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

Background. This study evaluated the causes of and risk factors for mortality among patients on chronic HD hospitalised with SARS-CoV-2; in particular, it evaluated whether the cause of death was directly related to coronavirus disease 2019 (Covid-19) or another pathology. The European Renal Association registry showed a 20% mortality rate after 28 days for these patients. Methods. The clinical data of chronic HD patients hospitalised because of SARS-CoV-2 at the Fondazione Policlinico Universitario Agostino Gemelli from 15 March 2020 to 28 February 2022 were analysed. Univariate and multivariate regression analyses were performed to identify risk factors for mortality. The causes of mortality were obtained from the hospital discharge forms. Results. One hundred fifty-two patients on maintenance haemodialysis with positive SARS-CoV-2 test results were hospitalised during the study period. There were 100 male (65.8%) and 52 female (34.2%) patients (mean age, 69 years; standard deviation [SD], 14.14 years). The mean Charlson comorbidity index (CCI) was 6.44 (SD, 2.64), and the average hospitalisation length was 23.57 days (SD, 24.55 days). Forty-two (27.6%) patients died, but only 22 deaths (59%) were directly caused by Covid-19. Conclusions. Only 59% of the deaths of patients with positive Covid-19 test results were directly caused by Covid-19. The survival of patients on chronic HD is independently related to specific patient characteristics (age, CCI, presence of peripheral vascular disease, and intensive care unit admission), but not to Covid-19.

Starting from the old concept of "fatty degeneration of the kidney", numerous studies have investigated lipid metabolism in chronic kidney disease. Today, it is known that collagenopathies, and more generally diseases involving alterations of the glomerular basement membrane, are characterized by intrapodocyte accumulation of lipid droplets, independent of serum cholesterol levels. Consequently, the latest scientific evidence has focused on the link between the kidney and lipid droplets, ubiquitous but unique organelles, at the same time allies and enemies of renal cells.

Background. Post-transplant Focal Segmental Glomerulosclerosis (FSGS) recurrence, the third cause of graft failure in the first year, and its treatment still remains an open challenge. Available evidence reports different approaches both to primary FSGS and post-transplant recurrence but optimal therapeutic management has not been established. This retrospective study aimed to analyze in a monocentric cohort of kidney transplanted patients those with primary FSGS to establish the post-transplant recurrence rate of FSGS and its treatment. Patients and Methods. 2816 kidney transplanted patients at Padova University Hospital from 1995 to 2023 were retrospectively evaluated to identify those with pretransplant primary FSGS, establish the recurrence rate of post-transplant FSGS and the adopted treatment. Results. 20 patients out of 2816 had pretransplant primary FSGS and in 5 of them post-transplant recurrences of FSGS were observed (25%). In these patients, immunosuppression regimens with tacrolimus/mycophenolate mofetil/corticosteroids were the most used (75%). Plasmapheresis was used in 4 recurrences and one patient was also treated with rituximab. Conclusions. Optimal management of FSGS recurrence after transplantation is not yet established while evidence regarding the positive effect of current treatment strategies is very little and limited by a very low number of well-designed randomized trials. Although with limitations, our study might be considered as a further contribution to the limited number of available studies on the still open challenge of identifying the most effective management to reduce/prevent post-transplant FSGS recurrence and provide its best treatment.

Left Ventricular Diastolic Dysfunction (LVDD) describes changes in the heart's structure and function, leading to impaired ventricular relaxation and increased filling pressures during the diastolic phase of the cardiac cycle. In the context of isolated LVDD, the left ventricular end-diastolic volume, global contractility, and ejection fraction (EF) are normal, with EF being 50% or higher. However, as filling pressures progressively increase, diastolic dysfunction worsens. LVDD is classified into varying degrees of severity along a continuum that may ultimately lead to heart failure. The diagnosis of LVDD in its early stages is carried out using echocardiographic criteria, which also help to determine the severity of diastolic dysfunction. The most recent update of echocardiographic criteria includes three categories: normal, indeterminate and diastolic dysfunction, that allow us to define better the CV risk of patients with or without CKD. The prevalence of left ventricular diastolic dysfunction (LVDD) increases among the elderly, as well as in populations with hypertension and diabetes, which heightens their cardiovascular risk. Additionally, these conditions are frequently linked to chronic kidney disease (CKD). Although LVDD and CKD share a common pathogenic pattern, the relationship between the two conditions is not yet well understood.

Introduction. Treating hyperkalemia is one of the main goals of supportive care in patients on hemodialysis. In this context, therapy with new potassium binders is a promising resource. Objective. The main aim is to evaluate the difference in serum potassium concentration after treatment with sodium zirconium cyclosilicate or patiromer compared to placebo/sodium polystyrene sulfonate/calcium polystyrene sulfonate. Methods. We will perform systematic research in PubMed, EMBASE, CINAHLE, and grey literature will be screened. We will screen RCTs on patients treated with SZC or patiromer in chronic hemodialysis, without sex or age restriction, which include the differences in serum potassium concentration, adverse events (AEs), and mortality as outcomes. Expected results. This systematic review is expected to provide a comprehensive evaluation of the efficacy and adverse effects of new potassium binders, compared to sodium polystyrene sulfonate or calcium polystyrene sulfonate or placebo, on serum potassium concentration, in a sample of hemodialysis patients. Furthermore, possible gaps in actual knowledge can be highlighted, suggesting new research. Conclusions. The present protocol for a systematic review will consider all existing evidence from published RCTs about the efficacy of HIF-PHIs on hemodialysis patients.

