Gianni Cappelli - Academia.edu (original) (raw)
Papers by Gianni Cappelli
Nephrology Dialysis Transplantation, 1998
The term 'ultrapure water' is a common way efficiency of the filtration system was a recirculatin... more The term 'ultrapure water' is a common way efficiency of the filtration system was a recirculating dextran-blue solution continuously monitored by a UV to define water used for on-line treatments: it refers to the absence of chemical, organic and microbiological detector. The idea was applied also to substitution fluids for HDF, but the on-line control was removed contamination. To be more accurate in definition, every known and potential contaminant has to be fixed due to problems with pyrogens contaminating the dextran solution. Since then, no other on-line micro-at its limit value. AAMI recommendations and various Pharmacopoeias have set limits for dialysate based on biological control has been proposed, but a great deal of effort has been devoted to improving the quality of traditional dialysis treatments, but on-line treatments should also be regulated by guidelines for infusion water used in the on-line HDF treatment modality. solutions. Modern water treatment technology allows us to obtain a proper chemical quality both for dialysate and infusion solutions in on-line dialysis. Which water quality?
ASAIO Journal, 1998
To reduce the level of contamination by bacterial products, ultrafiltration systems have been int... more To reduce the level of contamination by bacterial products, ultrafiltration systems have been introduced and validated for their capacity to block the passage of bacterial components reactive to the limulus amoebocyte lysate (LAL) test. In this study, the absorptive capacity of polysulfone membranes undergoing disinfection cycles with free chlorine and peracetic acid were evaluated at various concentrations and contact times. The results of this study implicate a relevant physicochemical derangement of the polysulfone membranes treated with sodium hypochlorite but not with peracetic acid, diluted peracetic acid (Dialox) or Amuchina. The implications for the practical use of ultrafilters are discussed.
Nephrology Dialysis Transplantation, 2003
Background. Biofilms are composed of communities of micro-organisms adhering to essentially any s... more Background. Biofilms are composed of communities of micro-organisms adhering to essentially any surface. We evaluated whether biofilm formation in the hydraulic circuit of a purposely contaminated haemodialysis monitor would modify the efficacy of different disinfection modalities against bacteria and endotoxin concentrations. Methods. A water-borne Pseudomonas aeruginosa (10 9 ) suspension was recirculated for 1 h and was left standing for 72 h (stationary phase) in the hydraulic circuit of the monitor. The monitor was then washed and disinfected by different physical (heat, 85 C) or chemical (hypochlorite or peracetic acid) disinfection modalities (protocol A). In protocol B, the bacterial suspension was also recirculated for 1 h, but the monitor was then immediately washed and disinfected by different chemical disinfection modalities (hypochlorite or peracetic acid). Results. Biofilm formation was revealed by scanning and confocal laser electron microscopy after the stationary phase (protocol A), but was absent when the monitor was immediately washed and disinfected (protocol B). In the presence of biofilm (protocol A), heat in association with citric acid was the most effective modality for reducing both colony forming units and endotoxin concentrations, whereas heat by itself was the least effective method of disinfection. Dwelling (60 h) with diluted peracetic acid completely prevented the formation of biofilm. In the absence of biofilm (protocol B), chemical disinfection proved to be effective against both colony forming units and endotoxin concentrations. Conclusions. We found that biofilm formation may markedly reduce the efficacy of presently available disinfection modalities. Therefore, different disinfection modalities and the combined action of descaling (by citric acid) and disinfection (physical/chemical agents) should be used periodically in haemodialysis monitors. In addition, dwelling with diluted peracetic acid should be adopted whenever monitors are not in use.
