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OBJECTIVE: The aim of this study was to assess the ability of lipid accumulation product (LAP) and visceral adiposity index (VAI) to predict metabolic syndrome (MetS) in patients with chronic kidney disease (CKD). We also aimed to determine whether VAI and LAP indices are superior to traditional body indices such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). PATIENTS AND METHODS: This study was performed by retrospectively scanning the files of patients with stage 3-5 chronic renal failure who came for nephrology outpatient follow-up between January 2017 and December 2017. Metabolic syndrome was identified using the 2009 harmonized criteria. The receiver operating characteristic curve (ROC) was used to compare the area under the ROC curve (AUC) of each index. RESULTS: 247 patients were included in the analyses. The prevalence of MetS was 80.9%. LAP was determined as the optimal predictor in chronic kidney disease patients, with 0.864 AUC in females and 0.908 AUC in males. Optimal cutoff values for LAP were 33.5 in females and 36.6 in males. VAI was the second most optimal predictor, with 0.856 AUC in females and 0.888 AUC in males. Optimal cut-off values for VAI were 2.24 in females and 1.56 in males. CONCLUSIONS: LAP and VAI are effective indices for the prediction of MetS in patients with chronic kidney disease; LAP is the best index for the determination of MetS in both men and women. [ABSTRACT FROM AUTHOR]

Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially fatal condition. Acquired cystic kidney disease (ACKD) may cause SRH in hemodialysis patients. However, presentation of retroperitoneal hematoma as hemoperitoneum in peritoneal dialysis (PD) patients is exceedingly rare. We report a 44‑year‑old male PD patient who presented with hemoperitoneum secondary to retroperitoneal hematoma. The reason of SRH was rupture of the cysts of ACKD. The patient underwent unilateral nephrectomy with subsequent disappearance of hemoperitoneum. The importance of this case lies in the fact that the patients who have been receiving dialysis for a long time should be under surveillance in terms of ACKD development and potential associated complications such as cyst hemorrhage and malignancy. [ABSTRACT FROM AUTHOR]

Objectives: The inflammatory response is critically important in acute pancreatitis (AP). Systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI), which are novel inflammatory markers, have been linked to determining outcomes in various diseases. The goal of the current study was to examine the relation of the SII index and SIRI with disease severity and acute kidney injury (AKI) in subjects with AP., Methods: A total of 332 subjects with AP were analyzed retrospectively. SII index was calculated using the formula; platelet (P)×neutrophil (N)/lymphocyte (L), while SIRI was calculated as N × monocyte (M)/L count. Multivariate regression (MR) was done to determine the independent risk factors for AKI and severe AP (SAP)., Results: Statistical analyses showed that both median SII index and median SIRI increased gradually with higher AP severity ( p  < 0.001). Both SII index and SIRI were higher in subjects with AKI compared to controls ( p  < 0.001). Using MR analysis, the SII index was found to independently predict both SAP (OR = 1.004, 95% CI: 1.001-1.008, p  = 0.018) and AKI (OR = 1.005, 95% CI: 1.003-1.008, p  < 0.001). ROC analysis showed that the SII index could accurately differentiate SAP (AUC = 0.809, p  < 0.001) and AKI (AUC = 0.820, p  = 0.001) in patients with acute pancreatitis. ROC analysis also showed that SIRI could also accurately differentiate SAP (0.782, p  < 0.001) and AKI (AUC = 0.776, p  = 0.001)., Conclusions: SIRI and the SII indexes can be used as potential biomarkers in predicting both disease severity and AKI development in subjects with AP.

