Changes in and the relationships between alpha-klotho, oxidative stress, and systemic inflammation in cigarette smokers

Background

Although smoking is known to accelerate aging, the mechanisms by which this occurs have not been fully clarified. Serum-soluble α-Klotho (sαKl), antiaging, anti-inflammatory, and developing resistance to oxidative stress properties are known.

Aim

This study aimed to determine the relationship between cigarette smoking, sαKl (antiaging hormone), inflammation, and oxidative stress.

Materials and Methods

Participants included in the study were divided into smoking and nonsmoking groups. sαKl, high-sensitivity C-reactive protein (hsCRP), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were assessed and compared in the study participants.

Results

There were one hundred and forty-six study participants comprising 47 (32.2%) females and 99 (67.8%) males. There were 79 (54.1%) in the nonsmoking group and 67 (45.9%) in the smoking group. A significant difference was found between the groups in respect of TAS (P < 0.001), OSI (P = 0.017), sαKl (P = 0.013), and hsCRP (P = 0.024) values. A significant negative correlation was found between the sαKl values of the smoking group and the years of smoking (r = -0.271, P = 0.038) and pack-years (r = -0.299, P = 0.021). Among the smoking group, a lower median sαKl value of <3.84 pg/ml was significantly associated with years of smoking (P = 0.028) and pack-years (P = 0.012).

Conclusions

This study found that sαKl, OSI, and hsCRP were elevated in those who smoke cigarette. Large prospective studies are needed to further elucidate this area of research.

EVALUATION OF THE ASSOCIATION OF PLASMA PENTRAXIN-3 LEVELS WITH CAROTID INTIMA-MEDIA THICKNESS AND HIGH-SENSITIVE CRP IN PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM

Context

Inflammation-related markers may predict cardiovascular diseases.

Objective

In this study, it was aimed to assess pentraxin-3 (PTX-3) levels and its relationship with carotid intima-media thickness (CIMT) and high-sensitive C-reactive protein (hsCRP) in patients with subclinical hypothyroidism.

Design

Prospective cross-sectional study.

Methods

This study included 60 patients (aged 30-60 years) with subclinical hypothyroidism and 30 healthy volunteers as controls. The demographic characteristics and anthropometric measurements were performed in all patients and controls. In addition, sonographic carotid artery examination, thyroid functional tests, lipid profile, hsCRP, and PTX-3 levels of the participants were investigated.

Results

The PTX-3, hsCRP levels and CIMT were higher in patients with subclinical hypothyroidism when compared to controls (p=0.008, p=0.001, p<0.001, respectively). The PTX-3 level was strongly correlated with hsCRP (r=0.865; p<0.001), but no such correlation was detected with CIMT (r=-0.255; p=0.50). In binominal logistic regression analysis, it was found that CIMT and serum uric acid levels were independent parameters associated with subclinical hypothyroidism. In ROC analysis, a cut-off value of >3.75 ng/mL for serum PTX-3 level predicted subclinical hypothyroidism with a sensitivity of 60% and specificity of 60.7% (AUC: 0.672, p=0.004).

Conclusion

Showing inflammation and endothelial dysfunction, the PTX-3 may be a helpful marker in patients with subclinical hypothyroidism associated with increased risk for cardiovascular disease.

The association of soluble Klotho levels with anemia and hemoglobin variability in hemodialysis patients

INTRODUCTION

The anti-aging protein Klotho levels are decreased, and Klotho deficiency is associated with cardiovascular diseases in patients with chronic kidney disease. There are recent studies about the relation between soluble Klotho levels and anemia. We aimed to investigate the correlation of anemia and hemoglobin variability with soluble Klotho levels in hemodialysis patients.

METHODS

Ninety-one hemodialysis patients were included in this study. The mean hemoglobin value, hemoglobin variability, and coefficient of variation of hemoglobin for each patient were calculated. According to mean hemoglobin levels, two groups were defined as under 11 and ≥11 g/dl. Soluble Klotho levels of each patient were studied.

RESULTS

Mean hemoglobin levels, hemoglobin variability, and coefficient of variation of hemoglobin were not significantly correlated with soluble Klotho levels. According to mean hemoglobin levels under 11 and ≥ 11 g/dl, there was no statistically significant correlation between anemia and soluble Klotho levels.

CONCLUSION

Soluble Klotho levels were not associated with anemia and hemoglobin variability in hemodialysis patients. Further studies are needed to reveal the complicated relation between anemia and soluble Klotho levels.

The Relationship between Bone Mineral Densitometry and Visceral Adiposity Index in Postmenopausal Women

OBJECTIVE

 It was aimed to compare visceral adiposity index (VAI) levels in patients with normal bone mineral density (BMD), osteopenia, and osteoporosis.

METHODS

 One hundred twenty postmenopausal women (40 with normal BMD, 40 with osteopenia, and 40 with osteoporosis) between the ages of 50 to 70 years were included in the study. For females, the VAI was calculated using the formula (waist circumference [WC]/[36.58 + (1.89 x body mass index (BMI))]) x (1.52/High-density lipoprotein [HDL]-cholesterol [mmol/L]) x (triglyceride [TG]/0.81 [mmol/L]).

