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1. Symptom Burden before and after Dialysis Initiation in Older Patients

Author

de Rooij, Esther N. M., Yvette, Meuleman, de Fijter, Johan W., Jager, Kitty J., Chesnaye, Nicholas C., Marie, Evans, Caskey, Fergus J., Claudia, Torino, Gaetana, Porto, Maciej, Szymczak, Christiane, Drechsler, Christoph, Wanner, Dekker, Friedo W., Hoogeveen, Ellen K., Andreas, Schneider, Anke, Torp, Beate, Iwig, Boris, Perras, Christian, Marx, 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, 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, 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, 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, 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., Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Methodology, APH - Global Health, APH - Health Behaviors & Chronic Diseases, and ACS - Pulmonary hypertension & thrombosis

Subjects
Transplantation, chronic kidney disease, dialysis, elderly, end stage kidney disease, epidemiology and outcomes, Nephrology, Epidemiology, Critical Care and Intensive Care Medicine
Abstract

Background and objectives For older patients with kidney failure, lowering symptom burden may be more important than prolonging life. Dialysis initiation may affect individual kidney failure-related symptoms differently, but the change in symptoms before and after start of dialysis has not been studied. Therefore, we investigated the course of total and individual symptom number and burden before and after starting dialysis in older patients.Design, setting, participants, & measurements The European Quality (EQUAL) study is an ongoing, prospective, multicenter study in patients >= 65 years with an incident eGFR

Published
2022

2. 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

3. Kidney failure prediction models

Author

Ramspek, Chava L, Evans, Marie, Wanner, Christoph, Drechsler, Christiane, Chesnaye, Nicholas C, Szymczak, Maciej, Krajewska, Magdalena, Torino, Claudia, Porto, Gaetana, Hayward, Samantha, Caskey, Fergus, Dekker, Friedo W, Jager, Kitty J, van Diepen, Merel, EQUAL Study Investigators: 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, Gaetana Porto, 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, Merel van Diepen, 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, Internal Medicine, Chava L, Ramspek, Marie, Evan, Christoph, Wanner, Christiane, Drechsler, Nicholas C, Chesnaye, Maciej, Szymczak, Magdalena, Krajewska, Claudia, Torino, Gaetana, Porto, Samantha, Hayward, Fergus, Caskey, Friedo W, Dekker, Kitty J, Jager, Merel, van Diepen, Study Investigators: Adamasco Cupisti, Equal, Sagliocca, Adelia, Ferraro, Alberto, Musiała, Aleksandra, Mele, Alessandra, Naticchia, Alessandro, Còsaro, Alex, Woodman, Alistair, Ranghino, Andrea, Stucchi, Andrea, Jonsson, Andrea, Schneider, Andrea, Pignataro, Angelo, Schrander, Anita, Torp, Anke, Mckeever, Anna, Szymczak, Anna, Blom, Anna-Lena, De Blasio, Antonella, Pani, Antonello, Tsalouichos, Ari, Ullah, Asad, Mclaren, Barbara, van Dam, Bastiaan, Iwig, Beate, Antonio, Bellasi, Raffaele Di Iorio, Biagio, Rogland, Björn, Perras, Bori, Alessandra, Butti, Harron, Camille, Wallquist, Carin, Siegert, Carl, Barrett, Carla, Gaillard, Carlo, Garofalo, Carlo, Abaterusso, Cataldo, Beerenhout, Charle, O'Toole, Charlotte, Somma, Chiara, Marx, Christian, Summersgill, Christina, Blaser, Christof, D'Alessandro, Claudia, Emde, Claudia, Zullo, Claudia, Pozzi, Claudio, Geddes, Colin, Verburgh, Corneli, Bergamo, Daniela, Ciurlino, Daniele, Motta, Daria, Glowski, Deborah, Mcglynn, Deborah, Vargas, Dene, Krieter, Detlef, Russo, Domenico, Fuchs, Dunja, Sands, Dympna, Hoogeveen, Ellen, Irmler, Ellen, Dimény, Emöke, Favaro, Enrico, Platen, Eva, Olczyk, Ewelina, Hoorn, Ewout, Vigotti, Federica, Ansali, Ferruccio, Conte, Ferruccio, Cianciotta, Francesca, Giacchino, Francesca, Cappellaio, Francesco, Pizzarelli, Francesco, Sundelin, Fredrik, Uhlin, Fredrik, Greco, Gaetano, Roy, Geena, Porto, Gaetana, Bigatti, Giada, Marinangeli, Giancarlo, Cabiddu, Gianfranca, Hirst, Gillian, Fumagalli, Giordano, Caloro, Giorgia, Piccoli, Giorgina, Capasso, Giovanbattista, Gambaro, Giovanni, Tognarelli, Giuliana, Bonforte, Giuseppe, Conte, Giuseppe, Toscano, Giuseppe, Del Rosso, Goffredo, Welander, Gunilla, Augustyniak-Bartosik, Hanna, Boots, Han, Schmidt-Gürtler, Han, King, Hayley, Mcnally, Helen, Schlee, Hendrik, Boom, Henk, Naujoks, Holger, Masri-Senghor, Houda, Murtagh, Hugh, Rayner, Hugh, Miśkowiec-Wiśniewska, Ilona, Schlee, Ine, Capizzi, Irene, Bascaran Hernandez, Isabel, Baragetti, Ivano, Manitius, Jacek, Turner, Jane, Eijgenraam, Jan-Willem, Kooman, Jeroen, Beige, Joachim, Pondel, Joanna, Wilcox, Joanne, Berdeprado, Jocelyn, Röthele, Jochen, Wong, Jonathan, Rotmans, Jori, Banda, Joyce, Mazur, Justyna, Hahn, Kai, Jędrzejak, Kamila, Nowańska, Katarzyna, Blouin, Katja, Neumeier, Katrin, Jones, Kirsteen, Anding-Rost, Kirsten, Gröntoft, Knut-Christian, Oldrizzi, Lamberto, Haydock, Lesley, Vogt, Liffert, Wilkinson, Lily, Gesualdo, Loreto, Schramm, Lothar, Biancone, Luigi, Nowak, Łukasz, Raasveld, Maarten, Durlik, Magdalena, Magnano, Manuela, Vervloet, Marc, Ricardi, Marco, Carmody, Margaret, Di Bari, Maria, Laudato, Maria, Luisa Sirico, Maria, Stendahl, Maria, Svensson, Maria, Weetman, Maria, van Buren, Marjolijn, Joinson, Martin, Ferraresi, Martina, Dutton, Mary, van Diepen, Merel, Matthews, Michael, Provenzano, Michele, Hopf, Monika, Malaguti, Moreno, Wuttke, Nadja, Morgan, Neal, Palmieri, Nicola, Frischmuth, Nikolau, Bleakley, Nina, Murrone, Paola, Cockwell, Paul, Leurs, Paul, Roderick, Paul, Voskamp, Pauline, Kashioulis, Pavlo, Ichtiaris, Pawlo, Blankestijn, Peter, Kirste, Petra, Schulz, Petra, Mason, Phil, Kalra, Philip, Cirillo, Pietro, Dattolo, Pietro, Acampora, Pina, Sajith, Rincy, Nigro, Rita, Boero, Roberto, Scarpioni, Roberto, Sicoli, Rosa, Malandra, Rosella, Aign, Sabine, Cäsar, Sabine, van Esch, Sadie, Chapman, Sally, Biribauer, Sandra, Navjee, Santee, Crosbie, Sarah, Brown, Sharon, Tickle, Sheila, Manan, Sherin, Röser, Silke, Savoldi, Silvana, Bertoli, Silvio, Borrelli, Silvio, Boorsma, Siska, Heidenreich, Stefan, Melander, Stefan, Maxia, Stefania, Maffei, Stefano, Mangano, Stefano, Palm, Stephanie, Konings, Stijn, Mathavakkannan, Suresh, Schwedler, Susanne, Delrieux, Sylke, Renker, Sylvia, Schättel, Sylvia, Dorota, Szyszkowska, Cicchetti, Teresa, Nieszporek, Teresa, Stephan, Theresa, Schmiedeke, Thoma, Weinreich, Thoma, Leimbach, Til, Rappa, Tiziana, Almquist, Tora, Stövesand, Torsten, Bahner, Udo, Jensen, Ulrika, Palazzo, Valentina, De Simone, Walter, Seeger, Wolfgang, Kuan, Ying, Heleniak, Zbigniew, Aydin, Zeynep, Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, APH - Methodology, APH - Quality of Care, and APH - Global Health

