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Sonmez O, Ozcan SG, Karaca C, Atli Z, Dincer MT, Trabulus S, Seyahi N. Effects of Antithymocyte Globulin, Basiliximab, and Induction-Free Treatment in Living Donor Kidney Transplant Recipients on Tacrolimus-Based Immunosuppression. EXP CLIN TRANSPLANT 2024; 22:270-276. [PMID: 38742317 DOI: 10.6002/ect.2023.0010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Induction treatment in renal transplant is associated with better graft survival. However, intensified immunosuppression is known to cause unwanted side effects such as infection and malignancy. Furthermore, the effects of the routine use of immunosuppressants in low-risk kidney transplant recipients are still not clear. In this study, we assessed the first-year safety and efficacy of induction treatment. MATERIALS AND METHODS We examined first living donor kidney transplant patients who were on tacrolimus based immunosuppression therapy. We formed 3 groups according to the induction status: antithymocyte globulin induction, basiliximab induction, and no induction. We collected outcome data on delayed graft function, graft loss, creatinine levels, estimated glomerular filtration rates, acute rejection episodes, hospitalization episodes, and infection episodes, including cytomegalovirus infection and bacterial infections. RESULTS We examined a total of 126 patients (age 35 ± 12 years; 65% male). Of them, 25 received antithymocyte globulin, 52 received basiliximab, and 49 did notreceive any induction treatment. We did not observe any statistically significant difference among the 3 groups in terms of acute rejection episodes, delayed graft function, and first-year graft loss. The estimated glomerular filtration rates were similar among the groups. Overall bacterial infectious complications and cytomegalovirus infection showed similar prevalence among all groups. Hospitalization was less common in the induction-free group. CONCLUSIONS In low-risk patients, induction-free regimens could be associated with a better safety profile without compromising graft survival. Therefore, induction treatment may be disregarded in first living donor transplant patients who receive tacrolimusbased triple immunosuppression treatment.
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Affiliation(s)
- Ozge Sonmez
- From the Department of Internal Medicine, Cerrahpasa Medical Faculty, 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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Murt A, Yadigar S, Yalin SF, Dincer MT, Parmaksiz E, Altiparmak MR. Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection. J Vasc Access 2023; 24:22-26. [PMID: 34082588 PMCID: PMC9846374 DOI: 10.1177/11297298211021253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. METHODS One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. RESULTS COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels (p = 0.02) and longer hospital stay (p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05-10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53-41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival (p = 0.000). CONCLUSIONS AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.
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Affiliation(s)
- Ahmet Murt
- Department of Nephrology, Cerrahpasa
Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey,Ahmet Murt, Nephrology Unit, Internal
Medicine Department, Cerrahpasa Medical Faculty, Istanbul University –
Cerrahpasa, Istanbul, 34303, Turkey.
| | - Serap Yadigar
- Department of Nephrology, Kartal Dr.
Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Serkan Feyyaz Yalin
- Department of Nephrology, Kartal Dr.
Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa
Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Ergun Parmaksiz
- Department of Nephrology, Kartal Dr.
Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Nephrology, Cerrahpasa
Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
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Dincer MT, Trabulus S, Seyahi N. Favipiravir therapy for Covid-19 infection and tacrolimus toxicity in a kidney transplant patient on chronic eculizumab therapy. Natl Med J India 2022; 35:232-234. [PMID: 36715032 DOI: 10.25259/nmji_378_21] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although the latest data show that complement activation has an essential role in the pathogenesis and severity of Covid-19, the data on the prognosis of patients using complement inhibitors during Covid-19 infection are scarce. There is no specific treatment for Covid-19 yet. The introduction of novel agents such as favipiravir may affect metabolism of immunosuppressive drugs. We report the clinical course of Covid-19 in a kidney transplant patient with atypical haemolytic uraemic syndrome on chronic eculizumab therapy. The patient had mild Covid-19 but had severe tacrolimus toxicity, which may be associated with favipiravir and eculizumab. The mild course of Covid-19 in our patient is encouraging for eculizumab use; on the other hand, unusually high levels of tacrolimus that we observed underlines the importance of frequent drug level monitoring in transplanted patients who are receiving new drugs.
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Affiliation(s)
- Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul 34360, Turkey
| | - Sinan Trabulus
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul 34360, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Istanbul 34360, Turkey
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Dincer MT, Dincer ZT, Bakkaloglu OK, Yalin SF, Trabulus S, Celik AF, Seyahi N, Altiparmak MR. Renal Manifestations in Inflammatory Bowel Disease: A Cohort Study During the Biologic Era. Med Sci Monit 2022; 28:e936497. [PMID: 35791280 PMCID: PMC9272730 DOI: 10.12659/msm.936497] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Toker Dincer
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Oguz Kagan Bakkaloglu
- Department of Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Sinan Trabulus
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aykut Ferhat Celik
- Department of Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Demir E, Tamer Dincer M, Karaca C, Erel C, Karahan L, Pekmezci A, Trabulus S, Seyahi N, Turkmen A. MO988: Malignancy After Kidney Transplantation: A Two-Center Experience. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.046] [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
Kidney transplantation (KT) is the preferred treatment option for patients with end-stage renal disease (ESRD) as it provides better patient survival and quality of life. While longer graft survival is maintained with potent immunosuppressive drugs used to prevent allograft rejection, de novo malignancy development after transplantation has become a substantial issue. In this study, we aimed to investigate the incidence and risk factors of post-transplant malignancy in kidney transplant recipients, including its demographic, clinical and laboratory features.
METHOD
A retrospective cohort study was conducted at two tertiary care kidney transplant centers in the same province. We recruited adult (>18 years of age) kidney transplant recipients who underwent kidney transplantation between 1986 and 2020. We excluded KT recipients who lost to follow-up in the early post-transplant period and/or with incomplete records. Malignancies that occurred after graft failure were also excluded. Kidney transplant recipients with malignancy were matched to KT recipients without malignancy using a 1:1 ratio.
RESULTS
In this study, 2750 eligible patients were reviewed for the development of malignancy after kidney transplantation. A total of 278 KT recipients (10.1%) had biopsy confirmed malignancies during the follow-up period. The median post-transplant follow-up time was 217 months (IQR: 148–290 months). The most common malignancies were nonmelanoma skin cancer (28.8%), urinary tract cancer (16.5%), Kaposi's sarcoma (9.7%), gastrointestinal tract cancer (6.5%) and post-transplant lymphoproliferative disease (6.5%). The median time from kidney transplantation to the diagnosis of malignancy was 127 months (IQR: 62–198 months).
In comparison to the control group, patients with malignancy were older (P ≤ 0.001), had a higher family history of malignancy (P ≤ 0.001), had a greater history of smoking (P = 0.005), and usage of erythropoietin in the pre-transplant period was higher (P ≤ 0.001). There was no significant difference between the two groups in terms of gender and the type of induction therapy. Overall mortality was higher in patients with malignancy (OR: 2.491 [CI: 1.586–3.912], P < 0.001).
CONCLUSION
The most common malignancy in kidney transplant recipients was found to be non-melanoma skin cancer. Elderly recipients, patients with a family history of malignancy and patients using erythropoietin in the pre-transplant period should be closely monitored for the development of malignancy.
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Affiliation(s)
- Erol Demir
- İstanbul Faculty of Medicine, İstanbul University, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Cebrail Karaca
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Cansu Erel
- İstanbul Faculty of Medicine, İstanbul University, Department of Internal Medicine, Istanbul, Turkey
| | - Latif Karahan
- İstanbul Faculty of Medicine, İstanbul University, Department of Internal Medicine, Istanbul, Turkey
| | - Aslihan Pekmezci
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Sinan Trabulus
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- İstanbul Faculty of Medicine, İstanbul University, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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7
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Ozturk S, Turgutalp K, Arici M, Gorgulu N, Zeki Tonbul H, Eren N, Gencer V, Ayli D, Pembegul I, Esra Dolarslan M, Ural Z, Colak H, Elif Ozler T, Can O, Emin Demir M, Altunoren O, Huddam B, Onec K, Demirelli B, Aydin Z, Altun E, Alagoz S, Ayar Y, Ebru Eser Z, Berktaş B, Yilmaz Z, Uslu Ates E, Yuksel E, Kumru Sahin G, Aktar M, Cebeci E, Dursun B, Yucel Kocak S, Yildiz A, Kazan S, Gok M, Erkan S, Tugcu M, Ozturk R, Kahvecioglu S, Kara E, Kaya B, Sahin G, Sakaci T, Sipahi S, Kurultak I, Algül Durak B, Riza Altiparmak M, Alisir Ecder S, Karadag S, Tamer Dincer M, Ozer H, Bek S, Ulu S, Gungor O, Ari Bakir E, Riza Odabas A, Seyahi N, Yildiz A, Ateş K. MO166: The Longitudinal Evolution of Covid-19 Outcomes Among Hemodialysis Patients: A Nationwide Multicentre Controlled Study. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac066.068] [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
Haemodialysis (HD) patients are at increased risk for adverse short-term consequences of COVID-19. In this study, we investigated the characteristics of chronic HD patients in the post-COVID-19 period and compared them with the control group.
