The impact of diabetes mellitus on peritoneal dialysis: the Turkey Multicenter Clinic Study.

PURPOSE: It is well established that diabetic peritoneal dialysis (PD) patients have a higher mortality rate than the other PD population. This study was designed to determine the overall predictors of survival and compared mortality and morbidity between diabetic and non-diabetic Turkish PD patients. METHODS: We conducted a multicenter retrospective study with 915 PD patients [217 had diabetes mellitus (DM)]. Serum albumin, PTH, HbA1c, co-morbid diseases, dialysis adequacy (Kt/V), and peritoneal transport characteristics as well as peritonitis episodes and ultrafiltration failure during the follow-up period were recorded. RESULTS: DM patients were older and had more co-morbidities than non-DM patients. Peritonitis rates were higher in DM patients (one episode per 35.9 patient months) compared to non-DM patients (one episode per 41.5 patient months) (p < 0.001). On Kaplan-Meier analysis, patient survival was significantly lower in DM patients with the 2-, 3- and 5-year patient survival rates of 90.8%, 87.8% and 78.2% in non-diabetics and 80.9%, 70.4% and 61.2% in diabetics, respectively. On Cox regression analysis, DM (HR 1.5, p = 0.022), age (HR 1.03, p < 0.001), baseline serum albumin (HR 0.39, p < 0.001), heart failure (HR 0.038, p = 0.038), peripheral artery disease (HR 1.83, p = 0.025) and amputation (HR 4.1, p = 0.009) at baseline were significant predictors of overall mortality. CONCLUSIONS: Patient survival is lower in diabetic compared to non-diabetic patients on PD. Peritonitis rates were also higher in diabetic PD patients. DM, older age, albumin level and cardiovascular co-morbidities are predictors of mortality.

Central sensitization: its prevalence and impact on quality of life among hemodialyzed patients.

BACKGROUND/AIM: Data on the role of central sensitization in hemodialyzed patients are scarce. The aim was to identify the impact of central sensitization on quality of life and elucidate the risk factors for the development of central sensitization in patients receiving hemodialysis. METHODS: Central sensitization, quality of life, psychological well-being, and sleep were assessed by the Central Sensitization Inventory (CSI), abbreviated version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF), Hospital Anxiety and Depression Scale (HADS), and Jenkins Sleep Evaluation Scale (JSS), respectively. The effect of central sensitization on quality of life and the predictors of the development of central sensitization were assessed by regression analyses. RESULTS: The frequency of central sensitization was 48% in the study population (n = 100). Patients with central sensitization had significantly higher pain intensity, worse sleep quality, and more impaired psychological status (p < 0.05 for all). The CSI score negatively affected all quality of life domains on its own (p < 0.001 for all, adjusted R2 ranged from 0.17 to 0.47). Dialysis vintage (OR, 0.8; 95% CI, 0.7 to 1.0), pain (OR, 1.5; 95% CI, 1.1 to 2.0), JSS (OR, 1.3; 95% CI, 1.1 to 1.5), and HADS-total (OR, 1.1; 95% CI, 1.0 to 1.2) were determined as the independent risk factors for central sensitization (p < 0.05 for all). CONCLUSION: This study confirms that given the high frequency of central sensitization and its significant negative impact on quality of life, the presence of central sensitization should be investigated in patients undergoing hemodialysis.

Serum fibroblast growth factor 23 levels do not correlate with carotid intima-media thickness in patients with chronic kidney disease.

High levels of fibroblast growth factor 23 (FGF 23) are associated with mortality and cardiovascular events in patients with chronic kidney disease (CKD). Carotid intima-media thickness (CIMT) is a useful marker of subclinical atherosclerosis. This study aimed to investigate the relationship between serum FGF23 levels and CIMT of CKD patients. In this cross-sectional study, CIMT was measured in 162 patients with CKD Stage of 2-5 (age range 18-79 years, 61.7% males). Serum FGF23 levels were determined by enzyme-linked immunosorbent assay. CIMT was measured by ultrasonography. Serum FGF-23 levels were significantly higher (P = 0.046) in advanced CKD patients. CIMT was thicker in patients with advanced CKD patients (P = 0.01). CIMT was correlated with age (r = 0.486, P <0.001), smoking (r = 0.411, P <0.001), and 25-OH Vitamin D (r = -0.195, P= 0.045). There was no correlation between serum FGF23 and CIMT. Multivariate analysis showed that age (ß = 0.373, P <0.001), smoking (ß = 0.228, P = 0.004), and serum 25-hydroxyvitamin D levels (ß = -0.164, P = 0.042) were associated with CIMT. There was no relationship between FGF23 and CIMT. The CIMT was found to be related to increased age, smoking, and 25-hydroxyvitamin D in CKD patients.

