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Siligato R, Gembillo G, Di Simone E, Di Maria A, Nicoletti S, Scichilone LM, Capone M, Vinci FM, Bondanelli M, Malaventura C, Storari A, Santoro D, Di Muzio M, Dionisi S, Fabbian F. Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol. Methods Protoc 2024; 7:34. [PMID: 38668141 PMCID: PMC11053909 DOI: 10.3390/mps7020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care.
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Affiliation(s)
- Rossella Siligato
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98121 Messina, Italy;
| | - Guido Gembillo
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98121 Messina, Italy;
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy;
| | - Emanuele Di Simone
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Alessio Di Maria
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Simone Nicoletti
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Laura Maria Scichilone
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Matteo Capone
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Francesca Maria Vinci
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Marta Bondanelli
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Cristina Malaventura
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Alda Storari
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy;
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Sara Dionisi
- Nursing, Technical and Rehabilitation, Department DATeR Azienda Unità Sanitaria Locale di Bologna, 40121 Bologna, Italy;
| | - Fabio Fabbian
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
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Piva G, Caruso L, Gómez AC, Calzolari M, Visintin EP, Davoli P, Manfredini F, Storari A, Spinozzi P, Lamberti N. Effects of forest walking on physical and mental health in elderly populations: a systematic review. Rev Environ Health 2024; 39:121-136. [PMID: 36239186 DOI: 10.1515/reveh-2022-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
There is a growing awareness that spending time in nature is associated with improvement of well-being; nevertheless, the prescription of forest bathing is still limited. The aim of this systematic review was to explore the physiological and psychological benefits of different forest therapies on healthy and pathological elderly populations (>60 years) to identify the most-effective type, duration, and frequency of these interventions. A search for literature was carried out in December 2021 using PubMed, EMBASE, ResearchGate, Google Scholar and Web of Science. Grey literature was searched as well. After removal of the duplicates, within the 214 articles identified, ten met the inclusion criteria. The methodological quality of the selected studies was rated. Forest walking, alone and in combination with other activities is the most effective intervention. The selected studies reported a positive impact on physical components, including reduction in blood pressure and heart rate and improvements in cardiopulmonary and neurochemical parameters. Favorable modifications have also been noted in the psychological field, with improvements in depression, stress levels and in quality of life perception. In conclusion, forest walking may play an important role in promoting physical and mental health in healthy and pathological elderly populations. However, the lack of high-quality studies limits the strength of the results, calling for more trials.
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Affiliation(s)
- Giovanni Piva
- PhD Program in Environmental Sustainability and Wellbeing, Department of Humanities, University of Ferrara, Ferrara, Italy
| | - Lorenzo Caruso
- Department of Environmental Sciences and Prevention, University of Ferrara Ferrara, Italy
| | - Alberto Cruz Gómez
- Freelance researcher; previously master Degree in Preventive and Adapted Phyisical Sciences, University of Ferrara Ferrara, Italy
| | - Marta Calzolari
- Architettura>Energia Research Centre, Department of Architecture, University of Ferrara Ferrara, Italy
| | | | - Pietromaria Davoli
- Architettura>Energia Research Centre, Department of Architecture, University of Ferrara Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara Ferrara, Italy
- Unit of Physical Medicine and Rehabilitation, University Hospital of Ferrara Ferrara, Italy
| | - Alda Storari
- Unit of Nephrology and Dialysis, University Hospital of Ferrara Ferrara, Italy
| | - Paola Spinozzi
- Department of Humanities, University of Ferrara Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara Ferrara, Italy
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Bulighin F, Aucella F, Bellizzi V, Cupisti A, Faga T, Gambaro G, Regolisti G, Storari A, Capitanini A, Battaglia Y. Physical activity and exercise programs for kidney patients: an Italian survey of nephrology centres. J Nephrol 2024:10.1007/s40620-024-01896-w. [PMID: 38446385 DOI: 10.1007/s40620-024-01896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/07/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Data on exercise activities in place, and on the interest for developing them in Nephrology Services in Italy is limited. To address this gap, we carried out this cross-sectional study to investigate the status of physical activity and exercise programs available in Italian Nephrology Centres. Additionally, research priorities on this topic were examined. METHODS We developed a 14-item electronic survey, which consisted of multiple-choice questions covering exercise training programs, physical assessment, barriers to exercise practice and to exercise programs, exercise and physical activity counselling practices, perceived exercise benefits, literature evidence, and research priorities. Data on the characteristics of the centres were also collected. RESULTS Sixty-two responses from Italian nephrology centres were collected. Ninety-three percent of the respondents were aware of the scientific evidence supporting the benefits of regular exercise programs for chronic kidney disease (CKD) patients. Additionally, in 75% of centres the nephrologists believed that physical activity counselling should be performed by the nephrologists. However, only 26% of centres provided exercise programs, mainly for dialysis patients, and 63% never or infrequently assessed physical activity in the context of patient management. Eighty-nine percent of centres reported barriers to implementing exercise programs, including lack of funding, institutional disinterest, patient refusal, and negative attitudes of the healthcare personnel. Forty-six research priorities related to exercise in CKD patients were suggested, with the majority focusing on impact of exercise programs and physical activity on cardiovascular, nutritional, and psychosocial outcomes. CONCLUSION This survey highlights the limited availability of exercise programs and physical activity evaluation in clinical practice in Italian Nephrology Centres. However, the survey also revealed a strong interest for counselling CKD patients on physical activity and implementing exercise prescriptions and interventions.
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Affiliation(s)
- Francesca Bulighin
- Department of Medicine, University of Verona, 37129, Verona, VR, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Via Monte Baldo, 24, 37019, Peschiera del Garda, VR, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, Casa Sollievo della Sofferenza, 71013, San Giovanni Rotondo, FG, Italy
| | - Vincenzo Bellizzi
- Nephrology and Dialysis Unit, Sant'Anna e San Sebastiano, 81100, Caserta, CE, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126, Pisa, PI, Italy
| | - Teresa Faga
- Nephrology and Dialysis Unit, AOU Mater Domini, 88100, Catanzaro, CZ, Italy
| | - Giovanni Gambaro
- Nephrology and Dialysis Unit, AOUI Verona, 37126, Verona, VR, Italy
| | | | - Alda Storari
- Nephrology Unit, AUO Ferrara, 44124, Ferrara, Italy
| | | | - Yuri Battaglia
- Department of Medicine, University of Verona, 37129, Verona, VR, Italy.
- Nephrology and Dialysis Unit, Pederzoli Hospital, Via Monte Baldo, 24, 37019, Peschiera del Garda, VR, Italy.
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Albertazzi V, Fontana F, Giberti S, Aiello V, Battistoni S, Catapano F, Graziani R, Cimino S, Scichilone L, Forcellini S, De Fabritiis M, Sara S, Delsante M, Fiaccadori E, Mosconi G, Storari A, Mandreoli M, Bonucchi D, Buscaroli A, Mancini E, Rigotti A, La Manna G, Gregorini M, Donati G, Cappelli G, Scarpioni R. Primary membranous nephropathy in the Italian region of Emilia Romagna: results of a multicenter study with extended follow-up. J Nephrol 2024; 37:471-482. [PMID: 37957455 DOI: 10.1007/s40620-023-01803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Since primary membranous nephropathy is a heterogeneous disease with variable outcomes and multiple possible therapeutic approaches, all 13 Nephrology Units of the Italian region Emilia Romagna decided to analyze their experience in the management of this challenging glomerular disease. METHODS We retrospectively studied 205 consecutive adult patients affected by biopsy-proven primary membranous nephropathy, recruited from January 2010 through December 2017. The primary outcome was patient and renal survival. The secondary outcome was the rate of complete remission and partial remission of proteinuria. Relapse incidence, treatment patterns and adverse events were also assessed. RESULTS Median (IQR) follow-up was 36 (24-60) months. Overall patient and renal survival were 87.4% after 5 years. At the end of follow-up, 83 patients (40%) had complete remission and 72 patients (35%) had partial remission. Among responders, less than a quarter (23%) relapsed. Most patients (83%) underwent immunosuppressive therapy within 6 months of biopsy. A cyclic regimen of corticosteroid and cytotoxic agents was the most commonly used treatment schedule (63%), followed by rituximab (28%). Multivariable analysis showed that the cyclic regimen significantly correlates with complete remission (odds ratio 0.26; 95% CI 0.08-0.79) when compared to rituximab (p < 0.05). CONCLUSIONS In our large study, both short- and long-term outcomes were positive and consistent with those published in the literature. Our data suggest that the use of immunosuppressive therapy within the first 6 months after biopsy appears to be a winning strategy, and that the cyclic regimen also warrants a prominent role in primary membranous nephropathy treatment, since definitive proof of rituximab superiority is lacking.
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Affiliation(s)
- Vittorio Albertazzi
- Nephrology and Dialysis Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Via Taverna 49, 29121, Piacenza, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Stefania Giberti
- Nephrology and Dialysis Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Valeria Aiello
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Sara Battistoni
- Unit of Nephrology and Dialysis, Ospedale Infermi, Rimini, Italy
| | - Fausta Catapano
- Unit of Nephrology, Dialysis and Hypertension, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Romina Graziani
- Unit of Nephrology and Dialysis, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Simonetta Cimino
- Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale di Modena, Ospedale Ramazzini, Carpi, Italy
| | - Laura Scichilone
- Nephrology and Dialysis Unit, Azienda USL Imola, Ospedale S. Maria Scaletta, Imola, Italy
| | | | - Marco De Fabritiis
- Unit of Nephrology and Dialysis, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Signorotti Sara
- Unit of Nephrology and Dialysis, Ospedale Bufalini, Cesena, Italy
| | - Marco Delsante
- Nephrology Unit, Parma University Hospital, University of Parma, Parma, Italy
| | - Enrico Fiaccadori
- Nephrology Unit, Parma University Hospital, University of Parma, Parma, Italy
| | - Giovanni Mosconi
- Unit of Nephrology and Dialysis, Ospedale Morgagni-Pierantoni, Forlì, Italy
- Unit of Nephrology and Dialysis, Ospedale Bufalini, Cesena, Italy
| | - Alda Storari
- Unit of Nephrology, University Hospital of Ferrara, Ferrara, Italy
| | - Marcora Mandreoli
- Nephrology and Dialysis Unit, Azienda USL Imola, Ospedale S. Maria Scaletta, Imola, Italy
| | - Decenzio Bonucchi
- Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale di Modena, Ospedale Ramazzini, Carpi, Italy
| | - Andrea Buscaroli
- Unit of Nephrology and Dialysis, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Elena Mancini
- Unit of Nephrology, Dialysis and Hypertension, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Angelo Rigotti
- Unit of Nephrology and Dialysis, Ospedale Infermi, Rimini, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Gabriele Donati
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Scarpioni
- Nephrology and Dialysis Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Via Taverna 49, 29121, Piacenza, Italy.
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Ferrara F, Siligato R, Di Maria A, Scichilone L, Di Simone E, Bondanelli M, Storari A, De Giorgi A, Di Muzio M, Fabbian F. Food insecurity and kidney disease: a systematic review. Int Urol Nephrol 2024; 56:1035-1044. [PMID: 37679580 PMCID: PMC10853316 DOI: 10.1007/s11255-023-03777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The risk of developing and worsening chronic kidney disease (CKD) is associated with unhealthy dietary patterns. Food insecurity is defined by a limited or uncertain availability of nutritionally adequate and safe food; it is also associated with several chronic medical conditions. The aim of this systematic review is to investigate the current knowledge about the relationship between food insecurity and renal disease. METHODS We selected the pertinent publications by searching on the PubMed, Scopus, and the Web of Science databases, without any temporal limitations being imposed. The searching and selecting processes were carried out through pinpointed inclusion and exclusion criteria and in accordance with the Prisma statement. RESULTS Out of the 26,548 items that were first identified, only 9 studies were included in the systemic review. Eight out of the nine investigations were conducted in the US, and one was conducted in Iran. The studies evaluated the relationship between food insecurity and (i) kidney disease in children, (ii) kidney stones, (iii) CKD, (iv) cardiorenal syndrome, and (v) end stage renal disease (ESRD). In total, the different research groups enrolled 49,533 subjects, and food insecurity was reported to be a risk factor for hospitalization, kidney stones, CKD, ESRD, and mortality. CONCLUSIONS The relationship between food insecurity and renal disease has been underestimated. Food insecurity is a serious risk factor for health problems in both wealthy and poor populations; however, the true prevalence of the condition is unknown. Healthcare professionals need to take action to prevent the dramatic effect of food insecurity on CKD and on other chronic clinical conditions.
