Hastaların perspektifinden: Periton diyalizinin yaşama ve ruhsal belirtilere etkisi

Amaç: Bu çalışmanın amacı; sürekli ayaktan periton diyalizi (SAPD) uygulayan hastaların kendi ifadeleri ile hastalığı nasıl tanımladıkları ve periton diyalizinin iş, aile, sosyal ve özel yaşamlarına etkisi ile ruhsal belirti sıklığı arasındaki ilişkileri incelemektir. Yöntem: Tanımlayıcı ve ilişki arayıcı olarak yapılan bu çalışma özel bir diyaliz merkezinde takip edilen 153 periton diyalizi hastasıyla yürütülmüştür. Çalışma verileri hasta tanıtım formu ve Kısa Semptom Envanteri (KSE) kullanılarak toplanmıştır. Bulgular: Hastaların yaş ortalaması 49.51±15.44 yıl olup, %53.6’sı erkektir. Hastaların %81.7’si evli ve %51.6’sı ilkokul mezunudur. Hastaların %18.3’ü “hastalığın doğal bir durum” olduğunu ve %46.6’sı “özel yaşamında hiçbir şeyin eskisi gibi olmadığını, daha karmaşık ve zor olduğunu” belirtmiştir. KSE puan ortalaması 49.01±13.21 olarak bulunmuştur. Periton diyalizinin iş yaşamlarını nasıl etkilediğine ilişkin ifadeleri açısından, KSE’nin somatik belirtiler, hostilite ve paranoid düşünceler alt boyutları arasında istatistiksel olarak anlamlı fark bulunmuştur (p<.01, p<.01 ve p<.05). Sonuç: Periton diyalizi hastaları yaş, cinsiyet, hastalıklarını algılayış biçimleri ve hastalığın yaşamlarını etkileme biçimlerine göre değişik sıklıkta ruhsal belirtiler yaşayabilmektedir

Şiddetli amfizemi olan aşiri obez bir hastada anterior yaklaşimli perkütan böbrek biyopsisi: Olgu bildirisi

The most commonly used technique of percutaneous renal biopsy is performed by approaching posteriorly. We had to perform a kidney biopsy with an anterior approach because of an access problem posteriorly. Except for transplanted kidney biopsies we could not find a similar application utilising anterior approach in the literature. Therefore, we are reporting our experience on this case who was extremely obese and had severe emphysema

Quality of life and psychiatric symptom distribution in chronic dialysis patients

WOS: 000267350900010Objective: End stage kidney failure cause many psychosocial problems and decrease quality of life (QoL). Our aim in this study was to determine QoL and psychiatric symptom distribution in chronic dialysis patients. Methods: Fifty-four chronic hemodialysis (HD) and 13 continuous ambulatory peritoneal dialysis (CAPD) patients (total 67 patients) who have been followed up by our nephrology unit have been included in this study. The tests applied in all patients were as following: Sociodemographic information form, Short Form-36 (SF-36) Quality of Life Scale, Hospital Anxiety and Depression Scale (HAD), Brief Symptom Inventory (BSI). Mann Whitney-U non-parametric test were used for statistical analysis. Results: There were 31 male, 36 female patients. Mean age in the hemodialysis group was 53.55 +/- 17.26 in the hemodialysis group and 47.83 +/- 13.76 in the CADP group. There no significant difference in the SF-36 sub-scales between two groups. According to the BSI sub-scales, there were significantly more somatization (p=0.027) and depression (p=0.045) in the HD group. All QoL subscales (except emotional role subscale in the anxiety group (p=0.186)) and BSI subscale points were statistically significantly worse among the patients who had over-threshold HAD anxiety and depression points. Conclusion: Psychiatric evaluation of chronic dialysis patients together with nephrologic evaluation seems quite important. Anxiety and/or depression, that cause deterioration in both QoL and psychiatric symptom distribution in these patients, can easily identified by quick and easily performed tests. By this way, psychiatric support can be provided to improve QoL, also psychiatric disorders can be early diagnosed, and thus necessary measures can be taken. Psychiatric evaluation and support seem to be very important and cannot be overlooked. By this means, caregiving "burn-out" syndrome can also be prevented. (Anatolian Journal of Psychiatry 2009; 10: 142-150

Evaluation of anti-body response of hemodialysis and peritoneal dialysis patients to Hepatitis-B vaccine