What is the optimal dwell time for maximizing ultrafiltration with icodextrin exchange in automated peritoneal dialysis patients?

BACKGROUND: Icodextrin is increasingly being used in automated peritoneal dialysis (APD) for the long dwell exchange to maintain adequate ultrafiltration (UF). However, the UF reported in the literature varies with different dwell times: from 200 to 500 mL with 12 - 15 hour dwells. In order to maximize UF, it is important to know the relationship between dwell time and UF when using icodextrin in APD patients. With this knowledge, decisions can be made with respect to dwell period, and adjustments to the dialysis prescription can be made accordingly. METHODS: We prospectively studied this relationship in 36 patients from Canada and Turkey. All patients did the icodextrin day exchange manually after disconnecting themselves from overnight cycler dialysis. Dwell period was increased by 1 hour every week, from 10 to 14 hours. Ultrafiltration was noted for each icodextrin exchange. Mean UF for each week (i.e., dwell period) was compared by repeated measures ANOVA. RESULTS: We found no difference in mean UF with increasing dwelt time: 351.73 +/- 250.59 mL at 10 hours versus 371.75 +/- 258.25 mL at 14 hours (p = 0.83). We also compared mean UF between different subgroups and found that males (p = 0.02 vs females) and high transporters (p = 0.04 vs low) had higher mean UF. Further analysis of maximal UF showed no correlation to age, sex, diabetic status, transport category, creatinine clearance, Kt/V, duration on peritoneal dialysis, or duration of icodextrin use. CONCLUSION: Icodextrin-related UF in APD patients is not related to demographic factors and does not increase significantly beyond 10 hours.

Loss of vision and renal function in a patient with miliary tuberculosis.

INTRODUCTION: Visual loss is a rare complication of tuberculosis; it can be related to anti-tuberculous drugs or to the infection itself. For the treatment of visual loss, differential diagnosis is important between infection and adverse effect of anti-tuberculous drugs. CASE: A 48-year-old male patient with a history of tuberculosis and visual loss during anti-tuberculous drug therapy was admitted to our hospital. Anti-tuberculous drugs had been stopped on the 2nd day of therapy due to development of optic neuritis secondary to ethambutol administration at another hospital. He had miliary tuberculosis, renal failure requiring dialysis and visual disturbances. Anti-tuberculous drugs, including ethambutol, were initiated at our clinic because the period between the ethambutol therapy and visual loss was too short and the dose of ethambutol was not very high. Computed brain tomography was normal. Fundoscopic examination revealed only hypertensive retinopathy. Our diagnosis was tuberculosis-related visual loss, which could be due to neuroretinitis, intraocular tuberculosis or chiasmal tuberculoma. In addition, ethambutol rarely causes visual loss during the early period or when given at lower doses. In our case no complications developed from the treatment and the patient's visual loss and renal function improved. At his last visit, 12 months later, his vision had improved and his serum creatinine was lower, at 2.2 mg/dL. CONCLUSION: With anti-tuberculous treatment, renal functions and visual disturbances were improved in a patient with miliary tuberculosis. During the anti-tuberculous therapy, visual loss can be related to ethambutol toxicity or the tuberculosis infection itself. Differential diagnosis is very important and anti-tuberculous drugs must be continued if the diagnosis is tuberculosis.

Severe acute renal failure due to tubulointerstitial nephritis, pancreatitis, and hyperthyroidism in a patient during rifampicin therapy.