RESULTS

 The time of menopause from the beginning was similar in all groups. Waist circumference was found to be higher in those with normal BMD than in the osteopenic and osteoporotic groups (p = 0.018 and p < 0.001, respectively), and it was also higher in the osteopenic group than in the osteoporotic group (p = 0.003). Height and body weight, BMI, blood pressure, insulin, glucose, HDL-cholesterol, and homeostasis model assessment-insulin resistance (HOMA-IR) levels were similar in all groups. Triglyceride levels were found to be higher in the normal BMD group, compared with the osteoporotic group (p = 0.005). The level of VAI was detected as higher in those with normal BMD, compared with the women with osteoporosis (p = 0.002). Additionally, the correlation analysis showed a positive correlation between dual-energy X-ray absorptiometry (DXA) spine T-scores, WC, VAI, and a negative correlation between DXA spine T-scores and age.

CONCLUSION

 In our study, we found higher VAI levels in those with normal BMD, compared with women with osteoporosis. We consider that further studies with a larger sample size will be beneficial in elucidating the entity.

The impact of COVID-19 pandemic on anxiety levels among patients who have to go to the hospital due to chronic illnesses: A prospective study

INTRODUCTION

Cancer and hemodialysis (HD) patients are at high risk for COVID-19. In our study, we aimed to evaluate the effect of pandemic on anxiety in these patients.

METHODS

One hundred and six oncology and 97 HD patients participated in the study. Anxiety levels were assessed by using the Beck Anxiety Inventory (BAI) and State-Trait Anxiety Inventory (STAI). At the end of 8-month follow-up, these questionnaires were re-administered.

RESULTS

During this period, 38 patients (38/203; 18.7%) had COVID-19 infection. Twenty-three patients (23/203; 11.3%) died due to COVID-19 and/or other causes. One hundred and thirteen of the remaining patients were participated in the second questionnaire. Having COVID-19 was not the independent factor for changes in STAI, and BAI scores in any regression models.

CONCLUSION

Having COVID-19 does not affect the increased anxiety levels in HD and oncology patients. The effect of the pandemic may have remained in the background, as these patients have more concerns about their own diseases.

The probabilities of type I and II error of null of cointegration tests: A Monte Carlo comparison

This paper evaluates the performance of eight tests with null hypothesis of cointegration on basis of probabilities of type I and II errors using Monte Carlo simulations. This study uses a variety of 132 different data generations covering three cases of deterministic part and four sample sizes. The three cases of deterministic part considered are: absence of both intercept and linear time trend, presence of only the intercept and presence of both the intercept and linear time trend. It is found that all of tests have either larger or smaller probabilities of type I error and concluded that tests face either problems of over rejection or under rejection, when asymptotic critical values are used. It is also concluded that use of simulated critical values leads to controlled probability of type I error. So, the use of asymptotic critical values may be avoided, and the use of simulated critical values is highly recommended. It is found and concluded that the simple LM test based on KPSS statistic performs better than rest for all specifications of deterministic part and sample sizes.

Effect of anxiety on COVID-19 infection in hemodialysis patients

Some evidence suggests that anxiety deteriorate the immune system. We aimed to determine the effect of anxiety on COVID‐19 infection in hemodialysis (HD) patients. Our study was conducted with 80 HD patients. State‐Trait Anxiety Inventory (STAI), and Beck Anxiety Inventory (BAI) questionnaires were administered between April 15 and May 1, 2020. These patients were followed up for about 8 months and COVID‐19 infection, hospitalization, and death rates were recorded. Twenty‐one (26%) of the patients were diagnosed with COVID‐19 infection. Fourteen out of twenty one (66.6%) of the patients were hospitalized, and 8/21 (38%) of them died due to COVID‐19. STAI‐S (p= 0.006) and BAI (p= 0.021) scores were found to be higher and STAI‐T (p= 0.040) score was found to be lower in HD patients who were infected with COVID‐19 compared to without, at the follow‐up period. It might be concluded in this study that COVID‐19 was more common in anxious HD patients.

The Relationship between Polycystic Ovary Syndrome and Serum Periostin Level

OBJECTIVE

To determine the changes of circulating periostin levels in polycystic ovary syndrome (PCOS) and its relationship with metabolic disorders.

STUDY DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Konya Research and Training Hospital, Turkey between September 2018 and April 2020.

METHODOLOGY

Patients with PCOS were compared with healthy individuals as control. The demographics, laboratory findings, anthropometric measurements, the levels of serum periostin and carotid intima media thickness (CIMT) were evaluated and compared.

RESULTS

There was no significant difference between patients with PCOS (n = 53) and controls (n = 35), according to demographic and laboratory findings and anthropometric measurements. The CIMT in patients with PCOS and control groups were measured as 0.5 ± 0.06 mm and 0.43 ± 0.1 mm, respectively (p <0.003). The levels of periostin in the patients with PCOS and control groups were found to be 6.43 ± 6.19 ng/mL and 3.61 ± 3.79 ng/mL, respectively (p <0.018). No statistically significant correlations were found according to periostin levels and metabolic variables.

CONCLUSION

Although there was no significant correlation between the periostin levels and the metabolic variables in patients with PCOS as compared to those without the periostin levels, but CIMT were higher in PCOS group. Key Words: Atherosclerosis, Carotid intima-media thickness, Insulin resistance, Periostin protein, Polycystic ovary syndrome.

