Ender HÜR,
Cenk GÖKALP , Şennur KÖSE, Elif DUMAN, Kemal MAĞDEN, Gürsel YILDIZ, Bilal TOKA, Siren SEZER, Soner DUMAN
Objective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition in chronic hemodialysis (HD) patients. In this prospective observational study, we investigated the survival predictability of impedance ratio
(IR) calculated by BIS in HD patients (Clinical Trials Gov Identifier: NCT01468363).
Materials and Methods: A total of 430 chronic HD patients, out of 500 prevalent chronic HD patients from the city of Zonguldak who met the inclusion criteria, were included in the study. With a mean follow-up of 32.2±14.4 months, BIS was performed in all patients. The IR percentage (IR%) was calculated by dividing the resistance values using the 200 kHz and 5 kHz
impulses. Student’s t-test, Cox regression analysis, and Kaplan–Meier survival analysis were performed, and a p<0.05 was
accepted as statistically significant.
Results: The mean age of 430 patients was 59±15 (10-92) years, and 54% of patients were male. By the end of the study, 125
(29%) patients died. Diabetes mellitus was observed in 46% of patients. Sixty-seven percent of patients used erythropoietin, and 41% used diuretics. The mean systolic blood pressure of patients before the dyalisis was 133±26 mmHg, and diastolic blood pressure was 79±12 mmHg. The IR values ranged between 73.2% and 94.1%. A multi-regression analysis that
used the IR and included diabetes mellitus, age, gender, and albumin and hemoglobin levels showed that the mortality risk
increased 16% (p<0.001). Evaluation using the quartiles showed decreased survival. Survival in the first quartile group was
42.8 months compared to 30.6 months in the last quartile group.
Conclusion: The IR calculated using BIS data is a useful tool that can be employed to predict the survival in chronic HD
patients. An early awareness of this increased mortality risk is important in terms of a close follow-up and appropriate
treatment of these patients.
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Kemal MAĞDEN, Bilal TOKA, İbrahim YILDIRIM, Gürsel YILDIZ, Fürüzan KÖKTÜRK, Cem CİL, Nesimi YAVUZ, Ender HÜR
Kemal MAĞDEN, Bilal TOKA, İbrahim YILDIRIM, Gürsel YILDIZ, Fürüzan KÖKTÜRK, Cem CİL,
... Devamını oku
Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialysis (HD). Our aim
in this study was to evaluate the risk factors of permanent catheter thrombosis and the necessity of anti-coagulant and
anti-aggregation drugs.
Materials and Methods: In this retrospective study, 34 patients undergoing HD, with removed internal jugulary permanent
catheters due to either thrombosis or maturation of operated arteriovenous fistulas, were included. Patients were divided
into thrombotic and non-thrombotic, according to the catheter thrombosis status.
Results: The mean age was 66.3±15.4 years, and the follow-up period was 10.9±8.5 (1-29) months. Catheter thrombosis
was found in 12 patients. Albumin and total protein levels were lower in the baseline thrombotic group (3.53±0.46 g/dL
and 6.64±0.92g/dL, respectively)than in the non-thrombotic group (3.95±0.41 and 7.37±0.46g/dL, respectively).In the
non-thrombotic group, hemoglobin, hematocrit higher, and platelet count were lower at the catheter removal time compared to the catheter insertion time (hemoglobin 11.45±1.25, hematocrit 35.61±4.51, and platelet count 193.82±66.32
versus hemoglobin 10.33±1.37g/dL, hematocrit 31.38±3.79% and platelet count 231.77±71.7x103/uL, respectively), but in
the thrombotic group, the ferritin levels significantly increased from 541.3±574.8ng/mL at the catheter insertion time to
745.1±406.5ng/mL at the catheter removal time.
Conclusion: Anti-coagulant and anti-aggregation drugs and renal failure etiology did nothave any effect on permanent
catheter thrombosis, but the albumin and total protein levels were related to it. Increased levels of ferritin and C-reactive
protein seem to emerge as the acute phase reactants associated with thrombosis.
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Bülent YARDIMCI, Tevfik ECDER
Bülent YARDIMCI, Tevfik ECDER
Smoking is the leading preventable cause of death worldwide. Smoking affects all systems of the organism. Smoking stimulates the sympathetic nervous system, increases blood pressure and albuminuria, and decreases renal function. Smoking
increases renal functional loss in patients with chronic kidney disease. Moreover, smoking accelerates the course of atherosclerosis, causing cardiovascular complications and premature death. Smoking decreases graft survival in kidney transplant
patients. As a result, all physicians and health care providers should acknowledge all patients who smoke about the deleterious effects of smoking and continuously motivate them to stop smoking.
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Microscopic polyangiitis nodosa (MPA) is a necrotizing vasculitis that affects small vessels, typically associated with myeloperoxidase anti-neutrophil cytoplasmic antibody. Cerebrovascular diseases are rarely reported to be associated with
MPA. A 41-year-old male patient presented to the emergency room with complaints of speech difficulty and loss of strength
on the left upper extremity, and MPA was detected with cerebral hemorrhage and renal failure. The case report, just as we
first defined with this case in the national literature, was presented to emphasize that MPA may be rarely demonstrated
with symptoms of cerebrovascular involvement except for commonly seen organ involvement.
