Mario Gaggiotti

Improvement in exercise capacity after correction of anemia in patients with end-stage renal failure

Changes in exercise tolerance occurring after correction of anemia with recombinant human erythropoietin in a group of patients with end-stage renal failure were evaluated. Ten patients, aged 29 +/- 11 years, on chronic hemodialysis treatment, with no associated diseases, were evaluated by cardiopulmonary bicycle exercise testing and M-mode, 2-dimensional and pulsed doppler echocardiography before and after anemia correction. After 1 and 3 months of therapy, hemoglobin plasma levels increased from 5.9 +/- 1.2 to 7.7 +/- 1.3 and 9.9 +/- 1.4 g/dl, with a concomitant increase in peak oxygen consumption (VO2) from 21.4 +/- 4.3 to 24.4 +/- 4.3 and 26.6 +/- 4.6 ml/kg/min and of VO2 at the ventilatory threshold from 15.0 +/- 3.7 to 17.3 +/- 3.7 and 16.8 +/- 3.4 ml/kg/min. After 3 months of therapy, systolic blood pressure significantly decreased both at peak exercise (159 +/- 35 to 134 +/- 22 mm Hg) and ventilatory threshold (140 +/- 27 to 123 +/- 19 mm Hg), whereas cardiac index at rest decreased from 3.3 +/- 0.7 to 2.8 +/- 0.5 liters/min/m2 and heart rate from 77 +/- 12 to 70 +/- 10 beats/min. However, no significant relation was found between hemoglobin plasma levels and peak VO2, whereas a significant relation was found between hemoglobin concentration and cardiac index at rest.

Hemodiafiltration in hypotension-prone elderly uremic patients

Hemodialfiltration (HDF) has shown good efficiency and cardiovascular stability in stable young hemodialysis patients. The aim of this work was to verify whether this is also valid for a population above the age of 65 on bicarbonate dialysis (BD) with frequent intradialytic hypotension episodes and dialysis intolerance.

Effects of intravascular volume loading and unloading on atrial sizes and left ventricular function in dialyzed uremic man

To evaluate the extent to which opposing changes in circulating blood volume might influence atrial dimensions and left ventricular performance, 11 dialyzed uremic patients with normal baseline left ventricular contractile indices were studied immediately before and after body fluid removal by ultrafiltration and again when they had returned to their original fluid-overloaded state (48 h later). Atrial and left ventricular dimensions were measured by two-dimensional echocardiography, and total blood volume by 131 I-labelled serum albumin, on every occasion

Vascular access in older patients: an Italian survey.

BACKGROUND The number of older patients starting 
hemodialysis is continuously increasing. The type of vascular access plays an important role in dialysis treatment, but it can be difficult to create in older patients. METHODS This study compared vascular access survival rates and patient survival rates in older (≥65 years) and younger (<65 years) patients starting hemodialysis in 2 Italian hospitals in 2006-2008. RESULTS The study enrolled 336 patients: 208 ≥65 years and 128 <65 years of age. The vascular accesses used, in order of frequency, were 102 distal arteriovenous fistulas (dAVFs) (49%), 55 midarm AVFs (pAVFs) (26%), 9 arteriovenous grafts (AVGs) (4%) and 42 central venous catheters (CVCs) (20%) in the older patients, and 89 dAVFs (69%), 25 pAVFs (19%), 6 AVGs (5%) and 8 CVCs (6%) in the younger patients. Survival rates of fistula and catheter did not differ between the 2 groups. AVGs failed earlier (p = 0.02) in the older patients. On Cox analysis, age (hazard ratio [HR] = 1.073; p<0.001) and CVC (HR = 4.152; p<0.001) increased the risk of death. CONCLUSION A fistula is the gold standard for hemodialysis vascular access in older patients if judged appropriately.

Cardiovascular status in the elderly on hemodialysis (HD) and peritoneal dialysis (PD)

The cardiovascular risk of death is greater for dialysis patients than for the general population and differs from country to country. At present, cardiovascular disease is the most frequent cause of death for patients on dialysis, accounting for 48% of deaths in the USA and 48–53% in Europe. It is not surprising that dialyzed elderly have a death rate that is more than double that of younger patients. However, the percentage of cardiac deaths of the total is the same for older and younger patients.

Plasma Levels of Human Atrial Natriuretic Peptide in Chronic Uremic Patients

So far, 3 atrial natriuretic polypeptides (ANP) have been isolated from human cardiocytes and, among them, the α-type seems to be preferentially released into the blood stream (1). In normal man, saline infusion or high sodium intake increase plasma α-hANP levels while the opposite is true on low sodium diet (2). These observations seem to suggest that α-hANP is involved in extracellular fluid volume (ECFV) homeostasis. This study was undertaken to obtain some more insight about the involvement of α-hANP in the pathophysiology of body fluid volume in man.