PubMed Health⌕ Search

Biomedical subjects

V Gaudiano

Publications and source records attributed to V Gaudiano.

9 recordsLinked to original sources
PubMed2001

Successful use of central venous catheter as permanent hemodialysis access: 84-month follow-Up in lucania.

Cuffed tunneled venous access catheters are commonly used for temporary and permanent access in hemodialysis (HD) patients. These catheters serve an essential role in providing permanent access in subjects in whom all other access options have been exhausted. The predominant complications are catheter thrombosis, catheter fibrin sheating and infection. The aim of this study was to evaluate long-term survival and complications of permanent venous catheters (PVC) placed for the purpose of HD during the period from January 1992 to December 1998, at the Dialysis Units of Lucania (a southern Italian region). A total of 98 PVC were placed in 88 patients during this period. The catheters used were of three types: (a) 72 VasCath Soft Cell catheters (Bard Instrument Company, Toronto, Ont., Canada); (b) 22 PermCath catheters (Quinton Instrument Company, Seattle, Wash., USA), and (c) 4 Tesio catheters (Bellco SpA, Mirandola, Italy). Survival curves of catheters were calculated using the Kaplan-Meier product-limit estimator. The patient survival was 60% at the 78th month. Actually, 52 patients (27 males, 25 females) are still alive: 15 (26.9%) of these patients have diabetes mellitus and 1 has been transplanted. The actuarial survival rate of PVC was 89% in the whole population studied and 82% in subjects alive after 84 months. Twenty-five patients (28.4%) had PVC as the first reliable vascular access. Long-term complications occurred 27 times (1 episode every 44.81 month/patient) as: breakage (3.1%); thrombosis (10.2%); displacement (2.0%); subcutaneous tunnel bleeding (3.1%); inadequate blood flow (7.1%), and infection (10.2%). In conclusion, our data confirm that PVC might represent an effective long-term blood access route for HD. Again, PVC are getting the access of choice for selected patients (i.e., older subjects with cardiovascular diseases and cancer patients) and are enjoying a dramatic increase in use for subjects who are terrified of repetitive venopuncture.

Actuarial Analysis↗
PubMed1992

Reconciliation between urea kinetics and direct dialysis quantification.

Previous studies comparing urea kinetic model (UKM) and direct dialysate quantification technique (DDQ) found statistically different results as far as the urea distribution volume (V) and protein catabolic rate (PCR) are concerned. In these studies, however, the true values for both the dialyser urea clearance (K) and urea concentration (C) were not used. The aim of this study was to compare UKM and DDQ using for both methods a variable-volume single-pool (VVSP) model as well as plasma water C and effective K. The study was performed during paired filtration dialysis (PFD) sessions because this technique allows bloodless measuring of K. Twenty dialysis patients were studied during a single PFD session. Dialysate and ultrafiltrate C and urea mass transfer rate were measured every 15 min to compute averaged K and total urea removal. Blood samples were obtained as for a three-point UKM, and an iterative technique was used for both methods. The results (means +/- SD) obtained with UKM were as follows: K = 176 +/- 23 ml/min; V = 29986 +/- 7620 ml, PCR = 65 +/- 15 g/day, Kt/V = 1.04 +/- 0.17. These results were not statistically different from those obtained using DDQ. In conclusion, when methodological errors are avoided, DDQ and UKM provide very similar results. This study shows also that PFD is very useful for studying solute kinetics during dialysis.

Female↗
PubMed1990

A modified algorithm of the single pool urea kinetic model.

Urea Kt/V, calculated according to the variable volume single pool urea kinetic model (UKM), has been accepted as the yardstick reflecting the adequacy of haemodialysis therapy. However, the classical algorithm of UKM requires great care in dialyser urea clearance (K) measurement in order to avoid major inaccuracies in estimating the urea distribution volume (V). Thus, we suggest a modified algorithm of UKM which avoids the measurement of K. It assumes an arbitrary V value and then calculates kinetically K as a function of the assumed V value. The rationale of the modified algorithm can be derived from the knowledge that the classical algorithm imposes a proportionality ration between K and V: given a particular set of data, a change in the attributed value of K leads to a proportional change in the calculated V value, so that the ratio K/V remains nearly constant. Aims of the study were (1) to validate the modified algorithm by comparing the resulting Kt/V and normalised protein catabolic rate (NPCR) values with the homologous ones obtained using the classical algorithm in a group of 33 patients on thrice-weekly haemodialysis; plasma water urea concentrations were used with the classical algorithm (CApw) and the modified algorithm (MApw); and (2) to verify the possibility of using plasma urea concentrations with the modified algorithm (MAp) instead of the more rigorous plasma water concentrations. NPCR (g/kg per day) was 1.33 +/- 0.05 in CApw, 1.29 +/- 0.05 in MApw and 1.28 +/- 0.04 in MAp. Kt/V was 1.27 +/- 0.03 in CApw, 1.25 +/- 0.03 in MApw and 1.26 +/- 0.03 in MAp.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1978

[Familial Mediterranean fever. Evidence of its autoimmune pathogenesis].

