Browsing by Author "Torun, Dilek"

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Approach to cases with resistant hypertension
(2014) Torun, Dilek
Resistant hypertension is defined as blood pressure that remains above 140/90 mm Hg despite the concurrent use of optimal dose of 3 antihypertensive agents of different classes. Ideally, 1 of these 3 agents should be a diuretic agent. The etiology of resistance hypertension is multifactorial. Successful treatment requires identification and reversal of lifestyle factors (obesity, dietary salt intake, alcohol intake, lack of adherence to prescribed medicines, and interfering substances), and to exclude the presence of pseudoresistance. Once confounding factors have been ruled out, evaluation for potentially treatable secondary causes of hypertension should be considered. Most forms of secondary hypertension are related with adrenal or renal disorders such as primary hyperaldosteronism and renovascular disease. Although, obstructive sleep apnea syndrome is not a typical cause of secondary hypertension, it is commonly present in resistant hypertension. Diagnostic workup and management of resistant hypertension were discussed in different clinical presentations.
Assessment of Hemoglobin Stability in Chronic Hemodialysis Patients Receiving Erythropoietin Therapy and the Effect of Hemoglobin Stability on Risk of Cardiovascular Disease
(2019) Guncan, Melda Ulas; Guncan, Sabri; Torun, Dilek
Objective: Anemia is one of the most important factors that decrease the quality of life in patients with end-stage renal desease receiving hemodialysis treatment. In these patients, Erythropoietin stimulating agents (ESAs) are used in the treatment of anemia. Although the target hemoglobin (Hb) value in chronic renal failure is 11-12 gr/dL, it is suggested that hemoglobin values fluctuate between normal, high and low values in the great majority, leading to cardiovascular structural changes which increase mortality. In this study, we investigated the effect of anemia and hemoglobin fluctuations on mortality rate and the risk of cardiovascular disease in chronic hemodialysis patients who received ESA thearapy. Materials and Methods: Hemoglobin values for 12 months of 181 patients were examined. The target Hb level was 11-12 gr/dL interval and the patients were divided into 6 groups according to the hemoglobin values; persistently low, low-normal, target, normal-high, low-high and persistently high. According to the variability in hemoglobin level, groups were compared in terms of demographic, laboratory characteristics, treatment, risk of cardiovascular disease, hospitalization and death frequency and causes. Result: The total of 181 patients were classified according to Hb levels; 22 (12.2%) patients were persistently-low, 72 (39.8%) were low-normal, 10 (5.5%) were normal-high and 77 (42.5%) patients were low-high Hb group. During the 12 month fallow up, there were no patients in target and high Hb group. The groups were similar in terms of the presence of comorbid diseases such as diabetes, hypertension, coronary artery disease and other demographic characteristics, and there was no difference between groups in terms of cardiovascular disease development. ESA doses and blood transfusion counts and mortality rates were significantly higher in the persistently-low hemoglobin group compared to the other groups. Conclusion: In our study, high rate of anemia and hemoglobin fluctuations were shown in chronic hemodialysis patients and anemia was associated with mortality. However, the possible association of these variables with cardiovascular diseases was not observed. Further studies are needed in the larger hemodialysis patient group to investigate the relationship between hemoglobin fluctuation and mortality and cardiovascular risk.
The Association of Upper Extremity Deep Vein Thrombosis and Homozygosity for the MTHFR 1298A-C Mutation in a Young Women with Membranoproliferative Glomerulonephritis
(2014) Yildiz, Ismail; Torun, Dilek; Ozelsancak, Ruya; Ozkan, Ugur; Canpolat, Tuba; 0000-0002-6267-3695; 0000-0002-0788-8319; AAD-9111-2021; AAD-5716-2021; AAK-8107-2021
Nephrotic syndrome increases the tendency to thromboembolic complications in both adults and children. Changes in the plasma concentrations of many proteins concerned with regulation of clotting and fibrinolytic systems, hyperviscosity, dehydration, corticosteroid and diuretic therapy may also contribute to thromboembolism. In addition, some of the genetic disorders also increase tendency to thromboembolic events. One of these disorders is methylene tetrahydrofolate reductase (MTHFR) A1298C mutation, which may cause hyperhomocysteinemia and thrombotic events when the folate level is low. A 26-year-old female was admitted to hospital with upper extremity deep vein thrombosis and nephrotic range proteinuria. On her renal biopsy, membranoproliferative glomerulonephritis (MPGN) was found. The other causes of thrombosis were excluded and homozygosity for the MTHFR A1298C mutation was determined. The levels of homocysteine and folic acid were normal. We report a first case of MPGN together with homozygosity for MTHFR 1298C mutation in adult nephrotic syndrome, complicated with unusual upper extremity venous thrombosis.
Cerebrovascular events in hemodialysis patients; a retrospective observational study
(2019) Ozelsancak, Ruya; Micozkadioglu, Hasan; Torun, Dilek; Tekkarismaz, Nihan; 0000-0002-0788-8319; 31830923
Background This study reports findings in subjects who underwent brain imaging for any reason, and examined factors influencing cerebrovascular events (CVEs) in hemodialysis (HD) patients. Methods We reviewed the files of patients on HD between January 2015 and January 2018. A total of 432 patients who underwent HD for at least 5 months by the January 2015 and who were older than 18 years were included in the study; 264 had been examined by cerebral computed tomography or magnetic resonance imaging examination within the 3 years. Cerebrovascular pathology was detected in 139 of 264 patients. Results Of the 139 patients, 65 (24.62%) had ischemic lesions, 25 (9.47%) had hemorrhagic lesions, and 49 (18.56%) had cerebral small vessel disease (CSVD). We compared recorded data and later clinical findings between patients with and those without CVEs. The cause of end-stage renal disease was diabetes in 58.5% of patients with ischemic lesions, 52% in those with hemorrhagic lesions, and 55% in those with CSVD (P < 0.05). Patients with cerebrovascular ischemia were older (P = 0.0001) and had lower serum creatinine (sCr) (P = 0.0001) and higher serum C-reactive protein (CRP) (P = 0.002) levels than normal subjects. Hemorrhagic patients were older (P = 0.003) and had lower sCr (P = 0.003) and serum predialysis potassium (P = 0.003) and parathyroid hormone (PTH) (P = 0.004) levels than normal subjects. Patients with CSVD were older (P < 0.0001) and had lower sCr (P < 0.0001), phosphorus (P < 0.007), and PTH (P < 0.013) and higher CRP (P < 0.002) levels than normal subjects. Conclusions HD patients with CVEs are older and typically have diabetes mellitus and lower sCr levels.
THE CHANGE OF FRONTAL QRS-T ANGLE AFTER RENAL TRANSPLANTATION IN DIALYSIS PATIENTS
(2020) Acibuca, Aynur; Yilmaz, Mustafa; Okar, Sefa; Kus, Murat; Caliskan, Kenan; Torer, Nihan; Torun, Dilek; Moray, Gokhan; Muderrisoglu, Haldun; Haberal, Mehmet A.
Characteristics and Survival Data of Patients with Primary Focal Segmental Segmental Glomerulosclerosis: Tsn-Goldmulti-Center Study
(2023) Dheir, Hamad; Cebeci, Egemen; Karadag, Serhat; Yildiz, Abdulmecit; Guller, Nurana; Altiparmak, Mehmet Riza; Eren, Necmi; Yilmaz, Zulfikar; Basturk, Taner; Sipahi, Savas; Sahin, Gulizar; Bakar, Betul; Okyay, Gulay Ulusal; Suleyman, Gultekin; Piskinpasa, Serhan Vahit; Dursun, Belda; Balal, Mustafa; Turgutalp, Kenan; Guzel, Fatma Betul; Kutlay, Sim; Tatar, Erhan; Elcioglu, Omer Celal; Karakan, Sebnem; Kayalar, Arzu Ozdemir; FarukAkcay, Omer; Yildirim, Tolga; Sahin, Idris; Sahin, Garip; Ogutmen, Melike Betul; Tokgoz, Bulent; Tunca, Onur; Gul, Cuma Bulent; Kurultak, Ilhan; Torun, Dilek; Ayar, Yavuz; Uzun, Sami; Yavuz, Mahmut; Oto, Ozgur Akin; Dincer, Mevlut Tamer; Ergul, Metin; Ozturk, Savas; Turkmen, Aydin; AAD-9111-2021
The Effect of Glomerular C3 Deposition on Renal Outcome in Patients with Membranous Nephropathy: Data of the Tsn-Gold Study
(2023) Gursu, Meltem; Ceheci, Egemen; Turkmen, Aydin; Dervisoglu, Erkan; Sezen, Mehnet; Turgutalp, Kenan; Sahin, Gulizar Manga; Trablus, Sinan; Kutlay, Sim; Uzun, Sami; Ustundag, Sedat; Dursun, Belda; Ayli, Deniz; Tatar, Erhan; Oztop, Kenan Evren; Basturk, Taner; Cevher, Simal Koksal; Yilmaz, Zulfikar; Tunca, Onur; Sevinc, Mustafa; Yadigar, Serap; Duranay, Murat; Arikan, Izzet Hakki; Elciuglu, Omer Celal; Karakan, Sebnem; Turkmen, Kultigin; Torun, Dilek; Gungor, Ozkan; Artan, Ayse Serra; Ozturk, Savas; Unsal, Abdulkadir; Seyahi, Nurhan; AAD-9111-2021
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.
The Effect of Serum Mannose-Binding Lectin Levels on Dialysis-Related Peritonitis and Catheter-Related Bacteremia
(2015) Erken, Ertugrul; Torun, Dilek; Sezgin, Nurzen; Micozkadioglu, Hasan; Zumrutdal, Aysegul; Ozelsancak, Ruya; Yildiz, Ismail; 0000-0002-6267-3695; 0000-0002-0788-8319; 0000-0001-5142-5672; 0000-0002-7054-1203; AAD-9111-2021; AAD-5716-2021; AAE-7608-2021; P-4517-2015
OBJECTIVE: Mannose-binding lectin (MBL) takes part in innate immunity through opsonisation and complement activation. Deficiency of MBL is associated with some infections and autoimmune disorders. This study focused on functional MBL deficiency and its effects on dialysis-related peritonitis and catheter-related bacteremia in patients with end stage renal disease. MATERIAL and METHODS: The study included 51 patients on chronic peritoneal dialysis (PD) program and 31 under maintenance hemodialysis (HD) who had tunneled/cuffed hemodialysis catheters (total 82). Serum MBL level measurements were performed by ELISA technique. RESULTS: The mean value for serum MBL in patient groups of PD, HD, and healthy controls were 2536.5 ng/ml, 2088.7 ng/ml, 1924 ng/ml respectively. Difference of MBL level was not significant among groups. Serum MBL value was negatively correlated to the number of peritonitis episodes in PD group (p=0.019). Deficiency of MBL was not associated with high incidence of peritonitis. Surveillance of catheter associated blood stream infection for tunneled/cuffed hemodialysis catheters was 2.07 episodes/1000 catheter days. An association with MBL deficiency and incidence of catheter-related bacteremia was not observed. CONCLUSION: Serum MBL value was negatively correlated to the number of peritonitis episodes but an expected association of MBL deficiency with high incidence of dialysis-related peritonitis and catheter-related bacteremia was not found. New studies with greater sample size might probably indicate the potential effect of MBL deficiency on dialysis-related peritonitis.
