Introduction. The Buttonhole technique described in the 1970s, and not further explored, may represent a valid alternative for the management of arteriovenous fistula; the limitations which caused the decline of this technique were high incidence of infections compared to the rope ladder or constant site techniques. Methods and Results. Creating a protocol to allow nursing training and uniformity of action in order to minimize the risk of infection and to benefit from the positive outcomes resulting from this technique. In Centers where BH was never performed we suggest to establish a small pilot group to experiment BH technique, first selecting patients with easily prickable fistulas, to minimize negative outcomes; when operators have reached a good level of dexterity and safety, the entire nursing team may be trained. Subsequently the pilot group will include more complex patients and gradually increase the number of patients suitable for BH; data collection and monitoring will allow continuous verification of the good progress of the project. Conclusions. BH technique can represent the most appropriate solution especially for difficult venipuncture cases and for the implementation of self venipuncture in home dialysis.
{"title":"Protocollo per la puntura a occhiello: dal passato una nuova tecnica","authors":"M. Canzi, Anna Grizzo","doi":"10.33393/gcnd.2022.2503","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2503","url":null,"abstract":"Introduction. The Buttonhole technique described in the 1970s, and not further explored, may represent a valid alternative for the management of arteriovenous fistula; the limitations which caused the decline of this technique were high incidence of infections compared to the rope ladder or constant site techniques.\u0000Methods and Results. Creating a protocol to allow nursing training and uniformity of action in order to minimize the risk of infection and to benefit from the positive outcomes resulting from this technique. In Centers where BH was never performed we suggest to establish a small pilot group to experiment BH technique, first selecting patients with easily prickable fistulas, to minimize negative outcomes; when operators have reached a good level of dexterity and safety, the entire nursing team may be trained. Subsequently the pilot group will include more complex patients and gradually increase the number of patients suitable for BH; data collection and monitoring will allow continuous verification of the good progress of the project.\u0000Conclusions. BH technique can represent the most appropriate solution especially for difficult venipuncture cases and for the implementation of self venipuncture in home dialysis.","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80289747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Burrai, Margherita Gambella, Valentina Micheluzzi
From the analysis of the national and international literature and considering the socio-demographic changes, it is necessary to rethink the organizational models capable of giving concrete answers to the new health and welfare needs of the population. The progressive increase of the elderly population and of people with at least one chronic disease and the SARS-CoV-2 pandemic have highlighted the need for a health and social system close to the population, which increases the territorial assistance, in particular at the patient’s home. Home care must become an elective place for prevention and health promotion activities. PNRR funds for proximity networks, telemedicine and innovation in the health field will enable assistance to be directed towards a new organizational and operational perspective, where the family and community nurse will play a key role. In the care of patients on home dialysis the evidence described in the literature reports the benefits of home hemodialysis treatment, in which the nurse of the family and community through his care skills, technical and psychological counselling, tele assistance and e-health can be integrated into the home care path, assisting the patient and the family unit and supporting them in the different health needs, especially in the quality of life outcome.
