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1. Radiation dose from medical imaging in end stage renal disease patients: a Nationwide Italian Survey

Author

Postorino, M, Lizio, D, De Mauri, A, Marino, C, Tripepi, G, Zoccali, C, Brambilla, M, Balestra, E, Bellino, D, Benevento, R, Bregant, C, Bregant, P, Cannillo, B, Casto, G, Chiarinotti, D, Cimolai, S, Colussi, G, De Agostini, A, Declich, F, Facchini, M, Galione, M, Gavotti, C, Gerini, U, Isoardi, P, Izzo, C, Levrero, F, Lorenzon, E, Maffei, S, Maggi, S, Mari, A, Mattana, F, Menegotto, A, Meniconi, O, Paruccini, N, Pierotti, L, Pieruzzi, F, Pontoriero, G, Postorino, A, Quaglia, M, Rampado, O, Ranghino, A, Reccanello, S, Sabatino, S, Sangalli, G, Sottocornola, C, Sutto, M, Tata, S, Torresin, A, Traino, A, Trianni, A, Zeni, L, Postorino M., Lizio D., De Mauri A., Marino C., Tripepi G. L., Zoccali C., Brambilla M., Balestra E., Bellino D., Benevento R., Bregant C., Bregant P., Cannillo B., Casto G., Chiarinotti D., Cimolai S., Colussi G., De Agostini A., Declich F., Facchini M. G., Galione M. A., Gavotti C., Gerini U., Isoardi P., Izzo C., Levrero F., Lorenzon E., Maffei S., Maggi S., Mari A., Mattana F., Menegotto A., Meniconi O., Paruccini N., Pierotti L., Pieruzzi F., Pontoriero G., Postorino A., Quaglia M., Rampado O., Ranghino A., Reccanello S., Sabatino S., Sangalli G., Sottocornola C., Sutto M., Tata S., Torresin A., Traino A., Trianni A., Zeni L., Postorino, M, Lizio, D, De Mauri, A, Marino, C, Tripepi, G, Zoccali, C, Brambilla, M, Balestra, E, Bellino, D, Benevento, R, Bregant, C, Bregant, P, Cannillo, B, Casto, G, Chiarinotti, D, Cimolai, S, Colussi, G, De Agostini, A, Declich, F, Facchini, M, Galione, M, Gavotti, C, Gerini, U, Isoardi, P, Izzo, C, Levrero, F, Lorenzon, E, Maffei, S, Maggi, S, Mari, A, Mattana, F, Menegotto, A, Meniconi, O, Paruccini, N, Pierotti, L, Pieruzzi, F, Pontoriero, G, Postorino, A, Quaglia, M, Rampado, O, Ranghino, A, Reccanello, S, Sabatino, S, Sangalli, G, Sottocornola, C, Sutto, M, Tata, S, Torresin, A, Traino, A, Trianni, A, Zeni, L, Postorino M., Lizio D., De Mauri A., Marino C., Tripepi G. L., Zoccali C., Brambilla M., Balestra E., Bellino D., Benevento R., Bregant C., Bregant P., Cannillo B., Casto G., Chiarinotti D., Cimolai S., Colussi G., De Agostini A., Declich F., Facchini M. G., Galione M. A., Gavotti C., Gerini U., Isoardi P., Izzo C., Levrero F., Lorenzon E., Maffei S., Maggi S., Mari A., Mattana F., Menegotto A., Meniconi O., Paruccini N., Pierotti L., Pieruzzi F., Pontoriero G., Postorino A., Quaglia M., Rampado O., Ranghino A., Reccanello S., Sabatino S., Sangalli G., Sottocornola C., Sutto M., Tata S., Torresin A., Traino A., Trianni A., and Zeni L.

Abstract

Background and objectives: End stage renal disease (ESRD) patients are exposed to the risk of ionizing radiation during repeated imaging studies. The variability in diagnostic imaging policies and the accompanying radiation doses across various renal units is still unknown. We studied this variability at the centre level and quantified the associated radiation doses at the patient level. Methods: Fourteen Italian nephrology departments enrolled 739 patients on haemodialysis and 486 kidney transplant patients. The details of the radiological procedures performed over one year were recorded. The effective doses and organ doses of radiation were estimated for each patient using standardized methods to convert exposure parameters into effective and organ doses Results: Computed tomography (CT) was the major contributor (> 77%) to ionizing radiation exposure. Among the haemodialysis and kidney transplant patients, 15% and 6% were in the high (≥ 20 mSv per year) radiation dose groups, respectively. In haemodialysis patients, the most exposed organs were the liver (16 mSv), the kidney (15 mSv) and the stomach (14 mSv), while the uterus (6.2 mSv), the lung (5.7 mSv) and the liver (5.5 mSv) were the most exposed in kidney transplant patients. The average cumulative effective dose (CED) of ionizing radiation among centres in this study was highly variable both in haemodialysis (from 6.4 to 18.8 mSv per patient-year; p = 0.018) and even more so in kidney transplant (from 0.6 to 13.7 mSv per patient-year; p = 0.002) patients. Conclusions: Radiation exposure attributable to medical imaging is high in distinct subgroups of haemodialysis and transplant patients. Furthermore, there is high inter-centre variability in radiation exposure, suggesting that nephrology units have substantially different clinical policies for the application of diagnostic imaging studies.

Published
2021

2. Radiation dose from medical imaging in end stage renal disease patients: a Nationwide Italian Survey

Author

Postorino M., Lizio D., De Mauri A., Marino C., Tripepi G. L., Zoccali C., Brambilla M., Balestra E., Bellino D., Benevento R., Bregant C., Bregant P., Cannillo B., Casto G., Chiarinotti D., Cimolai S., Colussi G., De Agostini A., Declich F., Facchini M. G., Galione M. A., Gavotti C., Gerini U., Isoardi P., Izzo C., Levrero F., Lorenzon E., Maffei S., Maggi S., Mari A., Mattana F., Menegotto A., Meniconi O., Paruccini N., Pierotti L., Pieruzzi F., Pontoriero G., Postorino A., Quaglia M., Rampado O., Ranghino A., Reccanello S., Sabatino S., Sangalli G., Sottocornola C., Sutto M., Tata S., Torresin A., Traino A., Trianni A., Zeni L., Postorino, M, Lizio, D, De Mauri, A, Marino, C, Tripepi, G, Zoccali, C, Brambilla, M, Balestra, E, Bellino, D, Benevento, R, Bregant, C, Bregant, P, Cannillo, B, Casto, G, Chiarinotti, D, Cimolai, S, Colussi, G, De Agostini, A, Declich, F, Facchini, M, Galione, M, Gavotti, C, Gerini, U, Isoardi, P, Izzo, C, Levrero, F, Lorenzon, E, Maffei, S, Maggi, S, Mari, A, Mattana, F, Menegotto, A, Meniconi, O, Paruccini, N, Pierotti, L, Pieruzzi, F, Pontoriero, G, Postorino, A, Quaglia, M, Rampado, O, Ranghino, A, Reccanello, S, Sabatino, S, Sangalli, G, Sottocornola, C, Sutto, M, Tata, S, Torresin, A, Traino, A, Trianni, A, and Zeni, L

