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Background Fragmented QRS (fQRS) on surface electrocardiogram is correlated with increased cardiovascular risk and mortality in normal population. Aims To investigate the presence of fQRS and its association with subclinical atherosclerosis and vascular calcification in chronic kidney disease (CKD) patients without cardiovascular disease. Methods A total of 129 CKD (63 males and 66 females) patients was enrolled for the study. Carotid intima-media thickness (CIMT) measurement and coronary artery calcification score (CACS) were performed by the same radiologist. A 12-lead electrocardiogram recording was used to detect fQRS. Results The mean age was 55.1 ± 15.1 years. fQRS was detected in 45% of patients. There was not any significant difference between patients with or without fQRS in terms of demographic parameters and comorbid diseases except for diabetes and hyperlipidaemia. The mean CIMT of CKD patients was 0.66 ± 0.18 mm and it was significantly higher in fQRS(+) group compared to the fQRS(-) group. Similarly CACS values were higher in fQRS(+) group. In the logistic regression analysis, fQRS remained significantly associated with CIMT (β = 0.220, t = 2.567, P = 0.011) (independent variables: CIMT, CACS, sodium and glomerular filtration rate (modification of diet in renal disease-glomerular filtration rate)). Conclusions This is the first study in the literature showing the relation of fQRS with CIMT and CACS in patients with CKD without known cardiovascular disease.

Introduction: Cardiovascular disease is the main cause of mortality and morbidity in chronic renal failure. It’s known that vascular calcification (VC) and carotid intima media thickness (CIMT) are strongly associated with cardiovascular diseases. Growth arrest specific protein 6 (Gas6) is a vitamin K-dependent protein and regulates various processes such as proliferation, cell survival, migration and inflammation. Gas6 is known to protect endothelial cells and vascular smooth muscle cells against apoptosis by inhibiting Bcl-2 induced Caspase 3 activation. The relationship between Gas6 and cardiovascular diseases has been demonstrated in many mouse models and cell cultures. However, there are conflicting reports whether Gas6 levels are increasing or decreasing in human studies of diabetic and/or chronic renal failure. In present study the aim was to examine plasma Gas6 levels and its relation with CIMT and coronary artery calcification score (CACS) in chronic kidney disease (CKD) patients. Methods: Total of 137 patients of which 32 chronic hemodialysis and 105 predialysis patients as well as 73 healthy controls were enrolled in the study. Human Gas6 levels in serum samples were studied by ELISA method. CIMT was measured by ultrasonography. CACS was measured by multislice computed tomography. Results: The mean age was 54.37±16.61 years in dialysis group, 55.20±14.80 years in predialysis group and 53.26±9.04 years in control group. Serum creatinine was 0.78±0.16 mg/dl in the control group and 1.96±1.64 mg/dl in the predialysis group and 5.94±1.55 mg/dl in the dialysis group. 24 hours urine protein levels were significally higher in the dialysis group than the predialysis and the control group. CIMT values were similar in predialysis and dialysis groups. These values were significantly higher than the control group. Although CACS was higher in dialysis group than predialysis and control group, the results were not statistically significant since the distribution range was very wide. Gas6 was 98.84±53.32 ng/mL in the control group and statistically higher than the dialysis (63.85±38.92 ng/mL) and the predialysis groups (54.96±38.49 ng/mL) (p=0.001). Gas6 levels were lower in diabetic patients than non-diabetics (53.69±35.26 ng/mL, 69.26±47.50 ng/mL, p=0.023, respectively). Negative correlation was detected between Gas6 and age, BMI, CACS, carotid IMT and proteinuria. In the logistic regression analysis, Gas6 remained significantly associated with BMI, CIMT and proteinuria. Conclusion: In our study, a negative correlation of Gas6 with BMI, CACS, CIMT and proteinuria and lower Gas6 levels in diabetic patients support that decreased Gas6 levels in chronic renal failure may have a role in vascular calcification through altered glucose tolerance, chronic inflammation, endothelial dysfunction and increased apoptosis. Our study has an importance because it is the first study showing a relation between Gas6 and proteinuria, CACS and carotid IMT in patients with chronic renal failure.

