Learning Curve for Temporary Hemodialysis Catheter Placement.

BACKGROUND: Training is essential for the safe and uncomplicated placement of hemodialysis catheters. This study explores the learning curve of this procedure. METHODS: In this prospective study, 60 patients who needed emergency hemodialysis without vascular access were included. All catheters were placed under ultrasound guidance. One nephrologist was included in each two groups, one to be consisted of a junior, and one to be consisted of a senior. Learning curves were created using the cumulative total methodology and receiver operating characteristic curve analyses. RESULTS: The patients' mean age was 67.92 ± 14.23 years. The mean catheter insertion time of the senior nephrologist was significantly shorter than that of the junior. According to cumulative total analysis, the junior group's maximum learning point overlaps with patient 22. When the confidence intervals of the study durations of both groups were examined, they overlapped in the 95% confidence interval starting from the 19th patient. When the mean catheter insertion time of the senior and the mean of the last 12 patients of the junior were compared, there was no significant difference between them (F = 15.827, P = .092). The receiver operating characteristic curve analysis showed a cutoff value of 320 seconds for the junior group compared with the senior group, indicating an overlap in case 22 for the junior nephrologist. CONCLUSION: This study suggests that 22 catheter insertions under the supervision of a senior nephrologist are needed to complete the learning curve for a junior nephrologist. If the number of nephrologists at the center is limited, safe catheter insertion may be allowed after 19 insertions.

The Longitudinal Evolution of Post-COVID-19 Outcomes Among Hemodialysis Patients in Turkey.

Introduction: Hemodialysis (HD) patients have increased risk for short-term adverse outcomes of COVID-19. However, complications and survival at the post-COVID-19 period have not been published extensively. Methods: We conducted a national, multicenter observational study that included adult maintenance HD patients recovered from confirmed COVID-19. A control HD group without COVID-19 was selected from patients in the same center. We investigated the characteristics and outcomes in the follow-up of HD patients and compare them with the non-COVID-19 group. Results: A total of 1223 patients (635 patients in COVID-19 group, 588 patients in non-COVID-19 group) from 47 centers were included in the study. The patients' baseline and HD characteristics were almost similar. The 28th-day mortality and mortality between 28th day and 90th day were higher in the COVID-19 group than non-COVID-19 group (19 [3.0%] patients vs. none [0%]; 15 [2.4%] patients vs. 4 [0.7%] patients, respectively). The presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection, and arteriovenous (AV) fistula thrombosis was significantly higher in the COVID-19 group in both the first 28 days and between 28 and 90 days. In the multivariable analysis, age (odds ratio [OR] [95% CI]: 1.029 [1.004-1.056]), group (COVID-19 group vs. non-COVID-19 group) (OR [95% CI]: 7.258 [2.538-20.751]), and vascular access type (tunneled catheter/AV fistula) (OR [95% CI]: 2.512 [1.249-5.051]) were found as independent parameters related to 90-day mortality. Conclusion: In the post-COVID-19 period, maintenance HD patients who have had COVID-19 have increased rehospitalization, respiratory problems, vascular access problems, and high mortality compared with the non-COVID-19 HD patients.

Body Shape Index Predicts Metabolic Syndrome and Insulin Resistance in Renal Transplant Recipients.

Obesity is one of the most important metabolic diseases around the world. There are no reliable and inexpensive methods to evaluate obesity. All of the anthropometric measurements used have some limitations. In 2012, Krakauer et al developed a new method, called A Body Shape Index (ABSI), to identify abdominal obesity that is derived from weight, height, and waist circumference. In this study, we aimed to investigate the clinical usefulness of the ABSI to predict the presence of insulin resistance (IR) and metabolic syndrome (MetS) in renal transplant recipients. A total of 155 patients were included in the study. Prevalence of IR was 17.4%, and MetS was 62.6%. ROC results demonstrated the power of all anthropometric indices to discriminate patients with and without MetS and IR in the renal transplant populations. ROC curves showed that waist-to-height ratio (WHtR) had the optimal power to discriminate MetS and IR in women. WC had higher area under curve than all other anthropometric indices to predict MetS and IR in men. WC in men and WHtR in women has higher discriminatory capacity to predict MetS and IR in renal transplant recipients. An obvious difference was observed in the optimal anthropometric measures between the 2 sexes, suggesting that sex-specific measures should be used in practice. In order to evaluate the value of ABSI in determining metabolic risk factors, studies with larger, randomized, controlled body fat ratios are needed.

