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Gabriele DONATI
Professore Associato
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa
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Pubblicazioni
2023
- Acute myeloma kidney and SARS-COV2 infection with dialysis need: never say never - a case report
[Articolo su rivista]
Donati, Gabriele; Przygocka, Agnieszka; Zappulo, Fulvia; Vischini, Gisella; Valente, Sabrina; La Manna, Gaetano
abstract
Background: Older individuals with multiple comorbidities and especially patients with multiple myeloma are at higher risk of contracting SARS-CoV-2. When patients with multiple myeloma (MM) are also affected by SARS-CoV-2 the time to start immunosuppressants is still a clinical dilemma especially when urgent hemodialysis is required for acute kidney injury (AKI). Case presentation: We present a case of an 80-year-old woman who was diagnosed with AKI in MM. The patient began hemodiafiltration (HDF) with free light chain removal combined with bortezomib and dexamethasone. The reduction of free light chains concurrently was obtained by means of HDF using poly ester polymer alloy (PEPA) high-flux filter: 2 PEPA filters were used in series during each 4-h length HDF session. A total of 11 sessions was carried out. The hospitalization was complicated with acute respiratory failure caused by SARS-CoV-2 pneumonia successfully treated with both pharmacotherapy and respiratory support. Once the respiratory status stabilized MM treatment was resumed. The patient was discharged in stable condition after 3 months of hospitalization. The follow up showed significant improvement of the residual renal function which allowed interruption of hemodialysis (HD). Conclusions: The complexity of patients affected by MM, AKI, and SARS-CoV-2 should not discourage the attending physicians to offer the adequate treatment. The cooperation of different specialists can lead to a positive outcome in those complicated cases.
2023
- Anti-Inflammatory Approach in Chronic Dialysis Patients with SARS-CoV-2: ATA or PMMA Dialyzers?
[Articolo su rivista]
Donati, G.; Gasperoni, L.; Napoli, M.; Scrivo, A.; Zappulo, F.; Abenavoli, C.; Hu, L.; Angelini, A.; Di Nunzio, M.; Tringali, E.; Cingolani, A.; Marchegiani, B. C.; Rigotti, A.; La Manna, G.
abstract
Introduction: High-flux hemodialysis membranes may modulate the cytokine storm of SARS-CoV-2, but their impact on chronic hemodialysis (CHD) patients is unknown. The aim of the study was the evaluation of asymmetric cellulose triacetate (ATA) and polymethylmethacrylate (PMMA) dialyzers on inflammatory markers and clinical outcomes in CHD patients with SARS-CoV-2. Methods: A prospective, observational study on CHD patients with SARS-CoV-2 was carried out. Patients were enrolled from March 2020 to May 2021. Pre- and postdialysis C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) were determined at each session. Patients who underwent on-line hemodiafiltration (OLHDF) with a PMMA dialyzer were compared with those treated with OLHDF with a ATA dialyzer. The primary endpoint was the differences in the reduction ratio per session (RR) of CRP, PCT, IL-6, and IL-6 RR >25%. Results: We consecutively enrolled 74 CHD patients with COVID-19, 48 were treated with ATA membrane, and 26 with PMMA. Median IL-6 RR was higher in the ATA group compared to PMMA (17.08%, IQR -9.0 to 40.0 vs. 2.95%, IQR -34.63 to 27.32). Median CRP RR was 7.77% (IQR 2.47-13.77) in the ATA group versus 4.8% (IQR -2.65 to 11.38) in the PMMA group (p = 0.0017). Median PCT-RR% was 77.38% (IQR 70.92-82.97) in ATA group versus 54.59% (IQR 42.62-63.16) in the PMMA group (p < 0.0001). A multiple logistic regression analysis with IL-6 RR >25% as the outcome including the membrane employed, pre-dialysis IL-6, CRP, PCT, and ferritin showed that ATA led to a higher probability to reach the outcome (OR 1.891, 95% CI 1.273-2.840, p = 0.0018) while higher CRP favors the risk of lower IL-6 RR values (OR 0.910, 95% CI 0.868-0.949, p ≤ 0.0001). Conclusions: In SARS-CoV-2 CHD patients treated with OLHDF, ATA showed a better anti-inflammatory profile, regarding IL-6 RR, compared to PMMA.
2023
- Comorbidity and in-hospital mortality in peritoneal dialysis patients: data of the Emilia Romagna region of Italy
[Articolo su rivista]
Fabbian, F.; De Giorgi, A.; Ferrara, F.; Alfano, G.; Mori, G.; Di Maria, A.; Frisina, M.; Veronesi, M.; Storari, A.; Donati, G.
abstract
Objective: Kidney failure increases in-hospital mortality (IHM); however, comorbidity is crucial for predicting mortality in dialysis patients. Our aim was to evaluate the impact of comorbidity, assessed by modified Elixhauser index (mEI), Charlson Comorbidity Index (CCI), and age-adjusted CCI, on IHM in a cohort of peritoneal dialysis patients admitted to hospitals of the Emilia Romagna region (ERR) of Italy. Patients and methods: All hospital admissions of peritoneal dialysis patients recorded between 2007 and 2021 in the ERR database were analyzed. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was used for detecting diagnoses and procedures, and the inclusion criterion was code 5498. Comorbidity burden was evaluated by three different scores, and hemodialysis (HD) treatment need was considered. IHM was our outcome. Results: During the 15 years of the study, 3,242 hospitalized peritoneal dialysis patients (62.7% males) were evaluated. Mean age was 62.8±20.6 years, 9.6% underwent HD, and IHM was 5.9% (n=192). IHM mortality was stable throughout the study period. Deceased subjects were older, were hospitalized longer, had a higher comorbidity burden, and had a higher percentage of HD treatment needs than survivors. Age, male sex, comorbidity burden, and HD treatment were predictors of IHM. Receiver operating characteristics (ROC) analysis confirmed the impact of comorbidity burden on IHM, especially when age was considered. Conclusions: We conclude that in male, elderly hospitalized peritoneal dialysis patients with failing dialysis technique, comorbidity burden should be considered being a predictor of IHM.
2023
- Correction: Acute myeloma kidney and SARS-COV2 infection with dialysis need: never say never - a case report (BMC Nephrology, (2023), 24, 1, (204), 10.1186/s12882-023-03237-8)
[Articolo su rivista]
Donati, G.; Przygocka, A.; Zappulo, F.; Vischini, G.; Valente, S.; Manna, G. L.
abstract
2023
- EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF MIGRANTS ON CHRONIC HEMODIALYSIS TREATMENT
[Abstract in Rivista]
Alfano, Gaetano; Fontana, Francesco; Magistroni, Riccardo; Donati, Gabriele
abstract
2023
- Hemodiafiltration with online reinfusion of the endogenous ultrafiltrate (HFR)
[Capitolo/Saggio]
Donati, Gabriele; Alfano, Gaetano; Ballestri, Marco
abstract
2023
- Impact of Single Hemodialysis Treatment on immune Cell Subpopulations
[Articolo su rivista]
Donadei, Chiara; Angeletti, Andrea; Pizzuti, Valeria; Zappulo, Fulvia; Conte, Diletta; Cappuccilli, Maria; Chiocchini, Anna Laura; Scrivo, Anna; Apuzzo, Delia; Mariggiò, Maria Addolorata; Gasperoni, Lorenzo; Donati, Gabriele; La Manna, Gaetano
abstract
: Hemodialysis (HD) is known to trigger a chronic inflammatory status, affecting the innate and acquired immune response. This study was aimed at a comparative analysis of immune cell subsets, proliferation, and apoptosis in subjects receiving chronic HD treatment with respect to a healthy control. Regardless of the dialysis filter used, we observed a reshaping of the acquired immune component both with respect to healthy patients and between the various sessions of dialysis treatment, with an impairment of CD3 cells, along with an increase in CD4 and CD8 cell populations producing pro-inflammatory factors such as IL-17 and IFN-gamma. The population of B cells, monocytes and NK cells were not impaired by the dialysis procedure. These results confirmed the high impact of the HD treatment on the patient's immune system, underlying the imbalance of T cell counterparts.
2023
- MAGNETIC RESONANCE RADIOMIC ANALYSIS FOR THE PREDICTION OF GRAFT FAILURE IN PATIENTS WITH KIDNEY TRANSPLANTATION
[Abstract in Rivista]
Fontana, Francesco; Alfano, Gaetano; Monelli, Filippo; Besutti, Giulia; Trojani, Valeria; Donati, Gabriele
abstract
2023
- Mycophenolate mofetil plus steroids compared to steroids alone in IgA nephropathy: a retrospective study
[Articolo su rivista]
Fontana, Francesco; Delsante, Marco; Vicari, Manuela; Pala, Chiara; Alfano, Gaetano; Giovanella, Silvia; Ligabue, Giulia; Leonelli, Marco; Manenti, Lucio; Rossi, Giovanni Maria; Magistroni, Riccardo; Fiaccadori, Enrico; Donati, Gabriele
abstract
2023
- Outcomes of radiocephalic arteriovenous fistula in octogenarians
[Articolo su rivista]
Mauro, R.; Pini, A.; Pini, R.; Abualhin, M.; Mascoli, C.; La Manna, G.; Chiocchini, A. L.; Donati, G.; Faggioli, G.; Gargiulo, M.
abstract
Background: Current guidelines recommend radiocephalic arteriovenous fistula (RCAVF) as a first choice access for hemodialysis, without specific indication for octogenarians.This study was undertaken to assess the efficacy of RCAVF in octogenarians compared with younger patients. Material and methods: All patients treated by RCAVF from January 2013 to December 2017 were included in a prospective database for a retrospective analysis. Patient demographics, comorbidities, and dialytic treatment data were collected prospectively and compared in patients <80 year-old and ⩾80 years-old. Clinical surveillance was performed during each dialysis session. The main endpoints were primary (PP) and assisted patency (AP). Results: Within the study period, a total of 294 RCAVF were analyzed: 245 (83.3%) RCAVF were performed in <80 year-old and 49 (16.7%) ⩾80 years old. The overall PP and AP at 2-year was 69% ± 2% and 73% ± 3%, respectively. Patients ⩾ 80 years-old had a significantly reduced 2-year PP, AP of RCAVF compared with the younger patients: 50% ± 8% and 62% ± 7% versus 73% ± 3% and 75% ± 3%, p = 0.01 and p = 0.03, respectively. The analysis for possible risk factors for reduction of PP in patients ⩾80 years identified in the central venous catheter(CVC) a predictor of earlier RCAVF failure: HR 3.03(95% CI 1.29–7.13), p = 0.01.Kaplan–Meier curve confirms the reduction of PP in ⩾80 years old patients at 2-year follow-up with previous CVC compared patients without history of CVC: 59% ± 10% versus 24% ± 11%, p = 0.01. A comparison between the two groups was made in order to evaluate the impact of previous history of CVC.In absence of a history of CVC use older patients had a similar 2-year PP compared with younger patients: 59% ± 10% versus 72% ± 4%, p = 0.46. Otherwise, the history of a previous CVC reduced significantly the 2-year PP in ⩾80 years old patients compared the younger: 24% ± 12% versus 75% ± 5%, p = 0.0001. Conclusions: Despite lower overall primary and primary assisted patency, RCAVF are associated with satisfactory results also in octogenarians if performed in absence of history of CVC. Under these circumstances RCAVF can be considered a first choice treatment.
2023
- PATIENT AND TECHNIQUE SURVIVAL ON PERITONEAL DIALYSIS: A RETROSPECTIVE STUDY
[Abstract in Rivista]
Scarmignan, Roberta; Alfano, Gaetano; Fontana, Francesco; Magistroni, Riccardo; Donati, Gabriele
abstract
2023
- Prevalence, clinical course and outcomes of COVID-19 in peritoneal dialysis (PD) patients: a single-center experience
[Articolo su rivista]
Alfano, Gaetano; Fontana, Francesco; Giovanella, Silvia; Morisi, Niccolo; Amurri, Alessio; Ligabue, Giulia; Guaraldi, Giovanni; Ferrari, Annachiara; Cappelli, Gianni; Magistroni, Riccardo; Gregorini, Mariacristina; Donati, Gabriele
abstract
Introduction There are limited data on the effects of COVID-19 on peritoneal dialysis (PD) patients. This study aimed to describe the impact of COVID-19 on the PD population. Methods A monocentric retrospective observational study was conducted on 146 consecutive PD patients followed from January 2020 to March 2022 at the University Hospital of Modena, Italy. Results Twenty-seven (18.4%) PD patients experienced 29 episodes of SARS-CoV-2 infection, corresponding to an incidence rate of 0.16 episodes/patient-year. Median age of COVID-19 patients was 60.4 (interquartile range [IQR] 50.2-66.5) years. In unvaccinated patients (n. 9), COVID-19 was always symptomatic and manifested with fever (100%) and cough (77.7%). COVID-19 caused hospital admission of three (33.3%) patients and two (22.2%) died of septic shock. COVID-19 was symptomatic in 83.3% of vaccinated subjects (n.18) and manifested with fever (61.1%) and cough (55.6%). Hospital admission occurred in 27.8% of the subjects but all were discharged home. Median SARS-CoV-2 shedding was 32 and 26 days in the unvaccinated and vaccinated groups, respectively. At the end of the follow-up, COVID-19 triggered the shift from PD to HD in two subjects without affecting the residual renal function of the remaining patients. Overall, COVID-19 caused an excess death of 22.2%. COVID-19 vaccination refusal accounted for only 1.6% in this cohort of patients. Conclusion COVID-19 incident rate was 0.16 episodes/patient-year in the PD population. About one-third of the patients were hospitalized for severe infection. Fatal outcome occurred in two (7.4%) unvaccinated patients. A low vaccination refusal rate was observed in this population.
2023
- Primary membranous nephropathy in the Italian region of Emilia Romagna: results of a multicenter study with extended follow-up
[Articolo su rivista]
Albertazzi, V.; Fontana, F.; Giberti, S.; Aiello, V.; Battistoni, S.; Catapano, F.; Graziani, R.; Cimino, S.; Scichilone, L.; Forcellini, S.; De Fabritiis, M.; Sara, S.; Delsante, M.; Fiaccadori, E.; Mosconi, G.; Storari, A.; Mandreoli, M.; Bonucchi, D.; Buscaroli, A.; Mancini, E.; Rigotti, A.; La Manna, G.; Gregorini, M.; Donati, G.; Cappelli, G.; Scarpioni, R.
abstract
Background: Since primary membranous nephropathy is a heterogeneous disease with variable outcomes and multiple possible therapeutic approaches, all 13 Nephrology Units of the Italian region Emilia Romagna decided to analyze their experience in the management of this challenging glomerular disease. Methods: We retrospectively studied 205 consecutive adult patients affected by biopsy-proven primary membranous nephropathy, recruited from January 2010 through December 2017. The primary outcome was patient and renal survival. The secondary outcome was the rate of complete remission and partial remission of proteinuria. Relapse incidence, treatment patterns and adverse events were also assessed. Results: Median (IQR) follow-up was 36 (24-60) months. Overall patient and renal survival were 87.4% after 5 years. At the end of follow-up, 83 patients (40%) had complete remission and 72 patients (35%) had partial remission. Among responders, less than a quarter (23%) relapsed. Most patients (83%) underwent immunosuppressive therapy within 6 months of biopsy. A cyclic regimen of corticosteroid and cytotoxic agents was the most commonly used treatment schedule (63%), followed by rituximab (28%). Multivariable analysis showed that the cyclic regimen significantly correlates with complete remission (odds ratio 0.26; 95% CI 0.08-0.79) when compared to rituximab (p < 0.05). Conclusions: In our large study, both short- and long-term outcomes were positive and consistent with those published in the literature. Our data suggest that the use of immunosuppressive therapy within the first 6 months after biopsy appears to be a winning strategy, and that the cyclic regimen also warrants a prominent role in primary membranous nephropathy treatment, since definitive proof of rituximab superiority is lacking.
2023
- Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19
[Articolo su rivista]
Alfano, G.; Morisi, N.; Ferri, C.; Fontana, F.; Giovanella, S.; Ligabue, G.; Mori, G.; Franceschini, E.; Ferrari, A.; Gregorini, M.; Cappelli, G.; Tagliazucchi, S.; Pecorari, M.; Guaraldi, G.; Magistroni, R.; Donati, G.
abstract
Background: The weakened immune system of patients on hemodialysis (HD) may prolong SARS-CoV-2 infection compared to the general population. Current international guidelines recommend ending isolation in conjunction with serial testing in moderately and severely immunocompromised subjects. This study aimed to estimate SARS-CoV-2 infectivity by measuring RT-PCR test positivity in HD patients. A comparison between RT-PCR test and cycle threshold (Ct) value has been performed as a secondary endpoint. Methods: A single-center retrospective study was conducted at the University of Modena (Italy) from March 2020 to October 2022. Only patients on chronic HD therapy with COVID-19 were enrolled in the study. In our HD Center, two negative nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) results were used to end quarantine in this population. SARS-CoV-2 RT-PCR test positivity duration measured the time elapsed from a positive RT-PCR to a second negative test. Ct cut-off of 35 cycles was used to definite “high Ct value,” a condition characterized by a large number of cycles of PCR amplification to register a positive RT-PCR test. Results: During the observational period, 159 cases of SARS-CoV-2 infections were diagnosed in 151 patients. Median age was 70.1 (54.3–81.6) years and males accounted for 59.6% of the COVID-19 population. Median duration of SARS-CoV-2 RT-PCR test positivity on the nasal mucosa accounted for 30 (IQR, 21–40.5) days. Unvaccinated patients experienced significantly longer RT-PCR test positivity compared to vaccinated patients (42 [IQR,31–56] vs. 28 [IQR,20–35.7] days; p = < 0.001). The use of high Ct value, a laboratory surrogate of SARS-CoV-2 replication, anticipated a negative RT-PCR test of 9 (IQR, 6–12) days. Multivariate linear regression analysis showed that increased age (β coefficient 0.31; confidence interval [CI] 95%, 0.14—0.43; p = < 0.001) and the lack of anti-SARS-CoV-2 vaccination (β 0.49 CI95%, 11.9–22.5; p = < 0.001) were predictors of a prolonged RT-PCR positivity. Conclusions: Patients with COVID-19 on HD had prolonged RT-PCR test positivity. The adoption of “high Ct value” criteria led to a significant reduction in the duration of RT-PCR test positivity compared to the use of the classical nucleic acid amplification test. In our study, the lack of SARS-CoV-2 vaccination and older age were independently associated with a longer RT-PCR positivity.
2023
- Risk of bleeding after percutaneous native kidney biopsy in patients receiving low-dose aspirin: a single-center retrospective study
[Articolo su rivista]
Fontana, Francesco; Cazzato, Silvia; Giaroni, Francesco; Bertolini, Fabrizio; Alfano, Gaetano; Mori, Giacomo; Giovanella, Silvia; Ligabue, Giulia; Magistroni, Riccardo; Cappelli, Gianni; Donati, Gabriele
abstract
Background Although discontinuation of antiplatelet agents at least 5 days before kidney biopsy is commonly recommended, the evidence behind this practice is of low level. Indeed, few non-randomized studies previously showed an equivalent risk of bleeding in patients receiving aspirin therapy.Methods We conducted a single center retrospective study comparing the risk of complications after percutaneous native kidney biopsy in patients who received low-dose aspirin (ASA) within 5 days from biopsy and those who did not. The main outcome was the difference in the incidence of major complications (red blood cell transfusion, need for selective arterial embolization, surgery, nephrectomy). Secondary outcomes included difference in minor complications, comparison between patients who received ASA within 48 h or within 3-5 days, identification of independent factors predictive of major complications.Results We analyzed data on 750 patients, of whom 94 received ASA within 5 days from biopsy. There were no significant differences in the proportion of major complications in patients receiving or not receiving ASA (2.59% and 3.19%, respectively, percentage point difference 1%, 95% CI - 3 to 4%, p = 0.74). Groups were also comparable for minor complications; among patients receiving ASA, there were no differences in major bleeding between those who received ASA within 48 h or 3-5 days from biopsy. Significant baseline predictors of major bleeding in our cohort were platelet count lower than 120*10(3)/ microliter, higher diastolic blood pressure and higher blood urea.Conclusions Treatment with low-dose ASA within 5 days from kidney biopsy did not increase the risk of complications after the procedure.[GRAPHICS].
2023
- SURVIVAL OF HEMODIALYSIS PATIENTS: A LARGE RETROSPECTIVE STUDY
[Abstract in Rivista]
Morisi, Niccolò; Scarmignan, Roberta; Alfano, Gaetano; Donati, Gabriele
abstract
2023
- Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial
[Articolo su rivista]
Heerspink, H. J. L.; Radhakrishnan, J.; Alpers, C. E.; Barratt, J.; Bieler, S.; Diva, U.; Inrig, J.; Komers, R.; Mercer, A.; Noronha, I. L.; Rheault, M. N.; Rote, W.; Rovin, B.; Trachtman, H.; Trimarchi, H.; Wong, M. G.; Perkovic, V.; Alarmartine, E.; Chae, D. W.; Del Vecchio, L.; Floege, J.; Hwang, S. -J.; Jelakovic, B.; Maes, B.; Malecki, R.; Miglinas, M.; Nolasco, F. E. B.; Praga, M.; Rabindranath, K.; Rosenberg, M.; Tang, S. C. W.; Tesar, V.; Bose, B.; Gangadharan, M.; Mcdonald, S.; Peh, C.; Jahan, S.; Yeap, C.; Clayton, P.; Irish, G.; Thyagarajan, N.; Hollett, P.; Krishnasamy, R.; Carroll, R.; Jesudason, S.; Crail, S.; Coates, T.; Waugh, J.; Noble, E.; Mahadevan, K.; Campbell, V.; Salehi, T.; Lim, W.; Boudville, N.; Chakera, A.; Chan, D.; Krishnan, A.; Eqbal, Y.; Gillies, A.; Vilayur, E.; Maung Myint, T. M.; Gray, N.; Cheetham, M.; Pollock, C.; Cooper, B.; Mather, A.; Roxburgh, S.; Shen, Y.; Stangenberg, S.; Siriwardana, A.; O'Lone, E.; Wan, S.; Neuen, B.; Tsun Kit Ha, J.; Kim, D.; Heath, L.; Jain, A.; Phua, E.; Li, Y.; Gallagher, M.; Jardine, M.; Ritchie, A.; Razavian, M.; Foote, C.; Wyndham, R.; Sen, S.; Endre, Z.; Erlich, J.; Fernando, M.; Yong, K.; Luxton, G.; Kotwal, S.; Roger, S.; Wijeratne, V.; Packham, D.; Fraser, I.; Vandewiele, B.; Laute, M.; Lemahieu, W.; Jamar, S.; Ombelet, S.; Meeus, G.; Decupere, M.; Schockaert, O.; Doubel, P.; Viaene, L.; Radermacher, L.; Masset, C.; Moonen, M.; Firre, E.; Milicevic, M.; Warling, X.; Vanacker, A.; Malfait, T.; Durlen, I.; Horvatic, I.; Savuk, A.; Gellineo, L.; Karanovic, S.; Dika, Z.; Plavljanic, D.; Mikacic, I.; Trajbar Kentric, D.; Barisic, D.; Stankovic, M.; Majstorovic Barac, K.; Kruljac, I.; Pavlovic, D.; Drinkovic, M.; Prkacin, I.; Barbic, J.; Sitas, Z.; Vujcic, D.; Rychlik, I.; Benesova, A.; Drinovska, K.; Kratka, K.; Maixnerova, D.; Ilmoja, M.; Unt, K.; Lilienthal, K.; Auerbach, A.; Leis, L.; Piel, J.; Adoberg, A.; Kolvald, K.; Veermae, K.; Telling, K.; Seppet, E.; Uhlinova, J.; Zaoui, P.; Carron, P. -L.; Masson, I.; Dinic, M.; Thibaudin, D.; Broyet, C.; Maillard, N.; Mohey, H.; Mariat, C.; Claisse, G.; Alamartine, E.; Dussol, B.; Burtey, S.; Chiche-Jourde, N.; Serre, J. -E.; Jeantet, G.; Chenine, L.; Blanchard, A.; Roueff, S.; Thervet, E.; Fouassier, D.; Buffet, A.; Livrozet, M.; Gaisset, R.; Karras, A.; Heng, A. -E.; Garrouste, C.; Philipponnet, C.; Nicolo, C.; Atenza, A.; Lanaret, C.; Greze, C.; Mayet, V.; Dumond, C.; Delmas, Y.; Combe, C.; Rigothier, C.; Burguet, L.; Labat, A.; Mucha, S.; de Precigout, V.; Weinreich, T.; Reichel, H.; Draganova, D.; Wolf, L.; Hohenstein, B.; Heinrichs, S.; Kulka, S.; Sat, S.; Weiland, L.; Krueger, T.; Wolf, G.; Kettner, C.; Schlosser, M.; Herfurth, J. K.; Koch, A.; Busch, M.; Werth, S. C.; Nitschke, M.; Cakiroglu, F.; Sarnow, F.; Schulz, L.; Weiner, S.; Wirtz, N.; Koester, E.; Moeller, M.; Stamellou, E.; Sanden, S.; Schmidt-Guertler, H.; Bernhardt, W.; Patecki, M.; Schlieper, G.; Schulte, K.; Girardet, A.; Kunzendorf, U.; Kwan, L. P. Y.; Mok, M. M. Y.; Chan, G. C. W.; Ma, M.; Lie, D. N. W.; Chan, A. T. P.; Szeto, C. C.; Ng, K. C. J.; Cheung, S. F.; Yue, T. T. A.; Fung, K. S. S.; Tang, H.; Yim, K. F.; Law, W. P.; Wong, Y. H.; Lam, C. K. D.; Wong, S. H. S.; Marcantoni, C.; Aliotta, R.; Deodato, F.; Patella, G.; Comi, N.; Vita, C.; Carullo, N.; Bolignano, D.; Musolino, M.; Trillini, M.; Perico, N.; Remuzzi, G.; Daina, E.; Biancone, L.; Colla, L.; Burdese, M.; Cogno, C.; Boaglio, E.; Abbasciano, I.; Zizzi, C. F.; Randone, P.; Napodano, P.; Ricchiuto, A.; Cassia, M.; Accarino, S.; Cozzolino, M.; Baccaro, R.; Costanzi, S.; Di Maio, F.; Arena, M.; Urciuolo, F.; Vigano, S.; Cavalli, A.; Limardo, M.; Bordoli, M.; Ponti, S.; Longhi, S.; Solazzo, A.; Giaroni, F.; Donati, G.; Torreggiani, M.; Catucci, D.; Colucci, M.; Esposito, V.; Esposito, C.; Gesualdo, L.; Capaccio, F.; Diletta Stea, E.; Sivo, C.; Annese, F.; Papadia, F.; Messa, P.; Belingheri, M.; Passerini, P.; Malvica, S.; Vickiene, A.; Zakauskiene, U.; Asakiene, E.; Bumblyte', I. A.;
abstract
Background: Sparsentan is a novel, non-immunosuppressive, single-molecule, dual endothelin and angiotensin receptor antagonist being examined in an ongoing phase 3 trial in adults with IgA nephropathy. We report the prespecified interim analysis of the primary proteinuria efficacy endpoint, and safety. Methods: PROTECT is an international, randomised, double-blind, active-controlled study, being conducted in 134 clinical practice sites in 18 countries. The study examines sparsentan versus irbesartan in adults (aged ≥18 years) with biopsy-proven IgA nephropathy and proteinuria of 1·0 g/day or higher despite maximised renin-angiotensin system inhibitor treatment for at least 12 weeks. Participants were randomly assigned in a 1:1 ratio to receive sparsentan 400 mg once daily or irbesartan 300 mg once daily, stratified by estimated glomerular filtration rate at screening (30 to <60 mL/min per 1·73 m2 and ≥60 mL/min per 1·73 m2) and urine protein excretion at screening (≤1·75 g/day and >1·75 g/day). The primary efficacy endpoint was change from baseline to week 36 in urine protein–creatinine ratio based on a 24-h urine sample, assessed using mixed model repeated measures. Treatment-emergent adverse events (TEAEs) were safety endpoints. All endpoints were examined in all participants who received at least one dose of randomised treatment. The study is ongoing and is registered with ClinicalTrials.gov, NCT03762850. Findings: Between Dec 20, 2018, and May 26, 2021, 404 participants were randomly assigned to sparsentan (n=202) or irbesartan (n=202) and received treatment. At week 36, the geometric least squares mean percent change from baseline in urine protein–creatinine ratio was statistically significantly greater in the sparsentan group (–49·8%) than the irbesartan group (–15·1%), resulting in a between-group relative reduction of 41% (least squares mean ratio=0·59; 95% CI 0·51–0·69; p<0·0001). TEAEs with sparsentan were similar to irbesartan. There were no cases of severe oedema, heart failure, hepatotoxicity, or oedema-related discontinuations. Bodyweight changes from baseline were not different between the sparsentan and irbesartan groups. Interpretation: Once-daily treatment with sparsentan produced meaningful reduction in proteinuria compared with irbesartan in adults with IgA nephropathy. Safety of sparsentan was similar to irbesartan. Future analyses after completion of the 2-year double-blind period will show whether these beneficial effects translate into a long-term nephroprotective potential of sparsentan. Funding: Travere Therapeutics.
