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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.

WOS: 000461206800006, Objective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition in chronic hemodialysis (HD) patients. In this prospective observational study, we investigated the survival predictability of impedance ratio (IR) calculated by BIS in HD patients (Clinical Trials Gov Identifier: NCT01468363). Materials and Methods: A total of 430 chronic HD patients, out of 500 prevalent chronic HD patients from the city of Zonguldak who met the inclusion criteria, were included in the study. With a mean follow-up of 32.2 +/- 14.4 months, BIS was performed in all patients. The IR percentage (IR%) was calculated by dividing the resistance values using the 200 kHz and 5 kHz impulses. Student's t-test, Cox regression analysis, and Kaplan-Meier survival analysis were performed, and a p

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.

WOS: 000461206800010, Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialysis (HD). Our aim in this study was to evaluate the risk factors of permanent catheter thrombosis and the necessity of anti-coagulant and anti-aggregation drugs. Materials and Methods: In this retrospective study, 34 patients undergoing HD, with removed internal jugulary permanent catheters due to either thrombosis or maturation of operated arteriovenous fistulas, were included. Patients were divided into thrombotic and non-thrombotic, according to the catheter thrombosis status. Results: The mean age was 66.3 +/- 15.4 years, and the follow-up period was 10.9 +/- 8.5 (1-29) months. Catheter thrombosis was found in 12 patients. Albumin and total protein levels were lower in the baseline thrombotic group (3.53 +/- 0.46 g/dL and 6.64 +/- 0.92g/dL, respectively) than in the non-thrombotic group (3.95 +/- 0.41 and 7.37 +/- 0.46g/dL, respectively). In the non-thrombotic group, hemoglobin, hematocrit higher, and platelet count were lower at the catheter removal time compared to the catheter insertion time (hemoglobin 11.45 +/- 1.25, hematocrit 35.61 +/- 4.51, and platelet count 193.82 +/- 66.32 versus hemoglobin 10.33 +/- 1.37g/dL, hematocrit 31.38 +/- 3.79% and platelet count 231.77 +/- 71.7x103/uL, respectively), but in the thrombotic group, the ferritin levels significantly increased from 541.3 +/- 574.8ng/mL at the catheter insertion time to 745.1 +/- 406.5ng/mL at the catheter removal time. Conclusion: Anti-coagulant and anti-aggregation drugs and renal failure etiology did nothave any effect on permanent catheter thrombosis, but the albumin and total protein levels were related to it. Increased levels of ferritin and C-reactive protein seem to emerge as the acute phase reactants associated with thrombosis.

Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients.Materials and Methods. Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded.Results. Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM,p<0.001) in HD patients. Serum sulphate level correlated with patient’s age, serum albumin, serum BUN and creatinine, and serum phosphorus level in HD patients. Serum sulphate levels were not associated with serum parathyroid hormone levels.Conclusion. Serum sulphate levels were approximately twofold higher in HD patients than in the normal control group. Inorganic sulphate does not seem to accumulate in long-term dialysis patients, and mild increased serum levels of sulphate has no poor clinical outcome in these patients.

OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS: A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS: The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg. The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well. The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION: Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis.

Objective: Body composition analysis is useful technique for assessing hydration, nutritional status and predicting clinical outcomes. Bioimpedance analysis (BIA) is a cheap and noninvasive tool for monitoring body composition but needs some improvements regarding measurement methods. We aimed to find out if body position has an effect on the BIA results. Material and Methods: Personal characteristics including age, gender, height, weight and blood pressure were recorded. Hydration and nutritional status measured by body composition monitor in supine and standing positions consequently for each individual. Results: Two hundred and one populations from various region in Turkey, 61% (n: 123) male, mean age was 46.3±12 years (18-76) of age, participated in this crossectional study. From supine to standing positions overhydration and extracellular water (ECW) were increased from 0.04±1.08 and 17.69±2.92 to 0.46±1.05 L and 17.84±2.90 L while intracellular water (ICW) decreased from 22.55±4.35 to 22.04±4.28 L significantly. Systolic and diastolic blood pressures were 131.3±18.1 and 75.1±12 decreased to 127.0±16.0 and 72.2±9.0 mmHg in supine to standing positions (p> 0.05). Conclusion: Supine and standing positions could affect the volume parameters of BIA due to shift of ECW and ICW by gravity but nutritional parameters also changes significantly. Protocols should be re evaluated in order to get more accurate results in bioimpedance measurements.

Introduction: Overhydration is the main contributory factor of left ventricular hypertrophy and closely associated with cardiovascular events in end stage renal disease (ESRD) patients. The aim of this prospective-study was to investigate the impact of strict salt and volume control on hypertension and cardiac condition in ESRD patients. Methods: A total of 12 peritoneal dialysis (PD) and 15 prevalent hemodialysis (HD) patients were enrolled. All patients either PD or HD were allocated to intervention of strict salt restriction according to basal hydration state of empty abdomen in PD and midweek predialysis HD which were estimated by body composition monitor (BCM) and echocardiography. Results: Mean ages were 48.3±16.7 years for PD, and 48.8±18 for HD patients. Extracellular water/height was 10.04±2.70 and 10.39±1.53L/m in PD and HD groups. Systolic blood pressures decreased in PD and HD from 133.1±28 and 147.3±28.5 to 114.8±16.5 and 119.3±12.1mmHg, respectively, (p0.05). LVMI and LAI were not increased in both groups. Conclusion: Strict salt and volume control in ESRD patients after assessment of hydration status with either using BCM or echocardiography provides better management of volume control leading to more precise cardiovascular protection. © 2013 Informa Healthcare USA, Inc.

