Dear Colleagues, In the previous editorial paper published by Balat et al. [1] as an Early View Article a few months ago, it was reported that there were changes in the Editorial Team of the European Journal of Therapeutics (Eur J Ther). During these few months, while the preparations for the new issue (June 2023, volume 29, Issue 2) continued, the editorial board also was revised. We would like to inform you that the Editorial Board has been strengthened by academics who are competent in their fields from many countries of the world and will continue to be strengthened in the future. As it is known, Eur J Ther started broadcasting in 1990 as a Journal of the Faculty of Medicine University of Gaziantep (In Turkish: Gaziantep Üniversitesi Tıp Fakültesi Dergisi). In the first paper titled “While Starting” (In Turkish: Başlarken) of the first issue, Prof. Sabri Güngör, who was the first Editor-in-Chief, stated that the aim of the journal is to have an influential place in the field of science [2]. Over the past three decades, the journal has continued to advance. At the present time, it is inevitable to reorganise the editorial board of the journal and enrich it with leading international editors in order to move the journal to better places. This editorial will explain essential developments in the journal in the last few months, and the new Editorial Board Members of the Eur J Ther will be introduced. Changes are inevitable, and we are delighted to announce that this issue marks several significant improvements. Specifically, we bolstered our editorial team with esteemed international academics and expanded our pool of referees. Consequently, the evaluation period for the submitted articles was significantly reduced. In the last two months, the journal metrics are as follows: Acceptance rate: %29 Average time until the final decision: 24.4 days Average time to publish as Accepted/Early View Article, after acceptance: 4.8 days. Thanks to these improvements, as you will notice, there are 25 articles in this issue. In this way, this issue has been the issue in which most articles have been published so far. In addition, applications were made to DOAJ (Directory of Open Access Journals) and BASE (Bielefeld Academic Search Engine), among the most essential open-access databases in the world, in May 2023. Moreover, cited references to the previous and/or alternative names of the journal (Gaziantep Medical Journal, Gaziantep Med J, Gaziantep Tıp Dergisi and Gaziantep Üniversitesi Tıp Fakültesi Dergisi) in Web of Science that were not reflected in the journal metrics were identified and reported to the Web of Science. Some of these correction requests have been finalized and corrected, and thus the total number of citations and the H-index of the journal increased [3]. After all these data are updated, it will be seen that the citation values of the Eur J Ther will increase even more. We will also update the guidelines for the authors and reviewers with respect to the ICMJE [4] and EQUATOR Network [5], which will enhance the quality of research in the medical fraternity. Additionally, the use of DOI for articles published in the journal started in 2011 (2011, volume 17, Issue 2). In order to facilitate the recognition and access of the articles, DOIs have also been defined for all articles published in previous issues.   Editors Ayşe Balat, MD, became the new Editor-in-Chief of Eur J Ther for the second time, the first between 2007-2010. She is a Professor in Pediatrics and a specialist in Pediatric Nephrology and Rheumatology. She has been working as Vice President of Gaziantep University since October 2020. She was the Dean of Gaziantep University Medical Faculty (2007-2010), President of the Mediterranean Kidney Society (MKS) between 2015 to 2018, and Secretary beginning in 2018. She is also President of the International Association for the History of Nephrology (IAHN) since 2022. In Gaziantep, she first established Pediatric Nephrology and Pediatric Rheumatology Units, and the first peritoneal dialysis was performed by her. She has several studies published in international and national peer-reviewed scientific journals (H-Index: 26, i10-index: 59 and approximately 2500 citations). She was the Guest Editor of the International Journal of Nephrology in 2012 (special issue titled “Devil’s Triangle in Kidney Diseases: Oxidative Stress, Mediators, and Inflammation”). She is a member of many national and international associations related to her field, including membership in the Turkish Pediatric Nephrology Association board in the past. She has several scientific presentation awards at national and international congresses. She has been joined as an “invited speaker” at 20 International Meetings.           As of 2007, she organizes World Kidney Day activities within the scope of the “Survival is not Enough” program (in the first rank among European pediatric nephrologists as an organizer of those activities). Recently, she was elected as a “lifelong member of the Academy of Medicine and Surgical Sciences” of the University of Naples, which is one of the four important academies in Naples.   Şevki Hakan Eren, MD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr Eren graduated from the Medical School, University of Gaziantep, Turkey and completed Emergency training at Cumhuriyet University. He has been working as a Professor at Gaziantep University, Department of Emergency Medicine, Gaziantep, Turkey. He is interested in traumatology, and toxicology.   