Results. The overall mortality rate was 14.6 deaths (95% CI: 14.214.9) per 100 person-years on C... more Results. The overall mortality rate was 14.6 deaths (95% CI: 14.214.9) per 100 person-years on CD, remaining essentially unchanged over the 12-year period, despite a 5-year increase in the median age. A reduction in mortality was found for patients >74 years from 29.8 ...
The emblematic case of a forgotten ureteral stent in a renal transplanted patient is reported. Th... more The emblematic case of a forgotten ureteral stent in a renal transplanted patient is reported. The removal was performed with no more difficulties than in a not transplanted patient, but we would emphasize the importance of removing the stent when its function of protecting the anastomosis finished, but before its permanence could compromise the graft.
On the basis of their experience, the authors refer to complications observable at the foot level... more On the basis of their experience, the authors refer to complications observable at the foot level in chronic uremic patients in long-term hemodialytic treatment. These complications, termed renal osteodystrophy, are attributed to alterations in the phosphocalcium metabolism and to hyperparathyroidism. From an anatomopathologic viewpoint, they are characterized by alteration in bone tissue (osteomalacia and/or fibrous osteitis) and by soft tissue alterations. Alterations in the foot are the same as those observed in other osteoarticular regions. They consist of bone subperiosteal reabsorption of the phalanges, vascular calcifications, articular and para-articular calcifications, spontaneous disinsertion of the Achilles tendon and peripheral canalicular neuropathies specifically represented by the tarsal tunnel syndrome. Another complication of this pathology is represented by "Calciphylaxis," characterized by calcifications of the middle tunica of arteries and small arterie...
Anemia is a common complication of chronic kidney disease (CKD), particularly in dialysis patient... more Anemia is a common complication of chronic kidney disease (CKD), particularly in dialysis patients. Correction of anemia in CKD patients includes the administration of both recombinant human erythropoietin and intravenous iron. An optimization of iron treatment requires ...
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, 2009
In Italy, the logistics for the creation of a vascular access are not well arranged. Numerous spe... more In Italy, the logistics for the creation of a vascular access are not well arranged. Numerous specialists are involved, mostly on a voluntary basis: they are those who ''know how to make the vascular access'', and have earned the title on the battlefield. When a native arteriovenous fistula, the gold standard, cannot be created, different solutions may prevail, depending on the local availability of specific skills. The use of vascular grafts for vascular access is not common in Italy. Grafts are mainly performed by vascular surgeons or, less frequently, by nephrologists with specific expertise in centers of excellence. By contrast, venous catheterization as an emergency access for dialysis is very common in Italian nephrology and dialysis centers. In optimal operating conditions, when both options are available and fistula creation and management are feasible, the choice of a graft fistula would be almost obligatory, although there are exceptions. Usually, the need ...
The emblematic case of a forgotten ureteral stent in a renal transplanted patient is reported. Th... more The emblematic case of a forgotten ureteral stent in a renal transplanted patient is reported. The removal was performed with no more difficulties than in a not transplanted patient, but we would emphasize the importance of removing the stent when its function of protecting the anastomosis finished, but before its permanence could compromise the graft.
La Fistola Arterovenosa Nativa rappresenta a tutt'oggi il gold standard degli accessi vascola... more La Fistola Arterovenosa Nativa rappresenta a tutt'oggi il gold standard degli accessi vascolari in emodialisi. Tuttavia essa non è applicabile a tutti i pazienti. Le protesi rappresentano una seconda scelta percorribile in alternativa al Catetere Venoso centrale a permanenza, ma sono gravate da maggiori complicanze, hanno una durata inferiore e richiedono un'adeguata sorveglianza e manutenzione. I due casi clinici qui presentati, illustrano come strategie combinate plurime, chirurgiche ed endovascolari, perfettamente complementari e sinergiche, possano garantirne la pervietà a lungo termine e ridurre il ricorso all'uso dei CVC.
