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Albertazzi V, Fontana F, Giberti S, Aiello V, Battistoni S, Catapano F, Graziani R, Cimino S, Scichilone L, Forcellini S, De Fabritiis M, Sara S, Delsante M, Fiaccadori E, Mosconi G, Storari A, Mandreoli M, Bonucchi D, Buscaroli A, Mancini E, Rigotti A, La Manna G, Gregorini M, Donati G, Cappelli G, Scarpioni R. Primary membranous nephropathy in the Italian region of Emilia Romagna: results of a multicenter study with extended follow-up. J Nephrol 2024; 37:471-482. [PMID: 37957455 DOI: 10.1007/s40620-023-01803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Since primary membranous nephropathy is a heterogeneous disease with variable outcomes and multiple possible therapeutic approaches, all 13 Nephrology Units of the Italian region Emilia Romagna decided to analyze their experience in the management of this challenging glomerular disease. METHODS We retrospectively studied 205 consecutive adult patients affected by biopsy-proven primary membranous nephropathy, recruited from January 2010 through December 2017. The primary outcome was patient and renal survival. The secondary outcome was the rate of complete remission and partial remission of proteinuria. Relapse incidence, treatment patterns and adverse events were also assessed. RESULTS Median (IQR) follow-up was 36 (24-60) months. Overall patient and renal survival were 87.4% after 5 years. At the end of follow-up, 83 patients (40%) had complete remission and 72 patients (35%) had partial remission. Among responders, less than a quarter (23%) relapsed. Most patients (83%) underwent immunosuppressive therapy within 6 months of biopsy. A cyclic regimen of corticosteroid and cytotoxic agents was the most commonly used treatment schedule (63%), followed by rituximab (28%). Multivariable analysis showed that the cyclic regimen significantly correlates with complete remission (odds ratio 0.26; 95% CI 0.08-0.79) when compared to rituximab (p < 0.05). CONCLUSIONS In our large study, both short- and long-term outcomes were positive and consistent with those published in the literature. Our data suggest that the use of immunosuppressive therapy within the first 6 months after biopsy appears to be a winning strategy, and that the cyclic regimen also warrants a prominent role in primary membranous nephropathy treatment, since definitive proof of rituximab superiority is lacking.
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Affiliation(s)
- Vittorio Albertazzi
- Nephrology and Dialysis Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Via Taverna 49, 29121, Piacenza, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Stefania Giberti
- Nephrology and Dialysis Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Valeria Aiello
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Sara Battistoni
- Unit of Nephrology and Dialysis, Ospedale Infermi, Rimini, Italy
| | - Fausta Catapano
- Unit of Nephrology, Dialysis and Hypertension, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Romina Graziani
- Unit of Nephrology and Dialysis, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Simonetta Cimino
- Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale di Modena, Ospedale Ramazzini, Carpi, Italy
| | - Laura Scichilone
- Nephrology and Dialysis Unit, Azienda USL Imola, Ospedale S. Maria Scaletta, Imola, Italy
| | | | - Marco De Fabritiis
- Unit of Nephrology and Dialysis, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Signorotti Sara
- Unit of Nephrology and Dialysis, Ospedale Bufalini, Cesena, Italy
| | - Marco Delsante
- Nephrology Unit, Parma University Hospital, University of Parma, Parma, Italy
| | - Enrico Fiaccadori
- Nephrology Unit, Parma University Hospital, University of Parma, Parma, Italy
| | - Giovanni Mosconi
- Unit of Nephrology and Dialysis, Ospedale Morgagni-Pierantoni, Forlì, Italy
- Unit of Nephrology and Dialysis, Ospedale Bufalini, Cesena, Italy
| | - Alda Storari
- Unit of Nephrology, University Hospital of Ferrara, Ferrara, Italy
| | - Marcora Mandreoli
- Nephrology and Dialysis Unit, Azienda USL Imola, Ospedale S. Maria Scaletta, Imola, Italy
| | - Decenzio Bonucchi
- Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale di Modena, Ospedale Ramazzini, Carpi, Italy
| | - Andrea Buscaroli
- Unit of Nephrology and Dialysis, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Elena Mancini
- Unit of Nephrology, Dialysis and Hypertension, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Angelo Rigotti
- Unit of Nephrology and Dialysis, Ospedale Infermi, Rimini, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Gabriele Donati
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Scarpioni
- Nephrology and Dialysis Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Via Taverna 49, 29121, Piacenza, Italy.