METHOD
We conducted a national multicentre observational study involving adult chronic HD patients recovering from COVID-19. The control HD group was selected from patients with similar characteristics who did not have COVID-19 in the same center. SARS-CoV-2 RT-PCR negative patients and patients in the active period of COVID-19 were not included.
RESULTS
A total of 1223 patients (635 COVID-19 groups, 588 control groups) were included in the study from the data collected from 47 centres between 21 April 2021 and 11 June 2021. The patients' baseline demographics, comorbidities, medications, HD characteristics and basic laboratory tests were quite similar between the groups (Table 1). 28th-day mortality and between 28th day and 90th day mortality were higher in the COVID-19 group than in the control group [19 (3.0%) patients and 0 (0%) patients; 15 (2.4%) patients and 4 (0.7%) patients, respectively]. Presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection and A-V fistula thrombosis were significantly higher in the COVID-19 group in the first 28 days of illness and between 28 and 90 days.
Mortality was significantly associated with preexisting COVID-19, age, current smoking, use of tunneled HD catheter, persistence of respiratory symptoms, rehospitalization, need for home oxygen support, presence of lower respiratory tract infection within 28 days and persistence of respiratory symptoms.
CONCLUSION
In the post-COVID-19 period, mortality, rehospitalization, respiratory problems and vascular access problems are higher in maintenance HD patients who have had COVID-19 compared to control HD patients.
Table 2. Comparative presentation of patients data on the 28th day and between 28 and 90 day COVID-19 groupN = 635 Control groupN = 588 28th-day results, n(%) Death* 19(3.0) 0(0) Any respiratory symptoms* 152(23.9) 11(1.9) Rehospitalization for any reason* 52(8.2) 24(4.1) Need for home oxygen support * 26(4.1) 2(0.3) Lower respiratory tract infection* 65(10.2) 8(1.4) AV fistula thrombosis* 13(2.0) 2(0.3) Other thromboembolic events * 15(2.4) 4(0.7) Need for HD catheter placement* 21(3.3) 9(1.5) 28th day-90. day resultsa n(%) N:616 N:588 Death* 15(2.4) 4(0.7) Any respiratory symptoms* 45(7.3) 10(1.7) Rehospitalization for any reason* 44(7.1) 18(3.1) Need for home oxygen support* 12(1.9) 2(0.3) AV fistula thrombosis* 9(1.5) 1(0.2) Other thromboembolic events* 9(1.5) 2(0.3) Need for HD catheter placement 13(2.1) 10(1.7) HD: haemodialysis, AV: arteriovenous. *P < .05. a Patients who died before 28 days were not included.
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Affiliation(s)
- Savas Ozturk
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Kenan Turgutalp
- Division of Nephrology, Department of Internal Medicine, Mersin University, Medical Faculty Hospital, Mersin, Turkey
| | - Mustafa Arici
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Numan Gorgulu
- Division of Nephrology, Department of Internal Medicine, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Halil Zeki Tonbul
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Necmi Eren
- Department of Nephrology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Vedat Gencer
- Division of Nephrology, Department of Internal Medicine,Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Deniz Ayli
- Department of Nephrology, University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Irem Pembegul
- Nephrology Department, Malatya Turgut Özal University, Malatya, Turkey
| | - Murside Esra Dolarslan
- Department of Nephrology, University of Health Sciences, Trabzon Kanuni Education and Research Hospital, Trabzon, Turkey
| | - Zeynep Ural
- Division of Nephrology, Department of Internal Medicine, Gazi University, Ankara Faculty of Medicine, Ankara, Turkey
| | - Hulya Colak
- Division of Nephrology, Department of Internal Medicine, Health Sciences University Faculty of Medicine, Education and Research Hospital, İzmir, Turkey
| | - Tuba Elif Ozler
- Division of Nephrology, Department of Internal Medicine, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Ozgur Can
- Department of Nephrology, Bitlis State Hospital, Bitlis, Turkey
| | - Mehmet Emin Demir
- Division of Nephrology, Department of Internal Medicine, Yeni Yuzyil University Faculty of Medicine, Istanbul, Turkey
| | - Orcun Altunoren
- Department of Internal Medicine, Department of Nephrology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Education and Research Hospital, Kahramanmaraş, Turkey
| | - Bulent Huddam
- Division of Nephrology, Departmant of Internal Medicine,, Mugla Sitki Kocman University Faculty of Medicine, Education and Research Hospital, Muğla, Turkey
| | - Kursad Onec
- Division of Nephrology, Department of Internal Medicine, Duzce University, Duzce Faculty of Medicine, Düzce, Turkey
| | - Bülent Demirelli
- Department of Nephrology, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Zeki Aydin
- Department of Nephrology, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Eda Altun
- Department of Nephrology, Golcuk Necati Celik Statement Hospital, Kocaeli, Turkey
| | - Selma Alagoz
- Department of Internal Medicine, Department of Nephrology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Ayar
- Division of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Zeynep Ebru Eser
- Division of Nephrology, Department of Internal Medicine, Mersin University, Medical Faculty Hospital, Mersin, Turkey
| | - Bayram Berktaş
- Division of Nephrology, Department of Internal Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - Zulfukar Yilmaz
- Division of Nephrology, Department of Internal Medicine, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Eser Uslu Ates
- Department of Nephrology, Antalya Atatürk State HospitalAntalya, Turkey
| | - Enver Yuksel
- Department of Nephrology, Diyarbakır Gazi Yaşargil Training and Research Hospital Nephrology/Dialysis Department, Diyarbakır, Turkey
| | - Gizem Kumru Sahin
- Department of Nephrology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Merve Aktar
- Division of Nephrology, Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Egemen Cebeci
- Division of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Belda Dursun
- Division of Nephrology, Department of Internal Medicine, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Sibel Yucel Kocak
- Department of Nephrology, University of Health Sciences, Bakirkoy DrSadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Abdulmecit Yildiz
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Sinan Kazan
- Department of Nephrology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Mahmut Gok
- Department of Nephrology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Sengul Erkan
- Department of Nephrology, Health Science University, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Murat Tugcu
- Division of Nephrology, Department of Internal Medicine, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Ozturk
- Department of Nephrology, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - Serdar Kahvecioglu
- Department of Nephrology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ekrem Kara
- Division of Nephrology, Department of Internal Medicine, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Bulent Kaya
- Division of Nephrology, Department of Internal Medicine, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Garip Sahin
- Division of Nephrology, Department of Internal Medicine, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Tamer Sakaci
- Department of Nephrology, Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Savas Sipahi
- Division of Nephrology, Department of Internal Medicine, Sakarya University Faculty of Medicine, Education and Research Hospital, Sakarya, Turkey
| | - Ilhan Kurultak
- Division of Nephrology, Department of Internal Medicine, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - Beyza Algül Durak
- Department of Nephrology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Mehmet Riza Altiparmak
- Division of Nephrology, Department of Internal Medicine, Istanbul University- Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sabahat Alisir Ecder
- Division of Nephrology, Department of Internal Medicine, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Serhat Karadag
- Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Hakan Ozer
- Division of Nephrology, Department of Internal Medicine, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Sibel Bek
- Division of Nephrology, Department of Internal Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | - Sena Ulu
- Division of Nephrology, Department of Internal Medicine, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey
| | - Ozkan Gungor
- Department of Nephrology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Education and Research Hospital, Kahramanmaraş, Turkey
| | - Elif Ari Bakir
- Department of Nephrology, University of Health Sciences, Kartal Training Hospital, Istanbul, Turkey
| | - Ali Riza Odabas
- Department of Nephrology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Alaattin Yildiz
- Division of Nephrology, Department of Internal Medicine, Istanbul University, İstanbul School of Medicine, Istanbul, Turkey
| | - Kenan Ateş
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
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Durcan E, Ozkan S, Saygi HI, Dincer MT, Korkmaz OP, Sahin S, Karaca C, Sulu C, Bakir A, Ozkaya HM, Trabulus S, Guzel E, Seyahi N, Gonen MS. Effects of SGLT2 inhibitors on patients with diabetic kidney disease: A preliminary study on the basis of podocyturia. J Diabetes 2022; 14:236-246. [PMID: 35229458 PMCID: PMC9060072 DOI: 10.1111/1753-0407.13261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/27/2022] [Accepted: 02/13/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on the glomerulus through the evaluation of podocyturia in patients with diabetic kidney disease (DKD). METHODS The study population was composed of 40 male patients with type 2 diabetes mellitus; 22 of them received SGLT2i (SGLT2i group), and the others who did not were the control. The DKD-related parameters of patients were monitored before SGLT2i initiation, and then in the third and sixth month of the follow-up period. Patients' demographic, clinical, laboratory, and follow-up data were obtained from medical charts. Microalbuminuria was measured in 24-h urine. The number of podocytes in the urine was determined by immunocytochemical staining of two different markers, namely podocalyxin (podx) and synaptopodin (synpo). Concentrations of urine stromal cell-derived factor 1a and vascular endothelial growth factor cytokines were quantified with an enzyme-linked immunosorbent assay kit. RESULTS At the end of the follow-up period, decreases in glycosylated hemoglobin, glucose, systolic and diastolic blood pressure, uric acid level, and microalbuminuria, and improvement in body mass index level and weight loss were significant for the SGLT2i group. On the other hand, there was no significant difference in terms of these parameters in the control group. The excretion of synaptopodin-positive (synpo+ ) and podocalyxin-positive (podx+ ) cells was significantly reduced at the end of the follow-up period for the SGLT2i group, while there was no significant change for the control. CONCLUSIONS At the end of the follow-up period, male patients receiving SGLT2i had better DKD-related parameters and podocyturia levels compared to baseline and the control group. Our data support the notion that SGLT2i might have structural benefits for glomerular health.
