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Sahutoglu T, Danis R, Pembegul I, Ozturk I, Huzmeli C, Tugcu M, Oguz EG, Bora F, Islam M, Ayar Y, Yilmaz Z, Tanburoglu DB, Genc F, Bindal ME, Tuglular S, Kazancioglu R. Resilience and challenges of peritoneal dialysis survivors in the aftermath of the 2023 Kahramanmaraş earthquake. Ther Apher Dial 2024. [PMID: 38647140 DOI: 10.1111/1744-9987.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Peritoneal dialysis (PD) remains understudied in disaster nephrology. This retrospective multicenter study explores the experiences of PD survivors following the February 6, 2023, Kahramanmaraş Earthquake. METHODS Adult PD patients from 11 affected cities were analyzed to assess challenges faced during and postearthquake, alongside clinical outcomes. RESULTS Among 101 participants (median age: 45 years, median PD duration: 24 months), 57 were female, with 79 on continuous ambulatory PD. Challenges included power outages and water shortages, with primary shelter in kin's houses (33%) and homes (28%). Twelve patients experienced PD program delays, and three lacked assistance postdisaster. Sixteen patients changed PD modalities, with seven experiencing postearthquake peritonitis. Clinical parameters remained stable, except for a slight decrease in hemoglobin levels. CONCLUSION Despite challenges, PD survivors exhibited resilience, highlighting the importance of addressing peritonitis and unusual pathogens in disaster preparedness initiatives.
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Affiliation(s)
- Tuncay Sahutoglu
- Department of Nephrology, Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Ramazan Danis
- Department of Nephrology, Diyarbakır Gazi Yaşargil Education Research Hospital, Diyarbakir, Turkey
| | - Irem Pembegul
- Department of Nephrology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ilyas Ozturk
- Department of Nephrology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Can Huzmeli
- Department of Nephrology, Hatay Education and Research Hospital, Hatay, Turkey
| | - Murat Tugcu
- Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, Etlik City Hospital, Health Sciences University, Ankara, Turkey
| | - Feyza Bora
- Department of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mahmud Islam
- Department of Nephrology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yavuz Ayar
- Nephrology Department, Bursa City Health Application Research Center, Bursa Faculty of Medicine, University of Health Sciences, Bursa, Turkey
| | - Zulfikar Yilmaz
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | | | - Fatih Genc
- Department of Nephrology, Faculty of Medicine, Elazig University, Elazig, Turkey
| | - Mehmet Emin Bindal
- Department of Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Serhan Tuglular
- Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Kurultak I, Gungor O, Ozturk S, Dirim AB, Eren N, Yenigün E, Dal EA, Dincer MT, Bora F, Akgur S, Sumnu A, Dursun B, Sipahi S, Cetinkaya H, Sahin I, Sahin G, Yilmaz M, Vatansever B, Aydın E, Ulu MS, Gundogdu A, Ustundag S, Sayarlioglu H, Kumru G, Elcioglu OC, Aydın Z, Selcuk NY, Onal Guclu C, Oruc M, Kucuk M, Aktas N, Derici U, Suleymanlar G. Clinical and histopathological characteristics of primary focal segmental glomerulosclerosis in Turkish adults. Sci Rep 2024; 14:6748. [PMID: 38514826 PMCID: PMC10957996 DOI: 10.1038/s41598-024-57305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/16/2024] [Indexed: 03/23/2024] Open
Abstract
The data regarding primary FSGS (pFSGS) from different parts of the world differ. While the prevalence of pFSGS has been increasing in Western countries like the USA, it follows an inconsistent trend in Europe and Asia and a decreasing trend in Far Eastern countries such as China in the last two decades. There are undetermined factors to explain those national and geographic discrepancies. Herein, we aimed to reveal the current prevalence with clinical and histopathological characteristics of pFSGS in Turkish adults. This study includes the biopsy-proven pFSGS patients data recorded between 2009 and 2019, obtained from the national multicenter primary glomerulonephritis registry system of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database. 850 of the 3875 primer glomerulonephritis patients(21.9%) have pFSGS. The mean age is 40.5 ± 14.2 and 435 (51.2%) of patients are male. Nephrotic syndrome is the most common biopsy indication (59.2%). 32.6% of patients have hematuria, 15.2% have leukocyturia and 7.8% have both. Serum creatinine, albumin, and proteinuria are 1.0 mg/dL (IQR = 0.7-1.4) mg/dl, 3.4 ± 0.9 g/dl, 3400 mg/day(IQR, 1774-5740), respectively. Females have lower mean arterial pressure (- 2.2 mmHg), higher eGFR (+ 10.0 mL/min/1.73 m2), and BMI (+ 1.6 kg/m2) than males. Thickened basal membrane(76.6%) and mesangial proliferation (53.5%) on light microscopy are the major findings after segmental sclerosis. IgM (32.7%) and C3 (32.9%) depositions are the most common findings on immunofluorescence microscopy. IgM positivity is related to lower eGFR, serum albumin, and higher proteinuria. The prevalence of pFSGS is stable although slightly increasing in Turkish adults. The characteristics of the patients are similar to those seen in Western countries.
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Affiliation(s)
- Ilhan Kurultak
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Trakya University, 22030, Edirne, Turkey.
| | - Ozkan Gungor
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Sutcu Imam University, Kahramanmaras, Turkey
| | - Savas Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul, Turkey
| | - Necmi Eren
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Kocaeli University, Kocaeli, Turkey
| | - Ezgi Yenigün
- Department of Internal Medicine, Division of Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Elbis Ahbab Dal
- Department of Internal Medicine, Division of Nephrology, Health Science University, Istanbul Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Feyza Bora
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Akdeniz University, Antalya, Turkey
| | - Suat Akgur
- Department of Internal Medicine, Division of Nephrology, Kutahya Health Science University, Evliya Celebi Yuksek Ihtisas Training and Research Hospital, Kutahya, Turkey
| | - Abdullah Sumnu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Medipol University, Istanbul, Turkey
| | - Belda Dursun
- Faculty of Medicine, Department of InternalMedicine, Division of Nephrology, Pamukkale University, Denizli, Turkey
| | - Savas Sipahi
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Sakarya University, Sakarya, Turkey
| | - Hakki Cetinkaya
- Department of Internal Medicine, Division of Nephrology, Sultan Abdulhamid Training and Research Hospital, Istanbul, Turkey
| | - Idris Sahin
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Inonu University, Malatya, Turkey
| | - Garip Sahin
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Murvet Yilmaz
- Department of Internal Medicine, Division of Nephrology, Health Science University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Bulent Vatansever
- Department of Internal Medicine, Division of Nephrology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Emre Aydın
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Dicle University, Diyarbakir, Turkey
| | - Memnune Sena Ulu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Afyon Kocatepe University, Afyon, Turkey
| | - Ali Gundogdu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Erciyes University, Kayseri, Turkey
| | - Sedat Ustundag
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Trakya University, 22030, Edirne, Turkey
| | - Hayriye Sayarlioglu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Samsun 19 Mayis University, Samsun, Turkey
| | - Gizem Kumru
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Ankara University, Ankara, Turkey
| | - Omer C Elcioglu
- Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Zeki Aydın
- Department of Internal Medicine, Division of Nephrology, Darıca Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Nedim Yılmaz Selcuk
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Selcuk University, Konya, Turkey
| | - Ceren Onal Guclu
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Hacettepe University, Ankara, Turkey
| | - Meric Oruc
- Department of Internal Medicine, Division of Nephrology, Kartal Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Mehmet Kucuk
- Department of Internal Medicine, Division of Nephrology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Nimet Aktas
- Department of Internal Medicine, Division of Nephrology, Health Science University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ulver Derici
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Gazi University, Ankara, Turkey
| | - Gultekin Suleymanlar
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Akdeniz University, Antalya, Turkey
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Bora F, Aslan B, Sarı F, Yılmaz F, Ersoy FF, Köksoy S, Özdem S, Küçükçetin İÖ, Sipahioğlu M, Karakaya İ, Koç Y, Ulu MS. C allele in transforming growth factor-β1 rs1800471 gene polymorphisms might indicate a protective feature in encapsulating peritoneal sclerosis development. Ther Apher Dial 2023; 27:353-360. [PMID: 36054236 DOI: 10.1111/1744-9987.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peritoneal fibrosis may progress in peritoneal dialysis (PD) patients to a fatal clinical condition called encapsulating peritoneal sclerosis (EPS). Transforming growth factor (TGF)-β plays a pivotal role in the pathogenesis of peritoneal fibrosis. We aimed to investigate the association among polymorphisms in the gene encoding TGF-β1, which were -509C/T (rs1800469), +869T/C (rs1982073), and +915G/C (rs1800471) in EPS patients. METHODS A total of 16 PD patients who were clinically and radiologically diagnosed with EPS were enrolled and 22 age- and gender-matched PD patients were selected as the non-EPS group. RESULTS G allele frequency at the rs1800471 gene polymorphism was significantly higher in the EPS group than non-EPS group (p = 0.005). Interestingly, the non-EPS group patients had CC or CG polymorphisms. CONCLUSION C allele in TGF-β1 rs1800471 gene polymorphisms might indicate a protective feature in EPS development. Knowing the presence of polymorphism may be effective in selecting renal replacement therapy in patients.
