42 results on '"Borrelli S"'
Search Results
2. CT Features of COVID-19: A Case Report
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Ramundo, Lamanna L, Fontanel Giovanni, Rubinetti G, Maio V Di, and Borrelli S
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medicine.medical_specialty ,Persistent dry cough ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine ,Chest ct ,Interstitial pneumonia ,General Medicine ,General Chemistry ,Radiology ,medicine.symptom ,business ,Malaise - Abstract
We describe here the Chest CT imaging features of a 68-year-old man presenting with fever (37.5 ℃), malaise, dyspnea and persistent dry cough for 7 days. The patient was seen by his GP, then sent to us for a CT and treated as a suspect even before exam execution, with all PPE and safety measures adequately put in place. Chest CT showed strikingly remarkable signs of interstitial pneumonia, compatible with COVID-19.
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- 2020
3. Cardiovascular System in COVID-19: Simply a Viewer or a Leading Actor?
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Mottola F. F., Verde N., Ricciolino R., Di Mauro M., Migliaccio M. G., Carfora V., Spiniello G., Coppola N., Macera M., Calo F., Sagnelli C., Monari C., Martini S., Stornaiuolo G., Stanzione M., De Pascalis S., Cascone A., Bianco A., Gentile V., Camaioni C., De Angelis G., Marino G., Astorri R., Starace M., Minichini C., Di Fraia A., De Sio I., Niosi M., Borrelli S., Celia B., Ceparano M., Cirillo S., De Luca M., Mazzeo G., Paoli G., Russo M. G., Russo A., Mottola, F. F., Verde, N., Ricciolino, R., Di Mauro, M., Migliaccio, M. G., Carfora, V., Spiniello, G., Coppola, N., Macera, M., Calo, F., Sagnelli, C., Monari, C., Martini, S., Stornaiuolo, G., Stanzione, M., De Pascalis, S., Cascone, A., Bianco, A., Gentile, V., Camaioni, C., De Angelis, G., Marino, G., Astorri, R., Starace, M., Minichini, C., Di Fraia, A., De Sio, I., Niosi, M., Borrelli, S., Celia, B., Ceparano, M., Cirillo, S., De Luca, M., Mazzeo, G., Paoli, G., Russo, M. G., and Russo, A.
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medicine.medical_specialty ,Myocarditis ,heart failure ,Review ,Disease ,030204 cardiovascular system & hematology ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Pericarditis ,0302 clinical medicine ,Diabetes mellitus ,Pandemic ,medicine ,myocardial injury ,030212 general & internal medicine ,lcsh:Science ,Intensive care medicine ,Ecology, Evolution, Behavior and Systematics ,business.industry ,Mechanism (biology) ,SARS-CoV-2 infection ,Paleontology ,Cancer ,medicine.disease ,Space and Planetary Science ,Heart failure ,cardiovascular system ,lcsh:Q ,business - Abstract
As of January 2020, a new pandemic has spread from Wuhan and caused thousands of deaths worldwide. Several studies have observed a relationship between coronavirus disease (COVID-19) infection and the cardiovascular system with the appearance of myocardial damage, myocarditis, pericarditis, heart failure and various arrhythmic manifestations, as well as an increase in thromboembolic risk. Cardiovascular manifestations have been highlighted especially in older and more fragile patients and in those with multiple cardiovascular risk factors such as cancer, diabetes, obesity and hypertension. In this review, we will examine the cardiac involvement associated with SARS-CoV-2 infection, focusing on the pathophysiological mechanism underlying manifestations and their clinical implication, taking into account the main scientific papers published to date.
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- 2020
4. CKD GENERAL AND CLINICAL EPIDEMIOLOGY 2
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Davids, M. R., Marais, N., Jacobs, J., Cohen, E., Krause, I., Goldberg, E., Garty, M., Dursun, B., Sahan, Y., Tanriverdi, H., Rota, S., Uslu, S., Senol, H., Minutolo, R., Gabbai, F. B., Agarwal, R., Chiodini, P., Borrelli, S., Stanzione, G., Nappi, F., Bellizzi, V., Conte, G., Nicola, L. D., J. V., De, Johnson, S., Fremeaux Bacchi, V., Ardissino, G., Ariceta, G., Beauchamp, J., Cohen, D., Greenbaum, L. A., Ogawa, M., Schaefer, F., Licht, C., Scalzotto, E., Nalesso, F., Zaglia, T., Corradi, V., Neri, M., Martino, F., Zanella, M., Brendolan, A., Mongillo, M., Ronco, C., Chinnappa, S., Mooney, A., A. M., El, Y. K., Tu, Tan, L. B., Jung, J. Y., Kim, A. J., Ro, H., Lee, C., Chang, J. H., Lee, H. H., Chung, W., Clarke, A. L., Young, H. M., Hull, K. L., Hudson, N., Burton, J. O., Smith, A. C., Marx, S., Petrilla, A., Filipovic, I., Lee, W. C., Meijers, B., Poesen, R., Storr, M., Claes, K., Kuypers, D., Evenepoel, P., Aukland, M., Betriu, A., Martinez Alonso, M., Arcidiacono, M. V., Cannata Andia, J., Pascual, J., Valdivielso, J. M., Fernandez Giraldez, E., Kingswood, J. C., Zonnenberg, B., Sauter, M., Zakar, G., Biro, B., Besenczi, B., Varga, A., Pekacs, P., Pizzini, P., Pisano, A., Leonardis, D., Panuccio, V., Cutrupi, S., Tripepi, G., Mallamaci, F., Zoccali, C., Arnold, J., Baharani, J., Rayner, H., B. H., So, Blackwell, S., Jardine, A. G., Macgregor, M. S., Cunha, C., Barreto, P., Pereira, S., Ventura, A., Mota, M., Seabra, J., Sakaguchi, T., Kobayashi, S., Yano, T., Yoshimoto, W., Bancu, I., Bastons, J. B., Escayola, M. C., Vallespin, E. V., Poblet, M. B., Luque, D. M., Fabregas, M. P., Chen, J., Chen, S., Chang, J., Hwang, S., Chen, H., Ahbap, E., Kara, E., Basturk, T., Sahutoglu, T., Koc, Y., Sakaci, T., Sevinc, M., Akgol, C., Ozagari, A. A., Unsal, A., Minami, S., Hesaka, A., Yamaguchi, S., Iwahashi, E., Sakai, S., Fujimoto, T., Sasaki, K., Fujita, Y., Yokoyama, K., Marks, A., Fluck, N., Prescott, G., Robertson, L., Smith, W. C., Black, C., Ohsawa, M., Fujioka, T., Omori, S., Isurugi, T., Tanno, K., Onoda, T., Omama, S., Ishibashi, Y., Makita, S., Okayama, A., Garland, J. S., Simpson, C. S., Metangi, M. F., Parfrey, B., Johri, A. M., Sloan, L., Mcauley, J., Cunningham, R., Mullan, R., Quinn, M., Harron, C., Chiu, H., Murphy Burke, D., Werb, R., Jung, B., Chan Yan, C., Duncan, J., Forzley, B., Lowry, R., Hargrove, G., Carson, R., Levin, A., Karim, M., Reznik, E. V., G. I. V., Rollino, C., Troiano, M., Bagatella, M., Liuzzo, C., Quarello, F., Roccatello, D., Blaslov, K., Bulum, T., Prkacin, I., Duvnjak, L., Heleniak, Z., Cieplinska, M., Szychlinski, T., Pryczkowska, M., Bartosinska, E., Wiatr, H., Kotlowska, H., Tylicki, L., Rutkowski, B., Song, Y. R., Kim, S. G., Kim, H. J., Noh, J. W., Tong, A., Jesudason, S., Craig, J. C., Winkelmayer, W. C., Hung, P. H., Huang, Y. T., Hsiao, C. Y., Sung, P. S., Guo, H. R., Tsai, K. J., Wu, C., Su, S., Kao, S., Lu, K., Lin, Y., Lin, W., Lee, H., Cheng, M., Wang, W., Yang, L., Wang, M., Lela, I. V., Sekoranja, M., Poljicanin, T., Karanovic, S., Abramovic, M., Matijevic, V., Stipancic, Z., Leko, N., Cvitkovic, A., Dika, Z., Kos, J., Laganovic, M., Grollman, A. P., Jelakovic, B., Dryl Rydzynska, T., Prystacki, T., Malyszko, J., Trifiro', Gianluca, Sultana, J., Giorgianni, F., Ingrasciotta, Y., Muscianisi, M., Tari, D. U., Perrotta, M., Buemi, Michele, Canale, V., Arcoraci, Vincenzo, Santoro, Domenico, Rizzo, M., Iheanacho, I., Van, F. E., Goldsmith, D., Grandtnerova, B., Beratsova, Z., Cervenˇova, M., Cˇervenˇ, J., Markech, M., Stefanikova, A., Engelen, W., Elseviers, M., Gheuens, E., Colson, C., Muyshondt, I., and Daelemans, R.
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Transplantation ,medicine.medical_specialty ,business.industry ,urologic and male genital diseases ,medicine.disease ,Gastroenterology ,female genital diseases and pregnancy complications ,Nephrology ,Internal medicine ,mental disorders ,Medicine ,Stage (cooking) ,Metabolic syndrome ,business ,Kidney disease - Published
- 2014
5. Prognosis of CKD Patients Receiving Outpatient Nephrology Care in Italy
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DE NICOLA, Luca, CHIODINI, Paolo, ZOCCALI C, BORRELLI S, CIANCIARUSO B, DI IORIO B, SANTORO D, GIANCASPRO V, ABATERUSSO C, GALLO, Ciro, CONTE, Giuseppe, MINUTOLO, Roberto, FOR THE SIN TABLE CKD STUDY GROUP, ZAMBOLI, Pasquale, DE NICOLA, Luca, Chiodini, Paolo, Zoccali, C, Borrelli, S, Cianciaruso, B, DI IORIO, B, Santoro, D, Giancaspro, V, Abaterusso, C, Gallo, Ciro, Conte, Giuseppe, Minutolo, Roberto, FOR THE SIN TABLE CKD STUDY, Group, Zamboli, Pasquale, De Nicola, L, Chiodini, P, Cianciaruso, Bruno, Di Iorio, B, Gallo, C, Conte, G, Minutolo, R, and SIN TABLE CKD Study, Group
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Nephrology ,Male ,Time Factors ,Epidemiology ,Kaplan-Meier Estimate ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,Risk Factors ,Ambulatory Care ,Cumulative incidence ,Prospective Studies ,Prospective cohort study ,Aged, 80 and over ,education.field_of_study ,Incidence ,Continuity of Patient Care ,Middle Aged ,female genital diseases and pregnancy complications ,Proteinuria ,Treatment Outcome ,Italy ,Cohort ,Disease Progression ,Female ,Kidney Diseases ,Glomerular Filtration Rate ,medicine.medical_specialty ,Population ,CKD conservative treatment ,Risk Assessment ,Ambulatory care ,Internal medicine ,Severity of illness ,medicine ,Humans ,Intensive care medicine ,education ,Aged ,Proportional Hazards Models ,Transplantation ,Analysis of Variance ,Chi-Square Distribution ,business.industry ,Original Articles ,medicine.disease ,nephrology care ,Nonlinear Dynamics ,Kidney Failure, Chronic ,business ,Kidney disease - Abstract
Prognosis in nondialysis chronic kidney disease (CKD) patients under regular nephrology care is rarely investigated. Design, setting, participants,measurements We prospectively followed from 2003 to death or June 2010 a cohort of 1248 patients with CKD stages 3 to 5 and previous nephrology care ≥1 year in 25 Italian outpatient nephrology clinics. Cumulative incidence of ESRD or death before ESRD were estimated using the competing-risk approach.Estimated rates (per 100 patient-years) of ESRD and death 8.3 (95% confidence interval [CI], 7.4 to 9.2) and 5.9 (95% CI 5.2 to 6.6), respectively. Risk of ESRD and death increased progressively from stages 3 to 5. ESRD was more frequent than death in stage 4 and 5 CKD, whereas the opposite was true in stage 3 CKD. Younger age, lower body mass index, proteinuria, and high phosphate predicted ESRD, whereas older age, diabetes, previous cardiovascular disease, ESRD, proteinuria, high uric acid, and anemia predicted death (P0.05 for all). Among modifiable risk factors, proteinuria accounted for the greatest contribution to the model fit for either outcome.In patients receiving continuity of care in Italian nephrology clinics, ESRD was a more frequent outcome than death in stage 4 and 5 CKD, but the opposite was true in stage 3. Outcomes were predicted by modifiable risk factors specific to CKD. Proteinuria used in conjunction with estimated GFR refined risk stratification. These findings provide information, specific to CKD patients under regular outpatient nephrology care, for risk stratification that complement recent observations in the general population.
