137 results on '"Biagio, Di Iorio"'
Search Results
2. FC 108BASELINE AND CORONARY ARTERY CALCIFICATION PROGRESSION MODULATES THE RISK OF DEATH IN INCIDENT TO DIALYSIS PATIENTS
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Carlo Ratti, Biagio Di Iorio, Antonio Bellasi, Domenico Russo, Luca Di Lullo, and Mario Cozzolino
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Cardiovascular event ,Transplantation ,medicine.medical_specialty ,business.industry ,Surrogate endpoint ,Dialysis patients ,Coronary artery calcium ,Nephrology ,Coronary artery calcification ,Internal medicine ,Cardiology ,Medicine ,Risk of death ,business - Abstract
Background and Aims It is estimated that Chronic Kidney Disease (CKD) accounts for 5 to 10 million deaths annually, mainly due to cardiovascular (CV) diseases. Although traditional CV risk factors are prevalent, other non-traditional CV risk factors such as vascular calcification (VC) are believed to contribute to this disproportionate CV risk burden in CKD subjects. We sought to investigate the association of Coronary Artery Calcification (CAC) progression with all-cause mortality in a cohort of patients new to hemodialysis (HD). Method This is a post hoc analysis of the Independent study (NCT00710788) originally designed to test the impact of 2 different phosphate binder regimens on various hard as well as surrogate endpoint in HD subjects. A total of 412 (88.4% of the Independent study cohort) underwent repeated CAC quantification according to the Agatston methods at study inception as well as after 12 months of follow-up. The square root method was used to assess CAC progression (CACP) and survival analyses were used to check the association of CACP and all-cause mortality. Results 412 middle age (65 years) men and women (51.2%) were considered. Detectable CAC was present in about 2 out 3 patients (68.2%) at study inception. At 12 months of follow-up completion, about 1 out of 3 subjects (33.1%) experience a significant CACP. CACP was associated with older age and use of calcium-based phosphate binders. At study completion (median follow-up: 36 months) 106 patients expired of all-cause. Age, diabetes mellitus, atherosclerotic CV events, baseline CAC extension were predictors of unfavorable outcome. Multivariable adjusted analysis confirmed an independent association of both baseline CAC (Hazard Ratio 1.29; 95% Confidence Interval: 1.17-1.44) and CACP (HR: 5.16; 95%CI: 2.61-10.21) with all-cause mortality. However, CACP diminished the risk associated with baseline CAC (p for interaction term 0.002) and use of calcium-free phosphate binders significantly weakened the link between CACP (HR. 1.95; 95%CI: 0.92-4.16) and mortality Conclusion Baseline CAC as well as CACP predict mortality in incident to HD individuals. Nevertheless, CACP mitigates the risk associated with baseline CAC and calcium-free phosphate binders attenuates the association of CACP and mortality, suggesting that CACP modulation may impact survival in this population
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- 2021
3. Kidney Diseases: Challenges and Opportunities of the Third Millenium. How can digital health help the National Health System?
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Luca Di Lullo, Biagio Di Iorio, and Antonio Bellasi
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National health ,Medical education ,business.industry ,Medicine ,General Medicine ,business ,Digital health - Published
- 2020
4. Cardiac valve calcification and use of anticoagulants: Preliminary observation of a potentially modifiable risk factor
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Domenico Russo, Vincenzo Barbera, Maria Fusaro, Luca Di Lullo, Biagio Di Iorio, Massimo Uguccioni, Claudio Ronco, Antonio Bellasi, Giovanni Tripepi, Graziella D'Arrigo, Ernesto Paoletti, Maura Ravera, Di Lullo, Luca, Tripepi, Giovanni, Ronco, Claudio, D'Arrigo, Graziella, Barbera, Vincenzo, Russo, Domenico, Raffaele Di Iorio, Biagio, Uguccioni, Massimo, Paoletti, Ernesto, Ravera, Maura, Fusaro, Maria, and Bellasi, Antonio
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Male ,Aortic valve ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Cardiac valve calcification ,Humans ,Medicine ,Outpatient clinic ,Longitudinal Studies ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Mitral valve calcification ,Rivaroxaban ,business.industry ,Warfarin ,Anticoagulants ,Calcinosis ,Atrial fibrillation ,Aortic Valve Stenosis ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Aortic Valve ,Disease Progression ,Cardiology ,Female ,Rivaroxaban Anticoagulants Chronic kidney disease Warfarin Mitral valve calcification Aortic valve calcification ,Aortic valve calcification ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,medicine.drug - Abstract
Aims: Direct oral anticoagulant (DOAC) has been recently introduced in the clinical practice. Rather than interfering with vitamin K-dependent posttranscriptional modification of various proteins, DOACs selectively inhibit factors involved in the coagulation cascade. In particular, in contrastwithWarfarin, Rivaroxabn does not interfere with activation of matrix Gla Protein (MGP), a potent vascular calcification Inhibitor. We herein sought to investigate the impact of Rivaroxaban and Warfarin on cardiac valve calcifications in a cohort of moderate-to advanced CKD patients. Methods and results: This is amulticenter, observational, retrospective, longitudinal study. Consecutive CKD stage 3b – 4 (according to KDIGO guidelines) patients from8 cardiologic outpatient clinicswere enrolled betweenMay 2015 and October 2017. All patients received anticoagulation (100Warfarin vs 247 Rivaroxaban) as part of their non-valvular atrial fibrillation management. Cardiac valve calcificationwas evaluated via standard trans-thoracic echocardiogram. 347 patients (mean age: 66 years;mean eGFR: 37 ml/min/1.73m2) were studied. Over a mean follow-up period of 16 months, Rivaroxaban compared toWarfarin reduced both mitral and aortic valve calcifications (p b 0.001) independently of the degree of calcifications at baseline and potential confounders. Notably, Rivaroxaban use was also associated with a significant reduction in C reactive protein (CRP) (p b 0.001) during follow-up. Conclusion: This study generates the hypothesis that the use of Rivaroxaban associateswith a reduction of cardiac valve calcification deposition and progression as compared to Warfarin, in a cohort of CKD stage 3b-4 patients. Future endeavors are needed to confirm and to establish the mechanisms responsible for these findings.
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- 2019
5. Ketoanalogs’ Effects on Intestinal Microbiota Modulation and Uremic Toxins Serum Levels in Chronic Kidney Disease (Medika2 Study)
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Biagio Di Iorio, Loreto Gesualdo, Roberto Ciarcia, Ighli di Bari, Stefania Marzocco, Maria De Angelis, Francesco Maria Calabrese, Maria Teresa Rocchetti, Carmela Cosola, Mirco Vacca, Rocchetti, M. T., Di Iorio, B. R., Vacca, M., Cosola, C., Marzocco, S., Bari, I. D., Calabrese, F. M., Ciarcia, R., De Angelis, M., and Gesualdo, L.
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0301 basic medicine ,medicine.medical_specialty ,Mediterranean diet ,ketoanalogs ,medicine.medical_treatment ,030232 urology & nephrology ,lcsh:Medicine ,Gut flora ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,p-cresyl sulfate ,medicine ,CKD ,Medical nutrition therapy ,indoxyl sulfate ,Dialysis ,Intestinal permeability ,biology ,business.industry ,Lachnospiraceae ,lcsh:R ,General Medicine ,medicine.disease ,biology.organism_classification ,Indoxyl sulfate ,Intestinal microbiome ,Ketoanalogs ,P-cresyl sulfate ,Very low protein diet ,intestinal microbiome ,030104 developmental biology ,very low protein diet ,Ketoanalog ,Azotemia ,business ,Kidney disease - Abstract
Nutritional therapy (NT) is a therapeutic option in the conservative treatment of chronic kidney disease (CKD) patients to delay the start of dialysis. The aim of this study was to evaluate the specific effect of ketoanalogs (KA)-supplemented diets for gut microbiota modulation. In a previous study we observed that the Mediterranean diet (MD) and a KA-supplemented very-low-protein diet (VLPD) modulated beneficially gut microbiota, reducing indoxyl- and p-cresyl-sulfate (IS, PCS) serum levels, and ameliorating the intestinal permeability in CKD patients. In the current study, we added a third diet regimen consisting of KA-supplemented MD. Forty-three patients with CKD grades 3B–4 continuing the crossover clinical trial were assigned to six months of KA-supplemented MD (MD + KA). Compared to MD, KA-supplementation in MD + KA determined (i) a decrease of Clostridiaceae, Methanobacteriaceae, Prevotellaceae, and Lactobacillaceae while Bacteroidaceae and Lachnospiraceae increased, (ii) a reduction of total and free IS and PCS compared to a free diet (FD)—more than the MD, but not as effectively as the VLPD. These results further clarify the driving role of urea levels in regulating gut integrity status and demonstrating that the reduction of azotemia produced by KA-supplemented VLPD was more effective than KA-supplemented MD in gut microbiota modulation mainly due to the effect of the drastic reduction of protein intake rather than the effect of KA.
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- 2021
6. Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients
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Luca Di Lullo, Maria Fusaro, Carlo Ratti, Mario Cozzolino, Michele Magnocavallo, Domenico Russo, Carlo Lavalle, Biagio Di Iorio, Roberto Ciarcia, Antonio Bellasi, Bellasi, Antonio, Di Lullo, Luca, Russo, Domenico, Ciarcia, Roberto, Magnocavallo, Michele, Lavalle, Carlo, 6, Carlo Ratti, Fusaro, Maria, Cozzolino, Mario, and Raffaele Di Iorio, Biagio
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medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,lcsh:Medicine ,Aorta calcification ,Coronary artery calcification ,Hemodialysis ,Risk prediction ,Vascular calcification ,Disease ,aorta calcification ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,risk prediction ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Medicine ,Framingham Risk Score ,hemodialysis ,business.industry ,lcsh:R ,General Medicine ,Predictive value ,coronary artery calcification ,hemodialysi ,vascular calcification ,Cardiology ,Risk of death ,business - Abstract
Background: Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts. Nevertheless, it is currently unclear which one of these methods for VC evaluation best predict outcome and if this piece of information adds to the predictive value of traditional CV risk factors in patients receiving hemodialysis (HD). Methods: data of 184 of the 466 patients followed in the Independent study (NCT00710788) were post hoc examined to assess the association three concurrent measures of vascular calcification and all-cause survival. Specifically, coronary artery calcification (CAC) was determined by the Agatston and the volume score while abdominal aorta calcification was determined by plain X-ray of the lumbar spine (Kauppila score (KS)). Survival and regression models as well as metrics of risk recalculation were used to test the association of VC and outcome beyond the Framingham risk score. Results: Middle-age (62.6(15.8) years) men (51%) and women (49%) starting HD were analyzed. Over 36 (median 36, interquartile range: 8&ndash, 36) months of follow-up 69 patients expired. Each measure of VC (CAC or KS) predicted all-cause mortality independently factors commonly associated with all-cause survival (p <, 0.001). Far more importantly, each measurement of VC significantly improved risk prediction and patient reclassification (p <, 0.001) beyond traditional cardiovascular risk factors. Conclusions: Overall, presence and extension of VC, irrespective of the arterial site, predict risk of all-cause of death in patients starting hemodialysis. Of note, both CAC and KS increase risk stratification beyond traditional CV risk factors. However, future efforts are needed to assess whether a risk-based approach encompassing VC screening to guide HD patient management improves survival.
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- 2021
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7. New evidence of direct oral anticoagulation therapy on cardiac valve calcifications, renal preservation and inflammatory modulation
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Fabio Miraldi, Luca Di Lullo, Domenico G. Della Rocca, Domenico Russo, Carlo Lavalle, Marco Valerio Mariani, Francesco Summaria, Claudio Ronco, Antonio Bellasi, Paolo Severino, Giovanni B. Forleo, Cristina Chimenti, Massimo Mancone, Michele Magnocavallo, Andrea Natale, and Biagio Di Iorio
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medicine.medical_specialty ,atrial fibrillation ,cytokine ,rivaroxaban ,warfarin ,calcification ,inflammation ,Population ,Renal function ,Kidney ,chemistry.chemical_compound ,Rivaroxaban ,Internal medicine ,Atrial Fibrillation ,medicine ,Cardiac valve calcification ,Humans ,Prospective Studies ,education ,Inflammation ,education.field_of_study ,Creatinine ,business.industry ,Warfarin ,Anticoagulants ,Calcinosis ,Atrial fibrillation ,medicine.disease ,Heart Valves ,Stroke ,Treatment Outcome ,chemistry ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Kidney disease ,Factor Xa Inhibitors - Abstract
Background Rivaroxaban is a direct inhibitor of activated Factor X (FXa), an anti-inflammatory protein exerting a protective effect on the cardiac valve and vascular endothelium. We compare the effect of Warfarin and Rivaroxaban on inflammation biomarkers and their contribution to heart valve calcification progression and renal preservation in a population of atrial fibrillation (AF) patients with chronic kidney disease (CKD) stage 3b – 4. Methods This was an observational, multicenter, prospective study enrolling 347 consecutive CKD stage 3b – 4 patients newly diagnosed with AF: 247 were treated with Rivaroxaban and 100 with Warfarin. Every 12 months, we measured creatinine levels and cardiac valve calcification via standard trans-thoracic echocardiogram, while plasma levels of inflammatory mediators were quantified by ELISA at baseline and after 24 months. Results Over a follow-up of 24 months, long-term treatment with Rivaroxaban was associated with a significative reduction of cytokines. Patients treated with Rivaroxaban experienced a more frequent stabilization/regression of valve calcifications comparing with patients treated with Warfarin. Rivaroxaban use was related with an improvement in kidney function in 87.4% of patients, while in those treated with Warfarin was reported a worsening of renal clearance in 98% of cases. Patients taking Rivaroxaban experienced lower adverse events (3.2% vs 49%, p-value Conclusions Our findings suggest that Rivaroxaban compared to Warfarin is associated with lower levels of serum markers of inflammation. The inhibition of FXa may exert an anti-inflammatory effect contributing to reduce the risk of cardiac valve calcification progression and worsening of renal function.
