Evaluation of the relationship between acute kidney injury and renin angiotensin system inhibition in COVID-19 patients.

OBJECTIVE: In patients with coronavirus disease 2019 (COVID-19), acute kidney injury (AKI) may alter the clinical course and outcome of the disease. In this study, the association of AKI with renin angiotensin system (RAS) inhibitor treatment and its clinical consequences were examined in COVID-19 patients admitted to our hospital during the initial stages of the pandemic. METHODS: A total of 407 patients between 18 and 85 years of age (202 male and 205 female) admitted to the Umraniye Research And Training Hospital between May 2020 and August 2020 with a diagnosis of COVID-19 were included in the study. Patients were categorized as follows: Group 1, subjects with no chronic conditions (n=150); and Group 2, subjects with comorbid conditions (n=257). Group 2 was subdivided into Group 2A (receiving angiotensin receptor blocker [ARB])/(angiotensin converting enzyme inhibitor [ACEI], n=81), and Group 2B (not receiving ARB/ACEI, n=176). RESULTS: Hypertension was the most frequent comorbid condition (36.4%). There was no difference in survival rates between the patients who used RAS inhibitor and the ones who did not based on log rank test (p=0.342). Fifty-four patients (13.4%) had developed AKI during the time frame of the disease. In patients with chronic diseases such as hypertension, the use of RAS inhibitory medication was not associated with developing AKI (OR 95% CI: 0.317-1.358; p=0.256). The survival rate of the patients with AKI was significantly lower than patients without AKI (p<0.0001). CONCLUSION: COVID-19 may cause renal injury represents a risk factor for mortality. Therefore, detection of renal injury has a particular prognostic importance.

The first kidney transplantation after recipient and living donor recovered from COVID-19.

SARS-CoV-2 is still a major threat to the world. In this pandemic, transplantation activities have largely been affected worldwide. We are still facing with this pandemic; however, after regulations, we have started our transplantation activities. We report the first kidney transplantation whose recipient and living donor recovered from COVID-19. A 31-year-old male with renal failure was admitted for transplantation with an ABO-compatible relative. The recipient and the donor were tested for COVID-19 before transplantation, and they were both positive with a polymerase chain reaction. The recipient had minor symptoms and received therapy; the living donor also received therapy. Thirty days after recovery, surgery was performed successfully. The recipient was discharged with mycophenolate mofetil (MMF), tacrolimus, and steroid 15 days after surgery. In the follow-up, they were both negative for COVID-19 45 days after surgery. Although there is missing literature regarding safety concerns and short-term follow-up, living-donor transplantation may be considered for patients, who recovered from COVID-19, after careful selection with paying attention to precautions.

A case of dasatinib-induced focal segmental glomerulosclerosis in a patient with Philadelphia chromosome positive chronic myeloid leukemia.

Focal segmental glomerulosclerosis is a common glomerular histological lesion, which is usually characterised by non-nephrotic range proteinuria or nephrotic syndrome. It may be idiopathic or occurs secondarily to drugs, diabetes, obesity or HIV nephropathy and other infections. Dasatinib, a tyrosine kinase inhibitor that has been used for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia, has a few renal adverse effects. Exceptional cases with non-nephrotic range proteinuria have been reported in relation with dasatinib. In this case, we report a patient with symptoms of nephrotic syndrome and nephrotic range proteinuria, who was diagnosed as focal segmental glomerulosclerosis by kidney biopsy after treated with dasatinib.

Is FGF23 effective on insulin resistance in individuals with metabolic syndrome?

