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3. Elevated Levels of Procalcitonin and Interleukin-6 are Linked with Postoperative Complications in Cardiac Surgery

Author

Claudio Ronco, Alessandra Brocca, Davide Giavarina, G M Virzì, M de Cal, and Mariarosa Carta

Subjects
Adult, Calcitonin, Male, medicine.medical_specialty, renal injury, Population, Inflammation, 030204 cardiovascular system & hematology, Procalcitonin, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, Renal Insufficiency, Cardiac Surgical Procedures, Interleukin 6, education, Aged, Aged, 80 and over, education.field_of_study, biology, business.industry, cardiac surgery, inflammation, interleukin-6, mortality, Extracorporeal circulation, Acute kidney injury, Postoperative complication, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Cardiac surgery, ROC Curve, Cardiology, biology.protein, Female, Surgery, medicine.symptom, business, Biomarkers
Abstract

Background: Cardiac surgery–associated acute kidney injury is a frequent and serious postoperative complication of cardiac surgery and is associated with an increased risk of morbidity, mortality, and length stay. In this study, we hypothesized that persistent elevation in inflammation in the first 48 h might be a powerful predictor of clinical outcome. Our aim was to elucidate the usefulness of interleukin-6 and procalcitonin postoperative levels in predicting mortality and renal complications in cardiac surgery patients. Methods: A total of 122 cardiac surgery patients were enrolled. Procalcitonin and interleukin-6 concentrations were measured on the second postoperative day, and their levels were evaluated versus a number of conditions and endpoints. Results: Procalcitonin has a good predictive value for adverse renal outcome (p Conclusion: We speculated that procalcitonin and interleukin-6 could be two effective biomarkers. There is a possibility of having a combined inflammatory multi-biomarker panel, with procalcitonin for predicting renal outcome and interleukin-6 for predicting mortality.

Published
2017
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4. Immune and inflammatory mechanisms

Author

G. Castellano, C. Cafiero, C. Divella, F. Sallustio, M. Gigante, L. Gesualdo, A. H. Kirsch, N. Smaczny, V. Riegelbauer, S. Sedej, A. Hofmeister, T. Stojakovic, M. Brodmann, E. Pilger, A. Rosenkranz, K. Eller, P. Eller, P. Meier, S. Lucisano, A. Arena, V. Donato, M. R. Fazio, D. Santoro, M. Buemi, M. Wornle, A. Ribeiro, S. Koppel, J. Pircher, T. Czermak, M. Merkle, K. Rupanagudi, O. P. Kulkarni, J. Lichtnekert, M. N. Darisipudi, S. R. Mulay, B. Schott, G. Hartmann, H.-J. Anders, A. Pletinck, G. Glorieux, E. Schepers, M. Van Landschoot, S. Eloot, W. Van Biesen, R. Vanholder, A. Castoldi, V. Oliveira, M. Amano, C. Aguiar, A. Caricilli, P. Vieira, M. Burgos, M. Hiyane, W. Festuccia, N. Camara, S. Djudjaj, S. Rong, H. Lue, A. Bajpai, B. Klinkhammer, M. Moeller, J. Floege, J. Bernhagen, T. Ostendorf, P. Boor, S. Ito, R. Aoki, K. Hamada, T. Edamatsu, Y. Itoh, M. Osaka, M. Yoshida, E. Oliva, F. Maritati, A. Palmisano, F. Alberici, C. Buzio, A. Vaglio, C. Grabulosa, E. Cruz, J. Carvalho, S. Manfredi, M. Canziani, L. Cuppari, B. Quinto, M. Batista, M. Cendoroglo, M. Dalboni, Z. Niemir, A. Swierzko, M. Polcyn-Adamczak, M. Cedzynski, A. Sokolowska, A. Szala, T. Baudoux, J.-M. Hougardy, A. Pozdzik, M.-H. Antoine, C. Husson, E. De Prez, J. Nortier, H.-F. Ni, J.-F. Chen, M.-H. Zhang, M.-M. Pan, B.-C. Liu, M. Machcinska, K. Bocian, G. Korczak-Kowalska, M. Tami Amano, V. Andrade-Oliveira, M. da Silva, M. Y. S. Miyagi, N. Olsen Camara, L. Xu, Y. Jin, F. Zhong, J. Liu, Q. Dai, W. Wang, N. Chen, F. Grosjean, C. Tribioli, V. Esposito, D. Catucci, G. Azar, M. Torreggiani, G. Merlini, C. Esposito, L. H. Fell, A. M. Zawada, K. S. Rogacev, S. Seiler, D. Fliser, G. H. Heine, N. Neprintseva, N. Tchebotareva, I. Bobkova, L. Kozlovskaya, G. M. Virzi, A. Brocca, M. de Cal, C. Bolin, G. Vescovo, C. Ronco, A. Fuchs, K. Eidenschink, A. Steege, C. Fellner, C. Bollheimer, W. Gronwald, J. Schroeder, B. Banas, M. C. Banas, A. Luthe, S. S. Seiler, K. Rogacev, D. Trimboli, G. Graziani, J. Haroche, R. Lupica, V. Cernaro, G. Montalto, G. Pettinato, E. Cho, J.-W. Lee, M.-G. Kim, S.-K. Jo, W.-Y. Cho, and H.-K. kim

Subjects
Transplantation, Immune system, Nephrology, business.industry, Immunology, Medicine, business
Published
2013
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5. Experimental models of CKD

Author

R. Kanlaya, K. Sintiprungrat, V. Thongboonkerd, N. Torremade, R. Bindels, J. Hoenderop, E. Fernandez, A. Dusso, J. M. Valdivielso, T. Krueger, P. Boor, C. Schafer, R. Westenfeld, V. Brandenburg, G. Schlieper, W. Jahnen-Dechent, M. Ketteler, W. Jee, X. Li, B. Richards, J. Floege, J. G. Goncalves, D. Canale, A. C. de Braganca, M. H. M. Shimizu, R. M. A. Moyses, L. Andrade, A. C. Seguro, R. A. Volpini, S. Romoli, A. Migliorini, H.-J. Anders, O. Eskova, N. Neprintseva, N. Tchebotareva, I. Bobkova, L. Kozlovskaya, I. Simic, M. Tabatabaeifar, T. Wlodkowski, H. Denc, G. Mollet, C. Antignac, F. Schaefer, I. A. Ekaterina, L. Giardino, M. P. Rastaldi, L. Van den Heuvel, E. Levtchenko, C. Okina, T. Okamoto, M. Kamata, J. Murano, K. Kobayashi, K. Takeuchi, F. Kamata, T. Sakai, S. Naito, T. Aoyama, T. Sano, Y. Takeuchi, K. Kamata, D. Thomasova, H. A. Bruns, H. Liapis, T. Iwashita, H. Hasegawa, K. Takayanagi, T. Shimizu, J. Asakura, S. Okazaki, Y. Kogure, M. Hatano, H. Hara, M. Inamura, M. Iwanaga, T. Mitani, T. Mitarai, V. J. Savin, M. Sharma, C. Wei, J. Reiser, E. T. McCarthy, R. Sharma, J.-F. Gauchat, B. Eneman, K. Freson, C. Van Geet, D. E. Choi, J. Y. Jeong, Y. K. Chang, K.-R. Na, K. W. Lee, Y. T. Shin, H.-F. Ni, J.-F. Chen, M.-H. Zhang, M.-M. Pan, B.-C. Liu, S. S. Kim, T. Suzuki, M. Iyoda, K. Matsumoto, Y. Shindo-Hirai, Y. Kuno, Y. Wada, Y. Yamamoto, T. Shibata, T. Akizawa, J. M. Munoz-Felix, J. M. Lopez-Novoa, C. Martinez-Salgado, J. Ehling, J. Babickova, F. Gremse, F. Kiessling, T. Lammers, M. Lech, R. Gunthner, G. Lorenz, M. Ryu, R. Grobmayr, H. Susanti, K. S. Kobayashi, R. A. Flavell, S. Rayego-Mateos, J. Morgado, A. B. Sanz, S. Eguchi, J. Pato, G. Keri, J. Egido, A. Ortiz, M. Ruiz-Ortega, M. Leduc, L. Geerts, B. Grouix, F. Sarra-Bournet, A. Felton, L. Gervais, S. Abbott, J.-S. Duceppe, B. Zacharie, C. Penney, P. Laurin, L. Gagnon, M. G. Detsika, P. Duann, E. A. Lianos, K. I. Leong, C.-K. Chiang, C.-C. Yang, C.-T. Wu, L.-P. Chen, K.-Y. Hung, S.-H. Liu, F. F. Carvalho, V. P. Teixeira, W. S. Almeida, N. Schor, D. M. Small, N. C. Bennett, J. Coombes, D. W. Johnson, G. C. Gobe, N. Montero, A. Prada, M. Riera, M. Orfila, J. Pascual, E. Rodriguez, C. Barrios, G. Kokeny, K. Fazekas, L. Rosivall, M. M. Mozes, N. Hornigold, J. Hughes, A. Mooney, A. Benardeau, W. Riboulet, A. Vandjour, B. Jacobsen, C. Apfel, K. Conde-Knape, J.-F. Bienvenu, T. Tanaka, J. Yamaguchi, M. Nangaku, T. Niwa, D. Bolati, H. Shimizu, M. Yisireyili, F. Nishijima, A. Brocca, G. Virzi, M. de Cal, C. Ronco, G. Priante, E. Musacchio, C. Valvason, L. Sartori, A. Piccoli, B. Baggio, M. Perkuhn, M. Weibrecht, S. Zok, I. V. Martin, F. Schoth, T. Ostendorf, C. Kuhl, A. Karabaeva, A. Essaian, O. Beresneva, M. Parastaeva, I. Kayukov, A. Smirnov, I. Audzeyenka, M. Kasztan, A. Piwkowska, D. Rogacka, S. Angielski, M. Jankowski, C. L. Bockmeyer, K. Kokowicz, P. A. Agustian, S. Zell, J. Wittig, J. U. Becker, R. Nishizono, M. P. Venkatareddy, M. A. Chowdhury, S. Q. Wang, A. Fukuda, L. T. Wickman, Y. Yang, R. C. Wiggins, M. R. Fazio, V. Donato, S. Lucisano, V. Cernaro, R. Lupica, D. Trimboli, G. Montalto, C. Aloisi, A. T. Mazzeo, M. Buemi, O. Gawrys, K. H. Olszynski, M. Kuczeriszka, K. Gawarecka, E. Swiezewska, M. Chmielewski, M. Masnyk, J. Rafalowska, E. Kompanowska-Jezierska, W.-C. Lee, Y.-Y. Chau, L.-C. Lee, C.-H. Chiu, C.-T. Lee, J.-B. Chen, W.-K. Kim, and S. J. Shin

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Medicine, business, Intensive care medicine
Published
2013
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6. Extracorporeal dialysis: techniques and adequacy - A

Author

D. Steckiph, G. Calabrese, A. Bertucci, A. Mazzotta, G. Vagelli, M. Gonella, D. Stamopoulos, E. Manios, N. Papachristos, E. Grapsa, G. Papageorgiou, V. Gogola, B. So, V. Dey, E. M. Spalding, C. Libetta, P. Esposito, E. Margiotta, P. Maffioli, A. Bonaventura, L. Bianchi, D. Romano, T. Rampino, G. De Rosa, A. Mauric, U. Haug, G. Enzinger, E. Kern-Derstvenscheg, A. Sluga, C. Ausserwinkler, W. Beck, A. R. Rosenkranz, V. Maheshwari, S. Haroon, Y. Loy, L. Samavedham, G. P. Rangaiah, T. Lau, N. Mpakirtzi, M. Panagiotou, D. Barbarousi, C. Matsouka, A. D. Bunani, M. Kowalczyk, P. Bartnicki, M. Banach, J. Rysz, P. Lentini, L. Zanoli, A. Granata, A. Contestabile, A. Basso, G. Berlingo, V. Pellanda, M. de Cal, V. Grazia, A. Clementi, M. Insalaco, R. Dell'Aquila, A. Karkar, M. Abdelrahman, A. R. Martins, L. Parreira, A. S. Duque, I. Rodrigues, A. B. Baffoun, M. A. Youssfi, A. Sayeh, M. Beji, R. Ben Khadra, J. Hmida, M. Akazawa, H. Horiuchi, Y. Hori, A. Yamada, H. Satou, S. Odamaki, S. Nakai, K. Satou, K. Aoki, I. Saito, Y. Kamijo, S. Ogata, Y. Ishibashi, F. Basso, M. Wojewodzka-Zelezniakowicz, D. Cruz, A. Giuliani, L. Blanca Martos, P. Piccinni, C. Ronco, J. Potier, G. Queffeulou, J. Bouet, A. Nilsson, J. Sternby, G. Grundstrom, M. Alquist, M. Ferraresi, M. C. Di Vico, F. N. Vigotti, M. Deagostini, S. Scognamiglio, V. Consiglio, R. Clari, I. Moro, E. Mongilardi, G. B. Piccoli, V. Hancock, S. Huang, K. Nilsson Ekdahl, C. Baldin, M. Petrarulo, D. Mancuso, P. Inguaggiato, G. Canepari, G. Gigliola, C. Ferrando, S. Meinero, C. Sicuso, A. Pacitti, N. Afentakis, T. Tomo, K. Matsuyama, T. Nakata, K. Ishida, T. Takeno, J.-i. Kadota, J. Minakuchi, J. Kastl, M. Merello, C. Boccato, G. Giordana, S. Mazzone, V. Moscardo, B. Reinhardt, R. Knaup, W. Kruger, D. Tovbin, S. Kim, L. Avnon, M. Zlotnik, S. Storch, K. Umimoto, Y. Shimamoto, M. Suyama, M. Miyata, E. Bosch Benitez-Parodi, E. E. Baamonde Laborda, G. Perez, J. I. Ramirez, A. Ramirez Puga, R. Guerra, C. Garcia Canton, M. M. Lago Alonso, A. Toledo, M. D. Checa Andres, F. E. Latif, Y. Mochida, K. Matsumoto, K. Morita, D. Tsutsumi, K. Ishioka, K. Maesato, M. Oka, H. Moriya, S. Hidaka, T. Ohtake, S. Kobayashi, A. Ficheux, N. Gayrard, F. Duranton, C. Guzman, I. Szwarc, J. Bismuth-Mondolfo, P. Brunet, M.-F. Servel, A. Argiles, N. Tsikliras, S. Mademtzoglou, E. Balaskas, M. Zeid, A. Mostafa, M. N. Mowafy, E. I. Abdo, O. M. Al Amin, A. Ksiazek, W. Zaluska, J. Waniewski, M. Debowska, A. Wojcik-Zaluska, M. Elias, H. Francois, E. Obada, H. K. Lorenzo, B. Charpentier, A. Durrbach, S. Beaudreuil, G. Imamovic, D. Marcelli, I. Bayh, R. Hrvacevic, S. Kapun, A. Grassmann, L. Scatizzi, J. Maslovaric, R. Daelemans, S. Mesens, E. A. Mohamed, A. Wafae, H. Kawtar, H. Mohamed Amine, K. Driss, and B. Mohammed

Subjects
Transplantation, medicine.medical_specialty, Extracorporeal Dialysis, Nephrology, business.industry, Medicine, business, Intensive care medicine
Published
2013
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7. Purity and Stability of Online-Prepared Hemodiafiltration Fluid after Storage

Author

M. De Cal, C. Ronco, P. Frisone, M. Rassu, Alessandra Brendolan, F. Furlan, A. Vázquez-Rangel, A. Bonaccorsi, D. Cruz, S. Cazzavillan, A. Morea, R. Grillone, and Valentina Corradi

Subjects
Acid-Base Equilibrium, Quality Control, Chromatography, Chemistry, Coefficient of variation, Significant difference, Analytical chemistry, Hemodiafiltration, Hematology, General Medicine, Acid–base homeostasis, Hydrogen-Ion Concentration, Long-Term Care, Hemodialysis Solutions, law.invention, Molecular analysis, Endotoxins, Electrolytes, Nephrology, Limulus amebocyte lysate, law, Humans, Sample collection, Crystallization, Electrolyte composition
Abstract

Background/Aims: Previous studies have suggested that online hemodiafiltration (OL-HDF) fluid can be used as dialysate for continuous renal replacement therapies, and thus HDF costs can be reduced. The aims of this study were to determine the purity of OL-HDF fluid and to verify the stability of the electrolyte composition and acid-base balance during its storage. Methods: OL-HDF fluid was collected in 70 individual bags and stored for up to 7 days. The following tests were performed daily in 10 bags: natural visible precipitation (macrocrystallization), sample collection for chemical analysis and fluid culture, limulus amebocyte lysate endotoxin test, standard culture of NALGENE® filters after passing of the fluid, and molecular analysis of bacterial DNA. Results: The values of pH and pCO2 showed a significant change starting at 24 h (p < 0.001); after 72 h, their values were beyond the measurable range. Coefficient of variation for pCO2 was as high as 25.7%. Electrolyte composition (Na+, K+, Cl–, Ca2+ and glucose) showed a statistically significant difference over time (p < 0.05); however, their coefficients of variation were low (1.7, 1.4, 0.6, 2.3 and 0.9%, respectively), which might not be considered clinically significant. Negative results were obtained at all points by fluid and filter cultures, endotoxin test and molecular analysis. No macrocrystallization was observed at any time point. Conclusions: We demonstrate the microbiological purity of OL-HDF fluid stored for up to 7 days. The electrolyte composition was stable, except for a relevant change in pCO2 and consequently in pH (first noted at 24 h), emphasizing the need to reassess the acid-base balance in multilayer plastic bags in future studies.

