[Home Hemodialysis: new organizational models to favor the economic and environmental sustainability in the province of Belluno].

The prevalence of chronic kidney disease is 7.05% in Italy. The replacement dialysis treatments determine greenhouse gas emissions thus contributing to climate change, an important source of risk to global health. Furthermore, the percentage of the Italian Gross Domestic Product destined to public health expenditure has progressively contracted. The province of Belluno has an area of 3610 km2, with a population density of 56 people/km2, an old age index of 248.5, and offers 4 dialysis centers; however, several patients take up to 8 hours/week to commute to the dialysis center, with a consequent significant environmental and economic impact. We have investigated the Home Hemodialysis (H-HD) models, both as Assisted Home Hemodialysis (AH-HD), and as Not-assisted Home Hemodialysis (NH-HD), to evaluate their environmental and economic sustainability, and the actual impact due to their adoption by 5 patients. Thanks to AH-HD it is possible a reduction up to 3767 kg of CO2 per year, and an economic saving of € 32 456 per year. Utilizing a NH-HD treatment, it is possible a reduction of 5330 kg of CO2 per year, and a reduction in annual healthcare costs up to € 30 156 per year. Furthermore, the adoption of H-HD treatment for 5 patients allowed an effective reduction of 14 537 kg of CO2 emitted and a net economic saving of € 57 975. Therefore, we consider H-HD methods a valid option for patients living in areas with low population density, where transports have a significant impact, allowing a net reduction of CO2 equivalent emissions and a considerable saving of the health resources.

["Naked" exit-site for peritoneal dialysis catheters].

Exit site infections (ESI) and peritoneal catheter tunnel infections are strongly associated with peritonitis. Alternative exit-site dressings can include the use of water and soap and the absence of sterile gauze. This article reports our experience with "naked" exit-sites, meaning without any kind of gauze to cover them. From January 2017 to October 2020, we enrolled 38 patients of the Nephrology and Dialysis Unit of the "San Martino" Hospital in Belluno. Nine of these patients had a "naked" exit-site. At the end of the study, no significant differences were found in the percentage of ESI-free patients, in the incidence rate of ESI, in the relative risk of developing ESI and in the incidence rate of peritonitis.

[Vascular access survey in the Triveneto area: data analysis for the year 2017].

In 2017 the Italian Society of Nephrology operating in the Triveneto area investigated through a questionnaire, distributed to the various nephrological centers in the regions of Friuli Venezia Giulia, Trentino Alto Adige and Veneto, the differences concerning organizational models, choice of dialysis, creation and management of vascular access. The results emerging from the analysis of the collected data are presented.

In vivo real time non invasive monitoring of brain penetration of chemicals with near-infrared spectroscopy: Concomitant PK/PD analysis.

BACKGROUND: Near-infrared spectroscopy (NIRS) is a non-invasive technique that monitors changes in oxygenation of haemoglobin. The absorption spectra of near-infrared light differ for the oxygenation-deoxygenation states of haemoglobin (oxygenate (HbO2) and deoxygenate (Hb), respectively) so that these two states can be directly monitored. COMPARISON WITH EXISTING METHOD(S): Different methodologies report different basal values of HbO2 and Hb absolute concentrations in brain. Here, we attempt to calculate basal HbO2 levels in rat CNS via evaluation of the influence of exogenous oxygen or exogenous carbon dioxide on the NIRS parameters measured in vivo. NEW METHOD: Furthermore the possibility that changes of haemoglobin oxygenation in rat brain as measured by NIRS might be a useful index of brain penetration of chemical entities has been investigated. Different compounds from different chemical classes were selected on the basis of parallel ex vivo and in vivo pharmacokinetic (PK/PD) studies of brain penetration and overall pharmacokinetic profile. RESULTS: It appeared that NIRS might contribute to assess brain penetration of chemical entities, i.e. significant changes in NIRS signals could be related to brain exposure, conversely the lack of significant changes in relevant NIRS parameters could be indicative of low brain exposure. CONCLUSIONS: This work is proposing a further innovation on NIRS preclinical applications i.e. a "chemical" NIRS [chNIRS] approach for determining penetration of drugs in animal brain. Therefore, chNIRS could became a non invasive methodology for studies on neurobiological processes and psychiatric diseases in preclinical but also a translational strategy from preclinical to clinical investigations.

Vascular access in older patients: an Italian survey.

BACKGROUND: The number of older patients starting hemodialysis is continuously increasing. The type of vascular access plays an important role in dialysis treatment, but it can be difficult to create in older patients. METHODS: This study compared vascular access survival rates and patient survival rates in older (≥65 years) and younger (<65 years) patients starting hemodialysis in 2 Italian hospitals in 2006-2008. RESULTS: The study enrolled 336 patients: 208 ≥65 years and 128 <65 years of age. The vascular accesses used, in order of frequency, were 102 distal arteriovenous fistulas (dAVFs) (49%), 55 midarm AVFs (pAVFs) (26%), 9 arteriovenous grafts (AVGs) (4%) and 42 central venous catheters (CVCs) (20%) in the older patients, and 89 dAVFs (69%), 25 pAVFs (19%), 6 AVGs (5%) and 8 CVCs (6%) in the younger patients. Survival rates of fistula and catheter did not differ between the 2 groups. AVGs failed earlier (p = 0.02) in the older patients. On Cox analysis, age (hazard ratio [HR] = 1.073; p<0.001) and CVC (HR = 4.152; p<0.001) increased the risk of death. CONCLUSION: A fistula is the gold standard for hemodialysis vascular access in older patients if judged appropriately.

Non-invasive in vivo infrared laser spectroscopy to analyse endogenous oxy-haemoglobin, deoxy-haemoglobin, and blood volume in the rat CNS.

Oxy-haemoglobin (HbO2) and deoxy-haemoglobin (Hb) are chromophores present in biological tissues. Near infrared spectroscopy (NIRS) is a non-invasive methodology based on the low extinction coefficient of tissue in the near infrared region. NIRS can be used to measure changes in the concentration of these chromophores, i.e., haemoglobin, in muscular tissue. In the present work, NIRS has been used for the non-invasive monitoring of HbO2, Hb, and blood volume (V: representing total haemoglobin, i.e., HbO2+Hb) in vivo in the whole rat brain. This has been performed by means of prototype instrumentation based on optic fibre probes placed in contact with the head of anaesthetised rats held in a stereotaxic frame. A preliminary test of the instrument has been performed on human muscle, i.e., lateral gastrocnemius, in order to evaluate the ability of the instrument to detect oxygenation changes. Afterwards, the effects of pharmacological treatments, such as systemic amphetamine and nicotine treatments on the CNS have been detected.