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Arcidiacono GP, Camozzi V, Zaninotto M, Tripepi G, Fusaro M, Torres MO, Zanchetta F, Cannito M, Cecchinato A, Diogo M, Peleg Falb M, Plebani M, Simioni P, Sella S, Giannini S. Tubular phosphate transport: a comparison between different methods of urine sample collection in FGF23-dependent hypophosphatemic syndromes. Clin Chem Lab Med 2024; 62:1126-1132. [PMID: 38295343 DOI: 10.1515/cclm-2023-1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/GFR) is used to evaluate renal phosphate reabsorption and it is a useful tool for the differential diagnosis of hypophosphatemic syndromes. TmP/GFR is typically calculated from fasting plasma and second morning void urine samples, obtained 2 h after the first void (TmP/GFR 2 h). The purpose of this study was to evaluate if TmP/GFR calculated from 24 h urine collection (TmP/GFR 24 h) can be used as an alternative for TmP/GFR 2 h in patients with urine phosphate wasting. METHODS We enrolled adult patients with X-linked hypophosphatemia (XLH) or tumor-induced osteomalacia (TIO). All patients underwent blood and urine sample collections, to calculate TmP/GFR 24 h and TmP/GFR 2 h. RESULTS Twenty patients (17 XLH and 3 TIO), aged 24-78 years, were included. All patients had low TmP/GFR 2 h (0.35 mmol/L, IQR 0.24-0.47 mmol/L) and TmP/GFR 24 h (0.31 mmol/L, IQR 0.22-0.43 mmol/L). The concordance correlation coefficient between TmP/GFR 2 h and TmP/GFR 24 h was 0.86 (95 % CI: 0.69-0.93), with a systematic bias of 0.05 mmol/L (95 % limits of agreement: -0.10 to 0.20). Furthermore, in 70 % (i.e., 14 patients out of 20) and 80 % (i.e., 16 patients out of 20) of cases the difference between TmP/GFR 2 h and TmP/GFR 24 h was within ±30 % and ±35 %, respectively. CONCLUSIONS Despite TmP/GFR 2 and 24 h show a relatively suboptimal agreement, the difference between the two parameters appears to be small and not clinically significant in the setting of adult patients with FGF23-dependent urine phosphate wasting and secondary hypophosphatemia.
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Affiliation(s)
| | - Valentina Camozzi
- Department of Medicine, Endocrinology Unit, University of Padova, Padova, Italy
| | - Martina Zaninotto
- Department of Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy
| | | | - Francesca Zanchetta
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Michele Cannito
- Department of Medicine, Endocrinology Unit, University of Padova, Padova, Italy
| | - Alberta Cecchinato
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Martin Diogo
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Mor Peleg Falb
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Paolo Simioni
- Department of Medicine, General Medicine and Thrombotic and Hemorrhagic Diseases Unit, University of Padova, Padova, Italy
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
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Arcidiacono GP, Poci C, Sella S, Torres MO, Zanchetta F, Cecchinato A, Diogo M, Peleg Falb M, Giannini S. Hepatitis C-associated Osteosclerosis (HCAO): Long-Term Follow-Up of a New Case Recovered After Antiviral Treatment. Calcif Tissue Int 2023; 113:571-577. [PMID: 37718324 DOI: 10.1007/s00223-023-01135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
Hepatitis C-associated osteosclerosis (HCAO) is a very rare condition that can be observed in a small number of patients with Hepatitis C Virus (HCV) infection. HCAO is usually characterized by widespread bone sclerosis, associated with severe bone pain, and increased levels of bone turnover markers, especially alkaline phosphatase (ALP). In this report, we present the case of a 55-year-old woman who was affected by HCV and came to our attention for severe and diffuse bone pain. Radiological studies showed bone sclerosis, and bone mineral density (BMD) was markedly increased, as well as serum ALP levels. The patient was initially treated with intravenous pamidronate, which provided only a transient benefit on clinical symptoms. Then antiviral therapy for HCV (interferon-alfa and ribavirin) was started and it was effective in making the viral load undetectable. After a long follow-up period, we observed a persistent remission of bone pain, a reduction in BMD together with a progressive trend toward the normalization of bone turnover markers. In conclusion, HCAO, although rare, should be considered among the potential causes of increased bone mass in patients with HCV infection, and treatment for the underlying infection may be effective in controlling the manifestations of this disease.
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Affiliation(s)
| | - Carlo Poci
- Department of Medicine, Clinica Medica 1, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Marco Onofrio Torres
- Department of Medicine, Clinica Medica 1, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Francesca Zanchetta
- Department of Medicine, Clinica Medica 1, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Alberta Cecchinato
- Department of Medicine, Clinica Medica 1, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Martin Diogo
- Department of Medicine, Clinica Medica 1, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Mor Peleg Falb
- Department of Medicine, Clinica Medica 1, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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3
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Tripepi G, Fusaro M, Arcidiacono G, Sella S, Giannini S. Evaluating benefit from vitamin D supplementation: defining the area for treatment. Osteoporos Int 2023; 34:1531-1533. [PMID: 37243726 DOI: 10.1007/s00198-023-06802-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Maria Fusaro
- Clinica Medica 1, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Gaetano Arcidiacono
- Clinica Medica 1, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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4
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Fusaro M, Schileo E, Crimi G, Aghi A, Bazzocchi A, Barbanti Brodano G, Girolami M, Sella S, Politi C, Ferrari S, Gasperini C, Tripepi G, Taddei F. A Novel Quantitative Computer-Assisted Score Can Improve Repeatability in the Estimate of Vascular Calcifications at the Abdominal Aorta. Nutrients 2022; 14:4276. [PMID: 36296959 PMCID: PMC9607651 DOI: 10.3390/nu14204276] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 10/29/2023] Open
Abstract
In CKD and in the elderly, Vascular Calcifications (VC) are associated to cardiovascular events and bone fractures. VC scores at the abdominal aorta (AA) from lateral spine radiographs are widely applied (the 0-24 semiquantitative discrete visual score (SV) being the most used). We hypothesised that a novel continuum score based on quantitative computer-assisted tracking of calcifications (QC score) can improve the precision of the SV score. This study tested the repeatability and reproducibility of QC score and SV score. In forty-four patients with VC from an earlier study, five experts from four specialties evaluated the data twice using a dedicated software. Test-retest was performed on eight subjects. QC results were reported in a 0-24 scale to readily compare with SV. The QC score showed higher intra-operator repeatability: the 95% CI of Bland-Altman differences was almost halved in QC; intra-operator R2 improved from 0.67 for SV to 0.79 for QC. Inter-observer repeatability was higher for QC score in the first (Intraclass Correlation Coefficient 0.78 vs. 0.64), but not in the second evaluation (0.84 vs. 0.82), indicating a possible heavier learning artefact for SV. The Minimum Detectable Difference (MDD) was smaller for QC (2.98 vs. 4 for SV, in the 0-24 range). Both scores were insensitive to test-retest procedure. Notably, QC and SV scores were discordant: SV showed generally higher values, and an increasing trend of differences with VC severity. In summary, the new QC score improved the precision of lateral spine radiograph scores in estimating VC. We reported for the first time an estimate of MDD in VC assessment that was 25% lower for the new QC score with respect to the usual SV score. An ongoing study will determine whether this lower MDD may reduce follow-up times to check for VC progression.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR)—Institute of Clinical Physiology (IFC), Via G. Moruzzi 1, 56124 Pisa, Italy
- Department of Medicine, University of Padua, Via Giustiniani 2, 35128 Padova, Italy
| | - Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gianluigi Crimi
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padova, 35128 Padova, Italy
| | - Alberto Bazzocchi
- Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Marco Girolami
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova, 35128 Padova, Italy
| | - Cristina Politi
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, 89124 Reggio Calabria, Italy
| | - Serge Ferrari
- Service des Maladies Osseuses, Département de Médecine, HUG, 1205 Genève, Switzerland
| | - Chiara Gasperini
- Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, 89124 Reggio Calabria, Italy
| | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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5
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Cianferotti L, Delli Poggi C, Bertoldo F, Caffarelli C, Crotti C, Gatti D, Giannini S, Gonnelli S, Mazzantini M, Ombretta V, Sella S, Setti A, Varenna M, Zucchi F, Brandi ML. Persistence and recurrence in tumor-induced osteomalacia: A systematic review of the literature and results from a national survey/case series. Endocrine 2022; 76:709-721. [PMID: 35381903 PMCID: PMC9156492 DOI: 10.1007/s12020-022-03039-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/08/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Tumor induced osteomalacia (TIO) is a rare disease of mineral metabolism, whose clinical picture is dominated by hypophosphatemia usually due to an excess of circulating FGF23 produced by small mesenchymal tumors. Data on the real prevalence of the disease are lacking, with the knowledge of the disease mainly relying on case reports and small case series. No estimate is available on the prevalence of uncured TIO. METHODS National multi-center, cross-sectional and retrospective study on persistent or recurrent cases of TIO followed in referral centers for bone diseases; systematic review of the published persistent and recurrent cases of TIO. Data from patients consecutively evaluated in referral Italian centers for bone diseases were collected; a PubMed search on persistent, recurrent and unoperable cases of TIO was carried out. RESULTS Sixteen patients (mean age at diagnosis 52.5 ± 10.6 years) with persistent (n = 6, 37,5%), recurrent (n = 7, 43.7%) or not operable (n = 3, 18.8%) TIO were described. Delay in diagnosis (2.5 ± 1.3 years) was demonstrated. All patients experienced fragility fractures or pseudofractures and disabling bone and muscle pain. BMD was significantly reduced (mean T-score -2.7 ± 1.7 and -2.7 ± 0.9 at lumbar spine and femoral neck, respectively). Fourteen patients were maintained under therapy with phosphate salts and calcitriol, while in 2 patients therapy with burosumab, an anti-FGF23 antibody, was commenced. CONCLUSION A significant number of patients with TIO remain either undiagnosed for tumor localization or tumor recur or persist after surgery. These patients with active disease represent possible candidates for burosumab treatment.
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Affiliation(s)
- Luisella Cianferotti
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, largo Palagi 1, 50139, Florence, Italy
| | - Chiara Delli Poggi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, largo Palagi 1, 50139, Florence, Italy
| | - Francesco Bertoldo
- Department of Medicine, University of Verona, Piazzale LA Scuro 10, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Chiara Crotti
- Bone Diseases Unit, Department of Rheumatology, Gaetano Pini Institute, Via Pini, 9, Milan, 20122, Italy
| | - Davide Gatti
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy
| | - Sandro Giannini
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, via Nicolò Giustiniani, 2, 35128, Padua, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Maurizio Mazzantini
- Rheumatology Unit, and Fracture Liaison Service, University Hospital of Pisa, via Roma 67, 56126, Pisa, Italy
| | - Viapiana Ombretta
- Rheumatology Section, Department of Medicine, University of Verona Hospital Trust, Policlinico G.B. Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy
| | - Stefania Sella
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, via Nicolò Giustiniani, 2, 35128, Padua, Italy
| | - Angela Setti
- Department of Medicine, University of Verona, Piazzale LA Scuro 10, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy
| | - Massimo Varenna
- Bone Diseases Unit, Department of Rheumatology, Gaetano Pini Institute, Via Pini, 9, Milan, 20122, Italy
| | - Francesca Zucchi
- Bone Diseases Unit, Department of Rheumatology, Gaetano Pini Institute, Via Pini, 9, Milan, 20122, Italy
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6
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Fusaro M, Luigi Tripepi G, Aghi A, Politi C, Crimi G, Bazzocchi A, Girolami M, Sella S, Barbanti Brodano G, Schileo E, Taddei F. MO547: A Novel Quantitative Computer-Assisted Score can Improve Repeatability in the Estimate of Vascular Calcifications at the Abdominal Aorta. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac073.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Vascular calcifications (VCs), a known risk factor for cardiovascular disease and mortality, are strongly linked to vertebral fractures (VFs) [1]. The coronary calcium score from computer tomography (CT) is the gold standard to measure VCs [2], but this implies high radiation doses and costs. Although, several calcifications scores at the abdominal aorta have been developed from lower-dose and low-cost lateral spine RX projections. These scores are widely applied (the 0–24 score): Kauppila Score (KS) [3]. Most RX scores are semi-quantitative implying an error-prone visual assessment. Indeed, so far, repeatability studies could not estimate the minimum detectable difference (MDD).
