Resilience and challenges of peritoneal dialysis survivors in the aftermath of the 2023 Kahramanmaraş earthquake

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.

Global variability of vascular and peritoneal access for chronic dialysis

AIM

Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited.

METHODS

An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation.

RESULTS

Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low-income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high-income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively.

CONCLUSION

There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low-income countries.

An Alternative and Up-To-Date Recommendation for a Proper Site for Parathyroid Transplantation: The Omentum

OBJECTIVES

Various sites have been used for parathyroid allotransplant, such as injection into the forearm, sternocleidomastoid, or deltoid muscles. However, transplant efficiency in these regions varies according to the results reported in the literature and also obtained from our previous studies. Using the omentum "as a natural incubator" for composite tissue-derived cell transplants to increase transplant success is possible.

MATERIALS AND METHODS

To examine the efficiency of transplant sites for parathyroid allotransplant, we compared clinical cases from the literature and our experience with 23 cases. The omental transplant process is performed under general anesthesia by laparoscopic intervention. The abdominal cavity is visualized with an endocamera from a 5-mm trocar. With the help of a flexible catheter from another 5-mm trocar, microencapsulated or naked parathyroid cells are deposited on the omentum in approximately 30 mL of isotonic saline. The trocar sites are then sutured, and the surgery is terminated. Recipients were followed for 6 months with examination of biochemical parameters (parathormone, calcium, and phosphorus levels), medication use, and clinical scoring.

RESULTS

In the 23 patients who received parathyroid allotransplants over the omentum, 7 recipients did not exhibit any changes according to the scoring system criteria. However, on average, serum calcium and phosphorus levels remained within the healthy reference range. In addition, use of oral medications among patients decreased, indicating successful transplant survival. These results were consistent with a significant decrease in hypocalcemia symptoms among patients.

CONCLUSIONS

In the 23 patients, the success rate was 69.5% for the first 6-month period after transplant. Recent developments and large cohorts are needed to demonstrate the higher efficacy of parathyroid allotransplant over the omentum.

The Challenge of Preoperative Panel Reactive Antibody Positivity in Parathyroid Transplantation

OBJECTIVES

Identifying suitable recipient criteria and matching recipients with appropriate donors are required to increase survival for parathyroid transplant. This study was undertaken to evaluate transplant survival rates while comparing preoperative panel reactive antibody positivity.

MATERIALS AND METHODS

The study included 14 hypoparathyroidism patients who presented to our clinic for parathyroid transplant. Preoperative ABO compatibility and negative cross-match tests were prioritized for recipient-donor matching, and panel reactive antibody screening tests were performed. During the 24-month follow-up, we evaluated medication use and serum calcium, phosphorus, and parathormone levels of patients.

RESULTS

Preoperative panel reactive antibody positivity was assessed in 3 groups. The HLA class I-positive group (mean fluorescence intensity range, 179-1770) showed decreased medication use and stability in serum calcium levels. The HLA class IIpositive (mean fluorescence intensity range, 85-3959) showed decreased medication use by 25% to 50% and returned to their former prescription doses after 12 months. An opposite pattern was observed in 2 patients with panel reactive antibody positivity for both HLA classes (mean fluorescence intensity range, 462-2289), with 1 patient requiring medication for continuing symptoms and the other patient occasionally taking additional magnesium supplementation, despite decreased medication doses after 12 months. Serum calcium levels remained normal, and parathormone and phosphorus levels were elevated.

CONCLUSIONS

Improving patient symptoms and having no requirement for intravenous calcium replacement are priorities, and monitoring serum levels is the next important step. Varied panel reactive antibody positivities and survival rates indicate a requirement, and each HLA class could require a proper limitation for the mean fluorescence intensity. Preoperative mean fluorescence intensity cut-off value should be <900. Higher mean fluorescence intensity values in panel reactive antibody screenings could increase risk of short-term graft survival after parathyroid transplant. Further studies should include immunological risk assessments by individualizing the outcome with donor-specific antibodies.

Assessment of metabolic risk factors for nephrolithiasis in patients with autosomal dominant polycystic kidney disease: a cross-sectional study

BACKGROUND

Nephrolithiasis is more common in autosomal dominant polycystic kidney disease (ADPKD) than in the normal population. We aimed to investigate the anatomical and metabolic factors that may be associated with nephrolithiasis in patients with ADPKD METHODS: In this cross-sectional study, a total of 180 participants were included. Eighty-five patients with ADPKD [42 patients with nephrolithiasis (PKD N +) and 43 without nephrolithiasis (PKD N -)] were recruited. Forty-seven nephrolithiasis patients without ADPKD (N) and 48 healthy controls (HC) were selected as control groups. 24-h urine collections were measured in all participants. 24-h urine citrate, calcium, urate, oxalate, magnesium and sodium, serum electrolytes, and eGFRs were compared.

