Evaluation of complications in urgent start peritoneal dialysis: Single-center experience.

BACKGROUND: Patients who were urgent start peritoneal dialysis (USPD) were evaluated in terms of complications. METHODS: The data from 102 patients (43 males and 59 females, mean age 58.18 ± 15.3 years) who were on peritoneal dialysis with a placed catheter between January 2014 and June 2019 in our Nephrology clinic was evaluated. The patients were divided into three groups according to the starting time of peritoneal dialysis. The development of complications between the groups (peritonitis, leakage, hernia), hemodialysis return time and overall survival times were compared. RESULTS: There was no difference between the groups in terms of survival and complications. Diabetes, advanced age, albumin values were found to be risk factors for mortality, while no differences were found between the groups in terms of complications and mortality. CONCLUSION: USPD can be recommended for both because it provides a permanent dialysis option and because it leads to fewer complications than urgent start HD.

Investigation of the relationship between disease severity and development of amyloidosis and genetic mutation in FMF disease.

BACKGROUND: Familial Mediterranean fever (FMF) is an autosomal recessive genetic disease. Amyloidosis is the most important complication of FMF that determines the prognosis of the disease. AIMS: In our study, we have investigated the relationship between the genetic mutations with the disease severity and the frequency of development of amyloidosis inpatients with FMF. METHODS: A total of 148 patients with FMF were included this study. The relationship between disease activity score, clinical findings, response to treatment, and presence of amyloid and genetic mutations were evaluated. RESULTS: One hundred forty-eight patients (80 women (54%), 68 men (46%)) were enrolled over 18 years of age. The mean age of the patients was 30.98 ± 11.18 (18-67) years. In our study, the most frequently seen mutations are M694V, M680I, R202Q, and E148Q, respectively. The most common genotype is M694V/M694V mutation and this mutation has been found in 37 patients (25%). In 25 patients, M694V heterozygous have been found (16.8%). The third frequent mutationis M694V/M680I/R202Q has been found in13 patients (8.7%). In 23 patients, amyloidosis has been developed. Ten patients with amyloidosis have M694V homozygous mutations (27%) and 5 patients with amyloidosis M694V heterozygous (20%) mutations. The both of the two patients who carry the homozygous E148Q mutations have developed amyloidosis. CONCLUSIONS: In our study, the distribution of the frequency of mutations is consistent with other similar studies performed in Turkey. We found that patients with M694V mutation had a significantly higher rate of exacerbation, higher drug doses for treatment, and a close relationship with amyloidosis, as compared to patients with other mutations.

Prevalence of Sleep Disorders and Related Factors in Individuals Undergoing Hemodialysis.

BACKGROUND: The quality of life of individuals undergoing hemodialysis is related to many factors, including sleep disorders. OBJECTIVE: To determine the prevalence of sleep disorders in individuals undergoing hemodialysis and to assess the effect of clinical and biochemical parameters on their sleep quality. METHOD: We conducted a cross-sectional descriptive survey in multiple hemodialysis centers. Individuals were interviewed using a questionnaire for obtaining general personal information, the Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality, and the Epworth Sleepiness Scale (ESS) for assessing excessive daytime sleepiness (EDS). RESULTS: The study included 338 individuals with a median age of 55 years. Poor sleep quality (PSQ) and EDS were present in 41.4% and 6.5% of the individuals, respectively. The individuals' PSQI scores were significantly proportional to their ESS scores. Concerns about the disease and its treatment (60.7%) and poor physical conditions (35.7%) were major reported reasons for PSQ. In a logistic regression analysis, female gender, household income, ESS score, chronic heart failure, and creatinine and parathormone levels were found to be independent predictors of PSQ; household income, PSQ presence, parathormone and potassium levels, and urea reduction ratio were found to be independent predictors of EDS. CONCLUSION: Sleep disorders are common in individuals undergoing hemodialysis and are related to gender, comorbid diseases, poor economic state, altered biochemical values, dialysis timing, and concerns about the disease and its treatment. Improving these individuals' quality of life through adequate psychological and financial support and early diagnosis of sleep disorders should decrease their mortality and morbidity rates.