2023
- Water treatment for haemodialysis.
[Capitolo/Saggio]
Cappelli, Gianni; Alfano, Gaetano; Donati, Gabriele
abstract
2022
- Anti-SARS-COV-2 antibodies in patients on maintenance hemodialysis
[Abstract in Rivista]
Morisi, N; Scarmignan, R; Alfano, G; Donati, G.
abstract
2022
- Anti-inflammatory approach in chronic dialysis patients with SARS-COV-2: ATA or PMMA dialyzers?
[Abstract in Rivista]
Gasperoni, L; Donati, G; Scrivo, A; Zappulo, F; Abenavoli, C; Hu, L; Angelini, A; Di Nunzio, M; Tringali, E; Cingolani, A; Marchegiani, B; Rigotti, A; La Manna, G.
abstract
2022
- Assessment and Management of Transplant Renal Artery Stenosis. A Literature Review
[Articolo su rivista]
Pini, A.; Faggioli, G.; Pini, R.; Mauro, R.; Gallitto, E.; Mascoli, C.; Grandinetti, V.; Donati, G.; Odaldi, F.; Ravaioli, M.; La Manna, G.; Gargiulo, M.
abstract
Background: Transplant renal artery stenosis (TRAS) following kidney transplantation is a possible cause of graft failure. This review aimed to summarize the evidence about physiopathology, diagnosis and early and late effectiveness of the endovascular treatment (EVT), including angioplasty and stenting procedures. Methods: A literature research was performed using Pubmed, Scopus and the Cochrane Library databases (January 2000–September 2020) according to PRISMA guidelines. Studies were included if they describe EVT, percutaneous transluminal angioplasty or stent placement of TRAS, published in English and with a minimum of ten patients. Results: Fifty-six studies were included. TRAS incidence ranges from 1% up to 12% in transplanted kidneys. The TRAS risk factors were: elderly donor and recipient, cytomegalovirus match status, Class II Donor Specific Antibodies (DSA), expanded donor criteria, delayed graft functioning and other anatomical and technical factors. The highest frequency of TRAS presentation is after 3–6 months after kidney transplantation. The most frequent localization of stenosis was para-anastomotic (ranging from 25% to 78%). In 9 studies, all patients were treated by percutaneous transluminal angioplasty (PTA), in 16 studies all patients received percutaneous transluminal stenting (PTS) and in 21 series patients received either PTA or PTS. The twelve months patency rates after EVT ranged from 72% to 94%. The overall complication rate was 9%, with pseudoaneurysms and hematomas as most frequent complications. Conclusions: TRAS can be successfully and safely treated through an endovascular approach. Stent delivery seems to guarantee a higher patency rate compared to simple angioplasty, however further studies are needed to confirm these results.
2022
- Automated Prediction of Kidney Failure in IgA Nephropathy with Deep Learning from Biopsy Images
[Articolo su rivista]
Testa, F.; Fontana, F.; Pollastri, F.; Chester, J.; Leonelli, M.; Giaroni, F.; Gualtieri, F.; Bolelli, F.; Mancini, E.; Nordio, M.; Sacco, P.; Ligabue, G.; Giovanella, S.; Ferri, M.; Alfano, G.; Gesualdo, L.; Cimino, S.; Donati, G.; Grana, C.; Magistroni, R.
abstract
Background and objectives Digital pathology and artificial intelligence offer new opportunities for automatic histologic scoring. We applied a deep learning approach to IgA nephropathy biopsy images to develop an automatic histologic prognostic score, assessed against ground truth (kidney failure) among patients with IgA nephropathy who were treated over 39 years. We assessed noninferiority in comparison with the histologic component of currently validated predictive tools. We correlated additional histologic features with our deep learning predictive score to identify potential additional predictive features. Design, setting, participants, & measurements Training for deep learning was performed with randomly selected, digitalized, cortical Periodic acid–Schiff–stained sections images (363 kidney biopsy specimens) to develop our deep learning predictive score. We estimated noninferiority using the area under the receiver operating characteristic curve (AUC) in a randomly selected group (95 biopsy specimens) against the gold standard Oxford classification (MEST-C) scores used by the International IgA Nephropathy Prediction Tool and the clinical decision supporting system for estimating the risk of kidney failure in IgA nephropathy. We assessed additional potential predictive histologic features against a subset (20 kidney biopsy specimens) with the strongest and weakest deep learning predictive scores. Results We enrolled 442 patients; the 10-year kidney survival was 78%, and the study median follow-up was 6.7 years. Manual MEST-C showed no prognostic relationship for the endocapillary parameter only. The deep learning predictive score was not inferior to MEST-C applied using the International IgA Nephropathy Prediction Tool and the clinical decision supporting system (AUC of 0.84 versus 0.77 and 0.74, respectively) and confirmed a good correlation with the tubolointerstitial score (r50.41, P,0.01). We observed no correlations between the deep learning prognostic score and the mesangial, endocapillary, segmental sclerosis, and crescent parameters. Additional potential predictive histopathologic features incorporated by the deep learning predictive score included (1)inflammation within areas of interstitial fibrosis and tubular atrophy and (2) hyaline casts. Conclusions The deep learning approach was noninferior to manual histopathologic reporting and considered prognostic features not currently included in MEST-C assessment.
2022
- Awaiting a cure for COVID-19: therapeutic approach in patients with different severity levels of COVID-19
[Articolo su rivista]
Alfano, G.; Morisi, N.; Frisina, M.; Ferrari, A.; Fontana, F.; Tonelli, R.; Franceschini, E.; Meschiari, M.; Donati, G.; Guaraldi, G.
abstract
COVID-19 is an unpredictable infectious disease caused by SARS-CoV-2. The development of effective anti-COVID-19 vaccines has enormously minimized the risk of severe illness in most immunocompetent patients. However, unvaccinated patients and non-re-sponders to the COVID-19 vaccine are at risk of short-and long-term consequences. In these patients, the outcome of COVID-19 relies on an interplay of multiple factors including age, immunocompetence, comorbid-ities, inflammatory response triggered by the virus as well as the virulence of SARS-CoV-2 variants. General-ly, COVID-19 is asymptomatic or mildly symptomatic in young people, but it may manifest with respiratory insufficiency requiring mechanical ventilation in cer-tain susceptible groups of patients. Furthermore, severe SARS-CoV-2 infection induces multiorgan failure syndrome by affecting liver, kidney heart and nervous system. Since December 2019, multiple drugs have been test-ed to treat COVID-19, but only a few have been prov-en effective to mitigate the course of the disease that continues to cause death and comorbidity worldwide. Current treatment of COVID-19 patients is essential-ly based on the administration of supportive oxygen therapy and the use of specific drugs such as steroids, anticoagulants, antivirals, anti-SARS-CoV-2 antibodies and immunomodulators. However, the rapid spread of new variants and the release of new data coming from the numerous ongoing clinical trials have cre-ated the conditions for maintaining a continuous up-dating of the therapeutic management of COVID-19 patients. Furthermore, we believe that a well-estab-lished therapeutic strategy along with the continu-um of medical care for all patients with COVID-19 is pivotal to improving disease outcomes and restoring healthcare care fragmentation caused by the pandem-ic. This narrative review, focusing on the therapeutic management of COVID-19 patients, aimed to provide an overview of current therapies for (i) asymptomatic or mildly/moderate symptomatic patients, (ii) hospitalized patients requiring low-flow oxygen, (iii) high-flow oxygen and (iv) mechanical ventilation.
2022
- COVID-19 Rapid Antigen Test Screening in Patients on Hemodialysis
[Articolo su rivista]
Alfano, Gaetano; Scarmignan, Roberta; Morisi, Niccolò; Fontana, Francesco; Giovanella, Silvia; Ligabue, Giulia; Rofrano, Laura; Gennari, William; Pecorari, Monica; Gregorini, Mariacristina; Cappelli, Gianni; Magistroni, Riccardo; Donati, Gabriele
abstract
Introduction. Patients receiving in-center hemodialysis are extremely vulnerable to COVID-19. It is unclear if routine screening of asymptomatic hemodialysis patients is an effective strategy to prevent COVID-19 outbreaks within the dialysis unit. Methods. We conducted a retrospective analysis of in-center hemodialysis patients who underwent bimonthly COVID-19 rapid antigen test screening from February 15(th) to December 26(th), 2021. Nasal rapid antigen testing was performed in all asymptomatic patients. All rapid antigen-positive tests were confirmed by RT-PCR nasopharyngeal swab. Besides universal rapid antigen screening, RT-PCR testing was conducted in all symptomatic patients and contacts of COVID-19 subjects. Results. Overall, 4079 rapid antigen tests were performed in 277 hemodialysis patients on chronic hemodialysis with a mean age of 68.4 +/- 14.6 years. Thirty-eight (0.9%) rapid antigen tests resulted positive. Only five (13.8%) positive-rapid antigen tests were also positive by RT-PCR testing. During the same period, 219 patients regularly screened by rapid antigen tests bimonthly underwent 442 RT-PCR nasopharyngeal swabs for clinical reasons. RT-PCR testing yielded a positive result in 13 (5.9%) patients. The time elapsed between PCR and the negative-rapid antigen test was 7.7 +/- 4.6 days (range 1.8-13.9 days). At the end of the follow-up, 6.4% of the population on in-center hemodialysis contracted COVID-19, and routine rapid antigen tests detected only 5 out of 18 (27.7%) COVID-19 cases. No outbreaks of COVID-19 were identified within the dialysis unit. Conclusion. Bimonthly rapid antigen screening led to the early diagnosis of COVID-19 in less than one-third of cases. The short incubation period of the new SARS-CoV-2 variants makes bimonthly test screening inadequate for an early diagnosis of COVID-19. More frequent tests are probably necessary to improve the utility of COVID-19 nasal rapid antigen test in patients on hemodialysis.
2022
- COVID-19 in patients on Peritoneal Dialysis: a case series
[Abstract in Rivista]
Alfano, G; Fontana, F; Morisi, N; Cappelli, G; Magistroni, R; Donati, G.
abstract
2022
- Early Light Chains Removal and Albumin Levels with a Double Filter-Based Extracorporeal Treatment for Acute Myeloma Kidney
[Articolo su rivista]
Donati, Gabriele; Zappulo, Fulvia; Maietti, Elisa; Scrivo, Anna; Gasperoni, Lorenzo; Zamagni, Elena; Tacchetti, Paola; Pantani, Lucia; Baraldi, Olga; Comai, Giorgia; Cappuccilli, Maria; Cavo, Michele; La Manna, Gaetano
abstract
Renal impairment in Multiple Myeloma (MM) represents one of the most important factors that influences patient survival. In fact, before the introduction of modern chemotherapy, less than 25% of patients with acute kidney injury (AKI) and MM who required dialysis recovered sufficient renal function to become independent from dialysis, with a median overall survival of less than 1 year. There are many other factors involved in determining patient survival. In this study we aimed to investigate the role of double filter-based extracorporeal treatment for removal of serum free light chains (sFLC) in acute myeloma kidney (AKI for MM) and to evaluate patient overall survival. All patients received Bortezomib-based chemotherapy and extracorporeal treatment for sFLC removal. For each session 2 dialyzers of the same kind were used. The dialytic dose was not related to the degree of renal function but to the removal of sFLC. The factors that have been found to be significantly associated with lower mortality were reduction of sFLC at day 12 and day 30, >50% reduction of sFLC at day 30, number of sessions and independence from dialysis. Among baseline characteristics, albumin level was statistically associated with the patients' outcome. Our analysis highlights the importance of the early treatment for removal of sFLC in AKI for MM. These results indicate that the early removal of sFLC can improve patient's outcome.
2022
- Efficacy of Supra-HFR in Removing FGF23 and Cytokines: A Single Session Analysis
[Articolo su rivista]
Donati, Gabriele; Angeletti, Andrea; Cappuccilli, Maria; Donadei, Chiara; Guglielmo, Chiara; Scrivo, Anna; Gasperoni, Lorenzo; Zambelli, Maddalena; Mattiotti, Maria; La Manna, Gaetano
abstract
Background/Aim: Supra hemodiafiltration with reinfusion of the endogenous ultrafiltrate (Supra-HFR) is a dialysis technique used to improve uremic toxin removal in the range of the middle molecular weight molecules. Supra-HFR does not require the preparation and online infusion of high purity dialysis water because it allows the production of an endogenous ultrafiltrate that undergoes detoxification through an adsorbing resin. Patients and Methods: We investigated the ability of Supra-HFR to remove fibroblast growth factor 23 (FGF23), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFalpha), interleukin 8 (IL-8), and transforming growth factor alpha (TGF-alpha) after a single session dialysis in nine patients affected by end stage renal disease (ESRD). The same patients underwent a single session of online hemodiafiltration (OLHDF) to evaluate possible differences in FGF23 and IL-6 levels. Results: A significant reduction in FGF23 was observed with both Supra-HFR (p=0.001) and OL-HDF. As for TNF-alpha and TGF-alpha, which were measured using Supra-HFR only, their percentage values were significantly lower at the end of dialysis
2022
- Ethical challenges in managing unvaccinated patients receiving chronic in-centre haemodialysis
[Articolo su rivista]
Alfano, G.; Fontana, F.; Morisi, N.; Mori, G.; Cappelli, G.; Magistroni, R.; Donati, G.
abstract
Insufficient vaccine coverage and dominance of the more transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are the leading causes of the continued spread of coronavirus disease 2019 (COVID-19) worldwide. To curb the surge in infections, COVID-19 vaccination has been advocated as a priority measure, especially for frail populations and people at high risk of exposure. Patients on in-centre maintenance haemodialysis (HD) embody both conditions. They are at high risk of severe COVID-19 consequences due to their advanced age and weakened immune system and carry an increased risk of SARS-CoV-2 transmission within shared dialysis rooms and public vehicles. Vaccination of the entire HD population is therefore the most effective strategy to protect patients from the dire consequences of COVID-19. Unfortunately, a minority of patients still express COVID-19 vaccine hesitancy. The management of this group of patients, who have the full right to HD treatment, poses demanding problems from a patient safety perspective. The placement of unvaccinated patients within the dialysis room and the protection of all vaccinated patients are some of the most urgent problems the nephrologist faces during the COVID-19 pandemic. In light of these COVID-19-driven changes, an ethical reflection on the management of unvaccinated patients appears crucial to act responsibly and contribute to the health promotion of dialysis patients.
2022
- Impact of the Type of Dialysis on Time to Transplantation: Is It Just a Matter of Immunity?
[Articolo su rivista]
Righini, M.; Capelli, I.; Busutti, M.; Raimondi, C.; Comai, G.; Donati, G.; Cappuccilli, M. L.; Ravaioli, M.; Chieco, P.; La Manna, G.
abstract
Background: Renal transplantation represents the therapeutic gold standard in patients with end stage renal disease (ESRD). Still the role of pre-transplant dialysis in affecting time to transplantation has yet to be determined. We wanted to verify whether the type of renal replacement therapy (hemodialysis vs. peritoneal dialysis) affects time to transplantation and to identify clinical features related to the longer time to transplantation. Methods: We performed a retrospective single-center observational study on patients who had received a transplant in the Bologna Transplant Unit from 1991 to 2019, described through the analysis of digital transplant list documents for sex, age, body mass index (BMI), blood group, comorbidities, underlying disease, serology, type of dialysis, time to transplantation, Panel Reactive Antibodies (PRA) max, number of preformed anti Human Leukocyte Antigens (HLA) antibodies. A p-value < 0.05 was considered statistically significant. Results: In the 1619 patients analyzed, we observed a significant difference in time to transplant, PRA max and Preformed Antibodies Number between patients who received Hemodialysis (HD) and Peritoneal dialysis (PD). Then we performed a multiple regression analysis with all the considered factors in order to identify features that support these differences. The clinical variables that independently and directly correlate with longer time to transplantation are PRA max (p < 0.0001), Antibodies number (p < 0.0001) and HD (p < 0.0001); though AB blood group (p < 0.0001), age (p < 0.003) and PD (p < 0.0001) inversely correlate with time to transplantation. Conclusions: In our work, PD population received renal transplants in a shorter period of time compared to HD and turned out to be less immunized. Considering immunization, the type of dialysis impacts both on PRA max and on anti HLA antibodies.
2022
- Interleukin-6 and Outcome of Chronic Hemodialysis Patients with SARS-CoV-2 Pneumonia
[Articolo su rivista]
Donati, G.; Gasperoni, L.; Zappulo, F.; Scrivo, A.; Napoli, M.; Di Filippo, F.; Cappuccilli, M.; Mancini, R.; La Manna, G.
abstract
Background and Objectives: Chronic hemodialysis (CHD) patients are at increased risk of SARS-CoV-2 infection and the related complications and mortality of COVID-19 due to the high rate of comorbidities combined with advanced age. This observational study investigated the clinical manifestations of SARS-CoV-2 infection in CHD and the risk factors for patients ' death. Materials and Methods: The study included 26 CHD patients with SARS-CoV-2 pneumonia detected by positive RT-PCR on nasopharyngeal swabs and high-resolution computed tomography at hospital admission, aged 71 + 5.9 years, 14 of which (53.8%) were male, 20 (77%) under hemodiafiltration, and 6 (23%) on standard hemodialysis, with a median follow-up of 30 days. Results: Simple logistic regression analysis revealed that the factors associated with a higher risk of death were older age (OR: 1.133; 95%CI: 1.028-1.326, p = 0.0057), IL-6 levels at admission (OR: 1.014; 95%CI: 1.004-1.028, p = 0.0053), and C-reactive protein (OR: 1.424; 95%CI: 1.158-2.044, p < 0.0001). In the multiple logistic regression model, circulating IL-6 values at admission remained the only significant prognosticator of death. The ROC curve indicated the discriminatory cut-off value of 38.20 pg/mL of blood IL-6 for predicting death in chronic hemodialysis patients with SARS-CoV-2 pneumonia (sensitivity: 100%; specificity: 78%; AUC: 0.8750; p = 0.0027). Conclusions: This study identified a threshold of IL-6 levels at hospital admission for death risk in CHD patients with SARS-CoV-2 pneumonia. This might represent a valuable outcome predictor, feasibly better than other clinical, radiological, or laboratory parameters and preceding the IL-6 peak, which is unpredictable.
2022
- QTC INTERVAL, POTASSIUM AND ELECTROLYTES KINETICS DURING AND AFTER DIALYSIS WITH SUPRA HFR (PANDORA STUDY)
[Abstract in Rivista]
Donati, G; Ursino, M; Ruggeri, M; Scrivo, A; Zappulo, F; Mattiotti, M; Napoli, M; Hu, L; Abenavoli, C; Croci Chiocchini, Al; La Manna, G
abstract
Background and Aims:
The QTc interval is a marker of arrhythmic risk in dialysis patients and its lengthening has been associated with an increased risk of sudden death [1]. This phenomenon could be due to accumulation of uremic toxins and their rapid removal with dialysis causing imbalance of electrolytes currents [2].
The aim of the study is to describe the kinetics of potassium (K+) and other electrolytes during and after dialysis with the goal of validate a mathematical model for predicting the respective kinetics [3]. The secondary endpoint is to identify a correlation between the kinetics of intra (Ki) and extracellular K+ (Ke) during and after dialysis and QTc interval.
Method:
6 anuric HD patients were enrolled in a interventional, exploratory, prospective study. Clinical and pharmacological factors favouring the onset of arrhythmias or influencing the total mass of K+ were excluded.
Ki and Ke, Ca2+, Na, blood gas analysis, glucose and urea every 30 minutes were assessed during a 4 hour HFR Supra dialysis session, the subsequent 7 hours and at the start of the following session after 48 hours. A 12 lead ECG were performed with the same schedule and a bioimpedance vector analysis (BIVA) was obtained at the start and the end of the dialysis and 1- and 7-hours after dialysis. Dialysate electrolytes were: Na 140 mEq/L, K 3 mEq/L, Ca2+ 1.5 mEq/L, HCO3- 30 mmol/L.
A selective ion probe was used to measure K+, the Ki value was obtained by an indirect formula expressed in a previous study [4].
The model of K+ kinetics includes the Na + / K + / ATPase-dependent pump, the passive diffusion of K+ from the intracellular to the extracellular compartment, the diffusion of K+ through the filter, the intradialytic volume variation, the K+ and solute rebound after dialysis, the role of plasma osmolality [3].
Results:
The model showed a better correlation to the in vivo data during the HFR phase than the post dialytic one regarding Ke, sodium, HCO3- and Ca2+. The wide variability recorded by Ki is significantly in contrast with the stability predicted by the model and the entity of post dialysis Ca2+ drop was greater than that predicted by the model. Kinetics prediction of urea had a precise fitting with in vivo data in every phase.
In Table 1 are resumed the in vivo results of the 5 patients regarding Ke, Ki, Ki/Ke, Ca2+ and QTc during and after HFR. In Figure 1 we see the data extrapolated from a patient (likewise the others), where the greatest waving of the QTc occurred in the first hour post HFR in parallel with fluctuations of Ki and Ki/Ke.
Conclusion:
The mathematical model for the prediction of the kinetics of solutes has shown a good correspondence with the in vivo data of K+, sodium, urea, Ca2+ and HCO3- during HFR, while it still needs to be refined in the post-dialysis phase. The major discrepancies for Ki could be due to difficult analytical processing.
As to the greater drop of Ca2+ compared to the predicted, it can be due to the role played by other Ca2+ compartments in addition to the intra and extracellular ones.
Although during the intradialytic period we faced a shortening of the QTc interval with a significant reduction in Ke, greater Ki/Ke and an increase in Ca2+, the post HFR period appeared to be the most critical period. This phase corresponded to the largest fluctuations in QTc values, Ki, Ki / Ke ratio, and to the rapid rebound of K+ and the drop of Ca2+.
2022
- Reactogenicity of COVID-19 vaccine in hemodialysis patients: a single-center retrospective study
[Articolo su rivista]
Alfano, Gaetano; Morisi, Niccolò; Fontana, Francesco; Scarmignan, Roberta; Tonelli, Laura; Ferri, Camilla; Montani, Martina; Melluso, Andrea; Giovanella, Silvia; Ligabue, Giulia; Mori, Giacomo; Franceschini, Erica; Guaraldi, Giovanni; Cappelli, Gianni; Magistroni, Riccardo; Donati, Gabriele
abstract
: Introduction: Some hemodialysis patients are reluctant to undergo COVID-19 vaccination for the fear of developing adverse events (AEs). The aim of this study was to verify the safety of the mRNA-1273 vaccine in hemodialysis patients. Methods: We conducted a retrospective analysis of in-center hemodialysis patients who underwent mRNA-1273 vaccine from March 1st to April 30th, 2021. All AEs occurring after the first and the second doses were collected and classified as local or systemic. Results: Overall, 126 patients on chronic maintenance dialysis without a prior COVID-19 diagnosis were vaccinated with two doses of mRNA-1273 vaccine. Mean age was 68 (IQR, 54,7-76) years and 53.6% of patients were aged ≥65 years. During the observational period of 68 (IQR, 66-70) days, AEs occurred in 57.9% and 61.9% of patients after the first dose and second dose, respectively. The most common AEs were: injection-site pain (61.9%), erythema (4.8%), itching (4.8%), swelling (16.7%), axillary swelling/tenderness (2.4%), fever (17.5%) headache (7.9%), fatigue (23.8%), myalgia (17.5%), arthralgia (12.7%), dyspnoea (2.4%), nausea/vomiting (7.1%), diarrhoea (5.6%), shivers (4%) and vertigo (1.6%). The rates of local AEs were similar after the first and second doses (P=0.8), whereas systemic AEs occurred more frequently after the second dose (P=0.001). Fever (P=0.03), fatigue (P=0.02) and nausea/vomiting (P=0.03) were significantly more frequent after the second dose of the vaccine. There were no age-related differences in the rate of AEs. Overall, vaccine-related AEs in hemodialysis patients seem to be lower than in the general population. Conclusion: The RNA-1273 vaccine was associated with the development of transient AEs after the first and second doses in patients on chronic maintenance hemodialysis. They were mostly local, whereas systemic AEs were more prevalent after the second dose. Overall, all AEs lasted for a few days, without any apparent sequelae.
