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INTRODUCTION Irritable bowel syndrome (IBS) is a functional bowel disease that is common in society, does not threaten life, impairs quality of life, and causes serious economic losses. Gastrointestinal system complaints and especially IBS are common in patients with chronic kidney disease. It has also been shown that psychiatric diseases are more common in patients with IBS. In this study, we aimed to determine the frequency of IBS in hemodialysis patients and to investigate the factors associated with IBS. METHODS In this cross-sectional study, the questionnaire prepared to evaluate depression, anxiety, and abdominal pain was administered face-to-face to 686 patients by the same researcher in seven dialysis centers; 404 patients without exclusion criteria were included in the study. The diagnosis of IBS was made according to Rome IV criteria. A multivariate logistic regression model was used to identify factors that are significantly related to IBS. FINDINGS In 69 (17.1%) of the patients included in the study, symptoms were consistent with IBS. Binominal logistic regression analysis was performed to evaluate the effect of age, dialysis duration, diabetes, proton pump inhibitor, non-steroidal anti-inflammatory drugs, calcium acetate use, Hamilton depression and anxiety scores associated with IBS in the presence of IBS of the participants. The logistic regression model was statistically significant, χ2 (3) = 69.748, P

Objective Older adults with co‐morbidities have been reported to be at higher risk for adverse outcomes of coronavirus disease 2019 (COVID‐19). The characteristics of COVID‐19 in older patients and its clinical outcomes in different kidney disease groups are not well known. Methods Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between 17 April 2020 and 31 December 2020. Hospitalised patients aged 18 years or older with confirmed COVID‐19 diagnosis suffering from stage 3‐5 chronic kidney disease (CKD) or on maintenance haemodialysis (HD) treatment were included in the database. Non‐uraemic hospitalised patients with COVID‐19 were also included as the control group. Results We included 879 patients [388 (44.1%) female, median age: 63 (IQR: 50‐73) years]. The percentage of older patients in the CKD group was 68.8% (n = 188/273), in the HD group was 49.0% (n = 150/306) and in the control group was 30.4% (n = 70/300). Co‐morbidities were higher in the CKD and HD groups. The rate of presentation with severe‐critical disease was higher in the older CKD and HD groups (43.6%, 55.3% and 16.1%, respectively). Among older patients, the intensive care unit (ICU) admission rate was significantly higher in the CKD and HD groups than in the control group (38.8%, 37.3% and 15.7%, respectively). In‐hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD groups (26.7% and 30.1%) compared with the control group (8.6% and 17.1%). In the multivariate analysis, in‐hospital mortality rates in CKD and HD groups were higher than control group [hazard ratio (HR): 4.33 (95% confidence interval [CI]: 1.53‐12.26) and HR: 3.09 (95% CI: 1.04‐9.17), respectively]. Conclusion Among older COVID‐19 patients, in‐hospital mortality is significantly higher in those with stage 3‐5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, co‐morbidities, clinical and laboratory data on admission.

Introduction and aim Cardiovascular diseases remain the most common cause of morbidity and mortality in patients with diabetes. Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Increased visceral adiposity is associated with proinflammatory activity, impaired insulin sensitivity, increased risk of atherosclerosis and high mortality. In the present study we aimed to investigate the relationship between EAT and visceral adiposity index (VAI) in patients with diabetes. Methods This was a cross-sectional study involving 128 patients with type 2 diabetes mellitus (73 females, 55 males; mean age, 54.09+±+9.17 years) and 32 control subjects (23 females, 9 males; mean age, 50.09+±+7.81 years). EAT was measured by using a trans-thoracic echocardiograph. Parameters such as waist circumference (WC), body mass index (BMI), triglyceride and high density lipoprotein (HDL) cholesterol were used to calculate VAI. Result EAT and VAI measurements were significantly higher in patients with diabetes when compared to control subjects. In the bivariate correlation analysis, VAI was positively correlated with uric acid level (r=0.214, p=0.015), white blood cell count (r= 0.262, p=0.003), platelet count (r=0.223, p=0.011) and total cholesterol levels (r= 0.363, p Conclusion Simple calculation of VAI was found to be associated with increased EAT in patients with type 2 diabetes.

Recent studies claim that FGF23 is also associated with anemia and inflammation. In this study, the relationship between FGF23 and anemia in hemodialysis (HD) and renal transplantation patients (RTx patients) patients was investigated. This was a cross-sectional study involving 40 RTx patients (13 females, 27 males; mean age, 45.93 ± 12.49 years) who had transplantation at least 6 months before, 25 HD patients (12 females, 13 males; mean age, 54.72 ± 15.5 years), and 20 healthy control subjects (13 females, 7 males; mean age, 36.7 ± 9.38 years). FGF23 was studied using Elisa method. Parameters such as iron, ferritin, total iron binding capacity, and transferrin saturation were assessed. FGF23 level was significantly higher in HD patients when compared with the RTx patients and control groups. In the bivariate correlation analysis, hemoglobin was positively correlated with albumin (r = 0.681, p = 0.000), ferritin (r = 0.446, p = 0.043), and negatively correlated with CRP (r = − 0.476, p = 0.016) and FGF23 (r = 0.493, p = 0.043). FGF23 was found to be an independent predictor of decreased hemoglobin in HD patients. In addition, this association was observed to disappear after transplantation. While FGF23 is closely related to hemoglobin levels in HD patients, we have shown that this relationship disappears after transplantation.

Background/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods: HA-AKI development was assessed in a group of stage 3-5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results: Among 621 hospitalized patients (age 60 [IQR: 47-73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9-44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9-33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion: AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients. Turkish Society of Nephrology for the organization We thank Turkish Society of Nephrology for the organization and funding of the study. We also would like to express our gratitude to the patients whose records were used in this study, without which this research would not be possible.

Background: we aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19.Methods: we conducted a multicenter, retrospective study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission.Results: one hundred nine patients (male/female: 63/46, mean age: 48.412.4years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p=0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60years) (39.1% vs. 13.9%; p=0.004), and had lower serum albumin (3.4g/dl [2.9-3.8] vs. 3.8g/dl [3.5-4.1], p=0.002), higher serum ferritin (679 mu g/L [184-2260] vs. 331 mu g/L [128-839], p=0.048), and lower lymphocyte counts (700/mu l [460-950] vs. 860 /mu l [545-1385], p=0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis. Conclusion: over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality., NA

Background Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and determinants of mortality in a large group of MHD patients hospitalized for COVID-19. Methods This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis. Results Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 [57–74] vs. 63 [52–71] years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 103 per mm3 versus 192 × 103 per mm3, p = 0.011) and lymphocyte (800 per mm3 versus 1000 per mm3, p p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 [95% CI, 1.003–1.041], p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 [95% CI, 2.168–17.863], p p = 0.009), ferritin levels on admission (HR; 1.057 [95% CI, 1.006–1.111], p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 [95% CI, 2.143–7.132], p 3 per mm3) during hospitalization (HR; 1.864 [95% CI, 1.025–3.390], p = 0.041) were risk factors for mortality. Conclusion Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.

