Presupposto fondamentale per una buona efficienza dialitica è la presenza di un accesso vascolare ben funzionante. La fistola arterovenosa con vasi nativi rappresenta l'accesso vascolare di prima scelta, sia per il basso rischio infettivo sia per la lunga sopravvivenza. Nel caso di grave depauperamento del patrimonio vascolare dell'avambraccio, la protesi in politetrafluoroetilene costituisce una valida alternativa. Il monitoraggio periodico con eco-color Doppler si è dimostrato in grado di individuare disfunzioni precoci sia della fistola arterovenosa che della protesi, anticipandone l'eventuale procedura interventistica e migliorandone la sopravvivenza a lungo termine. Tuttavia, è ancora controversa l'opportunità di un programma di monitoraggio ecografico sistematico dell'accesso vascolare.

Objective: Among the many health-related challenges posed by the increased number of Migrants, cardiovascular risk evaluation has been less extensively evaluated than communicable disease prevention and treatment. Ethnic background is one of the many non-modifiable determinants of cardiovascular disease, whereas stress and modifiable factors such as dietary habits and smoking are very likely to be profoundly altered in the migrant population. Design and method: To compare the prevalence of hypertension in Italian residents as compared with Migrants, a total of 6027 voluntary subjects underwent medical interview, body weight, height and blood pressure (BP) measurement, risk factor evaluation and urine analysis during the National Kidney Day survey held in 2012 and 2013 by the Federazione Italiana del Rene (FIR). Results: Migrants were 445/6027 (7.38%), with a rate remarkably similar to the percentage of non-Italian residents (8.09%). A wide heterogeneity was evident, with 53 different nationalities, subdivided in Eastern Europe (38.2%), Northern Africa (17.6%), Center and Southern Africa (12.9%), Latin America (12.8%), Indian subcontinent (9.6%), Far East (5.5%), Middle East (3.4%) macro-areas. Gender distribution and body mass index were comparable in the Italian and in the Migrant groups. Despite a 10-year age difference (50 ± 12 vs. 41 ± 15 years; p <0.001), the overall prevalence of hypertension was similar in the two groups (44.7% in Italians vs. 43.4% in Migrants), as defined by BP>140/90 mmHg and/or current antyhypertensive treatment. When stratified by age, Migrants presented significantly higher BP values, the prevalence of hypertension being at least 10% higher than in Italian residents in any decade group. A similar trend was observed for awareness, active treatment and satisfactory BP control rates. Also the rate of proteinuria and glycosuria was higher in the spot urine sample analysis. Conclusions: In Migrants, hypertension prevalence, treatment rate and control rate are significantly higher than in the Italian resident population. In the future years this will inevitably increase the burden of cardiovascular disease on society and health system. These data underscore the urgent need of prevention and intervention in this special population, trying to take into proper account all the involved social, cultural, economic and health-related factors.

Objective: Among the many health-related challenges posed by the increased number of Migrants, cardiovascular risk evaluation has been less extensively evaluated than communicable disease prevention and treatment. Ethnic background is one of the many non-modifiable determinants of cardiovascular disease, whereas stress and modifiable factors such as dietary habits and smoking are very likely to be profoundly altered in the migrant population. Design and method: To compare the prevalence of hypertension in Italian residents as compared with Migrants, a total of 6027 voluntary subjects underwent medical interview, body weight, height and blood pressure (BP) measurement, risk factor evaluation and urine analysis during the National Kidney Day survey held in 2012 and 2013 by the Federazione Italiana del Rene (FIR). Results: Migrants were 445/6027 (7.38%), with a rate remarkably similar to the percentage of non-Italian residents (8.09%). A wide heterogeneity was evident, with 53 different nationalities, subdivided in Eastern Europe (38.2%), Northern Africa (17.6%), Center and Southern Africa (12.9%), Latin America (12.8%), Indian subcontinent (9.6%), Far East (5.5%), Middle East (3.4%) macro-areas. Gender distribution and body mass index were comparable in the Italian and in the Migrant groups. Despite a 10-year age difference (50 ± 12 vs. 41 ± 15 years; p <0.001), the overall prevalence of hypertension was similar in the two groups (44.7% in Italians vs. 43.4% in Migrants), as defined by BP>140/90 mmHg and/or current antyhypertensive treatment. When stratified by age, Migrants presented significantly higher BP values, the prevalence of hypertension being at least 10% higher than in Italian residents in any decade group. A similar trend was observed for awareness, active treatment and satisfactory BP control rates. Also the rate of proteinuria and glycosuria was higher in the spot urine sample analysis. Conclusions: In Migrants, hypertension prevalence, treatment rate and control rate are significantly higher than in the Italian resident population. In the future years this will inevitably increase the burden of cardiovascular disease on society and health system. These data underscore the urgent need of prevention and intervention in this special population, trying to take into proper account all the involved social, cultural, economic and health-related factors.

BACKGROUND:Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested.METHODS:We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed. The study has been approved and funded by the Italian Agency of Drugs (Agenzia Italiana del Farmaco (AIFA)) within the 2006 funding plan for independent research on drugs (registered at www.clinicaltrials.gov (NCT00827021)).