Evaluation of sirtuin 1 (SIRT1) levels in autosomal dominant polycystic kidney disease

PURPOSE

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease and the majority of patients have a PKD-1 or PKD-2 mutation. Sirtuin 1 (SIRT1) has roles in cellular aging, antioxidant activity, cellular proliferation. In an experimental study, inhibition of SIRT1 was found to delay renal cyst development in ADPKD. The purpose of this study is to determine the SIRT1 levels in ADPKD patients. To our knowledge, this is the first study that investigating blood and urine SIRT1 levels in ADPKD patients.

METHODS

Sixty-seven patients with ADPKD and 34 control cases with normal renal functions and without renal cysts were included in this study. Serum and urine SIRT1 concentrations were determined by human enzyme-linked immunosorbent assay (ELISA) kit. 24-h urine samples were used for urine SIRT1 measurements.

RESULTS

The urine SIRT1 levels were statistically significantly lower in ADPKD patients group (p < 0.001). Although blood SIRT1 levels of ADPKD patients were higher than control cases but there were no statistically significant difference between the groups in terms of blood SIRT1 levels. Urine SIRT1 levels (β = 2.452, CI 95% 1.419-4.239, p = 0.001) were found an independent factor in multivariate regression analysis for ADPKD.

CONCLUSIONS

Urine SIRT1 levels were lower in ADPKD patients than control group. The low urinary SIRT1 levels despite the similar blood SIRT1 levels might be due to the impaired metabolism of SIRT1 in ADPKD patients; this state might has a role in cyst development.

The relationship of soluble klotho level with uremic cardiomyopathy and ecocardiographic parameters in hemodialysis patients

There are studies reporting that soluble kltho (sKlotho) deficiency plays a role in cardiovascular disease in addition to traditional risk factors such as diabetes, hypertension, anemia, smoking, and excessive volume burden. Our aim in this study was to investigate the relationship of sKlotho with uremic cardiomyopathy and echocardiographic parameters in patients receiving hemodialysis treatment. According to the median value, the sKlotho value was divided into two groups as ≥1.24 and <1.24 ng/ml. Ventricular wall thicknesses, ejection fractions, left atrium, M mode aorta systole, and diastole diameter measurements were taken. The left ventricular mass (LVM) was calculated using the Devereux formula. There were significant differences between the two groups in terms of age, number of patients with diabetes mellitus, comorbidity, dialysis time, sKlotho, phosphorus, parathormone, and albumin parameters. No significant difference was found between the two groups that were separated according to the median sKlotho value, when the echocardiographic parameters of interventricular septum thickness, left ventricular posterior wall thickness, left atrial diameter, left ventricular ejection fraction, and LVM index were compared. In conclusion, sKlotho is not a marker for showing and predicting uremic cardiomyopathy in hemodialysis patients.

Lipid accumulation product and visceral adiposity ındex: two new indices to predict metabolic syndrome in chronic kidney disease

OBJECTIVE

The aim of this study was to assess the ability of lipid accumulation product (LAP) and visceral adiposity index (VAI) to predict metabolic syndrome (MetS) in patients with chronic kidney disease (CKD). We also aimed to determine whether VAI and LAP indices are superior to traditional body indices such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR).

PATIENTS AND METHODS

This study was performed by retrospectively scanning the files of patients with stage 3-5 chronic renal failure who came for nephrology outpatient follow-up between January 2017 and December 2017. Metabolic syndrome was identified using the 2009 harmonized criteria. The receiver operating characteristic curve (ROC) was used to compare the area under the ROC curve (AUC) of each index.

RESULTS

247 patients were included in the analyses. The prevalence of MetS was 80.9%. LAP was determined as the optimal predictor in chronic kidney disease patients, with 0.864 AUC in females and 0.908 AUC in males. Optimal cut-off values for LAP were 33.5 in females and 36.6 in males. VAI was the second most optimal predictor, with 0.856 AUC in females and 0.888 AUC in males. Optimal cut-off values for VAI were 2.24 in females and 1.56 in males.

CONCLUSIONS

LAP and VAI are effective indices for the prediction of MetS in patients with chronic kidney disease; LAP is the best index for the determination of MetS in both men and women.

The relationship between glomerular filtration rate, and metabolic and inflammatory parameters in obese and non-obese patients with polycystic ovary syndrome

AIM

To investigate the relationship between glomerular filtration rates (GFR), and homeostasis model assesment of insulin resistance (HOMA-IR), C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) in patients with polycystic ovary syndrome (PCOS).

MATERIAL AND METHODS

Thirty-one overweight and obese PCOS patients with body mass index (BMI)≥25kg/m² and 25 non-obese PCOS patients with BMI<25kg/m² were included into patients' group, while 23 overweight and obese, and 25 non-obese age-and BMI-matched healthy individuals (aged between 18 and 40 years), were enrolled as controls. Levels of serum creatinine, glucose, insulin, CRP, and complete blood count were measured. eGFR, HOMA-IR and NLR were also calculated.

