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1. The relationship between uremic toxins and symptoms in older men and women with advanced chronic kidney disease

Author

Massy Z. A., Chesnaye N. C., Larabi I. A., Dekker F. W., Evans M., Caskey F. J., Torino C., Porto G., Szymczak M., Drechsler C., Wanner C., Jager K. J., Alvarez J. C., Schneider A., Torp A., Iwig B., Perras B., Marx C., Blaser C., Emde C., Krieter D., Fuchs D., Irmler E., Platen E., Schmidt-Gurtler H., Schlee H., Naujoks H., Schlee I., Casar S., Beige J., Rothele J., Mazur J., Hahn K., Blouin K., Neumeier K., Anding-Rost K., Schramm L., Hopf M., Wuttke N., Frischmuth N., Ichtiaris P., Kirste P., Schulz P., Aign S., Biribauer S., Manan S., Roser S., Heidenreich S., Palm S., Schwedler S., Delrieux S., Renker S., Schattel S., Stephan T., Schmiedeke T., Weinreich T., Leimbach T., Stovesand T., Bahner U., Seeger W., Cupisti A., Sagliocca A., Ferraro A., Mele A., Naticchia A., Cosaro A., Ranghino A., Stucchi A., Pignataro A., De Blasio A., Pani A., Tsalouichos A., Bellasi A., Raffaele Di Iorio B., Butti A., Abaterusso C., Somma C., D'Alessandro C., Zullo C., Pozzi C., Bergamo D., Ciurlino D., Motta D., Russo D., Favaro E., Vigotti F., Ansali F., Conte F., Cianciotta F., Giacchino F., Cappellaio F., Pizzarelli F., Greco G., Bigatti G., Marinangeli G., Cabiddu G., Fumagalli G., Caloro G., Piccoli G., Capasso G., Gambaro G., Tognarelli G., Bonforte G., Conte G., Toscano G., Del Rosso G., Capizzi I., Baragetti I., Oldrizzi L., Gesualdo L., Biancone L., Magnano M., Ricardi M., Di Bari M., Laudato M., Luisa Sirico M., Ferraresi M., Provenzano M., Malaguti M., Palmieri N., Murrone P., Cirillo P., Dattolo P., Acampora P., Nigro R., Boero R., Scarpioni R., Sicoli R., Malandra R., Savoldi S., Bertoli S., Borrelli S., Maxia S., Maffei S., Mangano S., Cicchetti T., Rappa T., Palazzo V., De Simone W., Schrander A., Van Dam B., Siegert C., Gaillard C., Beerenhout C., Verburgh C., Janmaat C., Hoogeveen E., Hoorn E., Boots J., Boom H., Eijgenraam J. -W., Kooman J., Rotmans J., Vogt L., Raasveld M., Vervloet M., Van Buren M., Van Diepen M., Leurs P., Voskamp P., Blankestijn P., Van Esch S., Boorsma S., Berger S., Konings C., Aydin Z., Musiala A., Szymczak A., Olczyk E., Augustyniak-Bartosik H., Miskowiec-Wisniewska I., Manitius J., Pondel J., Jedrzejak K., Nowanska K., Nowak L., Durlik M., Dorota S., Nieszporek T., Heleniak Z., Jonsson A., Blom A. -L., Rogland B., Wallquist C., Vargas D., Dimeny E., Sundelin F., Uhlin F., Welander G., Bascaran Hernandez I., Grontoft K. -C., Stendahl M., Svensson M., Heimburger O., Kashioulis P., Melander S., Almquist T., Jensen U., Woodman A., McKeever A., Ullah A., McLaren B., Harron C., Barrett C., O'Toole C., Summersgill C., Geddes C., Glowski D., McGlynn D., Sands D., Roy G., Hirst G., King H., McNally H., Masri-Senghor H., Murtagh H., Rayner H., Turner J., Wilcox J., Berdeprado J., Wong J., Banda J., Jones K., Haydock L., Wilkinson L., Carmody M., Weetman M., Joinson M., Dutton M., Matthews M., Morgan N., Bleakley N., Cockwell P., Roderick P., Mason P., Kalra P., Sajith R., Chapman S., Navjee S., Crosbie S., Brown S., Tickle S., Mathavakkannan S., Kuan Y., Massy, Z. A., Chesnaye, N. C., Larabi, I. A., Dekker, F. W., Evans, M., Caskey, F. J., Torino, C., Porto, G., Szymczak, M., Drechsler, C., Wanner, C., Jager, K. J., Alvarez, J. C., Schneider, A., Torp, A., Iwig, B., Perras, B., Marx, C., Blaser, C., Emde, C., Krieter, D., Fuchs, D., Irmler, E., Platen, E., Schmidt-Gurtler, H., Schlee, H., Naujoks, H., Schlee, I., Casar, S., Beige, J., Rothele, J., Mazur, J., Hahn, K., Blouin, K., Neumeier, K., Anding-Rost, K., Schramm, L., Hopf, M., Wuttke, N., Frischmuth, N., Ichtiaris, P., Kirste, P., Schulz, P., Aign, S., Biribauer, S., Manan, S., Roser, S., Heidenreich, S., Palm, S., Schwedler, S., Delrieux, S., Renker, S., Schattel, S., Stephan, T., Schmiedeke, T., Weinreich, T., Leimbach, T., Stovesand, T., Bahner, U., Seeger, W., Cupisti, A., Sagliocca, A., Ferraro, A., Mele, A., Naticchia, A., Cosaro, A., Ranghino, A., Stucchi, A., Pignataro, A., De Blasio, A., Pani, A., Tsalouichos, A., Bellasi, A., Raffaele Di Iorio, B., Butti, A., Abaterusso, C., Somma, C., D'Alessandro, C., Zullo, C., Pozzi, C., Bergamo, D., Ciurlino, D., Motta, D., Russo, D., Favaro, E., Vigotti, F., Ansali, F., Conte, F., Cianciotta, F., Giacchino, F., Cappellaio, F., Pizzarelli, F., Greco, G., Bigatti, G., Marinangeli, G., Cabiddu, G., Fumagalli, G., Caloro, G., Piccoli, G., Capasso, G., Gambaro, G., Tognarelli, G., Bonforte, G., Conte, G., Toscano, G., Del Rosso, G., Capizzi, I., Baragetti, I., Oldrizzi, L., Gesualdo, L., Biancone, L., Magnano, M., Ricardi, M., Di Bari, M., Laudato, M., Luisa Sirico, M., Ferraresi, M., Provenzano, M., Malaguti, M., Palmieri, N., Murrone, P., Cirillo, P., Dattolo, P., Acampora, P., Nigro, R., Boero, R., Scarpioni, R., Sicoli, R., Malandra, R., Savoldi, S., Bertoli, S., Borrelli, S., Maxia, S., Maffei, S., Mangano, S., Cicchetti, T., Rappa, T., Palazzo, V., De Simone, W., Schrander, A., Van Dam, B., Siegert, C., Gaillard, C., Beerenhout, C., Verburgh, C., Janmaat, C., Hoogeveen, E., Hoorn, E., Boots, J., Boom, H., Eijgenraam, J. -W., Kooman, J., Rotmans, J., Vogt, L., Raasveld, M., Vervloet, M., Van Buren, M., Van Diepen, M., Leurs, P., Voskamp, P., Blankestijn, P., Van Esch, S., Boorsma, S., Berger, S., Konings, C., Aydin, Z., Musiala, A., Szymczak, A., Olczyk, E., Augustyniak-Bartosik, H., Miskowiec-Wisniewska, I., Manitius, J., Pondel, J., Jedrzejak, K., Nowanska, K., Nowak, L., Durlik, M., Dorota, S., Nieszporek, T., Heleniak, Z., Jonsson, A., Blom, A. -L., Rogland, B., Wallquist, C., Vargas, D., Dimeny, E., Sundelin, F., Uhlin, F., Welander, G., Bascaran Hernandez, I., Grontoft, K. -C., Stendahl, M., Svensson, M., Heimburger, O., Kashioulis, P., Melander, S., Almquist, T., Jensen, U., Woodman, A., Mckeever, A., Ullah, A., Mclaren, B., Harron, C., Barrett, C., O'Toole, C., Summersgill, C., Geddes, C., Glowski, D., Mcglynn, D., Sands, D., Roy, G., Hirst, G., King, H., Mcnally, H., Masri-Senghor, H., Murtagh, H., Rayner, H., Turner, J., Wilcox, J., Berdeprado, J., Wong, J., Banda, J., Jones, K., Haydock, L., Wilkinson, L., Carmody, M., Weetman, M., Joinson, M., Dutton, M., Matthews, M., Morgan, N., Bleakley, N., Cockwell, P., Roderick, P., Mason, P., Kalra, P., Sajith, R., Chapman, S., Navjee, S., Crosbie, S., Brown, S., Tickle, S., Mathavakkannan, S., Kuan, Y., Nephrology, ACS - Diabetes & metabolism, Medical Informatics, APH - Methodology, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, APH - Health Behaviors & Chronic Diseases, and ACS - Pulmonary hypertension & thrombosis

Subjects
Transplantation, Nephrology, uremic toxins, CKD, symptoms, symptom, elderly
Abstract

Background Patients with stage 4/5 chronic kidney disease (CKD) suffer from various symptoms. The retention of uremic solutes is thought to be associated with those symptoms. However, there are relatively few rigorous studies on the potential links between uremic toxins and symptoms in patients with CKD. Methods The EQUAL study is an ongoing observational cohort study of non-dialyzed patients with stage 4/5 CKD. EQUAL patients from Germany, Poland, Sweden and the UK were included in the present study (n = 795). Data and symptom self-report questionnaires were collected between April 2012 and September 2020. Baseline uric acid and parathyroid hormone and 10 uremic toxins were quantified. We tested the association between uremic toxins and symptoms and adjusted P-values for multiple testing. Results Symptoms were more frequent in women than in men with stage 4/5 CKD, while levels of various uremic toxins were higher in men. Only trimethylamine N-oxide (TMAO; positive association with fatigue), p-cresyl sulfate (PCS) with constipation and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (negative association with shortness of breath) demonstrated moderately strong associations with symptoms in adjusted analyses. The association of phenylacetylglutamine with shortness of breath was consistent in both sexes, although it only reached statistical significance in the full population. In contrast, TMAO (fatigue) and PCS and phenylacetylglutamine (constipation) were only associated with symptoms in men, who presented higher serum levels than women. Conclusion Only a limited number of toxins were associated with symptoms in persons with stage 4/5 CKD. Other uremic toxins, uremia-related factors or psychosocial factors not yet explored might contribute to symptom burden.

Published
2022

2. Glomerular diseases in pregnancy: pragmatic recommendations for clinical management.

Author

Fakhouri, F., Schwotzer, N., Cabiddu, G., Barratt, J., Legardeur, H., Garovic, V., Orozco-Guillen, A., Wetzels, J., Daugas, E., Moroni, G., Noris, M., Audard, V., Praga, M., Llurba, E., Wuerzner, G., Attini, R., Desseauve, D., Zakharova, E., Luders, C., Wiles, K., Leone, F., Jesudason, S., Costedoat-Chalumeau, N., Kattah, A., Soto-Abraham, V., Karras, A., Prakash, J., Lightstone, L., Ronco, P., Ponticelli, C., Appel, G., Remuzzi, G., Tsatsaris, V., Piccoli, G.B., Fakhouri, F., Schwotzer, N., Cabiddu, G., Barratt, J., Legardeur, H., Garovic, V., Orozco-Guillen, A., Wetzels, J., Daugas, E., Moroni, G., Noris, M., Audard, V., Praga, M., Llurba, E., Wuerzner, G., Attini, R., Desseauve, D., Zakharova, E., Luders, C., Wiles, K., Leone, F., Jesudason, S., Costedoat-Chalumeau, N., Kattah, A., Soto-Abraham, V., Karras, A., Prakash, J., Lightstone, L., Ronco, P., Ponticelli, C., Appel, G., Remuzzi, G., Tsatsaris, V., and Piccoli, G.B.

Abstract

01 februari 2023, Item does not contain fulltext, Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.

Published
2023

6. Outcomes of Pregnancies After Kidney Transplantation

Author

Piccoli, Gb1, Cabiddu, G, Attini, R, Gerbino, M, Todeschini, P, Perrino, Ml, Manzione, Am, Piredda, Gb, Gnappi, E, Caputo, F, Montagnino, G, Bellizzi, V, Di Loreto, P, Martino, F, Montanaro, D, Rossini, M, Castellino, S, Biolcati, M, Fassio, F, Loi, V, Parisi, S, Versino, E, Pani, A, Todros, T, Italian Study group on Kidney and Pregnancy of the Italian Society of Nephrology Working Group on Pregnancy in Renal Transplantation: Paola Todeschini, Gaetano La Manna, Maria Luisa Perrino, Giacomo, Colussi, Ana Maria Manzione, Luigi, Biancone, Gianfranca, Cabiddu, Gianbenedetto, Piredda, Valentina, Loi, Stefania, Maxia, Elisa, Gnappi, Umberto, Maggiore, Flavia, Caputo, Barbara, Buscemi, Giuseppe, Montagnino, Piergiorgio, Messa, Vincenzo, Bellizzi, Giuseppe, Palladino, Pierluigi Di Loreto, Linda De Silvestro, Francesca, Martino, Claudio, Ronco, Domenico, Montanaro, Maria, Groppuzzo, Michele, Rossini, Loreto, Gesualdo, Delia, Davoli, Cappelli, Gianni, Maurizio, Postorino, Anna Rachele Rocca, Maria Luisa Framarino dei Malatesta, Piero, Stratta, Cristina, Izzo, Marco, Quaglia, Gisella, Setti, Giovanni, Cancarini, Dorella Del Prete, Luciana, Bonfante, Ciro, Esposito, Giovanni, Montagna, Massimiliano, Veroux, Domenico, Santoro, Vera, Paloschi, Antonio, Secchi, Olga, Credendino, Andrea, Tranquilli, Giorgia, Buscicchio, Piccoli, Giorgina Barbara, Cabiddu, Gianfranca, Attini, Rossella, Gerbino, Martina, Todeschini, Paola, Perrino, Maria Luisa, Manzione, Ana Maria, Piredda, Gian Benedetto, Gnappi, Elisa, Caputo, Flavia, Montagnino, Giuseppe, Bellizzi, Vincenzo, Di Loreto, Pierluigi, Martino, Francesca, Montanaro, Domenico, Rossini, Michele, Castellino, Santina, Biolcati, Marilisa, Fassio, Federica, Loi, Valentina, Parisi, Silvia, Versino, Elisabetta, Pani, Antonello, and Todros, Tullia

Subjects
Adult, medicine.medical_specialty, Population, 030232 urology & nephrology, 030204 cardiovascular system & hematology, urologic and male genital diseases, Risk Assessment, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, Internal medicine, medicine, Humans, Registries, Renal Insufficiency, Chronic, Young adult, education, Intensive care medicine, Kidney transplantation, Retrospective Studies, Transplantation, education.field_of_study, business.industry, Incidence, Infant, Newborn, Pregnancy Outcome, Retrospective cohort study, Transplantation, pregnancy after kidney transplant, medicine.disease, Kidney Transplantation, female genital diseases and pregnancy complications, OUTCOME OF PREGNANCY KIDNEY TRANSAPLANTATION, Pregnancy Complications, Italy, Female, business, Risk assessment, Kidney disease
Abstract

Kidney transplantation (KT) may restore fertility in chronic kidney disease (CKD). The reasons why maternofetal outcomes are still inferior to the overall population are only partially known. Comparison with the CKD population may offer some useful insights for management and counselling.Aim of this study was to analyse the outcomes of pregnancy after KT, compared with a large population of nontransplanted CKD patients and with low-risk control pregnancies, observed in Italy the new millennium.We selected 121 live-born singletons after KT (Italian study group of kidney in pregnancy, national coverage about 75%), 610 live-born singletons in CKD, and 1418 low-risk controls recruited in 2 large Italian Units in the same period (2000-2014). The following outcomes were considered: maternal and fetal death; malformations; preterm delivery; small for gestational age (SGA) baby; need for the neonatal intensive care unit; doubling of serum creatinine or increase in CKD stage. Data were analyzed according to kidney diseases, renal function (staging according to CKD-epidemiology collaboration), hypertension, maternal age, parity, ethnicity.Maternofetal outcomes are less favourable in CKD and KT as compared with the low-risk population. CKD stage and hypertension are important determinants of results. Kidney transplantation patients with estimated glomerular filtration rate greater than 90 have worse outcomes compared with CKD stage 1 patients; the differences level off when only CKD patients affected by glomerulonephritis or systemic diseases ("progressive CKD") are compared with KT. In the multivariate analysis, risk for preterm and early-preterm delivery was linked to CKD stage (2-5 vs 1: relative risk 3.42 and 3.78) and hypertension (RR 3.68 and 3.16) while no difference was associated with being a KT or a CKD patient.The maternofetal outcomes in patients with kidney transplantation are comparable with those of nontransplanted CKD patients with similar levels of kidney function impairment and progressive and/or immunologic kidney disease.

