Papers by francesca martino
Additional file 1. ROC curve analysis for [TIMP-2] × [IGFBP7], procalcitonine and the combination... more Additional file 1. ROC curve analysis for [TIMP-2] × [IGFBP7], procalcitonine and the combination of the two biomarkers.
Journal of clinical medicine, Feb 18, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Blood Purification, 2014
Inflammation is a common entity among chronic renal failure (CRF) patients. Neutrophil gelatinase... more Inflammation is a common entity among chronic renal failure (CRF) patients. Neutrophil gelatinase-associated lipocalin (NGAL) is a member of lipocalin family and released from many tissues and cells. We aimed to investigate the relationship between serum NGAL levels and the inflammation markers such as high sensitive CRP (hs-CRP), Interleukin-6 (IL-6) and Tumor Necrosis Factor-Alpha (TNF-α) with different vascular access types used in dialysis patients. Methods: The study population included 90 patients and 30 healthy age-matched controls. The patients were divided into three groups (I, II, III) and group IV included the controls. In group I and II the patients were with central venous permanent catheter (CVPC) and arterio-venous fistula (AVF) respectively. Group III included 30 patients with CRF. Hemogram, biochemical assays, ferritin, IL-6, hs-CRP, TNF-α and NGAL were evaluated in all groups. Results: Serum NGAL levels were markedly higher in HD patients with CVPC than in with AVF (7645.80±924.61 vs 4131.20±609.87 pg/ml; p < 0.05). Positive correlation were detected between NGAL levels and duration of CVPC (r = 0.73, p = 0.000), TNF-α (r = 0.57, p = 0.00), hs-CRP (r = 0.80, p = 0.00), IL-6 levels (r = 0.691, p = 0.00) and ferritin (r = 0.32, p = 0.01), whereas serum NGAL levels were negatively correlated with serum albumin levels (r =-0.49, p = 0.00). In multiple regression analysis, duration of CVPC, hs-CRP and TNF-α were predictors of serum NGAL in HD patients. Conclusion: The inflammation was observed in HD patients and increases with CVPC. Our findings show that a strong relationship between serum NGAL levels and inflammation markers. NGAL may be used as a new marker for inflammation in HD patients.
Clinical Genitourinary Cancer, Aug 1, 2022
INTRODUCTION The gold standard treatment for high-risk NMIBC is BCG immunotherapy. Some studies s... more INTRODUCTION The gold standard treatment for high-risk NMIBC is BCG immunotherapy. Some studies suggested an immomodulatory effects for commonly used drugs (ie, ACE-I and ARBs). We aimed to determine whether these drugs impact the prognosis of patients with high-risk NMIBC treated with BCG. MATERIALS AND METHODS Retrospective analysis on 208 patients from a single academic center with primary high-risk NMIBC treated with transurethral resection followed by 6 weekly instillations of BCG and up to 12 monthly maintenance instillations. ARBs or ACE-I use at the time of treatment initiation was recorded. Inverse probability of treatment weighting (IPTW) was used to adjust for clinical and pathological covariates. IPTW-adjusted Kaplan-Meier curves and weighted Cox proportional hazards regression were used to compare 2-yr failure-free (2-yr FFS), failure-free (FFS), overall recurrence-free (RFS) and progression-free survival (PFS). RESULTS A total of 68 patients were on ACE-I, and 38 on ARBs and treatment respectively. At a median follow-up of 26 months, ACE-I treatment had no significant impact on cancer-related outcomes. Conversely, patients treated with ARBs experienced significant improvements in 2-yr FFS (HR 0.3; 0.1-0.9, P = .004), FFS (HR 0.4, 0.1-0.9, P = .005), and PFS (HR 0.001; < 0.001-0.001, P < .001). No significant impact was found for ARB use in RFS (HR 0.6; P = .09). Sensitivity analyses confirmed these results. CONCLUSIONS our findings support a potential role of the angiotensin-renin system in bladder cancer development. We identified ARBs as potential beneficial drugs that seems to act in synergy with BCG-immunotherapy.
