Lege Artis Medicinae

[Factors influencing anisocytosis among inpatients with chronic kidney disease]

MOLNÁR D. László1, KISS István2,3, SZAKONY Szilvia4, AMBRUS Csaba5

DECEMBER 15, 2017

Lege Artis Medicinae - 2017;27(10-12)

[The coefficient of variation of RDW (RDW-CV) is a predictor of mortality in several patient cohorts. RDW and other factors were analyzed in an earlier report as potential predictors of inpatient mortality. In this paper, determinants of RDW were examined in a sample of hospitalized patients with chronic kidney disease not yet on dialysis using both frequentist and bayesian ANCOVA models. For the non-informative Bayesian model no prior knowledge about the model parameters was assumed. For the informative Bayesian model prior knowledge from previous experience was applied. Calculations were performed in R with the faraway, car and MCMCPack programme packages. Male gender identity, higher mch and mcv were strongly associated with higher RDW. Blood glucose concentration, white blood cell count, blood hemoglobin concentration, platelet count, age and glomerular fil-tration rate showed inverse relationship with RDW levels. ]

AFFILIATIONS

  1. Szociomed Kft.
  2. Semmelweis Egyetem, Geriátriai Tanszéki Csoport
  3. Szent Imre Egyetemi Oktatókórház, B.Braun Avitum Dialízis Hálózat
  4. Szent Imre Egyetemi Oktatókórház, Központi Laboratórium
  5. Szent Imre Egyetemi Oktatókórház, Nephrologia-Hypertonia Profil és Aktív Geriátriai Részleg; B.Braun Avitum Dialízis Hálózat, 1. Sz. Dialízisközpont

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Lege Artis Medicinae

[Feeding and eating in infancy and early childhood part I. - data on breastfeeding in the large-sample “For Healthy Offspring” project]

NÉMETH Tünde, VÁRADY Erzsébet, DANIS Ildikó, SCHEURING Noémi, SZABÓ László

[INTRODUCTION - Breastfeeding is the ideal and natural source of nutrition for infants, is associated with a reduced risk of many diseases in infants and mothers. It has a positive impact on the mother-infant relationship and also has considerable economic and environmental benefits. Subjects and methods - In the “For Healthy Offspring” Project parents of 1164, 0-3-year-old children completed a ques-tionnaire about breastfeeding and their feeding routine. The sample is not representative of the general population, but the sociodemographic and housing variables indicate an adequate spectrum. RESULTS - Breastfeeding was perceived by 60% of mothers enjoyable, while 20% of them had a negative experience with it. More than 50% of mothers had some breastfeeding difficulties, but it did not have a significant correlation with the negative perception of breastfeeding. The most common problem was the perception of inadequate milk supply. Among the studied variables maternal smoking, lower maternal education and the lack of antenatal breastfeeding education had the strongest correlation with the duration of breastfeeding. CONCLUSIONS - Adequate antenatal education on breastfeeding, proactive support of women and promptly attending their breastfeeding difficulties increases the duration of exclusive and any breastfeed-ing, helps mothers to reach their breastfeed-ing goals and to perceive breastfeeding enjoyable.]

Lege Artis Medicinae

[The Faith of Faithlessness ]

BÁNFALVI Attila

Lege Artis Medicinae

[What turns labour pain into suffering? The individual ways of coping]

