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1.
Sarcoidosis Vasc Diffuse Lung Dis ; 38(3): e2021017, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744417

RESUMO

Background: Granulomatous interstitial nephritis in sarcoidosis (sGIN) is generally clinically silent, but in <1% causes acute kidney injury (AKI). Methods: This Italian multicentric retrospective study included 39 sarcoidosis-patients with renal involvement at renal biopsy: 31 sGIN-AKI, 5 with other patterns (No-sGIN-AKI), 3 with nephrotic proteinuria. We investigate the predictive value of clinical features, laboratory, radiological parameters and histological patterns regarding steroid response. Primary endpoint: incident chronic kidney disease (CKD) beyond the 1°follow-up (FU) year; secondary endpoint: response at 1°line steroid therapy; combined endpoint: the association of initial steroid response and outcome at the end of FU. Results: Complete recovery in all 5 No-sGIN-AKI-patients, only in 45% (13/29) sGIN-AKI-patients (p=0.046) (one lost in follow-up, for another not available renal function after steroids). Nobody had not response. Primary endpoint of 22 sGIN-AKI subjects: 65% (13/20) starting with normal renal function developed CKD (2/22 had basal CKD; median FU 77 months, 15-300). Combined endpoint: 29% (6/21) had complete recovery and final normal renal function (one with renal relapse), 48% (10/21) had partial recovery and final CKD (3 with renal relapse, of whom one with basal CKD) (p=0.024). Acute onset and hypercalcaemia were associated to milder AKI and better recovery than subacute onset and patients without hypercalcaemia, women had better endpoints than men. Giant cells, severe interstitial infiltrate and interstitial fibrosis seemed negative predictors in terms of endpoints. Conclusions: sGIN-AKI-patients with no complete recovery at 1°line steroid should be treated with other immunosuppressive to avoid CKD, in particular if males with subacute onset and III stage-not hypercalcaemic AKI.

3.
Front Nutr ; 8: 701386, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34458305

RESUMO

A current hypothesis is that dialysis-treated patients are "anabolic resistant" i. e., their muscle protein synthesis (MPS) response to anabolic stimuli is blunted, an effect which leads to muscle wasting and poor physical performance in aging and in several chronic diseases. The importance of maintaining muscle mass and MPS is often neglected in dialysis-treated patients; better than to describe mechanisms leading to energy-protein wasting, the aim of this narrative review is to suggest possible strategies to overcome anabolic resistance in this patient's category. Food intake, in particular dietary protein, and physical activity, are the two major anabolic stimuli. Unfortunately, dialysis patients are often aged and have a sedentary behavior, all conditions which per se may induce a state of "anabolic resistance." In addition, patients on dialysis are exposed to amino acid or protein deprivation during the dialysis sessions. Unfortunately, the optimal amount and formula of protein/amino acid composition in supplements to maximixe MPS is still unknown in dialysis patients. In young healthy subjects, 20 g whey protein maximally stimulate MPS. However, recent observations suggest that dialysis patients need greater amounts of proteins than healthy subjects to maximally stimulate MPS. Since unneccesary amounts of amino acids could stimulate ureagenesis, toxins and acid production, it is urgent to obtain information on the optimal dose of proteins or amino acids/ketoacids to maximize MPS in this patients' population. In the meantime, the issue of maintaining muscle mass and function in dialysis-treated CKD patients needs not to be overlooked by the kidney community.

4.
G Ital Nefrol ; 38(3)2021 Jun 24.
Artigo em Italiano | MEDLINE | ID: mdl-34169689

RESUMO

In the last year, the Italian National Health Service as a whole and the Nephrology community have been severely challenged by the pandemic. It has been a dramatic stress test for the entire healthcare system, not only in Italy but worldwide. The general organization of our Nephrology units and our models of care were put under extreme pressure, and we had to quickly adopt unprecedented clinical practice recommendations and organizational models to overcome the impasse caused by the pandemic. The time has come to evaluate these new experiences, ask how we could have been better prepared and look for change. In this editorial, we outline a few proposals and suggestions for the future, weighing the information gathered in the 2018 Nephrology Census against the new organizational requirements imposed by the COVID-19 pandemic.


