Evaluation of the changes in electrocardiographic ventricular repolarization parameters after COVID-19 recovery in hemodialysis patients.

INTRODUCTION: Coronavirus disease-2019 (COVID-19) has cardiac manifestations. Data about electrocardiogram (ECG) changes after COVID-19 recovery is limited in hemodialysis patients. We aimed to investigate the changes in ventricular repolarization parameters after COVID-19 recovery in hemodialysis patients. METHODS: Fifty-five hemodialysis patients who recovered from COVID-19 infection were included. QT interval, Tp-e interval, corrected QT (QTc), QTc dispersion, and Tp-e dispersion values were determined on the patients' ECGs, taken before COVID-19 and at least 1 month after recovery. The patients' data before COVID-19 infection and after recovery were compared. RESULTS: It was found that longest QTc (QTcmax) and QTc dispersion values after recovery were prolonged compared with pre-infection period (427 ± 28 ms vs. 455 ± 26 ms, p = 0.000 and 39 ± 16 ms vs. 65 ± 20 ms, p = 0.000). CONCLUSION: In our hemodialysis patients, ventricular repolarization parameters increased after COVID-19 recovery. In hemodialysis patients, already predisposed to arrhythmic deaths, arrhythmia risk after COVID-19 recovery may become more pronounced.

The Relationship between Bone Mineral Densitometry and Visceral Adiposity Index in Postmenopausal Women.

OBJECTIVE: It was aimed to compare visceral adiposity index (VAI) levels in patients with normal bone mineral density (BMD), osteopenia, and osteoporosis. METHODS: One hundred twenty postmenopausal women (40 with normal BMD, 40 with osteopenia, and 40 with osteoporosis) between the ages of 50 to 70 years were included in the study. For females, the VAI was calculated using the formula (waist circumference [WC]/[36.58 + (1.89 x body mass index (BMI))]) x (1.52/High-density lipoprotein [HDL]-cholesterol [mmol/L]) x (triglyceride [TG]/0.81 [mmol/L]). RESULTS: The time of menopause from the beginning was similar in all groups. Waist circumference was found to be higher in those with normal BMD than in the osteopenic and osteoporotic groups (p = 0.018 and p < 0.001, respectively), and it was also higher in the osteopenic group than in the osteoporotic group (p = 0.003). Height and body weight, BMI, blood pressure, insulin, glucose, HDL-cholesterol, and homeostasis model assessment-insulin resistance (HOMA-IR) levels were similar in all groups. Triglyceride levels were found to be higher in the normal BMD group, compared with the osteoporotic group (p = 0.005). The level of VAI was detected as higher in those with normal BMD, compared with the women with osteoporosis (p = 0.002). Additionally, the correlation analysis showed a positive correlation between dual-energy X-ray absorptiometry (DXA) spine T-scores, WC, VAI, and a negative correlation between DXA spine T-scores and age. CONCLUSION: In our study, we found higher VAI levels in those with normal BMD, compared with women with osteoporosis. We consider that further studies with a larger sample size will be beneficial in elucidating the entity.

OBJETIVO: O objetivo foi comparar os níveis de índice de adiposidade visceral (IVA) em pacientes com densidade mineral óssea (DMO) normal osteopenia e osteoporose. MéTODOS: Cento e vinte mulheres na pós-menopausa (40 com DMO normal 40 com osteopenia e 40 com osteoporose) com idades entre 50 e 70 anos foram incluídas no estudo. Para o sexo feminino o VAI foi calculado pela fórmula (circunferência da cintura [CC]/[36 58 + (1 89 x índice de massa corporal (IMC))]) x (1 52/lipoproteína de alta densidade [HDL]-colesterol [mmol/L] ) x (triglicerídeo [TG]/0 81 [mmol/L]). RESULTADOS: O tempo de menopausa desde o início foi semelhante em todos os grupos. A circunferência da cintura foi maior naqueles com DMO normal do que nos grupos osteopênicos e osteoporóticos (p = 0 018 e p < 0 001 respectivamente) e também foi maior no grupo osteopênico do que no grupo osteoporótico (p = 0 003) . Altura e peso corporal IMC pressão arterial insulina glicose HDL-colesterol e os níveis de avaliação do modelo de homeostase-resistência à insulina (HOMA-IR) foram semelhantes em todos os grupos. Os níveis de triglicerídeos foram maiores no grupo DMO normal em comparação com o grupo osteoporótico (p = 0 005). O nível de VAI foi detectado como maior naquelas com DMO normal em comparação com as mulheres com osteoporose (p = 0 002). Além disso a análise de correlação mostrou uma correlação positiva entre a absorciometria de raios-X de dupla energia (DXA) nas pontuações T da coluna CC VAI e uma correlação negativa entre as pontuações T da coluna DXA e a idade. CONCLUSãO: Em nosso estudo encontramos níveis mais elevados de VAI naquelas com DMO normal em comparação com mulheres com osteoporose. Consideramos que novos estudos com maior tamanho amostral serão benéficos na elucidação da entidade.