Arteriovenous fistulas (AVFs) are the preferred vascular access for chronic hemodialysis patients due to their lower rates of infectious and thrombotic complications, reduced morbidity and mortality, and increased durability compared to central venous catheters. However, the creation of AVFs has become increasingly challenging due to the rising prevalence of chronic diseases like diabetes, hypertension, and cardiovascular conditions, which are leading causes of end-stage renal disease (ESRD). These comorbidities, coupled with the aging dialysis population, have led to an increase in peripheral vascular diseases, complicating AVF management. This paper discusses two major complications of AVFs: Hemodialysis Access-Induced Distal Ischemia (HAIDI) and high-flow AVFs. HAIDI is characterized by ischemia in extremities due to reduced capillary perfusion, potentially leading to severe outcomes such as tissue necrosis and digital amputations. Approximately 5% of hemodialysis patients with AVFs develop HAIDI, necessitating corrective treatment. High-flow AVFs, defined by excessive blood flow that disrupts overall circulatory dynamics, pose another significant challenge, particularly in patients with cardiovascular compromise. The management of these complications is complex and often requires specialized techniques to preserve the AVF and avoid its closure. This review presents both surgical and endovascular techniques aimed at reducing AVF flow and improving distal perfusion. Techniques discussed include vein approach like ligation, plication, banding, prosthetic graft interposition, and various arterial interventions like distal radial artery ligation and embolization. Additionally, the review presents techniques for anastomosis remodeling, offering innovative approaches to managing AVF complications. The review concludes with a proposed decision-making algorithm to guide clinicians in selecting appropriate interventions based on the specific AVF-related complications, ensuring optimal outcomes for hemodialysis patients. This comprehensive overview highlights the importance of individualized treatment strategies in the management of AVF complications.

Background. Chronic kidney disease poses global health risks, requiring specialized nursing skills and ongoing professional development. The objective of this review was to identify postgraduate nurse education programs in nephrology and dialysis. Design. A scoping review following the framework given by Arksey and O'Malley was conducted using five databases: Medline, Scopus, Cochrane Library, ASSIA and CINAHL. The research was supplemented by consulting gray literature. Screening of articles, data extraction and quality appraisal were independently performed by two authors. The included articles examined the modalities of skills acquisition by nephrology and dialysis nurses. Critical appraisal was conducted using JBI critical appraisal tools. Results. Out of 8789 records identified, 20 were included in this review. Analysis of the data indicated that nephrology and dialysis nurses acquire their skills through both structured training pathways and professional experience. This review identified a lack of standardized training pathways in this field, resulting in global heterogeneity in training programs. Educational interventions typically comprised theoretical and practical components, often delivered through a combination of teaching methods. Additionally, professional training was found to be essential for skill acquisition, with variations in reliance on mentorship, individual study, and direct experience. Conclusion. Despite the heterogeneity of existing training courses, this study outlines existing knowledge, laying the foundations for a review and standardization of training courses and underlining the need for a clear definition of nephrology and dialysis nurses' skills for curriculum development.

Human adenoviruses (HAdVs) are nonenveloped, icosahedral viruses with double-stranded DNA, classified within the Adenoviridae viral family. They are implicated in a diverse range of human illnesses. The HAdV group consists of 103 distinct genotypes, categorized into seven primary serotypes labeled A through G. This classification is based on the hemagglutinin properties of their fiber protein and their genomic similarities. While many infections caused by these viruses are either symptomless or self-limiting, certain populations, such as kidney transplant recipients, face heightened risks. Particularly, HAdV serotypes B1 and B2 are noteworthy for their ability to infect the kidneys, potentially leading to kidney damage and dysfunction. Diagnosis of HAdV infections typically involves histopathological examination, laboratory tests, and imaging techniques. Treatment strategies often hinge on restoring immune function. However, for HAdV infections, therapeutic options such as Cidofovir, Nitazoxanide, along with emerging approaches like nanoparticle- and siRNA-based medications, and monoclonal antibodies appear promising.

Introduction. Moral Distress in the nursing profession represents an increasingly important issue. Patients undergoing dialysis treatment have a long and complex clinical path and the nurse is required to express clinical decisions balancing the obligations of care not only towards patients and family members, but also towards himself and the organization. It therefore happens that the nurse finds himself in situations in which he is not able to translate his moral beliefs into ethically concrete actions causing a sense of anguish and frustration. Objective. To identify and describe the predisposing factors and strategies to address the phenomenon of Moral Distress in nurses who work in dialysis. Method. A literature review was conducted from 01/01/2024 to 09/30/2024 by consulting four databases: PubMed, Embase, CINAHL and Scopus. The study included primary experimental, quasi-experimental, observational, qualitative studies and secondary studies such as reviews, meta-analyses and scoping reviews, which described the phenomenon of Moral distress, its predisposing factors and the related strategies to deal with it in the context of dialysis. Results. The studies confirmed that the phenomenon of Moral Distress is very prevalent in the context of dialysis. The predisposing factors are related to: direct assistance with the dialysis patient (a), the work and organizational context (b) hierarchical barriers and impaired communication between nurses and the ward team (c). The strategies used suggest promoting the well-being of dialysis nursing staff; strategies such as: open communication with patients and relatives; opening of services that provide support on ethical reasoning and stress management; implementation of training activities regarding palliative care and end-of-life management. Discussion. Moral distress causes nursing staff working in dialysis to feel helpless, which can evolve into emotional exhaustion with physical and psychological repercussions that can affect the quality of care provided and increase abandonment of the profession. Conclusions. This literature review has identified the factors that determine the onset of Moral distress in the context of dialysis with the aim of outlining strategies to limit this phenomenon. In light of the results achieved, it becomes essential to implement research within nephrological contexts to prevent and contain the problem with the aim of ensuring high-quality care and at the same time the well-being of the professional.