Evaluation of the changes in electrocardiographic ventricular repolarization parameters after COVID-19 recovery in hemodialysis patients.

INTRODUCTION: Coronavirus disease-2019 (COVID-19) has cardiac manifestations. Data about electrocardiogram (ECG) changes after COVID-19 recovery is limited in hemodialysis patients. We aimed to investigate the changes in ventricular repolarization parameters after COVID-19 recovery in hemodialysis patients. METHODS: Fifty-five hemodialysis patients who recovered from COVID-19 infection were included. QT interval, Tp-e interval, corrected QT (QTc), QTc dispersion, and Tp-e dispersion values were determined on the patients' ECGs, taken before COVID-19 and at least 1 month after recovery. The patients' data before COVID-19 infection and after recovery were compared. RESULTS: It was found that longest QTc (QTcmax) and QTc dispersion values after recovery were prolonged compared with pre-infection period (427 ± 28 ms vs. 455 ± 26 ms, p = 0.000 and 39 ± 16 ms vs. 65 ± 20 ms, p = 0.000). CONCLUSION: In our hemodialysis patients, ventricular repolarization parameters increased after COVID-19 recovery. In hemodialysis patients, already predisposed to arrhythmic deaths, arrhythmia risk after COVID-19 recovery may become more pronounced.

Serious Multiorgan Toxicity Caused by Mixed Herbal Tea Ingestion: A Case Report.

Recent years have witnessed a growing trend in the use of complementary and alternative herbal products. However, the ingestion of some herbal products may cause a wide spectrum of adverse effects. We report a case of multiorgan toxicity following the ingestion of mixed herbal tea. A 41-year-old woman presented to the nephrology clinic with complaints of nausea, vomiting, vaginal bleeding, and anuria. She had consumed a glass of mixed herbal tea three times a day after meals for three days, to lose weight. Initial clinical and laboratory findings showed serious multiorgan toxicity including hepatotoxicity, bone marrow toxicity, and nephrotoxicity. Although herbal preparations are marketed as natural products, they may cause various toxic effects. There should more efforts to raise public awareness about the possible toxic effects of herbal preparations. Clinicians should consider the ingestion of herbal remedies as an etiology when encountering patients with unexplained organ dysfunctions.

Sexual dysfunction in female and male patients undergoing chronic ambulatory peritoneal dialysis.

BACKGROUND: To prolong survival and to provide a better quality of life (QoL) are two aims at the forefront in the care of peritoneal dialysis (PD) patients. In this study we aimed to determine frequency of sexual dysfunction (SD) and influencing factors in PD patients. METHODS: Of the 201 patients, 114 under 65 years and on chronic ambulatory PD for at least 3 months were enrolled. Forty-nine females and 65 males completed the study. Survey forms were applied using face-to-face interview method. Female Sexual Function Index (FSFI) was used to assess SD in women; International Index for Erectile Function (IIEF) was used to assess erectile dysfunction (ED) in men. All patients completed SF-36 and Beck Depression Inventory (BDI) forms. RESULTS: While SD was evident in 89.8% of female patients (FSFI score:10.4 ± 9.7), ED was present in 87.7% of males (IIEF score:13.8 ± 7.9). Depression rates were 65.3% and 49.2% in female and male patients, respectively. BDI scores were 21.6 ± 10.4 and 17.1 ± 9.5; physical component scores, 52.6 ± 20.4 and 55.2 ± 20.2; mental component scores, 45.2 ± 19.8 and 49.9 ± 22, in female and male patients, respectively. FSFI was correlated with age (ß = -0.53 p < 0.001) and BDI score (ß = -0.23 p = 0.04), (R2 = 0.64). ED showed correlation with age (ß = -0.36 p < 0.001), BDI score (ß = -0.57 p < 0.001), and hemoglobin level (ß = 0.26 p = 0.003), (R2 = 0.74). CONCLUSION: SD, often overlooked and not discussed by both patients and physicians, is encountered relatively frequently among PD patients. Left not discussed and untreated SD may adversely affect QoL.

Prevalence and related factors of poor sleep quality in patients with pre-dialysis chronic kidney disease.