ANCA-associated vasculitis after COVID-19.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are systemic autoimmune diseases that may lead to renal failure due to the infiltration of mononuclear cells and the destruction of small- and medium-sized blood vessels. It has been shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger the presentation or exacerbation of autoimmune diseases. Crescentic glomerulonephritis (GN) has rarely been reported in patients with Coronavirus disease-2019 (COVID-19). We present rare two cases with AAV after a recent diagnosis of COVID-19. The first case was 26-year-old male patient, who was presented with acute kidney injury after COVID-19. Serum creatinine increased and active urine sediment was seen. Serological evaluation showed anti-myeloperoxidase antibody was at a level of 80.6 U/mL. Kidney biopsy showed necrotizing GN with cellular crescents. Methylprednisolone, cyclophosphamide and plasma exchange were administered. He was discharged with hemodialysis. Second case was a 36-year-old female who was hospitalized because of fever, cough and dyspnea. After she was diagnosed with COVID-19, she had total hearing loss, with cavitary lesions on bilateral lung parenchyma and an acute kidney injury. Serological evaluation showed an elevated anti-proteinase-3 with a level of 1:32. Kidney biopsy showed necrotizing GN with cellular crescents. Renal function improved after methylprednisolone and cyclophosphamide treatment. With a systematic review of the literature, we found four cases of new-onset AAV due to COVID-19. Herein, we discuss two cases and provide a literature review on cases of new-onset pauci-immune GN after COVID-19 infection.

Self-reported practices of doctors and nurses for the measurement of blood pressure.

BACKGROUND: Hypertension is one of the most common health problems worldwide and can be diagnosed with an accurate blood pressure measurement (BPM). We aim to evaluate the self-reported practices of family physicians and nurses for BPM. METHODS: This study was conducted in the form of a survey administered through face-to-face interviews with 131 physicians and 371 nurses. The survey included questions about devices, patients, and BPM techniques. RESULTS: The mean age was 31 ± 7.4 years. The most commonly used device was the aneroid model (47.8%). The majority of participants reported that they had sufficient technical knowledge about the devices (81.1%), and the devices were regularly calibrated (77.5%). Only 44.8% reported that they had asked patients about caffeine or nicotine use. About half of those in both groups (54%) performed BPM only once during a presentation. The most commonly used position during BPM was sitting. BPM was performed mostly on one arm without preference for any side (67.5%). Approximately half of the respondents reported that they performed BPM by actively supporting the arm at the heart level. CONCLUSION: We found physicians and nurses had lack of adherence to proper techniques related to the use of appropriate positions and other relevant situations that should be considered during BPM. Accurate BPM is the most important factor for proper diagnosis and treatment of hypertension. Thus, BPM should be performed in accordance with the designated guidelines and can be performed with accurate results only as a result of repeated comprehensive training programs.

Age is not a risk factor in survival of severely ill patients with co-morbidities in a medical intensive care unit.

BACKGROUND: The individuals over 65 years old constitute an important patient population of medical intensive care units (ICUs). AIM: To evaluate the risk factors for mortality in a medical ICU consisting a group of patients with a large number of co-morbidities. METHODS: This is a retrospective study involving patients who were followed for more than 48 h. The cohort was divided into two groups according to age: (1) young, < 65 years old, and (2) elderly, ≥ 65 years old. RESULTS: A total of 693 patients (303 F, 390 M) were included. The median age was 68 years (18-97). There were 279 (40.3%) young and 414 (59.7%) elderly patients. There was no difference between the groups in gender and mortality (p = 0.436, p = 0.932, respectively). Most of the co-morbid diseases were more common in the elderly except solid malignancies which were more common in young patients (p = 0.033). Long ICU stay, long hospital stay before ICU, high APACHE II and Charlson co-morbidity index scores, pneumonia, acute hepatic failure/coma, malignancy, acute hemodialysis, need for vasopressors, and invasive mechanical ventilation were independent predictors of ICU mortality. CONCLUSION: Age and gender were not found to be predictors of mortality. There was no survival advantage between young and elderly patients. Co-morbid diseases, apart from malignancy, had no effect on mortality. In developing countries, where patients with terminal illness and multiple co-morbid diseases are treated in the ICU, age should not be a determining factor in patient selection for ICU or in the treatment decisions to be applied to patients.

