[Show abstract][Hide abstract] ABSTRACT: Thrombotic microangiopathies are a group of diseases presenting as microangiopathic hemolytic anemia, thrombocytopenia and end-organ dysfunction. As the role of the complement system was elucidated in atypical hemolytic uremic syndrome pathogenesis, eculizumab was successfully introduced into clinical practice. We present a large pedigree with multiple individuals carrying a functionally significant novel factor H mutation. We describe the proband's presentation following a presumed infectious trigger requiring plasma exchange and hemodialysis.
A 32-year-old Caucasian woman presented with pyrexia and headache lasting one week to our Emergency Department. She gave no history of diarrhea or other symptoms to account for her high temperature. She was not taking any medication. She was pyrexial (38°C), tachycardic (110bpm) and hypertensive (160/110mmHg). Her fundoscopy revealed grade IV hypertensive retinopathy. She had mild pretibial and periorbital edema, with oliguria (450mL/day). She had a pregnancy one year previously, during which she had hypertension, proteinuria and edema, with successful delivery at term. Her mother had died in her early 30s with a clinical picture consistent with thrombotic microangiopathy. Her laboratory evaluation showed microangiopathic hemolytic anemia. After 22 sessions of plasma exchange, her lactate dehydrogenase levels started to climb. As a result, she was classified as plasma resistant and eculizumab therapy was instituted. Her lactate dehydrogenase level and platelet count normalized, and her renal function recovered after three months of dialysis.
We demonstrate that, even in patients with atypical hemolytic uremic syndrome and prolonged dialysis dependence, recovery of renal function can be seen with eculizumab treatment. We suggest a treatment regime of at least three months prior to evaluation of efficacy.
Journal of Medical Case Reports 04/2015; 9(1):92. DOI:10.1186/s13256-015-0575-y
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Excessive relative interdialytic weight gain (RIDWG, %) is an important risk factor for long-term adverse cardiovascular outcomes in chronic hemodialysis (HD) patients. On the other hand, it may also be an index of good appetite and nutritional status. We aimed to assess the relationship between RIDWG and appetite, nutrition, inflammation parameters of chronic HD patients.
100 chronic anuric HD patients were enrolled in this prospective study between January 2013 and January 2014. Patients with hospitalization, major surgery, obvious infectious/inflammatory disease, end-stage liver disease, malignancies, and malabsorption syndromes were excluded. Patients were divided into 3 groups according to their RIDWG levels; group 1 = RIDWG < 3%, group 2 = RIDWG: 3 - 5%, and group 3 = RIDWG > 5%.
Group 3 patients were younger (p = 0.011) and had a lower body mass index (BMI) (p = 0.014). Nutrition and inflammation parameters including malnutrition inflammation score (MIS), serum albumin, prealbumin, triceps skinfold thickness, hs-CRP, and TNF-α ere not significantly different between the groups. Leptin and leptin/BMI ratio were significantly lower in group 3 (p = 0.001). RIDWG was negatively correlated with age (p = 0.001, r = -0.371), BMI (p = 0.001, r = -0.372), leptin (p = 0.001, r = -0.369), leptin/BMI (p = 0.001, r = -0.369). After adjustment for BMI in linear regression analyis, leptin/BMI remained significantly correlated with RIDWG (p = 0.024).
This study revealed that RIDWG was associated with younger age, lower BMI and dry weight, and lower serum leptin levels. More detailed studies are needed to validate and dissect the mechanisms of these findings.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Leptin is a hormone and a proinflammatory cytokine secreted from adipocytes, which functions to suppress appetite in healthy persons. Serum leptin levels are significantly elevated in patients with end-stage renal disease (ESRD) primarily due to decreased clearance by the kidneys The consequence of hyperleptinemia in ESRD is not fully understood. We aimed to investigate the association between serum leptin levels and nutrition/inflammation status in non-obese chronic hemodialysis (HD) patients.
