1,721,014 research outputs found
[Physical exercise in chronic kidney disease: an empty narrative or an effective intervention?]
No full textChronic kidney disease (CKD) is growing worldwide, with increasing numbers of patients facing end-stage renal disease, high cardiovascular risk, disability and mortality. Early recognition of CKD and improvements in lifestyle are crucial for maintaining or recovering both physical function and quality of life. It is well known that reducing sedentariness, increasing physical activity and initiating exercise programs counteract cardiovascular risk and frailty, limit deconditioning and sarcopenia, and improve mobility, without side-effects. However, these interventions, often requested by CKD patients themselves, are scarcely available. Indeed, it is necessary to identify and train specialists on exercise in CKD and to sensitize doctors and health personnel, so that they can direct patients towards an active lifestyle. On the other hand, effective and sustainable interventions, capable of overcoming patients' barriers to exercise, remain unexplored. Scientific societies, international research teams and administrators need to work together to avoid that exercise in nephrology remains an empty narrative, a niche interest without any translations into clinical practice, with no benefit to the physical and mental health of CKD patients
[Vascular calcification in chronic kidney disease]
No full text: Cardiovascular risk is higher in patients with chronic kidney disease (CKD) or with End-Stage Renal Disease (ESRD) than general population because in addition to the traditional cardiovascular (CV ) risk factors, CKD patients also have others non-traditional CV risk factors linked to CKD. Among these factors, presence and progression of coronary calcifications (CAC) are considered very important in CKD or ESRD patients in recent years. A number of noninvasive imaging methods are available to detect the presence, extent and progression of CAC. In this review, we discuss the importance of CAC as non-traditional CV risk factors in CKD patients and the noninvasive methods most frequently used to assess CAC
[Rhabdomyolysis: role of the nephrologist]
No full text: Rhabdomyolysis is characterized by skeletal muscle necrosis resulting in release of large amounts of toxic muscle cell components, including electrolytes, myoglobin, and other sarcoplasmic proteins into circulation. Creatinine phosphokinase (CPK) and myoglobin serum levels constitute the diagnostic hallmark. Nowadays, drugs have become one of the most frequent cause of rhabdomyolysis and acute kidney injury (AKI) is a potential life-threatening complication. The mechanisms involved in the development of AKI in rhabdomyolysis are intrarenal vasoconstriction, direct and ischemic tubule injury and tubular obstruction. According to some clinical series, the mortality rate in patients who develop AKI due to rhabdomyolysis is highly variable. The cornerstone in managing this condition is the early, aggressive repletion of fluids. The composition of replacement fluid remains controversial. Saline and sodium bicarbonate, especially in patients with metabolic acidosis, seem to be a reasonable approach. When AKI produces refractory hyperkalemia, acidosis or volume overload, renal replacement therapy is indicated
Exercise, Dialysis, and Environment: A Narrative Review in an Ecological Perspective
No full textBackground: Patient empowerment and environmental sustainability may contribute to creating efficient and resilient healthcare models. Chronic kidney diseases call for a sustainable approach aimed at improving physical function and mental health of patients and possibly contributing to the slowing down of the evolution toward the end stage of renal disease (ESRD) with a reduction of the environmental and economic impact. Summary: Multidisciplinary interventions should be implemented particularly, at the final stages when patients are exposed to sedentariness, reduced health-related quality of life (HR-QoL), high cardiovascular morbidity and mortality, and the healthcare services to high costs, and participation in environmental pollution. Ecological strategies based on specific nutritional approaches, exercise, and environment should be designed and tested. In particular, the introduction to physical exercise represents a useful replacement therapy to counteract the hazards derived from the sedentary behavior of ESRD patients, with low physical function associated with poor clinical outcomes. A more active and healthy lifestyle, particularly in the natural environment, could impact HR-QoL, mental and physical well-being but also on socialization, with lower anxiety and fatigue stress levels. Otherwise, combining sustainable exercise models into the patient’s daily routine can be enhanced by the biophilic design called to reproduce a natural environment in the dialysis center. Finally, the involvement of the personnel and the health professionals in properly managing the exercise interventions and the related factors (location, modality, dose, intensity, and duration) might improve the patients’ participation. In particular, ecological programs should be broadly inclusive and aimed to target the lowest performing populations through minimal feasible doses of exercise. Key Messages: Moving toward an ecological framework of lifestyle change in the very advanced stages of kidney disease, the potential synergies between environment, diet, and exercise may improve the physical and mental health of the patients and reduce the impact of dialysis
