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3 results on '"Zappulo, F"'

1. Vitamin D Effects on Bone Homeostasis and Cardiovascular System in Patients with Chronic Kidney Disease and Renal Transplant Recipients

Author

Francesco Tondolo, Lorenzo Gasperoni, Simona Barbuto, Francesca Iacovella, Giuseppe Cianciolo, Gaetano La Manna, Fulvia Zappulo, Irene Capelli, Diletta Conte, Maria Cappuccilli, Cianciolo G., Cappuccilli M., Tondolo F., Gasperoni L., Zappulo F., Barbuto S., Iacovella F., Conte D., Capelli I., and La Manna G.

Subjects
cardiovascular risk, kidney transplant, Nephrology, Vitamin, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, vitamin D, Review, 030204 cardiovascular system & hematology, urologic and male genital diseases, Cardiovascular System, Gastroenterology, Bone and Bones, vitamin D deficiency, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, medicine, Vitamin D and neurology, Homeostasis, Humans, TX341-641, Renal Insufficiency, Chronic, Dialysis, Kidney, Nutrition and Dietetics, Nutrition. Foods and food supply, business.industry, Dialysi, Vitamins, Vitamin D Deficiency, medicine.disease, Kidney Transplantation, CKD–MBD, Transplant Recipients, medicine.anatomical_structure, chemistry, dialysis, Cholecalciferol, business, chronic kidney disease, Food Science, Kidney disease
Abstract

Poor vitamin D status is common in patients with impaired renal function and represents one main component of the complex scenario of chronic kidney disease–mineral and bone disorder (CKD–MBD). Therapeutic and dietary efforts to limit the consequences of uremia-associated vitamin D deficiency are a current hot topic for researchers and clinicians in the nephrology area. Evidence indicates that the low levels of vitamin D in patients with CKD stage above 4 (GFR < 15 mL/min) have a multifactorial origin, mainly related to uremic malnutrition, namely impaired gastrointestinal absorption, dietary restrictions (low-protein and low-phosphate diets), and proteinuria. This condition is further worsened by the compromised response of CKD patients to high-dose cholecalciferol supplementation due to the defective activation of renal hydroxylation of vitamin D. Currently, the literature lacks large and interventional studies on the so-called non-calcemic activities of vitamin D and, above all, the modulation of renal and cardiovascular functions and immune response. Here, we review the current state of the art of the benefits of supplementation with native vitamin D in various clinical settings of nephrological interest: CKD, dialysis, and renal transplant, with a special focus on the effects on bone homeostasis and cardiovascular outcomes.

Published
2021
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2. Real-World Analysis of Outcomes and Economic Burden in Patients with Chronic Kidney Disease with and without Secondary Hyperparathyroidism among a Sample of the Italian Population.

Author

Barbuto S, Perrone V, Veronesi C, Dovizio M, Zappulo F, Vetrano D, Giannini S, Fusaro M, Ancona DD, Barbieri A, Ferrante F, Lena F, Palcic S, Re D, Rizzi FV, Cogliati P, Soro M, Esposti LD, and Cianciolo G

Subjects
Adult, Humans, Retrospective Studies, Financial Stress, Renal Dialysis adverse effects, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic therapy, Hyperparathyroidism, Secondary epidemiology, Hyperparathyroidism, Secondary therapy, Hyperparathyroidism, Secondary complications
Abstract

This real-world analysis evaluated the clinical and economic burden of non-dialysis-dependent CKD patients with and without secondary hyperparathyroidism (sHPT) in Italy. An observational retrospective study was conducted using administrative databases containing a pool of healthcare entities covering 2.45 million health-assisted individuals. Adult patients with hospitalization discharge diagnoses for CKD stages 3, 4, and 5 were included from 1 January 2012 to 31 March 2015 and stratified using the presence/absence of sHPT. Of the 5710 patients, 3119 were CKD-only (62%) and 1915 were CKD + sHPT (38%). The groups were balanced using Propensity Score Matching (PSM). Kaplan-Meier curves revealed that progression to dialysis and cumulative mortality had a higher incidence in the CKD + sHPT versus CKD-only group in CKD stage 3 patients and the overall population. The total direct healthcare costs/patient at one-year follow-up were significantly higher in CKD + sHPT versus CKD-only patients (EUR 8593 vs. EUR 5671, p < 0.001), mostly burdened by expenses for drugs (EUR 2250 vs. EUR 1537, p < 0.001), hospitalizations (EUR 4628 vs. EUR 3479, p < 0.001), and outpatient services (EUR 1715 vs. EUR 654, p < 0.001). These findings suggest that sHPT, even at an early CKD stage, results in faster progression to dialysis, increased mortality, and higher healthcare expenditures, thus indicating that timely intervention can ameliorate the management of CKD patients affected by sHPT.

Published
2023
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3. Folic Acid and Vitamin B12 Administration in CKD, Why Not?

Author

Capelli I, Cianciolo G, Gasperoni L, Zappulo F, Tondolo F, Cappuccilli M, and La Manna G

Subjects
Biomarkers, Cardiovascular Diseases complications, Cardiovascular Diseases metabolism, Folic Acid metabolism, Homocysteine metabolism, Humans, Hyperhomocysteinemia complications, Hyperhomocysteinemia metabolism, Kidney Failure, Chronic genetics, Risk Factors, Vitamin B 12 metabolism, Folic Acid administration & dosage, Kidney Failure, Chronic complications, Vitamin B 12 administration & dosage
Abstract

Patients affected by chronic kidney disease (CKD) or end-stage renal disease (ESRD) experience a huge cardiovascular risk and cardiovascular events represent the leading causes of death. Since traditional risk factors cannot fully explain such increased cardiovascular risk, interest in non-traditional risk factors, such as hyperhomocysteinemia and folic acid and vitamin B12 metabolism impairment, is growing. Although elevated homocysteine blood levels are often seen in patients with CKD and ESRD, whether hyperhomocysteinemia represents a reliable cardiovascular and mortality risk marker or a therapeutic target in this population is still unclear. In addition, folic acid and vitamin B12 could not only be mere cofactors in the homocysteine metabolism; they may have a direct action in determining tissue damage and cardiovascular risk. The purpose of this review was to highlight homocysteine, folic acid and vitamin B12 metabolism impairment in CKD and ESRD and to summarize available evidences on hyperhomocysteinemia, folic acid and vitamin B12 as cardiovascular risk markers, therapeutic target and risk factors for CKD progression.

Published
2019
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