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Introduction Turkey has one of the largest treated end-stage renal disease (ESRD) patient populations in Europe (N = 66,711). In 2013, the international Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective study of hemodialysis (HD) practices and outcomes, initiated data collection in Turkey. Here we provide comparisons of HD patients in DOPPS-Turkey with other international regions and with patients in the Registry of Turkish Nephrology, Dialysis and Transplantation. Methods DOPPS-Turkey study sites were randomly selected from all Turkish HD units treating ≥25 in-center chronic HD patients. Detailed patient- and facility-level data were collected for 20–30 randomly selected prevalent HD patients per facility. Findings Demographic and comorbidity profiles for DOPPS-Turkey patients were similar to HD patients overall in the 2013 Turkish Registry Report. In Turkey: diabetes was the most common ESRD cause (37%); arteriovenous fistula use was 83%; mean single pool Kt/V was 1.61. Compared with other international regions, Turkey had the highest mean hemoglobin (11.5 g/dL), ferritin (771 ng/mL), and interdialytic weight gain (3.28%), while Turkey had the lowest mean systolic blood pressure (127 mmHg) and erythropoiesis stimulating agent prescription (57%). Turkish patients also reported the highest depression scores. Discussion In this first DOPPS-Turkey report, the DOPPS sample agrees well with national Turkish Registry data. Treatment and laboratory data, and patient-reported outcomes, demonstrate similarities and previously unrecognized contrasts to DOPPS findings in Europe, Japan, and North America. Long-term follow-up of these patients will describe how these differences relate to clinical outcomes within Turkey.

reSultS: The mean age was 47 ± 13 years and 38 (74.5%) of the patients were male. No significant difference was found in echocardiographic parameters including ejection fraction, fractional shortening, left ventricular mass, left ventricular mass index, left ventricular posterior wall thickness, inter ventricular septal thickness, left atrial diameter, early diastolic filling/late diastolic filling ratio before and after the period of PD. Left ventricular end-systolic diameter and left ventricular end-diastolic diameter values were significantly lower found in the period after PD.

Background: Pulmonary arterial hypertension (PAH) is a common complication in hemodialysis (HD) patients and its pathogenesis is not explained clearly. Arterio-venous fistulas (AVFs) creation may contribute to the development of PAH because of increased pulmonary artery blood flow. However, it was not prospectively evaluated that effect of AVF on the development of PAH. Aim: We aimed to evaluate the effects of AVF on PAH and the relationship between blood flow rate of AVF and pulmonary artery pressure (PAP) in HD patients. Patients and Method: The prospective study included 50 patients with end-stage renal disease. Before an AVF was surgically created for hemodialysis, the patients were evaluated by echocardiography. Then, an AVF was surgically created in the patients. After mean 76.14 +/- 11.37 days, the second evaluation was performed by echocardiography. Results: Before AVF creation, 17 (34%) out of 50 patients had PAH. The systolic PAP was significantly higher in the patients with PAH compared with patients without PAH (47.82 +/- 9.82 mmHg vs. 30.15 +/- 5.70 mmHg, respectively, p = 0.001). In the second evaluation, 19 (38%) out of 50 patients had PAH. The systolic PAP values were significantly higher in the patients with PAH compared with patients without PAH (47.63 +/- 8.92 mmHg vs. 25.03 +/- 7.69 mmHg, P = 0.001, respectively). There was no relationship between the blood flow rate of AVF and PAP. Conclusion: PAH is a common problem in HD patients. AVF has no significant effect on the development of PAH within a short period. Similarly, blood flow rate of AVF also did not affect remarkably the systolic PAP.

Background: To investigate the relationship between depression, nutritional status, and inflammatory markers in patients on peritoneal dialysis (PD). Patients and Methods: This prospective study included 40 PD patients and 20 healthy people. The severity of depressive symptoms was assessed using the Beck Depression Inventory, the Hamilton Depression Rating Scale, and the Hamilton Anxiety Rating Scale. The depressive patients received antidepressant drug for 8 weeks. Blood samples were taken before and after antidepressant treatment for the high-sensitive C-reactive protein (hs-CRP), interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-alpha) levels. Results: Ten (25%) of the 40 PD patients had depression. No significant difference was determined between depressive patients and nondepressive patients. The mean erythrocyte sedimentation rate was higher in depressive patients. There was no significant difference for other inflammation parameters, including hs-CRP, TNF-alpha, IL-1, and IL-6, between depressive patients and nondepressive patients. In the depressive patients, we did not observe any significant change in nutritional parameters after antidepressant treatment. When we evaluated inflammation parameters of the depressive patients before and after antidepressant treatment, only IL-1 and IL-6 levels were significantly increased after antidepressant treatment. Conclusion: The depressive disorder in PD patients is a common psychopathology and has no significant effects on nutritional status and inflammation.

