Claudia Torino

Italian National Research Council | CNR · Institute of Clinical Physiology IFC

Background and objectives For older patients with kidney failure, lowering symptom burden may be more important than prolonging life. Dialysis initiation may affect individual kidney failure–related symptoms differently, but the change in symptoms before and after start of dialysis has not been studied. Therefore, we investigated the course of tota...

Background Trimethylamine N-oxide (TMAO), a metabolite from red meat and fish consumption, plays a role in promoting cardiovascular events. However, data regarding TMAO and its impact on clinical outcomes are inconclusive, possibly due to its undetermined dietary source. Objective We hypothesized circulating TMAO derived from fish intake might cau...

Background Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events and death in patients with advanced chronic kidney disease (CKD) is clinically useful and relevant. We aimed to externally validate a recently developed CKD G4+ risk calculator for these outcomes and to assess its potential clinical impact in...

Background and objectives In older people with kidney failure, improving health-related quality of life is often more important than solely prolonging life. However, little is known about the effect of dialysis initiation on health-related quality of life in older patients. Therefore, we investigated the evolution of health-related quality of life...

Background and objectives: In the EXerCise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a simple, personalized 6-month walking exercise program at home during the day off of dialysis improved the functional status and the risk for hospitalization in patients with kidney failure. In this post-trial observational study, we tested...

BACKGROUND Chronic Kidney Disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular...

Background Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular...

Objective: An exaggeration of the early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk. The early morning changes in these parameters have not been investigated in the hemodialysis population. Design and method: In a pilot, single center, study including a series of...

Background The EXCITE trial (JASN 28: 1259–1268, 2017) in dialysis patients showed that a 6-month home walking exercise program improves physical function and two dimensions of the KDQOLSF-SF™ questionnaire. Whether improvements in physical function achieved by exercise interventions are maintained in the long term has never been tested in the dial...

BACKGROUND AND AIMS In the general population, men have a higher risk of major adverse cardiovascular events (MACE) compared with women, with this risk difference between men and women decreasing with increasing age. Patients with chronic kidney disease (CKD) are at a higher risk of MACE compared with the general population, but sex differences in...

BACKGROUND AND AIMS The EXCITE trial (JASN 28: 1259–1268, 2017) in dialysis patients showed that a 6-month home walking exercise program increases the walking distance covered during the 6 min walking test (6MWT), improves the response to the 5 times sit-to-stand test (5STS) and the cognitive function and quality of social interaction scores of the...

BACKGROUND AND AIMS Ambulatory blood pressure monitoring (ABPM), extended to 44h or 48h for the diagnosis of hypertension in end-stage kidney disease (ESKD) patients, is recommended by Consensus Documents of the American Society of Nephrology and the European Renal Association. About 10%–20% of individuals in the general population report sleeping...

BACKGROUND AND AIMS In older people with end-stage kidney disease (ESKD), lowering symptom burden is likely more important than solely the prolongation of life. ESKD-related symptoms are multifactorial and dialysis initiation may affect distinct symptoms differently [1]. Symptoms caused by fluid overload (e.g. leg swelling) may be expected to impro...

BACKGROUND AND AIMS Amplified early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk in the general population. The early morning changes in these parameters have not been investigated in the haemodialysis population. METHOD In a pilot, single centre, study including a...

Introduction: An exaggeration of the early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk. The early morning changes in these parameters have not been investigated in the hemodialysis population. Methods: In a pilot, single center study including a series of 58 pati...

Background Prospective cohort studies are challenging to deliver, with one of the main difficulties lying in retention of participants. The need to socially distance during the COVID-19 pandemic has added to this challenge. The pre-COVID-19 adaptation of the European Quality (EQUAL) study in the UK to a remote form of follow-up for efficiency provi...

Exposure of the airways epithelium to environmental insults, including cigarette smoke, results in increased oxidative stress due to unbalance between oxidants and antioxidants in favor of oxidants. Oxidative stress is a feature of inflammation and promotes the progression of chronic lung diseases, including Chronic Obstructive Pulmonary Disease (C...

