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Bellasi A, Cozzolino M, Malberti F, Cancarini G, Esposito C, Guastoni CM, Ondei P, Pontoriero G, Teatini U, Vezzoli G, Pasquali M, Messa P, Locatelli F. New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology. J Nephrol 2019; 33:211-221. [PMID: 31853791 PMCID: PMC7118036 DOI: 10.1007/s40620-019-00677-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022]
Abstract
Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago.
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Affiliation(s)
- Antonio Bellasi
- UOC Ricerca, Innovazione, Brand Reputation, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Mario Cozzolino
- UOC Nefrologia e Dialisi ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Fabio Malberti
- Struttura Complessa di Nefrologia e Dialisi, Istituti Ospedalieri di Cremona, Cremona, Italy
| | - Giovanni Cancarini
- U.O.C. Nefrologia e Dipartimento della Cronicità, ASST, Spedali Civili e, Università di Brescia, Brescia, Italy
| | - Ciro Esposito
- Struttura Complessa di Nefrologia e Dialisi, ICS Maugeri SpA SB, Università di Pavia, Pavia, Italy
| | | | - Patrizia Ondei
- USS Emodialisi, Azienda Ospedaliera Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Ugo Teatini
- UOC Nefrologia e Dialisi. ASST Rhodense, Garbagnate M.se, Italy
| | - Giuseppe Vezzoli
- Unità di Nefrologia e Dialisi, IRCCS Istituto Scientifico San Raffaele, Università Vita Salute San Raffaele, Milan, Italy
| | - Marzia Pasquali
- UOC di Nefrologia-Azienda Ospedaliero-Universitaria Policlinico Umberto I Roma, Rome, Italy
| | - Piergiorgio Messa
- Unità Operativa Complessa di Nefrologia e Dialisi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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La Milia V, Ravasi C, Carfagna F, Alberghini E, Baragetti I, Buzzi L, Ferrario F, Furiani S, Barbone GS, Pontoriero G. Sodium removal and plasma tonicity balance are not different in hemodialysis and hemodiafiltration using high-flux membranes. J Nephrol 2019; 32:461-469. [DOI: 10.1007/s40620-018-00581-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/29/2018] [Indexed: 11/28/2022]
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Abstract
INTRODUCTION Hyperphosphatemia is common in late stages of chronic kidney disease and is often associated with elevated parathormone levels, abnormal bone mineralization, extra-osseous calcification, and increased risk of cardiovascular events and death. Several classes of oral phosphate binders are available to help control plasma phosphorus levels. Although effective at lowering serum phosphorus, they all have safety, tolerability, and compliance issues that need to be considered when selecting which one to use. AREAS COVERED This paper reviews the most established treatment options for hyperphosphatemia, in patients with chronic kidney disease, focusing on the new inhibitors of active phosphate absorption. EXPERT OPINION The prevention and the treatment of hyperphosphatemia is today far to be satisfactory. Nonetheless, an extending range of phosphate binders are now available. Aluminum has potentially serious toxic risks. Calcium-based binders are very effective but can lead to hypercalcemia and/or positive calcium balance and progression of cardiovascular calcification. No long-term data are available for the new calcium acetate/magnesium combination product. Lanthanum is an effective phosphate binder, and long-term effects of tissue deposition seem clinically irrelevant. Sevelamer, appear to have profiles that would lead to pleiotropic effects and reduced progression of vascular calcification, and the main adverse events seen with these agents are gastrointestinal. Iron has a powerful capability of binding phosphate, thus numerous preparations are available, both with and without significant systemic absorption of the iron component. The inhibitors of active intestinal phosphate transport, with their very selective mechanism of action and low pill burden seem the most interesting approach; however, do not seem at present to be effective alone, in reducing serum phosphorus levels.
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Affiliation(s)
- Fabio Carfagna
- a Department of Nephrology and Dialysis , A. Manzoni Hospital ASST Lecco , Lecco , Italy
| | - Lucia Del Vecchio
- a Department of Nephrology and Dialysis , A. Manzoni Hospital ASST Lecco , Lecco , Italy
| | - Giuseppe Pontoriero
- a Department of Nephrology and Dialysis , A. Manzoni Hospital ASST Lecco , Lecco , Italy
| | - Francesco Locatelli
- a Department of Nephrology and Dialysis , A. Manzoni Hospital ASST Lecco , Lecco , Italy
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Del Vecchio L, Casartelli D, Viganò S, Pontoriero G. SP164RITUXIMAB THERAPY IN PATIENTS WITH PRIMARY AND SECONDARY GLOMERULONEPHRITIS: RELATIONSHIP BETWEEN CLINICAL RESPONSE AND CD19+ TREND. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Sara Viganò
- Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy
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Bellasi A, Cozzolino M, Malberti F, Cancarini G, Esposito C, Genderini A, Guastoni CM, Ondei P, Pontoriero G, Teatini U, Vezzoli G, Messa P, Locatelli F. [New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of Nephrologists form Lombardy]. G Ital Nefrol 2018; 35:2018-vol3-3. [PMID: 29786181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago.
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Affiliation(s)
- Antonio Bellasi
- UOC di Nefrologia e Dialisi, Ospedale Sant'Anna, ASST-Lariana, Como
| | - Mario Cozzolino
- UOC Nefrologia e Dialisi ASST Santi Paolo e Carlo, Presidio San Paolo, Milano
| | - Fabio Malberti
- Struttura Complessa di Nefrologia e Dialisi Istituti Ospedalieri di Cremona
| | - Giovanni Cancarini
- Dipartimento della Cronicità, ASST, Spedali Civili e Università di Brescia
| | - Ciro Esposito
- Struttura Complessa di Nefrologia e Dialisi Fondazione IRCCS S. Maugeri Pavia
| | - Augusto Genderini
- Ospedale Pubblico, Divisione di Nefrologia e Dialisi, Ospedale Caduti Bollatesi, Bollate
| | | | - Patrizia Ondei
- USS Emodialisi, Azienda Ospedaliera Ospedale Papa Giovanni XXIII, Bergamo
| | | | - Ugo Teatini
- Divisione Nefrologia e Dialisi. Ospedale Bollate
| | - Giuseppe Vezzoli
- Unità di Nefrologia e Dialisi, Istituto di Ricovero e cura a carattere scientifico San Raffaele, Milano
| | - Piergiorgio Messa
- Unità Operativa Complessa di Nefrologia e Dialisi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
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Carfagna F, Di Filippo S, Bellasi A, Pontoriero G, Locatelli F. Shed a light on intradialytic calcium mass balance. Kidney Int 2018; 89:1402. [PMID: 27181783 DOI: 10.1016/j.kint.2016.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Fabio Carfagna
- Alessandro Manzoni Hospital, Nephrology and Dialysis, Lecco, Italy.
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Andrulli S, Chiavenna C, Bigi MC, Crepaldi M, Dell'Oro C, Tentori F, Manzoni C, Bacchini G, Corti MM, Pontoriero G. Predictors of first ischemic lower limb ulcer in dialysis patients: an observational cohort study. J Nephrol 2017; 31:435-443. [PMID: 28831705 DOI: 10.1007/s40620-017-0429-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/01/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Lower limb ischemia affects the quality of life, physical activity and life expectancy of dialysis patients. The aim of this study was to investigate the risk factors associated with ischemic foot ulcers considering clinical, laboratory and therapeutic domains. METHODS This observational cohort study was based on data from the Nephrology and Dialysis Department database of Alessandro Manzoni Hospital, Lecco (Italy). All of the incident patients who started dialysis between 1 January 1999 and 29 February 2012 were enrolled, excluding temporary guests, patients with acute renal failure and patients with previous limb ischemia or amputation. Multivariate Cox regression analysis identified the predictors in each domain, which were matched in the final model. A time-dependent approach was used to take into account the evolution of some of the prognostic covariates. RESULTS Of the 526 incident dialysis patients, 120 developed a lower limb ischemic lesion after a median of 13 months. The incidence of new ulcers was constant during the study period (6 per 100 person-years), but higher in the diabetics with a relative rate of 4.5. The variables significantly related to an increased risk of lower limb ulcers were age, male gender, diabetes, ischemic heart disease, treatment with proton pump inhibitors, iron, anticoagulants and calcium-based binders, and blood levels of phosphorus, triglycerides and C-reactive protein. CONCLUSION The incidence of lower limb ulcers was highest during the early dialysis follow-up and was associated with, in addition to diabetes, modifiable laboratory and therapeutic predictors such as anticoagulants, proton pump inhibitors, calcium-containing binders, calcimimetics and iron.
