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  1. Article ; Online: Nothing is less green than war.

    Piccoli, Giorgina Barbara / Bianchi, Stefano / De Nicola, Luca

    Journal of nephrology

    2023  Volume 36, Issue 8, Page(s) 2163–2164

    Language English
    Publishing date 2023-11-06
    Publishing country Italy
    Document type Editorial
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-023-01812-8
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    Zs.A 3369: Show issues Location:
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  2. Article: New trials in resistant hypertension: mixed blessing stories.

    Zoccali, Carmine / Mallamaci, Francesca / De Nicola, Luca / Minutolo, Roberto

    Clinical kidney journal

    2023  Volume 17, Issue 1, Page(s) sfad251

    Abstract: Resistant hypertension (RH) is linked to an increased risk of cardiovascular and renal complications. Treatment options include non-pharmacological interventions, such as lifestyle modifications, and the use of specific antihypertensive drug combinations, ...

    Abstract Resistant hypertension (RH) is linked to an increased risk of cardiovascular and renal complications. Treatment options include non-pharmacological interventions, such as lifestyle modifications, and the use of specific antihypertensive drug combinations, including diuretics. Renal denervation is another option for treatment-resistant hypertension. New compounds targeting different pathways involved in RH-including inhibitors of aminopeptidase A, endothelin antagonists and selective aldosterone synthase inhibitors-have been tested in clinical trials in this condition. The centrally acting drug firibastat, targeting the brain renin-angiotensin system, failed to demonstrate significant effectiveness in reducing blood pressure (BP) in patients with difficult-to-treat and RH in the Firibistat in Resistant Hypertension (FRESH) trial. Aprocitentan, a dual endothelin A and B receptor antagonist, showed a moderate but statistically significant decrease in BP in patients with RH in the Parallel-Group, Phase 3 Study with Aprocitentan in Subjects with Resistant Hypertension (PRECISION) trial. However, concerns remain about potential adverse events, such as fluid retention. The use of baxdrostat, a selective aldosterone synthase inhibitor, showed promising results in reducing BP in patients with treatment-resistant hypertension in the Baxdrostat in Resistant Hypertension (BrigHTN) trial. However, a subsequent trial, HALO, failed to meet its primary endpoint. The unexpected results may be influenced by factors such as patient adherence and white-coat hypertension. Despite the disappointing results from HALO, the potential benefits of inhibiting aldosterone synthesis remain to be fully understood. In conclusion, managing RH remains challenging, and new compounds like firibastat, aprocitentan and baxdrostat have shown varied effectiveness. Further research is needed to improve our understanding and treatment of this condition.
    Language English
    Publishing date 2023-09-27
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfad251
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  3. Article ; Online: Reply to Mocanu CA et al.

    Bellizzi, Vincenzo / Signoriello, Simona / Chiodini, Paolo / De Nicola, Luca

    The American journal of clinical nutrition

    2022  Volume 116, Issue 3, Page(s) 838–839

    Language English
    Publishing date 2022-07-17
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 280048-2
    ISSN 1938-3207 ; 0002-9165
    ISSN (online) 1938-3207
    ISSN 0002-9165
    DOI 10.1093/ajcn/nqac156
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  4. Article: Thiazide diuretics are back in CKD: the case of chlorthalidone.

    Minutolo, Roberto / De Nicola, Luca / Mallamaci, Francesca / Zoccali, Carmine

    Clinical kidney journal

    2022  Volume 16, Issue 1, Page(s) 41–51

    Abstract: Sodium and volume excess is the fundamental risk factor underlying hypertension in chronic kidney disease (CKD) patients, who represent the prototypical population characterized by salt-sensitive hypertension. Low salt diets and diuretics constitute the ... ...

    Abstract Sodium and volume excess is the fundamental risk factor underlying hypertension in chronic kidney disease (CKD) patients, who represent the prototypical population characterized by salt-sensitive hypertension. Low salt diets and diuretics constitute the centrepiece for blood pressure control in CKD. In patients with CKD stage 4, loop diuretics are generally preferred to thiazides. Furthermore, thiazide diuretics have long been held as being of limited efficacy in this population. In this review, by systematically appraising published randomized trials of thiazides in CKD, we show that this class of drugs may be useful even among people with advanced CKD. Thiazides cause a negative sodium balance and reduce body fluids by 1-2 l within the first 2-4 weeks and these effects go along with improvement in hypertension control. The recent CLICK trial has documented the antihypertensive efficacy of chlorthalidone, a long-acting thiazide-like diuretic, in stage 4 CKD patients with poorly controlled hypertension. Overall, chlorthalidone use could be considered in patients with treatment-resistant hypertension when spironolactone cannot be administered or must be withdrawn due to side effects. Hyponatremia, hypokalaemia, volume depletion and acute kidney injury are side effects that demand a vigilant attitude by physicians prescribing these drugs. Well-powered randomized trials assessing hard outcomes are still necessary to more confidently recommend the use of these drugs in advanced CKD.
    Language English
    Publishing date 2022-09-07
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfac198
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  5. Article ; Online: Evolving Strategies in the Treatment of Anaemia in Chronic Kidney Disease: The HIF-Prolyl Hydroxylase Inhibitors.

