African Journal of Microbiology Research, Nov 18, 2010
Abstract Crimean-congo hemorrhagic fever (CCHF) is a viral disease that can be seen in people epi... more Abstract Crimean-congo hemorrhagic fever (CCHF) is a viral disease that can be seen in people epidemically or as single patient. CCHF is a highly deadly disease caused by Nairovirus from Bunyaviridae family. Endothelial damage caused by secreted cytokines ...
Horseshoe kidney is a renal fusion anomaly during embryogenesis with incidence ranges of 1 in 400... more Horseshoe kidney is a renal fusion anomaly during embryogenesis with incidence ranges of 1 in 400 to 1 in 1800 live births. Adult polycystic kidney disease is a hereditary disorder and transmitted in autosomal dominant pattern with a reported incidence of 1 in 1000 to 1 in 5000 cases. Polycystic horseshoe kidney is a very rare occurrence with incidence ranges of 1 in 134 000 to 1 in 8 000 000 live births. We here present a patient who was admitted at the hospital with headache, hypertension and polycystic horseshoe kidney.
BACKGROUND AND OBJECTIVE Fluid overload is an important factor of morbidity and mortality in hemo... more BACKGROUND AND OBJECTIVE Fluid overload is an important factor of morbidity and mortality in hemodialysis patients. Today correct determination of dry weight (DW) remains an important issue of hemodialysis practice. Within this context, it is subjected to new method searching. The objective of this study was to calculate estimated pulmonary capillary wedge pressure (ePCWP) with Tissue Doppler Imaging (TDI) in hemodialysis patients and to evaluate its correlation with the other volume markers and to evaluate whether it can be a new method for detection of DW. MATERIALS AND METHODS Echocardiographic, hemodynamic, and biochemical volume markers of 41 hemodialysis patients were evaluated in the pre- and post-dialysis periods. Patients were divided into two groups based on ePCWP values (Group 1 ePCWP<20mmHg, Group 2 ePCWP>20mmHg). RESULTS In the pre-dialysis period; parameters related to volume load including ePCWP, systolic blood pressure, mean arterial pressure, pulse pressure, left atrial diameter, left atrial volume, E/é, ratio and E/Vp ratio were statistically significantly higher in Group2 compared to Group1. On the other hand, strong correlations were found between pre-dialysis ePCWP and systolic blood pressure, mean arterial pressure, pulse pressure, NT-ProBNP, left atrial diameter, E/é ratio and E/Vp ratio. CONCLUSIONS Strong correlations found between ePCWP which was calculated with TDI and the other volume markers both in pre-dialysis and post-dialysis periods. These findings can provide a significant contribution to routine evaluating of DW in hemodialysis patients. From this aspect, the prediction of ePCWP with TDI can be a new practical and reproducible method for the determination of DW.
Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequat... more Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients.Materials and Methods. Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded.Results. Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM,p<0.001) in HD patients. Serum sulphate level correlated wi...
Objective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition... more Objective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition in chronic hemodialysis (HD) patients. In this prospective observational study, we investigated the survival predictability of impedance ratio (IR) calculated by BIS in HD patients (Clinical Trials Gov Identifier: NCT01468363). Materials and Methods: A total of 430 chronic HD patients, out of 500 prevalent chronic HD patients from the city of Zonguldak who met the inclusion criteria, were included in the study. With a mean follow-up of 32.2±14.4 months, BIS was performed in all patients. The IR percentage (IR%) was calculated by dividing the resistance values using the 200 kHz and 5 kHz impulses. Student's t-test, Cox regression analysis, and Kaplan-Meier survival analysis were performed, and a p<0.05 was accepted as statistically significant. Results: The mean age of 430 patients was 59±15 (10-92) years, and 54% of patients were male. By the end of the study, 125 (29%) patients died. Diabetes mellitus was observed in 46% of patients. Sixty-seven percent of patients used erythropoietin, and 41% used diuretics. The mean systolic blood pressure of patients before the dyalisis was 133±26 mmHg, and diastolic blood pressure was 79±12 mmHg. The IR values ranged between 73.2% and 94.1%. A multi-regression analysis that used the IR and included diabetes mellitus, age, gender, and albumin and hemoglobin levels showed that the mortality risk increased 16% (p<0.001). Evaluation using the quartiles showed decreased survival. Survival in the first quartile group was 42.8 months compared to 30.6 months in the last quartile group. Conclusion: The IR calculated using BIS data is a useful tool that can be employed to predict the survival in chronic HD patients. An early awareness of this increased mortality risk is important in terms of a close follow-up and appropriate treatment of these patients.
Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialy... more Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialysis (HD). Our aim in this study was to evaluate the risk factors of permanent catheter thrombosis and the necessity of anti-coagulant and anti-aggregation drugs. Materials and Methods: In this retrospective study, 34 patients undergoing HD, with removed internal jugulary permanent catheters due to either thrombosis or maturation of operated arteriovenous fistulas, were included. Patients were divided into thrombotic and non-thrombotic, according to the catheter thrombosis status. Results: The mean age was 66.3±15.4 years, and the follow-up period was 10.9±8.5 (1-29) months. Catheter thrombosis was found in 12 patients. Albumin and total protein levels were lower in the baseline thrombotic group (3.53±0.46 g/dL and 6.64±0.92g/dL, respectively)than in the non-thrombotic group (3.95±0.41 and 7.37±0.46g/dL, respectively).In the non-thrombotic group, hemoglobin, hematocrit higher, and platelet count were lower at the catheter removal time compared to the catheter insertion time (hemoglobin 11.45±1.25, hematocrit 35.61±4.51, and platelet count 193.82±66.32 versus hemoglobin 10.33±1.37g/dL, hematocrit 31.38±3.79% and platelet count 231.77±71.7x103/uL, respectively), but in the thrombotic group, the ferritin levels significantly increased from 541.3±574.8ng/mL at the catheter insertion time to 745.1±406.5ng/mL at the catheter removal time. Conclusion: Anti-coagulant and anti-aggregation drugs and renal failure etiology did nothave any effect on permanent catheter thrombosis, but the albumin and total protein levels were related to it. Increased levels of ferritin and C-reactive protein seem to emerge as the acute phase reactants associated with thrombosis.
Background/Aims: Many systems including the cardiovascular system (ischemic heart diseases, heart... more Background/Aims: Many systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction. Methods: We included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups. Results: In COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV 1 %). Diastolic blood pressure was associated with pH and HCO 3 levels. The mean night time, day time pulse pressures and 24hour pulse per minute values were also associated with all the parameters except FEV 1 %. Conclusions: In this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.
OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD)... more OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS: A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS: The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg. The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well. The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION: Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis.
Arquivos Brasileiros de Endocrinologia & Metabologia, 2012
OBJECTIVE: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patie... more OBJECTIVE: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patients with type 2 diabetes mellitus (type 2 DM). Hyperhomocysteinemia (HHC) disrupts vascular structure and function, no matter the underlying causes. The risk of development of vascular disease is greater in diabetic patients with hyperhomocysteinemia than in patients with normal homocystein levels. The aim of the study was to investigate whether there are differences of homocystein levels in dipper and non-dippers patients with type 2 DM. SUBJECTS AND METHODS: We compared 50 patients (33 females, 17 males) with type 2 DM and 35 healthy individuals (18 females, 17 males ) in a control group. Ambulatory blood pressure monitoring (ABPM) was performed and homocysteine levels were measured in all patients. RESULTS: We found that the percentage of non-dipper pattern was 72% in patients with type 2 DM and 57% in control group. In diabetic and control individuals, homocystein levels were higher ...
