Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Secondary Hyperparathyroidism Is Associated with Pulmonary Hypertension in Older Patients with Chronic Kidney Disease and Proteinuria(2015) Genctoy, Gultekin; Arikan, Serap; Gedik, Olcay; 0000-0002-5145-2280; 0000-0001-5752-3812; 25537827; AAJ-5551-2021; AAM-4084-2021; AAJ-1289-2021Hyperparathyroidism is associated with pulmonary vascular calcification and pulmonary hypertension (PH) in a chronic kidney failure dog model, and increased prevalence of PH and a PH-hyperparathyroidism relationship in pre-dialysis chronic kidney disease (CKD) and hemodialysis patients are reported. This study investigated the prevalence of PH and relationships between PH and metabolic abnormalities in patients with stage 1-4 proteinuria CKD. One-hundred and ninety patients (mean age 61 +/- A 17.4, 116 males) with proteinuria CKD and no coronary diseases, congestive heart failure, smoking history, and pulmonary diseases were enrolled. Estimated glomerular filtration rate was 39.7 +/- A 23 ml/min. CKD etiology was diabetes mellitus in 52 (27.3 %), chronic glomerulonephritis or tubulointerstitial nephritis in 56 (29.4 %), hypertension in 36 (19 %), and other etiologies (nephrolithiasis, obstructive nephropathy, and amyloidosis) in 46 (25.3 %) patients. Echocardiography was performed, and systolic pulmonary artery pressure (PAP) and left ventricular ejection fraction were determined. Laboratory tests examined lipid parameters, serum albumin, urea, creatinine, calcium, phosphorus, C-reactive protein, parathyroid hormone, ferritin, and hemoglobin levels. PH (PAP > 35 mmHg) was detected in 68 patients (35.9 %). Patients with PH were older (68 +/- A 12.3 vs. 52.1 +/- A 16.7, p = 0.03), had lower ejection fractions (51.3 +/- A 13.4 vs. 60.8 +/- A 9.1 %, p = 0.003), lower hemoglobin (11.3 +/- A 1.5 vs. 12.1 +/- A 1.9, p = 0.05), and higher parathyroid hormone (218 +/- A 159.3 vs. 127.7 +/- A 67.4 pg/ml, p = 0.05) levels. The remaining parameters were similar between groups. Older age, lower ejection fraction, and secondary hyperparathyroidism may contribute to PH in stage 1-4 proteinuria CKD.Item Increased Frequency of Gallbladder Stone and Related Parameters in Hemodialysis Patients(2014) Genctoy, Gultekin; Ayidaga, Sevgul; Ergun, Tarkan; Lakadamyali, Hatice; Erbayrak, Mustafa; Sezer, Siren; https://orcid.org/0000-0002-5145-2280; https://orcid.org/0000-0002-6165-2569; https://orcid.org/0000-0002-7326-8388; 24918131; AAJ-5551-2021; JVN-6452-2024; JYQ-2550-2024Background/Aims: The prevalence of gallbladder stone (GBS) is shown to be increased in some studies in patients with chronic kidney disease (CKD). Nevertheless, some other studies did not confirm these findings. The controversial results about the prevalence of GBS in hemodialysis (HD) patients demand new studies to search GBS prevalence and associating risk factors in HD patients. In the present study, we aimed to investigate GBS prevalence and risk factors in our HD patients. Materials and Methods: A total of 104 HD and 149 control patients were involved. Complete physical examinations, including measurements of dry body weight and height, were done. Abdominal ultrasonography was conducted by the same experienced radiologist. Blood samples were drawn via venipuncture from the study participants after they had fasted overnight just before a midweek hemodialysis session for laboratory examinations. Results: The prevalence of GBS in HD patients was 34.6 % (36/104), and that was significantly higher than that of control group 12.9% (17/149; p=0.0001). In all study participants (HD patients and control group), patients with GBS were older than patients with no GBS (63.2 +/- 14.2 vs 53.7 +/- 16.7; p=0.0001). However, in HD patients, mean age was similar in patients with GBS and no GBS (64.3 +/- 13.8 vs 60.1 +/- 16.6; p>0.05). Patients with GBS had a higher prevalence of units of blood transfusions than patients with no GBS in hemodialysis patients (2.0 +/- 2.9 vs 0.9 +/- 1.3; p=0.047) Conclusion: The present study showed an increased prevalence of GBS in HD patients compared to healthy controls. The number of blood transfusions and autonomic neuropathy may be responsible for the increased prevalence of GBS in HD patients.Item Periaortic Fat Tissue: A Predictor of