Assuntos
COVID-19/epidemiologia , Nefrologia/organização & administração , Pandemias , Censos , Humanos , Itália/epidemiologia , Modelos Organizacionais , Nefrologia/tendências , Diálise Peritoneal/estatística & dados numéricos , Diálise Peritoneal Ambulatorial Contínua/estatística & dados numéricos , Médicos/provisão & distribuição , Diálise Renal/estatística & dados numéricos
5.
Clin Exp Rheumatol ; 39 Suppl 129(2): 107-113, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34014158

RESUMO

OBJECTIVES: It has been suggested that anti-neutrophil cytoplasmic antibody (ANCA) specificity, rather than clinical diagnosis influences the phenotype and course of ANCA-associated vasculitis (AAV). However, preliminary evidence suggests that further combined levels of categorisation might be of clinical relevance. The aim of this study was to investigate differences in clinical presentation at disease onset and outcomes based on clinical diagnosis and ANCA specificity. METHODS: Newly diagnosed patients with GPA or MPA assessed in three referral centres between 2000 and 2016 were included. Patients were grouped as MPO-ANCA-positive granulomatosis with polyangiitis (MPO-GPA), PR3-ANCA-positive-GPA (PR3-GPA), and MPO-ANCA-positive microscopic polyangiitis (MPO-MPA). RESULTS: Of the 143 AAV patients included (female 52%), 87 were categorised as PR3-GPA, 23 as MPO-GPA, and 33 as MPO-MPA. Patients with MPO-GPA were significantly younger than MPA patients (age 49±15 versus 63±10; p<0.001). MPO-GPA had significantly more frequent subglottic stenosis compared to PR3-GPA. Ear, nose, throat involvement was significantly more frequent in both GPA groups compared to MPA. Type of pulmonary involvement differed between both GPA groups and MPA with diffuse pulmonary haemorrhage being significantly more frequent in the latter (7% in PR3-GPA, 0% in MPO-GPA, 27% in MPOMPA; p<0.001). Renal involvement was more frequent in MPO-MPA compared to both MPO-GPA and PR3-GPA (impaired renal function in 84%, 39%, and 36%, respectively; p<0.001). PR3-GPA relapsed significantly more than the other two groups. After adjusting for age, MPO-GPA was a significant risk factor for mortality [HR 4.44 (95%CI 1.46-13.52), p=0.009]. CONCLUSIONS: ANCA specificity identifies specific subsets of disease characterised by different clinical presentation and outcome within the clinical diagnosis of GPA.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Granulomatose com Poliangiite , Adulto , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Anticorpos Anticitoplasma de Neutrófilos , Feminino , Granulomatose com Poliangiite/diagnóstico , Humanos , Pessoa de Meia-Idade , Mieloblastina , Peroxidase , Estudos Retrospectivos
6.
J Nephrol ; 34(2): 325-335, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33387336

RESUMO

BACKGROUND AND AIM: Over 80% (365/454) of the nation's centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. METHODS: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. RESULTS: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20-1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02-1.17), test-all policy (IRR 5.94, 95% CI 3.36-10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001-1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94-0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. CONCLUSIONS: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center's testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.


Assuntos
COVID-19/epidemiologia , Nefrologia , Pandemias , Medição de Risco/métodos , Sociedades Médicas , Feminino , Humanos , Itália/epidemiologia , Masculino , Fatores de Risco , Inquéritos e Questionários
7.
Kidney Blood Press Res ; 46(1): 11-16, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33517338