Purpose Metabolic syndrome (MetS) is a polymetabolic syndrome has high morbidity and mortality rates. Insulin resistance (IR) plays a key role in the increasing frequency of this situation and has been cited as being an important etiologic factor in MetS. In this study, the relationship between IR and fibroblast growth factor-23 (FGF23), was investigated in a population with MetS. Materials and methods Forty patients with diagnosis of MetS and 40 healthy volunteers with an equal number of males and females were included in the study and classified as patient group and control group. Blood samples were obtained after 12-h fasting period to study FGF23 and other parameters. MetS, defined according to the International Diabetes Federation (IDF) guidelines, FGF23 was studied by Enzyme-Linked ImmunoSorbent Assay (ELISA) method and IR was calculated using the homeostatic model assessment-insulin resistance (HOMA-IR) formula. Results There was a statistically significant difference in HOMA-IR between the patient and control group as expected, while levels of FGF23 were similar. According to gender, levels of FGF23 was statistically significantly higher in male patients compared with controls (p = 0.037). A relationship was not detected between HOMA-IR and FGF23 in the correlation analysis. Conclusion Although there are many studies suggesting the correlation between FGF23 and IR in different populations, we did not find any statistically significant relationship between IR and FGF23 levels in MetS in this study.

Burnout Syndrome Among Hemodialysis and Peritoneal Dialysis Nurses.

INTRODUCTION: Burnout, a syndrome with 3 dimensions of emotional exhaustion, depersonalization, and reduction of personal accomplishment, is very common among hemodialysis nurses, while data are scarce regarding the prevalence of burnout syndrome (BS) among peritoneal dialysis (PD) nurses. This study aimed to assess and compare demographic and professional characteristics and burnout levels in hemodialysis and PD nurses, and to investigate factors that increase the level of burnout in dialysis nurses. MATERIALS AND METHODS: A total of 171 nurses from 44 dialysis centers in Turkey were included in a cross-sectional survey study. Data were collected using a questionnaire defining the social and demographic characteristics and working conditions of the nurses as well as the Maslach Burnout Inventory for assessment of burnout level. RESULTS: There was no significant difference in the level of burnout between the hemodialysis and PD nurses groups. Emotional exhaustion and depersonalization scores were higher among the shift workers, nurses who had problems in interactions with the other team members, and those who wanted to leave the unit, as well as the nurses who would not attend training programs. In addition, male sex, younger age, limited working experience, more than 50 hours of working per week, and working in dialysis not by choice were associated with higher depersonalization scores. Personal accomplishment score was lower among the younger nurses who had problems in their interactions with the doctors, who would not regularly attend training programs, and who felt being medically inadequate. CONCLUSIONS: Improving working conditions and relations among colleagues, and also providing further dialysis education are necessary for minimizing burnout syndrome. Burnout reduction programs should mainly focus on younger professionals.

The Effects of Hemodialysis on Tear Osmolarity.

Aim. To determine the effects of hemodialysis (HD) on tear osmolarity and to define the blood biochemical tests correlating with tear osmolarity among patients with end stage renal disease (ESRD). Material-Method. Tear osmolarity of ESRD patients before and after the hemodialysis program was determined as well as the blood biochemical data including glucose, sodium, potassium, calcium, urea, and creatinine levels. Results. Totally 43 eyes of 43 patients (20 females and 23 males) with a mean age of 53.98 ± 18.06 years were included in the study. Tear osmolarity of patients was statistically significantly decreased after hemodialysis (314.06 ± 17.77 versus 301.88 ± 15.22 mOsm/L, p = 0.0001). In correlation analysis, pre-HD tear osmolarity was negatively correlated with pre-HD blood creatinine level (r = -0.366, p = 0.016). Post-HD tear osmolarity was statistically significantly correlated with the post-HD glucose levels (r = 0.305 p = 0.047). Tear osmolarity alteration by HD was negatively correlated with creatinine alteration, body weight alteration, and ultrafiltration (r = -0.426, p = 0.004; r = -0.365, p = 0.016; and r = -0.320, p = 0.036, resp.). There was no correlation between tear osmolarity and Kt/V and URR values. Conclusion. HD effectively decreases tear osmolarity to normal values and corrects the volume and composition of the ocular fluid transiently. Tear osmolarity alteration induced by HD is correlated with body weight changes, creatinine alterations, and ultrafiltration.

Relation of Complementary-Alternative Medicine use with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage.