Cardiac Valvular Calcification, Malnutrition, Inflammation, and Atherosclerosis Components in Hemodialysis Patients(2015) Genctoy, Gultekin; Eldem, Olcay; Ergun, Tarkan; Arikan, Serap; 0000-0002-5145-2280; 0000-0001-5752-3812; 25940595; AAJ-5551-2021; AAM-4084-2021; AAJ-1289-2021Cardiac valvular calcification (CVC) in end-stage renal disease is shown to be a component of malnutrition, inflammation, atherosclerosis, calcification (MIAC) syndrome. Thoracic periaortic fat tissue (T-PAFT) is shown to be increased in patients with end-stage renal disease (ESRD), and has positive correlation with MIAC. Negative correlation between CVC and vitamin D is shown in hemodialysis (HD) patients. In this study, we investigated a relationship between body composition, T-PAFT, metabolic and inflammatory parameters, and CVC in HD patients. Seventy-six HD patients (49M) were included. CVC is defined as bright echoes of >1mm on one or more cusps on echocardiography. Results were expressed as the number of calcified valves (0,1,2). Calcium, phosphorus, parathyroid hormone (PTH), C-reactive protein (CRP), albumin and 25-hydroxy vitamin D levels were studied from predialysis blood samples. T-PAFT was calculated using a method with manual definition of borders on images from multislice computed tomography. Basal metabolic rate, muscle mass, total and truncal fat mass were measured by bioimpedance analysis. There were 65.8% of patients who had CVC. Patients with CVC were older (63.5 +/- 14.6 +/- 17, P=0.02). T-PAFT (1599 +/- 596, 739.7 +/- 179mm(2), P=0.001) and CRP (15.8 +/- 11; 11.1 +/- 13.2mg/dL; P=0.04) were higher in the group with CVC. T-PAFT had positive correlations with CRP, MIAC, body mass index (BMI) and number of calcified valves, negative correlation with left ventricular ejection fraction, and no correlation with albumin, calcium, phosphorus, and PTH. The logistic regression analysis revealed that T-PAFT was a significant predictor of CVC. In this study, T-PAFT showed a positive correlation with inflammation, CVC, and MIAC score in HD patients. T-PAFT was a significant predictor of CVC.Item Urinary N-Acetyl-Beta-D Glucosaminidase Activity is Associated with Inflammation and Proteinuria in Diabetic and Non-Diabetic Patients with Different Stages of Chronic Kidney Disease(2015) Genctoy, Gultekin; Arikan, Serap; 0000-0002-5145-2280; 0000-0001-5752-3812; AAJ-5551-2021; AAM-4084-2021OBJECTIVE: Clinical studies have demonstrated that tubulointerstitial rather than glomerular pathology correlates with the degree and progression of renal impairment. Urinary n-acetyl-betaD- glucosaminidase (NAG) is a biomarker of tubular damage, shown to be elevated in patients with glomerulonephritis and acute kidney injury. However, it has not been assessed longitudinally in chronic kidney disease (CKD). The aim of the present study was to determine urinary NAG activity and its possible associations with metabolic and inflammatory parameters in CKD. MATERIAL and METHODS: A total of 72 patients (mean age: 64.5 +/- 15.7) with stage 1-5 CKD were included. Of the 72 patients 23 (32%) had diabetic nephropathy and 49 (68%) had different types of primary glomerular diseases. Fasting blood samples were collected to analyse complete blood count, urea, creatinine, albumin, lipid parameters, C-reactive protein, uric acid and parathyroid hormone. 24-hour urine was collected to determine protein excretion. Urinary NAG and creatinine levels were analysed from the first morning urine samples. The NAG index (urinary NAG/ creatinine) was used to exclude dilutional errors. RESULTS: Mean eGFR was 38.3 +/- 21.7 ml/min. The urinary NAG index was significantly higher in stage 3 compared to stage 2 (32.1 +/- 23.5 vs. 7.5 +/- 3.3 U/gr-creatinine; p=0.002) and lower in stage 5 compared to stage 3 CKD (8.2 +/- 7.6 vs. 32.1 +/- 23.5; p=0.017). The urinary NAG index was positively correlated with 24-hour urine protein excretion (r=0.43; p=0.0001) and serum CRP (r=0.549; p=0.04) and negatively correlated with hemoglobin levels (r-0.394; p=0.004). CONCLUSION: The present study demonstrated that urinary NAG correlates with systemic inflammation and proteinuria and may be associated with progression of CKD.Item Relationship Between Malnutrition Inflammation Score, Overhydration and Arterial Stiffness in