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Abstract

K.P. Katopodis and N.A. Hoenich

¹Department of Nephrology, School of Clinical Medical Sciences, Medical School, University of Newcastle upon Tyne, and Department of Renal Medicine, University Hospital of Ioannina, Greece, and ²Department of Nephrology, School of Clinical Medical Sciences, Medical School, University of Newcastle upon Tyne, Renal Research Laboratory, Renal Research Institute, New York, and Division of Nephrology and Hypertension, Beth Israel Medical Center, New York
Background: Statistical associations
between urea removal and survival have been described in a number of publications. Urea
removal during treatment may be quantified by the delivered dose of dialysis. Methods in
clinical use to measure delivered dose are retrospective and reliant on accurate blood
sampling. The new generation of single patient proportionating systems incorporate the
facility to automatically measure ionic dialysance throughout dialysis. Methods: In
a prospective study on 9 anuric patients with a stable dialysis prescription, we have
compared the agreement of the dose of dialysis determined from ionic dialysance (Dt/V)
with that derived from equilibriated Kt/V (eKt/V) and Kt/V measured by direct dialysis
quantification (Kt/V_DDQ) using 2 types of hemodialysis membrane (hemophan and
low-flux polysulfone). The variability of the delivered dose over a 1-month period was
also determined. Results: Ionic dialysance was independent of membrane type. It was
comparable to that established for plasma urea water clearance for hemophan but lower for
polysulfone (p < 0.001). The mean (± SD) delivered dose of dialysis (Dt/V) was similar
for both membranes (1.18 ± 0.15 (hemophan) and 1.18 ± 0.11 (low-flux polysulfone)).
Bland Altman comparisons showed the limits of agreement between Dt/V and Kt/V_DDQ
were ± 0.17 and for Dt/V compared with eKt/V ± 0.15. A 1-month measurement of Dt/V
demonstrated considerable treatment to treatment variability indicating that delivered
dose cannot be considered stable. Conclusion: The availability of online
measurement of ionic dialysance provides a step towards monitoring dialysis more closely
at the time of delivery, and its clinical application will ensure that a more constant
dialysis dose is delivered.

Abstract

K.H. Katsanos, J. Theodorou, K.P. Katopodis and K.C. Siamopoulos

Abstract

K.P. Katopodis, C.G. Katsios, E.L. Koliousi, D.S. Nastos and K.C. Siamopoulos

Departments of ¹Nephrology and ²Surgery, University Hospital of Ioannina, Ioannina, Greece
We report on a case of life-threatening abdominal aorta hemorrhage following percutaneous renal biopsy. A 42-year-old woman with chronic kidney disease stage 2 and microscopic hematuria underwent a percutaneous renal biopsy to evaluate renal insufficiency. One hour following the biopsy procedure, she complained of an abdominal pain and developed signs of oligemic shock. In despite of 4 blood units transfusion, the patient continued to be in shock. She was transmitted urgently to the operating room without any other examinations (such as abdominal computer tomography) and underwent an emergency laparotomy. A transverse tear in the abdominal aorta was identified as the bleeding site, and after occlusion, the hemorrhage was stopped. The patient gradually recovered and she was discharged in good clinical condition after a few days.Correspondence to:
K.C. Siamopoulos, MD, MSc, FRSH Professor of Medicine/Nephrology Department of Internal Medicine Medical School, University of Ioannina 451 10 Ioannina, Greece
Email: [email protected]

Abstract

H. Taskapan, F.F. Ersoy, P.S. Passadakis, P. Tam, D.E. Memmos, K.P. Katopodis, C. Ozener, F. Akcicek, T. Camsari, K. Ates, R. Ataman, J.G. Vlachojannis, N.A. Dombros, C. Utas, T. Akpolat, S. Bozfakioglu, G. Wu, I. Karayaylali, T. Arinsoy, C.P. Stathakis,

¹Inonu University Malatya, Turkey, ²Akdeniz University Antalya, Turkey, ³Alexandroupolis Hospital, Democritous University of Thrace, Greece, ⁴Scarborough Hospital Toronto, Canada, ⁵Hippokration Hospital, Aristotle University of Thessaloniki, Greece, ⁶University Hospital of Ioannina, Greece, ⁷Marmara University Istanbul, Turkey, ⁸Ege University Izmir, Turkey, ⁹Dokuz Eylül University Izmir, Turkey, ¹⁰Ankara University Ankara, Turkey, ¹¹Cerrahpasa Medical School, Istanbul University Istanbul, Turkey, ¹²University Hospital of Patra, Greece, ¹³Ahepa Hospital, Aristotle University of Thessaloniki, Greece, ¹⁴Erciyes University Kayseri, Turkey, ¹⁵Ondokuz Mayis University Samsun, Turkey, ¹⁶Capa Medical School, Istanbul University Istanbul, Turkey, ¹⁷Credit Valley Hospital Toronto, Canada, ¹⁸Cukurova University Adana, Turkey, ¹⁹Gazi University Ankara, Turkey, ²⁰Laiko General Hospital of Athens, Greece, ²¹Uludag University Bursa, Turkey, ²²General Hospital of Veria, Greece, ²³Agios Dimitrios Hospital of Thessaloniki, Greece, ²⁴Dicle University Diyarbakir, Turkey, ²⁵Toronto-Western Hospital Toronto, Canada
The aim of this study was to evaluate the prevalence of vitamin D deficiency in chronic renal failure (CRF) patients on peritoneal dialysis (PD) and to correlate the findings with various demographic and renal osteodystrophy markers. Method: This cross-sectional, multicenter study was carried out in 273 PD patients with a mean age of 61.7 ± 10.9 years and mean duration of PD 3.3 ± 2.2 years. It included 123 female and 150 male patients from 20 centers in Greece and Turkey, countries that are on the same latitude, namely, 36 – 42° north. We measured 25(OH)D3 and 1.25(OH)2D3 levels and some other clinical and laboratory indices of bone mineral metabolism. Results: Of these 273 patients 92% (251 patients) had vitamin D deficiency i.e. serum 25(OH)D3 levels less than 15 ng/ml, 119 (43.6%) had severe vitamin D deficiency i.e. serum 25(OH)D3 levels, less than 5 ng/ml, 132 (48.4%) had moderate vitamin D deficiency i.e. serum 25(OH)D3 levels, 5 – 15 ng/ml, 12 (4.4%) vitamin D insufficiency i.e. serum 25(OH)D3 levels 15 – 30 ng/ml and only 10 (3.6%) had adequate vitamin D stores. We found no correlation between 25(OH)D3 levels and PTH, serum albumin, bone alkaline phosphatase, P, and Ca × P. In multiple regression analyses, the independent predictors of 25(OH)D3 were age, presence of diabetes (DM-CRF), levels of serum calcium and serum 1.25(OH)2D3. Conclusion: We found a high prevalence (92%) of vitamin D deficiency in these 273 PD patients, nearly one half of whom had severe vitamin D deficiency. Vitamin D deficiency is more common in DM-CRF patients than in non-DM-CRF patients. Our findings suggest that these patients should be considered for vitamin D supplementation.Correspondence to:
H. Taskapan, MD

Associate Professor of Medicine and Nephrology

Inonu University Medical School

Department of Medicine

Division of Nephrology Malatya, Turkey
Email: [email protected]

Abstract

K.P. Katopodis, M. Mitsis, E.G. Triantou, M. Fatouros and K.C. Siamopoulos

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