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Background Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8–6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis.

Background Patients on kidney replacement therapy (KRT) are at very high risk of coronavirus disease 2019 (COVID-19). The triage pathway for KRT patients presenting to hospitals with varying severity of COVID-19 illness remains ill-defined. We studied the clinical characteristics of patients at initial and subsequent hospital presentations and the impact on patient outcomes. Methods The European Renal Association COVID-19 Database (ERACODA) was analysed for clinical and laboratory features of 1423 KRT patients with COVID-19 either hospitalized or non-hospitalized at initial triage and those re-presenting a second time. Predictors of outcomes (hospitalization, 28-day mortality) were then determined for all those not hospitalized at initial triage. Results Among 1423 KRT patients with COVID-19 [haemodialysis (HD), n = 1017; transplant, n = 406), 25% (n = 355) were not hospitalized at first presentation due to mild illness (30% HD, 13% transplant). Of the non-hospitalized patients, only 10% (n = 36) re-presented a second time, with a 5-day median interval between the two presentations (interquartile range 2–7 days). Patients who re-presented had worsening respiratory symptoms, a decrease in oxygen saturation (97% versus 90%) and an increase in C-reactive protein (26 versus 73 mg/L) and were older (72 vs 63 years) compared with those who did not return a second time. The 28-day mortality between early admission (at first presentation) and deferred admission (at second presentation) was not significantly different (29% versus 25%; P = 0.6). Older age, prior smoking history, higher clinical frailty score and self-reported shortness of breath at first presentation were identified as risk predictors of mortality when re-presenting after discharge at initial triage. Conclusions This study provides evidence that KRT patients with COVID-19 and mild illness can be managed effectively with supported outpatient care and with vigilance of respiratory symptoms, especially in those with risk factors for poor outcomes. Our findings support a risk-stratified clinical approach to admissions and discharges of KRT patients presenting with COVID-19 to aid clinical triage and optimize resource utilization during the ongoing pandemic.

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

Chronic kidney disease is associated with an increased cardiovascular risk. Several uremic toxins are also vascular toxins and may contribute to the increase of the cardiovascular risk through the development of aortic stiffening. In this process, oxidative stress and endothelial dysfunction play an important role. Considering that aortic stiffness is a known cardiovascular risk factor and a vascular biomarker involved in the development of chronic cardiac dysfunction, and that the reduction of aortic stiffness is associated with an improved survival of patients with end-stage kidney disease, we aim at reviewing the therapeutic options to reduce aortic stiffness and potentially the cardiovascular risk.

Introduction. A few number of literature specifically addresses vaccination uptake among Public Health Residents (PHRs). Influ- enza vaccine attitudes and risk perceptions of PHRs across Italy were studied, contributing to literature on influenza vaccination uptake predictors, in particular among young physicians. Methods. An online survey was conducted in 25 Schools of Public Health in Italy in 2011-2012. Results were analysed using preva- lence and logistic regression methods. Results. A total of 365 Italian public health residents were included in the study. Vaccination uptake was confirmed by 22.2 and 33.2% of PHRs in 2010-2011 and 2011-2012, respectively. For the 2010-2011 influenza season, vaccination was associated with male sex (adj-OR 3.43; 95%CI = 1.5-7.84) and vaccination history (adj-OR 29.44; 95%CI = 6.4-135.04). For the 2011-2012Â season, vaccination was significantly associated with having had between one and three influenza vaccinations in the previ- ous five years (adj-OR 11.56; 95%CI = 6.44-20.75) or more than three (adj-OR 136.43; 95%CI = 30.8-604.7) and with individual participation in general population vaccination campaigns (adj- OR 1.85; 95%CI = 1.01-3.41). Discussion. Italian residents in public health have no confidence and a low personal risk perception about vaccinations therefore taking no measures to protect patients, general population and themselves. Annual influenza vaccination acceptance is associ- ated with influenza vaccine uptake in the previous years and per- sonal involvement in general population vaccination campaigns. These factors should be considered for the design of future cam- paigns targeting public health residents.Â, Journal of Preventive Medicine and Hygiene, Vol 55, No 4 (2014)

