Patients and study design: Two hundred forty nine FMF patients who were followed up between 2000 and 2020 were retrospectively analyzed. Patients with malignancy, active infection, data deficiencies, diseases associated with the development of CKD (e.g., Diabetes mellitus (DM), hypertension (HT), and chronic inflammatory diseases), and non-regular follow up were excluded from the study. The endpoints of the study were renal replacement therapy requirement and death in the course of follow-up. Hypertension was defined as a systolic blood pressure (SBP) ≥ 140 mmHg or a diastolic blood pressure (DBP) ≥ 90 mmHg on repeated measurements, or both, or by the use of antihypertensive drugs. Diabetes was defined as a fasting glucose level ≥ 7.0 mmol/L, a glycated hemoglobin ≥ 6.5%, or use of antidiabetic drugs. The study continued with 178 patients. FMF diagnosis was made according to Tel-Hashomer criteria. Genetic test was obtained in cases which there was suspicion of diagnosis. Demographic characteristics (age, gender, FMF family history, and kidney biopsy status) and clinical characteristics (abdominal pain, chest pain, fever, arthritis, erysipelas like erythema, appendectomy history, drugs, drug doses, drug compliance, number of attacks, age at diagnosis, duration of follow-up, and whether there was CKD at the time of first and last admission) were recorded. CKD was diagnosed using the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The patients were divided into three groups according to their age of diagnosis: early onset under 20 years old; adult-onset aged 21–40 years old; and late-onset aged 41 and over. The patients were also divided into two subgroups according to their fibrinogen levels: those with subclinical inflammation had ≥ 400mg/dL and without subclinical inflammation had < 400mg/dL. The patients were divided into three groups according to their genetic features: Group I, patients with M694 V homozygous mutation; Group II, M694V heterozygous or M694V combined heterozygous; and Group III, non-M694 V homozygous, heterozygous, or combined heterozygous.
Laboratory analyses: The urea, creatinine, estimated glomerular filtration rate (eGFR), and 24-hour urine proteinuria levels of the patients were recorded at the time of the first and last admission. eGFR was calculated according to the formula CKD-EPI. The arithmetic mean of the sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen levels in all controls of the patients were recorded. In addition, complete blood count, uric acid, total protein, albumin, glucose, and mean blood pressure were evaluated. Blood samples were measured in the morning after an overnight fast. Molecular diagnosis of FMF was carried out in our hospital Laboratories. Peripheral blood samples of the patients were obtained for DNA extraction. A reverse hybridization test method by FMF strip assay (ViennaLab labordiagnostika Gmbh, Vienna, Austria) was performed. Twelve mutations (E148Q, P369S, F479L, M680I G/C, M6980 I G/A,1692 del, M694V, M694I, V726A, K695R, A744S, R791H) were investigated. The assay includes four successive steps for which reagents are provided: (a) DNA isolation from blood samples, (b) in vitro multiple amplification reaction, (c) hybridization of amplification products and (d) detection of bound biotinylated sequences. Amplifications were conducted on an Applied Biosynthesis Thermocycler 9700 using the protocol supplied by the manufacturer.
Statistical analyses: Analyses were conducted using BM Statistical Package for the Social Sciences 22.0 version (IBM SPSS Corp.; Armonk, NY, USA). All data were fist checked for normality of distribution using the Kolmogrov-Smirnov and Shapirov-Wilk test. Normally distributed data are presented as the mean ± standard deviation. Non-normally distributed data are represented as the median (inter-quartile range). Independent samples T test was used to compare parametric continuous variables between groups. Mann Whitney U was employed for the comparison of non-parametric variables. Pearson’s X2 or Fisher’s exact were used for categorical variables Univariate and multi-variate cox regression analyses were applied to determine the factors affecting the development of CKD and amyloidosis.