Blood pressure variability (BPV) has been associated with increased morbidity and mortality. There are a few studies that reported worse outcomes of chronic kidney disease (CKD) with greater ...visit-to-visit BPV (VVV), but data with ambulatory blood pressure monitoring (ABPM) is scarce.
Ambulatory hypertensive CKD (stage 2 - 4) patients (> 18 years old) with complete 24 hours of ABPM study (SpaceLabs), who were followed up between January 2012 and December 2016, were retrospectively analyzed for the baseline characteristics and outcomes of CKD. Coefficient of variation (CV) in diastolic blood pressure (DBP) was used as an index of BPV.
Data of 191 patients (mean age 59.7 ± 12.4 years, 54.9% males, 42.1% diabetic, mean eGFR-EPI (Chronic Kidney Disease Epidemiology Collaboration) 51.7 ± 22.0 mL/min/1.73m2, mean follow-up 26.2 ± 10.4 months) were available for the analysis. On multivariate linear regression analysis, greater DBP-CV was associated with slower decline in eGFR-EPI per year (B -0.648, p = 0.000). Likewise, the hazard ratio (HR) for dialysis inception (occurred in 9.4%) was found significantly lower with increasing DBP-CV in unadjusted and fully adjusted Cox models (HR 0.730, 95% CI 0.618 - 0.861, p = 0.000, and HR 0.678, 95% CI 0.526 - 0.874, p = 0.003, respectively).
These findings suggest that DBP variability in 24-hour ABPM may be a good prognostic factor for the outcomes of CKD. Further studies are needed to determine the impact of 24-hour ABPM BPV on CKD progression and its differences from VVV. .
Pneumonia of unknown cause was detected on 30 December 2019 in China. It was categorized as an outbreak and named as COVID-19 by the World Health Organization. The pandemic affects all people, but ...patient groups such as hemodialysis (HD) patients have been particularly affected. We do not know if refugees suffered more during the outbreak. In this study, we compared depressive symptom frequency between Syrian refugee HD patients and Turkish ones.
The study had a single-center, cross-sectional design. Demographic and clinical data were collected retrospectively from patients' files containing details about past medical history, demographic variables and laboratory values. Validated Turkish and Arabic forms of Beck Depression Inventory (BDI) were used to assess depressive symptoms. BDI scores were compared according to nationality, demographic features and clinical data. A BDI score more than 14 was accepted as suspicion of depression.
119 patients were enrolled in the study. After the exclusion of 22 patients, 75 Turkish and 22 Syrian patients were included for further analysis. The median BDI (interquartile range) score for Turkish and Syrian patients were 12 (7-23) and 19.5 (12.7-25.2), respectively (p = 0.03). Suspicion of depression was present at 42.7% of Turkish, and 72.7% of Syrian HD patients (p = 0.013). Regarding all patients, phosphorus level, Kt/V, and nationality were significantly different between patients with and without suspicion of depression (p = 0.023, 0.039, 0.013, respectively).
Syrian patients had higher BDI scores and more depressive symptoms than Turkish patients. Additional national measures for better integration and more mental support to Syrian HD patients are needed.
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.
Vascular calcification is associated with increased cardiovascular mortality in chronic hemodialysis patients. This prospective study investigated the relationship between serum osteoprotegerin, ...receptor activator of NF-κB ligand, inflammatory markers, and progression of coronary artery calcification score.
Seventy-eight hemodialysis patients were enrolled. Serum IL-1β, IL-6, TNF-α, osteoprotegerin, receptor activator of NF-κB, fetuin A, and bone alkaline phosphatase were measured by ELISA. Coronary artery calcification score was measured two times with 1-year intervals, and patients were classified as progressive or nonprogressive.
Baseline and first-year serum osteoprotegerin levels were significantly higher in the progressive than nonprogressive group (17.39±9.67 versus 12.90±6.59 pmol/L, P=0.02; 35.17±18.35 versus 24±11.65 pmol/L, P=0.002, respectively). The ratio of serum osteoprotegerin to receptor activator of NF-κB ligand at 1 year was significantly higher in the progressive group (0.26 0.15-0.46 versus 0.18 0.12-0.28, P=0.004). Serum osteoprotegerin levels were significantly correlated with coronary artery calcification score at both baseline (r=0.36, P=0.001) and 1 year (r=0.36, P=0.001). Importantly, progression in coronary artery calcification score significantly correlated with change in serum osteoprotegerin levels (r=0.39, P=0.001). In addition, serum receptor activator of NF-κB ligand levels were significantly inversely correlated with coronary artery calcification scores at both baseline (r=-0.29, P=0.01) and 1 year (r=-0.29, P=0.001). In linear regression analysis for predicting coronary artery calcification score progression, only baseline coronary artery calcification score and change in osteoprotegerin were retained as significant factors in the model.
