The factors that are associated with itching in chronic kidney patients and evaluation of itching with the 5d itch scale.

OBJECTIVE: Uremic pruritus is a distressing complication of chronic kidney disease (CKD), associated with mortality, and negatively impacts quality of life. The 5D-Itch Scale (5D-IS) is an easy-to-apply technique that evaluates 5 different dimensions of itching such as duration, severity, course, disability, and prevalence. We aimed to investigate the prevalence of itching in different CKD stages using the 5D-IS and to investigate the factors associated with itching in CKD patients. MATERIALS AND METHODS: 5D-IS was used to evaluate itching in chronic hemodialysis (HD) and Stage 3-5 CKD patients. Total itching score and sub-scores consist of duration, severity, course, disability and distribution were obtained. Itching scores and prevalence according to CKD stages were investigated. Also the relationships between itching scores and some laboratory and clinical parameters such as iPTH, Ca, P, CRP levels were examined. RESULTS: 158 CKD patients included in the study included (110 Stage 3-5 and 48 HD). The frequency of itching was higher in HD patients than in predialysis patients (62.5% vs 46.4%; p = 0.04). The total itching score increased along with CKD stages 3 to 5 (7.75 ± 3.39, 7.82 ± 4.11 and 9.08 ± 5.12 respectively; p = 0.14). The severity, duration and course scores of itching were similar between the groups, but the distribution scores increased as the CKD stage increased. The laboratory and clinical characteristics of patients with and without itching were not different. Even if a significant positive correlation was detected between the parathyroid hormone levels and both the total 5D-IS scores and all of the sub-scores, Ca and P values were not correlated with itching scores. In the multiple regression analysis, the only parameter that had an effect on the total 5D-IS Score was the parathyroid hormone level. CONCLUSION: In CKD, itching affects 40-70% of patients from the early stages. As the CKD stage increases, itching spreads throughout the body. The only parameter that seems to be associated with itching is the PTH level.

The frequency of sarcopenia has increased in patients with glomerulonephritis.

AIM: Sarcopenia is defined as the loss of muscle mass and muscle strength, and its frequency increases in kidney patients. However, sarcopenia frequency in patients with glomerulonephritis is unknown. The present study aimed to investigate the frequency of sarcopenia in patients with glomerulonephritis and compare the results with the healthy population for the first time in the literature. PATIENTS AND METHODS: A total of 110 participants, including 70 patients previously diagnosed with glomerulonephritis and 40 healthy individuals, were included in the study. The diagnosis of sarcopenia was made based on the EWSGOP 2 Criteria. RESULTS: The mean age of the glomerulonephritis patients group was 39.3 ± 1.5. In the anthropometric measurements of the patients, walking speed was low in 50 patients (71.4%), muscle strength was decreased in 44 patients (62.9%), and sarcopenia was detected in 10 patients (14.3%) according to the EWGSOP 2 Criteria. Considering the anthropometric measurements of the control group, sarcopenia was not detected in any of the subjects according to the EWGSOP 2 Criteria. CONCLUSION: The result of the present study revealed that the rate of sarcopenia was significantly higher in glomerulonephritis patients compared to the healthy population and that sarcopenia can also be observed even in middle age in this population. We think it would be beneficial for clinicians treating glomerulonephritis to be more careful regarding sarcopenia and keep these parameters in mind during treatment.

The effect of autosomal dominant polycystic kidney disease on mucociliary clearance.

