Taxonomy, Habitat Preference, and Niche Overlap of Two Arrow-Poison Flea Beetle Species of the Genus Polyclada in Sub-Saharan Africa (Coleoptera, Chrysomelidae).

Coupling the geographic distribution and the ecological requirements of species often supports taxonomy and biogeography. In this contribution, we update the distribution of two flea beetle species of ethno-entomological interest, Polyclada bohemani and P. pectinicornis, by analyzing original data. In addition, we supply their main morphological diagnostic characters, describing their aedeagal and spermathecal shapes for the first time. We also assess their niche differences in terms of climatic and vegetation needs, by means of ecological niche modelling and remote sensing techniques. Several new localities were identified to improve knowledge of the geographical distribution of both species. Moreover, we located a wide climatic suitability overlap in East Africa for these two flea beetle species, while in other areas they show a clear separation. Our analysis also reports that P. bohemani is associated with areas of denser tree cover than P. pectinicornis. Finally, the lectotypes of Diamphidia bohemani Baly, 1861, Clytra pectinicornis Olivier, 1791, and Diamphidia compacta Fairmaire, 1887 are here designated and the new synonymy Clytra pectinicornis Olivier = Diamphidia compacta Fairmaire syn.nov. is proposed.

DBSCAN and GIE, Two Density-Based "Grid-Free" Methods for Finding Areas of Endemism: A Case Study of Flea Beetles (Coleoptera, Chrysomelidae) in the Afrotropical Region.

Areas of endemism (AoEs) are a central area of research in biogeography. Different methods have been proposed for their identification in the literature. In this paper, a "grid-free" method based on the "Density-based spatial clustering of applications with noise" (DBSCAN) is here used for the first time to locate areas of endemism for species belonging to the beetle tribe Chrysomelidae, Galerucinae, Alticini in the Afrotropical Region. The DBSCAN is compared with the "Geographic Interpolation of Endemism" (GIE), another "grid-free" method based on a kernel density approach. DBSCAN and GIE both return largely overlapping results, detecting the same geographical locations for the AoEs, but with different delimitations, surfaces, and number of detected sinendemisms. The consensus maps obtained by GIE are in general less clearly delimited than the maps obtained by DBSCAN, but nevertheless allow us to evaluate the core of the AoEs more precisely, representing of the percentage levels of the overlap of the centroids. DBSCAN, on the other hand, appears to be faster and more sensitive in identifying the AoEs. To facilitate implementing the delimitation of the AoEs through the procedure proposed by us, a new tool named "CLUENDA" (specifically developed is in GIS environment) is also made available.

Climate change favours connectivity between virus-bearing pest and rice cultivations in sub-Saharan Africa, depressing local economies.

AIMS: Rice is a staple food for many countries, being fundamental for a large part of the worlds' population. In sub-Saharan Africa, its importance is currently high and is likely to become even more relevant, considering that the number of people and the per-capita consumption are both predicted to increase. The flea beetles belonging to the Chaetocnema pulla species group (pulla group), a harmful rice pest, are an important vector of the Rice Yellow Mottle Virus, a disease which leads even to 80-100% yield losses in rice production. We present a continental-scale study aiming at: (1) locating current and future suitable territories for both pulla group and rice; (2) identifying areas where rice cultivations may occur without suffering the presence of pulla group using an Ecological Niche Modelling (ENM) approach; (3) estimating current and future connectivity among pulla group populations and areas predicted to host rice cultivations, based on the most recent land-use estimates for future agricultural trends; (4) proposing a new connectivity index called "Pest Aggression Index" (PAI) to measure the agricultural susceptibility to the potential future invasions of pests and disease; (5) quantifying losses in terms of production when rice cultivations co-occur with the pulla group and identifying the SSA countries which, in the future inferred scenarios, will potentially suffer the greatest losses. LOCATION: Sub-Saharan Africa. METHODS: Since the ongoing climate and land-use changes affect species' distributions, we first assess the impact of these changes through a spatially-jackknifed Maxent-based Ecological Niche Modelling in GIS environment, for both the pulla group and rice, in two climatic/socioeconomic future scenarios (SSP_2.45 and 3.70). We then assess the connectivity potential of the pulla group populations towards rice cultivations, for both current and future predictions, through a circuit theory-based approach (Circuitscape implemented in Julia language). We finally measure the rice production and GPD loss per country through the spatial index named "Pest Aggression Index", based on the inferred connectivity magnitude. RESULTS: The most considerable losses in rice production are observed for Liberia, Sierra Leone and Madagascar in all future scenarios (2030, 2050, 2070). The future economic cost, calculated as USD lost from rice losses/country's GDP results are high for Central African Republic (-0.6% in SSP_2.45 and -3.0% in SSP_3.70) and Guinea-Bissau (-0.4% in SSP_2.45 and -0.68% in SSP_3.70), with relevant losses also obtained for other countries. MAIN CONCLUSIONS: Since our results are spatially explicit and focused on each country, we encourage careful land-use planning. Our findings could support best practices to avoid the future settlement of new cultivations in territories where rice would be attacked by pulla group and the virus, bringing economic and biodiversity losses.