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Affiliation(s)
- Feyza Bora
- Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey
| | - Bengisu Aslan
- Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey
| | - Funda Sarı
- Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey
| | - Fatih Yılmaz
- Department of Nephrology, Antalya Atatürk State Hospital, Antalya, Turkey
| | - Fettah Fevzi Ersoy
- Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey
| | - Sadi Köksoy
- Department of Medical Microbiology, Akdeniz University Medical School, Antalya, Turkey
| | - Sebahat Özdem
- Department of Basic Medical Sciences, Medical Biochemistry, Akdeniz University Medical School, Antalya, Turkey
| | - İkbal Özen Küçükçetin
- Department of Basic Medical Sciences, Medical Biochemistry, Akdeniz University Medical School, Antalya, Turkey
| | - Murat Sipahioğlu
- Department of Internal Medicine, Division of Nephrology, Erciyes University Medical School, Kayseri, Turkey
| | - İbrahim Karakaya
- Department of Internal Medicine, Division of Nephrology, Çukurova University Medical School, Adana, Turkey
| | - Yener Koç
- Department of Internal Medicine, Division of Nephrology, Cumhuriyet University Medical School, Sivas, Turkey
| | - Memnune Sena Ulu
- Department of Internal Medicine, Division of Nephrology Bahçeşehir University Medical School, Istanbul, Turkey
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Yılmaz F, Keleş M, Bora F. Relationship between the prognostic nutritional index and resistant hypertension in patients with essential hypertension. Clin Exp Hypertens 2022; 44:326-333. [PMID: 35180826 DOI: 10.1080/10641963.2022.2036995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Immune system activation plays a role in resistant hypertension (RHTN) pathogenesis. The clinical effect of the prognostic nutritional index (PNI) on patients with RHTN remains unclear. The aim of this study investigated the possible correlation between PNI and RHTN. METHODS In this cross-sectional study, we enrolled 180 adult subjects. In patients were classified into three groups according to their office and ambulatory blood pressure measurements (ABPM): RHTN (n = 60), controlled hypertension (CHTN, n = 60), and normotension-control (NT-C, n = 60). RHTN was defined as BP ≥140/90 mm Hg while taking ≥3 antihypertensive medications or BP <140/90 mm Hg while taking ≥4 medications. The PNI was calculated from the 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (/μL) formula. RESULTS Office and ABPM were significantly higher in patients with RHTN. Patients in the RHTN (46.1 ± 5.3) had significantly lower PNI than that in the CHTN (54.9 ± 6.7) (P = .032), and PNIs of both hypertensive groups were significantly lower than the NT-C group (P = .019, for both). The ROC curve analysis performed to assess the predictive value of PNI for RHTN and using 50.9 optimal cutoff value of PNI for RHTN gave a sensitivity of 77% and a specificity of 68.5% (AUC = 0.73, 95% CI 0.69-0.96).Multivariate analysis indicated diabetes, 24-h ABPM SBP, CRP, pill burden, and PNI (<51.6) as independent predictors of RHTN. CONCLUSION This study showed that the level of PNI was significantly lower in patients with RHTN compared to patients with CHTN. PNI is independently related to RHTN.
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Affiliation(s)
- Fatih Yılmaz
- Department of Nephrology, Antalya Atatürk State Hospital, Antalya, Turkey
| | - Meryem Keleş
- Department of Nephrology, Ankara City Hospital, Ankara, Turkey
| | - Feyza Bora
- Department of Internal Medicine, Division of Nephrology, Akdeniz University Medicine of Faculty, Antalya, Turkey
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Gülkesen KH, Bora F, Ilhanli N, Avsar E, Zayim N. Cohen's d and physicians' opinion on effect size: a questionnaire on anemia treatment. J Investig Med 2021; 70:814-819. [PMID: 34740945 DOI: 10.1136/jim-2021-002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/03/2022]
Abstract
A well-known effect size (ES) indicator is Cohen's d. Cohen defined d measures of small, medium, and large ES as 0.2, 0.5, and 0.8, respectively. This approach has been criticized because practical and clinical importance depends on the context of research. The aim of the study was to examine physicians' perception of ES using iron deficiency anemia treatment as an example and observing the effects of pretreatment level and duration of treatment on the magnitude of ES. We prepared a questionnaire describing four different clinical studies: (1) 1 month of treatment of anemia in a group of patients with a mean hemoglobin (Hb) of 10 g/dL; (2) 3 months of treatment at an Hb level of 10 g/dL; (3) 1 month of treatment at an Hb level of 8 g/dL; and (4) 3 months of treatment at an Hb level of 8 g/dL. In each scenario, respondents were required to evaluate six various levels of Hb improvement as being very small, small, medium, large, or very large effect: 0.1 g/dL, 0.3 g/dL, 0.7 g/dL, 1.1 g/dL, 1.7 g/dL, and 2.8 g/dL. The responses of 35 physicians were evaluated. For 10 mg/dL, the Cohen's d for small, medium, and large ES was 0.5, 0.8, and 1.2 respectively, for 1 month of treatment. In terms of 3 months of treatment, the Cohen's d was 0.8, 1.2, and 2, respectively. Two separate pretreatment Hb levels (8 g/dL and 10 g/dL) demonstrated a minor difference. Determination of ES during the planning phase of studies requires thorough evaluation of specific clinical cases. Our results are divergent from the classic Cohen's d values. Additionally, duration of treatment affects ES perception.
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Affiliation(s)
- Kemal Hakan Gülkesen
- Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
| | - Feyza Bora
- Division of Nephrology, Akdeniz University, Antalya, Turkey
| | - Nevruz Ilhanli
- Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
| | - Esin Avsar
- Division of Internal Medicine, Akdeniz University, Antalya, Turkey
| | - Nese Zayim
- Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
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Arikan H, Ozturk S, Tokgoz B, Dursun B, Seyahi N, Trabulus S, Islam M, Ayar Y, Gorgulu N, Karadag S, Gok M, Akcali E, Bora F, Aydın Z, Altun E, Ahbap E, Polat M, Soypacacı Z, Oguz EG, Koyuncu S, Colak H, Sahin İ, Dolarslan ME, Helvacı O, Kurultak I, Eren Z, Dheir H, Ogutmen MB, Taymez DG, Genek DG, Ozkurt S, Bakır EA, Yuksel E, Sahutoglu T, Oto OA, Boz G, Sengul E, Kara E, Tuglular S. Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology. PLoS One 2021; 16:e0256023. [PMID: 34375366 PMCID: PMC8354466 DOI: 10.1371/journal.pone.0256023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. METHODS In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. RESULTS The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. CONCLUSIONS Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.