2022
- Reactogenicity of MRNA-1273 vaccine in patients on hemodialysis
[Abstract in Rivista]
Alfano, G; Fontana, F; Morisi, N; Scarmignan, R; Tonelli, L; Cappelli, G; Magistroni, R; Donati, G.
abstract
2022
- Rethinking Chronic Kidney Disease in the Aging Population
[Articolo su rivista]
Alfano, Gaetano; Perrone, Rossella; Fontana, Francesco; Ligabue, Giulia; Giovanella, Silvia; Ferrari, Annachiara; Gregorini, Mariacristina; Cappelli, Gianni; Magistroni, Riccardo; Donati, Gabriele
abstract
The process of aging population will inevitably increase age-related comorbidities including chronic kidney disease (CKD). In light of this demographic transition, the lack of an age-adjusted CKD classification may enormously increase the number of new diagnoses of CKD in old subjects with an indolent decline in kidney function. Overdiagnosis of CKD will inevitably lead to important clinical consequences and pronounced negative effects on the health-related quality of life of these patients. Based on these data, an appropriate workup for the diagnosis of CKD is critical in reducing the burden of CKD worldwide. Optimal management of CKD should be based on prevention and reduction of risk factors associated with kidney injury. Once the diagnosis of CKD has been made, an appropriate staging of kidney disease and timely prescriptions of promising nephroprotective drugs (e.g., RAAS, SGLT-2 inhibitors, finerenone) appear crucial to slow down the progression toward end-stage kidney disease (ESKD). The management of elderly, comorbid and frail patients also opens new questions on the appropriate renal replacement therapy for this subset of the population. The non-dialytic management of CKD in old subjects with short life expectancy features as a valid option in patient-centered care programs. Considering the multiple implications of CKD for global public health, this review examines the prevalence, diagnosis and principles of treatment of kidney disease in the aging population.
2022
- Risk of complications after percutaneous native kidney biopsy in patients receiving anti-platelet agents
[Abstract in Rivista]
Fontana, F; Cazzato, S; Giaroni, F; Alfano, G; Cappelli, G; Donati, G.
abstract
2022
- Safety of Intradialytic Bamlanivimab/ Etesevimab Administration in Two COVID-19 Dialysis Outpatients
[Articolo su rivista]
Gasperoni, L; Abenavoli, C; Donati, G; Scrivo, A Zappulo F; Cingolani, A; Hu, L; La Manna, G.
abstract
Chronic hemodialysis patients are at high risk of severe COVID-19 disease and death related to the infection. Anti-spike monoclonal antibodies administration reduces risk of disease progression and hospitalization in high-risk subjects but no clear data on end-stage renal disease are available. We report 2 cases of Bamlanivimab/Etesevimab administration to two not hospitalized chronic hemodialysis patients with SARS-CoV2 infection. Since they are large molecules (human immunoglobulin G1) with molecular weight of 146,000 Da, administration was conducted during the second hour of the dialysis session with no adverse reaction. Conclusions: Intradialytic administration of Bamlanivimab/Etesevimab could be considered safe and may allow adequate clinical observation time without hospital-stay prolongation.
2022
- Sarcoidosis in a living donor candidate: case report and review of the literature
[Abstract in Rivista]
Mori, G; Tei, L; Alfano, G; Fontana, F; Magistroni, R; Donati, G.
abstract
2022
- Sickle Cell Trait and SARS-CoV-2-Induced Rhabdomyolysis: A Case Report
[Articolo su rivista]
Donati, G.; Abenavoli, C.; Vischini, G.; Cenacchi, G.; Costa, R.; Pasquinelli, G.; Ferracin, M.; Laprovitera, N.; Comai, G.; Monti, G.; Giostra, F.; La Manna, G.
abstract
BACKGROUND Rhabdomyolysis is a syndrome characterized by muscle necrosis and the subsequent release of intracellular muscle constituents into the bloodstream. Although the specific cause is frequently evident from the history or from the immediate events, such as a trauma, extraordinary physical exertion, or a recent infection, sometimes there are hidden risk factors that have to be identified. For instance, individuals with sickle cell trait (SCT) have been reported to be at increased risk for rare conditions, including rhabdomyolysis. Moreover, there have been a few case reports of SARS-CoV-2 infection-related rhabdomyolysis. CASE REPORT We present a case of a patient affected by unknown SCT and admitted with SARS-CoV-2 pneumonia, who suffered non-traumatic non-exertional rhabdomyolysis leading to acute kidney injury (AKI), requiring acute hemodialysis (HD). The patients underwent 13 dialysis session, of which 12 were carried out using an HFR-Supra H dialyzer. He underwent kidney biopsy, where rhabdomyolysis injury was ascertained. No viral traces were found on kidney biopsy samples. The muscle biopsy showed the presence of an "open nucleolus" in the muscle cell, which was consistent with virus-infected cells. After 40 days in the hospital, his serum creatinine was 1.62 mg/dL and CPK and Myoglobin were 188 U/L and 168 ng/mL, respectively; therefore, the patient was discharged. CONCLUSIONS SARS-CoV-2 infection resulted in severe rhabdomyolysis with AKI requiring acute HD. Since SARS-CoV-2 infection can trigger sickle-related complications like rhabdomyolysis, the presence of SCT needs to be ascertained in African patients.
2022
- The Next Evolution of HemoDialysis eXpanded: From a Delphi Questionnaire-Based Approach to the Real Life of Italian Dialysis Units
[Articolo su rivista]
Dellepiane, S.; Marengo, M.; D'Arezzo, M.; Donati, G.; Fabbrini, P.; Lacquaniti, A.; Ronco, C.; Cantaluppi, V.
abstract
Introduction: Impact assessment of new technologies in chronic hemodialysis (HD) is challenging due to HD patient frailty, the complexity of HD clinical trials and practice variability among countries. Among the most recent HD innovations, medium cut-off (MCO) dialyzers present an optimized membrane geometry that provides enhanced clearances for middle and large molecular weight uremic toxins (UT). These toxins are poorly cleared by available HD techniques and largely contribute to patient morbidity and mortality. The aim of this paper is to assess the available clinical evidence about MCO membranes and to identify the next steps needed to generate conclusive data on their use in HD. Methods: With this purpose, we first reviewed and compared the current HD technologies aimed to improve the clearance of middle and large UT; subsequently, we used a Delphi questionnaire to identify and discuss the consensus about MCO efficacy within a large sample of the Italian Nephrology community. Results and Conclusions: Our investigation gathered a significant degree of consensus on the beneficial role of MCO membrane and expanded HD. Finally, we used our results to propose future trial designs and clinical investigations aimed to improve evidence quality about the use of these membranes in the present clinical scenario of dialysis units.
2022
- Vacuum assisted thromboaspiration with Indigo system after acute arteriovenous fistula thrombosis: monocentric experience of an innovative interventional approach
[Abstract in Rivista]
Cingolani, A; Scrivo, A; Mattiotti, M; Zappulo, F; Croci Chiocchini, Al; Gasperoni, L; Hu, L; Abenavoli, C; Di Nunzio, M; Marchegiani, B; Tringali, E; Galverni, Mc; Cappelli, A; Mosconi, C; Renzulli, M; Golfieri, R; Donati, G; La Manna, G.
abstract
2022
- Weekly Rapid Antigen Test Screening for COVID-19 in Patients on Hemodialysis
[Articolo su rivista]
Alfano, Gaetano; Scarmignan, Roberta; Amurri, Alessio; Fontana, Francesco; Giovanella, Silvia; Ligabue, Giulia; Gennari, William; Pecorari, Monica; Sarti, Mario; Guaraldi, Giovanni; Cappelli, Gianni; Gregorini, Mariacristina; Magistroni, Riccardo; Donati, Gabriele
abstract
COVID-19 is a concerning issue among in-center hemodialysis (HD) patients. To prevent COVID-19 diffusion in our HD facility, weekly rapid nasal antigen test screening was performed for all asymptomatic patients on chronic HD. This study aimed to assess the performance of weekly rapid antigen test in detecting SARS-CoV-2 infection among asymptomatic patients receiving HD.
2022
- Which criteria should we use to end isolation in hemodialysis patients with COVID-19?
[Articolo su rivista]
Alfano, G.; Fontana, F.; Ferrari, A.; Morisi, N.; Gregorini, M.; Cappelli, G.; Magistroni, R.; Guaraldi, G.; Donati, G.
abstract
Safe and timely discontinuation of quarantine of in-center hemodialysis (HD) patients with a previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a challenging issue for the nephrological community because current guidelines for ending isolation do not mention dialysis patients. To prevent potentially fatal outbreaks of coronavirus disease 2019 (COVID-19), a cautionary approach has been adopted by most dialysis units. The criteria for ending the isolation in the HD population generally coincide with those recommended for immunocompromised people. Thus, a test-based strategy relying on two consecutive negative reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs has been adopted to terminate quarantine. This strategy has the disadvantage of prolonging isolation as RT-PCR positivity does not equate to SARS-CoV-2 infectivity. Consequentially, prolonged positivity of SARS-CoV-2 results in excessive workload for the HD staff who must face an increasing number of COVID-19 patients requiring isolation. This condition leads also to serious implications for the patients and their households including work productivity loss, postponement of health-care appointments and an increased risk of COVID-19 reinfection. To counteract this problem, other diagnostic tests should be used to provide the best care to HD patients. Recent results seem to encourage the use of RT-PCR cycle threshold (Ct) values and rapid antigen tests given their better correlation with cell culture for SARS-CoV-2 than RT-PCR testing. Here, we provide an overview of the current scientific evidence on the tests used to verify the infectiousness of the virus in order to stimulate the nephrological community to adopt a streamlined and pragmatic procedure to end isolation in COVID-19 patients on HD.
2021
- Detoxification of bilirubin and bile acids with intermittent coupled
plasmafiltration and adsorption in liver failure (HERCOLE study)
[Articolo su rivista]
Donati, G; Angeletti, A; Gasperoni, L; Piscaglia, F; Croci Chiocchini, Al; Scrivo, A; Natali, T; Ullo, I; Guglielmo, C; Simoni, P; Mancini, R; Bolondi, L; La Manna, G
abstract
2021
- Heparin-induced LDL precipitation in a non diabetic dialysis patient as rescue therapy for critica ischemic foot: a case report
[Abstract in Rivista]
Donati, G; Napoletano, A; Scrivo, A; Gasperoni, G; Zappulo, F; Prygocka, A; Minerva, V; La Manna, G
abstract
2021
- Immunosuppressive therapy reduction and early post-infection graft function in kidney transplant recipients with COVID-19
[Articolo su rivista]
Alfano, Gaetano; Damiano, Francesca; Fontana, Francesco; Ferri, Camilla; Melluso, Andrea; Montani, Martina; Morisi, Niccolò; Tei, Lorenzo; Plessi, Jessica; Giovanella, Silvia; Ligabue, Giulia; Mori, Giacomo; Guaraldi, Giovanni; Magistroni, Riccardo; Cappelli, Gianni; Donati, Gabriele
abstract
: Background: Kidney transplant (KT) recipients with COVID-19 are at high risk of poor outcomes due to the high burden of comorbidities and immunosuppression. The effects of immunosuppressive therapy (IST) reduction are unclear in patients with COVID-19. Methods: A retrospective study on 45 KT recipients followed at the University Hospital of Modena (Italy) who tested positive for COVID-19 by RT-PCR analysis. Results: The median age was 56.1 years (interquartile range,[IQR] 47.3-61.1), with a predominance of males (64.4%). Kidney transplantation vintage was 10.1 (2.7-16) years, and 55.6 % of patients were on triple IST before COVID-19. Early immunosuppression minimization occurred in 27 (60%) patients (reduced-dose IST group) and included antimetabolite (88.8%) and calcineurin inhibitor withdrawal (22.2%). After SARS-CoV-2 infection, 88.9% of patients became symptomatic and 42.2% required hospitalization. One patient experienced irreversible graft failure. There were no differences in serum creatinine level and proteinuria in non-hospitalized patients before and post-COVID-19, whereas hospitalized patients experienced better kidney function after hospital discharge (P=0.019). Overall mortality was 17.8%. without differences between full- and reduced-dose IST. Risk factors for death were age (odds ratio [OR]: 1.19; 95%CI: 1.01-1.39), and duration of kidney transplant (OR: 1.17; 95%CI: 1.01-1.35). One KT recipient developed IgA glomerulonephritis and two ones experienced symptomatic COVID-19 after primary infection and SARS-CoV-2 mRNA vaccine, respectively. Conclusions: Despite the reduction of immunosuppression, COVID-19 affected the survival of KT recipients. Age of patients and time elapsed from kidney transplantation were independent predictors of death . Early kidney function was favorable in most survivors after COVID-19.
2021
- Intravenous Iron Replacement Therapy Improves
Cardiovascular Outcomes in Hemodialysis Patients
[Articolo su rivista]
Righini, M; Dalmastri, V; Capelli, I; Orsi, C; Donati, G; Pallotti, Mg; Pedone, C; Casella, G; Chieco, P; LA MANNA, G
abstract
2021
- Primary and Secondary Hyperoxaluria in Chronic Dialysis Patients: Focus on Vascular Access
[Abstract in Rivista]
Donati, G; Mattiotti, M; Napoletano, A; Zappulo, F; Scrivo, A; Gasperoni, L; Giachino, D; Capelli, I; Mauro, R; La Manna, G
abstract
2021
- SARS-Covid 19 infection at various stages of kidney disease: a single center experience
[Abstract in Rivista]
Napoli, M; Donati, G; Gasperoni, L; Zappulo, F; Aiello, V; Scrivo, A; Busutti, M; Ruggeri, M; Di Filippo, F; Lerario, S; Bini, C; Tondolo, F; Stefanini, C; Comai, G; La Manna, G
abstract
2021
- The Use of Supra-Hemodiafiltration in Traumatic Rhabdomyolysis and Acute Kidney Injury: A Case Report
[Articolo su rivista]
Donati, G.; Cappuccilli, M.; Di Filippo, F.; Nicoletti, S.; Ruggeri, M.; Scrivo, A.; Angeletti, A.; La Manna, G.
abstract
Oliguric acute kidney injury due to traumatic rhabdomyolysis can be potentially lethal if the proper medical therapy combined with extracorporeal detoxification is not performed. Different extracorporeal techniques are available to overcome this syndrome. Here, we report the first case of removal of myoglobin and successful recovery from acute kidney injury in an elderly septic patient using supra-hemodiafiltration with endogenous reinfusion technique (HFR-Supra) combined with the medical therapy.
2021
- Toxin removal and inflammatory state modulation during online hemodiafiltration using two different dialyzers (Triad2 study)
[Articolo su rivista]
Donati, G.; Cappuccilli, M.; Donadei, C.; Righini, M.; Scrivo, A.; Gasperoni, L.; Zappulo, F.; La Manna, G.
abstract
Uremic toxins play a pathological role in atherosclerosis and represent an important risk factor in dialysis patients. Online hemodiafiltration (HDF) has been introduced to improve the clearance of middle-and large-molecular-weight solutes (>500 Da) and has been associated with reduced cardiovascular mortality compared to standard hemodialysis. This non-randomized, open-label observational study will explore the efficacy of two dialyzers currently used for online HDF, a polysulfone-based high-flux membrane, and a cellulose triacetate membrane, in hemodialysis patients with signs of middle-molecule intoxication or intradialytic hypotension. In particular, the two filters will be evaluated for their ability in uremic toxin removal and modulation of inflammatory status. Sixteen subjects in standard chronic bicarbonate hemodialysis requiring a switch to online HDF in view of their clinical status will be enrolled and divided into two treatment arms, according to the previous history of hypersensitivity to polysulfone/polyethersulfone dialysis filters and hypersensitivity to drugs or other allergens. Group A will consist of 16 patients without a previous history of hypersensitivity and will be treated with a polysulfone filter (Helixone FX100), and group B, also consisting of 16 patients, with a previous history of hypersensitivity and will be treated with asymmetric triacetate (ATA; SOLACEA 21-H) dialyzer. Each patient will be followed for a period of 24 months, with monthly assessments of circulating middle-weight toxins and protein-bound toxins, markers of inflammation and oxidative stress, lymphocyte subsets, activated lymphocytes, and monocytes, cell apoptosis, the accumulation of advanced glycation end-products (AGEs), variations in arterial stiffens measured by pulse wave velocity (PWV), and mortality rate. The in vitro effect on endothelial cells of uremic serum collected from patients treated with the two different dialyzers will also be investigated to examine the changes in angiogenesis, cell migration, differentiation, apoptosis and proliferative potential, and gene and protein expression profile. The expected results will be a better awareness of the different effects of polysulfone gold-standard membrane for online HDF and the new ATA membrane on the removal of uremic toxins removal and inflammation due to blood–membrane interaction.
2020
- Bloodstream infections and patient survival with tunneled-cuffed catheters for hemodialysis: A single-center observational study
[Articolo su rivista]
Donati, G.; Spazzoli, A.; Croci Chiocchini, A. L.; Scrivo, A.; Bruno, P.; Conte, D.; Ruggeri, M.; Cappuccilli, M.; La Manna, G.
abstract
Background: In hemodialysis patients, a tunneled-cuffed permanent catheter is mandatory when the arteriovenous fistula is not feasible. The major risks of the use of tunneled-cuffed permanent catheter are bloodstream infections. The aim of this study is to analyze bloodstream infections from tunneled-cuffed permanent catheter in hemodialysis patients. Methods: An observational prospective study was carried out and 79 hemodialysis patients with tunneled-cuffed permanent catheter were enrolled. Patients were divided into those with bloodstream infections from tunneled-cuffed permanent catheter and those without. Their clinical and laboratory characteristics were compared. An original tunneled-cuffed permanent catheter lock therapy sequence was carried out combined with systemic antibiotic therapy. In case of antibiotic resistance, the tunneled-cuffed permanent catheter was removed. Results: The patients affected by bloodstream infections from tunneled-cuffed permanent catheter were 16/79 (20.3%). The bloodstream infection from tunneled-cuffed permanent catheter’s incidence rate was 0.52 per 1000 catheter days. Twenty-three bloodstream infections from tunneled-cuffed permanent catheter were found in 16/79 patients who used tunneled-cuffed permanent catheter. Staphylococcus aureus was the cause of bloodstream infection from tunneled-cuffed permanent catheter in 35% of the cases and Staphylococcus epidermidis in 30% of the cases. Risk factors were infection located in other organs and the presence of peripheral obstructive arterial disease. Conclusion: The enrolled cohort showed a reduced bloodstream infection from tunneled-cuffed permanent catheter incidence rate in comparison with the reference value (1 per 1000 catheter days). To reduce the number of bloodstream infections from tunneled-cuffed permanent catheter, hand hygiene and asepsis management of the tunneled-cuffed permanent catheter during the connection to the extracorporeal circuit and an original tunneled-cuffed permanent catheter lock therapy sequence seem to be the most efficient measures. Infections of other organs and the presence of peripheral obstructive arterial disease are the most important risk factors for bloodstream infections from tunneled-cuffed permanent catheter.
2020
- Efficacy of early use of double filter-based extracorporeal treatment combined with chemotherapy in acute myeloma kidney
[Abstract in Rivista]
Zappulo, F; Donati, G; Maietti, E; Scrivo, A; Comai, G; Baraldi, O; Gasperoni, L; Pantani, L; Zamagni, E; La Manna, G
abstract
2020
- Immunological Effects of a Single
Hemodialysis Treatment
[Articolo su rivista]
Angeletti, A; Zappulo, F; Donadei, C; Cappuccilli, M; Di Certo, G; Conte, D; Comai, G; Donati, G; La Manna, G
abstract
2020
- L'infusione di ferro carbossimaltosio in una popolazione in emodialisi migliora gli outcomes cardiovascolari
[Abstract in Rivista]
Righini, M; Capelli, I; Dalmastri, V; Orsi, C; Donati, G; La Manna, G
abstract
2020
- LONG-TERM OUTCOME OF KIDNEY TRANSPLANTATION IN
PLASMA CELLS DYSCRASIAS
[Abstract in Rivista]
Zappulo, F; Donati, G; Comai, G; Bini, C; Angeletti, A; Scrivo, A; Zamagni, E; Cavo, M; La Manna, G
abstract
2020
- New mineralocorticoid receptor antagonists: update on their use in chronic kidney disease and heart failure
[Articolo su rivista]
Capelli, Irene; Gasperoni, Lorenzo; Ruggeri, Marco; Donati, Gabriele; Baraldi, Olga; Sorrenti, Giovanni; Caletti, Maria Turchese; Aiello, Valeria; Cianciolo, Giuseppe; La Manna, Gaetano
abstract
Aldosterone is a mineralocorticoid hormone with a well-known effect on the renal tubule leading to water retention and potassium reabsorption. Other major effects of the hormone include the induction of proinflammatory activity that leads to progressive fibrotic damage of the target organs, heart and kidney. Blocking the aldosterone receptor therefore represents an important pharmacological strategy to avoid the clinical conditions deriving from heart failure (CHF) and chronic kidney disease (CKD). However, steroidal mineralocorticoid receptor antagonists (MRA) have a low safety profile, especially in CKD patients due to the high incidence of hyperkalemia. A new generation of nonsteroidal MRA has recently been developed to obtain a selective receptor block avoiding side-effects like hyperkalemia and thereby making the drugs suitable for administration to CKD patients. This review summarizes the results of published preclinical and clinical studies on the nonsteroidal MRA, apararenone esaxerenone and finerenone. The trials showed a better safety profile with maintained drug efficacy compared with steroidal MRA. For this reason, nonsteroidal MRA represent an interesting new therapeutic approach for the prevention of CHF and CKD progression. Some basic research findings also yielded interesting results in acute clinical settings such as myocardial infarction and acute kidney injury.
2020
- Reazioni di intolleranza a membrane di dialisi sintetiche e loro risoluzione con membrane alternative
[Abstract in Rivista]
Trezzi, M; Rolla, D; Cadoni, C; Murgia, E; Bandera, A; Giozzet, M; Bonucchi, D; Antoniotti, R; Donati, G; La Manna, G; Rizzioli, E; Storari, A
abstract
2020
- Renal dysfunction in psoriatic patients
[Articolo su rivista]
Grandinetti, V.; Baraldi, O.; Comai, G.; Corradetti, V.; Aiello, V.; Bini, C.; Minerva, V.; Barbuto, S.; Fabbrizio, B.; Donati, G.; La Manna, G.
abstract
Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being considered as a systemic inflammatory disorder due to its association with cardiovascular, metabolic, pulmonary, renal, liver, and neurologic diseases. Renal involvement is rare but well documented and psoriasis is recognized as an independent factor for CKD and ESKD. A careful monitoring of the urinalysis and of renal function is recommended in psoriatic patients, especially those with moderate-to-severe disease. In case of pathologic findings, the execution of a renal biopsy appears necessary to make an accurate diagnosis and to establish the most appropriate therapeutic strategies to prevent the progression of kidney damage. The mechanisms of kidney involvement are different and not yet fully clarified. We present here two case reports of renal dysfunction during psoriasis. In one case, we diagnosed IgA nephropathy with particularly severe clinical presentation; in the other, an advanced kidney injury due to nephrotoxicity after prolonged CNI treatment.
2020
- Renal dysfunction in psoriatic patients
[Articolo su rivista]
Grandinetti, V.; Baraldi, O.; Comai, G.; Corradetti, V.; Aiello, V.; Bini, C.; Minerva, V.; Barbuto, S.; Fabbrizio, B.; Donati, G.; La Manna, G.
abstract
Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being considered as a systemic inflammatory disorder due to its association with cardiovascular, metabolic, pulmonary, renal, liver, and neurologic diseases. Renal involvement is rare but well documented and psoriasis is recognized as an independent factor for CKD and ESKD. A careful monitoring of the urinalysis and of renal function is recommended in psoriatic patients, especially those with moderate-to-severe disease. In case of pathologic findings, the execution of a renal biopsy appears necessary to make an accurate diagnosis and to establish the most appropriate therapeutic strategies to prevent the progression of kidney damage. The mechanisms of kidney involvement are different and not yet fully clarified. We present here two case reports of renal dysfunction during psoriasis. In one case, we diagnosed IgA nephropathy with particularly severe clinical presentation; in the other, an advanced kidney injury due to nephrotoxicity after prolonged CNI treatment.