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Affiliation(s)
- Emre Durcan
- Division of Endocrinology and Metabolism, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Serbay Ozkan
- Department of Histology and EmbryologyCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Halil Ibrahim Saygi
- Department of Histology and EmbryologyCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Mevlut Tamer Dincer
- Division of Nephrology, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Ozge Polat Korkmaz
- Division of Endocrinology and Metabolism, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Serdar Sahin
- Division of Endocrinology and Metabolism, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Cebrail Karaca
- Division of Nephrology, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Cem Sulu
- Division of Endocrinology and Metabolism, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Alev Bakir
- Department of Biostatistics and Medical InformaticsHalic UniversityIstanbulTurkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology and Metabolism, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Sinan Trabulus
- Division of Nephrology, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Elif Guzel
- Department of Histology and EmbryologyCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Nurhan Seyahi
- Division of Nephrology, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
| | - Mustafa Sait Gonen
- Division of Endocrinology and Metabolism, Department of Internal MedicineCerrahpasa Medical School, Istanbul University‐CerrahpasaIstanbulTurkey
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Ozturk S, Turgutalp K, Arici M, Gorgulu N, Tonbul HZ, Eren N, Gencer V, Ayli MD, Pembegul İ, Dolarslan ME, Ural Z, Colak H, Ozler TE, Can O, Demir ME, Altunoren O, Huddam B, Onec K, Demirelli B, Aydin Z, Altun E, Alagoz S, Ayar Y, Eser ZE, Berktas B, Yilmaz Z, Ates EU, Yuksel E, Sahin GK, Aktar M, Cebeci E, Dursun B, Kocak SY, Yildiz A, Kazan S, Gok M, Sengul E, Tugcu M, Ozturk R, Kahvecioglu S, Kara E, Kaya B, Sahin G, Sakaci T, Sipahi S, Kurultak İ, Durak BA, Altiparmak MR, Ecder SA, Karadag S, Dincer MT, Ozer H, Bek SG, Ulu MS, Gungor O, Bakir EA, Odabas AR, Seyahi N, Yildiz A, Ates K. The Longitudinal Evolution of Post-COVID-19 Outcomes Among Hemodialysis Patients in Turkey. Kidney Int Rep 2022; 7:1393-1405. [PMID: 35350104 PMCID: PMC8949692 DOI: 10.1016/j.ekir.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 10/25/2022] Open
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Dincer MT, Ozcan SG, Ikitimur B, Kiykim E, Bakir A, Trabulus S, Seyahi N. Blood Pressure Variability in Fabry Disease Patients. Nephron Clin Pract 2021; 146:343-350. [PMID: 34933310 DOI: 10.1159/000520699] [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: 06/23/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Fabry disease is a rare metabolic, multisystemic, and X-linked lysosomal storage disorder. The involvement of the autonomic nervous system is well defined; however, data on the variability of the blood pressure (BP) and heart rate in Fabry disease are largely missing. In this study, we aimed to examine the circadian variations of BP and heart rate variability in Fabry disease patients. METHODS We recruited 31 consecutive adult (age >18 years) Fabry disease patients (16 males and 15 females) who were regularly followed up in our outpatient clinic between July 2019 and March 2020. We performed ambulatory blood pressure monitoring and echocardiography in all patients. We used standard deviation (SD), coefficient of variation (CV), and average real variability as the measures of variability. We constructed 2 control groups for propensity score matching using age, sex, and eGFR parameters in the first group and adding antihypertensive drug use to the above parameters in the second group. RESULTS All BP measurements were significantly lower in the FD group compared to that of the control groups, except the nighttime systolic BP. Regarding nondipping and reverse dipping statuses, FD patients and controls were similar. We found that none of the BP variability measures were higher in FD patients. Regarding heart rate variability data, both the nighttime SD and CV were significantly lower in FD patients compared to those of the controls. CONCLUSION A decrease in heart rate variability, rather than an increase in BP variability, might be an early marker of autonomic involvement in FD.
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Affiliation(s)
- Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Seyda Gul Ozcan
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Baris Ikitimur
- Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ertugrul Kiykim
- Department of Pediatric Nutrition and Metabolism, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Alev Bakir
- Department of Biostatistics and Medical Informatics, Halic University, Istanbul, Turkey
| | - Sinan Trabulus
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
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Karaca C, Eren N, Dincer MT, Turan S, Karaca HK, Kucuk M, Kose S, Bek SG, Bakir A, Dervisoglu E, Seyahi N, Trabulus S. How Dialysis Patients Cope with a Curfew? A Comparison of Psychological Status between Hemodialysis and Peritoneal Dialysis Patients During the COVID-19 Pandemic. Blood Purif 2021; 51:458-463. [PMID: 34515061 PMCID: PMC8450823 DOI: 10.1159/000517839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/26/2021] [Accepted: 06/04/2021] [Indexed: 01/02/2023]
Abstract
Introduction There are many differences between hemodialysis (HD) and peritoneal dialysis (PD) treatments, including their impact on the psychological status of the patients. In this study, our aim was to compare the psychological statuses of HD and PD patients during the social isolation period due to the COVID-19 pandemic. Methods We conducted this cross-sectional study on adult HD and PD patients when the curfew measures were in effect. We used an electronic form composed of 3 sections to collect data. In the first section, we collected data on the demographics and clinical and laboratory parameters of the patients. The second and third sections consisted of the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R) questionnaires, respectively. Results The HD (n = 116) and PD (n = 130) groups were similar regarding age and sex, and they had similar HADS anxiety scores. HADS depression scores were higher in PD patients (p = 0.052). IES-R scores were significantly higher in PD patients in comparison to HD patients (p = 0.001). Frequencies of abnormal HADS-anxiety (p = 0.035) and severe psychological impact (p = 0.001) were significantly higher in PD patients. Discussion/Conclusion During the social isolation period due to the COVID-19 pandemic, HD patients had better mood profiles than PD patients. A more stable daily routine, an uninterrupted face-to-face contact with health-care workers, and social support among patients in the in-center dialysis environment might be the cause of the favorable mood status. PD patients might need additional psychological support during those periods.
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Affiliation(s)
- Cebrail Karaca
- Department of Nephrology, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Necmi Eren
- Department of Nephrology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Senol Turan
- Department of Psychiatry, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Hatice Kubra Karaca
- Department of Child and Adolescent Psychiatry, Istanbul Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Mehmet Kucuk
- Department of Nephrology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Sennur Kose
- Department of Nephrology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Sibel Gokcay Bek
- Department of Nephrology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Alev Bakir
- Department of Biostatistics and Medical Informatics, Halic University, Istanbul, Turkey
| | - Erkan Dervisoglu
- Department of Nephrology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Sinan Trabulus
- Department of Nephrology, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Murt A, Yadigar S, Yalin SF, Dincer MT, Parmaksiz E, Altiparmak MR. Arteriovenous fistula as the vascular access contributes to better survival of hemodialysis patients with COVID-19 infection. J Vasc Access 2021. [PMID: 34082588 DOI: 10.1177/11297298211021253.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While COVID-19 in chronic hemodialysis patients has high mortality and the pandemic will not end in the near future, effective follow up strategies should be implemented for these patients. Surgeries have been triaged according to their level of urgencies and arteriovenous fistula (AVF) operations were among elective surgeries. This study aimed to analyze the effect of vascular access on the outcomes of hemodialysis patients who had COVID-19. METHODS One hundred four hemodialysis patients who had COVID-19 were retrospectively analyzed. Seventy-two of them had AVF as the vascular access while 32 of them had tunneled catheters. Inflammatory markers and outcomes of patients with AVFs and catheters were compared. A logistic regression analysis was performed in order to define factors that contribute to better outcomes in hemodialysis patients. RESULTS COVID-19 had high mortality rate in hemodialysis patients (36.5%). Patients with catheters have higher peak ferritin levels (p = 0.02) and longer hospital stay (p = 0.00). Having AVF as the vascular access (OR = 3.36; 95% CI: 1.05-10.72; p = 0.041) and using medium cut-off dialyzers (OR = 7.99; 95% CI: 1.53-41.65; p = 0.014) were related to higher survival of the patients. COVID severity was inversely proportional to the survival (p = 0.000). CONCLUSIONS AVFs contribute to higher survival of hemodialysis patients with COVID-19. Even in the pandemic era, end stage renal disease patients should be given the opportunity to have their vascular access properly created.