Habitat Specificity, Host Plants and Areas of Endemism for the Genera-Group Blepharida s.l. in the Afrotropical Region (Coleoptera, Chrysomelidae, Galerucinae, Alticini).

The genus Calotheca Heyden (Chrysomelidae) is mainly distributed in the eastern and southern parts of sub-Saharan Africa, with some extensions northward, while Blepharidina Bechyné occurs in the intertropical zone of Africa, with two subgenera, Blepharidina s. str. and Blepharidina(Afroblepharida) Biondi and D'Alessandro. These genera show different ecological preferences. Through an up-to-date presence-absence dataset, in the light of the terrestrial ecoregions of sub-Saharan Africa and the distribution of their possible host plants, we interpreted the pattern of occurrence of these three supraspecific taxa, by geostatistical analyses in GIS and R environments. The separation of Blepharidina from Calotheca was probably driven by changes in climate as adaptation to more xeric and warm environments with a major occupancy of semidesert and savannah habitats, especially in the Afroblepharida species. Based on our data and analyses, Calotheca is mainly associated with Searsia (Anacardiaceae), and Blepharidina is likely associated with Commiphora (Burseraceae). This hypothesis is also corroborated by the widespread and even dominance of the Commiphora plants in the ecoregions where both Blepharidina s.str. and, above all, Afroblepharida, are more common. The main areas of endemism of the two genera are also differently located: Calotheca in the temperate zone; Blepharidina within the intertropical belt.

Investigating the Current and Future Co-Occurrence of Ambrosia artemisiifolia and Ophraella communa in Europe through Ecological Modelling and Remote Sensing Data Analysis.

The common ragweed Ambrosia artemisiifolia has spread throughout Europe since the 1800s, infesting croplands and causing severe allergic reactions. Recently, the ragweed leaf beetle Ophraella communa was found in Italy and Switzerland; considering that it feeds primarily on A. artemisiifolia in its invaded ranges, some projects started biological control of this invasive plant through the adventive beetle. In this context of a 'double' invasion, we assessed the influence of climate change on the spread of these alien species through ecological niche modelling. Considering that A. artemisiifolia mainly lives in agricultural and urbanized areas, we refined the models using satellite remote-sensing data; we also assessed the co-occurrence of the two species in these patches. A. artemisiifolia is predicted to expand more than O. communa in the future, with the medium and high classes of suitability of the former increasing more than the latter, resulting in lower efficacy for O. communa to potentially control A. artemisiifolia in agricultural and urbanized patches. Although a future assessment was performed through the 2018 land-cover data, the predictions we propose are intended to be a starting point for future assessments, considering that the possibility of a shrinkage of target patches is unlikely to occur.

[The unusual couple: a clinical case of coexistence between aHUS and Fabry's disease].

Atypical hemolytic-uremic syndrome (aHUS) is a rare, potentially lethal (1-4) systemic disorder, capable of affecting both adults and children, causing thrombotic microangiopathy (TMA) (5) that leads to the formation of thrombus within small blood vessels with multiple organ failure. The pathogenesis of the aHUS is part of a sort of chronic and uncontrolled activation of the complement system by genetic mutation of some proteins usually responsible for its self-regulation (6,7). Today, the rapid diagnosis of the disease and the timely start of treatment with eculizumab, improve outcomes of renal failure, stroke and heart attack (8-10). Fabry disease is a rare tesaurismosis, X linked, due to the deficiency of the lysosomal enzyme alpha-galactosidase A (11-13), necessary for the physiological catabolism of glycosphingolipids. Multisystem clinical manifestations lead to a serious degenerative pathology. The diagnostic suspicion based on anamnesis and careful research of the symptoms and then confirmed by the enzymatic dosage of alpha galactosidase or by molecular analysis, allows the early treatment of the patient with enzyme replacement therapy, guaranteeing the resolution and/or slowing down the evolution of the disease, especially in the brain, heart and kidneys. In this report, we describe the clinical case of a patient who is a carrier of both rare diseases.