Baseline coronary artery calcification score and serum osteoprotegerin levels were significantly associated with progression of coronary artery calcification score in hemodialysis patients.
Fabry disease (FD) is a rare disease associated with sphingolipid accumulation. Sphingolipids are components of plasma membranes that are important in podocyte function and accumulate in various ...glomerular diseases such as focal segmental glomerulosclerosis (FSGS). Both FD and FSGS can cause podocyte damage and are classified as podocytopathies. In this respect, FD and FSGS share the same pathophysiologic pathways. Previous screening studies have shown that a significant proportion of end-stage renal disease (ESRD) patients receiving hemodialysis (HD) have unsuspected FD, and the prevalence of low alpha-galactosidase A (αGLA) enzyme activity in these patients is higher than that in the normal population. We aimed to compare αGLA enzyme activity in patients with biopsy-proven FSGS and ESRD receiving HD.
The records of 232 patients 62 FSGS (F/M: 33/29); 170 HD (M/F: 93/79) were evaluated retrospectively. The screening was performed based on the αGLA enzyme activity on a dried blood spot, with the confirmation of plasma LysoGb3 levels, and the known GLA mutations were tested in patients with low enzyme activities. The two groups were compared using these parameters.
The mean level of αGLA enzyme activity was found to be lower in FSGS patients than in the HD group (2.88±1.2 μmol/L/h versus 3.79±1.9 μmol/L/h, p<0.001). There was no significant relationship between the two groups with regard to the plasma LysoGb3 levels (2.2±1.22 ng/ml versus 1.7±0.66 ng/ml, p: 0.4). In the analysis of GLA mutations, a D313Y mutation C(937G>T) in exon p was found in one patient from the FSGS group.
We found that αGAL activity in patients with FSGS is lower than that in patients undergoing HD. The low enzyme activity in patients with FSGS may be explained by considering the similar pathogenesis of FSGS and FD, which may also lead to sphingolipid deposition and podocyte injury.
Progressive renal disease is characterized by histological changes in the kidney and fibrosis is a common outcome. Renal biopsy is the only diagnostic tool to evaluate these histopathological ...changes. Pentraxin-2 (PTX-2) is an anti-inflammatory constitutive plasma protein associated with the innate immune system. Recently, as a biomarker, the circulating level of PTX-2 is shown to be decreased in chronic fibrotic diseases. In this study, we aimed to investigate the relationship between renal fibrosis severity and serum PTX-2 levels in patients undergoing renal biopsy.
This cross-sectional study included 45 patients and 16 healthy individuals (HIs). The severity of renal fibrosis was evaluated according to the Banff and Sethi scoring systems by the same pathologist. PTX-2 was measured by an enzyme-linked immunosorbent assay and compared with the demographical, clinical, biochemical, and histopathological data of the patients and HIs.
PTX-2 levels were lower in the biopsy group than in the HI group (p=0.12). Patients with moderate renal fibrosis had significantly lower serum PTX-2 levels than those in patients with minimal and mild fibrosis (p=0.017 and p=0.010, respectively). PTX-2 concentrations were correlated with serum albumin (r=0.30, p=0.016), and were negatively correlated with serum creatinine levels (rho=-0.42, p=0.01) and body mass index (r=-0.32, p=0.011).
The results indicated that PTX-2 levels are significantly lower in patients with renal fibrosis than HIs, and declining further in patients with severe fibrosis.
New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication and is considered a risk factor for patients undergoing renal transplant. The aim of this study was to evaluate ...the incidence and developing duration of new-onset diabetes after transplant (NODAT) and influencing factors.
All patients’ data was investigated retrospectively. Diabetics, follow-up period<6 months, age<18years were excluded. Demographic, clinical and laboratory data was recorded. Patients were divided into two groups: with/without NODAT. NODAT group was divided into four subgroups according to the time of developing NODAT, which were 0–3, 3–6, 6–12 and 12 months later. Two groups were compared, to investigate the incidence of NODAT and risk factors associated with the occurrence of NODAT.
