Factors affecting inadequate response to HBV vaccine in hemodialysis patients: northeast anatolia survey with six hemodialysis centers.

BACKGROUND: In hemodialysis patients Hepatitis B virus (HBV) infection is one of the problems. Because of HBV vaccine response is lower than in the general population, in this study it is aimed to determine the factors that may cause inadequate HBV vaccine response in hemodialysis patients. METHODS: In study, HBsAg, anti-HBs, anti-HBc IgG data belonging to 278 patients were obtained from file and computer records. It was seen that seronegative cases had been given recombinant HBV vaccine. Anti-HBs titers were monitored 1 month after vaccination was completed. According to this, the patients are divided into two groups. Those with anti-HBs < 10 IU/mL were identified as non-responders and with anti-HBs ≥ 10 IU/mL as responders. Factors such as age, serum albumin and urea reduction rate which may affect inadequate response to HBV vaccine were evaluated. As statistical examination, Chi-square test was used for the analysis of the data determined by counting, and logistic regression was used for statistically significant independent variables in chi-square test. p value of < 0.05 was considered statistically significant (Confidence interval: 95%). RESULTS: Out of 278 patients, according to exclusion criteria 81 patients were excluded. 13.2%(26/197) of HBV vaccinated patients had insufficient response. The inadequate response rate to HBV vaccination was found to be higher in patients with age ≥ 65 (p = 0.039), serum albumin < 3.5 g/dL (p = 0.024) and urea reduction rate ≤ 65 (p = 0.028). No statistically significant relationship was found between inadequate response to HBV vaccine and anti-HCV positivity, presence of diabetes mellitus, anemia status, vitamin D therapy and vascular access pathway variability. CONCLUSION: We conclude that relatively high patient age, low albumin level and insufficient urea reduction rate may cause inadequate HBV vaccine response. Taking these factors into consideration may provide a useful insight for an adequate response to vaccination.

Successful Treatment of Posttransplant Recurrent Complement C3 Glomerulopathy with Eculizumab.

Two-thirds of complement C3 glomerulopathy (C3G) recur after transplantation and commonly cause graft loss. There is not a standard treatment protocol for these cases. We present a kidney transplant patient with recurrent C3G who was successfully treated with eculizumab. Nephrotic proteinuria and hematuria occurred and creatinine levels increased after transplantation. A graft biopsy revealed recurrent C3G. The patient was administered 250 mg pulse methylprednisolone for 3 days and had 9 sessions of plasmapheresis. Since elevated creatinine levels and proteinuria persisted, eculizumab was instituted. A complete remission was observed after 9-month maintenance eculizumab treatment. Eculizumab may be a potentially effective option in kidney transplant patients with recurrent C3G unresponsive to other treatment modalities.

Increased serum renalase in peritoneal dialysis patients: Is it related to cardiovascular disease risk? / Aumento de renalasa sérica en pacientes de diálisis peritoneal: ¿está relacionado con el riesgo de enfermedad cardiovascular?

Background: Renalase, with possible monoamine oxidase activity, is implicated in degradation of catecholamines; which suggests novel mechanisms of cardiovascular complications in patients with chronic kidney diseases. Epicardial adipose tissue (EAT) has been found to correlate with cardiovascular diseases (CVD) in dialysis patients. The present study aimed to evaluate the association of serum renalase levels with EAT thickness and other CVD risk factors in peritoneal dialysis (PD) patients. Methods: The study included 40 PD patients and 40 healthy controls. All subjects underwent blood pressure and anthropometric measurements. Serum renalase was assessed by using a commercially available assay. Transthoracic echocardiography was used to measure EAT thickness and left ventricular mass index (LVMI) in all subjects. Results: The median serum renalase level was significantly higher in the PD patients than in the control group [176.5 (100-278.3) vs 122 (53.3-170.0) ng/ml] (p=0.001). Renalase was positively correlated with C-reactive protein (r=0.705, p<0.001) and negatively correlated with RRF (r=−0.511, p=0.021). No correlation was observed between renalase and EAT thickness or LVMI. There was a strong correlation between EAT thickness and LVMI in both the PD patients and the controls (r=0.848, p<0.001 and r=0.640, p<0.001 respectively). Conclusions: This study indicates that renalase is associated with CRP and residual renal function but not with EAT thickness as CVD risk factors in PD patients (AU)