Clinical Genitourinary Cancer, 2022
INTRODUCTION The gold standard treatment for high-risk NMIBC is BCG immunotherapy. Some studies s... more INTRODUCTION The gold standard treatment for high-risk NMIBC is BCG immunotherapy. Some studies suggested an immomodulatory effects for commonly used drugs (ie, ACE-I and ARBs). We aimed to determine whether these drugs impact the prognosis of patients with high-risk NMIBC treated with BCG. MATERIALS AND METHODS Retrospective analysis on 208 patients from a single academic center with primary high-risk NMIBC treated with transurethral resection followed by 6 weekly instillations of BCG and up to 12 monthly maintenance instillations. ARBs or ACE-I use at the time of treatment initiation was recorded. Inverse probability of treatment weighting (IPTW) was used to adjust for clinical and pathological covariates. IPTW-adjusted Kaplan-Meier curves and weighted Cox proportional hazards regression were used to compare 2-yr failure-free (2-yr FFS), failure-free (FFS), overall recurrence-free (RFS) and progression-free survival (PFS). RESULTS A total of 68 patients were on ACE-I, and 38 on ARBs and treatment respectively. At a median follow-up of 26 months, ACE-I treatment had no significant impact on cancer-related outcomes. Conversely, patients treated with ARBs experienced significant improvements in 2-yr FFS (HR 0.3; 0.1-0.9, P = .004), FFS (HR 0.4, 0.1-0.9, P = .005), and PFS (HR 0.001; < 0.001-0.001, P < .001). No significant impact was found for ARB use in RFS (HR 0.6; P = .09). Sensitivity analyses confirmed these results. CONCLUSIONS our findings support a potential role of the angiotensin-renin system in bladder cancer development. We identified ARBs as potential beneficial drugs that seems to act in synergy with BCG-immunotherapy.
Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, 2020
Acute kidney injury is a common complication of acute illnesses and is associated with increased ... more Acute kidney injury is a common complication of acute illnesses and is associated with increased morbidity and mortality. Over the past years several acute kidney injury biomarkers for diagnostication, decision-making processes, and prognosis of acute kidney injury and its outcomes have been developed and validated. Among these biomarkers, tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7), the so-called cell cycle arrest biomarkers, showed a superior profile of accuracy and stability even in patients with substantial comorbidities. Therefore, in 2014, the US Food and Drug Administration approved the use of the product of TIMP-2 and IGFBP7 ([TIMP-2] × [IGFBP7]), known as cell cycle arrest biomarkers, to aid critical care physicians and nephrologists in the early prediction of acute kidney injury in the critical care setting. To date, Nephrocheck® is the only commercially available test for [TIMP-2] × [IGFBP7]. In this narrative...
Home dialysis, and mainly peritoneal dialysis, is indicated as the optimal choice as far as the c... more Home dialysis, and mainly peritoneal dialysis, is indicated as the optimal choice as far as the comfort and lifestyle of uremic patients is concerned. Despite this, home treatments show a lack of growth. The reasons are mainly linked to the patients’ cognitive, psychosocial, familiar and physical barriers due to aging and morbidity. To overcome these barriers, we analyzed all the available institutional aids: civil disability, not-self-sufficiency funds, home, social and nursing assistance, expenses refunds. The assessment of the patients’ needs is performed through validated instruments such as multidimensional evaluation (VMD) and equivalent economic index (ISEE). Overall, economic relief is limited to low income patients, and those in serious distress. Some Italian regions have issued specific measures dedicated to home dialysis. Our review shows a great heterogeneity of measures, centered in some cases on economic aids and on home assistance in others. Moreover, some Italian dialysis centers directly provide caregivers for home dialysis. The international literature describes many experiences relating to home dialysis assistance. Their common message is that, in developed countries, economic help is generally sustainable despite the heterogeneity of health care systems. Home support and economic aids for dialysis, in fact, are made possible by the overall savings enabled by home treatments and by the careful redistributions of the funds.