Amaç: Hemodiyaliz hastaları, Hepatit B virüs (HBV) infeksiyonu yönünden toplumun diğer kesimlerine göre daha yüksek risk altındadır. Hepatit B aşısı ile sağlıklı insanlarda aşıya karşı yeterli antikor yanıtı (yaklaşık %90) alınırken, kronik böbrek yetmezliği (KBY) hastalarında bu oran %50–70 düzeylerinde kalmaktadır. Bu çalışmada, diyaliz hastalarında çift doz rekombinant hepatit B aşısına karşı yanıt oranlarının ve antikor oluşmasında rol olabilecek çeşitli faktörlerle renal replasman türünün etkisinin araştırılması amaçlanmıştır. Gereç ve yöntem: Bu retrospektif çalışmaya, 2004-2005 yılları arasında Düzce Üniversitesi Tıp Fakültesi Hastanesi Diyaliz Merkezi'nde hemodiyaliz ve sürekli ayaktan periton diyalizi (SAPD) programında olan 37 (19 erkek, 18 kadın) hasta dahil edilmiştir. Hastalara 0, 1, 2, ve 6. aylarda çift doz (40µg) olmak üzere toplam dört kez rekombinant DNA kökenli HBV aşısı intramusküler olarak yapılmıştır. Hastaların antikor yanıtları son doz aşılamadan bir ay sonra ELISA testi ile saptanan Anti-HBs titrasyon düzeylerine göre belirlenmiştir. Bulgular: Otuz yedi hastanın 6 (%16,2)'sında aşı yanıtı alınmazken; 15 (%40,5) hastada düşük yanıt, 16 (%43,2) hastada tam yanıt saptandı. Hemodiyaliz hastaları ile periton diyalizi hastaları arasında antikor yanıtı açısından fark saptanmadı (p0,05). Hemoglobin, total kolesterol, trigliserit, albumin düzeyleri, diyaliz türü, diyaliz süresi ve cinsiyet ile antikor yanıtları arasında korelasyon izlenmedi (p0,05). Sonuç: Hepatit B aşısına yanıt oranı normal popülasyona göre düşük olup yanıtsızlık nedeni multifaktöriyel gibi gözükmektedir.Objective: Hemodialysis patients are at higher risk for Hepatitis B virus (HBV) infection when compared with the rest of the population. Adequate antibody response (approximately 90%) is achieved when healthy individuals are immunized with HBV vaccine; however, the response is about 50% and 70% in chronic renal failure (CRF) patients. In this study, it is aimed to assess the influence of different factors and the type of renal replacement, for antibody response to double dose of recombinant HBV-vaccine in dialysis patients. Materials and methods: In this retrospective study, we included 37 patients (19 males, 18 females) who were in the schedule of hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) at the Dialysis Center of Düzce University Hospital between 2004 and 2005. The patients were administered double doses of recombinant DNA derived HBV vaccine IM for four times at 0, 1, 2, and 6 months. The patients' antibody responses were determined one month after the last dose of HBV-vaccine administration, according to the Anti-HBS titrations that are evaluated by ELISA test. Results: Six of the 37 patients (16.2%) had no response to the vaccine, while 15 patients (40.5%) had low response and 16 patients (43.2%) had complete response. There was no difference between hemodialysis patients and peritoneal dialysis patients in terms of the antibody response (p>0.05). Levels of hemoglobin, total cholesterol, triglyceride and albumin, type and duration of dialysis, and gender were not correlated with the antibody response (p>0.05). Conclusion: As a result, for dialysis patients, antibody response to the HBV-vaccine is lower than that in the healthy population and this decline in response seems to be multifactorial

Hiportiroidi olgularında antitiroid tedavinin akım-volüm eğrileri üzerindeki etkileri

Astım tanısı bulunmayan 20 hipertiroidi olgusunda anütiroid tedavinin akım-volüm eğrileri üzerindeki etkilerini değerlendirmek üzere prospektif bir çalışma düzenlendi. Antitiroid tedavinin başlangıcında ve üçüncü ayının sonunda hastaların tiroid hormonları (Total T3, Total T4 ve TSH), ultrasonografi ile tiroid bezi volümleri, boyun çevresi ölçümleri ve akım-volüm eğrileri değerlendirildi. Propilüourasil tedavisi ile tiroid bezi volümünde ve boyun çevresi ölçümünde istatistiksel olarak anlamlı azalma görüldü (sırasıyla; p 0.001 ve p 0.001). Çalışmanın en önemli sonucu maksimal ekspirasyon ortası akım hızı (MMEFR) parametresinde üç aylık propiltiourasil tedavisi sonrası görülen düzelme idi. Vital kapasitenin %25'indeki ortalama ekspiratuar akım hızı (FEF_{25}) ve vital kapasitenin %75'indeki ortalama ekspiratuar akım hızı (FEF_{75}) parametrelerinde kaydedilen artışlar tüm ekspiratuar akım parametrelerindeki düzelme ile uyumluydu (sırasıyla; p 0.044 ve p 0.012). Sonuçta hipertiroidi tedavisi için propiltiourasil kullanan hastaların akım-volüm eğrilerinde en erken değişiklik ekspiratuar akım parametrelerindeki düzelme olarak bulundu.This prospective study was designed to evaluate the effects of hyperthyroidism on flow-volume loops in nonasthmatic 20 patients with hyperthyroidism. Thyroid related hormones (Total T3, Total T4 and TSH), thyroid gland volumes with ultrasonography, circumference of neck values and flow-volume loops were obtained at the beginning and after three months of antithyroid treatment. Propylthiouracil treatment was followed by a statistically significant decrease in thyroid gland volume and circumference of neck (p< 0.001 and p< 0.001, respectively). The most significant result was improvement of maximum midexptratory flow rate (MMEFR) after propylthiouracil therapy for three months (p 0.003). Increases in mean forced expiratory flow after 25% of FVC has been exhaled (FEF_{25}), mean forced expiratory flow after 75% of FVC has been exhaled (FEF_{75})values were found consistent with the puerall improuement in expiratory flow parameters (p 0.044, p 0.072 respectively) in conclusion, we speculated that improvement of expiratory flow parameters might be the earlier changes in flow volume loops of patients who were treated with propylthiouracil for hyperthyroidism

