Ebru Gök Oğuz

Aims: The hemoglobin-albumin-lymphocyte-platelet (HALP) score is a composite biomarker reflecting systemic inflammation and nutritional status. However, its prognostic significance in immunoglobulin A nephropathy (IgAN) remains insufficiently explored. This study aimed to evaluate the renal prognostic value of inflammatory and nutritional indices, including the HALP score, measured at the time of kidney biopsy in patients with IgAN.Methods: The study cohort included 171 adult patients with biopsy-proven primary IgAN diagnosed between 1 January 2015 and 15 April 2025, with at least 12 months of follow-up unless the composite renal endpoint occurred earlier. Poor prognosis was defined as the occurrence of the primary composite endpoint: a ≥50% decline in estimated glomerular filtration rate from baseline or initiation of renal replacement therapy. Multivariable logistic regression, Kaplan-Meier survival, and receiver operating characteristic (ROC) curve analyses were performed to identify factors associated with poor renal prognosis. Results: During a median follow-up of 25.4 months, 45 patients (26.3%) reached the composite renal outcome. In the multivariable logistic regression analysis, each 10-unit increase in HALP was independently associated with lower odds of poor renal prognosis [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.62-0.99; p=0.040]. Kaplan-Meier survival analysis demonstrated significantly lower event-free survival in the low-HALP group (log-rank p

Background/aim: Posttransplant glomerulonephritis (GN) is an underrecognized but clinically important cause of allograft dysfunction. It remains uncertain whether GN detected in a clinically indicated kidney allograft biopsy provides prognostic information beyond graft function and chronic histological injury. The present study evaluates the association between biopsy-detected GN and death-censored graft loss. Materials and methods: Included in this retrospective single-center study were kidney transplant recipients (KTRs) who underwent clinically indicated allograft biopsy between May 2012 and October 2025. The primary outcome was death-censored graft loss, defined as a return to kidney replacement therapy. Postbiopsy graft survival was assessed using Kaplan–Meier analysis and sequential parsimonious Cox models. Results: Of the 120 KTRs in the study, 35 (29.2%) had biopsy-detected GN. Median death-censored graft survival was 2.19 years in the GN group and 7.71 years in the non-GN group (log-rank p = 0.005). GN was associated with graft loss in univariable analysis (HR, 2.04; 95% CI, 1.22–3.40; p = 0.006). In the main multivariable model adjusted for age, sex, biopsy estimated glomerular filtration rate, and interstitial fibrosis/tubular atrophy grade I–III, GN remained associated with graft loss (HR, 1.84; 95% CI, 1.06–3.18; p = 0.030). A multiple-imputation sensitivity analysis of the full cohort showed that additional adjustment for proteinuria attenuated the GN estimate (HR, 1.46; 95% CI, 0.84–2.54). The proportional hazards assumption was not satisfied for GN, and exploratory time-varying analysis suggested that the association may have varied over follow-up; however, later estimates were imprecise as few recipients with GN remained at risk. Conclusion: In this indication-biopsy cohort, biopsy-detected GN was associated with poorer death-censored graft survival after adjustment for graft function and chronic histological injury; however, this association was attenuated after additional adjustment for proteinuria. The magnitude and temporal pattern of the association require confirmation in larger cohorts.