- Published
- 2011
6. Prevalence and prognosis of mild anemia in non-dialysis chronic kidney disease: a prospective cohort study in outpatient renal clinics
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De Nicola, L, Minutolo, R, Chiodini, P, Zamboli, P, Cianciaruso, B, Nappi, F, Signoriello, S, Conte, G, Zoccali, C, Iodice, Fc, Borrelli, S, Scigliano, Rosella, Gallo, C, Materiale, T, Minale, B, Paglionico, C, Pota, A, Andreucci, Ve, Avella, Fabrizio, Di Iorio BR, Bellizzi, V, Cestaro, R, Martignetti, V, Morrone, L, Lupo, A, Abaterusso, C, Donadio, C, Bonomini, M, Sirolli, V, F Lopez T, Casino, Detomaso, F, Giannattasio, M, Virgilio, M, Tarantino, G, Cristofano, C, Tuccillo, S, Chimienti, S, Petrarulo, F, Giancaspro, V, Strippoli, M, Laraia, E, Gallucci, M, Gigante, B, Lodeserto, C, Santese, D, Montanaro, A, Giordano, R, Caglioti, A, Fuiano, G, Cariddi, G, Postorino, M, Savica, V, Monardo, P, Bellinghieri, G, Santoro, D, Castellino, P, Rapisarda, F, Fatuzzo, P, Messina, A, De Nicola, L, Minutolo, R, Chiodini, P, Zamboli, P, Cianciaruso, Bruno, Nappi, F, Signoriello, S, Conte, G, Zoccali, C, and SIN TABLE CDK Study, Group
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Male ,medicine.medical_specialty ,Epoietin- CKD -renal anemia- hemoglobin variability ,Survival ,Anemia ,Renal function ,Kaplan-Meier Estimate ,Chronic kidney disease ,End-stage renal disease ,Hemoglobin ,Aged ,Aged, 80 and over ,Ambulatory Care Facilities ,Female ,Glomerular Filtration Rate ,Hemoglobins ,Humans ,Kidney Failure, Chronic ,Longitudinal Studies ,Middle Aged ,Predictive Value of Tests ,Prevalence ,Prognosis ,Proportional Hazards Models ,Prospective Studies ,Renal Insufficiency, Chronic ,Survival Analysis ,Disease Progression ,End stage renal disease ,Kidney Failure ,Internal medicine ,80 and over ,medicine ,Renal Insufficiency ,Chronic ,Intensive care medicine ,Prospective cohort study ,Survival analysis ,business.industry ,Proportional hazards model ,medicine.disease ,Nephrology ,Predictive value of tests ,business ,Kidney disease - Abstract
Background/Aims: We evaluated prevalence and prognosis of mild anemia, defined as Hb (g/dl) 11–13.5 in males and 11–12 in females, in a prospective cohort of stage 3–5 chronic kidney disease (CKD) patients. Methods: We enrolled 668 consecutive patients in 25 renal clinics during 2003. Patients with frank anemia (Hb Results: Mild anemia was present in 41.3% at visit 1 and 34.1% at visit 2. We identified PER in 22% patients, RES in 10%, and PRO in 26%. In the subsequent 40 months, 125 patients developed end-stage renal disease (ESRD) and 94 died. At competing risk model, PER predicted ESRD (hazard ratio, HR, 1.82, 95% confidence interval, CI, 1.01–3.29) while PRO predicted both ESRD (HR 1.81, 95% CI 1.02–3.23) and death (HR 1.87, 95% CI 1.04–3.37). Conclusion: In non-dialysis chronic kidney disease, mild anemia is prevalent and it is a marker of risk excess when persistent or progressive over time.
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- 2010
7. Global approach to cardiovascular risk in chronic kidney disease: reality and opportunities for intervention
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De Nicola, L, Minutolo, R, Chiodini, P, Zoccali, C, Castellino, P, Donadio, C, Strippoli, M, Casino, F, Giannattasio, M, Petrarulo, F, Virgilio, M, Laraia, E, Di Iorio, B, Savica, V, Conte, G, Zamboli, P, Catapano, F, Maione, E, Tirino, G, Venditti, G, Avino, D, Borrelli, S, Scigliano, R, Materiale, T, Signoriello, G, Gallo, C, Cianciaruso, B, Torraca, S, Pota, A, Andreucci, Ve, Nappi, F, Avella, F, Di Iorio BR, Bellizzi, V, D'Apice, L, Mangiacapra, S, Caserta, D, Cestaro, R, Marzano, L, Giannattasio, P, Martignetti, V, Morrone, L, Budetta, F, Gigliotti, G, Iodice, C, Rubino, R, Lupo, A, Conte, M, Panichi, V, Bonomini, M, Sirolli, V, Lopez, T, Detomaso, F, Elia, F, Tarantino, G, Cristofano, C, Chimienti, S, Montanaro, A, Giordano, R, Marangi, A, Giancaspro, V, Gallucci, M, Gigante, B, Lodeserto, C, Santese, D, Caglioti, A, Mancuso, D, Fuiano, G, Mallamaci, F, Postorino, M, Monardo, P, Bellinghieri, G, Mallamace, A, Rapisarda, F, Fatuzzo, P, Messina, A, DE NICOLA, Luca, Minutolo, Roberto, Chiodini, Paolo, Zamboni, P., Zoccali, C., Castellino, P., Donadio, C., Strippoli, M., Casino, F., Giannattasio, M., Petrarulo, F., Virgilio, M., Laraia, E., DI IORIO, B., Savica, V., and Conte, Giuseppe
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Nephrology ,Male ,epoietin ,medicine.medical_specialty ,Anemia ,Cross-sectional study ,diuretic ,Hypercholesterolemia ,Severity of Illness Index ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,CKD ,Diabetes Mellitus ,Odds Ratio ,Prevalence ,Humans ,Antihypertensive Agents ,Aged ,Aged, 80 and over ,business.industry ,statin ,Odds ratio ,Middle Aged ,medicine.disease ,diuretics ,Confidence interval ,Surgery ,Proteinuria ,Cross-Sectional Studies ,Italy ,Cardiovascular Diseases ,Chronic Disease ,Hypertension ,Practice Guidelines as Topic ,Female ,Hypertrophy, Left Ventricular ,Kidney Diseases ,sodium excretion ,business ,Dyslipidemia ,Kidney disease - Abstract
The current implementation into nephrology clinical practice of guidelines on treatment of cardiovascular (CV) risk factors in chronic kidney disease (CKD) is unknown. We designed a cross-sectional analysis to evaluate the prevalence and treatment of eight modifiable CV risk factors in 1058 predialysis CKD patients (stage 3: n =486; stage 4: n =430, stage 5: n =142) followed for at least 1 year in 26 Italian renal clinics. The median nephrology follow-up was 37 months (range: 12–391 months). From stages 3 to 5, hypertension was the main complication (89, 87, and 87%), whereas smoking, high calcium-phosphate product and malnutrition were uncommon. The prevalence of proteinuria (25, 38, and 58%), anemia (16, 32, and 51%) and left ventricular hypertrophy (51, 55, and 64%) significantly increased, while hypercholesterolemia was less frequent in stage 5 (49%) than in stages 4 and 3 (59%). The vast majority of patients received multidrug antihypertensive therapy including inhibitors of renin–angiotensin system; conversely, diuretic treatment was consistently inadequate for both frequency and dose despite scarce implementation of low salt diet (19%). Statins were not prescribed in most hypercholesterolemics (78%), and epoietin treatment was largely overlooked in anemics (78%). The adjusted risk for having a higher number of uncontrolled risk factors rose in the presence of diabetes (odds ratio 1.29, 95% confidence interval 1.00–1.66), history of CV disease (odds ratio 1.48, 95% confidence interval 1.15–1.90) and CKD stages 4 and 5 (odds ratio 1.75, 95% confidence interval 1.37–2.22 and odds ratio 2.85, 95% confidence interval 2.01–4.04, respectively). In the tertiary care of CKD, treatment of hypertension is largely inadequate, whereas therapy of anemia and dyslipidemia is frequently omitted. The risk of not achieving therapeutic targets is higher in patients with diabetes, CV disease and more advanced CKD.
- Published
- 2006
8. The effect of increasing age on the prognosis of non-dialysis patients with chronic kidney disease receiving stable nephrology care
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De Nicola, L., Minutolo, R., Chiodini, P., Borrelli, S., Zoccali, C., Postorino, M., Iodice, C., Nappi, F., Fuiano, G., Gallo, C., Conte, G., Nicola, L., Zamboli, P., Signoriello, S., Materiale, T., Minale, B., Paglionico, C., Cianciaruso, B., Pota, A., Avella, F., Di Iorio, B. R., Bellizzi, V., Cestaro, R., Martignetti, V., Morrone, L., Lupo, A., Abaterusso, C., Donadio, C., Bonomini, M., Sirolli, V., Lopez, T., Detomaso, F., Giannattasio, M., Virgilio, M., Tarantino, G., Cristofano, C., Tuccillo, S., Chimienti, S., Petrarulo, F., Giancaspro, V., Strippoli, M., Laraia, E., Gallucci, M., Gigante, B., Lodeserto, C., Santese, D., Montanaro, A., Giordano, R., Caglioti, A., Caridi, G., Savica, Vincenzo, Monardo, P., Bellinghieri, Guido, Santoro, Domenico, Castellino, P., Rapisarda, F., Fatuzzo, P., Messina, A., DE NICOLA, Luca, Minutolo, Roberto, Chiodini, Paolo, Borrelli, Silvio, Zoccali, Carmine, Postorino, Maurizio, Iodice, Carmela, Nappi, Felice, Fuiano, Giorgio, Gallo, Ciro, and Conte, Giuseppe
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Male ,Nephrology ,Aging ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Kidney ,urologic and male genital diseases ,Risk Factors ,Age Factor ,Prospective Studies ,Prospective cohort study ,Multivariate Analysi ,Aged, 80 and over ,Proteinuria ,Incidence ,Age Factors ,Middle Aged ,age ,chronic kidney disease ,elderly ,ESRD ,nephrology care ,survival ,Prognosis ,female genital diseases and pregnancy complications ,Italy ,Disease Progression ,Female ,medicine.symptom ,Risk assessment ,Glomerular Filtration Rate ,Human ,medicine.medical_specialty ,Time Factor ,Prognosi ,Renal function ,Risk Assessment ,Follow-Up Studie ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Renal Insufficiency, Chronic ,Intensive care medicine ,Dialysis ,Proportional Hazards Models ,Aged ,Chi-Square Distribution ,business.industry ,Risk Factor ,medicine.disease ,Prospective Studie ,Multivariate Analysis ,Proportional Hazards Model ,Kidney Failure, Chronic ,business ,Follow-Up Studies ,Kidney disease - Abstract
To define whether age modifies the prognosis of patients with chronic kidney disease (CKD) on nephrology care, we prospectively followed patients with CKD who have been receiving nephrology care in a clinic for 1 year or more. The incidence of end-stage renal disease (ESRD), defined by the occurrence of dialysis or transplant, or death without ESRD was estimated by a competing-risk approach, and interactions between age and risk factors tested in Cox models over a median follow-up period of 62.4 months. Of 1248 patients with stage III-V CKD, 481 were younger than 65, 410 were between 65 and 75, and 357 were over 75 years old. Within each age class, the mean estimated glomerular filtration rate (eGFR) was 31, 32, and 29 ml/min per 1.73 m2, respectively. There were 394 ESRD events and 353 deaths. The risk of ESRD was higher than the risk of death without ESRD for ages 60 years, and independent of eGFR. The ESRD risk diminished with aging but still prevailed for eGFRs of 25-35 in patients between 65 and 75 years and with an eGFR below 15 in those up to 85 years old. Proteinuria significantly increased the risk of ESRD with advancing age. Surprisingly, the unfavorable effects of cardiovascular disease on ESRD and of diabetes on survival significantly decreased with increasing age. Male gender, higher phosphate, lower body mass index, and hemoglobin were age-independent predictors for ESRD, while cardiovascular disease, lower hemoglobin, higher proteinuria and uric acid, and ESRD also predicted death. Thus, in older patients on nephrology care, the risk of ESRD prevailed over mortality even when eGFR was not severely impaired. Proteinuria increases ESRD risk, while the predictive role of other modifiable risk factors was unchanged compared with younger patients. © 2012 International Society of Nephrology.
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9. Precision Nephrology Is a Non-Negligible State of Mind in Clinical Research
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Silvio Borrelli, Michele Andreucci, Carlo Garofalo, Michelle J Pena, Laura Antolini, Ida Gagliardi, Giulia Capitoli, Luca De Nicola, Michele Provenzano, Provenzano, M., De Nicola, L., Pena, M. J., Capitoli, G., Garofalo, C., Borrelli, S., Gagliardi, I., Antolini, L., Andreucci, M., Provenzano, M, De Nicola, L, Pena, M, Capitoli, G, Garofalo, C, Borrelli, S, Gagliardi, I, Antolini, L, and Andreucci, M
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medicine.medical_specialty ,Population ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Chronic kidney disease ,Ckd ,medicine ,Albuminuria ,Humans ,Precision Medicine ,Renal Insufficiency, Chronic ,Risk factor ,Intensive care medicine ,education ,education.field_of_study ,ESKD ,business.industry ,End-stage kidney disease ,Cardiovascular risk ,Prognosis ,Cardiovascular disease ,Precision medicine ,Personalized medicine ,Clinical trial ,Proteinuria ,Treatment Outcome ,Clinical research ,Nephrology ,Cohort ,Disease Progression ,Risk score ,Observational study ,Precision nephrology ,business ,Glomerular Filtration Rate - Abstract
CKD is a major public health problem. It is characterized by a multitude of risk factors that, when aggregated, can strongly modify outcome. While major risk factors, namely, albuminuria and low estimated glomerular filtration rate (eGFR) have been well analyzed, a large variability in disease progression still remains. This happens because (1) the weight of each risk factor varies between populations (general population or CKD cohort), countries, and single individuals and (2) response to nephroprotective drugs is so heterogeneous that a non-negligible part of patients maintains a high cardiorenal risk despite optimal treatment. Precision nephrology aims at individualizing cardiorenal prognosis and therapy. The purpose of this review is to focus on the risk stratification in different areas, such as clinical practice, population research, and interventional trials, and to describe the strategies used in observational or experimental studies to afford individual-level evidence. The future of precision nephrology is also addressed. Observational studies can in fact provide more adequate findings by collecting more information on risk factors and building risk prediction models that can be applied to each individual in a reliable fashion. Similarly, new clinical trial designs can reduce the individual variability in response to treatment and improve individual outcomes.