Subjects
Male, progression of chronic renal failure, medicine.medical_specialty, Time Factors, epidemiology and outcome, 030232 urology & nephrology, Risk Assessment, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Older patients, external validation, Predictive Value of Tests, medicine, Humans, Failure risk, Clinical Epidemiology, In patient, comprehensive external validation, 030212 general & internal medicine, Statistic, Aged, Aged, 80 and over, Kidney, Models, Statistical, business.industry, External validation, General Medicine, prediction, kidney failure, Europe, prediction model, medicine.anatomical_structure, chronic kidney disease, epidemiology and outcomes, prognosis, Nephrology, Emergency medicine, Disease Progression, Kidney Failure, Chronic, Female, business, prognostic, Predictive modelling, prognosi, Cohort study
Abstract

Background Various prediction models have been developed to predict the risk of kidney failure in patients with CKD. However, guideline-recommended models have yet to be compared head to head, their validation in patients with advanced CKD is lacking, and most do not account for competing risks. Methods To externally validate 11 existing models of kidney failure, taking the competing risk of death into account, we included patients with advanced CKD from two large cohorts: the European Quality Study (EQUAL), an ongoing European prospective, multicenter cohort study of older patients with advanced CKD, and the Swedish Renal Registry (SRR), an ongoing registry of nephrology-referred patients with CKD in Sweden. The outcome of the models was kidney failure (defined as RRT-treated ESKD). We assessed model performance with discrimination and calibration. Results The study included 1580 patients from EQUAL and 13,489 patients from SRR. The average c statistic over the 11 validated models was 0.74 in EQUAL and 0.80 in SRR, compared with 0.89 in previous validations. Most models with longer prediction horizons overestimated the risk of kidney failure considerably. The 5-year Kidney Failure Risk Equation (KFRE) overpredicted risk by 10%-\18%. The four- and eight-variable 2-year KFRE and the 4-year Grams model showed excellent calibration and good discrimination in both cohorts. Conclusions Some existing models can accurately predict kidney failure in patients with advanced CKD. KFRE performed well for a shorter time frame (2 years), despite not accounting for competing events. Models predicting over a longer time frame (5 years) overestimated risk because of the competing risk of death. The Grams model, which accounts for the latter, is suitable for longer-term predictions (4 years).

Published
2021

4. 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

5. The association between TMAO, CMPF and clinical outcomes in advanced CKD; results from the EQUAL study

Author

Dai, Lu, Ziad, A Massy, Peter, Stenvinkel, Nicholas, C Chesnaye, Islam Amine Larabi, Jean Claude Alvarez, Fergus, J Caskey, Claudia, Torino, Gaetana, Porto, Maciej, Szymczak, Magdalena, Krajewska, Christiane, Drechsler, Christoph, Wanner, Kitty, J Jager, Friedo, W Dekker, Pieter, Evenepoel, Marie, Evans, Andreas, Schneider, Anke, Torp, Beate, Iwig, Boris, Perras, Christian, Marx, 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, 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, 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, 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, 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, Björn, Rogland, Carin, Wallquist, Denes, Vargas, Emöke, Dimény, Fredrik, Sundelin, Fredrik, Uhlin, Gunilla, Welander, Isabel Bascaran Hernandez, Knut-Christian, Gröntoft, Maria, Stendahl, Maria Eriksson Svensson, Olof, Heimburger, Pavlos, Kashioulis, Stefan, Melander, Tora, Almquist, 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, and Ying, Kuan

Subjects
3-carboxy-4-methyl-5-propyl-2-furanpropionate, CKD, fish intake, kidney replacement therapy, mortality, red meat, trimethylamine N-oxide, uremic toxins
Published
2022

6. Very Low-Protein Diet (VLPD) Reduces Metabolic Acidosis in Subjects with Chronic Kidney Disease: The 'Nutritional Light Signal' of the Renal Acid Load

Author

Biagio Raffaele Di Iorio, Lucia Di Micco, Stefania Marzocco, Emanuele De Simone, Antonietta De Blasio, Maria Luisa Sirico, Luca Nardone, and on behalf of UBI Study Group

Subjects
Chronic Kidney Disease (CKD), Very Low-Protein Diet (VLPD), metabolic acidosis, nutritional light signal, Nutrition. Foods and food supply, TX341-641
Abstract

Background: Metabolic acidosis is a common complication of chronic kidney disease; current guidelines recommend treatment with alkali if bicarbonate levels are lower than 22 mMol/L. In fact, recent studies have shown that an early administration of alkali reduces progression of CKD. The aim of the study is to evaluate the effect of fruit and vegetables to reduce the acid load in CKD. Methods: We conducted a case-control study in 146 patients who received sodium bicarbonate. Of these, 54 patients assumed very low-protein diet (VLPD) and 92 were controls (ratio 1:2). We calculated every three months the potential renal acid load (PRAL) and the net endogenous acid production (NEAP), inversely correlated with serum bicarbonate levels and representing the non-volatile acid load derived from nutrition. Un-paired T-test and Chi-square test were used to assess differences between study groups at baseline and study completion. Two-tailed probability values ≤0.05 were considered statistically significant. Results: At baseline, there were no statistical differences between the two groups regarding systolic blood pressure (SBP), diastolic blood pressure (DBP), protein and phosphate intake, urinary sodium, potassium, phosphate and urea nitrogen, NEAP, and PRAL. VLPD patients showed at 6 and 12 months a significant reduction of SBP (p < 0.0001), DBP (p < 0.001), plasma urea (p < 0.0001) protein intake (p < 0.0001), calcemia (p < 0.0001), phosphatemia (p < 0.0001), phosphate intake (p < 0.0001), urinary sodium (p < 0.0001), urinary potassium (p < 0.002), and urinary phosphate (p < 0.0001). NEAP and PRAL were significantly reduced in VLPD during follow-up. Conclusion: VLPD reduces intake of acids; nutritional therapy of CKD, that has always taken into consideration a lower protein, salt, and phosphate intake, should be adopted to correct metabolic acidosis, an important target in the treatment of CKD patients. We provide useful indications regarding acid load of food and drinks—the “acid load dietary traffic light”.

Published
2017
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7. SARS-CoV-2 Infections and COVID-19 Fatality: Estimation of Infection Fatality Ratio and Current Prevalence

Author

Marco Pota, Massimo Esposito, Andrea Pota, and Maria Luisa Sirico

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Health, Toxicology and Mutagenesis, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), prevalence, lcsh:Medicine, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, 0302 clinical medicine, Case fatality rate, Epidemiology, Pandemic, infection fatality ratio, Humans, Medicine, 030212 general & internal medicine, Pandemics, Estimation, Entire population, case fatality rate, business.industry, SARS-CoV-2, Public health, lcsh:R, Public Health, Environmental and Occupational Health, COVID-19, Italy, business, Demography
Abstract

COVID-19 is one of the most important problems for public health, according to the number of deaths associated to this pathology reported so far. However, from the epidemiological point of view, the dimension of the problem is still unknown, since the number of actual cases of SARS-CoV-2 infected people is underestimated, due to limited testing. This paper aims at estimating the actual Infection Fatality Ratio (number of deaths with respect to the number of infected people) and the actual current prevalence (number of infected people with respect to the entire population), both in a specific population and all over the world. With this aim, this paper proposes a method to estimate Infection Fatality Ratio of a still ongoing infection, based on a daily estimation, and on the relationship between this estimation and the number of tests performed per death. The method has been applied using data about COVID-19 from Italy. Results show a fatality ratio of about 0.9%, which is lower than previous findings. The number of actual infected people in Italy is also estimated, and results show that (i) infection started at the end of January 2020, (ii) a maximum number of about 100,000 new cases in one day was reached at the beginning of March 2020, (iii) the estimated cumulative number of infections at the beginning of October 2020 is about 4.2 million cases in Italy (more than 120 million worldwide, if a generalization is conjectured as reasonable). Therefore, the prevalence at the beginning of October 2020 is estimated at about 6.9% in Italy (1.6% worldwide, if a generalization is conjectured).

