Search

Objective: Frailty is very common in kidney disease, and most of the end-stage kidney disease patients are described as frail. This study aimed to define frailty condition in kidney transplant candidates and investigate its relationship between dependency and laboratory parameters. Methods: One hundred two end-stage kidney disease patients on deceased kidney transplant waiting list were included in the study. Modified Fried Frailty Index and FRAIL frailty questionnaire were used to assess frailty and Activities of Daily Living scale and Instrumental Activities of Daily Living scale to assess functional dependency in kidney transplant candidates. Results: The patients’ mean age was 49.09 ± 13.77 years. According to the Modified Fried Frailty Index, 30.4% of patients were non-frail, 48.0% were pre-frail, and 21.6% were frail. According to the FRAIL scale, 34.3% of patients were non-frail, 40.2% were pre-frail, and 25.5% were frail. C-reactive protein level was found to be higher in frail and pre-frail patients (P = .049; P = .010). Frailty increased with age. According to the Activities of Daily Living scale 15 (14.7%) of the patients and according to the Instrumental Activities of Daily Living scale 27 (26.5%) of the patients were dependent. It was observed that frail patients were more dependent on Activities of Daily Living scale and Instrumental Activities of Daily Living scale (P < .001). Multivariate regression analyses revealed C-reactive protein and Activities of Daily Living scale are independent predictors of frailty. Conclusion: In our study, we found that frailty increased with age, with C-reactive protein levels as a marker of inflammation, and it had a negative impact on the Activities of Daily Living scale affecting daily life to a statistically significant degree. [ABSTRACT FROM AUTHOR]

Living donation challenges the ethical principle of non-maleficence in that it exposes healthy persons to risks for the benefit of someone else. This makes safety, informed consent (IC) and education a priority. Living kidney donation has multiple benefits for the potential donor, but there are also several known short- and long-term risks. Although complete standardization of IC is likely to be unattainable, studies have emphasized the need for a standardized IC process to enable equitable educational and decision-making prospects for the prevention of inequities across transplant centers. Based on the Three-Talk Model of shared decision-making by Elwyn et al. we propose a model, named 3-Step (S) Model, where each step coincides with the three ideal timings of the process leading the living donor to the decision to pursue living donation: prior to the need for kidney replacement therapy (team talk); at the local nephrology unit or transplant center, with transplant clinicians and surgeons prior to evaluations start (option talk); and throughout evaluation, after having learned about the different aspects of donation, especially if there are second thoughts or doubts (decision talk). Based on the 3-S Model, to deliver conceptual and practical guidance to nephrologists and transplant clinicians, we provide recommendations for standardization of the timing, content, modalities for communicating risks and assessment of understanding prior to donation. The 3-S Model successfully allows an integration between standardization and individualization of IC, enabling a person-centered approach to potential donors. Studies will assess the effectiveness of the 3-S Model in kidney transplant clinical practice. [ABSTRACT FROM AUTHOR]

Background: Calprotectin is an important molecule in the initiation and progression of the inflammatory process. Systemic and local intraperitoneal inflammation are distinct processes and consequences in peritoneal dialysis (PD). We aimed to evaluate dialysate calprotectin levels and its associations with peritonitis and dialysis adequacy in PD patients. Methods: Forty‐four PD patients were included in this prospective study. Calprotectin concentration was evaluated in 24‐h peritoneal drainage fluid. Patients were followed‐up for 1 year, and peritonitis episodes were recorded. Dialysate calprotectin levels were compared to dialysis adequacy parameters and peritonitis frequency. Results: The mean age of patients was 54.9±12.7 years. Median PD duration was 54 (23–76) months. Seventeen patients (38.6%) had previous peritonitis episodes. During follow‐up, 15 of 44 patients (34.1%) had peritonitis. The median calprotectin concentration was 79.5 (75.2–86.3) ng/ml. The patients were divided into low and high calprotectin groups according to median value. In the high calprotectin group, BMI was found higher (p = 0.04). There was no significant relationship between calprotectin concentration and peritonitis during follow‐up (p = 0.29). However, the patients that have had previous peritonitis had higher calprotectin concentrations (p = 0.02). The patients who had higher erythrocyte sedimentation rate (ESR) levels also had higher calprotectin concentrations (p = 0.01). Conclusion: Peritoneal calprotectin concentrations were correlated with higher BMI and ESR, and it was higher in patients with previous peritonitis episodes. To our knowledge, this is the first study to examine the peritoneal calprotectin levels in PD patients. Further studies are needed to determine the use of peritoneal calprotectin as an inflammatory marker in PD. [ABSTRACT FROM AUTHOR]

