Purpose
Decreased quality of life, anxiety, depression, and other negative psychosocial factors in autosomal dominant polycystic kidney disease (ADPKD) may lead to the patient’s attitudes that reduce ...treatment effectiveness. We aimed to evaluate the relationship between the depression, anxiety, perceived social support, genetic psychosocial risk and quality of life levels, and chronic kidney disease (CKD) stage in ADPKD and to investigate the relationship between these variables/parameters and the dietary compliance that is an essential factor in the course of the disease.
Methods
100 ADPKD patients were enrolled in this cross-sectional study. EuroQol-5D-3L (EQ-5D-3L) health-related quality of life ındex, EuroQol-5D-3L visual analog scale (EQ-5D-3L VAS), multidimensional scale of perceived social support (MSPSS), patient health questionnaire (PHQ)-9, and genetic psychosocial risk ınstrument (GPRI) were applied to the patients.
Results
There is a relationship with negative regression coefficient between the CKD stage and the total scores of the EQ-5D-3L and EQ-5D-3L VAS scales (
p
< 0.000 and
β
= − 5.355,
p
< 0.000, and
β
= − 8.394, respectively). There is a relationship with positive regression coefficient between the CKD stage and MSPSS total score and level (
p
< 0.000 and
β
= 0.364,
p
< 0.000 and
β
= 0.331, respectively). There is no relationship between the CKD stage and GPRI total score (
p
= 0.800). In addition, there is a relationship with positive regression coefficient between the dietary compliance and EQ-5D and EQ-5D VAS total scores (
p
= 0.006 and
β
= 2.687,
p
= 0.004 and
β
= 3.148, respectively). There is a relationship with negative regression coefficient between the dietary adherence and PHQ-9 total score and CKD stage (
p
= 0.003,
p
= 0.006, and
β
= − 0.692, respectively).
Conclusion
As the CKD stage increases in the ADPKD patients, the quality of life decreases, whereas the level of anxiety and depression increases. It has been seen that the ADPKD patients with more depressive complaints have less dietary compliance. In this particular patient group, the early detection and treatment of psychosocial difficulties and the work to improve the quality of life that affect the course of the ADPKD may be as important as the medical treatment. To determine the needs of ADPKD patients with multiple physical and psychosocial difficulties and to perform appropriate interventions, we think that there is a necessity for a specific scale that evaluates these effective components together in the ADPKD process.
Antibody-mediated rejections (AMRs) are critical clinical issues encountered in short- and long-term follow-up of kidney transplant patients. Whereas plasmapheresis is a mainstay treatment option in ...acute AMR cases, there is a paucity of data regarding its efficacy in management of chronic AMR. This report describes our experience addressing this issue.
We retrospectively investigated the data of 7 kidney transplant patients diagnosed with chronic AMR who were on 5 sessions of plasmapheresis (1 to 2 volume exchanges with fresh frozen plasma) on alternate days and 200 mg/kg of intravenous immunoglobulin after each session of plasmapheresis.
At 6 months after the initiation of treatment, 6 patients experienced partially improved kidney function. One patient had no response and her kidney function progressively deteriorated.
Our preliminary results are encouraging for the combination of plasmapheresis and intravenous immunoglobulin as an adjunctive therapy for kidney transplant patients suffering from chronic AMR.
Amaç: Son dönem böbrek yetmezliği olan hastalarda primer hastalığa veya diyaliz tedavisine sekonder olarak mukokutanöz lezyonlar oldukça sık gözlenmektedir. Bu çalışmanın amacı, son dönem böbrek ...yetmezliği olup hemodiyaliz ve periton diyalizi alan hastaların dermatolojik bulgularını prevalansını saptamak ve 2 grup arası farkları karşılaştırmaktır.
