Artificial intelligence and video dialysis, diabetes and obesity, microbiota, nutrition and fitness. These are some of the themes of the 63rd Congress of the Italian Society of Nephrology, which will take place from 5 to 8 October in Rimini, a moment of debate and comparison that summarizes the complexities of an open, evolving and increasingly necessary discipline. We will also discuss the biomarkers under study for earlier diagnosis and more effective therapies, the diagnostic-therapeutic novelties and the indissoluble kidney-heart link. Technology revolutionizes the lives of patients with chronic kidney disease: already today in some regions – including Lombardy, Piedmont and Puglia – it is possible to perform dialysis treatment ‘remotely’. Pioneering experiences that respond to the concrete needs of these extremely fragile patients, forced to move from their home even 3 times a week, with an important impact on healthcare costs and quality of life. “About 20% of dialysis treatments – explains Piergiorgio Messa, president of the Italian Society of Nephrology (SIN), former director of the Complex Operative Unit of Nephrology, Dialysis and Kidney Transplant – Polyclinic of Milan and full professor of Nephrology at the University of Milan – could be managed remotely (home dialysis), while 70/80% of extracorporeal dialysis remains, which requires the presence of a nurse or a caregiver who has undergone adequate training (ranging from 3 to 6 months). Peritoneal dialysis constitutes the real challenge of the next few years in terms of replacement therapy, being the technique that has more roots in the area and greater possibilities of conducting with telemedicine and video-dialysis techniques ”.
Not only home therapy, the technology also makes it possible to improve the safety of patients monitored remotely. Thanks to Artificial Intelligence (AI), in fact, the data obtained remotely are processed in order to predict adverse clinical events and send an alert message to the nephrologist, so as to be able to intervene in good time. “In the future, thanks to AI, it will be possible – intervenes Stefano Bianchi, president-elect of the Italian Society of Nephrology (SIN), former director of UOC Nephrology and Dialysis, ASL Toscana Nordovest – to make use of Digital health and Telemedicine techniques to facilitate tasks of healthcare workers and, for example, perform remote maneuvers, such as starting and stopping therapy. Home dialysis is evolving rapidly, thanks to new therapeutic solutions that meet the desire to pursue a ‘green’ nephrology, capable of containing the negative implications for the environment “. The green turning point in nephrology is accompanied by greater attention to the lifestyles of renal patients, to contain the spread of chronic kidney disease (CKD), one of the most widespread chronic diseases, in constant progression due to the aging of the general population . In Italy, patients at the third stage or at a more severe stage are almost 4.5 million and patients on dialysis about 50 thousand; as many follow-up kidney transplant carriers.
Extensive attention during the congress is dedicated to nutrition, lifestyles and the effects of obesity on kidney health: obesity is in fact a condition closely linked to the progression of chronic kidney disease, often associated with the presence of diabetes. The focus is on advances in scientific research for the identification of new biomarkers of Diabetic Kidney Disease, for earlier diagnosis and greater predictivity of kidney events. Diet and a correct lifestyle help slow down the course of CKD and prevent its onset; thanks to the new drugs available, to the therapeutic advances and to those made in the field of dietological science, today there are greater opportunities offered to renal patients to follow a balanced diet, in which the microbiota and physical activity also play an important role.
Many of the interventions useful for preserving kidney function, preventing CKD, are at the same time useful for preserving the health of our heart: PLADO (Plant-dominant) diet or Mediterranean diet that favors plant foods by limiting animal proteins and salt, regular physical activity, limiting body weight and maintaining optimal blood pressure values. The correction of many haematochemical alterations typical of CKD (anemia, electrolyte alterations and acid-base balance, alterations in mineral, glycidic and lipid metabolism) also benefit the heart. Furthermore, the arrival of SGLT2IR drugs, for which reimbursement is expected in the short term, is improving the well-being of patients with kidney disease and cardiological involvement. A therapeutic possibility that – as has been demonstrated in several clinical trials – drastically reduces the number of cardiovascular and renal events, up to 40% less. At the therapeutic level, there are many advantages, including:
· Slowing of the evolution of CKD which in recording studies have reached values close to halving the speed
Moderate anti-hypertensive and diuretic effect which could save on the use of other drugs with such actions, frequently used in patients with CKD
Reduced incidence of hyperkalaemia, a problem that often occurs with the use of other categories of drugs, also used to reduce the evolution of CKD (ace-inhibitors, sartans), making the association with these drugs more possible
Substantial excellent tolerability
Preliminary analyzes of the data collected during the SIN – ISS study indicate that vaccination in dialysis patients resulted in a clear reduction in the most serious consequences of the infection (hospitalization and / or death). Although the Omicron variant resulted in global growth in infections and a relative surge in the number of cases in patients with chronic kidney disease on dialysis, the clinical impact – as well as in the general population – was more modest in terms of hospitalizations and mortality. In the dialysis population, the mortality rate of 40% in the first phase of COVID-19 has gone from a mortality of less than 5%; an important discrepancy which, although it may partly depend on a reduced pathogenicity of the latest variants of the virus, is largely explained by the unquestionable efficacy of vaccination.