Effect of fluid and sodium removal on mortality in peritoneal dialysis patients.
Adequacy of peritoneal dialysis (PD) traditionally is assessed using Kt/Vurea and total creatinine clearance (TCC). ...However, this approach underestimates the importance of fluid and sodium removal. The aim of this study was to determine the effect of fluid and sodium removal on morbidity and mortality in PD patients.
One hundred twenty-five PD patients were monitored for three years from the beginning of the treatment. The effects of demographic features, comorbidity, peritonitis rate, blood pressure, medications, blood biochemistry, peritoneal membrane transport characteristics, residual renal function (RRF), Kt/Vurea, TCC, normalized protein nitrogen appearance (nPNA), and removal of sodium and fluid on mortality were evaluated. Total and cardiovascular hospitalization rates were also recorded. A Cox proportional hazards model was used to determine factors predicting mortality.
In the Cox model, comorbidity, total sodium and fluid removals, hypertensive status, serum creatinine, and RRF were independent factors affecting survival. In contrast, Kt/Vurea or TCC did not affect the adjusted survivals. Total sodium and fluid removal and hypertensive status also significantly influenced the hospitalization rate. Systolic and diastolic blood pressures were negatively correlated with total fluid (P < 0.001) and sodium removal (P < 0.001).
Together, these findings suggest that removal of sodium and fluid is a predictor of mortality in PD patients, whereas Kt/Vurea and TCC are not factors. Adequate fluid and sodium balance is crucial for the management of patients on PD.
Dyslipidemias, primarily hypercholesterolemia, are independent and strong predictors of cardiovascular (CV) events. The frequency of dyslipidemia is very important in terms of determining CV ...prevention policies. In order to determine the up-to-date frequency of CV risk factors in Turkey, a meta-analysis of the epidemiologic studies carried out in the last 15 years was performed. This article presents the results on the dyslipidemia data including hypercholesterolemia principally.
Epidemiological studies conducted during the last 15 years and having the potential to represent the general population in Turkey were searched in databases (Ovid Medline, Web of Science Core Collection, and Turkish Academic Network and Information Center ULAKBIM) and web pages (Ministry of Health, Turkey Statistical Institute, Turkish Society of Cardiology, Nephrology and Endocrinology Associations). A total of 7 studies including lipid data were found. Systematic review and meta-analysis of the studies with low bias score were performed. Crude values of the prevalence of hypercholeterolemia, hypertriglyceridemia and low HDL and mean lipid levels were calculated. Random effects model was used in meta-analysis.
The prevalence of hypercholesterolemia defined as a LDLcholesterol >130 and/or ≥130 mg/dL, was 29.1% (95% CI 23.6-35.0) in the general population, 30.2% in females (%95 CI 24.7-36.1), and 27.8% in males (95% CI 22.3-33.6). The prevalence of low HDLcholesterol (≤50 mg/dL for females and ≤40 mg/dL for males) was calculated as 46.1% (95% CI 42.4-49.9) in the whole group, 50.7% (95% CI 47.7-53.6) in females and 41.1% (95% CI 36.1-46.3) in males. The prevalence of hypertriglyceridemia (>150 mg/dL) was 36.5% (95% CI 30.6-42.5) in general, 32.0% (95% GA 26.6-37.8) in females and 41.3% (95% CI 34.9-47.8) in males.
Dyslipidemia constitutes a major public health problem in Turkey. In the adult population, almost 3 of 10 have hypercholesterolemia, one of 2 has a low HDL-cholesterol, and 1 of 3 has high triglycerides levels.
Background
We aimed to evaluate the perceptions of nephrologists about peritoneal dialysis (PD) in Turkey.
Materials and Methods
An anonymous survey was conducted to a total of 150 nephrologists. ...Demographic data, perceptions, PD indications, contraindications, and possible reasons for low preference of PD were questioned.