and uremic solutes, hemodialysis patients may have limited reserve to tolerate deviations in meta... more and uremic solutes, hemodialysis patients may have limited reserve to tolerate deviations in metabolic and volume status associated with the long two-day interdialytic interval. METHODS: We examined patients receiving hemodialysis from a large national dialysis organization in the US from 2007-2011 who were on a stable thrice-weekly hemodialysis schedule. We compared all-cause mortality by day-of-week among patients receiving hemodialysis on a Monday-Wednesday-Friday (MWF) vs. Tuesday-Thursday-Saturday (TTS) schedule. RESULTS: Among 105,120 patients who met eligibility criteria, 61,152 and 43,968 patients received hemodialysis on a MWF vs. TTS schedule (Table). In the overall cohort, the mean6SD age was 64 6 15 years, among whom 43% were female, 30% were African-American, 16% were Hispanic, and 53% had diabetes mellitus. Among patients receiving hemodialysis on a MWF schedule, the highest proportion of deaths was observed on the day after the long two-day interdialytic interval, followed by hemodialysis days after the one-day interval: 23.7%, 14.7%, and 15.4% deaths on Mondays, Wednesdays, and Fridays, respectively (Figure). A similar pattern was observed among patients receiving hemodialysis on a TTS schedule, such that the highest proportion of deaths was observed on the day after the long two-day interval, followed by hemodialysis days after the one-day interval: 22.3%, 16.2%, and 15.9%, respectively. CONCLUSIONS: Among patients receiving hemodialysis on a stable thrice-weekly schedule, the greatest proportion of deaths occurred on Mondays and Tuesdays after the long two-day interval. Further studies are needed to determine the factors implicated in the intensified mortality of the long interdialytic interval, including the excess accumulation of fluid, potassium, and/or uremic toxins, their removal with dialysis, and/or a weekend "lag" effect (i.e., reduced access to medical care or deferring medical services during the weekend).
Introduction: Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular d... more Introduction: Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. Material and methods: Forty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. Results: Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. Conclusions: Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.
Background: Serum amyloid A (SAA), which is produced in the liver, acts as an apoprotein of high-... more Background: Serum amyloid A (SAA), which is produced in the liver, acts as an apoprotein of high-density lipoprotein (HDL) accumulation in extracellular matrix of tissues and organs. SAA elevations play a significant role in the development of amyloidosis. Microalbuminuria (MAU) is the early period of amyloidosis in patients with familial Mediterranean fever (FMF). We assessed the association between SAA as an important factor for the development of amyloidosis in patients with FMF and cytokines, HDL, and MAU. Methods: A total of 40 FMF patients diagnosed with Tel-Hashomer criteria and making regular follow-up visits at the tertiary referral center from 2012 to 2013 were included in this study, besides 40 age-and sex-matched individuals as controls. Results: Compared with controls, FMF patients had higher SAA (25.20 ± 45.78 vs. 1.68 ± 0.63 ng/ml; P = 0.002). Also, FMF patients had higher MAU than controls (23.20 ± 39.86 vs. 9.40 ± 5.32 mg/day; P = 0.036). HDL was significantly lower in the patient group than in controls (39.35 ± 10.45 vs. 47.82 ± 15.31 mg/dl; P = 0.023). Interleukin-1 beta (IL-1), IL-6, and tumor necrosis factor alpha (TNFα) levels were higher in the FMF group than in controls (P < 0.0001, P = 0.009, P = 0.003, respectively). Conclusions: Our results suggest that IL-1, IL-6, TNF-α, SAA, and HDL may serve as markers of subclinical inflammation in FMF patients. Due to increased plasma HDL levels, antiinflammatory and antioxidant effects may elevate in FMF patients.
Hydatid cyst (CH), which is quite common in the world, mostly transmitted by dog faeces, is a par... more Hydatid cyst (CH), which is quite common in the world, mostly transmitted by dog faeces, is a parasitic disease caused by Echinococcus granulosus. CH often infects the liver and lungs. During the clinical course, renal involvement is rarely seen. In this article; due to liver hydatid disease, mezengioproliferatif glomerulonephritis case is presented.
