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Validazione clinica dell'analisi vettoriale di bioimpedenza (BIVA) nell'insuffcienza cardiaca, nella disidratazione e nell'insufficienza renale cronica in emodialisi
Full text linkQuesto volume raccoglie i risultati di alcuni degli studi a cui ho partecipato durante il corso del mio Dottorato in “ Fisiopatologia Cliniche e Scienze Nefrologiche”.
Il tema che ho approfondito maggiormente riguarda la valutazione dello stato di idratazione nel paziente afferente al Pronto Soccorso, interessandomi sia dei pazienti con scompenso cardiaco acuto e sovraccarico di liquidi, sia dei pazienti con disidratazione sintomatica.
Nei pazienti con scompenso cardiaco ho inoltre valutato l’utilità dell’analisi vettoriale di bioimpedenza quale strumento prognostico, approfondendo la tematica anche nei pazienti in trattamento emodialitico trisettimanale.
L’attività di ricerca durante questo studio è riuscita in questi 3 anni a stabilire:
- nuove modalità diagnostiche semplici nell’esecuzione e di basso impatto economico che permettano una valutazione rapida ed efficace dello stato di idratazione del paziente con patologie acute;
- nuovi criteri di stratificazione prognostica che permettano di inquadrare precocemente la possibile evoluzione del paziente
Proteinuria and blood pressure instead of urine volume are risk factors for progression of renal disease.
No full text
Equivalence of information from single frequency v. bioimpedance spectroscopy in bodybuilders
No full textBr J Nutr. 2007 Jan;97(1):182-92.
Equivalence of information from single frequency v. bioimpedance spectroscopy in bodybuilders.
Piccoli A, Pastori G, Codognotto M, Paoli A.
Source
Department of Medical and Surgical Sciences, University of Padova, Italy. [email protected]
Abstract
In bioelectrical impedance spectroscopy (BIS), it is assumed that the current path is only extracellular at the lowest frequencies and that it is both extra- and intracellular at the highest frequencies. We tested validity of BIS assumptions in bodybuilders who have an increased intracellular volume due to hypertrophy of muscle fibres. The study was observational cross-sectional in a study group of thirty professional bodybuilders compared with thirty control subjects. Resistance (R) and reactance (Xc) vector components fitting the Cole's arc with BIS (SFB3 analyser) were compared with components at 50 kHz frequency. The average Cole's arc in bodybuilders was significantly smaller and shifted to the left in the R-Xc plane (both R and Xc values were smaller at any individual frequency). The ratio of Xc at 5 kHz and Xc at the characteristic frequency was 70% in bodybuilders and 64% in control subjects, indicating a huge intracellular flow of the electric current at low frequencies in both groups (expected ratio close to 0 if the current path was extracellular). As a consequence of a common path, the correlation coefficient between R values at 50 kHz and at other frequencies (from 0 to infinity) was 0.94 to 1.00. The correlation between total body water estimated with BIS or with R at 50 kHz was 0.98. Hence, there was equivalence between information provided by the vector components R and Xc at 50 kHz and that provided by 496 correlated vectors that were measured with BIS
Influence of tonsillectomy on the progression of mesangioproliferative glomerulonephritis
No full textNephrol Dial Transplant. 2010 Aug;25(8):2583-9. Epub 2010 Mar 2.
Influence of tonsillectomy on the progression of mesangioproliferative glomerulonephritis.
Piccoli A, Codognotto M, Tabbi MG, Favaro E, Rossi B.
Source
Department of Medical and Surgical Sciences, Nephrology Clinic, University of Padova, Padova, Italy. [email protected]
Abstract
BACKGROUND:
Little information is available about the efficacy of tonsillectomy on long-term renal survival of patients with primary IgA nephropathy (IgAN).
METHODS:
In this retrospective cohort study, we considered 61 patients with IgAN who had tonsillectomy (n = 15) or not (n = 46) and compared them with 121 control patients with mesangioproliferative glomerulonephritis (MesGN) free of IgA deposits, who had tonsillectomy (n = 49) or not (n = 72). We evaluated the progression from a normal function [estimated glomerular filtration rate 60-220 mL/min/1.73 m(2), chronic kidney disease (CKD) stage 1 and 2] to a moderate renal dysfunction in CKD stage 3, which was considered the outcome.
