Pescia Hospital

Pescia, Italy

Pescia Hospital

Pescia, Italy

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Cupisti A.,University of Pisa | D'Alessandro C.,University of Pisa | Valeri A.,University of Pisa | Capitanini A.,Pescia Hospital | And 3 more authors.
Renal Failure | Year: 2010

This is a cross-sectional, multicenter, controlled study aiming to evaluate changes of actual dietary nutrient intake in 94 stable hemodialysis patients in respect to 52 normal subjects and guideline recommendations, and to assess the prevalence of signs of malnutrition. Energy and nutrients intake assessment was obtained by a three-day period food recall. Anthropometric and biochemical parameters of nutrition, bioelectric impedance vector analysis, and subjective global assessment (SGA) have been performed to assess nutritional status. SGA-B was scored in 5 of the patients. Body mass index < 20 Kgm2, serum albumin <35 gL, nPNA < 1.0 gKg, and phase angle <4.0° were detected in 16.3, 16, 23, and 8.0 of patients, respectively. HD patients showed a lower energy and protein intake in respect to controls, but no difference occurred when normalized per ideal body weight (29.3 ± 8.4 vs. 29.5 ± 8.4 KcalKg i.b.w.d and 1.08 ± 0.35 vs. 1.12 ± 0.32 KcalKg i.b.w. d, respectively). Age was the only parameter that inversely correlates with energy (r -0.35, p < 0.001) and protein intake (r -0.34, p < 0.001). This study shows that in stable dialysis patients, abnormalities of nutritional parameters are less prevalent than expected by analysis of dietary food intake. Age is the best predictor of energy and protein intake in the dialysis patients who ate less than normal people, but no difference emerged when energy and protein intakes were normalized for body weight. These results recall the attention for individual dietetic counseling in HD patients, and also for a critical re-evaluation of their dietary protein and energy requirements. © Informa UK, Ltd.


Cupisti A.,University of Pisa | Capitanini A.,Pescia Hospital | Betti G.,Massa Carrara Hospital | D'Alessandro C.,University of Pisa | Barsotti G.,University of Pisa
Clinical Nephrology | Year: 2011

Background and aim: Assessment of physical activity level and of energy expenditure is important in the clinical and nutritional care of dialysis patients, but it is not so easy to accomplish. The Sense Wear™ Armband (SWA) is a novel multisensory device that is worn on the upper arm and collects a variety of physiologic data related to physical activity. Thus, duration and intensity of physical activity is recorded and expressed as METs (Metabolic Equivalent Task), and energy expenditure is estimated. The aim of our study was to assess interdialytic spontaneous physical activity in stable chronic hemodialysis (HD) patients and the relation to nutritional status and dietary nutrient intake. Patients and methods: In 50 stable patients on maintenance hemodialysis treatment and 33 normal subjects (control group), level of spontaneous physical activity and estimated daily energy expenditure was assessed by SWAand related to biochemistry and anthropometry data, bioelectric impedance vector analysis, and energy and nutrient intake information coming from a 3-day food recall. Results: In respect to controls, HD patients showed lower mean daily METs value (1.3 ± 0.3 vs. 1.5 ± 0.2, p < 0.01), a lower time spent on activities > 3 METs (89 ± 85 vs. 143 ± 104 min/day, p < 0.05), lower number of steps per day (5,584 ± 3,734 vs. 11,735 ± 5,130, p < 0.001), resulting in a lower estimated energy expenditure (2,190 ± 629 vs. 2,462 ± 443 Kcal/day, p < 0.05). 31 out of the 50 HD patients (62%) had a mean daily value < 1.4 METs and hence were defined as sedentary. They differed from the active patients for higher age (63 ± 12 vs. 54 ± 12 y, p < 0.01), lower energy intake (26.1 ± 6.4 vs. 32.4 ± 11.3 Kcal/day, p < 0.05) and lower phase angle (5.5 ± 1.0 vs. 6.3 ± 0.9, p < 0.05). SWA-based estimation of daily energy expenditure was negatively related to age (r = -0.31, p < 0.05), whereas positive relations were observed with BMI (r = 0.51, p < 0.001), phase angle (r = 0.40, p < 0.01), serum phosphate (r = 0.49, p < 0.001) and albumin (r = 0.41, p < 0.01). The mean daily METs values were strongly related to normalized energy intake (r = 0.47, p < 0.001) and also to protein intake (r = 0.33, p < 0.05) and to phase angle (r = 0.38, p < 0.01). Multiple regression analysis showed that energy intake and dietary protein intake were independently related to the intensity of physical activity. Conclusion: Our findings indicate that poor physical activity is highly prevalent in stable dialysis patients even when free from physical or neurological disabilities or severe comorbid conditions. The level and intensity of physical activity is positively related to body composition and to dietary nutrient intake. This confirms the strong interrelationship between exercise and nutrition, which in turn are associated with survival, rehabilitation and quality of life in dialysis patients. ©2011 Dustri-Verlag Dr. K. Feistle.


