Fractal properties of the trabecular pattern of the mandible in chronic renal failure

OBJECTIVES

The purpose of this study was to evaluate fractal analysis as a tool to quantitatively determine the mandibular trabecular bone changes in patients with chronic renal failure (CRF).

METHODS

In the present study, fractal analysis was performed using ImageJ (National Institutes of Health, Bethesda, MD) program with box-counting method over panoramic radiographs of 25 patients (14 females and 11 males) with CRF and 26 healthy individuals (14 females and 12 males) as a control group. The fractal dimension (FD) values of the patients and healthy individuals were compared. In addition, average biochemical parameters [parathyroid hormone (PTH), calcium (Ca), phosphorus (P), product of Ca and P levels (CaxP), alkaline phosphatase (ALP), vitamin D] of the patients with CRF, as measured during the 3 months before the panoramic radiographs, were compared with FD values.

RESULTS

According to the results, FD values of the patients with CRF were found to be statistically lower than the control group (p < 0.05). The average PTH levels of the patients with CRF were 416.16 ± 310.3 pg ml(-1); average Ca levels were 8.94 ± 1.2 mg dl(-1); average P levels were 5.76 ± 1.7 mg dl(-1); average CaxP values were 51.12 ± 15.03; average ALP levels were 83.44 ± 36.8 U l(-1); and the average vitamin D values were 19.43 ± 9.7 ng ml(-1). In addition, there was no significant correlation between FD values and the biochemical parameters of the patients, and there was no correlation between age, gender and FD.

CONCLUSIONS

The FD values of the patients with CRF were lower than those of the controls. This finding suggests that FD analysis might be a promising simple and cost-effective tool for evaluating trabecular bone structure.

Caregiver Burden, Anxiety, Depression, and Sleep Quality Differences in Caregivers of Hemodialysis Patients Compared With Renal Transplant Patients

BACKGROUND

We compared the caregivers of hemodialysis (HD) patients and caregivers of patients with renal transplantation (Tx) in terms of anxiety, depression, sleep quality, and caregiver burden. We believe that caregivers of HD have more difficult conditions than caregivers of the patients with Tx.

METHODS

This cross-sectional study analyzed the psychological status of caregivers of Tx patients compared with those of HD patients with using the Hospital Anxiety and Depression Scale, Zarit Burden Interview, and Pittsburg Sleep Quality Indexes. We recruited 133 caregivers-65 caregivers in the Tx group and 68 in the HD group.

RESULTS

Mean age was 43.1 ± 8.5 years. The age, sex, income level, and education level were similar between the 2 groups. Caregivers in the HD group had significantly higher rates of anxiety and depression compared with the Tx group (P = .007 and P < .001, respectively). Good sleep quality rates for caregivers in the Tx group and caregivers in the HD group were 92% (n = 60) and 63% (n = 43), respectively. Poor sleep quality was significantly higher in caregivers in the HD group compared with caregivers in the Tx group (P < .001). Caregiver burden scores were significantly higher for caregivers in the HD group compared with caregivers in the Tx group (P < .001).

CONCLUSIONS

We suggest that Tx is the more appropriate renal replacement therapy for caregivers who undertake the care of patients with end-stage renal disease and chronic kidney disease.

Psychological and emotional status, and caregiver burden in caregivers of patients with peritoneal dialysis compared with caregivers of patients with renal transplantation

OBJECTIVES

We sought to examine the relationship between caregivers of continuous ambulatory peritoneal dialysis (CAPD) and of renal transplant (Tx) patients with regard to sleep quality, anxiety, depression, and overall burden.

METHODS

This cross-sectional study of prevalent caregivers of CAPD patients and of renal Tx patients used a multidimensional instrument to assess the association of sleep quality, depression and anxiety symptoms, as well as burden using a Zarit Burden Interview. Among the 113 caregivers who participated in this study, 53 were in the Tx and 60 in the CAPD group.