Background Fluid overload is the main determinant of hypertension and left ventricular hypertrophy in hemodialysis patients. However, assessment of fluid overload can be difficult in clinical practice. We investigated whether objective measurement of fluid overload with bioimpedance spectroscopy is helpful in optimizing fluid status. Study Design Prospective, randomized, and controlled study. Setting & Participants 156 hemodialysis patients from 2 centers were randomly assigned to 2 groups. Intervention Dry weight was assessed by routine clinical practice and fluid overload was assessed by bioimpedance spectroscopy in both groups. In the intervention group (n = 78), fluid overload information was provided to treating physicians and used to adjust fluid removal during dialysis. In the control group (n = 78), fluid overload information was not provided to treating physicians and fluid removal during dialysis was adjusted according to usual clinical practice. Outcomes The primary outcome was regression of left ventricular mass index during a 1-year follow-up. Improvement in blood pressure and left atrial volume were the main secondary outcomes. Changes in arterial stiffness parameters were additional outcomes. Measurements Fluid overload was assessed twice monthly in the intervention group and every 3 months in the control group before the mid- or end-week hemodialysis session. Echocardiography, 48-hour ambulatory blood pressure measurement, and pulse wave analysis were performed at baseline and 12 months. Results Baseline fluid overload parameters in the intervention and control groups were 1.45 ± 1.11 (SD) and 1.44 ± 1.12 L, respectively ( P = 0.7). Time-averaged fluid overload values significantly decreased in the intervention group (mean difference, −0.5 ± 0.8 L), but not in the control group (mean difference, 0.1 ± 1.2 L), and the mean difference between groups was −0.5 L (95% CI, −0.8 to −0.2; P = 0.001). Left ventricular mass index regressed from 131 ± 36 to 116 ± 29 g/m 2 ( P 2 ; P = 0.9); mean difference between groups was −10.2 g/m 2 (95% CI, −19.2 to −1.17 g/m 2 ; P = 0.04). In addition, values for left atrial volume index, blood pressure, and arterial stiffness parameters decreased in the intervention group, but not in the control group. Limitations Ambulatory blood pressure data were not available for all patients. Conclusions Assessment of fluid overload with bioimpedance spectroscopy provides better management of fluid status, leading to regression of left ventricular mass index, decrease in blood pressure, and improvement in arterial stiffness.

Introduction: Nephrotic syndrome (NS) and arterial stiffness (AS) have each been linked with increased risk for cardiovascular diseases. However, there is no data in the literature up-to-date on AS in adult patients with NS. Thus, in this study, we aimed to evaluate the potential associations between AS, volume and nutritional status in patients with NS in comparison to a healthy control group. Methods: 34 adult patients with newly diagnosed but untreated NS and 34 healthy controls were studied. AS was assessed by carotid-femoral PWV (cf-PWV) and body composition, nutritional status by multi-frequency bioelectric impedance analysis (BIA). Results: Mean age was 44.6 +/- 18.7 years (18 - 72). Mean cf-PWV was 8.3 +/- 2.5 m/s in patients with NS and 6.7 +/- 1.1 m/s in controls (p = 0.002). In univariate analysis, cf-PWV and positively correlated with age, systolic blood pressure, mean arterial pressure (MAP), pulse pressure, body mass index, body fat ratio, waisthip ratio, creatinine, uric acid and negatively with creatinine clearance. In linear regression analysis, only age and MAP predicted arterial stifffiess. Total body fluid, extracellular water (ECW), ECW/Height, ECW/body surface area and third space volumes were higher in patients with NS. Conclusion: Patients with NS have increased AS and are more hypervolemic compared to the healthy subjects.

WOS: 000393291900012 OBJECTIVE: Cinacalcet reduces parathyroid hormone levels by increasing the sensitivity of the parathyroid gland to calcium. in this study, we firstly aimed to evaluate the efficacy of cinacalcet in Turkish hemodialysis patients. MATERIAL and METHODS: 4483 hemodialysis patients were screened and 469 patients who had used cinacalcet were included in the study. the patients were divided into 4 groups according to drug usage durations (Group 1: 3 months, Group 2: 6 months, Group 3: 9 months and Group 4: 12 months). the patients' Parathormone, Ca, P and CaxP levels at the 3rd, 6th, 9th and 12th months were compared to the start of treatment and previous months. RESULTS: the levels of Parathormone, Ca, P and CaxP significantly decreased compared to their initial levels in all groups (from 1412 pg/ml to 1222 pg/mL for Parathormone, p< 0,001) in the 3rd month. However, this reduction was not continued in the subsequent months (Parathormone: 1381 pg/ml for the 12th month). CONCLUSION: Cinacalcet may not provide adequate benefit in control of hyperparathyroidism in Turkish hemodialysis patient population.