Background and Aims Therapeutic plasma exchange (PEX) has an increasingly long list of indications in recent years, in addition to immunosuppressive therapies in many life-threatening immune activations, it provides significant improvements in mortality and morbidity. In this study, we aimed to investigate the laboratory and clinical effects of PEX performed with nephrologic indication in our clinic. Method The records of 67 patients (36 females, 31 males; mean age, 45.7±15.8 years) who underwent PEX with nephrological indication between 2012 and 2017 in our clinic were retrospectively reviewed. Characteristics of the patients such as, indications of PEX, laboratory values and number of PEX sessions were recorded. In addition, clinical responses were also evaluated. Results When a total 398 PEX sessions were examined, the most common indication (40.3%) was acute humoral rejection after renal transplantation, followed by granulomatosis with polyangiitis (19.4%) and thrombotic microangiopathy (9%), respectively. The average of the PEX sessions was 5.94. There was a statistically significant increase in the bicarbonate value when the arterial blood gas of the patients was evaluated after PEX (p=0.002). However, no significant difference was observed in the pH and ionized calcium values (p=0.135, p=0.969, respectively) (Table 1). When all the patients were evaluated, there was no significant change in hemoglobin values (p=0.174), but platelet values decreased significantly (p=0.011) after PEX. However, when the patient group admitted with thrombotic microangiopathy was examined, it was observed that platelet count increased and LDH level decreased significantly (p=0.063, p=0.028, respectively). When the serum creatinine values of all patients were evaluated, a significant decrease was observed in the serum creatinine values after PEX (p=0.001). In addition, after 2 years following PEX treatment, 70.1% of patients were still alive and 12.5% of patients undergoing PEX for acute humoral rejection were undergoing on hemodialysis treatment. Conclusion According to the results of our study, patients should be followed up especially for acid-base and electrolyte changes after PEX. In addition, therapeutic PEX might be effective in terms of improving morbidity and 2 year-mortality of these patients.

AMAÇ: Hemodiyaliz hastalarında kronik bir metabolik asidoz eğilimi söz konusudur. Yüksek olgu sayılı çalışmalarda diyaliz öncesi serum bikarbonat konsantrasyonu ile mortalite arasında ilişki saptanmıştır. Çalışmamızda 32 ve 36 mmol/L bikarbonat içerikli diyaliz solüsyonu kullanımının asidoz kontrolüne etkisi araştırıldı.GErEÇ ve YÖnTEMLEr: Bir merkezde haftada üç kez hemodiyalize giren 91 (43E,48K) hastaya ilk altı ay 32 mmol/L diyalizat, ikinci altı ayda aynı hastalara 36 mmol/L bikarbonat diyalizat kullanılmaya başlandı ve diyaliz öncesi ve sonrası plazma bikarbonat düzeyleri karşılaştırıldı. BULGULAr: İlk altı ayda ortalama bikarbonat düzeyi 20,552,55 mmol/L olup sadece 30 hastada bikarbonat düzeyi 22 mmol/L ve üzerindeydi. İkinci altı aylık dönemde ise ortalama bikarbonat düzeyi 23,593,3 mmol/L olup hedef düzeylerdeydi. Ancak 19 hastada diyaliz sonu ortalama bikarbonat düzeyi 30 mmol/L'nin üzerinde bulundu. Prediyaliz asidozu olan hastaların ortalama interdiyalitik kilo artışı 2,80,5 kg olup, asidozu olmayan gruptan daha yüksekti (p0,05). Prediyaliz üre, Kt/V, albumin, potasyum ve CRP düzeyleri bakımından iki periyot arasında anlamlı farklılık yoktu. SOnUÇ: 36 mmol/L bikarbonat içeren diyaliz solüsyonu kullanımı ile asidoz kontrolü daha iyi yapılmakta ancak hastaların yaklaşık yüzde yirmisinde diyaliz sonunda ciddi metabolik alkaloz gelişmektedir. Bu durum aritmiyi tetikleyebilir. Bu nedenle aritmisi olan veya metabolik alkaloza eğilimi olan hastalarda yüksek bikarbonatlı solüsyon kullanımında bikarbonat içeriğinin ayarlanmasının gerektiğini düşünmekteyiz., OBJECTIVE: In hemodialysis patients; there is a continuing tendency to metabolic acidosis. In studies, the relationship between serum bicarbonate concentration and dialysis mortality has been determined. In our study, the effect of 32 and 36 mmol/L bicarbonate-containing dialysis solution on acidosis control was investigated. MATErıAL and METHODS: In a hemodialysis clinic, a 32 mmol/L bicarbonate-containing dialysate was used in the first six months and a 36 mmol/L bicarbonate-containing dialysate was used in the second six months. The study was performed on 91 (43M/48F) patients. Plasma bicarbonate levels before and after dialysis were compared. rESULTS: In the first period, only 30 patients' bicarbonate levels were 22 mmol/L or more. In the second period, the mean bicarbonate level was 23.59±3.3 mmol/L. However, the level of bicarbonate after dialysis was above 30 mmol/L in 19 patients. In patients with predialysis acidosis, the interdialytic mean weight gain was higher than in the group without acidosis (p>0.05). There were no significant differences between the two periods in terms of predialysis urea, Kt/V, albumin, potassium and CRP levels.CONClUSION: Acidosis control is better with the use of a dialysis solution containing 36 mmol/L bicarbonate. But at the end of dialysis, severe metabolic alkalosis developed on approximately twenty percent of patients. This situation can trigger arrhythmia. We therefore think that it is necessary to adjust the machine bicarbonate in the use of high bicarbonate solution in patients with arrhythmia or alkalosis tendency.

WOS: 000392937800028 PubMed ID: 28006774 Background/Aims: Fabry disease is a treatable cause of chronic kidney disease (CKD) characterized by a genetic deficiency of a-galactosidase A. European Renal Best Practice (ERBP) recommends screening for Fabry disease in CKD patients. However, this is based on expert opinion and there are no reports of the prevalence of Fabry disease in stage 1-5 CKD. Hence, we investigated the prevalence of Fabry disease in CKD patients not receiving renal replacement therapy. Methods: This prospective study assessed a-galactosidase activity in dried blood spots in 313 stage 1-5 CKD patients, 167 males, between ages of 18-70 years whose etiology of CKD was unknown and were not receiving renal replacement therapy. The diagnosis was confirmed by GLA gene mutation analysis. Results: Three (all males) of 313 CKD patients (0.95%) were diagnosed of Fabry disease, for a prevalence in males of 1.80%. Family screening identified 8 aditional Fabry patients with CKD. Of a total of 11 Fabry patients, 7 were male and started enzyme replacement therapy and 4 were female. The most frequent manifestations in male patients were fatigue (100%), tinnitus, vertigo, acroparesthesia, hypohidrosis, cornea verticillata and angiokeratoma (all 85%), heat intolerance (71%), and abdominal pain (57%). The most frequent manifestations in female patients were fatigue and cornea verticillata (50%), and tinnitus, vertigo and angiokeratoma (25%). Three patients had severe episodic abdominal pain attacks and proteinuria, and were misdiagnosed as familial Mediterranean fever. Conclusions: The prevalence of Fa bry disease in selected CKD patients is in the range found among renal replacement therapy patients, but the disease is diagnosed at an earlier, treatable stage. These data support the ERBP recommendation to screen for Fabry disease in patients with CKD of unknown origin. (C) 2016 The Author(s) Published by S. Karger AG, Basel Sanofi Genzyme Corporation; Intensificacion ISCIII and REDINREN [RD012/0021] We are indebted to our patients and their families for volunteering to contribute their medical information to the physicians who are dedicated to their care. This work was supported by grants from Sanofi Genzyme Corporation. The lead investigator had full access to all data in the study. All investigators take responsibility for the accuracy of the individual data that they entered in the system provided by FMF Arthritis Vasculitis and Orphan disease Research (FAVOR). AO was supported by Intensificacion ISCIII and REDINREN RD012/0021.

