The predictors of catheter-related bloodstream infections in patients undergoing hemodialysis: A single center experience

BACKGROUND

Here we aimed to investigate the predictors of catheter-related bloodstream infections (CRBSI) in patients with acute kidney injury or chronic kidney disease who required renal replacement therapy through a non-tunneled hemodialysis catheter.

METHODS

A total of 111 patients who received non-tunneled hemodialysis catheters were retrospectively evaluated. Patients were divided into two groups; those who developed CRBSI and those who did not. Patient's demographic data, laboratory results at admission, information regarding catheter infections, and culture results were obtained from electronic medical records.

RESULTS

The mean age of the patients was 64 ± 16 years, and 51 of them were male. CRBSI occurred in 14 patients (12.6%). Admission serum albumin level (OR: 0.119, 95% CI: 0.019-0.756, p = 0.024), admission mean platelet volume (OR: 2.207, 95% CI: 1.188-4.100, p = 0.012) and catheter duration (OR: 1.580, 95% CI: 1.210-2.064, p = 0.001) were independent predictors for the CRBSI development. ROC curve analysis demonstrated that a catheter duration of 22 days was predictive for presence of CRBSI (78% sensitivity, 76% specificity, AUC: 0.825, 95% CI: 0.724-0.925, p < 0.001).

CONCLUSIONS

Prolonged catheter duration, low serum albumin, and high mean platelet volume independently predict the development of CRBSI in patients undergoing hemodialysis for acute kidney injury or chronic kidney disease.

Relationship Between Serum Magnesium Level and Insulin Resistance in Turkey Non-obese Adult Population

The homeostasis model assessment of insulin resistance (HOMA-IR) is widely used in clinical practice to estimate insulin resistance. In particular, magnesium (Mg) is an extensively studied mineral that has been shown to function in the management of hyperglycemia and insulin resistance (IR) action. The pathophysiology of IR in non-obese patients has not been clearly demonstrated. From this point of view, we aimed to investigate the relationship between serum Mg level and IR in non-obese patients. We analyzed 957 patients who are not obese and estimated glomerular filtration rate (e-GFR) ≥ 60 mL/min/1.73 m². Patients were divided into two groups, with and without IR. The results of the IR detected group (HOMA-IR ≥ 2.5, n = 544) and the IR undetected group (HOMA-IR < 2.5, n = 413) were compared. The median Mg value of the patients was 1.76 [0.21] mg/dL. A statistically significant difference was observed between the two groups regarding serum Mg levels (p = 0.043). A negative correlation was found between the HOMA-IR index and serum Mg levels among patients (r =  - 0.064, p = 0.049). Multivariable logistic regression analysis revealed that serum Mg level (p = 0.039, odds ratio [OR] = 0.770[95%CI: [0.917-0.989]) was independent risk factors for IR. HOMA-IR increases as the Mg level decreases in advanced ages without obesity, especially in men with low e-GFR.

The Relationship Between Carotid Intima Media Thickness, Inflammation and GLA Rich Protein Levels in Chronic Kidney Disease

AIM

Vascular calcification is a common complication in CKD. Studies conducted in patients with end-stage renal disease (ESRD) showed that calcification in vascular structures is an important component of the atherosclerosis process. GLA rich protein (GRP) has been suggested as a potential marker for vascular calcification. We investigated the relationship between GRP levels, carotid intima media thickness and inflammatory parameters in patients with predialysis stage 3, 4 and 5 CKD.

MATERIAL AND METHODS

A total of 106 patients aged ≥18 years with CKD stage 3, stage 4 and non-dialysis stage 5 and 25 healthy volunteers were enrolled in the study. Patients with obesity, uncontrolled hypertension, coronary artery disease, with active cancer or liver disease, malignant hematologic disorders, acute renal failure, acute or chronic infections were excluded. As the control group, healthy volunteers without any known illness, regular drug use, smoking, alcohol use, and obesity were recruited.

RESULTS

Patients were divided into two groups as those with CIMT below 0.90 mm and those with CIMT 0.90 mm and above. There was no significant difference between the two groups in terms of the presence of HT and DM. While the CRP values of the group with high CIMT were found to be significantly higher (p=0.005), the GLA rich protein levels of this group were found to be significantly higher (p=0.019).

CONCLUSION

In our study, it was determined that there was a positive correlation between GRP levels and CIMT in patients with predialysis CKD, and GRP levels were higher in patients with CIMT above 0.90 mm. These findings suggest that GRP levels can be used as a cardiovascular event biomarker in patients with CKD.

Predicting hospital mortality in COVID-19 hemodialysis patients with developed scores

Various risk scores such as COVID-GRAM Critical Illness Risk Score (COVID-GRAM), quick COVID-19 Severity Index (qCSI), and systemic immune-inflammation index (SII) have been developed to determine critical illness in hospitalized patients. None of these risk scoring systems was evaluated in HD patients who indeed carry the highest risk of developing critical illnesses. We aimed to evaluate, in hemodialysis (HD) patients with COVID-19, the performance of these scoring systems for the need of intensive care unit (ICU) and mortality. The qCSI, COVID-GRAM, and SII scores of the patients at admission to hospital were calculated and grouped according to the scoring results. The primary outcome of the study was mortality and need of ICU. Critical illness was described as a composition of admission to the ICU, invasive ventilation, or death. It was determined that when the qCSI is over 6.5, the need for ICU increased 13.8 times and mortality increased 21.3 times. When the COVID-GRAM score is >157, the ICU need increased 14.7 times and the mortality increased 33.7 times. We found that the need for ICU increased 4.2 times and mortality increased 3.1 times when the SII score was >1145. These tests, which can be easily calculated, could be used to estimate the risk of developing critical illness among COVID-19 HD patients. Estimating the risk of critical illness could help to reduce mortality in HD patients.

Comparison of serum monocide chemoattractant protein levels with immunosuppressive therapy protocols in patients with renal transplantation

BACKGROUND

Renal transplantation stands out with lower cost advantages in life expectancy, quality of life and especially in the long-term perspective compared to dialysis. Having significant side effects of immunosuppressive drugs in terms of patient and graft survival limits the use of these drugs. A variety of markers are being explored to prolong the renal graft life. One of these molecules, monocide chemoattractant protein (MCP-1) is a marker involved in renal inflammation. The production of MCP-1 was blocked in kidney diseases and the disease was improved. Along with these promising developments, we decided to investigate whether there is a significant relationship between immunosuppressive therapies used in renal transplantation therapy and serum MCP-1 levels.

METHODS

Our study was performed in 80 patients who underwent kidney transplantation followed in Haydarpaşa Numune Training and Research Hospital. These 80 patients were examined in 4 groups as Group 1 (cyclosporin), Group 2 (tacrolimus), Group 3 (sirolimus) and Group 4 (everolimus). Serum MCP-1 levels were compared between the groups by using ELISA method.

RESULTS

In our study, serum MCP-1 levels were significantly higher in cyclosporine and tacrolimus groups than in sirolimus (p<0.05). When calcineurin inhibitors and everolimus were compared, it was not statistically significant, although calcineurin inhibitors were higher.

CONCLUSION

Understanding the role of MCP-1 in monocyte homeostasis and the effects of MCP-1 inhibition in kidney disease will help to design better diagnostic and treatment strategies in patients with inflammatory kidney disease (Tab. 2, Fig. 7, Ref. 45).

Assessment of Mean Platelet Volume in Patients with AA Amyloidosis and AA Amyloidosis Secondary to Familial Mediterranean Fever: A Retrospective Chart - Review Study

Background

Amyloidosis is a protein-misfolding disease characterized by the deposition of aggregated proteins in the form of abnormal fibrils that disrupt tissue structure, ultimately causing disease. Amyloidosis is very frequent in untreated familial Mediterranean fever (FMF) patients and it is the most important feature that determines the prognosis of FMF disease. The mean platelet volume (MPV) in FMF has been previously studied. However, whether MPV level in FMF patients is lower or higher compared to healthy controls remains a topic of ongoing debate. In this study, we aimed to investigate MPV values and to assess the correlation between MPV and proteinuria in patients with AA amyloidosis and AA amyloidosis secondary to familial Mediterranean fever (AA-FMF) through a retrospective chart-review.

