Paolo Ancarani

Istituto Giannina Gaslini

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Denise Parodi

The George Institute for Global Health

Giacomo Garibotto

University of Genoa

Sandro Scofferi

Rodolfo Russo

Ospedale Policlinico San Martino

Olga Terrile

Eugenio Devoto

Azienda Unità Sanitaria Locale Della Romagna

Giacomo Deferrari

University of Genoa

Antonella Matrisciano

Marco Amidone

Ospedale SS. Annunziata

Maria Rita Sala

University of Genoa

Cooperative Institutions

National Graduate Institute for Policy Studies

University of Genoa

St. Paul's Hospital

Fukushima Medical University

University College London

Sapienza University of Rome

Pediatric Nephrology of Alabama

Instituto de Salud Carlos III

Universitat de Barcelona

Istituti di Ricovero e Cura a Carattere Scientifico

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P134410 YEARS EXPERIENCE WITH HEMODIALYSIS TUNNELED CATHETERS

Nephrology Dialysis Transplantation (2020)

Paolo Ancarani Marco Amidone Elena Baratto Antonella Matrisciano

Abstract Background and Aims A well functioning vascular access ( VA) is vital for hemodialysis (HD) patients. To date a native arteriovenous fistula ( NAVF) remains the gold standard but patients vascular characteristics are often not optimal for vascular surgery. A tunneled central venous catheter (tCVC) are becoming increasingly used as permanent dialysis access and are also competitive to NAVF for the easy and safe insertion tecnique. Our retrospective study observe, during a 10 years period, infection rate of tCVC, bacteriologic analysis and cause of removal. Method From January 2010 to December 2019, 176 tCVC were placed in 158 patients ( mean age 74 +/- 18) . All tCVC were inserted by nephrologist in internal giugular vein (IGV), subclavian vein (SV) and femoral vein (FV) using ultasonographic guide. Standards protocols, according to European Renal Best Practice (2010) detailing all aspects of preventive care were used. Each tCVC was followed until it was removed or until the end of the study. 62110 days was the follow up period. 143 tCVC wew placed in IGV ( 81,5%), 22 in FV ( 11,5 %) and 11 in SV (7%). The diagnosis of infection was based on clinical evidence and positive blood culture or positive exit site swab, with no sign of other infection site. We considered a tCVC disfunction in case of blood flow less than 250 ml/m'. Event rates were calculated per 1000 catheters days. Results Mean tCVC duration was 353 days. We observed a progressive increment in CVC prevalence during the observational period ( from 15% in 2010 to 39% in 2019). Catheter replacement recurred in 19 patients and the main cause of replacement was loss of patency ( 0,3 per 1000 catheter days). We observed 63 catheter related bloodstream infection (CRBI) and 71 exit site/tunnel infection (ESI/TI). Incidence for CRBI was 1 per 1000 catheter days and ESI/TI was 1,14 per 1000 catheter days. In CRBI the most common organism isolated were MRSA (40%) and MSSA (26%) . In ESI/TI the most common organism isolated was Staphilococcus epidermidis (39.5%) . We used systemic antibiotics, local therapy and lock therapy with a 93% resolution without removal. 12 tCVC were removed for recurrent CRBI ( 0,19 per 1000 catheter days). At the end of the observation 25 tCVC were still in use. Conclusion Our data showed an high survival rate of tCVC in hemodialysis patients. We observed CRBI and ESI/TI rates at the lower limits of the data reported in the literature. Infections were successfully treated conservately in most cases. Careful nursing protocol may reduced the frequency of infection and an early diagnosis can facilitate the rescue of the tCVC with systemic/lock therapy or local therapy. We consider in an elderly population with many comorbidities the use on tCVC recommended especially in patients with poor native peripheral vessels, in patients with steal syndrome high risk and also with a low life expectancy.

Hemodialysis Catheter

Femoral vein

Subclavian vein

Nephrology

Central venous catheter

Dialysis catheter

10.1093/ndt/gfaa142.p1344

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SP612OUTCOMES OF NATIVE VASCULAR ACCESS IN HEMODIALYSIS PATIENTS: SINGLE CENTRE EXPERIENCE

Nephrology Dialysis Transplantation (2015)

Paolo Ancarani Eugenio Devoto Denise Parodi Giovanni Dardano

10.1093/ndt/gfv198.35

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Muscle protein turnover and amino acid metabolism in patients with chronic renal failure.

