Drugs and kidney in the elderly patient

Abstract

With aging, different factors contribute to change the pharmacokinetics and pharmacodynamics of drugs and therefore can cause variable and unpredictable clinical outcomes.

As we age, the body composition changes, liver and kidney blood flow decreases resulting in reduced function of both organs and therefore decreased metabolism and insufficient elimination of drugs. On the other hand, the elderly are at greater risk in the use of drugs both for the reasons listed above and for the presence of diseases that determine the intake of numerous drugs that can interact with each other. The lower physiological reserves and the conditions related to fragility contribute to the occurrence of toxicity or adverse events related to therapy. To these causes are added factors related to the health system such as the fragmentation of care with multiple prescribers and inadequate training in treating the elderly patient. The need for correct reconnaissance and pharmacological reconciliation is therefore of fundamental importance.

The frequency of adverse drug reactions is about three to ten times higher in the elderly patient and clinically the adverse reactions are more severe. Furthermore, there is a close relationship between the incidence of adverse reactions and renal function which is in turn responsible for changes in the pharmacokinetics and pharmacodynamics of drugs and the kidney is very often the target organ of adverse drug reactions.

 

Keywords: Drugs, kidney, adverse drugs reactions, drugs toxicity

Sorry, this entry is only available in Italian.

Kidney Transplant from donors after cardiac death (DCD): monocentric experience and literature review

Abstract

Kidney transplant from donor after circulatory death (DCD) represents a valid choice to increase the incidence of renal transplantation, presenting recipients’ and grafts’ survival rates comparable to those from brain dead donors (DBD). In January 2016, the Transplant Referral Center in the Emilia Romagna region has started a DCD program. In the present study we report on the first 30 months of the program as far as our own Center in Bologna is concerned, and we provide a comparison with DBD transplants performed over the same period. From January 2016 to September 2018, 16 kidney transplants from 10 DCD donors (5 SCD-DCD and 5 ECD-DCD) have been performed, with two graft-loss at 12 months of follow-up, both due to renal artery rupture caused by infectious arteritis with consequent transplantectomy. Two patients died due to sepsis. Seven (44%) delay graft function (DGF) have been reported. No differences have been found between DCD and DBD in terms of kidney function (serum creatinine and eGFR evaluated at discharge, 12 and 24 months of follow-up). Kidney from marginal donors (ECD-DCD or KDPI >65%) were associated with a higher rate of DGF and worst graft function at discharge. All the predicting factors that have been analysed, including Karpinsky Score, failed to show an association with serum creatinine and eGFR at 12 and 24 months of follow up.

Keywords: DCD, transplant, kidney, perfusion, outcomes, asystole

Sorry, this entry is only available in Italian.

Antifibrotic renal role of mineralcorticoid receptor antagonists

Abstract

Cardiovascular and renal diseases are one of the main health problems in all industrialized countries. Their incidence is constantly increasing due to the aging of the population and the greater prevalence of obesity and type 2 diabetes.

Clinical evidence suggests that aldosterone and the activation of mineralocorticoid receptors (MR) have a role in the pathophysiology of cardiovascular and renal diseases. Moreover, clinical studies demonstrate the benefits of mineralocorticoid receptor antagonists (MRAs) on mortality and progression of heart and kidney disease.

In addition to renal effects on body fluid homeostasis, aldosterone has multiple extrarenal effects including the induction of inflammation, vascular rigidity, collagen formation and stimulation of fibrosis.

Given the fundamental role of MR activation in renal and cardiac fibrosis, effective and selective blocking of the signal with MRAs can be used in the clinical practice to prevent or slow down the progression of heart and kidney diseases.

The aim of the present work is to review the role of MRAs in light of the new evidence as well as its potential use as an antifibrotic in chronic kidney disease (CKD). The initial clinical results suggest that MRAs are potentially useful in treating patients with chronic kidney disease, particularly in cases of diabetic nephropathy. We don’t yet have efficacy and safety data on the progression of kidney disease up to the end stage (ESRD) and filling this gap represents an important target for future trials.

 

Key words: mineralocorticoid receptor, aldosterone, kidney, cardiac, fibrosis

Sorry, this entry is only available in Italian.