The relationship between changes in peritoneal membrane solute transfer characteristics and cardiac remodeling in patients with peritoneal dialysis.

INTRODUCTION: We aimed to determine the relationship between the dilatation of the heart chambers and the change in peritoneal membrane solute transfer characteristics (PMTC) in long-term peritoneal dialysis (PD) patients. METHODS: This is a retrospective, single-center study including the follow-up of maintenance PD patients. According to the changes in PMTC from baseline to the last visit, patients were divided into three groups; stable (n = 11), increased (n = 41), and decreased transporters (n = 35). RESULTS: Left atrium (LA) and Right ventricle (RV) dilatation were more prominent in the PMTC-decreased group compared to PMTC-increased and stable groups (p < 0.001 and p = 0.07, respectively). The Cox regression analysis showed that only decreased PMTC was associated with LA dilatation (HR 2.89 [CI 95%1.54, 5.45] p < 0.01) and RV dilatation (HR 3.01 [CI 95%1.40, 6.21] p < 0.01). CONCLUSION: PD can be associated with unfavorable dynamic changes in cardiac structure and functions even at the subclinical level.

Non-diabetic nephropathy in diabetic patients: incidence, HbA1c variability and other predictive factors, and implications.

PURPOSE: Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) in the population. In patients with diabetes mellitus, the incidence of non-diabetic nephropathy (NDNP) has been estimated to range from 3% to 69.5%. Personal judgment is frequently employed while deciding whether or not to do a kidney biopsy (KB) on diabetic patients. NDNP alters the prognosis and course of treatment for people with DM. In our study, we examined the incidence of NDNP concurrent with the progression of diabetes mellitus, as well as the laboratory and clinical indicators that could be utilized to forecast it. METHODS: A retrospective analysis of 76 diabetic patients who underwent KB was conducted. Based on the pathological diagnoses of these patients, they were categorized as DNP (diabetic nephropathy) or NDNP. The definition of HbA1c variability was determined by calculating the mean HbA1c and the average value of the HbA1c measurements, as well as the standard deviation (SD) for each participant. RESULTS: NDNP was detected in 50% of 76 patients. Among patients with NDNP, 36.8% had focal segmental glomerulosclerosis (FSGS), 23.6% had membranous glomerulonephritis, and 7.8% had IgA nephritis. The NDNP group exhibited significantly higher rates of female gender, absence of diabetic retinopathy, shorter time to diagnosis of diabetes mellitus, chronic kidney disease, and proteinuria, less intensive medication for diabetes mellitus, presence of hematuria and leukociduria, immunological serological marker positivity, and non-HbA1C variability. Risk factors for predicting non-diabetic nephropathy, as determined by multivariate analysis, included female gender, the absence of diabetic retinopathy, non-HbA1c variability and a positive immunological serological test. CONCLUSION: In this study, a significant number of diabetic patients with chronic kidney disease were diagnosed with NDNP. Identifying these patients allows for treatment of the specific underlying disease. Factors such as the absence of DR, non-HbA1c variability, female gender, and immunological serological test positivity can predict NDNP and guide the clinician's decision on kidney biopsy. Further prospective studies are warranted to validate the efficacy of potential predictive factors like HbA1c variability.

The association between geriatric nutritional risk index variability and mortality in peritoneal dialysis patients.

BACKGROUND: The objective of this study is to examine the association between the Geriatric Nutritional Risk Index (GNRI) and overall mortality in this population. METHODS: GNRI values were calculated by using the serum albumin levels and body weight and the GNRI variability reflects the changes in GNRI change slopes in the follow-up. RESULTS: GNRI values showed a decrease from the median baseline GNRI of 106.3 (IQR, 95.0,113.4) to 98.4 (interquartile range [IQR], 91.9108.9) (p < 0.001). The median GNRI variability was 4.7 (IQR, 2.5, 10.3). Both baseline GNRI levels (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93, 0.99, p = 0.04) and more profoundly GNRI variability (adjusted OR: 1.23, 95% CI: 1.01, 1.44, p = 0.03) were independently associated with mortality. CONCLUSION: The monitorization of the changes in GNRI values as a variability index is an easy tool that might improve the predictive accuracy of mortality in peritoneal dialysis patients.

Is vitamin d insufficiency associated with mortality of critically ill patients?

Objective. To evaluate the vitamin D status of our critically ill patients and its relevance to mortality. Patients and Methods. We performed a prospective observational study in the medical intensive care unit of a university hospital between October 2009 and March 2011. Vitamin D levels were measured and insufficiency was defined as <20 ng/mL. Results. Two hundred and one patients were included in the study. The median age was 66 (56-77) and the majority of patients were male (56%). The median serum level of vitamin D was 14,9 ng/mL and 139 (69%) patients were vitamin D insufficient on admission. While we grouped the ICU patients as vitamin D insufficient and sufficient, vitamin D insufficient patients had more severe acute diseases and worse laboratory values on admission. These patients had more morbidities and were exposed to more invasive therapies during stay. The mortality rate was significantly higher in the vitamin D insufficient group compared to the vitamin D sufficient group (43% versus 26%, P = 0,027). However, logistic regression analysis demonstrated that vitamin D insufficiency was not an independent risk factor for mortality. Conclusion. Vitamin D insufficiency is common in our critically ill patients (69%), but it is not an independent risk factor for mortality.