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Affiliation(s)
- Hakki Arikan
- Department of Internal Medicine, Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Savas Ozturk
- Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Bulent Tokgoz
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Belda Dursun
- Department of Internal Medicine, Division of Nephrology, Pamukkale University Medical School, Denizli, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sinan Trabulus
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mahmud Islam
- Division of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey
| | - Yavuz Ayar
- Division of Nephrology, Bursa City Hospital, Faculty of Medicine, University of Health Sciences, Bursa, Turkey
| | - Numan Gorgulu
- Department of Nephrology, Istanbul Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serhat Karadag
- Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Gok
- Department of Nephrology, Sultan 2.Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Esra Akcali
- Department of Nephrology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Feyza Bora
- Department of Internal Medicine, Division of Nephrology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Zeki Aydın
- Department of Nephrology, Kocaeli Darica Farabi Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Eda Altun
- Division of Nephrology, Golcuk Necati Celik State Hospital, Kocaeli, Turkey
| | - Elbis Ahbap
- Department of Nephrology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Polat
- Division of Nephrology, Nevsehir State Hospital, Nevsehir, Turkey
| | - Zeki Soypacacı
- Department of Nephrology, Ataturk Training and Research Hospital, University of Katip Celebi, Izmir, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sumeyra Koyuncu
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hulya Colak
- Division of Nephrology, Tepecik Education and Research Hospital University of Health Sciences, İzmir, Turkey
| | - İdris Sahin
- Department of Internal Medicine, Division of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Murside Esra Dolarslan
- Division of Nephrology, Trabzon Kanuni Education and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Ozant Helvacı
- Division of Nephrology, Yenimahalle Research and Training Hospital, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Ilhan Kurultak
- Department of Nephrology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Zehra Eren
- Department of Nephrology, Alanya Alaaddin Keykubat University School of Medicine, Antalya, Turkey
| | - Hamad Dheir
- Department of Internal Medicine, Division of Nephrology, Sakarya University Medical Faculty Education and Research Hospital, Sakarya, Turkey
| | - Melike Betul Ogutmen
- Division of Nephrology, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek Guven Taymez
- Nephrology and Dialysis Department, Kocaeli State Hospital, Kocaeli, Turkey
| | - Dilek Gibyeli Genek
- Department of Nephrology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Sultan Ozkurt
- Department of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Elif Ari Bakır
- Department of Nephrology, Bahcesehir University Hospital, Istanbul, Turkey
| | - Enver Yuksel
- Department of Nephrology, Gaziyasargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
| | - Tuncay Sahutoglu
- Nephrology Unit, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Ozgur Akin Oto
- Department of Internal Medicine, Division of Nephrology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Gulsah Boz
- Division of Nephrology, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Erkan Sengul
- Division of Nephrology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Ekrem Kara
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Serhan Tuglular
- Department of Internal Medicine, Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
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Öztürk S, Turgutalp K, Arıcı M, Çetinkaya H, Altıparmak MR, Aydın Z, Soypaçacı Z, Bora F, Kara E, Cebeci E, Özler TE, Dölarslan ME, Sipahi S, Ayar Y, Şahin İ, Bakırdöğen S, İslam M, Görgülü N, Öğütmen MB, Şengül E, Güngör Ö, Seyahi N, Tokgöz BÜ, Odabaş AR, Tonbul HZ, Sezer S, Yıldız A, Ateş K. Impact of hospital-acquired acute kidney injury on Covid-19 outcomes in patients with and without chronic kidney disease: a multicenter retrospective cohort study. Turk J Med Sci 2021; 51:947-961. [PMID: 33611868 PMCID: PMC8283512 DOI: 10.3906/sag-2011-169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/21/2021] [Indexed: 01/08/2023] Open
Abstract
Background/aim Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods HA-AKI development was assessed in a group of stage 3–5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results Among 621 hospitalized patients (age 60 [IQR: 47–73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9–44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9–33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.
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Affiliation(s)
- Savaş Öztürk
- Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Kenan Turgutalp
- Department of Internal Medicine, Division of Nephrology, Mersin University Faculty of Medicine, Training and Research Hospital, Mersin, Turkey
| | - Mustafa Arıcı
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakkı Çetinkaya
- Department of Nephrology, Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Mehmet Rıza Altıparmak
- Department of Internal Medicine, Division of Nephrology, Cerrahpaşa Faculty of Medicine, İstanbul University–Cerrahpaşa, İstanbul, Turkey
| | - Zeki Aydın
- Department of Nephrology, Darıca Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Zeki Soypaçacı
- Department of Internal Medicine, Division of Nephrology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Feyza Bora
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ekrem Kara
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Egemen Cebeci
- Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Tuba Elif Özler
- Department of Internal Medicine, Division of Nephrology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Mürşide Esra Dölarslan
- Department of Nephrology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Savaş Sipahi
- Department of Internal Medicine, Division of Nephrology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Yavuz Ayar
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - İdris Şahin
- Department of Internal Medicine, Division of Nephrology, Turgut Özal Medical Center, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Serkan Bakırdöğen
- Department of Internal Medicine, Division of Nephrology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mahmud İslam
- Department of Nephrology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey
| | - Numan Görgülü
- Department of Internal Medicine, Division of Nephrology, Bağcılar Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Melike Betül Öğütmen
- Department of Nephrology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Erkan Şengül
- Department of Nephrology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Özkan Güngör
- Department of Nephrology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Nurhan Seyahi
- Department of Internal Medicine, Division of Nephrology, Cerrahpaşa Faculty of Medicine, İstanbul University–Cerrahpaşa, İstanbul, Turkey
| | - BÜlent Tokgöz
- Department of Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Rıza Odabaş
- Department of Nephrology, Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Halil Zeki Tonbul
- Department of Nephrology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Siren Sezer
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Atılım University, Ankara, Turkey
| | - Alaattin Yıldız
- Department of Internal Medicine, Division of Nephrology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Kenan Ateş
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Arıkan İH, Ozturk S, Tokgoz B, Dursun B, Seyahi N, Trablus S, Islam M, Ayar Y, Gorgulu N, Karadag S, Gok M, Akcali E, Bora F, Aydin Z, Altun E, Ahbap Dal E, Polat M, Soypacaci Z, Gok Oguz E, Koyuncu S, Colak H, Sahin İ, Dolarslan ME, Helvacı Ö, Kurultak I, Eren Z, Dheir H, OGUTMEN MELIKEBETUL, Guven Taymez D, Gibyeli Genek D, Ozkurt S, Ari Bakir E, Yuksel E, Sahutoglu T, Oto OA, Boz G, Erkan S, Kara E, Tuglular ZS. MO357ACUTE KIDNEY INJURY IN HOSPITALIZED COVID-19 PATIENTS: A MULTICENTRE STUDY BY TURKISH SOCIETY OF NEPHROLOGY. Nephrol Dial Transplant 2021. [PMCID: PMC8194783 DOI: 10.1093/ndt/gfab082.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.
Method
In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients.
Results
The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (41.5%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 80.7% and partial in 17% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. The in-hospital mortality rates across AKI stages by age, gender, and diabetes mellitus were shown in the Figure.
Conclusion
Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. Renal problems continue in a significant portion of the patients who were discharged.
