Comprehensive mastocytosis data analysis from a single center.

Mastocytosis is a very rare disorder and is divided into three prognostically distinct variants by World Health Organization: Cutaneous mastocytosis (CM), systemic mastocytosis (SM), and mast cell sarcoma or localized mast cell (MC) tumors. The wide range of complaints may cause patients to consult various clinics, with resulting mis- or underdiagnosis. Therefore, cooperation between different subspecialties is of paramount importance. In this article, we have compiled 104 adult mastocytosis cases diagnosed and followed in our Hematology and other clinics. 86 (82.7%) of 104 patients had systemic mastocytosis. Osteoporosis, disease-related complications, and secondary malignancies are important topics in this group. We know that indolent form has great survival. But smoldering or aggressive mastocytosis has a poor prognosis. CM and indolent SM have a significantly better prognosis compared to aggressive SM (p < 0.001). We found that the presence of more than 25% of mast cells in the bone marrow, the presence of concomitant marrow dysplasia, and the presence of disease-related complications affect survival (p < 0.001). In addition to the WHO classification, the IPSM scoring system is indicative of the prognosis in this rare disease.

Methionine, cysteine, and butylated hydroxytoluene enhance cryosurvival of ram semen on post-thaw and post-incubation time points.

Despite there have been many experiments conducted about antioxidants, the best sole or combination use of antioxidants to include as a standard ingredient to freezing extenders is yet to be found. This study was designed to investigate the different doses of methionine (2.5 and 5 mM), cysteine (1 and 2 mM), and butylated hydroxytoluene (BHT) (1 and 2 mM) for ram semen cryopreservation on post-thaw and post-incubation (6 h) time points over spermatological parameters. Semen samples were collected from Kivircik rams via electro-ejaculator in breeding season. After essential spermatological evaluations, appropriate samples were pooled then split into 7 equal aliquots to create study groups (antioxidant free control, 2.5 mM methionine, 5 mM methionine, 1 mM cysteine, 2 mM cysteine, 1 mM BHT, and 2 mM BHT). Semen samples were put into French straws (0.25 mL), and freezing procedure (two-step) was conducted via a programmable gamete freezer. At both time points, motility, HOST, PSA-FITC, and TUNEL assays were made to discover the impacts of cryopreservation and incubation process over sperm cells. Antioxidant supplemented groups yielded better results compared to the control groups in terms of various spermatological parameters not only at post-thaw time point but after incubation for 6 h of time. The study demonstrated that supplementing sperm freezing extenders with previous antioxidants may create new approaches to cryopreservation procedures, and through increasing success rate of freezing, fertility results may increase to better results in near future.

The Relationship between Serum Selenium Levels and Restless Leg Syndrome in Chronic Kidney Disease Patients.

Background and Objectives: Chronic kidney disease (CKD) is a global public health issue with rising incidence linked to substantial morbidity and mortality. Selenium, an antioxidant trace element, has been linked to low serum levels in end-stage renal disease. Restless Leg Syndrome (RLS), a sleep disorder, is prevalent in CKD patients and significantly impacts their quality of life. The objective of this study was to examine the correlation between serum selenium levels and the prevalence of restless leg syndrome in individuals with chronic kidney disease. Materials and Methods: Forty-six CKD patients undergoing serum selenium level assessments between 1 January 2020 and 28 February 2022, at the Hitit University Faculty of Medicine Department of Nephrology Outpatient Clinic or Hemodialysis Unit, were included. Patients over 18 years of age with no history of hematological or oncological diseases or acute or chronic inflammatory conditions were included in the study groups. Patients taking selenium supplements were excluded. Demographic data, comorbidities, and laboratory values were collected, and RLS presence and severity were evaluated. Statistical analyses include descriptive statistics, correlation analysis, the Mann-Whitney U test, Student's t test, and Chi-square test. Results: Among the 46 patients, 16 (34.78%) had RLS symptoms. The patient group included 34.78% predialysis, 34.78% peritoneal dialysis, and 30.44% hemodialysis patients, with a median age of 47.98 years. There was no difference in age, gender, and Charlson comorbidity between patients with or without RLS (p = 0.881, p = 0.702, p = 0.650). RLS prevalence varied across CKD subgroups, with hemodialysis patients having a higher prevalence (p = 0.036). Clinical parameters such as blood urea nitrogen, creatinine, calcium, phosphorus, platelet counts, and parathyroid hormone levels exhibited significant differences between patients with and without RLS (p < 0.05). Serum selenium levels were not significantly different between patients with and without RLS (p = 0.327). Conclusions: With an increased comorbidity burden, CKD poses a significant healthcare challenge. When accompanied by RLS, this burden can be debilitating. The difference in CKD stages between groups has shed light on a critical determinant of RLS in this population, emphasizing the role of the chronic kidney disease stage. In our study, serum selenium levels were not associated with the presence and severity of RLS. However, prospective studies with larger numbers of participants are needed to draw a definitive conclusion.