- Published
- 2020
10. Lived experiences of the partners of COVID-19 positive childbearing women: A qualitative study
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Simona Fumagalli, Sara Ornaghi, Antonella Nespoli, Patrizia Vergani, Sara E. Borrelli, Nespoli, A, Ornaghi, S, Borrelli, S, Vergani, P, and Fumagalli, S
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Coronaviru ,Context (language use) ,Midwifery ,Maternity care ,Birth companion ,Pregnancy ,Maternity and Midwifery ,Pandemic ,medicine ,Humans ,Childbirth ,Maternal Health Services ,MED/47 - SCIENZE INFERMIERISTICHE OSTETRICO-GINECOLOGICHE ,Qualitative Research ,Experience ,Interpretative phenomenological analysis ,Lived experience ,Infant, Newborn ,Parturition ,COVID-19 ,Obstetrics and Gynecology ,Delivery, Obstetric ,Family medicine ,Partner ,Female ,Psychology ,Qualitative research - Abstract
Problem Several maternity units worldwide have rapidly put in place changes to maternity care pathways and restrictive preventive measures in the attempt to limit the spread of COVID-19, resulting in birth companions often not being allowed to be present at birth and throughout hospital admission. Background The WHO strongly recommends that the emotional, practical, advocacy and health benefits of having a chosen birth companion are respected and accommodated, including women with suspected, likely or confirmed COVID-19. Aim To explore the lived experiences of the partners of COVID-19 positive childbearing women who gave birth during the first pandemic wave (March and April 2020) in a Northern Italy maternity hospital. Methods A qualitative study using an interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 14 partners. Thematic data analysis was conducted using NVivo software. Ethical approval was obtained from the relevant Ethics Committee prior to commencing the study. Findings The findings include five main themes: (1) emotional impact of the pandemic; (2) partner and parent: a dual role; (3) not being present at birth: a ‘denied’ experience; (4) returning to ‘normality’; (5) feedback to ‘pandemic’ maternity services and policies. Discussion and conclusion Key elements of good practice to promote positive childbirth experiences in the context of a pandemic were identified: presence of a birth companion; COVID-19 screening tests for support persons; timely, proactive and comprehensive communication of information to support persons; staggered hospital visiting times; follow-up of socio-psychological wellbeing; antenatal and postnatal home visiting; family-centred policies and services.
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- 2022
11. The experiences of childbearing women who tested positive to COVID-19 during the pandemic in northern Italy
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Simona Fumagalli, Sara E. Borrelli, Patrizia Vergani, Sara Ornaghi, Antonella Nespoli, Fumagalli, S, Ornaghi, S, Borrelli, S, Vergani, P, and Nespoli, A
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Male ,Coping (psychology) ,medicine.medical_specialty ,Referral ,Coronavirus disease 2019 (COVID-19) ,Coronaviru ,Midwifery ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Obstetrics and Gynaecology ,Maternity and Midwifery ,Pandemic ,medicine ,Humans ,Childbirth ,Women ,Maternal Health Services ,MED/47 - SCIENZE INFERMIERISTICHE OSTETRICO-GINECOLOGICHE ,Pandemics ,Qualitative Research ,Experience ,030219 obstetrics & reproductive medicine ,030504 nursing ,Interpretative phenomenological analysis ,Infant, Newborn ,Parturition ,COVID-19 ,Obstetrics and Gynecology ,Northern italy ,Coronavirus ,Maternity care ,Family medicine ,Female ,Pregnant Women ,Thematic analysis ,0305 other medical science ,Psychology - Abstract
Problem The COVID-19 pandemic has significantly challenged maternity provision internationally. COVID-19 positive women are one of the childbearing groups most impacted by the pandemic due to drastic changes to maternity care pathways put in place. Background Some quantitative research was conducted on clinical characteristics of pregnant women with COVID-19 and pregnant women’s concerns and birth expectations during the COVID-19 pandemic, but no qualitative findings on childbearing women’s experiences during the pandemic were published prior to our study. Aim To explore childbearing experiences of COVID-19 positive mothers who gave birth in the months of March and April 2020 in a Northern Italy maternity hospital. Methods A qualitative interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 22 women. Thematic analysis was completed using NVivo software. Ethical approval was obtained from the research site’s Ethics Committee prior to commencing the study. Findings The findings include four main themes: 1) coping with unmet expectations; 2) reacting and adapting to the ‘new ordinary’; 3) ‘pandemic relationships’; 4) sharing a traumatic experience with long-lasting emotional impact. Discussion The most traumatic elements of women’s experiences were the sudden family separation, self-isolation, transfer to a referral centre, the partner not allowed to be present at birth and limited physical contact with the newborn. Conclusion Key elements of good practice including provision of compassionate care, presence of birth companions and transfer to referral centers only for the most severe COVID-19 cases should be considered when drafting maternity care pathways guidelines in view of future pandemic waves.
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- 2022
12. Blood Pressure Variability, Mortality, and Cardiovascular Outcomes in CKD Patients
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Luca De Nicola, Francesca Mallamaci, Giovanna Stanzione, Graziella D'Arrigo, Giuseppe Conte, Carmine Zoccali, Carlo Garofalo, Michele Provenzano, Roberto Minutolo, Silvio Borrelli, Giovanni Tripepi, Mallamaci, F., Tripepi, G., D'Arrigo, G., Borrelli, S., Garofalo, C., Stanzione, G., Provenzano, M., De Nicola, L., Conte, G., Minutolo, R., and Zoccali, C.
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Male ,medicine.medical_specialty ,Time Factors ,hypertension ,Ambulatory blood pressure ,Prognosi ,Systole ,Epidemiology ,Population ,Critical Care and Intensive Care Medicine ,Risk Assessment ,Predictive Value of Tests ,Interquartile range ,Internal medicine ,Ambulatory Care ,medicine ,Humans ,Renal Insufficiency, Chronic ,education ,Aged ,Transplantation ,education.field_of_study ,business.industry ,cardiovascular ,Hazard ratio ,Editorials ,blood pressure ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,Confidence interval ,Blood pressure ,Cardiovascular Diseases ,Nephrology ,Cohort ,Ambulatory ,Cardiology ,mortality risk ,Female ,business ,chronic kidney disease ,Glomerular Filtration Rate - Abstract
Background and objectives Short-term BP variability (derived from 24-hour ambulatory BP monitoring) and long-term BP variability (from clinic visit to clinic visit) are directly related to risk for cardiovascular events, but these relationships have been scarcely investigated in patients with CKD, and their prognostic value in this population is unknown. Design, setting, participants, & measurements In a cohort of 402 patients with CKD, we assessed associations of short- and long-term systolic BP variability with a composite end point of death or cardiovascular event. Variability was defined as the standard deviation of observed BP measurements. We further tested the prognostic value of these parameters for risk discrimination and reclassification. Results Mean ± SD short-term systolic BP variability was 12.6±3.3 mm Hg, and mean ± SD long-term systolic BP variability was 12.7±5.1 mm Hg. For short-term BP variability, 125 participants experienced the composite end point over a median follow-up of 4.8 years (interquartile range, 2.3–8.6 years). For long-term BP variability, 110 participants experienced the composite end point over a median follow-up of 3.2 years (interquartile range, 1.0–7.5 years). In adjusted analyses, long-term BP variability was significantly associated with the composite end point (hazard ratio, 1.24; 95% confidence interval, 1.01 to 1.51 per 5-mm Hg higher SD of office systolic BP), but short-term systolic BP variability was not (hazard ratio, 0.92; 95% confidence interval, 0.68 to 1.25 per 5-mm Hg higher SD of 24-hour ambulatory systolic BP). Neither estimate of BP variability improved risk discrimination or reclassification compared with a simple risk prediction model. Conclusions In patients with CKD, long-term but not short-term systolic BP variability is related to the risk of death and cardiovascular events. However, BP variability has a limited role for prediction in CKD.
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- 2019
13. 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
14. Sex difference in ambulatory blood pressure control associates with risk of ESKD and death in CKD patients receiving stable nephrology care
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Rajiv Agarwal, Ernesto Paoletti, Francis B. Gabbai, Maura Ravera, Carlo Garofalo, Giuseppe Conte, Paolo Chiodini, Silvio Borrelli, Roberto Minutolo, Vincenzo Bellizzi, Luca De Nicola, Simona Signoriello, Minutolo, R., Gabbai, F. B., Agarwal, R., Garofalo, C., Borrelli, S., Chiodini, P., Signoriello, S., Paoletti, E., Ravera, M., Bellizzi, V., Conte, G., and De Nicola, L.
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Nephrology ,Male ,medicine.medical_specialty ,Ambulatory blood pressure ,epidemiology and outcome ,Renal function ,Blood Pressure ,Interquartile range ,Internal medicine ,medicine ,sex ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,Transplantation ,Sex Characteristics ,business.industry ,Hazard ratio ,Sex Characteristic ,Blood Pressure Monitoring, Ambulatory ,medicine.disease ,Confidence interval ,ambulatory blood pressure monitoring ,Prospective Studie ,Blood pressure ,Hypertension ,Kidney Failure, Chronic ,Female ,business ,chronic kidney disease ,Human ,Kidney disease - Abstract
Background It is unknown whether faster progression of chronic kidney disease (CKD) in men than in women relates to differences in ambulatory blood pressure (ABP) levels. Methods We prospectively evaluated 906 hypertensive CKD patients (553 men) regularly followed in renal clinics to compare men versus women in terms of ABP control [daytime Results Age, estimated glomerular filtration rate and use of renin–angiotensin system inhibitors were similar in men and women, while proteinuria was lower in women [0.30 g/24 h interquartile range (IQR) 0.10–1.00 versus 0.42 g/24 h, IQR 0.10–1.28, P = 0.025]. No sex-difference was detected in office BP levels; conversely, daytime and nighttime BP were higher in men (134 ± 17/78 ± 11 and 127 ± 19/70 ± 11 mmHg) than in women (131 ± 16/75 ± 11, P = 0.005/P Conclusions Our study highlights that higher ABP significantly contributes to higher risks of ESKD and mortality in men.
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- 2020
15. Midwifery students' perspectives of physical and virtual mobility activities including preferences for e-learning: A cross-sectional survey
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K. Coolin, Simona Fumagalli, Anne-Marike Smit, Antonella Nespoli, Sara E. Borrelli, Annely Karema, S. Mets-Oja, M. Van Oost, Louise Walker, Stathis Th. Konstantinidis, Helen Spiby, Borrelli, S, Walker, L, Coolin, K, Fumagalli, S, Karema, A, Konstantinidis, S, Mets-Oja, S, Nespoli, A, Smit, A, Van Oost, M, and Spiby, H
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Mobility model ,medicine.medical_specialty ,Higher education ,Language barrier ,Virtual mobility ,E-learning ,Midwifery ,Education ,Pregnancy ,medicine ,Global health ,Humans ,Intercultural sensitivity ,MED/47 - SCIENZE INFERMIERISTICHE OSTETRICO-GINECOLOGICHE ,Survey ,Erasmus+ ,General Nursing ,Bespoke ,Physical mobility ,business.industry ,Obstetrics ,Education, Nursing, Baccalaureate ,Student mobility ,Cross-Sectional Studies ,Virtual learning environment ,Erasmu ,Female ,Students, Nursing ,Psychology ,business ,Computer-Assisted Instruction - Abstract
Background Contemporary higher education requires that all midwifery students have insight and understanding of global health practice and demonstrate intercultural sensitivity. However, the mobility models currently offered do not often fit the lives of large numbers of midwifery students. Objectives To investigate midwifery students' international physical mobility activities and factors that affect mobility; to determine midwifery students' learning needs and preferences for related e-learning packages. Design Multi-centre, descriptive quantitative survey. Settings Four European Higher Education Institutions based in the United Kingdom, Estonia, Italy and the Netherlands offering an undergraduate midwifery programme. Participants The sample included 205 midwifery students from Italy (n = 93), the Netherlands (n = 51); United Kingdom (n = 35) and Estonia (n = 26). Methods Data were collected in June–July 2020 through an online cross-sectional, bespoke questionnaire and analysed using summary statistical analysis. Results There is a high level of interest across a range of mobility opportunities, especially those of shorter duration. Barriers to mobility comprised finance, caring responsibilities, concerns about fitting mobility activities into the midwifery programme, negative impact on studies and language barriers. The most frequently identified facilitators of mobility included professional perspectives such as interest in other cultures and midwifery in other settings and an endorsement that mobility would add value to their development as a midwife. When engaging in virtual learning, the most preferred resources mentioned by the students were videos, video calls with peers, choice quiz and discussion forum. Conclusions The barriers identified require new approaches to enable all midwifery students to benefit from transnational learning. The survey findings provide insights into midwifery students' perspectives from which a new mobility model can be developed.
