Browsing by Author "Tutal, Emre"

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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
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
Böbrek nakilli hastalarda interlökin 6 ve miyostatin düzeylerinin sarkopeni ile arasındaki ilişki
(Başkent Üniversitesi Tıp Fakültesi, 2018) Kaynar Erdoğan, Meltem; Tutal, Emre
Böbrek nakli KBH’nın en seçkin tedavisidir. Böbrek nakilli hastalarda sarkopeni normal popülasyona oranla daha sıktır. Bu duruma rağmen sarkopeni, böbrek nakilli hastalarda üzerinde henüz çok çalışılmamış, merak uyandıran bir konudur. Sarkopenide kronik enflamasyon, IL-6 ve miyostatinin rolü iyi bilinmesine rağmen böbrek nakli sonrasında sitokinlerin kas metabolizmasındaki etkileri henüz ortaya çıkarılamamıştır. Bu çalışmanın amacı; böbrek nakilli hastalarda IL-6 ve miyostatin düzeyleri ile sarkopeni arasındaki ilişkinin gösterilmesidir. Çalışma Başkent Üniversitesi Tıp Fakültesi Nefroloji Bilim Dalı polikliniğinde, 19.04.2017 – 08.11.2017 tarihleri arasında başvuran hastalarda gerçekleştirildi. Çalışma 120 böbrek nakilli hasta ve kontrol grup olarak benzer yaş aralığına sahip 40 sağlıklı birey üzerinde kesitsel olarak yapıldı. Bireylerin cinsiyet, yaş, vücut kitle indeksi, triceps kalınlığı, üst kol çevresi, bel çevresi, biyoelektrik impedans ölçümleri, kas gücü, kas kitle indeksi, yürüme testi sonuçları, diyabet varlığı durumu, aldıkları immünsupresif tedaviler, IL-6, miyostatin, ile rutinde incelenen kreatinin, plazma potasyum, hemoglobin, lökosit, glukoz, CRP değerleri kaydedilmiştir. Sarkopeni ‘Asia Working Group for Sarcopenia’ kriterlerine göre tanımlandı. Yaş ve diyabet varlığı gibi faktörlerin benzer olduğu gruplarda yapılan analizde böbrek nakilli hastalarda sarkopeni prevelansı %26,7, kontrol grupta %5 olarak saptandı. Böbrek nakilli hastalarda IL-6 düzeyi, kontrol gruba göre yüksekti (p<0,05). Böbrek nakilli hastalarda sarkopenisi olan ve olmayanlar arasında yapılan karşılaştırmalarda IL-6 ve miyostatin düzeyleri, rutin üçlü tedavi ve DM varlığı açısından anlamlı fark saptanmadı (p>0,05). Sonuç olarak; böbrek nakilli hastalarda sarkopeninin normal popülasyona göre daha sık görüldüğü bilinmektedir. Çalışmamızda böbrek nakilli hastalarda kronik enflamasyon devam etmesine rağmen bu durumun sarkopeni ile ilişkisi bulunamamıştır. Böbrek nakli alıcılarında multifaktöryel olarak gelişen sarkopeni mekanizmalarını daha iyi anlamak için daha fazla çalışmaya ihtiyaç vardır. Kidney transplantation is the most distinguished treatment of CKD. In renal transplant recipients, sarcopenia is more frequent than the normal population. But in renal transplant recipients, sarcopenia is a not much studied, intriguing subject. Although the role of chronic inflammation, IL-6 and myostatin in sarcopenia is well known, the influences of cytokines on muscle metabolism have not yet been shown after kidney transplantation. The aim of this study was to investigate the relationship between IL-6 and myostatin levels and sarcopenia in renal transplant recipients. The study was conducted in the Department of Nephrology, the Başkent University Faculty of Medicine, in the patients admitted to the polyclinic between the dates 19.04.2017 – 08.11.2017. The study was cross-sectional, consisting of similar age range of 120 transplant recipients and 40 healthy individuals as control group. In the study the parameters recorded included: gender, age, body mass index, triceps thickness, upper arm circumference, waist circumference, bioelectric impedance measurements, muscle strength, muscle mass index, walking test results, status of diabetes presence, immunosuppressive treatments, IL-6 levels, myostatin levels and the routine creatinine, plasma potasium, hemoglobin, leukocyte, glukose, and CRP values. Sarcopenia was defined according to the criteria of ‘Asia Working Group for Sarcopenia ‘. Among groups which were similar in terms of factors such as age and diabetes, sarcopenia prevalence was 26.7% in renal transplant recipients and 5% in the control group. In renal transplant recipients, IL-6 levels were higher than the control group (p<0.05). Between the patients with and without sarcopenia in renal transplant recipients, no significant difference in terms of IL-6 levels, myostatin levels, routine triple therapy and the presence of DM (p>0.05) was found. In conclusion it is known that sarcopenia is more frequent in renal transplant patients than the normal population. In this study, although chronic inflammation in renal transplant recipients continues, no relationship between this situation and sarcopenia was found. In order to better understand the mechanisms of sarcopenia developing as a multifactorial disorder in renal transplant recipients, more studies are needed.