AIM: Complementary and alternative medicine is a broad field of health including all health care practices and methods, and their accompanying theories and beliefs. In the present study, we aimed to examine the frequency of complementary-alternative medicine use, and its relation with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage. METHODS: A total of 1053 predialysis patients; 518 female and 535 male, that were followed up with chronic kidney disease for at least 3 months were enrolled into the study. Demographic features, biochemical parameters and findings of physical examination were recorded. Their compliance to diet, and knowledge about disease were questioned. Beck depression inventory and questionnaire regarding complementary-alternative medicine use were performed. RESULTS: The overall frequency of complementary-alternative medicine use was 40.3% . Total ratio of herbal products was 46%. Complementary-alternative medicine use was significantly more frequent in female or single patients, and patients that informed about chronic kidney disease or under strict diet (P = 0.007, P = 0.016, P = 0.02, P = 0.016, respectively). When glomerular filtration rate of participants were considered, complementary-alternative medicine use was similar in different stages of kidney disease. Depression was observed in 41.9% of patients and significantly frequent in patients with alternative method use (P = 0.002). Depression score was higher as creatinine increases and glomerular filtration rate decreases (P = 0.002; r = 0.093). CONCLUSION: We determined that complementary-alternative medicine use gradually increases at predialysis stage as glomerular filtration rate decreases and there is a strict relation between complementary-alternative medicine use and depression or female gender. Disorder related stressors may lead to seeking of alternative methods.

The relation of mean platelet volume with microalbuminuria and glomerular filtration rate in obese individuals without other metabolic risk factors: the role of platelets on renal functions.

INTRODUCTION: Mean platelet volume (MPV) is an indirect indicator of platelet activity that plays a major role in the pathogenesis of endothelial injury. Obese individuals have higher microalbuminuria which is the initial step of renal endothelial injury. We aimed to analyze the relation of microalbuminuria and MPV in obese individuals without metabolic risk factors. METHODS: A total of 290 obese individuals (body mass index (BMI)>30 kg/m2) without an accompanying chronic disorder, and 204 nonobese healthy subjects were enrolled into the study. All participants underwent physical examination. Biochemical, hemogram, and hormonal parameters along with urine albumin analysis were performed. Glomerular filtration rate (GFR) was measured by Cockcroft-Gault (GFRC&G), modification of diet in renal disease (MDRD). The BMI was calculated as weight/height2 (kg/m2). Logistic regression analysis was used to analyze relation of variables. RESULTS: The patient group consisted of 171 (59%) female (mean age: 37.15±8.05 years) and 119 (41%) male (mean age 38.98±10.68 years) obese individuals. 130 (63.7%) age matched female (mean age 36.18±8.26 years) and 74 (36.3%) age matched male (mean age 36.49±10.25 years) controls were assigned to the control group. There was a significant difference between groups with regard to BMI, spot microalbuminuria, spot urine microalbuminuria/creatinine ratio but not with to MPV and spot urine creatinine (p: 0.01, 0.004, 0.002; respectively). GFR measured by MDRD and Cockcroft-Gault formula were significantly higher in the obese group (p<0.001 for both). Correlation analysis revealed a significant correlation between BMI and spot urine microalbuminuria, spot urine microalbuminuria/creatinine ratio, GFR (Cockcroft-Gault Formula), Homeostasis Model Assessment of Insulin resistance (HOMA-IR), insulin, C-peptide, diastolic blood pressure, glucose, uric acid, total cholesterol, low density lipoprotein (LDL)-cholesterol, c-reactive protein (CRP), thyroid stimulating hormone (TSH), leukocyte count, platelet count. MPV was inversely and significantly correlated with spot urine creatinine, systolic blood pressure, triglyceride, C-peptide, and platelet count. Mean urea, creatinine, uric acid, triglyceride, total cholesterol, LDL-cholesterol, insulin, C-peptide, HOMA-IR were significantly higher in obese male individuals while obese female individuals had higher levels of mean high density lipoprotein (HDL), CRP, TSH, platelet count, spot urine microalbumin/creatinine rate, and GFR measured by MDRD. CONCLUSIONS: Obese individuals have higher microalbuminuria and nonsignificantly elevated MPV, however, urine albumin loss is independent of MPV.

