Fatma Nurhan Ozdemir

Gabapentin versus levodopa for the treatment of Restless Legs Syndrome in hemodialysis patients: an open-label study.

Background. Restless Legs Syndrome (RLS), a common problem increasing morbidity and mortality in hemodialysis (HD) patients, affects 20–30% of uremic patients. Our aim was to find the efficacy of gabapentin in the treatment of RLS in HD patients by comparing a largely used drug, levodopa. Methods. Patients with RLS answered three questionnaires (RLS rating scale proposed by IRLSSG, the Short Form (SF)‐36 and the Pittsburgh Sleep Quality Index) for the evaluation of severity of RLS, effects on quality of life and quality of sleep. Results. Fifteen patients (4.7%) (5 F, 10 M) with a mean age of 45.8 ± 15.3 years got RLS diagnosis. When we compare the two drugs for severity of RLS symptoms relief, the effect of gabapentin was more significant (p < 0.001). Gabapentin significantly improved general health, body pain and social functions (p < 0.001). Moreover, regarding sleep parameters, gabapentin was significantly superior to levodopa for sleep quality, sleep latency (p < 0.001) and sleep disturbance (p < 0.000). Conclusion.. To our knowledge this was the first study comparing gabapentin and levodopa efficacy for the treatment of RLS in HD patients. Our results suggested that gabapentin is an effective drug for the management of RLS in hemodialysis patients.

Renal transplantation offers a better survival in HCV-infected ESRD patients

Abstract:  The presence of hepatitis C virus (HCV) infection has been found to adversely affect the morbidity and mortality rates in the dialysis population. Renal transplantation is a treatment option after a careful pre‐transplant evaluation. We designed this study to find the impact of HCV infection on patient survival, co‐morbidity and allograft survival in a selected group of hemodialysis (HD) and transplant population. We retrospectively analyzed 116 renal transplant patients (94 HCV‐negative, 22 HCV‐positive) and 136 HD patients (106 HCV‐negative, 30 HCV‐positive) who had renal transplantation or underwent dialysis before 1996. The HCV‐infected patients were evaluated by liver biopsy for the absence of advanced liver disease before transplantation. There was no clinical or laboratory decompensation of liver disease in transplant and dialysis patient groups. The overall 5‐yr survival rates were 85.2% for renal transplant recipients and 74.5% for those on HD. The comparison results revealed a significant difference between HCV‐infected patients with and without transplantation. The 3‐yr renal allograft survival rates were comparable in HCV‐positive and ‐negative patients, but the risk of chronic allograft nephropathy (CAN) and graft failure were higher at the fifth year in HCV‐positive patients. In conclusion, renal transplantation should the preferred therapy in HCV‐infected dialysis patients as it improves the survival rates. The presence of HCV infection increases the CAN rate and the influence on allograft survival is evident at the fifth year of assessment.

Adherence, depression and quality of life in patients on a renal transplantation waiting list

To study nonadherence, and its relationship with depression and quality of life (QOL) in patients on a cadaveric renal transplantation waiting list (RTWL). In 86 RTWL patients (56 men/30 women), there were 49 nonadherent patients (age, 46.8 ± 21.8 years) and 37 adherent patients (age, 42.8 ± 12.1 years). Clinical nonadherence was defined as skipping or shortening dialysis sessions, interdialytic weight gain (IDWG) of >5.7% body weight, a predialysis potassium level of >6 mEq/l and a predialysis phosphate level of >7.5 mg/dl. For each study subject, marital status, level of education duration of dialysis, prior renal transplantation, IDWG, predialysis blood urea nitrogen (BUN) value and creatinine, potassium, phosphate levels were recorded as were scores from the short form‐36 and Beck depression inventory (BDI). A high IDWG (33.7% of the subjects) was the most common nonadherence pattern noted. Age, sex, marital status, duration of dialysis, prior transplantation, comorbid conditions the predialysis BUN values, the levels of creatinine, potassium, and phosphate were not significantly different between the two groups (P > 0.05). The level of education was higher in adherent group (P = 0.018). QOL and BDI scores were negatively correlated (P = 0.001, r = −0.561). Nonadherent patients had lower QOL (P = 0.04) and higher depression scores (P = 0.01) than did adherent patients. Of the depressed patients, 77.8% had a comorbid condition. Nonadherence was only associated with BDI scores (OR, 2.146; CI, 2.052–2.350; P = 0.002). In dialysis patients, close monitoring of adherence, early diagnosis of depression, and the treatment of disease may further enhance QOL during the waiting period for a cadaveric renal transplant.

Statin therapy helps to control blood pressure levels in hypertensive dyslipidemic patients.