Hemodialysis International, 2006
Water treatment system and dialysis monitors are susceptible to microbial contaminations and peri... more Water treatment system and dialysis monitors are susceptible to microbial contaminations and periodical disinfection procedures are mandatory to obtain results requested from international standards and guidelines. Several chemical germicides or some physical treatments are on the market validated by device manufacturer according to medical device directives. With time, interfering substances from dialysis device or water are able to modify disinfection efficiency. Simulating-use testing is not a common procedure to validate disinfectants and recent data document as biofilm represents the most important cause of disinfection inefficacy. Some international standards include tests in the presence of various interfering substances but their use is not widespread. When using a disinfectant, residue toxicity, material compatibility and potential risks for the staff also have to be considered. A quality assurance program has to be implemented to obtain adequate performances and to improve results on patients.
La Ricerca in Clinica e in Laboratorio
Minerva medica
Authors performed percutaneous renal biopsy guided by ultrasounds in 10 patients in whom urograph... more Authors performed percutaneous renal biopsy guided by ultrasounds in 10 patients in whom urography was dangerous or did not provided good renal images. The advantages of this method are in the directional and dimensional accuracy of ultrasound scanning, so that the exact topography of the kidney can be established. The use of ultrasonically guided renal biopsy is mainly recommended in iodine medium idiosyncrasy, in myelomas and renal failure. This method can be preferred in order to establish the exact topography of kidney, in acute anuric renal failure, in chronic failure (when high doses of iodate contrast are needed), and in the presence of cyst.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology
The International journal of artificial organs
Acid base balance during biofiltration (BF): Six patients on standard acetate hemodialysis (HD) w... more Acid base balance during biofiltration (BF): Six patients on standard acetate hemodialysis (HD) were switched to BF with 1 m2 AN69-S membrane, 12 hours weekly (BF-4h) and, later on, to a stage with 1.2 m2 AN69-S, 9 hours weekly (BF-3h). During BF, in order not to exceed 25 mEq/l in intradialytic arterial HCO3, arterial acid-base was examined hourly and a mean of 178 and 199 mEq of HCO3 respectively were infused in BF-4h and BF-3h. We obtained a better control of acidosis with a reduction of the intradialytic pCO2 decrease and hypoxemia. The amount of HCO3 infused was related to the patients deficit in HCO3 total pool and therefore it can be predicted, to avoid postdialytic alkalosis.
Contributions to nephrology
Nephrology Dialysis Transplantation
During the past 10 years the type of vascular haemodialysis, with particular emphasis on the Ital... more During the past 10 years the type of vascular haemodialysis, with particular emphasis on the Italian setting, as derived from an Italian Survey on Vascular access for haemodialysis procedures have changed markedly in our centre: more elbow AV fistulae Access (ISVA 97). The first steps of a Quality Assurance (QA) programme are also presented, in and more central venous catheters are now used. Nevertheless, early referral to nephrologists and avail-order to propose an integrated management for vascular access. ability of central venous catheters and peritoneal dialysis allow elderly people to be admitted for dialysis
Nephrology Dialysis Transplantation
The term 'ultrapure water' is a common way efficiency of the filtration system was a recirculatin... more The term 'ultrapure water' is a common way efficiency of the filtration system was a recirculating dextran-blue solution continuously monitored by a UV to define water used for on-line treatments: it refers to the absence of chemical, organic and microbiological detector. The idea was applied also to substitution fluids for HDF, but the on-line control was removed contamination. To be more accurate in definition, every known and potential contaminant has to be fixed due to problems with pyrogens contaminating the dextran solution. Since then, no other on-line micro-at its limit value. AAMI recommendations and various Pharmacopoeias have set limits for dialysate based on biological control has been proposed, but a great deal of effort has been devoted to improving the quality of traditional dialysis treatments, but on-line treatments should also be regulated by guidelines for infusion water used in the on-line HDF treatment modality. solutions. Modern water treatment technology allows us to obtain a proper chemical quality both for dialysate and infusion solutions in on-line dialysis. Which water quality?