WOS: 000312869700007, PubMed ID: 22630818, Mean platelet volume (MPV) is a determinant of platelet activation. Atherogenic index of plasma (AIP), which is defined as the logarithm of the ratio of plasma level of triglycerides to the level of high-density lipoprotein (HDL)-cholesterol (log[TG/HDL-C]), has recently been used as a marker of atherogenicity. This study included 104 normotensive individuals. Mean platelet volume and AIP were measured in all patients. Nondipper individuals (8.6 +/- 0.9 fL, 0.3 +/- 0.2) demonstrated higher values of MPV and AIP compared with dippers (7.9 +/- 1.1 fL, 0.1 +/- 0.2) (P

Aim: Encapsulated peritoneal sclerosis is characterized by neoangiogenesis and fibrosis. Octreotide, a somatostatin analogue is a well-known antifibrotic, antiproliferative and anti-angiogenic agent. The aim of the study is to evaluate the effects of octreotide in encapsulated peritoneal sclerosis-induced neoangiogenesis and fibrosis and compare the results with resting. Methods: Non-uraemic Wistar-Albino male rats (n = 35) were divided into four groups. Group I, control rats, received 2 mL isotonic saline i.p. daily for 3 weeks. Group II, received daily i.p. 2 mL/200 g injection of chlorhexidine gluconate (0.1%) and ethanol (%15) dissolved in saline for 3 weeks. Group III, chlorhexidine gluconate for 3 weeks plus an additional 3 weeks without any treatment (rest), to a total of 6 weeks. Group IV, chlorhexidine gluconate for 3 weeks plus an additional 3 weeks octreotide, 50 mcg/kg bodyweight s.c., for a total of 6 weeks. Results: Octreotide significantly reversed ultrafiltration capacity of peritoneum with decreasing inflammation, neoangiogenesis and fibrosis compared to the resting group. Octreotide also caused inhibition of dialysate transforming growth factor-β1, vascular endothelial growth factor and monocyte chemotactic protein-1 activity and improved mesothelial cell cytokeratin expression. Peritoneal resting has no beneficial effects on peritoneum. Conclusion: In conclusion, octreotide may have a therapeutic value in peritoneal dialysis patients who suffer from encapsulated peritoneal sclerosis.

Aim: Nephrotoxic potential of mammalian target of rapamycin inhibitors (mTORi) is different from calcineurin inhibitors (CNI). The aim of this study is to investigate the interstitial fibrosis (ci) and tubular atrophy (ct) progression from the baseline to first year under a mTORi-based, CNI-free regimen. Methods: Thirty-five kidney transplant recipients who had to have adequate baseline and first year protocol biopsy were enrolled. Exclusion criteria were: the replacement of CNI at any time; acute deterioration in allograft functions; and serum creatinine level above 3 mg/dL at 12 months. Banff criteria were used for histopathological classification. Progression was defined as delta ci + ct ≥ 2 (difference between 12th month and baseline). Results: Mean age of patients and donors were 34 ± 11 and 49 ± 10 years. Twelve patients had delayed graft function (DGF). The maintenance regimen consisted of sirolimus (n = 24) and everolimus (n = 11) with mycophenolate mofetil and steroids. Incidence of acute rejection was 25.7%. At baseline, the incidence of nil and mild fibrosis were 80% and 20%, respectively. At 12 months, 17.1% of patients had moderate, 40% had mild and 42.9% had nil fibrosis. Histological progression from baseline to first year was present in 34% of patients. In multivariate analysis the presence of DGF (P = 0.018) and deceased donor type (P = 0.011) were the most important predictors for fibrosis progression. Conclusion: Progression of graft fibrosis may be seen in one-third of patients under a mTORi-based regimen particularly manifested in deceased donor recipients with subsequent DGF.

Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with ileus symptoms and irreversible sclerosis of the peritoneal membrane. Inflammation, fibrosis, and neoangiogenesis are the main features of the pathophysiology. No evidence-based therapy is currently available for EPS. In recent years, anti-inflammatory and immunosuppressive (IS) treatment modalities have become more popular. The aim of the present study was to investigate the effects of various IS treatment strategies—glucocorticosteroid (GC), azathiopurine (AZT), and cyclosporin (CsA)—on regression of EPS. We divided 52 nonuremic Wistar albino rats into six groups: Control group—2 mL isotonic saline injected intraperitoneally (IP) daily for 3 weeks; CG group—2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for 3 weeks; Resting group—CG (weeks 1 – 3), plus peritoneal rest (weeks 4 – 6); Corticosteroid (GC) group—CG (weeks 1 – 3), plus 10 mg/L prednisolone in drinking water (weeks 4 – 6); AZT group—CG (weeks 1 – 3), plus 100 mg/L azathioprine in drinking water (weeks 4 – 6); and CsA group—CG (weeks 1 – 3), plus cyclosporin 7.5 mg/kg by subcutaneous injection daily (weeks 4 – 6). At the end of the study, under ketamine HCl anesthesia, the rats were humanely killed by bleeding. Parietal peritoneal samples were then taken from same location (away from the injection site) and changes of parietal peritoneum morphology were examined by a single pathologist. The CG severely disturbed parameters of peritoneal morphology, increasing peritoneal thickness, inflammatory activity, vascularity, and fibrosis score as compared with the Control group ( p < 0.05). No benefit was observed for any parameter in the Resting group as compared withthose parameters in the CG group ( p < 0.05). We observed a lower fibrosis score and less peritoneal thickness in the GC group as compared with the Resting group ( p < 0.05). No beneficial effects of AZT on peritoneal morphology were observed as compared with the effects of peritoneal rest or corticosteroid therapy. Treatment with cyclosporin resulted in more fibrosis, vascularity, and inflammation than was seen with corticosteroid therapy ( p < 0.05). Immunosuppressive therapies, especially those that are corticosteroid-based, may have therapeutic value in the management of EPS. Patients treated with cyclosporin may have a risk for developing EPS.

