Publications by authors named "Maurizio Bossola"

164 Publications

mHealth-based experience sampling method to identify fatigue in the context of daily life in haemodialysis patients.

Clin Kidney J 2021 Jan 1;14(1):245-254. Epub 2020 Sep 1.

Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.

Background: Fatigue in haemodialysis (HD) patients is a prevalent but complex symptom impacted by biological, behavioural, psychological and social variables. Conventional retrospective fatigue questionnaires cannot provide detailed insights into symptom variability in daily life and related factors. The experience sampling methodology (ESM) overcomes these limitations through repeated momentary assessments in patients' natural environments using digital questionnaires. This study aimed to gain in-depth understanding of HD patients' diurnal fatigue patterns and related variables using a mobile Health (mHealth) ESM application and sought to better understand the nature of their interrelationships.

Methods: Forty HD patients used the mHealth ESM application for 7days to assess momentary fatigue and potentially related variables, including daily activities, self-reported physical activity, social company, location and mood.

Results: Multilevel regression analyses of momentary observations (=1777) revealed that fatigue varied between and within individuals. Fatigue was significantly related to HD treatment days, type of daily activity, mood and sleep quality. Time-lagged analyses showed that HD predicted higher fatigue scores at a later time point (β = 0.22, P=0.013). Interestingly, higher momentary fatigue also significantly predicted more depressed feelings at a later time point (β = 0.05, P=0.019) but not the other way around.

Conclusions: ESM offers novel insights into fatigue in chronic HD patients by capturing informative symptom variability in the flow of daily life. Electronic ESM as a clinical application may help us better understand fatigue in HD patients by providing personalized information about its course and relationship with other variables in daily life, paving the way towards personalized interventions.
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http://dx.doi.org/10.1093/ckj/sfaa124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857808PMC
January 2021

Determinants of venous catheter hemodialysis onset and subsequent switch to arteriovenous fistula: An epidemiological study in Lazio region.

J Vasc Access 2020 Sep 30:1129729820959942. Epub 2020 Sep 30.

Department of Epidemiology of Lazio Regional Health Service, Rome, Italy.

Background: The factors associated with the inability to start hemodialysis with an arteriovenous fistula (AVF) in chronic kidney disease patients are not fully understood.

Aim: Evaluating factors associated with type of vascular access at the first chronic hemodialysis and at 1 year after it.

Methods: The study cohort includes patients registered in the Regional Dialysis and Transplant Registry of Lazio undergoing first hemodialysis between 2008 and 2015. Logistic regression models were used to evaluate the association between socio-demographic, clinical and care/organizational factors, and vascular access at first hemodialysis. Cox regression models were used to assess the odds of switching to AVF during the first year of hemodialysis among patients starting dialysis with central venous catheter (CVC).

Results: In the cohort of 6208 incident hemodialysis patients, 52.7% had an AVF and 47.3% had a CVC. Among the 2939 incident patients with CVC, 27.4% switched to FAV after 1 year. A higher probability of starting dialysis with AVF was observed among males (OR = 1.83; 95% CI 1.63-2.06), while a lower probability was observed among patients aged >85 years (OR 0.64; IC 95% 0.51-0.80). Patients with early referral to a nephrologist had a triple probability of start dialysis with AVF. We observed a higher odds of switch to AVF among males (HR = 1.62; 95% CI 1.40-1.89) and a lower odds among patients over 65 years.

Conclusion: The observed high rate of AVF at the start of hemodialysis and of the switch from CVC to AVF in the first year, although declining since 2008, is a positive outcome. However, over one-third of patients maintain the CVC as vascular access for the first year because of unmodifiable factors, such as gender, age, comorbidity. The present study suggests that logistics/management and assistance/welfare problems may contribute to the delay or lack of AVF placement in incident hemodialysis patients or within the first year of dialysis.
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http://dx.doi.org/10.1177/1129729820959942DOI Listing
September 2020

The Effect of Aromatherapy Massage With Lavender and Citrus Aurantium Essential Oil on Quality of Life of Patients on Chronic Hemodialysis: A Parallel Randomized Clinical Trial Study.

J Pain Symptom Manage 2021 Mar 1;61(3):456-463.e1. Epub 2020 Sep 1.

Università Cattolica del Sacro Cuore, Roma, Italy; Haemodialysis Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.

Context: Poor quality of life is a major problem in hemodialysis patients.

Objectives: This study was conducted to assess the effect of aromatherapy massage on hemodialysis patients' quality of life.

Methods: In this parallel randomized clinical trial study, 105 hemodialysis patients who meet the inclusion criteria were assessed and assigned into intervention and control groups using block randomization. Participants in the intervention groups received aromatherapy massage with Lavender essential oil or Citrus Aurantium essential oil for four weeks (three times per week). For the control group, only foot massage was performed. The level of quality of life was measured by the 36-Item Short-Form Health Survey questionnaire (SF-36) before and after the intervention. Data analysis was performed using descriptive and inferential statistics (analysis of variance, chi-square, and Fisher's exact tests).

Results: There was a significant difference between the mean score of quality of life in the Lavender essential oil group and Citrus Aurantium essential oil group with the control group after intervention. However, there was no significant difference between the mean score of quality of life in the Lavender essential oil group and Citrus Aurantium essential oil group after the intervention.

Conclusions: In this study, both aromatherapy massages have positive effects on the quality of life of hemodialysis patients. Therefore, nurses are advised to use these aromatherapy massages to improve the quality of life of hemodialysis patients.
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http://dx.doi.org/10.1016/j.jpainsymman.2020.08.032DOI Listing
March 2021

Peridialytic serum cytokine levels and their relationship with postdialysis fatigue and recovery in patients on chronic haemodialysis - A preliminary study.

Cytokine 2020 Nov 13;135:155223. Epub 2020 Aug 13.

Università Cattolica del Sacro Cuore, Rome, Italy; Haemodialysis Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Background: The aetiology of postdialysis fatigue (PDF), an intermittent but debilitating fatigue occurring after haemodialysis (HD) treatment, is still unclear. In other inflammatory diseases, increasing evidence points toward the involvement of the immune system in the onset of fatigue symptoms. Altered serum levels of inflammatory cytokines have also been shown in HD patients. Therefore, we investigated whether pre- and postdialysis serum levels of pro- and anti-inflammatory cytokines (i.e. IL-1β, IL-6, TNF-α and IL-10) or their intradialytic changes (if any) were related to PDF or the time HD patients reported needing to recover from HD treatment (TIRD).

Methods: Serum levels of IL-1β, IL-6, TNF-α and IL-10 were measured immediately before and after HD in 45 patients using commercially available kits on an ELLA™ automated immunoassay system. The presence and severity of PDF as well as TIRD duration were assessed by self-report measures.

