1
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Popa C, Piccoli GB. Ironing Out the Details: How to Manage Anemia in Pregnancy in Women Living With CKD. Kidney Int Rep 2024; 9:1152-1156. [PMID: 38707812 PMCID: PMC11069003 DOI: 10.1016/j.ekir.2024.03.019] [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] [Indexed: 05/07/2024] Open
Affiliation(s)
- Cristina Popa
- Nephrology, Dialysis, Transplantation, Clinical Hospital Dr C I Parhon, Iasi, Romania
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2
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Kalantar-Zadeh K, Bellizzi V, Piccoli GB, Shi Y, Lim SK, Riaz S, Arronte RU, Lau WP, Fouque D. Caring for Patients With Advanced Chronic Kidney Disease: Dietary Options and Conservative Care Instead of Maintenance Dialysis. J Ren Nutr 2023:S1051-2276(23)00022-5. [PMID: 36796502 DOI: 10.1053/j.jrn.2023.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
An expert advisory board discussed the prevention and treatment of chronic kidney disease (CKD), with a focus on dietary options. This is timely, given the uptake of value based models for kidney care in the United States. Timing of dialysis start is influenced by patients' clinical status and complex patient-clinician interactions. Patients value personal freedom and quality of life and may want to delay dialysis, whilst physicians are sometimes more concerned with clinical outcomes. Kidney-preserving therapy can prolong the dialysis-free period and preserve residual kidney function, thus patients are asked to adjust their lifestyle and diet, to follow a low- or very low-protein diet, with or without ketoacid analogues. Multi-modal approaches include pharmacotherapies, management of symptoms, and a gradual, individualized dialysis transition. Patient empowerment is vital, including CKD education and involvement in decision making. These ideas may help patients, their families, and clinical teams to improve the management of CKD.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Orange County, California
| | - Vincenzo Bellizzi
- Nephrology and Dialysis Division, Department of Medical Sciences, Hospital Sant'Anna e San Sebastiano, Caserta, Italy
| | - Giorgina B Piccoli
- Service de Néphrologie, Department of Medicine, Centre Hospitalier Le Mans, Le Mans, France
| | - Yunying Shi
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Soo Kun Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sumira Riaz
- Royal National Orthopaedic Hospital, London, UK
| | | | - Wai Pooi Lau
- Department of Dietetics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Cardiometabolism and Nutrition (CarMeN), Lyon, France.
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3
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Agar JWM, Piccoli GB. The regrets of a green dialysis warrior. J Nephrol 2022; 35:1949-1951. [PMID: 36242737 DOI: 10.1007/s40620-022-01472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- John W M Agar
- Renal Services, University Hospital Geelong, and Barwon Health, 74-76 Swanston Street, Geelong, VIC, 3220, Australia.
- Deakin University School of Medicine, Waurn Ponds, Geelong, VIC, 3221, Australia.
- , 9 Deans Marsh Road, Lorne, VIC, 3232, Australia.
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4
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Piccoli GB, Cabiddu G. Outside the box. The history of dialysis teaches a lesson of freedom. J Nephrol 2022; 35:1311-1313. [PMID: 35713796 DOI: 10.1007/s40620-022-01372-3] [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: 10/18/2022]
Affiliation(s)
- Giorgina B Piccoli
- Nephrologie, Centre Hospitalier Le Mans, Avenue Roubillard 186, 72000, Le Mans, France.
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5
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Pavlovic D, Salehi T, Piccoli GB, Coates PT. Half a Century of Haemodialysis: Two Patient Journeys. Clin Kidney J 2022; 15:1622-1625. [PMID: 35892017 PMCID: PMC9308084 DOI: 10.1093/ckj/sfac089] [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: 03/04/2022] [Indexed: 11/20/2022] Open
Abstract
The history of renal replacement therapy (RRT) for end-stage kidney disease (ESKD) started in 1960 and has reached, in these six decades, goals initially unforeseen. This report describes two patients who commenced dialysis at the age of 17 and 27, for 53 and 45 years, respectively, whereby the modality of RRT was mostly in the form of home haemodialysis. The history of these two patients, who started RRT in distant parts of the world, Australia and Croatia, highlights not only the advances made over time, to significantly delay the onset and reduce the morbidity and mortality associated with ESKD, but also underlines the importance of empowerment and commitment, added values in home haemodialysis.
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Affiliation(s)
- Drasko Pavlovic
- Polyclinic for Internal Medicine and Dialysis B.Braun Avitum, Zagreb, Croatia
| | - Tania Salehi
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
| | | | - Patrick T Coates
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia
- The University of Adelaide, Adelaide, Australia
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6
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Vanholder R, Agar J, Braks M, Gallego D, Gerritsen KGF, Harber M, Noruisiene E, Pancirova J, Piccoli GB, Stamatialis D, Wieringa F. OUP accepted manuscript. Nephrol Dial Transplant 2022; 38:1080-1088. [PMID: 35481547 DOI: 10.1093/ndt/gfac160] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
The world faces a dramatic man-made ecologic disaster and healthcare is a crucial part of this problem. Compared with other therapeutic areas, nephrology care, and especially dialysis, creates an excessive burden via water consumption, greenhouse gas emission and waste production. In this advocacy article from the European Kidney Health Alliance we describe the mutual impact of climate change on kidney health and kidney care on ecology. We propose an array of measures as potential solutions related to the prevention of kidney disease, kidney transplantation and green dialysis. For dialysis, several proactive suggestions are made, especially by lowering water consumption, implementing energy-neutral policies, waste triage and recycling of materials. These include original proposals such as dialysate regeneration, dialysate flow reduction, water distillation systems for dialysate production, heat pumps for unit climatization, heat exchangers for dialysate warming, biodegradable and bio-based polymers, alternative power sources, repurposing of plastic waste (e.g. incorporation in concrete), registration systems of ecologic burden and platforms to exchange ecologic best practices. We also discuss how the European Green Deal offers real potential for supporting and galvanizing these urgent environmental changes. Finally, we formulate recommendations to professionals, manufacturers, providers and policymakers on how this correction can be achieved.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Gent, Belgium
| | - John Agar
- Renal Services, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
| | - Daniel Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patients Federation, Wien, Austria
| | - Karin G F Gerritsen
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mark Harber
- University College London, Department of Renal Medicine, London, UK
| | - Edita Noruisiene
- European Kidney Health Alliance, Brussels, Belgium
- European Dialysis and Transplant Nurses Association-European Renal Care Association, Hergiswil, Switzerland
| | - Jitka Pancirova
- European Dialysis and Transplant Nurses Association-European Renal Care Association, Hergiswil, Switzerland
| | | | - Dimitrios Stamatialis
- Advanced Organ Bioengineering and Therapeutics-Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Fokko Wieringa
- European Kidney Health Alliance, Brussels, Belgium
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
- imec the Netherlands, Holst Centre, Eindhoven, The Netherlands
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7
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Cravedi P, Leventhal JS, Piccoli GB. Hypertension and glomerular diseases: the importance of a holistic approach. J Nephrol 2021; 34:1053-1055. [PMID: 33580456 DOI: 10.1007/s40620-021-00977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Translational Transplant Research Center, New York, NY, USA.