Background/Objectives: Secondary hyperparathyroidism (SHPT) is a prevalent complication of end-stage kidney disease. Although etelcalcetide has demonstrated short-term superiority over cinacalcet in randomized trials, real-world comparative data beyond 12 months remain scarce. This study compared the long-term effectiveness of etelcalcetide versus cinacalcet in hemodialysis patients over 24 months using propensity score matching. Methods: This multicenter retrospective study screened 457 hemodialysis patients across five centers in Türkiye. Propensity score matching on age, sex, hemodialysis vintage, and baseline intact parathyroid hormone (iPTH) yielded balanced cohorts of 21 versus 21 for 12-month and 14 versus 14 for 24-month analyses. The primary outcome was percentage change in iPTH from baseline (%ΔPTH). Secondary outcomes included responder rates, KDIGO target achievement, response trajectory classification, and depth-of-response analysis. Results: At 12 months, etelcalcetide achieved significantly greater iPTH reduction (%ΔPTH: −50.5 ± 25.6% vs. −29.7 ± 40.6%; p = 0.047), with effect sizes increasing from medium to medium–large at 24 months (Cohen’s d: −0.612 to −0.779). Sustained response (≥30% iPTH reduction at both timepoints) was significantly higher with etelcalcetide (78.6% vs. 28.6%; p = 0.021), as was deep response (≥75% reduction) at 24 months (57.1% vs. 14.3%; p = 0.046). At 24 months, etelcalcetide demonstrated significantly lower serum calcium (p = 0.015), calcium–phosphate product (p = 0.023), and superior phosphate target attainment (85.7% vs. 28.6%; p = 0.004). Inter-patient response variability was nearly three-fold lower with etelcalcetide (CV: 42% vs. 151%). Conclusions: Etelcalcetide provided significantly greater, more sustained, and more consistent iPTH suppression than cinacalcet over 24 months, with additional benefits in mineral metabolism control. These findings support etelcalcetide as a potent therapeutic option for SHPT in hemodialysis patients and warrant confirmation in larger prospective trials.

Background/Objectives: Finerenone improves cardiovascular and renal outcomes in diabetic kidney disease (DKD), but hyperkalemia remains a key safety concern. Patients with elevated baseline potassium levels (≥4.9 mEq/L) are largely excluded from clinical trials, and real-world data in this population are scarce. Methods: In this retrospective multicenter cohort study derived from the FINE-TURK cohort, adults with DKD who initiated finerenone with baseline potassium ≥ 4.9 mEq/L were included. The primary outcome was clinically significant hyperkalemia (K ≥ 5.5 mEq/L) within three months. Multivariable logistic regression analyses were used to identify associated factors, with multiple sensitivity analyses performed. Results: A total of 166 patients were included, of whom 47 (28.3%) had baseline potassium levels between 5.1 and 5.5 mEq/L. Of the 166 patients, 35 (21.1%) reached the primary outcome, and 10 (6%) patients had follow-up potassium ≥ 6.0 mEq/L. 126 (76.8%) patients required no intervention, 24 (14.6%) were initiated on potassium binders, and finerenone was discontinued in only 12 (7.3%) patients. Lower baseline estimated glomerular filtration rate, baseline urinary albumin, loop diuretic use and 20 mg finerenone dose were associated with the primary outcome. In contrast, baseline potassium was not associated with the primary outcome. Conclusions: In patients with DKD and elevated baseline potassium levels, finerenone initiation was associated with manageable rates of hyperkalemia. Our findings support the cautious use of finerenone in selected patients under close monitoring, as well as highlight the need for a multidimensional approach to hyperkalemia risk assessment.

Aim: Frailty is an important geriatric syndrome associated with adverse clinical outcomes. In chronic kidney disease, hemodialysis treatment prolongs survival; however, it cannot completely prevent the development of complications. This study aimed to determine the prevalence of frailty in geriatric patients receiving maintenance hemodialysis and to identify associated risk factors.Materials and Methods: This single-center, cross-sectional, observational study included a total of 419 geriatric individuals followed between April 15, 2024, and April 15, 2025. Of the participants, 136 were chronic kidney disease patients receiving maintenance hemodialysis, and 283 comprised a control group without a history of chronic kidney disease. Frailty was assessed using the Edmonton Frail Scale.Results: The prevalence of frailty was higher in the maintenance hemodialysis group than in the control group (58.1% vs. 39.2%, p=0.001). Among maintenance hemodialysis patients, frail individuals were older and had a higher comorbidity burden, longer duration of chronic kidney disease and hemodialysis, higher risk of malnutrition, and more frequent polypharmacy compared with non-frail individuals (all p