Introducción: La renalasa, posiblemente con actividad monoaminooxidasa, está implicada en la degradación de catecolaminas, lo que indica nuevos mecanismos de complicaciones cardiovasculares en pacientes con enfermedades renales crónicas. Se ha encontrado que el tejido adiposo epicárdico (TAE) se correlaciona con las enfermedades cardiovasculares (ECV) en pacientes de diálisis. El presente estudio tuvo como objetivo evaluar la asociación de los niveles de renalasa sérica con el espesor del EAT y otros factores de riesgo de ECV en pacientes de diálisis peritoneal (DP). Métodos: El estudio incluyó a 40 pacientes de DP y a 40 controles sanos. Se tomaron la presión arterial y las medidas antropométricas de todos los individuos. Se evaluó la renalasa sérica mediante un ensayo disponible comercialmente. Se utilizó la ecocardiografía transtorácica para medir el espesor del TAE y el índice de masa ventricular izquierda (IMVI) en todos los individuos. Resultados: La mediana del nivel de renalasa sérica fue significativamente mayor en los pacientes de DP que en el grupo control (176,5 [100-278,3] frente a 122 [5,3-170,0] ng/ml) (p=0,001). La renalasa se correlacionó positivamente con la proteína C reactiva (r=0,705; p<0,001) y negativamente con la FRR (r=-0,511, p=0,021). No se observó correlación entre la renalasa y el espesor del TAE ni el IMVI. Hubo una fuerte correlación entre el espesor del TAE y el IMVI tanto en los pacientes de DP como en los controles (r=0,848; p<0,001 y r=0,640; p<0,001, respectivamente). Conclusiones: Este estudio indica que la renalasa está asociada con la proteína C reactiva y la función renal residual, pero no con el espesor del TAE, como factores de riesgo de ECV en pacientes de DP (AU)

Increased serum renalase in peritoneal dialysis patients: Is it related to cardiovascular disease risk?

BACKGROUND: Renalase, with possible monoamine oxidase activity, is implicated in degradation of catecholamines; which suggests novel mechanisms of cardiovascular complications in patients with chronic kidney diseases. Epicardial adipose tissue (EAT) has been found to correlate with cardiovascular diseases (CVD) in dialysis patients. The present study aimed to evaluate the association of serum renalase levels with EAT thickness and other CVD risk factors in peritoneal dialysis (PD) patients. METHODS: The study included 40 PD patients and 40 healthy controls. All subjects underwent blood pressure and anthropometric measurements. Serum renalase was assessed by using a commercially available assay. Transthoracic echocardiography was used to measure EAT thickness and left ventricular mass index (LVMI) in all subjects. RESULTS: The median serum renalase level was significantly higher in the PD patients than in the control group [176.5 (100-278.3) vs 122 (53.3-170.0)ng/ml] (p=0.001). Renalase was positively correlated with C-reactive protein (r=0.705, p<0.001) and negatively correlated with RRF (r=-0.511, p=0.021). No correlation was observed between renalase and EAT thickness or LVMI. There was a strong correlation between EAT thickness and LVMI in both the PD patients and the controls (r=0.848, p<0.001 and r=0.640, p<0.001 respectively). CONCLUSIONS: This study indicates that renalase is associated with CRP and residual renal function but not with EAT thickness as CVD risk factors in PD patients.

Association Between Conjunctival and Corneal Calcification and Atherosclerotic Changes in the Carotid Artery in Maintenance Hemodialysis Patients.

