Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia最新文献

Background. Complications of chronic kidney disease include endocrine and metabolic abnormalities, anaemia and a wide range of disorders of homeostasis. Our study aims to better determine the role of CKD stage on the timing of the various complications associated with renal dysfunction. Methods. We performed an observational study on 71 (F:M = 39:32) patients with 486 repeated measurements, recording anemia, BUN, hyperparathyroidism, hyperphosphatemia, hyperkalemia, metabolic acidosis. Data were summarized as mean and standard deviation, median and interquartile range, or absolute number. Differences among groups were tested through the Mann-Whitney test or Pearson's Chi-Square. The associations between eGFR and each outcome was tested by Spearman's correlation test. All variables related to the outcomes (with p-value <0.1) were included in the multivariate models. Longitudinal analysis was performed using generalized estimated equations (GEE) for binary outcome and by Linear Mixed Models for continuous variables. The ROC Curve with the Youden J index was evaluated for all binary outcomes. Results. Baseline analysis revealed hyperparathyroidism in 49 patients (69.1%), hyperphosphatemia in 11 patients (15.5%), hyperkalemia in 20 patients (28.6%), and mean serum urea was 78 mg/dl [IQR: 59-99]. CKD stage was related with all outcomes. Youden J index suggested an eGFR predictive value of 37 ml/min/m2 for anemia, 34 ml/min/m2 for hyperkalemia, 26 ml/min/m2 for hyperphosphatemia, and 46 ml/min/m2 for hyperparathyroidism. Conclusion. Based on our findings, screening tests for endocrine and metabolic complications of CKD should be initiated at the beginning of the CKD stage III. We suggest screening for hyperphosphataemia at the CKD stage IV.

Chronic kidney disease (CKD) is an increasingly prevalent pathological condition. The global rise in the number of individuals affected by CKD is dependent on the ageing, as well as on the growing prevalence of obesity, diabetes and hypertension. The need for treatment strategies aimed at preventing the onset of CKD and slowing its progression has led to the implementation of combination therapy, consisting of a Renin-Angiotensin-Aldosterone System inhibitor (RAASi) and a sodium-glucose cotransporter-2 inhibitor (SGLT-2i), which has demonstrated efficacy in slowing CKD progression and reducing the occurrence of cardiovascular events. Updated guidelines recommend a tailored, multi-drug approach based on the residual cardiorenal risk of the individual patient. The KDIGO guidelines advocate for a stepwise approach in managing diabetes mellitus and CKD, with RAASi and SGLT-2i as first-line therapy, and GLP-1 receptor agonists (GLP-1 RA) and non-steroidal mineralocorticoid receptor antagonists (MRAs) as additional agents for further cardiorenal protection. Endothelin Receptor Antagonists (ERAs), a newer class of drugs, have shown antiproteinuric and nephroprotective effects in various trials. The objective of developing increasingly effective and personalized therapeutic strategies underscores the need to combine multiple drug classes that can act synergistically on different pathways.

Gender medicine explores how sex differences influence the onset, progression, and perception of specific diseases. In the case of ADPKD, female sex seems to impact various aspects of the condition. Women with ADPKD may experience a different progression of the disease compared to men, with a higher predisposition to developing certain complications such as polycystic liver disease, which can have a range of clinical consequences of varying severity. Perception and subjective experience of the disease can also vary significantly, affecting emotional well-being and quality of life. Pregnancy, for instance, represents a critical phase for women with ADPKD, requiring specialized monitoring and specific management to address potential complications. Genetic counseling is essential for providing informational support and helping families understand the hereditary implications of the disease. Modern pre-implantation diagnostic techniques also allow for the identification of the disease before birth, improving family planning and reducing the risk of transmission. Another important aspect is hormonal therapy, which was previously excluded in women with ADPKD due to concerns about potential effects on the growth of hepatic cysts. However, with advances in knowledge and increasing attention to specific needs, a targeted individual approach to hormonal therapy may prove beneficial, offering new therapeutic opportunities. Looking ahead, it is desirable for gender medicine to continue evolving, leading to increasingly personalized disease management and optimized care, with a positive impact on the overall well-being of individual patients.

Osteoporosis is a chronic skeletal disease characterized by reduced bone mineral density and deteriorated bone microarchitecture, which increases fracture risk. In patients with chronic kidney disease (CKD), osteoporosis management is complicated by disturbances in mineral and bone metabolism (CKD-MBD) that adversely affect bone health. Diagnosis requires a thorough clinical evaluation, including bone mineral density measurement via DEXA, bone microarchitecture assessment with TBS, and analysis of bone turnover biomarkers. Therapeutic management must be personalized and may include anti-resorptive or anabolic therapies, depending on the patient's bone metabolism and renal function. Policlinico Sant'Orsola employs an integrated care model involving nephrologists, endocrinologists, radiologists, and other specialists for optimal osteoporosis management. This multidisciplinary approach addresses the complexities of CKD-MBD comprehensively, improving diagnosis and treatment and, consequently, enhancing patient quality of life through a coordinated and personalized treatment plan.