Context Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are recent prognostic markers associated with inflammation in many diseases such as chronic kidney disease (CKD), malignancies, myocardial infarction. Objective In this study, we investigated the relationship between NLR-PLR and parathyroid hormone (PTH) and vitamin D in patients with high PTH levels. Design The patients with high PTH levels in Nephrology and Endocrinolgy Outpatient clinics were evaluated retrospectively. Subjects and methods The medical records of the patients were examined and clinical data, including demographic details, clinical and laboratory findings, treatment and follow-up data were obtained. NLR and PLR were calculated. Serum creatinine, calcium, phosphorus, magnesium, lipid levels, calcium phosphorus product, PTH and vitamin D values were investigated. The relationship between NLR-PLR and laboratory parameters, GFR (MDRD-GFR), PTH and vitamin D were investigated. Results 48 male and 253 female patients were enrolled in this study. The mean age was 57.57±13.28. NLR correlated negatively with albumin, hemoglobin, vitamin D, calcium and cholesterol and it positively correlated with creatinine and PTH. Multiple regression analysis showed that main determinants of NLR were PTH, albumin, LDL-cholesterol, hemoglobin and gender. Conclusions In this study NLR and PLR correlated negatively with hemoglobin and cholesterol. Positive correlation between NLR and creatinine could be explained by increased degrees of inflammation associated with more pronounced degrees of renal dysfunction. The impact of PTH on NLR was independent of GFR. In multiple regression model this suggests that PTH could be a pro-inflammatory parameter independent of the degree of renal dysfunction.

Amac: Glomerulonefrit glomerullerin inflamasyondur ve proteinuri kendisi glomeruler inflamasyonun klinik bir yansimasidir. Bu calismada, aterosklerozun en erken bulgularindan biri olan karotis intima media kalinligi (KIMK) ile glomeruler inflamasyon belirtecleri arasindaki iliskiyi arastirmayi amacladik. Gerec ve yontem: Biyopsi ile kanitlanmis 40 glomerulonefrit hastasi ve 46 saglikli kontrol calismaya dahil edildi. Serum orneklerinde Growth arrest spesific protein 6 (Gas6) duzeyleri ELISA ile calisildi. KIMK olcumu ayni radyolog tarafindan yapildi. Notrofil-lenfosit orani (NLO) tam kan test sonucundan elde edilen notrofil sayisinin lenfosit sayisina bolunmesiyle hesaplandi. Bulgular: Hasta grubunda ortalama yas 42,88±15,41, kontrol grubunda 38,26±9,04 idi. Ortalama hastalik suresi 29.07±52.90 ay, proteinuri 4027.05±4030.22 mg/gun, MDRD-GFR 53.80±48.32 mL/dk/1.73m 2 idi. KIMK hasta grubunda 0.62±0.17 mm, kontrol grubunda 0.46±0.10 mm idi. NLO hasta grubunda 3.69±4.46, kontrol grubundan anlamli derecede yuksekti (1.74±0.63). Kontrol grubunda Gas6 duzeyleri istatistiksel olarak daha yuksekti. KIMK yas, fibrinojen, ferritin, proteinuri ve NLO ile pozitif korelasyon gosterdi ve glomerulonefrit grubunda HDL kolesterol ve Gas6 ile negatif korelasyon gosterdi. Lojistik regresyon modelinde yas KIMK icin belirleyiciydi. Tum grupta KIMK yas, kreatinin, urik asit, fibrinojen, ferritin, CaxP carpimi, proteinuri ve NLO ile pozitif ve hemoglobin duzeyi, Gas6 ile negatif korelasyon gosterdi. Lineer lojistik regresyon analizinde karotis IMK, yas ve ferritin ve proteinuri ile anlamli sekilde iliskiliydi. Sonuc: Calismamizda proteinurinin bobrek fonksiyonu goreceli olarak korunmus glomerulonefritte GFR duzeylerinden bagimsiz olarak artmis KIMK'nin temel belirleyicilerinden biri oldugunu gosterdik.

The objective of the study is to evaluate the relationship between serum testos-terone levels and cardiovascular risk factors (CVRF) in patients after kidney transplantation and with chronic kidney disease (CKD). Seventy-five male patients, aged between 18 and 68 years, who had kidney transplantation at least six months earlier, were enrolled into the study. Only renal transplant recipients and CKD patients with a creatinine level of 0.05). Serum testosterone levels were independent risk factors affecting IVC collapse index, systolic BP and LA. m-TORi and CNIs drugs might have no negative effect on serum testosterone levels, and improvement of the serum testosterone levels after transplantation might have a positive contribution on cardiac risk factors.

Background/aims Functional bowel disorders (FBDs) impair the quality of life in patients with end-stage renal disease (ESRD). The aim of our study was to determine the prevalence and distribution of the subtypes of FBDs in hemodialysis (HD) patients. Materials and methods This prospective, cross-sectional study included 80 patients who received HD for more than 3 months (patient group) and 80 healthy controls (control group). FBDs were diagnosed according to the Rome II diagnostic criteria by excluding organic pathologies. Results Forty-six (57.5%) patients were males, and their average age was 62.13±12.92 (23-90) years. The mean duration of dialysis was 57.48±59.23 (3-312) months, and the mean Kt/V (K: dialyzer clearance of urea, t: dialysis time, V: volume of distrubition of urea) value was 1.53±0.31. The rate of FBDs was significantly higher in the patient group than in the control group (p=0.01). In total, 7.5% of the patients had irritable bowel syndrome, 3.8% had functional bloating, and 16.3% had functional constipation. FBDs were significantly higher in women (p=0.004). While there was no statistically significant difference between patients with and those without FBDs in terms of the presence of additional diseases, smoking, alcohol use, educational level, marital status, and resi- dential areas (p>0.05), serum phosphorus (P) levels were significantly higher in the patients with FBDs (p=0.03). Conclusion FBDs and their functional constipation subtype are more common in HD patients than in the healthy population in Turkey. FBDs are most frequently observed in females and housewives with high serum P levels.

Objective: Our aim was to investigate anti-inflammatory effect of sevelamer in ex - perimentally induced renal failure (RF) and whether this effect was related to a decrease in Es - cherichia coli colony counts in feces. Material and Methods: Eighteen female Wistar albino rats weighted 200-250 g were divided into three groups. RF was induced by 5/6 nephrectomy. Group 1 was the control group. Group 2 rats were those with induced RF receiving a high phosphate diet. Group 3 contained rats with induced RF receiving a high phosphate diet + sevelamer. E.coli count in feces, plasma creatinine, high-sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) concentrations were determined at the beginning and at the end of 1 st , 3 rd and 6 th weeks in all rats. Results: In Group 2 and 3, creatinine concentra - tions were found to be increased (p=0.03, p=0.02) in the 1 st week. In Group 2, there was an increase in number of E. coli colony count in the 3 rd week (p=0.05). In group 3, E. coli colony count and levels of inflammatory markers (IL-6, CRP, TNF-alfa) significantl y were increased in comparison to the basal values (p=0.042, p=0.021, p=0.042, respectively) in the 1 st week. In group 3, in the sixth week, E. coli colony count (p=0.02) and levels of inflammatory markers (IL-6, hsCRP, TNF- alpha) (p

Background & objectives: Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome manifested by features of nephritic syndrome and progressive loss of renal function over a short time. The objective of this study was to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and prognostic factors and pathological findings of renal biopsy in RPGN. Methods: Consecutive newly diagnosed RPGN patients who had follow up for at least six months were retrospectively analyzed. The estimated glomerular filtration rate (EGFR) was calculated. Albumin, C-reactive protein (CRP) levels and CRP/albumin ratio were also calculated. Results: Fifty four patients were included in the study. The mean age was 48.92±20.12 years. Clinicopathological diagnosis was pauci-immune glomerulonephritis (GN) in 40 while two had postinfectious GN, six systemic lupus erythematosus, three IgA nephropathy, two Henoch-Schönlein purpura and one membranoproliferative GN. The mean NLR was 7.02±6.34 and mean PLR was 273.90±39.15. Positive correlations between NLR and CRP levels (P=0.009, r=0.511) and CRP/albumin ratios (P=0.005, r=0.542) were observed. PLR and CRP/albumin ratios (P=0.041, r=0.412) were correlated positively. The per cent of fibrocellular crescents was negatively correlated with NLR (P=0.019, r=-0.291), and positively correlated with the lymphocyte count (P=0.05, r=0.256). In secondary crescentic subgroup, the per cent of fibrinoid necrosis had a positive correlation with PLR (P=0.013, r=0.642). Both NLR (P=0.036) and PLR (P=0.051) detected at the first month of the treatment period, were observed to be significantly correlated with mortality. Interpretation & conclusions: This study showed that NLR could predict mortality in patients with RPGN; correlated with systemic inflammation; showed a negative correlation with the per cent of fibrocellular crescents and could be regarded as a measure of glomerular inflammatory state. Moreover, PLR may be considered to be an indicator of disease severity in acute phase of crescentic GN. © 2019 Indian Journal of Medical Research.

The aim of the study was to evaluate the usefulness of serum bone turnover markers (BTM) and bone mineral density (BMD) determined by dual-energy X-ray absorptiometry (DEXA) in predialysis patients with chronic kidney disease (CKD). We enrolled 83 patients with CKD, 41 (49.4%) males, 42 (50.6%) females, with mean estimated glomerular filtration rate (eGFR) 23.90 ± 12 (range = 6.0-56.0). BMD of the lumbar spine (LS) (anteroposterior, L2 through L4), femoral neck (FN) and femoral trochanter (FT) were measured by DEXA. Biochemical BTM, including calcium (Ca), phosphorus (P), intact parathyroid hormone (PTH), serum specific alkaline phosphatase (serum AP), bone-specific AP (BSAP), plasma bicarbonate and 25-hydroxy-vitamin D (25hD) were used for the prediction of BMD loss. T score results of LS and FN were worse than FT. BMD levels were lower in females than in males (all p < 0.05). According to different BMD T score levels, patients with age ≥ 65 years and patients in menopause were significantly more osteopenic (p = 0.026) and there was no relation between different BMD T scores and presence of diabetes (p = 0.654). A positive correlation was identified between the BMD of FN T-Z scores (r = 0.270, p = 0.029, r = 0.306, p = 0.012), FT T-Z scores (r = 0.220, p = 0.076, r:0.250, p = 0.043) and serum HCO3, while the correlation with serum alkaline phosphatase (AP) and BSAP was considered to be negative. No statistically significant association was found between BMD of all the measured skeletal sites and eGFR. Loss of BMD was identified mostly in females over ≥ 65 years of age and after menopause. Higher serum levels of BSAP and AP can be determined in the advanced stages of renal failure and they reflect fracture risk of the femur, but not spine. Measurements of BMD by DEXA are useful to demonstrate bone loss, but not technical enough to distinguish the quantity of bone loss between different stages of CKD.

There are two types of malnutrition in patients with chronic renal failure (CRF); type 1 and type 2. The aim of this study was to investigate the relationship between malnutrition and inflammation and also the relationship between malnutrition and volume status. Ninety-four pre-dialysis CRF patients were included in the study. Nutritional status of the patients was calculated using the subjective global assessment. Scores of 1-5 were given according to the severity of the symptoms and physical examination findings. Serum inflammation markers [high-sensitive C-reactive protein (hs-CRP), interleukin-1β, interleukin-6 and tumor necrosis factor-alfa] and nutrition parameters (albumin, pre-albumin, transferrin, fetuin-A, insulin like growth factor-1 and insulin-like growth factor-binding protein-3)] were measured in all the patients. Serum N-terminal pro-brain natriuretic peptide levels and echocardiography were performed to evaluate the volume status of the patients. The mean age of the patients was 59.6 ± 13.3 years, the mean malnutrition score was 17.2 ± 6.01, the mean and the median of hs-CRP levels were 18.5 ± 40.7 and 5.6 mg/L, respectively, the mean albumin level was 3.46 ± 0.48 and the mean creatinine clearance was 23.7 ± 13.5 mL/min. A positive correlation between malnutrition scores with inflammation and volume parameters was found in the bivariate and multivariate analysis. In the multiple regression analysis, volume parameters proved to be the most important factors influencing malnutrition scores. Thus, the elimination of volume excess would ameliorate both inflammation and malnutrition. This hypothesis needs to be supported or proved with prospective studies.

Transplantation is the most effective treatment strategy for end-stage renal failure. We aimed to investigate the correlation of volume control parameters with health-related quality of life (HRQoL) in renal transplantation patients during the pre- and post-transplantation periods.Seventy-seven patients who underwent renal transplantation from deceased donors between January 2011 and January 2013 were included in the study. The biochemical markers, complete blood count, and creatinine levels were measured during pretransplantation and at post-transplantation month 6. The Turkish version of the Short Form 36 (SF-36) health survey questionnaire was used for the assessment of HRQoL. Blood pressure (BP) and echocardiographic measurements were used to evaluate the volume status.Significant improvements were achieved in all echocardiographic measurements, biochemical parameters except Ca(++), and SF-36 questionnaire domain scores (DSs) except vitality in the post-transplantation period. Systolic BP (SBP), the left atrium index, vena cava inferior collapsibility index (VCCI), and diastolic BP were associated with vitality (P = .02, .03, .05, and .04, respectively); SBP was associated with social functioning (P.01) and role emotional (P.01); and left ventricular mass index was associated with mental health (P = .05) DSs during the pretransplantation period. In the post-transplantation period, VCCI, left ventricular mass index, and SBP were associated with general health (P = .02, .05, and .05, respectively); VCCI and SBP were also associated with mental health (P = .05 and .01, respectively); and left atrium index was associated with role emotional (P = .05) DSs.Concomitant improvement in the volemic status may contribute to improvements in HRQoL after renal transplantation.