RESUMO

BACKGROUNDS: The recent coronavirus disease 2019 (CO-VID-19) pandemic has placed worldwide health systems and hospitals under pressure, and so are the renal care models. This may be a unique opportunity to promote and expand alternative models of health-care delivery in patients undergoing renal replacement therapies. SUMMARY: Despite the high risk of acquiring communicable diseases when undergoing in-centre treatments, only a small proportion of patients are currently being treated with home therapies. Recent data provided by the Italian Society of Nephrology (SIN), the REIN French Registry and the Wuhan Hemodialysis Quality Control Center clearly show that patients receiving hospital-based treatment have a 3- to 4-fold greater risk of infection, and a subsequent fatality proportion between 21 and 34%. On the other hand, home-based therapy can be managed remotely, there is little or no need for transport to and from the hospital, and it is less expensive. Besides, the digital revolution in health care with the development of virtual care systems can make home dialysis with telehealth a cost-effective solution for both patients and health-care providers. Such a transition would require specific training for physicians and health-care professionals and a functional re-organization of dialysis centres to improve the skills and expertise in caring for patients at home. CONCLUSION: The need for more widespread home treatment is the main lesson learnt by nephrologists by the COVID-19 pandemic.


Assuntos
COVID-19/epidemiologia , Hemodiálise no Domicílio/métodos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Telemedicina/métodos , COVID-19/prevenção & controle , Atenção à Saúde/métodos , Atenção à Saúde/tendências , Hemodiálise no Domicílio/tendências , Humanos , Telemedicina/tendências
8.
J Nephrol ; 34(1): 31-38, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32757171

RESUMO

Direct oral anticoagulants (DOAC) are mostly prescribed to prevent cardioembolic stroke in patients with non-valvular atrial fibrillation (AF). An increasing number of guidelines recommend DOAC in AF patients with preserved renal function for the prevention of thromboembolism and an increased use of DOAC in daily practice is recorded also in elderly patients. Aging is associated with a reduction of glomerular filtration rate and impaired renal function, regardless of the cause, increases the risk of bleeding. Multiple medication use (polypharmacy) for treating superimposed co-morbidities is common in both elderly and chronic kidney disease (CKD) patients and drug-drug interaction may cause accumulation of DOAC, thereby increasing the risk of bleeding. There is uncertainty on the safety profile of DOAC in patients with CKD, particularly in those with severely impaired renal function or end stage renal disease, due to the heterogeneity of studies and the relative paucity of data. This document reports the position of three Italian scientific societies engaged in the management of patients with atrial fibrillation who are treated with DOAC and present with CKD.


Assuntos
Fibrilação Atrial , Insuficiência Renal Crônica , Acidente Vascular Cerebral , Administração Oral , Idoso , Animais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Consenso , Humanos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
9.
J Ren Nutr ; 31(2): 116-120.e1, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32737016

RESUMO

The Academy of Nutrition and Dietetics and the National Kidney Foundation collaborated to provide an update to the Clinical Practice Guidelines (CPG) for nutrition in chronic kidney disease (CKD). These guidelines provide a valuable update to many aspects of the nutrition care process. They include changes in the recommendations for nutrition screening and assessment, macronutrients, and targets for electrolytes and minerals. The International Society of Renal Nutrition and Metabolism assembled a special review panel of experts and evaluated these recommendations prior to public review. As one of the highlights of the CPG, the recommended dietary protein intake range for patients with diabetic kidney disease is 0.6-0.8 g/kg/day, whereas for CKD patients without diabetes it is 0.55-0.6 g/kg/day. The International Society of Renal Nutrition and Metabolism endorses the CPG with the suggestion that clinicians may consider a more streamlined target of 0.6-0.8 g/kg/day, regardless of CKD etiology, while striving to achieve intakes closer to 0.6 g/kg/day. For implementation of these guidelines, it will be important that all stakeholders work to detect kidney disease early to ensure effective primary and secondary prevention. Once identified, patients should be referred to registered dietitians or the region-specific equivalent, for individualized medical nutrition therapy to slow the progression of CKD. As we turn our attention to the new CPG, we as the renal nutrition community should come together to strengthen the evidence base by standardizing outcomes, increasing collaboration, and funding well-designed observational studies and randomized controlled trials with nutritional and dietary interventions in patients with CKD.