Aim. Aside from lowering lipid levels; statins improve endothelial function, decrease platelet aggregation, reduce procoagulant blood factors, and decrease vascular tone. This study was conducted to investigate the possible effect of atorvastatin on blood pressure (BP) in a group of hypertensive and dyslipidemic patients. Methods. Thirty-six hypertensive and dyslipidemic patients with inadequately controlled lipid levels by diet were treated with atorvastatin 20 mg/day for 8 weeks and compared with 24 patient matched controls treated with diet alone. The type and dosage of antihypertensive medications were not altered during statin therapy. Blood lipid profile including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride (TG) levels were noted at inclusion and after 8 weeks. Ambulatory BP monitoring (ABPM) was carried out at study entry and at the end of week eight. Results. A total of 49 patients (32 patients in the atorvastatin group and 17 patients in the control group) completed the 3-month follow-up period of observation. The ABPM studies indicated significant reductions in total average systolic BP, total average diastolic BP, total average mean BP, day average systolic BP, day average diastolic BP, night average systolic BP, night average diastolic BP, and night average mean BP levels in the atorvastatin group, whereas these reductions were not observed in the control group. Conclusion. Our results indicate that atorvastatin therapy significantly improves BP control in hyperlipidemic hypertensive patients. However, the effects of other statins on BP, as well as, the different dosages need to be further investigated.

Is Hepatitis C virus positivity a contributing factor to occult Hepatitis B virus infection in hemodialysis patients

Hepatitis B (HBV) infections continue to occur in adult hemodialysis units. Occult HBV infection (serum hepatitis B surface antigen [HBsAg] negative but HBV DNA positive) may be a contributing factor in these patients. This study was designed to (1) investigate the prevalence of occult HBV infection in hemodialysis patients and (2) compare the prevalence of occult HBV infection among hepatitis C (HCV)-positive and HCV-negative hemodialysis patients. The study included 138 patients on chronic hemodialysis. Eighty-four patients were HCV positive and 54 were HCV negative. HBV DNA testing was performed by polymerase chain reaction. We also recorded general characteristics of the patients, duration of hemodialysis, and serum alanine aminotransferase and aspartate aminotransferase levels. Twenty-one (15.2%) of the 138 hemodialysis patients were HBV DNA positive. Nine (16.6%) of the 54 anti-HCV antibody negative hemodialysis patients were HBV DNA positive. Twelve (14.2%) of the 84 anti-HCV antibody positive patients were HBV DNA positive. The prevalence in anti-HCV Ab positive and negative hemodialysis patients were same (P > .05). Hemodialysis duration, demographic features, and biochemical parameters were not significantly different in patients with and without occult HBV infection in both HCV-positive and -negative hemodialysis patients (P > .05). HCV positivity is not a contributing factor to occult HBV infection in hemodialysis patients. None of the parameters tested help to distinguish patients with occult HBV infection from those who are HBV DNA negative.

Is HOMA index a predictor of nocturnal nondipping in hypertensives with newly diagnosed type 2 diabetes mellitus

ObjectiveInsulin resistance is involved in glucose intolerance, type 2 diabetes mellitus and hypertension. We aimed to analyze relationship between insulin resistance and nocturnal nondipping. MethodsPatients underwent physical and biochemical evaluation, clinic and ambulatory blood pressure measurements. The homeostasis model assessment (HOMA) index was calculated. ResultsNinety-six essential hypertensive patients, of whom 42 were dippers, with newly diagnosed type 2 diabetes mellitus were included. Nighttime average heart rate and mean arterial pressure of nondippers were higher than dippers (P<0.0001 and 0.001). Nondippers had higher fasting plasma glucose, serum insulin levels and HOMA indices than dipper patients (P=0.006, <0.0001 and <0.0001). Ten dippers and 36 nondippers were insulin resistant (P<0.0001). Clinic (r=+0.22, P=0.031), daytime average (r=+0.27, P=0.007), nighttime average (r=+0.33, P=0.001), 24-h average systolic (r=+0.25, P=0.015) and nighttime average diastolic blood pressures (r=+0.31, P=0.002) were positively correlated with homeostasis model assessment index. Nighttime mean arterial pressure and heart rates (daytime, nighttime, 24-h average) showed positive correlation with homeostasis model assessment index. In multivariate analysis, high homeostasis model assessment index was associated with increased nondipping risk (odds ratio: 1.85, confidence interval: 1.24–2.76, P=0.003). After adjustment of several factors, average nighttime systolic (P<0.0001), diastolic (P<0.0001) and 24-h diastolic blood pressure (P=0.029) and heart rate (P=0.001) measurements of insulin resistant patients were higher than nonresistant patients. ConclusionsInsulin resistance is related with diurnal blood pressure variation. The HOMA index may be a predictor of nocturnal nondipping in patients with essential hypertension and newly diagnosed type 2 diabetes mellitus.