Key Results: Seventy-four percent of patients reported PDF, with a median PDF severity index of 3.30 [IQR: 3.00-4.30] on a scale from 1 to 5. Median TIRD was 120 min [IQR: 60-480]. PDF severity correlated strongly with TIRD, r = 0.85, p < 0.001. Only predialysis levels of IL-10 significantly and positively correlated with PDF severity (r = 0.43, p = 0.003).

Conclusion: Findings of the present study do not support the involvement of the immune system in the onset of PDF or the time patients needed to recover from HD treatment. A positive, but counterintuitive relationship was found between predialysis levels of anti-inflammatory IL-10 and PDF severity, which warrants further research.
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http://dx.doi.org/10.1016/j.cyto.2020.155223DOI Listing
November 2020

Daily physical activity in patients on chronic haemodialysis and its relation with fatigue and depressive symptoms.

Int Urol Nephrol 2020 Oct 28;52(10):1959-1967. Epub 2020 Jul 28.

Università Cattolica del Sacro Cuore, Rome, Italy.

Objective: Fatigue and depressed mood are considered main impediments to physical activity in haemodialysis (HD) patients. A better understanding of their interrelationships is crucial to develop effective therapies. Moreover, measurement of daily physical activity (DPA) in HD patients is tricky, as it is usually assessed by subjective self-report questionnaires. Therefore, we aimed to objectively measure sponteanous DPA with motion sensors and to explore its relation with fatigue and depressive symptoms.

Methods: DPA was assessed for seven consecutive days in 37 HD patients based on their daily step count measured with the SenseWear™ Armband. The Fatigue Severity Scale (FSS) and Beck Depression Inventory-II (BDI-II) were administered to evaluate fatigue and depressed mood.

Results: Median DPA was 2424 steps/day, (IQR:892-4545). In 81% of subjects, DPA felt within a sedentary lifestyle classification, as they made < 5.000 steps/day. DPA did not correlate with fatigue (r = 0.04, p = 0.832), and did not significantly differ between patients categorized as clinically fatigued (n = 23, FSS ≥ 4) or not (n = 14, FSS < 4) (p = 0.654, d = 0.20). Although low-depressed subjects (n = 19, BDI-II ≤ 13) made on average 1.7 times more steps/day than high-depressed subjects (n = 18, BDI-II > 13) (p = 0.111, d = 0.60), depressive mood did also not correlate significantly with DPA (r = - 0.23, p = 0.175).

Conclusion: Objective assessment of DPA with motion sensors is feasible in HD patients and allows identifying a sedentary lifestyle. Our results suggest that spontanous DPA is determined by age rather than by fatigue or mood.
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http://dx.doi.org/10.1007/s11255-020-02578-9DOI Listing
October 2020

Unraveling Fatigue in Hemodialysis Patients: Comparing Retrospective Reports to Real-Time Assessments With an mHealth Experienced Sampling Method.

J Pain Symptom Manage 2020 12 6;60(6):1100-1108.e2. Epub 2020 Jul 6.

Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Limburg Brain Injury Centre, Maastricht, The Netherlands.

Context: Fatigue is prevalent among hemodialysis (HD) patients and associated with depressive mood. To advance our understanding of its etiology and develop appropriate treatments, reliable measurement instruments are needed. However, conventional fatigue and mood questionnaires are prone to bias because of their retrospective nature and may misrepresent or overestimate actual symptom experience (i.e., the so-called memory-experience gap). Experience sampling methodology (ESM) overcomes this limitation through repeated real-time assessments in patients' natural environment, thereby providing reliable and ecologically valid data.

Objectives: We investigated to what extent retrospective symptom reporting accurately represents real-time experiences of fatigue and mood in HD patients using an ESM mobile Health application (PsyMate™; smartHealth GmbH, Luxembourg).

Methods: Forty HD patients used the PsyMate for one week to assess real-time fatigue and mood. In addition, they retrospectively evaluated their symptom experience completing end-of-day and end-of-week questionnaires as well as the conventional Fatigue Severity Scale and Hospital Anxiety and Depression Scale.

Results: Results of real-time observations (N = 1777) showed that fatigue and mood varied between and within individuals. Retrospective end-of-week fatigue evaluation was significantly higher than the average real-time fatigue score; t(38) = 3.54, P = 0.001, and d = 0.57. Fatigue Severity Scale and Hospital Anxiety and Depression Scale correlated moderately to strong with the average ESM score for fatigue and mood: r = 0.66 and r = 0.77, respectively.

Conclusion: Retrospective fatigue assessment may lead to overestimation of real-time symptom experience. ESM provides detailed insight and personalized information about symptom experiences, which may be crucial for the design of more targeted and personalized interventions for fatigue and mood problems in HD patients.
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http://dx.doi.org/10.1016/j.jpainsymman.2020.06.042DOI Listing
December 2020

Identification of biomarkers for physical frailty and sarcopenia through a new multi-marker approach: results from the BIOSPHERE study.

Geroscience 2020 Jun 1. Epub 2020 Jun 1.

Fondazione Policlinico Universitario ''Agostino Gemelli'' IRCCS, L.go F. Vito 1, 00168, Rome, Italy.

Physical frailty and sarcopenia (PF&S) is a prototypical geriatric condition characterized by reduced physical function and low muscle mass. The aim of the present study was to provide an initial selection of biomarkers for PF&S using a novel multivariate analytic strategy. Two-hundred community-dwellers, 100 with PF&S and 100 non-physically frail, non-sarcopenic (nonPF&S) controls aged 70 and older were enrolled as part of the BIOmarkers associated with Sarcopenia and Physical frailty in EldeRly pErsons (BIOSPHERE) study. A panel of 74 serum analytes involved in inflammation, muscle growth and remodeling, neuromuscular junction damage, and amino acid metabolism was assayed. Biomarker selection was accomplished through sequential and orthogonalized covariance selection (SO-CovSel) analysis. Separate SO-CovSel models were constructed for the whole study population and for the two genders. The model with the best prediction ability obtained with the smallest number of variables was built using seven biomolecules. This model allowed correct classification of 80.6 ± 5.3% PF&S participants and 79.9 ± 5.1% nonPF&S controls. The PF&S biomarker profile was characterized by higher serum levels of asparagine, aspartic acid, and citrulline. Higher serum concentrations of platelet-derived growth factor BB, heat shock protein 72 (Hsp72), myeloperoxidase, and α-aminobutyric acid defined the profile of nonPF&S participants. Gender-specific SO-CovSel models identified a "core" biomarker profile of PF&S, characterized by higher serum levels of aspartic acid and Hsp72 and lower concentrations of macrophage inflammatory protein 1β, with peculiar signatures in men and women.SO-CovSel analysis allowed identifying a set of potential biomarkers for PF&S. The adoption of such an innovative multivariate approach could help address the complex pathophysiology of PF&S, translate biomarker discovery from bench to bedside, and unveil novel targets for interventions.
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http://dx.doi.org/10.1007/s11357-020-00197-xDOI Listing
June 2020

A novel multi-marker discovery approach identifies new serum biomarkers for Parkinson's disease in older people: an EXosomes in PArkiNson Disease (EXPAND) ancillary study.