2020
- Reply. A comment on “Early use of a PEPA (polyester polymer alloy) dialyzer for light chain removal and for the recovery from myeloma cast nephropathy: A case report”
[Articolo su rivista]
Donati, G; Zappulo, F; La Manna, G
abstract
Non applicabile (reply)
2020
- Vitamin B Supplementation and Nutritional Intake of
Methyl Donors in Patients with Chronic Kidney
Disease: A Critical Review of the Impact on
Epigenetic Machinery
[Articolo su rivista]
Cappuccilli, M; Bergamini, C; Giacomelli, Fa; Cianciolo, G; Donati, G; Conte, D; Natali, T; La Manna, G; Capelli, I
abstract
2019
- ACUTE MYELOMA KIDNEY: EFFICACY OF DOUBLE FILTER
BASED EXTRACORPOREAL TREATMENTS COMBINED TO
CHEMOTHERAPY FOR PATIENT AND KIDNEY SURVIVAL
[Abstract in Rivista]
Zappulo, F; Donati, G; Croci Chiocchini, Al; Scrivo, A; Maietti, E; Natali, T; Pelizzaro, E; Nicoletti, S; Rucci, P; Troiano, A; Zamagni, E; La Manna, G
abstract
2019
- Early use of PEPA dialyzer for light chains removal and for the recovery from myeloma cast nephropathy: a case report
[Articolo su rivista]
Donati, G; Zappulo, F; Croci Chiocchini, Al; Comai, G; Zamagni, E; La Manna, G
abstract
2019
- Effects of listening to live singing in patients undergoing hemodialysis: a randomized controlled crossover study
[Articolo su rivista]
Burrai, F; Lupi, R; Luppi, M; Micheluzzi, V; Donati, G; La Manna, G; Raghavan, R
abstract
Abstract
Background:
Participation in music therapy is associated with improved psychological and physical indices among chronically ill
patients. Listening to music during hemodialysis treatments positively affects patients’ hemodynamics, laboratory values, quality of
life, and physical symptoms. The effect of live singing during hemodialysis treatments, however, has not previously been studied.
Methods:
A total of 24 participants with a diagnosis of end-stage kidney disease participated in the study. The vocalist was a
musically trained dialysis nurse. Twelve of the patients listened to 15 min of live singing during 6 consecutive hemodialysis
sessions, while the other 12 underwent standard hemodia
lysis. After a washout period of 2 days, the two groups were
reversed.
Results:
Listening to live music was associated with improvements in systolic and diastolic blood pressure, better
quality of sleep, fewer cramps, and reduced anxiety/depression, pain, and itching (
p
< .05, all values).
Conclusions:
Listening to
live music during hemodialysis is an effective and potentially low-cost therapy for the dialysis care team to employ during
hemodialysis treatments
2019
- Evolution of the concept of quality of life in the population in end stage renal disease. A systematic review of the literature
[Articolo su rivista]
Cangini, G; Rusolo, D; Cappuccilli, M; Donati, G; La Manna, G
abstract
Given the rising prevalence of end-stage renal disease and subsequent progressive increase of patients starting renal replacement therapy, a great attention is given by scientific community to the assessment of life perception and Quality of Life (QoL) in dialysis patients. A broad literature review was conducted on PubMed and PsyInfo databases for articles published between January 2000 and July 2016 in order to understand the biological and psychosocial variables potentially affecting the QoL of the patients under artificial substitution of kidney function.
2019
- MIDDLE MOLECULES REMOVAL AND ANTICOAGULATION IN
HEMODIALYSIS WITH A MEDIUM CUT OFF MEMBRANE:
PRELIMINARY DATA FROM A MONOCENTRIC TRIAL
[Abstract in Rivista]
Bini, C; Donati, G; Pelizzaro, E; Scrivo, A; Croci
Chiocchini, Al; Magnoni, G; Mattiotti, M; Di Filippo, F; La Manna, G
abstract
2019
- REMOVAL OF LARGE-MIDDLE MOLECULES, INHIBITION OF
NEUTROPHIL ACTIVATION AND MODULATION OF
INFLAMMATION-RELATED ENDOTHELIAL DYSFUNCTION
DURING EXPANDED HEMODIALYSIS (HDX)
[Abstract in Rivista]
Cantaluppi, V; Marengo, M; Quercia, A; Berto, M; Donati, G; Lacquaniti, A; Cosa, F; Gernone, G; Teatini, U; Migliori, M; Panichi, V
abstract
2019
- SINGLE HEMODIALYSIS (HD) TREATMENT PROMOTES T
CELLS ACTIVATION
[Abstract in Rivista]
Donadei, C; Angeletti, A; Gasperoni, L; Guglielmo, C; Donati, G; La Manna, G
abstract
2019
- Time evolution of restless legs syndrome in haemodialysis patients
[Articolo su rivista]
Capelli, I; Pizza, F; Ruggeri, M; Gasperoni, L; Carretta, E; Donati, G; Cianciolo, G; Plazzi, G; La Manna, G.
abstract
Background: Restless legs syndrome (RLS) is characterized by an urge to move the extremities, accompanied by paraesthesiae, in the evening and at night. Uraemic RLS, a type of secondary RLS, occurs commonly in chronic kidney disease and end-stage renal disease. Progression of uraemic RLS over time is unclear. Therefore we investigated the prevalence, progression over time, risk factors and impact on survival of uraemic RLS in a cohort of dialysis patients.
Methods: We reviewed at the 7-year follow-up a cohort of haemodialysis (HD) patients we had previously investigated for RLS, through interviews, validated questionnaires and analysis of demographic and clinical data.
Results: At the 7-year follow-up, RLS was present in 16% of patients, with a persistence rate of 33%. A correlation was obtained between RLS and older age, diabetes, low albumin and low body mass index. RLS was associated with reduced overall survival (median survival of 3.3 versus 3.7 years), particularly with the continuous form of RLS (1.61 years). There was a higher incidence of myocardial infarction and peripheral vascular disease, although not reaching statistical significance. RLS patients had absolute higher scores in all quality of life domains. A large majority of study patients (96%) reported being symptom-free within a few days or weeks following kidney transplantation.
Conclusions: The development of RLS, especially the continuous form, in patients undergoing HD has important consequences associated with decreased survival. Our results indicated an association between uraemic RLS and ageing, diabetes and malnutrition. Considerable efforts should be focused on the treatment of RLS, since it significantly and persistently impacts the quality of life of HD patients. Kidney transplantation could represent an effective treatment option for that RLS impacts on dialysis patients' quality of life, thus confirming the secondary nature of RLS in most HD patients.
2018
- A MID-TERM REPORT OF HD TREATMENTS WITH THE NEW
DIALYZERS WITH MEDIUM CUT-OFF MEMBRANE (MCO
THERANOVA)
[Abstract in Rivista]
Cantaluppi, V; Donati, G; Grandaliano, G; Laquaniti, A; Teatini, U
abstract
2018
- Coupled Plasma Filtration Adsorption:
A Multipurpose Extracorporeal
Detoxification Therapy
[Articolo su rivista]
LA MANNA, G; Donati, G
abstract
Coupled plasma filtration adsorption (CPFA) is a detoxification
system that combines a plasma adsorption circuit with
a continuous renal replacement therapy. The circuit consists
of a plasma filter, a resin/adsorbent cartridge and a
haemofilter. It differs from many other types of extracorporeal
therapies in that the upper part of the circuit can be
considered a “closed loop”. In this manner, the plasma separated
by the plasma filter passes through an adsorbent
cartridge containing a resin with high affinity to many cytokines,
mediators and toxins/poisons. After passing
through the cartridge, the purified plasma is returned to
the patient. The second part of the circuit, the haemofilter,
can then be used to remove small toxins that are not adsorbed
by the resin or to modulate the patient hematic volume.
Although more complex, the use of a plasma-separation
step prior to the passage through the resin cartridge
offers advantages over adsorption by haemoperfusion. The
plasma passes through the resin cartridge with a lower velocity
than the blood flow, and this allows better contact
time for the toxins with the resin, and more thorough penetration
into the resin pores. The adsorption of many toxins
is highly dependent on a factor expressed as linear velocity.
In addition, the plasma does not contain cells or a very limited
number of platelets, allowing less potential activation
upon contact with the resin. Although the technique was
originally developed for the treatment of sepsis and septic
shock, there are many additional applications where there
can be an advantage of having access to larger molecular
weight toxins (compared to haemofiltration) and avoiding
the loss of important physiologic substances such as albumin.
Some of these new applications, in patients with or
without acute kidney injury, include liver failure, rhabdomyolysis,
severe autoimmune exacerbations and poisonings.
In this article, we discuss some of the basic principles
involved in sorbent technology, and how these may contribute
to treatment efficacy, review the actual experiences
with CPFA and finally discuss the results of recent human studies
and their implications.
2018
- Depurazione extracorporea mediante Coupled plasma filtration and adsorption (CPFA) in corso di insufficienza epatica acuta e acuta su cronica (studio HERCOLE)
[Abstract in Rivista]
Guglielmo, C; Bini, C; Donati, G; Tondolo, F; Natali, T; Scrivo, A; Croci Chiocchini, Al; Angeletti, A; Piscaglia, F; Simoni, P; Bolondi, L; La Manna, G
abstract
2018
- HEPATIC REGENERATION WITH COUPLED
PLASMAFILTRATION AND ADSORPTION FOR LIVER
EXTRACORPOREAL DETOXIFICATION (HERCOLE STUDY)
[Abstract in Rivista]
Donati, G; Guglielmo, G; Bini, C; Bruno, P; Tondolo, F; Scrivo, A; Croci Chiocchini, Al; Piscaglia, G; Simoni, P; La Manna, G.
abstract
2018
- Octogenarians in pre-dialysis phase do not have worse results of radio cephalic arteriovenous fistula compared to younger patients
[Abstract in Rivista]
Mauro, R; Abualhin, M; Pini, R; Croci Chiocchini, Al; Donati, G; Pini, A; Faggioli, Gl; La Manna, G; Stella, A; Gargiulo, M
abstract
2018
- Removal of large middle molecules on expanded hemodialysis (HDx): a multicentric observational study of 6 months follow up
[Abstract in Rivista]
Cantaluppi, V; Donati, G; Laquaniti, A; Cosa, F; Gernone, G; Marengo, M; Teatini, U.
abstract
2018
- Rimozione delle catene leggere libere mediante diverse tipologie di filtri dializzatori in pazienti con danno renale acuto da mieloma multiplo
[Abstract in Rivista]
Zappulo, F; Donati, G; Croci Chiocchini, Al; Scrivo, A; Guglielmo, C; Bini, C; Tondolo, F; Baraldi, O; Comai, G; Zamagni, E; Tacchetti, P; Mancini, R; La Manna, G
abstract
2018
- Rimozione di fibroblast growth factor 23 (FGF23) nel paziente in emodialisi: tecniche dialitiche a confronto
[Abstract in Rivista]
Guglielmo, C; Angeletti, A; Donadei, C; Tondolo, F; Natali, T; Scrivo, A; Croci Chiocchini, Al; Donati, G; La Manna, F
abstract
2018
- Sodium Prescription in the Prevention of
Intradialytic Hypotension: New Insights into an Old Concept?
[Articolo su rivista]
Donati, G; Ursino, M; Spazzoli, A; Natali, N; Schillaci, S; Conte, D; Angeletti, A; Croci Chiocchini, Al; Capelli, I; Baraldi, O; La Manna, G
abstract
Background: Sodium prescription in patients with intradialytic hypotension remains a challenge for the attending nephrologist as it increases dialysate conductivity in hypotension-prone patients, thereby adding to dietary sodium. Methods: New sodium prescription strategies are now available, including the use of a mathematical model to compute the sodium mass to be removed during dialysis as a physiological controller. Results: This review describes the sodium load of patients with end-stage renal disease on chronic hemodialysis and discusses two strategies to remove excess sodium in patients prone to intradialytic hypotension, namely Profiled hemodialysis and the HFR Aequilibrium System. Conclusion: The Profiled hemodialysis and Aequilibrium System trials both proved effective in counteracting intradialytic hypotension.
2017
- A Comparison of Two Surgical Techniques for the Second Stage of Brachiobasilic Arteriovenous Fistula Creation
[Articolo su rivista]
Mauro, Raffaella; Pini, Rodolfo; BIANCHINI MASSONI, Claudio; Donati, Gabriele; Faggioli, Gianluca; Gargiulo, Mauro; Freyrie, Antonio; LA MANNA, Gaetano; Stella, Andrea
abstract
Two-stage transposed brachiobasilic arteriovenous fistula is a common procedure after brachiobasilic fistula (BBF) creation. Different techniques can be used for basilic vein transposition but few comparative literature reports are available. The aim of our study was to compare two different techniques for basilic vein transposition. The first maintains the BBF anastomosis and the basilic vein is placed in a subcutaneous pocket (BBAVF). The second transects the basilic vein at the BBF anastomosis and tunnels it superficially, with a new BBF in the brachial artery (BBAVFTn). From 2009 to 2014, all patients who underwent basilic vein superficialization were treated by one of the two techniques, recorded in a dedicated database and retrospectively reviewed. The surgeon chose the technique on the basis of personal preference. The two techniques were compared in terms of perioperative complications, length of hospital stay, time of cannulation, ease of cannulation, and long-term patency. Eighty patients were included in the study: 40 (50%) BBAVF and 40 (50%) BBAVFTn. Length of hospital stay was similar in the two groups (median [interquartile range-IQR] 3(2) [BBAVF] vs. 2(1) [BBAVFTn], P=0.52, respectively). BBAVFTn was associated with a lower hematoma incidence (1/40 [2.5%] vs. 15/40 [37.5%], P=0.01), shorter first cannulation time (median IQR: 11(10) vs. 23(8) days, P=0.01) and easier cannulation compared with BBAVF (32/40 [80%] vs. 15/40 [37.5%], P<0.001). Median (IQR) follow-up was 16(7) months. No statistical differences in terms of primary and assisted primary patency were found in BBAVFTn vs. BBAVF (at 24 months 91(5) vs. 71(7), P=0.21 and 93(6) vs. 78(8), P=0.33, respectively). Patients who underwent BBAVFTn surgery showed fewer surgical complications, better dialytic performance, and easier cannulation compared with those submitted to BBAVF.
2017
- Acute Myeloma Kidney: free light chains removal associated with chemotherapy for patients and kidney survival
[Abstract in Rivista]
Zappulo, F; Ullo, I; Bruno, P; Bini, C; Scrivo, A; Croci Chiocchini, Al; Donati, G; Zamagni, E; Mancini, R; Cavo, M; La Manna, G
abstract
INTRODUCTION. Renal failure remains a principal cause of morbidity and mortality for patient with multiple myeloma. Among renal manifestation casts nephropathy (Myeloma Kidney) represents the most common. The aim of this study is to assess the efficacy and safety of the extracorporeal removal of free light chains by means of hemodialysis with double filter application in patients with Acute Myeloma Kidney associated with different schemas of chemotherapy.
METHODS. Fourteen patients (M/F = 11/ 3) were considered in the study. Acute Myeloma Kidney affected all these patients. Ten patients underwent renal biopsy and 9 cases of myeloma cast nephropathy were diagnosed. The median age of the patients was 72 years (range ). Every patient underwent the chemotherapy together with the extracorporeal treatment for the removal of free light chains by using double filter. Hemodialytic treatments were scheduled three times a week and the hemodialysis dose was not related to the degree of the renal failure but to the removal of free light chains. The dialysis filter used were characterized by high adsorbitive properties: PMMA filter (polymethylmetacrylate; Filtryzer BK-F 2.1 m2 surface area) cut-off 20,000 daltons; PEPA filter (polyester polymer alloy FDX 210-GW, 2.1 m2 surface area) cut-off 35,000 daltons. Each dialysis session lasted 4 hours. Low molecular weight heparin was used as anticoagulation. During each session two dialyzers were used and the substitution of the filter was carried out at the second hour of the hemodialysis session. For each session the reduction rate of free light chains was calculated. Urine output, hemoglobin, platelets, white blood cell, renal function and electrolytes were assessed.
RESULTS. Average number of dialytic session was 10. Median Reduction Rate for free light chains was 25 % (range 2.4% - 69%). There was no statistical significant difference in FLC reduction rate between PEPA double filter and PMMA double filter (median reduction rate 53% vs. 38%). Six patient involved in the study died because of the complications of multiple myeloma (infections, bone fractures, chronic kidney disease). They all required chronic hemodialysis. Eight patients survived: among these 6 restored their renal function and 2 required chronic hemodialysis treatment.
DISCUSSION. Early removal of free light chains in patient with renal involvement associated with specific chemotherapy is a predictive factor of recovery of renal function and that the recovery of renal function is associated to a best outcome of the patient. The use of an extracorporeal treatment based on substitution of filter at the second hour of the dialytic session was assessed. The two types of filters (PMMA and PEPA) didn’t show statistical differences.
2017
- Coupled Plasma Filtration Adsorption Application for Liver and Thyroid Toxins
[Articolo su rivista]
Donati, G; Capelli, I; Croci Chiocchini, Al; Natali, N; Scrivo, A; La Manna, G
abstract
Coupled plasma filtration and adsorption (CPFA) is a detoxification system that combines a plasma adsorption circuit and a continuous renal replacement therapy circuit. Its main application is for sepsis and septic shock with or without acute renal failure. Several recent studies have suggested that CPFA can reduce the mortality when the volume of plasma absorbed on the styrenic resin is at least >0.18 L/kg/day. At present, new applications for CPFA are under investigation, also in patients without significant kidney failure. We report here a successful case of CPFA use during acute liver failure, with a complete recovery of liver function in a patient after severe cholangitis and relapsing hemolytic anemia. The resin enabled the removal of bilirubin and protein-bound toxins, while the hemofilter removed the hydrophilic toxins such as ammonia and non-protein-bound toxins as free bilirubin. We also describe a second case of CPFA application during thyrotoxicosis to achieve free triiodothyronine (FT3) and free thyroxin (FT4) adsorptions. The CPFA efficacy seems to exceed that obtained by plasma exchange (PEX) as to FT3 and FT4 adsorptions. The resin allowed the adsorption of FT3 and FT4. The role of the hemofilter is to enhance the hemodynamic tolerance of the extracorporeal treatment and remove water-soluble toxins. The reduced duration of CPFA treatments, in case of normal renal function, is confirmed by the assessment of the resin cartridge saturation. Thus, multipurpose CPFA can play a role in the case of resistance to current medical therapy or as a bridge to liver transplantation or thyroidectomy.
2017
- Coupled plasma filtration and adsorption (CPFA) for extracorporeal detoxification during acute or acute on chronic liver failure
[Abstract in Rivista]
Ullo, I; Zappulo, F; Bini, C; Bruno, P; Scrivo, A; Donati, G; Bolondi, L; Piscaglia, F; Simoni, P; La Manna, G
abstract
INTRODUCTION: CPFA is currently used in the treatment of severe sepsis with the intention of removing the proinflammatory mediators from the systemic circulation. Some evidence exist about the bilirubin adsorbing ability of the neutral styrenic resin which is part of the extracorporeal circuit of CPFA. The aim of this study is to assess efficacy and safety of CPFA in extracorporeal detoxification of liver toxins in patients affected by acute or acute-on-chronic liver failure.
METHODS: 9 patients (age 23 - 61 years) with acute (n = 3) or acute-on-chronic (n = 6) liver failure were enrolled. A total of 22 CPFA treatments were carried out. Each CPFA treatment lasted 6 hours. Unfractionated heparin was used as anticoagulation of the extracorporeal circuit in 7 patients; citrate anticoagulation with the concomitant infusion of calcium chloride in 2 of them. The number of treatment for each patient was established on his/her clinical status. The reduction ratios per session of bilirubin and bile acids were considered. Hemoglobin, platelets, white blood cells, coagulation tests, urea, creatinine, and electrolytes were also checked on starting CPFA and at the end of CPFA, as biocompatibility measures.
RESULTS: All sessions were well tolerated by the patients. Alcohol was the most common etiology of the liver injury (n = 6), 1 patient was affected by acute cholangitis and Fisher-Evans syndrome, 1 had a viral etiology, and 1 patient had a postoperative jaundice. Median reduction rate per session for total bilirubin was 28% (range 2.2 – 40); for direct bilirubin was 31.4 (range 8.5 – 48.6); for indirect bilirubin was 29.1% (range 6.6 – 65); for bile acids was 30.6% (16.7 – 59.6); for lactic acid was 30% (range -57.2%-55.6%). In six out of nine patients was observed a recovery of liver function. At one year of follow-up 2 patients died during the hospitalization; 6 patients are followed like outpatients and 1 of them is no more in the waiting list for the transplant; the last one is in course of treatment.
CONCLUSIONS: Although CPFA is a non-standardized technique for the liver depuration, its use in patients with acute or acute-on-chronic liver failure has shown favorable effects on safety and efficacy in terms of detoxification. Thus it is considerable a “bridge technique” toward the liver transplant and the recovery of basal liver function.
2017
- Dialyzability of Oxycodone and Its Metabolites in Chronic Noncancer Pain Patients with End-Stage Renal Disease
[Articolo su rivista]
Samolsky Dekel, Bg; Donati, G; Vasarri, A; Croci Chiocchini, Al; Gori, A; Cavallari, G; Di Nino, G; Mercolini, L; Protti, M; Mandrioli, R; Melotti, Rm; La Manna, G
abstract
Objectives: Opioids are the preferred analgesic drugs to treat severe chronic pain conditions among dialysis patients; however, knowledge about their dialyzability features is limited. Oxycodone is increasingly used for the treatment of chronic pain conditions as oral controlled release (CR) tablets; however, evidence about this drug and its metabolites' dialyzability is lacking. Methods: We assessed, during 4-hour dialysis sessions, the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in n = 20 chronic pain patients with end-stage renal disease who were stably treated with oral CR oxycodone. Chromatographic techniques were used to evaluate the studied compounds' plasma concentrations at three different time points during dialysis. Results: Mean plasma concentrations of oxycodone and noroxycodone in the sample showed an overall reduction trend over time, but it was less enhanced for noroxycodone. Mean reduction in oxycodone and noroxycodone arterial concentrations was significant and higher with HDF (54% and 27%, respectively) than with HD (22% and 17%, respectively). Analysis of the regression of these compounds' clearance on their increasing arterial concentration showed a more stable and linear clearance prediction with HDF (roughly 85 mL/min); with HD, for increasing arterial concentration, clearance of oxycodone decreased while noroxycodone clearance increased. Discussion: While no oxymorphone or noroxymorphone metabolites were detected, limited dialyzability of oxycodone and noroxycodone was documented along with insignificant postdialysis pain increment. This evidence will contribute toward considerations as to the safety of the use of oxycodone in dialysis patients in the future.
2017
- Doppia Filtrazione a cascata (DFPP) nel trattamento del rigetto umorale di trapianto di rene: case report
[Abstract in Rivista]
Aiello, V; Natali, N; Comai, G; Capelli, I; Donati, G; D'Arcangelo, Liviano; G, ; La Manna, G.
abstract
2017
- Extreme placement of a tunneled cuffed catheter for hemodialysis
[Articolo su rivista]
Donati, Gabriele; Gargiulo, Mauro; Ullo, Ines; Mauro, Raffaella; Cuna, Vania; Capelli, Irene; Cappuccilli, Maria; D'Arcangelo, Giovanni Liviano; LA MANNA, Gaetano
abstract
Not applicable
2017
- Functional Abnormalities and Thyroid Nodules in Patients with End-stage Renal Disease
[Articolo su rivista]
Cuna, V; Menghi, V; Comai, G; Cappuccilli, M; Cianciolo, G; Raimondi, C; Grammatico, F; Donati, G; Baraldi, O; Capelli, I; La Manna, G.
abstract
BACKGROUND/AIM:
Clinical and subclinical hypothyroidism is more common in patients with end-stage renal disease (ESRD) than in the general population. Patients with ESRD with hypothyroidism are more susceptible to cardiovascular disease, with an increased risk of mortality than those with normal thyroid function. Moreover, these patients have higher incidence of benign and malignant nodules.
PATIENTS AND METHODS:
This was a retrospective study on 2,147 patients with ESRD on the renal transplant waiting list between 2000 and 2015 aimed at identifying the presence of hypothyroidism and associated variables.
RESULTS:
Hypothyroidism was detected in 437/2,147 (20.3%) patients, 289 of them having the subclinical form. Cardiovascular disease and older age were significantly associated with hypothyroidism, and autosomal polycystic kidney disease was correlated to goiter (p<0.001).
CONCLUSION:
Thyroid abnormalities, particularly hypothyroidism with nodules, should be investigated in patients with ESRD on a waiting list for renal transplant to control cardiovascular complications and cancer risk.
2017
- Identification of expanded T-cell clones by spectratyping in nonfunctioning kidney transplants
[Articolo su rivista]
Cappuccilli, Maria; Donati, Gabriele; Comai, Giorgia; Baraldi, Olga; Conte, Diletta; Capelli, Irene; Aiello, Valeria; Pession, Andrea; LA MANNA, Gaetano
abstract
Background: The aim of this study was the application of complementarity-determining region-3 spectratyping analysis to determine T-cell-repertoire complexity and to detect T-cellclone expansion, as a measure of immune response in nonfunctioning kidney transplants (group hemodialysis-transplant [HD-Tx]), nontransplanted dialysis patients (group hemodialysis [HD]), and normal subjects as controls (group C). Patients and methods: Analysis of T-cell receptor (TCR) diversity by spectratyping was applied to peripheral blood samples collected from 21 subjects: eight in group HD-Tx, seven in group HD, and six in group C. Results: Considering the extent of the skew in TCR variable region repertoires as a measure of clonal T cells, we found that the number of altered spectra showed a progressive increase from normal subjects to dialysis patients and to nonfunctioning kidney transplants, respectively. Healthy subjects had the lowest number of altered spectra, and patients with nonfunctioning kidney transplants the highest. Differences were significant for group HD-Tx vs group C (P=0.017) and group HD vs group C (P=0.015), but not between nonfunctioning kidney-transplant recipients and dialysis patients (group HD-Tx vs group HD). Conclusion: Although dialysis appears to be a weaker trigger for clonal expansion of T cells, our data suggest that the utilization of complementarity-determining region-3 spectratyping analysis of the TCR repertoire might be useful to monitor specific immunoactivation in patients before and after kidney transplantation.
2017
- Mathematical Model of Potassium Profiling in chronic Dialysis
[Articolo su rivista]
Ursino, M; Donati, G
abstract
Potassium balance is a difficult task in hemodialysis: low potassium in the dialysate is associated
with a high risk of sudden cardiac death, whereas excessive dialysate potassium
may provoke insufficient removal and hyperkalemia. A better understanding of the problem
can be achieved with the use of mathematical models of solute kinetics. This study is
aimed at presenting an improved model of solute kinetics and fluid shifts during hemodialysis.
