Scopus İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4809
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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 Effects of Nutritional Knowledge of Informal Caregivers on Depression and Metabolic Outcomes of Hemodialysis Patients(2021) Kiziltan, Gul; Turker, Perim Fatma; Beyaz, Esra Koseler; Saka, Mendane; Sayin, Cihat Burak; 0000-0001-8287-6572; 34459351; J-3707-2015Chronic renal failure (CRF) makes significant changes in the life of patients and their families. A good family support has a positive effect on successful patients' adaptation to the treatment and compliance with dietary regimen. This study aimed to examine the effects of nutritional knowledge of informal caregivers on depression and metabolic outcomes of hemodialysis patients. This was a cross-sectional study conducted at Baskent University Hemodialysis Center with 116 hemodialysis patients and their informal caregivers. Findings revealed that the caregivers who were the couple of the patients had the highest nutritional knowledge level than the other caregivers (p < .05). The postgraduate caregivers were more likely to have high nutritional knowledge level than the others (p < .05). The inflammation marker of the patients was significantly lower in the group of caregivers with higher level (T3 group) of nutritional knowledge than the others (p < .05). The mean CES-D scores were also more likely to be low in T3 group than in the others (p < .05). These findings highlight that the nutritional knowledge of caregivers of hemodialysis patients may have an additional benefit on patients' nutritional management and metabolic outcomes.Item Heart Valve Disease Predict Mortality in Hemodialysis Patients: A Single Center Experience(2019) Ozelsancak, Ruya; Tekkarismaz, Nihan; Torun, Dilek; Micozkadioglu, Hasan; 0000-0002-0788-8319; 30421548Our aim is to investigate the clinical and laboratory findings affecting the mortality of the patients in 3 years follow-up who underwent hemodialysis at our center. In this retrospective, observational cohort study, 432 patients who underwent hemodialysis at our center for at least 5 months were included. The first recorded data and subsequent clinical findings of patients who died and survived were compared. Two hundred and ninety patients survived, 142 patients died. The mean age of the patients who died was higher (63.4 +/- 12.3 years, vs. 52 +/- 16.1 years, P = 0.0001), 60.5% of them had coronary artery disease (P = 0.0001), 93.7% of them had a heart valve disease. Duration of hemodialysis (survived 57 [21-260] months; died 44 [5-183] months, P = 0.000) was lower in patients who died. Serum potassium level before dialysis (5.1 +/- 0.6; 4.9 +/- 0.7 mEq/L, P = 0.030), parathyroid hormone (435 [4-3054]; 304 [1-3145] pg/mL, P = 0.0001), albumin (3.9 +/- 0.4; 3.8 +/- 0.4 mg/dL, P = 0.0001) and Kt/V (1.48 +/- 0.3; 1.40 +/- 0.3, P = 0.019) levels were lower, C-reactive protein (5[1-208]; 8.7[2-256] mg/L, P = 0.000) levels were higher in patients who died. Logistic regression analysis showed age (OR = 1.1), coronary artery disease (OR = 1.7) and more than one heart valve disease (OR = 2.4) are independent risk factors for mortality. Potassium level before dialysis (OR = 0.60), parathyroid hormone (OR = 0.99), and higher Kt/V (OR = 0.28) were found to be an advantage for survival. Age, coronary artery disease and especially pathology in more than one heart valve are risk factors for mortality. Heart valve problems might develop because of malnutrition and inflammation caused by the chronic renal failure.Item Relationship Among Coping Strategies, Quality of Life, and Anxiety and Depressive Disorders in Hemodialysis Patients(2019) Ulusoy, Selen Isik; Kal, Oznur; 0000-0003-2550-8989; 31233289Patients with hemodialysis face many physical and emotional stressors; yet little is known regarding coping strategies and their effects on patients' quality of life (QOL) and anxiety and depressive disorders. A total of 117 patients were enrolled in this cross-sectional study between October 2016 and April 2017. This study assessed QOL (Medical outcome short form 36-MOS 36), coping (Assessment Scale for Coping Attitudes-COPE) and psychiatric