Yavuz Ayar

Fluvastatin Decreases Oxidative Stress in Kidney Transplant Patients.

OBJECTIVE Oxidative stress has been suggested to have a pivotal role in the development of cardiovascular disease in kidney transplant patients (KTPs). The effects of fluvastatin on oxidative status in KTPs have not been well evaluated. The aim of the present study was to evaluate the effects of fluvastatin on oxidative status by investigating erythrocyte superoxide dismutase (SOD), erythrocyte glutathione peroxidase (GPx), serum paraoxonase (PON1), and serum arylesterase (ARE), along with lipid peroxidation products, serum malonldialdehyde, and apolipoprotein B malondialdehyde (ApoB MDA). METHODS Eighteen KTPs were included in the present study. Blood samples were obtained after 1 nights fast. Erythrocyte SOD, erythrocyte GPx, serum PON1, serum ARE, serum MDA, and ApoB MDA were measured using methods described previously. Paired-sample t test was used for comparing the changes from week 0 to week 4 of parameters that might be associated with fluvastatin treatment. RESULTS The present study has shown that erythrocyte SOD and GPx, and serum PON1 and ARE activities increased at the fourth week of the statin treatment. Furthermore an increase in the antioxidant enzymes following fluvastatin may be a clue for the antioxidant effects of this drug. Four weeks of fluvastatin long-acting tablets 80 mg/day led to a decrease in plasma Apo-MDA and MDA levels. CONCLUSION The findings of the present study demonstrate that fluvastatin 80 mg long-acting tablets may be used safely for 4 weeks and decrease atherogenic lipoproteins in KTPs. Furthermore, after 4 weeks of fluvastatin treatment, the levels of antioxidant parameters increased and oxidative parameters decreased. Further placebo-controlled treatment studies would be helpful to evaluate the effects of fluvastatin on oxidant and antioxidant parameters including PON1 in patients with KT.

Sexual Dysfunction and Risk Factors in Females Patients on Renal Replacement Therapy

Introduction Women with chronic kidney disease have a higher risk of sexual dysfunction (SD). The etiology is often multifactorial and may include psychological problems. A successful kidney transplantation can improve SD. This study aimed to investigate SD frequency, and risk factors in the females under renal replacement therapy (RRT) and in the healthy ones. Materials and Methods A total of 62 kidney transplant recipients (Tx), 43 hemodialysis (HD) and 35 predialysis (PreD) patients and 52 healthy females were included. Sociodemographic and risk factor survey forms, the hospital anxiety depression scale and the 36-Item Short Form Health Survey were used. Sexual function was assessed according to the Female Sexual Function Index (FSFI). Women with a score ⩽22.7 were classified as presenting sexual dysfunction. Results Control and Tx patients groups were significantly younger than HD and PreD patients. There were differences in the ratios of asthenia and fatigue, pelvic surgery, urinary incontinence, cystitis history, dyspareunia, smoking, use of antidepressant and beta blockers between the groups. The depression and anxiety ratios of the groups were similar. The physiological health scores of the control group were significantly higher than those of the PreD and Tx groups and also scores of the Tx group than those of the HD and PreD groups. Mental health scores of the control group were significantly higher than those of the PreD and HD groups. The SD ratio of Tx group with FSFI (n:10, 16.1%) was significantly lower than HD group (n:18, 41.9%, p=0.006). The SD ratio of PreD group was 31.4% (n:11). The SD ratio of control group was 23.1% (n:12). Desire scores of the Tx and control groups were higher than those of HD and PreD groups. Arousal scores of HD and PreD group were significantly lower than those of control (p=0.013 vs. HD, p=0.047 vs. PreD) and Tx (p=0.004 vs. HD, p=0.015 vs. PreD) groups. Lubrication score of HD group was lower than those of Tx (p=0.006) and control (p=0.014) groups. Orgasm score of HD group was lower than those of Tx (p=0.012) and control (p=0.009) groups, and PreD group score was lower than that of control group (p=0.046). The overall scores of the HD and PreD groups were significantly lower than those of Tx (p=0.001 vs. HD, p=0.002 vs. PreD) and control (p=0.003 vs. HD, p=0.005 vs. PreD) groups (Table 1). Logistic regression analysis showed that inadequate sexual information (OR:3.333, 95%CI: 1.426-7.790, p=0.005), presence of anxiety (OR:2.978, 95%CI: 1.093-8.117, p=0.033) and depression (OR:4.514, 95%CI: 1.676-12.156, p=0.003) increased SD risk. Kidney transplantation significantly reduced SD risk (OR:0.236, 95%CI: 0.073-0.766, p=0.016). Conclusion SD improve after successful transplant. Our results do not support the impact of the sociocultural and economic factors in sexual function of women on renal replacement treatment. However, psychological factors negatively affect sexual function in dialysis patients. Table. No title available.

Clinical outcomes and survival in AA amyloidosis patients

AIM Amyloid A amyloidosis is a rare complication of chronic inflammatory conditions. Most patients with amyloid A amyloidosis present with nephropathy and it leads to renal failure and death. We studied clinical characteristics and survival in patients with amyloid A amyloidosis. METHODS A total of 81 patients (51 males, 30 females) with renal biopsy proven amyloid A amyloidosis were analyzed retrospectively. The patients were divided into good and poor outcomes groups according to survival results. RESULTS Most of the patients (55.6%) had nephrotic range proteinuria at diagnosis. Most frequent underlying disorders were familial Mediterranean fever (21.2%) and rheumatoid arthritis (10.6%) in the good outcome group and malignancy (20%) in the poor outcome group. Only diastolic blood pressure in the good outcome group and phosphorus level in the poor outcome group was higher. Serum creatinine levels increased after treatment in both groups, while proteinuria in the good outcome group decreased. Increase in serum creatinine and decrease in estimated glomerular filtration rate of the poor outcome group were more significant in the good outcome group. At the time of diagnosis 18.5% and 27.2% of all patients had advanced chronic kidney disease (stage 4 and 5, respectively). Median duration of renal survival was 65±3.54 months. Among all patients, 27.1% were started dialysis treatment during the follow-up period and 7.4% of all patients underwent kidney transplantation. Higher levels of systolic blood pressure [hazard ratios 1.03, 95% confidence interval: 1-1.06, p=0.036], serum creatinine (hazard ratios 1.25, 95% confidence interval: 1.07-1.46, p=0.006) and urinary protein excretion (hazard ratios 1.08, 95% confidence interval: 1.01-1.16, p=0.027) were predictors of end-stage renal disease. Median survival of patients with organ involvement was 50.3±16 months. CONCLUSION Our study indicated that familial Mediterranean fever constituted a large proportion of cases and increased number of patients with idiopathic amyloid A amyloidosis. Additionally, it was observed that patient survival was not affected by different etiological causes in amyloid A amyloidosis.