| | | | - Giorgina B Piccoli
- Centre Hospitalier Le Mans, Le Mans, France.,Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
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8
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Longhitano E, Zirino F, Calabrese V, Giuffrida A, Gembillo G, Cernaro V, Masturzo B, Attini R, Torreggiani M, Piccoli GB, Santoro D. Commonly used immunosuppressive drugs for kidney diseases and pregnancy: focus on open questions. Expert Rev Clin Pharmacol 2021; 14:1321-1323. [PMID: 34402354 DOI: 10.1080/17512433.2021.1968831] [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] [Indexed: 10/20/2022]
Abstract
Pregnancy is still a challenge in women with autoimmune diseases or kidney transplantation. In this context, management of the immunosuppressive therapy is critical, but, in spite of more than 60 years of experience, many issues remain open, also because of the difficulty in disentangling, in complex patients, the effect of the disease and of the frequent multiple treatments. For this purpose, we have tried to synthesize the existing knowledge and the unresolved issues, to support counseling and promote patient empowerment.
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Affiliation(s)
- Elisa Longhitano
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Fortunata Zirino
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Vincenzo Calabrese
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Alfio Giuffrida
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Guido Gembillo
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Valeria Cernaro
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology SC2U, Città Della Salute E Della Scienza, Sant'Anna Hospital, Turin, Italy
| | - Rossella Attini
- Department of Obstetrics and Gynecology SC2U, Città Della Salute E Della Scienza, Sant'Anna Hospital, Turin, Italy
| | | | - Giorgina B Piccoli
- Néphrologie Et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
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9
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Torreggiani M, Esposito C, Martinelli E, Jouve T, Chatrenet A, Rostaing L, Colucci M, Pasquinucci E, Sileno G, Esposito V, Piccoli GB, Malvezzi P. Outcomes in Living Donor Kidney Transplantation: The Role of Donor's Kidney Function. Kidney Blood Press Res 2021; 46:84-94. [PMID: 33592619 DOI: 10.1159/000512177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Living donor kidney transplant (LDKT) is one of the best therapeutic options for end-stage kidney disease (ESKD). Guidelines identify different estimated glomerular filtration rate (eGFR) thresholds to determine the eligibility of donors. The aim of our study was to evaluate whether pretransplant donor eGFR was associated with kidney function in the recipient. METHODS We retrospectively studied LDKT recipients who received a kidney graft between September 1, 2005, and June 30, 2016 in the same transplant center in France and that had eGFR data available at 3, 12, 24, and 36 months posttransplant. RESULTS We studied 90 donor-recipient pairs. The average age at time of transplant was 51.47 ± 10.95 for donors and 43.04 ± 13.52 years for recipients. Donors' average eGFR was 91.99 ± 15.37 mL/min/1.73 m2. Donor's age and eGFR were significantly correlated (p < 0.0001, r2 0.023). Donor's age and eGFR significantly correlated with recipient's eGFR at 3, 12, and 24 months posttransplant (age: p < 0.001 at all intervals; eGFR p = 0.001, 0.003, and 0.016, respectively); at 36 months, only donor's age significantly correlated with recipient's eGFR. BMI, gender match, and year of kidney transplant did not correlate with graft function. In the multivariable analyses, donor's eGFR and donor's age were found to be associated with graft function; correlation with eGFR was lost at 36 months; and donor's age retained a strong correlation with graft function at all intervals (p < 0.001). CONCLUSIONS Donor's eGFR and age are strong predictors of recipient's kidney function at 3 years. We suggest that donor's eGFR should be clinically balanced with other determinants of kidney function and in particular with age.
