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Sahutoglu T, Danis R, Pembegul I, Ozturk I, Huzmeli C, Tugcu M, Oguz EG, Bora F, Islam M, Ayar Y, Yilmaz Z, Tanburoglu DB, Genc F, Bindal ME, Tuglular S, Kazancioglu R. Resilience and challenges of peritoneal dialysis survivors in the aftermath of the 2023 Kahramanmaraş earthquake. Ther Apher Dial 2024. [PMID: 38647140 DOI: 10.1111/1744-9987.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Peritoneal dialysis (PD) remains understudied in disaster nephrology. This retrospective multicenter study explores the experiences of PD survivors following the February 6, 2023, Kahramanmaraş Earthquake. METHODS Adult PD patients from 11 affected cities were analyzed to assess challenges faced during and postearthquake, alongside clinical outcomes. RESULTS Among 101 participants (median age: 45 years, median PD duration: 24 months), 57 were female, with 79 on continuous ambulatory PD. Challenges included power outages and water shortages, with primary shelter in kin's houses (33%) and homes (28%). Twelve patients experienced PD program delays, and three lacked assistance postdisaster. Sixteen patients changed PD modalities, with seven experiencing postearthquake peritonitis. Clinical parameters remained stable, except for a slight decrease in hemoglobin levels. CONCLUSION Despite challenges, PD survivors exhibited resilience, highlighting the importance of addressing peritonitis and unusual pathogens in disaster preparedness initiatives.
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Affiliation(s)
- Tuncay Sahutoglu
- Department of Nephrology, Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Ramazan Danis
- Department of Nephrology, Diyarbakır Gazi Yaşargil Education Research Hospital, Diyarbakir, Turkey
| | - Irem Pembegul
- Department of Nephrology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ilyas Ozturk
- Department of Nephrology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Can Huzmeli
- Department of Nephrology, Hatay Education and Research Hospital, Hatay, Turkey
| | - Murat Tugcu
- Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ebru Gok Oguz
- Department of Nephrology, Etlik City Hospital, Health Sciences University, Ankara, Turkey
| | - Feyza Bora
- Department of Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mahmud Islam
- Department of Nephrology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yavuz Ayar
- Nephrology Department, Bursa City Health Application Research Center, Bursa Faculty of Medicine, University of Health Sciences, Bursa, Turkey
| | - Zulfikar Yilmaz
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | | | - Fatih Genc
- Department of Nephrology, Faculty of Medicine, Elazig University, Elazig, Turkey
| | - Mehmet Emin Bindal
- Department of Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Serhan Tuglular
- Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Mirioglu S, Kazancioglu R, Cebeci E, Eren N, Sakaci T, Alagoz S, Tugcu M, Tuglular S, Sumbul B, Seyahi N, Ozturk S. Humoral Response to BNT162b2 and CoronaVac in Patients Undergoing Maintenance Hemodialysis: A Multicenter Prospective Cohort Study. Nephron Clin Pract 2023; 147:392-400. [PMID: 36603567 PMCID: PMC9843732 DOI: 10.1159/000528170] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/11/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Data regarding inactivated vaccines for SARS-CoV-2 in patients undergoing maintenance hemodialysis (MHD) are limited. We aimed to investigate humoral responses induced by CoronaVac compared to BNT162b2 in this population. METHODS In this multicenter prospective cohort study, adult patients undergoing MHD who lacked a history of COVID-19 and decided to get vaccinated with BNT162b2 or CoronaVac were enrolled. Participants provided serum samples before, 1 and 3 months after 2 doses. Anti-SARS-CoV-2 IgG antibodies against receptor-binding domain of the virus were measured, and levels ≥50 AU/mL were considered as positive. Breakthrough infections and adverse events were recorded. RESULTS Ninety-two patients were included, 68 (73.9%) of whom were seronegative at baseline. BNT162b2 and CoronaVac were administered in 38 (55.9%) and 30 (44.1%) patients. At 1 month, seropositivity was 93.1% in BNT162b2 and 88% in CoronaVac groups (p = 0.519). Quantitative antibody levels were significantly higher in BNT162b2 (p < 0.001). At 3 months, both seropositivity (96.4% and 78.3%, p = 0.045) and antibody levels (p = 0.001) remained higher in BNT162b2 compared to CoronaVac. Five patients (7.4%) experienced breakthrough COVID-19. Adverse events were more frequent with BNT162b2, although all of them were mild. Multiple linear regression model showed that only vaccine choice (BNT162b2) was related to the humoral response (β = 0.272, p = 0.038). Seropositive patients at baseline (n = 24) had higher antibody levels at any time point. CONCLUSIONS BNT162b2 and CoronaVac induced humoral responses in naïve patients undergoing MHD, which were more robust and durable for 3 months after BNT162b2. Both vaccines created high antibody levels in patients who were seropositive at baseline.