RESULTS

In PCOS group, HOMA-IR (p=0.001), CRP (p=0.025) and waist hip ratio (WHR) (p=0.011) were higher than controls. In obese PCOS sub-group, HOMA-IR (p=0.004) and WHR (p=0.002) were higher than obese controls. In non-obese PCOS sub-group, HOMA-IR (p=0.001) were higher than non-obese controls. In obese PCOS sub-group; HOMA-IR (p=0.001) and CRP (p=0.001) levels were significantly higher than non-obese PCOS sub-group. In terms of other parameters, no significant difference was found between the groups. The analysis showed a negative correlation between GFR, and BMI and HOMA-IR in PCOS group, between GFR, WHR and insulin levels in obese PCOS sub-group, and between BMI, and HOMA-IR and NLR in non-obese PCOS sub-group.

CONCLUSION

Although HOMA-IR and CRP were higher in PCOS group, there was no difference in NLR and GFR levels between those with PCOS and controls.

Does altitude affect blood gases in hemodialysis patients?

INTRODUCTION

This study aimed to determine whether predialysis blood gases is affected by altitude differences in hemodialysis patients with arteriovenous fistulas living in Turkey at three different altitudes.

METHODS

Patients' predialysis blood gases were compared by standardizing both arterial blood gases collections and working methods for patients undergoing hemodialysis using a dialysate with the same properties at altitudes of 30 m (sea level), 1020 m (moderate altitude), and 1951 m (high altitude).

FINDINGS

Blood gases disorders were detected in 32 (82.1%) high altitude group patients, whereas 49 (74.2%) sea level group patients had no blood gases disorders (P < 0.001). pH values in the high altitude group were significantly lower than those in the other groups, and the pH increased as altitude decreased (P < 0.001). The partial pressure of carbon dioxide (PaCO₂ ) values was higher in the sea level group than in the other groups and increased at lower sea levels (P < 0.001). Bicarbonate values were significantly higher in the sea level group than in the other groups and increased at lower sea levels, similar to PaCO₂ values (P < 0.001). The partial pressure of oxygen (PaO₂ ) values in the high altitude and sea level groups were significantly higher and increased at lower sea levels (P < 0.001). The oxygen saturation (SaO₂ ) values were significantly lower in the high altitude group than in the other groups and increased gradually at lower sea levels (P < 0.001).

DISCUSSION

Predialysis metabolic acidosis was more pronounced in patients undergoing hemodialysis at high altitudes, whereas PaCO₂ , PaO₂ , and SaO₂ values were lower.

The association of decreased testosterone with atherosclerosis and inflammation in male predialysis patients with chronic kidney disease

PURPOSE

To investigate the frequency of hypogonadism and its relationship to inflammation and carotid intima-media thickness (CIMT) in male patients with predialysis chronic kidney disease (CKD).

METHODS

A total of 105 patients with CKD, 55 (52.4%) as stage 3, 33 (31.4%) as stage 4 and 17 (16.2%) as stage 5, were enrolled into the study. Total testosterone (TT) and free testosterone (FT), interleukin 6 (IL-6), C-reactive protein (CRP) levels, and CIMT were measured.

RESULTS

According to TT and FT, hypogonadism was detected in 18 (17.1%) and 22 (20.9%) patients, respectively. There was no difference in terms of TT and FT, CIMT, CRP and IL-6 between the stages of CKD. According to TT, the patients with hypogonadism had significantly higher CRP and high-density lipoprotein cholesterol (HDL-cholesterol) levels (p=0.004 and p=0.005, respectively). There was no significant difference in other parameters. According to FT, the patients with hypogonadism had significantly higher CRP (p=0.017), and TT were negatively correlated with body mass index (BMI), waist circumference (WC), hip circumference, and CRP levels. FT was negatively correlated with age, waist circumference, systolic blood pressure, diastolic blood pressure (DBP) and CRP.

CONCLUSIONS

The frequency of hypogonadism was found around 17-21% among the patients with CKD. Despite similar IL-6 and CIMT levels, CRP was found to be higher in the patients with hypogonadism. We consider that further studies with larger populations are needed to elucidate the entity.

THYROID DISORDERS PREVALENCE IN A COHORT OF KIDNEY TRANSPLANT RECIPIENTS

Context

As the life expectancy prolongs, malignancy has become an important issue in renal transplant recipients (RTRs). Thyroid cancer is the most common endocrine malignancy with ongoing increase in incidence all over the world.

Objective and design

This is a cross-sectional study that investigates the thyroid disorders and the prevalence of thyroid nodule and cancer in RTRs.

Subjects and methods

204 RTRs were evaluated for the thyroid diseases with ultrasonography, serum thyroid stimulating hormone, free T4, free T3 levels, anti-thyroglobulin antibody and anti-thyroid peroxidase antibody levels; FNAB was carried if required.

Results

191 patients (94.1%) had normal thyroid function. Subclinical hypothyroidism was diagnosed in 11 patients, subclinical hyperthyroidism in 1 patient and low T3 syndrome in 4 patients. The FNAB was performed in 17 (27.9%) from 61 patients with thyroid nodule. The cytological examination of biopsy materials revealed that 2 (11.8%) nodules were suspicious for malignancy, 13 (76.5%) were benign, and 2 (11.8%) with non diagnostic cytology. Thyroid cancer prevalence was 0.2% in Turkey but we detected that 0.98% of RTRs had thyroid cancer.