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Affiliation(s)
- İzzet Hakkı Arıkan
- Marmara University School of Medicine, Deparment of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Savas Ozturk
- Haseki Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Bulent Tokgoz
- Erciyes University School of Medicine, Deparment of Internal Medicine, Division of Nephrology, Kayseri, Turkey
| | - Belda Dursun
- Pamukkale University Medical School, Deparment of Internal Medicine, Division of Nephrology, Denizli, Turkey
| | - Nurhan Seyahi
- Istanbul University, Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Sinan Trablus
- Istanbul University, Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Mahmud Islam
- Zonguldak Ataturk State Hospital, Division of Nephrology, Zonguldak, Turkey
| | - Yavuz Ayar
- University of Health Science. Faculty of Medicine, Bursa City Hospital, Division of Nephrology, Bursa, Turkey
| | - Numan Gorgulu
- University of Health Sciences, Istanbul Bagcilar Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Serhat Karadag
- Haseki Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Mahmut Gok
- Sultan 2. Abdulhamid Han Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Esra Akcali
- Mersin University Faculty of Medicine, Department of Nephrology, Mersin, Turkey
| | - Feyza Bora
- Akdeniz University Faculty of Medicine, Deparment of Internal Medicine, Division of Nephrology, Antalya, Turkey
| | - Zeki Aydin
- University of Health Sciences, Kocaeli Darica Farabi Training and Research Hospital, Department of Nephrology, Kocaeli, Turkey
| | - Eda Altun
- Golcuk Necati Celik State Hospital, Division of Nephrology, Kocaeli, Turkey
| | - Elbis Ahbap Dal
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Mehmet Polat
- Nevsehir State Hospital, Division of Nephrology, Nevsehir, Turkey
| | - Zeki Soypacaci
- University of Katip Celebi, Ataturk Training and Research Hospital, Department of Nephrology, Izmir, Turkey
| | - Ebru Gok Oguz
- University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Sumeyra Koyuncu
- Erciyes University School of Medicine, Deparment of Internal Medicine, Division of Nephrology, Kayseri, Turkey
| | - Hulya Colak
- University of Health Sciences, Tepecik Education and Research Hospital, Division of Nephrology, Izmir, Turkey
| | - İdris Sahin
- Inonu University Faculty of Medicine, Deparment of Internal Medicine, Division of Nephrology, Malatya, Turkey
| | - Murside Esra Dolarslan
- University of Health Sciences,Trabzon Kanuni Education and Research Hospital, Division of Nephrology, Trabzon, Turkey
| | - Özant Helvacı
- Yildirim Beyazit University Yenimahalle Research and Training Hospital, Division of Nephrology, Ankara, Turkey
| | - Ilhan Kurultak
- Trakya University Faculty of Medicine, Department of Nephrology, Edirne, Turkey
| | - Zehra Eren
- Alanya Alaaddin Keykubat University School of Medicine, Deparment of Internal Medicine, Division of Nephrology, Antalya, Turkey
| | - Hamad Dheir
- Sakarya University Medical Faculty Education and Research Hospital, Deparment of Internal Medicine, Division of Nephrology, Sakarya, Turkey
| | - MELIKE BETUL OGUTMEN
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Division of Nephrology, Istanbul, Turkey
| | - Dilek Guven Taymez
- Kocaeli State Hospital, Nephrology and Dialysis Department, Kocaeli, Turkey
| | - Dilek Gibyeli Genek
- Mugla Sıtkı Kocman University, Faculty of Medicine, Department of Nephrology, Mugla, Turkey
| | - Sultan Ozkurt
- Eskisehir Osmangazi University Faculty of Medicine, Department of Nephrology, Eskisehir, Turkey
| | - Elif Ari Bakir
- Bahcesehir University Hospital, Department of Nephrology, Istanbul, Turkey
| | - Enver Yuksel
- University of Health Sciences, Gaziyaşargil Training and Research Hospital, Department of Nephrology, Diyarbakir, Turkey
| | - Tuncay Sahutoglu
- Sanliurfa Mehmet Akif Inan Training and Research Hospital, Nephrology Unit, Sanliurfa, Turkey
| | - Ozgur Akin Oto
- Istanbul University Istanbul Medical Faculty, Deparment of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Gulsah Boz
- Kayseri City Training and Research Hospital, Division of Nephrology, Kayseri, Turkey
| | - Sengul Erkan
- Health Science University, Kocaeli Derince Education and Research Hospital, Division of Nephrology, Kocaeli, Turkey
| | - Ekrem Kara
- Recep Uzmanı Tayyip Erdogan University, Faculty of Medicine, Deparment of Internal Medicine, Division of Nephrology, Rize, Turkey
| | - Z Serhan Tuglular
- Marmara University School of Medicine, Deparment of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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9
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Bora F, Yilmaz F, Sozel H, Akkaya B. A Case of Malignant Hypertension-Induced Thrombotic Microangiopathy with Gradually Improved Renal Function Using Appropriate Antihypertensives. Turk J Nephrol 2021. [DOI: 10.5152/turkjnephrol.2021.4404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, Cebeci E, Basturk T, Soypacaci Z, Sahin G, Elif Ozler T, Kara E, Dheir H, Eren N, Suleymanlar G, Islam M, Ogutmen MB, Sengul E, Ayar Y, Dolarslan ME, Bakirdogen S, Safak S, Gungor O, Sahin I, Mentese IB, Merhametsiz O, Oguz EG, Genek DG, Alpay N, Aktas N, Duranay M, Alagoz S, Colak H, Adibelli Z, Pembegul I, Hur E, Azak A, Taymez DG, Tatar E, Kazancioglu R, Oruc A, Yuksel E, Onan E, Turkmen K, Hasbal NB, Gurel A, Yelken B, Sahutoglu T, Gok M, Seyahi N, Sevinc M, Ozkurt S, Sipahi S, Bek SG, Bora F, Demirelli B, Oto OA, Altunoren O, Tuglular SZ, Demir ME, Ayli MD, Huddam B, Tanrisev M, Bozaci I, Gursu M, Bakar B, Tokgoz B, Tonbul HZ, Yildiz A, Sezer S, Ates K. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant 2020; 35:2083-2095. [PMID: 33275763 PMCID: PMC7716804 DOI: 10.1093/ndt/gfaa271] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3–5), HD and RT patients with a control group of patients is still lacking. Methods We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3–5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared. Results A total of 1210 patients were included [median age, 61 (quartile 1–quartile 3 48–71) years, female 551 (45.5%)] composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9–45.2; and 82/289 (28.4%); 95% CI 23.9–34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3–29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2–30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7–19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8–10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5–6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52–5.44); P = 0.001; 2.44 (1.35–4.40); P = 0.003; HD: 2.32 (1.21–4.46); P = 0.011; 2.25 (1.23–4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76–4.72); P = 0.169; 1.87 (0.81–4.28); P = 0.138, respectively]. Conclusions Hospitalized COVID-19 patients with CKDs, including Stages 3–5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3–5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.