It comprises a 2-compartment (intracellular and extracellular) description of sodium,
potassium, and urea, including volume fluid shifts induced by osmotic forces. Compared
with previous versions, the model also incorporates active Na + – K + transport across
the cellular membrane via the sodium-potassium pump. Simulations in chronic conditions,
concerning both a 4-h standard hemodialysis and the subsequent 20 h interdialytic
period, provide values of solute extracellular concentrations, fluid volumes, and potassium
Nernst potential, in agreement with literature. The model predicts that the active
Na + – K + transport decreases during the session (mainly due to a decrease in extracellular
potassium) but increases in the inter-dialytic period. Extracellular potassium exhibits a
rebound in the interdialytic phase, already evident in the first hours. The model also provides
preliminary testable predictions on the patterns of intracellular sodium and potassium
concentrations, which require further validation based on in vivo data. Particularly,
assuming no residual potassium removal from the organism, the intracellular K + concentration
assumes higher values in the chronic subject compared with the healthy basal
conditions. Finally, hemodialysis with profiled potassium (higher in the first half, reduced
in the second) is simulated, to point out the advantages compared with the standard session.
In perspective, the model can be used to optimize the dialysis treatment on the basis
of profiled dialysate concentrations and, with ad hoc in vivo measurements, to provide
deeper insight into the mechanisms of internal potassium balance.
2017
- Rimozione di medie molecole e anticoagulazione in emodialisi con membrane a medio cut-off: risultati preliminari di uno studio monocentrico
[Abstract in Rivista]
Bini, C; Ullo, I; Bruno, Pf; Zappulo, F; Scrivo, A; Croci Chiocchini, Al; Donati, G; La Manna, G
abstract
2017
- Seroprevalence of a “new” bacterium, Simkania negevensis, in renal transplant recipients and in hemodialysis patients
[Articolo su rivista]
Angeletti, Andrea; Biondi, Roberta; Battaglino, Giuseppe; Cremonini, Eleonora; Comai, Giorgia; Capelli, Irene; Donati, Gabriele; Cevenini, Roberto; Donati, Manuela; LA MANNA, Gaetano
abstract
Background: Simkania negevensis is an obligate intracellular bacterium belonging to the family Simkaniaceae in the Chlamydiales order. It is considered an ubiquitous microorganism and aquatic environments may be involved as a source of infection for humans. It was just isolated in samples from domestic water supplies and from mains water supplies, like spa water or swimming pool water, confirming its ability to resist to the common chlorination treatments. Evidence indicates a possible role of the microorganism in respiratory tract infections, in gastroenteric disorders and in the pathogenesis of cardiovascular disease, furthermore it has hypothesized that it could play a role in lung transplant rejection. Prevalence and possible effects in nephrology are unknown. Methods: We examined the occurrence of Simkania negevensis in two differents populations, both characterized by a high susceptibility to infectious complications: 105 hemodialysis patients, 105 renal transplant recipients and 105 healthy subjects through the IgG and IgA response to Simkania negevensis in their sera. Serum antibodies to Simkania negevensis were detected by a homemade ELISA performed according to the Kahane’s protocol. Furthermore water samples from hemodialytic circuit were collected, to evaluate Simkania negevensis resistance to usual treatment of disinfection. Results: Our results were unexpected, showing a higher seroprevalence of antibodies against Simkania negevensis in the hemodialysis patients, compared to renal transplant patients (IgG 22% vs 9% - IgA 9% vs 3%). S. negevensis was isolated in all water samples analyzed. Conclusions: Our study detected for the first time the occurrence of S. negevensis in hemodialysis and in renal transplant patients. Our findings suggest that water used in hemodialysis could be one of the possible sources of S. negevensis infection, without clinical involvement risk for patients.
2017
- Urinary neutrophil gelatinase-associated lipocalin is a biomarker of delayed graft function after kidney transplantation
[Articolo su rivista]
Capelli, I; Baraldi, O; Comai, G; Sala, E; Cappuccilli, M; Donadei, C; Cuna, V; Angelini, Ml; Donati, G; La Manna, G
abstract
Background: Acute kidney injury occurring after kidney transplantation frequently leads to delayed graft function with detrimental long-term effects on graft survival. Neutrophil gelatinase- associated lipocalin (NGAL) has been validated as a biomarker for posttransplant acute kidney injury. This observational study aimed to assess the effectiveness of urinary NGAL as a predictive marker of delayed graft function. Materials and methods: Forty-three consecutive patients who received renal transplant were included in the study. Urine samples were collected before transplant (if available) and at days 1, 3, 7, 14, and 30 after transplant, and urinary NGAL levels were quantified by enzyme-linked immunosorbent assay. Results: Urinary NGAL progressively decreased after transplant in patients with both delayed and immediate graft function. However, urinary NGAL concentration remained significantly higher in the presence of delayed graft function in the first 14 days after transplant. The area under the receiver operating characteristic curve showed that the ability of urinary NGAL to predict delayed graft function was accurate at 1st and 3rd days after transplant. Conclusion: The relative decrease of urinary NGAL concentration rather than its absolute value may be relevant to predict delayed graft function after renal transplant. In particular, urinary NGAL area under the curve for 3 days seems to be a more valuable parameter of decision making in the early posttransplant period.
2016
- Comparison of Two Parathyroid Hormone Assays in Hemodialysis Patients
[Articolo su rivista]
Donati, G; Cianciolo, G; Capelli, I; Baraldi, O; Gambaretto, C; Demelas, V; Marchetti, A; La Manna, G
abstract
Parathyroid hormone (PTH) determination is essential for the diagnosis of renal osteodystrophy, but differences between the laboratory assays can lead to different therapies. This study compared the new Tosoh ST AIA-Pack Intact PTH assay (Tosoh Bioscience, San Francisco, CA, USA) with the Elecsys Intact PTH Roche assay (Roche Diagnostics GmbH, Mannheim, Germany), currently considered the gold standard. Nineteen chronic stable hemodialysis patients were enrolled to check PTH levels with the two assays. Median age was 71 years (range 26–84), M/F = 10/9. Blood samples were taken before the start of the same midweek dialysis session. Two blood vacuettes were collected and immediately transported to the central laboratory. The median PTH value was 268 (range 35–901 pg/dL) with the AIA-Pack versus 184 (range 39–552 pg/dL) with Elecsys. The Wilcoxon test showed a significant difference between the two methods (P < 0.0001). AIA-Pack showed a delta value of +38% in comparison with Elecsys and a median bias of 27.4%. For PTH values <150 pg/dL, nine patients were detected with AIA-Pack (47.4%) versus nine patients detected with Elecsys (47.4%). For PTH values between 150 and 300 pg/dL, six patients were detected with AIA-Pack (31.6%) versus four patients with Elecsys (21.0%). For PTH values >300 pg/dL four patients were detected with AIA-Pack (21.0%) versus six patients with Elecsys (31.6%). The two assays showed no differences for each of the three PTH ranges considered. The two PTH assays tested are different and the attending physician should be aware of the differences when patients change their dialysis facility.
2016
- Hematopoietic Cell and Renal Transplantation in
Plasma Cell Dyscrasia Patients
[Articolo su rivista]
Baraldi, O; Grandinetti, V; Donati, G; Comai, G; Battaglino, G; Cuna, V; Capelli, I; Sala, E; La Manna, G
abstract
Gammopathies, multiple myeloma, and amyloidosis are plasma dyscrasias characterized by clonal proliferation
and immunoglobulin overproduction. Renal impairment is the most common and serious complication
with an incidence of 20–30% patients at the diagnosis. Kidney transplant has not been considered feasible in
the presence of plasma dyscrasias because the immunosuppressive therapy may increase the risk of neoplasia
progression, and paraproteins may affect the graft. However, recent advances in clinical management of
multiple myeloma and other gammopathies allow considering kidney transplant as a possible alternative to
dialysis. Numerous evidence indicates the direct relationship between hematological remission and renal function
restoring. The combination of kidney and hematopoietic cell transplant has been reported as a promising
approach to reestablish end-organ function and effectively treat the underlying disease. This review describes
current protocols used to perform kidney transplantation in patients with plasma dyscrasias.
2016
- Removal of free light chains in hemodialysis patients without multiple myeloma: A crossover comparison of three different dialyzers
[Articolo su rivista]
Donati, G; Moretti, Mi; Baraldi, O; Spazzoli, A; Capelli, I; Comai, G; Marchetti, A; Sarma, M; Mancini, R; La Manna, G
abstract
Background: Immunoglobulin light chains are classified as middle molecule uremic toxins able to interact with B lymphocyte membranes leading to the activation of transmembrane signaling. The ensuing impairment of neutrophil function can contribute to the chronic inflammation state of uremic patients, and the increased risk of bacterial infections or vascular calcifications. The aim of this crossover observational study was to assess the difference in free light chain removal by three different hemodialysis filters in patients not affected by multiple myeloma. Methods: Free light chain removal was compared in the polymethylmethacrylate (PMMA) membrane Filtryzer BK-F, the polyphenylene HFR17 filter and the conventional polysulfone filter F7HPS. Twenty chronic hemodialysis patients were enrolled: mean age was 67.7 ± 17.0 years, M/F = 14/6, dialysis vintage (months) 25.5 ± 32.0. The patients were randomized into two groups of treatment lasting 6 weeks each. The dialysis sessions checked were the midweek sessions and the blood was drawn at times 0, 120' and 240'. Kappa (k) and lambda (λ) light chain levels, β2microglobulin (β2M), C reactive protein (CRP) and albumin were checked. Results: K light chain levels were 345.0 ± 100.0 mg/L, λ light chains were 121.4 ± 27.0 mg/L. The values of k light chains at times 120' and 240' were significantly lower with PMMA and HFR17 than those obtained with F7. The reduction ratio per session (RRs) for k light chains was 44.1 ± 4.3% with HFR17, 55.3 ± 3.4% with PMMA, 25.7 ± 8.3% with F7 (p = 0.018). The RRs for λ light chains was 30.3 ± 2.9% with HFR17, 37.8 ± 17.3% with PMMA, 14.0 ± 3.9% with F7 (p = 0.032). As to β2M, RRs was 42.4 ± 3.2% with HFR17 vs. 33.9 ± 2.8% with PMMA vs. 6.3 ± 1.9% with F7 (p = 0.022). The three filters tested showed no differences in CRP or albumin levels. Conclusion: In terms of light chain and β2M removal, the PMMA and on-line HFR filters are similar and both are significantly more effective than the F7 filter in chronic dialysis patients. Trial registration: The present trial was registered retrospectively (NCT02950389, 31/10/2016).
2015
- Accessi vascolari estremi in emodialisi: posizionamento chirurgico di catetere di Tesio in vena iliaca comune destra
[Abstract in Atti di Convegno]
Ullo, I; Capelli, I; Cuna, V; Natali, N; Gambaretto, C; Mauro, R; Muccini, N; Freyrie, A; Casadei, A; Cianciolo, G; Donati, G; Gargiulo, M; La Manna, G
abstract
2015
- Donor/recipient delta age: A possible risk for arterial stenosis in renal transplantation
[Articolo su rivista]
Pallotti, G; Donati, G; Capelli, I; Baraldi, O; Comai, G; Agati, P; Nichelatti, M; Cianciolo, G; La Manna, G
abstract
Different arterial wall properties can significantly increase the risk of blood turbulent fluxes leading to complications such as atherosclerosis. Since the mechanical properties of arterial vessels are influenced by age, we investigated, in a retrospective study, the effects on renal artery stenosis of an age difference >15 years between donor and recipient in a cohort of 164 patients undergoing renal transplantation between 1981 and 1991. The age difference between donor and recipient was ≤15 years in 87 patients (53.0%) (Group A) and >15 years in 77 patients (47.0%) (Group B, p=ns). None of the Group A patients developed an anastomotic arterial stenosis, whereas 8/77 Group B patients (10.4%) had an anastomotic arterial stenosis (p<0.001). This study shows that an age difference >15 years is significantly linked to the risk of developing arterial stenosis after renal transplantation. Indeed, different wall properties can significantly increase the risk of generation of blood turbulent fluxes and involve, in the arterial vessels, the development of complications such as atherosclerosis.
2015
- Effetti della emodiafiltrazione on-line sulla concentrazione plasmatica dell'ossicodone in pazienti con dolore moderato severo: risultati preliminari
[Abstract in Atti di Convegno]
Croci Chiocchini, Al; Samolsky Dekel, Bg; Vassarri, A; Cavallari, G; Donati, G; Marchetti, A; Mercolini, L; Mandrioli, R; Fabbian, F; Storari, A; Manfredini, R; La Manna, G
abstract
2015
- Hepatorenal syndrome: Update on diagnosis and treatment
[Articolo su rivista]
Baraldi, O; Valentini, C; Donati, G; Comai, G; Cuna, V; Capelli, I; Angelini, Ml; Moretti, Mi; Angeletti, A; Piscaglia, F; La Manna, G
abstract
Acute kidney injury (AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome (HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.
2015
- Hypoacusia and chronic renal dysfunction: new etiopathogenetic prospective
[Articolo su rivista]
Cuna, Vania; Battaglino, Giuseppe; Capelli, Irene; Sala, Elisa; Donati, Gabriele; Cianciolo, Giuseppe; LA MANNA, Gaetano
abstract
The oto-renal axis describes the relationship between hearing loss and chronic nephropathy. Several clinical studies have investigated the incidence of hypoacusia in patients affected by chronic renal failure, but the etiopathogenic mechanism is not fully understood. In this context, there is a general agreement that hypoacusia is usually neurosensorial and the cochlea is the main site of lesion. Inner ear and kidney present an interesting similarity in terms of structure and function. In particular, the presence of pericytes and podocytes in inner ear and in glomeruli, respectively, evidence common characteristics of microcirculation. Defects in microcirculation in the inner ear mainly cause an electrolytic imbalance with the consequent impairment of endocochlear potential and sensorial transduction. In kidney, microvessels and podocytes contribute to glomerular stability and function. Microcirculation dysfunction often occurs during the inflammatory status, frequently reported both in chronic nephropathy and in cardiovascular disease. Clinical studies aimed to describe the hypoacusia in nephropathy patients are summarized. Then, in order to speculate the etiopathogenic mechanism of hearing loss in chronic nephropathy, we report the similarities between pericytes and podocytes in inner ear and glomeruli microcirculation in terms of structure and function. Finally, we propose a model in which inflammation plays an important role in oto-renal dysfunction. Our model proposes the inflammation, as an etiopathogenic mechanism of hypoacusia in chronic nephropathy and the defective cross-talk between pericytes/podocytes and vascular endothelium, as the initial event of the degenerative process.
2015
- Impact of Duplex Ultrasound
Surveillance Program on Patency
of Prosthetic Arteriovenous
Graft for Hemodialysis:
A Single-Center Experience
[Articolo su rivista]
Mauro, R; Pini, R; Faggioli, G; Donati, G; Facchini, Mg; D’Amico, R; 1 Freyrie, A; Gargiulo, M; Stella, A
abstract
Background: Arteriovenous prosthetic graft (AVG) is an alternative hemodialysis vascular access
choice; however, its performance is limited by a high rate of thrombosis. The aim of the
study was to compare the long-term secondary patency of AVG in patients undergoing a surveillance
program and the long-term secondary patency of AVG in patients with clinical assessment
of AVG malfunction.
Methods: From 2009 to 2012, all patients with AVG entered in a duplex ultrasound (DUS) surveillance
program (at 3 months and then every 6 months postoperatively) to assess AVG malfunction
and/or stenosis (stenosis >50% and blood flow decrease [<600 mL/min]) and
eventually treated by endovascular revascularization. AVG long-term patency in the surveillance
group was compared with that obtained in a historical control group in which the malfunction was
clinically detected. As secondary end point, the central vein catheter (CVC) placement after AVG
thrombosis was compared in the 2 groups.
Results: Sixty patients were included in the study, 33 (55%) in the surveillance program and 27
(45%) in the historical group. The 2 groups had similar clinical characteristics and follow-up (59,
interquartile range [IQR]: 45 vs. 56 [IQR, 40 months], P ¼ 0.32). Fifteen (45%) AVG malfunctions
were detected in the surveillance group and successfully treated (10 [66.6%] angioplasty
and 5 [33.4%] angioplasty stenting). No malfunction was detected in the historical control group.
By KaplaneMeier analysis, the 5-year secondary patency was significantly higher in the surveillance
group compared with the historical group: 42 ± 13% vs. 9 ± 7%, P ¼ 0.03. By Cox analysis,
the DUS surveillance was a significantly protective factor for AVG thrombosis, otherwise the use
of CVC before the AVG and diabetes mellitus were AVG thrombosis risk factors. The CVC
placement was significantly lower in the surveillance group compared with the historical group
(14.0% vs. 42.2%, P ¼ 0.02).
Conclusions: The DUS surveillance allows a greater secondary patency compared with a clinical
evaluation and reduces CVC placement rate.
2015
- PTFE Grafts Versus Tunneled Cuffed Catheters for Hemodialysis: Which Is the Second Choice When Arteriovenous Fistula Is Not Feasible?
[Articolo su rivista]
Donati, G; Cianciolo, G; Mauro, R; Rucci, P; Scrivo, A; Marchetti, A; Giampalma, E; Golfieri, R; Panicali, L; Iorio, M; Stella, A; La Manna, G; Stefoni, S
abstract
Vascular access-related complications are still one of the leading causes of morbidity in hemodialysis patients. The aim of this study was to compare polytetrafluoroethylene (PTFE) grafts versus tunneled cuffed permanent catheters (TCCs) in terms of vascular access and patients' survival. An observational study was carried out with a 2-year follow-up. Eighty-seven chronic hemodialysis patients were enrolled: 31 with a PTFE graft as vascular access for hemodialysis versus 56 with a TCC. Patients' mean age was 63.8 ± 14.6 (grafts) versus 73.5 ± 11.3 years (TCCs), P = 0.001. Significantly more patients with TCC had atrial fibrillation than patients with grafts (30.3% versus 6.5%, P = 0.01). In an unadjusted Kaplan-Meier analysis, median TCC survival at 24 months was 5.4 months longer than that of PTFE grafts but not significantly (log-rank test = 1.3, P = ns). In a Cox regression analysis adjusted for age, gender, number of previous vascular accesses, diabetes, atrial fibrillation, smoking, and any complication, this lack of significant difference in survival of the vascular access between TCC and PTFE groups was confirmed and diabetes proved to be an independent risk factor for the survival of both vascular accesses considered (P = 0.02). In an unadjusted Kaplan-Meier analysis, a higher mortality was found in the TCC group than in the PTFE group at 24 months (log-rank test = 10.07, P < 0.01). The adjusted Cox regression analysis showed that patients with TCC had a 3.2 times higher risk of death than patients with PTFE grafts. When an arteriovenous fistula (AVF) is not possible, PTFE grafts can be considered the vascular access of second choice, whereas TCCs can be used when an AVF or PTFE graft are not feasible or as a bridge to AVF or PTFE graft creation.
2015
- Rimozione delle catene leggere libere in pazienti in emodialisi cronica. Efficacia di tre differenti filtri dializzatori
[Abstract in Atti di Convegno]
Moretti, Mi; Spazzoli, A; Schillaci, R; Gambaretto, C; Sarma, M; Mancini, R; Capelli, I; Donati, G; Marchetti, G; La Manna, G
abstract
2014
- Extracorporeal Detoxification for Hepatic Failure Using Molecular Adsorbent Recirculating System: Depurative Efficiency and Clinical Results in a Long-Term Follow-Up
[Articolo su rivista]
Donati, G; La Manna, G; Cianciolo, G; Grandinetti, V; Carretta, E; Cappuccilli, M; Panicali, L; Iorio, M; Piscaglia, F; Bolondi, L; Colì, L; Stefoni, S
abstract
Acute liver failure and acute-on-chronic liver failure still show a poor prognosis. The molecular adsorbent recirculating system (MARS) has been extensively used as the most promising detoxifying therapy for patients with these conditions. Sixty-four patients with life-threatening liver failure were selected, and 269 MARS treatments were carried out as a bridge for orthotopic liver transplantation (OLT) or for liver function recovery. All patients were grouped according to the aim of MARS therapy. Group A consisted of 47 patients treated for liver function recovery (median age 59 years, range 23-82). Group B consisted of 11 patients on the waiting list who underwent OLT (median age 47 years, range 32-62). Group C consisted of 6 patients on the waiting list who did not undergo OLT (median age 45.5 years, range 36-54, P = 0.001). MARS depurative efficiency in terms of liver toxins, cytokines, and growth factors was assessed together with the clinical outcome of the patients during a 1-year follow-up. Total bilirubin reduction rate per session (RRs) for each MARS session was 23% (range 17-29); direct bilirubin RRs was 28% (21-35), and indirect bilirubin RRs was 8% (3-21). Ammonia RRs was 34% (12-86). Conjugated cholic acid RRs was 58% (48-61); chenodeoxycholic acid RRs was 34% (18-48). No differences were found between groups. Hepatocyte growth factor (HGF) values on starting MARS were 4.1 ng/mL (1.9-7.9) versus 7.9 ng/mL (3.2-14.1) at MARS end (P < 0.01). Cox regression analysis to determine the risk factors predicting patient outcomes showed that age, male gender, and Sequential Organ Failure Assessment score (but not Model for End-stage Liver Disease score) were factors predicting death, whereas the number of MARS sessions and the ΔHGF proved protective factors. Kaplan-Meier survival analysis was also used; after 12 months, 21.3% of patients in Group A survived, while 90.9% were alive in Group B and 16.7% in Group C (log rank = 0.002). In conclusion, MARS was clinically well tolerated by all patients and significantly reduced hepatic toxins. Better survival rates were linked to an OLT program, but patients' clinical characteristics on starting MARS therapy were the main factors predicting survival. The role of HGF should be evaluated in larger clinical trials.
2013
- Anti-neutrophil cytoplasmic autoantibody-associated vasculitis in the very elderly: a 90-year-old iron lady
[Articolo su rivista]
Donati, Gabriele; Cianciolo, Giuseppe; LA MANNA, Gaetano; Fusconi, M; Raimondi, Concettina; Grandinetti, Valeria; KWIN KWEDI, CHIMENE HERMINE; Righi, S; Ferri, S; Stefoni, Sergio
abstract
Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides are characterized by blood vessel inflammation resulting in organ dysfunction or in the patient’s death. The peak of incidence was observed in patients over 75 years of age. We describe an unusual ANCA vasculitis presentation in a 90-year old patient admitted to the emergency room for severe dyspnea, oliguria and a recent onset cutaneous purple rush. Plain chest radiography disclosed pulmonary edema and diffuse bilateral reticulonodular infiltrates. Creatinine was 7.3 mg/dl, azotemia 202 mg/dl, hemoglobin 6.8 g/dl. CPAP (continuous positive airway pressure), furosemide 20 ml/h, nitroglycerin 8γ/kg/min, blood transfusions and i.v. methylprednisolone 60 mg/day were administered. On day 1 a femoral venous catheter was placed and hemodialysis (HD) treatment started for acute renal failure. The patient underwent 13 HD sessions without heparin (EVAL dialyzer). On day 7 renal function had still not recovered and a new plain chest radiogram was unchanged. Proteinase 3(PR3) ANCA were 81 IU/ml (ELISA), C-reactive protein (CRP) was 18 mg/dl, C3 42 mg/dl, C4 5 mg/dl. A high resolution computed tomography considering that the 53% of cases were managed with glucocorticoids alone. Nonetheless, Walsh et al’s metanalysis showed that patients who received a course of glucocorticoid therapy for more than 12 months suffered fewer relapses of ANCA vasculitis. In patients older than 80 years any immunosuppressive therapy is associated with a significantly lower risk of ESRD and death, but the rate of infections is higher than in younger patients. In our patient the CY dose related to the body surface area was reduced to 200 mg in view of age, risk of infection and renal failure, but glucocorticoid therapy was maintained. During the 2 year follow-up no infections were reported, the Birmingham vasculitis score was lower than 10 and reached the 50% reduction of the initial disease activity score recommended. A good outcome was obtained and it seems to be related both to CY and to the long-term maintenance therapy with glucocorticoids.
2013
- Effect of Vitamin D Receptor Activator Therapy on Vitamin D Receptor and Osteocalcin Expression in Circulating Endothelial Progenitor Cells of Hemodialysis Patients
[Articolo su rivista]
Cianciolo, Giuseppe; La Manna, Gaetano; Della Bella, Elena; Cappuccilli, Maria; Angelini, Ml; Dormi, Ada; Capelli, Irene; Laterza, Claudio; Costa, Roberta; Alviano, Francesco; Donati, Gabriele; Ronco, C; Stefoni, Sergio
abstract
Background: The effects of vitamin D receptor (VDR) and osteocalcin (OC) expression as well as VDR agonist (VDRA) therapy on circulating endothelial progenitor cells (EPCs) has not been elucidated yet. Methods: We therefore analyzed EPCs in 30 healthy controls and 82 patients undergoing dialysis (no VDRA therapy: 28; oral calcitriol: 30, and intravenous paricalcitol, PCTA: 24). The percentage of EPCs (CD34+/CD133-/KDR+/CD45-) expressing VDR or OC, and VDR and OC expression defined by mean fluorescence intensity (MFI) were analyzed using flow cytometry. The in vitro effect of VDRAs was evaluated in EPCs isolated from each patient group. Results: The percentage of VDR+ EPCs correlated positively with VDRA therapy and 25(OH)D, and negatively with diabetes, C-reactive protein, hemoglobin and osteopontin. VDR-MFI correlated positively with VDRA therapy, parathyroid hormone (PTH) and 25(OH)D, and negatively with diabetes and osteopontin. The percentage of OC+ EPCs correlated positively with the calcium score, PTH and phosphate, and negatively with 25(OH)D. OC-MFI correlated positively with calcium score, PTH, phosphate and hemoglobin, and negatively with albumin, 25(OH)D and osteopontin. Cell cultures from patients without VDRA therapy had the highest levels of calcium deposition and OC expression, which both significantly decreased following in vitro VDRA administration: in particular extracellular calcium deposition was only reduced by adding PCTA. Conclusions: Our data suggest that 25(OH)D serum levels and VDRA therapy influence VDR and OC expression on circulating EPCs. Since OC expression may contribute to vascular calcification, we hypothesize a putative protective role of VDRA therapy.