The Effects of Cinacalcet Treatment on Bone Mineral Metabolism, Anemia Parameters, Left Ventricular Mass Index and Parathyroid Gland Volume in Hemodialysis Patients with Severe Secondary Hyperparathyroidism
(2016) Torun, Dilek; Yildiz, Ismail; Micozkadioglu, Hasan; Nursal, Gul Nihal; Yiğit, Fatma; Ozelsancak, Ruya; 26787561
The aim of this study was to investigate the effects of cinacalcet therapy on anemia parameters, bone mineral metabolism, left ventricular mass index (LVMI) and parathyroid gland volume in hemodialysis (HD) patients with secondary hyperparathyroidism. Twenty-five HD patients (M/F: 11/14, mean age: 45.2 +/- 17.9 years, mean HD duration: 96.4 +/- 32.7 months) were included in this prospective pilot study. The indication to start calcimimetic therapy was persistent serum levels of parathyroid hormone (PTH) > 1000 pg/mL, refractory to intravenous (i.v.) vitamin D and phosphate-binding therapy. The initial and one-year results of adjusted serum calcium (Ca+2), phosphate (P), Ca x P product, PTH, hemoglobin (Hb) and ferritin levels, transferrin saturation index (TSAT), median weekly erythropoietin (EPO) dose, LVMI, and parathyroid volume by parathyroid ultrasonography were determined. There were no differences between pre-and posttreatment levels of serum Ca+2 (P = 0.853), P (P = 0.447), Ca x P product (P = 0.587), PTH (P = 0.273), ferritin (P = 0.153) and TSAT (P = 0.104). After 1 year of calcimimetic therapy, the Hb levels were significantly higher than the initial levels (P = 0.048). The weekly dose of EPO decreased with no statistical significance. The dose of cinacalcet was increased from 32.4 +/- 12.0 to 60.0 +/- 24.4 mg/day (P = 0.01). There were no differences between the pre-and post-treatment results regarding weekly vitamin D dose, parenteral iron dose, LVMI and parathyroid volume. The results of our study suggest that cinacalcet therapy might have an additional benefit in the control anemia in HD patients.
Eritropoetin tedavisi alan kronik hemodiyaliz hastalarında hemoglobin stabilitesinin değelendirilmesi ve hemoglobin stabilitesinin kardiyovasküler hastalık riski üzerine etkisi
(Başkent Üniversitesi Tıp Fakültesi, 2015) Ulaş Güncan, Melda; Torun, Dilek
Anemi hemodiyaliz tedavisi gören son dönem böbrek yetmezlikli hastalarda hayat kalitesini düşüren en önemli etkenlerden biridir. Bu hastalarda anemi tedavisinde eritropoezi uyaran ilaçlar (ESA) kullanılmaktadır. Kronik böbrek yetmezliğinde hedef hemoglobin (Hb) değeri 11-12 gr/dl olmasına rağmen hastaların büyük çoğunluğunda hemoglobin değerleri normal, yüksek ve düşük değerler arasında dalgalanma göstermekte olup bu dalgalanmanın mortaliteyi artırdığı, kardiyovasküler yapısal değişikliklere yol açtığı öne sürülmektedir. Bu çalışmada ESA tedavisi alan kronik hemodiyaliz hastalarında hemoglobin dalgalanmaları ve bunun kardiyovasküler hastalık riski üzerine etkisini araştırdık. 181 hastanın 12 aylık hemoglobin değerleri incelendi. Hedef Hb düzeyi 11-12 gr/dl aralığı olarak kabul edilip hastalar hemoglobin değerlerine göre sürekli düşük, düşük normal, hedef, normal yüksek, düşük yüksek ve sürekli yüksek olmak üzere göre 6 gruba ayrıldı. Hemoglobin düzeyindeki değişkenliğe göre gruplar, demografik, laboratuar özellikler, kullandığı tedaviler, kardiyovasküler hastalık riski, hospitalizasyon ve ölüm sıklığı ve nedenleri açısından karşılaştırıldı. Toplam 181 hasta 12 aylık ortalama Hb düzeylerine göre sınıflandırıldığında 22 (%12,2) hasta sürekli düşük, 72 (%39,8) hasta düşük-normal, 10 (%5,5) hasta normal-yüksek, 77 (%42,5) hasta düşük-yüksek Hb grubuna dahil oldu. 12 aylık takip süresince Hb değeri sürekli hedefte ve sürekli yüksek olan grupta hasta yoktu. Gruplar diyabet, hipertansiyon, koroner arter hastalığı gibi yandaş hastalıkların varlığı ve diğer demografik özellikler bakımından benzer olup, gruplar arasında mortalite ve kardiyovasküler hastalık gelişimi açısından fark saptanmadı. Yalnızca sürekli düşük Hb grubunda ESA dozları ve kan transfüzyon sayısı diğer gruplara göre anlamlı derecede yüksek saptandı. Bu çalışmada kronik hemodiyaliz (HD) hastalarında yüksek oranda anemi ve hemoglobin