Clinical research is gaining interest among healthcare professionals. This review provides an in-depth analysis of key study designs used in epidemiology, which can help researchers use the right methodology to design and conduct a research project. Case-control studies evaluate the association between an exposure to a specific risk factor and a st...

Background and objectives The effect of sex on longitudinal health-related quality of life remains unknown in CKD. Here we assess differences in the sex-specific evolution of health-related quality of life in older men and women with advanced CKD. Design, setting, participants, & measurements The European Quality Study on Treatment in Advanced Chr...

Background: Patients with stage 4/5 chronic kidney disease (CKD) suffer from various symptoms. The retention of uremic solutes is thought to be associated with those symptoms. However, there are relatively few rigorous studies on the potential links between uremic toxins and symptoms in patients with CKD. Methods: The EQUAL study is an ongoing o...

Objective To identify the optimal estimated glomerular filtration rate (eGFR) at which to initiate dialysis in people with advanced chronic kidney disease. Design Nationwide observational cohort study. Setting National Swedish Renal Registry of patients referred to nephrologists. Participants Patients had a baseline eGFR between 10 and 20 mL/min...

Starting from our platform Med3D VR Lab, we implemented, in the MMM project, a basic algorithm within a software, able to capture, from DICOM images (MRIs/CT scans), the cloud of points needed to build 3D images.

Background Prospective cohort studies are challenging to deliver, with one of the main difficulties lying in retention of participants. The need to socially distance during the COVID-19 pandemic has added to this challenge. The pre-COVID-19 adaptation of the European Quality (EQUAL) study in the UK to a remote form of follow-up for efficiency provi...

In this work electrochemical sensors fabricated from compact disc material (waste or new) are used to quantify chloride ions in different types of samples. All three electrodes, working, counter, and pseudo-reference electrodes, were fabricated from the compact disc and directly used. Different parameters were studied in order to demonstrate the po...

Dopamine is an important neurotransmitter involved in many human biological processes as well as in different neurodegenerative diseases. Monitoring the concentration of dopamine in biological fluids, i.e., blood and urine is an effective way of accelerating the early diagnosis of these types of diseases. Electrochemical sensors are an ideal choice...

A sensitive and selective electrochemical sensor, based on reduced graphene oxide and gold nanoparticles obtained by simple co-electrodeposition, was developed for the detection of uric acid and ascorbic acid. Because of the electrochemical oxidation of both uric and ascorbic acid depending on the pH, the sensor performances were studied at differe...

Lung congestion, estimated by lung ultrasound is a risk factor for all-cause and cardiovascular mortality in patients on chronic hemodialysis and may be useful to guide ultrafiltration and drug therapy in this population. In an international, multi-center randomized controlled trial (NCT02310061) we investigated whether a lung ultrasound-guided tre...

Blood pressure changes upon standing reflect a hemodynamic response, which depends on the baroreflex system and euvolemia. Dysautonomia and fluctuations in blood volume are hallmarks in kidney failure requiring replacement therapy. Orthostatic hypotension has been associated with mortality in hemodialysis patients, but neither this relationship nor...

Nowadays, we are assisting in the exceptional growth in research relating to the development of wearable devices for sweat analysis. Sweat is a biofluid that contains useful health information and allows a non-invasive, continuous and comfortable collection. For this reason, it is an excellent biofluid for the detection of different analytes. In th...

Purpose Status epilepticus (SE) is associated with high morbidity and mortality. This multicenter retrospective cohort study aims to identify the factors associated with the occurrence of SE and the predictors of its recurrence in patients with adult-onset seizures. Methods We retrospectively analyzed data of 1115 patients with seizure onset>18 ye...

Background and Aims There is currently no direct evidence to inform a specific glomerular filtration rate (GFR) to initiate maintenance dialysis. Previous studies are limited by the number of kidney function thresholds compared, immortal time or lead time biases, or small sample sizes. The only randomised trial (IDEAL) found no difference between e...

