The positive effects of preoperative chlorhexidine rinse to reduce postoperative pneumonia after kidney transplantation surgery.

BACKGROUND: Postoperative pneumonia is one of the most observed hospital-acquired infections and increases the postoperative mortality rate. Further, it drives the healthcare systems under a severe financial burden. Preventing postoperative pneumonia is an incredibly challenging issue for clinicians. Since immunosuppression therapy, the patients who had kidney transplants are more vulnerable to postoperative infections. There is no data in the scientific literature focusing on the effects of preoperative oral care with chlorhexidine antiseptic solutions on postoperative pneumonia in kidney transplantation surgery cases. In the present research, we studied this topic. METHODS: A prospective, randomized clinical trial was conducted at our institution between August 2020 and August 2022. Group A: Received 0.12 % chlorhexidine oral rinse preoperatively; Group B: Not received 0.12 % chlorhexidine oral rinse preoperatively. We analyzed the differences between the two trial groups using a chi-square or t-test. The Mann-Whitney U test was used for the categorical data. RESULTS: Nine patients (17.6 %) were diagnosed with postoperative pneumonia in Group A and fourteen (25.9 %) in Group B (p < 0.05). Hospitalization time of Group B was prolonged (p < 0.05). In multivariate analysis, significant risk factors associated with postoperative pneumonia were advanced age, diabetes mellitus, smoking, delayed graft function and not gargling with 0.12 % chlorhexidine (p < 0.05). CONCLUSIONS: To reduce postoperative pneumonia risk in patients undergoing kidney transplantation surgery, an oral health protocol including 0.12 % chlorhexidine mouth rinse seems beneficial.

The impact of hypertension on retinal nerve fiber layer thickness and its association with carotid intima media thickness.

OBJECTIVE: Our aim was to investigate retinal nerve fiber layer (RNFL) thickness in hypertensive patients using spectral-domain optical coherence tomography (SD-OCT) and to evaluate the relationship between RNFL thickness and carotid intima media thickness (CIMT). METHODS: This study included 59 patients with hypertension (HT) (53.6 ± 10.7 years) and 54 age-matched healthy controls (51.0 ± 8.1 years). We evaluated anthropometric and metabolic parameters as well as RNFL and CIMT measurements in patients with hypertension and controls. RESULTS: The average RNFL thickness was 86.60 ± 10.86 µm in hypertensive patients and 93.63 ± 7.30 µm in healthy controls (p < 0.001). Selective thinning of the RNFL was found in the superior and inferior quadrants. Mean CIMT values were higher in patients with HT (0.80 ± 0.15 mm) than the healthy subjects (0.71 ± 0.1 mm) (p < 0.001). The average, inferior and nasal RNFL thickness were negatively associated with diastolic blood pressure respectively (r = - 0.112, r = - 0.210, r = - 0.225). There was an inverse correlation between RNFL thickness in the average and superior retinal quadrant and CIMT (r = - 0.201, r = - 0.185). There were no correlations between RNFL thickness and age, body mass index, fasting plasma glucose, lipid parameters, high-sensitive C-reactive protein and microalbuminuria. CONCLUSION: RNFL thickness is reduced in hypertensive patients and may be associated with atherosclerosis.

Glycated hemoglobin predicts overall and cardiovascular mortality in non-diabetic hemodialysis patients.