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Affiliation(s)
| | | | - Alessio Di Maria
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Laura Scichilone
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Emanuele Di Simone
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185, Rome , Italy
| | - Marta Bondanelli
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Alda Storari
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Alfredo De Giorgi
- Clinica Medica Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185, Rome , Italy
| | - Fabio Fabbian
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy.
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
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Elia R, Piva G, Bulighin F, Lamberti N, Manfredini F, Gambaro G, Di Maria A, Salvagno G, Carbonare LGD, Storari A, Valenti MT, Battaglia Y. The Impact of Physical Exercise on microRNAs in Hemodialysis Patients: A Review and a Protocol for an Ancillary Study. Biomedicines 2024; 12:468. [PMID: 38398071 PMCID: PMC10886953 DOI: 10.3390/biomedicines12020468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Physical inactivity is considered a significant risk factor for mortality and morbidity among chronic hemodialysis (HD) patients. Therefore, physical exercise is recommended in the treatment of HD patients. Although the beneficial effects of physical exercise in HD patients are well-described in the literature, the underlying physiological mechanisms still need to be fully understood. Recently, microRNAs (miRNAs) have emerged as potential mediators of the therapeutic effects of physical exercise in healthy individuals. miRNAs are short, single-stranded, noncoding RNAs involved in gene expression regulation. Specifically, upon forming the RNA-induced silencing complex, miRNAs selectively bind to specific miRNAs within cells, reducing gene expression. miRNAs can be secreted by cells in an accessible form or enclosed within exosomes or extracellular vesicles. They can be detected in various body fluids, including serum (circulating miRNAs), facilitating the study of their diverse expression. Currently, there is no available data regarding the impact of physical exercise on the expression of miRNAs involved in osteogenic differentiation, a fundamental mechanism in the development of vascular calcification, for HD patients. Therefore, we have designed an observational and longitudinal case-control study to evaluate the expression of miR-9 and miR-30b in HD patients participating in a 3-month interdialytic physical exercise program. This paper aims to present the study protocol and review the expression of circulating miRNAs in HD patients and their modulation through physical exercise.
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Affiliation(s)
- Rossella Elia
- PhD Program in Clinical and Experimental Biomedical Sciences, Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Giovanni Piva
- PhD Program in Environmental Sustainability and Wellbeing, Department of Humanities, University of Ferrara, 44122 Ferrara, Italy;
| | - Francesca Bulighin
- Nephrology and Dialysis Unit, Pederzoli Hospital, 37019 Peschiera del Garda, Italy;
- Department of Medicine, University of Verona, 37129 Verona, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44122 Ferrara, Italy; (N.L.); (F.M.)
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44122 Ferrara, Italy; (N.L.); (F.M.)
| | - Giovanni Gambaro
- Nephrology and Dialysis Unit, Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Alessio Di Maria
- Nephrology and Dialysis Unit, University Hospital of Ferrara, 44122 Ferrara, Italy; (A.D.M.); (A.S.)
| | - Gianluca Salvagno
- Section of Clinical Biochemistry, University of Verona, 37129 Verona, Italy;
| | - Luca Giuseppe Dalle Carbonare
- Internal Medicine, Section D, Department of Medicine, University of Verona, 37129 Verona, Italy; (L.G.D.C.); (M.T.V.)
| | - Alda Storari
- Nephrology and Dialysis Unit, University Hospital of Ferrara, 44122 Ferrara, Italy; (A.D.M.); (A.S.)
| | - Maria Teresa Valenti
- Internal Medicine, Section D, Department of Medicine, University of Verona, 37129 Verona, Italy; (L.G.D.C.); (M.T.V.)
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, Pederzoli Hospital, 37019 Peschiera del Garda, Italy;
- Department of Medicine, University of Verona, 37129 Verona, Italy
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7
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Fabbian F, De Giorgi A, Ferrara F, Alfano G, Mori G, Di Maria A, Frisina M, Veronesi M, Storari A, Donati G. Comorbidity and in-hospital mortality in peritoneal dialysis patients: data of the Emilia Romagna region of Italy. Eur Rev Med Pharmacol Sci 2023; 27:6867-6875. [PMID: 37522699 DOI: 10.26355/eurrev_202307_33158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Kidney failure increases in-hospital mortality (IHM); however, comorbidity is crucial for predicting mortality in dialysis patients. Our aim was to evaluate the impact of comorbidity, assessed by modified Elixhauser index (mEI), Charlson Comorbidity Index (CCI), and age-adjusted CCI, on IHM in a cohort of peritoneal dialysis patients admitted to hospitals of the Emilia Romagna region (ERR) of Italy. PATIENTS AND METHODS All hospital admissions of peritoneal dialysis patients recorded between 2007 and 2021 in the ERR database were analyzed. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was used for detecting diagnoses and procedures, and the inclusion criterion was code 5498. Comorbidity burden was evaluated by three different scores, and hemodialysis (HD) treatment need was considered. IHM was our outcome. RESULTS During the 15 years of the study, 3,242 hospitalized peritoneal dialysis patients (62.7% males) were evaluated. Mean age was 62.8±20.6 years, 9.6% underwent HD, and IHM was 5.9% (n=192). IHM mortality was stable throughout the study period. Deceased subjects were older, were hospitalized longer, had a higher comorbidity burden, and had a higher percentage of HD treatment needs than survivors. Age, male sex, comorbidity burden, and HD treatment were predictors of IHM. Receiver operating characteristics (ROC) analysis confirmed the impact of comorbidity burden on IHM, especially when age was considered. CONCLUSIONS We conclude that in male, elderly hospitalized peritoneal dialysis patients with failing dialysis technique, comorbidity burden should be considered being a predictor of IHM.
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Affiliation(s)
- F Fabbian
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
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Zerbinati L, Guerzoni F, Napoli N, Preti A, Esposito P, Caruso R, Bulighin F, Storari A, Grassi L, Battaglia Y. Psychosocial determinants of healthcare use costs in kidney transplant recipients. Front Public Health 2023; 11:1158387. [PMID: 37333548 PMCID: PMC10272730 DOI: 10.3389/fpubh.2023.1158387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Psychosocial factors frequently occur in kidney transplant recipients (KTRs), leading to behavioral alterations and reduced therapeutic adherence. However, the burden of psychosocial disorders on costs for KTRs is unknown. The aim of the study is to identify predictors of healthcare costs due to hospital admissions and emergency department access in KTRs. Methods This is a longitudinal observational study conducted on KTRs aged >18 years, excluding patients with an insufficient level of autonomy and cognitive disorder. KTRs underwent psychosocial assessment via two interviews, namely the Mini-International Neuropsychiatric Interview 6.0 (MINI 6.0) and the Diagnostic Criteria for Psychosomatic Research Interview (DCPR) and via the Edmonton Symptom Assessment System Revised (ESAS-R) scale, a self-administrated questionnaire. Sociodemographic data and healthcare costs for hospital admissions and emergency department access were collected in the 2016-2021 period. Psychosocial determinants were as follows: (1) ESAS-R psychological and physical score; (2) symptomatic clusters determined by DCPR (illness behavior cluster, somatization cluster, and personological cluster); and (3) ICD diagnosis of adjustment disorder, anxiety disorder, and mood disorder. A multivariate regression model was used to test the association between psychosocial determinants and total healthcare costs. Results A total of 134 KTRs were enrolled, of whom 90 (67%) were men with a mean age of 56 years. A preliminary analysis of healthcare costs highlighted that higher healthcare costs are correlated with worse outcomes and death (p < 0.001). Somatization clusters (p = 0.020) and mood disorder (p < 0.001) were positively associated with costs due to total healthcare costs. Conclusions This study showed somatization and mood disorders could predict costs for hospital admissions and emergency department access and be possible risk factors for poor outcomes, including death, in KTRs.
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Affiliation(s)
- Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Franco Guerzoni
- Programming and Management Control Service, Unit of Controls, St. Anna University-Hospital, Ferrara, Italy
| | - Nicola Napoli
- Programming and Management Control Service, Statistics Service, St. Anna University-Hospital, Ferrara, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University-Hospital, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Yuri Battaglia
- Department of Medicine, University of Verona, Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Verona, Italy
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9
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Di Maria A, Scichilone LM, Siligato R, Veronesi M, Capone M, Ferrara F, Fabbian F, Storari A, Gatto S. [Tic douloureux sustained by an eye tumor]. G Ital Nefrol 2023; 40:40-02-2023-07. [PMID: 37179479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Cancer is a major cause of morbidity and mortality in solid organ transplantation. Nonmelanoma skin cancer (NMSC) such as basocellular (BCC) and spinocellular (SCC) carcinoma, are common in renal transplant recipients. We report a case of an SCC affecting a lacrimal gland in a subject with kidney transplantation. A man aged 75 years who had suffered from glomerulopathy since 1967 and subsequently started haemodialysis, in 1989 was transplanted from a living donor. In 2019, he suffered paresthesia and pain in his right eyebrow arch and he was diagnosed to have neuralgia of the fifth cranial nerve. The failure of medical treatment and the development of a mass in his eyelid plus exophthalmos induced healthcare professionals to perform a magnetic resonance. The latter showed a retrobulbar mass measuring 39×22×16 mm3. Biopsy revealed an SCC and the patient underwent eye exenteration. Although NMSC of the eye is an extremely rare condition, risk factors such as male sex, history of glomerulopathy, and duration of immunosuppression should be taken into consideration at the time of the onset of eye symptoms.
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Affiliation(s)
- Alessio Di Maria
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
| | - Laura Maria Scichilone
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
| | - Rossella Siligato
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
| | - Marco Veronesi
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
| | - Matteo Capone
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
| | - Francesca Ferrara
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
| | - Fabio Fabbian
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
| | - Alda Storari
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
| | - Stefano Gatto
- U.O. di Nefrologia e Dialisi, Ospedale S. Anna (Cona, FE), Azienda Ospedaliero-Universitaria di Ferrara
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10
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Battaglia Y, Bellasi A, Esposito P, Bortoluzzi A, Rotondi S, Andreucci M, Fiorini F, Russo D, Storari A. The Impact of Cholecaciferol Supplementation on Bone Mineral Density in Long-Term Kidney Transplant Recipients. Biomolecules 2023; 13:biom13040629. [PMID: 37189376 DOI: 10.3390/biom13040629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Although reduced bone mineral density (BMD) is associated with a higher risk of fractures, morbidity, and mortality in kidney transplant patients (KTRs), there is no consensus on optimal treatment for the alterations of BMD in this population. This study aims at assessing the effect of cholecalciferol supplementation on BMD over a follow-up period of 2 years in a cohort of long-term KTRs. Patients with age ≥ 18 years were included and divided into two subgroups based on treatment with bisphosphonate and/or calcimimetics and/or active vitamin D sterols (KTRs-treated) or never treated with the above medications (KTRs-free). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral neck (FN) with standard DEXA at the beginning and end of the study. According to World Health Organization (WHO) criteria, results were expressed as T-score and Z-score. Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score < −1 and >−2.5 SD, respectively. Cholecalciferol was supplemented at a dose of 25,000 IU/week over 12 weeks followed by 1500 IU/day. KTRs-free (n. 69) and KTRs-treated (n. 49) consecutive outpatients entered the study. KTRs-free were younger (p < 0.05), with a lower prevalence of diabetes (p < 0.05) and of osteopenia at FN (46.3 % vs. 61.2 %) compared to KTRs-treated. At the entry none of the study subjects had a sufficient level of cholecalciferol; Z-score and T-score at LV and FN were not different between groups. At the end of the study period, serum cholecalciferol concentration was significantly increased in both groups (p < 0.001); the KTRs-free group presented an improvement in both T-score and Z-score at LV (p < 0.05) as well as a lower prevalence of osteoporotic cases (21.7% vs. 15.9%); in contrast, no changes were recorded in KTR-treated individuals. In conclusion, supplementation with cholecalciferol ameliorated Z-score and T-score at LV in long-term KTRs who had been never treated with active or inactive vitamin D sterols, bisphosphonates, and calcimimetics. Future endeavours are needed to confirm these preliminary findings.