comorbidities in hemodialysis patients. Beck Depression Scale and Beck Anxiety Scale were also applied. Differences between groups were evaluated using Student's t-tests and anova. Correlations among parameters were performed. Patients with any depressive disorder (22.2%, n = 26) and patients with any anxiety disorder (19.6%, n = 23) reported more impaired QOL. The most frequently used coping strategy in all patients was religious coping. Use of instrumental social support, humor, and positive reinterpretation scores were lower in patients with any depressive disorder (P = 0.009, P = 0.034, P = 0.047).The total score of emotion-focused coping strategies was lower with patients with any depressive disorder (P = 0.021) and emotion-focused coping strategies were positively correlated with QOL scores. Younger age and longer duration of hemodialysis have significant negative correlation with emotion-focused coping strategies' total score (P = 0.01, P = 0.02). Patients with hemodialysis use variety of coping strategies. The use of emotion-focused coping was associated with better QOL and reducing the risk of depressive disorder. Interventions to facilitate the use of adaptive coping strategies may improve patients' QOL and mood.Item Central venous occlusion in hemodialysis access: Comparison between percutaneous transluminal angioplasty alone and nitinol or stainless-steel stent placement(2019) Gur, S.; Oguzkurt, L.; Gedikoglu, M.; 30952526Purpose: The purpose of this study was to compare the primary and secondary patency rates occlusion; of percutaneous transluminal angioplasty (PTA) atone with those of metallic stent placement Angioplasty; in patients with hemodialysis access and central venous occlusion (CVO) and to compare the Hemodiatysis; respective effects of nitinol and stainless-steel stents on patency. Materials and methods: A total of 150 consecutive patients with hemodialysis access who under-went endovascular treatment for symptomatic CVO with ipsilateral functioning hemodialysis access were evaluated. There were 67 men and 83 women with a mean age of 56.2 +/- 15.2 (SD) years (range: 15-86 years). The primary endovascular treatment of CVO was PTA alone. Stent placement either with nitinol or stainless-steel stents was performed as a bailout procedure. The results were analyzed on a per patient basis. Results: Technical success was achieved in 141/150 patients (94%). Of the 141 patients, 109 (77%) underwent PTA alone and 32 (23%) underwent stent placement. The mean number of interventions in the stent group [4.3 +/- 2.5 (SD)] was significantly higher than that in the PTA alone group [2.6 +/- 2.8 (SD)] (P=0.002). The primary patency rates at 12, 24, and 60 months for the stent group (58.7%, 41.9%, and 27.9%, respectively) were significantly higher than those in the PTA alone group (42.4%, 36.3%, and 20.2%, respectively) (P=0.036). Secondary patency rates at 12, 24, and 60 months for the stent group (87.6%, 80.7%, and 50.3%, respectively) were significantly greater than those in the PTA alone group (68.4%, 56%, and 38.6%, respectively) (P = 0.046). Furthermore, the primary patency rates at 6 and 12 months in the nitinol stent group (89% and 80.9%, respectively) were significantly greater than those in the stainless-steel stent group (78.8% and 38.4%, respectively) (P= 0.007). The secondary patency rates at 6, 12 and 24 months for the nitinol stent group (92.8%, 87.7% and 65.8%, respectively) were significantly greater than those in the stainless-steel stent group (85.7%, 76.2% and 65.3%, respectively) (P=0.011). Conclusion: Although PTA alone is an effective interventional treatment strategy of CVO in short term, stent placement yields greater primary and secondary patency rates in the long-term. But the mean number of interventions per vein after stenting is significantly higher. Close follow-up and multiple re-interventions are necessary to ensure long-term patency. (C) 2019 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.Item Assessment of Hemoglobin Stability in Chronic Hemodialysis Patients Receiving Erythropoietin Therapy and the Effect of Hemoglobin Stability on Risk of Cardiovascular Disease(2019) Guncan, Melda Ulas; Guncan, Sabri; Torun, DilekObjective: Anemia