Neutrophil gelatinase-associated lipocalin (NGAL) is a member of the lipocalin family best known as a novel and early marker of acute kidney injury (AKI). Recent data suggest that NGQueryAL is not only a marker of AKI, but also an important player in the vascular remodeling, atherosclerotic plaque stability and thrombus formation. We conducted this study to investigate the association of serum NGAL levels with fatal and composite (fatal and non-fatal) cardiovascular events (CVE) in a cohort of patients with stage 1–5 CKD. This was an observational cohort study in which serum NGAL was obtained from 298 CKD (stages 1–5) patients. Fatal and composite CVE were recorded for a median 41 months. We examined alteration of serum NGAL through CKD groups as well as association with inflammatory markers. We also performed a Cox regression analysis to determine the association of NGAL with predefined clinical outcomes. The median value of NGAL was 50.5 ng/mL (IR 47.6–54.9 ng/mL), and higher NGAL values were recorded in diabetic patients. In a multiple linear regression model, including all univariate associates of NGAL, only log eGFR, log hs-CRP and log HDL cholesterol maintained an independent association with log NGAL. During the observational period, 30 patients died due to cardiovascular causes and 69 non-fatal CVE were registered. In the fully adjusted model, we observed a 2.08-fold increase in the risk of fatal CVE and a 1.50-fold increase in the risk of fatal and non-fatal CVE for each increment of 1 SD in log NGAL values. This is the first study that shows that serum NGAL is associated with cardiovascular events (fatal and non-fatal) in patients with CKD, independently of traditional risk factors, renal function and inflammation.

Acute kidney injury (AKI) is a common complication of cardiac surgery developing in 25-35% cases. Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine. Some studies demonstrated the predictive role of post-operative serum uric acid (SUA) as an early marker of AKI. We aimed to study the role of serum and urine NGAL as well as SUA to predict progression of AKI.This is a prospective observational study of patients undergoing cardiac surgery. Blood and urine samples for measurement of uric acid, serum and urine NGAL levels were collected prior to cardiac surgery (0 h), and in the time course at 2nd and 24th hours after surgery. Patients who developed AKI were divided into two subgroups as progressing and non-progressing AKI.Sixty patients (42 males, 18 females) were included. After cardiac surgery, 40 patients developed AKI, 20 of whom non-progressing AKI, and 20 progressing AKI. All of the markers significantly increased in AKI patients. A receiver operator characteristics (ROC) curve analysis showed higher predictive ability of SUA for progressing AKI compared with serum and urine NGAL. When compared markers obtained at the second hour after surgery, UA had significantly large AUC than NGAL to predict AKI developed at 24 and 48 h, particularly in patients, who require renal replacement therapy (RRT).Uric acid seems to predict the progression of AKI and RRT requirement in patients underwent cardiac surgery better than NGAL.

Chronic inflammation was found to be correlated with coronary (CAC) and thoracic peri-aortic calcification (TAC) in end-stage renal disease (ESRD) patients. Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in cardiac and noncardiac disorders. Data regarding NLR and its association with TAC and CAC are lacking. We aimed to determine the relationship between NLR and vascular calcification in ESRD patients. This was a cross-sectional study involving 56 ESRD patients (22 females, 34 males; mean age, 49.9 ± 14.2 years) receiving peritoneal dialysis or hemodialysis for ≥6 months in the Dialysis Unit of Necmettin Erbakan University. TAC and CAC scores were measured by using an electrocardiogram-gated 64-multidetector computed tomography. NLR was calculated as the ratio of the neutrophils and lymphocytes. There was a statistically significant correlation between NLR, TACS and CACS in ESRD patients (r = 0.43, P = 0.001 and r = 0.30, P = 0.02, respectively). The stepwise linear regression analysis revealed that age, as well as NLR were independent predictors of TACS. However, increased age was the only independent predictor of CACS according to linear regression analysis. Simple calculation of NLR can predict vascular calcification in ESRD patients.

OBJECTiVE: Renal transplantation (RTx) is the best therapeutic modality for end-stage renal disease patients. We report 8 years single-centre experience on cadaveric and living donor RTx in terms of demographic features along with graft functions, posttransplant medical complications, patients-graft survivals. maTERial and mETHOdS: We enrolled 66 RTx (female/male: 36/30) patients including 40 cadaveric and 26 living donors. At admission age, gender, causes of renal failure, dialysis typeduration, type of RTx, induction and maintenance immunosuppressive modalities, rejection episodes, biochemistry-hemogram parameters at 1, 6, 12, 24 and 60 months after transplantation and medical complications were obtained from the medical records. RESulTS: Mean recipient age was 41±11.6 years. Mean transplant duration was 32.2±31.4 months, and the mean creatinine values was 1.4±0.9 mg/dl. The most commonly used immunosuppressive protocol was corticosteroid+tacrolimus+mycophenolate mofetil. Delayed graft function, chronic allograft nephropathy and acute rejection were observed in 27.3%, 25.7% and 13.6% of patients, respectively. 1and 5-year patient survival rates were 100% and 100% for living donor patients and doi: 10.5262/tndt.2013.1001.05 Yazisma Adresi: Kultigin TURKmEn Erzincan Universitesi Mengucek Gazi Egitim ve Arastirma Hastanesi, Nefroloji Bolumu, Erzincan, Turkiye Phone : +90 446 212 21 12 E-mail : mdkt2010@yahoo.com Gelis Tarihi : 01.07.2012 Kabul Tarihi : 03.08.2012

Vascular calcifications that may cause cardiovascular disease are highly prevalent in chronic kidney disease (CKD). In this study, we aimed to determine abdominal aorta calcifications (AAC) in predialysis and hemodialysis patients by lateral lumbar radiography and to investigate factors that were associated with the calcifications.Two hundred and fifty-nine adult chronic hemodialysis patients, 300 predialysis CKD patients and 60 healthy subjects with normal kidney function as a control group were enrolled in the study. Lateral lumbar radiography was used to measure AAC. Calcified deposits of the abdominal aorta wall at the level of the first through fourth lumbar vertebrae were graded by a 24-point scoring system.AAC prevalence (AAC score ≥1) was significantly different in hemodialysis, predialysis and control groups (71.8, 45.7 and 33.3 %, respectively; p 0.001). AAC prevalence in CKD stages 1, 2, 3, 4 and 5 predialysis patients was 26.6, 43.3, 40, 58.3 and 55 %, respectively. AAC scores of the hemodialysis group were higher than of the predialysis group (p 0.001) and the control group (p 0.001). AAC scores of the predialysis group were not higher than of the control group (p = 0.314). AAC scores of the hemodialysis group were significantly higher than of the control group (p 0.001) and stage 1 (p 0.001), stage 2 (p = 0.001) and stage 3 predialysis groups (p = 0.002). Age (p 0.001), presence of diabetes mellitus (p 0.001) and serum phosphorus levels (p = 0.011) were found to be independent predictors of calcification in the hemodialysis group. Age (p 0.001), serum phosphorus levels (p = 0.007) and history of cardiovascular disease (p = 0.014) were found to be independent predictors of calcification in the predialysis group.Abdominal aortic calcification is highly prevalent in the hemodialysis population. Strict phosphorus control should be implemented to the predialysis and hemodialysis patients.

Thoracic peri-aortic fat tissue (PFT) is considered as a metabolically active organ in atherosclerosis. Malnutrition, inflammation and atherosclerosis/calcification (MIAC) are the most commonly encountered risk factors of cardiovascular disease in end-stage renal disease (ESRD) patients. Calcification of the aorta was found to be an important cardiovascular risk marker predicting future events, morbidity and mortality in this population. We aimed to investigate the relationship between PFT, MIAC syndrome and thoracic aortic calcification (TAC) in ESRD patients.Seventy-nine ESRD patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and 20 control subjects were enrolled in this cross-sectional study. PFT and TAC were assessed using a 64-MDCT scanner. Patients with serum albumin3.5 g/dL were defined as patients with malnutrition; those with serum C-reactive protein level10 mg/L had inflammation, and those with coronary artery calcification score (CACS)10 had atherosclerosis/calcification.TAC and PFT were significantly higher in ESRD patients compared with control subjects. There was a statistically significant relationship between PFT and TAC in ESRD patients (r = 0.458, p0.0001). PFT was found to be significantly increased when the MIAC components increased. PFT was positively associated with age, BMI, uric acid, hemoglobin and CAC. The multivariate analysis revealed that age and uric acid were independent predictors of increased PFT. Twenty-four (30.4 %) patients had none, 30 (37.9 %) had one component, 17 (21.5 %) had two components, and 8 (10.2 %) had all MIAC components. PFT was highest among patients having all three components (28.6 cm(3)) and lowest among those who do not have the MIAC syndrome (8.54 cm(3)). TAC was highest among patients having all three components (179.2 HU) and lowest among those who do not have the MIAC syndrome (0 HU).We found a relationship between PFT and MIAC syndrome in ESRD patients.

ObJEcTIVE: Vascular calcification (VC) and disturbed bone mineral metabolism (BMM) are commonly seen in patients with end-stage renal disease (ESRD). Fetuin-A has been found to be significantly low in ESRD patients. The aim of our study was to investigate the relation between coronary artery calcification, BMM and fetuin-A in peritoneal dialysis (PD) patients. MATERIAl and METHODS: 46 PD (M/F=28/18) patients were included in the study. Coronary artery calcification scoring (CACS) was performed by multi slice computed tomography. The patients were divided into 4 groups according to their CACS values as Group 1 (CACS: 0), Group 2 (CACS:199), Group 3 (CACS:100-399) and Group 4 (CACS: ≥400). Serum levels of fetuin-A were measured. Bone mineral densitometry was measured by dual energy X-ray absorptiometer (DEXA). RESUlTS: There was a statistically significant difference difference between CACS and femur T scores in PD patients. Femur T scores were found to be decreased while CACS values are increased. We could not find any differences in terms of CACS when we separated patients according to T scores greater or lower than -2. Osteopenic patients were found to be older and they also had low fetuin-A levels. cOnclUSIOn: We found an important relationship between CACS and bone mineralization in PD patients. KEy wORDS: Peritoneal dialysis, Vascular calcification, Bone mineral densitometry doi: 10.5262/tndt.2012.1003.07 Yazisma Adresi: Kultigin Turkmen Selcuk Universitesi Meram Tip Fakultesi, Nefroloji Bilim Dali, Konya, Turkiye Gsm : 0 538 492 78 77 E-posta : mdkt2010@yahoo.com Gelis Tarihi : 22.12.2011 Kabul Tarihi : 13.01.2012

ObJectIVe: Peritoneal dialysis is a renal replacement therapy in patients with end stage renal disease. Conjugated linoleic acid (CLA) refers to a class of positional and geometric conjugated isomers of the omega-6 essential fatty acid, linoleic acid. This study aimed to investigate biologically active isomers of CLA (10-trans, 12-cis CLA and -9-cis,11-trans CLA) and the relationship between these fatty acids and weight, body mass index (BMI), C-reactive protein (CRP) and parathyroid hormone (PTH) in continuous ambulatory peritoneal dialysis patients (CAPD) and healthy subjects. MAterIAl and MetHODS: This study was performed on 51 (21M, 30F) CAPD patients at least 6 months under dialysis, aged 20-75 years and 45 (25M, 20F) healthy control subjects aged 20-60 years. Plasma 10-trans, 12-cis CLA (t10,c12 CLA) and 9-cis,11-trans CLA (c9,t11 CLA) levels were measured by GS-MS technique. reSultS: t10,c12 and c9,t11 isomers of CLA levels of the CAPD patients were as follows: 11.84 ± 5.3 and 8.34 ± 4.4 mg/L respectively. The same parameters of the controls were as follows: 12.88 ± 4.1 and 9.20 ± 4.5 mg/L, respectively. The differences between plasma CLA isomers levels of CAPD doi: 10.5262/tndt.2012.1003.08 Yazisma Adresi: Fatma Humeyra YerlikAYA Necmettin Erbakan Universitesi, Meram Tip Fakultesi, Biyokimya Anabilim Dali, Konya, Turkiye Gsm : 0 505 466 42 31 E-posta : fhumeyray@hotmail.com Gelis Tarihi : 21.10.2011 Kabul Tarihi : 27.11.2011 Yerlikaya FH ve ark: Surekli Ayaktan Periton Diyalizi Hastalarinda Plazma 9-cis, 11-trans ve 10-trans, 12-cis Konjuge Linoleik Asit Izomerleri Duzeyleri 248 turk nefroloji Diyaliz ve transplantasyon Dergisi Turkish Nephrology, Dialysis and Transplantation Journal Turk Neph Dial Transpl 2012; 21 (3): 247-252 periton diyalizi (SAPD) hastalarinda ve saglikli kisilerde bu yag asit duzeylerini karsilastiran ve vucut kitle indeksi (VKI), C-reaktif protein (CRP) ve PTH ile iliskisini arastiran herhangi bir calismaya rastlanilmamistir. Biz bu calismada, SAPD hastalarinda ve saglikli kisilerde plazma c9,t11 KLA ve t10,c12 KLA izomerleri duzeylerini ve bu yag asitleri ile kilo, VKI, CRP, PTH arasindaki iliskiyi arastirmayi amacladik.

