Tamer Selen

Purpose: Controlled Nutritional Status (CONUT) score is strongly associated with mortality in various patient groups. This study aimed to assess the CONUT score’s ability to predict mortality in Hemodialysis (HD) patients. Patients and Methods: Data from 243 patients who started HD between 2012 and 2020 were analyzed retrospectively. Laboratory test results within the first month after dialysis initiation were recorded and CONUT scores were calculated. Results: Over a mean follow-up duration of 32.2 months, the association between early (within six months) and late mortality was assessed. During this period, 119 patients (48.8%) died. Non-survivors had higher CONUT scores. The optimal cut-off for the CONUT score was 5.5. Sensitivity and specificity for predicting mortality were 62.2% and 61.23%, respectively. The optimal cut-off for early mortality was 6.5. Sensitivity and specificity for predicting early mortality were 68% and 69.3%, respectively. The CONUT score demonstrated moderate predictive accuracy for mortality (AUC 0.665) and higher accuracy for early mortality (AUC 0.729), highlighting its clinical utility in risk stratification. Conclusion: CONUT score at the beginning of HD is a reliable tool in predicting overall mortality in these patients, but it is especially useful in predicting early mortality.

Purpose: In patients with end-stage renal disease (ESRD), infections, particularly pneumonias, are the most common cause of hospital admissions and death after cardiovascular diseases. It is recommended that dialysis patients receive the pneumococcal vaccine every five years and the influenza vaccine annually. Our study aims to determine the awareness and factors affecting influenza and pneumococcal vaccination rates in hemodialysis patients. Patients and Methods: This cross-sectional study was conducted on patients undergoing regular hemodialysis treatment in 10 different hemodialysis centers across 4 cities. After excluding patients with less than one year of hemodialysis duration and those under 18 years of age, 548 patients were included in the study. Patients were administered a 20-item survey via face-to-face interview and electronic medical records. Results: Out of the 548 patients, only 19 (3.5%) had knowledge about the pneumococcal vaccine, while 238 (43.4%) had knowledge about the influenza vaccine. There were 220 patients (20.1%) who had knowledge about both vaccines. Among the patients, 95 (17.3%) had received the pneumococcal vaccine, with 41.1% of them having received it five years ago or more. A significant proportion (33.7%) of the patients could not recall the timing of their vaccination. While 183 (33.4%) patients had not received the influenza vaccine, only 140 (25.5%) had been vaccinated regularly every year. The reasons for not receiving the influenza and pneumococcal vaccines were stated as “I do not feel the need because I do not get the flu“ (25%) and ”I do not know about the pneumonia vaccine” (36.7%), respectively. The ROC curve analysis for the influenza questionnaire score showed an AUC of 0.822 (95% CI 0.787– 0.856), with a p-value of < 0.001. The statistically significant cutoff value for predicting influenza vaccination was determined to be 2.5. In the univariate analysis, dialysis duration (HD duration), diabetes mellitus (DM), and vascular access type were found to be statistically significant. In the multivariate logistic regression analysis, dialysis duration and DM were identified as independent factors predicting a higher level of knowledge about the influenza vaccine (p=0.009, 0.003, and p=0.041). The ROC curve analysis for the pneumococcal questionnaire score showed an AUC of 0.920 (95% CI 0.886– 0.955), with a p-value of < 0.001. The statistically significant cutoff value for predicting pneumococcal vaccination was determined to be 3.5. In the univariate analysis, residence, dialysis duration, and education level were found to be statistically significant. In the multivariate logistic regression analysis, dialysis duration and education level were identified as independent factors predicting a higher level of knowledge about the pneumococcal vaccine (p=0.038, 0.040, and p=0.010). Conclusion: It was observed that awareness and vaccination rates regarding influenza and pneumococcal vaccines were lower in our patients than recommended. We believe that educating patients about vaccines and increasing the sensitivity of hemodialysis physicians, nurses and nephrologists on this issue will increase vaccination rates.

