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Biomedical subjects

L Catizone

Publications and source records attributed to L Catizone.

At least 19 recordsLinked to original sources

Exercise capacity and circulating endothelial progenitor cells in hemodialysis patients.

Mobilization of circulating endothelial progenitor cells (EPCs) is increased after acute exercise and training. This study aims to evaluate whether, in a low performance population, EPC levels may be related to exercise capacity in steady state conditions. Study population consisted of sixteen hemodialysis patients. The distance walked in the 6-minute walking test (6 MWD) and the maximal speed attained in an incremental treadmill test were used to assess the exercise capacity. Physical functioning was measured by the scale on the SF36 questionnaire. Quantification of peripheral blood CD34(+) cells and enumeration of EPCs, assessed as CD34(+) cells coexpressing AC 133 and vascular endothelial growth factor receptor-2, were performed. Hemoglobin concentration, white blood cells, high-sensitivity C-reactive protein, total cholesterol, and triglycerides were measured. Statistical analysis examined the relationship between blood progenitors cells versus performance parameters, laboratory parameters, age, body mass index, hemodialysis duration, and erythropoietin therapy. Univariate analysis revealed a significant association between percentage values of EPC and performance parameters only: 6 MWD (r=0.720; p=0.0017), maximal treadmill speed (r=0.721; p=0.0016), and physical functioning score (r=0.506; p=0.0453). A similar statistical association between EPC absolute values and performance parameters was found. No correlation between CD34 (+) and any parameter under study was observed. Multivariate analysis indicated 6 MWD as the most significant independent factor associated with EPC level. EPC percentage value was significantly lower (p=0.0087) in the worse (6 MWD < 300 m, n=8) than in the better performing group (6 MWD > 300 m, n=8). In a group of renal patients, mobilization of EPCs was related to the degree of exercise capacity, suggesting a possible connection with the cardiovascular risk in low performance populations limited by chronic diseases.

Aged↗

Role of B-type natriuretic peptide in cardiovascular state monitoring in a hemodialysis patient with primary amyloidosis.

BACKGROUND: Cardiac involvement occurs in up to 50% of patients with primary or A amyloidosis (ALA) and is associated with very poor prognosis. B-type natriuretic peptide (BNP) has been proposed as a guide for treatment of heart failure patients and as an index of myocardial dysfunction in patients with ALA. Data about BNP dosage for cardiovascular monitoring of patients with ALA on renal replacement therapy are lacking. CASE: A 64 year old Caucasian man was admitted because of nephrotic syndrome in July 2003. Renal diagnosis was ALA. Melphalan and prednisolone were given but renal function worsened and in April 2004 standard bicarbonate hemodialysis was started. In March 2004 thalidomide was added to his therapy. During the follow-up ejection fraction was stable and was 65% on the contrary E/A ratio gradually increased and overtook 1. BNP plasma levels were increased and the values recorded during the follow-up were: 2505 pg/mL in October 2003 (normal reference values<100), 1827 in April 2004, 4006 in June 2004, 5000 in September 2004, 3750 in January 2005 and 1920 in April 2005. In September 2005 BNP was 3380 pg/mL. The patient was still alive after a follow-up longer than two years. CONCLUSION: In ALA patients a powerful prognostic role of BNP has been reported whose expression is increased in ventricular myocytes of patients with cardiac involvement. BNP level monitoring does not appear to be superior to standard echocardiography in evaluating cardiovascular status of uremic patients with ALA.

Amyloidosis↗

Prevalence of hyperlipidemia in a cohort of CAPD patients. Italian Cooperative Peritoneal Dialysis Study Group (ICPDSG).