The effect of different treatment strategies on left ventricular myocardial deformation parameters in patients with chronic renal failure.

The aim of this study was to compare left ventricular (LV) functions by speckle tracking echocardiography (STE) in chronic kidney disease (CKD) patients in various stages and under different renal replacement treatments in order to evaluate possible differences between them. This prospective study included 150 patients with CKD. Renal transplantation patients with glomerular filtration rate greater than 60 ml/min/1.73 m2, patients receiving hemodialysis three times a week, and patients in the predialysis stage with glomerular filtration rate less than 30 ml/dk/1.73 m2 were assigned into Group 1 (n = 50), Group 2 (n = 50), and Group 3 (n = 50), respectively. LV longitudinal, circumferential, and radial myocardial deformation parameters (strain, strain rate [SR], rotation, twist) were evaluated by STE. Peak systolic longitudinal strain was higher in the transplantation group than the hemodialysis group (- 19.93 ± 3.50 vs - 17.47 ± 3.28%, p < 0.017). Peak systolic circumferential strain was lower in the hemodialysis group (- 20.97 ± 4.90%) than Groups 1 and 3 (- 25.87 ± 4.20 and - 24.74 ± 4.55%, respectively, p < 0.001). Peak systolic radial SR was higher in the transplantation group than the hemodialysis group (1.84 ± 0.52 vs 1.55 ± 0.52 s-1, respectively, p < 0.017). Other longitudinal and circumferential deformation parameters together with peak early diastolic radial SR and twist were also significantly different between the groups. Strain, SR, and twist values were mostly lower in the hemodialysis patients, but generally higher in the transplantation patients. LV functions evaluated by STE are better in the renal transplantation patients than the hemodialysis patients and than those in the predialysis stage. This may indicate beneficial effects of renal transplantation on cardiac functions.

Catheter-related atrial thrombus: tip of the iceberg?

Although guidelines recommend catheters as a last resort for establishing a vascular access in patients undergoing dialysis, they continue to be used widely for this purpose. Catheter-related atrial thrombus (CRAT) is rarely reported in this group of patients, and it can lead to serious complications. The aim of this study was to determine the incidence of CRAT in patients undergoing hemodialysis with permanent-tunneled catheters. A total of 50 patients undergoing hemodialysis with permanent catheters were included in this study. The diagnosis of CRAT was based on transthoracic echocardiography findings. Thrombus was present in nine patients (18%) and related to the tip of the catheter in all cases. Except for one patient with two foci of thrombus, all patients had a single focus. There were no significant associations between the development of thrombus and the duration of catheter use or the location of the catheter. Furthermore, catheter-related atrial thrombus did not appear to have a significant effect on mortality. The asymptomatic character of CRAT can be responsible for the low reporting rates, and its exact role in increased mortality and morbidity related with catheter use remains unknown. While planning management strategies, information on different options for vascular access routes and possible catheter-related complications should be provided to all patients who will undergo dialysis, together with a discussion involving other replacement alternatives for end-stage renal disease.

Red cell distribution width and mean platelet volume in amyloidosis.

We aimed to determine whether red cell distribution width (RDW) and mean platelet volume (MPV) values differ between patients with reactive amyloid A (AA) amyloidosis due to chronic inflammatory disease and in healthy participants. In this study, 33 patients with AA amyloidosis and 40 age- and sex-matched healthy controls were enrolled. Erythrocyte sedimentation rate (ESR), RDW, platelet count (PLT), and MPV levels were retrospectively obtained from our computerized patient database. We found RDW, ESR, and PLT levels to be significantly higher in patients with AA amyloidosis compared with the controls (P < .0001). Mean platelet volume was significantly lower in patients with amyloidosis (P < .0001). Inflammatory diseases such as AA amyloidosis may demonstrate low MPV and high RDW levels.

Renal transplantation in patients with familial Mediterranean fever.

