≥4.7 mg/dl vs SUA below 4.7 mg/dl, but not statistically significant after adjustment for all confounders. CONCLUSIONS SUA thresholds previously proposed by the URRAH study group are predictive of total and CV mortality also in people with diabetes. The threshold of 5.6 mg/dl can predict both total and CV mortality, and so is candidate to be a clinical cut-off for the definition of hyperuricemia in patients with diabetes.
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Affiliation(s)
- Maria Masulli
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Carlo M Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giancarlo Bilancio
- Department "Scuola Medica Salernitana", Baronissi, SA, University of Salerno
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Berardino Bruno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Massimo Cirillo
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperi's" Department, Niguarda Ca' Granda Hospital, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine, Avezzano, L'Aquila, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, "A.De Gasperi's" Department, Niguarda Ca' Granda Hospital, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria Della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Biomedical Science and Oncology, University of Bari, Bari, Italy
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marcello Rattazzi
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy; Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - Gianpaolo Reboldi
- Department of Medicine and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy.
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Ungar A, Rivasi G, Di Bari M, Virdis A, Casiglia E, Masi S, Mengozzi A, Barbagallo CM, Bombelli M, Bruno B, Cicero AF, Cirillo M, Cirillo P, Desideri G, D’elia L, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Ciccarelli M, Lippa L, Mallamaci F, Maloberti A, Mazza A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Salvetti M, Tikhonoff V, Tocci G, Cianci R, Verdecchia P, Viazzi F, Volpe M, Grassi G, Borghi C. The association of uric acid with mortality modifies at old age: data from the uric acid right for heart health (URRAH) study. J Hypertens 2022; 40:704-711. [PMID: 34939996 PMCID: PMC10863659 DOI: 10.1097/hjh.0000000000003068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/03/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In older individuals, the role of serum uric acid (SUA) as risk factor for mortality is debated. This study investigated the association of SUA with all-cause and cardiovascular (CV) mortality in older adults participating in the large multicentre observational uric acid right for heart health (URRAH) study. METHODS Eight thousand URRAH participants aged 65+ were included in the analysis. The predictive role of SUA was assessed using Cox regression models stratified according to the cut-off age of 75. SUA was tested as continuous and categorical variable (age-specific quartiles). The prognostic threshold of SUA for mortality was analysed using receiver operating characteristic curves. RESULTS Among participants aged 65-74, multivariate Cox regression analysis adjusted for CV risk factors and comorbidities identified an independent association of SUA with both all-cause mortality (hazard ratio [HR] 1.169, 95% confidence interval [CI] 1.107-1.235) and CV mortality (HR 1.146, 95% CI 1.064-1.235). The cut-off value of 4.8 mg/dl discriminated mortality status. In participants aged 75+, we observed a J-shaped relationship of SUA with all-cause and CV mortality, with risk increasing at extreme SUA levels. CONCLUSIONS These results confirmed the predictive role of SUA for all-cause and CV mortality in older adults, while revealing considerable age-related differences. Mortality risk increased at higher SUA levels in participants aged 65-74, with a prognostic threshold of 4.8 mg/dl. The relationship between SUA and mortality was J-shaped in oldest participants. Large interventional studies are needed to clarify the benefits and possible risks of urate-lowering treatments in older adults.
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Affiliation(s)
- Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Mauro Di Bari
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Carlo M. Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Bernardino Bruno
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna
| | - Massimo Cirillo
- Department of Public Health, “Federico II” University of Naples, Naples
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, Bari
| | | | - Lanfranco D’elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, Naples
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, Naples
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, Bari
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi's” Department, Niguarda Ca’ Granda Hospital, Milan
- School of Medicine and Surgery, Milano-Bicocca University, Milan
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples
| | - Michele Ciccarelli
- Department of Medicine Surgery and Odontology, University of Salerno, Fisciano
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L’Aquila
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi's” Department, Niguarda Ca’ Granda Hospital, Milan
- School of Medicine and Surgery, Milano-Bicocca University, Milan
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo
| | | | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari
| | | | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genoa
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Marcello Rattazzi
- Department of Medicine, University of Padua, Padua
- Medicina Interna I, Ca’ Foncello University Hospital, Treviso
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome
- IRCCS Neuromed, Pozzilli
| | | | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genoa
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome
- IRCCS Neuromed, Pozzilli
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna
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Leoncini G, Barnini C, Manco L, Nobili G, Dotta D, Penso M, Russo E, Cappadona F, Viazzi F, Pontremoli R. Uric acid lowering for slowing CKD progression after the CKD-FIX trial: a solved question or still a dilemma? Clin Kidney J 2022; 15:1666-1674. [PMID: 36003668 PMCID: PMC9394710 DOI: 10.1093/ckj/sfac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Hyperuricemia has been associated with several cardiovascular risk factors and is a well-known predictor of kidney disease. In vitro studies as well as animal models highlighted a role for uric acid in the development and progression of haemodynamic and tissue damage at the renal level leading to glomerular and tubulointerstitial abnormalities. Urate-lowering treatment, especially by xanthine oxidase inhibitors, has been proposed in order to improve kidney outcomes. However, recent randomized controlled trials failed to demonstrate a beneficial effect of allopurinol or febuxostat on renal disease, casting doubts on the role of this therapeutical approach to improve nephroprotection. We provide a critical overview of current literature on this topic and offer a possible interpretation of results from recent intervention trials with urate-lowering treatment on renal outcomes.