{"title":"Ruolo dell’Infermiere di Famiglia e di Comunità nell’assistenza dei pazienti in dialisi domiciliare e possibili effetti sugli outcome assistenziali","authors":"Francesco Burrai, Margherita Gambella, Valentina Micheluzzi","doi":"10.33393/gcnd.2022.2478","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2478","url":null,"abstract":"From the analysis of the national and international literature and considering the socio-demographic changes, it is necessary to rethink the organizational models capable of giving concrete answers to the new health and welfare needs of the population. The progressive increase of the elderly population and of people with at least one chronic disease and the SARS-CoV-2 pandemic have highlighted the need for a health and social system close to the population, which increases the territorial assistance, in particular at the patient’s home. Home care must become an elective place for prevention and health promotion activities. PNRR funds for proximity networks, telemedicine and innovation in the health field will enable assistance to be directed towards a new organizational and operational perspective, where the family and community nurse will play a key role. In the care of patients on home dialysis the evidence described in the literature reports the benefits of home hemodialysis treatment, in which the nurse of the family and community through his care skills, technical and psychological counselling, tele assistance and e-health can be integrated into the home care path, assisting the patient and the family unit and supporting them in the different health needs, especially in the quality of life outcome.","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75843371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Possiamo fare un passo avanti verso l’ignoto e immaginare che sarà stupendo","authors":"Luisa Sternfeld Pavia","doi":"10.33393/gcnd.2022.2443","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2443","url":null,"abstract":"","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83785870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessandra Zattarin, Francesco Francini-Pesenti, Claudia Da Col, P. Spinella, M. Alessi, Lucia Federica Stefanelli, L. Calò
Renal transplantation is the gold standard for the treatment of ESRD patients. During the early-stage post-transplantation, metabolic and electrolytic alterations may develop, including hypophosphatemia and the treatment includes a diet rich in phosphorus, sometimes with the addition of oral or intravenous phosphorus supplement. Forty-four kidney transplanted patients with hypophosphatemia were evaluated retrospectively. They were divided into two groups based on whether patients received (group A, 14 patients) or not (group B, 30 patients) dietary prescription for hypophosphatemia. Group A was further divided into two subgroups: group A1 (8 patients), with baseline phosphatemia ≥0.5 mmol/L, treated only with a diet rich in animal phosphorus, and group A2 (6 patients), with baseline phosphatemia ≤0.5 mmol/L, who received a potassium phosphate supplement in addition to the same dietary prescription. Three months after transplantation, group A had a greater increase of phosphatemia compared with group B (group A: 0.58 ± 0.12 vs 0.93 ± 0.22 mmol/L; group B: 0.59 ± 0.11 to 0.8 ± 0.13 mmol/L). Furthermore, in group A2 the increase of phosphatemia was lower than in group A1. In conclusion, dietary approach supported by dietary counseling was effective in treating post kidney transplantation hypophosphatemia. The results of this pilot study might represent a useful working hypothesis for studies with a larger cohort of enrolled patients in order to confirm for these patients the efficacy of the nutritional approach and of the dietary counseling to post renal transplantation hypophosphatemia.
肾移植是治疗ESRD患者的金标准。在移植后早期，代谢和电解质可能发生改变，包括低磷血症，治疗包括富含磷的饮食，有时添加口服或静脉补磷。对44例低磷血症肾移植患者进行回顾性评价。根据患者是否接受低磷血症饮食处方(A组，14例)和未接受低磷血症饮食处方(B组，30例)分为两组。A组进一步分为2个亚组:A1组(8例)，基线磷血症≥0.5 mmol/L，仅采用富含动物磷的饮食治疗;A2组(6例)，基线磷血症≤0.5 mmol/L，在相同的饮食处方基础上补充磷酸钾。移植后3个月，A组的血磷水平明显高于B组(A组:0.58±0.12 vs 0.93±0.22 mmol/L;B组:0.59±0.11 ~ 0.8±0.13 mmol/L)。此外，A2组的磷血症升高幅度低于A1组。综上所述，饮食咨询支持的饮食方法是治疗肾移植后低磷血症的有效方法。这项初步研究的结果可能代表了一个有用的工作假设，用于研究更大的入选患者队列，以确认这些患者的营养方法和饮食咨询对肾移植后低磷血症的疗效。