2013
- Survival of PTFE grafts vs. Tunneled cuffed Catheters (TCCs) for hemodialysis
[Abstract in Rivista]
Donati, G; Scrivo, A; Cianciolo, G; La Manna, G; Panicali, L; Rucci, P; Marchetti, A; Giampalma, E; Galaverni, Mc; Golfieri, R; Stefoni, S
abstract
2012
- Basics of sodium modelling on chronic hemodialysis
[Abstract in Rivista]
Grandi, F; Corazza, L; Donati, G; Stefoni, S.
abstract
2012
- Comparison of two laboratory assays for PTH determination in hemodialysis patients
[Abstract in Rivista]
Donati, G; Cianciolo, G; Angelini, Ml; Valentini, C; Panicali, L; Iorio, M; La Manna, G; Stefoni, S
abstract
Introduction. The comparison between the new Tosoh ST AIA-Pack Intact PTH assay and the Elecsys Intact PTH Roche assay was carried out to assess how different the new laboratory assay for Intact 1-84 PTH determination is in comparison with a common assay such as the Elecsys, which is very similar to the Allegro assay used for the NKF-DOQI statements.
Material and Methods.19 chronic stable hemodialysis patients were enrolled to check the PTH levels with the 2 assays. Median age was 71 (range 26-84 years), M/F = 10/9. Blood samples were taken before the start of the same midweek dialysis session. Two blood vacuettes were collected and immediately transported to the central laboratory.
Results. The median PTH value was 268 (range 35-1630 pg/dl) with the AIA-Pack vs. 184 (range 39-1225 pg/dl) with Elecsys (p=ns). AIA-Pack showed a Δ value of +38% in comparison to Elecsys and a median Bias of 27.4%. For PTH values < 150 pg/dl, 9 patients were detected with AIA-Pack (47.4%) vs. 9 patients detected with Elecsys (47.4%). For PTH values between 150 and 300 pg/dl, 6 patients were detected with AIA-Pack (31.6%) vs. 4 patients with Elecsys (21.0%). For PTH values >300 pg/dl 4 patients were detected with AIA-Pack (21.0%) vs. 6 patients with Elecsys (31.6%). A linear regression between the values of the two assays showed a good correlation (R = 0.9).
Conclusions. The two PTH assays that were tested are very similar, however the attending physician should be aware of the differences when the patient changes his/her dialysis facility.
2012
- EPC number and function is improved by VDRA treatment in hemodialysis patients
[Abstract in Atti di Convegno]
Angelini, Ml; Cianciolo, Giuseppe; LA MANNA, Gaetano; Cappuccilli, Maria; DELLA BELLA, Elena; Rum, I; Conte, Diletta; Cuna, Vania; Dormi, Ada; Todeschini, Paola; Donati, Gabriele; Costa, R; Bagnara, GIAN PAOLO; Stefoni, Sergio
abstract
2012
- Heparin infusion affects RANL/OPG system in hemodialysis patients: unfractioned heparin vs LMWH
[Abstract in Rivista]
Capelli, I; Cianciolo, G; La Manna, G; Donati, G; Cappuccilli, Ml; Cuna, V; Martelli, D; Iorio, M; Stefoni, S.
abstract
2012
- Improvement of cardiovascular stability during dialysis with HFR Aequilibrium: AIMS Study
[Abstract in Rivista]
Stefoni, S; Donati, G; Petitclerc, T; Colì, L; Feliciangeli, G; La Manna, G; Locatelli, F.
abstract
2012
- Sopravvivenza delle fistole protesiche in PTFE vs. i cateteri a permanenza tunnellizzati e cuffiati per emodialisi: esperienza di un singolo centro
[Abstract in Rivista]
Donati, G; Scrivo, A; Cianciolo, G; La Manna, G; Rucci, P; Marchetti, A; Mirelli, M; Mauro, R; Stella, A; Stefoni, S
abstract
2012
- Terapia con lantano carbonato in pazienti naive ed in pazienti resistenti al trattamento con chelanti del fosforo
[Abstract in Rivista]
Angelini, Ml; Cianciolo, G; La Manna, G; Donati, G; Iorio, M; Scrivo, A; Valentini, C; Grandinetti, V; Panicali, L; Capelli, I; Stefoni, S
abstract
2012
- Thrombosis of Tunneled-Cuffed Hemodialysis Catheters: Treatment With High-Dose Urokinase Lock Therapy
[Articolo su rivista]
Donati, G; Colì, L; Cianciolo, G; La Manna, G; Cuna, V; Montanari, M; Gozzetti, F; Stefoni, S.
abstract
Thrombosis-related malfunction of tunneled-cuffed central venous catheters (TCC) for hemodialysis (HD) currently leads to a high rate of untimely catheter removal. Urokinase (UK) therapy is used for TCC thrombosis/malfunction, but no consensus exists on the adequate dose to obtain thrombolysis. We selected 72 HD patients with TCC and a mean age and HD vintage of 74 years (range 65-87) and 36 months (range 12-61), respectively. All patients received warfarin therapy with a target international normalized ratio (INR) of 1.8-2.5. Coagulative assessment of the patients was obtained by checking the INR, activated partial thromboplastin time, fibrinogen, hemoglobin, and platelets. Sixty-five thrombotic events were recorded during a 3-year follow-up (median 0.3 events/patient/year). The patients selected were randomized into two groups according to a different thrombolytic therapy. Group A comprised 29 thrombotic events in 32 patients who received UK 25,000 IU in both arterial and venous lines of the TCC for each event. UK restored an adequate blood flow rate (BFR) for HD (≥ 250 mL/min) in 4/29 events (13.7%), whereas addition of 50,000 IU to both arterial and venous lines was required in 25/29 events (86.3%). For the same 25 events in the second HD session, a further 75,000 IU of UK was needed for each TCC lumen. Group B comprised 36 thrombotic events in 40 patients who received 100 000 IU of UK in the arterial and venous lumen of the TCC for each event. An adequate BFR was recovered in all events. In 12/36 events (33.3%), 100,000 IU UK for both lumens were needed in the second HD. In conclusion, group B patients obtained (i) a significantly better TCC patency than group A patients; (ii) a low UK administration in the following HD sessions; and (iii) no bleeding complications.
2011
- Effects of unfractioned heparin and low-molecular-weight heparin on osteoprotegerin and RANKL plasma levels in haemodialysis patients
[Articolo su rivista]
Cianciolo, Giuseppe; LA MANNA, Gaetano; Donati, Gabriele; Dormi, Ada; Cappuccilli, Maria; Cuna, Vania; Legnani, C; Palareti, Gualtiero; Colì, L; Stefoni, Sergio
abstract
BACKGROUND: This randomized crossover study investigated the effects of unfractioned heparin (UFH) and low-molecular-weight heparin (LMWH) on intra- and post-dialytic blood levels of osteoprotegerin (OPG), receptor activator of nuclear factor kappa B ligand (RANKL) and inflammatory cytokines.
METHODS: Forty patients on haemodialysis for at least 12 months were selected. UFH or LMWH was randomly assigned and maintained for 1 month, and then, in the following month, each patient was switched to the other form of heparin. In the mid-week session, we determined the changes in anti-Xa activity, OPG, RANKL, IL-1β, IL-6 and TNF-α values before heparin administration and after 15 min, 4, 8 and 24 h (T0, T1, T2, T3 and T4 respectively). Since these parameters at the various experimental times showed a non-normal distribution, log transformation was applied in order to run parametric ANOVA, with Bonferroni correction for multiple comparisons.
RESULTS: The changes in anti-Xa activity over time were similar but not the same for the UFH and LMWH. A highly significant (P < 0.001) increase in anti-Xa activity was detected at T1, regardless of the type of heparin, as confirmed in the comparison of T0 vs T1 using one-way ANOVA. Moreover, with both heparins, significant differences were found in the comparisons of anti-Xa activity at T1 vs T2 (both P < 0.001) and at T2 vs T3 (P = 0.0003 with UFH; P < 0.001 with LMWH). Conversely, the difference in anti-Xa activity at T3 vs T4 was still significant with UFH (P = 0.0186) but not significant with LMWH (P = 0.728). When comparing anti-Xa activity at T4 vs T0, no significant differences were found either with UFH (P = 0.1996) or with LMWH (P = 0.7470), thus indicating that 24 h after heparin infusion, anti-Xa activity returned back to the pre-infusion values. When we analysed the changes in OPG levels over time, we found that the administration of heparin, regardless of the type, determined an increase in circulating OPG with a zenith at 15 min (T1), with a return back to the baseline levels within the 24th hour post-infusion. One-way ANOVA revealed significant differences in OPG blood levels at T0 vs T1 with both UFH (P = 0.0112) and LMWH (P = 0.0288), whereas no significant difference was observed in the comparisons of OPG levels at T1 vs T2, T2 vs T3, T3 vs T4 and T4 vs T0, either with UFH or with LMWH. The circulating levels of RANKL, IL-1β, IL-6 and TNF-α at the different intra- and post-dialytic times did not show significant variations following heparin administration, either with UFH or with LMWH. One-way ANOVA performed on the log-transformed values of RANKL, IL-1β, IL-6 and TNF-α at the various experimental times (T0 vs T1, T1 vs T2, T2 vs T2, T3 vs T4 and T4 vs T0) revealed no significant intra- and post-dialytic changes in their blood levels, thus confirming that heparin infusion did not affect their blood levels.
CONCLUSIONS: These results suggest that heparin-regulated cyclic increases of OPG might play a role in the vascular pathology of haemodialysis patients.
2011
- Effects of unfractioned heparin and low-molecular-weight heparin on osteoprotegerin and RANKL plasma levels in hemodialysis patients
[Abstract in Atti di Convegno]
Cianciolo, Giuseppe; LA MANNA, Gaetano; Donati, Gabriele; Dormi, Ada; Cappuccilli, Maria; Cuna, Vania; Boneschi, Annalisa; Iorio, Mario; Legnani, C; Palareti, Gualtiero; Colì, L; Stefoni, Sergio
abstract
2011
- Eparina non frazionata vs eparina a basso peso molecolare: effetti sui livelli plasmatici di osteoprotegerina, RANKL e citochine infiammatorie in dialisi
[Abstract in Rivista]
Cianciolo, G; La Manna, G; Capelli, I; Donati, G; Cappuccilli, Ml; Angelini, Ml; Colì, L; Stefoni, S
abstract
2011
- L’espressione del VDR sui progenitori delle cellule endoteliali è modulata dai livelli sierici di vitamina D 25(OH) e dalla terapia con calcitriolo nei pazienti in dialisi
[Abstract in Rivista]
Cianciolo, G; La Manna, G; Cappuccilli, Ml; Della Bella, E; Boneschi, A; Martelli, D; Dormi, A; Donati, G; Bagnara, Gp; Stefoni, S
abstract
2011
- Role of the hemodialysis vascular access type in inflammation status and monocyte activation
[Articolo su rivista]
Colì, L; Donati, Gabriele; Cappuccilli, Maria; Cianciolo, Giuseppe; Comai, Giorgia; Cuna, Vania; Carretta, Elisa; La Manna, Gaetano; Stefoni, Sergio
abstract
Purpose: The aim of this study was to ascertain the role of different vascular access types in inflammatory status, monocyte activation, and senescence in hemodialysis patients.Methods: We recruited 126 hemodialysis patients, including 51 with arterovenous fistula (AVF), 32 with arterovenous graft (AVG), and 43 with tunneled cuffed catheters (TCC). In dialysis patients enrolled in the study and in a control group of 40 healthy subjects, we measured the serum levels of albumin, CRP, IL-6, and TNF-a, the expression of CD14, CD44, and CD32 on monocyte surface, and the percentage of monocytes exhibiting a senescent phenotype (CD14+CD32+). Results: The patients with AVG compared to those with AVF had: a) higher levels of CRP and TNF-a; b) increased expression of CD14 and CD32 on monocyte surface, with no difference in CD44 expression; c) no difference in the percentage of CD14+CD32+ monocytes. In the comparison of TCC vs. AVF group, we observed significantly higher values of: a) circulating inflammatory markers (CRP, IL-6, TNF-a); b) monocyte surface expression of cellular activation markers (CD14, CD44 and CD32); c) relative count of CD14+CD32+ monocytes. When comparing TCC vs. AVG group, we found: a) no difference in serum levels of CRP, IL-6, and TNF-a; b) no difference in the expression of CD14, CD44, and CD32 on monocyte surface; c) no difference in the percentage of CD14+CD32+ monocytes. Conclusions: These results suggest that the use of AVG and TCC for dialysis vascular access is associated with serological and cellular indexes of inflammatory reaction, also resulting in a higher degree of monocyte activation and senescence.
2011
- VDR Expression on Circulating Endothelial Progenitor Cells in Dialysis Patients Is Modulated by 25(OH)D Serum Levels and Calcitriol Therapy
[Articolo su rivista]
Cianciolo, G; LA MANNA, G; Cappuccilli, M; Lanci, N; DELLA BELLA, E; Cuna, V; Dormi, A; Todeschini, P; Donati, G; Alviano, F; Costa, R; Bagnara, Gp; Stefoni, S
abstract
Background/Aims: Vitamin D deficiency is associated with endothelial dysfunction in uremic patients, possibly by the impairment in the number and function of endothelial progenitor cells (EPCs). In 89 hemodialysis patients, we investigated the factors associated with the number of circulating EPCs (CD34(+)/CD133(+)/KDR(+) and CD34(+)/CD133(-)/KDR(+) cells), the presence of VDR and the determinants of VDR expression on EPCs, in particular in calcitriol therapy. Methods: EPC counts, percentages of VDR-positive EPCs and VDR expression were assessed by flow cytometry. Cells isolated from a subgroup of patients were cultured to analyze colony-forming units, specific markers expression and a capillary-like structure formation. Results/Conclusions: Our study demonstrates the presence of VDR on EPCs. In our dialysis patients, the parameters studied on both CD34(+)/CD133(+)/KDR(+) and CD34(+)/CD133(-)/KDR(+) cells, in particular VDR expression, seem to be influenced by uremia-related factors, including anemia, inflammation, diabetes, 25(OH)D serum levels and calcitriol therapy.
2010
- A case of Paget's disease in hemodialysis
[Articolo su rivista]
Cianciolo, Giuseppe; LA MANNA, Gaetano; Capelli, Irene; Donati, Gabriele; Persici, Elisa; Cuna, Vania; Corsini, Serena; Stefoni, Sergio
abstract
Paget's disease is the second most common bone disease after osteoporosis and causes an excessive bone turnover. Moreover, chronic kidney failure causes an impairment of bone mineral metabolism and electrolytes and PTH homeostasis. As far as we know, this is the first reported case of Paget's disease in a hemodialysis patient: the patient was also affected by secondary hyperparathyroidism and was successfully treated with clodronate, cinacalcet and paracalcitol. The safety and efficacy of this combined therapy was periodically revised in a 12-month follow-up considering the common markers of bone turnover as well as the dosage of OPG, RANKL, IL-6 and MCSF, involved in the pathophysiology of Paget's disease.
2010
- ANCA-Associated vasculitis in the very elderly: A 90-year-old iron lady
[Abstract in Atti di Convegno]
Righi, S; Ferri, S; Gianpaolo, L; Donati, G; Stefoni, S; Bianchi, Fb
abstract
2010
- Coronary Calcifications in End-Stage Renal Disease Patients: A New Link between Osteoprotegerin, Diabetes and Body Mass Index?
[Articolo su rivista]
Cianciolo, Giuseppe; LA MANNA, Gaetano; Donati, Gabriele; Persici, Elisa; Dormi, Ada; Cappuccilli, Maria; Corsini, Serena; Fattori, Rossella; Russo, V; Nastasi, Valentina; Coli', Luigi; Wratten, M; Stefoni, Sergio
abstract
The aim of the study was to assess the factors potentially involved in coronary artery calcifications (CAC) in end-stage renal disease patients. 253 hemodialysis (HD) patients (92 females, 161 males), aged 62.5 +/- 13.5, who had been on HD treatment for at least 6 months, were enrolled in a cross-sectional study. Calcium-phosphate product (Ca x P), body mass index (BMI), fetuin-A, osteoprotegerin (OPG), osteopontin, transforming growth factor-beta1 (TGF-beta1), fibroblast growth factor-23 (FGF-23) and matrix Gla protein (MGP) were considered. CAC was assessed using multislice spiral computed tomography and calcium score was quantified by means of the Agatston score. The median calcium score was 364 Agatston (range 0-7,336). CAC was detected in 228/253 patients (90.1%). Multivariate regression analysis, adjusted for age and for dialysis vintage, showed that TGF-beta1, OPG and days with Ca x P >55 mg/dl are independent predictors of CAC, while MGP was shown to be a protective factor. Surprisingly, results showed that BMI was a protective factor too: the interpolation with cubic spline function revealed a significant reduction in calcium score in patients with a high BMI (>28). However, when diabetes was considered in the regression analysis, only OPG emerged as a predictor of a high CAC score. The interpolation with spline function continued to show a significant reduction in CAC score in nondiabetic and in diabetic patients with the highest BMI quartile. The protective effect of a high BMI on CAC might represent another example of inverse biology in dialysis patients but it needs to be further addressed in larger longitudinal studies.
2010
- Dialisi peritoneale (DP) e nutrizione parenterale (NP) nella terapia della MNGIE: un caso clinico
[Abstract in Rivista]
Raimondi, C; Centofanti, F; Capelli, I; Todeschini, P; Donati, G; Colì, L; Rinaldi, R; Stanzani, M; Pironi, L; Stefoni, S
abstract
Viene descritto un caso di Encefalopatia Mitocondriale Neurogastrointestinale causata da mutazioni per il gene che codifica l'enzima Timidina fosforilasi con conseguenti deficit neurologici e dismotilità gastrointestinale con conseguente severa malnutrizione Il trattamento combinato DPNP ha consentito un netto miglioramento dello stato nutrizionale
2010
- Hemodiafiltration reduces mortality and prevents comorbidities? Technical innovations to improve hemodynamics and efficacy. [L'emodiafiltrazione riduce la mortalita' e previene le comorbidita'? Innovazioni tecniche per migliorare emodinamica ed efficacia.]
[Articolo su rivista]
Coli', Luigi; Cuna, Vania; Ferri, Annamaria; Donati, Gabriele; Cianciolo, Giuseppe; Stefoni, Sergio
abstract
Hemodiafiltration (HDF) is a dialysis technique characterized by the combination of diffusive and convective depuration. This allows the removal of both low and medium-high molecular weight toxins, keeping the intradialytic hemodynamic status of the patient more stable. Technical innovations in HDF technology aim to enhance the depurative efficacy of the treatment and reduce intradialytic hypotensive events and intolerance. Among these techniques, mixed HDF, middilution HDF and HFR Aequilibrium have particular innovative significance. Mixed HDF and mid-dilution HDF are clinically indicated to enhance the depurative efficacy of HDF and HFR Aequilibrium may serve to widen the depurative range in patients suffering from the malnutrition-inflammation complex syndrome and intradialytic hypotension or intolerance. Mixed HDF and mid-dilution HDF allow to improve the infusion volumes thanks to the intradialytic modulation of the pre/post-infusion ratio (mixed HDF) or the high-volume intradialyzer pre/postinfusion (mid-dilution HDF). HFR Aequilibrium is based on a) separation between convection (first chamber) and diffusion with body weight decrease (second chamber); b) infusion of endogenous ultrafiltrate purified by resin adsorption; c) use of dialysate sodium and ultrafiltration profiles automatically elaborated by a mathematical model incorporated in the software of the dialysis machine.
2010
- Il Molecular Adsorbent Recirculating System (MARS) nel trattamento dell'insufficenza epatica acuta e acuta su cronica: l'esperienza a Bologna
[Abstract in Rivista]
Colì, L; Donati, G; Cianciolo, G; Piscaglia, F; Gozzetti, F; Ferri, A; Montanari, M; Rasciti, L; Bolondi, L; Stefoni, S
abstract
2010
- Insufficienza epatica acuta e trattamento MARS dopo trapianto di midollo osseo
[Abstract in Rivista]
Gozzetti, F; Colì, L; Donati, G; Piscaglia, F; Ferri, A; Montanari, M; Bolondi, L; Stefoni, S
abstract
2010
- Optimal urokinase lock therapy for hemodialysis (HD) tunnelled cuffed catheter (TCC) thrombosis
[Abstract in Rivista]
Colì, L; Donati, G; Cianciolo, G; Gozzetti, G; Ferri, A; Cuna, V; Stefoni, S
abstract
2010
- The cardiovascular burden of end-stage renal disease patients
[Articolo su rivista]
Cianciolo, Giuseppe; Donati, Gabriele; LA MANNA, Gaetano; Ferri, Annamaria; Cuna, Vania; Ubaldi, Giulia; Corsini, Serena; Lanci, Nicole; Coli', Luigi; Stefoni, Sergio
abstract
Patients with end-stage renal disease are 10 to 20 times more at risk of cardiovascular death than the general population. Traditional cardiovascular risk factors are not able to explain the increase in the onset of cardiovascular diseases in dialysis patients. Some of the most important non traditional risk factors in uremic patients are: the inflammatory state of the patients, cytokines and growth factors, hyperhomocysteinemia, the presence of alterations of the calcium phosphorous product which can already be in progress when the glomerular filtration rate decreases to less than 60 mL/min. Clinically, these alterations cause vascular calcifications, calcifications of the heart valves and calcific uremic arteriolopathy or calciphylaxis. The pathogenesis of vascular calcification is complex and cannot be assigned to a simple, passive process: in fact, it includes factors which promote or inhibit calcification. In turn, these pathologic conditions have been found to be highly predictive of general and cardiovascular death. Given the serious clinical consequences that vascular calcifications can cause, it is necessary to carry out an early mapping of the traditional and non traditional risk factors of uremic patients as it seems that therapeutic interventions aimed at reducing or inverting the calcification process can improve the outcome of patients, above all when they are started quickly.
2009
- An in vivo autotransplant model of renal preservation: cold storage versus machine perfusion in the prevention of ischemia/reperfusion injury
[Articolo su rivista]
LA MANNA, Gaetano; Conte, Diletta; Cappuccilli, Maria; Nardo, Bruno; D'Addio, Francesca; Puviani, Lorenza; Comai, Giorgia; Bianchi, Francesca; Bertelli, Riccardo; Lanci, Nicole; Donati, Gabriele; Scolari, Maria; Faenza, Alessandro; Stefoni, Sergio
abstract
There is increasing proof that organ preservation by machine perfusion is able to limit ischemia/reperfusion injury in kidney transplantation. This study was designed to compare the efficiency in hypothermic organ preservation by machine perfusion or cold storage in an animal model of kidney autotransplantation. Twelve pigs underwent left nephrectomy after warm ischemic time; the organs were preserved in machine perfusion (n = 6) or cold storage (n = 6) and then autotransplanted with immediate contralateral nephrectomy. The following parameters were compared between the two groups of animals: hematological and urine indexes of renal function, blood/gas analysis values, histological features, tissue adenosine-5'-triphosphate (ATP) content, perforin gene expression in kidney biopsies, and organ weight changes were compared before and after preservation. The amount of cellular ATP was significantly higher in organs preserved by machine perfusion; moreover, the study of apoptosis induction revealed an enhanced perforin expression in the kidneys, which underwent simple hypothermic preservation compared to the machine-preserved ones. Organ weight was significantly decreased after cold storage, but it remained quite stable for machine-perfused kidneys. The present model seems to suggest that organ preservation by hypothermic machine perfusion is able to better control cellular impairment in comparison with cold storage.
2009
- Factors determining cardiovascular disease progression after kidney transplant
[Articolo su rivista]
Scolari, Maria; LA MANNA, Gaetano; Cianciolo, Giuseppe; Cappuccilli, Maria; Lanci, Nicole; Donati, Gabriele; Persici, Elisa; Cuna, Vania; Feliciangeli, Giorgio; LIVIANO D'ARCANGELO, Giovanni; Mosconi, Giovanni; Stefoni, Sergio
abstract
Cardiovascular disease is the leading cause of mortality and morbidity in renal transplant recipients as well as the leading cause of death with a functioning graft. The high cardiovascular risk is attributable to the prolonged exposure to multiple traditional and nontraditional risk factors in the pretransplant and posttransplant period. Particular attention must be paid to cardiovascular screening of candidates for kidney transplantation. After a transplant, treatment and prevention strategies should be focused on the modifiable risk factors including smoking, dietary habits, physical activity, weight control, hypertension, and dyslipidemia. Further studies on these factors are needed to better define the pharmacological approaches (hypotensive or hypolipemic drugs) and therapeutic targets. In view of the role of immunosuppressive therapy in the onset or worsening of several risk factors, it is important to tailor the treatment approach and dosage to the cardiovascular risk profile of the individual patient.
2009
- La sindrome delle gambe senza riposo in dialisi. Ruolo dell'infiammazione cronica
[Abstract in Rivista]
LA MANNA, G; Persici, E; Pizza, F; Donati, G; Cianciolo, G; Cappuccilli, Ml; Carretta, E; Coli'L, ; Montagna, P; Stefoni, S
abstract
2009
- When native arteriovenous fistula is not possible: the permanent catheter is better
[Articolo su rivista]
Coli', Luigi; Cuna, Vania; Capelli, Irene; KWIN KWEDI, CHIMENE HERMINE; Donati, Gabriele; LA MANNA, Gaetano; Stefoni, Sergio
abstract
Native arteriovenous fistula is still the vascular access of choice in hemodialysis. Other options are arteriovenous graft or, in patients in whom it is not possible to create a surgical vascular access, a permanent venous catheter. International guidelines on vascular access for hemodialysis recommend an increase in the percentage of arteriovenous fistulas compared to other types of vascular access. An analysis of the data relative to the distribution of the types of vascular access in different countries highlights the difficulty in following this recommendation: the only country to have increased the number of arteriovenous fistulas in recent years is the US, where the percentage of grafts has decreased while the use of permanent catheters has increased. In Italy and the rest of Europe, the number of fistulas has remained stable, there has been a constant reduction in the number of grafts and an increase in the percentage of permanent catheters. The reasons for this distribution of the types of vascular access are multifactorial and include the increased average age of patients, frequent late referrals, and increased incidence of diabetes mellitus, cardiovascular disease, obesity, etc. These factors have brought about technical difficulties for the creation of fistulas and grafts, leading to an increase in the number of catheters used. In relation to the evolution of the clinical characteristics of dialysis patients, the permanent catheter should no longer be considered a last-choice vascular access: in selected patients, it can be a better choice than a surgical fistula or graft.
