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1. Clinical policies on the management of chronic kidney disease patients in Italy

Author

SIR SIN STUDY INVESTIGATORS ACCIARRI P, MENEGATO MA, ANCARANI E, ANDREUCCI V, ANTONELLI A, AURICCHIO MR, BALDUCCI A, BASSI A, BATTAGLIA G, BELLINGHERI G, BELTRAME A, BIAGINI M, BONFANTE L, BONOFIGLIO R, BONOMINI M, BORGHI M, BRIGANTE M, BUCCIANTI G, BUONGIORNO E, CABIBBE M, CANCARINI G, CAPISTRANO M, CAPPELLI G, CAPUANO M, CASCONE C, CATIZONE L, CATUCCI AE, CAVATORTA F, CHIARINOTTI D, CICCHETTI T, CONCAS G, CONCETTI M, CONTE F, CONTI M, CORATELLI P, CORTI MM, COSTANZO R, DAL CANTON A, D'APICE L, DAVID S, DE CRISTOFARO V, DEFERRARI G, DELLA GROTTA F, DE NICOLA, Luca, DE SANTO NG, DE SIMONE W, DI DANIELE N, DI GIULIO S, DI LANDRO D, DI LUZIO V, DI MAGGIO A, FAGUGLI R, FARINA M, FERIANI M, GALLIENI M, GAMBARO G, GIORDANO R, GRECO S, GRILLO C, HUBER W, LIUZZO G, LOCATELLI F, LOMBARDI L, LOPEZ T, MALBERTI F, MANCINI W, MANENTI F, MANISCO G, MARROCCO A, MATOCCI G, MERICO G, MESSA P, MINUTOLO, Roberto, MONARDO P, MORICONI L, MURRONE P, NARDO A, NASO A, NOBILE R, PANARELLO G, PAONE A, PARRAVANO M, PEDRINI L, PIAZZA V, PISTIS R, PROCIDA M, QUARELLO F, RAPISARDA F, RICCIARDI B, RINDI P, RONCO C, ROTOLO U, RUSSO G, SARANITI A, SASDELLI M, SAVICA V, SCANZIANI R, SIDOTI A, SPOTTI D, STALTERI A, STEFONI S, STELLA A, STRIPPOLI P, TEATINI U, TEODORO C, TOZZO C, TRIOLO G, ZOCCALI C., Locatelli F, Zoccali C, Acciarri P, Menegato MA, Ancarani E, Andreucci V, Antonelli A, Auricchio MR, Balducci A, Bassi A, Battaglia G, Bellingheri G, Beltrame A, Biagini M, Bonfante L, Bonofiglio R, Bonomini M, Borghi M, Brigante M, Buccianti G, Buongiorno E, Cabibbe M, Cancarini G, Capistrano M, Cappelli G, Capuano M, Cascone C, Catizone L, Catucci AE, Cavatorta F, Chiarinotti D, Cicchetti T, Concas G, Concetti M, Conte F, Conti M, Coratelli P, Corti MM, Costanzo R, Dal Canton A, D'Apice L, David S, De Cristofaro V, Deferrari G, Della Grotta F, De Nicola L, De Santo NG, De Simone W, Di Daniele N, Di Giulio S, Di Landro D, Di Luzio V, Di Maggio A, Fagugli R, Farina M, Feriani M, Gallieni M, Gambaro G, Giordano R, Greco S, Grillo C, Huber W, Liuzzo G, Lombardi L, Lopez T, Malberti F, Mancini W, Manenti F, Manisco G, Marrocco A, Matocci G, Merico G, Messa P, Minutolo R, Monardo P, Moriconi L, Murrone P, Nardo A, Naso A, Nobile R, Panarello G, Paone A, Parravano M, Pedrini L, Piazza V, Pistis R, Procida M, Quarello F, Rapisarda F, Ricciardi B, Rindi P, Ronco C, Rotolo U, Russo G, Saraniti A, Sasdelli M, Savica V, Scanziani R, Sidoti A, Spotti D, Stalteri A, Stefoni S, Stella A, Strippoli P, Teatini U, Teodoro C, Tozzo C, Triolo G., SIR SIN STUDY INVESTIGATORS ACCIARRI, P, Menegato, Ma, Ancarani, E, Andreucci, V, Antonelli, A, Auricchio, Mr, Balducci, A, Bassi, A, Battaglia, G, Bellingheri, G, Beltrame, A, Biagini, M, Bonfante, L, Bonofiglio, R, Bonomini, M, Borghi, M, Brigante, M, Buccianti, G, Buongiorno, E, Cabibbe, M, Cancarini, G, Capistrano, M, Cappelli, G, Capuano, M, Cascone, C, Catizone, L, Catucci, Ae, Cavatorta, F, Chiarinotti, D, Cicchetti, T, Concas, G, Concetti, M, Conte, F, Conti, M, Coratelli, P, Corti, Mm, Costanzo, R, DAL CANTON, A, D'Apice, L, David, S, DE CRISTOFARO, V, Deferrari, G, DELLA GROTTA, F, DE NICOLA, Luca, DE SANTO, Ng, DE SIMONE, W, DI DANIELE, N, DI GIULIO, S, DI LANDRO, D, DI LUZIO, V, DI MAGGIO, A, Fagugli, R, Farina, M, Feriani, M, Gallieni, M, Gambaro, G, Giordano, R, Greco, S, Grillo, C, Huber, W, Liuzzo, G, Locatelli, F, Lombardi, L, Lopez, T, Malberti, F, Mancini, W, Manenti, F, Manisco, G, Marrocco, A, Matocci, G, Merico, G, Messa, P, Minutolo, Roberto, Monardo, P, Moriconi, L, Murrone, P, Nardo, A, Naso, A, Nobile, R, Panarello, G, Paone, A, Parravano, M, Pedrini, L, Piazza, V, Pistis, R, Procida, M, Quarello, F, Rapisarda, F, Ricciardi, B, Rindi, P, Ronco, C, Rotolo, U, Russo, G, Saraniti, A, Sasdelli, M, Savica, V, Scanziani, R, Sidoti, A, Spotti, D, Stalteri, A, Stefoni, S, Stella, A, Strippoli, P, Teatini, U, Teodoro, C, Tozzo, C, Triolo, G, and Zoccali, C.

