Fakülteler / Faculties
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Item Hypoalbuminemia, Poor Calcium-Phosphorus Control and High Transporter Peritoneal Characteristics - Three Important 10-Year Survival Predictors for Peritoneal Dialysis Patients(2014) Tutal, Emre; Bal, Zeynep; Sezer, Siren; Uyar, Mehtap Erkmen; 0000-0002-7326-8388; IAO-2608-2023; AAZ-5795-2021; JYQ-2550-2024OBJECTIVE: Peritoneal transport characteristic is a potential survival predictor. In this study we evaluated the effect of transport characteristics on 10 year patient survival and compared its' impact with other possible survival predictors. MATERIAL and METHODS: We included 75 CAPD patients who were followed in our center for at least 10 years after initiation of PD. Based on the standard peritoneal equilibration test, PD patients were divided into two transporter groups: Low / Low average (n: 27) and High / High Average (n: 48). Clinical and demographic data were collected from patient charts and impact of transporter characteristics and some other well-known survival predictors were studied. RESULTS: 10 year PD survival rates were significantly lower in H/HA group (p: 0.001). Atherosclerosis-related mortality rate was significantly higher in H/HA group (45.9% vs. 7.6%, p: 0.043). Hypoalbuminemia, increased CaxP, chronic inflammation, H/HA transport status were independent predictors of PD and patient survival. Further analysis revealed that hypoalbuminemia (p: 0.0001) and increased CaxP levels (p: 0.0001) were the main predictors. CONCLUSION: This study suggests that peritoneal transport status is an important survival predictor. However keeping the calcium and phosphorus levels in recommended ranges, and improving nutritional status still have more importance for lowering mortality rates of PD patients.Item Endothelial Nitric Oxide Synthase Polymorphism Influences Renal Allograft Outcome(2014) Uyar, Murathan; Sezer, Siren; Ozdemir, Fatma Nurhan; Kulah, Eyup; Arat, Zubeyde; Atac, Fatma Belgin; Haberal, Mehmet; https://orcid.org/0000-0002-7326-8388; https://orcid.org/0000-0002-5682-0943; https://orcid.org/0000-0001-6041-4254; https://orcid.org/0000-0001-6868-2165; https://orcid.org/0000-0002-3462-7632; 24372826; AAK-5313-2021; JYQ-2550-2024; AAK-1697-2021; AAJ-5764-2021; ABG-9966-2020; AAJ-8097-2021BackgroundAtherosclerotic lesions within the graft are considered to be a major cause of interstitial fibrosis/tubular atrophy (IF/TA). We evaluated the factors that influence the development of IF/TA and three- and five-yr graft survival including nitric oxide synthase (eNOS) and angiotensin II type 1 and type 2 receptor gene polymorphism. MethodsSeventy-one male and 35 female patients (age: 34.911.2yr) who underwent living-related renal transplantation were included. Angiotensin type 1 and type 2 receptor gene polymorphisms and eNOS intron 4 gene polymorphism were analyzed. The pre- and post-transplant laboratory data, patient characteristics, acute rejection episodes, and presence of IF/TA were evaluated. ResultsPatients with the bb allele of eNOS gene had a lower prevalence of post-transplant third year (12.6% and 38.5%, p=0.005) and fifth year IF/TA (46.6% and 82.3%, p=0.02) and a lower incidence of five-yr graft failure (35.4% and 55.6%, p<0.005). The eNOS gene polymorphism was independent and was the most prominent factor associated with third and fifth year IF/TA (p=0.01, RR: 29.72, and p=0.03, RR: 4.1, respectively). No significant relationship existed when angiotensin II gene polymorphisms were considered. ConclusionsWe concluded that recipient eNOS gene polymorphism can predict IF/TA, and the presence of the bb allele is associated with better graft outcome.Item Free Triiodothyronine in Hemodialysis Patients Link With Malnutrition and Inflammation(2014) Yavuz, Demet; Sezer, Siren; Yavuz, Rahman; Canoz, Mujdat Batur; Altinoglu, Alpaslan; Elsurer, Rengin; Arat, Zubeyde; Ozdemir, Fatma Nurhan; https://orcid.org/0000-0002-4082-6320; https://orcid.org/0000-0002-7326-8388; https://orcid.org/0000-0002-5682-0943; 24878944; ABG-9980-2021; JYQ-2550-2024; AAK-1697-2021Introduction. Free triiodothyronine (FT3) is a marker of comorbidity in end-stage renal disease and in many acute and chronic diseases. There is lack of data about the link between FT3 levels and malnutrition and inflammation in hemodialysis patients. The objective of the present study was to investigate the link between FT3 and malnutrition and inflammation in hemodialysis patients. Materials and Methods. A total of 84 patients were included in the study (38 men and 46 women; mean age, 56.2 +/- 14.8 years; hemodialysis duration, 95.72 +/- 10.35 months). Serum FT3, free thyroxin, and thyroid-stimulating hormone concentrations were