RESULTS

The overall mean age was 40.7 ± 13.6 years. The proportions of age, gender, income, and education level were similar between the 2 groups. Caregivers of peritoneal dialysis patients had significantly higher rates of anxiety and depression compared with the Tx group (P = .039 and P = .003, respectively). Good sleep quality rates for caregivers of Tx versus CAPD patients were 88.7% (n = 47) and 61.7% (n = 37), respectively. Poor sleep quality was significantly higher among caregivers of CAPD compared with those for Tx patients (P = .001). Caregiver burden scores were significantly higher in caregivers of CAPD patients compared with Tx patients (P < .001). Upon logistic regression analysis, caregivers of CAPD patients were 2.61 times (95% confidence interval, 1.03-6.59; P = .043) higher than the caregiver burden risk than those for Tx patients.

CONCLUSIONS

This study indirectly indicated that renal Tx improves the life quality and decreases psychiatric symptoms among caregivers of ESRD patients.

Does a predialysis education program increase the number of pre-emptive renal transplantations?

OBJECTIVES

Renal transplantation (RT) is the most appropriate form of treatment for end-stage renal disease (ESRD). Pre-emptive RT decreases the rates of delayed graft function and acute rejection episodes, increasing patient and graft survival, while reducing costs and complications associated with dialysis. In this study, we investigated the relationship between a predialysis education program (PDEP) for patients and their relatives and pre-emptive RT.

METHODS

We divided 88 live donor kidney transplant recipients into 2 groups: transplantation without education (non-PDEP group; n = 27), and enrollment in an education program before RT (PDEP group n = 61).

RESULTS

Five patients in the non-PDEP group underwent pre-emptive transplantation, versus 26 of the PDEP group. The rate of pre-emptive transplantations was significantly higher among the educated (42.62%) versus the noneducated group (18.51%; P < .001).

CONCLUSION

PDEP increased the number of pre-emptive kidney transplantations among ESRD patients.

Vitamin D Treatment Effect on Serum Endocan and High-Sensitivity C-Reactive Protein Levels in Renal Transplant Patients

Context:

Endocan is a marker showing endothelial dysfunction and inflammation. Significantly increased endocan levels have been observed in serum of patients with sepsis and cancer.

Objective:

Our aim was to investigate the relationship between vitamin D treatment and serum endocan and high-sensitivity C-reactive protein (hs-CRP) levels as inflammatory markers in transplant patients.

Design:

Prospective.

Setting:

Nephrology clinic.

Patients:

Thirty-eight renal transplant patients with serum 25-hydroxy-vitamin D (25-OH-vitamin D) levels below 20 ng/mL and transplanted at least 12 months.

Intervention:

One-time oral dose of 300 000 IU vitamin D3.

Main Outcome Measures:

Before and after vitamin D treatment, serum endocan, hs-CRP, calcium, phosphorus, and parathyroid hormone (PTH) levels were measured.

Results:

Median serum endocan and PTH values before vitamin D were significantly higher than those of after treatment values ( P = .001 and P < .001, respectively). On the other hand, serum total calcium and phosphorus levels before vitamin D treatment were lower than the values obtained after vitamin D treatment ( P = .0013 and P < .001, respectively). Serum hs-CRP was lower after vitamin D therapy than before, but the difference was not statistically significant ( P = .06). A moderate negative correlation was determined between endocan and 25-OH-vitamin D levels after treatment with vitamin D ( r = −.36, P = .02).

Conclusion:

This study has revealed that vitamin D treatment reduced markers of endothelial dysfunction in patients with renal transplantation and vitamin D deficiency.

Peritonitis incidence was correlated with duration of peritoneal dialysis rather than leptin or neutrophil to lymphocyte (n/l) ratio in peritoneal dialysis patients

OBJECTIVE

End stage renal disease (ESRD) has a high worldwide prevalence and incidence. Peritonitis is one of the leading causes of hospitalization in peritoneal dialysis patients. Although inflammatory markers show increased inflammatory responses, cellular immune response was decreased in ESRD patients. Leptin is an adipocyte-derived hormone that has activity in energy, nutrition and immune system. Neutrophil to lymphocyte ratio (N/L) was emerged as a predictive and prognostic criterion in many instances. In this study, we aimed to investigate the relationships between increased inflammation in peritoneal dialysis patients and leptin, N/L ratio.