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Affiliation(s)
- Giovanna Leoncini
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Cecilia Barnini
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Manco
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giulia Nobili
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniele Dotta
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Martina Penso
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Cappadona
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Genovesi S, Giussani M, Orlando A, Lieti G, Viazzi F, Parati G. Relationship between endothelin and nitric oxide pathways in the onset and maintenance of hypertension in children and adolescents. Pediatr Nephrol 2022; 37:537-545. [PMID: 34085102 PMCID: PMC8921137 DOI: 10.1007/s00467-021-05144-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
The mechanisms that regulate blood pressure are numerous and complex; one mechanism that plays an important role in this scenario is represented by the balance between the vasoconstrictor effect of endothelin-1 and the vasodilator effect of nitric oxide. While there is agreement on the fact that increased endothelin-1 activity and decreased nitric oxide bioavailability are present in hypertensive adults, the situation is less clear in children and adolescents. Not all studies agree on the finding of an increase in plasma endothelin-1 levels in hypertensive children and adolescents; in addition, the picture is often confused by the concomitant presence of obesity, a condition that stimulates the production of endothelin-1. Furthermore, there is recent evidence that, in younger obese and hypertensive subjects, there is an overproduction of nitric oxide, rather than a reduction. This condition may change over time, causing endothelial dysfunction due to a reduced availability of nitric oxide in hypertensive adolescents. The purpose of this review is to address the main biochemical and pathophysiological aspects of endothelin and nitric oxide involvement in hypertension and to summarize the available scientific evidence on their role in the onset and maintenance of high blood pressure in children and adolescents.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy. .,Department of Cardiovascular, Neural, and Metabolic Sciences, S Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy.
| | - Marco Giussani
- grid.418224.90000 0004 1757 9530Department of Cardiovascular, Neural, and Metabolic Sciences, S Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Antonina Orlando
- grid.418224.90000 0004 1757 9530Department of Cardiovascular, Neural, and Metabolic Sciences, S Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Giulia Lieti
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy
| | - Francesca Viazzi
- grid.410345.70000 0004 1756 7871Department of Internal Medicine, University of Study and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianfranco Parati
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy ,grid.418224.90000 0004 1757 9530Department of Cardiovascular, Neural, and Metabolic Sciences, S Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
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Abstract
Myostatin is a member of the transforming growth factor (TGF)-β superfamily. It is expressed by animal and human skeletal muscle cells where it limits muscle growth and promotes protein breakdown. Its effects are influenced by complex mechanisms including transcriptional and epigenetic regulation and modulation by extracellular binding proteins. Due to its actions in promoting muscle atrophy and cachexia, myostatin has been investigated as a promising therapeutic target to counteract muscle mass loss in experimental models and patients affected by different muscle-wasting conditions. Moreover, growing evidence indicates that myostatin, beyond to regulate skeletal muscle growth, may have a role in many physiologic and pathologic processes, such as obesity, insulin resistance, cardiovascular and chronic kidney disease. In this chapter, we review myostatin biology, including intracellular and extracellular regulatory pathways, and the role of myostatin in modulating physiologic processes, such as muscle growth and aging. Moreover, we discuss the most relevant experimental and clinical evidence supporting the extra-muscle effects of myostatin. Finally, we consider the main strategies developed and tested to inhibit myostatin in clinical trials and discuss the limits and future perspectives of the research on myostatin.