Based on this knowledge, we developed a new RX-based computer-assisted VCs score with the aim to test its precision (repeatability and reproducibility metrics and MDD estimate) compared to KS.
METHOD
New Quantitative Score (QS), computer-assisted tracking of calcifications, considers both abdominal aorta calcification and column length (range 0–1), then multiplied by 24 to easily compare with the standard score: KS.
Dedicated software developed with ALBA framework (https://github.com/IOR-BIC/ALBA) to subsequently record standard and new scores (see Figure 1). We enrolled 44 patients with VCs from an earlier study and the anonymous recorded data were randomized in two series. Five experts from four specialties in two institutions evaluated the data twice, with 1-month interval between series. Additional test-retest evaluation was performed on eight subjects with a second RX within 2 weeks.
RESULTS
Intra-observer analysis (Bland-Altman plots and regression analysis between series): both scores seem not biased; QS showed higher reproducibility [95% confidence interval (95% CI) of differences almost halved].
Inter-observer [Intra Class Correlation Coefficient (ICC)]: ICC higher for QS in the first series (0.78 versus 0.64); a lower difference was observed in the second evaluation (0.84 versus 0.82).
MDD (Standard Error of the Mean): reduced by around 25% for the QS (2.98 versus 4, in the 0–24 scale).
Test-retest (Wilcoxon paired test): not significantly different for both scores.
Agreement (Bland-Altman plots): scores are discordant. The QS shows significantly higher values and an increasing trend with calcification severity.
CONCLUSION
Our new quantitative computer-assisted score improved the precision of RX scores in the estimate of VCs. Furthermore, it showed higher intra-observer repeatability than KS and we reported for the first time an estimate of MDD in the VCs assessment. In detail, MDD was 25% lower for the new score.
An ongoing study will determine whether this lower MDD may reduce follow-up times to check for VCs progression and whether this new VCs score may act as a risk alert for the development/worsening of VFs.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR)—Institute of Clinical Physiology (IFC), Pisa, Italy
- University of Padua, Department of Medicine, Padua, Italy
| | - Giovanni Luigi Tripepi
- National Research Council (CNR)—Institute of Clinical Physiology (IFC), Reggio Calabria, Italy
| | - Andrea Aghi
- University of Padua, Department of Medicine, Clinica Medica 1, Padua, Italy
| | - Cristina Politi
- National Research Council (CNR)—Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Gianluigi Crimi
- Istituto Ortopedico Rizzoli, Bioengineering and Computing Laboratory, Bologna, Italy
| | | | - Marco Girolami
- Istituto Ortopedico Rizzoli, Spine Surgery Unit, Bologna, Italy
| | - Stefania Sella
- University of Padua, Department of Medicine, Clinica Medica 1, Padua, Italy
| | | | - Enrico Schileo
- Istituto Ortopedico Rizzoli, Bioengineering and Computing Laboratory, Bologna, Italy
| | - Fulvia Taddei
- Istituto Ortopedico Rizzoli, Bioengineering and Computing Laboratory, Bologna, Italy
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7
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Esposti LD, Perrone V, Sella S, Arcidiacono G, Bertoldo F, Giustina A, Minisola S, Napoli N, Passeri G, Rossini M, Giannini S. The Potential Impact of Inducing a Restriction in Reimbursement Criteria on Vitamin D Supplementation in Osteoporotic Patients with or without Fractures. Nutrients 2022; 14:nu14091877. [PMID: 35565842 PMCID: PMC9105449 DOI: 10.3390/nu14091877] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
In October 2019, the Italian Drug Agency (AIFA) restricted reimbursement criteria for vitamin D (VD) use outside the osteoporosis setting (Note 96). However, whether this restriction could also have involved patients at risk for or with osteoporotic fractures has not yet been investigated. We retrospectively analyzed databases from five Italian Local Health Units. Patients aged ≥50 years with either at least one prescription for osteoporosis treatment or with fragility fractures and evidence of osteoporosis from 2011 to 2020 were included. The proportion of subjects with an interruption in VD treatment before and after the introduction of the new reimbursement criteria and predictors of this interruption were analyzed. A total of 94,505 patients (aged 69.4 years) were included. Following the introduction of Note 96, a 2-fold (OR 1.98, 95% CI: 1.92–2.04) increased risk of VD discontinuation was observed. These findings were independent of seasonal variation, osteoporosis treatment patterns, as well as other confounding variables. However, a higher rate of interruption was observed in patients without vertebral/femur fracture (37.8%) vs. those with fracture (32.9%). Rheumatoid arthritis, dyslipidemia and previous fracture were associated with a lower risk of VD interruption, while stroke increased the risk of VD interruption. Our results highlight that a possible misinterpretation of newly introduced criteria for reimbursement restrictions in VD outside of osteoporosis have resulted in an inadequate level of VD supplementation in patients with osteoporosis. This undertreatment could reduce the effect of osteoporosis therapies leading to increased risk of negative outcome.
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Affiliation(s)
- Luca Degli Esposti
- CliCon Srl Società Benefit Health Economics and Outcome Research, 40137 Bologna, Italy; (L.D.E.); (V.P.)
| | - Valentina Perrone
- CliCon Srl Società Benefit Health Economics and Outcome Research, 40137 Bologna, Italy; (L.D.E.); (V.P.)
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (G.A.)
| | - Gaetano Arcidiacono
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (G.A.)
| | - Francesco Bertoldo
- Internal Medicine, Department of Medicine, University Hospital AOUI, 37134 Verona, Italy;
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Hospital, San Raffaele Vita-Salute University, 20132 Milan, Italy;
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiology, and Cardiovascular Sciences Sapienza University of Rome, 00185 Rome, Italy;
| | - Nicola Napoli
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Giovanni Passeri
- Unit of Clinica e Terapia Medica, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy;
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (G.A.)
- Correspondence: ; Tel.: +39-0498212169
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8
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Fusaro M, Cianciolo G, Tripepi G, Plebani M, Aghi A, Politi C, Zaninotto M, Nickolas TL, Ferrari S, Ketteler M, La Manna G, Gasperoni L, Messa P, Ravera M, Gallieni M, Cosmai L, Locatelli F, Iervasi G, Vettor R, Mereu MC, Sella S, Arcidiacono G, Giannini S. Oral Calcitriol Use, Vertebral Fractures, and Vitamin K in Hemodialysis Patients: A Cross-Sectional Study. J Bone Miner Res 2021; 36:2361-2370. [PMID: 34622481 DOI: 10.1002/jbmr.4440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 02/06/2023]
Abstract
Fractures and vascular calcifications (VCs) are common in patients with chronic kidney disease (CKD). They are related to abnormalities in vitamin D metabolism, calcium, phosphorus, parathyroid hormone, and fibroblast growth factor 23 (FGF23)/Klotho that occur with CKD. Impaired vitamin D metabolism and abnormal levels of calcium, phosphate, parathyroid hormone (PTH), and FGF23/Klotho drive bone and vascular changes in CKD. It is unclear if oral calcitriol safely mitigates fracture risk without increasing the burden of calcifications. Therefore, we investigated whether treatment with calcitriol affected the prevalence of fractures and VC progression in hemodialysis (HD) patients. This report is a secondary analysis of the Vitamin K Italian (VIKI) study, a cross-sectional study involving 387 HD patients. We assessed vitamin 25(OH)D, alkaline phosphatase, PTH, calcium, phosphate, osteocalcin or bone Gla protein, matrix Gla protein, and vitamin K levels. Vertebral fractures (VFs) and VCs were determined by spine radiograph. A reduction of >20% of vertebral body height was considered a VF. VCs were quantified by the length of calcific lesions along the arteries. The patients treated with oral calcitriol were 177 of 387 patients (45.7%). The prevalence of VF was lower in patients receiving oral calcitriol than in those untreated (48.6% versus 61.0%, p = 0.015), whereas the presence of aortic and iliac calcifications was similar (aortic: 81.9% versus 79.5%, respectively, p = 0.552; iliac: 52.0% and 59.5%, respectively, p = 0.167). In multivariable logistic regression analysis, oral calcitriol was associated with a 40.2% reduced odds of fracture (OR 0.598; 95% confidence interval [CI], 0.363-0.985; p = 0.043). In conclusion, we found a significant association between oral calcitriol and lower VF in HD patients without an increase in the burden of VC. Further prospective and interventional studies are needed to confirm these findings. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy.,Department of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Cianciolo
- Nephrology Dialysis and Kidney Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Giovanni Tripepi
- National Research Council-Institute of Clinical Physiology (CNR-IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | - Cristina Politi
- National Research Council-Institute of Clinical Physiology (CNR-IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Thomas L Nickolas
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Serge Ferrari
- Service des Maladies Osseuses, Département de Médecine, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Gaetano La Manna
- Nephrology Dialysis and Kidney Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Lorenzo Gasperoni
- Nephrology Dialysis and Kidney Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Piergiorgio Messa
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Maurizio Gallieni
- Nephrology and Dialysis Unit, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Department of Clinical and Biomedical Sciences 'Luigi Sacco', Università di Milano, Milan, Italy
| | - Laura Cosmai
- Onco-Nephrology Outpatient Clinic, Nephrology and Dialysis Unit, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Francesco Locatelli
- Alessandro Manzoni Hospital, Azienda Socio-Sanitaria Territoriale (ASST) Lecco, Lecco, Italy
| | - Giorgio Iervasi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Roberto Vettor
- Department of Medicine, University of Padova, Padova, Italy
| | | | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | | | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
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9
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Costantino G, Furlan L, Bracco C, Cappellini MD, Casazza G, Nunziata V, Cogliati CB, Fracanzani A, Furlan R, Gambassi G, Manetti R, Manna R, Piccoli A, Pignone AM, Podda G, Salvatore T, Sella S, Squizzato A, Tresoldi M, Perticone F, Pietrangelo A, Corazza GR, Montano N. Impact of implementing a Choosing Wisely educational intervention into clinical practice: The CW-SIMI study (a multicenter-controlled study). Eur J Intern Med 2021; 93:71-77. [PMID: 34353705 DOI: 10.1016/j.ejim.2021.07.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/28/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the impact of an educational intervention based on the Italian Society of Internal Medicine Choosing Wisely (CW-SIMI) recommendations. DESIGN Multicenter, interventional, controlled study. SETTING Twenty-three acute-care hospital wards in Italy. PARTICIPANTS 303 Physicians working in internal medicine wards. INTERVENTION An online educational course. MAIN OUTCOMES The rate of proton pump inhibitor (PPI) prescriptions, the number of days of central venous catheter (CVC) usage, and the duration of intravenous (IV) antibiotic prescriptions evaluated at one month (T1) and at six months (T2) after course completion. Patients admitted and discharged during a 30-day period before the educational intervention (T0, one year before T2) were considered the comparison group. RESULTS A total of 232 physicians completed the course, while 71 did not attend the course. Data from 608, 662, and 555 patients were analyzed at T0, T1, and T2, respectively. The rate of PPI prescriptions declined at one month (RR: 0.67, 95% CI: 0.52-0.87, p = 0.0005) and at six months (RR: 0.62, 95% CI: 0.46-0.84, p = 0.003), and the number of days of CVC usage was reduced at six months (9.13 days at T0 vs. 5.52 days at T2, p = 0.007). The duration of IV antibiotic prescriptions displayed a decreasing trend (7.94 days at T0 vs. 7.42 days at T2, p = 0.081). CONCLUSIONS A simple online educational intervention based on the CW-SIMI recommendations was associated with a clinically relevant reduction in the usage of PPIs and CVCs. Further studies are needed to confirm these findings and a possible benefit on patients' outcomes.