Effect of Increased Convection Volume by Mid-Dilution Hemodiafiltration on the Subclinical Chronic Inflammation in Maintenance Hemodialysis Patients.

Mid-dilution hemodiafiltration (MID) is a dialytic technique that might improve systemic inflammation of patients in chronic hemodialysis (HD) by increasing substitution volumes. To verify this hypothesis, we performed a prospective cross-over study comparing the effect on inflammatory biomarkers of higher convection by MID versus standard convection by post-dilution hemodiafiltration (HDF). Patients under chronic HD were therefore treated by MID and HDF by crossover design. Each treatment period lasted 4 months, with 1 month of wash-out where patients were treated by HD, for a total of 9 months. Primary outcome was the change of serum pre-dialytic C-Reactive Protein (CRP), interleukin 6 (IL-6), IL-1, IL-10, transforming growth factor-ß (TGF-ß), tumor necrosis factor-α, albumin and pre-albumin. Samples were obtained monthly. Ten HD patients were enrolled (age: 64.9 ± 12.6 years; 70% males; dialytic vintage: 10.6 [2.7-16.2] years). Mean convection volume was 40.1 ± 2.5 L/session in MID and 20.1 ± 2.6 L/session in HDF. A significant reduction of ß2-Microglobulin was detected as a result of either treatment. In MID, CRP decreased from 11.3 (3.2-31.0) to 3.1 (1.4-14.4) mg/L (p = 0.007), IL-6 from 12.7 (5.0-29.7) to 8.3 (4.4-14.0) pg/mL (p = 0.003), and TGF-ß from 10.6 (7.4-15.6) to 7.4 (5.9-9.3) ng/mL (p = 0.001). A significant reduction of CRP from 8.5 (3.2-31.0) to 4.6 (3.2-31.0) mg/L was also detected in HDF (p = 0.037), whereas no significant reduction of IL-6 (p = 0.147) and TGF-ß (p = 0.094) was found. Percentage reduction of IL-6 correlated with mean convective volume in HDF (R = 0.666; p = 0.036) and in MID (R = 0.760; p = 0.020). Therefore, MID and HDF are associated with an attenuation of inflammatory pattern that is correlated with a high convective volume.

[Bilirubin removal with Coupled Plasma Filtration and Adsorption in patients affected by hilar cholangiocarcinoma]. / Rimozione della bilirubina con Coupled Plasma Filtration and Adsorption in pazienti con colangiocarcinoma ilare.

BACKGROUND: Patients affected by hilar cholangiocarcinoma are eligible for surgery only in the 20-30% of the cases and postoperative mortality is 40-50%. Many specialists are involved in the treatment of this disease, like surgeons, gastroenterologists, oncologists and radiotherapists. Recent studies have shown that preoperative bilirubinaemia is a predictor of morbidity and mortality after surgery. Coupled Plasma Filtration and Adsorption (CPFA) is a blood purification extracorporeal therapy recommended for sepsis and able to reduce bilirubinaemia. METHODS: We treated 10 patients referred to our centre affected by hilar cholangiocarcinoma complicated by obstructive jaundice with 34 CPFA sessions to test its ability to reduce preoperative bilirubin levels and we checked for mortality at 90 days. RESULTS: CPFA reduced preoperative bilirubin of 30% for session; it also improved others inflammation and coagulation tests. Mortality at 90 days was 40%. CONCLUSIONS: CPFA is an effective therapy for hyperbilirubinaemia. Lowering preoperative bilirubinaemia and improvement of coagulation tests subsidized the management of the patients but in our study did not affect postoperative mortality. Further studies to evaluate the indications for treatments that remove bilirubin in this setting are needed.

Quality of life of hemodialysis patients in Central and Southern Italy: cross-sectional comparison between Hemodiafiltration with endogenous reinfusion (HFR) and Bicarbonate Hemodialysis.