Introduction: Data to guide the evaluation of living-related donor candidates for kidney transplant recipients with Alport syndrome (AS) spectrum are limited. We aimed to examine a cohort of living-related donors to recipients with AS and compare their outcomes with a control group to improve understanding of the clinical course and outcomes of living donation in this context. Methods: Living donors (LDs) of AS recipients and propensity score-matched control LDs without any family history of AS (control group) were followed for major cardiac events, death, post-donation estimated glomerular filtration rate (eGFR), and proteinuria. Results: There were 31 LDs (48.4% male), in whom relationship to AS recipient included mother (45.2%), father (32.3%), sibling (16.1%), grandparent (3.2%), and uncle (3.2%). Long-term outcomes over 10.0 (IQR, 3.0–15.0) years were evaluated in 25 and 25 LDs from study and control groups, respectively. During follow-up, 5 LDs (20.0%) in study group developed major cardiac event (acute coronary ischemia [n = 4] and severe congestive heart failure [n = 1]) after 5.5 (IQR, 4.5–10.3) years, whereas only 2 (8.0%) LDs in control group developed major cardiac events (p = 0.221). New-onset hypertension was higher in study group (56.0%) compared to the control group (16.0%) (p = 0.003). Three donors in study and 2 donors in control group who developed new-onset hypertension died during follow-up (p = 0.297). Major cardiac event rate was significantly higher in donors who developed hypertension after donation (0 vs. 28.0%, p < 0.001). There were no differences between study groups regarding last eGFR and proteinuria levels (p = 0.558 and p = 0.120, respectively). Discussion/Conclusion: Although the risk of kidney disease can be minimized by careful donor evaluation, our findings suggest that hypertension risk after the donation is higher than expected in related donors of recipients with AS. [ABSTRACT FROM AUTHOR]

Objective: Although liver dysfunction is not considered the main organ involvement in Systemic Lupus Erythematosus (SLE), the frequency of liver dysfunction or abnormal liver enzyme values may be observed in 50–60% of patients. The aim of this study was to assess fatty liver and liver fibrosis in SLE patients using Fibroscan as well as determine associated factors such as immunosuppressive medications. Methods: Sixty SLE patients and 30 healthy controls were included. Patients with HBV, HCV or cirrhosis, malignancy, cardiac disease, or patients on dialysis were excluded. All participants underwent Fibroscan measurements. Results: The prevalence of fatty liver disease was similar between SLE patients and healthy controls (21.7 vs 26.7%, p =.597). Liver fibrosis was also similar between the two groups (26.7 vs 10.0%, p =.069). Since the majority of SLE patients were female, we performed a subgroup analysis in female patients (n = 51) and controls (n = 25). Fatty liver disease was similar between female SLE patients and controls (23.5 vs 24.0%, p =.964). However, liver fibrosis in female patients with SLE was increased compared to female controls (29.4 vs 4.0%, p =.011) and was associated with age (Exp (B) 95% CI: 1.083 (1.006–1.166), p =.034) and low-dose cumulative glucocorticoid use (Exp (B) 95% CI: 14.116 (1.213–164.210), p =.034). Conclusion: The prevalence of fatty liver was similar between SLE patients and controls, while liver fibrosis was increased in the female patient group as compared to controls. Furthermore, liver fibrosis was associated with age and low dose cumulative glucocorticoid use. Interestingly, fatty liver did not precede liver fibrosis in the majority of cases, contrary to what is observed in the general population. Larger studies are needed to confirm our findings and determine whether immunosuppressive use has any impact on the development of liver fibrosis in SLE patients. [ABSTRACT FROM AUTHOR]