It is well known that rifampicin can cause nephrotoxicity. Rifampicin-related pancreatitis and hyperthyroidism are rarely reported in the same patient in the presence of tubulointerstitial nephritis. Reported herein is the medical management of a patient with hemolytic anemia, acute renal failure, pancreatitis, and hyperthyroidism during with rifampicin therapy. A 50-year-old man was admitted to the hospital owing to abdominal colic and acute renal failure. He was treated with 2 courses of tetracycline-rifampicin for brucellosis 3 weeks and 4 months prior to admission. Physical examination showed blood pressure of 130/70 mm Hg, pulmonary crackles, and edema. Laboratory findings are detailed in the case report. Findings of abdominal ultrasonography suggested edematose pancreatitis and thyroid ultrasonography showed several solid nodules. Renal biopsy showed tubulointerstitial nephritis. Although rifampicin-related tubulointerstitial nephritis and acute renal failure are not uncommon during rifampicin therapy, the convergence of hyperthyroidism, pancreatitis, tubulointerstitial nephritis, and acute renal failure rarely presents in the same patient. Although pancreatitis, tubulointerstitial nephritis, and acute renal failure were ameliorated with corticoid therapy within 2 months, hyperthyroidism continued and required antithyroid therapy. In conclusion, rifampicin may trigger hyperthyroidism in patients with goiter.

Effect of tempol (4-hydroxy tempo) on gentamicin-induced nephrotoxicity in rats.

We investigated the effects of tempol (4-hydroxy tempo), a membrane-permeable radical scavenger, on gentamicin-induced renal failure in rats. The rats were given gentamicin (100 mg/kg/day, i.p., once a day); and gentamicin (100 mg/kg/day, i.p.) and tempol (3.5, 7 or 14 mg/kg/day, i.p., once a day). At the end of 7 days, the gentamicin group produced the remarkable nephrotoxicity, characterized by a significantly decreased creatinine clearance and increased serum creatinine, blood urea nitrogen (BUN) and daily urine volume when compared with controls. In control the BUN value was 21.2 +/- 0.07 (mg/100 mL); in comparison, it was 96.9 +/- 6.03 in gentamicin group (P < 0.05). Renal histopathologic examination confirmed acute tubular necrosis in this group. In rats treated with gentamicin and tempol a partial improvement in biochemical and histologic parameters was observed. BUN values were 96.9 +/- 6.03 and 36.3 +/- 2.39 in gentamicin, and gentamicin plus tempol (14 mg/kg) treated groups, respectively (P < 0.05). These results suggest that the administration of tempol may have a protective effect on gentamicin-induced nephrotoxicity in rats.

The acute effect of trimetazidine on the high frequency fatigue in the isolated rat diaphragm muscle.

The objective of this study was to determine the acute effect of trimetazidine (TMZ) on the pre-fatigue, fatigue and post-fatigue contractile characteristics and tension-frequency relationships of isolated rat diaphragm muscle. Muscle strips were taken from the ventral-costal aspects of the diaphragm muscle of rats killed by decapitation. The muscle strips were suspended in organ baths containing Krebs solution, with a gas mixture of 95% O2 and 5% CO2 at 37 degrees C and pH 7.35-7.45. After determining the thermoregulation and optimum muscle length the muscles were subjected to direct supramaximal stimulation with 0.05 Hz frequency square pulses for periods of 0.5 msec to obtain control values. After adding 5 x 10(-6) and 5 x 10(-5) M trimetazidine solution to the respective bath media, the contractile parameters of the muscles were recorded. The contractile parameters were also recorded for both the trimetazidine and trimetazidine-free media after application of the high frequency fatigue protocols. Later, the tension-frequency relationship was determined by applying stimulating pulses of 10, 20, 50 and 100 Hz to the muscle strips. Whilst the twitch tension obtained from the 5 x 10(-6) and 5 x 10(-5) M trimetazidine media showed numerical increases compared to that of the controls, these were not statistically significant (p>0.05). The contraction time exhibited a dose dependent increase (p<0.001), whilst the contraction and relaxation rates did not differ significantly. The isometric contraction forces obtained with the different stimulating frequencies showed a significant increase in the tetanic contraction only at 100 Hz (p<0.05). A comparison of the pre- and post-fatigue twitch tensions in the trimetazidine media showed the post- fatigue twitch tensions to be significantly higher than those of the pre-fatigue contraction forces (p<0.05). In the 5 x 10(-6) and 5 x 10(-5) M trimetazidine media the increases in the post-fatigue contraction force were 22 and 30%, respectively. These results demonstrated that in isolated rat diaphragm muscle, TMZ significantly limited the mechanical performance decrease during fatigue. It is our opinion that trimetazidine contributed to the observed fatigue tolerance by eliminating the factors of fatigue, due to preservation of intracellular calcium homeostasis, provision of the ATP energy levels needed by ATPase dependent pumps and especially by keeping the intracellular pH within certain limits.

