Browsing by Author "Sezer, Siren"

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Acute Renal Failure and Its Impact on Survival Following Cardiac Transplantation
(2016) Sezer, Siren; Yavuz, Demet; Canoz, Mujdat Batur; Altunoglu, Alparslan; Sezgin, Atilla; Arat, Zubeyde; Ozdemir Acar, Fatma Nurhan; Haberal, Mehmet; 0000-0002-4082-6320; 0000-0002-3462-7632; ABG-9980-2021; AAJ-8097-2021
OBJECTIVE: We evaluated the incidence and risk factors for acute renal failure (ARF) and also the associated hazard of death in recipients of cardiac transplants. MATERIAL and MET HODS: We included 25 patients in the study; 18 patients developed ARF (72%) and underwent continuous venovenous hemodiafiltration (Group I) and 7 patients had stable renal function (28%) (Group II). We retrospectively retrieved demographic variables; clinical, perioperative, postoperative complications and echocardiographic data; and biochemical parameters at the time of the surgery and six months later. RESULTS: Cumulative survival was 72.2% after 6 months, 64.2% after 24 months, and 51.4% after 32 months for Group I and 50% after 32 months for Group II (p> 0.05). A total of 8 patients died (32%); 1 (5.5%) from Group I and 7 (87.5%) from Group II. Risk factors for ARF were preoperative serum BUN, creatinine levels, and cardiopulmonary bypass time (p< 0.05). Only one patient underwent chronic hemodialysis because of chronic renal dysfunction in Group I while there was no such patient in group II. CONCLUSION: Preoperative serum BUN, creatinine value, and cardioopulmonary bypass time were found to be risk factors for ARF after cardiac transplantation. Postoperative renal dysfunction did not affect long-term renal function and survival.
Age Related Differences in The Hydration, Nutritional Status and Arterial Stiffness in Maintenance Hemodialysis Patients
(2016) Bal, Zeynep; Ozelsancak, Ruya; Genctoy, Gultekin; Kal, Oznur; Tutal, Emre; Sezer, Siren; https://orcid.org/0000-0002-0788-8319; https://orcid.org/0000-0002-5145-2280; https://orcid.org/0000-0002-7751-4961; AAZ-5795-2021; AAD-5716-2021; AAJ-5551-2021; AAJ-7586-2021
Ambulatory Blood Pressure Measurement As A Prognostic Tool in Renal Transplant Recipients
(2016) Tutal, Emre; Sezer, Siren; Bal, Zeynep; Demirci, Bahar Gurlek; Moray, Gokhan; Colak, Turan; Haberal, Mehmet; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-8372-7840; https://orcid.org/0000-0002-3462-7632; AAZ-5795-2021; AAE-1041-2021; AAJ-8554-2021; AAJ-8097-2021
Ant-Hcv pozitif hemodiyaliz hastalarında insülin direnci ve arter sertliği risk faktörleri arasındaki ilişki
(Başkent Üniversitesi Tıp Fakültesi, 2007) Ülkü Adam, Fatma; Sezer, Siren
Hepatit C virüs (HCV) seropozitivitesiyle karotis arter plak ve karotis intima media kalınlığı arasında sağlıklı toplumda bağımsız ilişki bulunmuştur. Aynı şekilde insülin direnci de ateroskleroz için bir risk faktörüdür ve yine HCV(+) hastalarda Tip 2 DM sıklığının arttığı bilinmektedir. HCV’ünün hemodiyaliz hastalarında insülin direnci ve ateroskleroz üzerindeki etkilerinin belirlenmesi hastaların buna bağlı kardiyovasküler komplikasyonlardan korunması ve tedavilerinin planlanması açısından önemlidir. Bu çalışmada HCV enfeksiyonu olan hemodiyaliz hastalarında insülin direncinin varlığı ve bu hastalarda hepatit C virüsünün ve insülin direncinin ateroskleroz üzerindeki etkilerinin araştırılması amaçlandı. Çalışmaya son dönem böbrek yetmezliği nedeni ile en az 3 aydır hemodiyaliz programında olan