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Affiliation(s)
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A., Pavia, Italy.,Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Pavia, Italy
| | - Elena Martinelli
- Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Pavia, Italy
| | - Thomas Jouve
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Antoine Chatrenet
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Le Mans, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Marco Colucci
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A., Pavia, Italy
| | - Ettore Pasquinucci
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A., Pavia, Italy.,Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Pavia, Italy
| | - Giuseppe Sileno
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A., Pavia, Italy
| | | | - Giorgina B Piccoli
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Le Mans, France.,Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Torino, Italy
| | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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10
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Orozco-Guillien AO, Muñoz-Manrique C, Reyes-López MA, Perichat-Perera O, Miranda-Araujo O, D'Alessandro C, Piccoli GB. Quality or Quantity of Proteins in the Diet for CKD Patients: Does "Junk Food" Make a Difference? Lessons from a High-Risk Pregnancy. Kidney Blood Press Res 2021; 46:1-10. [PMID: 33535222 DOI: 10.1159/000511539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/18/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND How to manage patients with severe kidney disease in pregnancy is still a matter of discussion, and deciding if and when to start dialysis is based on the specialist's experience and dialysis availability. The effect of toxic substances usually cleared by the kidney may be more severe and readily evident. The review, and related case, underlines the importance of considering the presence of additives in food in delicate conditions, such as CKD pregnancy. The Case: A 39-year-old indigenous woman from a low-resourced area in Mexico was referred to the obstetric nephrology at 25 gestational weeks because of serum creatinine at 3.6 mg/dL, hypertension on low-dose alpha-methyl-dopa, and nephrotic-range proteinuria. Kidney ultrasounds showed small poorly differentiated kidneys; foetal ultrasounds detected a female foetus, normal for gestational age. The patient's baseline protein intake, which was estimated at 1.2-1.3 g/kg/day, was mostly of animal-origin (>70%) poor-quality food ("junk food"). In the proposed diet, protein intake was only slightly reduced (1.0-1.2 g/kg/day), but the source of proteins was changed (only 30% of animal origin) with attention to food quality. A remarkable decrease in BUN was observed, in concomitance with adequate dietary follow-up, with rapid rise of BUN when the patient switched temporarily back to previous habits. A healthy female baby weighing 2,460 g (11th centile for gestational age) was delivered at 37 gestational weeks. Discussion and Literature Review: While data on patients with chronic kidney disease are scant, the long list of contaminants present in food, especially if of low quality, should lead us to reflect on their potential negative effect on kidney function and make us realize that eating healthy, unprocessed "organic" food should be encouraged, in delicate conditions such as pregnancy and breastfeeding and for young children, in particular when kidney function is failing. The case herein described gave us the opportunity to reflect on the importance of diet quality and on the potential risks linked to food additives, many of which, including phosphates and potassium, are not declared on food labels, while others, including dyes, antioxidants, thickeners, emulsifiers, and preservatives, are qualitatively, but not quantitatively, reported.
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Affiliation(s)
| | - Cinthya Muñoz-Manrique
- Nutrition and Bioprogramming Research Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Maria Angelica Reyes-López
- Nutrition and Bioprogramming Research Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Otilia Perichat-Perera
- Nutrition and Bioprogramming Research Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Osvaldo Miranda-Araujo
- Department of Gynaecology and Obstetrics, Instituto Nacional de Perinatología Isidro Espinoza de los Reyes, Mexico City, Mexico
| | | | - Giorgina B Piccoli
- Néphrologie, Centre Hospitalier Le Mans, Le Mans, France, .,Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy,
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11
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Cupisti A, Giannese D, Moriconi D, D'Alessandro C, Torreggiani M, Piccoli GB. Nephroprotection by SGLT2i in CKD Patients: May It Be Modulated by Low-Protein Plant-Based Diets? Front Med (Lausanne) 2020; 7:622593. [PMID: 33425967 PMCID: PMC7793896 DOI: 10.3389/fmed.2020.622593] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 01/10/2023] Open
Abstract
Sodium-glucose-transporter 2 inhibitors (SGLT2i) are a new class of anti-diabetic drugs that in large trials such as CREDENCE have shown also a reduction of glomerular hyperfiltration and albuminuria in type 2 diabetic patients. Hence, the interest toward SGLT2i is focused toward this potential nephroprotective effect, in order to reduce the progression to overt nephropathy, and it seems to be confirmed in the most recent DAPA-CKD trial. This is the reason why the indication for SGLT2i treatment has been extended to chronic kidney disease (CKD) patients with eGFR up to 30 ml/min, namely with CKD stage 1-3. In patients with CKD stage 3 to 5, the most recent KDIGO guidelines recommend low-protein diet and plant-based regimens to delay end-stage kidney disease (ESKD) and improve quality of life. Similarly to SGLT2i, low-protein diets exert renal-protective effects by reducing single nephron hyperfiltration and urinary protein excretion. Beyond the glomerular hemodynamic effects, both protein restriction and SGLT2i are able to restore autophagy and, through these mechanisms, they may exert protective effects on diabetic kidney disease. In this perspective, it is likely that diet may modulate the effect of SGLT2i in CKD patients. Unfortunately, no data are available on the outcomes of the association of SGLT2i and low-protein and/or vegan diets. It is therefore reasonable to investigate whether CKD patients receiving SGLT2i may have further advantages in terms of nephroprotection from the implementation of a low-protein and/or plant-based diet or whether this association does not result in an additive effect, especially in vascular nephropathies.
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Affiliation(s)
- Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Giannese
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Giorgina B Piccoli
- Néphrologie, Centre Hospitalier Le Mans, Le Mans, France.,Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Torino, Italy
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12
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Affiliation(s)
| | | | - Giorgina B. Piccoli
- Centre Hospitalier Le Mans, Le Mans, France
- Dipartimento di Scienze Cliniche e Biologiche, University of Torino, Turin, Italy
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13
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Reyes-López MA, Piccoli GB, Leone F, Orozco-Guillén A, Perichart-Perera O. Nutrition care for chronic kidney disease during pregnancy: an updated review. Eur J Clin Nutr 2020; 74:983-990. [PMID: 31925336 PMCID: PMC7340623 DOI: 10.1038/s41430-019-0550-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 11/09/2022]
Abstract
Cases of chronic kidney disease (CKD), including CKD in pregnant women, have increased globally in recent years. CKD during pregnancy is associated with a higher risk of adverse outcomes, including gestational hypertension, preeclampsia, intrauterine growth restriction, and preterm birth, among others. Nutrition plays a significant role in many metabolic and physiological changes during pregnancy. Women with CKD are at increased risk of nutrition deficiencies and metabolic issues than women without CKD. Currently, we lack evidence regarding metabolic and nutritional adaptations during pregnancy in women with CKD and how these adaptations relate to perinatal outcomes. In this review, dietary and supplementation recommendations for CKD in adults and pregnant women are summarized from current clinical guidelines. We present the main nutrition care practices that have been studied in CKD pregnancies. This review will be helpful to health professionals as a preliminary reference for nutrition assessment and therapy in pregnant women with CKD.
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Affiliation(s)
| | - Giorgina B Piccoli
- Department of Clinical and Biological Sciencies, The University of Torino, Turin, Italy
| | - Filomena Leone
- Hospital Cittá della Salute e della Scienza, Turin, Italy
| | | | - Otilia Perichart-Perera
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City, Mexico.