Amyloidosis is the most common and devastating complication of familial Mediterranean fever (FMF). Renal transplantation is the choice of treatment of in most end-stage renal disease (ESRD). We report our experience on the outcomes in eight patients who underwent renal transplantation for ESRD due to FMF secondary to amyloidosis, and we provide a discussion on the current evidence on this topic of study. The clinical charts of eight renal transplant patients (seven male, one female) who underwent ESRD due to FMF-related amyloidosis were investigated. Five patients underwent living-donor renal transplantation and three patients underwent deceased-donor renal transplant. The mean follow-up period was 35 months (range 3-72). All patients were on triple immunosuppressive treatment and received colchicine. All allografts are currently functioning well with a mean serum creatinine level of 1.4 (range 0.7-2.6) mg/dL. Posttransplantation complications included acute rejection (n = 4), chronic rejection (n = 1), severe gastroenteritis (n = 2), and erythrocytosis (n = 5). None of the patients had proteinuria. During follow-up, we did not observe clinically severe FMF attack, septicemia, rhabdomylosis, symptoms related to vasculitis, and clinical neuropathy. The clinical outcome of the patients in this cohort was similar to that of other renal transplant patients with ESRD due to other causes. This study shows favorable prognosis of eight ESRD patients due to amyloidosis caused by FMF after renal transplantation. Renal transplantation is a safe procedure for ESRD patients having amyloidosis due to FMF. Regular use of colchicine after transplantation should be mentioned.

Effect of rosiglitazone on cisplatin-induced nephrotoxicity.

AIM: Nephrotoxicity is a major side effect of cisplatin (Cis), a widely used chemotherapeutic drug. Recent studies have strongly suggested that inflammatory mechanisms may play an important role in the pathogenesis of Cis nephrotoxicity. Rosiglitazone (Ros), a peroxisome proliferator-activated receptor-gamma agonist has been recently demonstrated to regulate inflammation by modulating the production of inflammatory mediators and adhesion molecules. The aim of this study was to evaluate the effect of Ros on the prevention of Cis-induced nephrotoxicity. METHODS: Eighteen male Sprague-Dawley rats weighing 150-200 g were included in the study. The rats were randomly divided into three groups: group 1: Cis-treated group; group 2: Cis-Ros-treated group; group 3: saline-treated group. Blood urea nitrogen (BUN) and serum creatinine concentrations were measured. In addition, extent of histological renal tubular injury in each animal was graded histologically. RESULTS: Mean BUN and serum creatinine concentrations were significantly lower in group 3 than in group 1 (p<0.05) and group 2 (p<0.05). There were no significant differences in terms of BUN and serum creatinine concentrations between groups 1 and 2 (p>0.05). Acute tubular injury with karyomegalic changes in corticomedullary junction was significantly higher in groups 1 and 2 than group 3 (p<0.05). However, there were no significant differences between groups 1 and 2 (p>0.05). CONCLUSION: This study indicates that post-insult administration of Ros does not seem to have a beneficial effect on prevention and severity of nephrotoxicity induced by Cis.

Transplantation tourism: high risk for the recipients.

BACKGROUND: The shortage of donor organ supply is forcing patients with end-stage renal disease to alternative searches. The aim of this study is to present the clinical and laboratory data of five patients who were transplanted in Egypt from paid living-unrelated donors and followed at our institution. METHODS: Five patients (four male, one female, mean age 51 yr) were included in this retrospective study. RESULTS: All allografts still have good function with a mean serum creatinine level of 0.9 mg/dL. Surgical and medical problems were common such as wound infection (n = 3), evisceration (n = 2), deep vein thrombosis (n = 2), unexplained abdominal incision requiring removal of an abdominal surgical compress left in situ during previous surgery, placement of allograft on the side of an unrepaired indirect inguinal hernia and transplant pyelonephritis. CONCLUSION: Although recent developments increased success in renal transplantation, receiving a kidney from a paid living donor at a commercial transplant center still carries great risks for the recipient.

Accuracy of sphygmomanometers at pharmacies.