benzer yaş, cinsiyet ve hemodiyaliz sürelerine sahip,diyabeti olmayan, normoglisemik 37 HCV(+) ve 30 HCV(-) toplam 67 hasta alındı. Hastaların insülin direnci “homeostasis assesment model” yöntemi ile ölçüldü. Arter sertliği “sertlik indeksi β” ve “elastik modulus” ölçümleri ile değerlendirildi. Çalışmaya alınan HCV(+) hastaların 20’si erkek, 17’si kadın, yaş ortalaması 43.4 ± 16.7 yıl, ortalama HD süresi 97.4±49.5 ay, HCV (-) gruptaki hastaların ise 19’u erkek, 11’i kadın, yaş ortalaması 44.5 ± 16.8 yıl, ortalama HD süresi 82.8±45.1 aydı. HCV(+) hastalarda ortanca HOMA-insülin direnci değeri 1.50 iken HCV(-)hastalarda 1.31 idi. Her 2 grup arasında istatistiksel olarak anlamlı farklılık yoktu. Sertlik indeksi β ve elastik modulus ölçümleri açısından da HCV(+) ve HCV(-) gruplar arasında farklılık saptanmadı. HCV(+) hasta grubunda bakılan arter sertliği parametreleri yaş, beyaz küre, trombosit, total kolesterol, LDL kolesterol, ürik asit, ortalama arter basıncı, diyastolik kan basıncı ve HOMA-insülin direnci ile pozitif korele iken HCV(-) hasta grubunda arter sertliği ile bu parametreler arasında ilişki gösterilemedi. Sonuç olarak, HCV(+) hemodiyaliz hastalarında insülin direnci ile birlikte aterosklerozla ilişkiyi kuvvetlendirdiğini tespit ettik. HCV (+) hemodiyaliz hastalarının kardiyovasküler morbidite ve mortalitelerinin azaltılması için insülin direnci açısından değerlendirilmeleri faydalı olacaktır. Bu çalışma bu konuda literatürde yapılmış olan ilk çalışmadır.
The Association Between Beta2-Microglobulin Levels, Inflammation and Nutritional Status in Chronic Hemodialysis and Kidney Transplant Patients
(2017) Tutal, Emre; Demirci, Bahar Gurlek; UyaniK, Saliha; Ekenci, Damla; Sezer, Siren
The Associations Between Sodium Intake and Kidney Damage with Echocardiographic Parameters in Renal Transplant Recipients
(2017) Tutal, Emre; Demirci, Bahar Gurlek; Sezer, Siren; Uyanik, Saliha; Ozdemir, Ozlem; Colak, Turan; Haberal, Mehmet; https://orcid.org/0000-0002-8372-7840; https://orcid.org/0000-0002-3462-7632; AAJ-8554-2021; AAJ-8097-2021
The Associations Between Sodium Intake and Kidney Damage with Echocardiographic Parameters in Renal Transplant Recipients
(2017) Tutal, Emre; Demirci, Bahar Gurlek; Sezer, Siren; Uyanik, Saliha; Ozdemir, Ozlem; Colak, Turan; Haberal, Mehmet; https://orcid.org/0000-0002-8372-7840; https://orcid.org/0000-0002-3462-7632; AAJ-8554-2021; AAJ-8097-2021
Blood Pressure and Age Are the Main Determinants of Aortic Stiffness
(2017) Sezer, Siren; Guclu, Aydin; Nar, Goksay; Icli, Atilla; Ozhan, Nail; 28982100
Böbrek nakilli hastalarda, normal popülasyonda ve kronik böbrek yetmezlikli hastalarda serum insülin benzeri büyüme faktörü-1, kas gücü ve kas kitlesi arasındaki ilişkilerin karşılaştırması
(Başkent Üniversitesi Tıp Fakültesi, 2016) Yıldırım, Saliha; Sezer, Siren
Böbrek nakli günümüzde KBH’ın en seçkin tedavi yöntemidir. Böbrek nakil hastalarında sarkopeni üzerinde çok fazla çalışmanın olmadığı bir konudur. İnsülin benzeri büyüme faktörü-1 (IGF-1) sağlıklı toplumda sarkopeni ile ilişkisi bilinen bir faktördür. Bu çalışmanın amacı; böbrek nakil hastalarında, benzer demografik özelliklere sahip kronik böbrek hastalarında ve böbrek fonksiyonu normal bireylerde serum IGF-1 düzeyi, kas gücü ve kas kitlesi arasındaki ilişkiyi ortaya koymaktır. Çalışma Başkent Üniversitesi Ankara Hastanesi Nefroloji Bilim Dalı’nda takip edilen ve 8 Mart 2016 - 30 Mayıs 2016 tarihleri arasında başvuran hastalarda