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Affiliation(s)
- Pasquale Esposito
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Daniela Picciotto
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, Ferrara, Italy
| | - Francesca Costigliolo
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Viazzi
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniela Verzola
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Russo E, Viazzi F, Pontremoli R, Barbagallo CM, Bombelli M, Casiglia E, Cicero AFG, Cirillo M, Cirillo P, Desideri G, D'Elia L, Dell'Oro R, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Leoncini G, Mallamaci F, Maloberti A, Masi S, Mengozzi A, Mazza A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Rattazzi M, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Quarti Trevano FAL, Ungar A, Verdecchia P, Virdis A, Volpe M, Grassi G, Borghi C. Serum Uric Acid and Kidney Disease Measures Independently Predict Cardiovascular and Total Mortality: The Uric Acid Right for Heart Health (URRAH) Project. Front Cardiovasc Med 2021; 8:713652. [PMID: 34646871 PMCID: PMC8502977 DOI: 10.3389/fcvm.2021.713652] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/23/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Serum uric acid predicts the onset and progression of kidney disease, and the occurrence of cardiovascular and all-cause mortality. Nevertheless, it is unclear which is the appropriate definition of hyperuricemia in presence of chronic kidney disease (CKD). Our goal was to study the independent impact of uric acid and CKD on mortality. Methods: We retrospectively investigated 21,963 patients from the URRAH study database. Hyperuricemia was defined on the basis of outcome specific cut-offs separately identified by ROC curves according to eGFR strata. The primary endpoints were cardiovascular and all-cause mortality. Results: After a mean follow-up of 9.8 year, there were 1,582 (7.20%) cardiovascular events and 3,130 (14.25%) deaths for all causes. The incidence of cardiovascular and all-cause mortality increased in parallel with reduction of eGFR strata and with progressively higher uric acid quartiles. During 215,618 person-years of follow-up, the incidence rate for cardiovascular mortality, stratified based on eGFR (>90, between 60 and 90 and <60 ml/min) was significantly higher in patients with hyperuricemia and albuminuria (3.8, 22.1 and 19.1, respectively) as compared to those with only one risk factor or none (0.4, 2.8 and 3.1, respectively). Serum uric acid and eGFR significantly interact in determining cardiovascular and all-cause mortality. For each SUA increase of 1 mg/dl the risk for mortality increased by 10% even after adjustment for potential confounding factors included eGFR and the presence of albuminuria. Conclusions: hyperuricemia is a risk factor for cardiovascular and all-cause mortality additively to eGFR strata and albuminuria, in patients at cardiovascular risk.
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Affiliation(s)
- Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Genova, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Genova, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Genova, Italy
| | - Carlo M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Massimo Cirillo
- Department of Public Health, Federico II University of Naples Medical School, Naples, Italy
| | - Pietro Cirillo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Cristina Giannattasio
- Cardiology IV, A. De Gasperis Department, School of Medicine and Sugery, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples Medical School, Naples, Italy
| | - Giovanna Leoncini
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Genova, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, A. De Gasperis Department, School of Medicine and Sugery, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
| | - Maria L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Marcello Rattazzi
- Department of Medicine, Ca' Foncello University Hospital, University of Padova, Treviso, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | | | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Scagliola R, Bonino B, Viazzi F, Balbi M, Ameri P. Relationship between venous congestion and systemic hypoperfusion in cardiorenal syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Renal impairment takes a relevant role in worsening clinical outcomes and increasing mortality risk in patients with heart failure (HF). In this context, the interplay between venous congestion and systemic perfusion in the pathogenesis of cardiorenal syndrome is currently a matter of extensive debate1.
Purpose
To investigate the relationship between renal function and hemodynamic variables, as the cardiac index and right atrial pressure, in a broad spectrum of HF patients undergoing right heart catheterization, as part of their pulmonary hypertension (PH) diagnostic work-up.
Patients and methods
From 1st September 2005 until 31st October 2019, hemodynamic data from 286 consecutive patients were collected, of whom 267 had available plasmatic creatinine values. The estimated glomerular filtration rate (eGFR) was calculated by using the Chronic Kidney Disease Epidemiology Collaboration formula. The overall study population was stratified in no PH group, pre-capillary PH group and post-capillary PH group, on the basis of the available hemodynamic values of mean pulmonary arterial pressure and pulmonary artery wedge pressure.