Yöntemler: Çalışmaya 49 hemodiyaliz (HD), 18 periton diyalizi (PD) alan 67 hasta kabul edildi. Yaş aralığı 20-90 arası idi. Hastaların medikal anamnezleri kaydedildi ve uygun ışık altında detaylı deri, saç, tırnak ve mukoza muayeneleri yapıldı ve bulgular kayıt altına alındı. Lüzum halinde lezyonlardan mikrobiyolojik ve histopatolojik ek incelemeler yapıldı.
Bulgular: HD ve PD alan 2 grupta en sık gözlenen deri bulgusu kserosisdi. Ekimoz, HD alan grupta PD alan gruba göre anlamlı yüksek saptandı. Müköz bulgu olarak en sık HD grubunda paslı dil, PD grubunda kserostomi gözlendi. Her 2 grupta en sık görülen tırnak bulgusu yarım ve yarım tırnak idi. Splinter hemoraji HD grubunda, PD grubuna göre anlamlı yüksek saptandı. Hemodiyaliz grubunda saç bulgusu alt ekstremite kıl kaybı oranı periton diyaliz grubundan anlamlı olarak daha yüksekti. PD alan grupta en sık kafa derisinde kıl kaybı saptandı.
Sonuç: Çalışmaya dahil edilen hastaların tümü en az bir dermatolojik bulgu göstermekte idi. HD ve PD alan 2 grupta mukokutanöz bulgular açısından minör farklılıklar saptandı.
The development of sexual dysfunction (SD) in dialysis patients is multifactorial. We aimed to evaluate whether adequate dialysis had an effect on the development of SD in male and female patients ...undergoing dialysis due to end stage renal disease. Anxiety, depression, health-related quality of life and the other risk factors related to dialysis were also evaluated in terms of SD.
Seventy men and 57 women undergoing haemodialysis (HD) or peritoneal dialysis (PD) and 65 healthy male volunteers and 48 healthy female volunteers, age-matched, were included in the study. The International Index of Erectile Function, Female Sexual Function Index, Beck Depression Inventory, Beck Anxiety Inventory and The Short Form-36 Health Survey were applied to all participants. The cut off value of Kt/V was determined as 1.3 for HD and 1.7 for PD to assess dialysis adequacy. Per gender, all the participants were divided into three groups as control, adequate dialysis and non-adequate dialysis.
Dialysis adequacy OR: 3.225, 95%CI (1.213-8.620), p=.019 was found as a more decisive factor for male SD, while dialysis adequacy OR: 3.015, 95%CI (.991-7.250), p=.041 and depression OR: 4.280, 95%CI (1.705-10.747), p=.002 were more significant for female SD. In addition, a strong relationship was found between male SD and physical functioning (r: .524, p=.032), social functioning (r: .565, p=.042), general health (r: .693, p=.037) perception, while female SD was found to be strongly associated with anxiety (r: -.697, p=.002) and depression (r: -.738, p=.001).
Dialysis adequacy was found to be the most important factor in reducing SD. Non-adequate dialysis resulted in worse sexual function, higher levels of depression and anxiety. Its negative effect on health-related quality of life was only seen in men.
Background/aim:
Hemodialysis is the most used renal replacement therapy option for patients with end-stage renal disease. Arteriovenous fistulas (AVFs) and tunnel-cuffed venous catheters (tCVC) are ...commonly used vascular access routes and have advantages and disadvantages compared to each other. This study focuses on the effects of AVFs and tCVCs on morbidity and mortality in hemodialysis patients.
Methods:
The records (between January 2015 and January 2017) of 110 patients (55 patients with AVF and 55 patients with tCVC) under hemodialysis therapy for at least 6 months were evaluated retrospectively. The data about blood tests, hospitalizations, and mortality were compared between patients with AVF and tCVC.