gerçekleştirildi. Çalışma 120 erkek, 60 kadın olmak üzere 180 böbrek nakil hastası ve benzer yaş grubundaki 30 kadın, 30 erkekten oluşan 60 kontrol ve 30 erkek, 30 kadından oluşan 60 kronik böbrek hastası üzerinde kesitsel olarak yapıldı. Hastaların cinsiyetleri, yaşları, vücut ağırlıkları, boyları, vücut kitle indeksleri, kas güçleri, triceps kalınlığı, üst kol çevresi, bel çevresi, 10 metre yürüme testi sonuçları, biyoelektrik impedans ölçümleri, IGF-1 düzeyleri ve laboratuvar değişkenleri kaydedildi. Yaş ve sigara gibi faktörlerin benzer olduğu gruplarda yapılan analizlerde böbrek nakil hastalarında kas gücü normal popülasyona göre düşük olsa da KBH grubuna göre istatistiksel anlamlı olarak yüksek bulunmuş; hastalarda kas gücünün kas kitlesi, yaş ve kreatinin düzeyi ile kas kitlesinin ise sadece IGF-1 düzeyi ile ilişkili olduğu bulunmuştur. IGF-1 düzeyleri KBH ve böbrek nakil gruplarında benzer iken bu iki grubun düzeyleri kontrol grubundan daha yüksek bulundu. Sonuç olarak kronik böbrek hastalığı sarkopeniye yol açmaktadır ve böbrek naklinden sonra bu durum kısmi olarak düzelmektedir. Sarkopeni varlığı kas kitlesi, kreatinin düzeyi ve yaş ile direkt ilişkili iken, kas kitlesi ise sadece yüksek IGF-1 düzeyi ile ilişkili bulunmuştur. IGF-1 düzeyi yüksek hastalarda sarkopeninin IGF-1 düzeyi normal olanlara göre daha fazla görülmesi böbrek nakli sonrası hastalarda IGF-1’e duyarlılığın artması fakat düzeylerinin tamamen normale dönmemesi ile açıklanabilir. Renal transplantation is the ideal treatment of chronic kidney disease in selected populations. Sarcopenia is an underestimated problem in renal transplant recipients. It is known that sarcopenia is related to IGF-1 resistance in general populations. The aim of this study was to investigate the differences of muscle mass, muscle strength and insuline like growth factor-1 levels (IGF-1) and their relationships with each other in renal transplant recipients, patients with chronic kidney disease and controls. This study was performed in Ankara Baskent University Hospital between 8 March 2016 and 30 May 2016. 120 male and 60 female transplant recipients, 30 male and 30 female patients with chronic kidney disease, 30 male and 30 female controls with normal renal function who were similar in age were included. Sex, ages, body weights, heights, body mass indexs, muscle strength, 10 meter walking time, bioelectrcal impedence measurements, waist circumference, triceps skinfold thickness, upper arm circumference, hand grip strength, IGF-1 levels and laboratory values were recorded. This study showed that renal transplant recipients had a better muscle strength than patients with chronic kidney disease but still a worse muscle mass than controls. In regression analyzes muscle strength was related to age, levels of serum creatinine and muscle mass. Muscle mass was related to only IGF-1 serum levels. IGF-1 levels were similar in renal transplant recipients and patients with chronic kidney disease, but IGF-1 levels of both groups were higher than control population. High IGF-1 levels were related to sarcopenia. In conclusion chronic renal disease contributes to sarcopenia, and in renal transplant recipients it is partially improved. Sarcopenia is associated with creatinine levels and muscle mass and muscle mass is related to high IGF-1 levels. It can be speculated that this is a result of the IGF-1 resistance in kidney disease which is suboptimally improved in renal transplant recipients.