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
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.
Evaluation of Hemodialysis Patients in Terms of Activities of Daily Living, Disability, Depression and Comorbidity
(2017) Turgay, Gulay; Tutal, Emre; Sezer, Siren
OBJECTIVE: This study was conducted to evaluate the hemodialysis patients in terms of activities of daily living (ADLs), disability, depression and comorbidity. MATERIAL and METHODS: The population of this cross-sectional study included 220 patients undergoing treatment at a dialysis center between June-August 2016. The study sample however was comprised of 144 patients who were 50 years old and above, had been undergoing hemodialysis treatment for at least six months and who agreed to participate in the research. The data was collected using the Patient Identification Form, the Katz Activities of Daily Living Scale, Lawton and Brody Instrumental Activities of Daily Living Scale, Brief Disability Questionnaire, Charlson Comorbidity Score and Beck Depression Inventory. RESULTS: The patients were divided into two groups: the 50-64 years age group and the 65-plus age group. The patients in the first group were found to have an Activities of Daily Living Scale score of 17.28 +/- 1.45, Instrumental Activities of Daily Living Scale score of 19.98 +/- 3.02, and a Brief Disability Questionnaire score of 7.42 +/- 3.99 whereas the patients in the second group were found to have score of 15.73 +/- 2.53, 17.29 +/- 3.43 and 10.7 +/- 4.18 respectively. CONCLUSION: Hemodialysis and age progression leads to dependency of patients at varying levels while they maintain their activities of daily living.
Fgf-23, Ngal and Endostatin: The Predictors of Allograft Function and Arterial Stiffness in Renal Transplant Recipients
(2017) Sezer, Siren; Demirci, Bahar Gurlek; Uyanik, Saliha; Erdogan, Meltem Kaynar; Tutal, Emre; Ozdemir, Ozlem; Orazbayev, Gani; Haberal, Mehmet; https://orcid.org/0000-0002-3462-7632; AAJ-8097-2021
FGF23, NGAL, and Endostatin: the Predictors of Allograft Function in Renal Transplant Recipients
(2018) Demirci, Bahar Gurlek; Sezer, Siren; Yildirim, Saliha Uyanik; Erdogan, Meltem Kaynar; Tutal, Emre; Ozdemir, Ozlem; Orazbayev, Gani; Haberal, Mehmet; 0000-0002-3462-7632; 29528011; AAJ-8097-2021
Objectives: Increased circulating levels of fibroblast growth factor 23, neutrophil gelatinase-associated lipocalin, and endostatin are independent risk factors for cardiovascular disease. Here, we evaluated correlations among these parameters and graft dysfunction and their relation with arterial stiffness. Materials and Methods: This prospective study included 73 maintenance kidney transplant patients with stable allograft function who had received the transplant at least 36 months previously. We calculated the estimated glomerular filtration rate (eGFR). Pulse-wave velocity was determined. Serum levels of fibroblast growth factor 23, neutrophil gelatinase-associated lipocalin, and endostatin were measured by enzyme-linked immunosorbent assay. Results: Demographic characteristics and pulse-wave velocity values were similar in groups 1 and 2 (GFR < 60 and > 60 mL/min, respectively). Mean levels of fibroblast growth factor 23 (P = .036), neutrophil gelatinase-associated lipocalin (P = .018), and endostatin were significantly higher in group 1. Fibroblast growth factor 23 was negatively correlated with eGFR (r = -0.267, P = .023) and positively correlated with neutrophil gelatinase-associated lipocalin (r = 0.258, P = .036) and endostatin (r = 0.321, P = .006). Serum endostatin levels were positively correlated with pulse-wave velocity (r = 0.276, P = .019). In linear regression analysis, eGFR was detected as the unique predictor of neutrophil gelatinase-associated lipocalin (P = .001). In addition, each 1 mL/min decrease in eGFR resulted in a 0.281 pg/mL increase in fibroblast growth factor 23 (P = .023) and a 0.04 ng/mL increase in neutrophil gelatinase-associated lipocalin (P = .007); each 1 cm/s increase in pulse-wave velocity resulted in a 3648.7 U/L increase of endostatin (P = .019). Conclusions: All 3 parameters were associated with loss of graft function in kidney transplant recipients. Moreover, endostatin can be used as an independent predictor for cardiovascular morbidity in this population.
Hand Grip Strength Is Associated with Serum Testosterone and Albumin Levels in Male Kidney Transplant Recipients
(2017) Sezer, Siren; Demirci, Bahar Gurlek; Tutal, Emre; Colak, Turan; Haberal, Mehmet; https://orcid.org/0000-0002-8372-7840; https://orcid.org/0000-0002-3462-7632; AAJ-8554-2021; AAJ-8097-2021
Hand-Grip Strength Is Associated With Serum Testosterone and Albumin Levels in Male Kidney Transplant Recipients
(2018) Demirci, Bahar Gurlek; Sezer, Siren; Tutal, Emre; Colak, Turan; Uyanik, Saliha; Haberal, Mehmet; 0000-0002-8372-7840; 0000-0002-3462-7632; 29527997; AAJ-8554-2021; AAJ-8097-2021
Objectives: In kidney transplant recipients, reduced muscle mass and hand-grip strength are associated with impaired nutritional status. Serum testosterone is highly associated with muscle strength in the general population. Here, we aimed to determine the associations among serum testosterone, hand-grip strength, and nutritional and inflammatory parameters, as well as graft function. Materials and Methods: Our study included 144 stable male kidney transplant recipients from our renal transplant outpatient clinic. All patients were evaluated for clinical parameters (age, duration of hemodialysis, and posttransplant time), biochemical parameters (calcium, phosphorus, parathyroid hormone, C-reactive protein, albumin, creatinine), and serum testosterone levels. Body composition was analyzed with the bioimpedance spectroscopy analysis technique using a body composition monitor that estimates body mass index and percent fat. Hand-grip strength was analyzed by using a dynamometer (ProHealthcareProducts.com, Park City, UT, USA). We calculated estimated glomerular filtration rate using the Modification of Diet in Renal Disease-4 equation. Results: Demographic characteristics, duration of dialysis before transplant, biochemical parameters, and estimated glomerular filtration rates were similar among study patients. Mean (standard deviation) serum testosterone was 588.0 (55.5) ng/dL, mean body mass index was 26.8 (0.6) kg/m(2), and mean hand-grip strength was 42.2 (1.7) mm(2). Serum testosterone levels were positively correlated with hand-grip strength (r = 0.445; P = .033) and serum albumin (r = 0.399; P = .05) and negatively correlated with serum C-reactive protein (r = -0.454;P= .05) and age. In linear multiple regression analysis, serum albumin (P= .033) and testosterone levels (P = .038) were shown to be predictors of hand-grip strength. However, we could not show a significant correlation between graft function and testosterone. Conclusions: Serum testosterone level is correlated with hand-grip strength and C-reactive protein and albumin levels, which may indicate that testosterone affects nutritional status and inflammation in male renal transplant recipients.