10.
J Nephrol ; 34(3): 673-680, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32870494

RESUMO

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a relatively new class of antidiabetic drugs that in addition to emerging as an effective antihyperglycemic treatment have been shown to improve, in several trials, both renal and cardiovascular outcomes. In consideration of the renal site of action and the associated osmotic diuresis, a negative sodium balance has been postulated during SGLT2i administration. Actually, sodium and water depletion may contribute to some positive actions of SGLT2i but evidence is far from being conclusive and the real physiologic effects of SGLT2i on sodium remain largely unknown. Indeed, no study has yet investigated how SGLT2i change sodium balance in the long term and especially the pathways through which the natriuretic effect is expressed. Furthermore, several experimental studies have recently identified different pathways, not directly linked to tubular sodium handling, which could contribute to the renal and cardiovascular benefits associated with SGLT2i. This paper will review the evidence of SGLT2i action on sodium transporters, their off-target effects and their potential role on kidney protection.


Assuntos
Sistema Cardiovascular , Diabetes Mellitus Tipo 2 , Inibidores do Transportador 2 de Sódio-Glicose , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipoglicemiantes/efeitos adversos , Sódio , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos
11.
Curr Opin Nephrol Hypertens ; 30(1): 97-107, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33186220

RESUMO

PURPOSE OF REVIEW: In advanced chronic kidney disease (CKD) patients with progressive uremia, dialysis has traditionally been the dominant treatment paradigm. However, there is increasing interest in conservative and preservative management of kidney function as alternative patient-centered treatment approaches in this population. RECENT FINDINGS: The primary objectives of conservative nondialytic management include optimization of quality of life and treating symptoms of end-stage renal disease (ESRD). Dietetic-nutritional therapy can be a cornerstone in the conservative management of CKD by reducing glomerular hyperfiltration, uremic toxin generation, metabolic acidosis, and phosphorus burden. Given the high symptom burden of advanced CKD patients, routine symptom assessment using validated tools should be an integral component of their treatment. As dialysis has variable effects in ameliorating symptoms, palliative care may be needed to manage symptoms such as pain, fatigue/lethargy, anorexia, and anxiety/depression. There are also emerging treatments that utilize intestinal (e.g., diarrhea induction, colonic dialysis, oral sorbents, gut microbiota modulation) and dermatologic pathways (e.g., perspiration reduction) to reduce uremic toxin burden. SUMMARY: As dialysis may not confer better survival nor improved patient-centered outcomes in certain patients, conservative management is a viable treatment option in the advanced CKD population.


Assuntos
Tratamento Conservador , Insuficiência Renal Crônica/terapia , Terapias Complementares , Humanos , Terapia Nutricional , Cuidados Paliativos , Assistência Centrada no Paciente , Qualidade de Vida , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Uremia/terapia
12.
J Clin Med ; 9(12)2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33297455

RESUMO

The prevalence of renal disease is constantly increasing in older adults and a prognostic evaluation by a valid tool may play a key role in treatment management. We aimed to assess the association(s) between the multidimensional prognostic index (MPI) and both the hospitalization and mortality among older adults with renal disease. Patients with chronic kidney disease (CKD) (stage 3-5 KDOQI) and on dialysis were considered. Clinical parameters were registered at baseline and after 2 years. In all the patients, the MPI was calculated and divided into grade 0 (low risk), 1 (moderate risk), and 2 (severe risk). Hospitalizations and mortality were recorded during the follow-up and analyzed according to MPI grade. A total of 173 patients, with a median age of 76 years, on conservative (n = 105) and replacement therapy (32 patients on hemodialysis, 36 patients on peritoneal dialysis) were enrolled. Of them, 60 patients were in MPI grade 0, 102 in grade 1, and 11 in grade 2. The median duration of all the hospitalizations was 6 days and the number of deaths was 33. MPI significantly correlated with days of hospitalization (r = 0.801, p < 0.00001) and number of hospitalizations per year (r = 0.808, p < 0.00001), which was higher in MPI grade 2 compared to grade 1 (p < 0.001) and to grade 0 (p < 0.001). We found a significant association between MPI grades and mortality (p < 0.001). Our results indicate that MPI was associated with outcomes in patients with renal disease, suggesting that a multidimensional evaluation should be implemented in this clinical setting.