An association between hyperlipidemia and cardiovascular disease is well described in the literature. We conducted an observational study in order to evaluate the lipid profile, the prevalence of hyperlipidemia and its relationship with age, sex, duration of CAPD, peritoneal glucose load (PGL), serum albumin (ALB), serum glucose (GLU), and BMI in a large cohort of uremics undergoing long-term treatment with CAPD. 457 nondiabetic patients (245 males, 212 females; mean age 63.8 +/- 11.9 years; mean duration of CAPD: 41.8 +/- 26.9 months) treated during 1992 in 25 centers participating in the Italian Cooperative Peritoneal Dialysis Study Group (ICPDSG) were studied. The serum lipid parameters evaluated were triglycerides (TG), total cholesterol (CHO), HDL-cholesterol (HDL). Indications given in the New England Journal of Medicine, SI Unit Conversion Guide, 1992, were adopted for normal ranges. In the whole population the evaluation of lipid parameters showed: TG 227.4 +/- 123.3 mg/dl, CHO 232.8 +/- 56.0 mg/dl, HDL 40.7 +/- 12.0 mg/dl. No differences were found between the two sexes with regard to age, BMI, duration of CAPD, distribution of renal diseases, TG, ALB, and GLU; whereas CHO and HDL were significantly lower in males than in females (CHO: 222.2 +/- 53.5 vs. 245.0 +/- 56.5 mg/dl, p < 0.001; HDL: 39.3 +/- 11.4 vs. 42.6 +/- 12.6 mg/dl, p < 0.05). The prevalence of hypercholesterolemia was significantly lower in males than in females (19.7 vs. 35.4%; p < 0.001). The multiple regression analysis indicated that TG were directly correlated to PGL (p < 0.05), and HDL was inversely correlated with TG (p < 0.001). The coexistence of the two variables (TG and HDL) may increase the risk of cardiovascular events. Further strategies should therefore be developed to select and manage CAPD patients to reduce the incidence of hyperlipidemia.

Blood Glucose↗

Two years of experience with a new device system: a multicenter study.

Peritonitis is a crucial complication of peritoneal dialysis. Over the last few years, new device systems have been developed to reduce episodes of peritonitis caused by exogenous contamination. Remarkable improvement has been obtained by modifying the original connection between the catheter and the bag with the introduction of the Y-set. The aims of this study were to test the reliability and simple use of a double-bag system without disinfectant in-line (Gemini, Gambro) and to evaluate the incidence of peritonitis in a 2-year period of follow-up. In a group of 167 patients, enrolled in 14 dialysis units in Italy, with a follow-up of 2433 patient-months, we observed 82 episodes of peritonitis in 52 patients, with a cumulative incidence of 1 episode every 29.7 patient-months. At 12 months the percentage of patients peritonitis-free was 69.7%, and at 24 months it was 62.8%. The training to complete the bag exchange, assessed by patient and nursing staff, was defined as "easy" in 61% of the cases and "difficult" in only 12% of the cases. The percentage of patients requiring a partner was 23%. For patients this device system presents easy handling in terms of the bag exchange, and it may prevent peritonitis.

Adult↗

Dialysis-related amyloidosis in a large CAPD population.

We studied 212 patients from 13 Italian dialysis centers to evaluate the clinical aspects of dialysis-related amyloidosis in continuous ambulatory peritoneal dialysis (CAPD). The mean age was 64.2 +/- 12.3 years and mean time on dialysis was 36.9 +/- 25.1 months. Residual diuresis was 615.7 +/- 554.0 mL/day and plasma beta 2-microglobulin (beta 2M) level was 27.0 +/- 12.8 mg/L. Radiological skeletal examination, neurological problems related to beta 2M, and urinary and dialytic balance of beta 2M were evaluated. Correlations between age, time on dialysis, residual diuresis, beta 2M plasma levels, beta 2M peritoneal and renal removal, carpal tunnel syndrome, and bone disease were studied. Only the number of bone lesions had a significant positive correlation with patient age and negative correlation with residual diuresis. The latter had an inverse relation with beta 2M plasma levels. Dialytic age did not correlate with any of the parameters. No other correlation was observed. Hand lesions were found in 85% of patients with bone dialysis-related amyloidosis. In conclusion, residual diuresis in our patients played a positive role in the number of bone localizations. Only age, but not time on dialysis, had a positive impact on the bone lesions. The high percentage of hand lesions suggests that the observation of this skeletal segment is a simple, safe, and effective modality of bone follow-up for dialysis-related amyloidosis.

Adult↗

Long-term outcome in continuous ambulatory peritoneal dialysis: a 10-year-survey by the Italian Cooperative Peritoneal Dialysis Study Group.

