A comparison between the costs of dialysis treatments in Marche Region, Italy: Macerata and Tolentino hospitals.

BACKGROUNDS: The main aim of this study was to estimate the costs of different dialysis modalities through the analysis of administrative databases in the Macerata and Tolentino hospitals, in Italy. METHODS: We retrospectively analyzed two main categories: medical direct costs (all the monetary costs whose consumption is wholly referable to dialysis treatment) and non-medical direct costs (all the costs that make treatment possible but that are outside the medical care sector), related to 2013. Attention was focused on the analysis of the extracorporeal dialysis methods (HD, HDF/AFB, HDF/MID/HFR) and the peritoneal dialysis (APD, CAPD). RESULTS: An analysis overall of economic costs (direct costs + indirect costs) for dialysis treatment, shows that the cost per week for Continuous Ambulatory Peritoneal Dialysis (CAPD) technique is less expensive for health-care budgets, followed by Automated Peritoneal Dialysis (APD). Regarding the extracorporeal dialysis methods, the treatment more affordable is HD. CONCLUSIONS: Results obtained confirm that peritoneal dialysis technique is more convenient for health-care budget than extracorporeal dialysis. Furthermore, this study allowed to develop a methodology that could be a reference for similar studies.

Post-dilution hemodiafiltration with a heparin-grafted polyacrylonitrile membrane.

The aim of this multicenter, prospective study was to explore the possibility of carrying out routine sessions of post-dilution hemodiafiltration with a polyacrylonitrile membrane grafted with heparin (HeprAN) and reduced anticoagulation. Forty-four patients from eight centers were included in the study and treated by means of post-dilution on-line hemodiafiltration with automatic control of TMP, according to three different modalities tested consecutively: phase 1, polyethersulfone filter primed with heparinized saline and anticoagulated with continuous infusion of unfractionated heparin 1000/h; phase 2, HeprAN membrane filter primed with saline without heparin. Anticoagulation: a 1000-unit bolus of unfractionated heparin at the start of session followed by a second one at the end of the second dialysis hour; phase 3, same filter and priming procedure as in phase 2; anticoagulation with nadroparin calcium at the beginning of treatment. Partial or massive clotting of the dialyzer occurred in less than 1% of sessions in phase 1; 10% and 7% in phase 2; and 1% and 2% in phase 3. Clotting limited to the drip chambers was observed in 13%, 34% and 12%, respectively. The study of coagulation parameters showed a better profile when low-molecular weight heparin (LMWH) was used in association with HeprAN membrane, while the generation of TAT complexes did not differ from that observed with the standard anticoagulation modality used in phase 1. Our results suggest that the HeprAN membrane can be used safely in routine post-dilution hemodiafiltration with reduced doses of LMWH.

[Epilepsy, vertigo, dizziness, headache, emesis as neurological manifestation in a Giteleman's Sindrome case]. / Crisi comiziali, vertigini, instabilità posturale, cefalea, vomito: manifestazioni neurologiche in un caso di Sindrome di Gitelman.

We report the case of a woman presenting the recent onset of multiple seizure and epilepsy episodes combined with other neurological symptoms (e.g. vertigo, dizziness, vomiting, headache). She was resistant to antiepileptic and symptomatic therapy, having been first admitted to the neurology ward and subsequently to the general medicine ward. In this case, several patient assessments and imaging exams were not conclusive evidence of specific etiopathogenesis, or definitive neurological illness; however, the patient showed laboratory indexes compatible with Gitelmans Syndrome. The correction of the electrolytic imbalances of tubulopathy (including low magnesium and potassium levels) led to the progressive improvement of clinical manifestations and the eventual interruption of the antiepileptic therapy.

[Nephrotic syndrome as first presentation of malignant thymoma: description of a clinical case]. / Sindrome nefrosica come prima presentazione di un timoma maligno: descrizione di un caso clinico.

Thymoma is a rare neoplasm originating from thymic epithelial cells. It is associated with paraneoplastic syndromes and a severe form of immunodeficiency. Kidney involvement is rare. We report the case of a 66-year-old woman affected by nephrotic syndrome and kidney failure. A diagnosis of thymoma was made after several months of hemodialysis. Numerous comorbidities made specific treatment impossible and the patient died one year after the diagnosis of thymoma.