RESULTS

Total kidney volumes were not different between patients with PKD N + and PKD N -. Hypocitraturia was common in all patients with ADPKD (69.4%), and it was not different between PKD N + (76.2%) and PKD N- (62.8%). However, hypocitraturia was statistically higher in PKD N + and PKD N - than in N (38.3%) and HC (12.5%) (p<0.05). 24-h urine calcium, urate, and oxalate levels were similar between PKD N + and PKD N - CONCLUSIONS: Hypocitraturia was found to be significantly higher in patients with ADPKD than in healthy adults and other kidney stone patients.

Disasters and kidney care: pitfalls and solutions

Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.

The prevalence and clinical significance of loss of appetite in older patients with chronic kidney disease

PURPOSE

To determine predictors of loss of appetite among older adults with chronic kidney disease (CKD).

METHODS

Demographic and clinical data, and scores of comprehensive geriatric assessment parameters of patients who were ≥ 60 years old and have CKD according to an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 were reviewed. Loss of appetite was defined as a score of ≤ 28 in The Council on Nutrition Appetite Questionnaire. Logistic regression analysis was performed to determine the predictors of loss of appetite.

RESULTS

Of the 398 patients included, 288 (72%) were female, and the mean age was 80 ± 7. Loss of appetite was present in 233 (59%) of patients. The frequency appeared to significantly increase with a decline in eGFR to < 45 mL/min/1.73 m2 (p < 0.05). Older age, female sex, the presence of frailty, and higher scores of Insomnia Severity Index and geriatric depression scale-15 were associated with a higher risk of loss of appetite, while longer time on education, higher levels of hemoglobin, eGFR, and serum potassium, and higher scores of handgrip strength, Tinetti gait and balance test, basic and instrumental activities of daily living, and Mini-Nutritional risk Assessment (MNA) were associated with a lower risk (p < 0.05). Associations between insomnia severity and geriatric depression remained significant after adjustment for all parameters including the MNA score.

CONCLUSION

Loss of appetite is quite common in older adults with CKD and may be a sign of poor health status in older people with CKD. There is a close relationship between loss of appetite and insomnia or depressive mood.

Frequency and Clinical Impact of Anticholinergic Burden in older patients: Comparing older patients with and without chronic kidney disease

AIM

This study aimed to determine the frequency and impact of anticholinergic burden in older adults with chronic kidney disease (CKD) and compare the results to older adults without CKD.

METHOD

Age- and sex-matched older adults (age ≥60) were selected from a total cohort of 1557 subjects, and grouped as CKD (n = 589) and Non-CKD (n = 589). Groups were compared for the frequency, type of anticholinergic agents, and their effects on comprehensive geriatric assessment parameters. The anticholinergic burden was assessed using the anticholinergic burden (ACB) scale. An ACB of ≥2 was categorized as high anticholinergic burden.

RESULTS

The mean age of the partients was 81±6, and 66% were female. More patients in the CKD group experienced a high anticholinergic burden (45%, versus 38%, p = 0.015). Patients with CKD were more likely to receive beta blocker (25% versus 19%, p = 0.018), diuretic (19% versus 6%, p<0.001), while those who did not have CKD were more likely to be treated with dopaminergic agents (8% versus 12%, p = 0.039). A high anticholinergic burden was associated with sarcopenia (OR 1.62, 95% CI 1.10-2.38, p = 0.015), geriatric depression scale (OR 1.50, 95% CI 1.02-2.20, p = 0.037), and polypharmacy (OR 4.05, 95% CI 2.38-6.90, p<0.001), after adjustment for age, sex and comorbidities in the CKD group (p<0.05).

CONCLUSION

Older patients with CKD are more likely to be exposed to drugs with anticholinergic effects, but have less clinical implications than those without CKD. A high anticholinergic burden is associated with polypharmacy, depression and sarcopenia in CKD.

Healthcare professional education in shared decision making in the context of chronic kidney disease: a scoping review

RATIONALE & OBJECTIVE

Shared decision making (SDM) is a collaborative effort between healthcare professionals, individuals with CKD whereby clinical evidence, expected outcomes and potential side-effects are balanced with individual values and beliefs to provide the best mutually decided treatment option. Meaningful SDM is supported by effective training and education. We aimed to identify the available evidence on SDM training and education of healthcare professionals caring for people with chronic kidney disease. We aimed to identify existing training programs and to explore what means are used to evaluate the quality and effectiveness of these educational efforts.

METHODOLOGY

We performed a scoping review to study the effectiveness of training or education about shared decision making of healthcare professionals treating patients with kidney disease. EMBASE, MEDLINE, CINAHL and APA PsycInfo were searched.

RESULTS

After screening of 1190 articles, 24 articles were included for analysis, of which 20 were suitable for quality appraisal. These included 2 systematic reviews, 1 cohort study, 7 qualitative studies, and 10 studies using mixed methods. Study quality was varied with high quality (n = 5), medium quality (n = 12), and low quality (n = 3) studies. The majority of studies (n = 11) explored SDM education for nurses, and physicians (n = 11). Other HCP profiles included social workers (n = 6), dieticians (n = 4), and technicians (n = 2). Topics included education on SDM in withholding of dialysis, modality choice, patient engagement, and end-of-life decisions.

