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bjective: Heart failure is a progressive and fatal disease even with appropriate treatment. Hypervolemia is a major cause of mortality and hospital admissions in these patients. Peritoneal dialysis has been successfully used for volume control in congestive heart failure patients with diuretic resistance in recent years. The present study aims to assess the effects of peritoneal dialysis on refractory heart failure. Methods: The 2-year follow-up data of 12 heart failure patients with reduced ejection fraction who had undergone peritoneal dialysis at our center between 2014 and 2019 were retrospectively analyzed in 3-month periods. The effects of peritoneal dialysis on functional status, echocardiography, physical and biochemical parameters, hospital admission, and mortality rates were assessed. Results: Functional capacity improved significantly (P = .005). When the sixth month was reached, no patient remained in the New York Heart Association class 4. A significant improvement was observed in mean arterial pressure (75.3 ± 17 vs. 91.3 ± 16.6; P = .005). There was an improvement in congestive symptoms (dyspnea, pleural effusion, and pretibial edema; P = .037; P = .0002; P = .005, respectively). Although statistical significance could not be reached, ejection fraction on echocardiography was found to increase (28.7% ± 12% vs. 37% ± 12%; P = .113). Despite statistical significance was not reached, there was a trend for an increase in hematocrit, serum albumin, and sodium levels and a decrease in uric acid level. The 1-year and 2-year mortality rates were 41.7% and 58.3%, respectively. Conclusion: In heart failure patients with reduced ejection fraction with diuretic resistance, peritoneal dialysis improves congestive symptoms, improves functional capacity, and offers a treatment option in addition to pharmacological therapy.

Objectives: There is limited data about coronavirus disease-19 (COVID-19) characteristics and results in peritoneal dialysis (PD) patients. This study aimed to investigate the characteristics and outcomes among PD patients and compare them with matched hemodialysis (HD) patients and a control group without kidney disease. Methods: We included 18 PD patients and consecutive age- and gender-matched 18 HD and 18 patients without kidney disease (control group) registered into the Turkish Society of Nephrology database including 1301 COVID-19 patients. We compared demographic, clinical, radiological, laboratory data, and outcomes namely intensive care unit (ICU) admission, mechanical ventilation, mortality, and composite outcome (death and/or ICU admission). Results: ICU admission, mechanical ventilation, and mortality rates in PD patients (27.8%, 22.2%, and 22.2%, respectively) and the HD group (16.7%, 11.1%, and 16.7%, respectively) were higher than the control group (11.1%, 11.1%, and 5.6%, respectively), but intergroup comparison did not reveal difference. A total of 11 (20.3%) patients had composite outcome (6 PD patients, 3 HD patients, and 2 patients in the control group). In Cox regression analysis, higher age and higher CRP level were related to increased risk of composite outcome. Adjusted rate of composite outcome in PD group was significantly higher than the control group (P =.050). This rate was similar in HD and control groups (P =.30). Conclusions: Combined in-hospital mortality and/or ICU admission of PD patients with COVID-19 was significantly higher than the control patients. There is a need for careful surveillance of PD patients for infection signs and prompt treatment of COVID-19.