Hemodiyaliz hastalarında üremik pruritus ile 25 hidroksi vitamin D arasındaki ilişki
(Başkent Üniversitesi Tıp Fakültesi, 2014) Göküstün, Dilek; Tutal, Emre
Üremik kaşıntı (ÜK), kronik böbrek yetmezliği (KBY) olan hastalarda en sık görülen ve en önemli dermatolojik semptomdur. Prevelansı %50-90 arasında değişmektedir. Hemodiyaliz (HD) ile ilgili gelişmelere rağmen sıklığı azalmakla beraber görülmeye devam etmektedir. Etyolojisi ve patogenezi tam olarak anlaşılamamıştır. Yaşam kalitesini ve morbiditeyi olumsuz yönde etkilemektedir. Multifonsiyonel bir vitamin olan D vitamini önemli bir immunmodülatör role sahiptir. KBY olan hastalarda 1,25 dihidroksi vitamin D’nin [1,25(OH)2D] yanında 25 hidroksi vitamin D [25(OH)D]’nin eksikliği de bilinmektedir. Bu çalışmada HD hastalarında 25(OH)D düzeyleri ile (ÜK)arasındaki ilişkinin araştırılması amaçlanmıştır. Kaşıntıyı değerlendirmek için Ankara Başkent Üniveristesi Tıp Fakültesi Hastanesi Nefroloji Bilim Dalı’nda izlenmekte olan KBY tanılı en az altı aydır haftada üç gün dört saat HD tedavisi gören hastalara bir anket uygulandı. Kaşıntısı olan 47 hasta çalışma grubu, olmayan 47 hasta da kontrol grubu olarak seçildi. Kaşıntı şiddeti Görsel Analog Cetveli (Visual Analog Scale, VAS) ile değerlendirildi. Araştırmaya katılan hastaların demografik özellikleri (yaş, cinsiyet), KBY etyolojileri ve HD süreleri ile son altı aylık diyaliz seansı girişinde alınan kandan elde edilen hemoglobin, serum demiri, demir bağlama kapasitesi, ferritin, kalsiyum, fosfor, magnezyum, PTH, ALP, kreatinin, ALT, CRP, albümin, total bilirubin değerleri ile hepatit serolojileri retrospektif olarak dosyalarından taranarak elde edildi. Tüm hastalardan diyaliz seansı girişinde alınan kandan 25(OH)D düzeyi çalışıldı. Araştırmaya dahil edilen hasta sayısı 94, bu hastaların 39’u kadındı. Olguların demografik özelliklerine bakıldığında hastaların yaş ortalamaları 59,2±13,6 yıldı ve yaş aralığı 24 ile 88 yıl arasında değişmekteydi. Ortalama diyaliz süresi 7 ile 300 ay arasında değişmekteydi. Hastaların KBY etyolojileri incelendiğinde en sık nedenin diyabetik nefropati (%28,7) ve hipertansiyon (%14) olduğu belirlendi. Gruplar arasında yaş, HD süresi, kreatinin, hemoglobin, serum demiri, serum demir bağlama kapasitesi, albümin, CRP, kalsiyum, magnezyum, ALT, ALP, PTH, total bilirubin, hepatit serolojileri ve aktif vitamin D kullanımı arasında anlamlı istatistiksel fark saptanmadı. Kaşıntısı olan grupta ferritin düzeyi daha yüksek olmasına rağmen istatistiksel olarak anlamlı fark bulunmadı. Çalışma grubunda fosfor (p=0,08) ve kalsiyumxfosfor (p=0,08) düzeyleri daha yüksek, 25(OH)D değerleri ise daha düşük bulundu (p=0,045) ve istatistiksel olarak anlamlı fark saptandı. Kaşıntı kadın cinsiyette