Warfarın increases the risk of vascular calcification in haemodialysis patients a multicenter case-control study

57th ERA-EDTA CongressERA, EDT

A multicenter study of the clinical, laboratory characteristics and potential prognostic factors in patients with aa amyloidosis on hemodialysis

Introduction While light chain (AL) amyloidosis is more common in western countries, the most common type of amyloidosis is amyloid A (AA) amyloidosis in Eastern Mediterranean Region, including Turkey. Although worse prognosis has been attributed to the AL amyloidosis, AA amyloidosis can be related to higher mortality under renal replacement therapies. However, there are no sufficient data regarding etiology, clinical presentation, and prognostic factors of AA amyloidosis. The objective of our study is to evaluate the clinical, laboratory characteristics, and possible predictive factors related to mortality in patients with AA amyloidosis undergoing hemodialysis (HD). Methods This multicenter, cross-sectional study was a retrospective analysis of 2100 patients on HD. It was carried out in 14 selected HD centers throughout Turkey. Thirty-two patients with biopsy-proven AA amyloidosis and thirty-two control patients without AA amyloidosis undergoing HD were included between October 2018 and October 2019. There was no significant difference between the groups in terms of age and dialysis vintage. Causes of AA amyloidosis, treatment (colchicine and/or anti-interleukin 1 [IL] treatment), and the number of familial Mediterranean fever (FMF) attacks in the last year in case of FMF, systolic and diastolic blood pressures, biochemical values such as mean CRP, hemoglobin, serum albumin, phosphorus, calcium, PTH, ferritin, transferrin saturation, total cholesterol levels, EPO dose, erythropoietin-stimulating agents resistance index, interdialytic fluid intake, body mass indexes, heparin dosage, UF volume, and Kt/V data in the last year were collected by retrospective review of medical records. Findings Prevalence of AA amyloidosis was found to be 1.87% in HD centers. In amyloidosis and control groups, 56% and 53% were male, mean age was 54 +/- 11 and 53 +/- 11 years, and mean dialysis vintage was 104 +/- 94 and 107 +/- 95 months, respectively. FMF was the most common cause of AA amyloidosis (59.5%). All FMF patients received colchicine and the mean colchicine dose was 0.70 +/- 0.30 mg/day. 26.3% of FMF patients were unresponsive to colchicine and anti-IL-1 treatment was used in these patients. In AA amyloid and control groups, erythropoietin-stimulating agents resistance index were 7.88 +/- 3.78 and 5.41 +/- 3.06 IU/kg/week/g/dl, respectively (p = 0.008). Additionally, higher CRP values (18.78 +/- 18.74 and 10.61 +/- 10.47 mg/L, p = 0.037), lower phosphorus (4.68 +/- 0.73 vs. 5.25 +/- 1.04 mg/dl, p = 0.014), total cholesterol (135 +/- 42 vs. 174 +/- 39 mg/dl, p < 0.01), and serum albumin (3.67 +/- 0.49 mg/dl, 4.03 +/- 0.22, p < 0.01) were observed in patients with AA amyloidosis compared to the control group. Discussion In this study, we found that long-term prognostic factors including higher inflammation, malnutritional parameters, and higher erythropoietin-stimulating agents resistance index were more frequent in AA amyloidosis patients under HD treatment

Relationship between disease progression and prognosis with inflammatory markers seen in first year after diagnosis in ulcerative colitis