Background/Objectives: Finerenone improves cardiovascular and renal outcomes in diabetic kidney disease (DKD), but hyperkalemia remains a key safety concern. Patients with elevated baseline potassium levels (≥ 4.9 mEq/L) are largely excluded from clinical trials, and real-world data in this population are scarce. Methods: In this retrospective multicenter cohort study derived from the FINE-TURK cohort, adults with DKD who initiated finerenone with baseline serum potassium ≥ 4.9 mEq/L were included. The primary outcome was clinically significant hyperkalemia (CSH) (≥ 5.5 mEq/L) within three months. Multivariable logistic regression analyses were used to identify associated factors, with multiple sensitivity analyses performed. Results: 166 patients were included, of whom 47 (28.3%) had baseline potassium levels between 5.1 to 5.5 mEq/L. Of the 166 patients, 35 (21.1%) developed CSH, and 10 (6%) patients had follow-up potassium ≥ 6.0 mEq/L. 126 (76.8%) patients required no intervention, 24 (14.6%) were initiated on potassium binders, and finerenone was discontinued only in 12 (7.3%) patients. Baseline eGFR, baseline urinary albumin, loop diuretic use and 20mg finerenone dose were associated with CSH. In contrast, baseline serum potassium was not associated with CSH. Conclusions: In patients with DKD and elevated baseline potassium levels, finerenone initiation was associated with manageable rates of hyperkalemia. Our findings support the cautious use of finerenone in selected patients under close monitoring, as well as highlight the need for a multidimensional approach to hyperkalemia risk assessment.

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder globally, and early identification of affected family members is essential. The goal of this study was to investigate family screening uptake among relatives of ADPKD patients and to identify patient-level factors affecting screening. Methods: This cross-sectional study was conducted at Etlik City Hospital, Ankara, with the approval of the local ethics committee. Sociodemographic data, clinical parameters, and family screening outcomes were collected, and health literacy was assessed using Türkiye Sağlık Okuryazarlığı Ölçeği-32 (TSÖY-32). Screening outcomes were defined as relatives who had been screened, expressed willingness to be screened, and refused screening. Analyses included descriptive statistics, Spearman correlations, chi-square tests, binary logistic regression, interaction modeling, and fractional logistic regression. Results: Among 395 relatives of 68 patients, 234 (59%) had been screened, 56 (14%) expressed willingness, and 105 (27%) declined. Higher health literacy (TSÖY-32) scores correlated with greater screening uptake (ρ = 0.77, P < .001). In multivariable logistic regression, TSÖY-32 was the only independent predictor (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.07–1.49, P = .005). Each 1-point increase in TSÖY-32 was associated with a 14% increase in screening odds (OR 1.14, 95% CI 1.09–1.20, P < .001). Conclusion: Family screening uptake remains suboptimal. Health literacy was the strongest predictor of screening. Interventions incorporating health literacy assessment, patient-centered counseling, and systematic screening opportunities are needed.

Background: Finerenone is associated with a lower, yet clinically relevant, risk of hyperkalemia compared with steroidal mineralocorticoid receptor antagonists in diabetic kidney disease (DKD) trials. However, real-world data on hyperkalemia and its associated factors are lacking. Methodology: FINE-TURK is a national, observational cohort of DKD patients who were initiated on finerenone. Eligible adults were included; demographic, clinical, and laboratory data were evaluated. The primary outcome (PO) was hyperkalemia risk signal (potassium ≥ 5.0 mEq/L), and the secondary outcome (SO) was clinically meaningful hyperkalemia (potassium ≥ 5.5 mEq/L). Multivariate logistic regression (LR) was used to define features associated with both PO and SO. LR, random forest (RF), gradient boosting, and CatBoost classifiers were used to define important features associated with the PO. Results: 699 patients were included. 259 (37.1%) reached the PO, and 51 (7.3%) reached the SO. Baseline potassium and estimated glomerular filtration rate (eGFR) were the most important variables associated with both outcomes and were consistently identified as the top features across all models. Thiazide use, presence of diabetic retinopathy, and diabetes duration were also associated with the PO. LR demonstrated the highest recall; random forest achieved the highest precision in performance. Discussion: Real-world data suggest that the risk of clinically meaningful hyperkalemia is similar to that in the clinical trials. In parallel with the safety analysis of clinical trials, baseline potassium and eGFR were consistently the most important factors associated with hyperkalemia risk.