Subjects
Nephrology, medicine.medical_specialty, Referral, Anemia, medicine.medical_treatment, Context (language use), Metabolic Diseases, Internal medicine, Surveys and Questionnaires, Italian Society of Nephrology, chronic kidney disease, questionnaire, medicine, Humans, Intensive care medicine, Dialysis, Settore MED/14 - Nefrologia, Transplantation, business.industry, Guideline, medicine.disease, Italy, Chronic Disease, Kidney Diseases, Hemodialysis, Guideline Adherence, business, Kidney disease
Abstract

BACKGROUND: Recent studies have indicated that the implementation of international guidelines for the management of renal patients is suboptimal in Italy. The Italian Society of Nephrology (SIN) decided to undertake a multicentre study to obtain a clear picture of clinical policies on chronic kidney disease (CKD) in Italy. METHODS: A 76-item structured questionnaire, designed to evaluate the organization of clinical care, was administered to the director of each participating centre, within the context of a large observational trial in 100 Italian nephrology centres, collecting information on newly diagnosed CKD patients (K/DOQI stage 3-5) on conservative treatment. This paper reports the questionnaire results related to management of anaemia and bone metabolism disorders; assessment of renal function; creation of a vascular access for dialysis and referral of patients to a nephrologist. RESULTS: Clinical policies at the centre level deviated from guideline recommendations in 70% (timing of vascular access creation) to 25% (assessment of iron deficiency) of centres. Assessment of renal function differed from the recommended approach in 30% of centres; clinical policies related to anaemia and bone disease did not coincide with guideline standards in 50 and 40% of centres, respectively. Directors of renal unit estimates indicate that the creation of a vascular access occurs very late in 38% of patients and that referral to a nephrologist is late in approximately 40% of cases. CONCLUSION: This survey in Italy highlights important deviations of clinical policies at the centre level from guideline recommendations.