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Affiliation(s)
- Ahmet Murt
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Serap Yadigar
- Department of Nephrology, Kartal Dr. Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Serkan Feyyaz Yalin
- Department of Nephrology, Kartal Dr. Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ergun Parmaksiz
- Department of Nephrology, Kartal Dr. Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
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Dincer MT, Karaca C, Sarac B, Ahmadzada S, Bakir A, Alagoz S, Kiykim E, Trabulus S, Seyahi N. MO055THE IMPACT OF THE COVID-19 PANDEMIC ON MOOD STATUS AND TREATMENT ADHERENCE IN PATIENTS WITH FABRY DISEASE. Nephrol Dial Transplant 2021. [PMCID: PMC8195199 DOI: 10.1093/ndt/gfab080.0027] [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: 11/30/2022] Open
Abstract
Background and Aims Fabry disease is a rare metabolic disorder, lifelong enzyme replacement therapy with recombinant human alpha-galactosidase A (agalsidase) constituted the cornerstone of disease-specific therapy. COVID-19 pandemic and epidemic control measures including lockdowns impaired access to health care services. We examined the effect of COVID-19 pandemic and lockdown measures on mood status and management of Fabry disease patients. Method We conducted a cross-sectional study between October 2020 and December 2020. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate the mood statuses of FD patients and the Morisky Medication Adherence Scale (MMAS-4) to assess patient adherence. We also examined age and sex-matched control group to compare mood status. Results A total of 68 (Male 48.5 %, mean age 37.0) FD patients were under regular follow-up in our institution, 59 of those patients were taking ERT every other week. Two of our patients had reported having a COVID-19 infection, and both of them recovered. 25 patients reported to miss an ERT for a median of one dose, 16 of these 25 patients have reported that they did not come to the hospital because of infection fear. Half of the patients had adopted home-based infusion; they arranged a nurse for home-based infusion therapy by their own means. According to MMAS-4 FD patients had good adherence to their therapy (Median score 0, range 0-2). Mood status of FD patients and controls are shown in Table 1. Both HADS depression and anxiety scores were higher in the control group compared to FD patients. Additionally, abnormal scores were more prevalent for HADS depression scores in controls (Figure 1). Conclusion We found that the mood status of FD patients was better than the control group. Traumatic growth may be an important factor to explain this finding. Their adherence to therapy was good. Home-based therapy was the preferred method by the patients. Government-supported home therapy programs might be beneficial for FD patients to increase adherence to the therapy.
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Affiliation(s)
- Mevlut Tamer Dincer
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, İstanbul, Turkey
| | - Cebrail Karaca
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, İstanbul, Turkey
| | - Betul Sarac
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Internal Medicine, İstanbul, Turkey
| | - Saffa Ahmadzada
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Pediatric Nutrition and Metabolism, İstanbul, Turkey
| | - Alev Bakir
- Halic University, Biostatistics and Medical Informatics, İstanbul, Turkey
| | - Selma Alagoz
- Istanbul Training and Research Hospital, Nephrology, İstanbul, Turkey
| | - Ertugrul Kiykim
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Pediatric Nutrition and Metabolism, İstanbul, Turkey
| | - Sinan Trabulus
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, İstanbul, Turkey
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, İstanbul, Turkey
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Murt A, Dincer MT, Karaca C, Trabulus S, Seyahi N, Altiparmak MR. MO371TIME AND THE ETIOLOGY OF ACUTE KIDNEY INJURY DEFINE PROGNOSIS IN THE COURSE OF COVID-19. Nephrol Dial Transplant 2021. [PMCID: PMC8195163 DOI: 10.1093/ndt/gfab082.0025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. There have been previous studies focusing on incidence and mortality of AKI in COVID-19 but none has made in depth analysis in relation to the background pathophysiology. Based on previous observations, we hypothesized that all AKIs seen in COVID-19 are not uniform and we aimed to analyze the etiologies and prognosis of AKI among hospitalized COVID-19 patients in relation to the time of AKI during different phases of the disease.
Method
A total of 1056 patients were admitted to the designated COVID-19 clinics from March to July in 2020. 77 Patients who were younger than 18 years old and 7 kidney transplant patients were excluded from the study. 427 of the remaining patients were confirmed by real time polymerase chain reaction (RT-PCR) test.). As eGFR below 60 mL/min/1,73 m2 was already shown to be related to mortality, these patients (44) were also excluded. As immunologic response is generally accepted to start with the second week of COVID-19 course, patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed.
Results
89 of the 383 included COVID-19 patients developed AKI. 24% of those who developed AKI died. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Additionally, patients who died had higher initial inflammatory marker levels and lower lymphocyte counts than those who survived. Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was as high as 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Patients who died had significantly higher ferritin and d-dimer levels upon their hospital admissions (p=0,000). Electrolyte disturbances, metabolic acidosis and mortality were also higher in patients who developed AKI later. Hypernatremia (OR: 6,5, 95% CI: 3 – 13,9) and phosphorus disturbances (both hyperphosphatemia (OR: 3,3; 95%CI: 1,6 – 6,9) and hypophosphatemia (OR: 3,9; 95% CI: 2,0-7,9)) were related to mortality.
Conclusion
Findings of this study suggest that AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies
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Affiliation(s)
- Ahmet Murt
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Cebrail Karaca
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Sinan Trabulus
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
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Murt A, Dincer MT, Karaca C. Shall We Use Hydroxychloroquine in Hemodialysis Patients? Blood Purif 2021; 51:97-98. [PMID: 33979800 DOI: 10.1159/000516161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/25/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Ahmet Murt
- Department of Internal Medicine/Division of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Internal Medicine/Division of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cebrail Karaca
- Department of Internal Medicine/Division of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Affiliation(s)
- Ahmet Murt
- Nephrology Unit, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Nephrology Unit, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cebrail Karaca
- Nephrology Unit, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Yalın SF, Altıparmak MR, Dincer MT, Yadigar S, Murt A, Parmaksiz E, Ronco C. Medium Cut-Off Dialysis Membranes: Can They Have Impact on Outcome of COVID-19 Hemodialysis Patients? Blood Purif 2021; 50:921-924. [PMID: 33445173 PMCID: PMC7900453 DOI: 10.1159/000513621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/08/2020] [Indexed: 12/19/2022]
Abstract
Introduction Severe acute respiratory syndrome coronavirus-2 may lead to high levels of expression of inflammatory cytokines. Medium cut-off (MCO) membranes may make greater clearances for large-middle molecules (including cytokines) than low-flux (LF) membranes. In this study, we aimed to evaluate the impact of MCO membranes on outcome of COVID-19 patients on hemodialysis (HD). Methods Sixty COVID-19 HD patients were included in this study. The patients were categorized into 2 groups regarding type of HD membranes. Clinical data were taken from medical records. Results Initial crp and ferritin levels, which are surragates of cytokine storm and severity of disease in COVID-19, were significantly higher in MCO membrane group compared to LF group (p = 0.037 and 0.000, respectively). Although there were more patients with severe disease in MCO group, there were no significant differences regarding need for intensive care unit and death. Conclusion It may be an option to use MCO membranes in HD patients with COVID-19 in order to reduce cytokine levels and prevent cytokine storm.
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Affiliation(s)
- Serkan Feyyaz Yalın
- Department of Nephrology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey,
| | - Mehmet Rıza Altıparmak
- Department of Nephrology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Serap Yadigar
- Department of Nephrology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Ahmet Murt
- Department of Nephrology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ergun Parmaksiz
- Department of Nephrology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Claudio Ronco
- Department of Medicine (DIMED), University of Padova, Padova, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
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18
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Dogan C, Gonen B, Dincer MT, Mergen B, Kiykim E, Bakir A, Trabulus S, Yetik H, Seyahi N. Evaluation of the reasons for the microvascular changes in patients with Fabry disease using optic coherence tomography angiography. Eur J Ophthalmol 2020; 31:3231-3237. [PMID: 33225739 DOI: 10.1177/1120672120974288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/17/2023]
Abstract
PURPOSE To investigate the blood flow changes in the choriocapillaris and the superficial and deep capillary plexus of the retina using optic coherence tomography angiography (OCTA) in patients with Fabry disease (FD) and reveal any possible association of these changes with the systemic findings. METHODS This cross-sectional study included 38 patients with FD and age- and gender-matched 40 healthy controls. OCTA images were obtained from all patients. Superficial (sCVD) and deep capillary vascular density (dCVD) in the foveal, parafoveal, and perifoveal zones and the whole image were recorded for each patient. Flow area in the choriocapillaris and central macular thickness (CMT) were also recorded. RESULTS Patients with FD showed a lower whole image (54.45 ± 5.99% vs 57.32 ± 6.71%, p = 0.004), foveal (34.94 ± 7.60% vs 39.65 ± 7.03%, p = 0.003), parafoveal (57.41 ± 4.85% vs 59.19 ± 4.67%, p = 0.043), and perifoveal (55.87 ± 6.43% vs 58.87 ± 7.02%, p = 0.003) dCVD compared to the healthy controls without a significant difference in the sCVD and choriocapillaris blood flow (p > 0.05). A significantly lower whole image and foveal dCVD in the FD patients with renal involvement was observed compared to the healthy controls (p = 0.027 and p = 0.024, respectively) without any significant difference between the FD patients without renal involvement and healthy controls (p = 0.17 and p = 0.13, respectively). CMT was significantly higher in FD patients with renal involvement compared to the ones without renal involvement (252.1 ± 18.5 µm vs 235.5 ± 17.6 µm, p = 0.016). CONCLUSION Patients with FD showed a lower dCVD without any change in sCVD and choriocapillaris compared to the healthy controls. This decrease was associated mostly with the renal involvement and duration of treatment.
