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112 results on '"Guastoni, C."'

1. Ramipril and Cardiovascular Outcomes in Patients on Maintenance Hemodialysis: The ARCADIA Multicenter Randomized Controlled Trial

Author

Ruggenenti, P, Podesta, M, Trillini, M, Perna, A, Peracchi, T, Rubis, N, Villa, D, Martinetti, D, Cortinovis, M, Ondei, P, Condemi, C, Guastoni, C, Meterangelis, A, Granata, A, Mambelli, E, Pasquali, S, Genovesi, S, Pieruzzi, F, Bertoli, S, Del Rosso, G, Garozzo, M, Rigotti, A, Pozzi, C, David, S, Daidone, G, Mingardi, G, Mosconi, G, Galfre, A, Romei Longhena, G, Pacitti, A, Pani, A, Hidalgo Godoy, J, Anders, H, Remuzzi, G, Ruggenenti P., Podesta M. A., Trillini M., Perna A., Peracchi T., Rubis N., Villa D., Martinetti D., Cortinovis M., Ondei P., Condemi C. G., Guastoni C. M., Meterangelis A., Granata A., Mambelli E., Pasquali S., Genovesi S., Pieruzzi F., Bertoli S. V., Del Rosso G., Garozzo M., Rigotti A., Pozzi C., David S., Daidone G., Mingardi G., Mosconi G., Galfre A., Romei Longhena G., Pacitti A., Pani A., Hidalgo Godoy J., Anders H. -J., Remuzzi G., Ruggenenti, P, Podesta, M, Trillini, M, Perna, A, Peracchi, T, Rubis, N, Villa, D, Martinetti, D, Cortinovis, M, Ondei, P, Condemi, C, Guastoni, C, Meterangelis, A, Granata, A, Mambelli, E, Pasquali, S, Genovesi, S, Pieruzzi, F, Bertoli, S, Del Rosso, G, Garozzo, M, Rigotti, A, Pozzi, C, David, S, Daidone, G, Mingardi, G, Mosconi, G, Galfre, A, Romei Longhena, G, Pacitti, A, Pani, A, Hidalgo Godoy, J, Anders, H, Remuzzi, G, Ruggenenti P., Podesta M. A., Trillini M., Perna A., Peracchi T., Rubis N., Villa D., Martinetti D., Cortinovis M., Ondei P., Condemi C. G., Guastoni C. M., Meterangelis A., Granata A., Mambelli E., Pasquali S., Genovesi S., Pieruzzi F., Bertoli S. V., Del Rosso G., Garozzo M., Rigotti A., Pozzi C., David S., Daidone G., Mingardi G., Mosconi G., Galfre A., Romei Longhena G., Pacitti A., Pani A., Hidalgo Godoy J., Anders H. -J., and Remuzzi G.

Abstract

BACKGROUND AND OBJECTIVES: Renin-angiotensin system (RAS) inhibitors reduce cardiovascular morbidity and mortality in patients with CKD. We evaluated the cardioprotective effects of the angiotensin-converting enzyme inhibitor ramipril in patients on maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this phase 3, prospective, randomized, open-label, blinded end point, parallel, multicenter trial, we recruited patients on maintenance hemodialysis with hypertension and/or left ventricular hypertrophy from 28 Italian centers. Between July 2009 and February 2014, 140 participants were randomized to ramipril (1.25-10 mg/d) and 129 participants were allocated to non-RAS inhibition therapy, both titrated up to the maximally tolerated dose to achieve predefined target BP values. The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included the single components of the primary end point, new-onset or recurrence of atrial fibrillation, hospitalizations for symptomatic fluid overload, thrombosis or stenosis of the arteriovenous fistula, and changes in cardiac mass index. All outcomes were evaluated up to 42 months after randomization. RESULTS: At comparable BP control, 23 participants on ramipril (16%) and 24 on non-RAS inhibitor therapy (19%) reached the primary composite end point (hazard ratio, 0.93; 95% confidence interval, 0.52 to 1.64; P=0.80). Ramipril reduced cardiac mass index at 1 year of follow-up (between-group difference in change from baseline: -16.3 g/m2; 95% confidence interval, -29.4 to -3.1), but did not significantly affect the other secondary outcomes. Hypotensive episodes were more frequent in participants allocated to ramipril than controls (41% versus 12%). Twenty participants on ramipril and nine controls developed cancer, including six gastrointestinal malignancies on ramipril (four were fatal), compared with none in controls. CONCLUSIONS: Ramipril di

Published
2021

2. The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: a systematic review and a meta-analysis

Author

Barello, Serena, Anderson, G., Acampora, Marta, Bosio, Caterina, Guida, E., Irace, V., Guastoni, C. M., Bertani, Barbara, Graffigna, Guendalina, Barello S. (ORCID:0000-0002-8514-2563), Acampora M. (ORCID:0000-0002-4836-6103), Bosio C., Bertani B., Graffigna G. (ORCID:0000-0003-4378-7467), Barello, Serena, Anderson, G., Acampora, Marta, Bosio, Caterina, Guida, E., Irace, V., Guastoni, C. M., Bertani, Barbara, Graffigna, Guendalina, Barello S. (ORCID:0000-0002-8514-2563), Acampora M. (ORCID:0000-0002-4836-6103), Bosio C., Bertani B., and Graffigna G. (ORCID:0000-0003-4378-7467)

Abstract

Purpose: Hemodialysis has become a standard therapy for adults with end-stage renal diseases. Adults undergoing hemodialysis have to cope with unique psychological issues that make their care journey particularly fatiguing. In this systematic review and meta-analysis, we aimed to summarize and evaluate the effects of psychosocial interventions on the reduction of anxiety and depression in adults with HDs. Methods: We included randomized controlled trials and quasi-experimental studies that measure change in depression, anxiety, and quality of life. Results: We identify three categories of psychosocial interventions delivered to adults undergoing hemodialysis. Based on our analysis, there was a medium effect of psychosocial intervention on depression (SMD − 0.85, 95%CI − 1.17; − 0.52, I2 = 80%, p < 0.01) and anxiety (SMD − 0.99, 95%CI − 1.65; − 0.33, I2 = 88%, p < 0.01) in adults undergoing hemodialysis. Conclusions: Psychosocial interventions, such as psychological support or relaxation-based therapy, seems all to reduce depression and anxiety in adults undergoing HD. Preliminary evidence suggests that there may be a benefit of psychosocial interventions on the quality of life for adults undergoing HD.