LIMITATIONS

We observed significant heterogeneity in study design and varied quality of the data. As the literature search is restricted to evidence published between January 2000 and March 2021, relevant literature outside of this time window has not been taken into account.

CONCLUSIONS

Evidence on training and education of SDM for healthcare professionals taking care of patients with CKD is limited. Curricula are not standardized, and educational and training materials do not belong to the public domain. The extent to which interventions have improved the process of shared-decision making is tested mostly by pre-post testing of healthcare professionals, whereas the impact from the patient perspective for the most part remains untested.

The optimization of peritoneal dialysis training in long-term

Peritoneal dialysis is a home based therapy for patients with advanced chronic kidney disease. This method provides adequate clearance of uremic toxins and removal of excess fluid when a proper dialysis prescription is combined with patient adherence. Peritonitis is the most frequent infectious complication among these patients and may render the continuity of the treatment. Training patients and their caregivers have prime importance to provide proper treatment and prevent complications including infectious ones. The training methods before the onset of treatment are relatively well established. However, patients may break the rules in the long term and tend to take shortcuts. So, retraining may be necessary during follow-up. There are no established guidelines to guide the retraining of PD patients yet. This review tends to summarize data in the literature about retraining programs and also proposes a structured program for this purpose.

Prevalence and co-incidence of geriatric syndromes according to glomerular filtration rate in older patients

BACKGROUND

Geriatric syndromes are complex clinical manifestations and significant causes of mortality and morbidity. This study was aimed to determine the frequency and co-incidence of geriatric syndromes in older patients with chronic kidney disease (CKD).

METHODS

Older patients were included in this cross-sectional retrospective study. All patients were questioned in terms of geriatric syndromes including dementia, polypharmacy, malnutrition, frailty, probable sarcopenia, urinary incontinence, falls, fear of falling, depression, insomnia, and excessive daytime sleepiness. Geriatric syndromes were evaluated according to Glomerular Filtration Rate (GFR) ≥ 60 ml/min/1.73 m², 30-59 ml/min/1.73 m² and < 30 ml/min/1.73 m².

RESULTS

Of the 1320 patients included, the mean age was 79.6 ± 7.8 and 929 (70%) were female. GFR groups ≥ 60 ml/min/1.73 m², 30-59 ml/min/1.73 m², and < 30 ml/min/1.73 m² comprised of 55%, 38%, and 7% patients, respectively. The rate of ≥ 3 syndromes in the same person was 66.4% in the group with GFR ≥ 60 ml/min/1.73 m^2. After age and sex adjusted; it was observed that frailty was 2.5 times, probable sarcopenia 2.4 times, and malnutrition 2.7 times more in those with GFR 30-59 ml/min/1.73 m² compared to those with GFR ≥ 60 ml/min/1.73 m² (p < 0.05). Dementia 1.4, frailty 1.55, polypharmacy 2.0, and urinary incontinence were 1.6 times more common in those with a GFR < 30 ml/min/1.73 m² (p < 0.05).

CONCLUSIONS

Each of the geriatric syndromes and their co-incidence are high in older CKD patients. Geriatricians and nephrologists should be aware of geriatric syndromes in older CKD patients, and they should cooperate for the management of these patients.

Humoral Response to BNT162b2 and CoronaVac in Patients Undergoing Maintenance Hemodialysis: A Multicenter Prospective Cohort Study

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.

Investigation of optimum hemoglobin levels in older patients with chronic kidney disease

AIM

The aim of the present study is to determine target hemoglobin (Hgb) values ​​in older females and males with chronic kidney disease (CKD) according to best performance in mood, gait and balance, muscle strength and activities of daily living, which are important parameters of geriatric assessment.

METHOD

Patients' age, gender, education level, and comorbidities were recorded. All the participants underwent comprehensive geriatric assessment (CGA) including Basic and Instrumental Activities of Daily Living for functional evaluation, Tinetti Performance-Oriented Assessment of Mobility and Timed Up and Go Test for fall risk, and hand grip strength for muscle strength. Hgb levels and kidney functions were analyzed on the same day as CGA measurements. Receiver Operating Characteristic (ROC) analysis was used to detect the optimum level of Hgb according to the best performance of CGA parameters.

RESULTS

622 elderly CKD patients (69.3% female, 55.7% with anemia) were included. After adjustment for confounders, those with anemia had dynapenia (OR 1.60), high risk of falls (OR 1.60), and decreased functional capacity (OR 1.83) among females and those with anemia had dynapenia (OR 4.31), a high risk of falling (OR 2.42) and decreased functional capacity (OR 2.94) among males. The optimum value of Hgb level is 11.8-12.1 in females and 12.6-12.8 in males according to ROC analysis.

