Do hemodialysis adequacy data reflect reality?

Hemodialysis (HD) adequacy requires monitoring in line with standards and at appropriate intervals. However, the use of inappropriate or incorrectly applied techniques in the determination of HD adequacy can lead to highly unfortunate results. This study was intended to identify the path to a solution by determining how far HD adequacy in HD centers in our region reflects reality. Three hundred and thirty HD patients from eight centers were included. On the first visit, predialysis and postdialysis blood collection with the centers' own methods being used were observed and errors were recorded. Kt/V1 was calculated from pre- and postdialysis blood specimens taken by the units themselves. On the second visit, one session later, pre- and postdialysis blood samples were collected in line with guidelines by ourselves, the authors, and Kt/V2 was calculated from these samples. The eight units' total Kt/V2 value was significantly lower compared with Kt/V1 (<0.0001). The level of patients in all centers with Kt/V1 <1.2 was 13.5%, and that of patients with Kt/V2 <1.2 was 22.1%. No center, apart from one unit, managed to complete the collection of blood specimens as recommended by the guidelines. With one exception, blood collection for HD adequacy was not performed using proper technique in any center. This simple but easily overlooked situation, HD being regarded as adequate though in fact it is not, may lead to patients not being treated effectively and accurately and to a rise in mortality and morbidity in the long term.

Using two-holed needles for both arterial and venous accesses to the arteriovenous fistula to improve flow during hemodialysis.

This prospective study compared methods using both arterial and venous needles with back eyes with those using only arterial needle with back eye for arteriovenous fistula cannulation. Sixty-one patients receiving hemodialysis (HD) via an arteriovenous fistula were evaluated. All patients underwent arteriovenous fistula puncture using only arterial needle with back eye in first 3 months and both arterial and venous needles with back eyes in following 3 months. Arterial and venous pressures, blood flow velocities, total blood volume cleared, and Kt/V values were compared. Mean blood flow velocity, arterial pressure, Kt/V, and cleared total blood volume values were higher and venous pressure was lower in patients who underwent cannulation using both needles with back eyes than in those with only the arterial needle with back eye. For arteriovenous fistula cannulation, using both arterial and venous needles with back eyes provides adequate HD more successfully.

Gallbladder Stone Prevalence and Related Factors in Predialysis Chronic Kidney Disease Patients.

BACKGROUND: The aim of this study was to determine the prevalence and factors associated with gallbladder stone in patients with predialysis chronic kidney disease. METHODS: This cross-sectional study retrospectively examined follow-up data of patients with chronic kidney disease between January 2015 and December 2020 at the Health Sciences University Antalya Training and Research Hospital who had undergone abdominal ultrasonography for any reason. Patients with gallbladder stone on abdominal ultrasonography and history of cholecystectomy due to gallbladder stone were identified as the gallstone group. The prevalence of gallbladder stone was determined according to disease stage. Patients with and without gallbladder stone were compared in terms of demographic and clinical characteristics and laboratory parameters that may be associated with the development of gallbladder stone. RESULTS: A total of 511 patients had chronic kidney disease (stages 3, 4, and 5 in 303 [59.3%], 176 [34.4%], and 32 [6.3%], respectively). The gallstone prevalence rates were 25.1%, 30.1%, and 46.9% in stage 3, 4, and 5 chronic kidney disease, respectively, and that in all the patients was 28.2% (95% CI: 24.3-32.3, P = .026). Logistic regression analysis revealed that increased age (odds ratio: 1.045; 95% CI: 1.027-1.063, P < .001) and decreased estimated glomerular filtration rate (odds ratio: 0.974; 95% CI: 0.956-0.991, P = .004) were associated with gallbladder stone. CONCLUSION: The prevalence of gallbladder stone was high in the predialysis patients with chronic kidney disease and increased with increasing disease stage. High age and low estimated glomerular filtration rate were associated with gallbladder stone formation.

Amikacin-induced nephropathy: is there any protective way?

Amikacin is a commonly used antibacterial drug that can cause significant nephrotoxic effects in both humans and experimental animals. It has been reported that one mechanism of the toxic effects of aminoglycoside antibiotics are the result of oxidative reactions. The aim of this study is to examine the effects of N-acetylcysteine, a thiol-containing antioxidant, on renal function (serum creatinine) and morphology (renal tubular damage) in mice subjected to amikacin-induced nephrotoxicity. A total of 32 mice were equally divided into four groups that were injected with either saline, amikacin (1.2 g/kg intraperitoneally), N-acetylcysteine (150 mg/kg intraperitoneally for three days) plus amikacin (1.2 g/kg intraperitoneally on the third day as a single dose), or N-acetylcysteine (150 mg/kg intraperitoneally). Amikacin administration led to granulovacuolar tubular degeneration in light microscopic examination and myeloid bodies, mitochondrial electron-dense material deposition, and mitochondrial swelling in the proximal tubule epithelium in the electron microscopic evaluation. N-acetylcysteine administration before amikacin injection caused significant decreases in myeloid body and mitochondrial swelling and granulovacuolar tubular degeneration formation. Serum creatinine levels did not change as a result of any treatment. The results show that N-acetylcysteine has a protective effect on nephrotoxicity induced by amikacin. Higher doses of amikacin should be tried to observe biochemical effects.