Background: Hyponatremia is classified according to volume status with the help of physical exami... more Background: Hyponatremia is classified according to volume status with the help of physical examination, biochemical measures, urine and serum osmolalities, and echocardiography. Bioimpedance spectroscopy (BIS) has been getting popularity for revealing tissue compositions of various patient groups. The aim of this observational study was to investigate the role of BIS for the differential diagnosis of hyponatremia (ClinicalTrials.gov Identifier: NCT01838759). Patients and methods: Personal characteristics of age, sex, weight, height, and blood pressure were recorded. Body composition monitor (BCM) was used for hydration status for each individual. Primary outcome was investigated by the accuracy of volume status measured by BIS. Statistics: Kappa statistic (K) is a measure of agreement between two sources, which is measured on a binary scale (i.e., condition present/absent). K statistic can take values between 0
Acute kidney injury (AKI) may result in complete recovery in some of the patients and partial rec... more Acute kidney injury (AKI) may result in complete recovery in some of the patients and partial recovery in others. AKI episodes may accelerate the progression to chronic kidney disease and end-stage renal failure, while risk for morbidity and mortality is high following AKI. Discharge of patients from the hospital, independently from dialysis is a crucial outcome. Many patients without a need for dialysis, require follow-up for various durations and different treatments. The objective of this study was to compare mean recovery time of the patients followed-up due to prerenal, renal and postrenal AKIs. In this prospective observational study, a total of 159 patients hospitalized in Bulent Ecevit Hospital, clinic of nephrology or monitored in the other wards and intensive care unit due to AKI, between June 2011 and January 2012, were enrolled. The cases were divided into three groups as prerenal, renal and postrenal, and monitored with the daily visits and renal function testing. Prere...
In this study, we compared estimated glomerular filtration rate (eGFR) calculated with the formul... more In this study, we compared estimated glomerular filtration rate (eGFR) calculated with the formulas of Cockcroft-Gault (C&G), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Mayo Clinic Quadratic (Mayo Q) and, GFR (mGFR) that was scintigraphically measured with creatinine clearance (CrCl) and technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA). Objective of this study was to define the correlations between the formulas, provide a reliable method for measurement and estimation of GFR in daily clinical practice and demonstrate the potential errors. C&G, CKD-EPI, Mayo Q and MDRD eGFR of 84(37 males, 47 females) patients diagnosed with chronic kidney disease were calculated. Values of 99mTc-DTPA based on mGFR were compared with eGFR values of the formulas. Significant correlations were found with the values of 99mTc-DTPA mGFR, CrCl, MDRD, CKD-EPI, Mayo Q and C&G eGFR. The highest correlation was found between LB...
Chronic kidney disease(CKD) and hemodialysis (HD) are associated with increased oxidative stress.... more Chronic kidney disease(CKD) and hemodialysis (HD) are associated with increased oxidative stress. Cardiovascular diseases (CVD) are the most important cause of mortality in these patients. Increased cardiovascular risk is associated with oxidative stress. The aim of this study was to evaluate whether the duration of single session hemodialysis may affect oxidative stress parameters on the patients with end-stage renal disease (ESRD). Total oxidant status (TOS) and oxidative stress index (OSI) as oxidative markers and total antioxidant status (TAOS), paraoxonase1 (PON1) and arylesterase (ARES) as antioxidant markers were compared hemodialysis therapy before and after the treatment. TOS levels before hemodialysis were found as 4.4±2.4 μmol H2O2 Equiv/L, TAOS 2.1±0.3 µmol trolox Equiv./L, OSI 0.2±0.1%, PON1 levels 58.5±35.6 U/L and ARES levels 22±0.2 U/L while after the HD the respective values were 1.4±1.2 μmol H2O2 Equiv/L, 1.4±0.5 µmol trolox Equiv./L, 0.1±0.1%, 54.3±31.3 U/L, 21.8±...