Results
Of the overall population, 46.1% of them were male, the mean age at the right heart catheterization was 65.5±13.7 years, and the mean eGFR value was 70.0±0.2 mL/min/1.73 m2. On the basis of hemodynamic parameters, 71 patients constituted the no PH group, 107 the pre-capillary PH group, and 63 the post-capillary PH group. Post-capillary PH patients were significantly older than both no PH and pre-capillary PH subjects (69.4±11.7 years; 61.2±16.7 years and 65.7±12.9 years respectively, p=0.003). eGFR was significantly lower in the post-capillary PH group, compared to both no PH group (63.1±22.8 mL/min/1.73 m2 vs. 73.0±23.9 mL/min/1.73 m2, p=0.029) and pre-capillary PH group (63.1±22.8 mL/min/1.73 m2 vs. 71.6±26.6 mL/min/1.73 m2, p=0.041). In post-capillary PH group, multivariate logistic regression analysis showed a significant correlation between eGFR <60 mL/min/1.73 m2 and both reduced cardiac index (Odds ratio [OR] 0.05, 95% confidence interval [CI] 0.00 to 0.72, p=0.027) and right atrial pressure (OR 0.75, 95% CI 0.57 to 0.99, p=0.039), compared to no PH group and pre-capillary PH group.
Conclusions
A significant association between renal impairment and both low systemic perfusion and venous congestion, was found in patients with post-capillary PH, rather than in other hemodynamic subsets. Further investigations are needed to disentangle the impact of the both sides of circulation on renal function, in different hemodynamic phenotypes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Scagliola
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Disease Unit, Genoa, Italy
| | - B Bonino
- Ospedale Policlinico San Martino IRCCS, Nephrology and Haemodialysis Unit, Genoa, Italy
| | - F Viazzi
- Ospedale Policlinico San Martino IRCCS, Nephrology and Haemodialysis Unit, Genoa, Italy
| | - M Balbi
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Disease Unit, Genoa, Italy
| | - P Ameri
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Disease Unit, Genoa, Italy
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Esposito P, Verzola D, Picciotto D, Cipriani L, Viazzi F, Garibotto G. Myostatin/Activin-A Signaling in the Vessel Wall and Vascular Calcification. Cells 2021; 10:2070. [PMID: 34440838 PMCID: PMC8393536 DOI: 10.3390/cells10082070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/15/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023] Open
Abstract
A current hypothesis is that transforming growth factor-β signaling ligands, such as activin-A and myostatin, play a role in vascular damage in atherosclerosis and chronic kidney disease (CKD). Myostatin and activin-A bind with different affinity the activin receptors (type I or II), activating distinct intracellular signaling pathways and finally leading to modulation of gene expression. Myostatin and activin-A are expressed by different cell types and tissues, including muscle, kidney, reproductive system, immune cells, heart, and vessels, where they exert pleiotropic effects. In arterial vessels, experimental evidence indicates that myostatin may mostly promote vascular inflammation and premature aging, while activin-A is involved in the pathogenesis of vascular calcification and CKD-related mineral bone disorders. In this review, we discuss novel insights into the biology and physiology of the role played by myostatin and activin in the vascular wall, focusing on the experimental and clinical data, which suggest the involvement of these molecules in vascular remodeling and calcification processes. Moreover, we describe the strategies that have been used to modulate the activin downward signal. Understanding the role of myostatin/activin signaling in vascular disease and bone metabolism may provide novel therapeutic opportunities to improve the treatment of conditions still associated with high morbidity and mortality.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (L.C.); (F.V.)
- IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi, Trapianto, 16132 Genova, Italy;
| | - Daniela Verzola
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (L.C.); (F.V.)
| | - Daniela Picciotto
- IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi, Trapianto, 16132 Genova, Italy;
| | - Leda Cipriani
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (L.C.); (F.V.)
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (L.C.); (F.V.)
- IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi, Trapianto, 16132 Genova, Italy;
| | - Giacomo Garibotto
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (P.E.); (D.V.); (L.C.); (F.V.)