Hemodialysis Patients(2016) Bal, Zeynep; Tutal, Emre; Ozelsancak, Ruya; Genctoy, Gultekin; Demirci, Bahar Gurlek; Sezer, Siren; https://orcid.org/0000-0002-0788-8319; https://orcid.org/0000-0002-5145-2280; AAZ-5795-2021; AAD-5716-2021; AAJ-5551-2021Item 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-7586-2021Item Association Between Vascular Access Type and Visceral and Peripheral Body Fat, Nutritional and Inflammatory Parameters in Incident Hemodialysis Patients(2017) Birtay, Tayfun; Saba, Tonguc; Haberal, Cevahir; Genctoy, Gultekin; 0000-0002-5145-2280; AAJ-5551-2021OBJECTIVE: Central venous catheters (CVCs) are preferred when a patent arteriovenous fistula (AVF) cannot be created. CVCs have been shown to be associated with increased inflammation and mortality. In the present study, we aimed to investigate a probable association between the vascular access type and BMI, total body fat, truncal fat, muscle mass, visceral (periaortic) fat, and the malnutrition inflammation atherosclerosis and calcification score (MIAC) in hemodialysis patients MATERIAL and METHODS: A total of 119 patients were involved. Ninety patients had patent AVF and 29 patients were undergoing hemodialysis via permanent jugular catheter. Two-dimensional echocardiography was performed to detect valvular calcification. Computed tomography was performed in all patients to detect the amount of thoracic periaortic fat tissue (T-PAFT). Biochemical analyses were performed using c8000 Architect. MIAC scores were calculated using valvular calcification, albumin, and CRP. Total body fat and truncal fat were detected using the bio impedance analysis method. Aortic calcification score (AoCS) was calculated using routine chest x-rays RESULTS: MIAC and AoCS was higher in patients with CVC (p=0.02 and 0.032). T-PA FT was higher in patients with AV (1631.5 +/- 645 vs 1112.2 +/- 606.8; p=0.035). CRP was higher in patients with CVC (p=0.04). Hemodialysis vintage, calcium and albumin were lower in patients with CVC Truncal fat (%), cholesterol and 25-OH vitamin D levels were lower in patients with CVC (p=0.04, p=0.02, p=0.03). T-PA FT was a significant predictor of vascular access type in favour of AVF (t=-2.17; p=0.04) CONCLUSION: The present study revealed that HI) patients with CVC had increased inflammation and decreased nutrition, visceral and truncal fat. Further prospective studies are needed to illuminate the relationship between vascular access type, nutritional parameters and body composition in HD patients.Item New Perspective On Fatigue In Hemodialysis Patients With Preserved Ejection Fraction: Diastolic Dysfunction Fatigue And Diastolic Dysfunction(2022) Akbay, Ertan; Akinci, Sinan; Coner, Ali; Adar, Adem; Genctoy, Gultekin; Demir, Ali Riza; https://orcid.org/0000-0002-9146-0621; https://orcid.org/0000-0001-5250-5404; AAD-5479-2021; AAD-5564-2021The relationship between diastolic dysfunction and fatigue in hemodialysis patients with preserved ejection fraction is unknown. In this context, the objective of this study is to assess fatigue using the relevant scales and to demonstrate its relationship with diastolic dysfunction. The patients who underwent hemodialysis were evaluated prospectively. Patients' fatigue was assessed using the Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F). The echocardiographic works were performed as recommended in the American Society of Echocardiography guidelines. A total of 94 patients [mean age 64.7 +/- 13.5 years, 54 males (57.4%)] were included in the study. The median VAS-F score of these patients was 68.5 (33.25-91.25), and they were divided into two groups according to this value. Peak myocardial velocities during early diastole (e ') and tricuspid annular plane systolic excursion (TAPSE) values were found to be significantly lower in the group with high VAS-F scores, whereas the early diastolic flow velocities (E)/e ' ratio and pulmonary artery peak systolic pressures (PAP) were found to be significantly higher (p < 0.05, for all). E/e ' ratio (r 0.311, p 0.002) and PAP (r 0.281, p 0.006) values were found to be positively correlated with the VAS-F score, as opposed to the TAPSE (r - 0.257, p 0.012) and e ' (r - 0.303, p 0.003) values, which were found to be negatively correlated with the VAS-F score. High fatigue scores