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease in adults. As a social media platform, YouTube has tremendous potential to both support and hinder public health efforts. The aim of this study was to assess the reliability and quality of the most viewed English-language YouTube videos on ADPKD. Methods: A YouTube search was conducted on 3 August 2023, using the keyword ADPKD disease and the top 200 videos were analyzed for relevance. Videos in the “Short” category that were duplicates, were not in English, were not audio or visual, and contained advertisements were excluded. Two reviewers divided the 159 included videos into groups based on their source and content. Results: In 106 (66.7%) of the 159 videos, general information about the disease was given, 58 (36.5%) discussed medical treatment, 11 (6.9%) discussed surgical treatment, 30 (18.9%) included patient images and radiological images, and eight (5%) discussed the genetic and pathological features of the disease. Additionally, 16 (10.1%) videos fell into the “other” category. According to the Journal of the American Medical Association, Quality Criteria for Consumer Health Information and Global Quality Scale scoring systems, videos uploaded by health associations and foundations received the highest scores (3 (1–4), 54 (28–70), 4 (1–5), respectively). Conclusion: Academic institutions and other official health organizations such as Health Associations/Foundations need to use YouTube more effectively to disseminate accurate, reliable and useful health-related information to society.

The prevalence of cardiovascular diseases is high among patients with chronic kidney disease (CKD) and peritoneal dialysis (PD) patients, which increases morbidity and mortality in this population and represents a significant financial burden for both the patients and the healthcare systems. Vascular calcification (VC) is associated with increased morbidity and mortality and VC risk is higher in patients with CKD than in healthy individuals. Calcification inhibitors, compounds that inhibit VC, were discovered as a result of efforts to explain why some patients are spared. It was found that certain proteins (e.g., fetuin‐A, osteopontin, osteoprotegerin, bone morphogenetic protein‐7) inhibit calcification in dialysis patients. In this narrative review, we provide an overview of known calcification inhibitors, describe the relevant regulatory mechanisms, and discuss their relation to VC development in PD patients.

Aim: This study aims to determine the frequency of kidney diseases based on histological diagnosis and to evaluate the relationship between clinical and histopathological findings in patients undergoing percutaneous kidney biopsy for various indications. Material and Method: In this cross-sectional study, demographic, anthropometric and laboratory data of the patients were obtained retrospectively from medical files and computer records. Biopsy indications and histopathological diagnoses (primary glomerular diseases, secondary glomerular diseases, tubulointerstitial diseases and other causes) of the patients were examined. Results: Of 103 patients, 57 (55.3%) were male and 46 (44.7%) were female. The mean age of the patients was 44.67±15.29 years. The most common biopsy indication was hematuria+proteinuria+renal dysfunction (n=28, 27.2%). The most common pathology in histopathological diagnoses was primary glomerular diseases (56.3%), the most common diagnosis was IgAN (n=16, 15.5%). Tubulointerstitial diseases were seen more frequently in the 60 years and older group. (n=4, 25%). The most common cause of secondary glomerulonephritis was AA amyloidosis. The number of tubular disorders increased with advanced age. Conclusion: In our center, renal biopsy was performed most frequently with the combination of proteinuria, hematuria, and renal dysfunction. The most common histopathological result was primary glomerulonephritis, in which IgAN took the first place.

Background & objectives: Cardiovascular disease (CVD) remains the leading cause of mortality among patients with chronic kidney disease (CKD). Liver function tests (LFTs) have emerged as markers of CVD risk in some population-based studies. Hence, in the present study the relation between LFTs and biochemical cardiovascular risk factors (CRFs) were evaluated in CKD patients. Methods: A total of 246 patients with stage 3-5 pre-dialysis CKD were enrolled. Demographics, LFTs [alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT)] and biochemical CRFs were recorded retrospectively. Glomerular filtration rate (GFR) was calculated using CKD-EPI equation. Results: ALT was positively correlated with GFR, albumin, triglyceride and 25-hydroxyvitamin D and negatively correlated with CRP and intact parathyroid hormone (iPTH); AST was positively correlated with GFR, albumin, high-density lipoprotein cholesterol (HDL-C) and 25-hydroxyvitamin D and negatively correlated with CRP and iPTH; GGT was positively correlated with GFR, CRP and triglyceride and negatively correlated with HDL-C. In diabetic patients, ALT correlated positively with GFR; AST correlated positively with GFR and HDL-C, but correlated negatively with iPTH. In the correlation analysis between GFR and CRF, GFR was positively correlated with albumin, triglyceride and 25-hydroxyvitamin D and negatively correlated with CRP, iPTH and albuminuria in both total study population and diabetic group. A partial correlation analysis revealed no correlation between LFTs and CRFs after being controlled for GFR. Interpretation & conclusions: The results of the present study suggest that the relationship between LFTs and biochemical CRFs seems to be a function of impaired GFR.

By FATMA AYERDEN EBİNÇ, GÜLAY ULUSAL OKYAY, SERPİL MÜGE DEĞER, et al., Published on 01/01/22