Autosomal-dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage renal disease (ESRD) worldwide. The number of ADPKD patients who are listed for transplantation or receive a kidney transplant is continuously increasing over time. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding kidney transplantation as therapeutic option of end-stage renal failure. The survey was conducted on 381 people with ADPKD, using computer-assisted web interviewing (CAWI). The results confirm that there are problems that need to be addressed before listing an ADPKD patient for a kidney transplantation, namely the patient’s comorbidities, the complexity of pre-transplant assessments and the shortage of organs. Pre-emptive transplantation from cadaver donor is a rare event in our country but it is a valid option, especially in case of living donation. Immunosuppression is well tolerated in a high percentage of subjects, but a follow-up is necessary to monitor negative side effects. Despite these problems, the outcome of kidney transplantation is optimal in these patients. Also, the relationship between patients and Nephrologists and/or Transplant Centers is important to ensure a positive outcome.
The efficacy of antiplatelet treatment with aspirin in the primary prevention of major cardiovascular events was questioned during 2018, following a new series of trials that we summarize here in a quick synoptic overview. The three studies involved are the ASPREE trial, the ASCEND study and the ARRIVE trial. These studies all have a double-blind randomized design, and 100 mg/day aspirin was administered with an intention-to-treat approach and against placebo. Age of the enrolled patients, prevalence of diabetes mellitus and geographical location of other studies are just some of the elements analyzed here, in addition to the different problems of cardiovascular events. The ASPREE study observed a marginal reduction of cardiovascular events with the use of aspirin, by approximately 5% with a confidence interval at risk of insignificancy. On the other hand, the increased risk of a hemorrhagic event appeared to be rather robust, resulting between 18% and 62%. The ASCEND study observed a reduction in cardiovascular events of around 12%, offset by an increase in the risk of major bleeding between 9% and 52%. The ARRIVE study did not detect any incidence of major cardiovascular events, while the risk of major bleeding appeared to even double. The evidences of the current literature push us to review a widespread conviction among professionals who fight the war against cardiovascular disease every day: the prescription of aspirin in the primary prevention can no longer happen systematically, and every single prescription need care between benefits and dangers connected to the treatment. (Cardionephrology)
From a statistical perspective, interaction (effect modification) occurs when the effect of an exposure on an outcome depends on the level of another factor. In epidemiology, effect modification (interaction) occurs if the joint effect of two (or more) factors is different from the expected effect if considering only their independent effects. In an additive model, the effect of one exposure is added to effect of another exposure, and there is interaction if the joint effect of the two exposures together is greater than the sum of their individual effects. In a multiplicative model, the effect of the second exposure multiplies the effect of the first exposure, and there is interaction if the joint effect of the two exposures together is greater than the product of their individual effects. Interaction of two (or more) factors is synergic or antagonistic if the total effect is, respectively, greater or smaller than the sum of the individual effects of each factor. (Epidemiology_statistics)
Our physical and mental well-being are directly linked to what we eat and drink. The nutritional content of what we eat determines the composition of our cell membranes, bone marrow, blood, hormones, tissues, organs, skin, and hair. Lifestyle and nutrition of the humankind has undergone substantial changes during the last century. Additives and processed food have become the basis of our nutrition. Ingredients such as salt, sugar and fat are sometimes added to processed foods to make their flavour more appealing and to extend their shelf life. When the processed food industry discovered that these ingredients could be formulated to produce a state of satiety, pleasure, and sensory hedonia in those who consumed them, it extended their use to the “bliss point”, the point where the levels of saltiness, sweetness, and richness were perceived by the consumer as just right. Such modified foods can dysregulate the brain’s food reward system by increasing dopamine production, thus making the foods addictive. It is not easy to avoid these foods: the only way is to eat mainly fresh or only lightly processed foods (such as canned tomatoes and frozen vegetables). It is helpful to know which foods are healthy and what you can do to ensure you eat the healthiest diet you can. Combining a variety of foods, eating regular meals, including wholegrains, fibres, fruit, vegetables and “healthy fats”, and limiting the amount of sugar, salt and fat you eat are all recommended for good nutrition. (Healthy_habits)
del tulipano, il fiore che ci rappresenta!Abbiamo piantato i nostri bulbi all'inizio dell'inverno e ora stanno fiorendo spero a tutti.Questi sono i miei, e ne vado molto fiera!