Subjects
Nephrology, medicine.medical_specialty, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Radiation Dosage, Effective dose (radiation), End stage renal disease, Ionizing radiation, Haemodialysi, Kidney transplantation, 03 medical and health sciences, 0302 clinical medicine, Radiation dosimetry, Renal Dialysis, Internal medicine, Medical imaging, medicine, Humans, Cancer, Kidney, business.industry, Stomach, medicine.disease, medicine.anatomical_structure, Italy, Kidney Failure, Chronic, Female, Radiology, business, Tomography, X-Ray Computed
Abstract

Background and objectives: End stage renal disease (ESRD) patients are exposed to the risk of ionizing radiation during repeated imaging studies. The variability in diagnostic imaging policies and the accompanying radiation doses across various renal units is still unknown. We studied this variability at the centre level and quantified the associated radiation doses at the patient level. Methods: Fourteen Italian nephrology departments enrolled 739 patients on haemodialysis and 486 kidney transplant patients. The details of the radiological procedures performed over one year were recorded. The effective doses and organ doses of radiation were estimated for each patient using standardized methods to convert exposure parameters into effective and organ doses Results: Computed tomography (CT) was the major contributor (> 77%) to ionizing radiation exposure. Among the haemodialysis and kidney transplant patients, 15% and 6% were in the high (≥ 20mSv per year) radiation dose groups, respectively. In haemodialysis patients, the most exposed organs were the liver (16mSv), the kidney (15mSv) and the stomach (14mSv), while the uterus (6.2mSv), the lung (5.7mSv) and the liver (5.5mSv) were the most exposed in kidney transplant patients. The average cumulative effective dose (CED) of ionizing radiation among centres in this study was highly variable both in haemodialysis (from 6.4 to 18.8mSv per patient-year; p = 0.018) and even more so in kidney transplant (from 0.6 to 13.7mSv per patient-year; p = 0.002) patients. Conclusions: Radiation exposure attributable to medical imaging is high in distinct subgroups of haemodialysis and transplant patients. Furthermore, there is high inter-centre variability in radiation exposure, suggesting that nephrology units have substantially different clinical policies for the application of diagnostic imaging studies.

Published
2020

5. Quality of life of hemodialysis patients in light of the DOPPS study

Author

Cavalli, A., Pontoriero, G., Cavalli, A., and Pontoriero, G.

Abstract

No abstract, Il DOPPS (Dialysis Outcomes and Practice Patterns Study) - ampio studio internazionale, prospettico, osservazionale – è iniziato nel 1996 per raccogliere i dati di un vasto campione di pazienti emodializzati con l'obiettivo di migliorare la terapia, la pratica dialitica ed ovviamente la loro qualità di vita. Lo studio DOPPS ha mostrato come i pazienti emodializzati presentino una qualità di vita molto inferiore rispetto ai soggetti di pari età, in tutte le sue diverse componenti (fisica, mentale e legata alla malattia renale cronica), oltre che una maggior prevalenza di sintomatologia depressiva. È inoltre emerso come alcuni fattori socioeconomici (tra cui la disoccupazione, un ridotto livello di formazione, uno scarso supporto sociale familiare e di staff dialitico) e medici (quali l'utilizzo di un catetere venoso centrale, bassi livelli di emoglobina ed albumina, una scarsa qualità del sonno) siano associati a una più bassa qualità della vita. Il DOPPS ha messo in evidenza l'associazione tra più bassi indici di qualità della vita e peggiori outcome clinici, in termini di ospedalizzazione e mortalità, permettendo pertanto di individuare i soggetti “più fragili” dal punto di vista fisico, sociale e clinico su cui intervenire in maniera specifica. Oggigiorno il DOPPS rappresenta, anche nel campo della valutazione della qualità della vita, un importante riferimento scientifico, che dimostra come uno studio osservazionale, eseguito in accordo ad adeguati criteri metodologici, possa diventare uno strumento informativo, credibile e capace di suggerire nuove ipotesi da testare in successivi studi clinici controllati.

Published
2018

8. What is the contribution of the DOPPS study in characterizing the concept of dialysis dose?

Author

Cavalli, A., Pontoriero, G., Cavalli, A., and Pontoriero, G.

Abstract

No abstract, La necessità di misurare oggettivamente la dose di dialisi somministrata ai pazienti ha determinato lo sviluppo di parametri utilizzabili per la valutazione dell'adeguatezza della terapia dialitica, di cui il principale è il Kt/V dell'urea (che mette in relazione la quantità di clearance dell'urea fornita al paziente nel tempo t di trattamento dialitico, con il volume di distribuzione dell'urea). Due importanti trial randomizzati (il “National Cooperative Dialysis Study” e l'Hemo Study) hanno valutato la dose di dialisi al fine di stabilire il livello minimo da garantire ai pazienti per evitare un aumento di morbilità e mortalità. Ad essi, si sono aggiunti numerosi studi osservazionali che hanno contribuito a definire molti degli aspetti correlati alla dose e all'adeguatezza dialitica. Anche il Dialysis Outcomes and Practice Patterns Study (DOPPS) - studio internazionale, prospettico, osservazionale iniziato nel 1996 per raccogliere dati riguardanti le pratiche cliniche di gestione di problematiche attinenti all'emodialisi - ha fornito rilevanti informazioni attinenti a tale argomento. Nel corso degli anni, il DOPPS ha evidenziato una crescente aderenza nei confronti di quanto raccomandato dalle linee guida internazionali, come dimostrato dall'aumento dei valori medi di Kt/V e da una percentuale sempre minore di pazienti che presentano una dose di dialisi inadeguata. Inoltre, sono stati raccolti e valutati periodicamente quei parametri della prescrizione dialitica in grado di influire sul raggiungimento del valore di Kt/V desiderato e suggerire le possibili modalità di intervento per ottenere i target raccomandati. I dati DOPPS, in accordo con un'analisi secondaria dell'HEMO Study, suggeriscono la possibilità che una più alta dose di dialisi possa associarsi a una miglior sopravvivenza nelle donne. Pertanto, oggigiorno, il DOPPS rappresenta, anche in fatto di adeguatezza dialitica, un importante riferimento scientifico e un credibile strumento informativo capace di

Published
2018

9. How the management of anemia for dialysis patients in the light of the DOPPS study has changed

Author

Cavalli, A., Pontoriero, G., Cavalli, A., and Pontoriero, G.

