111 research outputs found
[Treatment of hyperuricemia in CKD] - Trattamento dell’iperuricemia nel paziente nefropatico è giunto il momento di agire?
No full textNumerous epidemiological studies conducted in the general population indicate that hyperuricemia is associated with an increased risk of developing renal failure. Moreover, among those subjects who are already suffering from chronic kidney disease (CKD), hyperuricemia is associated with a more rapid progression of disease besides with an increased risk of mortality and cardiovascular events. However, to date, the causal role of hyperuricaemia in determining the onset and progression of cardiovascular and renal damage is not yet fully established. Therefore the indications for pharmacological treatment of hyperuricemia (and particulary of asymptomatic hyperuricemia) in patients with CKD are still assigned to the personal orientation of the physician. In order to produce an evidence-based clinical appraisal on this topic, we performed a comparative analysis that included all the prospective studies that have evaluated the impact of treatment with xanthine oxidase inhibithors (XOI) with respect to the onset and progression of CKD. Moreover, since in the past the treatment with XOI was associated with a high risk of toxicity in patients with impaired renal function, we analyzed the toxicity of these drugs for various degrees of renal function impairment summarizing indications, contraindications and recommended doses in patients affected by CKD. In the end, as conclusion of our analysis, we propose an algorithm aimed at guiding the clinical decisions about the treatment of hyperuricemia in patients with CKD
Supplemental Material, sj-docx-1-ptd-10.1177_08968608231209849 - Relationship between number of daily exchanges at CAPD start with clinical outcomes
No full textSupplemental Material, sj-docx-1-ptd-10.1177_08968608231209849 for Relationship between number of daily exchanges at CAPD start with clinical outcomes by Luca Nardelli, Antonio Scalamogna, Elisa Cicero, Federica Tripodi, Simone Vettoretti, Carlo Alfieri and Giuseppe Castellano in Peritoneal Dialysis International</p
Accelerated AGEing: The Impact of Advanced Glycation End Products on the Prognosis of Chronic Kidney Disease
No full textAdvanced glycation end products (AGEs) are aging products. In chronic kidney disease (CKD), AGEs accumulate due to the increased production, reduced excretion, and the imbalance between oxidant/antioxidant capacities. CKD is therefore a model of aging. The aim of this review is to summarize the present knowledge of AGEs in CKD onset and progression, also focusing on CKD-related disorders (cardiovascular diseases, sarcopenia, and nutritional imbalance) and CKD mortality. The role of AGEs as etiopathogenetic molecules, as well as potential markers of disease progression and/or therapeutic targets, will be discussed
Trattamento dell’iperuricemia nel paziente nefropatico: è giunto il momento di agire?
No full textNumerosi studi epidemiologici condotti nella popolazione generale indicano che l’iperuricemia si associa ad un incremento del rischio di sviluppare insufficienza renale. Inoltre, tra i soggetti che sono già affetti da una malattia renale cronica (MRC), l’iperuricemia si associa sia ad una più rapida progressione di malattia sia ad un significativo incremento della mortalità e degli eventi cardiovascolari. Tuttavia, ad oggi il ruolo causale dell’iperuricemia nel determinare l’insorgenza e la progressione del danno renale e cardiovascolare non è ancora completamente accertato, per cui le indicazioni al trattamento farmacologico dell’iperuricemia asintomatica nei pazienti con MRC sono ancora affidate all’orientamento personale del singolo medico. Al fine di stabilire se sia possibile esprimere un orientamento clinico basato sull’evidenza abbiamo eseguito un’analisi comparativa degli studi prospettici che hanno valutato l’impatto della terapia ipouricemizzante con inibitori della xantino ossidasi (IXAO) rispetto all’insorgenza e alla progressione del danno renale. Inoltre, dal momento che in passato nei soggetti con funzionalità renale ridotta il trattamento con IXAO è stato associato ad un elevato rischio di tossicità, abbiamo analizzato la tossicità di questi farmaci per vari gradi compromissione della funzione renale riassumendo indicazioni, controindicazioni e dosi consigliate nei pazienti affetti da MRC. In fine, a conclusione della nostra analisi abbiamo elaborato un algoritmo finalizzato ad orientare le decisioni cliniche in merito al trattamento dell’iperuricemia nei soggetti affetti da MRC.Numerous epidemiological studies conducted in the general population indicate that hyperuricemia is associated with an increased risk of developing renal failure. Moreover, among those subjects who are already suffering from chronic kidney disease (CKD), hyperuricemia is associated with a more rapid progression of disease besides with an increased risk of mortality and cardiovascular events. However, to date, the causal role of hyperuricaemia in determining the onset and progression of cardiovascular and renal damage is not yet fully established. Therefore the indications for pharmacological treatment of hyperuricemia (and particulary of asymptomatic hyperuricemia) in patients with CKD are still assigned to the personal orientation of the physician. In order to produce an evidence-based clinical appraisal on this topic, we performed a comparative analysis that included all the prospective studies that have evaluated the impact of treatment with xanthine oxidase inhibithors (XOI) with respect to the onset and progression of CKD. Moreover, since in the past the treatment with XOI was associated with a high risk of toxicity in patients with impaired renal function, we analyzed the toxicity of these drugs for various degrees of renal function impairment summarizing indications, contraindications and recommended doses in patients affected by CKD. In the end, as conclusion of our analysis, we propose an algorithm aimed at guiding the clinical decisions about the treatment of hyperuricemia in patients with CKD