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14
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Carrero JJ, González-Ortiz A, Avesani CM, Bakker SJL, Bellizzi V, Chauveau P, Clase CM, Cupisti A, Espinosa-Cuevas A, Molina P, Moreau K, Piccoli GB, Post A, Sezer S, Fouque D. Plant-based diets to manage the risks and complications of chronic kidney disease. Nat Rev Nephrol 2020; 16:525-542. [PMID: 32528189 DOI: 10.1038/s41581-020-0297-2] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3-5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis.
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Affiliation(s)
- Juan J Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Ailema González-Ortiz
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán, Mexico
| | - Carla M Avesani
- Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vincenzo Bellizzi
- Nephrology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Philippe Chauveau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux et Aurad-Aquitaine, Bordeaux, France
| | - Catherine M Clase
- Departments of Medicine and Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador, Zubirán, Mexico
| | - Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, Universitat de València, València, Spain
| | - Karine Moreau
- Renal transplant unit, Pellegrin Hospital, Bordeaux, France
| | - Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Adrian Post
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Siren Sezer
- Department of Nephrology, Baskent University School of Medicine, Ankara, Turkey
| | - Denis Fouque
- Department of Nephrology, Université de Lyon, Carmen, Hospital Lyon-Sud, Lyon, France
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15
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Piccoli GB, Burdese M, Quaglia M, Mezza E, Pacitti A, Maffei S, Fenoglio R, Fop F, Jeantet A, Grassi G, Dani F, Segoloni GP. Tailored Dialysis for Diabetic Patients: A Tool for Autonomy and Efficiency. Perit Dial Int 2020. [DOI: 10.1177/089686080202200418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Giorgina B. Piccoli
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Manuel Burdese
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Marco Quaglia
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Elisabetta Mezza
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Alfonso Pacitti
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Stefano Maffei
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Roberta Fenoglio
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Fabrizio Fop
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Alberto Jeantet
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
| | - Giorgio Grassi
- Division of Diabetology Department of Internal Medicine University of Torino, Italy
| | - Franco Dani
- Division of Diabetology Department of Internal Medicine University of Torino, Italy
| | - Giuseppe P. Segoloni
- Division of Nephrology Department of Internal Medicine University of Torino, Italy
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16
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Attini R, Grati FR, Menato G, Todros T, Colla L, Rossetti M, Malvestiti B, Alemanno MG, Masturzo B, Piccoli GB, Viora E. Pregnancy on dialysis and with a failing kidney graft: A double challenge for non-invasive prenatal testing. Prenat Diagn 2020; 40:387-389. [PMID: 31916614 DOI: 10.1002/pd.5639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Rossella Attini
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza- Sant'Anna Hospital, Torino, Italy
| | - Francesca R Grati
- Research and Development, Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays, Impact lab Group, Busto Arsizio (Varese), Italy
| | - Guido Menato
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza- Sant'Anna Hospital, Torino, Italy
| | - Tullia Todros
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza- Sant'Anna Hospital, Torino, Italy
| | - Loredana Colla
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Maura Rossetti
- SCDU Nephrology, Department Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Barbara Malvestiti
- Research and Development, Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays, Impact lab Group, Busto Arsizio (Varese), Italy
| | - Maria G Alemanno
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza- Sant'Anna Hospital, Torino, Italy
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza- Sant'Anna Hospital, Torino, Italy
| | - Giorgina B Piccoli
- Service de Nephrologie, Centre Hospitalier Le Mans, Le Mans, France.,Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Elsa Viora
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza- Sant'Anna Hospital, Torino, Italy
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17
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day. Saudi J Kidney Dis Transpl 2019; 29:261-275. [PMID: 29657192 DOI: 10.4103/1319-2442.229286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide. Kidney Health and Women's Health: a case for optimizing outcomes for present and future generations.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy; Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow; Nephrology, Moscow State University of Medicine and Dentistry, Moscow; Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. Women and kidney disease: reflections on World Kidney Day 2018: Kidney Health and Women's Health: a case for optimizing outcomes for present and future generations. Nephrol Dial Transplant 2019; 33:189-193. [PMID: 29401358 DOI: 10.1093/ndt/gfx358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 11/13/2022] Open
Abstract
Chronic kidney disease (CKD) affects ∼10% of the world's adult population: it is one of the top 20 causes of death worldwide and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day coincide in 2018, thus offering an opportunity to reflect on the importance of women's health, and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply these learnings more broadly. Girls and women, who make up ∼50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for the diagnosis of kidney disease, and also a state where acute and chronic kidney diseases may manifest and that may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for childbearing and on the fetus. Women have different complications on dialysis than men and are more likely to be donors than recipients of kidney transplants. In this editorial we focus on what we do and do not know about women, kidney health and kidney disease and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Department of Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation.,Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
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19
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day. TERAPEVT ARKH 2019; 90:4-14. [PMID: 30701898 DOI: 10.26442/terarkh201890614-14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- G B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrology department, Centre Hospitalier Le Mans, Le Mans, France
| | - M Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - E Zakharova
- Nephrology department, S.P. Botkin Moscow City Hospital, Moscow, Russia.,Department of Nephrology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia, Moscow, Russia