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De Giorgi A, Storari A, Forcellini S, Manfredini F, Lamberti N, Todeschini P, La Manna G, Manfredini R, Fabbian F. Body mass index and metabolic syndrome impact differently on major clinical events in renal transplant patients. Eur Rev Med Pharmacol Sci 2017; 21:4654-4660. [PMID: 29131248] [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: 06/07/2023]
Abstract
OBJECTIVE Kidney transplant recipients (KTRs) are bound to develop cardiovascular disease (CVD), and obesity represents a well-known risk factor for CVD. It has been reported that the metabolic syndrome (MetS) is a frequent finding in KTRs, and MetS could develop even if body mass index (BMI) is only mildly increased. We compared the impact of BMI and MetS on the development of major clinical events (MCEs) in a cohort of 107 KTRs during a follow-up of 63 ± 31 months. PATIENTS AND METHODS Clinical characteristics were recorded at the time of enrollment and patients were classified on the basis of MCEs development. In a Cox model, MCEs were the dependent variable while age, sex, history of CVD, glomerular filtration rate, length of dialysis pre-transplantation, BMI classes and diagnosis of MetS were independent variables. Patients were classified into 3 groups: normal (BMI < 25 kg/m2), overweight (BMI of 25 to 30 kg/m2) and obese (BMI > 30 kg/m2). RESULTS During follow-up, 55 MCEs were recorded: 16 patients died (15%), 19 (18%) had major cardiovascular events (CVEs), and 20 (19%) started dialysis due to graft failure. KTRs who had MCEs (n = 42) were older, had a lower renal function, longer dialysis vintage pre-transplantation, higher prevalence of history of CVD and higher BMI than those without MCEs. Cox regression analysis showed that length of dialysis pre-transplantation, renal function, previous CVD, and BMI classes (overweight and obesity) were related to MCEs. CONCLUSIONS BMI, but not MetS, predicted MCEs in KTRs as well as non-traditional CVD risk factors such as length of dialysis pre-transplantation and graft function. Thus, a simple evaluation during clinic visits could identify KTRs at high risk for MCEs.
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Affiliation(s)
- A De Giorgi
- Department of Medical Sciences, School of Medicine, University of Ferrara, Italy.
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Manfredini R, Gallerani M, De Giorgi A, Tiseo R, Lamberti N, Manfredini F, Forcellini S, Storari A, La Manna G, Fabbian F. Renal Transplantation and Outcome. Prog Transplant 2016; 26:397-398. [DOI: 10.1177/1526924816665368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Emergency surgery represents an independent risk factor for death and postoperative complications. The aim of this study was to investigate the literature data regarding outcome of daytime or nighttime renal transplantation surgery. Relevant papers, focused on renal transplantation surgery, time of the day, and complications, were searched across the PubMed database. We used the following search terms: “renal”, “transplantation”, “surgery”, “daytime”, “nighttime”, and “outcome”. A total of five papers, including 6,991 adult patients were evaluated. All patients received renal transplantation from deceased donor. Daytime or nighttime surgery do not seem to negatively impact on graft survival in renal transplantation. However, two out five studies reported higher odds of complications after nighttime operation. Since it is not possible to predict the availability of a deceased donor, nighttime surgery remains a valid option when necessary, maybe deserving a higher level of caution to reduce or avoid complications.
