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Background: Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known. Methods: We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m2 regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11-12 g/dL in women and 11-13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia. Results: The mean age was 63 ± 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 ± 13 mL/min/1.73 m2 and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1-1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m2 and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30-44 mL/min/1.73 m2) and moderate proteinuria (0.15-0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD {hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02-1.98]} and all-cause death [HR 1.55 (95% CI 1.04-2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20-2.51)] and death [HR 1.83 (95% CI 1.05-3.19)].

Submarine surveys carried out since the'90s along the coastland of Sinuessa allowed us to draw up a geomorphological map with archaeological findings. Along the sea bottom, 650 m off and −7 m depth, a Campanian Ignimbrite bedrock was detected: dated ∼39 kyr BP, its position is incompatible with the current sea level. Towards the northern edge of the shoal, a depressed area with 24 cubic elements in concrete was surveyed. These artefacts (pilae) are typical of Roman maritime structures widespread along the southernmost Phlegrean coast. Beachrocks and accessory landforms at the same depth of bedrock suggest that this was emerging and attended by man in Roman times, even for activities related to port facilities. Submerged palaeo-channels, in alignment of current watercourses on the mainland, dissect the shoal. These channels were moulded in subaerial environment during Würm glaciation, following the tuff deposition, and then were drowned by sea-level rise. The northernmost channel, next to the pilae, likely allowed transit and manoeuvring of Roman ships. The discovery along the seabed of a large stump of lead anchor, hundreds of Roman amphorae and fragments, as well as of a depression of millstone, confirm this finding. Probably the sinuous physiography favored the choice of this site for the docking of Sinuessa, as sheltered from storms.