PURPOSE: Autosomal dominant polycystic kidney disease (ADPKD) is a renal disease with genetic transmisson. Mutations in the PKD1 and PKD2 genes, which encode integral membrane proteins of the cilia of primary renal tubule epithelial cells, are seen in ADPKD. The aim of this study was to evaluate the sinonasal epithelium, which is epithelium with cilia, by measuring the nasal mucociliary clearance time, and to investigate the effect of ADPKD on nasal mucociliary clearance. METHODS: The study included 34 patients, selected from patients followed up in the Nephrology Clinic, and 34 age and gender-matched control group subjects. The nasal mucociliary clearance time (NMCT) was measured with the saccharin test. RESULTS: The mean age of the study subjects was 47.15 ± 14.16 years in the patient group and 47.65 ± 13.85 years in the control group. The eGFR rate was determined as mean 72.06 ± 34.26 mL/min in the patient group and 99.79 ± 17.22 mL/min in the control group (p < 0.001). The NMCT was determined to be statistically significantly longer in the patient group (903.6 ± 487.8 s) than in the control group (580 ± 259 s) (p = 0.006). CONCLUSIONS: The study results showed that the NMCT was statistically significantly longer in patients with ADPKD compared to the control group, but in the linear regression analysis results, no correlation was determined between eGFR and NMCT.

The amount of skeletal muscle mass is associated with arterial stiffness in hemodialysis patients.

INTRODUCTION: Sarcopenia was determined to be associated with increased arterial stiffness in the nondialysis patient population, but there is no available data on this subject in dialysis patients. METHODS: A total of 79 patients were included in the study. Sarcopenia was diagnosed according to the EWSGOP-2 criteria. Arterial stiffness was measured noninvasively with a mobile-O-Graph device. RESULTS: Skeletal muscle mass was observed to be positively correlated with weight, body mass index, creatinine, and uric acid, while negatively correlated with augmentation index. There was a correlation between augmentation index and sodium, phosphorus, systolic blood pressure, diastolic blood pressure, cardiac index, muscle percentage, fat percentage, and skeletal muscle mass. When the determinants of augmentation index in the linear regression analysis were viewed, just the systolic blood pressure and skeletal muscle mass were observed to be the determinant. CONCLUSION: Decreased skeletal muscle mass contributes to increased arterial stiffness in hemodialysis patients.

The relationship between hepatic fibrosis and arterial stiffness in hemodialysis patients.

INTRODUCTION: The main cause of death in hemodialysis patients is cardiovascular diseases. Increased arterial stiffness is a predictor of cardiovascular events for hemodialysis patients. Among the nondialysis patient population, arterial stiffness increases in those with hepatic fibrosis and nonalcoholic fatty liver disease. This study aims to examine the relationship between hepatic fibrosis and arterial stiffness in hemodialysis patients for the first time in the literature. MATERIAL AND METHOD: The study includes chronic hemodialysis patients over 18 years of age who had been treated for hemodialysis for at least 6 months. Patients with chronic liver disease, chronic viral hepatitis (HBV and HCV), alcohol use, or liver disease accompanied by polycystic kidney disease and active infection were excluded. Hepatic fibrosis scores were measured using the FibroScan device. Single-cuff Mobil-o-Graph was used for measurement of arterial stiffness. RESULTS: Fifty-nine patients were enrolled; 54.2% of the patients were male, and the mean age was 53.9 ± 12.9 years. Thirty-nine percent of the patients had diabetes. Average pulse wave velocity (PWV) value of the patients was 8.3 ± 1.6 m/s, and it had positive correlation with age, CAP score, fibrosis score, and body mass index and showed negative correlation to albumin. It was seen that the patients with a PWV value ≥ 10 m/s have significantly higher CAP score compared with the patients with a PWV < 10 m/s. When the factors predicting PWV were examined in the regression analysis, age and systolic blood pressure were found to be determinants. CONCLUSION: Increased hepatic fibrosis in hemodialysis patients is associated with increased arterial stiffness, but this relationship is not independent.

Demographic, clinical and laboratory characteristics of rapidly progressive glomerulonephritis in Turkey: Turkish Society of Nephrology-Glomerular Diseases (TSN-GOLD) Working Group.

