How many blood pressure measurements should we take in the office?

No consensus has emerged among different guidelines concerning how many blood pressure (BP) measurements should be performed at office visits in the diagnosis of hypertension. The purpose of this study was to examine the compatibility of various multiple average office BP measurements and 24-h BP monitoring (ABPM) in patients followed up in the posthoc analysis of the Cappadocia hypertension cohort. A total 1158 office BP measurements by 207 patients were examined. The results were then classified as G1 (average of the 1st and 2nd BP), G2 (average of the 2nd and 3rd), G3 (average of the 2nd, 3rd, and 4th), G4 (average of the 2nd, 3rd, 4th, and 5th), and G5 (average of all five measurements). Compatibility between the average values in the groups and concomitant 24-h ABPM data was examined. While a significant difference was observed between daytime 24-h ABPM SBP and G1 (p = .002), no difference was found in the other groups. Office DBP approached the daytime 24-h ABPM values as the number of measurements in the five groups increased, although average office DBP data in all groups were higher than daytime 24-h ABPM DBP (p = .000 for all). In light of our study results, we recommend that three office BP measurements be performed and that the average of the 2nd and 3rd measurements be used for SBP, while in terms of DBP, we recommend that as many measurements as possible be taken without the 1st value being included in the average.

The Effect of Ambient Air Pollution on Office, Home, and 24-Hour Ambulatory Blood Pressure Measurements.

BACKGROUND: Air pollution has recently been linked to a number of cardiovascular diseases, particularly hypertension (HT). In our study, we aimed to evaluate the association between air pollution and blood pressure (BP) and compare the relationship of BP measurement results obtained using different methods (office, home, and 24-hour ambulatory BP monitoring [ABPM]). METHODS: This retrospective nested panel study performed with prospective Cappadocia cohort data investigated the relationships between particulate matter (PM) 10 and sulfur dioxide (SO2) and concurrent home, office, and 24-hour ABPM data at each control performed over a 2-year period. RESULTS: A total of 327 patients in the Cappadocia cohort were included in this study. On the day of office blood pressure measurement, there was an increase of 1.36 mm Hg in systolic BP and 1.18 mm Hg in diastolic BP for every 10 µm/m3 rise in SO2 values. A mean 3-day 10 µm/m3 increase in SO2 was linked to an increase of 1.60 mm Hg in systolic BP and 1.33 mm Hg in diastolic BP. A 10 µm/m3 rise in mean SO2 on the day of 24-hour ABPM measurement was found to be associated with an increase of 1.3 mm Hg in systolic BP and 0.8 mm Hg in diastolic BP. SO2 and PM 10 had no effect on home measurements. CONCLUSION: In conclusion, increased SO2 levels, during winter months in particular, can be associated with an elevation in office BP values. Our study findings show that air pollution in the setting in which BP is measured may be associated with the results.

Clinical and pathologic features of primary membranous nephropathy in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group.

BACKGROUND: We aimed to evaluate the features of primary membranous nephropathy (MNP) in Turkish people. METHODS: This is a retrospective analysis of patients with biopsy-proven primary MNP. We obtained the data collected between 2009 and 2019 in the primary glomerulonephritis registry of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD). Patients with a secondary cause for MNP were excluded. Clinical, demographic, laboratory, and histopathological findings were analyzed. RESULTS: A total of 995 patients with primary MNP were included in the analyses. Males constituted the majority (58.8%). The mean age was 48.4 ± 13.9 years. The most common presentation was the presence of nephrotic syndrome (81.7%) and sub nephrotic proteinuria (10.3%). Microscopic hematuria was detected in one-third of patients. The median estimated glomerular filtration rate (eGFR) was 100.6 mL/min/1.73 m2 (IQR, 75.4-116.3), and median proteinuria was 6000 mg/d (IQR, 3656-9457). Serum C3 and C4 complement levels were decreased in 3.7 and 1.7% of patients, respectively. Twenty-four (2.4%) patients had glomerular crescents in their kidney biopsy samples. Basal membrane thickening was detected in 93.8% of cases under light microscopy. Mesangial proliferation and interstitial inflammation were evident in 32.8 and 55.9% of the patients, respectively. The most commonly detected depositions were IgG (93%), C3 complement (68.8%), and kappa and lambda immunoglobulin light chains (70%). Although renal functions were normal at presentation, vascular, interstitial, and glomerular findings were more prominent on biopsy in hypertensive patients. No significant effect of BMI on biopsy findings was observed. CONCLUSIONS: Despite some atypical findings, the main features of primary MNP in Turkey were similar to the published literature. This is the largest MNP study to date conducted in Turkish people.

Discontinuation of Eculizumab treatment after hematological remission in patients with atypical and drug-induced hemolytic uremic syndrome.

Introduction. The aim was to evaluate the effect of therapeutic plasma exchange (TPE) and eculizumab on hematological and renal survival in atypical hemolytic uremic syndrome (aHUS), and additionally, to examine the reliability of discontinuation of eculizumab treatment.Methods. This was an observational and retrospective study of 18 patients diagnosed with aHUS.Results. The median age of the study population was 30 (22-66) years. Four of 18 patients achieved hematological remission with the TPE alone. However, one patient died after three sessions of TPE. Eculizumab was used in 13 patients and no death was observed. One year after treatment, improved kidney function was observed in 2 of 3 (66%) patients for TPE and 5 of 9 (56%) patients for Eculizumab. We discontinued eculizumab treatment in 9 patients. One of the patients who had a C3 gene mutation experienced disease relapse after Eculizumab discontinuation. None of the patients who had drug associated aHUS developed disease relapse after Eculizumab discontinuation.Conclusion. Eculizumab treatment is a life-saving therapy in aHUS. Treatment discontinuation may be considered at least six months after hematologic remission in patients who had stable renal function or no expectancy for renal survival. Moreover, drug-associated cases seem to tend not to develop disease relapse in the long term.

Does Blood Pressure Variability Affect Hypertension Development in Prehypertensive Patients?

BACKGROUND: Blood pressure variability (BPV) is associated with end organ damage and cardiovascular outcomes in hypertensive patients. Prehypertensive patients frequently develop hypertension (HT). The purpose of the present study was to evaluate the effect of BPV on the development of HT. METHODS: Two hundred and seven prehypertensive patients from the Cappadocia cohort were monitored over 2 years, and 24-hour ambulatory blood pressure monitoring (ABPM), office BP, and home BP measurements were subsequently performed at 4- to 6-month intervals. BPV was calculated as average real variability (ARV) from 24-h ABPM data, home BP, and office BP measurements at first visit. The relationship was evaluated between baseline ARV and the development of HT. RESULTS: HT was diagnosed in 25.60% of subjects. Baseline 24-hour ABPM systolic blood pressure (SBP)ARV and diastolic blood pressure (DBP)ARV and home SBPARV were significantly higher in patients who developed HT than the other patients (P 0.006, 0.001 and 0.006, respectively). Baseline 24-hour ABPM SBPARV and home SBPARV exceeding the 90th percentile were identified as parameters affecting development of HT at logistic regression analysis. CONCLUSION: In conclusion, our prospective observational cohort study showed that short-term BPV in particular can predict the development of HT in the prehypertensive population.

First Reported Case of Echinococcal Disease on a Renal Graft Successfully Treated With Albendazole.

Echinococcal disease is an endemic disease for eastern Mediterranean countries. Various types of kidney involvement have been reported. Here, we report the first case of echinococcal disease on a transplanted kidney in a patient who was successfully treated with albendazole alone. The patient (a 38-year-old female) was evaluated for elevated creatinine levels 7 months after receiving a living-donor allograft. Standard immunosuppression therapy protocols were applied. Tacrolimus level was normal, and the patient was compliant with treatment. Creatinine level was 1.91 mg/dL (baseline: 1.2 mg/dL); proteinuria level was 1300 mg/day. The graft was found to be normal, as evaluated with standard sonographic methods. A kidney biopsy was performed, which showed that part of the cortical parenchyme was infiltrated by echinococcal protoscolices with hooklets. Because there were no cysts present on the graft, we concluded that disease was at an early stage. The patient was given albendazole for 3 months. After therapy, all echinococcal structures disappeared. Her creatinine level dropped to baseline, and proteinuria resolved. Echinococcal disease can affect transplanted kidneys. Albendazole is a valuable treatment option for patients who are not candidates for surgical resection.

Kidney biopsy in the elderly: diagnostic adequacy and yield.

PURPOSE: The number of kidney biopsies (KB) performed in elderly patients has been increasing. Safety and usefulness of elderly KB have been well established, whereas much less is known about diagnostic adequacy and yield in this patient population. METHODS: We performed a retrospective study of KBs in 428 patients from April 2015 to December 2017 at an academic institution. We compared KB from 50 patients aged over 64 (elderly) with KB from 378 patients aged between 18 and 64. RESULTS: Gender ratio, body mass index, systolic and diastolic BP, creatinine values, incidences of AKI at the time of biopsy, INR/aptt values, and platelets were similar between the two groups. eGFR and number of transplant biopsies were lower in the elderly biopsy group. The glomerular yield was similar between the two groups (22 ± 14 vs. 22 ± 13, p = 0.869). The likelihood of obtaining more than ten glomeruli was 87% and 88%, respectively, without a significant difference. Inadequate samples were encountered in 6% of the elderly and 5.6% of the non-elderly KB, again without a significant difference. Samples taken by nephrologist had higher glomerular yield for both groups (25 ± 13 vs. 18 ± 12 overall, 26 ± 14 vs. 18 ± 14 for elderly, p < 0.001 both). Inadequate biopsies were lower in the nephrologist group when all patients were considered (3% vs. 9%, p = 0.025). Results were numerically similar for the elderly patients, but the difference was not statistically significant (2% vs. 8%, p = 0.322). No deaths occurred in both arms. Minor complications were not different for each group (4.5% vs. 4%). There were no major complications in elderly patients. However, the difference did not reach statistical significance. CONCLUSION: The world is aging, leading to an increased number of KB in older patients. KB in the elderly is a safe, effective, and an indispensable tool for the nephrologist. This study suggests there is no need to fear lower diagnostic adequacy in the decision making of a KB for an elderly patient.

Vitamin D receptor polymorphisms and bone health after kidney transplantation

Background/aim: Bone disease is one of the most prominent complications after kidney transplantation. Bone diseases include osteoporosis, persistent secondary hyperparathyroidism, and avascular necrosis (AVN). We investigated the relationship between the polymorphisms of the vitamin D receptor (VDR) gene and bone diseases occurring after kidney transplantation. Materials and methods: The study consists of 234 kidney allograft recipients with a minimum follow-up of five years after kidney transplantation. Patients with glomerular filtration rates less than 30 mL/min/1.73m2, a history of parathyroidectomy, bisphosphonate use pre- or post-transplantation, and cinacalcet use posttransplantation excluded. We evaluated associations between the polymorphisms of the VDR gene (BsmI, TaqI, ApaI, FokI, and Cdx2), the first-year bone mineral density (BMD) scores, persistent secondary hyperparathyroidism, and AVN. Results: Patients with low BMD scores were significantly younger (P = 0.03) and had higher intact parathormone (iPTH) levels (P = 0.03). Cdx2 TT genotype significantly increases the risk of low BMD scores (OR: 3.34, P = 0.04). Higher phosphate levels were protective against abnormal BMD scores (OR: 0.53; P = 0.03). Patients with persistent hyperparathyroidism had significantly longer dialysis vintage and higher pretransplantation iPTH levels (P = 0.02 and P < 0.001, respectively). Cdx2, CT/TT, and ApaI CA/AA genotypes significantly increase the risk of persistent hyperparathyroidism (OR: 6.81, P < 0.001, OR: 23.32, P < 0.001, OR:4.01, P = 0.02, and OR: 6.30, P = 0.01; respectively). BsmI CT/TT genotypes were found to increase AVN risk with an HR of 3.48 (P = 0.03). Higher hemoglobin levels were also found to decrease AVN risk with an HR of 0.76 (P = 0.05). Conclusion: Certain VDR gene polymorphisms are associated with a higher risk for bone diseases after kidney transplantation.

Combining clinical features and MEST-C score in IgA nephropathy may be a better determinant of kidney survival.