Abstract

No abstract, L'anemia è una frequente complicanza della malattia renale cronica (Chronic Kidney Disease, o più brevemente CKD) e rappresenta un importante fattore di rischio cardiovascolare che aggrava ulteriormente la prognosi dei pazienti nefropatici. Gli agenti stimolanti l'eritropoiesi (ESA) e la supplementazione marziale rappresentano i cardini su cui attualmente si basa la terapia di questa complicanza della CKD. Il Dialysis Outcomes and Practice Patterns Study (DOPPS) - studio internazionale, prospettico, osservazionale - è stato avviato nel 1996 per raccogliere informazioni riguardanti le pratiche cliniche di gestione di molte problematiche attinenti l'emodialisi, tra cui anche il trattamento dell'anemia. Nel corso degli anni, il DOPPS ha evidenziato una crescente aderenza nei confronti di quanto raccomandato dalle linee guida internazionali, come dimostrato dall'aumento dei valori medi di emoglobina, dall'utilizzo di ESA in una percentuale crescente di pazienti e da una maggiore attenzione a garantire adeguate scorte marziali. Il DOPPS, inoltre, ha messo in risalto una rilevante associazione tra valori di emoglobina e rischio di ospedalizzazione e morte nei pazienti emodializzati. Oggigiorno il DOPPS rappresenta, anche nel campo della gestione dell'anemia secondaria alla CKD, un importante riferimento scientifico, che dimostra come uno studio osservazionale, eseguito in accordo ad adeguati criteri metodologici, possa diventare uno strumento informativo, credibile e capace di suggerire nuove ipotesi da testare in successivi studi clinici controllati.

Published
2018

14. Supplementary Material for: Sudden Death in End Stage Renal Disease: Comparing Hemodialysis versus Peritoneal Dialysis

Author

Genovesi, S., Porcu, L., Luise, M.C., Riva, H., Nava, E., Contaldo, G., Stella, A., Pozzi, C., Ondei, P., Minoretti, C., Gallieni, M., Pontoriero, G., Conte, F., Torri, V., Bertoli, S., and Vincenti, A.

Abstract

Background/Aims: This study aimed to evaluate total and sudden death (SD) in a cohort of dialysis patients, comparing hemodialysis (HD) vs. peritoneal dialysis (PD). Methods: This is a multicenter retrospective cohort study. Results: Deaths were 626 out of 1,823 in HD and 62 of 249 in PD patients. HD patients had a greater number of comorbidities (p < 0.05). PD patients had a lower risk of death than HD patients (p < 0.001); however, the advantage decreased with time (p < 0.001). Mortality predictors were left ventricular ejection fraction (LVEF) ≤35%, older age, ischemic heart disease, diabetes mellitus, previous stroke, and atrial fibrillation (p < 0.03). SDs were 84:71 in HD and 13 in PD population (12.1 and 22.8% of all causes of death, respectively). A non-significant risk of SD among PD compared to HD patients was detected. SD predictors were older age, ischemic heart disease, and LVEF ≤35% (p < 0.05). Conclusions: HD patients showed a greater presence of comorbidities and reduced survival compared to PD patients; however, the incidence of SD does not differ in the 2 populations. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=464347.

Published
2017
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15. Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney Disease

Author

Torres, Vicente E., Chapman, Arlene B., Devuyst, Olivier, Gansevoort, Ron T., Perrone, Ronald D., Koch, Gary, Ouyang, John, Mcquade, Robert D., Blais, Jaime D., Czerwiec, Frank S., Sergeyeva, Olga, Reprise, Trial Investigators, Cowley, B., Goldstein, S., Chertow, G., Wei, L., Alpers, D. H., Freston, J., Lewis, J. H., Hunt, C. M., La Fuente, J., Vallejos, A., Beresan, H. M., Diaz, H. C., Wasserman, A., Martin, R. S., Rial, M., Cusumano, A. M., Novoa, P. A., Mele, P., Raffaele, P., Fraser, I., Rangan, G., Mathew, M., Cooper, B., Faull, R., Holt, S., Snelling, P., Jardine, M., Thomas, M., Packham, D., Vilayur, E., Johnson, D., Niepen, P., Peeters, P., Bammens, B., Warling, X., Vlem, B., Doubel, P., Hellemans, R., Bichet, D., Pei, Y., Chow, S., Mcmahon, A., Murphy, S., Mcfarlane, P., Ting, R., Tesar, V., Ryba, M., Peskova, M., Oplustilova, A., Dusilova Sulkova, S., Tocik, J., Suchanova, J., Viklicky, O., Rehorova, J., Valkovsky, I., Dieperink, H., Birn, H., Bech, J., Christensen, J., Zaoui, P., Pouteil-Noble, C., Combe, C., Kessler, M., Lemeur, Y., Mariat, C., Chauveau, D., Laville, M., Rieu, P., Fauvel, J. P., Dellanna, F., Gross, P., Renders, L., Budde, K., Sommerer, C., Strutz, F., Hugo, C., Guberina, H., Leidig, M., Csiky, B., Haris, A., Ondrik, Z., Kukuy, O., Ben-Dov, I., Yagil, Y., Schwartz, D., Dijk, D., Kristal, B., Capasso, G., Capelli, G., Cerutti, R., Esposito, C., Frascà, G., Gesualdo, L., Mancini, E., Manunta, P., Pontoriero, G., Scolari, F., Drenth, J., Apeland, T., Marti, H. P., Stenehjem, A., Klatko, W., Klinger, M., Ksiazek, A., Malecki, R., Nowicki, M., Sulowicz, W., Bako, G., Achim, C., Dragulete, R., Marasaev, V., Nagibovich, O., Rossovskaya, M., Esayan, A., Rayner, B., Latiff, G., Muranda, A., Peces Serrano, R., Nieto Iglesias, J., Hueso Val, M., Praga Terente, M., Castro Alonso, C., Guron, G., Melin, J., Heimbürger, O., Fernström, A., Hellberg, O., Turner, N., D Souza, R., Barratt, J., Mikhail, A., Howse, M., Sayer, J., Shipley, T., Takats, D., sunil bhandari, Ong, A., Hillman, K., Vilar, E., Wood, G., Gale, D., Kingswood, J., Ayub, W., Lambie, S., Al-Saghir, F., Bai, L., Price, D., Dilley, J., Blumenfeld, J., Scott, D., Sothinathan, R., Mehta, B., Kaveh, K., Dahl, N., Haastrup, A., Kopyt, N., Harper, K., Ross, D., El-Shahawy, M., Nachman, P., Bellovich, K., Shirazian, S., Bart, S., Fadem, S., Watnick, T., Oo, T., Rastogi, A., Silva, A., Sullivan, J., Thomas, J., Mrug, M., Nossuli, A., Mcgreal, K., Hariachar, S., Umanath, K., Vernace, M., Rosner, M., Newman, G., Levitski-Heikkila, T., Smith, M., Schmidt, R., Reddy, B., Linfert, D., Roppolo, M., Edelstein, C., Rahbari Oskoui, F., Chonchol, M., Germain, M., Gupta, A., Kant, K., Goldberg, S., Mordujovich, J., Moustafa, M., Lifland, H., Cangiano, J., Visger, J., Negrea, L., Berg, J., Culpepper, M., Goral, S., Radhakrishnan, J., Navarro, J., Ryu, J., Burgner, A., Solomon, R., Venuto, R., Pisoni, R., Charen, E., Chuang, P., Mangoo-Karim, R., Lioudis, M., Cohen, R., Park, M., Delong, M., Siddiqi, S., Bodell, M., Mccune, T., Mandayam, S., Foringer, J., Raina, R., Pitone, J., Quadrini, M., Nwakoby, I., Vo, N., and Liss, K.