BACKGROUND: In our study, diagnostic and demographic characteristics of patients diagnosed with RPGN by biopsy, clinical and laboratory findings in our country were investigated. METHODS: Data were obtained from the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group database. Demographic characteristics, indications for biopsy, diagnosis of the glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were recorded. According to their types, RPGN patients were classified as type 1 (anti-GBM related), type 2 (immuncomplex related) and type 3 (pauci-immune). RESULTS: Of 3875 patients, 200 patients with RPGN (mean age 47.9 ± 16.7 years) were included in the study which constitutes 5.2% of the total glomerulonephritis database. Renal biopsy was performed in 147 (73.5%) patients due to nephritic syndrome. ANCA positivity was found in 121 (60.5%) patients. Type 1 RPGN was detected in 11 (5.5%), type 2 RPGN in 42 (21%) and type 3 RPGN in 147 (73.5%) patients. Median serum creatinine was 3.4 (1.9-5.7) mg/dl, glomerular filtration rate was 18 (10-37) ml/min/1.73m2 and proteinuria 2100 (1229-3526) mg/day. The number of crescentic glomeruli ratio was ratio 52.7%. It was observed that urea and creatinine increased and calcium and hemoglobin decreased with increasing crescentic glomerular ratio. CONCLUSIONS: Our data are generally compatible with the literature. Advanced chronic histopathological findings were prominent in the biopsy of 21 patients. Early biopsy should be performed to confirm the diagnosis of RPGN and to avoid unnecessary intensive immunosuppressive therapy. In addition to the treatments applied, detailed data, including patient and renal survival, are needed.

The relation between epicardial fat tissue thickness and atrial fibrillation in hemodialysis patients.

The prevalence of arrhythmia has increased in hemodialysis (HD) patients and the most frequent is atrial fibrillation (AF). It was reported that the amount of epicardial fat tissue (EFT) in the population without renal disease is closely related to AF. In the present study of ours, the relation between EFT thickness and AF was examined in HD patients. A total of 79 patients who underwent HD for periods longer than 3 months were included in the study. The mean age of the patients was 53.6 ± 15.2 years and 50.6% were male. The mean EFT thicknesses were measured as 7.2 ± 2.3 mm (3-12). A positive correlation was found between the EFT thickness and age, C-reactive protein, and left ventricle rear wall thickness. AF was found in 18 (22.8%) patients in the Holter ECG examination. When the group with AF was compared with the non-AF group; although the mean HD duration of the group with AF was longer, there were no significant differences in terms of epicardial adipose tissue thickness and other parameters. In the present study, no relations were found between EFT thickness and AF frequency in HD patients. Further studies with a larger number of the patient population are needed in this regard.

Ultrasound Elastography Evaluations in Patient Populations With Various Kidney Diseases.

Renal elastography is an ultrasonographic method that has been recently found to provide information on renal functions and fibrosis. In this study, we aimed to investigate the relationship between elastography scores and renal functions and proteinuria levels in patient populations with various kidney diseases. Seventy-five diabetic nephropathy patients, 66 kidney transplant patients, and 45 glomerulonephritis patients were included in the study. The amount of proteinuria was measured according to the protein-to-creatinine ratio in spot urine samples. The estimated glomerular filtration rate (eGFR) was calculated according to the Modification of Diet in Renal Disease formula. Ultrasound elastography scores were measured in each patient group by a radiologist. The mean age of diabetic nephropathy patients was 61 ± 10 years. The mean elastography score was 0.96 ± 0.30. Elastography score was positively correlated with serum blood urea nitrogen and creatinine levels and was negatively correlated with eGFR value. The mean age of kidney transplant patients was 42 ± 12 years. The mean elastography score was 1.10 ± 0.38. There was a significant relationship between elastography score and proteinuria level. The mean age of glomerulonephritis patients was 37 ± 13 years. The mean elastography score was 0.91 ± 0.41. Elastography score was positively correlated with serum blood urea nitrogen and creatinine levels. However, there was no relationship between elastography score and eGFR value and proteinuria level. Although renal elastography provides information on renal functions and proteinuria in patients with diabetic nephropathy, renal transplant, and glomerulonephritis, there is a need for studies with a larger number of patients on this subject.