Serious Multiorgan Toxicity Caused by Mixed Herbal Tea Ingestion: A Case Report.

Recent years have witnessed a growing trend in the use of complementary and alternative herbal products. However, the ingestion of some herbal products may cause a wide spectrum of adverse effects. We report a case of multiorgan toxicity following the ingestion of mixed herbal tea. A 41-year-old woman presented to the nephrology clinic with complaints of nausea, vomiting, vaginal bleeding, and anuria. She had consumed a glass of mixed herbal tea three times a day after meals for three days, to lose weight. Initial clinical and laboratory findings showed serious multiorgan toxicity including hepatotoxicity, bone marrow toxicity, and nephrotoxicity. Although herbal preparations are marketed as natural products, they may cause various toxic effects. There should more efforts to raise public awareness about the possible toxic effects of herbal preparations. Clinicians should consider the ingestion of herbal remedies as an etiology when encountering patients with unexplained organ dysfunctions.

The Relationship between Bone Mineral Densitometry and Visceral Adiposity Index in Postmenopausal Women / A relação entre a densitometria mineral óssea e o índice de adiposidade visceral em mulheres na pós-menopausa

Abstract Objective It was aimed to compare visceral adiposity index (VAI) levels in patients with normal bone mineral density (BMD), osteopenia, and osteoporosis. Methods One hundred twenty postmenopausal women (40 with normal BMD, 40 with osteopenia, and 40 with osteoporosis) between the ages of 50 to 70 years were included in the study. For females, the VAI was calculated using the formula (waist circumference [WC]/[36.58 + (1.89 x body mass index (BMI))]) x (1.52/High-density lipoprotein [HDL]-cholesterol [mmol/L]) x (triglyceride [TG]/0.81 [mmol/L]). Results The time of menopause from the beginning was similar in all groups. Waist circumference was found to be higher in those with normal BMD than in the osteopenic and osteoporotic groups (p = 0.018 and p < 0.001, respectively), and it was also higher in the osteopenic group than in the osteoporotic group (p = 0.003). Height and body weight, BMI, blood pressure, insulin, glucose, HDL-cholesterol, and homeostasis model assessment-insulin resistance (HOMA-IR) levels were similar in all groups. Triglyceride levels were found to be higher in the normal BMD group, compared with the osteoporotic group (p = 0.005). The level of VAI was detected as higher in those with normal BMD, compared with the women with osteoporosis (p = 0.002). Additionally, the correlation analysis showed a positive correlation between dual-energy X-ray absorptiometry (DXA) spine T-scores, WC, VAI, and a negative correlation between DXA spine T-scores and age. Conclusion In our study, we found higher VAI levels in those with normal BMD, compared with women with osteoporosis. We consider that further studies with a larger sample size will be beneficial in elucidating the entity.

Resumo Objetivo O objetivo foi comparar os níveis de índice de adiposidade visceral (IVA) em pacientes com densidade mineral óssea (DMO) normal osteopenia e osteoporose. Métodos Cento e vinte mulheres na pós-menopausa (40 com DMO normal 40 com osteopenia e 40 com osteoporose) com idades entre 50 e 70 anos foram incluídas no estudo. Para o sexo feminino o VAI foi calculado pela fórmula (circunferência da cintura [CC]/[36 58 + (1 89 x índice de massa corporal (IMC))]) x (1 52/lipoproteína de alta densidade [HDL]-colesterol [mmol/L]) x (triglicerídeo [TG]/0 81 [mmol/L]). Resultados O tempo de menopausa desde o início foi semelhante em todos os grupos. A circunferência da cintura foi maior naqueles com DMO normal do que nos grupos osteopênicos e osteoporóticos (p = 0 018 e p < 0 001 respectivamente) e também foi maior no grupo osteopênico do que no grupo osteoporótico (p = 0 003) . Altura e peso corporal IMC pressão arterial insulina glicose HDL-colesterol e os níveis de avaliação do modelo de homeostase-resistência à insulina (HOMA-IR) foram semelhantes em todos os grupos. Os níveis de triglicerídeos foram maiores no grupo DMO normal em comparação com o grupo osteoporótico (p = 0 005). O nível de VAI foi detectado como maior naquelas com DMO normal em comparação com as mulheres com osteoporose (p = 0 002). Além disso a análise de correlação mostrou uma correlação positiva entre a absorciometria de raios-X de dupla energia (DXA) nas pontuações T da coluna CC VAI e uma correlação negativa entre as pontuações T da coluna DXA e a idade. Conclusão Em nosso estudo encontramos níveis mais elevados de VAI naquelas com DMO normal em comparação com mulheres com osteoporose. Consideramos que novos estudos com maior tamanho amostral serão benéficos na elucidação da entidade.