65 chronic, anuric, nonobese (body mass index (BMI) < 25 kg/m2) HD patients were included in this cross-sectional study. Demographic, anthropometric, and biochemical data were obtained from all patients to determine nutrition and inflammation status. Patients were classified into the 3 groups according to serum leptin levels; group 1 (low leptin, n = 9), group 2 (normal leptin, n = 31), and group 3 (high leptin, n = 25).
Mean age and duration on dialysis of 65 patients (male/female: 34/31) were 51.6 ± 17.8 years and 78.0 ± 67.9 months, respectively. Serum leptin levels increased with older age, female gender, higher BMI and triceps skinfold thickness. Elevated serum leptin levels were significantly associated with good nutritional status parameters, such as higher albumin (p = 0.001), prealbumin (p = 0.033), total iron binding capacity (p = 0.045), total cholesterol (p = 0.041), and lower malnutrition inflammation score (MIS) (p = 0.002). Serum leptin levels remained a negative correlation with MIS after adjustments made for BMI. No correlation was established between leptin and inflammation parameters including ferritin, highly sensitive C-reactive protein (hs-CRP), and tumor necorsis factor alpha (TNF-α).
Elevated serum leptin levels seem to be associated with good nutritional status. However, there was no correlation between leptin and inflammatory status.
[Show abstract][Hide abstract] ABSTRACT: Background:
Amyloid A (AA) amyloidosis is a multisystem, progressive and fatal disease. Renal involvement occurs early in the course of AA. We aimed to investigate the etiology, clinical and laboratory features, and outcome of patients with biopsy-proven renal AA amyloidosis.
Materials and Methods:
A total of 121 patients (male/female: 84/37, mean age 42.6 ± 14.4 years) were analyzed retrospectively between January of 2001 and May of 2013. Demographic, clinical and laboratory features and outcomes data were obtained from follow-up charts.
Familial Mediterranean fever (37.2%) and tuberculosis (24.8%) were the most frequent causes of amyloidosis. Mean serum creatinine and proteinuria at diagnosis were 2.3 ± 2.1 mg/dL and 6.7 ± 5.3 g/day, respectively. Sixty-eight (56.2%) patients were started dialysis treatment during the follow-up period. Mean duration of renal survival was 64.7 ± 6.3 months. Age, serum creatinine and albumin levels were found as predictors of end-stage renal disease. Fifty patients (%41.3) died during the follow-up period. The mean survival of patients was 88.7 ± 7.8 months (median: 63 ± 13.9). 1, 2 and 5 years survival rates of patients were 80.7%, 68.2% and 51.3%, respectively. Older age, male gender, lower levels of body mass index, estimated glomerular filtration rate, serum albumin, calcium, and higher levels of phosphor, intact parathyroid hormone and proteinuria were associated with a higher mortality. Higher serum creatinine, lower albumin, dialysis requirement and short time to dialysis were predictors of mortality.
The outcome of patients with AA amyloidosis and renal involvement is poor, particularly in those who had massive proteinuria, severe hypoalbuminemia and dialysis requirement at the outset.
Journal of research in medical sciences 07/2014; 19(7):644-9. · 0.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction and Aims: Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) are new potential markers to determine inflammation in end-stage renal disease (ESRD) patients. The association between malnutrition, inflammation and appetite with PLR and NLR are lacking in hemodialysis (HD). Hence, we aimed to determine the relationship between PLR and NLR with malnutrition, inflammation and appetite in ESRD patients.
Methods: One-hundred patients receiving HD for ≥3 months in the dialysis unit of Sisli Etfal Educational and Research Hospital were enrolled in this cross-sectional study. Patients with hospitalization, major surgery, obvious infections, inflammatory disease, end stage liver disease, metastatic malignancies and malabsorbsion syndromes were excluded. To determine malnutrition and inflammation status, malnutrition inflammation score, hs-CRP and TNF-α levels were obtained from all patients.