Published
2022

3. Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

Author

Nordio, M., Reboldi, G., Di Napoli, A., Quintaliani, G., Alberici, F., Postorino, M., Aucella, F., Messa, P., Brunori, G., Bosco, M., Malberti, F., Mandreoli, M., Mazzaferro, S., Movilli, E., Ravera, M., Salomone, M., Santoro, D., Postorinolimido, M. A., Bonomini, M., Stingone, A., Maccarone, M., Di Loreto, E., Stacchiotti, L., Malandra, R., Chiarella, S., D'Agostino, F., Fuiano, G., Nicodemo, L., Bonofiglio, R., Greco, S., Mallamaci, F., Barreca, E., Caserta, C., Bruzzese, V., Galati, D., Tramontana, D., Viscione, M., Chiuchiolo, L., Tuccillo, S., Sepe, M., Vitale, F., Ciriana, E., Martignetti, V., Caserta, D., Stizzo, A., Romano, A., Iulianiello, G., Cascone, E., Minicone, P., Chiricone, D., Delgado, G., Barbato, A., Celentano, S., Molfino, I., Coppola, S., Raiola, I., Abategiovanni, M., Borrelli, S., Margherita, C., Bruno, F., Ida, M., Aliperti, E., Potito, D., Cuomo, G., De Luca, M., Merola, M., Botta, C., Garofalo, G., Alinei, P., Paglionico, C., Roano, M., Vitale, S., Ierardi, R., Fimiani, V., Conte, G., Di Natale, G., Romano, M., Di Marino, V., Scafarto, A., Meccariello, S., Pecoraro, C., Di Stazio, E., Di Meglio, E., Cuomo, A., Maresca, B., Rotaia, E., Capasso, G., Auricchio, M., Pluvio, C., Maddalena, L., De Maio, A., Palladino, G., Buono, F., Gigliotti, G., Mancini, E., La Manna, G., Storari, A., Mosconi, G., Cappelli, G., Scarpioni, R., Gregorini, M., Rigotti, A., Mancini, W., Bianco, F., Boscutti, G., Amici, G., Tosto, M., Fini, R., Pace, G., Cioffi, A., Boccia, E., Di Lullo, L., Di Zazzo, G., Simonelli, R., Bondatti, F., Miglio, L., Rifici, N., Treglia, A., Muci, M., Baldinelli, G., Rizzi, E., Lonzi, M., De Cicco, C., Forte, F., De Paolis, P., Grandaliano, Giuseppe, Cuzziol, C., Torre, V. M., Sfregola, P., Rossi, V., Fabio, G., Flammini, A., Filippini, A., Onorato, L., Vendola, F., Di Daniela, N., Alfarone, C., Scabbia, L., Ferrazzano, M., Grotta, B. D., Gamberini, M., Fazzari, L., Mene, P., Morgia, A., Catucci, A., Palumbo, R., Puliti, M., Marinelli, R., Polito, P., Marrocco, F., Morabito, S., Rocca, R., Nazzaro, L., Lavini, R., Iamundo, V., Chiappini, M., Casarci, M., Morosetti, M., Hassan, S., Firmi, G., Galliani, M., Serraiocco, M., Feriozzi, S., Valentini, W., Sacco, P., Garibotto, G., Cappelli, V., Saffioti, C., Repetto, M., Rolla, D., Lorenz, M., Pedrini, L., Polonioli, D., Galli, E., Ruggenenti, P., Scolari, F., Bove, S., Costantino, E., Bracchi, M., Mangano, S., Depetri, G., La Milia, V., Farina, M., Zecchini, S., Savino, R., Melandri, M., Guastoni, C., Paparella, M., Gallieni, M., Minetti, E., Bisegna, S., Righetti, M., Badalamenti, S., Alberghini, E., Bertoli, S., Fabbrini, P., Albrizio, P., Rampino, T., Colturi, C., Rombola, G., Lucatello, A., Guerrini, E., Ranghino, A., Lenci, F., Fanciulli, E., Santarelli, S., Damiani, C., Garofalo, D., Sopranzi, F., Santoferrara, A., Di Luca, M., Galiotta, P., Brigante, M., Manganaro, M., Maffei, S., Berto, I., Besso, L., Viglino, G., Cusinato, S., Chiarinottichiappero, D. F., Tognarelli, G., Gianoglio, B., Forneris, G., Biancone, L., Savoldi, S., Vitale, C., Boero, R., Filiberti, O., Borzumati, M., Gesualdo, L., Lomonte, C., Gernone, G., Pallotta, G., Di Paolo, S., Vernaglione, L., Specchio, A., Stallone, G., Dell'Aquila, R., Sandri, G., Russo, F., Napoli, M., Marangi, A., Morrone, L., Di Stratis, C., Fresu, A., Cicu, F., Murtas, S., Manca, O., Pani, A., Pilloni, M., Pistis, R., Cadoni, M., Contu, B., Logias, F., Ivaldi, R., Fancello, S., Cossu, M., Lepori, G., Vittoria, S., Battiati, E., Arnone, M., Rome, M., Barbera, A., Granata, A., Collura, G., Dico, C. L., Pugliese, G., Di Natale, E., Rizzari, G., Cottone, L., Longo, N., Battaglia, G., Marcantoni, C., Giannetto, G., Tumino, G., Randazzo, F., Bellissimo, L., Faro, F. L., Grippaldi, F., Urso, S., Quattrone, G., Todaro, I., Vincenzo, D., Murgo, A., Masuzzo, M., Pisacane, A., Monardo, P., Pontorierro, M., Quari, C., Bauro, A., Chimenz, R. R., Alfio, D., Girasole, F., Cascio, A. L., Caviglia, A., Tornese, F., Sirna, F., Altieri, C., Cusumano, R., Saveriano, V., La Corte, A., Locascio, G., Rotolo, U., Musso, S., Risuglia, L., Blanco, G., Minardo, G., Castellino, S., Zappulla, Z., Randone, S., Di Francesca, M., Cassetti, C. C., Oddo, G., Buscaino, G., Mucaria, F., Barraco, V. I., Di Martino, A., Rallo, D., Dani, L., Campolo, G., Manescalchi, F., Biagini, M., Agate, M., Panichi, V., Casani, A., Traversari, L., Garosi, G., Tabbi, M., Selvi, A., Cencioni, L., Fagugli, R., Timio, F., Leveque, A., Manes, M., Mennella, G., Calo, L., Fiorini, F., Abaterusso, C., Calzavara, P., Meneghel, G., Bonesso, C., Gambaro, G., Gammaro, L., Rugiu, C., Ronco, C., Nordio M., Reboldi G., Di Napoli A., Quintaliani G., Alberici F., Postorino M., Aucella F., Messa P., Brunori G., Bosco M., Malberti F., Mandreoli M., Mazzaferro S., Movilli E., Ravera M., Salomone M., Santoro D., PostorinoLimido M.A., Bonomini M., Stingone A., Maccarone M., Di Loreto E., Stacchiotti L., Malandra R., Chiarella S., D'Agostino F., Fuiano G., Nicodemo L., Bonofiglio R., Greco S., Mallamaci F., Barreca E., Caserta C., Bruzzese V., Galati D., Tramontana D., Viscione M., Chiuchiolo L., Tuccillo S., Sepe M., Vitale F., Ciriana E., Martignetti V., Caserta D., Stizzo A., Romano A., Iulianiello G., Cascone E., Minicone P., Chiricone D., Delgado G., Barbato A., Celentano S., Molfino I., Coppola S., Raiola I., Abategiovanni M., Borrelli S., Margherita C., Bruno F., Ida M., Aliperti E., Potito D., Cuomo G., De Luca M., Merola M., Botta C., Garofalo G., Alinei P., Paglionico C., Roano M., Vitale S., Ierardi R., Fimiani V., Conte G., Di Natale G., Romano M., Di Marino V., Scafarto A., Meccariello S., Pecoraro C., Di Stazio E., Di Meglio E., Cuomo A., Maresca B., Rotaia E., Capasso G., Auricchio M., Pluvio C., Maddalena L., De Maio A., Palladino G., Buono F., Gigliotti G., Mancini E., La Manna G., Storari A., Mosconi G., Cappelli G., Scarpioni R., Gregorini M., Rigotti A., Mancini W., Bianco F., Boscutti G., Amici G., Tosto M., Fini R., Pace G., Cioffi A., Boccia E., Di Lullo L., Di Zazzo G., Simonelli R., Bondatti F., Miglio L., Rifici N., Treglia A., Muci M., Baldinelli G., Rizzi E., Lonzi M., De Cicco C., Forte F., De Paolis P., Grandaliano G., Cuzziol C., Torre V.M., Sfregola P., Rossi V., Fabio G., Flammini A., Filippini A., Onorato L., Vendola F., Di Daniela N., Alfarone C., Scabbia L., Ferrazzano M., Grotta B.D., Gamberini M., Fazzari L., Mene P., Morgia A., Catucci A., Palumbo R., Puliti M., Marinelli R., Polito P., Marrocco F., Morabito S., Rocca R., Nazzaro L., Lavini R., Iamundo V., Chiappini M., Casarci M., Morosetti M., Hassan S., Firmi G., Galliani M., Serraiocco M., Feriozzi S., Valentini W., Sacco P., Garibotto G., Cappelli V., Saffioti C., Repetto M., Rolla D., Lorenz M., Pedrini L., Polonioli D., Galli E., Ruggenenti P., Scolari F., Bove S., Costantino E., Bracchi M., Mangano S., Depetri G., La Milia V., Farina M., Zecchini S., Savino R., Melandri M., Guastoni C., Paparella M., Gallieni M., Minetti E., Bisegna S., Righetti M., Badalamenti S., Alberghini E., Bertoli S., Fabbrini P., Albrizio P., Rampino T., Colturi C., Rombola G., Lucatello A., Guerrini E., Ranghino A., Lenci F., Fanciulli E., Santarelli S., Damiani C., Garofalo D., Sopranzi F., Santoferrara A., Di Luca M., Galiotta P., Brigante M., Manganaro M., Maffei S., Berto I., Besso L., Viglino G., Cusinato S., ChiarinottiChiappero D.F., Tognarelli G., Gianoglio B., Forneris G., Biancone L., Savoldi S., Vitale C., Boero R., Filiberti O., Borzumati M., Gesualdo L., Lomonte C., Gernone G., Pallotta G., Di Paolo S., Vernaglione L., Specchio A., Stallone G., Dell'Aquila R., Sandri G., Russo F., Napoli M., Marangi A., Morrone L., Di Stratis C., Fresu A., Cicu F., Murtas S., Manca O., Pani A., Pilloni M., Pistis R., Cadoni M., Contu B., Logias F., Ivaldi R., Fancello S., Cossu M., Lepori G., Vittoria S., Battiati E., Arnone M., Rome M., Barbera A., Granata A., Collura G., Dico C.L., Pugliese G., Di Natale E., Rizzari G., Cottone L., Longo N., Battaglia G., Marcantoni C., Giannetto G., Tumino G., Randazzo F., Bellissimo L., Faro F.L., Grippaldi F., Urso S., Quattrone G., Todaro I., Vincenzo D., Murgo A., Masuzzo M., Pisacane A., Monardo P., Pontorierro M., Quari C., Bauro A., Chimenz R.R., Alfio D., Girasole F., Cascio A.L., Caviglia A., Tornese F., Sirna F., Altieri C., Cusumano R., Saveriano V., La Corte A., Locascio G., Rotolo U., Musso S., Risuglia L., Blanco G., Minardo G., Castellino S., Zappulla Z., Randone S., Di Francesca M., Cassetti C.C., Oddo G., Buscaino G., Mucaria F., Barraco V.I., Di Martino A., Rallo D., Dani L., Campolo G., Manescalchi F., Biagini M., Agate M., Panichi V., Casani A., Traversari L., Garosi G., Tabbi M., Selvi A., Cencioni L., Fagugli R., Timio F., Leveque A., Manes M., Mennella G., Calo L., Fiorini F., Abaterusso C., Calzavara P., Meneghel G., Bonesso C., Gambaro G., Gammaro L., Rugiu C., and Ronco C.