Geroscience 2020 10 26;42(5):1323-1334. Epub 2020 May 26.

Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.

Dopaminergic nigrostriatal denervation and widespread intracellular α-synuclein accumulation are neuropathologic hallmarks of Parkinson's disease (PD). A constellation of peripheral processes, including metabolic and inflammatory changes, are thought to contribute to neurodegeneration. In the present study, we sought to obtain insight into the multifaceted pathophysiology of PD through the application of a multi-marker discovery approach. Fifty older adults aged 70+, 20 with PD and 30 age-matched controls were enrolled as part of the EXosomes in PArkiNson Disease (EXPAND) study. A panel of 68 circulating mediators of inflammation, neurogenesis and neural plasticity, and amino acid metabolism was assayed. Biomarker selection was accomplished through sequential and orthogonalized covariance selection (SO-CovSel), a multi-platform regression method developed to handle highly correlated variables organized in multi-block datasets. The SO-CovSel model with the best prediction ability using the smallest number of variables was built with seven biomolecules. The model allowed correct classification of 94.2 ± 3.1% participants with PD and 100% controls. The biomarker profile of older adults with PD was defined by higher circulating levels of interleukin (IL) 8, macrophage inflammatory protein (MIP)-1β, phosphoethanolamine, and proline, and by lower concentrations of citrulline, IL9, and MIP-1α. Our innovative approach allowed identifying and evaluating the classification performance of a set of potential biomarkers for PD in older adults. Future studies are warranted to establish whether these biomolecules could serve as biomarkers for PD as well as unveil new targets for interventions.
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http://dx.doi.org/10.1007/s11357-020-00192-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525911PMC
October 2020

Generation and Release of Mitochondrial-Derived Vesicles in Health, Aging and Disease.

J Clin Med 2020 May 12;9(5). Epub 2020 May 12.

Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy.

Mitochondria are intracellular organelles involved in a myriad of activities. To safeguard their vital functions, mitochondrial quality control (MQC) systems are in place to support organelle plasticity as well as physical and functional connections with other cellular compartments. In particular, mitochondrial interactions with the endosomal compartment support the shuttle of ions and metabolites across organelles, while those with lysosomes ensure the recycling of obsolete materials. The extrusion of mitochondrial components via the generation and release of mitochondrial-derived vesicles (MDVs) has recently been described. MDV trafficking is now included among MQC pathways, possibly operating via mitochondrial-lysosomal contacts. Since mitochondrial dysfunction is acknowledged as a hallmark of aging and a major pathogenic factor of multiple age-associated conditions, the analysis of MDVs and, more generally, of extracellular vesicles (EVs) is recognized as a valuable research tool. The dissection of EV trafficking may help unravel new pathophysiological pathways of aging and diseases as well as novel biomarkers to be used in research and clinical settings. Here, we discuss (1) MQC pathways with a focus on mitophagy and MDV generation; (2) changes of MQC pathways during aging and their contribution to inflamm-aging and progeroid conditions; and (3) the relevance of MQC failure to several disorders, including neurodegenerative conditions (i.e., Parkinson's disease, Alzheimer's disease) and cardiovascular disease.
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http://dx.doi.org/10.3390/jcm9051440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290979PMC
May 2020

Comparison of the effects of hemodialysis and hemodiafiltration on left ventricular hypertrophy in end-stage renal disease patients: A systematic review and meta-analysis.

Semin Dial 2020 03 11;33(2):120-126. Epub 2020 Mar 11.

Fondazione Policlinico Agostino Gemelli IRCCS, University Hospital, Università Cattolica del Sacro Cuore, Rome.

Whether hemodiafiltration (HDF) is better than conventional hemodialysis (HD) in improving left ventricular hypertrophy (LVH), defined as reduction of the left ventricular mass index (LVMi) and increasing the ejection fraction (EF), is unclear. A systematic literature search was performed. Primary outcome was the mean difference between pre- and post-procedural LVMi. Secondary outcome was the mean difference in EF. Seven studies with a total of 845 patients were included. The pooled mean difference between pre-and post-procedural LVMi was -8.0 g/m (95% confidence interval [CI] -13.1, -2.8). On subgroup analysis, the mean differences between pre- and post-procedural LVMi for HD and HDF were -6.7 g/m (95% CI -14.5, 1.1) and -9.3 g/m (95% CI -16.3, -2.3), respectively (P for subgroups = .62). Pooled mean difference between pre- and post-procedural EF was 2.4% (95% CI -1.8, 6.5). On subgroup analysis, the mean differences between pre- and post-procedural EF for HD and HDF were 3.6% (95% CI -2.7, 9.8) and 2.0% (95% CI 2.9, 6.8), respectively (P for subgroups = .68). On meta-regression, age (Beta -0.35 ± 0.05, P < .001) and longer dialysis duration (Beta -0.12 ± 0.02, P < .001) were associated with lower mean difference between pre-and post-procedural EF. No significant effects on changes in LVMi and EF were observed with HDF compared with conventional HD.
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http://dx.doi.org/10.1111/sdi.12864DOI Listing
March 2020

Thirst in patients on chronic hemodialysis: What do we know so far?

Int Urol Nephrol 2020 Apr 25;52(4):697-711. Epub 2020 Feb 25.

Divisione Di Geriatria, Neuroscienza E Ortopedia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

Thirst has been defined as "the sensation that leads animal's and human's actions toward the goal of finding and drinking water" or as "any drive that can motivate water intake, regardless of cause". Thirst, together with xerostomia, is the main cause of poor adherence to fluid restriction and of excessive intake of fluids in patients on chronic hemodialysis, and consequently of high interdialytic weight gain. Interdialytic weight gain (IDWG) should be lower than 4.0-4.5% of dry weight. Unfortunately, many patients have an IDWG greater than this value and some have IDWG of 10-20%. High IDWG is associated with a higher risk of all-cause and cardiovascular death and increased morbidity, such as ventricular hypertrophy and major adverse cardiac and cerebrovascular events. In addition, high IDWG leads to supplementary weekly dialysis sessions with consequent deterioration of quality of life and increased costs. Thus, the knowledge of thirst in patients on chronic hemodialysis is essential to prompt its adequate management to limit IDWG in the routine clinical practice. The present review aims to describe the physiology of thirst in patients on chronic hemodialysis, as well as the prevalence, its measures, the associated variables, the consequences, and the strategies for its reduction.
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http://dx.doi.org/10.1007/s11255-020-02401-5DOI Listing
April 2020

Enhanced Recovery After Surgery (ERAS) is safe, feasible and effective in elderly patients undergoing laparoscopic colorectal surgery: results of a prospective single center study.