Over a 10-year period, 1,990 end-stage renal disease patients in 30 centers were treated with continuous ambulatory peritoneal dialysis by the Italian Cooperative Peritoneal Dialysis Study Group. At the start of treatment, patients had an average age of 58.4 years, with a 66% prevalence of one or more clinical risk factors for premature death. Patient survival was 51% and 33% at 4 and 8 years on continuous ambulatory peritoneal dialysis, respectively, and technique survival was 62% and 48%, respectively. Occurrences of peritonitis progressively reduced until they reached an incidence of 0.50 episodes/yr in the last 5 years (1985 to 1989). Hernias and catheter-related problems did not influence the dropout rates. These Italian Cooperative Peritoneal Dialysis Study Group results demonstrate that continuous ambulatory peritoneal dialysis is a viable dialysis technique for long-term treatment of chronic renal failure and that it is an effective alternative to hemodialysis, especially for older and high-risk patients.

Adolescent↗

Ten years experience of CAPD in diabetics: comparison of results with non-diabetics. Italian Cooperative Peritoneal Dialysis Study Group.

CAPD outcomes were compared between a group of 301 diabetic patients (mean age +/- SD, 58.9 +/- 12.7 years, 55.8% males) and a group of 1689 non-diabetic patients (mean age +/- SD 57.8 +/- 14.8 years, 55.9% males) treated in 30 centres participating in the Italian Cooperative Peritoneal Dialysis Study Group from 1980 to 1989, with follow-up observation periods of 444 years (mean +/- SD, 1.48 +/- 1.24) and of 3502 years (mean +/- SD, 2.07 +/- 1.91) respectively. CAPD was the first modality for 87.2% of diabetics and 78.1% of non-diabetics (P < 0.001). The percentage of patients who needed a partner for CAPD was 45.9% in diabetics and 30.2% in non-diabetics (P < 0.001). In diabetics compared with non-diabetics, cardiovascular diseases and cachexia were nearly twice and infections other than peritonitis more than three times as frequent in causing death. In diabetics, survival was significantly worse (P < 0.0001) and the relative risk of death 2.13 times higher (P < 0.001). The technique survival and the relative risk of drop-out were not significantly different in the two groups. Clinical problems were the most important cause of drop-out among diabetics. The probability and relative risk of drop-out due to peritonitis, as well as of the first peritonitis episode, were not significantly different between the two groups and between diabetics using or not using intraperitoneal insulin. Days per patient year of hospitalization, excluding the first, were 18.4 in diabetics and 14.3 in non-diabetics. CAPD-related problems caused hospitalization in a similar way in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Well being in patients on CAPD and hemodialysis.

In the present multicenter study, 120 pts who had been treated by both hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) for at least 6 months each, were invited to answer questions on 34 matters, to compare symptoms and their well-being while on the two treatments. Patients were invited to choose HD or CAPD and indicate the reasons for their choice. For 28 patients the first treatment was HD and for 92 CAPD. The mean time between the change of therapy and the study was 46 +/- 35 months. Their final choices were found to be strictly related to the present treatment (p < 0.001). The reasons for choice of CAPD were: more free time (21%), more freedom (67%), better well-being (44%), less worry (5%); for HD they were: more free time (53%), better well-being (39%), less worry (13%), no need for a peritoneal catheter and fewer clinical complications (19%). The catheter was considered more cumbersome than the A.V. fistula, the time involved was considered to be shorter on HD by 52 patients and on CAPD by 39, thirst and cramps were considered to be more frequent and severe on CAPD by half of the patients. The prevalence and severity of problems and symptoms and choice of treatment were not related to sex, job, education or age.

Adult↗

[Bone cysts and continuous ambulatory peritoneal dialysis].

The clinical and radiologic patterns of amyloid osteoarthropathy in long-term hemodialysis patients are well known. However, few studies about the incidence of dialysis-associated amyloidosis in continuous ambulatory peritoneal dialysis (CAPD) patients have been published to date. In a series of 27 CAPD patients, the authors found bone cysts in 63.6% of cases, at the beginning of their dialysis treatment. After a mean follow-up period of 20.9 +/- 13.8 months, carpal bone cysts were seen in 70.4% of cases and clinical patterns worsened in 26.3% of patients. Therefore, CAPD does not prevent the development of dialysis-associated amyloidosis; prolonged uremic state and decreased diuresis seem to be the main pathogenetic factors of osteoarthropathy. The incidence and the evolution of bone lesions were related to the clinical data of this series and then compared with those of a group of hemodialysis patients. This study confirms that plain wrist films are a simple and useful method in the early detection and in the follow-up of amyloidosis-related disease.