Mehmet Sait Menzilcioğlu, MD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr. Menzilcioğlu graduated from the Medical School, University of Gaziantep, Turkey and completed Radiology training at the same University. He has been working as an Associate Professor at Gaziantep University, Department of Radiology, Gaziantep, Turkey. He is interested in neuroradiology, ultrasonography, doppler Ultrasonography, Computerized Tomography, Magnetic Resonance Imaging, interventional radiology, and obstetric sonography.   İlhan Bahşi, MD, PhD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr Bahşi is also on the Editorial Board of the Journal of Craniofacial Surgery, Frontiers in Neuroanatomy, and Mersin University School of Medicine Lokman Hekim Journal of History of Medicine and Folk Medicine. In addition, he has published more than 80 articles (H-index: 12 and i10-index: 15) and has been a referee for more than 600 academic papers in many internationally indexed journals. Dr Bahşi, who has been working in the Department of Anatomy at the Gaziantep University Faculty of Medicine since 2012, completed his doctorate education in 2017 and obtained the title of PhD. Besides anatomy, he is particularly interested in the history of medicine, medical ethics, and education.   İlkay Doğan, PhD, is the new Editorial Board member of the Eur J Ther for Statistics and Methodology. He is in the Department of Biostatistics at the Gaziantep University Faculty of Medicine. His professional focus lies in research about Structural Equation Modeling, Multivariate Analysis. With a wealth of experience spanning over 15 years across multiple disciplines, including veterinary, nursing, sport and medicine, Dr Doğan has held various notable articles. He is a member of the Turkish Biostatistics Association.   Ahmet Acıduman, MD, PhD, graduated from Ege University Faculty of Medicine in 1987 and later specialized in Neurosurgery in 1997. Dr Acıduman further expanded his academic credentials by completing a PhD in the History of Medicine and Ethics in 2005. Currently, he is a Professor in the Department of History of Medicine and Ethics at Ankara University Faculty of Medicine. With a notable record of over 200 academic publications, Dr Acıduman’s contributions to the field continue.   Bilal Çiğ, PhD, is a new Editorial board member of the Eur J Ther. Associate Prof Bilal Çiğ is a Postdoctoral researcher at King's College London Wolfson Card. He has been investigating the roles of ion channels in neurological diseases using the patch clamp technique for nearly 15 years. For the past few years, he has focused on the interactions of TRPA1 and Kir 4.1 channels in demyelination. He has 40 SCI-E and international publications, with about 1300 citations.   Tsvetoslav Georgiev, MD, PhD, holds an esteemed position as an associate professor at the First Department of Internal Medicine in Varna, Bulgaria, while also working as a clinician at the University Hospital St. Marina. He has successfully defended his doctoral dissertation in 2018 at the Medical University in Sofia. Having obtained a specialization in rheumatology that same year, Dr Georgiev has extensive expertise in this intricate field of medicine. He further expanded his knowledge and skills by attending comprehensive courses on imaging diagnostics and musculoskeletal ultrasound in rheumatology held in various locations. Dr Georgiev has been involved in formulating the Bulgarian consensus on osteoarthritis and EULAR recommendations for the non-pharmacological core management of osteoarthritis. Notably, Dr Georgiev has received recognition for his outstanding contributions as a reviewer, earning awards in 2019 and 2021 from the Korean Academy of Medical Sciences.   Davut Sinan Kaplan, PhD, is a new Editorial Board Member of the Eur J Ther. Dr Kaplan is an Associate Professor in the Department of Physiology at Gaziantep University Faculty of Medicine. He is also the Graduate School of Health Sciences’ Director. He has taken involved in a wide variety of research with animal models. His research generally focuses on Endocrinology, Metabolism, Physical Activity, and Breast Milk. He has mentored a large group of master’s and PhD students. He has served for many years as a member of the local animal experiments ethics committee.   Mehmet Karadağ, MD, is a new Editorial Board Member of the Eur J Ther for Psychiatry. Dr. Karadag is an Assoc

ABSTRACT Background Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor and living donor KT rates over the last decade. Methods KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle and high KT rate countries based on the KT rate at the start of study period in 2010. Results Experts from low KT rate countries reported more frequently that they had taken measures regarding staff, equipment and facilities to increase the total KT rate compared with middle and high KT rate countries. For donor type–specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators and (inter)national exchange of donor kidneys. Once a measure was taken, experts’ opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients’ lack of knowledge and distrust in the healthcare system. Conclusions Particularly in low KT rate countries, the KT rate might be stimulated by optimizing staff, equipment and facilities. In addition, all countries may benefit from measures specific to deceased and living donors.