Minerva Chir 2020 Jun 20;75(3):157-163. Epub 2020 Feb 20.

Hemodialysis Unit, Institute of Clinical Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.

Background: It is still unknown whether ERAS program is safe, feasible and effective in elderly patients undergoing laparoscopic colorectal surgery. In addition, the definition of the "old patient" in terms of age varies across the studies and different age cut-off, such as 65, 70, and 75 years have been used worldwide.

Methods: All adult patients undergoing primary, elective colorectal laparoscopic surgery between January 2017 and December 2018 were considered eligible to follow the ERAS protocol according to the Enhanced Recovery After Surgery (ERAS) Society guidelines. Elderly were defined according three different cut-off values: <65 and ≥65 years, <70 and ≥70 years, <75 and ≥75 years.

Results: One hundred and eight patients were included in the study. Adherence to protocol did not differ significantly between younger and older patients, for most of the items. Thirty-day mortality was absent. The frequency of postoperative complications globally considered and the frequency of the various single complications did not differ significantly between younger and older patients, independently of the cutoff considered to define the older age. Similarly, the frequency of re-intervention and readmission was similar in younger and older patients. Time to flatus and time to stool were similar in young and older patients, independently of the age cut-off used. Time to oral liquid diet was similar in patients with age <65 and ≥65 years while it was moderately longer in patients ≥70 years (1.5±1.1 days;) than in those <70 years (1.1±0.4 days; P=0.030) as well as in patients ≥75 years with respect to the younger ones (1.2±0.5 vs. 1.6±1.2 days; P=0.045). The time to oral solid feeding was similar in young and old patients, independently of the age cut-off used. Time to bladder catheter removal was significantly longer in older patients, independently of the age cut-off used, although the differences do not seem to be clinically relevant. The length of stay was significantly higher in older patients, when the cutoff of 70 years or 75 years was used, but did not differ significantly when the cut-off of 65 years was used.

Conclusions: The present study shows that the ERAS protocol is safe, feasible, and effective in elderly patients as in the young ones, undergoing laparoscopic elective colorectal surgery. This suggests that the ERAS program can be applied usefully to elderly patients in the routine clinical practice.
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http://dx.doi.org/10.23736/S0026-4733.20.08275-9DOI Listing
June 2020

Intensity, Duration, and Frequency of Post-Dialysis Fatigue in Patients on Chronic Haemodialysis.

J Ren Care 2020 Jun 26;46(2):115-123. Epub 2020 Jan 26.

Dipartimento di Nefrologia, Ospedale "Civile", Senigallia, Italia.

Background: Although frequent and debilitating, little is known about the characteristics of post-dialysis fatigue (PDF).

Objective: To characterise the intensity, duration and frequency of PDF and the associated variables in patients on chronic haemodialyses.

Design: Prospective, observational and multicenter study.

Patients: We studied 271 patients.

Measurements: Patients were considered to be suffering from PDF if they spontaneously offered this complaint when asked the open-ended question: "Do you feel fatigued after dialysis? Then, each patient was invited to rate the intensity, duration and frequency of PDF from 1 to 5.

Results: One hundred sixty-four patients (60.5%) had PDF. The median [95% confidence interval (CI)] scores of PDF intensity, duration and frequency were 3 (3-4), 3 (3-4) and 4 (4-4), respectively. The median (95% CI) of the sum of the scores (Sum Score) of PDF intensity, duration and frequency was 11 (10-12). Seventy four patients had a Sum Score ≥ 12. Using multiple regression analysis, PDF intensity was associated with dialytic age and ultrafiltration rate (UFR), PDF duration with dialytic age, while PDF fatigue frequency was associated with height. The Sum Score was associated with dialytic age and recovery time and negatively associated with daily activity, height and UFR (ml/kg/h).

Conclusion: The intensity, duration and frequency of PDF are high in a large percentage of patients, suggesting that PDF is an intense event in terms of quantity and quality. Understanding the relationship between the variables associated with PDF and its intensity, duration and frequency may help better understand the underlying mechanisms of this burdensome condition.
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http://dx.doi.org/10.1111/jorc.12315DOI Listing
June 2020

Dietary Daily Sodium Intake Lower than 1500 mg Is Associated with Inadequately Low Intake of Calorie, Protein, Iron, Zinc and Vitamin B1 in Patients on Chronic Hemodialysis.

Nutrients 2020 Jan 19;12(1). Epub 2020 Jan 19.

Unità Operativa Nefrologia ed Emodialisi, Ospedale "A. Murri", 60035 Jesi, Italy.

To measure daily sodium intake in patients on chronic hemodialysis and to compare the intake of nutrients, minerals, trace elements, and vitamins in patients who had a daily sodium intake below or above the value of 1500 mg recommended by the American Heart Association. Dietary intake was recorded for 3 days by means of 3-day diet diaries in prevalent patients on chronic hemodialysis. Each patient was instructed by a dietitian on how to fill the diary, which was subsequently signed by a next of kin. : We studied 127 patients. Mean sodium intake (mg) was 1295.9 812.3. Eighty-seven (68.5%) patients had a daily sodium intake 1500 mg (group 1) and 40 (31.5%) ≥ 1500 mg (group 2). Correlation between daily sodium intake and daily calorie intake was significant ( = 0.474 [0.327 to 0.599]; 0.0001). Daily calorie intake (kcal/kg/day) was lower in group 1 (21.1 6.6; 0.0001) than in group 2 (27.1 10.4). Correlation between daily sodium intake and daily protein intake was significant (r 0.530[0.392 to 0.644]; 0.0001). The daily protein intake (grams/kg/day) was lower in group 1 (0.823 0.275; 0.0003) than in group 2 (1.061 0.419). Daily intake of magnesium, copper, iron, zinc, and selenium was significantly lower in group 1 than in group 2. Daily intake of vitamin A, B2, B3, and C did not differ significantly between group 1 and group 2. Daily intake of vitamin B1 was significantly lower in group 1 than in group 2. Significantly lower was, in group 1 than in group 2, the percentage of patients within the target value with regard to intake of calories (11.5% vs. 37.5%; 0.001) and proteins (9.2% vs. 27.5%; 0.015) as well as of iron (23% vs. 45%; 0.020), zinc (13.8% vs. 53.8%; 0.008) and vitamin B1 (8.1% vs. 50%; 0.001). A low daily intake of sodium is associated with an inadequately low intake of calorie, proteins, minerals, trace elements, and vitamin B1. Nutritional counselling aimed to reduce the intake of sodium in patients on chronic hemodialysis should not disregard an adequate intake of macro- and micronutrients, otherwise the risk of malnutrition is high.
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http://dx.doi.org/10.3390/nu12010260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019794PMC
January 2020

Circulating amino acid signature in older people with Parkinson's disease: A metabolic complement to the EXosomes in PArkiNson Disease (EXPAND) study.