Results
In decision making, 93.4% of all stated that patients prioritized the doctor's opinion and 80.7% considered PD is the best initial dialysis option. The presence of many HD facilities (70.7%), inadequate knowledge, and education of patients (70%), physicians' reluctance to practice PD (70%), unwillingness of patients (68.7%), negative effect of other patients (67.3%), inadequate experience of PD staff (58.7%), and nonencouragement of PD by the state (58.7%) were the leading reasons of low prevalence.
Conclusion
Implementation of comprehensive predialysis education programs for patients, informing government and hospital officials about PD advantages, and reinforcing PD principles to the nephrologists could improve the low prevalence of PD in Turkey.
Chronic kidney disease (CKD) is a growing health problem worldwide that leads to end-stage kidney failure and cardiovascular complications. We aimed to determine the prevalence of CKD in Turkey, and ...to evaluate relationships between CKD and cardiovascular risk factors in a population-based survey.
Medical data were collected through home visits and interviews. Serum creatinine, blood glucose, total cholesterol, triglycerides, HDL, LDL and uric acid were determined from 12-h fasting blood samples, and spot urine tests were performed for subjects who gave consent to laboratory evaluation.
A total of 10 872 participants were included in the study. The final analysis was performed on 10 748 subjects (mean age 40.5 ± 16.3 years; 55.7% women) and excluded 124 pregnant women. A low glomerular filtration rate (GFR) (< 60 mL/min/1.73 m(2)) was present in 5.2% of the subjects who were evaluated for GFR, while microalbuminuria and macroalbuminuria were observed in 10.2% and 2% of the subjects, respectively. The presence of CKD was assessed in subjects who gave consent for urinary albumin excretion measurement (n = 8765). The overall prevalence of CKD was 15.7%; it was higher in women than men (18.4% vs. 12.8%, P < 0.001) and increased with increasing age of the subjects. The prevalence of hypertension (32.7% in the general population), diabetes (12.7%), dyslipidaemia (76.3%), obesity (20.1%) and metabolic syndrome (31.3%) was significantly higher in subjects with CKD than subjects without CKD (P < 0.001 for all).
The prevalence of CKD in Turkey is 15.7%. Cardiovascular risk factors were significantly more prevalent in CKD patients.
Abstract
Background and Aims
There is a hesitation in returning peritoneal dialysis (PD) after kidney transplant (KTx) failure. Studies in larger multicentre matched cohorts are missing.
Method
We ...conducted a retrospective study about 19 patients who started PD after KTx failure (PDpostTx group) between January 2010 and August 2022 in Ankara University School of Medicine who were compared with 70 never-transplanted patients having started PD during the same period (PDnoTx group). Patients’ clinical data and PD technique survival as well as peritonitis episodes were analysed.
Results
Mean age was 51 years and continuous ambulatory PD was the treatment of choice (59.6%) (Table 1). Even the mean time on PD was similar between groups (45.4 months in PDpostTx vs 51.7 months in PDnoTx, p = 0.525), transfer to HD was more common in PDpostTx patients (36.8% vs 10.0%, p = 0.015). The main cause of transfer to HD was ultrafiltration failure, which was significantly higher in PDpostTx group (p = 0.002). Diuresis at baseline was similar between groups, but decreased significantly in PDpostTx group at first year and final follow-up (p < 0.001, and p = 0.001, respectively). Peritonitis was more common in PDpostTx group (68.4% vs 30.0%, p = 0.002). Diabetes mellitus was a risk factor for peritonitis episode (p = 0.012), but we didn’t observe any effect of immunosuppressive therapy on peritonitis and reduction of the diuresis. In multivariate analysis, KTx failure (p = 0.014), peritonitis episodes (p = 0.011) and ultrafiltration failure (p < 0.001) were associated with a higher risk of transfer to HD. Over the study period, patients’ survival was similar between groups (p = 0.766).
Conclusion
We reported similar patient survival, but higher peritonitis rates and PD technique failure in the PDpostTx group, when compared to patients who started PD for other reasons. Considering these findings, taking precautions against peritonitis is more important for patients who started PD after KTx failure.
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