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Affiliation(s)
- Simeone Andrulli
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy.
| | - Chiara Chiavenna
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Maria Carla Bigi
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Monica Crepaldi
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Cesare Dell'Oro
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Flavia Tentori
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Celestina Manzoni
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Giuseppe Bacchini
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Mauro Maria Corti
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Giuseppe Pontoriero
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Via dell'Eremo 9, 23900, Lecco, Italy
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Del Vecchio L, Aicardi V, Longhi S, Tiscornia C, Pena F, Vargas K, Npobloete H, Pontoriero G. SP424THE NUTRITIONAL STATUS IN ELDERLY HEMODIALYSIS PATIENTS:A COMPARISON BETWEEN ITALY AND CHILE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx148.sp424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Genovesi S, Porcu L, Luise MC, Riva H, Nava E, Contaldo G, Stella A, Pozzi C, Ondei P, Minoretti C, Gallieni M, Pontoriero G, Conte F, Torri V, Bertoli S, Vincenti A. Sudden Death in End Stage Renal Disease: Comparing Hemodialysis versus Peritoneal Dialysis. Blood Purif 2017; 44:77-88. [PMID: 28365692 DOI: 10.1159/000464347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/18/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS This study aimed to evaluate total and sudden death (SD) in a cohort of dialysis patients, comparing hemodialysis (HD) vs. peritoneal dialysis (PD). METHODS This is a multicenter retrospective cohort study. RESULTS Deaths were 626 out of 1,823 in HD and 62 of 249 in PD patients. HD patients had a greater number of comorbidities (p < 0.05). PD patients had a lower risk of death than HD patients (p < 0.001); however, the advantage decreased with time (p < 0.001). Mortality predictors were left ventricular ejection fraction (LVEF) ≤35%, older age, ischemic heart disease, diabetes mellitus, previous stroke, and atrial fibrillation (p < 0.03). SDs were 84:71 in HD and 13 in PD population (12.1 and 22.8% of all causes of death, respectively). A non-significant risk of SD among PD compared to HD patients was detected. SD predictors were older age, ischemic heart disease, and LVEF ≤35% (p < 0.05). CONCLUSIONS HD patients showed a greater presence of comorbidities and reduced survival compared to PD patients; however, the incidence of SD does not differ in the 2 populations. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=464347.
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di Filippo S, Carfagna F, la Milia V, Bellasi A, Casagrande G, Bianchi C, Vito D, Costantino ML, Rombolà G, Minoretti C, Schönholzer C, Pontoriero G, Locatelli F. Assessment of intradialysis calcium mass balance by a single pool variable-volume calcium kinetic model. Hemodial Int 2017; 22:126-135. [PMID: 28164430 DOI: 10.1111/hdi.12531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A reliable method of intradialysis calcium mass balance quantification is far from been established. We herein investigated the use of a single-pool variable-volume Calcium kinetic model to assess calcium mass balance in chronic and stable dialysis patients. METHODS Thirty-four patients on thrice-weekly HD were studied during 240 dialysis sessions. All patients were dialyzed with a nominal total calcium concentration of 1.50 mmol/L. The main assumption of the model is that the calcium distribution volume is equal to the extracellular volume during dialysis. This hypothesis is assumed valid if measured and predicted end dialysis plasma water ionized calcium concentrations are equal. A difference between predicted and measured end-dialysis ionized plasma water calcium concentration is a deviation on our main hypothesis, meaning that a substantial amount of calcium is exchanged between the extracellular volume and a nonmodeled compartment. FINDINGS The difference between predicted and measured values was 0.02 mmol/L (range -0.08:0.16 mmol/L). With a mean ionized dialysate calcium concentration of 1.25 mmol/L, calcium mass balance was on average negative (mean ± SD -0.84 ± 1.33 mmol, range -5.42:2.75). Predialysis ionized plasma water concentration and total ultrafiltrate were the most important predictors of calcium mass balance. A significant mobilization of calcium from the extracellular pool to a nonmodeled pool was calculated in a group of patients. DISCUSSION The proposed single pool variable-volume Calcium kinetic model is adequate for prediction and quantification of intradialysis calcium mass balance, it can evaluate the eventual calcium transfer outside the extracellular pool in clinical practice.
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Affiliation(s)
| | - Fabio Carfagna
- Depatments of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy
| | - Vincenzo la Milia
- Depatments of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy
| | - Antonio Bellasi
- Depatments of Nephrology and Dialysis, Sant'Anna Hospital, Como, Italy
| | - Giustina Casagrande
- Depatments of Chemistry, Material and Chemical Engineering, Politecnico di Milano, Milano, Italy
| | - Camilla Bianchi
- Depatments of Chemistry, Material and Chemical Engineering, Politecnico di Milano, Milano, Italy
| | - Domenico Vito
- Depatments of Chemistry, Material and Chemical Engineering, Politecnico di Milano, Milano, Italy
| | - Maria Laura Costantino
- Depatments of Chemistry, Material and Chemical Engineering, Politecnico di Milano, Milano, Italy
| | - Giuseppe Rombolà
- Depatments of Nephrology and Dialysis, Hospital and Macchi Foundation, Varese, Italy
| | - Claudio Minoretti
- Depatments of Nephrology and Dialysis, Sant'Anna Hospital, Como, Italy
| | - Carlo Schönholzer
- Depatments of Nephrology and Dialysis, Regional Hospital of Lugano, Lugano, Switzerland
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Torino C, Gargani L, Sicari R, Letachowicz K, Ekart R, Fliser D, Covic A, Siamopoulos K, Stavroulopoulos A, Massy ZA, Fiaccadori E, Caiazza A, Bachelet T, Slotki I, Martinez-Castelao A, Coudert-Krier MJ, Rossignol P, Gueler F, Hannedouche T, Panichi V, Wiecek A, Pontoriero G, Sarafidis P, Klinger M, Hojs R, Seiler-Mussler S, Lizzi F, Siriopol D, Balafa O, Shavit L, Tripepi R, Mallamaci F, Tripepi G, Picano E, London GM, Zoccali C. The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study. Clin J Am Soc Nephrol 2016; 11:2005-2011. [PMID: 27660305 PMCID: PMC5108194 DOI: 10.2215/cjn.03890416] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/14/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Accumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its reliability in ESRD is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a lung ultrasound-guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis. The reliability of peripheral edema was tested as well. This study was on the basis of 1106 pre- and postdialysis lung ultrasound studies (in 79 patients) simultaneous with standardized lung auscultation (crackles at the lung bases) and quantification of peripheral edema. RESULTS Lung congestion by crackles, edema, or a combination thereof poorly reflected the severity of congestion as detected by ultrasound B lines in various analyses, including standard regression analysis weighting for repeated measures in individual patients (shared variance of 12% and 4% for crackles and edema, respectively) and κ-statistics (κ ranging from 0.00 to 0.16). In general, auscultation had very low discriminatory power for the diagnosis of mild (area under the receiver operating curve =0.61), moderate (area under the receiver operating curve =0.65), and severe (area under the receiver operating curve =0.68) lung congestion, and the same was true for peripheral edema (receiver operating curve =0.56 or lower) and the combination of the two physical signs. CONCLUSIONS Lung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, a trial adopting ultrasound B lines as an instrument to guide interventions aimed at mitigating lung congestion in high-risk patients on hemodialysis.
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Affiliation(s)
- Claudia Torino
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Gargani L, Sicari R, Raciti M, Serasini L, Passera M, Torino C, Letachowicz K, Ekart R, Fliser D, Covic A, Balafa O, Stavroulopoulos A, Massy ZA, Fiaccadori E, Caiazza A, Bachelet T, Slotki I, Shavit L, Martinez-Castelao A, Coudert-Krier MJ, Rossignol P, Kraemer TD, Hannedouche T, Panichi V, Wiecek A, Pontoriero G, Sarafidis P, Klinger M, Hojs R, Seiler-Mußler S, Lizzi F, Onofriescu M, Zarzoulas F, Tripepi R, Mallamaci F, Tripepi G, Picano E, London GM, Zoccali C. Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project. Nephrol Dial Transplant 2016; 31:1982-1988. [DOI: 10.1093/ndt/gfw329] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/24/2016] [Indexed: 02/06/2023] Open
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del Vecchio L, Aicardi V, Longhi S, Ravasi C, Cimadoro E, Bordoli M, La Milia V, Pontoriero G. MP676THE ROLE OF AGE ON NUTRITIONAL STATUS AND WATER BALANCE IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw199.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rivera RF, Guido D, Del Vecchio L, Corghi E, D'Amico M, Camerini C, Spotti D, Galassi A, Pozzi C, Cancarini G, Pontoriero G, Locatelli F. Impact of European medicines agency recommendations for hypersensitivity reactions on intravenous iron prescription in haemodialysis centres of the Lombardy region. J Nephrol 2015; 29:673-81. [PMID: 26715394 DOI: 10.1007/s40620-015-0254-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/18/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The European Medicines Agency (EMA) has recommended measures to minimize the risk of hypersensitivity reactions (HSRs) to intravenous iron (IVFe). We analysed the effects of these recommendations on IVFe clinical management among haemodialysis centres (HDCs) in Lombardy, Italy. MATERIALS AND METHODS A questionnaire was sent to all 117 HDCs to collect information on centre characteristics, e.g. HDC type [hospital centre (HC) vs. centre with limited assistance (CAL)], presence/absence of intensive care unit (ICU) and/or emergency trained staff, IVFe therapy regarding molecules, administration modalities, side effects, and percentage variations in iron prescription between 2014 and 2013 (outcome, Δ-IVFe%). A linear regression model was applied to evaluate the focus effect (β) of HDC type on the outcome, controlling for possible confounding effects of the other characteristics. RESULTS Response rate was 73.5 %. IVFe therapy was used in 69.1 % (HDC range 11-100) of patients. Following EMA recommendations, prescription was reduced by 12.6 %, with the largest reduction observed in CALs. No severe HSRs were reported. HCs had more frequently an ICU [97.2 vs. 20 %, odds ratio (OR) = 63.6 (95 % confidence interval 15.56; 537.47), p < 0.001], emergency trained staff [97.2 vs. 61.2 %, OR = 10.7 (2.68; 85.33), p < 0.001] and instrumental facilities (91.7 vs. 58 %, OR = 5.8 (2.03; 23.55), p < 0.001] than CALs. Linear regression demonstrated a significant raw effect of HDC type on Δ- IVFe% [β = 19.6 (9.82; 30.63), p < 0.001]. No association was found when HDC type was adjusted for ICU-presence [β = 6.7 (-2.32; 18.30), p = 0.199] or for all-confounding factors [β = 5.6 (-5.50; 17.08), p = 0.337]. CONCLUSIONS This survey shows a disparity in IVFe therapy prescription following EMA recommendations, which is largely influenced by the presence/absence of ICUs in HD centres.
