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Giornale di Clinica Nefrologica e Dialisi
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 0394-9362 - ISSN (Online) 1724-5974
Published by AboutScience Srl Homepage  [4 journals]
  • È possibile una gestione “ideale” della pandemia da
           malattia renale cronica'

    • Authors: Stefano Michelassi
      Pages: 1 - 9
      Abstract: Chronic Kidney Disease (CKD) is recognized as one of the major categories of noncommunicable epidemic diseases and in the last decades it has been largely growing in incidence and prevalence all over the world. Ideal management of CKD pandemic should be comprehensive of measures of tertiary, secondary, primary and primordial prevention. So, it should include prompt diagnosis and treatment of traditional and non-traditional risk factors for CKD, optimal conservative treatment for non-dialysis dependent CKD patients and appropriated dialysis therapy or renal transplantation for patients with end-stage renal disease. However, these goals are not easy to obtain on a global scale. It would be possible only by a broad and holistic approach, ranging from good governance to achievement of the sustainable development goals (SDGs).
      PubDate: 2022-01-08
      DOI: 10.33393/gcnd.2022.2352
      Issue No: Vol. 34 (2022)
  • L’infermiere e la percezione del Moral Distress nella cura del fine vita
           nel paziente dializzato

    • Authors: Elena Brioni, Nadia Pennacchio, Giulia Villa, Noemi Giannetta, Cristiano Magnaghi, Giuseppe Vezzoli, Duilio Fiorenzo Manara
      Pages: 10 - 13
      Abstract: The phenomenon of Moral Distress in nursing practice is described as a situation of suffering that arises when the nurse recognizes the ethically appropriate action to be taken and yet institutional impediments make it impossible for him to follow the right course of action. Dialysis patients often have a complex disease trajectory that sometimes involves professional and emotional challenges for staff, especially at the end of life. The objective of this review is to identify which strategies are useful for preserving emotional integrity and awareness in operational settings, for the benefit of both operators and patients.
      PubDate: 2022-01-08
      DOI: 10.33393/gcnd.2022.2357
      Issue No: Vol. 34 (2022)
  • L’assorbimento del glucosio in dialisi peritoneale: strumenti utili per
           il team multidisciplinare

    • Authors: Anna Laura Fantuzzi, Elisa Berri, Lida Tartaglione, Rossella Giannini, Sara Dominjanni, Silvia Porreca
      Pages: 14 - 21
      Abstract: Dialysis patients are often affected by protein energy wasting and the maintenance of an optimal nutritional state is a difficult goal to achieve. Moreover protein energy wasting is one of the strongest risk factors for mortality in chronic dialysis patients. To estimate glucose absorption in peritoneal dialysis is essential to determine patient’s dietary energy requirements and to prevent possible metabolic complications. The currently accepted methods of estimating glucose absorption are two. The first one is based on the average glucose absorption of continuous ambulatory peritoneal dialysis (CAPD) and is calculated with the Grodstein et al. formula. The second one is based on the Peritoneal equilibration test curves (D/D0 formula, Bodnar et al.) and takes into account transport characteristics. None of the two formulas perfectly calculated the absolute glucose absorption, even if the D/D0 is much closer to the true value, compared to Grodstein et al. formula. In this paper we described the multidisciplinary management experience of peritoneal dialysis patients, with a focus on the estimation of the patient’s energy requirements. Analyzing glucose absorption in a systematic way and monitoring the changes in glucose absorption during the time could significantly contribute to adjusting nutritional treatment. However it is always necessary to critically evaluate the results obtained by both formulas.
      PubDate: 2022-02-08
      DOI: 10.33393/gcnd.2022.2365
      Issue No: Vol. 34 (2022)
  • La complessità della relazione medico-paziente in nefrologia: perché è
           ancora più importante occuparsene oggi'

    • Authors: Marilena Cara
      Pages: 22 - 25
      Abstract: Medicine is more than just a science: it is a human contact between men. We must not forget that “Psyche depends on the body and the body depends on the psyche”. The 21st Century man’s Psyche is more stressed than in the past, as we live in a complexity increasingly understood with the passage of time. The only way to take care of the sick person in the body, and therefore suffering in the psyche, can only be that which rests on the relationship, since the relationship, in my opinion, can be considered the bridge between the psyche and the soma. If the medical technique today does not pass through the relationship could it be effective in the cure' Trust in the doctor today is no longer a certainty, as medicine has lost its character of sacredness, but must be acquired and conquered through a dedicated and continuous relationship. Unlike other pathologies, nephrology does not end in a diagnosis or in a therapy that is provided at home, but the patient’s only point of reference is the nephrology nursing staff. Effective communication will lead to a reduction in the time taken for communication, improving the patient’s ability to understand and trust, reducing the operator’s effort and improving the therapeutic result. Today’s medicine, and today’s “healers” can no longer fail to deal with the management of the operator-patient relationship in order to meet the demands that today’s society and healthcare organization make in the medical field.
      PubDate: 2022-03-16
      DOI: 10.33393/gcnd.2022.2381
      Issue No: Vol. 34 (2022)
  • ANTROPOCENE: la “salute” del villaggio globale e il
           “Cigno Nero”