Background: Our aim was to investigate the prevalence, size, locations, and shapes of torus palatinus (TP) in end-stage renal disease (ESRD) patients receiving peritoneal dialysis (PD) in order to analyze the relationship between the TP size and duration of PD. Materials and methods: During 2007, 91 ESRD patients receiving PD were studied using dental examinations at our outpatient clinic. Results: The prevalence of TP was 41.7% (n=38). Most cases of TP were < 2 cm in size (81.6%) and spindle-shaped (78.9%). The duration of PD was statistically higher in patients with TP size > 2 cm (6.8±3.6 years) than patients with TP size of < 2 cm (3.5±2.6 years). Conclusions: The higher prevalence of TP and different TP shape (spindle) in comparison with our previous study and the significant relationship between duration of PD and TP size might be due to an underlying disorder, such as renal osteodystrophy.

Aim: To evaluate the presence of the relationship between depression and proinflammatory cytokine levels in hemodialysis (HD) patients. Methods: The study included 40 HD patients and 20 healthy controls. All participants were evaluated for the presence of depression using the structured clinical interview based on criteria defined by Diagnostic and Statistical Manual Mental Disorders (Fourth Edition, Text Revision) Axis I disorders. The severity of depressive symptoms was assessed using the Beck Depression Inventory, the Hamilton Depression Rating Scale, and the Hamilton Anxiety Rating Scale. The depressive patients received antidepressants for 8 weeks. Blood samples were taken at baseline and after 8 weeks of antidepressant treatment for interleukin-1 (IL-1), IL-6, and tumor necrosis factor-alpha (TNF-alpha) levels. Results: A total of 9 (22.5%) of the 40 HD patients had depression. IL-1, IL-6, and TNF-a levels were significantly higher in HD patients compared with that in the control group, but were not significantly different between HD patients with and without depression. In the depressive patients, we observed no significant difference in proinflammatory cytokine levels after antidepressant treatment. The psychometric measurements in depressive patients decreased significantly after antidepressant treatment. Conclusion: We observed that depression is a common psychiatric disorder and has no significant effect on proinflammatory cytokine levels in HD patients; no important improvement in cytokine levels was observed after antidepressant therapy.

Objective: Tunneled cuffed dual-lumen catheters (TCCs) are commonly used for vascular access in hemodialysis (HD) patients. Catheter-related bloodstream infection (CRBSI) is the major problem leading to morbidity and mortality. We investigated whether 26% NaCl solution has any favorable effect on the infections and thrombosis caused by HD catheters. Methods: TCCs were locked with either 26% NaCl and heparin or standard heparin. The primer end point of the study was the CRBSI or thrombosis of the TCC. We compared the antimicrobial activity of the NaCl solutions (6.5%, 13%, 26%) with 0.9% NaCl solution by time-kill kinetic assay. All tests were performed in triplicate by incubation of test fluids with Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. Results: The mean catheter survival was significantly higher in the 26% NaCl and heparin group (129.5 +/- 50.1 catheter days to 103.3 +/- 59.8, p = 0.008). CRBSI rates (10-15.4%) did not differ significantly between the two groups (p = 0.54). The hypertonic 13% NaCl solution had bactericidal effects on E. coli and P. aeruginosa, but had bacteriostatic effect on S. aureus and S. epidermidis. Conclusion: In this study we demonstrated that the 13% NaCl solution and more hypertonic NaCl solutions revealed potent in vitro antimicrobial properties against all checked Gram-negative microorganisms.

mateRiaL and metHODs: The prospective study included 40 patients (mean age 33.2 ± 7.7 years;25 female /15 male) with ESRD. In all of these patients, renal transplantation was performed successfully; and the serum creatinine levels were less than 2 mg/dL. The echocardiographic evaluations were performed before renal transplantation and 12. month after renal transplantation. Left ventricular diastolic diameter (LVDD), left ventricular systolic diameter (LVESD), left ventricular mass (LV Mass), left ventricular mass index (LVMI), LV ejection fraction (LVEF), Doppler and tissue Doppler parameters were obtained in all patients.

Human brucellosis is a systemic disease that involves multiple organs and tissues concomitantly. In this case, we describe a patient with pancarditis and nephrotic syndrome requiring hemodialyses, which is an unusually fatal condition resulting from brucellosis. He was successfully treated with early aortic valve replacement and intensive medical therapy.

A 25-year-old male patient with end-stage renal disease due to chronic pyelonephritis who had undergone renal transplantation was admitted 20 days after the operation with complaints of nausea, vomiting and darkening in the skin of the transplantation site. A 30x30 cm area of skin at the transplantation site in the left inguinal area was dark colored and of necrotic appearance. Gram-negative and gram-positive bacilli were observed in the gram stain of the material taken from the lesion through thin needle aspiration. Surgical debridement of necrotic tissues at the lesion site was performed. There were fungi with bacterial groups and branched rough hyphae infiltrating the necrotic lipid and connective tissue. The venous wall was under the invasion of these fungi hyphae in the histopathological examination of the debridement material and a diagnosis of subcutaneous zygomycosis was established. Amphotericin B was administered for 14 days at a cumulative dose of 625 mg. The skin defect at the left lower quadrant was closed by placing a graft. The patient no longer required dialysis after two weeks of hospitalization. He was discharged 48 days later with total recovery of the lesion site and a serum creatinin level of 2 mg/dL, under treatment with cyclosporine 400 mg/day and prednisolone 20 mg/day.