Introduction. IgA nephropathy (IgAN) is a heterogeneous disease with highly variable clinical and histopathological features. We investigated the effects of Oxford classification and clinical features on renal survival in patients with IgAN.Methods. This retrospective observational study conducted from 2013 to 2017. Ninety-seven patients who were followed up more than six months were examined.Results. A total of 97 patients (68% male and median age 40 years) were enrolled in this study. 13% of patients developed end stage renal disease (ESRD) within the median of 37 months of follow-up. Need for renal replacement therapy at the time of diagnosis, serum creatinine level of higher than 1.97 mg/dl, serum albumin level less than 3.5 gr/dl, 24-hour urine protein level of higher than > 3.5 g/day, the percentage of glomerulosclerosis higher than 53%, T2 score and total MEST-C score higher than two were found to be significant predictors of development of ESRD. None of the clinical or histopathological features were found to be significant predictor of steroid treatment sensitivity except T1-2 scores.Conclusion. We think that IgA nephropathy is a heterogeneous disease that requires clinical and histopathological features to be evaluated together, but not individually, to determine renal survival.What is new. Iga nephropathy is a heterogeneous disease and modern pathologic classification systems is not enough to predict to prognosis. Histopathological features to be evaluated with clinical features, but not individually, to determine renal survival. Also glucocorticoid treatment response seems to be independent from clinical and histopathological features except T1-2 score.

Effects of medium cut-off dialysis membranes on inflammation and oxidative stress in patients on maintenance hemodialysis.

PURPOSE: Medium cut-off membranes were developed for providing increased clearance of larger middle-molecule uremic toxins. We compared the effect of low-flux, medium cut-off, and high-flux membranes on chronic inflammation and oxidative stress in patients with maintenance hemodialysis. METHODS: A total of 42 patients were enrolled in this study. Total antioxidant status, total oxidant status, paraoxonase-1, ischemia-modified albumin, total Thiol, disulfide bond, and native Thiol were measured to determine oxidative stress. C-reactive protein was measured to define inflammation. RESULTS: 37% of the total patients were females, and the mean age was 52.9 ± 16 years. Serum albumin and Kt/V were similar between groups during the study period. We did not find any significant difference at baseline in the 3rd and 6th months of the study when we compared the inflammatory marker and oxidative indicator levels between three hemodialysis membranes in the whole study group. In the subgroup analysis of 19 patients with a high C-reactive protein level, we found that the medium cut-off membrane significantly reduced serum C-reactive protein level, when compared to low-flux and high-flux membrane [2.8 mg/L vs. 13.7 mg/L and 6.1 mg/L, respectively, p = 0.05]. However, we did not find a significant change in oxidative stress indicators in patients with high C-reactive protein levels between the three dialysers. CONCLUSION: The medium cut-off membrane has favorable effects on inflammation in patients with maintenance hemodialysis. However, this positive effect could not be demonstrated in oxidative stress.

Late Acute Cellular Rejection After Anakinra Treatment in a Kidney Transplant Patient, Is It a Coincidence?

Familial mediterranean fever (FMF) is an autosomal recessive auto-inflammatory disorder, which could lead to secondary (AA) amyloidosis. Anakinra is an IL-1 receptor blocker and a treatment option for patients with FMF. There is no reported rejection episode associated with the use of Anakinra in the literature. A fortynine years old woman with a history of kidney transplantation is described here. Anakinra was initiated in the patients whose FMF attacks were exacerbated, and the inflammation could not be controlled under the colchicine treatment. After eight months of follow up under Anakinra treatment, a moderate but persistent increase in serum creatinine level was observed. Allograft biopsy was compatible with acute T cell-mediated rejection with BANFF type 2A. Data on the use of Anakinra in KTRs is limited. Antidrug- antibodies or hapten induced T cell activation may facilitate late-onset acute T cell-mediated rejection in the patient who used Anakinra.

Early Diagnostic Markers for Detection of Acute Kidney Injury in Allogeneic Hematopoietic Stem Cell Transplant Recipients.