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Affiliation(s)
- Cezmi Dogan
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Busenur Gonen
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burak Mergen
- Basaksehir Cam ve Sakura City Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Ertugrul Kiykim
- Cerrahpasa Medical Faculty, Department of Pediatrics, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alev Bakir
- Department of Biostatistics, Halic University, Istanbul, Turkey
| | - Sinan Trabulus
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Huseyin Yetik
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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19
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Sumnu A, Turkmen K, Cebeci E, Turkmen A, Eren N, Seyahi N, Oruc A, Dede F, Derici Ü, Basturk T, Şahin G, Sipahioglu M, Sahin GM, Tatar E, Dursun B, Sipahi S, Yılmaz M, Suleymanlar G, Ulu S, Gungor O, Kutlay S, Bahçebaşı ZB, Sahin İ, Kurultak I, Sevinc C, Yilmaz Z, Kazancioglu RT, Cavdar C, Candan F, Aydin Z, Oygar D, Gul B, Altun B, Paydas S, Uzun S, Istemihan Z, Ergul M, Dincer MT, Gullulu M, Piskinpasa S, Akcay OF, Unsal A, Koyuncu S, Gok M, Ozturk S. Characteristics of primary glomerular diseases patients with hematuria in Turkey: the data from TSN-GOLD Working Group. Int Urol Nephrol 2020; 53:945-954. [PMID: 33155086 DOI: 10.1007/s11255-020-02690-w] [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] [Received: 05/29/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Hematuria is one of the most common laboratory findings in nephrology practice. To date, there is no enough data regarding the clinical and histopathologic characteristics of primary glomerular disease (PGD) patients with hematuria in our country. METHODS Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The data of all PGD patients over the age of 16 years who were diagnosed with renal biopsy and had hematuria data were included in the study. Demographic characteristics, laboratory and biopsy findings were also recorded. RESULTS Data of 3394 PGD patients were included in the study. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Patients with hematuria had statistically higher systolic blood pressure, serum blood urea nitrogen, creatinine, albumin, levels and urine pyuria. However, these patients had statistically lower age, body mass index, presence of hypertension and diabetes, eGFR, 24-h proteinuria, serum total, HDL and LDL cholesterol, and C3 levels when compared with patients without hematuria. Hematuria was present 609 of 1733 patients (35.8%) among the patients presenting with nephrotic syndrome, while it was presented in 1090 of 1661 (64.2%) patients in non-nephrotics (p < 0.001). CONCLUSION This is the first multicenter national report regarding the demographic and histopathologic data of PGD patients with or without hematuria. Hematuria, a feature of nephritic syndrome, was found at a higher than expected in the PGDs presenting with nephrotic syndrome in our national database.
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Affiliation(s)
- Abdullah Sumnu
- Department of Nephrology, Medical Faculty, Medipol Mega Hastanesi, Medipol University, Göztepe Mahallesi Metin Sk. No: 4, Bağcılar, Istanbul, Turkey.
| | - Kultigin Turkmen
- Nephrology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Egemen Cebeci
- Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Aydin Turkmen
- Nephrology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Necmi Eren
- Nephrology Medical Faculty, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Nurhan Seyahi
- Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Aysegul Oruc
- Nephrology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Fatih Dede
- Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ülver Derici
- Nephrology, Medical Faculty, Gazi University, Ankara, Turkey
| | - Taner Basturk
- Nephrology, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Garip Şahin
- Nephrology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Murat Sipahioglu
- Nephrology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Gulizar Manga Sahin
- Nephrology, Sultan Abdulhamit Han Research and Training Hospital, Istanbul, Turkey
| | - Erhan Tatar
- Nephrology, Bozyaka Training and Research Hospital, Izmır, Turkey
| | - Belda Dursun
- Nephrology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Savas Sipahi
- Nephrology, Medical Faculty, Sakarya University, Sakarya, Turkey
| | - Mürvet Yılmaz
- Nephrology, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Sena Ulu
- Nephrology, Medical Faculty, Afyon University, Afyon, Turkey
| | - Ozkan Gungor
- Nephrology, Medical Faculty, Sutcu İmam University, Kahramanmaras, Turkey
| | - Sim Kutlay
- Nephrology, İbni Sina Hospital, Medical Faculty, Ankara University, Ankara, Turkey
| | | | - İdris Sahin
- Nephrology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Ilhan Kurultak
- Nephrology, Medical Faculty, Trakya University, Edirne, Turkey
| | - Can Sevinc
- Nephrology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | | | | | - Caner Cavdar
- Nephrology, Medical Faculty, Dokuz Eylul University, Izmir, Turkey
| | - Ferhan Candan
- Nephrology, Medical Faculty, Cumhuriyet University, Sivas, Turkey
| | - Zeki Aydin
- Nephrology, Darica Farabi Training and Research Hospital, Darıca, Kocaeli, Turkey
| | - Deren Oygar
- Nephrology, Burhan Nalbantoglu State Hospital, Lefkosa, Cyprus
| | - Bulent Gul
- Nephrology, Bursa Yuksek Ihtisas Training and Research Hospital, Nilüfer, Bursa, Turkey
| | - Bulent Altun
- Nephrology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Saime Paydas
- Nephrology, Medical Faculty, Cukurova University, Adana, Turkey
| | - Sami Uzun
- Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Zulal Istemihan
- Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Metin Ergul
- Nephrology Medical Faculty, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Mevlut Tamer Dincer
- Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mustafa Gullulu
- Nephrology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Serhan Piskinpasa
- Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | - Abdulkadir Unsal
- Nephrology, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sumeyra Koyuncu
- Nephrology, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Mahmut Gok
- Nephrology, Sultan Abdulhamit Han Research and Training Hospital, Istanbul, Turkey
| | - Savas Ozturk
- Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
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20
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Murt A, Dincer MT, Karaca C. Sudden Cardiac Death in Haemodialysis Patients under Hydroxychloroquine Treatment for COVID-19: A Report of Two Cases. Blood Purif 2020; 50:402-404. [PMID: 33032282 PMCID: PMC7649688 DOI: 10.1159/000511392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022]
Abstract
Hydroxychloroquine (HQ) has been used for the treatment of novel coronavirus disease (COVID-19) even though there is no clear evidence for its effectiveness yet. In contrary, HQ has major side effects like QTc prolongation and subsequent development of ventricular arrhythmias. Such side effects may possess additional risks on end-stage renal disease (ESRD) patients who have higher cardiovascular risks than general population. We herein present 2 cases of sudden cardiac death in 2 ESRD patients with COVID-19 for whom a treatment regimen including HQ was preferred. Both patients were clinically stable at the time of arrest. Death could not be attributed to worsening of the COVID-19 since the patients' clinical picture and laboratory values were improving. The cardiac events coincided with the end of routine haemodialysis sessions of both patients. Electrocardiography controls upon admission and on the 24 and 48 h of treatment showed normal QTc intervals. Potential risks contributing to sudden cardiac death during HQ treatment of ESRD patients are discussed.
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Affiliation(s)
- Ahmet Murt
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey,
| | - Mevlut Tamer Dincer
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cebrail Karaca
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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21
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Trabulus S, Karaca C, Balkan II, Dincer MT, Murt A, Ozcan SG, Karaali R, Mete B, Bakir A, Kuskucu MA, Altiparmak MR, Tabak F, Seyahi N. Kidney function on admission predicts in-hospital mortality in COVID-19. PLoS One 2020; 15:e0238680. [PMID: 32881976 PMCID: PMC7470363 DOI: 10.1371/journal.pone.0238680] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/21/2020] [Indexed: 01/15/2023] Open
Abstract
Background Recent data have suggested the presence of a reciprocal relationship between COVID-19 and kidney function. To date, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19. Methods We recruited 336 adult consecutive patients (male: 57.1%, mean age: 55.0±16.0 years) that were hospitalized with the diagnosis of COVID-19 in a tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19. Results Baseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.2% of the patients. In-hospital mortality rate was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p: 0.005, odds ratio: 0.974, CI: 0.956–0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2. Conclusions On admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19. We recommend that eGFR be measured in all patients on admission and used as an additional tool for risk stratification. Close follow-up should be warranted in patients with a reduced eGFR.
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Affiliation(s)
- Sinan Trabulus
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Cebrail Karaca
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Ahmet Murt
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Seyda Gul Ozcan
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Rıdvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Alev Bakir
- Department of Biostatistics and Medical Informatics, Halic University, Istanbul, Turkey
| | - Mert Ahmet Kuskucu
- Department of Microbiology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Istanbul, Turkey
- * E-mail:
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22
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Dincer MT, Özcan ŞG, Alagoz S, Karaca C, Gulcicek S, Trabulus S, Pekpak M, Seyahi N. P0889TO WHAT EXTENT CAN WE ACHIEVE MINERAL BONE METABOLISM TREATMENT TARGETS AS SUGGESTED BY UPDATED 2017 KDIGO GUIDELINES IN PATIENTS WITH PREDIALYSIS CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0889] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
The mineral bone disorder is an essential problem in chronic kidney disease (CKD). It is an independent modifiable risk factor for renal damage progression and CKD related mortality. Therefore, it is important to treat chronic kidney disease mineral bone disorder (CKD-MBD) according to international guidelines. Data on the management of mineral bone disorders in predialysis patients is scarce. We aimed to investigate the proportion of CKD-MBD patients reaching targets suggested by the updated 2017 KDIGO guidelines.