Published
2020
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8. Human Mature Adipocytes Express Albumin and This Expression Is Not Regulated by Inflammation

Author

Maria Luisa Sirico, Bruna Guida, Alfredo Procino, Andrea Pota, Maurizio Sodo, Giuseppe Grandaliano, Simona Simone, Giovanni Pertosa, Eleonora Riccio, and Bruno Memoli

Subjects
Pathology, RB1-214
Abstract

Aims. Our group investigated albumin gene expression in human adipocytes, its regulation by inflammation and the possible contribution of adipose tissue to albumin circulating levels. Methods. Both inflamed and healthy subjects provided adipose tissue samples. RT-PCR, Real-Time PCR, and Western Blot analysis on homogenates of adipocytes and pre-adipocytes were performed. In sixty-three healthy subjects and fifty-four micro-inflamed end stage renal disease (ESRD) patients circulating levels of albumin were measured by nephelometry; all subjects were also evaluated for body composition, calculated from bioelectrical measurements and an thropometric data. Results. A clear gene expression of albumin was showed in pre-adipocytes and, for the first time, in mature adipocytes. Albumin gene expression resulted significantly higher in pre-adipocytes than in adipocytes. No significant difference in albumin gene expression was showed between healthy controls and inflamed patients. A significant negative correlation was observed between albumin levels and fat mass in both healthy subjects and inflamed ESRD patients. Conclusions. In the present study we found first time evidence that human adipocytes express albumin. Our results also showed that systemic inflammation does not modulate albumin gene expression. The negative correlation between albumin and fat mass seems to exclude a significant contributing role of adipocyte in plasma albumin.

Published
2012
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9. A strategy to reduce inflammation and anemia treatment's related costs in dialysis patients

Author

Biagio Di Iorio, Lucia Di Micco, Luigi Russo, Luca Nardone, Emanuele De Simone, Maria Luisa Sirico, Gabriella Di Natale, and Domenico Russo

Subjects
Aged, 80 and over, Inflammation, Male, Cross-Over Studies, Water, Anemia, Middle Aged, Ferric Compounds, Hemodialysis Solutions, Epoetin Alfa, Hemoglobins, Cost Savings, Renal Dialysis, Costs and Cost Analysis, Hematinics, Humans, Kidney Failure, Chronic, Darbepoetin alfa, Female, Filtration, Aged, Distillation
Abstract

This is a post-hoc analysis evaluating erythropoiesis stimulating agents' (ESA) related costs while using an additional ultrafilter (Estorclean PLUS) to produce ultrapure dialysis water located within the fluid pathway after the treatment with reverse osmosis and before the dialysis machine. Twenty-nine patients (19 treated with epoetin alfa and 10 with darboepoetin alfa) were included in the analysis. We showed to gain savings of 210 € per patient (35 € per patient each month) with epoetin alfa during the experimental period of 6 months, compared to the control period and of 545 € per patient (90 € per patient each month) with darboepoetin alfa. Estorclean PLUS had a cost of 600 € (25 € per month per each patient) and was used for 6 months. Intravenous iron therapy with sodium ferrigluconate had a cost of 0,545 €/62,5 mg. In conclusion, during the experimental period with the use of Estorclean, we obtained global savings of 11 € per patient per month with epoetin alfa and 30 € per patient per month with darboepoetin alfa to treat anemia in dialysis patients.

Published
2018

10. Vascular Calcification and Subendocardial Ischemia in Hemodialysis Patients: A New Morpho-Functional Score to Assess Cardiovascular Risk: the Solofra Score

Author

Maria Luisa Sirico, Antonella De Blasio, Lucia Di Micco, and Biagio Di Iorio

Subjects
Male, medicine.medical_specialty, Aortography, medicine.medical_treatment, Population, Pulse Wave Analysis, Risk Assessment, Myocardial perfusion imaging, Ischemia, Renal Dialysis, Risk Factors, Internal medicine, medicine.artery, Internal Medicine, Humans, Medicine, Vascular Calcification, education, Aorta, Dialysis, Aged, education.field_of_study, medicine.diagnostic_test, Receiver operating characteristic, business.industry, Age Factors, Myocardial Perfusion Imaging, Middle Aged, Carotid Arteries, Cardiology, Aortic pressure, Kidney Failure, Chronic, Female, Hemodialysis, business
Abstract

Background: ESRD (end-stage renal disease) patients have a high cardiovascular mortality risk. A morphofunctional approach of vascular calcifications and myocardial perfusion is needed for the management of ESRD patients. We used SEVR (sub-endocardial viability ratio) and Kauppila score from the dialysis population of the Independent study to create a new morpho-functional score to assess cardiovascular risk in this population (the Solofra score). Materials and Methods: 184 patients were followed-up for 36 months. A side lumbar X-ray was performed to assess vascular calcifications of lumbar aorta using the Kauppila score. Central aortic pressure and pulse velocity wave (PWV) were assessed at the carotid artery site. Myocardial perfusion was estimated with SEVR. Independent risk mortality factors were identified with univariate regression analysis (p

Published
2015

11. Selected Abstracts from the 31th International Vicenza Course on Critical Care Nephrology. Vicenza, June 11-14, 2013

Author

Werner Beck, Catarina Teixeria, Ian T. Baldwin, Boris Zingerman, Franz Techert, D. Cruz, Irene Capelli, Sylvain J. Marchais, Nathan W. Levin, Jeroen P. Kooman, Cristina Marelli, Josipa Radic, Néstor Fontseré, Satz Mengensatzproduktion, Michael Bergman, Jeong Chul Kim, A. Bonaccorsi, Daniele Galavotti, M. Rassu, Annemie Dhondt, Gérard M. London, Golaun Odabaei, Gerald B. Appel, F. Furlan, Zaccaria Ricci, Michael Etter, Robert J. Kossmann, Rachel S. Levy-Drummer, Yang Shen, Vedran Kovacic, Mislav Radic, Francesco Alviano, Hee Chan Kim, Hertzel Salman, R. Grillone, Massimo de Cal, Sergio Picardo, Dragan Ljutic, Giuseppe Cianciolo, Ji Hyun Kim, Albert Power, Akash Nayak, Yaacov Ori, Grazia Maria Virzì, Len A. Usvyat, Claudio Laterza, Paola Cogo, Elaine Ku, Carla M. Nester, Maurizio Muraca, Aleix Cases, Hans Dietrich Polaschegg, Matteo Di Nardo, Elena Della Bella, Thierry Krummel, Milenka Sain, Roberta Costa, S. Cazzavillan, Vincenzo La Milia, Elisabet Massó, Maria Cappuccilli, Rod S. Passman, Stephan Thijssen, Hanna Bessler, Vito M. Campese, Keith C. Norris, Marian Klinger, Matteo Brolgli, M. Carrera, Alice Sue Appel, Bruno Pannier, Thierry Hannedouche, Franz Kappel, G M Virzì, Raymond Vanholder, Stefania Marzocco, Nevin M. Katz, Ulrike Haug, Peter Kotanko, Domenico Tartaglia, Tai-Gen Cui, Heike Lebsanft, Gaetano La Manna, Reinhold Deppisch, Maria Laura Angelini, Ted Toffelmire, Melvin Bonilla-Felix, Dinna N. Cruz, Maria Luisa Sirico, Jing Liu, V. Corradi, Elisa Scalzotto, Anja Kruse, Nosratola D. Vaziri, Uzi Gafter, Anna Giuliani, Stefan H. Jacobson, Fabrizio Dal Piaz, Stefano Picca, Marie Baldwin, George A. Kaysen, Jing Huang, Giuseppina Autore, Claudio Ronco, Frank A. Gotch, Marta Arias, C. Ronco, Corrado Bellini, Manel Vera, Juan M. Lopez Gomez, Alessandra Brocca, A. Vázquez-Rangel, Druck Reinhardt Druck Basel, Ivo Jelicic, Rosa Luciano, Josep M. Campistol, Anna Clementi, P. Frisone, Serena Torraca, Yuedong Wang, Fang Sun, Huijuan Mao, Francisco Maduell, Yi-Lun Zhou, A. Morea, Volker Wizemann, Francesco Garzotto, Bernard Canaud, Isabel Berdud, Ada Dormi, Francesco Locatelli, Manish Kaushik, Hervé Maheut, M. De Cal, Yosef S. Haviv, A. Brendolan, Federico Nalesso, Li-Jie Ma, Eungtaek Kang, Lucia Di Micco, Francesca Stoppa, Ingrid Ledebo, Frank Prosl, Daniele Marcelli, Alejandro Martin-Malo, Alessio Ficarella, Lourdes Blanca-Martos, Mauro Neri, Sudhir K. Bowry, Sergio Stefoni, Biagio Di Iorio, Adelheid Gauly, and Gabriele Donati

Subjects
Nephrology, medicine.medical_specialty, business.industry, Family medicine, Internal medicine, medicine, Hematology, General Medicine, Intensive care medicine, business
Published
2013

