Papers by Biagio Di Iorio
Journal of Clinical Medicine, 2021
Nutritional therapy (NT) is a therapeutic option in the conservative treatment of chronic kidney ... more Nutritional therapy (NT) is a therapeutic option in the conservative treatment of chronic kidney disease (CKD) patients to delay the start of dialysis. The aim of this study was to evaluate the specific effect of ketoanalogs (KA)-supplemented diets for gut microbiota modulation. In a previous study we observed that the Mediterranean diet (MD) and a KA-supplemented very-low-protein diet (VLPD) modulated beneficially gut microbiota, reducing indoxyl- and p-cresyl-sulfate (IS, PCS) serum levels, and ameliorating the intestinal permeability in CKD patients. In the current study, we added a third diet regimen consisting of KA-supplemented MD. Forty-three patients with CKD grades 3B–4 continuing the crossover clinical trial were assigned to six months of KA-supplemented MD (MD + KA). Compared to MD, KA-supplementation in MD + KA determined (i) a decrease of Clostridiaceae, Methanobacteriaceae, Prevotellaceae, and Lactobacillaceae while Bacteroidaceae and Lachnospiraceae increased; (ii) a ...
Blood purification, 2014
To conduct a cost-effectiveness analysis of sevelamer versus calcium carbonate in patients with n... more To conduct a cost-effectiveness analysis of sevelamer versus calcium carbonate in patients with non-dialysis-dependent CKD (NDD-CKD) from the Italian NHS perspective using patient-level data from the INDEPENDENT-CKD study. Patient-level data on all-cause mortality, dialysis inception and phosphate binder dose were obtained for all 107 sevelamer and 105 calcium carbonate patients from the INDEPENDENT-CKD study. Hospitalization and frequency of dialysis data were collected post hoc for all patients via a retrospective chart review. Phosphate binder, hospitalization, and dialysis costs were expressed in 2012 euros using hospital pharmacy, Italian diagnosis-related group and ambulatory tariffs, respectively. Total life years (LYs) and costs per treatment group were calculated for the 3-year period of the study. Bootstrapping was used to estimate confidence intervals around outcomes, costs, and cost-effectiveness and to calculate the cost-effectiveness acceptability curve. A subgroup ana...
Current Hypertension Reviews, Dec 31, 2014
Background: ESRD (end-stage renal disease) patients have a high cardiovascular mortality risk. A ... more Background: ESRD (end-stage renal disease) patients have a high cardiovascular mortality risk. A morphofunctional approach of vascular calcifications and myocardial perfusion is needed for the management of ESRD patients. We used SEVR (sub-endocardial viability ratio) and Kauppila score from the dialysis population of the Independent study to create a new morpho-functional score to assess cardiovascular risk in this population (the Solofra score).
Giornale Italiano Di Nefrologia Organo Ufficiale Della Societa Italiana Di Nefrologia, Nov 1, 2014
Giornale Italiano Di Nefrologia Organo Ufficiale Della Societa Italiana Di Nefrologia, Nov 1, 2014
Giornale Italiano Di Nefrologia Organo Ufficiale Della Societa Italiana Di Nefrologia, Jul 1, 2014
Spontaneous ureteric ruptures is a rare condition [1]and bilateral ureteric rupture is even more ... more Spontaneous ureteric ruptures is a rare condition [1]and bilateral ureteric rupture is even more uncommon. Few cases are described in the literature in which bilateral ureteric rupture is associated to dermatomyositis [2]or to intra-arterial contrast medium application for infrarenal aortic stent placement [3]. We discuss here a case of bilateral ureteric rupture in a 74-year-old man with bladder cancer, presenting oliguric acute kidney failure and a light abdominal pain.