The impact of COVID-19 pandemic on anxiety levels among patients who have to go to the hospital due to chronic illnesses: A prospective study.

INTRODUCTION: Cancer and hemodialysis (HD) patients are at high risk for COVID-19. In our study, we aimed to evaluate the effect of pandemic on anxiety in these patients. METHODS: One hundred and six oncology and 97 HD patients participated in the study. Anxiety levels were assessed by using the Beck Anxiety Inventory (BAI) and State-Trait Anxiety Inventory (STAI). At the end of 8-month follow-up, these questionnaires were re-administered. RESULTS: During this period, 38 patients (38/203; 18.7%) had COVID-19 infection. Twenty-three patients (23/203; 11.3%) died due to COVID-19 and/or other causes. One hundred and thirteen of the remaining patients were participated in the second questionnaire. Having COVID-19 was not the independent factor for changes in STAI, and BAI scores in any regression models. CONCLUSION: Having COVID-19 does not affect the increased anxiety levels in HD and oncology patients. The effect of the pandemic may have remained in the background, as these patients have more concerns about their own diseases.

The association of soluble Klotho levels with anemia and hemoglobin variability in hemodialysis patients.

INTRODUCTION: The anti-aging protein Klotho levels are decreased, and Klotho deficiency is associated with cardiovascular diseases in patients with chronic kidney disease. There are recent studies about the relation between soluble Klotho levels and anemia. We aimed to investigate the correlation of anemia and hemoglobin variability with soluble Klotho levels in hemodialysis patients. METHODS: Ninety-one hemodialysis patients were included in this study. The mean hemoglobin value, hemoglobin variability, and coefficient of variation of hemoglobin for each patient were calculated. According to mean hemoglobin levels, two groups were defined as under 11 and ≥11 g/dl. Soluble Klotho levels of each patient were studied. RESULTS: Mean hemoglobin levels, hemoglobin variability, and coefficient of variation of hemoglobin were not significantly correlated with soluble Klotho levels. According to mean hemoglobin levels under 11 and ≥ 11 g/dl, there was no statistically significant correlation between anemia and soluble Klotho levels. CONCLUSION: Soluble Klotho levels were not associated with anemia and hemoglobin variability in hemodialysis patients. Further studies are needed to reveal the complicated relation between anemia and soluble Klotho levels.

Individualized hemodialysis: Is similar hemodialysis adequacy possible using less water?

Background and aim: There are over 60,000 hemodialysis (HD) patients in Türkiye, and the number of patients is increasing yearly. Dialysate flow rate (Qd) is a factor in HD adequacy. Approximately 150 L of water are consumed per session to prepare the dialysate. We aimed to investigate whether HD effectiveness can be achieved at a low Qd in different patient groups for the purpose of saving water. Materials and methods: This prospective study included 81 HD patients from 2 centers. The patients underwent an aggregate total of 486 HD sessions, including 3 sessions at a Qd of 500 mL/min and 3 sessions at a Qd of 300 mL/min for each patient. We used online Kt/V readings recorded at the end of each dialysis session to compare the effectiveness of these 2 types of HD session performed at a different Qd. Results: The online Kt/V readings were similar between the standard (500) and low (300) Qd HD (1.51 ± 0.41 and 1.49 ± 0.44, respectively, p = 0.069). In the subgroup analyses, men had higher online Kt/V values at the standard Qd compared to the low Qd (1.35 ± 0.30 and 1.30 ± 0.32, respectively, p = 0.019), but the Kt/V values were not different for women. While the low Qd did not reduce online Kt/V in patients using small surface area dialysis membranes (1.75 ± 0.35 for 300 Qd and 1.75 ± 0.32 for 500 Qd, p = 0.931), it was associated with reduced online Kt/V in patients using large surface area dialysis membranes (1.12 ± 0.25 for 300 Qd and 1.17 ± 0.24 for 500 Qd, p = 0.006). The low Qd did not result in differences in online Kt/V among low-weight patients. However, online Kt/V values were better with the standard Qd in patients weighing 65 kg and above. Conclusion: In our study, dialysis adequacy at a reduced dialysate flow was not inferior for women, patients with low body weight, or patients using small surface area membranes. Individualized HD at a reduced Qd of 300 mL/min in eligible patients can save 48 L of water per HD session and an average of 7500 L of water per year.