PURPOSE: We aimed to investigate the association between atherosclerotic changes in the common carotid artery (CA) and conjunctival and corneal calcification (CCC) in maintenance hemodialysis (MHD) patients. METHODS: Fifty eyes of MHD patients with the highest CCC scores were enrolled. CCCs were scored according to the method described by Tokuyama et al. The eyes with the highest CCC scores were selected for further analysis. According to their CCC scores, the patients were classified into 3 groups: mild (0-2 score), moderate (3-5), and severe (6-10 score). Atherosclerosis of the common CA was evaluated by determination of intima-media thickness (IMT), peak systolic (PSV) and end diastolic (EDV) flow velocities, pulsatility index, and resistive index values by using Doppler ultrasonography. RESULTS: The mean IMT of the CA was 0.61 ± 0.09 mm in the mild group, 0.82 ± 0.16 mm in the moderate group, and 1.21 ± 0.32 mm in the severe group (P < 0.001). The PSV and EDV were significantly higher in the severe group than in the mild and moderate groups (all, P < 0.001). The CCC score was positively correlated with the duration of hemodialysis, ocular surface disease index score, IMT, PSV, EDV, lymphocyte, calcium, and sedimentation rate. In multiple stepwise linear regression analysis, IMT was the best predictive factor for the CCC score (R = 0.812, ß = 9.526 ± 1.05, and P < 0.001). CONCLUSIONS: Our results suggest that chronic ocular ischemia due to atherosclerotic changes may have a role in the formation or progression of CCC in MHD patients.

The impact of calcineurin inhibitors and mammalian target of rapamycininhibitors on anxiety and depression scores in kidney transplant patients.

BACKGROUND/AIM: Depression and anxiety are prevalent symptoms in kidney transplant patients. We aimed to evaluate the frequency and the severity of depression and anxiety symptoms in kidney transplant recipients using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). The data were compared between the patients on CNI-based and mTORi-based maintenance immunosuppressive regimens. MATERIALS AND METHODS: A total of 94 kidney transplant patients were enrolled in the study after exclusion of the patients already taking neuropsychiatric medications or unwilling to participate in the study. Participants were asked to self-report the inventories. RESULTS: Analysis of data showed that 62 (66%) recipients had BDI scores that indicated depression. The patients on CNI-based regimens (n = 74) had increased total BDI scores compared those on mTORi-based regimens [18 (8.75-28) vs. 6 (5.25-14.25), respectively, P < 0.001]. Regarding BAI scores, 79 patients (84%) had prominent anxiety symptoms. The patients on CNI-based regimens had significantly increased total BAI scores compared to those on mTORi-based regimens [21 (13-30.50) vs. 10.50 (8.25-14.75), respectively, P < 0.001]. CONCLUSION: Our results identified fewer side effects of mTORi-based maintenance immunosuppressive regimens regarding depression and anxiety symptoms compared to CNI-based regimens in kidney transplant patients.

Kaposi's sarcoma concurrent with granulomatosis polyangiitis.

Kaposi's sarcoma (KS), a malignant vascular tumor, can develop in patients who receive corticosteroids or immunosuppressive therapy. We report a patient with KS and granulomatosis polyangiitis (GPA). To the best of our knowledge, this is the first report regarding the co-occurrence of these two diseases. The physician must be aware of the risk of cancer in patients with rheumatism.

Increased serum renalase in hemodialysis patients: is it related to left ventricular hypertrophy?

INTRODUCTION: Left ventricular hypertrophy (LVH) is one of the most common cardiac abnormalities in patients with end stage renal disease (ESRD). Hypertension, diabetes, increased body mass index, gender, age, anemia, and hyperparathyroidism have been described as risk factors for LVH in patients on dialysis. However, there may be other risk factors which have not been described yet. Recent studies show that renalase is associated with cardiovascular events. The aim of this study was to reveal the relation between renalase, LVH in patients under hemodialysis (HD) treatment. METHODS: The study included 50 HD patients and 35 healthy controls. Serum renalase levels and left ventricle mass index (LVMI) were measured in all participants and the relation between these variables was examined. FINDINGS: LVMI was positively correlated with dialysis vintage and C-reactive protein (CRP) (r = 0.387, p = 0.005 and r = 0.597, p < 0.001, respectively) and was negatively correlated with residual diuresis and hemoglobin levels (r = -0.324, p = 0.022 and r = -0.499, p < 0.001, respectively). There was no significant association of renalase with LVMI in the HD patients (r = 0.263, p = 0.065). Serum renalase levels were significantly higher in HD patients (212 ± 127 ng/mL) compared to controls (116 ± 67 ng/mL) (p < 0.001). Renalase was positively correlated with serum creatinine and dialysis vintage (r = 0.677, p < 0.001 and r = 0.625, p < 0.001, respectively). DISCUSSION: In our study, LVMI was correlated with dialysis vintage, residual diuresis, CRP, and hemoglobin. LVMI tends to correlate with renalase and this correlation may be significant in studies with more patient numbers. The main parameters affecting renalase levels are dialysis vintage and serum creatinine.