Results: Mean age of 100 patients (Male/Female: 52/48) were 52.3±17.4 years. Group 1 (MIS ≤ 2), group 2 (MIS: 2-8) and group 3 (MIS > 8) consisted of 9, 64, 27 patients, respectively. Mean duration time on HD were less in group 1 (p=0.035). There were no differences regarding age, gender, ethiology, delivered dialysis dose between the groups. As expected, Group 3 (MIS > 8) patients had lower dry weight (p=0.008), BMI (p=0.002), triceps scinfold thickness (mm) (p=0.002), predialysis serum urea (p=0.020), creatinine (p=0.004), phosphorus (p=0.015), CaxP (p=0.008), prealbumin (p=0.001), albumin (p=0.001), TIBC (p=0.001) which means worse nutritional status. There were no significant difference between 3 groups about leptin, leptin/BMI, hs-CRP, TNF-α and NLR but PLR was founded significantly higher in group 3 compared to group 1 (p=0.007). NLR and PLR were positively correlated with hs-CRP (p=0.001, r=+0.333 and p=0.008, r=+0.262, respectively) and negatively correlated with transferrin saturation (%) (p=0.001, r=-0.418 and p=0.002, r=-0.309, respectively). There were no significant corellation between NLR and PLR with MIS, serum leptin levels.
Conclusions: NLR and PLR seems to be positively correlated with inflammation parameters in chronic HD population. PLR but not NLR were significantly high in malnourished group with MIS > 8.
51st ERA-EDTA CONGRESS, MAY 31ST JUNE 3RD, 2014, Amsterdam, The Netherlands; 05/2014
[Show abstract][Hide abstract] ABSTRACT: Introduction and Aims: Admissions and deaths have been shown to vary according to day of the week in patients receiving haemodialysis. Patients
with a range of chronic diseases are more likely to be admitted on a Monday, and have higher hospital associated mortality
at the weekend. We set out to explore these associations in patients receiving peritoneal dialysis (PD).mortality at the weekend.
These associations are explored in patients receiving peritoneal dialysis (PD).
Methods: Information on patients receiving PD from a cohort of patients starting renal replacement therapy in England between 2002
and 2006 collected by the UK Renal Registry was linked to hospitalisation data. Admission and death rates (in hospital and
out of hospital) by day of the week whilst receiving PD were calculated. 90 day technique survival following admission for
PD peritonitis according to day of the week was analysed using cox regression with a random effects term for renal centre,
comparing each day of the week to Wednesday when services should be optimal.
Results: 27,649 admissions in 6363 patients over 17,620 patient years were available for analysis. Mortality rate was 7.8 per 100
patient years and was stable across the week for both in hospital and out of hospital death. Acute admission rate was 1.15/year
for Monday to Friday and 0.85/year for the weekend (P<0.001). Admissions specifically for peritonitis were slightly lower
at the weekend (25.0 vs 26.5 per 100 patient years, P=0.004). Compared with technique survival following admission with peritonitis
on a Wednesday, Monday was associated with an increased risk (hazard ratio 1.18, 95% CI 1.01 - 1.38, P=0.04) an association
that persisted adjusting for age, comorbidity, ethnicity and including death as a technique failure event (hazard ratio 1.20,
95% CI 1.02 - 1.40 P=0.027).
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[Show abstract][Hide abstract] ABSTRACT: Disordered mineral metabolism is implicated in the pathogenesis of vascular calcification in hemodialysis (HD) patients. Fibroblast growth factor 23 (FGF-23) is the main regulator of phosphate metabolism. In this prospective study, we aimed to investigate the association of serum FGF-23 with progression of coronary artery calcification in HD patients.
Seventy-four HD patients(36 male/38 female,mean age:52 +/- 14 years) were included. Serum FGF-23 levels were measured by ELISA. Coronary artery calcification score(CACS) was measured twice with one year interval. Patients were grouped as progressive (PG)(36 patients-48%) and non-progressive (NPG).
