Lipoprotein-associated phospholipase A2 as cardiovascular risk factor and therapeutic target in nephropatic patients

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a serine lipase associated with Low-Density Lipoproteins, that increases the oxidative stress in atherosclerotic lesions and makes the plaque instable. Lp-PLA2 is recognized as a risk factor for cardiovascular and peripheral artery disease in general population, in cardiac and dysmetabolic patients, but no data are available for subjects with renal failure. The aim of the present PhD thesis was to investigate the role of Lp-PLA2 among patients with advanced renal failure. Chapter 1. In 102 hemodialyzed patients, it has been demonstrated that Lp-PLA2, activity is increased and associated with a more inflammatory phenotype. Chapter 2. In the first clinical observational study, it was demonstrated for the first time that Lp PLA2 is an independent risk factor for cardiovascular morbidity and mortality in 102 hemodialyzed subjects, followed for 3 years. Chapter 3. In the second clinical observational study, LP-PLA2 was recognized, for the first time, as independently associated with peripheral artery disease, in 102 dialyzed subjects followed for 5 years. Chapter 4. Here, it is reported a personal experience, demonstrating that lipoprotein apheresis -PLA, and improves lower limb ulcers, just confirming its role as additional therapy. Chapter 5. It was demonstrated that: first, the Mediterranean diet is associated with lower levels of LP-PLA2 in 41 subjects with advanced renal failure. Second, the low protein diet is effective in decreasing Lp-PLA2, in 28 subjects with advanced renal failure. In conclusion with this PhD project it was demonstrated that, also among renal patients, Lp-PLA2 could be considered a risk factor for acute cardiovascular morbidity and mortality and peripheral artery disease. Lp-PLA2 could also represent a useful target for non-pharmacological approaches (lipoprotein-apheresis) and nutritional therapy

SO045A NATIONWIDE SURVEY ON RADIATION RISK OF CANCER FROM MEDICAL IMAGING IN END STAGE KIDNEY DISEASE AND IN TRANSPLANT PATIENTS

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Probiotics-addicted low-protein diet for microbiota modulation in patients with advanced chronic kidney disease (ProLowCKD): A protocol of placebo-controlled randomized trial

Abstract Microbiota is a term coined to describe the population of bacteria, viruses and fungi that inhabit in symbiosis within a living host. A connection between unbalanced microbiota and chronic kidney disease has been established. In these patients, high levels of urea reach the intestine promoting the overgrowth of bacterial species that are prone to generate uremic toxins. Due to the high morbidity and mortality of this condition, a large number of therapeutic approaches to reduce inflammation and microbial uremic toxins have been proposed, with controversial results. A low protein diet, with a protein intake of 0.6–0.8 g/kg of body weight, is a useful and historically pursued option with this regard. The aim of our study is to evaluate, among patients with advanced renal failure not on dialysis, the synergic beneficial effects of this diet and the selected probiotics Bifidobacterium longum (mix DLBL) and Lactobacillus reuteri LRE02 (DSM 23878)

Прототип автоматической системы экстренного торможения транспортного средства

Разработка, сборка и испытание прототипа автономной системы экстренного торможения транспортного средства на основе 8-битного микроконтроллера AVR типа ATmega16 и ультразвукового дальномера HC-SR04, срабатывающей при приближении к объекту на расстояние около 10 см. Программу микроконтроллера будет написана на языке Си с использованием программатора STK-500.Development, assembly and testing of the prototype of the autonomous emergency braking system of a vehicle based on the 8-bit AVR microcontroller type ATmega16 and ultrasonic rangefinder HC-SR04, triggered when approaching the object at a distance of about 10 cm. The program of the microcontroller will be written in C language using the programmer STK -500

Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet

Background. In medicine, “compliance” indicates that the patient complies with the prescriber’s recommendations, “adherence” means that “the patient matches the recommendations” and “concordance” means “therapeutic alliance” between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. Patients. Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A2 (Lp-PLA2) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. Results. nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA2, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. Conclusion. This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in “adherent” and “concordant” patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions

Lipoprotein profile, lipoprotein-associated phospholipase A2 and cardiovascular risk in hemodialysis patients

Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis patients; the increased risk of cardiovascular disease is due to accelerated atherosclerosis, inflammation and impaired lipoprotein metabolism. We aimed to evaluate lipoprotein-associated phospholipase A2 (Lp-PLA2) and some pro-inflammatory aspects of the lipoprotein profile in dialyzed patients in order to evaluate the relationship with the accelerated atherosclerosis and vascular accidents

Radiation exposure from medical imaging in dialyzed patients undergoing renal pre-transplant evaluation

BACKGROUND AND AIM: Ionizing radiation exposure from medical procedures is rising sharply-the per-capita annual effective dose in the US is 3.0 millisieverts (mSv). Hemodialyzed and kidney transplanted patients receive still higher doses of ionizing radiation due to the presence of multiple comorbidities. The aim of this study was to assess the cumulative effective dose (CED) among dialyzed patients undergoing renal pre-transplant evaluation. PATIENTS AND METHODS: We evaluated 70 hemodialysis patients between June 2009 and December 2014, aged 46.4 \ub1 12.0 years. The number and type of radiologic procedures were collected through the Radiology Information System. CED was expressed as total mSv/patient and annual CED (mSv/patient/year). RESULTS: A total of 744 radiologic procedures were performed, accounting for 3869 mSv of ionizing radiation: conventional radiology, computed tomography and nuclear medicine accounted for 78, 14 and 8 % of the procedures, but they represented, respectively, 8, 83 and 9 % of the total CED. The mean (median) annual CED was 35 (7) mSv/patient/year, while total CED was 72 (32) mSv/patient. Thirty-seven patients were active waitlisted and received 47 (10) mSv during the pre-transplant evaluation and 36 (5) mSv during the waiting phase to maintain active status. Concerning cancer risk, 4 (7 %) patients were classified at low risk (<3 mSv/year), 19 (35 %) at moderate risk (3 to <20 mSv/year), 8 (15 %) at high risk (20 to <50 mSv/year), and 23 (43 %) at very high risk ( 6550 mSv/year). CONCLUSIONS: Our study demonstrated that during renal pre-transplant evaluation, dialyzed patients receive a high dose of ionizing radiation. Considering that transplanted individuals have a high incidence of cancer due to multifactorial etiology, it is mandatory to reduce the ionizing radiation imaging

Does Mediterranean Adequacy Index Correlate with Cardiovascular Events in Patients with Advanced Chronic Kidney Disease? An Exploratory Study

The Mediterranean Diet (MD) is a healthy dietary pattern, demonstrated to reduce the risk of cancer, diabetes, cardiovascular and neurodegenerative diseases, and early death. The Mediterranean Adequacy Index (MAI) is used to measure adherence to the MD in perspective studies in the general population and correlates with cardiovascular events. The aim of this study was to calculate the MAI among patients with advanced chronic kidney disease (CKD) and correlate it with traditional uremic, microbiota-derived, and proatherogenic toxins as well as nutritional status, quality of life, and cardiovascular events. A total of 60 adult patients with advanced CKD were enrolled and their MAI was calculated. According to the median value, patients were divided into lower (l-MAI, &lt;1.80) and higher (h-MAI, &ge;1.80) MAI groups. Biochemical parameters, microbiota-derived and proatherogenic toxins (p-Cresyl sulphate, Indoxyl-sulphate, and Lipoprotein-associated phospholipase A2), nutritional status, quality of life, and cardiovascular events that occurred in the previous three years were recorded. The mean value of the MAI was 2.78 &plusmn; 2.86. The MAI was significantly higher in foreigners (median (IQR) 6.38 (8.98) vs. 1.74 (1.67), p &lt; 0.001) and diabetic patients. The l-MAI and h-MAI groups had similar routinary blood, p-Cresyl-sulphate, Indoxyl-sulphate, and Lp-PLA2 as well as nutritional status and quality of life parameters. The MAI was not associated with previous cardiovascular events and did not correlate with cardiovascular events in CKD patients. New and nephro-tailored indexes are warranted to evaluate nutritional therapy in CKD patients

Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet

In medicine, “compliance” indicates that the patient complies with the prescriber’s recommendations, “adherence” means that “the patient matches the recommendations” and “concordance” means “therapeutic alliance” between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. Patients. Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A2 (Lp-PLA2) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. Results. nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA2, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. Conclusion. This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in “adherent” and “concordant” patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions