Search

Context The paucity of data on microvascular complications in patients with posttransplant diabetes (PTDM) is an obstacle to developing follow-up algorithms. Objective To evaluate diabetic microvascular complications in patients with long-standing PTDM. Methods In patients with ≥5-year history of PTDM and age-matched renal transplant recipients without PTDM (NDM), diabetic peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument, the CASE IV device, and in vivo corneal confocal microscopy (CCM). Cardiac autonomic neuropathy tests were performed using heart rate variability. Nephropathy screening was assessed using spot urine albumin/creatinine ratio and eGFR calculation. Diabetic retinopathy was evaluated by fundus examination and photography, and optical coherence tomography. Results This study included 41 patients with PTDM and 45 NDM patients. The median follow-up was 107.5 months in the PTDM group. Peripheral neuropathy was significantly higher in the PTDM group than in the NDM group (P =.02). In the PTDM patients with peripheral neuropathy, corneal nerve fiber density examined by CCM was significantly lower than in PTDM patients without neuropathy (P =.001). Parasympathetic involvement was observed in 58.5% of the PTDM group and 22% of the NDM group (P =.001). Sympathetic involvement was present in 65.9% of the PTDM group and 29.3% of the NDM group (P =.001). Retinopathy was observed in 19.5% of patients in the PTDM group and in none of the NDM patients (P <.001). Renal functions were similar between the study groups. Conclusion Cardiac autonomic neuropathy and diabetic retinopathy can affect patients with PTDM at a high rate. Diabetic retinopathy is a threat to the vision of PTDM patients. Diabetic peripheral neuropathy can be detected early in PTDM patients by CCM. [ABSTRACT FROM AUTHOR]

Introduction: Patients on hemodialysis, especially with diabetes, face elevated cardiovascular events. A major contributor to complications associated with diabetes is advanced glycation end products (AGEs). Removing these compounds is challenging in traditional hemodialysis. Medium‐cut‐off (MCO) membranes potentially remove toxins without significant albumin loss. This study explored how MCO membranes impact AGEs levels in uncontrolled diabetic patients undergoing hemodialysis. Methods: Sixteen patients received MCO membrane dialysis, while others used high‐flux (HF) membranes. After 12 sessions, the dialyzers were switched, totaling 24 sessions. Blood samples at trial initiation (T0), session 12 (T1) and session 24 (T2) tested for CML, Pentosidine, laboratory parameters. Results: Switching dialyzers showed increased albumin with MCO‐to‐HF and decreased with HF‐to‐MCO, albeit nonsignificant (p = 0.5/p = 0.1). Patients on MCO had lower albumin levels than HF (p = 0.03/p = 0.6, respectively). Hemodialysis with MCO demonstrated lower levels of CML/Pentosidine compared to HF (p = 0.09/p = 0.9 for CML; p = 0.04/p = 0.3 for Pentosidine). Transitioning to HF led to elevated levels (p = 0.4/p = 0.09 for CML; p = 0.3/p = 0.07 for Pentosidine). Conclusion: MCO dialysis in diabetic individuals notably reduces AGE levels. [ABSTRACT FROM AUTHOR]

Background: Changed body composition with increased fat content and decreased muscle mass is seen in renal transplantation recipients (RTRs). Increased fat mass might mask underlying muscle mass loss; measuring low body mass index and weight reduction alone may not be sensitive enough to diagnose malnutrition in RTRs. We aimed to determine the prevalence of malnutrition in stable RTRs using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess the use of muscle ultrasonography (US) to compare the performance of various muscle US measurements in the diagnosis of reduced muscle mass. Methods: Ninety‐one patients who had renal transplantation >6 months ago were enrolled in the study. GLIM criteria were performed for all patients, but not those at risk of malnutrition. Bioelectrical impedance analysis and muscle US were performed to identify reduced muscle mass. Results: The prevalence of malnutrition according to GLIM criteria was 25.3% (n = 23). All muscle US measurements were lower in the malnourished group than the well‐nourished group; however, the malnourished group had substantially lower muscle thicknesses in abdominal muscles, specifically the external oblique (EO) and internal oblique (IO) muscles, than the well‐nourished group (P = 0.001 and P = 0.007, respectively). There was a significant association between malnutrition and EO (odds ratio [OR] = 0.338, 95% CI = 0.163–0.699; P = 0.003) and IO (OR = 0.620, 95% CI = 0.427–0.900; P = 0.012) regardless of age and sex. Conclusion: One in four RTRs experience malnutrition. Muscle US could be used effectively for the diagnosis of reduced muscle mass and malnutrition in RTRs according to GLIM criteria. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to assess the degree of adherence to immunosuppressive medications and to identify the factors related to adherence in kidney transplant patients. Methods: A prospective, descriptive study was performed in a nephrology outpatient clinic between November 2017 and February 2018. All kidneytransplant patients had a face-to-face interview with a clinical pharmacist. The data on patients’ demographics and blood drug concentrations were recorded and the Immunosuppressive Therapy Adherence Scale was administered at the clinic. The factors that may affect medication adherence were evaluated among the groups of adherent and non-adherent patients. Results: The study included 100 kidney transplant patients. With regard to immunosuppressive medication, 67, 26, and 7 patients were using tacrolimus, cyclosporine, and everolimus, respectively. Only 32 patients had an Immunosuppressive Therapy Adherence Scale score of 12 (known as adherent). Blood drug concentrations of tacrolimus were found to be significantly different between adherent and non-adherent patient groups (P = 0.005). Except with body mass index (P = .019) and post-transplantation period (P = .041) no statistical association was found between the rest of the factors and adherence. The most common problem with drug usage was inappropriate time of drug administration (64.0%). Conclusion: A significant proportion (68%) of kidney transplant patients were non-adherent to immunosuppressive medication. Adherence to immunosuppressive medication can be influenced by patient-related factors such as body mass index and post-transplantation time. Therefore, healthcare professionals should be aware of the level of a patient’s adherence and factors affecting patient adherence level. A clinical pharmacist may play a critical role in identifying a patient’s level of adherence to maintain effective therapy. [ABSTRACT FROM AUTHOR]