INTRODUCTION: in hemodialysis (HD) patients, poor health-related quality of life (HR-QoL) is prevalent and associated with adverse outcomes. HR-QoL is strictly linked to nutritional status of HD patients. Hemodiafiltration with endogenous reinfusion (HFR) is an alternative dialysis technique that combines diffusion, convection and absorption. It reduces burden of inflammation and malnutrition and this effect may cause beneficial effect on HR-QoL. However no data on HR-QoL in HFR is currently available. METHODS: we designed a cross-sectional multicentre study in order to compare the HR-QoL in patients treated with HFR versus Bicarbonate HD (BHD). We enrolled adult patients HFR treated for at least 6 months, with life expectancy greater than six months and without overt cognitive deficit. The recruited patients in HFR were matched for age, gender, dialytic vintage and performance in activities of daily living (Barthel index) with BHD treated patients. SF-36 questionnaire for the assessment of HR-QoL was administered. RESULTS: one hundred fourteen patients (57 HFR vs 57 BHD) were enrolled (age 65.413.5 years; dialysis vintage 5.4 (3.3-10.3) years; 53% males) from 18 dialysis non-profit centres in central and southern Italy. As result of matching, no difference in age, gender, dialytic age and Barthel index was found between HFR and BHD patients. In HFR patients we observed better values of physical component score (PCS) of SF-36 than BHD patients (P=0.048), whereas no significant difference emerged in the mental component score (P=0.698). In particular HFR patients were associated with higher Physical Functioning (P=0.045) and Role Physical (P=0.027). CONCLUSIONS: HFR is associated with better physical component of HR-QoL than BHD, independently of age, gender, dialysis vintage and invalidity score. Whether these findings translate into a survival benefit must be investigated by longitudinal studies.

[The Ormond's disease: an intriguing obstructive nephrouropathy]. / La malattia di Ormond: una intrigante nefrouropatia ostruttiva.

Idiopathic retroperitoneal fibrosis also known as Ormonds disease is a rare disorder characterized by the development of fibrotic tissue in the retroperitoneum involving the abdominal aorta and iliac arteries, ureters and the inferior vena cava. The aberrant tissue may compress ureters leading to obstructive nephrouropathy and renal failure, which are the most common clinical manifestations of this condition. The nephrologist is often consulted to make differential diagnosis for acute renal failure and obstructive uropathy. Ultrasounds may suggest the disease and the diagnosis will be confirmed by computed tomography or magnetic resonance, but biopsy is still the diagnostic gold standard. The aim of therapy is to remove the ureteral obstruction and prevent the progression and recurrence of the disease. After urine drainage by ureteral stents, medical long-term therapy is usually started whereas the open surgery is reserved as a last resort in selected patients. The pathophysiology of Ormond's disease is uncertain. For years the disease was considered reactive to local and /or systemic triggers with primarily involvement of abdominal aorta but at present is classified in the more broad spectrum of IgG4- Related- Disease, clinical pathological entity on autoimmune basis that can affect almost all of the body districts. This last concept has shed light on the understanding of the pathogenesis and opened new therapeutic perspectives with the use of biological agents. In this paper, on the basis of our paradigmatic clinical case of bilateral obstructive nephrouropathy associated with acute renal failure and examining the recent literature, we describe the clinical and therapeutic approach to Ormonds disease.

[Management of antirheumatic drugs in kidney failure]. / Gestione dei farmaci antireumatici nell'insufficienza renale.

The nephrologist deals with the management of patients with rheumatic disease, both diagnostically and therapeutically. He must determine whether the renal pathology is related to the rheumatologic disease, mostly through the use of the renal biopsy. In the second case, he must know the nephrotoxic potential of the drugs prescribed and adjust their use to the degree of renal impairment. This task is made difficult by the absence of controlled clinical trials regarding their use on patients with renal insufficiency or on chronic dialysis. For this reason, the prescription will have to take into account the pharmacokinetics of the drugs. Kidney failure can affect the metabolism of antirheumatic drugs determining their accumulation, which can lead to increased toxicity, either renal or systemic. On the other hand, dialysis can cause excessive drug removal, leading to sub-therapeutic pharmacological effects and to the need for additional doses. In this brief review, we will consider the nephrotoxic effects of some important drugs used in rheumatology and examined individually, with specific reference to rheumatoid arthritis: methotrexate, leflunamide, hydroxychloroquine, cyclosporine, biological DMARDs. In the past, therapeutic success in rheumatic diseases associated with kidney impairment was severely limited by the well- known nephrotoxicity of drugs such as gold salts, D-penicillamine, NSAIDs, COX-2 inhibitors. Although generally effective, they are contraindicated in case of kidney failure. Biologic therapies have recently opened new therapeutic perspectives. Nevertheless, it is worth stressing how our knowledge of their action is still incomplete and this may result in exposure to immune-mediated renal disease.