RESULTS:
The mean duration of follow-up was 250 months (12-300 months) in the whole group of 182 patients. The survival to progression to stage 3 was 88% after 10 years, 71% after 20 years and 53% after 25 years. It was 72% after 20 years in both groups. Tonsillectomy was not significantly associated with CKD progression. Significant prognostic factors were age (P = 0.01), initial CKD stage (P = 0.03), proteinuria (P = 0.03), persistent proteinuria (P < 0.001) and diastolic blood pressure (P = 0.01). In the multivariate analysis (Cox model), there was no significant effect of tonsillectomy adjusted for the type of glomerulonephritis, initial CKD stage, persistent proteinuria, diastolic blood pressure and age. Only persistent proteinuria adjusted for the other factors was significantly associated with CKD progression (hazard ratio of 6.2, 95% confidence interval 3.1-12.7, P < 0.001).
CONCLUSIONS:
Tonsillectomy was not associated with a different progression rate of IgAN nor of MesGN after 20 years of follow-up
Combined evaluation of nutrition and hydration in dialysis patients with bioelectrical impedance vector analysis (BIVA).
No full textAbstract
BACKGROUND & AIMS:
Body hydration changes continuously in hemodialysis patients. The Subjective Global Assessment (SGA) is used for the nutritional evaluation but it does not allow a direct evaluation of hydration. Bioelectrical impedance vector analysis (BIVA) is very sensitive to hydration. The potential of the combined evaluation of hydration and nutrition with SGA and BIVA is still lacking.
METHODS:
Observational cross-sectional study on 130 (94 Male) uremic patients undergoing chronic hemodialysis three times a week. Nutritional status was evaluated with the SGA. Each subject was classified as SGA-A (normal nutritional status), SGA-B (moderate malnutrition), or SGA-C (severe malnutrition). Body hydration was evaluated with BIVA. The two vector components resistance (R) and reactance (Xc) were normalized by the subject's height and standardized as bivariate Z-score, i.e. Z(R) and Z(Xc).
RESULTS:
Undernutrition influenced impedance vector distribution both before and after a dialysis session. In pre-dialysis, the mean vector of SGA A was inside the 50% tolerance ellipse. In SGA B and C, Z(R) was increased and Z(Xc) decreased, indicating a progressive loss of soft tissue mass. Fluid removal with dialysis increased both Z(R) and Z(Xc) in SGA A and B but not in C. With ROC curve analysis on the slope of increase, we found the cutoff value of 27.8° below which undernutrition was present, either moderate or severe. The area under the ROC curve was 77.7° (95% CI 69.5-84.5, P < .0001) with sensitivity 75.9%, specificity 78.6%, positive predicted value 74.6%, and negative predicted value 79%.
CONCLUSIONS:
The distribution of impedance vectors is associated with the SGA classification of patients. The change in body hydration in each SGA category can be detected with BIVA
Body mass index and agreement between bioimpedance and anthropometry estimates of body compartments in anorexia nervosa
No full textEffect of a dialysis session on the prognostic values of NT-proBNP, troponins, endothelial damage and inflammation biomarkers
No full textAbstract
BACKGROUND: In hemodialysis, the relationship between the increased concentration of natriuretic peptides and volume overload, inflammatory activity, endothelial dysfunction, left ventricular function and mass, and silent ischemic events is not clear. To investigate the relationship, a 3-year prospective cohort study was conducted in 50 adult hemodialysis patients in NYHA class I-II who were free from diabetes and ischemic heart events.
METHODS: Doppler echocardiogram, plasma NT-proBNP, troponin T and I, CRP, TNF alpha, big-endothelin 1, and cystatin-C, were determined both before and after a dialysis session. The outcome was all-cause death.
RESULTS: 13 out of 50 patients died. Survival curves significantly differed by age (above vs. below the median 68 yrs), NT-proBNP (9719 pg/mL), troponin T (0.03 ng/mL), C-reactive protein (4.8 mg/L), left atrial volume index (51 mL/sqm), ejection fraction (61%), and diastolic pattern. In the Cox model only NT-proBNP (cutoff 10000 pg/mL) had a significant hazard ratio (4.1). Post-HD measurements of NT-proBNP, troponin T, and CRP maintained their prognostic value. The high correlation between pre and post values of NT-proBNP, and the lack of correlation with ultrafiltration volume excluded a role for acute fluid removal on its regulation.
CONCLUSIONS: The increased level of NT-proBNP is the most important prognostic factor even in the absence of severe heart dysfunction and myocardial ischemic events, without any relationship with endothelial dysfunction, inflammatory biomarkers, or with acute fluid removal. A cutoff value of NT-proBNP of 10000 pg/mL could be used to identify hemodialysis patients with a higher risk of death
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