OBJECTIVES: Acute kidney injury is a relatively frequent complication of allogenic hematopoietic stem cell transplant, resulting in increased risk of morbidity and mortality. Early diagnosis and management of acute kidney injury is of great importance for prevention of poor outcomes in these transplant recipients. MATERIALS AND METHODS: Fifty consecutive patients, hospitalized for allogenic hematopoietic stem cell transplant at the Bone Marrow Transplantation Unit of Gazi University Faculty of Medicine, were included in this prospective study. Serial measurements of serum creatinine and creatinine clearance were obtained before administration of conditioning regimen and at 0, 7, 14, 21, and 28 days after start of conditioning. Blood and urine samples were also obtained for the measurement of serum cystatin C and urine neutrophil gelatinase-associated lipocalin levels before conditioning and 24 hours before each serum creatinine measurement. RESULTS: During the median 25 days of follow-up, acute kidney injury developed in 19 patients: 10 patients had stage 1, 7 had stage 2, and 2 had stage 3 acute kidney injury according to the Acute Kidney Injury Network classification. There were significant positive correlations between serum cystatin C levels and serum creatinine levels and negative correlations with creatinine clearance levels at each time point (P < .001), whereas no statistically significant associations were observed with urinary neutrophil gelatinase-associated lipocalin levels. Both univariate and multivariate Cox regression models showed a statistically significant association between serum cystatin C levels and development of acute kidney injury, whereas urine neutrophil gelatinase-associated lipocalin levels did not show any significant associations. CONCLUSIONS: Serum cystatin C levels might be a useful marker for early detection of acute kidney injury in adult allogenic hematopoietic stem cell transplant recipients. Close monitoring of kidney function by sensitive biomarkers might provide early recognition and timely management of acute kidney injury in high-risk patient populations.

Evaluation of Clinical, Laboratory and Treatment Modalities in C3 Glomerulopathy: Single Center Experience.

BACKGROUND/AIM: C3 glomerulopathy (C3GP) defines a rare group of glomerulonephritis (GN), which could lead to end stage renal disease (ESRD). Histopathologic features of the disease have yet to be defined and the prognostic factors and optimal treatment are not fully known. The purpose of this study was to determine the demographic, histological change, treatment modalities and outcomes among patients with C3GP. MATERIAL AND METHOD: This retrospective observational study was conducted in the Department of Nephrology, Gazi University, Ankara, from 2013 to 2017. All patients with kidney biopsies fulfilling the criteria for C3GP were included in the study. RESULTS: Twenty-four patients with C3GP (50% male and of middle age - 43 years old) were enrolled in this study. 21% (5/24) patients developed ESRD. Renal biopsy findings such as crescent formation, glomerulo-sclerosis and tubular atrophy were similar in patients with ESRD, when compared to patients who did not develop ESRD. The treatment modalities of the patients were examined in two groups as MMF based and non-MMF based. The difference in the preservation of eGFR did not reach statistical significance between these two groups. The success rate of complete remission was similar between both groups. Serum creatinine levels >2.3 mg/dl at admission and need for renal replacement treatment (RRT) were associated with decreased renal survival. CONCLUSION: MMF based or non-MMF based treatments have similar efficacy in C3GP. Serum creatinine level higher than 2.3 mg/dl at the time of diagnosis and need for RRT during admission are a strong predictor of ESRD with high sensitivity and specificity.

A very rare pathogen in peritoneal dialysis peritonitis: Serratia liquefaciens.

Peritoneal dialysis (PD) peritonitis has been decreasing in frequency in recent years. However, it still causes significant morbidity and mortality. Nearly 1%-6% of all peritonitis attacks result in death. Hospitalizations, loss of PD access, and intravascular catheter insertion for hemodialysis are some examples of morbidity. Approximately 15%-20% of the infectious mortality of PD patients is attributed to peritonitis. The responsible pathogens are usually Gram-positive bacteria, but unusual pathogens may be present. Prognosis is worse when Gram-negative and fungal pathogens are involved. We report a case of Serratia liquefaciens peritonitis due to defiance of hygienic practices which presented with severe abdominal pain and fever and led to loss of PD access.

Coeliac crisis mimicking nephrotic syndrome in a post-partum patient.

BACKGROUND: Coeliac crisis is a life-threatening presentation of coeliac disease. Severe diarrhoea, weight loss, electrolyte imbalances and malnutrition are prominent features. Although mainly a disease of childhood, it can on the rare occasion be diagnosed in adults. CASE PRESENTATION: A 25-year-old female with severe generalised oedema, lower extremity weakness, hypokalemia and profound hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. Three months previously she had given birth to a healthy child following an uneventful pregnancy. She did not have proteinuria. She had a history of diarrhoea with gluten-containing food since childhood but lacked a formal diagnosis of coeliac disease. A duodenal biopsy confirmed the suspected diagnosis. Coeliac crisis was diagnosed with life-threatening multisystem involvement. Introduction of a gluten-free diet abolished all disease symptoms and ameliorated laboratory parameters at six months' follow-up. CONCLUSION: Coeliac crisis is a rare, yet dangerous presentation of coeliac disease in adults. As this case suggests, it can present with generalised oedema and hypoalbuminemia mimicking nephrotic syndrome. Rapid diagnosis is the key to successful treatment.