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Russo E, Viazzi F. Relationship between uric acid and kidney function in adults at risk for tumor lysis syndrome. Leuk Lymphoma 2021; 62:3067-3069. [PMID: 34296657 DOI: 10.1080/10428194.2021.1957880] [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: 10/20/2022]
Affiliation(s)
- Elisa Russo
- University of Genoa and IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy
| | - Francesca Viazzi
- University of Genoa and IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy
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Esposito P, Cipriani L, Verzola D, Grignano MA, Grosjean F, Russo E, Rampino T, Viazzi F. MO905EFFECTS OF DIFFERENT DIALYSIS TECHNIQUES ON INFLAMMATION IN MAINTENANCE HEMODIALYSIS PATIENTS WITH COVID-19: A RANDOMIZED STUDY. Nephrol Dial Transplant 2021. [PMCID: PMC8195053 DOI: 10.1093/ndt/gfab102.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022] Open
Abstract
Background and Aims Uncontrolled inflammation plays a relevant role in the pathogenesis of Coronavirus Disease-19 (COVID-19) and has been related to disease severity and unfavorable outcomes. Here, we studied the time trend of pro-and anti-inflammatory markers in a population of patients undergoing hemodialysis (HD) affected by COVID-19, evaluating the potential modulating effects of two different dialysis approaches. Method For this prospective randomized study, we recruited maintenance hemodialysis patients with confirmed COVID-19 infection. After diagnosis, the patients were randomized to two different dialysis modalities, expanded HD (HDx), performed by use of a medium cut-off membrane, and standard treatment based on the use of a protein-leaking dialyzer (PLD). Clinical and laboratory data were collected, including circulating pre and post-dialysis levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), soluble TLR4 (sTLR4), and interferon-gamma (IFN-g). Samples were collected at diagnosis (T0), one and two weeks after the diagnosis (T7 and T14, respectively). Results Twenty-seven HD patients with COVID-19 (69.7 ±16.6 years, 14 males) were compared with 14 non-infected HD patients, as the control group. COVID-19 patients presented a significantly reduced number of lymphocytes, including CD4 andCD8 subpopulations, and higher levels of ferritin and lactate dehydrogenase. Moreover, COVID-19 patients had higher levels of IL-6 [35.5 (59.4) vs 12 (43) pg/ml, p=0.048] and IL-10 [9.3 (20.8) vs 1.2 (1.4) pg/ml, p=0.02], while the levels of IL-8 and sTLR4 were comparable. Then, twenty-five patients were randomized to undergo HDx (n.15) or PLD (n.10). Basal characteristics and cytokine levels were not significantly different between the two groups. All over the study, no significant modifications of circulating cytokine levels were observed. Similarly, no significant differences were found between patients on HDx or PLD evaluated at different time points. After a single HD treatment, IL-8 showed a significant reduction compared to pre-dialysis levels in both groups. IL-8 reduction rate resulted significantly correlated with IL-8 pre-dialysis levels. Finally, there were no correlations between cytokine levels and clinical characteristics and outcomes. Conclusion In maintenance HD patients, COVID-19 is not related to a sustained inflammatory response. Modulation of the inflammation is not a suitable therapeutic target in this specific population. Other mechanisms could be involved in the pathogenesis of COVID-19 in HD patients.
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Affiliation(s)
- Pasquale Esposito
- University of Genova, Department of Internal Medicine, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italia. Clinica Nefrologica, Dialisi, Trapianto
| | - Leda Cipriani
- University of Genova, Department of Internal Medicine, Genova, Italy
| | - Daniela Verzola
- University of Genova, Department of Internal Medicine, Genova, Italy
| | - Maria Antonietta Grignano
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Italy
| | - Fabrizio Grosjean
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Italy
| | - Elisa Russo
- University of Genova, Department of Internal Medicine, Genova, Italy
| | - Teresa Rampino
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Italy
| | - Francesca Viazzi
- University of Genova, Department of Internal Medicine, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italia. Clinica Nefrologica, Dialisi, Trapianto
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D'Ercole M, Cipriani L, Picciotto D, Bianzina S, Russo E, Viazzi F, Esposito P. Hyperkalemia-induced acute flaccid paralysis: a case report. G Ital Nefrol 2021; 38:38-02-2021-09. [PMID: 33852225 DOI: pmid/33852225] [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: 02/07/2023]
Abstract
Acute flaccid paralysis is a medical emergency that may be caused by primary neuro-muscular disorders, metabolic alterations, and iatrogenic effects. Severe hyperkalemia is also a potential cause, especially in elderly patients with impaired renal function. Early diagnosis is essential for appropriate management. Here, we report the case of a 78-year-old woman with hypertension and diabetes presenting to the emergency department because of pronounced asthenia, rapidly evolving in quadriparesis. Laboratory examinations showed severe hyperkalemia of 9.9 mmol/L, metabolic acidosis, kidney failure (creatinine 1.6 mg/dl), and hyperglycemia (501 mg/dl). The electrocardiography showed absent P-wave, widening QRS, and tall T-waves. The patient was immediately treated with medical therapy and a hemodialysis session, presenting a rapid resolution of electrocardiographic and neurological abnormalities. This case offers the opportunity to discuss the pathogenesis, the clinical presentation, and the management of hyperkalemia-induced acute flaccid paralysis.
