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Introduction: Evidence suggests a relationship between electrocardiography (ECG) aVR (augmented voltage right) T wave and cardiovascular mortality in hemodialysis patients. The aim of our study was to investigate the relationship between ECG T aVR positivity and overall mortality together with other known risk factors in hemodialysis patients. Materials and methods: One hundred and one hemodialysis patients were retrospectively screened for ECG T aVR wave positivity. In parallel, the relationship between T aVR positivity and age, gender, calcium phosphorus index, heart rate, ECG and echocardiographic parameters, mortality, smoking, presence of diabetes mellitus, hypertension, myocardial infarction were investigated. RESULTS: Univariate analyzes revealed that patients with positive T aVR (16%) had a statistically lower dialysis time and ejection fraction compared to patient with negative T aVR (p=0.041 and p=0.046, respectively). Survival analysis revealed statistically significantly better prognosis for T aVR-negative patients compared to T aVR-positive patients (5-year survival 70.9%, and 45.5%, respectively; p=0.027). Among tested parameters, independent risk factors affecting survival in hemodialysis patients were found to be age (hazard ratio, HR: 1.03), high heart rate (HR: 1.03), smoking (HR: 3.37) and presence of diabetes mellitus (HR: 2.91). CONCLUSIONS: Our results indicate that routine monitorization of T wave in aVR derivation together with evaluation of other risk factors may provide information about the cardiovascular risk profile, mortality and life habits of hemodialysis patients.

Objective: Depression is the most common psychiatric disorder affecting patients on hemodialysis (HD) and has been associated with impaired Quality of Life (QoL). This study aimed to investigate the prevalence of depression and the relationship between depression, QoL, and demographic factors in HD patients. Methods: Short form 36 (SF–36) and Beck's depression inventory (BDI) were employed to assess the relationship between depression, QoL and demographics in 50 hemodialysis patients. The relationship between scores of BDI and SF–36, and annual biochemical and demographic data were then evaluated. Results: Mean age of the patients was 56.4 ±16.4 years and the mean HD duration was 57.11 ±39.09 months. The incidence of depression (BDI>14) was 36%. Age, hemoglobin, ferritin, body mass index (BMI), and Kt/V values were observed to be significantly correlated with the QoL scores (p

The effect of subclinical thyroid pathologies on erythropoietin (EPO) treatment has not been well defined. The aim of the study is to compare the frequency and dose of erythropoietin administration in patients with subclinical thyroid pathology and euthyroid hemodialysis patients.A cross-sectional and retrospective study was conducted with two hundred and ten patients. Special conditions were excluded, a total of one hundred and ninety-one patients were included. Patients were divided into three groups.The incidences of subclinical hypothyroidism, subclinical hyperthyroidism and euthyroidism were 10.5%, 3.1%, and 86.4% respectively. Statistically significant difference was found between subclinical hypothyroid and euthyroid patients in terms of the number of patients using erythropoietin (p=0.0207), monthly total erythropoietin doses (p=0.003) and total monthly erythropoietin doses per weight (p= 0.001).The erythropoietin dose required to achieve similar hemoglobin levels in hemodialysis patients was significantly higher in subclinical hypothyroid patients than in euthyroid patients. This article is protected by copyright. All rights reserved.

Coronavirus disease 2019 (COVID-19) has been accepted as a global pandemic, and poses a greater risk to the elderly and those with comorbidities. Comorbid diseases (particularly end-stage kidney disease with hemodialysis) and impaired immunity place patients in the high-risk group for COVID-19. In recent studies, it was also mentioned that exaggerated inflammation and a cytokine storm were the underlying causes related to the high mortality in COVID-19 patients. Currently, treatment modalities to balance the immune system of such vulnerable patient groups are essential, to protect them from the disease. Several vitamins (like vitamins C, D, and E), trace elements like zinc, and probiotics have been proposed as immune boosters to protect and combat infectious conditions. It is well known that these vitamins and elements are insufficient in hemodialysis patients. In this review, we aimed to evaluate the immune-boosting mechanisms of vitamins C, D, E, zinc, and probiotics, the studies related to their beneficial effects against infections, and their possible benefits for hemodialysis patients during the COVID-19 pandemic.