Background and Aims The number of older (≥65y) people with ESKD starting chronic dialysis increased substantially the past decade because of ageing of the population due to improved health care. In addition, older age is no longer a contraindication for dialysis. Finally, older individuals are more often ineligible for kidney transplantation. Many...

Background and Aims Lung ultrasound (US) is a reliable method for the identification of patients with lung congestion in the hemodialysis population (JACC Cardiovascular Imaging 2010;3:586-94) and a high number of US-B lines (an equivalent of B lines in the chest X-ray) is a powerful predictor of death and cardiovascular events in this population (...

Background and Aims Differences between the sexes are apparent in the epidemiology of CKD. Cross-sectional studies show that women consistently report a poorer health-related quality of life (QoL) than men, however, longitudinal studies are lacking. Here we investigate the sex-specific evolution of QoL over time in advanced CKD. As a secondary aim,...

A preliminary step when planning a randomized clinical trial (RCT) is the sample size calculation. This is the determination of the optimal number of patients which ensures an adequate power to the study to detect as statistically significant a certain between-arms difference, if any, in the frequency/magnitude of a specific endpoint. The sample si...

In this work, an electrochemical sensor for uric acid determination is shown with a preliminary study for its validation in real samples (milk and urine). Uric acid can be electrochemically oxidized in aqueous solutions and thus it is possible to obtain electrochemical sensors for this chemical by means of this electrooxidation reaction. Indium tin...

Objective The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. Design and Methods The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observ...

Background Various prediction models have been developed to predict the risk of kidney failure in patients with CKD. However, guideline-recommended models have yet to be compared head to head, their validation in patients with advanced CKD is lacking, and most do not account for competing risks. Methods To externally validate 11 existing models of...

Hyperkalemia is a potential life-threatening condition among chronic kidney disease (CKD) patients. Available estimates of the burden of this alteration in CKD are mainly derived from large administrative databases. Since K measurements in patients in these databases are often dictated by clinical reasons, longitudinal studies including pre-planned...

Prognosis aims at estimating the future course of a given disease in probabilistic terms. As in diagnosis, where clinicians are interested in knowing the accuracy of a new test to identify patients affected by a given disease, in prognosis they wish to accurately identify patients at risk of a future event conditional to one or more prognostic fact...

Background Cohort studies are among the most robust of observational studies but have issues with external validity. This study assesses threats to external validity (generalisability) in the European QUALity (EQUAL) study, a cohort study of people over 65 years with stage 4/5 chronic kidney disease. Methods Patients meeting the EQUAL inclusion cr...

Background: Lung ultrasound (US) reliably estimates lung water and it is increasingly applied in clinical practice in dialysis patients. A semi-quantitative US score summing up the US-B lines (an equivalent of B lines in the standard chest X-ray) at 28 sites in the intercostal spaces (Jambrik et al. Usefulness of ultrasound lung comets as a non-ra...

Background: Uncontrolled hypertension notwithstanding the use of at least three drugs or hypertension controlled with at least four drugs, the widely accepted definition of treatment-resistant hypertension (TRH), is considered as a common problem in the hemodialysis population. However, to date there is no estimate of the prevalence of this condit...

Introduction: Understanding the mechanisms underlying the differences in renal decline between men and women may improve sex-specific clinical monitoring and management. To this end, we aimed to compare the slope of renal function decline in older men and women in chronic kidney disease (CKD) Stages 4 and 5, taking into account informative censori...

Background and Aims Understanding the mechanisms underlying the differences in renal decline between men and women may improve sex-specific clinical monitoring and management. To this end, we aimed to compare the slope of renal function decline in older men and women in CKD 4-5, taking into account informative censoring related to the sex-specific...

Background and Aims Cardiovascular deaths cluster in the early morning hours and studies in the general population documented that an exaggeration of the early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk. The circadian profile of BP and HR in hemodialysis patients i...

Background and Aims Lung Ultrasound (US) reliably estimates lung water and it is increasingly applied in clinical practice in dialysis patients. Lung water is currently measured by applying a semi-quantitative US score summing up the US-B lines (an equivalent of B lines in standard X-rays of the thorax) detected in 28 lung intercostal spaces (LIS)...