Is hemodialysis a reason for unresponsiveness to hepatitis B vaccine? Hepatitis B virus and dialysis therapy.

Impaired renal function is associated with a high risk of chronicity of hepatitis B virus (HBV) infection. Patients on hemodialysis (HD) or peritoneal dialysis are at an increased risk of viral transmission due to frequent necessity of blood product transfer as well as use of contaminated dialysate or dialysis materials. Additionally, health professionals may cause viral spread via contaminated hands and carelessness against hygiene rules. The frequency of chronic HBV infection may be as high as 80% in patients on renal replacement therapies. This is because HBV vaccination is essential to eliminate chronic HBV infection. However, response rates of HD patients to HBV vaccination vary between 10%-50%. Dialysis adequacy and early vaccination before the onset of dialysis therapy seem to be major determinants of high seroconversion rates. Older age, male gender, duration of dialysis therapy and nutritional status are other well-known factors associated with seroconversion rate. There are controversial reports regarding the role of the presence of diabetes mellitus, HCV positivity, erythropoietin resistance, hyperparathyroidism, and vitamin D inadequacy. The role of genetic alteration in the functions or production of cytokines still needs to be elucidated.

Tuberculosis in dialysis patients: a nine-year retrospective analysis.

INTRODUCTION: Diagnosis of tuberculosis (TB) among dialysis patients may be difficult because of increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and non-specific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period. METHODOLOGY: A total of 651 patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) for at least three months in our unit between 2001 and 2010 were studied. Dialysis and follow-up were performed in our tertiary care center located in the eastern region of Turkey. Diagnosis of TB was established by combining clinical, radiological, biochemical, microbiological, and histological findings. Choice of anti-TB drug used, the results of therapy, and patient outcome were noted. RESULTS: Out of 651 dialysis patients studied, 322 (49.4%) were on PD and the remainder on HD (50.6%). Twenty-six (4%) of the 651 dialysis patients were diagnosed with TB (15 PD, 11 HD), 5 of whom were diagnosed by microbiological assessment, 9 by pathological assessment, and 12 by clinical and radiological findings. Mean age at diagnosis was 41.5 ± 16.5 years and the female/male ratio was 1.18. Three patients had a history of pulmonary TB. Extra-pulmonary involvement was observed in 17 (65.4%) patients. All patients were treated with rifampicin isoniazid, ethambutol, pyrazinamide and pyridoxine. Four patients died during the study. CONCLUSION: TB occurred in dialysis patients and extra-pulmonary TB was more commonly identified than pulmonary TB. Tuberculous lymphadenitis was the most frequent form of extra-pulmonary TB in our cohort.

Is there impact of mortality prior hemodialysis therapy in peritoneal dialysis patients?

Aim: The aim of this study is to investigate the mortality and the factors which may affect it in patients who were transferred to peritoneal dialysis (PD) from hemodialysis (HD), compared to patients assigned to PD as first-line therapy. Material and Methods: A total of 322 patients treated with PD between 2001 and 2010 were evaluated retrospectively. Twenty three patients were excluded and the data of remaining 299 patients (167F, mean follow up time 38.5±26.8 months, mean age 44.7±15.9 years) were evaluated. Patients were separated into two groups according to their HD history. Group 1 and group 2 consisted of patients with (n=48) and without (n=251) a history of prior HD, respectively. Socio-demographic characteristics such as who helped administer the PD and the preference of patients (compulsory vs their preference) were obtained from the patient records. The clinical data obtained during the last clinical evaluation before the initiation of PD (blood pressure, daily urine volumes, daily ultrafiltration amounts and laboratory parameters) were recorded. Additional systemic diseases and information about the etiologies of the end stage renal disease (ESRD) of all patients were recorded. Frequencies of the infectious complications were recorded. Patient and technique survival were investigated and compared between groups. Results: In group 1, the patients were older and had less urine amounts (p=0.028 and 0.041 respectively). Thirty five patients (70%) and 25 patients (9.3%) have been transferred to PD due to vascular problems in group 1 and 2, respectively (p<0.001). In group 1, 37 (74%) patients were carrying out PD (..) (AU)