değişkenliği gösterilmiş olup bu etkenlerin kardiyovasküler hastalık riski ve mortalite gibi muhtemel olumsuz sonuçları istatistiksel olarak anlamlı saptanmamıştır. Hb değişkenliği ve kardiyovasküler risk arasındaki ilişkinin araştırılması için daha büyük HD hasta grubunda ileriye dönük çalışmalara ihtiyaç vardır. Anemia is one of the most important problems that reduce the quality of life for end-stage renal disease patients undergoing hemodialysis. Erythropoietin stimulating agents (ESAs) are used for treatment of anemia in these patients. Although target Hb value is 11-12 g/dl in patients with chronic kidney disease, these values show fluctuations in the majority of patients. It has been proposed that these fluctuations increase mortality and cause cardiovascular structural changes. In this study we investigated the effect of fluctuations of hemoglobin for the development of cardiovascular risk in chronic hemodialysis patients under treatment of ESA. 181 patients’ hemoglobin values were examined in the last 12 months. Target hemoglobin level was accepted as 11-12 g/dl. Patients were divided into 6 groups according to the level of hemoglobin as; persistently low, low-normal, target, high-normal, low-high, and persistently high. According to the variability in hemoglobin levels groups were compared in terms of the risk of cardiovascular diseases, frequency of hospitalizations and mortality, and demographics, laboratory data, and treatments used. A total of 181 patients were classified according to Hb levels. 22 patients (12,2%) were in persistently low, 72 were (39.8%) in low-normal, 10 were (5.5%) in normal-high, and 77 were (42.5%) in low-high Hb group. During the 12-month follow-up, there were no patients in target and high Hb group. Groups are distributed uniformly in terms of diabetes, hypertension, coronary artery disease, and in terms of other demographic characteristics. There was no difference in terms of mortality and cardiovascular disease development. Only in persistently low Hb group, the ESA doses and the number of blood transfusion were significantly higher than the other groups. In this study, high rates of anemia and hemoglobin variability has been shown in chronic hemodialysis (HD) patients. But the potential adverse consequences, such as the development of cardiovascular diseases and mortality were not statistically related to Hb variability. To determine the relationship between hemoglobin variability and cardiovascular risk factors, prospective studies are needed in the larger HD population.
The Evaluation of Clinical Signs in Patients with Suspected Renovascular Hypertension
(2018) Tekkarismaz, Nihan; Torun, Dilek; Ozkan, Ugur; Zumrutdal, Aysegul; Acar, Fatma Nurhan Ozdemir; 0000-0001-7631-7395; 0000-0002-5682-0943; 0000-0002-6267-3695; AAD-9088-2021; AAK-1697-2021; AAD-9111-2021
OBJECTIVE: Renovascular hypertension (RVH) is the most common yet correctable cause of secondary hypertension if diagnosed early. There are many clinical signs that can suggest RVH. The aim of this study was to find which clinical or laboratory signs are more indicative in diagnosing RVH and in determining which patients should go through renal angiography. MATERIAL and METHODS: The study included 184 patients who presented to our clinic due to hypertension and were under risk of RVH. All patients underwent three-dimensional time-of-flight Magnetic Resonance Angiography with phase-contrast. The patients were divided into two groups as with and without renal artery stenosis, supported by MRA. RESULTS: Advanced age, low body mass index, high serum creatinine level, presence of proteinuria, and patients with diabetes mellitus and coronary artery disease were found to be significant risk factors for RVH. Only the presence of renal asymmetry and the history of coronary artery disease were found to be independent risk factors. CONCLUSION: In conclusion, detailed patient history and the evaluation of renal size are very important for patients with hypertension. Coronary artery disease and a difference in renal size of more than 1.5 cm could be strong indicators of RVH.