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Affiliation(s)
- Giorgio Costantino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - Ludovico Furlan
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milano, Italy
| | - Vanessa Nunziata
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - Chiara Beatrice Cogliati
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milano, Italy
| | - Anna Fracanzani
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Medicina Interna a indirizzo fisiopatologico, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Raffaello Furlan
- Humanitas Clinical and Research Center-IRCCS. Dept of Biomedical Sciences-Humanitas University, Rozzano, Italy
| | - Giovanni Gambassi
- Humanitas Clinical and Research Center-IRCCS. Dept of Biomedical Sciences-Humanitas University, Rozzano, Italy; Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Manetti
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italy
| | - Raffaele Manna
- Institute of Internal Medicine, Periodic Fever and Rare Diseases Research Centre, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alfonso Piccoli
- Medicina Interna, Istituto Clinico San Rocco di Istituti Ospedalieri Bresciani GSD, Italy
| | - Alberto Moggi Pignone
- Dipartimento Assistenziale Integrato di Emergenza ed Accettazione, Azienda Ospedaliera-Universitaria careggi, Firenze, Italy
| | - GianMarco Podda
- Medicina III, San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienza della Salute, Università degli Studi di Milano, Milano, Italy
| | - Teresa Salvatore
- UOC di Medicina Interna, Azienda Ospedaliera dell'Università degli Studi Luigi Vanvitelli, Napoli, Italy
| | - Stefania Sella
- Dipartimento di Medicina, Clinica Medica 1, Università degli Studi di Padova, Padova, Italy
| | | | - Moreno Tresoldi
- Medicina Generale e delle Cure Avanzate IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Antonello Pietrangelo
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Italy
| | - Gino Roberto Corazza
- Dipartimento di Medicina Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Italy
| | - Nicola Montano
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy.
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10
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Fusaro M, Tripepi G, Plebani M, Politi C, Aghi A, Taddei F, Schileo E, Zaninotto M, La Manna G, Cianciolo G, Gallieni M, Cosmai L, Messa P, Ravera M, Nickolas TL, Ferrari S, Ketteler M, Iervasi G, Mereu MC, Vettor R, Giannini S, Gasperoni L, Sella S, Brandi ML, Cianferotti L, De Caterina R. The Vessels-Bone Axis: Iliac Artery Calcifications, Vertebral Fractures and Vitamin K from VIKI Study. Nutrients 2021; 13:nu13103567. [PMID: 34684568 PMCID: PMC8539275 DOI: 10.3390/nu13103567] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 01/07/2023] Open
Abstract
Vascular calcification and fragility fractures are associated with high morbidity and mortality, especially in end-stage renal disease. We evaluated the relationship of iliac arteries calcifications (IACs) and abdominal aortic calcifications (AACs) with the risk for vertebral fractures (VFs) in hemodialysis patients. The VIKI study was a multicenter cross-sectional study involving 387 hemodialysis patients. The biochemical data included bone health markers, such as vitamin K levels, vitamin K-dependent proteins, vitamin 25(OH)D, alkaline phosphatase, parathormone, calcium, and phosphate. VF, IACs and AACs was determined through standardized spine radiograms. VF was defined as >20% reduction of vertebral body height, and VC were quantified by measuring the length of calcium deposits along the arteries. The prevalence of IACs and AACs were 56.1% and 80.6%, respectively. After adjusting for confounding variables, the presence of IACs was associated with 73% higher odds of VF (p = 0.028), whereas we found no association (p = 0.294) for AACs. IACs were associated with VF irrespective of calcification severity. Patients with IACs had lower levels of vitamin K2 and menaquinone 7 (0.99 vs. 1.15 ng/mL; p = 0.003), and this deficiency became greater with adjustment for triglycerides (0.57 vs. 0.87 ng/mL; p < 0.001). IACs, regardless of their extent, are a clinically relevant risk factor for VFs. The association is enhanced by adjusting for vitamin K, a main player in bone and vascular health. To our knowledge these results are the first in the literature. Prospective studies are needed to confirm these findings both in chronic kidney disease and in the general population.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy; (G.I.); (R.V.)
- Correspondence:
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy; (G.T.); (C.P.)
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, 35129 Padua, Italy; (M.P.); (M.Z.)
| | - Cristina Politi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy; (G.T.); (C.P.)
| | - Andrea Aghi
- Clinica Medica 1, Department of Medicine, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.T.); (E.S.)
| | - Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.T.); (E.S.)
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, 35129 Padua, Italy; (M.P.); (M.Z.)
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; (G.L.M.); (G.C.); (L.G.)
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; (G.L.M.); (G.C.); (L.G.)
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università di Milano, 20157 Milano, Italy;
| | - Laura Cosmai
- Nephrology Unit, ASST Fate Bene Fratelli Sacco, 20157 Milano, Italy;
| | - Piergiorgio Messa
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20157 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20157 Milan, Italy
| | | | - Thomas L. Nickolas
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Serge Ferrari
- Service des Maladies Osseuses, Département de Médecine, HUG, 1205 Genève, Switzerland;
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany;
| | - Giorgio Iervasi
- Department of Medicine, University of Padova, 35128 Padova, Italy; (G.I.); (R.V.)
| | | | - Roberto Vettor
- Department of Medicine, University of Padova, 35128 Padova, Italy; (G.I.); (R.V.)
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Lorenzo Gasperoni
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; (G.L.M.); (G.C.); (L.G.)
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (M.L.B.); (L.C.)
| | - Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; (M.L.B.); (L.C.)
| | - Raffaele De Caterina
- Cardiology, Cardiovascular Division, Pisa University Hospital, University of Pisa, Via Paradisa 2, 56126 Pisa, Italy;
- Fondazione Villa Serena per la Ricerca, Città Sant’Angelo, 65013 Pescara, Italy
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11
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Giannini S, Poci C, Fusaro M, Egan CG, Marcocci C, Vignali E, Cetani F, Nannipieri F, Loy M, Gambino A, Adami G, Braga V, Rossini M, Arcidiacono G, Baffa V, Sella S. Effect of neridronate in osteopenic patients after heart, liver or lung transplant: a multicenter, randomized, double-blind, placebo-controlled study. Panminerva Med 2021; 63:214-223. [PMID: 34154321 DOI: 10.23736/s0031-0808.21.04401-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transplantation (Tx) is an effective therapeutic option in patients with end-stage organ failure and osteoporosis and related fractures are a recognized complication in these patients. Aim of this study was to evaluate the efficacy of neridronate in patients with reduced bone mass after Tx of the heart, liver or lung. METHODS In this multicenter randomized double-blind controlled trial (RCT), 22 patients were treated with neridronate (25 mg i.m./month) and 17 received placebo. All patients received daily oral calcium (500 mg) and vitamin D (400 IU). Dual-energy X-ray absorptiometry (DXA) was evaluated at 0, 6 and 12 months and markers of bone turnover at 0, 3, 6, 9 and 12 months. RESULTS Thirty-nine patients (11 heart Tx, 21 liver Tx, 7 lung Tx), aged 49.3±9.1 years, with a T-score <-2.0 SD at lumbar spine or femoral level were included. In neridronate-treated patients, a significant increase in lumbar bone mineral density (BMD) was observed after 12 months vs. placebo control (0.92±0.13 g/cm2 vs. 0.84±0.08 g/cm2; P=0.005). Femur and hip BMD remained unchanged between groups. Total alkaline phosphatase, bone alkaline phosphatase and beta-cross-laps significantly decreased over the 12 months in neridronate-treated patients vs. placebo, respectively (107.4±74 U/L vs. 157.6±107.1 U/L, P=0.002; 5.7±3.3 µg/L vs. 11.7±4.3 µg/L, P<0.001 and 0.25±0.13 ng/mL vs. 0.73±0.57 ng/mL, P<0.001). No difference was observed between neridronate and placebo groups regarding safety profile. CONCLUSIONS This is the first RCT that demonstrates the efficacy of neridronate in increasing bone density and reducing bone turnover in organ Tx recipients with significant skeletal morbidity.
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Affiliation(s)
- Sandro Giannini
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy -
| | - Carlo Poci
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy.,Department of Medicine, University of Padua, Padua, Italy
| | | | - Claudio Marcocci
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Edda Vignali
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filomena Cetani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Monica Loy
- Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonio Gambino
- Unit of Cardiac Surgery, Department of Cardio-Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Adami
- Unit of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Vania Braga
- Unit of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Rossini
- Unit of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Gaetano Arcidiacono
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy
| | - Valeria Baffa
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy
| | - Stefania Sella
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy
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12
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Fusaro M, Aghi A, Politi C, Nickolas T, Cianciolo G, La Manna G, Gasperoni L, Mereu MC, Gallieni M, Ravera M, Giannini S, Sella S, Arcidiacono G, Tripepi GL. MO798ORAL CALCITRIOL USE, VERTEBRAL FRACTURES AND VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab096.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
In patients with Chronic Kidney Disease (CKD) mineral, bone, and calcific cardiovascular abnormalities are associated to adverse clinical outcomes, including fractures, cardiovascular events and mortality. Vitamin D hormonal system along with alteration levels that occur in calcium, phosphate, PTH, FGF23/Klotho are the main responsible of the bone and vascular metabolism changes, particularly in hemodialysis (HD) patients that experienced the very negative clinical consequences (decreased bone mass, increased fragility fractures and vascular calcification). In the setting of a comparative effectiveness study, we investigated the effect of oral calcitriol on fractures in HD patients taking into account a series of potential confounders.
Method
We conducted a secondary analysis of the VIKI database, a cross-sectional study involving 387 HD patients from 18 Italian dialysis centers. Routine biochemistry and bone biochemical markers such as vitamin K levels, VKDPs, vitamin 25(OH)D, ALP, PTH, Ca, P, osteocalcin (BGP), Matrix Gla Protein (MGP) were assessed. The presence of Vertebral Fractures (VF) and Vascular Calcification (VC) was determined through spine radiograph. Reduction of >20% of vertebral body height was considered a VF. The severity of the vertebral fractures was estimated as mild, moderate and severe (reduction: 20-25%, 25-40% or >40%, respectively). VC were quantified by measuring the length of calcific deposits along the arteries (mild 0,1-5 cm, moderate 5,1-10 cm and severe >10 cm).
Results
177 out 387 patients (45.7%) were treated with oral calcitriol. Oral calcitriol-treated and untreated patients did not differ as for Ca, P, PTH, Albumin, BGP, MGP, and ALP. The prevalence of VF was significantly lower in patients receiving oral calcitriol than in those untreated (48.6% vs 61%, P=0.015), whereas the presence of aortic and iliac calcifications was similar between the two groups (aortic: 81.9% vs 79.5% respectively, P=0.552; iliac: 52.0% and 59.5%, P=0.167). No significant between-groups differences were observed in terms of calcification severity. In a multivariable logistic regression analysis, after adjustment for all potential confounders, oral calcitriol was associated with a marked reduction (-40.2%) of the odds of fractures (OR: 0.598, 95% CI: 0.363-0.985, P=0.043) (see Table).
Conclusion
A significant association was found between oral calcitriol and lower VF rate in HD patients. Such an effect remained significant also after data adjustment for a large series of potential confounders. Further prospective and interventional studies are needed to confirm these findings.