Relationship between depressive affect and malnutrition‐inflammation complex syndrome in haemodialysis patients

Background:  Depression is associated with high mortality in haemodialysis (HD) patients, and can be associated with the poor oral intake that contributes to malnutrition. Malnutrition‐inflammation complex syndrome (MICS) causes increased morbidity and mortality in HD patients. We investigated relationships between depressive affect, social support and various components of MICS in HD patients.

Low dose intradermal vaccination is superior to high dose intramuscular vaccination for hepatitis B in unresponsive hemodialysis patients

After two intramuscular (IM) vaccination protocols (40 μg at 0, 1, 2, and 6 months), patients who were unresponsive to hepatitis B vaccination were collected from three HD centers. The aim of this study was to compare the effectiveness of intradermal (ID) and repeated IM vaccination protocols. Thirty-three of 639 HD patients were found to be unresponsive. Patients were randomly assigned into two groups: one to receive 80 μg ID and the other 160 μg IM vaccination protocol. Both ID (p = 0.000) and IM (p = 0.03) groups disclosed statistically significant seroconversion rates six months after the last vaccination dose. The seroconversion rate was 94.1% in the ID and 50% in the IM groups—showing a significant improvement in the ID group (p = 0.011). A low-dose ID is superior to standard IM vaccination protocol and also more cost-effective in unresponsive HD patients.

Factors related to fatigue and subgroups of fatigue in patients with end-stage renal disease.

INTRODUCTION AND AIMS Fatigue is a major determinant for quality of life for patients undergoing chronic hemodialysis (HD) treatment. The aim of this study was to determine the severity and contributing factors of fatigue in patients under chronic HD treatment. METHODS 154 end-stage renal disease (ESRD) patients under HD treatment (92 M, 62 F, mean age 53 ± 15 y, mean duration of HD treatment 92 ± 65 months) were enrolled. Patients were given Pipers fatigue scale (PFS), Epworth sleepiness scale (ESS) and Beck depression test (BDT). Study participants were evaluated at the end of the HD session. RESULTS ESS score was above 10 (indicating daytime sleepiness) in only 6 (3.9%) patients. The overall PFS scores were normal-to-mild in 25 (16.2%), moderate in 63 (40.9%) and severe in 66 (42.9%) patients. Total PFS score was correlated with presence of depression (OR: 2.48), employment status (OR: 2.25), calcium (OR: 2.64) and phosphate (OR: 3.70) concentration. PFS behavior score was correlated with employment status (OR: 2.29) and phosphate (OR: 1.96). PFS affective score was correlated with presence of depression (OR: 2.56), employment status (OR: 2.72) and creatinine (OR: 2.25) concentration. PFS sensory score was correlated with advanced age (OR: 1.95), presence of depression (OR: 2.90), albumin (nutritional status) (OR: 0.17), postdialysis serum urea level (OR: 2.37), hemoglobin (anemia) (OR: 0.21). CONCLUSION Daytime sleepiness is not prevalent; however, fatigue is closely related to presence of depression, employment status, and calcium and phosphate levels.

Post-transplant C-reactive protein monitoring can predict chronic allograft nephropathy

Abstract:  Chronic allograft nephropathy (CAN) is a major problem after renal transplantation and chronic inflammation can be one of its promoters. C‐reactive protein (CRP) is an important marker of inflammation and atherosclerosis. We retrospectively analyzed the predictive role of serum CRP levels on the development of CAN and graft failure. One hundred and twenty‐five renal transplant patients were randomly included into the study. Serum CRP levels were measured at pre‐transplant period, first month after transplantation and at yearly intervals throughout follow‐up. CAN was diagnosed in 40.8% of patients and 82.4% of them had graft failure in 60.9 ± 36.7 months. There was no difference at pre‐transplant CRP levels of patients with and without CAN, but the first month CRP levels were higher in those who experienced CAN. The initial 3‐yr mean CRP levels were higher, but not statistically different between the patients with and without CAN. The simultaneously detected CRP levels when CAN were diagnosed was significantly higher in those with CAN. High post‐transplant CRP levels at the first month and at the diagnosis of CAN significantly influenced the allograft failure according to the regression analysis. CRP monitoring gives important information about the risk for CAN and graft failure. Therefore, CRP levels should be included in the follow‐up data after renal transplantation.