Böbrek nakli sonrası uzun dönemde insülin direnci üzerine etkili faktörler
(Başkent Üniversitesi Tıp Fakültesi, 2009) Şaşak, Gülşah; Sezer, Siren
İnsülin direnci (İD) ’nin nakil sonrası diyabetin erken ve güçlü bir belirleyicisi olması yanı sıra diyabet ve hiperglisemi yokluğunda bile kardiyovasküler mortalite ve morbiditeyi artırdığı bilinmektedir. Demografik özellikleri benzer normal populasyonla karşılaştırıldığında İD, böbrek nakli yapılan hastalar arasında daha sık bulunmuştur. Bizde çalışmamızda açlık kan glukozu normal olan böbrek nakli hastalarında İD sıklığını ve kullanılan immünsüpresif ilacın serum seviyesi, dozu, obesite, yaş, kullanılan antihipertansif ilaçlar gibi faktörlerle ilişkili olup olmadığını saptamaya çalıştık. Çalışmamıza 1992–2006 yılları arasında Ankara Başkent Üniversitesi Hastanesi’nde böbrek nakli yapılan 106 hasta alındı. İD varlığını tespit etmek için HOMA-IR kullanıldı. HOMA-IR≥2,5 anlamlı kabul edildi. Çalışmaya alınan hastalarda İD sıklığı; %53,8 (n:57) olarak saptandı. Bel-kalça oranı ve kreatinin klirensi İD olan grupta anlamlı olarak daha yüksek saptandı (sırasıyla p=0,001, p=0,037). HOMA-IR; yaş (r=0,272,p=0,005), bel –kalça oranı (r=0,330,p=0,001), VKİ (r=228,p=0,019) ile korele bulundu. HOMA-IR ye etki eden bağımsız faktörleri belirlemek için yapılan multilineer regresyon analizinde bel-kalça oranı ile ilişkili idi (beta=0,238, p=0,022). Homa-IR düzeyi siklosporin A, sirolimus, takrolimus kullanan hastalarda sırasıyla 2,9±1,3, 2,4±1,5 ve 3,1±1,8 olarak saptandı (p>0.005) . Siklosporin A kullanan hastalarda yaş (r=0,328, p=0,048), bel-kalça oranı (r=0,421, p=0,010) ve VKİ (r=0,402, p=0,014) HOMA-IR ile korelasyon gösterdi. Sirolimus kullananlarda HOMA-IR ile VKİ (r=0,479, p=0,006) ile korele idi. Takrolimus kullananlarda ise bel-kalça oranı (r=0,443, p=0,006) ile korele idi. Multilineer regresyon analizinde HOMA-IR düzeyi, CsA ve takrolimus kullanan grupta bel-kalça oranı, sirolimus kullanan grupta VKİ ile korele idi (sırasıyla beta=-0,421, p=0,012, beta=0,379, p=0.023, beta= 0,529, p=0.007). Çalışmamızda sonuç olarak nakil sonrası uzun dönemde İD üzerine en etkili faktörün belkalça oranı olduğu gösterilmiştir. Sonuçlarımız açlık kan glukozu normal olsa bile hastalarda İD’nin araştırılması ve uygun diyet, fiziksel aktivite önerilmesi ile uzun süreli sonuçların daha da iyileşebileceğini düşündürmektedir. Insulin resistance (IR) is an early and very strong predictor of post-transplant diabetes mellitus as well as an important cardiovascular risk factors even in the absence of hyperglycemia. Patients after renal transplantation are insulin resistant compared to a control group with similar demographic characteristics. The aim of the study was to determine the frequency of IR in renal allograft patients without glucose disorders, to correlate IR indexes with the doses of immunosuppressive medications and other risk factors such as age, obesity and antihypertensive therapy used. One hundred and six patients who received a kidney transplant at Baskent University Hospital between 1992 and 2006 were enrolled the study. IR was diagnosed when HOMA-IR is of IR in our patients was 53.8% (n: 57), Waist-hip ratio and creatinine clearance was higher in IR patients (respectively p=0,001, p=0,037). HOMA-IR was correlated age, waist-hip ratio, body mass index (BMI) (respectively r=0,272,p=0,005, r=0,330,p=0,001, r=228,p=0,019). The waist-hip ratio was positively associated with HOMA-IR after multivariate analysis (beta=0,238, p=0,022). HOMA-IR level was 2,9±1,3, 2,4±1,5 and 3,1±1,8 in patients used cyclosporine A (CsA), sirolimus, tacrolimus (p>0.005). In patients used CsA, HOMA-IR was correlated with age, waisthip ratio, and BMI (respectively r =0,328, p=0,048, r=0,421, p=0,010, r=0,402, p=0,014). it was correlated with BMI in patients used sirolimus (r=0,479, p=0,006), and waist-hip ratio (r=0,443, p=0,006) in patients used tacrolimus. BMI was associated with HOMA-IR in all groups in multivariate analysis (respectively beta=-0,421, p=0,012, beta=0,379, p=0.023, beta= 0,529, p=0.007). Our results indicate that abdominal waist-hip ratio is a major determinant of IR after renal transplantation. Even in the absence of hyperglycemia, renal transplant patients may have IR. If obesity is prevented, the long term patients and graft survival may be better than now.