Objective: Kidney biopsy may unusually show non-lupus nephritis (LN) causes in patients with systemic lupus erythematosus (SLE). This study aimed to reveal the causes of non-LN and to compare the clinical and laboratory features of LN and non-lupus renal disease in patients with SLE. Methods: Patients with SLE followed between 2014 and 2020 at Hacettepe University Hospitals and who had kidney biopsy were the subject of the study. One hundred thirty four patients' kidney biopsies were evaluated retrospectively and grouped as LN and non-LN. Clinical characteristics, laboratory values at the time of kidney biopsy, and renal outcome were recorded. Results: Of 134 (107 females, 27 males) patients, 116 (86.6%) were in the LN group, and 18 (13.4%) were in the non-LN group. The most common diagnosis was focal segmental glomerulosclerosis (n=6) in the non-LN group. The median (interquartile range) biopsy age of LN patients was young [21 (17.7) vs. 36.5 (17), p<0.001], and high titer antinuclear antibody positivity over 1/320 at SLE diagnosis was more frequent in this group (50.9% vs 22.2%, p=0.02). Non-renal SLE involvement was similar in both groups. Anti-dsDNA positivity, low C3-4, and presence of active urinary sediment were significantly higher in LN patients, while serum creatinine, albumin, and proteinuria were not different between the groups at the time of kidney biopsy. Additionally, median renal SLEDAI was more elevated in LN patients. Conclusion: Anti-dsDNA positivity, low C3-C4, active urinary sediment, and high renal SLEDAI scores may give us some clues regarding renal disease in patients with SLE. However, it should be kept in mind that these serological abnormalities may also occur in non-lupus renal disease. [ABSTRACT FROM AUTHOR]

Objective: The epidemiology of a bloodstream infection (BSI) in a renal transplant recipient (RTR) and the resistance profiles of the isolates provide important guidance for empirical treatment. Materials and Methods: The medical records of RTRs from a single university hospital during the period of January 2000 to January 2016 were retrospectively evaluated for the presence of a BSI. Blood culture and antibiotic susceptibility results were reviewed in addition to demographic and clinical data. The distribution of causative microorganisms and risk factors for mortality in RTRs with a BSI were analyzed. Results: In all, 74 BSIs and 76 distinct bacteria were observed in 56 (8%) of 702 RTRs. The mean age of the patients was 43±14 years; 55% were female, and 54% of the transplants were from living donors. Gram-negative bacteria, predominantly Enterobacteriaceae, were the most common (71%) pathogen. One-fifth of all BSIs occurred within the first month of transplantation. Among those that were Gram-positive, there were 5 coagulase-negative staphylococci and 8 Staphylococcus aureus BSIs. The rate of resistance to extended-spectrum β-lactamase, quinolone, and trimethoprim-sulfamethoxazole in Gram-negative enteric bacilli (GNEB) was 36%, 34%, and 50%, respectively. All of the GNEB were susceptible to carbapenems and amikacin. The overall mortality rate was 25%. The median length of time from the onset of BSI to death was 8 days (min–max: 2–46 days). The urinary tract was the primary source of infection in 53% of the patients. Delayed graft function significantly increased the mortality risk among RTR patients with a BSI. Conclusion: Gram-negative bacteria were the leading cause of BSIs and demonstrated high resistance rates, and the most common site of infection was the urinary tract. Awareness of local epidemiology and resistance profiles will enable tailored treatment strategies to manage a BSI in RTRs. [ABSTRACT FROM AUTHOR]

Objective: Sodium may accumulate in subcutaneous tissue without any osmotic (non-osmotic) effect. There are insufficient data on non-osmotic sodium mechanisms in hemodialysis patients. We aimed to investigate the relationship between serum vascular endothelial growth factor-C levels, interdialytic weight gain, and salt intake in hemodialysis patients. Methods: The study included 20 anuric hemodialysis patients (11/9; female/male) with stable interdialytic weight gain in the last 3 months. Pre- and post-dialysis sodium and vascular endothelial growth factor-C levels were studied in 2 consecutive hemodialysis sessions. Fluid body components were determined by body composition monitor. The formulas derived from serum sodium and body fluids were used to calculate the interdialytic salt intake. The determinants of serum vascular endothelial growth factor-C levels were analyzed. Results: Salt intake in the interdialytic period was 10.36 ± 5.16 g/day and interdialytic weight gain 3.4% (0.53-6.98). While no correlation was found between salt intake and vascular endothelial growth factor-C levels in the correlation analysis, a moderate correlation was found between interdialytic weight gain and pre-and post-dialysis vascular endothelial growth factor-C levels (r: 0.453; P = .045 and r: 0.454; P = .044, respectively). In the partial correlation analysis performed by controlling the salt intake effect, an increase in this correlation was detected (r: 0.489; P = .34 and r: .525; P = .018, respectively). There was no relationship between age, gender, hemodialysis vintage, and vascular endothelial growth factor-C levels. Conclusion: A moderate correlation was detected between interdialytic weight gain and serum vascular endothelial growth factor-C levels and it may be a clinical reflection of long-term volume and salt loading. However, more extensive studies are needed to clarify this relationship and determine the factors affecting serum vascular endothelial growth factorC levels in hemodialysis patients. [ABSTRACT FROM AUTHOR]