BACKGROUND: Sleep disturbances in patients with chronic kidney disease (CKD) are related to decreased quality of life and increased health-related risks. There is insufficient data about actual prevalence and related factors of poor sleepers in this group. In this study, we aimed to investigate prevalence and related risk factors of self-reported poor sleep quality in patients with pre-dialysis CKD. METHODS: In this cross-sectional study, 259 pre-dialysis CKD patients (median age 56 years; range, 19-85) were included. Demographical, clinical and laboratory correlates were recorded. Body mass index (BMI) was calculated. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) formula. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire. Depression was evaluated using the Beck Depression Inventory (BDI). RESULTS: Median eGFR was 27.6 ml/min/1.73 m2 (range, 9-56). Of the 259 patients, 110 (42.5%) were poor sleepers with global PSQI score >5. The univariate correlation analysis revealed that global PSQI score was positively correlated with age, BMI, waist circumferences (WC), hip circumferences (HC), serum phosphorus and triglyceride levels, systolic blood pressure (BP), pulse pressure and BDI score, and negatively correlated with male gender and hemoglobin level. Logistic regression analysis, showed that HC, systolic BP, and BDI scores were independently associated with poor sleep quality (p = 0.001, p = 0.020 and p < 0.001, respectively). CONCLUSION: Prevalence of poor sleep quality in our pre-dialysis CKD patients was 42.5%. Systolic BP, depression and HC, all of these are potentially correctable factors, were associated with poor sleep quality independently.

Effect of congenital or acquired renal mass reduction on arterial stiffness.

BACKGROUND: The changes in kidney functions, adversely affect the cardiovascular system. The aim of this study was to investigate whether arterial stiffness (AS), an indicator of subclinical atherosclerosis, was affected in patients with congenital or acquired reduced renal mass. METHODS: In this prospective study, a total 135 patients (mean age 43.4 ± 8.5 years and 71.9% female) with congenital unilateral small/nonfunctioning kidney or unilateral agenesis or with unilateral nephrectomy were included. As control group, 44 healthy individuals with similar age and gender (mean age, 42.5 ± 7.1 year and 61.4% female) were included. Estimated glomerular filtration rate (eGFR) was calculated by Modification of Diet in Renal Disease formula. Official blood pressures (BP) and 24-h ambulatory noninvasive BP of both groups were measured. AS was assessed with pulse wave velocity (PWV) by using Mobile-O-Graph new genaration arteriograph device using oscillometrical method. RESULTS: There was no difference in terms of BP parameters and body mass index between groups. eGFR values of control group and study group were 93 ± 19 ml/min/1.73 m² and 89 ± 28 ml/min/1.73 m², respectively (p = 0.379). Compared with control group, the study group had higher PWV values (6.72 ± 1.11 m/s vs. 6.29± 0.75 m/s, p = 0.018). In linear regression analysis, PWV was found to be correlated with age (ß = 0.752, p < 0.001), and daytime ambulatory systolic BP (ß = 0.345, p < 0.001). CONCLUSION: Our study showed that AS was increased in patients with reduced renal mass and this increase in AS was related to age and systolic BP. No relation was determined between AS and eGFR.

Does the serum uric acid level have any relation to arterial stiffness or blood pressure in adults with congenital renal agenesis and/or hypoplasia?

BACKGROUND: The relationship between serum uric acid and arterial stiffness or blood pressure is not clear. The serum uric acid level and its association with cardiovascular risk is not well known in patients with reduced renal mass. We aimed to investigate the relation between serum uric acid levels and arterial stiffness and also blood pressure in patients with congenital renal agenesis and/or hypoplasia. MATERIAL AND METHODS: In this single center, cross-sectional study, a total of 55 patients (39 (% 70.9) with unilateral small kidney and 16 (%29.1) with renal agenesis) were included. The median age was 35 (21-50) years. The study population was divided into tertiles of serum uric acid (according to 2.40-3.96, 3.97-5.10, and 5.11-9.80 mg/dl cut-off values of serum uric acid levels). Official and 24-h ambulatory non-invasive blood pressures of all patients were measured. The arterial stiffness was assessed by pulse wave velocity (PWV). RESULTS: PWV values were increased from first to third tertile (5.5 ± 0.6, 5.7 ± 0.8, 6.1 ± 0.7, respectively), but this gradual increase between tertiles did not reach significance. Linear regression analyses showed a positive correlation between serum uric acid levels and PWV (ß = 0.40, p = 0.010), but no correlation was found between uric acid and daytime systolic blood pressure (ß = 0.24, p = 0.345). CONCLUSION: In congenital renal agenesis/hypoplasia, the serum uric acid level was positively correlated with arterial stiffness, but there was no correlation with blood pressure.

Temporary left ventricular dysfunction in mushroom poisoning: report of three cases.

