Effects of hemodialysis on corneal and anterior chamber morphometry and intraocular pressure in patients with end-stage renal disease.

PURPOSE: To evaluate the effects of hemodialysis (HD) on corneal and anterior chamber morphometry, as well as intraocular pressure (IOP) in patients with end-stage renal disease. METHODS: Fifty right eyes were examined 30 minutes before and after HD. IOP was measured with a Goldmann applanation tonometer, and Ehlers' formula was used to calculate the corrected IOP values. The central corneal thickness (CCT), corneal volume (CV), keratometric values, anterior chamber depth (ACD), aqueous depth (AQD), anterior chamber volume (ACV), and anterior chamber angle (ACA) in the nasal and temporal quadrants were measured with a Sirius anterior segment analysis system. Blood urea nitrogen levels, body mass, and systolic and diastolic arterial pressure were also measured before and after HD. RESULTS: The mean age was 60.80 ± 13.38 (range: 35-80) years. The mean uncorrected and corrected IOP values decreased from 18.06 ± 3.91 and 18.31 ± 4.83 mmHg to 16.94 ± 3.87 and 16.95 ± 4.74 mmHg after HD, respectively (p=0.011 and p=0.003, respectively). The mean CCT decreased from 536.38 ± 24.73 to 533.18 ± 27.25 µm (p=0.002), and the mean CV decreased from 57.52 ± 3.15 to 55.68 ± 3.55 mm³ (p<0.001) after HD. There were no significant changes in ACD, AQD, ACV, ACA, or the keratometric values (p>0.05 for all values). There were no significant correlations between the ocular and systemic parameters (p>0.05 for all correlations). CONCLUSIONS: Uncorrected IOP, corrected IOP, CCT, and CV values decreased after HD, whereas the anterior chamber morphometry values remained similar between the measurements performed before and after HD.

Effects of hemodialysis on corneal and anterior chamber morphometry and intraocular pressure in patients with end-stage renal disease / Efeitos da hemodiálise na morfometria da córnea e da câmara anterior, e na pressão intraocular em pacientes no estágio final da doença renal

ABSTRACT Purpose: To evaluate the effects of hemodialysis (HD) on corneal and anterior chamber morphometry, as well as intraocular pressure (IOP) in patients with end-stage renal disease. Methods: Fifty right eyes were examined 30 minutes before and after HD. IOP was measured with a Goldmann applanation tonometer, and Ehlers' formula was used to calculate the corrected IOP values. The central corneal thickness (CCT), corneal volume (CV), keratometric values, anterior chamber depth (ACD), aqueous depth (AQD), anterior chamber volume (ACV), and anterior chamber angle (ACA) in the nasal and temporal quadrants were measured with a Sirius anterior segment analysis system. Blood urea nitrogen levels, body mass, and systolic and diastolic arterial pressure were also measured before and after HD. Results: The mean age was 60.80 ± 13.38 (range: 35-80) years. The mean uncorrected and corrected IOP values decreased from 18.06 ± 3.91 and 18.31 ± 4.83 mmHg to 16.94 ± 3.87 and 16.95 ± 4.74 mmHg after HD, respectively (p=0.011 and p=0.003, respectively). The mean CCT decreased from 536.38 ± 24.73 to 533.18 ± 27.25 µm (p=0.002), and the mean CV decreased from 57.52 ± 3.15 to 55.68 ± 3.55 mm³ (p<0.001) after HD. There were no significant changes in ACD, AQD, ACV, ACA, or the keratometric values (p>0.05 for all values). There were no significant correlations between the ocular and systemic parameters (p>0.05 for all correlations). Conclusions: Uncorrected IOP, corrected IOP, CCT, and CV values decreased after HD, whereas the anterior chamber morphometry values remained similar between the measurements performed before and after HD.

