Hemoperfusion Treatment Of Digital Intoxication In Chronic Hemodialysis Patient

Diagnosis of Digitalis intoxication depends on good history taking, clinical signs and symptoms, and digoxin level. Sixty one years old female with diabetes mellitus (DM), coronary artery disease (CAD) and end-stage renal failure administered to emergency department with complaints of dyspnea and chest pain. Digoxin 0.50 mg once a day was prescribed by an internal medicine physician and she has been taking the drug for 7 days. In our case digoxin level was decreased to valuable level after hemoperfusion. In conclusion it was observed that hemoperfusion therapy of digitalis intoxication in chronic hemodialysis patient is effective

Elevated Serum Uric Acid to HDL-Cholesterol Ratio is Related to Cardiovascular Risk in Patients Receiving Hemodialysis

Aim: Chronic kidney disease (CKD) is a progressive disease in which frequent cardiovascular (CV) comorbidities. High uric acid to HDL-cholesterol ratio (UHR) results were quite notable in patients receiving peritoneal dialysis. Thus, in this study, we aimed to evaluate the UHR results in dialysis patients. Materials and Methods: This retrospective, multicenter, cross-sectional study was conducted with CKD patients, and the control group consisted of hypertensive patients with a normal glomerular filtration rate (GFR). Patients’ laboratory, ambulatory blood pressure monitoring, and demographic records were obtained from the follow-up cases of two university hospitals’ internal medicine and nephrology departments. The patients' group then were divided into five subsets according to GFR. Results: A total of 124 CKD patients and 127 control participated in this study. All CKD patients were also identified as pre-dialysis and dialysis. The cases of UHR, non-dipper blood pressure pattern, and nocturnal heart rate (HR) were increased in CKD compared to the control group. Per disease progression, the non-dipper HR and nocturnal HR were more significant in patients receiving dialysis with high UHR than in the pre-dialysis subset. In diabetic patients with an on-targeted HbA1c, those with high UHRs still had nocturnal diastolic BP elevations. Finally, there was not an exact stage-specific result for pulse wave velocity. Conclusions: Based on our results, dialysis patients with high UHRs have higher non-dipper PR, nocturnal heart rate, and nocturnal diastole blood pressure, associated with CV risk. Moreover, effective diabetic management might not prevent CV risk in dialysis patients with high UHRs

Diyabetik polinöropatili hastalarda eritropoietin uygulamasının eritrosit Na,K- ATPaz aktivitesi üzerine etkileri

WOS:000323180100003Amaç: Bu çalışmada diyabetik polinöropatili hastalarda eritropoietin uygulamasının eritrosit membranı Na,K-ATPaz aktivitesi üzerine etkisini araştırmayı amaçladık.Metot: Çalışma Konya Eğitim ve Araştırma Hastanesi Nefroloji kliniği ve Selçuk Üniversitesi Meram Tıp Fakültesi Hastanesi Biyokimya bölümünde yapıldı. Bu çalışma eritropoietin tedavisine başlanacak, 11 diyabetik polinöropatili hasta ile sağlıklı 10 kontrol vakası üzerine gerçekleştirildi. Hastalar diyabetik polinöropati tanısı almış, eritropoietin tedavisine yeni başlanacak hastalardan seçilmiştir. Hastalarda eritropoietin 150 U/kg/hafta dozunda kullanıldı. Sağlıklı kontrollerden ve diyabetik hastalardan eritropoietin uygulamasından önce ve bir ay sonra olmak üzere heparinize kan örnekleri alındı. Eritrosit membranları izole edildi ve eritrosit membranı Na,K-ATPaz aktviteleri ölçüldü. Na,K-ATPaz aktivitesi mmolPi.mg.protein-1.10 min-1olarak verildi.Bulgular: Na,K-ATPaz enzim aktivitesi kontrol grubunda ve eritropoietin uygulamasından önce ve sonra sırasıyla 2.910.38 µmolPi.mg.prt-1.10min-1, 1.930.38µmolPi.mg.prt-1.10min-1ve 2.400.63 µmolPi.mg.prt-1.10min-1 olarak bulundu. Na,K-ATPaz enzim aktivitesi uygulama öncesi hasta grubunda kontrol grubu ile karşılaştırıldığında azalmış olarak, uygulama sonrası grupta hastaların bazal seviyeleri ile karşılaştırıldığında artmış olarak bulundu. Çalışmamızda Eritropoietin tedavisinin 30. günündeki eritrosit zarı Na,K-ATPaz enzim aktivitesinin tedavi öncesindeki Na,K-ATPaz enzim aktivitesine gore %24 arttığını gözlemledik.Sonuç: Eritropoietin tedavisinin nöropatiyi iyileştirebildiği ve bu iyileşmenin, belirteç olarak kullanılabilen Na-K ATPaz enzim aktivitesi artışı ile desteklendiği sonucuna varılmıştırObjectives: In this study we aimed to investigate the effects of erythropoietin administration on Na,K-ATPase enzyme activity in diabetic patients with polyneuropathy.Methods: The study was carried out at Meram Education and Research Hospital department of Nephrology and Selcuk University Meram School of Medicine Hospital department of Biochemistry, Turkey. Eleven diabetic patients with diabetic polyneuropathy and on erythropoietin therapy and ten healthy control were contributed to this study. Diabetic group was formed from the patients with polyneuropathy and on erythropoietin therapy. Erythropoietin was administered with a dose of 150 U/kg/ week to the patients. Heparinized blood samples were taken from the control group for once and from the patients for twice before and one month after the erythropoietin therapy. Erythrocyte membranes were isolated and erythrocyte membrane Na,K-ATPase enzyme activities were measured. Na,K-ATPase activities were given as mmolPi.mg.protein–1.10 min-1. Results: Na,K-ATPase enzyme activities were 2.910.38 µmolPi.mg.prt-1.10min-1, 1.930.38µmolPi.mg.prt-1.10min-1 and 2.400.63 µmolPi.mg.prt-1.10min-1 in control group, and patient group before and after therapy, respectively. Na,K-ATPase enzyme activities decreased in patient group before the therapy compared to the control group and significantly increased in patient group after erythropoietin therapy compared to the basal levels of the patients. We determined 24% increase in erythrocyte Na,K-ATPase activities after one month EPO application compared to the basal levels.Conclusion: It was concluded that erythropoietin therapy could improve neuropathy and this improvement was supported with the increase in Na,K-ATPase activities which could be used as a marke