Published
2008

2. Prognostic role of LDL cholesterol in non-dialysis chronic kidney disease: Multicenter prospective study in Italy

Author

De Nicola, Luca, Provenzano, Michele, Chiodini, Paolo, D'Arrigo, Graziella, Tripepi, Giovanni, Del Vecchio, Lucia, Conte, Giuseppe, Locatelli, Francesco, Zoccali, Carmine, Minutolo, RobertoAcciarri P, Adorati, M, Ancarani, E, Andreucci, V, Antonelli, A, Auricchio, Mr, Balducci, A, Bassi, A, Battaglia, G, Bellingheri, G, Beltrame, A, Biagini, M, Bonfante, L, Bonofiglio, R, Bonomini, M, Borghi, M, Brigante, M, Buccianti, G, Buongiorno, E, Cabibbe, M, Cancarini, Giovanni, Capistrano, M, Cappelli, G, Capuano, M, Cascone, C, Catizone, L, Catucci, Ae, Cavatorta, F, Chiarinotti, D, Cicchetti, T, Concas, G, Concetti, M, Conte, F, Conte, G, Conti, M, Coratelli, P, Corti, Mm, Costanzo, R, Dal Canton, A, D'Apice, L, David, S, De Cristofaro, V, Deferrari, G, Della Grotta, F, De Santo NG, De Simone, W, Di Daniele, N, Di Giulio, S, Di Landro, D, Di Luzio, V, Di Maggio, A, Fagugli, R, Farina, M, Feriani, M, Gallieni, M, Gambaro, G, Giordano, R, Greco, S, Grillo, C, Huber, W, Liuzzo, G, Locatelli, F, Lombardi, L, Lopez, T, Malberti, F, Mancini, W, Manenti, F, Manisco, G, Marrocco, A, Matocci, G, Merico, G, Messa, P, Minutolo, R, Monardo, P, Moriconi, L, Murrone, P, Nardo, A, Naso, A, Nobile, R, Panarello, G, Paone, A, Parravano, M, Pedrini, L, Piazza, V, Pistis, R, Procida, M, Quarello, F, Rapisarda, F, Ricciardi, B, Rindi, P, Ronco, C, Rotolo, U, Russo, G, Santoro, D, Saraniti, A, Sasdelli, M, Savica, V, Scanziani, R, Sidoti, A, Spotti, D, Stalteri, A, Stefoni, S, Stella, A, Strippoli, P, Teatini, U, Teodoro, C, Tozzo, C, Triolo, G, Zoccali, C., De Nicola, L, Provenzano, M, Chiodini, P, D'Arrigo, G, Tripepi, G, Del Vecchio, L, Conte, G, Locatelli, F, Zoccali, C, and Minutolo, R

Subjects
Male, Nephrology, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Medicine (miscellaneous), Kidney Function Tests, Severity of Illness Index, chemistry.chemical_compound, Endocrinology, Risk Factors, Chronic kidney disease, 80 and over, Prospective Studies, Renal Insufficiency, Chronic, Prospective cohort study, Cardiovascular risk, Cholesterol, ESRD, LDL, Renal clinic, Nutrition and Dietetics, Cardiology and Cardiovascular Medicine, Aged, 80 and over, Medicine (all), Middle Aged, Prognosis, Diabetes and Metabolism, Italy, Cardiovascular Diseases, Female, Glomerular Filtration Rate, medicine.medical_specialty, Renal function, Median follow-up, Internal medicine, Diabetes mellitus, medicine, Humans, Renal replacement therapy, Renal Insufficiency, Chronic, Aged, business.industry, Cholesterol, LDL, medicine.disease, chemistry, business, Kidney disease
Abstract