ABSTRACT Background The aim of this study was to identify trends in total, deceased donor (DD) and living donor (LD) kidney transplantation (KT) rates in European countries. Methods The European Renal Association (ERA) Registry and the Global Observatory on Donation and Transplantation (GODT) databases were used to obtain the number of KTs in individual European countries between 2010 and 2018. General population counts were obtained from Eurostat or the national bureaus of statistics. The KT rate per million population (p.m.p.) and the average annual percentage change (APC) were calculated. Results The total KT rate in the 40 participating countries increased with 1.9% annually [95% confidence interval (CI) 1.5, 2.2] from 29.6 p.m.p. in 2010 to 34.7 p.m.p. in 2018, reflecting an increase of 3.4 p.m.p. in the DD-KT rate (from 21.6 p.m.p. to 25.0 p.m.p.; APC 1.9%; 95% CI 1.3, 2.4) and of 1.5 p.m.p. in the LD-KT rate (from 8.1 p.m.p. to 9.6 p.m.p.; APC 1.6%; 95% CI 1.0, 2.3). The trends in KT rate varied widely across European countries. An East–West gradient was observed for DD-KT rate, with Western European countries performing more KTs. In addition, most countries performed fewer LD-KTs. In 2018, Spain had the highest DD-KT rate (64.6 p.m.p.) and Turkey the highest LD-KT rate (37.0 p.m.p.). Conclusions The total KT rate increased due to a rise in the KT rate from DDs and to a lesser extent from LDs, with large differences between individual European countries.

Abstract Aim: The study aimed to evaluate the acute effect of ultrafiltration on the mechanical properties of the aorta using brachial-ankle pulse wave velocity (PWV) before and after hemodialysis (HD). Patients and Methods: This study included 80 patients who were on a long-term HD program. The input variables were anamnestic data, body composition monitor (BCM) parameters, and echocardiography findings. The assessment of hydration status was determined by BCM, whose work is based on the principle of multifrequency bioimpedance spectroscopy. Another diagnostic procedure was the use of an arteriograph apparatus to assess PWV and Augmentation Index (AIx). All measurements were performed before and after dialysis on the middle dialysis day of the week. Results: The participants were divided into two groups based on hydration status: the experimental group consisted of 40 overhydrated participants and the control group consisted of 40 normovolemic participants. Statistically, the following BCM parameters correlated significantly positively with PWV: total body fat (r = 0.222; P < 0.05), overhydration (r = 0.290; P < 0.001), and relative overhydration (r = 0.290; P < 0.001). From echocardiography findings, only left atrial diameter correlated statistically significantly positively with PWV (r = 0.359; P < 0.001). Comparison of the mean PWV values within the experimental group before and after HD showed a statistically significant decrease from 14.32 ± 2.34 m/s to 8.72 ± 1.52 m/s (Z = 3.254; P = 0.0001). Mean PWV values within the control group did not decrease significantly from 13.39 ± 1.32 m/s to 10.39 ± 1.18 m/s (Z = 0.524; P = 0.742). If we compare the mean values of PWV between groups, then before HD treatment, there was no statistically significant difference between groups with PWV values in the experimental group of 14.32 ± 2.34 m/s and the control group of 13.39 ± 1.32 m/s (Z = 0.762; P = 0.852). According to the results of univariate regression analysis before and after HD treatment, only overhydration showed an absolute effect on PWV before and after HD. Conclusion: Overhydration showed an effect on brachial-ankle PWV before and after HD, and brachial-ankle PWV should be followed in HD patients.