Subjects
Male, Contextual analysis, medicine.medical_treatment, Population, 030232 urology & nephrology, Recursive partitioning, 030204 cardiovascular system & hematology, Rate ratio, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Classification tree, COVID-19, Renal replacement therapy, Risk Factors, Medical, Surveys and Questionnaires, Health care, medicine, Settore MED/14 - NEFROLOGIA, Humans, education, Pandemics, Societies, Medical, Female, Italy, Nephrology, education.field_of_study, business.industry, Multilevel model, Decision rule, Confidence interval, Original Article, Hemodialysis, business, Contextual analysi, Societies, Demography
Abstract

Background and aim: Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.

Published
2021

7. La nefropatia da contrasto. Definizione, fattori di rischio, prevenzione

Author

Guastoni, C., Gidaro, B., Covella, P., Guastoni, C., Gidaro, B., and Covella, P.

Abstract

La nefropatia da mezzo di contrasto (contrast induced nephropathy) (CIN) è una delle cause più frequenti di danno renale acuto nei pazienti ricoverati. L'incidenza di CIN dipende dalla presenza di fattori di rischio legati al paziente (insufficienza renale, diabete, malattie cardiovascolari, età avanzata) e da cause dipendenti dalla procedura (dose elevata di mezzo di contrasto, via di somministrazione intra-arteriosa). L'insufficienza renale rappresenta il maggiore fattore di rischio di CIN, in particolare quando è associata al diabete. L'idratazione pre- e post-somministrazione di MDC rappresenta la sola terapia di prevenzione ad essere strettamente raccomandata dalle Linee Guida nei pazienti a rischio. Gli studi sulla prevenzione della CIN hanno riguardato soprattutto casistiche cardiologiche di pazienti con moderato rischio renale (GFR 60– 40 mL/min) sottoposti a somministrazione intra-arteriosa di mezzo di contrasto. In molti trial clinici è stata valutata l'efficacia dell'idratazione con bicarbonato di sodio e della N-acetilcisteina (NAC) nella prevenzione della CIN. L'infusione con sodio bicarbonato ha dimostrato una maggiore efficacia rispetto alla fisiologica, in modo particolare quando l'idratazione necessita tempi rapidi come nelle procedure in emergenza. La NAC non ha dimostrato una chiara efficacia in quanto i risultati positivi osservati in alcuni studi non sono stati confermati in altri. Il problema aperto rimane la prevenzione della CIN nei soggetti con elevato rischio renale (e-GFR < 30 mL/min) nei quali la presenza di CIN può associarsi all'ingresso in dialisi cronica., Contrast induced nephropathy (CIN) is one of the most frequent cause of acute kidney injury in recovered patients. CIN incidence depends on patient's risk factors (i.e. chronic kidney disease, diabetes, cardiovascular diseases and older age) and procedure's related factors (i.e. high contrast dose, intra arterial administration). Chronic kidney disease, especially if associated with diabetes, is the main risk factor of CIN. Hydration before and after contrast administration is the only preventive therapy strongly recommended in guidelines in patients at risk for CIN. CIN prevention studies have focused mainly on cardiological patients with moderate renal risk (GFR 60–40 mL/min) who underwent intra arterial contrast administration. Many clinical trials have evaluated efficacy of hydration associated with sodium bicarbonate and of N acetylcysteine (NAC) in CIN prevention. Sodium bicarbonate infusion has demonstrated better efficacy than saline infusion, particularly when short infusion times are needed, such as in emergency procedures. NAC hasn't shown clear effect, in fact some positive studies results haven't been confirmed in other trials yet. The discussion is still opened on the efficacy of renal replacement therapies in CIN prevention in high renal risk subjects (GFR

Published
2018

8. Two Cases of Retained Permanent Central Venous Hemodialysis Catheters

Author

Cornacchiari, M., Zuccari, M., Neri, A.L., Gidaro, B., Bellotti, N., Stasi, A., Di Toma, L.F., Guastoni, C., Cornacchiari, M., Zuccari, M., Neri, A.L., Gidaro, B., Bellotti, N., Stasi, A., Di Toma, L.F., and Guastoni, C.

Abstract

Temporary (CVCt) and or permanent (CVCp) central venous catheters (CVCs) have been more and more used in our dialysis units. One of the problems related to CVC use, due to permanent devices permanence in situ for a long time, is the difficulty in removing them because of tight adhesions between vessel wall and CVCp. For these complications rate growing in last years, there are no defined guidelines. It is therefore important to share clinical cases and procedures used to solve the problem to define the true incidence of the phenomenon, removal related complications and the best solutions. In this paper, we describe two cases of difficult removal of CVCp positioned via left internal jugular vein into superior vena cava and the method used to remove them from the vessel., I cateteri venosi centrali o permanenti sono sempre più utilizzati nei nostri Centri dialisi. Una delle problematiche emergenti, legata alla lunga permanenza dei CVC permanenti, è la difficoltà nel rimuoverli, a causa della formazione di tenaci aderenze tra tali dispositivi e la parete vasale. Attualmente per tali complicanze, non esistono linee guida definite. Riteniamo quindi importante condividere le singole esperienze e le procedure utilizzate per la loro rimozione anche per poter definire la reale incidenza del fenomeno, le eventuali complicanze e le migliori strategie da attuare. In questo articolo, descriviamo due casi clinici di difficile rimozione di un CVCp posizionato in vena giugulare interna sin ed i metodi utilizzati per la sua estrazione.

Published
2018

9. Contrast Nephropathy. Definition, Risk Factors, Prophylaxis

Author

Guastoni, C., Gidaro, B., Covella, P., Guastoni, C., Gidaro, B., and Covella, P.

Abstract

Contrast induced nephropathy (CIN) is one of the most frequent cause of acute kidney injury in recovered patients. CIN incidence depends on patient's risk factors (i.e. chronic kidney disease, diabetes, cardiovascular diseases and older age) and procedure's related factors (i.e. high contrast dose, intra arterial administration). Chronic kidney disease, especially if associated with diabetes, is the main risk factor of CIN. Hydration before and after contrast administration is the only preventive therapy strongly recommended in guidelines in patients at risk for CIN. CIN prevention studies have focused mainly on cardiological patients with moderate renal risk (GFR 60–40 mL/min) who underwent intra arterial contrast administration. Many clinical trials have evaluated efficacy of hydration associated with sodium bicarbonate and of N acetylcysteine (NAC) in CIN prevention. Sodium bicarbonate infusion has demonstrated better efficacy than saline infusion, particularly when short infusion times are needed, such as in emergency procedures. NAC hasn't shown clear effect, in fact some positive studies results haven't been confirmed in other trials yet. The discussion is still opened on the efficacy of renal replacement therapies in CIN prevention in high renal risk subjects (GFR, La nefropatia da mezzo di contrasto (contrast induced nephropathy) (CIN) è una delle cause più frequenti di danno renale acuto nei pazienti ricoverati. L'incidenza di CIN dipende dalla presenza di fattori di rischio legati al paziente (insufficienza renale, diabete, malattie cardiovascolari, età avanzata) e da cause dipendenti dalla procedura (dose elevata di mezzo di contrasto, via di somministrazione intra-arteriosa). L'insufficienza renale rappresenta il maggiore fattore di rischio di CIN, in particolare quando è associata al diabete. L'idratazione pre- e post-somministrazione di MDC rappresenta la sola terapia di prevenzione ad essere strettamente raccomandata dalle Linee Guida nei pazienti a rischio. Gli studi sulla prevenzione della CIN hanno riguardato soprattutto casistiche cardiologiche di pazienti con moderato rischio renale (GFR 60– 40 mL/min) sottoposti a somministrazione intra-arteriosa di mezzo di contrasto. In molti trial clinici è stata valutata l'efficacia dell'idratazione con bicarbonato di sodio e della N-acetilcisteina (NAC) nella prevenzione della CIN. L'infusione con sodio bicarbonato ha dimostrato una maggiore efficacia rispetto alla fisiologica, in modo particolare quando l'idratazione necessita tempi rapidi come nelle procedure in emergenza. La NAC non ha dimostrato una chiara efficacia in quanto i risultati positivi osservati in alcuni studi non sono stati confermati in altri. Il problema aperto rimane la prevenzione della CIN nei soggetti con elevato rischio renale (e-GFR < 30 mL/min) nei quali la presenza di CIN può associarsi all'ingresso in dialisi cronica.