WOS: 000340761700001, PubMed ID: 25177700, Objectives. Hypertension and hypervolemia relationship was proven among renal disease, although it is not known in normal population. Present study determines the fluid distribution defects in relation to blood pressure. Material and Methods. In a population-based survey in Turkey demographics, height, weight, blood pressure, urine analysis, and serum creatinine measurements were recorded. Bioimpedance measured with the Body Composition Monitor. Results. Total 2034 population of 71.6% male, mean age 47 +/- 12.6 (18-89) years, systolic blood pressure (SBP) 134.7 +/- 20, diastolic blood pressure 77.9 +/- 11.6 mmHg. Body mass index (BMI) was 28.5 +/- 4.5 (15.8-50.6) kg/m(2); overhydration was 0.05 +/- 1.05 L. There was a correlation between extracellular water (ECW)/height and SBP (r = 0.21, P < 0.001). Receiver operating characteristic (ROC) curve with the performance of 0.60 (P < 0.001) that showed cut-off value of ECW/height was 10.06 L/m, with the 69% sensitivity and 45% specificity for SBP: 140 mmHg values. Risk factors for high SBP were increase of ECW/Height, age, BMI and presence of diabetes. ECW/height, SBP, and fat tissue index (FTI) increased in BMI categories (low, normal, and obese) and in diabetics. SBP and FTI were lower in smokers. Conclusions. High blood pressure may be accompanied by increased extracellular volume indices. In the future volume status assessment could be of use in evaluating the effectiveness of pharmacological intervention in the treatment of hypertension.

AMAÇ: Kolistin gram negatif basillerde etkili, polipeptid yapıda bir polimiksin antibiyotiğidir. Geçmişte yan etkileri nedeniyle kullanımı azalmasına karşın son yıllarda özellikle çoklu ilaç direnci olan Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter ve Enterobacteriaceae’da etkinliği olduğundan kullanımı giderek artmaktadır. Bu çalışmada, merkezimizde kolistin kullanılan hastalar nefrotoksisite yönünden retrospektif olarak değerlendirilmiştir. GEREÇ ve YÖNTEMLER: Çalışmaya Ocak 2012– Ağustos 2013 yıllarında 2. basamak yoğun bakım ünitemizde yatarak kolistin tedavisi alan hastalar alındı. Demografik veriler; bazal, yatış sırasında günlük alınan ve taburculuk sonrası bakılan biyokimyasal tetkikler; ve kolistin başlangıç, idame ve toplamda verilen dozları değerlendirildi. BULGULAR: Yaş ortalaması 62±13 (31-86) yıl olan 17 (%63) erkek, toplam 27 hasta ortalama 63±89 gün izlenmiştir. Tüm izlem süresince hastaların 18’inde (%66,7) akut böbrek yetmezliği (ABY) gelişmiş, 17 (%63) hasta exitus olmuştur. Mortaliteler ABY grubunda 12 (%66,7), ABY olmayan grupta 5’tir (%55) (p> 0,05). Toplam kolistin dozu ve lökosit sayısı istatistiki olarak anlamlılığa ulaşmasa da ABY grubunda 3,75±2,34 g ve 12,04±5,05/mm3 olup ABY olmayan gruptaki 3,32±.1,86 g ve 7,60±3,7/ mm3 değerlerinden daha yüksektir. SONUÇ: Yoğun bakım hastalarında ABY mortaliteyi arttırmaktadır. Kolistin, dirençli enfeksiyonlarda kullanılan etkin bir tedavi ajanı olduğu halde ABY yan etkisi göz önüne alındığında bu ilacın yüksek dozlarda kullanımından mümkün olduğunca kaçınılması doğru bir yaklaşım olacaktır., OBJECTIVE: Colistin is a polymyxin antibiotic with a polypeptide structure and is effective against gram-negative bacilli. Although its use had decreased due to its side effects, it has increased again in recent years, especially for multi-drug resistant Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter and Enterobacteriaceae. In the present study, patients that received colistin at one center were retrospectively analysed in terms of nephrotoxicity. MATERIAL and METHODS: Patients hospitalized and treated with colistin in the intensive care unit between January 2012 and August 2013 were analyzed. Demographic data; biochemical tests at baseline, daily during hospitalization and after discharge; and the initial, maintenance and total doses of colistin were evaluated. RESULTS: The mean age was 62±13 (31-86) years for the 27 patients with 17 (63%) males that were followed-up for an average duration of 63±89 days. During follow-up, 18 patients (66.7%) developed acute renal failure (ARF) and 17 (63%) of died. There were 12 (66.7%) mortalities in the ARF group and 5 (55%) in the group without ARF ( p> 0.05). The total colistin dose and leukocyte count were higher in the ARF group with 3.75±2.34 g and 12.04±5.05/mm3 than the non-ARF group at 3.32±1.86 g and 7.60±3.7/mm3 but did not reach statistical significance. CONCLUSION: ARF increases the mortality in ICU patients. Although colistin is an effective therapeutic agent used for resistant infections, we have to avoid higher doses due to its potential side effect of ARF.