ABSTRACT Background Data on renal replacement therapy (RRT) for end-stage renal disease were collected by the European Renal Association (ERA) Registry via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article provides a summary of the 2019 ERA Registry Annual Report, including data from 34 countries and additional age comparisons. Methods Individual patient data for 2019 were provided by 35 registries and aggregated data by 17 registries. Using these data, the incidence and prevalence of RRT, the kidney transplantation activity and the survival probabilities were calculated. Results In 2019, a general population of 680.8 million people was covered by the ERA Registry. Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these patients, 62% were men, 54% were ≥65 years of age and 21% had diabetes mellitus as primary renal disease (PRD), and 84% had haemodialysis (HD), 11% had peritoneal dialysis (PD) and 5% had pre-emptive kidney transplantation as an initial treatment modality. The overall prevalence of RRT on 31 December 2019 was 893 p.m.p., with 58% of patients on HD, 5% on PD and 37% living with a kidney transplant. The overall kidney transplant rate was 35 p.m.p. and 29% of the kidney grafts were from a living donor. The unadjusted 5-year survival probability was 42.3% for patients commencing dialysis, 86.6% for recipients of deceased donor grafts and 94.4% for recipients of living donor grafts in the period 2010–14. When comparing age categories, there were substantial differences in the distribution of PRD, treatment modality and kidney donor type, and in the survival probabilities.

Abstract Introduction: Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD). The aim of this study was to analyze the presence of frailty phenotype among HD patients and to evaluate their interrelationship with different biochemical markers. Methods: For the frailty assessment the Frailty Phenotype by Fried et al. was used, where frailty was reported if three of the following criteria were met: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. From 281 HD patients, 126 patients were frail, 58 were pre-frail (two criteria were met) and the rest of the study population were robust (97 patients). BMI was calculated for all patients and venous blood samples were taken to determine laboratory parameters for bone alkaline phosphatase (BAP), phosphate (P), potassium (K), C-reactive protein (CRP) and albumin. Results: Patients who were on HD longer than 60 months have more characters of frailty. (p=0.019). A statistically significant positive correlations between frailty score and BAP (rho = 0.189; p = 0.001), and CRP (rho = 0.233; p < 0.001) were observed, and significant negative correlations between frailty score and albumin (rho = - 0.218; p < 0.001) and K (rho = - 0.198; p = 0.001). Conclusions: The associations of frailty with markers of mineral bone disorder, inflammation and nutrition indicate the importance of these parameters in the indirect assessment of the frailty phenotype in HD patients.

Abstract Background The European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry collects data on kidney replacement therapy (KRT) via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article summarizes the 2018 ERA-EDTA Registry Annual Report, and describes the epidemiology of KRT for kidney failure in 34 countries. Methods Individual patient data on patients undergoing KRT in 2018 were provided by 34 national or regional renal registries and aggregated data by 17 registries. The incidence and prevalence of KRT, the kidney transplantation activity and the survival probabilities of these patients were calculated. Results In 2018, the ERA-EDTA Registry covered a general population of 636 million people. Overall, the incidence of KRT for kidney failure was 129 per million population (p.m.p.), 62% of patients were men, 51% were ≥65 years of age and 20% had diabetes mellitus as cause of kidney failure. Treatment modality at the onset of KRT was haemodialysis (HD) for 84%, peritoneal dialysis (PD) for 11% and pre-emptive kidney transplantation for 5% of patients. On 31 December 2018, the prevalence of KRT was 897 p.m.p., with 57% of patients on HD, 5% on PD and 38% living with a kidney transplant. The transplant rate in 2018 was 35 p.m.p.: 68% received a kidney from a deceased donor, 30% from a living donor and for 2% the donor source was unknown. For patients commencing dialysis during 2009–13, the unadjusted 5-year survival probability was 42.6%. For patients receiving a kidney transplant within this period, the unadjusted 5-year survival probability was 86.6% for recipients of deceased donor grafts and 93.9% for recipients of living donor grafts.