Journal of Nephrology, Jul 1, 2023
Journal of Nephrology, Mar 29, 2022
Chronic Kidney Disease (CKD) is known to alter calcium, phosphorus metabolism and parathyroid hor... more Chronic Kidney Disease (CKD) is known to alter calcium, phosphorus metabolism and parathyroid hormone (PTH) secretion [1]. Under normal conditions, the parathyroid glands secrete PTH following a circadian rhythm [2], mainly influenced by daylight, calcium, phosphate, and vitamin D levels. Peritoneal dialysis (PD) strongly affects calcium, phosphate, and vitamin D levels. Currently, no data are available about the circadian rhythm of PTH in PD patients. We report a case series concerning PTH levels, serum calcium, and phosphorus in seven patients on PD over 24 h. All patients provided informed consent to allow their data to be published anonymously. All specific CKDmineral bone disorder (MBD) therapies (phosphate binders, calcium, calcimimetics, and vitamin D analogues) were discontinued at least 24 h before the blood examination day to reduce the interference of the drugs on calcium and phosphorus levels, as reported in Table 1. We evaluated PTH, calcium, and phosphorus every 4 h starting at 8 am, 12 pm, 4 pm, 8 pm, 12 am, and 4 am (+ 1 day) and lastly at 8 am (+ 1 day). Calcium and phosphorous were evaluated by the colorimetric method in automated machines, and PTH levels by a second-generation chemiluminescence immunoassay (CLIA, LIAISON® N-Tact® PTH II), reference interval 12–54 pg/ml, CV 5.1–8.9% [3]. Table 1 summarizes the main clinical features and peritoneal dialysis parameters. Unlike healthy individuals, this case series showed a lack of PTH pulsatile secretion over 24 h (Fig. 1), suggesting a pathological circadian rhythm. In fact, every patient showed peculiar PTH secretion. Interestingly, the PTH profile did not suggest any relationship with the meal, the sleep–wake condition, dialysis moment, and calcium and phosphorus levels. In particular, serum calcium and phosphate remained highly stable (Fig. 1) over the 24 h. Both ions appeared to be barely influenced by meals or by the time of day. In healthy individuals, the pulsatile PTH secretion would appear to be related to efficient bone turnover, suggesting a relationship between PTH circadian rhythm and healthy bone status [4]. Furthermore, in healthy individuals, a modification of the sleep–wake rhythm seems to increase the risk of bone disease, such as osteoporosis [4]. Little is known in this regard in CKD patients; only two studies on haemodialysis patients reported the maintenance of the PTH circadian rhythm with different behaviour compared to healthy subjects [5, 6]. Conversely, in our case series, we observed a tendency towards flat PTH levels over one day. Secretion rhythm would appear to be independent of the basal levels of PTH, dialysis program, meal, or sleep period. In our opinion, the functional/ structural changes of the parathyroid gland related to CKD may dysregulate the secretion of PTH, while continuous exposure to dialysis fluids could flatten the secretion curve. If the continuous exposure to dialysis fluid can easily explain calcium stability, the stability of phosphorus seems less understandable considering the expected peak after the meal. Interestingly, Lundin et al. also found substantial phosphate steadiness in PD patients after the meal [7]. Finally, calcium levels appeared slightly low in our patients. This effect could be related to the temporary discontinuation of Vitamin D analogues or calcium supplements 24 h before the observation period. Our case series suggests the loss of a defined circadian rhythm in PTH secretion and substantial stability of PTH, serum calcium, and phosphorous in PD patients. Other higher-quality research, such as RCTs are needed to understand the relationship between PD, PTH circadian rhythm, and pharmacological therapy. Accordingly, future studies could answer some interesting, currently unresolved issues: when should calcimimetics or vitamin D be administered? Does the type of peritoneal dialysis change the optimal time of drug administration? Can the PD solution help to * Francesca K. Martino [email protected]