| | - A Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Ibarra-Hernandez M, Alcantar-Vallin MDLL, Soto-Cruz A, Jimenez-Alvarado PM, Villa-Villagran F, Diaz-Avila JDJ, Tamez-Hernandez F, Leon-Barrios M, Chatrenet A, Piccoli GB, Garcia-Garcia G. Challenges in Managing Pregnancy in Underserved Women with Chronic Kidney Disease. Am J Nephrol 2019; 49:386-396. [PMID: 30982046 DOI: 10.1159/000499964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/28/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global public health problem and is linked to adverse outcomes during pregnancy; the high prevalence of CKD (3-6%) in women of childbearing age is of particular relevance in emerging countries where CKD prevalence is higher and resources are limited. Although CKD is a public health problem in Mexico, there is scant information on outcomes in pregnant CKD women in this country. We report maternal-fetal outcomes in a prospective cohort of poor, CKD pregnant women, and compare results with those of pregnant women without CKD. METHODS A prospective study of pregnant CKD women referred to a public obstetrics/nephrology clinic from July 2013 to December 2017; sociodemographic and clinical data, including complications and perinatal outcomes, were recorded. CKD was defined at referral as per KDIGO guidelines; preeclampsia and superimposed preeclampsia were defined as appearance or worsening of hypertension and proteinuria. Findings were compared to official data for -Mexico and to a historic control of pregnant women without CKD who delivered at our hospital. RESULTS Sixty-two pregnancies in CKD patients, age 23.4 ± 5.8 years were observed; 46.8% of patients were primiparous. At referral, serum creatinine was 1.8 (1.1-3.0) mg/dL with an estimate glomerular filtration rate (eGFR) of 38.1 (21.9-68.0) mL/min/1.73 m2. In half of the cases, CKD was diagnosed during pregnancy. Forty-eight pregnant women without CKD, age 27 (22-34) years, who delivered during the study period were selected as controls: 33% were primiparous, serum creatinine was 0.50 (0.4-0.6) mg/dL, and estimate glomerular filtration rate was 135 (112-174) mL/min/1.73 m2. Twenty patients needed dialysis (HD-CKD): 2 were already on dialysis, and 18 began treatment during pregnancy; 42 CKD patients did not require dialysis (non-HD CKD). After delivery, 15 patients remained dialysis dependent while 5 did not. Preeclampsia was more frequent in CKD patients in comparison to controls. In total, 93% of CKD patients and 98% of controls delivered a live baby. Prematurity was more frequent in CKD patients than controls and was higher in HD-CKD than in non-HD CKD. Birth weight was lower in CKD when compared to controls. Logistic regression showed a higher risk of preeclampsia in CKD pregnancies than in controls, but it was not affected by age, parity, CKD stage, or need for dialysis during pregnancy. CONCLUSIONS Underserved CKD Mexican women have a high rate of adverse maternal-fetal outcomes during pregnancy. The risk may be higher in patients needing dialysis during pregnancy, many of whom remained dialysis dependent after delivery.
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Affiliation(s)
- Margarita Ibarra-Hernandez
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Maria de la Luz Alcantar-Vallin
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Angela Soto-Cruz
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Patricia Maria Jimenez-Alvarado
- Obstetrics Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Francisco Villa-Villagran
- Obstetrics Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Jose de Jesus Diaz-Avila
- Obstetrics Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Fernando Tamez-Hernandez
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Mariana Leon-Barrios
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | | | - Giorgina B Piccoli
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico,
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Abstract
Pregnancy in dialysis patients is a rare but important event that challenges our knowledge and demands re-thinking many aspects of our practice, including vascular access. This editorial briefly discusses some open questions on vascular access in this situation that challenge the motto 'fistula first' and underline the need for personalised approaches. Information on vascular access in pregnant women is scant. Different approaches may be considered between women on dialysis already on a well-functioning tunnelled catheter and newly placed catheters: while a tunnelled catheter in a woman already stabilised on outpatient dialysis, who has shown being able to take correct care of it and who has freely chosen this option, is a reasonable choice, central venous catheters placed during pregnancy, especially in the hospital setting, may have a high risk of complications. Conversely, pregnancy may increase the risk of development of fistula aneurysms, but the frequency of this complication is still unknown. The problem of whether or not shifting pregnant patients on peritoneal dialysis to daily haemodialysis sessions is still open, as well as the role of patients' preference for avoidance of an invasive procedure, or refuse of pain. In the wait for answers, reflecting on the problems encountered by pregnant women on dialysis should make us reflect on how to improve vascular access management for all our patients.
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Affiliation(s)
- Giorgina B Piccoli
- 1 Nephrologie Centre Hospitaler Le Mans, Le Mans, France.,2 Dipartimento di Scienze Cliniche e Biologiche Università di Torino, Torino, Italy
| | | | - Maurizio Gallieni
- 4 Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, Department of Clinical and Biomedical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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22
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. Enfermedad renal en la mujer: reflexiones en el Día Mundial del Riñón 2018. NEFRO 2019. [DOI: 10.24875/nefro.m18000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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23
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. Women and kidney disease: reflections on World Kidney Day 2018. Kidney Int 2018; 93:278-283. [PMID: 29389388 DOI: 10.1016/j.kint.2017.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Italy; Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russia; Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russia; Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
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Piccoli GB, Zakharova E, Attini R, Ibarra Hernandez M, Orozco Guillien A, Alrukhaimi M, Liu ZH, Ashuntantang G, Covella B, Cabiddu G, Li PKT, Garcia-Garcia G, Levin A. Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases. J Clin Med 2018; 7:E415. [PMID: 30400594 PMCID: PMC6262338 DOI: 10.3390/jcm7110415] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/28/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023] Open
Abstract
Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy.
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia.
- Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia.
- Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia.
| | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy.
| | - Margarita Ibarra Hernandez
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico.
| | | | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE.
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China. zhihong--
| | - Gloria Ashuntantang
- Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon.
| | - Bianca Covella
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | | | - Philip Kam Tao Li
- Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico.
