Objective: The Turkish Society of Nephrology Registry collects data on hemodialysis, peritoneal dialysis, and transplantation annually. Registry reports are printed every year as a booklet, and this is the 30th year of registry reports. The registry
is in close collaboration with international registries.
Material and Methods: In this article, we have summarized data from the 2019 registry report; additionally, we have also
provided yearly trends of managing end-stage kidney disease.
Results: The number of patients on renal replacement therapy has increased, and by the end of 2019, 83 738 patients were
on renal replacement therapy. The prevalence and incidence of end-stage renal disease were 1007.6 and 150.5 per million
population, respectively. Diabetes was the most common cause of end-stage renal disease. Hemodialysis (73.2%) was the
most common type of treatment modality, followed by transplantation (22.9%) and peritoneal dialysis (3.9%).
Conclusion: End-stage kidney disease is a critical and growing health problem for our country. The Renal Registry of the
Turkish Society of Nephrology is one of the leading tools for providing current and sound data on this public health problem.
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Aim: We aimed to study the impact of major surgical procedures on clinical outcome in patients with end-stage kidney
disease (ESKD) treated with hemodialysis (HD) or peritoneal dialysis (PD).
Methods: We retrospectively evaluated chart records of all patients on HD and PD who had been treated for at least
3 months at our outpatient clinics between January 1, 2014 and December 31, 2018. In addition to clinical and laboratory
parameters, data on all major surgical procedures were recorded.
Results: Among the 202 patients, 133 (66%) were on HD and 69 (34%) on PD. Forty-seven patients (23%) had a major surgical operation. Operations were emergent in 10 patients (21%) and elective in the others (79%). Among the whole study
population, 59 patients (29%) died during the study period. The mortality rate was higher in patients who experienced postoperative complications (P < .001). Kaplan–Meier analysis revealed that mean (95% CI) survival time in operated patients
was 43 months (37-49 months), while it was 49 months (46-52 months) in the others (P=.023). Cox regression analyses
revealed that age (RR 1.033, 95% CI 1.010-1.057, P=.005), diabetes (RR 2.581, 95% CI 1.474-4.521, P=.001), pre-operative
C-reactive protein level (RR 1.005, 95% CI 1.002-1.007, P < .0001) and undergoing a major surgical procedure (RR 1.868, 95%
CI 1.068-3.268, P=.028) were independent predictors of mortality.
Conclusion: Our study shows that, in addition to age, diabetes, and inflammatory status, undergoing a major surgical procedure is an independent risk factor for mortality in dialysis patients. Proper management of perioperative complications
may result in more favorable outcomes in these patients.
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Objective: During the COVID-19 pandemic, working in hemodialysis (HD) can be a source of anxiety. In this study, the anxiety
status of HD healthcare professionals (HCPs) during the COVID-19 pandemic and the associated factors were investigated.
Materials and Methods: The data were collected through a web-based questionnaire. The questionnaire consisted of
3 parts: (1) demographic features, (2) questions about the causes and consequences of anxiety, and (3) general anxiety
disorder-7 survey.
Results: One hundred eighty-three HCPs completed the survey, mostly nurses and dialysis technicians (71.6%). Twothirds of the participants stated that preventive measures increase workload and cause physical harm (68.3%, 62.3%).
One-third of participants reported a lack of communication with the patients and a decrease in desire to work (31.1%,
35.6%). A moderate-severe anxiety was detected in 24.6%. Physical contact with infected people, being physically
harmed by preventive measures, decreased desire to work, and a lack of communication with the patients were found
to be significantly more in participants with anxiety (P = .036, P < .001, P < .001, P < .001). In multivariate analyzes, being
physically harmed by preventive measures was the only risk factor for anxiety (OR = 7.423, CI: 2.050-26.877, P = .002).
Conclusion: During the pandemic period, anxiety was observed in one-fourth of HCPs. Being physically harmed by preventive measures is the only risk factor for anxiety.
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Background: The X-linked Fabry disease (FD) with lysosomal storage of globotriaosylceramide (Gb3) due to α-galactosidase
deficiency contributes to nephropathy consisting of proteinuria and renal failure eventually. Early initiation of the enzyme
replacement therapy promises favorable renal outcomes. With the importance of early diagnosis, we screened FD among
proteinuric patients in whom biopsy findings revealed Fabry nephropathy.