Although some studies revealed a positive relationship between vitamin D3deficiency and inflammatory markers, there have been also many studies that failed to find this relationship. The aim of this large scaled study is to determine the association between the level of plasma 25 hydroxy vitamin D3[25-(OH) D3] and inflammatory markers in the general population without chronic kidney disease (CKD) and in patients with CKD. Participants with simultaneously measured inflammatory markers and 25-(OH) D3levels were retrospectively analyzed (n=1897). The incidence of all-cause inflammation infection, hospitalization, chronic renal failure, and vitamin B12 deficiency was evaluated. The medians of serum creatinine levels in subjects without renal failure were lower in 25-(OH) D3deficient group. Patients with CKD were more likely to have vitamin D3deficiency compared with normal GFR. 25-(OH) D3levels were associated with a greater incidence of all-cause hospitalization, hypoalbuminemia, and vitamin B12 deficiency. However, there was no relationship between inflammatory markers and vitamin D3levels. In 25-(OH) D3deficient patients, inflammatory markers can be related to other inflammatory and infectious status such as malnutrition and cachexia. We believed that there must be a relationship between vitamin deficiency and inflammatory markers due to other causes than low 25-(OH) D3status.

WOS: 000320810800001, PubMed ID: 23843788, Introduction. Acute kidney injury (AKI) pathogenesis is complex. Findings of gentamicin nephrotoxicity are seen in 30% of the AKI patients. Vitamin D has proven to be effective on renin expression, inflammatory response, oxidative stress, apoptosis, and atherosclerosis. We aimed to investigate the effect of vitamin D in an experimental rat model of gentamicin-induced AKI. Methods. Thirty nonuremic Wistar albino rats were divided into 3 groups: Control group, 1 mL saline intramuscular (im) daily; Genta group, gentamicin 100 mg/kg/day (im); Genta + vitamin D, gentamicin 100 mg/kg/day (im) in addition to 1 alpha, 25 (OH)(2)D-3 0.4 mcg/kg/day subcutaneously for 8 days. Blood pressures and 24-hour urine were measured. Blood urea and creatinine levels and urine tubular injury markers were measured. Renal histology was semiquantitatively assessed. Results. Urea, creatinine and urine neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 were all increased in Genta group indicating AKI model. Systolic blood pressure decreased, but urine volume and glutathione increased in Genta + Vit D group compared to Control group. Histological scores indicating tubular injury increased in Genta and Genta + Vit D groups. Conclusions. Vitamin D does not seem to be effective on histological findings although it has some beneficial effects via RAS system and a promising effect on antioxidant system.

50th European-Renal-Association - European-Dialysis-and-Transplant-Association Congress -- MAY 18-21, 2013 -- Istanbul, TURKEY, WOS: 000319498202399, …, European Renal Assoc (ERA), European Dialysis & Transplant Assoc (EDTA)

Congenital adrenal hyperplasia belongs to a group of autosomal recessive disorders affecting steroid biosynthesis; a rare disease with a prevalence of 1 case per 16,000 population. A 30-year-old phenotypically male patient had been diagnosed with 11-β hydroxylase deficiency at the age of 16; presenting with ambiguous genitalia, growth retardation, presence of menstrual cycles, severe hypertension, hypokalemia and renal dysfunction. He developed endstage renal disease due to hypertension and was treated with hemodialysis for 3 y. After careful evaluation, he was approved to undergo renal transplantation. The patient has now finished 6th month after transplantation and is currently under follow-up at our outpatient clinic, having no problems related to the transplant. While early treatment to prevent hypertension is mandatory in patients with congenital adrenal hyperplasia, once renal failure occurs, renal transplantation may the best choice of treatment. In this study, we describe the first report of a successful renal transplantation in an adrenal hyperplasia.

Background: We aimed here to investigate hydration status by echocardiography in end stage renal disease (ESRD) patients. Methods: 25 ESRD patients [15 males; mean age: 54.0 ± 16.6 years; 13 hemodialysis; 12 peritoneal dialysis] were considered eligible for this study. We also examined 29 healthy volunteers as a control group (17 males; mean age: 46.5 ± 12.8 years). Body composition analysis using the bioimpedance spectroscopy technique was performed for volume overload diagnosis. The ratio of extracellular water (ECW) to height was used as volume indices. The aortic elastic parameters were calculated by echocardiography. A correlation analyses was performed between the ratio of ECW to height indicating the volume overload and the aortic elastic parameters e.g. Aortic strain (AS), Aortic distensibility (AD) and Aortic stiffness index (ASI). Results: The ratio of ECW to height that indicates volume overload in ESRD patients was considerably higher than that in the control group (10.25 ± 1.98 L/m vs 8.66 ± 1.22 L/m, p=0.001). There was a negative correlation between the ratio of ECW to height and AS and AD and a positive correlation between the ratio of ECW to height and ASI. Conclusion: Given the importance of the diagnosis and follow up of volume overload, the results show that aortic elasticity measurements, being easy to perform and replicate, can be used for this purpose. © 2012 S. Karger AG, Basel.