Published
2018

12. High Efficiency Hemofiltration

Author

E. Minetti, Teatini U, Luigi Minetti, Giovanni Civati, Guastoni C, Perego A, and Perrino Ml

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Hemofiltration, Medicine, business, Intensive care medicine
Published
2015
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13. Clinical practice for the diagnosis of cardiac arrhythmias in patients on renal replacement therapy: data from a Lombard survey

Author

Genovesi, S, Nava, E, Pasa, A, Corghi, E, Ondei, P, Marta, E, Bellasi, A, Malberti, F, Teatini, U, Guastoni, C, Spatola, L, Luise, M, Tiboldo, R, Bertoli, S, Messa, P, Doria, M, Gallieni, M, Cozzolino, M, Spotti, D, Sala, V, Sironi, E, Boriani, G, PASA, ALICE, Guastoni, CM, Luise, MC, DORIA, MARIA, SIRONI, ELISABETTA LUCIA, Genovesi, S, Nava, E, Pasa, A, Corghi, E, Ondei, P, Marta, E, Bellasi, A, Malberti, F, Teatini, U, Guastoni, C, Spatola, L, Luise, M, Tiboldo, R, Bertoli, S, Messa, P, Doria, M, Gallieni, M, Cozzolino, M, Spotti, D, Sala, V, Sironi, E, Boriani, G, PASA, ALICE, Guastoni, CM, Luise, MC, DORIA, MARIA, and SIRONI, ELISABETTA LUCIA

Abstract

Among dialysis patients, 40% of deaths are due to cardiovascular causes, and 60% of cardiac deaths are due to an arrhythmia. The purpose of this survey, carried out with the organizational support of the Lombard Section of the Italian Society of Nephrology, is to evaluate the frequency and mode of use of non-invasive instruments for the diagnosis of cardiac arrhythmias in the dialysis centers of Lombardy. Information on the prevalence and type of cardiac devices at December 1, 2016 in this population was also required. Data from 18 centers were collected for a total of 3395 patients in replacement renal therapy, including 2907 (85.6%) in hemodialysis and 488 (14.4%) in peritoneal dialysis. All centers use the 12-lead ECG in case of evocative symptoms of an arrhythmic event and 2/3 perform the exam with programmed cadence (usually once a year). Twenty four-hour ECG Holter is not used as a routine diagnostic tool. The proportion of cardiac devices is relatively high, compared to literature data: n=259, equal to 7.6% of the population. Pace-Maker patients are 166 (4.9%), those with intracardiac defibrillator 52 (1.5%), those with resynchronization therapy 18 (0.5%) and those with resynchronization therapy and intracardiac defibrillator 23 (0.7%). The survey provides interesting information and can be an important starting point for trying to optimize clinical practice and collaboration between nephrologists and cardiologists in front of a major problem like that of arrhythmic disease in patients on renal replacement therapy.

Published
2017

14. Lymphocytic Intracellular pH and Na+/H+ Exchanger Activity in Hemodialysis Patients

Author

Giacomo Colussi, Giovanni Civati, Luigi Minetti, Giuseppe Rombolà, and Guastoni C

Subjects
medicine.medical_specialty, Sodium bicarbonate, business.industry, medicine.medical_treatment, Sodium, Intracellular pH, chemistry.chemical_element, Metabolic acidosis, medicine.disease, Amiloride, chemistry.chemical_compound, Sodium–hydrogen antiporter, Endocrinology, chemistry, Nephrology, Internal medicine, medicine, Hemodialysis, business, Intracellular, medicine.drug
Abstract

We have evaluated intracellular pH (pHi) and Na+/H+ exchanger activity in peripheral lymphocytes from 16 patients on regular acetate hemodialysis. All the patients wer

Published
1995
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15. High Efficiency Hemofiltration

Author

Minetti, L., primary, Guastoni, C., additional, Perego, A., additional, Teatini, U., additional, Minetti, E., additional, Perrino, M. L., additional, and Civati, G,, additional

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16. DIALYSIS. PATHOPHYSIOLOGY AND CLINICAL STUDIES

Author

Humalda, J. K., primary, Assa, S., additional, Navis, G. J., additional, Franssen, C. F. M., additional, De Borst, M. H., additional, Ogawa, H., additional, Ota, Y., additional, Watanabe, T., additional, Watanabe, Y., additional, Nishii, H., additional, Sato, A., additional, Waniewski, J., additional, Debowska, M., additional, Wojcik-Zaluska, A., additional, Ksiazek, A., additional, Zaluska, W., additional, Guastoni, C. M., additional, Turri, C., additional, Toma, L., additional, Rombola, G., additional, Frattini, G., additional, Romei Longhena, G., additional, Teatini, U., additional, Siriopol, D.-C., additional, Stuard, S., additional, Ciolan, A., additional, Mircescu, G., additional, Raluca, D., additional, Nistor, I., additional, Covic, A., additional, De Roij Van Zuijdewijn, C. L., additional, Chapdelaine, I., additional, Nube, M. J., additional, Blankestijn, P. J., additional, Bots, M. L., additional, Konings, S. J., additional, Van Den Dorpel, M. A., additional, Van Der Weerd, N. C., additional, Ter Wee, P. M., additional, Grooteman, M. P., additional, Djuric, P. S., additional, Jankovic, A., additional, Tosic, J., additional, Bajcetic, S., additional, Damjanovic, T., additional, Popovic, J., additional, Dimkovic, N., additional, Marinkovic, J., additional, Djuric, Z., additional, Knezevic, V., additional, Lazarevic, T., additional, Ljubenovic, S., additional, Markovic, R., additional, Rabrenovic, V., additional, Djukanovic, L., additional, Radovic Maslarevic, V., additional, Mathrani, V., additional, Drew, P., additional, Chess, J. I., additional, Williams, A. I., additional, Robertson, S., additional, Jibani, M., additional, Aithal, V. I., additional, Kumwenda, M., additional, Roberts, G., additional, Mikhail, A. I., additional, Grzegorzewska, A. E., additional, Ostromecki, G., additional, Mostowska, A., additional, Sowi ska, A., additional, Jagodzi ski, P. P., additional, Wu, H.-Y., additional, Chen, H.-Y., additional, Hsu, S.-P., additional, Pai, M.-F., additional, Yang, J.-Y., additional, Peng, Y.-S., additional, Hirose, M., additional, Hasegawa, T., additional, Kaneshima, N., additional, Sasai, F., additional, Komukai, D., additional, Takahashi, K., additional, Koiwa, F., additional, Shishido, K., additional, Yoshimura, A., additional, Selim, G., additional, Stojceva-Taneva, O., additional, Tozija, L., additional, Dzekova-Vidimliski, P., additional, Trajceska, L., additional, Petronievic, Z., additional, Gelev, S., additional, Amitov, V., additional, Sikole, A., additional, Moon, S. J., additional, Yoon, S. Y., additional, Shin, D. H., additional, Lee, J. E., additional, Kim, H.-J., additional, Park, H.-C., additional, Hadjiyannakos, D., additional, Filiopoulos, V., additional, Loukas, G., additional, Pagonis, S., additional, Andriopoulos, C., additional, Drakou, A., additional, Vlassopoulos, D., additional, Catarino, C., additional, Cunha, P., additional, Ribeiro, S., additional, Rocha-Pereira, P., additional, Reis, F., additional, Sameiro-Faria, M., additional, Miranda, V., additional, Bronze-Rocha, E., additional, Belo, L., additional, Costa, E., additional, Santos-Silva, A., additional, De Mauri, A., additional, Brambilla, M., additional, Chiarinotti, D., additional, Lizio, D., additional, Matheoud, R., additional, Conti, N., additional, Conte, M. M., additional, Carriero, A., additional, De Leo, M., additional, Karpetas, A. V., additional, Sarafidis, P. A., additional, Georgianos, P. I., additional, Koutroumpas, G., additional, Divanis, D., additional, Vakianis, P., additional, Tzanis, G., additional, Raptopoulou, K., additional, Protogerou, A., additional, Stamatiadis, D., additional, Syrganis, C., additional, Liakopoulos, V., additional, Efstratiadis, G., additional, Lasaridis, A. N., additional, Tersi, M., additional, Stamatiadis, D. N., additional, Kuczera, P., additional, Adamczak, M., additional, Wiecek, A., additional, Bove, S., additional, Giacon, B., additional, Corradini, R., additional, Prati, E., additional, Brognoli, M., additional, Tommasi, A., additional, Sereni, L., additional, Palladino, G., additional, Moriya, H., additional, Mochida, Y., additional, Ishioka, K., additional, Oka, M., additional, Maesato, K., additional, Hidaka, S., additional, Ohtake, T., additional, Kobayashi, S., additional, Moura, A., additional, Madureira, J., additional, Alija, P., additional, Fernandes, J. C., additional, Oliveira, J. G., additional, Lopez, M., additional, Filgueiras, M., additional, Amado, L., additional, Vieira, M., additional, Seok, J.-H., additional, Choi, H. Y., additional, Ha, S. K., additional, Park, H. C., additional, Bossola, M., additional, Laudisio, A., additional, Antocicco, M., additional, Tazza, L., additional, Colloca, G., additional, Tosato, M., additional, Zuccala, G., additional, Ettema, E. M., additional, Kuipers, J., additional, Groen, H., additional, Gansevoort, R. T., additional, Stade, K., additional, Bakker, S. J. L., additional, Gaillard, C. A. J. M., additional, Westerhuis, R., additional, Bacchetta, J., additional, Couchoud, K., additional, Semlali, S., additional, Sellier-Leclerc, A.-L., additional, Bertholet-Thomas, A., additional, Cartier, R., additional, Cochat, P., additional, Ranchin, B., additional, Kim, J. C., additional, Park, K., additional, Van Ende, C., additional, Wilmes, D., additional, Lecouvet, F. E., additional, Labriola, L., additional, Cuvelier, R., additional, Van Ingelgem, G., additional, Jadoul, M., additional, Doriana, C., additional, David, P., additional, Capurro, F., additional, Brustia, M., additional, Ruva, C. E., additional, Giungi, S., additional, Di Stasio, E., additional, Lemesch, S., additional, Leber, B., additional, Horvath, A., additional, Ribitsch, W., additional, Schilcher, G., additional, Zettel, G., additional, Tawdrous, M., additional, Rosenkranz, A. R., additional, Stadlbauer-Kollner, V., additional, Matsushima, H., additional, Oyama, A., additional, Bosch Benitez-Parodi, E., additional, Baamonde Laborda, E., additional, Batista Garcia, F., additional, Perez Suarez, G., additional, Anton Perez, G., additional, Garcia Canton, C., additional, Toledo Gonzalez, A., additional, Lago Alonso, M. M., additional, Checa Andres, M. D., additional, Cobo, G., additional, Di Gioia, C., additional, Camacho, R., additional, Garcia Lacalle, C., additional, Ortega, O., additional, Rodriguez, I., additional, Herrero, J., additional, Oliet, A., additional, Ortiz, M., additional, Mon, C., additional, Vigil, A., additional, Gallar, P., additional, Pellu, V., additional, Nebiolo, P. E., additional, Sasaki, K., additional, Yamguchi, S., additional, Hesaka, A., additional, Iwahashi, E., additional, Sakai, S., additional, Fujimoto, T., additional, Minami, S., additional, Fujita, Y., additional, Yokoyama, K., additional, Shutov, E., additional, Ryabinskya, G., additional, Lashutin, S., additional, Gorelova, E., additional, Volodicheva, E., additional, Podesta, M. A., additional, Cancarini, G., additional, Cucchiari, D., additional, Montanelli, A., additional, Badalamenti, S., additional, Graziani, G., additional, Distasio, E., additional, Pchelin, I., additional, Shishkin, A., additional, Fedorova, Y., additional, Kao, C.-C., additional, Chu, T.-S., additional, Tsai, T.-J., additional, Wu, K.-D., additional, Wu, M.-S., additional, Raikou, V., additional, Kaisidis, P., additional, Tsamparlis, E., additional, Kanellopoulos, P., additional, Boletis, J., additional, Ueda, A., additional, Hirayama, A., additional, Owada, S., additional, Nagai, K., additional, Saito, C., additional, and Yamagata, K., additional