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Affiliation(s)
- Savas Ozturk
- Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Kenan Turgutalp
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Mersin University Training and Research Hospital, Mersin, Turkey
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Riza Odabas
- Department of Nephrology, University of Health Sciences, Sultan 2.Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Internal Medicine, Division of Nephrology, Istanbul University - Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Zeki Aydin
- Department of Nephrology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Egemen Cebeci
- Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Taner Basturk
- Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeki Soypacaci
- Department of Internal Medicine, Division of Nephrology, Izmir Katip Celebi University, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Garip Sahin
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tuba Elif Ozler
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ekrem Kara
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Hamad Dheir
- Department of Internal Medicine, Division of Nephrology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Necmi Eren
- Department of Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Gultekin Suleymanlar
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mahmud Islam
- Department of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey
| | - Melike Betul Ogutmen
- Department of Nephrology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Erkan Sengul
- Department of Nephrology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Yavuz Ayar
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Murside Esra Dolarslan
- Department of Nephrology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Serkan Bakirdogen
- Department of Internal Medicine, Division of Nephrology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Seda Safak
- Department of Internal Medicine, Division of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ozkan Gungor
- Department of Nephrology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Idris Sahin
- Department of Internal Medicine, Division of Nephrology, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - Ilay Berke Mentese
- Department of Internal Medicine, Division of Nephrology, Marmara University Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Merhametsiz
- Department of Internal Medicine, Division of Nephrology, Yeni Yuzyil University Faculty of Medicine, Istanbul, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Dilek Gibyeli Genek
- Department of Internal Medicine, Division of Nephrology, Mugla Sitki Kocman University Faculty of Medicine, Training and Research Hospital, Mugla, Turkey
| | - Nadir Alpay
- Department of Internal Medicine, Division of Nephrology, Memorial Hizmet Hospital, Istanbul, Turkey
| | - Nimet Aktas
- Department of Nephrology, University of Health Sciences, Bursa Higher Specialization Training and Research Hospital, Bursa, Turkey
| | - Murat Duranay
- Department of Nephrology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Selma Alagoz
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Hulya Colak
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Training and Research Hospital, Izmir, Turkey
| | - Zelal Adibelli
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Usak University, Usak, Turkey
| | - Irem Pembegul
- Department of Nephrology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ender Hur
- Department of Nephrology, Manisa Merkezefendi State Hospital, Manisa, Turkey
| | - Alper Azak
- Department of Nephrology, Balıkesir Ataturk City Hospital, Balikesir, Turkey
| | | | - Erhan Tatar
- Department of Nephrology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Rumeyza Kazancioglu
- Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Aysegul Oruc
- Department of Nephrology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Enver Yuksel
- Department of Nephrology, University of Health Sciences, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Engin Onan
- Department of Nephrology, Adana City Training and Research Hospital, Adana, Turkey
| | - Kultigin Turkmen
- Department of Nephrology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | | | - Ali Gurel
- Department of Internal Medicine, Division of Nephrology, Firat University Faculty of Medicine, Elazig, Turkey
| | - Berna Yelken
- Department of Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Tuncay Sahutoglu
- Department of Nephrology, University of Health Sciences, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Mahmut Gok
- Department of Nephrology, University of Health Sciences, Sultan 2.Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Internal Medicine, Division of Nephrology, Istanbul University - Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Sevinc
- Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sultan Ozkurt
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Savas Sipahi
- Department of Internal Medicine, Division of Nephrology, Sakarya University Faculty of Medicine, Training and Research Hospital, Sakarya, Turkey
| | - Sibel Gokcay Bek
- Department of Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Feyza Bora
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Bulent Demirelli
- Department of Nephrology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Akin Oto
- Department of Internal Medicine, Division of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Orcun Altunoren
- Department of Nephrology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Serhan Zubeyde Tuglular
- Department of Internal Medicine, Division of Nephrology, Marmara University Faculty of Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Demir
- Department of Internal Medicine, Division of Nephrology, Yeni Yuzyil University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Deniz Ayli
- Department of Nephrology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Bulent Huddam
- Department of Internal Medicine, Division of Nephrology, Mugla Sitki Kocman University Faculty of Medicine, Training and Research Hospital, Mugla, Turkey
| | - Mehmet Tanrisev
- Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ilter Bozaci
- Department of Nephrology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Meltem Gursu
- Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Betul Bakar
- Department of Nephrology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Bulent Tokgoz
- Department of Nephrology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Halil Zeki Tonbul
- Department of Nephrology, Adana City Training and Research Hospital, Adana, Turkey
| | - Alaattin Yildiz
- Department of Internal Medicine, Division of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Siren Sezer
- Department of Internal Medicine, Division of Nephrology, Atilim University Faculty of Medicine, Istanbul, Turkey
| | - Kenan Ates
- Department of Internal Medicine, Division of Nephrology, Ankara University Faculty of Medicine Ankara, Turkey
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Yılmaz F, Bora F, Çetinkaya R, Gelen MT, Süleymanlar G, Ersoy F. A case of cyclic hemoperitoneum in a hemodialysis patient: Encapsulated peritoneal sclerosis complicated by endometriosis and fungal peritonitis. Semin Dial 2020; 34:176-179. [PMID: 33349976 DOI: 10.1111/sdi.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Encapsulated peritoneal sclerosis (EPS) is a rare, but frequently fatal, long-term complication of peritoneal dialysis. Endometriosis is a common gynecological problem but hemoperitoneum due to endometriosis has been reported to be extremely rare in hemodialysis (HD) patients. A 25-year-old female HD patient was admitted to our clinic with nausea, vomiting, abdominal pain, and weight loss for last 3 months. Candida tropicalis and Candida glabrata were isolated in the fungal cultures from peritoneal fluid. Her abdominal computerized tomography scan has shown irregular peritoneal calcifications, diffuse peritoneal thickening, dilatation of the small bowel loops, and cocoon formation which all were typical for EPS. Hemoperitoneum was reported to recur for four times with intervals suggesting menstrual cycles. Her peritoneal biopsy, along with the signs of EPS, has also revealed the presence of endometriosis. The patient died with symptoms of septic shock in the first year of EPS diagnosis.
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Affiliation(s)
- Fatih Yılmaz
- Department of Nephrology, Antalya Ataturk State Hospital, Antalya, Turkey
| | - Feyza Bora
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Ramazan Çetinkaya
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | | | - Gültekin Süleymanlar
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Fevzi Ersoy
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
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12
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Kurultak I, Gungor O, Ozturk S, Dirim AB, Eren N, Yenigun E, Ahbap Dal E, Dincer MT, Bora F, Akgur S, Sumnu A, Dursun B, Sipahi S, Çetinkaya H, Sahin İ, SAHIN G, Yılmaz M, Vatansever B, Aydin E, Ulu MS, Gundogan A, Üstündağ S, Sayarlioglu H, Kumru Şahin G, Elcioglu OC, Aydin Z, Selcuk NY, Onal C, Oruc M, Kucuk M, Aktas N, Derici Ü, Suleymanlar G. P0389THE PREVALENCE, CLINICAL AND PATHOLOGICAL CHARACTERISTICS OF PRIMARY FOCAL SEGMENTAL GLOMERULOSCLEROSIS IN TURKISH ADULTS: THE DATA FROM TSN-GOLD ( TURKISH SOCIETY OF NEPHROLOGY GLOMERULAR DISEASES) WORKING GROUP. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Focal segmental glomerulosclerosis (FSGS) is one of the primary glomerulopathies which is the most common cause of end-stage renal disease among all primary glomerular diseases. In adults, nephrotic syndrome develops 10-35% due to FSGS. However, its frequency has been increasing in recent years. This study was aimed to present the data and the prevalence of primary FSGS patients in Turkey.
Method
These data were obtained from the National Multicenter (47 centers) Primary Glomerular Diseases registry system, which was entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The presented data in this study is cross-sectional and includes the recorded data of the patients in the hospitalization period for the kidney biopsy. These demographic, clinic and pathological data of patients were evaluated with using statistically.
Results
Of the 3875 patients enrolled in the Primary Glomerular Diseases database, 850 (21.9%) had FSGS. The mean age of the patients was 47.1 ± 13.7 and 435 (52%) of patients were male. Two hundred and eighty one (33.1%) had hypertension and 93 (11%) had diabetes. Five hundred and four patients (59.3%) were diagnosed as nephrotic syndrome. At the time of diagnosis, the mean systolic blood pressure was 13.8 ± 18.6 mm Hg and the mean diastolic blood pressure was 81.4± 11.4 mm Hg. The laboratory findings at the time of diagnosis on following; serum creatinine 1.2 ± 0.04 mg / dl, albumin 3.3 ± 0.03 g / dl, and 24 hours urinary proteinuria amounts to 4743 ± 181 mg / day. Demographical and clinical data of the patients at the time of diagnosis were presented on Table 1. In pathological examination; the mean number of glomeruli was 16.8 ± 0.3, global sclerotic glomeruli were 3.1 ± 0.1, and segmental sclerotic glomeruli were 2.4 ± 0.1. Summary of Pathological Findings were presented on Table 2
Conclusion
It is very difficult to determine the absolute incidence and prevalence of primary FSGS. Incidence rates have been reported to range from 0.2 to 1.8 / 100,000 per year in the literature. In a United States study, the most common diagnosis in 2501 kidney biopsies was FSGS (35.9%). According to this database, the prevalence of FSGS in primary glomerular diseases in our country is 21.9%.