Aged↗

In vitro and in vivo efficacy of a new connector device for continuous ambulatory peritoneal dialysis.

The purpose of this study was to evaluate the in vitro and in vivo efficacy of a new connection system for continuous ambulatory peritoneal dialysis (CAPD), called the T-set. With this system the patient wears a 27-cm extension line filled with Amuchina during the dwell time; the bag is made of a fill container linked to a drainage tube with a Y-shaped set. For bag exchange, only one connection is needed and this is subsequently flushed with the entire drainage volume. The in vitro efficacy of the system was tested with 20 sets filled with 10 mL of Amuchina and inoculated in the distal lumen with 2.1 x 10(3) colony-forming units (cfu) of S. aureus. After an incubation of 4-6 hours at 35-37 degrees C, three dialysate samples per set were collected, respectively, at the beginning of drainage and filling. All 120 samples were negative, whereas two control sets, filled with a phosphate-buffered saline, had positive drainage samples, and at least one positive infusion sample, indicating the efficacy of Amuchina in sterilizing the system under conditions simulating touch contamination. To evaluate the in vivo efficacy, safety, and acceptability of the T-system, a prospective randomized controlled trial was performed in seven centers: a control group (CG) of 56 patients (follow-up: 952.3 months, mean +/- SD: 17.0 +/- 7.8) was treated with a long branch (21 patients) or short branch (35 patients) Y-set and a test group (TG) of 66 patients (follow-up:898.1 months, mean +/- SD: 13.6 +/- 7.8) with the T-set.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗

Ten years of continuous ambulatory peritoneal dialysis: analysis of patient and technique survival.

The patient survival (PS) and technique survival (TS) were evaluated in 1990 patients on continuous ambulatory peritoneal dialysis (CAPD) (males: 55.9%, mean age +/- SD: 58.4 +/- 14.8 years), treated in 30 centers participating in the Italian PD Study Group, from 1980 to 1989 (follow-up: 3953 years; mean +/- SD: 2.02 +/- 1.86 years). The total PS was 50.7% at 4 years, compared to 73.3% of patients without clinical high-risk condition (HRC) at the beginning of CAPD. In this group (34.0%) PS was significantly higher (p < 0.001) compared, respectively, to patients with cardiovascular disease (30.5%), diabetes (13.1%), and age > or = 70 years (11.2%). The percentage of death reached the mean value of 11.3% per year without any statistically significant tendency to variation during the follow-up, despite the increased number of patients > or = 65 years old and those with HRC (p < 0.001). Cardiovascular diseases (47.3%) and cachexia (17.8%) were the most frequent causes of death, whereas the mortality due to peritonitis showed a progressive increase in patients with peritonitis incidence 1 ep/year (G4) compared to those with < 0.5 ep/year (G2). Peritonitis (0.68 ep/year) was the most frequent cause of technique failure (30.0%), with clinical complications (18.2%) and peritoneal membrane failure (16.4%) as the second and third causes. The dropout percentage was 8.3% per year with a significant decrease over time (p = 0.012) and a positive correlation with the reduction of peritonitis incidence (p = 0.035). The total TS was 50.1% at 7 years, and it was significantly worse in G4 compared to G2.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Relationship between plasma beta 2-microglobulin and residual diuresis in continuous ambulatory peritoneal dialysis and hemodialysis patients.