is one of the most important factors that decrease the quality of life in patients with end-stage renal desease receiving hemodialysis treatment. In these patients, Erythropoietin stimulating agents (ESAs) are used in the treatment of anemia. Although the target hemoglobin (Hb) value in chronic renal failure is 11-12 gr/dL, it is suggested that hemoglobin values fluctuate between normal, high and low values in the great majority, leading to cardiovascular structural changes which increase mortality. In this study, we investigated the effect of anemia and hemoglobin fluctuations on mortality rate and the risk of cardiovascular disease in chronic hemodialysis patients who received ESA thearapy. Materials and Methods: Hemoglobin values for 12 months of 181 patients were examined. The target Hb level was 11-12 gr/dL interval and the patients were divided into 6 groups according to the hemoglobin values; persistently low, low-normal, target, normal-high, low-high and persistently high. According to the variability in hemoglobin level, groups were compared in terms of demographic, laboratory characteristics, treatment, risk of cardiovascular disease, hospitalization and death frequency and causes. Result: The total of 181 patients were classified according to Hb levels; 22 (12.2%) patients were persistently-low, 72 (39.8%) were low-normal, 10 (5.5%) were normal-high and 77 (42.5%) patients were low-high Hb group. During the 12 month fallow up, there were no patients in target and high Hb group. The groups were similar in terms of the presence of comorbid diseases such as diabetes, hypertension, coronary artery disease and other demographic characteristics, and there was no difference between groups in terms of cardiovascular disease development. ESA doses and blood transfusion counts and mortality rates were significantly higher in the persistently-low hemoglobin group compared to the other groups. Conclusion: In our study, high rate of anemia and hemoglobin fluctuations were shown in chronic hemodialysis patients and anemia was associated with mortality. However, the possible association of these variables with cardiovascular diseases was not observed. Further studies are needed in the larger hemodialysis patient group to investigate the relationship between hemoglobin fluctuation and mortality and cardiovascular risk.Item Cerebrovascular events in hemodialysis patients; a retrospective observational study(2019) Ozelsancak, Ruya; Micozkadioglu, Hasan; Torun, Dilek; Tekkarismaz, Nihan; 0000-0002-0788-8319; 31830923Background This study reports findings in subjects who underwent brain imaging for any reason, and examined factors influencing cerebrovascular events (CVEs) in hemodialysis (HD) patients. Methods We reviewed the files of patients on HD between January 2015 and January 2018. A total of 432 patients who underwent HD for at least 5 months by the January 2015 and who were older than 18 years were included in the study; 264 had been examined by cerebral computed tomography or magnetic resonance imaging examination within the 3 years. Cerebrovascular pathology was detected in 139 of 264 patients. Results Of the 139 patients, 65 (24.62%) had ischemic lesions, 25 (9.47%) had hemorrhagic lesions, and 49 (18.56%) had cerebral small vessel disease (CSVD). We compared recorded data and later clinical findings between patients with and those without CVEs. The cause of end-stage renal disease was diabetes in 58.5% of patients with ischemic lesions, 52% in those with hemorrhagic lesions, and 55% in those with CSVD (P < 0.05). Patients with cerebrovascular ischemia were older (P = 0.0001) and had lower serum creatinine (sCr) (P = 0.0001) and higher serum C-reactive protein (CRP) (P = 0.002) levels than normal subjects. Hemorrhagic patients were older (P = 0.003) and had lower sCr (P = 0.003) and serum predialysis potassium (P = 0.003) and parathyroid hormone (PTH) (P = 0.004) levels than normal subjects. Patients with CSVD were older (P < 0.0001) and had lower sCr (P < 0.0001), phosphorus (P < 0.007), and PTH (P < 0.013) and higher CRP (P < 0.002) levels than normal subjects. Conclusions HD patients with CVEs are older and typically have diabetes mellitus and lower sCr levels.Item Surgical