Wos İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Predictive Factors of Mortality in Granulomatosis with Polyangiitis: A Single-Center Study(2021) Tufan, Muge Aydin; Tekkarismaz, Nihan; 0000-0002-2686-9762; 0000-0001-7631-7395; 34870176; AAJ-9057-2021; AAD-9088-2021Objectives: The aim of this study was to identify predictors of mortality in granulomatosis with polyangiitis (GPA) patients and to seek the ways of improving survival in GPA patients. Patients and methods: Between January 2005 and June 2020, a total of 60 patients (26 males, 34 females; median age: 49 years; range, 19 to 75 years) who were diagnosed with GPA were retrospectively analyzed. Demographic, clinical, laboratory, and radiological findings of all patients were recorded. Survival rates were analyzed using the Kaplan-Meier plot. Results: The median follow-up was 36 months, and 10 (16.7%) patients died during the study period. Univariate analysis showed that the prognostic values were attributed to high serum creatinine levels (>2.1 mg/dL; p=0.01), proteinuria (p=0.01), dialysis-requiring renal damage at the time of diagnosis (p=0.01) or at any time during follow-up (p=0.01), low lymphocyte levels (p=0.01), hypoalbuminemia (p=0.04), absence of upper respiratory tract involvement (p=0.01), presence of lung involvement with cavitary lesions (p=0.01), high Birmingham Vascular Activity Score (p=0.02), and history of serious infection (p=0.01). In the multivariate analysis, the presence of renal damage requiring dialysis at any time during follow-up (relative risk [95% confidence interval]: 21 [4.1-18.3]; p=0.01) was found to be an independent predictor of mortality. Immunosuppressive drugs exerted no effect on mortality, and the most common causes of death were infections (50%). Conclusion: The presence of dialysis-requiring renal damage is the most important risk factor for mortality in GPA patients. These patients should be followed more closely and carefully to improve survival.Item Factors affecting relapse in patients with Granulomatosis Polyangiitis: a single-center retrospective cohort study(2021) Aydin Tufan, Muge; Tekkarismaz, Nihan; Yucel, Ahmet Eftal; 0000-0001-7631-7395; 0000-0002-2686-9762; 33315347; AAD-9088-2021; AAJ-9057-2021Background and aim: This study aimed to determine the frequency of relapse, the risk factors for relapse, and the correlation of relapse with immunosuppressive regimens in patients with granulomatosis polyangiitis (GPA). Materials and methods: The demographic characteristics, the clinical, laboratory, and radiological findings, the immunosuppressive treatment regimens, and the remission and relapse rates of 50 patients with GPA were obtained retrospectively from medical records. Results: The mean relapse-free survival rates at years 1, 3, and 5 were 82%, 60%, and 50%, respectively. Increased relapse rates were observed in patients who had cavitary lung lesions (52.2% vs. 22.2%, p = 0.04) and in those who had elevated serum creatinine levels (1.8 vs. 0.9, p = 0.00). The patients received two different types of remission induction therapies; 36% of them received the combination therapy involving cyclophosphamide (CYC) and rituximab (RTX), and 62% received CYC alone. Relapse was observed in 22.3% of the patients who received the combination remission induction therapy and in 61.3% of the patients who received CYC alone (P = 0.003). Conclusion: An increased risk of relapse was observed in patients who had cavitary lung lesions and in those who had elevated serum creatinine levels. The combined use of RTX and CYC for the remission therapy in GPA reduced the relapse rates compared with the use of CYC alone.Item EVALUATION OF EPICARDIAL FAT AND CAROTID AND FEMORAL INTIMA-MEDIA THICKNESSES IN GERIATRIC PATIENTS WITH END-STAGE RENAL DISEASE(2020) Gunesli, Aylin; Yilmaz, Mustafa; Yalcin, Cigdem; Tekkarismaz, Nihan; Alkan, Ozlem; 0000-0002-2557-9579; 0000-0001-5483-8253; 0000-0001-7631-7395; S-6973-2016; AAM-4284-2021; AAD-9088-2021Introduction: Although atherosclerotic cardiovascular diseases and cardiovascular risks are known to increase in patients with end-stage renal disease, it is not clear whether these risks increase in the geriatric patient population as well. This study aims to evaluate these risks in geriatric patients with end-stage renal disease by evaluating epicardial fat and carotid and femoral intima-media thicknesses, known as markers, for subclinical atherosclerosis and cardiovascular risks. Materials and Methods: This cross-sectional study included 52 patients who started to receive chronic hemodialysis treatment after the age of 65 years (mean age 73.92 +/- 5.63) years with