Bone Loss Is Associated with Graft Dysfunction at the Time of First Year of Kidney Transplantation: A Cross-Sectional Study
(2014) Sezer, Siren; Demirci, Bahar Gurlek; Tutal, Emre; Guliyev, Orhan; Sayin, Cihat Burak; Acar, Fatma Nurhan Ozdemir; Haberal, Mehmet; https://orcid.org/0000-0002-7326-8388; https://orcid.org/0000-0001-8287-6572; https://orcid.org/0000-0002-5682-0943; https://orcid.org/0000-0002-3462-7632; J-3707-2015; AAK-1697-2021; AAJ-8097-2021
Comparison of the Effects of Paricalcitol and Calcitriol on Vascular Calcification in Patients Undergoing Chronic Hemodialysis
(2021) Karakose, Suleyman; Bal, Zeynep; Sezer, Siren; 0000-0002-7326-8388; AAZ-5795-2021
Introduction: Secondary hyperparathyroidism is considered an unconventional risk factor of vascular calcification in hemodialysis patients (HPs). An important factor of vascular calcification is vitamin D receptor activator used in the treatment of secondary hyperparathyroidism. This study aimed to investigate the change in pulse wave velocity (PWV) and fibroblast growth factor-23 (FGF-23), Klotho, and 25-hydroxyvitamin D [25(OH)D] levels as a result of 1-year treatment with paricalcitol or calcitriol among patients undergoing chronic dialysis. Methods: Eighty HPs were included in the study, and PWV measurements were obtained at the beginning and after 1 year of treatment. Serum Klotho and 25(OH)D levels were evaluated at the end of 1-year treatment with paricalcitol or calcitriol. Results: At the end of 1 year, FGF-23 levels in the paricalcitol group were significantly lower than those in the calcitriol group. Klotho and 25(OH)D levels were significantly higher in the paricalcitol group. The PWV at the beginning of the study was statistically similar between the two groups; in contrast, PWV at 1 year was significantly lower in the paricalcitol group than in the calcitriol group (p=0.002). When the PWV change was considered as the dependent variable, the most powerful determinant in multiple regression analysis was the FGF-23 level. Conclusion: In HPs, paricalcitol has a protective effect against vascular calcification compared with calcitriol treatment, owing to its positive effects on both parathyroid hormone and calcium-phosphorus balance. Therefore, paricalcitol should be the first choice in the treatment of secondary hyperparathyroidism.
Depression, Inflammation, and Social Support in Hemodialysis Patients
(2015) Yavuz, Rahman; Yavuz, Demet; Altunoglu, Alparslan; Canoz, Mujdat Batur; Sezer, Siren; Yalcin, Bektas Murat; Demirag, Mehmet Derya
Aim: Depression and inflammation are common in patients with end-stage renal disease (ESRD). In our study, we aimed to investigate the relationship between depression, inflammation and social support. Material and Method: Accordingly. 137 patients were enrolled. We used Beck Depression Inventory (BDI) and Multidimensional Scale of Perceived Social Support (MSPSS) and Malnutrition Inflammation Score (MIS) in all patients. Results: BDI, MSPSS and MISS were 15.9 +/- 9.5,60.5 +/- 15.1,7.8 +/- 2.9 respectively. The patients were divided into two groups with respect to BDI scores: patients with depression (BDI score >= 7, n=55, 40.2%) and patients without depression (BDI score< 17.0 =82, 59.8%). In depressive patients, the majority were female (58%) and lived alone (97%). The weekly erythropoietin dose and CRP levels were higher in patients with depression than in patients without depression and this difference did not reach statistical significance (p>0.05). MIS scores were higher in patients with depression (10.5 +/- 1.8) than in patients without depression (6 +/- 2.2) (p<0.001). Patients with depression (57.3 +/- 1 7.91 had lower MSPSS scores than patients without depression (62.7 +/- 12.5) (p<0.05). There was positive correlation between BDI and MIS, while negative correlation was observed between BDI and MSPSS. In the multivariate linear regression analysis (gender, BUN, albumin, MIS and MSPSS), depression was independently associated with MIS (beta=0.60, t=9.9 p<0.001) and MSPSS (beta=-0.37, t=-6.2 p<0.001). Discussion: Hemodialysis patients needed more social and psychological support. They had higher inflammation and lower social support that associated with the presence of depression, although large-scale studies are needed to confirm our results.