The study aimed to investigate the role of magnesium sulfate prophylaxis in nephrotoxicity caused by colistin. Thirty Wistar Albino rats were divided into four groups: control, colistin, magnesium (Mg), and Mg+colistin. The drugs were administered to the groups for seven days. Urea-creatinine values were measured at the beginning (T0) and end (T1) of the study. Malondialdehyde (MDA) levels were measured in plasma and kidney tissue, glutathione (GSH) levels were analyzed in the erythrocyte and kidney tissues. At the end of the study, the semiquantitative score (SQS) was calculated by the histopathological examination of the kidneys. Urea values significantly decreased in Mg and Mg+colistin groups compared to the baseline (p=0.013 and p=0.001). At the time of T1, these groups had significantly lower urea values than the colistin and control groups. Creatinine value was significantly increased in the colistin group compared to baseline (p=0.005), the creatinine value in the colistin group was significantly higher than the Mg+colistin group (p=0.011). Plasma MDA levels were significantly higher in the colistin group compared to the other groups at the time of T1 (p<0.001). The Mg+colistin group had lower renal MDA levels than the colistin group. The colistin group had significantly higher renal tubular grade (p=0.035), renal affected area (p<0.001), and SQS (p=0.001) than the Mg+colistin group. The results of the study suggested that Mg sulfate may have a nephrotoxicity-reducing effect on colistin., (Copyright © 2021 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To investigate the correlation between depression severity and oxidative stress in patients undergoing hemodialysis (HD) using thiol disulfide homeostasis (TDH)., Study Design: Descriptive, analytical study., Place and Duration of Study: Konya Health Application and Research Center, Konya, Turkey from September 2019 to March 2020., Methodology: A total of 67 patients including 35 males (52.2%) and 32 females (47.8%), receiving HD treatment, were included in the study. The Hamilton depression rating scale (HAM-D) was applied to the participants. Thiol disulfide homeostasis (total thiol (TT), native thiol (NT), disulfide, disulfide/NT ratio, disulfide/TT ratio, and NT/TT ratio) parameters, albumin, and ischemia modified albumin (IMA) levels were determined. The study groups were investigated by dividing them into groups according to their gender and HAM-D score., Results: According to HAM-D score, there were 32 (47.8%) patients with depression symptom (DS, HAM-D score of ≥8) and 35 (52.2%) patients without DS (HAM-D score: 0-7). Modified Charlson comorbidity index (MCCI), disulfide, disulfide/NT%, and disulfide/TT% levels were statistically and significantly higher and NT/TT% was statistically and significantly lower in DS group than the values of the groups without DS (p = 0.003, p =0.043, p = 0.017, p=0.017 and p = 0.017, respectively). HAM-D score and MCCI were statistically and significantly higher in females than males (p <0.001, p = 0.001, respectively). While, 21 patients (65.6%) had DS in women; according to HAM-D score, this rate was found to be statistically higher than men (11 patients, 31.4%, p = 0.005)., Conclusion: Almost half of HD patients had at least moderate depression symptoms. In the group of HD patients with DS, TDH shifted in the oxidative direction. This may contribute to the future studies in enlightening depression etiology in HD patients. Key Words: Hemodialysis, Depression, Thiol disulfide homeostasis (TDH), IMA.

Purpose: An inverse association was shown between serum magnesium levels and anemia in the general population. However, limited information is available about the association between serum magnesium level and anemia in the patient population with chronic kidney disease. We aimed to investigate the relationship between hypomagnesemia and anemia in pre-dialysis patients with chronic kidney disease stage 3-5., Methods: This cross-sectional retrospective study included 213 chronic kidney disease patients with an estimated glomerular filtration rate of 60 mL/min and below. Laboratory and demographic data of outpatients were collected in January 2018-January 2019. Patients with a magnesium level below 1.9 mg/dL were accepted as the hypomagnesemia group., Results: Serum magnesium level of 62 (29.1%) of these patients were below 1.9 mg/dL. Compared with normomagnesemic patients, hypomagnesemic patients had lower mean hemoglobin values (11.3 g/dL vs. 12.7 g/dL, P < 0.001), proton-pump inhibitor usage rates were significantly higher (33.9% vs. 17.2%, P = 0.008) and the median urine protein/creatinine ratio was found to be significantly higher (1017.5 mg/gCr vs. 536 mg/gCr, P = 0.045). In the multivariate analysis, the use of hemoglobin (OR 0.634; 95% CI 0.505-0.795; P < 0.001) and proton-pump inhibitor (OR 2.670; 95% CI 1.113-6.318; P = 0.025) were independent predictors of hypomagnesemia., Conclusions: Hypomagnesemia is a common electrolyte disorder in pre-dialysis CKD patients. In this patient group, anemia is independently associated with hypomagnesemia.