OBJeCTIve: Vascular calcification is commonly seen in patients with end-stage renal disease (ESRD). Fetuin-A has been found to be a vascular calcification inhibitor and its level is significantly low in ESRD patients. The aim of our study was to investigate the relation between coronary artery calcification, inflammation and fetuin-A levels in peritoneal dialysis (PD) and hemodialysis (HD) patients.

ObjecTIve: Despite the unethical characteristic and unfavorable consequences, paid livingunrelated renal transplantation is still considered as an option for end-stage renal disease patients. This study aimed to compare the medical and surgical complications along with allograft functions of PLURT patients with age and gender matched transplant recipients who received a living or deceased donor kidney at our center.

Amyloid fibrils can affect vascular structure through deposition and by causing nitric oxide depletion and increase of asymmetric dimethyl arginine. Patients with amyloidosis are prone to development of hypotension. Hypotension may also affect the maturation of arteriovenous fistula (AVF) and may set the stage for formation of thrombosis and fistula failure. Thus, we aimed to evaluate effects of secondary amyloidosis on AVF outcomes and intradialytic hypotension. This is a case-control study which included 20 hemodialysis patients with amyloidosis and 20 hemodialysis patients without amyloidosis as control group. All patients underwent Doppler ultrasound of AVF. A thorough fistula history and baseline laboratory values along with episodes of intradialytic hypotension and blood pressure measurements were recorded. There was no difference between the groups regarding age, gender, body mass index, presence of comorbidities, hypertension, and drug use. Systolic and diastolic blood pressures were similar (119 ± 28/75 ± 17 and 120 ± 14/75 ± 10 mmHg for patients with and without amyloidosis, respectively). Intradialytic hypotension episodes were also similar. Patients with amyloidosis had significantly lower serum albumin and higher C-reactive protein values compared to control hemodialysis patients. AVF sites and total number of created fistulas were similar in both groups. Flow rates of current functional AVFs were not different between the groups (1084 ± 875 and 845 ± 466 mL/minute for patients with and without amyloidosis, respectively, p:0.67). Patency duration of first AVF was not different between the groups. Clinical fistula outcomes and rate of intradialytic hypotension episodes were not significantly different between patients with and without secondary systemic amyloidosis.

Health-related quality of life (HRQoL) and sleep quality (SQ) were impaired in patients with end-stage renal disease (ESRD). The impairment of both HRQoL and SQ and being in a depressive mood were found to be associated with increased morbidity and mortality in dialysis patients. We aimed to investigate the association between SQ, HRQoL, and depression, and to define independent predictors of SQ and depression in peritoneal dialysis (PD) and hemodialysis (HD) patients. Ninety HD patients (41 females, 49 males with mean age 50 ± 15.7 years) and 64 PD patients (27 females, 37 males with mean age 52.4 ± 15.3 years) receiving renal replacement therapy for at least 3 months were screened for the assessment of SQ, HRQoL, and depression in this cross-sectional study. A modified postsleep inventory, Short Form of Medical Outcomes Study (SF-36) and Beck depression inventory (BDI) were applied to all patients for evaluating SQ, HRQoL, and depression, respectively. HD and PD patients had similar total SQ scores. Physical and mental component scale of HRQoL were found to be significantly higher in HD patients (p < 0.001). PD patients were found to be much more in depressive mood when compared with HD patients (p < 0.001). Independent predictors of depression in patients were mental component scale of HRQoL, gender (being female), and dialysis modality (being PD patient). Physical component scale was also found to be an independent predictor of SQ. This study showed that despite similar SQ scores between two groups, HD patients had better HRQoL and less depression than PD patients.

Vascular calcification and increased oxidative stress are commonly seen in patients with end-stage renal disease (ESRD). Nitrotyrosine is one of the end products of nitric oxide metabolism and is accepted as an indicator of oxidative stress. Nitrotyrosine levels have been found to be high in ESRD patients. The aim of our study is to investigate the relation between coronary artery calcification and oxidative stress in peritoneal dialysis (PD) and hemodialysis (HD) patients. 46 PD and 34 HD patients are included in the study. Coronary artery calcification scoring (CACS) is made by multi slice computed tomography. Patients are divided into 4 groups according to their CACS values as Group 1 (CACS: 0), Group 2 (CACS:1-99), Group 3 (CACS:100-399) and Group 4 (CACS: ≥400). Serum nitrotyrosine levels were measured. Nitrotyrosine levels were significantly increased in HD patients compared to PD patients. Nitrotyrosine levels were found to be elevated in accordance with increased CACS in PD patients. However, we could not find this relationship in HD patients. There might be an important relationship between CACS and oxidative stress in PD patients., Son dönem böbrek yetersizliği (SDBY) gelişen hastalarda vasküler kalsifikasyon (VK) ve oksidatif stres yaygın olarak gözlenmektedir. SDBY’li hastalarda oksidatif stres belirteci olan nitrotirozin düzeyinin yüksek olduğu tespit edilmiştir. Çalışmamızın amacı periton diyaliz (PD) ve hemodiyaliz (HD) hastalarında koroner arter kalsifikasyonu ile oksidatif stres arasındaki ilişkiyi incelemektir. Çalışmamıza 46 PD ve 34 HD hastası alınmıştır. Hastalara multi slice bilgisayarlı tomografi ile koroner arter kalsiyum skorlaması (KAKS) yapıldı. KAKS değerlerine göre hastalar Grup 1 (KAKS 0), Grup 2 , Grup 3 ve Grup 4 (KAKS: ≥400) olmak üzere 4 gruba ayrıldı. Serumda nitrotirozin düzeyleri ölçüldü. PD hastalarıyla kıyaslandığında, HD hastalarının nitrotirozin düzeyi anlamlı olarak yüksekti. PD ve HD hastaları KAKS göre gruplara ayrıldığında PD hastalarında KAKS arttığında nitrotirozin düzeyi de anlamlı olarak artmaktaydı, halbuki bu ilişki HD hastalarında tespit edilemedi.PD hastalarında KAKS ile oksidatif stres arasında anlamlı bir ilişki mevcuttur

Cardiovascular (CV) disease is the leading cause of death in dialysis patients. Traditional CV risk factors aggregate in this population as well as an abundance of novel risk factors unique to dialysis population. Dyslipidemia is related to increased CV risk in the general population. However, recent randomized trials showed no clear benefit of treating dyslipidemia in hemodialysis patients with a statin. Several hypotheses have been put forward to account for these discouraging results, including differences in atherosclerotic plaque composition, qualitative and quantitative changes in lipid profiles of hemodialysis patients, and increased frequency of sudden deaths in this population, among others. Dialysis mode, namely HD or peritoneal dialysis (PD), also lead to some particular changes in the lipid and lipoprotein profiles. PD patients generally have a more atherogenic lipid profile compared with their HD counterparts. Modifications in some parameters of HD or PD along with pharmacologic therapy, mainly statins, constitute the current therapeutic armamentarium against dyslipidemia in dialysis patients. Future randomized controlled trials taking into account the particular characteristics of dialysis dyslipidemia are needed for evidence-based answers in this currently controversial topic.