H. Colak, I. Sert, C. Ekmekci, C. Tugmen, Y. Kurtulmus, S. Kursat, and H. Toz Department of Nephrology, Tepecik Training and Research Hospital, Izmir, Turkey; Department of General Surgery, Tepecik Training and Research Hospital, Izmir, Turkey; Department of Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey; Tissue Typing Laboratory, Tepecik Training and Research Hospital, Izmir, Turkey; Department of Nephrology, Celal Bayar University, Manisa, Turkey; and Department of Nephrology, Ege University, Izmir, Turkey

We encountered 9 cases of tuberculosis out of our 157 chronic HD patients in 36 months. Four pulmonary, 4 lymph nodal and one isolated dermal involvement were detected. Therapy was commenced without waiting for absolute cultural or pathologic diagnosis because of the high index of clinical suspicion. All cases except one recovered completely. Among associated conditions, peptic ulcer disease, anti-HCV positivity, and diabetes mellitus were noted, though the last two did not reach statistical significance. Prompt institution of the specific therapy and close supervision of the cases during treatment enabled us to obtain a cure in all cases except one and to discern adverse drug effects immediately and to make appropriate changes in the therapy. Thus, no morbidity due to the disease itself or drugs was observed.

Amaç: Siroz hastalarında portal hipertansiyona bağlı olarak gelişen özefagus varis kanamaları (ÖVK), çok önemli bir mortalite nedenidir. Buna rağmen, varis kanamasının sekonder profilaksisine yönelik, birbirleri ile çelişen sonuçlar mevcuttur. Bu çalışmada varis kanamalarının tekrarının önlenmesi için kullanılan yöntemlerin klinik etkinliği ve sağkalım süreleri üzerine olan etkileri araştırılmıştır. Yöntem : Çalışmamızda siroz teşhisi konulmuş ve özefagus varis kanaması geçiren 180 hasta incelendi. Bu hastalar profilaksi almış olanlar ve profilaksi almamışlar olarak iki gruba ayrıldı. Profilaksi başlanmış olan hastalar da kullandıkları tedavi modalitesine göre 7 alt gruba ayrıldı. Bu hastalarda sağkalım süreleri, mortalite oranları ve profilaksiden sonra kanama rekürrensi değerlendirildi. Bulgular: Çalışmaya alınan hastaların 133 tanesine profilaksi başlanmış olup, bu hastaların gastroskopilerindeki varislerin derecesinin artması ile sağkalım sürelerinin kısaldığı belirlendi. Hastaların Child evreleri de sağkalım süreleri ile doğrudan ilişkiliydi ve tedavinin başlangıcında Child derecesi yüksek olarak tespit edilen hastaların yaşam süreleri daha kısaydı. Profilaksi başlanan hastalarda mortalite oranları anlamlı derecede daha düşük, sağkalım süreleri ise belirgin olarak daha uzundu. Yaşam süresi dikkate alındığında; tedavi gruplarında en iyi başarı, beta -bloker + bant ligasyonu tedavisi ile elde edildi. Sonuç : Bizim çalışmamızın sonuçları, ÖVK geçi ren hastalarda, sekonder profilaksinin, olumlu ve yararlı etkilerini yansıtmaktadır. Beta -bloker tedavisi ile alınan olumlu sonuçlar, bu grubun profilaksideki etkinliğinin bir göstergesi olarak düşünülebilir. Ayrıca beta -blokerlerin bant ligasyonu ile birl ikte kullanıldığında elde edilen yüksek klinik başarı, profilakside kullanılan medikal tedavilerin, girişimsel endoskopik yöntemlerle kombine edilmesinin, hastalar için daha yararlı olduğunu düşündürmektedir. Objective : Esophageal variceal bleeding (EVB) due to portal hypertension in cirrhotic patients is very important because of mortality. There were contradicted results in secondary prophylaxis for variceal bleeding. In this study our primary aim is to investigate that methods to prevent variceal rebleeding are really efficacious and to establish different treatment methods clinical success. Our secondary aim is to determine of effective factors on survival period. Method : One hundred eighty patients with established cirrhosis disease and had vari ceal bleeding enrolled in this study. Patients divided into two groups as they had prophylaxis or not. Patients in the prophylaxy group were divided into seven subgroups. Survival periods, mortality proportions, and bleeding recurrency after prophylaxis are evaluated as treatment success. The factors which influenced patients treatment success are investigated. These groups evaluated clinically and compared with each other statistically. Results : We started prophylaxis to one hundred thirty three of the patients enrolled and we determined survival periods of these patients decreased by their variceal grades are increased in endoscopies. Child grades of patients are related to survival periods, while the patients grade was increasing, survival period was decreasing. In the prophylaxy group, mortality proportions were significantly increased. In regard to survival period, best success in treatment groups has acquired with beta -blocker plus band ligation treatment. Conclusion : We concluded that, with our study results, secondary prophylaxis has advantage and is essential in patients who had EVB. The positive results achieved with beta -blocker treatment can be accepted as this groups activity and success in prophylaxis. Moreover the high clinical success with beta -blocker plus band ligation is suggesting medical treatments combination with invasive endoscopy methods are more useful for patients.