Background: Initiation of renal replacement therapy often results from a combination of kidney function deterioration and symptoms related to chronic kidney disease (CKD) progression. We investigated the association between kidney function decline and symptom development in patients with advanced CKD. Methods: In the European Quality study on tr...

Introduction: Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. Objective and methods: We investigated the effect modification by sys...

Background: Old patients with end-stage kidney disease (ESKD) represent an increasing segment of the ESKD population maintained on chronic dialysis treatment. Quality of life (QoL) is notoriously poor in ESKD but relationship between QoL and mortality has not been investigated in the old dialysis population. The objective of this study is to inves...

Background and objective: Patients with End- Stage Kidney Disease (ESKD) have a unique cardiovascular risk. This study aims at predicting, with a certain precision, death and cardiovascular diseases in dialysis patients. Methods: To achieve our aim, machine learning techniques have been used. Two datasets have been taken into consideration: the...

Erythroferrone (ERFE) is a hepcidin inhibitor whose synthesis is stimulated by erythropoietin, which increases iron absorption and mobilization. We studied the association between serum ERFE and mortality and non-fatal cardiovascular (CV) events in a cohort of 1123 hemodialysis patients and in a cohort of 745 stage 1–5 chronic kidney disease (CKD)...

Background: The prognostic relevance of health-related quality of life (HRQoL) has been scarcely studied in the dialysis population and the prognostic power for mortality of the HRQoL domains is unknown. Methods: We tested the prognostic value for mortality of the HRQoL domains included in the 36-item Short Form Health Survey (SF-36) by Cox's re...

Background Older adults dialysis patients represent the frailest subgroup of the End Stage Renal Disease (ESRD) population and physical exercise program may mitigate the age-related decline in muscle mass and function. Methods Dialysis patients of the EXCITE trial aged > 65 years (n = 115, active arm, n = 53; control arm, n = 62) were submitted in...

Prevalence and control of hypertension by 48-h ambulatory blood pressure monitoring in haemodialysis patients: a study by the European Cardiovascular and Renal Medicine (EURECA-m) working group of the ERA-EDTA, Nephrol Dial Transplant 2018; gfy147. doi: 10.1093/ndt/gfy147.

Background: Population-specific consensus documents recommend that the diagnosis of hypertension in haemodialysis patients be based on 48-h ambulatory blood pressure (ABP) monitoring. However, until now there is just one study in the USA on the prevalence of hypertension in haemodialysis patients by 44-h recordings. Since there is a knowledge gap...

Background: Quality of life (QoL) is an important outcome in chronic kidney disease (CKD). Patients feel that symptoms are an important determinant of QoL. However, this relation is unknown. The aims of this study were to investigate the impact of the number and severity of symptoms on QoL in elderly pre-dialysis patients, assessed by both the eff...

[This corrects the article DOI: 10.1371/journal.pone.0196313.].

Background: The epidemiology and prognosis of chronic kidney disease (CKD) differ by sex. We aimed to compare symptom prevalence and the clinical state in women and men of ≥65 years of age with advanced CKD receiving routine nephrology care. Methods: The European QUALity study on treatment in advanced chronic kidney disease (EQUAL) study follows...

HR of suPAR for all-cause mortality/cardiovascular mortality/noncardiovascular mortality across gender, diabetes, BMI, dialysis vintage, systolic blood pressure, albumin, CRP, fibrinogen, and Kt/V categories. All P values for the effect modification are >0.05.

Main causes of death recorded during the follow-up.

HR of all-cause mortality in the fully adjusted model (model 1), in a model without albumin (model 2) or without CRP (model 3) or without albumin and CRP (model 4).

Comparison of HR of suPAR (third tertile vs. first tertile) for noncardiovascular and cardiovascular mortality obtained by standard Cox regression analysis and competing risk regression analysis. Both models are adjusted for traditional, inflammation and nutritional status, and ESKD-related risk factors.