Introduction: This study aimed to determine whether predialysis blood gases is affected by altitude differences in hemodialysis patients with arteriovenous fistulas living in Turkey at three different altitudes., Methods: Patients' predialysis blood gases were compared by standardizing both arterial blood gases collections and working methods for patients undergoing hemodialysis using a dialysate with the same properties at altitudes of 30 m (sea level), 1020 m (moderate altitude), and 1951 m (high altitude)., Findings: Blood gases disorders were detected in 32 (82.1%) high altitude group patients, whereas 49 (74.2%) sea level group patients had no blood gases disorders (P < 0.001). pH values in the high altitude group were significantly lower than those in the other groups, and the pH increased as altitude decreased (P < 0.001). The partial pressure of carbon dioxide (PaCO 2 ) values was higher in the sea level group than in the other groups and increased at lower sea levels (P < 0.001). Bicarbonate values were significantly higher in the sea level group than in the other groups and increased at lower sea levels, similar to PaCO 2 values (P < 0.001). The partial pressure of oxygen (PaO 2 ) values in the high altitude and sea level groups were significantly higher and increased at lower sea levels (P < 0.001). The oxygen saturation (SaO 2 ) values were significantly lower in the high altitude group than in the other groups and increased gradually at lower sea levels (P < 0.001)., Discussion: Predialysis metabolic acidosis was more pronounced in patients undergoing hemodialysis at high altitudes, whereas PaCO 2 , PaO 2 , and SaO 2 values were lower., (© 2020 International Society for Hemodialysis.)

Background: Depression is common in chronic kidney disease (CKD) patients and associated with significant increase in morbidity and mortality. In recent years, a relationship between vitamin D deficiency and depression has been shown. The aim of this study is to investigate the relationship between 25-hydroxy (OH) vitamin D and depression in hemodialysis patients., Methods: A total of 140 patients were included in the study. Hamilton depression scale (HAM-D) was completed by all patients. 25(OH) vitamin D levels were compared between patients with and without depressive symptoms., Results: Patients who had depressive symptoms had significantly lower 25(OH) vitamin D levels (13.70 [24.3-8.25] vs. 18.20 [29.2-11.7] ng/mL, p = 0.016). HAM-D score showed significant association with gender (p = 0.011) and 25(OH) vitamin D level (p = 0.011). Univariate logistic regression analysis showed that males had lower risk of depression by a ratio of 61.1% (OR 0.389, p = 0.012) and vitamin D-deficient patients had 2.88 times greater risk of depression compared to non-deficient patients (OR 2.885, p = 0.013). Multivariate logistic regression analysis showed that males had 53.7% less risk of depression (OR 0.463, p = 0.046) and vitamin D-deficient patients had 2.39 times greater risk of depression (OR 2.397, p = 0.047). When evaluated by gender, univariate logistic regression analysis showed that 25(OH) vitamin D and other variables were not associated with depression in females (p > 0.05), while only vitamin D level had a significant effect on depression in males (OR 8.207, p = 0.008)., Conclusions: We found a significant association between vitamin D level and depressive symptoms in hemodialysis patients. When analyzed according to gender, this association was found to stand independent of other variables only in males.