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Affiliation(s)
- Rodolfo F Rivera
- Division of Nephrology and Dialysis, San Gerardo Hospital, Pergolesi 33, 20090, Monza, Italy.
| | - Davide Guido
- Medical and Genomic Statistics Unit, Department of Brain and Behavioural Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.,Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Lucia Del Vecchio
- Division of Nephrology and Dialysis, A. Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Enzo Corghi
- Division of Nephrology and Dialysis, Bassini Hospital, via Gorki 50, 20092, Cinisello Balsamo (MI), Italy
| | - Marco D'Amico
- Division of Nephrology and Dialysis, Sant'Anna Hospital, via Ravona 20, 22020, San Fermo della Battaglia, Como, Italy
| | - Corrado Camerini
- Operative Unit of Nephrology, A.O. Spedali Civili and University of Brescia, Ple Spedali Civili 1, 25123, Brescia, Italy
| | - Donatella Spotti
- Operative Unit of Nephrology and Dialysis, San Raffaele, via Olgettina 60, 20132, Milan, Italy
| | - Andrea Galassi
- Division of Nephrology and Dialysis, Desio Hospital, Via Mazzini 1, 20832, Desio, Italy
| | - Claudio Pozzi
- Division of Nephrology and Dialysis, Bassini Hospital, via Gorki 50, 20092, Cinisello Balsamo (MI), Italy
| | - Giovanni Cancarini
- Operative Unit of Nephrology, A.O. Spedali Civili and University of Brescia, Ple Spedali Civili 1, 25123, Brescia, Italy
| | - Giuseppe Pontoriero
- Division of Nephrology and Dialysis, A. Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Francesco Locatelli
- Division of Nephrology and Dialysis, A. Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy
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La Milia V, Pontoriero G, Virga G, Locatelli F. Ionic conductivity of peritoneal dialysate: a new, easy and fast method of assessing peritoneal membrane function in patients undergoing peritoneal dialysis. Nephrol Dial Transplant 2015; 30:1741-6. [PMID: 26185051 DOI: 10.1093/ndt/gfv275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/05/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Peritoneal membrane function can be assessed using the peritoneal equilibration test (PET) and similar tests, but these are almost always complicated to use, require a considerable amount of working time and their results cannot always be easily interpreted. Ionic conductivity is a measure of the ability of an electrolyte solution to conduct electricity. We tested the hypothesis that the ionic conductivity of peritoneal dialysate can be used to evaluate peritoneal membrane function in peritoneal dialysis patients. METHODS We measured the ionic conductivity and classic biochemical parameters of peritoneal dialysate in 69 patients during a modified PET and compared their ability to evaluate peritoneal membrane function and to diagnose ultrafiltration failure (UFF). RESULTS Ionic conductivity was correlated well with classical parameters of peritoneal transport as glucose reabsorption of glucose (D/D0: r(2) = 0.62, P < 0.0001) and creatinine transport (D/PCreat: r(2) = 0.72, P < 0.0001). Twelve patients (17%) experienced UFF and, in them, the ionic conductivity area under the receiver-operating characteristic curve was 0.91 (95% confidence interval: 0.81-0.96) with sensitivity of 1.00 and specificity of 0.84 at a cut-off value of 12.75 mS/cm. CONCLUSIONS These findings indicate that the ionic conductivity of peritoneal dialysate can be used as a new screening tool to evaluate peritoneal membrane function.
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Affiliation(s)
- Vincenzo La Milia
- Division of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy
| | | | - Giovambattista Virga
- Nephrology and Dialysis Unit, Provincial Hospital, Camposampiero (Padova), Italy
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Di Filippo S, La Milia V, Carfagna F, Minoretti C, Rombolà G, Schönholzer C, Casagrande G, Bianchi C, Costantino ML, Pontoriero G, Locatelli F. FP517PRELIMINARY RESULTS OF DIALYSIS STUDY: ACCURACY OF A SINGLE POOL VARIABLE-VOLUME CALCIUM KINETIC MODEL WITH DIFFERENT CALCIUM DIALYSATE CONCENTRATIONS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv179.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Filippo S, La Milia V, Carfagna F, Minoretti C, Rombolà G, Schönholzer C, Casagrande G, Bianchi C, Costantino ML, Pontoriero G, Locatelli F. FP488PRELIMINARY RESULTS OF DIALYSIS STUDY: SINGLE POOL VARIABLE-VOLUME CALCIUM KINETIC MODEL. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv179.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Genovesi S, Porcu L, Luise MC, Riva H, Nava E, Stella A, Pozzi C, Ondei P, Minoretti C, Gallieni M, Pontoriero G, Conte F, Torri V, Vincenti A. Mortality, sudden death and indication for cardioverter defibrillator implantation in a dialysis population. Int J Cardiol 2015; 186:170-7. [DOI: 10.1016/j.ijcard.2015.03.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/09/2015] [Accepted: 03/16/2015] [Indexed: 12/18/2022]
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Vincenzo LM, Elisabetta S, Pontoriero G. FP552A SIMPLE MODEL TO PREDICT ENCAPSULATING PERITONEAL SCLEROSIS IN PATIENTS UNDERGOING PERITONEAL DIALYSIS: A 20 YEARS PROSPECTIVE CONTROLLED LONGITUDINAL COHORT STUDY OF PERITONEAL MEMBRANE FUNCTION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv180.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rivera R, Guido D, Del Vecchio L, Galassi A, D’amico M, Corghi E, Spotti D, Camerini C, Pozzi C, Cancarini G, Locatelli F, Pontoriero G. FP678IMPACT OF EUROPEAN MEDICINES AGENCY RECOMMENDATIONS FOR ALLERGIC REACTIONS TO INTRAVENOUS IRON-CONTAINING DRUGS IN DIALYSIS CENTERS OF LOMBARDY REGION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv182.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aicardi V, Del Vecchio L, Longhi S, Cimadoro E, Milani C, La Milia V, Pontoriero G. SP433EVALUATION OF NUTRITIONAL STATUS IN ELDERLY HD PATIENTS: IMPACT OF THE DEGREE OF AUTONOMY AND ALIMENTARY HABITS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv193.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Locatelli F, Di Filippo S, Pontoriero G, Bacchini G, Fabrizi F, La Milia V, Corti M. The effect of electrolyte balances on cardiovascular stability during hemodialysis. Contrib Nephrol 2015; 106:125-8. [PMID: 8174356 DOI: 10.1159/000422937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- F Locatelli
- Division of Nephrology and Dialysis, Hospital of Lecco, Italy
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Colussi G, Antonacci A, Surian M, Pontoriero G, Rombolà G, De Ferrari ME, Cosci P, Malberti F, Minetti L. Effects of low calcium diet on urinary calcium and oxalate excretion in patients with idiopathic calcium nephrolithiasis. Contrib Nephrol 2015; 37:22-6. [PMID: 6713874 DOI: 10.1159/000408543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Locatelli F, Altieri P, Andrulli S, Sau G, Bolasco P, Pedrini LA, Basile C, David S, Gazzanelli L, Tampieri G, Isola E, Marzolla O, Memoli B, Ganadu M, Reina E, Bertoli S, Ferrara R, Casu D, Logias F, Tarchini R, Mattana G, Passaghe M, Fundoni G, Villa G, Di Iorio BR, Pontoriero G, Zoccali C. Phosphate levels in patients treated with low-flux haemodialysis, pre-dilution haemofiltration and haemodiafiltration: post hoc analysis of a multicentre, randomized and controlled trial. Nephrol Dial Transplant 2014; 29:1239-1246. [DOI: 10.1093/ndt/gfu031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Lemoine S, Fournier T, Kocevar G, Belloi A, Ibarrola D, Sappey-Marinier D, Juillard L, Kaysen G, Usvyat L, Grassmann A, Marcelli D, Pecoits-Filho R, Marelli C, Kooman J, Van Der Sande F, Haviv