To evaluate whether the continuous ambulatory peritoneal dialysis (CAPD) technique is able per se to obtain lower beta 2-microglobulin (beta 2M) plasma levels than hemodialysis (HD) or whether other factors, such as residual diuresis, can make a significant contribution, we compared 69 CAPD and 38 cuprophan HD patients, matched for age and dialysis duration. Residual diuresis was 680.3 +/- 531.8 mL/day in CAPD and 285.5 +/- 381.8 mL/day in HD (p < 0.001) subjects. Daily diuresis was > 300 mL/day in 63.8% of CAPD and in 31.6% of HD patients. The beta 2M plasma levels were 26.3 +/- 9.9 mg/L and 34.9 +/- 13.3 mg/L (p < 0.001) in CAPD and HD, respectively. In both groups the difference was significant when we compared the patients with diuresis below versus above 300 mL/day (p < 0.001). Instead, the differences were not significant upon comparing the CAPD and HD patients with the same amount of daily diuresis. The comparison between beta 2M plasma levels and residual diuresis showed a significant inverse correlation in both groups (p < 0.001). We conclude that the dialysis technique itself does not affect beta 2M plasma levels. The diuresis volume may be a very important factor in lowering beta 2M levels in both CAPD and HD patients. CAPD's capacity to maintain a higher diuresis for longer than HD may account for the lower beta 2M plasma levels in CAPD patients.

Aged↗

Local haemofiltration with free radical scavenger treatment during revascularisation of severe muscular ischaemia induced in sheep limbs.

Many treatments have been proposed for the prevention of the revascularisation syndrome following embolectomy or thrombectomy in patients with severe ischaemia. These include the administration of diuretics, bicarbonate, buffer solutions, free radical scavengers, washing out the venous blood from the ischaemic leg, or systemic dialysis. The aim of our study was to investigate the effect of combining haemofiltration with a treatment using compound oxy-radical scavengers in order to prevent or to reduce the appearance of the revascularisation syndrome. The study was performed on 13 sheep. Eight animals underwent 4 h of aortic and vena cava occlusion using irrigation-occlusion catheters, followed by normal reperfusion (control group). Five sheep underwent the same period of ischaemia, followed by 1 h of local haemofiltration and re-oxygenation and 2 h of normal revascularisation. The priming solution for the ECC circuit consisted of 500 ml of 20% mannitol and 500 ml of 18/1000 HCO3- contained: superoxide dismutase (150,000 I.U.), methylprednisolone, 1 g, and heparin, 10,000 I.U. After the 3rd h of ischaemia, 2.1 g of acetate alpha-tocopherol (30 mg kg-1) were injected i.m. The treatment produced good protection against oxidative stress, shown by an increase in the glutathione ratio (GSH/GSSG), and reduced muscular damage, confirmed by a moderate increase in creatine phosphokinase (CPK) levels (significantly higher in the control group). Diuresis was significantly higher in the treated group, and the acid-basic and potassium balance returned to normal more rapidly. Our data suggest that this combined treatment could be effective in the prevention of the ischaemia-reperfusion syndrome.

Animals↗

Comparison of survival in CAPD and hemodialysis: a multicenter study.

We studied 1,622 patients who started regular dialysis treatment between 1985 and 1989 in 19 centers from the Italian CAPD Study Group. There were 962 pts (59%) and on HD; 660 pts (41%) on CAPD. CAPD pts were older and had more risk factors at the start than HD pts (p < 0.0001). Overall patient survival was not statistically different between CAPD and HD at 6 years (42% CAPD; 54% HD). Multivariate analysis (Cox's model) on all population revealed that age and pretreatment risk factors had a statistically significant impact on patient survival (p < 0.0001), but not the type of dialytic treatment (CAPD or HD). When multivariate analysis was applied separately by treatment modalities, in HD group age and risk factors had the same negative influence on survival (p < 0.0001) while in CAPD group the influence of age on survival was less significant (p 0.025). This multicenter study carried out with appropriate statistical methods in a large number of pts demonstrates that patients' survival at 6 years is not different on CAPD and HD (despite the worse patient selection on CAPD) and can be even better on CAPD for aged patients.

Adult↗

The impact of peritonitis on CAPD results.