12. Abstracts

Author

Elena Della Bella, Roberta Costa, Carla M. Nester, Aleix Cases, Elisabet Massó, Stefania Marzocco, Giuseppe Cianciolo, Franz Techert, Yi-Lun Zhou, Lourdes Blanca-Martos, Maria Laura Angelini, Hanna Bessler, Keith C. Norris, Ted Toffelmire, Nosratola D. Vaziri, Druck Reinhardt Druck Basel, A. Morea, Rachel S. Levy-Drummer, Sergio Stefoni, Biagio Di Iorio, Adelheid Gauly, Ada Dormi, Rosa Luciano, Gerald B. Appel, Gabriele Donati, Fang Sun, Josep M. Campistol, Huijuan Mao, Marian Klinger, Serena Torraca, F. Furlan, Alice Sue Appel, Elisa Scalzotto, Jeroen P. Kooman, Volker Wizemann, Bruno Pannier, G M Virzì, S. Cazzavillan, Anna Clementi, Albert Power, Thierry Hannedouche, Heike Lebsanft, Nathan W. Levin, Francesco Garzotto, Bernard Canaud, Isabel Berdud, Cristina Marelli, Gaetano La Manna, Yuedong Wang, George A. Kaysen, Corrado Bellini, Ulrike Haug, Uzi Gafter, Michael Etter, P. Frisone, Akash Nayak, Maria Luisa Sirico, R. Grillone, M. De Cal, Ian T. Baldwin, Claudio Ronco, Alessio Ficarella, Francisco Maduell, Hertzel Salman, Anja Kruse, Zaccaria Ricci, Maria Cappuccilli, Dragan Ljutic, Sergio Picardo, Vedran Kovacic, Dinna N. Cruz, Gérard M. London, Satz Mengensatzproduktion, Francesco Locatelli, Paola Cogo, Stephan Thijssen, Josipa Radic, Hee Chan Kim, Jeong Chul Kim, Franz Kappel, Manish Kaushik, Yang Shen, Stefano Picca, Matteo Di Nardo, Elaine Ku, Nevin M. Katz, A. Bonaccorsi, Giuseppina Autore, Jing Huang, Hans Dietrich Polaschegg, Mislav Radic, Francesco Alviano, Thierry Krummel, Rod S. Passman, Hervé Maheut, Tai-Gen Cui, Frank A. Gotch, Fabrizio Dal Piaz, Ji Hyun Kim, C. Ronco, Jing Liu, Manel Vera, Marta Arias, Francesca Stoppa, Massimo de Cal, Daniele Galavotti, Claudio Laterza, Yosef S. Haviv, Domenico Tartaglia, Maurizio Muraca, Yaacov Ori, Milenka Sain, Anna Giuliani, Grazia Maria Virzì, Len A. Usvyat, Juan M. Lopez Gomez, M. Rassu, Annemie Dhondt, A. Brendolan, V. Corradi, Golaun Odabaei, Reinhold Deppisch, Marie Baldwin, Vito M. Campese, Irene Capelli, Peter Kotanko, Melvin Bonilla-Felix, Michael Bergman, Robert J. Kossmann, Federico Nalesso, Li-Jie Ma, Raymond Vanholder, Matteo Brolgli, Eungtaek Kang, M. Carrera, Lucia Di Micco, Néstor Fontseré, Vincenzo La Milia, Werner Beck, Mauro Neri, Catarina Teixeria, Ingrid Ledebo, Stefan H. Jacobson, Boris Zingerman, Sylvain J. Marchais, Frank Prosl, Daniele Marcelli, Alejandro Martin-Malo, Sudhir K. Bowry, D. Cruz, Ivo Jelicic, Alessandra Brocca, and A. Vázquez-Rangel

Subjects
medicine.medical_specialty, Nephrology, business.industry, medicine.medical_treatment, Medicine, Hematology, General Medicine, business, medicine.disease, Intensive care medicine, Dialysis, Kidney disease
Published
2013

13. Blood Pressure Variability and Mortality in end Stage Renal Disease

Author

Serena Torraca, Biagio Di Iorio, Maria Luisa Sirico, and Lucia Di Micco

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Diastole, Retrospective cohort study, medicine.disease, End stage renal disease, Organ damage, Blood pressure, Internal medicine, medicine, Cardiology, Internal Medicine, Risk factor, Intensive care medicine, business, Dialysis, Kidney disease
Abstract

Blood pressure (BP) measurement is a simple, and reproducible methool and is easily accepted by patients. It is well known that in a single subject BP may change during the day; this fact is considered physiological by many physicians and does not influence the final estimated value of BP. However, it’s reasonable to suppose that blood pressure variability (BPV) has clinical consequences and that exists a cardiovascular risk related to it. In fact, recent observations indicate that BP variations could be responsible for organ damage associated with hypertension more than the systolic and diastolic BP. In this study, we aim to analyze and compare published data in literature concerning the presumable correlations between BP variability and outcomes, both in Chronic Kidney Disease (CKD) and End stage Renal Disease (ESRD). We conclude that BPV represents an important cardiovascular risk factor for both patients with CKD and for those in dialysis. No correlations were found between BPV and the progression of CKD. However, this is a retrospective study and more (RCTS) are needed on this topic.

Published
2012

14. Does Daily Dialysis Improve Hypertension in Chronic Haemodialysis Patients?

Author

Biagio Di Iorio, Serena Torraca, Maria Luisa Sirico, Lucia Di Micco, and Stefania Marzocco

Subjects
medicine.medical_specialty, Dialysis Therapy, business.industry, medicine.medical_treatment, Renal function, Internal Medicine, medicine, Chronic hemodialysis, Hemodialysis, Risk factor, Intensive care medicine, business, Dialysis, Cardiovascular mortality
Abstract

Hemodialysis patients have a high cardiovascular mortality and hypertension is the most prevalent treatable risk factor. Hemodialysis is an unphysiological therapy respect to daily renal function, and the approach to avoid the related may be to increase dialysis frequency using a daily dialysis therapy. We analyze as the effect of more long or frequent weekly dialysis can improve the hypertension in hemodialysis patients.

Published
2012

15. Lower Sodium Intake and Renal Protective Effects

Author

Serena Torraca, Maria Luisa Sirico, Biagio Di Iorio, Lucia Di Micco, and Vincenzo Bellizzi

Subjects
Nephrology, medicine.medical_specialty, Proteinuria, business.industry, medicine.medical_treatment, Sodium, food.diet, chemistry.chemical_element, Low sodium diet, medicine.disease, Sodium intake, Blood pressure, Endocrinology, food, Low-protein diet, chemistry, Internal medicine, Internal Medicine, medicine, medicine.symptom, business, Kidney disease
Abstract

The control of sodium intake, and the implementation of low sodium diet in nephrology clinical practice is very low, is difficult when salt have been implicated as targets for manipulation to limit progression of kidney disease. It is well recognized that better control of blood pressure is important in mitigating the progression of CKD. We describe the effects of Very Low protein Diet on intake of Sodium, and, consequently, on proteinuria and blood pressure.

Published
2012

16. Blood pressure variability and outcomes in chronic kidney disease

Author

Roberto Rubino, Biagio Di Iorio, Antonio Bellasi, Lucia Di Micco, Pasquale Guastaferro, Andrea Pota, Maria Luisa Sirico, and Serena Torraca

Subjects
Male, Nephrology, medicine.medical_specialty, medicine.medical_treatment, Renal function, Blood Pressure, Internal medicine, medicine, Humans, Outpatient clinic, Longitudinal Studies, Renal Insufficiency, Chronic, Dialysis, Aged, Retrospective Studies, Aged, 80 and over, Transplantation, business.industry, Hazard ratio, Retrospective cohort study, medicine.disease, Surgery, Cohort, Female, business, Kidney disease
Abstract

Background. We investigated the effects of visit-to-visit systolic blood pressure variability (SBPV) on both mortality and dialysis inception in a cohort of chronic kidney disease (CKD) patients not requiring dialysis therapy. Furthermore, we also explored the carry-over effect of visit-to-visit SBPVon mortality after dialysis initiation. Methods. We conducted a longitudinal retrospective, observational, multi-centre study in three tertiary care nephrology outpatient clinics. All the ambulatory CKD patients admitted to the outpatient clinics from 1 January 2004 to 31 December 2005 were screened for study eligibility. We selected all consecutive patients older than 18 years of age with a mean estimated glomerular filtration rate of