Objetivo: El presente estudio pretende analizar la mortalidad y los factores que pueden influir en ella en los pacientes que pasan de la hemodiálisis (HD) a la diálisis peritoneal (DP), en comparación con los pacientes a los que se les prescribe DP como tratamiento de elección. Materiales y método: Se evaluaron retrospectivamente 322 pacientes tratados con DP entre 2001 y 2010. Fueron excluidos del estudio 23 pacientes y se evaluaron los datos de los 299 restantes (167 mujeres, tiempo medio de seguimiento: 38,5 ± 26,8 meses; edad media: 44,7 ± 15,9 años). Se formaron dos grupos de pacientes en función de su historial de HD. El grupo 1 y el grupo 2 incluían, respectivamente, a pacientes con (n = 48) y sin (n = 251) historial de HD previa. Las características sociodemográficas como quién colaboraba en la administración de la DP y la preferencia de los pacientes (obligatoria frente a elegida) se recogieron de los historiales de los pacientes. Se registraron los datos clínicos obtenidos durante la última evaluación clínica antes de comenzar con la DP (presión arterial, volúmenes de orina diarios, cantidad de líquido ultrafiltrado diario y parámetros analíticos). Se procedió de igual manera con otras enfermedades sistémicas e información sobre la etiología de la enfermedad renal de etapa terminal (ERET). Se hizo constar la frecuencia de las complicaciones infecciosas y se investigó la supervivencia de los pacientes y de la (..) (AU)

Is there impact of mortality prior hemodialysis therapy in peritoneal dialysis patients?

AIM: The aim of this study is to investigate the mortality and the factors which may affect it in patients who were transferred to peritoneal dialysis (PD) from hemodialysis (HD), compared to patients assigned to PD as first-line therapy. MATERIAL AND METHODS: A total of 322 patients treated with PD between 2001 and 2010 were evaluated retrospectively. Twenty three patients were excluded and the data of remaining 299 patients (167F, mean follow up time 38.5±26.8 months, mean age 44.7±15.9 years) were evaluated. Patients were separated into two groups according to their HD history. Group 1 and group 2 consisted of patients with (n=48) and without (n=251) a history of prior HD, respectively. Socio-demographic characteristics such as who helped administer the PD and the preference of patients (compulsory vs their preference) were obtained from the patient records. The clinical data obtained during the last clinical evaluation before the initiation of PD (blood pressure, daily urine volumes, daily ultrafiltration amounts and laboratory parameters) were recorded. Additional systemic diseases and information about the etiologies of the end stage renal disease (ESRD) of all patients were recorded. Frequencies of the infectious complications were recorded. Patient and technique survival were investigated and compared between groups. RESULTS: In group 1, the patients were older and had less urine amounts (p=0.028 and 0.041 respectively). Thirty five patients (70%) and 25 patients (9.3%) have been transferred to PD due to vascular problems in group 1 and 2, respectively (p<0.001). In group 1, 37 (74%) patients were carrying out PD treatment by themselves, compared to 222 (88.4%) patients in group 2 (p=0.016). Incidences of peritonitis and catheter exit site/tunnel infection attacks were found 24.9±26.8 and 27.2±26.5 patient-months in group 1, and 27.4±22.4 and 33.4±24.5 patient-months in group 2, respectively (p=0.50 and 0.12). In group 1, twenty three patients have death and 2 patients have discontinued the treatment due to transplantation. In group 2, 174 patients have discontinued the treatment (55 patients have died, 80 patients have been switched to hemodialysis and 39 patients have received renal transplantation). There were significant differences between groups according to the last condition (p<0.001). Mean patient survival were found 22.9±4.2 and 55.5±2.8 patient-months in group 1 and group 2, respectively. The patient survival rates by Kaplan-Meier analysis were 50%, 40.9%, 27.3% and 9.1% at 1, 2, 3, and 4 years in group 1 and 90.9%, 81.6%, 73.9%, 64.9% and 53.1% at 1, 2, 3, 4 and 5 years in group 2, respectively. The mortality rate is higher in patients who have undergone HD before PD compared without HD history (log rank:<0.001). In the Cox proportional hazards model analysis, preference of PD (RR: 7.72, p<0.001), presence of diabetes (RR: 2.26, p=0.01), pretreatment serum albumin level (RR: 0.37, p<0.001) and catheter exit size infection attacks (RR:0.34, p=0.01) were identified as predictors of mortality. CONCLUSION: Our data show that mortality in patients transferred to PD from HD was higher than in patients undergoing PD as first-line therapy. Compulsory choice such as vascular access problems and social factors were the most important causes of increasing mortality in patients transferred to PD from HD.