    • Authors: Alessandro Capitanini
      Pages: 26 - 30
      Abstract: Over the past three centuries, the effects of humans on the global environment have increased. It seems appropriate to assign the term “Anthropocene” to the current geological epoch, which is in many ways dominated by humans. The Anthropocene can be said to have begun in the latter part of the 18th century, when analyses of air trapped in polar ice showed the beginning of the rise in global concentrations of carbon dioxide and methane. This date also coincides with the design of the steam engine by James Watt in 1784. In particular, the 21st century witnessed an unforeseen but predictable resurgence of infectious diseases, not least the COVID-19 pandemic, which had a devastating impact on lives and livelihoods worldwide. The 2003 severe acute respiratory syndrome coronavirus outbreak, the 2009 swine flu pandemic, the 2012 Middle East respiratory syndrome coronavirus outbreak, and the 2013-2016 Ebola virus outbreak in West Africa all caused significant morbidity and mortality as they spread through the global village across borders to infect people in multiple countries. In the last 70 years, the speed at which human habits have changed through technological, demographic and climatic changes is unprecedented: airline flights have doubled since 2000, more people live in urban than rural areas since 2007, climate change poses a growing threat to society, and humans have stopped following the high road shown by nature with proper nutrition and regular exercise. In this review, we consider the extent to which these recent global changes have increased the risk of infectious disease outbreaks, even though improved sanitation and access to health care have led to significant progress worldwide.
      PubDate: 2022-03-17
      DOI: 10.33393/gcnd.2022.2368
      Issue No: Vol. 34 (2022)
  • Grazie di cuore per il vostro 5x1000

    • Authors: Luisa Sternfeld Pavia
      Pages: 31 - 31
      PubDate: 2022-04-30
      DOI: 10.33393/gcnd.2022.2395
      Issue No: Vol. 34 (2022)
  • Un malato di rene policistico ha diritto all’esenzione del ticket e

    • Authors: Luisa Sternfeld Pavia
      Pages: 32 - 34
      PubDate: 2022-04-30
      DOI: 10.33393/gcnd.2022.2396
      Issue No: Vol. 34 (2022)
  • Io, Lei e … il pupo

    • Authors: Rossella Jannello
      Pages: 35 - 36
      PubDate: 2022-04-30
      DOI: 10.33393/gcnd.2022.2397
      Issue No: Vol. 34 (2022)
  • Metformina e rene policistico dell’adulto: tra ricerca e impiego

    • Authors: Giovanni Piscopo
      Pages: 37 - 40
      Abstract: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common monogenic nephropathy. It is characterized by the onset of progressively enlarging cysts in kidneys (and in other organs, mainly in the liver) that cause the progressive deterioration of renal function. Since 2018, Tolvaptan is available for the treatment of the disease (and in Italy also Octreotide), and allows to slow the progression of the disease towards renal failure. This new drug, even representing an epochal revolution in the management of this pathology, is not without side effects as well as potential adverse events that, although rare, should not be neglected (so much so as to make it necessary to monitor, first monthly and then quarterly, some important bio-humoral parameters). Therefore, the war for the defeat of ADPKD is far from being won and new efforts are needed to increase knowledge about the complex pathophysiology of this disease in order to identify other candidate molecules for the treatment of the disease. Among these Metformin, a drug that has long been used in the treatment of type 2 diabetes mellitus, according to numerous preclinical and clinical studies, would be able to reduce the development and formation of cysts, with a slowdown in the tissue damage related to them and of the progression to end-stage renal failure.
      PubDate: 2022-04-30
      DOI: 10.33393/gcnd.2022.2398
      Issue No: Vol. 34 (2022)
  • La Nefrologia incontra il Nursing e la Medicina Narrativa: una ricerca di
           triangolazione. Un nuovo approccio alla malattia