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- 2021
8. Current management of hyperkalemia in non-dialysis CKD: Longitudinal study of patients receiving stable nephrology care
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Massimo Torreggiani, Giorgina Barbara Piccoli, Luca Apicella, Roberto Minutolo, Domenico Giannese, Giuseppe Conte, Paolo Chiodini, Vincenzo Bellizzi, Michele Provenzano, Luca De Nicola, Biagio Di Iorio, Carlo Garofalo, Domenico Santoro, Adamasco Cupisti, Silvio Borrelli, Vincenzo Calabrese, Borrelli, S., De Nicola, L., Minutolo, R., Conte, G., Chiodini, P., Cupisti, A., Santoro, D., Calabrese, V., Giannese, D., Garofalo, C., Provenzano, M., Bellizzi, V., Apicella, L., Piccoli, G. B., Torreggiani, M., and Di Iorio, B. R.
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Nephrology ,Male ,Longitudinal study ,Hyperkalemia ,medicine.medical_treatment ,030232 urology & nephrology ,Longitudinal Studie ,030204 cardiovascular system & hematology ,Gastroenterology ,RAASI ,chemistry.chemical_compound ,0302 clinical medicine ,CKD ,Diet ,Potassium ,Aged ,Bicarbonates ,Buffers ,Diuretics ,Female ,Follow-Up Studies ,Humans ,Longitudinal Studies ,Middle Aged ,Renal Insufficiency, Chronic ,Renal Insufficiency ,Chronic ,Nutrition and Dietetics ,Bicarbonate ,Current management ,medicine.symptom ,lcsh:Nutrition. Foods and food supply ,Buffer ,Human ,medicine.medical_specialty ,Urinary system ,lcsh:TX341-641 ,Article ,Follow-Up Studie ,03 medical and health sciences ,Internal medicine ,Diabetes mellitus ,medicine ,Diuretic ,Dialysis ,business.industry ,medicine.disease ,chemistry ,business ,Food Science - Abstract
Background: No study has explored the limitations of current long-term management of hyperkalemia (HK) in outpatient CKD clinics. Methods: We evaluated the association between current therapeutic options and control of serum K (sK) during 12-month follow up in ND-CKD patients stratified in four groups by HK (sK ≥ 5.0 mEq/L) at baseline and month 12: Absent (no-no), Resolving (yes-no), New Onset (no-yes), Persistent (yes-yes). Results: We studied 562 patients (age 66.2 ± 14.5 y, 61% males, eGFR 39.8 ± 21.8 mL/min/1.73 m2, RAASI 76.2%). HK was “absent” in 50.7%, “resolving” in 15.6%, “new onset” in 16.6%, and “persistent” in 17.1%. Twenty-four hour urinary measurements testified adherence to nutritional recommendations in the four groups at either visit. We detected increased prescription from baseline to month 12 of bicarbonate supplements (from 5.0 to 14.1%, p <, 0.0001), K-binders (from 2.0 to 7.7%, p <, 0.0001), and non-K sparing diuretics (from 34.3 to 41.5%, p <, 0.001), these changes were consistent across groups. Similar results were obtained when using higher sK level (≥5.5 mEq/L) to stratify patients. Mixed-effects regression analysis showed that higher sK over time was associated with eGFR <, 60, diabetes, lower serum bicarbonate, lower use of non-K sparing diuretics, bicarbonate supplementation, and K-binder use. Treatment-by-time interaction showed that sK decreased in HK patients given bicarbonate (p = 0.003) and K-binders (p = 0.005). Conclusions: This observational study discloses that one-third of ND-CKD patients under nephrology care remain with or develop HK during a 12-month period despite low K intake and increased use of sK-lowering drugs.
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- 2021
9. Nephrology in Italy
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Piergiorgio Messa, Luca Di Lullo, Carlo Alfieri, Biagio Di Iorio, Matteo Tozzi, Antonio Bellasi, Claudio Ronco, and Marco Franchin
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Nephrology ,medicine.medical_specialty ,Kidney ,business.industry ,medicine.medical_treatment ,medicine.disease ,Peritoneal dialysis ,Transplantation ,medicine.anatomical_structure ,Internal medicine ,medicine ,Hemodialysis ,Renal replacement therapy ,business ,Intensive care medicine ,Kidney transplantation ,Dialysis - Abstract
Nephrology in Italy was organized as a medical society in 1957. A publicly funded system provides no-fee and universal healthcare for all people within the national territory, including renal replacement therapy, with coverage of renal dialysis and kidney transplantation. With a population of 60 million, about 46,474 patients are currently on dialysis. Hemodialysis is the main modality of renal replacement therapy, treating 90% of the patients on chronic dialysis. Peritoneal dialysis is still underutilized. Similarly, transplantation, with about 2200 kidney transplants per year, can be expanded. This chapter presents a general overview of nephrology in Italy, covering historical aspects, the main renal diseases, and renal replacement therapy, including hemodialysis, peritoneal dialysis, and kidney transplantation.
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- 2021
10. Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients
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Domenico Russo, Luca Di Lullo, Roberto Ciarcia, Mario Cozzolino, Carlo Lavalle, Carlo Ratti, Antonio Bellasi, Biagio Di Iorio, Michele Magnocavallo, Bellasi, A., Di Lullo, L., Russo, D., Ciarcia, R., Magnocavallo, M., Lavalle, C., Ratti, C., Cozzolino, M., and Di Iorio, B. R.
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Adult ,Male ,medicine.medical_specialty ,QH301-705.5 ,medicine.drug_class ,medicine.medical_treatment ,Population ,030232 urology & nephrology ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,risk prediction ,0302 clinical medicine ,Renal Dialysis ,Renal Dialysi ,Internal medicine ,Post-hoc analysis ,medicine ,Humans ,Biology (General) ,Renal Insufficiency, Chronic ,education ,Vascular Calcification ,Kidney transplantation ,Coronary Vessel ,Aged ,Aged, 80 and over ,education.field_of_study ,hemodialysis ,business.industry ,Hazard ratio ,coronary artery calcification ,progression ,General Medicine ,Middle Aged ,medicine.disease ,Coronary Vessels ,Confidence interval ,Phosphate binder ,Cardiology ,Female ,Hemodialysis ,Hemodialysi ,business ,Kidney disease ,Human - Abstract
Background: It is estimated that chronic kidney disease (CKD) accounts globally for 5 to 10 million deaths annually, mainly due to cardiovascular (CV) diseases. Traditional as well as non-traditional CV risk factors such as vascular calcification are believed to drive this disproportionate risk burden. We aimed to investigate the association of coronary artery calcification (CAC) progression with all-cause mortality in patients new to hemodialysis (HD). Methods: Post hoc analysis of the Independent study (NCT00710788). At study inception and after 12 months of follow-up, 414 patients underwent computed tomography imaging for quantification of CAC via the Agatston methods. The square root method was used to assess CAC progression (CACP), and survival analyses were used to test its association with mortality. Results: Over a median follow-up of 36 months, 106 patients died from all causes. Expired patients were older, more likely to be diabetic or to have experienced an atherosclerotic CV event, and exhibited a significantly greater CAC burden (p = 0.002). Survival analyses confirmed an independent association of CAC burden (hazard ratio: 1.29, 95% confidence interval: 1.17–1.44) and CACP (HR: 5.16, 2.61–10.21) with all-cause mortality. CACP mitigated the risk associated with CAC burden (p = 0.002), and adjustment for calcium-free phosphate binder attenuated the strength of the link between CACP and mortality. Conclusions: CAC burden and CACP predict mortality in incident to dialysis patients. However, CACP reduced the risk associated with baseline CAC, and calcium-free phosphate binders attenuated the association of CACP and outcomes, suggesting that CACP modulation may improve survival in this population. Future endeavors are needed to confirm whether drugs or kidney transplantation may attenuate CACP and improve survival in HD patients.
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- 2021
11. Pro-Inflammatory Effects of Indoxyl Sulfate in Mice: Impairment of Intestinal Homeostasis and Immune Response
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Fabrizio Dal Piaz, Giuseppina Autore, Stefania Marzocco, Fuyu Nishijima, Biagio Di Iorio, Shara Francesca Rapa, Francesco Prisco, Orlando Paciello, Ada Popolo, Valentina Iovane, Rapa, Shara Francesca, Prisco, Francesco, Popolo, Ada, Iovane, Valentina, Autore, Giuseppina, Di Iorio, Biagio Raffaele, Dal Piaz, Fabrizio, Paciello, Orlando, Nishijima, Fuyu, and Marzocco, Stefania
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0301 basic medicine ,medicine.medical_treatment ,030232 urology & nephrology ,Nitric Oxide Synthase Type II ,medicine.disease_cause ,lcsh:Chemistry ,chemistry.chemical_compound ,Mice ,0302 clinical medicine ,intestinal inflammation ,Intestinal Mucosa ,lcsh:QH301-705.5 ,Spectroscopy ,bcl-2-Associated X Protein ,biology ,Nitrotyrosine ,intestinal epithelial cell ,General Medicine ,Computer Science Applications ,Nitric oxide synthase ,primary murine peritoneal macrophage ,Tumor necrosis factor alpha ,intestinal epithelial cells ,Hemodialysis ,medicine.symptom ,medicine.medical_specialty ,Inflammation ,primary murine peritoneal macrophages ,Catalysis ,Article ,chronic kidney disease ,indoxyl sulfate ,oxidative stress ,Inorganic Chemistry ,03 medical and health sciences ,Immune system ,Internal medicine ,medicine ,Animals ,Physical and Theoretical Chemistry ,Renal Insufficiency, Chronic ,Molecular Biology ,oxidative stre ,business.industry ,Animal ,Tumor Necrosis Factor-alpha ,Organic Chemistry ,medicine.disease ,Mice, Inbred C57BL ,Oxidative Stress ,030104 developmental biology ,Endocrinology ,chemistry ,lcsh:Biology (General) ,lcsh:QD1-999 ,Gene Expression Regulation ,Cyclooxygenase 2 ,biology.protein ,Tyrosine ,business ,Indican ,Oxidative stress ,Kidney disease - Abstract
The intestines are recognized as the main source of chronic inflammation in chronic kidney disease (CKD) and, among other cells, macrophages are involved in modulating this process as well as in the impaired immune response which also occurs in CKD patients. In this study, we evaluated the effect of Indoxyl Sulfate (IS), a protein bound uremic toxin poorly eliminated by hemodialysis, on inflammatory, oxidative stress and pro-apoptotic parameters, at the intestinal level in mice, on intestinal epithelial cells (IEC-6) and on primary murine peritoneal macrophages. C57BL/6J mice were treated with IS (800 mg/kg i.p.) for 3 or 6 h and histopathological analysis showed that IS induced intestinal inflammation and increased cyclooxygenase-2 (COX-2), nitrotyrosine and Bax expression in intestinal tissue. In IEC-6 cells, IS (125&ndash, 1000 µ, M) increased tumor necrosis factor-&alpha, levels, COX-2 and inducible nitric oxide synthase expression and nitrotyrosine formation. Moreover, IS increased pro-oxidant, pro-inflammatory and pro-apoptotic parameters in peritoneal macrophages from IS-treated mice. Also, the serum concentration of IS and pro-inflammatory levels of cytokines resulted increased in IS-treated mice. Our results indicate that IS significantly contributes to affect intestinal homeostasis, immune response, and to induce a systemic pro-inflammatory state thus highlighting its potential role as therapeutic target in CKD patients.
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- 2021
12. Glifozines and cardiorenal outcomes
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Biagio Di Iorio, Vincenzo Triggiani, Carlo Lavalle, Silvio Settembrini, Edoardo Guastamacchia, Gaetano La Manna, Claudio Ronco, Luca Di Lullo, Domenico Russo, Giuseppe Cianciolo, Antonio Bellasi, Di Lullo L., Bellasi A., Guastamacchia E., Triggiani V., Ronco C., Lavalle C., Di Iorio B.R., Russo D., Cianciolo G., La Manna G., and Settembrini S.
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Diabetes mellitu ,medicine.medical_specialty ,Renal function ,030204 cardiovascular system & hematology ,Hypoglycemia ,03 medical and health sciences ,Health problems ,0302 clinical medicine ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Hypoglycemic drugs ,030212 general & internal medicine ,Adverse effect ,Intensive care medicine ,Sodium-Glucose Transporter 2 Inhibitors ,Gliflozin ,business.industry ,medicine.disease ,Diabetes Mellitus, Type 2 ,Cardiology and Cardiovascular Medicine ,business ,Diabetic cardionephropathy ,Developed country - Abstract
Diabetes mellitus, with its complications, is one of the major health problems in economically developed countries and its prevalence is constantly increasing. Kidneys and heart involvement represent main comorbidities in diabetic patients often leading to organ failure. The treatments available until a few years ago are often associated with hypoglycemia, weight gain, gastro-intestinal disorders and other side effects together with serious adverse effects on renal function. The new frontiers of diabetic cardionephropathy treatment are mainly focused on delay of heart and renal failure both on diabetic and nondiabetic patients ad it was shown by last data reports. In the following review, we will focus on Gliflozins, one of the newest classes of hypoglycemic drugs that have shown to hold peculiar pharmacological properties in managing cardiac and renal complications.