![Research paper thumbnail of [The optimization of the treatment and timing of the intervention by a nephrologist in pre-dialytic chronic renal insufficiency]](https://a.academia-assets.com/images/blank-paper.jpg)
Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
Early referral to nephrologists of patients with chronic renal failure (CRF) reduces morbidity an... more Early referral to nephrologists of patients with chronic renal failure (CRF) reduces morbidity and mortality in dialysis. Aim of this work is to evaluate the condition of early and late referral, and whether the two different conditions can affect the treatments. This is a prospective study with a 12-month follow-up period. During this time, we verified the prevalence of patients with serum creatinine > 1.5 mg/dL (CRF patients) and the condition of early or late referral, defined as referral to nephrologists for > or < 3 times during follow up, respectively. Diagnosis of diabetes mellitus and/or arterial hypertension, and the use of antihypertensive drugs, insulin, hypoproteic diet and erythropoietin was recorded in each patient. CRF (mean serum creatinine value = 2.11+/-1.52 mg/dL) was observed in 190 patients aged 72.05+/-11.62 years. The prevalence of CRF was 4718 pmp. Diabetes and hypertension were diagnosed in 107 subjects (56.3%) and 152 subjects (80%), respectively. Only 74.2% (no. 141) of the patients with CRF was habitually followed by the nephrologist and the frequency was directly correlated to the degree of CRF: 100% of the patients with Creatinine Clearance (Cr Cl) < 25 mL/min, 70% with Cr Cl >25 < 50, and 0% with Cr Cl >50 < 80 mL/min. Early referral was coupled with a wider use of a hypoproteic diet, erythropietin, and the association ACE-I + Angiotensin II receptor antagonists. In conclusion, our data show a prevalence of CRF that is at least 5 times greater than that of dialysis patients. The condition of late referral is present in about 30% of the CRF population from the time of the initial phases of renal disease. Referral time affects the modalities of the treatment.
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
We present an unusual case of a young patient regularly followed in our Chronic Renal Insufficien... more We present an unusual case of a young patient regularly followed in our Chronic Renal Insufficiency ambulatory with the periodicity of 2-3 visits per year - with stabilization of his residual renal function. The patient came to the emergency department declaring abdominal pain but make a diagnosis turned out to be more complicated than we expected
International journal of nephrology, 2011
Seminars in Nephrology, 2006
Studies in patients on maintenance hemodialysis have disclosed a high prevalence of sleeping diso... more Studies in patients on maintenance hemodialysis have disclosed a high prevalence of sleeping disorders, which have been linked to various factors including blood urea levels, creatinine levels, parathyroid hormone levels, anemia, systolic and diastolic blood pressure, quality of life, disease intrusiveness, and comorbidities. In contrast, few studies have been performed in patients with chronic kidney disease (CKD), who represent the target of the present study. A group of 52 CKD patients were enrolled after characterization of their renal function. Comorbidities were evaluated by means of the Charlson Comorbidity Index. Sleep disorders were evaluated by means of the Sleep Disorder Questionnaire (SDQ), a 26-item questionnaire providing a hierarchic classification for relevant insomnia, relevant hypersomnia, subclinical disorders, or absence of sleep complaints. Results indicate that, in the early stages of CKD, at a time the comorbidity index is low, sleep disorders are present in 80.7% of patients. This finding, which needs to be confirmed in a larger cohort of patients, indicates that sleep disorders affect the lives of CKD patients as soon a diagnosis of disease potentially progressing to end-stage renal disease was made. Semin Nephrol 26:64-67
Nutrition and Dietary Supplements, 2012
Phosphate is present in food in two forms, ie, organic and inorganic phosphate salts, which are n... more Phosphate is present in food in two forms, ie, organic and inorganic phosphate salts, which are naturally present in food and as phosphates added for industrial and commercial reasons. There is also a high content of added phosphate in beverages, and phosphates in this form are highly absorbable. The real content of phosphate contained in beverages is often unrecognized, and nephrologists do not always take into account the amount of phosphorus that patients ingest in this form.
Nephrology Dialysis Transplantation, 1996
Journal of Renal Nutrition, 2013
Journal of Medical Economics, 2013
Objectives: To determine the cost effectiveness of sevelamer versus calcium carbonate in patients... more Objectives: To determine the cost effectiveness of sevelamer versus calcium carbonate in patients with chronic kidney disease and not on dialysis (CKD-ND) from the perspective of the National Health Service (NHS) in the UK.
Hypertension Research, 2012
Pulse wave velocity (PWV) is a predictor of morbidity and mortality in patients with end-stage re... more Pulse wave velocity (PWV) is a predictor of morbidity and mortality in patients with end-stage renal disease (ESRD). Dialysis patients show cyclic changes in PWV related to their hydration status and blood pressure. Our aim is to assess the impact of daily dialysis on PWV. We performed a randomized crossover study of 60 patients who underwent standard hemodialysis (HD) three times per week for at least 6 months. Patients were classified into three groups according to their PWV values before (pre-) and after (post-) HD, with a cutoff value of 12 m s À1 , as follows: the low-low (LL) group had normal pre-HD and post-HD PWV; the high-low (HL) group had high pre-HD PWV and normal post-HD PWV; and the high-high (HH) group had high pre-and post-HD PWV. All patients continued standard HD for 2 weeks. A total of 10 patients from each group were randomly assigned to continue standard HD for 1 week and then underwent daily dialysis for 1 week. The remaining 10 patients underwent daily dialysis for 1 week and then underwent standard HD for 1 week. PWV values were measured before and 1 h after each dialysis session. With daily dialysis treatment, 2 of 20 patients (10%) moved from the PWV-HH group to the PWV-HL group, whereas 18 of 20 patients (90%) moved from the PWV-HL group to the PWV-LL group (P¼0.030). Daily dialysis reduces PWV in the ESRD patients. As PWV is a strong predictor of mortality in ESRD and has cyclic variations in patients who are on standard HD, we believe that daily dialysis may be used in patients with high PWV levels to reduce their mortality risk.
