Muhittin Ertilav

Risk factors and consequences of post-transplant diabetes mellitus.

Demirci MS, Toz H, Yılmaz F, Ertilav M, Asci G, Ozkahya M, Zeytinoglu A, Nart D, Ok E. Risk factors and consequences of post‐transplant diabetes mellitus.
Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2010.01247.x.
© 2010 John Wiley & Sons A/S.

Patients with failed renal transplant may be suitable for peritoneal dialysis

Background: It has been claimed that patients with late transplant failure returning to peritoneal dialysis have lower patient and technique survival. Purpose: In this retrospective study, we aimed to clarify this issue in a large PD population. Methods: Thirty-four PD patients with a failed renal transplant (FTx) and 82 PD patients who had never received a kidney transplant (Non-Tx) or HD treatment were investigated. All fTx patients were using only steroids (5–10 mg/day) for first 3 months of peritoneal dialysis. The groups were similar regarding to age, sex, residual renal function and KT/V; none of them was diabetic. Results: Ftx group had a higher number of peritonitis attack than Non-Tx group (2.42 ± 0.41 v 1.61 ± 0.15, attack per patient, p = 0.013). PET status was not different. One, 3 and 5 year patient survival calculated with the Kaplan Meier method were 93%; 93%; 93% respectively in Ftx and 97%; 89%; 82% respectively in Non-Tx patients. Technique survival was 83%; 77%; 60% in Ftx and 91%; 64%; 48% in Non-Tx patients respectively. Conclusions: We conclude that PD appears to be a good option for fTx patients. A previous renal transplantation does not adversely affect patient and technique survival. Although the somewhat higher infection risk is of some concern, we did not observe earlier loss of peritoneal functions (high transporter) in the post transplant patients.

Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease

Background and Aim:  It is speculated that the prevalence of gastroesophageal reflux disease (GERD) might increase with asthma or chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the prevalence of GERD in patients with asthma and COPD in an area representative of developing countries.

The Impact of Membrane Permeability and Dialysate Purity on Cardiovascular Outcomes

The effects of high-flux dialysis and ultrapure dialysate on survival of hemodialysis patients are incompletely understood. We conducted a randomized controlled trial to investigate the effects of both membrane permeability and dialysate purity on cardiovascular outcomes. We randomly assigned 704 patients on three times per week hemodialysis to either high- or low-flux dialyzers and either ultrapure or standard dialysate using a two-by-two factorial design. The primary outcome was a composite of fatal and nonfatal cardiovascular events during a minimum 3 years follow-up. We did not detect statistically significant differences in the primary outcome between high- and low-flux (HR=0.73, 95% CI=0.49 to 1.08, P=0.12) and between ultrapure and standard dialysate (HR=0.90, 95% CI=0.61 to 1.32, P=0.60). Posthoc analyses suggested that cardiovascular event-free survival was significantly better in the high-flux group compared with the low-flux group for the subgroup with arteriovenous fistulas, which constituted 82% of the study population (adjusted HR=0.61, 95% CI=0.38 to 0.97, P=0.03). Furthermore, high-flux dialysis associated with a lower risk for cardiovascular events among diabetic subjects (adjusted HR=0.49, 95% CI=0.25 to 0.94, P=0.03), and ultrapure dialysate associated with a lower risk for cardiovascular events among subjects with more than 3 years of dialysis (adjusted HR=0.55, 95% CI=0.31 to 0.97, P=0.04). In conclusion, this trial did not detect a difference in cardiovascular event-free survival between flux and dialysate groups. Posthoc analyses suggest that high-flux hemodialysis may benefit patients with an arteriovenous fistula and patients with diabetes and that ultrapure dialysate may benefit patients with longer dialysis vintage.

Glycosylated hemoglobin levels are associated with cardiovascular events in nondiabetic peritoneal dialysis patients.

BACKGROUND High glycosylated hemoglobin (HbA1c) levels are recognized as a risk factor for cardiovascular disease in the diabetic dialysis population. However, it is not known whether this also applies to nondiabetic dialysis patients. We prospectively investigated the association between HbA1c levels and new cardiovascular events in nondiabetic patients treated with peritoneal dialysis. METHODS Eighty nondiabetic patients who had been on peritoneal dialysis treatment were prospectively followed for 5 years. HbA1c levels were measured at baseline and every 3 months. Fatal and nonfatal cardiovascular events were assessed during the follow-up. RESULTS Mean age was 48.5 ± 15.2 years; 51% were male. Baseline HbA1c level was 5.46% ± 0.41% (range 4.6%-6.3%). Mean HbA1c was 5.44% ± 0.31% (range 4.8%-6.3%) during the study, and positively correlated with age and high-sensitivity C-reactive protein. Twenty fatal and nonfatal cardiovascular events were observed during a mean 41.8 ± 7.1 months of follow-up. Event-free survival was better in patients with HbA1c levels <5.45%, compared with that for those with HbA1c levels =5.45% (p=0.01). In crude Cox regression analysis, an increase in HbA1c level of 0.1% was associated with a 1.22-fold increase in new cardiovascular events (p=0.007). In Cox analyses, HbA1c level was found as a significant predictor of cardiovascular events. CONCLUSION HbA1c levels predict fatal and nonfatal cardiovascular events in nondiabetic peritoneal dialysis patients.

