Deni Aldo Procaccini

Polymorphism of the Angiotensin-Converting Enzyme Gene in End-Stage Renal Failure Patients

The plasma levels of angiotensin-converting enzyme (ACE) are modulated by the insertion (I)/deletion (D) polymorphism within the ACE gene locus. An association between progressive renal disease, raised cardiovascular risk, and ACE plasma levels has been shown. To evaluate the genotype frequencies of the I/D polymorphism in terminal renal failure, we have enrolled 341 dialysis patients (321 on hemodialysis and 20 on peritoneal dialysis) in a district of southern Italy (Foggia). As controls, 1,307 subjects from the same area have been enrolled. Genomic DNA was obtained from leukocytes, and the ACE I/D polymorphism was determined by polymerase chain reaction. Among uremics, 151 subjects (44.3%) carried the DD genotype, 149 (43.7%) the ID, and 41 (12.0%) the II genotype. In controls, 560 subjects (42.8%) had the DD genotype, 577 (44.1%) the ID, and 170 (13.1%) the II genotype (p = n.s.). Among patients, the frequency of DD subjects was higher in men (48.3%) than in women (39.7%, p < 0.01). A slight different frequency of the DD genotype was found according to the duration of dialysis treatment: 47.5% in patients on dialysis up to 60 months and 41.7 and 40.6% in those with a dialytic age of 60–120 and >120 months, respectively (p for trend: 0.53). Patients with or without cardiovascular diseases, such as hypertension, left ventricular hypertrophy, coronary artery disease, and chronic cardiac failure, did not exhibit any difference in ACE I/D allele and genotype frequencies (p always >0.05). In conclusion, frequencies of the ACE DD genotype were similar in uremics and in controls and did not differ between patients with and without cardiovascular diseases. A nonsignificant inverse relationship with the time spent on dialysis was observed, suggesting that ACE I/D polymorphism may influence the cardiovascular death rate.

Monitoring of Lifestyle and Cognitive Status in Seniors at Risk of Dementia: The SmartAging Program

Lifestyle and risk factors affect the development of diseases, cognitive decline and loss of autonomy during ageing. In the Italian Smart Health 2.0 project, we developed the SmartAging program offering innovative ICT solutions, grounded upon the Italian Telecom platform (“Nuvola Italian Home Doctor”), to contrast cognitive decline and support “active” ageing. Specifically, the SmartAging program includes tools for daily telemonitoring at subjects’ home of: (i) eating behaviour, (ii) physical exercise, (iii) tobacco consumption, (iv) cultural, social and relational activities, (v) cognitive functions, (vi) weight, temperature, and blood pressure. Furthermore, a Point of Care device and a Self-Assessment Health Station (i.e. health medical equipment), in proximity to the subjects’ home, allowed periodic measures of blood biomarkers and physiological indices. To demonstrate the feasibility of this program, we performed a clinical proof of concept study for 16 weeks on 10 elderly subjects (5 being oncological long-term survivors). All subjects expressed a need for education and assistance concerning a healthy lifestyle. Most of them expressed a preference for ICT-based home programs to improve the lifestyle over institutional programs. All expressed satisfaction with the SmartAging program in terms of simplicity, clarity, adequacy and reported a positive impact on their quality of life. These results suggest that the SmartAging program fulfills all the requirements to be considered an innovative technological approach for the lifestyle education and telemonitoring of seniors, to prevent dementing disorders. Some concepts of the SmartAging program have been further developing in the H2020-MSCA-ITN-ETN BBDiag project.

Mediterranean diet for patients with polycystic kidney disease

The changes that have occurred in peoples eating habits and lifestyle from the second half of the 20th century have modified the state of health of the general population. Extensive scientific evidence indicates the need of reconsidering the eating habits, reverting to the typical foods of the Mediterranean diet. The Mediterranean diet, together with physical activity, abstention from smoking and other addictions, and with conviviality can have an effect not only on the progression of chronic degenerative diseases but also, certainly, on quality of life. It is well known that a high-protein diet with high sodium content, combined with alcohol abuse, is an important cause of the worsening of renal diseases. By contrast, following a Mediterranean diet, rich in fruits, vegetables, legumes, cereals, and olive oil with a moderate consumption of animal proteins and alcohol, plays a protective role on renal function. The Medi¬terranean diet has proved to contribute to the reduction of cardiovascular diseases and oxidative stress. Hence, there are the conditions to assess whether the Mediterranean diet is able to significantly reduce the activation of the oxidative stress and, therefore, the cardio-vascular risk in patients with ADPKD.