Carotid intima-media thickness (CIMT) is an early marker of atherosclerosis and is increased in peritoneal dialysis (PD) patients. Association of CIMT with cardiovascular disease (CVD) or mortality is less clear. Fibroblast growth factor-23 (FGF-23) is a hormone associated with vascular calcification, atherosclerosis, and mortality in the hemodialysis population. We investigated whether baseline CIMT and FGF-23 are associated with CVD and mortality in PD patients. Fifty-five PD patients were included. CVD was defined as ischemic heart disease, stroke, or peripheral artery disease. Intact FGF-23 was measured in plasma. CIMT was measured by ultrasonography. Twenty-one patients developed CVD and 12 died over 47.1 ± 33.8 months. Patients with CVD were older (55.9 ± 10.5 vs. 42.5 ± 12.9 years, P < .01), had lower albumin (3.8 ± 0.5 vs. 4.2 ± 0.3 g/dL, P < .01) and higher CIMT (0.87 ± 0.22 vs. 0.61 ± 0.11 mm, P < .01). Patients with mortality were also older (53.5 ± 11.5 vs. 45.8 ± 13.8 years, P = .05), had lower albumin (3.7 ± 0.6 vs. 4.1 ± 0.3 g/dL, P < .01), higher CRP (15.0 ± 8.5 vs. 7.6 ± 8.4 mg/L, P < .01) and CIMT (0.9 ± 0.3 vs. 0.6 ± 0.1 mm, P < .01). Albumin and CIMT were associated with CVD and CIMT > 0.75 mm was associated with cardiovascular mortality. FGF-23 did not show any correlations. CIMT at baseline is associated with CVD and mortality in PD patients. [ABSTRACT FROM AUTHOR]

Studies assessing peritoneal thickness by CT in peritoneal dialysis (PD) patients are lacking. In this study, we aimed to investigate the association between peritoneal thickness as measured by CT and dialysis adequacy with peritoneal membrane characteristics in PD patients. Ninety-four PD patients were enrolled. Peritoneal thickness was measured by CT. Patients with and without a decrease in Kt/V of at least 0.3 over time were classified as Group 1 and Group 2, respectively. An increase of 0.1 unit of dialysate/plasma (D/P) creatinine over time were considered significant. The relationship between peritoneal membrane thickness, change in Kt/V, and peritoneal membrane characteristics were investigated. There were 31 (33.0%) patients in Group 1. The duration of PD (86.0 ± 64.1 vs. 59.6 ± 45.2 months, p: 0.023), peritoneal thickness (1.02 ± 0.37 vs. 0.87 ± 0.21 mm, p: 0.015), peritoneal calcification (7 [22.6%] vs. 3 [4.8%] patients, p: 0.013], increased D/P creatinine ratio (14 [45.2%] vs. 14 [22.2%] patients, p: 0.031) and CRP (13.9 ± 11.2 vs. 7.1 ± 4.8 mg/L, p: 0.045) were significantly higher in Group 1, whereas albumin (3.6 ± 0.5 vs. 3.8 ± 0.6 g/dL, p: 0.047) and parathyroid hormone (355.2 ± 260.2 vs. 532.1 ± 332.9 ng/L, p: 0.015) levels were significantly lower. Peritoneal thickness was significantly correlated with duration of PD (r: 0.775, p < 0.001) and CRP (r: 0.282, p: 0.006). Regression analysis showed that peritoneal thickness (Exp (B) [95% CI]: 0.029 [0.003-0.253], p: 0.001) was independent predictor of decreased Kt/V in PD patients. In conclusion, prolonged PD duration and increased peritoneal thickness are associated with a decrease in Kt/V over time. CT may be an alternative and noninvasive method instead of peritoneal biopsy for determining the structural changes of the peritoneal membrane. [ABSTRACT FROM AUTHOR]