Interventions for Late Complications of Arteriovenous Fistulas(2014) Belli, Sedat; Yabanoglu, Hakan; Aydogan, Cem; Parlakgumus, Alper; Yildirim, Sedat; Haberal, Mehmet; 25058786Our aim was to determine the most effective surgical treatment for arteriovenous fistula (AVF) complications after all other methods of salvage have failed. We evaluated 110 patients for 139 complications that occurred after the initial AVF placement and for whom surgical intervention was the last hope for retaining fistula access. Vascular steal syndrome and venous hypertension were the most common complications seen in our patients. The anastomoses of 17 of the vascular steal syndrome cases were narrowed either by stitches or by a polytetrafluoroethylene graft. The second most performed revision surgery was excision of the aneurysm and repair with primary suturing, followed by excision of the aneurysm and interposition grafting. Successful surgical outcomes were achieved in 111 of 139 procedures after revision surgery without constructing a new AVF. AVF salvage surgery is of paramount importance in order to increase the patency rate, which prolongs survival and increases the patient's quality of life.Item Hepatitis C infection in hemodialysis patients: A review(2015) Etik, Digdem Ozer; Ocal, Serkan; Boyacioglu, Ahmet Sedat; 25937865Hepatitis C virus (HCV)-related liver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) who is treated with dialysis or kidney transplantation (KT). The survival rate for HCV-infected renal transplant recipients is better than that for HCV-infected hemodialysis patients on transplant waiting lists. Early diagnosis and treatment HCV infection prior to KT prevents complications post-transplantation and reduces mortality. In addition to screening for anti-HCV antibodies and detecting HCV RNA, percutaneous liver biopsy is particularly valuable for assessing the stage of liver damage in HCV-infected patients, because the stage of fibrosis is important determining optimal treatment for HCV. Studies have been demonstrated that with conventional interferon (IFN) monotherapy or pegylated IFN monotherapy are similar efficacy and safety in HCV-infected hemodialysis patients. Sustained viral responses (SVRs) with these monotherapies have ranged approximately 30% to 40%. Limited reports support the use of IFN and ribavirin combination therapy as antiviral treatment for ESRD patients or patients on hemodialysis. Ribavirin can be started at low dose and careful monitoring for side effects. Patients that show SVR after treatment are strong candidates for KT. It is also generally accepted that ESRD patients with decompensated cirrhosis and portal hypertension should be referred to the liver transplant team for consideration of combined liver-KT.Item Impact of surgeon factor on radiocephalic fistula patency rates(2016) Arer, Ilker Murat; Yabanoglu, Hakan; 26900457Introduction: Hemodialysis with arteriovenous fistula (AVF) has been widely accepted treatment modality for patients with chronic renal failure (CRF). Radiocephalic fistulas are considered to be the most desirable for the initial vascular access. The aim of this study is to investigate the surgeon factor on radiocephalic fistula patency rates. Methods: A total of 186 patients with diagnosis of CRF underwent Radiocephalic fistula for hemodialysis access were included. Patients were divided into 2 groups according to operating surgeon. Patients were evaluated according to demographic characteristics, secondary patency rates, second AVF creation and complications. Results: Mean age was 57.7 +/- 14.8 years. The most common etiology of CRF was idiopathic (66.6%). 40 (75.5%) patients in group 1 and 122 (91.7%) patients in group 2 were pre-dialysis patients (p < 0.05). Overall secondary patency rate was 77.4%. Patients in group 1 and group 2 have secondary patency rates of 83% and 75.2%, respectively (p = 0.458). Second AVF creation was done in 2 (3.8%) patients in group 1 and 23 (17.3%) patients in group 2 (p < 0.05). Postoperative complication rate was 9.6%. Conclusion: Operating surgeon is not a major factor of secondary patency in radiocephalic arteriovenous fistulas. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Limited.