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Background/aim: The aim of this study is to analyze and compare the predictive values of the Geriatric Nutritional Risk Index (GNRI) and Creatinine Index (CI) in the short-term mortality of maintenance hemodialysis patients and to determine their best cut-offs. Material and Methods: A total of 169 adult hemodialysis patients were included in this retrospective, cross-sectional, and single-center study. The demographic, clinical, and laboratory data of the month in which the patients were included in the study were obtained from their medical files and computer records. All-cause death was the primary outcome of the study during a 12-month follow-up after baseline GNRI and CI calculations. Results: The mean age of the study population was 57 ± 16 years (49.7% were women, 15% were diabetic). During the one-year observation period, 19 (11.24%) of the cases died (8 CV deaths). The optimal cut-off value for GNRI was determined as 104.2 by ROC analysis [AUC = 0.682 ± 0.06, (95% CI, 0.549-0.815), p = 0.01]. The low GNRI group had a higher risk for all-cause and CV mortality compared to the higher GNRI group (p = 0.02 for both in log-rank test). The optimal sex-specific cut-off was 12.18 mg/kg/day for men [AUC = 0.723 ± 0.07, (95% CI, 0.574-0.875), p = 0.03] and was 12.08 mg/kg/day for females [AUC = 0.649 ± 0.13, (95% CI, 0.384-0.914), p = 0.01]. Patients with lower sex-specific CI values had higher all-cause and CV mortality (p = 0.001 and p = 0.009 in log-rank test, respectively). In multivariate cox models, both GNRI [HR = 4.904 (% 95 CI, 1.77-13.56), p = 0.002] and sex-specific CI [HR = 5.1 (95% CI, 1.38-18.9), p = 0.01] predicted all-cause mortality. The association of GNRI with CV was lost [HR = 2.6 (CI 95%, 0.54-13.455), p = 0.22], but low CI had a very strong association with CV mortality [HR = 11.48 (CI 95%, 1.25 -104), p = 0.03]. Conclusion: In hemodialysis patients, GNRI and CI have similar powers in predicting all-cause short-term mortality. The association of CI with all-cause death depends on gender. On the other hand, sex-specific CI predicts CV mortality better than GNRI. [ABSTRACT FROM AUTHOR]

Background/aim: Depression and anxiety are prevalent symptoms in kidney transplant patients. We aimed to evaluate the frequency and the severity of depression and anxiety symptoms in kidney transplant recipients using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). The data were compared between the patients on CNI-based and mTORi-based maintenance immunosuppressive regimens. Materials and methods: A total of 94 kidney transplant patients were enrolled in the study after exclusion of the patients already taking neuropsychiatric medications or unwilling to participate in the study. Participants were asked to self-report the inventories. Results: Analysis of data showed that 62 (66%) recipients had BDI scores that indicated depression. The patients on CNI-based regimens (n = 74) had increased total BDI scores compared those on mTORi-based regimens [18 (8.75-28) vs. 6 (5.25-14.25), respectively, P < 0.001]. Regarding BAI scores, 79 patients (84%) had prominent anxiety symptoms. The patients on CNI-based regimens had significantly increased total BAI scores compared to those on mTORi-based regimens [21 (13-30.50) vs. 10.50 (8.25-14.75), respectively, P < 0.001]. Conclusion: Our results identified fewer side effects of mTORi-based maintenance immunosuppressive regimens regarding depression and anxiety symptoms compared to CNI-based regimens in kidney transplant patients. [ABSTRACT FROM AUTHOR]

A 65-year-old man was admitted to the emergency department with the complaints of general discomfort, nausea, vomiting, abdominal pain, dysuria and shortness of breath. Type II diabetes mellitus, essential hypertension, atrial fibrillation and chronic obstructive pulmonary disease were noted in his medical history. He was using metformin, warfarin and diltiazem besides inhaler medications. Laboratory test results were as follows: BUN 52 mg/dl, creatinine 2.9 mg/dl (one month ago it was 0.9 mg/dl), potassium 6.3 mmol/L, PT-INR 17.78, arterial blood pH 7.05, bicarbonate 5.3 mmol/L, partial carbon dioxide pressure 19 mmHg, and lactate level 175 mg/dl. The urine examination revealed pyuria and urinary density was 1028. The patient was considered to suffer from acute kidney injury, urinary tract infection and metformin-associated lactic acidosis (MALA). Metformin was withdrawn immediately and acute hemodialysis was planned. However, a central venous catheter could not be inserted because of high PT-INR values. Parenteral 0.9% NaCl, glucose - insulin solution infusions, sodium bicarbonate infusion as well as empirical intravenous ceftriaxone treatments were started. He dramatically responded to medical therapy and did not require any dialysis support. In the literature, hemodialysis has been proposed as the initial treatment modality of MALA. However, herein, we presented a favorable outcome without utilizing hemodialysis. [ABSTRACT FROM AUTHOR]

