BACKGROUND:Psychiatric disorders, particularly anxiety and depression, are highly prevalent among dialysis patients and adversely affect clinical outcomes, including adherence to treatment. We aimed to evaluate the impact of dialysis modality on mental health and medication adherence. METHODS:We conducted a cross-sectional study with 192 patients: 89 on hemodialysis (HD) and 103 on peritoneal dialysis (PD). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), while medication adherence was evaluated with the Morisky Medication Adherence Scale-8 (MMAS-8). RESULTS:HD patients had higher mean HADS-A (8.03 ± 4.41) and HADS-D (9.47 ± 4.97) scores compared to PD patients (HADS-A: 6.7 ± 3.04; HADS-D: 6.46 ± 3.86, p < 0.01). Regression analysis revealed HD as an independent predictor of anxiety. HD patients had a higher risk of depression than PD patients, although this did not reach statistical significance after adjusting for potential confounders. Medication adherence was higher in PD patients, with 18.4% showing high adherence versus 8.9% in HD patients (p < 0.001). Anxiety and depression were not significantly associated with adherence, although trends suggested lower adherence in patients with worse mental health. CONCLUSION:HD patients experience higher rates of anxiety, depression, and lower medication adherence compared to PD patients. Tailored interventions targeting mental health and adherence could improve clinical outcomes. Future research should explore long-term strategies to optimize care.

Aim: Brucellosis is a zoonotic disease caused by Brucella species. Brucella can invade directly the kidney and cause tubule-interstitial injury, abscesses, and granulomatous formation. In this study, we aim to assess the factors that might have an impact on proteinuria development in brucellosis. Material and Methods: This is a prospective self-control study. The individuals who were diagnosed with Brucella infection between March 2019 and March 2021 were enrolled in the study. Clinical and laboratory features of the participants were noted. The urine protein creatinine ratio (UPro/UCre) that estimates the 24-hour protein excretion in grams per day was detected before and after the 45-day treatment. Urinary cultures were performed in all patients if the patients had pyuria. Results: Eighty-seven patients were enrolled in the study. The mean age was 33 +/- 18 years. Fifty-two of the patients were male (59.8%). Seven of the patients (8%) had urinary system symptoms (8%). None of the urinary cultures were found to be positive for any microorganism. UPro/UCre was 407 +/- 328 before treatment and 251 +/- 155 after treatment (p= 0.003). When correlation analysis was made, proteinuria before treatment was found to be correlated with Brucella titer (r=0.273, p=0.03) and body temperature (r=0.387; p=0.04). Discussion: Brucella is a common zoonotic infection that may present with proteinuria in addition to its classic symptoms. The disappearance of proteinuria with antibiotic treatment and the correlation of proteinuria with fever suggest that fever is the leading cause.

Objective: Hemolysis is a rare adverse effect of hemodialysis. ıt is induced by chemical pollution, heat, or mechanical harm to clogged hemodialysis lines. Lactate dehydrogenase transforms pyruvate to lactate in the absence of oxygen to make energy. LDH serum levels are raised due to tissue breakdown. A number of clinical illnesses, such as hemolytic disorders, are associated with high serum LDH. Both the Rexeed and Leoceed dialyzers are made by AsahiKASEI. They had the same membrane architecture and permeability, but blood entry angle, chamber length, and hole count varied. The aim of this study is to examine if dialyzer design affects hemolysis. Materials and Methods: A total of 142 patients who were chronically undergoing hemodialysis therapy at the ……………….for a total of 12 hours per week were included. A retrospective examination of the patients was performed. The pre-HD and post-HD LDH levels of individuals who had undergone hemodialysis with both dialyzers during separate sessions of hemodialysis were compared. Results: A hundred forty two patients (63% female) on hemodialysis (HD) treatment were enrolled in the study. Twenty eight patients (20%) had diabetes, 45 had hypertension (32%) and 16 had ischemic heart disease (11%) as a comorbid condition. When LDH difference is compared between groups Leoceed dialyzer group) had statistically significantly higher LDH difference when compared with Rexeed dialyzer group (49.1±20 U/l vs229.8±24.45 U/l;p=0.008). (Table 2). Conclusion: It is possible that the design of the dialyzer contributes in some way to the cell damage that is caused by the larger serum LDH increase in the Leoceed dialyzer. In order to carry out corrective studies on dialyzer design, it would be helpful to analyze the impact of dialyzer design on cell damage using a larger series of patients.