Y, Power A, Kotanko P, Migliori M, Cantaluppi V, Medica D, Paoletti S, Panichi V, Kuragano T, Yahiro M, Kida A, Nagasawa Y, Hasuike Y, Nanami M, Nakanishi T, Garneata L, Slusanschi O, Dragomir DR, Corbu-Stancu A, Barbulescu C, Mircescu G, Minutolo R, Borrelli S, De Nicola L, Conte G, Basic-Jukic N, Katalinic L, Ivandic E, Kes P, Jelakovic B, Beberashvili I, Sinuani I, Azar A, Shapiro G, Feldman L, Stav K, Sandbank J, Averbukh Z, Bruschetta E, Righetti M, Colombo F, Palmieri N, Prencipe M, Bracchi O, Stefani F, Amar K, Scalia A, Conte F, Rosenberger J, Majernikova M, Kissova V, Straussova Z, Boldizsar J, Cobo G, Di Gioia C, Camacho R, Garcia Lacalle C, Ortega O, Rodriguez I, Mon C, Ortiz M, Herrero J, Oliet A, Vigil A, Gallar P, Kyriazis J, Markaki A, Kourtesi K, Kalymniou M, Vougazianos S, Kyriazis P, Stylianou K, Tanaka H, Tsuneyoshi S, Sawa M, Fujisaki K, Daijo Y, Hristea D, Paris A, Lefrancois G, Volteau C, Savoiu C, Ozenne S, Testa A, Coupel S, Bertho I, Legall MC, Magnard J, Deschamps T, Capusa C, Stoian I, Barbulescu C, Santimbrean C, Dumitru D, Mircescu G, Kato S, Lindholm B, Yuzawa Y, Shiels PG, Hwang JC, Jiang MY, Lu YH, Wang CT, Chiou TTY, Lee YT, Ng HY, Lee CT, Kaminska D, Koscielska-Kasprzak K, Chudoba P, Mazanowska O, Zabinska M, Banasik M, Boratynska M, Lepiesza A, Korta K, Klinger M, Struijk-Wielinga T, Neelemaat F, Slieker T, Koolen M, Ter Wee PM, Weijs PJ\, Tsuchida K, Hirose D, Minakuchi J, Kawashima S, Tomo T, Lee JE, Yun GY, Choi HY, Lee S, Kim W, Jo IY, Ha SK, Kim HJ, Park HC, Migliori M, Scatena A, Cantaluppi V, Rosati A, Pizzarelli F, Panichi V, Shin BC, Kim HL, Chung JH, Malgorzewicz S, Chmmielewski M, Debska-Slizien A, Rutkowski B, Kolesnyk M, Stepanova N, Korol L, Kulizkyi M, Ablogina O, Migal L, Takahashi T, Kitajima Y, Hirano S, Naka A, Ogawa H, Aono M, Sato Y, Hoppe K, Schwermer K, K Ysz P, Kaczmarek J, Baum E, Sikorska D, Radziszewska D, Szkudlarek M, Olejniczak P, Pawlaczyk K, Lindholm B, Oko A, Severova Andreevska G, Trajceska L, Gelev S, Dzekova P, Selim G, Sikole A, Trajceska L, Severova Andreevska G, Rambabova Busletik I, Gelev S, Pavleska Kuzmanovska S, Dzekova Vidimiski P, Selim G, Sikole A, Borrelli S, De Simone E, Laurino S, De Simone W, Ahbap E, Kara E, Basturk T, Sakaci T, Koc Y, Sahutoglu T, Akgol C, Sevinc M, Atan Ucar Z, Unsal A, Girndt M, Fiedler R, Martus P, Pawlak M, Storr M, Boehler T, Templin M, Trojanowicz B, Ulrich C, Glomb M, Liehr K, Werner K, Zickler D, Schindler R, Vishnevskii KA, Gerasimchuk RP, Zemchenkov AY, Moura A, Madureira J, Alija P, Fernandes JC, Oliveira JG, Lopez M, Filgueiras M, Amado L, Sameiro-Faria M, Miranda V, Vieira M, Santos-Silva A, Costa E, Zaluska W, Kotlinska-Hasiec EKH, Zaluska A, Rzecki Z, Zadora P, Dabrowski W, Sikole A, Trajceska L, Amitov V, Busletik IR, Dzekova P, Selim G, Severova Andreevska G, Gelev S, Aicardi Spalloni V, La Milia V, Longhi S, Volo L, Del Vecchio L, Pontoriero G, Locatelli F, Martino F, Scalzotto E, Corradi V, Nalesso F, Zanella M, Brandolan A, Perez De Jose A, Abad S, Vega A, Reque J, Quiroga B, Lopez-Gomez JM, Esteve Simo V, Duarte Gallego V, Moreno Guzman F, Fulquet Nicolas M, Pou Potau M, Saurina Sole A, Carneiro Oliveira J, Ramirez De Arellano Serna M, Ahbap E, Kara E, Basturk T, Koc Y, Sakaci T, Sahutoglu T, Sevinc M, Atan Ucar Z, Unsal A, Van Diepen AT, Hoekstra T, De Mutsert R, Rotmans JI, De Boer M, Suttorp MM, Struijk DG, Boeschoten EW, Krediet RT, Dekker FW, Trigka K, Chouchoulis K, Musso CG, Kaza M, Mpimpi A, Pipili C, Kyritsis I, Douzdampanis P, Streja E, Rezakhani S, Rhee CM, Kalantar-Zadeh K, Streja E, Doshi M, Rhee C, Kovesdy C, Moradi H, Kalantar-Zadeh K, Dantas MA, Resende LL, Silva LF, Matos CM, Lopes GB, Lopes AA, Knap B, Arnol M, Buturovic J, Ponikvar R, Bren A, Codognotto M, Piasentin P, Conte F, Righetti M, Limido A, Tsuchida K, Michiwaki H, Minakuchi J, Kawashima S, Tomo T, Mutsaers HA, Jansen J, Van Den Broek PH, Verweij VG, Van Den Heuvel LP, Hoenderop JG, Masereeuw R, Clari R, Mongilardi E, Vigotti FN, Scognamiglio S, Consiglio V, Nazha M, Avagnina P, Piccoli G, Costelloe SJ, Freeman J, Keane DF, Lindley EJ, Thompson D, Kang GW, Lee IH, Ahn KS. DIALYSIS. PROTEIN-ENERGY WASTING, INFLAMMATION AND OXIDATIVE STRESS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Monova D, Monov S, Todorov T, Soderberg D, Kurz T, Weiner M, Eriksson P, Segelmark M, Jakuszko K, Sebastian A, Bednarz Z, Krajewska M, Wiland P, Madziarska K, Weyde W, Klinger M, Naidoo J, Wearne N, Jones E, Swanepoel C, Rayner B, Okpechi I, Endo N, Tsuboi N, Furuhashi K, Matsuo S, Maruyama S, Clerte M, Levi C, Touzot M, Fakhouri F, Monge C, Lebas C, Abboud I, Huart A, Durieux P, Charlin E, Thervet E, Karras A, Smykal-Jankowiak K, Niemir ZI, Polcyn-Adamczak M, Whatmough S, Sweeney N, Fernandez S, Hussain M, Dhaygude A, Jakuszko K, Bednarz Z, Sebastian A, Krajewska M, Gniewek K, Wiland P, Weyde W, Klinger M, Manenti L, Urban ML, Vaglio A, Gintoli E, Galletti M, Buzio C, Monova D, Monov S, Argirova T, Wong I, Ibrahim FH, Goh BL, Lim TS, Chan MW, Hiramtasu R, Ubara Y, Hoshino J, Takaichi K, Ghafoor V, Hussain M, Dhaygude A, Whatmough S, Fernandez S, Sweeney N, Hussain M, Dhaygude A, Sahay M, Soma J, Nakaya I, Sasaki N, Yoshikawa K, Sato H, Kaminskyy V, ZAbi Ska M, Krajewska M, Ko Cielska-Kasprzak K, Jakuszko K, Klinger M, Niemir Z, Wozniczka K, Swierzko A, Cedzynski M, Polcyn-Adamczak M, Sokolowska A, Szala A, Arjunan A, Mikhail A, Shrivastava R, Parker C, Aithal S, Gursu M, Ozari M, Yucetas E, Sumnu A, Doner B, Cebeci E, Ozkan O, Aktuglu MB, Karaali Z, Koldas M, Ozturk S, Marco H, Picazo M, Da Silva I, Gonzalez A, Arce Y, Gracia S, Corica M, Llobet J, Diaz M, Ballarin J, Schonermarck U, Hagele H, Baumgartner A, Fischereder M, Muller S, Oliveira CBL, Oliveira ASA, Carvalho CJB, Pessoa CTBC, Sette LHBC, Fernandes GV, Cavalcante MAGM, Valente LM, Wan Q, Hu H, He Y, Li T, Aazair N, Houmaid Z, Rhair A, Bennani N, Demin A, Petrova O, Kotova O, Demina L, Roccatello D, Sciascia S, Rossi D, Naretto C, Baldovino S, Alpa M, Salussola I, Modena V, Zakharova EV, Vinogradova OV, Stolyarevich ES, Yap DYH, Chan TM, Thanaraj V, Dhaygude A, Ponnusamy A, Pillai S, Argentiero L, Schena A, Rossini M, Manno C, Castellano G, Martino M, Mitrotti A, Giliberti M, Digiorgio C, Di Palma AM, Battaglia M, Ditonno P, Grandaliano G, Gesualdo L, Oliveira CBL, Carvalho CJB, Oliveira ASA, Pessoa CTBC, Sette LHBC, Fernandes GV, Cavalcante MAGM, Valente LM, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Rabrenovi V, Kova Evi Z, Jovanovi D, Rabrenovi M, Anti S, Ignjatovi L, Petrovi M, Longhi S, Del Vecchio L, Vigano S, Casartelli D, Bigi MC, Corti M, Limardo M, Tentori F, Pontoriero G, Zeraati AA, Shariati Sarabi Z, Davoudabadi Farahani A, Mirfeizi Z, Bae E. PRIMARY AND SECONDARY GLOMERULONEPHRITIDES 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Locatelli F, Choukroun G, Fliser D, Moecks J, Wiggenhauser A, Gupta A, Swinkels DW, Lin V, Guss C, Pratt R, Carrilho P, Martins AR, Alves M, Mateus A, Gusmao L, Parreira L, Assuncao J, Rodrigues I, Stamopoulos D, Mpakirtzi N, Afentakis N, Grapsa E, Zitt E, Sturm G, Kronenberg F, Neyer U, Knoll F, Lhotta K, Weiss G, Robinson BM, Larkina M, Bieber B, Kleophas W, Li Y, Locatelli F, McCullough K, Nolen JG, Port FK, Pisoni RL, Kalicki RM, Uehlinger DE, Ogawa C, Kanda F, Tomosugi N, Maeda T, Kuji T, Fujikawa T, Shino M, Shibata K, Kaneda T, Nishihara M, Satta H, Kawata SI, Koguchi N, Tamura K, Hirawa N, Toya Y, Umemura S, Chanliau J, Martin H, Stamatelou K, Gonzalez-Tabares L, Manamley N, Farouk M, Addison J, Donck J, Schneider A, Gutjahr-Lengsfeld L, Ritz E, Scharnagl H, Gelbrich G, Pilz S, Macdougall IC, Wanner C, Drechsler C, Kuntsevich V, Charen E, Kobena D, Sheth N, Siktel H, Levin NW, Winchester JF, Kotanko P, Kaysen G, Kuragano T, Kida A, Yahiro M, Nanami M, Nagasawa Y, Hasuike Y, Nakanishi T, Stamopoulos D, Mpakirtzi N, Dimitratou V, Griveas I, Lianos E, Grapsa E, Sasaki Y, Yamazaki S, Fujita K, Kurasawa M, Yorozu K, Shimonaka Y, Suzuki N, Yamamoto M, Zwiech R, Szczepa ska J, Bruzda-Zwiech A, Rao A, Gilg J, Caskey F, Kirkpantur A, Balci MM, Turkvatan A, Afsar B, Alkis M, Mandiroglu F, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Hasuike Y, Kida A, Oue M, Yamamoto K, Kimura T, Fukao W, Yahiro M, Kaibe S, Nanami M, Nakanishi T, Djuric PS, Ikonomovski J, Tosic J, Jankovic A, Majster Z, Stankovic Popovic V, Dimkovic N, Aicardi Spalloni V, Del Vecchio L, Longhi S, Violo L, La Milia V, Pontoriero G, Locatelli F, Shino M, Kuji T, Fujikawa T, Toya Y, Umemura S, Macdougall I, Rumjon A, Mangahis E, Goldstein L, Ryzlewicz T, Becker F, Kilgallon W, Fukasawa M, Otake Y, Yamagishi T, Kamiyama M, Kobayashi H, Takeda M, Toida T, Sato Y, Fujimoto S. DIALYSIS ANAEMIA. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vlahu CA, De Graaff M, Struijk DG, Krediet RT, Shin HS, Ryu ES, Choi HS, Ryu DR, Choi KB, Kang DH, Sanchez-Alvarez E, Rodriguez-Suarez C, Galvan-.Hernandez JA, Kim YL, Kee YK, Lee MJ, Oh HJ, Park JT, Han SH, Yoo TH, Kang SW, Zhu F, Abbas SR, Bologa R, Lanto B, Kotanko P, Parikova A, Smit W, Struijk DG, Krediet RT, Rroji ( Molla) M, Seferi S, Cafka M, Thereska N, Huang CC, Wang IK, Shiao YT, Teixeira L, Sousa I, Rodrigues A, Mendonca D, Ueda A, Iwase M, Usui T, Hirayama A, Nagai K, Saito C, Yamagata K, La Milia V, Pontoriero G, Locatelli F, Kim SM, Kim TY, Lee JE, Teta D, Guillodo MP, Kolko-Labadens A, Lasseur C, Levannier M, Panaye M, Fouque D, HAMADA C, Hara K, Kang SH, Cho KH, Park JW, Yoon KW, Do JY, Dogan I, Biro Dr B, Zakar Dr G, Foldine Z, Staudt S, Martins AR, Vizinho R, Branco PQ, Gaspar MA, Barata JD, Sikorska D, Klysz P, Posnik B, Baum E, Hoppe K, Schwermer K, Wanic-Kossowska M, Frankiewicz D, Pawlaczyk K, Lindholm B, Oko A, Busuioc M, Trolliet P, Guerraoui A, Caillette-Beaudoin A, Hallonet P, Yang JO, Gursu M, Topcuoglu D, Koc LK, Yucel L, Sumnu A, Cebeci E, Doner B, Ozkan O, Behlul A, Koc L, Ozturk S, Kazancioglu R, Casas Parra AII, Gonzalez MTT, Sandoval DA, Carlota GC, Grinyo JMM, Tseng CH, Chao CT, Yen CJ, Chiang CK, Hung KY, Huang JW, Al Wakeel JS, Al Ghonaim M, Al Suwaida A, Al Harbi A, Makoshi Z, Abdullah S, Matsushita Y, Basic-Jukic N, Coen-Herak D, Martinovic Z, Radi -Antoli M, Kes P, Wu TJ, Chen JS, Lin SH, Shiang JC, Wu CC, Munteanu D, Gemene M, Mircescu G, Opatrna S, Popperlova A, Tesar V, Rychlik I, Viklicky O, Jin K, Park BS, Jeong HJ, Kim YW, Hogas S, Voroneanu L, Onofriescu M, Nistor I, Apetrii M, Siriopol D, Cujba M, Hogas M, Covic A. PERITONEAL DIALYSIS 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fontsere N, Mestres G, Burrel M, Barrufet M, Montana X, Arias M, Ojeda R, Maduell F, Campistol JM, Nagaraja P, Rees D, Husein T, Chess J, Lin CC, Yang WC, Khosravi M, Kandil H, Cross J, Hopkins S, Collier S, Lopes D, Pereira S, Gomes AM, Ventura A, Martins V, Seabra J, Rothuizen TC, Damanik F, Visser MJT, Lavrijsen T, Cox MAJ, Moroni L, Rabelink TJ, Rotmans JI, Fontsere N, Cardozo C, Donate J, Soriano A, Muros M, Pons M, Mensa J, Campistol JM, Navarro-Gonzalez JF, Maduell F, Wijewardane A, Murley A, Powers S, Allen C, Baharani J, Wilmink T, Esenturk M, Zengin M, Dal M, Tahtal N, Shibata K, Shinzato T, Satta H, Nishihara M, Koguchi N, Kuji T, Kawata S, Kaneda T, Yasuda G, Scrivano J, Pettorini L, Rutigliano T, Ciavarella GM, De Biase L, Punzo G, Mene P, Pirozzi N, El Haggan W, Belazrague K, Ehoussou S, Foucher V, El Salhy M, Ouellet G, Davis J, Caron P, Leblanc M, Pettorini L, Romitelli F, Fazzari L, Scrivano J, Ortu G, Di Stasio E, Punzo G, Mene P, Pirozzi N, Loizzo G, Vigano SM, Bacchini G, Rocchi E, Sala V, Pontoriero G, Letachowicz K, Go biowski T, Kusztal M, Letachowicz W, Weyde W, Klinger M, Murley A, Wijewardane A, Powers S, Allen C, Hollingsworth L, Wilmink T, Baharani J, Roca-Tey R, Samon R, Ibrik O, Roda A, Gonzalez-Oliva JC, Martinez-Cercos R, Viladoms J, Renaud CJ, Lim EK, Seow TY, Teh HS, Tosic J, Jankovic A, Djuric P, Radovic Maslarevic V, Popovic J, Dimkovic N, Kazantzi A, Trigka K, Buono F, Laurino S, Toriello G, Di Luccio R, Galise A, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Asano M, Oguchi K, Saito A, Onishi Y, Yamamoto Y, Fukuhara S, Akiba T, Akizawa T, Kurokawa K, Guedes Marques M, Ibeas J, Maia P, Ponce P, Chang KY, Park HS, Kim HW, Choi BS, Park CW, Yang CW, Jin DC, Likaj E, Seferi S, Caco G, Petrela E, Barbullushi M, Idrizi A, Thereska N, Lomonte C, Casucci F, Libutti P, Lisi P, Basile C, Ancarani P, Valsuani G, Cavallo L, Parodi D, Lorusso C, Renaud C, Lai BC, Tho S, Yeoh L, Guedes Marques M, Botelho C, Maia P, Ponce P, Yankovoy A, Alexandr S, Smoliacov A, Stepanov V, Rees D, Parker C, Davies P, Taylor S, Mikhail A, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Gubensek J, Persic V, Vajdic B, Ponikvar R, Buturovic-Ponikvar J, Hadimeri U, Warme AV, Stegmayr B, Jankovic A, Suvakov S, Tosic J, Damjanovic T, Djuric P, Bajcetic S, Radovic-Maslarevic V, Popovic J, Simic T, Dimkovic N, Likaj E, Seferi S, Petrela E, Idrizi A, Rroji M, Barbullushi M, Thereska N, Chua HL, Kanda H, See SL, Liew NC, Tsuchida K, Tomo T, Fukasawa M, Kawashima S, Minakuchi J, Thanaraj V, Dhaygude A, Ikeda K, Forneris G, Cecere P, Pozzato M, Trogolo M, Vallero A, Mesiano P, Roccatello D, Esenturk M, Zengin M, Keskin L, Loizzo G, Vigano SM, Bacchini G, Rocchi E, Sala V, Pontoriero G, Casey JR, Hanson CS, Winkelmayer WC, Craig J, Palmer S, Strippoli G, Tong A, Ferrara D, Scamarda S, Bernardino L, Amico L, Lorito MC, Incalcaterra F, Visconti L, Visconti G, Valenza F, D'Amato F, Di Napoli A, Tazza L, Chicca S, Lapucci E, Silvestri P, Di Lallo D, Michelozzi P, Davoli M. DIALYSIS VASCULAR ACCESS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Locatelli F, Del Vecchio L, Violo L, Pontoriero G. Phosphate binders for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis: a comparison of safety profiles. Expert Opin Drug Saf 2014; 13:551-61. [PMID: 24702470 DOI: 10.1517/14740338.2014.907791] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hyperphosphatemia is common in the late stages of chronic kidney disease (CKD) and is associated with elevated parathormone levels, abnormal bone mineralization, extraosseous calcification and increased risk of cardiovascular events and death. Several classes of oral phosphate binders are available to help control phosphorus levels. Although effective at lowering serum phosphorus, they all have safety issues that need to be considered when selecting which one to use. AREAS COVERED This paper reviews the use of phosphate binders in patients with CKD on dialysis, with a focus on safety and tolerability. In addition to the more established agents, a new resin-based phosphate binder, colestilan, is discussed. EXPERT OPINION Optimal phosphate control is still an unmet need in CKD. Nonetheless, we now have an extending range of phosphate binders available. Aluminium has potentially serious toxic risks. Calcium-based binders are still very useful but can lead to hypercalcemia and/or positive calcium balance and cardiovascular calcification. No long-term data are available for the new calcium acetate/magnesium combination product. Lanthanum is an effective phosphate binder, but there is insufficient evidence about possible long-term effects of tissue deposition. The resin-based binders, colestilan and sevelamer, appear to have profiles that would lead to less vascular calcification, and the main adverse events seen with these agents are gastrointestinal effects.
