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Mazzaferro S, D'Alonzo S, Morosetti M. Unmet needs about iron deficiency in peritoneal dialysis: a Delphi consensus panel. BMC Nephrol 2022; 23:336. [PMID: 36266621 PMCID: PMC9585765 DOI: 10.1186/s12882-022-02969-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Anaemia and iron deficiency (ID) are common in chronic kidney disease (CKD) patients and related to outcomes. There is growing interest about the role of iron supplementation in CKD, particularly ferric carboxymaltose (FCM), also in relation to the use of erythropoiesis stimulating agents (ESAs). Despite a greater knowledge on ID management in patients receiving haemodialysis, a paucity of data exists about peritoneal dialysis (PD). Furthermore, the aim of this paper is to provide the results of a nationwide Italian survey about ID in PD using the Delphi method. Methods A list of 16 statements (48 items) was developed about four main topics: (1) approach to iron therapy in PD; (2) management experience about iron therapy in PD; (3) ESA and iron in PD; (4) pharmacoeconomic impact. Using the Delphi methodology, the survey was distributed online to 36 Italian nephrologists with expertise in PD, who rated their level of agreement with each item on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement. Results Twenty-five experts (70%) answered the survey. 35 items (73%) achieved a consensus (8 negative and 27 positive). In particular, the diagnosis of ID is widely known, but some doubts exist about how frequently test it. The use of I.V. iron seems to be routinary and can save money reducing the administration of ESAs. However, internal protocols are welcome. Conclusions Expert PD nephrologists know well the problem of ID and feel the necessity of shared protocols to optimize the iron therapy and consequently the use of ESAs.
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Affiliation(s)
- Sandro Mazzaferro
- Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia D'Alonzo
- Department of Medical and Surgical Sciences, Nephrology Unit, Fondazione Policlinico Universitario "A. Gemelli" Istituto Di Ricovero E Cura a Carattere Scientifico, Rome, Italy
| | - Massimo Morosetti
- Nephrology Unit, Giovambattista Grassi Hospital, via Giancarlo Passeroni 28, 00122, Rome, Italy.
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Vischini G, D'Alonzo S, Grandaliano G, D'Ascenzo FM. SARS-CoV-2 in the peritoneal waste in a patient treated with peritoneal dialysis. Kidney Int 2020; 98:237-238. [PMID: 32413379 PMCID: PMC7217108 DOI: 10.1016/j.kint.2020.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Gisella Vischini
- Department of Medical and Surgical Sciences, Nephrology Unit Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
| | - Silvia D'Alonzo
- Department of Medical and Surgical Sciences, Nephrology Unit Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giuseppe Grandaliano
- Department of Medical and Surgical Sciences, Nephrology Unit Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Department of Translational Medicine and Surgery, Nephrology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Maria D'Ascenzo
- Department of Medical and Surgical Sciences, Nephrology Unit Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Lombardi G, Ferraro PM, Bargagli M, Naticchia A, D'Alonzo S, Gambaro G. Hyperchloremia and acute kidney injury: a retrospective observational cohort study on a general mixed medical-surgical not ICU-hospitalized population. Intern Emerg Med 2020; 15:273-280. [PMID: 31388894 DOI: 10.1007/s11739-019-02165-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/27/2019] [Indexed: 01/30/2023]
Abstract
The aim of this observational retrospective cohort study was to analyze the association between hyperchloremia and serum chloride variation with in-hospital acute kidney injury (AKI) and mortality in a general, no-ICU hospitalized population. We performed a retrospective study on inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2010 and December 2014 with inclusion of adult patients with at least two values available for chloride, sodium and creatinine. Hyperchloremia was defined as serum chloride concentration ≥ 108 mmol/L (moderate hyperchloremia: chloremia between 108-110 mmol/L, severe hyperchloremia: chloremia > 110 mmol/L). According to the time of onset of the electrolyte disturbance, hyperchloremia was then classified as hospital acquired (HA) and community acquired (CA). In patients with HA-hyperchloremia, chloride variation (ΔCl) was calculated. In-hospital AKI was defined according to creatinine kinetics criteria occurring 48 h after hospital admission. Logistic regression analysis was used to evaluate the association between the exposures of interest and in-hospital AKI and mortality. A total of 24,912 hospital admissions met the inclusion criteria. Regression analyses showed that only severe HA-hyperchloremia was associated with increased risk of in-hospital AKI [odds ratio (OR) 2.60, 95% confidence interval (CI) 1.58, 4.30, p value < 0.001] and death (OR 3.89, 95% CI 2.11, 7.18, p value < 0.001). With increasing ΔCl, the OR of in-hospital AKI increased progressively (p value for trend = 0.005). In conclusion, severe hyperchloremia is an independent predictor for in-hospital AKI and mortality; HA-hyperchloremia is more detrimental for patient outcome; higher ΔCl from hospital admission is associated with increased risk of AKI.