Kidney international. Supplement
Biocompatibility in hemodialysis is now regarded as a multifactorial problem and dialysate repres... more Biocompatibility in hemodialysis is now regarded as a multifactorial problem and dialysate represents a main risk. Pyrogenic fractions mostly coming from gram-negative bacteria easily pass through dialysis membrane, either by backdiffusion or by backfiltration, and induce blood cell activation. To demonstrate the long-term efficiency of a 2 m2 polyamide ultrafilter in producing a pyrogen free solution, we used an experimental circuit ultrafiltering for 240 hours (500 ml/min) a bicarbonate dialysate contaminated (5 to 48 EU/ml) by a Pseudomonas aeruginosa filtrate. The efficiency was monitored by LAL-test and IL-1 PBMC so to detect not only lipid A containing endotoxins but also other cytokines inducing bacterial fractions. At the post-ultrafilter sampling port the LAL-test was < 0.005 to 0.034 EU/ml; IL-1 PBMC was below the detection limit (20 pg/ml) being 27 to 63 pg/ml at the pre-ultrafilter level. Polyamide ultrafiltration represents an efficient system to obtain an endotoxin-free dialysate and a single filter works up to 240 hours.
Nephrology Dialysis Transplantation
ABSTRACT
La rilevanza e la portata del problema del trattamento delle acque di dialisi in Italia sono stat... more La rilevanza e la portata del problema del trattamento delle acque di dialisi in Italia sono state recentemente analizzate in una esaustiva indagine effettuata su tutto il territorio nazionale. I risultati di questa indagine e altre considerazioni più generali (tra le quali l'esigenza di trovare un accordo a livello nazionale sulla falsa riga delle European Best Practice Guidelines), hanno portato alla stesura delle prime Linee Guida Italiane sul trattamento delle acque di dialisi, pubblicate su questo numero del giornale. Introduzione Il controllo della qualità delle acque di dialisi è riconosciuto universalmente come requisito fondamentale per la sicurezza del paziente sottoposto a trattamento sostitutivo Giornale Italiano di Nefrologia / Anno 22 n. 3, 2005 / pp. 241-245
Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
The importance of high quality water for dialysis is well established. This study aimed to obtain... more The importance of high quality water for dialysis is well established. This study aimed to obtain a picture of the Italian situation to develop national guidelines. Questionnaire analysis was used to assess water quality control protocols and types of chemical and microbiological parameters monitored. Regions with responses from at least half the units were considered for the study. Eighteen out of 20 regions fulfilled the inclusion criteria; 297/469 dialysis units answered the questionnaire (5208 dialysis beds, 18213 patients). Eighty-one percent of Italian units follow a regular water quality control program. The reverse osmosis outlet is the sampling point used most for assessing chemical and microbiological parameters. The most common frequency in monitoring is < or =6 months. Fifteen chemical items, suggested by the Italian Farmacopea Ufficiale (FU), are periodically controlled by at least half the units. Aluminum is measured in about 70% of units, chloramines and volatile halogenated hydrocarbons, respectively, in 42 and 30% of units. According to the FU, bacterial counts at 22 degrees C (84%) and endotoxin determinations (60%) are the most common microbiological analyzes. The survey demonstrated protocol differences among the units, confirming the need for Italian guidelines to ameliorate and standardize dialysis water monitoring. More than half the units are following the FU, but we cannot rule out less strict monitoring only in non-participating units.
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis
The side effects of glucose degradation products (GDPs) in conventional peritoneal dialysis (PD) ... more The side effects of glucose degradation products (GDPs) in conventional peritoneal dialysis (PD) fluids are well described. Using the three-compartment bag concept--that is, in situ preparation of concentrated glucose solution into a standard ionic solution--a GDP-free solution can be processed. To investigate the possible impact of this product on biological and clinical parameters, we carried out a prospective cross-over study with 31 patients, comparing the short-term effects of conventional PD and GDP-free PD solutions. Classical peritoneal parameters and ultrafiltration rate did not change during the study. After three months and after six months with the three-compartment bag, cancer antigen 125 (CA125) concentration in overnight fluid increased significantly (p < 0.001) from 24.4 IU/mL to 44.4 IU/mL and 41.1 IU/mL respectively. CA125 decreased significantly (p < 0.01) to 21.7 IU/mL after three months with the conventional solution. No change in hyaluronan concentration ...