Published
2017

22. Sudden Death in End Stage Renal Disease: Comparing Hemodialysis versus Peritoneal Dialysis

Author

Genovesi, S, Porcu, L, Luise, M, Riva, H, Nava, E, Contaldo, G, Stella, A, Pozzi, C, Ondei, P, Minoretti, C, Gallieni, M, Pontoriero, G, Conte, F, Torri, V, Bertoli, S, Vincenti, A, GENOVESI, SIMONETTA CARLA, LUISE, MARIA CARMEN, CONTALDO, GINA, STELLA, ANDREA, Vincenti, A., Genovesi, S, Porcu, L, Luise, M, Riva, H, Nava, E, Contaldo, G, Stella, A, Pozzi, C, Ondei, P, Minoretti, C, Gallieni, M, Pontoriero, G, Conte, F, Torri, V, Bertoli, S, Vincenti, A, GENOVESI, SIMONETTA CARLA, LUISE, MARIA CARMEN, CONTALDO, GINA, STELLA, ANDREA, and Vincenti, A.

Abstract

This study aimed to evaluate total and sudden death (SD) in a cohort of dialysis patients, comparing hemodialysis (HD) vs. peritoneal dialysis (PD).

Published
2017

28. Mortality, sudden death and indication for cardioverter defibrillator implantation in a dialysis population

Author

Genovesi, S, Porcu, L, Luise, M, Riva, H, Nava, E, Stella, A, Pozzi, C, Ondei, P, Minoretti, C, Gallieni, M, Pontoriero, G, Conte, F, Torri, V, Vincenti, A, GENOVESI, SIMONETTA CARLA, LUISE, MARIA CARMEN, RIVA, HILARY, STELLA, ANDREA, Vincenti, A., Genovesi, S, Porcu, L, Luise, M, Riva, H, Nava, E, Stella, A, Pozzi, C, Ondei, P, Minoretti, C, Gallieni, M, Pontoriero, G, Conte, F, Torri, V, Vincenti, A, GENOVESI, SIMONETTA CARLA, LUISE, MARIA CARMEN, RIVA, HILARY, STELLA, ANDREA, and Vincenti, A.

Abstract

Background The incidence of sudden death among dialysis patients is high, but end stage renal disease was an exclusion criterion in the trials that demonstrated the benefit of implantable cardioverter defibrillator (ICD) for sudden death prevention. Methods Dialysis patients alive on January 2010 or starting dialysis between January 2010 and January 2013 were enrolled and retrospectively evaluated. Patients were divided into three groups: No-Indication, Indication-With ICD and Indication-Without ICD. Cox and Fine and Gray regression models were used to estimate the total and cause-specific (sudden or non-sudden) mortality hazard ratio (HR, HRcpRisk), respectively. Survival was defined as the time from start of dialysis to the time of death. Results 154/2072 patients (7.4%) had indication for ICD implantation and 52 (33.8%) of them received the device; 688 (33.2%) deaths were recorded. Mortality was different among groups [Indication-With ICD vs No-Indication: HR 1.59 (95% CI 1.06-2.38) and Indication-Without ICD vs No-Indication: HR 2.67 (95% CI 2.09-3.39, p < 0.001)]. 84/688 (12.2%) were sudden deaths. The cumulative incidence of sudden death was higher in patients with ICD indication [Indication-With ICD vs No-Indication HRcpRisk 3.21 (95% CI 1.38-7.40) and Indication-Without ICD vs No-Indication: HRcpRisk 4.19 (95% CI 2.38-7.39), p < 0.001], but also No-Indication patients showed a high rate of sudden death [8.5% (95% CI.6.5-10.9) at 8 years of follow-up]. Conclusions Dialysis patients with ICD indication had a worse survival than No-Indication subjects and the prognosis was particularly poor for the Indication-Without ICD group. Sudden death incidence was much higher than in the general population, even among No-Indication subjects.

Published
2015

29. The Dialysis Outcomes and Practice Patterns Study (DOPPS): results of the Italian cohort

Author

Pontoriero, G, Santoro, Domenico, Messina, A, Vitiello, P, Tasco, A, Milei, M, Capiferri, R, Bellazzi, R, Flammini, A, Baroni, A, Morra, M, Cappelli, G, Mucaria, S, Boggi, R, Amico, Me, Volzone, A, D'Andrea, T, Paglionico, C, Antonucci, F, Ivaldi, R, Tentori, F, BRAGG GRESHAM, J, Pisoni, R, Andreucci, Ve, and Locatelli, F.

Subjects
Male, Middle Aged, outcomes, Cohort Studies, Treatment Outcome, Italy, Renal Dialysis, quality, Dialysis, Humans, Kidney Failure, Chronic, Female, Aged
Abstract

The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective, longitudinal, observational study examining the relationship between dialysis unit practices and outcomes for hemodialysis (HD) patients in seven developed countries France, Germany, Italy, Spain, United Kingdom, Japan and the United States. Results of the DOPPS in Italy are the subject of this report.A national representative sample of 20 dialysis units (21 in Germany) was randomly selected in each of the European DOPPS countries (Euro-DOPPS). In these units, the HD in-center patients were included on a facility census, and their survival rates continuously monitored. A representative sample of incident (269 in Italy, 1553 in the Euro-DOPPS) and prevalent (600 in Italy, 3038 in the Euro-DOPPS) patients was randomly selected from the census for more detailed longitudinal investigation with regard to medical history, laboratory values and hospital admission.Comparing the Italian and Euro-DOPPS cohorts we found comparable mean age for prevalent patients (61.4 vs. 59.5 yrs), but incident patients were older in Italy. Italian prevalent patients had less cardiovascular disease, more satisfactory nutritional status and more frequent use of native vascular access. These data were associated with a comparable mortality (15.7 vs. 16.3 deaths/100 patient yrs), but morbidity was lower in Italy. Kt/V levels were comparable in the two cohorts (1.32 vs. 1.37), but 35% of Italian patients showed a Kt/V below the recommended target. Moreover, hemoglobin levels were below 11 g/dL in 60% of Italian patients.The DOPPS results bring to light several positive aspects and the opportunity for further possible improvements for Italian patients, but at the same time highlight some critical points that could represent a risk for dialysis quality.

