Başkent Üniversitesi Makaleler

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    An International Survey of the Diagnosis, Management, and Treatment of Hepatitis C in Patients with End-Stage Renal Disease
    (Başkent Üniversitesi, 2009-12) Araya, Victor; Ortiz, Jorge; Olson, Mira R.; Grewal, Kevin S.; Bingaman, Adam; Zaki, Radi; Stewart, Shelby; Horton, John
    Objectives: Hepatitis C is one of the leading causes of death from liver disease in the United States, and is frequently associated with renal disease. Two major organizations—the American Association for the Study of Liver Disease and the National Kidney Foundation—have published recommendations regarding the treatment of hepatitis C in the presence of chronic kidney disease; however, these guidelines do not always provide the same recommendations. Given the paucity of data on adherence to the current guidelines, a survey was conducted to provide information about the current practices of physicians in comparison to the published guidelines. Materials and Methods: An observational study was conducted via a global survey asking physicians treating patients who had concurrent hepatitis C and chronic kidney disease. Results: The 218 questionnaires collected requested the physician’s subspecialty, the number of transplants performed at the hospital, the usual method of screening for hepatitis C, the preferred route, the indication and frequency of liver biopsy, the use of ribavirin and interferon, the use of hepatitis-C–positive donors in kidney transplant, and consent requirements. Conclusions: Our results showed that many physicians do not follow current recommendations. We argue that a consensus group be formed to set forth guidelines for the management of hepatitis C to optimize outcomes, and improve overall morbidity.
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    Tamoxifen Therapy in Kidney-Transplant Patients Presenting With Severe Encapsulating Peritoneal Sclerosis After Treatment for Acute Humoral Rejection
    (Başkent Üniversitesi, 2009-09) Mohamed, Abdellatif Ould; Rostaing, Lionel; Duffas, Jean Pierre; Esposito, Laure; Nogier, Marie-Béatrice; Kamar, Nassim
    Objectives: Encapsulating peritoneal sclerosis is a rare but serious complication in patients undergoing peritoneal dialysis. Its mortality rate is approximately 30%, despite treatment with total parenteral nutrition, surgery, tamoxifen, or immunosuppressants. Materials and Methods: Of 991 kidney transplants performed at our institution over 9 years, 50 patients were treated for chronic peritoneal dialysis at the time of transplant. Results: Two cases of encapsulating, peritoneal sclerosis occurred in patients receiving pretransplant peritoneal dialysis. Both had received intensive posttransplant treatment for acute humoral rejection. Encapsulating peritoneal sclerosis occurred at 3 months and 4 months after the transplant. Both presented with intestinal pain and gut obstruction. They were given total parenteral nutrition plus tamoxifen (20 mg/d) for 3 months. Outcomes were favorable for 1, though there was no improvement for the second patient, who was then also given sirolimus. He died later from multiorgan failure secondary to digestive-related sepsis, and encapsulating, peritoneal, sclerosis-related symptoms. Conclusions: When encapsulating, peritoneal sclerosis occurs after kidney transplant, tamoxifen therapy could be implemented.
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    Bacteremia Using the Molecular Adsorbent Recirculating System in Patients Bridged to Liver Transplantation
    (Başkent Üniversitesi, 2005-06) Doria, Cataldo; Marino, Ignazio R.
    Objective: To retrospectively analyze the incidence and implications of bacteremia in patients supported by a molecular adsorbent recirculating system bridged to liver transplantation. Material and Methods: From September 2000 to April 2003, 30 patients (17 males and 13 females, aged 15-70 years; median age, 52 years) presenting with acute-on-chronic liver failure were treated with a molecular adsorbent recirculating system. Results: Nine patients (30%) developed bacteremia (positive blood culture) during treatment, 100% of them died during the same hospital admission. The most common isolates were Pseudomonas aeruginosa (44.4%) and Escherichia coli (33.3%). Sputum (44.4%) and ascites (33.3%) represented the most common sources of infection followed by urine and purely bloodborne infections (11.1% each). The isolate in the sputum was Pseudomonas aeruginosa 100% of the time, whereas Escherichia coli was found in 66.6% of the ascites cultures. The hemodynamic profile of patients who developed positive blood cultures showed significantly lower systemic vascular resistance indexes compared with those of nonbacteremic patients before and after treatment. There was a statistically significant difference (P = 0.0002) in survival between the bacteremic (who all died) and the nonbacteriemic patients treated. Conclusions: Bacteremia was found to be a negative prognostic factor for patients supported with a molecular adsorbent recirculating system and therefore, a contraindication to starting and/or continuing treatment. Infection should be carefully ruled out prior to initiating treatment using a molecular adsorbent recirculating system. Moreover, prophylaxis with broad-spectrum antibiotics that provide double coverage against Gram-negative bacteria should be mandatory.
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    Türkiye’de Diyaliz Hizmetlerinin Epidemiyolojisi (1997-2003)
    (Başkent Üniversitesi, 2005-05) C. Özcan; B. Keskinkılıç; F. Sözen; N. Özdemir
    Bu çalışmada ülkemizde 1997-2003 yıllarında kronik böbrek hastalarına sunulan diyaliz hizmetlerinin bir karşılaştırılması yapılmıştır. Bu dönemde diyaliz merkezlerinin bağlı bulunduğu kurumlara göre sayısı, bulunduğu yer, cihaz, hasta ve seans sayılarına ait gelişmeler yıllara göre belirtilmiştir. 1997 ve 2003 yılı sonunda hastaların yaşı, cinsiyeti ve sosyal güvence durumları ile morbidite ve mortalitesine ait temel demografik bilgiler verilmiştir. Son altı yıl içerisinde diyaliz merkez sayısında %104,4 cihaz sayısında %124,5, hemodiyalize giren hasta sayısında %142,6’lık bir artış olmuştur. Periton diyalizi sayısı ve payı 1997 yılı sonunda %5,1 (597 hasta) iken 2003 yılı sonunda bu oran %16,7 (3855 hasta)’ya ulaşmıştır. Diyaliz merkezlerinin açılma, işletme, personel standardı ve eğitimi ile izlenmesi ve denetimi açısından mevcut yasal durum incelenmiş, uygulamaya ait sorunlar belirlenerek, öneriler ortaya konulmuştur. Özellikle merkezlerde sunulan hizmetlerin kalitesi ile hastaların yaşam kalitesinin arttırılmasına ait gelişmelerin önemi vurgulanmıştır. Examination of Dialysis Services in Turkey: 1997-2003 We exemined the activities of the dialysis services in Turky betveen 1997-2003. These are nomber of location of services existing dialysis machines, distribution of patients and number of session/patient. During the last 6 years, there has been a 100.4% increase in the number of dialysis centers, a 124.5% increase in the number of dialysis machines, and a 142.6% increase in the number of patients. While the percentage of peritoneal dialysis patients was 5.1% (597) in 1997, it increased to 16.7% (3855 patients) by the end of 2003. Licensing, administration, personnel post and their training, monitoring, and evaluation procedures were examined for all existing dialysis centers. After determining the problems, possible solutions were given, especially with regard to quality of services and the importance of patients’ quality of life.