Coronavirus disease 2019 (COVID-19) has been accepted as a global pandemic, and poses a greater risk to the elderly and those with comorbidities. Comorbid diseases (particularly end-stage kidney disease with hemodialysis) and impaired immunity place patients in the high-risk group for COVID-19. In recent studies, it was also mentioned that exaggerated inflammation and a cytokine storm were the underlying causes related to the high mortality in COVID-19 patients. Currently, treatment modalities to balance the immune system of such vulnerable patient groups are essential, to protect them from the disease. Several vitamins (like vitamins C, D, and E), trace elements like zinc, and probiotics have been proposed as immune boosters to protect and combat infectious conditions. It is well known that these vitamins and elements are insufficient in hemodialysis patients. In this review, we aimed to evaluate the immune-boosting mechanisms of vitamins C, D, E, zinc, and probiotics, the studies related to their beneficial effects against infections, and their possible benefits for hemodialysis patients during the COVID-19 pandemic.
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Low-molecular-weight heparins, particularly enoxaparin, are widely used for pulmonary embolism prophylaxis in hospitalized patients. Although rare, bleeding has been reported due to these drugs. Because of their excretion from the kidney, the risk of bleeding is higher in the kidney patient population, and these patients should be careful, and dose adjustment should be made. This article reports 2 cases of bleeding due to enoxaparin in 2 different kidney patients who then required transfusion, the literature on this topic has been reviewed.
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Objective: To conduct a histopathologic examination of the effects of a combination of parenteral nutrition (PN) and starvation on rabbits’ kidney tissue using light microscopy and transmission electron microscopy. Methods: Four groups consisting of equal numbers of adult female and male New Zealand rabbits were formed (n = 14 each). Rabbits in the PN + oral feeding group were provided with half of their daily caloric needs from rabbit feed and the other half through PN. Rabbits in the PN + starvation group received a full dose of PN daily and received no feed. Rabbits in the half-starvation group were provided with rabbit feed covering only half their daily caloric needs. Rabbits in the control group were provided with all their caloric needs from rabbit feed. After 10 days, all the rabbits were weighed, anesthetized, and euthanized, and their kidney tissue samples were collected. Histopathologic examination was performed by a surgical pathologist blinded to the experimental groups. Results: The kidney tissue samples of rabbits in the PN + starvation group showed mild tubular dilatation, mild tubular degeneration, moderate renal inflammation, mild interstitial fibrosis, and increased apoptosis. The destructive effects were considerably milder in the PN + oral feeding group. Conclusion: PN combined with starvation can cause devastating damage to the kidneys. The damage can be minimized by combining PN with enteral nutrition.
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Objective: Tacrolimus (TAC), the mainstay immunosuppressive drug in kidney transplantation, is a narrow therapeutic index drug and has strict bioequivalence (BE) acceptance criteria adopted by regulatory agencies. Possible acute rejection resulting from the use of a generic drug is the main matter of concern for responsible physicians. We aimed to show the possible differences in drug dosages and serum concentrations and to share our experience on this subject. Methods: We retrospectively screened all the patients who underwent living-related kidney transplantation between January 2016 and August 2020. There were 106 patients in the Prograf® group and 39 patients in the Adoport® group. We investigated the demographics, daily drug dosages of TAC (mg/day and mg/body weight (kg)/day), TAC trough levels (TTL), renal functions, biopsy-proven acute rejections, post-transplant complications (hypertension, diabetes, cytomegalovirus and BK replication), graft survival, and patient survival. Results: The medical records of a total of 145 (47 females, 32%) patients whose mean age was 42.9 ± 12 were retrieved with a follow-up time of 31 (IQR, 19-44) months. Comparisons showed that there was no difference in drug dosages, TTLs, acute rejection, graft loss, and mortality, between the patients who received the generic TAC or the original one, at the end of the follow-up time. In total, 20 biopsy-proven acute rejections were seen (17, 16% in the Prograf® group and 3, 7% in the Adoport® group; P = .213). We found that although the drug levels and dosages were the same, creatinine and proteinuria were slightly higher in the Prograf® group in the first and second months. This difference was lost at subsequent time periods. Conclusion: We concluded that the use of generic TAC in living-related kidney transplantation is a safe move, with efficacy and acceptable outcomes similar to the use of the original brand.
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Background: Infections are the most common complications in patients with peritoneal dialysis (PD). The association between the anatomical localization of the exit site (ES) and infectious complications is unclear. In this study, we evaluated the relationship between the anatomic location of the ES and infectious complications of PD.Methods: We examined the ES of 53 patients on PD. To define the anatomical localization of the ES, its distance from the line between right and left anterior superior iliac spines (A line), umbilicus (B line), and the anterior superior iliac spine on the catheter side (C line) was measured.Results: Coiled catheters were used in all patients. The mean lengths of A line, B line, and C line were 4.1 ± 2.2 cm (range, 0-9.5 cm), 9.6 ± 2.9 cm (range, 4-17 cm), and 9.3 ± 2.9 cm (range, 5-18 cm), respectively. ES infection was documented in 9 patients (17%), tunnel infection in 1 patient (2%), and peritonitis in 27 (50.9%) patients. The B line was significantly longer in those with peritonitis than those without peritonitis (10.6 ± 3 vs. 8.7 ± 2.7 cm; P = .036). Other variables were not associated with infectious complications.Conclusion: There was an association between the anatomical localization of the ES and the development of peritonitis. An ES close to the umbilicus could reduce the risk of peritonitis by enabling access by the patient to perform daily care.