Exp Gerontol 2019 12 27;128:110766. Epub 2019 Oct 27.

Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.

Background And Aim: Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder in old age. Neurotoxicity of dopaminergic neurons triggered by aggregation of misfolded α-synuclein is a major pathogenic trait of PD. However, growing evidence indicates that peripheral processes, including metabolic changes, may precede and contribute to neurodegeneration. The present study was undertaken to identify a metabolic signature of PD through the quantification of serum amino acids and derivatives.

Participants And Methods: Twenty older adults with PD (11 men and 9 women; mean age 73.1 ± 10.2 years) and 30 age-matched controls (14 men and 16 women; mean age 74.6 ± 4.3 years) were enrolled. A panel of 37 serum amino acids and derivatives was assessed by ultra-performance liquid chromatography/mass spectrometry. Partial least squares - discriminant analysis (PLS-DA) followed by double cross-validation was used to characterize the relationship between amino acid profiles and PD.

Results: The optimal complexity of the PLS-DA model was found to be three latent variables. The proportion of correct classifications was 99.3 ± 2.5% for participants with PD and 94.7 ± 3.0% for non-PD controls. Higher levels of β-amino butyric acid, cystine, ornithine, phosphoethanolamine, and proline defined the circulating amino acid profile of older people with PD. Controls were characterized by higher concentrations of 3-methyl-histidine, citrulline, and serine.

Conclusion: Our findings indicate the existence of a distinct metabotype in older persons with PD. Future studies will have to establish whether changes in amino acid metabolism are involved in the pathogenesis of PD. This knowledge may be harnessed to identify novel disease biomarkers as well as new targets for interventions.
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http://dx.doi.org/10.1016/j.exger.2019.110766DOI Listing
December 2019

Serum interleukin-6 and endotoxin levels and their relationship with fatigue and depressive symptoms in patients on chronic haemodialysis.

Cytokine 2020 01 18;125:154823. Epub 2019 Sep 18.

Università Cattolica del Sacro Cuore, Roma, Italy; Haemodialysis Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.

Background: Little is known about the underlying aetiology of fatigue in haemodialysis (HD) patients apart from a significant association and overlapping symptomatology with depressive symptoms. Growing evidence exists for the involvement of the immune system, by pro-inflammatory cytokines, in the development of fatigue in other inflammatory diseases. In HD patients, increased exposure to bacterial endotoxins may contribute to an inflammatory response and may potentially lead to fatigue. We therefore aimed (i) to assess the interrelationship between serum endotoxin (EA) levels, interleukin-6 (IL-6) levels and fatigue in HD patients; (ii) to evaluate whether there is a relationship between depressive symptoms and inflammation as well and (iii) to what extent depressive symptoms and fatigue are related to each other.

Methods: Fatigue and depressive symptoms in daily life were assessed in 59 individuals using the SF-36 vitality subscale and the Geriatric Depression Scale. Blood samples were collected on a mid-week dialysis session to determine EA levels, through the Endotoxin Activity Assay (EAA™), and IL-6 concentrations, through the commercially available Abcam ELISA (Enzyme-Linked Immunosorbent Assay) kit.

Results: EA, IL-6 levels and depressive symptoms were significantly correlated with fatigue. EA levels and depressive symptoms were significant predictors of fatigue, explaining 31% of its variance. However, EA and IL-6 were not significantly associated with depression.

Conclusions: Fatigue in HD patients may be related to endotoxemia and inflammation through IL-6. Furthermore, fatigue is significantly associated with depressive symptoms. Future research into the causal interrelationship of inflammation, fatigue and depression in HD patients might lead to potential targets for therapeutic strategies.
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http://dx.doi.org/10.1016/j.cyto.2019.154823DOI Listing
January 2020

The metabolomics side of frailty: Toward personalized medicine for the aged.

Exp Gerontol 2019 10 14;126:110692. Epub 2019 Aug 14.

Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, 00168 Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy.

Frailty encompasses several domains (i.e., metabolic, physical, cognitive). The multisystem derangements underlying frailty pathophysiology, its phenotypic heterogeneity, and the fluctuations of individuals across severity states have hampered a comprehensive appraisal of the condition. Circulating biomarkers emerged as an alleged tool for capturing this complexity and, as proxies for organismal metabolic changes, may hold the advantages of: 1) supporting diagnosis, 2) tracking the progression, 3) assisting healthcare professionals in clinical and therapeutic decision-making, and 4) verifying the efficacy of an intervention before measurable clinical manifestations occur. Among available analytical tools, metabolomics are able to identify and quantify the (ideally) whole repertoire of small molecules in biological matrices (i.e., cells, tissues, and biological fluids). Results of metabolomics analysis may define the final output of genome-environment interactions at the individual level. This entire collection of metabolites is called "metabolome" and is highly dynamic. Here, we discuss how monitoring the dynamics of metabolic profiles may provide a read-out of the environmental and clinical disturbances affecting cell homeostasis in frailty-associated conditions.
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http://dx.doi.org/10.1016/j.exger.2019.110692DOI Listing
October 2019

Reward (BIS/BAS) mechanisms and fatigue in patients on chronic hemodialysis.

Psychol Health Med 2020 07 11;25(6):710-718. Epub 2019 Aug 11.

Department of Psychology, Catholic University of the Sacred Heart , Milan, Italy.

Recently, it has been demonstrated that chronic inflammation could have a role on fatigue onset in chronic hemodialysis (HD). Research on neuro-immune interactions highlighted that an alteration of basal ganglia functioning, secondary to chronic inflammation, may translate in a reduced motivation and altered reward processes in chronic diseases. This study investigated a possible correlation between fatigue severity and reward mechanisms, that regulate motivational dispositions, in HD patients. Evaluation scales were administered to ninety-four patients on HD (54 Male, 40 Female; Md = 67±26.5; Dialytic Md in years = 4±6.3. Fatigue was assessed by using Fatigue Severity Scale (FSS). Behavioural Inhibition System (BIS) and Behavioural Activation System (BAS) Scale was administered to investigate approach/avoidance behaviours. Anxiety and depression were measured by State-Trait Anxiety Inventory (STAI-Y) and Beck Depression Inventory (BDI-II). Results show that the distribution of HD patients for FSS score did not show a normal pattern. FSS score was significantly higher in patients with high BIS Z-score than in patients with low and medium BIS Z-score. BDI score and STAI-Y scores were similar among BIS Z-score groups of patients. Findings suggest that in patients on chronic hemodialysis there is a correlation between fatigue severity symptoms and motivational disposition mechanisms that predispose to action inhibition.
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http://dx.doi.org/10.1080/13548506.2019.1653477DOI Listing
July 2020

Association between fatigue, motivational measures (BIS/BAS) and semi-structured psychosocial interview in hemodialytic treatment.