African Journal of Microbiology Research, Nov 18, 2010
Abstract Crimean-congo hemorrhagic fever (CCHF) is a viral disease that can be seen in people epi... more Abstract Crimean-congo hemorrhagic fever (CCHF) is a viral disease that can be seen in people epidemically or as single patient. CCHF is a highly deadly disease caused by Nairovirus from Bunyaviridae family. Endothelial damage caused by secreted cytokines ...
Horseshoe kidney is a renal fusion anomaly during embryogenesis with incidence ranges of 1 in 400... more Horseshoe kidney is a renal fusion anomaly during embryogenesis with incidence ranges of 1 in 400 to 1 in 1800 live births. Adult polycystic kidney disease is a hereditary disorder and transmitted in autosomal dominant pattern with a reported incidence of 1 in 1000 to 1 in 5000 cases. Polycystic horseshoe kidney is a very rare occurrence with incidence ranges of 1 in 134 000 to 1 in 8 000 000 live births. We here present a patient who was admitted at the hospital with headache, hypertension and polycystic horseshoe kidney.
BACKGROUND AND OBJECTIVE Fluid overload is an important factor of morbidity and mortality in hemo... more BACKGROUND AND OBJECTIVE Fluid overload is an important factor of morbidity and mortality in hemodialysis patients. Today correct determination of dry weight (DW) remains an important issue of hemodialysis practice. Within this context, it is subjected to new method searching. The objective of this study was to calculate estimated pulmonary capillary wedge pressure (ePCWP) with Tissue Doppler Imaging (TDI) in hemodialysis patients and to evaluate its correlation with the other volume markers and to evaluate whether it can be a new method for detection of DW. MATERIALS AND METHODS Echocardiographic, hemodynamic, and biochemical volume markers of 41 hemodialysis patients were evaluated in the pre- and post-dialysis periods. Patients were divided into two groups based on ePCWP values (Group 1 ePCWP<20mmHg, Group 2 ePCWP>20mmHg). RESULTS In the pre-dialysis period; parameters related to volume load including ePCWP, systolic blood pressure, mean arterial pressure, pulse pressure, left atrial diameter, left atrial volume, E/é, ratio and E/Vp ratio were statistically significantly higher in Group2 compared to Group1. On the other hand, strong correlations were found between pre-dialysis ePCWP and systolic blood pressure, mean arterial pressure, pulse pressure, NT-ProBNP, left atrial diameter, E/é ratio and E/Vp ratio. CONCLUSIONS Strong correlations found between ePCWP which was calculated with TDI and the other volume markers both in pre-dialysis and post-dialysis periods. These findings can provide a significant contribution to routine evaluating of DW in hemodialysis patients. From this aspect, the prediction of ePCWP with TDI can be a new practical and reproducible method for the determination of DW.
Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequat... more Objective. Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients.Materials and Methods. Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded.Results. Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM,p<0.001) in HD patients. Serum sulphate level correlated wi...
Objective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition... more Objective: Bioimpedance spectroscopy (BIS) can be used to determine hypervolemia and malnutrition in chronic hemodialysis (HD) patients. In this prospective observational study, we investigated the survival predictability of impedance ratio (IR) calculated by BIS in HD patients (Clinical Trials Gov Identifier: NCT01468363). Materials and Methods: A total of 430 chronic HD patients, out of 500 prevalent chronic HD patients from the city of Zonguldak who met the inclusion criteria, were included in the study. With a mean follow-up of 32.2±14.4 months, BIS was performed in all patients. The IR percentage (IR%) was calculated by dividing the resistance values using the 200 kHz and 5 kHz impulses. Student's t-test, Cox regression analysis, and Kaplan-Meier survival analysis were performed, and a p<0.05 was accepted as statistically significant. Results: The mean age of 430 patients was 59±15 (10-92) years, and 54% of patients were male. By the end of the study, 125 (29%) patients died. Diabetes mellitus was observed in 46% of patients. Sixty-seven percent of patients used erythropoietin, and 41% used diuretics. The mean systolic blood pressure of patients before the dyalisis was 133±26 mmHg, and diastolic blood pressure was 79±12 mmHg. The IR values ranged between 73.2% and 94.1%. A multi-regression analysis that used the IR and included diabetes mellitus, age, gender, and albumin and hemoglobin levels showed that the mortality risk increased 16% (p<0.001). Evaluation using the quartiles showed decreased survival. Survival in the first quartile group was 42.8 months compared to 30.6 months in the last quartile group. Conclusion: The IR calculated using BIS data is a useful tool that can be employed to predict the survival in chronic HD patients. An early awareness of this increased mortality risk is important in terms of a close follow-up and appropriate treatment of these patients.
Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialy... more Objective: Permanent catheters are used for vascular access in some patients undergoing hemodialysis (HD). Our aim in this study was to evaluate the risk factors of permanent catheter thrombosis and the necessity of anti-coagulant and anti-aggregation drugs. Materials and Methods: In this retrospective study, 34 patients undergoing HD, with removed internal jugulary permanent catheters due to either thrombosis or maturation of operated arteriovenous fistulas, were included. Patients were divided into thrombotic and non-thrombotic, according to the catheter thrombosis status. Results: The mean age was 66.3±15.4 years, and the follow-up period was 10.9±8.5 (1-29) months. Catheter thrombosis was found in 12 patients. Albumin and total protein levels were lower in the baseline thrombotic group (3.53±0.46 g/dL and 6.64±0.92g/dL, respectively)than in the non-thrombotic group (3.95±0.41 and 7.37±0.46g/dL, respectively).In the non-thrombotic group, hemoglobin, hematocrit higher, and platelet count were lower at the catheter removal time compared to the catheter insertion time (hemoglobin 11.45±1.25, hematocrit 35.61±4.51, and platelet count 193.82±66.32 versus hemoglobin 10.33±1.37g/dL, hematocrit 31.38±3.79% and platelet count 231.77±71.7x103/uL, respectively), but in the thrombotic group, the ferritin levels significantly increased from 541.3±574.8ng/mL at the catheter insertion time to 745.1±406.5ng/mL at the catheter removal time. Conclusion: Anti-coagulant and anti-aggregation drugs and renal failure etiology did nothave any effect on permanent catheter thrombosis, but the albumin and total protein levels were related to it. Increased levels of ferritin and C-reactive protein seem to emerge as the acute phase reactants associated with thrombosis.
Background/Aims: Many systems including the cardiovascular system (ischemic heart diseases, heart... more Background/Aims: Many systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction. Methods: We included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups. Results: In COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV 1 %). Diastolic blood pressure was associated with pH and HCO 3 levels. The mean night time, day time pulse pressures and 24hour pulse per minute values were also associated with all the parameters except FEV 1 %. Conclusions: In this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.
OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD)... more OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS: A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS: The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg. The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well. The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION: Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis.
Arquivos Brasileiros de Endocrinologia & Metabologia, 2012
OBJECTIVE: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patie... more OBJECTIVE: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patients with type 2 diabetes mellitus (type 2 DM). Hyperhomocysteinemia (HHC) disrupts vascular structure and function, no matter the underlying causes. The risk of development of vascular disease is greater in diabetic patients with hyperhomocysteinemia than in patients with normal homocystein levels. The aim of the study was to investigate whether there are differences of homocystein levels in dipper and non-dippers patients with type 2 DM. SUBJECTS AND METHODS: We compared 50 patients (33 females, 17 males) with type 2 DM and 35 healthy individuals (18 females, 17 males ) in a control group. Ambulatory blood pressure monitoring (ABPM) was performed and homocysteine levels were measured in all patients. RESULTS: We found that the percentage of non-dipper pattern was 72% in patients with type 2 DM and 57% in control group. In diabetic and control individuals, homocystein levels were higher ...