Conclusions

Screening the RTRs for thyroid disorders is necessary, so that early diagnosis and appropriate treatment of thyroid disease and cancer may improve the quality of life.

Nondipping heart rate and associated factors in patients with chronic kidney disease

BACKGROUND

Nondipping heart rate (NHR) is a condition reported to be associated with cardiovascular events and cardiovascular mortality recently. We aimed to search whether there is difference among hypertensive patients with and without chronic kidney disease (CKD) in terms of NHR pattern and the factors associated with NHR in patients with CKD.

METHODS

The study included 133 hypertensive patients with normal kidney functions, 97 hypertensive patients with predialysis CKD, and 31 hypertensive hemodialysis patients. Heart rate, blood pressure and pulse wave velocity (PWV) were measured by 24-h ambulatory blood pressure monitorization. NHR was defined as a decrease of less than 10% at night mean heart rate when compared with daytime values.

RESULTS

NHR pattern was established as 26.3% in non-CKD hypertensive group, 43.3% in predialysis group and 77.4% in dialysis group. Among patients with CKD, when NHR group was compared with dipper heart rate group, it was seen that they were at older age, there were higher prevalence of diabetes mellitus and more female sex, and while the value of urea, creatinine, phosphorus, intact parathyroid hormone, and PWV were significantly higher, the value of hemoglobin, albumin and calcium were significantly lower. By multivariate analysis, hemoglobin [odds ratio (OR) 0.661; 95% CI 0.541-0.806; p < 0.001] and PWV (OR 1.433; 95% CI 1.107-1.853; p = 0.006) were established as independent determinants of NHR pattern.

CONCLUSIONS

NHR pattern is significantly more frequently seen in hypertensive CKD patients than in hypertensive patients with non-CKD. Anemia and increased arterial stiffness are seen independently associated with NHR in CKD patients.

Serum endocan levels, carotid intima-media thickness and microalbuminuria in patients with newly diagnosed hypertension

Background: Endocan is a particular protein of endothelial cells. The purpose of this study was to determine the relationship of serum endocan levels with carotid intima-media thickness (cIMT), inflammation, and microalbuminuria in patients with newly-diagnosed hypertension.Materials-Methods: This prospective study included 61 patients with newly-diagnosed hypertension (HT) and 30 controls. Endocan, microalbuminuria and cIMT measurements were taken from all patients.Results: The serum endocan levels, the mean cIMT and microalbuminuria levels of patients with HT were significantly higher than those of the control group (p < .0001, p = .015 and p < .001, respectively).Conclusion: We found that endocan levels were increased in our study. This increase in endocan levels shows a relation with cIMT and microalbuminuria, which are associated with endothelial dysfunction.

A Rare Case of Acute Kidney Injury: McKittrick Wheelock Syndrome

McKittrick-Wheelock syndrome is a rare complication of rectosigmoid villous adenoma leading to secretory diarrhea, prerenal acute kidney injury and severe fluid and electrolyte imbalances. There are about 50 cases reported in literature. We represent a case of 71 year-old patient with persistant chronic diarrhea, prerenal azotemia, severe hypokalemia, and hyponatremia. Initially, the patient's kidney function and serum potassium values were normalized by conservative treatment, and villous adenoma was removed by surgery.

Predictors of Sleep Quality in Hemodialysis Patients

Purpose

Poor sleep quality (SQ) is common in hemodialysis (HD) patients. Factors associated with poor SQ are not well understood. The objectives of the present study were to determine the prevalence of poor SQ in HD patients in our region and to examine the association between SQ and health-related quality of life (HRQoL), depression, and certain clinical and laboratory parameters.

Methods

A total of 233 HD patients at 5 centers in the city center of Konya, Turkey were included in this study. Their demographic data and biochemical parameters were analyzed. All patients were instructed to complete Turkish versions of three questionnaires, namely, a modified post-sleep inventory (PSI), Beck Depression Inventory (BDI) and a Short Form of Medical Outcomes Study (SF-36).

Results

The mean age of the patients was 52.8±15.3 years and the male to female ratio was 1.33:1. The prevalence of poor sleepers, defined as those having a total sleep score (PSI-4 score) ≥ 4, was 60.9%. Compared with good sleepers, poor sleepers had higher BDI scores and as well as lower PCS and MCS domains of HRQoL. In addition, poor sleepers were older and more likely to be unemployed. There was a significant inverse correlation of PSI-4 score with PCS and MCS, and significant positive correlation of PSI-4 score with BDI and age (p<0.001). The significant independent predictors of PSI-4 score were BDI score, MCS score and employment status.

Conclusions

Depression, MCS score and employment status were the most important predictors of sleep quality in HD patients.

Predictive Value of Atrial Electromechanical Delay on Long-Term Cardiovascular Outcomes in Hemodialysis Patients

BACKGROUND

Atrial electromechanical delay (AEMD) times were considered independent predictors of cardiovascular morbidity among the general population. We aimed at evaluating AEMD times and other risk factors associated with 2-year combined cardiovascular (CV) events in HD patients.