CONCLUSION

Anemia is associated with dynapenia, high risk of falls, and decreased functional capacity in older CKD patients regardless of genericity. To prevent these negative outcomes, Hgb should be kept in the range of 11.8-12.1 in older females with CKD and 12.6-12.8 in older males with CKD.

MO128: Predisposing Metabolic Factors to Urinary System Stone Formation in Patients with Autosomal Dominant Polycystic Kidney Disease

BACKGROUND AND AIMS

The risk of urinary tract stone formation in patients with autosomal dominant polycystic kidney disease (ADPKD) is 20%, twice as high as in the normal population. The most important reason for this increased tendency to stone disease is thought to be anatomic changes in the kidney. To investigate metabolic factors that predispose to urinary system stone formation in individuals with ADPKD.

METHOD

A total of 180 volunteers who applied to our outpatient clinic between December 2019 and May 2021 were included in the study. Four groups were formed: patients with ADPKD and urinary system stones (ADPKD + STONE) (n = 42), patients with ADPKD but no stones (ADPKD + STONE FREE) (n = 43), stone patients without ADPKD (STONE) (n = 47) and healthy controls (HEALTHY) (n = 48) groups. Spot urine pH, 24-h urine volume, calcium, uric acid, oxalate, citrate, sodium and magnesium parameters were measured. STONE group data were obtained retrospectively. Along with these parameters, serum electrolyte, parathormone (PTH), ferritin, albumin, creatinine, urea and uric acid values were also compared. A P value of &lt;.05 was considered significant for statistical analysis.

RESULTS

There was no statistically significant difference between the four groups in terms of age and gender (P &gt; .05). The citrate value in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than the STONE and HEALTHY groups (P &lt; .05). The citrate value in the 24-h urine was significantly lower in the STONE group than in the HEALTHY group (P &lt; .05). The citrate value in 24-h urine did not differ significantly between the ADPKD + STONE and ADPKD + STONE FREE groups (P &gt; .05).  In the ADPKD + STONE and ADPKD + STONE-FREE groups, the 24-h urinary calcium value was significantly lower than the STONE and HEALTHY groups (P &lt; .05). In the STONE group, the 24-h urinary calcium value was significantly higher than the HEALTHY group (P &lt; .05). There was no significant difference in the 24-h urinary calcium value between the ADPKD + STONE and ADPKD + STONE FREE groups (P &gt; .05). The uric acid level in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &lt; .05). The uric acid value in the 24-h urine did not differ significantly between the ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &gt; .05). The uric acid value in 24-h urine did not differ significantly between the STONE and HEALTHY groups (P &gt; .05). Oxalate, sodium and magnesium values in 24-h urine and 24-h urine volume did not differ significantly between the groups (P &gt; .05). Urine pH value was significantly lower in the ADPKD + STONE, ADPKD + STONE-FREE and STONE groups than in the HEALTHY group (P &lt; .05). The pH value did not differ significantly between ADPKD + STONE, ADPKD + STONE-FREE and STONE groups (P &gt; .05).

Serum PTH values were significantly higher in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &lt; .05). The PTH values did not differ significantly between the STONE and HEALTHY groups (P &gt; .05). PTH values did not differ significantly between ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &gt; .05).

There was no significant difference between the groups in terms of serum ferritin, sodium, potassium, calcium, phosphorus, magnesium and uric acid values (P &gt; .05).

CONCLUSION

In our study, 24-h urine citrate level was found to be significantly lower in both ADPKD + STONE and ADPKD + STONE-FREE patients compared to the volunteers in the STONE and HEALTHY groups (P &lt; .05). In conclusion, patients with ADPKD should also be evaluated for hypocitraturia in the outpatient clinic.

The quality of life and comfort levels of hemodialysis patients with constipation: A descriptive and cross-sectional study

INTRODUCTION

This study was conducted to determine the constipation-related quality of life, bowel habits, and comfort levels of constipated hemodialysis patients. It is known that the prevalence of constipation is high in hemodialysis patients.

METHODS

This was a cross-sectional and correlational study. The study included 164 hemodialysis patients who were determined to have constipation by examining the constipation statuses of 385 patients based on the Rome-IV criteria. The study was reported according to the STrengthening the Reporting of OBservational studies in Epidemiology Declaration.

FINDINGS

It was determined that as the constipation-related quality of life of the patients increased, their comfort levels also increased. Constipation-related quality of life increased in parallel with an increasing Bristol Stool Scale (BSS) score and an increasing number of bowel movements. The BSS scores of the patients were found to have a significant positive correlation with the patients' bowel movement frequencies and a significant negative correlation with their constipation frequencies. There was a negative correlation between years of dialysis and bowel movement frequencies. The presence of a previous gastrointestinal system complaint, the presence of an impact of constipation on the patient's dialysis session, and comfort levels were determined to be significant predictors of constipation-related quality of life that explained 26.3% of the total variance in constipation-related quality of life.