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11
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De Giorgi A, Storari A, Rodríguez-Muñoz PM, Cappadona R, Lamberti N, Manfredini F, López-Soto PJ, Manfredini R, Fabbian F. Seasonal pattern in elderly hospitalized with acute kidney injury: a retrospective nationwide study in Italy. Int Urol Nephrol 2022; 54:3243-3253. [PMID: 35779158 PMCID: PMC9605924 DOI: 10.1007/s11255-022-03271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
Purpose Acute kidney injury (AKI) frequently complicates hospitalization and is associated with in-hospital mortality (IHM). It has been reported a seasonal trend in different clinical conditions. The aim of this study was to evaluate the possible relationship between seasons of the year and IHM in elderly hospitalized patients with AKI. Methods We selected all admissions complicated by AKI between 2000 and 2015 recorded in the Italian National Hospital Database. ICD-9-CM code 584.xx identified subjects with age ≥ 65 years and age, sex, comorbidity burden, need of dialysis treatment and IHM were compared in hospitalizations recorded during the four seasons. Moreover, we plotted the AKI observed/expected ratio and percentage of mortality during the study period. Results We evaluated 759,720 AKI hospitalizations (mean age 80.5 ± 7.8 years, 52.2% males). Patients hospitalized with AKI during winter months had higher age, prevalence of dialysis-dependent AKI, and number of deceased patients. In whole population IHM was higher in winter and lower in summer, while the AKI observed/expected ratio demonstrated two peaks, one in summer and one in winter. Logistic regression analysis demonstrated that parameters such as age, autumn, winter, comorbidity burden were positively associated with IHM. Conclusion We conclude that a seasonality exists in AKI, however, relationship between seasons and AKI could vary depending on the aspects considered. Both autumn and winter months are independent risk factors for IHM in patients with AKI regardless of age, sex and comorbidity burden. On the contrary, summer time reduces the risk of death during hospitalizations with AKI.
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Affiliation(s)
| | - Alda Storari
- Nephrology and Dialysis Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Pedro Manuel Rodríguez-Muñoz
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Salamanca, Spain.,Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Rosaria Cappadona
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Pablo Jesús López-Soto
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain.,Department of Nursing, Universidad de Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Roberto Manfredini
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Fabio Fabbian
- Department of Medical Science, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
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12
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Battaglia Y, Bellasi A, Fiorini F, Esposito P, Granata A, Andreucci M, Storari A. MO1011: The Effect of Vitamin D on Bone Mineral Density: A Real-Life Study in Long-Term Kidney Transplant Recipients Never Supplemented. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac088.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Vitamin D insufficiency has been associated with decreased bone mineral density (BMD) in kidney transplant patients (KTRs). However, few data on BMD changes due to vitamin D supplementation in long-term KTRs are available. The purpose of our study is to ascertain the effect of 25-OH-vitamin D (25-OH-D) supplementation on the BMD over a follow-up period of up to 3 years in a real-life cohort of long-term KTRs never supplemented with 25-OH-D and not treated with active vitamin D, bisphosphonate and calciomimetics.
METHOD
Demographic, clinical and laboratory data were collected. Inclusion criteria were: (1) being a recipient of a kidney from a cadaveric or living donor, (2) age ≥ 18 years and (3) no therapy with inactive vitamin D sterols. Patients with parathyroidectomy and/or history of bone fractures were excluded. BMD was evaluated with standard DEXA, performed at baseline (before vitamin D supplementation) and at the end of the study period. BMD was assessed at lumbar vertebral bodies (LV) and right femoral neck (FN) by a single operator. Bone mineral content (BMC) was calculated in grams (g), bone area in centimetres squared (cm2), and BMD in g/cm2 (BMC divided by the area). According to WHO criteria, results were expressed as T-score [standard deviation (SD) relative to young healthy adults] and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T-score ≤−2.5 SD and T-score <−1 and >−2.5 SD, respectively. According to plasma levels, 25-OH-D was supplemented as recommended for the general population. Linear mixed model analysis was implemented to test the impact of 25-OH-D use on Z-score, T-score and BMD changes (dependent variables) adjusted for sex, age, BMI and presence of diabetes. Z-score, T-score and BMD changes were defined as Z-score, T-score and BMD at follow-up, Z-score, T-score and BMD at study inception.
RESULTS
A total of 118 KTRs consecutive outpatients never supplemented with 25-OH-D, of whom 69 KTRs were untreated (KTRs-free) and 49 were treated (control group) with bisphosphonate (n = 13) and/or calcio-mimetics (n = 11) and/or active vitamin D (n = 29) were enrolled. Clinical and biochemical characteristics are shown in Table 1. At the basal DEXA, the percentage of osteopenia and osteoporosis was 39.0% and 21.2% at LV; 52.5% and 16.9% at FN, respectively. The mean study-period was 27.7 ± 3.4 months. Basal and follow-up Z-score, T-score and BMD at both measurement sites are reported in Table 2. In linear mixed model analysis, a positive interaction of 25-OH-D supplementation on T-score and Z-score changes at the lumbar vertebral bodies was found (P < .05). At the end of the study, no statistical differences in Z-score, T-score and BMD gains were observed.
CONCLUSION
Prolonged supplementation with 25-OH-D affects Z-score and T-score at LV in long-term KTRs never supplemented with active or inactive vitamin D.
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Affiliation(s)
- Yuri Battaglia
- Medicine, University of Verona, Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Antonio Bellasi
- Nephrology Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Fulvio Fiorini
- Nephrology and Dialysis Unit, `Santa Maria della Misericordia’ Hospital, Rovigo, Italy
| | - Pasquale Esposito
- Nephrology, Dialysis and Transplantation Unit, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Granata
- Nephrology Unit, San Giovanni di Dio Hospital, Catania, Italy
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, `Magna Graecia’ University, Catanzaro, Italy
| | - Alda Storari
- Nephrology and Dialysis Unit, University of Ferrara, Ferrara, Italy
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13
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Battaglia Y, Bellasi A, Bortoluzzi A, Tondolo F, Esposito P, Provenzano M, Russo D, Andreucci M, Cianciolo G, Storari A. Bone Mineral Density Changes in Long-Term Kidney Transplant Recipients: A Real-Life Cohort Study of Native Vitamin D Supplementation. Nutrients 2022; 14:nu14020323. [PMID: 35057505 PMCID: PMC8780110 DOI: 10.3390/nu14020323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 02/07/2023] Open
Abstract
Vitamin D insufficiency has been associated with reduced bone mineral density (BMD) in kidney transplant patients (KTRs). However, the efficacy of vitamin D supplementation on BMD remains poorly defined, especially for long-term KTRs. We aimed to investigate the effect of native vitamin D supplementation on the BMD of KTRs during a 2-year follow-up. Demographic, clinical, and laboratory data were collected. BMD was evaluated with standard DEXA that was performed at baseline (before vitamin D supplementation) and at the end of study period. BMD was assessed at lumbar vertebral bodies (LV) and right femoral neck (FN) by a single operator. According to WHO criteria, results were expressed as the T-score (standard deviation (SD) relative to young healthy adults) and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as a T-score ≤ -2.5 SD and a T-score < -1 and a > -2.5 SD, respectively. Based on plasma levels, 25-OH-vitamin D (25-OH-D) was supplemented as recommended for the general population. Data from 100 KTRs were analyzed. The mean study period was 27.7 ± 3.4 months. At study inception, 25-OH-D insufficiency and deficiency were recorded in 65 and 35 patients. At the basal DEXA, the percentage of osteopenia and osteoporosis was 43.3% and 18.6% at LV and 54.1% and 12.2% at FN, respectively. At the end of the study, no differences in the Z-score and T-score gains were observed. During linear mixed model analysis, native vitamin D supplementation was found to have a negative nitration with Z-score changes at the right femoral neck in KTRs (p < 0.05). The mean dose of administered cholecalciferol was 13.396 ± 7.537 UI per week; increased 25-OH-D levels were found (p < 0.0001). Either low BMD or 25-OH-vitamin D concentration was observed in long-term KTRs. Prolonged supplementation with 25-OH-D did not modify BMD, Z-score, or T-score.
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Affiliation(s)
- Yuri Battaglia
- Department of Medicine, University of Verona, 37129 Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, 37019 Verona, Italy
- Correspondence:
| | - Antonio Bellasi
- Nephrology Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and St. Anna University-Hospital, 44124 Ferrara, Italy;
| | - Francesco Tondolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy; (F.T.); (G.C.)
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy;
- Clinica Nefrologica, Dialisi, Trapianto, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Domenico Russo
- Department of Public Health, University Federico II, 80100 Napoli, Italy;
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS—Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy; (F.T.); (G.C.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University-Hospital, 44124 Ferrara, Italy;
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14
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Battaglia Y, Lamberti N, Piva G, Manfredini F, Storari A. [Physical exercise in chronic kidney disease: an empty narrative or an effective intervention?]. G Ital Nefrol 2021; 38:38-06-2021-01. [PMID: 34919791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease (CKD) is growing worldwide, with increasing numbers of patients facing end-stage renal disease, high cardiovascular risk, disability and mortality. Early recognition of CKD and improvements in lifestyle are crucial for maintaining or recovering both physical function and quality of life. It is well known that reducing sedentariness, increasing physical activity and initiating exercise programs counteract cardiovascular risk and frailty, limit deconditioning and sarcopenia, and improve mobility, without side-effects. However, these interventions, often requested by CKD patients themselves, are scarcely available. Indeed, it is necessary to identify and train specialists on exercise in CKD and to sensitize doctors and health personnel, so that they can direct patients towards an active lifestyle. On the other hand, effective and sustainable interventions, capable of overcoming patients' barriers to exercise, remain unexplored. Scientific societies, international research teams and administrators need to work together to avoid that exercise in nephrology remains an empty narrative, a niche interest without any translations into clinical practice, with no benefit to the physical and mental health of CKD patients.
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Affiliation(s)
- Yuri Battaglia
- Unità Operativa di Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Nicola Lamberti
- Dipartimento di Neuroscienze e Riabilitazione, Università degli studi di Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
| | - Giovanni Piva
- PhD program in Environmental Sustainability and Wellbeing, Università degli studi di Ferrara, Via Paradiso 12, 44121 Ferrara, Italy
| | - Fabio Manfredini
- Dipartimento di Neuroscienze e Riabilitazione, Università degli studi di Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; Unità Operativa di Medicina Riabilitativa, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italia
| | - Alda Storari
- Unità Operativa di Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
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15
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Battaglia Y, Zerbinati L, Belvederi Murri M, Provenzano M, Esposito P, Andreucci M, Storari A, Grassi L. Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis. J Clin Med 2021; 10:jcm10204747. [PMID: 34682870 PMCID: PMC8540707 DOI: 10.3390/jcm10204747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.
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Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
- Correspondence:
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Pasquale Esposito
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
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Fabbian F, De Giorgi A, Cappadona R, Lamberti N, Manfredini F, Limido A, Postorino M, Storari A, Manfredini R. Infodemiology of renal diseases: a novel opportunity to investigate public global interest. Eur Rev Med Pharmacol Sci 2021; 25:198-207. [PMID: 33506908 DOI: 10.26355/eurrev_202101_24385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the global community interest about renal diseases through relative search volumes (RSVs) of Google Trends (GT). MATERIALS AND METHODS The online interest for the search terms hematuria (H), proteinuria (P), chronic kidney disease (CKD) and dialysis (D) was measured by evaluating RSVs from 2010 to 2019. All countries listed in GT were analysed and those presenting RSVs related to all search terms were considered following geographical position. RESULTS Mean values of RSVs for D, CKD, H and P were 80±9%, 11±2%, 17±2% and 11±1%, respectively. D is the search term most frequently typed in English-speaking countries. On the other hand, in Latin Countries, the interest for P and H was higher than D. Searching for D, CKD and H are highly correlated whilst correlation coefficients between RSVs for D, CKD, and H with P are lower. Since 2010, the interest for renal diseases maintained stable. CONCLUSIONS GT is a reliable tool in evaluating global interest for renal diseases in different geographical areas and temporal patterns. Although infodemiology represents a method for investigating the dissemination of information at a global level, our results suggest the need for increasing general population's interest for renal diseases especially, and move from simple interest to global awareness in the view of prevention strategies.
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Affiliation(s)
- F Fabbian
- Department of Medical Sciences, University of Ferrara, and Clinical Medicine Unit, Azienda Ospedaliero-Universitaria 'S. Anna', Ferrara, Italy.