Introduction: Acute kidney injury (AKI) is an important lifethreatening complication in patients hospitalized in intensive care units (ICU). This study was conducted to determine the incidence of AKI in the medical intensive care unit of a tertiary university hospital and to compare the predictive performance of three different AKI criteria (RIFLE, AKIN, and KDIGO) for in-hospital mortality.Methods: The data of all consecutive patients were evaluated from their hospitalization to ICU until discharge or death, retrospectively. Patients with end-stage renal disease, history of kidney transplantation, those who stayed in the ICU for less than 72 hours, who underwent dialysis before admission to the ICU, and those with incomplete medical records were excluded. AKI was defined using serum creatinine criteria of RIFLE, AKIN, and KDIGO.Results: 303 patients were included in this study. According to RIFLE, AKIN, and KDIGO criteria the incidence of AKI were 47.9 %, 44.6%, and 50.2%; respectively. In-hospital mortality rates were higher in AKI patients (P < .05 according to all three criteria). Regression analysis revealed that AKI was a predictor of in-hospital mortality (P < .05, for all). The ROC analyses showed that each of these criteria had similar abilities to predict in-hospital mortality (area under (Au) ROC for RIFLE = 0.76, AuROC for AKIN = 0.72, and AuROC for KDIGO = 0.76).Conclusion: The incidence of AKI was higher with KDIGO criteria. In-hospital mortality rates were higher in patients with AKI. Each criteria had similar abilities to predict in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background and Aims: Contrast-induced nephropathy (CIN) has a growing incidence in which renal vasoconstriction and medullary hypoxia are important mechanisms. Therapeutic approaches are very restricted and there is a considerable interest in advancing preventive strategies. Adrenomedullin is a relatively novel peptide having antioxidant, vasoactive and vasodilatory properties. We aimed to investigate whether adrenomedullin might have a preventive role against the development of experimental CIN., Methods: Wistar albino rats (n=24) were allocated randomly into four equal groups of 6 each; Control (C), Adrenomedullin (A), Contrast Media (CM) and Adrenomedullin plus Contrast Media (ACM). All rats were deprived of water from day 1 to day 4 during 72 hours. Then, intravenous administrations of chemicals were performed. Adrenomedullin was given at dose of 12&micro;g/kg to groups A and ACM. A single dose of high-osmolar contrast media; diatrizoate (Urografin 76%, Schering AG, Germany) was injected to groups CM and ACM at dose of 10mL/kg. On day 1 and 6 blood samples were drawn for renal function tests and inflammatory markers including TNF-&alpha; IL-1&beta;, IL-6 and IL-18. After sacrification, kidney histologies were examined with hematoxylin-eosin staining., Results: Compared to CM group, serum cystatin-C levels on 6th day were found significantly lower in ACM group (p&lt;0.05). Additionally, daily protein excretion rates, absolute changes in daily urine output and creatinine clearance values were significantly lower in ACM group than those in CM group (p&lt;0.05). In histopathological evaluation, regarding the degree of tubular damage and medullary congestion scores, ACM group had slightly better scores compared to CM group; however the differences did not reach significance as shown in inflammatory markers., Conclusion: This study demonstrated a beneficial impact of adrenomedullin on deteriorated renal function tests in an experimental CIN model. Adrenomedullin might be a candidate agent for prophylaxis of CIN. However, further studies are needed to shed more light on this issue.

We reported here a case of bilateral chylothorax as a result of widespread thrombi formation in a patient who was heterozygote for factor V leiden gene mutation and who had antithrombin III deficiency. We performed bilateral chest tubes, thrombolytic and oral anticoagulant therapy. The patient responded to the therapy. She has been in follow up without symptoms for 18 months.