DISCUSSION

In patients receiving hemodialysis treatment, constipation is an important and frequently encountered problem. Constipation leads to a reduction in quality of life and hemodialysis-related comfort.

Associations between nutritional factors and excessive daytime sleepiness in older patients with chronic kidney disease

BACKGROUND

Excessive daytime sleepiness (EDS) is prevalent in not only older adults, but also patients with chronic kidney disease (CKD), and is associated with higher risks of morbidity and mortality.

AIMS

The aim of the present study is to determine associations between EDS and nutritional status and serum nutrient levels in older patients with CKD.

METHODS

This cross-sectional study included 367 patients (aged ≥ 65 years) with CKD (eGFR < 60 ml/min/1.73 m² and/or > 30 mg/day of albuminuria for > 3 months). EDS was recorded using the Epworth Sleepiness Scale (a score of ≥ 11). Malnutrition was diagnosed according to the Mini Nutritional Assessment (MNA) tool (a score of < 17).

RESULTS

The mean age was 81 ± 7 years, and 248 (67%) were female. EDS was seen in 99 (26.9%) patients. Those with EDS had significantly lower MNA scores and more frequent malnutrition than those without EDS (p < 0.05). In multivariable analysis adjusted for age, sex, cerebrovascular disease, dementia, number of drugs, and number of urinations at night, and the Charlson Comorbidity Index the relationship between malnutrition and EDS persisted (OR 2.58, 95% CI 1.38-4.83, p = 0.003). There was no significant difference between the presence of EDS and serum levels or deficiencies of vitamin D, vitamin B₁₂, and folate (p > 0.05).

CONCLUSIONS

EDS is associated with malnutrition in older patients with CKD. Therefore, EDS and nutritional status should be evaluated together in clinical practice. However, future studies are needed to determine the direction of the association between malnutrition and EDS and to evaluate if dietary intervention can improve EDS.

Endothelial Dysfunction and Atherosclerosis in Patients With Autosomal Dominant Polycystic Kidney Disease

Introduction

In this study, we aimed to determine the endothelial dysfunction (ED) and atherosclerosis in patients with autosomal dominant polycystic kidney disease (ADPKD).

Materials and methods

This study was conducted with 83 subjects (26 male, mean age: 46±11 years) consisted of three groups including ADPKD, hypertension (HT) and healthy control groups. The groups were evaluated in terms of serum endocan and asymmetric dimethylarginine (ADMA) levels, flow-mediated dilatation (FMD), nitroglycerin-mediated dilation (NMD) and carotid intima-media thickness (CIMT).

Results

Serum endocan and ADMA levels and CIMT were significantly higher while NMD was significantly lower in ADPKD group than control group. FMD and NMD were lower but serum ADMA level was higher in the ADPKD group than HT group; while serum endocan level and CIMT were not significantly different in ADPKD and HT groups. In ADPKD patients, CIMT value and serum endocan and ADMA levels were higher while NMD was lower in patients with eGFR≤60 mL/min/1.73 m² than patients with eGFR>60 mL/min/1.73 m². Serum ADMA level was higher and NMD was lower in hypertensive ADPKD patients than non-hypertensive ones. Serum endocan level was higher in ADPKD patients with nephrolithiasis and a negative correlation was detected between serum endocan level and 24-hour urine volume.

Conclusions

Endothelial dysfunction and atherosclerosis are common conditions in ADPKD patients and it was further reinforced in our study. In order to clarify the relationship between serum endocan level and 24-hour urine volume, which is a remarkable finding in our study, larger studies that including the measurement of urine endocan may be useful.

Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey

Background

Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3–5), HD and RT patients with a control group of patients is still lacking.

Methods

We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3–5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared.

Results

A total of 1210 patients were included [median age, 61 (quartile 1–quartile 3 48–71) years, female 551 (45.5%)] composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9–45.2; and 82/289 (28.4%); 95% CI 23.9–34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3–29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2–30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7–19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8–10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5–6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52–5.44); P = 0.001; 2.44 (1.35–4.40); P = 0.003; HD: 2.32 (1.21–4.46); P = 0.011; 2.25 (1.23–4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76–4.72); P = 0.169; 1.87 (0.81–4.28); P = 0.138, respectively].

Conclusions

Hospitalized COVID-19 patients with CKDs, including Stages 3–5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3–5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.

COVİD-19 infection in a membranous nephropathy patient treated with rituximab

While COVID-19 pandemic continues to affect our country and most countries in the world, we have to make some changes both in our social life and our approach to healthcare. We have to struggle with the pandemic on one hand and also try to follow up and treat our patients with chronic diseases in the most appropriate way. In this period, one of our group of patients who are challenging us for follow-up and treatment are those who should start or continue to use immunosuppressive therapy. In order to contribute to the accumulation of knowledge in this area, we wanted to report a patient who was followed up with the diagnosis of COVID-19 and had been administered rituximab very recently due to a nephrotic syndrome caused by membranous nephropathy.