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

Author

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

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

Author

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

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

Author

E. Gok Oguz, R. Olmaz, K. Turgutalp, N. Muslu, M. A. Sungur, A. Kiykim, W. Van Biesen, J. Vanmassenhove, G. Glorieux, R. Vanholder, S. Chew, K. Forster, T. Kaufeld, J. Kielstein, T. Schilling, A. Haverich, H. Haller, B. Schmidt, P. Hu, X. Liang, Y. Chen, R. LI, F. Jiang, Z. LI, W. Shi, C. C. W. Lim, C. M. L. Chia, A. K. Tan, C. S. Tan, R. Ng, S. Subramani, A. Perez de Jose, C. Bernis Carro, R. Madero Jarabo, J. Bustamante, J. A. Sanchez Tomero, W. Chung, H. Ro, J. H. Chang, H. H. Lee, J. Y. Jung, L. Fazzari, A. Giuliani, J. Scrivano, L. Pettorini, U. Benedetto, R. Luciani, A. Roscitano, A. Napoletano, D. Coclite, E. Cordova, G. Punzo, R. Sinatra, P. Mene, N. Pirozzi, L. Shavit, R. Manilov, N. Algur, Y. Wiener-Well, I. Slotki, C. Pipili, C. S. Vrettou, K. Avrami, F. Economidou, K. Glynos, S. Ioannidou, V. Markaki, E. Douka, S. Nanas, A. De Pascalis, P. Cofano, S. Proia, A. Valletta, O. Vitale, F. Russo, E. Buongiorno, V. Filiopoulos, D. Biblaki, D. Lazarou, D. Chrysis, M. Fatourou, S. Lafoyianni, D. Vlassopoulos, O. Zakiyanov, V. Kriha, J. Vachek, J. Svarcova, T. Zima, V. Tesar, M. Kalousova, M. Kaushik, C. Ronco, D. Cruz, L. Zhang, W. Zhang, N. Chen, A. A. Ejaz, G. Kambhampati, N. Ejaz, B. Dass, V. Lapsia, A. A. Arif, A. Asmar, M. Shimada, M. Alsabbagh, R. Aiyer, R. Johnson, T.-H. Chen, C.-H. Chang, M.-Y. Chang, Y.-C. Tian, C.-C. Hung, J.-T. Fang, C.-W. Yang, Y.-C. Chen, V. Cantaluppi, A. D. Quercia, F. Figliolini, S. Giacalone, A. Pacitti, M. Gai, C. Guarena, G. Leonardi, L. Biancone, G. Camussi, G. P. Segoloni, M. De Cal, P. Lentini, A. Clementi, G. M. Virzi, E. Scalzotto, A. Lacquaniti, V. Donato, M. R. Fazio, S. Lucisano, V. Cernaro, R. Lupica, M. Buemi, I. Helvaci, E. Anik, M. Wani, D. I. Wani, D. M. A. Bhat, D. K. Banday, D. M. S. Najar, D. A. R. Reshi, D. N. A. Palla, P. Iglesias, T. Olea, C. Vega-Cabrera, M. Heras, M. A. Bajo, G. Del Peso, M. J. Arias, R. Selgas, J. J. Diez, E. Daher, P. L. Costa, E. N. S. Pereira, R. D. P. Santos, K. L. Abreu, G. Silva Junior, E. D. B. Pereira, M. Raimundo, S. Crichton, Y. Syed, J. Martin, C. Whiteley, D. Bennett, M. Ostermann, A. Gjyzari, N. Thereska, A. Koroshi, M. Barbullushi, S. Kodra, A. Idrizi, A. Strakosha, E. Petrela, J. Lemmich Smith, A. Klimenko, E. Tuykhmenev, S. Villevalde, Z. Kobalava, S. Avdoshina, E. Tyukhmenev, M. Efremovtseva, H. Hayashi, S. Suzuki, K. Kataoka, Y. Kondoh, H. Taniguchi, D. Sugiyama, K. Nishimura, W. Sato, S. Maruyama, S. Matsuo, Y. Yuzawa, D. Geraldine, F. Muriel, H. Alexandre, R. Eric, P. Fu, M. Pozzato, F. Ferrari, P. Cecere, P. Mesiano, A. Vallero, S. Livigni, F. Quarello, L. Hudier, O. Decaux, A. Haddj-Elmrabet, L. Mandart, M. Lino-Daniel, F. Bridoux, E. Renaudineau, T. Sawadogo, P. Le Pogamp, C. Vigneau, D. Famee, H. M. Koo, H. J. Oh, S. H. Han, K. H. Choi, S.-W. Kang, M. Mehdi, M. Nicolas, C. Mariat, P. Shah, V. B. Kute, A. Vanikar, M. Gumber, H. Patel, H. Trivedi, C. Manetos, S. Poulaki, E.-S. Tripodaki, A. Papastylianou, C. Routsi, K. Uchida, U. Kensuke, K. Yamagata, C. Saitou, M. Okada, G. Chita, M. Davies, Y. Veriawa, S. Naicker, P. Mukhopadhyay, D. Mukherjee, R. Mishra, M. Kar, D. Zickler, H. Wesselmann, R. Schindler, E. Gutierrez, J. Egido, A. Rubio-Navarro, I. Buendia, L. M. Blanco-Colio, O. Toldos, F. Manzarbeitia, A. De Lorenzo, R. Sanchez, M. Praga, J. A. Moreno, M. Y. Kim, N. R. Kang, H. R. Jang, J. E. Lee, W. Huh, Y.-G. Kim, D. J. Kim, S.-C. Hong, J.-S. Kim, H. Y. Oh, T. Okamoto, K. Kamata, S. Naito, H. Tazaki, S. Kan, L.-G. Anne-Kathrin, K. Matthias, T. Speer, L. Andreas, G. Heinrich, V. Thomas, A. Poppleton, F. Danilo, C.-F. Lai, V.-C. Wu, C.-C. Shiao, T.-M. Huang, K.-D. Wu, M. Bedford, C. Farmer, J. Irving, P. Stevens, F. Patera, F. Mattozzi, S. Battistoni, R. M. Fagugli, M. Y. Park, S. J. Choi, J. G. Kim, S. D. Hwang, H. Xie, H. Chen, S. Xu, Q. He, J. Liu, W. Hu, Z. Liu, M. Dalboni, R. Blaya, B. M. Quinto, R. Narciso, M. Oliveira, J. Monte, M. Durao, M. Cendoroglo, M. Batista, A. L. Hanemann, A. Liborio, A. Martins, M. C. C. Pinheiro, G. Meneses, R. De Paula Pessoa, M. Sousa, F. S. M. Bezerra, P. L. M. M. Albuquerque, J. B. Lima, C. B. Lima, M. D. S. B. Veras, T. Nemoto Matsui, C. Totoli, M. C. Cruz Andreoli, M. P. Vilela Coelho, N. K. Guimaraes de Souza, A. L. Ammirati, F. De Carvalho Barreto, B.-H. Ferraz Neto, B. Fortunato Cardoso Dos Santos, A. Abraham, G. Abraham, M. Mathew, P. M. A. Duarte, F. B. Duarte, E. M. Barros, F. Q. S. Castro, H. Palomba, I. Castro, S. R. Sousa, A. N. Jesus, T. Romano, E. Burdmann, L. Yu, S. H. Kwon, J. Y. You, Y. K. Hyun, S. A. Woo, J. S. Jeon, H. J. Noh, D. C. Han, L. Tozija, Z. Petronievic, G. Selim, I. Nikolov, O. Stojceva-Taneva, K. Cakalaroski, A. Lukasz, J. Beneke, J. Menne, M. Schiffer, N. Polanco, E. Hernandez, V. Gutierrez Millet, E. Gonzalez Monte, E. Morales, L. Francisco Javier, G.-F. Nuria, M.-G. Jose Maria, M. Bes Rastrollo, A. Angioi, M. Conti, R. Cao, A. Atzeni, G. Pili, V. Matta, E. Murgia, P. Melis, V. Binda, A. Pani, F. Thome, F. Leusin, E. Barros, C. Morsch, A. Balbinotto, C. Pilla, V. Premru, J. Buturovic-Ponikvar, R. Ponikvar, A. Marn-Pernat, B. Knap, J. Kovac, J. Gubensek, B. Kersnic, L. Krnjak, M. Prezelj, J. Granatova, M. Havrda, Z. Hruskova, K. Kratka, O. Remes, M. Mokrejsova, M. Bolkova, V. Lanska, I. Rychlik, M. D. Uniacke, R. J. Lewis, S. Harris, P. Roderick, N. Martin, K. Ulrich, B. Jan, B. Jorn, B. Reinhard, K. Jan, H. Hermann, F. Meyer Tobias, R. Leyla, M. W. Schmidt Bernhard, S. Harald, S. Jurgen, K. Tanja, S. Mario, E. Sang Hi, M. Claus, V. Frank, S. Aleksej, S. Sengul, S. Robert, W. Karin, G. Feikah, F. Menne Tobias, N. Meyer Tobias, G. Beutel, S. Fleig, J. Steinhoff, T. Meyer, C. Hafer, J. Bramstedt, V. Busch, M. Vischedyk, U. Kuhlmann, W. Ries, S. Mitzner, S. Mees, S. Stracke, J. Nurnberger, P. Gerke, M. Wiesner, B. Sucke, M. Abu-Tair, A. Kribben, N. Klause, F. Merkel, S. Schnatter, E. Dorresteijn, O. Samuelsson, R. Brunkhorst, G. Stec-Hus Registry, A. Reising, F.-C. Bange, M. Hiss, F. Vetter, S. M. Bode-Boger, J. Martens-Lobenhoffer, B. M. W. Schmidt, J. T. Kielstein, H. S. Shin, Y. S. Jung, and H. Rim

Subjects
Transplantation, Nephrology
Published
2012
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11. Effect of Cyclosporine, Mycophenolate Mofetil, and Their Combination With Steroids on Apoptosis in a Human Cultured Monocytic U937 Cell Line

Author

M. Pappas, Ranistha Ratanarat, A Yavuz, Emilios Andrikos, Gabriella Salvatori, Nathan W. Levin, C. Ronco, Valeria Bordoni, M. De Cal, G Yakupoglu, and Monica Bonello

Subjects
Programmed cell death, medicine.medical_treatment, Apoptosis, Pharmacology, Mycophenolate, Mycophenolic acid, Cell Line, Tumor, medicine, Humans, Annexin A5, Transplantation, Dose-Response Relationship, Drug, business.industry, Immunosuppression, U937 Cells, Mycophenolic Acid, Ciclosporin, Immunology, Cyclosporine, Steroids, Surgery, business, medicine.drug
Abstract

Transplant patient plasma produces an increased rate of mononuclear cell apoptosis despite a normal serum creatinine value. Immunosuppressive medications may be one factor that causes an altered apoptotic pattern. We evaluated the in vitro effects of various doses of cyclosporine, mycophenolate mofetil, and steroids on apoptosis of a cultured human monocytic U937 cell line, using estimates by fluorescence microscopy and annexin V assays. Increasing cyclosporine concentrations (100 to 800 ng/mL) progressively increased apoptosis rates (16% to 32%). The combination of steroid (0.01 μg/mL) and cyclosporine increased the apoptosis rate to 45%. Mycophenolate mofetil alone (0.3 μg/mL) led to an apoptosis rate of 34%. Therapeutic levels of mycophenolate mofetil from 3 to 7 μg/mL led to apoptosis rates from 56% to 67%. The combination of cyclosporine, steroid, and mycophenolate mofetil increased the rate of apoptosis to 95%. Immunosuppressive therapy may contribute to the high rate of apoptosis observed among mononuclear cells of transplanted patients. This effect may alter patient susceptibility to infections and contribute to a unique mechanism of immunosuppression.

Published
2005
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12. The impact of malnutrition in morbidity and mortality in stable haemodialysis patients

Author

M. de Cal, C. Gamez, Roberto Marcén, and José L. Teruel

Subjects
Transplantation, medicine.medical_specialty, Protein–energy malnutrition, business.industry, medicine.medical_treatment, medicine.disease, Comorbidity, Surgery, Malnutrition, Nephrology, Internal medicine, Medicine, Hemodialysis, Risk factor, business, Body mass index, Dialysis, Cause of death
Abstract

Background When assessed by single biochemical measurements, malnutrition in dialysis patients is associated with increased mortality, but there are few data evaluating abnormalities in anthropometry or composite nutritional scores and outcome. The aim of our study was to ascertain the prevalence and severity of malnutrition in 761 stable patients from 20 haemodialysis centres and its influence in morbidity and mortality after one year of follow-up. Methods Malnutrition was estimated by scoring four anthropometric indexes; body mass index (BMI), triceps skinfold thickness (TSF), mid-arm circumference (MAC), and mid-arm muscle circumference (MAMC); three biochemical measurements; serum albumin, serum transferrin and total lymphocyte count; and clinical examination. Mortality and hospitalizations were collected prospectively during the year of follow-up. Results A moderate/severe degree of malnutrition was presented by 51.6% of male and 46.3% of female patients. TSF was moderate-severely decreased in 41% without differences between males and females. MAMC was moderately decreased in 19.8% of males and in 8.1% of females (P 65 years (OR = 1.96, CI: 1.22-3.14), male sex (OR = 1.95, CI: 1.24-3.07), comorbidity index (OR = 1.23, CI: 1.03-1.45), time on dialysis (OR = 1.13, CI: 1.08-1.18), duration of dialysis (OR = 0.73, CI: 0.63-0.85) and PCR related to ideal body weight (OR = 0.17, CI: 0.06-0.50). After 1 year of follow-up, data from 442 patients were available. A total of 68 patients died (15.4%) with cardiovascular diseases being the most frequent cause of death (57.3% of the cases). The predictors of mortality were: age (OR = 1.06, CI: 1.03-1.09), cardiovascular disease (OR = 2.13, CI: 1.19-3.83), neurological disease (OR = 2.96, CI: 1.41-6.15), nephroangiosclerosis (OR = 2.34, CI: 1.10-4.98) and total lymphocyte count (OR = 0.93, CI: 0.87-0.98). Hospitalization was needed in 44% of patients. The comorbidity index, serum albumin and age were the predictive factors of hospitalization. Conclusions Protein-calorie malnutrition is frequent in haemodialysis patients. Fat depletion predominated in both sexes. Duration of dialysis and protein catabolic rate related to ideal body weight was the only predictor which could be influenced by a nutritional intervention. Morbidity appeared to be influenced by the comorbidity index and age was the strongest predictor of mortality. The only nutritional measurements predictive of morbidity and mortality were serum albumin and total lymphocyte count respectively. Therefore, the influence of malnutrition in morbidity and mortality can not be definitively stated.

Published
1997
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13. Clinical pattern of adult polycystic kidney disease in a northeastern region of Italy

Author

Valentina Corradi, M de Cal, Fiorella Gastaldon, Sachin S Soni, Chang Yin Chionh, G M Virzì, D. Cruz, Claudio Ronco, and Maurizio Clementi

Subjects
Adult, Male, Pathology, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Population, Prevalence, Autosomal dominant polycystic kidney disease, urologic and male genital diseases, Statistics, Nonparametric, Cystic kidney disease, Risk Factors, Internal medicine, medicine, Humans, Genetic Predisposition to Disease, Renal replacement therapy, Family history, Child, education, Aged, education.field_of_study, Chi-Square Distribution, PKD1, urogenital system, business.industry, General Medicine, Middle Aged, Polycystic Kidney, Autosomal Dominant, medicine.disease, female genital diseases and pregnancy complications, Pedigree, Italy, Nephrology, Child, Preschool, Female, business, Microsatellite Repeats, Kidney disease
Abstract

Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disorder, with a prevalence of 1 : 500 to 1 : 1,000. ADPKD is genetically heterogeneous: the genes involved are PKD1 and PKD2. ADPKD occurs worldwide and in all ethnic groups and is an important cause of CKD Stage 5. Prevalence of ADPKD on renal replacement therapy (RRT) in Italy has been reported to be 8.2%. In the dialysis population of Vicenza, a province in Northeastern Italy, it accounts for 13.4%. The study aims to investigate reasons for the high prevalence of ADPKD in our region and to describe the clinical profile and genetics of these patients. Methods Since April 2007, ADPKD patients have been enrolled. Patients from families not native to Vicenza have been excluded. The diagnosis of ADPKD is defined by ultrasound criteria. Complete clinical details have been recorded, including family history. We have used linkage analysis to identify the gene involved in each family. Results We describe the first 100 patients recruited from a total of 42 families. 29 patients were in ESRD at the time of enrollment. Renal stones and hepatic cysts were present in 24% and 40%, respectively. The majority of the ADPKD patients (61%) were diagnosed either incidentally or by screening. Positive family history was recorded in 86 patients. The involved gene was PKD1 in 83.7% and PKD2 in 16.3% of the studied patients. PKD2 patients presented the common haplotype. Conclusions It is the first epidemiological study from Northeastern Italy reporting clinical profile and genetic analysis of ADPKD patients. The clinical profile of the patients is similar to previous reports, but there is a high prevalence of ADPKD in our region. The presence of a common haplotype is in accordance with our hypothesis of a founder effect in our province, suggesting that a strong lineage-specific gene is present. If the sequence analysis confirms the same mutation, this might suggest a common ancestral origin and a segregation of a specific mutation.