Published
2017

8. Conservative Treatment of CKD' Study Group of the Italian Society of Nephrology. Controversial issues in CKD clinical practice: position statement of the CKD-treatment working group of the Italian Society of Nephrology

Author

Bellizzi, V, Conte, G, Mandreoli, M, Borrelli, S, Cupisti, A, De Nicola, L, Di Iorio, Br, Cabiddu, G, Paoletti, E, Piccoli, Gb, Quintaliani, G, Ravera, M, Santoro, Domenico, Torraca, S, and Minutolo, R.

Subjects
Position statement CKD Renal biopsy Diabetes RAAS Iron Salt intake Protein intake Low protein diet Bicarbonate Overweight Obesity Conservative therapy
Published
2017

9. Pregnancy outcomes after kidney graft in Italy: are the changes over time the result of different therapies or of different policies? A nationwide survey (1978-2013)

Author

Piccoli, Gb, Cabiddu, G, Attini, R, Gerbino, M, Todeschini, P, Perrino, Ml, Manzione, Am, Piredda, Gb, Gnappi, E, Caputo, F, Montagnino, G, Bellizzi, V, Di Loreto, P, Martino, F, Montanaro, D, Rossini, M, Castellino, S, Biolcati, M, Fassio, F, Loi, V, Parisi, S, Versino, E, Pani, A, Todros, T, Manna, G, Colussi, G, Biancone, L, Piredda, G, Maxia, S, Maggiore, U, Buscemi, B, Messa, P, Palladino, G, De Silvestro, L, Ronco, C, Groppuzzo, M, Gesualdo, L, Davoli, D, Cappelli, G, Postorino, M, Rocca, Ar, Dei Malatesta ML, Stratta, P, Izzo, C, Quaglia, M, Setti, G, Cancarini, Giovanni, Del Prete, D, Bonfante, L, Esposito, C, Montagna, G, Veroux, M, Santoro, D, Paloschi, V, Secchi, A, Credendino, O, Tranquilli, A, Buscicchio, G, Gammaro, L, Gernone, G, Giacchino, F, Limardo, M., Piccoli, Giorgina Barbara, Cabiddu, Gianfranca, Attini, Rossella, Gerbino, Martina, Todeschini, Paola, Perrino, Maria Luisa, Manzione, Ana Maria, Piredda, Gian Benedetto, Gnappi, Elisa, Caputo, Flavia, Montagnino, Giuseppe, Bellizzi, Vincenzo, Di Loreto, Pierluigi, Martino, Francesca, Montanaro, Domenico, Rossini, Michele, Castellino, Santina, Biolcati, Marilisa, Fassio, Federica, Loi, Valentina, Parisi, Silvia, Versino, Elisabetta, Pani, Antonello, and Todros, Tullia

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Péregnancy, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Surveys and Questionnaires, medicine, Humans, Registries, Renal replacement therapy, Kidney transplantation, Dialysis, Transplantation, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Incidence, Infant, Newborn, Pregnancy Outcome, medicine.disease, Kidney Transplantation, Kidney graft, Pregnancy Complications, Italy, Nephrology, Premature birth, Cohort, Premature Birth, Small for gestational age, Female, pregnancy, kidney transplant, immunosuppression, Transplantation, Péregnancy, business, Immunosuppressive Agents
Abstract

BACKGROUND Kidney transplantation is the treatment of choice to restore fertility to women on renal replacement therapy. Over time, immunosuppressive, support therapies and approaches towards high-risk pregnancies have changed. The aim of this study was to analyse maternal-foetal outcomes in two cohorts of transplanted women who delivered a live-born baby in Italy in 1978-2013, dichotomized into delivery before and after January 2000. METHODS A survey involving all the Italian transplant centres was carried out, gathering data on all pregnancies recorded since the start of activity at each centre; the estimated nationwide coverage was 75%. Data on cause of ESRD, dialysis, living/cadaveric transplantation, drug therapy, comorbidity, and the main maternal-foetal outcomes were recorded and reviewed. Data were compared with a low-risk cohort of pregnancies from two large Italian centres (2000-14; Torino and Cagliari Observational Study cohort). RESULTS The database consists of 222 pregnancies with live-born babies after transplantation (83 before 2000 and 139 in 2000-13; 68 and 121 with baseline and birth data, respectively), and 1418 low-risk controls. The age of the patients significantly increased over time (1978-99: age 30.7 ± 3.7 versus 34.1 ± 3.7 in 2000-13; P < 0.001). Azathioprine, steroids and cyclosporine A were the main drugs employed in the first time period, while tacrolimus emerged in the second. The prevalence of early preterm babies increased from 13.4% in the first to 27.1% in the second period (P = 0.049), while late-preterm babies non-significantly decreased (38.8 versus 33.1%), thus leaving the prevalence of all preterm babies almost unchanged (52.2 and 60.2%; P = 0.372). Babies below the 5th percentile decreased over time (22.2 versus 9.6%; P = 0.036). In spite of high prematurity rates, no neonatal deaths occurred after 2000. The results in kidney transplant patients are significantly different from controls both considering all cases [preterm delivery: 57.3 versus 6.3%; early preterm: 22.2 versus 0.9%; small for gestational age (SGA): 14 versus 4.5%; P < 0.001] and considering only transplant patients with normal kidney function [preterm delivery: 35 versus 6.3%; early preterm: 10 versus 0.9%; SGA: 23.7 versus 4.5% (P < 0.001); risks increase across CKD stages]. Kidney function remained stable in most of the patients up to 6 months after delivery. Multiple regression analysis performed on the transplant cohort highlights a higher risk of preterm delivery in later CKD stages, an increase in preterm delivery and a decrease in SGA across periods. CONCLUSIONS Pregnancy after transplantation has a higher risk of adverse outcomes compared with the general population. Over time, the incidence of SGA babies decreased while the incidence of 'early preterm' babies increased. Although acknowledging the differences in therapy (cyclosporine versus tacrolimus) and in maternal age (significantly increased), the decrease in SGA and the increase in prematurity may be explained by an obstetric policy favouring earlier delivery against the risk of foetal growth restriction.

Published
2016

10. Old and New Perspectives on Peritoneal Dialysis in Italy Emerging from the Peritoneal Dialysis Study Group Census

Author

Marinangeli, G, Cabiddu, G, Neri, L, Viglino, G, Russo, R, Teatini, U, Bonfante, Luciana, Italian Society of Nephrology Peritoneal Dialysis Study Group, Marinangeli, G, Cabiddu, G, Neri, L, Viglino, G, Russo, R, Teatini, U on behalf of the Italian Society of Nephrology Peritoneal Dialysis Group including, and Vezzoli, G

Subjects
medicine.medical_specialty, medicine.medical_treatment, Peritonitis, Peritoneal dialysis, Peritoneal Dialysis, Continuous Ambulatory, Surveys and Questionnaires, Internal medicine, medicine, Humans, Dialysis, business.industry, Incidence, Incidence (epidemiology), Censuses, Peritoneal Fibrosis, Original Articles, General Medicine, medicine.disease, Surgery, Survival Rate, Transplantation, Catheter, Italy, Nephrology, Ambulatory, Hemodialysis, business, Peritoneal Dialysis
Abstract

Background To understand how peritoneal dialysis (PD) was being used in Italy in 2005 and 2008, a census of all centers was carried out. Methods In 2005 and 2008, data were collected from, respectively, 222 and 223 centers, with respect to 4432 and 4094 prevalent patients. Results In the two periods, the PD incidence remained stable (24.3% vs 22.9%), varying from center to center. Continuous ambulatory PD (CAPD) was the main initial method (55%), but APD was more widespread among prevalent patients (53%). Among patients returning to dialysis from transplantation (Tx), PD was used in 10%. The use of incremental CAPD increased significantly from 2005 to 2008, in terms both of the number of centers (27.0% vs 40.9%) and of patients (13.6% vs 25.7%). Late referrals remained stable at 28%, with less use of PD. The overall drop-out rate (episodes/100 patient–years) remained unchanged (31.0 vs 32.8), with 13.1 and 12.9 being the result of death, and 11.8 and 12.4 being the result of a switch to hemodialysis, mainly after peritonitis. A dialysis partner was required by 21.8% of the PD patients. The incidence of peritonitis was 1 episode in 36.5 and 41.1 patient–months, with negative cultures occurring in 17.1% of cases in both periods. The incidence of encapsulating peritoneal sclerosis (episodes/100 patient–years) was 0.70, representing 1.26% of patients treated. The catheter types used and the sites and methods of insertion varied widely from center to center. Conclusions These censuses confirm the good results of PD in Italy, and provide insight into little-known aspects such as the use of incremental PD, the presence of a dialysis partner, and the incidence of encapsulating peritoneal sclerosis.

Published
2012

11. Prevalence and progression of cardiovascular calcifications in peritoneal dialysis patients: A prospective study

Author

Gallieni M, Caputo F, Filippini A, Gabella P, Giannattasio M, Stingone A, Farina M, Amato M, Avella F, Bertoli M, Bocci C, Borgatti P, Buongiorno E, Cavatorta F, Cabiddu G, Coratelli P, Costanzo R, Daidone G, D'Angelo A, Della Grotta F, De Vecchi A, Ferrari G, Gaggiotti E, Fanciulli E, Fusaroli M, La Rosa R, Malberti F, Marinangeli G, Mauro MM, Oliva B, Orazi E, Rapisarda F, Rocca AR, Ronco C, Sacchetti A, Sasdelli M, Scanziani R, Sessa A, Spinelli C, STEFONI, SERGIO, Viglino G., Gallieni M, Caputo F, Filippini A, Gabella P, Giannattasio M, Stingone A, Farina M, Amato M, Avella F, Bertoli M, Bocci C, Borgatti P, Buongiorno E, Cavatorta F, Cabiddu G, Coratelli P, Costanzo R, Daidone G, D'Angelo A, Della Grotta F, De Vecchi A, Ferrari G, Gaggiotti E, Fanciulli E, Fusaroli M, La Rosa R, Malberti F, Marinangeli G, Mauro MM, Oliva B, Orazi E, Rapisarda F, Rocca AR, Ronco C, Sacchetti A, Sasdelli M, Scanziani R, Sessa A, Spinelli C, Stefoni S, and Viglino G.

Subjects
Adult, Male, medicine.medical_specialty, Histology, Physiology, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Population, Left ventricular hypertrophy, Gastroenterology, Peritoneal dialysis, Young Adult, Cardiovascular calcification, PERITONEAL DIALYSIS, Internal medicine, medicine, Prevalence, CKD-MBD, Humans, Renal osteodystrophy, Prospective Studies, education, Prospective cohort study, Dialysis, CARDIOVASCULAR CALCIFICATION, Aged, Demography, Aged, 80 and over, education.field_of_study, business.industry, Calcinosis, Phosphorus, Middle Aged, medicine.disease, Survival Analysis, Surgery, Italy, Multivariate Analysis, OBSERVATIONAL STUDY, Disease Progression, SURVIVAL, Calcium, Female, Hypertrophy, Left Ventricular, Hemodialysis, business, Cardiomyopathies
Abstract

Background Patients on dialysis may have abnormal serum levels of Ca, P and parathyroid hormone, with related bone diseases. This population has an increased risk of death, with cardiovascular calcification (CC) a contributing factor. Patients on peritoneal dialysis appear to be at increased risk of hyperlipidemia, a contributing factor to atherosclerotic plaque formation. Although several studies have described the presence and progression of CC in hemodialysis populations, there are fewer data in patients on peritoneal dialysis. Study design The Renal Osteodystrophy and Calcifications: Key factors in Peritoneal Dialysis (ROCK-PD) study was a 36-month, prospective observational study conducted in Italy. The study examined the presence and progression of CC in two cardiac valves and five arterial sites. The potential associations of serum Ca and P with mortality and cardiovascular morbidity, demographic, clinical and blood chemistry variables was investigated. Results CC was present in 77% of patients at baseline ( N = 369) and in 90% of patients by study end ( N = 145), progressing in 73% of patients. There were 42 deaths (11%). Analyses showed a marked correlation between baseline P levels and the presence of left ventricular hypertrophy. However, there were no consistent correlations between serum Ca or P with mortality or morbidity. Conclusions CC was common in peritoneal dialysis patients and progressed in a majority of patients.