Published
2014
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17. PERITONEAL ULTRAFILTRATION IN REFRACTORY HEART FAILURE: A COHORT STUDY

Author

Bertoli, Sv, Musetti, C, Ciurlino, D, Basile, C, Galli, E, Gambaro, Giovanni, Iadarola, G, Guastoni, C, Carlini, A, Fasciolo, F, Borzumati, M, Gallieni, M, Farina, S., Gambaro, Giovanni (ORCID:0000-0001-5733-2370), Bertoli, Sv, Musetti, C, Ciurlino, D, Basile, C, Galli, E, Gambaro, Giovanni, Iadarola, G, Guastoni, C, Carlini, A, Fasciolo, F, Borzumati, M, Gallieni, M, Farina, S., and Gambaro, Giovanni (ORCID:0000-0001-5733-2370)

Abstract

Introduction: Acutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without end-stage renal disease.

Published
2013

21. Uremic inhibitors of erythropoiesis: a study during treatment with recombinant human erythropoietin

Author

Luigi Minetti, Tuttia De Feo, Luigi Ballerini, Busnach G, Brunati C, Maria Domenica Cappellini, Guastoni C, Giovanni Civati, and Gemino Fiorelli

Subjects
Adult, medicine.medical_specialty, Anemia, medicine.medical_treatment, law.invention, law, hemic and lymphatic diseases, Internal medicine, medicine, Humans, Erythropoiesis, Erythropoietin, Cells, Cultured, Uremia, Erythroid Precursor Cells, Chemotherapy, business.industry, medicine.disease, Growth Inhibitors, Recombinant Proteins, Endocrinology, Mechanism of action, Nephrology, Recombinant DNA, Kidney Failure, Chronic, Hemodialysis, medicine.symptom, Complication, business, medicine.drug
Abstract

The effects of increasing amounts of uremic sera (US) on the growth of erythroid progenitor cells [burst-forming unit erythroid (BFU-E)] collected from peripheral blood of normal subjects were evaluated to assess the potential role of uremic inhibitors of erythropoiesis during a treatment with recombinant human erythropoietin (r-HuEpo). US were collected from 8 patients on regular dialysis with marked anemia (Hb 6 +/- 0.5 g%) before and after a treatment with high doses of r-HuEpo (from 300 to 525 U/kg/week). Standard cultures for BFU-E were performed in alpha-metylcellulose with fetal calf serum (FCS) and 4 U/ml of r-HuEpo (Cilag, Ortho). In successive cultures, US were added at increasing amounts to the standard culture in order to assess a possible inhibitory effect on BFU-E growth. Finally, in order to assess a possible lack of stimulatory factors, we partially substituted FCS with US. The addition of US collected either before or after therapy with r-HuEpo to the standard culture had no effect on the growth of BFU-E. Vice versa, the number of cultured BFU-E decreased when FCS was partially substituted with US collected before r-HuEpo. This effect was not evident when FCS was partially substituted with US collected after r-HuEpo. No significant differences were recorded in the tested sera collected before and after therapy considering erythropoietin levels and amino acid levels. We hypothesized that some other factors with erythropoietic stimulatory activity (burst-promoting activity?) may be deficient in uremic patients with marked anemia and can be induced during therapy with r-HuEpo.

Published
1992

24. Erythrocyte ferritin in patients on chronic hemodialysis treatment

Author

Brunati, C, Piperno, A, Guastoni, C, Perrino, M, Civati, G, Teatini, U, Perego, A, Fiorelli, G, Minetti, L, Minetti, L., PIPERNO, ALBERTO, Brunati, C, Piperno, A, Guastoni, C, Perrino, M, Civati, G, Teatini, U, Perego, A, Fiorelli, G, Minetti, L, Minetti, L., and PIPERNO, ALBERTO

Abstract

Serum ferritin (SF) and erythrocyte ferritin (EF) were evaluated in 35 patients on chronic hemodialysis treatment (CHD), in 45 healthy subjects and in 22 nonnephropathic females with iron deficiency anemia. Twenty-five CHD patients with basal SF less than 500 micrograms/l were treated orally with 200 mg of Fe2+ for 2 months and the positive (hemoglobin increase greater than 1 g/dl) or negative response to the therapy was correlated to the basal levels of SF and EF. Three groups of CHD patients could be defined on the basis of their basal SF levels (hypo-, normo- or hyperferritinemic). Nine patients with increased SF levels had also EF levels significantly higher than the other CHD patients and controls since they were probably iron-overloaded. In the other 2 groups of CHD patients, EF levels were significantly higher than in controls for each level of SF probably because of the reduced utilization of iron by uremic bone marrow. Among the 25 treated CHD patients, only 5 responded to the therapy: 3 were hypoferritinemic while the other 2 responders had basal SF within the normal range. Four hypoferritinemic patients did not respond to the therapy. Four out of five responders had the lowest EF levels among CHD patients. EF measurement could be an important and useful test in detecting the presence of an iron deficiency erythropoiesis in CHD patients.

Published
1990

26. Epidemiology of hepatitis D virus (HDV) infection in an urban area of Northern Italy.

Author

Paschale, M., Manco, M., Belvisi, L., Magnani, C., Re, T., Viganò, P., Biagiotti, S., Capelli, F., Mazzone, A., Baldacci, M., Ferrara, A., Neri, A., Guastoni, C., Bonazzina, R., Brando, B., and Clerici, P.

Subjects
INTRAVENOUS drug abuse, INFECTIOUS disease transmission, CONFIDENCE intervals, HEPATITIS D, FISHER exact test, IMMIGRANTS, RESEARCH, CROSS-sectional method, HIV seroconversion, SEROPREVALENCE, DESCRIPTIVE statistics
Abstract

Objectives: The introduction of vaccination against hepatitis B initially reduced the number of HBV (hepatitis B virus) and HDV (hepatitis delta virus) infections, but the decreasing trend of HDV infection seems to have stopped. The aim of this study was to assess the prevalence of HDV infection in the general population living in the catchment area of Legnano Hospital in northern Italy. Methods: Of the 22,758 subjects tested in 2007-2008, the 488 who were HBsAg (hepatitis B surface antigen)-positive [including 107 (21.9%) of non-Italian origin] were subsequently tested for anti-HDV antibodies. Results: Of the 488 subjects who tested positive for HBsAg, 24 (4.9%) were anti-HDV positive, all aged between 30 and 60 years. The difference in prevalence between males (7.1%) and females (1.9%) was statistically significant ( p < 0.05), but not that between Italian (5.0%) and non-Italian patients (4.7%). The differences in anti-HDV seropositivity between the patients with acute (0%) and chronic infections (6.3%), and between the incident (2.5%) and prevalent cases (7.4%), were not statistically significant, but there was a significant difference ( p < 0.01) between those with asymptomatic (2.1%) and clinically symptomatic infections (10.3%). Intravenous drug abuse was the main source of infection. Conclusions: In the catchment area of our hospital, the prevalence of HDV infection does not seem to be due to patients of non-Italian origin, but to Italian patients who are not vaccinated against HBV and who survived the HDV epidemic of the 1970s and 1980s. Nevertheless, the increase in the number of immigrants from non-EU countries in recent years is soon likely to lead to a change in the epidemiology of HDV. [ABSTRACT FROM AUTHOR]

