Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Chemical, microbiological and ecotoxicological monitoring of biodegradation in PAH-contaminated sediments

This study was performed in order to evaluate factors that influence the magnitude and rates of PAH biodegradation processes in contaminated sediments at a laboratory scale. Several factors influence the feasibility and effectiveness of sediment biodegradation: (1) the existence of an indigenous sediment microbial population capable of degrading PAH contaminants, (2) the availability of the contaminants to sediment microbial population (bioavailability), (3) the optimization of environmental factors such as temperature and oxygen, and nutrients availability, (4) the influence of a natural surfactant on PAH degradation velocity. The rate and extent of PAH biodegradation were evaluated by sediment-slurry experiments by monitoring chemical, microbiological and ecotoxicological parameters. The last focus of our work was to investigate the source and the extent of toxicity in slurry experiments using the Microtox\uae test both on solid and liquid phases, in order to determine any enhancement or shift in toxicity over the time and/or between the solid and liquid phases due to release or increased bioavailability of the target contaminants

Biotreatability of Polycyclic Aromatic Hydrocarbons in Brackish Sediments: Preliminary Studies of an Integrated Monitoring

An integrated monitoring, of chemical, microbiological and ecotoxicological parameters, was performed for a biotreatability study of polycyclic aromatic hydrocarbons (PAHs)—contaminated brackish sediments. Three slurry reactors were prepared, consisting of (a) a slurry with sediment and seawater called TQ slurry, to evaluate the intrinsic bioremediation potential, (b) a slurry with the addition of a selected microbial consotrium called BIO slurry, to evaluate the bioaugmentation effect, (c) a slurry with the addition of Soya lecithin called LEC slurry, to evaluate the effect of the addition of a natural surfactant. Biodegradation results showed that both BIO and LEC slurries enhanced PAHs removal, increasing the biodegradation rate for 5- and 6-ring PAHs. Furthermore, ecotoxicological response (Microtoxs assay on whole sediment, aqueous extract and organic extract) demonstrated a detoxification of the PAHs initial mixture only for BIO slurry. The findings that aerobic PAHs degradation can be stimulated via inoculation with adapted sediment bacteria suggest that a bioaugmentation process may be a useful strategy for ex-situ treatment

Kidney dysfunction and related cardiovascular risk factors among patients with type 2 diabetes

Background. Kidney dysfunction is a strong predictor of end-stage renal disease and cardiovascular (CV) events. The main goal was to study the clinical correlates of diabetic kidney disease in a large cohort of patients with type 2 diabetes mellitus (T2DM) attending 236 Diabetes Clinics in Italy.Methods. Clinical data of 120 903 patients were extracted from electronic medical records by means of an ad hoc-developed software. Estimated glomerular filtration rate (GFR) and increased urinary albumin excretion were considered. Factors associated with the presence of albuminuria only, GFR < 60 mL/min/1.73 m(2) only or both conditions were evaluated through multivariate analysis.Results. Mean age of the patients was 66.6 +/- 11.0 years, 58.1% were male and mean duration of diabetes was 11.1 +/- 9.4 years. The frequency of albuminuria, low GFR and both albuminuria and low GFR was 36.0, 23.5 and 12.2%, respectively. Glycaemic control was related to albuminuria more than to low GFR, while systolic and pulse pressure showed a trend towards higher values in patients with normal kidney function compared with those with both albuminuria and low GFR. Multivariate logistic analysis showed that age and duration of disease influenced both features of kidney dysfunction. Male gender was associated with an increased risk of albuminuria. Higher systolic blood pressure levels were associated with albuminuria, with a 4% increased risk of simultaneously having albuminuria and low GFR for each 5 mmHg increase.Conclusions. In this large cohort of patients with T2DM, reduced GFR and increased albuminuria showed, at least in part, different clinical correlates. A worse CV risk profile is associated with albuminuria more than with isolated low GFR