The level of post-traumatic growth in kidney transplant recipients with long term duration of graft
No full textBackground and Aims: Kidney transplant (KT)can cause a psychological trauma due to changes in self-perception, in interpersonal relationships, and in the philosophy of life. However, the exposure to this traumatic event might lead to not only stress disorders but also positive growth. Primary aim of study was to evaluate the prevalence of post-traumatic growth (PTG)in KTRs. Secondary aim was to explore any association between PTG and psychiatric, psychosocial and medical variables, specifically psychiatric diagnoses, demoralization, as well as physical and general problems or symptoms. Method: KTRs followed up in a single nephrology Unit, were evaluated. Each patient was individually administered MINI International Neuropsychiatric Interview 6.0. and DCPR interview to evaluate ICD-10 psychiatric diagnoses and DCPR diagnoses. PTG Inventory (PTGI), ESAS-revised, CPC, and DS-IT were given as self-report instruments to be filled in. PTGI was used to investigate positive psychological experience of patients after KT on a 0 to 5-point Likert scale(0=I did not experience this change as a result of my KT;5=I experienced this change to a very great degree as a result of my KT).It consists of 21 items divided in five factors: New Possibilities(NP),Relating to Others(RO),Personal Strength(PS),Spiritual Change(SC),and Appreciation of Life(AL).ESAS-revised, DS-IT and CPC were used to examine the severity of physical and psychological symptoms on a 0 to 10 scale; to measure the severity of demoralization on a 0 to 4 scale and to evaluate the physical and general problems in a yes/no(0–1)format, respectively. Results: Data pertaining to 134 out of 143 consecutive outpatients were collected. Clinical characteristics of sample and ranking order of ICD and DCPR diagnoses are shown in Tab.1.Mean score of PTGI total of sample was 52.02 (±20.69).SC(4.26±2.94)experience was markedly lower than RO(16.26±8.18),NP(11.25±5.56),PS(10.91±5.33)and AL(9.77±3.72).PS changes were higher in KTRs with adaption ICD diagnosis(p<0.001);while no SC change was found in KTRs with an ICD diagnosis of mood disorders(p<0.01).DCPR diagnosis of alexithymia and Irritability were associated with low RO score(13.74±6.51 and 13.97±6.95,respectively)(p <0.05).AL subscale was positively correlated with ESAS anxiety symptom and ESAS psychological distress sub-score(p<0.05); and negatively with DS-lT loss of meaning and purpose subscale(p<0.05).Women(57.2±23.07)had higher scores of PTGI than men (49.5±19.04)(p <0.05).No significant correlation was found between CPC problems, blood chemistry and socio-demographic characteristics, including months after transplant. Conclusion: This study shows that KTRs had moderate-to-high levels of PTG which did not change after KT overtime. Also, lower RO score was associated with DCPR diagnosis of alexithymia, highlighting the potential ability of PTGI to identify KTRs who need psychological support. Further multicentre studies should be conducted to investigate the positive psychological changes after KT
[Muscle-wasting in end stage renal disease in dialysis treatment: a review]
No full text: Progressive and generalized loss of muscle mass (muscle wasting) is a frequent complication in dialysis patients. Common uremic signs and symptoms such as insulin-resistance, increase in glucocorticoid activity, metabolic acidosis, malnutrition, inflammation and dialysis per se contribute to muscle wasting by modulating proteolytic intracellular mechanisms (ubiquitin-proteasome system, activation of caspase-3 and IGF-1/PI3K/Akt pathway). Since muscle wasting is associated with an increase in mortality, bone fractures and worsening in life quality, a prompt and personalised diagnostic and therapeutic approach seems to be essential in dialysis patients. At present, nuclear magnetic resonance (NMR), computed tomography (CT), dual-energy x-ray absorptiometry (DXA), impedance analysis, bioelectric impedance analysis (BIA) and anthropometric measurements are the main tools used to assess skeletal muscle mass. Aerobic and anaerobic training programmes and treatment of uremic complications reduce muscle wasting and increase muscle strength in uremic patients. The present review analyses the most recent data about the physiopathology, diagnosis, therapy and future perspectives of treatment of muscle wasting in dialysis patients
Identification of new α-galactosidase A mutation responsible for Fabry disease: A case report
No full textFabry disease (FD) is an X- linked lysosomal storage disorder due to α-galactosidase A deficiency caused by mu- tation in the GLA gene [1, 2]. To date, more than 770 mutations have already been identi- fied, most of them are private alterations [3].