Prevalence and related factors of poor sleep quality in patients with pre-dialysis chronic kidney disease.

BACKGROUND: Sleep disturbances in patients with chronic kidney disease (CKD) are related to decreased quality of life and increased health-related risks. There is insufficient data about actual prevalence and related factors of poor sleepers in this group. In this study, we aimed to investigate prevalence and related risk factors of self-reported poor sleep quality in patients with pre-dialysis CKD. METHODS: In this cross-sectional study, 259 pre-dialysis CKD patients (median age 56 years; range, 19-85) were included. Demographical, clinical and laboratory correlates were recorded. Body mass index (BMI) was calculated. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) formula. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire. Depression was evaluated using the Beck Depression Inventory (BDI). RESULTS: Median eGFR was 27.6 ml/min/1.73 m2 (range, 9-56). Of the 259 patients, 110 (42.5%) were poor sleepers with global PSQI score >5. The univariate correlation analysis revealed that global PSQI score was positively correlated with age, BMI, waist circumferences (WC), hip circumferences (HC), serum phosphorus and triglyceride levels, systolic blood pressure (BP), pulse pressure and BDI score, and negatively correlated with male gender and hemoglobin level. Logistic regression analysis, showed that HC, systolic BP, and BDI scores were independently associated with poor sleep quality (p = 0.001, p = 0.020 and p < 0.001, respectively). CONCLUSION: Prevalence of poor sleep quality in our pre-dialysis CKD patients was 42.5%. Systolic BP, depression and HC, all of these are potentially correctable factors, were associated with poor sleep quality independently.

Effect of congenital or acquired renal mass reduction on arterial stiffness.

BACKGROUND: The changes in kidney functions, adversely affect the cardiovascular system. The aim of this study was to investigate whether arterial stiffness (AS), an indicator of subclinical atherosclerosis, was affected in patients with congenital or acquired reduced renal mass. METHODS: In this prospective study, a total 135 patients (mean age 43.4 ± 8.5 years and 71.9% female) with congenital unilateral small/nonfunctioning kidney or unilateral agenesis or with unilateral nephrectomy were included. As control group, 44 healthy individuals with similar age and gender (mean age, 42.5 ± 7.1 year and 61.4% female) were included. Estimated glomerular filtration rate (eGFR) was calculated by Modification of Diet in Renal Disease formula. Official blood pressures (BP) and 24-h ambulatory noninvasive BP of both groups were measured. AS was assessed with pulse wave velocity (PWV) by using Mobile-O-Graph new genaration arteriograph device using oscillometrical method. RESULTS: There was no difference in terms of BP parameters and body mass index between groups. eGFR values of control group and study group were 93 ± 19 ml/min/1.73 m² and 89 ± 28 ml/min/1.73 m², respectively (p = 0.379). Compared with control group, the study group had higher PWV values (6.72 ± 1.11 m/s vs. 6.29± 0.75 m/s, p = 0.018). In linear regression analysis, PWV was found to be correlated with age (ß = 0.752, p < 0.001), and daytime ambulatory systolic BP (ß = 0.345, p < 0.001). CONCLUSION: Our study showed that AS was increased in patients with reduced renal mass and this increase in AS was related to age and systolic BP. No relation was determined between AS and eGFR.

The probabilities of type I and II error of null of cointegration tests: A Monte Carlo comparison.

This paper evaluates the performance of eight tests with null hypothesis of cointegration on basis of probabilities of type I and II errors using Monte Carlo simulations. This study uses a variety of 132 different data generations covering three cases of deterministic part and four sample sizes. The three cases of deterministic part considered are: absence of both intercept and linear time trend, presence of only the intercept and presence of both the intercept and linear time trend. It is found that all of tests have either larger or smaller probabilities of type I error and concluded that tests face either problems of over rejection or under rejection, when asymptotic critical values are used. It is also concluded that use of simulated critical values leads to controlled probability of type I error. So, the use of asymptotic critical values may be avoided, and the use of simulated critical values is highly recommended. It is found and concluded that the simple LM test based on KPSS statistic performs better than rest for all specifications of deterministic part and sample sizes.

Evaluation of sirtuin 1 (SIRT1) levels in autosomal dominant polycystic kidney disease.

