Funda Sari

Soluble Klotho and fibroblast growth factor 23 levels in diabetic nephropathy with different stages of albuminuria

The relationship between soluble Klotho (s-Klotho) levels, fibroblast growth factor 23 (FGF23) levels, and albuminuria in patients with diabetic chronic kidney disease (CKD) remains unclear. A total of 109 patients with type 2 diabetes (mean age 61.63±9.77 years), at the outpatient clinic of the Antalya Research and Training Hospital Nephrology Unit between January and June 2014, as well as 32 healthy controls (mean age 49.53±7.32 years) were enrolled for this cross-sectional study. Patients were classified into three groups according to their urinary albumin creatinine ratio (UACR), normoalbuminuria (UACR<30 mg/g), microalbuminuria (UACR 30–300 mg/g), and macroalbuminuria (UACR>300 mg/g). The blood was analyzed for FGF23, s-Klotho, parathyroid hormone (PTH), P, Ca, creatinine, and 25-hydroxyvitamin D3 (25hD) levels. Creatinine, s-Klotho, FGF23, and PTH levels were significantly higher and 25hD levels were significantly lower in the patient group than in the healthy controls (p<0.001). Between the groups according to UACR, 1-way analysis of variance revealed statistically significant differences for creatinine (p<0.001), 25hD (p<0.001), PTH (p=0.002), Ca (p=0.002), and albumin levels (p<0.001). A statistically significant positive correlation was found between s-Klotho and FGF23 (r=0.768; p=0.001), and between FGF23 levels and UACR (r=0.768; p=0.001). In conclusion, the results of the present study suggest that s-Klotho levels are significantly elevated in patients with diabetes and s-Klotho levels decreased with increasing albumin excretion in our patients despite a reduction in estimated glomerular filtration rate.

Serum prolactin and macroprolactin levels in diabetic nephropathy

OBJECTIVE Three molecular forms of prolactin with molecular weights of 23 (monomeric), 50 - 60 and > 100 kDA (macroprolactin) have been defined. Prolactin levels have been shown to be reduced in especially poorly controlled diabetes mellitus and the prevalence of macroprolactinemia in diabetic patients has been higher than the non-diabetic population. PATIENTS AND METHODS A total 234 Type 2 diabetic patients with different nephropathy stage was included in the study. Serum prolactin levels were analyzed by the Electrochemiluminescense method. Following polyethylene glycol (PEG) precipitation, recovery less than or equal to 40% was taken as evidence that a significant level of macroprolactin was present in the serum. RESULTS Hyperprolactinemia and macroprolactinemia were detected in 40 (17%) and 13 (5.5%) patients, respectively. Macroprolactinemia was detected 13 of 40 patients with hyperprolactinemia (32.5%). Increased prolactin and macroprolactin levels in patients with moderate and severe renal failure (Stage 3, 4, and 5) according to the U.S. NKF-DOQI classification (p < 0.001). Prolactin and macroprolactin levels were not increased in patients with normoalbuminuria, microalbuminuria and macroalbuminuria (p > 0.05). Serum creatinine levels correleted positively with both prolactin (r = 0.51, p < 0.001) and macroprolactin levels (r = 0.43, p < 0.001). On the other hand, glomerular filtration rate correlated negatively with both prolactin (r = -0.54, p < 0.001) and macroprolactin levels (r = -0.44, p < 0.001). Albuminuria significantly related with neither prolactin nor macroprolactin levels (p > 0.05). CONCLUSION In the present study, we found that not only serum prolactin but also serum macroprolactin levels increased especially in moderate to severe renal failure which was due to decreased glomerular filtration and renal parenchymal function resulting in an increased amount of monomeric prolactin and macroprolactin in the circulation in patients with Type 2 diabetes mellitus.

High serum soluble CD200 levels in patients with autosomal dominant polycystic kidney disease