The Italian Committee of medical residents in Hygiene, Preventive Medicine and Public Health is a member of the Italian Society of Hygiene, Preventive Medicine and Public Health with the aim of developing a network among Italian resident in public health and promoting the educational path improvement through comparisons and debates between postgraduate medical schools. In this perspective, during last years account has been taken of some essential topics concerning education of public health medical residents, which represent future health-care and public health experts.Cross-sectional researches were conducted among Italian public health medical residents (PHMRs) through self-administered and web-based questionnaires. Each questionnaire was previously validated by pilot studies conducted during the 46th National Conference of the Italian Society of Hygiene, Preventive Medicine and Public Health.Seventy percent of Italian PHMRs considered the actual length of Public Health postgraduate medical school excessively long, with regard to predetermined educational goals. Confirming this statement, 90% of respondents were inclined to a reduction from 5 to 4 years of postgraduate medical school length, established by Law Decree 104/2013. Seventy seven percent of surveyed PHMRs stand up for a rearrangement on a national setting of the access contest to postgraduate medical schools. Moreover 1/3 of Italian schools performed less than 75%of learning and qualifying activities specified in Ministerial Decree of August 2005. In particular, data analysis showed considerable differences among Italian postgraduate schools. Finally, in 2015 only four Italian Universities (Napoli Federico II, Palermo, Pavia, Roma Tor Vergata) provide for the Second Level Master qualify for the functions of occupational doctor. This offer makes available 60 positions against a request of over 200 future Public Health medical doctors who have shown interest in the Master.In Italy, after the introduction of Ministerial Decree 285/2005, the educational course of PHMRs was significantly improved. The standardization of learning and qualifying activities allowed for the first time the attendance at medical directions or Local Health Units. Nevertheless, the excessive lenght of postgradute schools and the differences about training among Italian Universities are critical and actual issue. Moreover, the remarkable interest shown by PHMRs in the Master could suggest a poor job replacement prospect for young medical specialist in Hygiene, Preventive Medicine and Public Health.

