Gastrointestinal System Endoscopy and Pathological Findings in Non-Dialysis Chronic Kidney Disease: A Single-Center Study - Article abstract #946516

Background: Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) affect left ventricular hemodynamics. This study compared the effect of two treatment modalities, CAPD and HD, on left ventricular systolic and diastolic functions in maintenance dialysis patients. Methods: A total of 47 patients (24 CAPD and 23 HD) undergoing long-term dialysis were included in the study. Left ventricular functions, left ventricular hypertrophy, and left ventricular geometry were evaluated using echocardiography. Results: The mean age of the patients was 58.6 ± 11.2 years. The mean dialysis time was 125.1 ± 35.2 months. When echocardiographic parameters were examined, left ventricular muscle mass, mass index, E/e’ ratios, and global longitudinal strain were significantly higher in the CAPD group. The rates of diastolic dysfunction (66.7% vs. 26.1%) and left ventricular hypertrophy (91.7% vs. 60.9%) were higher in the CAPD group than in the HD group. Dialysis modality CAPD, abnormal global longitudinal strain (GLS), and increased serum calcium were associated with an increased risk of diastolic dysfunction. Conclusions: The study results demonstrated that left ventricle (LV) diastolic dysfunction and deterioration in left ventricular geometry were significantly higher in patients receiving long-term CAPD treatment than for long-term HD treatment.

Background: Sodium–glucose cotransporter 2 (SGLT2) inhibitors have demonstrated significant renoprotective effects in patients with chronic kidney disease. However, kidney transplant recipients have been excluded from major randomized trials, and evidence in non-diabetic transplant patients remains limited. This study aimed to investigate the potential effects of SGLT2 inhibitors in non-diabetic kidney transplant recipients. Methods: Kidney transplant recipients were screened retrospectively and divided into two groups based on SGLT2 inhibitor use. A total of 18 non-diabetic patients receiving SGLT2 inhibitors (Group 1) were compared with 30 matched controls (Group 2). Patients were followed at baseline, 3, 6, and 12 months. Proteinuria, serum creatinine, eGFR, uric acid, and tacrolimus levels were analyzed. Results: Baseline demographic and biochemical characteristics were similar between groups. In Group 1, proteinuria decreased by 20% at 6 months and 26% at 12 months compared with baseline. The reduction in proteinuria from baseline to 6 months was significantly greater in Group 1 than in controls (p = 0.037). No significant changes were observed in serum creatinine, eGFR, tacrolimus levels, or infection-related adverse events between groups. Conclusions: SGLT2 inhibitors may confer an early antiproteinuric benefit in non-diabetic kidney transplant recipients without apparent adverse effects on renal function or safety. Larger prospective studies are needed to confirm long-term effects.

The global population of patients with kidney disease is steadily increasing; however, the number of nephrologists available to treat this patient group is concurrently declining. Although the underlying causes of this trend have been investigated in various countries, no such study has been conducted in Türkiye. Therefore, in this survey study, we aimed to examine the perspectives of internal medicine research assistants in our country regarding the nephrology subspecialty. This cross-sectional survey targeted all internal medicine research assistants working in 80 university and training/research hospitals across seven geographical regions of Türkiye. Data were collected through an online questionnaire developed by the researchers, created using Google Forms (Google LLC, Mountain View, CA, USA), and distributed to participants via e-mail or text message. A total of 2161 research assistants participated in the study, corresponding to a response rate of 60%. Of the participants, 52.1% were female and 47.9% male; 50.4% worked in university hospitals; and 89.6% had never worked in another specialty. The majority reported that they either did not wish to pursue nephrology (50.7%) or were undecided (27.7%). The three most frequently cited reasons for not choosing nephrology were: the high frequency of emergency cases (64.1%), the intense workload during regular working hours (51.7%), and the complexity and severity of the patient population (45.5%). Among those not planning to choose nephrology, 83.7% stated they might reconsider if on-call duties and shifts were less demanding, 44.3% if economic conditions improved, and 19.9% if they had the opportunity to attend a nephrology congress during residency. A heavy daytime workload, demanding on-call duties, limited financial incentives, and the presence of a chronically ill and complex patient population contribute to the low preference for nephrology in Türkiye. Implementing measures to address these issues may enhance the attractiveness of nephrology and strengthen the healthcare system in the future.

Peritoneal dialysis (PD) and hemodialysis (HD) are the two primary renal replacement therapies for patients with end-stage renal disease (ESRD). While PD is an effective and convenient modality, long-term use can lead to ultrafiltration failure, recurrent peritonitis, and progressive structural alterations in the peritoneal membrane, necessitating a transition to HD. In recent years, rather than a complete transition, the combined use of PD and HD has emerged as a viable alternative, offering potential advantages for selected patient populations.This retrospective study included patients with PD-related complications, such as resistant hypervolemia, frequent peritonitis episodes, peritoneal failure, and clinical deterioration. Based on eligibility criteria, patients were either transitioned to HD or initiated on combined PD+HD therapy. A total of 28 patients underwent transition to HD, while 26 received PD+HD combination therapy. Survival rates, Kt/V, residual urine output, and various laboratory parameters were evaluated and compared between the two groups. Both groups demonstrated significant improvements in Kt/V, volume stabilization, and cardiovascular stability after transitioning from PD. However, no statistically significant differences were observed in laboratory parameters between the two groups. These findings suggest that for patients experiencing PD failure, frequent peritonitis, or fluid overload, combined PD+HD therapy may serve as a feasible alternative to conventional HD. Careful patient selection and individualized treatment planning are crucial for optimizing outcomes. Given its comparable efficacy to HD, combined PD+HD therapy may represent an important option for patients requiring a tailored approach to dialysis.