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- 2020
13. Dietary satisfaction and quality of life in chronic kidney disease patients on low-protein diets: A multicentre study with long-term outcome data (TOrino-Pisa study)
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Antoine Chatrenet, Marta Nazha, Gianfranca Cabiddu, Biagio Di Iorio, Antioco Fois, Irene Capizzi, Claudia D’Alessandro, Adamasco Cupisti, Patrick Saulnier, Stefania Maxia, Giorgina Barbara Piccoli, and Federica Neve Vigotti
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Adult ,Male ,medicine.medical_specialty ,Low protein ,medicine.medical_treatment ,Protein-Restricted ,Personal Satisfaction ,survival analysis ,Young Adult ,Quality of life ,CKD ,chronic renal insufficiency ,nutrition ,quality of life ,Aged ,Aged, 80 and over ,Cross-Sectional Studies ,Diet, Protein-Restricted ,Disease Progression ,Female ,Glomerular Filtration Rate ,Humans ,Middle Aged ,Patient Compliance ,Prognosis ,Renal Insufficiency, Chronic ,Survival Rate ,Quality of Life ,Internal medicine ,medicine ,80 and over ,Renal Insufficiency ,Chronic ,Dialysis ,Transplantation ,Proportional hazards model ,business.industry ,medicine.disease ,Comorbidity ,Discontinuation ,Diet ,Nephrology ,Hemodialysis ,business ,Kidney disease - Abstract
BackgroundConcerns about adherence and quality of life (QoL) limit the diffusion of low-protein diets (LPDs) as a way to slow chronic kidney disease (CKD) progression and postpone dialysis. The aim of this multicentre study is to assess dietary satisfaction in stable CKD patients.MethodsThis was a multicentre cross-sectional study with long-term follow-up data. Prevalent patients on LPD for at least 6 months were selected in four Italian centres. QoL was assessed using the World Health Organization Quality of Life questionnaire, and diet satisfaction with the Modification of Diet in Renal Disease satisfaction questionnaire. Comorbidity was assessed by Charlson Comorbidity Index, estimated glomerular filtration rate (eGFR) was calculated by the CKD Epidemiology Collaboration equation and protein intake by Maroni–Mitch formula. Survival was analysed with Kaplan–Meier curves and Cox Proportional Hazard Model.ResultsFour hundred and twenty-two CKD Stages 3–5 patients were enrolled. Over 95% were on moderately restricted diets (0.6 g/kg/day). Compliance was good (protein intake: 0.59 g/kg/day at baseline, 0.72 at the end of follow-up). Median dietary satisfaction was 4 on a 1–5 scale. QoL was not affected by the type of diet, but was influenced by age, comorbidity and setting of care. Two years later, at the end of follow-up, 66.6% of the patients were still on a diet; the main causes of discontinuation were dialysis and death. The dropout rate was low (5.5%); in Cox analysis, patient and renal survival were influenced by age and eGFR, but not by QoL, setting of care or type of diet.ConclusionsLPDs are compatible with high dietary satisfaction and minimal dropout, at least in patients who are able to follow such a diet for at least 6 months.
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- 2020
14. Inflammation and Oxidative Stress in Chronic Kidney Disease—Potential Therapeutic Role of Minerals, Vitamins and Plant-Derived Metabolites
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Stefania Marzocco, Pietro Campiglia, August Heidland, Biagio Di Iorio, and Shara Francesca Rapa
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0301 basic medicine ,medicine.medical_treatment ,uremic toxins ,030232 urology & nephrology ,Review ,medicine.disease_cause ,Systemic inflammation ,Bioinformatics ,Antioxidants ,lcsh:Chemistry ,0302 clinical medicine ,oxidative stress ,chronic kidney disease (ckd) ,lcsh:QH301-705.5 ,Spectroscopy ,Kidney transplantation ,Chronic kidney disease (CKD) ,Inflammation ,Minerals ,Oxidative stress ,Plant-derived metabolites ,Uremic toxins ,Vitamins ,General Medicine ,minerals ,vitamins ,plant-derived metabolites ,Computer Science Applications ,Disease Progression ,Cytokines ,medicine.symptom ,Anemia ,Catalysis ,End stage renal disease ,Inorganic Chemistry ,03 medical and health sciences ,medicine ,Animals ,Humans ,ddc:610 ,Renal Insufficiency, Chronic ,Physical and Theoretical Chemistry ,Molecular Biology ,Dialysis ,Plant Extracts ,business.industry ,Organic Chemistry ,medicine.disease ,Kidney Transplantation ,030104 developmental biology ,lcsh:Biology (General) ,lcsh:QD1-999 ,inflammation ,Heart failure ,Kidney Failure, Chronic ,business ,Kidney disease - Abstract
Chronic kidney disease (CKD) is a debilitating pathology with various causal factors, culminating in end stage renal disease (ESRD) requiring dialysis or kidney transplantation. The progression of CKD is closely associated with systemic inflammation and oxidative stress, which are responsible for the manifestation of numerous complications such as malnutrition, atherosclerosis, coronary artery calcification, heart failure, anemia and mineral and bone disorders, as well as enhanced cardiovascular mortality. In addition to conventional therapy with anti-inflammatory and antioxidative agents, growing evidence has indicated that certain minerals, vitamins and plant-derived metabolites exhibit beneficial effects in these disturbances. In the current work, we review the anti-inflammatory and antioxidant properties of various agents which could be of potential benefit in CKD/ESRD. However, the related studies were limited due to small sample sizes and short-term follow-up in many trials. Therefore, studies of several anti-inflammatory and antioxidant agents with long-term follow-ups are necessary.
- Published
- 2019
15. Microbiota issue in CKD: how promising are gut-targeted approaches?
- Author
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Biagio Di Iorio, Alice Sabatino, Enrico Fiaccadori, Carmela Cosola, Maria Teresa Rocchetti, and Loreto Gesualdo
- Subjects
Nephrology ,medicine.medical_specialty ,medicine.medical_treatment ,Gut–brain axis ,030232 urology & nephrology ,Synbiotics ,030204 cardiovascular system & hematology ,Gut flora ,Kidney ,urologic and male genital diseases ,Bioinformatics ,Cardiovascular System ,digestive system ,law.invention ,03 medical and health sciences ,Probiotic ,0302 clinical medicine ,law ,Internal medicine ,Diet, Protein-Restricted ,medicine ,Animals ,Humans ,Urea ,Renal Insufficiency, Chronic ,Uremia ,Bacteria ,biology ,business.industry ,Probiotics ,Prebiotic ,Brain ,medicine.disease ,biology.organism_classification ,Gastrointestinal Microbiome ,Intestines ,Renal Elimination ,Prebiotics ,Host-Pathogen Interactions ,Dysbiosis ,business ,Kidney disease - Abstract
In chronic kidney disease (CKD), the progressive decline in the renal excretory function leads to accumulation of urea and toxins in the blood. The CKD-associated dysbiosis of gut microbiota further contributes to uremia by increasing intestinal toxins production. Gut microbiota is involved in a complex network of human organs, mediated by microbial metabolites: in CKD, gut-heart and gut-brain axes may have a role in increased cardiovascular risk and neuropsychiatric disorders. While the cardiovascular toxicity of some microbial molecules is well known, their presumptive neurotoxicity needs to be confirmed by specific studies. In this review, we describe gut-heart and gut-brain axes in CKD, with an overview of the experimental and human studies characterizing CKD-associated gut microbiota, and we discuss the benefits coming from new approaches aimed at gut manipulation. Microbiota metabolism is emerging as a modifiable non-traditional risk factor in nephrology. In order to take advantage of this issue, it is necessary to consider the microbiota manipulation as part of the nutritional management of CKD. Integrating the low-protein nutritional approach with prebiotic, probiotic and synbiotic supplementation is a promising tool to control disease progression and comorbidities, though an extensive validation in large-scale clinical trials is still required.
- Published
- 2018
16. Safety and effectiveness of rivaroxaban and warfarin in moderate-to-advanced CKD: real world data
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Antonio De Pascalis, Luca Di Lullo, Antonio Bellasi, Biagio Di Iorio, Claudio Ronco, Ernesto Paoletti, Vincenzo Barbera, Antonio Granata, Maria Fusaro, Maura Ravera, Giovanni Tripepi, and Domenico Russo
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,030232 urology & nephrology ,Hemorrhage ,030204 cardiovascular system & hematology ,Risk Assessment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Rivaroxaban ,Randomized controlled trial ,Risk Factors ,law ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Outpatient clinic ,Longitudinal Studies ,Renal Insufficiency, Chronic ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Anticoagulant ,Warfarin ,Anticoagulants ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Cerebrovascular Disorders ,Venous thrombosis ,Treatment Outcome ,Italy ,Nephrology ,Female ,business ,Factor Xa Inhibitors ,medicine.drug - Abstract
In recent years, novel anticoagulant drugs have been introduced in the clinical armamentarium and have progressively gained momentum. Although their use is increasing among CKD patients, some skepticism about their risk–benefit ratio still persists. We sought to investigate the safety and effectiveness of rivaroxaban in a cohort of moderate-to-advanced CKD patients. This observational, retrospective, longitudinal study involved 347 consecutive CKD stage 3b–4 (according to NKF–KDOQI guidelines) patients enrolled from 8 cardiac outpatient clinics between March 2015 and October 2017. All patients received anticoagulation (100 warfarin vs. 247 rivaroxaban) as part of their non-valvular atrial fibrillation management at the attending physician’s discretion. Clinical effectiveness (defined as the occurrence of ischemic stroke, venous thromboembolism, or transient ischemic attack) and safety (intracranial hemorrhage, gastrointestinal or other bleeding) were assessed separately. Over a mean follow-up period of 16 ± 0.3 months, 25 stroke episodes (15 hemorrhagic, and 10 ischemic) occurred in 24 warfarin treated patients vs. none in the rivaroxaban arm. There were 5 vs. 0 episodes of deep venous thrombosis and 8 vs. 2 major episodes of bleeding in the warfarin and rivaroxaban groups, respectively. In contrast, the proportion of minor episodes of bleeding was similar between groups. Rivaroxaban seems a safe and effective therapeutic option in CKD stage 3b–4 patients. However, future randomized controlled trials are needed to definitively establish the role of rivaroxaban in CKD patients.
- Published
- 2018
17. Ultrapure dialysis water obtained with additional ultrafilter may reduce inflammation in patients on hemodialysis
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Biagio Di Iorio, Vittoria D'Esposito, Lucia Di Micco, Domenico Russo, Pietro Formisano, Luca Nardone, Dario Bruzzese, Luigi Russo, Di Iorio, B, Di Micco, L, Bruzzese, Dario, Nardone, L, Russo, L, Formisano, Pietro, D'Esposito, Vittoria, and Russo, Domenico
- Subjects
Nephrology ,medicine.medical_specialty ,Dialysis water ,Anemia ,Ultrapure water ,medicine.medical_treatment ,030232 urology & nephrology ,Ultrafiltration ,Inflammation ,030204 cardiovascular system & hematology ,Gastroenterology ,Hemoglobins ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Serum amyloid A ,Aged ,Aged, 80 and over ,Cross-Over Studies ,biology ,business.industry ,Dialysis patients ,C-reactive protein ,Water ,Middle Aged ,medicine.disease ,Hemodialysis Solutions ,Surgery ,C-Reactive Protein ,Ultrafilter ,Erythropoietin stimulating agents ,Hematinics ,biology.protein ,Cytokines ,Original Article ,Hemodialysis ,Hemoglobin ,Erratum ,medicine.symptom ,Dialysis (biochemistry) ,business - Abstract
Background Patients on standard dialysis, in particular those on high-flux and high-efficiency dialysis, are exposed to hundreds of liters of dialysis-water per week. The quality of dialysis-water is a factor responsible for inflammation in dialysis patients. Inflammation is a potent trigger of atherosclerosis and a pathogenetic factor in anemia, increasing mortality and morbidity in dialysis patients. Current systems for water treatment do not completely eliminate bacteria and endotoxins. This prospective study tested whether improved dialysis-water purity by an additional ultrafilter can reduce inflammation and ameliorate hemoglobin levels, with a consequent reduction in erythropoietin-stimulating agents (ESA). Methods An ultrafilter, composed of two serially positioned devices with polysulfone membranes of 2.0 and 1.0 m2, respectively, was positioned within the fluid pathway before the dialysis machine. Prevalent dialysis patients were assigned either to continue dialysis with conventional dialysis-water (control phase) or to initiate dialysis sessions with improved dialysis-water purity (study phase). After 6 months, patients were crossed over. Total study duration was 1 year. Routine chemistry, bacterial count, endotoxin levels in dialysis-water as well as blood levels of pro- and anti-inflammatory cytokines, human serum amyloid A, C-reactive protein and fraction 5 of complement were measured. Results Thirty-two patients completed the study. Mean bacterial count was lower and endotoxin levels were absent in dialysis-water obtained with the ultrafilter. At the end of the study-phase, C-reactive protein and pro-inflammatory cytokines decreased while anti-inflammatory ones increased. Hemoglobin levels were improved with lower ESA doses. Conclusions An additional ultrafilter improved dialysis-water purity, reduced levels of inflammation markers, ameliorated hemoglobin concentration with reduced ESA doses. These results remain speculative but they may generate studies to assess whether improved dialysis-water quality with an ultrafilter can reduce inflammation and improve survival of dialysis patients. Electronic supplementary material The online version of this article (doi:10.1007/s40620-017-0422-x) contains supplementary material, which is available to authorized users.