Background and aims The prognostic role of LDL in non-dialysis chronic kidney disease (CKD) is still undefined. We addressed this question in a multicenter prospective study including patients referred to nephrologist for management. Methods and results 1306 patients with CKD stage III–V were studied at basal visit in 79 Italian nephrology clinics in 2004–2006, and then followed for survival analyses. Study endpoints were incident cardiovascular -CV events (fatal and major non-fatal) and renal events (start of renal replacement therapy or eGFR halving). Mean age was 67.6 ± 11.8 years, male 65%, diabetes 25%, CV disease 27%, and eGFR 35.8 ± 12.5 mL/min/1.73 m 2 . LDL was 119 ± 40 mg/dL, with high levels in 50.1% and 82.8% defined on the basis of the individual CV risk profile estimated according to ATPIII 2001 and ESC 2012 guidelines (LDL 100 to 160, and >70 or >100 mg/dL, respectively). Over a median follow up of 2.87 years, 178 CV and 181 renal events occurred. At multivariable Cox analyses, CV risk linearly increased with higher LDL (hazard ratio-HR per 40 mg/dL higher LDL: 1.20, 95% confidence intervals-CI 1.03–1.39); risk doubled when considering high LDL defined according to ESC 2012 (HR 2.37, 95%CI 1.39–4.03) while this association was not significant when considering the higher threshold levels of ATPIII 2001 (HR 1.10, 95%CI 0.82–1.49). No association emerged between LDL and renal risk. Conclusion In non-dialysis CKD patients, CV risk increases linearly with higher LDL and is more than doubled when considering the lower threshold values currently indicated for defining optimal LDL level.

Published
2015

3. 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

4. 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

5. Clinical policies on the management of chronic kidney disease patients in Italy

Author

Locatelli, F, Zoccali, C, SIR SIN STUDY INVESTIGATORS, COLLABORATORS ACCIARRI, P, Menegato, Ma, Ancarani, E, Andreucci, V, Antonelli, A, Auricchio, Mr, Balducci, A, Bassi, A, Battaglia, G, Bellingheri, G, Beltrame, A, Biagini, M, Bonfante, L, Bonofiglio, R, Bonomini, M, Borghi, M, Brigante, M, Buccianti, G, Buongiorno, E, Cabibbe, M, Cancarini, Giovanni, Capistrano, M, Cappelli, G, Capuano, M, Cascone, C, Catizone, L, Catucci, Ae, Cavatorta, F, Chiarinotti, D, Cicchetti, T, Concas, G, Concetti, M, Conte, F, Conti, M, Coratelli, P, Corti, Mm, Costanzo, R, Dal, Canton, A, D'Apice, L, David, S, DE CRISTOFARO, V, Deferrari, G, DELLA GROTTA, F, Nicola, L, DE SANTO NG, DE SIMONE, W, DI DANIELE, N, DI GIULIO, S, DI LANDRO, D, Luzio, V, DI MAGGIO, A, Fagugli, R, Farina, M, Feriani, M, Gallieni, M, Gambaro, G, Giordano, R, Greco, S, Grillo, C, Huber, W, Liuzzo, G, Lombardi, L, Lopez, T, Malberti, F, Mancini, W, Manenti, F, Manisco, G, Marrocco, A, Matocci, G, Merico, G, Messa, P, Minutolo, R, Monardo, P, Moriconi, L, Murrone, P, Nardo, A, Naso, A, Nobile, R, Panarello, G, Paone, A, Parravano, M, Pedrini, L, Piazza, V, Pistis, R, Procida, M, Quarello, F, Rapisarda, F, Ricciardi, B, Rindi, P, Ronco, C, Rotolo, U, Russo, G, Saraniti, A, Sasdelli, M, Savica, V, Scanziani, R, Sidoti, A, Spotti, D, Stalteri, A, Stefoni, S, Stella, A, Strippoli, P, Teatini, U, Teodoro, C, Tozzo, C, Triolo, G, and Zoccali, C.