Method
We performed a multicenter cross-sectional study. We recruited consecutive adult (>18 years of age) CKD 3-5 patients who were on regular nephrology outpatient clinic follow up. Patients who have GFR loss over 30% in the last six months, patients with malignancy, and decreased life expectancy due to severe comorbid disease and patients on renal replacement therapy were excluded. Data were collected in two-time points: one during the recruitment (second data point) and one, three to six months prior to the current visit (first data point). Persistent laboratory abnormalities were defined by out of normal range values in both time points. Therapeutic inertia was calculated for hyperphosphatemia. It was defined as a lack of using phosphate binders despite hyperphosphatemia.
Results
We examined a total of 213 patients for 3 different nephrology outpatient clinics. Of these patients, 49.5 % were male, with a mean age of 64,9 ± 12,0 years. 51.7 % of the patients were diabetic, 78 % were hypertensive, and 20.1 % had a history of coronary artery disease. Laboratory values related to MBD are shown in Table 1. KDIGO guideline targets were not reached in 14.8%, 18.4%, 59.0%, 71.0% patients regarding Ca, P, PTH, and vitamin D in the first visit. The targets were not reached in 15.0%, 19,2%, 61,2%, 81% patients regarding Ca, P, PTH, and vitamin D in the second visit. Persistence of out of target values were observed in 5.8%, 9.9%, 49.2% and 65.4% of the patients for Ca,P, PTH and Vitamin D respectively. The prevalence of therapeutic inertia for hyperphosphatemia was 34,4 % in the second visit
Conclusion
Regarding KDIGO guidelines, MBD is not optimally managed in predialysis CKD patients. Clinicians should have an active attitude regarding the correction of MBD even at the earlier stages of CKD.
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Affiliation(s)
- Mevlut Tamer Dincer
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Şeyda Gül Özcan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Istanbul, Turkey
| | - Selma Alagoz
- Bagcilar Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Cebrail Karaca
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Sibel Gulcicek
- Istanbul Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Sinan Trabulus
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Meltem Pekpak
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul, Turkey
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23
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Turgutalp K, Cebeci E, Turkmen A, Derici Ü, Seyahi N, Eren N, Dede F, Gullulu M, Basturk T, Manga Sahin G, Yılmaz M, Sipahi S, SAHIN G, Ulu MS, Tatar E, Gundogdu A, Turan Kazancioglu R, Sevinc C, Gungor O, Sahin İ, Kutlay S, Kurultak I, Aydin Z, Altun B, Dursun B, Yilmaz Z, Uzun O, Suleymanlar G, Candan F, Sezer S, Tanburoglu DB, Bicik Bahçebaşı Z, Guven Taymez D, Oygar D, Akcali E, Istemihan Z, Akcay OF, Dincer MT, Ergul M, Yenigun E, Turkmen K, Ozturk S. P0490IS THE SEVERITY OF GLOMERULAR IGG STAINING IN PATIENT WITH IGA NEPHROPATHY USEFUL FOR PREDICTING POOR RENAL PROGNOSIS? THE DATA FROM TSN-GOLD WORKING GROUP. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0490] [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
In IgA nephropathy (IgAN), which is characterized by mesangial IgA accumulation, there is the formation of circulating autoantibodies against galactose deficient IgA1s (Gd-IgA1). IgG / Gd-IgA1 immunocomplexes accumulate in the glomerular mesangium and play a role in the pathogenesis of IgAN. Recent studies have suggested a relationship between glomerular IgG deposition and the severity of glomerular inflammation. However, detection of the presence and severity of IgG in routine immunofluorescence microscopy (IFM) may fail. This study aims to investigate whether IgG positivity detected by IFM is associated with poor renal prognostic indicators and whether renal prognosis can be predicted according to IgG positivity.
Method
4399 patients who were enrolled between May 2009-June 2019 in database of Turkish Society of Nephrology, Glomerular Diseases Working Group (TSN-GOLD) including 44 centers were evaluated. After exclusion criteria, 994 primary IgAN patients were included in the study. Glomerular IgG negative and positive patients were compared by means of Oxford classification scores, histopathological evaluations, proteinuria, creatinine, albumin, blood pressures. IgG positive patients were divided into subgroups according to the grade of the IFM positivity. The relationship between IgG positivity and poor prognosis criteria were evaluated.
Results
Demographic and biochemical findings of glomerular IgG positive and negative patients at the time of biopsy are shown in Table 1. No difference was found between the groups. There was no difference in the demographic and biochemical findings at the time of biopsy in IgG subgroup analyses (Table 2). There was no difference between the histopathological and Oxford MEST scores of the subgroups. Glomerular IgG positivity was not associated with diastolic blood pressure, systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p> 0.05 for all, r= -0.084, r= -0.102, r= -0.006, r=0.062, r= 0.014, r= -0.044, r= -0.061, r= -0.066, r= 0.150, respectively).
Conclusion
Glomerular IgG positivity detected by routine IFM in IgAN is not associated with poor renal prognostic indicators. It is difficult to predict renal prognosis by looking at the severity of IgG positivity at the baseline evaluation.
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Affiliation(s)
| | - Egemen Cebeci
- Haseki Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul University, Department of Nephrology, Istanbul, Turkey
| | - Ülver Derici
- Gazi University Faculty of Medicine, Department of Nephrology, Ankara, Turkey
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Necmi Eren
- Kocaeli University, Department of Nephrology, Kocaeli, Turkey
| | - Fatih Dede
- Health Sciences University, Ankara Numune Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Mustafa Gullulu
- Uludag University Faculty of Medicine, Department of Medicine, Bursa, Turkey
| | - Taner Basturk
- Health Sciences University, Sıslı Hamidiye Etfal Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Gulizar Manga Sahin
- Istanbul Abdulhamid Han Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Mürvet Yılmaz
- Health Sciences University, Bakirkoy Sadi Konuk Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Savas Sipahi
- Sakarya University Medical Faculty Education and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | - Garip SAHIN
- Eskisehir Osmangazi University, Department of Nephrology, Istanbul, Turkey
| | - Memnune Sena Ulu
- Afyon Health Sciences University, Department of Nephrology, Afyon, Turkey
| | - Erhan Tatar
- Health Sciences University, Izmir Bozyaka Training and Research Hospital, Department of Nephrology, Izmir, Turkey
| | - Ali Gundogdu
- Erciyes University, Department of Nephrology, Kayseri, Turkey
| | | | - Can Sevinc
- Atatürk University, Department of Nephrology, Erzurum, Turkey
| | - Ozkan Gungor
- Kahramanmaras Sutcu Imam University, Department of Nephrology, Kahramanmaraş, Turkey
| | - İdris Sahin
- Inonu University Faculty of Medicine, Department of Nephrology, Malatya, Turkey
| | - Sim Kutlay
- Ankara University, School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Ilhan Kurultak
- Trakya University, Department of Nephrology, Edirne, Turkey
| | - Zeki Aydin
- Darica Farabi Training and Research Hospital, Department of Nephrology, Kocaeli, Turkey
| | - Bulent Altun
- Hacettepe University, Department of Nephrology, Ankara, Turkey
| | - Belda Dursun
- Pamukkale University, Department of Nephrology, Denizli, Turkey
| | - Zulfikar Yilmaz
- Dicle University, Department of Nephrology, Diyarbakır, Turkey
| | - Ozcan Uzun
- Dokuz Eylül University, Department of Nephrology, İzmir, Turkey
| | | | - Ferhan Candan
- Cumhuriyet University, Department of Nephrology, Sivas, Turkey
| | - Siren Sezer
- Atilim University Medicana International Hospital, Department of Nephrology, Ankara, Turkey
| | | | - Zerrin Bicik Bahçebaşı
- Kartal Lutfi Kirdar Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
| | | | - Deren Oygar
- Lefkosa BND Training and Research Hospital, Department of Nephrology, Lefkosa, Cyprus
| | - Esra Akcali
- Mersin University, Department of Nephrology, Mersin, Turkey
| | - Zulal Istemihan
- Istanbul University, Department of Nephrology, Istanbul, Turkey
| | - Omer Faruk Akcay
- Gazi University Faculty of Medicine, Department of Nephrology, Ankara, Turkey
| | - Mevlut Tamer Dincer
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Metin Ergul
- Kocaeli University, Department of Nephrology, Kocaeli, Turkey
| | - Ezgi Yenigun
- Health Sciences University, Ankara Numune Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Kultigin Turkmen
- Necmettin Erbakan University, Meram School of Medicine, Department of Internal Medicine, Division of Nephrology, Konya, Turkey
| | - Savas Ozturk
- Haseki Training and Research Hospital, Department of Nephrology, Istanbul, Turkey
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Sumnu A, Turkmen K, Cebeci E, Turkmen A, Eren N, Seyahi N, Oruc A, Dede F, Derici Ü, Basturk T, SAHIN G, Sipahioglu M, Manga Sahin G, Tatar E, Dursun B, Sipahi S, Yılmaz M, Suleymanlar G, Ulu MS, Gungor O, Kutlay S, Bicik Bahçebaşı Z, Sahin İ, Kurultak I, Sevinc C, Yilmaz Z, Turan Kazancioglu R, Cavdar C, Candan F, Aydin Z, Oygar D, Gul CB, Altun B, Paydas S, Uzun S, Istemihan Z, Ergul M, Dincer MT, Gullulu M, Piskinpasa SV, Akcay OF, Unsal A, Koyuncu S, Gok M, Ozturk S. P0448CHARACTERISTICS OF PRIMARY GLOMERULAR DISEASE PATIENTS WITH HEMATURIA IN TURKEY: THE DATA FROM TSN-GOLD WORKING GROUP. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0448] [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
Hematuria is one of the most common laboratory findings in nephrology practice. In different regions of the world, the etiologic causes differ. To date, there is no enough data regarding the clinical and histopathologic characteristics of primary glomerular diseases (PGD) patients with hematuria in our country.