The impact of peritonitis on CAPD results was evaluated in 1990 pts (mean age +/- SD:58.4 +/- 14.8 yrs, 55.9% males), treated in 30 centres participating in Italian PD Study Group, during 1980-89, with an overall observation period of 3953 years (mean +/- SD 24.1 +/- 22.3 months). The incidence of peritonitis decreases from 1.21 (1980-84) to 0.48 (1985-89) ep/year (overall:0.68) with a significant (P < 0.001) reduction of the probability of developing the first peritonitis episode (FPE) through the same periods. The probability of developing FPE and the relative risk of peritonitis were significantly lower (P < 0.001) in pts for whom CAPD has been the first treatment (80.1%); on the contrary these parameters did not gain significant difference according to sex, age 65 years, diabetes or cardiovascular disease. As far as the organisms responsible for peritonitis are concerned a significant reduction of S. epid. and an increase of S. aureus, other Gram pos. and Pseudomonas was observed in the second 5-yr periods. Peritonitis episodes caused catheter removal in 8.2% of cases and were associated with catheter infection in 10.8% of cases. Peritonitis accounted for 24.2% of hospitalization causes and for 6.7% and 30.0% of death and of drop-out respectively. The probability of death and drop-out was significantly high (p < 0.001) in pts with a peritonitis incidence > 1 ep/year than in those with < 0.5 ep/year. The probability of drop-out due to peritonitis was not higher in diabetic or older patients.

Female↗

A new catheter to prevent exit-site infection in peritoneal dialysis.

In order to prevent exit-site infection, we studied a new Tenckhoff-derived catheter, named the "Malpighi catheter," capable of avoiding sinus tract formation. The outer cuff of this new device is 3.5 cm long and is deliberately positioned half-extruded; in fact, half of the cuff remains outside the skin exit-site. The implantation technique is identical to that of the standard two-cuff Tenckhoff catheter. We implanted eight Malpighi catheters in 5 CAPD and 3 IPD patients. The observation period was 146 patient-months (range 14-23, M +/- SD 18.2 +/- 3.3). We observed excellent adhesion between the outer cuff and surrounding tissue. Actually, by pulling the catheter the skin around the half-extruded cuff becomes cone-shaped, with the cone's apex tightly stuck to cuff and the sinus tract disappearing completely. Only one case of exit-site infection by Staphylococcus aureus and two cases of ulcer of the skin beneath the external part of the half-extruded cuff were observed. These complications were resolved completely. No catheter needed to be removed and there were no leakages. The histological study of the cuff showed a good infiltration of the dacron cuff by fibrous tissue. On the grounds of our preliminary experience, we believe that the absence of the sinus tract, the formation of an efficient mechanical and bacterial barrier and the reduction of exit-site infection incidence are all factors that encourage further research.

Aged↗

Hydrothorax in a PD patient: successful treatment with intrapleural autologous blood instillation.

An 80-year-old female developed massive right hydrothorax at the start of an IPD program. Peritoneal dialysis was interrupted and after complete evacuation of the pleural effusion, 40 ml of the patient's blood was infused into the right pleural cavity. For the first 2 days the patient maintained the Fowler position. Three weeks later, IPD was recommended, but pleural effusion reappeared early on. Infusion of a further 40 ml of the patient's blood was repeated after another pleural evacuation and the dialysis was again stopped for another 3-week period. Subsequently, IPD was restarted with only one-liter exchanges and the patient kept in the Fowler position during the dialysis sessions. After three weeks, standard IPD was started with the patient supine and two-liter exchanges. Hydrothorax did not re-appear and so far (12-month follow-up) no pleural effusion has been noticed. The patient feels well on IPD. Blood instillation was painless and caused one-day fever on the first time only. Pleurodesis achieved with autologous blood is a very safe, simple and effective way of treating hydrothorax in PD patients.

Aged↗

Peritoneal equilibration curve for beta-2-microglobulin (B2M) in CAPD patients.

To evaluate B2M removal during CAPD, the equilibration curve was determined in 9 CAPD patients (aged 67.9 +/- 6.5 years, treated for 19.0 +/- 17.4 months). The study was carried out on 2 consecutive days using 1.36% (day 1) and 3.86% (day 2) dextrose dialysis solutions for 6 hours each day. The B2M plasma value was the mean of 4 samples taken at the start and after 2, 4 and 6 hours. Dialysate values were determined on 3 ml samples taken every 30 minutes. The curve was fitted for dialysate to plasma B2M ratio (D/P) versus time to define the B2M equilibration curve. Our results showed that the value had a linear regression with both types of solution in all patients. The D/P B2M ratio was linear during the 6 hours of dwell time. Furthermore, there was no significant difference between the 2 solutions used. In conclusion, standard CAPD allows a low but constant B2M removal. An increase or a reduction in dwell time do not seem to have any influence on the B2M removal, which could be improved by methods other than varying dwell time and/or solution osmolarity.

Aged↗