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Cappadona R, De Giorgi A, Di Simone E, Di Muzio M, Di Muzio F, Di Muzio F, Lamberti N, Manfredini F, Storari A, Manfredini R, Fabbian F. Infodemiology of solid organ transplantation: relationship to the Global Observatory on Donation and Transplantation data. Eur Rev Med Pharmacol Sci 2021; 24:12630-12637. [PMID: 33378009 DOI: 10.26355/eurrev_202012_24159] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although transplantation medicine has been continuously improving, its impact on the general population needs to be evaluated. This study describes the global community interest in solid organ transplantation (SOT) using Google Trends, comparing relative search volumes (RSVs) and data from the World Health Organization (WHO) Global Observatory on Donation and Transplantation (GODT) regarding SOT activity all around the world. MATERIALS AND METHODS The online interest for the search terms "kidney transplantation", "liver transplantation", "heart transplantation" and "lung transplantation" was measured, evaluating RSVs and the number of worldwide SOT recorded in the GODT website from 2008 to 2018. RESULTS The mean values of RSVs were 51.7±16.8 for liver transplantation, 39.8±9.6 for kidney transplantation, 22.4±7.4 for heart transplantation and 15.4±5.2 for lung transplantation, and these values gradually reduced during the study period. Anglo Saxon countries had the highest interest for SOT, and the mean values of RSVs per year and annual numbers of SOT were inversely correlated. CONCLUSIONS Despite the apparent interest and awareness, we found that public interest in SOT is decreasing. Access to information is crucial for improving understanding of transplantation and motivation to donate. Health care professionals could take advantage by using the internet, and evaluation of RSVs could represent valuable feedback.
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Affiliation(s)
- R Cappadona
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
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Battaglia Y, Zerbinati L, Provenzano M, Esposito P, Andreucci M, Storari A, Grassi L. MO946THE LEVEL OF POST-TRAUMATIC GROWTH IN KIDNEY TRANSPLANT RECIPIENTS WITH LONG TERM DURATION OF GRAFT. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab110.0025] [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
Kidney transplant (KT)can cause a psychological trauma due to changes in self-perception, in interpersonal relationships, and in the philosophy of life. However, the exposure to this traumatic event might lead to not only stress disorders but also positive growth. Primary aim of study was to evaluate the prevalence of post-traumatic growth (PTG)in KTRs. Secondary aim was to explore any association between PTG and psychiatric, psychosocial and medical variables, specifically psychiatric diagnoses, demoralization, as well as physical and general problems or symptoms.
Method
KTRs followed up in a single nephrology Unit, were evaluated. Each patient was individually administered MINI International Neuropsychiatric Interview 6.0. and DCPR interview to evaluate ICD-10 psychiatric diagnoses and DCPR diagnoses. PTG Inventory (PTGI), ESAS-revised, CPC, and DS-IT were given as self-report instruments to be filled in. PTGI was used to investigate positive psychological experience of patients after KT on a 0 to 5-point Likert scale(0=I did not experience this change as a result of my KT;5=I experienced this change to a very great degree as a result of my KT).It consists of 21 items divided in five factors: New Possibilities(NP),Relating to Others(RO),Personal Strength(PS),Spiritual Change(SC),and Appreciation of Life(AL).ESAS-revised, DS-IT and CPC were used to examine the severity of physical and psychological symptoms on a 0 to 10 scale; to measure the severity of demoralization on a 0 to 4 scale and to evaluate the physical and general problems in a yes/no(0–1)format, respectively.
Results
Data pertaining to 134 out of 143 consecutive outpatients were collected. Clinical characteristics of sample and ranking order of ICD and DCPR diagnoses are shown in Tab.1.Mean score of PTGI total of sample was 52.02 (±20.69).SC(4.26±2.94)experience was markedly lower than RO(16.26±8.18),NP(11.25±5.56),PS(10.91±5.33)and AL(9.77±3.72).PS changes were higher in KTRs with adaption ICD diagnosis(p<0.001);while no SC change was found in KTRs with an ICD diagnosis of mood disorders(p<0.01).DCPR diagnosis of alexithymia and Irritability were associated with low RO score(13.74±6.51 and 13.97±6.95,respectively)(p <0.05).AL subscale was positively correlated with ESAS anxiety symptom and ESAS psychological distress sub-score(p<0.05); and negatively with DS-lT loss of meaning and purpose subscale(p<0.05).Women(57.2±23.07)had higher scores of PTGI than men (49.5±19.04)(p <0.05).No significant correlation was found between CPC problems, blood chemistry and socio-demographic characteristics, including months after transplant.
Conclusion
This study shows that KTRs had moderate-to-high levels of PTG which did not change after KT overtime. Also, lower RO score was associated with DCPR diagnosis of alexithymia, highlighting the potential ability of PTGI to identify KTRs who need psychological support. Further multicentre studies should be conducted to investigate the positive psychological changes after KT.
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Affiliation(s)
- Yuri Battaglia
- St. Anna University Hospital, Nephrology and Dialysis Unit, Ferrara, Italy
| | - Luigi Zerbinati
- University of Ferrara, Department of Biomedical and Specialty Surgical Sciences, Ferrara, Italy
| | - Michele Provenzano
- Magna Graecia University, Department of Health Sciences, Catanzaro, Italy
| | - Pasquale Esposito
- University of Genova, Department of Internal Medicine, Genova, Italy
| | - Michele Andreucci
- Magna Graecia University, Department of Health Sciences, Catanzaro, Italy
| | - Alda Storari
- St. Anna University Hospital, Nephrology and Dialysis Unit, Ferrara, Italy
| | - Luigi Grassi
- University of Ferrara, Department of Biomedical and Specialty Surgical Sciences, Ferrara, Italy
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Battaglia Y, Fiorini F, Azzini C, Esposito P, De vito A, Granata A, Storari A, Mignani R. Deficiency in the Screening Process of Fabry Disease: Analysis of Chronic Kidney Patients Not on Dialysis. Front Med (Lausanne) 2021; 8:640876. [PMID: 33634157 PMCID: PMC7900152 DOI: 10.3389/fmed.2021.640876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/05/2021] [Indexed: 02/05/2023] Open
Abstract
Fabry Disease (FD), a rare and progressive, X-linked lysosomal storage disorder, is caused by mutations in the α-galactosidase A (GLA) gene which leads to enzymatic deficiency of GLA. Misdiagnosed and undiagnosed FD cases are common for the variable FD phenotype, ranging from asymptomatic and/or impairment of single organs, which is typically seen in females and in patients with late-onset mutation, to multiple organ disease, which is frequently found in males with classic GLA mutation. Consequently, for an early diagnosis and an efficient treatment of FD, three different strategies of screening, new-born screening, high-risk screening and familiar screening, have been conducted. However, most of FD screening in the CKD population has been carried out in hemodialysis patients and kidney transplant recipients, for whom the renal damage is already irreversible, so the effectiveness of enzymatic replacement therapy is limited and delayed therapeutic intervention results in worse long-term outcomes. This review investigates the actual strategies of screening initiatives for the identification of FD, examining in detail those performed in CKD patients not on dialysis.
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Affiliation(s)
- Yuri Battaglia
- Division of Nephrology and Dialysis, St. Anna University Hospital, Ferrara, Italy
- *Correspondence: Yuri Battaglia
| | - Fulvio Fiorini
- Division of Nephrology and Dialysis, “Santa Maria della Misericordia” Hospital, Rovigo, Italy
| | - Cristiano Azzini
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Alessandro De vito
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Antonio Granata
- Division of Nephrology and Dialysis, “Cannizzaro” Hospital, Catania, Italy
| | - Alda Storari
- Division of Nephrology and Dialysis, St. Anna University Hospital, Ferrara, Italy
| | - Renzo Mignani
- Division of Nephrology and Dialysis Department, Infermi Hospital, Rimini, Italy
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Manfredini F, Lamberti N, Battaglia Y, Straudi S, Belvederi Murri M, Donadi M, Piva G, Fabbian F, López-Soto PJ, Grassi L, Manfredini R, Basaglia N, Storari A. A Personalized Patient-Centered Intervention to Empower through Physical Activity the Patient in the Dialysis Center: Study Protocol for a Pragmatic Nonrandomized Clinical Trial. Methods Protoc 2020; 3:mps3040083. [PMID: 33470990 PMCID: PMC7768449 DOI: 10.3390/mps3040083] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022] Open
Abstract
Sedentariness of patients affected by end-stage kidney disease (ESKD) expose them to high risk of unfavorable clinical outcomes. Exercise training is effective in improving physical function, quality of life (QoL) and long-term outcomes. However, the existing barriers related to patients, programs and dialysis staff limit patient participation and call for new strategies. This pragmatic nonrandomized trial will test the impact on ESKD population of an intervention proposed by an exercise facilitator regularly present in a dialysis center. The patient will be free to choose among three-month walking and/or resistance low-intensity training programs: (a) guided physical activity increase; (b) home-based exercise; (c) in-hospital (pre/post dialysis) supervised exercise; (d) performance assessment only. The first phase will define feasibility and the characteristics and preference of responders. The second phase will evaluate safety and patients’ adherence. Outcome measures will be collected at baseline, after three-month and at six-month follow-up. They will include: aerobic capacity, QoL, gait speed, strength, depression and long-term clinical outcomes (hospitalization and mortality). The trial was approved by the Area-Vasta Emilia-Romagna Centro Ethics Committee with approval number 48/2019. Written informed consent will be obtained from all participants. The results of the study will be presented in international congresses, published in peer-reviewed journals and communicated to the patient community. Registration details: Clinicaltrials.gov NCT04282616 [Registered:24/02/2020].
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Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and Rehabilitation, Section of Sports Sciences, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (F.M.); (G.P.)
- Unit of Physical Medicine and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, Section of Sports Sciences, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (F.M.); (G.P.)
- Correspondence: ; Tel.: +39-053-223-6187
| | - Yuri Battaglia
- Unit of Nephrology and Dialysis, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (Y.B.); (M.D.); (A.S.)
| | - Sofia Straudi
- Unit of Physical Medicine and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64, 44121 Ferrara, Italy; (M.B.M.); (L.G.)
| | - Maria Donadi
- Unit of Nephrology and Dialysis, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (Y.B.); (M.D.); (A.S.)
| | - Giovanni Piva
- Department of Neuroscience and Rehabilitation, Section of Sports Sciences, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (F.M.); (G.P.)
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (F.F.); (R.M.)
| | - Pablo Jesús López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, 14004 Cordoba, Spain;
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64, 44121 Ferrara, Italy; (M.B.M.); (L.G.)
| | - Roberto Manfredini
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (F.F.); (R.M.)
| | - Nino Basaglia
- Unit of Physical Medicine and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Alda Storari
- Unit of Nephrology and Dialysis, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (Y.B.); (M.D.); (A.S.)
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Battaglia Y, Zerbinati L, Piazza G, Martino E, Massarenti S, Provenzano M, Esposito P, Andreucci M, Storari A, Grassi L. The Use of Demoralization Scale in Italian Kidney Transplant Recipients. J Clin Med 2020; 9:jcm9072119. [PMID: 32635625 PMCID: PMC7408932 DOI: 10.3390/jcm9072119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
Demoralization is a commonly observed syndrome in medically ill patients. The risk of demoralization may increase in patients after a kidney transplant (KTRs) because of the stressful nature of renal transplantation, psychosocial challenges, and adjustment needs. No study is available on demoralization amongst KTRs. The purpose of our study was to evaluate the validity of the Italian version of the Demoralization Scale (DS-IT) and the prevalence of demoralization in KTRs. Also, we aimed at exploring the association of the DS-IT with International Classification of Diseases (ICD) psychiatric diagnoses, post-traumatic growth (PTG), psychological and physical symptoms, and daily-life problems. A total of 134 KTRs were administered the MINI International Neuropsychiatric Interview 6.0. and the Diagnostic Criteria for Psychosomatic Research-Demoralization (DCPR/D) Interview. The DS-IT, the Edmonton Symptom Assessment System (ESAS), the Canadian Problem Checklist (CPC), were used to measure demoralization, physical and psychological symptoms, and daily-life problems; also, positive psychological experience of kidney transplantation was assessed with the PTG Inventory. Routine biochemistry and sociodemographic data were collected. Exploratory factor analysis demonstrated a four-dimensional factor structure of the DS-IT, explaining 55% of the variance (loss of meaning and purpose, disheartenment, dysphoria, and sense of failure). DS-IT Cronbach alpha coefficients indicated good or acceptable level of internal consistency. The area under the Receiving Operating Characteristics (ROC) curve for DS-IT (against the DCPR/D interview as a gold standard) was 0.92. The DS-IT optimal cut-off points were ≥20 (sensitivity 0.87, specificity 0.82). By examining the level of demoralization, 14.2%, 46.3%, 24.6%, and 14.6% of our sample were classified as having no, low, moderate, and high demoralization, respectively, with differences according to the ICD psychiatric diagnoses (p < 0.001). DS-IT Total and subscales scores were positively correlated with scores of ESAS symptoms and CPC score. A correlation between DS-IT loss of meaning and purpose subscale and PTGI appreciation of life subscale (p < 0.05) was found. This study shows, for the first time, a satisfactory level of reliability of the DS-IT and a high prevalence of severe demoralization in KTRs.