In patients on maintenance hemodialysis (HD) malnutrition is frequent, affects quality of life an... more In patients on maintenance hemodialysis (HD) malnutrition is frequent, affects quality of life and is associated with an increased risk of death. Causes of malnutrition in HD patients are numerous and various. Prevention and treatment of malnutrition becomes very im- portant. Patients must be prescribed adequate protein and energy intakes. More aggressive measures include addition of dietary protein and energy
There is an ongoing debate on the technique for central venous catheterization associated with th... more There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent in-sertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. The results of our retrospective study suggest that the 'low lateral' approach to the internal jugular vein, as ...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
The Vascular Access Study Group of Italian Society of Nephrology has designed a National Register... more The Vascular Access Study Group of Italian Society of Nephrology has designed a National Register in order to create an archive that collects the data on vascular accesses more detailed than the mere indication of arteriovenous fistula with native vessels, prosthetic fistula and central venous catheter. The obstacles to such a project are represented by the absence of "uniformity" in the name of the arterovenous fistula, the difficulty in increasing the daily work of dialysis centers with another registry and finally by privacy concerns. In order to standardize the vascular accesses name the Study Group proposal is to eliminate any denomination and adopt a code-descriptive system, indicating the seat of the anastomosis (1/3 distal, middle and proximal forearm, arm or lower limb), the limb (if dominant or non-dominant), the vessels involved, the type of anastomosis and the number of interventions that the pt has undergone including the last one. In this way, uniformity and ...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
In hemodialysis patients with secondary hyperparathyroidism (SHPT) ultrasonography of the parathy... more In hemodialysis patients with secondary hyperparathyroidism (SHPT) ultrasonography of the parathyroid glands allows to assess the glandular growth and to define the limits of medical treatment. The present retrospective study evaluated the relationship between parathyroid gland hyperplasia and the effectiveness of new drugs. Fifty-three patients with SHPT (iPTH > 400 pg/mL) after treatment with oral calcitriol were included in the study. These patients underwent parathyroid ultrasonography and sequential therapy with intravenous calcitriol (first step), paracalcitol (second step), and paracalcitol + cinacalcet (third step). Patients with median PTH < 300 pg/mL during the period of therapy and follow-up were considered responders. The therapeutic response was correlated with ultrasound parameters (number of parathyroid glands, maximum longitudinal diameter, structural score, and vascular score). Four (10%) of 41 patients treated with IV calcitriol, 7 (27%) of 26 patients treate...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
In Italy, the use of arteriovenous grafts (AVGs) is limited (1-4%) due to different approaches to... more In Italy, the use of arteriovenous grafts (AVGs) is limited (1-4%) due to different approaches to vascular access management compared to other countries, where guidelines that may not apply to the Italian setting have been produced. Therefore, the Vascular Access Study Group of the Italian Society of Nephrology produced this position paper, providing a list of 8 recommendations built upon current guidelines. The most controversial and innovative issues of the existing guidelines have been summed up in 12 different topics. We selected 60 Italian dialysis graft experts, nephrologists and vascular surgeons (PP1SIN Study Investigators). They were asked to express their approval or disapproval on each issue, thus creating a new method to share and exchange information. Almost all agreed on specific criteria for the choice of AVG over native arteriovenous fistulas (AVF) and tunneled venous catheters (tVC) and on the necessary conditions to implant them. They did not fully agree on the use...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
The Vascular Access Study Group of the Italian Society of Nephrology has scheduled four national ... more The Vascular Access Study Group of the Italian Society of Nephrology has scheduled four national studies regarding the choice, implantation and use of vascular access. Study topics will include 1) utilization of vascular grafts for hemodialysis; 2) indications and use of venous catheters; 3) tunneled central venous catheter infection; 4) organization of the implantation and repair of vascular access. After examining the difficulties in implementing international guidelines on vascular access in Italy and the differences in practice patterns between our and other countries (where the most important studies were published), the Study Group set out to prepare four position papers based on discussion of controversial aspects of the international guidelines by nephrologists and surgeons experienced in the Italian practice. An innovative operative method for verifying the consensus on vascular access practice patterns was used. The final aim was to write a document addressed to vascular a...