2008
- 5-Methyltetrahydrofolate Administration Is Associated with Prolonged Survival and Reduced Inflammation in ESRD Patients
[Articolo su rivista]
Cianciolo, G; La Manna, G; Colì, L; Donati, G; D'Addio, F; Persici, E; Comai, G; Wratten, M; Dormi, A; Mantovani, V; Grossi, G; Stefoni, S
abstract
Background: Hemodialysis (HD) patients have a greatly increased risk of cardiovascular morbidity and mortality. For this reason, attempts are often made to normalize hyperhomocysteinemia. This randomized prospective study sought to determine which risk factors are predictors of mortality and whether high doses of folates or 5-methyltetrahydrofolate (5-MTHF) could improve hyperhomocysteinemia and survival in HD patients. Methods: 341 patients were divided into two groups: group A was treated with 50 mg i.v. 5-MTHF, and group B was treated with 5 mg/day oral folic acid. Both groups received i.v. vitamin B(6) and B(12). By dividing patients into C-reactive protein (CRP) quartiles, group A had the highest survival for CRP <12 mg/l, whereas no survival difference was found for group B. CRP was the only predictive risk factor for death (RR 1.17, range 1.04-1.30, p = 0.02). Dialysis age, hyperhomocysteinemia, methylenetetrahydrofolate reductase polymorphism, albumin, lipoprotein (a) and folate did not influence mortality risk. Survival in group A was higher than that in group B, namely 36.2 +/- 20.9 vs. 26.1 +/- 22.2 months (p = 0.003). Results: Our results suggest that CRP, but not hyperhomocysteinemia, is the main risk factor for mortality in HD patients receiving vitamin supplements. Intravenous 5-MTHF seems to improve survival in HD patients independent from homocysteine lowering
2008
- MARS and Prometheus: our clinical experience in acute chronic liver failure
[Articolo su rivista]
Faenza, Stefano; Baraldi, Olga; Bernardi, Mauro; Bolondi, Luigi; Coli', Luigi; Cucchetti, Alessandro; Donati, Gabriele; Gozzetti, Francesco; Lauro, A; Mancini, E; Pinna, ANTONIO DANIELE; Piscaglia, Fabio; Rasciti, L; Ravaioli, Matteo; Ruggeri, Giovanni; Santoro, Antonio; Stefoni, Sergio
abstract
INTRODUCTION: In our clinical context, there are two groups that practice blood purification treatments on acute or chronic liver failure (AoCLF) patients: one group used MARS (molecular adsorbent recirculating system) and the other Prometheus. MATERIALS AND METHODS: The MARS group used the lack of response to standard medical treatment after 72 hours of observation as the access criterion. The Prometheus group used the access criteria of the multicenter Helios protocol for patients in AoCLF, as well as those with primary nonfunction (PNF) and secondary liver insufficiency. Both groups performed treatment sessions of at least 6 hours, which were repeated at least every 24 to 36 hours. RESULTS: The 56 treated AoCLF patients underwent 278 treatment sessions; 41 out of 191 procedures with MARS and 16 out of 87 procedures with prometheus, which was also applied in two cases in PNF and four in secondary liver insufficiency. The results showed that both systems accomplished a good purification efficiency and that application to patients enabled reinstatement on the transplant list and grafts in 70% of the cases with either method. CONCLUSION: Treatment led to recovery in dysfunction among patients not destined for transplantation, achieved with a 48.5% 3-month survival in the MARS group and 33.5% in the Prometheus groups. The treatment results were inversely proportional to the MELD at the time of entry; The treatment appeared to be pointless. Among PNF and secondary liver insufficiency cases.
2008
- MECHANICAL INVESTIGATIONS ON ARTIFICIAL HEMODIALYSIS
[Capitolo/Saggio]
Pallotti, G; Pettazzoni, P; Caroli, E; Coli, L; Donati, G; Liepsch, D; Slawomirski, M; Stefoni, S
abstract
The studies on cardiovascular system introduced by Max Anliker and coll have been very important because have opened a new method to look to determine the mechanical properties of the wall of the large vessels.
The data have given the constant phase velocities for the pressure, axial and torsion waves, also the laws of attenuation of these waves were egual with exponential law with a negative constant multiplied by proportion of distance and wavelength. The law of attenuation has open a great problem of discussion, because the biological tissues have viscous-elastic properties but not linear as everybody who knows such materials knows.
Now if a biological soft tissue has a deformation to return to the original condition is not given by a curve of presenting an egual shape but the presence of Coulomb resistance to deformation gives the particular low damping of the return to original dimension.
The Knopoff theory has been used to arrive to a solution and explication of the experimental results by Anliker. We do not discuss now the mathematical problems and the equations connected to this theoretical biomechanical analysis, but if somebody is interested to discuss we have no problems of fit, because wee must see the interest of this medical people present now.
When a transplant of organ is made we have the arteries of two different persons are connected and we are in presence of two similar but not egual wall are sutured, if the second is more soft then the previous part, will generate to a short period of time a stenosis due to a turbulent movement of the blood in the initial part of the new artery, with the process of sedimentation of the blood cells and obviously the sutured part is closed, the blood has at first difficulty to enter in the donor organs and day by day the blood stops and the donor organ is out owing to a necrosis. We have seen how this process can arrive to interest tilt 10% of patient, when the different age between patient and donor is of 15 years and the donor is younger in kidney transplantation.
The definition of this effect was called Bononiensis Control Parameter (BCP).
In conclusion, the importance of the determination of the viscous-elastic properties of the great vessels of cardiovascular system of a patient is very important to define and know when a transplant is necessary, looking for and selecting the more similar condition of the donor vessels or prosthesis.
2008
- STUDY ON THE MECHANICAL PROPERTIES OF THE TISSUES OF THE GREAT ARTERIES
[Capitolo/Saggio]
Pallotti, G; Pettazzoni, P; Caroli, E; Colì, L; Donati, G; Liepsch, D; Slawomirski, M; Stefoni, S
abstract
The studies on cardiovascular system introduced by Max Anliker and coll have been very important because have opened a new method to look to determine the mechanical properties of the wall of the large vessels.
The data have given the constant phase velocities for the pressure, axial and torsion waves, also the laws of attenuation of these waves were egual with exponential law with a negative constant multiplied by proportion of distance and wavelength. The law of attenuation has open a great problem of discussion, because the biological tissues have viscous-elastic properties but not linear as everybody who knows such materials knows.
Now if a biological soft tissue has a deformation to return to the original condition is not given by a curve of presenting an egual shape but the presence of Coulomb resistance to deformation gives the particular low damping of the return to original dimension.
The Knopoff theory has been used to arrive to a solution and explication of the experimental results by Anliker. We do not discuss now the mathematical problems and the equations connected to this theoretical biomechanical analysis, but if somebody is interested to discuss we have no problems of fit, because wee must see the interest of this medical people present now.
When a transplant of organ is made we have the arteries of two different persons are connected and we are in presence of two similar but not egual wall are sutured, if the second is more soft then the previous part, will generate to a short period of time a stenosis due to a turbulent movement of the blood in the initial part of the new artery, with the process of sedimentation of the blood cells and obviously the sutured part is closed, the blood has at first difficulty to enter in the donor organs and day by day the blood stops and the donor organ is out owing to a necrosis. We have seen how this process can arrive to interest tilt 10% of patient, when the different age between patient and donor is of 15 years and the donor is younger in kidney transplantation.
The definition of this effect was called Bononiensis Control Parameter (BCP).
In conclusion, the importance of the determination of the viscous-elastic properties of the great vessels of cardiovascular system of a patient is very important to define and know when a transplant is necessary, looking for and selecting the more similar condition of the donor vessels or prosthesis.
2007
- Acute systemic, splanchnic and renal haemodynamic changes induced by molecular adsorbent recirculating system (MARS) treatment in patients with end-stage cirrhosis
[Articolo su rivista]
Donati, Gabriele; Piscaglia, Fabio; Coli', Luigi; Silvagni, Elena; Righini, R; Donati, Gabriele; Pini, P; Stefoni, Sergio; Bolondi, Luigi
abstract
AIM: To evaluate the acute effect of treatment with the molecular adsorbent recirculating system (MARS) on splanchnic, renal and systemic haemodynamics in patients with end-stage cirrhosis. METHODS: Twelve patients with end-stage cirrhosis, undergoing MARS treatment, were enrolled. The following haemodynamic parameters were measured by means of Doppler ultrasonography and thoracic electrical bioimpedance, before and after each session: portal velocity, renal and splenic resistance indices, cardiac output, cardiac stroke volume, heart rate, mean arterial pressure, systemic vascular resistance. RESULTS: Median portal velocity increased significantly after treatment (23.7 vs. 20.3 cm/s, P < 0.05) while renal resistance index (0.72 vs. 0.75, P < 0.05) and splenic resistance index (0.60 vs. 0.65, P < 0.05) decreased significantly. Mean arterial pressure (83 vs. 81 mmHg, P < 0.05) and vascular resistance (899 vs. 749 dyne. s/cm5, P < 0.05) increased significantly, while cardiac output and stroke volume showed no significant changes. CONCLUSIONS: Data emerging from this investigation suggest that MARS treatment improves significantly various haemodynamic alterations in cirrhotic patients in the short term. The observed decrease in renal vascular resistance and improvement in splenic resistance index, a parameter related to portal resistance, which leads us to hypothesize that these haemodynamic effects are probably mediated by clearance of vasoactive substances during MARS treatment.
2007
- Clinica, biologia e biotecnologia del rischio cardiovascolare del paziente con insufficienza renale cronica
[Capitolo/Saggio]
Stefoni, S; Cianciolo, G; Donati, G; Nastasi, V; Piccari, M.
abstract
2007
- Clinical application of artificial liver support with the Molecular Adsorbent Recirculating System (MARS): impact on cytokines and growth factors
[Abstract in Atti di Convegno]
Coli', Luigi; Donati, Gabriele; Cappuccilli, Maria; Cianciolo, Giuseppe; Gozzetti, Francesco; Comai, Giorgia; Piccari, Matteo; Nastasi, Valentina; Silvagni, Elena; Piscaglia, Fabio; Bolondi, Luigi; Stefoni, Sergio
abstract
2007
- Clinical application of artificial liver support with the Molecular Adsorbent Recirculating System (MARS): impact on cytokines and growth factors
[Abstract in Rivista]
Colì, L; Donati, G; Cappuccilli, Ml; Cianciolo, G; Gozzetti, F; Comai, G; Piccari, M; Nastasi, V; Silvagni, E; Piscaglia, F; Bolondi, L; Stefoni, S
abstract
2007
- Combined application of Hemodiafiltration and Profiler: short and mid-term clinical results in 16 patients
[Abstract in Rivista]
Colì, L; Donati, G; Ursino, M; Cianciolo, G; Piccari, M; Comai, G; Nastasi, V; Ricci, D; Stalteri, L; Ruggeri, G; Stefoni, S
abstract
2007
- Impiego clinico del “Fegato Artificiale” MARS: effetti sulle citochine e sui fattori di crescita
[Abstract in Rivista]
Coli', L; Donati, G; Cappuccilli, Ml; Cianciolo, G; Gozzetti, F; Comai, G; Piccari, M; Nastasi, V; Silvagni, E; Piscaglia, F; Bolondi, L; Stefoni, S.
abstract
2007
- Impiego combinato HFR-Profiler: risultati clinici a breve-medio termine
[Abstract in Rivista]
Coli', L; Donati, G; Ursino, M; Cianciolo, G; Piccari, M; Comai, G; Nastasi, V; Ricci, D; Stalteri, L; Ruggeri, G; Stefoni, S.
abstract
2007
- Is beta2-microglobulin-related amyloidosis of hemodialysis patients a multifactorial disease? A new pathogenetic approach
[Articolo su rivista]
Cianciolo, Giuseppe; Coli', Luigi; LA MANNA, Gaetano; Donati, Gabriele; D’Addio, F; Comai, Giorgia; Ricci, Davide; Dormi, Ada; Wratten, M; Feliciangeli, Giorgio; Stefoni, Sergio
abstract
PURPOSE:
Beta2-microglobulin amyloidosis (Abeta(2)M) is one of the main long-term complications of dialysis treatment. The incidence and the onset of Abeta(2)M has been related to membrane composition and/or dialysis technique, with non-homogeneous results. This study was carried out to detect: i) the incidence of bone cysts and CTS from Abeta(2)M; ii) the difference in Abeta(2)M onset between cellulosic and synthetic membranes; iii) other risk factors besides the membrane.
METHODS:
480 HD patients were selected between 1986 to 2005 and grouped according to the 4 types of membranes used (cellulose, synthetically modified cellulose, synthetic low-flux, synthetic high-flux). The patients were analyzed before and after 1995, when the reverse osmosis treatment for dialysis water was started at our center, and the incidence of Abeta(2)M was compared between the two periods. Routine plain radiography, computer tomography (CT) and nuclear magnetic resonance imaging (MRI) as well as electromyography were used to investigate the clinical symptoms.
RESULTS:
Bone cysts occurred in 29.2% of patients before 1995 vs. 12.2% after 1995 (p<0.0001). CTS occurred in 24% of patients before 1995 vs. 7.1% after 1995 (p<0.0001). Bone cysts and CTS occurred in older patients, who began dialysis at a late age, with high CRP, low albumin, low residual GFR, and low Hb. Cox regression analysis showed that the risk factor for bone cysts was high CRP (RR 1.3, p<0.01), while albumin (RR 0.14, p<0.0001) and residual GFR (RR 0.81, p<0.0001) were revealed to be protective factors. Cox analysis for CTS confirmed CRP as a risk factor (RR 1.2, p<0.01), and albumin (RR 0.59, p<0.0001) and residual GFR (RR 0.75, p<0.0001) as protective factors. The comparison obtained between membranes did not suggest any protective effect on Abeta(2)M.
CONCLUSIONS:
The findings that the inflammatory status as well as low albumin and the residual GFR of the uremic patient are predictive of Abeta(2)M lesions suggests that Abeta(2)M has a multifactorial origin rather than being solely a membrane- or technique-related side effect.
2007
- Jugular vein-mammary artery fistula after catheterism for hemodialysis: case report
[Articolo su rivista]
Coli', Luigi; Donati, Gabriele; Galaverni, Mc; Golfieri, Rita; Raimondi, Concettina; Cianciolo, Giuseppe; Comai, Giorgia; Piccari, Matteo; Rossi, C; Stefoni, Sergio
abstract
The demographic characteristics of hemodialysis (HD) patients increase the need for the tunneled cuffed permanent catheter (TCC) as a definitive vascular access (VA) for HD. The internal jugular vein is increasingly being used as a route for TCC or temporary catheter placement and can be associated with serious complications. Among them other authors have described arteriovenous fistula (AVF) creation between the common carotid artery and the right jugular vein. We describe a case of an AVF between the right internal jugular vein and the right internal mammary artery. The fistula was detected during the TCC placement in a patient who underwent several jugular and subclavian catheterisms for HD in her clinical history.
2007
- Metabolic syndrome after kidney transplantation
[Articolo su rivista]
Faenza, Alessandro; Fuga, Giovanni; Nardo, Bruno; Donati, Gabriele; Cianciolo, Giuseppe; Scolari, Maria; Stefoni, Sergio
abstract
BACKGROUND: Metabolic syndrome (MS) includes some risk factors for development of diabetes and cardiovascular disease, obesity (BMI > 30), high triglycerides, low HDL cholesterol, hypertension and impaired glucose tolerance. Following the definition of the Adult Treatment Panel III criteria, a diagnosis of MS was established when 3 or more factors were present. In renal transplant patients MS has been reported to negatively influence both patient and graft survivals. The present study sought to verify the effect of MS among our cases. METHODS: 298 cadaveric renal transplant recipients operated between January 1, 1996 and December 31, 2001 with absence of diabetes before transplantation, stable renal function 1 year posttransplantation and at least 4 years follow up were retrospectively evaluated from the end of the first post-operative year. RESULTS: 50 patients out of 298 (16,7%) had MS at the beginning of the study, including 37 of them with 3 and 13 with 4 risk factors. Only one patient with MS died of cardiovascular disease. Graft failure was observed in 23.5% MS patients versus 9,7% patients without the Syndrome (p:n.s.) Only Creatinine and the incidence of Cardiovascular Diseases at 4 years were statistically higher in MS patients (P < .001). CONCLUSIONS: These results suggested that MS is a risk factor for increasing CVD morbidity and decreased graft function, but early treatment of risk factors as soon as they become apparent can limit the adverse effects on patient and graft survival.
2007
- Prevenzione della trombosi dei cateteri a permanenza per emodialisi: profilassi mediante anticoagulazione con warfarin
[Abstract in Rivista]
Coli', L; Donati, G; Cianciolo, G; Raimondi, C; Piccari, M; Comai, G; Ricci, D; Gozzetti, F; Stefoni, S.
abstract
2007
- Warfarin anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheters thrombosis
[Abstract in Rivista]
Colì, L; Donati, G; Cianciolo, G; Raimondi, C; Piccari, M; Comai, G; Ricci, D; Gozzetti, F; Stefoni, S
abstract
2006
- A new mathematical model for profiled-HFR
[Abstract in Atti di Convegno]
Coli', Luigi; Ursino, Mauro; Magosso, Elisa; Capriotti, P; Donati, Gabriele; Cianciolo, Giuseppe; Panicali, Laura; Ruggeri, Giovanni; Nastasi, Valentina; Piccari, Matteo; Di Nicolò, P; Cannarile, DANIELA CECILIA; Bergamini, C; Stefoni, Sergio
abstract
2006
- Anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheters (TCC) thrombosis
[Articolo su rivista]
Coli', Luigi; Donati, Gabriele; Cianciolo, Giuseppe; Raimondi, Concettina; Comai, Giorgia; Panicali, Laura; Nastasi, Valentina; Cannarile, DANIELA CECILIA; Gozzetti, Francesco; Piccari, Matteo; Stefoni, Sergio
abstract
BACKGROUND: Chronic oral anticoagulation is currently used to avoid thrombosis and the malfunction of tunneled cuffed catheters (TCCs) for hemodialysis (HD). The aim of the study was to assess the efficacy of early warfarin administration, after TCC placement, in comparison to its administration after the first thrombosis or malfunction event of the TCC. PATIENTS AND METHODS: One hundred and forty-four chronic dialysis patients, who underwent TCC placement between June 2001 and June 2005, were randomized into two groups: 81 patients, group A, started oral anticoagulation 12 hr after the TCC placement (target international normalized ratio (INR) 1.8-2.5), in association with ticlopidine 250 mg/die; 63 patients, group B, started warfarin after the first thrombosis/malfunction episode (target INR 1.8-2.5) in association with ticlopidine 250 mg/die. The efficacy of oral anticoagulation therapy in preventing TCC thrombotic complications was evaluated in a 12-month follow-up period, after TCC placement, in terms of: a) the number of patients with thrombotic-malfunction events; b) the number of thrombotic-malfunction events with urokinase infusion (events/patient/year); c) intradialytic blood flow rate (BFR, ml/min); d) negative blood pressure (BP) from the arterial line of the TCC (AP, mmHg); e) positive BP, in the extracorporeal circuit from the venous line (VP, mmHg); and f) bleeding complications. RESULTS: Ten patients (12%) in group A showed TCC thrombosis/malfunction vs. 33 patients (52%) in group B (p < 0.01). In group A, 0.16 events of thrombosis/malfunction per patient/year vs. 1.65 in group B (p < 0.001) were ob-served. BFR was respectively 305 +/- 34 vs. 246 +/- 42 ml/min (p < 0.001). AP was -124 +/- 13 in group A vs. -174 +/- 21 mmHg in group B (p < 0.05). VP was 112 +/- 28 in group A vs. 168 +/- 41 mmHg in group B (p < 0.05). No patient showed any bleeding events. CONCLUSIONS: Early warfarin therapy allows a significant reduction in TCC thrombotic complications and an improvement in both arterial and venous fluxes in comparison with the same therapy administered after the first TCC thrombotic/malfunction event. This therapy did not induce any bleeding complications in the patients included in the study.
2006
- Arterial wall mechanical properties and kidney graft arterial stenosis
[Articolo su rivista]
Colì, L; Donati, G; Tedesco, A; Pallotti, G; Pettazzoni, P; Stefoni, S
abstract
2006
- EXTRACORPOREAL DETOXIFICATION FOR HEPATIC FAILURE WITH MARS: DEPURATIVE EFFICIENCY AND CLINICAL RESULTS IN 38 PATIENTS
[Abstract in Rivista]
Coli', L; Donati, G; Ruggeri, G; Cianciolo, G; Raimondi, C; Piscaglia, F; Silvagni, E; Donati, G; Baraldi, O; Mezzopane, D; Gozzetti, F; Bolondi, L; Stefoni, S
abstract
2006
- Extracorporeal Detoxification with MARS in patients with Hepatic Failure: depurative and clinical results in 37 patients
[Relazione in Atti di Convegno]
Donati, G; Colì, L; Ruggeri, G; Cianciolo, G; Raimondi, C; Piscaglia, F; Silvagni, E; Panicali, L; Gozzetti, F; Bolondi, L; Stefoni, S
abstract
2006
- MARS EFFICIENCY IN 38 PATIENTS WITH LIVER FAILURE
[Abstract in Atti di Convegno]
Coli', Luigi; Donati, Gabriele; Cianciolo, Giuseppe; Raimondi, Concettina; E., Silvagni; Gozzetti, Francesco; Bolondi, Luigi; Stefoni, Sergio
abstract
2006
- Molecular Adsorbent Recirculating System (MARS) application in liver failure: Clinical and hemodepurative results in 22 patients
[Articolo su rivista]
Stefoni, Sergio; Coli', Luigi; Bolondi, Luigi; Donati, Gabriele; Ruggeri, Giovanni; Feliciangeli, Giorgio; Piscaglia, Fabio; Silvagni, Elena; M., Sirri; Donati, Gabriele; Baraldi, Olga; Soverini, Maria Letizia; Cianciolo, Giuseppe; Boni, Paola; Patrono, Daniela; E., Ramazzotti; Motta, Roberto; Roda, Aldo; Simoni, Patrizia; Magliulo, Maria; Borgnino, Luigi Carlo; Ricci, Davide; D., Mezzopane; Cappuccilli, Maria
abstract
PURPOSE:
Acute liver failure (ALF) and acute on chronic liver failure (ACLF) still show a poor prognosis. MARS was used in 22 patients with ALF or ACLF to prolong patient survival for liver function recovery or as a bridge to transplantation.
DESIGN:
Evaluation of depurative efficiency, biocompatibility, hemodynamics, encephalopathy (HE) and clinical outcome.
PROCEDURES:
During 71 five-hour sessions we evaluated (0', 60', 120', 180', 240', 300'): bilirubin, ammonia, cholic acid (CCA), chenodeoxycholic acid (CCDCA), leukocytes, platelets, hemoglobin and mean arterial pressure (MAP). Serum creatinine, electrolytes, cardiac output, cardiac index (bioimpedence) and HE (West Haven Criteria score) were evaluated at 0' and 300'. STATISTICAL METHODS AND OUTCOME MEASURES: Student's t-test for pre- vs. end-session values was used. For bilirubin and ammonia the correlation test was made between pre- and end-session values and between pre-session values and removal rates (RRS).
MAIN FINDINGS:
Survival was 90.9% at 7 days, 40.9% at 30 days. Pre- vs. end-session: bilirubin from 37.2 +/- 12.5 mg/dL to 24.9 +/- 8.9 mg/dL (p < 0.01), ammonia from 88.0 +/- 60.4 micromol/L to 43.6 +/- 32.9 micromol/L (p < 0.01), CCA from 42.8 +/- 21.0 micromol/L 18.2 +/- 9.8 micromol/L (p < 0.01), CCDCA from 26.3 +/- 6.3 micromol/L to 15.7+/-7.6 micromol/L (p<0.01). The correlation test between pre-session values of bilirubin and ammonia vs. RR S was respectively 0.32 (p = 0.01) and 0.30 (p = 0.04). Leukocytes, platelets and hemoglobin remained stable. MAP increased from 82.0 +/- 12.0 mmHg to 87.0 +/- 13.0 mmHg (p < 0.05), West Haven Criteria score decreased from 2.7 +/- 0.7 to 0.7 +/- 0.7 (p < 0.001).
CONCLUSION:
MARS treatment led in all patients to an improvement of clinical, hemodynamic and neurological conditions, with significant reduction in the hepatic toxins blood level. Treatment biocompatibility and tolerance were satisfactory.
2006
- Profiled-HFR: a new Mathematical model for sodium and UF profile elaboration
[Abstract in Rivista]
Colì, L; Ursino, M; Magosso, E; Capriotti, P; Donati, G; Cianciolo, G.
abstract
2006
- Pulse wave propagation in blood vessels: theoretical investigation and clinical application
[Abstract in Rivista]
Belmonte, G; Colì, L; Donati, G; Pallotti, G; Pettazzoni, P
abstract
2006
- Pulse wave propagation in blood vessels:theoretical investigation and clinical applications
[Abstract in Atti di Convegno]
Barbieri, I; Belmonte, G; Colì, L; Donati, G; Gardini, Gl; Pallotti, G; Pettazzoni, P; Salcito, D; Selezov, I; Tedesco, A; Zvonareva, O.
abstract
A general investigation of the heart pulse propagation in blood vessel has been done and this research has been conducted for the blood flow in physiological conditions; then also the problems connected to new surgical techniques and also necessary in the organs transplantations. In particular in presence of insertion at some distance from the input is investigated and also the effects of the connection of vascular segments with different mechanical properties increases the risk of generation of blood turbolence fluxes and involves, in the arterial vessels. Mechanical models of cardiovascular system have been studied and the effects considered in clinical applications.