A rare cause of secondary amyloidosis: common variable immunodeficiency disease.

The common variable immunodeficiency disease (CVID) is the most common symptomatic primary antibody deficiency. It is the most frequently observed cause of panhypogammaglobulinemia in adults. Here, we present a case of systemic amyloidosis that developed secondary to the common variable immunodeficiency disease causing recurrent infections in a young female patient. A 24-year-old female patient, who was under treatment at the gynecology and obstetrics clinic for pelvic inflammatory disease, was referred to our clinic when she was observed to have swellings in her legs, hands, and face. She had proteinuria at a rate of 3.5 gr/day, and her serum albumin was 1.5 gr/dl. The levels of immunoglobulins are IgG: 138 mg/dl, IgA: 22,6 mg/dl, and IgM: 16,8 mg/dl. The renal USG revealed that the kidneys were observed to be enlarged. Since the patient had recurrent infections, hypogammaglobulinemia, nephrotic range proteinuria, and enlarged kidneys in the renal USG, she was thought to have type AA amyloidosis and therefore underwent a renal biopsy. The kidney biopsy revealed amyloid (+). So the patient was diagnosed with AA type of amyloidosis secondary to common variable immunodeficiency disease. A treatment regimen (an ACE inhibitor and a statin) with monthly administration of intravenous immunoglobulin was started.

Impact of volume status on blood pressure and left ventricle structure in patients undergoing chronic hemodialysis.

In this study, we aimed to examine the impact of volume status on blood pressure (BP) and on left ventricular mass index (LVMI) in chronic hemodialysis (HD) patients. This study enrolled 74 patients (F/M: 36/38, mean age 53.5 ± 15.3 years, mean HD time 41.5 ± 41 months) that were on HD treatment for at least 3 months. Demographics, biochemical tests, hemogram and C-reactive protein levels, mean interdialytic weight gain (IDWG), mean percentage of ultrafiltration (UF), and intradialytic complications such as hypotension and cramps were determined. Mean values of predialysis and postdialysis BP measurements were recorded a month before echocardiographic examination. On the day after a midweek dialysis session, 24 h ambulatory BP monitoring (ABPM) and echocardiographic examination were made concurrently. The patients were classified into two groups according to volume status: normovolemic (group 1; 14F/24M, mean age 50 ± 16.7 years, mean dialysis time 47.7 ± 47.7 months) and hypervolemic (group 2; 15F/21M, mean age 57.3 ± 12.7 years, mean dialysis time 34.9 ± 32 months). HD duration, IDWG, UF, and interdialytic complication rates were similar between the two groups (p < 0.05). Eleven patients (28.9%) of group 1 and 8 patients (22.2%) of group 2 showed dipper (p = 0.50). Valvular damage was more common in group 2 (p = 0.002). Whereas 33 patients (91.7%) had left ventricular hypertrophy (LVH) in group 2, 21 patients of the group 1 (55.3%) had LVH (p < 0.001). Although LVMI showed a significant positive correlation with cardiothoracic index, predialysis and postdialysis BP, IDWG, UF, daytime and nighttime BP measurements of 24 h ABPM, a significant negative correlation was seen with Kt/V urea and serum albumin levels. In conclusion, increased IDWG and UF and elevated BP are independent predictors of LVH for HD patients. Increased volume status leads to IDWG and elevated BP and eventually causes severe LVMI increases.