- Published
- 2017
18. Associations of Calcium from Food Sources versus Phosphate Binders with Serum Calcium and FGF23 in Hemodialysis Patients
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Sara Mahdavi, Tabo Sikaneta, Karan Nagra, Luke W. Johnston, Biagio Di Iorio, Paul Tam, and Antonio Bellasi
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Vitamin ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,chemistry.chemical_element ,Parathyroid hormone ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Calcium ,fibroblast growth factor 23 (fgf23) ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Statistical significance ,medicine ,Dialysis ,dietary calcium ,calcium balance ,business.industry ,Confounding ,lcsh:R ,General Medicine ,calcium supplements, serum calcium ,stomatognathic diseases ,Endocrinology ,chemistry ,Cohort ,Hemodialysis ,business - Abstract
Background: Dysregulated serum calcium and FGF23 are associated with increased mortality and morbidity rates in patients receiving hemodialysis. Preliminary data suggest serum calcium regulates FGF23 secretion independently of serum phosphate, parathyroid hormone, and 25-OH vitamin D. It is unclear to what extent dietary and prescription sources of calcium influence calcium and FGF23 levels, and whether they confound this relationship. In this cross-sectional analysis of a multi-ethnic cohort of prevalent hemodialysis patients, association of dietary calcium and prescribed calcium were examined against serum calcium and FGF23. Bi- and multivariable linear regression was used for all analyses. Results: 81 patients (mean age 58 years, dialysis vintage 2 years, 51 men) participated. Dietary calcium was inversely associated with FGF23 (p = 0.04) however association of FGF23 with prescribed calcium did not reach statistical significance (0.08). In multivariable models, dietary calcium and prescribed calcium were associated in opposing directions with serum calcium (prescribed calcium, ß, coefficient = &minus, 0.35, p = 0.005 versus dietary calcium, coefficient = 0.35, p = 0.03). FGF23 was independently associated with serum calcium (p = 0.007). Conclusions: We found differing, sometimes opposing, associations between serum calcium and FGF23 levels when considering prescribed versus dietary sources of calcium. Serum calcium and FGF23 were strongly correlated regardless of possible confounders examined in this hemodialysis cohort. Dietary calcium was associated with higher serum calcium and lower FGF23 concentrations, while prescribed calcium was only inversely associated with serum calcium. Further studies are required to confirm these associations and determine causality.
- Published
- 2019
19. Nutritional Therapy Modulates Intestinal Microbiota and Reduces Serum Levels of Total and Free Indoxyl Sulfate and P-Cresyl Sulfate in Chronic Kidney Disease (Medika Study)
- Author
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Mattia Di Iorio, Loreto Gesualdo, Maria Teresa Rocchetti, Biagio Di Iorio, Antonio Bellasi, Maria De Angelis, Marco Gobbetti, Ighli di Bari, Stefania Marzocco, Mirco Vacca, Matteo Accetturo, Carmela Cosola, and Lucia Di Micco
- Subjects
medicine.medical_specialty ,Mediterranean diet ,CKD ,P-cresyl sulfate ,indoxyl sulfate ,microbiome ,very low protein diet ,medicine.medical_treatment ,030232 urology & nephrology ,lcsh:Medicine ,Gut flora ,urologic and male genital diseases ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Low-protein diet ,Internal medicine ,Lactobacillus ,medicine ,030304 developmental biology ,0303 health sciences ,Intestinal permeability ,biology ,business.industry ,lcsh:R ,Lachnospiraceae ,General Medicine ,medicine.disease ,biology.organism_classification ,Roseburia ,business ,Kidney disease - Abstract
In chronic kidney disease (CKD), the gut-microbiota metabolites indoxyl sulfate (IS) and p-cresyl sulfate (PCS) progressively accumulate due to their high albumin-binding capacity, leading to clinical complications. In a prospective crossover controlled trial, 60 patients with CKD grades 3B&ndash, 4 (GFR = 21.6 ±, 13.2 mL/min) were randomly assigned to two dietary regimens: (i) 3 months of free diet (FD) (FD is the diet usually used by the patient before being enrolled in the Medika study), 6 months of very low protein diet (VLPD), 3 months of FD and 6 months of Mediterranean diet (MD), (ii) 3 months of FD, 6 months of MD, 3 months of FD, and 6 months of VLPD. VLPD reduced inflammatory Proteobacteria and increased Actinobacteria phyla. MD and VLPD increased some butyrate-forming species of Lachnospiraceae, Ruminococcaceae, Prevotellaceae, Bifidobacteriaceae, and decrease the pathobionts Enterobacteriaceae. The increased level of potential anti-inflammatory Blautia and Faecalibacterium, as well as butyrate-forming Coprococcus and Roseburia species in VLPD was positively associated with dietary intakes and it was negatively correlated with IS and PCS. Compared to FD and MD, VLPD showed a lower amount of some Lactobacillus, Akkermansia, Streptococcus, and Escherichia species. MD and VLPD reduced both the total and free serum IS (MD &minus, 36%, &minus, 40% and VLPD &minus, 69%, &minus, 73%, respectively) and PCS (MD &minus, 38%, &minus, 44% and VLPD &minus, 58%, &minus, 71%, respectively) compared to FD. VLPD reduced serum D-lactate compared to MD and FD. MD and, to a greater extent, VLPD are effective in the beneficial modulation of gut microbiota, reducing IS and PCS serum levels, and restoring intestinal permeability in CKD patients.
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- 2019
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20. Etelcalcetide in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism. Multicenter Study in 'Real Life'
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Domenico Russo, Immacolata Gaia Paduano, Vincenzo Panuccio, Luca Di Lullo, Giovanni Tripepi, Bernadette Scognamiglio, Biagio Di Iorio, Fabio Malberti, Rocco Tripepi, Russo, Domenico, Tripepi, Rocco, Malberti, Fabio, Di Iorio, Biagio, Scognamiglio, Bernadette, Di Lullo, Luca, Gaia Paduano, Immacolata, Luigi Tripepi, Giovanni, and Antonio Panuccio, Vincenzo
- Subjects
Parathyroidectomy ,medicine.medical_specialty ,Cinacalcet ,endocrine system diseases ,Calcimimetic ,medicine.medical_treatment ,030232 urology & nephrology ,Urology ,Parathyroid hormone ,lcsh:Medicine ,cinacalcet ,hypocalcemia ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,secondary hyperparathyroidism ,medicine ,030212 general & internal medicine ,Etelcalcetide ,etelcalcetide ,business.industry ,lcsh:R ,Correction ,General Medicine ,gastrointestinal side effects ,medicine.disease ,Secondary hyperparathyroidism ,Hemodialysis ,business ,gastrointestinal side eects ,medicine.drug - Abstract
Etelcalcetide is a new calcimimetic indicated for the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients. Etelcalcetide efficacy in SHPT has been ascertained only in randomized controlled trials. This multicenter study was carried out in &ldquo, real world&rdquo, setting that is different from randomized controlled trials (RCTs) to (1) evaluate the effectiveness of etelcalcetide in SHPT, (2) to assess calcium, phosphorus, alkaline phosphatase changes, (3) to register gastrointestinal side effects. Data were collected from twenty-three dialysis units with n = 1190 patients on the charge. From this cohort, n = 168 (14%) patients were on treatment with etelcalcetide, and they were evaluated for statistics. A median weekly dose of etelcalcetide was 15 mg (7.5&ndash, 45 mg). Patients were either naï, ve (33%) or switched from cinacalcet to obtain better control of SHPT with reduced side effects or pills burden. Serum parathyroid hormone (PTH) declined over time from a median value of 636 pg/mL to 357 pg/mL. The median time for responders (intact PTH (iPTH) range: two to nine times the upper normal limit) was 53 days, the percentage of responders increased (from baseline 27% to 63%) being similar in switched-patients and naï, ve-patients. Few patients had symptomatic hypocalcemia requiring etelcalcetide withdrawal (four cases (3%) at 30-day control, two cases (2%) at 60-day, one case (1%) at 90-day control). Side effects with etelcalcetide were lower (3&ndash, 4%) than that registered during cinacalcet treatment (53%). Etelcalcetide is a new therapeutic option for SHPT with low side effects and pills burden. Etelcalcetide may improve adherence to therapy, avoiding unremitting SHP. It remains to be assessed whether etelcalcetide may reduce parathyroidectomy, vascular calcification, or mortality. Being etelcalcetide very potent in suppressing PTH levels, even in severe SHPT, future studies should evaluate the potential risk of more adynamic bone disease during long-term therapy.
- Published
- 2019
21. Fractional Excretion of Phosphate (FeP) Is Associated with End-Stage Renal Disease Patients with CKD 3b and 5
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Antonio Bellasi, Biagio Di Iorio, Emanuele De Simone, Raffaella Vigilante, Mattia Di Iorio, Luca Di Lullo, Lucia Di Micco, Domenico Russo, Bellasi, Antonio, Di Micco, Lucia, Russo, Domenico, De Simone, Emanuele, Di Iorio, Mattia, aella Vigilante, Ra, Di Lullo, Luca, and Ra aele Di Iorio, Biagio
- Subjects
Nephrology ,Fibroblast growth factor 23 ,medicine.medical_specialty ,Population ,030232 urology & nephrology ,Renal function ,lcsh:Medicine ,030204 cardiovascular system & hematology ,FeP ,Article ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,education ,Survival analysis ,phosphate ,education.field_of_study ,business.industry ,Hazard ratio ,lcsh:R ,General Medicine ,medicine.disease ,CKD–MBD ,fractional excretion of phosphate ,phosphate balance ,outcome ,business ,Kidney disease - Abstract
Background: The perturbation of phosphate homeostasis portends unfavorable outcomes in chronic kidney disease (CKD). However, the absence of randomized clinical trials (RCT) fuels the discussion of whether phosphate or some other phosphorous-related factor(s) such as fibroblast growth factor 23 (FGF-23) mediates the cardiovascular and systemic toxicity. We herein test whether the fractional excretion of phosphate (FeP) as a marker of renal stress to excrete phosphorous predicts unfavorable outcomes in CKD patients. Methods: Retrospective, cross-sectional observational study. For current analysis, an historical cohort of 407 records of CKD stage 3b-5 patients attending between January 2010 and October 2015 at the Nephrology Unit of Solofra (AV), Italy were utilized. Demographic, clinical, laboratory, and outcome data were identified through the subjects&rsquo, medical records. We tested whether quartiles of FeP are associated with the risk of CKD progression or all causes of death. Parametric as well as non-parametric tests, linear and logistic regression, as well as survival analysis were utilized. Results: Overall, we investigated middle-age (mean 66.0, standard deviation 12.3 years) men and women (male 43%) with CKD stage 3b to 5 (creatinine clearance 32.0 (13.3) mL/min). Older age, lower diastolic blood pressure, poor renal function, as well as higher serum phosphate were associated with FeP. Patients with higher FeP were at an increased risk of starting dialysis or dying (hazard ratio 2.40, 95% confidence interval (1.44, 3.99)). Notably, when the two endpoints were analyzed separately, FeP was associated with renal but not all-cause survival. Conclusion: FeP is associated with ESRD, but not all-cause mortality risk in a large cohort of moderate to advanced CKD patients. Future efforts are required to validate FeP as a marker of nephron stress and risk factor for CKD progression in this high-risk population.
- Published
- 2019
22. Very Low Protein Diet for Patients with Chronic Kidney Disease: Recent Insights
- Author
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Biagio Di Iorio, Luca Di Lullo, Lucia Di Micco, and Antonio Bellasi
- Subjects
metabolic acidosis ,cardiovascular risk ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,lcsh:Medicine ,Review ,urea ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,microbioma ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Low-protein diet ,Edema ,Internal medicine ,Medicine ,Medical nutrition therapy ,phosphorus ,Proteinuria ,business.industry ,lcsh:R ,Metabolic acidosis ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,Blood pressure ,very low protein diet ,vascular calcification ,gut ,Dose reduction ,medicine.symptom ,proteinuria ,business ,nutritional therapy ,chronic kidney disease ,Kidney disease - Abstract
Use of nutritional therapy (NT) in chronic kidney disease (CKD) patients is still debated among nephrologists, but it represents a fundamental point in the conservative treatment of CKD. It has been used for years and it has new goals today, such as (1) the reduction of edema, diuretics, and blood pressure values with a low sodium-content diet; (2) the dose reduction of phosphate levels and phosphate binders; (3) the administration of bicarbonate with vegetables in order to correct metabolic acidosis and delay CKD progression; (4) the reduction of the number and the doses of drugs and chemical substances; and (5) the lowering of urea levels, the cure of intestinal microbioma, and the reduction of cyanates levels (such as indoxyl-sulphate and p-cresol sulphate), which are the most recent known advantages achievable with NT. In conclusion, NT and especially very low protein diet (VLPD) have several beneficial effects in CKD patients and slows the progression of CKD.
- Published
- 2019
23. Carbohydrates and Lipids
- Author
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Lucia Di Micco, Bruno Cianciaruso, and Biagio Di Iorio
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education.field_of_study ,medicine.medical_specialty ,business.industry ,Insulin ,medicine.medical_treatment ,Population ,Hypertriglyceridemia ,Lipid metabolism ,medicine.disease ,Sepsis ,Insulin resistance ,Parenteral nutrition ,Endocrinology ,Internal medicine ,medicine ,lipids (amino acids, peptides, and proteins) ,education ,Energy source ,business - Abstract
Acute renal failure (ARF) is associated with sepsis, trauma, and multiple-organ failure in about 36% of patients in the intensive care unit (ICU). Patients usually have hormonal dysfunction such as protein, carbohydrate, and lipid metabolism alterations. The principal alterations of metabolism in critically ill patients with ARF are hyperglycemia, hypertriglyceridemia and low cholesterol levels. Major causes of hyperglycemia in ARF are: insulin resistance, augmented hepatic glucose output, inadequate insulin secretion, and impaired metabolic clearance of insulin. The leading cause of lipid abnormalities in ARF is impaired lipolysis. Mechanisms causing hyperglycemia have been shown in several experiments; few data are available on lipid metabolism. A poor glucose control in critically ill patients may cause an increment of mortality up to 20% per each mmol of increase of plasma glucose. Some randomized studies demonstrated that intensive insulin therapy may be important in reducing morbidity and mortality in ICU patients, but recent trials do not confirm these data. In fact, more recent guidelines suggest higher glycemic targets. Data on incidence of hypertriglyceridemia and on the effects of lipids administration in ARF are scarce. The metabolism of lipids contained in commercial solutions used for parenteral nutrition is similar to endogen VLDLs; thus, also the clearance of exogenous lipids administered may be altered in ARF. Despite the altered lipid metabolism in ARF, lipids remain a fundamental energy source; there are contrasting data on the benefits of intensive insulin therapy on this population.