Analisi comparativa dei percorsi formativi offerti dalle Scuole di specializzazione di Igiene e Medicina Preventiva in Italia Background: Il percorso formativo dello specialista in Igiene e Medicina Preventiva dovrebbe garantire adeguate conoscenze tecnico-scientifiche e professionali nei campi della medicina preventiva, della promozione della salute e della programmazione dei servizi sanitari secondo quanto indicato anche dal DM 285/2005. La Consulta degli Specializzandi, da sempre coinvolta in attività di monitoraggio della formazione a livello nazionale, si prefigge l’obiettivo di valutare l’omogeneità delle proposte formative tra le diverse sedi italiane, non solo per segnalare le criticità, ma anche per evidenziarne le opportunità. Metodi: Lo studio, di tipo cross-sectional, è stato condotto mediante la somministrazione di un questionario semi-strutturato inviato per la compilazione ai rappresentanti delle 32 le Scuole di Igiene e Medicina Preventiva italiane. Lo strumento di valutazione è costituito da quattro sezioni: informazioni generali, attività formativa universitaria, attività formativa extra-universitaria, attività formativa intersettoriale. L’indagine è stata svolta nel periodo tra marzo e maggio 2013 ed è stata prodotta un’analisi descrittiva dei dati ottenuti. Risultati: Il questionario è stato compilato da 28 Scuole su 32 (tasso di risposta 88%), distribuite su tutto il territorio nazionale. Il numero di medici in formazione varia tra 7 e 31 e il rapporto tra docenti del settore scientifico-disciplinare di interesse e i discenti è compreso tra 0,2 e 2. Per quanto riguarda la didattica, solo in 4 Scuole si effettuano tutti i corsi previsti dal DM. La maggior parte delle sedi svolge almeno il 75% dei corsi previsti, ma esistono sedi in cui il numero di corsi è inferiore al 50%. La maggior parte delle Scuole svolge più del 60% delle attività professionalizzanti essenziali secondo il decreto, ma 2 Scuole non arrivano al 50%. Tutte le Scuole prevedono un tirocinio di 6-12 mesi in ASL, affiancando principalmente attività del Dipartimento di Prevenzione. Ovunque è previsto un periodo in Direzione Medica Ospedaliera, mentre le Strutture Riabilitative rientrano raramente nella rete formativa. Nella maggioranza delle Scuole è possibile frequentare aziende con rischio biologico oppure seguire simili attività nei Servizi dedicati della ASL. Molte Scuole, infine, consentono di frequentare diverse strutture territoriali (Agenzia di Controllo delle Acque), regionali (Assessorati) o nazionali (Ministero, Istituto Superiore di Sanità); in alcuni casi si tratta di Università gemellate e Istituti di Ricerca. Conclusioni: Nonostante il DM 285/2005 indichi quali siano le fondamenta della sanità pubblica, la flessibilità nella scelta formativa è vista come requisito essenziale per ottimizzare le risorse e contestualizzare l’adeguata formazione del medico in formazione specialistica in Igiene e Medicina Preventiva. La maggior parte delle Scuole di Specializzazione italiane dovrebbe però prevedere lo svolgimento della quasi totalità delle attività formative previste, al fine di non creare disuguaglianze formative tra gli specializzandi. Infine, considerato che la sanità pubblica è una disciplina in continuo divenire, il DM del 2005 andrebbe rivisitato tenendo in considerazione la flessibilità della formazione ed i continui cambiamenti dei bisogni di salute essenziali della popolazione. Inoltre, nel processo di rivisitazione dei bisogni formativi dei medici in formazione specialistica, dovrebbero essere coinvolti anche i discenti al fine di rafforzare il potere e l’efficacia dell’insegnamento. Background The postgraduate medical Schools in Public Health (locally known as School of Hygiene and Preventive Medicine) should ensure adequate scientific and technical knowledge and professional skills in preventive medicine, health promotion and healthcare planning as provided by Ministerial Decree 285/2005. The Italian Committee of Medical Residents in Hygiene, Preventive Medicine and Public Health of the Italian Society of Hygiene, Public Health and Preventive Medicine - S.It.I. (Consulta Nazionale dei medici in formazione specialistica S.It.I.) has always been engaged in monitoring activities on public health teaching, guaranteeing the homogeneity of educational proposals among all national Schools in Public Health. The purpose of this study is to provide a 'snapshot' of public health education and training in Italy and to identify the improvement actions needed for implementing an innovative and homogeneous public health training. Methods: A cross-sectional study was carried out over a period of three months (March to May 2013). A self-administered questionnaire was e-mailed to local Committee’s delegates of all 32 postgraduate medical Schools in Public Health in Italy. The questionnaire was structured in four sections: general information, University education and training, extra-University training, interdisciplinary activities. The majority of local Committee’s delegates have agreed to be enrolled in the survey. Results: A total of 28 questionnaires were returned (88% response rate). The number of residents in each Italian School in Public Health ranged from 7 to 31. The distribution of professors in relation to residents is not similar for each University Schools. The ratio professors/residents spanning from 0.2 to 2. About teaching, only 4 University Schools offered all courses requested by Ministerial Decree 285/2005. Most of them offered at least 75% of the requested courses, but there were Schools in which the courses were less than 50%. The vast majority of schools held more than 60% of the qualifying activities considered essential according to the Decree, while 2 Schools were below 50%. All Schools required an internship of 6-12 months in local health authority offices (ASL), mainly concerning the Department of Prevention activities. In all Schools a period of stay in a Hospital Medical Direction was scheduled, while professional activities at Residential care homes were very rarely included in training programmes. Many Schools allowed residents to attend companies with biological hazard or to follow similar activities in dedicated services of ASL. Finally, in the majority of Schools, a training period in various local (Service for Water Control), regional (Departments) or national (Ministry, National Institute of Health) health facilities was contemplated and, in some cases, also in other Universities or Research Institutes. Conclusions: Although the Ministerial Decree indicates the essential milestones of the public health education, flexibility is seen as an important element in order to optimize resources and contextualize the adequate education of residents. In any case, at least regarding public health courses, the majority of University education and extra-University training activities should be carried out by all Schools. In order to obtain shared knowledge and skills, the Ministerial Decree should be revised taking into account flexibility and changing as intrinsic characteristics of public health profession and learners should be involved in the reform to strengthening the role of public health teaching

