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Hemodiafiltration (HDF) is a dialysis technique characterized by the combination of diffusive and convective depuration. This allows the removal of both low and medium-high molecular weight toxins, keeping the intradialytic hemodynamic status of the patient more stable. Technical innovations in HDF technology aim to enhance the depurative efficacy of the treatment and reduce intradialytic hypotensive events and intolerance. Among these techniques, mixed HDF, middilution HDF and HFR Aequilibrium have particular innovative significance. Mixed HDF and mid-dilution HDF are clinically indicated to enhance the depurative efficacy of HDF and HFR Aequilibrium may serve to widen the depurative range in patients suffering from the malnutrition-inflammation complex syndrome and intradialytic hypotension or intolerance. Mixed HDF and mid-dilution HDF allow to improve the infusion volumes thanks to the intradialytic modulation of the pre/post-infusion ratio (mixed HDF) or the high-volume intradialyzer pre/postinfusion (mid-dilution HDF). HFR Aequilibrium is based on a) separation between convection (first chamber) and diffusion with body weight decrease (second chamber); b) infusion of endogenous ultrafiltrate purified by resin adsorption; c) use of dialysate sodium and ultrafiltration profiles automatically elaborated by a mathematical model incorporated in the software of the dialysis machine.

Uso di carboanto di lantanio quale chelante non calcico per il trattamento dell'iperfosforemia nel paziente con insufficienza renale cronica terminale

viene descritto un caso di Encefalopatia Mitocondriale Neurogastrointestinale causata da mutazioni per il gene che codifica l'enzima Timidina fosforilasi con conseguenti deficit neurologici e dismotilità gastrointestinale con conseguente severa malnutrizione Il trattamento combinato DPNP ha consentito un netto miglioramento dello stato nutrizionale

Native arteriovenous fistula is still the vascular access of choice in hemodialysis. Other options are arteriovenous graft or, in patients in whom it is not possible to create a surgical vascular access, a permanent venous catheter. International guidelines on vascular access for hemodialysis recommend an increase in the percentage of arteriovenous fistulas compared to other types of vascular access. An analysis of the data relative to the distribution of the types of vascular access in different countries highlights the difficulty in following this recommendation: the only country to have increased the number of arteriovenous fistulas in recent years is the US, where the percentage of grafts has decreased while the use of permanent catheters has increased. In Italy and the rest of Europe, the number of fistulas has remained stable, there has been a constant reduction in the number of grafts and an increase in the percentage of permanent catheters. The reasons for this distribution of the types of vascular access are multifactorial and include the increased average age of patients, frequent late referrals, and increased incidence of diabetes mellitus, cardiovascular disease, obesity, etc. These factors have brought about technical difficulties for the creation of fistulas and grafts, leading to an increase in the number of catheters used. In relation to the evolution of the clinical characteristics of dialysis patients, the permanent catheter should no longer be considered a last-choice vascular access: in selected patients, it can be a better choice than a surgical fistula or graft.

AIM: To evaluate the acute effect of treatment with the molecular adsorbent recirculating system (MARS) on splanchnic, renal and systemic haemodynamics in patients with end-stage cirrhosis. METHODS: Twelve patients with end-stage cirrhosis, undergoing MARS treatment, were enrolled. The following haemodynamic parameters were measured by means of Doppler ultrasonography and thoracic electrical bioimpedance, before and after each session: portal velocity, renal and splenic resistance indices, cardiac output, cardiac stroke volume, heart rate, mean arterial pressure, systemic vascular resistance. RESULTS: Median portal velocity increased significantly after treatment (23.7 vs. 20.3 cm/s, P < 0.05) while renal resistance index (0.72 vs. 0.75, P < 0.05) and splenic resistance index (0.60 vs. 0.65, P < 0.05) decreased significantly. Mean arterial pressure (83 vs. 81 mmHg, P < 0.05) and vascular resistance (899 vs. 749 dyne. s/cm5, P < 0.05) increased significantly, while cardiac output and stroke volume showed no significant changes. CONCLUSIONS: Data emerging from this investigation suggest that MARS treatment improves significantly various haemodynamic alterations in cirrhotic patients in the short term. The observed decrease in renal vascular resistance and improvement in splenic resistance index, a parameter related to portal resistance, which leads us to hypothesize that these haemodynamic effects are probably mediated by clearance of vasoactive substances during MARS treatment.

A general investigation of the heart pulse propagation in blood vessel has been done and this research has been conducted for the blood flow in physiological conditions; then also the problems connected to new surgical techniques and also necessary in the organs transplantations. In particular in presence of insertion at some distance from the input is investigated and also the effects of the connection of vascular segments with different mechanical properties increases the risk of generation of blood turbolence fluxes and involves, in the arterial vessels. Mechanical models of cardiovascular system have been studied and the effects considered in clinical applications.