Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item 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-5795-2021Introduction: 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.Item Epidemiological features of primary glomerular disease in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group(2020) Sezer, Siren; 33189135Background 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.Item New Method to Predict Survival in Hemodialysis Patients Using the Impedance Ratio(2019) Hur, Ender; Gokalp, Cenk; Kose, Sennur; Duman, Elif; Magden, Kemal; Yildiz, Gursel; Toka, Bilal; Sezer, Siren; Duman, SonerObjective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition in chronic hemodialysis (HD) patients. In this prospective observational study, we investigated the survival predictability of impedance ratio (IR) calculated by BIS in HD patients (Clinical Trials Gov Identifier: NCT01468363). Materials and Methods: A total of 430 chronic HD patients, out of 500 prevalent chronic HD patients from the city of Zonguldak who met the inclusion criteria, were included in the study. With a mean follow-up of 32.2 +/- 14.4 months, BIS was performed in all patients. The IR percentage (IR%) was calculated by dividing the resistance values using the 200 kHz and 5 kHz impulses. Student's t-test, Cox regression analysis, and Kaplan-Meier survival analysis were performed, and a p<0.05 was accepted as statistically significant. Results: The mean age of 430 patients was 59 +/- 15 (10-92) years, and 54% of patients were male. By the end of the study, 125 (29%) patients died. Diabetes mellitus was observed in 46% of patients. Sixty-seven percent of patients used erythropoietin, and 41% used diuretics. The mean systolic blood pressure of patients before the dyalisis was 133 +/- 26 mmHg, and diastolic blood pressure was 79 +/- 12 mmHg. The IR values ranged between 73.2% and 94.1%. A multi-regression analysis that used the IR and included diabetes mellitus, age, gender, and albumin and hemoglobin levels showed that the mortality risk increased 16% (p<0.001). Evaluation using the quartiles showed decreased survival. Survival in the first quartile group was 42.8 months compared to 30.6 months in the last quartile group. Conclusion: The IR calculated using BIS data is a useful tool that can be employed to predict the survival in chronic HD patients. An early awareness of this increased mortality risk is important in terms of a close follow-up and appropriate treatment of these patients.Item QUALITY OF SLEEP, QUALITY OF LIFE AND FATIGUE: ARE THEY RELATED WITH SERUMVITAMIN D LEVEL?(2015) Demirci, Bahar Gurlek; Sayin, Cihat Burak; Tutal, Emre; Bal, Zeynep; Sezer, SirenItem 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 DeryaAim: 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.Item 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-5795-2021Background: 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.Item Retarding chronic kidney disease (CKD) progression: a practical nutritional approach for non-dialysis CKD(2016) Sezer, Siren; Bellizzi, Vincenzo; Carrero, Jan Jesus; Chauveau, Philippe; Cozzolino, Mario; Cupisti, Adamasco; D'Alessandro, Claudia; De Nicola, Luca; Fiaccadori, Enrico; Johansson, Lina; Minutolo, Roberto; Molina, Pablo; Ter Wee, Pieter; Teta, Daniel; Wanner, Christoph; Calella, Patrizia; Fouque, DenisThis is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2nd International Conference of the European Renal Nutrition working group at ERA-EDTA-" Retarding CKD progression: readily available through comprehensive nutritional management?"and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections-basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD-linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD) What nutritional assessment/monitoring for protein-energy wasting (PEW) should be employed? Is a body mass index (BMI) of 21 kg/m2 adequate? What phosphate target should be pursued? What are the nutritional habits in patients with incident CKD? What protein needs and amount of dietary protein should be pursued? Does the quality of protein matter? What amount of dietary salt should be employed? How should this be obtained? How should normal serum phosphate be achieved? What diet should be recommended? Is a vegetarian diet an option? Second visit: Major nutritional targets in non-dialysis CKD Consequences of unintentional weight loss What is the role of the renal dietitian in helping the patient adhere to a renal diet? Intermediate visits: Nutritional follow-up in non-dialysis CKD What treatment for calcium/parathyroid hormone (PTH) will affect CKD progression? Final visits: Would a dietary recall/intensive dietary education improve adherence with the diet? Would a very-low-protein diet (VLPD)/ketodiet be indicated for this patient?Item Blood Pressure and Age Are the Main Determinants of Aortic Stiffness(2017) Sezer, Siren; Guclu, Aydin; Nar, Goksay; Icli, Atilla; Ozhan, Nail; 28982100Item Mediterranean