MATERIAL AND METHODS

Sixty hemodialysis (HD) and 44 healthy individuals were enrolled in this prospective study. Echocardiography was performed before the mid-week dialysis session for HD patients. Data were expressed as mean ± SD. Spearman test was used to assess linear associations. Survival was examined with the Kaplan-Meier method. Multivariate Cox regression analysis was used to determine the predictors of combined CV events in this cohort.

RESULTS

At the beginning of the study, left intra-atrial-AEMD times were significantly longer in HD patients compared to the left intra-atrial-AEMD times in healthy individuals. After 24 months, 41 patients were still on HD treatment and 19 (31.6%) had died. Serum triglyceride, total cholesterol and albumin were found to be higher and C-reactive protein (CRP) levels, left intra-atrial EMD time (LIAT) and interatrial EMD times were found to be lower in survived HD patients. With the cut-off median values of 3.5 g/dl for albumin, 0.87 mg/dl for CRP, 157 mg/dl for total cholesterol and 151 mg/dl for triglyceride, the Kaplan-Meier curves demonstrated significant differences in terms of all-cause mortality. We also demonstrated the Kaplan-Meier survival curves of HD patients according to tertile values of LIAT. Cox regression analysis revealed that increased CRP and higher LIAT were found to be independent predictors of combined CV events.

CONCLUSIONS

Increased LIAT and inflammation were found to be closely associated with 2 years combined CV events and all-cause mortality in HD patients.

Determination of minimum enzymatic decolorization time of reactive dye solution by spectroscopic & mathematical approach

Synthetic dyes are very important for textile dyeing, paper printing, color photography and petroleum products. Traditional methods of dye removal include biodegradation, precipitation, adsorption, chemical degradation, photo degradation, and chemical coagulation. Dye decolorization with enzymatic reaction is an important issue for several research field (chemistry, environment) In this study, minimum decolorization time of Remazol Brilliant Blue R dye with Horseradish peroxidase enzyme was calculated using with mathematical equation depending on experimental data. Dye decolorization was determined by monitoring the absorbance decrease at the specific maximum wavelength for dye. All experiments were carried out with different initial dye concentrations of Remazol Brilliant Blue R at 25 degrees C constant temperature for 30 minutes. The development of the least squares estimators for a nonlinear model brings about complications not encountered in the case of the linear model. Decolorization times for completely removal of dye were calculated according to equation. It was shown that mathematical equation was conformed exponential curve for dye degradation.

Effect of MDR1 polymorphisms on the blood concentrations of tacrolimus in Turkish renal transplant patients

BACKGROUND

Tacrolimus, a calcineurin inhibitör, is prescribed to prevent allograft rejection in renal transplantation. Tacrolimus not only has a narrow therapeutic index, but also shows significant interindividual differences. The absorption and metabolism of this drug are affected by multidrug resistance (MDR) 1 gene polymorphisms that correlated with single-nucleotide polymorphisms (SNPs) affecting in vivo P-glycoprotein activity. This study investigated associations of MDR1 gene C3435T polymorphism with tacrolimus blood concentrations and dose requirements as well as acute rejection episodes among Turkish renal transplant patients.

METHODS

One hundred living-donor transplant recipients and 150 healthy control subjects underwent C3435T genotyping using polymerase chain reaction-restriction fragment length polymorphism. Blood concentrations of tacrolimus were determined with the cloned enzyme donor immunoassay.

RESULTS

The CC, CT, and TT genotype frequencies among patients were, respectively, 44.0%, 33.0%, and 23.0% versus 36.7%, 43.3%, and 20.0% among control subjects. There was no significant difference between (P = .061; P = .102; P = .211; respectively). The ratio of blood concentration to dose of tacrolimus for patients with mutant homozygous 3435 TT genotype was higher than that of wild-type 3435 CC genotype homozygous individuals. The doses for these patients were lower at 1, 3, and 12 months (P = .048; P = .03; P = .041, respectively). There were no significant differences between the groups regarding coprescription of drugs that affect tacrolimus concentrations, such as diltiazem. Acute rejection episodes were not associated with the CC vs CT or TT genotypes: odds ratio (OR), 0.517 (95% confidence interval [CI], 0.190-1.407; P = .192); OR 1.558 (95% CI, 0.587-4.136; P = .372); OR 1.346; (95% CI, 0.456-3.968; P = .590), respectively.

CONCLUSIONS

Determination of MDR1 polymorphism may help to achieve target of tacrolimus blood concentrations.

Masked hypertension in renal transplant recipients

PURPOSE

Arterial hypertension is a risk factor affecting graft function in renal transplant recipients (RTRs). In pediatric RTRs, high prevalence of masked and nocturnal hypertension was reported. Most of the RTRs had a history of hypertension and some of them were normotensive at outpatient visits whereas home blood pressure (BP) levels were higher. Masked hypertension (MHT) is defined as a normal office BP but an elevated ambulatory BP. Previous reports have demonstrated the detrimental role of MHT in clinical outcomes in hypertensive patients. However, the true prevalence of MHT in RTRs is yet to be defined.

METHODS

A total of 113 RTRs (mean age 44 ± 16 years, 72 males, 41 females) with normal office BP (< 140/90 mmHg) were enrolled to the study from the outpatient renal transplantation clinic. Ambulatory BP monitoring (ABPM) was performed in all participants for a 24-h period. Average daytime BP values above 135 mmHg systolic and 85 mmHg diastolic were defined as MHT.

