Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and ...determinants of mortality in a large group of MHD patients hospitalized for COVID-19.
This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis.
Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 57-74 vs. 63 52-71 years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 10
per mm
versus 192 × 10
per mm
, p = 0.011) and lymphocyte (800 per mm
versus 1000 per mm
, p < 0.001) counts and albumin levels (median, 3.2 g/dl versus 3.5 g/dl, p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 95% CI, 1.003-1.041, p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 95% CI, 2.168-17.863, p < 0.001), presence of congestive heart failure (HR: 2.247 95% CI, 1.228-4.111, p = 0.009), ferritin levels on admission (HR; 1.057 95% CI, 1.006-1.111, p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 95% CI, 2.143-7.132, p < 0.001) and low platelet count (< 150 × 10
per mm
) during hospitalization (HR; 1.864 95% CI, 1.025-3.390, p = 0.041) were risk factors for mortality.
Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.
The accumulation of arsenic (As) and physiological responses of Lemna minor L. under different concentration (0, 1, 4, 16 and 64 μM) and duration (1, 2, 4 and 6 days) of two species As, NaAsO₂ and ...Na₂HAsO₄·7H₂O, were studied in hydroponics. The accumulation of both As species depended on As concentration and exposure duration. The highest accumulation of As was found as 17408 and 8674 μg g⁻¹, for plants exposed to 64 μM of As(III) and As(V), respectively, after 6 days. Two-way ANOVA analyses indicated that, for plants exposed to arsenite (As(III)), exposure duration had a greater effect than concentration on As accumulation. Conversely, exposure concentration had a greater effect on As accumulation in plants exposed to arsenate (As(V)). Arsenic exposure levels, approaching 16 μM for As(III) and 64 μM for As(V), did not significantly affect EC values. Beyond these exposure concentrations, EC values increased in a manner that depended on duration. Significant effect of As(III) on lipid peroxidation was observed at 1 μM application whereas, this effect started to be significant after an exposure to 16 μM As(V). For both As(III) and As(V), photosynthetic pigment levels slightly increased for the first day with respect to the control, followed by a gradual decline at higher concentrations and durations. An increase in protein content and enzyme activity was observed at moderate exposure conditions, followed by a decrease. Significant positive correlations were determined between accumulated As and ion leakage and lipid peroxidation. Negative correlations were found between accumulated As and total chlorophyll and protein content. Our results suggested that exposure duration and concentration had a strong synergetic effect on antioxidant enzyme activity. The findings of the present study may be useful when this plant is used as a phytoremediator in arsenic-polluted water.
We aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19.
We conducted a multicenter, retrospective ...study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission.
One hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl 2.9-3.8 vs. 3.8 g/dl 3.5-4.1, p = 0.002), higher serum ferritin (679 μg/L 184-2260 vs. 331 μg/L 128-839, p = 0.048), and lower lymphocyte counts (700/μl 460-950 vs. 860 /μl 545-1385, p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis.
Over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.
Background
In our study, diagnostic and demographic characteristics of patients diagnosed with RPGN by biopsy, clinical and laboratory findings in our country were investigated.
Methods
Data were ...obtained from the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group database. Demographic characteristics, indications for biopsy, diagnosis of the glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were recorded. According to their types, RPGN patients were classified as type 1 (anti-GBM related), type 2 (immuncomplex related) and type 3 (pauci-immune).
Results
Of 3875 patients, 200 patients with RPGN (mean age 47.9 ± 16.7 years) were included in the study which constitutes 5.2% of the total glomerulonephritis database. Renal biopsy was performed in 147 (73.5%) patients due to nephritic syndrome. ANCA positivity was found in 121 (60.5%) patients. Type 1 RPGN was detected in 11 (5.5%), type 2 RPGN in 42 (21%) and type 3 RPGN in 147 (73.5%) patients. Median serum creatinine was 3.4 (1.9–5.7) mg/dl, glomerular filtration rate was 18 (10–37) ml/min/1.73m
2
and proteinuria 2100 (1229–3526) mg/day. The number of crescentic glomeruli ratio was ratio 52.7%. It was observed that urea and creatinine increased and calcium and hemoglobin decreased with increasing crescentic glomerular ratio.
Conclusions
Our data are generally compatible with the literature. Advanced chronic histopathological findings were prominent in the biopsy of 21 patients. Early biopsy should be performed to confirm the diagnosis of RPGN and to avoid unnecessary intensive immunosuppressive therapy. In addition to the treatments applied, detailed data, including patient and renal survival, are needed.
After a successful kidney transplantation, renal and endocrine functions quickly return to normal in many women and ovulation ensues. Woman with a renal transplant can have a successful pregnancy, ...however, there are many risks for both the mother and the fetus. For this reason, these patients should be carefully monitored with a multidisciplinary approach including a nephrologist and an obstetrician. Counseling about contraception and pregnancy after transplant should be initiated during the pretransplant evaluation process. The live birth rate appears comparable to the general population. Pregnancy timing depends on whether the graft function is optimal, but the general recommendation is to wait a year after transplantation. The recommended maintenance immunosuppressive therapy in pregnant women includes the use of calcineurin inhibitors (preferably tacrolimus), azathioprine, and low dose prednisone. Vaginal delivery should be preferred in kidney transplant patients. Cesarean section may be considered only when there is an absolute indication. Kidney transplant patients can breastfeed their children with appropriate drug combinations after birth; patients should be encouraged in this regard.
Background: The neutrophil-to-lymphocyte ratio (NLR) is a simple and inexpensive examination that is considered to show inflammation. In this study, which included a control group, the authors aimed ...to investigate if there was a relationship between glycaemic regulation parameters and NLR in patients with Type 2 diabetes mellitus.