RESUMO Objetivo: Avaliar os efeitos da hemodiálise (HD) na morfometria da córnea e da câmara anterior e da pressão intraocular (PIO) em pacientes com doença renal terminal. Métodos: Cinquenta olhos direitos foram examinados 30 minutos antes e após hemodiálise. A pressão intraocular foi medida com um tonômetro de aplanação de Goldmann, e a fórmula de Ehlers foi utilizada para calcular os valores de pressão in traocular corrigidos. Mediram-se a espessura corneana central (CCT), o volume corneano (CV), os valores ceratométricos, a profundidade da câmara anterior (ACD), a profundidade aquosa (AQD), o volume da câmara anterior (ACV) e o ângulo da câmara anterior (ACA) nos quadrantes nasais e temporais com um sistema de análise de segmento Sirius anterior. Os níveis de nitrogênio ureico no sangue (BUN), peso corporal e pressão arterial sistólica e diastólica também foram medidos antes e após a HD. Resultados: A média de idade foi de 60,80 ± 13,38 (35-80) anos. Os valores médios não corrigidos e corrigidos da pressão intraocular diminuíram de 18,06 ± 3,91 e 18,31 ± 4,83 mmHg para 16,94 ± 3,87 e 16,95 ± 4,74 mmHg após hemodiálise (p=0,011 e p=0,003, respectivamente). A espessura corneana central média diminuiu de 536,38 ± 24,73 para 533,18 ± 27,25 µm (p=0,002), e o volume corneano médio diminuiu de 57,52 ± 3,15 para 55,68 ± 3,55 mm³ (p<0,001) após hemodiálise. Não houve alteração significativa nos valores de profundidade da câmara anterior, profundidade aquosa, volume da câmara anterior, ângulo da câmara anterior e ceratométricos (p>0,05 para todos os valores). Não houve correlação significativa entre os parâmetros oculares e sistêmicos (p>0,05 para todas as correlações). Conclusão: A pressão intraocular não corrigida, a pressão intraocular corrigida, a espessura corneana central e os valores de volume corneano diminuíram após hemodiálise, enquanto os valores de morfometria da câmara anterior foram semelhantes entre as medidas realizadas antes e após a hemodiálise.

Serum cystatin C is not an appropriate marker for kidney involvement in patients with primary Sjögren's syndrome.

OBJECTIVES: We aimed to investigate serum cystatin C (cysC) levels in primary Sjögren's syndrome (pSS) patients, and evaluate its correlation with renal involment. MATERIALS AND METHODS: Eighty-six pSS patients and 65 age- and gender-matched healthy controls were enrolled into the study. Serum cysC, urea, serum creatinine (SCr), creatinine clearance (CrCl), glomerular filtration rates (GFR), Na, K, Mg, Ca, uric acid, P, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-Ro/SS-A, anti-La/SS-B, antinuclear antibodies, 24-h urinary poteinuria and microalbuminuria were evaluated. RESULTS: Mean serum cysC levels did not differ between the patients and healthy controls (P > 0.05). Nine patients with pSS had proteinuria over 150 mg (and microalbuminuria over 30 mg) per 24 h. In patients with proteinuria, serum cysC levels correlated with serum K (r = 0.279, P = 0.024), ESR (r = 0.405, P = 0.001) and the disease duration (r = 0.235, P = 0.04), respectively. Patients with positive anti-Ro/SS-A and anti-La/SS-B antibodies had higher SCr levels compared to those with negative serology (r = 0.292, P = 0.009, and r = 0.259, P = 0.022, respectively). Nine patients with proteinuria and anti-Ro/SS-A, anti-La/SS-B positivity tended to have lower K and Mg levels which suggests subclinical renal tubular acidosis. CONCLUSION: There were no associations between serum cysC levels and renal involvement in patients with pSS. However, in patients with proteinuria, serum cysC levels were correlated with acute-phase reactants, suggesting an association with disease activity in terms of degree of inflammation.

Serum Paraoxonase Levels are Correlated with Impaired Aortic Functions in Patients with Chronic Kidney Disease.

BACKGROUND: The correlation between aortic functions and paraoxonase levels has been previously demonstrated by several earlier studies. In this study, we aimed to investigate the correlation between serum paraoxonase levels and aortic functions among patients with chronic kidney disease. METHODS: Our study enrolled 46 chronic kidney disease patients and 45 healthy controls. From these patients, serum cholesterol, creatinine, hemoglobin, and paraoxonase-1 levels were analyzed. RESULTS: Paraoxonase-1 levels were significantly lower in patients with chronic kidney disease compared to the controls (p < 0.001). Additionally, the extent of aortic stiffness index (%) was significantly higher in chronic kidney disease patients, but aortic strain and aortic distensibility were significantly higher in healthy controls (p < 0.001, p < 0.001, and p < 0.001, respectively). We further found that paraoxonase-1 levels were correlated with aortic stiffness index, aortic strain, and aortic distensibility (p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSIONS: Our study demonstrated that serum paraoxonase-1 levels were significantly correlated with impaired aortic functions. The results of this study highlight the impact of serum paraoxonase-1 activity on atherosclerosis and cardiovascular adverse events. KEY WORDS: Aortic functions; Atherosclerosis; Chronic kidney disease; Echocardiography; Paraoxonase.

Comparison of plasma vitamin D levels in patients with Sjögren's syndrome and healthy subjects.