A Markov Model of Gap Occurrence in Continuous Glucose Monitoring Data for Realistic in Silico Clinical Trials
No full textBackground and objective: Continuous glucose monitoring (CGM) sensors measure interstitial glucose concentration every 1-5 min for days or weeks. New CGM-based diabetes therapies are often tested in in silico clinical trials (ISCTs) using diabetes simulators. Accurate models of CGM sensor inaccuracies and failures could help improve the realism of ISCTs. However, the modeling of CGM failures has not yet been fully addressed in the literature. This work aims to develop a mathematical model of CGM gaps, i.e., occasional portions of missing data generated by temporary sensor errors (e.g., excessive noise or artifacts). Methods: Two datasets containing CGM traces collected in 167 adults and 205 children, respectively, using the Dexcom G6 sensor (Dexcom Inc., San Diego, CA) were used. Four Markov models, of increasing complexity, were designed to describe three main characteristics: number of gaps for each sensor, gap distribution in the monitoring days, and gap duration. Each model was identified on a portion of each dataset (training set). The remaining portion of each dataset (real test set) was used to evaluate model performance through a Monte Carlo simulation approach. Each model was used to generate 100 simulated test sets with the same size as the real test set. The distributions of gap characteristics on the simulated test sets were compared with those observed on the real test set, using the two-sample KolmogorovSmirnov test and the Jensen-Shannon divergence. Results: A six-state Markov model, having two states to describe normal sensor operation and four states to describe gap occurrence, achieved the best results. For this model, the Kolmogorov-Smirnov test found no significant differences between the distribution of simulated and real gap characteristics. Moreover, this model obtained significantly lower Jensen-Shannon divergence values than the other models.Conclusions: A Markov model describing CGM gaps was developed and validated on two real datasets. The model describes well the number of gaps for each sensor, the gap distribution over monitoring days, and the gap durations. Such a model can be integrated into existing diabetes simulators to realistically simulate CGM gaps in ISCTs and thus enable the development of more effective and robust diabetes management strategies.& COPY; 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/
Impact of Carbohydrate Counting Error on Glycemic Control in Open-Loop Management of Type 1 Diabetes: Quantitative Assessment Through an in silico Trial
No full textBackground: In the management of type 1 diabetes (T1D), systematic and random errors in carb-counting can have an adverse effect on glycemic control. In this study, we performed an in silico trial aiming at quantifying the impact of different levels of carb-counting error on glycemic control. Methods: The T1D patient decision simulator was used to simulate 7-day glycemic profiles of 100 adults using open-loop therapy. The simulation was repeated for different values of systematic and random carb-counting errors, generated with Gaussian distribution varying the error mean from -10% to +10% and standard deviation (SD) from 0% to 50%. The effect of the error was evaluated by computing the difference of time inside (∆TIR), above (∆TAR) and below (∆TBR) the target glycemic range (70-180mg/dl) compared to the reference case, that is, absence of error. Finally, 3 linear regression models were developed to mathematically describe how error mean and SD variations result in ∆TIR, ∆TAR, and ∆TBR changes. Results: Random errors globally deteriorate the glycemic control; systematic underestimations lead to, on average, up to 5.2% more TAR than the reference case, while systematic overestimation results in up to 0.8% more TBR. The different time in range metrics were linearly related with error mean and SD (R2>0.95), with slopes of βMEAN=0.21, βSD=-0.07 for ∆TIR, βMEAN=-0.25, βSD=+0.06 for ∆TAR, and βMEAN=0.05, βSD=+0.01 for ∆TBR. Conclusions: The quantification of carb-counting error impact performed in this work may be useful understanding causes of glycemic variability and the impact of possible therapy adjustments or behavior changes in different glucose metrics
On-line calibration of glucose sensors from the measured current by a time-varying calibration function and Bayesian priors
No full textMinimally-invasive continuous glucose monitoring (CGM) sensors measure in the subcutis a current signal which is converted into interstitial glucose (IG) concentration by a calibration process periodically updated using fingerstick blood glucose (BG) references. Though important in diabetes management, CGM sensors still suffer from accuracy problems. Here, we propose a new on-line calibration method improving accuracy of CGM glucose profiles with respect to manufacturer calibration
A Real-Time Continuous Glucose Monitoring Based Algorithm to Trigger Hypotreatments to Prevent/Mitigate Hypoglycemic Events
No full textCOMPARISON OF DIFFERENT CALIBRATION STRATEGIES FOR CONTINUOUS GLUCOSE MONITORING SENSORS
No full textEXPANDING THE REPLAYBG SIMULATION METHODOLOGY DOMAIN OF VALIDITY TO SINGLE-DAY MULTIPLE-MEAL SCENARIOS
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