Serum apelin is associated with affective disorders in peritoneal dialysis patients.

OBJECTIVE: Depression and anxiety are prevalent affective disorders in peritoneal dialysis (PD) patients. Recent research has proposed a potential role of apelinergic system in pathogenesis of depression. The present study aimed to evaluate the frequency of depression and anxiety and their potential relation with serum apelin levels among PD patients. METHODS: A total of 40 PD patients were enrolled into the study. Depressive symptoms and anxiety were assessed with the Beck's Depression Inventory and the Beck's Anxiety Inventory. Serum apelin-12 levels were measured by immunoenzymatic assays using commercially available ELISA kit for standard human apelin. RESULTS: Of the patients, 16 (40%) had depression, 20 (50%) had anxiety. The patients with depression and anxiety had a significantly longer time on dialysis (p < 0.001 for both), significantly higher serum apelin (p < 0.001 for both) and C-reactive protein levels (p < 0.001 for both) than those without depression and anxiety. In multivariate analysis, serum apelin was the only parameter associated independently with depression and anxiety scores. CONCLUSIONS: A substantial number of PD patients had depression and anxiety. Increased levels of serum apelin may constitute a significant independent predictor of development of depression and anxiety in PD patients.

Efficacy of Combined Plasmapheresis and Intravenous Immunoglobulin Therapy in Kidney Transplant Patients With Chronic Antibody-mediated Rejection.

INTRODUCTION: Antibody-mediated rejections (AMRs) are critical clinical issues encountered in short- and long-term follow-up of kidney transplant patients. Whereas plasmapheresis is a mainstay treatment option in acute AMR cases, there is a paucity of data regarding its efficacy in management of chronic AMR. This report describes our experience addressing this issue. MATERIALS AND METHODS: We retrospectively investigated the data of 7 kidney transplant patients diagnosed with chronic AMR who were on 5 sessions of plasmapheresis (1 to 2 volume exchanges with fresh frozen plasma) on alternate days and 200 mg/kg of intravenous immunoglobulin after each session of plasmapheresis. RESULTS: At 6 months after the initiation of treatment, 6 patients experienced partially improved kidney function. One patient had no response and her kidney function progressively deteriorated. CONCLUSIONS: Our preliminary results are encouraging for the combination of plasmapheresis and intravenous immunoglobulin as an adjunctive therapy for kidney transplant patients suffering from chronic AMR.

Long-Term Success with Adhesiolysis in Post-Transplant Encapsulating Peritoneal Sclerosis: A Retrospective Case Series of 4 Patients and Review of the Literature.

Encapsulating peritoneal sclerosis (EPS) is an occasional and serious complication for peritoneal dialysis (PD) patients for whom no evidence-based management strategies have yet been established. Encapsulating peritoneal sclerosis could appear after kidney transplantation in patients who previously underwent long-term PD. In this report, we present our experience in four PD patients diagnosed with EPS after kidney transplantation. Adhesiolysis provided improvement in their acute clinical conditions and allograft functions, despite the long-term follow-up. Surgical intervention may be a safe modality for this specific group of patients.

Is hepcidin-25 a predictor of atherosclerosis in hemodialysis patients?