determined. Demographic data and laboratory values were evaluated. Patients' comorbidity status was determined using the Charlson Comorbidity Index (CCI), and malnutrition-inflammation status was determined by Malnutrition-Inflammation Score (MIS). Results. Serum FT3 concentration inversely correlated with age (r = -0.328, P =.002), CCI (r = -0.591, P < .001), C-reactive protein (r = -0.299, P =.01), and MIS (r = -0.671, P < .001), and positively correlated with serum albumin (r = 0.389, P < .001). In multivariate linear regression analysis, FT3 was independently associated with MIS (beta, -0.14; 95% confidence interval, -0.175 to 0.063, P = .003), adjusted for CCI, C-reactive protein level, serum albumin level, and MIS. Conclusions. The results of this study indicate that FT3 is negatively correlated with inflammatory markers, namely C-reactive protein, and it is independently related with MIS in hemodialysis patients. Therefore, we suggest that FT3 can be accepted as an inflammatory marker in hemodialysis patients.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 Differential Influence of Vitamin D Analogs on Left Ventricular Mass Index in Maintenance Hemodialysis Patients(2014) Sezer, Siren; Tutal, Emre; Bal, Zeynep; Uyar, Mehtap Erkmen; Bal, Ugur; Cakir, Ulkem; Acar, Nurhan Ozdemir; Haberal, Mehmet; https://orcid.org/0000-0002-7326-8388; https://orcid.org/0000-0002-9446-2518; https://orcid.org/0000-0002-3462-7632; 24619898; JYQ-2550-2024; AAZ-5795-2021; AAK-4322-2021; AAJ-8097-2021Purpose: Secondary hyperparathyroidism (SHPT) is a common feature in maintenance hemodialysis (MHD) patients. Inadequate treatment of SHPT has been associated with cardiovascular complications, and vitamin D therapy might influence the development of cardiovascular diseases. In the present study, we aimed to evaluate the effects of intravenous paricalcitol and calcitriol treatments on left ventricular mass index changes in MHD patients. Methods: We conducted an observational study with a 12-month follow-up duration to compare the outcomes of intravenous paricalcitol and calcitriol treatments in MHD patients. Eighty patients with moderate to severe SHPT were enrolled in the study. All the patients had normalized total serum Ca concentration <10.5 mg/dL, serum calcium-phosphorus product (Ca x P) <75, and parathyroid hormone level (PTH) level >= 300 pg/mL at the begining of the follow-up period. Results: The patients were divided into a paricalcitol group (n = 40) and a calcitriol group (n = 40). The demographic, clinical, and biochemical characteristics of the patients were similar at baseline. We observed significantly superior control of SHPT; lesser frequency of hypercalcemia and hyperphosphatemia, and Ca x P level elevations; and interruption of vitamin D treatment in the paricalcitol group. Moreover, we found no significant change in left ventricular mass index in the paricalcitol group, but found a significantly increased left ventricular mass index in the calcitriol group during the follow-up period (from 136.6 +/- 35.2 g/m(2) to 132.9 +/- 40.4 g/m(2) vs. from 137.2 +/- 30.1 g/m(2) to 149.4 +/- 31.0 g/m(2); p<0.044). Conclusion: We observed that, compared with calcitriol therapy, paricalcitol therapy reduced the PTH concentrations more effectively without causing hypercalcemia and hyperphosphatemia and might have a substantial beneficial effect on the development of left ventricular hypertrophy.Item Hematological Parameters Can Predict the Extent of Coronary Artery Disease in Patients with End-Stage Renal Disease(2015) Bal, Zeynep; Bal, Ugur; Okyay, Kaan; Yilmaz, Mustafa; Balcioglu, Serhat; Turgay, Ozge; Hasirci, Senem; Aydinalp, Alp; Yildirir, Aylin; Sezer, Siren; Muderrisoglu, Haldun; 0000-0002-8342-679X; 0000-0001-6134-8826; 0000-0002-6731-4958; 0000-0002-9635-6313; 0000-0002-3761-8782; 0000-0002-9446-2518; 0000-0001-8750-5287; 0000-0002-2557-9579; 26246038; AAK-7805-2021; AAK-7355-2020; GPX-1387-2022; AAG-8233-2020; AAD-5841-2021; AAK-4322-2021; AAZ-5795-2021; A-4947-2018; S-6973-2016Aside from traditional factors (e.g., diabetes, age, and hypertension), some hematological parameters, such as neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), and mean platelet volume (MPV), have increasingly been reported as measures of systemic inflammation and atherosclerosis in patients with end-stage renal disease (ESRD). This study aimed to determine whether there is an association between these hematological parameters and the extent of coronary artery disease (CAD) in patients with ESRD. A total of 149 consecutive ESRD patients (66 % males) without established CAD were studied. NLR, RDW, and MPV values in all patients were calculated from the complete blood count before coronary