PURPOSE: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease and the majority of patients have a PKD-1 or PKD-2 mutation. Sirtuin 1 (SIRT1) has roles in cellular aging, antioxidant activity, cellular proliferation. In an experimental study, inhibition of SIRT1 was found to delay renal cyst development in ADPKD. The purpose of this study is to determine the SIRT1 levels in ADPKD patients. To our knowledge, this is the first study that investigating blood and urine SIRT1 levels in ADPKD patients. METHODS: Sixty-seven patients with ADPKD and 34 control cases with normal renal functions and without renal cysts were included in this study. Serum and urine SIRT1 concentrations were determined by human enzyme-linked immunosorbent assay (ELISA) kit. 24-h urine samples were used for urine SIRT1 measurements. RESULTS: The urine SIRT1 levels were statistically significantly lower in ADPKD patients group (p < 0.001). Although blood SIRT1 levels of ADPKD patients were higher than control cases but there were no statistically significant difference between the groups in terms of blood SIRT1 levels. Urine SIRT1 levels (ß = 2.452, CI 95% 1.419-4.239, p = 0.001) were found an independent factor in multivariate regression analysis for ADPKD. CONCLUSIONS: Urine SIRT1 levels were lower in ADPKD patients than control group. The low urinary SIRT1 levels despite the similar blood SIRT1 levels might be due to the impaired metabolism of SIRT1 in ADPKD patients; this state might has a role in cyst development.

Adherence to the Mediterranean diet in Turkish hospitalized older adults and its association with hospital clinical outcomes.

AIM: To identify the Mediterranean diet adherence in Turkish older inpatients and its relation to clinical outcomes. METHODS: A total of 200 hospitalized patients over 60 years old (mean age; 72.9 ± 8.5 years, 59.5% female) were included in the study. Beside evaluating the demographic properties, they were evaluated by Elderly Dietary Index (EDI), Mini-nutritional assessment-short form (MNA-SF), and FRAIL index. Length of hospital stay, need of intensive care, and hospital clinical outcomes were also recorded. RESULTS: According to the EDI scoring, the rate of unhealthy diets among study population was 91.5% and 56% of the patients were frail and 17% were malnourished. EDI score was significantly and positively correlated with height (rho=0.183), weight (rho=0.142), MNA-SF score (rho=0.204), glomerular filtration rate (GFR) (rho=0.152), and alanine-aminotransferase (ALT) (rho=0.278) levels (p = 0.009; 0.046; 0.004; 0.032; and <0.001, respectively). EDI scores were higher in male and married patients when compared to female and widow ones (p = 0.001 and 0.023, respectively). There was a negative, moderate, and statistically significant correlation between EDI score and length of hospital stay in patients hospitalized for infectious diseases (rho:-0.510; p = 0.036). EDI score was also significantly related to frailty status (p = 0.017) and malnutrition (p = 0.026). The EDI score was found to be an independent parameter for frailty in a regression analysis model (OR=0.826;%95 CI: 0.713-0.959; p = 0.012). CONCLUSION: It was shown that hospitalized older adults had a low adherence to the Mediterranean diet. Unhealthy diet group might be associated with poor clinical outcomes such as malnutrition, frailty, increased length of hospital stay, and recurrent emergency department admissions.

Effect of anxiety on COVID-19 infection in hemodialysis patients.

Some evidence suggests that anxiety deteriorate the immune system. We aimed to determine the effect of anxiety on COVID-19 infection in hemodialysis (HD) patients. Our study was conducted with 80 HD patients. State-Trait Anxiety Inventory (STAI), and Beck Anxiety Inventory (BAI) questionnaires were administered between April 15 and May 1, 2020. These patients were followed up for about 8 months and COVID-19 infection, hospitalization, and death rates were recorded. Twenty-one (26%) of the patients were diagnosed with COVID-19 infection. Fourteen out of twenty one (66.6%) of the patients were hospitalized, and 8/21 (38%) of them died due to COVID-19. STAI-S (p= 0.006) and BAI (p= 0.021) scores were found to be higher and STAI-T (p= 0.040) score was found to be lower in HD patients who were infected with COVID-19 compared to without, at the follow-up period. It might be concluded in this study that COVID-19 was more common in anxious HD patients.

Pregnancy and its outcomes in hemodialysis patients in Turkey.