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Affiliation(s)
- Maria Fusaro
- Institute of Clinical Physiology (IFC), National Research Council (CNR), Pisa, Italy
- University of Padua, Department of Medicine, Padova, Italy
| | - Andrea Aghi
- Clinica Medica 1, Department of Medicine, University of Padua, Padova, Italy
| | - Cristina Politi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Institute of Biomedicine, Reggio Calabria, Italy
| | - Thomas Nickolas
- Division of Nephrology, Columbia University Irving Medical Center, Department of Medicine, New York, United States of America
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna, Italy
| | - Lorenzo Gasperoni
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna, Italy
| | | | - Maurizio Gallieni
- Sacco Hospital, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università di Milano, Milano, Italy
| | - Maura Ravera
- IRCCS AOU San Martino, Clinica Nefrologica, Dialisi e Trapianto, Universita' di Genova, Genova, Italy
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padua, Padova, Italy
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padua, Padova, Italy
| | - Gaetano Arcidiacono
- Clinica Medica 1, Department of Medicine, University of Padua, Padova, Italy
| | - Giovanni Luigi Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Institute of Biomedicine, Reggio Calabria, Italy
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13
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Fusaro M, Cozzolino M, Plebani M, Iervasi G, Ketteler M, Gallieni M, Aghi A, Locatelli F, Cunningham J, Salam S, Zaninotto M, Ravera M, Russo D, Mereu MC, Giannini S, Brandi ML, Ferrari S, Sella S, Egan CG, Bellasi A, Di Lullo L, Tripepi G, Nickolas T. Sevelamer Use, Vitamin K Levels, Vascular Calcifications, and Vertebral Fractures in Hemodialysis Patients: Results from the VIKI Study. J Bone Miner Res 2021; 36:500-509. [PMID: 33188702 DOI: 10.1002/jbmr.4214] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/11/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022]
Abstract
Hyperphosphatemia is a risk factor for vascular calcifications (VCs), which are part of the chronic kidney disease-mineral and bone disorders (CKD-MBD). Vitamin K-dependent proteins such as matrix Gla protein (MGP) and bone Gla proteins (BGP, or osteocalcin) can inhibit VCs and regulate bone mineralization. In this analysis of the Vitamin K Italian (VIKI) study, the relationship between vitamin K status, vertebral fractures (VFs) and VCs in 387 hemodialysis (HD) patients with (N = 163; 42.1%) or without N = 224; 57.9%) sevelamer was evaluated. Levels of vitamin K vitamers K1 and K2 or menaquinones (MK; MK4-7), total and undercarboxylated (uc) forms for both BGP and MGP were determined. Although no differences in clinical characteristics were noted, lower levels of MK4 (0.45 versus 0.6 ng/mL, p = .01) and a greater MK4 deficiency was observed in sevelamer-treated patients (13.5% versus 5.4%, p = .005). Multivariate logistic regression revealed that MK4 deficiency was associated with sevelamer use (odds ratio [OR] = 2.64, 95% confidence interval [CI] 1.25-5.58, p = .011) and aortic calcification (OR = 8.04, 95% CI 1.07-60.26, p = .04). In the same logistic model, sevelamer amplified the effect of total BGP levels on the odds of VFs in patients with total BGP <150 μg/L compared with those with total BGP ≥150 μg/L (OR = 3.15, 95% CI 1.46-6.76, p = .003). In contrast, there was no such effect in those untreated (total BGP <150 μg/L versus total BGP ≥150 μg/L: OR = 1.21, 95% CI 0.66-2.23, p = .54]; p = .049 for effect modification by sevelamer). Sevelamer may interfere with MK4 levels in HD patients and interact with low BGP levels to increase bone fractures in CKD patients. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR)-Institute of Clinical Physiology (IFC), Pisa, Italy.,Department of Medicine, University of Padua, Padua, Italy
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Giorgio Iervasi
- National Research Council (CNR)-Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Department of Clinical and Biomedical Sciences 'Luigi Sacco', Università di Milano, Milan, Italy
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | | | | | - Syazrah Salam
- Sheffield Kidney Institute, Sheffield Teaching Hospitals National Health Service Foundation Trust, and Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, Medical School-University of Sheffield, Sheffield, UK
| | | | - Maura Ravera
- Clinica Nefrologica, Dialisi e Trapianto, Universita' di Genova e Policlinico San Martino, Genoa, Italy
| | - Domenico Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Maria Luisa Brandi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Serge Ferrari
- Service des Maladies Osseuses, Département de Médecine, HUG, Genève, Switzerland
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | | | - Antonio Bellasi
- UOC Ricerca, Innovazione, Brand Reputation, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi, Delfino Hospital, Rome, Italy
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Thomas Nickolas
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York City, NY, USA
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Giannini S, Passeri G, Tripepi G, Sella S, Fusaro M, Arcidiacono G, Torres MO, Michielin A, Prandini T, Baffa V, Aghi A, Egan CG, Brigo M, Zaninotto M, Plebani M, Vettor R, Fioretto P, Rossini M, Vignali A, Fabris F, Bertoldo F. Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study. Nutrients 2021; 13:nu13010219. [PMID: 33466642 PMCID: PMC7828675 DOI: 10.3390/nu13010219] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Little information is available on the beneficial effects of cholecalciferol treatment in comorbid patients hospitalized for COVID-19. The aim of this study was to retrospectively examine the clinical outcome of patients receiving in-hospital high-dose bolus cholecalciferol. Patients with a positive diagnosis of SARS-CoV-2 and overt COVID-19, hospitalized from 15 March to 20 April 2020, were considered. Based on clinical characteristics, they were supplemented (or not) with 400,000 IU bolus oral cholecalciferol (200,000 IU administered in two consecutive days) and the composite outcome (transfer to intensive care unit; ICU and/or death) was recorded. Ninety-one patients (aged 74 ± 13 years) with COVID-19 were included in this retrospective study. Fifty (54.9%) patients presented with two or more comorbid diseases. Based on the decision of the referring physician, 36 (39.6%) patients were treated with vitamin D. Receiver operating characteristic curve analysis revealed a significant predictive power of the four variables: (a) low (<50 nmol/L) 25(OH) vitamin D levels, (b) current cigarette smoking, (c) elevated D-dimer levels (d) and the presence of comorbid diseases, to explain the decision to administer vitamin D (area under the curve = 0.77, 95% CI: 0.67-0.87, p < 0.0001). Over the follow-up period (14 ± 10 days), 27 (29.7%) patients were transferred to the ICU and 22 (24.2%) died (16 prior to ICU and six in ICU). Overall, 43 (47.3%) patients experienced the combined endpoint of transfer to ICU and/or death. Logistic regression analyses revealed that the comorbidity burden significantly modified the effect of vitamin D treatment on the study outcome, both in crude (p = 0.033) and propensity score-adjusted analyses (p = 0.039), so the positive effect of high-dose cholecalciferol on the combined endpoint was significantly amplified with increasing comorbidity burden. This hypothesis-generating study warrants the formal evaluation (i.e., clinical trial) of the potential benefit that cholecalciferol can offer in these comorbid COVID-19 patients.
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Affiliation(s)
- Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
- Correspondence: ; Tel.: +39-049-8212169
| | - Giovanni Passeri
- Unit of Clinica e Terapia Medica, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (A.V.)
| | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy;
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Maria Fusaro
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy
| | - Gaetano Arcidiacono
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Marco Onofrio Torres
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Alberto Michielin
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Tancredi Prandini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Valeria Baffa
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Andrea Aghi
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | | | - Martina Brigo
- Internal Medicine, Department of Medicine, University Hospital AOUI, 37134 Verona, Italy; (M.B.); (F.B.)
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.Z.); (M.P.)
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (M.Z.); (M.P.)
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine, University of Padova, 35128 Padova, Italy; (R.V.); (P.F.)
| | - Paola Fioretto
- Clinica Medica 3, Department of Medicine, University of Padova, 35128 Padova, Italy; (R.V.); (P.F.)
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy;
| | - Alessandro Vignali
- Unit of Clinica e Terapia Medica, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.P.); (A.V.)
| | - Fabrizio Fabris
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (M.F.); (G.A.); (M.O.T.); (A.M.); (T.P.); (V.B.); (A.A.); (F.F.)
| | - Francesco Bertoldo
- Internal Medicine, Department of Medicine, University Hospital AOUI, 37134 Verona, Italy; (M.B.); (F.B.)
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15
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Fusaro M, Cianciolo G, Brandi ML, Ferrari S, Nickolas TL, Tripepi G, Plebani M, Zaninotto M, Iervasi G, La Manna G, Gallieni M, Vettor R, Aghi A, Gasperoni L, Giannini S, Sella S, M. Cheung A. Vitamin K and Osteoporosis. Nutrients 2020; 12:nu12123625. [PMID: 33255760 PMCID: PMC7760385 DOI: 10.3390/nu12123625] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/31/2020] [Accepted: 11/14/2020] [Indexed: 12/12/2022] Open
Abstract
Vitamin K acts as a coenzyme of carboxylase, catalyzing the carboxylation of several vitamin K dependent proteins. Beyond its well-known effects on blood coagulation, it also exerts relevant effects on bone and the vascular system. In this review, we point out the relevance of an adequate vitamin K intake to obtain sufficient levels of carboxylated (active form) vitamin K dependent proteins (such as Osteocalcin and matrix Gla protein) to prevent bone health. Another bone-related action of Vitamin K is being a ligand of the nuclear steroid and xenobiotic receptor (SXR). We also discuss the recommended intake, deficiency, and assessment of vitamin K. Furthermore, we review the few available studies that have as pre-specified outcome bone fractures, indicating that we need more clinical studies to confirm that vitamin K is a potential therapeutic agent for bone fractures.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy; (M.F.); (G.I.)
- Department of Medicine, University of Padova, 35128 Padova, Italy;
| | - Giuseppe Cianciolo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.C.); (G.L.M.); (L.G.)
| | - Maria Luisa Brandi
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
| | - Serge Ferrari
- Department of Medicine, Service of Bone Diseases, Faculty of Medicine and Geneva University Hospital, 1205 Geneva, Switzerland;
| | - Thomas L. Nickolas
- Department of Medicine, Division of Nephrology, Columbia University, New York, NY 10032, USA;
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy;
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, 35128 Padua, Italy; (M.P.); (M.Z.)
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, 35128 Padua, Italy; (M.P.); (M.Z.)
| | - Giorgio Iervasi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy; (M.F.); (G.I.)
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.C.); (G.L.M.); (L.G.)
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università di Milano, 20157 Milano, Italy;
| | - Roberto Vettor
- Department of Medicine, University of Padova, 35128 Padova, Italy;
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Lorenzo Gasperoni
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.C.); (G.L.M.); (L.G.)
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padua, 35128 Padua, Italy; (A.A.); (S.G.); (S.S.)
| | - Angela M. Cheung
- Department of Medicine, University Health Network, University of Toronto, 200 Elizabeth Street, Eaton North 7-221, Toronto, ON M5G 2C4, Canada
- Correspondence:
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16
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Fusaro M, Cosmai L, Evenepoel P, Nickolas TL, Cheung AM, Aghi A, Tripepi G, Plebani M, Iervasi G, Vettor R, Zaninotto M, Ravera M, Foramitti M, Giannini S, Sella S, Gallieni M. Vitamin K and Kidney Transplantation. Nutrients 2020; 12:nu12092717. [PMID: 32899501 PMCID: PMC7551925 DOI: 10.3390/nu12092717] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
The assessment of the vitamin K status and its effects on clinical outcomes in kidney transplantation (KT) patients has sparked interest, but it is still largely unfulfilled. In part, this is due to difficulties in laboratory measurements of vitamin K, especially K2 vitamers. Vitamin K status is currently best assessed by measuring undercarboxylated vitamin-K-dependent proteins. The relative contribution of vitamin K1 and K2 to the health status of the general population and CKD (chronic kidney disease) patients, including KT patients, is also poorly studied. Through a complete and first review of the existing literature, we summarize the current knowledge of vitamin K pathophysiology and its potential role in preventing KT complications and improving organ survival. A specific focus is placed on cardiovascular complications, bone fractures, and the relationship between vitamin K and cancer. Vitamin K deficiency could determine adverse outcomes, and KT patients should be better studied for vitamin K assessment and modalities of effective therapeutic approaches.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy;
- Department of Medicine, University of Padova, 35128 Padova, Italy;
- Correspondence:
| | - Laura Cosmai
- Nephrology Unit, ASST Fatebenefratelli Sacco, 20157 Milano, Italy; (L.C.); (M.G.)
| | - Pieter Evenepoel
- Laboratory of Nephrology, Department of Immunology and Microbiology, B-3000 Leuven, Belgium;
| | - Thomas L. Nickolas
- Division of Nephrology, Department of Medicine, Columbia University, New York City, NY 10032, USA;
| | - Angela M. Cheung
- Department of Medicine, University of Toronto, Toronto, ON M5S, Canada;
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padua, 35128 Padova, PD, Italy; (A.A.); (S.G.); (S.S.)