angiography. Angiographic views were assessed by an experienced interventional cardiologist, and the extent of CAD was evaluated by the Gensini score. The patients were divided into quartiles of the Gensini score. Age, time on dialysis, calcium-phosphorus product, C-reactive protein levels, NLR, and MPV were significantly different among the groups (all p < 0.05). The Gensini score was correlated with age, time on dialysis (both p < 0.001), NLR (p = 0.004), and C-reactive protein levels (p = 0.034) and inversely correlated with left ventricular ejection fraction (p = 0.023). Multivariate regression analysis showed that age (p = 0.001), time on dialysis (p < 0.001), NLR (p = 0.001), and MPV (p = 0.005) were independent predictors of the extent of CAD. Aside from the well-known traditional factors, NLR and MPV are independent predictors of the extent of CAD in patients with ESRD.Item The Relationship between Body Composition Analysis, Erythropoietin Requirements and Hemoglobin Variability in Hemodialysis Patients(2015) Tutal, Emre; Erkmen Uyar, Mehtap; Sezer, Siren; Bal, Zeynep; Bozkurt, Tugba; Ozdemir Acar, Nurhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-1461-5933; AAZ-5795-2021; AAJ-8097-2021; IAO-2608-2023OBJECTIVE: Despite of similar body weight and body mass index patients might have different body composition. Our aim was to analyze the relationship between Hb variability, rHuEPO requirements and body composition analysis of MHD patients. MATERIAL and METHODS: Monthly laboratory values and rHuEPO requirements of 110 MHD patients were collected. Patients were grouped according to Hb variability during last 6 months as Group LS (low stable, Hb<10 g/dL, n: 24), Group HS (high stable, Hb=10 g/dL, n: 43), Group V (variable, Hb varying between target, low target and high target levels, n: 43). RESULTS: Group LS had higher CRP but lower albumin levels compared to Group HS while Group V patients had lower albumin compared to HS and lower CRP levels compared to LS patients (p: 0.005). Group LS patients required significantly higher rHuEPO compared to other groups (p: 0.0001). Group HS patients had significantly higher muscle mass (p: 0.042) and muscle ratio (p: 0.018) compared to Group LS. CONCLUSION: Not only chronic inflammation but also nutritional status is closely related with Hb variability. We believe that there is a tendency to lose all body components in case of malnutrition associated with chronic inflammation while in malnutrition patients without chronic inflammation there is a tendency to loose mainly visceral fat component of total fat mass.Item Restless Legs Syndrome, Sleep Quality and Fatigue in Hemodialysis Patients(2018) Turgay, Gulay; Tutal, Emre; Sezer, SirenOBJECTIVE: Restless legs syndrome (RLS) is a common condition in hemodialysis patients and can lead to both insomnia and fatigue. This study examines the relationship between RLS, sleep quality and fatigue in hemodialysis patients. MATERIAL and METHODS: The population of this cross-sectional study included 360 patients on hemodialysis treatment. 61 patients of study group were diagnosed with RLS due to criteria of International RLS study group. 50 patients of study group without RLS were evaluated as the control group of study. Data were collected from the patient data charts; International RLS study group criteria severity scale intended for determining the severity of RLS in patients with RLS; the Pittsburgh Sleep Quality Index(PSQI), the Epworth sleepiness scale (ESS) and the Piper Fatigue Scale (PFS) were used. RESULTS: RLS was found in 17.8% (n=61) of patients and the mean severity score was 22.5 +/- 8.1. The RLS group was found to have a PSQI score of 10.8 +/- 4.8, an ESS score of 6.5 +/- 4.3 and a PFS score of 5.8 +/- 2.4 whereas the control group was found to have scores of 6.4 +/- 3.8,3.7 +/- 3.2 and 3.3 +/- 2.2 respectively (p=0.0001). CONCLUSION: RLS associated with chronic renal failure, both increase the fatigue of patients and adversely affect the quality of sleep.Item Peripheral Muscle Strength Indicates Respiratory Function Testing in Renal Recipients(2017) Ulubay, Gaye; Uyanik, Saliha; Dedekarginoglu, Balam Er; Serifoglu, Irem; Kupeli, Elif; Bozbas, Serife Savas; Sezer, Siren; Haberal, Mehmet; 0000-0002-5826-1997; 0000-0002-7230-202X; 0000-0002-3462-7632; 0000-0003-2478-9985; 28260479; AAB-5345-2021; AAI-8064-2021; AAJ-8097-2021; AAB-5064-2021; AAS-6628-2021Objectives: Muscle wasting occurs in renal recipients due to decreased physical performance, and de creased respiratory muscle strength may occur due to changes in structure and function. Data are scarce regarding the roles of sarcopenia and nutritional status on respiratory muscle function in these patients. Here, we