Published
2012

12. The children of dialysis: Live-born babies from on-dialysis mothers in Italy - An epidemiological perspective comparing dialysis, kidney transplantation and the overall population

Author

Piccoli, Giorgina Barbara, Cabiddu, G, Daidone, G, Guzzo, G, Maxia, S, Ciniglio, I, Postorino, V, Loi, V, Ghiotto, S, Nichelatti, M, Attini, Rossella, Coscia, A, Postorino, M, Pani, A, Italian Study Group Kidney, Pregnancy, and Pieruzzi, F

Subjects
Adult, Counseling, Male, Pediatrics, medicine.medical_specialty, dialysi, Time Factors, medicine.medical_treatment, Birth weight, Population, Gestational Age, Peritoneal dialysis, Young Adult, Renal Dialysis, Infant Mortality, medicine, Birth Weight, Humans, Registries, education, Dialysis, Kidney transplantation, Retrospective Studies, Pregnancy, education.field_of_study, business.industry, Incidence, Infant, Newborn, Pregnancy Outcome, Gestational age, Middle Aged, medicine.disease, Kidney Transplantation, Transplantation, Pregnancy Complications, counselling, Italy, Nephrology, Kidney Failure, Chronic, Female, pregnancy, business, Follow-Up Studies, transplantation
Abstract

Background A successful pregnancy is an exceptional event on dialysis. Few data are available comparing pregnancy rates on dialysis, transplantation and the overall population. The aim of the study was to assess the incidence of live births from mothers on chronic dialysis compared with the overall population and with kidney transplant patients. Methods The setting of the study is in Italy between 2000-12. Data on dialysis was aquired by phone inquiries that were carried out between June and September, 2013, involving all the public dialysis centres in Italy; the result was a 100% response rate. The date included was end-stage renal disease, type of dialysis, residual glomerular filtration rate, changes in dialysis and therapy, hospitalization; week of birth, birth weight, centile; and outcome of mother and child. Information on transplantation was acquired by inquiry by the kidney and pregnancy study group who were contacted by phone or e-mail; the result was a 60% response rate. Data concerning prevalence of women in childbearing age (20-45) were obtained from the Italian Dialysis and Transplant Registries (2010-11 update). Official site of the Italian Ministry of Health. Results During the study period, 23 women on dialysis (three on peritoneal dialysis) delivered live-born babies and one woman delivered twins (24 babies). Three babies died in the first weeks-months of life (including one twin); 19 of 21 singletons with available data were pre-term (33.3%

Published
2014

13. Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

Author

Cabiddu, G, Castellino, S, Gernone, G, Santoro, D, Giacchino, F, Credendino, O, Daidone, G, Gregorini, G, Moroni, G, Attini, R, Minelli, F, Manisco, G, Todros, T, Piccoli, G, Pieruzzi, F, Pieruzzi, FUEG, Cabiddu, G, Castellino, S, Gernone, G, Santoro, D, Giacchino, F, Credendino, O, Daidone, G, Gregorini, G, Moroni, G, Attini, R, Minelli, F, Manisco, G, Todros, T, Piccoli, G, Pieruzzi, F, and Pieruzzi, FUEG

Abstract

Background: Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion. Methods: A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000–2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips. Main results: Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75 % may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

Published
2015

14. Children of a lesser god or miracles? An emotional and behavioural profile of children born to mothers on dialysis in Italy: A multicentre nationwide study 2000-12

Author

Piccoli, G, Postorino, V, Cabiddu, G, Ghiotto, S, Guzzo, G, Roggero, S, Manca, E, Puddu, R, Meloni, F, Attini, R, Moi, P, Maxia, S, Piga, A, Mazzone, L, Pani, A, Postorino, M, Castellino, S, Gernone, G, Guida, B, Calabria, S, Galliani, M, Manisco, G, Di Tullio, M, Vernaglione, L, Chiappini, M, Proietti, E, Saffiotti, S, Gangeni, C, Brunati, C, Montoli, A, Esposito, C, Montagna, G, Tata, S, Romano, P, Amatruda, O, Cervini, P, Casiraghi, E, Fabbrini, P, Pieruzzi, F, Di Benedetto, A, Alfisi, G, Heidempergher, M, Buskermolen, M, Leveque, A, Autuly, V, Giofrè, F, Alati, G, Lombardi, L, Riccio, M, Riccio, I, Stingone, A, D'Angelo, B, Lucchi, L, Stipo, L, Loi, V, Piccoli, G, Postorino, V, Cabiddu, G, Ghiotto, S, Guzzo, G, Roggero, S, Manca, E, Puddu, R, Meloni, F, Attini, R, Moi, P, Maxia, S, Piga, A, Mazzone, L, Pani, A, Postorino, M, Castellino, S, Gernone, G, Guida, B, Calabria, S, Galliani, M, Manisco, G, Di Tullio, M, Vernaglione, L, Chiappini, M, Proietti, E, Saffiotti, S, Gangeni, C, Brunati, C, Montoli, A, Esposito, C, Montagna, G, Tata, S, Romano, P, Amatruda, O, Cervini, P, Casiraghi, E, Fabbrini, P, Pieruzzi, F, Di Benedetto, A, Alfisi, G, Heidempergher, M, Buskermolen, M, Leveque, A, Autuly, V, Giofrè, F, Alati, G, Lombardi, L, Riccio, M, Riccio, I, Stingone, A, D'Angelo, B, Lucchi, L, Stipo, L, and Loi, V

Abstract

Background Pregnancy on dialysis is increasingly being reported. This study evaluates the behavioural profile of the children of mothers on dialysis and the parental stress their mothers undergo when compared with a group of mothers affected by a different chronic disease (microcythaemia) and a group of healthy control mothers. Methods Between 2000 and 2012, 23 on-dialysis mothers gave birth to 24 live-born children in Italy (23 pregnancies, 1 twin pregnancy, one of the twins deceased soon after delivery); of these, 16 mothers and 1 father (whose wife died before the inquiry) were included in the study (1 mother had died and the father was unavailable; 2 were not asked to participate because their children had died and 3 were unavailable; children: median age: 8.5, min-max: 2-13 years). Twenty-three mothers affected by transfusion-dependent microcythaemia or drepanocitosis (31 pregnancies, 32 children) and 35 healthy mothers (35 pregnancies, 35 children; median age of the children: 7, min-max: 1-13 years) were recruited as controls. All filled in the validated questionnaires: 'Child Behaviour Checklist' (CBCL) and the 'Parental Stress Index-Short Form' (PSI-SF). Results The results of the CBCL questionnaire were similar for mothers on dialysis and healthy controls except for pervasive developmental problems, which were significantly higher in the dialysis group, while microcythaemia mothers reported higher emotional and behavioural problems in their children in 8 CBCL sub-scales. Two/16 children in the dialysis and 3/32 in the microcythaemia group had pathological profiles, as assessed by T-scores (p: ns). PSI-SF indicated a normal degree of parental stress in microcythaemia subjects and healthy controls, while mothers on dialysis declared significantly lower stress, suggesting a defensive response in order to minimize problems, stress or negativity in their relationship with their child. Conclusions According to the present analysis, the emotional and behavioural o

Published
2015

15. PREGNANCY AND PROGRESSION OF IGA NEPHROPATHY: RESULTS OF AN ITALIAN MULTICENTER STUDY

Author

Limardo, M, Imbasciati, E, Ravani, P, Surian, M, Torres, D, Gregorini, G, Magistroni, R, Casellato, D, Gammaro, L, Pozzi, C, Gammaro L, Rene e. Gravidanza Collaborative Group of the Italian Society of N. e. p. h. r. o. l. o. g. y., Beati, S, Ambroso, G, Maggio, M, Del Giudice, A, De Cristofaro, V, Gallo, E, Gernone, G, Marega, A, Rustichelli, R, Cabiddu, G, Rollino, C, Fanciulli, E, Feriozzi, S, Pecchini, P, Bizzarri, D, D'Amico, M, Proietti, E, Baratelli, L, Battista Reinero, G, Garibotto, Giacomo, Rocchietti, M, Allegri, L, Dugo, M, Cirami, L, Esposito, C, Amico, L, Mariani, P, Baroli, A, Giannattasio, M, Stratta, P, Montanaro, D, Gesualdo, L, Daidone, G, Manfellotto, D, and Castellino, S.

Published
2010

17. Transplantation - clinical studies II

Author

Marques, I. B., primary, Silva, R. d. M., additional, Moraes, C. E., additional, Azevedo, L. S., additional, Nahas, W. C., additional, David-Neto, E., additional, Furmanczyk-Zawiska, A., additional, Baczkowska, T., additional, Chmura, A., additional, Szmidt, J., additional, Durlik, M., additional, Joslin, J., additional, Blaker, P., additional, White, B., additional, Marinaki, A., additional, Sanderson, J., additional, Goldsmith, D. J., additional, Medani, S., additional, Traynor, C., additional, Mohan, P., additional, Little, D., additional, Conlon, P., additional, Molina, M., additional, Gonzalez, E., additional, Gutierrez, E., additional, Sevillano, A., additional, Polanco, N., additional, Morales, E., additional, Hernandez, A., additional, Praga, M., additional, Morales, J. M., additional, Andres, A., additional, Park, S. J., additional, Kim, T. H., additional, Kim, Y. W., additional, Kim, Y. H., additional, Kang, S. W., additional, Kujawa-Szewieczek, A., additional, Szotowska, M., additional, Kuczera, P., additional, Chudek, J., additional, Wiecek, A., additional, Kolonko, A., additional, Mahrova, A., additional, Svagrova, K., additional, Bunc, V., additional, Stollova, M., additional, Teplan, V., additional, Hundt, F., additional, van Heteren, P., additional, Woitas, R., additional, Cavallo, M. C., additional, Sepe, V., additional, Conte, F., additional, Albrizio, P., additional, Bottazzi, A., additional, Geraci, P. M., additional, Alpay, N., additional, Gumber, M. R., additional, Kute, V. B., additional, Vanikar, A. V., additional, Patel, H. V., additional, Shah, P. R., additional, Engineer, D. P., additional, Trivedi, H. L., additional, Golebiewska, J. E., additional, Debska-Slizien, A., additional, Rutkowski, B., additional, Matias, P., additional, Martins, A. R., additional, Raposo, L., additional, Jorge, C., additional, Weigert, A., additional, Birne, R., additional, Bruges, M., additional, Adragao, T., additional, Almeida, M., additional, Mendes, M., additional, Machado, D., additional, Masin-Spasovska, J., additional, Dohcev, S., additional, Stankov, O., additional, Stavridis, S., additional, Saidi, S., additional, Dejanova, B., additional, Rambabova-Busletic, I., additional, Dejanov, P., additional, Spasovski, G., additional, Nho, K. W., additional, Han, D. J., additional, Park, S.-K., additional, Kim, S. B., additional, Fenoglio, R., additional, Lazzarich, E. E., additional, Cagna, D., additional, Cena, T., additional, Conti, N., additional, Quaglia, M., additional, Radin, E., additional, Izzo, C., additional, Stratta, P., additional, Oh, I. H., additional, Park, J.-S., additional, Lee, C. H., additional, Kang, C. M., additional, Kim, G.-H., additional, Leone, F., additional, Lofaro, D., additional, Gigliotti, P., additional, Lupinacci, S., additional, Toteda, P., additional, Vizza, D., additional, Perri, A., additional, Papalia, T., additional, Bonofiglio, R., additional, di Loreto, P., additional, de Silvestro, L., additional, Montanaro, D., additional, Martino, F., additional, Sandrini, S., additional, Minetti, E., additional, Cabiddu, G., additional, Yildirim, T., additional, Yilmaz, R., additional, Turkmen, E., additional, Abudalal, A., additional, Altindal, M., additional, Ertoy-Baydar, D., additional, Erdem, Y., additional, Panuccio, V., additional, Tripepi, R., additional, Parlongo, G., additional, Versace, M. C., additional, Politi, R., additional, Zoccali, C., additional, Mallamaci, F., additional, Porrini, E., additional, Silva, I., additional, Diaz, J., additional, Ibernon, M., additional, Moreso, F., additional, Benitez, R., additional, Delgado Mallen, P., additional, Osorio, J., additional, Lauzurica, R., additional, Torres, A., additional, Ersoy, A., additional, Koca, N., additional, Gullu Koca, T., additional, Kirhan, E., additional, Sarandol, E., additional, Ersoy, C., additional, Dirican, M., additional, Milne, J., additional, Suter, V., additional, Mikhail, A., additional, Akalin, H., additional, Dizdar, O., additional, Pascual, J., additional, Torio, A., additional, Garcia, C., additional, Hernandez, J., additional, Perez-Saez, M. J., additional, Mir, M., additional, Anna, F., additional, Crespo, M., additional, Carta, P., additional, Zanazzi, M., additional, Antognoli, G., additional, Di Maria, L., additional, Caroti, L., additional, Ray, D. S., additional, Mukherjee, K., additional, Bohidar, N. P., additional, Pattanaik, A., additional, Das, P., additional, Thukral, S., additional, Kimura, T., additional, Yagisawa, T., additional, Ishikawa, N., additional, Sakuma, Y., additional, Fujiwara, T., additional, Nukui, A., additional, Gavela, E. E., additional, Sancho, A. A., additional, Kanter, J. J., additional, Avila, A. A., additional, Beltran, S. S., additional, Pallardo, L. L., additional, Dawoud, F. G., additional, Aithal, V., additional, Majernikova, M., additional, Rosenberger, J., additional, Prihodova, L., additional, Nagyova, I., additional, Jarcuskova, M., additional, Roland, R., additional, Groothoff, J. W., additional, van Dijk, J. P., additional, van Agteren, M., additional, de Weerd, A., additional, van de Wetering, J., additional, IJzermans, J., additional, Betjes, M., additional, Weimar, W., additional, Popoola, J., additional, Reed, A., additional, Tavarro, R., additional, Chryssanthopoulou, C., additional, MacPhee, I., additional, Mayor, M., additional, Franco, S., additional, Jara, P., additional, Ayala, R., additional, Orue, M. G., additional, Martinez, A., additional, Martinez, M., additional, Wasmouth, N., additional, Arik, G., additional, Yasar, A., additional, Yilmaz, S., additional, Arici, M., additional, Bihari Bansal, S., additional, Pokhariyal, S., additional, Jain, S., additional, Sethi, S., additional, Ahlawat, R., additional, Kher, V., additional, Martins, L. S., additional, Aguiar, P., additional, Dias, L., additional, Fonseca, I., additional, Henriques, A. C., additional, Cabrita, A., additional, Davide, J., additional, Sparkes, T. M., additional, Trofe-Clark, J., additional, Reese, P. P., additional, Jakobowski, D., additional, Goral, S., additional, Doll, S. L., additional, Abt, P. L., additional, Sawinski, D., additional, MBloom, R. D., additional, Knap, B., additional, Lukac, J., additional, Lukin, M., additional, Majcen, I., additional, Pavlovec, F., additional, Kandus, A., additional, Bren, A. F., additional, Kong, J. M., additional, Jeong, J. H., additional, Ahn, J., additional, Lee, D. R., additional, Son, S. H., additional, Kim, B. C., additional, Choi, W. Y., additional, Whang, E. J., additional, Czajka, B., additional, Malgorzewicz, S., additional, Panizo, N., additional, Rengel, M. A., additional, Vega, A., additional, Abad, S., additional, Tana, L., additional, Arroyo, D., additional, Rodriguez-Ferrero, M., additional, Perez de Jose, A., additional, Lopez-Gomez, J. M., additional, Koutroutsos, K., additional, Sackey, J., additional, Paolini, L., additional, Ramkhelawon, R., additional, Chowrimootoo, M., additional, Whelan, D., additional, Slatinska, J., additional, Honsova, E., additional, Wohlfahrtova, M., additional, Slimackova, E., additional, Rajnochova, S. B., additional, Viklicky, O., additional, Yankovoy, A., additional, Smith, I. S. J., additional, Wylie, E., additional, Ruiz-Esteban, P., additional, Lopez, V., additional, Garcia-Frias, P., additional, Cabello, M., additional, Gonzalez-Molina, M., additional, Vozmediano, C., additional, Hernandez, D., additional, Pavlovic, J., additional, Radivojevic, D., additional, Lezaic, V., additional, Simic-Ogrizovic, S., additional, Lausevic, M., additional, Naumovic, R., additional, Sakhuja, V., additional, Gundlapalli, S., additional, Rathi, M., additional, Jha, V., additional, Kohli, H. S., additional, Sharma, A., additional, Minz, M., additional, Nimgirova, A., additional, Esayan, A., additional, Kayukov, I., additional, Zuyeva, E., additional, Bilen, Y., additional, Cankaya, E., additional, Keles, M., additional, Gulcan, E., additional, Turkeli, M., additional, Albayrak, B., additional, Uyanik, A., additional, Yildirim, R., additional, Molitor, N., additional, Praktiknjo, M., additional, Abeygunaratne, T. N., additional, Balasubramanian, S., additional, Baker, R., additional, Nicholson, T., additional, Toprak, O., additional, Sari, Y., additional, Keceli, S., additional, Kurt, H., additional, Rocha, A., additional, Malheiro, J., additional, Pedroso, S., additional, Henriques, A., additional, Nihei, C., additional, Bacelar Marques, I., additional, Seguro, C. A., additional, Mate, G., additional, Martin, N., additional, Colon, L., additional, Casellas, L., additional, Garangou, D., additional, de la Torre, M., additional, Torguet, P., additional, Garcia, I., additional, Calabia, J., additional, Valles, M., additional, Pruthi, R., additional, Calestani, M., additional, Leydon, G., additional, Ravanan, R., additional, Roderick, P., additional, Korkmaz, S., additional, and Gulten, S., additional