Vitamin D is essential for the organism and it interacts with a lot of systems in mammalians. Vitamin D deficiency is common in the world. Many studies have shown that chronic vitamin D deficiency may have serious adverse consequences such as increased risk of hypertension, multiple sclerosis, rheumatoid arthritis, infections and malignancy, autoimmune diseases. New ones have been added on these adverse consequences nowadays. Vitamin D has got both stimulatory and antiproliferative effects on the immune system. This paradoxical effects of 1, 25-(OH)2D3 leads to discussions about the relationship between the immune systems and vitamin D. Inflammatory markers can be increased with other reasons in patients with vitamin D deficiency. Vitamin D deficiency may occur due to insufficient intake, hepatic disease, renal disease, loss of vitamin D binding protein etc. Many confounding factors will affect this relationship in both cases. Despite large-scaled studies found a positive relationship between vitamin D deficiency and some markers of inflammation but on the contrary many studies cannot find this relationship. The aim of this brief review is to discuss whether plasma 25 hydroxy vitamin D [25-(OH) D] level is associated with inflammatory markers in general population and in patients with chronic kidney disease. For this purpose, the old and new data related to the immune systems and vitamin D will be examined.

INTRODUCTION Encapsulated peritoneal sclerosis (EPS) is a devastating complication of peritoneal dialysis. We aimed to investigate the effects of mycophenolate mofetil (MMF) treatment in experimental EPS in rats. METHODS 40 nonuremic Wistar albino rats were divided equally into 4 groups: control rats received 2 ml isotonic saline intraperitoneally daily for 3 weeks without any other treatment. The chlorhexidine gluconate group received intraperitoneally 2 ml/200 g injection of chlorhexidine gluconate and ethanol dissolved in saline for 3 weeks. The resting group received chlorhexidine gluconate (0 - 3rd week) + peritoneal resting (4th - 6th week). The MMF group received chlorhexidine gluconate (0 - 3rd week) + 125 mg/l MMF in drinking water (4th - 6th week). Dialysate cytokine levels, leukocyte count, peritoneal thickness, inflammation and fibroblast activities were evaluated. RESULTS Although the MMF and resting groups showed beneficial effects on ultrafiltration and D1/D0 glucose compared to the chlorhexidine gluconate group, only MMF treatment improved dialysate TGFβ1, VEGF and MCP-1 levels compared to the resting group. Inflammatory activity and vascularity observed in a tissue biopsy, including capillaries number per mm2 of submesothelial area, decreased in the treatment group. CONCLUSIONS MMF treatment has beneficial effects on EPS via inhibiting inflammation and neovascularisation by reducing dialysate VEGF overexpression.

A practical, inexpensive, and reliable method is needed for the assessment of volume status in peritoneal dialysis (PD) patients. In the present study, we investigated the efficiency of bioimpedance spectroscopy (BIS) for detection of hypervolemia. The study enrolled 79 prevalent PD patients (mean age: 47 +/- 14 years; PD duration: 30 +/- 17 months; 55% men; 19% with diabetes) from a single center. Echocardiography and body composition analysis using the BIS technique [50 frequencies (Body Composition Monitor: Fresenius Medical Care, Bad Homburg, Germany)] were performed. Overhydration (OH) and extracellular water (ECW) in liters and OH/ECW ratio were used as volume indices. The mean left ventricular (LV) mass index was 117 +/- 37 g/m2, and 46% of patients had LV hypertrophy (LVH). Mean OH and OH/ECW ratio were 1.3 +/- 1.7 L and 7.6% +/- 9.3% respectively The OH/ ECW ratio correlated with LV mass index (r = 0.237, p0.036) and with left atrium index (r = 0.354, p0.001). Compared with patients not having LVH, patients with LVH had higher OH values (1.79 +/- 1.82 L vs 0.93 +/- 1.62 L, p = 0.003). In linear regression analysis, the OH/ECW ratio was an independent risk factor for LVH (t = 2.558, p = 0.01). In PD patients, BIS is a reliable method for evaluating volume status. The OH/ECW measured by BIS is a major determinant of LV mass. Control of hypervolemia and blood pressure is associated with better cardiac condition.

Introduction Arterial stiffness is a risk marker for cardiovascular events. In this study we aimed to compare the effect on calcineurin inhibitors (CNI) and mammalian Target of Rapamycine inhibitors (mTORi) on arterial stiffness in renal transplant patients. Patients and methods 81 renal transplant patients under CNI-based or mTORi-based protocol for at least 6 months were included in the study. Arterial stiffness was measured by using the SphygmoCor device (AtCor Medical, Sydney, Australia). Vitamin K-dependent, calcification inhibitor matrix Gla protein (MGP) concentrations were quantified by ELISA methods (Biomedica, Vienna, Austria). Results 34 patients were on mTORi-based and 47 on CNI-based immunosuppression. Mean age was 37.9 ± 10.8 (18 - 71) years and 45% were female. Age, gender, graft functions and follow-up period of the groups were similar. Augmentation index was 15.2 ± 12.6% in CNI and 18.8 ± 14.0% in mTORi groups (p > 0.05). There was no difference regarding carotid-femoral pulse wave velocity between groups. Arterial stiffness was positively correlated with age, total cholesterol, LDL cholesterol, mean arterial pressure (MAP) and proteinuria. MGP levels were higher in the mTORi group but were not predictors for carotid-femoral pulse wave velocity. Conclusion Rather than specific immunosuppressive drug effects, conventional risk factors, blood pressure and proteinuria are the most important predictors for arterial stiffness in renal transplant patients.