Published
2009

14. Effect of vitamin E-coated dialysis membranes on anemia in patients with chronic kidney disease: an Italian multicenter study

Author

Claudio Ronco, D. Cruz, Francesco Garzotto, M. De Cal, Valentina Corradi, Federico Nalesso, and Alessandra Brendolan

Subjects
Vitamin, Male, medicine.medical_specialty, Anemia, medicine.medical_treatment, 030232 urology & nephrology, Biomedical Engineering, Medicine (miscellaneous), Tocopherols, Bioengineering, 030204 cardiovascular system & hematology, Gastroenterology, Biomaterials, 03 medical and health sciences, chemistry.chemical_compound, Hemoglobins, 0302 clinical medicine, Coated Materials, Biocompatible, Renal Dialysis, Internal medicine, Medicine, Humans, Erythropoietin, Dialysis, Aged, Cross-Over Studies, business.industry, Vitamin E, Membranes, Artificial, General Medicine, Free Radical Scavengers, medicine.disease, Recombinant Proteins, Surgery, Oxidative Stress, Treatment Outcome, chemistry, Italy, Kidney Failure, Chronic, Female, Hemoglobin, Hemodialysis, business, medicine.drug, Kidney disease
Abstract

Background Increased oxidant stress is increasingly recognized as a crucial factor in anemia in patients with chronic kidney disease. Vitamin E-coated membranes (VECMs) consist of a multilayer membrane with liposoluble vitamin E on the blood surface allowing direct free radical scavenging at the membrane site, which is of potential clinical benefit. Our objective was to examine the effect of VECMs on anemia in chronic hemodialysis (HD). Methods We enrolled 172 stable chronic HD patients (94 men, 78 women, age 65.4 ± 13.4 years) in an open-label multicenter study. They were shifted from their previous dialyzer to VECM for 1 year. Hemoglobin (Hb) levels and recombinant human erythropoietin (rHuEpo) dosage were analyzed after 4, 8, and 12 months on the VECM and compared with baseline values using paired tests. Results Hb significantly increased from 10.9 ± 1.2 g/dL at baseline to 11.7 ± 1.2 g/dL after 12 months (pConclusions Dialysis with VECM in stable chronic HD patients was associated with significantly improved Hb levels and lower rHuEpo requirements. These results suggest that the antioxidant properties of VECMs may impact favorably on anemia management in chronic HD patients. Possible mechanisms include enhanced membrane biocompatibility, reduced oxidative stress and inflammation with VECMs, resulting in improved red blood cell survival and/or rHuEpo responsiveness. This therapy may potentially contribute to more effective anemia management in hemodialysis patients, and merits further rigorous study.

Published
2008

15. Inflammation and subclinical infection in chronic kidney disease: a molecular approach

Author

D. Cruz, Catalina Ocampo, Claudio Ronco, C. Segala, Valentina Corradi, Nathan W. Levin, S. Cazzavillan, Natalia Polanco, Ranistha Ratanarat, M. De Cal, and M. Rassu

Subjects
DNA, Bacterial, medicine.medical_treatment, Population, Inflammation, Bacteremia, medicine.disease_cause, Sepsis, Immunity, Renal Dialysis, RNA, Ribosomal, 16S, medicine, Humans, education, Subclinical infection, education.field_of_study, Cross Infection, business.industry, Hematology, General Medicine, Bacterial Infections, medicine.disease, Hemodialysis Solutions, Nephrology, Immunology, Kidney Failure, Chronic, Hemodialysis, medicine.symptom, business, Oxidative stress, Biomarkers, Kidney disease
Abstract

Inflammation and infection seem to be important causes of morbidity and mortality in chronic kidney disease (CKD) patients; subclinical infections have been proposed as an important cause of inflammatory syndrome, but to date this hypothesis remains speculative. We developed a method for the molecular detection of the presence of bacterial DNA in a population of CKD patients in order to correlate the molecular data with the degree and level of inflammation and to evaluate its usefulness in the diagnosis of subclinical infection. The study was divided into two phases: (1) a population of 81 CKD patients was screened for the prevalence and level of inflammation and the presence of possible infection, and (2) a subgroup of 38 patients, without evident clinical causes of inflammation, underwent complete molecular evaluation for subclinical infection using bacterial DNA primers for sequencing. Additionally, complete analysis was carried out in the blood and dialysate compartments of the hemodialyzers used. The general population showed a certain degree of subclinical inflammation and no difference was found between patients with and without evident causes of inflammation. Hemoculture-negative patients were positive for the presence of bacterial DNA when molecular methods were used. We found a correlation trend between the presence of bacterial DNA and the increase in hs-CRP, IL-6 and oxidative stress (advanced oxidation protein product) levels and a reduction in the mean fluorescence intensity for HLA-DR. Hemodialyzer membranes seem to have properties that stick to bacteria/bacterial DNA and work as concentrators. In fact, patients with negative bacterial DNA in the circulating blood displayed positivity in the blood compartment of the dialyzer. The dialysate was negative for bacterial DNA but the dialysate compartment of the hemodialyzers used was positive in a high percentage. Moreover our data suggest that bacterial DNA can traverse hemodialysis membranes. Molecular methods have been found to be far more sensitive than standard methods in detecting subclinical infection. The presence of bacterial DNA seems to influence the variation in some parameters of inflammation and immunity. Apart from the limitations and pitfalls, the molecular method could be useful to screen for subclinical infection and diagnose subclinical sepsis when the hemoculture is negative. However, the identification of the microorganism implicated must be done with species-specific primers.

Published
2006

17. Experimental pathology

Author

D. X. Yi Chun, H. Alexandre, B. Edith, O. Nacera, P. Julie, J. Chantal, R. Eric, X. Zhang, Y. Jin, M. Miravete, R. Dissard, J. Klein, J. Gonzalez, C. Caubet, C. Pecher, B. Pipy, J.-L. Bascands, M. Mercier-Bonin, J. Schanstra, B. Buffin-Meyer, R. Claire, C. Rigothier, D. Richard, L. Sebastien, S. Moin, B. Chantal, C. Christian, R. Jean, M. Migliori, V. Cantaluppi, C. Mannari, D. Medica, L. Giovannini, V. Panichi, A. Goldwich, S. Alexander, G. Andre, K. Amann, A. Migliorini, C. Sagrinati, M. L. Angelotti, S. R. Mulay, E. Ronconi, A. Peired, P. Romagnani, H.-J. Anders, W. C. Chiang, C. F. Lai, W.-H. Peng, C. F. Wu, F.-C. Chang, Y.-T. Chen, S.-L. Lin, Y. M. Chen, K. D. Wu, K.-S. Lu, T. J. Tsai, O. Virgine, F. Qing Feng, S.-Y. Zhang, D. Dominique, A. Vincent, C. Marina, L. Philippe, G. Georges, A. Pawlak, D. Sahali, S. Matsumoto, H. Kiyomoto, A. Ichimura, T. Dan, T. Nakamichi, T. Tsujita, K. Akahori, S. Ito, T. Miyata, S. Xie, B. Zhang, W. Shi, Y. Yang, H. Nagasu, M. Satoh, K. Kidokoro, Y. Nishi, C. Ihoriya, H. Kadoya, T. Sasaki, N. Kashihara, C.-F. Wu, Y.-H. Chou, J. Duffield, C. Rocca, M. Gregorini, V. Corradetti, T. Valsania, G. Bedino, F. Bosio, E. F. Pattonieri, P. Esposito, V. Sepe, C. Libetta, T. Rampino, A. Dal Canton, H. Omori, N. Kawada, K. Inoue, Y. Ueda, R. Yamamoto, I. Matsui, J. Kaimori, Y. Takabatake, T. Moriyama, Y. Isaka, H. Rakugi, A. Wasilewska, K. Taranta-Janusz, W. Deebek, E. Kuroczycka-Saniutycz, A. S. Lee, J. E. Lee, Y. J. Jung, K. P. Kang, S. Lee, W. Kim, N. Arfian, N. Emoto, K. Yagi, K. Nakayama, A. B. Hartopo, D. A. Nugrahaningsih, M. Yanagisawa, K.-I. Hirata, J. M. Munoz-Felix, J. M. Lopez-Novoa, C. Martinez-Salgado, B. Oujo, M. Arevalo, C. Bernabeu, F. Perez-Barriocanal, K. Jesper, V. Nathalie, G. Pierre, M. Iyoda, T. Shibata, K. Matsumoto, Y. Shindo-Hirai, Y. Kuno, Y. Wada, T. Akizawa, I. Schwartz, D. Schwartz, C. Prot Bertoye, S. Terryn, J. Claver, W. B. Beghdadi, R. Monteiro, U. Blank, O. Devuyst, E. Daugas, K. Van Beneden, C. Geers, M. Pauwels, I. Mannaerts, C. Van den Branden, L. A. Van Grunsven, I. Seckin, M. Pekpak, M. Uzunalan, B. Uruluer, S. Kokturk, Z. Ozturk, H. Sonmez, E. Yaprak, Y. Furuno, M. Tsutsui, T. Morishita, H. Shimokawa, Y. Otsuji, N. Yanagihara, N. Kabashima, S. Ryota, K. Kanegae, T. Miyamoto, J. Nakamata, N. Ishimatsu, M. Tamura, T. Nakagawa, K. Ichikawa, M. Miyamoto, D. Takabayashi, H. Yamazaki, K. Kakeshita, T. Koike, S. Kagitani, F. Tomoda, T. Hamashima, Y. Ishii, H. Inoue, M. Sasahara, F. El Machhour, M. Kerroch, L. Mesnard, C. Chatziantoniou, J.-C. Dussaule, K. Inui, F. Sasai, Y. Maruta, H. Nishiwaki, E. Kawashima, Y. Inoue, A. Yoshimura, E. Musacchio, G. Priante, C. Valvason, L. Sartori, B. Baggio, J. H. Kim, O. Gross, R. Diana, D. H. Gry, B. Asimal, T. Johanna, S.-E. Imke, W. Lydia, M. Gerhard-Anton, D. Hassan, J. L. Cano, M. Griera, G. Olmos, P. Martin, M. A. Cortes, S. Lopez-Ongil, D. Rodriguez-Puyol, S. DE Frutos, M. Gonzalez, A. Luengo, M. Rodriguez-Puyol, L. Calleros, R. Lupica, A. Lacquaniti, V. Donato, R. Maggio, C. Mastroeni, S. Lucisano, V. Cernaro, M. R. Fazio, A. Quartarone, M. Buemi, M. Kacik, S. Goedicke, H. Eggert, J. D. Hoyer, S. Wurm, A. Steege, M. Banas, A. Kurtz, B. Banas, L. Lasagni, E. Lazzeri, S. Romoli, I. Schaefer, B. Teng, K. Worthmann, H. Haller, M. Schiffer, C. Prattichizzo, G. S. Netti, M. T. Rocchetti, L. Cormio, G. Carrieri, G. Stallone, G. Grandaliano, E. Ranieri, L. Gesualdo, A. Kucher, A. Smirnov, M. Parastayeva, O. Beresneva, I. Kayukov, I. Zubina, G. Ivanova, A. Abed, L. Schlekenbach, B. Foglia, B. Kwak, C. Chadjichristos, N. Queisser, N. Schupp, S. Brand, L. Himer, B. Szebeni, E. Sziksz, S. Saijo, E. Kis, A. Prokai, N. F. Banki, A. Fekete, T. Tulassay, A. Vannay, B. Hegner, T. Schaub, C. Lange, D. Dragun, B. M. Klinkhammer, K. Rafael, M. Monika, M. Anna, C. Van Roeyen, P. Boor, B. Eva Bettina, O. Simon, S. Esther, J. Floege, U. Kunter, D. Janke, J. Jankowski, M. Hayashi, I. Takamatsu, C. Horimai, T. Yoshida, G. Seno DI Marco, M. Koenig, C. Stock, S. Reiermann, S. Amler, G. Koehler, M. Fobker, F. Buck, H. Pavenstaedt, D. Lang, M. Brand, E. Plotnikov, M. Morosanova, I. Pevzner, L. Zorova, N. Pulkova, D. Zorov, M. Wornle, A. Ribeiro, F. Belling, M. Merkle, D. Nakazawa, S. Nishio, S. Shibasaki, U. Tomaru, I. Akihiro, I. Kobayashi, Y. Imanishi, M. Kurajoh, Y. Nagata, M. Yamagata, M. Emoto, T. Michigami, E. Ishimura, M. Inaba, C.-C. Wu, K.-C. Lu, J.-S. Chen, P. Chu, Y.-F. Lin, K. Eller, A. Schroll, A. Kirsch, J. Huber, G. Weiss, I. Theurl, A. R. Rosenkranz, A. Zawada, K. Rogacev, M. Achenbach, D. Fliser, G. Held, G. H. Heine, Y. Miyamoto, Y. Iwao, H. Watanabe, D. Kadowaki, Y. Ishima, V. T. G. Chuang, K. Sato, M. Otagiri, T. Maruyama, H. Iwatani, D. Honda, T. Noguchi, M. Tanaka, H. Tanaka, M. Fukagawa, J. Pircher, S. Koppel, H. Mannell, F. Krotz, G. M. Virzi, C. Bolin, D. Cruz, E. Scalzotto, M. De Cal, G. Vescovo, C. Ronco, R. Grobmayr, M. Lech, M. Ryu, Y. Aoshima, M. Mizobuchi, H. Ogata, C. Kumata, A. Nakazawa, F. Kondo, N. Ono, F. Koiwa, E. Kinugasa, W. Freisinger, N. Lale, A. Lampert, T. Ditting, S. Heinlein, R. E. Schmieder, R. Veelken, H. Nave, R. Perthel, M. Suntharalingam, S. Bode-Boger, G. Beutel, J. Kielstein, R. Rodrigues-Diez, S. Rayego-Mateos, C. Lavoz, L. G. Stark Aroeira, M. Orejudo, M. Alique, A. Ortiz, J. Egido, M. Ruiz-Ortega, W. Oskar, C. Rusan, J.-S. Padberg, A. Wiesinger, S. Reuter, A. Grabner, D. Kentrup, A. Lukasz, H. Oberleithner, H. Pavenstadt, P. Kumpers, H. U. Eberhardt, C. Skerka, Q. Chen, T. Hallstroem, A. Hartmann, M. J. Kemper, P. F. Zipfel, K. N'gome-Sendeyo, Q.-F. Fan, J. Toblli, G. Cao, J. F. Giani, F. P. Dominici, J. S. Kim, J. W. Yang, M. K. Kim, B. G. Han, and S. O. Choi

Subjects
Transplantation, Nephrology
Published
2011
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18. Diabetes mellitus - clinical studies - 2

