[Health-related quality of life in patients with chronic kidney disease]. / Qualita' della vita nei nefropatici.

Assessment of quality of life in patients with different degrees of chronic kidney disease is an important issue because of its impact on clinical decisions and financial resource management in the health-care system. The aim of this study was to assess whether a generic instrument like the SF-36 questionnaire is able to discriminate three different populations of patients with different degrees of renal disease (pre-ESRD, ESRD, TxR). Five hundred sixty-three patients from 12 Italian nephrology units completed the SF-36 scales by themselves. The results from these samples were compared with those from the general population. Univariate analysis and multivariate regression were used. The generic SF-36 questionnaire proved to be a powerful instrument to discriminate populations with different degrees of chronic renal failure. The quality of life of patients on dialysis is significantly worse than that of the normal population and other patients with less severe renal function impairment.

[Hypertension and fluid volume increase in uremic patients treated with convective hemodialysis: electric bioimpedence analysis]. / Ipertensione arteriosa ed iperidratazione in uremici in emodialisi alternative: uso della bioimpedenza.

PURPOSE: Hypertension is considered an important cardiovascular (CV) risk for uremic patients on hemodialysis (HD). Its main pathogenetic factor is the extracellular fluid volume increase. METHODS: This study aimed to evaluate the water distribution by electric bioimpedence (BIA) in hypertensive uremic patients treated with convective hemodialysis (HD) (group A) and with diffusive HD (group B). The patients were on antihypertensive therapy: angiotensin-converting enzyme (ACE)-inhibitors, beta blockers, calcium antagonists and angiotensin II (ATII) antagonists. RESULTS: The BIA analysis demonstrated that the total and extracellular body water had the same distribution in the two groups with no statistical differences (Student's t-test); although the interdialytic weight gain was higher in group B than in group A. CONCLUSIONS: Blood pressure (BP) was treated by less drug use in patients on convective HD than in patients on diffusive HD.

[Acquired cystic kidney disease (ACKD): experience of a dialysis center]. / Patologia cistica renale acquisita (ACKD): esperienza di un centro dialisi.

Acquired cystic kidney disease (ACKD) is characterized by the substitution of renal parenchyma with multiple cysts in patients either with end stage renal disease who are treated for uremia with dialysis (as on haemodialysis--HD--as on peritoneal dialysis--PD) due to non cystic kidney diseases. The aim of our study was to value the prevalence of ACKD in our haemodialysed patients (with exclusion of polycystic disease and obstructive nephropathy), its relationship between clinical and bioumoral parameters, and its complications in the follow-up. We have studied 56 uremic patients (32f and 24m) on bicarbonate HD three in a week. All our patients underwent renal echography using ECO B mode ALOKA SSD500 with electronic convex sector probe 3.5 MHz for to diagnose ACKD. We divided the population of the study in two groups: the group A includes 23 patients with ACKD; the group B includes 33 patients without ACKD. We analyzed in all patients body mass index (BMI), protein catabolic rate normalized (nPCR), dialitic adequacy index (KT/V), Hb, the serum levels of EPO by ELISA test (MEDAL GmbH, GE, Diagnostika, Hamburg; normal values 5 divided by 30 mUI/ml). We have found a prevalence of 42% for ACKD and statistical significance between the two groups for the duration of HD and BMI (Anova p < 0.01). The EPO serum concentration was higher in the group A (p < 0.05), while their rhuEPO requirement was lower. In two patients of group with ACKD we have found renal carcinoma. In conclusion, by our experience should be opportune to carry out a renal echography at the start of dialysis treatment and every six months for patients with ACKD and every year for those without ACKD. It is necessary to perform the echography of the kidney in all uremic patients before the start of haemo or peritoneal dialysis and report this examination in those patients with ACKD every six months and every year in those without ACKD.