Subjects
Chrinic kidney disease, anemia
Published
2008

7. Epidemiology of end-stage renal disease in an interregional perspective: Registries of Puglia and Basilicata, southren Italy

Author

Vitullo, F., Casino, F. G., Di Matteo, A., Di Candia, V. D., Gaudiano, V., Piras, V., Alfonso, L., Basile, C., Procaccini, D. A., Gesualdo, L., Chiarulli, G., Lomonte, C., D Ambrosio, N., Petrarulo, F., Sacchetti, A., D Agustino, F., Navarra, A., Laraia, A., Carabellese, S., Coratelli, P., Ramunni, A., Schena, F. P., Pertosa, G., Caringella, A., Depalo, T., NICOLA LATTANZI, Allegretti, A., Brandi, S., Ranieri, F., Anna, A., Muschitielllo, M., Tricarico, G., Strippoli, P., Castrignanò, E., Bozzi, M., Buongiorno, E., Lupo, N., Min, A. M., Capotorto, M., Passione, A., Di Dio, M., Manisco, G., Sozzo, E., Gidante, B., Gallucci, M., Mastrangelo, F., Chimienti, S., Perrone, F., Giordano, R., Virgilio, M., Brusasco, A., Pastore, G., Conversano, A., Giannatasio, M., Gernone, G., Stalllone, C., Pompa, G., Avanzi, C., Tasco, A., Stefanelli, G., Scatizzi, L. C., Nuzzo, V., Gaudiano, G., Bellizi, V., Lopez, T., Procida, M., Lauria, M. A., Oriente, L., Pergamo, O., Valente, V., Ianuzziello, F., Carretta, P., Ricchiuti, V., Bombini, A., and Pampaloni, M.

8. 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

9. 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

10. 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, and Piccoli GB

Subjects
Body Weight, Counseling, Diet, Female, Humans, Italy, Kidney Diseases diagnosis, Kidney Diseases physiopathology, Kidney Function Tests standards, Patient Selection, Peritoneal Dialysis adverse effects, Predictive Value of Tests, Pregnancy, Pregnancy Complications diagnosis, Pregnancy Complications physiopathology, Renal Dialysis adverse effects, Risk Factors, Time Factors, Time-to-Treatment, Treatment Outcome, Kidney physiopathology, Kidney Diseases therapy, Nephrology standards, Peritoneal Dialysis standards, Pregnancy Complications therapy, Renal Dialysis standards
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
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11. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery.

Author

Manisco G, Potì' M, Maggiulli G, Di Tullio M, Losappio V, and Vernaglione L

Abstract

Pregnancy in women with chronic kidney disease has always been considered as a challenging event both for the mother and the fetus. Over the years, several improvements have been achieved in the outcome of pregnant chronic renal patients with increasing rates of successful deliveries. To date, evidence suggests that the stage of renal failure is the main predictive factor of worsening residual kidney function and complications in pregnant women. Moreover, the possibility of success of the pregnancy depends on adequate depurative and pharmacological strategies in patients with end-stage renal disease. In this paper, we propose a review of the current literature about this topic presenting our experience as well.

Published
2015
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13. Bone densitometry with L125 in the study of uraemic osteropathy: semeiological signifiance and limitations.