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- 2022
16. Anticoagulant treatment in COVID-19: a narrative review
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Carfora, Vincenzo, Spiniello, Giorgio, Ricciolino, Riccardo, Di Mauro, Marco, Migliaccio, Marco Giuseppe, Mottola, Filiberto Fausto, Verde, Nicoletta, Coppola, Nicola, Sagnelli, Caterina, De Pascalis, Stefania, Stanzione, Maria, Stornaiuolo, Gianfranca, Cascone, Angela, Martini, Salvatore, Macera, Margherita, Monari, Caterina, Calò, Federica, Bianco, Andrea, Russo, Antonio, Gentile, Valeria, Camaioni, Clarissa, De Angelis, Giulia, Marino, Giulia, Astorri, Roberta, De Sio, Ilario, Niosi, Marco, Borrelli, Serena, Celia, Benito, Ceparano, Maria, Cirillo, Salvatore, De Luca, Maria, Mazzeo, Grazia, Paoli, Giorgio, Russo, Maria Giovanna, Carfora, V., Spiniello, G., Ricciolino, R., Di Mauro, M., Migliaccio, M. G., Mottola, F. F., Verde, N., Coppola, N., Sagnelli, C., De Pascalis, S., Stanzione, M., Stornaiuolo, G., Cascone, A., Martini, S., Macera, M., Monari, C., Calo, F., Bianco, A., Gentile, V., Camaioni, C., De Angelis, G., Marino, G., Astorri, R., De Sio, I., Niosi, M., Borrelli, S., Celia, B., Ceparano, M., Cirillo, S., De Luca, M., Mazzeo, G., Paoli, G., Russo, M. G., and Russo, A.
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medicine.medical_specialty ,Disease ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Article ,Pathogenesis ,03 medical and health sciences ,Anticoagulation ,0302 clinical medicine ,Internal medicine ,Pandemic ,medicine ,Humans ,Thrombophilia ,Endothelial dysfunction ,Intensive care medicine ,030304 developmental biology ,Coronavirus ,0303 health sciences ,Hematology ,business.industry ,SARS-CoV-2 ,Anticoagulants ,COVID-19 ,Thrombosis ,medicine.disease ,COVID-19 Drug Treatment ,Host-Pathogen Interactions ,business ,Cytokine storm ,Cardiology and Cardiovascular Medicine ,Algorithms - Abstract
The actual Coronavirus Disease (COVID 19) pandemic is due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the coronavirus family. Besides the respiratory involvement, COVID 19 patients frequently develop a pro-coagulative state caused by virus-induced endothelial dysfunction, cytokine storm and complement cascade hyperactivation. It is common to observe diffuse microvascular thrombi in multiple organs, mostly in pulmonary microvessels. Thrombotic risk seems to be directly related to disease severity and worsens patients’ prognosis. Therefore, the correct understanding of the mechanisms underlying COVID-19 induced prothrombotic state can lead to a thorough assessment of the possible management strategies. Hence, we review the pathogenesis and therapy of COVID 19-related thrombosis disease, focusing on the available evidence on the possible treatment strategies and proposing an algorithm for the anticoagulation strategy based on disease severity.
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- 2020
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17. Contribution of Predictive and Prognostic Biomarkers to Clinical Research on Chronic Kidney Disease
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Ida Gagliardi, Salvatore Rotundo, Michele Provenzano, Paolo Chiodini, Daniela Foti, Giovambattista De Sarro, Michele Andreucci, Elvira Angotti, Raffaele Serra, Ashour Michael, Silvio Borrelli, Provenzano, M., Rotundo, S., Chiodini, P., Gagliardi, I., Michael, A., Angotti, E., Borrelli, S., Serra, R., Foti, D., De Sarro, G., and Andreucci, M.
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medicine.medical_specialty ,end-stage kidney disease (ESKD) ,Renal function ,Review ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Catalysis ,lcsh:Chemistry ,Inorganic Chemistry ,03 medical and health sciences ,0302 clinical medicine ,cardiovascular disease ,Epidemiology ,medicine ,CKD ,Humans ,030212 general & internal medicine ,Physical and Theoretical Chemistry ,Renal Insufficiency, Chronic ,Intensive care medicine ,lcsh:QH301-705.5 ,Molecular Biology ,Spectroscopy ,business.industry ,Incidence (epidemiology) ,Organic Chemistry ,Reproducibility of Results ,biomarkers ,General Medicine ,Biomarker ,medicine.disease ,Prognosis ,female genital diseases and pregnancy complications ,Computer Science Applications ,Clinical trial ,Observational Studies as Topic ,Oxidative Stress ,Clinical research ,lcsh:Biology (General) ,lcsh:QD1-999 ,Albuminuria ,Observational study ,epidemiology ,medicine.symptom ,business ,Kidney disease - Abstract
Chronic kidney disease (CKD), defined as the presence of albuminuria and/or reduction in estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, is considered a growing public health problem, with its prevalence and incidence having almost doubled in the past three decades. The implementation of novel biomarkers in clinical practice is crucial, since it could allow earlier diagnosis and lead to an improvement in CKD outcomes. Nevertheless, a clear guidance on how to develop biomarkers in the setting of CKD is not yet available. The aim of this review is to report the framework for implementing biomarkers in observational and intervention studies. Biomarkers are classified as either prognostic or predictive; the first type is used to identify the likelihood of a patient to develop an endpoint regardless of treatment, whereas the second type is used to determine whether the patient is likely to benefit from a specific treatment. Many single assays and complex biomarkers were shown to improve the prediction of cardiovascular and kidney outcomes in CKD patients on top of the traditional risk factors. Biomarkers were also shown to improve clinical trial designs. Understanding the correct ways to validate and implement novel biomarkers in CKD will help to mitigate the global burden of CKD and to improve the individual prognosis of these high-risk patients.
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- 2020
18. Predictive effect of salt intake on patient and kidney survival in non-dialysis CKD: competing risk analysis in older versus younger patients under nephrology care
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Antonio Pisani, Giuseppe Conte, Michele Provenzano, Silvio Borrelli, Michele Andreucci, Carlo Garofalo, Luca De Nicola, Garofalo, C., Provenzano, M., Andreucci, M., Pisani, A., De Nicola, L., Conte, G., and Borrelli, S.
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Nephrology ,medicine.medical_specialty ,medicine.medical_treatment ,Renal function ,Kidney ,Risk Assessment ,Internal medicine ,CKD ,Medicine ,Humans ,Prospective Studies ,Mortality ,Salt intake ,Renal Insufficiency, Chronic ,Sodium Chloride, Dietary ,Prospective cohort study ,Dialysis ,Aged ,Transplantation ,ESKD ,business.industry ,Hazard ratio ,medicine.disease ,Cohort ,Disease Progression ,Kidney Failure, Chronic ,business ,Kidney disease ,Glomerular Filtration Rate - Abstract
Background The optimal level of salt intake remains ill-defined in non-dialysis chronic kidney disease (CKD) patients under regular nephrology care. This unanswered question becomes critical in older patients who are exposed to higher risk of worsening of cardiorenal disease due to volemic changes. Methods In this pooled analysis of four prospective studies in CKD, we compared the risk of all-cause mortality and end-stage kidney disease (ESKD) between patients ≤65 and >65 years of age stratified by salt intake level (8 g/day) estimated from two measurements of 24-h urinary sodium. Results The cohort included 1785 patients. The estimated glomerular filtration rate was 37 ± 21 mL/min/1.73 m2 overall, 41 ± 25 in younger patients and 34 ± 16 in older patients (P 8 g sodium chloride/day in 21.9, 26.2 and 52.0% of older patients and 18.6, 25.2 and 56.2% in younger patients, respectively (P = 0.145). During a median follow-up of 4.07 years we registered 383 ESKD and 260 all-cause deaths. In the whole cohort, the risks of ESKD and all-cause death did not differ by salt intake level. In older patients, ESKD risk [multi-adjusted hazard ratio (HR) and 95% confidence interval (CI)] was significantly lower at salt intakes of 6–8 g/day [HR 0.577 (95% CI 0.361–0.924)] and >8 g/day [HR 0.564 (95% CI 0.382–0.833)] versus the reference group ( Conclusions CKD patients under nephrology care show a moderate salt intake (8.4 g/day) that is lower in older versus younger patients. In this context, older patients are not exposed to higher mortality across different levels of salt intake, while salt intake
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- 2020
19. Area Deprivation and Risk of Death and CKD Progression: Long-Term Cohort Study in Patients under Unrestricted Nephrology Care
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Silvio Borrelli, Toni De Stefano, Carlo Garofalo, Salvatore Panico, Roberto Minutolo, Giuseppe Conte, Vittorio Simeon, Paolo Chiodini, Luca De Nicola, Michele Provenzano, Michele Andreucci, Nicola Caranci, Borrelli, S., Chiodini, P., Caranci, N., Provenzano, M., Andreucci, M., Simeon, V., Panico, S., De Stefano, T., De Nicola, L., Minutolo, R., Conte, G., and Garofalo, C.
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Nephrology ,Male ,medicine.medical_specialty ,Deprivation ,Population ,Renal function ,Comorbidity ,Vulnerable Populations ,chemistry.chemical_compound ,Interquartile range ,Risk Factors ,Internal medicine ,Cause of Death ,Chronic kidney disease ,medicine ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,education ,Prospective cohort study ,Referral and Consultation ,Aged ,Creatinine ,education.field_of_study ,business.industry ,Middle Aged ,medicine.disease ,chemistry ,Italy ,Socioeconomic Factors ,Disease Progression ,Female ,business ,Cohort study ,Kidney disease - Abstract
Background: Area deprivation index (ADI) associates with prognosis in non-dialysis CKD. However, no study has evaluated this association in CKD patients under unrestricted nephrology care. Methods: We performed a long-term prospective study to assess the role of deprivation in CKD progression and mortality in stage 1–4 CKD patients under regular nephrology care, living in Naples (Italy). We used ADI calculated at census block levels, standardized to mean values of whole population in Naples, and linked to patients by georeference method. After 12 months of “goal-oriented” nephrology treatment, we compared the risk of death or composite renal outcomes (end-stage kidney disease or doubling of serum creatinine) in the tertiles of standardized ADI. Estimated glomerular filtration rate (eGFR) decline was evaluated by mixed effects model for repeated eGFR measurements. Results: We enrolled 715 consecutive patients (age: 64 ± 15 years; 59.1% males; eGFR: 49 ± 22 mL/min/1.73 m2). Most (75.2%) were at the lowest national ADI quintile. At referral, demographic, clinical, and therapeutic features were similar across ADI tertiles; after 12 months, treatment intensification allowed better control of hypertension, proteinuria, hypercholesterolaemia, and anaemia with no difference across ADI tertiles. During the subsequent long-term follow-up (10.5 years [interquartile range 8.2–12.6]), 166 renal events and 249 deaths were registered. ADI independently associated with all-cause death (p for trend = 0.020) and non-cardiovascular (CV) mortality (p for trend = 0.045), while CV mortality did not differ (p for trend = 0.252). Risk of composite renal outcomes was similar across ADI tertiles (p for trend = 0.467). The same held true for eGFR decline (p for trend = 0.675). Conclusions: In CKD patients under regular nephrology care, ADI is not associated with CKD progression, while it is associated with all-cause death due to an excess of non-CV mortality.
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- 2020
20. Timing of hospital admission in labour: latent versus active phase, mode of birth and intrapartum interventions. A correlational study
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Sara E. Borrelli, Simona Fumagalli, Antonella Nespoli, Elisabetta Colciago, A. Rota, Laura Antolini, Rota, A, Antolini, L, Colciago, E, Nespoli, A, Borrelli, S, and Fumagalli, S
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Adult ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Psychological intervention ,Intrapartum intervention ,Midwifery ,Time-to-Treatment ,Early labour ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,Pregnancy ,Oxytocics ,Intervention (counseling) ,Artificial rupture of membranes ,Active phase ,Maternity and Midwifery ,medicine ,Humans ,Caesarean section ,030212 general & internal medicine ,reproductive and urinary physiology ,Labor, Obstetric ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Obstetrics ,Parturition ,Pregnancy Outcome ,Obstetrics and Gynecology ,Delivery, Obstetric ,Hospital admission ,medicine.disease ,Patient Care Management ,Hospitalization ,Italy ,Labor Onset ,Latent phase ,Female ,business - Abstract
Background Hospitalization of women in latent labour often leads to a cascade of unnecessary intrapartum interventions, to avoid potential disadvantages the recommendation should be to stay at home to improve women’s experience and perinatal outcomes. Aim The primary aim of this study was to investigate the association between hospital admission diagnosis (latent vs active phase) and mode of birth. The secondary aim was to explore the relationship between hospital admission diagnosis, intrapartum intervention rates and maternal/neonatal outcomes. Methods A correlational study was conducted in a large Italian maternity hospital. Data from January 2013 to December 2014 were collected from the hospital electronic records. 1.446 records of low risk women were selected. These were dichotomized into two groups based on admission diagnosis: ‘latent phase’ or ‘active phase’ of labour. Findings 52.7% of women were admitted in active labour and 47.3% in the latent phase. Women in the latent phase group were more likely to experience a caesarean section or an instrumental birth, artificial rupture of membranes, oxytocin augmentation and epidural analgesia. Admission in the latent phase was associated with higher intrapartum interventions, which were statistically correlated to the mode of birth. Conclusions Women admitted in the latent phase were more likely to experience intrapartum interventions, which increase the probability of caesarean section. Maternity services should be organized around women and families needs, providing early labour support, to enable women to feel reassured facilitating their admission in labour to avoid the cascade of intrapartum interventions which increases the risk of caesarean section.
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- 2018
21. Novel Strategies to Increase Sodium Removal and to Reduce Glucose Exposures in Peritoneal Dialysis
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Carlo Garofalo, Silvio Borrelli, Di Liberato L, Centi A, Palumbo R, Mario Bonomini, Michele Provenzano, Divino Jc, Netti A, Reboldi G, De Nicola L, Giuseppe Conte, Polese L, Peruzzu N, Roberto Minutolo, Arduini A, Borrelli, S, Garofalo, C, Peruzzu, N, Polese, L, Netti, A, Minutolo, R, De Nicola, L, Provenzano, M, Conte, G, Palumbo, R, Centi, A, Reboldi, G, Bonomini, M, Di Liberato, L, Arduini, A, and Divino, Jc
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Dialysis adequacy ,medicine.medical_specialty ,business.industry ,Sodium ,medicine.medical_treatment ,Urology ,chemistry.chemical_element ,General Medicine ,Xylitol ,Icodextrin ,Peritoneal dialysis ,chemistry.chemical_compound ,chemistry ,medicine ,business - Abstract
The success of Peritoneal Dialysis (PD) as renal replacement treatment is mainly due to the achievement of dialysis adequacy with a good adaptability to the patients’ needs.
