A Rare Reason for Severe Hypocalcemia Following Kidney Transplant: Denosumab Treatment.

Deviations of calcium, phosphate, parathyroid hormone, and vitamin D levels are the basis for the diagnosis of calcium-phosphate metabolism disorders. The plasma concentration of the biologically active form known as free calcium is regulated in a harmonious manner by its exchange in the bones and reabsorption by the kidneys. These steps take place under the control of parathyroid hormone and calcitriol. In the process of chronic kidney disease, the kidney cannot synthesize adequate calcitriol, and the resulting hypocalcemia and hyperphosphatemia cause the development of secondary hyperparathyroidism. Osteoporosis is a metabolic bone disease and is essentially the consequence of osteoclastogenesis-induced bone resorption that exceeds bone formation. Osteoporosis is common after kidney transplant. However, hypocalcemia following kidney transplant is rare. The hungry bone syndrome after parathyroidectomy is often responsible for this condition in the pretransplant period. Denosumab is a human monoclonal antibody developed against the receptor activator of nuclear factor kappa-B ligand (known as RANKL). Denosumab exerts an antiresorptive effect on bones by reducing differentiation into osteoclasts. It is an effective treatment option for osteoporosis in the general population. There is insufficient scientific data regarding the use of denosumab in kidney transplant patients. Here, we present the case of a kidney transplant recipient who developed severe hypocalcemia (serum calcium 4.7 mg/dL) after denosumab treatment for osteoporosis.

Effect of Gastrostomy Tube Feeding Education on Parents of Children with Gastrostomy.

BACKGROUND: Success in long-term enteral feeding is, in part, dependent on careful selection of the appropriate enteral access device and placement technique together with proper maintenance and care. This study was conducted to evaluate the effect of education on satisfaction with gastrostomy tube feeding, quality of life, caregiver burden, and anxiety. METHODS: A quasi-experimental, pretest and posttest research design without a control group was used. A total 78 mothers were included in the study. The child and parent data form, Zarit Caregiver Burden Scale, Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8), State-Trait Anxiety Inventory (STAI), 36-Item Short-Form quality-of-life scale (SF-36), complication control form, and the gastrostomy care skill assessment checklist were used. RESULTS: There was a significant decrease in participants' burden as caregivers (anxiety, P < .001) and a significant increase in positive outcomes in caregivers' satisfaction with gastrostomy feeding and in the physical component summary and mental component summary scores (P < .05). Posteducation, the mean score of subdimensions showed increases (P < .05). CONCLUSION: The intervention increased positive outcomes and decreased negative outcomes for caregivers during the first 3 months postgastrostomy placement.

Fragmented QRS as a predictor of subclinical cardiovascular disease in patients with chronic kidney disease.

BACKGROUND: Fragmented QRS (fQRS) on surface electrocardiogram is correlated with increased cardiovascular risk and mortality in normal population. AIMS: To investigate the presence of fQRS and its association with subclinical atherosclerosis and vascular calcification in chronic kidney disease (CKD) patients without cardiovascular disease. METHODS: A total of 129 CKD (63 males and 66 females) patients was enrolled for the study. Carotid intima-media thickness (CIMT) measurement and coronary artery calcification score (CACS) were performed by the same radiologist. A 12-lead electrocardiogram recording was used to detect fQRS. RESULTS: The mean age was 55.1 ± 15.1 years. fQRS was detected in 45% of patients. There was not any significant difference between patients with or without fQRS in terms of demographic parameters and comorbid diseases except for diabetes and hyperlipidaemia. The mean CIMT of CKD patients was 0.66 ± 0.18 mm and it was significantly higher in fQRS(+) group compared to the fQRS(-) group. Similarly CACS values were higher in fQRS(+) group. In the logistic regression analysis, fQRS remained significantly associated with CIMT (ß = 0.220, t = 2.567, P = 0.011) (independent variables: CIMT, CACS, sodium and glomerular filtration rate (modification of diet in renal disease-glomerular filtration rate)). CONCLUSIONS: This is the first study in the literature showing the relation of fQRS with CIMT and CACS in patients with CKD without known cardiovascular disease.