Bioelectrical impedance vector analysis and brain natriuretic peptide in the evaluation of patients with chronic kidney disease in hemodialitic treatment.

INTRODUCTION: Setting dry weight (DW) in haemodialysis (HD) patients is still an hard issue. Several clinical, haematochimical and instrumental parameters have been considered. In the last years bioelectrical impedance vector analysis (BIVA) became the main method to evaluate body composition and water body percentage. However it is still difficult to assess the nutritional status and identify a correct DW in HD patients. AIM: to set DW and nutritional status, combining BIVA with phase angle (PhA) and serum brain natriuretic peptide (BNP) in HD patients. METHODS: we evaluated PhA and BNP modifications before (T0), after HD section (T1) and after 60 days (T2), in all patients treated in our HD centre. RESULTS: A total of 50 patients (36 males) with a mean age of 70.1 ± 8.85 years, were recruited. We did not report significant changes in BNP and PhA between T0 and T1, while they were significantly different between T0 and T2. We also reported a significant difference between T0 and T2 in ECW / TBW, while we did not show significant variations in ECM / BMC between T0, T1 and T2 indicating a stability of the nutritional status. PhA, BNP and ECW / TBW, returned to a normal value in patients in which we reached a DW, also considering clinical parameters such as blood pressure and antihypertensive therapy. The weight loss obtained with the evaluation of the BIVA and the BNP was 1.2-5.7 kg, greater than that calculated empirically which stood at around 0.9-4.3 Kg. CONCLUSION: We suggest to carry out BIVA with PhA combined with BNP to assess an adequate DW and evaluate a correct nutritional status in HD patients.

[Day of Prevention of Renal Diseases in Amatrice, Italy].

Chronic kidney disease (CKD) is a very common condition and its prevalence is increasing worldwide. The CARHES study in Italy showed a prevalence of 6.5% in women and 7.5% in men. As a matter of fact, an early diagnosis is essential to slow down the progression and improve the renal and cardiovascular prognosis. For this purpose the A.N.Di.P. association (National Association of Peritoneal Dialysis-Onlus "Enzo Siciliano ") organized the DAY OF PREVENTION OF RENAL DISEASES which was held in AMATRICE the 15th of July 2017 called "WE START A NEW PATH OF LIFE TOGETHER". The goal of this initiative was to highlight and spread the importance of prevention and early diagnosis of renal disease in Amatrice and its surroundings. During this day, medical history, blood pressure measurements, urinalysis, serum creatinine and serum uric acid were carried out and we suggested to patients how to proceed, if necessary, in a further diagnostic and therapeutic process. We also recommended a correct lifestyle, based on healthy eating and regular physical activity. The choice to dedicate particular attention to the population tragically affected by the earthquake occurred to identify renal diseases, since they are a possible consequence of the earthquake, to draw attention to the importance of renal function and to demonstrate that simple routine checks may lead to an early diagnosis of unrecognized kidney diseases, also reducing cardiovascular risk.

[Geriatric nephrology: an overview]. / Nefrologia geriatrica: an overview.

INTRODUCTION: Chronic kidney disease (CKD) is a highly prevalent condition and its prevalence is increasing worldwide, particularly in adults aged 70 years. Epidemiological studies showed that as many as 2054% of the older adults suffer from CKD in stages 3-5. Nevertheless the question whether this lower eGFR is a consequence of kidney disease or if it is the result of a physiological aging is still debated, even if it implies a reduced renal reserve and vulnerability to drugs overdose with increased risk of acute kidney injury (AKI). MATERIALS AND METHODS: PubMed search was conducted for available English literature, describing the actual knowledge about specific and frequent issues reported in the acute and chronic kidney disease in older adults. Prospective and retrospective studies, as well as meta-analyses and latest systematic reviews were included. RESULTS: Most of the studies examined and reviewed were discarded for wrong population or intervention or deemed unfit. Only 103 met the inclusion criteria for the review. The studies included in the review were grouped into two areas: chronic and acute kidney disease in older adults and we have analysed the peculiar and frequently found issues in this population. CONCLUSIONS: The geriatric population is increasing worldwide. We should consider peculiar aspects of this population, such as sarcopenia, malnutrition, psychological and cognitive deficits and increased risk of AKI, in order to reach a good quality of life, with improved doctor / patient relationship, a greater adherence to therapy, a reduction in health care costs, and if possible, adequate "end of life", as far as it is approved by the patient and his family. The achievement of these objectives requires an organized work in multidisciplinary teams that evaluate overall the geriatric patient.

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis.

INTRODUCTION: Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients. MATERIALS AND METHODS: 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated. RESULTS: LVMI was higher in PD than HD patients (139 y 19 vs. 104 y 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined. CONCLUSIONS: Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored.