Introduction: A link exists between inflammation and left ventricular hypertrophy, which is a risk factor for cardiovascular disease in patients with end-stage renal failure. Neutrophil, lymphocyte, and platelet counts are used to calculate the systemic immune inflammation index. To calculate the neutrophil to albumin ratio, we divided the total number of neutrophils by the albumin concentration. Some articles have illustrated the value of systemic immune inflammation index and neutrophil to albumin ratio for diagnosing disorders associated with inflammation. The purpose of this study was to investigate whether a connection exists between left ventricular hypertrophy and inflammation, as measured by systemic immune inflammation index and neutrophil to albumin ratio, in hemodialysis patients aged >65 years. Materials and Method: This study included 51 patients who had been receiving HD for at least three months. Test results and echocardiography measurements were obtained from patient files. Results: Average patient age was 72.88±5.12 years. Patients were divided into two groups based on left ventricular hypertrophy status. C reactive protein, systemic immune inflammation index and neutrophil to albumin ratio were considerably lower in the left ventricular hypertrophy (-) group, and multivariate logistic regression analysis revealed that high neutrophil to albumin ratio was an independent predictor of left ventricular hypertrophy (odds ratio [OR]:8.83, 95 percent confidence interval [CI]:1.32-28.83, P .0005), in conjunction with a high C reactive protein level (OR:3.45, 95 percent CI:1.905-6.645, P .005). Conclusion: Neutrophil to albumin ratio correlates with C-reactive protein and left ventricular hypertrophy, thereby predicting the inflammation characteristic of left ventricular hypertrophy. Keywords: Inflammation; Hypertrophy, Left Ventricular; Renal Dialysis.

Introduction: Worldwide, >200 million patients are affected by peripheral arterial disease (PAD) and endovascular interventional treatments are increasingly being applied. Contrast-induced nephropathy (CIN) is the third most common cause of renal failure in hospitals. However, factors such as renal vasoconstriction, decrease in renal blood flow, endothelial dysfunction, and oxidative stress have been suggested in the etiology of CIN. Studies are showing that inflammatory markers increase in CIN. Systemic immune inflammation index (SII), a newly defined parameter, is calculated by multiplying the platelet and lymphocyte counts and dividing by the neutrophil count. Studies are showing that this parameter influences prognosis in various cancer types. Considering that inflammation may play a role in CIN, we planned this study to investigate the role of SII in patients undergoing percutaneous peripheral vascular interventions. Material and Method: 300 patients who underwent percutaneous peripheral vascular interventions between August 2018-December 2021 due to peripheral arterial disease were included in the study. The data of the patients were scanned retrospectively from the patient files. The neutrophil-lymphocyte ratio (NLR) was calculated by dividing the neutrophil count by the lymphocyte count. SII was found by multiplying NLR with platelet count Results: Contrast-induced nephropathy developed in 41 (12.3%) patients. CIN(+) patients also, had higher CRP levels (5.1±0.7vs 2.4±0.4,P<0.05), NLR (4.07±1.07vs 2.65±0.84, P<.005), SII score (1778±627.57vs 867.14±491.88, P<.005.) the contrast media used was also higher in CIN(+) patients (176.19±48.44 vs 128.72±48.44;P<0.05) Multivariate logistic regression analysis demonstrated that a high SII score was an independent predictor of development of CIN (odds ratio [OR]: 1.002, 95% confidence interval [CI]: 1.001-1.002, P<.0005) together with high NLR (OR: 3.56, 95% CI: 1.905-6.675, P<.005) and CRP (OR: 1.002, 95% CI: 1.001-1.002, P<.005 Receiver operating characteristic curve analysis demonstrated that the best cutoff value of 1224 for SII to predict the development of CIN with 85% sensitivity and 72% specificity (area under ROC curve 0.904 [95% CI: 0.866-0.942], P<.005). Conclusion: Imbalance in inflammatory cells, the increase in neutrophils, and the decrease in lymphocytes play a role in developing kidney damage. Impaired immune functions due to lymphocytopenia contribute to the development of acute kidney injury. Oxidative stress exacerbates the inflammatory state by increasing inflammatory cell infiltration. AS a result, SII may be a powerful predictor of inflammation and can be used to determine the risk before interventional procedures.