Renin angiotensin system (RAS) is a system that is the role of renal hemodynamics, blood pressure and fluid electrolyte balance regulation with progression to end-stage renal disease (ESRD). Angiotensin II (AII),the main mediator of this system, is thought to cause a functional impairment in insulin receptor and post receptor signaling pathways. Our aim; was to show the relation of angiotensin-converting enzyme (ACE), angiotensin II receptor type 1 (AT1 R) and angiotensinogen gene (AGT) polymorphisms, that cause genetic susceptibility to over activation of RAS, to glucose intolerance in patient with end stage renal failure. The study included one hundredth patients. Based on fasting plasma glucose values and oral glucose tolerance test second hours glucose values, patients were grouped as normal patients and patients with glucose intolerance (impaired fasting glycemia (IFG), impaired glucose tolerance (IGT) and diabetes mellitus (DM)). Insulin resistance was calculated by HOMA-IR method and insulin sensitivity index was calculated by ISI-S method. ACE, AT1 R, AGT polymorphisms were detected by polymerase chain reaction (PCR) method. There was no statistically significant difference between distribution of ACE, AT1R and AGT genotypes and glucose intolerance groups, and insulin resistance. There was a statistically significant difference between MM and TT genotypes and average insulin resistance values (p < 0,04). We have obtained results suggesting a relation between ACE gene D allele and glucose intolerance in patients with end stage renal failure (p=0.06). Moreover, a relation has been shown between AGT gene T allele and insulin resistance (p=0.04).

The aim is to research the relationship between the degree of depression–malnutrition and inadequate volume control. The mean age of the 52 patients was 55 ± 14.6 years. Malnutrition score [subjective global assessment (SGA)] and depression score [Taiwanese Depression Questionnaire (TDQ)] of each chronic hemodialysis (CHD) patient were calculated. Then an echocardiographic assessment was carried out with the same device 1 day before the second HD session of the week. The 24 h blood pressure monitoring was performed 1 day before the second HD session of the week. TDQ scores (TDQS) were ≥19 in 41 and

Background: The aim of this study is to investigate the relationship between the degree of malnutrition and inadequate volume control evidenced by echocardiography. Methods: In this study 72 chronic hemodialysis patients were investigated in a cross-sectional manner. The malnutrition score was calculated using Subjective Global Assessment. M-mode echocardiography was performed in all patients. Results: The highest malnutrition score (23.2 ± 1.5 points) and lowest vena cava inferior collapse index (35 ± 2%) were observed in the eccentric left ventricular hypertrophy group. The malnutrition index was found to be in positive relationship with the left atrium diameter and index, left ventricular mass and index, and left ventricular end-diastolic diameter. On the other hand, a negative correlation was detected with the vena cava inferior collapse index. When all parameters that were found to be related to malnutrition were assessed by multivariate analyses, a statistically significant relation was found between the left ventricular end-diastolic diameter and the malnutrition index. Conclusion: The results of our study show that the progressive worsening of the nutritional status follows a parallel course along with the deterioration in the echocardiographic parameters concerning hypervolemia. This in turn suggests that increasing degrees of malnutrition are associated with more profound derangements in the volume status. Volume excess might be a mechanism explaning the increased mortality and morbidity caused by malnutrition in hemodialysis patients. Owing to its cross-sectional design, this study cannot provide unequivocal evidence regarding the cause and effect relationship between volume overload and malnutrition in hemodialysis patients.

Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation. We hereby report a patient proved to be a case of unrecognized hypothyroidism presenting with rhabdomyolytic acute renal failure precipitated by the combined use of statin and fenofibrate. A 63-year-old woman was referred to our department because of fatigue, diffuse muscle pain and oliguria. On the basis of pathogenesis, clinical and laboratory examination the diagnoses of acute renal failure secondary to the statin-fibrate-derivative combination induced rhabdomyolysis and auto-immune thyroiditis induced hypothyroidism were made. Although saline, furosemide and sodium bicarbonate infusions enabled diuresis and have led to a rapid recovery of renal function and normalization of blood pressure in five days (creatinine level decreased from 4.5 mg/dl to 1.2 mg/dl), only thyroid replacement therapy (0,1 mg thyroxine) that begun after the exclusion of adrenal insufficiency resulted in complete resolution of rhabdomyolysis. This prompted the diagnosis of background, clinically silent rhabdomyolysis aggrevated by the statin-fibrate-derivative combination. To our knowledge this case illustrates the first example of rhabdomyolytic acute renal failure induced by a statin-fibrate-derivative combination with underlying hypothyroidism which was responsible for the basal clinically unobservable rhabdomyolysis.

Aim: Increased blood pressure variability (BPV) in end-stage renal disease (ESRD) patients is proved to be a risk factor for cardiovascular disease [Tozawa et al. 1999]. The effect of ultrafiltration (UF) on BPV in hemodialysis (HD) patients has not been reported in the literature. This study was undertaken to define the effect of a single UF on BPV in HD patients. Methods: Prior and after HD with UF, 24-hour ambulatory BP monitoring (ABPM) was applied to each patient and then diurnal and nocturnal BP and BPV parameters (both before and after UF) were compared and correlated with UF values. Results: Increase in BPV after single UF in all groups was statistically significant (p < 0.05). Only the daytime systolic (DS) BPV increase (median 42.4%) was in positive correlation with A body weight (body wt) (median 3.07%) or UF amount (r = 0.649, p < 0.01 ). Conclusions: Large volume depletions and sympathetic hyperreactivity could explain the increase in BPV. Increased interdialytic weight gain requires more UF and subsequently BPV, morbidity and mortality also increase. Thus, considerable efforts must be made to prevent great interdialytic weight gain in HD patients.

Background: Malnutrition is very common in chronic kidney disease patients and it starts from predialytic stage. The purpose of our project is to investigate the relationship between volume and