daha fazla görüldü ve istatistiksel olarak iii anlamlı fark bulundu(p=0,047). Kaşıntısı olan grupta cilt kuruluğu daha fazla görüldü (p=0,003). Kaşıntının %29,8 hastada sırtta, %44,7 hastada ekstremitelerde yoğun olduğu, gün içinde %34 hastada akşam, %34 hastada gece saatlerinde daha sık görüldüğü, %48,9 hastada bazen de olsa kaşıntının uykuyu etkilediği tespit edildi. Kaşıntısı olan %51,1 hastada kaşıntı genellikle bir yıldan uzun süredir vardı ve hastaların %61,7’sinde hem yaz hem de kış mevsiminde görülmekteydi. Kaşıntısı olan hastaların %53,2’sinde HD’nin kaşıntıya etkisi olmadığı saptandı. Antihistaminik kullanan %42,5 hastanın %36,2’si ve topikal tedavi alan hastaların %29,8 hastanın %14,9’unda verilen tedaviye yanıt alındığı belirlendi. Sonuç olarak; ÜK ile düşük 25(OH)D düzeyi arasında bir ilişki tespit ettik. 25(OH)D ÜK patogenezinde sorumlu bir faktör olabilir. Bu nedenle kaşıntısı olan hastalarda 25(OH)D bakılmasını, bu hipotezle ilgili başka çalışmalar da yapılmasını önermekteyiz.
Hypoalbuminemia, Poor Calcium-Phosphorus Control and High Transporter Peritoneal Characteristics - Three Important 10-Year Survival Predictors for Peritoneal Dialysis Patients
(2014) Tutal, Emre; Bal, Zeynep; Sezer, Siren; Uyar, Mehtap Erkmen; 0000-0002-7326-8388; IAO-2608-2023; AAZ-5795-2021; JYQ-2550-2024
OBJECTIVE: Peritoneal transport characteristic is a potential survival predictor. In this study we evaluated the effect of transport characteristics on 10 year patient survival and compared its' impact with other possible survival predictors. MATERIAL and METHODS: We included 75 CAPD patients who were followed in our center for at least 10 years after initiation of PD. Based on the standard peritoneal equilibration test, PD patients were divided into two transporter groups: Low / Low average (n: 27) and High / High Average (n: 48). Clinical and demographic data were collected from patient charts and impact of transporter characteristics and some other well-known survival predictors were studied. RESULTS: 10 year PD survival rates were significantly lower in H/HA group (p: 0.001). Atherosclerosis-related mortality rate was significantly higher in H/HA group (45.9% vs. 7.6%, p: 0.043). Hypoalbuminemia, increased CaxP, chronic inflammation, H/HA transport status were independent predictors of PD and patient survival. Further analysis revealed that hypoalbuminemia (p: 0.0001) and increased CaxP levels (p: 0.0001) were the main predictors. CONCLUSION: This study suggests that peritoneal transport status is an important survival predictor. However keeping the calcium and phosphorus levels in recommended ranges, and improving nutritional status still have more importance for lowering mortality rates of PD patients.