[New therapeutic prospects for renal transplant: extracorporeal photochemotherapy]. / Nuove prospettive terapeutiche per il trapianto di rene: la fotochemioterapia extracorporea.

Since 1960, different classes of immunosuppressive drugs have been used in the post-transplant follow-up. Each is assessed for its effectiveness in preventing rejection but also on the basis of the many side effects induced by prolonged treatment. To reduce these side effects, continuous development of knowledge and medical technology to create cutting-edge therapies in the field is necessary. One of these is extracorporeal photochemotherapy (ECP), an immunomodulatory therapy approved by the United States Food and Drug Administration in 1988 for the treatment of advanced forms of cutaneous T-cell lymphoma. EC P is a useful therapeutic tool for the development of immunomodulation supported by CD8+ clone-specific cytotoxic lymphocytes. The T cells targeted by EC P are modified by photoactivation and seem to develop marked immunogenicity with no suppression of the immune response. Recent studies suggest the possible utility of EC P in the treatment of glomerulonephritis and in countering rejection after transplantation of organs including the kidney.

[Quality of life assessment in patients on hemodialysis and peritoneal dialysis]. / Qualità di vita e aspetti psicologici dell'anziano uremico in trattamento dialitico: confronto tra emodialisi e dialisi peritoneale.

Assessment of the quality of life (QoL) of patients with end-stage renal disease undergoing replacement therapy is very important. The aim of our study was to assess the QoL of patients on hemodialysis (HD) and peritoneal dialysis (PD). To determine the state of health of the patients as well as psychological aspects we used two international questionnaires: the Health-Related Short Form (SF-36) and the Psychological General Well-being Index (PGWBI). The study included 48 patients (26 men, 22 women) with chronic kidney disease (KDOQI: 5). All patients were on dialysis treatment. Their mean age was 63 years (range 59-73) and the mean duration of dialysis was 18 months (range 12-34). Twenty-four patients (13 men, 11 women) were on DP and 24 (13 men, 11 women) on HD. The results demonstrate that the PD and HD groups diverged on almost all scales. The scales that measure both the mental and physical dimensions of QoL showed PD to be associated with a higher level of psychophysical well-being than HD. The SF-36 revealed that both the physical and mental dimensions were directly influenced by the type of treatment. On the depression scale of PGWBI we found that patients on HD were more prone to depression than patients on PD. In conclusion, PD appears to have clear advantages in terms of QoL, especially in elderly patients, thanks to the possibility to perform the treatment independently at the patient's home.

Extracorporeal photochemotherapy for the treatment of glomerulopathies with associated nephrotic syndrome.

INTRODUCTION: Patients with glomerulopathies associated with nephrotic syndrome have few effective treatment options. Here we report on the use of extracorporeal photochemotherapy (ECP) in 6 patients in whom glomerulopathy failed to respond to pharmacologic therapy. ECP is a promising immunomodulatory therapy associated with few side effects, that has been successfully used in the treatment of other immune-mediated conditions such as solid organ transplant rejection and graft-versus-host disease. METHODS: In this study, patients underwent 12 months of ECP. In all patients, progressive improvement in proteinuria was noted during the follow-up period, and total cholesterol and triglyceride levels also returned to near-normal values. RESULTS: In the 4 patients who had adequate renal function at study initiation, improvement of renal function was observed, as indicated by improved glomerular filtration rates (GFRs) and decreased proteinuria to creatininuria (Pru/Cru) ratios. In contrast, renal function progressively worsened in the 2 patients with inadequate renal function at study initiation. CONCLUSIONS: The results suggest that ECP is a feasible treatment for patients with glomerulopathies associated with nephrotic syndrome who have adequate baseline renal function. Additional clinical evaluation will have to be performed to better define the patient population in which ECP is most effective.

National survey of apheresis activity in Italy (2000).

Data collection on apheresis in Italy throughout 2000, including techniques, machines, clinical indications and adverse effects, has been performed by means of a standardized questionnaire. These data provided from 102 Apheresis Units from 19 Italian regions, albeit rough, are sufficiently informative. In 2000 a total number of 164,943 apheresis procedures has been carried out, with a clear-cut prevalence of productive apheresis (90.8%), that has been performed by all Apheresis Units. Lombardy, Venetia and Liguria have been the most active regions for therapeutic apheresis (54.0% of the total activity). Adverse events, predominantly mild ones (i.e., paresthesia due to citrate-induced hypocalcemia) have occurred in 0.59% of productive and in 6.75% of therapeutic apheresis sessions, particularly in the course of peripheral blood stem cell collection (13.0%).