Peritoneal tuberculosis is a rare but a severe disease in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).A 60 years old male, who had been the CAPD program during the last 5 months, was admitted to our clinic with fever, loss of appetite, night sweats, cough, weight loss and cloudy dialysate.Mycobacteria cultures of blood and pleural fluid were sterile.Bacterial cultures of peritoneal fluid were also sterile.The patient was initially treated for presumed bacterial peritonitis but remained febrile and also the dialysate remained cloudy.Laparoscopic peritoneal biopsy was performed.The peritoneal biopsy revealed giant cell granulomas formed by lymphocytes, histiocytes and Langerhans cells.Triple anti-tuberculous treatment was started.In this case tuberculosis peritonitis was successfully treated without interruption of dialysis and removal of the peritoneal dialysis catheter.We concluded that laparoscopic biopsy can be applied to the patients with persistent culture negative peritonitis.

AbstractIntroduction. None of the classification systems in immunoglobulin A (IgA) nephropathy has been widely agreed or implemented by clinicians or pathologists. In order to meet this need, "Oxford Classification System", which is highly reproducible and predictive for clinical course, was developed in 2009. In the present study, we investigated clinical and pathological characteristics of patients with IgA nephropathy based on current classification and the predictivity of crescent presence on prognosis. Methods. The study comprised 40 patients with diagnosis of primary IgA nephropathy on renal biopsy. The biopsy findings and follow-up parameters of patients were retrospectively re-evaluated. Pathological findings were examined based on the Oxford classification system. The presence of crescent formation in the specimens was noted. Results. The presence of crescent formation was predictive of poor prognosis regarding the glomerular filtration rate (eGFR), the level of proteinuria, and mean arterial pressure (MAP). Conclusion: Considering the importance of crescent formation in prediction of the clinical course and need for immunosuppressive therapy, it is suggested that crescent presence can be included in this classification system.

OBJECTIVE: Cinacalcet reduces parathyroid hormone levels by increasing the sensitivity of the parathyroid gland to calcium. In this study, we firstly aimed to evaluate the efficacy of cinacalcet in Turkish hemodialysis patients.MATERIAL and METHODS: 4483 hemodialysis patients were screened and 469 patients who had used cinacalcet were included in the study. The patients were divided into 4 groups according to drug usage durations (Group 1: 3 months, Group 2: 6 months, Group 3: 9 months and Group 4: 12 months). The patients' Parathormone, Ca, P and CaxP levels at the 3rd, 6th, 9th and 12th months were compared to the start of treatment and previous months.RESULTS: The levels of Parathormone, Ca, P and CaxP significantly decreased compared to their initial levels in all groups (from 1412 pg/ml to 1222 pg/mL for Parathormone, p< 0,001) in the 3rd month. However, this reduction was not continued in the subsequent months (Parathormone: 1381 pg/ml for the 12th month).CONCLUSION: Cinacalcet may not provide adequate benefit in control of hyperparathyroidism in Turkish hemodialysis patient population.