Iloprost as an acute kidney injury-triggering agent in severely atherosclerotic patients
(2016) Uyar, Mehtap Erkmen; Yucel, Piril; Ilin, Sena; Bal, Zeynep; Yildirim, Saliha; Uyar, Ahmet Senol; Akay, Tankut; Tutal, Emre; Sezer, Siren; 27841898; AAZ-5795-2021
Background: Iloprost, a stable prostacyclin analog, is used as a rescue therapy for severe peripheral arterial disease (PAD). It has systemic vasodilatory and anti-aggregant effects, with severe vasodilatation potentially causing organ ischaemia when severe atherosclerosis is the underlying cause. In this study, we retrospectively analysed renal outcomes after iloprost infusion therapy in 86 patients. Methods: Eighty-six patients with PAD who received iloprost infusion therapy were retrospectively analysed. Clinical and biochemical parameters were recorded before (initial, Cr1), during (third day, Cr2), and after (14th day following the termination of infusion therapy, Cr3) treatment. Acute kidney injury (AKI) was defined according to KDIGO guidelines as a >= 0.3 mg/dl (26.52 mu mol/l) increase in creatinine levels from baseline within 48 hours. Results: Cr2 (1.46 +/- 0.1 mg/dl) (129.06 +/- 8.84 mu mol/l) and Cr3 (1.53 +/- 0.12 mg/dl) (135.25 +/- 10.61 mu mol/l) creatinine levels were significantly higher compared to the initial value (1.15 +/- 0.6 mg/dl) (101.66 +/- 53.04 mu mol/l). AKI was observed in 36 patients (41.86%) on the third day of iloprost infusion. Logistic regression analysis revealed smoking and not using acetylsalicylic acid as primary predictors (p = 0.02 and p = 0.008, respectively) of AKI during iloprost treatment. On the third infusion day, patients' urinary output significantly increased (1813.30 +/- 1123.46 vs 1545.17 +/- 873.00 cm(3)) and diastolic blood pressure significantly decreased (70.07 +/- 15.50 vs 74.14 +/- 9.42 mmHg) from their initial values. Conclusion: While iloprost treatment is effective in patients with PAD who are not suitable for surgery, severe systemic vasodilatation can cause renal ischaemia, resulting in non-oliguric AKI. Smoking, no acetylsalicylic acid use, and lower diastolic blood pressure are the clinical risk factors for AKI during iloprost treatment.
Long-Term Oral Nutrition Supplementation Improves Outcomes in Malnourished Patients With Chronic Kidney Disease on Hemodialysis
(2014) Sezer, Siren; Bal, Zeynep; Tutal, Emre; Uyar, Mehtap Erkmen; Acar, Nurhan Ozdemir; 24436491
Background: There is no consensus on the type, time of initiation, or duration of use of enteral nutrition in patients with chronic kidney disease (CKD). This study aimed to compare the effects of a renal-specific oral nutrition supplement (RS-ONS) and a standard recommended nutrition regime on biochemical and nutrition markers in malnourished patients with CKD on hemodialysis. Methods: Sixty-two malnourished patients with CKD, divided into experimental (RS-ONS; n = 32; mean [SD] age, 62.0 [11.3] years; 55.2% female) and control (CON; n = 30; mean [SD] age, 57.2 [12.3] years; 31% female) groups, were evaluated for anthropometric, biochemical, and inflammatory parameters. Results: Mean (SD) serum albumin levels were significantly increased in the RS-ONS group from 3.5 (0.3) g/dL at baseline to 3.7 (0.2) g/dL at 6 months (P = .028). Significantly fewer patients had serum albumin levels of <3.5 g/dL after month 6. Dry weight of patients significantly increased in the RS-ONS but decreased in the CON groups (P < .001 for each). Percent change from baseline revealed negative results for bioelectrical impedance analysis (P < .001) in the CON group. Malnutrition inflammation score at 6 months (P = .006) and erythropoietin (EPO) dose requirements were higher in the CON group (P = .012). Conclusions: Our findings indicate that consuming RS-ONS improves serum albumin and anthropometric measures, as well as reduces EPO dose, in patients with CKD.
Low 25-Hydroxy Vitamin D, High Fibroblast Growth Factor 23 and Arterial Stiffness in Hemodialysis Patients with Chronic Kidney Disease: "The Chicken or Egg Phenomenon"
(2014) Bal, Zeynep; Uyar, Mehtap Erkmen; Gokustun, Dilek; Demirci, Bahar Gurlek; Tutal, Emre; Sezer, Siren; https://orcid.org/0000-0002-7326-8388; AAZ-5795-2021; JYQ-2550-2024
Low Magnesium Levels Are Closely Related with Fgf-23 Levels and Arterial Stiffness in Hemodialysis Patients
(2016) Tutal, Emre; Bal, Zeynep; Uyar, Erkmen Mehtap; Sezer, Siren; AAZ-5795-2021