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Affiliation(s)
- Francesco Locatelli
- Alessandro Manzoni Hospital, Department of Nephrology Dialysis , Via dell'Eremo 9, 23900 Lecco , Italy +39 0341 489850 ; +39 0341 489860 ;
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Locatelli F, Spasovski G, Dimkovic N, Wanner C, Dellanna F, Pontoriero G. The effects of colestilan versus placebo and sevelamer in patients with CKD 5D and hyperphosphataemia: a 1-year prospective randomized study. Nephrol Dial Transplant 2013; 29:1061-73. [PMID: 24302608 PMCID: PMC4005560 DOI: 10.1093/ndt/gft476] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study compared the effects of short-term titrated colestilan (a novel non-absorbable, non-calcium, phosphate binder) with placebo, and evaluated the safety and efficacy of colestilan over 1 year compared with sevelamer, in patients with chronic kidney disease (CKD) 5D. METHODS This prospective multicentre study comprised a 4-week phosphate binder washout period, a 16-week short-term, flexible-dose, treatment period (including a 4-week placebo-controlled withdrawal period) and a 40-week extension treatment phase. RESULTS At Week 16 (the end of the 4-week placebo-controlled withdrawal period), serum phosphorus level was 0.43 mmol/L (1.32 mg/dL) lower with colestilan than placebo (P < 0.001; primary end point). Serum LDL-C level was also lower with colestilan than with placebo (P < 0.001). Both colestilan and sevelamer produced significant reductions from baseline in serum phosphorus levels (P < 0.001), maintained for 1 year, and the proportion of patients achieving target levels of ≤1.78 mmol/L (5.5 mg/dL) or ≤1.95 mmol/L (6.0 mg/dL) at study end were similar (65.3 and 73.3%, respectively, for colestilan, and 66.9 and 77.4%, respectively, for sevelamer). Serum calcium level remained stable in the colestilan group but tended to increase slightly in the sevelamer group (end-of-study increase of 0.035 mmol/L over baseline). Both binders produced similar reductions from baseline in LDL-C level (P < 0.001), and responder rates after 1 year, using a target of <1.83 mmol/L (70 mg/dL) or <2.59 mmol/L (100 mg/dL) were similar in both groups (50.7 and 85.3% for colestilan and 54.0 and 80.6% for sevelamer). Colestilan was generally well tolerated. CONCLUSIONS Colestilan is effective and safe for the treatment of hyperphosphataemia in patients with CKD 5D, and affords similar long-term phosphorus and cholesterol reductions/responder rates to sevelamer.
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Affiliation(s)
- Francesco Locatelli
- Department of Nephrology Dialysis and Renal Transplantation, A Manzoni Hospital, Lecco, Italy
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Wong MMY, Thijssen S, Usvyat LA, Kotanko P, Maddux FW, Speer T, Rohrer L, Blyzszuk P, Krankel N, Zewinger S, Martin T, von Eckardstein A, Luscher T, Landmesser U, Fliser D, Prats M, Font R, Garcia C, Cabre C, Jariod M, Martinez Vea A, Costa E, Ribeiro S, do Sameiro-Faria M, Rocha-Pereira P, Kohlova M, Fernandes J, Reis F, Miranda V, Quintanilha A, Bronze-da-Rocha E, Belo L, Santos-Silva A, do Sameiro-Faria M, Kohlova M, Ribeiro S, Rocha-Pereira P, Fernandes J, Nascimento H, Reis F, Miranda V, Bronze-da-Rocha E, Quintanilha A, Belo L, Costa E, Santos-Silva A, Schepers E, Glorieux G, Van den Abeele T, Neirynck N, Vanholder R, Neirynck N, Glorieux G, Boelaert J, Liabeuf S, Massy Z, Vanholder R, Kaynar K, Kural BV, Ulusoy S, Cansiz M, Akcan B, Misir N, Yaman S, Kaya N, Dimas GG, Iliadis FS, Tegos TJ, Spiroglou SG, Pitsalidis CG, Karamouzis IM, Didaggelos TP, Adamidou AP, Savopoulos CG, Karamouzis MI, Orologas AG, Hatzitolios AI, Grekas DM, Flisinski M, Brymora A, Stefanska A, Strozecki P, Manitius J, Khalfina TN, Maksudova AN, Valeeva IK, Bantis C, Kouri NM, Bamichas G, Stangou M, Tsantekidou E, Natse T, Fazio MR, Basile G, Lucisano S, Montalto G, Valeria C, Donato V, Lupica R, Trimboli D, Aloisi C, Buemi M, Henze A, Raila J, Scholze A, Schweigert F, Tepel M, Nakamichi R, Prates E, Redublo Quinto BM, Zanella MT, Batista MC, Masajtis-Zagajewska A, Kurnatowska I, Wajdlich M, Nowicki M, Mennini F, Russo S, Marcellusi A, Quintaliani G, Andrulli S, Chiavenna C, Bigi MC, Tentori F, Crepaldi M, Corti MM, Dell'Oro C, Bacchini G, Limardo M, Pontoriero G, Williams C, Abbas SR, Zhu F, Flores-Gama C, Moskowitz J, Cartagena C, Carter M, Levin N, Kotanko P, de Oliveira RB, Liabeuf S, Okazaki H, Lenglet A, Desjardins L, Lemke HD, Valholder R, Choukroun G, Massy ZA. Nutrition / inflammation. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Locatelli F, Manzoni C, Del Vecchio L, Di Filippo S, Pontoriero G, Cavalli A. Management of Anemia by Convective Treatments. Contributions to Nephrology 2011:162-172. [DOI: 10.1159/000321757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Locatelli F, Cavalli A, Manzoni C, Pontoriero G. The Membrane Permeability Outcome Study. Contributions to Nephrology 2011:81-92. [DOI: 10.1159/000333816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
Recent observational studies of patients with stage 3-5 chronic kidney disease (CKD) not undergoing dialysis have shown that even slight increases in parathyroid hormone (PTH) levels are associated with an increased cardiovascular risk, regardless of the serum levels of calcium and phosphorus and vitamin D therapy. These studies suggest paying particular attention to monitoring PTH levels from the early stages of CKD, and preventing any mineral metabolism disorders that may trigger the excessive synthesis and secretion of PTH. However, it is not easy to determine when an appropriate response becomes maladaptive and requires the pharmacological suppression of the parathyroid gland because the gland's adaptive response can vary widely from one person to another. Furthermore, PTH levels are not always a good predictor of bone turnover and current PTH assays have various methodological limitations. Treating the early mineral metabolism abnormalities of CKD may help prevent the cardiovascular complications whose frequency, costs and mortality have a profound effect on society as a whole. For this reason, there is great interest in establishing adequate target ranges for PTH at different stages of CKD, and determining the most appropriate strategies for reaching them.
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Affiliation(s)
- Giuseppe Pontoriero
- Department of Nephrology and Dialysis, Ospedale Alessandro Manzoni, Lecco, Italy.