INTRODUZIONE La Consulta dei Medici in formazione specialistica (già Consulta degli Specializzandi) è un organo della Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (S.It.I.) costituitosi nel 1998 e riconosciuto come componente ufficiale nello statuto della Società nel 2012. I compiti principali della Consulta sono quelli di creare e favorire una rete di contatti tra colleghi e di promuovere il miglioramento della formazione degli Specializzandi in Igiene. OBIETTIVI Obiettivo della presente indagine è valutare la conoscenza della Consulta dei Medici in Formazione Specialistica S.It.I. da parte degli operatori in ambito igienistico, e in particolare le opinioni riguardo le attività e il contributo della stessa Consulta nell'ambito della Società Scientifica. METODI L'indagine si è svolta utilizzando un questionario semistrutturato, composto da sei domande, somministrato, in forma anonima e volontaria, ai partecipanti al Congresso Nazionale S.It.I. tenutosi a Cagliari nell'ottobre 2012, presso lo stand della Consulta. Il questionario indagava il giudizio e il grado di conoscenza delle attività della Consulta e quali fossero le attività che la stessa avrebbe dovuto incrementare rispetto agli anni precedenti. I dati sono stati archiviati ed analizzati utilizzando Excel di Microsoft Office 2010. RISULTATI Sono stati compilati in totale 105 questionari, di cui 70 (66,67%) da parte di specializzandi. Il 94,3% dei rispondenti conosce la Consulta degli Specializzandi, la maggior parte dei quali, grazie all'opera di divulgazione da parte dei rappresentanti della Consulta delle varie Scuole di Specializzazione (65,7%). La Consulta è in grado di rappresentare in maniera sufficiente le esigenze dei Medici in formazione specialistica presso la società secondo il 46,2% dei rispondenti, le rappresenta in maniera soddisfacente per il 34,6%. Il principale contributo apportato dalla Consulta risulta essere (43,4%) l'incremento della comunicazione e del confronto tra specializzandi, Scuole di Specializzazione e S.It.I. Le attività che dovrebbero essere implementate sono parimenti: la promozione di indagini per la valutazione dei bisogni formativi degli specializzandi (25,5%); la promozione di tematiche di Sanità Pubblica (27,8%); lo sviluppo del network con gli specializzandi di altri Paesi europei (25,5%). CONCLUSIONE La Consulta dei Medici in Formazione Specialistica S.It.I. è un organo conosciuto tra gli operatori della Sanità Pubblica e risulta attendere efficacemente il proprio compito principale di promozione del confronto e del dialogo tra specializzandi, pur evidenziandosi la necessità sia di intensificare le attività di ricerca e di formazione nell'ambito dei bisogni degli specializzandi che di promuovere maggiormente lo scambio con gli specializzandi di Sanità Pubblica europei.

