Siren Sezer

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.

THE ASSOCIATION OF INTERDIALYTIC WEIGHT GAIN WITH NUTRITIONAL PARAMETERS AND MORTALITY RISK IN HEMODIALYSIS PATIENTS

High interdialytic weight gain (IDWG) is considered as an indicator of noncompliance but could also be interpreted as an index of appetite. This study was designed to investigate the relationship IDWG with malnutrition and mortality risk in hemodialysis (HD) patients through a follow-up of 24 months. We divided HD patients into two groups according to their IDWG as Group I (IDWG<3% of dry weight/day) (27 patients; age 46.8 ± 21.1 years; HD duration: 28.3 ± 39.5 months) and Group II (IDWG ≥ 3% of dry weight/day) (41 patients; age 40.9 ± 11.3 years; HD duration: 54.7 ± 38.7 months). We investigated malnutrition through biochemical analysis (albumin, prealbumin, total cholesterol, creatinine, predialysis potassium and phosphorus levels), normalized protein catabolic rate (nPCR), anthropometric measurements. On initial assessment, group I had significantly lower predialysis creatinine, prealbumin and potassium levels than Group II (p<0.0001, p<0.01 and p<0.001, respectively). At the 24th month, there were significantly lower creatinine, prealbumin, potassium and phosphorus levels in the low-IDWG group. Group I had significantly lower nPCR, body weight, body mass index and triceps skinfold thickness during the follow-up. Over the 24 months, 13 (48.1%) Group I patients and nine (21.9%) Group II patients exhibited loss of dry weight (p<0.02). According to the survival curves prognosis was significantly poorer for Group I than Group II (2-year survival 74.0% and 92.6%, p<0.03). Group I individuals with low albumin levels had the worst survival rate (57.1%). In conclusion there is a strong association of IDWG with nutritional parameters in HD patients. Our study draws attention for a possible risk of developing malnutrition in a HD patient with low IDWG.

Predictors for quality of life in continuous ambulatory peritoneal dialysis patients

Aim:  Peritoneal dialysis patients have diminished quality of life scores compared with healthy subjects. Measures of quality of life have been reported to have a significant predictive value for patient survival and hospitalization in peritoneal dialysis patients. The purpose of this study is to determine the clinical, biochemical and psychological predictors for the quality of life in continuous ambulatory peritoneal dialysis (CAPD) patients.

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.

Tuberculosis in Patients With End-Stage Renal Disease Undergoing Dialysis in an Endemic Region of Turkey

The incidence of tuberculosis (TB) is high in end-stage renal disease (ESRD) patients undergoing dialysis. Diagnosis is difficult and delayed in this patient group owing to extrapulmonary involvement and nonspecific symptoms. Adverse effects of antituberculosis treatment are seen more frequently in these patients. We retrospectively evaluated the frequency and clinical progression of TB in 18 of 343 dialysis patients diagnosed with TB over a 5-year period at a university hospital in Adana, Turkey. Mean time between initiation of dialysis to diagnosis of TB was 19.5 +/- 26.1 months. Extrapulmonary TB was more frequent (77.8%) than pulmonary TB (22.2%). Diagnosis of TB was made based on clinical data in 1 patient, and microbiologically or pathologically in others. Antituberculosis treatment with 3 or 4 drugs was administered to patients for 6 to 12 months; second-line treatment was initiated in 1 patient infected with multidrug-resistant bacilli. One patient died owing to a cause other than TB; another was lost to follow-up. Adverse effects were hepatotoxicity in 3, optic neuritis in 1, and neuropsychiatric in 3 patients. A clinical response to therapy was achieved in all of the 16 patients who completed treatment. In conclusion, the incidence of TB and the frequency of extrapulmonary involvement are high in dialysis patients. Physicians must be alert to unusual presentations and localizations of the disease; TB must be strongly suspected in endemic regions. Owing to the greater frequency of adverse effects of treatment in these patients, they must be carefully observed during treatment.

Is low blood magnesium level associated with hemodialysis headache

Objective.—The aim of this study was to evaluate the prevalence, demographic, clinical features, and possible risk factors for hemodialysis headache (HDH).

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.

Triad of Malnutrition, Inflammation, and Atherosclerosis in Hemodialysis Patients

Background/Aim: As chronic inflammation underlies both atherosclerosis and malnutrition, a possible link between these factors has been suggested in hemodialysis (HD) patients. We designed this study to compare nutritional indices and inflammatory parameters of HD patients with demonstrated atherosclerosis (group I) and HD patients without (group II). Methods: We included 59 and 57 patients in groups I and II, respectively. The patient groups were matched for the risk factors for atherosclerosis such as age, gender, smoking habits, hypertension, and HD duration. The nutritional status of the patients was evaluated according to laboratory parameters, normalized protein catabolic rate, anthropometric measurements, and subjective global assessment. Results: Laboratory parameters (albumin, prealbumin, total cholesterol, phosphorus, creatinine), normalized protein catabolic rate, and triceps skinfold thickness revealed a significant decline in the nutritional status of the patients with atherosclerosis. We found that the patients with atherosclerosis had significantly higher C-reactive protein, ferritin, and fibrinogen levels when we compared the patient groups for acute-phase reactants. When we assessed malnutrition as being in category B/C (B = mild to moderately malnourished, C = severely malnourished) according to subjective global assessment and inflammation on the basis of a C-reactive protein level ≧10 mg/l, among patients with atherosclerosis, there was a significantly higher proportion of them having malnutrition and inflammation. Additionally, the proportion of patients without any evidence of malnutrition and inflammation was significantly lower in group I than in group II. Conclusion: Our study gives evidence for the possible triad of malnutrition, inflammation, and atherosclerosis in HD patients.