OBJECTIVE: Esophageal variceal bleeding EVB due to portal hypertension in cirrhotic patients is very important because of mortality. There were contradicted results in secondary prophylaxis for variceal bleeding. In this study our primary aim is to investigate that methods to prevent variceal rebleeding are really efficacious and to establish different treatment methods clinical success. Our secondary aim is to determine of effective factors on survival period.METHODS: One hundred eighty patients with established cirrhosis disease and had variceal bleeding enrolled in this study. Patients divided into two groups as they had prophylaxis or not. Patients in the prophylaxy group were divided into seven subgroups. Survival periods, mortality proportions, and bleeding recurrency after prophylaxis are evaluated as treatment success. The factors which influenced patients treatment success are investigated. These groups evaluated clinically and compared with each other statistically.RESULTS: We started prophylaxis to one hundred thirty three of the patients enrolled and we determined survival periods of these patients decreased by their variceal grades are increased in endoscopies. Child grades of patients are related to survival periods, while the patients grade was increasing, survival period was decreasing. In the prophylaxy group, mortality proportions were significantly increased. In regard to survival period, best success in treatment groups has acquired with beta-blocker plus band ligation treatment. CONCLUSION: We concluded that, with our study results, secondary prophylaxis has advantage and is essential in patients who had EVB. The positive results achieved with beta-blocker treatment can be accepted as this groups activity and success in prophylaxis. Moreover the high clinical success with beta-blocker plus band ligation is suggesting medical treatments combination with invasive endoscopy methods are more useful for patients., AMAÇ: Siroz hastalarında portal hipertansiyona bağlı olarak gelişen özefagus varis kanamaları ÖVK , çok önemli bir mortalite nedenidir. Buna rağmen, varis kanamasının sekonder profilaksisine yönelik, birbirleri ile çelişen sonuçlar mevcuttur. Bu çalışmada varis kanamalarının tekrarının önlenmesi için kullanılan yöntemlerin klinik etkinliği ve sağkalım süreleri üzerine olan etkileri araştırılmıştır. YÖNTEMLER: Çalışmamızda siroz teşhisi konulmuş ve özefagus varis kanaması geçiren 180 hasta incelendi. Bu hastalar profilaksi almış olanlar ve profilaksi almamışlar olarak iki gruba ayrıldı. Profilaksi başlanmış olan hastalar da kullandıkları tedavi modalitesine göre 7 alt gruba ayrıldı. Bu hastalarda sağkalım süreleri, mortalite oranları ve profilaksiden sonra kanama rekürrensi değerlendirildi. BULGULAR: Çalışmaya alınan hastaların 133 tanesine profilaksi başlanmış olup, bu hastaların gastroskopilerindeki varislerin derecesinin artması ile sağkalım sürelerinin kısaldığı belirlendi. Hastaların Child evreleri de sağkalım süreleri ile doğrudan ilişkiliydi ve tedavinin başlangıcında Child derecesi yüksek olarak tespit edilen hastaların yaşam süreleri daha kısaydı. Profilaksi başlanan hastalarda mortalite oranları anlamlı derecede daha düşük, sağkalım süreleri ise belirgin olarak daha uzundu. Yaşam süresi dikkate alındığında; tedavi gruplarında en iyi başarı, beta-bloker + bant ligasyonu tedavisi ile elde edildi. SONUÇ: Bizim çalışmamızın sonuçları, ÖVK geçiren hastalarda, sekonder profilaksinin, olumlu ve yararlı etkilerini yansıtmaktadır. Beta-bloker tedavisi ile alınan olumlu sonuçlar, bu grubun profilaksideki etkinliğinin bir göstergesi olarak düşünülebilir. Ayrıca beta-blokerlerin bant ligasyonu ile birlikte kullanıldığında elde edilen yüksek klinik başarı, profilakside kullanılan medikal tedavilerin, girişimsel endoskopik yöntemlerle kombine edilmesinin, hastalar için daha yararlı olduğunu düşündürmektedir.

Hypertensions is a common clinical problem among patients with end stage renal failure. Because physiopathology of hypertension in these patients is multifactoriel, complicated and less understood, effective blood pressure control usually can not be achieved in this population. Major two risk factors in the pathogenesis of hypertension in patients receiving hemodialysis treatment are extracellular volume and dietary sodium intake. Therapeutic targets should be determined according to etiopathogenesis. There is increasing number of evidence indicating sodium intake in patients with end stage renal failure is related to volume overload and hypertension. Because sodium plays a key role in hypertension development among these population, salt restriction and additional ultrafiltration, if necessary, should be the mainstay of the antihypertensive treatment instead of antihypertensive drugs., Hipertansiyon, son dönem böbrek yetmezliği SDBY hastalarında oldukça yaygın görülen bir klinik problemdir. Buna karşın bu hastaların etkin kan basıncı kontrolünden çoğu zaman uzak olmasının önemli bir sebebi, bu hasta grubunda hipertansiyon fizyopatolojisinin karmaşık, multifaktoriyel ve az anlaşılmış olmasından kaynaklanmaktadır. Hemodiyaliz hastalarındaki hipertansiyonun patogenezinde majör risk faktörlerinden ikisi, artmış ekstrasellüler volüm ve sodyum alımıdır. Buradan yola çıkarak terapödik hedefin anahatları da bu etyopatogenez çerçevesinde belirlenmelidir. Bulgular SDBY hastalarında sodyum yüklenmesinin, volüm yüklenmesi ve hipertansiyonla paralel seyrettiğini düşündürmektedir. Bu durum sodyumun, hipertansiyon için kilit bir rol oynadığını ve tedavinin yönetiminde esas uğraşı alanının antihipertansif ilaç desteği değil, tuz kısıtlaması ve gereğinde ek ultrafiltrasyon desteğinin olması yönündeki mücadelenin merkezi rolünü düşündürmektedir.