Published
2012

17. Dialysate bath and QTc interval in patients on chronic maintenance hemodialysis: pilot study of single dialysis effects

Author

Piscopo C, Domenico Russo, Andrea Pota, Di Iorio B, Serena Torraca, Di Micco L, Maria Luisa Sirico, Berardino L, Luigi Morrone, Tartaglia D, Di Iorio, B, Torraca, S, Piscopo, C, Sirico, Ml, Di Micco, L, Pota, A, Tartaglia, D, Berardino, L, Morrone, Lf, and Russo, Domenico

Subjects
Male, medicine.medical_specialty, Time Factors, Alkalosis, medicine.medical_treatment, Potassium, Bicarbonate, Action Potentials, chemistry.chemical_element, Pilot Projects, Risk Assessment, QT interval, Electrocardiography, chemistry.chemical_compound, Bicarbonate, Calcium, Dialysate, Hemodialysis, Potassium, QTc interval, Heart Conduction System, Predictive Value of Tests, Renal Dialysis, Risk Factors, Internal medicine, medicine, Humans, cardiovascular diseases, Dialysis, Aged, Calcium metabolism, Cross-Over Studies, business.industry, Arrhythmias, Cardiac, Hydrogen-Ion Concentration, Middle Aged, medicine.disease, Crossover study, Hemodialysis Solutions, Surgery, Bicarbonates, Treatment Outcome, Italy, chemistry, Nephrology, Multivariate Analysis, Cardiology, Calcium, Female, Hemodialysis, business
Abstract

Introduction: Serum concentrations of potassium (K) and calcium (Ca) influence ionic currents and play an important role in the duration of ventricular action potential. Further, the influence of alkalosis in reducing ionized calcium has been well known for a long time. The aim of this study was to assess the effects of different dialysate electrolytes and bicarbonate concentrations on changes of QTc interval in patients on chronic hemodialysis. Methods: The study hemodialysis sessions were performed in 22 patients, with different electrolyte and bicarbonate concentrations in dialysate. Tested dialysate concentrations were K of 2 and 3 mmol/L; Ca 1.25, 1.5 and 1.75 mmol/L; and bicarbonate 30 and 34 mmol/L. An electrocardiogram (ECG) was recorded 1 hour before, at the end and every hour for 4 hours after each study dialysis session. QTc interval was measured from the beginning of the QRS complex to the end of a T wave on a 12-lead ECG. Blood was collected and K, total Ca, ionic Ca and pH evaluated. Results: At the end of the study hemodialysis session with dialysate containing low K (2 mmol/L), low Ca (1.25 mmol/L) and high bicarbonate concentration (34 mmol), mean QTc interval was significantly prolonged compared with that recorded with dialysate containing high K (3 mmol/L), high Ca (1.75 mmol/L) and bicarbonate (30 mmol) (40 ± 10 milliseconds vs. 2 ± 2 milliseconds; p

Published
2011

18. Variability of pulse wave velocity and mortality in chronic hemodialysis patients

Author

Domenico Russo, Antonio Bellasi, Filippo Nigro, Biagio Di Iorio, Maria Luisa Sirico, Paolo Romano, Pasquale Guastaferro, Luigi Morrone, Antonietta De Blasio, and Serena Torraca

Subjects
Urinary output, medicine.medical_specialty, business.industry, medicine.medical_treatment, Hematology, Surgery, Basal (phylogenetics), Blood pressure, Nephrology, Internal medicine, cardiovascular system, Cardiology, Medicine, Chronic hemodialysis, cardiovascular diseases, Hemodialysis, Analysis of variance, business, Pulse wave velocity, Dialysis, circulatory and respiratory physiology
Abstract

We have already demonstrated that in chronic hemodialysis (HD) patients, the cyclic variations in both hydration status and blood pressure are responsible for changes in pulse wave velocity (PWV). The aim of this study is to verify whether the cyclic variation of PWV influences mortality in dialysis patients. We studied 167 oligoanuric (urinary output o500 mL/day) patients on chronic standard bicarbonate HD for at least 6 months. They performed 3 HD sessions of 4 hours per week. Patients were classified into 3 groups: normal PWV before and after dialysis (LL); high PWV before and normal PWV after dialysis (HL); and high PWV before and after dialysis (HH). The carotid-femoral PWV was measured with an automated system using the foot-to-foot method. Analysis of variance was used to compare the different groups. The outcome event studied was all-cause mortality and cardiovascular mortality. The PWV values observed were LL in 44 patients (26.3%); HL in 53 patients (31.8%); and HH in 70 patients (41.9%). The 3 groups of patients are homogenous for sex, age, and blood pressure. The HH group had a higher prevalence of (Po0.001) ASCVD. It is interesting that the distribution of patients in the 3 groups is correlated with the basal value of PWV. In fact, when the basal measure of PWV is elevated, there is a higher probability that an HD session cannot reduce PWV (o12 ms). A total of 53 patients (31.7%) died during the follow-up of 2 years: 5 patients in the LL group (11.4%); 16 in the HL group (30.2%); and 32 in the HH group (50.7%) (LL vs. HL, P =0.047; LL vs. HH, Po0.00001; HL vs. HH, P=0.034). We evidence for the first time that different behaviors of PWV in dialysis subjects determine differences in mortality.

Published
2011

19. Subendocardial Viability Ratio Predicts Cardiovascular Mortality in Chronic Kidney Disease Patients

Author

B. Di Iorio, Antonio Bellasi, Paolo Salvi, L. Di Micco, and Maria Luisa Sirico

Subjects
Male, Nephrology, medicine.medical_specialty, Population, Pulse Wave Analysis, Asymptomatic, Internal medicine, Post-hoc analysis, medicine, Humans, Prospective Studies, Renal Insufficiency, Chronic, Stage (cooking), Prospective cohort study, education, Aged, Cardiovascular mortality, education.field_of_study, business.industry, Hematology, General Medicine, Middle Aged, Prognosis, medicine.disease, Cardiovascular Diseases, Cardiology, Female, medicine.symptom, business, Follow-Up Studies, Kidney disease
Abstract

Background: The subendocardial viability ratio (SEVR), calculated by pulse wave analysis, is an index of myocardial oxygen supply and demand. Here we analyze the relation between SEVR and cardiovascular mortality in the chronic kidney disease (CKD) population of a post hoc analysis of a multicenter, prospective, randomized, nonblinded study. Methods: We studied 212 consecutive asymptomatic outpatients receiving care at 12 nephrology clinics in south Italy. Inclusion criteria were age >18 years, 6 months of follow-up before the enrollment and stage 3-4 CKD. Results: During follow-up, 34 subjects died, 29 of them for cardiovascular causes. SEVR correlated inversely with vascular calcifications (r = -0.37) and myocardial mass (r = -0.45); SEVR changed from 1.33 ± 0.24 to 1.36 ± 0.16 (p = NS; baseline and final values, respectively) in living patients, and from 1.16 ± 0.31 to 0.68 ± 0.26 in deceased patients (p < 0.001). Kaplan-Meier curves show that that a greater reduction of SEVR values during the study (third tertile) significantly predicts cardiovascular mortality (p < 0.0001). Conclusions: This post hoc analysis shows that a reduction of SEVR values impacts cardiovascular mortality in CKD patients.

Published
2013

20. Variability of pulse wave velocity and mortality in chronic hemodialysis patients

Author

Serena Torraca, Maria Luisa Sirico, Pasquale Guastaferro, Luigi Francesco Morrone, Filippo Nigro, Antonietta De Blasio, Paolo Romano, Antonio Bellasi, Biagio Di I.o.r.i.o., RUSSO, DOMENICO, Serena, Torraca, Maria Luisa, Sirico, Pasquale, Guastaferro, Luigi Francesco, Morrone, Filippo, Nigro, Antonietta De, Blasio, Paolo, Romano, Russo, Domenico, Antonio, Bellasi, and Biagio Di, I. o. r. i. o.