Abstract Chronic kidney disease (CKD) is a major health problem because of its high prevalence, associated complications and high treatment costs. Several aspects of CKD differ significantly in the Eastern European nephrology community compared with Western Europe because of different geographic, socio-economic, infrastructure, cultural and educational features. The two most frequent aetiologies of CKD, DM and hypertension, and many other predisposing factors, are more frequent in the Eastern region, resulting in more prevalent CKD Stages 3–5. Interventions may minimize the potential drawbacks of the high prevalence of CKD in Eastern Europe, which include several options at various stages of the disease, such as raising public, medical personnel and healthcare authorities awareness; early detection by screening high-risk populations; preventing progression and CKD-related complications by training health professionals and patients; promoting transplantation or home dialysis as the preferred modality; disseminating and implementing guidelines and guided therapy and encouraging/supporting country-specific observational research as well as international collaborative projects. Specific ways to significantly impact CKD-related problems in every region of Europe through education, science and networking are collaboration with non-nephrology European societies who have a common interest in CKD and its associated complications, representation through an advisory role within nephrology via national nephrology societies, contributing to the training of local nephrologists and stimulating patient-oriented research. The latter is mandatory to identify country-specific kidney disease–related priorities. Active involvement of patients in this research via collaboration with the European Kidney Patient Federation or national patient federations is imperative to ensure that projects reflect specific patient needs.

Introduction: Plasmapheresis is often used as a therapy in the treatment of thrombotic thrombocytopenic purpura (TTP). TTP is manifested in thrombotic microangiopathy, consumed thrombocytopenia, hemolytic anemia and acute kidney injury with HUS development, neurologic dysfunction, and fever. Case report: we will present a case of a patient with acute kidney injury and refractory TTP at the beginning of hospitalization, subsequently manifested in secondary nephrotic syndrome. The patient was a female, 39 years of age, who as an emergency case was referred from the hospital in East Sarajevo to the Clinic of Endocrinology, Diabetes and Metabolism Disorders of the Clinical Center University of Sarajevo with suspected TTP. A few days before hospitalization she had a fever and vomiting, and therefore consulted her physician. She was hospitalized due to severe general condition, generalized edema, visible body hematomas, and diuresis amounting to 600 ml/12 hours. Laboratory results on admission were as follows: Leukocytes 19.5, Erythrocytes 3.23, Hemoglobin 103, Hematocrit 28.8%, Platelets 65.4 with few schistocytes and 2 reticulocytes, Sodium 140 mmol/L,, Potassium 4.5 mmol/L, Calcium 1.90 mmol/L, Glucose 7.9 mmol/L, Urea 37.5 mmol/L, Creatinine 366 umol/L,, Bilirubin 19.0 umol/L, Lactate dehydrogenase 1194 U /L. The patient was communicative, in cardiopulmonary sufficient state. Central venous catheter was placed in the right jugular vein and the first plasmapheresis was performed. During the hospitalization 38 plasmapheresis treatments with frozen plasma were performed, followed by three Rituximab treatment cycles. After the last plasmapheresis treatment a platelet count was 138. Also, parameters of the renal function were in their referent values. At the beginning of the treatment proteinuria was 19.6 g/24 hours urine. We were faced with a dilemma whether renal biopsy should be repeated in the future given that it might be the case of primary and not secondary nephrotic syndrome. Controlled proteinuria was 4.7g after plasmapheresis. The patient used only Prednisolone at a dose of 10 mg daily and although initially diagnosed with acute kidney injury she was not treated with dialysis. Conclusion: early diagnosis and early start of plasmapheresis therapy is vital for treatment of patients with acute kidney injury and TTP (HUS). A small number of patients is refractory to plasmapheresis and introducing Rituximab and plasmapheresis treatment is recommended.