- Published
- 2019
24. Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy
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Michele Magnocavallo, Luca Di Lullo, Maria Fusaro, Maura Ravera, Ernesto Paoletti, Marco Valerio Mariani, Antonio Bellasi, Vincenzo Barbera, Paolo Severino, Biagio Di Iorio, Domenico G. Della Rocca, Carlo Lavalle, and Roberto Palumbo
- Subjects
medicine.medical_specialty ,left atrial appendage occlusion ,medicine.medical_treatment ,lcsh:Medicine ,Renal function ,Review ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,direct oral anticoagulants ,Left atrial appendage occlusion ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,atrial fibrillation ,030212 general & internal medicine ,chronic kidney disease ,warfarin ,end stage renal disease ,Stroke ,business.industry ,Mortality rate ,lcsh:R ,Warfarin ,Atrial fibrillation ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,Cardiology ,business ,medicine.drug ,Kidney disease - Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.
- Published
- 2020
25. Correction: Etelcalcetide in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism. Multicenter Study in 'Real Life'. J. Clin. Med. 2019, 8, 1066
- Author
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Giovanni Tripepi, Fabio Malberti, Bernadette Scognamiglio, Domenico Russo, Rocco Tripepi, Biagio Di Iorio, Vincenzo Panuccio, Luca Di Lullo, and Immacolata Gaia Paduano
- Subjects
Etelcalcetide ,Pediatrics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,lcsh:R ,MEDLINE ,lcsh:Medicine ,General Medicine ,medicine.disease ,n/a ,Multicenter study ,Medicine ,In real life ,Secondary hyperparathyroidism ,In patient ,Hemodialysis ,business - Abstract
The authors wish to make the following corrections to the previous publication [...]
- Published
- 2020
26. Phosphate Control in Chronic Kidney Disease: an Unresolved Issue
- Author
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Biagio Di Iorio, Domenico Russo, Antonio Bellasi, and Luca Di Lullo
- Subjects
medicine.medical_specialty ,business.industry ,medicine.drug_class ,030232 urology & nephrology ,chemistry.chemical_element ,General Medicine ,Serum phosphate ,030204 cardiovascular system & hematology ,Calcium ,Phosphate ,medicine.disease ,Placebo ,Phosphate binder ,03 medical and health sciences ,chemistry.chemical_compound ,Lanthanum carbonate ,0302 clinical medicine ,Endocrinology ,chemistry ,Internal medicine ,Unresolved Issue ,medicine ,business ,Kidney disease ,medicine.drug - Published
- 2018
27. Nutritional treatment of advanced CKD: twenty consensus statements
- Author
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Francesco Locatelli, Massimo Sandrini, Franca Pasticci, Loreto Gesualdo, Alessandro Capitanini, Mario Salomone, Giacomo Garibotto, Roberto Minutolo, Patrizia Babini, Enrico Fiaccadori, Giovanni Gambaro, Giuliano Brunori, Giorgina B Piccoli, Claudia D’Alessandro, Giuseppe Conte, Vincenzo Bellizzi, Annalisa Gennari, Giovanni Cancarini, Adamasco Cupisti, Anna Laura Fantuzzi, Carmela Cosola, Domenico Santoro, Biagio Di Iorio, Piergiorgio Bolasco, Giuseppe Quintaliani, Marcora Mandreoli, Mariacristina Gregorini, Cupisti, Adamasco, Brunori, Giuliano, Di Iorio, Biagio Raffaele, D’Alessandro, Claudia, Pasticci, Franca, Cosola, Carmela, Bellizzi, Vincenzo, Bolasco, Piergiorgio, Capitanini, Alessandro, Fantuzzi, Anna Laura, Gennari, Annalisa, Piccoli, Giorgina Barbara, Quintaliani, Giuseppe, Salomone, Mario, Sandrini, Massimo, Santoro, Domenico, Babini, Patrizia, Fiaccadori, Enrico, Gambaro, Giovanni, Garibotto, Giacomo, Gregorini, Mariacristina, Mandreoli, Marcora, Minutolo, Roberto, Cancarini, Giovanni, Conte, Giuseppe, Locatelli, Francesco, and Gesualdo, Loreto
- Subjects
Nephrology ,Dietary Fiber ,Potassium intake ,medicine.medical_treatment ,030232 urology & nephrology ,Chronic renal failure ,CKD ,Dialysis ,Diet ,Kidney transplant ,Nutritional treatment ,Consensus ,Contraindications ,Dietary Proteins ,Dietary Supplements ,Dysbiosis ,Humans ,Nutrition Assessment ,Patient Care Team ,Patient Compliance ,Patient Education as Topic ,Phosphorus, Dietary ,Renal Insufficiency, Chronic ,Renal Replacement Therapy ,Sodium, Dietary ,Energy Intake ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Medicine ,Renal Insufficiency ,Chronic ,Dialysi ,Phosphorus ,medicine.medical_specialty ,MEDLINE ,Dietary ,03 medical and health sciences ,Internal medicine ,Renal replacement therapy ,Medical prescription ,Position papers and Guidelines ,Intensive care medicine ,business.industry ,Sodium ,medicine.disease ,business ,Kidney disease - Abstract
The Italian nephrology has a long tradition and experience in the field of dietetic-nutritional therapy (DNT), which is an important component in the conservative management of the patient suffering from a chronic kidney disease, which precedes and integrates the pharmacological therapies. The objectives of DNT include the maintenance of an optimal nutritional status, the prevention and/or correction of signs, symptoms and complications of chronic renal failure and, possibly, the delay in starting of dialysis. The DNT includes modulation of protein intake, adequacy of caloric intake, control of sodium and potassium intake, and reduction of phosphorus intake. For all dietary-nutritional therapies, and in particular those aimed at the patient with chronic renal failure, the problem of patient adherence to the dietetic-nutritional scheme is a key element for the success and safety of the DNT and it can be favored by an interdisciplinary and multi-professional approach of information, education, dietary prescription and follow-up. This consensus document, which defines twenty essential points of the nutritional approach to patients with advanced chronic renal failure, has been written, discussed and shared by the Italian nephrologists together with representatives of dietitians (ANDID) and patients (ANED).
- Published
- 2018
28. Epicardial adipose tissue: new parameter for cardiovascular risk assessment in high risk populations
- Author
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Domenico Russo, Roberta Russo, Biagio Di Iorio, Luca Di Lullo, Russo, Roberta, Di Iorio, Biagio, Di Lullo, Luca, and Russo, Domenico
- Subjects
Nephrology ,medicine.medical_specialty ,Epicardial adipose tissue · Cardiovascular risk · Coronary artery disease · Chronic kidney disease · Coronary artery calcification ,Population ,Inflammation ,030204 cardiovascular system & hematology ,Bioinformatics ,Risk Assessment ,Severity of Illness Index ,Coronary artery disease ,Pathogenesis ,03 medical and health sciences ,Paracrine signalling ,0302 clinical medicine ,Adipokines ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Animals ,Humans ,030212 general & internal medicine ,education ,Adiposity ,Kidney ,education.field_of_study ,business.industry ,digestive, oral, and skin physiology ,medicine.disease ,Prognosis ,Coronary arteries ,medicine.anatomical_structure ,Adipose Tissue ,Cardiovascular Diseases ,medicine.symptom ,business ,Pericardium ,Signal Transduction - Abstract
Epicardial adipose tissue (EAT) is localized between the myocardial surface and visceral layer of the pericardium. It is a metabolically active organ that secretes several cytokines which modulate cardiovascular morphology and function. EAT may interact locally with coronary arteries through paracrine secretion mechanisms. Cytokines from peri-adventitial EAT may pass through the coronary wall by diffusion from the outside to the inside, interacting with cells. An additional potential mechanism by which EAT interacts locally with coronary arteries may be the vasocrine secretion.EAT may play a significant role as a modulator of cardiac functions. In physiologic conditions, EAT has biochemical cardio-protective properties, secreting anti-atherosclerosis substances; in metabolic disease states, EAT secretes bioactive molecules that may play an important role in the pathogenesis of coronary artery disease and cardiac arrhythmias by promoting atherosclerosis. EAT has been evaluated both in the general population and in metabolic disease states that are characterized by inflammation, such as cardiovascular diseases and chronic kidney disease.This review focuses on the current state of knowledge on EAT as a reliable new parameter for cardiovascular risk stratification in high risk populations.
- Published
- 2018
29. Nutritional therapy in autosomal dominant polycystic kidney disease
- Author
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Antonio Bellasi, Biagio Di Iorio, Adamasco Cupisti, Vincenzo Barbera, Claudia D’Alessandro, and Luca Di Lullo
- Subjects
Nephrology ,medicine.medical_specialty ,Phosphorus intake ,Drinking ,030232 urology & nephrology ,Autosomal dominant polycystic kidney disease ,Nutritional Status ,Renal function ,Physiology ,Organism Hydration Status ,Disease ,030204 cardiovascular system & hematology ,Recommended Dietary Allowances ,urologic and male genital diseases ,03 medical and health sciences ,Fluid intake ,Nutritional therapy ,0302 clinical medicine ,Internal medicine ,medicine ,CKD ,Humans ,Medical nutrition therapy ,Renal Insufficiency, Chronic ,ADPKD ,Acid-Base Equilibrium ,business.industry ,Metabolic acidosis ,Sodium, Dietary ,Protein intake ,Sodium intake ,Polycystic Kidney, Autosomal Dominant ,medicine.disease ,female genital diseases and pregnancy complications ,Treatment Outcome ,Phosphorus, Dietary ,Dietary Proteins ,Diet, Healthy ,Acidosis ,business ,Nutritive Value - Abstract
CKD-related nutritional therapy (NT) is a crucial cornerstone of CKD patients' treatment, but the role of NT has not been clearly investigated in autosomal dominant polycystic kidney disease (ADPKD). Several clinical studies have focused on new pharmacological approaches to delay cystic disease progression, but there are no data on dietary interventions in ADPKD patients. The aim of this paper is to analyze the evidence from the literature on the impact of five nutritional aspects (water, sodium, phosphorus, protein intake, and net acid load) in CKD-related ADPKD extrapolating-where information is unavailable-from what occurs in CKD non-ADPKD patients Sodium intake restriction could be useful in decreasing the growth rate of cysts. Although further evidence is needed, restriction of phosphorus and protein intake restriction represent cornerstones of the dietary support of renal non-ADPKD patients and common sense can guide their use. It could be also helpful to limit animal protein, increasing fruit and vegetables intake together with a full correction of metabolic acidosis. Finally, fluid intake may be recommended in the early stages of the disease, although it is not to be prescribed in the presence of moderate to severe reduction of renal function.
- Published
- 2018
30. Nutritional therapy reduces protein carbamylation through urea lowering in chronic kidney disease
- Author
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Lucia Di Micco, Stefania Marzocco, Fabrizio Dal Piaz, Emanuele De Simone, Carmela Cosola, Loreto Gesualdo, Biagio Di Iorio, Antonio Bellasi, and Maria Teresa Rocchetti
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Parathyroid hormone ,urea ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Low-protein diet ,Internal medicine ,Mediterranean diet ,Diet, Protein-Restricted ,CKD ,Medicine ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,protein carbamylation ,Aged ,Homocitrulline ,Transplantation ,Cross-Over Studies ,business.industry ,very low protein diet ,Proteins ,medicine.disease ,Crossover study ,Blood pressure ,Endocrinology ,chemistry ,Biochemistry ,Nephrology ,Ageing ,Urea ,Female ,business ,Kidney disease - Abstract
Background Protein carbamylation is one of the non-enzymatic reactions involved in protein molecular ageing. We sought to investigate the relationship between urea levels and protein carbamylation, and whether a Mediterranean diet (MD) and a very low protein diet (VLPD) reduce protein carbamylation through reduction in urea levels in patients with chronic kidney disease (CKD). Methods This is a prospective, randomized, crossover controlled trial that investigated 60 patients with CKD grades 3B-4 (46 males, mean age of 67 years). The enrolled CKD patients were randomly assigned (1:1) to two different nutritional treatment arms: (i) 3 months of free diet (FD), 6 months of VLPD, 3 months of FD and 6 months of MD; and (ii) 3 months of FD, 6 months of MD, 3 months of FD and 6 months of VLPD. Blood levels of lysine (Lys) and homocitrulline (Hcit) and their ratio were used as markers of cyanate levels. Due to a lack of pre-existing data on the potential effects of different dietary regimens and in light of the exploratory nature of the study, no formal sample size estimation was carried out. Results At study completion, lower diastolic blood pressure and decreased serum levels of urea, sodium, phosphorus and parathyroid hormone, but higher serum levels of bicarbonate and haemoglobin, were noted with MD and VLPD. When compared with FD, both MD and VLPD were also associated with a decrease in serum Hcit levels and Hcit/Lys ratios (P
- Published
- 2018
31. Vascular Calcification and Subendocardial Ischemia in Hemodialysis Patients: A New Morpho-Functional Score to Assess Cardiovascular Risk: the Solofra Score
- Author
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Maria Luisa Sirico, Antonella De Blasio, Lucia Di Micco, and Biagio Di Iorio
- Subjects
Male ,medicine.medical_specialty ,Aortography ,medicine.medical_treatment ,Population ,Pulse Wave Analysis ,Risk Assessment ,Myocardial perfusion imaging ,Ischemia ,Renal Dialysis ,Risk Factors ,Internal medicine ,medicine.artery ,Internal Medicine ,Humans ,Medicine ,Vascular Calcification ,education ,Aorta ,Dialysis ,Aged ,education.field_of_study ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Age Factors ,Myocardial Perfusion Imaging ,Middle Aged ,Carotid Arteries ,Cardiology ,Aortic pressure ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business - Abstract
Background: ESRD (end-stage renal disease) patients have a high cardiovascular mortality risk. A morphofunctional approach of vascular calcifications and myocardial perfusion is needed for the management of ESRD patients. We used SEVR (sub-endocardial viability ratio) and Kauppila score from the dialysis population of the Independent study to create a new morpho-functional score to assess cardiovascular risk in this population (the Solofra score). Materials and Methods: 184 patients were followed-up for 36 months. A side lumbar X-ray was performed to assess vascular calcifications of lumbar aorta using the Kauppila score. Central aortic pressure and pulse velocity wave (PWV) were assessed at the carotid artery site. Myocardial perfusion was estimated with SEVR. Independent risk mortality factors were identified with univariate regression analysis (p
- Published
- 2015
32. Arterial Stiffness, Pulse Wave Analyses: What Can’t Blood Pressure Tell you in Chronic Kidney Disease
- Author
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Paolo Salvi, Carlo Ratti, Biagio Di Iorio, Sergio Papagni, Antonio Bellasi, Emiliana Ferramosca, Domenico Russo, Antonio, Bellasi, Paolo, Salvi, Sergio, Papagni, Emiliana, Ferramosca, Carlo, Ratti, Russo, Domenico, and Biagio Di, Iorio
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,Left ventricular hypertrophy ,medicine.disease ,Pulse pressure ,Blood pressure ,Mean blood pressure ,Internal medicine ,medicine ,Cardiology ,Arterial stiffness ,Internal Medicine ,business ,education ,Arterial stiffness, pulse wave velocity, vascular calcification, chronic kidney disease, atherosclerosis ,Pulse wave velocity ,Kidney disease - Abstract
Increased arterial stiffness is emerging as a useful marker of cardiovascular damage. A growing body of evidence suggests that the stiffening of the conduit arteries is linearly associated with poor survival in the general population and high-risk population such as Chronic Kidney Disease (CKD) patients. Indeed, the loss of the elastic properties of conduit arteries induces an increase in the central pulse pressure and cardiac workload leading to left ventricular hypertrophy and reduced coronary and capillary perfusion. Notably, all these changes are independent of mean blood pressure and other established cardiovascular risk factors. Though, evidence is still inconclusive, some preliminary data suggest that arterial stiffness and central blood pressure evaluation can be of use for risk stratification and treatment individualization. We herein summarize the current evidence supporting the usefulness of arterial stiffness assessment for CKD patients’ management.