Dietary Fiber Intake: Its Relation With Glycation End Products and Arterial Stiffness in End-Stage Renal Disease Patients
(2019) Demirci, Bahar Gurlek; Tutal, Emre; Eminsoy, Irem O.; Kulah, Eyup; Sezer, Siren; 30314838; AAB-3881-2021
Objective: We aimed to analyze the relationship between the effect of total dietary fiber intake on C-reactive protein (CRP) and on oxidative stress parameters such as serum advanced glycation end products (AGEs), superoxide dysmutase (SOD), malondialdehyde, and arterial stiffness by pulse wave velocity (PWv) in maintanace hemodialysis (MHD) patients. Methods: Among 650 MHD patients, 128 were selected according to inclusion criteria. The dietary survey was performed with a 3-day dietary history. Dietary fiber level was adjusted for total energy intake by the residual method. Patients were stratified by quartiles of adjusted dietary fiber (ADF) level as group 1 (n = 32) (ADF: <8.86 g/day), group 2 (n = 35) (ADF: 8.86-12.50 g/day), group 3 (n = 31) (ADF: 12.51-15.90 g/day), and group 4 (n = 30) (ADF: >= 15.91 g/day). Monthly assessed biochemical parameters including serum hemoglobin, albumin, CRP, calcium, phosphorus, and lipid profile levels were recorded. Serum AGEs, SOD, and malondialdehyde levels were determined by ELISA method. The PWv was determined from pressure tracing over carotid and femoral arteries. Results: Patients in group 3 and 4 had significantly lower CRP and AGE than those in group 1 and 2. Mean serum SOD level and PWv were significantly higher in group 4. In regression analysis, ADF intake was the unique predictor for both AGE (r(2) = 0.164, P = 0.017) and CRP levels (r(2) = 0.238, P = 0.01). Conclusion: Present data show that dietary fiber intake is independently correlated with inflammation and oxidative stress. In addition, decreased fiber intake results in impaired arterial stiffness. Thus, adequate fiber intake could prevent cardiovascular events and inflammatory processes in patients undergoing MHD. (C) 2018 by the National Kidney Foundation, Inc. All rights reserved.
Differential Influence of Vitamin D Analogs on Left Ventricular Mass Index in Maintenance Hemodialysis Patients
(2014) Sezer, Siren; Tutal, Emre; Bal, Zeynep; Uyar, Mehtap Erkmen; Bal, Ugur; Cakir, Ulkem; Acar, Nurhan Ozdemir; Haberal, Mehmet; https://orcid.org/0000-0002-7326-8388; https://orcid.org/0000-0002-9446-2518; https://orcid.org/0000-0002-3462-7632; 24619898; JYQ-2550-2024; AAZ-5795-2021; AAK-4322-2021; AAJ-8097-2021
Purpose: Secondary hyperparathyroidism (SHPT) is a common feature in maintenance hemodialysis (MHD) patients. Inadequate treatment of SHPT has been associated with cardiovascular complications, and vitamin D therapy might influence the development of cardiovascular diseases. In the present study, we aimed to evaluate the effects of intravenous paricalcitol and calcitriol treatments on left ventricular mass index changes in MHD patients. Methods: We conducted an observational study with a 12-month follow-up duration to compare the outcomes of intravenous paricalcitol and calcitriol treatments in MHD patients. Eighty patients with moderate to severe SHPT were enrolled in the study. All the patients had normalized total serum Ca concentration <10.5 mg/dL, serum calcium-phosphorus product (Ca x P) <75, and parathyroid hormone level (PTH) level >= 300 pg/mL at the begining of the follow-up period. Results: The patients were divided into a paricalcitol group (n = 40) and a calcitriol group (n = 40). The demographic, clinical, and biochemical characteristics of the patients were similar at baseline. We observed significantly superior control of SHPT; lesser frequency of hypercalcemia and hyperphosphatemia, and Ca x P level elevations; and interruption of vitamin D treatment in the paricalcitol group. Moreover, we found no significant change in left ventricular mass index in the paricalcitol group, but found a significantly increased left ventricular mass index in the calcitriol group during the follow-up period (from 136.6 +/- 35.2 g/m(2) to 132.9 +/- 40.4 g/m(2) vs. from 137.2 +/- 30.1 g/m(2) to 149.4 +/- 31.0 g/m(2); p<0.044). Conclusion: We observed that, compared with calcitriol therapy, paricalcitol therapy reduced the PTH concentrations more effectively without causing hypercalcemia and hyperphosphatemia and might have a substantial beneficial effect on the development of left ventricular hypertrophy.