BACKGROUND/AIMS: The aims of this study are to assess the reasons of using sphygmomanometers at pharmacies and to evaluate their accuracy. METHODS: 135 devices (118 aneroid, 1 mercury, and 16 automated) from 125 pharmacies (located in Samsun city center) were included in the study. A non-randomized, cross-sectional design was used for the study protocol which had two parts: assessment of devices and a questionnaire about the pharmacy and present sphygmomanometer(s). RESULTS: 40 (30%) of the 135 sphygmomanometers were inaccurate. 65 (48%) of the devices were older than 1 year and there was no correlation between the duration of the ownership of the sphygmomanometers and their inaccuracy (p > 0.05). Blood pressure measurement is a frequent practice at pharmacies. The aneroid type of sphygmomanometers was common. A limited number of devices were checked for accuracy before. The number of validated devices was low. CONCLUSION: Training programs for pharmacists including the accuracy of sphygmomanometers and regular checks of sphygmomanometers for accuracy will be beneficial to the community and to the subjects requesting measurement of blood pressure at the pharmacies.

Home sphygmomanometers: validation versus accuracy.

OBJECTIVE: The validation and accuracy of sphygmomanometers are important issues in the home sphygmomanometer market and in clinical practice. The aims of this study are to assess the frequency of validated home sphygmomanometers and to evaluate the relationship between the validation and accuracy of the devices. METHODS: Eight hundred and ninety-six home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic for this study, and 870 (97%) of the devices were in adequate working condition and suitable for analysis. The relationship between accuracy and validation was investigated only in automated sphygmomanometers (n = 554). RESULTS: Both the manufacturer and model were known in 500 devices (90%), and these devices were eligible for evaluation of validation. We found 74 devices listed in the dabl Educational Trust website. Twenty-two of the 74 (30%) devices were validated. Four hundred (72%) of the 554 automated sphygmomanometers were inaccurate. The frequency of accuracy was higher among validated devices compared with nonvalidated devices (68 vs. 15%) (P<0.01). CONCLUSION: Our study showed that the frequency of accurate devices was higher among validated sphygmomanometers compared with nonvalidated sphygmomanometers. To our knowledge, our study is the first to demonstrate the relationship between accuracy and validation of home sphygmomanometers. The frequency of device-related errors can be decreased by training patients and supervising the blood pressure device market. Nonprofit organizations can help patients to overcome some of the problems in the blood pressure device market.

Lemon juice as an alternative therapy in hypertension in Turkey.

We aimed to learn the frequency of lemon juice usage among the hypertensive patients in a local region of northern Turkey. One hundred fifty six (72.5%) of hypertensive patients were using alternative therapy and eighty six patients (40%) were drinking lemon juice. We think that to gain success in the treatment of hypertension educating the society is important and there should be clinical studies about the effect of lemon juice on blood pressure, which is one of the most common alternative therapies in our country.

Evidence of left ventricular systolic and diastolic dysfunction by color tissue Doppler imaging despite normal ejection fraction in patients on chronic hemodialysis program.

BACKGROUND: Cardiovascular diseases are responsible for about half of deaths and are the major cause of mortality in hemodialysis patients. The aim of this study is to assess left ventricular (LV) longitudinal myocardial functions by color tissue Doppler imaging (TDI) in patients with chronic renal failure on a regular hemodialysis program. METHODS: Thirty-one patients on a regular hemodialysis program (mean age 47 +/- 12 years; 17 males, 14 females) were included into the study. Twenty-three healthy subjects (mean age 44 +/- 8 years; 15 males, 8 females) were studied as a control group. The patients had been on maintenance hemodialysis for at least 1 month and hemodialysis sessions were three times per week. For color TDI, apical two- and four-chamber views of left ventricle were used. Sample volumes were placed on the mid-left ventricle in the inner half of the myocardium at the septum, lateral, inferior, and anterior walls. Peak LV strain, peak systolic strain rate, peak early diastolic strain rate, peak late diastolic strain rate, peak systolic tissue velocity, peak early diastolic tissue velocity, and peak late diastolic tissue velocity values were measured. RESULTS: Mean peak LV strain, mean peak systolic strain rate, and mean peak systolic tissue velocity values were all lower in the hemodialysis group. Although mean peak late diastolic strain rate and mean peak late diastolic tissue velocity values were similar between the groups, mean peak early diastolic strain rate and mean peak early diastolic tissue velocity values were lower in the hemodialysis group. CONCLUSION: Patients with chronic renal failure on regular hemodialysis program show significant alterations at LV longitudinal myocardial function parameters assessed by color TDI.

Self-measurement of blood pressure at home: is it reliable?