BACKGROUND/AIM: This study aimed to investigate pregnancy frequency and evaluate the factors affecting live births in hemodialysis (HD) patients. MATERIALS AND METHODS: Female HD patients whose pregnancy was retrospectively reported between January 1, 2014, and December 31, 2019. The duration of HD, primary disease, whether the pregnancy resulted in abortion, stillbirth, or live birth, whether the HD duration was prolonged after diagnosing the pregnancy and whether it accompanied preeclampsia were recorded. RESULTS: In this study, we reached 9038 HD female patients? data in the study. A total of 235 pregnancies were detected in 145 patients. The mean age was 35.42 (35 ± 7.4) years. The mean age at first gestation was 30.8 ± 6.5 years. The average birth week was 32 (28 - 36) weeks. 53.8% (no = 78) of the patients had live birth, 51.7% (no = 70) had at least one abortion in the first 20 weeks, and 13.1% (no = 19) had at least one stillbirth after 20 weeks. The rate of patients' increased numbers of dialysis sessions during pregnancy was 71.7%. The abortion rate was 22.4% in those with increased HD sessions, whereas 79.3% in those not increased HD sessions (p < 0.001). Live birth frequency was 67.2% in the increased HD sessions group and 3.4% in those who did not differ in HD sessions (p < 0.001). CONCLUSION: For the first time, we reported pregnancy outcomes in HD female patients, covering all regions of Turkey. It has been observed that; increasing the number of HD sessions in dialysis patients will decrease fetal and maternal complications and increase live birth rates.

The Relationship between Polycystic Ovary Syndrome and Serum Periostin Level.

OBJECTIVE: To determine the changes of circulating periostin levels in polycystic ovary syndrome (PCOS) and its relationship with metabolic disorders. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Konya Research and Training Hospital, Turkey between September 2018 and April 2020. METHODOLOGY: Patients with PCOS were compared with healthy individuals as control. The demographics, laboratory findings, anthropometric measurements, the levels of serum periostin and carotid intima media thickness (CIMT) were evaluated and compared. RESULTS: There was no significant difference between patients with PCOS (n = 53) and controls (n = 35), according to demographic and laboratory findings and anthropometric measurements. The CIMT in patients with PCOS and control groups were measured as 0.5 ± 0.06 mm and 0.43 ± 0.1 mm, respectively (p <0.003). The levels of periostin in the patients with PCOS and control groups were found to be 6.43 ± 6.19 ng/mL and 3.61 ± 3.79 ng/mL, respectively (p <0.018). No statistically significant correlations were found according to periostin levels and metabolic variables. CONCLUSION: Although there was no significant correlation between the periostin levels and the metabolic variables in patients with PCOS as compared to those without the periostin levels, but CIMT were higher in PCOS group. Key Words: Atherosclerosis, Carotid intima-media thickness, Insulin resistance, Periostin protein, Polycystic ovary syndrome.

The relationship of soluble klotho level with uremic cardiomyopathy and ecocardiographic parameters in hemodialysis patients.

There are studies reporting that soluble kltho (sKlotho) deficiency plays a role in cardiovascular disease in addition to traditional risk factors such as diabetes, hypertension, anemia, smoking, and excessive volume burden. Our aim in this study was to investigate the relationship of sKlotho with uremic cardiomyopathy and echocardiographic parameters in patients receiving hemodialysis treatment. According to the median value, the sKlotho value was divided into two groups as ≥1.24 and <1.24 ng/ml. Ventricular wall thicknesses, ejection fractions, left atrium, M mode aorta systole, and diastole diameter measurements were taken. The left ventricular mass (LVM) was calculated using the Devereux formula. There were significant differences between the two groups in terms of age, number of patients with diabetes mellitus, comorbidity, dialysis time, sKlotho, phosphorus, parathormone, and albumin parameters. No significant difference was found between the two groups that were separated according to the median sKlotho value, when the echocardiographic parameters of interventricular septum thickness, left ventricular posterior wall thickness, left atrial diameter, left ventricular ejection fraction, and LVM index were compared. In conclusion, sKlotho is not a marker for showing and predicting uremic cardiomyopathy in hemodialysis patients.

The relationship between glomerular filtration rate, and metabolic and inflammatory parameters in obese and non-obese patients with polycystic ovary syndrome

AIM: To investigate the relationship between glomerular filtration rates (GFR), and homeostasis model assesment of insulin resistance (HOMA-IR), C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) in patients with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Thirty-one overweight and obese PCOS patients with body mass index (BMI)≥25kg/m2 and 25 non-obese PCOS patients with BMI<25kg/m2 were included into patients' group, while 23 overweight and obese, and 25 non-obese age-and BMI-matched healthy individuals (aged between 18 and 40 years), were enrolled as controls. Levels of serum creatinine, glucose, insulin, CRP, and complete blood count were measured. eGFR, HOMA-IR and NLR were also calculated. RESULTS: In PCOS group, HOMA-IR (p = 0.001), CRP (p = 0.025) and waist hip ratio (WHR) (p = 0.011) were higher than controls. In obese PCOS sub-group, HOMA-IR (p = 0.004) and WHR (p = 0.002) were higher than obese controls. In non-obese PCOS sub-group, HOMA-IR (p = 0.001) were higher than non-obese controls. In obese PCOS sub-group; HOMA-IR (p = 0.001) and CRP (p = 0.001) levels were significantly higher than non-obese PCOS sub-group. In terms of other parameters, no significant difference was found between the groups. The analysis showed a negative correlation between GFR, and BMI and HOMA-IR in PCOS group, between GFR, WHR and insulin levels in obese PCOS sub-group, and between BMI, and HOMA-IR and NLR in non-obese PCOS sub-group. CONCLUSION: Although HOMA-IR and CRP were higher in PCOS group, there was no difference in NLR and GFR levels between those with PCOS and controls