Introduzione Molti studi hanno dimostrato che le esperienze formative internazionali (International Health Electives - IHE) contribuiscono all'acquisizione di conoscenze e competenze fondamentali per i futuri professionisti in Sanità proprio attraverso l'opportunità di confronto fra sistemi sanitari e contesti socio-culturali differenti. Sebbene le IHE siano in crescita, non ci sono dati che riguardino quelle svolte dagli specializzandi italiani in Igiene. L'obiettivo dello studio è di raccogliere informazioni sulle loro pregresse esperienze formative internazionali e di comprendere motivazioni ed eventuali criticità relative alla decisione di effettuare una IHE. Materiali e metodi Gli specializzandi in Igiene e Medicina Preventiva (n=575) delle 33 Scuole di Specializzazione attive in Italia hanno risposto, a giugno 2013, ad un questionario autosomministrato online, elaborato dal gruppo di lavoro 'Survey on International Health Electives' della Consulta degli specializzandi S.It.I. Il questionario era composto da 70 domande a risposta mista e strutturato in 5 sezioni: anagrafica, accademica, linguistica, IHE pregresse e recenti, interesse e criticità ad effettuare una IHE. E' stata condotta un'analisi descrittiva e, tramite test Chi-quadrato, è stata valutata l'associazione delle variabili sesso, anno di nascita e Scuola di provenienza con il curriculum internazionale e la volontà di svolgere in futuro una IHE. I dati sono stati analizzati tramite STATA 10.1. Risultati Tutte le Scuole hanno raggiunto un'adesione >30% e sono state quindi incluse nello studio. Hanno risposto 417 specializzandi (72.5%), di cui 274 donne (65.7%) e 143 uomini (34.3%); il 67.1% dei rispondenti è nato dopo il 1979, il 50.8% è iscritto ai primi 2 anni di corso mentre il 49.2% ai 2 successivi. L'auto-valutazione della conoscenza dell'inglese è 6.8/10. L'87.8% dei rispondenti afferma che l'iniziativa di svolgere una IHE provenga dallo specializzando; le informazioni fornite dalle proprie Scuole su opportunità e pregresse esperienze di altri colleghi sono ritenute soddisfacenti rispettivamente dal 37.6% e dal 40.8%. Il 18.9% dei rispondenti ha svolto una IHE prima dell'ingresso in specializzazione (49.4% Erasmus). 30 (7.2%) hanno svolto almeno una IHE durante la specializzazione e 3 di questi ne hanno effettuato almeno 2. Il 75.8% delle IHE sono svolte in Europa e riguardano ambiti della salute globale (22.2%), organizzazione ed economia sanitaria (19.0%) e promozione della salute (14.3%). Il 67.9% dei rispondenti si dichiara interessato a svolgere una IHE in futuro mentre il 32.1% non è interessato (52.9% per ragioni familiari). Attraverso l'analisi univariata, l'età più giovane influisce sull'interesse a svolgere una IHE (p=0,0001) mentre il sesso femminile influisce sulle motivazioni del disinteresse, più frequentemente familiari (p=0,006), e sull'effettivo svolgimento di IHE (p=0,002). Gli specializzandi delle Scuole del Nord e Centro-Italia hanno svolto IHE durante la specializzazione più frequentemente rispetto a quelli del Sud (p=0,05). Conclusioni I risultati preliminari di questo studio dimostrano che gli specializzandi italiani in Igiene hanno una percezione positiva delle IHE e la maggior parte di loro è interessato a svolgerne una durante la specializzazione. Tuttavia emerge che, sia nella ricerca dei contatti quanto nella formulazione di una proposta alla propria Scuola, l'iniziativa dello specializzando sia fondamentale per l'effettiva realizzazione di una IHE. Altre variabili che influiscono su volontà e svolgimento di una IHE saranno indagate più approfonditamente.

Vaccinating health care workers is considered to be one of the most important steps in preventing the transmission of the influenza virus to vulnerable patients. Public Health physicians are the main promoters and executors of influenza vaccination campaigns for both healthcare workers and the general population. The objective of the present survey was to analyze the knowledge, attitudes and practices regarding influenza vaccination among Hygiene and Preventive Medicine Residents. 64% of the participants had not been vaccinated against the influenza virus in the past 5 years, and 29% had been vaccinated only occasionally , with only 7.2% of the study popu-lation having been vaccinated every year. 20.3% of those surveyed were vaccinated in the 2010/2011 season. The best strategy to increase vaccination rates among health care workers according to the study participants was the participation of future public health operators to multidisciplinary training (34.8%). the main factors associated with influenza vaccination compliance were having been vaccinated in the previous season for 2011/2012 (OR [95%]: 41.14 [7.56 - 223.87]) and having received the vaccination always or occasionally during the previous 5 years for both 2010/2011 (p-value

Background: Public Health Residents (PHRs) have to be considered of relevant interest among health care workers (HCWs) since they are strongly asked to recommend and perform influenza vaccination to other HCWs and general population. Despite this consideration, Italian HCWs have influenza vaccination rates significantly below the 75% coverage proposed by International Public Health guidelines. In order to increase future coverage towards influenza vaccination, the aim of this study is to assess determinants associated with influenza vaccine uptake among Italian PHR. Methods: A survey was carried out on PHRs attending 25 out 32 Post-Graduate University training programmes on Public Health in Italy (78.1%). Each participant was interviewed through an anonymous self-administered questionnaire including questions on knowledge, attitudes and practices dealing with influenza and influenza vaccination. Each questionnaire included five sections and twenty items. The questionnaire answers were entered in a database created within EpiInfo 3.5.1 software. All the data were analyzed using the R statistical software package. Results: The response rate was 80.1% (365/456). Vaccination coverage was 22.2% for seasonal 2010-2011 influenza, 33,7% for seasonal 2011-2012 influenza. Medical residents who stated they were vaccinated against seasonal 2010-2011 influenza were significantly more likely to be vaccinated against 2011–2012 seasonal influenza (OR 42.07; 95% CI: 19,4 – 94,2). Vaccination against seasonal 2010-2011 influenza (p < 0.0001), and seasonal 2011-2012 influenza (p