    Locatelli, Francesco / Minutolo, Roberto / De Nicola, Luca / Del Vecchio, Lucia

    Drugs

    2022  Volume 82, Issue 16, Page(s) 1565–1589

    Abstract: Chronic kidney disease (CKD) affects approximately 10% of the worldwide population; anaemia is a frequent complication. Inadequate erythropoietin production and absolute or functional iron deficiency are the major causes. Accordingly, the current ... ...

    Abstract Chronic kidney disease (CKD) affects approximately 10% of the worldwide population; anaemia is a frequent complication. Inadequate erythropoietin production and absolute or functional iron deficiency are the major causes. Accordingly, the current treatment is based on iron and erythropoiesis stimulating agents (ESAs). Available therapy has dramatically improved the management of anaemia and the quality of life. However, safety concerns were raised over ESA use, especially when aiming to reach near-to-normal haemoglobin levels with high doses. Moreover, many patients show hypo-responsiveness to ESA. Hypoxia-inducible factor (HIF) prolyl hydroxylase domain (PHD) inhibitors (HIF-PHIs) were developed for the oral treatment of anaemia in CKD to overcome these concerns. They simulate the body's exposure to moderate hypoxia, stimulating the production of endogenous erythropoietin. Some molecules are already approved for clinical use in some countries. Data from clinical trials showed non-inferiority in anaemia correction compared to ESA or superiority for placebo. Hypoxia-inducible factor-prolyl hydroxylase domain inhibitors may also have additional advantages in inflamed patients, improving iron utilisation and mobilisation and decreasing LDL-cholesterol. Overall, non-inferiority was also shown in major cardiovascular events, except for one molecule in the non-dialysis population. This was an unexpected finding, considering the lower erythropoietin levels reached using these drugs due to their peculiar mechanism of action. More data and longer follow-ups are necessary to better clarifying safety issues and further investigate the variety of pathways activated by HIF, which could have either positive or negative effects and could differentiate HIF-PHIs from ESAs.
    MeSH term(s) Humans ; Prolyl-Hydroxylase Inhibitors/pharmacology ; Prolyl-Hydroxylase Inhibitors/therapeutic use ; Quality of Life ; Anemia/drug therapy ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/drug therapy ; Erythropoietin/therapeutic use ; Hematinics/therapeutic use ; Iron ; Prolyl Hydroxylases
    Chemical Substances Prolyl-Hydroxylase Inhibitors ; Erythropoietin (11096-26-7) ; Hematinics ; Iron (E1UOL152H7) ; Prolyl Hydroxylases (EC 1.14.11.-)
    Language English
    Publishing date 2022-11-09
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 120316-2
    ISSN 1179-1950 ; 0012-6667
    ISSN (online) 1179-1950
    ISSN 0012-6667
    DOI 10.1007/s40265-022-01783-3
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    Zs.A 762: Show issues Location:
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  6. Article ; Online: Recommendations on nutritional intake of potassium in CKD: it's now time to be more flexible!

    De Nicola, Luca / Garofalo, Carlo / Borrelli, Silvio / Minutolo, Roberto

    Kidney international

    2022  Volume 102, Issue 4, Page(s) 700–703

    MeSH term(s) Eating ; Humans ; Potassium ; Renal Insufficiency, Chronic
    Chemical Substances Potassium (RWP5GA015D)
    Language English
    Publishing date 2022-09-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2022.04.046
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    Zs.A 797: Show issues Location:
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  7. Article ; Online: Resistance to erythropoiesis stimulating agents in a dialysis patient after kidney graft failure.

    Borrelli, Silvio / Garofalo, Carlo / Marzano, Federica / Ambrosino, Paolo Tino / Andriella, Simona / De Nicola, Luca / Minutolo, Roberto

    Journal of nephrology

    2024  

    Language English
    Publishing date 2024-01-18
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-023-01836-0
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  8. Article: The effect of a ketogenic diet on weight loss in CKD: a randomized controlled trial in obese stage G1-3a CKD patients.

    Zoccali, Carmine / Bellizzi, Vincenzo / Minutolo, Roberto / Mallamaci, Francesca / Conte, Giuseppe / De Nicola, Luca

    Clinical kidney journal

    2023  Volume 16, Issue 12, Page(s) 2309–2313

    Abstract: This study describes a multicentre randomized controlled trial comparing the effects of a ketogenic diet with a low-energy standard diet containing 0.8 g/kg/day on weight loss and metabolic alterations in adult patients with mild-to-moderate non-diabetic ...

