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G Panzetta

Publications and source records attributed to G Panzetta.

42 records · Page 3Linked to original sources
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[Role of iron deficiency in erythropoietin sensitivity in dialysis patients with elevated C-reactive protein].

BACKGROUND: Chronic inflammation is a well-known cause of hyporesponsiveness of the bone marrow to erythropoietin (Epo). Factors which contribute to Epo resistance in the presence of inflammation include inhibition of erythroid precursor proliferation and functional iron deficiency induced by inflammatory cytokines. The specific role of iron deficiency in this clinical context, however, has not yet been clarified. METHODS: Our dialysis population consisted of 200 patients, from which 163 (91 males, mean age 67 +/- 12 years) who had been in dialysis for at least 4 (mean 62.4 +/- 71) months were selected for further study. Two groups were defined on the basis of C-reactive protein (CRP) concentrations: Group A (normal CRP < 5 mg/L; 78 patients) and Group B (elevated CRP > 15 mg/L; 43 patients). The remaining 42 patients with CRP in the range of 5 to 15 mg/L were excluded from the study. RESULTS: Erythropoietin dose and the parameter EpoDose/hemoglobin (Hb) were both greater in Group B (dose: 150 +/- 65 vs. 106 +/- 56 U/kg, p<0.001; EpoDose/Hb: 14.0 +/- 6 vs. 9.8 +/- 6, p<0.001. The two groups were stratified on the basis of transferrin saturation (tSAT) greater or less than 20%: A1 (tSAT > 20%, n = 52), A2 (tSAT < 20%, n = 26), B1 (tSAT > 20%, n = 19) and B2 (tSAT < 20%, n = 24). Erythropoietin dose and EpoDose/Hb were lower in A1 compared to A2 (dose: 96 +/- 52 vs. 124 +/- 6 U/kg, p<0.05; EpoDose/Hb: 8.4 +/- 5 vs. 12.4 +/- 7, p < 0.05), whereas in the B subgroups the variables were equally elevated (dose: 151 +/- 71 vs 142 +/- 59 U/kg, ns; EpoDose/Hb: 14.4 +/- 7 vs. 13.6 +/- 6, ns). Patients in subgroups A2 and B2 were treated with intravenous Fe gluconate 31 mg after each dialysis session for 6 months. Erythropoietin dose and EpoDose/Hb were significantly reduced only in subgroup A2 with normal CRP (dose: from 126 +/- 55 to 95 +/- 52 U/kg, p < 0.05; EpoDose/Hb: from 12.4 +/- 7 to 8.4 +/- 5, p < 0.05), whereas no improvement was observed in subgroup B2 with elevated CRP (dose: from 142 +/- 59 to 151 +/- 65 U/kg, ns; EpoDose/Hb: from 13.6 +/- 6 to 14.4 +/- 7, ns). CONCLUSIONS: Our data demonstrate that dialysis patients with CRP greater than 15 mg/L require an erythropoietin dose approximately 40% higher than patients with normal CRP, both in the presence and absence of iron deficiency. Iron therapy in patients with normal CRP and tSAT < 20% significantly improved the response to erythropoietin, but was completely ineffective in patients with increased CRP. These results suggest that functional iron deficiency plays a marginal role in resistance to erythropoietin observed in patients with elevated CRP concentrations.

Aged↗
PubMedDate not supplied

[Frail elderly in hemodialysis].

A new category of patients aged >75 yrs, namely the elderly, is now being freely admitted to hemodialysis (HD) and this category is becoming predominant. The absence of systematic studies makes this patient category almost indistinguishable from other categories, even though its peculiarity is now evident. At least 30-40% of individuals in this age bracket are expected to be dependent and/or frail, but the incidence of frailty is likely to be higher in the elderly undergoing HD. Due to severe physical and/or mental impairment and often because of strong social hardships, these patients rarely experience clinical stability and are dependent on third parties for their survival. Their care produces complex problems for welfare services and this has proved responsible for modifying the organization of renal care units. These repeated patient admissions to hospital are filling nephrology facilities, and the dialysis management -- mainly concerning outpatients -- requires a much greater use of facilities and staff than normal if compared to average dialysis patients. In 112 elderly patients consecutively admitted to the dialysis program over a period of 10 yrs, we identified 35 dependent or frail patients (31.2%), even taking into consideration only extreme degrees of infirmity. Dependence proved to be the only clinical parameter associated with survival (mortality at 6 months 23.6 vs. 10.6%, p<0.01; Kaplan-Meier survival curves, p<0.03 log-rank test), while comorbidities -- in particular cardiovascular -- that usually affect dialysis mortality rates, did not seem to be discriminating risk factors in the elderly. More precisely, with the confirmation of these data through wider case studies, the idea will be reinforced that, also in dialysis, the elderly must be constantly monitored for dependence and frailty, as is the case in any exclusively geriatric field. Prevention, as well as a therapeutic approach specifically modeled on these conditions, could help to improve the prognosis of this patient category, which is particularly difficult to deal with and is becoming predominant in dialysis units.

Activities of Daily Living↗
PubMedDate not supplied

[The hemodiafiltration with infusion of acetate-free dialysis fluid can modify the inflammatory response in patients "high responders" to inflammatory stimuli?].

PURPOSE: This study aimed to verify the effects of paired hemodiafiltration on-line (PHF-AF) on inflammation in patients who were "high responders" to inflammatory stimuli: elevated C-reactive protein (CRP), genetic polymorphisms influencing a low transcription for interleukin-10 (IL-10) and a high transcription for IFN-gamma. METHODS: Ten patients selected as high responders for IFN-gamma and low responders for IL-10 were included in a crossover study to compare PHF-AF and standard bicarbonate hemodialysis (BHD). At study entry and before the start of each dialysis session the following examinations were performed: CRP, albumin, fibrinogen, ferritin, transferrin, prealbumin and serum levels of IL-6, IL-10, IFN-gamma, tumor necrosis factor-alpha (TNF-alpha). After the 1st and 3rd week of the study, the blood samples were also collected after the dialysis session. RESULTS: . There was a significant reduction in albumin and prealbumin in PHF-AF patients during the study; none of the other parameters were changed in both patient groups. CRP tended to be elevated after dialysis in both PHF-AF and BHD. While IL-6, IL-10 and IFN-gamma were unchanged during the dialysis session, there was a significant variation in TNF-alpha levels, which were increased in BHD (from 10.9 +/- 3.1 to 14.7 +/- 4.1 pg/mL; p=0.004) and reduced in PHF-AF (from 11.9 +/-2.8 to 6.3 +/- 2.2 pg/mL; p=0.0004). CONCLUSION: Although the cytokine levels were unchanged during the study in both BHD and PHF-AF, the modification of TNF-alpha during the dialysis session was considered as inflammatory significance.

Acetates↗