Effects of trimetazidine and selenium on high-frequency fatigue in isolated rat diaphragm muscle.

Trimetazidine (TMZ), which has been used in numerous experimental studies, is applied nowadays with the aim of reducing myocardial ischemia. The aim of this study was to determine the prefatigue and postfatigue contractile characteristics associated with the relationship between the force and frequency of contraction in muscle. The study was conducted using diaphragm muscle isolated from 40 male Wistar rats weighing 230 to 270 g. The rats were divided into 4 groups of 10 animals each: controls and TMZ-, selenium (Se)-, and TMZ+Se-treated groups. The rats in the control group were treated with 2 mL of physiologic serum (SF), those in the second group with Se 30 microg/kg in 2mL of SF, those in the third group with TMZ 5 mg/kg in 2 mL of SF, and those in the fourth group with a combination of TMZ 5 mg/kg + Se 30 microg/kg in 2 mL of SF. All rats were treated twice daily for 15 days by means of gastric lavage. The rats were then killed by cervical dislocation. The diaphragm muscle bands were removed and placed in an organ bath. After a 2-hour thermoregulatory period, muscles were fatigued with 5-ms pulses at a frequency of 40 Hz. Force-frequency relationships were studied after the application of 10, 50, and 100 Hz and the development of contraction curves. Contraction forces for the groups treated with TMZ, Se, and TMZ+Se (16.1 +/- 1.2, 13.2 +/- 1.3, and 14.9 +/- 1.0 g, respectively) were significantly lower than for the control group (17.0 +/- 1.4 g) during the prefatigue period (P<.001). Similarly, postfatigue contraction forces for the treated groups (15.7 +/- 1.3, 8.8 +/- 1.0, and 12.0 +/- 1.4 g, respectively) were significantly lower than for the control group (12.4 +/- 1.2 g, P<.001, P<.001, and P<.05, respectively). A significant decrease was noted in postfatigue contraction forces and contraction and relaxation rates in the Se- and TMZ+Se-treated groups compared with prefatigue values (P<.001), but the difference was not significant. Force-frequency relationships were evaluated at 10, 50, and 100 Hz. The tetanic contraction forces for the control, Se-, TMZ-, and TMZ+Se-treated groups at 100 Hz were 81.3 +/- 5.7, 91.6 +/- 6.8, 65.3 +/- 5.0, and 84.9 +/- 7.5 g, respectively. In the TMZ-treated group, a significant increase was observed in tetanic contraction forces at 100 Hz compared with controls (P<.001); no significant changes were seen in the force-frequency relationships at 10 and 50 Hz. The decrease in the contraction force in the postfatigue period was prevented to a larger extent in the TMZ-treated group than in the TMZ+Se- and Se-treated groups.

Effects of cyclosporine and tacrolimus on maintenance therapy after renal transplantation.

The immunosuppressive agents cyclosporine A and tacrolimus have demonstrated efficacy in preventing acute organ rejection after renal transplantation, but no comparative studies of these 2 agents have been published. This study compared the effects of tacrolimus and cyclosporine A on the renal function, blood pressure, and serum glucose and lipid levels of patients who underwent cyclosporine A therapy and C2 monitoring or tacrolimus therapy and standard monitoring during the first 24 months after transplantation. By the end of the follow-up period, no significant difference between either treatment group was noted in the measures of creatine clearance; BUN, glucose, uric acid, and lipid levels; or diastolic blood pressure (P>.05 for all), which were maintained at normal values throughout the study. Systolic blood pressure was significantly lower in the cyclosporine A group at the end of the 1 st month (P<.025) but this difference was not evident at months 6, 12, and 24 (P>.05). These results indicate that tacrolimus and cyclosporine (when combined with C2 monitoring) were equally effective and safe in preventing acute organ rejection.

