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Originals

Dyspepsia and gastroparesis in chronic renal failure: the role of Helicobacter pylori

R. Schoonjans, B. Van Vlem, W. Vandamme, N. Van Heddeghem, H. Verdievel, R. Vanholder, N. Lameire and M. De Vos

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Volume 57 (2002) p. 201 - 207

Abstract

R. Schoonjans, B. Van Vlem, W. Vandamme, N. Van Heddeghem, H. Verdievel, R. Vanholder, N. Lameire and M. De Vos

¹Department of Internal Medicine, Gastroenterology Division, and ²Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
Aims: Many patients with chronic renal failure have dyspeptic symptoms. In the present study, we assessed the Helicobacter pylori (Hp) status, dyspeptic symptoms and gastric emptying rates in uremic patients. The present study was undertaken to compare chronic renal failure patients not under dialysis therapy (predialysis), hemodialysis (HD) patients and peritoneal dialysis (PD) patients for these variables and to search for a possible causative role of Hp. Methods: We used a standardized questionnaire to assess dyspeptic symptoms. Gastric emptying rates were determined by the 13C-octanoic acid breath test. HD patients were examined outside a dialysis session, PD patients were examined with a ?full? abdomen. Specific Helicobacter pylori IgG was measured by a second-generation enzyme-linked immunosorbent assay. Results: Sixty-six HD patients, 58 predialytic patients and 28 PD patients were included. Prevalences of Hp infection were highest in HD patients (46.2%) and predialysis patients (42.3%) compared to PD patients (28.6%) (p < 0.02). On the contrary, the prevalence of dysmotility-like dyspepsia was higher in PD patients (67.9%) when compared to HD patients (33.3%) (p < 0.01) and predialytic patients (53.6%) (difference not significant). Neither dyspepsia nor delayed gastric emptying were related to the presence of Helicobacter pylori IgG antibodies. Conclusion: A positive Helicobacter status based on serology was not related to the presence of dyspepsia or gastroparesis in uremic patients, whether on dialysis therapy or not. Dyspeptic complaints as well as gastroparesis are most prevalent in patients on peritoneal dialysis. The physiopathological mechanisms and clinical impact of these findings merit further investigation.

Originals

Serum potassium in the crush syndrome victims of the Marmara disaster

M.S. Sever, E. Erek, R. Vanholder, G. Kantarci, M. Yavuz, A. Turkmen, H. Ergin, M.Y. Tulbek, M. Duranay, G. Manga, S. Sevinir and N. Lameire

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Volume 59 (2003) p. 326 - 333

Abstract

M.S. Sever, E. Erek, R. Vanholder, G. Kantarci, M. Yavuz, A. Turkmen, H. Ergin, M.Y. Tulbek, M. Duranay, G. Manga, S. Sevinir and N. Lameire