Although brucellosis is an endemic disease in Mediterranean countries, there are few reported cases of Brucella endocarditis and glomerulonephritis. We report a case of Brucella prosthetic mitral valve endocarditis and glomerulonephritis that could be managed by using only antibiotic therapy, including rifampicin, doxycycline and ceftriaxone, without a surgical procedure.

Central venous catheterization is frequently performed for perioperative management and long-term intravenous access. Although complications associated with central venous catheter insertion have been widely reported, there are few reports of carotid-jugular arteriovenous fistula formation. Endovascular procedures are associated with a risk of immediate and delayed thromboembolic and ischemic complications. We describe a case of a carotid-jugular arteriovenous fistula and a cerebrovascular infarct following the insertion of a double-lumen catheter for hemodialysis access. We provide recommendations for the prevention and the early detection of this iatrogenic complication.

The aim of this prospective study was to evaluate long-term effects of arteriovenous fistula (AVF) on the development of pulmonary arterial hypertension (PAH) and the relationship between blood flow rate of AVF and pulmonary artery pressure (PAP) in the patients with end-stage renal disease (ESRD). This prospective study was performed in 20 patients with ESRD. Before an AVF was surgically created for hemodialysis, the patients were evaluated by echocardiography. Then, an AVF was surgically created in all patients. After mean 23.50 ± 2.25 months, the second evaluation was performed by echocardiography. Also, the blood flow rate of AVF was measured at the second echocardiographic evaluation. Pulmonary arterial hypertension was defined as a systolic PAP above 35 mmHg at rest. Mean age of 20 patients with ESRD was 55.05 ± 13.64 years; 11 of 20 patients were males. Pulmonary arterial hypertension was detected in 6 (30%) patients before AVF creation and in 4 (20%) patients after AVF creation. Systolic PAP value was meaningfully lower after AVF creation than before AVF creation (29.95 ± 10.26 mmHg vs. 35.35 ± 7.86 mmHg, respectively, P: 0.047). However, there was no significant difference between 2 time periods in terms of presence of PAH (P>0.05). Pulmonary artery pressure did not correlate with blood flow rate of AVF and duration after AVF creation (P>0.05). In hemodialysis patients, a surgically created AVF has no significant effect on the development of PAH within a long-term period. Similarly, blood flow rate of AVF also did not affect remarkably systolic PAP within the long-term period.

Aim: We aimed to investigate the prevalence, type, and possible risk factors of renal tubular acidosis (RTA) in Turkish patients with renal transplantation. Patients and method: The study included 66 adult renal transplantation recipients. We recorded the parameters of venous blood gas analysis including serum pH value, serum bicarbonate (HCO(3)) concentration, presence of metabolic acidosis, which was defined as low HCO(3) (

Aim: Acute renal failure (ARF) after hematopoietic stem cell transplantation (HSCT) is a widespread complication leading to considerable morbidity and mortality. The present study aims to determine the incidence and risk factors of ARF and to investigate whether there exists a relationship between the renal injury indicators and quantity of the transplanted stem cells in a uniform patient population after allogeneic myeloablative HSCT. Methods: Patients undergoing myeloablative allogeneic HSCT from 2007 to 2008 were monitored prospectively in terms of their renal functions during the first 100 days after transplantation. ARF was defined as a twofold rise in serum creatinine concentration of baseline value or a >50% decrease in creatinine clearance and classified into three grades. Results: ARF occurred in 51.3% of patients over a period of 100 days after HSCT. ARF developed in 12 (60.0%) patients within the first 2 weeks, whereas in 8 (40.0%) of them ARF development was observed within 2-4 weeks. No correlation was found between ARF development and the quantity of the infused hematopoietic stem cells. Additionally, we were not able to identify a particular cause which was significantly associated with the occurrence of ARF after HSCT. Conclusion: A 51.3% incidence of ARF was found in patients after myeloablative allogeneic HSCT. ARF in HSCT patients could not be linked to a single cause. Rather a combination of multiple risk factors seems to be responsible for ARF development.

Aim: Peritoneal dialysis patients with ultrafiltration failure frequently have fluid overload. It is known that the increase in the ultrafiltration is associated with decrease in the left ventricle (LV) dysfunction. This study was designed to examine the potential effects of serum brain natriuretic peptide (BNP) on cardiac functions and to determine the relationship between BNP and cardiac parameters in continuous ambulatory peritoneal dialysis (CAPD) patients with ultrafiltration failure. Methods: Twenty-eight patients with high or high-average membrane permeability as indicated by the peritoneal equilibration test were enrolled and randomized to receive either once or twice daily icodextrin. Serum BNP levels and echocardiographic measurements were evaluated at baseline and at the end of the eighth week. The correlations between the percentage changes of parameters from baseline were also studied. Results: In both groups there was a significant decrease in serum BNP, LV mass, heart rate (HR) and cardiothoracic index (CTI) and an improvement in ejection fraction (all P