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Limardo M, Pontoriero G, Locatelli F. [KDIGO guidelines for the diagnosis and treatment of chronic kidney disease mineral and bone disorder: what's new?]. G Ital Nefrol 2010; 27:211-214. [PMID: 20540007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Eandi M, Pradelli L, Iannazzo S, Chiroli S, Pontoriero G. Economic evaluation of cinacalcet in the treatment of secondary hyperparathyroidism in Italy. Pharmacoeconomics 2010; 28:1041-1054. [PMID: 20936886 DOI: 10.2165/11538600-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Imbalanced levels of parathyroid hormone (PTH), serum calcium (Ca) and phosphorous (P) are associated with an increased risk of cardiovascular (CV) death and fracture in dialysis patients with secondary hyperparathyroidism (SHPT). The calcimimetic agent cinacalcet can attenuate the mineral and hormonal imbalances characteristic of SHPT and may improve outcomes in such patients. Here we describe a cost-utility analysis of cinacalcet for SHPT in dialysis patients in Italy. METHODS We developed a probabilistic Markov model to simulate the effect of cinacalcet on Ca, P and PTH levels in dialysis patients with SHPT, based on data from a European, multicentre, open-label study. The model then correlated these levels with mortality and morbidity (CV events, fractures and parathyroidectomies) using data from the literature, and incorporated Italian data for dialysis, drugs and management of events according to the national cost structure. The simulation horizon was patient lifetime; simulated treatment alternatives were standard treatment (mainly vitamin D sterols and phosphate binders) and cinacalcet + standard treatment. A 3.5% discount rate was applied to life expectancy (LE), quality-adjusted life-expectancy (QALE), costs and times below the upper ranges (time in range [TiR]) recommended by the National Kidney Foundation - Kidney Disease Outcomes Quality initiative for PTH, Ca, P and Ca × P. Utilities were derived from the published literature and took into account dialysis and the impairment of quality of life due to the occurrence of CV events and fractures. Costs were evaluated in year 2009 values from the perspective of the Italian National Healthcare System. RESULTS Baseline results were calculated with 10,000 iterations. Compared with standard treatment alone, addition of cinacalcet was associated with a mean (SD) increase in TiR of 5.26 (6.59), 3.63 (6.87), 1.70 (6.66) and 2.68 (5.55) discounted patient-years for PTH, Ca and P, respectively, and combined PTH, Ca, P and Ca × P. Cinacalcet increased LE by 1.20 (3.75) life-years (LYs) and QALE by 0.89 (2.59) QALYs. When including the cost for dialysis, the incremental cost-effectiveness ratio (ICER) was €50,012 per LY and €67,361 per QALY, while, if dialysis costs were not included, the ICER was €23,473 per LY and €31,616 per QALY. CONCLUSIONS The results suggest that cinacalcet treatment could be considered cost effective for treatment of SHPT in the Italian healthcare setting, but further investigations are needed to confirm these findings.
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Locatelli F, Dimkovic N, Pontoriero G, Spasovski G, Pljesa S, Kostic S, Manning A, Sano H, Nakajima S. Effect of MCI-196 on serum phosphate and cholesterol levels in haemodialysis patients with hyperphosphataemia: a double-blind, randomized, placebo-controlled study. Nephrol Dial Transplant 2009; 25:574-81. [PMID: 19736246 DOI: 10.1093/ndt/gfp445] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hyperphosphataemia in patients on haemodialysis (HD) can lead to, or worsen, secondary hyperparathyroidism (with associated bone disease) and extra-skeletal calcifications associated with increased cardiovascular morbidity and mortality. MCI-196 is a new, non-absorbed, non-calcium-based phosphate binder. The aim of this study was to determine the effect of three fixed doses of MCI-196, on serum phosphorus level and other parameters relevant to HD patients. METHODS A total of 120 chronic kidney disease (CKD) stage 5 patients on HD and with the serum phosphorus level >2.1 mmol/l were randomized to receive double-blind treatment with either 3, 6 and 9 g/day MCI-196 or placebo for 3 weeks. RESULTS Serum phosphorous decreased in all three treatment groups (-0.038, -0.268 and -0.257 mmol/l in the 3, 6 and 9 g/day groups, respectively). The difference between treatment and placebo groups was significant for the 6 and 9 g/day groups (P < 0.05 in both cases). Changes in the mean serum calcium were minimal and without relevant differences between groups. However, calcium-phosphorus product (Ca x P) was significantly reduced in the 6 and 9 g/day groups P < 0.05). MCI-196 at all doses decreased serum intact PTH between baseline and endpoint, and differences between treatment groups and placebo were statistically significant for the 3 and 9 g/day groups (P < 0.02 in both cases). Both serum total and LDL cholesterol decreased significantly in all treatment groups compared to placebo (by 0.71-1.05 mmol/l, for total cholesterol and 0.68-0.94 mmol/l for LDL cholesterol P < 0.001 in all cases). There was minimal change in serum HDL cholesterol. MCI-196 at all doses decreased significantly serum uric acid between baseline and endpoint compared to placebo (P < 0.005 in all cases). The drug was well tolerated. CONCLUSION MCI-196 significantly reduced serum phosphorus, Ca x P and PTH, without effecting serum calcium levels. The additional reduction in total cholesterol and LDL cholesterol indicates a possible dual mechanism of action of MCI-196 that has the potential to reduce cardiovascular morbidity in CKD stage 5 patients.
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Affiliation(s)
- Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplantation, A Manzoni Hospital, Lecco, Italy.
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Manzoni C, Cavalli A, Pontoriero G, Di Filippo S, Locatelli F. [Do convective treatments significantly reduce morbidity and mortality?]. G Ital Nefrol 2009; 26 Suppl 45:S16-S19. [PMID: 19382089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Standard hemodialysis is a far from ideal treatment for uremia since the morbidity and mortality of patients on hemodialysis are still significantly higher than those of non-hemodialyzed subjects with similar demographic characteristics. Because it has been suggested that the cause could lie in the inadequate removal of ''middle molecules'' by standard hemodialyis, two alternative treatments have been proposed: high-efficiency hemodialyis and high-flux hemodialyis. The 2002 results of the HEMO study showed that both these treatments are associated with a non-significant reduction in the relative risk of death (4% and 8%, respectively). The MPO study, which - unlike the HEMO study - enrolled only incident cases and not did not allow reuse of dialyzers, evaluated the mortality rate with high-flux and low-flux hemodialysis in a sicker population, i.e., patients with hypoalbuminemia, and showed a significant reduction in the relative risk of death especially in patients with diabetes. In an attempt to define the clinical impact of hemodiafiltration, some of the efficacy data from clinical studies are reviewed in light of a number of factors that may be related to the high mortality among hemodialysis patients. The current state of affairs suggests it is reasonable to prefer high-flux hemodialysis in sicker patients, especially diabetics. Moreover, the use of ultrapure dialysis fluid is recommended to reduce chronic inflammation and its consequences.
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Affiliation(s)
- C Manzoni
- Dipartimento di Nefrologia, Dialisi e Trapianto Renale, Ospedale A. Manzoni, Lecco 23900, Italy
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Wilkie M, Pontoriero G, Macário F, Yaqoob M, Bouman K, Braun J, von Albertini B, Brink H, Maduell F, Graf H, Frazão JM, Bos WJ, Torregrosa V, Saha H, Reichel H, Zani VJ, Carter D, Messa P. Impact of Vitamin D Dose on Biochemical Parameters in Patients with Secondary Hyperparathyroidism Receiving Cinacalcet. ACTA ACUST UNITED AC 2009; 112:c41-50. [DOI: 10.1159/000212102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 09/19/2008] [Indexed: 11/19/2022]
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Locatelli F, Limardo M, Pontoriero G. New approaches to treatment of secondary hyperparathyroidism. Curr Opin Investig Drugs 2008; 9:363-370. [PMID: 18393103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A large number of patients with chronic kidney disease are affected by secondary hyperparathyroidism. The related mineral metabolism abnormalities are associated with an increased relative risk of morbidity and mortality. The management of secondary hyperparathyroidism is made more complex by the fact that the disease progresses over time. Recent approaches to its management include vitamin D analogs, non-calcium/non-aluminum containing phosphate binders and calcimimetics.
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Affiliation(s)
- Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplantation, A Manzoni Hospital, Lecco, Italy.
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Pontoriero G, Pozzoni P, Vecchio LD, Locatelli F. International Study of Health Care Organization and Financing for renal replacement therapy in Italy: an evolving reality. ACTA ACUST UNITED AC 2007; 7:201-15. [PMID: 17641969 DOI: 10.1007/s10754-007-9016-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Italian national health system funds universal health care through general taxation, but health services are provided by local institutions. This study examines the epidemiology, provision, and funding of renal replacement therapy (RRT) in Italy. In 2001, prevalence and incidence of RRT in Italy were 0.083% and 0.014%, respectively. A 1999 donation law markedly increased renal transplantation rates. Italy spends 8.3% of its GDP on health care; 1.8% is for end-stage renal disease (ESRD) patients, who represent 0.083% of the general population. The reorganization of the NHS requires attention from the health community so that economic and geographic health disparities are not exacerbated.