end-stage renal failure and 51 healthy volunteers (mean age: 74.49 +/- 4.63 years). Epicardial fat and carotid and femoral intima-media thicknesses were measured and compared between these groups. Results: Carotid intima-media and epicardial fat thicknesses were significantly higher in the patient group than in the control group (0.91 +/- 0.08 vs. 0.71 +/- 0.1 mm, p<0.001 and 0.84 +/- 0.17 vs. 0.75 +/- 0.17 cm, p=0.01, respectively). However, no significant difference was observed in femoral intima-media thickness between the two groups (0.58 +/- 0.07 vs. 0.56 +/- 0.97 mm, p=0.266). Correlation analysis revealed a significant positive correlation between the duration of dialysis and epicardial fat and carotid intima-media thicknesses (r=0.611, p<0.001 and r=0.337, p=0.015, respectively). Furthermore, regression analysis revealed a significant relationship between the duration of dialysis and carotid intima-media thickness (beta=0.657, p=0.001). Conclusion: Epicardial fat and carotid intima-media thicknesses increase in geriatric patients with end-stage renal disease but with no significant changes in femoral intima-media thickness, indirectly suggesting that subclinical atherosclerosis and cardiovascular risks are increased in these patients.Item Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single centre in Turkey(2020) Tekkarismaz, Nihan; Torun, Dilek; 0000-0001-7631-7395; 0000-0002-6267-3695; 32041385; AAD-9088-2021; AAD-9111-2021Background/aim: The aim of this study was to evaluate the clinical outcomes and identity the predictors of mortality in peritoneal dialysis patients. Materials and methods: Medical records of all incident peritoneal dialysis (PD) patients followed up between January 2011 and May 2019 were reviewed retrospectively. All patients were followed up until death, renal transplantation, transfer to haemodialysis or the end of the study Results: A total of 242 patients were included in thestudy: The incidence of peritonitis was 0.18 (ranging from 0 to 14.9) episodes per patient year. Death occurred in 280 (n: 68) of cases. Age, diabetes mellitus, malignancy and refractory heart failure were independent risk factors for all-cause mortality according to multivariate analysis. 'the presence of comorbid disease and diabetes mellitus and patients aged > 65 years were associated with increased risk of mortality and decreased patient survival. Peritonitis history was associated with increased risk of mortality Between peritonitis and peritonitis-free group, there was no significant difference in Kaplan-Meier curves in terms of patient survival. Conclusion: This is the first study to define 9-year mortality predictors in PD patients in our centre. Although peritonitis is the most feared complication of PD, our study showed that peritonitis did ot reduce patient survival.Item Dialysis modality and sexual dysfunction in male patients(2020) Tekkarismaz, Nihan; Tunel, Munevver; Ozer, Cevahir; 0000-0001-7631-7395; 0000-0002-7850-6912; 0000-0001-7140-1803; 0000-0001-6037-7991; 32627887; AAD-9088-2021; AAM-2222-2020; AAD-8660-2021Sexual dysfunction is an under-recognised problem in due to very limited number of studies in the literature. This study aims to evaluate the sexual dysfunction related effects of dialysis modality among male patients with chronic renal failure. All patients were asked to complete 2 questionnaires: Hospital Anxiety Depression Scale [HADS] and International Index of Erectile Function [IIEF-5]. A total of 51 patients who completed the questionnaires were included in the study. 31 of them were under haemodialysis (HD) treatment, and 20 were under peritoneal dialysis (PD) treatment. After adjustment for age and HADS score, there was no statistically significant difference between HD and PD groups in terms of the mean IIEF scores (55 vs. 40,p = .058), and the frequency of sexual dysfunction (12.9% vs. 30%,p = .163). Age (r = -0.553), blood pressure (r = -0.299/ -0.374), use of iron (r = -0.333), lipid levels (r = -0.281/ -0.276) and HADS-D score (r = -0.276) inversely associated with IIEF score (p < .05). To conclude, sexual dysfunction is more common in patients who receive PD therapy than those who receive HD therapy. Older age, higher blood pressure, iron treatment, higher lipid levels and the presence of depression were associated with higher prevalance of sexual dysfunction.Item Experience with antiviral agents for treatment of hepatitis C virus infection in hemodialysis patients on the kidney wait list(2019) Torun, Dilek; Soydas, Baris; Tekkarismaz, Nihan; Ozelsancak, Ruya; Micozkadioglu, Hasan; Haberal, Mehmet; 30762283Introduction Hepatitis C virus (HCV) infection