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy;
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, 35128 Padova, Italy; (M.P.); (M.Z.)
| | - Giorgio Iervasi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy;
| | - Roberto Vettor
- Department of Medicine, University of Padova, 35128 Padova, Italy;
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, 35128 Padova, Italy; (M.P.); (M.Z.)
| | | | - Marina Foramitti
- Divisione di Nefrologia e Dialisi, Renal Department, ASST-Cremona, Largo Priori 1, 26100 Cremona, Italy;
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padua, 35128 Padova, PD, Italy; (A.A.); (S.G.); (S.S.)
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padua, 35128 Padova, PD, Italy; (A.A.); (S.G.); (S.S.)
| | - Maurizio Gallieni
- Nephrology Unit, ASST Fatebenefratelli Sacco, 20157 Milano, Italy; (L.C.); (M.G.)
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università di Milano, 20157 Milano, Italy
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Ravera M, Nickolas T, Plebani M, Iervasi G, Aghi A, Khairallah P, Gallieni M, Mereu MC, Giannini S, Sella S, Zaninotto M, Paoletti E, Bussalino E, Di Lullo L, Bellasi A, Cosmai L, Foramitti M, Malberti F, Brandi ML, Ferrari S, Tripepi G, Fusaro M. Overweight-obesity is associated with decreased vitamin K2 levels in hemodialysis patients. Clin Chem Lab Med 2020; 59:581-589. [PMID: 32383688 DOI: 10.1515/cclm-2020-0194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/24/2020] [Accepted: 04/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Obesity is an important risk factor for morbidity and mortality. Vitamin K2 is involved in the production of bone and matrix amino acid g-carboxy-glutamic acid (Gla) proteins (vitamin K-dependent proteins [VKDPs]), regulating bone and vascular calcification (VC). Bone Gla protein (BGP) is involved both in bone mineralization and VCs. We assessed the relationships between vitamin K levels and body mass index (BMI) according to the hypothesis that the impact of BMI on mortality is partly driven by low vitamin K levels. METHODS The Vitamin K Italian (VIKI) study included 387 hemodialysis patients from 18 dialysis centers in Italy. We determined plasma levels of bone markers: vitamin K levels, VKDPs, vitamin 25(OH)D, alkaline phosphatase (ALP), parathyroid hormone (PTH), calcium (Ca), phosphorus (P) and routine biochemistry. BMI was classified into the following categories: underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). RESULTS 45.2% of patients were overweight or obese. Stratification by BMI demonstrated lower median menaquinone-7 (MK7)/triglycerides levels in obese patients (0.42 ng/mg [0.19, 0.87], p = 0.005). BGP levels were lower in overweight and obese patients (152 mcg/L [83.2, 251] and 104 mcg/L [62.7, 230], p = <0.001). Furthermore, there was an inverse correlation between MK7/triglycerides levels and BMI (regression coefficient β = -0.159; p = 0.003). In multiple linear regression, there was an inverse relationship between BGP levels and BMI (β = - 0.119; p = 0.012). CONCLUSIONS These data are the first to report an inverse relationship between Vitamin K2 levels and BMI in hemodialysis patients. Further studies are needed to confirm these findings and to determine if lower levels of Vitamin K are related to greater morbidity and mortality in this at-risk population.
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Affiliation(s)
| | - Thomas Nickolas
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Giorgio Iervasi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | - Pascale Khairallah
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Department of Clinical and Biomedical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | | | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | | | - Luca Di Lullo
- Department of Nephrology and Dialysis, Parodi-Delfino Hospital, Colleferro, Rome, Italy
| | - Antonio Bellasi
- Department of Research, Innovation, Brand Reputation, Bergamo Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Cosmai
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Fabio Malberti
- Nephrology and Dialysis Unit, ASST Cremona, Cremona, Italy
| | - Maria Luisa Brandi
- Department of Biomedical Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Serge Ferrari
- Department of Medicine, Service of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy.,Department of Medicine, University of Padua, Via Giustiniani 2, 35128 Padova, PD, Italy
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18
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Sella S, Bonfante L, Fusaro M, Neri F, Plebani M, Zaninotto M, Aghi A, Innico G, Tripepi G, Michielin A, Prandini T, Calò LA, Giannini S. Efficacy of weekly administration of cholecalciferol on parathyroid hormone in stable kidney-transplanted patients with CKD stage 1-3. Clin Chem Lab Med 2020; 59:343-351. [PMID: 32374278 DOI: 10.1515/cclm-2020-0282] [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: 03/08/2020] [Accepted: 04/10/2020] [Indexed: 11/15/2022]
Abstract
Objectives Kidney transplant (KTx) recipients frequently have deficient or insufficient levels of serum vitamin D. Few studies have investigated the effect of cholecalciferol in these patients. We evaluated the efficacy of weekly cholecalciferol administration on parathyroid hormone (PTH) levels in stable KTx patients with chronic kidney disease stage 1-3. Methods In this retrospective cohort study, 48 stable KTx recipients (37 males, 11 females, aged 52 ± 11 years and 26 months post-transplantation) were treated weekly with oral cholecalciferol (7500-8750 IU) for 12 months and compared to 44 untreated age- and gender-matched recipients. Changes in levels of PTH, 25(OH) vitamin D (25[OH]D), serum calcium, phosphate, creatinine and estimated glomerular filtration rate (eGFR) were measured at baseline, 6 and 12 months. Results At baseline, clinical characteristics were similar between treated and untreated patients. Considering the entire cohort, 87 (94.6%) were deficient in vitamin D and 64 (69.6%) had PTH ≥130 pg/mL. Serum calcium, phosphate, creatinine and eGFR did not differ between groups over the follow-up period. However, 25(OH)D levels were significantly higher at both 6 (63.5 vs. 30.3 nmol/L, p < 0.001) and 12 months (69.4 vs. 30 nmol/L, p < 0.001) in treated vs. untreated patients, corresponding with a significant reduction in PTH at both 6 (112 vs. 161 pg/mL) and 12 months (109 vs. 154 pg/mL) in treated vs. untreated patients, respectively (p < 0.001 for both). Conclusions Weekly administration of cholecalciferol can significantly and stably reduce PTH levels, without any adverse effects on serum calcium and renal function.
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Affiliation(s)
- Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Luciana Bonfante
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Maria Fusaro
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Flavia Neri
- Department of Surgery, Renal and Pancreas Transplant Unit, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Martina Zaninotto
- Department of Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Georgie Innico
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Giovanni Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Institute of Biomedicine, Reggio Calabria, Italy
| | - Alberto Michielin
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Tancredi Prandini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
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Degli Esposti L, Saragoni S, Perrone V, Sella S, Andretta M, Rossini M, Giannini S. Economic Burden of Osteoporotic Patients with Fracture: Effect of Treatment With or Without Calcium/Vitamin D Supplements . NDS 2020. [DOI: 10.2147/nds.s234911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Fusaro M, Aghi A, Giorgio I, Plebani M, Fabris F, D'arrigo G, Wei LL, Pitino A, Gori M, Locatelli F, Gallieni M, Brunori G, Sella S, Mereu MC, Ravera M, Paoletti E, Tripepi GL. FP694HIGHER BMI IS ASSOCIATED WITH DECREASED VITAMIN K2 LEVELS IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp694] [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: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | - Graziella D'arrigo
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Ling Lau Wei
- University of California, Irvine, United States of America
| | | | | | | | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy
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Degli Esposti L, Girardi A, Saragoni S, Sella S, Andretta M, Rossini M, Giannini S. Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk. Endocrine 2019; 64:367-377. [PMID: 30515678 DOI: 10.1007/s12020-018-1824-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/25/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality. METHODS This observational retrospective study was based on data from administrative databases of five Italian Local Health Units. Osteoporosis patients aged ≥ 50 years with hospitalization for vertebral or hip fracture occurring between 01/01/2011 and 31/12/2015 were included. Treatment adherence was calculated using the medication possession ratio. Multivariable proportional hazard Cox model was used to identify factors associated with time to re-fracture and all-cause mortality. RESULTS A cohort of 3475 patients were included and 41.5% of them did not receive any specific anti-fracture treatment. Among treated patients (N = 2032), the majority (83.6%) received calcium/vitamin D supplementation. Over a mean follow-up of 3 years, the risk of subsequent fractures was 44.4% lower in treated patients compared to untreated ones (HR = 0.556, 95% CI = 0.420-0.735, p < 0.001) and 64.4% lower in those receiving calcium/vitamin D supplementation compared to osteoporosis treatment only (HR = 0.356, 95% CI = 0.237-0.533, p < 0.001). The risk of re-fracture was 77.2% lower in treated patients who were adherent to medication (HR = 0.228, 95% CI = 0.139-0.376, p < 0.001). Treated patients had 64% lower mortality risk over the follow-up compared to untreated ones (HR = 0.360, 95% CI = 0.310-0.418, p < 0.001). CONCLUSIONS A consistent proportion of osteoporosis patients did not receive specific treatment after a fracture, showing poor adherence to national guidelines on osteoporosis treatment. Osteoporosis drug treatment, and to a greater extent in combination with calcium/vitamin D, and adherence were correlated with lower risk of both re-fracture and all-cause mortality.