Background Hypervolemia is a risk factor for left ventricular hypertrophy and hypertension in peritoneal dialysis patients. Icodextrin improves volume control by increasing ultrafiltration in peritoneal dialysis patients. Aim To examine the effects of twice-daily icodextrin administration on blood pressure and left ventricular hypertrophy in peritoneal dialysis patients with hypervolemia and ultrafiltration failure. Method and Results Administration of icodextrin twice daily resulted in a significant reduction in the left ventricular mass index (LVMI) of patients by the end of the third month ( p < 0.05). The reduction in LVMI was also significant for the once-daily icodextrin group ( p < 0.05). Mean blood pressure of patients receiving icodextrin twice daily was significantly reduced ( p < 0.05). By the end of the third month no significant changes were observed in mean blood pressure of the patients using once-daily icodextrin ( p > 0.05). No statistically significant changes were observed in weekly total creatinine clearances or Kt/V of patients in either group at the end of 3 months (NS). Conclusion Twice-daily icodextrin administration was clinically beneficial as shown by reduced blood pressure and prevention of the progress of left ventricular hypertrophy without causing any decrease in dialysis adequacy or any side effects. The icodextrin metabolite results did not suggest any further increase in their values when comparing once- to twice-daily administration of icodextrin. Although prescription of icodextrin once daily may yield good clinical results in the long term, this study showed that it may be more efficient to use twice-daily icodextrin for at least a specific period for the purpose of obtaining quicker results in patients with ultrafiltration failure, serious hypervolemia, or hard-to-control blood pressure conditions.

The incidence of active tuberculosis in patients undergoing maintenance dialysis for a long time is considerably higher than that in general population. A 39-year-old male treated by hemodialysis three times a week for six months was admitted to the hospital with a painless mass palpable under his right areola. X-ray examination of chest showed a hyperintense lesion. Computed tomography revealed a cystic mass in the superior segment of inferior lobe near the thoracic vertebrae. Needle aspiration of the lesion revealed granulomas and acid-resistant bacteria. Anti-tuberculous therapy was therefore initiated. After eight months the patient was admitted back with paraplegia. Magnetic resonance imaging (MRI) revealed that the lesion defined by computed tomography (CT) was extending to the spinal duct and compressing the spinal cord. A tissue biopsy was performed and granulomas were identified. Mycobacterium tuberculosis grew in the culture. This case suggests that in areas with a high incidence of tuberculosis renal patients in a high-risk group should be examined periodically to exclude insidious infection and reduce morbidity and mortality.

Purpose Posttransplant anemia (PTA) is associated with a higher risk of cardiac mortality, which is the most frequent cause of death among renal transplant recipients. In this study, we sought to determine the prevalence and causes of PTA among Turkish patients. Patients and methods The study included 75 (52 male, 23 female) adults. Anemia was defined as an hemoglobin (Hb) level ≤ 13 g/dL for men and ≤ 12 g/dL for women. Results The prevalence of PTA was 49.3% at a mean duration of 60.45 months after renal transplantation. The most frequent causes of PTA were erythropoietin (EPO) and iron deficiency. The mean Hb level of 12.76 ± 2.31 g/dL was significantly higher in male compared to female patients (13.26 ± 2.31 g/dL vs 11.64 ± 1.93 g/dL, P = .005). The Hb value was positively correlated with creatinine clearance and serum albumin level, and negatively correlated with serum creatinine level, the amount of proteinuria, and cyclosporine level. Creatinine clearance and serum albumin level were found to be an independent risk factors for PTA upon multivariate analysis. Only 12 of 37 anemic patients received treatment for anemia: 5 (13.5%) with EPO and 7 (18.9%) with iron preparations. Conclusion PTA a common complication was unfortunately neglected in this setting. Impaired renal allograft function and decreased serum albumin were major risk factors for PTA. Increased cyclosporine levels were also correlated with decreased Hb concentrations.

Extraintestinal manifestations of Crohn's disease are common. Granulomas may occur in different tissues in Crohn's disease, although kidney granulomas are extremely rare. Although ocular complications of Crohn's disease are infrequent, most ocular manifestations include iritis, uveitis, episcleritis, scleritis, and conjunctivitis. Central retinal vein occlusion has been reported in a few patients with Crohn's disease. The choroidal neovascularization is related to inflammatory disorders such as panuveitis, sarcoidosis. We report a patient with Crohn's disease complicated by granulomatous interstitial nephritis, choroidal neovascularization, and central retinal vein occlusion.

Background Pruritus is a common problem in continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis patients. There are few studies on the clinical characteristics of uremic itch, the cause of which is still unknown. Objectives The aim of this study was to define the prevalence and clinical characteristics of pruritus in CAPD and haemodialysis patients. Methods A questionnaire was used to evaluate pruritus in 52 CAPD and 289 haemodialysis patients in two dialysis units. The relationship of various factors and medical parameters to itch was examined. Results Of the 341 patients, 177 (51.9%) had pruritus at the time of examination, 97 (28.4%) had pruritus in the past. Pruritus was present in 145 (50.2%) of the haemodialysis patients and 32 (61.5%) of the CAPD patients. Men, patients with liver disease, and patients with pruritus before starting dialysis treatment were more likely to have uremic pruritus. Conclusions This study showed us that uremic pruritus was observed more in men than women. The high prevalence of uremic pruritus in our study does not support the decrease of pruritus due to an improvement in the management of dialysis patients.