Encapsulated peritoneal sclerosis is characterized by neoangiogenesis and fibrosis. Octreotide, a somatostatin analogue is a well-known antifibrotic, antiproliferative and anti-angiogenic agent. The aim of the study is to evaluate the effects of octreotide in encapsulated peritoneal sclerosis-induced neoangiogenesis and fibrosis and compare the results with resting.Non-uraemic Wistar-Albino male rats (n = 35) were divided into four groups. Group I, control rats, received 2 mL isotonic saline i.p. daily for 3 weeks. Group II, received daily i.p. 2 mL/200 g injection of chlorhexidine gluconate (0.1%) and ethanol (%15) dissolved in saline for 3 weeks. Group III, chlorhexidine gluconate for 3 weeks plus an additional 3 weeks without any treatment (rest), to a total of 6 weeks. Group IV, chlorhexidine gluconate for 3 weeks plus an additional 3 weeks octreotide, 50 mcg/kg bodyweight s.c., for a total of 6 weeks.Octreotide significantly reversed ultrafiltration capacity of peritoneum with decreasing inflammation, neoangiogenesis and fibrosis compared to the resting group. Octreotide also caused inhibition of dialysate transforming growth factor-β1, vascular endothelial growth factor and monocyte chemotactic protein-1 activity and improved mesothelial cell cytokeratin expression. Peritoneal resting has no beneficial effects on peritoneum.In conclusion, octreotide may have a therapeutic value in peritoneal dialysis patients who suffer from encapsulated peritoneal sclerosis.

Clinical question or problem Summary statement of why this case is noteworthy. What is the Educational Message? Can be done away with altogether if the Abstract is satisfactory

Bioimpedance spectroscopy (BIS) is used to assess volume status in peritoneal dialysis (PD) patients. However, it is proposed that it may be troubling in patients with abnormal fluid distribution and body geometry. It is not clear whether having an empty abdomen or not interferes with the BIS results and its relation with echocardiographic findings in PD patients.Twenty-five prevalent PD patients were enrolled. Echocardiography and body composition analysis using BIS technique (50 frequencies, the Body Composition Monitor, BCM) were performed. Overhydration (OH), extracellular water (ECW) in liters and OH/ECW ratio were used as volume status indices. Differences in volume and echocardiographic findings, in patients with empty and with full abdomen, and their correlations with echocardiographic parameters were investigated.Mean age and PD duration were 61 ± 2.5 years and 42 ± 33 months, respectively. Sixty-four percent were male and 24% were diabetic. Mean left ventricular mass index (LVMi) was 131 ± 43 g/m (,) (2) mean left atrium diameter (LA) was 4.1 ± 0.1 cm, mean left ventricular ejection fraction (EF) was 64 ± 10%. Mean OH in patients with full abdomen were 1.67 ± 1.51 L and 1.68 ± 1.48 L, depending on the inclusion or exclusion of the dialysate volume, respectively. In patients with an empty abdomen, mean OHs were 2.12 ± 1.76 L and 1.91 ± 1.56 L, depending on the inclusion or exclusion of the dialysate volume. BIS measurements with an empty, but not with a full abdomen, was related to the echocardiographic parameters.BIS is a reliable method to evaluate volume status in PD patients. BIS performed after peritoneal equilibration test with an empty abdomen, better reflects overhydration and is related to echocardiographic parameters.

WOS: 000297673000008, PubMed ID: 21737961, Aim: Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins. Its activity decreases in dialysis patients but is restored after transplantation. Whether it affects arterial stiffness is unclear. In this study we aimed to investigate the effects of PON 1 on arterial stiffness in renal transplant patients. Methods: Seventy renal transplant recipients were enrolled. Arterial stiffness was measured using a Syphmocor device. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. Results: Mean age was 39.0 +/- 9.6 years and 5.7% of the patients were diabetic. Post-transplant follow-up time was 46.7 +/- 37.9 months. Eighty-five percent received anti-hypertensive and 12.9% anti-hyperlipidemic medication. Mean PON1 activity was 75.9 +/- 52.4 U/L. PON1 activity was negatively correlated with systolic and diastolic blood pressure, mean arterial pressure, LDL-cholesterol and carotid-femoral pulse wave velocity (cf-PWV). Mean c-f PWV was 8.10 +/- 1.39 m/s. Cf-PWV was positively correlated with age, systolic and diastolic blood pressure, mean arterial pressure, proteinuria and negatively correlated with PON1, PON1/HDL ratio and creatinine clearance. In linear regression analysis, PON1 was a predictor of cf-PWV in a model that included age, gender, diabetes, mean arterial pressure, urine protein level, creatinine clearance and PON 1. Conclusions: Reduced PON1 activity is significantly associated with increased arterial stiffness. The results of this study show the possible role of PON1 for arterial stiffening in renal transplant recipients.

The analysis of body composition gained much more interest with the use of non-invasive practical method of bioimpedance. This technique uses electrical properties of materials like body cells. Cel...