Subjects
Aged, 80 and over, Male, Time Factors, Middle Aged, Anuria, Bicarbonates, Cardiovascular Diseases, Heart Rate, Renal Dialysis, Hemodialysis, pulse wave velocity, mortality, Humans, Female, Aged, Follow-Up Studies
Abstract

We have already demonstrated that in chronic hemodialysis (HD) patients, the cyclic variations in both hydration status and blood pressure are responsible for changes in pulse wave velocity (PWV). The aim of this study is to verify whether the cyclic variation of PWV influences mortality in dialysis patients. We studied 167 oligoanuric (urinary output o500 mL/day) patients on chronic standard bicarbonate HD for at least 6 months. They performed 3 HD sessions of 4 hours per week. Patients were classified into 3 groups: normal PWV before and after dialysis (LL); high PWV before and normal PWV after dialysis (HL); and high PWV before and after dialysis (HH). The carotid-femoral PWV was measured with an automated system using the foot-to-foot method. Analysis of variance was used to compare the different groups. The outcome event studied was all-cause mortality and cardiovascular mortality. The PWV values observed were LL in 44 patients (26.3%); HL in 53 patients (31.8%); and HH in 70 patients (41.9%). The 3 groups of patients are homogenous for sex, age, and blood pressure. The HH group had a higher prevalence of (Po0.001) ASCVD. It is interesting that the distribution of patients in the 3 groups is correlated with the basal value of PWV. In fact, when the basal measure of PWV is elevated, there is a higher probability that an HD session cannot reduce PWV (o12 ms). A total of 53 patients (31.7%) died during the follow-up of 2 years: 5 patients in the LL group (11.4%); 16 in the HL group (30.2%); and 32 in the HH group (50.7%) (LL vs. HL, P=0.047; LL vs. HH, Po0.00001; HL vs. HH, P=0.034). We evidence for the first time that different comportments of PWV in dialysis subjects determine differences in mortality.

Published
2011

21. High-tone external muscle stimulation in patients with acute kidney injury (AKI): beneficial effects on NO metabolism, asymmetric dimethylarginine, and endothelin-1

Author

Antonella De Blasio, Lucia Di Micco, August Heidland, Biagio Di Iorio, Simona Adesso, Maria Luisa Sirico, Gholamreza Fazeli, Giuseppina Autore, and Stefania Marzocco

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Urology, Electric Stimulation Therapy, urologic and male genital diseases, medicine.disease_cause, Arginine, Nitric Oxide, Nitric oxide, Cohort Studies, chemistry.chemical_compound, Renal Dialysis, Electrical muscle stimulation, medicine, Humans, Endothelial dysfunction, Muscle, Skeletal, Dialysis, Aged, Aged, 80 and over, Leg, Endothelin-1, business.industry, Acute kidney injury, General Medicine, Endothelin1 (ET-1), Acute Kidney Injury, Middle Aged, medicine.disease, Endothelin 1, ADMA, chemistry, Nephrology, Anesthesia, Female, Hemodialysis, Asymmetric dimethylarginine, business, Oxidative stress
Abstract

Objectives The aim of this study was to assess potential effects of high-tone external muscle stimulation (HTEMS) on parameters of endothelial dysfunction (ED) in patients with acute kidney injury (AKI). Background The bad outcome of AKI patients is markedly influenced by ED, microinflammation, oxidative stress and protein hypercatabolism. Recently, we have shown that intradialytic application of HTMS was associated with a faster resolution of AKI. Here, we investigated in the same cohort of patients whether parameters of ED such as nitric oxide (NO), asymmetric-dimethylarginine (ADMA), and endothelin 1 (ET-1) are modulated by HTEMS as compared to non-HTEMS-treated AKI patients. Methods In a post-hoc study we analyzed plasma samples of the 34 AKI patients stage 5, of whom 17 underwent intradialytic HTEMS treatment while the other 17 served as AKI dialysis controls. Measurements included plasma nitrate and nitrite (NOx), ADMA, ET-1 and were performed before and on days 3, 7, 14, 21, and 28 after start of daily dialysis. Additional 16 healthy volunteers served as controls. Results Initially, in both AKI groups NOx levels were markedly lower and ADMA and ET-1 levels were higher compared to the healthy controls. After initiation of daily hemodialysis the HTEMS group showed a faster improvement of NOx and ET-1 (after 1 week) and ADMA levels (after 2 weeks) compared to the No- HTEMS group. After 2 weeks, all parameters of the HTEMS group were not different from healthy controls, while the No-HTEMSAKI group needed 3 - 4 weeks. Conclusion Our findings suggest for the first time that in AKI patients, application of HTEMS is associated with a faster normalization of lowered NOx and elevated ADMA and ET-1 plasma levels. We hypothesize that the more rapid amelioration of these parameters in the HTEMS group contributed to the accelerated recovery of AKI. With regard to the small study groups with different causes of AKI, investigations in a greater number of AKI patients is required.

Published
2014

22. [The devil teaches us his tricks... and also how to hide them]

Author

Lucia, Di Micco, Ernesto, D'Avanzo, Antonella, De Blasio, Maria Luisa, Sirico, Lanfranco Aquilino, Musto, and Biagio, Di Iorio

Subjects
Male, Rupture, Spontaneous, Urinary Bladder Neoplasms, Humans, Ureteral Diseases, Aged
Abstract

Spontaneous ureteric ruptures is a rare condition [1]and bilateral ureteric rupture is even more uncommon. Few cases are described in the literature in which bilateral ureteric rupture is associated to dermatomyositis [2]or to intra-arterial contrast medium application for infrarenal aortic stent placement [3]. We discuss here a case of bilateral ureteric rupture in a 74-year-old man with bladder cancer, presenting oliguric acute kidney failure and a light abdominal pain.

Published
2014

23. [An unusual case of acute kidney insufficiency]

Author

Maria Luisa, Sirico, Ernesto, D'Avanzo, Antonella, De Blasio, Giovanna, De Piano, Nicola, Lomazzo, Lucia, Di Micco, Lanfranco Aquilino, Musto, and Biagio, Di Iorio

Subjects
Male, Humans, Acute Kidney Injury, Middle Aged
Abstract

Acute aortic dissection (AAD) is a life-threatening condition with high morbidity and mortality, that involves renal arteries in at least 5-10% so leading to renal ischemia and insufficiency. AAD presenting with anuria and the necessity of renal replacement therapy occurs rarely. Here we describe a case of a hypertensive and obese patient presenting with anuria and acute kidney injury, who underwent to hemodialysis and later was diagnosed with aortic dissection. Through this case, we underline the importance of considering AAD as an important differential in patients with a long history of uncontrolled hypertension presenting with anuria.

Published
2014

25. Phosphorus, beverages, and chronic kidney disease

Author

Biagio Di Iorio, Maria Luisa Sirico, Serena Torraca, and Lucia Di Micco

Subjects
Nutrition and Dietetics, Materials science, Phosphorus, digestive, oral, and skin physiology, Medicine (miscellaneous), chemistry.chemical_element, lcsh:TX341-641, Phosphate, medicine.disease, lcsh:Nutritional diseases. Deficiency diseases, chemistry.chemical_compound, Inorganic phosphate, chemistry, medicine, Nutrition and Dietary Supplements, Food science, lcsh:Nutrition. Foods and food supply, lcsh:RC620-627, Kidney disease
Abstract

Biagio Di Iorio, Lucia Di Micco, Serena Torraca, Maria Luisa SiricoNephrology-Medicine Department, "A Landolfi" Hospital, Solofra, ItalyAbstract: Phosphate is present in food in two forms, ie, organic and inorganic phosphate salts, which are naturally present in food and as phosphates added for industrial and commercial reasons. There is also a high content of added phosphate in beverages, and phosphates in this form are highly absorbable. The real content of phosphate contained in beverages is often unrecognized, and nephrologists do not always take into account the amount of phosphorus that patients ingest in this form.Keywords: phosphorus, beverages, additive, diet

Published
2012

26. Very low protein diet reduces indoxyl sulfate levels in chronic kidney disease

Author

Serena Torraca, Maria Luisa Sirico, Stefania Marzocco, Lucia Di Micco, Fabrizio Dal Piaz, Biagio Di Iorio, Domenico Tartaglia, and Giuseppina Autore

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Pilot Projects, Indoxyl sulfate, Very low protein diet, Chronic kidney disease, Gastroenterology, Indoxyl sulfate, Low-protein diet, Renal Dialysis, Chronic kidney disease, Internal medicine, Post-hoc analysis, medicine, Diet, Protein-Restricted, Humans, Prospective Studies, Amino Acids, Renal Insufficiency, Chronic, Prospective cohort study, Dialysis, Aged, Cross-Over Studies, business.industry, Case-control study, Hematology, General Medicine, Middle Aged, medicine.disease, Crossover study, Keto Acids, Fibroblast Growth Factor-23, Treatment Outcome, Very low protein diet, Nephrology, Case-Control Studies, Creatinine, Disease Progression, Female, Hemodialysis, business, Indican, Kidney disease
Abstract