PURPOSE:Peritoneal fibrosis is almost uniform feature encountered in peritoneal dialysis patients. The transition of epithelial cells to mesenchymal phenotype, neovascularization, and consequently development of peritoneal fibrosis occur due to the involvement of peritoneal membrane by various insults such as uremia itself, peritonitis attacks, and exposure to bio-incompatible peritoneal dialysis fluids. Bevacizumab is a monoclonal antihuman antibody developed against vascular endothelial growth factor and can reduce fibrosis by preventing neovascularization. There has been no study so far that demonstrates the effect of bevacizumab on peritoneal fibrosis in a rat model.METHODS:A total of 41 female Wistar albino rats were divided into six groups. The control group (C) received 0.9 % isotonic saline (2 ml/day) intraperitoneally (i.p) for 21 days. Chlorhexidine group (CH) received 15 % ethyl alcohol and 0.1 % chlorhexidine gluconate (CG) in saline (2 ml/day) i.p for 21 days. The resting group (R) received CG 2 ml/day i.p for 21 days. The bevacizumab-1 group (B1) received CG 2 ml/day i.p for 21 days and bevacizumab 2.5 mg/kg i.p as a single dose on day 21. The bevacizumab-2 group (B2) received CG 2 ml/day for 21 days and bevacizumab 2.5 mg/kg i.p on day 0 and day 21. The bevacizumab-3 group (B3) received bevacizumab 2.5 mg/kg i.p on day 0 and day 21. Peritoneal samples were taken from the left anterior abdominal wall. The thickness, vascularization, and fibrosis scores in the peritoneal samples were assessed using a light microscope.RESULTS:On histopathological evaluations, peritoneum thicknesses, vascularization scores, and fibrosis significantly decreased in bevacizumab groups B1 and B2.CONCLUSION:Histopathologically, bevacizumab was proven to attenuate fibrotic process in experimental peritoneal sclerosis model.

Objective: Encapsulating peritoneal sclerosis (EPS) is a devastating complication of peritoneal dialysis terminating with peritoneal sclerosis and coccooning of intestinal loops. The inhibitors of mammalian target of rapamycin (mTOR), everolimus and sirolimus, have attenuated EPS findings in experimental animal models. The effect of combination of sirolimus with steroid has not been documented so far. The aim of the study was to determine the effect of combination of sirolimus and steroid on experimental sclerosing peritonitis model. Material and Methods: 41 wistar albino male rats were divided into 6 groups : control group (C; isotonic saline injected intraperitoneally), chlorhexidine gluconate group (CG; model group), resting group (R; CG then peritoneal rest, prednisolone group (P; CG then prednisolone), sirolimus group (Sir; CG then sirolimus), and prednisolone-sirolimus group (P-Sir; CG then prednisolone plus sirolimus). Peritoneal specimens obtained after sacrification at the end of study were examined for peritoneal thickness, fibrosis, and vascular intensities under light microscopy. Results: In the CG and R groups there was a significant increase in peritoneal thickness, fibrosis score and vascular intensity compared to C, P, Sir, and P-Sir groups in both parietal and visceral peritoneum (p<0.05). The parameters at the end of the study were not different in C, P, Sir, and P-Sir groups. The difference between P, Sir, and P-Sir groups were not significant. Resting was shown to be ineffective in attenuating EPS parameters. Conclusion: In this study we observed that sirolimus-prednisolone combination was equally effective in experimental EPS model compared to prednisolone and sirolimus only regimens.

The prognostic value of the type and extent of extracapillary proliferation (ECP) in pauci-immune necrotizing crescentic glomerulonephitis (PIGN) was evaluated in this study. In 141 PIGN cases, all glomeruli with ECP were grouped according to type (cellular, fibrocellular and fibrous) and extent of the lesions in Bowman's space; (segmental, semicircumferential and circumferential, which might be termed full moon-FM). Cases with cellular and fibrous lesions involving ≥ 50% of glomeruli with ECP were classified as cellular and fibrous groups, respectively, while the remaining cases were classified as fibrocellular. Cases with segmental and circumferential (FM glomerulus) lesions involving ≥ 50% of glomeruli with ECP were classified as ECPI and ECPIII (FM) groups, respectively, while the rest were classified as ECPII. All the cases were classified according to Berden et al. Significant results were only nearly obtained for the FM group, including the need for dialysis. The Cox regression model revealed a 2.6-fold risk for FM cases regarding dialysis requirement. We propose that the percentage of FM glomeruli should be noted in the pathology report, and cases with more than 50% of FM glomeruli (FM group) should be identified in the group with increased risk of dialysis requirement. Our series also suggests that classification according to Berden et al. is of clinical relevance.