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Affiliation(s)
- Safak Mirioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey,
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Egemen Cebeci
- Division of Nephrology, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Necmi Eren
- Division of Nephrology, Kocaeli University School of Medicine, İzmit, Turkey
| | - Tamer Sakaci
- Division of Nephrology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selma Alagoz
- Division of Nephrology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Tugcu
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Bilge Sumbul
- Department of Medical Microbiology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Istanbul University-Cerrahpasa Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Savas Ozturk
- Division of Nephrology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
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Coban H, Barutcu Atas D, Kursun M, Tugcu M, Asicioglu E, Hakki Arikan I, Cimsit C, Serhan Tuglular Z, Velioglu A. MO956: Sarcopenia Predicts Mortality in Renal Transplant Candidates. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.014] [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
Sarcopenia is common in chronic kidney disease (CKD) and is associated with increased mortality and morbidity. Sarcopenia in CKD can be defined as a decreased muscle mass, mainly due to the catabolic state caused by the uremic environment. Malnutrition and inflammation are also common in sarcopenic patients. In this study, we aimed to investigate the prevalence of sarcopenia defined as low muscle mass determined by Psoas Muscle Index (PMI) in waitlisted end-stage renal disease (ESRD) patients and its association between ‘Prognostic Nutritional Index (PNI)’, ‘C-reactive protein (CRP) to Albumin Ratio (CAR)’ and mortality.
METHOD
ESRD patients registered to national kidney transplant waiting list and had abdomen CT at admission were included in the study. Kidney donor candidates were constituted as healthy controls. PMI (cm2/m2) were calculated by proportioning the psoas muscle area detected in the abdomen CT with the square of the height. The PMI of the controls at the fifth percentile according to gender was accepted as the limit value for sarcopenia. PNI and CAR were calculated using albumin, CRP and absolute lymphocyte count. The associations between PMI, PNI, CAR and all-cause mortality were investigated.
RESULTS
A total of 162 ESRD patients and 87 age matched healthy controls were included in the study. The mean age of the patients was 44.7 ± 14.2 years and follow-up time was 3.37 (0.35–9.60) years. The mean PMI were similar between the groups (5.24 ± 1.71 versus 5.48 ± 1.87 cm2/m2 P = 0.302). While prevalence of sarcopenia (16.7% versus 3.4%, P = 0.002) and CAR [1.47 (0.12–37.10) versus 0.74 (0.21–10.20), P < 0.001] was higher; PNI [40 (20.4–52.2) versus 44 (36.1–53.0), P < 0.001] was lower in ESRD patients than controls. When ESRD patients compared according to sarcopenia PMI [3.45 ± 0.9 versus 5.59 ± 1.6, P < 0.001] and PNI [39 (20.4–51) versus 41 (23–52.2), P = 0.005] was significantly lower and CAR [2.03 (0.28–34.65) versus 1.28 (0.12–37.1), P = 0.041] was higher in sarcopenic ESRD group than non-sarcopenic ESRD group (Table 1). In the correlation analysis, PMI was positively correlated with PNI (r = 0.246, P = 0.002), no correlated with CAR (r = −0.061, P = 0.445). In the follow-up, 67 waitlisted patients had been transplanted. In the five-year survival analysis, the non-sarcopenic transplant group [95% CI: 4.612–5.123 versus 95% CI: 2.721–5.413, P = 0.001] had better survival than sarcopenic transplant group (Figure 1). Mortality rates were similar in both sarcopenic transplant group and non-sarcopenic-non-transplant group. Multivariate regression analysis showed that sarcopenia (HR: 10.277, 95% CI: 3.912–27.000, P < 0.001), not having a transplant (HR: 3.949, 95% CI: 1.301–11.993, P = 0.015), low PNI (HR: 3.532, 95% CI: 1.303–9.574, P = 0.013) and duration of renal replacement therapy (HR: 1.009, 95% CI: 1.002–1.015, P = 0.008) were independent risk factors for mortality in all ESRD group.