Background: Nondipping heart rate (NHR) is a condition reported to be associated with cardiovascular events and cardiovascular mortality recently. We aimed to search whether there is difference among hypertensive patients with and without chronic kidney disease (CKD) in terms of NHR pattern and the factors associated with NHR in patients with CKD., Methods: The study included 133 hypertensive patients with normal kidney functions, 97 hypertensive patients with predialysis CKD, and 31 hypertensive hemodialysis patients. Heart rate, blood pressure and pulse wave velocity (PWV) were measured by 24-h ambulatory blood pressure monitorization. NHR was defined as a decrease of less than 10% at night mean heart rate when compared with daytime values., Results: NHR pattern was established as 26.3% in non-CKD hypertensive group, 43.3% in predialysis group and 77.4% in dialysis group. Among patients with CKD, when NHR group was compared with dipper heart rate group, it was seen that they were at older age, there were higher prevalence of diabetes mellitus and more female sex, and while the value of urea, creatinine, phosphorus, intact parathyroid hormone, and PWV were significantly higher, the value of hemoglobin, albumin and calcium were significantly lower. By multivariate analysis, hemoglobin [odds ratio (OR) 0.661; 95% CI 0.541-0.806; p < 0.001] and PWV (OR 1.433; 95% CI 1.107-1.853; p = 0.006) were established as independent determinants of NHR pattern., Conclusions: NHR pattern is significantly more frequently seen in hypertensive CKD patients than in hypertensive patients with non-CKD. Anemia and increased arterial stiffness are seen independently associated with NHR in CKD patients.

Background : Endocan is a particular protein of endothelial cells. The purpose of this study was to determine the relationship of serum endocan levels with carotid intima-media thickness (cIMT), inflammation, and microalbuminuria in patients with newly-diagnosed hypertension. Materials-Methods : This prospective study included 61 patients with newly-diagnosed hypertension (HT) and 30 controls. Endocan, microalbuminuria and cIMT measurements were taken from all patients. Results : The serum endocan levels, the mean cIMT and microalbuminuria levels of patients with HT were significantly higher than those of the control group ( p < .0001, p = .015 and p < .001, respectively). Conclusion : We found that endocan levels were increased in our study. This increase in endocan levels shows a relation with cIMT and microalbuminuria, which are associated with endothelial dysfunction.

Purpose: 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., Methods: 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., Results: 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., Conclusions: Abdominal aortic calcification is highly prevalent in the hemodialysis population. Strict phosphorus control should be implemented to the predialysis and hemodialysis patients.

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.

Objectives: 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., Design and Methods: 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., Results: 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)., Conclusion: Uric acid seems to predict the progression of AKI and RRT requirement in patients underwent cardiac surgery better than NGAL.

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.

Unintentional weight loss in a renal transplant recipient is an important condition, requiring diagnostic search within the framework of malignancy and opportunistic infections. To the best of our knowledge, there are no data in the literature reporting underlying coeliac disease as the cause of significant weight loss after renal transplant. We report a 32-year-old woman, who complained of significant weight loss during the 3.5 years posttransplant. Diagnostic work-up revealed coeliac disease, and a gluten-free diet stabilized her weight loss. Considering the high frequency of coeliac disease, this should be kept in the differential diagnosis of renal transplant recipients presented with weight loss and other suggestive features.

Background: Cardiovascular risk is increased in the early stages of chronic kidney disease (CKD) and also found to be ongoing in renal transplant (Rtx) patients. As a sign of atherosclerosis, increased carotid intima-media thickness (CIMT) has been widely accepted as a strong predictor of cardiovascular disease (CVD) and mortality in CKD patients. A novel markers, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and neutrophil-to-lymphocyte ratio (NLR) were introduced as potential markers in inflammatory disorders including CKD. The role of Rtx in terms of atherogenesis is still unclear. We aimed to investigate the relationship between sTWEAK, NLR and CIMT in Rtx patients without overt CVD and to compare these results with those obtained from healthy subjects., Methods: Cross-sectional analysis in which CIMT measurements, NLR and serum TWEAK levels were assessed in 70 Rtx patients (29 females; mean age, 40.6 ± 12.4 years) and 25 healthy subjects (13 females, mean age; 37.4±8.8 years)., Results: sTWEAK levels were significantly decreased (p=0.01) and hs-CRP, NLR and CIMT levels of Rtx patients were significantly increased compared to healthy subjects (p<0.0001, p=0.001, p<0.0001, respectively). sTWEAK was also found to be decreased when eGFR was decreased (p=0.04 between all groups). CIMT was positively correlated with sTWEAK and NLR in Rtx patients (r=0.81, p<0.0001 and r=0.33, p=0.006, respectively). sTWEAK was also positively correlated with NLR (r=0.37, p=0.002). In the multivariate analysis only sTWEAK was found to be an independent variable of increased CIMT., Conclusion: sTWEAK might have a role in the pathogenesis of ongoing atherosclerosis in Rtx patients.