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Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
- Correspondence:
| | - Luigi Zerbinati
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Giulia Piazza
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Elena Martino
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Sara Massarenti
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
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Battaglia Y, Provenzano M, Tondolo F, Bellasi A, Esposito P, La Manna G, Russo D, Andreucci M, Storari A. P1621VITAMIN D SUPPLEMENTATION: CHANGES IN BONE MINERAL DENSITY IN KIDNEY TRANSPLANT PATIENTS WITH LONG TERM DURATION OF THE GRAFT. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa143.p1621] [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 the medical literature, several studies have linked bone mineral density (BMD) with vitamin D deficiency in kidney transplant patients (KTRs). However, in spite of the fact that ergocalciferol, cholecalciferol and calcifediol reduce parathyroid hormone (PTH) and improves calcium levels, their effects on the bone mineral density (BMD) in KTRs remain undefined. In consideration of the lack of data available, we aim at investigating the effect of inactive form of vitamin D supplementation on the BMD over a follow-up period up to 2 year, in a real-life cohort of long-term kidney transplant(KT).
Method
This study was carried out in KTRs who were followed up in a Nephrology Unit. Exclusion criteria were parathyroidectomy, therapy with bisphosphonate, previous history of bone fractures. Demographic, clinical and immunosuppressive agents were collected. Based on 25-OH-D levels, KTRs were classified as suffering from deficiency (< 30 ng/mL). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral hip (FH) by a single operator, using a standard dual energy X-ray absorptiometry. According to WHO criteria, results were expressed as T-score (standard deviation [SD] relative to young healthy adults), and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score < −1 and > −2.5 SD, respectively. Laboratory data, 25-OH-D, and BMD were measured at baseline and after 24 months of supplementation therapy. Vitamin D deficiency was corrected using standard treatment strategy recommended for general population. Continuous variables were expressed as mean ± SD whereas categorical variables as percentage. The Student’s t test and chi-square test were used to compare to compare continuous and categorical variables, respectively. For before and after comparisons of continuous variables, the paired t-test or one-sample Wilcoxon signed rank test were used based on variable’s distribution.
Results
Data pertaining to 111 out of 133 consecutive outpatients were collected, of whom most were males (69.4%), no-smokers (89.1%) and treated with glucocorticoids (84%). The mean age was 53.9±11.6 years and months after transplant was 161.6±128.3. No statistical differences were found among patients with normal BMD, osteopenia or osteoporosis at LV and FH in terms of age at transplant, gender distribution, time on dialysis, BMI and eGFR, serum calcium, serum phosphate, 25-OH-D and iPTH. At baseline, 25-OH-D was 13.9±7.2 ng/ml and the prevalence of osteopenia/osteoporosis was 40.9% (T-Score -1.69±0.37; Z-score -1.16±1.09) and 21.8 % (T-Score -3.15±0.50; Z-score -2.27±0.58) at LV; 55.3 % (T-Score -1.8±0.46; Z-score -0.84±0.633) and 14 % (T-Score -2.83±0.39; Z-score -1.65±0.49) at FH. After 27.6±3.7 months of therapy with cholecalciferol at mean dose of 13.396±7.537 UI at week, 25-OH-D values increased to 29.4±9.4 ng/ml (p<0.0001) while no statistically significant changes were found in Z-score and T-score at both sites, except for a mild improvement in lumbar vertebral Z-score, reaching −0.82± 0.7 (p = 0.06) in KTRs with osteopenia
Conclusion
Our study showed BMD remained stable after up to 2 years of inactive vitamin D therapy in long-term kidney transplant with vitamin D deficiency. A mild increase in Z-score was observed in the L-spine. Further designated studies should be conducted to demonstrate the effect of vitamin D on BMD.
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Affiliation(s)
- Yuri Battaglia
- St. Anna University-Hospital, Nephrology and Dialysis, Ferrara, Italy
| | | | | | | | | | | | | | | | - Alda Storari
- St. Anna University-Hospital, Nephrology and Dialysis
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23
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Battaglia Y, Ullo I, Massarenti S, Esposito P, Prencipe M, Ciancio G, Provenzano M, Fiorini F, Andreucci M, Storari A, Sabatino A, Fiaccadori E, Granata A. Ultrasonography of Quadriceps Femoris Muscle and Subcutaneous Fat Tissue and Body Composition by BIVA in Chronic Dialysis Patients. Nutrients 2020; 12:nu12051388. [PMID: 32408709 PMCID: PMC7285004 DOI: 10.3390/nu12051388] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 04/08/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023] Open
Abstract
Protein Energy Wasting (PEW) in hemodialysis (HD) patients is a multifactorial condition due to specific pathology-related pathogenetic mechanisms, leading to loss of skeletal muscle mass in HD patients. Computed Tomography and Magnetic Resonance Imaging still represent the gold standard techniques for body composition assessment. However, their widespread application in clinical practice is difficult and body composition evaluation in HD patients is mainly based on conventional anthropometric nutritional indexes and bioelectrical impedance vector analysis (BIVA). Little data is currently available on ultrasound (US)-based measurements of muscle mass and fat tissue in this clinical setting. The purpose of our study is to ascertain: (1) if there are differences between quadriceps rectus femoris muscle (QRFM) thickness and abdominal/thigh subcutaneous fat tissue (SFT) measured by US between HD patients and healthy subjects; (2) if there is any correlation between QRFM and abdominal/thigh SFT thickness by US, and BIVA/conventional nutritional indexes in HD patients. We enrolled 65 consecutive HD patients and 33 healthy subjects. Demographic and laboratory were collected. The malnutrition inflammation score (MIS) was calculated. Using B-mode US system, the QRFM and SFT thicknesses were measured at the level of three landmarks in both thighs (superior anterior iliac spine, upper pole of the patella, the midpoint of the tract included between the previous points). SFT was also measured at the level of the periumbilical point. The mono frequency (50 KHz) BIVA was conducted using bioelectrical measurements (Rz, resistance; Xc, reactance; adjusted for height, Rz/H and Xc/H; PA, phase angle). 58.5% were men and the mean age was 69 (SD 13.7) years. QRFM and thigh SFT thicknesses were reduced in HD patients as compared to healthy subjects (p < 0.01). Similarly, also BIVA parameters, expression of lean body mass, were lower (p < 0.001), except for Rz and Rz/H in HD patients. The average QRFM thickness of both thighs at top, mid, lower landmarks were positively correlated with PA and body cell mass (BCM) by BIVA, while negatively correlated with Rz/H (p < 0.05). Abdominal SFT was positively correlated with PA, BCM and basal metabolic rate (BMR) (p < 0.05). Our study shows that ultrasound QRFM and thigh SFT thicknesses were reduced in HD patients and that muscle ultrasound measurements were significantly correlated with BIVA parameters.
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Affiliation(s)
- Yuri Battaglia
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-393-432-0061
| | - Ines Ullo
- Division of Nephrology, ASST Sette Laghi, 21100 Varese, Italy;
| | - Sara Massarenti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Prencipe
- Division of Nephrology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71100 Foggia, Italy;
| | - Giovanni Ciancio
- Division of Rheumatology, University of Ferrara, 44121 Ferrara, Italy;
| | - Michele Provenzano
- Division of Nephrology and Dialysis, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Fulvio Fiorini
- Division of Nephrology and Dialysis, “Santa Maria della Misericordia” Hospital, 45100 Rovigo, Italy;
| | - Michele Andreucci
- Division of Nephrology and Dialysis, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
| | - Alice Sabatino
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Enrico Fiaccadori
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Antonio Granata
- Division of Nephrology, San Giovanni di Dio Hospital, 92100 Agrigento, Italy;
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Battaglia Y, Zerbinati L, Piazza G, Martino E, Provenzano M, Esposito P, Massarenti S, Andreucci M, Storari A, Grassi L. Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients. J Clin Med 2020; 9:jcm9040995. [PMID: 32252326 PMCID: PMC7230823 DOI: 10.3390/jcm9040995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.
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Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
- Correspondence:
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Giulia Piazza
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Elena Martino
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Pasquale Esposito
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Sara Massarenti
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
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Battaglia Y, Cojocaru E, Fiorini F, Granata A, Esposito P, Russo L, Bortoluzzi A, Storari A, Russo D. Vitamin D in kidney transplant recipients
. Clin Nephrol 2020; 93:57-64. [PMID: 31319906 DOI: 10.5414/cn109735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 02/07/2023] Open
Abstract
Kidney transplant recipients (KTRs) are susceptible to low levels of vitamin D, which may be responsible for mineral and bone metabolism disorders and play some role in the occurrence of cardiovascular, metabolic, immunologic, neoplastic, and infectious complications after kidney transplant. Kidney Disease Improving Global Outcomes (KDIGO) guidelines of the year 2017 recommended vitamin D supplementation in the first 12 months after transplant using the same treatment strategies for the general population. However, no recommendations are provided after the first 12 months due to a lack of sufficient data. This review analyses some studies that assessed the vitamin D status of KTRs and the effects of nutritional and active vitamin D supplementation on bone mineral density, cardiovascular disease, proteinuria, and graft function in KTRs.
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Battaglia Y, Esposito P, Corrao S, Russo L, Balducci A, Storari A, Russo D. Evaluation of Hypertension, Proteinuria, and Abnormalities of Body Weight in Italian Adolescents Participating in the World Kidney Days. Kidney Blood Press Res 2020; 45:286-296. [PMID: 32036372 DOI: 10.1159/000502547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/06/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION World Kidney Day (WKD) was promoted by the Italian Kidney Foundation and the Italian Society of Nephrology for raising awareness, detection, prevention, and treatment of kidney diseases. The Italian WKD focused on the "School Project" by screening students attending the fifth year of high school. The main goal of the "School Project" was to assess in healthy adolescents the presence of hypertension (HTN) and proteinuria; as well as to evaluate potential interrelations between overweight, obesity (both measured with different anthropometric methods), blood pressure (BP) levels, and proteinuria. The ancillary goal was to have an estimate of awareness on some nephrology topics. METHODS The study population consisted of 17- to 19-year-old students. HTN was defined as systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mm Hg. Isolated systolic hypertension (ISH) was defined as SBP ≥140 mm Hg and DBP <90 mm Hg; isolated diastolic hypertension as SBP <140 mm Hg and DBP ≥90 mm Hg; systolic and diastolic hypertension as SBP ≥140 mm Hg and DBP ≥90 mm Hg; pre-hypertension as SBP >120 mm Hg but <140 mm Hg or DBP >80 mm Hg but <90 mm Hg; and optimal BP as SBP ≤120 mm Hg and DBP ≤80 mm Hg. Urine tests were performed with a dipstick; the subjects were regarded as proteinuric when the urine dipstick was positive (proteinuria ≥30 mg/dL). Body weight, height, and waist circumference (WC) were measured; body mass index (BMI), waist-to-height ratio (WHtR), and conicity index (Ci) were calculated. According to the BMI, the following classifications were adopted: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), class-I obesity (30-34.9 kg/m2), class-II obesity (35-39.9 kg/m2), class-III obesity (≥40 kg/m2). RESULTS Data from 12,125 students (45.6% males) were evaluated. HTN was found in 1,349 participants (11.1%; 61.1% male), and ISH was present in 7.4%. Overweight (24.1%) and class-I (6%), -II (3.6%), and -III (1%) obesity were present in hypertensive participants. Compared to participants with normal BP, hypertensive participants had a higher BMI (p < 0.001), WC (p < 0.001), and WHtR (p < 0.001); whereas the Ci was not different (p = 0.527). Multivariate linear regression analysis showed that both WC and BMI were predictors of abnormal SBP and DBP (p < 0.001) both in males and females. Proteinuria was present in 14.8, 13.8, 14.7, and 14.7% of all normal weight, overweight, obese, and all subjects, respectively. In addition, no association was found between body weight, proteinuria, and BP. CONCLUSION This study shows that overweight and obesity were significantly associated to HTN in Italian adolescents. BMI and WC were predictors of SBP and DBP. The occurrence of proteinuria was quite similar to that of HTN, but it was not associated with anthropometric indicators or HTN.