Author

A. Sattar, István Wittmann, Domenico Corradi, M. Haapio, Bernhard M.W. Schmidt, Susumu Ogawa, Ruth Mitchell, Carlos Alberto Mayora Aita, Colin J. Meyer, Peter-Rene Mertens, Esztella Mikolás, P. Miarka, Tatjana Cvetkovic, Ling Li, Georgios Hadjigeorgiou, J.A. Kellum, JoséMauro Vieira, Pál Brasnyó, Vuddhidej Ophascharoensuk, Hiroshi Sato, Eszter Fehér, Mártóon Mohás, Julia B. Lewis, Yusuke Osaki, Ulrike Raff, Tuneo Ishizuka, Mirela Liana Gliga, Sadayoshi Ito, Maximilian von Eynatten, Augusto Vaglio, Spyridon Arampatzis, Ramesh Chandra Vyasam, F. Nurhan Ozdemir, Jutalai Tanterdtham, M. Walus-Miarka, Marcus Baumann, Laura Pavone, Ausilia Maione, Carlos Kornhauser, Weiqian Sun, Renate Koppensteiner, Myrto Giannopoulou, Grigore Aloiziu Dogaru, Nestor Schor, August Heidland, Srilatha Vadlamudi, C. Argyropoulos, Peter Boor, Somkiat Vasuvattakul, L. Weissfeld, Alessandra Palmisano, Gloria Barbosa-Sabaner, M. Stompor, Jae Sung Lee, Demet Yavuz, Vladimir Arandjelovic, Ioanna Chronopoulou, Paisal Parichatikanond, Maria Goretti Polito, Takashi Nakamichi, Masanori Ito, Denise H.M.P. Diniz, Katarína Šebeková, T. Grodzicki, Bi-Cheng Liu, Toshio Mochizuki, Federico Alberici, Roberto Zatz, Jamille Godoy Mendes, Pingyan Shen, M. de Cal, Qi Long, Tadayuki Okumoto, M. Unruh, Nan Chen, Kraiwiporn Kiattisunthorn, Predrag Vlahovic, Gerit-Holger Schernthaner, Carlo Salvarani, Ilma Modanez, Per M. Humpert, Stacey Ruiz, Peggy Gao, Boonyarit Cheunsuchon, M. Batur Canoz, Lei Yan, Guntram Schernthaner, Dietmar Zdunek, Maria Dardioti, Claudio Ronco, Simeone Andrulli, Silvia M. Titan, Hans-Henrik Parving, Mohammed Bashir, Roland E. Schmieder, Florian Hoellerl, Hideyuki Inoue, Kristína Klenovicsová, Daniel Cruz, W. Sulowicz, Norman K. Hollenberg, Antonio Nicolucci, Ioannis Stefanidis, Donal O'Shea, Paulo C. Fortes, Vladislav Stefanovic, Seiji Hashimoto, Edmund J. Lewis, Ines Casazza, F. Nalesso, Wattana B. Watanapa, Rosario Foti, Sasa Milenkovic, Sherwyn Schwartz, Gianna Mastroianni-Kirsztajn, Takayuki Yamada, Judit Cseh, Athakorn Kirakul, M. Krzanowski, Johannes Mann, Efthymios Dardiotis, Jeffrey G. Supko, T J Cawood, Angelika Bierhaus, Chiara Grasselli, Cornelia Zumpe, E. Chowaniec, Wen Zhang, Hyeong Cheon Park, Takuma Hosoya, Mihai Gliga, Frederik Persson, Pablo Pergola, Erika Oliveira da Silva, Jicheng Lv, Chien-Te Lee, Tasuku Nagasawa, Noemi Gutierrez-Romero, Alberto Pesci, Karsten Kreuer, Sung Jin Moon, Douglas Denham, Roberto Pecoits-Filho, Hong Zhang, Kriengsak Vareesangthip, B. Ciepiela, Miguel C. Riella, A.A. House, Ke-Dan Cai, Terry Ting-Yu Chiou, Silvia Regina Moreira, Ravi Raju Tatapudi, Craig A. Hurwitz, Davide Martorana, Peter P. Nawroth, Giovanni F.M. Strippoli, István András Szijártó, Jung Eun Lee, Inés Birlouez-Aragon, Takao Koike, Hong Ren, kos Mérei, Ampica Mangklabruk, Gabriella Moroni, Hai-yan Wang, Veronika Somoza, Thomas K. Schwarz, Johanna Brix, Branka Mitic, Zi-Lin Sun, Saori Nishio, Sufang Shi, Sung Kyu Ha, Xiaoxia Pan, Ravi Shankar Subramaniam, Georg Hess, P. Lentini, Prasad Gullipalli, Siren Sezer, Sankar D. Navaneethan, Soung Rok Sim, Marcel Roos, Rui Toledo Barros, Uwe Heemann, Jennifer Brady, Kazuhiro Nako, Markus P. Schneider, Barbara Murray, Tibor Vas, M. Dubiel, Giselle Saavedra, Carlo Buzio, Vidojko Djordjevic, Rue-Tsuan Liu, Daisuke Ito, Vassilios Liakopoulos, T. Stompor, Suchai Sritippayawan, Carmen Caldararu, and Takefumi Mori

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Internal medicine, Diabetes mellitus, medicine, business, medicine.disease
Published
2009
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19. Protein-energy wasting, inflammation and oxidative stress

Author

Kanji Shishido, Georgia Antoniadi, Csilla Z Madarász, Luigi Lombardi, Jose Antonio Sanchez Tomero, Milada Kostirova, Evaggelos Kapeleris, P. Barany, Pedro Figueroa, Suresh C. Tiwari, Adam Remport, Mari Nakamura, Carmen Sanchez, Simona Stancu, Stefan Reuter, Philip Bangen, Marie Vinglerova, Ankur Gupta, Shyam Prakash, Christoforos Papadopoulos, Monika Lichodziejewska-Niemierko, L. Nordfors, Mhairi K. Sigrist, Saso Gelev, Vladimir Pusevski, Siamak Ahmadzade, Bolesław Rutkowski, Archit Patel, Katalin Fornadi, Rui Filipe, Tomohito Matsunaga, Ernesto Rocha, Guillermina Barril, Marta Kalousová, A. Barrientos, Tomoyuki Yamakawa, Marta Codognotto, Artemisia Dona, Kuan-Yu Hung, Yoshiki Nishizawa, Theodoros Eleftheriadis, G. Mircescu, Dana Lixandru, Umapati Hegde, Karina Furaz, I. Bobek, Mohan Rajapurkar, Sylvie Dusilová-Sulková, C. Sintimbreanu, Kathrin Koch, F. Coronel, Noriyuki Kato, Olof Heimbürger, Abdul Rashid Qureshi, Kyoko Nagasue, Liliana González-Espinoza, Marianna Zsom, Maryam Sharifian, Tibor Fülöp, All Nephrologists from Normandy, Alberto de Lorenzo, Marta Novak, Oto Mestek, Alireza Hamidian Jahromi, George Ntatsis, L. Cabrerizo, S. Soni, Atin Kumar, Bayram Edemir, Ana Bernardo, Ewa Aleksandrowicz, Mohammadmahdi Sagheb, Senji Okuno, Andrea Malagoli, Antonio C. Cordeiro, Grammati Galaktidou, Maria Lopez Picasso, Hirokazu Honda, Vassilios Liakopoulos, J. J. Carrero, Nozomu Hosaka, Peter Stenvinkel, Yashar Talebi, Ghanbarali Raissjalali, George Fares, Ramin Radmehr, Tomáš Zima, Miguel Medina, M.A. Rubio, Daisuke Sanada, Christopher W. McIntyre, Mar Ruperto, Kenway Ng, Jan T. Kielstein, Istvan Kiss, Sandeep Mahajan, M. Schalling, Eniko Sárváry, Ales Kubena, Makrouhi Sonikian, Dimitrios Poulikakos, Antonio Piccoli, Sanjay K. Agarwal, Enrique Rojas Campos, Effie Ioannidou, J. Axelsson, Athanassia Kokkinari, Jacky Potier, F. Nalesso, Alexandra Scholze, Stavroula Ziakka, M.J. de la Cruz, Ioannis Stefanidis, Masaaki Inaba, Eleftheria Ferentinou, Daniela Mladenovska, Ambar Khaira, Alfonso M. Cueto-Manzano, M.E. Suliman, C. Ronco, John E. Sanderson, Jonas Axelsson, Jorgen Hegbrant, Isabel Dias, Sanaz Shabani, María Elisa Casos, Luciano De Paola, Suhas Lele, Shiho Kojima, Bengt Lindholm, O. Véber, M. de Cal, Ute Neugebauer, Katharina Krueger, Chen-Hua Liu, Martin Giorgi, Kiyoshi Maekawa, Kaori Kohno, A.R. Qureshi, Laura Cortés-Sanabria, Benjamín Gómez, Ioannis Koutis, Daniel Cruz, Raj Kumar Sharma, Shinichi Mashiba, Giovanni F.M. Strippoli, Bogdan Manolescu, Mohammadreza Khalilzade, M. Rahsaz, Detlef Lang, Anja Juehling, Gabriella Beko, Anupma Kaul, Jamshid Roozbeh, Stefan Heidenreich, Hung-Bin Tsai, Helen Jefferies, R. Martinescu, Rama Tripathi, J.A. Herrero, Anna Rudas, József Eller, Carolina Batis, Amirali Sohrabpoor, Banibrata Mukhopadhyay, Masashi Ueda, Aleksandar Sikole, Pavlina Dzekova, Nicolas Papagalanis, Vladimir Tesar, Lajos Zsom, Susan Ordaz, Cristina Capusa, László Rosivall, Catherine Wells, Tadao Akizawa, Mei-Tsu Chen, Justyna Golebiewska, Charlotta Wollheim, Mikołaj Majkowicz, Rodolfo Valtuille, Youko Katoh, Fabiola Martin del Campo, Anurag Singh, Alfonso Martn Cueto-Manzano, P. Stenvinkel, O.M. Rathi, Pau-Chung Chen, I. Perez Flores, Adolfo Romeo, Juan Jesus Carrero, Michele Buemi, Wieslawa Lysiak-Szydlowska, Linda Cardona, Dimitra Bimplaki, Patricia Pena, Raha Afshariani, Gabriel Mircescu, P. Matilla, Keiko Takahashi, Liliana Gonzalez Espinoza, Navide Ahmadinajad, Ligia Petrescu, Juana Gonzalez, W.I. Alkrekshi, Isabel Fonseca, Mandy Man-Mei Sea, A. Witasp, Hiroki Suzuki, Gulsen Selim, Davide Bolignano, Andre A. Kaplan, Sophia Trompouki, Stephen G. John, Christopher W.K. Lam, Filippos Karakassis, Michael F. Flessner, Makoto Ishizaki, Iris H.S. Chan, Miklos Z. Molnar, Hamid Tayebi Khosroshahi, Jia-Horng Kao, Sishir Gang, Dimosthenis Vlassopoulos, Maria E. Czira, Makoto Watanabe, Elmer Andrés Fernández, R. Martin, Angela Y.M. Wang, Parin Hedayati, Labrini Takouli, Lada Trajceska, Akos Ujszaszi, Agostino Naso, Hermann Pavenstädt, P. Lentini, Ioannis Karabinis, Stefanie M. Bode-Boeger, Peter Bárány, Chara Spiliopoulou, B. Lindholm, Alfonso Martín Cueto Manzano, Jean Woo, Jose Montalban, Anna Dongari-Bagtzoglou, Irina Stoian, Martin Tepel, Giuseppe Coppolino, Kalpesh Gohel, Eiji Ishimura, Istvan Mucsi, Liliana Gonzalez, Roxana Martinescu, Anoop Saraya, Iakovos Skarakis, and Mariana Ayala

Subjects
Transplantation, medicine.medical_specialty, Endocrinology, Nephrology, business.industry, Internal medicine, medicine, Inflammation, Protein energy wasting, medicine.symptom, business, medicine.disease_cause, Oxidative stress
Published
2009
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20. Acute renal failure - clinical studies - 2

Author

Irena Dolgoker, Xiuling Chen, Renata Heck, Anousheh Haghighi, Seong Gyun Kim, A.A. House, Shriganesh Barnela, Sudarshan Ballal, Horng Ruey Chua, W.Y. Kong, Duaa Aresmouk, Carlo Guastoni, Ha Young Oh, Soo Bong Lee, Vishwanath Billa, Lucian Jiga, Christoforos Giannaki, Oon Cheong Ooi, Gopalkishan Adikey, Shinya Ikematsu, Fred Lai, Christina Karatzaferi, Shukun Wu, Catherine S. Forster, Cetin Turgan, J.S. Sekhon, A.S. Dayanand, T.C. Keng, Mansour Jannati, Dae-Eun Choi, A. Brendolan, Chew Ming Wong, Kajohnsak Noppakun, Hilmi Ozkutlu, Thaís Gonçalves, Jordana de Fraga Guimarães, Ji Eun Oh, Jun Ma, Florian Thilo, Adalbert Schiller, L.P. Tan, Boon Wee Teo, So Yeon Park, R.N. Sahoo, Soo Jin Kim, Batya Kristal, Katarzyna Szamotulska, Amish Dilip Patel, Xiaonong Chen, Hyung Jik Kim, Hany Yassa, Martin Tepel, Ling Qin, Ki Ryang Na, Giovanni Seveso, Wooseong Huh, Scott O. Grebe, F. Nalesso, Pierre-Yves Martin, Belen Ponte, Rahmi Yilmaz, Thanit Kasemset, Sreedhar Reddy, Yip Boon Chong, Nikita Mehra, Claudio Ronco, Pi-Ru Tsai, Joanna Matuszkiewicz-Rowińska, Nicoletta Bellotti, Hong Ren, Norberto Garcia-Cairasco, M. Haapio, Lavinia Virvorea, Ling Wang, S. Soni, Magdy Francis, Mihai Ionac, Tolga Yildirim, Kwan-Dun Wu, Anna Lisa Neri, GhanbarAli Raaeisjalali, Yue Zhang, Antônio Balbinotto, Stefano De Servi, Wen Zhang, Daqing Hong, Bernhard K. Kraemer, S. Vishwanath, Jose Chacko, Christoph Loddenkemper, Lavdas Eleftherios, Valter Barzaghi, M. Zanella, P. Lentini, Emerson Q. Lima, Manas Ranjan Sahoo, Shrirang Bichu, Isac de Castro, Hari Janakiraman, Patrick Haage, Ping Zhang, Eugenia Singer, Kosaku Nitta, Hyoung Su Kim, Luca Di Toma, Yoon-Goo Kim, Wen Chang Chan, Kang Wook Lee, Micheal Kamel, Kimitoshi Nishiwaki, Jiaqi Qian, Sedigheh Amooee, Bahar Bastani, Cássia Morsch, Itzchak Slotki, F. Garzotto, Dong Won Lee, Hui Gao, Aysun Aybal, I. Bobek, Daisuke Sugiyama, Koutedakis Yiannis, Shailesh Gondane, Yukio Yuzawa, Adelina Mihaescu, Lilach Shema, Kai M. Schmidt-Ott, Liakopoulos Vassilios, Fernando Saldanha Thomé, George Patrut, Sébastien Perbet, Sarah Chung, Jinhee Cho, Su-Kyong Yu, Hiroki Hayashi, Thomas F. Mueller, Jonathan Barasch, Jungmin Son, Ben He, Somnath Chatterji, Serhan Piskinpasa, K Babu, A.K. Das, Melissa A. Laudano, Kazimierz Suwalski, Márcio Dantas, Zhaohui Ni, Lei Pu, Pingyan Shen, Vincent Sapin, Kenji Kadomatsu, I. Bolgan, Georgi Abraham, Jialiang Li, Raha Afshariani, Amanda R. Martins, Linda Shavit, M. Anoop, Ravindra Bhattu, Corrado Turri, Eui-Sic Kim, Bharati Sahoo, Jérôme Pugin, Luis Yu, Dariusz Wlodarczyk, Geron Ronit, Wen-Yi Li, Li Wang, Bertrand Souweine, Eun Young Seong, Chuen Neng Lee, Bora Peynircioglu, Alexander Altenburg, Gyu-Tae Shin, Jeong-Ah Kwon, Dilip Ashok Kirpalani, Zahra Najmi, Ashok Kirpalani, Fabrizio Poletti, Maryam Sharifian, Jean-Etienne Bazin, Taku Morito, Yu-Feng Lin, Hui Xu, Sakkas Giorgos, Miguel Moysés Neto, Lidia Lewandowska, Thomas L. Nickolas, Ramon Ramos Filho, Gaurav Daga, Jung Woo Noh, Vin-Cent Wu, Ken Tsuchiya, Barbaros Cil, Qiang He, Young Rim Song, Nan Chen, Oana Constantinescu, Waichi Sato, Rafael Carlos Miranda, Emmanuel Futier, Nicu Olariu, Ravindra L. Mehta, Soudabeh Kheirkhah, R. Anuradha, Hadjigeorgiou Georgios, M. de Cal, Agnieszka Grzejszczak, S. Puri, Weiming Wang, Alireza Serati, Stefanidis Ioannis, Soo Kun Lim, Wen-Jo Ko, Elvino José Guardão Barros, V. Corradi, Inwhee Park, Jamshid Roozbeh, Kinga Giers, Małgorzata Dębowska, Stanisław Niemczyk, Sang Heon Song, Ji-Yoon Jung, Fang Wang, Kudret Aytemir, P. Piccinni, Heungsoo Kim, Daniel Cruz, Youg-Tai Shin, Emmanuel A. Burdmann, Alexandre Lautrette, Bismay Kumar, S.Y. Tan, B. Noland, Fuquan Yang, Daejoong Kim, Bulent Altun, Meghan E. Sise, Seiichi Matsuo, S.H. Teo, Jean-Michel Constantin, Amit Nagarik, Oliver Schmalz, S. Mehta, J.S. Sandhu, Niranjan Mohanty, Jin Chen, Minoru Ando, Jung Eun Lee, Young-Hoon Kim, Shoichi Maruyama, Laurence Roszyk, Thayza Santos, Liora Ore, Arampatzis Spyridon, Erika Berg, Hamid Reza Samimagham, Hardik Shah, Ihm Soo Kwak, and Patrick Saudan