Published
2005

32. DIALYSIS VASCULAR ACCESS

Author

Fontsere, N., primary, Mestres, G., additional, Burrel, M., additional, Barrufet, M., additional, Montana, X., additional, Arias, M., additional, Ojeda, R., additional, Maduell, F., additional, Campistol, J. M., additional, Nagaraja, P., additional, Rees, D., additional, Husein, T., additional, Chess, J., additional, Lin, C.-C., additional, Yang, W.-C., additional, Khosravi, M., additional, Kandil, H., additional, Cross, J., additional, Hopkins, S., additional, Collier, S., additional, Lopes, D., additional, Pereira, S., additional, Gomes, A. M., additional, Ventura, A., additional, Martins, V., additional, Seabra, J., additional, Rothuizen, T. C., additional, Damanik, F., additional, Visser, M. J. T., additional, Lavrijsen, T., additional, Cox, M. A. J., additional, Moroni, L., additional, Rabelink, T. J., additional, Rotmans, J. I., additional, Fontsere, N., additional, Cardozo, C., additional, Donate, J., additional, Soriano, A., additional, Muros, M., additional, Pons, M., additional, Mensa, J., additional, Navarro-Gonzalez, J. F., additional, Wijewardane, A., additional, Murley, A., additional, Powers, S., additional, Allen, C., additional, Baharani, J., additional, Wilmink, T., additional, Esenturk, M., additional, Zengin, M., additional, Dal, M., additional, Tahtal , N., additional, Shibata, K., additional, Shinzato, T., additional, Satta, H., additional, Nishihara, M., additional, Koguchi, N., additional, Kuji, T., additional, Kawata, S., additional, Kaneda, T., additional, Yasuda, G., additional, Scrivano, J., additional, Pettorini, L., additional, Rutigliano, T., additional, Ciavarella, G. M., additional, De Biase, L., additional, Punzo, G., additional, Mene, P., additional, Pirozzi, N., additional, El Haggan, W., additional, Belazrague, K., additional, Ehoussou, S., additional, Foucher, V., additional, El Salhy, M., additional, Ouellet, G., additional, Davis, J., additional, Caron, P., additional, Leblanc, M., additional, Romitelli, F., additional, Fazzari, L., additional, Ortu, G., additional, Di Stasio, E., additional, Loizzo, G., additional, Vigano, S. M., additional, Bacchini, G., additional, Rocchi, E., additional, Sala, V., additional, Pontoriero, G., additional, Letachowicz, K., additional, Go  biowski, T., additional, Kusztal, M., additional, Letachowicz, W., additional, Weyde, W., additional, Klinger, M., additional, Hollingsworth, L., additional, Roca-Tey, R., additional, Samon, R., additional, Ibrik, O., additional, Roda, A., additional, Gonzalez-Oliva, J. C., additional, Martinez-Cercos, R., additional, Viladoms, J., additional, Renaud, C. J., additional, Lim, E. K., additional, Seow, T. Y., additional, Teh, H. S., additional, Tosic, J., additional, Jankovic, A., additional, Djuric, P., additional, Radovic Maslarevic, V., additional, Popovic, J., additional, Dimkovic, N., additional, Kazantzi, A., additional, Trigka, K., additional, Buono, F., additional, Laurino, S., additional, Toriello, G., additional, Di Luccio, R., additional, Galise, A., additional, Kim, Y. O., additional, Yoon, S. A., additional, Kim, Y. S., additional, Choi, S. J., additional, Min, J. W., additional, Cheong, M. A., additional, Asano, M., additional, Oguchi, K., additional, Saito, A., additional, Onishi, Y., additional, Yamamoto, Y., additional, Fukuhara, S., additional, Akiba, T., additional, Akizawa, T., additional, Kurokawa, K., additional, Guedes Marques, M., additional, Ibeas, J., additional, Maia, P., additional, Ponce, P., additional, Chang, K. Y., additional, Park, H. S., additional, Kim, H. W., additional, Choi, B. S., additional, Park, C. W., additional, Yang, C. W., additional, Jin, D. C., additional, Likaj, E., additional, Seferi, S., additional, Caco, G., additional, Petrela, E., additional, Barbullushi, M., additional, Idrizi, A., additional, Thereska, N., additional, Lomonte, C., additional, Casucci, F., additional, Libutti, P., additional, Lisi, P., additional, Basile, C., additional, Ancarani, P., additional, Valsuani, G., additional, Cavallo, L., additional, Parodi, D., additional, Lorusso, C., additional, Renaud, C., additional, Lai, B. C., additional, Tho, S., additional, Yeoh, L., additional, Botelho, C., additional, Yankovoy, A., additional, Alexandr, S., additional, Smoliacov, A., additional, Stepanov, V., additional, Parker, C., additional, Davies, P., additional, Taylor, S., additional, Mikhail, A., additional, Gubensek, J., additional, Persic, V., additional, Vajdic, B., additional, Ponikvar, R., additional, Buturovic-Ponikvar, J., additional, Hadimeri, U., additional, Warme, A. V., additional, Stegmayr, B., additional, Suvakov, S., additional, Damjanovic, T., additional, Bajcetic, S., additional, Radovic-Maslarevic, V., additional, Simic, T., additional, Rroji, M., additional, Chua, H. L., additional, Kanda, H., additional, See, S. L., additional, Liew, N. C., additional, Tsuchida, K., additional, Tomo, T., additional, Fukasawa, M., additional, Kawashima, S., additional, Minakuchi, J., additional, Thanaraj, V., additional, Dhaygude, A., additional, Ikeda, K., additional, Forneris, G., additional, Cecere, P., additional, Pozzato, M., additional, Trogolo, M., additional, Vallero, A., additional, Mesiano, P., additional, Roccatello, D., additional, Keskin, L., additional, Casey, J. R., additional, Hanson, C. S., additional, Winkelmayer, W. C., additional, Craig, J., additional, Palmer, S., additional, Strippoli, G., additional, Tong, A., additional, Ferrara, D., additional, Scamarda, S., additional, Bernardino, L., additional, Amico, L., additional, Lorito, M. C., additional, Incalcaterra, f., additional, Visconti, L., additional, Visconti, G., additional, Valenza, F., additional, D'Amato, F., additional, Di Napoli, A., additional, Tazza, L., additional, Chicca, S., additional, Lapucci, E., additional, Silvestri, P., additional, Di Lallo, D., additional, Michelozzi, P., additional, and Davoli, M., additional

Published
2014
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33. DIALYSIS ANAEMIA