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Affiliation(s)
- Gianmarco Lombardi
- Nefrologia, Dipartimento di Medicina, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italia
- U.O.C Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Pietro Manuel Ferraro
- U.O.C Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italia.
- Università Cattolica del Sacro Cuore, Roma, Italia.
| | - Matteo Bargagli
- U.O.C Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Alessandro Naticchia
- U.O.C Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Silvia D'Alonzo
- U.O.C Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giovanni Gambaro
- Nefrologia, Dipartimento di Medicina, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italia
- U.O.C Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
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Morosetti M, Rocca AR, Domenici A, D'Alonzo S, Caramiello S, Filippini A, Santoboni A, Palumbo R, Menè P, Mazzaferro S, Neri L. [Peritoneal dialysis in the Lazio region: results from 2017 regional audit]. G Ital Nefrol 2020; 37:37-01-2020-8. [PMID: 32068362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 2011, a first peritoneal dialysis audit was held in the Lazio region to analyze the problems hindering the spread of this method and to improve the quality of care through the sharing of best practices across Centers. A scientific board was therefore set up, representing all the Centers offering PD, in order to assess clinical effectiveness using KPIs (Key Performance Indicators) and to quantify the objectives to be achieved. The analysis made it possible to identify the main problems and take action, all the while monitoring progress through KPIs. A second audit was carried out in 2017 and the collected data was analyzed and compared with the findings of the previous study. Overall, data showed an increase in prevalence, although the incidence showed a slight decrease. Indicators on the change of dialysis treatment, the dropout from domiciliary treatment and the incidence of late referral appeared stable over time. A slight improvement was observed in clinical data on peritonitis and on the length of hospitalization. All participants in the audit declared that sharing and discussing clinical practices had been really useful. In addition, through the drafting of practical documents (guides for patients, guidance on informed consent, protocols of clinical follow-up), a number of tools have been provided to ensure a uniformly high level of care across the different regional Centers.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Paolo Menè
- Azienda Ospedaliera Sant'Andrea Roma, Italy
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5
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Recupero M, Fulignati P, Naticchia A, D'Alonzo S, D'Ascenzo F, Costanzi S. [The pathway of vasopressin as a pharmacological target in nephrology: a narrative review]. G Ital Nefrol 2018; 35:35-6-2018-5. [PMID: 30550035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
ADH is a hormone secreted by neurohypophysis that plays different roles based on the target organ. At the renal level, this peptide is capable of causing electrolyte-free water absorption, thus playing a key role in the hydro-electrolytic balance. There are pathologies and disorders that jeopardize this balance and, in this field, ADH receptor inhibitors such as Vaptans could play a key role. By inhibiting the activation pathway of vasopressin, they are potentially useful in euvolemic and hypervolemic hypotonic hyponatremia. However, clinical trials in heart failure have not given favourable results on clinical outcomes. Even in SIADH, despite their wide use, there is no agreement by experts on their use. Since vaptans inhibit the cAMP pathway in tubular cells, their use has been proposed to inhibit cystogenesis. A clinical trial has shown favourable effects on ADPKD progression. Because vaptans have been shown to be effective in models of renal cysts disorders other than ADPKD, their use has been proposed in diseases such as nephronophthisis and recessive autosomal polycystic disease. Other possible uses of vaptans could be in kidney transplantation and cardiorenal syndrome. Due to the activity of ADH in coagulation and haemostasis, ADH's activation pathway by Desmopressin Acetate could be a useful strategy to reduce the risk of bleeding in biopsies in patients with haemorrhagic risk.