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Affiliation(s)
| | - Anna Girardi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | | | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | | | - Maurizio Rossini
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padova and Regional Center for Osteoporosis, Padova, Italy
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Fusaro M, Gallieni M, Aghi A, Rizzo MA, Iervasi G, Nickolas TL, Fabris F, Mereu MC, Giannini S, Sella S, Giusti A, Pitino A, D’Arrigo G, Rossini M, Gatti D, Ravera M, Di Lullo L, Bellasi A, Brunori G, Piccoli A, Tripepi G, Plebani M. Osteocalcin (bone GLA protein) levels, vascular calcifications, vertebral fractures and mortality in hemodialysis patients with diabetes mellitus. J Nephrol 2019; 32:635-643. [DOI: 10.1007/s40620-019-00595-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
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Fusaro M, Aghi A, Tripepi G, Nickolas T, Iervasi G, Plebani M, Sella S, Mereu MC, Gallieni M. FP601DECREASED OSTEOCALCIN LEVELS AND INCREASED MORTALITY IN HEMODIALYSIS PATIENTS WITH DIABETES MELLITUS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp601] [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: 11/13/2022] Open
Affiliation(s)
- Maria Fusaro
- Department of Medicine, University of Padova, Padova, Italy
- Institute of Clinical Physiology (IFC), National Research Council (CNR), Pisa, Italy
| | - Andrea Aghi
- Department of Medicine, University of Padova, Padova, Italy
| | - Giovanni Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Institute of Biomedicine, Reggio Calabria, Italy
| | - Thomas Nickolas
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, United States
| | - Giorgio Iervasi
- Institute of Clinical Physiology (IFC), National Research Council (CNR), Pisa, Italy
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | | | - Maurizio Gallieni
- DIBIC "Luigi Sacco", University of Milano, Milano, Italy
- Nephrology and Dialysis, Ospedale San Carlo Borromeo- ASST Santi Paolo e Carlo, Milano, Italy
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Bernardi M, Amati E, Chieregato K, Lievore C, Menarin M, Sella S, Tagliaferri C, Alghisi A, Ruggeri M, Astori G. A comparison between two open systems for the ex-vivo expansion of mesenchymal stromal cells. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.167] [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: 10/17/2022]
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Fusaro M, Gallieni M, Aghi A, Iervasi G, Rizzo MA, Stucchi A, Noale M, Tripepi G, Nickolas T, Veronese N, Fabris F, Giannini S, Calo L, Piccoli A, Mereu MC, Cosmai L, Ferraro A, Magonara F, Spinello M, Sella S, Plebani M. Cigarette Smoking is Associated with Decreased Bone Gla-protein (BGP) Levels in Hemodialysis Patients. Curr Vasc Pharmacol 2017; 16:603-609. [PMID: 28933309 DOI: 10.2174/1570161115666170919182421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/03/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bone Gamma-carboxyglutamic acid (Gla)-protein (BGP or osteocalcin) is a vitamin K-dependent protein involved in the regulation of bone mineralization. Smoking is a risk factor for osteoporosis. METHODS We carried out a secondary analysis of the Vitamin K Italian (VIKI) study to investigate the association between cigarette smoking and BGP levels in patients with end stage renal disease. Data were collected in 370 haemodialysis patients, 37% (136) smokers (or ex-smokers) and 63% (234) nonsmokers. Vascular calcifications and vertebral fractures (quantitative morphometry) were identified on spine radiographs. RESULTS Smokers had significantly lower BGP levels (152 vs. 204 µg/L, p=0.003). Smokers had lower plasma phosphate levels (4.2 vs. 4.7 mg/dl, p<0.01). Lower BGP levels were associated with aortic calcification (p<0.001), iliac calcification (p=0.042) and vertebral fractures (p=0.023). In addition, the regression model showed that smoking is associated with a significant reduction of total BGP levels by about 18% (p=0.01). CONCLUSION This is the first clinical study in a haemodialysis population, which identifies cigarette smoking as a potential factor that can lower BGP levels, a protective agent in bone and vascular health.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa Via G. Moruzzi 1, 56124, Pisa, PI, Italy.,Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, PD, Italy
| | - Maurizio Gallieni
- Department of Clinical and Biomedical Sciences "Luigi Sacco", Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, University of Milan, Milan, Italy
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Giorgio Iervasi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa Via G. Moruzzi 1, 56124, Pisa, PI, Italy
| | - Maria A Rizzo
- Nephrology and Dialysis Unit, Ospedale di Circolo di Busto Arsizio, ASST Valle Olona, Italy
| | - Andrea Stucchi
- Nephrology and Dialysis Unit, IRCCS Multimedica, Sesto San Giovanni (Milano), Milan, Italy
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Padua, Italy
| | - Giovanni Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Institute of Biomedicine, Reggio Calabria, Calabria, Italy
| | - Thomas Nickolas
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, United States
| | - Nicola Veronese
- Department of Medicine (DI-MED), Geriatric Section, University of Padua, Italy
| | - Fabrizio Fabris
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Lorenzo Calo
- Nephrology Unit, University of Padua, Padua, Italy
| | | | - Maria C Mereu
- Ospedale N.S. di Bonaria, San Gavino Monreale, Italy
| | | | | | - Fiorenza Magonara
- Unita di Nefrologia e Dialisi, Ospedale Alto Vicentino Santorso, Vicenza, Italy
| | - Michela Spinello
- Unita di Nefrologia-Emodialisi O.C. Piove di Sacco Ulss 6, Padova, Italy
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padova, Padova, Italy
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Fusaro M, Gallieni M, Rizzo MA, Stucchi A, Delanaye P, Cavalier E, Moysés RMA, Jorgetti V, Iervasi G, Giannini S, Fabris F, Aghi A, Sella S, Galli F, Viola V, Plebani M. Vitamin K plasma levels determination in human health. Clin Chem Lab Med 2017; 55:789-799. [PMID: 27732556 DOI: 10.1515/cclm-2016-0783] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [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: 06/19/2016] [Accepted: 09/06/2016] [Indexed: 12/31/2022]
Abstract
Vitamin K (phylloquinone or vitamin K1 and menaquinones or vitamin K2) plays an important role as a cofactor in the synthesis of hepatic blood coagulation proteins, but recently has also aroused an increasing interest for its action in extra-hepatic tissues, in particular in the regulation of bone and vascular metabolism. The accurate measurement of vitamin K status in humans is still a critical issue. Along with indirect assays, such as the undercarboxylated fractions of vitamin K-dependent proteins [prothrombin, osteocalcin (OC), and matrix gla protein], the direct analysis of blood levels of phylloquinone and menaquinones forms might be considered a more informative and direct method for assessing vitamin K status. Different methods for direct quantification of vitamin K serum levels are available. High-performance liquid chromatography (HPLC) methods coupled with post-column reduction procedures and fluorimetric or electrochemical detection are commonly used for food and blood analysis of phylloquinone, but they show some limitations when applied to the analysis of serum menaquinones because of interferences from triglycerides. Recent advancements include liquid chromatography tandem mass spectrometry (LCMS/MS) detection, which assures higher specificity. The optimization and standardization of these methods requires specialized laboratories. The variability of results observed in the available studies suggests the need for further investigations to obtain more accurate analytical results.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR) - Institute of Clinical Physiology (IFC), Pisa Via G. Moruzzi 1, 56124, Pisa, PI
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milan, Milan
| | | | - Andrea Stucchi
- Nephrology and Dialysis Unit, IRCCS Multimedica, Sesto San Giovanni (Milano), Milan
| | - Pierre Delanaye
- Department of Nephrology, Dialysis, and Transplantation, University of Liège, Centre Hospitalier Universitaire du Sart Tilman (ULg CHU), Liège
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, Centre Hospitalier Universitaire du Sart Tilman, Liège
| | | | | | - Giorgio Iervasi
- Institute of Clinical Physiology, National Council of Research, Pisa
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padova, Padova
| | - Fabrizio Fabris
- Department of Medicine, Clinica Medica 1, University of Padova, Padova
| | - Andrea Aghi
- Department of Medicine, Clinica Medica 1, University of Padova, Padova
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padova, Padova
| | - Francesco Galli
- Department of Pharmaceutical Sciences, University of Perugia
| | - Valentina Viola
- Azienda Ospedaliera Universitaria Policlinico Tor Vergata, Rome
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padova, Padova
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Giannini S, Sella S, Rossini M, Braghin D, Gatti D, Vilei MT, Amabile A, Fusaro M, Frigo AC, Sergi G, Lovato R, Nobile M, Fabris F, Adami S. Declining trends in the incidence of hip fractures in people aged 65years or over in years 2000-2011. Eur J Intern Med 2016; 35:60-65. [PMID: 27363306 DOI: 10.1016/j.ejim.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/27/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to explore hip fracture (HFx) incidence in the Veneto Region of Italy, looking at potential differences with the national data. METHODS We analyzed HFx incidence for people aged 65years or over, in years 2000-2011, using data from the Regional Hospitalization Database. Patients were stratified by sex, calendar year and 5-year age class. Data for the single provinces of the Region were also obtained. Absolute number of HFx, crude incidence for 10,000 inhabitants and age-standardized fracture rates were calculated. RESULTS During the study period, there were 53,917 hospitalizations for HFx (77.7% in females). In the whole 11year period of observation, the absolute HFx number increased by 17.7% in males and 10.6% females, respectively. However, age-standardized incidence rates declined by 18% in the same period (IRR 0.82, 95% CI 0.78-0.87). This decreasing trend was almost identical through all the age-cohorts up to 84years. In the whole study period, HFx incidence was lower for Padova (IRR 0.63, 95% CI 0.60-0.66) and Verona (IRR 0.66, 95% CI 0.63-0.70) provinces as compared to the others. This regional profile was quite different with respect to the data published, for the same calendar years, for Italy as a whole, in spite of an almost identical demography of the population. CONCLUSIONS HFx incidence is declining in the Veneto Region of Italy. Further studies, aimed to investigate factors involved in this figure are needed.
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Affiliation(s)
- Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy.
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
| | - Daniela Braghin
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
| | - Maria Teresa Vilei
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Annalisa Amabile
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Maria Fusaro
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Giuseppe Sergi
- Geriatrics Division, Department of Medicine, University of Padova, Italy
| | - Roberto Lovato
- Osteoporosis Center, Casa di Cura Villa Berica, Vicenza, Italy
| | - Martino Nobile
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Fabrizio Fabris
- Clinica Medica 1, Department of Medicine, University of Padova and Regional Center for Osteoporosis, Padova, Italy
| | - Silvano Adami
- Rheumatology Unit, Department of Medicine, University of Verona and Regional Center for Osteoporosis, Verona, Italy
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Panzavolta C, Benvegnù L, Aghi A, Biolo M, Giannini S, Noale M, Tripepi G, Plebani M, Veronese N, Messa P, Rossini M, Gallieni M, Sella S, Fabris F, Manzato E, Previato L, Bertocco S, Zambon A, Fusaro M, Zambon S. Statin therapy reduces phospate levels in dialysis patients: Results from the epidemiological vitamin K Italian study (VIKI study). Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.437] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dalle Carbonare L, Vilei MT, Stranieri C, Innamorati G, Rosato A, Boldrin E, Sella S, Giannini S, Valenti MT. Fast method for skeletal tissue gene expression analysis. Biomed Rep 2016; 5:248-250. [PMID: 27446551 DOI: 10.3892/br.2016.699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/24/2016] [Accepted: 05/11/2016] [Indexed: 12/11/2022] Open
Abstract
Several chronic diseases have been associated with bone alteration in the last few years. Despite the wealth of information provided by the analysis of the transcriptome in affected tissues, only a limited number of studies evaluated gene expression in bone tissue due to the difficulty to obtain high quality RNA. Therefore, skeletal pathologies have been often associated to a defective maturation process that occurs during recruitment of progenitor stem cells. In order to explore the possibility of analysing the gene expression during osteogenic differentiation in skeletal tissue, a single-step method to extract well-preserved RNA from bone specimens was performed. A comparison between this technique and a traditional method was made by analysing the quality and yield of RNA obtained. In addition, RNAs were assayed by reverse transcription-quantitative polymerase chain reaction to analyse the expression levels of the bone genes associated with the differentiation process in a mouse model. The present data showed that good quality RNA can be obtained from bone tissue by a simple single-step method allowing the expression analysis of the genes encoded by skeletal tissue. In conclusion, the present study allows the possibility to easily obtain good quality RNA from bone tissue that is suitable for gene expression studies of bone diseases.