RESULTS

The prevalence of MHT in our cohort was 39% (n = 45). Fasting glucose and C-reactive protein levels were higher in patients with MHT compared with normal BP group (p = 0.02 and p = 0.04, respectively). RTRs with deceased donor type had higher prevalence of MHT than RTRs with living donor (40% vs 19%, p = 0.003). In multivariate analysis, deceased donor type could predict the MHT independent of age, gender, office systolic BP level, diabetes mellitus, serum creatinine, C-reactive protein, and glucose levels (OR = 3.62, 95% CI 1.16-11.31, p = 0.03).

CONCLUSION

We demonstrated an increased prevalence of MHT in a typical renal transplant cohort. In addition, transplantation from a deceased donor may be a predictor of MHT. The prevalence of MHT may help to explain high rate of cardiovascular events in RTRs. Therefore, routine application of ABPM in RTRs may be plausible, particularly in RTRs with deceased donor type.

Health-related qualıty of lıfe, sleep qualıty, and depressıon in peritoneal dialysis and hemodıalysıs patıents

Health-related quality of life (HRQoL) and sleep quality (SQ) were impaired in patients with end-stage renal disease (ESRD). The impairment of both HRQoL and SQ and being in a depressive mood were found to be associated with increased morbidity and mortality in dialysis patients. We aimed to investigate the association between SQ, HRQoL, and depression, and to define independent predictors of SQ and depression in peritoneal dialysis (PD) and hemodialysis (HD) patients. Ninety HD patients (41 females, 49 males with mean age 50 ± 15.7 years) and 64 PD patients (27 females, 37 males with mean age 52.4 ± 15.3 years) receiving renal replacement therapy for at least 3 months were screened for the assessment of SQ, HRQoL, and depression in this cross-sectional study. A modified postsleep inventory, Short Form of Medical Outcomes Study (SF-36) and Beck depression inventory (BDI) were applied to all patients for evaluating SQ, HRQoL, and depression, respectively. HD and PD patients had similar total SQ scores. Physical and mental component scale of HRQoL were found to be significantly higher in HD patients (p < 0.001). PD patients were found to be much more in depressive mood when compared with HD patients (p < 0.001). Independent predictors of depression in patients were mental component scale of HRQoL, gender (being female), and dialysis modality (being PD patient). Physical component scale was also found to be an independent predictor of SQ. This study showed that despite similar SQ scores between two groups, HD patients had better HRQoL and less depression than PD patients.

An exceedingly rare localization of a brown tumor in a hemodialysis patient

Brown tumor, which is seen in the context of hyperparathyroidism, is defined as a uremic bone disease characterized by increased osteoclastic activity and fibroblastic proliferation in the involved bone. In chronic renal failure, there is an excessive parathyroid hormone secretion due to hypocalcemia, hyperphosphatemia, and vitamin D deficiency. Brown tumor of the femur, facial bones, mandible, sternum, ribs, and pelvis are rare, whereas, it rarely involves sacrum. Here, we presented a brown tumor of the sacrum that developed secondary to parathyroid hyperplasia in a patient receiving hemodialysis.

Relationship between Plasma Pentraxin-3, Neutrophil-to-Lymphocyte Ratio, and Atherosclerosis in Renal Transplant Patients

BACKGROUND/AIMS: Atherosclerosis and inflammation are the most important risk factors in the pathogenesis of cardiovascular diseases (CVD) in patients with end-stage renal disease (ESRD). Pentraxin-3 (PTX-3) was shown to predict inflammation and atherosclerosis in ESRD patients. However, the role of renal transplantation (Rtx) in terms of atherogenesis is still unclear. We aimed to investigate the relationship between PTX-3, neutrophil-to-lymphocyte ratio (NLR), and carotid intima-media thickness (CIMT) in Rtx patients and healthy controls. METHODS: This was a cross-sectional study involving 29 Rtx patients (12 females, 40.1 ± 11.9 years) without overt CVD and 19 healthy subjects (9 females, 36.9 ± 8.9 years), testing the relationship between CIMT, assessed by ultrasonography, and selected biomarkers. RESULTS: CIMT, PTX-3, and high-sensitivity C-reactive protein (hs-CRP) levels of Rtx patients were found to be significantly higher compared to healthy subjects. CIMT was positively correlated with age, creatinine, uric acid, triglyceride, PTX-3, hs-CRP, and NLR, and negatively correlated with estimated glomerular filtration rate in all participants. In Rtx patients, CIMT was positively correlated with age, BMI, serum phosphorus, low-density lipoprotein, and hs-CRP. The multivariate analysis revealed that hs-CRP was found to be an independent variable of CIMT in Rtx patients. CONCLUSION: Our data showed that inflammation and atherosclerosis persist in Rtx patients. Serum hs-CRP might be a useful marker to assess these parameters in this population.

Sleep quality, depression, and quality of life in elderly hemodialysis patients

OBJECTIVE

Both the incidence and the prevalence of end-stage renal disease (ESRD) in elderly patients are increasing worldwide. Elderly ESRD patients have been found to be more prone to depression than the general population. There are many studies that have addressed the relationship between sleep quality (SQ), depression, and health related quality of life (HRQoL) in ESRD patients, but previous studies have not confirmed the association in elderly hemodialysis (HD) patients. Therefore, the aim of the present study was to demonstrate this relationship in elderly HD patients.