Amaç: Diabetik nefropati (DN) son dönem böbrek yetersizliğinin önemli bir nedenidir. Vasküler hastalıklarda kullanılan ve anti-inflamatuar özellikleri olan pentoksifilinin diyabetik nefropatide olumlu etkileri olabileceği öne sürülmüştür. Bu çalışmada DN nedeni ile takipte olan ve pentoksifilin kullanan hastaların tedavi öncesi ve sonrası dönemdeki böbrek fonksiyonları ve proteinürileri değerlendirilmiştir. Gereç ve Yöntemler: Kliniğimizde takipte olup pentoksifilin (1200 mg/gün) tedavisi alan 36 diabetik nefropati hastası retrospektif olarak tarandı. Tedavi başlanmadan önceki 3. ve 6. ay; pentoksifilin tedavisinin 3., 6., 9. ve 12. aylardaki günlük proteinüri miktarı ve eGFR (estimated glomerular filtration rate, tahmini glomerüler filtrasyon hızı) değerleri kayıt edildi. Bulgular: Çalışmaya alınan 36 hastanın ortalama yaşı 51,9±12,3 yıl, 12’si erkek ve 16’sı Anjiotensin dönüştürücü enzim (Angiotensin converting enzyme inhibitor, ACEİ) ya da Anjiotensin reseptör blokeri (Angiotensin receptor blocker, ARB) kullanıyordu. Pentoksifilini 23 hasta ≤6 ay (A grubu) 13 hasta >6 ay (B grubu) süre kullanmıştı. Proteinüri miktarı ve eGFR kaybı yönünden her iki grupta anlamlı farklılık saptanmadı. Sonuç: Çalışmamızda diabetik nefropatili hastalarda 1 yıllık takip sırasında pentoksifilin tedavisinin proteinüri miktarı ve eGFR kaybına etkisi saptanamamıştır. Anahtar kelimeler: Diabetik nefropati, pentoksifilin, proteinüri

PubMedID: 31582680 Objective: Ventricular repolarization (VR) markers may predict ventricular arrhythmias and cardiac arrest. The aim of this study was to investigate the acute effects of a hemodialysis (HD) session and HD adequacy on VR markers in HD patients. Methods: This cross-sectional study was conducted at 2 university hospitals with 83 patients and VR markers were measured before and after an HD session: QT, QTc, QT minimum, QT maximum, dispersion of QT (QTd), T-peak to T-end (Tp-e) interval, and Tp-e/QT. Kt/V measurements calculated using the second generation Daugirdas formula were used to indicate dialysis adequacy. The patients were divided into 2 groups according to the Kt/V value. Group 1 patients had a Kt/V of ?1.6 with a standard dialysis dose, and Group 2 comprised those with a measurement of >1.6 with a high dialysis dose. Results: There were 36 patients in Group 1 and 47 patients in Group 2. There were statistically significantly more female patients in Group 2 (p=0.016). After an HD session, heart rate increased, blood pressure decreased, and the QT, QTc, QT maximum, QTd, Tp-e interval, and Tp-e/QT were prolonged (p

Anemia in patients with chronic kidney disease (CKD) is the result of reduced erythropoietin, disturbed erythropoiesis and decreased lifespan of circulating erythrocytes. Excessive eryptosis or premature suicidal erythrocyte death is characterized by cell shrinkage and phosphatidylserine externalization. This study aimed to explore accelerated eryptosis and accompanying biochemical alterations in CKD patients.A total of 106 CKD patients (59 predialysis [PreD] patients, 26 haemodialysis [HD] patients and 21 peritoneal dialysis [PD] patients) and a control group composed of 29 healthy volunteers were included in this study. Data on superoxide dismutase (SOD) activity (U/mL), annexin-V binding (mean fluorescent intensity, MFI) and intracellular calcium ([CaThe [CaIn conclusion, our findings revealed the presence accelerated eryptosis, as a potential contributing factor to development of anemia, in patients with CKD stages 3-5D. Inflamation and parathormon can also accelerate eryptosis. Favorable effect of CCB and EPO on eryptosis needs to be confirmed in larger scale studies.

Background and Aims One of the many factors in the pathogenesis of renal anaemia, is eryptosis. The aim of this study is to evaluate eryptosis in patients with chronic renal disease stage 3-5 and 5 dialysis (5D). Method Patients with CKD who were monitored in our nephrology department were included in the study. The age range of the patient groups was 18-80 years and haemoglobin levels were Results The amount of intracellular calcium were 3.05 ± 1.66 in predialysis group, 2.24 ± 0.99 in haemodialysis group, 2.38 ± 0.87 in peritoneal dialysis group and 1.71 ± 0.46 in control group. For intracellular calcium there was statistically significant difference only between predialysis group and control group (p Conclusion We determined increased eryptosis in patients with CKD stage 3-5 and 5D in our study. Inflammation and elevated parathormone were also associated with increased eryptosis. Therefore, eryptosis may be an important factor in the pathogenesis of renal anaemia. Inflammation associated CKD may increase eryptosis. In addition, this effect can be taken into consideration in the planning of treatment because of the lower incidence of eryptosis in patients using calcium channel blocker and EPO.