Parameters of oxidative stress and echocardiographic indexes in patients on dialysis therapy.

AIM: Quantity of oxidative stress (OS) is enhanced in every stage of chronic renal failure (CRF). OS and its effects on echocardiographic indexes in patients on hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) were evaluated. MATERIALS AND METHODS: Thirty-nine patients on CAPD, 32 patients on HD, and 30 healthy individuals with similar demographic features were included. Patients with diabetes mellitus and chronic inflammatory diseases were excluded. Blood samples were collected to examine hematological and biochemical parameters and levels of malonyldialdehyde (MDA), glutathione peroxidase (GSH-px), and superoxide dismutase (SOD) after a 12-hour fasting period in the middle of dialysis week. OS parameters were compared with ejection fraction (EF), interventricular septum diameter (IVSd), left ventricular posterior wall diameter (LVPWd), and left atrium diameter (LAd) determined in M-mod echocardiographic examination. RESULTS: No significant difference was observed between MDA and GSH-px levels of patients and control group; however, SOD levels of patients group were significantly lower (p<0.0001). SOD levels of patients on HD were lower than that of patients on CAPD (p=0.039). Negative correlation was detected between MDA and EF (r=-0.380, p=0.001); SOD has negative correlation with systolic blood pressure (r=-0.265, p=0.011), diastolic blood pressure (r=-0.230, p=0.028), phosphorus (r=-0.327, p=0.001), intact parathyroid hormone (iPTH) (r=-0.259, p=0.013), C-reactive protein (CRP) (r=-0.235, p=0.024), fibrinogen (r=-0.342, p=0.001), and total cholesterol (r=-0.249, p=0.017); and positive correlation with hemoglobin (r=0.414, p<0.001) and albumin (r=0.367, p<0.001). MDA was independently related with age (beta=-0.258, p=0.035), male gender (beta=-0.312, p=0.004), and EF (beta=-0.461, p<0.001). No correlation was determined between antioxidants and cardiac indexes. CONCLUSION: SOD levels decreased significantly especially in patients on HD, and it was observed that lower levels of SOD would lead to OS in patients on HD and CAPD when compared to healthy individuals; MDA levels were independently influenced from EF.

An atypical localisation of tuberculosis infection in patients undergoing haemodialysis: a case report.

Spinal tuberculosis (TB) is a rare skeletal system localisation of TB in haemodialysis patients. In this paper, a case of Pott's disease with a psoas muscle abscess is reported. The patient had been on the dialysis programme for five years and was complaining of back pain, weight loss and weakness, which were investigated. A thoracolumbar magnetic resonance imaging showed multiple paravertebral abscesses invading the psoas muscle. TB diagnosis was made by microbiological analysis of specimen, which was obtained by fine needle aspiration under computerised tomography guidance.

The association of demographic, clinical, and thrombophilic factors with the failure of arteriovenous fistula among hemodialysis patients.

OBJECTIVE: To evaluate the association of demographic, clinical, and thrombophilic factors with the failure of arteriovenous fistula (AVF) among patients undergoing chronic hemodialysis. METHODS: Sixty-two (33 males, 29 females) patients undergoing chronic hemodialysis were included in the study in March 2005 at the Hemodialysis Center of the Medicine Faculty at Dicle University, Diyarbakir, Turkey. The patients were divided into 2 groups according to whether they needed (group II) or do not need (group I) more than one fistula placed. RESULTS: Female gender, longer vintage of hemodialysis, frequent intradialytic hypotensive episodes, elevated levels of phosporous, calcium-phosporous product (CaP), and intact parathormone (iPTH), and left ventricle hypertrophy were more likely in group 2. CONCLUSION: Arteriovenous fistula loss, and recurrent requirement of AVF constitution increase with hemodialysis vintage. We believe that female gender, frequent intradialytic hypotensive episodes, elevated serum levels of phosporous, iPTH, and high CaP products are risk factors related to the failure of AVF among hemodialysis patients.