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Affiliation(s)
- Ilhan Kurultak
- Trakya University, Faculty of Medicine, Nephrology, Edirne, Turkey
| | - Ozkan Gungor
- Sutcu Imam University, Faculty of Medicine, Nephrology, Turkey
| | - Savas Ozturk
- Haseki Education and Research Hospital, Nephrology, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Istanbul University, Faculty of Medicine, Nephrology, Istanbul, Turkey
| | - Necmi Eren
- Kocaeli University, Faculty of Medicine, Nephrology, Kocaeli, Turkey
| | - Ezgi Yenigun
- Ankara Numune Education and Research Hospital, Nephrology, Ankara, Turkey
| | - Elbis Ahbap Dal
- Hamidiye Sisli Etfal Education and Research Hospital, Nephrology, Istanbul, Turkey
| | | | - Feyza Bora
- Akdeniz University, Faculty of Medicine, Nephrology, Antalya, Turkey
| | - Suat Akgur
- Uludag University, Faculty of Medicine, Nephrology, Bursa, Turkey
| | - Abdullah Sumnu
- Medipol University, Faculty of Medicine, Nephrology, İstanbul
| | - Belda Dursun
- Pamukkale University, Faculty of Medicine, Nephrology, Denizli, Turkey
| | - Savaş Sipahi
- Sakarya University, Faculty of Medicine, Nephrology, Sakarya, Turkey
| | - Hakkı Çetinkaya
- Sultan Abdulhamid Han Education and Research Hospital, Nephrology, Istanbul, Turkey
| | - İdris Sahin
- Inonu University, Faculty of Medicine, Nephrology, Malatya, Turkey
| | - Garip SAHIN
- Eskisehir Osmangazi Universitesi, Faculty of Medicine, Nephrology, Eskişehir, Turkey
| | - Mürvet Yılmaz
- University of Halth Sciences, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Nephrology, Istanbul, Turkey
| | - Bulent Vatansever
- Izmir Bozkaya Education and Research Hospital, Nephrology, Izmir, Turkey
| | - Emre Aydin
- Dicle University, Faculty of Medicine, Nephrology, Urfa, Turkey
| | - Memnune Sena Ulu
- Afyon University, Faculty of Medicine, Nephrology, Afyon, Turkey
| | - Ali Gundogan
- Erciyes University, Faculty of Medicine, Nephrology, Kayseri, Turkey
| | - Sedat Üstündağ
- Trakya University, Faculty of Medicine, Nephrology, Edirne, Turkey
| | | | - Gizem Kumru Şahin
- Ankara University, Faculty of Medicine, Ibni-Sina Hospital, Nephrology, Ankara, Turkey
| | - Omer Celal Elcioglu
- Bezmialem Vakıf University, Faculty of Medicine, Nephrology, Istanbul, Turkey
| | - Zeki Aydin
- Darıca Farabi Education and Research Hospital, Nephrology, Kocaeli, Turkey
| | | | - Ceren Onal
- Hacettepe University, Faculty of Medicine, Nephrology, Ankara, Turkey
| | - Meric Oruc
- Kartal Dr. Lutfi Kırdar Education and Research Hospital, Nephrology, Istanbul, Turkey
| | - Mehmet Kucuk
- Okmeydanı Education and Research Hospital, Nephrology, Istanbul, Turkey
| | - Nimet Aktas
- Bursa Yuksek Ihtisas Education and Research Hospital, Nephrology, Bursa, Turkey
| | - Ülver Derici
- Gazi University, Faculty of Medicine, Nephrology, Ankara, Turkey
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13
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Bora F, Asar E, Yılmaz F, Çakmak Ü, Ersoy FF, Suleymanlar G. P0296LAST HIT ‘' INFECTIONS'’ BROUGHT THE END: CHRONIC KIDNEY DISEASE TO RENAL REPLACEMENT TREATMENT. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
It is evident that Chronic Kidney Disease (CKD) influences the risk of developing AKI (Acute Kidney Injury) and recent studies suggest that CKD patients who experienced an episode of AKI are more likely to progress to end stage renal disease (ESRD) than patients without CKD. AKI-CKD association might originate from common comorbidities associated with both AKI and CKD, such as diabetes and/or hypertension, and concurrent increase in interventions leading to frequent exposure to various nephrotoxins. AKI in the elderly has been shown to increase the risk of progression to CKD to ESRD. AKI is common in critically ill patients, and those patients with the most severe form of AKI, requiring RRT, have a mortality rate of 50–80 %. Patients with an eGFR <45 ml/min per 1.73m2 who experienced an episode of dialysis-requiring AKI were at very high risk for impaired recovery of renal function. Our aim was to determine the reasons that initiate hemodialysis (renal decompensation) in patients with regular follow-up in the low clearance polyclinic without renal replacement treatment (RRT).
Method
The retrospective study included predialysis CKD patients who had followed up regularly and had undergone RRT in recent 4 years. Data on baseline characteristics and medical history were obtained from patient hospital records.
Results
Of the 228 patients, 155 (68%) were male and 73 (32%) were female. The mean age was 58 years (45-66). Diabetes Mellitus was the first in the etiology of CKD (26,3 %), the second was unknown (12,7 %), the third was hypertension (11,8 %). 145 patients (63,6%) underwent regular hemodialysis (HD) (62 years, 55-69), 25 patients (11%) began peritoneal dialysis (PD), 58 patients (25%) had renal transplantation. 52 patients underwent HD with renal decompensation, 22 (%42,3) had working arteriovenous fistula (AVF). There was no decompensation in patients with PD or transplantation plan. 34 patients started HD because of infections (65%), 8 patients (15%) after operations (4 was Coronary Artery Bypass Grafting-CABG), 6 patients (%11,5) after coronary angiography, 4 patients (7,5%) with cardiac decompensation. 2 patients died during the hospitalisation for infections. Of 145 HD patients, 89 (%61,4) had AVF. The patients who had renal decompensation were more older 63 (58-70), have lower Hgb 9,7 g/L (9,1-10,7) and albumin 3,5 g/L (3,2-3,9) level (p<0,05). There was no difference in eGFR at the beginning of HD between renal decompensation and other HD patients. 42 patients did not undergo HD at the time we suggested during visits. Of them 9 patients (%21) had renal decompensation (6 infections,3 CABG), 17 patients (%40) had AVF. 3 of them died. The others underwent HD for uremic complications.
Conclusion
We have shown that infections are as the leading cause of renal decompensation. Most of our patients who started to RRT from our low clearance outpatient clinic have chosen HD for RRT. Prevention of infections via vaccination programs or early diagnosis at regular policlinic or telephone visits, and informing patients adequately about nephrotoxic drugs or the conditions that may cause renal decompensation are among the first tasks of the predialysis outpatient clinic. Transition of CKD patients to RRTs, with proper preparation, neither late nor early- at the most appropriate time- should be among in our goals. This may reduce the cost of ESRD patients.
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Affiliation(s)
- Feyza Bora
- Akdeniz University, Nephrology department, Antalya, Turkey
| | - Emine Asar
- Akdeniz University, Nephrology department, Antalya, Turkey
| | - Fatih Yılmaz
- Antalya State Hospital, Nephrology department, Antalya, Turkey
| | - Ümit Çakmak
- Akdeniz University, Nephrology department, Antalya, Turkey
| | - Fevzi F Ersoy
- Akdeniz University, Nephrology department, Antalya, Turkey
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14
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Aydin Z, Turkmen K, Dede F, Yasar E, Ozturk S, Aydin M, Tatar E, SAHIN G, Manga Sahin G, Oto OA, Sumnu A, Eroglu E, Dincer MT, Dursun B, Eren N, Sevinc M, Guzel FB, Yalin SF, Kutlay S, Apaydin S, Berktas HB, Kazan S, Dheir H, Bora F, Basturk T, Sahin İ. P0395DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS IN TURKEY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Rapidly progressive glomerulonephritis (RPGN) is a clinical condition that develops due to different etiologic causes, characterized by a rapid and progressive decrease in renal function and progresses to end-stage renal failure in weeks to months if not treated. In our study, diagnostic and demographic characteristics of patients diagnosed with RPGN by biopsy, clinical and laboratory findings in our country were investigated.
Method
Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group database between May 2009 and June 2019. Demographic characteristics such as age, sex, indications for biopsy, diagnosis of the glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were recorded. The data presented is cross-sectional and includes application data for the biopsy period. According to their types, RPGN patients were classified as type 1 (anti-GBM related), type 2 (immunocomplex related) and type 3 (immune-negative; “pauci-immune”).