Experience with antiviral agents for treatment of hepatitis C virus infection in hemodialysis patients on the kidney wait list
(2019) Torun, Dilek; Soydas, Baris; Tekkarismaz, Nihan; Ozelsancak, Ruya; Micozkadioglu, Hasan; Haberal, Mehmet; 30762283
Introduction Hepatitis C virus (HCV) infection is associated with increased mortality and morbidity in kidney transplant patients. The ability to establish a sustained viral response before renal transplant is important for these patients. Direct-acting antiviral agents can increase the sustained viral response in most patients with HCV infection. In this case series, we aimed to determine the efficacy and safety of a combined therapy of ombitasvir, paritaprevir, ritonavir, and dasabuvir with or without ribavirin in patients with HCV genotype 1 infection without cirrhosis and on hemodialysis who were awaiting deceased-donor kidney transplant. Methods Our study included eight male and two female HCV ribonucleic acid (RNA)-positive hemodialysis patients (mean age 50.7 +/- 15 years, mean hemodialysis duration 14 +/- 5.5 years, mean HCV duration 18 +/- 3.7 years). Findings Three patients with genotype 1a received oral therapy with 12.5 mg ombitasvir, 150 mg paritaprevir, 7 5 mg ritonavir, and 250 mg dasabuvir plus 200 mg ribavirin for 12 weeks. Seven patients with genotype 1b received 12.5 mg ombitasvir, 150 mg paritaprevir, 75 mg ritonavir, and 250 mg dasabuvir without ribavirin treatment for 12 weeks. The sustained virologic response rate was 100% at 12 weeks after completion of antiviral treatment in both treatment groups. No serious adverse effects were observed in either treatment group. Five patients had constitutional symptoms such as nausea, anorexia, and fatigue. During the treatment period, hemoglobin, white cell blood count, thrombocyte, and ferritin levels were similar to pretreatment levels. Treatment did not affect weekly erythropoietin and monthly intravenous iron treatment doses. Discussion Direct-acting antiviral agents are safe and effective for generating a sustained viral response in HCV genotype 1-infected hemodialysis patients on kidney wait lists.
Four-Year Analyses of Renal Graft Biopsies: A Single-Center Pathology Experience
(2017) Canpolat, Tuba; Ozdemir, Binnaz Handan; Torun, Dilek; Caliskan, Kenan; Haberal, Mehmet; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-6267-3695; https://orcid.org/0000-0002-8767-5021; https://orcid.org/0000-0002-3462-7632; 27099951; AAK-8107-2021; X-8540-2019; AAD-9111-2021; AAJ-7201-2021; AAJ-8097-2021
Objectives: Kidney transplant is the best treatment for patients with end-stage renal disease. Long-term graft survival depends on the protection of renal allograft function. Renal allograft biopsy is the most important method for examining an allograft function. Biopsy provides critical information, enabling diagnosis and grading of pathologic changes, prediction of response to therapy, and long-term graft prognosis. Materials and Methods: We reviewed the medical records of patients who underwent renal transplant from living and deceased donors at Baskent University Adana Teaching and Research Hospital between 2010 and 2014 and who had an indication for biopsy. Clinical characteristics and laboratory results of patients were recorded. Patient biopsy samples were examined according to the Banff 2009 classification. Results: Between 2010 and 2014, there were 175 renal transplants performed at our hospital, with 134 recipients (76.6%) having living-donor and 41 recipients (23.4%) having deceased-donor transplants. Fifty-one patients (29.1%) were children, and 124 patients (70.9%) were adults. We found that there were 123 biopsies made from 75 transplant patients over a 4-year period. When examined according to Banff 2009 criteria, the biopsy samples revealed acute T-cell-mediated rejection alone in 14.1% of the samples, acute antibody-mediated rejection in 4%, and a combination of the 2 rejections in 5.7%. Specific infections were detected in 12 patients. The graft nephrectomy rate was 5.1%. Conclusions: This study investigated biopsy results, their relation with patient clinical status and 4-year survival rates, and our pathology experience and found that rejection and infection rates were similar to the literature. Our future studies with a longer follow-up and a larger sample size will likely provide more accurate information about graft survival and biopsy results.