OBJETIVO: investigar la relación entre las tasas de filtración glomerular (TFG) y la evaluación del modelo de homeostasis de la resistencia a la insulina (HOMA-IR), la proteína C-reactiva (PCR) y la relación de neutrófilos a linfocitos (NLR) en pacientes con síndrome de ovario poliquístico (PCOS). MATERIAL Y MÉTODOS: Treinta y un pacientes con PCOS con sobrepeso y obesidad con índice de masa corporal(IMC) ≥25 kg/m 2 y 25 pacientes con PCOS no obesos con IMC <25 kg/m 2 constituyeron el grupo de pacientes, mientras que 23 con sobrepeso y obesidad, y Se inscribieron como controles 25 sujetos sanos no obesos, todos con edad e IMC(edad entre 18 y 40 años). Se midieron los niveles séricos de creatinina, glucosa, insulina y PCR, y se evaluó el recuento sanguíneo completo; Se calcularon eGFR, HOMA-IR y NLR. RESULTADOS: en el grupo PCOS, HOMA-IR (p = 0.001), CRP (p = 0.025) y la relación cintura-cadera(WHR) (p = 0.011) fueron más altos que los controles. En el subgrupo de PCOS obesos, HOMA-IR (p = 0.004) y WHR (p = 0.002) fueron más altos que los controles obesos. En el subgrupo PCOS no obeso, HOMA-IR (p = 0.001) fue mayor que los controles no obesos. En el subgrupo de PCOS obesos; Los niveles de HOMA-IR (p = 0.001) y CRP (p = 0.001) fueron significativamente más altos que los del subgrupo PCOS no obeso. En cuanto a otros parámetros, no se encontraron diferencias significativas entre los grupos. CONCLUSIÓN: Aunque los niveles de HOMA-IR y CRP se encontraron más altos en el grupo PCOS, no hubo diferencias en los niveles de NLR y GFR entre aquellos con PCOS y controles

The relationship between glomerular filtration rate, and metabolic and inflammatory parameters in obese and non-obese patients with polycystic ovary syndrome.

AIM: To investigate the relationship between glomerular filtration rates (GFR), and homeostasis model assesment of insulin resistance (HOMA-IR), C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) in patients with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Thirty-one overweight and obese PCOS patients with body mass index (BMI)≥25kg/m2 and 25 non-obese PCOS patients with BMI<25kg/m2 were included into patients' group, while 23 overweight and obese, and 25 non-obese age-and BMI-matched healthy individuals (aged between 18 and 40 years), were enrolled as controls. Levels of serum creatinine, glucose, insulin, CRP, and complete blood count were measured. eGFR, HOMA-IR and NLR were also calculated. RESULTS: In PCOS group, HOMA-IR (p=0.001), CRP (p=0.025) and waist hip ratio (WHR) (p=0.011) were higher than controls. In obese PCOS sub-group, HOMA-IR (p=0.004) and WHR (p=0.002) were higher than obese controls. In non-obese PCOS sub-group, HOMA-IR (p=0.001) were higher than non-obese controls. In obese PCOS sub-group; HOMA-IR (p=0.001) and CRP (p=0.001) levels were significantly higher than non-obese PCOS sub-group. In terms of other parameters, no significant difference was found between the groups. The analysis showed a negative correlation between GFR, and BMI and HOMA-IR in PCOS group, between GFR, WHR and insulin levels in obese PCOS sub-group, and between BMI, and HOMA-IR and NLR in non-obese PCOS sub-group. CONCLUSION: Although HOMA-IR and CRP were higher in PCOS group, there was no difference in NLR and GFR levels between those with PCOS and controls.