in hemodialysis patients may be associated with diastolic dysfunction. In addition, in our study, we determined the correlation of VAS-F score with E/e ' ratio, PAP and TAPSE.Item Determinants of reverse dipping blood pressure in normotensive, non-diabetic population with an office measurement below 130/85mmHg(2021) Coner, Ali; Akbay, Ertan; Akinci, Sinan; Ozyildiz, Gokhan; Genctoy, Gultekin; Muderrisoglu, Haldun; 0000-0002-5711-8873; 0000-0002-9146-0621; 0000-0001-5250-5404; 0000-0002-5145-2280; 34151642; ABD-7321-2021; AAD-5479-2021; AAD-5564-2021; AAJ-5551-2021Objective: The role of dipping blood pressure pattern in normotensives is unclear. The study aims to search the circadian blood pressure rhythm and the clinical determinants related to reverse dipping pattern in a strictly selected, normotensive population. Methods: The study population was divided into three groups depending on the nocturnal dipping pattern as dipping, non-dipping, and reverse dipping. Basal clinical characteristics, anthropometric measurements, and spot urine samples from the first-morning void were collected. Clinical determinants related to the presence of reverse dipping pattern were tested by the Multiple Binary Logistic Regression analysis. Results: A total of 233 participants were involved in the study population (median age 45 years [40-50]). Dipping pattern was detected in 55.4%, non-dipping pattern in 33.0%, and reverse dipping pattern in 11.6% of the study population. There was no difference between the groups in terms of basal clinical features. Albumin-to-creatinine ratio (ACR) (p < .001) and hs-CRP levels (p = .006) were also statistically significant across the groups. ACR (HR: 1.195, 95% CI: 1.067-1.338, p = .002) and hs-CRP (HR: 2.438, 95% CI: 1.023-5.808, p = .044) were found to be related to the presence of reverse dipping blood pressure pattern. Conclusions: The absence of nocturnal physiological dipping is seen at a remarkable rate in the normotensive Turkish population. ACR and hs-CRP are the clinical determinants related to the presence of reverse dipping blood pressure pattern.Item Prognosis Of Patients Hospitalized With A Diagnosis Of COVID-19 Pneumonia İn A Tertiary Hospital İn Turkey(2021) Birtay, Tayfun; Bahadir, Suzan; Kabacaoglu, Ebru; Yetiz, Ozgur; Demirci, Mehmet Fatih; Genctoy, Gultekin; 0000-0002-0019-5851; 34873938; AAD-5931-2021BACKGROUND: SARS-CoV2/COVID-19 emerged in China and caused a global pandemic in 2020. The mortality rate has been reported to be between 0% and 14.6% in all patients. In this study, we determined the clinical and laboratory parameters of COVID-19 related morbidity and mortality in our hospital. OBJECTIVES: Investigate the relationship between demographic, clinical, and laboratory parameters on COVID-19-related morbidity and mortality. DESIGN: Retrospective observational study. SETTINGS: Tertiary care hospital. PATIENTS AND METHODS: Patients diagnosed with COVID-19 pneumonia from March until the end of December were included in the study. MAIN OUTCOME MEASURES: The relationship between demographic, clinical, and laboratory parameters and the morbidity and mortality rates of patients diagnosed with COVID-19. SAMPLE SIZE: 124 patients RESULTS: The mortality rate was 9.6% (12/124). Coronary artery disease (P<.0001) diabetes mellitus (P=.04) fever (>38.3 degrees C) at presentation (P=.04) hypertension (P<.0001), and positive smoking history (P<.0001) were significantly associated with mortality. Patients who died were older, had a higher comorbid disease index, pneumonia severity index, fasting blood glucose, baseline serum creatinine, D-dimer, and had lower baseline haemoglobin, SaO(2) percentage of lymphocyte counts and diastolic blood pressure. Patients admitted to the ICU were older, had a higher comorbidity disease index, pneumonia severity index, C-reactive protein, WBC, D-dimer, creatinine, number of antibiotics used, longer O-2 support duration, lower hemoglobin, lymphocyte (%), and baseline SaO(2) (%). CONCLUSIONS: Our results were consistent with much of the reported data. We suggest that the frequency, dosage, and duration of steroid treatment should be limited. LIMITATIONS: Low patient number, uncertain reason of mortality, no standard treatment regimen, limited treatment options, like ECMO.