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Dialysis adequacy and a state of "eunutrition" are two essential elements to consider in the evaluation of patient undergoing dialysis treatment. Dialysis inadequacy is often associated with malnutrition, and the combination of these two factors significantly worsens the prognosis. In the following monocentric and prospective study, the correlation between nutritional markers and dialytic adequacy was tested in a cohort of patients permanently followed by the peritoneal dialysis clinic, followed consistently for two years. It was therefore evaluated if modification of dialysis therapy, aimed to reach adequacy parameters, could simultaneously improve metabolic parameters. Although there were no frankly malnourished patients, the group of "inadequate" patients had a significantly lower nPCR value. In this same group, after about 6 months, therapeutic measures adopted allowed an overall improvement in Kt/V and nPCR, with other nutritional parameters (such as body weight, albumin, pre-albumin, total cholesterolemia) remaining stable. At the end of the follow-up period the Kt/V of the "inadequate" (<1.7) was higher ​​than the baseline, reaching statistical significance at the 12th and 24th months. Early identification of a dialysis inadequacy, therefore, allowed the execution of therapeutic changes necessary to achieve a lasting improvement in "adequate" replacement therapy, and a temporary improvement in the patient's nutritional status. Suddenly, despite the persistent improvement of the Kt/V there was a new reduction of the nPCR., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Chronic Kidney Disease (CKD) is a major risk factor for mortality and morbidity, as well as a growing public health problem. Several studies describe the epidemiology of CKD (i.e. prevalence, incidence) by examining short time intervals. Conversely, the trend of epidemiology over time has not been well investigated, although it may provide useful information on how to improve prevention measures and the allocation of economic resources. Our aim here is to describe the main aspects of the epidemiology of CKD by focusing on its temporal variation. The global incidence of CKD has increased by 89% in the last 27 years, primarily due to the improved socio-demographic index and life-expectancy. Prevalence has similarly increased by 87% over the same period. Mortality rate has however decreased over the last decades, both in the general and CKD populations, due to a reduction in cardiovascular and infectious disease mortality. It is important to emphasize that the upward trend of incidence and prevalence of CKD can be explained by the ageing of the population, as well as by the increase in the prevalence of comorbidities such as hypertension, diabetes and obesity. It seems hard to compare trends between Italy and other countries because of the different methods used to assess epidemiologic measures. The creation of specific CKD Registries in Italy appears therefore necessary to monitor the trend of CKD and its comorbidities over time., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Background: Ramipril administered once daily is characterized by an attenuation of its pharmacological activity in the following 24 hours, whose effects on antiproteinuric activity have not yet been investigated., Methods: The antiproteinuric efficacy of Ramipril has been evaluated in a cross-over study in 20 patients with renal disease, proteinuria and hypertension (GFR50 mL / min, proteinuria <3 g / day; SBP/DBP 150/90 mmHg). Proteinuria was measured over 24 hours on three consecutive urine collections (morning, afternoon and night) in the absence of antiproteinuric drugs and after ten days of treatment with single morning administration of Ramipril 2.5 mg or Ramipril 10 mg., Results: At baseline: mean proteinuria was not significantlychanged over the course of the three urinary collections (88 7.2 mg/h in the morning of 80 10.5 mg/h in the afternoon and 81 10.1 mg/hr during the night). After Ramipril 2.5 mg/day: slight reduction in mean proteinuria, with no significant differences between collections (80 11 mg/h in the morning, 69 7.4 mg/h in the afternoon and 75 9.1 mg/h during the night). After Ramipril 10 mg/day: afternoon and night values of proteinuria were significantly reduced compared to baseline; noctural proteinuria was significantly lower than morning value (51 7.5 mg/h vs. 81 10 mg/h, p <0.05)., Conclusion: The antiproteinuric effectiveness of Ramipril tends to decrease significantly over the 24hours after a single daily administration. An increase and/or division of Ramipril dose might help to stabilize and to maximizeits antiproteinuric effectiveness.

Iodinated radiographic contrast media may cause kidney dysfunction that occurs in particular in patients with pre-existing renal impairment and/or diabetes. This impairment of renal function is called contrast-induced nephropathy (CIN), i.e. an acute renal failure occurring within 24-72 hours after the intravascular injection of iodinated radiographic contrast media that cannot be attributed to other causes. The pathogenesis of CIN has not been fully elucidated yet. It may be due to several factors, including renal ischaemia, particularly in the renal medulla, formation of reactive oxygen species (ROS), reduction of nitric oxide (NO) production, tubular epithelial and vascular endothelial injury. CIN can be prevented. For prevention, however, we need to know the risk factors. I have reviewed the pathogenesis and the risk factors for CIN and discussed the measures for its prevention, providing a long list of references which will allow readers to evaluate deeply this iatrogenic disease.