14.
Blood Transfus ; 18(6): 478-485, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33000751

RESUMO

Direct oral anticoagulants (DOAC) are mostly prescribed to prevent cardioembolic stroke in patients with non-valvular atrial fibrillation (AF). An increasing number of guidelines recommend DOAC in AF patients with preserved renal function for the prevention of thromboembolism, and an increased use of DOAC in daily practice has been recorded also in elderly patients. Ageing is associated with a reduction in glomerular filtration rate, and impaired renal function, regardless of the cause, increases the risk of bleeding. Multiple medication use (polypharmacy) for treating superimposed co-morbidities is common in both elderly and chronic kidney disease (CKD) patients and drug-drug interaction may cause accumulation of DOAC, thereby increasing the risk of bleeding. The safety profile of DOAC in patients with CKD has not been defined with any certainty, particularly in those with severely impaired renal function or end stage renal disease. This has been due to the heterogeneity of studies and the relative paucity of data. This document reports the position of three Italian scientific societies engaged in the management of patients with atrial fibrillation who are treated with DOAC and present with CKD.


Assuntos
Antitrombinas/uso terapêutico , Hemorragia/induzido quimicamente , Insuficiência Renal Crônica/fisiopatologia , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Antídotos/uso terapêutico , Antitrombinas/efeitos adversos , Antitrombinas/farmacocinética , Fibrilação Atrial/complicações , Estudos de Coortes , Dabigatrana/efeitos adversos , Dabigatrana/farmacocinética , Dabigatrana/uso terapêutico , Interações Medicamentosas , Monitoramento de Medicamentos , Taxa de Filtração Glomerular , Hemorragia/tratamento farmacológico , Humanos , Rim/fisiopatologia , Taxa de Depuração Metabólica , Estudos Observacionais como Assunto , Polimedicação , Guias de Prática Clínica como Assunto , Pirazóis/efeitos adversos , Pirazóis/farmacocinética , Pirazóis/uso terapêutico , Piridinas/efeitos adversos , Piridinas/farmacocinética , Piridinas/uso terapêutico , Piridonas/efeitos adversos , Piridonas/farmacocinética , Piridonas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Renal Crônica/complicações , Rivaroxabana/efeitos adversos , Rivaroxabana/farmacocinética , Rivaroxabana/uso terapêutico , Tiazóis/efeitos adversos , Tiazóis/farmacocinética , Tiazóis/uso terapêutico
16.
G Ital Nefrol ; 37(Suppl 75)2020 08 03.
Artigo em Italiano | MEDLINE | ID: mdl-32749081

RESUMO

Background: Given the public health challenge represented by chronic kidney disease, the Italian Society of Nephrology (SIN) promoted a census of the renal and dialysis units to analyze structural and human resources, organizational aspects, activities and workload, referring to the year 2018. Methods: An on-line questionnaire including 60 questions, exploring structural and human resources, organizational aspects, activities and epidemiological data referred to 2018, was sent to the heads of all identified Italian renal or dialysis unit. Results: Renal and dialysis activity was performed by over 2,718 physicians (41 pmp). The management of the acute renal failure was one of the most relevant activities in the public renal units (3,000 pmp patients in ICU and 183.000 dialysis sessions). Italian Nephrologists performed about 6000 AV fistulas out of a total of 9300. In the survey there are a lot of data regarding organization, workforce and workload of the renal unit in Italy. Conclusions: Data from this census may be used for benchmarking and comparison between centers, regions and groups of regions. These data offer a snapshot of the clinical management of renal disease in Italy.