The incidence of cancer is greater in transplant recipients compared with the general population. Posttransplantation lymphoproliferative disorder (PTLD) is the second most common cancer in these patients. Non-Hodgkin lymphoma is most commonly observed, and multiple myeloma (PTLD-MM) accounts for less than 4% of PTLDs. Most reported PTLD-MM is of recipient origin, and to date, few cases of donor-origin PTLD-MM have been reported. Bortezomib is a protease inhibitor that has been used successfully to treat multiple myeloma. Herein, we describe the case of a patient in whom multiple myeloma developed shortly after paid living-unrelated renal transplantation performed abroad (in Egypt). The patient had no apparent risk factors for PTLD-MM. Thus, it was supposed that PTLD-MM was of donor origin, considering its early development, lack of recipient risk factors, and no available donor medical status. To our knowledge, this report is the first to describe the use of bortezomib in this setting. Although bortezomib plus dexamethasone therapy resulted in hematologic remission, the patient remained dialysis-dependent.

WOS: 000284158800011, PubMed: 20697163, Common variable immunodeficiency (CVID) is a heterogenous group of predominantly antibody deficiency disorders that make up the greatest proportion of patients with symptomatic primary hypogam maglobulinemia The rare coincidence of amyloidosis and hypogamma globulinemia has been reported previously Contrary to the usual insidious slowly progressive disease following hepatitis C infection a rapidly progressive cirrhotic form can develop in hypogammaglobulinemic patients We report a HCV positive patient with a new onset of nephrotic syndrome and systemic amyloidosis secondary to CVID Blood analyses showed serum creatininne of 1 8 mg/dL and serum albumin of 3 1 gm/dL 24 h urinary protein was 11 800 mg/day Serum immunoglobulin levels were IgG 340 mg/dL IgM 18 mg/dL IgA 11 mg/dL Duodenal biopsy revealed AA type amvloidosis with potassium permanganite and Congo red staining After a month of antiprotemuric therapy the proteinurin was reduced to 3350 mg/day

In literature, there was little data about frequency and outcome of ARF with two or more causes in etiology. Therefore, the aim of this study was to search this issue. This series included 339 patients with ARF from Jan 1,1987 to Jan 1,1999. Fourty-six (30 males) of all patients (13.5%) had two or more causes in etiology of ARF. Of these patients, causes were prerenal and renal in 26 (56%), prerenal, renal and postrenal in 12 (26%), renal and postrenal in 4 (9%), and prerenal and postrenal in 4 (9%). The most frequent cause is diarrhea and vomiting in prerenal, gentamycin usage in renal and prostate hypertrophy in postrenal. Of these patients, there was oliguria in 32 (70%), anuria in 8 (17%) and non-oliguria in 6 (13%). Treatment modalities of patients was only medical in 19 (41%), dialysis in addition to medical therapy in 27 (59%). In spite of treatment, 5 (10.8) of patients with two or more causes in etiology died. Causes of death were uremic coma in 2, cardiac disorders in 2 and septic shock in 1. Three (11.2%) of other patients with one cause died. Mortality rates were not different (chi2: 0.0298, p0.5). Cortical necrosis was diagnosed in one patient with multiple etiology and 2 of other patients. Finally, frequency of ARF with two or more etiologic causes was 13.5%, and most frequent causes were hypovolemia and nephrotoxic drugs. Outcome of these patients was similar to other patients with one cause.

HELLP syndrome, a syndrome of hemolysis, elevated liver enzymes and low platelets may occur in pregnancy with pre-eclampsia/eclampsia, and its a significant complication is acute renal failure (ARF). The aim of study was to determine frequency and outcome of HELLP syndrome complicated by ARF. Thirty-nine patients with pregnancy-related ARF were treated between Jan 1, 1989 and Jan 1, 1999. In these patients, the most frequent causes were HELLP syndrome (n = 14; 36%), postpartum hemorrhage (n = 10; 26%), pre-eclampsia/eclampsia (n = 6; 15%) and abruptio placenta (n = 4; 10%). Seven of the patients with HELLP syndrome had impairment of consciousness during hospitalization. Of these patients, coma in 5, stupor in 1, confusion in 1 were diagnosed. Twelve of the patients with HELLP syndrome and 14 of the other patients were treated by dialysis. Mann-Whitney U test and chi2 test(corrected by Yates and Fisher exact) were used for statistical analysis. Although serious clinical findings, with supportive treatment, 12 patients with HELLP syndrome and 21 other patients were fully recovered. One patient both with and without HELLP syndrome could not recovered due to diffuse cortical necrosis. Moreover, one patient with HELLP syndrome and 3 other patients were died. Mortality rate of the patients with HELLP syndrome was not found different from those of the other patients (p = 0.544). The causes of death were cerebral hemorrhage in patient with HELLP syndrome and disseminated intravascular coagulation (n = 1), cerebral emboli (n = 1), adult respiratory distress syndrome (n = 1). Fetal death occurred in 4 patients with HELLP syndrome (28.5%) and 7 other patients (28%), and rates were similar (p0.5). Finally, HELLP syndrome was the most frequent cause leading to ARF in pregnancy and their prognosis was not different from those of the other patients.

In recent years, the incidence of acute renal failure (ARF) in pregnancy has decreased in developed countries. This cause of this decline has been reported to be liberalized abortion laws and improved prenatal care. The aim of this study was to determine if the incidence and etiology of ARE in pregnancy in our population had undergone similar changes. Between January 1, 1980 and January 1 1997 the number of the patients with ARF was 487. In 74 (15%) of these patients, the etiology of ARF was associated with pregnancy. The frequency of ARF in pregnancy was 17.4% between January 1980 and August 1985, 15.4% between September 1985 and November 1989, 13.5% between December 1989 and January 1997. The differences between the frequencies were not statistically significant (p0.5). In the present series, the various disorders leading to ARF in pregnancy were abortion (30%), HELP syndrome and pre-eclampsia (14%), pre-eclampsia or eclampsia (12%), postpartum hemorrhage (15%), fetal death (12%), abruption placentae (6%) and placentae previa (1%).

Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.

Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in end-stage renal disease (ESRD) patients. One of the established risk factor in this population is dyslipidemia. We aimed to determine the relationship between atherogenic index of plasma (AIP) and EAT in ESRD patients.This was a cross-sectional study involving 76 ESRD patients receiving PD or HD for ≥6 months and 42 healthy subjects. EAT was measured by using an electrocardiogram-gated 64-multidetector computed tomography (MDCT). Atherogenic index of plasma was calculated as the logarithmically transformed ratio of the serum trigliseride to HDL-cholesterol.The etiology of ESRD patients was diabetic nephropathy (n = 16), chronic glomerulonephritis (n = 10), hypertensive nephropathy (n = 23), polycystic kidney disease (n = 7), nephrolithiasis (n = 5) and unknown (n = 15). There were no differences with respect to the following variables between ESRD patients and healthy subjects: age; sex; BMI; predialysis levels of DBP; serum levels of albumin, HDL-cholesterol and hemoglobin. However, ESRD patients had higher serum levels of trigliseride, hs-CRP and AIP when compared to healthy subjects. There was a statistically significant relationship between EAT, BMI and AIP in ESRD patients (r = 0.42, p 0.001 and r = 0.25, p = 0.028, respectively). The stepwise linear regression analysis revealed that age, as well as BMI were independent predictors of EAT.We found a relationship between EAT as defined by MDCT and AIP in ESRD patients. Further clinical and experimental studies are needed.