    • Authors: Lapo Raugei, Marco Lombardi
      Pages: 41 - 43
      Abstract: Introduction: In the late 20th Century, Kleinman and Good created Narrative Medicine (NM). In the following years, this method made its way in healthcare, reaching the peak in 2009 when R. Charon set up the first academic course of Narrative Medicine. Nevertheless, NM is still not well known and used. The main goal of this survey is attempting to understand the emotions felt by the patient while telling his/her own illness’ experience and then understand whether this approach improves therapy. Methods: The survey is developed through a methodological triangulation research consisting of a qualitative part, where 24 stories selected from the first two editions of “Quirino Maggiore” National Competition were analysed through the Van Kaam method, and a quantitative research, performed through a questionnaire submitted to patients suffering from chronic kidney disease thanks to the National Association of Hemodialysis Patients (ANED) and to Onlus Santa Maria Annunziata, Bagno a Ripoli, Florence. We received responses from 219 patients between 24 September 2021 and 18 October 2021. Results: The qualitative research identified 94 expressions grouped in 10 labels in which the most representative themes come to light. Through the questionnaire we can see that most people are not familiar with Nursing and Narrative Medicine, but that they consider the relationship between patients and healthcare workers very important. Conclusions: Although it’s impossible to generalize the results, we can understand that Nursing and Narrative Medicine should be more integrated into the care pathway. Furthermore, healthcare workers should be trained in a suitable way.
      PubDate: 2022-04-12
      DOI: 10.33393/gcnd.2022.2402
      Issue No: Vol. 34 (2022)
  • La malattia renale cronica: qualità di vita, ansia e depressione in un
           gruppo di pazienti in fase pre-dialitica

    • Authors: Gianfranca Gerbino, Giorgio Soragna, Daniele Curci, Derli Fazzari, Maggiorina Bauducco, Aspasia Panunzi, Laura Fabbrini, Giorgia Damilano, Emiliano Bruno, Antonella Laezza, Corrado Vitale
      Pages: 44 - 50
      Abstract: Patients with chronic diseases frequently show a marked deterioration in their quality of life (QoL). This paper was aimed at investigating on both the prevalence of psychological disorders and the impact on QoL in patients with chronic renal failure. The survey was conducted on 155 patients, aged 77±11 years, 104/51 M/F, with renal failure on conservative treatment (stages IV-V) referring to Nephrology Unit in Mauriziano Hospital, Turin. 13 of them (8.4%) were aged 30-64 years, 63 (40.6%) were aged 65-79 years and 79 (51%) 80 years and older. Two validated questionnaires were administered, namely the SF-12 (general state of health) and the HADS (anxiety and depression). Sixty-five percent of patients believed to have a low QoL associated with health, finding difficulties in daily life activities. The prevalence of all psychologic disturbances was higher in females (p = 0.09) and in patients with more comorbidities (p = 0.05). Depression was more frequent in elderly (p = 0.05) and in females (p = 0.012). Among patients aged 80 years or over, we found a prevalence rate of 36% for anxiety and of 51% for depression. In all patients, anxiety and depression were strongly associated (p < 0.01). In conclusion, compared to the general population, patients with chronic renal failure have a higher rate of either anxiety or depression, or both, and present with lower QoL scores. Clinical teams dedicated to the management of chronic renal diseases should pursue an interdisciplinary approach to their patients, in order to provide them with a suitable monitoring of QoL and psychological support if needed.
      PubDate: 2022-04-12
      DOI: 10.33393/gcnd.2022.2400
      Issue No: Vol. 34 (2022)
  • Abstracts XXXX Congresso Nazionale SIAN ITALIA: L'evoluzione
           professionale e la formazione: ieri, oggi e domani - Rimini 9-11 Maggio

    • Pages: 51 - 55
      PubDate: 2022-05-05
      DOI: 10.33393/gcnd.2022.2410
      Issue No: Vol. 34 (2022)
  • Il ruolo del medico nella visione sanitaria olistica della salute

    • Authors: Aurora Pianigiani , Francesco Romizi
      Pages: 56 - 58
      Abstract: na
      PubDate: 2022-06-14
      DOI: 10.33393/gcnd.2022.2430
      Issue No: Vol. 34 (2022)
  • Inibitori del SGLT2: suggerimenti dal mondo degli anfibi