{"title":"Approccio nutrizionale all’ipofosforemia post-trapianto di rene: uno studio pilota","authors":"Alessandra Zattarin, Francesco Francini-Pesenti, Claudia Da Col, P. Spinella, M. Alessi, Lucia Federica Stefanelli, L. Calò","doi":"10.33393/gcnd.2022.2472","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2472","url":null,"abstract":"Renal transplantation is the gold standard for the treatment of ESRD patients. During the early-stage post-transplantation, metabolic and electrolytic alterations may develop, including hypophosphatemia and the treatment includes a diet rich in phosphorus, sometimes with the addition of oral or intravenous phosphorus supplement. Forty-four kidney transplanted patients with hypophosphatemia were evaluated retrospectively. They were divided into two groups based on whether patients received (group A, 14 patients) or not (group B, 30 patients) dietary prescription for hypophosphatemia. Group A was further divided into two subgroups: group A1 (8 patients), with baseline phosphatemia ≥0.5 mmol/L, treated only with a diet rich in animal phosphorus, and group A2 (6 patients), with baseline phosphatemia ≤0.5 mmol/L, who received a potassium phosphate supplement in addition to the same dietary prescription. Three months after transplantation, group A had a greater increase of phosphatemia compared with group B (group A: 0.58 ± 0.12 vs 0.93 ± 0.22 mmol/L; group B: 0.59 ± 0.11 to 0.8 ± 0.13 mmol/L). Furthermore, in group A2 the increase of phosphatemia was lower than in group A1.\u0000In conclusion, dietary approach supported by dietary counseling was effective in treating post kidney transplantation hypophosphatemia. The results of this pilot study might represent a useful working hypothesis for studies with a larger cohort of enrolled patients in order to confirm for these patients the efficacy of the nutritional approach and of the dietary counseling to post renal transplantation hypophosphatemia.","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88479977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Aterini, A. M. Ciciani, F. Bergesio, Lorenzo Aterini, Barbara Vadalà, Marco Gallo
Introduction: Intradialytic hypotension (IDH) is a frequent complication of hemodialysis. IDH causes intradialytic discomfort and subclinical ischemia, resulting in a higher rate of morbidity and mortality. Levocarnitine (LC) administration has been suggested for the treatment of IDH, but conflicting reports about its efficacy have been published. We describe the effect of LC supplementation in patients experiencing recurrent IDH episodes, in spite of common strategies used to prevent it. Methods: Sixteen hemodialysis patients were studied. IDH was defined as a drop in systolic blood pressure ≥20 mmHg, with or without symptoms, prompting an intervention by the dialysis staff, such as reducing/stopping ultrafiltration rate and/or fluid administration. Blood pressure was recorded for 192 hemodialysis sessions, before LC supplementation. Thereafter LC (30 mg/kg dry weight) was administered at the beginning of each hemodialysis, registering blood pressure for 384 hemodialysis treatments. The difference between the predialysis systolic blood pressure and the minimum systolic blood pressure of each hemodialysis was evaluated (∆SBP), before and after LC supplementation. Cardiac ejection fraction was also measured. Results: Predialysis and postdialysis systolic, diastolic, and mean arterial pressures did not differ before and after LC supplementation. Before LC supplementation, 36 episodes of IDH occurred (19%), while after LC supplementation, the IDH episodes were 29 during 384 hemodialysis sessions (8%; χ2 = 16.03; p = 0.0001). ∆SBP was lower after LC supplementation, even though the difference was not significant (p = 0.22). Conclusion: IDH frequency was significantly reduced by predialysis LC supplementation, which can be helpful for patients’ well-being and reduction in IDH-associated risks.