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Objective: We aimed to study whether long-term kidney function would be affected by different chemotherapy regimens in patients with malignancy.Methods: In this study, 500 cancer patients between the ages of 18 and 85 years were included. Estimated glomerular filtration rate (eGFR) calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was used to evaluate renal function. Patients with eGFR less than 60 mL/min/1.73 m2 before chemotherapy were excluded. Demographic and clinical data were recorded. Patients were divided into 4 groups according to the chemotherapy protocols: cisplatin-containing regimens, carboplatin-containing regimens, oxaliplatin-containing regimens, and platinum-free regimens. eGFR, urea, and creatinine values of 0th, 7th, 30th,and 180th days were recorded.Results: In 180 days of treatment, eGFR decreased in 69 (13.8%) patients, whereas it increased in 46 (9.2%) patients (P = .001) and remained unchanged in 385 patients (77%). The cisplatin group had lower eGFR at the 180th day compared to the carboplatin (P = .033), oxaliplatin (P = .007), and platinum-free groups (P < .001). The median eGFR at the 180th day was lower in the cisplatin group compared to baseline (P < .001), while eGFR levels were not changed in the carboplatin and oxaliplatin groups and were significantly increased in the platinum-free group (P = .004).Conclusion: Cisplatin-based treatment protocols were shown to worsen renal function during long-term follow-up. It is important to monitor kidney function closely for early intervention.
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Objective: Geriatric donors may be associated with worse allograft quality and less survival rates. We report the outcomes of allografts harvested from geriatric deceased donors and the survival rates of the recipients.Methods: In this study, 284 deceased donors and their recipients were enrolled in the study. Donors and recipients were divided into 3 groups according to the World Health Organisation age classification: child (<18 years), adult (≥18 and <65 years), and geriatric (≥65 years). The geriatric group was divided into the elderly (≥65 and <75 years) and very elderly (≥75 years) groups. Short- and long-term survival of the allografts and recipients and factors might have an impact on those were investigated.Results: 284 recipients were followed-up median of 55 months (0-143), in which 52 recipients died and the median allograft survival was 49 months (0-143). In the geriatric donor group, the average allograft survival rate was less compared to other age groups. However, the elderly donor and very elderly groups have a similar 1-, 3-, and 5-year allograft survival rate. Oneyear allograft survival rate was similar among all age groups, however, less at third and fifth years post-transplant, in the elderly and very elderly groups. One-, 3-, and 5-year recipient survival rates were similar among all age groups. However, in subgroup analysis, in the very elderly group, the 5-year recipient survival rate was the worst.Conclusion: One-year allograft survival rates are similar among all age groups. However, allograft loss becomes apparent at 3- and 5-year post-transplant in geriatric donors. Short- and long-term outcomes of allografts from the elderly and very elderly deceased donors are similar. When considering a kidney allograft transplantation from geriatric donors, the inverse impacts of donors’ age should be considered in matching donors and recipients. Nevertheless, clinicians should not hesitate to transplant an allograft from a very elderly deceased donor to a recipient candidate considering the worse outcomes of dialysis modalities.
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Familial Mediterranean fever is the most common hereditary auto-inflammatory disease characterized by a recurrent attack of fever and serositis. Untreated patients frequently develop AA type of amyloidosis which results in end-stage kidney disease (ESKD). Renal transplantation is the preferred renal replacement modality for these patients. Recurrence of amyloidosis in the graft is possible but generally requires several years after transplantation. We herein present a patient with an unexpected early recurrence of AA type amyloidosis secondary to familial Mediterranean fever in graft kidney despite regular colchicine prophylaxis.
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Primary hyperaldosteronism (PH) is the excessive and uncontrolled production of aldosterone from the adrenal glands. Until now, the disease was frequently discussed among the endocrine causes of secondary hypertension, and patients with particularly resistant hypertension were included in the risk group. However, the data that emerged over the years have changed this perspective. Currently, the incidence of PH among hypertensive patients is more than 20% and it is clear that it affects a much larger population than previously thought. We consider that PH is an important public health problem and should be considered by all physicians dealing with the hypertensive population. In this article, we aim to create a practical approach to the diagnosis of PH from our clinical viewpoint and in the light of the contemporary literature.
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Cihan HEYBELİ, Pınar SOYSAL
Cihan HEYBELİ, Pınar SOYSAL
Objective: Studies on predictors of mortality among elderly chronic kidney disease (CKD) patients have conflicting results.We aimed to assess the factors related to mortality in CKD versus non-CKD elderly subjects.Methods: Medical records of consecutive elderly subjects presented to geriatrics outpatient clinics were retrospectivelysearched. Logistic regression models were set in order to determine independent predictors of mortality.Results: The median age was 73 (67-80) years, and 837 (67.9%) were female. CKD constituted 21.9% of the cohort. Duringthe follow-up of 3 to 4 years, 7.2% of the patients died. In the CKD cohort, older age (per year, OR 1.12, 95% CI 1.01-1.25, P= .040) and serum uric acid levels (per 1 mg/dL increase, OR 1.74, 95% CI 1.12-2.69, P = .013) were associated with a higherrisk of mortality while serum albumin (per 1 g/dL increase, OR 0.08, 95% CI 0.01-0.52, P = .008) and vitamin D levels (per1 ng/mL increase, OR 0.77, 95% CI 0.62-0.96, P = .019) were associated with a lower risk of mortality in the multivariateregression model.Conclusion: Older age, lower serum albumin and vitamin D levels, and higher serum uric acid levels are independent predictors of mortality in outpatient elderly subjects with CKD.
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