Low 25-OH vitamin D levels have been linked to peritonitis and cardiovascular mortality in peritoneal dialysis (PD) patients. In this study we aimed to investigate the association of 25-OH vitamin D levels with peritoneal membrane characteristics in chronic PD patients. Consecutive 103 PD patients were enrolled in this retrospective study. Peritoneal dialysate to plasma (D/P) creatinine increase more than 0.1 with time were accepted as significant according Roc curve analysis. Patients with and without an increase in the D/P creatinine ratio of 0.1 were classified as Group 1 and Group 2, respectively. The relationship between baseline 25-OH vitamin D and peritoneal membrane characteristics were investigated. Mean age of the patients was 53.4±14.9 years and duration of PD was 72.1±50.3 months. There were thirty (29.1%) patients in Group 1. The duration of PD [73.5 (52.3-133.8) vs 49.0 (33.5-94.0) months, p:0.008]; hemoglobin [11.4 (10.4-12.2) vs. 10.2 (9.4-11.0) g/dL, p:0.001]and PTH [500.5 (254.5-748.3) vs 329.0 (205.0-549.5)ng/mL, p:0.047] levels were significantly higher in Group 1, whereas 25-OH vitamin D levels [5.0 (3.0-9.3) vs 7.8 (4.5-11.1)μg/L, p:0.027] and CRP [4.0 (3.0-7.2) vs. 8.0 (3.0-13.5)mg/L, p:0.028] were significantly lower. Multivariate analysis revealed duration of PD [Exp(B):1.012 (95%CI:1.001-1.022), p:0.028]; hemoglobin [Exp(B):1.756 (95%CI:1.199-2.571), p:0.004]; C-reactive protein (CRP) [Exp(B):0.882 (95%CI:0.789-0.985), p:0.026] and 25-OH vitamin D [Exp(B):0.853 (95%CI:0.754-0.965), p:0.012] were independent predictors of an increase in D/P creatinine ratio in PD patients. Increased D/P creatinine ratio was negatively correlated with 25-OH vitamin D level (r: -0.217, p:0.028). Lower levels of initial 25-OH vitamin D were associated with an increase in D/P creatinine ratio over-time. [ABSTRACT FROM AUTHOR]

Vitamin D has a critical role in bone-mineral disorders in chronic kidney disease (CKD) and its deficiency is further associated with increased cardiovascular morbidity and mortality among CKD patients. We aimed to evaluate prevalence of vitamin D deficiency and investigate the laboratory and clinical parameters associated with 25- OH vitamin D deficiency in peritoneal dialysis (PD) patients. Sixty-four (33M/31F) peritoneal dialysis patients were enrolled in this retrospective single center study. Clinical and laboratory data were obtained from patient charts. Prevalence of 25-OH vitamin D deficiency and its associations were analyzed. The patients’ mean age was 49.7±13.3 years and the mean duration of PD was 61.0±55.0 months. The mean 25-OH vitamin D level was 8.9±2.4 ng/ml and none of the patients were on 25-OH vitamin D therapy. All of the patients had lower than normal 25-OH vitamin D levels according to KDOQI guidelines. Levels of 25-OH vitamin D were deficient and insufficient in 84.4% (57.8% mild; 26.6% severe) and 15.6% of the patients, respectively. There was no association between 25-OH vitamin D levels and sex, age, BMI, duration of PD and cause of ESRD. There was a negative correlation between 25-OH vitamin D levels and uric acid and parathyroid hormone. Uric acid was an independent predictor of 25-OH vitamin D deficiency in the logistic regression analysis [OR (95%CI): 0.139 (0.029-0.667), p: 0.014]. We conclude that 25-OH vitamin D deficiency is very common in PD patients. Serum uric acid is an independent predictor of 25-OH vitamin D deficiency which should further be investigated in larger studies. [ABSTRACT FROM AUTHOR]

BK virus infections which usually remains asymptomatic in healthy adults may have different clinical manifestations in immunocompromised patient population. BK virus reactivation can cause BK virus nephropathy in 8% of kidney transplant patients and graft loss may be seen if not treated. Clathrin or Caveolar system is known to be required for the transport of many viruses from Polyomaviruses family including BK viruses. In this study, kidney transplant patients with BK virus viremia were divided into two groups according to the BK virus nephropathy found in kidney biopsy (Group I: Viremia+, Nephropathy+ / Group II: Viremia+, Nephropathy−). Kidney biopsies were examined with immunohistochemical staining to determine the distribution and density of the Caveolin‐1 and Clathrin molecules. Immunohistochemical staining of the 31 pathologic specimens with anti‐caveolin‐1 immunoglobulin revealed statistically significant difference between group‐I and group‐II. The number of the specimens stained with anti‐caveolin‐1 was less in group I. On the other hand, we did not find any difference between the groups regarding the anti‐clathrin immunochemical analysis. According to these findings, caveolin‐1 expression differences in kidney transplant patients may be important in disease progression. [ABSTRACT FROM AUTHOR]

