[Peritoneal Dialysis Network in North-East Italy: Survey About the Peritoneal Catheter Exit-Site Infection Management and Comparison with ISPD Guidelines].

Introduction. The Triveneto Peritoneal Dialysis (PD) Network aims to bring together doctors and nurses who deal with PD in a collaborative network in which to exchange mutual knowledge and optimize the use of this method of replacing renal function. A topic of particular interest was the management of peritoneal catheter exit-site infection, given the recent publication of the new guidelines of the International Society of Peritoneal Dialysis (ISPD). Materials and methods. The survey concerned the criteria for carrying out nasal swab and exit-site, management of exuberant granulation tissue "Proud Flesh", treatment of exit-site infection (ESI), use of silver dressings, the role of subcutaneous tunnel ultrasound and cuff shaving. Results. All PD centers in the North-East Italy area have joined the survey with at least one operator per centre. There was a wide variability between the indications for performing the exit-site swab. In the presence of ESI, the prevalent approach is that of oral systemic empiric therapy associated (20.0%) or less (28.9%) with topical therapy, and then adapting it in a targeted manner to the culture examination. Discussion. From the discussion of the survey emerged the importance of the ESI as an outcome indicator, which allows us to verify whether our clinical practice is in line with the reference standards. It is essential to know and base our activity on what is indicated in national and international guidelines and to document the events that occur in the patient population of each dialysis unit.

The vascular disease of diabetic kidney disease.

The incidence of cardiovascular disease (CVD) is increased in patients with diabetic kidney disease (DKD). Aortic stiffness is a well-accepted biomarker for cardiovascular (CV) events in all stages of CKD. The worldwide prevalence of diabetes continues to grow, as does the prevalence of DKD. Insulin resistance, hyperglycaemia, hypertension and the metabolic abnormalities of type-2 diabetes are all involved in the pathogenesis of CVD. The effect of these toxins on cardiac and vascular function is amplified by the worsening of renal function and the parallel rise of uraemic toxins. In this narrative review, we analysed why arterial stiffening can be considered a vascular mediator between diabetes and cardiac dysfunction, and we discussed the strong CV and nephroprotective effects of sodium-glucose cotransporter type 2 inhibitors (SGLT2i).

["Naked" exit-site for peritoneal dialysis catheters].

Exit site infections (ESI) and peritoneal catheter tunnel infections are strongly associated with peritonitis. Alternative exit-site dressings can include the use of water and soap and the absence of sterile gauze. This article reports our experience with "naked" exit-sites, meaning without any kind of gauze to cover them. From January 2017 to October 2020, we enrolled 38 patients of the Nephrology and Dialysis Unit of the "San Martino" Hospital in Belluno. Nine of these patients had a "naked" exit-site. At the end of the study, no significant differences were found in the percentage of ESI-free patients, in the incidence rate of ESI, in the relative risk of developing ESI and in the incidence rate of peritonitis.

[Home hemodialysis: multicenter observational study].

Home dialysis is a primary objective of Italian Ministry of Health. As stated in the National Chronicity Plan and the Address Document for Chronic Renal Disease, it is mostly home hemodialysis and peritoneal dialysis to be carried out in the patient's home. Home hemodialysis has already been used in the past and today has found new technologies and new applications. The patient's autonomy and the need for a caregiver during the sessions are still the main limiting factors. In this multicenter observational study, 7 patients were enrolled for 24 months. They underwent six weekly hemodialysis sessions of 180' each; periodic medical examinations and blood tests were performed (3, 6, 12, 18 and 24 months). After 3-6 months of home hemodialysis there was already an improvement in the control of calcium-phosphorus metabolism (improvement in phosphorus values, (p <0.01), a reduction in parathyroid hormone (p <0.01)); in the number of phosphorus binders used (p <0.02); in blood pressure control (with a reduction in the number of hypotensive drugs p <0.02). Home hemodialysis, although applicable to a small percentage of patients (10-15%), has improved blood pressure control, calcium-phosphorus metabolism and anemia, reducing the need for rhEPO.

[The COVID-19 pandemic and hemodialysis: a multicentric experience].