Journal of Clinical Medicine, Nov 15, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Clinical Medicine, Dec 28, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The follow-up automated peritoneal dialysis (APD) patients has been recently improved as data can... more The follow-up automated peritoneal dialysis (APD) patients has been recently improved as data can be transmitted remotely to an internet cloud. The introduction of remote patient monitoring (RPM) technologies also allows a better clinical control and tailoring of dialysis treatment through a web-based software (Claria-Sharesource Baxter). The aim of the present study is to determine the impact of RPM in a single center, both in clinical and organizational terms, compared to traditional technologies. We studied 26 prevalent APD patients aged 69±13 years, observing them for a period of six months while using the traditional technology and then further six months using the new technology. The patients had been on dialysis for 9 months before the start of the study and a relevant portion of them lived in mountainous or hilly areas. Our study shows an increase in the number of proactive calls from the center to the patients, a reduction of anxiety in patients and caregivers, an earlier detection of clinical problems, a reduction of unscheduled (urgent) visits and finally a reduction of hospitalizations after the adoption of RPM software. In our experience, the RPM system showed a good performance and a simple interface, allowing for the precise assessment of daily APD. Furthermore, RPM system improved the interaction between patients and healthcare providers, with a significant benefit in terms of safety and of care quality.
Nephrology Dialysis Transplantation
Background and Aims Dialysis treatment (DT) is the most common approach for patients with kidney ... more Background and Aims Dialysis treatment (DT) is the most common approach for patients with kidney failure. However, this may not be optimal for geriatric individuals, as more than half of elderly patients who initiate DT die within the first year. As a result, current guidelines advocate for presenting comprehensive conservative management (CM) as an alternative option for vulnerable patients and their families. A recent meta-analysis (2022) revealed that DT had a median survival time of 20-67 months, compared to 6-31 months for CM, indicating that individuals who opt for DT may have higher survival benefits. This distinction, however, disappears in +80 y/o patients, suggesting that both therapies may yield similar outcomes in this population. The efficacy of CM, however, remains poorly recognized due to the difficulty in comparing the treatments and the heterogeneous nature of the studies conducted. Therefore, our study aimed to investigate and compare the survival of the elderly wh...
Journal of Nephrology, 2022
Chronic Kidney Disease (CKD) is known to alter calcium, phosphorus metabolism and parathyroid hor... more Chronic Kidney Disease (CKD) is known to alter calcium, phosphorus metabolism and parathyroid hormone (PTH) secretion [1]. Under normal conditions, the parathyroid glands secrete PTH following a circadian rhythm [2], mainly influenced by daylight, calcium, phosphate, and vitamin D levels. Peritoneal dialysis (PD) strongly affects calcium, phosphate, and vitamin D levels. Currently, no data are available about the circadian rhythm of PTH in PD patients. We report a case series concerning PTH levels, serum calcium, and phosphorus in seven patients on PD over 24 h. All patients provided informed consent to allow their data to be published anonymously. All specific CKDmineral bone disorder (MBD) therapies (phosphate binders, calcium, calcimimetics, and vitamin D analogues) were discontinued at least 24 h before the blood examination day to reduce the interference of the drugs on calcium and phosphorus levels, as reported in Table 1. We evaluated PTH, calcium, and phosphorus every 4 h starting at 8 am, 12 pm, 4 pm, 8 pm, 12 am, and 4 am (+ 1 day) and lastly at 8 am (+ 1 day). Calcium and phosphorous were evaluated by the colorimetric method in automated machines, and PTH levels by a second-generation chemiluminescence immunoassay (CLIA, LIAISON® N-Tact® PTH II), reference interval 12–54 pg/ml, CV 5.1–8.9% [3]. Table 1 summarizes the main clinical features and peritoneal dialysis parameters. Unlike healthy individuals, this case series showed a lack of PTH