    Abstract This study describes a multicentre randomized controlled trial comparing the effects of a ketogenic diet with a low-energy standard diet containing 0.8 g/kg/day on weight loss and metabolic alterations in adult patients with mild-to-moderate non-diabetic chronic kidney disease (CKD) and mild-to-severe obesity. The study is being conducted to understand the impact of the ketogenic diet on weight loss in these patients, as the existing evidence on the ketogenic diet's effect in CKD patients is limited and inconclusive. The study will enrol mild-to moderate adult CKD patients (Stages G1-3a) with albumin to creatinine ratio ≥200 mg/g, without diabetes, with obesity (body mass index ≥30 kg/m
    Language English
    Publishing date 2023-07-18
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfad176
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  9. Article ; Online: Estimated glomerular filtration rate in observational and interventional studies in chronic kidney disease.

    Provenzano, Michele / Hu, Lilio / Abenavoli, Chiara / Cianciolo, Giuseppe / Coppolino, Giuseppe / De Nicola, Luca / La Manna, Gaetano / Comai, Giorgia / Baraldi, Olga

    Journal of nephrology

    2024  

    Abstract: Estimated glomerular filtration rate is considered the principal measure of kidney function and, together with albuminuria, is a relevant prognostic factor for the development of end-stage kidney disease. Due to the strong association between estimated ... ...

    Abstract Estimated glomerular filtration rate is considered the principal measure of kidney function and, together with albuminuria, is a relevant prognostic factor for the development of end-stage kidney disease. Due to the strong association between estimated glomerular filtration rate and clinical events, such as commencement of dialysis, cardiovascular outcomes and all-cause death, estimated glomerular filtration rate is crucial for clinical decision-making in terms of scheduling follow-up and pharmacological interventions, and planning renal replacement therapies in advanced chronic kidney disease. In this review we discuss the available methods for measuring glomerular filtration rate and for estimating it through mathematical equations developed over the last few decades. We summarize the prognostic association of different percentages of estimated glomerular filtration rate decline and the main clinical outcomes, and how treatments modify estimated glomerular filtration rate decline and the risk of future endpoints. We also examine the role of pre-clinical trial slope and that of estimated glomerular filtration rate as a useful biomarker when evaluating patients for inclusion into both observational and interventional studies.
    Language English
    Publishing date 2024-02-12
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-024-01887-x
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  10. Article ; Online: Recommendations for the management of hyperkalemia in patients receiving renin-angiotensin-aldosterone system inhibitors.

    De Nicola, Luca / Ferraro, Pietro Manuel / Montagnani, Andrea / Pontremoli, Roberto / Dentali, Francesco / Sesti, Giorgio

    Internal and emergency medicine

    2023  Volume 19, Issue 2, Page(s) 295–306

    Abstract: Hyperkalemia is common in clinical practice and can be caused by medications used to treat cardiovascular diseases, particularly renin-angiotensin-aldosterone system inhibitors (RAASis). This narrative review discusses the epidemiology, etiology, and ... ...

    Abstract Hyperkalemia is common in clinical practice and can be caused by medications used to treat cardiovascular diseases, particularly renin-angiotensin-aldosterone system inhibitors (RAASis). This narrative review discusses the epidemiology, etiology, and consequences of hyperkalemia, and recommends strategies for the prevention and management of hyperkalemia, mainly focusing on guideline recommendations, while recognizing the gaps or differences between the guidelines. Available evidence emphasizes the importance of healthcare professionals (HCPs) taking a proactive approach to hyperkalemia management by prioritizing patient identification and acknowledging that hyperkalemia is often a long-term condition requiring ongoing treatment. Given the risk of hyperkalemia during RAASi treatment, it is advisable to monitor serum potassium levels prior to initiating these treatments, and then regularly throughout treatment. If RAASi therapy is indicated in patients with cardiorenal disease, HCPs should first treat chronic hyperkalemia before reducing the dose or discontinuing RAASis, as reduction or interruption of RAASi treatment can increase the risk of adverse cardiovascular and renal outcomes or death. Moreover, management of hyperkalemia should involve the use of newer potassium binders, such as sodium zirconium cyclosilicate or patiromer, as these agents can effectively enable optimal RAASi treatment. Finally, patients should receive education regarding hyperkalemia, the risks of discontinuing their current treatments, and need to avoid excessive dietary potassium intake.
    MeSH term(s) Humans ; Renin-Angiotensin System ; Hyperkalemia ; Renal Insufficiency, Chronic/complications ; Potassium ; Kidney ; Heart Failure/complications
    Chemical Substances Potassium (RWP5GA015D)
    Language English
    Publishing date 2023-09-29
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-023-03427-0
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