RADOS Melinda, MÉSZÁROS Judit

[INTRODUCTION - Pain is not only a sensory experience, but includes emotional, motivational and cognitive dimensions, thus women’s perceptions of labour pain are largely influenced by individual attitudes. The distinction between pain and suffering sheds light on valuable information. Our aim was to study the relationship between women’s labour pain and their sense of suffering, and the effects of epidural analgesia on their judgements of pain, stress and satisfaction. SAMPLE AND METHOD - 342 women participated in our study. Their pain was assessed with the Numerical Rating Scale, sense of suffering with the shortened Perceived Stress Scale, which were followed by questions of epidural analgesia administration, its perceived effects and satisfaction. RESULTS - Women’s feelings of pain and sense of suffering show a strong positive correlation (R=0,283, p<0,001); but with the increase of these dimensions their satisfaction decreased (R=-0,162 and R= -0,444 respectively, p<0,001). The administration of epidural analgesia did not have a significant effect on their judgements of pain, stress and satisfaction. Perceived stress had the strongest determining influence on satisfaction (b=-0,534, p<0,001). CONCLUSIONS - According to our results on pain relief, we suggest the wider use of various non-pharmacological methods. Alleviation of maternal fear and suffering through non-judgemental, patient and supportive attitude of caregivers is of paramount importance.]

Lege Artis Medicinae

[Editor’s Commentary to Attila Bánfalvi’s Publication ‘The Faith of Faithlessness’ ]

KAPÓCS Gábor

Lege Artis Medicinae

[Differential diagnosis of anemia and abdominal pain - case report of a lead poisoned family]

NÉMETH Aliz, LISKA Zsófia, TÖRÖK Eszter, NÁDAI Mária, SCHANDL László, KIS János Tibor

[The authors describe a patient’s case, who was hospitalized with stomach pain. During the study of the patient, a microscopic examination of the blood vessel helped the diagnosis. Basophil eruptions of red blood cells raised the suspicion of lead poisoning, which was confirmed by a high lead level in the serum. The source of the lead poisoning was a lead covered jug, in which the family stored a homemade syrups that is popular among Hungarians. At several members of the family, who had been consumed the syrup, we measured high non-symptomatic lead levels. The patient and his family were successfully treated with a chelating therapy. The au-thors summarize the symptoms of lead poisoning through a case report. Call the attention that excessive lead exposure in Hungary is rarely recognized, and the symptoms are often misleading.]

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Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

GÜLER Siber, NAKUS Engin, UTKU Ufuk

Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

Hypertension and nephrology

[Sexual problems in CKD – a narrative review]

TÖRÖK Marietta, JÖRGEN Hegbrant, GIOVANNI Strippoli

[Sexual dysfunction is highly prevalent in patients with CKD, especially those receiving dialysis. Given the high prevalence of sexual problems in CKD patients, there has been growing interest in finding effective treatments for sexual dysfunction. PDE5i and zinc have been found promising interventions for treating sexual dysfunction in men with CKD in a systematic review of RCTs, but the evidence supporting their routine use in CKD patients is limited. In the Collaborative Depression and Sexual Dysfunction (CDS) Study, over a cohort of 1611 men in hemodialysis, 83% reported erectile dysfunction and 47% reported severe erectile dysfunction, with depression strongly correlated to this problem. Similarly, sexual dysfunction was highly prevalent in women undergoing hemodialysis. Of the 659 respondents, 555 (84%) reported sexual dysfunction and more than half of sexually active women reported sexual dysfunction, associated with age, depressive symptoms, menopause, low serum albumin, and diuretic therapy.]

Hypertension and nephrology

[Prognostic role of arterial stiffness in IgA nephropathy]