AIMS: Besides diabetic patients, glycated hemoglobin (HbA1c) levels have been reported to predict mortality in non-diabetics patients. However, the importance of HbA1c levels in non-diabetic hemodialysis patients still remains unknown. Thus, we aimed to prospectively investigate the impact of HbA1c on all-cause and cardiovascular mortality in a large group of prevalent non-diabetic hemodialysis patients. METHODS: HbA1c was measured quarterly in 489 non-diabetic prevalent hemodialysis patients. Overall and cardiovascular mortality were evaluated over a 3 year follow-up. RESULTS: Mean HbA1c level was 4.88 ± 0.46% (3.5 - 6.9%). During the 28.3 ± 10.6 months follow-up period, 67 patients (13.7%) died; 31 from cardiovascular causes. In Kaplan-Meier analysis, patients in the lowest (< 4.69%) and highest HbA1c (> 5.04%) tertiles had poorer overall survival compared to the middle HbA1c tertile (p < 0.001). Adjusted Cox-regression analysis revealed that the highest HbA1c tertile was associated with both overall (HR = 3.60, 95% CI 1.57 - 8.27, p = 0.002) and cardiovascular (HR = 6.66, 95% CI 1.51 - 29.4; p = 0.01) mortality. Also, low HbA1c levels tended to be associated with overall mortality (HR = 2.26, 95% CI 0.96 - 5.29, p = 0.06). CONCLUSION: Upper normal HbA1c levels are independently associated with cardiovascular and overall mortality in non-diabetic hemodialysis patients, whereas lower HbA1c levels are not.

The impact of low serum sodium level on mortality depends on glycemic control.

BACKGROUND: Low serum sodium levels have been associated with mortality both in patients with and without chronic kidney disease. In this study, we investigated this association in relation to glycemic control in hemodialysis (HD) patients. MATERIALS AND METHODS: Between March and September 2005, 697 prevalent HD patients were enrolled in this prospective observational study and followed up for all-cause and cardiovascular mortality. The associations of serum sodium concentration with both overall and cardiovascular survival rates were studied. RESULTS: At baseline, mean predialysis serum sodium concentration was 138.4 ± 2.3 mEq/L (range: 130-145 mEq/L). Mild hyponatremia (< 135 mEq/L) was present in only 41 subjects (5.9%), and no patient had serum sodium level < 130 mEq/L. During 20.2 ± 6.2 months of follow-up, 119 patients (15.9%) died, 68 from CV causes. In adjusted Cox regression analysis, lowest sodium quartile was associated with 2.13-fold increased risk of overall mortality (95% confidence interval (CI) 1.14-3.98, P = 0.01, model chi-square 114.6, P < 0.001). As a continuous variable, each 1 mEq/L increase in predialysis sodium concentration was associated with a hazard ratio (HR) of 0.87 for overall mortality (95% CI 0.81-0.95, P = 0.002) and 0.86 for cardiovascular mortality (95% CI 0.78-0.96, P = 0.007). The predictivity of low serum sodium was prominent in diabetic subjects but not in nondiabetics. However, relationship between serum sodium and patient survival in diabetics was lost after adjustment for the HbA1c level: HR 0.91 (95% CI 0.78-1.05, P = 0.20). CONCLUSIONS: Low serum sodium concentration is associated with mortality only in those with diabetes. Furthermore, the impact of serum sodium on survival in these patients seems to be derived from poor glucose control.

Global Effects of SARS-CoV-2 Era on Kidney Transplantation Activities: Analysis of WHO Data.

BACKGROUND: Uncertainty raises questions in kidney transplant during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic regarding the recipient, the donor, and health care professionals. The pandemic not only has disrupted kidney transplanted patients but also has influenced transplant systems, donation chains, and timely and safe transplant surgeries. In the present study, we aimed to explore the global effects of the SARS-CoV-2 pandemic on kidney transplant. METHODS: We collected transplantation statistics and SARS-CoV-2 pandemic data from the World Health Organization website on June 15, 2021. Spearman correlation analysis was applied to assess the strength of a monotonic relationship among quantitative variables. We also demonstrated the clinical characteristics of our kidney recipients with SARS-CoV-2 infection. RESULTS: Comparison of the mean of global kidney transplantation statistics between 2010 and 2019 with 2020 statistics showed a significant decrease in kidney transplant from living donors (P < .001). From the beginning of the pandemic to June 15, 2021, 1 of the 43 kidney transplant patients we treated in our clinic died of SARS-CoV-2 infection after discharge. Two of the patients we transplanted and saw in follow-up before the pandemic died of SARS-CoV-2 infection. CONCLUSION: While the overall kidney transplant numbers have increased in the year to date, kidney transplants decreased drastically at the onset of the pandemic.