Self-measurement of blood pressure (BP) at home is more common than 10 years ago and encouraged by current guidelines to increase patient adherence to treatment and reach the goal of target BP. The aims of this study are to evaluate the accuracy of home sphygmomanometers and to investigate behavior/knowledge of the sphygmomanometer owners. A campaign was planned to determine the accuracy of home sphygmomanometers in 2006. Seven hundred and twenty-three home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic within 1 year and 693 (96%) of the devices were in adequate working condition and suitable for analysis. Four hundred and thirty-nine (63%) of the sphygmomanometers were automatic. Four hundred and eleven (59.3%) of the 693 sphygmomanometer were inaccurate. About 80% (256/320) of the wrist devices were inaccurate. Most studies evaluating the accuracy of sphygmomanometers are conducted in hospital or primary care settings; studies investigating home sphygmomanometers are rare. High frequency of inaccurate home devices is a major public health problem. In conclusion, inaccurate devices have been used in home BP measurements frequently and frequency of device-related errors can be decreased by awareness and training of the patients. Physicians and healthcare providers should advise the patients to check the accuracy of their home sphygmomanometers regularly.

Renal Behçet's disease: an update.

OBJECTIVE: The aims of this study are (1) to report 33 patients with Behçet's disease (BD) having various renal manifestations, and (2) to update current data using our patients and published papers about BD and renal manifestations. METHODS: The PubMed database was searched using the terms BD or Behçet's syndrome. We found reports of 94 patients (including ours) with BD and specific renal diseases (amyloidosis, 39; glomerulonephritis [GN], 37; renal vascular disease, 19; interstitial nephritis, 1). RESULTS: The presentation of renal disease was edema/nephrotic syndrome in 12 patients (36%). Renal disease was incidentally diagnosed by routine urine analysis and measurement of serum creatinine level in 20 patients (61%). Renal failure was present in 23 patients (70%) and 5 of them have had cyclosporine treatment. The frequency of renal disease among BD patients has been reported to vary from less than 1 to 29%. CONCLUSIONS: The clinical spectrum of renal BD shows a wide variation. Amyloidosis (AA type), GN, and macroscopic/microscopic vascular disease are the main causes of renal BD. Patients with vascular involvement have a high risk of amyloidosis and amyloidosis is the most common cause of renal failure in BD. Several types of glomerular lesions are seen in BD. Current treatment options for renal BD are not evidence based. Radiological vascular intervention combined with immunosuppressive drugs can be useful in selected cases. Routine urine analysis and measurement of serum creatinine level are needed for early diagnosis of renal BD.

SAA1 alpha/alpha alleles in Behçet's disease related amyloidosis.

Behçet's disease (BD) related amyloidosis is relatively rare. Serum amyloid A protein (SAA) protein gene polymorphism is one of the factors implicated in the pathogenesis of AA type amyloidosis. The aim of this study is to investigate SAA1 gene polymorphism in different patient groups: (1) BD related amyloidosis, (2) BD without amyloidosis, and (3) healthy controls. One hundred eleven patients from three main groups were included in the study: (1) BD related amyloidosis (n = 9), (2) BD without amyloidosis (n = 39), and (3) healthy controls (n = 63). Homozygous alpha/alpha is present in 78% of patients with BD and amyloidosis. The SAA1 alpha/alpha genotype is significantly more common among patients with BD and amyloidosis. This study demonstrated increased frequency of alpha/alpha genotype in BD related amyloidosis. To our knowledge, the relationship between alpha/alpha genotype and BD related amyloidosis was not studied previously. In conclusion, the SAA1 alpha/alpha genotype is a risk factor for amyloidosis in BD.

Garlic, hypertension and patient education.

The aims of this study are to investigate the frequency of garlic usage in hypertensive population and to evaluate acute effect of garlic and garlic tablets on blood pressure in patients with hypertension. 4102 of the 7703 patients (53.3%) reported that they were using garlic. No significant effect on blood pressure was observed in any of the three groups (placebo, garlic or garlic tablets). Use of garlic is common among the hypertensive population, garlic and garlic tablets do not have acute blood pressure lowering effect, and a special education program informing patients and public about garlic is required.