MATERIALS AND METHODS

Forty-one ESRD patients, who were been at least 12 months of peritoneal dialysis therapy, were included in the study. Patients' demographic properties were recorded. Serum leptin level, WBC count, C-reactive protein, erythrocyte sedimentation rate and biochemical markers were measured. Patients with active viral or bacterial infection, malignancy, inflammatory disease, immunosuppressive medication users were all excluded from the study. Age and sex-matched healthy control group was included in the study only for their leptin levels.

RESULTS

The measured mean serum leptin level of the patient group was statistically significantly higher than control group (1624.88±1608.16 and 416±439.85). The calculated mean peritonitis incidence was 0.041±0.047 peritonitis/per year. The number of peritonitis attack was significantly correlated with duration of peritoneal dialysis, body mass index (BMI), age and presence of cardiovascular disease. Serum leptin level was significantly correlated with sex, age, primary cause of ESRD, BMI, blood glucose level and duration of peritoneal dialysis (PD).

CONCLUSION

We detected that ESRD patients have higher serum leptin levels compare to healthy adults. Increased leptin was correlated with sex, age, BMI, primary cause of ESRD and serum glucose level. Number of peritonitis attack and peritonitis incidence was significantly correlated with the duration of PD, BMI and sex. We weren't able to show the predictive N/L value in PD patients in case of peritonitis.

Changes in Exfoliative Cell of Oral Mucosa in Kidney Transplant Patients

OBJECTIVES

The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods.

METHODS

We enrolled 32 kidney transplant patients. Smears were obtained from the buccal mucosa transplant patients before and 12 months after kidney transplantation. Smears from each individual were stained using the Papanicolaou method and were analyzed using a stereological method.

RESULTS

Statistically, the nuclear volumes and cytoplasmic volumes in the cells of buccal mucosa were markedly higher after kidney transplantation (P < .05). There was a decreased positive cell density in the oral epithelial cells after kidney transplantation compared with before renal transplantation (P < .05).

CONCLUSIONS

These findings suggest that there are alterations in the oral epithelial cells after kidney transplantation, which are detectable by microscopy and cytomorphometry.

Are We Late in the Diagnosis of Malignities Occurring in Solid Organ Transplant Patients? 11 Years' Experience

OBJECTIVE

Our aim is to evaluate the frequency and characteristics of cancer in the population of patients with solid organ transplant who are under immunosuppressive medication. In this study we aimed to emphasize the importance of early diagnosis of cancer in solid organ transplant recipients. An aging population began to receive solid organ transplantation and survival times prolonged. But this had a cost and new problems came forward. Especially de novo cancers because of immunosuppressive therapy took notice. Risk of malignancy increases after organ transplantation and cancer incidence was about 2.3-3.1% in these patients including skin cancer, lung cancer, malign lymphoma, cervix cancer, kaposi sarcoma, and hepatobiliary cancer.

MATERIALS AND METHODS

The files of 328 organ transplant recipients followed from January 2004 to April 2015 at Atatürk University Medical Faculty were retrospectively reviewed.

RESULTS

Eight patients developed cancer (2.4%). There were six males and two females. Age at cancer diagnosis ranged from 42 to 79 years old with average of 55 years. The interval from solid organ transplantation to cancer diagnosis ranged from 6 months to 30 years. Among the patients, five were renal transplant recipients and two were liver transplant recipients. Four patients had stage IV disease, one patient stage IIIB, and three patients had stage I disease. For none of the patients a diagnosis with screening methods was used for cancer before any complaints of tumor emerged.

CONCLUSION

To diagnose cancer at early stages in solid organ transplant recipients, earlier and detailed cancer screening is very important. The association between diagnosis of cancer at early stages and prolonged overall survival time is well known. Detailed and careful evaluation for occult malignancies in pre-transplantation period is also important.