    • Authors: Stefano Michelassi
      Pages: 63 - 69
      Abstract: Sodium-glucose cotransporter 2 inhibitors are a class of antidiabetic drugs that inhibit glucose reabsorption in the proximal renal tubules. In many trials these drugs have shown unpredictable major cardio- and nephroprotective properties. Multiple hypotheses have been raised to elucidate the mechanisms underlying the last effects. Some authors suggest they may be due to the contemporary urinary loss of energy (as glucose) and water (by osmotic diuresis). This particular condition could induce metabolic changes resulting in more efficient energetics at cardiac and renal levels and in less oxidative stress. These changes might really be part of a series of evolutionarily conserved metabolic switches that allow organisms to survive in arid habitats with restricted nutrients and water availability, well studied in amphibians and collectively named “estivation”.
      PubDate: 2022-07-25
      DOI: 10.33393/gcnd.2022.2423
      Issue No: Vol. 34 (2022)
  • Intradialytic hypotension frequency is reduced by levocarnitine

    • Authors: Stefano Aterini, Anna Maria Ciciani, Franco Bergesio, Lorenzo Aterini, Barbara Vadalà, Marco Gallo
      Pages: 70 - 73
      Abstract: Introduction: Intradialytic hypotension (IDH) is a frequent complication of hemodialysis. IDH causes intradialytic discomfort and subclinical ischemia, resulting in a higher rate of morbidity and mortality. Levocarnitine (LC) administration has been suggested for the treatment of IDH, but conflicting reports about its efficacy have been published. We describe the effect of LC supplementation in patients experiencing recurrent IDH episodes, in spite of common strategies used to prevent it. Methods: Sixteen hemodialysis patients were studied. IDH was defined as a drop in systolic blood pressure ≥20 mmHg, with or without symptoms, prompting an intervention by the dialysis staff, such as reducing/stopping ultrafiltration rate and/or fluid administration. Blood pressure was recorded for 192 hemodialysis sessions, before LC supplementation. Thereafter LC (30 mg/kg dry weight) was administered at the beginning of each hemodialysis, registering blood pressure for 384 hemodialysis treatments. The difference between the predialysis systolic blood pressure and the minimum systolic blood pressure of each hemodialysis was evaluated (∆SBP), before and after LC supplementation. Cardiac ejection fraction was also measured. Results: Predialysis and postdialysis systolic, diastolic, and mean arterial pressures did not differ before and after LC supplementation. Before LC supplementation, 36 episodes of IDH occurred (19%), while after LC supplementation, the IDH episodes were 29 during 384 hemodialysis sessions (8%; χ2 = 16.03; p = 0.0001). ∆SBP was lower after LC supplementation, even though the difference was not significant (p = 0.22). Conclusion: IDH frequency was significantly reduced by predialysis LC supplementation, which can be helpful for patients’ well-being and reduction in IDH-associated risks.
      PubDate: 2022-08-31
      DOI: 10.33393/gcnd.2022.2466
      Issue No: Vol. 34 (2022)
  • Approccio nutrizionale all’ipofosforemia post-trapianto di rene: uno
           studio pilota

    • Authors: Alessandra Zattarin, Francesco Francini-Pesenti, Claudia Da Col, Paolo Spinella, Marianna Alessi, Lucia Federica Stefanelli, Lorenzo A. Calò
      Pages: 74 - 79
      Abstract: Renal transplantation is the gold standard for the treatment of ESRD patients. During the early-stage post-transplantation, metabolic and electrolytic alterations may develop, including hypophosphatemia and the treatment includes a diet rich in phosphorus, sometimes with the addition of oral or intravenous phosphorus supplement. Forty-four kidney transplanted patients with hypophosphatemia were evaluated retrospectively. They were divided into two groups based on whether patients received (group A, 14 patients) or not (group B, 30 patients) dietary prescription for hypophosphatemia. Group A was further divided into two subgroups: group A1 (8 patients), with baseline phosphatemia ≥0.5 mmol/L, treated only with a diet rich in animal phosphorus, and group A2 (6 patients), with baseline phosphatemia ≤0.5 mmol/L, who received a potassium phosphate supplement in addition to the same dietary prescription. Three months after transplantation, group A had a greater increase of phosphatemia compared with group B (group A: 0.58 ± 0.12 vs 0.93 ± 0.22 mmol/L; group B: 0.59 ± 0.11 to 0.8 ± 0.13 mmol/L). Furthermore, in group A2 the increase of phosphatemia was lower than in group A1. In conclusion, dietary approach supported by dietary counseling was effective in treating post kidney transplantation hypophosphatemia. The results of this pilot study might represent a useful working hypothesis for studies with a larger cohort of enrolled patients in order to confirm for these patients the efficacy of the nutritional approach and of the dietary counseling to post renal transplantation hypophosphatemia.
      PubDate: 2022-09-14
      DOI: 10.33393/gcnd.2022.2472
      Issue No: Vol. 34 (2022)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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