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Affiliation(s)
- Yuri Battaglia
- Division of Nephrology and Dialysis, University-Hospital St. Anna, Ferrara, Italy,
| | - Pasquale Esposito
- Nephrology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Salvatore Corrao
- Internal Medicine Unit, National Relevance and High Specialization Hospital Trust, Palermo, Italy
| | - Luigi Russo
- Nephrology Unit, Ospedale del Mare, Naples, Italy
| | | | - Alda Storari
- Division of Nephrology and Dialysis, University-Hospital St. Anna, Ferrara, Italy
| | - Domenico Russo
- Department of Public Health, Nephrology Unit, University Federico II, Naples, Italy
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Battaglia Y, Guerzoni F, Gigante M, Veronesi M, Oppi C, Forini E, Ullo I, Vagnoni E, Storari A. [Economic impact of kidney patients with sepsis in hospital setting]. G Ital Nefrol 2019; 36:36-06-2019-8. [PMID: 31830394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: Over the last decades, sepsis has become a real medical emergency, with a high mortality rate and often requiring admission to an intensive care unit. An increasing number of CKD patients contracts sepsis due to several clinical risk factors (use of catheters, immunosuppressive therapy, comorbidity, etc.) and is treated in Nephrology wards, generating additional costs that are not covered by hospital Diagnosis Related Groups (DRG) reimbursement. The aim of the study is to evaluate the costs of sepsis in one Nephrology Unit and to detect the mortality rate of CKD patients with sepsis. Methods: We conducted a retrospective study on a cohort of CKD patients admitted into one Nephrology Unit in 2017. CKD inpatients were divided in two groups: patients with sepsis (SP) and without (control group). Socio-demographic, clinical and therapeutic data, as well as routine biochemistry, were collected through a "sepsis form". SP were identified thanks to hospital discharge records (HDR). The hospital-related costs of a SP were obtained by summing up: (1) the average cost of an inpatient day of care for the average length of stay in the Nephrology Unit; (2) the average cost of the antimicrobial therapy, as recorded on the clinical folder. Results: Among the 408 CKD inpatients, 61 were septic. The overall average cost of a SP was 23.087,57 €; the average cost of the hospital stay and of the antimicrobial therapy was 19.364,98 € and 3.722,60 € respectively. The average length of stay in the Nephrology Unit was 16.7 days. The in-hospital mortality rate was 41.7%, with a 312% additional mortality rate. Conclusions: SP had an overall average cost three times higher than CKD inpatients without sepsis (9.290,79 €). This additional cost was due to a longer hospital stay (8.7 days more on average) and a higher cost of antimicrobial therapy per case (€ 221,24). A national multi-centre study is needed to confirm our data and to promote an adjustment of reimbursement tariff for DRG-sepsis, which is now applicable only to an ICU setting.
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Affiliation(s)
- Yuri Battaglia
- UOC di Nefrologia e Dialisi, AOU "Sant'Anna", Ferrara, Italia
| | - Franco Guerzoni
- Nucleo Aziendale Controlli, AOU "Sant'Anna", Ferrara, Italia
| | - Manuel Gigante
- UOC di Nefrologia e Dialisi, AOU "Sant'Anna", Ferrara, Italia
| | - Marco Veronesi
- UOC di Nefrologia e Dialisi, AOU "Sant'Anna", Ferrara, Italia
| | - Chiara Oppi
- Dipartimento di Economia e Management, Università di Ferrara, Italia
| | - Elena Forini
- Ufficio Statistico, AOU "Sant'Anna", Ferrara, Italia
| | - Ines Ullo
- UOC di Nefrologia e Dialisi, ASST Sette Laghi, Varese, Italia
| | - Emidia Vagnoni
- Dipartimento di Economia e Management, Università di Ferrara, Italia
| | - Alda Storari
- UOC di Nefrologia e Dialisi, AOU "Sant'Anna", Ferrara, Italia
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Fabbian F, De Giorgi A, Tiseo R, Cappadona R, Zucchi B, Rubbini M, Signani F, Storari A, De Giorgio R, La Manna G, Manfredini R. Neoplasms and renal transplantation: impact of gender, comorbidity and age on in-hospital mortality. A retrospective study in the region Emilia-Romagna of Italy. Eur Rev Med Pharmacol Sci 2019; 22:2266-2272. [PMID: 29762828 DOI: 10.26355/eurrev_201804_14814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to investigate the relationship between cancer, non-immunologic comorbidity, estimated by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codification, gender and in-hospital mortality (IHM) in a large sample of renal transplant recipients (RTRs) living in the region Emilia-Romagna (RER) of Italy. PATIENTS AND METHODS We evaluated IHM in RTRs admitted between 2000 and 2013 recorded in the RER database. By using ICD-9-CM codes, the Elixhauser index (EI) was calculated, and cancers were identified and classified as skin cancers (SC), solid organ cancers (SOC) and post-transplant lymphoproliferative disorders (PTLD). IHM was the dependent variable of the multivariate models, while age, gender, EI corrected removing the effect of malignancies (cEI), and different types of cancer were the independent ones. RESULTS During the examined period, a total of 9,063 admissions in 3,648 RTRs were recorded, of whom 117 died (3.2%). The mean age was 52.9±13.1 years. Cancers were reported in 580 admissions (6.4%), and mean cEI was 3.5±3.4. Deceased RTRs were older, had a higher prevalence of PTLD and SOC, and had a higher cEI than survivors. IHM was independently associated with (in decreasing order) PTLD (OR 12.431, 95%CI 5.834-26.489, p<0.001), SOC (OR 6.804, 95%CI 4.323-10.707, p<0.001), female gender (OR 1.633, 95%CI 1.057-2.523, p=0.006), cEI (OR 1.106, 95%CI 1.068-1.145, p<0.001), and age (OR 1.049, 95%CI 1.031-1.068, p<0.001) CONCLUSIONS: Cancer, in particular SOC and PTLD, is strongly associated with IHM in RTRs. On the other hand, rather surprisingly, female gender exhibited a stronger association with IHM than other more expected factors, such as comorbidity and age.
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Affiliation(s)
- F Fabbian
- Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy.
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Battaglia Y, Ullo I, Esposito P, Prencipe M, Fiorini F, Massarenti S, Russo D, La Manna G, Granata A, Storari A. FP736ULTRASONOGRAPHY OF QUADRICEPS FEMORIS MUSCLE AND FAT TISSUE: A NONINVASIVE METHOD FOR NUTRITIONAL ASSESSMENT IN CHRONIC DIALYSIS PATIENTS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp736] [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: 11/14/2022] Open
Affiliation(s)
| | - Ines Ullo
- University of Bologna, Bologna, Italy
| | | | - Michele Prencipe
- Casa Sollievo della Sofferenza, San Giovanni Rotondo, Province of Foggia, Italy, Italy
| | | | | | | | - Gaetano La Manna
- Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Battaglia Y, Martino E, Piazza G, Cojocaru E, Massarenti S, Peron L, Storari A, Grassi L. Abnormal Illness Behavior, Alexithymia, Demoralization, and Other Clinically Relevant Psychosocial Syndromes in Kidney Transplant Recipients: A Comparative Study of the Diagnostic Criteria for Psychosomatic Research System versus ICD-10 Psychiatric Nosology. Psychother Psychosom 2019; 87:375-376. [PMID: 30391961 DOI: 10.1159/000490000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/12/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, Ferrara, Italy
| | - Elena Martino
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Giulia Piazza
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Elena Cojocaru
- Nephrology and Dialysis Unit, St. Anna University Hospital, Ferrara, Italy
| | - Sara Massarenti
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Luana Peron
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, St. Anna University Hospital and NHS Community Health Trusts, Ferrara, Italy
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy, .,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, St. Anna University Hospital and NHS Community Health Trusts, Ferrara, Italy,
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Manfredini R, Fabbian F, De Giorgi A, Cappadona R, Zucchi B, Storari A, Rodriguez Borrego MA, Carmona Torres JM, Lopez Soto PJ. Takotsubo syndrome and dialysis: an uncommon association? J Int Med Res 2018; 46:4399-4406. [PMID: 30178683 PMCID: PMC6259368 DOI: 10.1177/0300060518794249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This review was performed to investigate the association between treatment with dialysis and Takotsubo syndrome in patients with end-stage renal disease. We systematically explored the PubMed database using the search terms "Takotsubo cardiomyopathy" and/or "stress-induced cardiomyopathy" and/or "Takotsubo syndrome" in combination with "dialysis" and "uremia." Of 3630 articles found, 8 articles reporting 10 cases were selected for analysis. Most patients were women, and their age ranged from 51 to 84 years. Diabetes mellitus and hypertension were diagnosed in 40% of patients, and glomerular disease was diagnosed in 30%. One only patient was treated with peritoneal dialysis; all others were treated with hemodialysis. The outcome was unfavorable in only one patient. An association between Takotsubo syndrome and dialysis is uncommon, but not negligible, and comorbidities play a major role in determining the clinical outcome.
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Affiliation(s)
- Roberto Manfredini
- 1 Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy.,2 Azienda Ospedaliera-Universitaria, Ferrara, Italy.,3 Instituto Maimonides de Investigacion Biomedica de Cordoba (IMIBIC), University of Cordoba, Spain
| | - Fabio Fabbian
- 1 Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy.,2 Azienda Ospedaliera-Universitaria, Ferrara, Italy.,3 Instituto Maimonides de Investigacion Biomedica de Cordoba (IMIBIC), University of Cordoba, Spain
| | | | - Rosaria Cappadona
- 1 Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy
| | - Beatrice Zucchi
- 1 Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Italy
| | - Alda Storari
- 2 Azienda Ospedaliera-Universitaria, Ferrara, Italy
| | | | | | - Pablo Jesus Lopez Soto
- 3 Instituto Maimonides de Investigacion Biomedica de Cordoba (IMIBIC), University of Cordoba, Spain
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Santoro A, Gibertoni D, Rucci P, Mancini E, Bonucchi D, Buscaroli A, Campagna A, Cappelli G, David S, Gregorini MC, La Manna G, Mosconi G, Rigotti A, Scarpioni R, Storari A, Mandreoli M. [Challenges and results of the PIRP project (Prevenzione della Insufficienza Renale Progressiva) of the Emilia-Romagna Region]. G Ital Nefrol 2018; 35:35-5-2018-9. [PMID: 30234236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The PIRP project was conceived in 2004; with the aim to face the increased prevalence of chronic kidney disease (CKD) associated with the aging and increased survival of the population. The first phase of the project consisted of training primary care physicians to identify people at risk of CKD and to implement intervention strategies that proved to be effective in preventing CKD it or delaying its progression once it is established. In the second phase of the project, dedicated ambulatories were opened in the nephrology units of Emilia-Romagna hospitals to provide an in-depth assessment and personalized care to CKD patients, following them up until renal failure or death or referring them back to general practitioners, according to the study protocol. A web-based registry was implemented to collect demographic and clinical data on PIRP patients. As of 30 June 2018, the registry included 26.211 CKD patients, with a median follow-up of 24.5 months. Over the 14 years of the PIRP the mean age of incident patients increased from 71.0 years to 74.2 years and the mean eGFR increased from 30.56 to 36.52 mL/min/1.73 m ², proving that the project was successful in recruiting older patients with a better renal function. At 5 years, the percentage of patients still active in the project was =45%.The implementation of the project has seen a reduction in the number of patients arriving every year to the dialysis treatment in E-R (about 100 units less from 2006 to 2016). The PIRP cohort is the largest in Italy and in Europe, which makes it ideal for research based on international comparisons and as a model for national registries.