Author

Locatelli, F., primary, Choukroun, G., additional, Fliser, D., additional, Moecks, J., additional, Wiggenhauser, A., additional, Gupta, A., additional, Swinkels, D. W., additional, Lin, V., additional, Guss, C., additional, Pratt, R., additional, Carrilho, P., additional, Martins, A. R., additional, Alves, M., additional, Mateus, A., additional, Gusmao, L., additional, Parreira, L., additional, Assuncao, J., additional, Rodrigues, I., additional, Stamopoulos, D., additional, Mpakirtzi, N., additional, Afentakis, N., additional, Grapsa, E., additional, Zitt, E., additional, Sturm, G., additional, Kronenberg, F., additional, Neyer, U., additional, Knoll, F., additional, Lhotta, K., additional, Weiss, G., additional, Robinson, B. M., additional, Larkina, M., additional, Bieber, B., additional, Kleophas, W., additional, Li, Y., additional, Locatelli, F., additional, McCullough, K., additional, Nolen, J. G., additional, Port, F. K., additional, Pisoni, R. L., additional, Kalicki, R. M., additional, Uehlinger, D. E., additional, Ogawa, C., additional, Kanda, F., additional, Tomosugi, N., additional, Maeda, T., additional, Kuji, T., additional, Fujikawa, T., additional, Shino, M., additional, Shibata, K., additional, Kaneda, T., additional, Nishihara, M., additional, Satta, H., additional, Kawata, S.-I., additional, Koguchi, N., additional, Tamura, K., additional, Hirawa, N., additional, Toya, Y., additional, Umemura, S., additional, Chanliau, J., additional, Martin, H., additional, Stamatelou, K., additional, Gonzalez-Tabares, L., additional, Manamley, N., additional, Farouk, M., additional, Addison, J., additional, Donck, J., additional, Schneider, A., additional, Gutjahr-Lengsfeld, L., additional, Ritz, E., additional, Scharnagl, H., additional, Gelbrich, G., additional, Pilz, S., additional, Macdougall, I. C., additional, Wanner, C., additional, Drechsler, C., additional, Kuntsevich, V., additional, Charen, E., additional, Kobena, D., additional, Sheth, N., additional, Siktel, H., additional, Levin, N. W., additional, Winchester, J. F., additional, Kotanko, P., additional, Kaysen, G., additional, Kuragano, T., additional, Kida, A., additional, Yahiro, M., additional, Nanami, M., additional, Nagasawa, Y., additional, Hasuike, Y., additional, Nakanishi, T., additional, Dimitratou, V., additional, Griveas, I., additional, Lianos, E., additional, Sasaki, Y., additional, Yamazaki, S., additional, Fujita, K., additional, Kurasawa, M., additional, Yorozu, K., additional, Shimonaka, Y., additional, Suzuki, N., additional, Yamamoto, M., additional, Zwiech, R., additional, Szczepa ska, J., additional, Bruzda-Zwiech, A., additional, Rao, A., additional, Gilg, J., additional, Caskey, F., additional, Kirkpantur, A., additional, Balci, M. M., additional, Turkvatan, A., additional, Afsar, B., additional, Alkis, M., additional, Mandiroglu, F., additional, Kim, Y. O., additional, Yoon, S. A., additional, Kim, Y. S., additional, Choi, S. J., additional, Min, J. W., additional, Cheong, M. A., additional, Oue, M., additional, Yamamoto, K., additional, Kimura, T., additional, Fukao, W., additional, Kaibe, S., additional, Djuric, P. S., additional, Ikonomovski, J., additional, Tosic, J., additional, Jankovic, A., additional, Majster, Z., additional, Stankovic Popovic, V., additional, Dimkovic, N., additional, Aicardi Spalloni, V., additional, Del Vecchio, L., additional, Longhi, S., additional, Violo, L., additional, La Milia, V., additional, Pontoriero, G., additional, Macdougall, I., additional, Rumjon, A., additional, Mangahis, E., additional, Goldstein, L., additional, Ryzlewicz, T., additional, Becker, F., additional, Kilgallon, W., additional, Fukasawa, M., additional, Otake, Y., additional, Yamagishi, T., additional, Kamiyama, M., additional, Kobayashi, H., additional, Takeda, M., additional, Toida, T., additional, Sato, Y., additional, and Fujimoto, S., additional

Published
2014
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34. PRIMARY AND SECONDARY GLOMERULONEPHRITIDES 2

Author

Monova, D., primary, Monov, S., additional, Todorov, T., additional, Soderberg, D., additional, Kurz, T., additional, Weiner, M., additional, Eriksson, P., additional, Segelmark, M., additional, Jakuszko, K., additional, Sebastian, A., additional, Bednarz, Z., additional, Krajewska, M., additional, Wiland, P., additional, Madziarska, K., additional, Weyde, W., additional, Klinger, M., additional, Naidoo, J., additional, Wearne, N., additional, Jones, E., additional, Swanepoel, C., additional, Rayner, B., additional, Okpechi, I., additional, Endo, N., additional, Tsuboi, N., additional, Furuhashi, K., additional, Matsuo, S., additional, Maruyama, S., additional, Clerte, M., additional, Levi, C., additional, Touzot, M., additional, Fakhouri, F., additional, Monge, C., additional, Lebas, C., additional, Abboud, I., additional, Huart, A., additional, Durieux, P., additional, Charlin, E., additional, Thervet, E., additional, Karras, A., additional, Smykal-Jankowiak, K., additional, Niemir, Z. I., additional, Polcyn-Adamczak, M., additional, Whatmough, S., additional, Sweeney, N., additional, Fernandez, S., additional, Hussain, M., additional, Dhaygude, A., additional, Gniewek, K., additional, Manenti, L., additional, Urban, M. L., additional, Vaglio, A., additional, Gintoli, E., additional, Galletti, M., additional, Buzio, C., additional, Monova, D., additional, Argirova, T., additional, Wong, I., additional, Ibrahim, F. H., additional, Goh, B. L., additional, Lim, T. S., additional, Chan, M. W., additional, Hiramtasu, R., additional, Ubara, Y., additional, Hoshino, J., additional, Takaichi, K., additional, Ghafoor, V., additional, Sahay, M., additional, Soma, J., additional, Nakaya, I., additional, Sasaki, N., additional, Yoshikawa, K., additional, Sato, H., additional, Kaminskyy, V., additional, ZAbi Ska, M., additional, Ko Cielska-Kasprzak, K., additional, Niemir, Z., additional, Wozniczka, K., additional, Swierzko, A., additional, Cedzynski, M., additional, Sokolowska, A., additional, Szala, A., additional, Arjunan, A., additional, Mikhail, A., additional, Shrivastava, R., additional, Parker, C., additional, Aithal, S., additional, Gursu, M., additional, Ozari, M., additional, Yucetas, E., additional, Sumnu, A., additional, Doner, B., additional, Cebeci, E., additional, Ozkan, O., additional, Aktuglu, M. B., additional, Karaali, Z., additional, Koldas, M., additional, Ozturk, S., additional, Marco, H., additional, Picazo, M., additional, Da Silva, I., additional, Gonzalez, A., additional, Arce, Y., additional, Gracia, S., additional, Corica, M., additional, Llobet, J., additional, Diaz, M., additional, Ballarin, J., additional, Schonermarck, U., additional, Hagele, H., additional, Baumgartner, A., additional, Fischereder, M., additional, Muller, S., additional, Oliveira, C. B. L., additional, Oliveira, A. S. A., additional, Carvalho, C. J. B., additional, Pessoa, C. T. B. C., additional, Sette, L. H. B. C., additional, Fernandes, G. V., additional, Cavalcante, M. A. G. M., additional, Valente, L. M., additional, Wan, Q., additional, Hu, H., additional, He, Y., additional, Li, T., additional, Aazair, N., additional, Houmaid, Z., additional, Rhair, A., additional, Bennani, N., additional, Demin, A., additional, Petrova, O., additional, Kotova, O., additional, Demina, L., additional, Roccatello, D., additional, Sciascia, S., additional, Rossi, D., additional, Naretto, C., additional, Baldovino, S., additional, Alpa, M., additional, Salussola, I., additional, Modena, V., additional, Zakharova, E. V., additional, Vinogradova, O. V., additional, Stolyarevich, E. S., additional, Yap, D. Y. H., additional, Chan, T. M., additional, Thanaraj, V., additional, Ponnusamy, A., additional, Pillai, S., additional, Argentiero, L., additional, Schena, A., additional, Rossini, M., additional, Manno, C., additional, Castellano, G., additional, Martino, M., additional, Mitrotti, A., additional, Giliberti, M., additional, Digiorgio, C., additional, Di Palma, A. M., additional, Battaglia, M., additional, Ditonno, P., additional, Grandaliano, G., additional, Gesualdo, L., additional, Neprintseva, N., additional, Tchebotareva, N., additional, Bobkova, I., additional, Kozlovskaya, L., additional, Rabrenovi , V., additional, Kova Evi , Z., additional, Jovanovi , D., additional, Rabrenovi , M., additional, Anti , S., additional, Ignjatovi , L., additional, Petrovi , M., additional, Longhi, S., additional, Del Vecchio, L., additional, Vigano, S., additional, Casartelli, D., additional, Bigi, M. C., additional, Corti, M., additional, Limardo, M., additional, Tentori, F., additional, Pontoriero, G., additional, Zeraati, A. A., additional, Shariati Sarabi, Z., additional, Davoudabadi Farahani, A., additional, Mirfeizi, Z., additional, and Bae, E., additional