Atherosclerotic cardiovascular disease is an important cause of mortality and morbidity in hemodialysis patients. Iron accumulation in arterial wall macrophages is increased in atherosclerotic lesions. Hepcidin is a key hepatic hormone regulating iron balance. It inhibits iron release from macrophages and iron absorption from enterocytes by binding and inactivating the cellular iron exporter ferroportin. The aim of this study is to investigate the relation of hepcidin-25, iron parameters, and atherosclerosis measured by carotid intima media thickness (CIMT) in hemodialysis patients. Eighty-two hemodialysis patients were enrolled in this cross-sectional study. Predialysis blood samples were centrifuged at 1500 g and 4°C for 10 minutes and stored at -80°C for the measurement of hepcidin-25. DRG hepcidin enzyme-linked immunosorbent assay kit was used for the measurement of hepcidin-25. Ultrasonographical B-mode imaging of bilateral carotid arteries was performed with a high-resolution real-time ultrasonography (Mindray DC7). Mean age of the study population was 57.90 ± 16.08 years and 43.9% were men. Total study population was grouped into two according to median value of hepcidin-25. There was no difference between groups with respect to age, dialysis vintage, and C-reactive protein. CIMT was found to be statistically significantly higher in low hepcidin-25 group. In correlation analysis, CIMT was found to be correlated with age (P < 0.01, R = 0.33) and hepcidin-25 (P < 0.01, R = 0.46). In linear regression analysis, age (ß = 0.31) and hepcidin-25 (ß = 0.44) were found to be the determinants of CIMT in hemodialysis patients. Our results implicate that hepcidin may take part in pathophysiology of atherosclerosis and cardiovascular disease in hemodialysis patients.

Effects of acute kidney injury on clinical outcomes in patients with upper gastrointestinal bleeding.

AIM: Upper gastrointestinal bleeding (UGIB) is a very frequently encountered condition that has a high morbidity and which increases treatment costs. Duration of hospital stay and mortality increases in patients with UGIB complicated by acute kidney injury (AKI). The aim of this study was to reveal risk factors in patients with UGIB developing AKI and to compare clinical outcomes and hospital costs between patients with UGIB developing AKI and those with UGIB not developing AKI. MATERIAL AND METHODS: This retrospective study included 245 patients admitted to the emergency unit and the intensive care unit for internal diseases at Ankara Numune Education and Research Hospital, Turkey. RESULTS: The difference in mortality rates between the patients with AKI and those without AKI was significant (p < 0.001). The mean duration of intensive care unit stay was 0.2 ± 1.1 days in the patients without AKI (n = 143) and 2.5 ± 5.6 days in the patients with AKI. It was significantly higher in the patients with AKI (p < 0.001). Hospital stay was significantly longer in the patients with AKI than those without AKI, and as severity of AKI increased, hospital stay became considerably longer (p < 0.001). Hospital costs were significantly higher in the patients with AKI than those without AKI, and as severity of AKI increased, hospital costs considerably rose (p < 0.001). CONCLUSION: AKI is a condition that lengthens hospital stay, increases hospital costs and creates a burden on health care systems. Detect kidney injury earlier and administering an appropriate treatment can improve clinical outcomes in patients with UGIB developing AKI.

Fibroblast growth factor is associated to left ventricular mass index, anemia and low values of transferrin saturation / El factor de crecimiento fibroblástico está asociado con el índice de masa ventricular izquierda, anemia y niveles bajos de saturación de la transferrina

Background: Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone. In chronic kidney disease (CKD), circulating FGF-23 levels are markedly elevated and independently associated with mortality. Left ventricular hypertrophy (LVH) is a potent risk factor for mortality in CKD, and FGFs have been implicated in the pathogenesis of myocardial hypertrophy. In addition, the effect of anemia on CV disease and LVH is well known in CKD. A relation between iron and FGF-23 metabolism is mentioned in a few studies. The aim of this study was to test the association of FGF-23 levels with echocardiographic (ECHO) and iron parameters in peritoneal dialysis patients (PD). Methods: In this cross-sectional study, 61 subjects with PD (29 women and 32 men, mean age: 46.9±13.3 years, mean PD vintage: 69.5±39 months) underwent echocardiograms to assess left ventricular mass index (LVMI). Medical treatments and average values of the basic laboratory results of the last 6 months for all patients were recorded. Serum FGF- 23 concentrations were measured using intact FGF-23 (iFGF-23) human enzyme-linked immunosorbent assay (ELÿISA) kit. According to the median levels of serum FGF-23 the patients were grouped into two (FGF-23 high and low groups). Results: Significant positive correlation was recorded between serum FGF-23 levels and LVMI (P = 0.023). There was also significant difference in terms of hemoglobin (12.1±2 versus 11.0±2, P = 0.017), transferrin saturation (TSAT) (24.9±16.8 versus 19.5±10.8, P = 0.042) between low and high FGF-23 group. Also in linear regression analysis the negative relation between FGF-23 and hemoglobin is persisted (r = 0.199, P = 0.045). Conclusions: FGF-23 is associated with LVMI, anemia and low TSAT in patients with PD. Whether increased FGF-23 is a marker or a potential mechanism of myocardial hypertrophy and anemia in patients with end-stage renal disease (ESRD) requires further study (AU)