ETIOLOGY AND PROGNOSIS IN 36 ACUTE RENAL FAILURE CASES RELATED TO PREGNANCY IN CENTRAL ANATOLIA

Aim: In this study, the reason of the acute renal failure (ARF) clinic features and results of it has examined as retrospectively. Methods: In this study, the etiology, clinical features and outcome of acute renal failure (ARF) evaluted retrospectively in the Anatolian region of Turkey. Above mentioned features were examined retrospectively in 36 ARF cases (mean age 31.6±6.8, range 17-46), related to pregnancy between 1997 and 2001. Results: The ARF has developed approximately on the 30th gestational week. The reasons of ARF were; HELLP Syndrome and preclampsia (44%) in 16 cases, postpartum hemorrhage in 7 cases (19%), placenta detachment in 5 cases (14%), septic or spontaneous abortion in 5 cases (14%), and eclampsia in 3 cases. The 5 cases related to the abortion were seen (14%) in the first trimester and others were developed (86%) in the third trimester or postpartum period. In 9 cases (25%) there were intrauterine dead. In 24 of the ARF cases (67%) had hypertension at the time of the diagnosis whereas six cases (17%) had hypotension related to the vaginal bleeding. All cases had oliguria and the avarage duration was 4.8±8.7 (2-27) days. The avarage of the staying period in the hospital was 11.7 ±7.6 ( 4-28 )days. Hemodialysis was applied to 17 cases (47%), and not needed for 19 cases (53%). Conclusion: ARF related to the pregnancy was seen commonly in the third or the later pregnancies and the most common reasons were HELLP Syndrome, placenta detachment, and postpartum hemorrhage and resulted in a high risk condition for fetal and maternal mortality therefore, we think that the number of the pregnancies should be limited and especially multipar pregnancies must be closely controlled for ARF

Subcutaneous C.E.R.A. for the Treatment of Chronic Renal Anemia in Predialysis Patients

Background: We investigated the efficacy, safety and tolerability of once-monthly administration of C.E.R.A. in erythropoiesis stimulating agents (ESAs) naive predialysis patients with CKD for anemia treatment Study Design: Single arm, open label study. Methods: A total of 75 patients (mean (SD) age was 52.8 (16.4) years, 76.0% were female) were included in this study conducted between 12 August 2008 and 30 October 2009 in 9 centers across Turkey. The mean change in Hb concentration (g/dL) between baseline (week 0) and the efficacy evaluation period (EEP) was the primary efficacy parameter evaluated in three consecutive periods including a dose titration period (DTP; with initial 1.2 μg/kg dose of C.E.R.A., subcutaneously, 28 weeks), EEP (8 weeks) and a long-term safety period (16 weeks). Results: Our analysis revealed an improvement in Hb levels from baseline value of 9.4 (0.4) g/dL to time adjusted average level of 11.4 (0.7) g/dL in EEP in the per protocol (PP) population and from 9.3 (0.5) g/dL to 11.1 (1.0) g/dL in intent-to-treat (ITT) population. Mean (SD) change in Hb levels from baseline to EEP was 2.0 (0.7) g/dl in the PP population (primary endpoint) and 1.7 (1.1) g/dL in the ITT population. The percentage of patients whose Hb concentrations remained within the target range of 10.0-12.0 g/dL throughout the EEP was 43.9% (95% CI: 28.5-60.3%) in the PP population and 38.7% (95% CI: 27.6% to 50.6%) in the ITP population. A total of 206 adverse events (AE) were reported in 77.0% of patients with hypertension (20%) as the most frequent AE. Conclusion: Once-monthly subcutaneous C.E.R.A. administration is effective and safe in the treatment of anemia in pre-dialysis patients with CKD, who are not currently treated with ESAs