Allopurinol desensitization with A 2 weeks modified protocol in an elderly patients with multiple comorbidities: a case report.

BACKGROUND: Allopurinol is an effective urate-lowering drug that is well tolerated by the majority of patients. Patients with chronic renal insufficiency have an increased risk of hypersensitivity reactions with allopurinol. CASE PRESENTATION: 75 year old male patient with gout, renal insufficiency, history of metastatic colorectal carcinoma status post-resection was referred to Allergy clinic for a maculopapular eruption that developed 1 week after initiating therapy with allopurinol. The rash resolved with discontinuation of allopurinol. However, his serum urate level rose to 19.9 mg/dl. We initially proposed a slow 4 week oral allopurinol desensitization. The treating nephrologist felt it was critical to lower urate more rapidly. As a result, we modified the dose and standard 4 week protocol down to 2 weeks. A suspension of allopurinol was prepared by the allergy nurse practitioner with a 300 mg allopurinol tablet. The sensitization protocol was modified as a starting dose of 0.3 mg escalating to a final dose of 300 mg/day in 2 weeks. There was no reaction during or after the desensitization. The patient's urate level normalized (6.3 mg/dl) and has continued on 300 mg allopurinol daily without reaction. CONCLUSION: A 2 week modified allopurinol desensitization protocol is a safe alternative for elderly patients with multiple comorbidities.

The relationship between retinal nerve fiber layer thickness and carotid intima media thickness in patients with type 2 diabetes mellitus.

AIMS: The aim of the present study was to investigate retinal nerve fiber layer (RNFL) thickness in patients with type 2 diabetes mellitus (T2D) using spectral-domain optical coherence tomography and to evaluate the relationship between RNFL thickness and carotid intima media thickness (CIMT). METHODS: This study included 171 patients with T2D (53.2 ± 8.8 years) and age matched 61 healthy controls (51.9 ± 8.1 years). We evaluated anthropometric and metabolic parameters as well as RNFL and CIMT measurements in patients with T2D and controls. The Mann-Whitney U test was used to compare the continuous variables and the Chi-square test was used to compare categorical variables. Spearman's rank correlation test was used for calculation of associations between variables. RESULTS: The average RNFL thickness was 84.82 ± 11.22 µm in patients with T2D and 92.35 ± 8.45 µm in healthy controls (p<0.001). Mean CIMT values were higher in patients with T2D (0.80 ± 0.1mm) than the healthy subjects (0.72 ± 0.1mm) (p<0.001). A significant negative correlation was found between age and all quadrants of RNFL. There was a negative correlation between average RNFL thickness and HbA1c (r=-0.176), uric acid (r=-0.145), CIMT (r=-0.190) and presence of carotid plaque (r=-0.193). The superior RNFL thickness was negatively associated with HbA1c (r=-0.175), CIMT (r=-0.207) and carotid plaque (r=-0.176). There was also an inverse correlation between the inferior RNFL thickness and HbA1c (r=-0.187) and carotid plaque (r=-0.157). CONCLUSION: Thinning of RNFL might be associated with atherosclerosis in patients with T2D.

Effect of infliximab against cisplatin-induced nephrotoxicity.

OBJECTIVES: To investigate whether infliximab (Ib), an inhibitor of tumor necrosis factor alpha (TNF-α), prevents cisplatin (Cis)-induced nephrotoxicity. METHODS: The study was performed in the Department of Internal Medicine, Recep Tayyip Erdogan University, Rize, Turkey, between November 2012 and May 2013. Thirty male Wistar albino rats were divided into 3 groups, a control group, a Cis group, and a Cis+Ib group. The animals of the Cis group were injected with a single dose (7 mg/kg) of Cis intraperitoneally. The animals of the Cis+Ib group were injected with a single dose (7 mg/kg) of Ib 72 hours prior to Cis injection. RESULTS: The TNF-α, interleukin-1 beta (IL-1b), nitric oxide (NO) and adenosine deaminase (ADA) levels of the Cis group were higher than both the control group TNF-α (p<0.001), IL-1α (p<0.001), NO (p<0.001) and ADA (p<0.001), and the Cis+Ib group TNF-α (p<0.001), IL-1b (p<0.001), NO (p<0.001), and ADA (p=0.003). Histopathological examination revealed extensive damage in the Cis group, while the damage in the Cis+Ib group was lower. While the carbonic anhydrase II (CA-II) level of the Cis group was lower than both groups, it was similar in the Cis+Ib and the control groups. CONCLUSION: Infliximab acts against Cis-induced nephrotoxicity by a strong inhibition of TNF-α. Additionally, the combination of these 2 drugs does not obviously change the level of CA-II.

