[Peritoneal Dialysis in Italy: the 7th GSDP-SIN census 2019].

Objectives: Analysis of the results of the 7th National Census (Cs-19) of Peritoneal Dialysis in Italy, conducted in 2020-21 by the Peritoneal Dialysis Project Group of the Italian Society of Nephrology, for the year 2019. Materials and methods: The data was initially collected using specially designed software, which after entering the data of individual patients allows the aggregate extraction of the necessary information. The difficulties due to the COVID pandemic made it necessary to also use the traditional on-line questionnaire used previously. Of the 237 Centers envisaged, 198 responded, of which 177 with complete data for HD also in 2016. Results: Overall incidence and prevalence (31/12/2019) were respectively 1,363 (CAPD/APD = 741/622) and 3,922 (CAPD/APD = 1,857 / 2,065) patients. The percentage incidence and prevalence (177 Centers) decreased compared to 2016, respectively, from 23.8% to 22.1% and from 17.3% to 16.6%. 31.4% started PD incrementally in 60.3% of the Centers. The catheter is placed by the Nephrologist alone in 19.7%. Assisted PD is used by 24.5% of the prevalent patients, mostly (83.8%) by a family member. In 2019, the exit from PD (ep/100 years-pts: 11.6 in HD; 8.9 death; 6.0 Tx) is decreasing for all causes. The main cause of transfer to HD remains peritonitis (26.8%). The incidence of peritonitis in 2019 dropped further to 0.190 ep/year-pts as well as the incidence of new cases of EPS (0.103 ep/100 years-pts). Conclusions: The Cs-19 confirms the good results of the DP in Italy.

Hemodialysis shake-up on the front lines of the Covid-19 pandemic: the Treviglio Hospital experience.

The new coronavirus disease (Covid-19) pandemic in Italy formally started on 21st February 2020, when a 38-years old man was established as the first Italian citizen with Covid-19 in Codogno, Lombardy region. In a few days, the deadly coronavirus swept beyond expectations across the city of Bergamo and its province, claiming thousands of lives and putting the hospital in Treviglio under considerable strain. Since designated Covid-dialysis hospitals to centrally manage infected hemodialysis patients were not set up in the epidemic areas, we arranged to treat all our patients. We describe the multiple strategies we had to implement fast to prevent/control Covid-19 infection and spread resources in our Dialysis Unit during the first surge of the pandemic in one of the worst-hit areas in Italy. The recommendations provided by existing guidelines and colleagues with significant experience in dealing with Covid-19 were combined with the practical judgement of our dialysis clinicians, nurses and nurse's aides.

Personalization of automated peritoneal dialysis treatment using a computer modeling system.

The use of almost standardized dialysis programs--and the absence of any adjustment over time in these program to match the progressive decline in residual kidney function, in addition to the reduction in peritoneal depuration because of the frequency of peritonitis and the use of solutions containing high glucose concentrations--often leads to technique drop-out and transfer to hemodialysis. Our study enrolled 15 clinically stable patients (13 white men, 2 white women; average age: 67.3 +/- 12.99 years; average dialysis vintage: 32.25 +/- 25.10 months) who had been on automated peritoneal dialysis treatment with a standard treatment profile for at least 6 months (dwell time per cycle and solutions fixed at various glucose concentrations in all exchanges). After a peritoneal equilibration test had been performed and clearances (peritoneal and renal) were measured, the dialysis program was modified, individualizing it to the patient ' peritoneal membrane transport by the Twardowski system of classification and taking into account the patient's residual diuresis and need for ultrafiltration. The change was implemented using the Patient on Line software created by Fresenius Medical Care (Bad Homburg, Germany). After a month of personalized dialysis treatment, weekly peritoneal Kt/V in the study group increased significantly (to 1.47 + 0.61 from 1.02 +/- 0.37, p = 0.001); no difference in renal Kt/V was observed. Total Kt/V reached levels of optimum dialysis adequacy (to 2.21 +/- 0.28 from 1.62 +/- 0.33, p = 0.0001). Weekly peritoneal creatinine clearance also increased to 32.86 +/- 16.94 L/1.73 m2 from 22.27 +/- 9.16 L/1.73 m2 (p = 0.005), with renal creatinine clearance essentially stable, and total weekly clearance increasing to 67.58 +/- 14.52 L/1.73 m2 from 53.51 +/- 16.86 L/1.73 m2 (p < 0.0001). The dialysis adequacy improvements obtained involved no statistically significant differences in the total infused volume of dialysis solution, ultrafiltration, or the duration of dialysis treatment. It should also be noted that no changes in residual diuresis occurred.

Telmisartan: just an antihypertensive agent? A literature review.

INTRODUCTION: The modulation of the renin angiotensin aldosterone system (RAAS) is an important pathway in managing high blood pressure, and its overexpression plays a key role in target end-organ damage. Telmisartan is an angiotensin II receptor blocker (ARB) with unique pharmacologic properties, including the longest half-life among all ARBs; this leads to a significant and 24-h sustained reduction of blood pressure. Telmisartan has well-known antihypertensive properties, but there is also strong clinical evidence that it reduces left ventricular hypertrophy, arterial stiffness and the recurrence of atrial fibrillation, and confers renoprotection. AREAS COVERED: This paper reviews telmisartan's pharmacological properties in terms of efficacy for hypertension control and, importantly, focuses on its new therapeutic indications and their clinical implications. EXPERT OPINION: ONTARGET (ongoing telmisartan alone and in combination with ramipril global endpoint trial) demonstrated, that telmisartan confers cardiovascular protective effects similar to those of ramipril, but with a better tolerability. Moreover, recent investigations focused on the capability of telmisartan to modulate the peroxisome proliferator-activated receptor-gamma (PPAR-γ), an established target in the treatment of insulin resistance, diabetes and metabolic syndrome, whose activation is also correlated to anti-inflammatory and, finally, anti-atherosclerotic properties. Telmisartan shows peculiar features that go beyond blood pressure control. It presents promising and unique protective properties against target end-organ damage, potentially able to open a scenario of new therapeutic approaches to cardiovascular disease.

[Home peritoneal ultrafiltration in the treatment of chronic heart failure]. / Ultrafiltrazione peritoneale domiciliare (UFPD) nella terapia dello scompenso cardiaco cronico.

Due to its epidemiological characteristics, chronic heart failure refractory to conventional medical treatment is a significant problem involving an increasing number of cardiac patients. Chronic heart failure currently represents one of the most remarkable clinical manifestations of cardiovascular disease because of its frequency, morbidity, impact on quality of life, and costs. The use of new therapeutic approaches is particularly important for patients who become refractory to conventional therapies or are not eligible for heart transplant or other surgical treatment. The benefits of continuous extracorporeal ultrafiltration therapies are well known, but these treatments may be associated with complications and can be used only during hospitalization. Peritoneal ultrafiltration seems to be useful as chronic therapy to improve the quality of life and physical and social rehabilitation of patients with refractory chronic heart failure. The aim of this paper is to evaluate peritoneal ultrafiltration as an integrative treatment in chronic heart failure. Data from the literature suggest that peritoneal ultrafiltration is useful for the preservation of residual renal function, continuous ultrafiltration, hemodynamic stability, better middle-molecule clearance, sodium sieving with maintenance of normonatremia, and reduction of hospital admissions.