Bulckaen M.,Pescia Hospital | Capitanini A.,Pescia Hospital | Lange S.,Pescia Hospital | Caciula A.,Pescia Hospital | And 2 more authors.
Journal of Nephrology | Year: 2011

Introduction: Exercise training is beneficial for hemodialysis patients, but it should be tailored to individual abilities and willingness to participate. This study evaluated the effects of different 6-month programs of physical activity in 18 patients of a single hemodialysis unit.Methods: Before and after a 12-month control period (T0), and following 3 (T3) and 6 (T6) months of training, the patients underwent the 6-minute walk test (6MWT) and constant treadmill test at 3 km/hour speed and 10% grade; spontaneous physical activity was assessed by pedometers. All patients trained for coordination, flexibility and muscular strengthening for 30 minutes within the first 2 hours of hemodialysis sessions: 9 patients underwent home exercise walking training (advised walking group [AWG]); the other 9 patients underwent the advised home training program plus an additional supervised gym training session, twice weekly (supervised walking group [SWG]). Results: In both AWG and SWG, no changes occurred during the control period (232 ± 204 m and 248 ± 187 m at T0). In contrast, endurance performance at treadmill increased at T3 and T6 in the AWG (377 ± 272 m and 615 ± 413 m; p<0.01) and in the SWG (424 ± 272 m and 890 ± 364 m; p<0.001). No unwanted side effects occurred. Conclusion: This study shows that physical exercise programs can safely increase physical performance in hemodialysis patients. The training program should be continued for at least 6 months to increase muscle strength and endurance. Intradialytic exercise and home-based, pedometer-based regimens may be a useful and easy approach, whereas supervised programs can give additional benefits in motivated, selected patients. © 2011 Societa Italiana di Nefrologia.


Masotti L.,Santa Maria Nuova Hospital | Masotti L.,Cecina Hospital | Lorenzini G.,Cecina Hospital | Lorenzini G.,University of Pisa | And 5 more authors.
Journal of Thrombosis and Thrombolysis | Year: 2015

Although new oral anticoagulants (NOAs) have been marketed in many countries, concern exists about the management of bleedings related to these drugs due to the lack of specific antidotes. The aim of our study was to report on real life management of NOAs-related life-threatening or major bleedings. We report data from consecutive cases of NOAs related major bleedings admitted to 4 hospitals since NOAs became marketed in Italy. We treated 8 patients, 4 males, with mean age 84 ± 7 years, 7 of whom were on dabigatran and one on rivaroxaban. The indication for NOA was atrial fibrillation. All bleedings were spontaneous and involving the gastro-intestinal tract. At the time of bleeding all patients had a drop in hemoglobin levels over 20 g/L. Creatinine clearance was ≤30 mL/min in 4 patients. All patients received general supportive measures, 4 of 8 patients were transfused with packed red cells and one patient received platelet transfusion. Three patients were treated with tranexamic acid and one patient on dabigatran received 4-factor prothrombin complex concentrate (PCC) with bleeding cessation, although coagulation parameters were not corrected. The median time for normalization of coagulation parameters was 3 days (range 1–6 days). All patients were discharged alive and NOAs were discontinued. In NOAs related major gastro-intestinal bleeding general supportive measures seem to be effective for the majority of patients. Despite promoting bleeding cessation, 4-factor PCC does not reverse abnormal coagulation parameters. © 2014, Springer Science+Business Media New York.


Atzori L.,University of Cagliari | Antonucci R.,University of Cagliari | Barberini L.,University of Cagliari | Locci E.,University of Cagliari | And 7 more authors.
Frontiers in Bioscience - Elite | Year: 2010

Pediatric nephrourological diseases are associated with functional alterations frequently related to inflammatory states. A feedback loop adjusts urinary system function while forcing adaptation to internal and external influences during disease development and as a result of treatment. We hypothesized that nephrourological dysfunction would alter the urine metabolite pattern in children in a defined manner. To characterize the metabolite patterns associated with nephrouropathies, a proton nuclear magnetic resonance ( 1H NMR)-based metabonomic analysis was performed on urine samples obtained from twenty-one children affected by nephrouropathies and 19 healthy controls. Urine samples were analyzed with a 400 MHz Varian spectrometer and multivariate statistical techniques were applied for data interpretation. Linear discriminant analysis-based classification of the spectral data demonstrated high accuracy (95%) in the separation of the two groups of samples. By extension, the urine metabolite profiles were shown to correlate with nephrourological disorders in our model. In conclusion, 1H NMR-based metabonomic analysis of urine appears to be a promising, non-invasive approach for investigating and monitoring pediatric nephrourological diseases.


Atzori L.,University of Cagliari | Antonucci R.,University of Cagliari | Barberini L.,University of Cagliari | Locci E.,University of Cagliari | And 9 more authors.
Frontiers in Bioscience - Elite | Year: 2011

Metabolomics is a technique used to noninvasively determine metabolic status of an organism. Aim of our study was to analyze urinary metabolic profiles in term and preterm infants in order to identify gestational age-related metabolic differences and to predict metabolic maturity at birth. Twenty-six healthy term infants and 41 preterm infants were prospectively enrolled. A urine sample was collected non-invasively within the first hours of life. Samples were analyzed by proton nuclear magnetic resonance (1H NMR) spectroscopy and NMR urine spectra were analyzed by multivariate statistical analysis. Distinct metabolic patterns were found between term infants and preterm infants, as well as between preterm infants of 23- 32 weeks' gestation and those of 33-36 weeks' gestation. Individual metabolites discriminating between these groups were hippurate, tryptophan, phenylalanine, malate, tyrosine, hydroxybutyrate, N-acetyl-glutamate, and proline. Metabolomic analysis revealed distinct urinary metabolic profiles in neonates of different gestational ages, and identified the discriminating metabolites. This holistic approach appears to be a promising tool for investigating newborn metabolic maturation over time, and might lead to a tailored management of neonatal disorders.

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