Published
2014
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35. PERITONEAL DIALYSIS 2

Author

Vlahu, C. A., primary, De Graaff, M., additional, Struijk, D. G., additional, Krediet, R. T., additional, Shin, H.-S., additional, Ryu, E.-S., additional, Choi, H.-S., additional, Ryu, D.-R., additional, Choi, K.-B., additional, Kang, D.-H., additional, Sanchez-Alvarez, E., additional, Rodriguez-Suarez, C., additional, Galvan-.Hernandez, J. A., additional, Kim, Y. L., additional, Kee, Y. K., additional, Lee, M. J., additional, Oh, H. J., additional, Park, J. T., additional, Han, S. H., additional, Yoo, T.-H., additional, Kang, S.-W., additional, Zhu, F., additional, Abbas, S. R., additional, Bologa, R., additional, Lanto, B., additional, Kotanko, P., additional, Parikova, A., additional, Smit, W., additional, Rroji ( Molla), M., additional, Seferi, S., additional, Cafka, M., additional, Thereska, N., additional, Huang, C.-C., additional, Wang, I.-K., additional, Shiao, Y.-T., additional, Teixeira, L., additional, Sousa, I., additional, Rodrigues, A., additional, Mendonca, D., additional, Ueda, A., additional, Iwase, M., additional, Usui, T., additional, Hirayama, A., additional, Nagai, K., additional, Saito, C., additional, Yamagata, K., additional, La Milia, V., additional, Pontoriero, G., additional, Locatelli, F., additional, Kim, S. M., additional, Kim, T. Y., additional, Lee, J. E., additional, Teta, D., additional, Guillodo, M.-P., additional, Kolko-Labadens, A., additional, Lasseur, C., additional, Levannier, M., additional, Panaye, M., additional, Fouque, D., additional, HAMADA, C., additional, Hara, K., additional, Kang, S. H., additional, Cho, K. H., additional, Park, J. W., additional, Yoon, K. W., additional, Do, J. Y., additional, Dogan, I., additional, Biro Dr, B., additional, Zakar Dr, G., additional, Foldine, Z., additional, Staudt, S., additional, Martins, A. R., additional, Vizinho, R., additional, Branco, P. Q., additional, Gaspar, M. A., additional, Barata, J. D., additional, Sikorska, D., additional, Klysz, P., additional, Posnik, B., additional, Baum, E., additional, Hoppe, K., additional, Schwermer, K., additional, Wanic-Kossowska, M., additional, Frankiewicz, D., additional, Pawlaczyk, K., additional, Lindholm, B., additional, Oko, A., additional, Busuioc, M., additional, Trolliet, P., additional, Guerraoui, A., additional, Caillette-Beaudoin, A., additional, Hallonet, P., additional, Yang, J.-O., additional, Gursu, M., additional, Topcuoglu, D., additional, Koc, L. K., additional, Yucel, L., additional, Sumnu, A., additional, Cebeci, E., additional, Doner, B., additional, Ozkan, O., additional, Behlul, A., additional, Koc, L., additional, Ozturk, S., additional, Kazancioglu, R., additional, Casas Parra, A. I. I., additional, Gonzalez, M. T. T., additional, Sandoval, D. A., additional, Carlota, G. C., additional, Grinyo, J. M. M., additional, Tseng, C.-H., additional, Chao, C.-T., additional, Yen, C.-J., additional, Chiang, C.-K., additional, Hung, K.-Y., additional, Huang, J.-W., additional, Al Wakeel, J. S., additional, Al Ghonaim, M., additional, Al Suwaida, A., additional, Al Harbi, A., additional, Makoshi, Z., additional, Abdullah, S., additional, Matsushita, Y., additional, Basic-Jukic, N., additional, Coen-Herak, D., additional, Martinovic, Z., additional, Radi -Antoli , M., additional, Kes, P., additional, Wu, T.-J., additional, Chen, J.-S., additional, Lin, S.-H., additional, Shiang, J.-C., additional, Wu, C.-C., additional, Munteanu, D., additional, Gemene, M., additional, Mircescu, G., additional, Opatrna, S., additional, Popperlova, A., additional, Tesar, V., additional, Rychlik, I., additional, Viklicky, O., additional, Jin, K., additional, Park, B.-S., additional, Jeong, H. J., additional, Kim, Y.-W., additional, Hogas, S., additional, Voroneanu, L., additional, Onofriescu, M., additional, Nistor, I., additional, Apetrii, M., additional, Siriopol, D., additional, Cujba, M., additional, Hogas, M., additional, and Covic, A., additional

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2014
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36. Discussion of the presentations made at the congress

Author

Ronco, C, Locatelli, F, Bolasco, P, Pontoriero, G, Malberti, F, Feriani, M, Gonella, M, Santoro, A, Di Filippo, S, Ledebo, I, Iorio, L, Basile, C, Boggi, R, Amato, M, Bonforte, G, Zucchelli, P, and Costantini, S

Subjects
Transplantation, Nephrology
Published
2003

37. Phosphate levels in patients treated with low-flux haemodialysis, pre-dilution haemofiltration and haemodiafiltration: post hoc analysis of a multicentre, randomized and controlled trial

Author

Locatelli, F., primary, Altieri, P., additional, Andrulli, S., additional, Sau, G., additional, Bolasco, P., additional, Pedrini, L. A., additional, Basile, C., additional, David, S., additional, Gazzanelli, L., additional, Tampieri, G., additional, Isola, E., additional, Marzolla, O., additional, Memoli, B., additional, Ganadu, M., additional, Reina, E., additional, Bertoli, S., additional, Ferrara, R., additional, Casu, D., additional, Logias, F., additional, Tarchini, R., additional, Mattana, G., additional, Passaghe, M., additional, Fundoni, G., additional, Villa, G., additional, Di Iorio, B. R., additional, Pontoriero, G., additional, and Zoccali, C., additional