CONCLUSION
In this study we observed that sarcopenia, as defined by low muscle mass, is almost seen five times more frequent in ESRD patients than controls and positively correlated with PNI. Sarcopenia is an independent risk factor for mortality in waitlisted patients.
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Affiliation(s)
- Harun Coban
- Marmara University, School of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Dilek Barutcu Atas
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Meltem Kursun
- Marmara University, School of Medicine, Department of Radiology, Istanbul, Turkey
| | - Murat Tugcu
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ebru Asicioglu
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Izzet Hakki Arikan
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Canan Cimsit
- Marmara University, School of Medicine, Department of Radiology, Istanbul, Turkey
| | - Z. Serhan Tuglular
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Arzu Velioglu
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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Berke Mentese I, Barutcu Atas D, Hakki Arikan I, Tugcu M, Velioglu A, Asicioglu E. MO702: Etiology and the Impact of Refractory Peritonitis on Clinical Outcomes of Patients on Peritoneal Dialysis—12 Years’ Single-Center Experience from Turkey. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac078.039] [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
The outcomes of refractory peritonitis in peritoneal dialysis (PD) patients have been reported to be inferior to those of solitary peritonitis. The current study aimed to examine the factors associated with treatment failure in PD patients experiencing refractory peritonitis.
METHOD
This single-center retrospective study included all episodes of refractory peritonitis in adult PD patients in Marmara University Hospital, Turkey, between 2009 and 2020. Patient characteristics, microbiological data, outcomes and factors associated with refractory peritonitis were analysed. The primary outcome was peritonitis-related catheter loss. Secondary outcomes were hospitalization and peritonitis-related death.
RESULTS
Overall, 236 episodes of refractory peritonitis occurring in 135 patients were included. Gram-positive, gram-negative and fungal infections accounted for 44.1%, 20.4% and 2.4% of all peritonitis episodes, respectively. Forty-seven patients (34.8%) needed catheter removal, 2 patients (1.5%) died due to peritonitis complications and 59 episodes (25%) needed hospitalization. Mean fifth day PD fluid cell count was significantly greater among patients who required PD catheter removal (3621.3 $ \pm $ 3144.1 versus 1589.4 $ \pm $ 2316.6 P < 0.001). Furthermore, patients with >1000/mm3 cell count on the fifth day had higher rate of catheter removal (72.3% versus 37.6%, P < 0.001) as compared to patients with cell count under 300/mm3. Treatment failure was more common in peritonitis episodes caused by gram (−) organisms (31.9% versus 14.8%, P:0.012). Pseudomonas and fungi-associated peritonitis were also significantly correlated with catheter loss (P:0.001 and P: <0.001) (Table 1). When peritonitis episodes with more and <1000 cells/mm3 on the fifth day were compared, there were more episodes with gram (−) bacteria (29.7% versus 12.9%, P:0.003) and hospitalization (41.9% versus 11.4%, P: <0.001) in the group with more than 1000 cells/mm3. In the multivariate analysis, factors associated with catheter loss were a cell count of >1000 on the fifth day and hospitalization, while presence of gram (+) bacteria related peritonitis was inversely correlated with catheter loss (Table 2).
CONCLUSION
Our study shows that the PD cell count on the fifth day of peritonitis can be used as a prognostic tool to determine the prognosis of refractory peritonitis episodes. Although we were unable to show the adverse prognostic effect of gram (−) bacteria related peritonitis, gram (+) bacteria related peritonitis was associated with better outcome. Prospective studies are needed to assess the risk factors for adverse outcomes of patients with refractory peritonitis, as the evidence in this area is sparse.