Background: The most common infections among renal transplant patients are urinary tract infections (UTI). Our main objective in this study is to determine the incidence of UTIs in patients who have undergone renal transplantation in our hospital, to identify the causative microbiological agents, risk factors and determine the effects of UTI on short-term graft survival. Methods: Urinary tract infections, which developed within the first year of renal transplantation, were investigated. Patients were compared regarding demographic, clinical, laboratory characteristics and graft survival. Results: 102 patients were included in our study. Fifty-three patients (53%) were male and 49 (48%) were female. Sixty-seven urinary tract infection attacks in 21 patients (20.5%) were recorded. Age (p = 0.004; 95% Confidence Interval [CI]: 1.032–1.184), longer indwelling urinary catheter stay time (p = 0.039; 95% Confidence Interval [CI]: 1.013–1.661) and urologic complications (p = 0.006; 95% Confidence Interval [CI]: 0.001–0.320) were found as risk factors for UTI development in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated microorganisms. Of these bacteria, 63.2% were found to be extended spectrum beta lactamase (ESBL) positive. Multidrug resistant microorganisms (MDROs) were more frequent in male patients (32 episodes in males vs. 14 episodes in females, p = <0.001). UTI had no negative impact on short-term graft survival. Conclusion: Our study results represent the high incidence of UTI with MDROs in KT recipients. Infection control methods should be applied even more vigorously especially in male transplant patients since a higher incidence of UTI caused by resistant microorganisms was reported in male patients. [ABSTRACT FROM AUTHOR]

Objective: We aim to evaluate the effects of low-dose dopamine (LDD) infusion (0.5 -- 2.5 g/kg/min) on hemodynamic status and short-term graft function in kidney transplant recipients. Materials and Methods: Patients who underwent kidney transplantation surgery between January 2007 and December 2016 were included in the study. Demographic and laboratory data, presence of delayed graft function, and the rates of rejection, graft loss, and mortality were recorded. The data were compared between patients with and without LDD treatment. Results: A total of 126 patients were included in the study (M/F:50.8%/49.2%; mean age, 38.94 ± 11.8 years). Ninety-four patients (74.6%) received living-donor transplants. Fifty-seven patients underwent LDD infusion in the postoperative period (LDD group), while 69 patients did not receive LDD infusion. Demographic and laboratory data of the patients did not significantly differ between groups. Nineteen patients in the LDD group experienced delayed graft function (p=0.039). However, these patients tended to be older, have a longer dialysis period prior to transplantation, deceased and hypertensive donors. There was no significant difference in renal function at 6 months after transplantation between groups. Conclusion: Although, LDD infusion increases kidney blood flow, we observed no significant effects on short-term graft function or patient survival between the LDD and non-LDD groups. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method: Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results: One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX. Conclusion: Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population. [ABSTRACT FROM AUTHOR]

Background: Infections are the most common complications in patients with peritoneal dialysis (PD). The association between the anatomical localization of the exit site (ES) and infectious complications is unclear. In this study, we evaluated the relationship between the anatomic location of the ES and infectious complications of PD. Methods: We examined the ES of 53 patients on PD. To define the anatomical localization of the ES, its distance from the line between right and left anterior superior iliac spines (A line), umbilicus (B line), and the anterior superior iliac spine on the catheter side (C line) was measured. Results: Coiled catheters were used in all patients. The mean lengths of A line, B line, and C line were 4.1 ± 2.2 cm (range, 0-9.5 cm), 9.6 ± 2.9 cm (range, 4-17 cm), and 9.3 ± 2.9 cm (range, 5-18 cm), respectively. ES infection was documented in 9 patients (17%), tunnel infection in 1 patient (2%), and peritonitis in 27 (50.9%) patients. The B line was significantly longer in those with peritonitis than those without peritonitis (10.6 ± 3 vs. 8.7 ± 2.7 cm; P = .036). Other variables were not associated with infectious complications. Conclusion: There was an association between the anatomical localization of the ES and the development of peritonitis. An ES close to the umbilicus could reduce the risk of peritonitis by enabling access by the patient to perform daily care. [ABSTRACT FROM AUTHOR]