Podocyte Injury in Autosomal Dominant Polycystic Kidney Disease

BACKGROUND/AIMS

Autosomal dominant polycystic kidney disease (ADPKD) is a tubulointerstitial disease. Different degrees of glomerular affection in ADPKD may affect the further course of disease in which it may hypothetically be secondary to the result of glomerular involvement causing podocyte injury. Our aim was to compare urinary excretion of podocin and podocalyxin, which are biomarkers of podocyte injury, and to assess their relationship with proteinuria and renal function in ADPKD.

METHODS

Fifty-six patients with ADPKD and 28 volunteers were enrolled to study. Podocin, podocalyxin protein levels, and proteinuria were measured in urine. Patients were categorized based on their estimated glomerular filtration rate (eGFR).

RESULTS

Patients with ADPKD had higher podocin and podocalyxin levels compared to the control group. The levels of podocin and podocalyxin were higher in ADPKD patients both with eGFR ≥60 mL/min/1.73 m2 and with eGFR <60 mL/min/1.73 m2 than in controls. The levels of podocin and podocalyxin were higher in ADPKD patients with eGFR <60 mL/min/1.73 m2 than in ADPKD patients with eGFR ≥60 mL/min/1.73 m2. Podocin and podocalyxin were negatively correlated with eGFR and positively correlated with urine protein to creatinine ratio in ADPKD patients.

CONCLUSION

Urine biomarkers of podocytes injury were significantly higher in ADPKD patients even in the early stage of the disease than in the control group. It should be clarified whether these biomarkers can provide new prognostic parameters for disease surveillance.

Hemodialysis Experience of a Large Group of Syrian Refugees in Turkey: All Patients Deserve Effective Treatment

BACKGROUND/AIMS

Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey.

METHODS

Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed.

RESULTS

There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%.

CONCLUSION

This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.

Global nephrology workforce: gaps and opportunities toward a sustainable kidney care system

The health workforce is the cornerstone of any health care system. An adequately trained and sufficiently staffed workforce is essential to reach universal health coverage. In particular, a nephrology workforce is critical to meet the growing worldwide burden of kidney disease. Despite some attempts, the global nephrology workforce and training capacity remains widely unknown. This multinational cross-sectional survey was part of the Global Kidney Health Atlas project, a new initiative administered by the International Society of Nephrology (ISN). The objective of this study was to address the existing global nephrology workforce and training capacity. The questionnaire was administered online, and all data were analyzed and presented by ISN regions and World Bank country classification. Overall, 125 United Nations member states responded to the entire survey, with 121 countries responding to survey questions pertaining to the nephrology workforce. The global nephrologist density was 8.83 per million population (PMP); high-income countries reported a nephrologist density of 28.52 PMP compared with 0.31 PMP in low-income countries. Similarly, the global nephrologist trainee density was 1.87 PMP; high-income countries reported a 30 times greater nephrology trainee density than low-income countries (6.03 PMP vs. 0.18 PMP). Countries reported a shortage in all care providers in nephrology. A nephrology training program existed in 79% of countries, ranging from 97% in high-income countries to 41% in low-income countries. In countries with a training program, the majority (86%) of programs were 2 to 4 years, and the most common training structure (56%) was following general internal medicine. We found significant variation in the global density of nephrologists and nephrology trainees and shortages in all care providers in nephrology; the gap was more prominent in low-income countries, particularly in African and South Asian ISN regions. These findings point to significant gaps in the current nephrology workforce and opportunities for countries and regions to develop and maintain a sustainable workforce.

Global coverage of health information systems for kidney disease: availability, challenges, and opportunities for development

Development and planning of health care services requires robust health information systems to define the burden of disease, inform policy development, and identify opportunities to improve service provision. The global coverage of kidney disease health information systems has not been well reported, despite their potential to enhance care. As part of the Global Kidney Health Atlas, a cross-sectional survey conducted by the International Society of Nephrology, data were collected from 117 United Nations member states on the coverage and scope of kidney disease health information systems and surveillance practices. Dialysis and transplant registries were more common in high-income countries. Few countries reported having nondialysis chronic kidney disease and acute kidney injury registries. Although 62% of countries overall could estimate their prevalence of chronic kidney disease, less than 24% of low-income countries had access to the same data. Almost all countries offered chronic kidney disease testing to patients with diabetes and hypertension, but few to high-risk ethnic groups. Two-thirds of countries were unable to determine their burden of acute kidney injury. Given the substantial heterogeneity in the availability of health information systems, especially in low-income countries and across nondialysis chronic kidney disease and acute kidney injury, a global framework for prioritizing development of these systems in areas of greatest need is warranted.