Effect of hemodiafiltration with endogenous reinfusion on overt idiopathic chronic inflammation in maintenance hemodialysis patients: a multicenter longitudinal study.

Chronic inflammation is widely diffuse in maintenance hemodialysis (MHD) patients and is associated with poor survival. Hemodiafiltration with endogenous reinfusion (HFR) is a dialysis technique, highly biocompatible, able to adsorb proinflammatory cytokines and to decrease amino acids and antioxidants loss. These features could be helpful in MHD patients affected by idiopathic chronic inflammation, but this issue remains to be elucidated. We performed a multicenter longitudinal study to assess the effect of the switching from bicarbonate HD to HFR in patients with serum C-reactive Protein (CRP) > 5 mg/L coupled with albumin <4.0 g/dL in the last 6 months. We enrolled 24/176 (14%) patients, of which 20 patients were assessed at 4 months and 18 completed the study. We excluded 11 patients with evident causes of inflammation. At baseline, serum levels of CRP (18.7[7.0-39.4] mg/L) and albumin (3.5[3.3-3.7] g/dL) were significantly correlated (r = -0.49; P = 0.028). The effect on CRP and albumin was almost evident in the first 4 months and remained stable until to eighth month. A strict correlation (R = -0.49; 0.040) between percentage change of CRP (-35%) and albumin (+14%) after 8 months of HFR. These effects were associated with the reduction of IL-6, IL-1ß, and TNF-α and the increment of pre-albumin and leptin, whereas the serum levels of Branched Chain Amino Acid (BCAA) remained unchanged. In MHD patients affected by idiopathic chronic inflammation the switching from BHD to HFR is associated with improvement of inflammation. Whether these favorable effects may modify the outcomes of these high-risk patients needs to be confirmed by studies ad hoc.

[Role of the ultrasounds in the kidney biopsy: a case of postbiopsy hematoma linked to renal arteriovenous fistula]. / Ruolo degli ultrasuoni nella biopsia renale: un caso di ematoma post-bioptico associato a fistola artero-venosa renale.

In the planning of a kidney biopsy procedure, ultrasound examination has a crucial role before percutaneous renal biopsy (PRB) in detecting renal abnormalities that could contraindicate the biopsy; during PRB as a method to locate the kidney; and after PRB to diagnose and monitor postbiopsy complications. The case of a 40-year-old woman who underwent ultrasound-guided PRB for urinary abnormalities is described. Careful renal assessment by ultrasonography before the kidney biopsy was not performed. The post-PRB ultrasound examination revealed a perinephric hematoma along with an arteriovenous fistula (AVF) at the lower pole of the biopsied kidney. Surprisingly, a later renal angiography showed AVFs in both kidneys and therefore a diagnosis of non-iatrogenic, idiopathic AVFs was made. Based on our unusual case report, we discuss the diagnostic approach and therapeutic strategies for renal AVFs and we emphasize the usefulness of ultrasound for initial pre-PRB evaluation. In addition, with respect to the post-biopsy hematoma, the advantages offered by ultrasound during and after the implementation of PRB are debated. Finally, the role of post-biopsy hematoma as a possible indicator of post-PRB complications is reported.

[Diagnostic pathway of an unusual case of nephrotic syndrome: immunotactoid glomerulopathy]. / Una insolita sindrome nefrosica (Immunotactoid Glomerulopathy): percorso diagnostico.