- Published
- 2012
33. The treatment of type 2 diabetes mellitus in patients with chronic kidney disease: What to expect from new oral hypoglycemic agents
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Luca Di Lullo, Domenico Russo, Antonio De Pascalis, Vincenzo Barbera, Michela Mangano, Claudio Ronco, Antonio Bellasi, Biagio Di Iorio, Mario Cozzolino, Di Lullo, L, Mangano, M, Ronco, C, Barbera, V, De Pascalis, A, Bellasi, A, Russo, Domenico, Di Iorio, B, and Cozzolino, M.
- Subjects
medicine.medical_specialty ,medicine.drug_class ,Endocrinology, Diabetes and Metabolism ,Administration, Oral ,030209 endocrinology & metabolism ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Diabetic nephropathy ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Animals ,Humans ,Hypoglycemic Agents ,Thiazolidinedione ,Renal Insufficiency, Chronic ,business.industry ,Type 2 Diabetes Mellitus ,General Medicine ,medicine.disease ,Prognosis ,Metformin ,Endocrinology ,Diabetes Mellitus, Type 2 ,business ,Pioglitazone ,Kidney disease ,medicine.drug - Abstract
Worldwide, an estimated 200 million people have chronic kidney disease (CKD), whose most common causes include hypertension, arteriosclerosis, and diabetes. About 40% of patients with diabetes develop CKD and intensive blood glucose control through pharmacological intervention can delay CKD progression. Standard therapies for the treatment of type 2 diabetes mellitus include metformin, sulfonylureas, meglitinides, thiazolidinediones, and insulin. While these drugs have an important role in the management of type 2 diabetes, only the thiazolidinedione pioglitazone can be used across the spectrum of CKD (stages 2–5) and without dose adjustment. Newer therapies, particularly dipeptidyl peptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors, are increasingly being used in the treatment of type 2 diabetes; however, a major consideration is whether these newer therapies can also be used safely and effectively across the spectrum of renal impairment.
- Published
- 2017
34. Controversial issues in CKD clinical practice: position statement of the CKD-treatment working group of the Italian Society of Nephrology
- Author
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Biagio Di Iorio, Giorgina Barbara Piccoli, Silvio Borrelli, Roberto Minutolo, Giuseppe Quintaliani, Maura Ravera, Domenico Santoro, Marcora Mandreoli, Vincenzo Bellizzi, Luca De Nicola, Gianfranca Cabiddu, Serena Torraca, Ernesto Paoletti, Adamasco Cupisti, Giuseppe Conte, Bellizzi, Vincenzo, Conte, Giuseppe, Borrelli, Silvio, Cupisti, Adamasco, DE NICOLA, Luca, Di Iorio, Biagio R, Cabiddu, Gianfranca, Mandreoli, Marcora, Paoletti, Ernesto, Piccoli, Giorgina B, Quintaliani, Giuseppe, Ravera, Maura, Santoro, Domenico, Torraca, Serena, and Minutolo, Roberto
- Subjects
Nephrology ,medicine.medical_treatment ,Biopsy ,030232 urology & nephrology ,Angiotensin-Converting Enzyme Inhibitors ,Position statement ,030204 cardiovascular system & hematology ,Overweight ,Sodium Chloride ,Kidney ,Diabete ,Bicarbonate ,CKD ,Conservative therapy ,Diabetes ,Iron ,Low protein diet ,Obesity ,Protein intake ,RAAS ,Renal biopsy ,Salt intake ,Renin-Angiotensin System ,0302 clinical medicine ,Risk Factors ,Diabetic Nephropathies ,Renal Insufficiency ,Chronic ,Evidence-Based Medicine ,Iron Deficiencies ,Diet, Sodium-Restricted ,Clinical Practice ,medicine.symptom ,medicine.medical_specialty ,Dietary ,Protein-Restricted ,03 medical and health sciences ,Angiotensin Receptor Antagonists ,Predictive Value of Tests ,Renal Dialysis ,Diabetes mellitus ,Internal medicine ,Diet, Protein-Restricted ,medicine ,Humans ,Renal Insufficiency, Chronic ,Sodium Chloride, Dietary ,Intensive care medicine ,Dialysis ,Sodium-Restricted ,business.industry ,medicine.disease ,Diet ,Endocrinology ,Position paper ,business - Abstract
This position paper of the study group "Conservative treatment of Chronic Kidney Disease-CKD" of the Italian Society of Nephrology addresses major practical, unresolved, issues related to the conservative treatment of chronic renal disease. Specifically, controversial topics from everyday clinical nephrology practice which cannot find a clear, definitive answer in the current literature or in nephrology guidelines are discussed. The paper reports the point of view of the study group. Concise and practical advice is given on several common issues: renal biopsy in diabetes; dual blockade of the renin-angiotensin-aldosterone system (RAAS); management of iron deficiency; low protein diet; dietary salt intake; bicarbonate supplementation; treatment of obesity; the choice of conservative therapy vs. dialysis. For each topic synthetic statements, guideline-style, are reported.
- Published
- 2017
35. Parathyroid hormone may be an early predictor of low serum hemoglobin concentration in patients with not advanced stages of chronic kidney disease
- Author
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Domenico Russo, Luigi Russo, Michele Andreucci, Carmela Errichiello, Maria Grazia De Gregorio, Biagio Di Iorio, Luigi Morrone, Francesco Locatelli, Russo, Domenico, Morrone, L, Di Iorio, B, Andreucci, M, De Gregorio, Mg, Errichiello, C, Russo, L, and Locatelli, F.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anemia ,medicine.medical_treatment ,Parathyroid hormone Hemoglobin Anemia Chronic kidney disease ,Parathyroid hormone ,Renal function ,Severity of Illness Index ,Gastroenterology ,Hemoglobins ,Predictive Value of Tests ,Chronic kidney disease ,Internal medicine ,medicine ,Humans ,Hemoglobin ,Renal Insufficiency, Chronic ,Dialysis ,Aged ,Retrospective Studies ,Hyperparathyroidism ,business.industry ,Middle Aged ,medicine.disease ,Endocrinology ,ROC Curve ,Nephrology ,Area Under Curve ,Female ,Original Article ,Secondary hyperparathyroidism ,business ,Glomerular Filtration Rate ,Kidney disease - Abstract
Background Parathyroid hormone (PTH) has been associated with anemia only in dialysis patients with severe hyperparathyroidism. Whether an association between PTH and hemoglobin also exists in patients with chronic kidney disease not on dialysis (CKD-patients) is still unclear. In this study we evaluated the association between PTH and hemoglobin in CKD-patients without severe secondary hyperparathyroidism. Methods Hospitalized patients and outpatients (N = 979) were retrospectively evaluated and categorized according to PTH quartile and serum hemoglobin (
- Published
- 2014
36. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study
- Author
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Mauro Pezzotta, Adamasco Cupisti, Giorgina Barbara Piccoli, Roberto Minutolo, Biagio Di Iorio, Luca De Nicola, Giuliano Barsotti, Battista Fabio Viola, Vincenzo Bellizzi, Paolo Chiodini, Bellizzi, V, Chiodini, Paolo, Cupisti, A, Viola, Bf, Pezzotta, M, DE NICOLA, Luca, Minutolo, Roberto, Barsotti, G, Piccoli, Gb, and Di Iorio, B.
- Subjects
Male ,Nephrology ,medicine.medical_specialty ,medicine.medical_treatment ,Nutritional Status ,Protein-Restricted ,CKD ,CV risk ,ketoacids ,survival ,very low-protein diet ,Aged ,Amino Acids ,Cardiovascular Diseases ,Female ,Humans ,Italy ,Keto Acids ,Prevalence ,Prognosis ,Prospective Studies ,Renal Dialysis ,Renal Insufficiency, Chronic ,Renal Replacement Therapy ,Risk Factors ,Survival Rate ,Diet, Protein-Restricted ,Transplantation ,Medicine (all) ,End stage renal disease ,Internal medicine ,medicine ,Renal Insufficiency ,Renal replacement therapy ,Chronic ,Survival rate ,Dialysis ,business.industry ,Hazard ratio ,medicine.disease ,Diet ,CKD, CV risk, ketoacids, survival, very low protein diet ,very low protein diet ,Endocrinology ,Hemodialysis ,business ,Kidney disease - Abstract
BACKGROUND Very low-protein intake during chronic kidney disease (CKD) improves metabolic disorders and may delay dialysis start without compromising nutritional status, but concerns have been raised on a possible negative effect on survival during dialysis. This study aimed at evaluating whether a very low-protein diet during CKD is associated with a greater risk of death while on dialysis treatment. METHODS This is an historical, cohort, controlled study, enrolling patients at dialysis start previously treated in a tertiary nephrology clinic with a very low-protein diet supplemented with amino acids and ketoacids (s-VLPD group, n = 184) or without s-VLPD [tertiary nephrology care (TNC) group, n = 334] and unselected patients [control (CON) group, n = 9.092]. The major outcome was survival rate during end-stage renal disease associated to s-VLPD treatment during CKD. The propensity score methods and Cox regression model were used to match groups at the start of dialysis to perform survival analysis and estimate adjusted hazard ratio (HR). RESULTS In s-VLPD, TNC and CON groups, average age was 67.5, 66.0 and 66.3 years, respectively (P = 0.521) and male prevalence was 55, 55 and 62%, respectively (P = 0.004). Diabetes prevalence differed in the three groups (P < 0.001), being 18, 17 and 31% in s-VLPD, CON and TNC, respectively. A different prevalence of cardiovascular (CV) disease was found (P < 0.001), being similar in TNC and CON (31 and 25%) and higher in s-VLPD (41%). Median follow-up during renal replacement therapy (RRT) was 36, 32 and 36 months in the three groups. Adjusted HR estimated on matched propensity patients was 0.59 (0.45-0.78) for s-VLPD versus CON. Subgroup analysis showed a lower mortality risk in s-VLPD versus matched-CON in younger patients (
- Published
- 2014
37. Phosphate levels in patients treated with low-flux haemodialysis, pre-dilution haemofiltration and haemodiafiltration: post hoc analysis of a multicentre, randomized and controlled trial
- Author
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Simeone Andrulli, Francesco Locatelli, Carlo Basile, Renzo Tarchini, Ernesto Reina, Marino Ganadu, Biagio Di Iorio, Piergiorgio Bolasco, Bruno Memoli, Gianfranco Fundoni, Guido Tampieri, Giovanna Sau, Francesco Logias, Luciano A. Pedrini, Salvatore David, Onofrio Marzolla, Domenica Casu, Giuseppe Villa, Paolo Altieri, Luanna Gazzanelli, Carmine Zoccali, Giuseppe Pontoriero, Giovanni Mattana, Mario Passaghe, Elisabetta Isola, Rocco Ferrara, and Silvio Bertoli
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Parathyroid hormone ,Hemodiafiltration ,Sevelamer ,Phosphates ,law.invention ,chemistry.chemical_compound ,Randomized controlled trial ,Renal Dialysis ,law ,Post-hoc analysis ,Hemofiltration ,medicine ,Humans ,Aged ,Transplantation ,business.industry ,Middle Aged ,medicine.disease ,Phosphate ,Surgery ,Renal Replacement Therapy ,Bicarbonates ,chemistry ,Parathyroid Hormone ,Nephrology ,Heart failure ,Kidney Failure, Chronic ,Calcium ,Female ,Hemodialysis ,business ,medicine.drug - Abstract
Whether convective therapies allow better control of serum phosphate (P) is still undefined, and no data are available concerning on-line haemofiltration (HF). The objectives of the study are to evaluate the effect of convective treatments (CTs) on P levels in comparison with low-flux haemodialysis (HD) and to evaluate the correlates of serum phosphate in a post hoc analysis of a randomized clinical trial.This analysis was performed in the database of a multicentre, open label and randomized controlled study in which 146 chronic HD patients from 27 Italian centres were randomly assigned to HD (70 patients) or CTs: on-line pre-dilution HF (36 patients) or on-line pre-dilution haemodiafiltration (40 patients).CTs did not affect P (P = 0.526), calcium (Ca) (P = 0.849) and parathyroid hormone levels (P = 0.622). P levels were associated with the use of phosphate binders including aluminium-based phosphate binders (P0.001) and sevelamer (P0.001), pre-dialysis bicarbonate levels (P0.001) and pre-dialysis blood K levels (P0.001). On multivariate analysis (generalized linear model), serum P was again largely unassociated with CTs (P = 0.631). Notably, participating centres were by far the strongest independent correlate of serum P, explaining 45.3% of the variance of serum P over the trial and this association was confirmed at multivariate analysis. Bicarbonate (P0.001) and, to a weaker extent, serum K (P = 0.032) were independently related to serum P.In comparison with low-flux HD, CTs did not significantly affect serum P levels. Participating centres were the main source of P variability during the trial followed by treatment with phosphate binders, serum bicarbonate and, to a weak extent, serum potassium levels (ClinicalTrials.gov Identifier: NCT011583309).