2006
- Un nuovo modello matematico per la HFR profilata
[Abstract in Rivista]
Coli', L; Donati, G; Cianciolo, G; Ursino, M; Ruggieri, G; Baraldi, O; DI NICOLO', P; Panicali, L; Stefoni, S.
abstract
2005
- Accesso vascolare e infiammazione: fistola arterovenosa (FAV) vs protesi in PTFE vs cateteri venosi centrali a permanenza (TCC)
[Abstract in Rivista]
Cianciolo, G; Coli', L; Raimondi, C; Donati, G; LA MANNA, G; Tampieri, E.; Mezzopane, D; Falaschini, A; Borgnino, Lc; Cappuccilli, Ml; Cristino, S; Stefoni, S
abstract
2005
- Impiego del MARS nell'insufficienza epatica: efficacia depurativa e risultati clinici in 22 pazienti
[Abstract in Rivista]
Coli', L; Donati, G; Baraldi, O; Ricci, D; Soverini, Ml; Ruggeri, G; Donati, G; Silvagni, E; Bolondi, L; Stefoni, S
abstract
2005
- Multislice spiral computed tomography (MSCT) for coronary artery calcifications in hemodialysis patients
[Abstract in Rivista]
Cianciolo, G; Coli', L; Donati, G; Soverini, Ml; Persici, E; Baraldi, O; Fattori, R; Russo, V; Tampieri, E; Chiarini, A; Stefoni, S
abstract
2004
- Fattori predittivi di rigetto acuto in una popolazione di trapiantati
[Abstract in Rivista]
La Manna, G; Cappuccilli, Ml; Mina, Gd; Persici, E; Nascetti, S; Bianchi, F; Ortolani, M; Comai, G; Donati, G; Feliciangeli, G; Scolari, Mp; Stefoni, S
abstract
2004
- PREDICTIVE FACTORS FOR ACUTE REJECTION IN A
POPULATION OF KIDNEY TRANSPLANTED PATIENTS
[Abstract in Rivista]
La Manna, G; Cappuccilli, Ml; Faenza, A; Mina, Gd; Persici, E; Nascetti, S; Bianchi, F; Ortolani, M; Comai, G; Donati, G; Feliciangeli, G; Mp, Scolari; Stefoni, S
abstract
Aims: The purpose of the present study is the identification of
genotypes at higher relative risk of Acute Rejection (AR) by the
analysis of gene polymorphisms implicated in apoptosis and inflammation
processes. AR still represents an important complication
leading to organ dysfunction, especially if it occurs late. Many studies
have emphasized a key role of inflammatory molecules and apoptosis
mediators in the pathogenesis of AR. Some cytokines, such as
IL-4, IL-6 and IL-10, carry gene polymorphisms (Single Nucleotide
Polymorphisms, SNPs) responsible for the individual production levels
of the molecule. These polymorphisms, generally located in the
promoter region of the gene, determine the presence in the general
population of genotypes defined as “low, intermediate and high producers”,
that have been associated with the risk of AR. Moreover, a
correlation between the increased expression of genes encoding for
apoptosis molecules and the incidence and severity of AR appears to
be likely.
Methods: Genotype analysis has been carried out for polymorphisms
of Granzyme B (GzmB), Perforin (PRF1) and Serine Proteinase
Inhibitor member 9 (PI9) amongst apoptosis genes and three
SNPs located in the promoter region of IL-10 gene amongst inflammatory
molecules. For each polymorphism, a case-control study was
conducted within a panel of 70 patients who had received cadaveric
kidney transplants between 1998 and 2002 at the Institute of Nephrology
of the St. Orsola University Hospital of Bologna by comparing
the allele frequencies between AR group (n 29) and non-AR
group (n 41). Cases and controls were matched for age and number
of HLA-DR mismatches. Genotype analysis was performed by RFLP
(Restriction Fragment Lenght Polymorphism) and Primer Extension/
denaturing High-Performance Liquid Chromatography assay.
Results: By variance analysis (ANOVA e Student’s t-test), it has
been established which variables (clinical parameters, unmodifiable
factors and distribution of genotypes) showed significative differences
in case and control groups. In this study, the polymorphisms of
apoptosis genes do not seem to influence acute kidney rejection
episodes. In contrast, the heterozygous genotype for IL-10/G–1082A
polymorphism showed a higher frequency in the non-AR group.
When considering the sinergistic effect of the three SNPs of IL-10
gene on the cytokine production, the high/intermediate producer
genotypes highlighted an inversely positive association with creatinine
plasma levels.
Conclusions: These results seem to indicate a protective effect
towards AR of the heterozygous genotype for IL-10/G–1082A polymorphism
and a possible relationship between renal function and
IL-10 high/intermediate production in kidney transplant recipients.
2004
- The history of clinical renal transplant
[Articolo su rivista]
Stefoni, Sergio; Campieri, Claudio; Donati, Gabriele; Orlandi, Valentina
abstract
After pioneeristic clinical and experimental work done by Jaboulay and Carrel in Lyon at the begining of the XX century, it was only in 1936 that Yu Yu Voronoy in Ukraine and then in 1945 Landsteiner and Hufnagel in Boston, USA, transplanted human kidneys. In 1955 Murray reported the first successful homotransplantation in identical twins and he later received the Nobel Prize in 1990 for this achievement. These milestones associated to the broadening of knowledge in the field of tissue typing, allowed the diffusion of kidney and other organ transplantation.
2004
- Use of profiler in hypotensive patients: 8 months follow-up
[Abstract in Rivista]
Colì, L; Cianciolo, G; Donati, G; Soverini, Ml; Baraldi, O; Fosco, B; Cristino, S
abstract
2004
- Variazioni emodinamiche splancniche, renali e sistemiche in corso di terapia con sistema depurativo epatico artificiale (Molecular Adsorbent Recirculating System - MARS)
[Abstract in Rivista]
Donati, G; Piscaglia, F; Vidili, G; Colì, L; Donati, G; Stefoni, S; Bolondi, L
abstract
2003
- Artificial kidney: status of the art and new perspectives
[Articolo su rivista]
Stefoni, S; Cianciolo, G; Coli, L; Raimondi, C; Dalmastri, V; Donati, G; Manna, C; Grammatico, F
abstract
Extracorporeal dialysis was first performed in 1943 and has become a routine for End Stage Renal Patients from the early sixties. In the last 30 years researchers have focused on biocompatibility of artificial materials and optimisation of removal of uremic toxins by the membrane as in the long term treatment many complications like amylodosis heart and bone lesions, accelerated amyloidosis and immune system failure can occur. From this point of view high flux dialytic membranes are currently considered more biocompatible therefore being able to prevent such diseases.
2003
- Attivazione infiammatoria durante la dialisi: emodialisi vs.Emodiafiltrazione (HDF) on-line
[Abstract in Rivista]
Colì, L; Donati, G; Cianciolo, G; D'Addio, F; Raimondi, C; Ramazzotti, E; Comai, G; Stefoni, S
abstract
2003
- Attivazione piastrinica intra- e post- dialitica e rilascio di PDGF-AB
[Capitolo/Saggio]
Stefoni, S; Cianciolo, G; Donati, G; D'Addio, F; Colì, L.
abstract
2003
- Basiliximab e tacrolimus (FK506) nella pratica clinica del trapianto di rene: risultati clinici ad un anno. Esperienza di un singolo centro
[Abstract in Atti di Convegno]
Todeschini, P; Liviano d'Arcangelo, G; Donati, G; Sestigiani, E; Tampieri, E; Faenza, A; Scolari, Mp; Stefoni, S
abstract
2003
- Basiliximab e tacrolimus (FK506) nella pratica clinica del trapianto di rene: risultati clinici ad un anno. Esperienza di un singolo centro
[Abstract in Rivista]
Todeschini, P; Liviano D'Arcangelo, G; Donati, G; Sestigiani, E; Tampieri, E; Scolari, Mp; Stefoni, S
abstract
2003
- Clinical application of sodium profiling
in the treatment of intradialytic hypotension
[Articolo su rivista]
Colì, L; Ursino, M; Donati, G; Cianciolo, G; Soverini, Ml; Baraldi, O; La Manna, G; Feliciangeli, G; Scolari, Mp; Stefoni, S.
abstract
BACKGROUND:
Intradialytic hypotension is mainly induced by the removal of extracellular sodium during dialysis, which impairs intravascular fluid refilling and reduces blood volume. To counter this complication we tested a new kind of profiled hemodialysis (PHD) consisting of the intradialytic modulation of dialysate sodium concentration according to individual profiles set up using a new mathematical model for intradialytic solutes and water kinetics. The clinical aim of this PHD is to stabilize blood pressure maintaining higher blood volume values than standard dialysis treatments. We clinically validated PHD in comparison with constant dialysate sodium dialysis (CHD).
METHODS:
Twenty hypotensive dialysis patients underwent one PHD and one CHD session maintaining the same dialysis length, sodium mass removal and body weight decrease. A new mathematical model was used to define both the dialysate sodium profiles for PHD and the constant dialysate sodium for CHD. Percent blood volume variation (Crit-line), mean blood pressure, heart rate, cardiac output (Doppler-echocardiography) were monitored intradialitically.
RESULTS:
Cardiovascular stability improved on PHD as compared with CHD sessions; blood volume and cardiac output during PHD showed a lower decrease than on CHD, the differences statistically significant (from 30' and 60' respectively). Mean blood pressure was, at all time intervals, more stable on PHD than on CHD and was accompanied, on PHD, by a lower heart rate increase (differences statistically significant).
CONCLUSIONS:
This study shows that PHD performed using dialysate sodium profiles elaborated by our mathematical model obtains, in hypotensive patients, a higher hemodynamic intradialytic stability than CHD, probably due to a higher stabilization of blood volume.
2003
- Embolizzazione da cristalli di colesterolo: una possibile causa di "primary allograft non function" nel trapianto renale. Caso clinico
[Abstract in Atti di Convegno]
Sestigiani, E; Grigioni, W; Faenza, A; Mosconi, G; Donati, G; D'Addio, F; Scolari, Mp; Stefoni, S
abstract
2003
- Embolizzazione da cristalli di colesterolo: una possibile causa di "primary allograft nonfunction" nel trapianto renale. Caso clinico
[Abstract in Rivista]
Sestigiani, E; Grigioni, W; Faenza, A; Mosconi, G; Donati, G; D'Addio, F; Scolari, Mp; Stefoni, S
abstract
2003
- Fluidodynamic evaluation of arteriovenous fistulae for hemodialysis
[Articolo su rivista]
Liepsch, D; Pallotti, G; Pettazzoni, P; Colì, L; Donati, G; Rossi, C; Losinno, F; Freyrie, A; Stefoni, S.
abstract
2003
- In vivo evaluation of cellular and inflammatory response to a new polyethersulfone membrane
[Articolo su rivista]
Stefoni, S; Colì, L; Cianciolo, G; Donati, G; Dalmastri, V; Orlandi, V; D'Addio, F; Ramazzotti, E
abstract
2003
- Infiammazione e accesso vascolare: fistola arterovenosa vs. catetere venoso centrale (CVC) a permanenza
[Abstract in Rivista]
Donati, G; Colì, L; Cianciolo, G; Raimondi, C; Toriello, G; Zambianchi, L; Di Nicolò, P; Ramazzotti, E; Stefoni, S
abstract
2003
- Inflammatory response of a new synthetic dialyzer membrane. A randomised cross-over comparison between polysulfone and helixone
[Articolo su rivista]
Stefoni, S; Colì, L; Cianciolo, G; Donati, G; Ruggeri, G; Ramazzotti, E; Pohlmeier, R; Lang, D.
abstract
2003
- Istruzione-Formazione su dialisi, trapianto e donazione, dalla scuola superiore all'Università: protocollo di trial randomizzato
[Abstract in Rivista]
Piccoli, Gb; Soragna, G; Putaggio, S; Mezza, E; Giacchino, F; Burdese, M; Bergamo, D; Jeantet, A; Segoloni, Gp; Piccoli, G; La Manna, G; Donati, G; Stefoni, S; Federico, S; Carrano, R; Andreucci, V
abstract
2003
- L'impiego del micofenolato mofetile (MMF) nel trapianto renale: esperienza di un singolo centro
[Abstract in Rivista]
Donati, G; Sestigiani, E; Campieri, C; Liviano, G; Cristino, S; Scolari, Mp; Stefoni, S
abstract
2003
- L'impiego del micofenolato mofetile (MMF) nel trapianto renale: esperienza di un singolo centro
[Abstract in Atti di Convegno]
Donati, G; Sestigiani, E; Campieri, C; Liviano, G; Cristino, S; Faenza, A; Scolari, Mp; Stefoni, S
abstract
2003
- Valutazione prospettica dell'impiego di differenti cateteri venosi a permanenza per emodialisi: Tesio, Permcath, Mahurkar, Opti-flow, Dialock
[Abstract in Rivista]
Colì, L; Donati, G; Feliciangeli, G; Cianciolo, G; Raimondi, C; D'Addio, F; Toriello, G; Zambianchi, L; Di Nicolò, P; Comai, G; Stefoni, S
abstract
2002
- 5-MTHF vs Folic Acid therapy on hyperomocysteinemia and Endothelial function in dialysis patients
[Abstract in Rivista]
Donati, G; Cianciolo, G; Mantovani, V; Silvestri, Mg; D'Addio, F; Zambianchi, L; Grossi, G; Colì, L; Stefoni, S
abstract
2002
- Analisi di sequenza e di espressione del gene della beta-2 microglobulina in pazienti dializzati
[Capitolo/Saggio]
Canaider, S; La Manna, G; Strippoli, P; Rondelli, D; Cianciolo, G; Donati, G; Casadei, R; Arpinati, M; Stefoni, S; Carinci, P.
abstract
2002
- Force spectroscopy study of the adhesion of plasma
proteins to the surface of a dialysis membrane: Role of the
nanoscale surface hydrophobicity and topography
[Articolo su rivista]
Conti, M; Donati, G; Cianciolo, G; Stefoni, S; Samorì, B
abstract
A mechanochemical study of the process of adhesion
of plasma proteins to the surface of dialysis membranes
was carried out with a scanning force microscope
(SFM) in the force spectroscopy mode. Three representative
blood plasma proteins (fibronectin, fibrinogen, and albumin)
covalently were grafted to a SFM probe, and the adhesion
forces of these proteins to cellulosic and synthetic dialysis
membranes were measured. The experiment was tailored
to apply a controlled load on the protein molecules
adsorbed onto the surface in order to simulate the squeezing
forces exerted on them during blood filtration. The deadhesion
forces, measured using this new approach for
studying the interaction between a protein and dialysis
membranes, suggest that the membrane’s topography, at a
nanometer scale, plays a critical role in the adhesion process.
This result was strongly supported by parallel experiments
performed on a flattened glass surface with the same dominant
hydrophilic character as dialysis membranes. In contrast,
a hydrophobic polystyrene surface led to de-adhesion
forces at least one order of magnitude greater, overwhelming
any possible shape recognition process between the protein
molecules and the surface.
2002
- Il "follow-up" degli accessi vascolari protesici
[Relazione in Atti di Convegno]
Colì, L; Donati, G; Raimondi, C; Cianciolo, G; D'Addio, F; Stefoni, S
abstract
2002
- Insufficienza renale cronica e la sua sostituzione con metodiche artificiali (dialisi) e/o naturali (trapianto). Integrazione tra clinica, biologia, tecnologia e biotecnologia
[Capitolo/Saggio]
Stefoni, S; Scolari, Mp; Campieri, C; Colìl, ; Feliciangeli, G; Liviano d'Arcangelo, G; Cianciolo, G; La Manna, G; Mosconi, G; Buscaroli, A; Donati, G; Iannelli, S.
abstract
2002
- Low TGF-beta1 serum levels are a risk factor for atherosclerosis
disease in ESRD patients
[Articolo su rivista]
Stefoni, S; Cianciolo, G; Donati, G; Dormi, A; Silvestri, Mg; Coli`, L; De Pascalis, A; Iannelli, S
abstract
2002
- Plasma cytokine imbalance is a risk factor for atherosclerosis disease in hemodialysis patients
[Abstract in Rivista]
Donati, G; Cianciolo, G; D'Addio, F; Zambianchi, L; Toriello, G; Dalmastri, V; Colì, L; Stefoni, S
abstract
2002
- Platelet activation and PDGF-AB release during dialysis
[Articolo su rivista]
Donati, G; Cianciolo, G; D'Addio, F; Colì, L; La Manna, G; Feliciangeli, G; Stefoni, S
abstract
During hemodialysis the blood-membrane contact causes a release of platelet granule content, which contains Platelet Derived Growth Factor (PDGF-AB). In view of its possible role in accelerated atherosclerotic processes, we evaluated the intra- and post-dialytic changes in PDGF-AB serum levels during hemodialysis sessions performed with Hemophan and Polysulfone membranes. PDGF-AB, PF4, betaTG and MPV levels were determined in the peripheral blood in 30 patients each of whom underwent 6 dialysis sessions: 3 with Hemophan (HE) membrane and 3 with Polysulfone (PS) membrane, interpolated by a wash out session with PS membrane. Blood samples were taken at times 0', 30', 120', 180', 240' during dialysis sessions and at 1, 4 and 20 hours after the end of the session. Statistical analysis was done using the ANOVA one way test and Student's t test PDGF-AB serum levels initially increased and, except for a sharp fall at 120', remained constantly high during HD with both membranes tested, not returning to basal values until 20 hours after the end of the session. PF4, betaTG and MPV all showed a similar trend to PDGF. No statistically significant difference was found between the two membranes tested. PDGF-AB, a powerful growth factor in cells of mesenchymal origin, is released during dialysis mainly as a result of the blood-membrane contact. This we found regardless of the type of dialyzer we tested, and, above all, proved to return very slowly to basal values. We speculate that the release of PDGF-AB could play a part like other atherosclerosis risk-factors in the appearance and worsening of atherosclerotic lesions in hemodialysis patients.
2002
- Sequence and expression analysis of the β-2-microglobulin gene in dialysis patients
[Articolo su rivista]
Canaider, S; La Manna, G; Strippoli, P; Rondelli, D; Cianciolo, G; Donati, G; Casadei, R; Arpinati, M; Stefoni, S; Carinci, P.
abstract
2002
- Standard heparin versus low-molecular-weight heparin. A
medium-term comparison in hemodialysis
[Articolo su rivista]
Stefoni, S; Cianciolo, G; Donati, G; Colì, L; La Manna, G; Raimondi, C; Dalmastri
V, ; Orlandi, V; D'Addio, F
abstract
2002
- YMDD mutants of HBV virus in long-term lamivudine treatment of renal transplant patients
[Abstract in Rivista]
Mosconi, G; Scolari, Mp; Donati, G; Morelli, C; Corradi, F; Berardi, S; Miglioli, M; Stefoni, S
abstract
2001
- Intra and post dialytic platelet activation and PDGF-AB release: cellulose diacetate versus polysulfone membranes
[Articolo su rivista]
Cianciolo, G; Stefoni, S; Donati, G; De Pascalis, A; Iannelli, S; Manna, C; Colì, L; Bertuzzi, V; La Manna, G; Raimondi, C; Boni, P; Stefoni, V
abstract
BACKGROUND:
During haemodialysis the blood-membrane contact causes a release of platelet granule content, which contains platelet-derived growth factor AB (PDGF-AB). In view of the potential role of this in altering biocompatibility during haemodialysis, we evaluated the intra- and post-dialytic changes in PDGF-AB serum levels during haemodialysis sessions performed with cellulose diacetate (CDA) and polysulfone (PS) membranes respectively.
METHODS:
PDGF-AB, platelet factor 4 (PF4), beta thromboglobulin (betaTG), and mean platelet volume (MPV) levels were determined in 30 patients, each of whom underwent six dialysis sessions: three with a CDA and three with a PS membrane. Blood samples were taken at times 0, 15, 30, 120, 180, and 240 min during dialysis and at 1, 4, and 20 h after the end of the session. Statistical analysis was performed using a one-way ANOVA and Student's t test.
RESULTS:
PDGF-AB at 15 min was increased to +41+/-9% with CDA vs +20+/-5% with PS (P<0.001) from the T0 values, and at 120 min it was +19+/-8% with CDA vs -25+/-9% with PS (P<0.001) from T0 levels. At 240 min it was +95+/-14% with CDA vs +49+/-15% with PS (P<0.001) from the T0 values, returning to basal only 20 h after the end of the session. betaTG at 15 min was +60+/-8% for CDA vs +24+/-7.5% for PS (P<0.001) from the T0 values. PF4 showed a similar trend to betaTG. MPV at 30 min from the start of dialysis was 7.4+/-0.3 fl with CDA and 8+/-0.3 fl with PS (P<0.001), and at 240 min MPV was 7.9+/-0.3 fl with CDA and 8.4+/-0.3 fl with PS (P<0.001).
CONCLUSIONS:
Platelet activation and platelet release reactions are lower with PS than with CDA membranes. PDGF-AB, released during and after dialysis, represents a clear biocompatibility marker. Its slow return to basal values and its action on vascular cells make it a potential risk factor for atherosclerosis in uraemic patients.
2001
- La Emodialisi Precoce
[Relazione in Atti di Convegno]
Stefoni, S; Cianciolo, G; Dalmastri, V; Donati, G
abstract
2001
- Renal transplantation and HCV hepatitis. A longitudinal study
[Articolo su rivista]
Mosconi, G; Scolari, M. P.; Morelli, C; Nardo, B; Bertuzzi, V; De Pascalis, A; Donati, G; Zambianchi, L; Buscaroli, A; Stefoni, S
abstract
2000
- "Release" intra e post-dialitico di PDGF-AB
[Articolo su rivista]
Cianciolo, G; Donati, G; De Pascalis, A; Manna, C; Iannelli, S; Colì, L; Raimondi, C; Dalmastri, V; Marseglia, Cd; Stefoni, S
abstract
2000
- Assessment of the inflammatory response of FX60 versus F60 dialyzers
[Abstract in Rivista]
Colì, L; Donati, G; Zambianchi, L; Isola, E; Manna, C; Sestigiani, E; Grammatico, F; Marseglia, Cd; Iannelli, S; Ramazzotti, E; Lang, D; Pohlmeier, R; Stefoni, S
abstract
2000
- Calcitriolo e.v. ad alte dosi in presenza di severa recidiva di iperparatiroidismo dopo paratiroidectomia con auto-trapianto
[Abstract in Rivista]
Mosconi, G; Bertuzzi, V; Grammatico, F; Isola, E; Manna, C; Donati, G; Toriello, G; Orsoni, G; Cianciolo, C; Raimondi, C; Colì, L; Stefoni, S
abstract
2000
- La dialisi peritoneale nel paziente con trapianto renale in fallimento
[Abstract in Rivista]
Orsoni, G; Canova, C; Toriello, G; Donati, G; Grammatico, F; Isola, E; Manna, C; Stefoni, S
abstract
2000
- Membranes, technologies and long-term results in chronic haemodialysis
[Articolo su rivista]
Stefoni, S; Scolari, M. P.; Cianciolo, G; Mosconi, G; De Sanctis, L. B.; De Pascalis, A; La Manna, G; Donati, G; Manna, C; Sestigiani, E; Grammatico, F
abstract
2000
- Modulating dialysate sodium and ultrafiltration: various profiles and their clinical effectiveness
[Abstract in Rivista]
Colì, L; Dalmastri, V; De Pascalis, A; Isola, E; Magelli, C; Magnani, G; Potena, L; Carinci, V; Ursino, M; Sestigiani, E; Manna, C; Donati, G; Grammatico, F; Stefoni, S
abstract
2000
- Modulazione del sodio nel dialisato e della ultrafiltrazione: efficacia clinica di diversi profili
[Abstract in Rivista]
Dalmastri, V; Colì, L; Isola, E; Magelli, C; Magnani, G; Potena, L; Carinci, V; Poci, Mg; De Pascalis, A; Raimondi, C; Manna, C; Orsoni, G; Donati, G; Ursino, M; Stefoni, S
abstract
2000
- Plasma Cytokine imbalance in HD patients with cardiovascular diseases
[Abstract in Rivista]
Cianciolo, G; De Pascalis, A; Iannelli, S; Donati, G; Isola, E; Manna, C; Zambianchi, L; Colì, L; Stefoni, S
abstract
2000
- Platelet and coagulative activation, lipid profile during hemodialysis: standard vs low molecular weight heparin
[Abstract in Rivista]
Cianciolo, G; Donati, G; Manna, C; Grammatico, F; Mosconi, G; Raimondi, C; Colì, L; Stefoni, S
abstract
1999
- Evaluation of Excebrane by Infrared Imaging
[Articolo su rivista]
Stefoni, S; Masotti, L; Feliciangeli, G; Calonghi, N; Atti, E; De Pascalis, A; Donati, G; La Manna, G; Scolari, Mp
abstract
1999
- Trattamento selle stenosi ostiali delle arterie renali mediante stent di Palmaz
[Abstract in Rivista]
Zuccalà, A; Losinno, F; Mambelli, E; Donati, G; De Fabritiis, A; Campieri, C; Zucchelli, P.
abstract
1998
- Anticoagulation and platelet activation in hemodialysis: clinical results with PMMA
[Articolo su rivista]
Colì, L; Cianciolo, G; Feliciangeli, G; De Sanctis L., B; Zanchelli, F; Dalmastri, V; De Pascalis, A; Sestigiani, E; Donati, G; Stefoni, S
abstract
1998
- Clinical biology of artificial organ substitution
[Articolo su rivista]
Stefoni, S; La Manna, G; De Sanctis L., B; Dalmastri, V; Perna, C; Pace, G; Donati, G; De Pascalis, A; Bertuzzi, V; Stefoni, V; Zanchelli, F
abstract
1998
- Favourable outcome of anuric acute renal failure in a pregnant women at 28th gestational week
[Abstract in Rivista]
Pace, G; Prandini, R; Donati, G; Orsi, C; Liviano, G; Montesano, L; Manna, C; Scolari, Mp; Vangelista, A; Bonomini, V
abstract
1997
- Alternative Vascular Access for Hemodialysis
[Abstract in Rivista]
Mosconi, G; Zanchelli, F; Colì, L; Pace, G; Perna, C; Donati, G; Dalmastri, V; Gargiulo, M; Freyrie, A; Stefoni, S
abstract
1997
- Genotipo virale e andamento clinico dell'infezione da HCV
[Abstract in Rivista]
Zanchelli, F; Mosconi, G; Raimondi, C; Marseglia, Cd; Donati, G; De Pascalis, A; Morelli, C; Polifemo, Am; Bonomini, V
abstract