Riassunto Uno studio conoscitivo condotto tra i medici in formazione specialistica in Igiene, Medicina Preventiva e Sanità Pubblica italiani è stato condotto in 25 scuole di specializzazione italiane di tale disciplina (78,1% del totale). Ciascun partecipante è stato intervistato tramite un questionario anonimo ed autosomministrato con domande riguardo attitudini, pratiche e conoscenze sull’influenza e la relativa vaccinazione. La vaccinazione contro l’influenza stagionale 2010-2011 e 2011-2012 è significativamente associata con l’essersi vaccinato almeno 3 volte nelle ultime cinque stagioni influenzali. Gli specializzandi che hanno preso parte durante il loro percorso formativo a campagne di vaccinazione nella popolazione generale sono più propensi a vaccinarsi nelle due stagioni vaccinali prese in esame. Secondo i medici in formazione in Igiene e Medicina Preventiva italiani, per implementare le coperture vaccinali e le attitudini a raccomandare la vaccinazione antinfluenzale alla popolazione generale sono necessari corsi di formazione multidisciplinari (48.2%) e una migliore formazione universitaria sull’argomento (23.3%).

Adducins are cytoskeletal actin-binding proteins (α, β, γ) that function as heterodimers and heterotetramers and are encoded by distinct genes. Experimental and clinical evidence implicates α- and β-adducin variants in hypertension and renal dysfunction. Here, we have addressed the role of α- and β-adducin on glomerular function and disease using β-adducin null mice, congenic substrains for α- and β-adducin from the Milan hyperten- sive (MHS) and Milan normotensive (MNS) rats and patients with IgA nephropathy. Targeted deletion of β- adducin in mice reduced urinary protein excretion, preceded by an increase of podocyte protein expression (phosphonephrin, synaptopodin, α-actinin, ZO-1, Fyn). The introgression of polymorphic MHS β-adducin locus into MNS (Add2, 529R) rats was associated with an early reduction of podocyte protein expression (nephrin, synaptopodin, α- actinin, ZO-1, podocin, Fyn), followed by severe glomerular and interstitial lesions and increased urinary protein excretion. These alterations were markedly attenuated when the polymorphic MHS α-adducin locus was also present (Add1, 316Y). In patients with IgA nephropathy, the rate of decline of renal function over time was associated to polymorphic β-adducin (ADD2, 1797T, rs4984) with a significant interaction with α-adducin (ADD1, 460W, rs4961). These findings suggest that adducin genetic variants participate in the development of glomerular lesions by modulating the expression of specific podocyte proteins.

BACKGROUND: This study is part of a 3-country study testing whether normal levels of hemoglobin (Hgb) delay the progression of left ventricular (LV) growth in chronic kidney disease (CKD) patients not on dialysis. METHODS: This was an open-label, randomized, multicenter, controlled trial conducted in 27 tertiary-care hospitals in Italy. Treated subjects (n=46) received epoetin-alpha (EPO-alpha) to maintain Hgb levels in the range 12-14 g/dL. Control subjects (n=49) were not treated unless their Hgb decreased to 9.0 g/dL. Primary outcome was LV mass index (MI) change after 24 months. Subcutaneous EPO-alpha was withdrawn in Europe and the study prematurely terminated; therefore, a 12-month analysis was carried out. RESULTS: Mean age was 57 years (38% were women, 18% with diabetes, 76% taking ACEI or ARB and 22% statins). EPO-alpha median final dose was 2,000 IU/week. Hgb significantly increased (12.4 -/+ 1.1 g/L) for the treatment group and decreased for controls (11.3 -/+ 1.3 g/L; p