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Affiliation(s)
- Luca Dalle Carbonare
- Department of Medicine, Section of Internal Medicine D, University of Verona, I-37134 Verona, Italy
| | - Maria Teresa Vilei
- Clinica Medica 1, Department of Medicine, University of Padova, I-35128 Padova, Italy
| | - Chiara Stranieri
- Department of Medicine, Section of Internal Medicine D, University of Verona, I-37134 Verona, Italy
| | - Giulio Innamorati
- Department of Medicine, Section of Internal Medicine D, University of Verona, I-37134 Verona, Italy
| | - Antonio Rosato
- Department of Surgery Oncology and Gastroenterology, University of Padova, I-35128 Padova, Italy; Veneto Institute of Oncology-IRCCS, I-35128 Padova, Italy
| | - Elisa Boldrin
- Clinica Medica 1, Department of Medicine, University of Padova, I-35128 Padova, Italy
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova, I-35128 Padova, Italy
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, I-35128 Padova, Italy
| | - Maria Teresa Valenti
- Department of Medicine, Section of Internal Medicine D, University of Verona, I-37134 Verona, Italy
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Astori G, Amati E, Alghisi A, Bernardi M, Borghero C, Budelli S, Chieregato K, Elice F, Giordano R, Lazzari L, Lievore C, Montelatici E, Montemurro T, Raimondi R, Sella S, Tagliaferri C, Rodeghiero F. Cord Blood-Derived Mesenchymal Stromal Cells for the Treatment of Graft-Versus Host Disease Following Hematological Stem Cell Transplantation. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fusaro M, Giannini S, Gallieni M, Noale M, Tripepi G, Rossini M, Messa P, Rigotti P, Pati T, Barbisoni F, Piccoli A, Aghi A, Alessi M, Bonfante L, Fabris F, Zambon S, Sella S, Iervasi G, Plebani M. Calcimimetic and vitamin D analog use in hemodialyzed patients is associated with increased levels of vitamin K dependent proteins. Endocrine 2016; 51:333-41. [PMID: 26130027 DOI: 10.1007/s12020-015-0673-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 04/09/2015] [Accepted: 06/20/2015] [Indexed: 12/24/2022]
Abstract
Matrix Gla protein (MGP) and bone Gla protein (BGP) are two vitamin K-dependent proteins (VKDPs) involved in the regulation of vascular calcification (VC). We carried out a secondary analysis of the VIKI study to evaluate associations between drug consumption and VKDP levels in 387 hemodialyzed patients. The VIKI study assessed the prevalence of vitamin K deficiency in hemodialysis patients. We evaluated drug consumption, determined BGP and MGP levels, and verified the presence of any vertebral fractures (VF) and VC by spine radiographs. Total BGP levels were twice as high with calcimimetics versus no calcimimetics (290 vs. 158.5 mcg/L, p < 0.0001) and 69 % higher with vitamin D analogs (268 vs. 159 mcg/L, p < 0.0001). Total MGP was 19 % higher with calcimimetics (21.5 vs. 18.1 mcg/L, p = 0.04) and 54 % higher with calcium acetate (27.9 vs. 18.1 mcg/L, p = 0.003); no difference was found with vitamin D analogs (21.1 vs. 18.3 mcg/L, p = 0.43). Median Total BGP level was 29 % lower in patients with ≥1 VF (151 vs. 213 mcg/L, p = 0.0091) and 36 % lower in patients with VC (164 vs. 262.1 mcg/L, p = 0.0003). In non-survivors, median BGP and MGP were lower, but only for MGP this difference reached the statistical significance (152 vs. 191 mcg/L, p = 0.20 and 15.0 vs. 19.7 mcg/L, p = 0.02, respectively). Pending studies on vitamin K supplementation, calcimimetics, and vitamin D analogs may play a role in preserving vitamin K-dependent protein activity, thus contributing to bone and vascular health in CKD patients.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Neuroscience Institute, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Sandro Giannini
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | - Maurizio Gallieni
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giovanni Tripepi
- CNR-IFC Pathophysiology of Renal Diseases and Hypertension Unit, Reggio Calabria, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Piergiorgio Messa
- Fondazione Ca' Granda-IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Rigotti
- Kidney - Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Tecla Pati
- Nephrology and Dialysis Unit, Hospital of Rovigo, Rovigo, Italy
| | | | | | - Andrea Aghi
- Nephrology Unit, University of Padua, Padua, Italy
| | | | | | - Fabrizio Fabris
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | - Sabina Zambon
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | - Stefania Sella
- Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
| | | | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
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Fusaro M, Gallieni M, Noale M, Tripepi G, Miozzo D, Plebani M, Zaninotto M, Guglielmi G, Miotto D, Fabris F, Piccoli A, Vilei MT, Sella S, Morachiello P, Stoppa F, Rossini M, Giannini S. The relationship between the Spine Deformity Index, biochemical parameters of bone metabolism and vascular calcifications: results from the Epidemiological VERtebral FRACtures iTalian Study (EVERFRACT) in dialysis patients. Clin Chem Lab Med 2014; 52:1595-603. [PMID: 24897402 DOI: 10.1515/cclm-2014-0194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/19/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Spine Deformity Index (SDI) is a measure of vertebral fractures (VFs), providing information on both their number and severity. METHODS We evaluated the relationships between SDI and clinical, biochemical and arterial calcification parameters in 387 hemodialysis (HD) patients. VFs, assessed by quantitative vertebral morphometry, and vascular calcifications were identified in the same lateral spinal X-ray. To improve the detection of fracture severity, we created a corrected SDI (c-SDI), by dividing SDI for the number of VFs. We assessed routine biochemistry, bone-Gla-protein (BGP), undercaboxylated BGP (ucBGP), and matrix-Gla-protein (MGP). RESULTS VFs prevalence was 55.3%. HD patients with a SDI >1 were more frequently males (p<0.05), and had lower BGP (p<0.01). Patients with a c-SDI >1 had higher LDL-cholesterol (p<0.05) and lower ucBGP (p<0.05) and MGP (p<0.05). Calcifications of the abdominal aorta (AAoC) were more frequent in patients with SDI >1 (p<0.05) and with c-SDI >1 (p<0.05). Multivariate logistic regression showed that male sex (OR 1.86, CI 1.20-2.91), age (OR 1.03, CI 1.01-1.05) and albumin ≥3.5 g/dL (OR 0.54, CI 0.31-0.93) were predictors of a SDI >1. Age (OR 1.05, CI 1.03-1.07), LDL-cholesterol (OR 1.74, CI 1.04-2.92) and ucBGP (OR 0.35, CI 0.18-0.70) were associated with c-SDI >1. CONCLUSIONS We conclude that the severity of VFs was associated with age, atherogenic factors and bone metabolism markers.
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Rossini M, Caimmi C, Giannini S, Sella S, Mattarei A, Lovato R, Piazza I, Fassio A, Persi P, Benetollo PP, Adami S. The initiative on hip fractures of the Veneto Region. Clin Cases Miner Bone Metab 2012; 9:45-49. [PMID: 22783336 PMCID: PMC3392679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE to assess the prevalence of the most relevant environmental and individual risk factors in subjects with a recent hip fracture was the aim of this observational study promoted by the Health Authorities of the Regione Veneto (Italy). METHODS patients aged > 60 years of both genders with a recent hip fracture not associated with malignancies, were administered questionnaires on dietary habits, sun exposure, disability score. A complete family, pharmacological and pathology history was collected together with previous falls, details of the fracture index, anthropometric data. In a subgroup of patients blood was taken for the measurements of serum 25 hydroxy-vitamin D (25OHD). RESULTS the study includes 704 patients (573 women and 131 men). Mean age was 81±8 years (range 60-102). Severe pre-fracture disability was a common feature (58%) associated with multiple co-morbidities (84%), more frequently cardiovascular and neurological diseases, and specific medications. In a large proportion (86%) of the patients environmental or individual risk factors for falling were found. Vitamin D insufficiency was quite common, particularly in the regional Health Districts were strategies for preventing vitamin D deficiency were not implemented. Only a small proportion (17%) of the study population had been evaluate and treated for osteoporosis. CONCLUSIONS in senile patients with a recent hip fracture pre-existing disability, multiple co-morbidities, high risk of falling and inadequate intake of calcium and vitamin D was quite common. Community and case-finding interventions are highly warranted.
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Affiliation(s)
- Maurizio Rossini
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
| | - Cristian Caimmi
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
| | - Sandro Giannini
- Osteoporosis Centers, Veneto Region, Italy, University Hospital of Padova, Padova, Italy
| | - Stefania Sella
- Osteoporosis Centers, Veneto Region, Italy, University Hospital of Padova, Padova, Italy
| | - Alberto Mattarei
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
| | - Roberto Lovato
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
| | - Ilaria Piazza
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
| | - Angelo Fassio
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
| | - Pierluigi Persi
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
| | - Pier Paolo Benetollo
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
| | - Silvano Adami
- Osteoporosis Centers, Veneto Region, Italy, Integrated University Hospital of Verona, Verona, Italy
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Rossini M, Mattarei A, Braga V, Viapiana O, Zambarda C, Benini C, Pancheri S, Spanevello MC, Lovato R, Sella S, Giannini S, Olivi P, Lavini F, Giulini GM, Fracassi E, Gatti D, Adami S. [Risk factors for hip fracture in elderly persons]. Reumatismo 2011; 62:273-82. [PMID: 21253621 DOI: 10.4081/reumatismo.2010.273] [Citation(s) in RCA: 3] [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: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this observational study, promoted by the Health Authorities of the Regione Veneto (Italy), is to assess the prevalence of the most relevant environmental and individual risk factors in subjects with a recent hip fracture. METHODS Patients aged more than 60 years of both genders with a recent hip fracture not associated with malignancies, were administered questionnaires on dietary habits, sun exposure, and disability score. A complete family, pharmacological and pathology history was collected together with information on previous falls, details of the fracture index, and anthropometric data. In all subjects, blood was taken for the measurement of serum 25 hydroxy-vitamin D (25OHD). RESULTS The study included 704 patients (573 women and 131 men). Mean age was 81 ± 8 years (range 60-102). Severe pre-fracture disability was a common feature (58%) associated with multiple co-morbidities (84%), more frequently cardiovascular and neurological diseases, and specific medications. In a large proportion (86%) of the patients, environmental or individual risk factors for falling were found. Vitamin D insufficiency (serum 25OHD levels < 75 nmol/l) was quite common (70%), particularly in the regional Health Districts were strategies for preventing vitamin D deficiency were not implemented (91%). Only a small proportion (17%) of the study population had been evaluated and treated for osteoporosis. CONCLUSIONS In senile patients with a recent hip fracture, pre-existing disability, multiple co-morbidities, high risk of falling and inadequate intake of calcium and vitamin D is relatively common. Community and case-finding interventions aimed at selecting subjects at high risk of osteoporosis, preventing vitamin D and dietary calcium deficiency, and increasing awareness on the environmental risks of falling are highly warranted.
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Affiliation(s)
- M Rossini
- Centro Regione Veneto Specializzato per l'Osteoporosi, U.O. Reumatologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italia.
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Valenti MT, Giannini S, Donatelli L, Zanatta M, Bertoldo F, Sella S, Vilei MT, Ossi E, Realdi G, Lo Cascio V, Dalle Carbonare L. The effect of risedronate on osteogenic lineage is mediated by cyclooxygenase-2 gene upregulation. Arthritis Res Ther 2010; 12:R163. [PMID: 20738860 PMCID: PMC2945066 DOI: 10.1186/ar3122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 01/22/2010] [Revised: 08/02/2010] [Accepted: 08/25/2010] [Indexed: 12/16/2022] Open
Abstract
Introduction The purpose of this study was to evaluate the effects of risedronate (Ris) in the modulation of bone formation in rats with glucocorticoid (GC)-induced osteoporosis by histomorphometric, immunohistochemical and gene expression analyses. Methods We analyzed structure, turnover and microarchitecture, cyclooxygenase 2 (COX-2) levels and osteocyte apoptosis in 40 female rats divided as follows: 1) vehicle of methylprednisolone (vGC) + vehicle of risedronate (vRis); 2) Ris 5 μg/Kg + vGC; 3) methylprednisolone (GC) 7 mg/Kg + vRis; 4) GC 7 mg/Kg +Ris 5 μg/Kg. In addition, we evaluated cell proliferation and expression of COX-2 and bone alkaline phosphatase (b-ALP) genes in bone marrow cells and MLO-y4 osteocytes treated with Ris alone or in co-treatment with the selective COX-2 inhibitor NS-398 or with dexametasone. Results Ris reduced apoptosis induced by GC of osteocytes (41% vs 86%, P < 0.0001) and increased COX-2 expression with respect to controls (Immuno-Hystochemical Score (IHS): 8.75 vs 1.00, P < 0.0001). These positive effects of Ris in bone formation were confirmed by in vitro data as the viability and expression of b-ALP gene in bone marrow cells resulted increased in a dose dependent manner. Conclusions These findings suggest a positive effect of Ris in bone formation and support the hypothesis that the up-regulation of COX-2 could be an additional mechanism of anabolic effect of Ris.
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Sella S, Cattelan C, Realdi G, Giannini S. Bone disease in primary hypercalciuria. Clin Cases Miner Bone Metab 2008; 5:118-26. [PMID: 22460993 PMCID: PMC2781204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Primary Hypercalciuria (PH) is very often accompanied with some degrees of bone demineralization. The most frequent clinical condition in which this association has been observed is calcium nephrolithiasis. In patients affected by this disorder bone density is very frequently low and increased susceptibility to fragility fractures is reported. The very poor definition of this bone disease from a histomorphometric point of view is a crucial aspect. At present, the most common finding seems to be a low bone turnover condition. Many factors are involved in the complex relationships between bone loss and PH. Since bone loss was mainly reported in patients with fasting hypercalciuria, a primary alteration in bone metabolism was proposed as a cause of both hypercalciuria and bone demineralization. This hypothesis was strengthened by the observation that some bone resorbing-cytokines, such as IL-1, IL-6, and TNF-α are high in hypercalciuric patients. The effect of an excessive response to the acid load induced by dietary protein intake seems an additional factor explaining a primitive alteration of bone. The intestine plays a major role in the clinical course of bone disease in PH. Patients with absorptive hypercalciuria less frequently show bone disease and a reduction in dietary calcium greatly increases the probability of bone loss in PH subjects. It has recently been reported that greater bone loss is associated with a larger increase in intestinal calcium absorption in PH patients. Considering the absence of PTH alterations, it was proposed that this is not a compensatory phenomenon, but probably the marker of disturbed cell calcium transport, involving both intestinal and bone tissues. While renal hypercalciuria is rather uncommon, the kidney still seems to play a role in the pathogenesis of bone loss of PH patients, possibly via the effect of mild to moderate urinary phosphate loss with secondary hypophosphatemia. In conclusion, bone loss is very common in PH patients. Even if most of the factors involved in this process have been identified, many aspects of this intriguing clinical condition remain to be elucidated.