Chronic hemodialysis requires an efficient vascular access which is fundamental for a good dialytic efficiency. The native arteriovenous fistula is preferred for its longer survival and lower infection rates. In case of patients with inadequate vessels, synthetic grafts may be created. Periodic monitoring of vascular access with duplex ultrasound has been demonstrated to be able to identify early access dysfunction, thus anticipating surgical intervention and improving its long-term survival. Nevertheless, the need for a systematic monitoring of vascular access with ultrasonography is still debated.

Introduction and Aims: Gadolinium chelate (GC)s using in magnetic resonance imaging (MRI) have been traditionally considered as non-nephrotoxic contrast materials.But, in some recent articles it has been suggested that GCs may have a nephrotoxic potential.Nevertheless, most of these reports are retrospective, and evaluated contrast agents and their doses were not homogenous.To investigate the effect of gadopentetate dimeglumine (GD) and magnetic field on renal function in patients with high-risk for acute kidney injury (AKI).Methods: We designed a prospective case control study, and age and sex-matched two groups of patients were included the study.Both of groups were consisted of the patients with high-risk for AKI (diabetes mellitus, hypotension, chronic renal failure, using nephrotoxic material, i.e.) (n=40, for each group).While contrast (gadopentetate dimeglumin)-enhanced non-vascular MRI was performed to group 1 patients, MRI without conrast agent was performed in goup 2 patients.Fixed dose of GD (0.2 mmol/kg) were administered to group 1 patients.All patients were followed up 72 hours.Before and at the 6, 24 and 72 hours after the MRI; biochemical markers, urinalysis, microalbumin/creatinine ratio in spot urine, serum creatinine, and glomerular filtration rate were measured.Results: Baseline serum creatinine, microalbumin/creatinine ratio, and GFR was not different between group 1 and group 2 ( p>0.05).We did not observe adverse effect related to procedures.There were no significant changes in renal functional tests (? serum creatinine, ?microalbumin/creatinin ratio, and ?GFR) in both groups after 6, 24 or 72 hours of the procedures ( p>0,05).Conclusions: Non-vascular contrast-enhanced (GD, 0.2 mmol/kg) MRI is a safe procedure for patients with high-risk for AKI.

Autonomic dysfunction in patients with end- stage renal disease is associated with poor prognosis. Heart rate variability (HRV), determined by the standard deviation of the normal R- R interval, has been reported to be a useful evaluation of cardiac autonomic modulation. The relationship between HRV and hydration status (HS) can be analyzed by whole body bioimpedance spectroscopy. This allows a classification of patients according the combination of HS with predialysis systolic blood pressure. Differences in HRV can be studied in patients with high over hydration, but normal or low blood pressure, with respect to fluid-overloaded/hypertensive patients and normohydrated/normotensive patients. In conclusion, the assessment of the autonomic nervous system response to the hemodialysis treatment in end- stage renal disease patients, classified according to a reliable and quantitative measurement of their fluid overload, could permit better management of both arterial blood pressure and HS.

To investigate the role of protein charge in early diabetic proteinuria, the clearance of proteins differing in charge and/or size (anionic and cationic Igs, albumin) was evaluated in 98 insulin-dependent (type I) diabetic patients selected as a representative sample of the 418 patients attending our clinics. Of the patients, 12.9% were microalbuminuric and 4.8% were macroalbuminuric. Anionic and total IgG clearances were significantly increased in 30.6 and 12.2% of patients and were correlated with duration of disease. Anionic IgG4 clearances were increased in patients (9.2%) with normal IgG excretion, suggesting that charge-selectivity impairment is responsible for protein loss. Anionic Ig clearances were also higher in some patients (14.3%) with normal albumin clearance, probably as a result of different glomerular filtration and/or tubular reabsorption. The anionic-cationic IgG clearance ratio tended to increase in parallel with albumin clearance, but once above macroalbuminuric levels, it tended to fall again, indicating the concomitant presence of size-selectivity loss. The anionic IgG clearance and the anionic-cationic IgG ratio, in addition to albumin excretion, may be valuable in assessing early kidney protein charge-selectivity impairment and better characterizing normoalbuminuric patients and those in the preclinical stage of diabetic nephropathy.

Studies have been carried out in insulin-dependent diabetics of porcine Des-pheB1 insulin, which is an insulin analogue obtained by removal of the N-terminal aminoacid of the B chain. The therapeutic activity of Des-phe insulin (regular and semilinte preparations) was tested in a group of 24 insulin-dependent diabetics and compared with the unmodified parent compound. Both types of insulin, Des-phe and unmodified were chromatographically purified preparations. The mean daily blood glucose profile obtained with Des-phe insulin was slightly higher than that of unmodified preparations, while the mean blood glucose and the "M" index of Schlichtkrull were similar. The biological activity of regular Des-phe and its unmodified parent compound was evaluated in 6 further insulin-dependent diabetics, with the aid of an artificial endocrine pancreas. The insulin requirement to achieve an optimal metabolic control was 10% less with Des-phe insulin than with the unmodified preparation. The immunogenicity of Des-phe and unmodified insulins, tested by measuring plasma insulin antibody titres in diabetic patients either newly or already insulin treated, was comparable. However the binding capacity of 125I-Des-phe insulin to preexisting antibodies seemed to be less than that of unmodified 125I-insulin in patients previously treated with unmodified insulin. Finally Des-phe appeared able to correct promptly and completely the insulin-induced lipodystrophy of three insulin-dependent diabetics.