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Affiliation(s)
| | | | | | - Murat Tugcu
- Nephrology, Marmara University Research And Education Hospital, Turkey
| | - Arzu Velioglu
- Nephrology, Marmara University Research And Education Hospital, Turkey
| | - Ebru Asicioglu
- Nephrology, Marmara University Research And Education Hospital, Turkey
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Gokmen K, Barutcu Atas D, Tugcu M, Velioglu A, Hakki Arikan I, Alibaz-Oner F, Direskeneli H, Serhan TZ, Asicioglu E. MO121: The Relationship between Perceived Stress with Anxiety, Depression, Sleep Quality, Insomnia and Drug Adherence in Patients with Systemic Lupus Erythematosus during the COVID-19 Pandemic. Nephrol Dial Transplant 2022. [PMCID: PMC9383868 DOI: 10.1093/ndt/gfac066.024] [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: 12/03/2022] Open
Abstract
BACKGROUND AND AIMS Sleep disorders, depression and anxiety are commonly reported in patients with systemic lupus erythematosus (SLE). Public health emergencies such as pandemics can also increase these psychosocial distresses. Early diagnosis and treatment of these disorders will substantially affect patients' quality of life and medication adherence. The aim of this study was to evaluate both medication non-adherence and the incidence of perceived stress, anxiety, depression, sleep quality and insomnia during the COVID pandemic in patients with SLE. METHOD This was a cross-sectional, descriptive survey study. A total of 211 participants, including 160 SLE patients aged 18 years and older and 51 healthy volunteers who were similar in age and gender, were included. A questionnaire of socio-demographics and COVID-19 status, Medication Compliance Reporting Scale (MARS-5), Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HAD-A and HAD-D), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) scales was assessed. The participants were interviewed face to face, and the answers were recorded by the researcher. RESULTS The mean age of the patients was 41.85 ± 12.97 years and 142 (88.7%) of the patients were female. There was no significant difference between the patient and control groups in terms of the history of COVID-19 infection, symptoms and hospitalization. Fifty-nine (36.9%) patients had high perceived stress, 16 (10.0%) had anxiety, 45 (28.1%) had depression, 77 (48.1%) had poor sleep quality and 62 (38.8%) patients had insomnia. PSS (23.64 ± 7.86 versus 19.73 ± 4.80, P = .001), HAD-D (5.60 ± 3.40 versus 4.08 ± 2.21, P = .003), PSQI (6.31 ± 3.62 versus 4.43 ± 2.20, P = .001) and ISI (6.81 ± 4.98 versus 4.53 ± 2.83, P = .002) scores were significantly higher in the patient group than controls. Patients with PSS score ≥ 25 were categorized as patients with a high PSS score. Presence of anxiety, depression, poor sleep quality and insomnia were significantly higher in patients with a high PSS score. Medication non-adherence was detected in 79 (49.4%) of the patients. Interestingly, there was no difference in MARS-5 scores between high and low PSS groups. Comparison of baseline characteristics and clinical data of the patients according to PSS score is shown in Table 1. The high PSS score was positively correlated with HAD-A, HAD-D, PSQI and ISI scores. Regression analysis revealed that high perceived stress is an independent predictor of depression [Exp(β) 95% CI: 1.488 (1.245–1.779), P < .001], and anxiety [Exp(β) 95% CI: 1.235 (1.026–1.487), P = .026]. CONCLUSION SLE patients demonstrated increased levels of perceived stress, depression, poor sleep quality and insomnia compared to the healthy population during the COVID-19 pandemic. SLE patients with high perceived stress had more depression, anxiety, poor sleep quality and insomnia than those without. It needs to be determined whether these findings will have an impact on patient outcomes during long-term follow-up.
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Affiliation(s)
- Kardelen Gokmen
- Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Dilek Barutcu Atas
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Murat Tugcu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Arzu Velioglu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Izzet Hakki Arikan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz-Oner
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Tuglular Z Serhan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ebru Asicioglu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
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6
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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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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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Barutcu Atas D, Tugcu M, Asicioglu E, Velioglu A, Arikan H, Koc M, Tuglular S. Prognostic nutritional index is a predictor of mortality in elderly patients with chronic kidney disease. Int Urol Nephrol 2021; 54:1155-1162. [PMID: 34562196 DOI: 10.1007/s11255-021-03002-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/04/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Prognostic nutritional index (PNI), a composite indicator of inflammation and nutritional status, has recently been recognized as an independent prognostic marker for chronic kidney disease (CKD). We aimed to investigate PNI and its relationship with mortality in elderly patients with CKD. METHODS Three hundred and fifty-nine patients over the age of 80 years with stage 3-4 CKD were enrolled in this retrospective study. PNI was used to assess the nutritional status of the patients. Patients were divided into two different groups as deceased and survived and as low PNI (< 39) and high PNI (≥ 39) according to median value of PNI. RESULTS The mean age of the patients was 85.7 ± 3.7 years. One hundred and ninety-five (54.3%) patients died during follow-up. Multivariate analysis revealed that male gender, PNI, proteinuria, and diabetes mellitus (DM) were independent predictors of mortality in elderly patients with CKD. When patients with low PNI were compared to those with high PNI, initiation of dialysis and mortality rate were significantly higher whereas albumin, hemoglobin and lymphocyte count were lower. Pearson correlation analysis showed that PNI was significantly correlated with albumin (r = 1.000, p < 0.001), hemoglobin (r = 0.340, p < 0.001) and eGFR (r = 0.123, p = 0.020). Hemoglobin was an independent predictor of PNI in multivariate analysis. CONCLUSION In this study, we observed that PNI was significantly associated with mortality over the age of 80 years in patients with CKD and can be used to monitor nutritional status in this patient population.