ersoy, fevzi/0000-0001-9722-1560; Karayalcin, Binnur/0000-0001-5809-0369; camsari, taner/0000-0001-8293-3688 WOS: 000234144800015 PubMed: 16369903 The aim of this study was to assess the clinical and laboratory correlations of bone mineral density (BMD) measurements among a large population of patients on chronic peritoneal dialysis (PD). This cross-sectional, multicenter study was carried out in 292 PD patients with a mean age of 56 +/- 16 years and mean duration of PD 3.1 +/- 2.1 years. Altogether, 129 female and 163 male patients from 24 centers in Canada, Greece, and Turkey were included in the study. BMD findings, obtained by dual-energy X-ray absorptiometry (DEXA) and some other major clinical and laboratory indices of bone mineral deposition as well as uremic osteodystrophy were investigated. In the 292 patients included in the study, the mean lumbar spine T-score was -1.04 +/- 1.68, the lumbar spine Z-score was -0.31 +/- 1.68, the femoral neck T-score was -1.38 +/- 1.39, and the femoral neck Z score was -0.66 +/- 1.23. According to the WHO criteria based on lumbar spine T-scores, 19.2% of 292 patients were osteoporotic, 36.3% had osteopenia, and 44.4% had lumbar spine T-scores within the normal range. In the femoral neck area, the prevalence of osteoporosis was slightly higher (26%). The prevalence of osteoporosis was 23.3% in female patients and 16.6% in male patients with no statistically significant difference between the sexes. Agreements of lumbar spine and femoral neck T-scores for the diagnosis of osteoporosis were 66.7% and 27.3% and 83.3% for osteopenia and normal BMD values, respectively. Among the clinical and laboratory parameters we investigated in this study, the body mass index (BMI) (P < 0.001), daily urine output, and urea clearance time x dialysis time/volume (Kt/V) (P < 0.05) were statistically significantly positive and Ca x PO4 had a negative correlation (P < 0.05) with the lumbar spine T scores. Femoral neck T scores were also positively correlated with BMI, daily urine output, and KT/V; and they were negatively correlated with age. Intact parathyroid hormone levels did not correlate with any of the BMD parameters. Femoral neck Z scores were correlated with BMI (P < 0.001), and ionized calcium (P < 0.05) positively and negatively with age, total alkaline phosphatase (P < 0.05), and Ca x P (P < 0.01). The overall prevalence of fractures since the initiation of PD was 10%. Our results indicated that, considering their DEXA-based BMD values, 55% of chronic PD patients have subnormal bone mass-19% within the osteoporotic range and 36% within the osteopenic range. Our findings also indicate that low body weight is the most important risk factor for osteoporosis in chronic PD patients. An insufficient dialysis dose (expressed as KT/V) and older age may also be important risk factors for osteoporosis of PD patients.

Gingival hyperplasia is a well-known complication of cyclosporine therapy, affecting 21% to 35% of renal transplant patients. Metronidazole, clarithromycin, and azithromycin, all azalid antimicrobial agents derived from the macrolide antibiotic erythromycin, have been used for treatment. Marked improvements in gingival hyperplasia have been recorded in particular with azithromycin. The aim of the present study was to investigate histopathological features of cyclosporine-induced gingival hyperplasia and to evaluate the quantitative efficacy of short-term azithromycin therapy.Eighteen renal transplant patients with cyclosporine-induced gingival hyperplasia were included in the study. All patients received azithromycin with a dose of 500 mg/d for 3 consecutive days. Changes in gingival hyperplasia were evaluated by measuring the gingival sulcus depth to the cementum-enamel junction of every tooth in each of the four quadrants on days 0, 7, 30, 90, 180. Gum biopsies were obtained on days 0 and 30; the degree of inflammation was classified as "mild," "intermediate," and "severe".Gingival hyperplasia was reduced in all treated patients throughout the study. The degree of improvement was more significant between 0 to 7 and 7 to 30 days than at other times (respectively, P.0001 and P.002). Histopathologically, eight patients had severe and one patient moderate chronic inflammation at the beginning of therapy. Three other biopsies were reported as papilloma, mucosal hyperplasia, and normal gingival tissue biopsy.Azithromycin appears to be useful to treat cyclosporine-induced gingival hyperplasia in renal transplant patients. Treatment is inexpensive and free from known adverse effects.

Aims: A small body size may increase the risk for hernia development in patients on continuous ambulatory peritoneal dialysis (CAPD). The present study investigates whether there is a relationship between body size and hernia development in CAPD patients. Material and methods: The records of 78 patients on CAPD were reviewed retrospectively. Body mass index (BMI), body surface area (BSA) and total body water (TBW) were calculated in all patients. Correlations between different body size indicators (BMI, BSA and TBW) and hernia development were assessed using analysis of covariance in which we adjusted for sex. Results: A total of 14 patients (17.9%) with no physical evidence of hernia before catheter insertion developed hernias. Body size was significantly lower in CAPD patients with hernias than those without hernias when adjusted for sex. Conclusions: We conclude that patients with small body size tend to have an increased risk for hernia development. A simple estimation of patients' height, weight, body surface area and total body water would be helpful to predict development of hernias or other complications related to increased intraperitoneal pressure in CAPD patients.