The association of decreased testosterone with atherosclerosis and inflammation in male predialysis patients with chronic kidney disease / Asociación entre el descenso del nivel de testosterona y aterosclerosis e inflamación en varones con insuficiencia renal crónica prediálisis

PURPOSE: To investigate the frequency of hypogonadism and its relationship to inflammation and carotid intima-media thickness (CIMT) in male patients with predialysis chronic kidney disease (CKD). METHODS: A total of 105 patients with CKD, 55 (52.4%) as stage 3, 33 (31.4%) as stage 4 and 17 (16.2%) as stage 5, were enrolled into the study. Total testosterone (TT) and free testosterone (FT), interleukin 6 (IL-6), C-reactive protein (CRP) levels, and CIMT were measured. RESULTS: According to TT and FT, hypogonadism was detected in 18 (17.1%) and 22 (20.9%) patients, respectively. There was no difference in terms of TT and FT, CIMT, CRP and IL-6 between the stages of CKD. According to TT, the patients with hypogonadism had significantly higher CRP and high-density lipoprotein cholesterol (HDL-cholesterol) levels (p = 0.004 and p = 0.005, respectively). There was no significant difference in other parameters. According to FT, the patients with hypogonadism had significantly higher CRP (p = 0.017), and TT were negatively correlated with body mass index (BMI), waist circumference (WC), hip circumference, and CRP levels. FT was negatively correlated with age, waist circumference, systolic blood pressure, diastolic blood pressure (DBP) and CRP. CONCLUSIONS: The frequency of hypogonadism was found around 17-21% among the patients with CKD. Despite similar IL-6 and CIMT levels, CRP was found to be higher in the patients with hypogonadism. We consider that further studies with larger populations are needed to elucidate the entity

OBJETIVO: Investigar la frecuencia de hipogonadismo y su relación con la inflamación y grosor de la íntima-media carotídea (CIMT) en varones con insuficiencia renal crónica (IRC) prediálisis. MÉTODOS: Se incluyó en el estudio a un total de 105 pacientes con IRC, 55 (52,4%) en estadio 3, 33 (31,4%) en estadio 4, y 17 (16,2%) en estadio 5. Se midieron testosterona total (TT) y testosterona libre (TL), interleucina 6 (IL-6), niveles de proteína C reactiva (PCR), y CIMT. RESULTADOS: Con respecto a TT y TL, se detectó hipogonadismo en 18 (17,1%) y 22 (20,9%) pacientes, respectivamente. No se encontraron diferencias en términos de TT y TL, CIMT, PCR e IL-6 entre los diferentes estadios de IRC. Con respecto a TT, los pacientes con hipogonadismo tenían valores significativamente más altos de PCR y colesterol de lipoproteínas de alta densidad (HDL-colesterol) (p = 0,004 y p = 0,005, respectivamente). No se encontraron diferencias significativas en cuanto a otros parámetros. Con respecto a TL, los pacientes con hipogonadismo tenían valores significativamente más altos de PCR (p = 0,017), y TT guardó una correlación negativa con el índice de masa corporal (IMC), perímetro de la cintura, perímetro de la cadera, y niveles de PCR. TL se correlacionó negativamente con la edad, perímetro de cintura, presión arterial sistólica (PAS), presión arterial diastólica (PAD) y PCR. CONCLUSIONES: Se encontró frecuencia de hipogonadismo en cerca del 17-21% de los pacientes con IRC. A pesar de encontrar niveles similares de IL-6 y CIMT, los niveles de PCR fueron más altos en los pacientes con hipogonadismo. Consideramos que son necesarios más estudios, con poblaciones de mayor tamaño, para explicar esta entidad

Does altitude affect blood gases in hemodialysis patients?

INTRODUCTION: This study aimed to determine whether predialysis blood gases is affected by altitude differences in hemodialysis patients with arteriovenous fistulas living in Turkey at three different altitudes. METHODS: Patients' predialysis blood gases were compared by standardizing both arterial blood gases collections and working methods for patients undergoing hemodialysis using a dialysate with the same properties at altitudes of 30 m (sea level), 1020 m (moderate altitude), and 1951 m (high altitude). FINDINGS: Blood gases disorders were detected in 32 (82.1%) high altitude group patients, whereas 49 (74.2%) sea level group patients had no blood gases disorders (P < 0.001). pH values in the high altitude group were significantly lower than those in the other groups, and the pH increased as altitude decreased (P < 0.001). The partial pressure of carbon dioxide (PaCO2 ) values was higher in the sea level group than in the other groups and increased at lower sea levels (P < 0.001). Bicarbonate values were significantly higher in the sea level group than in the other groups and increased at lower sea levels, similar to PaCO2 values (P < 0.001). The partial pressure of oxygen (PaO2 ) values in the high altitude and sea level groups were significantly higher and increased at lower sea levels (P < 0.001). The oxygen saturation (SaO2 ) values were significantly lower in the high altitude group than in the other groups and increased gradually at lower sea levels (P < 0.001). DISCUSSION: Predialysis metabolic acidosis was more pronounced in patients undergoing hemodialysis at high altitudes, whereas PaCO2 , PaO2 , and SaO2 values were lower.