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Affiliation(s)
- Martina D'Ercole
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Leda Cipriani
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Daniela Picciotto
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefania Bianzina
- Neonatal and Pediatric Intensive Care Unit, G. Gaslini Institute, Genova, Italy
| | - Elisa Russo
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Francesca Viazzi
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Pasquale Esposito
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
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Esposito P, Civati A, Picciotto D, Falqui V, Conti N, Russo E, Viazzi F. Central line-associated bloodstream infections in hemodialysis patients in the COVID-19 era. Hemodial Int 2021; 25:275-278. [PMID: 33533126 PMCID: PMC8013291 DOI: 10.1111/hdi.12910] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/14/2020] [Accepted: 01/14/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Pasquale Esposito
- Unit of Nephrology, Dialysis and Transplantation, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Alessandra Civati
- Unit of Nephrology, Dialysis and Transplantation, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Daniela Picciotto
- Unit of Nephrology, Dialysis and Transplantation, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Valeria Falqui
- Unit of Nephrology, Dialysis and Transplantation, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Novella Conti
- Unit of Nephrology, Dialysis and Transplantation, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Elisa Russo
- Unit of Nephrology, Dialysis and Transplantation, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Francesca Viazzi
- Unit of Nephrology, Dialysis and Transplantation, Department of Internal MedicineUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
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Esposito P, Cipriani L, Verzola D, Grignano MA, De Amici M, Testa G, Grosjean F, Russo E, Garibotto G, Rampino T, Viazzi F. Effects of Different Dialysis Strategies on Inflammatory Cytokine Profile in Maintenance Hemodialysis Patients with COVID-19: A Randomized Trial. J Clin Med 2021; 10:jcm10071383. [PMID: 33808205 PMCID: PMC8037035 DOI: 10.3390/jcm10071383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/04/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023] Open
Abstract
Uncontrolled inflammation plays a relevant role in the pathogenesis of coronavirus disease-19 (COVID-19). Here, we studied the time trend of inflammatory markers in a population of hemodialysis (HD) patients affected by COVID-19, undergoing two different dialysis approaches. In a prospective study, thirty-one maintenance HD patients with COVID-19 were randomized to expanded HD (HDx), performed using a medium cut-off membrane, or standard treatment using a protein-leaking dialyzer (PLD). Circulating levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), soluble TLR4 (sTLR4), and interferon-gamma (IFN-γ), were collected at diagnosis, and one and two weeks after. Compared with 14 non-infected HD patients, COVID-19 patients showed lymphopenia and higher ferritin and lactate dehydrogenase levels. Moreover, COVID-19 patients had higher levels of IL-10 (15.2 (12.5) vs. 1.2 (1.4) pg/mL, p = 0.02). Twenty-nine patients were randomized to HDx (n = 15) or PLD (n = 14). After a single treatment, IL-8 showed a significant reduction in both groups, whereas IL-10 decreased only in HDx. All over the study, there were no significant modifications in circulating cytokine levels between the two groups, except for a parallel increase of IL-8 and IL-10 at one week control in the HDx group. No correlations were found between cytokine levels and clinical outcomes. In maintenance HD patients, COVID-19 is not related to a sustained inflammatory response. Therefore, modulation of inflammation seems not to be a suitable therapeutic target in this specific population.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
- IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi, Trapianto, 16132 Genova, Italy
- Correspondence:
| | - Leda Cipriani
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
| | - Daniela Verzola
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
| | - Maria Antonietta Grignano
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, 27100 Pavia, Italy; (M.A.G.); (F.G.); (T.R.)
| | - Mara De Amici
- Laboratory of Immuno-Allergology of Clinical Chemistry and Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Giorgia Testa
- Pediatrics Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Fabrizio Grosjean
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, 27100 Pavia, Italy; (M.A.G.); (F.G.); (T.R.)
| | - Elisa Russo
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
| | - Giacomo Garibotto
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
| | - Teresa Rampino
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, 27100 Pavia, Italy; (M.A.G.); (F.G.); (T.R.)
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy; (L.C.); (D.V.); (E.R.); (G.G.); (F.V.)
- IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi, Trapianto, 16132 Genova, Italy
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Abstract
Uric acid has long been considered responsible for a single specific disease, namely gout. In recent years, novel knowledge has emerged linking serum uric acid with a variety of conditions and related risk factors, from hypertension, metabolic syndrome, and type 2 diabetes, to fatal/nonfatal cardiovascular diseases and all-cause death, with the underlying mechanisms involving disrupted neurohormonal and metabolic signaling as well as oxidative stress and inflammation. Importantly, the cut-off value of serum uric acid predicting the risk of incident events is within the range of normality and below the threshold for increased risk of gout. A large contribution to the advancement in knowledge in the cardiovascular implications of uric acid derives from the Italian study URic acid Right for heArt Health (URRAH). This review summarizes the mechanisms linking uric acid with cardiovascular risk and the major findings of the URRAH study. The need for a reappraisal of the definition of range of normality for uric acid is discussed.