For the Marmara Earthquake Study Group: ¹Department of Nephrology, Istanbul School of Medicine, Istanbul, ²Department of Nephrology, Cerrahpasa School of Medicine, Istanbul, ³Renal Division, University Hospital, Ghent, Belgium, ⁴Department of Nephrology, Marmara School of Medicine, Istanbul, ⁵Department of Nephrology, Uludag School of Medicine, Bursa, ¹Department of Nephrology, Istanbul School of Medicine, Istanbul, ⁶Department of Nephrology, Goztepe Social Security Hospital, Istanbul, ⁷Gulhane Military Hospital, Renal Division, Istanbul, ⁸Department of Nephrology, Etlik Social Security Hospital, Ankara, ⁹Department of Nephrology, Sisli Etfal State Hospital, Istanbul, ¹⁰Department of Nephrology, Bursa Social Security Hospital, Bursa, Turkey, and ¹¹University Hospital, Ghent, Belgium
Background: Hyperkalemia is a major cause of mortality in the patients who suffer from crush syndrome in the aftermath of major earthquakes. The aim of this study is to investigate the frequency and effects of hyperkalemia in the 639 victims of catastrophic Marmara earthquake that struck northwestern Turkey, in August 1999. Patients and methods: Within the first week of disaster, questionnaires were sent to 35 reference hospitals that treated the victims. Information on serum potassium which was provided in 595 out of 639 questionnaires was submitted to analysis. Results: In the patients who were admitted within the first 3 days of the disaster (n = 401) serum potassium was 5.4 ± 1.3 mEq/l, which was higher than in those admitted thereafter (n = 171) (4.5 ± 1.1 mEq/l) (p = 0.02). Considering the whole series, males (p = 0.01), patients needing dialysis support (p < 0.001) and non-survivors (p = 0.001) were characterized by higher serum potassium at admission. Seventy patients’ serum potassium was above 7 mEq/l, while 22 patients were hypokalemic (< 3.5 mEq/l). Admission potassium correlated with many clinical and laboratory variables indicating the severity of the trauma, and a logistic regression model with clinical and laboratory parameters upon admission, revealed potassium as the most significant predictor of dialysis needs in the victims admitted within the first 3 days (p = 0.008, OR = 3.33). Among the victims who were admitted to hospitals 1 week after the disaster, 8 had serum potassium levels above 6.5 mEq/l; among 4 of them were complicated by hyperkalemia even higher than 7.5 mEq/l. These findings undeline the importance of hyperkalemia during clinical course. Conclusion: The most important and fatal medical complication in crush syndrome patients is hyperkalemia. Risk of fatal hyperkalemia continues even after hospitalization. Empirical therapy at the scene is indicated especially in male victims with severe soft tissue traumas. Early detection and treatment of hyperkalemia may improve the final outcome of renal disaster victims.

Originals

Lessons learned from the catastrophic Marmara earthquake: factors influencing the final outcome of renal victims

M.S. Sever, E. Erek, R. Vanholder, M. Koc, M. Yavuz, N. Aysuna, H. Ergin, R. Ataman, M. Yenicesu, B. Canbakan, C. Demircan and N. Lameire

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Volume 61 (2004) p. 413 - 421

Abstract

M.S. Sever, E. Erek, R. Vanholder, M. Koc, M. Yavuz, N. Aysuna, H. Ergin, R. Ataman, M. Yenicesu, B. Canbakan, C. Demircan and N. Lameire

¹Local Coordinator for the Renal Disaster Relief Task Force (RDRTF) for the International Society of Nephrology (ISN), Department of Nephrology, Istanbul School of Medicine, Istanbul, Turkey, ²Department of Nephrology, Turkish Society of Nephrology, Cerra
Background: During catastrophic earthquakes, crush syndrome is the second most frequent cause of death after the direct impact of trauma. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 639 crush syndrome victims with acute renal problems. The factors influencing their final outcome have been the subject of this study. Patients/methods: Within the first week of the disaster questionnaires asking about 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information obtained by means of these questionnaires, including the factors with a potential influence on outcome, was submitted to analysis. Results: Overall mortality rate was 15.2%. In univariate analysis, nonsurvivors were older (p = 0.048); the highest mortality rates were observed among the victims coming from the closest cities to the reference hospitals. Admission within the first 3 days of the disaster (p = 0.016), with oliguria (p = 0.042), lower figures for blood pressure (p < 0.001), platelets (p = 0.004) and serum albumin (p = 0.005) were associated with mortality. Also, higher body temperature (p = 0.013) and serum potassium (p < 0.001) as well as suffering from thoracic or abdominal traumas, extremity amputations and medical complications other than renal failure (for all 4: p < 0.0001) in addition to need of dialysis support (p = 0.015) and mechanical ventilation (p < 0.0001) indicated higher risk of death. In the multivariate analysis, age (p = 0.030, OR = 1.02), presence of disseminated intravascular coagulation (p = 0.001, OR = 4.49), abdominal trauma (p = 0.012, OR = 4.05) and amputations (p = 0.010, OR = 2.81) were predictors of mortality. Dialyzed patients were characterized by higher mortality rates than nondialyzed victims (17.2% versus 9.3%, p = 0.015). Conclusion: Outcome of the renal victims of catastrophic earthquakes is influenced by the type of trauma, comorbid events and complications observed during the clinical course as well as epidemiological features such as age, distance to reference hospitals and time lapse between disaster and admission to reference hospitals.

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