{"title":"Intradialytic hypotension frequency is reduced by levocarnitine supplementation","authors":"S. Aterini, A. M. Ciciani, F. Bergesio, Lorenzo Aterini, Barbara Vadalà, Marco Gallo","doi":"10.33393/gcnd.2022.2466","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2466","url":null,"abstract":"Introduction: Intradialytic hypotension (IDH) is a frequent complication of hemodialysis. IDH causes intradialytic discomfort and subclinical ischemia, resulting in a higher rate of morbidity and mortality. Levocarnitine (LC) administration has been suggested for the treatment of IDH, but conflicting reports about its efficacy have been published. We describe the effect of LC supplementation in patients experiencing recurrent IDH episodes, in spite of common strategies used to prevent it.\u0000Methods: Sixteen hemodialysis patients were studied. IDH was defined as a drop in systolic blood pressure ≥20 mmHg, with or without symptoms, prompting an intervention by the dialysis staff, such as reducing/stopping ultrafiltration rate and/or fluid administration. Blood pressure was recorded for 192 hemodialysis sessions, before LC supplementation. Thereafter LC (30 mg/kg dry weight) was administered at the beginning of each hemodialysis, registering blood pressure for 384 hemodialysis treatments. The difference between the predialysis systolic blood pressure and the minimum systolic blood pressure of each hemodialysis was evaluated (∆SBP), before and after LC supplementation. Cardiac ejection fraction was also measured.\u0000Results: Predialysis and postdialysis systolic, diastolic, and mean arterial pressures did not differ before and after LC supplementation. Before LC supplementation, 36 episodes of IDH occurred (19%), while after LC supplementation, the IDH episodes were 29 during 384 hemodialysis sessions (8%; χ2 = 16.03; p = 0.0001). ∆SBP was lower after LC supplementation, even though the difference was not significant (p = 0.22).\u0000Conclusion: IDH frequency was significantly reduced by predialysis LC supplementation, which can be helpful for patients’ well-being and reduction in IDH-associated risks.","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79707681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sodium-glucose cotransporter 2 inhibitors are a class of antidiabetic drugs that inhibit glucose reabsorption in the proximal renal tubules. In many trials these drugs have shown unpredictable major cardio- and nephroprotective properties. Multiple hypotheses have been raised to elucidate the mechanisms underlying the last effects. Some authors suggest they may be due to the contemporary urinary loss of energy (as glucose) and water (by osmotic diuresis). This particular condition could induce metabolic changes resulting in more efficient energetics at cardiac and renal levels and in less oxidative stress. These changes might really be part of a series of evolutionarily conserved metabolic switches that allow organisms to survive in arid habitats with restricted nutrients and water availability, well studied in amphibians and collectively named “estivation”.
{"title":"SGLT2 inhibitors: suggestions from the amphibian world","authors":"S. Michelassi","doi":"10.33393/gcnd.2022.2423","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2423","url":null,"abstract":"Sodium-glucose cotransporter 2 inhibitors are a class of antidiabetic drugs that inhibit glucose reabsorption in the proximal renal tubules. In many trials these drugs have shown unpredictable major cardio- and nephroprotective properties. Multiple hypotheses have been raised to elucidate the mechanisms underlying the last effects. Some authors suggest they may be due to the contemporary urinary loss of energy (as glucose) and water (by osmotic diuresis). This particular condition could induce metabolic changes resulting in more efficient energetics at cardiac and renal levels and in less oxidative stress. These changes might really be part of a series of evolutionarily conserved metabolic switches that allow organisms to survive in arid habitats with restricted nutrients and water availability, well studied in amphibians and collectively named “estivation”.","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81950882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Il ruolo del medico nella visione sanitaria olistica della salute","authors":"Aurora Pianigiani, Francesco Romizi","doi":"10.33393/gcnd.2022.2430","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2430","url":null,"abstract":"<jats:p>na</jats:p>","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75208840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abstracts XXXX Congresso Nazionale SIAN ITALIA: L'evoluzione professionale e la formazione: ieri, oggi e domani - Rimini 9-11 Maggio 2022","authors":"","doi":"10.33393/gcnd.2022.2410","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2410","url":null,"abstract":"","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84318319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"MMetformina e rene policistico dell’adulto: tra ricerca e impiego clinico","authors":"Giovanni Piscopo","doi":"10.33393/gcnd.2022.2398","DOIUrl":"https://doi.org/10.33393/gcnd.2022.2398","url":null,"abstract":"","PeriodicalId":12617,"journal":{"name":"Giornale di Clinica Nefrologica e Dialisi","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78641963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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