Published
2013
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18. Peritoneal dialysis

Author

Liu, J., primary, Liu, J., additional, Liu, Y., additional, Xu, Y., additional, Zhao, X., additional, Qian, J., additional, Sun, B., additional, Xing, C., additional, Kanda, R., additional, Hamada, C., additional, Nakano, T., additional, Wakabayashi, K., additional, Io, H., additional, Horikoshi, S., additional, Tomino, Y., additional, Ishimatsu, N., additional, Miyamoto, T., additional, Morimoto, H., additional, Nakamata, J., additional, Baba, R., additional, Kanegae, K., additional, Serino, R., additional, Kabashima, N., additional, Otsuji, Y., additional, Doi, Y., additional, Tamura, M., additional, Kusumoto, T., additional, Fukami, K., additional, Yamagishi, S.-I., additional, Ueda, S., additional, Kaida, Y., additional, Hazama, T., additional, Nakayama, Y., additional, Ando, R., additional, Obara, N., additional, Okuda, S., additional, Matsumoto, M., additional, Furuno, Y., additional, Bang-Gee, H., additional, Mazzotta, L., additional, Rosati, A., additional, Carlini, A., additional, Henriques, V. T., additional, Zangiacomi Martinez, E., additional, Divino-Filho, J. C., additional, Pecoits-Filho, R., additional, Cardeal Da Costa, J. A., additional, Gama Axelsson, T., additional, Lindholm, B., additional, Carrero, J. J., additional, Heimburger, O., additional, Stenvinkel, P., additional, Qureshi, A. R., additional, Akazawa, M., additional, Uno, T., additional, Kanda, E., additional, Maeda, Y., additional, Aktsiali, M., additional, Antonopoulou, S., additional, Tsiolaki, K., additional, Bakirtzi, N., additional, Patrinou, A., additional, Georgopoulou, M., additional, Liaveri, P., additional, Afentakis, N., additional, Tsirpanlis, G., additional, Hasegawa, T., additional, Nishiwaki, H., additional, Hirose, M., additional, Komukai, D., additional, Tayama, H., additional, Koiwa, F., additional, Yoshimura, A., additional, Lui, S. L., additional, Lui, S., additional, Yung, S., additional, Tang, C., additional, Ng, F., additional, Lo, W. K., additional, Chan, T. M., additional, Koo, H. M., additional, Doh, F. M., additional, Yoo, D. E., additional, Oh, H. J., additional, Yoo, T.-H., additional, Choi, K. H., additional, Kang, S.-W., additional, Han, D. S., additional, Han, S. H., additional, Fernandes, N., additional, Bastos, M. G., additional, Gianotti Franco, M. R., additional, Chaoubah, A., additional, Gloria Lima, M. D., additional, Kang, S., additional, Do, J., additional, Cho, K., additional, Park, J., additional, Yoon, K., additional, Chen, J.-B., additional, Cheng, B.-C., additional, Chen, T.-C., additional, Su, Y.-J., additional, Wu, C.-H., additional, Park, Y., additional, Jeon, J., additional, Tsikeloudi, M., additional, Pateinakis, P., additional, Patsatsi, K., additional, Manou, E., additional, Sotiriadis, D., additional, Tsakiris, D., additional, Teixeira, L., additional, Rodrigues, A., additional, Carvalho, M. J., additional, Cabrita, A., additional, Mendonca, D., additional, Bruschi, M., additional, Candiano, G., additional, Santucci, L., additional, Luzio, S., additional, Cannavo, R., additional, Ghiggeri, G. M., additional, Verrina, E., additional, Varadarajan, Y., additional, Raju, B., additional, Cho, K.-H., additional, Park, J.-W., additional, Yoon, K.-W., additional, Kim, T.-W., additional, Kimmel, M., additional, Braun, N., additional, Latus, J., additional, Alscher, M. D., additional, Struijk, D., additional, Van Esch, S., additional, Krediet, R. T., additional, Van den Beukel, T., additional, Hoekstra, T., additional, Tirapani, L., additional, De Andrade Bastos, K., additional, Bastos, M., additional, Dekker, F., additional, Yasuhisa, T., additional, Kanai, H., additional, Harada, K., additional, Kawai, Y., additional, Sugiyama, H., additional, Ito, Y., additional, Tsuruya, K., additional, Yoshida, H., additional, Maruyama, H., additional, Goto, S., additional, Nakayama, M., additional, Nakamoto, H., additional, Morinaga, H., additional, Matsuo, S., additional, Makino, H., additional, DI Gioia, M. C., additional, Gallar, P., additional, Laso, N., additional, Rodriguez, I., additional, Cobo, G., additional, Oliet, A., additional, Hynostroza, J., additional, Herrero, J. C., additional, Mon, C., additional, Ortiz, M., additional, Vigil, A., additional, Tomo, T., additional, Portoles, J., additional, Uta, S., additional, Tato, A. M., additional, Lopez-Sanchez, P., additional, Rivera, M., additional, Rodriguez-Pena, R., additional, Del Peso, G., additional, Ortega, M., additional, Felipe, C., additional, Tsampikaki, E., additional, Aperis, G., additional, Kaikis, A., additional, Paliouras, C., additional, Karvouniaris, N., additional, Maragaki, M., additional, Alivanis, P., additional, Kortus-Gotze, B., additional, Hoferhusch, T., additional, Hoyer, J., additional, Martino, F., additional, Kaushik, M., additional, Rodighiero, M. P., additional, Creapldi, C., additional, Ronco, C., additional, Lacquaniti, A., additional, Donato, V., additional, Fazio, M. R., additional, Lucisano, S., additional, Cernaro, V., additional, Lupica, R., additional, Buemi, M., additional, Aloisi, C., additional, Bavbek Ruzgaresen, N., additional, Secilmis, S., additional, Yilmaz, H., additional, Akcay, A., additional, Duranay, M., additional, Akalin, N., additional, Altiparmak, M. R., additional, Trabulus, S., additional, Yalin, A. S., additional, Ataman, R., additional, Serdengecti, K., additional, Schneider, K., additional, Bator, B., additional, Niko, B., additional, Peter, F., additional, Ulmer, C., additional, Joerg, L., additional, Martin, K., additional, Dagmar, B., additional, German, O., additional, Fabian, R., additional, Juergen, D., additional, Stephan, S., additional, Dominik, A., additional, Fritz, P., additional, Rettenmaier, B., additional, Hirschburger, S., additional, Segerer, S., additional, Biegger, D., additional, Lang, T., additional, Ott, G., additional, Habib, M., additional, Korte, M., additional, Hagen, M., additional, Dor, F., additional, Betjes, M., additional, Zietse, R., additional, Scharpf, C., additional, Chang, T. I., additional, Shin, D. H., additional, Han, D.-S., additional, Choi, H. Y., additional, Lee, Y. K., additional, Kim, B. S., additional, Yoo, T. H., additional, Park, H. C., additional, Lee, H. Y., additional, Horimoto, N., additional, Tuji, K., additional, Kitamura, S., additional, Isshiki, R., additional, Iwagami, M., additional, Tsutsumi, D., additional, Mochida, Y., additional, Ishioka, K., additional, Oka, M., additional, Maesato, K., additional, Moriya, H., additional, Ohtake, T., additional, Hidaka, S., additional, Kobayashi, S., additional, Higuchi, C., additional, Tanihata, Y., additional, Ishii, M., additional, Sugimoto, H., additional, Sato, N., additional, Kyono, A., additional, Ogawa, T., additional, Nishimura, H., additional, Otsuka, K., additional, Do, J.-Y., additional, Du Halgouet, C., additional, Latifa, A., additional, Anne Sophie, V., additional, Emmanuel, D., additional, Christine, R., additional, Francois, V., additional, Grzelak, T., additional, Czyzewska-Majchrzak, L., additional, Kramkowska, M., additional, Witmanowski, H., additional, Czyzewska, K., additional, Janda, K., additional, Krzanowski, M., additional, Dumnicka, P., additional, Sulowicz, W., additional, Rroji, M., additional, Seferi, S., additional, Barbullushi, M., additional, Likaj, E., additional, Petrela, E., additional, Thereska, N., additional, Cabiddu, G., additional, Dessi, E., additional, Arceri, A., additional, Laura, P., additional, Manca, E., additional, Conti, M., additional, Cao, R., additional, Pani, A., additional, Liao, C.-T., additional, Vega Vega, O., additional, Mendoza de la Garza, A., additional, Correa-Rotter, R., additional, Ueda, A., additional, Nagai, K., additional, Morimoto, M., additional, Hirayama, A., additional, Owada, S., additional, Tonozuka, Y., additional, Saito, C., additional, Yamagata, K., additional, Matsuda, A., additional, Tayama, Y., additional, Iwanaga, M., additional, Noiri, C., additional, Hatano, M., additional, Kiba, T., additional, Kanozawa, K., additional, Katou, H., additional, Hasegawa, H., additional, Mitarai, T., additional, Ros-Ruiz, S., additional, Fuentes-Sanchez, L., additional, Jironda-Gallegos, C., additional, Gutierrez-Vilches, E., additional, Garcia-Frias, P., additional, Hernandez-Marrero, D., additional, Lee, S., additional, Lai, X., additional, Chen, W., additional, Guo, Z., additional, Braide, M., additional, Cristina, V., additional, Popa, S. G., additional, Maria, M., additional, Eugen, M., additional, DI Loreto, P., additional, Spahia, N., additional, Sanchez Macias, L. O., additional, Lares Castellanos, K. I., additional, Hernandez Pacheco, J. A., additional, Correa Rotter, R., additional, Pedro Ventura, A., additional, Olivia, S., additional, Joana, V., additional, Francisco, F., additional, Maria Joao, C., additional, Antonio, C., additional, Rodrigues, A. S., additional, Atas, N., additional, Erten, Y., additional, Onec, K., additional, Inal, S., additional, Topal, S., additional, Akyel, A., additional, Celik, B., additional, Okyay, G. U., additional, Tavil, Y., additional, Zeiler, M., additional, Monteburini, T., additional, Agostinelli, R. M., additional, Marinelli, R., additional, Santarelli, S., additional, Yaylaci, C., additional, Sahin, G., additional, Guz, G., additional, Sindel, S., additional, Pinho, A., additional, Malho Guedes, A., additional, Fragoso, A., additional, Carreira, H., additional, Pinto, I., additional, Bernardo, I., additional, Leao, P., additional, Kusnierz-Cabala, B., additional, Krasniak, A., additional, Chowaniec, E., additional, Tabor-Ciepiela, B., additional, Turkmen, K., additional, Ozbek, O., additional, Kayrak, M., additional, Samur, C., additional, Guler, I., additional, Tonbul, H. Z., additional, Rusai, K., additional, Herzog, R., additional, Kratochwill, K., additional, Kuster, L., additional, Aufricht, C., additional, Meier, C.-M., additional, Fliser, D., additional, Schilling, M. K., additional, Klingele, M., additional, Fukasawa, M., additional, Takeda, M., additional, Kamiyama, M., additional, Song, Y. R., additional, Kim, H. J., additional, Kim, S. G., additional, Kim, J.-K., additional, Noh, J. W., additional, Yoon, J. W., additional, and Koo, J.-R., additional

Published
2012
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22. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes.

Author

Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, and Ravani P

Abstract

BACKGROUND: Prognostic criteria to inform women with moderate to severe renal insufficiency who wish to bear children are not well established. STUDY DESIGN: Longitudinal multicenter cohort study. SETTINGS & PARTICIPANTS: Nondiabetic white women with pregnancies proceeded beyond the 20th week and estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m(2) (<1 mL/s/1.73 m(2)) before conception. PREDICTORS: Baseline GFR and proteinuria (exposure); other clinical characteristics at conception (covariates). OUTCOMES & MEASUREMENTS: Difference in GFR decreases before conception versus after delivery (mixed linear models); low birth weight (<2,500 g), and maternal renal survival (logistic and Cox regressions). RESULTS: 49 women were studied. Mean serum creatinine and GFR at conception were 2.1 +/- 1 (SD) mg/dL (186 +/- 88 micromol/L) and 35 +/- 12 mL/min/1.73 m(2) (0.58 +/- 0.2 mL/s/1.73 m(2)), respectively. Overall mean GFR after delivery was less than before conception (30 +/- 13.8 versus 35 +/- 12.2 mL/min/1.73 m(2) [0.50 +/- 0.23 versus 0.58 +/- 0.20 mL/s/1.73 m(2)]; P < 0.001), but the rate of GFR decrease did not change (0.55 +/- 0.8 versus 0.50 +/- 0.3 mL/min/mo [0.0092 +/- 0.013 versus 0.0083 +/- 0.005 mL/s/mo]; P = 0.661). Independent of potential confounders, the combined presence of baseline GFR less than 40 mL/min/m(2) (<0.67 mL/s/m(2)) and proteinuria with protein greater than 1 g/d, but not either factor alone, predicted faster GFR loss after delivery compared with before conception (1.17 +/- 1.23 versus 0.55 +/- 0.39 mL/min/mo; difference, 0.62 mL/min/mo; 95% confidence interval [CI], 0.27 to 0.96 mL/min/mo [0.020 +/- 0.021 versus 0.0092 +/- 0.007 mL/s/mo; difference, 0.10 mL/s/mo; 95% CI, 0.005 to 0.016 mL/s/mo]). The presence of both risk factors, but not either alone, also predicted shorter time to dialysis therapy or GFR halving (N = 20; hazard ratio, 5.2; 95% CI, 1.7 to 15.9) and low birth weight (N = 29; odds ratio, 5.1; 95% CI, 1.03 to 25.6). LIMITATIONS: Generalizability to other settings; study power. CONCLUSION: In women with renal insufficiency, the presence of both GFR less than 40 mL/min/1.73 m(2) (<0.67 mL/s/m(2)) and proteinuria with protein greater than 1 g/d before conception predicts poor maternal and fetal outcomes.Copyright © 2007 by National Kidney Foundation, Inc. [ABSTRACT FROM AUTHOR]

Published
2007
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23. Predilution haemofiltration--the Second Sardinian Multicentre Study: comparisons between haemofiltration and haemodialysis during identical Kt/V and session times in a long-term cross-over study.

Author

Altieri, P, Sorba, G, Bolasco, P, Asproni, E, Ledebo, I, Cossu, M, Ferrara, R, Ganadu, M, Cadinu, F, Serra, G, Cabiddu, G, Sau, G, Casu, D, Passaghe, M, Bolasco, F, Pistis, R, and Ghisu, T

Abstract

The potential superiority of various renal replacement treatment modalities consisting largely of convective mass transfer as opposed to primarily diffusive mass transfer, is still a matter of debate. The objective of the present study was to evaluate acute and long-term clinical effects of varying degrees of convection and diffusion in a group of 24 clinically stable patients with end-stage renal disease.

Published
2001
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24. Effect of high-flux dialysis on the anaemia of haemodialysis patients.

Author

Locatelli, F, Andrulli, S, Pecchini, F, Pedrini, L, Agliata, S, Lucchi, L, Farina, M, La Milia, V, Grassi, C, Borghi, M, Redaelli, B, Conte, F, Ratto, G, Cabiddu, G, Grossi, C, and Modenese, R

Abstract

Anaemia is one of the major clinical characteristics of patients with chronic renal failure, and has a considerable effect on morbidity and mortality. Adequate dialysis is of paramount importance in correcting anaemia by removing small and medium-sized molecules, which may inhibit erythropoiesis. However, high-molecular-weight inhibitors cleared only by means of highly porous membranes have also been found in uraemic serum and it has been claimed from uncontrolled studies that high-flux dialysis could improve anaemia in haemodialysis patients.