Pregnancy-associated plasma protein A in dialysis patients

Coskun, Abdurrahman/0000-0002-1273-0604; Alcelik, Aytekin/0000-0002-3156-1076WOS: 000243978400012PubMed: 17243917Background: Pregnancy-associated plasma protein A (PAPP-A) was recently described as a new marker of cardiovascular events and of inflammation in uremic patients. The aim of this study was to determine levels of PAPP-A in chronic dialysis patients and its possible relationships with renal osteodystrophy. Methods: A total of 99 adult chronic hemodialysis patients, 14 peritoneal dialysis patients and 41 control subjects were included in the study. Serum PAPP-A, intact parathormone (iPTH), calcium, phosphorus and alkaline phosphatase (ALP) were measured. The correlations between PAPP-A and iPTH, calcium, phosphorus and ALP were determined. Results: PAPP-A levels were significantly higher in peritoneal dialysis [4.5 (3.2-6.7) mU/L, median (interquartile range)], and hemodialysis patients [4.7 (3.8-6.5) mU/L] in comparison to control subjects [3.4 (3.0-5-0) mU/L] (p < 0.05). In hemodialysis patients, post-dialysis PAPP-A levels [6.2 (4.7-9.4) mU/L] were significantly higher than pre-dialysis levels [4.7 (3.8-6.5) mU/L] (p < 0.05). There was a weak but statistically significant positive correlation between serum PAPP-A and iPTH (r=0.216; p=0.041) and ALP (r=0.205; p=0.044) in the hemodialysis group. Correlation between the duration of dialysis therapy and PAPP-A levels was also significant (r=0.267; p=0.008) in the hemodialysis group. Conclusions: PAPP-A levels are elevated in acute coronary syndromes and are closely related to inflammation and oxidative stress. We conclude that PAPP-A levels are increased in dialysis patients and may reflect a greater degree of chronic inflammation than osteodystrophy in uremic patients

The predictive value of CRP levels on future severe renal disease in overweight and obese subjects without diabetes mellitus and hypertension

Ozbek, Orhan/0000-0002-7388-0542WOS: 000251826200006PubMed: 18091366Background: Obesity and related disorders have a high prevalence all over the world. Increased C-reactive protein (CRP) value in obese individuals and its potential adverse effects have been reported. Here we have investigated the relationship between CRP levels and renal functions in nondiabetic, nonhypertensive, overweight, and obese individuals. The aim of this study was to evaluate the predictive value of CRP levels on future severe renal disease. Methods: One hundred sixty individuals were included in the study. They were grouped as normal weight, overweight, and obese. Anthropometric measurements, renal function tests, and serum hsCRP values were obtained. Mean values were compared and correlation analysis was performed. Results: Significant differences were detected between the groups according to body mass index, waist circumference (WC), and body fat percentage. There was a significant difference with respect to creatinine clearance (CC). Difference in the mean urinary albumin excretion (UAE) was significant between normal-weight and overweight subjects. There was a linear increase in serum CRP values in parallel to the increase in body weight; mean values were significant between groups. A positive correlation was detected between CC and body mass index and WC, and there were significant correlations between CRP and anthropometric measurements, CC and UAE. Conclusions: This study showed that increased CRP levels in nondiabetic, nonhypertensive, overweight, and obese individuals could possibly associated with impaired renal functions that might be originating from endothelial dysfunction. Determination of cutoff levels of CRP, as in cardiovascular diseases, may be useful for early estimation and prevention of renal diseases

Temporary Catheter Insertions and Complications in Our Nephrology Clinic: Clinical Experience of One Year

Aim: Urgent hemodialysis in patients with renal insufficiency is usually provided by catheter insertions. Early complications of hemodialysis catheter insertions can increase morbidity and mortality. In this study, we investigated the characteristics of patients undergoing temporary hemodialysis catheter insertion in our nephrology clinic and complications. Methods: In this study, we reviewed the records of 151 patients in whom temporary hemodialysis catheters were inserted by the nephrologists of our clinic between August 2012 and August 2013. Demographic features, catheter insertion indications, and catheter insertion sites were assessed and complications were noted. Results: A total of 151 patients (94 female and 57 male) were included in the study. The average age of the patients was 58.66±16.8 years (minimum: 17, maximum: 92). No complication was observed in 112 (74.2%) patients during catheter insertions. Catheter insertion was repeated in 39 (25.8%) patients for various reasons. Arterial puncture occurred in 12 (7.9%) of 151 patients who had catheter insertions for the first time. None of the patients required surgical intervention. Conclusion: Temporary catheter insertions are required in patients needing urgent hemodialysis. However, they bring along the risk for many complications. Early referral of patients who require hemodialysis to nephrology clinic and application of permanent vascular interventions will reduce the need for temporary catheters and complications