We retrospectively analyzed the records of 570 patients, of which 420 patients were included. Seventy (16.6%) patients had NODAT (36 female, mean age 51.7±8.2 years, mean follow-up 41.6±21.5 months), 52.8% of patients developed NODAT within the first three months of being diagnosed. 350 patients (116 female, mean age 43.2±12.5 years, mean follow-up 41.6±21.5 months) were without NODAT. The incidence of impaired fasting glucose (IFG) during the first week after transplant was found to be higher in the patients with NODAT (p<0.001). There was positive correlation between NODAT and older age, obesity, family history of diabetes, presence of IFG, fasting plasma glucose, total and LDL-cholesterol, triglycerides, parathormone. Old age, obesity, presence of IFG, pretransplant hypertriglyceridemia and hyperparathyroidism were predictors of development of NODAT.
Incidence of NODAT, especially the first six months, was high. All patients should be screened for IFG within the first week. Patients with dyslipidemia, elderly and obese patients should be closely monitored for the risk of development of NODAT.
La diabetes postrasplante de nueva aparición (NODAT, new-onset diabetes after transplantation) es una complicación metabólica frecuente y se considera un factor de riesgo para los pacientes a los que se ha realizado un trasplante renal. El objetivo de este estudio fue evaluar la incidencia y la duración del desarrollo de NODAT y los factores que influyen en ello.
Se estudiaron los datos de todos los pacientes de manera retrospectiva. Se excluyó a los diabéticos, a los pacientes con un período de seguimiento inferior a 6 meses y a aquellos con menos de 18 años. Se registraron los datos demográficos, clínicos y de laboratorio. Se dividió a los pacientes en 2 grupos: con/sin NODAT. El grupo con NODAT se dividió en 4 subgrupos de acuerdo con el momento en que desarrollaron NODAT, que fueron 0-3, 3-6, 6-12 y 12 meses más tarde. Se compararon los 2 grupos para analizar la incidencia de NODAT y los factores de riesgo asociados con la aparición de NODAT.
Se analizaron retrospectivamente los registros de 570 pacientes, de los cuales se incluyó a 420 pacientes. Un total de 70 pacientes (16,6%) presentaron NODAT (36 mujeres, con media de edad de 51,7±8,2 años y un seguimiento medio de 41,6±21,5 meses). El 52,8% de los pacientes desarrollaron NODAT durante los 3 primeros meses tras el diagnóstico. Otros 350 pacientes (116 mujeres, con una media de edad de 43,2±12,5 años y un seguimiento medio de 41,6±21,5 meses) no presentaron NODAT. Se encontró que la incidencia de la alteración de la glucemia en ayunas (IFG, impaired fasting glucose) durante la primera semana después del trasplante fue mayor en los pacientes con NODAT (p<0,001). Hubo correlación positiva entre NODAT y edad avanzada, obesidad, antecedentes familiares de diabetes, IFG, glucemia plasmática en ayunas, colesterol total y colesterol-LDL, triglicéridos y hormona paratiroidea. Edad avanzada, obesidad, IFG, hipertrigliceridemia e hiperparatiroidismo pretrasplante fueron factores predisponentes a desarrollar NODAT.
La incidencia de NODAT, especialmente durante los primeros 6 meses, fue alta. Se tuvo que examinar a todos los pacientes en busca de IFG durante la primera semana. Se debe controlar estrechamente el riesgo de desarrollar NODAT en pacientes con dislipidemia, ancianos y obesos.
Aim: New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication and is considered a risk factor for patients undergoing renal transplant. The aim of this study was to ...evaluate the incidence and developing duration of new-onset diabetes after transplant (NODAT) and influencing factors. Methods: All patients’ data was investigated retrospectively. Diabetics, follow-up period < 6 months, age < 18years were excluded. Demographic, clinical and laboratory data was recorded. Patients were divided into two groups: with/without NODAT. NODAT group was divided into four subgroups according to the time of developing NODAT, which were 0–3, 3–6, 6–12 and 12 months later. Two groups were compared, to investigate the incidence of NODAT and risk factors associated with the occurrence of NODAT. Results: We retrospectively analyzed the records of 570 patients, of which 420 patients were included. Seventy (16.6%) patients had NODAT (36 female, mean age 51.7 ± 8.2 years, mean follow-up 41.6 ± 21.5 months), 52.8% of patients developed NODAT within the first three months of being diagnosed. 350 patients (116 female, mean age 43.2 ± 12.5 years, mean follow-up 41.6 ± 21.5 months) were without NODAT. The incidence of impaired fasting glucose (IFG) during the first week after transplant was found to be higher in the patients with NODAT (p < 0.001). There was positive correlation between NODAT and older age, obesity, family history of diabetes, presence of IFG, fasting plasma glucose, total and LDL-cholesterol, triglycerides, parathormone. Old age, obesity, presence of IFG, pretransplant hypertriglyceridemia and hyperparathyroidism were predictors of development of NODAT. Conclusion: Incidence of NODAT, especially the first six months, was high. All patients should be screened for IFG within the first week. Patients with dyslipidemia, elderly and obese patients should be closely monitored for the risk of development of NODAT.