Introduction. Central Catheter-related infections and biofilm formation are significant issues in the context of nosocomial infections that increase resistance to conventional therapies. Methodology. This case report describes an unconventional treatment for a Serratia Marcescens Central Venous Catheter infection in a hemodialysis patient through the combination of polyguanide and betaine. Clinical evaluations were conducted using the Visual Exit-Site Score and culture swabs. Results. After the first four treatment sessions there was a significant reduction in redness and pain (VES=1); the culture swab at the end of treatment was negative. Conclusions. The results of this case report encourage further research on the effectiveness of non-antibiotic treatments.

Introduction: peritoneal dialysis (PD) is a widely used renal replacement therapy allowing end-stage renal disease patients to undergo a home-based treatment. The remote monitoring (RM) and the telemedicine in patients undergoing automated peritoneal dialysis (APD) improve the technique and the patient survival. This study evaluated their impact on PD patients, evaluating the safety of the technique, infectious complications and hospitalizations, and the effects on the quality of life. Patients and methods: 73 patients undergoing PD at the Nephrology and Dialysis Unit of the Papardo Hospital in Messina were enrolled. 39 patients (APD group) were followed with scheduled visits at the hospital centre, whereas the remaining 34 patients (RM-APD group) received complete assistance at home. Results: the hospitalizations were statistically lower in the RM-APD group than APD patients (7 vs 17; p: 0.03). During the follow-up period, 13 patients were switched from the PD technique to HD. In particular, 10 patients belonged to the ADP group, whereas the remaining 3 patients were followed through the remote control. PD patients had a better psycho-physical state, with better scores in physical performance (p = 0.02) and psycho-emotional well-being (p = 0.001), performing social functions more adequately than HD patients (p = 0.01). The final result is a better perception of health in general in PD patients. Conclusion: the telemedicine and the remote control have opened new ways to increase the number of patients who can perform PD treatment at home safely, reducing the infective risk and the rate of hospitalization.

Natural emergencies represent unpredictable events which, due to their intensity, can determine multiple effects on the healthcare system with increased pressure on the hospital network. The purpose of this article is to focus attention on dialysis patients and provide a quick overview of the possible complications that can occur following emergency events, also suggesting a working scheme to deal with them in the nephrology field. Both the preventive and operational procedures to be implemented to ensure the safety of patients undergoing dialysis treatment will therefore be discussed, focusing on the need to set up a working group to make the territorial response homogeneous.

Hypokalemia is among the most common electrolyte abnormalities, often well tolerated, but sometimes responsible for an increase in morbidity and mortality due to cardiovascular causes. The kidneys play a key role in potassium homeostasis, making the nephrologist the professional directly involved in the diagnosis and treatment of this condition. We present the clinical case of a 24-year-old man who came in with multiple episodes of emesis and hyperpyrexia. The patient rapidly developed severe hypokalemia with ascending flaccid paralysis. Despite early treatment with potassium chloride, intensive therapy was necessary to manage the complications. The clinical case illustrates the diagnostic and therapeutic challenges encountered and demonstrates how a multidisciplinary approach and a thorough diagnostic process, including genetic testing, identified a heterozygous mutation in the CACNA1S gene, confirming the diagnosis of hypokalemic periodic paralysis type I. The importance of early recognition and appropriate management of hypokalemia is emphasized to prevent potentially fatal complications.

The KDOQI guidelines (Kidney Disease Outcomes Quality Initiative) recommend autologous arteriovenous fistula (AVF) as the primary vascular access in hemodialysis patients because of the higher quality of life and lower complication rates if compared to arteriovenous grafts (AVGs) or central venous catheter (CVC). Several studies used various inflammatory biomarkers to evaluate the association between systemic inflammation and AVF dysfunction. A novel inflammatory biomarker, the platelet-lymphocyte ratio (PLR), is a useful and easy laboratory parameter that can reveal systemic inflammation. Our study aimed to evaluate the relationship between PLR value changes over time and AVF dysfunction. The impact of PLR on our outcome showed a trend close to the significance (OR: 4,9; 95%CI: [0.84-28.5]; p = 0.08) but the slope was not linear. Therefore, we performed the same analysis splitting the patients by the median PLR value and we highlighted a significant relationship between our outcome and the PLR (log-transformed) for PLR-value under the median value (OR: 9.97; 95%CI: [2.53-39.25]; p = 0.001). Furthermore, in patients with PLR above the median value, the interaction visit-PLR showed an impact close to the statistical significance (OR: 7.7; 95%CI: [0.81-72.97]; p = 0.07). PLR (log-transformed) was positively correlated with AVF age (Rho: 0.254, p = 0.002).