Assuntos
Nefrologia , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Carga de Trabalho/estatística & dados numéricos , Censos , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Sociedades Médicas
17.
G Ital Nefrol ; 37(Suppl 75)2020 08 03.
Artigo em Italiano | MEDLINE | ID: mdl-32749082

RESUMO

Background: Given the public health challenge represented by chronic kidney disease, the Italian Society of Nephrology (SIN) promoted a census of the renal and dialysis units to analyze structural and human resources, organizational aspects, activities and workload, referring to the year 2018. Methods: An on-line questionnaire including 60 questions, exploring structural and human resources, organizational aspects, activities and epidemiological data referred to 2018, was sent to the heads of all identified Italian renal or dialysis unit. Results: 567 renal units were identified, 3.3 public and full renal unit pmp. The nephrology beds are about 37.6 pmp. The nurses were 8,130 in HD wards, 1,827 in the nephrology wards, only 432 for outpatient clinics. Conclusions: Data from this census may be used for benchmarking and comparison between centers, regions and groups of regions. These data offer a snapshot of the clinical management of renal disease in Italy.


Assuntos
Nefrologia/organização & administração , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Instituições de Assistência Ambulatorial/organização & administração , Censos , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Sociedades Médicas
19.
J Nephrol ; 33(4): 725-736, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32621109

RESUMO

BACKGROUND: Between February and April 2020, Italy experienced an overwhelming growth of the COVID-19 pandemic. Little is known, at the country level, where and how patients on renal replacement therapy (RRT) have been mostly affected. METHODS: Survey of the network of Nephrology centers using a simplified 17 items electronic questionnaire designed by Italian Society of Nephrology COVID-19 Research Group. We used spatial epidemiology and geographical information systems to map SARS-CoV-2 spread among RRT patients in Italy. RESULTS: On April 9th 2020, all nephrology centers (n = 454) listed in the DialMap database were invited to complete the electronic questionnaire. Within 11 days on average, 365 centers responded (80.4% response rate; 2.3% margin of error) totaling 60,441 RRT patients. The surveyed RRT population included 30,821 hemodialysis (HD), 4139 peritoneal dialysis (PD), and 25,481 transplanted (Tx) patients respectively. The proportion of SARS-CoV-2 positive RRT patients in Italy was 2.26% (95% CI 2.14-2.39) with significant differences according to treatment modality (p < 0.001). The proportion of patients positive for SARS-CoV-2 was significantly higher in HD (3.55% [95% CI 3.34-3.76]) than PD (1.38% [95% CI 1.04-1.78] and Tx (0.86% [95% CI 0.75-0.98]) (p < 0.001), with substantial heterogeneity across regions and along the latitude gradient (p < 0.001). In RRT patients the highest rate was in the north-west (4.39% [95% CI 4.11-4.68], followed by the north-east (IR 2.06% [1.79-2.36]), the center (0.91% [0.75-1.09]), the main islands (0.67% [0.47-0.93]), and the south (0.59% [0.45-0.75]. During the COVID-19 pandemic, among SARS-Cov-2 positive RRT patients the fatality rate was 32.8%, as compared to 13.3% observed in the Italian population as of April 23rd. CONCLUSIONS: A substantial proportion of the 60,441 surveyed RRT patients in Italy were SARS-Cov-2 positive and subsequently died during the exponential phase of COVID-19 pandemic. Infection risk and rates seems to differ substantially across regions, along geographical latitude, and by treatment modality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Terapia de Substituição Renal , COVID-19 , Infecções por Coronavirus/mortalidade , Humanos , Transplante de Rim , Nefrologia , Pandemias , Diálise Peritoneal , Pneumonia Viral/mortalidade , SARS-CoV-2 , Sociedades Médicas , Inquéritos e Questionários
20.
J Nephrol ; 33(2): 197, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32232773

RESUMO

The originally published article the co-author name Marco Heidempergher incorrectly spelled as Marco Hedemperger. The correct name given below.

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