Protein-Energy Wasting and Mortality in Chronic Kidney Disease

Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome

Kidney Protein Dynamics and Ammoniagenesis in Humans with Chronic Metabolic Acidosis

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Carico assistenziale e bisogni del caregiver della persona in fase avanzata di malattia oncologica nella provincia di Reggio Emilia. Ricp- La rivista italiana di cure palliative 2017;vol.2-Estate 2017.

Il presente studio, relativo alla realtà di Reggio Emilia, si propone di analizzare il profilo e le necessità del caregiver informale della persona in fase avanzata di malattia oncologica, alla luce della attuale crisi socioeconomica. La popolazione studiata proviene da tre dei sei Day Hospital e dai due hospice della provincia reggiana. Per la raccolta delle informazioni è stato utilizzato un questionario anonimo strutturato tratto da Corli et al (2005). Oltre alle caratteristiche dei caregiver e delle persone malate, lo studio ha voluto indagare l’entità dell’impegno assistenziale, la relazione con il setting di cura e l’onere economico a carico della famiglia. Il profilo del caregiver emerso dal nostro studio (prevalentemente donna, di mezza età, coniuge o figlio del malato e non lavoratore) non si discosta da quello individuato da precedenti indagini. I risultati suggeriscono che i caregiver di pazienti non autosufficienti, coloro che prestano assistenza da più di due anni e i caregiver completamente soli nell’accudimento, sono i soggetti a maggior rischio di sovraccarico, verso cui indirizzare tempestivamente interventi di sostegno. Un lavoro d’equipe interdisciplinare potrebbe essere il modo migliore per fornire un’assistenza adeguata e andare incontro alle necessità non solo dei pazienti, ma anche delle loro famiglie.The present study aims to describe characteristics and needs of informal caregivers of patients with advanced cancer phase, in the province of Reggio Emilia. The sample was recruited in three of the six Day Hospital and in both the hospice of the area. Data were collected using the anonymous standardized questionnaire of Corli et al (2005). The questionnaire covered socio-demographic characteristics of both the caregiver and patient, caregiving characteristics, the relationship with the health care service and the economic burden for each family. Caregiver profile did not change compared to previous investigations. The results suggest that to be a caregiver of non self-sufficient patients, a caregiving period longer than two years and to be a caregiver without any care support from other family members, are characteristics associated with caregiving burden outcomes, that should be considered when developing targeted supporting interventions. A multidisciplinary approach seems to be the best way to provide a complete health care assistance and to give an appropriate answer to caregiver and patients needs