Background. Despite the developments in haemodialysis, there are still some difficulties in maintaining the haemodynamic stability. Bioimpedance analysis (BIA) has been proposed for the estimation of dry weight in haemodialysis patients. We aimed to investigate the effects of dialysate sodium and glucose contents on volume distribution in body compartments after haemodialysis by using BIA, a sensitive and reliable method. Methods. Seventeen chronic haemodialysis patients [11 males, 6 females, mean age: 36.9 (18–64) years] were included in the study. Patients were evaluated in three periods. The patients (period 1-P1) underwent haemodialysis with dialysate of 200 mg/dL glucose and 140 mmol/dL sodium for 4.5 h in the middle session of the first week. At the beginning and the end of the session, haematocrit, vital parameters (blood pressure, pulse), ultrafiltrated volume, plasma osmolarity and plasma renin activity were recorded. Also multi-frequency bioelectric impedance analyses (Bodystat®Quadscan 4000) were applied to all patients at 5, 50, 100 and 200 kHz, including the impedance index (Z200/Z5). In the second midweek session the same procedure was repeated with same glucose concentration and 135 mmol/dL sodium including dialysate (period 2-P2), and in the third week, it was performed with a dialysate that included 140 mmol/dL sodium and no glucose (period 3-P3). Results. The change of the ratio of the intracellular volume to total body weight (ICV/TBW) at the beginning and the end of the session was same in all periods. However, there were significant differences in the change (after/before session) ratio for the extracellular volume/total body weight (ECV/TBW) in P2 compared to other periods ( P values for P1–P2: <0.001 and P2–P3: 0.007). Likewise, the same was observed in the changes of impedance ( P values for P1–P2: 0.08, P1–P3: 0.44 and P2–P3: 0.063). There was a significant increase of hypotensive events in P2 against the other periods ( P = 0.001). Conclusion. Decreasing dialysate sodium concentration results in important haemodynamic changes but the lack of glucose in dialysate does not result in any changes in haemodynamic and inflammatory parameters. The changes in bioimpedance parameters are parallel to haemodynamic changes in the haemodialysis patients.

Aim The association of increased resistin levels in chronic kidney disease with diabetic nephropathy has not yet been clarified. Our aim was to analyze the relationship between serum resistin levels and various diabetic microvascular complications in patients. Methods A total of 83 patients were enrolled in this cross-sectional study. The subjects were divided into 3 groups: 27 patients with type 2 diabetes mellitus (T2DM) having no diabetic retinopathy (DRP) or microalbuminuria and having normal renal function were included in Group-1, 28 patients with T2DM having DRP and normal renal function in Group-2, and 28 patients with T2DM with DRP and microalbuminuria and an estimated glomerular filtration rate (eGFR) of<60 ml/min/1.73 m² in Group-3. Serum resistin levels were analyzed by enzyme-linked immunosorbent assay. Results The mean age of the patients [46 female (55.4%)] was 54.8±9.1 years. The resistin level in Group-3 was significantly higher than in Group-1 and Group-2 (p<0.001).However the resistin level was not different between Group-1 (without microvascular complications) and Group-2 (with microvascular complications). The resistin level was found to be correlated negatively with eGFR (r=−0.459; p<0.001) and albumin (r=−0.402; p<0.001), and positively with high-sensitivity C-reactive protein (hs-CRP) (r=0.366; p=0.001). In multivariate analysis, it was observed that eGFR and hs-CRP were independent determinants of plasma resistin level. Conclusion The main determinants of resistin level in patients with T2DM are the level of renal function and inflammation rather than presence of microvascular complications, obesity and insulin resistance.

Background Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras. Methods This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group. Results Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K⁺, and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%. Conclusion Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols. Graphical abstract

Objective Older adults with comorbidities have been reported to be at higher risk for adverse outcomes of Coronavirus disease 2019(COVID-19). The characteristics of COVID-19 in older patients and its clinical outcomes in different kidney disease groups are not well known. Methods Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between April 17, 2020, and December 31, 2020. Hospitalized patients aged 18 years or older with confirmed COVID-19 diagnosis suffering from stage 3-5 chronic kidney disease(CKD) or on maintenance hemodialysis(HD) treatment were included in the database. Non-uremic hospitalized patients with COVID-19 were also included as the control group. Results We included 879 patients [388(44.1%) female, median age: 63(IQR:50-73) years]. The percentage of older patients in the CKD group was 68.8%(n=188/273), in HD group was 49.0%(n=150/306) and in the control group was 30.4%(n=70/300). Comorbidities were higher in the CKD and HD groups. The rate of presentation with severe-critical disease was higher in the older CKD and HD groups (43.6%, 55.3%, 16.1%, respectively). Among older patients, the intensive care unit(ICU) admission rate was significantly higher in the CKD and HD group than in the control group (38.8%, 37.3%, and 15.7%, respectively). In-hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD group (26.7% and 30.1%) compared to the control group (8.6% and 17.1%). In the multivariate analysis, in-hospital mortality rates in CKD and HD groups were higher than control group [Hazard ratio(HR): 4.33([95% confidence interval(CI): 1.53-12.26] and HR: 3.09(95%CI: 1.04-9.17), respectively]. Conclusion Among older COVID-19 patients, in-hospital mortality is significantly higher in those with stage 3-5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, comorbidities, clinical and laboratory data on admission.

AAbstract Background/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data looking for the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. HA-AKI development was assessed in a group of stage 3-5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Among 621 hospitalized patients (age 60 [IQR:47-73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4% and, stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1 % compared to 14.3 % of patients with HA-AKI but no CKD (p<0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate as patients with CKD without AKI. Adjusted mortality risk of the AKI+non-CKD group (HR: 9.0, 95%CI:1.9-44.2) and AKI+CKD group (HR: 7.9, 95%CI:1.9-33.3) were significantly higher than non-AKI+non-CKD group. AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcome whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.