Mushroom poisoning can result in acute kidney injury and fulminant hepatic failure as well as gastrointestinal and neurological disorders. The effects of mushroom poisoning on cardiac functions have not been known well. Only a few case reports have been published to date (1-3). We report 3 patients out of 45 patients who were followed due to acute kidney injury and hepatic injury secondary to naturally growing mushroom ingestion between 2009 and 2012. These three cases suffered from transient impairment in cardiac systolic function in addition to other manifestations of mushroom poisoning.

Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center.

INTRODUCTION: Impairment of health-related quality of life (HRQoL) and being in a depressive mood were found to be associated with increased mortality in peritoneal dialysis (PD) patients. We aimed to investigate the association between HRQoL, depression, other factors and mortality in PD patients. MATERIALS AND METHODS: Totally 171 PD patients were included and followed for 7 years in this prospective study. RESULTS: Of 171 PD patients, 45 (26.3%) deceased, 18 (10.5%) maintained on PD, 87 (50.9%) shifted to hemodialysis (HD) and 21 (12.3%) underwent transplantation. The most common cause of death was cardiovascular disease (32, 71.1%) followed by infection (6, 13.3%), cerebrovascular accident (5, 11.2%). The etiology of patients who shifted to HD was PD failure (41, 47.1%), peritonitis (33, 37.9%), leakage (6, 6.9%), catheter dysfunction (3, 3.4%), self willingness (4, 4.6%). Non-survivors were older than survivors (56.6 ± 15.0 vs. 43.6 ± 14.6, p = 0.003). There were also statistically significant difference in terms of albumin, residual urine, presence of diabetes and co-morbidity. When the groups were compared regarding HRQoL scores, non-survivors had lower physical functioning (p < 0.001), role-physical (p = 0.0045), general health (p = 0.004), role-emotional (p = 0.011), physical component scale (PCS) (p = 0.004), mental component scale (MCS) (p = 0.029). Age, presence of residual urine, diabetes, albumin, PCS and MCS were entered in regression analysis. Decrease of 1 g/dL of albumin and being diabetic were found to be the independent predictors of mortality. CONCLUSIONS: Diabetes and hypoalbuminemia but not HRQOL scores were associated with higher mortality in PD patients after 7 years of following period.

Masked hypertension in renal transplant recipients.

PURPOSE: Arterial hypertension is a risk factor affecting graft function in renal transplant recipients (RTRs). In pediatric RTRs, high prevalence of masked and nocturnal hypertension was reported. Most of the RTRs had a history of hypertension and some of them were normotensive at outpatient visits whereas home blood pressure (BP) levels were higher. Masked hypertension (MHT) is defined as a normal office BP but an elevated ambulatory BP. Previous reports have demonstrated the detrimental role of MHT in clinical outcomes in hypertensive patients. However, the true prevalence of MHT in RTRs is yet to be defined. METHODS: A total of 113 RTRs (mean age 44 ± 16 years, 72 males, 41 females) with normal office BP (< 140/90 mmHg) were enrolled to the study from the outpatient renal transplantation clinic. Ambulatory BP monitoring (ABPM) was performed in all participants for a 24-h period. Average daytime BP values above 135 mmHg systolic and 85 mmHg diastolic were defined as MHT. RESULTS: The prevalence of MHT in our cohort was 39% (n = 45). Fasting glucose and C-reactive protein levels were higher in patients with MHT compared with normal BP group (p = 0.02 and p = 0.04, respectively). RTRs with deceased donor type had higher prevalence of MHT than RTRs with living donor (40% vs 19%, p = 0.003). In multivariate analysis, deceased donor type could predict the MHT independent of age, gender, office systolic BP level, diabetes mellitus, serum creatinine, C-reactive protein, and glucose levels (OR = 3.62, 95% CI 1.16-11.31, p = 0.03). CONCLUSION: We demonstrated an increased prevalence of MHT in a typical renal transplant cohort. In addition, transplantation from a deceased donor may be a predictor of MHT. The prevalence of MHT may help to explain high rate of cardiovascular events in RTRs. Therefore, routine application of ABPM in RTRs may be plausible, particularly in RTRs with deceased donor type.

An exceedingly rare localization of a brown tumor in a hemodialysis patient.

Brown tumor, which is seen in the context of hyperparathyroidism, is defined as a uremic bone disease characterized by increased osteoclastic activity and fibroblastic proliferation in the involved bone. In chronic renal failure, there is an excessive parathyroid hormone secretion due to hypocalcemia, hyperphosphatemia, and vitamin D deficiency. Brown tumor of the femur, facial bones, mandible, sternum, ribs, and pelvis are rare, whereas, it rarely involves sacrum. Here, we presented a brown tumor of the sacrum that developed secondary to parathyroid hyperplasia in a patient receiving hemodialysis.