Erythrocytosis in a patient on hemodialysis for thirteen years.

Most hemodialysis patients exhibit renal anemia mainly due to erythropoietin deficiency as a result of impaired erythropoetin production in the kidney. However, erythrocytosis in patients with renal failure requiring hemodialysis is extremely rare. We report the development of erythrocytosis in a patient with a polycystic kidney disease on hemodialysis for 13 years. She had erythrocytosis with increased serum erythropoietin levels despite severe secondary hyperparathyroidism, which is known to depress erythrocytosis. Since neither renal disease (renal cell carcinoma) nor extrarenal diseases (hypoxia, hepatoma, cerebellar diseases) linked with erythropoietin production could be proven, this case might be one with inappropriate idiopathic erythropoietin production after 13 years of hemodialysis, the longest duration of dialysis in the literature before erythrocytosis was observed.

Improvement of renal functions after embolization of renal AVF in a patient who had been on dialysis for 5 years.

Recently, ultrasound-guided percutaneous renal biopsy has been used in the diagnosis of renal diseases. Development of an arteriovenous fistula (AVF), which is one of the post-biopsy complications, is not frequently encountered. AVFs are usually asymptomatic; however, they may lead to serious outcomes. We report a 21-year-old patient, who had been on dialysis for 5 years. Due to high blood pressure (230/160 mmHg) and a thrill in the lumbar area detected on physical examination, Doppler examination was performed and a renal AVF was detected. Because the patient had a history of renal biopsy 5 years previously, the fistula was thought to be secondary to the biopsy. After embolization of the AVF, renal functions improved enough to terminate dialysis treatment.

An unusual etiology of erythropoietin resistance: hyperthyroidism.

Many possible causes of resistance to human recombinant erythropoietin (rh-EPO) have been reported in patients with renal failure. This case presents an unusual cause of erythropoietin-resistant anemia in a patient with chronic renal failure. A 61-year-old male patient who was on chronic hemodialysis program due to diabetic nephropathy for seven months developed erythropoietin resistant anemia. No iron deficiency was revealed by laboratory data, no megaloblastic anemia were found by biochemical investigation, and no inflammatory states including infection or neoplastic diseases were disclosed by abdominal ultrasonography, chest X-ray, bone marrow aspiration and biopsy, or other methods (normal C-reactive protein levels). This hemodialysis patient had epoetin-resistant anemia with primary autoimmune hyperthyroidism. The anti-thyroid therapy was effective not only against the hyperthyroidism but also against his epoetin resistant anemia.

Renal hypoplasia and situs inversus totalis.

A spectrum of renal abnormalities of patients with situs inversus has been reported. Renal dysplasia is the most common. Herein is described for the first time, an association of situs inversus totalis, unilateral congenital renal hypoplasia and external ear cartilage deformity.

TGF-beta and TNF-alpha producing effects of losartan and amlodipine on human mononuclear cell culture.

AIM: The modulation of cytokine release, which affects adhesion of leucocytes to endothelial cells, and proliferation of peripheral blood mononuclear cells with antihypertensive drugs was explored. METHOD: In the present study, mononuclear cells were incubated with losartan and amlodipine at concentrations of 10(-6), 10(-5) and 10(-4) mol/L for 6 h. Transforming growth factor (TGF)-beta and tumour necrosis factor (TNF)-alpha levels were measured. Proliferation of mononuclear cells were assessed at the same concentrations of amlodipine and losartan with the methylthiazoletetrazolium (MTT) test. RESULTS: Amlodipine was found to induce TGF-beta synthesis from mononuclear cells with increasing concentrations, while it was found to inhibit TNF-alpha secretion with increasing concentrations. In contrast, losartan was found to induce TGF-beta and TNF-alpha secretion with increasing concentrations. CONCLUSION: Anti-atherosclerotic effects of amlodipine and losartan might be through increased secretion of TGF-beta from mononuclear cells. Different results at different concentrations might be due to the pharmocokinetic differences of these drugs.

Renal failure due to Bardet-Biedl syndrome. A case report.

OBJECTIVE: To describe a case of Bardet-Biedl syndrome involving renal failure and retinal dystrophy. CASE PRESENTATION AND INTERVENTION: A 50-year-old female patient presented to the emergency service with uremic symptoms and metabolic acidosis. Polydactyly, retinitis pigmentosa, obesity, strabismus, nistagmus and renal failure were found. Because she had end-stage renal failure, hemodialysis therapy was started. She has been well for 18 months, without any complication on hemodialysis. CONCLUSION: Bardet-Biedl syndrome should be considered in patients with polydactyly, retinitis pigmentosa and renal failure.