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

Management of diabetes mellitus in hemodialysis is highly complex due to increased glycemic variability and hypoglycemic risk. The use of technologies applied to diabetes has been shown to improve glycemic control, however data in dialysis patients are limited. Purpose. To describe the efficacy and safety of the minimed 780G AHCL system in a stable hemodialysis patient and during hospitalization in the Intensive Care Unit (ICU). Case. A 47-year-old patient with chronic transplant rejection complicated by post-transplant diabetes mellitus (PTD) and chronic ischemic heart disease. He is undergoing MDI multi-injection insulin therapy with reduced compliance and the need for therapeutic adjustments in relation to hypoglycemia and daily and intradialytic glycemic variability. The use of an advanced integrated CGM+insulin pump system (AHCL) was indicated. Three-month data showed the achievement of therapeutic objectives for frail patients with comorbidities; they were also confirmed in a subsequent ICU admission for an episode of pneumonia and respiratory failure. The basal insulin requirement was adjusted automatically by the PID algorithm with daily adaptation of the insulin dose, even during hemodialysis sessions. Conclusions. The use of the AHCL system has proven to be safe, effective and flexible in achieving metabolic compensation both during dialysis and in interdialysis periods and also during a severe acute episode, with excellent control of glycemic values ​​during the same.

Background. Nurses working in nephrology play a critical role in managing patients with kidney diseases, providing highly personalized care that integrates advanced technical and specialized competencies. However, the absence of a formal professional profile in Italy limits both professional development and the standardization of competencies. This study aims to explore the basic and advanced competencies of nephrology nurses to propose unified educational and professional standards. Design. A cross-sectional study based on an ad hoc questionnaire was conducted between March and May 2024 among nurses working in nephrology within the National Health Service, with dissemination support from the Society of Nephrology Nurses. The questionnaire was structured into three sections: theoretical knowledge, practical competencies, and professional development, and was validated through a pilot phase. Data were analyzed using SPSS 27 software. Results. The study involved 296 nurses, 77% of whom were employed in hemodialysis. Only 14% reported having completed specific post-basic training courses, while 71% expressed interest in further educational opportunities. Technical-specialist competencies in hemodialysis were widely applied, but significant gaps were identified in pharmacological management (37% with moderate or low competency levels) and nutrition (35% with moderate or low competency levels). Decision-making and communication skills scored higher, with 65% of participants perceiving themselves at a high or excellent level in these areas. Conclusion. This study represents an important step towards defining a comprehensive professional profile for nephrology nurses in Italy. The findings underscore the need of standardized educational and professional frameworks to promote formal recognition of this specialization while enhancing the quality of care through advanced competencies, humanized approaches, and personalized patient support.

Chronic kidney disease is a very common condition, often underdiagnosed, and a major risk factor for cardiovascular complications and premature death. There is an increasing interest in scientific society in implementing effective treatments for kidney disease to slow progression. In the last decades angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been the only drugs recommended for chronic kidney disease. More recently a further therapeutic choice has been developed: SGLT2 inhibitors. We present a single center observational study aimed at understanding the efficacy and safety of Dapaglifozin in nephropathic population. The trial started in February 2023, and concluded in June 2024. We collected blood tests monthly and one urine sample for urinecolture in the first month, afterwards only in case of disuric symptoms. We enrolled 21 diabetic patients and 7 nondiabetic patients. They were all receiving a maximum tolerated dose of renin-angiotensin system at enrolment.

Potassium is the main intracellular cation, and its serum concentration is finely controlled through various mechanisms to maintain it within the range of 3-5 mmol/L. Hyperkalaemia occurs when the serum concentration of K⁺ exceeds 5.0 mmol/L and can be classified as mild, moderate, or severe. Hyperkalaemia is a serious and potentially life-threatening medical condition, and its incidence tends to increase when comorbid conditions are present, such as diabetes mellitus, heart failure, and renal insufficiency, particularly in the subgroup of patients undergoing haemodialysis, where the incidence of hyperkalaemia is even higher. This leads to an increase in hospitalizations and mortality. Control of potassium in haemodialysis patients has always been a central focus for nephrologists, although chronic management strategies have often been ineffective and poorly tolerated by patients. Recently, two new medications have been introduced for chronic potassium control: Patiromer and Sodium Zirconium Cyclosilicate, the latter approved for use in haemodialysis. We conducted an observational study at our dialysis unit on 28 chronic haemodialysis patients, where after detecting hyperkalaemia, therapy with Sodium Zirconium Cyclosilicate was initiated. We evaluated the potassium levels over time, changes in home treatments, and the drug's tolerability.

Septic shock is a high-risk disease secondary to infections by pathogens, often rapidly evolving and requiring complex treatment. Dysregulation of the immune response can lead to organ hypoperfusion, multiorgan failure and death. In this context, multiple studies are being conducted to find new therapeutic strategies that can improve prognosis. Among these, hemoperfusion techniques using adsorbent filters have emerged. In this paper, we describe our experience in the treatment of septic shock in a kidney transplant patient.

Lactic acidosis is a severe and life-threatening complication that can occur in patients affected by diabetes mellitus. The severity of this clinical condition is primarily due to the challenging correction of acid-base balance, which often requires continuous renal replacement therapies. This clinical case outlines the main clinical manifestations of the condition, along with its key pathophysiological and management aspects.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a genetic disorder characterized by the development of multiple renal cysts and the growth of total kidney volume, often leading to progressive kidney failure. While glomerulonephritis is potentially recognized as a complication, the presence of glomerulonephritis among ADPKD patients is considered uncommon, and the incidence of nephrotic syndrome within this population is exceptionally rare. We present a case of a young woman with ADPKD who developed nephrotic syndrome, likely due to minimal change disease. The diagnostic challenges, management strategies, and existing literature on this rare association are here comprehensively reviewed.

Current clinical practice is guided by novel robust evidence from randomized clinical trials (RCT). These studies usually follow a rigorous prospective design with pre-defined visits and planned exams during follow-up. In the context of Nephrology, RCTs have been mainly designed to test the efficacy of new therapies in reducing the risk for kidney failure, estimated Glomerular Filtration Rate decline and mortality or cardiovascular events. However, the progress of informatics is reflected in an improvement and expansion of technologies and innovations in present and future RCTs. We here present some innovations and future directions of RCTs in Chronic Kidney Disease patients.

The Kidney Failure Risk Equation (KFRE) is a predictive tool that estimates the risk of progression to end-stage renal disease (ESKD) in patients with chronic kidney disease (CKD). This study evaluated the systematic implementation of KFRE in our nephrology center to improve the management of pre-dialysis patients. Through the analysis of 100 patients followed in the pre-dialysis pathway in the last 36 months, we observed a significant reduction in the initiation of dialysis in late referral mode, a lower use of temporary central venous catheters and an increase in timely preparation of vascular or peritoneal access. The comparison with historical pre-implementation data (2017-2020) highlighted an improvement in clinical organization and patient awareness in the choice of dialysis modality. The KFRE has proven to be a valid tool for risk stratification, optimizing the timing of renal replacement therapy and improving the allocation of healthcare resources. The integration of KFRE into clinical practice could represent a step towards precision nephrology, promoting more informed and personalized therapeutic decisions.