Published
2012
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32. Uremic Polyneuropathy Can Be Cured by High-Efficiency Hemofiltration

Author

Teatini U, D. D’Urso, V. Grassi, Luigi Minetti, Perego A, Civati G, and Guastoni C

Subjects
medicine.medical_specialty, Resuscitation, business.industry, medicine.medical_treatment, Hematology, General Medicine, medicine.disease, Surgery, Uremic polyneuropathy, Peripheral neuropathy, Nephrology, Hemofiltration, medicine, sense organs, Renal replacement therapy, skin and connective tissue diseases, business, Polyneuropathy
Abstract

13 patients under artificial renal replacement therapy have been studied as to the changes of electromyographic patterns and peripheral neuropathy symptoms. 10 patients have been treated by high-effic

Published
1983
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34. Erythrocyte ferritin in patients on chronic hemodialysis treatment

Author

Giovanni Civati, Luigi Minetti, A. Piperno, Perrino Ml, Teatini U, Perego A, Guastoni C, Brunati C, G. Fiorelli, Brunati, C, Piperno, A, Guastoni, C, Perrino, M, Civati, G, Teatini, U, Perego, A, Fiorelli, G, and Minetti, L

Subjects
Adult, Male, medicine.medical_specialty, Resuscitation, Erythrocytes, Anemia, medicine.medical_treatment, Iron, Gastroenterology, Bone Marrow, Renal Dialysis, Internal medicine, medicine, Humans, Erythropoiesis, Chronic hemodialysis, Serum ferritin, Aged, Anemia, Hypochromic, Ferritin, biology, business.industry, Iron Deficiencies, Iron deficiency, Middle Aged, medicine.disease, Erythrocyte, Red blood cell, medicine.anatomical_structure, Ferritins, Immunology, biology.protein, Female, Hemodialysis, MED/09 - MEDICINA INTERNA, business, Human
Abstract

Serum ferritin (SF) and erythrocyte ferritin (EF) were evaluated in 35 patients on chronic hemodialysis treatment (CHD), in 45 healthy subjects and in 22 nonnephropathic females with iron deficiency anemia. Twenty-five CHD patients with basal SF less than 500 micrograms/l were treated orally with 200 mg of Fe2+ for 2 months and the positive (hemoglobin increase greater than 1 g/dl) or negative response to the therapy was correlated to the basal levels of SF and EF. Three groups of CHD patients could be defined on the basis of their basal SF levels (hypo-, normo- or hyperferritinemic). Nine patients with increased SF levels had also EF levels significantly higher than the other CHD patients and controls since they were probably iron-overloaded. In the other 2 groups of CHD patients, EF levels were significantly higher than in controls for each level of SF probably because of the reduced utilization of iron by uremic bone marrow. Among the 25 treated CHD patients, only 5 responded to the therapy: 3 were hypoferritinemic while the other 2 responders had basal SF within the normal range. Four hypoferritinemic patients did not respond to the therapy. Four out of five responders had the lowest EF levels among CHD patients. EF measurement could be an important and useful test in detecting the presence of an iron deficiency erythropoiesis in CHD patients.

37. [Effects of Dose of Erythropoiesis Stimulating Agents on Cardiovascular Outcomes, Quality of Life and Costs of Haemodialysis. The Clinical Evaluation of the DOSe of Erythropoietins (C.E. DOSE) Trial]

Author

Saglimbene V, D'Alonzo D, Ruospo M, Vecchio M, Natale P, Gargano L, Nicolucci A, Pellegrini F, Jc, Craig, Triolo G, Da, Procaccini, Santoro A, Giulio S, Rosa S, Murgo A, Mammarella R, Sambati M, D'Ambrosio N, Greco V, Giannoccaro G, Flammini A, Boccia E, Montalto G, Pagano S, Amarù S, Fici M, Lumaga G, Mancini E, Veronesi M, Patregnani L, Querques M, Schiavone P, Chimienti S, Palumbo R, Franco D, Volpe M, Gori E, Salomone M, Iacono A, Moscoloni M, Treglia A, Casu D, Am, Piras, Silva A, Mandreoli M, Lopez A, Quarello F, Catizone L, Russo G, Forcellini S, Maccarone M, Catucci G, Paolo B, Stingone A, D'Angelo B, Guastoni C, Pasquali S, Minoretti C, Bellasi A, Boscutti G, Martone M, David S, Schito F, Urban L, Iorio B, Caruso F, Mazzoni A, Musacchio R, Andreoli D, Cossu M, Cavoli G, Cornacchiari M, Granata A, Clementi A, Giordano R, Barzaghi W, Miriam Valentini, Hegbrant J, Tognoni G, and Gf, Strippoli

Subjects
Risk, Dose-Response Relationship, Drug, Disease Management, Anemia, Middle Aged, Hemoglobins, Observational Studies as Topic, Double-Blind Method, Meta-Analysis as Topic, Renal Dialysis, Research Design, Outcome Assessment, Health Care, Hematinics, Quality of Life, Humans, Kidney Failure, Chronic, Diabetic Nephropathies, Female
Abstract

Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested.We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed. The study has been approved and funded by the Italian Agency of Drugs (Agenzia Italiana del Farmaco (AIFA)) within the 2006 funding plan for independent research on drugs (registered at www.clinicaltrials.gov (NCT00827021)).

38. Clinical practice for the diagnosis of cardiac arrhythmias in patients on renal replacement therapy: data from a Lombard survey,Pratica clinica per la diagnostica delle aritmie cardiache in pazienti in terapia renale sostitutiva: dati di una survey lombarda

Author

Genovesi, S., Nava, E., Pasa, A., Corghi, E., Ondei, P., Marta, E., Bellasi, A., Malberti, F., Teatini, U., Guastoni, C. M., Spatola, L., Luise, M. C., Tiboldo, R., Bertoli, S., Messa, P., Doria, M., Gallieni, M., Mario Cozzolino, Spotti, D., Sala, V., Sironi, E., and Boriani, G.

39. Effects of dose of erythropoiesis stimulating agents on cardiovascular outcomes, quality of life and costs of haemodialysis. the clinical evaluation of the DOSe of erythropoietins (C.E. DOSE) Trial | Effetti della dose degli agenti stimolanti l'eritropoiesi su esiti cardio-cerebrovascolari, qualità di vita e costi in emodialisi

Author

Saglimbene, V., D Alonzo, D., Ruospo, M., Vecchio, M., Natale, P., Gargano, L., Nicolucci, A., Pellegrini, F., Craig, J. C., Triolo, G., Procaccini, D. A., Santoro, A., Di Giulio, S., La Rosa, S., Murgo, A., Di Toro Mammarella, R., Sambati, M., D Ambrosio, N., Greco, V., Giannoccaro, G., Flammini, A., Boccia, E., Giuseppe MONTALTO, Pagano, S., Amarù, S., Fici, M., Lumaga, G. B., Mancini, E., Veronesi, M., Patregnani, L., Querques, M., Schiavone, P., Chimienti, S., Palumbo, R., Di Franco, D., Della Volpe, M., Gori, E., Salomone, M., Iacono, A., Moscoloni, M., Treglia, A., Casu, D., Piras, A. M., Di Silva, A., Mandreoli, M., Lopez, A., Quarello, F., Catizone, L., Russo, G., Forcellini, S., Maccarone, M., Catucci, G., Di Paolo, B., Stingone, A., D Angelo, B., Guastoni, C., Pasquali, S., Minoretti, C., Bellasi, A., Boscutti, G., Martone, M., David, S., Schito, F., Urban, L., Di Iorio, B., Caruso, F., Mazzoni, A., Musacchio, R., Andreoli, D., Cossu, M., Li Cavoli, G., Cornacchiari, M., Granata, A., Clementi, A., Giordano, R., Barzaghi, W., Valentini, M., Hegbrant, J., Tognoni, G., and Strippoli, G. F.

40. New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of Nephrologists form Lombardy

Author

Bellasi, A., Mario Cozzolino, Malberti, F., Cancarini, G., Esposito, C., Genderini, A., Guastoni, C. M., Ondei, P., Pontoriero, G., Teatini, U., Vezzoli, G., Messa, P., Locatelli, F., Bellasi, Antonio, Cozzolino, Mario, Malberti, Fabio, Cancarini, Giovanni, Esposito, Ciro, Genderini, Augusto, Guastoni, Carlo Maria, Ondei, Patrizia, Pontoriero, Giuseppe, Teatini, Ugo, Vezzoli, Giuseppe, Messa, Piergiorgio, and Locatelli, Francesco

Subjects
etelcalcetide, secondary hyperparathyroidism, CKD-MBD, cinacalcet, PTH
Abstract

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago. Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago.

43. SIRM-SIN-AIOM: appropriateness criteria for evaluation and prevention of renal damage in the patient undergoing contrast medium examinations-consensus statements from Italian College of Radiology (SIRM), Italian College of Nephrology (SIN) and Italian Association of Medical Oncology (AIOM)

Author

Antonio Orlacchio, Carlo Guastoni, Giordano Domenico Beretta, Laura Cosmai, Michele Galluzzo, Stefania Gori, Emanuele Grassedonio, Lorena Incorvaia, Carmelita Marcantoni, Giuseppe Stefano Netti, Matteo Passamonti, Camillo Porta, Giuseppe Procopio, Mimma Rizzo, Silvia Roma, Laura Romanini, Fulvio Stacul, Alice Casinelli, Orlacchio A., Guastoni C., Beretta G.D., Cosmai L., Galluzzo M., Gori S., Grassedonio E., Incorvaia L., Marcantoni C., Netti G.S., Passamonti M., Porta C., Procopio G., Rizzo M., Roma S., Romanini L., Stacul F., and Casinelli A.