Heart Valve Disease Predict Mortality in Hemodialysis Patients: A Single Center Experience
(2019) Ozelsancak, Ruya; Tekkarismaz, Nihan; Torun, Dilek; Micozkadioglu, Hasan; 0000-0002-0788-8319; 30421548
Our aim is to investigate the clinical and laboratory findings affecting the mortality of the patients in 3 years follow-up who underwent hemodialysis at our center. In this retrospective, observational cohort study, 432 patients who underwent hemodialysis at our center for at least 5 months were included. The first recorded data and subsequent clinical findings of patients who died and survived were compared. Two hundred and ninety patients survived, 142 patients died. The mean age of the patients who died was higher (63.4 +/- 12.3 years, vs. 52 +/- 16.1 years, P = 0.0001), 60.5% of them had coronary artery disease (P = 0.0001), 93.7% of them had a heart valve disease. Duration of hemodialysis (survived 57 [21-260] months; died 44 [5-183] months, P = 0.000) was lower in patients who died. Serum potassium level before dialysis (5.1 +/- 0.6; 4.9 +/- 0.7 mEq/L, P = 0.030), parathyroid hormone (435 [4-3054]; 304 [1-3145] pg/mL, P = 0.0001), albumin (3.9 +/- 0.4; 3.8 +/- 0.4 mg/dL, P = 0.0001) and Kt/V (1.48 +/- 0.3; 1.40 +/- 0.3, P = 0.019) levels were lower, C-reactive protein (5[1-208]; 8.7[2-256] mg/L, P = 0.000) levels were higher in patients who died. Logistic regression analysis showed age (OR = 1.1), coronary artery disease (OR = 1.7) and more than one heart valve disease (OR = 2.4) are independent risk factors for mortality. Potassium level before dialysis (OR = 0.60), parathyroid hormone (OR = 0.99), and higher Kt/V (OR = 0.28) were found to be an advantage for survival. Age, coronary artery disease and especially pathology in more than one heart valve are risk factors for mortality. Heart valve problems might develop because of malnutrition and inflammation caused by the chronic renal failure.
The Higher Mortality Is Associated with Heart Valve Disease in End Stage Kidney Disease; A Single Center Experience
(2018) Ozelsancak, Ruya; Tekkarismaz, Nihan; Torun, Dilek; Micozkadioglu, Hasan; 0000-0002-6267-3695; 0000-0001-7631-7395; 0000-0001-5142-5672; 0000-0002-0788-8319; AAD-9111-2021; AAD-9088-2021; AAE-7608-2021; AAD-5716-2021
Investigation of miRNA and Anti HLA Antibodies Correlation in Patients with Kidney Transplant
(2018) Basturk, Bilkay; Sozer, Oktay; Kantaroglu, Bircan; Caliskan, Kenan; Torun, Dilek; Noyan, Aytul; Haberal, Mehmet; 0000-0002-8784-1974; 0000-0002-8767-5021; 0000-0002-6267-3695; 0000-0002-3462-7632; AAD-6918-2021; AAJ-7201-2021; AAD-9111-2021; AAD-5713-2021; AAJ-8097-2021
Listeriosis in a Patient Undergoing Hemodialysis: A Case Report and Review of the Literature
(2017) Tekkarismaz, Nihan; Ozelsancak, Ruya; Torun, Dilek; Aliskan, Hikmet Eda; 0000-0001-7631-7395; 0000-0001-9060-3195; 0000-0002-0788-8319; 0000-0002-6267-3695; AAD-9088-2021; AAE-2282-2021; AAD-5716-2021; AAD-9111-2021
Listeria monocytogenes (L. monocytogenes) infection is an uncommon manifestation in patients with chronic renal failure. In this article, we present a case of L. monocytogenes bacteremia in a patient undergoing hemodialysis. In addition, we are also present the listeriosis cases in hemodialysis patients reported so far in the literature. The patient was a 58-year-old man who was undergoing hemodialysis and had been admitted to hospital with fever. On the 5th day of admission, L. monocytogenes was detected in his blood cultures. He responded dramatically to ampicillin treatment. Listeriosis is a disease that requires careful microbiological laboratory examination. If the patient cultures are not analyzed carefully, the disease can be misdiagnosed. Only early diagnosis and adequate treatment can ensure a good prognosis.
Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single centre in Turkey
(2020) Tekkarismaz, Nihan; Torun, Dilek; 0000-0001-7631-7395; 0000-0002-6267-3695; 32041385; AAD-9088-2021; AAD-9111-2021
Background/aim: The aim of this study was to evaluate the clinical outcomes and identity the predictors of mortality in peritoneal dialysis patients. Materials and methods: Medical records of all incident peritoneal dialysis (PD) patients followed up between January 2011 and May 2019 were reviewed retrospectively. All patients were followed up until death, renal transplantation, transfer to haemodialysis or the end of the study Results: A total of 242 patients were included in thestudy: The incidence of peritonitis was 0.18 (ranging from 0 to 14.9) episodes per patient year. Death occurred in 280 (n: 68) of cases. Age, diabetes mellitus, malignancy and refractory heart failure were independent risk factors for all-cause mortality according to multivariate analysis. 'the presence of comorbid disease and diabetes mellitus and patients aged > 65 years were associated with increased risk of mortality and decreased patient survival. Peritonitis history was associated with increased risk of mortality Between peritonitis and peritonitis-free group, there was no significant difference in Kaplan-Meier curves in terms of patient survival. Conclusion: This is the first study to define 9-year mortality predictors in PD patients in our centre. Although peritonitis is the most feared complication of PD, our study showed that peritonitis did ot reduce patient survival.
Pneumococcal and Influenza Vaccines in Dialysis Patients: Vaccination Information, Rates, and Patient Awareness
(2022) Kara, Sibel; Torun, Dilek; Oruc, Ebru; Habesoglu, Mehmet Ali; Akcay, Muserref Sule; GVT-0626-2022
Objective: Pneumococcal and influenza vaccination rates are still far below the desired levels in dialysis patients. We aimed to determine the pneumococcal and influenza vaccination information, rates, and knowledge levels of dialysis patients. Methods: The study is a descriptive cross-sectional study in which 307 dialysis patients between 2020 and 2021 were analyzed retrospectively. Demographic characteristics of all patients and vaccination information were obtained from the face-to-face questionnaire and hospital medical records. Results: Of the participants, 52.4% were males, and the mean age was 56 +/- 15.45 years. The pneumococcal vaccination rate was 37.1%, and the influenza vaccination rate was 58.6%. Of 114 patients who had received a pneumococcal vaccine, 91.2% had received a single dose of the vaccine. While the type of vaccine could not be determined in 86.8% of the patients in this group, the rate of vaccination with the 2 types of the pneumococcal vaccine was only 8.8%. Annual vaccination was given to all those who were vaccinated against influenza. In the whole group, the rate of those who had never heard of the pneumococcal vaccine was 24.4%, while this rate was 6.5% for the influenza vaccine. The patients had a very low level of knowledge of both vaccines (41% and 53.7%, respectively). Conclusion: Pneumococcal and influenza vaccination rate of dialysis patients was low. Influenza vaccination had been performed in compliance with the recommended scheme, but the doses of the pneumococcal vaccine were incomplete. Although the level of patient knowledge was low for both vaccines, patients were more aware of the influenza vaccine.