Nonsynergistic effects of trimetazidine and selenium combination therapy on renal ischemic-reperfusion injury in rats.

Reactive oxygen species (ROS) have been postulated to play a major role in postischemic acute renal injury. Moreover, lipid peroxidation has been described as an important pathway of ROS-induced postischemic acute renal failure. To evaluate effects of selenium (Se) and trimetazidine (TMZ) on postischemic renal failure, renal tissue malondialdehyde (MDA) and superoxide dismutase (SOD) concentrations were measured in Wistar rats with ischemic renal failure. Treatment groups consisted of rats treated with TMZ (5 mg/kg orally) or Se (30 microg/kg orally) or TMZ+Se for 15 days. Ischemic groups consisted of rats with clamped left renal arteries for 1 hour. Before left renal arterial clamping, right nephrectomy was performed; after 24 hours, left nephrectomy was done. The animals were divided into 5 groups. Group 1 (n=7) was the nonischemic control group without treatment; Group 2 (n=6) was the ischemic control group treated with physiologic solution; Group 3 (n=5) received TMZ; Group 4 (n=5) received Se; and Group 5 (n=6) received TMZ+Se for 15 days. After TMZ and Se treatment, right renal tissue MDA significantly decreased in Groups 3-5 when compared with those in Group 1. There was no significant difference between nonischemic and ischemic renal tissue MDA in Groups 3, 4, and 5. Postischemic renal tissue SOD levels were higher than nonischemic levels in Group 3. In Groups 4 and 5, no significant differences were observed between nonischemic and ischemic renal tissue SOD levels. Moreover, total scores obtained from histopathologic evaluation of ischemic and nonischemic kidney samples in Groups 3, 4, and 5 were similar, but these scores in Group 2 were significantly different from those of Groups 3, 4, and 5. These results indicate that, under these study conditions, TMZ, Se, and TMZ+Se treatments prevent lipid peroxidation in ischemic and nonischemic renal tissue. Moreover, these treatments prevent histologic findings of postischemic-perfusion renal injury.

Serum levels of prostate-specific antigen and vitamin D in peritoneal dialysis patients.

Measuring the free:total ratio of prostate-specific antigen (f/t-PSA) can improve the specificity of single-serum PSA values, distinguishing between benign prostatic hyperplasia (BPH) and prostatic carcinoma (PCa) in men over the age of 50. Additionally, clinical trials have shown that dihydroxyvitamin D3 can slow the rate of PSA rise in PCa patients. However, little is known regarding the applicability of those findings in men undergoing chronic peritoneal dialysis (CPD). In the present study, we investigated the prevalence of increased serum PSA levels among CPD patients and correlated those values with serum levels of vitamin D [25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3]. We undertook a cross-sectional study of 71 male CPD patients without a known history of prostate cancer from 24 centers in Canada, Greece, and Turkey. All of the patients were more than 50 years of age. In these patients, we measured serum concentrations of PSA, free PSA (f-PSA), total PSA (t-PSA), prostate alkaline phosphatase (PAP), 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and intact parathyroid hormone (iPTH). We recorded serum PSA levels < 4 ng/mL in 62 patients (87.3%, group A) and levels > 4 ng/mL in 9 patients (12.7%, group B). The f/t-PSA ratio was < 0.25 in 16 patients (22.5%). Group B patients were older than those in group A (median: 73 years vs. 65 years, p < 0.01) and had a lower body weight (median: 66.5 kg vs. 76.7 kg, p < 0.05). We observed no statistically significant difference between the two groups for serum 1,25-dihydroxyvitamin D3 (median: 9.8 ng/mL vs. 10.1 ng/mL) or 25-hydroxyvitamin D3 (8 ng/mL vs. 8.2 ng/mL) levels. Also, we observed no correlation between vitamin D levels and f/t-PSA, but iPTH levels were significantly higher in group A (200.5 pg/mL vs. 61.2 pg/mL, p < 0.04). Also, serum PAP levels correlated significantly with PSA (r = 0.49, p = 0.01) and with f-PSA (r = 0.56, p = 0.000). Our results showed no clear relationship between vitamin D and serum levels of PSA or-of f/t-PSA in PD patients. However, further studies are needed to better define the uses of these PSA markers in PD patients because, in such patients, other relevant factors might be implicated in their predictive value.