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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25
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Piccoli GB, Alrukhaimi M, Zhi-Hong L, Zakharova E, Levin A. [What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day]. TERAPEVT ARKH 2018; 90:4-14. [PMID: 32598653 DOI: 10.26442/terarkh20189064-14] [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: 04/11/2020] [Indexed: 11/22/2022]
Abstract
On behalf of the World Kidney Day Steering Committee Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- G B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrology department, Centre Hospitalier Le Mans, Le Mans, France
| | - M Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - L Zhi-Hong
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - E Zakharova
- Nephrology department, S.P. Botkin Moscow City Hospital, Moscow, Russia.,Department of Nephrology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia
| | - A Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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26
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Motta D, Airoldi A, Bainotti S, Burdese M, Campo A, Costantini L, Cravero R, Mesiano P, Piccoli GB, Randone O, Serra A, Vio P, Boero R. [Renal Infarction: multicentric cases in Piedmont]. G Ital Nefrol 2018; 35:2018-vol3-11. [PMID: 29786189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED We describe factors associated to renal infarction, clinical, instrumental and laboratoristic features, and therapeutic strategies too. This is an observational, review and polycentric study of cases in Nephrologic Units in Piedmont during 2013-2015, with diagnosis of renal infarction by Computed Tomography Angiography (CTA). We collected 48 cases (25 M, age 57±16i; 23 F age 70±18, p = 0.007), subdivided in 3 groups based on etiology: group 1: cardio-embolic (n=19) ; group 2: coagulation abnormalities (n= 9); group 3: other causes or idiopathic (n=20). Median time from symptoms to diagnosis, known only in 38 cases, was 2 days (range 2 hours- 8 days). Symptoms of clinical presentation were: fever (67%), arterial hypertension (58%), abdominal o lumbar pain (54%), nausea/vomiting (58%), neurological symptoms (12%), gross hematuria (10%). LDH were increased (>530 UI/ml) in 96% of cases (45 cases out of 47), PCR (>0.5 mg/dl) in 94% of cases (45 out of 48), and eGFR <60 ml/min in 56% of cases (27 out of 48). Comparison of the various characteristics of the three groups shows: significantly older age (p=0.0001) in group 1 (76±12 years) vs group 2 (54±17 years) and group 3 (56±17 years); significantly more frequent cigarette smoking (p = 0.01) in group 2 (67%; 5 cases out of 9) and group 3 (60%; 12 cases out of 20) than group 1 (17%). No case has been subjected to endovascular thrombolysis. In 40 out of 48 cases, anticoagulant therapy was performed after diagnosis: in 12 (32%) cases no treatment, in 12 cases (30%) heparin, in 8 cases (20%) low molecular weight heparin, in 4 cases (10%) oral anticoagulants, in 3 cases fondaparinux (7%), in 1 case (2%) dermatan sulfate. CONCLUSIONS Although some characteristics may guide the diagnosis, latency between onset and diagnosis is still moderately high and is likely to affect timely therapy.
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Affiliation(s)
| | | | | | - Manuel Burdese
- S.C. Nefrologia e Dialisi, Città della Salute e della Scienza, Torino
| | | | | | | | - Paola Mesiano
- S.C. Nefrologia e Dialisi, San Giovanni Bosco, Torino
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Piccoli GB, Liu ZH, Levin A. Women and kidney diseases: reflection on World Kidney Day and International Woman's Day. ARCH ARGENT PEDIATR 2018; 116:e273-e278. [PMID: 29557614 DOI: 10.5546/aap.2018.eng.e273] [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: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022]
Abstract
Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Italy.,Nephrology, Centre Hospitalier Le Mans, Le Mans, France.,Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation.,Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases: Questions unanswered and answers unquestioned : Reflection on World Kidney Day and International Woman's Day. Pediatr Nephrol 2018; 33:529-540. [PMID: 29497823 DOI: 10.1007/s00467-018-3917-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation.,Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day. Physiol Int 2018; 105:1-18. [DOI: 10.1556/2060.105.2018.1.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic kidney disease (CKD) affects approximately 10% of the world’s adult population; it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world’s population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, which not only offers an opportunity for diagnosis of kidney disease, but also states where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for childbearing, and on the fetus. Women have different complications on dialysis than men and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- GB Piccoli
- 1 Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- 2 Department of Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - M Alrukhaimi
- 3 Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Z-H Liu
- 4 National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - E Zakharova
- 5 Department of Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- 6 Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- 7 Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - A Levin
- 8 Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
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B Piccoli G, Alrukhaimi M, Liu ZH, Zakharov E, Levin A. What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day. Rev Colomb Nefrol 2018. [DOI: 10.22265/acnef.5.2.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
y el impacto de la enfermedad en el paciente y sus familias puede ser devastador. En el 2018 el Día Mundial del Riñón y el Día Internacional de la Mujer coinciden, ofreciéndonos una oportunidad para demostrar el impacto que tiene la salud de la mujer, específicamente su salud renal, en la comunidad y en las generaciones futuras, es importante fomentar el conocimiento sobre aspectos específicos de la enfermedad renal en la mujer y poder aplicarlos de forma extensiva.Las mujeres y niñas representan aproximadamente el 50 % de la población mundial, siendo integrantes fundamentales de la sociedad y de sus familias. Las diferencias de género persisten alrededor del mundo, afectando su acceso a la educación, cuidados de salud y su inclusión en estudios clínicos. Actualmente, el embarazo en la mujer es una etapa única que ofrece la oportunidad de diagnosticar la enfermedad renal, donde las enfermedades renales agudas y crónicas pueden manifestarse, lo cual podría impactar en la salud renal de las generaciones futuras.Existen varias enfermedades autoinmunes y algunos otros factores que afectan más comúnmente a la mujer, con serias consecuencias durante el embarazo para la madre y para el feto. Las mujeres en diálisis en comparación con los hombres tienen complicaciones diferentes; además son más comúnmente donadoras que receptoras del trasplante renal. En esta editorial, nos enfocamos en qué hacemos y en qué no conocemos sobre la mujer, la salud y enfermedad renal, y qué podemos aprender para mejorar sus condiciones en todo el mundo.
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Ruggiero A, Li PKT, Garcia GG, Piccoli GB. Peritoneal Dialysis in Pregnancy-A Reflection on the Occasion of World Kidney Day. Perit Dial Int 2018; 38:83. [PMID: 29563273 DOI: 10.3747/pdi.2017.00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Agnese Ruggiero
- World Kidney Day Campaign Manager, The International Society of Nephrology, Cranford, USA
| | - Philip K T Li
- Prince of Wales Hospital, Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong
| | - Guillermo Garcia Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jal. Mexico
| | - Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Italy
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: reflection on World Kidney Day and International Woman's Day. BMC Nephrol 2018; 19:66. [PMID: 29544451 PMCID: PMC5856379 DOI: 10.1186/s12882-018-0864-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 12/30/2022] Open
Abstract
Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly.Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants.In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation.,Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.