Hemodialysis International, 2010
Despite the clinical importance of pulse-wave velocity (PWV), there are no standards for accurate... more Despite the clinical importance of pulse-wave velocity (PWV), there are no standards for accurate carotid-radial pulse-wave measurement in uremic patients with respect to carotid-femoral measurement. We assessed the reproducibility of PWV values using the carotid-radial PWV measurement. We have measured the carotid-femoral PWV and carotid-radial PWV with an automated system (Pulse Pen, DiaTecne) using 2 different blind operators in 105 hemodialysis (HD) patients. The carotid-femoral waveforms were acquired by the first blind operator simultaneously with 2 pressure-sensitive transducers and the transit time of the pulse was calculated using the system software. Similarly, the second blind operator acquired the carotid-radial waveforms. The two operators performed 2 consecutive measurements from the same subject, in a random order. In fact, after the first operator had completed 2 consecutive measurements from 1 subject, all of the sensors were detached, and the second operator attached sensors again to the same subject. The measurements were performed during interval of a midweek dialysis-free day. To evaluate the reproducibility of the system, both within-observer and between-observer analyses were performed. We studied 105 dialysis patients (HD) and 20 controls. All HD patients had three dialysis sessions lasting at least 4 h/wk. A total of 28 patients (26.7%) had diabetic nephropathy. The mean age of HD was 64.6 AE 16.1 years, the body weight was 71.1 AE 15.1 kg, and the height was 164.6 AE 6.1 cm. All population studied is referral at a tertiary care from at least 6 months (mean 11.1 AE 2.1 months). A total of 45% of patients are smokers or ex-smokers. The PWV of carotid-femoral is 8.58 AE 3.99 and the PWV of carotid-radial is 8.70 AE 4.01 m/sec, respectively, by the first and the second operator; the difference of PWV (femoral-radial measure) is À 0.037 AE 0.99 m/sec. The linear correlation of carotid-femoral vs. carotid-radial PWV measurements is the highest (R 2 = 0.90). The results regarding reproducibility, including mean differences and standard deviations, standard errors, and correlation coefficients were analyzed for each regional PWV value for the between-observer and within-observer studies. All of the measurements showed significant correlation coefficients, ranging from 0.94 to 0.98. The reproducibility of regional PWV values for 2 consecutive measurements from the same subject was also analyzed using Bland-Altman plots, with the reproducibility expressed as the mean difference and 2 standard deviations between the measurements obtained by the 2 operators during carotid-femoral and carotid-radial measurements. Carotid-radial PWV measurement provides an accurate analysis with a high reproducibility with respect to carotidfemoral PWV measurement, and it can be used for arterial stiffness analysis in hemodialysis patients.
Current Hypertension Reviews, 2013
Hypertension is responsible for a significantly increased burden of cardiovascular events and it ... more Hypertension is responsible for a significantly increased burden of cardiovascular events and it is cause and a consequence of Chronic Kidney Disease (CKD) and a determinant factor in its progression to End Stage Kidney Disease (ESKD). Therefore, nephrologists have been focusing their attention on hypertension control to prevent CKD progression, delaying it but with poor results on cardiovascular mortality reduction. An important effect is the difficulty to adequately reduce BP levels in CKD patients and especially in dialysis patients despite the polipharmacological therapy. We have to take into account other aspects influencing mortality risk in CKD patients .The first aspect to consider is whether brachial blood pressure (BP) measurement is sufficient to describe the complex relationship between the alteration of BP and outcomes in renal subjects. The second aspect to consider is the variability of BP (BPV). We think that BP measurement cannot only take into account brachial BP, because it represents a limited measure of a complex clinical condition in CKD or ESRD patients. The inability to evaluate hypertension in its complexity explains why several aspects are still unrecognized.
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Papers by Biagio Di Iorio