Investigation of mindin levels in hypertensive patients with left ventricular hypertrophy and QRS fragmentation on electrocardiography.

PURPOSE: Mindin was associated with diabetic nephropathy, podocyte injury, colitis, allergic asthma, liver ischaemia and reperpusion injury and ischaemic brain injury. On the other hand, it was reported as a protective factor against obesity, cardiac hypertrophy, fibrosis and remodelling. Fragmented QRS complexes (fQRS) are markers of altered ventricular depolarisation owing to a prior myocardial scar and fibrosis. In this study, we aimed to investigate mindin levels in hypertensive patients with left ventricular hypertrophy and fQRS on electrocardiography. METHODS: This observational case-control study enrolled 70 (36 female) hypertensive patients with fQRS and 38 (23 female) hypertensive control patients. All patients were evaluated by transthoracic echocardiography. Mindin levels were measured by the enzyme-linked immunosorbent assay (ELISA). Clinical, echocardiographic and laboratory data were compared between patient and control groups. RESULTS: There was no significant difference between patient and control groups in terms of clinical, echocardiographic and routine laboratory parameters. The mindin levels were significantly higher in the patient group than controls (11.3 (7.21-19.31) vs 4.15 (2.86-6.34); p < .001). Multiple logistic regression analyses defined increased mindin levels as an independent predictor for the presence of fQRS (Odds ratio: 1.733; p = .034). Mindin levels >6.74 predicted the presence of fQRS with a sensitifity of 84.3% and specificity of 79.9% on receiver operating characteristic (ROC) curve analysis (The area under the curve:0.889; Confidence Interval: 0.827-0.951; p < .001). CONCLUSION: Mindin expressin is upregulated in hypertensive patients with fQRS complexes. In contrary to previous studies, increased mindin levels may be associated with myocardial fibrosis.

Serum ADMA, endothelial dysfunction, and atherosclerosis in hypervolemic hemodialysis patients

Background/aim: Asymmetric dimethyl arginine (ADMA) is a strong predictor of cardiovascular disease and mortality in patients under hemodialysis treatment. We aimed to investigate the relationship among volume status, endothelial dysfunction, and ADMA in hemodialysis patients. Materials and methods: A total of 120 patients with a history of hemodialysis treatment were included. ADMA and CRP were measured. Echocardiographic evaluation and carotid artery intima-media thickness (CIMT) measurements were performed. Patients were divided into two groups according to clinical evaluation, ultrafiltration rate, vena cava inferior diameter (VCI), and cardiothoracic index (CTI); the two groups were hypervolemic and normovolemic. Results: The hypervolemic group included 61 patients while the normovolemic group included 59 patients. CIMT was higher in the hypervolemic group, but this result was not statistically significant (0.95 mm versus 0.85 mm, P = 0.232). There was a statistically significant difference between the hypervolemic and normovolemic groups in terms of ADMA (P < 0.001) (0.69 ± 0.57 µmol/L and 0.41 ± 0.04 µmol/L, respectively). Positive correlations were observed between serum ADMA, VCI, CTI, CRP, CIMT, and cardiac mass (P < 0.001, P = 0.016, P < 0.001, P = 0.006, P = 0.022, respectively), and negative correlations were observed between ADMA and ejection fraction and albumin (P = 0.024, P = 0.024, respectively). In multiple linear regression analysis, ADMA was independently associated with age, systolic blood pressure, CTI, and volume status. Conclusion: ADMA may be a potential determinant of hypervolemia as well as atherosclerosis in patients under hemodialysis treatment.

Evaluation of potential long-term changes in endothelial functions and basic echocardiographic parameters in unilateral nephrectomy patients.