Lactic acidosis induced by metformin in a chronic hemodialysis patient with diabetes mellitus type 2.

Metformin is a biguanide group oral antidiabetic drug used for the treatment of type 2 diabetes mellitus. Nausea, vomiting, diarrhea, abdominal pain, and anorexia are the most common adverse effects encountered during treatment. Lactic acidosis is a serious side effect seen with metformin use, and while the incidence of lactic acidosis is similar to other oral antidiabetics, metformin is not recommended to patients with certain risk factors, such as cardiovascular, pulmonary, and renal and liver failure. We describe a chronic hemodialysis patient treated with metformin, presenting to the nephrology department with altered mental status.

Once-monthly continuous erythropoietin receptor activator (CERA) for haemoglobin maintenance in haemodialysis patients with chronic renal anaemia.

BACKGROUND: This study was conducted to evaluate the efficacy and safety of once-monthly continuous erythropoietin receptor activator (CERA) for maintenance of stable haemoglobin (Hb) levels in adult chronic renal anaemia patients on dialysis according to local clinical judgment in Turkey. METHODS: This was a prospective, open-label, single-arm, multi-centre study conducted in 20 centres in Turkey. After a 4-week screening period, eligible patients receiving conventional erythropoiesis-stimulating agents were converted to monthly intravenous CERA and entered a 16-week CERA dose-titration period (DTP) followed by an 8-week efficacy evaluation period (EEP) and a 4-week safety follow-up. The primary endpoint was the proportion of patients whose Hb concentration remained stable within ±1.0 g/dL of their reference Hb and within the range of 10.0-12.0 g/dL during the EEP. RESULTS: A total of 173 patients were screened, 132 entered the DTP and 84 completed the study. Thirty-nine patients [46.4% (95% confidence interval: 35.5-57.7%)] maintained stable target Hb concentrations. The mean change in time-adjusted average Hb concentration was 0.29 ± 1.08 g/dL between baseline and the EEP. The mean CERA monthly dose was 112.4 ± 76.78 µg during the EEP, and the CERA dose was adjusted in 39 patients (36.4%). Eleven patients (8.4%) reported 13 treatment-related adverse events, the most frequent adverse events being infections and infestations, gastrointestinal and vascular disorders. CONCLUSIONS: Once-monthly CERA maintains stable Hb concentrations in chronic renal anaemia patients on dialysis in Turkey. The study results confirm the known efficacy and safety profile of CERA.

Arm circumference: its importance for dialysis patients in the obesity era.

PURPOSE: The purposes of this study were to investigate the association between arm circumference and body mass index (BMI) and to discuss problems, mainly arm circumference and cuff size mismatch, that could affect the reliability of home blood pressure monitoring (HBPM) among peritoneal dialysis (PD) and hemodialysis (HD) patients. METHODS: 525 PD and 502 HD patients from 16 centers were included in the study. A two-part questionnaire was used to gather information from the participants. Arm circumferences were categorized into four groups according to the British Hypertension Society cuff size recommendations. RESULTS: Mean BMI and arm circumference of all participants were 25.0 kg/m(2) and 27.6 cm, respectively. There was a significant correlation between BMI and arm circumference. The mean BMI and arm circumference values were higher in PD patients than in HD patients. Requirement of a large-sized adult cuff was more common among PD patients compared to HD patients (14 % vs 8 %, p = 0.002). CONCLUSIONS: Since HBPM is a useful tool for clinicians to improve BP control, nephrologists should be aware of the problems related to HBPM in dialysis patients and take an active role to increase the reliability of HBPM.

Bone mineral density and its correlation with clinical and laboratory factors in chronic peritoneal dialysis patients.