Background and Objectives: High levels of indoxyl sulfate (IS) are associated with chronic kidney disease (CKD) progression and increased mortality in CKD patients. The aim of this pilot study was to assess whether a very low protein diet (VLPD; 0.3 g/kg bw/day), with a consequent low phosphorus intake, would reduce IS serum levels compared to a low protein diet (LPD; 0.6 g/kg bw/day) in CKD patients not yet on dialysis. Material and Methods: This is a post hoc analysis of a preceding cross-over study aimed to analyze FGF23 during VLPD. Here we performed a prospective randomized controlled crossover study in which 32 patients were randomized to receive either a VLPD (0.3 g/kg bw/day) supplemented with ketoanalogues during the first week and an LPD during the second week (group A, n = 16), or an LPD during the first week and a VLPD during the second week (group B, n = 16 patients). IS serum levels were measured at baseline and at the end of each study period. We compared them to 24 hemodialysis patients (HD) and 14 healthy subjects (control). Results: IS serum concentration was significantly higher in the HD (43.4 ± 12.3 µM) and CKD (11.1 ± 6.6 µM) groups compared to the control group (2.9 ± 1.1 µM; p < 0.001). IS levels also correlated with creatinine values in CKD patients (R2 = 0.42; p < 0.0001). After only 1 week of a VLPD, even preceded by an LPD, CKD patients showed a significant reduction of IS serum levels (37%). Conclusions: VLPD supplemented with ketoanalogues reduced IS serum levels in CKD patients not yet on dialysis.

Published
2012

27. Urinary phosphate excretion and fibroblast growth factor 23 in chronic kidney disease

Author

Serena Torraca, Maria Luisa Sirico, Lucia Di Micco, and Biagio Di Iorio

Subjects
Fibroblast growth factor 23, Male, medicine.medical_specialty, Urinary system, Medicine (miscellaneous), chemistry.chemical_element, Article, Phosphates, Excretion, chemistry.chemical_compound, Vascular stiffness, Vascular Stiffness, Internal medicine, Medicine, Humans, Renal Insufficiency, Chronic, Nutrition and Dietetics, business.industry, Phosphorus, Phosphates urine, medicine.disease, Phosphate, Endocrinology, chemistry, Nephrology, Phosphorus, Dietary, Female, business, Kidney disease
Published
2012

28. Does brachial blood pressure need to predict cardiovascular outcomes in end stage renal disease? An update

Author

Serena Torraca, Paolo Salvi, Salvatore Palmese, Biagio Di Iorio, Maria Luisa Sirico, and Lucia Di Micco

Subjects
medicine.medical_specialty, Brachial Artery, Blood Pressure, urologic and male genital diseases, Dialysis patients, End stage renal disease, Risk Factors, Internal Medicine, medicine, Humans, Intensive care medicine, Pulse wave velocity, Cardiovascular mortality, Hypertension control, business.industry, Blood Pressure Determination, medicine.disease, female genital diseases and pregnancy complications, Blood pressure, Hypertension, Renovascular, Cardiovascular Diseases, Disease Progression, Kidney Failure, Chronic, business, Cardiovascular outcomes, Kidney disease
Abstract

Hypertension is responsible for a significantly increased burden of cardiovascular events and it is cause and a consequence of Chronic Kidney Disease (CKD) and a determinant factor in its progression to End Stage Kidney Disease (ESKD). Therefore, nephrologists have been focusing their attention on hypertension control to prevent CKD progression, delaying it but with poor results on cardiovascular mortality reduction. An important effect is the difficulty to adequately reduce BP levels in CKD patients and especially in dialysis patients despite the polipharmacological therapy. We have to take into account other aspects influencing mortality risk in CKD patients .The first aspect to consider is whether brachial blood pressure (BP) measurement is sufficient to describe the complex relationship between the alteration of BP and outcomes in renal subjects. The second aspect to consider is the variability of BP (BPV). We think that BP measurement cannot only take into account brachial BP, because it represents a limited measure of a complex clinical condition in CKD or ESRD patients. The inability to evaluate hypertension in its complexity explains why several aspects are still unrecognized.

Published
2012

29. Acute effects of very-low-protein diet on FGF23 levels: a randomized study

Author

Domenico Russo, Luigi Russo, Francesco Mirenghi, Biagio Di Iorio, Lucia Di Micco, Serena Torraca, Maria Luisa Sirico, Andrea Pota, Di Iorio, B, Di Micco, L, Torraca, S, Sirico, Ml, Russo, L, Pota, A, Mirenghi, F, and Russo, Domenico

Subjects
Fibroblast growth factor 23, Male, medicine.medical_specialty, Time Factors, Epidemiology, very-low-protein diet, ketoanalogues , fibroblast growth factor 23, CKD patients, medicine.medical_treatment, Urinary system, Down-Regulation, Pilot Projects, Critical Care and Intensive Care Medicine, Gastroenterology, law.invention, Low-protein diet, Randomized controlled trial, law, Internal medicine, Diet, Protein-Restricted, Odds Ratio, Medicine, Humans, Prospective Studies, Prospective cohort study, Dialysis, Aged, Transplantation, Cross-Over Studies, business.industry, Odds ratio, Middle Aged, Crossover study, Fibroblast Growth Factors, Fibroblast Growth Factor-23, Endocrinology, Treatment Outcome, Italy, Nephrology, Chronic Disease, Multivariate Analysis, Phosphorus, Dietary, Regression Analysis, Female, Kidney Diseases, business, Biomarkers
Abstract

Summary Background and objectives High levels of fibroblast growth factor 23 are associated with mortality, CKD progression, and calcification in CKD patients. The aim of this pilot study is to assess whether a very-low-protein diet (0.3 g/kg per day) with a consequent low intake of phosphorus would reduce fibroblast growth factor 23 compared with a low-protein diet (0.6 g/kg per day) in CKD patients not yet on dialysis. Design, setting, participants, & measurements A prospective, randomized, controlled crossover study was performed in which 32 patients were randomized into two groups. Group A (16 patients) received a very-low-protein diet (0.3 g/kg body wt per day) supplemented with ketoanalogues during the first week and a low-protein diet during the second week, and group B (16 patients) received a low-protein diet during the first week and a very-low-protein diet during the second week. Fibroblast growth factor 23, seric, and urinary phosphate levels were measured at baseline and the end of each study period. Results After only 1 week of the very-low-protein diet, reductions in fibroblast growth factor 23 levels (33.5%), serum phosphate (12%), and urinary phosphate (34%) with the very-low-protein diet compared with the low-protein diet were observed. Serum and urinary phosphate levels and protein intake were significant determinants of fibroblast growth factor 23 (95% confidence interval=1.04–1.19, 1.12–1.37, and 1.51–2.23, respectively). Conclusions A very-low-protein diet supplemented with ketoanalogues reduced fibroblast growth factor 23 levels in CKD patients not yet on dialysis.

Published
2012

30. Daily dialysis reduces pulse wave velocity in chronic hemodialysis patients

Author

Biagio Di Iorio, Serena Torraca, Lucia Di Micco, Domenico Tartaglia, and Maria Luisa Sirico

Subjects
Adult, Male, medicine.medical_specialty, Physiology, medicine.medical_treatment, Dialysis patients, Heart Rate, Predictive Value of Tests, Renal Dialysis, Internal medicine, Internal Medicine, Medicine, Humans, Chronic hemodialysis, cardiovascular diseases, Pulse wave velocity, Dialysis, Antihypertensive Agents, Hydration status, Aged, Aged, 80 and over, Cross-Over Studies, business.industry, Middle Aged, Crossover study, Surgery, Blood pressure, Hypertension, cardiovascular system, Cardiology, Kidney Failure, Chronic, Female, Hemodialysis, Cardiology and Cardiovascular Medicine, business, circulatory and respiratory physiology
Abstract

Pulse wave velocity (PWV) is a predictor of morbidity and mortality in patients with end-stage renal disease (ESRD). Dialysis patients show cyclic changes in PWV related to their hydration status and blood pressure. Our aim is to assess the impact of daily dialysis on PWV. We performed a randomized crossover study of 60 patients who underwent standard hemodialysis (HD) three times per week for at least 6 months. Patients were classified into three groups according to their PWV values before (pre-) and after (post-) HD, with a cutoff value of 12 m s(-1), as follows: the low-low (LL) group had normal pre-HD and post-HD PWV; the high-low (HL) group had high pre-HD PWV and normal post-HD PWV; and the high-high (HH) group had high pre- and post-HD PWV. All patients continued standard HD for 2 weeks. A total of 10 patients from each group were randomly assigned to continue standard HD for 1 week and then underwent daily dialysis for 1 week. The remaining 10 patients underwent daily dialysis for 1 week and then underwent standard HD for 1 week. PWV values were measured before and 1 h after each dialysis session. With daily dialysis treatment, 2 of 20 patients (10%) moved from the PWV-HH group to the PWV-HL group, whereas 18 of 20 patients (90%) moved from the PWV-HL group to the PWV-LL group (P = 0.030). Daily dialysis reduces PWV in the ESRD patients. As PWV is a strong predictor of mortality in ESRD and has cyclic variations in patients who are on standard HD, we believe that daily dialysis may be used in patients with high PWV levels to reduce their mortality risk.