pulsatile secretion over 24 h (Fig. 1), suggesting a pathological circadian rhythm. In fact, every patient showed peculiar PTH secretion. Interestingly, the PTH profile did not suggest any relationship with the meal, the sleep–wake condition, dialysis moment, and calcium and phosphorus levels. In particular, serum calcium and phosphate remained highly stable (Fig. 1) over the 24 h. Both ions appeared to be barely influenced by meals or by the time of day. In healthy individuals, the pulsatile PTH secretion would appear to be related to efficient bone turnover, suggesting a relationship between PTH circadian rhythm and healthy bone status [4]. Furthermore, in healthy individuals, a modification of the sleep–wake rhythm seems to increase the risk of bone disease, such as osteoporosis [4]. Little is known in this regard in CKD patients; only two studies on haemodialysis patients reported the maintenance of the PTH circadian rhythm with different behaviour compared to healthy subjects [5, 6]. Conversely, in our case series, we observed a tendency towards flat PTH levels over one day. Secretion rhythm would appear to be independent of the basal levels of PTH, dialysis program, meal, or sleep period. In our opinion, the functional/ structural changes of the parathyroid gland related to CKD may dysregulate the secretion of PTH, while continuous exposure to dialysis fluids could flatten the secretion curve. If the continuous exposure to dialysis fluid can easily explain calcium stability, the stability of phosphorus seems less understandable considering the expected peak after the meal. Interestingly, Lundin et al. also found substantial phosphate steadiness in PD patients after the meal [7]. Finally, calcium levels appeared slightly low in our patients. This effect could be related to the temporary discontinuation of Vitamin D analogues or calcium supplements 24 h before the observation period. Our case series suggests the loss of a defined circadian rhythm in PTH secretion and substantial stability of PTH, serum calcium, and phosphorous in PD patients. Other higher-quality research, such as RCTs are needed to understand the relationship between PD, PTH circadian rhythm, and pharmacological therapy. Accordingly, future studies could answer some interesting, currently unresolved issues: when should calcimimetics or vitamin D be administered? Does the type of peritoneal dialysis change the optimal time of drug administration? Can the PD solution help to * Francesca K. Martino [email protected]
International Urology and Nephrology, 2021
We performed a pilot study to evaluate the feasibility of future research about the presence of s... more We performed a pilot study to evaluate the feasibility of future research about the presence of subclinical kidney damage after Gadolinium-based contrast media exposure. The future study aims to understand which are the behaviors of two markers of kidney damage, such as urinary NephroCheck (NC) and/or neutrophil gelatinase-associated lipocalin (NGAL). Specifically, after GBCM exposure, NC urinary detection should identify proximal tubule damage while NGAL urinary detection should be related to distal tubule damage. We performed a pilot study in patients who had Gadolinium exposure. The feasibility of future study is reached when at least 90% of candidates completed the pilot study. In each patient, we tested urinary NC and NGAL levels 24 h before magnetic resonance imaging (MRI) and 12–24 h after the exposure. Furthermore, we evaluated the administration of other nephrotoxic agents, the presence of comorbidity, and kidney function by S-creatinine and urine protein before the MRI. We enrolled 35 candidates of whom 33 patients completed all study procedures. Our population had a mean age of 60.7 ± 14.8 years with normal kidney function with a median S-creatinine equal to 0.7 mg/dl (Interquartile range [IQR] 0.6–0.91). Urinary NC levels increased from 0.21 ng2/ml2 (IQR 0.11–0.4) before MRI to 0.34 ng2/ml2 (IQR 0.16–0.86) (p = 0.005). Conversely, we did not appreciate any significant modification in urinary NGAL (p = 0.53). Our pilot study seems adequate in terms of feasibility and encourages us to focus our future research on renal proximal tubule, as the principal site of subclinical kidney damage after Gadolinium exposure.