BMC Psychol 2019 Jul 23;7(1):49. Epub 2019 Jul 23.

Hemodialysis Service, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.

Background: Nowadays there is a growing interest in exploring causes of fatigue symptoms and the possible linked aspects in patients with Chronic Kidney Disease (CKD) receiving hemodialysis (HD) treatment. Inflammatory processes were demonstrated to influence motivational systems functioning in chronic conditions. However, there is a lack of connection between quantitative motivational systems measure and patients self-report motivational and fatigue issue. Thus, the aim of this study was to identify an association between HD patients reward mechanisms, fatigue severity and psychosocial variables emerging from semi-structured interviews.

Methods: Interviews were held for a sample of ninety-four patients (54 males, 40 females; M = 62.98 ± 17.94; dialytic mean age in months = 76.55 ± 84.89) receiving chronic HD treatment and consequently analyzed by means of quantitative and qualitative analysis. Behavioral motivation systems reflecting inhibition/approach tendency to rewards were measured by Behavioral Inhibition/Activation System (BIS/BAS) scale and the fatigue severity experienced by HD patients was measured with the Fatigue Severity Scale. Scale results were correlated to psychosocial variables and topics derived from the semi-structured interviews.

Results: Findings highlight the presence of two effects: one related to the Behavioral Activation System (BAS) as a protective factor against the HD treatment pervasive consequences; the other one deals with the self-reported levels of fatigue that seemed to significantly interfere with patients' daily life, as a function of gender.

Conclusions: Such results encourage the use of a mixed method approach to understand the complexity of the subjective experience of patients' facing chronic disease and treatments.
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http://dx.doi.org/10.1186/s40359-019-0321-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651918PMC
July 2019

Xerostomia in patients on chronic hemodialysis: An update.

Authors:
Maurizio Bossola

Semin Dial 2019 09 22;32(5):467-474. Epub 2019 May 22.

Servizio Emodialisi, Università Cattolica del Sacro Cuore, Roma, Italia.

Xerostomia, or dryness of oral cavity, is relatively common in patients on chronic hemodialysis and significantly impairs their quality of life. Xerostomia is often the consequence of reduced salivary flow resulting from atrophy and fibrosis of the salivary glands, an event that is of uncertain origin. Many medications commonly used in dialysis patients may also cause or exacerbate xerostomia. Its consequences may be serious and disturbing and include difficulties in chewing, swallowing, tasting, and speaking; increased risk of oral disease, including lesions of the mucosa, gingiva and tongue; bacterial and fungal infections, such as candidiasis, dental caries, and periodontal disease; interdialytic weight gain resulting from increased fluid intake; and a reduction in the quality of life. Therapeutically, stimulation of the salivary glands to increase the production of saliva mechanically by chewing-gum, mouthwash, acupressure, or transcutaneous electrical stimulation has had modest success. However, the long-term effectiveness of such treatments still needs to be investigated and defined. Xerostomia remains a frustrating and disturbing symptom for patients on hemodialysis. Further efforts should be made to find the causes and the mechanisms of the reduced salivary flow observed in patients on chronic hemodialysis.
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http://dx.doi.org/10.1111/sdi.12821DOI Listing
September 2019

Inflammatory signatures in older persons with physical frailty and sarcopenia: The frailty "cytokinome" at its core.

Exp Gerontol 2019 07 2;122:129-138. Epub 2019 May 2.

Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.

Background: The construct of physical frailty and sarcopenia (PF&S) identifies an age-related pre-disability condition defined by reduced physical performance and low muscle mass. Whether PF&S is characterized by perturbations of the cytokine network is presently unclear. Furthermore, the existence of gender-specific inflammatory profiles of PF&S is unknown. This study was designed to explore the association between a large panel of inflammatory biomolecules and PF&S in older adults through a multivariate statistical approach. Gender-specific inflammatory patterns were also explored.

Methods: One-hundred community-dwellers aged 70 years and older with PF&S and 100 non-sarcopenic, non-frail controls (nonPF&S) were enrolled. A panel of 30 circulating inflammatory biomarkers was assayed. Partial least squares discriminant analysis (PLS-DA) was employed to explore the relationship between inflammatory molecules and PF&S. Separate PLS-DA models were built for the whole sample and the two genders. Double cross-validation procedures were used to validate the predictive ability of PLS-DA models.

Results: The optimal complexity of the PLS-DA model built on the whole sample was found to be four latent variables. The proportion of correct classification was 75.6 ± 1.3% (82.3 ± 1.6% for enrollees with PF&S and 68.7 ± 2.5% for nonPF&S controls). The inflammatory profile of people with PF&S was defined by higher levels of P-selectin, C-reactive protein (CRP), and interferon γ-induced protein 10. NonPF&S participants were characterized by higher levels of myeloperoxidase (MPO), interleukin (IL) 8, monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α, platelet-derived growth factor (PDGF) BB. Gender-specific PLS-DA allowed identifying a "core" inflammatory signature of PF&S, composed by higher levels of CRP, and lower concentrations of MPO, IL8, MCP-1, and PDGF-BB, with peculiar patterns of relationships for men and women.

Conclusions: A core inflammatory profile was identified in people with PF&S with a gender-specific signature. The dissection of the PF&S "cytokinome" will provide novel insights into the role played by inflammation in the disabling cascade and allow designing personalized treatment strategies.
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http://dx.doi.org/10.1016/j.exger.2019.04.019DOI Listing
July 2019

Treating symptoms to improve the quality of life in patients on chronic hemodialysis.

Int Urol Nephrol 2019 May 19;51(5):885-887. Epub 2019 Mar 19.

Department of Gerontology, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.

Health-related quality of life (HRQOL) in patients on chronic hemodialysis has not improved significantly in the last 20 years. This is largely due to their substantial symptom burden which is rarely assessed and treated in routine clinical practice. This is also consequence of the lack of an appropriate armamentarium for the treatments of such symptoms. Adequate studies on the causes and pathogenesis of the symptoms of hemodialysis patients are needed followed by high-quality studies on possible therapeutic pharmacological and non-pharmacological interventions. Patients on chronic hemodialysis deserve a better quality of life.
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http://dx.doi.org/10.1007/s11255-019-02121-5DOI Listing
May 2019

Exploring the Diurnal Course of Fatigue in Patients on Hemodialysis Treatment and Its Relation With Depressive Symptoms and Classical Conditioning.