Published
2000
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25. Adequacy in pre-dilution haemofiltration: Kt/V or infusion volume?

Author

Bolasco, P., Altieri, P., Sorba, G., Cabiddu, G., Ferrara, R., Serra, G., Cadinu, F., Passaghe, M., Piras, A., Calvisi, L., Pistis, R., and Ghisu, T.

Abstract

Kt/V is the main index of adequacy for diffusive and diffusive-convective methods of extracorporeal depuration, yet there exists no universally acceptable validation of an adequacy index for the solely convective methods such as haemofiltration (HF). The aim of the present study is to analyse which of the parameters of adequacy used in two multicentre HF studies, Kt/V for urea or infusion volume, correlate best with nutritional parameters and can therefore be utilized for the evaluation of treatment dose in on-line pre-dilution HF.
Twenty-three clinically stable patients were enrolled in the first study [3 months of haemodialysis (HD)+3 months of HF]. In the second study, 24 stable patients were studied in three phases: 6 months in HF, 6 months in HD and a further 6 months in HF; in this study, a target of Kt/V=1.2 in all three periods was pre-established: 15 patients completed the full study. In both studies, we utilized the same monitor (AK 100/200 Ultra, Gambro), the same membrane (polyamide) and the same on-line prepared ultrapure dialysis fluid and sterile infusion solution.
In both studies, we ensured that HF fulfilled the following parameters of adequacy: urea kinetics, cardiovascular and blood pressure stability (better in HF than in HD), common haematochemical and nutritional parameters, reduction in β2-microglobulin levels, a good intra- and extra-session clinical outcome, and a good quality of life with morbidity and mortality rates no different from those of HD.
HF proved to be an efficacious method of ensuring adequate depuration and a good quality of life for uraemic patients. We have shown that in longer periods of HF, a notable correlation between Kt/V and normalized protein catabolic rate (nPCR) and an equally good correlation between total ultrafiltration (UF)/dry weight ratio and nPCR could be achieved. In both studies, the patients showed a good level of epuration adequacy when total UF per session was at least 1.3 times the dry body weight. The total UF/body weight ratio thus seems to be an easy method in HF because of its greater ease of predictability and measurement, also when it is used independently of the Kt/V index.

Published
2000

27. Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters

Author

Locatelli, F, Mastrangelo, F, Redaelli, B, Ronco, C, Marcelli, D, Lagreca, G, Orlandini, G, Corti, M, Pontoriero, G, Difilippo, S, Rossi, R, Farma, R, Colantonio, P, Martinelli, D, Vasile, A, Allegra, V, Mengozzi, G, Martinbianco, L, Bonomini, V, Stefoni, C, Coli, L, Cianciolo, G, Desanctis, L, Deblasi, V, Alfonso, L, Rizzelli, S, Patruno, P, Brendolan, A, Crepaldi, C, Casu, Md, Mureddu, S, Maiorca, R, Cristinelli, L, Setti, G, Camerini, C, Salvadori, M, Bandini, S, Rosati, A, Mancini, G, Panzetta, G, Ianche, M, Delmastro, G, Cogoni, G, Accalai, Gp, Sechi, Ma, Alloatti, S, Paternoster, G, Gaiter, A, Manes, M, Schena, Fp, Pertosa, G, Bottalico, D, Cantafio, S, Salvo, E, Dagostino, F, Guido, A, Limido, D, Beretta, P, Vigano, Mr, Dadone, G, Verzetti, G, Navino, C, Barbe, Mc, Ruva, Ce, Amato, M, Aterini, S, Ippolito, E, Splendiani, G, Sturniolo, A, Costanzi, S, Passalacqua, S, Scatizzi, A, Dimaggio, A, Montemurro, N, Vercellone, A, Segoloni, G, Pacitti, A, Maffei, S, Scaccia, F, Fini, R, Bandiani, G, Antiga, G, Nicolini, Ma, Asproni, E, Cadinu, F, Salvietti, N, Urti, D, Lorusso, P, Dani, L, Peona, C, Filiberti, O, Porcu, Mc, Barbieri, C, Costa, S, Nicrosini, F, Mioli, V, Bibiano, L, Carletti, P, Panichi, N, Melappioni, M, Mecca, G, Mingardi, G, Perticucci, E, Huber, W, Riegler, P, Giacon, B, Altieri, P, Ferrara, R, Bolasco, Pg, Cabiddu, G, Paolillo, A, Morgante, F, Cascone, C, Deluca, M, Demin, Am, Capotorto, M, Ungaro, N, Specchio, A, Albertazzi, A, Delrosso, G, Bonomini, M, Surian, M, Bonforte, G, Dozio, B, Frizzi, V, Ciciani, Am, Ravaglia, F, Giachino, F, Bosticardo, Gm, Francisco, M, Biasioli, S, Petrosino, L, Chimienti, S, Cristofano, C, Perrone, F, Grassi, C, Orazi, E, Bisegna, S, Bracchi, O, Bazzato, G, Toffoletto, Pp, Tesio, F, Faimondi, A, Boggi, R, Campogiani, V, Gentili, F, Bolasco, F, Pistis, R, Pillosu, I, Stallone, C, Aucella, F, Procaccini, D, Avanzi, C, Sorba, G, Solinas, R, Cossu, M, Deangelis, S, Ripani, R, Piccoli, G, Martina, G, Quarello, F, Borghi, M, Massazza, M, Tagliaferri, M, Pascucci, M, Galiotta, P, Bertolucci, E, Sessa, A, Conte, F, Serbelloni, P, Virgilio, M, Delvino, A, Conte, M, Mura, C, Conti, P, Pinna, A, Neumair, F, Bonadonna, A, Stanic, L, Munaretto, G, Ciccarelli, P, Stefoni, A, Biagini, M, Gerace, Ms, Capece, R, Bordoni, E, Petroselli, F, Scaffone, V, Lombardo, V, Coppola, E, Micucci, G, Concetti, M, Capponi, E, Lisi, E, Raccosta, G, Sanna, Gm, Calvisi, L, Cherchi, Gl, Vitali, P, Castelli, P, Estivi, R, Saporiti, E, Dececco, G, Lorenzi, S, Maschio, G, Tessitore, N, Loschiavo, C, Rovati, C, Andreotti, C, Gilli, P, Depaoli, E, Natili, G, and Pensalfini, V

Subjects
medicine.medical_specialty, Beta-2 microglobulin, business.industry, medicine.medical_treatment, Synthetic membrane, Urology, Ultrafiltration, Liter, Surgery, chemistry.chemical_compound, Membrane, chemistry, Nephrology, medicine, Polysulfone, Hemodialysis, business, Dialysis
Abstract

Effects of different membranes and dialysis technologies on patient treatment tolerance and nutritional parameters. There is increasing evidence that the biochemical and cellular phenomena induced by blood/membrane/dialysate interactions contribute to dialysis-related intradialytic and long-term complications. However, there is a lack of large, prospective, randomized trials comparing biocompatible and bioincompatible membranes, and convective and diffusive treatment modalities. The primary aim of this prospective, randomized trial was to evaluate whether the use of polysulfone membrane with bicarbonate dialysate offers any advantages (in terms of treatment tolerance, nutritional parameters and pre-treatment β 2 -microglobulin levels) over a traditional membrane (Cuprophan®). A secondary aim was to assess whether the use of more sophisticated methods consisting of a biocompatible synthetic membrane with different hydraulic permeability at different ultrafiltration rate (highflux hemodialysis and hemodiafiltration) offers any further advantages. Seventy-one Centers were involved and stratified according to the availability of only the first two or all four of the following techniques: Cuprophan® hemodialysis (Cu-HD), low-flux polysulfone hemodialysis (LfPS-HD), high-flux polysulfone high-flux hemodialysis (HfPS-HD), and high-flux polysulfone hemodiafiltration (HfPS-HDF). The 380 eligible patients were randomized to one of the two or four treatments (132 to Cu-HD, 147 to LfPS-HD, 51 to HfPS-HD and 50 to HfPS-HDF). The follow-up was 24 months. No statistical difference was observed in the algebraic sum of the end points between bicarbonate dialysis with Cuprophan® or with low-flux polysulfone, or among the four dialysis methods under evaluation. There was a significant decrease in pre-dialysis plasma β 2 -microglobulin levels in high-flux dialysis of 9.04 ± 10.46 mg/liter (23%) and in hemodiafiltration of 6.35 ± 12.28 mg/liter (16%), both using high-flux polysulfone membrane in comparison with Cuprophan® and low-flux polysulfone membranes (P = 0.032). The significant decrease in pre-dialysis plasma β 2 -microglobulin levels could have a clinical impact when one considers that β 2 -microglobulin accumulation and amyloidosis are important long-term dialysis-related complications.

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29. [A closed cycle]

Author

Logias F, Cabiddu G, Em, Manca, Granata Antonio, and Manca O

Subjects
Hymen, Humans, Pain, Female, Hydronephrosis, Renal Insufficiency, Child, Congenital Abnormalities
Abstract

A young girl was admitted to the Renal Unit of our Hospital because of loin pain and mild renal failure with bilateral hydronephrosis. The abdomen ultrasound was very helpful to get the right diagnosis.

31. Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients

Author

Chava L. Ramspek, Rosemarijn Boekee, Marie Evans, Olof Heimburger, Charlotte M. Snead, Fergus J. Caskey, Claudia Torino, Gaetana Porto, Maciej Szymczak, Magdalena Krajewska, Christiane Drechsler, Christoph Wanner, Nicholas C. Chesnaye, Kitty J. Jager, Friedo W. Dekker, Maarten G.J. Snoeijs, Joris I. Rotmans, Merel van Diepen, Adamasco Cupisti, Adelia Sagliocca, Alberto Ferraro, Aleksandra Musiała, Alessandra Mele, Alessandro Naticchia, Alex Còsaro, Alistair Woodman, Andrea Ranghino, Andrea Stucchi, Andreas Jonsson, Andreas Schneider, Angelo Pignataro, Anita Schrander, Anke Torp, Anna McKeever, Anna Szymczak, Anna-Lena Blom, Antonella De Blasio, Antonello Pani, Aris Tsalouichos, Asad Ullah, Barbara McLaren, Bastiaan van Dam, Beate Iwig, Bellasi Antonio, Biagio Raffaele Di Iorio, Björn Rogland, Boris Perras, Butti Alessandra, Camille Harron, Carin Wallquist, Carl Siegert, Carla Barrett, Carlo Gaillard, Carlo Garofalo, Cataldo Abaterusso, Charles Beerenhout, Charlotte O'Toole, Chiara Somma, Christian Marx, Christina Summersgill, Christof Blaser, Claudia D'alessandro, Claudia Emde, Claudia Zullo, Claudio Pozzi, Colin Geddes, Cornelis Verburgh, Daniela Bergamo, Daniele Ciurlino, Daria Motta, Deborah Glowski, Deborah McGlynn, Denes Vargas, Detlef Krieter, Domenico Russo, Dunja Fuchs, Dympna Sands, Ellen Hoogeveen, Ellen Irmler, Emöke Dimény, Enrico Favaro, Eva Platen, Ewelina Olczyk, Ewout Hoorn, Federica Vigotti, Ferruccio Ansali, Ferruccio Conte, Francesca Cianciotta, Francesca Giacchino, Francesco Cappellaio, Francesco Pizzarelli, Fredrik Sundelin, Fredrik Uhlin, Gaetano Greco, Geena Roy, Giada Bigatti, Giancarlo Marinangeli, Gianfranca Cabiddu, Gillian Hirst, Giordano Fumagalli, Giorgia Caloro, Giorgina Piccoli, Giovanbattista Capasso, Giovanni Gambaro, Giuliana Tognarelli, Giuseppe Bonforte, Giuseppe Conte, Giuseppe Toscano, Goffredo Del Rosso, Gunilla Welander, Hanna Augustyniak-Bartosik, Hans Boots, Hans Schmidt-Gürtler, Hayley King, Helen McNally, Hendrik Schlee, Henk Boom, Holger Naujoks, Houda Masri-Senghor, Hugh Murtagh, Hugh Rayner, Ilona Miśkowiec-Wiśniewska, Ines Schlee, Irene Capizzi, Isabel Bascaran Hernandez, Ivano Baragetti, Jacek Manitius, Jane Turner, Jan-Willem Eijgenraam, Jeroen Kooman, Joachim Beige, Joanna Pondel, Joanne Wilcox, Jocelyn Berdeprado, Jochen Röthele, Jonathan Wong, Joris Rotmans, Joyce Banda, Justyna Mazur, Kai Hahn, Kamila Jędrzejak, Katarzyna Nowańska, Katja Blouin, Katrin Neumeier, Kirsteen Jones, Kirsten Anding-Rost, Knut-Christian Gröntoft, Lamberto Oldrizzi, Lesley Haydock, Liffert Vogt, Lily Wilkinson, Loreto Gesualdo, Lothar Schramm, Luigi Biancone, Łukasz Nowak, Maarten Raasveld, Magdalena Durlik, Manuela Magnano, Marc Vervloet, Marco Ricardi, Margaret Carmody, Maria Di Bari, Maria Laudato, Maria Luisa Sirico, Maria Stendahl, Maria Svensson, Maria Weetman, Marjolijn van Buren, Martin Joinson, Martina Ferraresi, Mary Dutton, Michael Matthews, Michele Provenzano, Monika Hopf, Moreno Malaguti, Nadja Wuttke, Neal Morgan, Nicola Palmieri, Nikolaus Frischmuth, Nina Bleakley, Paola Murrone, Paul Cockwell, Paul Leurs, Paul Roderick, Pauline Voskamp, Pavlos Kashioulis, Pawlos Ichtiaris, Peter Blankestijn, Petra Kirste, Petra Schulz, Phil Mason, Philip Kalra, Pietro Cirillo, Pietro Dattolo, Pina Acampora, Rincy Sajith, Rita Nigro, Roberto Boero, Roberto Scarpioni, Rosa Sicoli, Rosella Malandra, Sabine Aign, Sabine Cäsar, Sadie van Esch, Sally Chapman, Sandra Biribauer, Santee Navjee, Sarah Crosbie, Sharon Brown, Sheila Tickle, Sherin Manan, Silke Röser, Silvana Savoldi, Silvio Bertoli, Silvio Borrelli, Siska Boorsma, Stefan Heidenreich, Stefan Melander, Stefania Maxia, Stefano Maffei, Stefano Mangano, Stephanie Palm, Stijn Konings, Suresh Mathavakkannan, Susanne Schwedler, Sylke Delrieux, Sylvia Renker, Sylvia Schättel, Szyszkowska Dorota, Teresa Cicchetti, Teresa Nieszporek, Theresa Stephan, Thomas Schmiedeke, Thomas Weinreich, Til Leimbach, Tiziana Rappa, Tora Almquist, Torsten Stövesand, Udo Bahner, Ulrika Jensen, Valentina Palazzo, Walter De Simone, Wolfgang Seeger, Ying Kuan, Zbigniew Heleniak, Zeynep Aydin, Vascular Surgery, MUMC+: MA Med Staf Spec Vaatchirurgie (9), RS: Carim - V03 Regenerative and reconstructive medicine vascular disease, Ramspek, C. L., Boekee, R., Evans, M., Heimburger, O., Snead, C. M., Caskey, F. J., Torino, C., Porto, G., Szymczak, M., Krajewska, M., Drechsler, C., Wanner, C., Chesnaye, N. C., Jager, K. J., Dekker, F. W., Snoeijs, M. G. J., Rotmans, J. I., van Diepen, M., Cupisti, A., Sagliocca, A., Ferraro, A., Musiala, A., Mele, A., Naticchia, A., Cosaro, A., Woodman, A., Ranghino, A., Stucchi, A., Jonsson, A., Schneider, A., Pignataro, A., Schrander, A., Torp, A., Mckeever, A., Szymczak, A., Blom, A. -L., De Blasio, A., Pani, A., Tsalouichos, A., Ullah, A., Mclaren, B., van Dam, B., Iwig, B., Antonio, B., Di Iorio, B. R., Rogland, B., Perras, B., Alessandra, B., Harron, C., Wallquist, C., Siegert, C., Barrett, C., Gaillard, C., Garofalo, C., Abaterusso, C., Beerenhout, C., O'Toole, C., Somma, C., Marx, C., Summersgill, C., Blaser, C., D'Alessandro, C., Emde, C., Zullo, C., Pozzi, C., Geddes, C., Verburgh, C., Bergamo, D., Ciurlino, D., Motta, D., Glowski, D., Mcglynn, D., Vargas, D., Krieter, D., Russo, D., Fuchs, D., Sands, D., Hoogeveen, E., Irmler, E., Dimeny, E., Favaro, E., Platen, E., Olczyk, E., Hoorn, E., Vigotti, F., Ansali, F., Conte, F., Cianciotta, F., Giacchino, F., Cappellaio, F., Pizzarelli, F., Sundelin, F., Uhlin, F., Greco, G., Roy, G., Bigatti, G., Marinangeli, G., Cabiddu, G., Hirst, G., Fumagalli, G., Caloro, G., Piccoli, G., Capasso, G., Gambaro, G., Tognarelli, G., Bonforte, G., Conte, G., Toscano, G., Del Rosso, G., Welander, G., Augustyniak-Bartosik, H., Boots, H., Schmidt-Gurtler, H., King, H., Mcnally, H., Schlee, H., Boom, H., Naujoks, H., Masri-Senghor, H., Murtagh, H., Rayner, H., Miskowiec-Wisniewska, I., Schlee, I., Capizzi, I., Hernandez, I. B., Baragetti, I., Manitius, J., Turner, J., Eijgenraam, J. -W., Kooman, J., Beige, J., Pondel, J., Wilcox, J., Berdeprado, J., Rothele, J., Wong, J., Rotmans, J., Banda, J., Mazur, J., Hahn, K., Jedrzejak, K., Nowanska, K., Blouin, K., Neumeier, K., Jones, K., Anding-Rost, K., Grontoft, K. -C., Oldrizzi, L., Haydock, L., Vogt, L., Wilkinson, L., Gesualdo, L., Schramm, L., Biancone, L., Nowak, L., Raasveld, M., Durlik, M., Magnano, M., Vervloet, M., Ricardi, M., Carmody, M., Di Bari, M., Laudato, M., Sirico, M. L., Stendahl, M., Svensson, M., Weetman, M., van Buren, M., Joinson, M., Ferraresi, M., Dutton, M., Matthews, M., Provenzano, M., Hopf, M., Malaguti, M., Wuttke, N., Morgan, N., Palmieri, N., Frischmuth, N., Bleakley, N., Murrone, P., Cockwell, P., Leurs, P., Roderick, P., Voskamp, P., Kashioulis, P., Ichtiaris, P., Blankestijn, P., Kirste, P., Schulz, P., Mason, P., Kalra, P., Cirillo, P., Dattolo, P., Acampora, P., Sajith, R., Nigro, R., Boero, R., Scarpioni, R., Sicoli, R., Malandra, R., Aign, S., Casar, S., van Esch, S., Chapman, S., Biribauer, S., Navjee, S., Crosbie, S., Brown, S., Tickle, S., Manan, S., Roser, S., Savoldi, S., Bertoli, S., Borrelli, S., Boorsma, S., Heidenreich, S., Melander, S., Maxia, S., Maffei, S., Mangano, S., Palm, S., Konings, S., Mathavakkannan, S., Schwedler, S., Delrieux, S., Renker, S., Schattel, S., Dorota, S., Cicchetti, T., Nieszporek, T., Stephan, T., Schmiedeke, T., Weinreich, T., Leimbach, T., Rappa, T., Almquist, T., Stovesand, T., Bahner, U., Jensen, U., Palazzo, V., De Simone, W., Seeger, W., Kuan, Y., Heleniak, Z., Aydin, Z., Medical Informatics, APH - Aging & Later Life, APH - Methodology, APH - Quality of Care, Nephrology, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, ACS - Diabetes & metabolism, and Internal Medicine