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Affiliation(s)
- Rita Del Pinto
- Dipartimento Medicina Clinica, Sanità Pubblica, Scienza della Vita e dell'Ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Francesca Viazzi
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy
| | - Roberto Pontremoli
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy
| | - Claudio Ferri
- Dipartimento Medicina Clinica, Sanità Pubblica, Scienza della Vita e dell'Ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy -
| | - Francesco Carubbi
- Dipartimento Medicina Clinica, Sanità Pubblica, Scienza della Vita e dell'Ambiente, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Elisa Russo
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy
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Russo E, Viazzi F, Pontremoli R, Barbagallo CM, Bombelli M, Casiglia E, Cicero AFG, Cirillo M, Cirillo P, Desideri G, D'Elia L, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Leoncini G, Mallamaci F, Maloberti A, Masi S, Mengozzi A, Mazza A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Rattazzi M, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Virdis A, Volpe M, Grassi G, Borghi C. Association of uric acid with kidney function and albuminuria: the Uric Acid Right for heArt Health (URRAH) Project. J Nephrol 2021; 35:211-221. [PMID: 33755930 PMCID: PMC8803667 DOI: 10.1007/s40620-021-00985-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/06/2020] [Accepted: 01/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hyperuricemia is commonly observed in patients with chronic kidney disease (CKD). However, a better understanding of the relationship among uric acid (UA) values, glomerular filtration rate (GFR) and albuminuria may shed light on the mechanisms underlying the excess of cardiovascular mortality associated with both chronic kidney disease and hyperuricemia and lead to better risk stratification. Our main goal was to study the relationships between serum uric acid and kidney disease measures (namely estimated GFR [eGFR] and albuminuria) in a large cohort of individuals at cardiovascular risk from the URic acid Right for heArt Health (URRAH) Project database. METHODS Clinical data of 26,971 individuals were analyzed. Factors associated with the presence of hyperuricemia defined on the basis of previously determined URRAH cutoffs for cardiovascular and all-cause mortality were evaluated through multivariate analysis. Chronic kidney disease was defined as eGFR < 60 ml/min per 1.73 m2 and/or abnormal urinary albumin excretion diagnosed as: (i) microalbuminuria if urinary albumin concentration was > 30 and ≤ 300 mg/L, or if urinary albumin-to-creatinine ratio (ACR) was > 3.4 mg/mmol and ≤ 34 mg/mmol; (ii) macroalbuminuria if urinary albumin concentration was > 300 mg/L, or if ACR was > 34 mg/mmol. RESULTS Mean age was 58 ± 15 years (51% males, 62% with hypertension and 12% with diabetes), mean eGFR was 81 ml/min per 1.73m22with a prevalence of eGFR < 60 and micro- or macroalbuminuria of 16, 15 and 4%, respectively. Serum uric acid showed a trend towards higher values along with decreasing renal function. Both the prevalence of gout and the frequency of allopurinol use increased significantly with the reduction of eGFR and the increase in albuminuria. Hyperuricemia was independently related to male gender, eGFR strata, and signs of insulin resistance such as body mass index (BMI) and triglycerides. CONCLUSIONS The lower the eGFR the higher the prevalence of hyperuricemia and gout. In subjects with eGFR < 60 ml/min the occurrence of hyperuricemia is about 10 times higher than in those with eGFR > 90 ml/min. The percentage of individuals treated with allopurinol was below 2% when GFR was above 60 ml/min, it increased to 20% in the presence of CKD 3b and rose further to 35% in individuals with macroalbuminuria.
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Affiliation(s)
- Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Viale Benedetto XV, 6, 16132, Genoa, Italy.