- Published
- 2014
38. FP598SECONDARY HYPERPARATHYROIDISM AND ANEMIA CORRECTION IN ESRD: DATA FROM THE OPTIMAL ESRD TREATMENT RCT
- Author
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Stefano Mangano, Biagio Di Iorio, Carlo Ratti, Luca Di Lullo, Michela Mangano, Carlo Campana, Mario Cozzolino, and Antonio Bellasi
- Subjects
Transplantation ,Hyperparathyroidism ,Pediatrics ,medicine.medical_specialty ,Randomized controlled trial ,Nephrology ,business.industry ,law ,Anemia ,medicine ,medicine.disease ,business ,law.invention - Published
- 2018
39. Chronic Kidney Disease: The Silent Epidemy
- Author
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Antonio Bellasi, Biagio Di Iorio, and Luca Di Lullo
- Subjects
medicine.medical_specialty ,urogenital system ,business.industry ,lcsh:R ,MEDLINE ,lcsh:Medicine ,General Medicine ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,n/a ,Editorial ,Internal medicine ,medicine ,business ,Kidney disease - Abstract
Numerous observations suggest that chronic kidney disease (CKD) is an epidemic condition [...]
- Published
- 2019
40. Kidney Disease in HIV Infection
- Author
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Gianni Cappelli, Biagio Di Iorio, Francesco Fontana, Luca Di Lullo, Antonio Bellasi, Giovanni Guaraldi, and Gaetano Alfano
- Subjects
medicine.medical_specialty ,antiretroviral therapy ,Population ,030232 urology & nephrology ,lcsh:Medicine ,Review ,Disease ,urologic and male genital diseases ,CKD ,HIV ,chronic kidney disease ,nephrotoxicity ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Epidemiology ,medicine ,030212 general & internal medicine ,Intensive care medicine ,education ,education.field_of_study ,business.industry ,lcsh:R ,General Medicine ,medicine.disease ,Comorbidity ,Life expectancy ,business ,Progressive disease ,Kidney disease - Abstract
Antiretroviral therapy (ART) has significantly improved life expectancy of infected subjects, generating a new epidemiological setting of people aging withHuman Immunodeficiency Virus (HIV). People living with HIV (PLWH), having longer life expectancy, now face several age-related conditions as well as side effects of long-term exposure of ART. Chronic kidney disease (CKD) is a common comorbidity in this population. CKD is a relentlessly progressive disease that may evolve toward end-stage renal disease (ESRD) and significantly affect quality of life and risk of death. Herein, we review current understanding of renal involvement in PLWH, mechanisms and risk factors for CKD as well as strategies for early recognition of renal dysfunction and best care of CKD.
- Published
- 2019
41. Search for a reliable biomarker of acute kidney injury: to the heart of the problem
- Author
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Biagio Di Iorio, Claudio Ronco, Luca Di Lullo, and Antonio Bellasi
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,030204 cardiovascular system & hematology ,Kidney ,urologic and male genital diseases ,Timely diagnosis ,Unmet needs ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Lipocalin-2 ,Sodium Potassium Chloride Symporter Inhibitors ,Acetylglucosaminidase ,medicine ,Humans ,Hepatitis A Virus Cellular Receptor 1 ,Cystatin C ,Stage (cooking) ,Intensive care medicine ,Aged ,Aged, 80 and over ,Heart Failure ,Creatinine ,biology ,business.industry ,Acute kidney injury ,Renal tissue ,030208 emergency & critical care medicine ,General Medicine ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Troponin ,United States ,female genital diseases and pregnancy complications ,Diuresis ,Editorial ,Treatment Outcome ,chemistry ,Acute Disease ,biology.protein ,Biomarker (medicine) ,Female ,business ,Biomarkers ,Glomerular Filtration Rate - Abstract
Worsening renal function (WRF) in the setting of aggressive diuresis for acute heart failure treatment may reflect renal tubular injury or simply indicate a hemodynamic or functional change in glomerular filtration. Well-validated tubular injury biomarkers,Patients in the multicenter ROSE-AHF trial with baseline and 72-hour urine tubular injury biomarkers were analyzed (n=283). WRF was defined as a ≥20% decrease in glomerular filtration rate estimated with cystatin C.Consistent with protocol-driven aggressive dosing of loop diuretics, participants received a median 560 mg IV furosemide equivalents (interquartile range, 300-815 mg), which induced a urine output of 8425 mL (interquartile range, 6341-10 528 mL) over the 72-hour intervention period. Levels ofKidney tubular injury does not appear to have an association with WRF in the context of aggressive diuresis of patients with acute heart failure. These findings reinforce the notion that the small to moderate deteriorations in renal function commonly encountered with aggressive diuresis are dissimilar from traditional causes of acute kidney injury.
- Published
- 2018
42. QT interval in CKD and haemodialysis patients
- Author
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Antonio Bellasi and Biagio Di Iorio
- Subjects
QT interval ,medicine.medical_specialty ,medicine.medical_treatment ,Original Contributions ,Population ,morbidity ,Internal medicine ,medicine ,Clinical significance ,Myocardial infarction ,cardiovascular diseases ,education ,Dialysis ,Transplantation ,education.field_of_study ,business.industry ,Cardiac arrhythmia ,medicine.disease ,mortality ,Nephrology ,Cardiology ,cardiovascular system ,dialysis ,Hemodialysis ,Minireview ,business ,chronic kidney disease ,Kidney disease - Abstract
Cardiovascular (CV) disease is the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients. Although about half of the deaths are due to CV causes, only a minority are directly linked to myocardial infarction and it is estimated that cardiac arrest or cardiac arrhythmias account for about a quarter of all deaths registered in dialysis patients. Thus, simple non-invasive tools such as electrocardiogram (ECG) may detect those patients at increased risk for arrhythmias. The QT interval on the standard 12-lead ECG is the time from ventricular depolarization (Q wave onset) to cardiac repolarization completion (end of the T wave) and represents a marker of cardiac repolarization defects. Numerous studies suggest a direct association between QT abnormalities and poor prognosis in the general population, CKD patients and dialysis patients. Of note, multivariable adjustments for different traditional and CKD-specific risk factors for CV events attenuate but do not cancel these associations. We herein review the clinical significance of simple non-invasive tools such as the QT tract on ECG for detecting those patients at increased risk of CV event and possibly for treatment individualization.
- Published
- 2013
43. Conversion from Epoetin and Darbepoetin to C.E.R.A. in Non-Dialysis CKD Patients: A Multicenter Italian Prospective Study in Nephrology Practice
- Author
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Sandro Feriozzi, Mario Cozzolino, Giuseppe Conte, Ferdinando Carlo Sasso, Biagio Di Iorio, Luca De Nicola, Roberto Minutolo, Domenico Santoro, Felice Nappi, Marina Di Luca, Carlo Manno, and Pasquale Polito
- Subjects
Erythrocyte Indices ,Male ,Nephrology ,medicine.medical_specialty ,Time Factors ,Anemia ,medicine.medical_treatment ,urologic and male genital diseases ,Drug Substitution ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,Intensive care medicine ,Prospective cohort study ,Erythropoietin ,Dialysis ,Aged ,Aged, 80 and over ,Hematology ,Erythrocyte indices ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Treatment Outcome ,Female ,Peptides ,business ,medicine.drug - Abstract
Background: In non-dialysis patients (ND-CKD), C.E.R.A. has been extensively investigated in ESA-naïve subjects but no data are available on its efficacy after switch from other ESA. Methods: In this prospective, multicenter, open-label study lasting 24 weeks, ND-CKD patients (n = 157) receiving ESA were converted to C.E.R.A. at doses lower than recommended. Primary outcome was the prevalence of Hb target (11-12.5 g/dl). Results: Age was 73 ± 13 years and GFR was 26.2 ± 9.4 ml/min/1.73 m2; male gender, diabetes and prior cardiovascular disease were 49, 33 and 19%, respectively. Doses of darbepoetin (25 ± 16 µg/week, n = 124) and epoetin (5,702 ± 3,190 IU/week, n = 33) were switched to low dose C.E.R.A. (87 ± 17 µg/month). During the study, prevalence of Hb target increased from 60% to 68% at week-24, while that of Hb < 11 g/dl declined from 32% to 16% (p < 0.001). Hb increased from 11.3 ± 0.8 at baseline to 11.7 ± 0.9 g/dl at week-24 (p = 0.01) without changes in C.E.R.A. dose. Significant predictors of Hb increase were low BMI, low Hb and longer dosing intervals before switch. These factors also predicted the risk of Hb overshooting (Hb > 12.5 g/dl) occurring in 57 patients. Conclusions: In ND-CKD, conversion from other ESAs to C.E.R.A. is associated with a better anemia control induced by a greater Hb increase in patients previously treated with ESAs at extended dosing interval. This parameter should be considered when switching to long-acting ESA for its potential impact on the risk of overshooting.