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Medicine, business, Intensive care medicine
Published
2009
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21. Vascular access - 2

Author

Vanja Persic, Andreana De Mauri, Biljana Gerasimovska-Kitanovska, Eli Iola Gurgel Andrade, Maurizio Bossola, Michelle Mokrzycki, Francisco de Assis Acurcio, Antenore Giussani, Loreley Betancourt, Esra Baskin, Silvia Mattei, Zoltan Bansaghi, Xueqiang Xu, Fayeq Abu Shalhoub, Jerzy Głowiński, Gianmario Bosticardo, Luisa Berardinelli, Nurcan Cengiz, Marian Klinger, Jyoti Baharani, Isabel Cristina Gomes, Michel Jadoul, Yasemin Soyoral, Ho Jun Chin, Marek Gacko, Antonio Pasciucco, Marco Melandri, Patrizio Pezzotti, Pietro Bajardi, Joan Perandreu, Ralph Crott, Laura Labriola, Stephen B. Ting, László Tornóci, Manel Solano, Michal Mysliwiec, Jolanta Malyszko, Charles R.V. Tomson, Jordi Branera, F. Nalesso, Timmy Lee, Shvan Korsheed, Rafael Ponikvar, Hyung Soo Kim, Kaan Gulleroglu, Christopher W. McIntyre, John Davies, Krzysztof Letachowicz, Vincenzo Pirozzi, Haibing Ren, Richard Fluck, Bo Zhang, Augusto Vaglio, Umut Selda Bayrakci, Veronica Morellini, Jadranka Buturović Ponikvar, Francesco Principe, Seung Suk Han, Luisa Persichini, Changying Xing, Joan Falcó, Bin Sun, Irena Głowińska, Wang Xi, Andrea Toth, Antonio Giménez, Yong Chul Kim, Carme Grau, Mercedeh Kiaii, Paola David, Jennie Wilson, Khai Ping Ng, Waldemar Letachowicz, Maria Teresa Saravo, Hasan Yardim, Wacław Weyde, C. Chion, Marco Battisti, Sejoong Kim, Paolo Manunta, Maria P. Valenzuela, László Rosivall, Mehmet Haberal, F. Basso, Juan Carlos Martinez-Ocaña, Vesna Gerasimovska, Carlo Edoardo Ruva, Nadia Martin, Cristina Tantardini, Aleksandar Sikole, Francesca Apponi, Mariangela De Maria, Maria Letizia Giarrizzo, Antonino Musumeci, Monica Beaulieu, Hyun Hee Lee, Luigi Marzano, Hale Sakalli, Ariberto Corradi, F. Garzotto, Rick Luscombe, Tae Woo Lee, Joaquim Vallespín, Salvatore David, Simona Delli Carpini, Nuria Ramírez, Bruno Minale, Luigi Tazza, A. Brendolan, Giorgio Slaviero, Carmine Pecoraro, Jose R. Fortuño, Chiara Lanzani, Marilena Conte, Jinaming Hu, Gabriele Malgieri, Federica Capurro, Montserrat Marcet, Stephen G. John, Judit Greguschik, Angel Rodríguez-Jornet, Carmen Moya, Donatella Spotti, Huseyin Begenik, Rubén Iglesias, Ruth Blackburn, Charmaine Lok, Martino De Leo, I. Bobek, Adeera Levin, Ildiko Vizi, M. Zanella, Donal O'Donoghue, Domenico Di Lallo, Jin-woong Park, M. de Cal, Serena Chicca, Manuel Garcia, Paolo Detoma, Carlo Navino, Louise Moist, Ivan D. Maya, Anteo Di Napoli, C. Ronco, Francesca Nuzzi, Ming Zeng, Jaeseok Yang, S. Soni, Doriana Chiarinotti, Isabel Granados, Mariangela Leal Cherchiglia, Alfonso Ferretti, Remo Luciani, Huijuan Mao, Jose Ibeas, Xiangbao Yu, Hyosang Kim, Daniela Coclite, P. Lentini, Serhat Avcu, Ningning Wang, Marta Fernandez, Maddalena Brustia, George Prince, D. Cruz, Edina Juhasz, Patricia Bermúdez, Alexandra Romann, Reha Erkoc, Angel Oncevski, Egidio Pozzoli, Gisele Freire da Silva, Csaba Rikker, Nicola Pirozzi, Sabrina Valle, and Suhnggwon Kim

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, medicine, Vascular access, Intensive care medicine, business
Published
2009
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22. Acute renal failure - clinical studies - 3

Author

Marcia Cristina da Silva Magro, Zouhir Oualim, M. Batur Canoz, I. Bobek, Anna Hawrot-Kawecka, Stefanie M. Bode-Boeger, Miguel A. Ribeiro, Stanislaw Wos, P. Piccinni, Brenda R. Hemmelgarn, Jan Dulawa, Nicu Olariu, Jan Stange, Serena Antniolli, Benedetta Ferri, Christian Joukhadar, C. Chion, Robert Faulhaber-Walter, Reinaldo F. Neto, Igor M. Santos, Jan T. Kielstein, Maristela Bohlke, Heiko Hickstein, Vlado Pusevski, Rinaldo Bellomo, Mustapha Allam, Sverrir Hardarson, Sandra Figueiredo, Ana Cortesão Costa, Emannuel Rivers, Burak Canver, Paolo Manunta, Veronica Testa, Mariana Bobic, Sehmus Ozmen, Helen Murray, Ken McCune, Agotha Borcanea, C. MacEwen, Elisa Lazzarich, Maurício de Nassau Machado, Lilia Nigro Maia, Sascha David, Giorgio Bellomo, Kaline Oliveira, Claudio Campieri, Susana Martins, Sebastian Klammt, Stephanie Brillhart, Alan Slade, Wojciech Domaradzki, Michael Burg, K. Soto, Belma Özlem Tural Balsak, Xueqing Yu, Atilla Sezgin, Piero Stratta, Grzegorz Kawecki, Jens Martens-Lobenhoffer, Ying Kuan, Ramesh Naik, Stefan Liebe, Nur Baykara, Oana Constantinescu, Gustavo Tragnago, José António Lopes, Alberto Zangrillo, Hartmut Hecker, Ioan Sporea, P. Lentini, Juliane Gruenert, Eric Hoste, Ligia Petrica, Gang Chen, Philip Kam-Tao Li, Kirsten Colpaert, Ana Paula Otaviano, Roman Mrozek, Davide Rossi, Vala Palmadottir, Sergio Stefoni, Patrick T. Murray, Mihael Potocki, Mohamed Hassani, Li Wang, Nathan I. Shapiro, Maria do Socorro Albuquerque, Michael Bennett, Marco Quaglia, Barbara Singh, Luis Resende, Virginia Trandafirescu, Paulo Percio Magro, Abdellali Bahadi, C. Ronco, Gheorghe Bozdog, Betul Erismis, Neesh Pannu, Robert Birkhan, A. Brendolan, Sebastian Koball, Kenneth Kupfner, Davut Akin, D. Cruz, Elena Bignami, Ana Maria Sararu, Judd E. Hollander, Carsten Hafer, Silvia Velciov, Antonio N. Diogo, Thomas Dumortier, Maria de Fatima Vattimo, Anna Mizzi, Arben Asani, Kamil Toker, Andrea Airoldi, Adelina Mihaescu, Paolo Calzavacca, Zola Mzimba, Hermann Haller, Joao Nobrega, Elizabeth De Francesco Daher, Scott Klarenbach, Anne Goetze, A. Fabbri, Joerg Emmerich, Stephen Trzeciak, Alper Usluogullari, Deidre Campbell, Liljana Tozija, Elena Brioni, Corina Vernic, Itir Yegenaga, Polianna Lemos Moura Moreira Albuquerque, Steffen Mitzner, Laura Madeira, Christian Mueller, M. de Cal, Prasad Devarajan, Saulo R. Garcez, Nele Brusselaers, Tobias Breidthardt, Seok-won Lee, Roberta Fenoglio, F. Basso, H. Martins, A. Borges, Jay L. Koyner, Geraldo Bezerra da Silva Junior, Sabrina Strube, Cristina Gluhovschi, Xiuling Chen, Flaviu Bob, F. Nalesso, Ken Kupfer, Rafael V. Barreto, Duska Dragun, Paulo Caruso, Joseane S. Santos, Zvezdana Petronijevic, Giovanni Landoni, Thorvaldur Magnusson, Robert Schmouder, Anja Haase-Fielitz, S. Soni, Olaf Burkhardt, Frei Ulrich, Stan Monstrey, Philipp Kümpers, Lukasz Chrobak, Koco Cakalaroski, Demet Yavuz, S. Auriemma, Alexander Lukasz, Luciana M.M. Barbosa, F. Garzotto, Jessica Vasconcelos, Paul Bateson, Matthew T. James, Johan Decruyenaere, M. Emin Yilmaz, Zhentong Wang, Adalbert Schiller, Tiffany Osborne, Kleyton A. Bastos, Nunzia Casamassima, Aleksandar Sikole, Fabiana Hirata, Ulysses dos Santos Torres, Geoffrey Block, Francesco Grammatico, M. Zanella, Chiara Lanzani, Fang Wang, Galina Savinova, Gheorghe Gluhovschi, Lindsey Barker, Manisha Sahay, Michael Haase, Tulio Reichert, L. Cunha, Volker Kliem, António Gomes da Costa, B. Rodrigues, Tobias Reichlin, I. Bolgan, Ana Carolina Brochado Geist, Rosana G. Bruetto, A.L. Papolia, Xiuchuan Yang, Franklin Correa Barcellos, Emmanuel A. Burdmann, Alessandro Ciavatti, Minghui Zhao, Kerstin Schuster, Brian Noland, Florica Gadalean, Mario G. Lopes, Ahmed Amer, Stijn Blot, Catrin Oye, A. D'Onofrio, Margrét Birna Andrésdóttir, Markus Noveanu, Pedro T. L. Pereira, F. Nurhan Ozdemir, Guisen Li, Doru Valceanu, Serhan Tuglular, Valeria Rechnik, Fernando B. Rodrigues, Siren Sezer, Hendrik Veldink, Helena Rotta Pereira, Qiang He, P. Devarajan, Alessandra Chiarini, Ilaria Crespi, and G. Cresce

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, medicine, Intensive care medicine, business
Published
2009
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23. Pulse high volume hemofiltration

Author

A, Brendolan, V, D'Intini, Z, Ricci, M, Bonello, R, Ratanarat, G, Salvatori, V, Bordoni, M, De Cal, E, Andrikos, C, Ronco, and G, Salvadori

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Multiple Organ Failure, 030106 microbiology, Biomedical Engineering, Sepsis syndrome, Medicine (miscellaneous), Bioengineering, Biomaterials, Sepsis, 03 medical and health sciences, 0302 clinical medicine, medicine, High volume hemofiltration, Humans, Intensive care medicine, Aged, Pulse (signal processing), business.industry, Critically ill, High mortality, Organ dysfunction, General Medicine, Acute Kidney Injury, Middle Aged, medicine.disease, Systemic Inflammatory Response Syndrome, Female, Hemofiltration, medicine.symptom, business, 030215 immunology
Abstract

The sepsis syndrome is the most common cause of acute renal failure and multiple organ dysfunction in critically ill subjects and continues to have an alarmingly high mortality. Normal immune homeostasis is interrupted by a complex storm of inflammatory mediators responsible for the deleterious effects. Extracorporeal blood purification techniques can confer benefits in sepsis by proven non-specific removal of these mediators (pro- or anti-inflammatory), and provide a logical and adequate approach to treat this syndrome. High volume hemofiltration (HVHF) has had the most dramatic effect conferring benefits in hemodynamics, reduction in vasopressor doses and improvement in survival. “Pulse HVHF” is the latest approach which may offer the most efficient results: a daily schedule of 6–8 hours followed by standard CVVH. This paper describes the rationale and potential of this technique. Reliability and tolerance of this technique and biological effects are described.

24. Residual of bacterial DNA in hemodialyzers: the proof of subclinical infection sustaining chronic inflammation

Author

M. De Cal, C. Ronco, M. Rassu, and S. Cazzavillan

Subjects
DNA, Bacterial, 030232 urology & nephrology, Biomedical Engineering, Medicine (miscellaneous), Bioengineering, Inflammation, 030204 cardiovascular system & hematology, Biology, Cohort Studies, Biomaterials, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, medicine, Humans, Serum Albumin, Subclinical infection, Interleukin-6, Bacterial Infections, General Medicine, medicine.disease, C-Reactive Protein, Immunology, Kidney Failure, Chronic, medicine.symptom, Bacterial dna, Kidney disease
Abstract

Background and purpose Inflammation and infection seem to be important causes of morbidity and mortality in Chronic Kidney Disease (CKD) patients. Subclinical infections have been proposed as an important cause of inflammatory syndrome but to date this hypothesis remains speculative. In this investigation, we developed a method for molecular detection of the presence of bacterial DNA in a population of chronic kidney disease patients in order to correlate molecular data with the degree and level of inflammation and to evaluate the usefulness of the method in the diagnosis of subclinical infection. Design The study was divided into two phases: the study of a population of 81 CKD patients for prevalence and level of inflammation and infection; and the molecular evaluation of a subgroup of 38 patients without evident clinical causes of inflammation for molecular evaluation of subclinical infection. Results Patients hemoculture negative turned out positive for the presence of bacterial DNA when molecular methods were used. We found a trend of correlation with the presence of bacterial DNA and the increase in hs-CRP, IL-6 and oxidative stress (AOPP) levels and a reduction in MFI DR+. Hemodialyzer membranes seem to have properties that are “sticky” to bacteria/bacterial DNA and work as concentrators. Moreover our data suggest that DNA can traverse hemodialysis membranes. Conclusions Molecular methods have turned out to be far more sensitive than standard methods in detecting subclinical infection. The presence of bacterial DNA seems to influence the variation of some parameters of inflammation and immunity. Apart from the limitations and pitfalls, a molecular method could be useful for the screening of subclinical infection and diagnosis of sepsis when the hemoculture is negative. The identification of the microorganism involved, however, must be done with species-specific primers. These results are preliminary and more investigations will have to be performed in order to confirm our results.

25. Dialytic performance evaluation of Rexeed: a new polysulfone-based dialyzer with improved flow distributions

Author

Alessandra Brendolan, S. Cazzavillan, D. Cruz, M. De Cal, N. Techawathanawanna, Carlo Crepaldi, Federico Nalesso, Antonio Fortunato, and C. Ronco

Subjects
Polymers, 030232 urology & nephrology, Biomedical Engineering, Medicine (miscellaneous), Pilot Projects, Bioengineering, 030204 cardiovascular system & hematology, Biomaterials, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Renal Dialysis, Humans, Sulfones, Polysulfone, Process engineering, Chromatography, business.industry, Chemistry, Membranes, Artificial, Equipment Design, General Medicine, Equipment Failure Analysis, High flux, Treatment Outcome, Flow (mathematics), Kidney Failure, Chronic, Rheology, business, Blood Flow Velocity
Abstract

New dialyzers are designed to optimize the convective and diffusive components of solute transport. Asahi Kasei Medical Co., Ltd. has developed a new high flux dialyzer series called Rexeed™ with improved flow distributions. We evaluated the in vivo dialytic performance of two dialyzers of the Rexeed™ series: Rexeed-18A and Rexeed-25A (1.8 m2 and 2.5 m2). We calculated the clearance for urea, creatinine, phosphate and b2-microglobulin both in high flux dialysis (HFD) and in 15 liter postidiluitional on-line hemodiafiltration (HDF) mode. With n=3 patients in high flux HD at blood flow 450, 400, 350 and 250 ml/min we found remarkably high clearance for urea (347±4%,305±0%,288±5%,230±3%, for Rexeed-18A and 361±3%,329±0%,313±1%,234±3% for Rexeed-25A), creatinine (282±10%,234±0%, 221±8%, 174±8%, for Rexeed-18A and 276±6%,245±0%,226±9%,172±13% for Rexeed-25A), phosphate (347±0%,316±0%,275±4%,202±16%, for Rexeed-18A and 364±3%,365±0%,286±3%,224±2% for Rexeed-25A) and b2-microglobulin (133±21%,124±0%,118±12%,98±11%, for Rexeed-18A and 159±8%,169±0%,157±8%,129±7% for Rexeed-25A) With n=2 patients in HDF at blood flow 300 ml/min we found remarkably high clearance for urea (268±2%, for Rexeed-18A and 283±2% for Rexeed-25A), creatinine (183±6% for Rexeed-18A and 205±9% for Rexeed-25A), phosphate (245±3%, for Rexeed-18A and 270±2% for Rexeed-25A) and b2-microglobulin (166±12%, for Rexeed-18A and 192±4% for Rexeed-25A). Our preliminary evaluation describes the characteristics and the performances of a new polysulfone-based hemodialyzer series called Rexeed™. Several innovative features have been implemented by the manufacturer. These constructive approaches seem to have produced a positive effect on the dialyzer performance at the bedside.