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Affiliation(s)
- Antonio Santoro
- UO Nefrologia, Dialisi e Ipertensione, Policlinico S.Orsola-Malpighi, Bologna, Italia
| | - Dino Gibertoni
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italia
| | - Paola Rucci
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italia
| | - Elena Mancini
- UO Nefrologia, Dialisi e Ipertensione, Policlinico S.Orsola-Malpighi, Bologna, Italia
| | | | - Andrea Buscaroli
- UO Nefrologia e Dialisi, Ospedale S. Maria delle Croci, Ravenna, Italia
| | | | - Gianni Cappelli
- UO Nefrologia e Dialisi, Ospedale Universitario di Modena, Italia
| | | | | | - Gaetano La Manna
- UO Nefrologia, Dialisi e Trapianto, Policlinico S.Orsola-Malpighi, Bologna Italia
| | - Giovanni Mosconi
- UO Nefrologia e Dialisi, Ospedale Morgagni-Pierantoni, Forlì e Ospedale M.Bufalini, Cesena, Italia
| | - Angelo Rigotti
- UO Nefrologia e Dialisi, Ospedale degli Infermi, Rimini, Italia
| | - Roberto Scarpioni
- UO Nefrologia e Dialisi, Ospedale Guglielmo da Saliceto, Piacenza, Italia
| | - Alda Storari
- UO Nefrologia e Dialisi, Arcispedale S. Anna, Ferrara, Italia
| | - Marcora Mandreoli
- UO Nefrologia e Dialisi, Ospedale S. Maria della Scaletta, Imola, Italia
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Battaglia Y, Piazza G, Martino E, Massarenti S, Peron L, Esposito P, Storari A, Grassi L. SP716DEMORALIZATION AND POST TRAUMATIC GROWTH IN KIDNEY TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp716] [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)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University-Hospital, iFerrara, Italy
| | - Giulia Piazza
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elena Martino
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Sara Massarenti
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Luana Peron
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University-Hospital, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
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Battaglia Y, Piazza G, Martino E, Massarenti S, Esposito P, Peron L, Storari A, Grassi L. SP707CROSS-SECTIONAL VALIDITY OF EDMONTON SYMPTOM ASSESSMENT SYSTEM IN KIDNEY TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp707] [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)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University-Hospital, Ferrara, Italy
| | - Giulia Piazza
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elena Martino
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Sara Massarenti
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Luana Peron
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University-Hospital, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, University of Ferrara, Ferrara, Italy
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Fiocchi O, Bedani P, Orzincolo C, Storari A, Cavazzini P, Malacarne F, Farinelli A. Radiological Features of Dialysis Amyloid Spondyloarthropathy. Int J Artif Organs 2018. [DOI: 10.1177/039139888901200403] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nine patients undergoing regular dialytic treatment (RDT) for more than 60 months (mean 125± 33 months) showed clinical and radiological evidence of non-infective destructive spondyloarthropathy (DSA). The cervical spine was the skeletal segment most affected (100% of cases). Three patients were found also to be suffering from discal and bone alterations of the dorsal column, and in two other patients the vertebral bodies L4-L5 were changed. Typical radiological pictures showed a narrowing of intervertebral spaces with the destruction or sclerosis of adjacent subchondral bones, erosions of vertebral body plates and cavitations. CT studies of the altered spines confirmed discal lesions and osteolytic areas with bone condensation at each level. Ligamentous lesions resulting in severe disorders of spinal statics were discovered during autopsy of three patients. Histological study of disc and peridiscal ligaments indicated the presence of large amyloid deposits containing beta-2-microglobulin (B2-m). It is possible that the minor biocompatibility of the cuprophan membrane of dialyzers is the most significant factor responsible for the hyperproduction of B2-m and thus of the osteo-articular deposition of a new type of amyloidosis.
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Affiliation(s)
- O. Fiocchi
- Division of Nephrology - S. Anna Hospital, Ferrara - Italy
| | - P.L. Bedani
- Division of Nephrology - S. Anna Hospital, Ferrara - Italy
| | - C. Orzincolo
- Service of Radiology - S. Anna Hospital, Ferrara - Italy
| | - A. Storari
- Division of Nephrology - S. Anna Hospital, Ferrara - Italy
| | - P.L. Cavazzini
- Institute of Pathology, University School of Medicine, Ferrara - Italy
| | - F. Malacarne
- Division of Nephrology - S. Anna Hospital, Ferrara - Italy
| | - A. Farinelli
- Division of Nephrology - S. Anna Hospital, Ferrara - Italy
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Bedani P, Orzincolo C, Storari A, Perini L, Soffritti S, Gilli P. Clinical and Radiological Features of Bone Disease in Long-Term (15 or more years) Hemodialysis Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139889301601005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fifteen patients on regular dialytic treatment for more than 15 years were given X-rays of the skull, spine, shoulders, wrists, pelvis and knees with the purpose of studying the principal skeletal and articular alterations due or not due to the uraemic status. Serum calcium, phosphorus, parathyroid hormone, alkaline phosphatase and basal aluminium were recorded. Osteopenia was evident in all the patients. Ten of whom (67%) showed alterations due to hyperparathyroidism. Nine patients presented the marks of dialysis spondyloarthropathy; in 14/15 cases geodes were present in the wrists, humeral heads or hip-joints; in ten patients there were multiple amyloid lesions. Two patients with serum basal aluminum above 100 μg/L showed the typical radiographic marks of osteomalacia. The majority of the long-term survivors showed multifactorial osteo-articular alterations resulting mainly from the combination of hyperparathyroidism and dialysis-related amyloidosis. The less frequent joint alterations were represented by arthrosis, enthesopathy and Chondrocalcinosis. Disability and decreased articular mobility resulted in being mainly due to amyloid osteo-arthropathy.
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Affiliation(s)
| | - C. Orzincolo
- Division of Service of Radiology, S. Anna Hospital, Ferrara - Italy
| | | | - L. Perini
- Division of Nephrology Ferrara - Italy
| | | | - P. Gilli
- Division of Nephrology Ferrara - Italy
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De Giorgi A, Storari A, Forcellini S, Manfredini F, Lamberti N, Todeschini P, La Manna G, Manfredini R, Fabbian F. Body mass index and metabolic syndrome impact differently on major clinical events in renal transplant patients. Eur Rev Med Pharmacol Sci 2017; 21:4654-4660. [PMID: 29131248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Kidney transplant recipients (KTRs) are bound to develop cardiovascular disease (CVD), and obesity represents a well-known risk factor for CVD. It has been reported that the metabolic syndrome (MetS) is a frequent finding in KTRs, and MetS could develop even if body mass index (BMI) is only mildly increased. We compared the impact of BMI and MetS on the development of major clinical events (MCEs) in a cohort of 107 KTRs during a follow-up of 63 ± 31 months. PATIENTS AND METHODS Clinical characteristics were recorded at the time of enrollment and patients were classified on the basis of MCEs development. In a Cox model, MCEs were the dependent variable while age, sex, history of CVD, glomerular filtration rate, length of dialysis pre-transplantation, BMI classes and diagnosis of MetS were independent variables. Patients were classified into 3 groups: normal (BMI < 25 kg/m2), overweight (BMI of 25 to 30 kg/m2) and obese (BMI > 30 kg/m2). RESULTS During follow-up, 55 MCEs were recorded: 16 patients died (15%), 19 (18%) had major cardiovascular events (CVEs), and 20 (19%) started dialysis due to graft failure. KTRs who had MCEs (n = 42) were older, had a lower renal function, longer dialysis vintage pre-transplantation, higher prevalence of history of CVD and higher BMI than those without MCEs. Cox regression analysis showed that length of dialysis pre-transplantation, renal function, previous CVD, and BMI classes (overweight and obesity) were related to MCEs. CONCLUSIONS BMI, but not MetS, predicted MCEs in KTRs as well as non-traditional CVD risk factors such as length of dialysis pre-transplantation and graft function. Thus, a simple evaluation during clinic visits could identify KTRs at high risk for MCEs.
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Affiliation(s)
- A De Giorgi
- Department of Medical Sciences, School of Medicine, University of Ferrara, Italy.
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Battaglia Y, Martino E, PIazza G, Massarenti S, Peron L, Storari A, Grassi L. MP777DCPR SYNDROMES IN KIDNEY TRANSPLANT RECIPIENTS AND IN PATIENTS ON WAITING LIST FOR KIDNEY TRANSPLANT. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx182.mp777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Manfredini R, Gallerani M, De Giorgi A, Tiseo R, Lamberti N, Manfredini F, Forcellini S, Storari A, La Manna G, Fabbian F. Renal Transplantation and Outcome. Prog Transplant 2016; 26:397-398. [DOI: 10.1177/1526924816665368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Emergency surgery represents an independent risk factor for death and postoperative complications. The aim of this study was to investigate the literature data regarding outcome of daytime or nighttime renal transplantation surgery. Relevant papers, focused on renal transplantation surgery, time of the day, and complications, were searched across the PubMed database. We used the following search terms: “renal”, “transplantation”, “surgery”, “daytime”, “nighttime”, and “outcome”. A total of five papers, including 6,991 adult patients were evaluated. All patients received renal transplantation from deceased donor. Daytime or nighttime surgery do not seem to negatively impact on graft survival in renal transplantation. However, two out five studies reported higher odds of complications after nighttime operation. Since it is not possible to predict the availability of a deceased donor, nighttime surgery remains a valid option when necessary, maybe deserving a higher level of caution to reduce or avoid complications.
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Affiliation(s)
- Roberto Manfredini
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Ruana Tiseo
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Forcellini
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Alda Storari
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, Nephrology and Transplantation Unit, University of Bologna, Bologna, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
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Fabbian F, De Giorgi A, Manfredini F, Lamberti N, Forcellini S, Storari A, Todeschini P, Gallerani M, La Manna G, Mikhailidis DP, Manfredini R. Impact of comorbidity on outcome in kidney transplant recipients: a retrospective study in Italy. Intern Emerg Med 2016; 11:825-32. [PMID: 27003820 DOI: 10.1007/s11739-016-1438-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/09/2016] [Indexed: 01/06/2023]
Abstract
The aim of this study was to relate in-hospital mortality (IHM), cardiovascular events (CVEs) and non-immunologic comorbidity evaluated on the basis of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codification, in Italian kidney transplant recipients (KTRs). We evaluated IHM and admissions due to CVEs between 2000 and 2013 recorded in the database of the region Emilia Romagna. The Elixhauser score was calculated for evaluation of non-immunologic comorbidity. Three main outcomes (i.e. IHM, admission due to major CVEs and combined outcome) were the dependent variables of the multivariate models, while age, gender and Elixhauser score were the independent ones. During the examined period, a total of 9063 admissions in 3648 KTRs were recorded; 1945 patients were males (53.3 %) and 1703 females (46.7 %) and the mean age was 52.9 ± 13.1 years. The non-immunological impaired status of the KTRs, examined by the Elixhauser score, was 3.88 ± 4.29. During the 14-year follow-up period, IHM for any cause was 3.2 % (n = 117), and admissions due to CVEs were 527 (5.8 %). Age and comorbidity were independently associated with CVEs, IHM and the combined outcome. Male gender was independently associated with IHM and combined outcome, but not with CVEs. Evaluation of non-immunological comorbidity is important in KTRs and identification of high-risk patients for major clinical events could improve outcome. Moreover, comorbidity could be even more important in chronic kidney disease patients who are waiting for a kidney transplant.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy.
| | - Alfredo De Giorgi
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Forcellini
- Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alda Storari
- Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Paola Todeschini
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), University College London (UCL) Medical School, London, UK
| | - Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy
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Manfredini R, Gallerani M, Giorgi AD, Boari B, Lamberti N, Manfredini F, Storari A, Manna GL, Fabbian F. Lack of a “Weekend Effect” for Renal Transplant Recipients. Angiology 2016; 68:366-373. [DOI: 10.1177/0003319716660245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The “weekend (WE) effect” defines the association between WE hospital admissions and higher rate of mortality. The aim of this study was to evaluate the relationship between WE effect and renal transplant recipients (RTRs) using the database of the Emilia-Romagna region (ERR), Italy. We included ERR admissions of RTRs ( International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] code V420) between 2000 and 2013. In-hospital mortality, admissions due to cardiovascular events (CVEs), and the Elixhauser score were evaluated on the basis of ICD-9-CM codification. Out of 9063 hospital admissions related to 3648 RTRs (mean age 53 ± 13 years, 62.9% male), 1491 (16.5%) were recorded during the WE. During the follow-up period, 1581 (17.4%) patients deceased and 366 (4%) had CVEs. Length of hospital stay (LOS) was 9.7 ± 12.1 days. Logistic regression analysis showed that only LOS was independently associated with WE admissions (odds ratio: 1594, confidence interval: 1.385-1.833; P < .001). Renal transplant recipients are not exposed to higher risk of adverse outcome during WE admissions. However, WE admissions were characterized by an increased duration of hospitalization.