Subjects
SDG 3 - Good Health and Well-being, external validation, Nephrology, cardiovascular disease, death, CKD, kidney failure, prognostic model
Abstract

Introduction: Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events, and death among patients with advanced chronic kidney disease (CKD) is clinically useful and relevant. We aimed to externally validate a recently developed CKD G4+ risk calculator for these outcomes and to assess its potential clinical impact in guiding vascular access placement. Methods: We included 1517 patients from the European Quality (EQUAL) study, a European multicentre prospective cohort study of nephrology-referred advanced CKD patients aged ≥65 years. Model performance was assessed based on discrimination and calibration. Potential clinical utility for timing of referral for vascular access placement was studied with diagnostic measures and decision curve analysis (DCA). Results: The model showed a good discrimination for KRT and “death after KRT,” with 2-year concordance (C) statistics of 0.74 and 0.76, respectively. Discrimination for cardiovascular events (2-year C-statistic: 0.70) and overall death (2-year C-statistic: 0.61) was poorer. Calibration was fairly accurate. Decision curves illustrated that using the model to guide vascular access referral would generally lead to less unused arteriovenous fistulas (AVFs) than following estimated glomerular filtration rate (eGFR) thresholds. Conclusion: This study shows moderate to good predictive performance of the model in an older cohort of nephrology-referred patients with advanced CKD. Using the model to guide referral for vascular access placement has potential in combating unnecessary vascular surgeries.

Published
2022

32. Associations between depressive symptoms and disease progression in older patients with chronic kidney disease

Author

Eveleens Maarse, Boukje C., Chesnaye, Nicholas C., Robbert, Schouten, Michels, Wieneke M., Bos, Willem Jan W., Maciej, Szymczak, Magdalena, Krajewska, Marie Evans, Olof Heimburger, Caskey, Fergus J., Christoph, Wanner, Jager, Kitty J., Dekker, Friedo W., Yvette, Meuleman, Andreas, Schneider, Anke, Torp, Beate, Iwig, Boris, Perras, Christian, Marx, Christiane, Drechsler, Christof, Blaser, Claudia, Emde, Detlef, Krieter, Dunja, Fuchs, Ellen, Irmler, Eva, Platen, Hans, Schmidt-Gürtler, Hendrik, Schlee, Holger, Naujoks, Ines, Schlee, Sabine, Cäsar, Joachim, Beige, Jochen, Röthele, Justyna, Mazur, Kai, Hahn, Katja, Blouin, Katrin, Neumeier, Kirsten, Anding-Rost, Lothar, Schramm, Monika, Hopf, Nadja, Wuttke, Nikolaus, Frischmuth, Pawlos, Ichtiaris, Petra, Kirste, Petra, Schulz, Sabine, Aign, Sandra, Biribauer, Sherin, Manan, Silke, Röser, Stefan, Heidenreich, Stephanie, Palm, Susanne, Schwedler, Sylke, Delrieux, Sylvia, Renker, Sylvia, Schättel, Theresa, Stephan, Thomas, Schmiedeke, Thomas, Weinreich, Til, Leimbach, Torsten, Stövesand, Udo, Bahner, Wolfgang, Seeger, Cupisti, Adamasco, Adelia, Sagliocca, Alberto, Ferraro, Alessandra, Mele, Alessandro, Naticchia, Alex, Còsaro, Andrea, Ranghino, Andrea, Stucchi, Angelo, Pignataro, Antonella De Blasio, Antonello, Pani, Aris, Tsalouichos, Bellasi, Antonio, Biagio Raffaele Di Iorio, Butti, Alessandra, Cataldo, Abaterusso, Chiara, Somma, Claudia, D'Alessandro, Claudia, Torino, Claudia, Zullo, Claudio, Pozzi, Daniela, Bergamo, Daniele, Ciurlino, Daria, Motta, Domenico, Russo, Enrico, Favaro, Federica, Vigotti, Ferruccio, Ansali, Ferruccio, Conte, Francesca, Cianciotta, Francesca, Giacchino, Francesco, Cappellaio, Francesco, Pizzarelli, Gaetano, Greco, Gaetana, Porto, Giada, Bigatti, Giancarlo, Marinangeli, Gianfranca, Cabiddu, Giordano, Fumagalli, Giorgia, Caloro, Giorgina, Piccoli, Giovanbattista, Capasso, Giovanni, Gambaro, Giuliana, Tognarelli, Giuseppe, Bonforte, Giuseppe, Conte, Giuseppe, Toscano, Goffredo Del Rosso, Irene, Capizzi, Ivano, Baragetti, Lamberto, Oldrizzi, Loreto, Gesualdo, Luigi, Biancone, Manuela, Magnano, Marco, Ricardi, Maria Di Bari, Maria, Laudato, Maria Luisa Sirico, Martina, Ferraresi, Maurizio, Postorino, Michele, Provenzano, Moreno, Malaguti, Nicola, Palmieri, Paola, Murrone, Pietro, Cirillo, Pietro, Dattolo, Pina, Acampora, Rita, Nigro, Roberto, Boero, Roberto, Scarpioni, Rosa, Sicoli, Rosella, Malandra, Silvana, Savoldi, Silvio, Bertoli, Silvio, Borrelli, Stefania, Maxia, Stefano, Maffei, Stefano, Mangano, Teresa, Cicchetti, Tiziana, Rappa, Valentina, Palazzo, Walter De Simone, Anita, Schrander, Bastiaan van Dam, Carl, Siegert, Carlo, Gaillard, Charles, Beerenhout, Cornelis, Verburgh, Cynthia, Janmaat, Ellen, Hoogeveen, Ewout, Hoorn, Friedo, Dekker, Johannes, Boots, Henk, Boom, Jan-Willem, Eijgenraam, Jeroen, Kooman, Joris, Rotmans, Kitty, Jager, Liffert, Vogt, Maarten, Raasveld, Marc, Vervloet, Marjolijn van Buren, Merel van Diepen, Nicholas, Chesnaye, Paul, Leurs, Pauline, Voskamp, Peter, Blankestijn, Sadie van Esch, Siska, Boorsma, Stefan, Berger, Constantijn, Konings, Zeynep, Aydin, Aleksandra, Musiała, Anna, Szymczak, Ewelina, Olczyk, Hanna, Augustyniak-Bartosik, Ilona, Miśkowiec-Wiśniewska, Jacek, Manitius, Joanna, Pondel, Kamila, Jędrzejak, Katarzyna, Nowańska, Łukasz, Nowak, Magdalena, Durlik, Szyszkowska, Dorota, Teresa, Nieszporek, Zbigniew, Heleniak, Andreas, Jonsson, Anna-Lena, Blom, Björn, Rogland, Carin, Wallquist, Denes, Vargas, Emöke, Dimény, Fredrik, Sundelin, Fredrik, Uhlin, Gunilla, Welander, Isabel Bascaran Hernandez, Knut-Christian, Gröntoft, Maria, Stendahl, Maria, Svensson, Marie, Evans, Olof, Heimburger, Pavlos, Kashioulis, Stefan, Melander, Tora, Almquist, Ulrika, Jensen, Alistair, Woodman, Anna, Mckeever, Asad, Ullah, Barbara, Mclaren, Camille, Harron, Carla, Barrett, Charlotte, O'Toole, Christina, Summersgill, Colin, Geddes, Deborah, Glowski, Deborah, Mcglynn, Dympna, Sands, Fergus, Caskey, Geena, Roy, Gillian, Hirst, Hayley, King, Helen, Mcnally, Houda, Masri-Senghor, Hugh, Murtagh, Hugh, Rayner, Jane, Turner, Joanne, Wilcox, Jocelyn, Berdeprado, Jonathan, Wong, Joyce, Banda, Kirsteen, Jones, Lesley, Haydock, Lily, Wilkinson, Margaret, Carmody, Maria, Weetman, Martin, Joinson, Mary, Dutton, Michael, Matthews, Neal, Morgan, Nina, Bleakley, Paul, Cockwell, Paul, Roderick, Phil, Mason, Philip, Kalra, Rincy, Sajith, Sally, Chapman, Santee, Navjee, Sarah, Crosbie, Sharon, Brown, Sheila, Tickle, Suresh, Mathavakkannan, Ying, Kuan, Internal medicine, Nephrology, ACS - Diabetes & metabolism, Medical Informatics, APH - Methodology, APH - Aging & Later Life, Graduate School, APH - Quality of Care, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, Eveleens Maarse, B. C., Chesnaye, N. C., Schouten, R., Michels, W. M., Bos, W. J. W., Szymczak, M., Krajewska, M., Evans, M., Heimburger, O., Caskey, F. J., Wanner, C., Jager, K. J., Dekker, F. W., Meuleman, Y., Schneider, A., Torp, A., Iwig, B., Perras, B., Marx, C., Drechsler, C., Blaser, C., Emde, C., Krieter, D., Fuchs, D., Irmler, E., Platen, E., Schmidt-Gurtler, H., Schlee, H., Naujoks, H., Schlee, I., Casar, S., Beige, J., Rothele, J., Mazur, J., Hahn, K., Blouin, K., Neumeier, K., Anding-Rost, K., Schramm, L., Hopf, M., Wuttke, N., Frischmuth, N., Ichtiaris, P., Kirste, P., Schulz, P., Aign, S., Biribauer, S., Manan, S., Roser, S., Heidenreich, S., Palm, S., Schwedler, S., Delrieux, S., Renker, S., Schattel, S., Stephan, T., Schmiedeke, T., Weinreich, T., Leimbach, T., Stovesand, T., Bahner, U., Seeger, W., Cupisti, A., Sagliocca, A., Ferraro, A., Mele, A., Naticchia, A., Cosaro, A., Ranghino, A., Stucchi, A., Pignataro, A., De Blasio, A., Pani, A., Tsalouichos, A., Antonio, B., Raffaele Di Iorio, B., Alessandra, B., Abaterusso, C., Somma, C., D'Alessandro, C., Torino, C., Zullo, C., Pozzi, C., Bergamo, D., Ciurlino, D., Motta, D., Russo, D., Favaro, E., Vigotti, F., Ansali, F., Conte, F., Cianciotta, F., Giacchino, F., Cappellaio, F., Pizzarelli, F., Greco, G., Porto, G., Bigatti, G., Marinangeli, G., Cabiddu, G., Fumagalli, G., Caloro, G., Piccoli, G., Capasso, G., Gambaro, G., Tognarelli, G., Bonforte, G., Conte, G., Toscano, G., Del Rosso, G., Capizzi, I., Baragetti, I., Oldrizzi, L., Gesualdo, L., Biancone, L., Magnano, M., Ricardi, M., Di Bari, M., Laudato, M., Luisa Sirico, M., Ferraresi, M., Postorino, M., Provenzano, M., Malaguti, M., Palmieri, N., Murrone, P., Cirillo, P., Dattolo, P., Acampora, P., Nigro, R., Boero, R., Scarpioni, R., Sicoli, R., Malandra, R., Savoldi, S., Bertoli, S., Borrelli, S., Maxia, S., Maffei, S., Mangano, S., Cicchetti, T., Rappa, T., Palazzo, V., De Simone, W., Schrander, A., Van Dam, B., Siegert, C., Gaillard, C., Beerenhout, C., Verburgh, C., Janmaat, C., Hoogeveen, E., Hoorn, E., Boots, J., Boom, H., Eijgenraam, J. -W., Kooman, J., Rotmans, J., Vogt, L., Raasveld, M., Vervloet, M., Van Buren, M., Van Diepen, M., Leurs, P., Voskamp, P., Blankestijn, P., Van Esch, S., Boorsma, S., Berger, S., Konings, C., Aydin, Z., Musiala, A., Szymczak, A., Olczyk, E., Augustyniak-Bartosik, H., Miskowiec-Wisniewska, I., Manitius, J., Pondel, J., Jedrzejak, K., Nowanska, K., Nowak, L., Durlik, M., Dorota, S., Nieszporek, T., Heleniak, Z., Jonsson, A., Blom, A. -L., Rogland, B., Wallquist, C., Vargas, D., Dimeny, E., Sundelin, F., Uhlin, F., Welander, G., Bascaran Hernandez, I., Grontoft, K. -C., Stendahl, M., Svensson, M., Kashioulis, P., Melander, S., Almquist, T., Jensen, U., Woodman, A., Mckeever, A., Ullah, A., Mclaren, B., Harron, C., Barrett, C., O'Toole, C., Summersgill, C., Geddes, C., Glowski, D., Mcglynn, D., Sands, D., Roy, G., Hirst, G., King, H., Mcnally, H., Masri-Senghor, H., Murtagh, H., Rayner, H., Turner, J., Wilcox, J., Berdeprado, J., Wong, J., Banda, J., Jones, K., Haydock, L., Wilkinson, L., Carmody, M., Weetman, M., Joinson, M., Dutton, M., Matthews, M., Morgan, N., Bleakley, N., Cockwell, P., Roderick, P., Mason, P., Kalra, P., Sajith, R., Chapman, S., Navjee, S., Crosbie, S., Brown, S., Tickle, S., Mathavakkannan, S., and Kuan, Y.