Age, serum phosphorus, baseline and first year CACS were found to be significantly higher in the PG compared to NPG group. Serum FGF-23 levels were significantly higher in PG [155 (80--468) vs 147 (82--234), p = 0.04]. Patients were divided into two groups according to baseline CACS (low group, CACS <= 30; high group, CACS > 30). Serum FGF-23 levels were significantly correlated with the progression of CACS (DeltaCACS) in the low baseline CACS group (r = 0.51, p = 0.006), but this association was not found in high baseline CACS group (r = 0.11, p = 0.44). In logistic regression analysis for predicting the PG patients; serum FGF-23, phosphorus levels and baseline CACS were retained as significant factors in the model.
Serum FGF-23 was found to be related to progression of CACS independent of serum phosphorus levels. FGF-23 may play a major role in the progression of vascular calcification especially at the early stages of calcification process in HD patients.
[Show abstract][Hide abstract] ABSTRACT: Aim:
To evaluate the clinical outcome, identify predictors of patient and technique survival in our peritoneal dialysis (PD) patients in the western region of Turkey.
We included all patients who initiated therapy between 2001 and 2010. Socio-demographic characteristics such as who helped to administer the PD as well as conditions under which PD was chosen by patients were investigated from patients' files. Hemodialysis (HD) history and duration, additional systemic diseases, and end-stage renal disease etiologies of all patients were recorded. Clinical data such as blood pressure, amount of ultrafiltration, and laboratory parameters were evaluated before initiation of PD and during the last monitoring period. Infectious complications and their incidences were investigated. Patient and technique survival were investigated for every patient.
322 patients started PD treatment during the study period. 23 patients were excluded. Data from the remaining 299 patients (167 female, mean follow-up time 38.5 ± 26.8 months, mean age 44.7 ± 15.9 years) were evaluated retrospectively. It was determined that 87.3% of the patients made their PD exchanges without help from anyone. 79.9% of patients chose PD as their personal preference. 48 patients had HD history before PD. Peritonitis incidences and catheter exit site/tunnel infection attacks were 27 ± 23 and 32.3 ± 24.9 patient-months, respectively. During the follow-up period, 199 patients (80 patients transferred to HD, 78 patients died and, 41 patients had transplantation) were withdrawn from PD. The most frequent causes of death were cardiovascular events and peritonitis and/or sepsis, whereas most frequent causes of transfer to HD were peritonitis and/or sepsis. Mean survival time was 49.9 ± 2.6 months. The estimation of survival rate was 85.2%, 66.5% and 45.3% at 1, 3, and 5 years, respectively. Preference for PD (RR: 4.77, p < 0.001), presence of HD history (RR: 2.08, p = 0.04), presence of diabetes mellitus (RR: 2.13, p = 0.01), low pretreatment serum albumin (RR: 0.32, p < 0.001), and low serum parathormone levels at last visit (RR: 0.99, p = 0.04) were predictors of mortality. Mean technique survival duration was 48.5 ± 2.4 months. The estimation of technique survival by Kaplan-Meier analyses was 92%, 67% and 43% at 1, 3, and 5 years, respectively. Technique survival was associated with preference for PD (RR: 0.45, p < 0.001), presence of diabetes mellitus (RR: 1.92, p = 0.003), and pretreatment serum albumin levels (RR: 0.58, p = 0.003).
Patient survival in the presented institute is similar to that reported in Western countries. Compulsory choice of PD, presence of HD history, presence of diabetes, low pretreatment serum albuminm, and low serum parathormone levels at last visit were the strongest predictors of death. Risk factors for technique failure were compulsory choice of PD, presence of diabetes, low pretreatment serum albumin.
[Show abstract][Hide abstract] ABSTRACT: To investigate the impacts of infectious complications on mortality and morbidity; and to identify the other potential factors effective in mortality in peritoneal dialysis (PD) patients.