The triggers of secondary thrombotic thrombopcytopenic purpura (TTP) include drug toxicity, radiation and high-dose chemotherapy, angioinvasive infections, surgery and acute graft versus host disease. TTP secondary to surgery have been reported in a number of cases. Most of the cases have been occurred after open heart surgery. Extensive endothelial damage is held responsible as the initiating mechanism in postoperative TTP cases. However, there is no report of secondary TTP describing development owing to ABO incompatible blood transfusion. Here, we describe a patient who developed TTP after transfusion of ABO incompatible blood during hospitalization for bypass surgery. We also propose a hypothesis which may account for the possible underlying mechanism.

Coenzyme Q10 (CoQ10) supplementation has been shown to improve diastolic heart function in various patient cohorts. Systolic and diastolic dysfunctions are common in patients with end-stage renal disease. Favorable effects of CoQ10 on cardiac functions are yet to be seen in hemodialysis patients. We aimed to evaluate effect of CoQ10 supplementation on diastolic function in a cohort of maintenance hemodialysis patients. This was a prospective, double-blind, placebo-controlled, crossover study in which all patients received placebo and oral CoQ10 200 mg/d during the 8 weeks in each phase, with a 4-week washout period. Participants underwent conventional and tissue Doppler echocardiography before and after each study phase. Parameters characterizing left ventricle diastolic function and other standard echocardiographic measurements were recorded. Twenty-eight patients were randomized, but 22 patients completed study protocol. Intraventricular septum (IVS) thickness and left ventricle mass were significantly decreased in CoQ10 group (P = 0.03 and P = 0.01, respectively). Myocardial peak systolic and early diastolic velocities derived from IVS were significantly increased (P = 0.048 and P = 0.04, respectively). Isovolumetric relaxation time and E/Em ratio calculated for IVS also significantly reduced in CoQ10 group (p = 0.02 and p = 0.04, respectively). There was no significant difference in any of the studied echocardiographic parameters in placebo group. The results of this study showed that CoQ10 supplementation did not significantly improved diastolic heart functions compared with placebo in maintenance hemodialysis patients., (© 2013 The Authors. Hemodialysis International © 2013 International Society for Hemodialysis.)

Purpose: In dialysis patients, painful peripheral neuropathy (PPN) is associated with sleep disturbance and mood disorders. Our goal was to compare the effects of gabapentin and pregabalin on improving sleep quality and depression among hemodialysis patients with PPN., Methods: Fifty hemodialysis patients with PPN were randomized into 2 groups, to receive gabapentin and pregabalin, respectively. After 6 weeks of treatment, patients underwent a 2-week washout period, followed by crossover and another 6 weeks of treatment. All patients underwent electromyography (EMG) at the outset and completed the modified Short Form of McGill Pain Questionnaire (SF-MPQ), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality (PSQI) assessment at baseline and at the end of the study. Forty out of 50 patients completed the 14-week study period., Results: Thirty-one out of 40 patients (77.5 %) had EMG-proven PPN. Both gabapentin and pregabalin significantly improved SF-MPQ, BDI and PSQI scores at the end of the study compared with pretreatment scores (p < 0.001). There was no significant difference between the two drugs in any studied parameter., Conclusions: Our results showed for the first time a good and similar efficacy of both drugs on pain intensity, quality of sleep and depression in hemodialysis patients with PPN.