AIM: Decreased nephron count may result in lower glomerular filtration rate (GFR) and cardiorenal injury in the absence of compensatory hyperfunction. In this study, we aimed to evaluate long-term effects of 50% nephron loss on endothelial functions and cardiac morphology in nondonor nephrectomy patients. METHODS: This study comprised 26 patients (median age: 44 [37.5-50] years, male: 14) with unilateral nephrectomy and 25 healthy controls (median age: 47 [42-50] years, male: 9). Echocardiography was performed in all patients. Endothelial function was examined by measuring ischemia-induced flow-mediated dilation (FMD) of the brachial artery. RESULTS: The mean nephrectomy time was 12.5 (8.75-23.25) years. Estimated glomerular filtration rate (eGFR [CKD-EPI]) was significantly lower in the patient group than controls (85.54±16.27 vs 96.35±11.68 mL/min, P=0.009). Uric acid levels were significantly higher in the patient group than controls (5.7±1.3 vs 4.5±0.8, P<0.001). Percentage of FMD was significantly lower in the unilateral nephrectomy patients than the control group (11.6±6.2 vs 16.1%±7.9%; P=0.029). Left ventricular posterior wall thickness (LVPWT) (P<0.001), interventricular septal thickness (IVST) (P<0.001), left ventricular (LV) mass (P=0.014), and left ventricular mass index (P=0.014) were significantly higher in the patient group. CONCLUSION: In conclusion, 50% decrease in nephron mass due to unilateral nephrectomy may result in decreased eGFR, impaired endothelial functions and cardiac hypertrophy. What triggers endothelial dysfunction and cardiac hypertrophy in the event of mild decrease in GFR when creatinine has not been elevated yet remains unclear, but uric acid may be playing a role in this process necessitating large-scaled studies.

Hyponatremia Due to Escitalopram and Thiazide Use After Cardiac Surgery.

Depression and mood disorders occur commonly following emergent cardiac surgery. Selective serotonin reuptake inhibitors are commonly used antidepressants. We report the development of severe hyponatremia leading to adverse clinical effects due to escitalopram and thiazide diuretic use concomitantly in a patient with depression after emergency coronary artery bypass grafting.

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment.

BACKGROUND: Malnutrition is common in subjects undergoing hemodialysis and is associated with increased morbidity and mortality. Studies investigating factors associated with malnutrition and effect of various interventions to treat these patients are needed. We aimed to screen older and young patients undergoing chronic hemodialysis, for malnutrition, and seek its association with clinical factors including anxiety and depression and laboratory variables including urea/creatinine ratio (UCR). METHODS: Duration of hemodialysis treatment, medications taken, anthropometric measurements and routine laboratory results were recorded. Mini nutritional assessment and Beck anxiety and Beck depression inventories were applied. Study variables between subjects with malnutrition, malnutrition risk and normal nutritional states were compared. Older and younger patients were also compared regarding malnutrition and laboratory results. Linear regression analysis was performed to seek independent factors associated with malnutrition score. RESULTS: Clinical and laboratory data except for UCR were found to be similar among young and older patients. UCR increased, while albumin, body mass index and weight circumference decreased along with worse nutritional state. Low albumin level, body mass index and UCR and higher hemoglobin level and depression score were independent factors associated with malnutrition. CONCLUSION: In addition to routinely used markers of malnutrition UCR may provide additional information regarding malnutrition in this population.

Evaluation of serum Spondin 2 levels in the different stages of Type 2 diabetic nephropathy.

AIM: We aimed to determine whether serum SPON2 is a useful biomarker in the detection of Diabetic Nephropathy (DN) and to compare serum SPON2 levels with 24-hour urinary albumin excretion rate (UAER) in patients with DN at different stages. METHODS: The cohort included 80 adult patients with T2D and 20 healthy controls. The patients with T2D were divided into four groups according to UAER and serum creatinine (sCr) levels. Group 1 consisted of patients with normoalbuminuria (n = 20), Group 2 with microalbuminuria (n = 20), Group 3 with macroalbuminuria (n = 20) and Group 4 with albuminuria and sCr > 1.5 mg/dL (n = 20). RESULTS: There were no significant differences between the groups in terms of demographic data, C-reactive protein, HbA1c, lipids, serum uric acid levels and leukocyte counts. SPON2 levels were observed to increase linearly with increasing severity of diabetic nephropathy levels. The SPON2 levels of Group 4 were significantly higher than Group 1 and the controls, and SPON2 levels of Group 3 were significantly higher than Group 1. Blood urea nitrogen, creatinine and UAER were significantly positively correlated with SPON2; serum total protein and calcium levels were negatively correlated with SPON2 in patients with DN. CONCLUSION: We observed a linear and significant increase in SPON2 levels of patients with T2D as the stage of DN increased, but serum SPON2 level was not as effective as microalbuminuria in reflecting nephropathy. Also, serum SPON2 level was not as good as urine and tissue levels of SPON2 in detection of renal damage in DN.