Results. The overall mortality rate was 14.6 deaths (95% CI: 14.214.9) per 100 person-years on C... more Results. The overall mortality rate was 14.6 deaths (95% CI: 14.214.9) per 100 person-years on CD, remaining essentially unchanged over the 12-year period, despite a 5-year increase in the median age. A reduction in mortality was found for patients >74 years from 29.8 ...
The emblematic case of a forgotten ureteral stent in a renal transplanted patient is reported. Th... more The emblematic case of a forgotten ureteral stent in a renal transplanted patient is reported. The removal was performed with no more difficulties than in a not transplanted patient, but we would emphasize the importance of removing the stent when its function of protecting the anastomosis finished, but before its permanence could compromise the graft.
On the basis of their experience, the authors refer to complications observable at the foot level... more On the basis of their experience, the authors refer to complications observable at the foot level in chronic uremic patients in long-term hemodialytic treatment. These complications, termed renal osteodystrophy, are attributed to alterations in the phosphocalcium metabolism and to hyperparathyroidism. From an anatomopathologic viewpoint, they are characterized by alteration in bone tissue (osteomalacia and/or fibrous osteitis) and by soft tissue alterations. Alterations in the foot are the same as those observed in other osteoarticular regions. They consist of bone subperiosteal reabsorption of the phalanges, vascular calcifications, articular and para-articular calcifications, spontaneous disinsertion of the Achilles tendon and peripheral canalicular neuropathies specifically represented by the tarsal tunnel syndrome. Another complication of this pathology is represented by "Calciphylaxis," characterized by calcifications of the middle tunica of arteries and small arterie...
Anemia is a common complication of chronic kidney disease (CKD), particularly in dialysis patient... more Anemia is a common complication of chronic kidney disease (CKD), particularly in dialysis patients. Correction of anemia in CKD patients includes the administration of both recombinant human erythropoietin and intravenous iron. An optimization of iron treatment requires ...
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, 2009
In Italy, the logistics for the creation of a vascular access are not well arranged. Numerous spe... more In Italy, the logistics for the creation of a vascular access are not well arranged. Numerous specialists are involved, mostly on a voluntary basis: they are those who ''know how to make the vascular access'', and have earned the title on the battlefield. When a native arteriovenous fistula, the gold standard, cannot be created, different solutions may prevail, depending on the local availability of specific skills. The use of vascular grafts for vascular access is not common in Italy. Grafts are mainly performed by vascular surgeons or, less frequently, by nephrologists with specific expertise in centers of excellence. By contrast, venous catheterization as an emergency access for dialysis is very common in Italian nephrology and dialysis centers. In optimal operating conditions, when both options are available and fistula creation and management are feasible, the choice of a graft fistula would be almost obligatory, although there are exceptions. Usually, the need ...
The emblematic case of a forgotten ureteral stent in a renal transplanted patient is reported. Th... more The emblematic case of a forgotten ureteral stent in a renal transplanted patient is reported. The removal was performed with no more difficulties than in a not transplanted patient, but we would emphasize the importance of removing the stent when its function of protecting the anastomosis finished, but before its permanence could compromise the graft.
La Fistola Arterovenosa Nativa rappresenta a tutt'oggi il gold standard degli accessi vascola... more La Fistola Arterovenosa Nativa rappresenta a tutt'oggi il gold standard degli accessi vascolari in emodialisi. Tuttavia essa non è applicabile a tutti i pazienti. Le protesi rappresentano una seconda scelta percorribile in alternativa al Catetere Venoso centrale a permanenza, ma sono gravate da maggiori complicanze, hanno una durata inferiore e richiedono un'adeguata sorveglianza e manutenzione. I due casi clinici qui presentati, illustrano come strategie combinate plurime, chirurgiche ed endovascolari, perfettamente complementari e sinergiche, possano garantirne la pervietà a lungo termine e ridurre il ricorso all'uso dei CVC.