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Affiliation(s)
- Roberto Manfredini
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Ruana Tiseo
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Forcellini
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Alda Storari
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, Nephrology and Transplantation Unit, University of Bologna, Bologna, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
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Fabbian F, De Giorgi A, Manfredini F, Lamberti N, Forcellini S, Storari A, Todeschini P, Gallerani M, La Manna G, Mikhailidis DP, Manfredini R. Impact of comorbidity on outcome in kidney transplant recipients: a retrospective study in Italy. Intern Emerg Med 2016; 11:825-32. [PMID: 27003820 DOI: 10.1007/s11739-016-1438-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/23/2015] [Accepted: 03/09/2016] [Indexed: 01/06/2023]
Abstract
The aim of this study was to relate in-hospital mortality (IHM), cardiovascular events (CVEs) and non-immunologic comorbidity evaluated on the basis of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codification, in Italian kidney transplant recipients (KTRs). We evaluated IHM and admissions due to CVEs between 2000 and 2013 recorded in the database of the region Emilia Romagna. The Elixhauser score was calculated for evaluation of non-immunologic comorbidity. Three main outcomes (i.e. IHM, admission due to major CVEs and combined outcome) were the dependent variables of the multivariate models, while age, gender and Elixhauser score were the independent ones. During the examined period, a total of 9063 admissions in 3648 KTRs were recorded; 1945 patients were males (53.3 %) and 1703 females (46.7 %) and the mean age was 52.9 ± 13.1 years. The non-immunological impaired status of the KTRs, examined by the Elixhauser score, was 3.88 ± 4.29. During the 14-year follow-up period, IHM for any cause was 3.2 % (n = 117), and admissions due to CVEs were 527 (5.8 %). Age and comorbidity were independently associated with CVEs, IHM and the combined outcome. Male gender was independently associated with IHM and combined outcome, but not with CVEs. Evaluation of non-immunological comorbidity is important in KTRs and identification of high-risk patients for major clinical events could improve outcome. Moreover, comorbidity could be even more important in chronic kidney disease patients who are waiting for a kidney transplant.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy.
| | - Alfredo De Giorgi
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Forcellini
- Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alda Storari
- Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Paola Todeschini
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), University College London (UCL) Medical School, London, UK
| | - Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy
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Battaglia Y, Forcellini S, Cojocaru E, Fiorini F, Granata A, Russo L, Storari A, D'amelio A, Russo D. MP710VITAMIN D STATUS IN KIDNEY TRANSPLANT PATIENTS: AN ITALIAN COHORT REPORT. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw200.34] [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: 11/13/2022] Open
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Battaglia Y, Galeano D, Cojocaru E, Fiorini F, Forcellini S, Zanoli L, Storari A, Granata A. [Muscle-wasting in end stage renal disease in dialysis treatment: a review]. G Ital Nefrol 2016; 33:gin/00240.7. [PMID: 27067216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Progressive and generalized loss of muscle mass (muscle wasting) is a frequent complication in dialysis patients. Common uremic signs and symptoms such as insulin-resistance, increase in glucocorticoid activity, metabolic acidosis, malnutrition, inflammation and dialysis per se contribute to muscle wasting by modulating proteolytic intracellular mechanisms (ubiquitin-proteasome system, activation of caspase-3 and IGF-1/PI3K/Akt pathway). Since muscle wasting is associated with an increase in mortality, bone fractures and worsening in life quality, a prompt and personalised diagnostic and therapeutic approach seems to be essential in dialysis patients. At present, nuclear magnetic resonance (NMR), computed tomography (CT), dual-energy x-ray absorptiometry (DXA), impedance analysis, bioelectric impedance analysis (BIA) and anthropometric measurements are the main tools used to assess skeletal muscle mass. Aerobic and anaerobic training programmes and treatment of uremic complications reduce muscle wasting and increase muscle strength in uremic patients. The present review analyses the most recent data about the physiopathology, diagnosis, therapy and future perspectives of treatment of muscle wasting in dialysis patients.