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Affiliation(s)
- Michi Recupero
- U.O.C. Nefrologia, Università cattolica del sacro cuore. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Pierluigi Fulignati
- U.O.C. Nefrologia, Università cattolica del sacro cuore. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Alessandro Naticchia
- U.O.C. Nefrologia, Università cattolica del sacro cuore. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Silvia D'Alonzo
- U.O.C. Nefrologia, Università cattolica del sacro cuore. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Francesca D'Ascenzo
- U.O.C. Nefrologia, Università cattolica del sacro cuore. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Stefano Costanzi
- U.O.C. Nefrologia, Università cattolica del sacro cuore. Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
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6
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D'Elia L, Recupero M, Porri MG, Naticchia A, D'Alonzo S. [Hemodialysis treatment as a trigger cause of cryoglobulinemic purpura: a case report]. G Ital Nefrol 2018; 35:35-6-2018-8. [PMID: 30550038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We describe the clinical case of a patient who developed mixed cryoglobulinemia syndrome after hemodialysis treatment with dialysate temperature lower than 36°C despite the negativization of the viral genome for HCV after eradication therapy.
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Affiliation(s)
- Lorenzo D'Elia
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, ROMA
| | - Michi Recupero
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, ROMA
| | - Maria Grazia Porri
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, ROMA
| | | | - Silvia D'Alonzo
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, ROMA
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7
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Bargagli M, Fulignati P, D'Alonzo S, Naticchia A, Galli D, Ferraro PM. [Recurrent Kidney Stones in a patient with Malabsorption Syndrome]. G Ital Nefrol 2018; 35:35-2018-5. [PMID: 30035444] [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
Enteric hyperoxaluria is one of the most frequent complications of bariatric surgery. In this setting the prevalence of kidney stones is increased. Currently the treatment of enteric hyperoxaluria is based not only on the reduction of urinary oxalate but even controlling other lithogenic risk factors, like urinary volume and urinary citrate levels. This case report suggests a possible benefit using magnesium citrate in addition to calcium supplementation, in the treatment of hyperoxaluria caused by enteric malabsorption.
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Affiliation(s)
- Matteo Bargagli
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - Pierluigi Fulignati
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - Silvia D'Alonzo
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - Alessandro Naticchia
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - Diego Galli
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - Pietro Manuel Ferraro
- UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma
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8
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Di Maio F, Vittori M, Bassi P, Fulignati P, D'Alonzo S, Ferraro PM. [A young girl with recurrent calculosis and hypercalcemia]. G Ital Nefrol 2018; 35:2018-vol3-10. [PMID: 29786188] [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
Mutations of the CYP24A1 gene are associated with alterations in the activity of the enzyme 25-OH-D-24-hydroxylase, resulting in dysfunction of the metabolism of vitamin D. This enzymatic deficiency may cause hypercalcemia, low parathyroid hormone levels, hypercalciuria, nephrolithiasis and nephrocalcinosis. The clinical case of a young woman with recurrent renal lithiasis, hypercalcemia and hypercalciuria is described. These features are linked to deficiency of the enzyme 25-OH-D-24-hydroxylase, therefore to a biallelic mutation of the CYP24A1 gene.