Material/Methods

This study was carried out on 27 patients with AA amyloidosis, 36 patients with AA amyloidosis secondary to FMF (a total of 63 patients with AA), and 29 healthy controls. There was no statistically significant difference between the AA patients and the control group (p=0.06) or between the AA-FMF group and the control group in terms of MPV values (p=0.12).

Results

We found a statistically significant negative correlation between MPV and thrombocyte count in all groups (p<0.05 for all groups), but there was no correlation between MPV and proteinuria levels in AA patients (p=0.091).

Conclusions

While similar results also exist, these findings are contrary to the majority of previous studies. Therefore, further controlled clinical prospective trials are necessary to address this inconsistency.

Image Clustering with Optimization Algorithms and Color Space

In image clustering, it is desired that pixels assigned in the same class must be the same or similar. In other words, the homogeneity of a cluster must be high. In gray scale image segmentation, the specified goal is achieved by increasing the number of thresholds. However, the determination of multiple thresholds is a typical issue. Moreover, the conventional thresholding algorithms could not be used in color image segmentation. In this study, a new color image clustering algorithm with multilevel thresholding has been presented and, it has been shown how to use the multilevel thresholding techniques for color image clustering. Thus, initially, threshold selection techniques such as the Otsu and Kapur methods were employed for each color channel separately. The objective functions of both approaches have been integrated with the forest optimization algorithm (FOA) and particle swarm optimization (PSO) algorithm. In the next stage, thresholds determined by optimization algorithms were used to divide color space into small cubes or prisms. Each sub-cube or prism created in the color space was evaluated as a cluster. As the volume of prisms affects the homogeneity of the clusters created, multiple thresholds were employed to reduce the sizes of the sub-cubes. The performance of the proposed method was tested with different images. It was observed that the results obtained were more efficient than conventional methods.

Soluble TWEAK levels are independently associated with coronary artery disease severity in patients with stage 2-3 kidney disease

PURPOSE

Patients diagnosed with chronic kidney disease (CKD) have a greater rate of cardiovascular mortality compared with the general population. The soluble form of TNF-like weak inducer of apoptosis (TWEAK) plays a role in cellular proliferation, migration, and apoptosis. The current study aimed to analyze whether soluble TWEAK levels are associated with the severity of coronary arterial disease (CAD) in CKD patients.

METHODS

Ninety-seven patients diagnosed with CKD stages 2-3 according to their estimated glomerular filtration rate and the presence of kidney injury were included in the study. Plasma sTWEAK concentrations were determined using commercially available ELISA kits. Coronary angiographies were performed through femoral artery access using the Judkins technique.

RESULTS

Correlation analysis of sTWEAK and Gensini scores showed significant association (p < 0.01, r (2) = 0.287). When patients were divided into two groups with a limit of 17 according to their Gensini score, sTWEAK levels indicated a statistically significant difference (p < 0.01).

CONCLUSIONS

Our results indicate a relationship between sTWEAK levels and CAD in CKD stages 2-3 patients.

Measurement of epidermal thickness in a patient with psoriasis by computer-supported image analysis

The aim of the present study was to measure full epidermal thickness, stratum corneum thickness, rete length, dermal papilla widening and suprapapillary epidermal thickness in psoriasis patients using a light microscope and computer-supported image analysis. The data obtained were analyzed in terms of patient age, type of psoriasis, total body surface area involvement, scalp and nail involvement, duration of psoriasis, and family history of the disease. The study was conducted on 64 patients and 57 controls whose skin biopsies were examined by light microscopy. The acquired microscopic images were transferred to a computer and measurements were made using image analysis. The skin biopsies, taken from different body areas, were examined for different parameters such as epidermal, corneal and suprapapillary epidermal thickness. The most prominent increase in thickness was detected in the palmar region. Corneal thickness was more pronounced in patients with scalp involvement than in patients without scalp involvement (t=-2.651, P=0.008). The most prominent increase in rete length was observed in the knees (median: 491 microm, t=10.117, P=0.000). The difference in rete length between patients with a positive and a negative family history was significant (t=-3.334, P=0.03), being 27% greater in psoriasis patients without a family history. The differences in dermal papilla distances among patients were very small. We conclude that microscope-supported thickness measurements provide objective results.