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Fabbian F, De Giorgi A, Forcellini S, Ricciardelli MA. Are nephrologists involving all physicians for management of sudden cardiac arrest in chronic kidney disease patients? Int Urol Nephrol 2015; 47:1439-40. [DOI: 10.1007/s11255-015-1050-9] [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] [Received: 06/22/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
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Fabbian F, De Giorgi A, Monesi M, Pala M, Tiseo R, Forcellini S, Storari A, Graziani R, Volpi R, Mikhailidis DP, Manfredini R. A possible relationship between renal impairment and complications development in type 2 diabetes mellitus: a prospective, observational study in Italy. J Diabetes Complications 2015; 29:771-5. [PMID: 26025698 DOI: 10.1016/j.jdiacomp.2015.05.003] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/26/2015] [Accepted: 05/06/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND We investigated the relationship between complications development and estimated glomerular filtration rate (eGFR), in a cohort of type 2 diabetes mellitus (T2DM) outpatients. METHODS This observational study considered 1284 T2DM outpatients, who had been followed-up for 4.5 ± 1.6 years. eGFR was estimated using Chronic Kidney Disease Epidemiology Collaboration equation. The independent relationship between development of complications and clinical data was evaluated, and hazard ratio (HR) by Cox regression analysis calculated. RESULTS Mean age of the population was 66.8 ± 10.4 years; mean serum creatinine and eGFR were 1.05 ± 0.36 mg/dl and 71.6 ± 21.6 ml/min/1.73 m(2), respectively. Complications including death (14.2% of the whole population) were recorded in 504 subjects (39.3%). Patients with complications were older and more frequently male with history of hypertension, coronary heart disease, congestive heart disease, retinopathy, nephropathy and had higher levels of glycated hemoglobin. At Cox regression analysis, eGFR was the major risk factor for development of complications, and the HR increased according with lower eGFR (HR 1.53 and 1.86, for eGFR<45 and<30 ml/min/1.73 m(2), respectively). CONCLUSIONS In our cohort of T2DM outpatients, a reduced eGFR was associated with an increased risk of complications development.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara.
| | - Alfredo De Giorgi
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | - Marcello Monesi
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara
| | - Marco Pala
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | - Ruana Tiseo
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | | | - Alda Storari
- Nephrology and Dialysis, University Hospital St. Anna, Ferrara
| | - Roberto Graziani
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara
| | - Riccardo Volpi
- Department of Internal Medicine and Biomedical Science, University of Parma, Parma
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), University College London Medical School, University College London (UCL), London, UK
| | - Roberto Manfredini
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
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Battaglia Y, Forcellini S, Cojocaru E, Fiorini F, Granata A, Morrone L, Di Iorio B, Russo L, Storari A, Russo D. FP097ANTHROPOMETRIC INDICATORS AND HYPERTENSION IN ITALIAN YOUNG ADULTS FROM THE WORD KIDNEY DAYS 2010 - 2011. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv169.21] [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: 11/13/2022] Open
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Forcellini S, Fabbian F, Battaglia Y, Storari A. [Rhabdomyolysis: role of the nephrologist]. G Ital Nefrol 2014; 31:gin/00199.2. [PMID: 25504160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rhabdomyolysis is characterized by skeletal muscle necrosis resulting in release of large amounts of toxic muscle cell components, including electrolytes, myoglobin, and other sarcoplasmic proteins into circulation. Creatinine phosphokinase (CPK) and myoglobin serum levels constitute the diagnostic hallmark. Nowadays, drugs have become one of the most frequent cause of rhabdomyolysis and acute kidney injury (AKI) is a potential life-threatening complication. The mechanisms involved in the development of AKI in rhabdomyolysis are intrarenal vasoconstriction, direct and ischemic tubule injury and tubular obstruction. According to some clinical series, the mortality rate in patients who develop AKI due to rhabdomyolysis is highly variable. The cornerstone in managing this condition is the early, aggressive repletion of fluids. The composition of replacement fluid remains controversial. Saline and sodium bicarbonate, especially in patients with metabolic acidosis, seem to be a reasonable approach. When AKI produces refractory hyperkalemia, acidosis or volume overload, renal replacement therapy is indicated.