Results
After exclusion of 46 patients with missing data, 200 patients (mean age 47.9 ± 16.7 years, 44% female) were included in the study which constitutes 5.2% of the total glomerulonephritis database (total number of patients: 3875). Hypertension was present in 62 patients (31.0%) and diabetes was present in 18 patients (9.0%). Renal biopsy was performed in 147 (73.5%) patients due to nephritic syndrome (RPGN included). 80.2% of the patients' biopsies were performed in nephrology clinics and 19.8% of them were performed in radiology clinics. ANCA positivity was found in 121 (60.5%) patients (proteinase 3-ANCA was positive in 55 and myeloperoxidase-ANCA positive in 66 patients). Type 1 RPGN was detected in 11 (5.5%), type 2 RPGN in 42 (21%) and type 3 RPGN in 147 (73.5%) patients. In 21 patients (10.5%), biopsy revealed RPGN with advanced chronic changes (fibrous global sclerotic glomeruli, advanced interstitial fibrosis and tubular atrophy). Mean serum creatinine was 4.2 ± 3.4 mg/dl, median glomerular filtration rate was 18 (10-37) ml/min and proteinuria 2100 (1229-3526) mg/day according to CKD-EPI formula. The mean number of glomeruli in the biopsies was 18.8 ± 10.6 and the number of crescentic glomeruli was 9.9 ± 7.7 (ratio: 52.7%) (Figure). The patients were divided into 3 groups according to their crescentic glomeruli ratios. The proportion of crescentic glomeruli is 10-50% in group 1, 50-80% in group 2, and >80% in group 3. The demographic, laboratory and histopathological characteristics of the groups are given in Figure. It was observed that urea and creatinine increased and calcium and hemoglobin decreased with increasing crescentic glomerular ratio.
Conclusion
Our study provides valuable demographic, clinical, laboratory and histopathological data about RPGN in our country. Our data are generally compatible with the literature. In our study, advanced chronic histopathological findings were prominent in the biopsy of 21 patients. Early biopsy should be performed to confirm the diagnosis of RPGN and to avoid unnecessary intensive immunosuppressive therapy. In addition to the treatments applied, detailed data, including patient and renal survival are needed.
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Affiliation(s)
- Zeki Aydin
- Darica Farabi Training and Research Hospital, Nephrology, Kocaeli, Turkey
| | - Kultigin Turkmen
- Necmettin Erbakan University, Meram Medical School, Nephrology, Turkey
| | - Fatih Dede
- Ankara Numune Training and Research Hospital, Nephrology, Ankara, Turkey
| | - Emre Yasar
- Gazi University Medical School, Nephrology, Ankara, Turkey
| | - Savas Ozturk
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Mehmet Aydin
- Uludag University Medical School, Nephrology, Bursa, Turkey
| | - Erhan Tatar
- Bozyaka Training and Research Hospital, Nephrology, Izmir, Turkey
| | - Garip SAHIN
- Osmangazi University Medical School, Nephrology, Eskisehir, Turkey
| | - Gulizar Manga Sahin
- Sultan Abdülhamid Han Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Ozgur Akin Oto
- Istanbul University Medical School, Nephrology, Istanbul, Turkey
| | - Abdullah Sumnu
- Medipol University Medical School, Nephrology, Istanbul, Turkey
| | - Eray Eroglu
- Erciyes University Medical School, Nephrology, Kayseri, Turkey
| | | | - Belda Dursun
- Pamukkale University Medical School, Nephrology, Denizli, Turkey
| | - Necmi Eren
- Kocaeli University Medical School, Nephrology, Kocaeli, Turkey
| | - Mustafa Sevinc
- Sisli Hamidiye Etfal Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Fatma Betul Guzel
- Sutcu Imam University Medical School, Nephrology, Kahramanmaraş, Turkey
| | - Serkan Feyyaz Yalin
- Dr Lutfi Kırdar Kartal Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Sim Kutlay
- Ankara University Medical School, Nephrology, Ankara, Turkey
| | - Suheyla Apaydin
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Nephrology, Istanbul, Turkey
| | | | - Sinan Kazan
- Afyonkarahisar SBU Medical School, Nephrology, Afyonkarahisar, Turkey
| | - Hamad Dheir
- Sakarya University Medical School, Nephrology, Sakarya, Turkey
| | - Feyza Bora
- Akdeniz University Medical School, Nephrology, Antalya, Turkey
| | - Taner Basturk
- Sisli Hamidiye Etfal Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - İdris Sahin
- Inonu University Medical School, Nephrology, Malatya, Turkey
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15
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Yılmaz F, Günen Yılmaz S, Sözel H, Bora F, Yılmaz AB. The prevalence of temporomandibular disorders in chronic hemodialysis patients: a cross-sectional study. Cranio 2020; 40:249-257. [PMID: 32079511 DOI: 10.1080/08869634.2020.1727170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: This study aimed to investigate the prevalence of temporomandibular disorders (TMD) in patients with chronic hemodialysis and evaluate the risk factors of developing TMD.Methods: One hundred forty-six subjects were included in the study. The examination for TMD was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders. Axis I protocol was used to evaluate the prevalence of TMD sub-diagnoses.Results: The prevalence of TMD was 41.5% in hemodialysis patients and significantly higher than in the control group. The most common symptom was TMJ pain, and the most common TMD subtype was muscular type. Female patients had significantly higher TMD than males. C-reactive protein, hemoglobin, parathyroid hormone, and albumin were significantly associated with TMD.Conclusion: There was an elevated prevalence of TMD in hemodialysis patients.
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Affiliation(s)
- Fatih Yılmaz
- Department of Nephrology, Antalya Atatürk State Hospital, Antalya, Turkey
| | - Sevcihan Günen Yılmaz
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Hasan Sözel
- Department of Internal Medicine, Antalya Gazipaşa State Hospital, Antalya, Turkey
| | - Feyza Bora
- Department of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ahmet Berhan Yılmaz
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
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17
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Bora F, Avsar E, Asar E, Sari F, Ersoy F, Cetinkaya R, Suleymanlar G. Starting of Renal Replacement Treatment: Two Years Experience. Turk J Nephrol 2019. [DOI: 10.5152/turkjnephrol.2019.3571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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18
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Ersoy FF, Sanli T, Bozkurt N, Bora F, Sarı F, Cetinkaya R, Süleymanlar G. SP513AN IMPROVED CAPD SUBMODALITY USING A NEW ASSIST DEVICE: CAAPD (CONTINUOUS AMBULATORY/AUTOMATED PERITONEAL DIALYSIS). Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Fevzi Ersoy
- Akdeniz University Medical School Hospital, Antalya, Turkey
| | - Turkan Sanli
- Akdeniz University Medical School Hospital, Antalya, Turkey
| | | | - Feyza Bora
- Akdeniz University Medical School Hospital, Antalya, Turkey
| | - Funda Sarı
- Akdeniz University Medical School Hospital, Antalya, Turkey
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19
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Yılmaz F, Bora F, Ersoy F. Peritoneal Dialysis Related Peritonitis by Sphingomonas Paucimobilis. Ther Apher Dial 2017; 22:205-206. [PMID: 29193656 DOI: 10.1111/1744-9987.12637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Fatih Yılmaz
- Division of Nephrology, Department of Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Feyza Bora
- Division of Nephrology, Department of Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Fevzi Ersoy
- Division of Nephrology, Department of Medicine, Akdeniz University Medical School, Antalya, Turkey
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20
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Yılmaz F, Bora F, Ersoy F. "Streptococcus vestibularis": A Rare Cause of Peritoneal Dialysis-Related Peritonitis. Ther Apher Dial 2017; 21:418-419. [PMID: 28321985 DOI: 10.1111/1744-9987.12538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/21/2017] [Accepted: 01/25/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Fatih Yılmaz
- Division of Nephrology, Department of Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Feyza Bora
- Division of Nephrology, Department of Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Fevzi Ersoy
- Division of Nephrology, Department of Medicine, Akdeniz University Medical School, Antalya, Turkey
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21
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Bora F, Yılmaz F, Bora T. Ecstasy (MDMA) and its effects on kidneys and their treatment: a review. Iran J Basic Med Sci 2016; 19:1151-1158. [PMID: 27917269 PMCID: PMC5126214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ecstasy (MDMA; 3,4-methylenedioxymethylamphetamine) is an illicit drug that has been increasingly abused by young people. Its effects include euphoria, enhanced sociability and heightened mental awareness. These come about via the increase of serotonin in both the central nervous system and the sympathetic nervous system. Despite the drug's prevalent abuse, serious or adverse effects are rare. Due to personal pharmacokinetics, effects from the same dosage vary according to the individual. Fatal instances may include acute hyponatremia, hyperthermia (>42 °C), disseminated intravascular coagulation (DIC) resulting from hyperthermia affecting the kidneys, and non-traumatic rhabdomyolysis. However, it is seldom the case that hyponatremia and hyperthermia co-exist. Hyponatremia is thought to be caused by HMMA - a metabolite of MDMA. Hyponatremia is caused by the inappropriate secretion of arginine vasopressin (AVP) and the excessive intake of hypotonic liquid accompanied by increased hyperthermia. Symptomatic, even deadly hyponatremia is seen more frequently in females, with the effects of oestrogen on arginine vasopressin believed to be the cause. Onset in such cases is acute, and treatment should be given to symptomatic patients as quickly as possible, with 3% saline administered when necessary. Reasons for acute kidney injury may include rhabdomyolysis, malign hypertension, and necrotizing vasculitis.