Background: Painful peripheral neuropathy (PPN) is common in haemodialysis patients and associated with impaired health-related quality of life (HR-QoL). Gabapentin and pregabalin have not been fully investigated in haemodialysis patients. Therefore, we compared the effects of gabapentin and pregabalin on intensity of pain and associated HR-QoL in haemodialysis patients with PPN., Methods: Gabapentin and pregabalin were administered after each haemodialysis session at doses of 300 and 75 mg, respectively. Patients were randomized into two groups; after 6 weeks patients underwent a 2-week washout and crossover and received another 6 weeks of treatment. All patients underwent electromyography at the outset. The short-form McGill pain questionnaire (SF-MPQ) for assessment of pain, and short-form medical outcomes study for assessment of HR-QoL at baseline and at the end of the study were applied., Results: Forty patients completed the 14-week study period. Gabapentin and pregabalin significantly improved SF-MPQ total scores compared with pretreatment values (mean ± SD) [from 18.9 ± 4.3 to 9.3 ± 4.3 for gabapentin, p < 0.001, and from 18.5 ± 3.9 to 9.8 ± 3.6 for pregabalin, p < 0.001]. There was no significant difference between the study drugs in terms of efficacy against neuropathic pain (p > 0.05). Both gabapentin and pregabalin significantly improved HR-QoL at the end of the study compared with pretreatment scores (p < 0.001)., Conclusion: Our results showed strong efficacy of gabapentin and pregabalin on pain intensity in the given doses. HR-QoL was also significantly improved by both drugs.

With the advent of potent immunosuppressive options, acute rejection episodes have decreased at the expense of increased incidence of opportunistic infections in solid organ recipients. In the absence of any preventive therapy, 30-75 % of transplant recipients develop cytomegalovirus (CMV) infection. Candida spp. and Aspergillus spp. account for more than 80 % of invasive fungal infections in solid organ recipients. This co-occurrence of two commonly seen opportunistic infections may end up in fatality. Here, we present a case of concomitant Aspergillus spp. and CMV infection and discuss the relevant literature. A 54-year-old male patient presented with fever, shortness of breath, and chest pain on the 9th posttransplant week after renal transplantation. CMV-DNA by polymerase chain reaction (PCR) was 1,680,000 copies/ml, thus, valganciclovir dose was increased. There were inspiratory crackles at both lung bases, and chest computed tomography (CT) revealed multiple fungal balls throughout the right lung. Galactomannan antigen was positive, and voriconazole and other antimicrobials were subsequently added to the treatment. At the end of the therapy, on control CT, pneumonic consolidation had disappeared, sputum cultures didn't show Aspergillus spp., and CMV-DNA reduced to 700 copies/ml. The patient showed a favorable clinical response to combined treatment; fever, dyspnea, and pleuritic chest pain disappeared. Both CMV disease and aspergillosis may present as pulmonary disease; thus, the characterization of one may not preclude the search for the other and the timely initiation of treatment is of paramount importance for good outcomes.

Heparin-induced thrombocytopenia (HIT) is caused by heparin exposure and presents with reduced platelet count. Patients undergoing hemodialysis (HD) treatment have increased risk of developing HIT due to prolonged exposure to unfractionated heparin or low-molecular weight heparin. We report a 79-year-old male patient with end-stage renal disease who developed type-II HIT during maintenance HD. Platelet count of the patient decreased gradually and antiplatelet factor IV antibody was found to be positive. The patient was treated with fondaparinux and continued heparin-free HD. Unfortunately, despite favorable initial response without any thrombotic episodes, the patient died due to severe sepsis complicated by gastrointestinal hemorrhage., (© 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.)