This study was designed to investigate the humoral immune status and immunological abnormalities in relation to the pathogenesis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The levels of serum and dialysate total protein, immunoglobulins (IgG, I-A, I-M, and IgG subgroups), and C3 were measured at baseline and at the end of the study in 12 children and 10 adult patients on CAPD. The relationship between the levels of immunoglobulin and C3 and the frequency of peritonitis was investigated. Peritonitis occurred at a frequency of one episode every 3.9 and 6.3 patient-months in children at the beginning and at the end of the study, respectively; however, the respective rates for adult patients were one episode every 5.6 and 9.8 patient-months. The levels of serum immunoglobulin and C3 were normal in adults at the beginning and at the end of the study. However, the levels of serum IgG were low in 4 of 12 pediatric patients. Of the 4 patients with low total IgG, I-A was low in I and IgM was low in 2 patients. Of 4 patients with low total IgG, 2 also had low IgG1 and IgG2. However, 3 of the patients with normal IgG had low IgG2 levels at the end of the study. The levels of C3 were low in 6 of 12 and in 3 of 10 pediatric patients at the beginning and at the end of the study, respectively. The protein levels of dialysate were increased at 1-year follow-up in both groups, but the difference was only statistically significant in adult patients (P

Amyloidosis is a multisystem disease which may cause organ loss. Renal involvement is the most common clinical problem in amyloidosis, however involvement of endocrin organs is possible. In this study to assess adrenocortical function and to evaluate the usefulness of low dose ACTH test in patients with renal amyloidosis, we determined cortisol, 17-hydroxyprogesteron (17-OHP) and 11-deoxycortisol (11-DOC) responses to both 1 microg and 250 microg Synacthen. We also determined the size of adrenal glands radiologically by using computerized tomography. Twenty one patients with renal amyloidosis and 16 healthy subjects for hormonal evaluation, and 20 patients with renal amyloidosis and 22 healthy subjects for radiologic evaluation were included in the study. In four patients (19%) peak serum cortisol levels following stimulation with the low dose of Synacthen were less than 20 microg/dL (550 nmol/L). Two of them had also subnormal cortisol response to the 250 microg Synacthen stimulation test. Basal and stimulated levels of 11-DOC were lower than those of control values (p=0.000 and p

Parathyroid carcinoma is a rare malignancy and an infrequent cause of parathormone-dependent hypercalcemia. The most effective treatment for the tumor is a complete resection of the primary tumor. In spite of this, the tumor usually recurs. In the present study, we report the case of a 42-year-old patient who has undergone continuous ambulatory peritoneal dialysis and presented with hypercalcemia due to inoperable parathyroid carcinoma. The patient's hypercalcemia was successfully controlled with cinacalcet plus alendronate despite continuing parathyroid hormone overproduction.

Fungal peritonitis is a rare but serious complication in patients undergoing peritoneal dialysis (PD). We aimed to analyze the predisposing factors, clinical aspects, etiological agents, and treatment of fungal peritonitis in patients with PD in our hospital.The data of all patients with PD, who were followed-up between January 1995 and December 2009, were evaluated retrospectively. Twenty-one patients with fungal peritonitis were included into the study.Mean age was 46 ± 13. Twelve of the 21 patients were females. Median PD duration was 48 (range 9 to 95) months. Candida species were the most common pathogens isolated from peritoneal effluent fluid (n: 16): Candida albicans (14), Candida rugosa (n: 1), and Candida glabrata (n: 1). The other involved fungi were Aspergillus species (n: 1), Saccharomyces species (n: 1), Acromonium species (n: 1), Fusarium species (n: 1), and Rhodotorula mucilaginosa (n: 1). The PD catheter was removed in all of the patients. Median time until the PD catheter removal was 1 (range 0 to 10) day. Before 2005, this duration was 4 (0-10) days, whereas after 2005 it was 0 (0-2) days (P: 0.001). Therapy with amphotericin B and fluconazole was continued after catheter removal in 19 and in 2 of the patients, respectively. As a result of fungal peritonitis, 19 patients were transferred to hemodialysis. Two patients died during the episode of peritonitis.Candida albicans was the most common pathogen. For the successful management of fungal peritonitis besides the antifungal therapy, peritoneal catheter removal was necessary in all of the patients.

Fibric acid derivatives and statins have been increasingly recognized as causes of rhabdomyolysis and acute renal failure. We report severe rhabdomyolysis and acute renal failure associated to combination treatment with statin and fenofibrate in two patients with underlying coronary artery disease. Both patients developed rhabdomyolysis-induced acute renal failure after their hyperlipidemia treatment was changed from statin to statin plus fenofibrate. Both patients experienced intense muscle symptoms, hemoglobinuria, oliguria, and elevation of blood urea nitrogen and serum creatinine. Their serum creatine kinase levels were markedly elevated (case 1; 97,392 IU/l and case 2; 96,639 IU/l). Rhabdomyolysis induced acute renal failure was diagnosed in both patients. Both patients were managed with cessation of the statin-fibrate combination, adequate fluid resuscitation and forced alkaline-mannitol diuresis. Although both patients required hemodialysis, their renal function recovered. Fenofibrate initiation is associated with an increased risk for rhabdomyolysis in patients receiving statin therapy. To prevent future events, it is crucial that clinicians recognize the interaction risk associated with concurrent use of statin and fenofibrate. We recommend careful monitoring when fenofibrate is given to patients receiving statin therapy.