Introducción: El factor de crecimiento fibroblástico 23 (FGF-23) es una hormona reguladora del fósforo. En la enfermedad renal crónica (ERC), los niveles de FGF-23 son especialmente elevados y se relacionan de manera independiente con mortalidad. La hipertrofia ventricular izquierda (HVI) es un importante factor de riesgo de mortalidad en la ERC y se ha implicado a los FGF en la patogenia de la hipertrofia del miocardio. Además, se conoce el efecto de la anemia en la enfermedad cardiovascular y la HVI en la ERC. En algunos estudios se menciona una relación entre el hierro y el metabolismo del FGF-23. El objetivo de este estudio fue comprobar la asociación de los niveles de FGF-23 con parámetros ecocardiográficos y de hierro en pacientes con diálisis peritoneal (DP). Metodología: En este estudio transversal se procedió a realizar un ecocardiograma a 61individuos con DP (29mujeres y 32 hombres; media de edad: 46,9±13,3 años; DP clásica media: 69,5±39 meses) para evaluar el índice de masa ventricular izquierda (IMVI). Se registraron los tratamientos médicos y los valores promedio de los resultados básicos de laboratorio de los últimos 6 meses de todos los pacientes. Las concentraciones en suero del FGF-23 se midieron con el kit ELISA (enzyme-linked immunosorbent assay) de FGF-23 humano intacto (iFGF-23). Según los niveles promedio de FGF-23 en suero, los pacientes se distribuyeron en dos grupos (FGF-23 alto y bajo). Resultados: Se registró una correlación positiva significativa entre los niveles de FGF-23 en suero e IMVI (P = 0,023). También hubo diferencias significativas en cuanto a la hemoglobina (12,1±2 frente a 11,0±2, P = 0,017) y saturación de la transferrina (TSAT; 24,9±16,8 frente a 19,5±10,8, P = 0,042) entre los grupos de FGF-23 bajo y alto. También en el análisis de regresión lineal se mantuvo la relación negativa entre el FGF-23 y la hemoglobina (r = 0,199, P = 0,045). Conclusiones: El FGF-23 se asocia con IMVI, anemia y TSAT baja en pacientes con DP. Saber si el aumento del FGF-23 es un marcador o un mecanismo potencial de la hipertrofia miocárdica y la anemia en pacientes con insuficiencia renal terminal exige un estudio en mayor detalle (AU)

Fibroblast growth factor is associated to left ventricular mass index, anemia and low values of transferrin saturation.

BACKGROUND: Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone. In chronic kidney disease (CKD), circulating FGF-23 levels are markedly elevated and independently associated with mortality. Left ventricular hypertrophy (LVH) is a potent risk factor for mortality in CKD, and FGFs have been implicated in the pathogenesis of myocardial hypertrophy. In addition, the effect of anemia on CV disease and LVH is well known in CKD. A relation between iron and FGF-23 metabolism is mentioned in a few studies. The aim of this study was to test the association of FGF-23 levels with echocardiographic (ECHO) and iron parameters in peritoneal dialysis patients (PD). METHODS: In this cross-sectional study, 61 subjects with PD (29 women and 32 men, mean age: 46.9±13.3 years, mean PD vintage: 69.5±39 months) underwent echocardiograms to assess left ventricular mass index (LVMI). Medical treatments and average values of the basic laboratory results of the last 6 months for all patients were recorded. Serum FGF-23 concentrations were measured using intact FGF-23 (iFGF-23) human enzyme-linked immunosorbent assay (ELISA) kit. According to the median levels of serum FGF-23 the patients were grouped into two (FGF-23 high and low groups). RESULTS: Significant positive correlation was recorded between serum FGF-23 levels and LVMI (P=0.023). There was also significant difference in terms of hemoglobin (12.1±2 versus 11.0±2, P=0.017), transferrin saturation (TSAT) (24.9±16.8 versus 19.5±10.8, P=0.042) between low and high FGF-23 group. Also in linear regression analysis the negative relation between FGF-23 and hemoglobin is persisted (r=0.199, P=0.045). CONCLUSIONS: FGF-23 is associated with LVMI, anemia and low TSAT in patients with PD. Whether increased FGF-23 is a marker or a potential mechanism of myocardial hypertrophy and anemia in patients with end-stage renal disease (ESRD) requires further study.