Subjects
Male, Consensus, Contrast Media, General Medicine, Acute Kidney Injury, urologic and male genital diseases, Kidney, Medical Oncology, Oncology, Settore MED/36, Nephrology, Risk Factors, Kidney injury, Humans, Radiology, Nuclear Medicine and imaging, Female, Diagnostic, Nephrotoxicity, Radiology
Abstract

The increasing number of examinations and interventional radiological procedures that require the administration of contrast medium (CM) in patients at risk for advanced age and/or comorbidities highlights the problem of CM-induced renal toxicity. A multidisciplinary group consisting of specialists of different disciplines—radiologists, nephrologists and oncologists, members of the respective Italian Scientific Societies—agreed to draw up this position paper, to assist clinicians increasingly facing the challenges posed by CM-related renal dysfunction in their daily clinical practice.The major risk factor for acute renal failure following CM administration (post-CM AKI) is the preexistence of renal failure, particularly when associated with diabetes, heart failure or cancer.In accordance with the recent guidelines ESUR, the present document reaffirms the importance of renal risk assessment through the evaluation of the renal function (eGFR) measured on serum creatinine and defines the renal risk cutoff when the eGFR is The cutoff of renal risk is considered an eGFR Intravenous hydration using either saline or Na bicarbonate solution before and after CM administration represents the most effective preventive measure in patients at risk of post-CM AKI. In the case of urgency, the infusion of 1.4% sodium bicarbonate pre- and post-CM may be more appropriate than the administration of saline.In cancer patients undergoing computed tomography, pre- and post-CM hydration should be performed when the eGFR is In patients with more severe renal risk (i.e., with eGFR In magnetic resonance imaging (MRI) using gadolinium CM, there is a lower risk of AKI than with iodinated CM, particularly if doses 30 ml/min/1.73 m2. Dialysis after MRI is indicated only in patients already undergoing chronic dialysis treatment to reduce the potential risk of systemic nephrogenic fibrosis.

Published
2022

44. New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology

Author

Piergiorgio Messa, Giuseppe Vezzoli, Mario Cozzolino, Ciro Esposito, Patrizia Ondei, Giovanni Cancarini, Antonio Bellasi, Francesco Locatelli, Giuseppe Pontoriero, Marzia Pasquali, Carlo Guastoni, Fabio Malberti, Ugo Teatini, Bellasi, A., Cozzolino, M., Malberti, F., Cancarini, G., Esposito, C., Guastoni, C. M., Ondei, P., Pontoriero, G., Teatini, U., Vezzoli, G., Pasquali, M., Messa, P., and Locatelli, F.

Subjects
Nephrology, medicine.medical_specialty, Calcimimetic, medicine.medical_treatment, Population, urologic and male genital diseases, Chronic kidney disease-mineral and bone disorder, Internal medicine, CKD-MBD, medicine, Humans, Position papers and Guidelines, Intensive care medicine, education, Dialysis, Chronic Kidney Disease-Mineral and Bone Disorder, Etelcalcetide, education.field_of_study, business.industry, medicine.disease, female genital diseases and pregnancy complications, Secondary hyperparathyroidism, Italy, Position paper, Cinacalcet, Peptides, business, PTH, Kidney disease
Abstract

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago.

Published
2019
Full Text
View/download PDF

45. Ramipril and Cardiovascular Outcomes in Patients on Maintenance Hemodialysis: The ARCADIA Multicenter Randomized Controlled Trial

Author

Federico Pieruzzi, Jorge Hidalgo Godoy, Antonello Pani, Claudio Pozzi, Andrea Galfré, Silvio Bertoli, Hans-Joachim Anders, Giovanni Mosconi, Giuseppe Daidone, Simonetta Genovesi, E. Mambelli, Giulio Mingardi, Goffredo Del Rosso, Agnese Meterange-Lis, Annalisa Perna, Piero Ruggenenti, Antonio Granata, Angelo Rigotti, Matias Trillini, Manuel Alfredo Podestà, Salvatore David, Carmela Giuseppina Condemi, Tobia Peracchi, Sonia Pasquali, Patrizia Ondei, Davide Villa, Giorgio Romei Longhena, Carlo Guastoni, Maurizio Garozzo, Nadia Rubis, Monica Cortinovis, Davide Martinetti, Giuseppe Remuzzi, Alfonso Pacitti, Ruggenenti, P, Podesta, M, Trillini, M, Perna, A, Peracchi, T, Rubis, N, Villa, D, Martinetti, D, Cortinovis, M, Ondei, P, Condemi, C, Guastoni, C, Meterangelis, A, Granata, A, Mambelli, E, Pasquali, S, Genovesi, S, Pieruzzi, F, Bertoli, S, Del Rosso, G, Garozzo, M, Rigotti, A, Pozzi, C, David, S, Daidone, G, Mingardi, G, Mosconi, G, Galfre, A, Romei Longhena, G, Pacitti, A, Pani, A, Hidalgo Godoy, J, Anders, H, and Remuzzi, G

Subjects
Ramipril, Male, medicine.medical_specialty, Epidemiology, medicine.medical_treatment, Angiotensin-Converting Enzyme Inhibitors, Critical Care and Intensive Care Medicine, law.invention, Randomized controlled trial, law, Renal Dialysis, Multicenter trial, Internal medicine, ACE inhibitor, medicine, Clinical endpoint, media_common.cataloged_instance, Humans, Prospective Studies, European union, Stroke, media_common, Aged, Transplantation, renin angiotensin system, business.industry, Editorials, Middle Aged, medicine.disease, cardiovascular event, Clinical trial, hemodialysi, Nephrology, Cardiovascular Diseases, Female, Hemodialysis, business, medicine.drug
Abstract

Background and objectives Renin-angiotensin system (RAS) inhibitors reduce cardiovascular morbidity and mortality in patients with CKD. We evaluated the cardioprotective effects of the angiotensin-converting enzyme inhibitor ramipril in patients on maintenance hemodialysis. Design, setting, participants, & measurements In this phase 3, prospective, randomized, open-label, blinded end point, parallel, multicenter trial, we recruited patients on maintenance hemodialysis with hypertension and/or left ventricular hypertrophy from 28 Italian centers. Between July 2009 and February 2014, 140 participants were randomized to ramipril (1.25–10 mg/d) and 129 participants were allocated to non-RAS inhibition therapy, both titrated up to the maximally tolerated dose to achieve predefined target BP values. The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included the single components of the primary end point, new-onset or recurrence of atrial fibrillation, hospitalizations for symptomatic fluid overload, thrombosis or stenosis of the arteriovenous fistula, and changes in cardiac mass index. All outcomes were evaluated up to 42 months after randomization. Results At comparable BP control, 23 participants on ramipril (16%) and 24 on non-RAS inhibitor therapy (19%) reached the primary composite end point (hazard ratio, 0.93; 95% confidence interval, 0.52 to 1.64; P=0.80). Ramipril reduced cardiac mass index at 1 year of follow-up (between-group difference in change from baseline: −16.3 g/m2; 95% confidence interval, −29.4 to −3.1), but did not significantly affect the other secondary outcomes. Hypotensive episodes were more frequent in participants allocated to ramipril than controls (41% versus 12%). Twenty participants on ramipril and nine controls developed cancer, including six gastrointestinal malignancies on ramipril (four were fatal), compared with none in controls. Conclusions Ramipril did not reduce the risk of major cardiovascular events in patients on maintenance hemodialysis. Clinical Trial registry name and registration number: ARCADIA, NCT00985322 and European Union Drug Regulating Authorities Clinical Trials Database number 2008–003529–17.