WOS: 000075230300009 PubMed: 9689161 Several patients with end-stage renal disease went to Bombay for renal transplantation from nonrelated living donors and then returned to Turkey for posttransplantation follow-up. The aims of this study are to evaluate the long-term results of renal transplantation from nonrelated living donors in Turkish patients with end-stage renal disease and to discuss the ethical and social aspects of nonrelated kidney donation. One hundred and twenty-seven patients (89 males, 38 females; mean age 38.1, range 17-63 years) were investigated retrospectively. None of the patients went to Bombay on our advice. All transplantations were performed between 1991 and 1995. The mean follow-up period after transplantation was 34.2 (range 1-68) months. Graft survival rates were 85, 83, and 57% after 3 months and 1 and 5 years, respectively. Patient survival rates were 94, 93, and 92% after 3 months and 1 and 5 years, respectively. Seven patients died within the first 3 months after the transplantation. Surgical problems, infections, acute rejection, ciclosporin nephrotoxicity, and hepatic problems were common complications. We conclude that medical and surgical complications occur frequently in paid kidney transplantation, but most of these complications can be prevented by adequate preoperative management, and precautionary measures should be taken to prevent commercialization of renal transplantation before the spread of emotionally related living kidney donation.

It is well established that diabetic peritoneal dialysis (PD) patients have a higher mortality rate than the other PD population. This study was designed to determine the overall predictors of survival and compared mortality and morbidity between diabetic and non-diabetic Turkish PD patients.We conducted a multicenter retrospective study with 915 PD patients [217 had diabetes mellitus (DM)]. Serum albumin, PTH, HbA1c, co-morbid diseases, dialysis adequacy (Kt/V), and peritoneal transport characteristics as well as peritonitis episodes and ultrafiltration failure during the follow-up period were recorded.DM patients were older and had more co-morbidities than non-DM patients. Peritonitis rates were higher in DM patients (one episode per 35.9 patient months) compared to non-DM patients (one episode per 41.5 patient months) (p 0.001). On Kaplan-Meier analysis, patient survival was significantly lower in DM patients with the 2-, 3- and 5-year patient survival rates of 90.8%, 87.8% and 78.2% in non-diabetics and 80.9%, 70.4% and 61.2% in diabetics, respectively. On Cox regression analysis, DM (HR 1.5, p = 0.022), age (HR 1.03, p 0.001), baseline serum albumin (HR 0.39, p 0.001), heart failure (HR 0.038, p = 0.038), peripheral artery disease (HR 1.83, p = 0.025) and amputation (HR 4.1, p = 0.009) at baseline were significant predictors of overall mortality.Patient survival is lower in diabetic compared to non-diabetic patients on PD. Peritonitis rates were also higher in diabetic PD patients. DM, older age, albumin level and cardiovascular co-morbidities are predictors of mortality.

Aim: Contrast-induced nephropathy (CIN) is a relatively common and serious complication, which occurs after the administration of contrast materials to patients. Although the pathophysiology of CIN is not exactly understood, ischemia of the medulla, oxidative stress, and direct toxicity of the contrast material are some of the factors that are implicated for the pathogenesis of CIN. To date, the only therapy that reduces the risk of CIN is volume expansion. There are conflicting results about the roles of angiotensin receptor blockers (ARB) and calcium channel blockers (CCB) in studies on CIN. For this reason the aim of this study was to compare the efficiency of the prophylactic use of amlodipine/valsartan plus hydration versus hydration only for the prevention of CIN in patients undergoing coronary angiography (CAG). Patients and methods: We prospectively enrolled 90 patients whose baseline serum creatinine levels were under 2.1 mg/dL and who were scheduled for CAG. Patients were divided into two groups. Group I (n = 45), consisted of patients who received amlodipine/valsartan plus hydration, group II (n = 45) consisted of patients who received only hydration. The patients in group I were given amlodipine/valsartan 5/160 mg once a day for a total of 3 days, starting one day before CAG and continuing on the day of and the day after the procedure. A 1 mL/kg/h sodium chloride infusion was administered for a total of 24 h, starting 12 h before the procedure and 12 h after, in all patients. The baseline serum creatinine (S-cre) level was obtained before the procedure and repeated 48 h after. CIN was defined as an increase of >= 0.5 mg/dL or an increase of >25% in baseline S-cre on the second day after CAG. Results: The baseline clinical characteristics of the treatment groups were similar. Baseline S-cre was 1.13 +/- 0.33 in group I and 1.07 +/- 0.23 mg/dL in group II (p = 0.31). There was a significant difference between the S-cre levels 48 h after CAG between the two groups (1.18 +/- 0.33-1.05 +/- 0.23) (p = 0.03). The reason for this was the increase of S-cre in group I. CIN occurred in 17.8% (8/45) of patients in group I and in 6.7% (3/45) of patients in group II (p = 0.197). In the diabetic subgroup, CIN occurred in 10.5% (2/19) of patients taking amlodipine/valsartan and in none of the patients in group II (p = 0.486). The Mehran scores of the patients who developed CIN were significantly higher than those patients who did not develop CIN. Conclusion: Amlodipine/valsartan therapy plus hydration did not reduce the risk of CIN in chronic kidney disease (CKD) Stage 2 patients who underwent elective CAG using a low-osmolar nonionic contrast medium. This is because there was a decrease in the glomerular filtration rate (GFR) using the Levey Modification of Diet in Renal Disease (MDRD) formula in the amlodipine/valsartan group and CIN occurred at a higher frequency in this group; ARBs and CCBs may be withheld before CAG in high-risk patients.