Guidelines, policies, and barriers to kidney care: findings from a global survey

An international survey led by the International Society of Nephrology in 2016 assessed the current capacity of kidney care worldwide. To better understand how governance and leadership guide kidney care, items pertinent to government priority, advocacy, and guidelines, among others, were examined. Of the 116 responding countries, 36% (n = 42) reported CKD as a government health care priority, which was associated with having an advocacy group (χ2 = 11.57; P = 0.001). Nearly one-half (42%; 49 of 116) of countries reported an advocacy group for CKD, compared with only 19% (21 of 112) for AKI. Over one-half (59%; 68 of 116) of countries had a noncommunicable disease strategy. Similarly, 44% (48 of 109), 55% (57 of 104), and 47% (47 of 101) of countries had a strategy for nondialysis CKD, chronic dialysis, and kidney transplantation, respectively. Nearly one-half (49%; 57 of 116) reported a strategy for AKI. Most countries (79%; 92 of 116) had access to CKD guidelines and just over one-half (53%; 61 of 116) reported guidelines for AKI. Awareness and adoption of guidelines were low among nonnephrologist physicians. Identified barriers to kidney care were factors related to patients, such as knowledge and attitude (91%; 100 of 110), physicians (84%; 92 of 110), and geography (74%; 81 of 110). Specific to renal replacement therapy, patients and geography were similarly identified as a barrier in 78% (90 of 116) and 71% (82 of 116) of countries, respectively, with the addition of nephrologists (72%; 83 of 116) and the health care system (73%; 85 of 116). These findings inform how kidney care is currently governed globally. Ensuring that guidelines are feasible and distributed appropriately is important to enhancing their adoption, particularly in primary care. Furthermore, increasing advocacy and government priority, especially for AKI, may increase awareness and strategies to better guide kidney care.

Global overview of health systems oversight and financing for kidney care

Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the world's population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.

Global capacity for clinical research in nephrology: a survey by the International Society of Nephrology

Due to the worldwide rising prevalence of chronic kidney disease (CKD), there is a need to develop strategies through well-designed clinical studies to guide decision making and improve delivery of care to CKD patients. A cross-sectional survey was conducted based on the International Society of Nephrology Global Kidney Health Atlas data. For this study, the survey assessed the capacity of various countries and world regions in participating in and conducting kidney research. Availability of national funding for clinical trials was low (27%, n = 31), with the lowest figures obtained from Africa (7%, n = 2) and South Asia (0%), whereas high-income countries in North America and Europe had the highest participation in clinical trials. Overall, formal training to conduct clinical trials was inadequate for physicians (46%, n = 53) and even lower for nonphysicians, research assistants, and associates in clinical trials (34%, n = 39). There was also diminished availability of workforce and funding to conduct observational cohort studies in nephrology, and participation in highly specialized transplant trials was low in many regions. Overall, the availability of infrastructure (bio-banking and facilities for storage of clinical trial medications) was low, and it was lowest in low-income and lower-middle-income countries. Ethics approval for study conduct was mandatory in 91% (n = 106) of countries and regions, and 62% (n = 66) were reported to have institutional committees. Challenges with obtaining timely approval for a study were reported in 53% (n = 61) of regions but the challenges were similar across these regions. A potential limitation is the possibility of over-reporting or under-reporting due to social desirability bias. This study highlights some of the major challenges for participating in and conducting kidney research and offers suggestions for improving global kidney research.

Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 countries, composing 91.5% of the world's population, providing data on this domain. Most countries were unable to access eGFR and albuminuria in their primary care settings. Only one-third of low-income countries (LICs) were able to measure serum creatinine and none were able to access eGFR or quantify proteinuria. The ability to monitor diabetes mellitus through serum glucose and glycated hemoglobin measurements was suboptimal. Pathology services were rarely available in tertiary care in LICs (12%) and lower middle-income countries (45%). While acute and chronic hemodialysis services were available in almost all countries, acute and chronic peritoneal dialysis services were rarely available in LICs (18% and 29%, respectively). Kidney transplantation was available in 79% of countries overall and in 12% of LICs. While over one-half of all countries publicly funded RRT and kidney medications with or without copayment, this was less common in LICs and lower middle-income countries. In conclusion, this study demonstrated significant gaps in services for kidney care and funding that were most apparent in LICs and lower middle-income countries.

A Rare Case of Peritonitis: Streptococcus Salivarius

Streptococcus salivarius is a Gram-positive bacteria that may cause infections like endocarditis and meningitis. However, it has not been reported as a causative agent of peritonitis in peritoneal dialysis patients. In this paper we present a rare case of peritonitis with Streptococcus salivarius admitted to our Clinic with abdominal pain, who had been on peritoneal dialysis treatment for 19 months. Streptococus salivarius was cultured from the effluent, sensitive to ampicillin and penicillin G. Patient was discharged completely cured. Peritonitis is the most important clinical issue that occurs in patients treated with peritoneal dialysis, and every effort should be invested to determine the causative agent while even rare bacteria as Streptococcus salivarius may be found.

Skin disorders in peritoneal dialysis patients: An underdiagnosed subject

AIM: To examine all skin changes in peritoneal dialysis (PD) patients followed up in our unit.