AIM: Sjögren's syndrome (SS) is a systemic autoimmune disease characterized by chronic inflammation of the salivary and lacrimal glands. There is increasing evidence indicating that vitamin D is important in the initiation and propogation of a range of autoimmune diseases which may include SS. The aim of the present study was to evaluate plasma vitamin D (vit D) levels in patients with SS and to compare this with a control group. METHOD: One hundred and seven SS patients (97 [90.7%] female and 10 [9.3%] male) and 74 healthy controls (64 [86.5%] female and 10 [13.5%] male) were included into the study. Plasma baseline 25-hydroxy-vit D levels were measured by high-powered liquid chromatography method using an Agilent 1100 liquid chromatograph. RESULTS: Plasma vit D levels in SS patients (20.5 ± 10.5 µg/L) were significantly lower than in the control group (28.4 ± 15.2 µg/L) (P < 0.001). Female SS patients had significanly lower vit D levels (19.3 ± 9.3 µg/L) than controls (28.3 ± 15.8 µg/L) (P < 0.001) but this difference was not present among the male patients and controls. There was no correlation between plasma vit D levels and erythrocyte sedimentation rate and C-reactive protein in SS patients. CONCLUSION: Vit D deficiency was frequent in patients with SS. In particular, female SS patients had the risk of vit D deficiency. It may be convenient to look for vit D deficiency and to correct vit D nutritional status in SS patients.

Comparison of serum oxidant and antioxidant parameters in familial Mediterranean fever patients (FMF) with attack free period.

OBJECTIVE: Familial Mediterranean fever (FMF) is an autoinflammatory, autosomal recessive, inherited disease characterized by recurrent self-limiting attacks of serosal surfaces. The imbalance of oxidants/antioxidants may play a role in such attacks. In this study, we aimed to evaluate the relationship between serum paraoxonase (PON1) activity, PON1 phenotype, and other parameters in patients with FMF and healthy controls. METHODS: A total of 120 FMF patients with an attack-free period (AFP) and 65 healthy subjects were included in this study. The serum PON1 activity, stimulated paraoxonase (SPON) activity, PON1 phenotype (representing Q192R polymorphism; QQ, QR, RR), arylesterase activity, total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), advanced oxidative protein products (AOPP), total thiols (TTL), and ischemia-modified albumin (IMA) and cystatin-c (CYS-C) levels were measured. RESULTS: For the QQ phenotype, the median TTL and AOPP levels of the control group were 264.50 (57.75) mol/L and 21.26 (21.17) mmol/L, respectively, whereas the median TTL, AOPP levels of the patients were 309.00 (47.00) mol/L and 12.98 (6.96) mmol/L, respectively. There was a statistically significant difference between the patients and controls with the QQ phenotype in terms of TTL and AOPP (p< 0.001 and p= 0.004, respectively). However, there were no statistically significant differences between the QQ and QR+RR phenotypes with respect to TAC, TOS, OSI, or the other parameters. CONCLUSIONS: The FMF patients with AFP had higher TTL and lower AOPP levels than the controls. However, other oxidant and antioxidant parameters were similar among the patients during AFP and the controls.

Free triiodothyronine in hemodialysis patients: link with malnutrition and inflammation.

INTRODUCTION: Free triiodothyronine (FT3) is a marker of comorbidity in end-stage renal disease and in many acute and chronic diseases. There is lack of data about the link between FT3 levels and malnutrition and inflammation in hemodialysis patients. The objective of the present study was to investigate the link between FT3 and malnutrition and inflammation in hemodialysis patients. MATERIALS AND METHODS: A total of 84 patients were included in the study (38 men and 46 women; mean age, 56.2 +/- 14.8 years; hemodialysis duration, 95.72 +/- 10.35 months). Serum FT3, free thyroxin, and thyroid-stimulating hormone concentrations were determined. Demographic data and laboratory values were evaluated. Patients' comorbidity status was determined using the Charlson Comorbidity Index (CCI), and malnutrition-inflammation status was determined by Malnutrition-Inflammation Score (MIS). RESULTS: Serum FT3 concentration inversely correlated with age (r = -0.328, P = .002), CCI (r = -0.591, P = .001), C-reactive protein (r = -0.299, P = .01), and MIS (r = -0.671, P = .001), and positively correlated with serum albumin (r = 0.389, P = .001). In multivariate linear regression analysis, FT3 was independently associated with MIS (beta;, -0.14; 95% confidence interval, -0.175 to 0.063, P = .003), adjusted for CCI, C-reactive protein level, serum albumin level, and MIS. CONCLUSIONS: The results of this study indicate that FT3 is negatively correlated with inflammatory markers, namely C-reactive protein, and it is independently related with MIS in hemodialysis patients. Therefore, we suggest that FT3 can be accepted as an inflammatory marker in hemodialysis patients.