The prevalence and the characteristics of tuberculosis patients undergoing chronic dialysis treatment: experience of a dialysis center in southeast Turkey.

Tuberculosis remains a significant health problem for patients receiving chronic dialysis. The purpose of this study was to evaluate the prevalence, clinical characteristics, and outcomes of tuberculosis among patients with end-stage renal failure (ESRF) undergoing chronic hemodialysis and continuous ambulatory peritoneal dialysis. Between 1999 and 2006, we diagnosed 21 active tuberculosis patients among a total of 674-dialysis patient in our dialysis center (582 patients on hemodialysis and 92 patients on continuous ambulatory peritoneal dialysis program). Fourteen patients developed extrapulmonary tuberculosis (generally tuberculous lymphadenitis, n = 8) and seven patients developed pulmonary tuberculosis. All patients who developed tuberculosis after starting dialysis had low creatinine clearances and, in general, anemia and hypoalbuminemia. Three of patients greater than 40 years died. In conclusion, tuberculous lymphadenitis was the most frequent form of extrapulmonary tuberculosis in our dialysis population. If no cause is found despite extensive investigations in an end stage renal failure case with fever, loss of weight, and/or atypical lymphadenopathy, the physician should consider the possibility of tuberculosis. Finally, it was considered that ESRF is associated with depressed immune system and elevated risk of tuberculosis; thus, in this population, clinicians must evaluate patients carefully.

The effect of venlafaxine HCl on painful peripheral diabetic neuropathy in patients with type 2 diabetes mellitus.

OBJECTIVE: The objective of this study was to evaluate the efficacy of venlafaxine HCl in the symptomatic treatment of painful peripheral diabetic neuropathy (PPDN) among patients with type 2 diabetes mellitus (DM). DESIGN: This study was designed as a prospective, randomized, and controlled trial. SETTING: This study was conducted at the Dicle University Medical Faculty (Diyarbakir, Turkey). PATIENTS: Sixty type 2 DM outpatients (47 females and 13 males) with PPDN who had a minimum visual analog scale (VAS) score of 40 mm were enrolled in this study. INTERVENTIONS: Patients randomized to the treatment group (n=30) received venlafaxine HCl, whereas those randomized to the control group (n=30) received a combination of vitamins B(1)and B(6) tablets. MEASURES: Severity of pain was measured by VAS, Short-Form McGill Pain Questionnaire, and numerical analog scale scores at admission and at the second, fourth, and eighth weeks of the study. Polyneuropathy was supported by electromyelography. OUTCOME: In the treatment group, severity of pain was measured as 70.0+/-13.0 in the VAS, as 24.9+/-6.2 in the Short-Form McGill Pain Questionnaire, and as 7.2+/-1.1 in the numerical analog scale. In the control group, it was measured as 73.0+/-8.0 in the VAS, as 26.8+/-6.2 in the Short-Form McGill Pain Questionnaire, and as 7.4+/-0.8 in the numerical analog scale (P>.05). RESULTS: The most common form of PPDN was distal symmetrical sensorimotor polyneuropathy in both groups (46.8% vs. 50.0%). At the end of the study, there was a significant difference in severity of pain between the groups. In the treatment group, scores were 8.5+/-5.2 and 3.1+/-1.6 in the Short-Form McGill Pain Questionnaire and numerical analog scale, respectively; in the control group, these were 20.5+/-7.0 and 5.5+/-1.6, respectively (P<.001). CONCLUSIONS: Venlafaxine HCl is a safe and well-tolerable analgesic drug in the symptomatic treatment of PPDN; however, it has minimal adverse effects. It showed its efficacy markedly in the second week of therapy.