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Affiliation(s)
- Roberto Manfredini
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Benedetta Boari
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Alda Storari
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
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Battaglia Y, Forcellini S, Cojocaru E, Fiorini F, Granata A, Russo L, Storari A, D'amelio A, Russo D. MP710VITAMIN D STATUS IN KIDNEY TRANSPLANT PATIENTS: AN ITALIAN COHORT REPORT. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw200.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Battaglia Y, Galeano D, Cojocaru E, Fiorini F, Forcellini S, Zanoli L, Storari A, Granata A. [Muscle-wasting in end stage renal disease in dialysis treatment: a review]. G Ital Nefrol 2016; 33:gin/00240.7. [PMID: 27067216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Progressive and generalized loss of muscle mass (muscle wasting) is a frequent complication in dialysis patients. Common uremic signs and symptoms such as insulin-resistance, increase in glucocorticoid activity, metabolic acidosis, malnutrition, inflammation and dialysis per se contribute to muscle wasting by modulating proteolytic intracellular mechanisms (ubiquitin-proteasome system, activation of caspase-3 and IGF-1/PI3K/Akt pathway). Since muscle wasting is associated with an increase in mortality, bone fractures and worsening in life quality, a prompt and personalised diagnostic and therapeutic approach seems to be essential in dialysis patients. At present, nuclear magnetic resonance (NMR), computed tomography (CT), dual-energy x-ray absorptiometry (DXA), impedance analysis, bioelectric impedance analysis (BIA) and anthropometric measurements are the main tools used to assess skeletal muscle mass. Aerobic and anaerobic training programmes and treatment of uremic complications reduce muscle wasting and increase muscle strength in uremic patients. The present review analyses the most recent data about the physiopathology, diagnosis, therapy and future perspectives of treatment of muscle wasting in dialysis patients.
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Manfredini R, De Giorgi A, Storari A, Fabbian F. Pears and renal stones: possible weapon for prevention? A comprehensive narrative review. Eur Rev Med Pharmacol Sci 2016; 20:414-425. [PMID: 26914114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Urinary stones have been recognized as a human disease since dawn of history and treatment of this condition is reported by Egyptian medical writings. Also, pears have a very long history, being one of the earliest cultivated fruit trees and also known for medicinal use. Urinary tract stone formation represents a common condition and also a significant burden for health care service, due also to possible frequent relapses. Furthermore, urinary stones have been reported to have relationship with different metabolic derangements, and appropriate diet could contribute to avoid or reduce urinary stone formation. Citrate is an inhibitor of crystal growth in the urinary system, and hypocitraturia represents a main therapeutical target in stone formers. Pears contain a significant amount of malic acid, a precursor of citrate, and have antioxidant activity as well. A diet supplemented with pears, and associated with low consumption of meat and salt could impact positively cardiometabolic risk and urinary tract stone formation. However, very few studies evaluated the impact of pears utilization on health, and none on urinary tract stone formation in particular. High content in malate could warrant protection against stone formation, avoiding patients at high risk to be compelled to assume a considerable and expensive amount of pills.
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Affiliation(s)
- R Manfredini
- Department of Medical Sciences, University of Ferrara, School of Medicine; Clinica Medica Unit, Azienda Ospedaliero-Universitaria, Ferrara, Italy.
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Fabbian F, De Giorgi A, Monesi M, Pala M, Tiseo R, Forcellini S, Storari A, Graziani R, Volpi R, Mikhailidis DP, Manfredini R. A possible relationship between renal impairment and complications development in type 2 diabetes mellitus: a prospective, observational study in Italy. J Diabetes Complications 2015; 29:771-5. [PMID: 26025698 DOI: 10.1016/j.jdiacomp.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/26/2015] [Accepted: 05/06/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND We investigated the relationship between complications development and estimated glomerular filtration rate (eGFR), in a cohort of type 2 diabetes mellitus (T2DM) outpatients. METHODS This observational study considered 1284 T2DM outpatients, who had been followed-up for 4.5 ± 1.6 years. eGFR was estimated using Chronic Kidney Disease Epidemiology Collaboration equation. The independent relationship between development of complications and clinical data was evaluated, and hazard ratio (HR) by Cox regression analysis calculated. RESULTS Mean age of the population was 66.8 ± 10.4 years; mean serum creatinine and eGFR were 1.05 ± 0.36 mg/dl and 71.6 ± 21.6 ml/min/1.73 m(2), respectively. Complications including death (14.2% of the whole population) were recorded in 504 subjects (39.3%). Patients with complications were older and more frequently male with history of hypertension, coronary heart disease, congestive heart disease, retinopathy, nephropathy and had higher levels of glycated hemoglobin. At Cox regression analysis, eGFR was the major risk factor for development of complications, and the HR increased according with lower eGFR (HR 1.53 and 1.86, for eGFR<45 and<30 ml/min/1.73 m(2), respectively). CONCLUSIONS In our cohort of T2DM outpatients, a reduced eGFR was associated with an increased risk of complications development.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara.
| | - Alfredo De Giorgi
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | - Marcello Monesi
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara
| | - Marco Pala
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | - Ruana Tiseo
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
| | | | - Alda Storari
- Nephrology and Dialysis, University Hospital St. Anna, Ferrara
| | - Roberto Graziani
- Diabetes and Clinical Nutrition, University Hospital St. Anna, Ferrara
| | - Riccardo Volpi
- Department of Internal Medicine and Biomedical Science, University of Parma, Parma
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), University College London Medical School, University College London (UCL), London, UK
| | - Roberto Manfredini
- Clinica Medica, Department of Medical Sciences, University Hospital St. Anna, Ferrara
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Battaglia Y, Forcellini S, Cojocaru E, Fiorini F, Granata A, Morrone L, Di Iorio B, Russo L, Storari A, Russo D. FP097ANTHROPOMETRIC INDICATORS AND HYPERTENSION IN ITALIAN YOUNG ADULTS FROM THE WORD KIDNEY DAYS 2010 - 2011. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv169.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Battaglia Y, Fiorini S, Cojocaru E, Fiorini F, Granata A, Morrone L, Di Iorio B, Russo L, Storari A, Russo D. SP281ASSOCIATION BETWEEN URINARY ABNORMALITIES AND ANTHROPOMETRIC INDICATORS IN ITALIAN YOUNG PEOPLE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv191.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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48
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Forcellini S, Fabbian F, Battaglia Y, Storari A. [Rhabdomyolysis: role of the nephrologist]. G Ital Nefrol 2014; 31:gin/00199.2. [PMID: 25504160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rhabdomyolysis is characterized by skeletal muscle necrosis resulting in release of large amounts of toxic muscle cell components, including electrolytes, myoglobin, and other sarcoplasmic proteins into circulation. Creatinine phosphokinase (CPK) and myoglobin serum levels constitute the diagnostic hallmark. Nowadays, drugs have become one of the most frequent cause of rhabdomyolysis and acute kidney injury (AKI) is a potential life-threatening complication. The mechanisms involved in the development of AKI in rhabdomyolysis are intrarenal vasoconstriction, direct and ischemic tubule injury and tubular obstruction. According to some clinical series, the mortality rate in patients who develop AKI due to rhabdomyolysis is highly variable. The cornerstone in managing this condition is the early, aggressive repletion of fluids. The composition of replacement fluid remains controversial. Saline and sodium bicarbonate, especially in patients with metabolic acidosis, seem to be a reasonable approach. When AKI produces refractory hyperkalemia, acidosis or volume overload, renal replacement therapy is indicated.
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Reyes-Bahamonde J, Raimann JG, Canaud B, Etter M, Kooman JP, Levin NW, Marcelli D, Marelli C, Power A, Van Der Sande FM, Thijssen S, Usvyat LA, Wang Y, Kotanko P, Blank PR, Szucs TD, Gibertoni D, Torroni S, Mandreoli M, Rucci P, Fantini MP, Santoro A, Van Der Veer SN, Nistor I, Bernaert P, Bolignano D, Brown EA, Covic A, Farrington K, Kooman J, Macias J, Mooney A, Van Munster BC, Van Den Noortgate N, Topinkova E, Wirnsberger G, Jager KJ, Van Biesen W, Stubnova V, Os I, Grundtvig M, Waldum B, Wu HY, Peng YS, Wu MS, Chu TS, Chien KL, Hung KY, Wu KD, Carrero JJ, Huang X, Sui X, Ruiz JR, Hirth V, Ortega FB, Blair SN, Coppolino G, Bolignano D, Rivoli L, Presta P, Mazza G, Fuiano G, Marx S, Petrilla A, Hengst N, Lee WC, Ruggajo P, Skrunes R, Svarstad E, Skjaerven R, Reisaether AV, Vikse BE, Fujii N, Hamano T, Akagi S, Watanabe T, Imai E, Nitta K, Akizawa T, Matsuo S, Makino H, Scalzotto E, Corradi V, Nalesso F, Zaglia T, Neri M, Martino F, Zanella M, Brendolan A, Mongillo M, Ronco C, Occelli F, Genin M, Deram A, Glowacki F, Cuny D, Mansurova I, Alchinbayev M, Malikh MA, Song S, Shin MJ, Rhee H, Yang BY, Kim I, Seong EY, Lee DW, Lee SB, Kwak IS, Isnard Bagnis C, Speyer E, Beauger D, Caille Y, Baudelot C, Mercier S, Jacquelinet C, Gentile SM, Briancon S, Yu TM, Li CY, Krivoshiev S, Borissova AM, Shinkov A, Svinarov D, Vlachov J, Koteva A, Dakovska L, Mihaylov G, Popov A, Polner K, Mucsi I, Braunitzer H, Kiss A, Nadasdi Z, Haris A, Zdrojewski L, Zdrojewski T, Rutkowski B, Minami S, Hesaka A, Yamaguchi S, Iwahashi E, Sakai S, Fujimoto T, Sasaki K, Fujita Y, Yokoyama K, Dey V, Farrah T, Traynor J, Spalding E, Robertson S, Geddes CC, Mann MC, Hobbs A, Hemmelgarn BR, Roberts D, Ahmed SB, Rabi D, Elewa U, Fernandez B, Alegre ER, Mahillo I, Egido J, Ortiz A, Marx S, Pomerantz D, Vietri J, Zewinger S, Speer T, Kleber ME, Scharnagl H, Woitas R, Pfahler K, Seiler S, Heine GH, Lepper PM, Marz W, Silbernagel G, Fliser D, Caldararu CD, Gliga ML, Tarta ID, Szanto A, Carlan O, Dogaru GA, Battaglia Y, Del Prete MA, De Gregorio MG, Errichiello C, Gisonni P, Russo L, Scognamiglio B, Storari A, Russo D, Kuma A, Serino R, Miyamoto T, Tamura M, Otsuji Y, Kung LF, Naito S, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Kang YU, Kim HY, Choi JS, Kim CS, Bae EH, Ma SK, Kim SW, Muthuppalaniappan VM, Byrne C, Sheaff M, Rajakariar R, Blunden M, Delmas Y, Loirat C, Muus P, Legendre C, Douglas K, Hourmant M, Herthelius M, Trivelli A, Goodship T, Bedrosian CL, Licht C, Marks A, Black C, Clark L, Prescott G, Robertson L, Simpson W, Simpson W, Fluck N, Wang SL, Hsu YH, Pai HC, Chang YM, Liu WH, Hsu CC, Shvetsov M, Nagaytseva S, Gerasimov A, Shalyagin Y, Ivanova E, Shilov E, Zhang Y, Zuo W, Marx S, Manthena S, Newmark J, Zdrojewski L, Rutkowski M, Zdrojewski T, Bandosz P, Gaciong Z, Solnica B, Rutkowski B, Wyrzykowski B, Ensergueix G, Karras A, Levi C, Chauvet S, Trivin C, Ficheux M, Augusto JF, Boudet R, Chambaraud T, Boudou-Rouquette P, Tubiana-Mathieu N, Aldigier JC, Jacquot C, Essig M, Thervet E, Oh YJ, Lee CS, Malho Guedes A, Silva AP, Goncalves C, Sampaio S, Morgado E, Santos V, Bernardo I, Leao Neves P, Onuigbo M, Agbasi N. CKD GENERAL AND CLINICAL EPIDEMIOLOGY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu146] [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: 01/24/2023] Open
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Battaglia Y, Russo L, Asimakopoulos G, Storari A. [Vascular calcification in chronic kidney disease]. G Ital Nefrol 2014; 31:gin/00189.17. [PMID: 25030018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cardiovascular risk is higher in patients with chronic kidney disease (CKD) or with End-Stage Renal Disease (ESRD) than general population because in addition to the traditional cardiovascular (CV ) risk factors, CKD patients also have others non-traditional CV risk factors linked to CKD. Among these factors, presence and progression of coronary calcifications (CAC) are considered very important in CKD or ESRD patients in recent years. A number of noninvasive imaging methods are available to detect the presence, extent and progression of CAC. In this review, we discuss the importance of CAC as non-traditional CV risk factors in CKD patients and the noninvasive methods most frequently used to assess CAC.
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