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Piccoli GB, Jaar BG, Henderson H. On the shoulders of giants. The story behind the 'Pioneers of Nephrology' project. BMC Nephrol 2018. [PMID: 29529988 PMCID: PMC5848534 DOI: 10.1186/s12882-018-0863-z] [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: 11/25/2022] Open
Abstract
This editorial introduces a series of interviews with the pioneers of Nephrology. It’s a story that speaks by itself, given the thousands of people that are now alive thanks to the remarkable advances in renal replacement therapies such as dialysis, and kidney transplantation but also the many scientific advances in our understanding of the pathophysiology and treatment of kidney diseases worldwide. The interviews that we have selected for this series are, however, not dealing with their achievements, and their success; they try to pass on to future generations the idea of how they were, why they were passionate, what they loved, and, not last, where they found poetry in our profession. At a time in which narrative medicine points out the importance of the different life experiences in understanding diseases, we would invite you to discover a narrative portrait of the men and women who made our discipline what it is now.
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Affiliation(s)
- Giorgina B Piccoli
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy. .,Nephrologie, Centre Hospitalier du Mans, Le Mans, France.
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Nephrology Center of Maryland, Baltimore, MD, USA
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know About Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman's Day. Can J Kidney Health Dis 2018; 5:2054358118761656. [PMID: 29552348 PMCID: PMC5846917 DOI: 10.1177/2054358118761656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/08/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chronic kidney disease affects approximately 10% of the world's adult population: It is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus giving an occasion to reflect on open questions on the importance of kidney health in women for the present and the future generations. OBJECTIVES In this review, we summarize some aspects that are unique to women's kidney health, offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. FINDINGS Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is not only a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for childbearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. CONCLUSION Improving knowledge on women, kidney health, and kidney disease, may be a way to improve outcomes of kidney diseases worldwide.
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Affiliation(s)
- Giorgina B. Piccoli
- Department of Clinical and Biological Sciences, University of Turin, Italy
- Nephrology, Centre Hospitalier–Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- Nephrology, Moscow State University of Medicine and Dentistry, Russian Federation
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman s Day. j-pucr 2018. [DOI: 10.14534/j-pucr.2018236887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A, World Kidney Day Steering Committee W. What We Do and Do Not Know About Women and Kidney Diseases: Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman's Day. Iran J Kidney Dis 2018; 12:65-77. [PMID: 29507268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
Chronic kidney disease affects approximately 10% of the world's adult population; it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. The World Kidney Day and the International Women's Day coincide in 2018, thus offering an opportunity to reflect on the importance of women's health, and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women, with profound consequences for child bearing and the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women's kidney health and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
| | | | | | | | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
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Affiliation(s)
- Giorgina B. Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases - questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day. Nephrology (Carlton) 2018; 23:199-209. [DOI: 10.1111/nep.13193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences; University of Torino; Torino Italy
- Nephrology; Centre Hospitalier Le Mans; Le Mans France
| | - Mona Alrukhaimi
- Department of Medicine; Dubai Medical College; Dubai United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital; Nanjing University School of Medicine; Nanjing China
| | - Elena Zakharova
- Nephrology Department; Moscow City Hospital n.a. S.P. Botkin; Moscow Russian Federation
- Chair of Nephrology; Moscow State University of Medicine and Dentistry; Moscow Russian Federation
- Chair of Nephrology; Russian Medical Academy of Continuous Professional Education; Moscow Russian Federation
| | - Adeera Levin
- Division of Nephrology, Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women's Day. Am J Nephrol 2018; 47:103-114. [PMID: 29455210 DOI: 10.1159/000486408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 12/27/2022]
Abstract
Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to have an impact on women, with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P., Moscow, Russian Federation
- Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman's Day. Blood Purif 2018; 45:364-375. [PMID: 29478067 DOI: 10.1159/000484686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to have an impact on women, with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P., Moscow, Russian Federation.,Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know About Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman's Day. Am J Hypertens 2018; 31:375-384. [PMID: 29438477 DOI: 10.1093/ajh/hpx218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we know and do not know about women and kidney diseases: questions unanswered and answers unquestioned: reflection on World Kidney Day and International Women's Day. Intern Med J 2018; 48:113-123. [PMID: 29415356 DOI: 10.1111/imj.13694] [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] [Received: 11/02/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Department of Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital S.P. Botkin, Moscow, Russia.,Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russia.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Affiliation(s)
- Giorgina B. Piccoli
- Department of Clinical and Biological Sciences; University of Torino; Italy
- Department of Nephrology; Centre Hospitalier Le Mans; Le Mans France
| | - Mona Alrukhaimi
- Department of Medicine; Dubai Medical College; Dubai United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases; Jinling Hospital, Nanjing University School of Medicine; Nanjing China
| | - Elena Zakharova
- Department of Nephrology; Moscow City Hospital n.a. S.P. Botkin; Moscow Russian Federation
- Department of Nephrology; Moscow State University of Medicine and Dentistry; Moscow Russian Federation
- Department of Nephrology; Russian Medical Academy of Continuous Professional Education; Moscow Russian Federation
| | - Adeera Levin
- Department of Medicine; Division of Nephrology, University of British Columbia, Vancouver; British Columbia Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. Women and kidney disease: reflections on World Kidney Day 2018. Clin Kidney J 2018; 11:7-11. [PMID: 29435267 PMCID: PMC5793722 DOI: 10.1093/ckj/sfx147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 01/05/2023] Open
Abstract
Chronic kidney disease affects ∼10% of the world’s adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health, and specifically their kidney health, to the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women, so that we may apply those learnings more broadly. Girls and women, who make up ∼50% of the world’s population, are important contributors to society as a whole and to their families. Gender differences continue to exist around the world in access to education, medical care and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, and also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and for the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Department of Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation.,Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women's Day. Kidney Dis (Basel) 2018; 4:37-48. [PMID: 29594141 PMCID: PMC5848484 DOI: 10.1159/000485269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic kidney disease affects approximately 10$ of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50$ of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to have an impact on women, with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B. Piccoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow State University of Medicine and Dentistry, Moscow, Russia
- Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russia
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. [Questions unanswered and Answers unquestioned: what we do and do not know about women and kidney diseases. Reflection on World Kidney Day and International Women's Day]. G Ital Nefrol 2018; 35:2018-vol1-1. [PMID: 29390236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Burdese M, Mezza E, Consiglio V, Mangiarotti G, Thea A, Bermond F, Gai M, Lanfranco G, Jeantet A, Segoloni GP. Maintenance of Residual Renal Function 10 Years after the Start of Hemodialysis: The Advantage of Tailored Schedules? Int J Artif Organs 2018; 27:251-4. [PMID: 15112891 DOI: 10.1177/039139880402700312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Maintenance of residual renal clearance is a clinical advantage, protecting against the long-term effects of uremia: although demonstrated in peritoneal dialysis, the strategies in hemodialysis are less clear. This case suggests that dialysis schedules individualized on the basis of renal clearances may help preserve residual function. SB is a 58 year-old male who started dialysis in emergency (creatinine 30.7 mg/dL) in 1993. He had a history of gout, small shrunken kidneys and moderate hypertension. The clinical diagnosis was vasculointerstitial nephropathy. Eighteen months after starting hemodialysis on a conventional thrice weekly schedule, the patient was switched to 2 sessions/week (creatinine clearance increased to 6 ml/min). Thereafter, clearances were checked in alternate months and treatment was tailored to an equivalent renal clearance 12 ml/min (1–2 sessions, 2-3.30 hours/week). Ten years after beginning dialysis, he is on a twice weekly schedule (3.30 hours), is normotensive, works full-time and does not want to go on a transplant waiting list.