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- 2019
22. Sex Differences in the Progression of CKD Among Older Patients: Pooled Analysis of 4 Cohort Studies
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Carlo Garofalo, Francis B. Gabbai, Silvio Borrelli, Domenico Russo, Giuseppe Conte, Paolo Chiodini, Vincenzo Bellizzi, Luca De Nicola, Roberto Minutolo, Michele Provenzano, Minutolo, R., Gabbai, F. B., Chiodini, P., Provenzano, M., Borrelli, S., Garofalo, C., Bellizzi, V., Russo, D., Conte, G., and De Nicola, L.
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Male ,end-stage kidney disease (ESKD) ,medicine.medical_treatment ,eGFR decline ,030232 urology & nephrology ,Chronic kidney disease (CKD) ,older adult ,Cohort Studies ,0302 clinical medicine ,Renal Dialysi ,Epidemiology ,Age Factor ,030212 general & internal medicine ,Kidney transplantation ,Aged, 80 and over ,estimated glomerular filtration rate (eGFR) ,Confounding ,Age Factors ,renal disease progression ,Middle Aged ,Proteinuria ,Italy ,Nephrology ,outcome ,Disease Progression ,epidemiology ,Female ,Human ,Cohort study ,Glomerular Filtration Rate ,medicine.medical_specialty ,sex difference ,Renal function ,03 medical and health sciences ,Sex Factors ,Renal Dialysis ,Internal medicine ,medicine ,sex ,Humans ,Mortality ,Renal Insufficiency, Chronic ,Dialysis ,Aged ,Proportional Hazards Models ,business.industry ,medicine.disease ,Kidney Transplantation ,Relative risk ,Proportional Hazards Model ,Kidney Failure, Chronic ,Cohort Studie ,business ,Kidney disease - Abstract
Rationale & Objective: Data for the association of sex with chronic kidney disease (CKD) progression are conflicting, a relationship this study sought to examine. Study Design: Pooled analysis of 4 Italian observational cohort studies. Setting & Participants: 1,311 older men and 1,024 older women with estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2 followed up in renal clinics. Predictor: Sex. Outcomes: End-stage kidney disease (ESKD), defined as maintenance dialysis or kidney transplantation, as the primary outcome; all-cause mortality and eGFR decline as secondary outcomes. Analytical Approach: Cox proportional hazard analysis to estimate the relative risk for ESKD and mortality and linear mixed models to estimate the rate of eGFR decline. Results: Age, systolic blood pressure, and use of renin-angiotensin system inhibitors were similar in men and women. Baseline eGFRs were 27.6 ± 10.2 in men and 26.0 ± 10.6 mL/min/1.73 m2 in women (P < 0.001), while median proteinuria was lower in women (protein excretion, 0.45 [IQR, 0.14-1.10] g/d) compared with men (0.69 [IQR 0.19-1.60] g/d; P < 0.001). During a median follow-up of 4.2 years, 757 developed ESKD (59.4% men) and 471 died (58.4% men). The adjusted risks for ESKD and mortality were higher in men (HRs of 1.50 [95% CI, 1.28-1.77] and 1.30 [95% CI, 1.06-1.60], respectively). This finding was consistent across CKD stages. We observed a significant interaction between sex and proteinuria, with the risk for ESKD in men being significantly greater than for women at a level of proteinuria of ∼0.5 g/d or greater. The slope of decline in eGFR was steeper in men (−2.09; 95% CI, −2.21 to −1.97 mL/min/1.73 m2 per year) than in women (−1.79; 95% CI, −1.92 to −1.66 mL/min/1.73 m2 per year; P < 0.001). Although sex differences in eGFR decline were not different across CKD stages (P = 0.3), the difference in slopes between men and women was progressively larger with proteinuria > 0.5 g/d (P = 0.04). Limitations: Residual confounding; only whites were included. Conclusions: Excess renal risk in men may, at least in part, be related to higher levels of proteinuria in men compared with women.
- Published
- 2018
23. Ferric Carboxymatose in Non-Hemodialysis CKD Patients: A Longitudinal Cohort Study
- Author
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Luca De Nicola, Giuseppe Conte, Nicola Peruzzu, Antonella Netti, Maria Elena Liberti, Roberto Minutolo, Francesco Locatelli, Lucia Del Vecchio, Silvio Borrelli, Patrizia Berto, Carlo Garofalo, Minutolo, R., Berto, P., Liberti, M. E., Peruzzu, N., Borrelli, S., Netti, A., Garofalo, C., Conte, G., De Nicola, L., Del Vecchio, L., and Locatelli, F.
- Subjects
medicine.medical_specialty ,Anemia ,medicine.medical_treatment ,030232 urology & nephrology ,lcsh:Medicine ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Gastroenterology ,Article ,Peritoneal dialysis ,FERRIC CARBOXYMALTOSE ,03 medical and health sciences ,iron deficiency ,0302 clinical medicine ,hemic and lymphatic diseases ,Internal medicine ,medicine ,biology ,business.industry ,lcsh:R ,General Medicine ,Iron deficiency ,medicine.disease ,anemia ,ferric carboxymaltose ,female genital diseases and pregnancy complications ,Ferritin ,biology.protein ,Ferric ,Hemodialysis ,Hemoglobin ,business ,chronic kidney disease ,medicine.drug - Abstract
No information is available on the efficacy of ferric carboxymaltose (FCM) in real-world CKD patients outside the hemodialysis setting. We prospectively followed 59 non-hemodialysis CKD patients with iron deficient anemia (IDA: hemoglobin <, 12.0/<, 13.5 g/dL in women/men and TSAT <, 20% and/or ferritin <, 100 ng/mL) who were intolerant or non-responders to oral iron. Patients received ferric carboxymaltose (FCM) (single dose of 500 mg) followed by additional doses if iron deficiency persisted. We evaluated efficacy of FCM in terms of increase of hemoglobin, ferritin, and TSAT levels. Direct and indirect costs of FCM were also analyzed in comparison with a hypothetical scenario where same amount of iron as ferric gluconate (FG) was administered intravenously. During the 24 weeks of study, 847 ± 428 mg of FCM per patient were administered. IDA improved after four weeks of FCM and remained stable thereafter. At week-24, mean change (95%CI) from baseline of hemoglobin, ferritin and TSAT were +1.16 g/dL (0.55–1.77), +104 ng/mL (40–168) and +9.5% (5.8–13.2), respectively. These changes were independent from ESA use and clinical setting (non-dialysis CKD, peritoneal dialysis and kidney transplant). Among ESA-treated patients (n = 24), ESA doses significantly decreased by 26% with treatment and stopped either temporarily or persistently in nine patients. FCM, compared to a FG-based scenario, was associated with a cost saving of 288 euros/patient/24 weeks. Saving was the same in ESA users/non-users. Therefore, in non-hemodialysis CKD patients, FCM effectively corrects IDA and allows remarkable cost savings in terms of societal, healthcare and patient perspective.
- Published
- 2021
24. Sodium Intake and Chronic Kidney Disease
- Author
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Luca De Nicola, Ashour Michael, Silvio Borrelli, Carlo Garofalo, Michele Provenzano, Giuseppe Conte, Ida Gagliardi, Michele Andreucci, Maria Elena Liberti, Borrelli, S., Provenzano, M., Gagliardi, I., Ashour, M., Liberti, M. E., De Nicola, L., Conte, G., Garofalo, C., and Andreucci, M.
- Subjects
medicine.medical_treatment ,Water-Electrolyte Imbalance ,030232 urology & nephrology ,Blood Pressure ,Review ,030204 cardiovascular system & hematology ,Left ventricular hypertrophy ,lcsh:Chemistry ,Renin-Angiotensin System ,0302 clinical medicine ,Intravascular volume status ,Medicine ,lcsh:QH301-705.5 ,Spectroscopy ,General Medicine ,Diet, Sodium-Restricted ,Prognosis ,Computer Science Applications ,Hypertension ,Cardiology ,Hypertrophy, Left Ventricular ,Hypervolemia ,medicine.medical_specialty ,Ambulatory blood pressure ,Prognosi ,Sodium ,chemistry.chemical_element ,Catalysis ,Inorganic Chemistry ,03 medical and health sciences ,Renal Dialysis ,Internal medicine ,Humans ,Renal Insufficiency, Chronic ,Sodium Chloride, Dietary ,Mortality ,Physical and Theoretical Chemistry ,Salt intake ,Molecular Biology ,Dialysis ,business.industry ,Organic Chemistry ,Cardiovascular risk ,medicine.disease ,lcsh:Biology (General) ,lcsh:QD1-999 ,chemistry ,Kidney Failure, Chronic ,business ,Kidney disease - Abstract
In Chronic Kidney Disease (CKD) patients, elevated blood pressure (BP) is a frequent finding and is traditionally considered a direct consequence of their sodium sensitivity. Indeed, sodium and fluid retention, causing hypervolemia, leads to the development of hypertension in CKD. On the other hand, in non-dialysis CKD patients, salt restriction reduces BP levels and enhances anti-proteinuric effect of renin–angiotensin–aldosterone system inhibitors in non-dialysis CKD patients. However, studies on the long-term effect of low salt diet (LSD) on cardio-renal prognosis showed controversial findings. The negative results might be the consequence of measurement bias (spot urine and/or single measurement), reverse epidemiology, as well as poor adherence to diet. In end-stage kidney disease (ESKD), dialysis remains the only effective means to remove dietary sodium intake. The mismatch between intake and removal of sodium leads to fluid overload, hypertension and left ventricular hypertrophy, therefore worsening the prognosis of ESKD patients. This imposes the implementation of a LSD in these patients, irrespective of the lack of trials proving the efficacy of this measure in these patients. LSD is, therefore, a rational and basic tool to correct fluid overload and hypertension in all CKD stages. The implementation of LSD should be personalized, similarly to diuretic treatment, keeping into account the volume status and true burden of hypertension evaluated by ambulatory BP monitoring.
- Published
- 2020
25. Effect of Increased Convection Volume by Mid-Dilution Hemodiafiltration on the Subclinical Chronic Inflammation in Maintenance Hemodialysis Patients
- Author
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Walter De Simone, Roberto Minutolo, Giuseppe Conte, Luca De Nicola, Emanuele De Simone, Carlo Garofalo, Silvio Borrelli, Michele Provenzano, Borrelli, S, Minutolo, R, De Nicola, L, Conte, G, and Garofalo, C
- Subjects
Male ,medicine.medical_specialty ,030232 urology & nephrology ,Inflammation ,Hemodiafiltration ,030204 cardiovascular system & hematology ,Systemic inflammation ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Subclinical infection ,Aged ,Cross-Over Studies ,business.industry ,Albumin ,Hematology ,General Medicine ,Maintenance hemodialysis ,Blood Proteins ,Middle Aged ,Mid-dilution ,Crossover study ,Dilution ,Volume (thermodynamics) ,Nephrology ,Chronic Disease ,Female ,medicine.symptom ,business - Abstract
Mid-dilution hemodiafiltration (MID) is a dialytic technique that might improve systemic inflammation of patients in chronic hemodialysis (HD) by increasing substitution volumes. To verify this hypothesis, we performed a prospective cross-over study comparing the effect on inflammatory biomarkers of higher convection by MID versus standard convection by post-dilution hemodiafiltration (HDF). Patients under chronic HD were therefore treated by MID and HDF by crossover design. Each treatment period lasted 4 months, with 1 month of wash-out where patients were treated by HD, for a total of 9 months. Primary outcome was the change of serum pre-dialytic C-Reactive Protein (CRP), interleukin 6 (IL-6), IL-1, IL-10, transforming growth factor-β (TGF-β), tumor necrosis factor-α, albumin and pre-albumin. Samples were obtained monthly. Ten HD patients were enrolled (age: 64.9 ± 12.6 years; 70% males; dialytic vintage: 10.6 [2.7–16.2] years). Mean convection volume was 40.1 ± 2.5 L/session in MID and 20.1 ± 2.6 L/session in HDF. A significant reduction of β2-Microglobulin was detected as a result of either treatment. In MID, CRP decreased from 11.3 (3.2–31.0) to 3.1 (1.4–14.4) mg/L (p = 0.007), IL-6 from 12.7 (5.0–29.7) to 8.3 (4.4–14.0) pg/mL (p = 0.003), and TGF-β from 10.6 (7.4–15.6) to 7.4 (5.9–9.3) ng/mL (p = 0.001). A significant reduction of CRP from 8.5 (3.2–31.0) to 4.6 (3.2–31.0) mg/L was also detected in HDF (p = 0.037), whereas no significant reduction of IL-6 (p = 0.147) and TGF-β (p = 0.094) was found. Percentage reduction of IL-6 correlated with mean convective volume in HDF (R = 0.666; p = 0.036) and in MID (R = 0.760; p = 0.020). Therefore, MID and HDF are associated with an attenuation of inflammatory pattern that is correlated with a high convective volume.