Immunological disturbances in FMF have not been previously reported. In present case, positivity for RA and Waaler-Rose test as well as increase of plasma IgG and IgM immunoglobulins during an episode of acute peritonitis is described. These findings, in association with very high levels of urinary FDP, suggest an autoimmune pathogenesis of the disease.

Acute Kidney Injury↗
PubMed1978

Unusual immunologic findings in familial Mediterranean fever.

Familial Mediterranean fever (FMF) is an inherited disease of unknown etiology. We report a case in which, during an acute febrile attack, rheumatoid factor and immunoglobulin levels rose, and the levels of complement components fell. The level of urinary fibrinogen degradation products also increased, and all results of tests returned to normal at the end of the acute attack. This suggests that an immunologic phenomenon may play a substantial role in the etiology of FMF.

Adult↗
PubMedDate not supplied

[The need for integrated care of patients with chronic nephropathies: the epidemiology of 'late referral'].

BACKGROUND: The recent need for information has prompted this collaboration between health system epidemiologists (Basilicata) and clinicians to compare models of 'local' epidemiology in the management of diseases. The referral of patients to a nephrologist represents a working hypothesis of research- intervention. METHODS: Analysis of renal registry (RR) and administrative databases (hospital discharge abstracts/HDA, ambulatory);ad hoc surveys. RESULTS: Patients on dialysis between 1994 and 1998 are 594, cumulative deaths are 190 (32%). Males and the elderly (age = 65 years) are associated with more than 50% and threefold increase in relative risk of death, and with a diabetic nephropathy of 60% vs other renal diseases. Of 570 patients alive in 1996, 442 are linked with 2,628 HAD. Comorbid conditions are underreported in the RR (the Charlson index has been computed using HDA). Of 66 new dialysis cases, 31 are referred to a nephrologist only 6 months before the start of dialysis (47%) (22% diabetics). Patients discharged with chronic nephropathies (CN) and diabetes are 21% of CN patients (5% of diabetics). Of 100 patients with pre-end stage renal disease and diabetes, only 11-14 are discharged from the nephrology ward. At the local level, 3 out of 4 patients with serum creatinine higher than 1.5 mg/dl are not referred to a nephrologist. The prevalence of CN may vary from 0.4% to more than 1%. CONCLUSIONS: While an improvement in health databases in the regions is underway, collaboration studies are essential for planning specific interventions for prevention and management of diabetic nephropathy to improve the use of resources in nephrology.

Adult↗
PubMedDate not supplied

[Regional epidemiology of chronic nephropathies: referral to nephrologist and initiation of dialysis].

BACKGROUND: The epidemiology of pre-dialysis chronic nephropathies (CN) in well-defined contexts is essential to prevent delays in delivering appropriate care. METHODS: The registration of consecutive patients in seven out-patient and four in-patient dialysis centers of Basilicata (2001) formed a retrospective study on clinical charts and dialysis registers integrated with ad hoc data. RESULTS: Newly observed outpatients (I) numbered 328; prevalent patients (P) numbered 343. The age and gender of both I and P patients was similar (males: 60%, age media: 67 yr). In 316 I patients with creatinine (mean Cr: 2.3 mg/dL), the mean filtration rate (GFR) was 40.9 mL/min/1.73 m2: 13.6% were in advanced stage (S5) of GFR (<15 mL/min), 23.4% in S4/severe (15-29), 45.6% in S3/moderate (30-59), 10.8% in S2/mild (60-89), and 6.6% in S1 (>90). When compared to I patients, P patients had a mean GFR of 35.0 mL/min; S4+S5 was 48% (vs. 37%); hypertension 68% (vs. 58%); vasculopathies 15% (vs. 10%); coronary disease 10% (vs. 4%); erythropoietin 13% (vs. 7%); and low-protein diet 34% (vs. 20%) (p<0.01). Of 316 I patients, 117 in S5+S4 ('late referral' 37%) had a (mean) GFR of 18.4 mL/min, Cr 3.7 mg/dL, and were aged 70 yrs (vs. 64 yrs for 'early referral'). Of 53 new patients on dialysis, 26 (49%) were seen for the first time <6 months prior to starting (mean age: 71 yr vs. 62; female 58% vs. 26%; complications 50% vs. 17%). CONCLUSIONS: In this population, age-related factors are associated with late referral. Although sociodemographic variables depend on local contexts, these results are consistent with similar international studies. Social and cultural factors may influence physicians to postpone referring patients to a nephrologist, independently of clinical conditions.

Adult↗