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Affiliation(s)
- Federica Di Maio
- UOC di Nefrologia Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Matteo Vittori
- UOC di Urologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - PierFrancesco Bassi
- UOC di Urologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pierluigi Fulignati
- UOC di Nefrologia Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Silvia D'Alonzo
- UOC di Nefrologia Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pietro Manuel Ferraro
- UOC di Nefrologia Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
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Makhija D, Alscher MD, Becker S, D'Alonzo S, Mehrotra R, Wong L, McLeod K, Danek J, Gellens M, Kudelka T, Sloand JA, Laplante S. Remote Monitoring of Automated Peritoneal Dialysis Patients: Assessing Clinical and Economic Value. Telemed J E Health 2017; 24:315-323. [PMID: 29024613 DOI: 10.1089/tmj.2017.0046] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND For chronic kidney disease patients who progress to end-stage renal disease, survival is dependent on renal replacement therapy in the form of kidney transplantation or chronic dialysis. Peritoneal dialysis (PD), which can be performed at home, is both more convenient and less costly than hemodialysis that requires three 4-h visits per week to the dialysis facility and complicated equipment. Remote therapy management (RTM), technologies that collect medical information and transmit it to healthcare providers for patient management, has the potential to improve the outcomes of patients receiving automated peritoneal dialysis (APD) at home. OBJECTIVE Estimate through a simulation study the potential impact of RTM on APD patients use of healthcare resources and costs in the United States, Germany, and Italy. METHODS Twelve APD patient profiles were developed to reflect potential clinical scenarios of APD therapy. Two versions of each profile were created to simulate healthcare resource use, one assuming use of RTM and one with no RTM. Eleven APD teams (one nephrologist, one nurse) estimated resources that would be used. RESULTS Results from U.S., German, and Italian clinicians found that RTM could avoid use of 59, 49, and 16 resources over the 12 profiles, respectively. Estimated reduced utilization across the three countries ranged from one to two hospitalizations, one to four home visits, two to five emergency room visits, and four to eight unplanned clinic visits. Total savings across all scenarios were $23,364 in the United States, $11,477 in Germany, and $7,088 in Italy. CONCLUSION In a simulated environment, early intervention enabled by RTM reduced healthcare resource utilization and associated costs.
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Affiliation(s)
- Dilip Makhija
- 1 Baxter Healthcare Corporation, Deerfield, Illinois
| | | | | | | | - Raj Mehrotra
- 5 University of Washington , Seattle, Washington
| | | | | | - Judy Danek
- 1 Baxter Healthcare Corporation, Deerfield, Illinois
| | - Mary Gellens
- 1 Baxter Healthcare Corporation, Deerfield, Illinois
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Ferraro PM, Sturniolo A, Naticchia A, D'Alonzo S, Gambaro G. Temporal trend of cadmium exposure in the United States population suggests gender specificities. Intern Med J 2012; 42:691-7. [PMID: 22032496 DOI: 10.1111/j.1445-5994.2011.02627.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Over the years, environmental cadmium exposure has been linked to increased mortality. Over the years, the use of cadmium has generally decreased. AIMS Although even relatively low levels of cadmium have been associated with increased mortality in the general population, whether this applies to blood cadmium is not well understood. METHODS The authors analysed data of the National Health and Nutrition Examination Survey to study the temporal trend of cadmium exposure in the period 1988-2006 and the risk of all-cause, cancer and cardiovascular mortality associated with blood cadmium levels. RESULTS Urinary cadmium decreased significantly over time in males (0.58 (0.01) mcg/g to 0.41 (0.01) mcg/g; P < 0.001) but not in females (0.71 (0.09) mcg/g to 0.63 (0.08) mcg/g; P= 0.66). All-cause mortality was significantly higher in the highest quartiles compared with the lowest quartile of blood cadmium in both males (hazard ratio 1.89, 95% confidence interval 1.22, 2.89; P= 0.005) and females (hazard ratio 2.03, 95% confidence interval 1.06, 3.89; P= 0.035) after adjustment for age, race/ethnicity, smoke status, alcohol intake, annual household income and body mass index. There was also a significant association with cardiovascular mortality in females (P= 0.025). CONCLUSIONS Our data show that elevated blood cadmium levels are associated with elevated mortality, that there seem to be gender differences in temporal trends of cadmium exposure and that blood cadmium is a proxy of chronic cadmium exposure.
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Affiliation(s)
- P M Ferraro
- Division of Nephrology and Dialysis, Department of Internal Medicine and Medical Specialties, Renal Program, Columbus-Gemelli University Hospital, Catholic University of Rome, Rome, Italy.