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, 2020
The follow-up automated peritoneal dialysis (APD) patients has been recently improved as data can... more The follow-up automated peritoneal dialysis (APD) patients has been recently improved as data can be transmitted remotely to an internet cloud. The introduction of remote patient monitoring (RPM) technologies also allows a better clinical control and tailoring of dialysis treatment through a web-based software (Claria-Sharesource Baxter). The aim of the present study is to determine the impact of RPM in a single center, both in clinical and organizational terms, compared to traditional technologies. We studied 26 prevalent APD patients aged 69±13 years, observing them for a period of six months while using the traditional technology and then further six months using the new technology. The patients had been on dialysis for 9 months before the start of the study and a relevant portion of them lived in mountainous or hilly areas. Our study shows an increase in the number of proactive calls from the center to the patients, a reduction of anxiety in patients and caregivers, an earlier d...
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia, 2020
Home dialysis, and mainly peritoneal dialysis, is indicated as the optimal choice as far as the c... more Home dialysis, and mainly peritoneal dialysis, is indicated as the optimal choice as far as the comfort and lifestyle of uremic patients is concerned. Despite this, home treatments show a lack of growth. The reasons are mainly linked to the patients’ cognitive, psychosocial, familiar and physical barriers due to aging and morbidity. To overcome these barriers, we analyzed all the available institutional aids: civil disability, not-self-sufficiency funds, home, social and nursing assistance, expenses refunds. The assessment of the patients’ needs is performed through validated instruments such as multidimensional evaluation (VMD) and equivalent economic index (ISEE). Overall, economic relief is limited to low income patients, and those in serious distress. Some Italian regions have issued specific measures dedicated to home dialysis. Our review shows a great heterogeneity of measures, centered in some cases on economic aids and on home assistance in others. Moreover, some Italian dia...
International Urology and Nephrology, 2021
Follow-up of automated peritoneal dialysis (APD) has been improved by data transmission by cellul... more Follow-up of automated peritoneal dialysis (APD) has been improved by data transmission by cellular modem and internet cloud. With the new remote patient monitoring (RPM) technology, clinical control and prescription of dialysis are performed by software (Baxter Claria-Sharesource), which allows the center to access home operational data. The objective of this pilot study was to determine the impact of RPM compared to traditional technology, in clinical, organizational, social, and economic terms in a single center. We studied 21 prevalent APD patients aged 69 ± 13 years, on dialysis for a median of 9 months, for a period of 6 months with the traditional technology and 6 months with the new technology. A relevant portion of patients lived in mountainous or hilly areas. Our study shows more proactive calls from the center to patients after the consultation of RPM software, reduction of calls from patients and caregivers, early detection of clinical problems, a significant reduction of unscheduled visits, and a not significant reduction of hospitalizations. The analysis also highlighted how the RPM system lead to relevant economic savings, which for the health system have been calculated € 335 (mean per patient-month). With the social costs represented by the waste of time of the patient and the caregiver, we calculated € 685 (mean per patient-month). In our pilot report, the RPM system allowed the accurate assessment of daily APD sessions to suggest significative organizational and economic advantages, and both patients and healthcare providers reported good subjective experiences in terms of safety and quality of follow-up.
Blood Purification, 2016
Aims: The study aimed to determine whether the available literature supports a positive or negati... more Aims: The study aimed to determine whether the available literature supports a positive or negative influence of dialysis on regulatory T-cells (Tregs). Methods: We performed a systematic search and a meta-analysis. Mean differences in Tregs number of chronic kidney disease stages G5 on dialysis patients (CKD G5D) and healthy controls (HCs) were compared. Random effects model was applied. The software used was general package for meta-analysis (version 4.3-0, depends R (≥2.9.1)). Results: Five studies were included in the meta-analysis. The mean difference in percentage of Tregs on CD4+ T-cells between CKD G5D and HCs was not statistically different. Moreover, CKD GFR stages G5 not on dialysis (CKD G5) versus HC (p = 0.002; mean difference in Treg percentage was -2.47% in CKD G5 vs. HC) and CKD G5 versus CKD G5D (not significant). Conclusion: This meta-analysis demonstrates an association between the uremic state and lower Tregs, and supports the hypothesis that hemodialysis alter T...
Nephrology Dialysis Transplantation, 2014
Uploads
Papers by francesca martino