Luciano A Pedrini

• Doctor of Medicine -Director of Nephrology and Dialysis Dept.
• Managing Director at Azienda Ospedaliera Bolognini Seriate - NephroCare

Gitelman's syndrome (GS) is a rare autosomal recessive disorder characterized by hypokalemia, hypomagnesaemia, metabolic alkalosis, hypocalciuria and secondary hyperaldosteronism. The impact of GS on pregnant patients is still not clear, despite the many clinical cases described in literature. In particular, there is no data on the development of g...

Background Improved responsiveness to erythropoiesis stimulating agents (ESAs) in patients on on-line post-dilution hemodiafiltration (Post-HDF) compared with conventional hemodialysis (HD) was reported by some authors but challenged by others. This prospective, cross-over randomized study tested the hypothesis that an alternative infusion modality...

Background: Innovative care models such as public-private partnerships (PPPs) may help meet the challenge of providing cost-effective high-quality care for the steadily growing and complex chronic kidney disease population since they combine the expertise and efficiency of a specialized dialysis provider with the population care approach of a publ...

Background Anemia is a major comorbidity of patients with end-stage renal disease and poses an enormous economic burden to health-care systems. High dose erythropoiesis-stimulating agents (ESAs) have been associated with unfavorable clinical outcomes. We explored whether mixed-dilution hemodiafiltration (Mixed-HDF), based on its innovative substitu...

Descriptive analyses for the laboratory parameters: Albumin [g/dl], creatinine [mg/dl], Beta-2-microglobulin [mg/l] and CRP [mg/l]. Data are presented as mean ± SD for albumin, creatinine and Beta-2-microglobulin and as median with 25th and 75th percentiles [q1;q3] for CRP. CRP: C-reactive protein, Mixed-HDF: Mixed-dilution hemodiafiltration, Post-...

Descriptive analysis for fluid overload [l] and delta body weight [kg]. Data are presented as mean ± SD for both parameters. Mixed-HDF: Mixed-dilution hemodiafiltration, Post-HDF: Post-dilution hemodiafiltration. (PDF)

Descriptive analysis for the iron metabolism parameters: Iron/4weeks [mg], ferritin [μg/l], transferrin [mg/dl] and TSAT [%]. Data are presented as mean ± SD for all parameters. Mixed-HDF: Mixed-dilution hemodiafiltration, Post-HDF: Post-dilution hemodiafiltration. (PDF)

Descriptive analyses for the dialysis performance parameters: Substitution volume [l], mean blood flow [ml/min], effective treatment time [min] and OCM Kt/V. Data are presented as mean ± SD for all parameters. Mixed-HDF: Mixed-dilution hemodiafiltration, Post-HDF: Post-dilution hemodiafiltration. (PDF)

Cause of renal disease of the study patients. (PDF)

Intraindividual analysis: inference statistical models for A) hemoglobin (g/dl) and B) erythropoietin consumption (ESA/4weeks, IU). Treatment x time interaction terms were calculated to test for both parameters (hemoglobin and ESA/4 weeks) whether the steepness of the slopes differ between the baseline period (Post-HDF) of the Mixed-HDF group and t...

Total monthly ESA consumption [IU] of the study patients within the study period. (PDF)

Used ESA and iron medications in the study. (PDF)

Major cardiovascular and hematological comorbidities of the study patients. (PDF)

Monthly averages of hemoglobin levels [g/dl] of the study patients within the study period. (PDF)

A great deal of evidence has now accumulated on the ability of extracorporeal convective therapies to enhance removal of compounds of different molecular weight which are markers or causative agents of severe uremic pathology, such as cardiovascular disease, chronic inflammation, anemia and bone metabolism derangement. A general reduction of the ur...

Background: Aim of this prospective crossover study was to identify the nature of the middle-molecular weight solutes removed during high-volume post-dilution HDF. Methods: The efficiency in removing small molecules, protein-bound and middle-molecular proteins was evaluated in 16 chronic dialysis patients on post-dilution HDF with two high-flux dia...

Introduction and Aims: Previous studies suggested that sevelamer hydrochloride attenuates progression of arterial calcification and may reduce the risk of death in a head-to-head comparison with calcium-based phosphate binders. In the real world, however, sevelamer is often used as add-on or alternative therapy for patients with hyperphosphatemia w...