26. Acute Kidney Injury in Patients After Cardiac Arrest: Effects of Targeted Temperature Management.

Author

De Rosa S, Lassola S, Visconti F, De Cal M, Cattin L, Rizzello V, Lampariello A, Zannato M, Danzi V, and Marcante S

Abstract

Background: Cardiac arrest (CA) is a leading cause of mortality and morbidity, with survivors often developing post-cardiac arrest syndrome (PCAS), characterized by systemic inflammation, ischemia-reperfusion injury (IRI), and multiorgan dysfunction. Acute kidney injury (AKI), a frequent complication, is associated with increased mortality and prolonged intensive care unit (ICU) stays. This study evaluates AKI incidence and progression in cardiac arrest patients managed with different temperature protocols and explores urinary biomarkers' predictive value for AKI risk., Methods: A prospective, single-center observational study was conducted, including patients with Return of Spontaneous Circulation (ROSC) post-cardiac arrest. Patients were stratified into three groups: therapeutic hypothermia (TH) at 33 °C, Targeted Temperature Management (TTM) at 35 °C, and no temperature management (No TTM). AKI was defined using KDIGO criteria, with serum creatinine and urinary biomarkers (TIMP-2 and IGFBP7) measured at regular intervals during ICU stay., Results: AKI incidence at 72 h was 31%, varying across protocols. It was higher in the No TTM group at 24 h and in the TH and TTM groups during rewarming. Persistent serum creatinine elevation and fluid imbalance were notable in the TH group. Biomarkers indicated moderate tubular stress in the TTM and No TTM groups., Conclusions: AKI is a frequent complication post-cardiac arrest, with the rewarming phase identified as critical for renal vulnerability. Tailored renal monitoring, biomarker-guided risk assessment, and precise temperature protocols are essential to improve outcomes.

Published
2025
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27. Iodinated Contrast Adsorption in Cartridges With Styrene-Divinylbenzene Sorbent.

Author

Reis T, Ramírez-Guerrero G, Pecoits-Filho R, Lorenzin A, de Cal M, Corradi V, Klinkmann G, Ronco F, Neves FAR, Bellomo R, and Ronco C

Abstract

Background: Contrast-associated acute kidney injury (CA-AKI) is frequent in patients with chronic kidney disease who are submitted to cardiac endovascular procedures using iodinated contrast. In hemoadsorption, cartridges containing styrene-divinylbenzene sorbent resin are applied to remove substances from the blood through an extracorporeal circuit. Importantly, iodinated contrast is also removed via adsorption. We aimed to determine the adsorptive kinetics of the iodinated contrast medium iohexol using a 1:3 scale model of the HA380 cartridge., Methods: An experimental in vitro study utilizing a closed-loop extracorporeal circuit with an interposed sorbent cartridge. A solution spiked with iohexol was recirculated for 60 min. Samples for the measurement of iohexol were drawn at 0, 5, 10, 15, 20, 30, 40, and 60 min. The experiment was carried out twice., Results: In experiments 1 and 2, the reduction ratio after 60 min was 53.0% and 53.1%, respectively. In experiment 1, iohexol clearance was 46.79 mL/min during the first 5 min and decayed to 3.57 mL/min during the last 20 min. In experiment 2, iohexol clearance was 46.72 mL/min and decayed to 3.87 mL/min during the last 20 min. The ratio of adsorbate/sorbent was 155 mg/g., Conclusion: A 1:3 scale model of the HA380 cartridge efficiently removes iodinated contrast in a clinical-scale in vitro circuit. These findings provide a rationale for hemoadsorption as an intervention in clinical trials to prevent or attenuate CA-AKI., (© 2025 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Published
2025
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28. Adsorption Mass Transfer Zone of Vancomycin in Cartridges With Styrene-Divinylbenzene Sorbent.

Author

Reis T, Ronco C, Ramírez-Guerrero G, Marcello M, de Cal M, Neves FAR, and Lorenzin A

Subjects
Adsorption, Anti-Bacterial Agents pharmacokinetics, Polystyrenes, Humans, Vancomycin pharmacokinetics
Abstract

Cartridges for hemoadsorption containing styrene-divinylbenzene sorbent are used for multiple conditions, such as intoxication. The mass transfer zone comprises the extension along the longitudinal span of the cartridge where adsorption occurs. The aim of this experiment is to evaluate the mass transfer zone for vancomycin in the HA380 cartridge. The experiment was carried out twice. A saline solution with vancomycin passed through a HA380-modified cartridge at 100 ml/min in a single-pass fashion. The cartridge had four openings along its longitudinal dimension, at 3, 6, 9, and 12 cm. In both experiments, the collection of aliquots occurred at minute 4, in the four openings and pre- and post-cartridge, and an additional sample from the effluent bag at the end of each experiment. In the second experiment, an additional sampling of the same six sites occurred at minute 14. The sigmoidal shape of the curve for the mass transfer zone of vancomycin was similar to the theoretical one. In experiment one, at minute 4, vancomycin clearance was 98.75 ml/min. In experiment two, vancomycin clearance at minutes 4 and 14 was 93.76 and 93.20 ml/min, respectively. This implies an adequate and optimal design of the HA380 cartridge., Competing Interests: Disclosure: T.R. has received funding for lectures and has been a consultant or advisory board member for Alexion, AstraZeneca, B. Braun, Baxter, bioMérieux, Boehringer Ingelheim, Contatti (CytoSorbents), Eurofarma, George Clinical, Jafron, Lifepharma, Medcorp, Nipro, and Nova Biomedical. C.R. has been on advisory boards or speaker’s bureau for AstraZeneca, Aferetica, Asahi, B. Braun, Baxter, bioMérieux, CytoSorbents, GE, Medica, Medtronic, and Jafron. The other authors have no conflicts of interest to report., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.)

Published
2024
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29. Sorbent functionalization with vancomycin enhances bacteria killing in extracorporeal hemoadsorption.

Author

Ramírez-Guerrero G, de Cal M, Lorenzin A, Vigolo D, Toscano AI, Araya-Rojas M, Zanella M, and Ronco C

Subjects
Humans, Vancomycin pharmacology, Staphylococcus aureus, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Sepsis drug therapy, Bacteremia drug therapy
Abstract

Background: The level of bacteremia in patients with sepsis and septic shock is a predictor of complications and mortality, regardless of the type of bacteria. Devices for bacteria, endotoxin and cytokines removal by adsorption have been recently developed. Thus, extracorporeal blood purification therapies have been proposed as adjunctive therapy in sepsis in combination with drugs. Some potentially useful drugs, however, are precluded due to their organ or metabolic toxicity. The present study represents a preliminary report on the in vitro effect of a sorbent device (minimodule with HA380 beads, Jafron medical, Zhuhai, China) in which the particles have been functionalized with vancomycin on the surface. The impact of the surface-modified beads on circulating bacteria (Staphylococcus aureus) has been tested in a simulated in vitro circulation., Methods: In vitro experiments were carried out with 800 mL of blood enriched with S. aureus species. Blood was circulated in the vancomycin-functionalized and non-functionalized mini-module cartridges in hemoadsorption setup (300 mL each) and the bactericidal effect was assessed. Also, 200 mL of blood was used as a control., Results: A significant increase in the time to positivity of blood cultures was observed after 60 min and also after 120 min of therapy with the mini-module functionalized with vancomycin as opposed to the non-functionalized cartridge., Conclusions: These results suggest a possible way of treating sepsis by using drug- or antibiotic-functionalized cartridges without worrying about pharmacological toxicity. The prolongation of the time to bacterial culture positivity to S. aureus after a passage through a column packed with beads functionalized with vancomycin represents a proof of concept., (© 2023 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Published
2024
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30. Extracorporeal Removal of Per- and Polyfluoroalkyl Substances by Hemoadsorption: In vitro Kinetic Model.

Author

Pavan P, Lorenzin A, Chiementin L, Perin N, de Cal M, Brendolan A, Morisi N, Zanella M, and Ronco C

Subjects
Humans, Water Pollutants, Chemical blood, Kinetics, Adsorption, Water Purification methods, Fluorocarbons blood
Abstract

Introduction: Per- and polyfluoroalkyl substances (PFAS) are known water pollutants leading to potential public health consequences. High blood levels of PFAS have been associated with several pathological conditions including testicular and kidney cancer. Classic extracorporeal therapies have demonstrated limited efficiency, and new approaches should be explored. In this study, we studied the possible role of hemoadsorption to achieve a fast, safe, and effective removal of PFAS from blood in patients with high blood levels., Methods: We developed an in vitro model of hemoadsorption to test the potential of PFAS removal by extracorporeal treatment. We recirculated a highly polluted batch of water (4 L) through a sorbent cartridge (Jafron Medical, Zhuhai, China) for 120 min at a flow of 150 mL/min. We collected samples at different time points and analyzed 39 different PFAS compounds., Results: For the PFAS compounds with concentrations significantly above normal, we observed a removal ratio close to 90% already within the first 60 min of circulation leading to almost complete elimination of all pollutants at 120 min., Conclusions: The in vitro model of hemoadsorption suggests the possible application in vivo of this technique to reduce/normalize the concentrations of PFAS in patients exposed to water or environmental pollution., (© 2024 S. Karger AG, Basel.)

Published
2024
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31. Human Proenkephalin A 119-159 (penKid) in Extracorporeal Therapies: Ex vivo Sieving Coefficient, Diffusive Clearance, and Hemoadsorption Kinetics.

Author

Lorenzin A, de Cal M, Perin N, Morisi N, Brendolan A, Lentini P, Zanella M, and Ronco C

Subjects
Humans, Kinetics, Hemofiltration methods, Renal Dialysis methods, Continuous Renal Replacement Therapy methods, Adsorption, Acute Kidney Injury therapy, Acute Kidney Injury blood, Peptide Fragments blood, Enkephalins blood, Protein Precursors blood
Abstract

Introduction: Enkephalins, endogenous opioid peptides, are involved in the regulation of renal function. One derived molecule, proenkephalin A, also known as penKid, has been demonstrated to be a reliable biomarker for kidney function and its plasma concentration correlates with measured glomerular filtration rate. penKid is used for prediction and diagnosis of AKI and need of renal replacement therapy (RRT). penKid has also been used to predict the successful weaning from RRT in patients with AKI. Whether the concentration of penKid is affected or not by RRT is a controversial point and there are no studies describing the kinetics of the molecule in such conditions. The low molecular weight (4.5 kDa) would imply free removal by the glomerulus and the dialysis membranes. During RRT, this reduction could not be detected in clinical practice due to the complex kinetics involving either low dialytic clearance or increased production in response to impaired kidney function. The aim of this study was to determine the sieving coefficient and the diffusive clearance of the penKid molecule in conditions of in vitro continuous veno-venous hemofiltration (CVVH) and continuous veno-venous hemodialysis (CVVHD), respectively, and also the penKid removal ratio in conditions of in vitro hemoadsorption (HA) using a synthetic microporous resin., Methods: Blood spiked with a lyophilized penKid peptide solved in 20 mm dipotassium phosphate and 6 mm disodium EDTA [pH 8] to reach target concentrations is used as testing solution. In each experiment, the blood batch was adjusted at a volume of 1,000 mL, maintained at 37°, and continuously stirred. Samples were collected from blood, ultrafiltrate, and spent dialysate at different times during the experiments. Sieving, clearance, and removal ratio were calculated., Results: Significant removal of penKid was observed in CVVH (sieving 1.04 ± 0.27), in CVVHD (clearance 23.08 ± 0.89), and in HA (removal ratio 76.1 ± 1% after 120 min)., Conclusion: penKid is effectively removed by extracorporeal therapies. In presence of anuria, penKid generation kinetics can be calculated based on extracorporeal removal and volume variation. In steady state conditions, declining values may be the result of an initial renal function recovery and may suggest discontinuation and successful liberation from RRT., (© 2024 S. Karger AG, Basel.)

Published
2024
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32. Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options?

Author

Ramírez-Guerrero G, Reis T, Marcello M, de Cal M, and Ronco C

Subjects
Humans, Crush Syndrome complications, Crush Syndrome therapy, Earthquakes, Acute Kidney Injury diagnosis, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology
Abstract

Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CR has received funding for lectures, been consultant or advisory board member for Asahi, Astute, B. Braun, Baxter, bioMérieux, Bioporto, CytoSorbents, Estor, Fresenius Medical Care, General Electric (GE), Jafron, Medtronic, Toray. TR has received funding for lectures, been consultant or advisory board member for AstraZeneca, B. Braun, Baxter, bioMérieux, Boehringer Ingelheim, Contatti Medical (CytoSorbents), Eurofarma, Fresenius Medical Care, Jafron, Lifepharma, and Nova Biomedical. GRG declare no competing interests GR-G. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article. The authors alone are responsible for the content and writing of this article.

Published
2024
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33. Effect of Mechanical Vibration on Kinetics of Solute Adsorption.

Author

Ramírez-Guerrero G, Reis T, Lorenzin A, Marcello M, de Cal M, Zanella M, and Ronco C

Subjects
Adsorption, Kinetics, Hemoperfusion methods, Hemoperfusion instrumentation, Humans, Vibration, Vancomycin
Abstract

Introduction: Hemadsorption with new sorbent cartridges is an emerging extracorporeal blood purification technique. Flow distribution inside the sorbent is one of the main issues concerning the device's performance and optimal sorbent utilization. In this experiment, we aimed to investigate the efficacy of vibration during adsorption by measuring the removal of vancomycin., Methods: In this experimental study, 1,000 mL of saline with 10 g of vancomycin was circulated in a closed circuit (set flow of 250 mL/min) simulating a hemadsorption blood run using HA380 minimodule cartridge containing 75 g of wet resin. This vibration model was implemented with a damping head device installed in front of the adsorption cartridge during the experiment. The kinetics of the vancomycin were assessed by removal ratio over 120 min., Results: We found no difference between the two models. Adsorption with and without vibration did not differ significantly for partial reduction ratios, overall amount of adsorbed molecule, or adsorption kinetics., Conclusion: The current design and structure of the minimodule cartridge demonstrated no difference in small-middle solute removal. Further improvement with the addition of mechanical vibration to the device was not observed., (© 2024 S. Karger AG, Basel.)

Published
2024
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34. Neutrophil Gelatinase-Associated Lipocalin in Peritoneal Dialysis-Related Peritonitis: Correlation with White Blood Cells over Time and a Possible Role as the Outcome Predictor.

Author

Virzi GM, Mattiotti M, Milan Manani S, Gnappi M, Tantillo I, Corradi V, De Cal M, Giuliani A, Carta M, Giavarina D, Ronco C, and Zanella M

Subjects
Humans, Lipocalin-2, Acute-Phase Proteins metabolism, Acute-Phase Proteins therapeutic use, Lipocalins metabolism, Lipocalins therapeutic use, Proto-Oncogene Proteins metabolism, Proto-Oncogene Proteins therapeutic use, Biomarkers metabolism, Leukocytes metabolism, Peritoneal Dialysis adverse effects, Peritonitis diagnosis, Peritonitis etiology, Peritonitis drug therapy
Abstract

Introduction: The present study aimed to monitor peritoneal neutrophil gelatinase-associated lipocalin (pNGAL) during peritonitis episodes and to enhance its diagnostic value by evaluating pNGAL at scheduled times in parallel with white blood cell (WBC) count. In addition, we investigated possible correlations between pNGAL and the etiology of peritonitis, evaluating it as a possible marker of the clinical outcome., Methods: Twenty-two patients with peritoneal dialysis (PD)-related peritonitis were enrolled. Peritonitis was divided into Gram-positive, Gram-negative, polymicrobial, and sterile. WBC count and neutrophil gelatinase-associated lipocalin (NGAL) in PD effluent were measured at different times (days 0, 1, 5, 10, 15, and/or 20 and 10 days after antibiotic therapy discontinuation). NGAL was measured by standard quantitative laboratory-based immunoassay and by colorimetric NGAL dipstick (NGALds) (dipstick test)., Results: We found strong correlations between peritoneal WBC, laboratory-based NGAL, and NGALds values, both overall and separated at each time point. On day 1, we observed no significant difference in WBC, both NGALds (p = 0.3, 0.9, and 0.2) between Gram-positive, Gram-negative, polymicrobial, and sterile peritonitis. No significant difference has been found between de novo versus relapsing peritonitis for all markers (p &gt; 0.05). We observed a parallel decrease of WBC and both NGAL in patients with favorable outcomes. WBC count and both pNGAL resulted higher in patients with negative outcomes (defined as relapsing peritonitis, peritonitis-associated catheter removal, peritonitis-associated hemodialysis transfer, peritonitis-associated death) at day 10 (p = 0.04, p = 0.03, and p = 0.05, respectively) and day 15 (p = 0.01, p = 0.04, and tendency for p = 0.005). There was a tendency toward higher levels of WBC and NGAL in patients with a negative outcome at day 5. No significant difference in all parameters was proven at day 1 (p = 0.3, p = 0.9, p = 0.2) between groups., Conclusion: This study confirms pNGAL as a valid and reliable biomarker for the diagnosis of PD-peritonitis and its monitoring. Its trend is parallel to WBC count during peritonitis episodes, in particular, patients with unfavorable outcomes., (© 2023 S. Karger AG, Basel.)