Immunotactoid glomerulopathy is a clinicopathological entity characterized by extracellular deposition of microtubular substructures, which are negative for the usual staining that identifies amyloid within the mesangium and capillary walls of renal glomeruli. Despite ongoing debate in the nephrological community, it is kept distinct from fibrillary glomerulonephritis on the basis of the size and arrangement of the microtubules and microfibrils. It is clinically characterized by the presence of glomerular proteinuria in the nephrotic range, microscopic hematuria and hypertension, and is often associated with hypocomplementemia, monoclonal gammopathy, and lymphoprolipherative disorders. A 47-year-old woman was referred to our unit for evaluation of proteinuria associated with nephrotic syndrome. Laboratory findings revealed a serum M component and hypocomplementemia. Renal biopsy yielded three fragments for optical microscopy, immunofluorescence, and electron microscopy; Congo red staining was used. Renal histology showed a morphological pattern of membranoproliferative glomerulonephritis. Immunofluorescence showed IgG deposits with monoclonal kappa light chain restriction as well as C3 and C1q deposits. Electron microscopy revealed the presence within the mesangium of microtubules measuring >35 nm that were focally parallel oriented. The final diagnosis was nephrotic syndrome caused by immunotactoid glomerulopathy. The clinical diagnosis of immunotactoid glomerulopathy is based on pathological, clinical and hematological features and requires the exclusion of other diseases that are associated with organized glomerular deposits. We discuss the diagnostic options offered by the clinical and morphological elements of this case; the use of electron microscopy is emphasized, especially when a renal syndrome is associated with paraproteinemia.

Effects of efficiency and length of acetate-free biofiltration session on postdialysis solute rebound.

BACKGROUND: Postdialytic rebound (PDR) of plasma solutes is a relevant drawback of intermittent hemodialysis, but its pathophysiological process remains undefined. We assessed the independent effects of efficiency and length of dialytic session on PDR of urea, phosphate, and potassium. METHODS: Uremic patients were evaluated at the beginning and end of dialysis and after 180 minutes in 2 randomized crossover studies. In study 1, we compared the effect of standard versus higher efficiency acetate-free biofiltration (AFB) while maintaining the same duration of 4 hours. In study 2, we compared the effect of 3- versus 5-hour AFB sessions while maintaining similar efficiency. RESULTS: In study 1, greater Kt/V (1.49 +/- 0.20 versus 1.22 +/- 0.15; P < 0.0001) was coupled with significant increases in both absolute removal and PDR of urea and phosphate (PDR of urea, +45% versus +29%; PDR of phosphate, +79% versus +52%), but not of potassium. Similarly, in study 2, shortening the AFB session while maintaining similar absolute removal and Kt/V (1.28 +/- 0.09 versus 1.31 +/- 0.09) significantly increased PDR of urea and phosphate (PDR of urea, +32% versus +19%; PDR of phosphate, +63% versus +36%), but not of potassium. In both studies, greater PDRs of urea and phosphate were associated with estimated greater removal of these solutes per hour. CONCLUSION: The rate of removal of phosphate and urea is a critical determinant of their PDR; conversely, potassium is not influenced by removal rate, likely because of its marked cell compartmentalization.

Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients.

BACKGROUND: Chronic kidney disease patients who are resistant to erythropoietin (EPO) treatment may suffer from malnutrition and/or inflammation. METHODS: In a cross-sectional study of haemodialysis patients, we investigated the relationship between the natural logarithm of the weekly EPO dose normalized for post-dialysis body weight and outcome measures of nutrition and/or inflammation [BMI, albumin and C reactive protein (CRP)] by means of multiple linear regression analysis. On the basis of the decile distribution of weekly EPO doses, we also evaluated four groups of patients: untreated, hyper-responders, normo-responders and hypo-responders. RESULTS: Six hundred and seventy-seven adult haemodialysis patients were recruited from five Italian centres. BMI and albumin were lower in the hypo-responders than in the other groups (21.3+/-3.8 vs 24.4+/-4.7 kg/m(2), P<0.001; and 3.8+/-0.6 vs 4.1+/-0.4 g/dl, P<0.001), whereas the median CRP level was higher (1.9 vs 0.8 mg/dl, P = 0.004). The median weekly EPO dose ranged from 30 IU/kg/week in the hyper-responsive group to 263 IU/kg/week in the hypo-responsive group. Transferrin saturation linearly decreased from the hyper- to hypo-responsive group (37+/-15 to 25+/-10%, P = 0.003), without any differences in transferrin levels. Ferritin levels were lower in the hypo-responsive than in the other patients (median 318 vs 445 ng/ml, P = 0.01). At multiple linear regression analysis, haemoglobin, BMI, albumin, CRP and serum iron levels were independently associated with the natural logarithm of the weekly EPO dose (R(2) = 0.22). CONCLUSIONS: Our findings support a clear association between EPO responsiveness and nutritional and inflammation variables in haemodialysis patients; iron deficiency is still a major cause of hypo-responsiveness.