Aim: Pruritus is common in dialysis patients. Peripheral neuropathy is also prevalent in this patient population. However, the role of neuropathy in the genesis of uraemic itch has not been adequately studied to date. Therefore, we aimed to investigate the effects of gabapentin and pregabalin on uraemic pruritus along with neuropathic pain in patients receiving haemodialysis., Methods: This is a 14 week long randomized, prospective, cross-over trial. Haemodialysis patients with established neuropathy and/or neuropathic pain were included. Fifty patients were randomly assigned to gabapentin 300 mg after each haemodialysis session and pregabalin 75 mg daily. After 6 weeks of treatment, cross-over was performed and patients received the other drug for another 6 weeks. Short Form of McGill Pain Questionnaire and Visual Analogue Scale were used to evaluate pain and pruritus, respectively. At each week's visit, patients were interrogated in terms of adverse effects of study drugs. Baseline laboratory data and demographic characteristics were recorded from patient charts., Results: Forty (12 males, 28 females) out of 50 patients completed the study. Mean age was 58.2 ± 13.7. Overall, 29 out of 40 patients (72.5%) had pruritus symptoms at baseline evaluation. Fifteen patients (37.5%) were diabetic. Thirty-one out of 40 patients (77.5%) had electromyography (EMG)-proven peripheral neuropathy. Twenty three patients (57.5%) had both EMG-proven neuropathy and pruritus. Gabapentin and pregabalin improved both neuropathic pain and pruritus significantly. There was no difference between the study drugs in terms of efficacy against pain and pruritus., Conclusion: Treatment of neuropathic pain with either pregabalin or gabapentin effectively ameliorates uraemic itch., (© 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.)

Brucellosis is a zoonotic infection that humans contract usually by ingestion of unpasteurized milk and milk products or by direct contact with raw infected animal products. Infection is endemic in many countries, including Turkey. Being a systemic disease, brucellosis may affect almost any part of the body. The peritoneum is a site rarely involved in brucellosis. Most peritonitis episodes involving Brucella species have been spontaneous cases reported in cirrhotic patients with ascites. To our knowledge, the literature contains only 5 cases of Brucella peritonitis related to continuous ambulatory peritoneal dialysis. Here, we report Brucella peritonitis in a continuous ambulatory peritoneal dialysis patient, and we discuss the relevant literature.

Purpose: A few studies investigated renal size using computed tomography (CT) in middle-aged and elderly patients while taking renal function into account. Thus, we aimed to assess kidney dimensions and their predictors in patients without known renal disease by multi-detector computed tomography (MDCT)., Methods: This is a 6-month-long prospective observational study. Estimated glomerular filtration rate (eGFR) was calculated with Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) formulas. Pole-to-pole kidney length (R1) was determined from coronal and sagittal oblique images. Kidney length (R2), width (R3), and parenchymal thickness were measured in axial slices., Results: The data of the 930 patients were included in this study. CG-eGFR was more closely correlated with R1, R2, and R3 than MDRD-eGFR. CG-eGFR, female gender, and presence of diabetes mellitus were independent predictors of R1 size in logistic regression analyses., Conclusion: Kidney sizes diminish with advancing age. CG-eGFR shows a better correlation with kidney dimensions compared with MDRD. Overall, age was a stronger determinant of eGFR than renal dimensions.

Background/aims: 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., Methods: 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., Results: 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 (p < 0.0001, r = 0.48)., Conclusion: 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.