Does neutrophyl to lymphocyte ratio really predict chronic kidney disease progression?

PURPOSE: Chronic kidney disease (CKD) is an inflammatory process. In addition to increased morbidity and mortality, inflammation also contributes to the progression of CKD. Neutrophil/lymphocyte ratio (NLR) is a marker of inflammation. Some recent data suggest that NLR may predict the progression of CKD. METHODS: In this study, 5-year data of 740 patients with stage 2-4 CKD were reviewed retrospectively. Demographic data, NLR, CRP, albumin, the amount of proteinuria were recorded. At the beginning and the end of follow-up the glomerular filtration rate (GFR) and the annual GFR decline rate were calculated. Patients were divided to high and low NLR group according to median value of their baseline NLR. Reaching stage 5 CKD or initiation of renal replacement therapy was determined as end-point for follow-up. RESULTS: The mean age was 62.8 ± 0.57 years, eGFR 40 ml/min/1.73 m2, median NLR was 2.76. NLR increased as the CKD-stage increased. Mean follow-up time was 51.2 ± 30 months and 21.4% of patients reached the end-point. NLR was significantly increased at follow-up (from 3.22 to 5.68, p < 0.001). Annual GFR loss and baseline CRP were higher but baseline albumin and GFR were lower of patients with high NLR. The percent of patients reaching the end-point was not different between the groups with high and low baseline NLR. Kaplan Meier analysis showed that patients with high NLR had significantly lower mean renal survival (86.5 months) than patients with low NLR (105 months) (p < 0.001). In the Cox-regression analysis NLR was not an independent predictor in reaching the end-point but presence of diabetes mellitus, younger age and low baseline eGFR were found effective. CONCLUSIONS: NLR is an indicator of inflammation in chronic kidney disease. It may not be an independent predictor of CKD progression except that the CKD is in a more advanced stage and reflects the associated inflammation. Classical risk factors such as DM and lower GFR are more powerful predictors of progression.

Evaluation of Atrial Electromechanical Delay to Predict Atrial Fibrillation in Hemodialysis Patients.

Background and objective: Prevalence of atrial fibrillation is higher in hemodialysis patients as compared to the general population. Atrial electromechanical delay is known as a significant predictor of atrial fibrillation. In this study, we aimed to reveal the relationship between atrial electromechanical delay and attacks of atrial fibrillation. Materials and methods: The study included 77 hemodialysis patients over 18 years of age giving written consent to participate in the study. The patients were divided into two groups based on the results of 24-h Holter Electrocardiogram (Holter ECG) as the ones having attacks of atrial fibrillation and the others without any attack of atrial fibrillation. Standard echocardiographic measurements were taken from all patients. Additionally, atrial conduction times were measured by tissue Doppler technique and atrial electromechanical delays were calculated. Results: Intra- and interatrial electromechanical delay were found as significantly lengthened in the group of patients with attacks of atrial fibrillation (p = 0.03 and p < 0.001 respectively). The optimal cut-off time for interatrial electromechanical delay to predict atrial fibrillation was >21 ms with a specificity of 79.3% and a sensitivity of 73.7% (area under the curve 0.820; 95% confidence interval (CI), 0.716⁻0.898). In the multivariate logistic regression model, interatrial electromechanical delay (odds ratio = 1.230; 95% CI, 1.104⁻1.370; p < 0.001) and hypertension (odds ratio = 4.525; 95% CI, 1.042⁻19.651; p = 0.044) were also associated with atrial fibrillation after adjustment for variables found to be statistically significant in univariate analysis and correlated with interatrial electromechanical delay. Conclusions: Interatrial electromechanical delay is independently related with the attacks of atrial fibrillation detected on Holter ECG records in hemodialysis patients.