Background: The Turkish Society of Nephrology registry annually collects nationwide data on hemodialysis, peritoneal dialysis (PD), and kidney transplantation. Registry findings are published annually; the current report marks the thirty-fifth year of data collection. The registry is in close collaboration with international registries. Methods: This study summarized data from the 2024 registry report and provided yearly trends in the management of end-stage kidney disease. Results: The number of patients receiving kidney replacement therapy continued to rise, reaching 92 461 individuals by the end of 2024. The prevalence and incidence of end-stage kidney disease were 1079.3 and 164 per million population, respec tively. Diabetes mellitus remained the leading cause of end-stage kidney disease. Hemodialysis was the most common type of treatment modality (70.4%), followed by kidney transplantation (25.4%) and PD (4.2%). Conclusion: End-stage kidney disease remains a major and expanding public health challenge in Türkiye. The kidney reg istry of the Turkish Society of Nephrology is one of the leading tools for providing current and sound data on this public health problem. Cite this article as: Seyahi N, Koçyiğit İ, Dinçer MT, et al. Current status of kidney replacement therapy in Türkiye: A summary of 2024 Turkish Society of Nephrology Registry Report. Turk J Nephrol. 2026;35(2):163-170.

Objective: Chronic kidney disease (CKD) is associated with numerous systemic complications. Neuropathic pain is a significant neurological problem that affects quality of life. Neuropathic pain is an understudied complication in CKD patients undergoing hemodialysis treatment. In our study, we aimed to evaluate the prevalence of neuropathic pain in hemodialysis patients and the associated risk factors. Methods: This cross-sectional study was carried out at Ankara Etlik City Hospital between January and December 2024. We enrolled 141 adult patients who had been on maintenance hemodialysis for at least six months. Neuropathic pain was screened using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, with a cutoff score of ≥12 indicating neuropathic pain. Information on sociodemographic profile, clinical characteristics, dialysis duration, duration of chronic kidney disease, comorbid conditions, and lifestyle habits was systematically recorded. A multivariable logistic regression model was constructed to identify factors independently associated with the presence of neuropathic pain. Results: Neuropathic pain according to the LANSS scale was identified in 70 patients (49.6%). Patients with neuropathic pain had significantly longer hemodialysis duration (median 96 vs. 14 months, p < 0.001) and CKD duration (median 144 vs. 48 months, p < 0.001). Polypharmacy (67.1% vs. 39.4%, p = 0.001) and current smoking (40.0% vs. 16.9%, p = 0.002) were more common in the neuropathic pain group. Multivariate analysis revealed prolonged hemodialysis duration (OR 1.151, 95% CI 1.063–1.247, p < 0.001), longer CKD duration (OR 1.032, 95% CI 1.003–1.062, p = 0.047), polypharmacy (OR 9.06, 95% CI 5.536–15.322, p = 0.010), and smoking (OR 2.359, 95% CI 1.159–3.494, p = 0.024) as independent predictors. Conclusion: Neuropathic pain is highly prevalent among hemodialysis patients and is strongly associated with longer disease and treatment duration, polypharmacy, and smoking. Routine screening for neuropathic pain, which negatively impacts quality of life and clinical outcomes, should focus on modifiable risk factors such as careful medication management and smoking cessation.