This study aims to determine fibroblast growth factor-23 and soluble α-Klotho levels in patients with autosomal dominant polycystic kidney disease. A total of 76 patients with autosomal dominant polycystic kidney disease and 32 healthy volunteers were included in the study. Serum fibroblast growth factor-23 and soluble α-Klotho levels were measured with ELISA kits. Parathyroid hormone, phosphate, calcium, creatinine, 25-hydroxyvitamin D3 levels, urinary protein to creatinine ratio and estimated glomerular filtration rate were also measured or calculated. Patients with autosomal dominant polycystic kidney disease had significantly higher serum parathyroid hormone (p<0.001), fibroblast growth factor-23 (p<0.001), soluble α-Klotho levels (p=0.001) and lower serum 25-hydroxyvitamin D3 levels (p<0.001) as compared with healthy volunteers. Serum fibroblast growth factor-23, soluble α-Klotho and 25-hydroxyvitamin D3 levels were similar in all five chronic kidney disease stages of autosomal dominant polycystic kidney disease (p>0.05). Fibroblast growth factor-23 (r=−0.251, p=0.034) and soluble α-Klotho levels (r=−0.251, p=0.034) were found to be negatively correlated with estimated glomerular filtration rate. This study shows increased fibroblast growth factor-23 levels in patients with autosomal dominant polycystic kidney disease which is in harmony with the general trend in patients with chronic kidney disease of other aetiologies, but, unlike them, also a significant increase in serum soluble α-Klotho levels in patients with autosomal dominant polycystic kidney disease suggesting an aberrant production or a decreased clearance of α-Klotho molecule. Considering the unique increases in erythropoietin levels due to erythropoietin production in renal cysts, we assume, patients with autosomal dominant polycystic kidney disease may potentially have different soluble α-Klotho production/clearance characteristics than the patients with other parenchymal renal diseases.

Decrease of Urotensin II activity can impact on the volume status in predialysis chronic kidney disease

Abstract Urotensin II (U-II) was thought to be one of the mediators of primary renal sodium retention due to effects on renal sodium excretion. For this purpose, the relationship between U-II and overhydration was investigated. A total of 107 patients were enrolled in the study. According to body compositor monitor analysis, fluid overload up to 1.1 L, was considered normohydration. Patients were divided according to hydration status; overhydrate (n = 42) and normohydrate (n = 65) were studied in both groups. Pulse waveform velocity propagation for arterial stiffness and blood pressure analysis and echocardiographic left ventricular and left atrial indices were performed with known fluid overload-related parameters. U-II levels were measured by using Human ELISA kit. In overhydrated group, U-II levels were significantly lower. All parameters (blood pressure, arterial stiffness parameters, echocardiographic data, age, gender, diabetes, U-II, hemoglobin) correlated with overhydration, were determined by linear regression model (method = enter), when considered together, U-II was found to be an independent predictor from other conventional overhydration-related parameters. Male sex, left ventricular mass index, left atrial volume index, hemoglobin value were found to be independent predictors for overhydration. Considering the association of low U-II levels with adverse cardiovascular events and its role in sodium retention, we think that low U-II levels can be accepted as a potential therapeutic target in patients with hypervolemic cardio-renal syndrome.

Sexual Dysfunction Is Associated with Depression and Anxiety in Patients with Predialytic Chronic Kidney Disease

Objective We aimed to determine the prevalence of sexual dysfunction and clarify the relationship between sexual dysfunction and depressive mood state, drugs, and disease activities in patients with predialytic chronic kidney disease (CKD). Materials and Methods In total, 150 patients with CKD who had an estimated glomerular filtration rate of 15-60 mL/min were included; 65 healthy controls were selected. A detailed medical and sexual medical history was taken from individuals in the control and patient groups by applying the Golombok-Rust Inventory of Sexual Satisfaction and Hospital Anxiety and Depression Scale. Results Sexual frequency (p=0.027), impotence (p<0.001), and premature ejaculation scores (p<0.001) in male patients and sexual frequency (p=0.004), communication (p=0.004),, satisfaction (p<0.001), avoidance (p=0.008), orgasmic dysfunction (p<0.001), sensuality (p=0.002), and total sexual dysfunction scores (p<0.001) in female patients with CKD were found to be higher compared with the control group. In female patients, the depression scores of patients with stage 3 CKD were found to be higher than those of patients with stage 4 CKD (p=0.028). The avoidance scores of male patients with depression (p=0.006) were high. In contrast, the communication score of female patients with depression was high (p=0.004). It has been detected that the factors that affect the sexual dysfunction score of patients with CKD in males are age (p=0.006), hypertension (p=0.008), anxiety (p=0.003), and depression (p=0.002) and those in female patients are age (p=0.034), anxiety (p<0.001), and depression (p=0.001). Conclusion Patients with predialytic CKD substantially have sexual dysfunction. The most important factors that affect sexual dysfunction are age, hypertension, anxiety, and depression.