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Affiliation(s)
- Stefania Sella
- Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
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Dalle Carbonare L, Bertoldo F, Valenti MT, Zordan S, Sella S, Fassina A, Turco G, Realdi G, Lo Cascio V, Giannini S. Risedronate prevents the loss of microarchitecture in glucocorticoid-induced osteoporosis in rats. J Endocrinol Invest 2007; 30:739-46. [PMID: 17993765 DOI: 10.1007/bf03350811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Osteoporosis is a severe complication of glucocorticoid treatment. Bisphosphonates are a powerful therapeutic option to prevent osteoporotic fractures. The aims of this study were: a) to determine bone alterations induced by therapy with glucocorticoids (GC); b) to establish the efficacy of risedronate (Ris) in the prevention of these effects. We studied 40 female Sprague-Dawley rats randomly divided into 4 groups of treatment, administered 3 times a week sc: 1. CONTROL vehicle of methylprednisolone (GC) + vehicle of Ris; 2. Ris: Ris 5 mug/kg body weight vehicle of GC; 3. GC: GC 7 mg/kg + vehicle of Ris; 4. GC+Ris: GC 7 mg/kg, Ris 5 microg/kg. Animals were treated for 30 days and then were sacrificed. Densitometry was performed at baseline and at the end of the treatment. Right tibiae were removed for histomorphometric analyses. The GC group showed a 7% decrease in bone density vs controls (p<0.05), while the GC+Ris group was associated with a 3.5% increase in bone density vs controls (p<0.05). In the GC group, histomorphometric evaluations showed reduced bone volume (BV/TV) and thinning of trabeculae (Tb.Th) vs controls (BV/TV: 31+/-1 vs 35+/-1%, p<0.05; Tb.Th: 43+/-2 vs 50+/-3 microm, p<0.01; Ac.f: 1.8+/-0.2 vs 1.6+/-0.3 N/yr). The GC+Ris group had increased BV/TV and Tb.Th, and reduced Ac.f vs the GC group. Ris also maintained trabecular microarchitecture. At the histological level, glucocorticoid-induced osteoporosis was characterized by decreased bone volume, reduced osteoblastic activity, and deterioration of microarchitecture. Ris counteracted these effects both by prolonging osteoblast activity, and by maintaining bone microarchitecture.
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Affiliation(s)
- L Dalle Carbonare
- Clinic of Internal Medicine D, Department of Biomedical and Surgical Sciences, University of Verona, 37134 Verona, Italy.
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Abstract
Primary hypercalciuria (PH) is very often accompanied by some degree of bone demineralization. The most frequent clinical condition in which this association has been observed is calcium nephrolithiasis. In patients affected by this disorder, bone density is very frequently low, and increased susceptibility to fragility fractures is reported. The very poor definition of this bone disease from a histomorphometric point of view is a crucial aspect. At present, the most common finding seems to be a low bone turnover condition. Many factors are involved in the complex relationships between bone loss and PH. Since bone loss was mainly reported in patients with fasting hypercalciuria, a primary alteration in bone metabolism was proposed as a cause of both hypercalciuria and bone demineralization. This hypothesis was strengthened by the observation that some bone resorbing-cytokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor nechrosis factor-alpha (TNF-alpha), are high in hypercalciuric patients. An excessive response to the acid load induced by dietary protein intake seems to be an additional factor explaining a primitive alteration of bone. The intestine plays a major role in the clinical course of bone disease in PH. Patients with absorptive hypercalciuria less frequently show bone disease, and a reduction in dietary calcium greatly increases the probability of bone loss in PH subjects. It has recently been reported that greater bone loss is associated with a larger increase in intestinal calcium absorption in PH patients. Considering the absence of parathyroid hormone (PTH) alterations, it was proposed that this is not a compensatory phenomenon, but probably the marker of disturbed cell calcium transport, involving both intestinal and bone tissues. While renal hypercalciuria is rather uncommon, the kidney still seems to play a role in the pathogenesis of bone loss in PH patients, possibly via the effect of mild-to-moderate urinary phosphate loss with secondary hypophosphatemia. In conclusion, bone loss is very common in PH patients. Even if most of the factors involved in this process have been identified, many aspects of this intriguing clinical condition remain to be elucidated.
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Affiliation(s)
- Sandro Giannini
- Department of Medical and Surgical Sciences, University of Padova, Italy.
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Dalle Carbonare L, Bertoldo F, Valenti MT, Zenari S, Zanatta M, Sella S, Giannini S, Cascio VL. Histomorphometric analysis of glucocorticoid-induced osteoporosis. Micron 2005; 36:645-52. [PMID: 16243531 DOI: 10.1016/j.micron.2005.07.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [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: 05/30/2005] [Revised: 07/04/2005] [Accepted: 07/07/2005] [Indexed: 11/25/2022]
Abstract
Bone histomorphometry or quantitative histology consists of counting or measuring tissue components: cells, extracellular constituents and microarchitecture. Bone histomorphometry is the only method that allows the measurement of mineralization rate and the study of bone formation at three levels: cell, remodeling unit and tissue levels. It is a useful tool to explain the pathogenesis and cellular mechanisms of different metabolic bone diseases such as glucocorticoid-induced osteoporosis (GIO). Glucocorticoids (GC) affect calcium and bone metabolism at every level, but the main effect is the osteoblastic dysfunction. Concerning the bone formation, some histomorphometric studies have shown a depressed osteoblastic activity at a cell, bone remodeling unit, and tissue levels. In addition, there is evidence of a shortening of the period in which the osteoblasts work actively forming the bone matrix. This latter effect seems to occur after high cumulative doses of GC. With regard to the resorption, the results are still debated, but histomorphometric parameters seem to be increased in the majority of studies, at least in the first period of the GC treatment. From a structural point of view, GC seem to induce a thinning of the trabeculae without their perforation, which occurs only after high cumulative doses. Anti-resorptive treatments, such as bisphosphonates, are able to counteract the negative effects of GC on bone. In particular, along with their active working period, they prolong the lifespan of osteoblasts and osteocytes. In addition, the anti-resorptive treatments seem to extend the time for secondary mineralization through a reduction of the Activation Frequency. The latter is an intriguing mechanism of bisphosphonates in GIO that needs further ad hoc investigations.
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Affiliation(s)
- L Dalle Carbonare
- Department of Biomedical and Surgical Sciences, Medicina Interna D, University of Verona, Italy.
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Giannini S, Nobile M, Dalle Carbonare L, Lodetti MG, Sella S, Vittadello G, Minicuci N, Crepaldi G. Hypercalciuria is a common and important finding in postmenopausal women with osteoporosis. Eur J Endocrinol 2003; 149:209-13. [PMID: 12943523 DOI: 10.1530/eje.0.1490209] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE AND DESIGN The prevalence and the effects of hypercalciuria on bone in patients with primary osteoporosis are poorly defined. We therefore retrospectively analyzed the data of 241 otherwise healthy women. They were 45-88 years of age and had been referred for their first visit to our Unit for Metabolic Bone Diseases over a 2-year period because of primary osteoporosis (bone density T-score < -2.5). METHODS The main parameters of calcium and skeletal metabolism had been analyzed in all subjects. This population was then divided into two groups, according to the presence (HC+) or absence (HC-) of hypercalciuria. RESULTS Elevated urinary calcium was present in 19% of the subjects. Due to the selection criteria, spinal and femoral bone loss was similar in the two groups. Urinary calcium, phosphate and fractional calcium excretion were higher in hypercalciuric patients. In a logistic regression model, the higher the Tm of phosphate, the lower the risk of hypercalciuria (odds ratio 0.33, confidence interval 0.18-0.62). On the contrary, hypercalciuria was the most important predictor of low bone mass in HC+ (accounting for more than 50% of the variance in spinal bone density). CONCLUSIONS Hypercalciuria is a common feature in postmenopausal bone loss. Since increased urinary calcium excretion and low bone mass appear to be linked, hypercalciuria seems to be an important determinant of reduced bone density in this setting as well.
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Affiliation(s)
- Sandro Giannini
- Department of Medical and Surgical Sciences, Clinica Medica 1, University of Padua, Padua, Italy.
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Abstract
In order to understand better the role of associate nurse in the primary nursing model, narratives from associate nurses were analysed using hermeneutic approach. Major themes in the narratives included: connecting with patients, collaborating with other nurses, and making decisions. Associate nurses were found to define their practice as 'primary' in terms of their contributions to patient care and being a responsible professional. A better understanding of the associate role in clinical practice can enhance patient care and professional relationships. Further research into the philosophical nature of primary nursing is suggested.
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Rittman MR, Sella S. Storytelling: an innovative approach to staff development. J Nurs Staff Dev 1995; 11:15-9. [PMID: 7869133] [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: 01/27/2023]
Abstract
Using stories or narratives from clinical practice as a teaching/learning strategy is new in nursing education programs in hospitals. In this article, the authors describe three staff development programs using storytelling to enable others to use the interpretation of stories to promote expertise in clinical practice.
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Abstract
This is the second part of a two-part article that presents findings from a staff nurse survey one year after the implementation of primary nursing on four medical and surgical pilot units in a tertiary teaching hospital. The introduction of primary nursing was one phase of a project to develop theory-based nursing practice within the institution. The researchers hoped that obtaining the staff nurse perspective on the change to primary nursing would provide evaluative information and suggestions to provide additional support in the project. Role theory (Hardy, 1978) provides the theoretical framework for this study. While the previous article discussed issues related to the change process, this article focuses on evaluation of role transitions.
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Abstract
One year after the introduction of primary nursing on four medical and surgical units in the tertiary hospital, a 23-item survey was distributed to primary and associate nurses on these units to evaluate the nurses' perceptions of the status of this change in nursing care delivery. Lewin's theory of change provided direction for evaluation of the change. The survey assessed improvements in patient care, changes in nursing practice, and interactions with other disciplines. The majority of nurses surveyed reported that patient care had improved under primary nursing; 100% of the primary nurses agreed that care had improved. The nurses identified continuity of care, communications, and awareness of patient problems as specific areas of improvement. They also identified improved interactions with many members of the healthcare team; the greatest were with dietitians, social workers, and physicians. The authors reported both positive and negative perceptions of how practice had changed under primary nursing. Results from the survey provided suggestions for continued support for staff nurses in this change in nursing care delivery within the studied facility, and suggested the need for future assessment and further evaluation.
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Affiliation(s)
- S Sella
- VA Medical Center, Gainesville, FL
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Barash V, Mandel H, Sella S, Geiger R. 3-Hydroxy-3-methylglutaryl-coenzyme A lyase deficiency: biochemical studies and family investigation of four generations. J Inherit Metab Dis 1990; 13:156-64. [PMID: 2116546 DOI: 10.1007/bf01799678] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) lyase activity was determined by the recently described spectrophotometric method of Wanders et al. (1988a) in polymorphonuclear leukocytes and lymphocytes obtained from 33 members of a highly consanguineous Arab-Bedouin family belonging to four generations. Seven subjects were obligatory heterozygotes (parents and grandparents of three propositi); in seven additional subjects enzyme activity in both cell types was in the heterozygote range. No asymptomatic homozygotes were found. The results support the proposed autosomal recessive mode of inheritance of this disorder.
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Affiliation(s)
- V Barash
- Department of Clinical Biochemistry, Hadassah University Hospital, Jerusalem, Israel
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