Early Conversion to mTOR Inhibitors Prevents Kidney Function Better Than Late Conversion
(2018) Atay, Gokhan; Sayin, Burak; Colak, Turan; Acar, Nurhan Ozdemir; Sezer, Siren; Haberal, Mehmet; 0000-0001-8287-6572; 0000-0002-8372-7840; 0000-0002-3462-7632; J-3707-2015; AAJ-8554-2021; AAJ-8097-2021
The Effect of Hemodialysis on Balance Measurements and Risk of Fall
(2016) Erken, Ertugrul; Ozelsancak, Ruya; Sahin, Safak; Yilmaz, Emine Ece; Torun, Dilek; Leblebici, Berrin; Kuyucu, Yunus Emre; Sezer, Siren; https://orcid.org/0000-0002-0788-8319; https://orcid.org/0000-0002-6267-3695; 27497737; AAD-5716-2021; AAD-9111-2021
Patients with end-stage renal disease (ESRD) have increased risk of falls and fall-related complications. Other than aging and factors related to chronic kidney disease, treatment of hemodialysis may also contribute to this increased risk. The aim of this study was to demonstrate the impairment of balance after a session of hemodialysis with a quantitative assessment and reveal an increased fall risk that would possibly be related to treatment of hemodialysis for patients on maintenance hemodialysis. Fifty-six patients with ESRD on chronic hemodialysis program and 53 healthy individuals were involved in this study. Fall Index percentages were calculated, and fall risk categories were determined for all patients and healthy controls using Tetrax posturography device (Sunlight Medical Ltd Israel). The patient group was evaluated twice for balance, before and after a routine session of hemodialysis. Fall Index scores of healthy controls were lower than that of ESRD patients (p = 0.001). In the patient group, we found the mean Fall Index to be significantly higher at the post-dialysis assessment compared to the pre-dialysis assessment (p = 0.003). The number of patients with high risk of falling also increased at the post-dialysis assessment yet the difference did not reach significance. Fall Index was correlated with the increase in age only at the pre-dialysis balance measurement (p = 0.038). Patients with better dialysis adequacy had significantly lower Fall Index scores than the others at the pre-dialysis balance measurement (p = 0.004). The difference was not significant at the post-dialysis measurement. In the current study, we evaluated the balance of ESRD patients before and after a routine session of hemodialysis treatment. This is the first study to investigate the effect of hemodialysis on balance, using an electronic posturographic balance system. We found the Fall Index score to be significantly higher after hemodialysis, indicating a negative effect of hemodialysis on postural stability. As expected, our data showed an increased Fall Index score correlated with the increase in age both in ESRD patients and in healthy controls. However, the correlation with age was not observed for the patient group at the post-dialysis balance measurement. We might conceive that young patients with ESRD are also prone to fall risk after a session of hemodialysis. Methods that provide quantitative assessment for fall risk could be rather beneficial for high-risk populations such as patients on maintenance hemodialysis.
Effect of Smoking on Peripheral Blood Lymphocyte Subsets of Patients With Chronic Renal Failure
(2016) Birben, Ozlem Duvenci; Akcay, Sule; Sezer, Siren; Sirvan, Sale; Haberal, Mehmet; 0000-0002-8360-6459; 0000-0002-3462-7632; 27805522; AAB-5175-2021; AAJ-8097-2021
Objectives: Smoking is known to suppress the immune system. It is also known that chronic renal failure affects the immune system. However, the number of studies investigating the effects of chronic renal failure and smoking together is limited. In our study, we examined whether smoking affects the diminished response of the immune system in patients with chronic renal failure. Materials and Methods: We compared peripheral blood lymphocyte subsets in smoking and nonsmoking patients with chronic renal failure. We also used the Fagerstrom Test for Nicotine Dependence to evaluate its correlation with the lymphocyte subset count in patients who are current smokers. Results: Our study included 126 patients with chronic renal failure. According to their smoking habits, patients were divided into 2 groups: smokers and nonsmokers. The average age of patients who were smokers was 53.2 +/- 1.5 years, with average age of nonsmokers being 59.2 +/- 2.2 years. The average duration of smoking in smokers was 30.7 +/- 2.7 pack-years. We found that the percentage of cluster of differentiation 16-56 cells (natural killer cells) and lymphocyte percentage were significantly lower among smokers in our study (P < .05). We compared the lymphocyte subset panel to pack-years and found that the rate of cluster of differentiation 16-56 cells decreased as smoking duration increased. Conclusions: Our study revealed that smoking suppresses the immune system, as measured by lymphocyte subsets, in patients with chronic renal failure, similar to that shown in healthy smokers. According to our findings, patients with chronic renal failure, where infection is the primary reason for mortality and morbidity, must be questioned for smoking and referred to smoking cessation clinics. Because of its immunosuppressive effects, smoking behaviors must be solved preoperatively in transplant candidates.