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. Women and Kidney Disease: Reflections on World Kidney Day 2018. Nephrol Nurs J 2018; 45:65-70. [PMID: 29470007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
World Kidney Day and International Women's Day 2018 are commemorated on the same day (March 8), an opportunity to highlight the importance of women's health, and particularly, their kidney health. On its 13th anniversary, World Kidney Day promotes affordable and equitable access to health education, health care, and prevention for all women and girls in the world. In this article, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Researcher in Nephrology, Department of Clinical and Biological Sciences, University of Torino, Italy
- Head of a Nephrology Unit, Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Professor of Medicine, Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- Professor of Medicine, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Head of the Nephrology Unit, Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- Associate Professor of Nephrology and a Chair, Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Associate Professor of Nephrology and Dialysis Chair, Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Professor of Medicine, Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Nava J, Moran S, Figueroa V, Salinas A, Lopez M, Urbina R, Gutierrez A, Lujan JL, Orozco A, Montufar R, Piccoli GB. Successful pregnancy in a CKD patient on a low-protein, supplemented diet: an opportunity to reflect on CKD and pregnancy in Mexico, an emerging country. J Nephrol 2017; 30:877-882. [PMID: 28918595 DOI: 10.1007/s40620-017-0428-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/02/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022]
Abstract
Pregnancy is probably the most important challenge in young women with chronic kidney disease (CKD). The challenge is greater in developing countries, in which access to dialysis is uneven, and prenatal care for CKD patients is not uniformly available. This case report summarizes some of the challenges faced by pregnant CKD women in a developing country. A 35-year-old woman, affected by an undiagnosed kidney disease, experienced preeclampsia at 24 years of age, and started dialysis in emergency at age 31 in the context of severe preeclampsia in her second pregnancy. Following slow recovery of kidney function, after 18 months of dialysis she started a moderately restricted, supplemented, low-protein diet, which allowed her to discontinue dialysis. A few months after dialysis discontinuation, she started a new pregnancy in the presence of severely reduced kidney function (serum creatinine 4.6 mg/dl at the last pre-pregnancy control). Interestingly, she discontinued nephrology and nutritional follow-up, mainly because she was worried that she would be discouraged from continuing the pregnancy, but also because she continued to feel well. She self-managed her diet in pregnancy and delivered a healthy baby, with normal intrauterine growth, at term; while the last laboratory data confirmed the presence of severe kidney function impairment, she is still dialysis-free at the time of the present report. Her story, with its happy ending, underlines the importance of dedicated programs for CKD pregnancies in developing countries and confirms the safety of moderately protein-restricted diets in pregnancy.
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Affiliation(s)
- Julia Nava
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Silvia Moran
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Veronica Figueroa
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Adriana Salinas
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Margy Lopez
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Rocio Urbina
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Abril Gutierrez
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Jose Luis Lujan
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico
| | - Alejandra Orozco
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPER), Calle Montes Urales 800, Ciudad de Mexico, Mexico
| | - Rafael Montufar
- Centro de Atencion Nutricional Fresenius Kabi, Dante 36, 3er Piso, Colonia Anzures, Delegacion Miguel Hidalgo, Ciudad de Mexico, Mexico.
| | - Giorgina B Piccoli
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy.
- Nephrologie, Centre Hospitalier Le Mans, Avenue Roubillard, 72000, Le Mans, France.
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Abstract
In this editorial we present the special issue dedicated to low-protein diets (LPDs) in chronic kidney disease, from a global perspective.The experiences gathered from several countries across all continents have created an issue which we hope you will find insightful, and lead to further discussion on this interesting topic.We discover that LPDs are feasible in both developed and low income countries, in patients where literacy is an issue, and are also safe, including during pregnancy and in old age.Patients prescribed a low protein diet are more inclined to follow and adhere to this change in lifestyle, provided the diet has been adapted to meet their own individual needs. With an increasing list of different menu options and better medical advice being offered we no longer need to identify low protein diets with a specific menu, ingredient or supplement, or with a specific level of protein restriction. Evidence shows how the best diet is often the one chosen by the patients, which doesn't drastically affect their day-to-day life, and delays the start of dialysis for as long as is safe under careful clinical control. The colourful menus gathered from all over the world remind us that a low protein diet does not necessarily mean that the pleasure of preparing a delicious meal is lost. The final comment is therefore dedicated to our patients: low protein diets can be beautiful.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy. .,Nephrologie, CH Le Mans, Le Mans, 72000, France.
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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