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Pietro Pozzoni

Publications and source records attributed to Pietro Pozzoni.

6 recordsLinked to original sources
PubMed2003

Epidemiology of cardiovascular risk in patients with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) patients are highly prone to cardiovascular disease for a number of reasons. At the time of starting renal replacement treatment, their cardiovascular condition is already severely compromised, suggesting that cardiovascular risk factors begin to operate very early in the progression of CKD. Moreover, those patients reaching end-stage renal disease without cardiovascular abnormalities have a high probability of developing de novo cardiovascular disease. METHODS: In this review, we analyse the prevalence of the major cardiovascular risk factors in CKD patients and their importance as contributors to the excess cardiovascular disease in this population. We also describe and discuss the main results obtained in the management of these risk factors in terms of preventing cardiovascular morbidity and mortality. RESULTS: Hypertension plays a major role in determining cardiac damage at all stages of CKD, including the dialytic phase. Anaemia is a major determinant of the development of left ventricular hypertrophy and therefore its correction can be expected to improve cardiovascular status and long-term survival, but this needs to be done before changes in cardiac structure become well established. Calcium-phosphate disorders are increasingly acknowledged to be cardiovascular risk factors in CKD, yet their medical control is still far from being satisfactory. Dyslipidaemia is particularly frequent in CKD patients, but the benefit of lipid-lowering treatments still has to be proven. Finally, CKD is associated with newly recognized risk factors for atherosclerosis, although their importance as cardiovascular risk factors is still controversial. CONCLUSIONS: Nephrologists should attempt to give optimal treatment for well-established cardiovascular risk factors, even if this generally fails to prevent the excess cardiovascular disease of CKD patients. Increasing attention is now being paid to newly recognized CKD-related risk factors for atherosclerosis, although their real importance is still under debate and, before therapeutic prescriptions can be applied to CKD patients, further studies in these new fields are needed.

Cardiovascular Diseases↗
PubMed2003

The quality of dialysis water.

INTRODUCTION: Every week, haemodialysis patients are exposed to approximately 400 l of water used for the production of dialysis fluids which, albeit with the interposition of a semi-permeable artificial membrane, come into direct contact with the bloodstream. It is therefore clearly important to know and monitor the chemical and microbiological purity of dialysis water. METHODS: In this review, we analyse the sources of chemical and microbiological water contamination, and the problems involved in water purification systems and modalities. We also analyse the compliance of dialysis units with the microbiological standards established by the most widely accepted guidelines relating to the quality of dialysis fluids. RESULTS: The risk of chemical contamination is due mainly to the primary pollution of municipal water, whereas the most important microbiological problem is the control of bacterial growth in the water treatment and distribution system. Dialysis water treatment implies various levels of pre-treatment, a final purification module (which, in many cases, is reverse osmosis: RO) and a hydraulic circuit for the distribution of the purified water. RO-based treatment systems produce water of optimal chemical and microbial quality, and so dialysis units need to concentrate on maintaining this quality level in the long term by means of effective maintenance and disinfection strategies. The most widely accepted standards for water purity are those recommended by the Association for the Advancement of Medical Instrumentation and the European Pharmacopea, which respectively allow bacterial growth of <200 and <100 c.f.u./ml, and an endotoxin concentration of <2 and <0.25 IU/ml. However, a number of multicentre studies have reported that 7-35% of water samples have bacterial growth of >200 c.f.u./ml, and up to 44% have endotoxin levels of >5 IU/ml. CONCLUSIONS: The results of multicentre studies indicate that the microbial quality of dialysis fluids is still a too often neglected problem, particularly as there is evidence of a possible relationship between dialysis fluid contamination and long-term morbidity. The time has now come to take advantage of innovations in water treatment processes and improvements in dialysis machines in order to modify clinical practices and start improvement processes aimed at decreasing the risk of microbial contamination to the minimum, as it has already been successfully done in the case of chemical contamination.

Dialysis Solutions↗
PubMed2002

The importance of early detection of chronic kidney disease.

Despite the absence of precise epidemiological data, we know there are a great many patients in the conservative phase of chronic kidney disease (CKD). The incidence and prevalence of renal replacement therapy (RRT) is increasing worldwide. As well as being a large and growing clinical problem, CKD is of an economic and organizational concern, since RRT consumes a considerable proportion of health care resources. In this context, any medical intervention that may prevent the progression of CKD towards end-stage renal disease (ESRD) is extremely important. Improving the patients' cardiovascular status is also a major objective in the management of this population, as cardiovascular disease (CVD) is the leading cause of morbidity and mortality for dialysis patients. Several interventions to delay the progressive loss of renal function and/or to prevent the development of CVD are now available. These include low-protein diets; correction of calcium-phosphate disorders and anaemia; blood pressure and proteinuria control; and smoking cessation. Other interventions, such as the administration of lipid-lowering agents, anti-inflammatory drugs, and anti-oxidant agents are emerging as particularly promising therapeutic approaches, although prospective, controlled, randomized clinical trials are needed to demonstrate their clinical usefulness. Intervention in the conservative phase of CKD is likely to be more effective if performed as early as possible in the course of the disease, since it has been widely demonstrated that early and regular nephrology specialist care is associated with decreased morbidity and mortality.

Anemia↗
PubMedDate not supplied

Epidemiology of chronic kidney disease in Italy: possible therapeutical approaches.

Chronic kidney disease (CKD) affects a significant percentage of the Italian population, particularly among the elderly. It is estimated that more than 300 patients per million population (pmp) are diagnosed as having CKD each year, and about 0.8% of Italians are thought to have serum creatinine levels >=1.5 mg/dL. The number of patients being admitted to renal replacement therapies (RRT) has been growing up rapidly in the last decades, leading to 134 patients pmp starting RRT throughout 2000 and to 804 patients pmp on chronic RRT in the same year. As such therapies are very expensive, CKD must be therefore considered as a striking problem also by a socio-economical point of view. As a consequence, any medical intervention being able to halt or at least to slow down the progression of CKD and/or to prevent the development of related complications or comorbidities is of paramount importance. Several therapeutical interventions, including hypertension and proteinuria control, protein restriction, anemia, calcium-phosphate disorders and dyslipidemia correction and smoking cessation, showed to be actually effective in at least partially achieving these objectives. Other emerging therapeutical approaches, although well promising, need further evidence to be definitively included in the management of CKD patients. Particular efforts should be made in order to refer these patients to the nephrologist as early as possible, as it has been widely demonstrated that an early and regular nephrological care leads to decreased morbidity and mortality and also to decreased social costs.

Adult↗