diet as the diet of choice for patients with chronic kidney disease(2018) Sezer, Siren; Chauveau, Philippe; Aparicio, Michel; Bellizzi, Vincenzo; Campbell, Katrina; Hong, Xu; Johansson, Lina; Kolko, Anne; Molina, Pablo; Wanner, Christoph; Ter Wee, Pieter M.; Teta, Daniel; Fouque, Denis; Carreo, Juan; 29106612Traditional dietary management of chronic kidney disease (CKD) focuses on the quantity within the diet of energy and protein, and the restriction of single micronutrients, with little mention of dietary quality. Dietary patterns that are more plant-based, lower in meat (including processed meat), sodium and refined sugar, and have a higher content of grains and fibres are now included in multiple clinical guidelines for chronic disease prevention. The Mediterranean diet (MD) has been associated with reduced cardiovascular disease incidence in both observational and interventional studies. A wealth of evidence links MD with other beneficial effects on chronic diseases such as diabetes, obesity or cognitive health. This review examines each constituent of the classical MD and evaluates their suitability for the management of patients with CKD. We also evaluate the potential hyperkalaemia risk of increasing fruit and vegetable intake. Overall, a decrease in net endogenous acid production and increase in fibre may lead to a better control of metabolic acidosis. This, together with other putative favourable effects of MD on endothelial function, inflammation, lipid profile and blood pressure, provide mechanistic pathways to explain the observed reduced renal function decline and improved survival in CKD patients adhering to an MD.Item Hemodiyaliz hastalarında panel eeaktif antikor düzeyini etkileyen parametreler(Türk Nefroloji Diyaliz ve Transplantasyon Dergisi/Office Journal of the Turkish Nephrology, Association 1999;4:188-191, 1999) Özdemir, F.Nurhan; Sezer, Siren; Turan, Minüre; Güz, Galip; Arat, Zübeyde; Gülmüş, Şale; Haberal, MehmetKan transfüzyon sayısı, transplantasyon ve hamilelik hikayesi hemodiyaliz (HD) hastalarında panel reaktif antikor (PRA) düzeyini etkileyen en önemli üç faktör olarak bilinmektedir. Bu faktörlerin dışında da, PRA duyarlılığının nedeni bilinmeyen bir hasta grubunun da varlığı, diğer olası faktörlerin araştırılmasına yol açmıştır. Çalışmamızda merkezimizde HD programında olan hastaların PRA pozitifliğini etkileyen klinik ve laboratuvar parametreleri araştırmayı planladık. Çalışma grubu 94 kadın, 99 erkek hastadan (yaş ortalaması 44.6±15.8 yıl ve hemodiyaliz süresi 42.2+15.3 ay, 100 HCV(-), 93 HCV(+)) oluşuyordu. Otuz hastada renal transplantasyon hikayesi vardı. PRA düzeyi tayini One Lambda Cell Tray kullanılarak gerçekleştirildi. PRA değeri %30'dan yüksek olan hastaların sonucu pozitif kabul edildi. Hastaların yaş, HD süresi, kan grubu, transplantasyon hikayesi, HCV pozitifliği ve aldığı ortalama haftalık r-HuEPO dozu ile PRA pozitifliği arasındaki korelasyon araştırıldı. Çalışmamızda, HD süresi ve transplantasyon hikayesi ile PRA pozitifliği arasında istatistiksel açıdan anlamlı bir ilişki mevcuttu (PRA (+) ve (-) hastaların sırasıyla HD süresi 50.8+40.5 ay, 37.1+38.9 ay, p =0.028, ve transplantasyon hikayesi olan hastaların PRA (+) olma oranı: %90 iken diğer hastalarda %17.2, p=0.0002 olarak bulundu). Hastaların yaş, cinsiyet, kan grubu, kan transfüzyonu sayısı, HCV enfeksiyonu, r- HuEPO dozu ve PRA pozitifliği arasında bir ilişki bulunmadı. Sonuç olarak, HD süresi ve renal transplantasyon PRA sensitizasyonu etkileyen önemli bir faktörlerdir. Bu konuda daha geniş çalışmalara ihtiyaç vardır. Blood transfusion, previous transplantation and pregnancy are the most important factors that influence the panel reactive antibody (PRA) sensitization in hemodialysis (HD) patients. The presence of PRA positive patients who has not been exposed to common triggering fetors have led the investigators to search for other causes of PRA sensitivity. We planned this study to search for the clinical and laboratory parameters and PRA positivity. Our study group was consisted of 94 female and 99 male patients (mean age: 44.6+15.8, mean HD duration: 42.2+15.3 months, hepatitis markers: 100 HCV (-) and 93 HCV ( +). Thirty of the patients had renal transplantation history. PRA measurement was performed with One Lambda Cell Tray. The patients whose PRA levels were more than 30% were accepted to be PRA positive. There was significant relation between transplantation history, HD duration and PRA levels of the patients (HD duration was 50.8+40.5 and 37.1+38.9 months, p =0.028 in PRA (+) and (-) patients respectively and PRA positivity ratio of patients with previous transplantation and those without were 90% and 17.2%, respectively, p=0.0002). We did not find any signifcant relationship between age, gender, HD duration, blood group, number of blood transfusions, r-HuEPO dose, presence of HCV infection and PRA positivity. In conclusion, HD duration and previous transplantation are important factors influencing PRA positivity.