Acute renal infarction in Turkey: a review of 121 cases.

PURPOSE: Renal infarction is a clinical condition which is caused by renal artery occlusion and leads to permanent renal parenchymal damage. In the literature, there are generally case reports on this subject, and few studies that include a large group of patients. Therefore, we aimed to present the data of a large group of patients who were diagnosed with acute renal infarction in our country in this retrospective study. METHODS: The data of patients who were diagnosed with acute renal infarction according to clinical and radiological findings in Turkey in the last 3 years were examined. For this purpose, we contacted with more than 40 centers in 7 regions and obtained support from clinically responsible persons. Demographic data of patients, laboratory data at the time of diagnosis, tests performed for etiologic evaluation, given medications, and patients' clinical status during follow-up were obtained from databases and statistical analysis was performed. RESULTS: One-hundred and twenty-one patients were included in the study. The mean age was 53 ± 1.4 (19-91) years. Seventy-one (58.7%) patients were male, 18 (14.9%) had diabetes, 53 (43.8%) had hypertension, 36 (30%) had atrial fibrillation (AF), and 6 had a history of lupus + antiphospholipid syndrome (APS). Forty-five patients had right renal infarction, 50 patients had left renal infarction, and 26 (21.5%) patients had bilateral renal infarction. The examinations for the ethiologies revealed that, 36 patients had thromboemboli due to atrial fibrillation, 10 patients had genetic anomalies leading to thrombosis, 9 patients had trauma, 6 patients had lupus + APS, 2 patients had hematologic diseases, and 1 patient had a substance abuse problem. Fifty-seven (57%) patients had unknown. The mean follow-up period was 14 ± 2 months. The mean creatinine and glomerular filtration rate (GFR) values at 3 months were found to be 1.65 ± 0.16 mg/dl and 62 ± 3 ml/min, respectively. The final mean creatinine and GFR values were found to be 1.69 ± 0.16 mg/dl and 62 ± 3 ml/min, respectively. CONCLUSIONS: Our study is the second largest series published on renal infarction in the literature. More detailed studies are needed to determine the etiological causes of acute renal infarction occurring in patients.

IL-33 and ST2 levels in chronic kidney disease: Associations with inflammation, vascular abnormalities, cardiovascular events, and survival.

OBJECTIVE: Increased inflammation, associated with the increase in chronic kidney disease (CKD) stage, has a very important influence in vascular injury and cardiovascular diseases. In this study, we aimed to investigate the levels of IL-33 and ST2 in the different stages of CKD and to determine their effect on vascular damage and cardiovascular events (CVE). METHODS: This was an observational cohort study in which serum IL-33 and ST2 were obtained from 238 CKD (stages 1-5) patients. We examined the changes in IL-33/ST2 levels in CKD patients, as well as the association with a surrogate of endothelial dysfunction. Fatal and non-fatal CVE were recorded for a mean of 24 months. We also performed a COX regression analysis to determine the association of IL-33/ST2 levels with CVE and survival. RESULTS: IL-33 and ST2 levels were significantly increased and estimated glomerular filtration rates (eGFR) were decreased. Flow-mediated dilatation (FMD) was significantly decreased from stage 1 to stage 5 CKD. IL-33 and ST2 levels were associated with FMD, and ST2 was a predictor. Multivariate Cox analysis showed that the presence of diabetes mellitus, smoking, and proteinuria and haemoglobin, Hs-CRP, IL-33, and ST2 were associated with the risk of CVE. Kaplan-Meier survival curves showed that patients with IL-33 and ST2 levels below the median value (IL-33 = 132.6 ng/L, ST2 = 382.9 pg/mL) had a higher cumulative survival compared with patients who had IL-33 and ST2 levels above the median value (log-rank test, p = 0.000). CONCLUSION: This is the first study that demonstrates that serum IL-33 and ST2 are associated with vascular injury, cardiovascular events, and survival in CKD patients.