Health-related quality of life, sleep quality, and depression in peritoneal dialysis and hemodialysis patients.

Health-related quality of life (HRQoL) and sleep quality (SQ) were impaired in patients with end-stage renal disease (ESRD). The impairment of both HRQoL and SQ and being in a depressive mood were found to be associated with increased morbidity and mortality in dialysis patients. We aimed to investigate the association between SQ, HRQoL, and depression, and to define independent predictors of SQ and depression in peritoneal dialysis (PD) and hemodialysis (HD) patients. Ninety HD patients (41 females, 49 males with mean age 50 ± 15.7 years) and 64 PD patients (27 females, 37 males with mean age 52.4 ± 15.3 years) receiving renal replacement therapy for at least 3 months were screened for the assessment of SQ, HRQoL, and depression in this cross-sectional study. A modified postsleep inventory, Short Form of Medical Outcomes Study (SF-36) and Beck depression inventory (BDI) were applied to all patients for evaluating SQ, HRQoL, and depression, respectively. HD and PD patients had similar total SQ scores. Physical and mental component scale of HRQoL were found to be significantly higher in HD patients (p < 0.001). PD patients were found to be much more in depressive mood when compared with HD patients (p < 0.001). Independent predictors of depression in patients were mental component scale of HRQoL, gender (being female), and dialysis modality (being PD patient). Physical component scale was also found to be an independent predictor of SQ. This study showed that despite similar SQ scores between two groups, HD patients had better HRQoL and less depression than PD patients.

Comparison of effects of automated peritoneal dialysis and continuous ambulatory peritoneal dialysis on health-related quality of life, sleep quality, and depression.

Few studies investigating the effects of automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) on health-related quality of life (HRQoL), depression, and sleep quality exist in the literature. We aimed to determine differences between APD and CAPD modalities with respect to these parameters. Twenty APD and 48 CAPD patients were included in this cross-sectional study. Biochemical values were measured at outpatient evaluation. A modified postsleep inventory was used to evaluate sleep quality. Health-related quality of life and depression were evaluated by the Short Form of Medical Outcomes Study and Beck Depression Inventory, respectively. Automated peritoneal dialysis and CAPD patients were compared in terms of sleep quality, HRQoL, and depression. Our results showed that there were no significant differences between APD and CAPD in any of the studied parameters. Moderate or severe sleep problems were found in 60% and 69% of the APD and CAPD patients, respectively. Mean HRQoL scores for any of the 8 Short Form of Medical Outcomes Study-36 domains were similar in the 2 groups. The mean physical component score was 51.1 ± 21.2 and 48.9 ± 18.2 in APD and CAPD patients, respectively (P=0.672). The mean mental component score was 47.5 ± 20.1 in APD patients, whereas it was 42.4 ± 19.5 in CAPD patients (P=0.291). Depression was detected in 70% of APD and 62.5% of the CAPD patients. The mean Beck Depression Inventory scores were also similar in the 2 groups. This study showed that HRQoL, sleep quality, and depression were similar in APD and CAPD patients.

Female sexual dysfunction in peritoneal dialysis and hemodialysis patients.

BACKGROUND: Sexual dysfunction (SD) is a common problem in end-stage renal disease (ESRD). In contrast to basic and clinical research in the field of male SD, the sexual problems of women have received relatively little attention and are often under-treated. We evaluated sexual function in female ESRD patients using the validated Female Sexual Function Index (FSFI) and relation with QOL, depression, and some laboratory parameters. METHODS: 117 ESRD patients (85 peritoneal dialysis [PD], 32 hemodialysis [HD], mean age 48.5 +/- 13.9 years) were enrolled. All patients had been dialyzed (PD or HD) for more than three months. In addition, an age-matched married control group of 48 subjects (mean age 47.1 +/- 12.7 years) were enrolled in the study. All patients were asked to complete three questionnaires of the FSFI, Beck Depression Index (BDI) and SF-36. RESULTS: Female sexual dysfunction was found in 80 of the 85 peritoneal dialysis patients (94.1%) and all of the HD patients (100%), but in only 22 subjects of the control group (45.8%). A significant negative correlation was found between total FSFI score and age (r = -0.288, p = 0.002), BDI score (r = -0.471, p < 0.001), mental-physical component score of QOL (r = -0.463, p < 0.001 and r = -0.491, p < 0.001, respectively) in PD and HD patients. The rates of depression were 75.3, 43.8, and 4.2% in the PD and HD patients and control subjects, respectively. CONCLUSION: Female sexual dysfunction is common problem ESRD. This problem especially related with depression and QOL. Thus, sexual function should be evaluated in female subjects to determine its impact on quality of life.