Whether convective therapies allow better control of serum phosphate (P) is still undefined, and no data are available concerning on-line haemofiltration (HF). The objectives of the study are to evaluate the effect of convective treatments (CTs) on P levels in comparison with low-flux haemodialysis (HD) and to evaluate the correlates of serum phosp...

Introduction and Aims: Hemodiafiltration (HDF) is increasingly used as a means of improving the clearance of middle-weight molecular substances in patients with end stage renal disease. Post hoc analysis of two large randomized controlled trials showed that patients treated with the highest convective volume had a lower mortality risk. The aim of t...

Medium-long-term application of on-line high-efficiency HDF compared to low- and high-flux HD results in enhanced removal and lower basal levels of small, medium and protein-bound uremic solutes, some of which are retained as markers or causative agents of several uremic derangements, mainly inflammation, secondary hyperparathyroidism, dyslipidemia...

In a recent survey among more than 6 000 nephrology professionals, almost half were in favour of the use of high-flux HD and HDF as their best option for extracorporeal dialysis therapy. An analysis of clinical literature suggests that on-line HDF provides an increase in years of life gained, a reduction of adverse events, reduced hospitalizations,...

Mixed hemodiafiltration is a novel technique in which the traditional infusion modes of predilution and postdilution are carried out simultaneously in the same dialyzer to overcome the limits and risks of each and join their advantages. It is performed under the control of transmembrane pressure feedback, which constantly monitors blood and dialysa...

Predictors of haemoglobin (Hb) levels and resistance to erythropoiesis-stimulating agents (ESAs) in dialysis patients have not yet been clearly defined. Some mainly uncontrolled studies suggest that online haemodiafiltration (HDF) may have a beneficial effect on Hb, whereas no data are available concerning online haemofiltration (HF). The objective...

The impact of hemodiafiltration (HDF) on survival is still a topic of under investigation. Most recently, the results of two large prospective trials (the CONTRAST Study and the Turkish HDF Study) did not find any difference in survival between on-line HDF versus low- and high-flux hemodialysis (HD) in the overall dialysis population. However, seco...

Haemodiafiltration (HDF) may improve survival of chronic dialysis patients. This prospective, multicentre randomized cross-over study evaluated the effects of long-term on-line HDF on the levels of solutes of different molecular weight markers or causative agents of the most common metabolic derangements in uraemia. Sixty-nine patients from eight I...

INTRODUCTION AND AIMS: There is currently no consensus about the indications for therapeutic apheresis, also due to the lack of large clinical trials. A registry where all the data can be organized and analyzed therefore becomes a priority for all professionals involved in apheresis. METHODS: The Apheresis Study Group of the Italian Society of Nep...

Intra-individual comparison of technical and clinical characteristics of two hemodiafiltration (HDF) strategies, namely, post-dilution HDF (post-HDF) with a high-flux α-polysulfone hemodiafilter and reverse mid-dilution HDF (MD-HDF). Fifteen patients who were stable on RRT were randomly submitted to both HDF techniques under matched operational con...

Symptomatic intradialytic hypotension is a common complication of hemodialysis (HD). The application of convective therapies to the outpatient setting may improve outcomes, including intradialytic hypotension. In this multicenter, open-label, randomized controlled study, we randomly assigned 146 long-term dialysis patients to HD (n = 70), online pr...

Large observational studies have shown a reduction in morbidity and mortality in patients on high-flux haemodialysis (HD) or convective techniques, compared with low-flux HD. An index to evaluate treatment efficiency in middle molecule (MM) removal would be recommended. Since beta-2-microglobulin (beta2-M) is a recognized MM marker, we evaluated an...

Hypertension is a very common finding in hemodialysis patients and one of the most important risk factors for cardiovascular disease, the leading cause of morbidity and mortality in dialysis. The discontinuous nature of hemodialysis gives blood pressure a unique profile and makes the pathogenesis of hypertension complex in this population. Water an...

The European Renal Best Practice (ERBP) Advisory Board recently decided to follow up existing guidelines, and to publish position statements when new evidence would necessitate a change in the existing guideline [1].The purpose of this document is to provide guidance on the interpretation and relevancy of the current European Best Practice Guidelin...