PubMed (1992)

Giacomo Garibotto Rodolfo Russo Maria Rita Sala Paolo Ancarani Cristina Robaudo

Muscle protein turnover and amino acid (AA) exchange were studied in 4 patients with chronic renal failure (CRF) and in 5 controls in the postabsorptive state by using the forearm perfusion method together with the systemic infusion of 3H-Phe. In CRF patients muscle protein breakdown is increased and is associated with a parallel increase in protein synthesis. Protein breakdown is inversely related to arterial bicarbonate. Net proteolysis is unchanged. The release of total AA, glutamine and alanine is not different from controls, whereas the release of valine and leucine is reduced and serine uptake tends to be decreased. In conclusion, in postabsorptive patients with CRF, well before the uremic stage, an increased protein breakdown associated with metabolic acidosis takes place; net proteolysis is unaffected. Alterations in BCAA metabolism suggest the occurrence of increased BCAA degradation proceeding beyond the transamination step.

Protein turnover

Proteolysis

Protein metabolism

Protein Degradation

Transamination

Bicarbonate

Alanine

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Reversed-phase high-performance liquid chromatographic analysis of branched-chain keto acid hydrazone derivatives: optimization of techniques and application to branched-chain keto acid balance studies across the forearm

Journal of Chromatography B Biomedical Sciences and Applications (1991)

Giacomo Garibotto Paolo Ancarani Rodolfo Russo Maria Rita Sala Fulvio Fiorini

Chain (unit)

10.1016/0378-4347(91)80469-s

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AMINO ACID METABOLISM IN RENAL FAILURE

Giacomo Deferrari Giacomo Garibotto Cristina Robaudo R. Russo Paolo Ancarani

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Proteolytic Activity and Free Amino Acid Concentrations in Polymorphonuclear Leucocytes

Annals of Clinical Biochemistry International Journal of Laboratory Medicine (1993)

Alba Carrea A. Canepa Francesco Perfumo Paolo Ancarani Enrico Verrina

Polymorphonuclear granulocytes (PMN) are valuable tools for evaluating amino acid (AA) metabolism in nucleated cells, although variations of free amino acid concentrations due to the methods used for the separation of the cells and the procedures used for lysis have been reported. Furthermore, analytical variations in PMN AA concentration may be induced by protease activation during preparation, so that free AA detected in cells could originate from proteolysis other than from the physiological metabolic pathways and transport systems. To study this possibility we measured granulocyte protease activity and AA concentrations in cell suspensions processed with and without the addition of antiproteolytic agents. Granulocyte AA concentrations and protease activity in samples treated with antiproteolytics were 8–15 times lower than in samples processed without antiproteolytics. The use of protease inhibitors throughout the sample preparation is necessary for reliable estimation of free AA in granulocytes.

Proteolysis

Protease inhibitor (pharmacology)

10.1177/000456329303000606

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DIALYSIS VASCULAR ACCESS

Nephrology Dialysis Transplantation (2014)

N. Fontsere Gaspar Mestres Marta Burrel M. Barrufet Xavier Montañá

Introduction and Aims: On-line dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs.This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared with a historic control group.Methods: We studied 148 long-term hemodialysis patients with arteriovenous fistulas (historical control group, n = 74) for 2 years.During the study period, the indications for vascular treatments were the Kt reduction ≥20% with respect to baseline values or Qa less than 500 mL/min (or a decrease in flow > 20%).Differences between the Qa and Kt groups were tested using Student's T-Test or the Wilcoxon test, as appropriate.The χ2 test was used to analyze the angioplasty and thrombosis rates compared with the historical control group.A P-value ≤0.05 was considered statistically significant.Results: During the study period, we detected 16 cases of significant vascular access dysfunction.The Kt value after vascular treatment was 71.1L (59L; P = 0.001) and BTM-Qa was 1218.6 mL/min (519.7 mL/min; P = 0.001).Compared with the control group, the thrombosis rate was 0.027 vs 0.148 episodes/patient-year (P = 0.009) and the total access-related cost was €22,293 vs €47,467 (P = 0.033).Conclusions: This study suggests that a combined monitoring program based on Kt and Qa-BTM represents an effective screening method that significantly reduces the thrombosis rate and economic costs of vascular treatments SP523

10.1093/ndt/gfu156

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MP64460 MONTHS NATIVE VASCULAR ACCESS FOLLOW UP IN A SINGLE CENTRE

Nephrology Dialysis Transplantation (2017)

Paolo Ancarani Eugenio Devoto Teseo Stefanini Marco Amidone Olga Terrile

10.1093/ndt/gfx178.mp644

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PERITONEAL DIALYSIS 1

Nephrology Dialysis Transplantation (2014)

James Fotheringham Michael J. Campbell Martin Wilkie Deirisa Lopes Barreto Denise E. Sampimon