Effects of incremental peritoneal dialysis with low glucose-degradation product neutral pH solution on clinical outcomes

PURPOSE

Incremental peritoneal dialysis (IPD) could decrease unfavorable glucose exposure results and preserve (RKF). However, there is no standardization of dialysis prescriptions for patients undergoing IPD. We designed a prospective observational multi-center study with a standardized IPD prescription to evaluate the effect of IPD on RKF, metabolic alterations, blood pressure control, and adverse outcomes.

METHODS

All patients used low GDP product (GDP) neutral pH solutions in both the incremental continuous ambulatory peritoneal dialysis (ICAPD) group and the retrospective standard PD (sPD) group. IPD patients started treatment with three daily exchanges five days a week. Control-group patients performed four changes per day, seven days a week.

RESULTS

A total of 94 patients (47 IPD and 47 sPD) were included in this study. The small-solute clearance and mean blood pressures were similar between both groups during follow-up. The weekly mean glucose exposure was significantly higher in sPD group than IPD during the follow-up (p < 0.001). The patients with sPD required more phosphate-binding medications compared to the IPD group (p = 0.05). The rates of peritonitis, tunnel infection, and hospitalization frequencies were similar between groups. Patients in the sPD group experienced more episodes of hypervolemia compared to the IPD group (p = 0.007). The slope in RKF in the 6th month was significantly higher in the sPD group compared to the IPD group (65% vs. 95%, p = 0.001).

CONCLUSION

IPD could be a rational dialysis method and provide non-inferior dialysis adequacy compared to full-dose PD. This regimen may contribute to preserving RKF for a longer period.

Relationship between left atrial functions, P-terminal force and interatrial block in chronic haemodialysis patients

OBJECTIVE

Interatrial block (IAB) connotes a P wave duration ≥ 110 msec on electrocardiography (ECG). P-terminal force corresponds to a biphasic P wave with its terminal negative phase ≥ 40 msec x mm in V1 derivation on ECG. IAB and P-terminal force are closely related parameters and they are accepted as predictors for left atrial dysfunction, left atrial dilatation, atrial fibrillation and strokes. Left atrial functions in chronic haemodialysis patients becomes worse in the course of time because of long standing pressure and volume overload. The aim of this study is to evaluate the relationship between IAB, P-terminal force and left atrial functions.

PATIENTS AND METHODS

68 chronic haemodialysis patients and 60 control subjects were included in the study. Conventional echocardiography and left atrial dynamic functions were measured in all cases. The subjects with IAB and P-terminal force on ECG were identified.

RESULTS

Left ventricular size, wall thickness and left atrial diameters were significantly greater in haemodialysis patients than the control group (p < 0.001). 42 (62%) patients had IAB (≥ 110 msec) and 45 (66%) patients had P-terminal force ( ≥ 40 msec x mm) in the haemodialysis group. Left atrial reservoir, conduit and pump functions were significantly lower in the haemodialysis group than the control group (p < 0.001). There was a statistically significant correlation between left atrial functions, IAB (≥ 110 msec) and P-terminal force (≥ 40msec x mm) in all parameters (p < 0.001).

CONCLUSIONS

This study showed that decreased left atrial functions in chronic haemodialysis patients are closely correlated with IAB and P-terminal force.

Assessment of salivary gland function in patients after successful kidney transplantation using (99m)Tc-pertechnetate salivary gland scintigraphy

Chronic renal failure and its treatment can induce oral health problems and salivary glands dysfunction. The purpose of this study was to assess salivary glands function in patients with kidney transplantation using technetium-99m pertechnetate ((99m)Tc-P) salivary glands scintigraphy. We prospectively studied 34 patients with kidney transplantation (30 males and 4 females,mean age 39.76±11.6 years) and 28 healthy controls (12 males and 16 females, mean age 36.1±9.5 years). Salivary gland scintigraphy was performed nearly 4.4±2.9 years after successful kidney transplantation. Dynamic salivary glands scintigraphy was performed during 25min after the intravenous administration of 185MBq of (99m)Tc-P. Time-activity curves and glands functional parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation of the radionuclide, and excretion fraction. Statistical analysis of the functional parameters showed no significant differences between patients with kidney transplantation and healthy controls (P>0.05). In conclusion, this study showed that using (99m)Tc-P salivary gland scintigraphy, salivary glands function of patients with successful kidney transplantation do not differ statistically from those in healthy controls.