Background. Mid-dilution haemodiafiltration (MD-HDF), reported as a highly efficient convective-mixed technique, has demonstrated serious drawbacks in relation to the high pressure originating inside the blood compartment of the filter during clinical application. This randomized crossover design study was planned to optimize the efficiency of the...

Hemodiafiltration is the dialytic strategy enabling the high potential of hydraulic and solute permeability of synthetic membranes to be most properly exploited, thus greatly enhancing removal of small and middle-molecular toxic compounds. Several of those solutes have a pathogenic role or are recognized as marker of the most frequent long-term com...

The application of effective hemodialysis in humans was delayed until the development of cellulose-based membranes in 1940s, and the advent of heparin as the primary means of anticoagulation. Unfractionated heparin is still the most commonly used agent for anticoagulation, but its potentially serious complications, such as hemorrhage and heparin-in...

Improvement in the uraemic toxicity profile obtained with the application of convective and mixed dialysis techniques has stimulated the development of more efficient strategies. Our study was a prospective randomized evaluation of the clinical and technical characteristics of two new haemodiafiltration (HDF) strategies, mixed HDF and mid-dilution...

Mixed-dilution hemodiafiltration (mixed HDF) controlled by the transmembrane pressure (TMP) feedback, improves the depurative capacity of the more traditional HDF techniques by fully exploiting the convective mechanism of small- and middle-molecular-weight solute removal. The feedback allows the TMP to be set and profiled from patient and operation...

The Italian Society of Nephrology promoted a national survey to obtain detailed information from all the Renal and/or Dialysis Units through an on-line questionnaire concerning structural, technological and human resources, as well as organisation characteristics and activities. The purpose of this initiative was to obtain regional reference benchm...

The aim of the present study was transmembrane pressure (TMP) modulation in high-volume mixed hemodiafiltration (HDF) to optimize efficiency and minimize protein loss. The optimal flow/pressure conditions in on-line mixed HDF assisted with a feedback control of TMP were defined in this prospective randomized study in order to obtain maximal efficie...

The National Society of Nephrology has promoted the development of specific Italian Guidelines for dialysis fluids. Two previous national inquiries showed a wide variety in the type and frequency of both microbiological and chemical controls concerning dialysis water, reinforcing the need for specific standards and recommendations. An optimal water...

Baclofen, a GABA agonist, is frequently used to treat muscle spasticity due to spinal cord injury and multiple sclerosis. Baclofen overdose can lead to coma, respiratory depression, hyporeflexia, and flaccidity. Because baclofen is primarily excreted unchanged through the kidneys, it should be given with caution, and it may be necessary to reduce t...

In HDF la modalità di reinfusione è in grado di influenzare in modo rilevante i regimi pressori e i flussi all’interno del dializzatore

Darbepoetin alpha is a novel erythropoiesis stimulating protein with unique properties as compared to recombinant human erythropoietin (rHuEPO), including a three-fold longer elimination half-life that allows for less frequent dosing. This study was aimed at testing the efficacy and safety of darbepoetin alpha in a large number of chronic dialysis...

Increased middle-molecular uremic toxin removal seems to favorably influence survival in dialysis patients. The aim of this study was to verify if, in on-line mixed hemodiafiltration, solute removal by convection may be enhanced by forcing the ultrafiltration rate (QUF) and optimizing the infusion technique in order to achieve the highest possible...

Hemodiafiltration (HDF) is the strategy enabling the high potential of hydraulic and solute permeability of synthetic membranes to be most properly exploited. On-line production of unlimited amount of sterile dialysate at low cost has favored its extensive diffusion in the recent years. However, to achieve the most efficient convective transport, u...

The concept of dialysis adequacy has to be widened to include medium size and large molecule removal in addition to urea kinetics. The HEMO study found a non-significant trend toward a beneficial effect on mortality of high-flux dialysis compared with low-flux dialysis. In that study, the beneficial effect of convection could have been attenuated b...