Eculizumab experience in an adult patient with atypical hemolytic uremic syndrome

Atypical hemolytic-uremic syndrome is a disease characterized by nonimmune hemolytic anemia, thrombocytopenia, and renal failure. In this study, we present a case of a patient with atypical hemolytic-uremic syndrome treated successfully with eculizumab. A 20-year-old female was admitted with clinical signs of atypical hemolytic syndrome. The laboratory findings were as follows: hemoglobin 9.2 g/dL, platelet count 18 × 103/μL, creatinine 4.69 mg/dL, schistocytes were in peripheral blood smear, lactate dehydrogenase 2080 U/L, and emergency plasmapheresis procedure with fresh frozen plasma were initiated. The patient was anuric within 12 h of her admittance. ADAMTS13 activity was normal. Her mothers cousin developed acute rejection immediately after receiving a renal transplant and died two months later. As she did not respond to the treatment and considering her family history, eculizumab was initiated which resulted in platelet counts starting to rise on day 5, and the patient no longer needed dialysis after 22 days.

Comparison of Intraperitoneal Amino Acid and Oral Amino Acid Supplements in Peritoneal Dialysis Patients

Purpose: Among patients end-stage renal disease who receive peritoneal dialysis, malnutrition is an strong predictor of increased morbidity and mortality rates. In cases with malnutrition, hypoalbuminemia occurs mainly due to the leakage of albumin through peritoneal membrane. Therefore, the current study aimed to investigate and compare the effects of intraperitoneal or oral amino acid supplements in preventing hypoalbuminemia. 1.2 1.2 Method: Our study included 36 patients on continuous ambulatory peritoneal dialysis (CAPD) in our center. In one group, one of the exchanges was replaced with a daily dose of 2000ml of peritoneal dialysis solution with 1.1% amino acids (AAs). The other group was given oral supplementation of keto/amino acids. The group receiving intraperitoneal (IP) AAs was composed of 16 patients, while oral keto/amino acid group included 20 patients. The baseline levels of serum albumin, prealbumin, transferrin, CRP, CO2, cholesterol panels and weights (recorded during PET) were compared with the values measured after 6 months of treatment. Results: The baseline albumin levels in the IP AA group were lower than the Oral AA group (p=0.008). When we categorized the patients based on their peritoneal membrane permeability, we found no difference between the peritoneal membrane permeability values of the groups and their laboratory variables (p>0.05). At the end of month 6, the BUN levels significantly elevated in the group receiving IP AA solution, whereas their levels of phosphorus and HDL declined (p <0.05). The group receiving oral AAs supplement had lower levels of albumin and HbA1C at the end of month 6 (p <0.05). Conclusion: Although treatment with AAs supplements administered either intraperitoneally or orally, can be considered a good nutritional support, it should be borne in mind that the important point is to increase the amount of dietary protein intake in individual patients.

The Evaluation of the Causes of Discontinuation in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

ABS TRACT Ob jec ti ve: Pe ri to ne al di aly sis is one of the re nal rep la ce ment the rapy mo da li ti es in pa ti ents with end-sta ge re nal di se a se. Tre at ment sho uld be dis con ti nu ed du e to va ri o us re a sons. To elu ci da te the se re a sons and pre vent them is very im por tant in ma in ta i ning pe ri to ne al di aly sis. In the pre sent study, re a sons tho se le ad to dis con ti nu a ti on of tre at ment we re eva lu a ted in pa ti ents who un der went pe ri to ne al di aly sis and ha ve be en fol lo wed in our Nep hro logy De part ment. Ma te ri al and Met hods: Da ta from 313 pa ti ents (194 ma le and 119 fe ma le) who un der went pe ri to ne al di aly sis in the last 12 ye ars (1997-2009) we re re vi e wed ret ros pec ti vely. Among the se, pa ti ents who dis con ti nu ed pe ri to ne al di aly sis we re as ses sed. Da ta analy zed by using des crip ti ve sta tis tic tests. Re sults: The me an age for di aly sis on set was 51.9 ± 17.6 ye ars and the me an di aly sis du ra ti on was 27.5 ± 27.1 months (me di an 20 months; ran ge: 3-166 months). Du ring fol low-up pe ri od, 212 pa ti ents (67.7%) ce a sed pe ri to ne al di aly sis. Re a sons of dis con ti nu a ti on we re as fol lows: de ath in 58 pa ti ents (27.4%), pe ri to ni tis in 36 pa ti ents (17.0%), trans fer to anot her fa ci lity (8.0%), ina de qu a te di aly sis in 16 pa ti ents (7.5%), im pro ve ment in re nal fa i lu re in 16 pa ti ents (7.5%), trans plan ta ti on in 14 pa ti ents (6.6%), pa ti ent in comp li an ce in 12 pa ti ents (5.7%), un wil ling ness of the pati ent for pe ri to ne al di aly sis in 8 pa ti ents (3.8%), hyper vo le mi a in 5 pa ti ents (2.4%), le a ka ge in 9 pa ti ents (4.2%), her ni a in 4 pa ti ents (1.9%) and ot her tech ni cal fac tors in 17 pa ti ents (8.0%). The re we re not any re la ti ons hip bet we en the re a sons of dis con ti nu a ti on and ca u ses of end-sta ge re nal di se a se, pri or re nal rep la ce ment his tory, co mor bid di se a se, he mog lo bin le vel, whi te blo od cell co unt, and le vels of se rum albu min, cal ci um, phosp ho rus, pa rat hor mo ne, to tal cho les te rol and trigl yce ri de (p> 0.05). Conc lu si on: Our re sults in di ca ted that pe ri to ni tis was the most im por tant re a son for be ing unab le to ma in ta in long term pe ri to ne al di aly sis and dis con ti nu a ti on of this tre at ment mo da lity. Con se qu ently, dec re a sing the in ci den ce of pe ri to ni tis sho uld be con si de red as an im por tant fac tor in ma in ta i ning tre at ment.