ersoy, fevzi/0000-0001-9722-1560; Kazancioglu, Rumeyza/0000-0003-1217-588X; camsari, taner/0000-0001-8293-3688 WOS: 000322718000027 PubMed: 22752452 The purposes of this study were to investigate the association between arm circumference and body mass index (BMI) and to discuss problems, mainly arm circumference and cuff size mismatch, that could affect the reliability of home blood pressure monitoring (HBPM) among peritoneal dialysis (PD) and hemodialysis (HD) patients. 525 PD and 502 HD patients from 16 centers were included in the study. A two-part questionnaire was used to gather information from the participants. Arm circumferences were categorized into four groups according to the British Hypertension Society cuff size recommendations. Mean BMI and arm circumference of all participants were 25.0 kg/m(2) and 27.6 cm, respectively. There was a significant correlation between BMI and arm circumference. The mean BMI and arm circumference values were higher in PD patients than in HD patients. Requirement of a large-sized adult cuff was more common among PD patients compared to HD patients (14 % vs 8 %, p = 0.002). Since HBPM is a useful tool for clinicians to improve BP control, nephrologists should be aware of the problems related to HBPM in dialysis patients and take an active role to increase the reliability of HBPM.

rESULTS: Dialysate B2M level and peritoneal clearance of B2M were higher in the high transporter group than in the low transporter group (5.92 ± 2.62 mg/L vs. 3.42 ± 1.51 mg/L, p: 0.05). Serum B2M concentration was positively correlated with duration of PD (r: 0.518, p

We describe a rare case of peritonitis caused by an unusual fungus, Trichoderma sp., in a patient on continuous ambulatory peritoneal dialysis. Management of the patient consisted of Tenckhoff catheter removal and antifungal chemotherapy, but the patient died.

Aim: Hypomagnesemia is a frequent complication in RTRs, particularly in the early post-transplant period. Hypomagnesemia is usually associated with the use of calcineurin inhibitors. The relationship between cyclosporine use and hypomagnesemia is well known. However, it has been reported in several studies that hypomagnesemia was seen more in RTRs treated with tacrolimus compared to those treated with cyclosporine. In this study, we aimed to investigate the frequency and risk factors of post-transplant hypomagnesemia and effects of calcineurin inhibitors on hypomagnesemia among Turkish patients. Patients and method: The study included 68 adult renal transplantation recipients. Hypomagnesemia was defined as serum magnesium level

Background: In the Chronic REnal Disease In Turkey - CREDIT Study, a large population-based study on 10,748 adults, the prevalence of chronic kidney disease (CKD) and relationship between CKD and other cardiovascular risk factors had been studied. Methods: This report presents the results of CREDIT study on the prevalence, awareness, treatment, and control of hypertension among CKD patients. Results: The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. Of the patients with hypertension, 31.5.% were under treatment, and 16.4% had hypertension under control. Prevalence of CKD was 25.3% in patients with hypertension. Among CKD patients (15.7% of the CREDIT study population), 56.3% had hypertension. The prevalence of hypertension was 34.8% at stage 1, 79.8% at stage 3, and 92.3% at stage 5 CKD. Only 13.4% of patients with CKD have optimal blood pressure. Among CKD patients, 61.9% were aware of hypertension, and 44.2% were under treatment. Overall control rate of hypertension in subjects with CKD was 16.3% with the lowest rate at stage 1 (12.3%) and highest rate at stage 4 (40%). The control rate increased to 28.8% for CKD patients under treatment for hypertension. Conclusion: As a conclusion, hypertension is highly prevalent in subjects with CKD in Turkey with suboptimal awareness, treatment, and control rates. Appropriate health strategies should be implicated to improve prevention, early diagnosis, and treatment of hypertension, which is one of the leading causes of CKD. Copyright (C) 2012 S. Karger AG, Basel

Peritonitis is an uncommon complication of brucellosis. Brucella peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients has not been reported before. A male patient is presented with peritonitis caused by Brucella melitensis who was on CAPD. The source of infection was thought to be unpasteurized, unsalted cheese eaten a month before the onset of symptoms. At the beginning, antibiotic therapy with doxycyline and rifampicin led to a rapid clinical improvement, with disappearance of the organism in the peritoneal fluid. However, peritonitis relapsed after discontinuation of antimicrobial therapy. Successful management required a combination of medical therapy and removal of the Tenckhoff catheter.

The central nervous system (CNS) toxicity of fluoroquinolones is well known but usually occurs benign. In the literature, there are a few number of severe CNS toxicity cases related to fluoroquinolones. Levofloxacin is a third-generation fluorinated quinolone antibiotic, is the active levo stereoisomer of ofloxacin, and has one of the most favorable adverse reaction profiles. We describe a case of delirium associated with levofloxacin in a 55-year-old man who was hospitalized in our medical clinic for pneumonia.