We included patients who initiated therapy between 2001-2011. Patients were divided into two groups regarding to presence or absence of infectious complications. Socio-demographic data and clinical courses were compared and the reasons for PD withdrawal were obtained. Survival analysis of all patients was performed and the effects of infectious complications on mortality were investigated.
301 patients were included in this retrospective study. 214 patients (mean follow-up time 28.7±16.5 months) had infection history, 87 patients (mean follow-up time 48.9±29.6 months) had no infection history. There were no statistically significant difference in comparison of the groups in terms age, gender, education levels, hemodialysis history. In patients with infection history, 465 peritonitis and 213 catheter exit site infection attacks were diagnosed. The most frequently agent was methicillin-sensitive Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus in both conditions, while 25% of catheter exit site infection and 25% of peritonitis attacks were culture negative. During follow-up period, 60 patients transferred to hemodialysis, 58 patients died, 18 patients had renal transplantation in patients with infection history. In other group, 27 patients died, 23 patients had renal transplantation and 11 patients transferred to hemodialysis. Mean survival times were 56.3±2.8 months in patients with infection history and 86.8±6.1 months in other group. Mortality rate was found higher in patients with infection history (long-rank: 0.030). PD preference (OR: 5.213, p < 0.001), pretreatment low serum albumin (OR: 0.378, p = 0.001), low hemoglobin levels (OR: 0.810, p = 0.029) were found as predictors of survival in patients with infection history.
Infectious complications have negative effects on patient survival. Nature of PD preference, initial hypoalbuminemia and anemia were found to increase the mortality rate. The major causes of deaths were peritonitis and/or sepsis in patients with infectious complications, while the major cause of death was cardiac reasons in patients without infectious complications.
European review for medical and pharmacological sciences 04/2013; 17(8):1064-72. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Diagnosis of tuberculosis (TB) among dialysis patients may be difficult because of increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and non-specific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period.
A total of 651 patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) for at least three months in our unit between 2001 and 2010 were studied. Dialysis and follow-up were performed in our tertiary care center located in the eastern region of Turkey. Diagnosis of TB was established by combining clinical, radiological, biochemical, microbiological, and histological findings. Choice of anti-TB drug used, the results of therapy, and patient outcome were noted.
Out of 651 dialysis patients studied, 322 (49.4%) were on PD and the remainder on HD (50.6%). Twenty-six (4%) of the 651 dialysis patients were diagnosed with TB (15 PD, 11 HD), 5 of whom were diagnosed by microbiological assessment, 9 by pathological assessment, and 12 by clinical and radiological findings. Mean age at diagnosis was 41.5 ± 16.5 years and the female/male ratio was 1.18. Three patients had a history of pulmonary TB. Extra-pulmonary involvement was observed in 17 (65.4%) patients. All patients were treated with rifampicin isoniazid, ethambutol, pyrazinamide and pyridoxine. Four patients died during the study.
TB occurred in dialysis patients and extra-pulmonary TB was more commonly identified than pulmonary TB. Tuberculous lymphadenitis was the most frequent form of extra-pulmonary TB in our cohort.
The Journal of Infection in Developing Countries 03/2013; 7(3):208-213. DOI:10.3855/jidc.2664 · 1.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
To investigate the effects of ESRD etiologies on mortality in peritoneal dialysis patients.
We included patients who initiated therapy between 2001-2011 and classified them according to etiologies including amyloidosis, diabetes mellitus, chronic glomerulonephritis and polycistic renal disease. Socio-demographic data, clinical courses and infectious complications were compared between groups, and the reasons for peritoneal dialysis withdrawal were recorded. Patient and technique survival analysis were performed.