Endothelial Nitric Oxide Synthase Polymorphism Influences Renal Allograft Outcome
(2014) Uyar, Murathan; Sezer, Siren; Ozdemir, Fatma Nurhan; Kulah, Eyup; Arat, Zubeyde; Atac, Fatma Belgin; Haberal, Mehmet; https://orcid.org/0000-0002-7326-8388; https://orcid.org/0000-0002-5682-0943; https://orcid.org/0000-0001-6041-4254; https://orcid.org/0000-0001-6868-2165; https://orcid.org/0000-0002-3462-7632; 24372826; AAK-5313-2021; JYQ-2550-2024; AAK-1697-2021; AAJ-5764-2021; ABG-9966-2020; AAJ-8097-2021
BackgroundAtherosclerotic lesions within the graft are considered to be a major cause of interstitial fibrosis/tubular atrophy (IF/TA). We evaluated the factors that influence the development of IF/TA and three- and five-yr graft survival including nitric oxide synthase (eNOS) and angiotensin II type 1 and type 2 receptor gene polymorphism. MethodsSeventy-one male and 35 female patients (age: 34.911.2yr) who underwent living-related renal transplantation were included. Angiotensin type 1 and type 2 receptor gene polymorphisms and eNOS intron 4 gene polymorphism were analyzed. The pre- and post-transplant laboratory data, patient characteristics, acute rejection episodes, and presence of IF/TA were evaluated. ResultsPatients with the bb allele of eNOS gene had a lower prevalence of post-transplant third year (12.6% and 38.5%, p=0.005) and fifth year IF/TA (46.6% and 82.3%, p=0.02) and a lower incidence of five-yr graft failure (35.4% and 55.6%, p<0.005). The eNOS gene polymorphism was independent and was the most prominent factor associated with third and fifth year IF/TA (p=0.01, RR: 29.72, and p=0.03, RR: 4.1, respectively). No significant relationship existed when angiotensin II gene polymorphisms were considered. ConclusionsWe concluded that recipient eNOS gene polymorphism can predict IF/TA, and the presence of the bb allele is associated with better graft outcome.
Epidemiological features of primary glomerular disease in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group
(2020) Sezer, Siren; 33189135
Background The largest data on the epidemiology of primary glomerular diseases (PGDs) are obtained from the databases of countries or centers. Here, we present the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group. Methods Data of patients who underwent renal biopsy and received the diagnosis of PGD were recorded in the database prepared for the study. A total of 4399 patients from 47 centers were evaluated between May 2009 and May 2019. The data obtained at the time of kidney biopsy were analyzed. After the exclusion of patients without light microscopy and immunofluorescence microscopy findings, a total of 3875 patients were included in the study. Results The mean age was 41.5 +/- 14.9 years. 1690 patients were female (43.6%) and 2185 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGD was IgA nephropathy (25.7%) followed by membranous nephropathy (25.6%) and focal segmental glomerulosclerosis (21.9%). The mean total number of glomeruli per biopsy was 17 +/- 10. The mean baseline systolic blood pressure was 130 +/- 20 mmHg and diastolic blood pressure was 81 +/- 12 mmHg. The median proteinuria, serum creatinine, estimated GFR, and mean albumin values were 3300 (IQR: 1467-6307) mg/day, 1.0 (IQR: 0.7-1.6) mg/dL, 82.9 (IQR: 47.0-113.0) mL/min and 3.2 +/- 0.9 g/dL, respectively. Conclusions The distribution of PGDs in Turkey has become similar to that in other European countries. IgA nephropathy diagnosed via renal biopsy has become more prevalent compared to membranous nephropathy.