How the repair bonding strength of hybrid ceramic CAD/CAM blocks is influenced by the use of surface treatments and universal adhesives.

We examined how different methods of surface treatment and different universal adhesives with or without extra silane affected the repair bonding strength of hybrid ceramic CAD/CAM restorations. Cerasmart specimens (n=320) were subjected to thermocycling and assigned to the following surface pretreatment protocols: control, diamond bur (DB), hydrofluoric acid (HF), and tribochemical silica coating (TSC). Half the specimens received a coating of silane, followed by application of the universal adhesives Futurabond M+ (FMU), Tokuyama Universal Bond (TUB), Single Bond Universal (SBU), or Clearfil Universal Bond Quick (CUQ) (n=10). A hybrid composite resin was used to simulate repair; then the specimens underwent further thermocycling. Shear bond strength (SBS) was determined and modes of failure were examined. The TSC-CUQ silane (-) group showed the highest SBS values. The best repairs were obtained when the surface was treated with TSC, with the exception of the DB-TUB silane (-) group. TUB increased SBS more than the other adhesives. Additional silane decreased SBS in the HF-TUB and TSC-CUQ groups, while increasing it in the TSC-TUB and DB-FMU groups (p<0.05).

The effect of hand fine motor skills on peritoneal dialysis-related peritonitis.

INTRODUCTION: We aimed to evaluate the relationship between the hand fine motor skills of peritoneal dialysis (PD) practitioners and PD-related peritonitis. METHODS: This multicenter prospective observational study was conducted with 120 incident PD patients. Patients were divided into two groups who had PD-related peritonitis within the first year as Group 1, and those who did not as Group 2. Hand fine motor skills were evaluated by Nine-Hole Peg Test (NHPT) and Nut Screwing Test (NST). RESULTS: Initial NHPT (28.5 ± 6.0 s vs. 25.8 ± 5.0 s, p = 0.011) and NST (82.3 (61.5-102.8) s versus 65.3 (52.3-88.5) s p = 0.023) scores were significantly higher in Group 1 than Group 2. In multivariate logistic regression analysis, NHPT, Body Mass Index, Mini-Mental Test, self PD practitioner, and catheter complications were found to be independent variables in predicting PD-related peritonitis. CONCLUSION: Decreased hand fine motor skills of PD patients is a risk factor for peritonitis.

The perception of nephrologists about peritoneal dialysis in Turkey.

BACKGROUND: We aimed to evaluate the perceptions of nephrologists about peritoneal dialysis (PD) in Turkey. MATERIALS AND METHODS: An anonymous survey was conducted to a total of 150 nephrologists. Demographic data, perceptions, PD indications, contraindications, and possible reasons for low preference of PD were questioned. RESULTS: In decision making, 93.4% of all stated that patients prioritized the doctor's opinion and 80.7% considered PD is the best initial dialysis option. The presence of many HD facilities (70.7%), inadequate knowledge, and education of patients (70%), physicians' reluctance to practice PD (70%), unwillingness of patients (68.7%), negative effect of other patients (67.3%), inadequate experience of PD staff (58.7%), and nonencouragement of PD by the state (58.7%) were the leading reasons of low prevalence. CONCLUSION: Implementation of comprehensive predialysis education programs for patients, informing government and hospital officials about PD advantages, and reinforcing PD principles to the nephrologists could improve the low prevalence of PD in Turkey.

The Relationship Between Serum Selenium Level, Cognitive Functions, and Depression in Patients With Chronic Kidney Disease.