Nephrology Dialysis Transplantation, 1998
The term 'ultrapure water' is a common way efficiency of the filtration system was a recirculatin... more The term 'ultrapure water' is a common way efficiency of the filtration system was a recirculating dextran-blue solution continuously monitored by a UV to define water used for on-line treatments: it refers to the absence of chemical, organic and microbiological detector. The idea was applied also to substitution fluids for HDF, but the on-line control was removed contamination. To be more accurate in definition, every known and potential contaminant has to be fixed due to problems with pyrogens contaminating the dextran solution. Since then, no other on-line micro-at its limit value. AAMI recommendations and various Pharmacopoeias have set limits for dialysate based on biological control has been proposed, but a great deal of effort has been devoted to improving the quality of traditional dialysis treatments, but on-line treatments should also be regulated by guidelines for infusion water used in the on-line HDF treatment modality. solutions. Modern water treatment technology allows us to obtain a proper chemical quality both for dialysate and infusion solutions in on-line dialysis. Which water quality?
ASAIO Journal, 1998
To reduce the level of contamination by bacterial products, ultrafiltration systems have been int... more To reduce the level of contamination by bacterial products, ultrafiltration systems have been introduced and validated for their capacity to block the passage of bacterial components reactive to the limulus amoebocyte lysate (LAL) test. In this study, the absorptive capacity of polysulfone membranes undergoing disinfection cycles with free chlorine and peracetic acid were evaluated at various concentrations and contact times. The results of this study implicate a relevant physicochemical derangement of the polysulfone membranes treated with sodium hypochlorite but not with peracetic acid, diluted peracetic acid (Dialox) or Amuchina. The implications for the practical use of ultrafilters are discussed.
Nephrology Dialysis Transplantation, 2003
Background. Biofilms are composed of communities of micro-organisms adhering to essentially any s... more Background. Biofilms are composed of communities of micro-organisms adhering to essentially any surface. We evaluated whether biofilm formation in the hydraulic circuit of a purposely contaminated haemodialysis monitor would modify the efficacy of different disinfection modalities against bacteria and endotoxin concentrations. Methods. A water-borne Pseudomonas aeruginosa (10 9 ) suspension was recirculated for 1 h and was left standing for 72 h (stationary phase) in the hydraulic circuit of the monitor. The monitor was then washed and disinfected by different physical (heat, 85 C) or chemical (hypochlorite or peracetic acid) disinfection modalities (protocol A). In protocol B, the bacterial suspension was also recirculated for 1 h, but the monitor was then immediately washed and disinfected by different chemical disinfection modalities (hypochlorite or peracetic acid). Results. Biofilm formation was revealed by scanning and confocal laser electron microscopy after the stationary phase (protocol A), but was absent when the monitor was immediately washed and disinfected (protocol B). In the presence of biofilm (protocol A), heat in association with citric acid was the most effective modality for reducing both colony forming units and endotoxin concentrations, whereas heat by itself was the least effective method of disinfection. Dwelling (60 h) with diluted peracetic acid completely prevented the formation of biofilm. In the absence of biofilm (protocol B), chemical disinfection proved to be effective against both colony forming units and endotoxin concentrations. Conclusions. We found that biofilm formation may markedly reduce the efficacy of presently available disinfection modalities. Therefore, different disinfection modalities and the combined action of descaling (by citric acid) and disinfection (physical/chemical agents) should be used periodically in haemodialysis monitors. In addition, dwelling with diluted peracetic acid should be adopted whenever monitors are not in use.
Hemodialysis International, 2006
Water treatment system and dialysis monitors are susceptible to microbial contaminations and peri... more Water treatment system and dialysis monitors are susceptible to microbial contaminations and periodical disinfection procedures are mandatory to obtain results requested from international standards and guidelines. Several chemical germicides or some physical treatments are on the market validated by device manufacturer according to medical device directives. With time, interfering substances from dialysis device or water are able to modify disinfection efficiency. Simulating-use testing is not a common procedure to validate disinfectants and recent data document as biofilm represents the most important cause of disinfection inefficacy. Some international standards include tests in the presence of various interfering substances but their use is not widespread. When using a disinfectant, residue toxicity, material compatibility and potential risks for the staff also have to be considered. A quality assurance program has to be implemented to obtain adequate performances and to improve results on patients.