Nephrotoxic potential of mammalian target of rapamycin inhibitors (mTORi) is different from calcineurin inhibitors (CNI). The aim of this study is to investigate the interstitial fibrosis (ci) and tubular atrophy (ct) progression from the baseline to first year under a mTORi-based, CNI-free regimen.Thirty-five kidney transplant recipients who had to have adequate baseline and first year protocol biopsy were enrolled. Exclusion criteria were: the replacement of CNI at any time; acute deterioration in allograft functions; and serum creatinine level above 3 mg/dL at 12 months. Banff criteria were used for histopathological classification. Progression was defined as delta ci + ct ≥ 2 (difference between 12th month and baseline).Mean age of patients and donors were 34 ± 11 and 49 ± 10 years. Twelve patients had delayed graft function (DGF). The maintenance regimen consisted of sirolimus (n = 24) and everolimus (n = 11) with mycophenolate mofetil and steroids. Incidence of acute rejection was 25.7%. At baseline, the incidence of nil and mild fibrosis were 80% and 20%, respectively. At 12 months, 17.1% of patients had moderate, 40% had mild and 42.9% had nil fibrosis. Histological progression from baseline to first year was present in 34% of patients. In multivariate analysis the presence of DGF (P = 0.018) and deceased donor type (P = 0.011) were the most important predictors for fibrosis progression.Progression of graft fibrosis may be seen in one-third of patients under a mTORi-based regimen particularly manifested in deceased donor recipients with subsequent DGF.

WOS: 000284018500017, PubMed ID: 20651153, Background and objectives: Low serum testosterone levels in hemodialysis (HD) patients have recently been associated with cardiovascular risk factors and increased mortality. To confirm this observation, we investigated the predictive role of serum total testosterone levels on mortality in a large group of male HD patients from Turkey. Design, settings, participants, & measurements: A total of 420 prevalent male HD patients were sampled in March 2005 and followed up for all-cause mortality. Serum total testosterone levels were measured by ELISA at baseline and studied in relation to mortality and cardiovascular risk profile. Results: Mean testosterone level was 8.69 +/- 4.10 (0.17 to 27.40) nmol/L. A large proportion of patients (66%) had testosterone deficiency (10.1 nmol/L; 64 versus 81%; P = 0.004). A 1-nmol/L increase in serum testosterone level was associated with a 7% decrease in overall mortality (hazard ratio 0.93; 95% confidence interval 0.89 to 0.98; P = 0.01); however, this association was dependent on age and other risk factors in adjusted Cox regression analyses. Conclusions: Testosterone deficiency is common in male HD patients. Although testosterone levels, per se, predicted mortality in this population, this association was largely dependent on age. Clin J Am Soc Nephrol 5: 2018-2023, 2010. doi: 10.2215/CJN.03600410, Loo and Hans Osterman's Foundation; Swedish Kidney Association; Karolinska Institute's Centre for Gender MedicineKarolinska Institutet; Fresenius Medical Care, Istanbul, Turkey, J.J.C. obtained support from the Loo and Hans Osterman's Foundation, the Swedish Kidney Association, and the Karolinska Institute's Centre for Gender Medicine.; We thank all staff of the participating hemodialysis centers for their help and support.; This study was supported by Fresenius Medical Care, Istanbul, Turkey, with an unrestricted grant. EO., T.A., and M.S.S. are members of the scientific advisory board of Fresenius Medical Care, Turkey.

Long-term use of the peritoneum as a dialysis membrane results in progressive irreversible dysfunction, described as peritoneal fibrosis. Oxidative stress during peritoneal dialysis has been established in many studies. Generation of reactive oxygen species (ROS) by conventional peritoneal dialysis solutions, regardless of whether produced by high glucose, angiotensin II, or glucose degradation products may be responsible for progressive membrane dysfunction. The well-known antioxidant molecule N-acetylcysteine (NAC) is capable of direct scavenging of ROS. The aim of the present study was to investigate the effect of NAC therapy on both progression and regression of encapsulating peritoneal sclerosis (EPS). We divided 49 nonuremic Wistar albino rats into four groups: Control group—2 mL isotonic saline intraperitoneally (IP) daily for 3 weeks; CG group—2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for a total of 3 weeks; Resting group—CG (weeks 1 – 3), plus peritoneal resting (weeks 4 – 6); NAC-R group—CG (weeks 1 – 3), plus 2 g/L NAC (weeks 4 – 6). At the end of the experiment, all rats underwent a 1-hour peritoneal equilibration test with 25 mL 3.86% PD solution. Dialysate-to-plasma ratio (D/P) urea, dialysate white blood cell count (per cubic milliliter), ultrafiltration (UF) volume, and morphology changes of parietal peritoneum were examined. The CG group progressed to encapsulating peritoneal sclerosis, characterized by loss of UF, increased peritoneal thickness, inflammation, and ultimately, development of fibrosis. Resting produced advantages only in dialysate cell count; with regard to vascularity and dialysate cell count, NAC was more effective than was peritoneal rest. Interestingly, we observed no beneficial effects of NAC on fibrosis. That finding may be a result of our experimental severe peritoneal injury model. However, decreased inflammation and vascularity with NAC therapy were promising results in regard to membrane protection.