Introduction Impairment of cognitive functions can commonly develop in patients with chronic kidney disease (CKD) and increase morbidity and mortality. The antioxidant activity of selenium reduces cognitive decline by protecting neurons from free radical damage. We aimed to explore the associations between serum selenium levels, cognitive impairment, and depression in CKD patients in this research. Methods In this prospective cross-sectional research, 100 participants between the ages of 20 and 65 were included, and four groups of 25 patients each were formed (control group, stage 3-4 CKD, peritoneal dialysis [PD], hemodialysis [HD]). The Standardized Mini Mental Test (sMMT) was used to measure cognitive skills, and the Beck Depression Inventory (BDI) was utilized to diagnose depression. Simultaneously, measurements of serum selenium levels were done from collected blood samples. Results Cognitive impairment was detected in 4% of the control group, 16% of CKD patients (n=75), and 30% of the dialysis patients (n=50). Depression was found in 16% of the control group, 40% of the stage 3-4 CKD group, 50% of the PD group, and 44% of the HD group. In the control group, sMMT scores were higher than the other groups (p<0.001 for all), while the BDI score was statistically significantly lower (p=0.003). Serum selenium levels were found to be higher than HD and PD groups in patients with non-dialysis CKD and control groups in the post hoc analyses (p=0.001, p<0.001, p<0.001, p<0.001, respectively). Conclusion Depression and cognitive impairment are particularly prevalent in CKD and dialysis patients. Our results indicate serum selenium insufficiency may be related to depression and cognitive impairment in this patient group. Nonetheless, these findings need to be confirmed by larger-scale studies.

Effects of repeated intravenous doses of tranexamic acid on closed tibial fracture healing: Experimental study based on the rat model.

OBJECTIVE: The aim of this study was to assess the effects of tranexamic acid on fracture healing in the rat tibia closed fracture model. METHODS: Sixty-four male Sprague-Dawley rats were included in this study, where closed fracture and intramedullary nailing were performed on their right tibial diaphyses. They were divided into 2 main groups, the experimental group, which was given weekly tranexamic acid injections, and the control group, which received no additional treatment. Eight rats from each group were sacrificed and evaluated for fracture healing at the first experimental group and control group, second experimental group and control group, third experimental group and control group, and fourth experimental group and control group weeks. Fracture healing was radiologically assessed according to the "Spencer Index" and "Lane and Sandhu Scoring System," and histologically evaluated according to the scoring system devised by Huo et al. Results: According to the Spencer Index, the mean union score was statistically significantly higher in the E3 group than in the third con- trol group (P = .014). Furthermore, the mean union score was statistically significantly higher in the fourth experimental group compared to the fourth control group (P=.047). According to the Lane and Sandhu Scoring System, only the mean union scores of the E3-4 groups were statistically significantly higher than the mean union scores of the C3-4 groups (P=.048). There was no histological difference between groups in terms of union, according to the criteria defined by Huo et al (P > .05). CONCLUSION: This study showed us that repeated intravenous administrations of tranexamic acid had no negative effect on fracture heal- ing in the rat tibia fracture model. Although tranexamic acid demonstrated better radiological healing in the late period, it had no effect on histological union.

The relationship between cognitive impairment and fatty acids and carnitine in hemodialysis patients.

BACKGROUND/AIM: The prevalence of cognitive impairment (CI) is high in hemodialysis patients. In this study, the relationship between CI and serum carnitine, plasma omega-3, omega-6 and omega-3/omega-6 fatty acid ratio was evaluated in hemodialysis patients. MATERIALS AND METHODS: Sixty two patients [male: 40 (64.5%), mean age 51±13 years] were included in this cross-sectional study. Serum total and free-carnitine levels were determined by ELISA. Plasma omega-3 [eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)] and omega-6 [arachidonic acid (AA), dihomo gamma linoleic acid (DGLA)] levels were measured using LC-ESI-MS/MS. According to the Montreal Cognitive Assessment (MoCA) scores, ≤24 points were considered as CI. MoCA score ≤24 and >24 were determined as Group 1 and Group 2, respectively. RESULTS: Group 1 had significantly higher AA+DGLA/EPA+DHA ratios and lower free-carnitine, DHA and EPA+DHA levels compared to Group 2 (P=0.008, P=0.040, P=0.032, P=0.032, respectively). Group 1 had a statistically lower education level (P<0.05). Negative correlation was found between MoCA scores and AA+DGLA/EPA+DHA ratios (rs=-0.284, P=0.026). Free-carnitine levels were positively correlated with EPA and EPA+DHA levels (rs=0.278, P=0.030 and rs=0.271, P=0.034, respectively), and negative correlated with AA+DGLA/EPA+DHA ratios (rs=-0.414, P=0.001). In multivariate logistic regression analysis, MoCA scores was associated with AA+DGLA/EPA+DHA ratio (P=0.009) and education level (P<0.001). CONCLUSION: It was determined that high AA+DGLA/EPA+DHA ratio and low education level could be independent risk factors of the CI. It has been shown that free-carnitine level can have positive effects on plasma EPA+DHA and AA+DGLA distributions. Low omega-3 fatty acid levels may be associated with CI in hemodialysis patients, and low carnitine level may contribute partially to this process. In addition, cognitive education programs may have an effect on preventing CI in hemodialysis patients with low education levels.