The goal of this study was to evaluate the relationship between serum albumin levels and 24-hour ambulatory blood pressure monitoring (24-h ABPM) recordings in non-diabetic essential hypertensive ...patients.
A total of 354 patients (mean SD age: 55.5 14.3 years, 50% females) with essential hypertension and 24-h ABPM recordings were included. Patient 24-h nighttime and daytime ABPM values, systolic and diastolic dipping status and average nocturnal dipping were recorded. The correlations between serum albumin levels and nocturnal systolic and diastolic dipping were evaluated, and correlates of average nocturnal systolic dipping were determined via a linear regression model.
Overall, 73.2% of patients were determined to be non-dippers. The mean (SD) levels of serum albumin (4.2 0.3 g/dL vs. 4.4 0.4 g/dL, p<0.001) and the average nocturnal systolic (15.2 4.8 mmHg vs. 0.3 6.6 mmHg, p<0.001) and diastolic dipping (4.2 8.6 mmHgvs. 18.9 7.0 mmHg, p<0.001) were significantly lower in non-dippers than in dippers. A significant positive correlation was noted between serum albumin levels and both systolic (r=0.297, p<0.001) and diastolic dipping (r=0.265, p<0.001). The linear regression analysis revealed that for each one-unit increase in serum albumin, the average nocturnal dip in systolic BP increased by 0.17 mmHg (p=0.033).
Our findings indicate an association between serum albumin levels and the deterioration of circadian BP rhythm among essential hypertensive patients along with the identification of a non-dipper pattern in more than two-thirds of patients. Our findings emphasize the importance of serum albumin levels, rather than urinary albumin excretion, as an independent predictor of nocturnal systolic dipping, at least in non-diabetic essential hypertensive patients with moderate proteinuria.
Uremic polyneuropathy is very common among patients with Chronic Kidney Disease (CKD). The patients have electrophysiologic signs of impaired nerve function, although a lower percentage of patients ...are symptomatic. Electrophysiological parameters are quantitative indices of Polyneuropathy (PNP) severity.
To assess the frequency of PNP in patients on long term Peritoneal Dialysis (PD) treatment.
Twenty three PD patients were analysed, who were receiving dialysis for at least five years and the study population divided into two groups according to duration of PD treatment. Group 1 consisted of the patients who were dialysed for at least 10 years and Group 2 consisted of patients who were dialysed for five to nine years. Patients who switched from Haemodialysis (HD) to PD and patients with coexisting diseases that could lead to disturbances in nerve conduction were excluded from the study. PNP was diagnosed when slowing of Nerve Conduction Velocity (NCV) and/or lengthening of distal latencies and/or decrease in amplitude of muscle action potential were present in two or more nerves and longer F wave response was present in one or two nerves. Carpal Tunnel Syndrome (CTS) was diagnosed if slowing of NCV and/or decrease in amplitude of muscle action potential and/or lenghening of distal latency of either sensory or motor median nerve present.
PNP was observed in 17 of the patients {73.9%; Group 1 (n=10) and Group 2 (n=7)}. Mixed type sensory motor neuropathy was diagnosed in nine patients from Group 1 and five patients from Group 2; one patient from Group 1 had demyelinating PNP affecting motor and sensory nerves; one patient from Group 2 had axonal PNP affecting motor and sensory nerves. From Group 1, two patients had CTS related to PNP and one patient had CTS without PNP. The results of motor conductivity testing showed lower conduction velocity for left popliteal nerve in Group 1 and Group 2 patients (13.85±2.17 ms, 4.80±1.11 ms, p=0.01). In both groups, mean motor and sensory latency, amplitude and velocity of other nerves were not found to be significantly different (p>0.05).
PNP is a common complication in long term PD patients. Over five years of treatment, frequency of PNP and CTS do not increase with duration of dialysis.
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