È possibile una gestione “ideale” della pandemia da malattia renale cronica?

Chronic Kidney Disease (CKD) is recognized as one of the major categories of noncommunicable epidemic diseases and in the last decades it has been largely growing in incidence and prevalence all over the world. Ideal management of CKD pandemic should be comprehensive of measures of tertiary, secondary, primary and primordial prevention. So, it should include prompt diagnosis and treatment of traditional and non-traditional risk factors for CKD, optimal conservative treatment for non-dialysis dependent CKD patients and appropriated dialysis therapy or renal transplantation for patients with end-stage renal disease. However, these goals are not easy to obtain on a global scale. It would be possible only by a broad and holistic approach, ranging from good governance to achievement of the sustainable development goals (SDGs).

Presa in carico infermieristica nella Malattia Renale Cronica

n 2017, thanks to an initiative of IPASVI College (the Order of Nursing Professionals of the province of Bologna) in response to 2014 legislations referring to the Guidelines about Chronic Kidney Disease (CKD), nephrology professionals and members of EDTNA/ERCA Italian Branch Association (which in 2018 became Società Infermieri Area Nefrologica, SIAN) in 2021 were requested to contribute to define the role and skills performed by nurses on a daily basis. The management of the CKD patient has been structured into 7 phases: the model for each phase takes into consideration the professionals involved, the care settings and the tools used. To support this approach, we decided to introduce two elements which broaden the clinical and care approach to the patient and at the same time highlight the contribution of nursing professionals, with a referring workflow for the CKD patient, the nurses’ role and skills required throughout the patient’s journey. Furthermore, to ensure the best continuity of care, we believe that it is necessary to apply a logical model based on the principles of early recognition of health and welfare needs; guarantee the most appropriate healthcare response; ensure early care; standardize the procedures of professionals to improve the quality of life of the patient and manage the social and economic impact.

Telemedicina tra clinica e nutrizione nella Malattia Renale Cronica (MRC): appunti di esperienze al femminile

In Italy, starting from 2015, the date of publication of the guidelines on the 2014-2020 Digital Growth Strategy, technological evolution in medicine has provided encouraging results. The term telemedicine is now in common use, and it is also indicated at an encyclopedic level as “the set of technical and health care monitoring tools, created through systems designed to provide quick access to both medical specialists and patients, regardless of the place where they are respectively located”. Nowadays, in the COVID era, the need for social distancing has highlighted the contribution of digital technology to healthcare in terms of access to care and healthcare spending. With regard to chronic kidney disease, telemedicine has always proved essential in improving patients’ quality of life, as in the case of peritoneal dialysis. The remote management and monitoring of patients undergoing peritoneal dialysis has not only proved to radically change and improve patients’ quality of life in replacement therapy, but has also reduced costs. There are some situations in which telemonitoring can guarantee the maintenance of an adequate quality of life for patients in the different stages of the disease. Thanks to the constant commitment of some groups of professionals where the largest part is represented by the “pink quota”, it was possible to experiment and implement evaluation protocols for the renal patient in conservative and replacement treatment in some of the most central aspects of care: medical and dietary therapy.

Fattori di rischio per l’ipertensione arteriosa sistemica: valutazione dell’efficacia delle azioni di educazione sanitaria

L’ipertensione arteriosa sistemica è la più frequente delle malattie cardiovascolari e risponde come principale fattore di rischio per le complicanze più comuni, come l’ictus e l’infarto miocardico acuto, oltre alla malattia renale cronica allo stadio finale. L’educazione sanitaria è lo strumento principale per i cambiamenti nelle abitudini e nello stile di vita, fondamentale nel processo preventivo per questa patologia. L’obiettivo di questa ricerca era quello di analizzare l’influenza delle azioni educative in salute sull’ipertensione arteriosa sistemica nel cambiamento di stile di vita dei servi della Corte di giustizia dello Stato di Amap. Lo studio ha avuto la partecipazione di 255 server ed è stato utilizzato un questionario per la raccolta dei dati, che sono stati analizzati tramite SPSS versione 22 (IBM SPSS, USA). È stato osservato che il 54,1% era di sesso femminile, il 66,3% marrone, il 33,7% tra i 40 e i 49 anni, il 47,8% aveva un’istruzione superiore e il 59,6% era sposato o viveva in un’unione stabile. L’indice di massa corporea ha mostrato che il 48,2% era ≥ sovrappeso, il 64,7% aveva una circonferenza addominale aumentata e il 10,6% aveva valori capillari di glucosio nel sangue ≥ 99 mg/dL. Per quanto riguarda la pressione sanguigna, il 33,3% degli uomini e il 21,7% delle donne avevano PA ≥ e 140 e/o 90 mmHg. Per quanto riguarda la partecipazione a qualche attività preventiva o educativa, il 76,1% ha dichiarato sì, di cui il 60,4% li ha considerati soddisfacenti e il 44,7% ritiene che non vi sia alcuna influenza sul cambiamento di stile di vita. Si è concluso che le azioni di educazione sanitaria stanno in parte influenzando il cambiamento delle abitudini dei dipendenti, perché gli indici dei fattori di rischio sollevano ancora preoccupazione.

Progetto per uno studio pilota per un ambulatorio di nefrologia narrativa: un approccio bio-psico-sociale alla malattia renale cronica

Introduction: Poor medication adherence in CKD patients is associated with high mortality and morbidity and can reach up to 80%. The most effective interventions to increase patients’ adherence to treatments are conducted by a multi-professional team and with the active participation of patients and their families. Narrative evidence-based medicine has been proved as a useful methodology in the care of chronic patients also in promoting their adherence to treatments. Methods: Around 50-70% of CKD patients treated in our centre will follow clinical protocol based on a narrative medicine approach: (1) patients will be invited to write a brief history related to their experience with the CKD and treatments; (2) screening for depression (HADS; PHQ-9); (3) intervention of pharmaceutical counselling aimed to explore patients’ behaviours about taking their medications; (4) sharing of decision-making: the results of the narrative histories and of questionnaires will be discussed with the patients; (5) psychoeducational groups. Results: The pilot phase of the project will last 6 months. During these months, patients will be monitored for biochemical (e.g. anemia) and anthropometric (e.g. blood pressure) parameters and depression. Medical visits or diagnostic tests missed by patients will also be recorded. Conclusions: The development of an active role of patients in taking care of themselves is one of the main challenge of clinical nephrology. The present project aims to implement in the clinical routine a protocol based on the narrative medicine approach in which the biological, psychological and social needs of CKD patients are considered and discussed with them.

Disuguaglianze e malattia renale cronica: risultati dall’atlante italiano delle disuguaglianze di mortalità per livello di istruzione

non disponibile (Epidemiology_statistics)

Rivaroxaban e malattia renale cronica: evidenze dal presente e prospettive future

Cardiovascular diseases represent the main cause of comorbidly in chronic kidney disease (CKD) patients, with a 7% incidence in atrial fibrillation (AF) in end-stage renal disease (ESRD) patients. Until recently, prophylactic treatment of atrial fibrillation complications (such as thromboembolism) was mainly based on vitamin K antagonists (VKA) or heparin. In the last years, direct oral anticoagulants (DOACs) have been made available; however, their renal clearance limits their use on patients with severe renal impairment (eGFR <15 mL/min). Among DOACs, Rivaroxaban, a factor X-activated (Xa) inhibitor, shows good renal profile and it can be used in CKD patients up to stage 4 as well as in ESRD patients (at the moment only in North America and Canada). (Cardionephrology)