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  • ISSN: 2573-1637
    Early Online
    Volume 3, Issue 1
    Research Article
    Jacqueline Ellis, Peter Tregaskis, Kye Manefield, Trish Buena, Yen Ng, Sandra Cooke, Omar Tombocon1, Scott Wilson and Rowan Walker*
    Aim: To evaluate the quality, effectiveness, and sustainability of peritoneal dialysis as a home-based dialysis care option in older patients as well as younger patients after initiation of a nurse led Home before Hospital model of care.
    Methods: Because peritoneal dialysis is reputedly less effective for older patients, especially those with comorbidities, clinical data (demographics, peritoneal dialysis modality, complications, reasons for technique failure / discontinuation of peritoneal dialysis and other clinical and outcome measures) was collected over 8 years until December 2019 in a cohort of 317 patients (324 episodes of care) and compared between two age group categories (< 60 years (younger (n= 149)) and > 60 years (older (n=168)) both descriptively and analytically.
    Results: Diabetes (as a diagnosis or a comorbid condition (n=134) was more common in the older group (p<.007) as was death (n=76) as an outcome (p<.001). Progression to transplantation (n=77) was more likely in the younger (p<.001) but the reasons for transfer to hemodialysis (n=59) was not different between the groups including peritonitis (n=16) or membrane failure (n=5). The technique failure rate when censored for death favored the older group (HR=0.74 (CI 95% (0.44 - 1.23)) but not significantly so (p=.246) and the death-censored technique survival rate in the older group exceeded 75% at 3 years.
    Conclusion: Using a nurse-led model of care, an extremely high level of transition to a sustainable and successful home-based therapy (centered on peritoneal dialysis) can be achieved in older as well as younger patients.
    Review Article
    Murat İnanç Cengiz, and Kuddusi Cengiz*
    Periodontitis is characterized by a chronic inflammation produced in response to a disease-associated multispecies bacterial community in the subgingival region. Although the inflammatory processes occur locally in the oral cavity, several studies have determined that inflammatory mediators produced during periodontitis, as well as subgingival species and bacterial components, can disseminate from the oral cavity, contributing therefore, to various extraoral diseases like systemic AA amyloidosis. Interestingly, amyloidosis associated with periodontal species has been observed in both the oral cavity and extra oral sites. A few studies were showing a strong association between amyloidosis and poor oral health, presence of periodontitis –associated bacteria, tooth loss and clinical signs of periodontitis. Proinflammatory pathways are activated either by mono-or polymicrobial infections, resulting in an increase in the expression of proinflammatory molecules such as IL-6,IL-8,IL-1β and TNF-α. In addition, it has been shown that several periodontitis –associated species induce the expression of genes related to cell proliferation, cell cycle, apoptosis, transport and immune and inflamatory responses. Intriguinly, many of these pathways are linked to systemic AA amyloidosis. Periodontitis can increase the levels of acute-phase reactans and potentiate the development of amyloidosis either by themselves or association with traditional factors, such as familial Mediterranean fever and other chronic inflammatory diseases. Thus, preventing or treating periodontitis might prevent or at least alleviate the progression of amyloidosis. Periodontal evaluation should be performed as part of a medical assessment and considered as an etiologic factor for secondary amyloidosis. It is hoped that medical, dental practitioners, and other health-care professionals will be familiar with perio-systemic link and risk factors, and need to refer to the specialized dental care.
    Case Series
    Anupama D. Kumar, Lesley A. Inker, David A. Drew, Raymond L. Comenzo, and Cindy Varga*
    Background: Monoclonal gammopathy of renal significance (MGRS) is a coined term to describe patients with monoclonal gammopathy and concomitant renal pathology, typically due to immunoglobulin deposition or a fragment thereof, without evidence of an overt hematologic malignancy. Early identification of MGRS and treatment with chemotherapy can prevent progression to kidney failure. There is limited data on the characteristics of populations with concomitant MGUS and chronic kidney disease (CKD), and on the prevalence of diagnosed MGRS in this particular population. 
    Methods: Through retrospective chart review, we identified 246 patients with ICD-9 or -10 codes denoting both MGUS and chronic kidney disease (CKD) between the years of 2000 and 2017.  Patients with related overt malignancies such as multiple myeloma, Waldenstrom’s macroglobulinemia, and amyloidosis at onset were excluded, leaving 144 evaluable patients. 
    Results: The median age of the study population was 61, and females made up 40.3% of patients. At time of MGUS diagnosis, the median eGFR was 48 mL/min/1.73 m², and in patients with a quantifiable gammopathy, the median M-protein was 0.54 g/dL. Eighteen (12.5%) patients underwent kidney biopsy, and MGRS was confirmed in three. Nine patients (6.25%) developed malignant transformation to multiple myeloma during the follow-up period. 
    Conclusion: MGRS needs to be considered in patients with a monoclonal protein and chronic kidney disease. Renal biopsies are underutilized. Based on our findings, we propose a simple algorithm for workup of suspected MGRS.
    What is already known about this subject: Monoclonal gammopathy of renal significance (MGRS) is a disorder of deposition of monoclonal protein in the kidney without overt multiple myeloma or lymphoproliferative disorder, and can result in irreversible kidney failure.
    What this study adds: This study describes the characteristics of a population who harbor both a monoclonal protein and CKD, and identifies the prevalence of MGRS in this cohort. We postulate that MGRS is likely underreported due to a lack of kidney biopsies, and propose a simple algorithm for the workup of MGRS.
    What impact this may have on practice or policy: This study may result in increased awareness of MGRS as a disease as well as an increased need for the pursuit of a renal biopsy in this particular at risk population.
    Hayat Kumbasar Karaosmanoglu*
    Objective: We aimed to summarize the clinical data from seven hemodialysis patients with COVID-19 pneumonia.
    Methods: For this retrospective, single center study, we recruited 539 hospitalized patients who were diagnosed with COVID-19 pneumonia from March 27 to April 15, 2020 in Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul. Seven hemodialysis patients with Covid-19 pneumonia were analyzed.
    Results: This study included seven hemodialysis patients of 539 cases with confirmed COVID-19, with an average age of 64 years (range, 42-83 years), including 3 females and 4 males. Among the seven patients, two cases were asymptomatic, five patients had fever and respiratory symptoms on admission . Asymptomatic patients were exposed to the virus via infected adults in their household.
    Conclusion: All cases had high fever, low oxygen saturation (SO2 <93% ), high CRP, elevated ferritin and cytopenia at the seventh day of hospitalization. This suggests that cytokine storm may be more common in hemodialysis cases and the disease may progress more progressively.
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