Objectives: There is scarce data about effects of treatment of clinical depression in peritoneal dialysis (PD) population. We aimed to determine prevalence of depression, its association with health-related quality of life (HRQoL) and effects of sertraline treatment in PD patients., Materials and Methods: We included 124 PD patients who had been on PD at least for 6 months. Short Form of Medical Outcomes Study was used to evaluate HRQoL. Depression was screened by Beck Depression Inventory (BDI). Patients with a BDI score > or = 17 were deemed to have depression and were referred to a psychiatrist for evaluation via Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) of diagnosis of clinical depression. About 25 patients diagnosed with clinical depression agreed to receive antidepressant treatment (Sertraline hydrochloride, 50 mg/day) for a 12-week period. After the treatment, biochemical analyses and questionnaires were repeated., Results: Thirty-two patients (25.8%) had depression. BDI score of patients were lower compared to those without depressive symptoms (23 + or - 6.7 and 9.8 + or - 3.0, respectively P < 0.001). Physical component scale (PCS) and mental component scale (MCS) domains of HRQoL were significantly decreased in patients with depression than in patients without depression (P < 0.001 for PCS and MCS). In bivariate analysis the BDI score was correlated inversely with the PCS and MCS (P < 0.001). Sertraline treatment improved BDI score of patients with depression (P < 0.001). HRQoL parameters also improved. No adverse effects requiring drug cessation was seen in the study group., Conclusions: Treatment of depression with sertraline is associated with improvement of the HRQoL and symptoms related to depression.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common of the inherited renal cystic diseases and constitutes 10% of the end stage kidney disease population. ADPKD is caused by PKD1 and PKD2 gene mutations in 85% and 15% of the cases respectively. Its high prevalence and negative impact on health outcomes fostered efforts to explain pathophysiologic pathways of cyst formation in kidneys. Among these are increased apoptosis, unopposed proliferation of tubule cells, impaired polarization and planar cell polarity, impaired cAMP pathway, cilier dysfunction, activated mTOR pathway, increased tumor necrosis factor-alpha (TNF-alpha) production. Many drugs have been tried in an attempt to halt cystogenesis in some point. Despite success to some extent in experimental studies, none reached clinical armamentarium yet. Colchicine, originally extracted from Colchicum autunale, is an anti-inflammatory drug that has been in continuous use for more than 3000 years. It has been used successfully to prevent attacks of familial mediterranien fever and amyloidosis, to treat gout and pseudogout attacks for a few decades. Colchicine principally is a microtubule inhibitor, thus prevents cell migration, division, and polarization. It also has anti-apoptotic, anti-proliferative and anti-inflammatory effects and down-regulates (TNF-alpha) receptors. As can easily be seen, many of the effects of colchicine have pathophysiologic counterparts in ADPKD. Thus, we hypothesized that colchicine would be beneficial to prevent or at least delay cyst formation in ADPKD patients. Indirect evidence also support our hypothesis, in which taxol and paclitaxel, other two microtubule inhibitors, were shown to delay cyst formation in experimental models of ADPKD. To our opinion, despite its narrow therapeutic index, widespread experience makes colchicine a suitable candidate for prolonged clinical use, should experimental studies show any benefit in ADPKD.

Background: Sleep quality (SQ) is a significant problem in peritoneal dialysis (PD) patients, yet the underlying factors are not well known. In addition, depression and impaired quality of life (QOL) are main problems in PD patients. We measured the SQ and investigated the effect of depression, QOL, and some other factors on SQ in PD patients., Methods: Data were collected from 124 PD patients (59 male, 65 female) in our center. Demographic data and laboratory values were analyzed. All patients were asked to complete the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Index (BDI), and SF-36., Results: Mean age of the patients was 52.6 +/- 14.3 year. The prevalence of poor SQ was 43.5%, defined as global PSQI score >5. The prevalence of depression was 25.8%, defined as BDI scores >17. The poor sleepers had higher BDI scores, poor QOL, older age, and lower duration of PD compared to the good sleepers. There was not a difference in hemoglobin, albumin, C-reactive protein, Kt/V, urea, creatinine, lipid parameters, gender, marital status, cigarette smoking, mode of PD, and comorbidity between poor and good sleepers. The global PSQI score was correlated negatively with both PCS and MCS (r = -0.414, r = -0.392, respectively; p < 0.001) and correlated positively with BDI scores and age (r = 0.422, p < 0.001 and r = 0.213, p = 0.018, respectively). In multivariate analysis, only BDI scores were found to be factors that could predict the patients being poor sleepers., Conclusion: Poor SQ is a significant problem in PD patients, and we found an association with depression, QOL, and age. Regular assessment and management of SQ may be important especially with PD patients who are depressive and elderly to increase QOL.