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Yusuf Ziya ŞENER, Seher ŞENER
Yusuf Ziya ŞENER, Seher ŞENER
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Seyit UYAR, Mehmet KÖK, Aysun ÜNAL, Gökhan KÖKER,
Süleyman DOLU , Ayça İNCİ, Ayhan Hilmi ÇEKİN
Objective: Wasting and malnutrition are problems frequently encountered in patients undergoing hemodialysis that may
increase morbidity and mortality. The malnutrition universal screening tool (MUST) is a quick and easy-to-use nutritional
screening tool. The aim of this study was to determine the validity of MUST by comparing two accepted nutritional screening methods in hemodialysis patients.
Materials and Methods: The MUST, malnutrition inflammation score (MIS), and nutritional status according to the International Society of Renal Nutrition and Metabolism (ISRNM) report were applied to 88 hemodialysis patients. Albumin,
pre-albumin, C-reactive protein levels, body mass index, and calf circumference were measured in all patients.
Results: Malnutrition was identified in 14.78% of patients according to MUST, 10.22% according to MIS, and 13.63% according to the ISRNM report. The sensitivity of MUST was 22.2% using the MIS criteria, and 50% using the ISRNM report.
Specificity was 86.1% according to MIS and 90.8% according to the ISRNM report.
Conclusion: Although not sensitive, the MUST is a specific nutritional screening tool in patients undergoing hemodialysis
according to the MIS and ISRNM report.
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Objective: The monitoring of immunosuppressive medication adherence is an important issue for solid organ transplant
patients. In Turkey, there has been no valid and reliable measurement tool specific to transplantation for evaluation of
medication adherence. The aim of this methodological study was to develop and psychometrically test Immunosuppressive Medication Adherence Scale.
Materials and Methods: The Immunosuppressive Medication Adherence Scale was developed, and its validity and reliability were examined using data from 200 solid organ transplant patients. An expert panel evaluated the content validity,
and factor analysis was used to evaluate the construct validity. Internal consistency analysis was performed to evaluate the
reliability of the scale, and item–total correlations were evaluated.
Results: As a result of exploratory factor analysis, all 11 items were found to be collected in a single dimension, and factor
loadings varied between 0.32 and 0.87. All scale items had a good positive significant correlation with the total scale score.
Content validity was evidenced by obtaining the views of 13 experts (0.80 content validity index). Cronbach’s α was 0.61.
Conclusion: The Immunosuppressive Medication Adherence Scale has acceptable internal consistency, good content, and
construct validity. The scale is appropriate for use in clinical practice settings and research to evaluate immunosuppressive
medication adherence of solid organ transplant patients.
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Patients with sickle cell disease (SCD) tend to develop many renal abnormalities, including concentration defect, renal
papillary necrosis, and glomerulopathy that often presents with proteinuria. We report a case of a patient who presented
with sickle cell crisis and proteinuria. A diagnosis of SCD glomerulopathy was confirmed with renal biopsy. Treatment with
angiotensin-converting enzyme inhibitor was initiated, and proteinuria rapidly reduced to 0.27 g/day. It is crucial for a
clinician to recognize this important complication and take necessary precautions to delay progression to end-stage renal
disease.
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Objective: Chronic kidney disease has shown a gradual rise in prevalence. Kidney transplantation is the gold standard of
renal replacement therapy and is associated with improved quality of life and decreased morbidity and mortality. The main
goal of the present study was to understand the attitudes of patients with end-stage renal disease toward and apprehensions for renal transplantation.
Materials and Methods: This cross-sectional study included patients age >18 years without a history of transplantation
who were receiving chronic dialysis for at least 1 month. A newly developed questionnaire form was used to obtain the necessary information on the attitudes of the patients. The questionnaire consisted of 59 questions, and the patients’ answers
were evaluated.
Results: A total of 85 patients who provided consent were included in the study. Of the 85 patients, 71 (83.5%) were on hemodialysis (HD), and 14 (16.5%) were on peritoneal dialysis. Most of the patients did not consider gender, race, belief, lifestyle of the donor, and the living or deceased status of the donor to be a barrier for their transplantation. Of the 85 patients,
37.6% reported that they had their family members screened to ascertain their suitability for donation.
Conclusion: Patients who have end-stage kidney disease should be informed about the renal transplantation preparation
process, follow-up process, and post-transplantation treatment and care.
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Yasin UZUNTARLA
Yasin UZUNTARLA
Objective: Blood and organ transplantation treatment cannot be performed at the desired level, although it has life-saving
characteristics. This study was aimed to analyze the relationship between blood donation and organ donation.
Materials and Methods: This cross-sectional study was conducted with healthcare personnel working in a education and
research hospital in Ankara. 1012 (84.3% of total) health personnels participated in the study. Data was collected using the
survey method. SPSS 22.0 program was used in evaluation of the data.
Results: 51.4% of the participants were blood donors, 32.5% were willing but not yet donated, 4.1% did not consider to
donate, and 12.0% could not forgive due to medical reasons. Additionally, It was found that 52.8% of health personnel were
volunteer for organ donation, however, 16.7% of them had organ donation card.
Conclusion: There is a significant relationship between blood donation and organ donation. Volunteers who donate organs also show a positive attitude towards blood donation. It is evaluated that positive behavior towards blood donation
is higher and it should be provided also in organ donation.
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