Do elevated plasma S100A12 levels predict atherosclerosis in peritoneal dialysis patients?

AIM: Atherosclerotic cardiovascular disease is one of the major causes of mortality and morbidity in peritoneal dialysis (PD) patients. S100A12 is an endogenous receptor ligand of advanced glycation end-products. It was shown to contribute to the development of atherosclerosis in animal models. The aim of this study was to evaluate the relationship between S100A12 levels and carotid atherosclerosis in PD patients. METHODS: A cross-sectional study was performed in 56 PD patients and 20 control subjects. Plasma S100A12 levels were measured from all participants beside routine laboratory evaluation. All subjects underwent high-resolution B-mode ultrasonography to determine carotid intima media thickness (CIMT). S100A12 levels were compared between patient and control groups. Correlation analyses of S100A12 with other laboratory values and CIMT were also performed. RESULTS: Plasma S100A12 levels were higher in PD patients compared with control subjects (129.5 ± 167.2 ng/mL vs. 48.5 ± 30.3 ng/mL, respectively, p < 0.001). In the patient group, CIMT was found to be positively correlated with age (r = 0.354; p = 0.007), CRP level (r = 0.269; p = 0.045), and S100A12 (r = 0.293; p = 0.028) level while it was found to be negatively correlated with hemoglobin concentration (r = -0.264; p = 0.049). In the linear regression analysis, the model, including CRP, S100A12, age, and Hgb, was found to be significant (F: 4.177, p: 0.005). When the parameters are analyzed age and S100A12 were found to be independent determinants of CIMT (ß = 0.308, p = 0.018 and ß = 0.248, p = 0.049, respectively). CONCLUSIONS: This study suggests that an elevated plasma S100A12 level was closely associated with atherosclerosis. With aging elevated plasma S100A12 may show a powerful proatherogenic potential in patients undergoing PD.

The relation between apelin levels, echocardiographic findings and carotid intima media thickness in peritoneal dialysis patients.

BACKGROUND: Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in patients with end stage renal disease (ESRD). Apelin expressed in endothelial and other tissues including brain and kidney is an adipocytokine defined recently and is emerging an important mediator of cardiovascular homeostasis. The aim of this study was to test whether apelin levels might be associated with carotid artery atherosclerosis and left ventricular mass index (LVMI) in peritoneal dialysis patients. PATIENTS AND METHODS: Fifty peritoneal dialysis patients (25 female, mean age 41.4 ± 11.9 years, mean dialysis vintage 65.0 ± 35.4 months) and 18 healthy individuals (9 female, mean age 41.7 ± 6.8 years) were included in this cross-sectional study. Serum apelin 12 levels, echocardiographic findings and carotid intima media thickness (CIMT) were recorded as well as clinical and laboratory data. RESULTS: There were no differences between the patient and the control groups with regard to demographic characteristics. In patient group, LVMI, CIMT, CRP and apelin levels were elevated compared to control group. However there was no association between apelin, LVMI and CIMT. There was a positive correlation between apelin and CRP, which was not statistically significant. When patients were divided into two groups according to the mean serum apelin levels, LVMI, CIMT and CRP were higher in the high apelin group but this difference did not reach statistical significance. CONCLUSION: We observed an increased inflammation and CVD risk in peritoneal dialysis patients. However, serum apelin levels seem not to be associated with cardiovascular risk in this group of patients.

Rational approaches to the treatment of hypertension: drug therapy-monotherapy, combination, or fixed-dose combination?