- Published
- 2018
26. Reassessment of Ambulatory Blood Pressure Improves Renal Risk Stratification in Nondialysis Chronic Kidney Disease
- Author
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Michele Provenzano, Silvio Borrelli, Carlo Garofalo, Paolo Chiodini, Giuseppe Conte, Francis B. Gabbai, Giovanna Stanzione, Luca De Nicola, Roberto Minutolo, Maria Elena Liberti, Mario Pacilio, Minutolo, Roberto, Gabbai, F, Chiodini, Paolo, Garofalo, C, Stanzione, G, Liberti, Me, Pacilio, M, Borrelli, S, Provenzano, M, Conte, Giuseppe, and DE NICOLA, Luca
- Subjects
Male ,medicine.medical_specialty ,Ambulatory blood pressure ,genetic structures ,Renal function ,Blood Pressure ,Kidney ,Risk Assessment ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Renal Insufficiency, Chronic ,Survival analysis ,Aged ,business.industry ,Hazard ratio ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,Prognosis ,medicine.disease ,Confidence interval ,Surgery ,Hypertension ,Cardiology ,Female ,business ,Cohort study ,Kidney disease - Abstract
In nondialysis chronic kidney disease, ambulatory blood pressure (ABP) performs better than clinic BP in predicting outcome, but whether repeated assessment of ABP further refines prognosis remains ill-defined. We recruited 182 consecutive hypertensive patients with nondialysis chronic kidney disease who underwent 2 ABPs 12 months apart to evaluate the enhancement in risk stratification provided by a second ABP obtained 1 year after baseline on the risk (hazard ratio and 95% confidence interval) of composite renal end point (death, chronic dialysis, and estimated glomerular filtration rate decline ≥40%). The difference in daytime and nighttime systolic BP between the 2 ABPs (daytime and nighttime bias) was added to a survival model including baseline ABP. Net reclassification improvement was also calculated. Age was 65.6±13.4 years; 36% had diabetes mellitus and 36% had previous cardiovascular event; estimated glomerular filtration rate was 42.2±19.6 mL/min per 1.73 m 2 , and clinic BP was 145±18/80±11 mm Hg. Baseline ABP (daytime, 131±16/75±10 and nighttime, 122±18/66±10 mm Hg) and daytime/nighttime BP goals (58.2% and 43.4%) did not change at month 12. Besides baseline ABP values, bias for daytime and nighttime systolic BP linearly associated with renal outcome (1.12, 1.04–1.21 and 1.18, 1.08–1.29 for every 5-mm Hg increase, respectively). Classification of patients at risk improved when considering nighttime systolic level at second ABP (net reclassification improvement, 0.224; 95% confidence interval, 0.005–0.435). Patients with first and second ABPs above target showed greater renal risk (2.15, 1.29–3.59 and 1.71, 1.07–2.72, for daytime and nighttime, respectively). In nondialysis chronic kidney disease, reassessment of ABP at 1 year further refines renal prognosis; such reassessment should specifically be considered in patients with uncontrolled BP at baseline.
- Published
- 2015
27. Assessment of Achieved Clinic and Ambulatory Blood Pressure Recordings and Outcomes During Treatment in Hypertensive Patients With CKD: A Multicenter Prospective Cohort Study
- Author
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Rajiv Agarwal, Felice Nappi, Giuseppe Conte, Paolo Chiodini, Luca De Nicola, Roberto Minutolo, Vincenzo Bellizzi, Silvio Borrelli, Giovanna Stanzione, Francis B. Gabbai, Minutolo, Roberto, Gabbai, Fb, Agarwal, R, Chiodini, Paolo, Borrelli, S, Bellizzi, V, Nappi, F, Stanzione, G, Conte, Giuseppe, and DE NICOLA, Luca
- Subjects
Male ,Nephrology ,medicine.medical_specialty ,Ambulatory blood pressure ,White coat hypertension ,Cohort Studies ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,Myocardial infarction ,Renal Insufficiency, Chronic ,Prospective cohort study ,Aged ,business.industry ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,medicine.disease ,Treatment Outcome ,Hypertension ,Ambulatory ,Physical therapy ,Female ,business ,Cohort study ,Kidney disease - Abstract
Background: We investigated the effect of having clinic and/or ambulatory blood pressures (BPs) not at goal on cardiorenal risk in patients with non-dialysis-dependent chronic kidney disease (CKD). Study Design: Multicenter prospective study. Setting & Participants: 489 consecutive hypertensive patients with CKD (stages 1-5) with concomitant assessment of ambulatory and clinic BPs followed up in tertiary nephrology clinics. Predictors: Achievement of goal for ambulatory (day- and night-time BPs < 135/85 and < 120/70 mm Hg, respectively) and clinic (
- Published
- 2014
28. SGLT2 Inhibitors: Nephroprotective Efficacy and Side Effects
- Author
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Maria Elena Liberti, Giuseppe Conte, Carlo Garofalo, Michele Provenzano, Michele Andreucci, Silvio Borrelli, Roberto Minutolo, Luca De Nicola, Garofalo, Carlo, Borrelli, S., Liberti, M. E., Andreucci, M., Conte, G., Minutolo, R., Provenzano, M., and De Nicola, L.
- Subjects
medicine.medical_specialty ,Population ,Review ,Infections ,survival ,albuminuria ,GFR ,Diabetic Ketoacidosis ,End stage renal disease ,Nephropathy ,Fractures, Bone ,Diabetes mellitus ,medicine ,Humans ,Diabetic Nephropathies ,Intensive care medicine ,education ,Sodium-Glucose Transporter 2 Inhibitors ,end stage renal disease ,Canagliflozin ,lcsh:R5-920 ,education.field_of_study ,diabetes ,business.industry ,SGLT-2 inhibitors ,Type 2 Diabetes Mellitus ,General Medicine ,Acute Kidney Injury ,medicine.disease ,Neuroprotective Agents ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,diabete ,Urinary Tract Infections ,SGLT-2 inhibitor ,Albuminuria ,medicine.symptom ,lcsh:Medicine (General) ,business ,chronic kidney disease ,Kidney disease ,medicine.drug - Abstract
The burden of diabetic kidney disease (DKD) has increased worldwide in the last two decades. Besides the growth of diabetic population, the main contributors to this phenomenon are the absence of novel nephroprotective drugs and the limited efficacy of those currently available, that is, the inhibitors of renin-angiotensin system. Nephroprotection in DKD therefore remains a major unmet need. Three recent trials testing effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2-i) have produced great expectations on this therapy by consistently evidencing positive effects on hyperglycemia control, and more importantly, on the cardiovascular outcome of type 2 diabetes mellitus. Notably, these trials also disclosed nephroprotective effects when renal outcomes (glomerular filtration rate and albuminuria) were analyzed as secondary endpoints. On the other hand, the use of SGLT2-i can be potentially associated with some adverse effects. However, the balance between positive and negative effects is in favor of the former. The recent results of Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation Study and of other trials specifically testing these drugs in the population with chronic kidney disease, either diabetic or non-diabetic, do contribute to further improving our knowledge of these antihyperglycemic drugs. Here, we review the current state of the art of SGLT2-i by addressing all aspects of therapy, from the pathophysiological basis to clinical effectiveness.
- Published
- 2019
29. CKD in the Elderly: Kidney Senescence or Blood Pressure–Related Nephropathy?
- Author
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Roberto Minutolo, Silvio Borrelli, Luca De Nicola, Minutolo, Roberto, Borrelli, S, and DE NICOLA, Luca
- Subjects
Male ,Senescence ,Aging ,Kidney ,medicine.medical_specialty ,business.industry ,Urology ,Renal function ,medicine.disease ,Article ,Nephropathy ,Blood pressure ,medicine.anatomical_structure ,Nephrology ,Hypertension ,Albuminuria ,Humans ,Medicine ,Female ,Renal Insufficiency, Chronic ,business ,Glomerular Filtration Rate - Published
- 2015
30. miR-205 regulates basement membrane deposition in human prostate: implications for cancer development
- Author
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Marco Folini, Paolo Gandellini, Anna Casamichele, Maurizio Colecchia, Nicola Fenderico, Maurizio Callari, Riccardo Valdagni, Silvia Pozzi, M. De Cesare, G Santilli, S. Borrelli, Valentina Profumo, Roberto Mantovani, Nadia Zaffaroni, Giulia Petrovich, Gandellini, P, Profumo, V, Casamichele, A, Fenderico, N, Borrelli, S, Petrovich, G, Santilli, G, Callari, M, Colecchia, M, Pozzi, S, De Cesare, M, Folini, M, Valdagni, R, Mantovani, R, and Zaffaroni, N
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Transcription, Genetic ,Biology ,medicine.disease_cause ,Basement Membrane ,Cell Line ,Metastasis ,Extracellular matrix ,Prostate cancer ,Prostate ,microRNA ,medicine ,Humans ,Promoter Regions, Genetic ,Molecular Biology ,Basement membrane ,Original Paper ,Tumor Suppressor Proteins ,Integrin beta4 ,Cell Biology ,medicine.disease ,Epithelium ,Cell biology ,MicroRNAs ,Cell Transformation, Neoplastic ,medicine.anatomical_structure ,Carcinogenesis ,Cell Adhesion Molecules ,Transcription Factors - Abstract
The basement membrane (BM) is a layer of specialized extracellular matrix that surrounds normal prostate glands and preserves tissue integrity. Lack or discontinuity of the BM is a prerequisite for tumor cell invasion into interstitial spaces, thus favoring metastasis. Therefore, BM maintenance represents a barrier against cancer development and progression. In the study, we show that miR-205 participates in a network involving ΔNp63α, which is essential for maintenance of the BM in prostate epithelium. At the molecular level, ΔNp63α is able to enhance miR-205 transcription by binding to its promoter, whereas the microRNA can post-transcriptionally limit the amount of ΔNp63α protein, mostly by affecting ΔNp63α proteasomal degradation rather than through a canonical miRNA/target interaction. Functionally, miR-205 is able to control the deposition of laminin-332 and its receptor integrin-β4. Hence, pathological loss of miR-205, as widely observed in prostate cancer, may favor tumorigenesis by creating discontinuities in the BM. Here we demonstrate that therapeutic replacement of miR-205 in prostate cancer (PCa) cells can restore BM deposition and 3D organization into normal-like acinar structures, thus hampering cancer progression.
- Published
- 2012
31. Prevalence and clinical correlates of white coat hypertension in chronic kidney disease
- Author
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V. Bellizzi, Roberto Minutolo, Raffaele Scigliano, Felice Nappi, Pasquale Zamboli, Luca De Nicola, Silvio Borrelli, Giuseppe Conte, Paolo Chiodini, Bruno Cianciaruso, Minutolo, Roberto, Borrelli, S, Scigliano, R, Bellizzi, V, Chiodini, Paolo, Cianciaruso, B, Nappi, F, Zamboli, Pasquale, Conte, Giuseppe, DE NICOLA, Luca, Minutolo, R, Chiodini, P, Cianciaruso, Bruno, Zamboli, P, Conte, G, and De Nicola, L.