Higher ultrafiltration rate is associated with right ventricular mechanical dispersion.

OBJECTIVE: Ultrafiltration rate is one of the major determinants of adverse outcomes in patients undergoing hemodialysis (HD) therapy. Previous studies have focused on the impact of HD on right ventricular (RV) peak strain values. However, the influence of HD on the temporal characteristics of deformation has not been reported yet. The aim of the present study was to evaluate the impact of high ultrafiltration rate (HUR) on RV mechanical dyssynchrony. METHODS: Echocardiographic images focused on the RV and left ventricle (LV) were obtained from 60 patients (49.2+-17.3 years, 22 female) before and after HD. Patients were divided into two groups according to ultrafiltration rate. Changes in echocardiographic parameters with HD were examined. Two-dimensional speckle-tracking strain analysis was used to assess deformation. Mechanical dispersion was measured as the standard deviation of time to peak longitudinal strain of six segments for RV and 18 segments for LV. RESULTS: The average ultrafiltrated volume and ultrafiltration rate were 3000.1+-1007.9 mL and 11.4+-2.9 mL/kg/h, respectively. Global longitudinal strain (GLS) of the RV and LV decreased after HD in both groups. A significant difference was observed in RV mechanical dispersion with HD for patients in the high ultrafiltration group. A mild statistically insignificant increase in LV mechanical dispersion was also observed after HD. CONCLUSION: HUR has a substantial impact on LV and RV GLS and RV dyssynchrony. Ultrafiltration rates and volumes should be kept as low as possible to achieve hemodynamic stability and tolerability.

High neutrophil to lymphocyte ratio predicts acute allograft rejection in kidney transplantation; a retrospective study

Background/aim: Our research focused on the identification of easily available and sensitive markers for early prediction of acute kidney allograft rejection (AR). We aimed to investigate the association between neutrophil-to-lymphocyte ratio (NLR) and AR in kidney transplant patients. Materials and methods: The medical records of 51 kidney transplant patients [12 female/39 male; median age of 32 (IQR: 24­44) years] were evaluated retrospectively. We considered a cut-off value of >2.5 as high NLR. Results: A total of 22 biopsy-proven AR patients and 29 controls were evaluated. The AR group had a higher NLR compared to the controls (P < 0.001). NLR levels over 2.5 [95% CI: 54.88 (9.96­302.3), P < 0.001] were significantly associated with AR in univariate analysis. The NLR levels were the only significant factor associated with AR in multivariate models, in model 1 (adjusted by age and sex) [95% CI: 114 (11.1­1175), P < 0.001], and in model 2 (adjusted by steroid dosage, uric acid, and NLR) [95% CI: 4.60 (1.59­29.3), P = 0.004]. Conclusions: Our data showed that higher NLR values (>2.5) are associated with AR in kidney transplant patients, leading to the conclusion that NLR might be an easily available and useful marker option for detection of AR in this patient population.

Relationship between plasma YKL-40 levels and endothelial dysfunction in chronic kidney disease

Background/aim: We aimed to evaluate the relationship between YKL-40 and endothelial dysfunction in chronic kidney disease. Materials and methods: Twenty-nine hemodialysis patients, 101 patients with nondialytic (stage 2, 3, 4, and 5 ND) chronic kidney disease (CKD), and 38 healthy individuals as a control group were included. YKL-40 levels were measured by ELISA. Endothelial dysfunction was indirectly measured by flow-mediated dilatation percentage (FMD) in the brachial artery.YKL-40 levels were higher in CKD patients than controls and highest in HD patients (P = 0.001). FMD values were lower in nondialytic CKD patients and lowest in HD patients (P = 0.001). YKL-40 negatively correlated with eGFR and FMD values (r = ­0.674 and r = ­0.471, respectively).This study shows that YKL-40 increases with CKD stage and is negatively correlated with FMD measurements

Hemodialysis Experience of a Large Group of Syrian Refugees in Turkey: All Patients Deserve Effective Treatment.

BACKGROUND/AIMS: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. METHODS: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. RESULTS: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. CONCLUSION: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.