Background: to evaluate the relationship between FGF23 and changes in biochemical parameters, left ventricle mass index, coronary, aortic and, valve calcifications. Methods: Totally 185 patients with chronic renal disease were included in this prospective, cross-sectional study. The patients were stratified according to GFR levels (mL/min/1.73m²) into 5 groups: ≥60, 45-59, 30-44, 15-29 and <15 (group 1-5 respectively).Biochemical parameters, serum FGF23 levels were measured. Echocardiographic assessments and Coronary artery calcification (CAC) with multidetector computerized tomography (MDCT) were done, left ventricle muscle mass (LVMI) was measured all patients. Results: Left ventricular hypertrophy (LVH), aortic and valve calcification were detected in 27.8%, 25.3% and 12% of patients respectively. CAC was detected in 18 patients. LVMI and FGF23 levels were found to increase proportionally with the severity of renal failure. A significant positive correlation between FGF-23 level and serum phosphate, log_PTH, and CaxP product was found. While a correlation between FGF-23 and valve calcification was detected, no correlation could be detected with LVMI, LVH, coronary and aortic calcification. Conclusion: In CKD, circulating FGF-23 and LVMI levels gradually increase with declining renal function such that by the time patients reach end-stage renal disease. Correlation between log_FGF23 and valve calcification was significant, whereas no statistically significant relationship was found between log_FGF23 and LVMI, LVH, aortic and coronary artery calcifications.

Patient survival in the presented institute is similar to that reported in Western countries. Compulsory choice of PD, presence of HD history, presence of diabetes, low pretreatment serum albuminm, and low serum parathormone levels at last visit were the strongest predictors of death. Risk factors for technique failure were compulsory choice of PD, presence of diabetes, low pretreatment serum albumin.

Background: To investigate the effects of ESRD etiologies on mortality in peritoneal dialysis patients. Methods: We included patients who initiated therapy between 2001-2011 and classified them according to etiologies including amyloidosis, diabetes mellitus, chronic glomerulonephritis and polycistic renal disease. Socio-demographic data, clinical courses and infectious complications were compared between groups, and the reasons for peritoneal dialysis withdrawal were recorded. Patient and technique survival analysis were performed. Results: 354 patients were included to the study. Thereafter, 154 patients were excluded. Totally, 29 patients with AA-amyloidosis (mean age 37.9±16.4 years, follow-up time 21.7±20.2 months), 78 patients with diabetes mellitus (mean age 56.9±13.6 years, follow-up time 35±28.6 months), 68 patients with chronic glomerulonephritis (mean age 37.2±12 years, follow-up time 47.7±29.9 months), 29 patients with polycystic renal disease (mean age 35.6±13.8 years, follow-up time 45.4±36.8 months) were evaluated. Albumin level was lower in patients with amyloidosis at initiation and the end of study (for both p<0.001). Incidence of peritonitis and catheter exit site/tunnel infection attacks were higher in patients with amyloidosis (p=0.002 and 0.018 respectively). There was statistical difference among groups with respect to the last status of patients (p<0.001). Deaths were frequent in amyloidotic and diabetic patients. The majority of deaths were due to peritonitis and/or sepsis and, cardiovascular reasons. The mortality rate was found higher in patients with amyloidosis (log rank=0.005), especially at first 2-3 years. Presence of anyone helping to administer peritoneal dialysis(OR:6.244, p=0,025), initial serum albumin level(OR:0.352, p=0,034) and presence of catheter exit site/tunnel infection(OR:0.250, p=0,015) were independent predictors of patient survival. Conclusion: Renal failure etiology has effects on peritoneal dialysis patients’ survival. Patients with amyloidosis have the worst survival. Because of loss of PD survival advantage seen in first years of therapy in patients with amyloidosis, peritoneal dialysis may not be suitable as first choice therapy in this group.

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OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS:A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS:The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg.The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well.The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION:Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis. Ölen hastaların diyabet oranı, hastaneye yatışları ve kan transfüzyon sayıları daha fazla idi. Ölen hastalarda: klinik hipervolemi bulgularından diyastolik kan basıncı, BİS hipervolemi göstergesi olan aşırıhidrasyon (OH), Hücredışı su (ECW), artmış, malnütrisyon bulgusu olarak yağ kitle endeksi azalmıştı. Bu grupta anlamlı anemi ve hipoalbuminemi mevcuttu.