- Published
- 2013
44. Selected Abstracts from the 31th International Vicenza Course on Critical Care Nephrology. Vicenza, June 11-14, 2013
- Author
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Werner Beck, Catarina Teixeria, Ian T. Baldwin, Boris Zingerman, Franz Techert, D. Cruz, Irene Capelli, Sylvain J. Marchais, Nathan W. Levin, Jeroen P. Kooman, Cristina Marelli, Josipa Radic, Néstor Fontseré, Satz Mengensatzproduktion, Michael Bergman, Jeong Chul Kim, A. Bonaccorsi, Daniele Galavotti, M. Rassu, Annemie Dhondt, Gérard M. London, Golaun Odabaei, Gerald B. Appel, F. Furlan, Zaccaria Ricci, Michael Etter, Robert J. Kossmann, Rachel S. Levy-Drummer, Yang Shen, Vedran Kovacic, Mislav Radic, Francesco Alviano, Hee Chan Kim, Hertzel Salman, R. Grillone, Massimo de Cal, Sergio Picardo, Dragan Ljutic, Giuseppe Cianciolo, Ji Hyun Kim, Albert Power, Akash Nayak, Yaacov Ori, Grazia Maria Virzì, Len A. Usvyat, Claudio Laterza, Paola Cogo, Elaine Ku, Carla M. Nester, Maurizio Muraca, Aleix Cases, Hans Dietrich Polaschegg, Matteo Di Nardo, Elena Della Bella, Thierry Krummel, Milenka Sain, Roberta Costa, S. Cazzavillan, Vincenzo La Milia, Elisabet Massó, Maria Cappuccilli, Rod S. Passman, Stephan Thijssen, Hanna Bessler, Vito M. Campese, Keith C. Norris, Marian Klinger, Matteo Brolgli, M. Carrera, Alice Sue Appel, Bruno Pannier, Thierry Hannedouche, Franz Kappel, G M Virzì, Raymond Vanholder, Stefania Marzocco, Nevin M. Katz, Ulrike Haug, Peter Kotanko, Domenico Tartaglia, Tai-Gen Cui, Heike Lebsanft, Gaetano La Manna, Reinhold Deppisch, Maria Laura Angelini, Ted Toffelmire, Melvin Bonilla-Felix, Dinna N. Cruz, Maria Luisa Sirico, Jing Liu, V. Corradi, Elisa Scalzotto, Anja Kruse, Nosratola D. Vaziri, Uzi Gafter, Anna Giuliani, Stefan H. Jacobson, Fabrizio Dal Piaz, Stefano Picca, Marie Baldwin, George A. Kaysen, Jing Huang, Giuseppina Autore, Claudio Ronco, Frank A. Gotch, Marta Arias, C. Ronco, Corrado Bellini, Manel Vera, Juan M. Lopez Gomez, Alessandra Brocca, A. Vázquez-Rangel, Druck Reinhardt Druck Basel, Ivo Jelicic, Rosa Luciano, Josep M. Campistol, Anna Clementi, P. Frisone, Serena Torraca, Yuedong Wang, Fang Sun, Huijuan Mao, Francisco Maduell, Yi-Lun Zhou, A. Morea, Volker Wizemann, Francesco Garzotto, Bernard Canaud, Isabel Berdud, Ada Dormi, Francesco Locatelli, Manish Kaushik, Hervé Maheut, M. De Cal, Yosef S. Haviv, A. Brendolan, Federico Nalesso, Li-Jie Ma, Eungtaek Kang, Lucia Di Micco, Francesca Stoppa, Ingrid Ledebo, Frank Prosl, Daniele Marcelli, Alejandro Martin-Malo, Alessio Ficarella, Lourdes Blanca-Martos, Mauro Neri, Sudhir K. Bowry, Sergio Stefoni, Biagio Di Iorio, Adelheid Gauly, and Gabriele Donati
- Subjects
Nephrology ,medicine.medical_specialty ,business.industry ,Family medicine ,Internal medicine ,medicine ,Hematology ,General Medicine ,Intensive care medicine ,business - Published
- 2013
45. Abstracts
- Author
-
Elena Della Bella, Roberta Costa, Carla M. Nester, Aleix Cases, Elisabet Massó, Stefania Marzocco, Giuseppe Cianciolo, Franz Techert, Yi-Lun Zhou, Lourdes Blanca-Martos, Maria Laura Angelini, Hanna Bessler, Keith C. Norris, Ted Toffelmire, Nosratola D. Vaziri, Druck Reinhardt Druck Basel, A. Morea, Rachel S. Levy-Drummer, Sergio Stefoni, Biagio Di Iorio, Adelheid Gauly, Ada Dormi, Rosa Luciano, Gerald B. Appel, Gabriele Donati, Fang Sun, Josep M. Campistol, Huijuan Mao, Marian Klinger, Serena Torraca, F. Furlan, Alice Sue Appel, Elisa Scalzotto, Jeroen P. Kooman, Volker Wizemann, Bruno Pannier, G M Virzì, S. Cazzavillan, Anna Clementi, Albert Power, Thierry Hannedouche, Heike Lebsanft, Nathan W. Levin, Francesco Garzotto, Bernard Canaud, Isabel Berdud, Cristina Marelli, Gaetano La Manna, Yuedong Wang, George A. Kaysen, Corrado Bellini, Ulrike Haug, Uzi Gafter, Michael Etter, P. Frisone, Akash Nayak, Maria Luisa Sirico, R. Grillone, M. De Cal, Ian T. Baldwin, Claudio Ronco, Alessio Ficarella, Francisco Maduell, Hertzel Salman, Anja Kruse, Zaccaria Ricci, Maria Cappuccilli, Dragan Ljutic, Sergio Picardo, Vedran Kovacic, Dinna N. Cruz, Gérard M. London, Satz Mengensatzproduktion, Francesco Locatelli, Paola Cogo, Stephan Thijssen, Josipa Radic, Hee Chan Kim, Jeong Chul Kim, Franz Kappel, Manish Kaushik, Yang Shen, Stefano Picca, Matteo Di Nardo, Elaine Ku, Nevin M. Katz, A. Bonaccorsi, Giuseppina Autore, Jing Huang, Hans Dietrich Polaschegg, Mislav Radic, Francesco Alviano, Thierry Krummel, Rod S. Passman, Hervé Maheut, Tai-Gen Cui, Frank A. Gotch, Fabrizio Dal Piaz, Ji Hyun Kim, C. Ronco, Jing Liu, Manel Vera, Marta Arias, Francesca Stoppa, Massimo de Cal, Daniele Galavotti, Claudio Laterza, Yosef S. Haviv, Domenico Tartaglia, Maurizio Muraca, Yaacov Ori, Milenka Sain, Anna Giuliani, Grazia Maria Virzì, Len A. Usvyat, Juan M. Lopez Gomez, M. Rassu, Annemie Dhondt, A. Brendolan, V. Corradi, Golaun Odabaei, Reinhold Deppisch, Marie Baldwin, Vito M. Campese, Irene Capelli, Peter Kotanko, Melvin Bonilla-Felix, Michael Bergman, Robert J. Kossmann, Federico Nalesso, Li-Jie Ma, Raymond Vanholder, Matteo Brolgli, Eungtaek Kang, M. Carrera, Lucia Di Micco, Néstor Fontseré, Vincenzo La Milia, Werner Beck, Mauro Neri, Catarina Teixeria, Ingrid Ledebo, Stefan H. Jacobson, Boris Zingerman, Sylvain J. Marchais, Frank Prosl, Daniele Marcelli, Alejandro Martin-Malo, Sudhir K. Bowry, D. Cruz, Ivo Jelicic, Alessandra Brocca, and A. Vázquez-Rangel
- Subjects
medicine.medical_specialty ,Nephrology ,business.industry ,medicine.medical_treatment ,Medicine ,Hematology ,General Medicine ,business ,medicine.disease ,Intensive care medicine ,Dialysis ,Kidney disease - Published
- 2013
46. Blood Pressure Variability and Mortality in end Stage Renal Disease
- Author
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Serena Torraca, Biagio Di Iorio, Maria Luisa Sirico, and Lucia Di Micco
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Diastole ,Retrospective cohort study ,medicine.disease ,End stage renal disease ,Organ damage ,Blood pressure ,Internal medicine ,medicine ,Cardiology ,Internal Medicine ,Risk factor ,Intensive care medicine ,business ,Dialysis ,Kidney disease - Abstract
Blood pressure (BP) measurement is a simple, and reproducible methool and is easily accepted by patients. It is well known that in a single subject BP may change during the day; this fact is considered physiological by many physicians and does not influence the final estimated value of BP. However, it’s reasonable to suppose that blood pressure variability (BPV) has clinical consequences and that exists a cardiovascular risk related to it. In fact, recent observations indicate that BP variations could be responsible for organ damage associated with hypertension more than the systolic and diastolic BP. In this study, we aim to analyze and compare published data in literature concerning the presumable correlations between BP variability and outcomes, both in Chronic Kidney Disease (CKD) and End stage Renal Disease (ESRD). We conclude that BPV represents an important cardiovascular risk factor for both patients with CKD and for those in dialysis. No correlations were found between BPV and the progression of CKD. However, this is a retrospective study and more (RCTS) are needed on this topic.
- Published
- 2012
47. Phosphate attenuates the anti-proteinuric effect of very low-protein diet in CKD patients
- Author
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Giovanni Tripepi, Antonio Bellasi, Graziella D'Arrigo, Vincenzo Bellizzi, Carmine Zoccali, Serena Torraca, and Biagio Di Iorio
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Renal function ,Urine ,Urine sodium ,Cohort Studies ,Excretion ,Young Adult ,chemistry.chemical_compound ,Low-protein diet ,Internal medicine ,Diet, Protein-Restricted ,Humans ,Medicine ,Renal Insufficiency, Chronic ,Aged ,Transplantation ,Proteinuria ,business.industry ,Middle Aged ,Prognosis ,Phosphate ,medicine.disease ,Organophosphates ,Endocrinology ,chemistry ,Nephrology ,Dietary Supplements ,Female ,medicine.symptom ,business ,Follow-Up Studies ,Glomerular Filtration Rate ,Kidney disease - Abstract
Background. High phosphate levels attenuate nephroprotection through angiotensin-converting enzyme inhibition in patients with proteinuric chronic kidney disease (CKD). Whether this phenomenon holds true for other nephroprotective interventions like very-low-protein diet (VLPD) is unknown. Methods. We tested the hypothesis that phosphate interferes with the anti-proteinuric response to VLPD in a non-randomized, sequential study in 99 proteinuric CKD patients who sequentially underwent low-protein diet (LPD; 0.6 g/kg) and VLPD (0.3 g/kg) supplemented with keto-analogues, each for periods longer than 1 year. Results. Serum phosphate significantly reduced during VLPD (3.2 ± 0.6 mg/dL) when compared with LPD (3.7 ± 0.6 mg/ dL, P < 0.001), an effect paralleled by a substantial decline in phosphate excretion (LPD, 649 ± 180 mg/day; VLPD, 462 ± 97 mg/day; P < 0.001). The median proteinuria during LPD was 1910 mg/24 h (interquartile range: 1445–2376 mg/ 24 h) and reduced to 987 mg/24 h (656–1300 mg/24 h) during VLPD (P < 0.001). No significant change in the estimated glomerular filtration rate (eGFR) was observed during the two diet periods. In linear mixed models including the diagnosis of renal disease, eGFR, 24-h urine sodium and urea and other potential confounders, there was a strong interaction between serum phosphate (P = 0.04) and phosphaturia (P < 0.001) with the anti-proteinuric response to VLPD. Accordingly, 24-h proteinuria reduced modestly in patients who maintained relatively higher serum phosphate levels or relatively higher phosphaturia to be maximal in those who achieved the lowest level of serum and urine phosphate. Conclusion. Phosphate is an important modifier of the antiproteinuric response to VLPD. Reducing phosphate burden may decrease proteinuria and slow the progression of renal disease in CKD patients, an issue that remains to be tested in specific clinical trials.
- Published
- 2012
48. Does Daily Dialysis Improve Hypertension in Chronic Haemodialysis Patients?
- Author
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Biagio Di Iorio, Serena Torraca, Maria Luisa Sirico, Lucia Di Micco, and Stefania Marzocco
- Subjects
medicine.medical_specialty ,Dialysis Therapy ,business.industry ,medicine.medical_treatment ,Renal function ,Internal Medicine ,medicine ,Chronic hemodialysis ,Hemodialysis ,Risk factor ,Intensive care medicine ,business ,Dialysis ,Cardiovascular mortality - Abstract
Hemodialysis patients have a high cardiovascular mortality and hypertension is the most prevalent treatable risk factor. Hemodialysis is an unphysiological therapy respect to daily renal function, and the approach to avoid the related may be to increase dialysis frequency using a daily dialysis therapy. We analyze as the effect of more long or frequent weekly dialysis can improve the hypertension in hemodialysis patients.
- Published
- 2012
49. Lower Sodium Intake and Renal Protective Effects
- Author
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Serena Torraca, Maria Luisa Sirico, Biagio Di Iorio, Lucia Di Micco, and Vincenzo Bellizzi
- Subjects
Nephrology ,medicine.medical_specialty ,Proteinuria ,business.industry ,medicine.medical_treatment ,Sodium ,food.diet ,chemistry.chemical_element ,Low sodium diet ,medicine.disease ,Sodium intake ,Blood pressure ,Endocrinology ,food ,Low-protein diet ,chemistry ,Internal medicine ,Internal Medicine ,medicine ,medicine.symptom ,business ,Kidney disease - Abstract
The control of sodium intake, and the implementation of low sodium diet in nephrology clinical practice is very low, is difficult when salt have been implicated as targets for manipulation to limit progression of kidney disease. It is well recognized that better control of blood pressure is important in mitigating the progression of CKD. We describe the effects of Very Low protein Diet on intake of Sodium, and, consequently, on proteinuria and blood pressure.
- Published
- 2012
50. Low-protein diets for chronic kidney disease patients: the Italian experience
- Author
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L. Oldrizzi, Piergiorgio Bolasco, Giuliano Brunori, Luca De Nicola, Lucia Di Micco, Adamasco Cupisti, Serena Torraca, Battista Fabio Viola, Roberto Minutolo, Vincenzo Bellizzi, Francesco Locatelli, Domenico Santoro, Biagio Di Iorio, Marcora Mandreoli, Stefania Caria, Giacomo Garibotto, Enrico Fiaccadori, Giorgina Barbara Piccoli, Giuseppe Quintaliani, Giovanni Cancarini, Bellizzi, Vincenzo, Cupisti, Adamasco, Locatelli, Francesco, Bolasco, Piergiorgio, Brunori, Giuliano, Cancarini, Giovanni, Caria, Stefania, DE NICOLA, Luca, Di Iorio, Biagio R, Di Micco, Lucia, Fiaccadori, Enrico, Garibotto, Giacomo, Mandreoli, Marcora, Minutolo, Roberto, Oldrizzi, Lamberto, Piccoli, Giorgina B, Quintaliani, Giuseppe, Santoro, Domenico, Torraca, Serena, and Viola, Battista F.
- Subjects
Nephrology ,medicine.medical_specialty ,Nephrotic Syndrome ,Low protein ,medicine.medical_treatment ,030232 urology & nephrology ,Psychological intervention ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Diabetes Complications ,03 medical and health sciences ,0302 clinical medicine ,Chronic kidney disease ,Internal medicine ,Correspondence ,Diet, Protein-Restricted ,medicine ,Humans ,Nephrology, Low protein diet, Chronic kidney disease, amino acids ,Medical nutrition therapy ,Amino Acids ,Renal Insufficiency, Chronic ,Intensive care medicine ,Dialysis ,business.industry ,Sodium, Dietary ,medicine.disease ,Adaptation, Physiological ,Low protein diet ,Malnutrition ,Nutrition Assessment ,Italy ,Phosphorus, Dietary ,Dietary Proteins ,Energy Metabolism ,business ,Nephrotic syndrome ,Kidney disease - Abstract
Background Nutritional treatment has always represented a major feature of CKD management. Over the decades, the use of nutritional treatment in CKD patients has been marked by several goals. The first of these include the attainment of metabolic and fluid control together with the prevention and correction of signs, symptoms and complications of advanced CKD. The aim of this first stage is the prevention of malnutrition and a delay in the commencement of dialysis. Subsequently, nutritional manipulations have also been applied in association with other therapeutic interventions in an attempt to control several cardiovascular risk factors associated with CKD and to improve the patient's overall outcome. Over time and in reference to multiple aims, the modalities of nutritional treatment have been focused not only on protein intake but also on other nutrients. Discussion This paper describes the pathophysiological basis and rationale of nutritional treatment in CKD and also provides a report on extensive experience in the field of renal diets in Italy, with special attention given to approaches in clinical practice and management. Summary Italian nephrologists have a longstanding tradition in implementing low protein diets in the treatment of CKD patients, with the principle objective of alleviating uremic symptoms, improving nutritional status and also a possibility of slowing down the progression of CKD or delaying the start of dialysis. A renewed interest in this field is based on the aim of implementing a wider nutritional therapy other than only reducing the protein intake, paying careful attention to factors such as energy intake, the quality of proteins and phosphate and sodium intakes, making today’s low-protein diet program much more ambitious than previous. The motivation was the reduction in progression of renal insufficiency through reduction of proteinuria, a better control of blood pressure values and also through correction of metabolic acidosis. One major goal of the flexible and innovative Italian approach to the low-protein diet in CKD patients is the improvement of patient adherence, a crucial factor in the successful implementation of a low-protein diet program.
- Published
- 2016
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