Wos İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4807
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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 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; 24436491Background: 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.Item New-Onset Diabetes and Glucose Regulation Are Significant Determinants of Left Ventricular Hypertrophy in Renal Transplant Recipients(2015) Sezer, Siren; Uyar, Mehtap Erkmen; Tutal, Emre; Bal, Zeynep; Guliyev, Orhan; Colak, Turan; Hasdemir, Efe; Haberal, Mehmet; 25945353Background. New-onset diabetes after transplantation (NODAT) is associated with decreased graft survival and an increased risk for cardiovascular disease. The objective of this study was to evaluate the risk factors for development of NODAT and its' relationship with arterial stiffness and left ventricular mass index (LVMI) in kidney transplant recipients. Methods. 159 kidney transplant recipients were selected from our transplantation center who underwent renal transplantation between years 2007 and 2010. Results. Among 159 patients, 57 (32.2%) patients were with NODAT who were significantly older than patients without diabetes (P: 0.0001). Patients with NODAT had significantly higher pulse wave velocity (PWv) (P: 0.033) and left ventricular mass index LVMI (P: 0.001) compared to patients without NODAT. Further analysis was done according to LVMI as follows: LVMI > 130 g/m(2) (n: 57) and LVMI <= 130 g/m(2) (n: 102). We observed higher office systolic and diastolic BP, serum trygliceride, glucose, creatinine, age, and HbA1c (P: 0.0001) levels in patients with LVMI > 130 g/m(2). Linear regression analysis revealed that HbA1c was the major determinant of LVMI (P: 0.026, beta: 0.361). Conclusions. HbA1c is the major determinant of LVMI, so strict control of serum glucose levels is essential for preventing cardiovascular disease in patients with NODAT.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 Prolongation of Corrected QT Interval Is a Strong Predictor of Arterial Stiffness in Maintenance Hemodialysis Patients: A Prospective Observational Study(2017) Bal, Ugur; Bal, Zeynep; Karakose, Suleyman; Tutal, Emre; Uyar, Mehtap Erkmen; Sezer, Siren; 0000-0003-2026-2764; 0000-0002-9446-2518; P-4553-2018; AAK-4322-2021; AAZ-5795-2021Background: Rate of mortality due to cardiovascular diseases is high in Maintenance Hemodialysis (MHD) patients. Additionally, prolonged QT interval is reportedly associated with high-risk ventricular arrhythmia and sudden death. Vascular calcification may be related to QT dispersion interval in MHD patients because the extensive nature of the calcification process may involve the conducting system and myocardium. Objectives: This study aimed to evaluate the relationship between QT interval and Pulse Wave Velocity (PWV) as a sign of arterial stiffness associated with atherosclerosis in MHD patients. Patients and Methods: This prospective, observational study was conducted on 149 eligible MHD patients for 12 months. Patients using drugs known to affect QT interval were excluded. The patients were divided into four groups as follows: normal corrected QT (QTc) interval at the beginning and end of the study (n = 44, 29.5%), normal QTc interval at the beginning but prolonged QTc interval at the end of the study (n = 30, 20.1%), prolonged QTc interval at the beginning but normal QTc interval at the end of the study (n = 24, 16.1%), and prolonged QTc interval at the beginning and end of the study (n = 51, 34.2%). Demographic parameters, laboratory parameters, and PWV were assessed at the beginning and the 12th month of the study. Then, the data were analyzed using ANOVA or Pearson 2 test and P < 0.05 was considered to be statistically significant. Results: The study groups were similar with respect to age and comorbidities, including diabetes mellitus, hypertension, and dyslipidemia. In addition, there were no significant differences among the groups regarding the initial PWV (P = 0.412); however, the ending PWV showed significant differences (P = 0.029). The results of multivariate analysis showed that PWV was independently associated with change in the maximum QTc (confidence interval: 0.039 -1.787, P = 0.031, beta= 0.178). Conclusions: The results suggested inclusion of QTc interval prolongation, as a predictor of cardiovascular disease, either alone or in combination with PWV in such high-risk patients.