354 patients were included to the study. Thereafter, 154 patients were excluded. Totally, 29 patients with AA-amyloidosis (mean age 37.9±16.4 years, follow-up time 21.7±20.2 months), 78 patients with diabetes mellitus (mean age 56.9±13.6 years, follow-up time 35±28.6 months), 68 patients with chronic glomerulonephritis (mean age 37.2±12 years, follow-up time 47.7±29.9 months), 29 patients with polycystic renal disease (mean age 35.6±13.8 years, follow-up time 45.4±36.8 months) were evaluated. Albumin level was lower in patients with amyloidosis at initiation and the end of study (for both p<0.001). Incidence of peritonitis and catheter exit site/tunnel infection attacks were higher in patients with amyloidosis (p=0.002 and 0.018 respectively). There was statistical difference among groups with respect to the last status of patients (p<0.001). Deaths were frequent in amyloidotic and diabetic patients. The majority of deaths were due to peritonitis and/or sepsis and, cardiovascular reasons. The mortality rate was found higher in patients with amyloidosis (log rank=0.005), especially at first 2-3 years. Presence of anyone helping to administer peritoneal dialysis (OR:6.244, p=0,025), initial serum albumin level (OR:0.352, p=0,034) and presence of catheter exit site/tunnel infection(OR:0.250, p=0,015) were independent predictors of patient survival.
Renal failure etiology has effects on peritoneal dialysis patients' survival. Patients with amyloidosis have the worst survival. Because of loss of PD survival advantage seen in first years of therapy in patients with amyloidosis, peritoneal dialysis may not be suitable as first choice therapy in this group.
Kidney and Blood Pressure Research 11/2012; 36(1):182-190. DOI:10.1159/000343407 · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fungal peritonitis (FP) is a rare but serious complication in patients undergoing peritoneal dialysis (PD), and is associated with higher morbidity, mortality. We aimed to analyze the predisposing factors, etiological agents, outcome and treatment of FP in patients with PD.
We evaluated retrospectively all PD patients PD center between 2001 and 2011. Sixteen patients with FP were included into the study.
The clinical records of 16 patients with FP among 355 patients were reviewed for the clinical and laboratory data. Among 506 episodes of PD-related peritonitis in 10 years, we identified 16 episodes of FP. Median PD duration was 36.7±22.2 months. In 87.5% of patients had one or more previous episode of bacterial peritonitis that were treated with multipl broad-spectrum antibiotics. FP was primary infection in five patients, whereas eleven patients experienced FP during the course of treatment of bacterial peritonitis. Six patients died due to the fungal infection whereas others were transferred to haemodialysis.
Treatment of bacterial peritonitis with broad spectrum antibiotics was an important risk factor predisposing to the development of FP. The catheter removal and initiation of antifungal therapy as soon as possible are obligatory in episode of FP because it is responsible from high mortality rate.
European review for medical and pharmacological sciences 11/2012; 16(12):1696-700. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to investigate the effects of rosiglitazone treatment on insulin resistance (IR) and tumor necrosis factor-alpha (TNF-alpha) levels in non-diabetic chronic kidney disease (CKD) patients with IR.
Thirty non-diabetic CKD patients with IR were enrolled in the study. Patients were grouped into two: group 1 (n = 15) received rosiglitazone 4 mg tablet for 3 months and patients who did not receive rosiglitazone treatment constituted the group 2 (n = 15). Baseline and after rosiglitazone treatment, homeostatis model assessment-insulin resistance (HOMA-IR) and TNF-alpha levels were measured.
There were no statistical differences in gender, age, HOMA-IR and TNF-alpha levels among group 1 and group 2 (p > 0.05 for all). Compared to baseline in group 1, significant differences were found in HOMA-IR and TNF-alpha levels after 3 months (p = 0.023; p = 0.001, respectively).
Our study indicates that, rosiglitazone treatment improves the IR and decreases TNF-alpha levels in non-diabetic patients CKD with IR.