La Ricerca in Clinica e in Laboratorio
Minerva medica
Authors performed percutaneous renal biopsy guided by ultrasounds in 10 patients in whom urograph... more Authors performed percutaneous renal biopsy guided by ultrasounds in 10 patients in whom urography was dangerous or did not provided good renal images. The advantages of this method are in the directional and dimensional accuracy of ultrasound scanning, so that the exact topography of the kidney can be established. The use of ultrasonically guided renal biopsy is mainly recommended in iodine medium idiosyncrasy, in myelomas and renal failure. This method can be preferred in order to establish the exact topography of kidney, in acute anuric renal failure, in chronic failure (when high doses of iodate contrast are needed), and in the presence of cyst.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology
The International journal of artificial organs
Acid base balance during biofiltration (BF): Six patients on standard acetate hemodialysis (HD) w... more Acid base balance during biofiltration (BF): Six patients on standard acetate hemodialysis (HD) were switched to BF with 1 m2 AN69-S membrane, 12 hours weekly (BF-4h) and, later on, to a stage with 1.2 m2 AN69-S, 9 hours weekly (BF-3h). During BF, in order not to exceed 25 mEq/l in intradialytic arterial HCO3, arterial acid-base was examined hourly and a mean of 178 and 199 mEq of HCO3 respectively were infused in BF-4h and BF-3h. We obtained a better control of acidosis with a reduction of the intradialytic pCO2 decrease and hypoxemia. The amount of HCO3 infused was related to the patients deficit in HCO3 total pool and therefore it can be predicted, to avoid postdialytic alkalosis.
Contributions to nephrology
Nephrology Dialysis Transplantation
During the past 10 years the type of vascular haemodialysis, with particular emphasis on the Ital... more During the past 10 years the type of vascular haemodialysis, with particular emphasis on the Italian setting, as derived from an Italian Survey on Vascular access for haemodialysis procedures have changed markedly in our centre: more elbow AV fistulae Access (ISVA 97). The first steps of a Quality Assurance (QA) programme are also presented, in and more central venous catheters are now used. Nevertheless, early referral to nephrologists and avail-order to propose an integrated management for vascular access. ability of central venous catheters and peritoneal dialysis allow elderly people to be admitted for dialysis
Nephrology Dialysis Transplantation
The term 'ultrapure water' is a common way efficiency of the filtration system was a recirculatin... more The term 'ultrapure water' is a common way efficiency of the filtration system was a recirculating dextran-blue solution continuously monitored by a UV to define water used for on-line treatments: it refers to the absence of chemical, organic and microbiological detector. The idea was applied also to substitution fluids for HDF, but the on-line control was removed contamination. To be more accurate in definition, every known and potential contaminant has to be fixed due to problems with pyrogens contaminating the dextran solution. Since then, no other on-line micro-at its limit value. AAMI recommendations and various Pharmacopoeias have set limits for dialysate based on biological control has been proposed, but a great deal of effort has been devoted to improving the quality of traditional dialysis treatments, but on-line treatments should also be regulated by guidelines for infusion water used in the on-line HDF treatment modality. solutions. Modern water treatment technology allows us to obtain a proper chemical quality both for dialysate and infusion solutions in on-line dialysis. Which water quality?