The relation between carotid intima media thickness and serum osteoprotegerin levels in nonalcoholic fatty liver disease.

AIM: This study was designed to evaluate carotid intima media thickness (CIMT) and serum osteoprotegerin (OPG) levels in nonalcoholic fatty liver disease (NAFLD) in comparison to healthy controls and to investigate factors predicting the CIMT increase. MATERIALS AND METHODS: A total of 60 outpatients [median (min-max) age 44.5 (24.0-65.0) years, 63.3% were females] diagnosed with NAFLD via ultrasonography performed during their admission to our hospital for any reason and 30 control subjects [median (min-max) age 39.5 (24.0-57.0) years, 73.3% were females] with normal liver echogenicity in ultrasonography were included in this study. Data on demographic characteristics, anthropometric measurements, biochemical and hematological tests, CIMT measurement, serum levels for OPG, and predictive factors for the CIMT increase were collected. RESULTS: Median (min-max) CIMT [0.60 (0.40-1.10) vs. 0.50 (0.30-0.60), P<0.001) and OPG (pg/mL) [65.0 (18.1-272.8) vs. 32.0 (10.1-82.3), P<0.001] levels were significantly higher in NAFLD patients compared to controls, while there was a significant positive correlation between CIMT and serum OPG (r=0.42, P<0.001). Mean CIMT value was determined to increase significantly by 0.001 cm (P=0.001) for each 1 pg/mL of increase in OPG levels, by 0.103 cm (P<0.001) in case of concomitant NAFLD (P<0.001), and by 0.006 cm (P<0.001) for each 1 pg/mL of increase in urea levels. CONCLUSION: Our findings indicate higher levels of serum OPG and CIMT in patients with NAFLD compared to controls along with a positive correlation between serum OPG and CIMT levels. High levels of serum OPG, presence of NAFLD, and high levels of serum urea seem to be the independent risk factors predictive for the CIMT increase.

Relation between serum estradiol levels and mortality in postmenopausal female hemodialysis patients.

BACKGROUND: Recently, low serum estradiol levels have been associated with increased cardiovascular risk and mortality in non-uremic patient populations. We investigated the predictive value of serum estradiol levels for mortality in female hemodialysis patients. METHODS: One hundred and forty-seven prevalent female hemodialysis patients were included in March 2005 and followed up for 32 ± 16 months. Serum estradiol levels were determined by ELISA at baseline and studied in relation to cardiovascular and overall mortality. RESULTS: Mean serum estradiol level was 28.6 ± 15.4 pg/ml (5.7-81.3). Patients in the higher estradiol tertile were likely to be more often diabetic and to have more cardiovascular diseases and higher body mass index (BMI). Serum estradiol was inversely correlated with age and urea reduction rate and positively correlated with postdialysis body weight, BMI and hs-CRP levels. During the follow-up period, 52 (35.6 %) patients died. Patients who died were older, had shorter dialysis vintage, were more likely to have a history of diabetes and cardiovascular disease, and lower serum creatinine, albumin, hemoglobin, and higher hs-CRP levels than those who survived. In Cox regression analysis, estradiol levels, in a bimodal (U-shaped) distribution, along with diabetes, low serum albumin and high hs-CRP levels, were predictors for overall mortality. CONCLUSIONS: A U-shaped association between serum estradiol levels and cardiovascular and overall mortality was found in postmenopausal hemodialysis patients.