Decreased plasma vitamin D levels in patients with undifferentiated spondyloarthritis and ankylosing spondylitis.

OBJECTIVE: The aim of the present study was to evaluate the plasma vitamin D (vit D) levels and their association with the disease activity in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA) compared with healthy populations. METHODS: This study included 161 spondyloarthritis patients (113 uSpA patients and 48 AS patients) attending our rheumatology out-patient clinic, along with 92 controls. RESULTS: The plasma vit D levels were 18 µg/L (8-38) in the AS group, 20 µg/L (4-92.3) in the uSpA group and 24.3 µg/L (7.2-76.8) in the control group. The plasma vit D levels of the AS patients were significantly lower than those of the patients in the control group (p=0.004). The men in the AS group had significanly lower vit D levels than those in the control group (p=0.005). On the other hand, the women in the uSpA group had significanly lower vit D levels than those in the control group (p=0.011). The vit D levels were inversely related to both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the AS patients (p=0.002, R=-0.428; p<0.001, R=-0.592, respectively). This correlation was not demonstrated in the uSpA patients. The vit D levels were not found to correlate with the Bath ankylosing spondylitis disease activity index (BASDAI) levels in either the AS or uSpA patients. CONCLUSION: 25-hydroxy-vit D deficiency is frequently observed in patients with SpAs. In this study, vit D deficiency was much more prominent in the male AS patients. On the other hand, among women, the uSpA patients exhibited much more prominent vit D deficiency than the control group subjects. The acute phase response may inversely affect the vit D levels in AS patients.

Phenotype 2 familial mediterranean fever: evaluation of 22 case series and review of the literature on phenotype 2 FMF.

Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disorder characterized by recurrent bouts of fever and serosal inflammation. FMF may be complicated by AA-type amyloidosis, worsening the prognosis, with associated renal failure in some patients. Complication rate varies with race, being as high as 60% in Turks and as low as 2% in Armenians. In a few cases of patients with FMF (phenotype 2), amyloid nephropathy may be the presenting manifestation. This study included 420 patients who were admitted to the Nephrology and Rheumatology Departments of Atatürk Education and Research Hospital with unexplained proteinuria/nephrotic syndrome. The initial screening test for amyloidosis was the presence of significant proteinuria (300 mg/24 h). All MEFV gene exons were screened for causative mutations by direct DNA sequencing to check for any mutations. There were 22 phenotype 2 FMF patients with 27 allelic variants. The most prevalent allelic variants were M694V (10/27, 37%) and E148Q (7/27, 26%). Phenotype 2 FMF is not as rare as it was thought before; this should be kept in mind for all patients with unexplained proteinuria and/or acute phase response in high-risk ethnic groups for FMF.

Three family members with familial Mediterranean fever carrying the M694V mutation showed different clinical presentations.

Familial Mediterranean fever (FMF) is an inherited disease characterized by recurrent episodes of fever and serositis. FMF is caused by mutations in the MEFV gene that encodes pyrin/marenostrin. The 5 most frequent mutations are M694V, M694I, V726A, M680I and E148Q. Here, we reported 3 FMF patients, a sister and two brothers, who have the same M694V mutation with different clinical presentations. While the sister presented with abdominal pain, one of the brothers presented with erysipelas-like erythema and the other brother with bilateral sacroiliitis. Here, we report the different clinical courses of FMF in a family carrying the same M694V mutation.

Low plasma vitamin D levels in patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is an autosomal recessive, inherited autoinflammatory disease characterized by recurrent, self-limited attacks of fever and inflammation of serosal surfaces. There is an explosion of the data regarding inflammatory markers in FMF and clinical effects of chronic inflammation on the disease presentation. Vitamin D (vit D) is the common denomination of a group of sterols with a crucial role in phospho-calcium metabolism. There are some data about the importance of vit D in the initiation and propogation of a range of autoimmune diseases. The aim of the present study was to determine whether vit D deficiency is present in patients with FMF compared with healthy individuals. The study group included 99 patients with diagnosis of FMF attended to our outpatient Rheumatology and Nephrology Clinics of Atatürk Education and Research Hospital. The control group comprised 51 age- and sex-matched healthy people selected from hospital staff. Serum baseline 25-hydroxy vit D levels were measured by HPLC method using an Agilent 1100 Liquid Chromatograph. We found significantly lower serum 25-hydroxy vit D levels among FMF patients compared with matched controls and a high prevalence of vit D deficiency. This study demonstrated that vit D deficiency is frequent in patients with FMF than the healthy controls. It is convenient to look for vit D deficiency and to correct vit D nutritional status in FMF patients.