Methods: Patients with light microscopic biopsy findings of vacuolated cells, focal and/or segmental glomerular sclerosis,
tubular atrophy, and interstitial fibrosis were not associated with particular etiology, the presence of acro-paresthesia,
angiokeratomas, and cornea verticillata, stroke history younger than 50 years, family history of renal failure with no cardiovascular risk factors were screened. Fifty-three of 308 consecutive adult patients (45.34 ± 15.23 years old, 60.1% male) who
underwent renal biopsy because of proteinuria were enrolled in the study. Screening for FD was performed by assessing
α-Gal A activity in dried blood spots (DBS) for males and by genetic testing for females.
Results: Fifty-three patients (39.94 ± 11.97 years, 69.8% male) who underwent renal biopsy were screened. Laboratory
findings revealed mean serum creatinine of 1.44 ± 1.06 mg/dL, mean estimated glomerular filtration rate of 78.31 ±
39.89 mL/min/1.73 $m^2$
, and mean proteinuria of 4.32 ± 3 g/day, whereas the females genetic screening was negative. Two of
37 males had low enzyme activity (<0.1 micmol/L/h) and confirmed FD by genetic analysis in whom one had a novel mutation of GLA gene (c.(1047G>A) p.(Trp349*)).
Conclusion: It is worth noting that FD screening in patients with proteinuria, in whom vacuolated cells, mesangial expansion, glomerulosclerosis, interstitial fibrosis, and tubular atrophy of unknown etiology, are present in the renal biopsy
either with or without a family history of kidney disease.
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Elephantiasis nostras verrucosa (ENV) is a rare, chronic, and progressive disease. Recurrent leg ulcers and cellulitis are the
major cause of morbidity and mortality for ENV. However, the coexistence of ENV with AA amyloidosis is extremely rare.
Also, obesity is exceptionally responsible for the etiology of ENV. Herein, We present a morbid obese case of severe kidney
failure and nephrotic syndrome due to AA amyloidosis associated with ENV.
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Kamyar Kalantar ZADEH, Philip KAM TAO LI, Ekamol TANTISATTAMO, Latha KUMARASWAMI, Vassilios LIAKOPOULOS, Siu Fai LUI, Ifeoma ULASI, Sharon ANDREOLI, Alessandro BALDUCCI, Sophie DUPUIS, Tess HARRIS, Anne HRADSKY, Richard KNIGHT, Sajay KUMAR, Maggie NG, Alice POIDEVIN, Gamal SAADI, Allison TONG
Kamyar Kalantar ZADEH, Philip KAM TAO LI, Ekamol TANTISATTAMO, Latha KUMARASWAMI, Vassilios LIAKOPOULOS, Siu Fai LUI,
... Devamını oku
Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients
and their care-partners, including family members or friends involved in their care, may help minimize the burden and consequences of CKD related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney
disease and re-engagement in life, including an emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of “Living Well with Kidney Disease” to increase education and awareness on the
important goal of patient empowerment and life participation. This calls for the development and implementation of validated
patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by
regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices. Funding agencies could
establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners
should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the
overall wellness program for kidney disease patients, the need for prevention should be reiterated. Early detection with a prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations,
professionals, and policy makers, applicable to both developed and developing countries.
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Objective: The levels of plasma preβ-HDL increase as the stages of chronic kidney disease (CKD) progress. Epicardial
adipose tissue (EAT) increases the risk of cardiovascular incidents in patients with moderate to severe CKD. The aim of
our study was to compare the levels of plasma preβ1-HDL with the EAT thickness on transthoracic echocardiography in
patients with CKD (stage 3-5).
Methods: Forty-four patients with CKD and 44 healthy volunteers (control group) were included in the study. Plasma preβ1-
HDL was measured with ELISA (enzyme-linked immunosorbent assay) method in both groups. EAT thickness (both systole
and diastole) was evaluated by the same cardiologist on the transthoracic echocardiographic method only in the patient
group. P < .05 was accepted as statistically significant.