Neither oxidized nor anti-oxidized low-density lipoprotein level is associated with atherosclerosis or mortality in hemodialysis patients.

It is anticipated that oxidized low‐density lipoprotein (oxLDL) and anti‐oxLDL are associated with atherosclerosis and mortality. However, data on this issue are controversial and limited. We aimed to investigate the effect of these two markers on the extent and progression of atherosclerosis and mortality in a group of hemodialysis patients. In this prospective observational study with a follow‐up of 36 months, 124 hemodialysis patients were studied. Ninety‐five patients underwent carotid intima media thickness (CA‐IMT) measurement by B‐Mode ultrasonography both at baseline and at the end of the study. oxLDL and anti‐oxLDL were measured by enzyme‐linked immunosorbent assay. The extent and progression of CA‐IMT, along with overall and cardiovascular mortality, were assessed. The mean age at baseline was 54.0 ± 14.8 years, 57.3% male and 20% diabetic. The mean oxLDL and anti‐oxLDL levels were 8.11 ± 3.16 mU/L and 1.30 ± 0.31, respectively. Baseline mean CA‐IMT was 0.82 ± 0.20 mm. Fifteen patients died during a follow‐up period of 28.5 ± 6.6 months, 11 from cardiovascular causes. Only oxLDL, not anti‐oxLDL, was correlated with the extent of atherosclerosis at baseline. However, both had no role in the progression of atherosclerosis. Also, in unadjusted and adjusted models, both parameters were not associated with overall or cardiovascular mortality. Neither oxLDL nor anti‐oxLDL level is associated with the progression of atherosclerosis or mortality in hemodialysis patients.

Biochemical parameters, renal function, and outcome of pregnancy in kidney transplant recipient.

INTRODUCTION The number of women who would like to have a baby after renal transplantation has increased. The aim of this study was to evaluate the effects of pregnancy on the lipid profiles and renal functions among transplantation patients as well as the maternal and fetal results of pregnancy. MATERIALS AND METHODS We searched files of female patients who underwent renal transplantation between 1998 and 2008 to discover 31 pregnancies among 24 women. RESULTS Mean duration of dialysis and age at transplantation for the 24 cases were 22.7 ± 24.1 months (range, 0-72) and 21.2 ± 4.6 years (range, 13-34), respectively. The time between transplantation and conception as well as age at conception were 5.2 ± 1.9 and 26.4 ± 4.4 years, respectively. Creatinine levels in the second trimester were significantly lower (P = .000). Gestational bicarbonate and albumin levels were significantly lower (P = .009 and P = .001, respectively). There were significant differences between the preconception triglyceride (TG) and those in the second and third trimesters (P = .006 and P = .00, respectively). TG levels increased as trimesters progressed (P = .000). Moreover, TG levels were higher among patients taking cyclosporine. Of pregnancies that passed the first trimester, 88.4% resulted in live births. There were 23 (74.19%) live births among 31 pregnancies with a cesarean section rate of 58%. Of the cases, 16.1% delivered preterm and 19.4% of babies had low birth weights. CONCLUSION We believe that women with renal transplants can have healthy babies with close monitoring during pregnancy and without any effect on graft survival.

Octreotide lessens peritoneal injury in experimental encapsulated peritoneal sclerosis model

Aim:  Encapsulated peritoneal sclerosis is characterized by neoangiogenesis and fibrosis. Octreotide, a somatostatin analogue is a well‐known antifibrotic, antiproliferative and anti‐angiogenic agent. The aim of the study is to evaluate the effects of octreotide in encapsulated peritoneal sclerosis‐induced neoangiogenesis and fibrosis and compare the results with resting.

Glycated hemoglobin predicts overall and cardiovascular mortality in non-diabetic hemodialysis patients.

AIMS Besides diabetic patients, glycated hemoglobin (HbA1c) levels have been reported to predict mortality in non-diabetics patients. However, the importance of HbA1c levels in non-diabetic hemodialysis patients still remains unknown. Thus, we aimed to prospectively investigate the impact of HbA1c on all-cause and cardiovascular mortality in a large group of prevalent non-diabetic hemodialysis patients. METHODS HbA1c was measured quarterly in 489 non-diabetic prevalent hemodialysis patients. Overall and cardiovascular mortality were evaluated over a 3 year follow-up. RESULTS Mean HbA1c level was 4.88 ± 0.46% (3.5 - 6.9%). During the 28.3 ± 10.6 months follow-up period, 67 patients (13.7%) died; 31 from cardiovascular causes. In Kaplan-Meier analysis, patients in the lowest (< 4.69%) and highest HbA1c (> 5.04%) tertiles had poorer overall survival compared to the middle HbA1c tertile (p < 0.001). Adjusted Cox-regression analysis revealed that the highest HbA1c tertile was associated with both overall (HR = 3.60, 95% CI 1.57 - 8.27, p = 0.002) and cardiovascular (HR = 6.66, 95% CI 1.51 - 29.4; p = 0.01) mortality. Also, low HbA1c levels tended to be associated with overall mortality (HR = 2.26, 95% CI 0.96 - 5.29, p = 0.06). CONCLUSION Upper normal HbA1c levels are independently associated with cardiovascular and overall mortality in non-diabetic hemodialysis patients, whereas lower HbA1c levels are not.