Blood pressure (BP) control is inadequate worldwide. Many clinical trials suggest that BP is not satisfactorily controlled using monotherapy in most patients. Free drug or fixed-dose combinations are other therapeutic options. The advantages and disadvantages for different treatment approaches are discussed in this review.

[A case of ventilator-associated pneumonia due to Pantoea agglomerans]. / Pantoea agglomerans'a Bagli Ventilatörle Iliskili Pnömoni Gelisen Bir Olgu.

Pantoea species, which are the members of Enterobacteriaceae family are gram-negative bacilli that are frequently found on many plants and in soil. They may lead to localized infections in healthy subjects and systemic infections in immunosuppressed patients. In this case report a ventilator-associated pneumoniae due to Pantoea agglomerans was presented. A 55 year-old male patient with chronic renal failure was hospitalized in intensive care unit following cardiopulmonary arrest. The patient developed fever (38.8°C), had pulmonary infiltrations in chest X-ray and leucocytosis. Treatment with piperacillintazobactam was initiated upon diagnosis of nosocomial pneumoniae. Bacterial growth from the deep tracheal aspirate of the patient was identified as P.agglomerans by VITEK2 automated system (bioMérieux, France) and the identification was confirmed by conventional microbiological methods. Since the strain was susceptible to the cephoperazon-sulbactam, tobramycin, tetracycline, gentamicin and levofloxacine, the treatment was changed to levofloxacine and cephoperazon-sulbactam and the patient improved. This case was presented to withdraw attention to rare opportunistic pathogens that may lead to nosocomial infections particularly in patients with underlying diseases.

Serum fibroblast growth factor-23 (FGF-23) levels are independently associated with left ventricular mass and myocardial performance index in maintenance haemodialysis patients.

BACKGROUND: Fibroblast growth factor-23 (FGF-23) is a phosphorus-regulating substance. Circulating FGF-23 levels increase markedly in dialysis patients and are independently associated with increased risk of mortality. Given the fact that cardiovascular disease is the leading cause of death in dialysis patients, the aim of this study was to test if elevated FGF-23 levels might be associated with left ventricular mass index (LVMI) and left ventricular index of myocardial performance (MPI) in maintenance haemodialysis patients. METHODS: In this cross-sectional study, plasma FGF-23 concentrations were measured using a C-terminal human enzyme-linked immunosorbent assay kit, and echocardiography was performed in 128 maintenance haemodialysis patients (65 women and 63 men, mean age: 55.5 ± 13 years, mean haemodialysis vintage: 52 ± 10 months, all patients are on haemodialysis thrice a week) and 40 control subjects (21 women and 19 men; mean age: 54 ± 11 years) with normal kidney function (eGFR > 90 mL/min/1.73 m(2)). RESULTS: Serum FGF-23 levels were elevated when compared with age- and gender-matched controls with preserved kidney function [(median 958 RU/mL; interquartile range 106-1894 RU/mL) vs (median 27 RU/mL; interquartile range 11-35), P < 0.0001]. Patients with a history of coronary artery disease and aortic valve calcifications had higher levels of log FGF-23 than those without (3.00 ± 0.22 vs 2.82 ± 0.26, P = 0.002; and 3.06 ± 0.19 vs 2.83 ± 0.26, P = 0.0001, respectively). Patients with MPI > 0.47 had higher serum FGF-23 levels than those with MPI < 0.47 [(median 1156 RU/mL; interquartile range 396-1894 RU/mL) vs (median 657 RU/mL; interquartile range 106-1102 RU/mL), P = 0.0001]. Significant correlations were recorded between log FGF-23 levels and LVMI (r = 0.281, P = 0,007) and MPI (r = 0.555, P = 0.0001). Multivariable-adjusted regression analyses revealed that increased log FGF-23 concentrations were independently associated with increased left ventricular mass index (30% increase per 1-SD increase in log FGF-23 concentration, P = 0.002) and increased MPI (28.5% increase per 1-SD increase in log FGF-23 concentration, P = 0.001). CONCLUSIONS: Plasma FGF-23 concentration is independently associated with LVMI and MPI in maintenance haemodialysis patients. Further prospective studies are needed to clarify whether increased serum FGF-23 level is a marker or a potential mechanism for left ventricular involvement in patients with end-stage renal disease.