is associated with increased mortality and morbidity in kidney transplant patients. The ability to establish a sustained viral response before renal transplant is important for these patients. Direct-acting antiviral agents can increase the sustained viral response in most patients with HCV infection. In this case series, we aimed to determine the efficacy and safety of a combined therapy of ombitasvir, paritaprevir, ritonavir, and dasabuvir with or without ribavirin in patients with HCV genotype 1 infection without cirrhosis and on hemodialysis who were awaiting deceased-donor kidney transplant. Methods Our study included eight male and two female HCV ribonucleic acid (RNA)-positive hemodialysis patients (mean age 50.7 +/- 15 years, mean hemodialysis duration 14 +/- 5.5 years, mean HCV duration 18 +/- 3.7 years). Findings Three patients with genotype 1a received oral therapy with 12.5 mg ombitasvir, 150 mg paritaprevir, 7 5 mg ritonavir, and 250 mg dasabuvir plus 200 mg ribavirin for 12 weeks. Seven patients with genotype 1b received 12.5 mg ombitasvir, 150 mg paritaprevir, 75 mg ritonavir, and 250 mg dasabuvir without ribavirin treatment for 12 weeks. The sustained virologic response rate was 100% at 12 weeks after completion of antiviral treatment in both treatment groups. No serious adverse effects were observed in either treatment group. Five patients had constitutional symptoms such as nausea, anorexia, and fatigue. During the treatment period, hemoglobin, white cell blood count, thrombocyte, and ferritin levels were similar to pretreatment levels. Treatment did not affect weekly erythropoietin and monthly intravenous iron treatment doses. Discussion Direct-acting antiviral agents are safe and effective for generating a sustained viral response in HCV genotype 1-infected hemodialysis patients on kidney wait lists.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 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 Listeriosis in a Patient Undergoing Hemodialysis: A Case Report and Review of the Literature(2017) Tekkarismaz, Nihan; Ozelsancak, Ruya; Torun, Dilek; Aliskan, Hikmet Eda; 0000-0001-7631-7395; 0000-0001-9060-3195; 0000-0002-0788-8319; 0000-0002-6267-3695; AAD-9088-2021; AAE-2282-2021; AAD-5716-2021; AAD-9111-2021Listeria monocytogenes (L. monocytogenes) infection is an uncommon manifestation in patients with chronic renal failure. In this article, we present a case of L. monocytogenes bacteremia in a patient undergoing hemodialysis. In addition, we are also present the listeriosis cases in hemodialysis patients reported so far in the literature. The patient was a 58-year-old man who was undergoing hemodialysis and had been admitted to hospital with fever. On the 5th day of admission, L. monocytogenes was detected in his blood cultures. He responded dramatically to ampicillin treatment. Listeriosis is a disease that requires careful microbiological laboratory examination. If the patient cultures are not analyzed carefully, the disease can be misdiagnosed. Only early diagnosis and adequate treatment can ensure a good prognosis.Item The Evaluation of Clinical Signs in Patients with Suspected Renovascular Hypertension(2018) Tekkarismaz, Nihan; Torun, Dilek; Ozkan, Ugur; Zumrutdal, Aysegul; Acar, Fatma Nurhan Ozdemir; 0000-0001-7631-7395; 0000-0002-5682-0943; 0000-0002-6267-3695; AAD-9088-2021; AAK-1697-2021; AAD-9111-2021OBJECTIVE: Renovascular hypertension (RVH) is the most common yet correctable cause of secondary hypertension if diagnosed early. There are many clinical signs that can suggest RVH. The aim of this study was to find which clinical or laboratory signs are more indicative in diagnosing RVH and in determining which patients should go through renal angiography. MATERIAL and METHODS: The study included 184 patients who presented to our clinic due to hypertension and were under risk of RVH. All patients underwent three-dimensional time-of-flight Magnetic Resonance Angiography with phase-contrast. The patients were divided into two groups as with and without renal artery stenosis, supported by MRA. RESULTS: Advanced age, low body mass index, high serum creatinine level, presence of proteinuria, and patients with diabetes mellitus and coronary artery disease were found to be significant risk factors for RVH. Only the presence of renal asymmetry and the history of coronary artery disease were found to be independent risk factors. CONCLUSION: In conclusion, detailed patient history and the evaluation of renal size are very important for patients with hypertension. Coronary artery disease and a difference in renal size of more than 1.5 cm could be strong indicators of RVH.