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Affiliation(s)
- Dilek Barutcu Atas
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey.
| | - Murat Tugcu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Ebru Asicioglu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Arzu Velioglu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Hakki Arikan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Mehmet Koc
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
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Barutcu Atas D, Asicioglu E, Tugcu M, Arikan IH, Velioglu A. Long-Term Predictors of Mortality in Peritoneal Dialysis Patients. Turk J Nephrol 2021. [DOI: 10.5152/turkjnephrol.2021.4712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tugcu M, Velioglu A, Asicioglu E, Arikan IH, Tuglular ZS. Impact of the Anatomical Localization of the Exit Site on Complications in Patients on Peritoneal Dialysis. Turk J Nephrol 2021. [DOI: 10.5152/turkjnephrol.2021.4390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Berke Mentese I, Tugcu M, Velioglu A, Nazli I, Tuglular ZS. MO313A CASE OF ALPORT SYNDROME WITH PREGNANCY-RELATED ATYPICAL HEMOLYTIC UREMIC SYNDROME, AND CRESCENTIC GLOMERULONEPHRITIS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab104.0071] [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
Thrombotic microangiopathy (TMA) is one of the most important complications in pregnant patients with chronic kidney disease (CKD) causing clinical deterioration. However, little is known about the pregnancy course in women with Alport syndrome (AS).
Case
A 28-week pregnant, 22-year-old woman was admitted to our clinic because of widespread edema. Her medical history was notable only for hearing impairment. On examination, vital signs were normal except for the blood pressure (150/90 mmHg). There were diffuse crackles at the lung bases, and 3+ pitting edema in both legs. Lab results revealed heavy proteinuria with 11 gr/day and isomorphic erythrocytes with granular casts in microscopic urine examination. An emergency c-section was performed due to severe preeclampsia at 30 weeks’ gestation.
After delivery, her edema did not improve, serum creatinine and lactate dehydrogenase levels elevated, anemia and thrombocytopenia developed (Table 1). Additional tests revealed negative Coombs test, schistocytes on peripheral smear and normal ADAMTS13 level. There was no pathology in serological studies.
She received four sessions of plasmapheresis therapy, and with the diagnosis of aHUS, eculizumab therapy was started. Despite improving thrombocytopenia and anemia, serum creatinine levels continued to rise and her urine output decreased. A kidney biopsy was performed (Figure 1). In the light microscopy, 11 of 15 glomeruli had circumferential cellular crescents and 4 had partial cellular crescents. The sample had no findings consistent with TMA. No staining was seen with IgG, IgA, IgM, C3, C1q, κ and λ in immunofluorescence.
Further evaluation of hearing impairment revealed bilateral sensorineural hearing loss. A homozygous mutation was identified on COLA4 gene, while homozygous polymorphism on complement factor H (CFH) c.1204C>T and heterozygotic polymorphisms on CFH c.2808G>T and c.3148A>T were revealed.
After discharge, her kidney function remained poor requiring maintenance hemodialysis despite 6 months of eculizumab therapy.
Discussion
Alport syndrome is a genetic disease with the triad of hematuria, sensorineural hearing loss, and ocular symptoms due to the defect in the synthesis of α3, α4 and α5 chains of Type 4 collagen. The increase in proteinuria, hypertension and the presence of CKD are shown as poor prognostic factors for both maternal and fetal health in pregnant women with AS.