Background: The psychological distress and sleep problems caused by current Covid-19 outbreak is not well known in kidney transplant recipients. In this study, we aimed to investigate the association between perceived stress with sleep quality, insomnia, anxiety, depression and kidney function in kidney transplant recipients during the Covid-19 pandemic. Material and methods: A hundred-six kidney transplant recipients were enrolled. Questionnaire of "Socio-demographics", "Perceived Stress Scale (PSS)", "Pittsburgh Sleep Quality Index (PSQI)", "Insomnia Severity Index (ISI)" and "Hospital Anxiety Depression Scale (HADS)" are performed. The laboratory data is recorded. The perceived stress related to Covid-19 pandemic and its associations were investigated. Results: The mean age of patients was 44.2±13.3 years, and 65 of the patients (61.3%) were men. Forty-nine (46.2%) of the patients had high-perceived stress; 51 (48.1%) of the patients had poor sleep quality, 40 (37.7%) of the patients had insomnia, 25 (23.6%) of the patients had anxiety and 47 (44.3%) of the patients had depression. The patients having a history of Covid-19 infection in own or closed relatives (9.09±4.17 vs 6.49±4.16, p:0.014) and the patients who have a rejection episode any of time (8.24±5.16 vs 6.37±3.57, p:0.033) have had significantly higher anxiety scores, when they compared to others. The high PSS were positively correlated with PSQI, ISI, HAD-A and HAD-D. Regression analyses revealed that high-perceived stress is an independent predictor of anxiety and depression. There was not significant difference between kidney function with PSS, PSQI, ISI, HAD-A and HAD-D. Conclusions: High PSS is positively correlated with poor sleep quality and insomnia and also an independent predictor of anxiety and depression in kidney transplant recipients during the outbreak of Covid-19. As the pandemic is still spreading worldwide quickly early identification and intervention of sleep disturbances and psychiatric disorders are essential to protect graft function with high compliance to treatment in transplantation patients. [ABSTRACT FROM AUTHOR]

There were also transplant-specific factors such as concomitant tacrolimus use, pre-existing graft dysfunction, and inadequate hydration status. Human papilloma virus (HPV) is mostly associated with genital warts, such as condyloma and verruca vulgaris. It has previously been suggested that mTOR inhibitors can suppress viral replications and also regulate cell growth and survival; the pathways of which are often dysregulated in various types of malignancies.[8] Therefore, avoiding MMF and changing to everolimus-based treatment can be considered in cases with HPV-related conditions. [Extracted from the article]

Peritoneal dialysis (PD) is a home-based kidney replacement therapy that has declined in recent years, despite offering several advantages such as preservation of residual renal function, patient independence, and low cost. It has taken COVID-19 to emphasize the advantages of PD and this may be the trend of the future where more patients prefer home-based therapies. Indeed, initial reports confirm the incidence of COVID-19 is much lower in PD patients.3,4 We are a university hospital with a dedicated PD unit including a predialysis patient education program. [Extracted from the article]

The article describes the case of a 40-year-old male kidney transplant patient receiving eculizumab, who is presented with Covid-19.

Copyright of Marmara Medical Journal is the property of Marmara Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article describes the case of a 58-year-old renal allograft transplant recipient with recurrent esophageal candidiasis diagnosed with esophageal carcinoma, with topics mentioned such as pancytopenia, dysplasia, and mucosal candidiasis lesions.

The article presents a case study of a 45-year-old woman referred to nephrology outpatient clinic with bilateral ankle swelling. Topics discussed include Abdominal computed tomography scan reveals right-sided hydronephrosis due to obstruction of the uretero-pelvic junction (UPJ); unilateral partial UPJ obstruction could be the cause of full-blown nephrotic syndrome; and patient treated with oralmethyl prednisolone therapy.

