Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes

Adult Tetanus With Fatal Course: A Case Report

WOS: 000481718600018Despite improvements in medicine, tetanus is still a fatal infectious disease which can be prevented by immunoprophylaxis and it should always be kept in mind after injuries. in this case report, we present a patient who had no previous immunization history and did not have tetanus prophylaxis completed at the first visit of the emergency department after injury. the patient was followed with a clinical picture of generalized tetanus in intensive care unit, but autonomic dysfunction could not be taken under control despite treatment and resulted in mortality. Tetanus prophylaxis should be questioned in patients applying with injury or trauma. Strategies should be developed in order to achieve regular vaccination, with respect to adult immunization in particular

Is peritoneal dialysis a therapeutic option for polycystic kidney disease? 15 years' experience in a single center

WOS: 000381245700005PubMed ID: 27320369Background. - Peritoneal dialysis (PD) is often avoided for patients with polycystic kidney disease (PKD) because of increased risk of complications and technique failure due to limited intra-abdominal space. In this study, we have aimed to determine clinical outcomes, patient and technique survivals in patients with PKD performing PD and to define whether PD is appropriate for these patients. Methods. - Totally 99 patients: 33 with PKD and 66 with diseases other than PKD were included in this retrospective study. All patients started PD between 2001 and 2015 years and have been matched by time of PD therapy initiation. Socio-demographic characteristics, clinical data and complications during the specified period were evaluated. The factors associated with mortality and patient and technique survival were investigated for all patients. Results. - The two groups were similar in terms of demographic, baseline and last visit clinical and laboratory parameters, additional systemic diseases, with the exception of higher pretreatment and last visit serum albumin levels in PKD patients (P = 0.03 and 0.01 respectively) and younger age of non-PKD patients (P = 0.002). Incidence of peritonitis and catheter exit-site/tunnel infections were similar among the two groups (P = 0.26 and 0.12 respectively). The two groups were similar in terms of leak and hernia developments (P = 0.07 and 0.57, respectively). By the end of the study period; in PKD group, 10 patients had been transferred to HD and had kidney transplantation and only 6 patients had died. In non-PKD group, 19 patients had been transferred to HD, 11 patients had kidney transplantation and 23 patients had died. Mortality was lower in PKD group (log rank = 0.034). The two groups were similar regarding death and HD transfer reasons (P = 0.35 and 0.36 respectively). The technique survival rates were similar among the two groups (log rank = 0.37). Conclusions. - Peritoneal dialysis may be a suitable renal replacement therapy option for PKD patients. PKD is not an additional risk factor in patients treated by PD. Mortality is similar with non-diabetic PD patients. Peritoneal dialysis in PKD patients is associated with a similar overall rate of technique survival, incidences of hernia, leak and infectious complications as in non-PKD patients. (C) 2016 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved

The Impact of Peritonitis on Clinical Outcomes of PD Patients: A Single Center Experience

WOS: 000461206800012Objective: The aim of the present study was to investigate peritonitis episodes and causative agents in patients undergoing peritoneal dialysis (PD), to examine the effects of peritonitis on technical and patient survival, and to determine whether the number of peritonitis episodes and causative agents was a risk factor or not. Materials and Methods: The medical records of 387 patients who started PD between January 2001 and January 2015 were evaluated retrospectively. Patients without peritonitis (Group 1 (n=123 patients)) and with detected peritonitis (Group 2 (n=243 patients)) were divided into two groups. Group 2 patients were subdivided according to the number of peritonitis (Group 2a 1 episode and Group 2b >= 2 episodes). Sociodemographic data and clinical courses were compared, and the reasons for PD withdrawal were obtained between the groups. Survival analysis was performed, and the effects of peritonitis on mortality were investigated. Results: A total of 427 peritonitis episodes were detected. The most common organism was Staphylococcus aureus (36%). The leading cause of death was cardiovascular disease in Group 1, whereas it was infection in Group 2a and Group 2b. Technique survival and mortality rates were similar among the groups. Risk factors for patient survival were history of peritonitis more than once and history of catheter exit site/tunnel infection. History of catheter exit site/tunnel infection was the only risk factor for technique survival. Conclusion: Our study has shown that even though the causes for mortality were different, mortality rates, and technique survival were similar between the two main groups. Infectious complications may affect patient and technical survival

Prevalence and Characteristics of Atrial Fibrillation in Turkish Patients Undergoing Hemodialysis