The Effect of Demographical and Social Parameters on Patient Survey in Peritoneal Dialysis Patients

The effect of demographical and social parameters on patient survival in peritoneal dialysis patients. OBJECTIVE: Peritoneal dialysis is a renal replacement therapy in patients with end stage renal disease and the characteristics of patients may affect their survival. The aim of this study was to investigate the effect of age, gender, education level and fi nancial status on patient survival in patients undergoing peritoneal dialysis at the our nephology clinic. MATERIAL and METHODS: The medical fi les of a total of 313 peritoneal dialysis patients were retrospectively evaluated. Age, gender, education level and fi nancial status were reported. The effect of these parameters on patient survival was tested was analyzed using the chi-square test and Mann-Whitney U test. RESULTS: The mean age at the start of dialysis was 51.9 ± 17.6 years and the mean dialysis duration was 27.5 ± 27.1 (median: 20, range: 3-166) months. A total of 58 (18.5%) patients had died. Total 194 (62%) patients were male and 119 (38%) were female. A total of 106 patients were not literate, 163 patients had graduated from primary school, 39 patients from middle school, and 5 patients from higher school. The mortality rates in these patients were 17.9%, 22%, 7.7% and 0%, respectively. The fi nancial status was good in 58 (18.6%) patients, moderate in 187 (59.7%) patients and poor in 68 (21.7%) patients. A total of 163 (52.1%) patients were living at rural areas and 150 (47.9%) were living at urban areas. The mortality rate decreased with young age (p=0.002) and high education level (p=0.045). There was no relationship between mortality and gender, living in rural or urban areas, or fi nancial status (p>0.05). Funda SARI Metin SARIKAYA Mustafa EREN Ayşe Jini GÜNEŞ Ahmet KORKMAZ Ramazan ÇETİNKAYA Antalya Eğitim ve Araştırma Hastanesi, Nefroloji Kliniği, Antalya, Türkiye Sarı F ve ark: Periton Diyaliz Hastalarında Demografi k Özellikler ve Sosyal Durumun Hasta Sağ Kalımına Etkisi Cilt/Vol: 19, No: 2, 2010, Sayfa/Page: 121-123 122 Türk Nefroloji Diyaliz ve Transplantasyon Dergisi Turkish Nephrology, Dialysis and Transplantation Journal

The Effect of Catheter Placement Technique on Technical Survival in Patients Receiving Continuous Ambulatory Peritoneal Dialysis

RESulTS: Technical survival rates were 89.1%, 84% and 74.1% in the first, third and fifth year, respectively. The technique complication incidence was higher in patients where the catheter were placed percutaneously (31.3%) than those who had undergone surgical catheter placement (19.5%) (p=0.27). Incidence of exit site infection was lower in patients who were catheterized by the percutaneous technique (20.1.%) than those catheterized by the surgical technique (47.3%) (p<0.001). Herniation incidence was lower in patients where the catheter was placed percutaneously (3.6%) than surgically (17.2%) (p=0.001). There was no relationship between catheter placement method and peritonitis, leakage or revision requirement.