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Naticchia A, Ferraro PM, D'Alonzo S, Gambaro G. [Hyponatremia: practical approach to diagnosis and treatment]. G Ital Nefrol 2011; 28:305-313. [PMID: 21626499] [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] [Indexed: 05/30/2023]
Abstract
Hyponatremia is one of the most frequent ion and water disorders. It is generally due to disproportionate renal water retention. Severe hyponatremia (<125 mEq/L) is associated with well-known clinical symptoms and manifestations. However, even mild reductions in sodium blood levels have been shown to be associated with increased mortality and with the risk of falls and fractures. The diagnosis of hyponatremia, although requiring simple clinical and laboratory tests, may be complex and difficult. Treatment should be tailored to the clinical manifestations and severity of hyponatremia. Vaptans may be used in euvolemic or hypervolemic hyponatremia and particularly in SIADH.
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Affiliation(s)
- Alessandro Naticchia
- Divisione di Nefrologia e Dialisi, Complesso Integrato Columbus-Policlinico Gemelli, Universita' Cattolica del Sacro Cuore, Roma, Italy.
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12
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D'Alonzo S, Dell'aquila R. [Innovative policies, conservative physicians: a lesson from the Piedmont audit on peritoneal dialysis]. G Ital Nefrol 2011; 28:126-127. [PMID: 21488018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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13
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Mollica N, D'Alonzo S. [Dilated cardiomyopathy in childhood: clinical aspects, echocardiographic diagnosis]. Minerva Cardioangiol 1997; 45:299-303. [PMID: 9432572] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors report a study of 30 patients admitted to hospital between January 1982 and August 1994 for dilatative cardiomyopathy. The majority of children were under one year old. At the time of admittance all patients were suffering from congestive heart decompensation. A clinical examination, electrocardiogram and chest X-ray led to a suspected diagnosis of dilatative cardiomyopathy, and mono, 2-dimensional and Doppler echocardiography constantly showed left atrial and ventricular failure, widespread parietal hypokinesia and associated mitralic insufficiency, all of which represent the essential data for a full and reliable diagnosis of this disease. Echocardiography also allowed the evolution of the pathology to be followed non-invasively without risk for such small patients. The authors underline the value of clinical data and in particular echocardiographic findings in the diagnosis and management of dilatative cardiomyopathy.
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Affiliation(s)
- N Mollica
- Divisione di Cardiologia, Ospedale Pediatrico Giovanni XXIII, USL BA/11, Bari
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14
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Savi L, Montebelli MR, D'Alonzo S, Mettimano M, Folli G. Sublingual nicardipine versus nifedipine to treat hypertensive urgencies. Int J Clin Pharmacol Ther Toxicol 1992; 30:41-5. [PMID: 1551744] [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] [Indexed: 12/27/2022]
Abstract
Hypertensive urgencies are clinical settings in which a steady therapeutic intervention is needed, but this may be safely stretched over some hours. An appropriate antihypertensive drug to use in an urgency should show a potent but gradual effect: it should reduce BP in a short time and it should be easy to modulate the antihypertensive effect, according to individual needs. Sublingual administration is the easiest way for a therapeutical intervention in an urgency. The use of nicardipine administered sublingually was tested in comparison with nifedipine, during a hypertensive urgency, in 24 hypertensive subjects. The peak effect of nifedipine occurred within 10-20 minutes after the administration, whereas that of nicardipine occurred after 45-50 minutes; nevertheless a significant decrease both in systolic and diastolic blood pressure was already observed 20 min after nicardipine administration. The hypotensive effect of nicardipine was longer lasting than that of nifedipine. Some adverse effects were observed in the group receiving nifedipine, whereas no side effects were described by patients receiving nicardipine.
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Affiliation(s)
- L Savi
- Istituto Patologia Medica, Università Cattolica Sacro Cuore, Roma
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15
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Ranieri L, D'Alonzo S, Calvani V, Antoncecchi E, Antoncecchi E. [Evaluation of the efficacy of propafenone in rhythm disorders in childhood using Holter monitoring]. Minerva Cardioangiol 1987; 35:87-90. [PMID: 3587666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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