European review for medical and pharmacological sciences 11/2012; 16(11):1519-24. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/aims:
A few patients stay on peritoneal dialysis (PD) for 5 years or longer from initiation of therapy. We investigated patient survival and factors affecting mortality in PD patients.
This was a retrospective study including 354 PD patients. The demographic, clinical, and biochemical data were collected from the medical records. Two hundred patients were excluded. Evaluation was carried out on data from 154 patients, including 83 surviving 5 years or more and 71 who were taken as surviving less than 5 years.
Mean age, number of comorbid diseases, prevalence of diabetes mellitus (DM), rate of mandatory preference of PD, making their PD exchanges with help from anyone were lower in surviving patients, and education level was higher in surviving patients. Advanced age, high rate of mandatory preference of PD, high rate of baseline high, and high-average peritoneal transporters were associated with an increased risk of death.
Long-term survival is possible for PD patients, particularly nondiabetics, those having higher education level, those with a self-preference of PD, and those making PD exchanges without any help.
[Show abstract][Hide abstract] ABSTRACT: Background:
To evaluate the relationship between FGF23 and changes in biochemical parameters, left ventricle mass index, coronary, aortic and, valve calcifications.
Totally 185 patients with chronic renal disease were included in this prospective, cross-sectional study. The patients were stratified according to GFR levels (mL/min/1.73 m2) into 5 groups: ≥60, 45-59, 30-44, 15-29 and <15 (group 1-5 respectively). Biochemical parameters, serum FGF23 levels were measured. Echocardiographic assessments and Coronary artery calcification (CAC) with multidetector computerized tomography (MDCT) were done, left ventricle muscle mass (LVMI) was measured all patients.
Left ventricular hypertrophy (LVH), aortic and valve calcification were detected in 27.8%, 25.3% and 12% of patients respectively. CAC was detected in 18 patients. LVMI and FGF23 levels were found to increase proportionally with the severity of renal failure. A significant positive correlation between FGF-23 level and serum phosphate, logPTH, and CaxP product was found. While a correlation between FGF-23 and valve calcification was detected, no correlation could be detected with LVMI, LVH, coronary and aortic calcification.
In CKD, circulating FGF-23 and LVMI levels gradually increase with declining renal function such that by the time patients reach end-stage renal disease. Correlation between logFGF23 and valve calcification was significant, whereas no statistically significant relationship was found between logFGF23 and LVMI, LVH, aortic and coronary artery calcifications.
Kidney and Blood Pressure Research 08/2012; 36(1):55-64. DOI:10.1159/000339026 · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to examine the effects of angiotensin-converting enzyme inhibitors on peritoneal membrane transport, peritoneal protein loss, and proteinuria in peritoneal dialysis patients.
Fifty-four peritoneal dialysis patients were included in the study. The patients were divided into two groups. Group 1 (n = 34) was treated with angiotensin-converting enzyme inhibitors. Group 2 (n = 20) did not receive any antihypertensive drugs during the entire follow-up. Eleven patients were excluded from the study thereafter. Thus, a total of 30 patients in Group 1 and 13 patients in Group 2 completed the study. We observed the patients for six months. Group 1 patients received maximal doses of angiotensin-converting enzyme inhibitors for six months. Parameters at the beginning of study and at the end of six months were evaluated.
At the end of six months, total peritoneal protein loss in 24-hour dialysate effluent was significantly decreased in Group 1, whereas it was increased in Group 2. Compared to the baseline level, peritoneal albumin loss in 24-hour dialysate effluent and 4-hour D/P creatinine were significantly increased in Group 2 but were not significantly changed in Group 1. A covariance analysis between the groups revealed a significant difference only in the decreased amount of total protein loss in 24-hour dialysate. Proteinuria was decreased significantly in Group 1.
This study suggests that angiotensin-converting enzyme inhibitors reduce peritoneal protein loss and small-solute transport and effectively protect peritoneal membrane transport in peritoneal dialysis patients.