Objective: Encapsulating peritoneal sclerosis (EPS) is a rare, but potentially fatal complication of peritoneal dialysis. Currently, treatment of peritoneal fibrosis is not fully possible yet. In this study, we aimed to demonstrate the effects of tacrolimus therapy on peritoneal fibrosis and inflammation when administered alone or with mycophenolate mofetil (MMF) in the EPS model induced in rats. Methods: Thirty six Wistar albino rats were separated into six equal groups. Group I was the control group. Group II-VI were administered intraperitoneal chlorhexidine (CH) for induced EPS model in rats. Group II, IV, V, VI were administered isotonic liquid, tacrolimus, tacrolimus and concurrently with CH, tacrolimus and MMF together, respectively. Group III was not administered any drug. All peritoneal samples were stained immunohistochemically with matrix metalloproteinase-2 (MMP-2) antibody. Thickness of peritoneal fibrosis, subserosal large collagen fibers, subserosal fibroblast proliferation and subserosal fibrotic matrix deposition were evaluated. Results: Comparing the experimentally induced EPS groups, the best histopathological results and the largest staining with MMP-2 were achieved in Group VI. Furthermore, in all treatment groups (IV, V, VI) more staining with MMP-2 was detected compared to non-treatment groups (I, II, III) but no statistically significant differences were found among all groups. A statistically significant remission was observed in all histopathological parameters, primarily peritoneal thickness in rats that were administered MMF with tacrolimus, compared to rats which were administered tacrolimus only. Conclusion: Concurrent use of tacrolimus and MMF in the treatment of EPS may be a promising approach. RESUMEN Objetivos: La esclerosis peritoneal encapsulante (EPE) es una complicación rara, peropotencialmente fatal de la diálisis peritoneal. Actualmente, el tratamiento de la fibrosis peritoneal aún no es posible. En este estudio, apuntamos a demostrar los efectos de la terapia con tacrolimus en la fibrosis peritoneal y la inflamación cuando se administran solos o con micofenolato de mofetilo (MMF) en el modelo EPE inducido en ratas. Métodos: Treinta y seis ratas Wistar albinas se separaron en seis grupos iguales. El Grupo I era el grupo de control. En los grupos II-VI se administró clorhexidina intraperitoneal (CH) para el modelo EPE inducido en ratas. En los Grupos II, IV, V, VI se administró respectivamente líquido isotónico, tacrolimus, tacrolimus y CH y finalmente tacrolimus y MMF juntos. El grupo III no recibió ningún medicamento. Todas las muestras peritoneales se tiñeron inmunohistoquímicamente con el anticuerpo Matrix Metaloproteinasa-2 (MMP- 2). Se evaluó el grosor de la fibrosis peritoneal, se evaluaron las fibras de colágeno grandes subserosas, la proliferación de fibroblastos subserosa y la deposición de la matriz fibrótica subserosa. Resultados: Comparando los grupos de EPE inducidos experimentalmente, los mejores resultados histopatológicos y la tinción con MMP- 2 más extensa se lograron en el Grupo VI. Además, en todos los grupos de tratamiento (IV, V, VI) se detectó más tinción con MMP-2 en comparación con los grupos de no tratamiento (I, II, III), pero no se encontraron diferencias estadísticamente significativas entre todos los grupos. Se observó una remisión estadísticamente significativa en todos los parámetros histopatológicos, principalmente el espesor peritoneal en ratas que recibieron MMF con tacrolimus, en comparación con las ratas que recibieron solo tacrolimus. Conclusión: El uso concurrente de tacrolimus y MMF en el tratamiento de EPS puede ser una aplicación prometedora.

© 2014 International Society for Hemodialysis.Primary failure, early thrombosis, and inadequate maturation are the main complications encountered in arteriovenous fistulas. Doppler ultrasonographic assessment of flow-mediated dilatation (FMD) is currently used for the early diagnosis of atherosclerosis. Clinical experience in the use of FMD for preoperative assessment of vasculature is rather limited; therefore, we sought to elucidate the relationship between preoperative FMD and primary failure of the fistula. Thirty-three patients with end-stage renal disease who were admitted to our hospital between January and July 2005 were included in our study. Medical histories were established and the internal diameter, wall thickness, peak systolic flow rate, and resistive index (RI) were measured in the cephalic vein and radial and brachial arteries. Flow-mediated dilatation and nitrate-mediated dilatation (NMD) of the brachial artery were assessed. Fistulas were evaluated 48 hours and 30 days postoperatively. Brachial arterial internal diameter was lower in all fistulas that developed primary failure in 48 hours (0.4±0.07cm vs. 0.35±0.07cm, P=0.016). The radial artery RI was found to be significantly elevated in fistulas with both early (48-hour) and late-term (30-day) failure (0.9±0.08 vs. 0.68±0.3, P=0.01, and 0.86±0.8 vs. 0.67±0.3, P=0.038, respectively). The brachial artery peak systolic flow rate was significantly reduced in patients in the radiocephalic fistula group that developed early and late-term failure (42.9±12cm/sec vs. 68.4±10cm/sec, P=0.01, and 44.1±13cm/sec vs. 57.7±16cm/sec, P=0.038, respectively). Our study, constrained by a smaller, older patient group, was unable to show a statistically significant correlation between FMD, NMD, and fistula success. Any single parameter may not be sufficient to assess vascular health preoperatively. A multifactorial approach incorporating parameters evaluating arterial and venous function might be more effective in predicting fistula success. Further studies on larger patient groups may indeed demonstrate the value of these assessments.

