AA Amiloidozlu Hastalarda Serum FGF-23 Düzeyi Subklinik Aterosklerozun Göstergesi midir?

Objective: Amyloid A (AA) amyloidosis is the most prevalent form of systemic amyloidosis, and is a serious condition characterized by protein-misfolding. Cardiovascular involvement is known to be a significant manifestation of the disease and common carotid artery intima-media thickness (CIMT) assessment is one of the well-recognized tools for identification of subclinical atherosclerosis. It was reported that FGF-23 may be a significant factor associated with atherosclerosis development in patients with AA amyloidosis, as well as being an independent risk factor for increased CIMT. In this study, we aimed to investigate whether elevated FGF-23 levels might be associated with CIMT levels in AA amyloidosis patients. Method: We studied 63 patients with AA amyloidosis and 29 aged-matched healthy controls. All subjects’ demographic data were recorded and the following parameters were measured: erythrocyte sedimentation rate, C-reactive protein, creatinine, urea, albumin, calcium, phosphate, parathyroid hormone, FGF-23, eGFR, CIMT, blood pressure and BMI. Results: CIMT levels were significantly higher in AA amyloidosis patients compared to the control group (p<0.001). However, serum FGF-23 levels were similar (p=0.110). CIMT was correlated with patient age (r=0.471, p<0.001), but serum FGF-23 was not associated with CIMT in patients with amyloidosis (r=0.031, p=0.807). Conclusion: Although our results suggest a lack of association between FGF-23 levels and CIMT in patients with AA amyloidosis.Amaç: Amiloidoz proteinlerin anormal katlantı oluşturması ile karekterize hayatı tehdit eden bir hastalıktır, Amyloid-associated (AA) amiloidoz sistemik amiloidozun en yaygın formudur. Kardiyovasküler tutulum amiloidozun en önemli klinik tezahürüdür ve karotis intima media kalınlığının ölçümü (KIMK) subklinik aterosklerozu tespit etmek için iyi tanımlanmış yöntemlerden birisidir. FGF-23 AA amiloidozda KIMK’dan bağımsız olarak subklinik ateroskleroz ile ilişkili olabileceği bildirilmiştir. Bu çalışmada amacımız, AA amiloidozlu hastalarda KIMK ile yükselmiş serum FGF-23 ile ilişkisinin olup olmadığına bakmaktı. Yöntem: Çalışmaya 63 AA amiloidozlu hasta ve 29 sağlıklı kontrol dahil ettik. Tüm olguların demografik verileri, eritrosit sedimantasyon hızı, Crp, kreatinin, üre, albumin, kalsiyum, fosfat, parathormon, FGF-23, eGFR, KIMK, kan basıncı ve vücut kitle indeksleri kayıt edildi. Bulgular: Karotis intima media kalınlığı AA amiloidozlu hastalarda kontrol grubuna göre anlamlı derecede fazlaydı (p<0.001). Bununla birlikte serum FGF-23 seviyesi iki grup arasında farklı değildi (p =0.110). KIMK yaş ile köreleydi (r=0.471, p<0.001), fakat serum FGF-23 seviyesi amiloidozlu hastalarda KIMK ile körele değildi (r=0.031, p=0.807). Sonuç: Bizim çalışmamızda, AA amiloidozlu hastalarda KIMK ile Serum FGF-23 seviyesi arasında bir korelasyon tespit edilememiştir

The importance of complement levels and clinical characteristics of primary membranoproliferative glomerulonephritis in Turkey

ERA EDTA..

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