In patients on maintenance hemodialysis (HD) malnutrition is frequent, affects quality of life an... more In patients on maintenance hemodialysis (HD) malnutrition is frequent, affects quality of life and is associated with an increased risk of death. Causes of malnutrition in HD patients are numerous and various. Prevention and treatment of malnutrition becomes very im- portant. Patients must be prescribed adequate protein and energy intakes. More aggressive measures include addition of dietary protein and energy
There is an ongoing debate on the technique for central venous catheterization associated with th... more There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent in-sertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. The results of our retrospective study suggest that the 'low lateral' approach to the internal jugular vein, as ...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
The Vascular Access Study Group of Italian Society of Nephrology has designed a National Register... more The Vascular Access Study Group of Italian Society of Nephrology has designed a National Register in order to create an archive that collects the data on vascular accesses more detailed than the mere indication of arteriovenous fistula with native vessels, prosthetic fistula and central venous catheter. The obstacles to such a project are represented by the absence of "uniformity" in the name of the arterovenous fistula, the difficulty in increasing the daily work of dialysis centers with another registry and finally by privacy concerns. In order to standardize the vascular accesses name the Study Group proposal is to eliminate any denomination and adopt a code-descriptive system, indicating the seat of the anastomosis (1/3 distal, middle and proximal forearm, arm or lower limb), the limb (if dominant or non-dominant), the vessels involved, the type of anastomosis and the number of interventions that the pt has undergone including the last one. In this way, uniformity and ...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
In hemodialysis patients with secondary hyperparathyroidism (SHPT) ultrasonography of the parathy... more In hemodialysis patients with secondary hyperparathyroidism (SHPT) ultrasonography of the parathyroid glands allows to assess the glandular growth and to define the limits of medical treatment. The present retrospective study evaluated the relationship between parathyroid gland hyperplasia and the effectiveness of new drugs. Fifty-three patients with SHPT (iPTH > 400 pg/mL) after treatment with oral calcitriol were included in the study. These patients underwent parathyroid ultrasonography and sequential therapy with intravenous calcitriol (first step), paracalcitol (second step), and paracalcitol + cinacalcet (third step). Patients with median PTH < 300 pg/mL during the period of therapy and follow-up were considered responders. The therapeutic response was correlated with ultrasound parameters (number of parathyroid glands, maximum longitudinal diameter, structural score, and vascular score). Four (10%) of 41 patients treated with IV calcitriol, 7 (27%) of 26 patients treate...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
In Italy, the use of arteriovenous grafts (AVGs) is limited (1-4%) due to different approaches to... more In Italy, the use of arteriovenous grafts (AVGs) is limited (1-4%) due to different approaches to vascular access management compared to other countries, where guidelines that may not apply to the Italian setting have been produced. Therefore, the Vascular Access Study Group of the Italian Society of Nephrology produced this position paper, providing a list of 8 recommendations built upon current guidelines. The most controversial and innovative issues of the existing guidelines have been summed up in 12 different topics. We selected 60 Italian dialysis graft experts, nephrologists and vascular surgeons (PP1SIN Study Investigators). They were asked to express their approval or disapproval on each issue, thus creating a new method to share and exchange information. Almost all agreed on specific criteria for the choice of AVG over native arteriovenous fistulas (AVF) and tunneled venous catheters (tVC) and on the necessary conditions to implant them. They did not fully agree on the use...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
The Vascular Access Study Group of the Italian Society of Nephrology has scheduled four national ... more The Vascular Access Study Group of the Italian Society of Nephrology has scheduled four national studies regarding the choice, implantation and use of vascular access. Study topics will include 1) utilization of vascular grafts for hemodialysis; 2) indications and use of venous catheters; 3) tunneled central venous catheter infection; 4) organization of the implantation and repair of vascular access. After examining the difficulties in implementing international guidelines on vascular access in Italy and the differences in practice patterns between our and other countries (where the most important studies were published), the Study Group set out to prepare four position papers based on discussion of controversial aspects of the international guidelines by nephrologists and surgeons experienced in the Italian practice. An innovative operative method for verifying the consensus on vascular access practice patterns was used. The final aim was to write a document addressed to vascular a...
Uploads
Papers by L. Tazza