Here we report the case of a Bangladeshi patient who had been hospitalized because of abdominal pain and proteinuric renal failure due to a rare mutation in the GLA gene
Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data
No full textAlthough the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKT
THE EFFECT OF VITAMIN D ON BONE MINERAL DENSITY: A REAL-LIFE STUDY IN LONG-TERM KIDNEY TRANSPLANT RECIPIENTS NEVER SUPPLEMENTED
No full textBackground and Aims: Vitamin D insufficiency has been associated to reduced bone mineral density (BMD) in kidney transplant patients (KTRs). However, data of vitamin D supplementation on BMD is still conflicting especially for long-term KTRs. The purpose of our study is to ascertain the effect of 25-OH-vitamin D (25-OH-D) supplementation on the BMD over a follow-up period up to 3 years, in a real-life cohort of long-term KTRs never supplemented with 25-OH-D and no treated with active vitamin D, bisphosphonate and calciomimetics. Method: Demographic, clinical and laboratory data were collected. Inclusion criteria were: 1) being a recipient of a kidney from a cadaveric or living donor; 2) age ≥ 18 years; 3) no therapy with inactive vitamin D sterols. Patients with parathyroidectomy, and/or history of bone fractures were excluded. BMD was evaluated with standard DEXA, performed at baseline (before vitamin D supplementation) and at the end of study period. BMD was assessed at lumbar vertebral bodies (LV) and right femoral neck (FN) by a single operator. Bone mineral content (BMC) was calculated in grams (g), bone area in centimetres squared (cm2), and BMD in g/cm2 (BMC divided by the area). According to WHO criteria, results were expressed as T-score (standard deviation [SD] relative to young healthy adults), and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score < −1 and > −2.5 SD, respectively. According to plasma levels, 25-OH-D was supplemented as recommended for general population. Linear mixed model analysis was implemented to test the impact of 25-OH-D use on Z-score, T-score and BMD changes (dependent variables) adjusted for sex, age, BMI and presence of diabetes. Z-score, T-score and BMD changes were defined as Z-score, T-score and BMD at follow-up – Z-score, T-score and BMD at study inception. Results: 107 KTRs consecutive outpatients never supplemented with 25-OH-D were enrolled. 42 KTRs treated with bisphosphonate (n. 13) and/or calcio-mimetics (n. 11) and/or active vitamin D (n. 29) were considered as control group. Clinical and biochemical characteristics are shown in Table 1. The mean study-period was 27.7±3.4 months. Dexa data were reported in Table 2. At linear mixed model analysis, a positive interaction of 25-OH-D supplementation on T-score and Z-score changes at lumbar vertebral bodies was found (p<0.05). At the end of the study, no statistical differences in Z-score, T-score and BMD gains were observed. Conclusion: Prolonged supplementation with 25-OH-D effects on Z-score and T-score at LV in long-term KTRs never supplemented
Vitamin D status in kidney transplant recipients: an Italian cohort report
No full textINTRODUCTION AND AIMS
Abnormal low levels of vitamin D are frequent in both general
population and in patients with chronic kidney disease.
In kidney transplant recipients, serum vitamin D levels are
reported to increase from early post-transplant period. In this
population, however, the assessment of vitamin D levels is not
routinely performed despite the pleiotropic action of the
hormone involved in both bone health control and in the
reduction of diabetes, cardiovascular disease and cancer.
Therefore, it is clinically relevant to assess calcidiol
concentration and find any potential factor which may affect its
concentration.
The aim of this cross-sectional study is to assess the levels of
serum calcidiol and find out any potential factor associated with
low calcidiol concentration in kidney transplant patients.
METHODS
132 kidney transplant recipients, followed in one nephrology
unit, were enrolled.
The analyzed variables were immunosuppressive agents,
supplementary intake of calcidiol or 1-25-dihydroxyvitamin D,
intact PTH, eGFR, serum calcium, serum phosphorus, urinary
calcium excretion, urinary phosphorus excretion, lactate
dehydrogenase, creatine phosphokinase, total protein, albumin.
On the basis of serum calcidiol levels patients were classified as
suffering from hormone insufficiency (< 30 ng/mL), deficiency
(< 20 ng/mL) or severe deficiency (<10 ng/mL). Hip and
lumbar spine BMD was measured by dual-energy X-ray
absorptiometry (DXA).
RESULTS 1
Cohort clinical characteristics and blood chemistry are listed in
Tab 1.
Primary renal diseases were: glomerulonephritis (40.9%),
ADPKD (18.2%), hypertension (3%), diabetes mellitus (4.5%),
interstitial nephritis (9.8%), other diseases (23.6%).
Mean serum calcidiol levels were 17.5±8.7 ng/mL. Vitamin D
insufficiency, deficiency and severe deficiency was observed in
19.7 %, 34.5 %, 34.1%, respectively. No differences were
observed between males (15.9±8.8 ng/mL) and females
(14.5±8,5 ng/mL), seasonal blood collections (winter/autumn
15.4±8.6 ng/mL VS summer/spring 16.0±9.6 ng/mL) or
exposure to sunlight (outdoor job 16.5±8.9 ng/mL VS indoor job
13.1±8.0 ng/mL). RESULTS 2
Only 9.8 % of the patients had normal calcidiol levels. In an
univariate analysis, calcidiol levels were associated with eGFR
(r= ,180; p=0.04), PTH (r= -,334; p=0.01), serum calcium ( r= ,
208; p=0.02) and PTH (r=−0.254, P<0.001).
On multiple regression analysis, PTH (Beta= -252; p=0.003) and
serum calcium (Beta= ,180; p=0.03) predicted levels of calcidiol/
On multiple regression analysis, levels of calcidiol were expected
with PTH (Beta= -252; p=0.003) and serum calcium (Beta= ,180;
p=0.03).
In 53% of the patients, BMD T-score from lumbar spine
(-1.48±0.95) and hip (-1.27±1.4) was considered osteopenia
according to WHO.
CONCLUSIONS
Low levels of calcidiol are very frequent in kidney transplant
patients. Less than 10% of the patients have normal serum
concentration of calcidiol. By contrast, PTH and calcium serum
concentrations influence calcidiol levels.
These findings should be taken into account in kidney transplant
recipients with low calcidiol levels, who may benefit from oral
vitamin D supplementatio
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