Congestion represents a crucial clinical component of both heart failure and cardiorenal syndrome and it has been postulated to modulate heart and kidney cross-link. Diuretic therapy is a corner stone in the treatment patients with heart failure, and renal replacement therapies are mainly used for patients with refractory heart failure who have not reached the worst stages of renal disfunction. Peritoneal dialysis is a home-based therapeutic modality providing both solute clearance and ultrafiltration, together with relief from congestion in decompensated heart failure patients. The following review will focus on sodium removal in refractory decompensated heart failure patients undergoing peritoneal dialysis. (Cardionephrology)
Purpose: A patient diagnosed with chronic kidney disease (CKD) is forced to reorganise his/her entire lifestyle according to the rhythm of dialysis, a life-saving therapy that becomes a life-long sentence. Slowly, the clinic becomes a prison of pain and frustration, worsening the symptoms and affecting the medical staff as well. Thus, I decided to work on the doctor-patient relationship in order to guide those under therapy in finding a new perception of themselves “beyond the disease”. Methods: In pursuing this goal, I adopted the methodology of narrative medicine, structured through three interviews: the first one on the disease; the second one on the past (i.e. emotions, fond memories, etc.); the third one on future projects. I also launched other weekly activities, such as sharing good news from the newspaper, watching movies, and organising outdoor activities. Results Throughout the project, I observed a significant improvement in the well-being of the patients, through a decrease in their stress levels and an increased response to therapy. Furthermore, I was able to establish a group dynamic among the patients as well as between them and the staff. Conclusions; At the end of the first year, the project was renewed, and its scope widened. We collected some photos and thoughts of the patients during our outdoor activities and published them in a book, which was given to the patients for Christmas, as the symbol of both the end of the first year and the start of another… beyond the disease. (narrative nephrology)
Chronic kidney disease (CKD) is constantly increasing in terms of prevalence and incidence. Subjects with impaired renal function, even if only in the presence of micro/macroalbuminuria, have an increased cardiovascular risk profile. Therefore, we must pay particular attention to the treatment of all associated risk factors. Therapy with oral hypoglycemic agents often requires modulation of drug dosage based on kidney function. Today, there are molecules available that are able not only to induce cardiovascular protection, but also to slow the progression of renal damage.
Habits may be the key word in the future of health. In the last years scientist have demonstrated that habits have a great importance on peoples’ future. Factors such as a sedentary lifestyle, abuse of processed food, and deterioration of the social life and the environment are putting a strain on the adaptability of the human body. New chronic diseases are replacing the old ones and imposing very high social and health costs. Awareness of the original habits’ value can allow a sustainable health care. (Healthy_habits)
The World Kidney Day (WKD) 2016 in Bormio took place in a primary school, with two classes of the 5th grade. After being introduced by Dr. Colturi, Gianluigi narrated his experience as a kidney patient, dialysed and transplanted. In this contribution, the two authors report the statements collected from some students. The enormous curiosity and the great and heartfelt participation of children confirm - if there were any need - the importance of storytelling and ‘literacy’ in this health case at any level. (narrative nephrology)
Preeclampsia is a pregnancy-specific disorder usually defined as new-onset hypertension and proteinuria after the 20th week of gestation. Preeclampsia is a systemic disease with multiorgan involvement, and it is associated with a high risk of maternal and fetal morbidity and mortality. To date its pathogenesis is not completely understood, but placental hypoxia or hypoxia/reoxigenation may be the basic condition leading to systemic inflammation and endothelial dysfunction that induce all the clinical manifestations of the disorder. Delivery is the only curative treatment. Indeed, for the management of preeclampsia one needs to consider both the maternal risks due to continued pregnancy and the fetal risks associated with induced preterm delivery.
