The choice of the dialysate calcium concentration in the management of patients on haemodialysis and haemodiafiltration

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Fisiopatologia dell'iperparatiroidismo secondario

Abstract non disponibil

Il trattamento chirurgico dell'iperparatiroidismo nel paziente uremico: Ruolo attuale della paratiroidectomia: aspetti epidemiologici e nuove acquisizioni:

Abstract non disponibil

Optimizing the dialysate calcium concentration in bicarbonate haemodialysis

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Response of microchannel plates in ionization mode to single particles and electromagnetic showers

Hundreds of concurrent collisions per bunch crossing are expected at future hadron colliders. Precision timing calorimetry has been advocated as a way to mitigate the pileup effects and, thanks to their excellent time resolution, microchannel plates (MCPs) are good candidate detectors for this goal. We report on the response of MCPs, used as secondary emission detectors, to single relativistic particles and to electromagnetic showers. Several prototypes, with different geometries and characteristics, were exposed to particle beams at the INFN-LNF Beam Test Facility and at CERN. Their time resolution and efficiency are measured for single particles and as a function of the multiplicity of particles. Efficiencies between 50% and 90% to single relativistic particles are reached, and up to 100% in presence of a large number of particles. Time resolutions between 20ps and 30ps are obtained.Comment: 20 pages, 9 figures. Paper submitted to NIM

Management of mineral metabolism in hemodialysis patients: discrepancy between interventions and perceived causes of failure

none8BACKGROUND: Mineral and bone disorders (MBD) in patients undergoing hemodialysis (HD) are a major clinical complication. Current therapeutic strategies do not attain the expected results. The Italian audit on mineral metabolism was implemented to investigate MBD management through a "patient-oriented" approach. METHODS: Clinical and laboratory data pertinent to MBD from 509 prevalent adult patients on chronic HD were recorded and examined (audit), after which individual strategies were elaborated to improve MBD control. Their effectiveness was evaluated 6 months after the audit (Post-6). RESULTS: The audit disclosed poor MBD control in a high percentage of patients (56 %). Low compliance to treatment was the major determinant of failure (in 43.5 % of cases). Logistic regression showed a direct correlation between high degree of compliance and the achievement of therapeutic targets, e.g. parathyroid hormone: odds ratio (OR) 2.48, p = 0.015. In contrast, a minority of the proposed interventions (14.7 %) included strategies to improve patient compliance. At Post-6, despite a significant increase in drug prescription (p < 0.05 vs. audit), the rate of successful MBD control was unchanged. CONCLUSIONS: Low compliance with treatment is a major, but still neglected, cause of failure in the achievement of MBD control in HD patients.Esposito, P; Rampino, T; Gregorini, M; Tinelli, C; De Silvestri, A; Malberti, F; Coppo, R; Dal Canton, A.Esposito, P; Rampino, Teresa; Gregorini, Marilena; Tinelli, C; De Silvestri, A; Malberti, F; Coppo, R; DAL CANTON, Antoni

New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago

New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago

Iperfosfatemia in dialisi: la scelta del chelante

Le linee guida KDIGO del 2017 confermano le indicazioni delle precedenti sulla necessit\ue0 di mantenere i livelli sierici di fosforo nei pazienti in dialisi quanto pi\uf9 possibile vicino alle concentrazioni normali dello ione. Questi suggerimenti nascono da numerosi studi che hanno evidenziato sia una stretta associazione tra livelli di fosforemia ed eventi fatali e non fatali sia che circa il 30% dei pazienti emodializzati presenta livelli sierici elevati di fosforo. Le stesse linee guida KDIGO forniscono indicazioni terapeutiche sul controllo della iperfosforemia, sottolineando l\u2019importanza sia della nutrizione sia dell\u2019opportuna prescrizione dei chelanti del fosforo in considerazione del parziale controllo della iperfosforemia ottenibile mediante le tecniche dialitiche. Il chelante \u201cideale\u201d tuttora non esiste; tuttavia l\u2019 ampia disponibilit\ue0 di chelanti del fosforo consente di ottenere una terapia personalizzata cio\ue8 funzionale al singolo paziente. Questo contribuisce ad ottenere sia un miglior controllo della fosforemia con minori effetti collaterali sia di incrementare la aderenza (compliance) del paziente alla terapia chelante. La quantit\ue0 di pillole prescritta dal medico al paziente \ue8 inversamente correlata all\u2019aderenza terapeutica del paziente stesso. A rendere questo problema particolarmente importante \ue8 il peso enorme che ha la terapia chelante il fosforo sul carico di compresse assunto ogni giorno dai pazienti dializzati. Negli ultimi anni \ue8 disponibile un chelante non contenente calcio l\u2019ossidrossido sucroferrico, il cui potere legante il fosforo \ue8 molto elevato per cui si rende necessario prescrivere un numero limitato di pillole. Questa caratteristica dell\u2019ossidrossido sucroferrico \ue8 stata confermata dagli studi controllati e randomizzati finora disponibili. L\u2019ossidrossido sucroferrico pu\uf2 rappresentare una alternativa terapeutica, in monoterapia e in associazione, nel trattamento dell\u2019iperfosforemia. Studi sono in corso per verificare nella \u201creal life\u201d la incidenza di effetti collaterali gastroenterici evidenziati con l\u2019ossidrossido sucroferrico.Several studies have evidenced the association between high serum phosphorus concentrations and adverse events especially in patients on dialysis. Recent K-DIGO guidelines suggest lowering elevated phosphate levels toward the normal range. This goal should be achieved by combining dietary counseling, optimizing dialysis procedures and prescribing phosphate binders. Despite the availability of several binders, the "ideal" phosphate binder that combines high efficacy, low pills burden, minimal side effects and low cost is still not available. In clinical practice it is crucial to reach a high patient's compliance to therapy. The pill burden is the most relevant factor contributing to low compliance. This is the case of phosphate binder therapy that represents almost 50% of total pills prescribed to patients on dialysis. It has been evidenced an association between pills of phosphate binder and poor control of phosphorus and PTH. In recent years sucroferric oxyhydroxide is available as a new phosphate binder. Its peculiarity is an high phosphate binding capability that requires prescription of low number of pills per day. This characteristic has been confirmed by several randomized controlled trials. These trials have also evidenced that sucroferric oxyhydroxide may cause some gastrointestinal side effects. There is an ongoing study to confirm in "the real world" the incidence of side effects reported by controlled trials