Subjects
Transplantation, prospective cohort study, depressive symptoms, nephrology care, Nephrology, clinical outcome, chronic kidney disease, clinical trial, epidemiology, joint model, survival analysis, depressive symptom
Abstract

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (≥65 years; estimated glomerular filtration rate ≤20 mL/min/1.73 m2) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off ≤70; 0–100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was –0.12 mL/min/1.73 m2/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03–1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men.

Published
2022

33. Children of a lesser god or miracles? An emotional and behavioural profile of children born to mothers on dialysis in Italy: A multicentre nationwide study 2000-12

Author

Piccoli, Giorgina Barbara, Postorino, Valentina, Cabiddu, Gianfranca, Ghiotto, Sara, Guzzo, Gabriella, Roggero, Simona, Manca, Eleonora, Puddu, Rosalba, Meloni, Francesca, Attini, Rossella, Moi, Paolo, Guida, Bruna, Maxia, Stefania, Piga, Antonio Giulio, Mazzone, Luigi, Pani, Aantonello, Postorino, Maurizio, 'Kidney, Pregnancy Study Group' of the 'Italian Society of Nephrology' including Castellino, Santina, Gernone, Giuseppe, Calabria, Santo, Galliani, Marco, Manisco, Gianfranco, Di Tullio, Massimo, Vernaglione, Luigi, Chiappini, Maria Grazia, Proietti, Emanuela, Saffiotti, Stefano, Gangeni, Concetta, Brunati, Chiara, Montoli, Alberto, Esposito, Ciro, Montagna, Giovanni, Tata, Salvatore, Romano, Paolo, Amatruda, Ottavio, Cervini, Paolo, Casiraghi, Erika, Fabbrini, Paolo, Pieruzzi, Federico, Di Benedetto, Attilio, Alfisi, Giuseppina, Heidempergher, Marco, Buskermolen, Monique, Leveque, Alessandro, Autuly, Valerie, Giofrè, Francesco, Alati, Giovanni, Lombardi, Luigi, Riccio, Mara, Riccio, Ivano, Stingone, Antonio, D'Angelo, Benito, Lucchi, Leonardo, Stipo, Lucia, Loi, Valentina, Piccoli, Giorgina Barbara, Postorino, Valentina, Cabiddu, Gianfranca, Ghiotto, Sara, Guzzo, Gabriella, Roggero, Simona, Manca, Eleonora, Puddu, Rosalba, Meloni, Francesca, Attini, Rossella, Moi, Paolo, Guida, Bruna, Maxia, Stefania, Piga, Antonio, Mazzone, Luigi, Pani, Antonello, Postorino, Maurizio, Piccoli, G, Postorino, V, Cabiddu, G, Ghiotto, S, Guzzo, G, Roggero, S, Manca, E, Puddu, R, Meloni, F, Attini, R, Moi, P, Maxia, S, Piga, A, Mazzone, L, Pani, A, Postorino, M, Castellino, S, Gernone, G, Guida, B, Calabria, S, Galliani, M, Manisco, G, Di Tullio, M, Vernaglione, L, Chiappini, M, Proietti, E, Saffiotti, S, Gangeni, C, Brunati, C, Montoli, A, Esposito, C, Montagna, G, Tata, S, Romano, P, Amatruda, O, Cervini, P, Casiraghi, E, Fabbrini, P, Pieruzzi, F, Di Benedetto, A, Alfisi, G, Heidempergher, M, Buskermolen, M, Leveque, A, Autuly, V, Giofrè, F, Alati, G, Lombardi, L, Riccio, M, Riccio, I, Stingone, A, D'Angelo, B, Lucchi, L, Stipo, L, and Loi, V

Subjects
Counseling, Male, dialysi, Pediatrics, medicine.medical_treatment, Child Behavior, CBCL, Kidney Failure, Renal Dialysi, Pregnancy, stre, Surveys and Questionnaires, Surveys and Questionnaire, Medicine, Chronic, Child Behavior Checklist, Child, Depression (differential diagnoses), Twin Pregnancy, Mother, Mental Disorders, Settore MED/39 - Neuropsichiatria Infantile, Italy, Nephrology, Child, Preschool, depression, Mental Disorder, Female, Case-Control Studie, Human, Adult, medicine.medical_specialty, ESRD, dialysis, microcythaemia, pregnancy, stress, Adolescent, Case-Control Studies, Humans, Infant, Kidney Failure, Chronic, Mothers, Renal Dialysis, Stress, Psychological, Stress, Preschool, Dialysis, Transplantation, business.industry, Case-control study, medicine.disease, Psychological, business
Abstract

BACKGROUND: Pregnancy on dialysis is increasingly being reported. This study evaluates the behavioural profile of the children of mothers on dialysis and the parental stress their mothers undergo when compared with a group of mothers affected by a different chronic disease (microcythaemia) and a group of healthy control mothers. METHODS: Between 2000 and 2012, 23 on-dialysis mothers gave birth to 24 live-born children in Italy (23 pregnancies, 1 twin pregnancy, one of the twins deceased soon after delivery); of these, 16 mothers and 1 father (whose wife died before the inquiry) were included in the study (1 mother had died and the father was unavailable; 2 were not asked to participate because their children had died and 3 were unavailable; children: median age: 8.5, min-max: 2-13 years). Twenty-three mothers affected by transfusion-dependent microcythaemia or drepanocitosis (31 pregnancies, 32 children) and 35 healthy mothers (35 pregnancies, 35 children; median age of the children: 7, min-max: 1-13 years) were recruited as controls. All filled in the validated questionnaires: 'Child Behaviour Checklist' (CBCL) and the 'Parental Stress Index-Short Form' (PSI-SF). RESULTS: The results of the CBCL questionnaire were similar for mothers on dialysis and healthy controls except for pervasive developmental problems, which were significantly higher in the dialysis group, while microcythaemia mothers reported higher emotional and behavioural problems in their children in 8 CBCL sub-scales. Two/16 children in the dialysis and 3/32 in the microcythaemia group had pathological profiles, as assessed by T-scores (p: ns). PSI-SF indicated a normal degree of parental stress in microcythaemia subjects and healthy controls, while mothers on dialysis declared significantly lower stress, suggesting a defensive response in order to minimize problems, stress or negativity in their relationship with their child. CONCLUSIONS: According to the present analysis, the emotional and behavioural outcome is normal in most of the children from on-dialysis mothers. A 'positive defence' in the dialysis mothers should be kept in mind when tailoring psychological support for this medical miracle.

Published
2015

34. Kuwanon-L as a New Allosteric HIV-1 Integrase Inhibitor: Molecular Modeling and Biological Evaluation

Author

Riccardo Martini, Elisa Rita Ceresola, Bruno Botta, Massimo Clementi, Enzo Tramontano, Andrea Calcaterra, Cristina Tintori, Frauke Christ, Gianluigi Cabiddu, Filippo Canducci, Francesca Esposito, Valentina Iovine, Maurizio Botta, Roberto Ferrarese, Zeger Debyser, Angela Corona, Esposito, F., Tintori, C., Martini, R., Christ, F., Debyser, Z., Ferrarese, R., Cabiddu, G., Corona, A., Ceresola, E. R., Calcaterra, A., Iovine, V., Botta, B., Clementi, M., Canducci, F., Botta, M., and Tramontano, E.

Subjects
Protein Structure, Allosteric regulation, protein-protein interactions, allosterism, HIV-1 integrase, inhibitors, integrase multimerization, kuwanon-L, Allosteric Regulation, Binding Sites, Cell Line, Flavonoids, Flavonolignans, HIV Integrase, HIV Integrase Inhibitors, HIV-1, Humans, Molecular Docking Simulation, Morus, Plant Roots, Protein Structure, Tertiary, Recombinant Proteins, Virus Replication, Biochemistry, Organic Chemistry, Molecular Medicine, Molecular Biology, Biology, Protein–protein interaction, Binding site, Virtual screening, Active site, Integrase, Docking (molecular), biology.protein, biochemistry, organic chemistry, molecular medicine, molecular biology, Tertiary
Abstract

HIV-1 integrase (IN) active site inhibitors are the latest class of drugs approved for HIV treatment. The selection of IN strand-transfer drug-resistant HIV strains in patients supports the development of new agents that are active as allosteric IN inhibitors. Here, a docking-based virtual screening has been applied to a small library of natural ligands to identify new allosteric IN inhibitors that target the sucrose binding pocket. From theoretical studies, kuwanon-L emerged as the most promising binder and was thus selected for biological studies. Biochemical studies showed that kuwanon-L is able to inhibit the HIV-1 IN catalytic activity in the absence and in the presence of LEDGF/p75 protein, the IN dimerization, and the IN/LEDGF binding. Kuwanon-L also inhibited HIV-1 replication in cell cultures. Overall, docking and biochemical results suggest that kuwanon-L binds to an allosteric binding pocket and can be considered an attractive lead for the development of new allosteric IN antiviral agents. Docking simulations exploring a small library of natural compounds, together with biological studies, allowed kuwanon-L to be identified as a new HIV-1 integrase (IN) inhibitor with an allosteric mode of action. Kuwanon-L can thus be considered an attractive lead for the development of new allosteric IN antiviral agents.

Published
2015

35. Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

Author

Gianfranca, Cabiddu, Santina, Castellino, Giuseppe, Gernone, Domenico, Santoro, Franca, Giacchino, Olga, Credendino, Giuseppe, Daidone, Gina, Gregorini, Gabriella, Moroni, Rossella, Attini, Fosca, Minelli, Gianfranco, Manisco, Tullia, Todros, Giorgina Barbara, Piccoli, Lucia, Stipo, Cabiddu, G, Castellino, S, Gernone, G, Santoro, D, Giacchino, F, Credendino, O, Daidone, G, Gregorini, G, Moroni, G, Attini, R, Minelli, F, Manisco, G, Todros, T, Piccoli, G, Pieruzzi, F, Cabiddu, Gianfranca, Castellino, Santina, Gernone, Giuseppe, Santoro, Domenico, Giacchino, Franca, Credendino, Olga, Daidone, Giuseppe, Gregorini, Gina, Moroni, Gabriella, Attini, Rossella, Minelli, Fosca, Manisco, Gianfranco, Todros, Tullia, and Piccoli, Giorgina Barbara

Subjects
Counseling, Nephrology, medicine.medical_specialty, Time Factors, Best practice, medicine.medical_treatment, Peritoneal dialysis, Daily dialysi, MEDLINE, Chronic kidney disease, Daily dialysis, Dialysis efficiency, Evidence based medicine, Hemodialysis, Kidney, Kidney Function Tests, Time-to-Treatment, Predictive Value of Tests, Pregnancy, Renal Dialysis, Risk Factors, Internal medicine, Peritoneal dialysi, Humans, Medicine, Intensive care medicine, Dialysis, business.industry, Patient Selection, Body Weight, Evidence-based medicine, medicine.disease, Diet, Pregnancy Complications, Treatment Outcome, Italy, Chronic kidney disease Hemodialysis Peritoneal dialysis Dialysis efficiency Evidence based medicine Daily dialysis, Female, Kidney Diseases, Hemodialysi, business
Abstract

Background: Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion. Methods: A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000–2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips. Main results: Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75% may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

Published
2015

36. [News on Peritoneal Dialysis].

Author

Cabiddu G, Pani A, and Lepori N

Subjects
Humans, Practice Guidelines as Topic, Peritoneal Dialysis adverse effects, Peritoneal Dialysis methods, Peritoneal Dialysis standards, Peritonitis prevention & control, Peritonitis etiology
Abstract

Among the recent advancements in Peritoneal Dialysis, the guidelines on the prevention and treatment of peritonitis, published in March 2022 by the International Society for Peritoneal Dialysis (ISPD), are of particular importance. The ISPD periodically updates these guidelines, with the previous update dating back to 2016. Peritonitis, despite its decreased incidence, remains a significant challenge in PD as it continues to be a major cause of morbidity, mortality, and dropout from the modality. The 2022 ISPD guidelines update the previous recommendations and introduce new ones. These recommendations are evidence-based where evidence is available., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Published
2024

37. Ultrasound-guided kidney biopsy: a ten-year retrospective single-center experience and the promising role of clinical hypnosis.

Author

Angioi A, Mascia G, Sirigu D, Cao R, Bianco P, Onnis D, Floris M, Cabiddu G, Pani A, and Lepori N

Abstract

This retrospective analysis investigates the outcomes and complications of 682 kidney biopsies performed at ARNAS G. Brotzu from 2010 to 2021. Our findings indicate a minor complication rate of 9.1%, with severe complications being exceedingly rare at 0.3%. Age did not contribute to an increased risk, underscoring the procedure's safety across age groups. Clinical hypnosis was incorporated into the biopsy protocol in a subset of patients (n = 45) from April 2019 to December 2023. Over 90% of these patients reported no perception of the procedure, and 60% experienced no pain. According to STAY-Y test scores, this approach significantly reduced anxiety post-procedure (p = 0.001); no major or minor complications were observed in this group. While our study reaffirms the very low risk of severe complications in kidney biopsies, it also highlights the potential benefits of adjunct clinical hypnosis in enhancing patient comfort and cooperation during the procedure. This exploration opens a promising avenue for further investigation to improve patient experiences and procedural outcomes in kidney biopsies., (© 2024. The Author(s).)

Published
2024
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41. Any reduction in maternal kidney mass makes a difference during pregnancy in gestational and fetal outcome.

