Aims: This study aimed to screen for Fabry disease in adult kidney transplant patients at a nephrology clinic in Turkiye. Methods: This cross-sectional, single-center study prospectively enrolled ...kidney transplant recipients regardless of the etiology of renal failure. a-galactosidase A (a-GLA) enzyme activity and a-GLA gene analysis were used to screen for Fabry disease. The screening was initiated by measuring enzyme activity in males, and those with <2.5 nmol/mL/hour activity underwent gene analysis. Females were screened directly by gene analysis, independent of the enzyme activity. Results: We screened 125 patients (age: 48.9 + or - 10.1, male: 70.4%). Gene analysis was performed on a 68-year-old male patient with enzyme activity at the lower end of the reference range. No mutations associated with Fabry disease were detected. The enzyme activity test was considered false positive. A heterozygous c.937G>T (p. D313Y) mutation was detected in the gene analysis of a 29-year-old female patient. However, systemic evaluation did not reveal any clinical findings consistent with Fabry disease. Screening tests were within normal limits in other patients. Although there were abnormal screening findings in 2 patients, none was diagnosed with Fabry disease. Conclusions: Screening studies for Fabry disease in kidney transplant patients may contribute to the determination of the true prevalence. Keywords: Kidney transplant patients, Fabry disease, screening
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.
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.
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.
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.
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.
Aim: The current data have proven the pivotal role of inflammation in the development of atherosclerosis and cardiovascular diseases in patients with chronic kidney disease (CKD). Neutrophil to ...lymphocyte (N/L) ratio has increasingly been reported as a measure of systemic inflammation. This study assessed N/L ratio and investigated its associations with standard inflammatory biomarkers in different stages of CKD patients. Material and methods: This cross-sectional study included 30 predialysis, 40 hemodialysis, 35 peritoneal dialysis patients, and 30 healthy subjects. N/L ratio and important clinical and laboratory parameters were registered. Multivariate regression analyses were carried out to investigate the relations of N/L ratio. Results: N/L ratio was significantly higher in each patient group compared to the healthy subjects (for all, p < 0.001). It was positively correlated with interleukin-6 (IL-6) (r = 0.393, p < 0.001) and high-sensitivity C-reactive protein (hs-CRP) (r = 0.264, p = 0.002) levels and negatively correlated with hemoglobin (r = −0.271, p = 0.001), serum albumin (r = −0.400, p < 0.001), and high-density lipoprotein (HDL) cholesterol levels (r = −0.302, p < 0.001). In CKD patients with hypertension (HT), higher N/L ratio was detected when compared to those without HT (p = 0.006). Having CKD, the presence of HT, serum albumin, HDL-cholesterol, IL-6, and hs-CRP levels were found to be independent predictors of the ratio after adjusting for significant covariates (p < 0.001). Conclusion: An easy and inexpensive laboratory measure of N/L ratio might provide significant information regarding inflammation in CKD including predialysis and dialysis patients.
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.
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