Ülseratif Kolit (ÜK) hastalarının rutin takipleri sırasında bakılan eritrosit sedimantasyon hızı (ESR), C-reaktif protein (CRP), hemoglobin (hb), beyaz küre (bk), nötrofil lenfosit oranı (NLO), ortalama platelet volumu (MPV) ve albumin (alb) düzeyleri tanı anı (0.ay), 3.ay, 6.ay, 9.ay ve 12.ayda olmak üzere retrospektif olarak kaydedildi ve bu değerlerin zamana göre değişiminin eğri altında kalan alanı (AUC) hesaplandı. Tanı anından sonra 1 yıl içindeki değişiminin hastalık gidişatını ve kümülatif barsak hasarını öngördüğünü gösterebilmek amaçlandı. Hesaplanan AUC'ler ile tedavi şekilleri, hastalık gidişatı, atak durumu arasındaki ilişki incelendi. Toplam 118 (53 kadın) hasta çalışmaya dahil edildi. Ortalama takip süresi 3,4 yıldı. İmmunmodülatör kullanan hastalarda CRP, ESR, bk, NLO için hesaplanan AUC değerleri immunmodülatör kullanmayan hastalara göre anlamlı olarak yüksek saptanırken (p<0.001, p<0.01,p<0.01,p<0.01); hb, alb, MPV için hesaplanan AUC'ler anlamlı olarak düşük saptandı (p<0.01, p<0.001,p<0.05). Anti-TNF kullanan hastalarda CRP, ESR için hesaplanan AUC değerleri anti-TNF kullanmayan hastalara göre anlamlı olarak yüksek saptanırken (p<0.001, p<0.05), hb, alb, MPV için hesaplanan AUCler anlamlı olarak düşük saptandı(p<0.01, p<0.05, p<0.01). Ayrıca sadece immunmodülatör alan 29 hasta ile Anti-TNF alan 9 hastanın CRP değerlerine ilişkin AUCler Anti TNF alanlarda anlamlı olarak yüksek (p<0.05), hb değerlerine ilişkin AUCler anlamlı olarak düşük bulundu (p<0.05). Ülseratif kolit hastalarının tanı anı ve hastalığı erken evresindeki inflamatuar belirteçlerin düzeyi hastalığın gidişatını öngörmede ve kümülatif barsak hasarını göstermekte yardımcıdır. Olasıdır ki inflamatuar belirteçlerden özellikle CRP ne kadar yüksekse hastalık o kadar kötü seyirli ve ileri basamak tedavi gerektiren özelliktedir. Ancak hasta sayısı yetersiz olması nedeniyle bir eşik değer hesaplamak mümkün olmamıştır, bu konuda başka çalışmalara ihtiyaç vardır.Levels of erytrocyte sedimentation rate (ESR), C-reactive protein(CRP), hemoglobin (hb), white blood cell count (WBC), neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV) and albumin (alb) which has been seen at the time of diagnosis, 3th, 6th, 9th, 12th month during the routine follow up in ulcerative colitis patients were recorded retrospectively. The area under the curve (AUC) of the variation of these values with respect to time was calculated. With these calculations to show the disease progression and cumulative intestine damage prediction were aimed. The relationships between tretment modalities, disease progression, flares and calculated AUCs were investigated. One hundred and eighteen (53 women) were admitted into this study. Mean follow-up time was 3.4 years. Calculated AUCs for CRP, ESR, WBC, NLO were significantly higher (p<0.001, p<0.01,p<0.01,p<0.01) and AUCs for hb, alb, MPV were significantly lower (p<0.01, p<0.001,p<0.05) in patients whom used immunomodulator compared with those not used ones. AUCs for CRP, ESR were significantly higher (p<0.001, p<0.05) and AUCs for hb, alb, MPV were significantly lower (p<0.01, p<0.05, p<0.01) in patients whom used anti-TNF compared with not used ones. Additionaly, in patients whom used anti-TNF the calculated AUCs for CRP were significantly higher (p<0.05) and AUCs for hb were significantly lower (p<0.05) than in patients whom used immunomodulator only. The levels of inflammatory markers at the time of diagnosis and in early course of disease is helpful for predicting the disease progression and prognosis. It is possible to assume that, the higher the CRP is, the worse the prognosis is. Because of the number of patients is inadequate, we can't calculate target levels for inflammatory markers to predict the course. So furhther studies are needed for this regard

Middle-term outcomes in renal transplant recipients with COVID-19: a national, multicenter, controlled study

Background In this study, we evaluated 3-month clinical outcomes of kidney transplant recipients (KTR) recovering from COVID-19 and compared them with a control group. Method The primary endpoint was death in the third month. Secondary endpoints were ongoing respiratory symptoms, need for home oxygen therapy, rehospitalization for any reason, lower respiratory tract infection, urinary tract infection, biopsy-proven acute rejection, venous/arterial thromboembolic event, cytomegalovirus (CMV) infection/disease and BK viruria/viremia at 3 months. Results A total of 944 KTR from 29 different centers were included in this study (523 patients in the COVID-19 group; 421 patients in the control group). The mean age was 46 +/- 12 years (interquartile range 37-55) and 532 (56.4%) of them were male. Total number of deaths was 8 [7 (1.3%) in COVID-19 group, 1 (0.2%) in control group; P = 0.082]. The proportion of patients with ongoing respiratory symptoms [43 (8.2%) versus 4 (1.0%); P Conclusion The prevalence of ongoing respiratory symptoms increased in the first 3 months post-COVID in KTRs who have recovered from COVID-19, but mortality was not significantly different