- Subjects
cardiovascular risk ,Male ,medicine.medical_specialty ,Ambulatory blood pressure ,Renal function ,Blood Pressure ,White coat hypertension ,Left ventricular hypertrophy ,Body Mass Index ,Diabetes mellitus ,Internal medicine ,Prevalence ,medicine ,Humans ,Systole ,Aged ,Transplantation ,business.industry ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,medicine.disease ,ambulatory blood pressure monitoring ,Cross-Sectional Studies ,Endocrinology ,Blood pressure ,Nephrology ,Chronic Disease ,Hypertension ,Cardiology ,Regression Analysis ,Female ,Kidney Diseases ,white coat hypertension ,business ,chronic kidney disease ,Glomerular Filtration Rate ,Kidney disease - Abstract
Background. The role of white coat hypertension (WCH) in the poor control of blood pressure (BP) in chronic kidney disease (CKD) is ill defined. Methods. We measured systolic clinical (CBP) and ambulatory blood pressure (ABP) in 290 consecutive patients with non-dialysis CKD [glomerular filtration rate (GFR)
- Published
- 2007
32. Independent Role of Underlying Kidney Disease on Renal Prognosis of Patients with Chronic Kidney Disease under Nephrology Care
- Author
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Michele Provenzano, Adelia Sagliocca, Roberto Minutolo, Giuseppe Conte, Paolo Chiodini, Luca De Nicola, Carlo Garofalo, Silvio Borrelli, Mario Pacilio, Maria Elena Liberti, DE NICOLA, Luca, Provenzano, M, Chiodini, Paolo, Borrelli, S, Garofalo, C, Pacilio, M, Liberti, Me, Sagliocca, A, Conte, Giuseppe, and Minutolo, Roberto
- Subjects
Male ,Nephrology ,medicine.medical_specialty ,Endpoint Determination ,Renal function ,lcsh:Medicine ,urologic and male genital diseases ,Nephropathy ,Cohort Studies ,Diabetic nephropathy ,Internal medicine ,Diabetes mellitus ,Hypertensive Nephropathy ,medicine ,Polycystic kidney disease ,Humans ,Renal Insufficiency, Chronic ,Intensive care medicine ,lcsh:Science ,Referral and Consultation ,Aged ,Proportional Hazards Models ,Multidisciplinary ,business.industry ,lcsh:R ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Multivariate Analysis ,Disease Progression ,Female ,lcsh:Q ,business ,Research Article ,Follow-Up Studies ,Glomerular Filtration Rate ,Kidney disease - Abstract
Primary kidney disease is suggested to affect renal prognosis of CKD patients; however, whether nephrology care modifies this association is unknown. We studied patients with CKD stage I-IV treated in a renal clinic and with established diagnosis of CKD cause to evaluate whether the risk of renal event (composite of end-stage renal disease and eGFR decline ≥ 40%) linked to the specific diagnosis is modified by the achievement or maintenance in the first year of nephrology care of therapeutic goals for hypertension (BP ≤ 130/80 mmHg in patients with proteinuria ≥ 1 50 mg/24h and/or diabetes and ≤ 140/90 in those with proteinuria
- Published
- 2015
33. Efficacy of a reduced pill burden on therapeutic adherence to calcineurin inhibitors in renal transplant recipients: an observational study
- Author
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Massimo Sabbatini, Sossio Vitale, Luigi Russo, Rosa Carrano, Stefano Federico, Domenico Capone, Silvio Borrelli, Massimiliano Torino, Gianluca Garofalo, Antonio Pisani, Riccardo Gallo, Sabbatini, M, Garofalo, G, Borrelli, S, Vitale, S, Torino, M, Capone, D, Russo, L, Pisani, A, Carrano, R, Gallo, R, Federico, S., Sabbatini, Massimo, Pisani, Antonio, and Federico, Stefano
- Subjects
Drug ,medicine.medical_specialty ,media_common.quotation_subject ,Medicine (miscellaneous) ,Renal function ,Pharmacology ,once-daily tacrolimus ,Internal medicine ,renal transplant ,medicine ,adherence ,Pharmacology, Toxicology and Pharmaceutics (miscellaneous) ,media_common ,Original Research ,lcsh:R5-920 ,business.industry ,Health Policy ,calcineurin inhibitors ,Tacrolimus ,Calcineurin ,Patient Preference and Adherence ,adherence, calcineurin inhibitors, once-daily tacrolimus, renal transplant ,Pill ,Cohort ,Anxiety ,Observational study ,medicine.symptom ,business ,lcsh:Medicine (General) ,Social Sciences (miscellaneous) - Abstract
Massimo Sabbatini,1 Gianluca Garofalo,1 Silvio Borrelli,2 Sossio Vitale,1 Massimiliano Torino,1 Domenico Capone,3 Luigi Russo,3 Antonio Pisani,1 Rosa Carrano,1 Riccardo Gallo,1 Stefano Federico11Nephrology, Department of Public Health, University Federico II of Naples, 2Department of Nephrology, Second University of Naples, 3Department of Neurosciences, Unit of Clinical Pharmacology, University Federico II of Naples, Naples, ItalyPurpose: The aim of this study was to determine the prevalence of nonadherence in a cohort of renal transplant recipients (RTRs) and to evaluate prospectively whether more intense clinical surveillance and reduced pill number enhanced adherence.Patients and methods: The study was carried out in 310 stable RTRs in whom adherence, life satisfaction, and transplant care were evaluated by specific questionnaires (time 0). The patients under tacrolimus (TAC; bis in die [BID]) were then shifted to once-daily TAC (D-TAC) to reduce their pill burden (Shift group) and were followed up for 6 months to reevaluate the same parameters. Patients on cyclosporin or still on BID-TAC constituted a time-control group.Results: The prevalence of nonadherence was 23.5% and was associated with previous rejection episodes (P
- Published
- 2014
34. Plasma p-Cresol Lowering Effect of Sevelamer in Peritoneal Dialysis Patients: Evidence from a Cross-Sectional Observational Study
- Author
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Lucia Grumetto, Giuliana Salerno, Andrea Memoli, Francesco Barbato, Bruna Guida, Andrea Pota, Eleonora Riccio, Silvio Borrelli, Bruno Memoli, Gennaro Argentino, Mauro Cataldi, Guida, Bruna, Cataldi, Mauro, Riccio, Eleonora, Grumetto, Lucia, Pota, Andrea, Borrelli, S, Memoli, A, Barbato, Francesco, Argentino, Gennaro, Salerno, Giuliana, Memoli, Bruno, Guida, B, Cataldi, M, Riccio, E, Grumetto, L, Pota, A, Barbato, F, Argentino, G, Salerno, G, and Memoli, B.
- Subjects
Mineral Metabolism and the Kidney ,Male ,medicine.medical_treatment ,lcsh:Medicine ,Toxicology ,Sevelamer ,Cresols ,Hyperphosphatemia ,Chronic Kidney Disease ,Blood plasma ,Toxin Binding ,Polyamines ,p-Cresol ,sevelamer ,lcsh:Science ,Chelating Agents ,Multidisciplinary ,end-stage renal disease ,Clinical Pharmacology ,uremic toxins ,Middle Aged ,peritoneal dialysi ,Nephrology ,Observational Studies ,Medicine ,Female ,Peritoneal Dialysis ,Research Article ,medicine.drug ,Adult ,Drugs and Devices ,medicine.medical_specialty ,lanthanum ,Clinical Research Design ,medicine.drug_class ,Urology ,Renal function ,Phosphates ,Peritoneal dialysis ,Internal medicine ,parasitic diseases ,medicine ,Humans ,Dialysis ,Aged ,Inflammation ,business.industry ,lcsh:R ,Immunity ,medicine.disease ,Phosphate binder ,Cross-Sectional Studies ,Endocrinology ,Kidney Failure, Chronic ,Clinical Immunology ,lcsh:Q ,business ,Kidney disease - Abstract
p-Cresol is a by-product of the metabolism of aromatic aminoacid operated by resident intestinal bacteria. In patients with chronic kidney disease, the accumulation of p-cresol and of its metabolite p-cresyl-sulphate, that represents more than 95% of circulating p-cresol, causes endothelial dysfunction and ultimately increases the cardiovascular risk of these patients. Therapeutic strategies able to reduce plasma p-cresol levels are highly demanded but unfortunately not available yet. Because it has been reported that the phosphate binder sevelamer also sequesters p-cresol in vitro we hypothesized that it could do so also in peritoneal dialysis patients. To explore this hypothesis we measured total cresol plasma concentrations in 57 patients with end-stage renal disease on peritoneal dialysis patients, 29 receiving sevelamer for the treatment of hyperphosphatemia and 28 patients not assuming this drug. Among the patients not assuming sevelamer, 16 were treated with lanthanum whereas the remaining 12 received no drug because they were not hyperphosphatemic. When we compared total p-cresol plasma concentrations in these different groups of patients, we, we found that plasma p-cresol levels were significantly lower in patients receiving sevelamer than in subjects receiving lanthanum or no drug. Patients assuming sevelamer had also lower high sensitivity C-reactive protein serum concentrations compared to patients not assuming this drug. Multiple linear regression analysis showed that Conversely, no difference either in residual glomerular filtration rate, total weekly dialysis dose or serum phosphate levels were observed among the different groups. These results suggest that sevelamer could be an effective strategy to lower p-cresol circulating levels in peritoneal dialysis patients in which it could also favorably affect the cardiovascular risk because of its anti-inflammatory effect.
- Published
- 2013
35. Early pushing urge in labour and midwifery practice: A prospective observational study at an Italian maternity hospital
- Author
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Anna Locatelli, Antonella Nespoli, Sara E. Borrelli, Borrelli, S, Locatelli, A, and Nespoli, A
- Subjects
Adult ,medicine.medical_specialty ,Labour ,Psychological intervention ,Hospitals, Maternity ,Midwifery ,Young Adult ,Nursing ,Pregnancy ,Maternity and Midwifery ,Medicine ,Childbirth ,Humans ,Prospective Studies ,Medical diagnosis ,Early pushing urge, Labour, Second stage, Midwifery practice ,MED/47 - SCIENZE INFERMIERISTICHE OSTETRICO-GINECOLOGICHE ,Labor, Obstetric ,business.industry ,Obstetrics ,Incidence (epidemiology) ,Incidence ,Parturition ,Obstetrics and Gynecology ,Early pushing urge ,Delivery, Obstetric ,Position (obstetrics) ,Italy ,Scale (social sciences) ,Second stage ,Observational study ,Female ,Cervical dilatation ,business ,Midwifery practice - Abstract
Objective: to investigate the early pushing urge (EPU) incidence in one maternity unit and explore how it is managed by midwives. The relation to some obstetric outcomes was also observed but not analysed in depth. Design: prospective observational study. Setting: Italian maternity hospital. Sample: 60 women (44 nullips and 16 multips) experiencing EPU during labour. Findings: the total EPU incidence percentage was 7.6%. The single midwives' incidences range had a very wide margin, noting an inverse proportion between the number of diagnoses of EPU and midwife's waiting time between urge to push and vaginal examination. Two care policies were adopted in relation to the phenomenon: the stop pushing technique (. n=52/60) and the '. let the woman do what she feels' technique (. n=8/60). In case of stop pushing techniques, midwives proposed several combined techniques (change of maternal position, blowing breath, vocalisation, use of the bath). The EPU diagnosis at less than 8. cm of cervical dilatation was associated with more medical interventions. Maternal and neonatal outcomes were within the range of normal physiology. An association between the dilatation at EPU diagnosis and obstetric outcomes was observed, in particular the modality of childbirth and perineal outcomes. Conclusions and implication for practice: this paper contributes new knowledge to the body of literature around the EPU phenomenon during labour and midwifery practices adopted in response to it. Overall, it could be argued that EPU is a physiologic variation in labour if maternal and fetal conditions are good. Midwives might suggest techniques to woman to help her to stay with the pain, such as change of position, blowing breath, vocalisation and use of the bath. However, the impact of policies, guidelines and culture on midwifery practices of the specific setting are a limitation of the study because it is not representative of other similar maternity units. Thus, a larger scale work should be considered, including different units and settings. The optimal response to the phenomenon should be studied, considering EPU at different dilatation ranges. Future investigations could also focus on qualitative analysis of women and midwives' personal experience in relation to the phenomenon.
- Published
- 2013
36. Resistant Hypertension in Nondialysis Chronic Kidney Disease
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Silvio Borrelli, Giuseppe Conte, Giovanna Stanzione, Roberto Minutolo, Luca De Nicola, Borrelli, S, DE NICOLA, Luca, Stanzione, G, Conte, Giuseppe, and Minutolo, Roberto
- Subjects
Sympathetic nervous system ,medicine.medical_specialty ,education.field_of_study ,lcsh:Diseases of the circulatory (Cardiovascular) system ,business.industry ,medicine.medical_treatment ,Population ,White coat hypertension ,Review Article ,medicine.disease ,medicine.anatomical_structure ,Blood pressure ,lcsh:RC666-701 ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Risk factor ,Diuretic ,business ,education ,Kidney disease - Abstract
Resistant hypertension (RH) is defined as blood pressure (BP) that remains above the target of less than 140/90 mmHg in the general population and 130/80 mmHg in people with diabetes mellitus or chronic kidney disease (CKD) in spite of the use of at least three full-dose antihypertensive drugs including a diuretic or as BP that reaches the target by means of four or more drugs. In CKD, RH is a common condition due to a combination of factors including sodium retention, increased activity of the renin-angiotensin system, and enhanced activity of the sympathetic nervous system. Before defining the hypertensive patient as resistant it is mandatory to exclude the so-called “pseudoresistance.” This condition, which refers to the apparent failure to reach BP target in spite of an appropriate antihypertensive treatment, is mainly caused by white coat hypertension that is prevalent (30%) in CKD patients. Recently we have demonstrated that “true” RH represents an independent risk factor for renal and cardiovascular outcomes in CKD patients.
- Published
- 2013
37. Burden of resistant hypertension in hypertensive patients with non-dialysis chronic kidney disease
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Francis B. Gabbai, Silvio Borrelli, Luca De Nicola, Carmela Iodice, Santo Vitiello, Pasquale Zamboli, Roberto Minutolo, Paolo Chiodini, Giuseppe Conte, DE NICOLA, Luca, Borrelli, S, Gabbai, Fb, Chiodini, Paolo, Zamboli, Pasquale, Iodice, C, Vitiello, S, Conte, Giuseppe, and Minutolo, Roberto
- Subjects
Nephrology ,Male ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Renal function ,urologic and male genital diseases ,Gastroenterology ,Cohort Studies ,Cost of Illness ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Antihypertensive Agents ,Aged ,Retrospective Studies ,Proteinuria ,business.industry ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,medicine.disease ,Blood pressure ,Endocrinology ,Hypertension ,Kidney Failure, Chronic ,Female ,Diuretic ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,Follow-Up Studies - Abstract
Background/Aims: In chronic kidney disease (CKD), no data on resistant hypertension (RH) are so far available despite the high prevalence of uncontrolled hypertension. We evaluated frequency, correlates and prognosis of RH in 300 consecutive incident hypertensive CKD patients in an academic renal clinic. Methods: RH was defined as office blood pressure (BP) ≧130/80 mm Hg despite ≧3 drugs at full dose including a diuretic, or as BP at goal with ≧4 full-dose drugs. Patients were evaluated at referral and after 6 months of nephrology management; thereafter, they were included in a renal survival analysis lasting 37.6 months. Results: On referral, glomerular filtration rate was 41.3 ± 16.6 ml/min/1.73 m2 and BP 148 ± 23/81 ± 12 mm Hg. After 6 months, BP decreased by 8 ± 23/3 ± 12 mm Hg. From referral to month 6, RH detection increased from 26 to 38% due to the significant increment in full-dose antihypertensive medications (from 2.0, IQR 1.0–3.0 to 2.5, IQR 2.0–3.0). Diabetes and proteinuria predicted the incidence of RH at month 6. Presence of RH at month 6 was associated with greater risk of renal death (HR, 1.85, 95% CI, 1.13–3.03), independent of main clinical features and degree of BP control. Conclusion: In CKD, RH is prevalent and associated with decreased renal survival, independent of BP levels.