Depression and Anxiety Symptoms in Patients With Cirrhosis: A Prospective Study Before and After Liver Transplantation

BACKGROUND

Timely identification of possible psychiatric symptoms and/or disorders, such as depression and anxiety, in liver cirrhosis and liver transplant patients is important. This study aimed to determine whether patients with both liver cirrhosis and liver transplantation have depression and anxiety symptoms and, if so, to determine the relationship of these symptoms with the stage of the liver disease and other conditions.

METHODS

Ninety patients with liver cirrhosis and 31 who underwent liver transplantation for liver cirrhosis were included in the study. Patients were divided into 4 groups. Patients with Child-Pugh A cirrhosis were group 1, patients with Child-Pugh B cirrhosis were group 2, patients with Child-Pugh C cirrhosis were group 3, and transplanted patients were group 4. All patient groups answered Beck Depression Inventory and Beck Anxiety Inventory questionnaires.

RESULTS

Depression and anxiety scores were similar in patients who underwent liver transplantation and in the Child-Pugh A and Child-Pugh B groups. The lowest depression score was observed in the Child-Pugh A group. This was not statistically different from the patients in the liver transplantation group (3.19 ± 3.487, 7.13 ± 7.822, P > .05). Depression and anxiety scores were statistically higher in the Child-Pugh C group (25.55 ± 8.878, 21.66 ± 11.053, and 25.55 ± 8.878, respectively; P < .001), and depression and anxiety scores increased as the cirrhosis stage increased.

CONCLUSIONS

In patients with Child-Pugh C liver cirrhosis, evaluation for symptoms of anxiety and depression is strongly recommended.

The effects of dual and triple combinations of trandolapril, telmisartan, and verapamil on overt proteinuria in the patients with diabetic nephropathy

Diabetic nephropathy (DN) is one of the most important causes of the end-stage renal failure and its prevalence is found to be increasing. The presence of hypertension and progressive proteinuria is among the important findings. In this study, the effects of double and triple combinations of trandolapril, telmisartan, and verapamil on proteinuria were investigated in diabetic patients with nephropathy. Seventy-eight patients (mean age: 56.11 ± 11.26 years; 47 females and 31 males) with overt proteinuria and DN were included in this study. The patients were divided into four groups: Group I (n: 18, trandolapril + telmisartan), Group II (n: 20, trandolapril + verapamil), Group III (n: 20, trandolapril +telmisartan + verapamil), and Group IV (n: 20, telmisartan + verapamil). At the end of a three-month therapy, within and between group comparisons were done about the effects of the use of double or triple drug combinations on proteinuria, glomerular filtration rate (GFR), electrolytes, serum albumin, low-density lipoprotein (LDL)- cholesterol, and HbA1C. There was no significant difference among groups in terms of age, gender, diabetes duration, body mass index, and retinopathy frequency. The decreases in proteinuria and mean arterial blood pressure (MABP) were significant in all groups. The decrease in proteinuria was independent of the decrease in MABP [the reduction rate in proteinuria was 39% (P <0.001) in Group I, 37% (P <0.001) in Group II, 42% (P <0.001) in Group III, and 43% (P <0.001) in Group IV; the reduction rate in MABP was 10.6% (P <0.001) in Group I, 13.7% (P <0.001) in Group II, 17.5% (P <0.001) in Group III, and 15.4% (P <0.001) in Group IV]. Decrease in HbA1C (before and after treatment) was significant in Groups III and IV when com- pared to Groups I and II. Any adverse event, like hyperkalemia, was not observed. There was no significant difference among the groups in terms of GFR, LDL-cholesterol, albumin, and potassium. All the patients tolerated the drugs well. In conclusion, in patients with DN, both double or triple combinations of trandolapril, telmisartan and verapamil resulted in significant decreases in proteinuria and MABP. Triple combinations did not have any superiority over double combinations. Therefore, the suitable drug combinations may be chosen according to the clinical status of a patient.