evaluated interactions among peripheral muscle strength, sarcopenia, nutritional parameters, and respiratory muscle function in renal transplant recipients. Materials and Methods: Ninety-nine patients were prospectively enrolled between September and April 2016 at Baskent University. Forced vital capacity values (via pulmonary function tests), respiratory muscle strength (via maximal static inspiratory and expiratory pressures), and peripheral muscle strength (via hand grip strength test) were recorded. Nutritional para meters, fat weight, arm circumference, waist circumference, and C-reactive protein levels were also recorded. Results: Of 99 patients, 68 were renal transplant recipients (43 men, mean age: 39.09 +/- 10.70 y) and 31 were healthy participants (14 men, mean age: 34.94 +/- 10.95 y). Forced vital capacity (P < .001, r = 0.65), maximal inspiratory (P = .002, r = 0.39) and expiratory (P < .001, r = 0.4) pressure, and hand grip strength showed significant relations in transplant recipients. Positive correlations were found between serum albumin levels and both hand grip strength (P = .16, r = 0.347) and forced vital capacity (P = .03, r = 0.436). Forced vital capacity was statistically different between renal recipients and healthy participants (P = .013), whereas maximal inspiratory and expiratory pressures were not (P > .05). No statistically significant relation was observed between biochemical para meters and maximal inspiratory and expiratory pressures (P > .05). Conclusions: Respiratory function and peripheral muscle strength were significantly related in renal transplant recipients, with significantly lower peripheral muscle strength suggesting the presence of inadequate respiratory function. Peripheral and respiratory muscle training and nutritional replacement strategies could help to improve postoperative respiratory function.Item The Effect of Hemodialysis on Balance Measurements and Risk of Fall(2016) Erken, Ertugrul; Ozelsancak, Ruya; Sahin, Safak; Yilmaz, Emine Ece; Torun, Dilek; Leblebici, Berrin; Kuyucu, Yunus Emre; Sezer, Siren; https://orcid.org/0000-0002-0788-8319; https://orcid.org/0000-0002-6267-3695; 27497737; AAD-5716-2021; AAD-9111-2021Patients with end-stage renal disease (ESRD) have increased risk of falls and fall-related complications. Other than aging and factors related to chronic kidney disease, treatment of hemodialysis may also contribute to this increased risk. The aim of this study was to demonstrate the impairment of balance after a session of hemodialysis with a quantitative assessment and reveal an increased fall risk that would possibly be related to treatment of hemodialysis for patients on maintenance hemodialysis. Fifty-six patients with ESRD on chronic hemodialysis program and 53 healthy individuals were involved in this study. Fall Index percentages were calculated, and fall risk categories were determined for all patients and healthy controls using Tetrax posturography device (Sunlight Medical Ltd Israel). The patient group was evaluated twice for balance, before and after a routine session of hemodialysis. Fall Index scores of healthy controls were lower than that of ESRD patients (p = 0.001). In the patient group, we found the mean Fall Index to be significantly higher at the post-dialysis assessment compared to the pre-dialysis assessment (p = 0.003). The number of patients with high risk of falling also increased at the post-dialysis assessment yet the difference did not reach significance. Fall Index was correlated with the increase in age only at the pre-dialysis balance measurement (p = 0.038). Patients with better dialysis adequacy had significantly lower Fall Index scores than the others at the pre-dialysis balance measurement (p = 0.004). The difference was not significant at the post-dialysis measurement. In the current study, we evaluated the balance of ESRD patients before and after a routine session of hemodialysis treatment. This is the first study to investigate the effect of hemodialysis on balance, using an electronic posturographic balance system. We found the Fall Index score to be significantly higher after hemodialysis, indicating a negative effect of hemodialysis on postural stability. As expected, our data showed an increased Fall Index score correlated with the increase in age both in ESRD patients and in healthy controls. However, the correlation with age was not observed for the patient group at the post-dialysis balance measurement. We might conceive that young patients with ESRD are also prone to fall risk after a session of hemodialysis. Methods that provide quantitative assessment for fall risk could be rather beneficial for high-risk populations such as patients on maintenance hemodialysis.