Published
2012

31. Human Mature Adipocytes Express Albumin and This Expression Is Not Regulated by Inflammation

Author

Andrea Pota, Giuseppe Grandaliano, Giovanni Pertosa, Simona Simone, Maria Luisa Sirico, Bruna Guida, Maurizio Sodo, Bruno Memoli, Eleonora Riccio, Alfredo Procino, Sirico, Ml, Guida, Bruna, Procino, A, Pota, A, Sodo, Maurizio, Grandaliano, G, Simone, S, Pertosa, G, Riccio, E, and Memoli, Bruno

Subjects
Adult, Male, medicine.medical_specialty, Article Subject, Immunology, Blotting, Western, Adipose tissue, Inflammation, Biology, In Vitro Techniques, Systemic inflammation, End stage renal disease, chemistry.chemical_compound, Western blot, Nephelometry and Turbidimetry, Adipocyte, Internal medicine, Albumins, Gene expression, medicine, Adipocytes, lcsh:Pathology, Humans, medicine.diagnostic_test, Interleukin-6, Reverse Transcriptase Polymerase Chain Reaction, Albumin, Cell Biology, Middle Aged, Endocrinology, C-Reactive Protein, chemistry, Clinical Study, Female, medicine.symptom, lcsh:RB1-214
Abstract

Aims. Our group investigated albumin gene expression in human adipocytes, its regulation by inflammation and the possible contribution of adipose tissue to albumin circulating levels.Methods. Both inflamed and healthy subjects provided adipose tissue samples. RT-PCR, Real-Time PCR, and Western Blot analysis on homogenates of adipocytes and pre-adipocytes were performed. In sixty-three healthy subjects and fifty-four micro-inflamed end stage renal disease (ESRD) patients circulating levels of albumin were measured by nephelometry; all subjects were also evaluated for body composition, calculated from bioelectrical measurements and an thropometric data.Results. A clear gene expression of albumin was showed in pre-adipocytes and, for the first time, in mature adipocytes. Albumin gene expression resulted significantly higher in pre-adipocytes than in adipocytes. No significant difference in albumin gene expression was showed between healthy controls and inflamed patients. A significant negative correlation was observed between albumin levels and fat mass in both healthy subjects and inflamed ESRD patients.Conclusions. In the present study we found first time evidence that human adipocytes express albumin. Our results also showed that systemic inflammation does not modulate albumin gene expression. The negative correlation between albumin and fat mass seems to exclude a significant contributing role of adipocyte in plasma albumin.

Published
2012
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32. Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk

Author

Serena Torraca, Lucia Di Micco, Roberto Rubino, Antonietta De Blasio, Filippo Nigro, Luigi Chiuchiolo, Paolo Romano, T. Lopez, Francesco G. Casino, Maria Luisa Sirico, Andrea Pota, Biagio Di Iorio, Pasquale Guastaferro, and Luigi Morrone

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Blood Pressure, Kaplan-Meier Estimate, Diabetes Complications, Young Adult, Maximum blood pressure, Renal Dialysis, Risk Factors, Internal medicine, Diabetes mellitus, medicine, Confidence Intervals, Humans, Renal Insufficiency, Risk factor, Intensive care medicine, Serum Albumin, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Hazard ratio, Age Factors, Retrospective cohort study, Middle Aged, medicine.disease, Pulse pressure, Blood pressure, Nephrology, Cardiovascular Diseases, Creatinine, Hypertension, Cardiology, Female, Hemodialysis, business, Biomarkers, Follow-Up Studies
Abstract

Background: Hemodialysis patients have a high car- diovascular mortality, and hypertension is the most prevalent treatable risk factor. We aimed to assess the predictive significance of dialysis-to-dialysis variabil- ity in blood pressure in hemodialysis patients. Methods: We performed a historical cohort study in 1,088 prevalent hemodialysis patients, followed up for 5 years. The risk of cardiovascular death was determined in relation to dialysis-to-dialysis variability in blood pressure, maximum blood pressure and pulse pressure. Results: Variability in blood pressure was a predictor of cardiovascular death (hazard ratio (HR) = 1.242; 95% confidence interval (95% CI), 1.004-1.537; p=0.046). Also age (HR=1.021; 95% CI, 1.011-1.048; p=0.049), diabetes (HR=1.134; 95% CI, 1.128-1.451; p=0.035), creatinine (HR=0.837; 95% CI, 0.717-0.977; p=0.024) and albumin (HR=0.901; 95% CI, 0.821-0.924; p=0.022) influenced mortality. Maximum blood pressure and pulse pressure did not show any effect on cardiovascular death. Conclusion: Dialysis-to-dialysis variability in blood pressure is a predictor of cardiovascular mortality in hemodialysis patients, and blood pressure variability may be used in managing hypertension and predicting outcomes in dialysis patients.

Published
2011

33. A project to prevent renal diseases in the general population

Author

Domenico, Russo, Paola, Napolitano, Maria Luisa, Sirico, and Vittorio E, Andreucci

Subjects
Male, Middle Aged, Proteinuria, Cross-Sectional Studies, Italy, Hypertension, Diabetes Mellitus, Humans, Mass Screening, Female, Kidney Diseases, Mobile Health Units, Aged, Hematuria
Abstract

Early identification of subjects unaware of hypertension, diabetes and urinary abnormalities may prevent and/or reduce the onset and progression of kidney disease and ameliorate outcomes. In this study, the presence of hypertension, diabetes and urinary abnormalities was checked in subjects walking in a large square of Naples.Data on age, habits and history of hypertension and/or diabetes were collected. Systolic and diastolic blood pressure were recorded. Protein, glucose, leukocytes and red blood cells were measured in urine.Participants numbered 698. Smoking (past or current smoking) was reported by 77%. Many of the participants with hypertension (35%) showed uncontrolled hypertension despite antihypertensive therapy. Hypertension was found for the first time in 154 subjects, and was confirmed in 28% of them afterwards; 23 participants (15% of hypertensive subjects) did not recheck blood pressure (BP) despite our summons. Proteinuria was found in 18% of new hypertensive participants. In 14 out of 17 diabetic participants without history of hypertension, hypertension was found for the first time and confirmed thereafter. Urinary abnormalities were present in more than one half of the participants, and were more prevalent in women and diabetics. Diabetics numbered 55 out of 698 subjects. In spite of therapy, glucosuria was present in almost one third of diabetics. Glucosuria was found in 6 participants with no history of diabetes (0.9% of all subjects).These data demonstrate that (a) many persons with hypertension are not aware of it; (b) control of hypertension is inadequate in most treated hypertensive patients and even worse in diabetics; (c) urinary abnormalities are frequently present in otherwise healthy subjects; (d) projects with the aim of raising awareness of hypertension, urinary abnormalities and diabetes in out-clinic subjects should be supported; (e) the use of a transportable clinic parked in residential areas of cities appears a suitable way for promoting evaluation of BP and urine test in subjects unaware of disease.

Published
2007

34. Sudden cardiac death in patient with CKD

Author

Maria Luisa Sirico, Antonella De Blasio, Emanuele De Simone, Lucia Di Micco, Luca Nardone, and Biagio Di Iorio

Subjects
Death, Sudden, Cardiac, Humans, Kidney Failure, Chronic
Abstract

Despite significant improvements in technology of dialysis delivery, cardiovascular disease remains the mayor cause of death in dialysis patients. Individuals with End Stage Renal Disease (ESRD( present an high incidence of coronary artery disease, arrhythmia and sudden cardiac death (SCD). This review summarizes the current available literature regarding the physiopathology, the risk factors and potential interventions to reduce the risk of SCD in dialysis patients, including medical therapy or defibrillators.

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