Results: The mean plasma preβ1-HDL level was higher in the patient group compared to the control group but did not
reach statistical significance. It was determined that the level of mean preβ1-HDL was increased in CKD patients as the
stages progress but the result was not statistically significant. When the level of mean plasma preβ1-HDL and EAT thickness
of CKD patients were compared, a statistically significant and negative correlation was determined (P = .013, r = −0.398;
P = .006, r = −0.441, respectively, for systole and diastole).
Conclusion: We determined a statistically significant and negative relationship between the levels of plasma preβ1-HDL
and EAT thickness in CKD patients.
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Aim: The aim of the study was to evaluate physical symptoms in patients on peritoneal dialysis treatment and to determine
the relationship between the socio-demographic features affecting the symptoms and the disease and self-care.
Methods: The sample of this descriptive study included 120 patients who were followed in the peritoneal dialysis clinic of
2 hospitals in the center of Trabzon. The data were collected using the “patient information form,” “The Dialysis Symptom
Index (DSI),” and “The Self-Care Agency Scale for Chronic Dialysis Patients.”
Results: In this study, 60.8% of the participants were women. The most common symptom (64.2%) was constipation. There
was a significant difference in the mean DSI score between the patients supported during dialysis and those who were not
and the mean DSI score was higher in the patients supported during dialysis (P < .05). In addition, there was a significant
difference in terms of the mean self-care agency score between the patients supported during dialysis and the patients who
were not. Contrary to the DSI mean score, the mean self-care agency score was higher in patients who were not supported
during dialysis (P < .05). A significant negative correlation was found between self-care agency and DSI (r = −0.288, P < .01).
Conclusion: The study demonstrated that patients lacking self-care agency have to cope with both more symptoms and
more severe symptoms.
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Objective: Endoscopic subureteric injection (ESI) is a minimally invasive and effective method for the treatment of vesicoureteral reflux. Ureterovesical junction (UVJ) obstruction after subureteric dextranomer/hyaluronic acid (Dx/HA) injection
has been reported in the literature. Inflammatory changes in the several different wall layers of the UVJ after injection of Dx/
HA have not been investigated before. The aim of this study is to evaluate the inflammatory response induced by Dx/HA in
the several different wall layers of UVJ in an experimental rat model.
Methods: Dx/HA was injected into the UVJ submucosally, intramuscularly, and adventitially to the consecutive group of
rats. Inflammatory cell densities were determined and granuloma thickness was measured under the light microscope.
Results: Density of mononuclear cells, macrophages, giant cells, and thickness of granuloma formation have been found to
be increased in the muscular layer and adventitial layer injection groups compared to the submucosal layer injection group
(P< .01). However, the highest chronic inflammatory response has been found in the adventitial layer injection groupwhereas
the lowest chronic inflammatory response has been found in the submucosal layer injection group (P < .01).
Conclusion: We conclude that injection of the Dx/HA into the correct ureteral wall layer is important to minimize the risk of
severe inflammatory response resulting in UVJ obstruction.
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Objective: The presence of preoperative kidney disease or the development of postoperative renal failure (RF) is an undesirable condition and complication in patients who have undergone open-heart surgery (OHS). The purpose of this study
is to assess the strategies and practical clinical interventions for patients with preoperative renal function impairment or
newly developed postoperative renal function impairment subsequent to OHS.
Methods: We retrospectively analyzed 1115 patients who underwent OHS from 2010 to 2018 and collected data from
184 patients (71 patients had end-stage renal disease with dialysis routine, whereas 113 patients had preoperative compensated RF without dialysis requirement).
Results: The mortality rate of 141 patients with end-stage RF who underwent OHS and who needed renal replacement due
to RF at the postoperative period was 11.34%. Three patients could be withdrawn from cardiopulmonary bypass with the
help of an intra-aortic balloon pump. Five patients underwent revision due to bleeding. Mean intensive care unit length of
stay and mean hospitalization duration were 4.3 ± 1.1 and 11.4 ± 1.8, respectively.
Conclusion: Multidisciplinary collaboration for the management of patients with preoperative or postoperative renal dysfunction may provide better results in the long term.
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