Published
2014
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39. Nutrition / inflammation

Author

Wong, M. M. Y., primary, Thijssen, S., additional, Usvyat, L. A., additional, Kotanko, P., additional, Maddux, F. W., additional, Speer, T., additional, Rohrer, L., additional, Blyzszuk, P., additional, Krankel, N., additional, Zewinger, S., additional, Martin, T., additional, von Eckardstein, A., additional, Luscher, T., additional, Landmesser, U., additional, Fliser, D., additional, Prats, M., additional, Font, R., additional, Garcia, C., additional, Cabre, C., additional, Jariod, M., additional, Martinez Vea, A., additional, Costa, E., additional, Ribeiro, S., additional, do Sameiro-Faria, M., additional, Rocha-Pereira, P., additional, Kohlova, M., additional, Fernandes, J., additional, Reis, F., additional, Miranda, V., additional, Quintanilha, A., additional, Bronze-da-Rocha, E., additional, Belo, L., additional, Santos-Silva, A., additional, Nascimento, H., additional, Schepers, E., additional, Glorieux, G., additional, Van den Abeele, T., additional, Neirynck, N., additional, Vanholder, R., additional, Boelaert, J., additional, Liabeuf, S., additional, Massy, Z., additional, Kaynar, K., additional, Kural, B. V., additional, Ulusoy, S., additional, Cansiz, M., additional, Akcan, B., additional, Misir, N., additional, Yaman, S., additional, Kaya, N., additional, Dimas, G. G., additional, Iliadis, F. S., additional, Tegos, T. J., additional, Spiroglou, S. G., additional, Pitsalidis, C. G., additional, Karamouzis, I. M., additional, Didaggelos, T. P., additional, Adamidou, A. P., additional, Savopoulos, C. G., additional, Karamouzis, M. I., additional, Orologas, A. G., additional, Hatzitolios, A. I., additional, Grekas, D. M., additional, Flisinski, M., additional, Brymora, A., additional, Stefanska, A., additional, Strozecki, P., additional, Manitius, J., additional, Khalfina, T. N., additional, Maksudova, A. N., additional, Valeeva, I. K., additional, Bantis, C., additional, Kouri, N.-M., additional, Bamichas, G., additional, Stangou, M., additional, Tsantekidou, E., additional, Natse, T., additional, Fazio, M. R., additional, Basile, G., additional, Lucisano, S., additional, Montalto, G., additional, Valeria, C., additional, Donato, V., additional, Lupica, R., additional, Trimboli, D., additional, Aloisi, C., additional, Buemi, M., additional, Henze, A., additional, Raila, J., additional, Scholze, A., additional, Schweigert, F., additional, Tepel, M., additional, Nakamichi, R., additional, Prates, E., additional, Redublo Quinto, B. M., additional, Zanella, M. T., additional, Batista, M. C., additional, Masajtis-Zagajewska, A., additional, Kurnatowska, I., additional, Wajdlich, M., additional, Nowicki, M., additional, Mennini, F., additional, Russo, S., additional, Marcellusi, A., additional, Quintaliani, G., additional, Andrulli, S., additional, Chiavenna, C., additional, Bigi, M. C., additional, Tentori, F., additional, Crepaldi, M., additional, Corti, M. M., additional, Dell'Oro, C., additional, Bacchini, G., additional, Limardo, M., additional, Pontoriero, G., additional, Williams, C., additional, Abbas, S. R., additional, Zhu, F., additional, Flores-Gama, C., additional, Moskowitz, J., additional, Cartagena, C., additional, Carter, M., additional, Levin, N., additional, de Oliveira, R. B., additional, Okazaki, H., additional, Lenglet, A., additional, Desjardins, L., additional, Lemke, H.-D., additional, Valholder, R., additional, Choukroun, G., additional, and Massy, Z. A., additional

Published
2013
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40. 'Pulse oral' versus intravenous calcitriol therapy in chronic hemodialysis patients. A prospective and randomized study

Author

Bacchini G, Fabrizi F, Pontoriero G, Daniele Marcelli, Di Filippo S, and Locatelli F

Subjects
Male, Administration, Oral, Middle Aged, Alkaline Phosphatase, Phosphates, Calcitriol, Parathyroid Hormone, Renal Dialysis, Injections, Intravenous, Hypercalcemia, Humans, Calcium, Female, Hyperparathyroidism, Secondary, Prospective Studies
Abstract

The aim of this prospective and randomized study was to compare the efficacy, side effects, and costs of 'pulse oral' versus intravenous calcitriol in the treatment of secondary hyperparathyroidism in hemodialysis (HD) patients. A total of 20 patients were randomized to receive over a 4-month period pulse orally administered calcitriol (pulse oral group; n = 10) or intravenous calcitriol (intravenous group; n = 10). All patients used standard dialysate calcium (1.75 mmol/l) throughout the study period. In accordance with the study design calcium dialysate concentrations were reduced when this was necessary to avoid hypercalcemic crises. The patients were stratified into two subgroups according to their initial serum PTH levels: patients with mild or moderate degree of hyperparathyroidism (17 patients) and patients with severe hyperparathyroidism (3 patients). Intravenous and pulse oral cacitriol did not significantly reduce serum PTH concentrations in patients with severe hyperparathyroidism (1,157 +/- 156 vs. 807 +/- 228 pg/ml [corrected], p = 0.09). Intermittent calcitriol, administered by intravenous or oral route, significantly reduced serum PTH levels (326 +/- 119 vs. 109 +/- 79 pg/ml [corrected], p = 0.0001) in patients with mild or moderate hyperparathyroidism. In patients with mild or moderate hyperparathyroidism, intravenous calcitriol significantly reduced PTH concentrations at the end of the 1st month, before the increase of serum ionized calcium levels, whereas 'pulse oral' calcitriol significantly suppressed parathyroid activity at the end of the 2nd month. Calcium dialysate concentration was reduced in 9 out of 10 (90%) patients of the pulse oral group and in all patients (10/10) of intravenous group. The incidence of hypercalcemic crises was 24% (39/160) in the pulse oral group and 14% (27/160) in the intravenous group. Analysis of costs showed that intravenous calcitriol was more expensive compared to pulse oral calcitriol. These data indicate that intermittent intensive calcitriol therapy, regardless of the route of administration, is effective in suppressing parathyroid activity in HD patients with mild or moderate hyperparathyroidism. In contrast, intermittent calcitriol therapy has a limited ability to achieve sustained serum PTH reductions in HD patients with severe hyperparathyroidism. Intravenous calcitriol was more expensive than pulse oral calcitriol, and we recommend the use of pulse oral calcitriol in HD patients with mild or moderate secondary hyperparathyroidism.

Published
1997

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