Material and Methods: A total of 278 Type 2 diabetic patients were included in the study. An additional total of 148 healthy people were also included as a control group. NLR was calculated by dividing the absolute neutrophil number by the absolute lymphocyte number. The patients were divided into two groups: the good glycaemic control group (HbA1c ≤7.5%) and the poor glycaemic control group (HbA1c >7.5%). NLR was compared between the diabetic groups. In addition, NLR was compared with diabetic patients and control group.
Results: The NLR was statistically and significantly higher in the poor glycaemic control group compared to the good glycaemic control group (2.48 1.97–2.60 to 2.07 1.72–2.40, respectively; p=0.020). In addition, NLR was significantly higher in the patients than in the control group (2.30 2.04–2.49 to 2.01 1.85–2.18, respectively; p=0.002).
Conclusion: According to the authors’ knowledge, increased NLR may be associated with poor glycaemic control in Type 2 diabetic patients. NLR may be useful used as an easily measurable, noninvasive, available, and cost-effective parameter for the follow-up of diabetic patients.
Hypertension remains one of the most important medical problems in spite of significant medical advances. In many studies, both systolic and diastolic blood pressures have been found to be closely ...related with cardiovascular (CV) morbidity and mortality. The primary aim in the treatment of hypertension is to reduce CV disease risk and the related morbidity and mortality. Hypertension is one of the most common causes of death worldwide due to its high prevalence. Because it is thought that it will be an important public health problem in the future, as it is now, the need for developing new guidelines based on new studies emerges. Individualized treatment plans based on up-to-date guidelines would be the most appropriate approach for physicians. Herein, the current approach to the treatment of hypertension has been summarized in the light of recent guidelines.
The concentrations of metals (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn) in street sediment samples were determined by flame atomic absorption spectrometry (FAAS) using the modified BCR (the European ...Community Bureau of Reference) sequential extraction procedure. According to the BCR protocol for extracting the metals from the relevant target phases, 1.0
g of specimen of the sample was treated with 0.11
M acetic acid (exchangeable and bound to carbonates), 0.5
M hydroxylamine hydrochloride (bound to iron- and manganese-oxides), and 8.8
M hydrogen peroxide plus 1
M ammonium acetate (bound to sulphides and organics), sequentially. The residue was treated with aqua regia solution for recovery studies, although this step is not part of the BCR procedure. The mobility sequence based on the sum of the BCR sequential extraction stages was: Cd
≈
Zn (∼90%)
>
Pb (∼84%)
>
Cu (∼75%)
>
Mn (∼70%)
>
Co (∼57%)
>
Ni (∼43%)
>
Cr (∼40%)
>
Fe (∼17%). Enrichment factors as the criteria for examining the impact of the anthropogenic emission sources of heavy metals were calculated, and it was observed that the highest enriched elements were Cd, Pb, and Zn in the dust samples, average 190, 111, and 20, respectively. Correlation analysis (CA) and principal component analysis (PCA) were applied to the data matrix to evaluate the analytical results and to identify the possible pollution sources of metals. PCA revealed that the sampling area was mainly influenced from three pollution sources, namely; traffic, industrial, and natural sources. The results show that chemical sequential extraction is a precious operational tool. Validation of the analytical results was checked by both recovery studies and analysis of the standard reference material (NIST SRM 2711 Montana Soil).
Background
Asymmetric dimethylarginine (ADMA) is accepted as a risk factor for coronary artery disease because it causes endothelial dysfunction and vasospasm. In this study we aimed to investigate ...the relationship between ADMA levels and echocardiographic and metabolic parameters in peritoneal dialysis (PD) patients.
Methods
This is a cross-sectional study in which PD patients aged 18–80, with at least 3-month duration of dialysis and without active cardiac, infectious or malignant diseases, and clinically evident hypervolemia, were included. ADMA levels and echocardiographic parameters were recorded.
Results
Of the 55 patients included, the mean age was 53 ± 15 years. Mean ADMA level was 81.9 ± 48.0 μmol/l. The variables found to be positively correlated with ADMA levels were weight, body surface area, body mass index (BMI), serum glucose level, uric acid and sodium levels, ultrafiltration volume, left atrium diameter, intraventricular end-systolic diameter and intraventricular end-diastolic diameter. The parathyroid hormone, dialysate
K
t
/
V
and ejection fraction were negatively correlated with ADMA levels. ADMA levels were higher in patients with hypertension. With multivariate analysis, gender, BMI and use of acetyl salicylic acid were found to be the independent variables determining ADMA levels.
Conclusion
The correlation of ADMA with BMI, gender, hypertension, left atrium diameter, intraventricular end-systolic diameter and intraventricular end-diastolic diameter led to the idea that ADMA may aid in the determination of cardiovascular disease risk in PD patients.
Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with ...in-hospital outcomes among hospitalized patients with COVID-19 and AKI. In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio HR 95% confidence interval (95%CI): 1.01 1.0-1.03, p = 0.035, male gender (HR 95%CI: 1.47 1.04-2.09, p = 0.029), diabetes mellitus (HR 95%CI: 1.51 1.06-2.17, p = 0.022) and cerebrovascular disease (HR 95%CI: 1.82 1.08-3.07, p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR 95%CI: 1.55 1.05-2.30, p = 0.027) and AKI stage 2 (HR 95%CI: 1.98 1.25-3.14, p = 0.003) and stage 3 (HR 95%CI: 2.25 1.44-3.51, p = 0.0001) were independent predictors of in-hospital mortality. Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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