Author

Mastrangelo F, Manisco G, Lopez T, Rizzelli S, Corliano C, and Alfonso L

Subjects
Bone and Bones chemistry, Female, Humans, Kidney Failure, Chronic metabolism, Male, Minerals analysis, Sex Factors, Chronic Kidney Disease-Mineral and Bone Disorder diagnosis, Densitometry methods, Iodine Radioisotopes
Abstract

Bone densitometry using I125 is a very easy method of investigation; it may be used repeatedly and simultaneously at different bone levels without distress to patients. The problems involved were those of the value, semeiological significance and possible limitations of this method in the investigation of uraemic osteopathy. These problems were solved successfully in tests carried out on 87 patients of both sexes suffering from various degrees of chronic nephropathy and on chronic haemodialysis patients. The method is reliable: reproducibility tests in normal and uraemic subjects were satisfactory; the indexes remain constant, usually in normal subjects. The parameters are "Bone Mineral Content" and "Bone Index". Trabecular bone is more sensitive than cortical bone, although comparisons between the two types of bone produce interesting data. There are difference dependent on sex. The method which is more sensitive than others enables: 1) Normal and nephropathic subjects, to be distinguished from one another. The latter generally show a lower mineral content and bone index (clinical picture of osteomalacia, osteoporosis, hyperparathyroidism) seldom a higher or a normal one. 2) The same bone sites to be examined over a given period. 3) Treatment of patients to be monitored.

Published
1976

15. [Ca++ kinetics during acetate and bicarbonate dialysis].

Author

Manisco G, De Blasi V, Alfonso L, Rizzelli S, Corlianò C, Aprile M, Cagnazzo A, and Mastrangelo F

Subjects
Humans, Kidney Failure, Chronic therapy, Kinetics, Acetates therapeutic use, Bicarbonates therapeutic use, Calcium metabolism, Renal Dialysis
Published
1981

17. [Antibiotic therapy in the course of renal insufficiency].

Author

Magliari F, Mastrangelo F, Lopez T, Rizzelli S, Manisco G, and Corliano C

Subjects
Adult, Aged, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents adverse effects, Anti-Bacterial Agents metabolism, Drug Interactions, Female, Humans, Liver metabolism, Male, Middle Aged, Renal Dialysis adverse effects, Sisomicin administration & dosage, Sisomicin adverse effects, Sisomicin therapeutic use, Urinary Tract Infections drug therapy, Acute Kidney Injury complications, Anti-Bacterial Agents therapeutic use, Bacterial Infections drug therapy, Kidney drug effects, Kidney Failure, Chronic complications
Published
1978

19. [Paraquat poisoning; clinical toxicological aspects and a case description].

Author

Soldani G, Del Tacca M, Salesi M, Caione R, and Manisco G

Subjects
Adolescent, Female, Humans, Kinetics, Paraquat toxicity, Suicide, Time Factors, Paraquat poisoning
Abstract

The clinical course of a young woman following the ingestion of the herbicide Paraquat in a suicide attempts is reported. Clinical signs of intoxication consisted at first in alterations of hepatic and renal functions, and later in progressive pulmonary failure. The patient died in severe respiratory distress on the 8th day due to cardiac arrest, probably anoxic. Treatment was initially on standard lines, with cathartics with the aim to prevent the absorption of Paraquat in the plasma and its accumulation in the lungs. In addition, high doses of steroids, immunosuppressive agents, prophylactic antibiotics and cardiotonics were given. Peritoneal dialysis and haemodialysis were concomitantly assured. The Authors suggest that in Paraquat poisoning an adequate therapeutic treatment could consist in specific sorbents such as Fuller's earth and bentonite, haemoperfusion over a coated charcoal system or cation exchange resins. Administration of drugs such as corticosteroids, immunosuppressants (bleomycine) and the enzyme superoxide dismutase may be also indicated. On the contrary, oxygen therapy should be carefully monitored: in fact hyperoxic atmospheres, by increasing the rate of generation of superoxide radicals, enhance cellular toxicity of Paraquat.

Published
1980

22. [Nephropathy in acute poisoning by paraquat and diquat].

Author

Mastrangelo F, Rizzelli S, Manisco G, Lopez T, Corlianò C, De Blasi V, Giordano C, and Faggiano F

Subjects
Acute Kidney Injury chemically induced, Humans, Kidney Tubules, Poisoning complications, Diquat poisoning, Kidney Diseases chemically induced, Paraquat poisoning, Pyridinium Compounds poisoning
Published
1979

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