WOS: 000318850200013, PubMed: 22753454, Background: Thoracic peri-aortic fat tissue (PFT) and epicardial adipose tissue (EAT) are metabolically active visceral fat deposits surrounding the thoracic aorta and the heart, respectively. Various studies have demonstrated a positive predictive value of both PFT and EAT for coronary artery disease in the general population. In the present study, we aimed to investigate PFT thickness and the independent predictors of PFT in peritoneal dialysis (PD) patients. Methods: Our cross-sectional study enrolled 35 PD patients (10 women, 25 men) and 30 age-and-sex-matched healthy subjects (15 women, 15 men). We measured PFT, thoracic artery calcification (TAC), EAT, and coronary artery calcification (CAC) by electrocardiogram-gated 64-multi-detector computed tomography. Results: The measured PFT, EAT, CAC, and TAC were significantly higher in the PD group than in the healthy subjects (p < 0.05 each). In the PD group, PFT and TAC were significantly correlated (r = 0.33, p = 0.007). Also, PFT measurements were positively correlated with EAT and total CAC in the PD and the control group alike (r = 0.58, p = 0.001 and r = 0.54, p = 0.01 respectively). A stepwise linear regression analysis revealed that age, duration of hypertension, and being a PD patient were independent predictors of PFT. Conclusions: Measured PFT was higher in PD patients than in healthy subjects and, in the PD population, was also shown to be related to calcification scores and EAT., Scientific Investigation and Project Foundation of Selcuk University Meram School of MedicineSelcuk University, This study was supported by the Scientific Investigation and Project Foundation of Selcuk University Meram School of Medicine.

Background/Aims: Atherosclerosis and inflammation are the most important risk factors in the pathogenesis of cardiovascular diseases (CVD) in patients with end-stage renal disease (ESRD). Pentraxin-3 (PTX-3) was shown to predict inflammation and atherosclerosis in ESRD patients. However, the role of renal transplantation (Rtx) in terms of atherogenesis is still unclear. We aimed to investigate the relationship between PTX-3, neutrophil-to-lymphocyte ratio (NLR), and carotid intima-media thickness (CIMT) in Rtx patients and healthy controls. Methods: This was a cross-sectional study involving 29 Rtx patients (12 females, 40.1 ± 11.9 years) without overt CVD and 19 healthy subjects (9 females, 36.9 ± 8.9 years), testing the relationship between CIMT, assessed by ultrasonography, and selected biomarkers. Results: CIMT, PTX-3, and high-sensitivity C-reactive protein (hs-CRP) levels of Rtx patients were found to be significantly higher compared to healthy subjects. CIMT was positively correlated with age, creatinine, uric acid, triglyceride, PTX-3, hs-CRP, and NLR, and negatively correlated with estimated glomerular filtration rate in all participants. In Rtx patients, CIMT was positively correlated with age, BMI, serum phosphorus, low-density lipoprotein, and hs-CRP. The multivariate analysis revealed that hs-CRP was found to be an independent variable of CIMT in Rtx patients. Conclusion: Our data showed that inflammation and atherosclerosis persist in Rtx patients. Serum hs-CRP might be a useful marker to assess these parameters in this population.

Kultigin Turkmen,1 Fatih Mehmet Erdur,1 Ibrahim Guney,2 Abduzhappar Gaipov,1 Faruk Turgut,3 Lutfullah Altintepe,2 Mustafa Saglam,1 Halil Zeki Tonbul,1 Emaad M Abdel-Rahman41Division of Nephrology, Meram School of Medicine, Necmettin Erbakan University, Meram, Konya, Turkey; 2Division of Nephrology, Meram Research and Training Hospital, Meram, Konya, Turkey; 3Division of Nephrology, Iskenderun State Hospital, Iskenderun, Hatay, Turkey; 4Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USAObjective: Both the incidence and the prevalence of end-stage renal disease (ESRD) in elderly patients are increasing worldwide. Elderly ESRD patients have been found to be more prone to depression than the general population. There are many studies that have addressed the relationship between sleep quality (SQ), depression, and health related quality of life (HRQoL) in ESRD patients, but previous studies have not confirmed the association in elderly hemodialysis (HD) patients. Therefore, the aim of the present study was to demonstrate this relationship in elderly HD patients.Patients and methods: Sixty-three elderly HD patients (32 females and 31 males aged between 65 and 89 years) were included in this cross-sectional study. A modified Post-Sleep Inventory (PSI), the Medical Outcomes Study 36-item short form health survey, and the Beck Depression Inventory (BDI) were applied.Results: The prevalence of poor sleepers (those with a PSI total sleep score [PSI-4 score] of 4 or higher) was 71% (45/63), and the prevalence of depression was 25% (16/63). Of the 45 poor sleepers, 15 had depression, defined as a BDI score of 17 or higher. Poor sleepers had a significantly higher rate of diabetes mellitus (P = 0.03), significantly higher total BDI scores, and lower Physical Component Scale scores (ie, lower HRQoL) than good sleepers. The PSI-4 score correlated negatively with Physical Component Scale (r = −0.500, P < 0.001) and Mental Component Scale scores (r = −0.527, P < 0.001) and it correlated positively with the BDI score (r = 0.606, P < 0.001). In multivariate analysis, independent variables of PSI-4 score were BDI score (beta value [β] = 0.350, P < 0.001), Mental Component Scale score (β = −0.291, P < 0.001), and age (β = 0.114, P = 0.035).Conclusion: Poor SQ is a very common issue and is associated with both depression and lower HRQoL in elderly HD patients.Keywords: health-related quality of life, end-stage renal disease, poor sleep quality, Post-Sleep Inventory, Beck Depression Inventory

Colchicine has been used in a number of disorders. Because colchicine is partially excreted from the kidney, there is a need for dose reduction in case of renal functional impairment. There are no data with regards to safe dosing schedule of colchicine in hemodialysis patients. We aimed to evaluate adverse effects of colchicine use in a hemodialysis cohort. We screened hemodialysis patients who were using colchicine for any reason. All patients were interviewed regarding possible toxicities of colchicine use and were examined with a special focus on neuromuscular system. Creatine kinase and myoglobin were used to detect any subclinical muscle injury or rhabdomyolysis, respectively. Twenty-two maintenance hemodialysis patients who were on colchicine for more than 6 months and 20 control hemodialysis patients not using colchicine were included in the study. Four of 22 patients were using 0.5 mg/day, 4 patients were using 1.5 mg/day, and 14 patients were using 1 mg/day colchicine. Mean duration for colchicine use was 8.9±8.2 years. There was no difference between the groups in terms of myoneuropathic signs and symptoms and blood counts except for white blood cell count, which was significantly higher in patients on colchicine. Serum creatine kinase (56.3±39.5 and 52.1±36.1 for colchicine and control groups, respectively, P=0.72) and myoglobin (191.4±108.8 and 214.6±83.5 for colchicine and control groups, respectively, P=0.44) levels were not different between the groups. We conclude that in a small number of haemodialysis patients who were apparently tolerating colchicine, detailed assessment revealed no evidence of sublinical toxicity when compared with controls.

