[HFR-AEQUILIBRIUM and intradialytic cardiovascular stability: results of the first multicenter study in Lazio]. / HFR-AEQUILIBRIUM e stabilità cardiovascolare intradialitica: risultati del primo studio multi-centrico laziale.

Intradialytic hypotension (IDH) is a still-frequent and poorly-understood complication of haemodialysis. Haemofiltration has recently been shown to reduce the phenomenon of IDH. HFR-Aequilibrium adds to traditional HFR and is, in practice, a variant comprising endogenous re-infusion of haemodiafiltration with dialysate sodium concentration and ultrafiltration rate profiles elaborated by the 'Profiler' plasma sodium biofeedback system, and measurement of plasma sodium via the on-line Natrium sodium sensor.

[Sustained low-efficiency dialysis (SLED) in patients with prevalent systolic heart failure refractory to medical treatment and with chronic renal failure]. / Dialisi prolungata a bassa efficienza (SLED) in pazienti affetti da insufficienza cardiaca prevalentemente sistolica (IV NYHA) refrattaria al trattamento polifarmacologico e insufficienza renale cronica.

Systolic heart failure refractory to conventional medical therapy is the principal cause of the high hospitalization rates and of high mortality risks. When this condition is associated with chronic renal failure it is necessary to treat the body liquid composition alterations, and the alterations in the hemodynamic state without creating low flow conditions, trying to achieve an electrolytic and an acid-base balance to reduce the plasmatic volume and permit refilling between the interstitium and plasm. Sustained low-efficiency dialysis (SLED) is a dialysis technique allowing the maintenance of hemodynamic stability through a reduced ultrafiltration rate, it allows an adequate clearance of small solutes, and with sustained treatment it maximizes the dialysis dose and determines a clinical improvement through the removal of the hydric overload. Our experience suggests that SLED is a substitutive treatment for acute dialysis in patients with systolic heart failure refractory to conventional medical treatment.

[Quality of life in patients with combined treatments for heart failure]. / Qualità di vita nei pazienti con trattamenti combinati nello scompenso di cuore.

The low quality of life in patients with end-stage heart failure is correlated, above all, to frequent hospitalization and to the awareness of having an illness that limits survival. The quality of life in these patients with heart failure using treatment with sustained low efficiency dialysis (SLED) is determined through the Minnesota Living with Heart Failure (MLHF) Questionnaire. The reliability of this evaluation system has been examined through consultation with international trials. After 1 yr of this treatment, we observed an improvement in quality of life.

[Dialytic treatment in patients with renal insufficiency and heart failure refractory to combined drug therapy]. / Trattamento emodialitico in pazienti affetti da insufficienza renale cronica e scompenso cardiaco refrattario alla terapia polifarmacologica.

The incidence and prevalence of heart failure are continuously on the increase. Pharmacological therapy is not sufficient in the advanced stages of the illness to control the signs and symptoms, especially when stressing factors intervene and complicate the illness course. Dialytic treatments are always indicated more than necessary in the severe forms of heart failure, but the optimal treatment has not yet been established. In our division, 24 patients with heart failure (III-IV NYHA) and renal failure (III-IV NKF-DOQI) were treated with low flux bicarbonate dialysis, variable dialysate and limited ultra-filtration. Arrhythmia, pericarditis, ischemic cardiopathy and hyponatremia were the stressing factors that determined acute heart failure. Fifteen patients presented with diastolic failure, whereas nine patients had systolic heart failure. The first group of patients had higher arterial pressure, better ejection fraction and better prognosis regarding renal function and survival rate. The results obtained with this treatment in prevalently diastolic heart failure are satisfactory in terms of survival, as well as in renal function recovery, whereas they are not adequate in systolic failure where other approaches are being studied. Therefore, we believe that the therapeutic choice must always be determined in relation to the type of heart failure.

Early dialysis in heart insufficiency of patients with chronic renal failure.

In patients with severe heart failure life expectancy is short, the quality of life is affected, and the service costs are very high. Drug therapies remain restricted despite continuous clinical research. Therefore new therapeutic approaches have been attempted to improve the signs and symptoms of the disorder. In our study we followed patients suffering from class-IV cardiac failure concomitant with chronic renal failure. The patients were initially treated by means of hemofiltration, and subsequently they underwent a personalized dialysis program. The survival rate after 2 years was 62.5%. In 7 of the 8 patients the results revealed a drop to a class-III condition. The hospitalization period was limited to a few days. Early dialytic therapy represents a reality for such patients.

Daily hemofiltration in severe heart failure.

Heart failure of class IV NYHA has a very severe prognosis. Its most frequent electrolytic alterations are hyponatremia, hypokalemia, and hypomagnesemia which can cause serious arrhythmias and sudden death. The regulation of the electrolytic equilibrium by means of pharmacological therapy becomes impossible in patients with severe heart failure resistant to strong doses of diuretics in the oligo-anuric phase. This study focused on the use of daily hemofiltration in a group of patients suffering from cardiac insufficiency of class IV NYHA. The results have been evaluated over 1 year.

The benefits of daily hemofiltration in the management of anuria in patients with severe heart failure (NYHA IV).

The aim of the study was to evaluate the daily use of hemofiltration in patients with anuria and heart failure IV NYHA, and not reacting to pharmacological therapy. Patients were submitted to daily hemofiltration therapy considering: the dry weight, BP, pO2, creatininemia, natriemia, kaliemia, and magnesiemia. Every month an echocardiogram and an ECG were done. Two patients passed from IV to III class NYHA, with a reduction in the telediastolic diameter and improvement in the ejection fraction and in the cardiothoracic index. In NYHA IV patients, it was possible to obtain a very good improvement in the clinical situation, echocardiographic parameters and survival with daily hemofiltration.

Daily hemofiltration in severe heart failure.

We treated nine patients having severe heart failure (IV NYHA classification) with anuria resistant to diuretics who were on daily hemofiltration, and estimated their survival for a year. The total volume of liquids removed was estimated by means of an echographic determination of the caval collapsability index. Dry weight was obtained from 6 to 22 days. The fluid removed varied from 10 to 35 liters. Five patients at the end of the therapy took up diuresis again and recovered their sensitivity to diuretics. Three of these patients went beyond the 12 months of survival, and two patients died earlier. Four patients did not show the resumption of diuresis and they continued with daily hemofiltration. Three survived over 20 weeks; one died after 15 weeks. We conclude that daily hemofiltration is useful in patients with severe heart decompensation in that it increases their survival rate.

Cistercian medicinal herbs for renal therapy in the 15th century.

The rule conceived the monastery as a citadel of divine service so that medicine, together with other arts, was the subject of studies and searches which contributed to the foundation of monastic medicine. In the 14th and 15th centuries, Cistercian monks did not limit themselves to the study of the ancient treatises on medicinal herbs, but enlarged their knowledge through clinical experience to such an extent that they created the principal therapy of diseases for about five centuries.

Hyperlipidemia in dialysis patients: what treatment?

The incidence of hyperlipidemia in the dialysis population in our hospital reflects the incidence reported by other authors but we ascertained a high incidence of hypercholesterolemic patients. The importance of cardiovascular illnesses as the cause of death in patients on dialysis means taking into consideration risk factors. In our study, omega-3 fatty acids proved to be effective in about half the patients treated and did not have side effects. In a comparison of patients who underwent alternative techniques with high-flux membranes and those who underwent standard dialysis, the first group showed a virtually normal lipid profile. High-flux membranes could be a therapeutical possibility for hypertriglyceridemic patients under dialysis.