Method
Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The data of all PGD patients over the age of 16 years who were diagnosed with renal biopsy and had hematuria data were included in the study. The biopsy samples were processed using a light microscopy and immunofluorescence examination. Demographic characteristics such as age, sex, indications for biopsy, primary glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were also recorded. Hematuria was defined as the presence of at least 5 red blood cells/hpf.
Results
Data of 3394 patients were included to the study after the exclusion of patients with secondary glomerulonephritis and patients with missing biopsy findings. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Demographic, laboratory, and histopathological characteristics of patients with and without hematuria are given in Table. Patients with hematuria had statistically higher systolic blood pressure (SBP), serum blood urea nitrogen, creatinine, albumin, levels and urine pyuria, however, these patients had statistically lower age, body mass index, presence of hypertension and diabetes, eGFR, 24-hour proteinuria, serum total, HDL and LDL-cholesterol and C3 levels when compared with patients without hematuria. Figure depicted the etiologic causes of patients with and without hematuria. According to histopathological findings, number of global sclerotic glomeruli, cellular and fibrocellular crescents, the levels of mesangial proliferation, endocapillary proliferation, exudative changes in glomeruli, severe tubular atrophy, interstitial inflammation, subendothelial deposition, moderate and severe IgA and C3 deposition were found to be significantly higher and the levels of basal membrane thickening, interstitial fibrosis, subepithelial deposition, severe IgG staining were found to be significantly lower in patients with hematuria.
Conclusion
This is the first multicenter national report regarding the demographic and histopathologic data of PGD patients with or without hematuria. Hematuria, a feature of nephritic syndrome, was found at a higher than expected in the PGDs presenting with nephrotic syndrome in our national database.
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Affiliation(s)
- Abdullah Sumnu
- Medipol University, Medical Faculty, Nephrology, Istanbul, Turkey
| | - Kultigin Turkmen
- Necmettin Erbakan University, Meram Medical Faculty, Nephrology, Konya, Turkey
| | - Egemen Cebeci
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul University, Istanbul Medical Faculty, Nephrology, Istanbul, Turkey
| | - Necmi Eren
- Kocaeli University, Medical Faculty, Nephrology, Kocaeli, Turkey
| | - Nurhan Seyahi
- Istanbul University, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Aysegul Oruc
- Uludag University, Medical Faculty, Nephrology, Bursa, Turkey
| | - Fatih Dede
- Ankara Numune Training and Research Hospital, Nephrology, Ankara, Turkey
| | - Ülver Derici
- Gazi University, Medical Faculty, Nephrology, Ankara, Turkey
| | - Taner Basturk
- Hamidiye Sisli Etfal Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Garip SAHIN
- Eskisehir Osmangazi University, Medical Faculty, Nephrology, Eskisehir, Turkey
| | - Murat Sipahioglu
- Erciyes University, Medical Faculty, Nephrology, Kayseri, Turkey
| | - Gulizar Manga Sahin
- Sultan Abdulhamit Han Research and Training Hospital, Nephrology, Istanbul, Turkey
| | - Erhan Tatar
- Bozyaka Training and Research Hospital, Nephrology, Izmır, Turkey
| | - Belda Dursun
- Pamukkale University, Medical Faculty, Nephrology, Denizli, Turkey
| | - Savas Sipahi
- Sakarya University, Medical Faculty, Nephrology, Sakarya, Turkey
| | - Mürvet Yılmaz
- Bakirkoy Sadi Konuk Training and Research Hospital, Nephrology, Istanbul, Turkey
| | | | | | - Ozkan Gungor
- Sutcu İmam University, Medical Faculty, Nephrology, Kahramanmaras, Turkey
| | - Sim Kutlay
- Ankara University, Medical Faculty, İbni Sina Hospital, Nephrology, Ankara, Turkey
| | | | - İdris Sahin
- Inonu University, Medical Faculty, Nephrology, Malatya, Turkey
| | - Ilhan Kurultak
- Trakya University, Medical Faculty, Nephrology, Edirne, Turkey
| | - Can Sevinc
- Ataturk University, Medical Faculty, Nephrology, Erzurum, Turkey
| | - Zulfikar Yilmaz
- Dicle University, Medical Faculty, Nephrology, Diyarbakir, Turkey
| | | | - Caner Cavdar
- Dokuz Eylul University, Medical Faculty, Nephrology, Izmir, Turkey
| | - Ferhan Candan
- Cumhuriyet University, Medical Faculty, Nephrology, Sivas, Turkey
| | - Zeki Aydin
- Darica Farabi Training and Research Hospital, Nephrology, Kocaeli, Turkey
| | - Deren Oygar
- Burhan Nalbantoglu State Hospital, Nephrology, Lefkosa, Cyprus
| | - Cuma Bulent Gul
- Bursa Yuksek Ihtisas Training and Research Hospital, Nephrology, Bursa, Turkey
| | - Bulent Altun
- Hacettepe University, Medical Faculty, Nephrology, Ankara, Turkey
| | - Saime Paydas
- Cukurova University, Medical Faculty, Nephrology, Adana, Turkey
| | - Sami Uzun
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Zulal Istemihan
- Istanbul University, Istanbul Medical Faculty, Internal Medicine, Istanbul, Turkey
| | - Metin Ergul
- Kocaeli University, Medical Faculty, Nephrology, Kocaeli, Turkey
| | - Mevlut Tamer Dincer
- Istanbul University, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Mustafa Gullulu
- Uludag University, Medical Faculty, Nephrology, Bursa, Turkey
| | | | | | - Abdulkadir Unsal
- Hamidiye Sisli Etfal Training and Research Hospital, Nephrology, Istanbul, Turkey
| | - Sumeyra Koyuncu
- Erciyes University, Medical Faculty, Nephrology, Kayseri, Turkey
| | - Mahmut Gok
- Sultan Abdulhamit Han Research and Training Hospital, Nephrology, Istanbul, Turkey
| | - Savas Ozturk
- Haseki Training and Research Hospital, Nephrology, Istanbul, Turkey
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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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Murt A, Dincer MT, Ercaliskan A, Karaca C, Elverdi T, Trabulus S, Ar MC, Altiparmak MR, Seyahi N. P1350A COMPARISON OF CENTRAL VENOUS CATHETER INFECTIONS FOR HEMODIALYSIS AND HEMATOLOGY PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1350] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
In addition to nephrologists who use central venous catheters (CVCs) as venous access for hemodialysis, it is also a routine practice for hematologists to benefit from them for their medical applications. There may be immediate or delayed complications of CVC placement and infections are accepted as delayed complications. We aimed to compare CVC-related infections in hematology and hemodialysis patients groups both of whose CVCs were placed by interventional nephrologists. Group specific infectious agents as well as infection risk factors were analyzed in order to develop guides and practices to decrease infection rates for the future.
Method
The number of patients who were placed a CVC in bone marrow transplantation (BMT) unit was 69 (37 males, 32 females) in the year of 2019. These patients were 47,5 ± 14,3 years old. Their CVC infection numbers and rates as well as infection agents were analyzed. This group was compared with hemodialysis patients that have non-cuffed hemodialysis catheters and who were age and sex matched with the BMT group. Infection rates for 1000 catheter days were calculated separately for both groups. Catheter infections were defined as hemoculture positivity of samples obtained from catheter lumens and/or identification of any microorganism in the catheter tip. Cases were followed up from insertion day of the catheters until when infection was identified or until the day of catheter removal.
Results
Catheters remained in a central vein for a median of 25 days in hemodialysis group [range: 10-51 days] while these duration was 16 days [range:8-29 days] for BMT group. The number of cases in whom a catheter related infection was identified was 17 for BMT (24%) and nine (13%) for hemodialysis group. Infection rate was 23 for 1000 catheter days in BMT group while it was 11 for 1000 catheter days in hemodialysis patients. BMT patients have a wider range of infection agents; 78% of them being gram positives and 19% of them being gram negatives. It was noteworthy that all of the catheter related infections in hemdialysis patients were related to gram positive bacteria. Rate of infections due to extended spectrum beta lactamase (ESBL) secreting E.coli or Klebsiella was 24% and infection risk of ESBL secreting agents was directly proportional to the time spent with the catheter. Infection findings in the catheter exit site (e.g. erythema, crusts or effusions) was found as statistically significant risk factors for bloodstream infections in BMT patients while these factors were not statistically significant for hemodialysis patients.