Published
2024
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35. Endotoxin removal therapy with Polymyxin B immobilized fiber column: a single center experience from EUPHAS2 registry.

Author

Forin E, Lorenzoni G, Ferrer R, De Cal M, Zanella M, Marchionna N, Gregori D, Forfori F, Lorenzin A, Danzi V, Ronco C, and De Rosa S

Subjects
Humans, Critical Illness therapy, Endotoxins, Polymyxin B therapeutic use, Retrospective Studies, Hemoperfusion, Shock, Septic
Abstract

Although the precise clinical indication for initiation of PMX-HA is widely debated in the literature, a proper patient selection and timing of treatment delivery might play a critical role in the clinical course of a specific subphenotype of septic shock (endotoxic shock). In light of this view, since 2019, we have introduced in our clinical practice a diagnostic-therapeutic flowchart to select patients that can benefit the most from the treatment proposed. In addition, we reported in this study our experience of PMX-HA in a cohort of critically ill patients admitted to our intensive care unit (ICU). We analyzed a single centre, retrospective, observational web-based database (extracted from the EUPHAS2 registry) of critically ill patients admitted to the ICU between January 2016 and May 2021 who were affected by endotoxic shock. Patients were divided according to the diagnostic-therapeutic flowchart in two groups: Pre-Flowchart (Pre-F) and Post-Flowchart (Post-F). From January 2016 to May 2021, 61 patients were treated with PMX-HA out of 531 patients diagnosed with septic shock and of these, fifty patients (82%) developed AKI during their ICU stay. The most common source of infection was secondary peritonitis (36%), followed by community-acquired pneumonia (29%). Fifty-five (90%) out of 61 patients received a second PMX-HA treatment, with a statistically significant difference between the two groups (78% of the Pre-F vs. 100% of the Post-F group, p = 0.005). In both groups, between T0 and T120, the Endotoxin Activity Assay (EAA) decreased, while the SOFA score, mean arterial pressure (MAP), and Vasoactive Inotropic Score (VIS) improved with no statistically significant difference. Furthermore, when performing a propensity score matching analysis to compare mortality between the two groups, statistically significant lower ICU and 90-day mortalities were observed in the Post-F group [p = 0.016]. Although in this experienced centre data registry, PMX-HA was associated with organ function recovery, hemodynamic improvement, and current EAA level reduction in critically ill patients with endotoxic shock. Following propensity score-matched analysis, ICU mortality and 90-day mortalities were lower in the diagnostic-therapeutic flowchart group when considering two temporal groups based on strict patient selection criteria and timing to achieve PMX. Further Randomised Control Trials focused on centre selection, adequate training and a flowchart of action when assessing extracorporeal blood purification use should be performed., (© 2023. Springer Nature Limited.)

Published
2023
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36. The Cytotoxic Effect of Septic Plasma on Healthy RBCs: Is Eryptosis a New Mechanism for Sepsis?

Author

Marcello M, Virzì GM, Marturano D, de Cal M, Marchionna N, Sgarabotto L, De Rosa S, Ronco C, and Zanella M

Subjects
Humans, Interleukin-6, Erythrocytes, Eryptosis, Antineoplastic Agents, Sepsis
Abstract

Sepsis is a life-threatening multiple-organ dysfunction induced by infection and is one of the leading causes of mortality and critical illness worldwide. The pathogenesis of sepsis involves the alteration of several biochemical pathways such as immune response, coagulation, dysfunction of endothelium and tissue damage through cellular death and/or apoptosis. Recently, in vitro and in vivo studies reported changes in the morphology and in the shape of human red blood cells (RBCs) causing erythrocyte death (eryptosis) during sepsis. Characteristics of eryptosis include cell shrinkage, membrane blebbing, and surface exposure to phosphatidylserine (PS), which attract macrophages. The aim of this study was to evaluate the in vitro induction of eryptosis on healthy RBCs exposed to septic plasma at different time points. Furthermore, we preliminary investigated the in vivo levels of eryptosis in septic patients and its relationship with Endotoxin Activity Assay (EAA), mortality and other biological markers of inflammation and oxidative stress. We enrolled 16 septic patients and 16 healthy subjects (no systemic inflammation in the last 3 months) as a control group. At diagnosis, we measured Interleukin-6 (IL-6) and Myeloperoxidase (MPO). For in vitro study, healthy RBCs were exposed to the plasma of septic patients and CTR for 15 min, 1, 2, 4 and 24 h. Morphological markers of death and eryptosis were evaluated by flow cytometric analyses. The cytotoxic effect of septic plasma on RBCs was studied in vitro at 15 min, 1, 2, 4 and 24 h. Healthy RBCs incubated with plasma from septic patients went through significant morphological changes and eryptosis compared to those exposed to plasma from the control group at all time points (all, p < 0.001). IL-6 and MPO levels were significantly higher in septic patients than in controls (both, p < 0.001). The percentage of AnnexinV-binding RBCs was significantly higher in septic patients with EAA level ≥0.60 (positive EAA: 32.4%, IQR 27.6-36.2) compared to septic patients with EAA level <0.60 (negative EAA: 14.7%, IQR 5.7-30.7) ( p = 0.04). Significant correlations were observed between eryptosis and EAA levels (Spearman rho2 = 0.50, p < 0.05), IL-6 (Spearman rho2 = 0.61, p < 0.05) and MPO (Spearman rho2 = 0.70, p < 0.05). In conclusion, we observed a quick and great cytotoxic effect of septic plasma on healthy RBCs and a strong correlation with other biomarkers of severity of sepsis. Based on these results, we confirmed the pathological role of eryptosis in sepsis and we hypothesized its use as a biomarker of sepsis, potentially helping physicians to face important treatment decisions.

Published
2023
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38. Plasma Cell-Free DNA and Caspase-3 Levels in Patients with Chronic Kidney Disease.

Author

Clementi A, Virzì GM, Manani SM, de Cal M, Battaglia GG, Ronco C, and Zanella M

Abstract

Background: Cell-free plasma DNA (cfDNA) is circulating extracellular DNA arising from cell death mechanisms (apoptosis, necrosis, etc.). It is commonly existent in healthy individuals, but its ranks increase in diverse clinical circumstances, such as kidney disease, sepsis, myocardial infarction, trauma and cancer. In patients with advanced chronic kidney disease, cfDNA is connected to inflammation, and it has been associated with higher mortality. Caspase-3 plays a dominant role in apoptosis, a mechanism of programmed cell death involved in the pathogenesis and progression of chronic kidney disease (CKD). The aim of this pilot study was the evaluation of cfDNA levels and caspase-3 concentrations in patients with chronic kidney disease, in order to investigate the potential role of these molecules, deriving from inflammatory and apoptotic mechanisms, in the progression of renal damage., Methods: We compared cfDNA and caspase-3 levels in 25 CKD patients and in 10 healthy subjects, evaluating their levels based on CKD stage. We also explored correlations between cfDNA and caspase-3 levels in CKD patients and between cfDNA and caspase-3 levels and serum creatinine and urea in this population., Results: We observed that cfDNA and caspase-3 levels were higher in patients with CKD compared to healthy subjects, in particular in patients with advanced renal disease (CKD stage 5). A positive correlation between cfDNA and caspase-3 levels and between cfDNA and caspase-3 and creatinine and urea were also noticed., Conclusions: Patients with chronic kidney disease show higher levels of cfDNA and caspase-3 levels compared to the control group. Based on these preliminary results, we speculated that the worsening of renal damage and the increase in uremic toxin concentration could be associated with higher levels of cfDNA and caspase-3 levels, thus reflecting the potential role of inflammation and apoptosis in the progression of CKD. Future studies should focus on the validation of these promising preliminary results.

Published
2023
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39. Extracorporeal therapy in the treatment of sepsis: In vitro assessment of the effect of an absorbent cartridge on the circulating bacterial concentration and its interaction with the antibiotic therapy.

Author

de Cal M, Lorenzin A, Risino B, Zanetti F, Fanton G, Fallico L, Rassu M, De Rosa S, Ronco C, and Zanella M

Subjects
Humans, Vancomycin, Staphylococcus aureus, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Bacteria, Sepsis drug therapy, Sepsis microbiology, Hemoperfusion methods
Abstract

Sepsis is one of the major causes of death worldwide. In its physiopathological process, a broad spectrum of pro and antiinflammatory mediators plays a strategic role, leading to a sepsis induced state of immunoparalysis. The rationale behind the employment of extracorporeal purification techniques as a complement to therapy for sepsis is based on their ability to remove the mediators involved. Until now, attention was focused on the immunomodulation allowed by purification therapies. However, the focus of studies on the application possibilities that these techniques offer as a supplement to antimicrobial therapy and resuscitation of critically ill patients must be extended. In this study, the possible removal by adsorption that the Jafron ® HA330 cartridge operates against bacteria (S. aureus) was evaluated in vitro. Subsequently, it was evaluated whether the adsorptive capabilities toward bacteria were maintained by using a cartridge functionalized with Vancomycin and whether the latter maintains its bactericidal activity. This study showed that HA330 reduces the circulating bacterial load, even in the presence of pre-adsorbed Vancomycin. Vancomycin, once adsorbed by the cartridge, does not guarantee its bactericidal activity during the 2-h of hemoperfusion treatment.

Published
2023
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40. Bilirubin Removal by Plasmafiltration-Adsorption: Ex vivo Adsorption Kinetics Model and Single Case Report.

Author

Marcello M, Lorenzin A, De Cal M, Zorzi M, La Malfa MS, Fin V, Sandini A, Fiorin F, Bellomo R, De Rosa S, Ronco C, and Zanella M

Subjects
Humans, Adsorption, Kinetics, Hyperbilirubinemia, Bilirubin, Hemoperfusion
Abstract

Background: Extracorporeal removal of bilirubin in patients with severe liver dysfunction is a key blood purification strategy. We conducted an ex vivo study to assess the quantitative capacity to remove bilirubin from plasma of a novel adsorptive cartridge., Methods: We studied a downscaled module of the BS330 Plasma Bilirubin Adsorption Column Cartridge (Jafron Biomedical, Zhuhai City, China) to minimize the plasma requirement in an ex vivo circulation using a solution of hyperbilirubinemic plasma. We measured the bilirubin concentration gap (ΔC) between inlet (Cpin) and outlet (Cpout) of the unit and we calculated the removal ratio (RR) as mass adsorbed at different time points. Moreover, we compared the ex vivo model with the bilirubin adsorption kinetics in a patient with acute on chronic liver failure treated with the BS330 cartridge., Results: Bilirubin concentration change across the cartridge at 30 min was 16.5%, and cartridge saturation was reached at 750 min. We used a minimodule downscaled to 1:3 and containing approximately 131 g of BS330 sorbent beads: the device retained 759 mg of bilirubin with a RR of 78.1% and a RR of 42.6% at 120 min. Thus, the adsorption capacity was 5.76 mg of bilirubin per gram of sorbent. Bilirubin adsorption kinetics in our clinical case with a full-scale unit shows a coherent trend with a total bilirubin mass adsorbed after 180 min of 470 mg., Discussion: Our findings provide the first assessment of bilirubin adsorption in an ex vivo model of plasma perfusion and can be used to design interventional studies in humans, providing guidance for an adequate prescription of treatment frequency and duration., (© 2022 S. Karger AG, Basel.)

Published
2023
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41. Vancomycin Adsorption during in vitro Model of Hemoperfusion with Mini-Module of HA380 Cartridge.

Author

Lorenzin A, de Cal M, Marcello M, Sorbo D, Copelli S, Ronco C, de Rosa S, and Zanella M

Subjects
Humans, Vancomycin, Adsorption, Critical Illness, Anti-Bacterial Agents, Hemoperfusion methods
Abstract

Introduction: Sepsis is a frequent complication in critically ill patients. Patients may require control of the source of infection, removal of pathogens and damaged cells, and organ support. Often, these targets can be achieved through the utilization of extracorporeal therapies including hemoperfusion for the adsorption of cytokines and other circulating mediators. On extracorporeal organ support, patients are generally treated with antibiotic therapy, and vancomycin is one of the most commonly used antibiotics. Because of the aspecific nature of adsorption, antibiotics can be removed from the circulation, leading to altered plasma levels and requiring prescription adjustment. The aim was to define the amount of vancomycin adsorbed by a sorbent cartridge (HA380, Jafron, China) during hemoperfusion and to establish possible strategies to maintain an effective plasma level in critically ill patients undergoing extracorporeal therapies., Methods: In vitro experiments with incremental concentrations of vancomycin in the test solution (500 and 1,000 mL) were carried out in a recirculation circuit until sorbent saturation was observed. A maximum of 10 g of vancomycin were injected and mini-modules containing 25 g of dry resin were utilized., Results: In different experiments with various concentration of vancomycin, a maximum amount of 244 mg/g of sorbent was adsorbed reaching saturation between 60 and 80 min from the beginning of the experiments. The kinetics of adsorption appears to be governed by a Langmuir-like isotherm with maximal removal speed in the early minutes and a plateau after 60 min., Discussion/conclusion: HA380 adsorbs significant amounts of vancomycin. Adjusting the achieved results with the experimental mini-module to a full-scale cartridge, a total of 25 g of antibiotic can be removed. This might have affected outcome results in clinical trials. This suggests prescribing administration to critically ill patients requiring hemoperfusion, immediately after or in the inter-session time window. In case of administration during hemoperfusion, adequate adjustment and plasma level monitoring is strongly recommended., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Published
2023
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42. Endotoxin in Sepsis: Methods for LPS Detection and the Use of Omics Techniques.

Author

Virzì GM, Mattiotti M, de Cal M, Ronco C, Zanella M, and De Rosa S

Abstract

Lipopolysaccharide (LPS) or endotoxin, the major cell wall component of Gram-negative bacteria, plays a pivotal role in the pathogenesis of sepsis. It is able to activate the host defense system through interaction with Toll-like receptor 4, thus triggering pro-inflammatory mechanisms. A large amount of LPS induces inappropriate activation of the immune system, triggering an exaggerated inflammatory response and consequent extensive organ injury, providing the basis of sepsis damage. In this review, we will briefly describe endotoxin's molecular structure and its main pathogenetic action during sepsis. In addition, we will summarize the main different available methods for endotoxin detection with a special focus on the wider spectrum offered by omics technologies (genomics, transcriptomics, proteomics, and metabolomics) and promising applications of these in the identification of specific biomarkers for sepsis.

Published
2022
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43. Incidence of Acute Kidney Injury in Polytrauma Patients and Predictive Performance of TIMP2 × IGFBP7 Biomarkers for Early Identification of Acute Kidney Injury.

Author

Golino G, Greco M, Rigobello A, Danzi V, De Cal M, Malchiorna N, Zannella M, Navalesi P, Costa-Pinto R, Ronco C, and De Rosa S

Abstract

Background: Acute kidney injury (AKI) is a common cause of organ failure in trauma patients who survive their initial injuries. It is independently associated with increased morbidity and mortality and prolongs the length of hospital stays. The objectives of this study were to describe the incidence of early AKI and influence of risk factors in polytrauma patients and evaluate the predictive potential of TIMP2 × IGFBP7 biomarkers in this patient cohort. Methods: We conducted a retrospective cohort study of severely injured adult patients who were consecutively admitted to a multidisciplinary ICU from May 2017 to May 2019. Detailed patient data was retrieved from ICU medical records. Fluid balance, urinary output, and sCr values up to 72 h were collected. Urine samples for measuring TIMP2 × IGFBP7 concentrations were obtained and analyzed from ICU admission to 72 h. Results: Among the 153 patients eligible for analysis, 45 were included in the AKI, and 108 in the no AKI cohorts. The incidence of AKI within 72 h, based on KDIGO criteria, was 28.8%. There were no differences in ISS, type and mechanism of injury, heart rate, and systolic BP at admission between groups. Patients with early AKI were older (68 vs. 49 years, p < 0.001), obese (BMI 26.2 vs. 24.7, p < 0.048), and more likely to have previous cardiac disease (27% vs. 5.6%, p < 0.001). TIMP2 × IGFBP7 values on ICU admission were associated with subsequent AKI in patients without evidence of AKI at the time of ICU admission. They were also higher in the AKI cohort and significantly correlated with renal replacement therapy (RRT) and episodes of hypotension. Multivariable analysis confirmed age, previous cardiac disease, and NephroCheck as the variables mostly associated with AKI, with AUC 0.792. Conclusions: TIMP2 × IGFBP7 may help identify trauma patients with tubular damage that may evolve into a clinically manifested syndrome. Prospective studies of TIMP2 × IGFBP7, as a trigger for early AKI bundle care, are warranted.