J Pain Symptom Manage 2019 05 16;57(5):890-898.e4. Epub 2019 Feb 16.

Università Cattolica del Sacro Cuore, Roma; Haemodialysis Unit, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia.

Context: Fatigue is one of the most prevalent symptoms among hemodialysis (HD) patients. To design effective treatments, it is crucial to understand the diurnal pattern of fatigue in this population.

Objectives: The objectives of this study were to assess diurnal changes in fatigue in patients undergoing hemodialysis and their relation with depressive symptoms and to explore whether fatigue may become a classically conditioned response to the hospital environment.

Methods: A prospective, observational study was conducted in 51 HD patients. Subjects repeatedly rated their current fatigue on three different days during one week of hemodialysis treatment to capture changes in momentary fatigue. First, on an HD treatment day, fatigue was measured one hour before and immediately before dialysis, as well as immediately after dialysis and again at 22:00 pm Second, on the postdialysis day and on the seventh weekday (when patients had not received treatment on the previous day), fatigue was measured at the same moments in time as the two measurements before dialysis on the treatment day. Beck Depression Inventory-II and Fatigue Severity Scale were administered to evaluate depressive mood and fatigue severity in daily life.

Results: Fatigue increased as a result of hemodialysis treatment over the entire sample. However, diurnal fatigue patterns differed significantly between individuals high and low in depressive symptoms, with the former being fatigued more constantly throughout the day, and the latter experiencing increases in fatigue due to treatment. Pretreatment fatigue experienced in the hospital environment followed a pattern consistent with the development of a classically conditioned response.

Conclusion: Diurnal fatigue patterns during hemodialysis treatment are associated with depressive symptoms, and classical conditioning may play a role in the experience of pretreatment fatigue.
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http://dx.doi.org/10.1016/j.jpainsymman.2019.02.010DOI Listing
May 2019

Administration of Enalapril Started Late in Life Attenuates Hypertrophy and Oxidative Stress Burden, Increases Mitochondrial Mass, and Modulates Mitochondrial Quality Control Signaling in the Rat Heart.

Biomolecules 2018 12 17;8(4). Epub 2018 Dec 17.

Fondazione Policlinico Universitario "Agostino Gemelli" IRCSS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.

Mitochondrial dysfunction is a relevant mechanism in cardiac aging. Here, we investigated the effects of late-life enalapril administration at a non-antihypertensive dose on mitochondrial genomic stability, oxidative damage, and mitochondrial quality control (MQC) signaling in the hearts of aged rats. The protein expression of selected mediators (i.e., mitochondrial antioxidant enzymes, energy metabolism, mitochondrial biogenesis, dynamics, and autophagy) was measured in old rats randomly assigned to receive enalapril ( = 8) or placebo ( = 8) from 24 to 27 months of age. We also assessed mitochondrial DNA (mtDNA) content, citrate synthase activity, oxidative lesions to protein and mtDNA (i.e., carbonyls and the abundance of mtDNA deletion), and the mitochondrial transcription factor A (TFAM) binding to specific mtDNA regions. Enalapril attenuated cardiac hypertrophy and oxidative stress-derived damage (mtDNA oxidation, mtDNA deletion, and protein carbonylation), while increasing mitochondrial antioxidant defenses. The binding of mitochondrial transcription factor A to mtDNA regions involved in replication and deletion generation was enhanced following enalapril administration. Increased mitochondrial mass as well as mitochondriogenesis and autophagy signaling were found in enalapril-treated rats. Late-life enalapril administration mitigates age-dependent cardiac hypertrophy and oxidative damage, while increasing mitochondrial mass and modulating MQC signaling. Further analyses are needed to conclusively establish whether enalapril may offer cardioprotection during aging.
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http://dx.doi.org/10.3390/biom8040177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315620PMC
December 2018

Lived experiences of patients on hemodialytic treatment: A discursive perspective on fatigue and motivational issues.

Health Psychol Open 2018 Jul-Dec;5(2):2055102918809761. Epub 2018 Nov 3.

Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.

Fatigue is an incapacitating symptom for patients on chronic hemodialysis treatment. This study explored the relationship between hemodialysis patients' subjective experience and motivation. The investigation of patients' narratives and fatigue-related factors was performed by holding semi-structured interviews with 31 hemodialysis patients. Fatigue Severity Scale and Behavioral Inhibition/Activation System questionnaire were used to assess fatigue severity and motivational mechanisms. Results showed significant differences in the use of specific topics and words (such as "family," "to manage," "dialysis," "psychological issues") depending on high, medium, and low Behavioral Inhibition System, Behavioral Activation System, and Fatigue Severity Scale scores, indicating that hemodialysis patients' narratives contain keywords related to the motivational sphere.
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http://dx.doi.org/10.1177/2055102918809761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236492PMC
November 2018

A Distinct Pattern of Circulating Amino Acids Characterizes Older Persons with Physical Frailty and Sarcopenia: Results from the BIOSPHERE Study.

Nutrients 2018 Nov 6;10(11). Epub 2018 Nov 6.

Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.

Physical frailty and sarcopenia (PF&S) are hallmarks of aging that share a common pathogenic background. Perturbations in protein/amino acid metabolism may play a role in the development of PF&S. In this initial report, 68 community-dwellers aged 70 years and older, 38 with PF&S and 30 non-sarcopenic, non-frail controls (nonPF&S), were enrolled as part as the "BIOmarkers associated with Sarcopenia and Physical frailty in EldeRly pErsons" (BIOSPHERE) study. A panel of 37 serum amino acids and derivatives was assayed by UPLC-MS. Partial Least Squares⁻Discriminant Analysis (PLS-DA) was used to characterize the amino acid profile of PF&S. The optimal complexity of the PLS-DA model was found to be three latent variables. The proportion of correct classification was 76.6 ± 3.9% (75.1 ± 4.6% for enrollees with PF&S; 78.5 ± 6.0% for nonPF&S). Older adults with PF&S were characterized by higher levels of asparagine, aspartic acid, citrulline, ethanolamine, glutamic acid, sarcosine, and taurine. The profile of nonPF&S participants was defined by higher concentrations of α-aminobutyric acid and methionine. Distinct profiles of circulating amino acids and derivatives characterize older people with PF&S. The dissection of these patterns may provide novel insights into the role played by protein/amino acid perturbations in the disabling cascade and possible new targets for interventions.
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http://dx.doi.org/10.3390/nu10111691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265849PMC
November 2018

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate.

Blood Purif 2019 19;47(1-3):45-51. Epub 2018 Sep 19.

Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy.

Introduction: The present study aimed to determine the variables that are associated with a longer dialysis recovery time (DRT) and to define the relationship that exists between DRT and the ultrafiltration rate (UFR) in prevalent chronic hemodialysis (CHD) patients.

