[Epidemiology of chronic kidney disease in a population: residents in the territory of Umbria "Gubbio - Gualdese"]. / Epidemiologia della malattia renale cronica in una popolazione: i residenti nel territorio umbro "eugubino-gualdese"

The incidence of chronic kidney disease (CKD) has clearly increased in recent years. It is likely to be correlated with the aging population and with the growing association with vascular diseases. In Italy, there are different registers of dialysis and transplantation, providing an excellent means of monitoring patients in substitution treatment. On the contrary, few material is in our possession regarding CKD patients on conservative therapy. Therefore it lacks a necessary mean to implement mechanisms of prevention and programming for a disease that increasingly shows significant social - health consequences.

Blood thiol status and erythrocyte glutathione-S-transferase in chronic kidney disease patients on treatment with frequent (daily) hemodialysis.

BACKGROUND: Chronic kidney disease (CKD) is a condition of impaired homeostasis of blood thiols characterized by a severe hyperhomocysteinemia (HH) and abnormal expression of the red blood cell glutathione (GSH)-consuming enzyme GSH S-transferase (eGST) (Galli et al., Clin Chem 1999). The correlation between plasma Hcy and eGST recently identified by our group (Dessì et al., Amino Acids 2012) suggests a role of this detoxifying enzyme in the impaired thiol status of CKD treated with hemodialysis therapy (HD). This retrospective study is aimed at investigating whether frequent HD can alleviate these biochemical symptoms of CKD. METHODS: Laboratory data of a population of 98 HD patients investigated for plasma Hcy and blood thiol status between 1999 and 2004 were examined. A frequent HD method carried out with a 2-h daily schedule (daily HD) (DHD) was compared with standard 4-h × 3/week protocol of HD (SHD) in either cross-sectional (n = 70 SHD vs. n = 28 DHD) and prospective A-B design (n = 18 SHD patients shifted to DHD). RESULTS: The results demonstrate that DHD produces a better correction than SHD of the uremic retention solute Hcy as well as of Cys and Cys-Gly measured in plasma. Such a correction effect of DHD on HH correlates with that on the detoxification enzyme eGST and on pGSH. CONCLUSIONS: These findings point to a role of frequent dialysis in the depuration of uremic retention solutes that may interfere with thiol metabolism and redox in HD patients. These solutes may include substrates of eGST that await further investigation for molecular identification and better removal by more efficient dialysis therapies.

In vitro study of the efficacy of a two-way connection with disinfectant in the prevention of peritonitis.

A new connection system for continuous ambulatory peritoneal dialysis (CAPD) has been established, and its efficacy in preventing microbial contamination of the peritoneal cavity has been tested in vitro. The system consists of a Y-shaped channel formed in the bottom of a Plexiglas cup. The Luer-lock shaped ends of the Y-shaped channel are designed to host the connectors from the drainage bag, the catheter transfer set, and the bag of fresh dialysate. Because the connectors from the catheter transfer set and the fresh bag are located at the inner surface of the cup bed, and because the cup is filled with disinfectant during the entire exchange procedure, all at-risk steps are continuously protected by disinfectant (that is, removal of the caps from the connectors, connection and disconnection, replacement of the caps). Still, because the patient could inadvertently extract and contaminate one of the two connectors (although such a possibility is unlikely), the disinfecting efficacy of the system was tested in vitro. Despite contamination with various micro-organisms at the highest possible concentrations, all tests showed negative bacterial growth, thus confirming the absolute efficacy of the system in preventing exogenous transluminal peritonitis.

Free-hand ultrasound-guided renal biopsy: report of 650 consecutive cases.

In the past 4 years we have carried out 650 percutaneous renal biopsies (PRB), 54 on transplanted and 596 on native kidneys. PRB was performed with a 14-gauge one-piece disposable needle that was introduced free-handedly into the lumbar wall without any form of fixed guidance or support. Ultrasound was used to locate the kidney pole and to follow the progression of the needle tip in the renal parenchyma. The time needed for the whole procedure was about 5 min. The tissue specimen was adequate for histological evaluation in 98.8% of the cases. The prevalence of post-biopsy complications (haematuria, pain, anaemia) was 2.5%. Haematuria was not a common complication (1.6%) in our series, whereas clinically silent perirenal haematoma was common. Mild perirenal bleeding (volume < 5 ml) was found in 40 of a series of 150 patients (26.6%) who underwent ultrasound scan 24 h after the PRB. Haematoma exceeding 100 ml was revealed with US in only 0.6% of the patients. We conclude that free-hand ultrasound-guided PRB makes this technique easier, highly successful, time-saving and almost free of severe side effects.