- Published
- 2011
38. Hypertension management in chronic kidney disease: translating guidelines into daily practice
- Author
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Carmela Iodice, Silvio Borrelli, Pasquale Zamboli, Francis B. Gabbai, Giuseppe Conte, Roberto Minutolo, Luca De Nicola, Paolo Chiodini, DE NICOLA, Luca, Borrelli, S, Chiodini, Paolo, Zamboli, Pasquale, Iodice, C, Gabbai, Fb, Conte, Giuseppe, and Minutolo, Roberto
- Subjects
Male ,Nephrology ,medicine.medical_specialty ,Renal function ,Blood Pressure ,Comorbidity ,Cohort Studies ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Antihypertensive Agents ,Aged ,Retrospective Studies ,Proteinuria ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Treatment Outcome ,Blood pressure ,Chronic Disease ,Hypertension ,Practice Guidelines as Topic ,Cardiology ,Physical therapy ,Regression Analysis ,Female ,Kidney Diseases ,medicine.symptom ,business ,Follow-Up Studies ,Glomerular Filtration Rate ,Kidney disease - Abstract
BACKGROUND Whether nephrology management improves over time achievement of blood pressure (BP) goal (
- Published
- 2011
39. Prognostic role of ambulatory blood pressure measurement in patients with nondialysis chronic kidney disease
- Author
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Felice Nappi, Bruno Cianciaruso, Rajiv Agarwal, Pasquale Zamboli, Giuseppe Conte, Paolo Chiodini, Vincenzo Bellizzi, Francis B. Gabbai, Silvio Borrelli, Luca De Nicola, Roberto Minutolo, Minutolo, Roberto, Agarwal, R, Borrelli, S, Chiodini, Paolo, Bellizzi, V, Nappi, F, Cianciaruso, B, Zamboli, Pasquale, Conte, Giuseppe, Gabbai, Fb, DE NICOLA, Luca, Minutolo, R, Chiodini, P, Cianciaruso, Bruno, Zamboli, P, Conte, G, and De Nicola, L.
- Subjects
Male ,medicine.medical_specialty ,Ambulatory blood pressure ,hypertension ,Renal function ,CKD conservative treatment ,Essential hypertension ,Risk Assessment ,Predictive Value of Tests ,Risk Factors ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Aged ,Kidney ,business.industry ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,ambulatory blood pressure monitoring ,medicine.anatomical_structure ,Blood pressure ,Chronic Disease ,Ambulatory ,Cardiology ,Female ,Kidney Diseases ,business ,Kidney disease - Abstract
Background Ambulatory blood pressure (BP) measurement allows a better risk stratification in essential hypertension compared with office blood pressure measurement, but its prognostic role in nondialysis chronic kidney disease has been poorly investigated. Methods The prognostic role of daytime and nighttime systolic BP (SBP) and diastolic BP (DBP) in comparison with office measurements was evaluated in 436 consecutive patients with chronic kidney disease. Primary end points were time to renal death (end-stage renal disease or death) and time to fatal and nonfatal cardiovascular events. Quintiles of BP were used to classify patients. Results The mean (SD) age of the patients was 65.1 (13.6) years, and the glomerular filtration rate was 42.9 (19.7) mL/min/1.73 m 2 ; 41.7% of the participants were women, 36.5% had diabetes, and 30.5% had cardiovascular disease. Office-measured SBP/DBP values were 146 (19)/82 (12) mm Hg; daytime SBP/DBP was 131 (17)/75 (11) mm Hg, and nighttime SBP/DBP was 122 (20)/66 (10) mm Hg. During follow-up (median, 4.2 years), 155 and 103 patients reached the renal and cardiovascular end points, respectively. Compared with a daytime SBP of 126 to 135 mm Hg, patients with an SBP of 136 to 146 mm Hg and those with an SBP higher than 146 mm Hg had an increased adjusted risk of the cardiovascular end point (hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.13-4.41 and 3.07; 1.54-6.09) and renal death (1.72; 1.02-2.89 and 1.85; 1.11-3.08). Nighttime SBPs of 125 to 137 mm Hg and higher than 137 mm Hg also increased the risk of the cardiovascular end point (HR, 2.52; 95% CI, 1.11-5.71 and 4.00; 1.77-9.02) and renal end point (1.87; 1.03-3.43 and 2.54; 1.41-4.57) with respect to the reference SBP value of 106-114 mm Hg. Office measurement of BP did not predict the risk of the renal or cardiovascular end point. Patients who were nondippers and those who were reverse dippers had a greater risk of both end points. Conclusion In chronic kidney disease, ambulatory BP measurement and, in particular, nighttime BP measurement, allows more accurate prediction of renal and cardiovascular risk; office measurement of BP does not predict any outcome.
- Published
- 2011
40. Intradialytic changes of plasma amino acid levels: effect of hemodiafiltration with endogenous reinfusion versus acetate-free biofiltration
- Author
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Giuseppe Conte, Ludovica D'Apice, Silvio Borrelli, Raffaele Genualdo, Olga Credendino, L. De Nicola, G Iacono, A Sarti, B Zito, Pasquale Zamboli, Pasquale Guastaferro, Maria Rita Auricchio, V Apperti, Filippo Nigro, A De Paola, A Di Serafino, Caterina Saviano, Maria Capuano, Carmela Iodice, M Merola, E De Simone, Roberto Minutolo, G Iulianiello, Borrelli, S, Minutolo, Roberto, DE NICOLA, Luca, Zamboli, Pasquale, Iodice, C, DE PAOLA, A, DE SIMONE, E, Zito, B, Guastaferro, P, Nigro, F, Apperti, V, Iulianiello, G, Credendino, O, Iacono, G, DI SERAFINO, A, D'Apice, L, Saviano, C, Sarti, A, Capuano, M, Genualdo, R, Auricchio, M, Merola, M, and Conte, Giuseppe
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Endogeny ,Hemodiafiltration ,Renal Dialysis ,Internal medicine ,Diabetes mellitus ,Hfr cell ,medicine ,Humans ,Acetate-Free Biofiltration ,Amino Acids ,Dialysis ,Aged ,chemistry.chemical_classification ,Chemistry ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Plasma amino acid levels ,Hemodialysis Solutions ,Amino acid ,Endocrinology ,Cross-Sectional Studies ,Biochemistry ,Nephrology ,Hemodialysis - Abstract
During hemodialysis, amino acids (AA) are lost in the ultrafiltrate with consequent modification of their plasma profile. The aim of this cross-sectional study was to evaluate intradialytic changes of plasma AA levels during a single session of hemodiafiltration with endogenous reinfusion (HFR) versus acetate-free biofiltration (AFB). 48 patients chronically treated with HFR or AFB were matched 1:1 for age, gender, Kt/V and diabetes. Blood samples were collected at the beginning and the end of dialysis. Baseline plasma levels (µmol/l) of total AA (3,176 ± 722), essential AA (889 ± 221), and branched chain AA (459 ± 140) levels in HFR were similar to those in AFB (3,399 ± 621, 938 ± 277, and 463 ± 71, respectively). Plasma intradialytic AA levels did not change in HFR, while in AFB there was a reduction by about 25%. In conclusion, as compared with AFB, HFR has a sparing effect on AA loss due to the lack of adsorption by cartridge and to their complete reinfusion in blood.
- Published
- 2010
41. Effects of age on hypertensive status in patients with chronic kidney disease
- Author
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Giuseppe Conte, Paolo Chiodini, Luca De Nicola, Vincenzo Bellizzi, Silvio Borrelli, Roberto Minutolo, Pasquale Zamboli, Fausta Catapano, Raffaele Scigliano, Felice Nappi, Bruno Cianciaruso, Minutolo, R, Borrelli, S, Chiodini, P, Scigliano, R, Bellizzi, V, Cianciaruso, Bruno, Nappi, F, Zamboli, P, Catapano, F, Conte, G, De Nicola, L., Minutolo, Roberto, Chiodini, Paolo, Cianciaruso, B, Zamboli, Pasquale, Conte, Giuseppe, and DE NICOLA, Luca
- Subjects
Adult ,Male ,Aging ,medicine.medical_specialty ,Ambulatory blood pressure ,Physiology ,medicine.medical_treatment ,circadian rhythm disorder ,Blood Pressure ,Circadian Rhythm Disorders ,Internal medicine ,Chronic Kidney Disease ,Internal Medicine ,medicine ,Chronic renal insufficiency ,Humans ,In patient ,Prospective Studies ,Dialysis ,Aged ,chronic renal insufficiency ,business.industry ,Age Factors ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,medicine.disease ,Surgery ,ambulatory blood pressure monitoring ,Blood pressure ,Cross-Sectional Studies ,Ambulatory ,Chronic Disease ,Hypertension ,Female ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,Glomerular Filtration Rate - Abstract
OBJECTIVE: To evaluate effect of age on hypertensive status in chronic kidney disease (CKD). METHODS: We studied 459 prevalent CKD patients (stages 2-5, no dialysis), grouped by age (< 55, 55-64, 65-74, >or= 75 years), undergoing clinical blood pressure (CBP) and ambulatory blood pressure (ABP) measurement. RESULTS: Prevalence of diabetes, left ventricular hypertrophy and previous cardiovascular disease progressively increased with aging; glomerular filtration rate (GFR) and hemoglobin decreased. Achievement of CBP target decreased from 16% in patients < 55 years to 6% in those >or= 75 years (P = 0.023). ABP 24-h systolic rose while diastolic decreased, with a consequent pulse pressure increase from 45 +/- 8 to 65 +/- 14 mmHg (P < 0.0001). Age, proteinuria, diabetes, cardiovascular disease and anemia but not GFR predicted higher 24-h pulse pressure. CBP overestimated systolic/diastolic daytime ABP by 14 +/- 18/7 +/- 11 mmHg on average, a greater difference in older than younger groups (P < 0.005). Conversely, CBP night-time ABP difference did not vary among groups (24 +/- 20/16 +/- 11 mmHg). These age-dependent differences determined a rising prevalence of white-coat hypertension (from 19 to 40%, P = 0.001) and night/day ratio of at least 0.9 (from 43 to 66%, P = 0.0004). Age, diabetes, left ventricular hypertrophy and anemia but not GFR predicted nondipping status. Among the oldest patients, 13% had diastolic CBP below 70 mmHg, with 48% below the corresponding values of daytime (< 69 mmHg) or night-time ABP (< 60 mmHg). CONCLUSION: In CKD, prevalence of white-coat hypertension, nondipping status and potentially dangerous low diastolic ABP increases with aging. This suggests wider use of ABP monitoring in older patients and need for trials addressing identification of an age-specific blood pressure target.
- Published
- 2007
42. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial
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Giuseppe Conte, Diego Baldanza, Raffaele Scigliano, Simona Laurino, Paolo Trucillo, Luca De Nicola, Mascia S, Roberto Minutolo, Silvio Borrelli, Francis B. Gabbai, Minutolo, Roberto, Gabbai, Fb, Borrelli, S, Scigliano, R, Trucillo, P, Baldanza, D, Laurino, S, Mascia, R, Conte, Giuseppe, and DE NICOLA, Luca
- Subjects
Male ,medicine.medical_specialty ,Ambulatory blood pressure ,genetic structures ,medicine.drug_class ,Adrenergic beta-Antagonists ,Diastole ,Administration, Oral ,Renal function ,Hemodynamics ,Angiotensin-Converting Enzyme Inhibitors ,Blood Pressure ,Pilot Projects ,Drug Administration Schedule ,Internal medicine ,Humans ,Medicine ,Antihypertensive drug ,Antihypertensive Agents ,Aged ,Morning ,business.industry ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,Calcium Channel Blockers ,medicine.disease ,Circadian Rhythm ,Proteinuria ,Blood pressure ,Endocrinology ,Cardiovascular Diseases ,Nephrology ,Chronic Disease ,Hypertension ,Cardiology ,Drug Therapy, Combination ,Female ,Kidney Diseases ,business ,Glomerular Filtration Rate ,Kidney disease - Abstract
Background Nondipping status is associated with greater cardiovascular morbidity and mortality and faster progression of chronic kidney disease (CKD). We examined whether shifting 1 antihypertensive drug from morning to evening restores the circadian rhythm of blood pressure in nondipper patients with CKD. Study Design 8-week clinical trial without a control group. Setting & Participants We selected from our outpatient renal clinic 32 patients with CKD with estimated glomerular filtration rate less than 90 mL/min/1.73 m 2 and night-day ratio of mean ambulatory blood pressure (ABP) greater than 0.9, but with normal daytime ABP ( Intervention Shifting 1 antihypertensive drug from morning to evening. Outcomes Percentage of patients changing the night-day ratio of mean ABP from greater than 0.9 to 0.9 or less 8 weeks after the shift. Measurements Office blood pressure/ABP and proteinuria at baseline and after the shift. Results There were 55% men with a mean age of 67.4 ± 11.3 years and estimated glomerular filtration rate of 46 ± 12 mL/min/1.73 m 2 . They were treated with 2.4 ± 1.4 antihypertensive drugs. After the drug shift, the night-day ratio of mean ABP decreased in 93.7% of patients, with normal circadian rhythm restored in 87.5%. The nocturnal systolic and diastolic ABP decrease was not associated with an increase in diurnal ABP and was independent from number and class of shifted drug. Office blood pressure in the morning also decreased (from 136 ± 16/77 ± 10 to 131 ± 13/75 ± 8 mm Hg; P = 0.02). Urinary protein excretion decreased from 235 ± 259 to 167 ± 206 mg/d ( P Limitations Absence of a control group and patients with severe proteinuria or uncontrolled daytime ABP. Conclusions In nondipper patients with CKD, changing the timing of antihypertensive therapy decreases nocturnal blood pressure and proteinuria.
- Published
- 2007
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