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Del Vecchio L, Pozzoni P, Limardo M, Caruso S, Fortunato M, Pontoriero G, Locatelli F. [Recent advances in the prevention of cardiovascular morbidity and mortality in end-stage renal disease: role of anemia, hyperparathyroidism and calcifications]. G Ital Nefrol 2007; 24 Suppl 38:25-32. [PMID: 17922444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The mortality rate in patients with end-stage renal disease (ESRD) is extremely high, mainly because of the high prevalence of cardiovascular disease. In addition to traditional cardiovascular risk factors, other factors peculiar to chronic kidney disease play a role. Anemia and calcium-phosphate disorders are of particular interest, not only because they have been related to an increased risk of death but, more importantly, because they can be reversed by treatment, thereby providing the opportunity to prevent or delay the onset of cardiovascular disease. Despite a clear association between higher hemoglobin levels and better survival, data from interventional trials do not seem to show a significant positive effect of hemoglobin normalization with erythropoiesis-stimulating agents on survival and left ventricular mass in ESRD patients. Nevertheless, partial correction of anemia is still an important goal to be reached, as is also suggested by international guidelines. Disorders of calcium-phosphate metabolism have also been clearly related to increased mortality. Unlike anemia, which can be easily corrected by treatment in most cases, mineral metabolism is much less effectively treated. New agents, such as phosphate binders not containing calcium and aluminum, vitamin D analogs with lower calcemic activity, and calcimimetics, are becoming increasingly available in everyday clinical practice and are likely to allow a higher percentage of patients to achieve the recommended targets for calcium-phosphate and parathyroid hormone. Given that these molecules have only been introduced recently, clear data from interventional studies showing improved survival after adequate correction of mineral metabolism parameters are still lacking.
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Affiliation(s)
- L Del Vecchio
- UF d'Ipertensione e Nefrologia Preventiva, IRCCS Multimedia, Sesto San Giovanni (MI), Italy
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Abstract
The traditional treatment of secondary hyperparathyroidism, which affects many patients with chronic kidney disease and is associated with an increased risk of morbidity and mortality, is not very effective. Recent approaches to its management include the use of vitamin D analogues, non-calcium non-aluminium containing phosphate binders, and calcimimetics.
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Pontoriero G, Locatelli F, Andreucci VE, Bragg-Gresham J, Eichleavy MA, Pisoni RL, Port FK. [DOPPS estimate of guideline impact on survival in hemodialysis in Italy]. G Ital Nefrol 2007; 24:221-9. [PMID: 17554734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Knowing the relative risk (RR) of mortality associated with being outside the guideline targets and the percentage of patients in this situation, it is possible to estimate the number of patient life years that could be gained from adhering to guideline recommendations. We used a prevalent cross-sectional sample of 576 Italian patients from the Dialysis Outcomes and Practices Patterns Study (DOPPS) phase II (2002-2004) to determine the percentage of patients who failed to meet the Italian Society of Nephrology's targets for dialysis dose (spKt/V ≥ 1.3), anemia management (hemoglobin ≥ 11 g/dL), and mineral metabolism (serum calcium and phosphorus: ≤ 2.6 and ≤ 1.8 mmol/L, respectively), and the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (K/DOQI) targets for nutritional status (serum albumin ≥ 4 g/dL) and vascular access (facility catheter use ≤ 10%). We used a larger random sample of DOPPS patients to establish the adjusted RRs of mortality associated with the 6 examined targets. The percentage of patients outside the targets and the adjusted RRs were 34% and 1.12 for dialysis dose, 37.7% and 1.20 for anemia management, 40.8% and 1.14 for phosphorus, 14.4% and 1.22 for calcium, 62.5% and 1.46 for albumin, and 40.1% and 1.20 for facility catheter use. The adjusted sum of life years potentially gained by complete adherence to all 6 guidelines was 25,156 over a period of 5 years (2006-2010); a more conservative estimate, modeling life years potentially gained by bringing half of all patients outside targets within them, was 13,382. In conclusion, this analysis suggests opportunities to improve hemodialysis patient care in Italy. The magnitude of potential savings in life years should encourage greater adherence to guidelines and practices that are significantly associated with better survival.
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Affiliation(s)
- G Pontoriero
- Divisione di Nefrologia e Dialisi, Ospedale A. Manzoni, Lecco - Italy
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Pozzoni P, DI Filippo S, Pontoriero G, Locatelli F. Effectiveness of sodium and conductivity kinetic models in predicting end-dialysis plasma water sodium concentration: Preliminary results of a single-center experience. Hemodial Int 2007; 11:169-77. [PMID: 17403167 DOI: 10.1111/j.1542-4758.2007.00165.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The attainment of a neutral sodium balance represents a major objective in hemodialysis patients. It requires that at the end of each dialysis session, total body water volume (V(f)) and total plasma water sodium concentration (Na(pwf)) are constant. Whereas to achieve a constant V(f) it is sufficient that ultrafiltration equals the interdialytic increase in body weight, it is impossible to predict the value of Na(pwf) and calculate the dialysate sodium concentration needed to obtain it without making use of kinetic mathematical models. The effectiveness of both sodium and conductivity kinetic models in predicting Na(pwf) has already been validated in previous clinical studies. However, applying the sodium kinetic model appears to be poorly feasible in the everyday clinical practice, due to the need for blood samples at the start of each dialysis session for the determination of predialysis plasma water sodium concentration. The conductivity kinetic model appears to be more easily applicable, because no blood samples or laboratory tests are needed to determine plasma water conductivity (C(pw)) and ionic dialysance (ID), used in place of plasma water sodium concentration and sodium dialysance, respectively. We applied the 2 models in 69 chronic hemodialysis patients using the Diascan Module for the automatic determination of C(pw) and ID, and using the latter as an estimate of sodium dialysance in the sodium kinetic model. The conductivity kinetic model was shown to be more accurate and precise in predicting Na(pwf) as compared with the sodium kinetic model. Both accuracy and imprecision of the 2 models were not significantly affected by the method used to estimate total body water volume. These findings confirm the conductivity kinetic model as being an effective and easily applicable instrument for the achievement of a neutral sodium balance in chronic hemodialysis patients.
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Affiliation(s)
- Pietro Pozzoni
- Department of Nephrology and Dialysis, A. Manzoni Hospital, University of Milano-Bicocca, Lecco, Italy
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Abstract
Mineral metabolism disorders, including those related to secondary hyperparathyroidism, affect a large number of patients with chronic kidney disease and are associated with increased relative risk of morbidity and mortality in hemodialysis patients. The traditional therapy of secondary hyperparathyroidism based on vitamin D compounds and calcium-based phosphate binders is often limited by the increase of serum calcium and phosphorus levels limiting the dose that can be given safely, and thus, preventing the attainment of treatment targets. Cinacalcet hydrochloride (Sensipar®, Mimpara®, Parareg®) is the first in a new class of therapeutic agents, the calcimimetics, that increase the sensitivity of calcium-sensing receptors to the extracellular calcium ions, thus lowering parathyroid hormone production and release, decreasing serum calcium and phosphorous concentrations simultaneously. Different randomized, double-blind, placebo-controlled trials evaluated the safety and ability of cinacalcet hydrochloride treatment to improve achievement of target levels of parathyroid hormone, calcium, phosphorus and calcium phosphorus product in dialysis patients. Cinacalcet hydrochloride has also demonstrated to be effective in reducing parathyroid hormone and serum calcium concentrations in patients with primary hyperparathyroidism. On the basis of available data, calcimimetics represent an important innovation and will change the management of mineral metabolism disorders in patients with chronic kidney disease and primary hyperparathyroidism.
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Affiliation(s)
- Francesco Locatelli
- a Department of Nephrology. A. Manzoni Hospital, Via dell'eremo 9/11 23900 Lecco, Italy. f.locatelli@
| | - Giuseppe Pontoriero
- b Department of Nephrology. A. Manzoni Hospital, Via dell'eremo 9/11 23900 Lecco, Italy.
| | - Monica Limardo
- c Department of Nephrology. A. Manzoni Hospital, Via dell'eremo 9/11 23900 Lecco, Italy.
| | - Flavia Tentori
- d Department of Nephrology. A. Manzoni Hospital, Via dell'eremo 9/11 23900 Lecco, Italy.
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Di Filippo S, Pozzoni P, Manzoni C, Andrulli S, Pontoriero G, Locatelli F. Relationship between urea clearance and ionic dialysance determined using a single-step conductivity profile. Kidney Int 2005; 68:2389-95. [PMID: 16221245 DOI: 10.1111/j.1523-1755.2005.00702.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND On-line determination of ionic dialysance (ID) has been used to measure the clearance of small solutes like urea. However, attempts to determine the in vivo relationship between ID and urea clearance have led to discordant findings. The aim of this study was to determine the relationship between the mean values of repeated instantaneous determinations of ID throughout a dialysis session ((m)ID), obtained using a single-step inlet dialysate conductivity profile, and the mean values of urea clearance corrected for access recirculation (K(eu1)), total recirculation (access plus cardiopulmonary recirculation, K(eu2)), and the entire postdialysis urea rebound (K(wb)). METHODS Eighty-two anuric patients on chronic thrice-weekly hemodialysis were studied using an Integra machine equipped with the Diascan module for the automatic determination of ID. The mean values of repeated ID measurements made at 30-minute intervals were compared with K(eu1) (available for only 31 patients), K(eu2), and K(wb). RESULTS The results in all 82 patients were: (m)ID = 176 +/- 23 mL/min; K(eu2) = 181 +/- 25 mL/min; K(wb) = 159 +/- 22 mL/min. The mean (m)ID/K(wb) and (m)ID/K(eu2) ratios were, respectively, 1.11 +/- 0.06 and 0.98 +/- 0.06. The results in the 31 patients for whom K(eu1) values were available were: (m)ID = 179 +/- 24 mL/min and K(eu1) = 200 +/- 27 mL/min; the mean (m)ID/K(eu1) ratio was 0.90 +/- 0.05. CONCLUSION The mean value of repeated ID determinations obtained using a single-step conductivity profile underestimates urea clearance corrected for access recirculation, and may be considered an adequate estimate of urea clearance corrected for total recirculation.
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