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Saglimbene V, D'Alonzo D, Ruospo M, Vecchio M, Natale P, Gargano L, Nicolucci A, Pellegrini F, Craig JC, Triolo G, Procaccini DA, Santoro A, Di Giulio S, La Rosa S, Murgo A, Di Toro Mammarella R, Sambati M, D'Ambrosio N, Greco V, Giannoccaro G, Flammini A, Boccia E, Montalto G, Pagano S, Amarù S, Fici M, Lumaga GB, Mancini E, Veronesi M, Patregnani L, Querques M, Schiavone P, Chimienti S, Palumbo R, Di Franco D, Della Volpe M, Gori E, Salomone M, Iacono A, Moscoloni M, Treglia A, Casu D, Piras AM, Di Silva A, Mandreoli M, Lopez A, Quarello F, Catizone L, Russo G, Forcellini S, Maccarone M, Catucci G, Di Paolo B, Stingone A, D'Angelo B, Guastoni C, Pasquali S, Minoretti C, Bellasi A, Boscutti G, Martone M, David S, Schito F, Urban L, Di Iorio B, Caruso F, Mazzoni A, Musacchio R, Andreoli D, Cossu M, Li Cavoli G, Cornacchiari M, Granata A, Clementi A, Giordano R, Guastoni C, Barzaghi W, Valentini M, Hegbrant J, Tognoni G, Strippoli GFM. [Effects of dose of erythropoiesis stimulating agents on cardiovascular outcomes, quality of life and costs of haemodialysis. the clinical evaluation of the DOSe of erythropoietins (C.E. DOSE) Trial]. G Ital Nefrol 2013; 30:gin/00072.21. [PMID: 23832463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested. METHODS We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed. The study has been approved and funded by the Italian Agency of Drugs (Agenzia Italiana del Farmaco (AIFA)) within the 2006 funding plan for independent research on drugs (registered at www.clinicaltrials.gov (NCT00827021)).
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Forcellini S, Fabbian F. [The role of terlipressin in hepatorenal syndrome]. G Ital Nefrol 2010; 27:469-476. [PMID: 20922678] [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: 05/29/2023]
Abstract
Hepatorenal syndrome (HRS) is a severe complication in patients with endstage liver disease. It consists of functional renal vasoconstriction leading to severe reduction of the glomerular filtration rate. In some patients the renal failure shows a rapidly progressive course, a clinical pattern known as type 1 HRS. In other cases the renal failure is less severe and remains stable for months, a condition known as type 2 HRS. HRS is pathogenically related to disturbances in circulatory function, mainly characterized by marked arterial vasodilation of the splanchnic circulation, triggered by portal hypertension. This vasodilation may result in effective arterial underfilling, with subsequent activation of vasoconstrictor systems including the renin-angiotensin system and the sympathetic nervous system, as well as hypersecretion of arginine vasopressin. These compensatory mechanisms may lead to renal failure due to the increase in intrarenal resistance and hypoperfusion. Although the available data are derived from studies including a limited number of patients mainly affected by type 1 HRS, vasoconstrictor drugs, in particular the vasopressin analog terlipressin, seem to be the most effective approach for the management of HRS. Associated with albumin infusion, these drugs have been shown to lead to reduced mortality and improved renal function in type 1 HRS. This is particularly true in HRS patients awaiting liver transplantation in whom the vasoconstrictor drugs appear to be the ''bridging'' therapy of choice. Finally, their use has been shown to be safe, and side effects usually disappear after dose reduction.
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Affiliation(s)
- Silvia Forcellini
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Clinica Medica, Azienda Ospedaliera-Universitaria Arcispedale S. Anna, Ferrara, Italy.
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Fabbian F, Ricci F, De Giorgi A, Forcellini S, Scanelli G. The May-Hegglin anomaly in a kidney transplant recipient. Clin Kidney J 2010; 3:312. [PMID: 28657035 PMCID: PMC5477938 DOI: 10.1093/ndtplus/sfq001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 12/30/2009] [Accepted: 12/31/2009] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabio Fabbian
- Department of Clinical and Experimental Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Franco Ricci
- Department of Clinical and Experimental Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Clinical and Experimental Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Silvia Forcellini
- Department of Clinical and Experimental Medicine, University Hospital St. Anna, Ferrara, Italy
| | - Giovanni Scanelli
- Department of Clinical and Experimental Medicine, University Hospital St. Anna, Ferrara, Italy
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