Kidney international. Supplement
Biocompatibility in hemodialysis is now regarded as a multifactorial problem and dialysate repres... more Biocompatibility in hemodialysis is now regarded as a multifactorial problem and dialysate represents a main risk. Pyrogenic fractions mostly coming from gram-negative bacteria easily pass through dialysis membrane, either by backdiffusion or by backfiltration, and induce blood cell activation. To demonstrate the long-term efficiency of a 2 m2 polyamide ultrafilter in producing a pyrogen free solution, we used an experimental circuit ultrafiltering for 240 hours (500 ml/min) a bicarbonate dialysate contaminated (5 to 48 EU/ml) by a Pseudomonas aeruginosa filtrate. The efficiency was monitored by LAL-test and IL-1 PBMC so to detect not only lipid A containing endotoxins but also other cytokines inducing bacterial fractions. At the post-ultrafilter sampling port the LAL-test was < 0.005 to 0.034 EU/ml; IL-1 PBMC was below the detection limit (20 pg/ml) being 27 to 63 pg/ml at the pre-ultrafilter level. Polyamide ultrafiltration represents an efficient system to obtain an endotoxin-free dialysate and a single filter works up to 240 hours.
Nephrology Dialysis Transplantation
ABSTRACT
La rilevanza e la portata del problema del trattamento delle acque di dialisi in Italia sono stat... more La rilevanza e la portata del problema del trattamento delle acque di dialisi in Italia sono state recentemente analizzate in una esaustiva indagine effettuata su tutto il territorio nazionale. I risultati di questa indagine e altre considerazioni più generali (tra le quali l'esigenza di trovare un accordo a livello nazionale sulla falsa riga delle European Best Practice Guidelines), hanno portato alla stesura delle prime Linee Guida Italiane sul trattamento delle acque di dialisi, pubblicate su questo numero del giornale. Introduzione Il controllo della qualità delle acque di dialisi è riconosciuto universalmente come requisito fondamentale per la sicurezza del paziente sottoposto a trattamento sostitutivo Giornale Italiano di Nefrologia / Anno 22 n. 3, 2005 / pp. 241-245
Giornale italiano di nefrologia: organo ufficiale della Societa italiana di nefrologia
The importance of high quality water for dialysis is well established. This study aimed to obtain... more The importance of high quality water for dialysis is well established. This study aimed to obtain a picture of the Italian situation to develop national guidelines. Questionnaire analysis was used to assess water quality control protocols and types of chemical and microbiological parameters monitored. Regions with responses from at least half the units were considered for the study. Eighteen out of 20 regions fulfilled the inclusion criteria; 297/469 dialysis units answered the questionnaire (5208 dialysis beds, 18213 patients). Eighty-one percent of Italian units follow a regular water quality control program. The reverse osmosis outlet is the sampling point used most for assessing chemical and microbiological parameters. The most common frequency in monitoring is < or =6 months. Fifteen chemical items, suggested by the Italian Farmacopea Ufficiale (FU), are periodically controlled by at least half the units. Aluminum is measured in about 70% of units, chloramines and volatile halogenated hydrocarbons, respectively, in 42 and 30% of units. According to the FU, bacterial counts at 22 degrees C (84%) and endotoxin determinations (60%) are the most common microbiological analyzes. The survey demonstrated protocol differences among the units, confirming the need for Italian guidelines to ameliorate and standardize dialysis water monitoring. More than half the units are following the FU, but we cannot rule out less strict monitoring only in non-participating units.
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis
The side effects of glucose degradation products (GDPs) in conventional peritoneal dialysis (PD) ... more The side effects of glucose degradation products (GDPs) in conventional peritoneal dialysis (PD) fluids are well described. Using the three-compartment bag concept--that is, in situ preparation of concentrated glucose solution into a standard ionic solution--a GDP-free solution can be processed. To investigate the possible impact of this product on biological and clinical parameters, we carried out a prospective cross-over study with 31 patients, comparing the short-term effects of conventional PD and GDP-free PD solutions. Classical peritoneal parameters and ultrafiltration rate did not change during the study. After three months and after six months with the three-compartment bag, cancer antigen 125 (CA125) concentration in overnight fluid increased significantly (p < 0.001) from 24.4 IU/mL to 44.4 IU/mL and 41.1 IU/mL respectively. CA125 decreased significantly (p < 0.01) to 21.7 IU/mL after three months with the conventional solution. No change in hyaluronan concentration ...