WOS: 000312167700006, PubMed: 22493602, Background: Atherosclerosis, endothelial dysfunction, coronary artery calcification (CAC), and left ventricular hypertrophy are the most commonly encountered risk factors in the pathogenesis of cardiovascular disease in end-stage renal disease patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT has been shown in healthy subjects and patients with a high risk of coronary artery disease. In the present study, we aimed to investigate the relationship between EAT and CAC in peritoneal dialysis (PD) patients. Patients and Methods: Forty-five PD patients (18 females, 27 males, with a mean age of 50.6 +/- 15 years) and 25 healthy subjects (12 females, 13 males, with a mean age of 52.4 +/- 10.7 years) were enrolled in the study. EAT and CAC score (CACS) measurements were performed by a multidetector computed tomography scanner. Results: EAT of the PD patients was significantly higher than that of the healthy subjects (p = 0.02). When patients were divided into two subgroups (group 1: CACS 10, n = 25), EAT was also significantly higher in group 2 patients than in group 1 patients and healthy subjects. Age and EAT were also found to be correlated with CACS >= 10. Conclusion: There is a relationship between the anatomic assessment of coronary artery lesions by multidetector computed tomography and EAT in PD patients. This relationship might be attributed to increased inflammation and proinflammatory cytokines in uremic patients. copyright (C) 2012 S. Karger AG, Basel

Rationale/objectives: Data are limited regarding the use of paricalcitol in calcitriol-resistant patients with secondary hyperparathyroidism (SHPT). We aimed to evaluate the effects of paricalcitol in calcitriol-resistant hemodialysis patients with SHPT. Methods: This is a 12-month, open-label, prospective study. Forty patients with calcitriol-resistant and/or calcitriol-intolerant SHPT were included. After a washout period, all patients converted to paricalcitol with a 1:3 conversion ratio. Serum calcium and phosphorus were monitored monthly, while serum intact parathyroid hormone (iPTH) once in every 3 months. Paricalcitol dose was reduced or discontinued in case of hypercalcemia and/or hyperphosphatemia. Pre- and posttreatment electrolyte and iPTH values were compared with Student’s t-test and Wilcoxon signed-rank test, respectively. Main findings: Forty patients completed the study. Mean initiation dose of paricalcitol was 23 ± 7 µg/week. Mean serum calcium was 8.9 ± 0.8 mg/dL at baseline and 9.4 ± 0.7 mg/dL at study end (p = 0.07). Mean monthly serum phosphorus levels stayed stable. Paricalcitol was effective in reducing iPTH levels when compared with pretreatment values (747.9 ± 497.2 pg/mL, 307.3 ± 417.1 pg/mL, respectively; p < 0.001). Thirty-two patients had to discontinue intravenous (IV) paricalcitol at some time during their treatment. Main reasons for discontinuation were as follows: hyperphosphatemia (58%), hypercalcemia (25%), and iPTH < 150 pg/mL (17%). Principle conclusions: Paricalcitol was found to be effective in reducing iPTH levels in calcitriol-resistant patients with SHPT despite relatively frequent drug discontinuation rates.

Patients with end-stage renal disease (ESRD) have elevated serum levels of inflammatory mediators including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin (IL)-6. Systemic inflammation was found to be correlated with coronary artery disease (CAD) in this population. Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in cardiac and non-cardiac disorders. Data regarding NLR and its association with inflammation are lacking. We aimed to determine the relationship between NLR and inflammation in ESRD patients.This was a cross-sectional study involving 61 ESRD patients (25 females and 36 males; mean age: 48.3 ± 14.5 years) receiving peritoneal dialysis (PD) or hemodialysis (HD) for ≥6 months in the Dialysis Unit of Selcuk University. NLR, CRP, TNF-α, and IL-6 levels were measured.NLR, serum CRP, IL-6, and TNF-α levels were significantly higher in PD patients when compared with HD patients. ESRD patients with NLR ≥ 3.5 had significantly higher TNF-α levels when compared with patients with NLR3.5. In the bivariate correlation analysis, NLR was positively correlated with TNF-α in this population.Simple calculation of NLR can predict inflammation in ESRD patients.

Atherosclerosis, coronary artery calcification, diabetes mellitus, inflammation, endothelial dysfunction, and left ventricular hypertrophy are the most commonly encountered risk factors in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease (CAD) and EAT was shown in healthy subjects and patients with high risk of CAD. To date, there is not enough data about EAT in diabetic and nondiabetic ESRD patients. Therefore, we aimed to investigate the EAT and coronary artery calcification score (CACS) in diabetic and nondiabetic ESRD patients and healthy subjects.Sixty ESRD patients (17 diabetic, 43 nondiabetic ESRD patients) and 20 healthy subjects were enrolled in the study. EAT and CACS were performed by a 64-slice multidetector computed tomography scanner.There were no differences in age, gender, body mass index, predialysis systolic and diastolic blood pressure levels, biochemical parameters including serum low-density lipoprotein and high-density lipoprotein cholesterol, triglycerides, and C-reactive protein between healthy subjects, diabetic, and nondiabetic ESRD patients. Total CACSs and EAT measurements were significantly higher in diabetic ESRD patients when compared with nondiabetic ESRD patients and healthy subjects. There was statistically significant relationship between EAT and CACS in ESRD patients (p0.0001, r = 0.48).In conclusion, we found a significant increase in terms of EAT and CACS in diabetic ESRD patients when compared with nondiabetic ESRD patients and healthy subjects.

WOS: 000293721400019, PubMed: 21757644, Background and objectives Malnutrition, inflammation, atherosclerosis/calcification (MIAC) and endothelial dysfunction are the most commonly encountered risk factors in the pathogenesis of cardiovascular disease in ESRD patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between CAD and EAT was shown in patients with high risk of coronary artery disease. In this study, we aimed to investigate the relationship between EAT and MIAC syndrome in ESRD patients. Design, setting, participants, & measurements Eighty ESRD patients and 27 healthy subjects enrolled in this cross-sectional study. EAT and coronary artery calcification score were measured by a multidetector computed tomography (MDCT) scanner. Patients with serum albumin 10 ng/dl (normal range, 0-5 ng/dl) had inflammation; and those with CACS >10 had atheroscleosis/calcification. Results Total CACS and EAT measurements were significantly higher in ESRD patients when compared with healthy subjects. There was a statistically significant relationship between EAT and CACS in ESRD patients (r = 0.48). EAT measurements were higher in PD patients than HD patients. Twenty-four of the patients had no component, 31 had one component, 17 had two components, and nine had all of the MIAC components. EAT was found to be significantly increased when the presence of MIAC components increased. EAT was positively correlated with age, body mass index, and presence of MIAC. These parameters were also found as independent predictors of increased EAT. Conclusions We found a relationship between EAT and components of MTAC syndrome in ESRD patients. J Am Soc Nephrol 6: 1920-1925, 2011. doi: 10.2215/CJN.00890111, Scientific Investigation and Project Foundation of Selcuk University Meram School of MedicineSelcuk University, This study was supported by the Scientific Investigation and Project Foundation of Selcuk University Meram School of Medicine.