Methods: We studied 210 prevalent CHD of 5 hemodialysis units in Central Italy. Patients were invited to answer to the question: "How long does it take you to recover from a dialysis session?" Answers to this question were subsequently converted into minutes. Demographic, clinical and laboratory parameters were recorded for each patient as well as the UFR (mL/kg/h), the dialysate sodium concentration and temperature.

Results: Median DRT was 180 min (60-420). Ninety five (45%) patients had a DRT ≥ the median value. Mean UFR was 9.2 ± 3.0 mL/kg/h. Patients with a lower DRT had a less prevalent disability in the instrumental activities daily living, had a higher UFR, and a lower dialysate temperature, as compared with subjects with higher DRT. According to the logistic regression model, UFR was associated with a DRT below the median (i.e., 180) in the unadjusted model (OR 1.12; 95% CI 1.02-1.23; p = 0.019), after adjusting for age and sex (OR 1.11; 95% CI 1.01-1.22; p = 0.025), and in the fully adjusted model (OR 1.11; 95% CI 1.04-1.22; p = 0.040). UFR increase was associated with increasing probability of DRT below the median (p for trend = 0.035). The highest tertile of DRT was associated with UFR below the mean value (i.e., 9.2 mL/kg/h) in multinomial logistic regression having the lowest DRT tertile as reference. DRT was significantly lower in patients with UFR > 13 mL/kg/h than in patients with UFR 10-13 or < 10 mL/kg/h.

Conclusion: DRT is inversely associated with UFR in CHD patients. Whether a high UFR should be recommended to reduce the DRT needs to be elucidated through an adequate prospective randomized study.
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http://dx.doi.org/10.1159/000492919DOI Listing
May 2019

Prevalence and Severity of Postdialysis Fatigue Are Higher in Patients on Chronic Hemodialysis With Functional Disability.

Ther Apher Dial 2018 Dec 4;22(6):635-640. Epub 2018 Jul 4.

Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.

The aim of the present study was to determine the intensity, duration, frequency and prevalence of postdialysis fatigue (PDF) in patients on chronic hemodialysis (PCD) with and without functional disability. Patients underwent assessment of functional ability by the Katz ADL (activity daily living) questionnaire and the Lawton and Brody scale for the instrumental activity daily living (IADL) fatigue using the SF-36 Vitality Subscale, comorbidity through the Charlson comorbidity score index (CDI), and time of recovery after hemodialysis (TIRD). We studied 271 PCD. ADL and IADL disabilities were present in 75 (27.6%) and 168 (62%) patients, respectively. Patients with ADL disability were significantly older and showed higher CDI scores, and lower levels of serum albumin and Kt/V. Prevalence of PDF was significantly higher in patients with ADL disability as well as its severity, intensity, duration and frequency. Patients with IADL disability were significantly older, had a higher CCI score, had lower levels of serum albumin and Kt/V, and had a higher severity, intensity, duration and frequency of PDF. At multivariate regression analysis, ADL disability was positively associated with age, prevalence and severity of PDF, and dialysate temperature and inversely associated with serum albumin levels. IADL disability was instead positively associated with age and dialysate temperature and inversely associated with serum albumin levels. In conclusion, prevalence and severity of PDF are significantly higher in PCD with ADL disability than in those without it. This knowledge may have important implications for the development of interventions to reduce PDF in PCD.
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http://dx.doi.org/10.1111/1744-9987.12705DOI Listing
December 2018

The "BIOmarkers associated with Sarcopenia and PHysical frailty in EldeRly pErsons" (BIOSPHERE) study: Rationale, design and methods.

Eur J Intern Med 2018 10 10;56:19-25. Epub 2018 May 10.

Department of Geriatrics, Neuroscience and Orthopedics, Teaching Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, Rome, Italy.

Sarcopenia, the progressive and generalised loss of muscle mass and strength/function, is a major health issue in older adults given its high prevalence and burdensome clinical implications. Over the years, this condition has been endorsed as a marker for discriminating biological from chronological age. However, the absence of a unified operational definition has hampered its full appreciation by healthcare providers, researchers and policy-makers. In addition to this unsolved debate, the complexity of musculoskeletal ageing represents a major challenge to the identification of clinically meaningful biomarkers. Here, we illustrate the advantages of biomarker discovery procedures in muscle ageing based on multivariate methodologies as an alternative approach to traditional single-marker strategies. The rationale, design and methods of the "BIOmarkers associated with Sarcopenia and PHysical frailty in EldeRly pErsons" (BIOSPHERE) study are described as an application of a multi-marker strategy for the development of biomarkers for the newly operationalised Physical Frailty & Sarcopenia condition.
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http://dx.doi.org/10.1016/j.ejim.2018.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367722PMC
October 2018

Fatigue is associated with high prevalence and severity of physical and emotional symptoms in patients on chronic hemodialysis.

Int Urol Nephrol 2018 Jul 4;50(7):1341-1346. Epub 2018 May 4.

Hemodialysis Service, Institute of Clinical Surgery, Catholic University of the Sacred Heart, Rome, Italy.

Purpose: The symptom burden of fatigued hemodialysis patients is poorly known. We aimed to investigate possible differences in the prevalence and severity of symptoms between fatigued and not fatigued patients on chronic hemodialysis.

Methods: All prevalent patients on chronic hemodialysis referring to the Hemodialysis Service between January 2016 and June 2017 were considered eligible. The Dialysis Symptom Index (DSI) questionnaire was performed during the dialysis treatment. Patients underwent assessment of fatigue using the Italian version of the vitality scale of the SF-36 (SF-36VS).

Results: We studied 137 patients: 107 (78.1%) were fatigued and 30 (31.9%) were non-fatigued. The median [95% CI] number of symptoms was 15 [14-16] for patients who reported fatigue and 9 [8-19] for the non-fatigued (P < 0.0001). In fatigued patients, with respect to non-fatigued ones, the prevalence of dry skin, itching, muscle soreness, bone or joint pain, restless legs, shortness of breath, feeling sad, feeling anxious, difficulty concentrating, and difficulty becoming sex aroused was significantly higher. Restless legs, feeling sad, difficulty concentrating, and difficulty becoming sex aroused were symptoms independently associated with fatigue. The severity of dry skin, trouble staying asleep, and bone/joint pain was higher in fatigued patients.

Conclusion: Fatigued hemodialysis patients report suffering from physical and emotional symptoms more frequently than non-fatigued patients. This finding suggests the need to accurately and routinely define the symptom burden of chronic hemodialysis patients and may help to investigate eventually common underlying pathogenic mechanisms of symptoms in these patients.
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http://dx.doi.org/10.1007/s11255-018-1875-0DOI Listing
July 2018