Background Drug dosing for Tacrolimus (TAC) and Mycophenolate Mofetil (MMF) after kidney transplantation remains challenging. Therapeutic drug monitoring (TDM) offers a means to individualize drug dosing and improve outcomes. Methods In this observational study, patients having mycophenolic acid (MPA) exposure assessed by limited sampling strategy (LSS) within the first 6 months were included and followed for 1 year. Results A total of 113 clinical events occurring in 110 patients were classified into 3 groups: Group 1 Stable (n = 34), Group 2 Over drug exposed (n = 64) having infections or drug toxicity and Group 3 Under drug exposed (n = 15) developing rejection or de novo donor-specific alloantibodies. Although TAC levels, MMF dose, MPA, and MPA Glucuronide (MPAG) exposure, expressed as area under curve (AUC), individually failed to predict outcomes, a scoring model incorporating all 3 drug levels TAC TDM × (MPA AUC + MPAG/10 AUC) correctly classified outcomes. A score over 1071 had a sensitivity and specificity of 0.94 (95% CI 0.56-0.83) and 0.84 (95% CI 0.69-0.89) for over exposure. A score below 625 had a sensitivity and specificity of 0.76 (95% CI 0.53-0.93) and 0.80 (95% CI 0.41-0.70) for under exposure. Conclusions This integrated model of assessing TAC and MMF exposure may facilitate individualized therapy.

Abdominal aort anevrizması, aortik plaklardaki inflamatuar hücrele- rin retroperitoneal bölgeye kaçağına bağlı olarak nadir olarak retro- peritoneal fibrozise neden olabilir. Biz de abdominal aort anevrizma- sı ve buna sekonder retroperitoneal fibrozisi hipertansiyon ve akut böbrek yetmezliği ile prezente olan hastayı sunmayı amaçladık Abdominal aortic aneurysm can rarely cause retroperitoneal fibrosis secondary to the leakage of inflammatory cells from aortic plaques to the retroperitoneal area. In this study, we present a case with severe hy- pertension and acute renal failure secondary to retroperitoneal fibrosis related to abdominal aortic aneurysm

Although metformin is a well tolerated anti-hyperglycemic drug it may cause lactic acidosis which has high mortality. In this paper we reported a renal transplant patient with lactic acidosis. Fifty-five year old renal transplant patient was admitted to our hospital with confusion and lactic acidosis. Her confusion improved dramatically after restoring blood glucose, supportive therapy and hemodialysis. Her obstructive ureteral stone was removed with ureteral catheterization. In follow up period her renal function was similar to baseline. In summary rapid diagnosis and also appropriate treatment including hemodialysis can prevent morbidity/ mortality in a patient with metformin associated lactic acidosis. Metformin users, especially renal transplant receivers who have high risk of acute renal failure, should be educated about the discontinuation of the drug when their urine volume decreased., Metformin iyi tolere edilen bir anti-hiperglisemik ilaç olmasına rağmen tedavisi sırasında mortalitesi yüksek laktik asidoza neden olabilir. Burada laktik asidoz ve böbrek yetersizliği gelişen bir böbrek nakil hastası rapor edilmiştir. Ellibeş yaşında böbrek nakil hastası hastanemize şuur bozukluğu, hipoglisemi ve laktik asidoz ile getirildi. Hastada postrenal akut böbrek yetersizliği saptandı. Hipoglisemi ve destek tedavisini takiben hemodiyaliz sonrası hastanın konfüzyonu dramatik olarak düzeldi. Üreteral taşın çıkarılmasından sonra böbrek fonksiyonları önceki değerlerde normal seyretti. Metformine bağlı gelişen laktik asidozda erken tanı ve geciktirilmeden hemodiyaliz dahil destek tedavisi ile morbidite ve mortaliteyi önleyebilir. Ayrıca, akut böbrek yetersizliği gelisme riski yüksek transplant hastaları dahil Metformin kullanan hastaların idrar azalması durumunda metformine ara vermesi konusunda eğitilmesi önemli olabilir.

PubMedID: 22010990 [No abstract available]