Electrolyte and acid-base balance may be differently affected by the infusion mode in on-line hemodiafiltration (HDF). We studied the effects of the different infusion modes on bicarbonate transport across the dialyzer membrane, and thus on the final bicarbonate balance of the HDF sessions. Instantaneous HCO3- transfer across the dialyzer membrane,...

In vivo, the control of calcium-mediated acute PTH release during induced hypo- or hypercalcaemia is linked not only to plasma calcium concentration per se but also to the rate and direction of calcium change. In fact, during induced hypocalcaemia, the predominant mechanism that causes PTH to be released is the reduction of plasma Ca(2+) irrespecti...

On postdilution hemodiafiltration (post-HDF), convective removal of medium-high molecular weight solutes is, at the highest ultrafiltration rates, limited by high blood viscosity and protein concentration. Prefilter reinfusion (pre-HDF) may overcome this problem, but plasma dilution may affect the overall efficiency of the technique. In this study,...

Anaemia is one of the major clinical characteristics of patients with chronic renal failure, and has a considerable effect on morbidity and mortality. Adequate dialysis is of paramount importance in correcting anaemia by removing small and medium-sized molecules, which may inhibit erythropoiesis. However, high-molecular-weight inhibitors cleared on...

Background: Anaemia is one of the major clinical characteristics of patients with chronic renal failure, and has a considerable effect on morbidity and mortality. Adequate dialysis is of paramount importance in correcting anaemia by removing small and medium-sized molecules, which may inhibit erythropoiesis. However, high-molecular-weight inhibito...

The calcium-PTH relationship in uremic patients has been often studied during dialysis sessions with high or low dialysate calcium concentration (CaD). This method has been used because it is less complex and invasive than i.v. infusion of calcium salts and calcium chelating agents. However, the constancy of CaD during the tests does not allow for...

Recent studies showing that highly biocompatible membranes minimize dialysis-related oxidative stress and AGEs formation, lead to the speculation that their prolonged use, besides delaying dialysis-related amyloidosis, could prevent lipid derangement and reduce the incidence of atherosclerotic cardiovascular lesions and accelerated aging, leading t...

A computerized system, structured by 4 different models concerning urea depuration, and bicarbonate and sodium handling in acetate-free hemodiafiltration has been conceived for integrated use covering each step of the therapeutic cycle, from a) the prescription of the session to b) its delivery, up to c) the dose-response analysis: the system, now...

Long-term behavior of naturally acquired anti-HBs antibody was tested every 6 months for 3 years in 22 dialysis patients. Fifteen of them maintained protective levels throughout follow-up (102 and 85.5 mUI/ml at the beginning and the end, respectively). Seven of them became anti-HBs and were submitted to a 40-micrograms booster injection of hepatit...

A computer model was developed to simulate sodium and water kinetics during hemodiafiltration (HDF), acetate-free biofiltration (AFB) and hemodialysis (HD). Multiple regression analysis of the results of 3,240 simulated applications of the model (1,620 HDF, 1,080 AFB, 540 HD) showed that, during HDF and AFB, there is a close correlation (R2 = 0.92...

To evaluate the sodium balance in haemo-dialysis and haemodiafiltration a computerised model has been developed, which calculates net sodium balance from the infusive, diffusive, and convective sodium fluxes for each minute of treatment, updating the value of plasma water ionised sodium concentration at each step. Using this model and assuming cons...

The rapid increase in end-dialysis urea concentration (Co) immediately after the end of dialysis (HD), which greatly exceeds that expected as an effect of urea generation and defined as "net rebound," was assessed in 21 chronic HD patients. The curve of serial values of net rebound correlated (r = 0.70) with the theoretical curve predicted by the t...

The kinetics of sodium across dialysis membranes were studied during diffusion and during convection utilizing cuprophan and cellulose hydrate membranes. During diffusion the changes in plasma water sodium concentration are correlated to the sodium concentration gradient between plasma water and dialysate but an increase also occurs when the gradie...

Forty three uremic patients on regular hemodialysis treatment (4 hours 3 times/week) were dialyzed for a period of 28.95 ± 14.46 months with a dialysate sodium concentration (NaD) of 142 mEq/l, similar to their plasma water sodium concentration corrected for the Donnan factor («physiological» NaD). Blood pressure (BP) and body weight (BW) dropped s...