Outcomes of acute renal failure patients requiring intermittent hemodialysis

The published studies on the prognosis of patients requiring intermittent hemodialysis (IHD) are scarce and have some conflicts. In this study, we retrospectively analyzed our data on ARF patients who were treated with IHD. A total of 192 (female: 85, 44.3%; male: 107, 55.7%) patients were included in the study. The mean age was 56.3 +/- 17.1 years. In all, 48.9% of the patients were older than 60 years. The mean number of IHD sessions was 7.8 +/- 8.0 per patient; 12.4% was due to prerenal causes, 76.8% was due to intrarenal causes, and 10.8% was due to postrenal causes. The leading indication of the IHD was uremic symptoms (46.8%). With the exclusion of hypertension, 72.4% of the patients had at least one systemic comorbidity. After treatment, 75.5% of the patients recovered, in contrast to 9.4% of patients who were transferred to chronic renal replacement programs and 15.1% who died during IHD period. Pre-dialytic serum creatinine (p = 0.003) and albumin levels (p = 0.016), total lHD session number per patient (p = 0.003), and age (p = 0.034) were the parameters that were related to high mortality in statistical analysis. Mortality was higher if the leading indication of IHD was biochemical disturbances (p = 0.013). Diabetes mellitus did not influence mortality. Consequently, predialytic serum creatinine and albumin levels may be very important predictors of mortality. Patients in high-risk groups (older age, female sex, and low pre-dialytic creatinine and albumin levels) should be considered to be treated with slow continuous renal replacement methods

The influence of low dialysate sodium and glucose concentration on volume distributions in body compartments after haemodialysis: a bioimpedance analysis study

Background. Despite the developments in haemodialysis, there are still some difficulties in maintaining the haemodynamic stability. Bioimpedance analysis (BIA) has been proposed for the estimation of dry weight in haemodialysis patients. We aimed to investigate the effects of dialysate sodium and glucose contents on volume distribution in body compartments after haemodialysis by using BIA, a sensitive and reliable method

Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology

Background Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. Conclusions Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged

Fabry Disease Prevalence in Renal Replacement Therapy in Turkey

Background: Fabry disease (FD) is an X-linked lysosomal storage disorder resulting from lack of alpha-galactosidase A (AGALA) activity in lysosomes. Objective: In this multicenter study, we aimed to evaluate the prevalence of FD in renal transplant (Tx) recipients in Turkey. We also screened dialysis patients as a control group. Methods: All Tx and dialysis patients were screened regardless of the presence of a primary disease. We measured the AGALA activity in all male patients as initial analysis. Mutation analysis was performed in male patients with decreased AGALA activity and in female patients as the initial diagnostic assay. Results: We screened 5,657 patients. A total of 17 mutations were identified. No significant difference was observed between the groups regarding the prevalence of patients with mutation. We found FD even in patients with presumed primary kidney diseases. Seventy-one relatives were analyzed and mutation was detected in 43 of them. We detected a patient with a new, unknown mutation (p.Cys223) in the GLA gene. Conclusions: There are important implications of the screening. First, detection of the undiagnosed patients leads to starting appropriate therapies for these patients. Second, the transmission of the disease to future generations may be prevented by prenatal screening after appropriate genetic counseling. In conclusion, we suggest screening of kidney Tx candidates for FD, regardless of etiologies of chronic kidney disease. (C) 2019 S. Karger AG, Base

ACUTE KIDNEY INJURY IN HOSPITALIZED COVID-19 PATIENTS: A MULTICENTRE STUDY BY TURKISH SOCIETY OF NEPHROLOGY

BackgroundAcute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and theseverity of AKI is linked to adverse outcomes. In this study, we investigated the factors asso-ciated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.MethodsIn this multicenter retrospective observational study, we evaluated the characteristics andin-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI.Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI defini-tion and staging were based on the Kidney Disease Improving Global Outcomes criteria.Patients with end-stage kidney disease or with a kidney transplant were excluded. Renaloutcomes were identified only in discharged patients.ResultsThe median age of the patients was 69 years, and 60.9% were males. The most frequentcomorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kid-ney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%,and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit.Renal improvement was complete in 81.7% and partial in 17.2% of the patients who weredischarged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. Theoverall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was notdifferent in patients with preexisting non-dialysis CKD compared to patients without CKD(34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio[HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p =0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lac-tate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p =0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]:2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality.ConclusionsAdvanced-stage AKI is associated with extremely high mortality among hospitalizedCOVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality inpatients with COVID-19 in the general population, are also related to in-hospital mortality inpatients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mor-tality rate among AKI patients. Renal problems continue in a significant portion of thepatients who were discharged.&nbsp;</div

Epidemiological features of primary glomerular disease in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group

Background The largest data on the epidemiology of primary glomerular diseases (PGDs) are obtained from the databases of countries or centers. Here, we present the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group. Methods Data of patients who underwent renal biopsy and received the diagnosis of PGD were recorded in the database prepared for the study. A total of 4399 patients from 47 centers were evaluated between May 2009 and May 2019. The data obtained at the time of kidney biopsy were analyzed. After the exclusion of patients without light microscopy and immunofluorescence microscopy findings, a total of 3875 patients were included in the study. Results The mean age was 41.5 +/- 14.9 years. 1690 patients were female (43.6%) and 2185 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGD was IgA nephropathy (25.7%) followed by membranous nephropathy (25.6%) and focal segmental glomerulosclerosis (21.9%). The mean total number of glomeruli per biopsy was 17 +/- 10. The mean baseline systolic blood pressure was 130 +/- 20 mmHg and diastolic blood pressure was 81 +/- 12 mmHg. The median proteinuria, serum creatinine, estimated GFR, and mean albumin values were 3300 (IQR: 1467-6307) mg/day, 1.0 (IQR: 0.7-1.6) mg/dL, 82.9 (IQR: 47.0-113.0) mL/min and 3.2 +/- 0.9 g/dL, respectively. Conclusions The distribution of PGDs in Turkey has become similar to that in other European countries. IgA nephropathy diagnosed via renal biopsy has become more prevalent compared to membranous nephropathy