Objective: Rhabdomyolysis is an important etiology for developing acute kidney injury (AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to be a lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the form of severe and widespread pain, tenderness, weakness in the muscles and dark urine. It is characterized by the disruption of cell integrity in myocytes as a result of widespread damage to skeletal muscles and the passage of intracellular components into the circulation. Case Presentation: Here we presented a case report of a young man who had rhabdomyolysis induced by electrical injury which is relatively less common among the other etiological factors with preserved renal functions. He had electrical injury related wounds on extremities. Urgent intravenous fluid therapy was initiated as soon as his admission to the emergency department (ED), without delay. Conclusion: AKI is very common due to the nephrotoxic effect of myoglobinuria and the prerenal status. It is rare that AKI does not develop in patients with a severe increase in creatinine kinase. It is a very important point to start effective fluid therapy in a short time.

Резюме. Потоко-опосередкована вазодилатація (ПОВ) є корисним, неінвазивним інструментом для виявлення ендотеліальної дисфункції у пацієнтів з атеросклеротичними серцево-судинними захворюваннями, які є основною причиною смертності хворих на хронічну хворобу нирок. Лігандна система Fas/Fas апоптозу, яка виникає в результаті активації каспазного каскаду, сприяє патофізіології атеросклерозу. Ця «апоптотична» система відіграє центральну роль в імунному гомеостазі. Ендотеліальні клітини судин і прозапальні клітини є основними ресурсами Fas-ліганду. У цьому дослідженні ми мали на меті дослідити роль розчинного ліганду Fas (sFasL) як маркера ПОВ у пацієнтів, які лікуються методом перитонеального діалізу (ПД). Методи. До цього перехресного обсерваційного дослідження було включено 43 ПД пацієнти 40 умовно-здорових донорів. Досліджувались демографічні дані, антропометричні вимірювання та клінічні обстеження. Функцію ендотелію оцінювали за допомогою ПОВ плечової артерії та УЗД високої роздільної здатності. Концентрації sFasL у сироватці крові вимірювали за допомогою набору для імуноферментного аналізу. Результати. Включені до дослідження учасники були розділені на 2 групи: ПД пацієнти, які лікувались ПД щонайменше 12 тижнів (група 1; середній вік 41±14 років, M/F: 22/21) та 40 здорових осіб контролю (група 2; середній вік) 50±12 років, М/Ж: 19/20). Рівні ПОВ передпліччя та концентрації sFasL у сироватці крові були значно нижчими у ПД пацієнтів порівняно з контролем (3,95±2,01 проти 8,83 ± 6,17; p

Background and aim: Uric acid elevation has been shown to be an important risk factor for cardiovascular and cerebrobascular disease. QT dispersion (QTd) is a parameter that shows the heterogeneity of ventricular repolarization and can be calculated noninvasively from surface electrocardiography. Increased QTd has been associated with severe arrhythmia and risk of sudden death in many patients and disease groups. In this context, we aimed to investigate the effect of uric acid levels on QTd and the effects of decrease in uric acid levels on QTd. Methods: A total of 225 patients with normal renal function were included in the study; 133 of these patients were hyperuricemic (>7 mg/dL), and the remaining 72 patients were normouricemic (Group 1). The hyperuricemic patients were randomly divided into 2 groups, one group (n = 67) was given placebo (Group 2) for 4 months, and the remaining 66 patients were given allopurinol 300 mg/day (Group 3). Results: Hyperuricemic patients had higher hsCRP and QTd and lower eGFR values compared to the normouricemic control group. After 4 months of treatment, 66 patients treated with allopurinol showed a significant decrease in serum uric acid, systolic and diastolic blood pressure, and hsCRP levels, and a significant increase in eGFR. Although the QTd values in the treatment group did not decrease to the same levels as in the normouricemic control group, a statistically significant decrease was found compared to their baseline values. In hyperuricemic control and normouricemic control patients, there were no differences in the levels of uric acid, hsCRP, eGFR, systolic and diastolic blood pressure, and QTd values compared to baseline values. Conclusions: There was a significant association between elevated serum uric acid and QTd, as well as with inflammatory biomarkers. Also, patients who had received hypouricemic therapy during the follow-up period presented a significant decrease in inflammatory markers as well as QTd. This indicates the beneficial effects of decreasing uric acid levels in decreasing the risk for future major adverse events related to ventricular arrhythmias.