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Michele Bombelli
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Monza, Italy
| | - Edoardo Casiglia
- Department of Medicine, Studium Patavinum, University of Padua, Padua, Italy
| | | | - Massimo Cirillo
- Department of Public Health, Federico II University of Naples Medical School, Naples, Italy
| | - Pietro Cirillo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Cristina Giannattasio
- Cardiology IV, A. De Gasperis Department, Health Science Department, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples Medical School, Naples, Italy
| | - Giovanna Leoncini
- Department of Internal Medicine, University of Genoa and IRCCS Ospdedale Policlinico San Martino, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Francesca Mallamaci
- Reggio Cal Unit, CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, A. De Gasperis Department, Health Science Department, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Paolo Palatini
- Department of Medicine, Studium Patavinum, University of Padua, Padua, Italy
| | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, Milan, Italy
| | - Marcello Rattazzi
- Department of Medicine, Medicina Interna 1°, Ca' Foncello University Hospital, University of Padova, Treviso, Italy
| | - Giulia Rivasi
- Department of Medicine, University of Padua, Padua, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Monza, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Affiliation(s)
- Elisa Russo
- Department of Internal Medicine, Ospedale Policlinico San Martino, Viale Benedetto XV, 16132, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, Ospedale Policlinico San Martino, Viale Benedetto XV, 16132, Genoa, Italy.
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50
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Pugliese NR, Mengozzi A, Virdis A, Casiglia E, Tikhonoff V, Cicero AFG, Ungar A, Rivasi G, Salvetti M, Barbagallo CM, Bombelli M, Dell'Oro R, Bruno B, Lippa L, D'Elia L, Verdecchia P, Mallamaci F, Cirillo M, Rattazzi M, Cirillo P, Gesualdo L, Mazza A, Giannattasio C, Maloberti A, Volpe M, Tocci G, Georgiopoulos G, Iaccarino G, Nazzaro P, Parati G, Palatini P, Galletti F, Ferri C, Desideri G, Viazzi F, Pontremoli R, Muiesan ML, Grassi G, Masi S, Borghi C. The importance of including uric acid in the definition of metabolic syndrome when assessing the mortality risk. Clin Res Cardiol 2021; 110:1073-1082. [PMID: 33604722 PMCID: PMC8238697 DOI: 10.1007/s00392-021-01815-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/01/2021] [Indexed: 12/18/2022]
Abstract
Introduction Serum uric acid (SUA) has been depicted as a contributory causal factor in metabolic syndrome (MS), which in turn, portends unfavourable prognosis. Aim We assessed the prognostic role of SUA in patients with and without MS. Methods We used data from the multicentre Uric Acid Right for Heart Health study and considered cardiovascular mortality (CVM) as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. Results A total of 9589 subjects (median age 58.5 years, 45% males) were included in the analysis, and 5100 (53%) patients had a final diagnosis of MS. After a median follow-up of 142 months, we observed 558 events. Using a previously validated cardiovascular SUA cut-off to predict CVM (> 5.1 mg/dL in women and 5.6 mg/dL in men), elevated SUA levels were significantly associated to a worse outcome in patients with and without MS (all p < 0.0001) and provided a significant net reclassification improvement of 7.1% over the diagnosis of MS for CVM (p = 0.004). Cox regression analyses identified an independent association between SUA and CVM (Hazard Ratio: 1.79 [95% CI, 1.15–2.79]; p < 0.0001) after the adjustment for MS, its single components and renal function. Three specific combinations of the MS components were associated with higher CVM when increasing SUA levels were reported, and systemic hypertension was the only individual component ever-present (all p < 0.0001). Conclusion Increasing SUA levels are associated with a higher CVM risk irrespective of the presence of MS: a cardiovascular SUA threshold may improve risk stratification. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01815-0.
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Affiliation(s)
- Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | | | - Valerie Tikhonoff
- Department of Medicine and Studium Patavinum, University of Padua, Padua, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Science, Hypertension and Cardiovascular Risk Factors Research Center, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Berardino Bruno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luciano Lippa
- Italian Society of General Medicine, Avezzano, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | | | - Francesca Mallamaci
- Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, CNR-IFC, Reggio Calabria, Italy
| | - Massimo Cirillo
- Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Marcello Rattazzi
- Department of Medicine, Medicina Interna 1°, Ca' Foncello University Hospital, University of Padova, Treviso, Italy
| | - Pietro Cirillo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
| | - Cristina Giannattasio
- Cardiology IV, A. De Gasperis Department, Health Science Department, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
| | - Alessandro Maloberti
- Cardiology IV, A. De Gasperis Department, Health Science Department, Niguarda Ca' Granda Hospital, Milano-Bicocca University, Milan, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Georgios Georgiopoulos
- First Department of Cardiology, Medical School, Hippokration Hospital, University of Athens, Athens, Greece
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS S. Luca Hospital, Lucca, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Paolo Palatini
- Department of Medicine, University of Padua, Padua, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Science, Hypertension and Cardiovascular Risk Factors Research Center, Alma Mater Studiorum University of Bologna, Bologna, Italy
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