Published
2021

46. Clinical practice for the diagnosis of cardiac arrhythmias in patients on renal replacement therapy: data from a Lombard survey

Author

Genovesi, Simonetta, Nava, Elisa, Pasa, Alice, Corghi, Enzo, Ondei, Patrizia, Marta, Elisabetta, Bellasi, Antonio, Malberti, Fabio, Teatini, Ugo, Guastoni, Carlo Maria, Spatola, Leonardo, Luise, Maria Carmen, Tiboldo, Renza, Bertoli, Silvio, Messa, Piergiorgio, Doria, Maria, Gallieni, Maurizio, Cozzolino, Mario, Spotti, Donatella, Sala, Valeria, Sironi, Elisabetta, Boriani, Giuseppe, Genovesi, S, Nava, E, Pasa, A, Corghi, E, Ondei, P, Marta, E, Bellasi, A, Malberti, F, Teatini, U, Guastoni, C, Spatola, L, Luise, M, Tiboldo, R, Bertoli, S, Messa, P, Doria, M, Gallieni, M, Cozzolino, M, Spotti, D, Sala, V, Sironi, E, and Boriani, G

Subjects
Pacemaker, Artificial, Cardiology, Electric Countershock, cardiac devices, Arrhythmias, electrocardiogram, Kidney Failure, Cardiac Resynchronization Therapy, Electrocardiography, Ambulatory, Humans, Chronic, peritoneal dialysis, Patient Care Team, echocardiogram, haemodialysis, Arrhythmias, Cardiac, Defibrillators, Implantable, Disease Management, Electrocardiography, Ambulatory, Health Care Surveys, Heart Arrest, Italy, Kidney Failure, Chronic, Nephrology, Stroke, Renal Replacement Therapy, cardiac device, Pacemaker, haemodialysi, Artificial, Implantable, Cardiac, Arrhythmia, Defibrillators
Abstract

Among dialysis patients, 40% of deaths are due to cardiovascular causes, and 60% of cardiac deaths are due to an arrhythmia. The purpose of this survey, carried out with the organizational support of the Lombard Section of the Italian Society of Nephrology, is to evaluate the frequency and mode of use of non-invasive instruments for the diagnosis of cardiac arrhythmias in the dialysis centers of Lombardy. Information on the prevalence and type of cardiac devices at December 1, 2016 in this population was also required. Data from 18 centers were collected for a total of 3395 patients in replacement renal therapy, including 2907 (85.6%) in hemodialysis and 488 (14.4%) in peritoneal dialysis. All centers use the 12-lead ECG in case of evocative symptoms of an arrhythmic event and 2/3 perform the exam with programmed cadence (usually once a year). Twenty four-hour ECG Holter is not used as a routine diagnostic tool. The proportion of cardiac devices is relatively high, compared to literature data: n=259, equal to 7.6% of the population. Pace-Maker patients are 166 (4.9%), those with intracardiac defibrillator 52 (1.5%), those with resynchronization therapy 18 (0.5%) and those with resynchronization therapy and intracardiac defibrillator 23 (0.7%). The survey provides interesting information and can be an important starting point for trying to optimize clinical practice and collaboration between nephrologists and cardiologists in front of a major problem like that of arrhythmic disease in patients on renal replacement therapy.

Published
2017

47. [High-flow fistula: a problem not easy to handle].

Author

Mudoni A, Cornacchiari M, Borin F, Liccardo A, Visciano B, Ponticelli MG, and Guastoni C

Subjects
Humans, Aged, Hemodynamics, Renal Dialysis adverse effects, Arteriovenous Shunt, Surgical adverse effects, Heart Failure etiology, Arteriovenous Fistula complications
Abstract

High-output cardiac failure is a well-known phenomenon of high-flow fistula in hemodialysis patients. The definition of "high flow" is varied and almost always connected to proximal arteriovenous fistulas (AVF). High flow access is a condition in which hemodynamics is affected by a greater rate of blood flow required for hemodialysis and this can compromise circulatory dynamics, particularly in the elderly in the context of pre-existing heart disease. High access flow is associated with complications like high output heart failure, pulmonary hypertension, massively dilated fistula, central vein stenosis, dialysis associated steal syndrome or distal hypoperfusion ischemic syndrome. Although there is no single agreement about the values of AVF flow volume, nor about the definition of high-flow AVF, there is no doubt that AVF flow should be considered too high if signs of cardiac failure develop. The exact threshold for defining high flow access has not been validated or universally accepted by the guidelines, although a vascular access flow rate of 1 to 1.5 l/min has been suggested. Moreover, even lower values may be indicative of relatively excessive blood flow, depending on the patient's condition. The pathophysiology contributing to this disease process is the shunting of blood from the high-resistance arterial system into the lower resistance venous system, increasing the venous return up to cardiac failure. Accurate and well-timed diagnosis of high flow arteriovenous hemodynamics by monitoring of blood flow of fistula and cardiac function is required in order to stop this process prior to cardiac failure. We present two cases of patients with high flow arteriovenous fistula with a review of the literature., (Copyright by Società Italiana di Nefrologia SIN, Rome,Italy.)

Published
2023

48. SIRM-SIN-AIOM: appropriateness criteria for evaluation and prevention of renal damage in the patient undergoing contrast medium examinations-consensus statements from Italian College of Radiology (SIRM), Italian College of Nephrology (SIN) and Italian Association of Medical Oncology (AIOM).

Author

Orlacchio A, Guastoni C, Beretta GD, Cosmai L, Galluzzo M, Gori S, Grassedonio E, Incorvaia L, Marcantoni C, Netti GS, Passamonti M, Porta C, Procopio G, Rizzo M, Roma S, Romanini L, Stacul F, and Casinelli A

Subjects
Contrast Media, Female, Humans, Kidney physiology, Male, Medical Oncology, Risk Factors, Acute Kidney Injury chemically induced, Acute Kidney Injury prevention & control, Nephrology, Radiology
Abstract

The increasing number of examinations and interventional radiological procedures that require the administration of contrast medium (CM) in patients at risk for advanced age and/or comorbidities highlights the problem of CM-induced renal toxicity. A multidisciplinary group consisting of specialists of different disciplines-radiologists, nephrologists and oncologists, members of the respective Italian Scientific Societies-agreed to draw up this position paper, to assist clinicians increasingly facing the challenges posed by CM-related renal dysfunction in their daily clinical practice.The major risk factor for acute renal failure following CM administration (post-CM AKI) is the preexistence of renal failure, particularly when associated with diabetes, heart failure or cancer.In accordance with the recent guidelines ESUR, the present document reaffirms the importance of renal risk assessment through the evaluation of the renal function (eGFR) measured on serum creatinine and defines the renal risk cutoff when the eGFR is < 30 ml/min/1.73 m2 for procedures with intravenous (i.v.) or intra-arterial (i.a.) administration of CM with renal contact at the second passage (i.e., after CM dilution with the passage into the pulmonary circulation).The cutoff of renal risk is considered an eGFR < 45 ml/min/1.73 m2 in patients undergoing i.a. administration with first-pass renal contact (CM injected directly into the renal arteries or in the arterial district upstream of the renal circulation) or in particularly unstable patients such as those admitted to the ICU.Intravenous hydration using either saline or Na bicarbonate solution before and after CM administration represents the most effective preventive measure in patients at risk of post-CM AKI. In the case of urgency, the infusion of 1.4% sodium bicarbonate pre- and post-CM may be more appropriate than the administration of saline.In cancer patients undergoing computed tomography, pre- and post-CM hydration should be performed when the eGFR is < 30 ml/min/1.73 m2 and it is also advisable to maintain a 5 to 7 days interval with respect to the administration of cisplatin and to wait 14 days before administering zoledronic acid.In patients with more severe renal risk (i.e., with eGFR < 20 ml/min/1.73 m2), particularly if undergoing cardiological interventional procedures, the prevention of post-CM AKI should be implemented through an internal protocol shared between the specialists who treat the patient.In magnetic resonance imaging (MRI) using gadolinium CM, there is a lower risk of AKI than with iodinated CM, particularly if doses < 0.1 mmol/kg body weight are used and in patients with eGFR > 30 ml/min/1.73 m2. Dialysis after MRI is indicated only in patients already undergoing chronic dialysis treatment to reduce the potential risk of systemic nephrogenic fibrosis., (© 2022. The Author(s).)

Published
2022
Full Text
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49. [CEUS, a world to discover. Three clinical cases and literature review].

Author

Cornacchiari M, Mudoni A, Visciano B, Mereghetti M, and Guastoni C

Subjects
Adult, Contrast Media, Humans, Ultrasonography, Kidney Diseases chemically induced, Kidney Diseases diagnostic imaging, Vascular Diseases
Abstract

Currently, CEUS (Contrast-Enhanced UltraSound) is used in the evaluation of different organs and systems. It offers valuable information about vascular disease, both on a macro- and a micro-vascular level, and has a series of well-established applications in the monitoring of adult patients; official guidelines and recommendations are also available. Its use in a nephrological setting is constantly growing thanks to the lack of nephrotoxicity of the contrast agent, the absence of ionizing radiation and the possibility of characterizing focal pathologies, for diagnosis and in clinical practice. We describe here 3 clinical cases relating to renal diseases and we review the relevant literature with a specific focus on the use of CEUS in a nephro-urological setting., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Published
2021

50. [Evaluation via ecocolordoppler before creating a vascular access for hemodyalisis: a monocentric experience].

Author

Cornacchiari M, Mudoni A, Borin F, Stasi A, Ponticelli MG, Visciano B, and Guastoni C

Subjects
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Peritoneal Dialysis statistics & numerical data, Postoperative Complications prevention & control, Radial Artery diagnostic imaging, Radial Artery physiology, Regional Blood Flow, Subclavian Vein diagnostic imaging, Subclavian Vein physiology, Time Factors, Ulnar Artery diagnostic imaging, Ulnar Artery physiology, Vascular Patency, Arteriovenous Shunt, Surgical, Preoperative Care methods, Renal Dialysis statistics & numerical data, Ultrasonography, Doppler
Abstract

The use of a preoperative echocolordoppler improves the clinical evaluation because provides anatomical and hemodynamic information that make it an important tool in planning vascular access strategy. The preoperative ultrasound study of the vessels can significantly reduce the failure rate and the incidence of complications of vascular access. We describe the experience of our center, lasting 10-year, where the ultrasound assessment was performed in all patients before the creation of vascular access. Indeed, ultrasound reduces the rate of fistula failure and increases the utilization of fistula, allowing proper selection of vessels. In addition, the presence of the vascular access team has allowed us to achieve quite satisfactory results., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Published
2020

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