Masked Hypertension and Obesity in Renal Transplant Recipients.

The diagnosis of arterial hypertension has traditionally been based on measurements of blood pressure (BP) in the clinic. However, home or ambulatory BP monitoring (ABPM) is reported to correlate better with target organ damage than clinic BP readings. The other potential advantage of out-of-clinic BP measurement is the detection of both white-coat hypertension (WCHT) and masked hypertension (MHT). Studies have suggested that MHT have an increased risk of cardiovascular disease (CVD). We aimed to investigate the prevalence of MHT and to evaluate risk factors by ABPM in our renal transplant recipients. One hundred twenty-ninety patients who were followed up in our nephrology clinic were included in the study. The prevalence of MHT was 17%. In logistic regression analysis, we investigated factors associated with MHT. In a model with age, sex, smoking, presence of Diabetes mellitus (DM) and blood glucose, estimated glomerular filtration rate (eGFR), donor type, body mass index, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), we found that WHR (r: 18.61, P: .007) and smoking (r: 2.79, P: .011) were related with MHT. MHT was related to target organ damage and cardiovascular disease. The diagnosis and treatment of MHT are important. These findings suggesting that patients with high WC and smokers should be investigated with ABPM to diagnose masked hypertension. This approach may reduce adverse cardiovascular outcomes after transplantation.

Pregnancy in immunoglobulin M nephropathy.

Immunoglobulin M nephropathy is an uncommon glomerular disease and a relatively less recognized clinico-immunopathological entity in the domain of glomerulonephritis, often thought to be a bridge between minimal change disease and focal segmental glomerulosclerosis. It is characterized by asymptomatic hematuria, episodes of macroscopic hematuria and proteinuria. Corticosteroids remain the mainstay of therapeutic strategies for such patients. We present what we believe to be the first known case of successful pregnancy in a 40-year-old woman with a 12-year history of underlying immunoglobulin M nephropathy. In view of the rarity of this disease we hope this report will assist professionals managing such cases.

Demographic and clinical characteristics of patients with autosomal dominant polycystic kidney disease: a multicenter experience.

AIM: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. It accounts for 5-10% of patients with end-stage renal disease (ESRD). The aim of this multicenter study was to investigate the demographic and clinical characteristics of patients with ADPKD. METHODS: 1,139 patients with ADPKD who were followed up at 12 different centers were recruited for this study. The investigated demographic and clinical characteristics were gender, age, smoking history, educational status, the existence of hypertension, hematuria, urinary tract infection, urinary tract stones and renal replacement therapy. Patients were considered as hypertensive if they were taking antihypertensive medications or if they had blood pressure (BP) of 140/90 mm Hg or greater. If the patients were currently on antihypertensive drugs, the classes of these agents were noted. RESULTS: 548 male and 591 female patients were included and the mean age at initial diagnosis was 37.1 ± 16.3 years. 20.3% were current smokers whereas 15% were ex-smokers. The mean systolic and diastolic BPs were 136.1 ± 29.8 and 84.9 ± 17.8 mm Hg, respectively. 63.7% used antihypertensive drugs and 73.1% of those used renin-angiotensin system blockers. 11.8% had ESRD, of which 75.8% were treated with hemodialysis. CONCLUSION: This study showed that hypertension is the most common (72.6%) clinical finding in ADPKD patients in Turkey and renin-angiotensin system blockers are widely used.