The SARS-CoV-2 pandemic has forced a reshaping of economic, productive, commercial and healthcare systems. The last one had the dual mandate to limit intra-hospital infections and strengthen its ability to deal with the ongoing emergency. In this paper we report the experience gained by the staff of the Nephrology and Dialysis Unit of the AULSS7 Pedemontana (Vicenza - Veneto region) and the organizational model pursued during the first wave of the pandemic.

Relationship of fetuin-A with glomerular filtration rate and endothelial dysfunction in moderate-severe chronic kidney disease.

BACKGROUND: In end-stage renal disease, fetuin-A has been demonstrated to be reduced and inversely related to cardiovascular mortality. This study had 2 distinct aims. The first was to verify if circulating concentration of fetuin-A may depend on renal function in patients with chronic kidney disease (CKD). Furthermore, we analyzed the correlation of fetuin-A with the biomarker of endothelial dysfunction endothelin-1 (ET-1), and with the inflammatory cytokine interleukin-6 (IL-6). METHODS: In 108 subjects with stage 3-5 CKD, plasma levels of fetuin-A, ET-1 and IL-6 were assayed. Patients were studied first as a whole group and then were divided according to stages of CKD and fetuin-A tertiles. RESULTS: Fetuin-A concentration decreased in parallel with the increase in ET-1 and IL-6 levels as renal function declined. Multiple regression analysis showed that fetuin-A was independently associated with estimated glomerular filtration rate (beta=0.386; p<0.001), IL-6 (beta=-0.393; p=0.001) and ET-1 (beta=-0.219; p=0.02), in a multivariate model including also sex, parathyroid hormone and the calcium x phosphorus product. CONCLUSIONS: These results seem to indicate that in CKD, even when not severe, inflammatory processes are increased and linked to endothelial dysfunction, worsening progressively with the decline of renal function.

Exhaled air temperature in asthmatic children: a mathematical evaluation.

Recently, the exhaled breath temperature has been proposed as a potential marker for the evaluation of airway inflammation in asthma. The purpose of this study was to verify the ability to distinguish asthmatics from normal controls by a dedicated detailed mathematical evaluation of the exhaled air curve. Analysis was performed in the different phases of the curve of exhaled temperature, i.e. the rate of temperature increase (Delta e degrees T) and the mean plateau value. Principal components analysis (PCA) and artificial neural networks (ANNs) were used for the evaluation of the data in 90 asthmatic children and in 33 healthy age-matched controls. Both PCA and ANNs showed that a separation between patients and controls can be obtained only by the evaluation of the plateau phase of the curve, which better reflects the periphery of the airway.

Characterization of tissue-engineered scaffolds microfabricated with PAM.

PAM (pressure-activated microsyringe) is a new microfabrication technique that allows the fabrication of two- and three-dimensional scaffolds with a well-defined geometry using polymers soluble in volatile solvents. In this study, polymeric scaffolds were realized with four different polymers--PCL, PLLA, PLGA, and a blend of PCL and PLLA--and with three different geometries-square grids, hexagonal grids, and octagonal grids. The scaffolds were characterized in terms of porosity, hydrophilicity, cell adhesion, and their mechanical properties. An analysis of the measured data shows that the physical and mechanical properties of the scaffold depend on its geometry and line width, both of which are easily modulated using PAM.

Innovative tissue engineering structures through advanced manufacturing technologies.

Awide range of rapid prototyping (RP) techniques for the construction of three-dimensional (3-D) scaffolds for tissue engineering has been recently developed. In this study, we report and compare two methods for the fabrication of poly-(epsilon-caprolactone) and poly-(epsilon-caprolactone)-poly-(oxyethylene)-poly-(epsilon-caprolactone) copolymer scaffolds. The first technique is based on the use of a microsyringe and a computer-controlled three-axis micropositioner, which regulates motor speed and position. Polymer solutions are extruded through the needle of the microsyringe by the application of a constant pressure of 10-300 mm Hg, resulting in controlled polymer deposition of 5-600 microm lateral dimensions. The second method utilises the heating energy of a laser beam to sinter polymer microparticles according to computer-guided geometries. Materials may be fed either as dry powder or slurry of microparticles. Both powder granulometry and laser working parameters influence resolution (generally 300 microm x 700 microm), accuracy of sintering and surface and bulk properties of the final structures. The two RP methods allow the fabrication of 3-D scaffolds with a controlled architecture, providing a powerful means to study cell response to an environment similar to that found