METHODS: Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all findings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences (SPSS) for Windows 16.0 standard version was used for statistical analysis.

RESULTS: Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently (P = 0.045). No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using.

CONCLUSION: Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked.

The relationship between FGF-23 and ghrelin levels in CKD patients: preliminary data

BACKGROUND

Fibroblast growth factor (FGF)-23 is a recently discovered phosphaturic hormone that increases in chronic kidney disease (CKD). It has been accepted as a determinant of mortality and a therapeutic target in these patients. Ghrelin is a hormone that has roles in energy and nutrient metabolism. Ghrelin level was found to be increased in CKD patients. This is a controlled study in which the relationship between FGF-23 and ghrelin levels in CKD patients has been studied.

METHODS

Three groups were involved: 88 individuals. Dialysis group (DG, 33 patients) including patients on hemodialysis (21 patients) or peritoneal dialysis program (12 patients); predialysis group (PG, 29 patients) consisting of patients with stage-3 CKD; and the control group (CG, 29 individuals) of healthy adults. Serum FGF-23 and ghrelin levels were measured as well as routine biochemical parameters.

RESULTS

FGF-23 levels were similar within the groups (CG: 268±45 pg/mL, PG: 284±94 pg/mL, DG: 259±87 pg/mL, P=0.11). Ghrelin level was higher in the PG group compared with the DG and CG, while DG had higher ghrelin level than the CG (CG: 2.79±0.38 ng/mL, PG: 4.53±1.18 ng/mL, DG: 3.98±0.89 ng/mL). When all groups were studied together; a strong correlation was found between FGF-23 and ghrelin levels. When the analysis was repeated with PG and DG accepted as CKD group; this strong correlation persisted; while it was not true for the CG.

CONCLUSIONS

There might be a strong correlation between FGF-23 and ghrelin levels irrespective of the stage of CKD and the dialysis modality. There is need for further studies to clarify the pathophysiological link between these parameters.

Idiopathic Systemic Capillary Leak Syndrome: A Case Report

INTRODUCTION

Idiopathic systemic capillary leak syndrome (ISCLS) is rarely seen, and presents with recurrent episodes of hypotension, shock, hemoconcentration, and hypoproteinemia. The main pathology is the dysfunction of the vascular endothelium, and it is characterized by an increase of capillary permeability that is accompanied by the loss of intravascular fluid and protein.

CASE PRESENTATION

We present a 58-year-old female who presented with peripheral edema, leg pain, and syncope at the emergency department. Interestingly demyemilising neuropathy, which is a rare finding, ensued on day 4. She is still being treated using intravenous immunoglobulin therapy.

CONCLUSIONS

The early signs and symptoms of ISCLS may be subtle; therefore the diagnosis can easily be missed and prompt treatment of the syndrome may be postponed. Thus, the clinician must consider ISCLS in differential diagnosis in cases of hypotension, hemoconcentration, and hypoalbuminemia.

Is handgrip strength and key pinch measurement related with biochemical parameters of nutrition in peritoneal dialysis patients?

BACKGROUNDS & OBJECTIVE

End-stage renal disease (ESRD) frequently causes Protein Energy Wasting (PEW), which is an important morbidity and mortality factor. Although it is difficult to assess PEW with a reliable method, there are various methods such as Handgrip strength test (HST), serum albumin, cholesterol, etc. HST is a simple and reliable antropometric method which is used for nutritional status and body muscle strength. This study aims to assess the relationship between HST and biochemical markers in evolution of nutritional status of ESRD patients.

METHODS

This cross-sectional study included 36 consecutive patients, who are on peritoneal dialysis and 36 healthy -control subjects. Jamar-hand dynamometer was used for handgrip strength test; a pinch gauge was used for key pinch. Other antropometric tests included skin fold thicknesses at biceps, triceps, umbilical, suprailiac and subscapular regions; circumferences at waist hip, neck and midarm. Biochemical tests were performed only in Peritoneal Dialysis (PD) group. SPSS for Windows ver. 15.0 was used for statistics.

RESULTS

The mean age of patients was 49.3±14.4, and mean age of control group was 43.8±10.6 (p=0.075). In PD group dominant hand dynamometer test 1,2 and 3 results were 19.3±9.3 kg, 25.3±10.8 kg, 25.5± 10.6 kg and; 34.2±10.3 kg, 34.4±9.8 kg, 34.6±10.0 kg for control group (p< 0,001). Right key pinch results were 6.7±1.9 kg for patients; 13.5±4.5 kg for control group (p<0.001). Left key pinch results were 6.8±1.9 kg for patients; 13.2±4.4 kg for control group (p<0.001). There was not any significant relationship concerning handgrip or key pinch tests with biochemical parameters.

CONCLUSION

Handgrip Strength Test and key pinch may be reliable, cheap and easily performed tests for the diagnosis of Protein Energy Wasting in patients on Peritoneal Dialysis.