SÁGI Balázs, KÉSŐI István, VAS Tibor, CSIKY Botond, KOVÁCS Tibor, NAGY Judit

[Background: Arterial stiffness has a prognostic role in chronic cardiovascular diseases. Pulse wave velocity (PWV) determined by the carotid-femoral pulse detection is accepted as a gold standard method. Further diagnostic procedures are in use to assess the arterial stiffness including the finger photoplethysmography. The prognostic role of this method is limited in chronic renal diseases. The goal of our investigation was to determine the prognostic significance of the stiffness index (SIDVP) measured by the photoplethysmographic method in IgA nephropathy. Patients and methods: One hundred and three histologically proved IgA nephropathy patients with chronic kidney disease stage 1-4 were investigated (67 male, 36 female, 45 ± 11 years) and followed for an average 65 (6-107) months. The stiffness index was determined by the volume alteration of the digital artery during the cardiac cycle (Pulse Trace system, Micro Medical, Gilingham, Kent, UK). The primary combined end point was total mortality, major cardiovascular events (stroke, myocardial infarction or cardiovascular procedure, for example revascularisation) plus achieving end stage renal disease. The secondary end points were cardiovascular and renal end points alone. Results: The patients with increased stiffness index (> 10 m/s) had significantly more combined primary end point events (10/60 vs. 19/43, P = 0.015). In case of the secondary end points the renal end points were significantly more frequent in patients with higher stiffness index. Stiffness index has also proved to be an independent predictor on survival from other cardiovascular risk factors (age, hypertension, diabetes, obesity, lipid disturbances and decrease of renal function) using the Cox regression model in IgA nephropathy. Every 1 m/s increase in stiffness index resulted a 17% gain in the occurrence of the combined primary end point. Conclusions: Stiffness index determined by finger photoplethysmography is an eligible parameter to assess the prognosis in IgA nephropathy. Increased stiffness index in IgA nephropathy seems to be a good prognostic tool for identification of higher risk patients.]

Hypertension and nephrology

[Fructose-induced hyperuricaemia]

NAGY Judit, KISS István, WITTMANN István, KOVÁCS Tibor

[The consumption of fructose and fructose-based sweeteners has dramatically increased in the last hundred years and correlates epidemiologically with the rising prevalence of obesity, hypertension and metabolic syndrome worldwide. The administration of fructose to animals and humans increases uric acid generation independently from excessive caloric intake. Fructose ingestion may also be a risk factor of chronic kidney disease, that includes glomerular hypertension, vascular alterations (arteriolosclerosis) and albuminuria. The discovery that fructose-mediated generation of uric acid may have a casual role in metabolic syndrome and kidney disease provides new insight into pathogenesis and therapies for these important diseases.]

Hypertension and nephrology

[Prevalence of bone abnormalities and soft tissue calcification and their determining factors in dialyzed patients]

KISS Zoltán, AMBRUS Csaba, SZABÓ András, SZEGEDI János, BALLA József, TÖRÖK Marietta, LADÁNYI Erzsébet, CSIKY Botond, ÁRKOSSY Ottó, TÚRI Sándor, KULCSÁR Imre, KISS István

[Disturbances of bone and mineral metabolism are frequent complications of chronic kidney disease. In the last decades, increasing evidence of both pathophysiological and epidemiological nature support the relationship between bone disease and soft tissue calcification. In this current research, we analysed characteristics, determining factors and relationship of these two complications in a nationwide, cross-sectional cohort of dialysed patients. We collected demographical data (age, gender, body weight, height, diabetes, type of dialysis), laboratory results (serum parathormone, calcium, phosphat, albumin levels) and the presence of diabetes mellitus, bone abnormalities and soft-tissue calcification in patients on maintenance dialysis in 2010. The prevalence of bone abnormalities and soft tissue calcification followed similar pattern: both prevalences were high when parathormone <150 pg/ml (42.9% and 51.5%, respectively) or >500 pg/ml (44.2% and 55.5%) and they were significantly lower when parathormone was between 150-500 pg/ml (30.7% and 47.4%). In a multivariate logistic regression model, independent predictors of bone abnormalities were low (<150 pg/ml) and high (>500 pg/ml) parathormone levels (p<0.001), orhemodialysis (vs peritoneal dialysis) (p<0.001), age (p<0.001) and diabetes (p<0.001). In a similar statistical model, predictors of soft tissue calcification were also low (<65 pg/ml) (p<0.01) and high (>500 pg/ml) parathormone levels (p<0.001), hemodialysis (p<0.001), age (p<0.001), diabetes (p<0.001) and serum calcium level greater than 2.4 mmol/l (p<0.05). In summary, there was a U-shaped relationship between increasing serum parathormone levels and prevalence of bone abnormalities and soft tissue calcification in ESRD patients on maintenance dialysis. Further research and long term follow up are needed in order to reveal more detailed relationship among the two diseases and their determining factors.]