Is there any relationship between metabolic parameters and left ventricular functions in type 2 diabetic patients without evident heart disease?

BACKGROUND: The aim of the present study was to evaluate left ventricle (LV) systolic and diastolic function, using tissue Doppler echocardiography (TDE) and color M-mode flow propagation velocity, in relation to blood glucose status in normotensive patients with type 2 diabetes mellitus (T2DM) who had no clinical evidence of heart disease. METHODS: Seventy-two patients with T2DM (mean age 49.1 +/- 9.8 years) without symptoms, signs or history of heart disease and hypertension, and 50 ages matched healthy controls (mean age 46.1 +/- 9.8 years) had echocardiography. Systolic and diastolic LV functions were detected by using conventional echocardiography, TDE and mitral color M-mode flow propagation velocity (V(E)). Fasting blood glucose level (FBG) after 8 hours since eating a meal, postprandial blood glucose level (PPG), and HbA(1C) level were determined. The association of FBG, PPG and HbA(1C) with the echocardiographic parameters was investigated. RESULTS: It was detected that although systolic functions of two groups were similar, diastolic functions were significantly impaired in diabetics. No relation of FBG and PPG with systolic and diastolic functions was determined. However, HbA(1C) was found to be related to diastolic parameters such as E/A, Em/Am, V(E) and E/V(E) (beta=-0.314, P = < 0.05; beta=-0.230, P < 0.05; beta=-0.602, P < 0.001, beta= 0.387, P < 0.005, respectively). In addition to HbA(1C), LV, diastolic functions were also correlated with age and diabetes duration. CONCLUSION: Diastolic LV dysfunction may develop even in absence of ischemia, hypertension, and LVH in T2DM. FBG and PPG have no effect on LV functions, but HbA(1C) levels may affect diastolic parameters.

Exercise does not increase QTcmax and QTcd in diabetic patients with autonomic neuropathy.

BACKGROUND: The purpose of this study was to examine the effects of exercise on maximum QTc interval (QTcmax) and QTc dispersion (QTcd) in diabetic patients without clinically evident heart disease. METHODS: Seventy-six diabetic patients who had no coronary artery disease or hypertension (group I; mean age 48 +/- 9 years old) and 40 healthy volunteers (group II; mean age 46 +/- 13 years old) were enrolled in the study. Cases with clinically evident heart disease were excluded from the study. Resting 12-lead electrocardiogram (ECG) and maximal treadmill exercise test (according to Bruce protocol) were performed in all cases. The QTcmax interval was determined at rest (RQTcmax) and during peak exercise (PQTcmax). Also, the QTcd was measured at rest (RQTcd) and during peak exercise (PQTcd). Autonomic neuropathy was assessed by measuring the heart rate variability (HRV). RESULTS: There was no significant difference between clinical characteristics of two groups. In group I, HRV parameters were significantly lower than group II. RQTcd, PQTcd, RQTcmax, and PQTcmax were significantly longer in group I (56 +/- 16 vs 34 +/- 11; P< 0.001, 62 +/- 22 vs 40 +/- 15; P < 0.001, respectively). In diabetic patients, there was no significant difference between RQTcmax and PQTcmax (428 +/- 19 vs 420 +/- 31; P > 0.05), and no significant difference was present between RQTcd and PQTcd (56 +/- 16 vs 62 +/- 22; P > 0.05, respectively). CONCLUSION: Exercise does not affect QTcd in patients with diabetes mellitus and without clinically evident heart disease.

[A multiple myeloma case presenting with bilateral pleural involvement]. / Bilateral plevral tutulum ile basvuran multipl miyelom olgusu.

Pleural effusion is a relatively infrequent finding in multiple myeloma (MM) and malign effusions due to myelomatous effusion is seen very rarely. In this article we reported a case with bilateral myelomatous effusion. Myelomatous etiology was detected by demonstrating gammopathy in pleural fluid protein electrophoresis and demonstrating abundant number of atypical plasma cells in pleural fluid cytology. Pleural fluids due to MM are usually seen in IgA type of MM's, IgG on the surface of CD-138 positive cell was demonstrated in flow cytometric study of the pleural fluid of the reported case. In conclusion we mentioned that a patient who does not have diagnosis of MM before may present with pleural involvement, the involvement may be bilateral and flow cytometry can be used in diagnosis.