When a patient with chronic renal failure is told he must undergo hemodialysis, he/she lives an emotional shock, followed by a phase of anxiety. If this shock can’t be overcome, the patient can face some anxious-depressive pathologies that will complicate the already complex clinical picture. The aim of this work is to demonstrate how the communicative/educational measures are the clinical instruments, applied especially by nurses, that lead the patient to the acquisition of different skills (such as self-reliance and psycho-social abilities). In conclusion, an efficient communication, mainly based on active and participative listening, represents the most effective instrument for the patient with chronic-degenerative pathologies to promote the awareness of his own capacities of self-management, and to make him play a leading role in his own health. (narrative nephrology)
No one wants to question the scientific method, which is the method science uses to proceed and expand our knowledge of the reality. However, we can ask ourselves if scientific research has limits that we cannot overcome? In 1942, Julius Robert Oppenheimer, who ran the Manhattan project to develop the first atomic bomb, was the first to understand that the limits should not be overcome in scientific research. With the discovery of the molecular structure of the nucleic acid, and its meaning in the transmission of information in living beings, we have entered the knowledge of the "mysteries" of life. We have learned to read DNA, to write it and to modify it, cutting defective parts with the CRISPR/Cas9 technique. With genetic editing we can not only avoid many diseases, but also modify the DNA sequence in future generations. Have we reached a point where we must stop? Perhaps we must begin to consider that science must progress together with philosophical and ethical thought in the interest of the community. (Clinical_Management)
On Saturday the16th March 2019, AIRP participated at the 1st European ADPKD Patient Summit – a unique event designed to promote patient-centred care by providing an interactive forum for patients and experts to discuss ADPKD care, research and advocacy. Forty patient representatives from 15 countries, including Italy, Belgium, Finland, Denmark, France, Germany, Ireland, Lithuania, Netherlands, Spain, Sweden, Switzerland, Turkey, UK and USA joined the ADPKD experts and spokespersons from the European Kidney Health Alliance and EURORDIS. The Summit was co-hosted by PKD International, a global network of patient organizations created to fight all forms of polycystic kidney disease (PKD), and the European ADPKD Forum (EAF), a multidisciplinary, international faculty of experts dedicated to improving the health and quality of life of people with ADPKD. The event aimed to help, inform and empower patients and families to: • be fully involved in the management of their own health and talk about ADPKD with their healthcare team and participate in making decisions about their care • make the best use of the services available • learn about ADPKD research and boost ADPKD advocacy. The programme was designed and delivered together by patients and EAF experts from across Europe, based on the ADPKD Patient Route Map launched in 2018 (available at www.pkdinternational.org) and the EAF Multidisciplinary Position Statement on ADPKD Care (free online here at the Nephrology, Dialysis and Transplantation journal). During the first plenary session of the day, Prof. Albert Ong, Prof. Djalila Mekahli and David Baron (PKD Foundation) updated the participants on some of the latest international developments in ADPKD research, namely the Polycystic Kidney Disease Outcomes Consortium (PKDOC), ADPKD paediatric registries and the Standardised Outcomes in Nephrology – Polycystic Kidney Disease (SONG-PKD) study. Flavia Galletti (AIRP Italy) then moderated a session on the important steps that patients and caregivers can take, together with their healthcare team, to help protect their kidneys and reduce the risk of cardiovascular disease (including heart attacks and stroke). Prof. Tevfik Ecder discussed current recommendations on smoking cessation and managing high blood pressure, together with salt restriction and coffee intake. According to Prof. Ecder, these measures will become even more vital as obesity and diabetes, which also increase the risk of cardiovascular diseases, become more common. In addition, Prof. Mekahli explained how these aspects apply to children with ADPKD. Other sessions, led jointly by patient representatives and experts from across Europe, focused on predicting the progress of ADPKD, treating liver cysts and pain, genetics and genetic testing, renal replacement therapy (i.e. dialysis and transplantation) and how patients can better understand and get involved in research. There were also plenary sessions on current research and patient advocacy in ADPKD, and on the perspective of industry. Videos and slides from this very successful Summit will soon be available on the PKD International website. In addition, each breakout group resulted in a series of aspirations and priorities for ADPKD care and research in the future. These will be soon developed into a Summit ‘Manifesto’.
Studies in patients with chronic kidney disease have definitively shown that “dual-energy X-ray absorptiometry” (DXA) may be helpful in assessing fracture risk. Moreover, it is essential to diagnose osteoporosis and evaluate response to treatment. In order to obtain the best utility from DXA, nephrologists need to know the fundamentals of this technique, its indications in clinical practice, and the potential pitfalls in the interpretation of its results. This review will provide an overview of the fundamentals, methodology, and current clinical applications of DXA with special focus on the nephrologist’s perspective.