Fibromyalgia syndrome and related factors in hemodialysis, peritoneal dialysis, and renal transplant patients: A cross-sectional study.

Objectives: This study aims to investigate the point prevalence of fibromyalgia in patients on hemodialysis and peritoneal dialysis and after renal transplantation compared to healthy controls and to evaluate depressive symptoms, anxiety level, and the impact of fibromyalgia on quality of life (QoL). Patients and methods: Between January 2018 and January 2019, a total of 107 hemodialysis patients (Group 1) (48 males, 59 females; median age: 50 years; range, 42 to 56 years), 51 peritoneal dialysis patients (Group 2) (32 males, 19 females; median age: 49 years; range, 39 to 54 years), 52 renal transplant patients (Group 3) (23 males, 29 females; median age: 45.5 years; range, 37 to 52 years), and 50 healthy controls (Group 4) (23 males, 27 females; median age: 46.5 years; range, 42 to 50 years) were included in the study. Age, sex, amount of time spent on dialysis, and laboratory data were recorded. Impact of fibromyalgia on QoL was evaluated using the Fibromyalgia Impact Questionnaire (FIQ), while depressive symptoms and anxiety level were assessed using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Results: The point prevalence of fibromyalgia was 14% in Group 1 (n=15), 5.9% in Group 2 (n=3), 9.6% in Group 3 (n=5), and 4% in Group 4. There was a significant difference in the point prevalence of fibromyalgia between the hemodialysis group and healthy controls (p<0.05). The median FIQ scores were significantly higher in all patient groups than Group 4 (p<0.001); however, there was no significant difference between the patient groups (p>0.05). The median BDI scores were significantly higher in Group 1 and Group 2 than Group 4 (p<0.05). The median BAI scores were significantly higher in Group 1 than Group 4 (p<0.05). When the patients with and without fibromyalgia were compared, FIQ and BAI in Group 1, BAI in Group 2, and FIQ in Group 3 significantly differed (p<0.05). There was no relationship between fibromyalgia and any of the laboratory data, age, or time spent on dialysis (p>0.05). Conclusion: Fibromyalgia is significantly more common among hemodialysis patients than healthy individuals with a similar prevalence to the healthy individuals for peritoneal dialysis and renal transplant patients. The presence of fibromyalgia is related to depressive symptoms, anxiety, and higher impact on QoL for patients with chronic kidney disease.

The perspectives of dialysis patients about the Covid-19 pandemic and differences between the modalities.

The novel coronavirus disease was declared as a pandemic and CKD is an important risk factor for morbidity and mortality. Dialysis has additional contributions on transmission risk so prompt preventive strategies were implemented for dialysis patients. We aimed to evaluate pandemic-related perceptions and concerns of dialysis patients and differences between dialysis modalities. An anonymous survey for assessing concerns, knowledge, and attitudes about the pandemic was sent online to a total of 339 patients on maintenance dialysis at four tertiary dialysis centers in Turkey. A total of 309 patients (54.9 ± 15.1 years, 51.6% females, 55.7% in-center HD, 44.3% peritoneal dialysis) enrolled. The anonymous online survey was conducted at the end of April 2020. HD patients were more concerned about transmission risk (p = 0.002) and risks associated with the dialysis treatment environment and the transport methods (p < 0.001). The total concern score was significantly higher in the HD group (2.60 ± 0.93 vs. 1.65 ± 0.54, p < 0.001). The knowledge about the pandemic and prevention methods and the attitudes of prevention were similar between the groups (p = 0.161 and 0.418, respectively). The compliance rate of personal preventive strategies was 98.1%. Considering changing the current dialysis modality due to the pandemic was higher in the HD group (p < 0.001). Although the preventive strategies were performed properly in the HD centers, HD patients were more concerned about the Covid-19 outbreak compared with PD. Our results support home dialysis treatments for modality decisions with patients' positive perspective of PD over HD during the pandemic.