Aim: BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients., Materials and Methods: Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study., Results: 13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 ±  13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 ± 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 ±  0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m 2 . In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy., Conclusion: BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.

Competing Interests: Outside the submitted work, S.M. reports receiving support for attending meetings and travel from Amgen and Sanofi Genzyme, and A.V. received honoraria for lectures, presentations, speaker's bureaus, manuscript writing or educational events from Alexion. The remaining authors have no disclosures. The results presented in this letter have not been published previously in whole or part, except in abstract format.

Introduction: Most studies of solid organ transplant (SOT) recipients with COVID-19 focus on outcomes within one month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined., Methods: We used data from a multicenter registry to calculate mortality by 90 days following initial SARS-CoV-2 detection in SOT recipients hospitalized for COVID-19 and developed multivariable Cox proportional-hazards models to compare risk factors for death by days 28 and 90., Results: Vital status at day 90 was available for 936 of 1117 (84%) SOT recipients hospitalized for COVID-19: 190 of 936 (20%) died by 28 days and an additional 56 of 246 deaths (23%) occurred between days 29 and 90. Factors associated with mortality by day 90 included: age > 65 years [aHR 1.8 (1.3-2.4), p =<0.001], lung transplant (vs. non-lung transplant) [aHR 1.5 (1.0-2.3), p=0.05], heart failure [aHR 1.9 (1.2-2.9), p=0.006], chronic lung disease [aHR 2.3 (1.5-3.6), p<0.001] and body mass index ≥ 30 kg/m 2 [aHR 1.5 (1.1-2.0), p=0.02]. These associations were similar for mortality by day 28. Compared to diagnosis during early 2020 (March 1-June 19, 2020), diagnosis during late 2020 (June 20-December 31, 2020) was associated with lower mortality by day 28 [aHR 0.7 (0.5-1.0, p=0.04] but not by day 90 [aHR 0.9 (0.7-1.3), p=0.61]., Conclusions: In SOT recipients hospitalized for COVID-19, >20% of deaths occurred between 28 and 90 days following SARS-CoV-2 diagnosis. Future investigations should consider extending follow-up duration to 90 days for more complete mortality assessment., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Studies assessing peritoneal thickness by CT in peritoneal dialysis (PD) patients are lacking. In this study, we aimed to investigate the association between peritoneal thickness as measured by CT and dialysis adequacy with peritoneal membrane characteristics in PD patients. Ninety-four PD patients were enrolled. Peritoneal thickness was measured by CT. Patients with and without a decrease in Kt/V of at least 0.3 over time were classified as Group 1 and Group 2, respectively. An increase of 0.1 unit of dialysate/plasma (D/P) creatinine over time were considered significant. The relationship between peritoneal membrane thickness, change in Kt/V, and peritoneal membrane characteristics were investigated. There were 31 (33.0%) patients in Group 1. The duration of PD (86.0 ± 64.1 vs. 59.6 ± 45.2 months, p: 0.023), peritoneal thickness (1.02 ± 0.37 vs. 0.87 ± 0.21 mm, p: 0.015), peritoneal calcification (7 [22.6%] vs. 3 [4.8%] patients, p: 0.013], increased D/P creatinine ratio (14 [45.2%] vs. 14 [22.2%] patients, p: 0.031) and CRP (13.9 ± 11.2 vs. 7.1 ± 4.8 mg/L, p: 0.045) were significantly higher in Group 1, whereas albumin (3.6 ± 0.5 vs. 3.8 ± 0.6 g/dL, p: 0.047) and parathyroid hormone (355.2 ± 260.2 vs. 532.1 ± 332.9 ng/L, p: 0.015) levels were significantly lower. Peritoneal thickness was significantly correlated with duration of PD (r: 0.775, p < 0.001) and CRP (r: 0.282, p: 0.006). Regression analysis showed that peritoneal thickness (Exp (B) [95% CI]: 0.029 [0.003-0.253], p: 0.001) was independent predictor of decreased Kt/V in PD patients. In conclusion, prolonged PD duration and increased peritoneal thickness are associated with a decrease in Kt/V over time. CT may be an alternative and noninvasive method instead of peritoneal biopsy for determining the structural changes of the peritoneal membrane ., (© 2021 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.)