Conclusion
Gram positive infections make up the majority of CVC-related infections both for hematology and hemodialysis patients. Infection risks due to resistant species is proportional to the time spent with catheters. Catheter exit site findings should be cautionary for probable bloodstream infections especially for immunosuppressed patients.
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Affiliation(s)
- Ahmet Murt
- Cerrahpaşa Medical Faculty, Nephrology, Istanbul, Turkey
| | | | | | - Cebrail Karaca
- Cerrahpaşa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Tugrul Elverdi
- Cerrahpasa Medical Faculty, Hematology, Istanbul, Turkey
| | - Sinan Trabulus
- Cerrahpaşa Medical Faculty, Nephrology, Istanbul, Turkey
| | - M Cem Ar
- Cerrahpasa Medical Faculty, Hematology, Istanbul, Turkey
| | | | - Nurhan Seyahi
- Cerrahpaşa Medical Faculty, Nephrology, Istanbul, Turkey
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Ozkan S, Saygi Hİ, Polat Korkmaz O, Durcan E, Murt A, Sahin S, Dincer MT, Bakir A, Özkaya HM, Trabulus S, Seyahi N, Güzel E, Gönen MS. P1010EFFECTS OF SGLT2 INHIBITORS ON DIABETIC NEPHROPATHY: PODOCYTURIA ON FOCUS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1010] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Sodium-glucose co-transporter 2 (SGLT2) inhibitors which are a class of oral anti-diabetic drugs are being used in the treatment of type 2 diabetes (T2D). Basically these drugs reduce blood glucose by blocking glucose reabsorption of primary sodium-coupled glucose transporter in the proximal tubules. Diabetic nephropathy (DN) is a progressive disease with the pathology of glomerular filtration barrier damage and loss of podocytes. In this respect, podocyturia which is the case characterized with presence of podocytes in urine have recently been considered to be a candidate marker for glomerular damage. Therefore, we aimed to investigate effects of SGLT2 inhibitors on glomerulus through the evaluation of podocyturia in DN patients.
Method
Our study population was composed of two T2D patient groups; one of which received SGLT2 inhibitor (SGLT2 group) and the other one is control which did not received. Patients with T2D for at least 5 years, diagnosed with DN and having microalbuminuria >30 mg/day, glomerular filtration rate (GFR) >60 ml/min and HbA1c< 8.5 were involved. In addition, all patients had received angiotensin converting enzyme inhibitor or angiotension receptor blocker for at least 6 months. Nephrologic parameters of patients were monitored before and 3rd and 6th month of follow up period. Patients’ age, sex, diabetes duration and HbA1c value were obtained from medical charts. GFR was calculated using the abbreviated MDRD formula. Microalbuminuria was measured in 24 hour urine. Number of podocytes in the urine was determined by immunocytochemical staining of two different markers as podocalyxin (podx) and synaptopodin (synp). Statistical analyses were carried out using Statistical Package for the Social Sciences version (SPSS) 24.0 and statistical significance was set as p<0.05.
Results
We evaluated a total of 29 patients (mean age: 57.59 ± 9.66). The number of patients for SGLT2 and control groups are 18 (mean age: 54.89 ± 7.73) and 11 (mean age: 62.00 ± 11.60) respectively. Between these two groups, there was no statistical difference with respect to durations of diabetes (p=0.875) and HbA1c (p=0.05) values except for age (p=0.023) in which control group is statistically higher than the SGLT receiving group. Among the patients receiving SGLT2 inhibitor, podocyturia and microalbuminuria (mca) levels in the 6th month of follow up period were statistically lower than the initial ones [p=0.039 (synp), p=0.016 (podx) and p=0.011 (mca) respectively] while there was no statistical difference for creatinine clearance rate between the initial and follow up period (p:0.371 and ;p=0.111) (Figure-1). For control group, although podocyturia was significantly reduced in the 6th month of follow up period [p=0.013 (synp) and p:0.005 (podx)], microalbuminuria (p=0.263) in addition to creatinine clearance (p:0.214; p=0.173) did not change significantly (p=0.263). Furthermore, while there was no significant difference for initial microalbuminuria level between the control and SGLT2 groups (p=0.353); in the 3rd and 6th month follow up period, microalbuminuria was significantly lower than the control group accordingly (p=0.011 and p=0.015 respectively).
Conclusion
According to our preliminary results; patients receiving SGLT2 inhibitors had better microalbuminuria levels than the ones did not and this parameter was correlated with podocyturia. However, even though microalbuminuria of the control group did not change during the follow up period, podocyturia was found out as reduced in the 6th month of follow up period. This discrepancy in the podocyturia level could be resulted from lower number of patients in control so that there is need for evaluation of more patients to emphasize podocyte protective effect of SGLT2 inhibitors.
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Affiliation(s)
- Serbay Ozkan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Histology and Embryology, Fatih, Turkey
| | - Halil İbrahim Saygi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Histology and Embryology, Fatih, Turkey
| | - Ozge Polat Korkmaz
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Endocrinology and Metabolism, Department of Internal Medicine, Fatih, Turkey
| | - Emre Durcan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Endocrinology and Metabolism, Department of Internal Medicine, Fatih, Turkey
| | - Ahmet Murt
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Nefrology, Department of Internal Medicine, Fatih, Turkey
| | - Serdar Sahin
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Endocrinology and Metabolism, Department of Internal Medicine, Fatih, Turkey
| | - Mevlut Tamer Dincer
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Nefrology, Department of Internal Medicine, Fatih, Turkey
| | - Alev Bakir
- Halic University, Department of Biostatistics and Medical Informatics, Beyoğlu, Turkey
| | - Hande mefküre Özkaya
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Endocrinology and Metabolism, Department of Internal Medicine, Fatih, Turkey
| | - Sinan Trabulus
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Nefrology, Department of Internal Medicine, Fatih, Turkey
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Nefrology, Department of Internal Medicine, Fatih, Turkey
| | - Elif Güzel
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Histology and Embryology, Fatih, Turkey
| | - Mustafa Sait Gönen
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Endocrinology and Metabolism, Department of Internal Medicine, Fatih, Turkey
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28
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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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Alagoz S, Dincer MT, Eren N, Bakir A, Pekpak M, Trabulus S, Seyahi N. Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor? PLoS One 2020; 15:e0230980. [PMID: 32240223 PMCID: PMC7117725 DOI: 10.1371/journal.pone.0230980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/12/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Anemia is highly prevalent in chronic kidney disease patients; however, its identification and management have been reported to be suboptimal. In this study we aimed to describe the prevalence, severity, risk factors, and treatment of anemia in different nephrology centers, among chronic kidney disease patients who were not given renal replacement therapy. MATERIALS AND METHODS We performed a multicenter cross-sectional study in three different nephrology clinics. Adult (>18 years of age) chronic kidney disease patients with an estimated glomerular filtration rate (eGFR) below 60 ml/min, and who were not started dialysis were recruited. Demographic, clinical and laboratory data regarding anemia and its management were collected using a standard data form. Anemia was defined as a hemoglobin level below 12g/dL and severe anemia as a hemoglobin level below 10g/dl. RESULTS A total of 1066 patients were enrolled in the study. Anemia and severe anemia were present in 55.9% and 14.9% of the patients, respectively. The mean hemoglobin level for the whole cohort was 11.8±1.8 g/dL. Univariate analyses revealed that the mean hemoglobin level was significantly different among the centers. Moreover, the frequency of the presence of anemia stratified by severity was also significantly different among the centers. According to binary logistic regression analysis, gender, levels of eGFR and iron, ferritin ≥ 100 ng/mL, and the nephrology center were independent determinants of severe anemia. CONCLUSIONS We found a high prevalence of anemia among chronic kidney disease patients who were not on renal replacement therapy. Each center should determine the treatment strategy according to the patient's characteristics. According to our results, the center-specific management of anemia seems to be important.
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Affiliation(s)
- Selma Alagoz
- Department of Nephrology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necmi Eren
- Department of Nephrology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Alev Bakir
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Halic University, Istanbul, Turkey
| | - Meltem Pekpak
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinan Trabulus
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Affiliation(s)
- Ahmet Murt
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Cebrail Karaca
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
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Dincer MT, Yalin SF, Toker Dincer Z, Trabulus S, Seyahi N, Celik AF, Altiparmak MR. MP011RENAL MANIFESTATIONS IN INFLAMMATORY BOWEL DISEASES. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx160.mp011] [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: 11/13/2022] Open
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Toker Dincer Z, Dincer MT, Yalin SF, Trabulus S, Seyahi N, Altiparmak MR. SP647EVALUATION OF GERIATRIC PATIENTS UNDERWENT EMERGENCY HEMODIALYSIS IN A TERTIARY CARE HOSPITAL. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx154.sp647] [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: 11/13/2022] Open
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