Findings:
Fifty-five patients (25 male, 58 ± 14 years old) were undergoing hemodialysis via AVF. Fifty-five patients (17 male, 63 ± 14 years old) were undergoing hemodialysis via tunneled CVCs. Thirty (54.5%) of the hospitalization patients had AVF and 46 (83.6%) had CVCs (p < 0.01). The only independent predictor of hospitalization was the use of tCVC as vascular access, according to multivariate regression analysis (p = 0.01). Seven (30%) of the dead patients had AVF and 16 (69.6%) had CVCs (p = 0.035). Use of tCVC appeared to be a mortality predictor in univariate regression analysis (p = 0.039). But the significance did not continue in multivariate model (p = 0.578) in which the duration of hemodialysis appeared as the only significant factor (p = 0.002).
Conclusion:
Patients undergoing hemodialysis via AVF had fewer all-cause hospitalizations and mortality rate than those using tunneled CVCs.
Background To evaluate changes in ocular biometric parameters after hemodialysis (HD) in patients with end-stage renal disease (ESRD). Methods Forty eyes of 40 patients undergoing HD were included in ...this cross-sectional study. Keratometry (K) readings, white-to-white (WTW) distance, central corneal thickness (CCT), anterior chamber depth (ACD), pupil diameter, lens thickness (LT), axial length (AL), and intraocular lens (IOL) power calculation were measured with Lenstar LS 900 (Haag Streit AG, Koeniz, Switzerland) before and after hemodialysis. Intraocular pressure (IOP) was measured with a non-contact tonometer (Tonopachy NT-530P, Nidek Co., LTD, Tokyo, Japan). Main outcomes were changes in biometric parameters after HD. Reliability of the measurements (intraclass correlation coefficients (ICCs)) and the effect size (Cohen's d) were also calculated. Results Mean difference in AL before and after HD was −0.041 ± 0.022 mm with ICCs > 0.90 (p < 0.001 and Cohen's d = 0.06). Pupil diameter was also significantly different before (4.28 ± 0.81 mm) and after (4.44 ± 0.79 mm) HD with ICCs > 0.90 (p = 0.041 and Cohen's d = 0.20). Hemodialysis had no significant effect on K readings, WTW distance, CCT, ACD, LT, or IOP. Conclusion Axial length and pupil diameter increase after HD with small effect size, while HD does not significantly affect IOL power calculations.
Introduction
The transmission risk of Severe Acute Respiratory Syndrome Coronavirus‐2 virus infection is increased in maintenance hemodialysis (MHD) patients, and also the disease causes much higher ...mortality than the normal population. The aim of this study is to define the predictive value of neutrophil‐to‐lymphocyte ratio (NLR) in terms of worse outcomes in MHD patients.
Methods
A total of 123 MHD patients who had received inpatient care due to COVID‐19 infection were included in this multicentered retrospective study. Receiver operating curve analysis were plotted to illustrate C reactive protein (C‐rp), systemic inflammatory index (SII) and NLR best cut‐off values for estimation of need for intensive care unit (ICU) and mortality. Multivariate regression analysis and Cox proportional hazard models were constructed to determine the association between C‐rp, SII and NLR and mortality.
Results
Twenty‐eight (23%) patients with MHD were dead due to COVID‐19. Nonsurvivor patients was significantly older than the survivors (p < 0.001) and also had higher rates of diabetes mellitus (p = 0.01) and coronary artery disease (p = 0.02). Cox regression analysis revealed that NLR >5.17 significantly associated with mortality HR: 6.508, p < 0.001. Similarly, SII > 726 HR: 3.124, p = 0.006 and C‐rp > 88 HR: 4.590, p = 0.002 were significantly associated with mortality due to COVID‐19 in hospitalized MHD patients. Multivarite logistic regression analysis showed that age older than 60 years, higher ferritin, and NLR > 5.17 were independent factors associated with mortality.
Conclusion
NLR had favorable predictive value than the C‐rp and SII in terms of need for ICU and mortality in MHD patients. Determining the poor prognosis with simple and easily applicable markers may reduce mortality in these patients with early supportive treatments.
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