However, crescentic glomerulonephritis is not the classical biopsy finding of AS. In a few studies, crescents in AS have been reported to correlate with rapid disease progression.
There is increasing knowledge that the complement system is involved in the pathogenesis of pauci-immune crescentic GN. High plasma c3a, c5a, c5b-9, Bb and low plasma properdin levels were found to show alternative complement activation and correlate with disease activity in pauci-immune crescentic GN patients. Few reports show that anti-complement therapies might be an option in these cases. Although our case’s kidney functions did not improve on eculizumab, we conclude that the polymorphisms in the complement genes may have induced crescent formation in the presence of pregnancy and abnormal glomerular structure due to AS.
Conclusion
Here we presented a case with AS complicated by aHUS and crescentic GN. Given this complex combination of rare causes of acute kidney injury, detailed clinical evaluation is of great importance in the evaluation of acute kidney injury during pregnancy.
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Affiliation(s)
- Ilay Berke Mentese
- Marmara University Research And Education Hospital, Nephrology, İstanbul, Turkey
| | - Murat Tugcu
- Marmara University Research And Education Hospital, Nephrology, İstanbul, Turkey
| | - Arzu Velioglu
- Marmara University Research And Education Hospital, Nephrology, İstanbul, Turkey
| | - Ismail Nazli
- Marmara University Research And Education Hospital, Internal Medicine, Istanbul, Turkey
| | - Z Serhan Tuglular
- Marmara University Research And Education Hospital, Nephrology, İstanbul, Turkey
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Atas D, Velioglu A, Tugcu M, Arikan H, Asicioglu E. Prevalence and predictors of 25-OH Vitamin D deficiency in peritoneal dialysis patients: A single center study. Med-Science 2021. [DOI: 10.5455/medscience.2020.11.244] [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: 11/03/2022] Open
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Atas D, Aykent B, Arikan H, Tugcu M, Velioglu A, Asicioglu E. Low serum 25-OH vitamin D levels are associated with increased D/P creatinine ratio in peritoneal dialysis patients. Med-Science 2021. [DOI: 10.5455/medscience.2021.03.082] [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: 11/03/2022] Open
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Tugcu M, Kasapoglu U, Ruhi C, Boynuegri B, Sahin G, Apaydın S. SP756IMPACT OF CLINICAL CHARACTERISTISC AND METABOLIC PARAMETERS ON SURVIVAL OF THE INCIDENT GERIATRIC HEMODIALYSIS PATIENTS: A SINGLE CENTER EXPERIENCE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv200.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bronsther O, Ersoz S, Tugcu M, Eghtesad B, Gurakar A, Van Thiel DH. Liver transplantation for HBV-related disease under immunosuppression with tacrolimus: an experience with 78 consecutive cases. J Okla State Med Assoc 1995; 88:103-108. [PMID: 7539077] [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] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Hepatitis B viral liver disease (HBVLD) is a major worldwide health problem. It is estimated over 300 million people have had hepatitis B virus infection and that one-third of these have chronic HBVLD. Little effective therapy exists for HBVLD even though high dose interferon (IFN) has been advocated. For those who either are untreated or do not respond to IFN, HBVLD is steadily progressive and orthotopic liver transplantation (OLTx) is the only available therapy. Until quite recently, all OLTx recipients received cyclosporine (CyA) and prednisone. The consequence of OLTx for HBV disease in individuals immunosuppressed with tacrolimus has not previously been reported. A total of 78 consecutive patients with HBV-related liver diseases who were transplanted between January 1, 1990, and December 31, 1991, and treated with tacrolimus were studied. The clinical records of these patients were reviewed retrospectively. HBV disease recurrence was documented with serologic and histologic methods. As of April 1, 1993, 57 of 78 (73%) of the patients were still alive. Thirty-one of the alive patients have documented HBV recurrence. Eighteen of these 31 patients, however, have normal liver function. With a median follow-up of 24 months, 8 patients (10.9%) have died of recurrent HBVLD. Seven of 8 patients, who preoperatively were HBeAg+, developed recurrence and 4 of these patients have already died of recurrence. Patients who were HBsAg+ rarely recurred (1 of 16 patients). The use of HBIG did not prevent recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- O Bronsther
- Department of Surgery, University of Pittsburgh School of Medicine, Pa., USA
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