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Affiliation(s)
- Feyza Bora
- Department of Nephrology, Yenimahalle Training and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey,Corresponding author: Feyza Bora. Department of Nephrology, Yenimahalle Training and Research Hospital, Yıldırım Beyazıt University, Batıkent, Ankara, Turkey. Fax: +90312587 37 75;
| | - Fatih Yılmaz
- Department of Nephrology, State Hospital, Zonguldak, Turkey
| | - Taner Bora
- Department of Chemistry, Ankara Police Forensic Laboratory, Gölbaşı, Ankara, Turkey
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Basyigit S, Sapmaz F, Bora F. Eosinophilic Peritonitis Caused by Echinococcus granulosus in a Patient Receiving Maintenance Peritoneal Dialysis. Ther Apher Dial 2015; 20:92-3. [PMID: 26626146 DOI: 10.1111/1744-9987.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/19/2015] [Accepted: 06/29/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Sebahat Basyigit
- Kecioren Research and Training Hospital, Department of Gastroenterology, Ankara, Turkey.
| | - Ferdane Sapmaz
- Kecioren Research and Training Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Feyza Bora
- Yenimahalle State Hospital, Department of Nephrology, Ankara, Turkey
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23
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Altunoglu A, Ozturk C, Erten S, Kucuksahin O, Yayar OY, Bora F, Kilic L, Uz E, Ersoy O. SP036THE FREQUENCY OF MEFV GENE MUTATIONS IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv187.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Carotid body paragangliomas (CBP) are rare neoplasms arising from the small chemoreceptor organ in the adventitia of the common carotid bifurcation. The aim of this study is to present the diagnostic process, performed treatment and obtained results in patients with carotid body paragangliomas of the Department of Otolaryngology of Istanbul Education and Research Hospital between March 1997 and November 2008. Retrospective analysis was carried out, based on the medical documentation of 5 patients with carotid body paragangliomas (3 women and 2 men), age range 44 to 68 years with a mean of 59.6 years. Four of the patients were diagnosed and treated with Shamblin type II tumor, one of the patients with type I. Physical examination, radiological evaluation, method of the treatment and post-treatment complications were studied. The most common and single symptom was nonspecific neck mass. Preoperative diagnostic evaluation consisted of a color duplex ultrasonography, computerized tomography with contrast enhancement, magnetic resonance imaging and digital subtraction angiography. In all patients with Shamblin type I and II, blunt dissection of the tumor was conducted smoothly in the subadventitial plane. Postoperative vagus nerve and hypoglossal nerve deficit were reported in one case. Carotid body paraganglioma excision has higher risk of cranial nerve paresis and carotid artery injury, so it requires careful handling and good surgical skills to ensure complete removal.
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Affiliation(s)
- B A Erdogan
- Department of Otolaryngology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
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25
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Bora F, Aliosmanoglu I, Kocak H, Dinckan A, Uslu HB, Gunseren F, Suleymanlar G. Drug interaction between tacrolimus and ertapenem in renal transplantation recipients. Transplant Proc 2013. [PMID: 23195020 DOI: 10.1016/j.transproceed.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To show drug interactions between tacrolimus and ertapenem, we retrospectively evaluated 13 renal transplant recipients who had been treated with ertapenem for urinary tract infections during prescription of a constant dose. The mean dose of tacrolimus to achieve desired therapeutic concentrations decreased significantly after beginning ertapenem. The decrease from 0.079 mg/kg to 0.043 mg/kg occurred 2 days after initiation of ertapenem (P < .005). These results suggest that ertapenem, which is not metabolized through the cytochrome (CYP) P450 3A metabolic pathway, interacts with tacrolimus by an unknown mechanism. This report recommends tacrolimus concentration monitoring and dose reductions when the two drugs are administered in combination.
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Affiliation(s)
- F Bora
- Department of General Surgery, Dicle University Medical Facility, Diyarbakir, Turkey
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26
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Erdogan BA, Avseren E, Paksoy M, Bora F, Altin G. Assessing quality of life in septorhinoplasty patients with two different instruments. B-ENT 2013; 9:277-283. [PMID: 24597102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Quality of life (QOL) assessment in patients with nasal obstruction has not been well studied. The main objectives of this study were to determine the QOL of patients after septorhinoplasty, to measure the efficacy of septorhinoplasty with a validated quality-of-life instrument--the Nasal Obstructive Symptoms Evaluation (NOSE) scale--and with the Glasgow Benefit Inventory (GBI) QOL scores comprising patient assessments of nasal function. PATIENTS AND METHODS The patient population consisted of a consecutive series of 50 patients who underwent septorhinoplasty at the ages of 18 to 48 years between 2009 and 2011. Quality of life was assessed with the NOSE scale (pre- and postoperatively) and with GBI scores (postoperatively). Demographic data, along with patient assessments of nasal obstruction with a linear analogue scale, were recorded. RESULTS The mean patient age was 28.3 +/- 14.6 years (age range, 18-48 years). Twenty-eight patients were male (56%) and 22 (44%) were women. Evaluation of each of the 5 items on the NOSE scale individually revealed that patients experienced improvement in all areas. In this study, there was a statistically significant fall in all five parameters (p = 0.000 < 0.05). The mean total GBI score was 34.89 +/- 22.53 and the mean general subscale score was 38.25 +/- 24.31. The mean social support score was 19.67 +/- 33.79 and the mean physical health score was 36.67 +/- 27.97. Each patient had improved QOL scores on the GBI and NOSE scales (P < 0.05). CONCLUSIONS This study found improved QOL after rhinoplasty in Turkish adult patients. With proper pre-operative assessment and selection, excellent functional and psychosocial outcomes can be expected. NOSE and GBI are valuable tools for the assessment of benefit from nasal septal surgery for nasal obstruction and may be applicable in clinical practice.
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Affiliation(s)
- B A Erdogan
- Kartal Dr. Lutfi Kirdar Education and Research Hospital, ENT Department, Istanbul, Turkey.
| | - E Avseren
- Viransehir State Hospital, Otolaryngology Department, Turkey
| | - M Paksoy
- Kartal Dr. Lutfi Kirdar Education and Research Hospital, ENT Department, Istanbul, Turkey
| | - F Bora
- Kafkas University, Otolaryngology Department, Turkey
| | - G Altin
- Kartal Dr. Lutfi Kirdar Education and Research Hospital, ENT Department, Istanbul, Turkey
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