Surveillance of hemodialysis related infections: a prospective multicenter study.

As in many countries, there is neither a surveillance system nor a study to reveal the hemodialysis (HD) related infection rates in Turkey. We aimed to investigate the infection rate among HD outpatients and implement CDC's surveillance system. A multicenter prospective surveillance study is performed to investigate the infection rate among HD patients. CDC National Healthcare Safety Network (NHSN) dialysis event (DE) protocol is adopted for definitions and reporting. During April 2016-April 2018, 9 centers reported data. A total of 199 DEs reported in 10,035 patient-months, and the overall DE rate was 1.98 per 100 patient-months. Risk of blood culture positivity is found to be 17.6 times higher when hemodialysis was through a tunneled catheter than through an arteriovenous fistula. DE rate was significantly lower in patients educated about the care of their vascular access site. Staphylococcus aureus was the most causative microorganism among mortal patients. Outcomes of DEs were hospitalization (73%), loss of vascular access (18.2%), and death (7.7%). This first surveillance study revealed the baseline status of HD related infections in Turkey and showed that CDC National Healthcare Safety Network (NHSN) DE surveillance system can be easily implemented even in a high workload dialysis unit and be adopted as a nationwide DE surveillance program.

Assessment of Ischemia Modified Albumin as a Marker of Oxidative Stress in Chronic Kidney Disease.

Increased oxidative stress (OS) in chronic kidney disease (CKD), and particularly in those undergoing hemodialysis (HD), is widely recognized. We aimed to evaluate ischemia modified albumin (IMA) as a marker of OS in CKD patients who are not yet on HD compared to chronic HD patients. A cross-sectional study was conducted in Hitit University, Corum, Turkey in 2015. In this study, 39 chronic HD and 36 CKD patients in stage 3-4 were included, as well as 34 healthy individuals as a control group. IMA levels in HD patients (before and after HD session), stage 3-4 CKD patients and control group were evaluated using the ELISA method. Pre-HD and post-HD albumin levels were measured and albumin-adjusted IMA (aIMA) levels were calculated. IMA and aIMA levels were higher in chronic HD and CKD patients who are not yet on HD, compared to healthy individuals (IMA, 179.76 ± 60.46, 209.67 ± 69.84, 67.41 ± 32.22, P <0.001, respectively, aIMA, 186.22 ± 64.84, 212.96 ± 72.84, 68.80 ± 34.42, P <0.001, respectively). Likewise, IMA and aIMA levels in post-HD patients were higher than pre-HD levels (IMA, 294.62 ± 66.64, 179.76 ± 60.46, P <0.001, respectively, aIMA, 298.31 ± 70.93, 186.22 ± 64.83, P <0.001). Linear regression analysis identified glomerular filtration rate as the most effective factor on IMA (P <0.001). CKD is associated with increased OS and the HD procedure itself also contributes to the increase in OS. IMA may serve as a feasible biomarker for determination of OS.

The Comparison Spondin 2 Levels in Primary Glomerular Diseases.

Spondin 2 (SPON2) plays an important role in multiple processes and is a member of the Spondin 2/F-spondin family of extracellular matrix proteins. We investigated serum SPON2 levels and its correlation with renal functions and urine protein excretion in different glomerular diseases. The cohort included 97 consecutive adults with persistant proteinuria (>300 mg/day) with the diagnosis of focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), IgA nephropathy (IgAN), membranoproliferative glomerulonephritis (MPGN), and AA amyloidosis and the control groups with 15 polycystic kidney disease (PKD) and 32 healthy people. Serum SPON2 levels in MN (64.6 ng/mL), FSGS (47.8 ng/mL), IgAN (52.6 ng/mL), MPGN (54.6 ng/mL), and AA amyloidosis (60.7 ng/mL) groups were higher than those of the control (26.4 ng/mL) and nonglomerular disease groups (PKD) (15.3 ng/mL). Only serum SPON2 levels were correlated with serum uric acid and triglyceride levels in patients with glomerular disease. This is the first study to show that serum SPON2 levels are similar in different glomerular diseases and that there is no correlation between SPON2 and proteinuria grade.