PATIENTS AND METHODS

Sixty-three elderly HD patients (32 females and 31 males aged between 65 and 89 years) were included in this cross-sectional study. A modified Post-Sleep Inventory (PSI), the Medical Outcomes Study 36-item short form health survey, and the Beck Depression Inventory (BDI) were applied.

RESULTS

The prevalence of poor sleepers (those with a PSI total sleep score [PSI-4 score] of 4 or higher) was 71% (45/63), and the prevalence of depression was 25% (16/63). Of the 45 poor sleepers, 15 had depression, defined as a BDI score of 17 or higher. Poor sleepers had a significantly higher rate of diabetes mellitus (P = 0.03), significantly higher total BDI scores, and lower Physical Component Scale scores (ie, lower HRQoL) than good sleepers. The PSI-4 score correlated negatively with Physical Component Scale (r = -0.500, P < 0.001) and Mental Component Scale scores (r = -0.527, P < 0.001) and it correlated positively with the BDI score (r = 0.606, P < 0.001). In multivariate analysis, independent variables of PSI-4 score were BDI score (beta value [β] = 0.350, P < 0.001), Mental Component Scale score (β = -0.291, P < 0.001), and age (β = 0.114, P = 0.035).

CONCLUSION

Poor SQ is a very common issue and is associated with both depression and lower HRQoL in elderly HD patients.

Poor quality of life is associated with increased mortality in maintenance hemodialysis patients: a prospective cohort study

Despite all developments in hemodialysis (HD), the mortality rate is still apparently higher than that in the general population, and worse health-related quality of life (HRQOL) is associated with increased mortality. We prospectively investigated the mortality status of HD patients during a five-year period and the association between mortality, HRQOL, laboratory parameters and clinical and sociodemographic characteristics at baseline. At the end of the five years, 293 patients out of 420 patients were still on HD treatment and 127 patients died. Those who died had a higher mean age, lower mean values of serum creatinine and albumin, higher prevalence of diabetes mellitus, received more HD twice weekly for less than 4 h in almost all HD sessions and had lower HRQOL than the survivors. We conclude that age, comorbidity, HD sessions lasting less than 4 h, malnutrition [hypoalbuminemia, low body mass index (BMI)] and lower physical component scores of SF-36 survey (PCS) were associated with higher risk of death in the HD population.

Comparison of effects of automated peritoneal dialysis and continuous ambulatory peritoneal dialysis on health-related quality of life, sleep quality, and depression

Few studies investigating the effects of automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) on health-related quality of life (HRQoL), depression, and sleep quality exist in the literature. We aimed to determine differences between APD and CAPD modalities with respect to these parameters. Twenty APD and 48 CAPD patients were included in this cross-sectional study. Biochemical values were measured at outpatient evaluation. A modified postsleep inventory was used to evaluate sleep quality. Health-related quality of life and depression were evaluated by the Short Form of Medical Outcomes Study and Beck Depression Inventory, respectively. Automated peritoneal dialysis and CAPD patients were compared in terms of sleep quality, HRQoL, and depression. Our results showed that there were no significant differences between APD and CAPD in any of the studied parameters. Moderate or severe sleep problems were found in 60% and 69% of the APD and CAPD patients, respectively. Mean HRQoL scores for any of the 8 Short Form of Medical Outcomes Study-36 domains were similar in the 2 groups. The mean physical component score was 51.1 ± 21.2 and 48.9 ± 18.2 in APD and CAPD patients, respectively (P=0.672). The mean mental component score was 47.5 ± 20.1 in APD patients, whereas it was 42.4 ± 19.5 in CAPD patients (P=0.291). Depression was detected in 70% of APD and 62.5% of the CAPD patients. The mean Beck Depression Inventory scores were also similar in the 2 groups. This study showed that HRQoL, sleep quality, and depression were similar in APD and CAPD patients.

Uncontrolled hypertension secondary to leukemic cell infiltration of kidneys in a hemodialysis patient

Leukemic infiltration of the kidney is usually silent, and the admission of the patients with renal dysfunction or acute kidney injury is uncommon. We present a 34-year old hemodialysis patient with new onset of uncontrolled hypertension, erythropoietin-resistant anemia, thrombocytopenia, and Bell's palsy. On admission, his blood pressure (BP) was 210/110 mmHg and he had petechiae and purpura at upper and lower extremities. Renal ultrasonography (USG) showed bilaterally enlarged kidneys without hydronephrosis, unlike his previous USG, which determined bilaterally atrophic kidneys. Acute lymphoblastic leukemia, hypertensive crisis due to bilateral leukemic cell infiltration of kidneys, tumor lysis syndrome, and leukemic involvement of the facial nerve were diagnosed. Despite intense antihypertensive management, his BP was not controlled. After prednisolone, daunorubicine, and vincristine therapy, the size of kidneys diminished and his BP dropped under normal range. In conclusion, pathological findings such as uncontrolled hypertension, flank pain, skin rashes, and abnormal blood count should be considered carefully, even in patients with end-stage renal disease receiving renal replacement therapy.