Published
2022
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44. Electrospun Chitosan Functionalized with C12, C14 or C16 Tails for Blood-Contacting Medical Devices.

Author

Dettin M, Roso M, Messina GML, Iucci G, Peluso V, Russo T, Zamuner A, Santi M, Milan Manani S, Zanella M, Battocchio C, Marletta G, Modesti M, Rassu M, De Cal M, and Ronco C

Abstract

Medical applications stimulate the need for materials with broad potential. Chitosan, the partially deacetylated derivative of chitin, offers many interesting characteristics, such as biocompatibility and chemical derivatization possibility. In the present study, porous scaffolds composed of electrospun interwoven nanometric fibers are produced using chitosan or chitosan functionalized with aliphatic chains of twelve, fourteen or sixteen methylene groups. The scaffolds were thoroughly characterized by SEM and XPS. The length of the aliphatic tail influenced the physico-chemical and dynamic mechanical properties of the functionalized chitosan. The electrospun membranes revealed no interaction of Gram+ or Gram- bacteria, resulting in neither antibacterial nor bactericidal, but constitutively sterile. The electrospun scaffolds demonstrated the absence of cytotoxicity, inflammation response, and eryptosis. These results open the door to their application for blood purification devices, hemodialysis membranes, and vascular grafts.

Published
2022
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45. Flow Dynamic Analysis by Contrast-Enhanced Imaging Techniques of Medium Cutoff Membrane Hemodialyzer.

Author

Lorenzin A, Golino G, de Cal M, Pajarin G, Savastano S, Lupi A, Sandini A, Fiorin F, and Ronco C

Subjects
Dialysis Solutions, Humans, Membranes, Artificial, Renal Dialysis methods, Hemodiafiltration, Kidney Failure, Chronic, Kidneys, Artificial
Abstract

Introduction: Medium cutoff (MCO) membranes represent an interesting innovation in the field of hemodialysis. Given the correlation between large (PM >25 kDa) middle molecules (LMM) and clinical outcomes, the possibility to broaden the spectrum of solutes removed in hemodialysis with MCO membranes introduces a new perspective for end-stage kidney disease patients. Due to low diffusion coefficients of LMM, the use of convection is required to maximize extracorporeal clearance. High convective rates are achieved with high-flux membranes in hemodiafiltration, a technique not available in the US. In case of the MCO membrane, remarkable clearances of LMM are achieved combining the permeability of the membrane with a significant amount of internal convection. The mechanism of filtration-backfiltration inside the dialyzer enables effective removal of LMM in a technique called expanded hemodialysis (HDx). Given such theoretical explanation, it is important to demonstrate the blood and ultrafiltration rheology inside the MCO dialyzer., Method: This study for the first time describes flow dynamic parameters and internal cross-filtration, thanks to specific radiology and nuclear imaging techniques., Results: Flow dynamic analysis of the blood and dialysate compartment confirms excellent distribution of velocities and an excellent matching of blood and dialysate. Average blood flow velocity allows for wall shear rates adequate to avoid protein stagnation at the blood membrane interface and increase in blood viscosity. Cross-filtration analysis demonstrates a remarkable filtration/backfiltration flux reaching values >30 mL/min at a blood flow of 300 mL/min and zero net filtration., Conclusion: The MCO dialyzer Theranova 400 appears to have a design optimized to perform expanded hemodialysis (HDx)., (© 2021 S. Karger AG, Basel.)

Published
2022
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46. Ultrasonographic Intraparenchymal Renal Resistive Index Variation for Assessing Renal Functional Reserve in Patients Scheduled for Cardiac Surgery: A Pilot Study.

Author

Samoni S, Villa G, De Rosa S, Husain-Syed F, Guglielmetti G, Tofani L, De Cal M, Nalesso F, Meola M, and Ronco C

Subjects
Biomarkers, Humans, Kidney diagnostic imaging, Pilot Projects, ROC Curve, Acute Kidney Injury diagnosis, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Cardiac Surgical Procedures adverse effects
Abstract

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication in patients undergoing cardiac surgery. Preoperative renal functional reserve (RFR) has been demonstrated to be highly predictive of CSA-AKI. We have previously demonstrated that intraparenchymal renal resistive index variation (IRRIV) measured by ultrasound (US) can identify the presence of RFR in healthy individuals. This study aimed (1) to examine the correlation between the US IRRIV test and RFR measured through the protein loading test in patients undergoing elective cardiac surgery and (2) to determine the value of the 2 methods for predicting occurrence of AKI or subclinical AKI after cardiac surgery., Methods: Consecutive patients scheduled for cardiac surgery were enrolled for this pilot study. The protein loading test and the IRRIV test were performed in all patients 2 days before cardiac surgery. Correlation between IRRIV and RFR was tested using Pearson correlation analysis. Association between presence of RFR and positive IRRIV test, presence of RFR and AKI and subclinical AKI, and positive IRRIV test and AKI and subclinical AKI was evaluated using logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the values of IRRIV for predicting RFR, RFR for predicting AKI and subclinical AKI, and IRRIV for predicting AKI and subclinical AKI., Results: Among the 31 patients enrolled, significant association was found between IRRIV and RFR (r = 0.81; 95% CI: 0.63-0.90; p < 0.01). The association between RFR and IRRIV was described in 27/31 (87.1%) patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the IRRIV test were 100, 84, 60, and 100%, respectively. In ROC curve analysis, the area under the curve (AUC) was 0.80 (95% CI: 0.64-0.96). After cardiac surgery, 1/31 (3.2%) patient had AKI and 12/31 (38.7%) had subclinical AKI. RFR predicted subclinical AKI (odds ratio [OR] = 0.93; 95% CI: 0.87-0.98; p = 0.02). The sensitivity, specificity, PPV, and NPV of the RFR were 61, 88.8, 80, and 76%, respectively; the AUC was 0.75 (95% CI: 0.59-0.91). IRRIV predicts subclinical AKI (OR = 0.79; 95% CI: 0.67-0.93; p = 0.005). The sensitivity, specificity, PPV, and NPV of the IRRIV test were 46.1, 100, 100, and 72%, respectively; the AUC was 0.73 (95% CI: 0.58-0.87)., Conclusion: This pilot study suggests that a positive IRRIV test can significantly predict the presence of RFR in patients scheduled for cardiac surgery. RFR measured by the protein loading test or by the US IRRIV test can predict the occurrence of subclinical postoperative AKI. The findings of this study need to be confirmed in large patient cohorts., (© 2021 S. Karger AG, Basel.)

Published
2022
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47. Clinical Assessment of Continuous Hemodialysis with the Medium Cutoff EMiC®2 Membrane in Patients with Septic Shock.

Author

Ferrari F, Husain-Syed F, Milla P, Lorenzin A, Scudeller L, Sartori M, Gramaticopolo S, D'Auria L, Guglielmi A, Cornara P, De Rosa S, Zanella M, Corradi V, De Cal M, Danzi V, Giavarina D, Brendolan A, Mojoli F, Arpicco S, and Ronco C

Subjects
Humans, Critical Illness, Renal Dialysis, Albumins, Continuous Renal Replacement Therapy, Shock, Septic therapy, Shock, Septic etiology, Acute Kidney Injury therapy, Hemodiafiltration adverse effects
Abstract

Introduction: At the time of renal replacement therapy, approximately 20% of critically ill patients have septic shock. In this study, medium cutoff (MCO) continuous venovenous hemodialysis (CVVHD) was compared to high-flux membrane continuous venovenous hemodiafiltration (CVVHDF) in terms of hemodynamic improvement, efficiency, middle molecule removal, and inflammatory system activation., Methods: This is a monocenter crossover randomized study. Between December 31, 2017, and December 31, 2019, 20 patients with septic shock and stage 3 acute kidney injury (AKI) admitted to 2 Italian ICUs were enrolled. All patients underwent CVVHD with Ultraflux® EMiC®2 and CVVHDF with AV1000S® without washout. Each treatment lasted 24 h., Results: Compared to AV1000S®-CVVHDF, EMIC®2-CVVHD normalized cardiac index (β = -0.64; p = 0.02) and heart rate (β = 5.72; p = 0.01). Interleukin-8 and myeloperoxidase removal were greater with AV1000S®-CVVHDF than with EMiC®2-CVVHD (β = 0.35; p &lt; 0.001; β = 0.43; p = 0.03, respectively). Leukocytosis improved over 24 h in EMiC®2-CVVHD-treated patients (β = 4.13; p = 0.03), whereas procalcitonin levels decreased regardless of the modality (β = 0.89; p = 0.01) over a 48-h treatment period. Reduction rates, instantaneous plasmatic clearance of urea, creatinine, and β2-microglobulin were similar across modalities. β2-Microglobulin removal efficacy was greater in the EMiC®2 group (β = 0-2.88; p = 0.002), while albumin levels did not differ. Albumin was undetectable in the effluent in both treatments., Discussion: In patients with septic shock and severe AKI, the efficacy of uremic toxin removal was comparable between MCO-CVVHD and CVVHDF. Further, MCO-CVVHD was associated with improved hemodynamics. Fraction of filtration and transmembrane pressure reduction and the maintenance of equal efficacy might be the key features of CVVHD with MCO membranes in critically ill patients., (© 2022 S. Karger AG, Basel.)

Published
2022
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48. Gadolinium-based contrast media exposure and the possible risk of subclinical kidney damage: a pilot study.

Author

Martino F, Amici G, Godi I, Baretta M, Biasi C, Carta M, Corradi V, De Cal M, Knust M, Tamayod C, Varotto A, Iannucci G, Giavarina D, Savastano S, and Ronco C

Subjects
Acute Kidney Injury diagnosis, Aged, Biomarkers urine, Biomedical Research, Feasibility Studies, Female, Humans, Kidney Function Tests, Male, Middle Aged, Pilot Projects, Risk Assessment, Acute Kidney Injury chemically induced, Acute Kidney Injury urine, Contrast Media adverse effects, Gadolinium adverse effects, Lipocalin-2 urine, Magnetic Resonance Imaging methods
Abstract

Purpose: We performed a pilot study to evaluate the feasibility of future research about the presence of subclinical kidney damage after Gadolinium-based contrast media exposure. The future study aims to understand which are the behaviors of two markers of kidney damage, such as urinary NephroCheck (NC) and/or neutrophil gelatinase-associated lipocalin (NGAL). Specifically, after GBCM exposure, NC urinary detection should identify proximal tubule damage while NGAL urinary detection should be related to distal tubule damage., Methods: We performed a pilot study in patients who had Gadolinium exposure. The feasibility of future study is reached when at least 90% of candidates completed the pilot study. In each patient, we tested urinary NC and NGAL levels 24 h before magnetic resonance imaging (MRI) and 12-24 h after the exposure. Furthermore, we evaluated the administration of other nephrotoxic agents, the presence of comorbidity, and kidney function by S-creatinine and urine protein before the MRI., Results: We enrolled 35 candidates of whom 33 patients completed all study procedures. Our population had a mean age of 60.7 ± 14.8 years with normal kidney function with a median S-creatinine equal to 0.7 mg/dl (Interquartile range [IQR] 0.6-0.91). Urinary NC levels increased from 0.21 ng 2 /ml 2 (IQR 0.11-0.4) before MRI to 0.34 ng 2 /ml 2 (IQR 0.16-0.86) (p = 0.005). Conversely, we did not appreciate any significant modification in urinary NGAL (p = 0.53)., Conclusion: Our pilot study seems adequate in terms of feasibility and encourages us to focus our future research on renal proximal tubule, as the principal site of subclinical kidney damage after Gadolinium exposure., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature.)

Published
2021
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49. PMMA-Based Continuous Hemofiltration Modulated Complement Activation and Renal Dysfunction in LPS-Induced Acute Kidney Injury.

Author

Stasi A, Franzin R, Divella C, Sallustio F, Curci C, Picerno A, Pontrelli P, Staffieri F, Lacitignola L, Crovace A, Cantaluppi V, Medica D, Ronco C, de Cal M, Lorenzin A, Zanella M, Pertosa GB, Stallone G, Gesualdo L, and Castellano G

Subjects
Acute Kidney Injury diagnosis, Acute Kidney Injury mortality, Animals, Biomarkers, C-Reactive Protein genetics, C-Reactive Protein metabolism, Disease Models, Animal, Fibrosis, Gene Expression, Humans, Immunohistochemistry, Inflammation Mediators, Kidney Function Tests, Renal Dialysis, Sepsis complications, Serum Amyloid P-Component genetics, Serum Amyloid P-Component metabolism, Swine, Treatment Outcome, Acute Kidney Injury etiology, Acute Kidney Injury therapy, Complement Activation drug effects, Hemofiltration adverse effects, Hemofiltration methods, Lipopolysaccharides adverse effects, Polymethyl Methacrylate administration & dosage
Abstract

Sepsis-induced acute kidney injury (AKI) is a frequent complication in critically ill patients, refractory to conventional treatments. Aberrant activation of innate immune system may affect organ damage with poor prognosis for septic patients. Here, we investigated the efficacy of polymethyl methacrylate membrane (PMMA)-based continuous hemofiltration (CVVH) in modulating systemic and tissue immune activation in a swine model of LPS-induced AKI. After 3 h from LPS infusion, animals underwent to PMMA-CVVH or polysulfone (PS)-CVVH. Renal deposition of terminal complement mediator C5b-9 and of Pentraxin-3 (PTX3) deposits were evaluated on biopsies whereas systemic Complement activation was assessed by ELISA assay. Gene expression profile was performed from isolated peripheral blood mononuclear cells (PBMC) by microarrays and the results validated by Real-time PCR. Endotoxemic pigs presented oliguric AKI with increased tubulo-interstitial infiltrate, extensive collagen deposition, and glomerular thrombi; local PTX-3 and C5b-9 renal deposits and increased serum activation of classical and alternative Complement pathways were found in endotoxemic animals. PMMA-CVVH treatment significantly reduced tissue and systemic Complement activation limiting renal damage and fibrosis. By microarray analysis, we identified 711 and 913 differentially expressed genes with a fold change >2 and a false discovery rate <0.05 in endotoxemic pigs and PMMA-CVVH treated-animals, respectively. The most modulated genes were Granzyme B, Complement Factor B, Complement Component 4 Binding Protein Alpha, IL-12, and SERPINB-1 that were closely related to sepsis-induced immunological process. Our data suggest that PMMA-based CVVH can efficiently modulate immunological dysfunction in LPS-induced AKI., Competing Interests: GC reports research grant donation from TORAY (Toray Industries, Inc), during the conduct of the study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Stasi, Franzin, Divella, Sallustio, Curci, Picerno, Pontrelli, Staffieri, Lacitignola, Crovace, Cantaluppi, Medica, Ronco, de Cal, Lorenzin, Zanella, Pertosa, Stallone, Gesualdo and Castellano.)

Published
2021
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50. The relationship between intra-parenchymal renal resistive index variation and renal functional reserve in healthy subjects.

Author

Samoni S, Villa G, De Rosa S, Neri M, Tofani L, Husain-Syed F, De Cal M, Nalesso F, Meola M, and Ronco C

Subjects
Healthy Volunteers, Humans, Acute Kidney Injury, Kidney diagnostic imaging
Abstract

Background: Renal functional reserve can be used as a clinical tool for risk stratification of patients undergoing potentially nephrotoxic procedures. Ultrasound assessment of intra-parenchymal renal resistive index variation-IRRIV test-has been recently proposed as a safe, reproducible, inexpensive and easy to perform technique to identify the presence of renal functional reserve. The present study has been designed to externally validate the IRRIV test in a validation cohort of healthy subjects., Methods: We examined data from a group of 47 healthy subjects undergoing protein loading and IRRIV testing. The correlation between IRRIV and renal functional reserve was tested using Pearson correlation analysis. Concordance between presence of renal functional reserve (i.e. a value of renal functional reserve ≥ 15 ml/min/1.73 m 2 ) and IRRIV was evaluated using logistic regression analysis., Results: We found a significant correlation between IRRIV and renal functional reserve (Pearson correlation coefficient = 0.83 [95% confidence interval (CI) 0.71-0.90; p < 0.01]). Concordance between the presence of renal functional reserve and the IRRIV test was described in 45 (95.7%) subjects. In particular, a negative IRRIV test correctly predicted the absence of renal functional reserve in 5 subjects, while a positive IRRIV test correctly predicted the presence of renal functional reserve in 40 subjects. Only two subjects were incorrectly classified by the IRRIV test. IRRIV predicts renal functional reserve with a ROC-AUC of 0.86 [CI 95% 0.68-1]., Conclusions: The IRRIV test is an ultrasound technique that significantly predicts the presence and the degree of renal functional reserve in healthy subjects.

Published
2021
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