Author

Piccoli GB, Attini R, Torreggiani M, Chatrenet A, Manzione AM, Masturzo B, Casula V, Longhitano E, Dalmasso E, Biancone L, Pani A, and Cabiddu G

Subjects
Pregnancy, Infant, Newborn, Humans, Female, Pregnancy Outcome epidemiology, Kidney, Solitary Kidney complications, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic complications, Pyelonephritis
Abstract

Little is known about the effect tubulointerstitial nephropathies have in modulating maternal-fetal outcomes in pregnancy. Therefore, we analyzed the main outcomes of pregnancy in these women to gain a better understanding of the role of a reduction in maternal kidney mass. From the Torino Cagliari Observational Study (TOCOS) cohort, we selected 529 patients with a diagnosis of tubulointerstitial disease and focused on 421 patients with chronic kidney disease (CKD) stage 1, without hypertension but with proteinuria less than 0.5 g/day at referral. From a cohort of 2969 singleton deliveries from low-risk pregnancies followed in the same settings we selected a propensity score matched control cohort of 842 pregnancies match 2:1 for age, parity, body mass index, ethnicity, and origin. Time to delivery was significantly shorter in the study cohort 38.0 (Quartile 1-Quartile 3: 37.0-39.0) versus 39.0 (Q1-Q3 38.0-40.0) weeks, with respect to controls. Incidence of delivery of less than 37 gestational weeks significantly increased from controls (7.4%) to women with previous acute pyelonephritis (10.8%), other tubulointerstitial diseases (9.7%) and was the highest in patients with a single kidney (31.1%). Similarly, neonatal birthweight significantly and progressively decreased from controls (3260 g [Q1-Q3: 2980-3530]), previous acute pyelonephritis (3090 g [Q1-Q3: 2868-3405], other tubulointerstitial diseases (3110 g [Q1-Q3: 2840-3417]), and to solitary kidney (2910 g [Q1-Q3: 2480-3240]). Risk of developing preeclampsia was significantly higher in the CKD cohort (3.6% vs 1.7% in low-risk controls). Thus, even a small reduction in functional kidney mass, such as a pyelonephritic scar, is associated with a shorter duration of pregnancy and an increased risk of preterm delivery. The risk is proportional to the extent of parenchymal reduction and is highest in cases with a solitary kidney., (Copyright © 2024 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Published
2024
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42. Peritoneal Dialysis in Italy: the 8th GPDP-SIN Census 2022 - 2nd Part: the Centers.

Author

Neri L, Viglino G, Vizzardi V, Porreca S, Mastropaolo C, Marinangeli G, and Cabiddu G

Subjects
Humans, Censuses, Italy, Peritoneal Dialysis methods, Peritonitis, Nephrology
Abstract

Objectives. The results are presented of the 8th National Census (Cs-22) of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology relating to the characteristics of the Centers in Italy which used PD in 2022. Materials and methods. The 227 non-pediatric centers which used Peritoneal Dialysis (PD) in 2022 took part. The data requested were sent in aggregate form. For the first time, the resources available and training were investigated as well as home visits. The Centers have been divided into Quartiles according to the number of prevalent PD patients at 31/12/2022. Results. Centers with a smaller PD program (<9 pts) are characterized by 1. smaller overall size - 2. fewer personnel (doctors/nurses) dedicated to PD - 3. greater recourse to external personnel for training - 4. Less incremental prescription and evaluation of peritoneal permeability - 5. higher drop-out to HD in particular for choice/impossibility to continue and for adequacy/catheter-related issues. A lower peritonitis rate was recorded in Centers with a more extensive PD program (≥25 pts). Home visits are carried out regularly by a small minority of Centers. Conclusions. The analysis shows an association between size of Center PD program and available resources, PD modality and outcome., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Published
2024

43. Role of the Opinions of the Nephrologist and Structural Factors in Dialysis Modality Selection. Results of a Peritoneal Dialysis Study Group Questionnaire.

Author

Neri L, Viglino G, Vizzardi V, Porreca S, Mastropaolo C, Marinangeli G, and Cabiddu G

Subjects
Humans, Nephrologists, Dialysis, Renal Dialysis, Surveys and Questionnaires, Peritoneal Dialysis, Kidney Failure, Chronic therapy
Abstract

Background. The use of PD depends on economic, structural and organizational factors. The nephrologist's opinion is that peritoneal dialysis is less used than it shold be. In Italy, PD is not carried out in private Centers, but neither is it in around one third of Public Centers. The aim of this study was to investigate the opinions of nephrologists on PD in Public Centers only, thereby nullifying the influence of the economic factors. Materials and Methods. The investigation was carried out by means of an online questionnaire (Qs) via mail, and during meetings and Congresses in 2006-07. The Qs investigated the characteristics of the Centers, the nephrologists interviewed, and opinions on the various aspects of the choice of Renal Replacement Therapy Renal Replacement Therapy (RRT) (26 questions). Responses were received from 454 nephrologists in 270 public Centers. Among these, 205 centers (370 Qs) report PD (PD-YES), 36 (42 Qs) do not (PD-NO) and 29 (42 Qs) do not use it but send patients selected for PD to other Centers (PD-TRANSF). Results. The PD-NO and PD-TRANSF Centers are significantly smaller, with greater availability of beds. In the PD-YES Centers the presence of a pre-dialysis pathway, early referral and nurses dedicated solely to PD are associated with a higher use of PD. The nephrologists in the PD-NO Centers rate PD more negatively in terms of both clinical and non-clinical factors. The belief that more than 40% of patients can do either PD or HD differs among the nephrologists in the PD-YES (74.3%), PD-TRANSF (45.2%) and PD-NO (28.6%) Centers. Likewise, the belief that PD can be used as a first treatment in more than 30% of cases differs among the nephrologists in PD-YES (49.2%), PD-TRANSF (33.3%) and PD-NO (14.3%) Centers. Conclusions. The use of PD in Public Centers is conditioned by both structural and organizational factors, and by the opinions of nephrologists on the use and effectiveness of the technique., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Published
2024

44. Acute Kidney Disease in Oncology: A New Concept to Enhance the Understanding of the Impact of Kidney Injury in Patients with Cancer.

Author

Floris M, Trevisani F, Angioi A, Lepori N, Simeoni M, Cabiddu G, Pani A, and Rosner MH

Subjects
Humans, Risk Factors, Renal Insufficiency, Chronic complications, Disease Progression, Prevalence, Acute Kidney Injury etiology, Acute Kidney Injury therapy, Neoplasms complications
Abstract

Background: Cancer patients are prone to developing acute kidney disease (AKD), yet this phenomenon remains understudied compared to acute kidney injury (AKI). AKD, which often develops insidiously, can cause treatment interruptions, extended hospital stays, and increased mortality., Summary: This perspective article explores the intricate relationship between AKD and cancer, focusing on prevalence, risk factors, implications for anticancer therapy, and long-term outcomes, including chronic kidney disease progression., Key Messages: To emphasize the importance of early detection and intervention, this work advocates for increased research and awareness among clinicians to improve patient outcomes and manage healthcare burdens associated with AKD in cancer patients., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Published
2024
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45. [Classification and Management of MGRS Related Diseases].

Author

Angioi A, Lepori N, Derudas D, Floris M, Mascia G, Cabiddu G, and Pani A

Subjects
Humans, Kidney pathology, Immunoglobulin Light Chains, Antibodies, Monoclonal, Paraproteinemias diagnosis, Paraproteinemias therapy, Kidney Diseases diagnosis, Kidney Diseases etiology, Kidney Diseases therapy
Abstract

Monoclonal Gammopathies of Renal Significance (MGRS) are a complex group of disorders characterized by the production of aberrant monoclonal proteins that interact with kidney structures, causing tissue damage. Unlike neoplastic forms, kidney damage in MGRS does not correlate with clone mass or circulating monoclonal protein levels, conferring unique pre-neoplastic or non-neoplastic properties to the responsible clones. This manuscript explores the heterogeneity of monoclonal proteins involved, varying from full immunoglobulins to free light chains (FLC), and how they result in a spectrum of kidney lesions with differing prognoses. We also elaborate on diagnostic challenges, emphasizing the indispensable role of kidney biopsy, including advanced techniques like laser microdissection and mass spectrometry (LMD/MS) for deposit characterization, particularly in ambiguous or complex cases. Clinical management and treatment considerations, including the necessity for clone identification, are also discussed., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Published
2023

46. [An Integrated Multidisciplinary Approach to the Care of Renal Cancer Patients Undergoing Nephrectomy].

Author

Floris M, Angioi A, Lepori N, Mascia G, Trevisani F, Boero M, Scartozzi M, Cabiddu G, and Pani A

Subjects
Male, Humans, Female, Kidney pathology, Nephrectomy adverse effects, Nephrectomy methods, Glomerular Filtration Rate, Retrospective Studies, Carcinoma, Renal Cell diagnosis, Carcinoma, Renal Cell surgery, Kidney Neoplasms, Renal Insufficiency, Chronic
Abstract

Kidney cancer is one of the most common cancers globally, ranking 9th and 14th among men and women, respectively. Advances in diagnostic techniques have enabled earlier and potentially less invasive interventions, however, this progress poses a challenge in managing low-malignancy tumors that were previously undiagnosed. To navigate treatment pathways, a deep understanding of the bidirectional relationship between Chronic Kidney Disease (CKD) and Renal Cell Carcinoma (RCC) is essential, influenced by risk factors such as hypertension and obesity. The debate between partial (PN) and radical nephrectomy (RN) continues to be fueled by a rich body of studies in the last two decades, aiming to determine the precise benefits of renal function preservation and overall survival. However, long-term monitoring remains inadequate. There is an urgent need for heightened clinical vigilance, urging meticulous periodic evaluations that include both eGFR and the urinary albumin-creatinine ratio, to identify potential deteriorations early. Furthermore, non-neoplastic renal parenchyma requires equal attention, often overshadowed by the assessment of tumor mass. A nuanced analysis is necessary to identify a range of nephropathies that guide more effective therapeutic strategies. A collaborative strategy that brings nephrologists, urologists, nuclear radiologists, oncologists, and pathologists together on a unified platform, focusing on a personalized medicine approach grounded on a profound analysis of individual risk factors, is pivotal in shaping the future of management and prevention strategies. This approach ensures a detailed therapeutic outlook and facilitates early interventions, marrying vigilance with interdisciplinary cooperation, thereby guarding against late diagnoses and offering patients a robust shield in their battle against kidney afflictions., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Published
2023

47. [Transplant Candidate with Cancer: Should We Proceed?]

Author

Mascia G, Floris M, Angioi A, Argiolas D, Lepori N, Cabiddu G, and Pani A

Subjects
Humans, Renal Dialysis, Immunosuppression Therapy, Kidney Failure, Chronic surgery, Kidney Failure, Chronic epidemiology, Kidney Transplantation, Neoplasms etiology
Abstract

Individuals who suffer from end-stage renal disease are at a higher risk of developing certain types of tumors. This risk increases as kidney function deteriorates further. Dialysis patients often witness a surge in the incidence of such malignancies. Interestingly, after the initial period following a kidney transplant, there is a dip in the number of deaths related to neoplasms. However, a long-term view reveals a progressive increase in the risk of developing tumors. The evaluation process for transplant candidacy is thorough, taking into account several factors, including the individual's history of neoplasms and the implications of immunosuppressive therapy. Immunosuppressive therapy is a double-edged tool in managing post-transplant complications, as it can foster environments conducive to neoplasm growth. It is essential to reevaluate, with the aid of an oncological opinion, the waiting time between cancer recovery and the listing for kidney transplantation, based on clinical data and follow-up. Independent of the type of tumor, the requirement to treat and achieve remission delays the listing process, consequently extending the time spent with end-stage renal disease and undergoing dialysis. These factors correlate with increased mortality, heightened risk of cardiovascular disease, and graft loss., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Published
2023

48. Peritoneal Dialysis in Italy: the 8th GPDP-SIN census 2022

Author

Neri L, Viglino G, Vizzardi V, Porreca S, Mastropaolo C, Marinangeli G, and Cabiddu G

Subjects
Humans, Censuses, Italy epidemiology, Incidence, Peritoneal Dialysis adverse effects, Peritonitis epidemiology, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic therapy, Kidney Failure, Chronic complications
Abstract

Objectives. The results are reported here of the 8th National Census (Cs-22) of Peritoneal Dialysis in Italy, carried out in 2022-23 by the Italian Society of Nephrology's Peritoneal Dialysis Project Group and relating to 2022. Methods. The Census was conducted in the 227 non pediatric centers which performed Peritoneal Dialysis (PD) in 2022. The results have been compared with the previous Censuses carried out since 2005. Results. Incidence: in 2022, 1350 patients (CAPD=52.1%) started on PD (1st treatment for ESRD). PD was started incrementally by 35.3% in 136 Centers. The catheter was placed exclusively by a Nephrologist in 17.0% of known cases. Prevalence: there were 4152 (CAPD=43.4%) patients on PD on 31/12/2022, with 21.1% of prevalent patients on assisted PD (family member caregiver: 86.3%). Out: in 2022 the PD drop-out rate (ep/100 pt-yrs) was: 11.7 to HD; 10.1 death, down; 7.5 Tx. The main cause of transfer to HD remains peritonitis (23.5%), although its reduction over the years is confirmed (Cs-05: 37.9%). Peritonitis/EPS: the incidence of peritonitis in 2022 was 0.176 ep/pt-yr (696 episodes). The incidence of new cases of EPS fell in 2021-22 (7 cases). Other results: the number of Centers using 3.86% for the peritoneal equilibration test (PET) (57.7%) increased. PD for heart failure continues to be used in 44 Centers (66 pts). Conclusions. Cs-22 confirms PD's good results in Italy., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Published
2023

49. Chronic kidney disease, female infertility, and medically assisted reproduction: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology.

Author

Attini R, Cabiddu G, Ciabatti F, Montersino B, Carosso AR, Gernone G, Gammaro L, Moroni G, Torreggiani M, Masturzo B, Santoro D, Revelli A, and Piccoli GB

Subjects
Pregnancy, Female, Humans, Pregnancy, Twin, Kidney, Infertility, Female diagnosis, Infertility, Female etiology, Infertility, Female therapy, Nephrology, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic therapy
Abstract

Fertility is known to be impaired more frequently in patients with chronic kidney disease than in the general population. A significant proportion of chronic kidney disease patients may therefore need Medically Assisted Reproduction. The paucity of information about medically assisted reproduction for chronic kidney disease patients complicates counselling for both nephrologists and gynaecologists, specifically for patients with advanced chronic kidney disease and those on dialysis or with a transplanted kidney. It is in this context that the Project Group on Kidney and Pregnancy of the Italian Society of Nephrology has drawn up these best practice guidelines, merging a literature review, nephrology expertise and the experience of obstetricians and gynaecologists involved in medically assisted reproduction. Although all medically assisted reproduction techniques can be used for chronic kidney disease patients, caution is warranted. Inducing a twin pregnancy should be avoided; the risk of bleeding, thrombosis and infection should be considered, especially in some categories of patients. In most cases, controlled ovarian stimulation is needed to obtain an adequate number of oocytes for medically assisted reproduction. Women with chronic kidney disease are at high risk of kidney damage in case of severe ovarian hyperstimulation syndrome, and great caution should be exercised so that it is avoided. The higher risks associated with the hypertensive disorders of pregnancy, and the consequent risk of chronic kidney disease progression, should likewise be considered if egg donation is chosen. Oocyte cryopreservation should be considered for patients with autoimmune diseases who need cytotoxic treatment. In summary, medically assisted reproduction is an option for chronic kidney disease patients, but the study group strongly advises extensive personalised counselling with a multidisciplinary healthcare team and close monitoring during the chosen medically assisted reproduction procedure and throughout the subsequent pregnancy., (© 2023. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Published
2023
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