The aim of this study was to assess the clinical and laboratory correlations of bone mineral density (BMD) measurements among a large population of patients on chronic peritoneal dialysis (PD). This cross-sectional, multicenter study was carried out in 292 PD patients with a mean age of 56 +/- 16 years and mean duration of PD 3.1 +/- 2.1 years. Altogether, 129 female and 163 male patients from 24 centers in Canada, Greece, and Turkey were included in the study. BMD findings, obtained by dual-energy X-ray absorptiometry (DEXA) and some other major clinical and laboratory indices of bone mineral deposition as well as uremic osteodystrophy were investigated. In the 292 patients included in the study, the mean lumbar spine T-score was -1.04 +/- 1.68, the lumbar spine Z-score was -0.31 +/- 1.68, the femoral neck T-score was -1.38 +/- 1.39, and the femoral neck Z score was -0.66 +/- 1.23. According to the WHO criteria based on lumbar spine T-scores, 19.2% of 292 patients were osteoporotic, 36.3% had osteopenia, and 44.4% had lumbar spine T-scores within the normal range. In the femoral neck area, the prevalence of osteoporosis was slightly higher (26%). The prevalence of osteoporosis was 23.3% in female patients and 16.6% in male patients with no statistically significant difference between the sexes. Agreements of lumbar spine and femoral neck T-scores for the diagnosis of osteoporosis were 66.7% and 27.3% and 83.3% for osteopenia and normal BMD values, respectively. Among the clinical and laboratory parameters we investigated in this study, the body mass index (BMI) (P < 0.001), daily urine output, and urea clearance time x dialysis time/volume (Kt/V) (P < 0.05) were statistically significantly positive and Ca x PO(4) had a negative correlation (P < 0.05) with the lumbar spine T scores. Femoral neck T scores were also positively correlated with BMI, daily urine output, and KT/V; and they were negatively correlated with age. Intact parathyroid hormone levels did not correlate with any of the BMD parameters. Femoral neck Z scores were correlated with BMI (P < 0.001), and ionized calcium (P < 0.05) positively and negatively with age, total alkaline phosphatase (P < 0.05), and Ca x P (P < 0.01). The overall prevalence of fractures since the initiation of PD was 10%. Our results indicated that, considering their DEXA-based BMD values, 55% of chronic PD patients have subnormal bone mass-19% within the osteoporotic range and 36% within the osteopenic range. Our findings also indicate that low body weight is the most important risk factor for osteoporosis in chronic PD patients. An insufficient dialysis dose (expressed as KT/V) and older age may also be important risk factors for osteoporosis of PD patients.

Is there any relationship between serum levels of interleukin-10 and atherosclerosis in hemodialysis patients?

OBJECTIVE: Cardiovascular complications due to atherosclerosis (AS) are the major cause of mortality in hemodialysis (HD) patients. Inflammation may play an important role in the development of AS. Several studies have demonstrated an association between AS and acute-phase proteins and cytokines in the general population and in HD patients. Interleukin-10 (IL-10) is an anti-inflammatory cytokine. The aim of this study was to compare serum levels of inflammatory and anti-inflammatory indicators in HD patients according to the presence or absence of AS. MATERIAL AND METHODS: A total of 33 HD patients were studied. AS was defined as the presence of plaques as detected by Doppler ultrasonography. The patients were subgrouped according to the presence or absence of plaques. Serum levels of IL-1, -2, -6 and -10, C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) were measured. Risk factors for AS, such as age, gender, hypertension, hyperlipidemia and duration of HD, were also evaluated. RESULTS: Patients with AS had significantly higher high sensitivity (hs)-CRP and lower IL-10 levels. Blood pressure was also elevated in patients with AS. There was an inverse correlation between CRP and IL-10 levels in patients with AS. CONCLUSION: Patients with AS undergoing HD had low serum levels of the anti-inflammatory cytokine IL-10 and high serum levels of hs-CRP. These results may suggest that limitation of the anti-inflammatory response in atherosclerotic uremic patients is a triggering or contributory factor for AS.

A unique form of polycythemia associated with minimal change disease.

OBJECTIVE: To present a case with nephrotic syndrome due to minimal change disease and polycythemia. CLINICAL PRESENTATION AND INTERVENTION: A 20-year-old female was admitted to our clinic for edema and severe proteinuria present with minimal change disease since the age of 7 years. Polycythemia was found during the last activation of nephrotic syndrome. The patient was placed on glucocorticoid therapy that caused disappearance of edema, proteinuria and polycythemia. Ten months later both hemoglobin and hematocrit levels were within normal range. CONCLUSION: This patient with nephrotic syndrome due to minimal change disease and polycythemia was successfully treated with glucocorticoid.