34th National Congress of Nephrology -- OCT 18-22, 2017 -- Antalya, TURKEYHasbal, Nuri Baris/0000-0002-2229-5140WOS: 000547335800006Objective: Atrial fibrillation (AF) is one of the most common and cumulatively important cardiac arrhythmias. Prevalence of AF is much higher in patients with chronic kidney disease (may be up to 27%). We aimed to study the prevalence and clinical features of AF in hemodialysis centers. Materials and Methods: Patients who had been under chronic in-center hemodialysis for at least 6 months and were >= 18 years of age were included in this cross-sectional study conducted at five hemodialysis centers across Istanbul between May 2017 and July 2017. Medical history, clinical (including medications and echocardiography), and laboratory data were obtained using a standardized study form. Results: the data of 632 prevalent patients undergoing in-center hemodialysis (mean age 62.7 +/- 13.9 years, males 350 and females 282) were included in the analysis. AF was present in 92 (14.5%) of the patients. the prevalence of AF was lowest in patients = 2 or less. Conclusion: AF is highly prevalent in patients undergoing hemodialysis, and warfarin was used in nearly 5% of the patients with AF undergoing hemodialysis in this study, which suggests that the current knowledge is unconvincing to proceed for the treatment with anticoagulation. Further studies are needed to guide the management for prevention of strokes in patients with AF undergoing dialysis

Incisional Complications and Cosmetic Evaluation After Hand-assisted Retroperitoneoscopic Donor Nephrectomy

1st International Transplant Network Congress -- OCT 17-21, 2018 -- Antalya, TURKEYAydogdu, Ibrahim/0000-0001-7900-8598; SARDOGAN, CEYDA/0000-0002-4263-3653WOS: 000487349900018PubMed: 31474288Purpose. Hand-assisted retroperitoneoscopic (HARP) donor nephrectomy prevents major complications, but incision site complications may be more frequent in hand-assisted approach. We evaluated long-term incisional complication rates and cosmetic outcomes after HARP donor nephrectomy in our series. Materials and Methods. A total of 609 donors who underwent nephrectomy between February 2009 and June 2016 were invited for physical examination and face-to-face interview. A total of 209 donors (35.3%) participated to the study. Sex, age, body mass index (BMI), mean follow-up period, incision-related outcomes of cosmesis, and postoperative complications were evaluated. Body image scale (BIS) and cosmetic scale (CS) (scar test) questionnaires were applied. Higher cosmesis and body image scores indicated greater satisfaction. Results. A total of 191 donors had paramedian (91.4%), and 18 donors had Pfannenstiel incision (8.6%); 121 donors were female (57.9%). the donor mean age and BMI were 49.1 (SD, 1.8) years and 29.7 (SD, 5.1), respectively. Body mass index was significantly lower in the Pfannenstiel group (P < .001). the mean BIS score was 18.9 (SD, 1.8), and the CS questionnaire score was 19.3 (SD, 4,7). the BIS score was significantly better in donors with Pfannenstiel incisions (P < .001), but there was no statistical significance in CS score. the total rate of wound infection was 4.8%, and rate of incisional hernia was 4.8%. the rate of incisional hernia was more frequent in donors with paramedian incision (5.2%), but there was no statistical significance. Six donors (2.9%) required rehospitalization because of incision site complications. Conclusion. Hand-assisted retroperitoneoscopic donor nephrectomy avoids intra-abdominal complications, but rate of incision site complications can be higher in hand-assisted procedure. the donors were convinced from the cosmetic outcome after HARP donor nephrectomy. the ones who had Pfannenstiel incision had better satisfaction according to BIS score

Clinical Prognosis of Renal Retransplant Patients: A Single-Center Experience

1st International Transplant Network Congress -- OCT 17-21, 2018 -- Antalya, TURKEYWOS: 000487349900032PubMed: 31474292Background. Retransplantation is a treatment option in patients with end-stage renal failure due to graft loss. Outcomes of these patients due to high immunologic risk remain unclear. the aim of this study was to evaluate outcomes of renal retransplantation patients retrospectively. Methods. Renal retransplant patients in our unit were evaluated retrospectively between 2010 and 2018. Patients' demographic characteristics, primary diseases, the causes of prior graft loss, immunologic status, desensitization protocols, the induction and maintenance treatments, the complications during the follow-up period, numbers of acute rejections, and the clinical prognosis were all detected from the patients' files. Results. We retrospectively evaluated 17 patients who underwent a second or third renal allograft. of these, 16 received a second and the remaining 1 patient received a third renal allograft. Immunologically, all of the 17 patients had negative flow cytometry crossmatch, 1 patient had a positive complement-dependent cytotoxicity crossmatch (Auto 12%), 16 patients had positive panel reactive antibody, the median HLA-mismatch was 3.5, and the score of donor-specific antibody relative intensity score (RIS) was 6.4 +/- 6.3. Ten pretransplant patients had desensitization treatment. While scores for HLA-MM and HLA-RIS in the patients who had a desensitization therapy were determined higher, no statistical difference was observed (respectively, P = .28 and.55). No acute rejection episode developed. BK virus DNA viremia was detected in 4 patients during the posttransplant 6th month. We observed no patient death or no graft loss during the follow-up period. Conclusion. Although the retransplant patients who had a graft loss previously have high immunologic risks, retransplantation is reliable in these patients, but they should be followed up carefully in terms of BKV nephropathy

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival. CONCLUSIONS: Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis

COVID-19 in kidney transplant recipients: A multicenter experience in Istanbul.

© 2020 Wiley Periodicals LLCIntroduction: Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19. Material and Methods: Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation. Results: Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up. Discussion: COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period