and uremic solutes, hemodialysis patients may have limited reserve to tolerate deviations in meta... more and uremic solutes, hemodialysis patients may have limited reserve to tolerate deviations in metabolic and volume status associated with the long two-day interdialytic interval. METHODS: We examined patients receiving hemodialysis from a large national dialysis organization in the US from 2007-2011 who were on a stable thrice-weekly hemodialysis schedule. We compared all-cause mortality by day-of-week among patients receiving hemodialysis on a Monday-Wednesday-Friday (MWF) vs. Tuesday-Thursday-Saturday (TTS) schedule. RESULTS: Among 105,120 patients who met eligibility criteria, 61,152 and 43,968 patients received hemodialysis on a MWF vs. TTS schedule (Table). In the overall cohort, the mean6SD age was 64 6 15 years, among whom 43% were female, 30% were African-American, 16% were Hispanic, and 53% had diabetes mellitus. Among patients receiving hemodialysis on a MWF schedule, the highest proportion of deaths was observed on the day after the long two-day interdialytic interval, followed by hemodialysis days after the one-day interval: 23.7%, 14.7%, and 15.4% deaths on Mondays, Wednesdays, and Fridays, respectively (Figure). A similar pattern was observed among patients receiving hemodialysis on a TTS schedule, such that the highest proportion of deaths was observed on the day after the long two-day interval, followed by hemodialysis days after the one-day interval: 22.3%, 16.2%, and 15.9%, respectively. CONCLUSIONS: Among patients receiving hemodialysis on a stable thrice-weekly schedule, the greatest proportion of deaths occurred on Mondays and Tuesdays after the long two-day interval. Further studies are needed to determine the factors implicated in the intensified mortality of the long interdialytic interval, including the excess accumulation of fluid, potassium, and/or uremic toxins, their removal with dialysis, and/or a weekend "lag" effect (i.e., reduced access to medical care or deferring medical services during the weekend).
Introduction: Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular d... more Introduction: Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. Material and methods: Forty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. Results: Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. Conclusions: Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.
Background: Serum amyloid A (SAA), which is produced in the liver, acts as an apoprotein of high-... more Background: Serum amyloid A (SAA), which is produced in the liver, acts as an apoprotein of high-density lipoprotein (HDL) accumulation in extracellular matrix of tissues and organs. SAA elevations play a significant role in the development of amyloidosis. Microalbuminuria (MAU) is the early period of amyloidosis in patients with familial Mediterranean fever (FMF). We assessed the association between SAA as an important factor for the development of amyloidosis in patients with FMF and cytokines, HDL, and MAU. Methods: A total of 40 FMF patients diagnosed with Tel-Hashomer criteria and making regular follow-up visits at the tertiary referral center from 2012 to 2013 were included in this study, besides 40 age-and sex-matched individuals as controls. Results: Compared with controls, FMF patients had higher SAA (25.20 ± 45.78 vs. 1.68 ± 0.63 ng/ml; P = 0.002). Also, FMF patients had higher MAU than controls (23.20 ± 39.86 vs. 9.40 ± 5.32 mg/day; P = 0.036). HDL was significantly lower in the patient group than in controls (39.35 ± 10.45 vs. 47.82 ± 15.31 mg/dl; P = 0.023). Interleukin-1 beta (IL-1), IL-6, and tumor necrosis factor alpha (TNFα) levels were higher in the FMF group than in controls (P < 0.0001, P = 0.009, P = 0.003, respectively). Conclusions: Our results suggest that IL-1, IL-6, TNF-α, SAA, and HDL may serve as markers of subclinical inflammation in FMF patients. Due to increased plasma HDL levels, antiinflammatory and antioxidant effects may elevate in FMF patients.
Hydatid cyst (CH), which is quite common in the world, mostly transmitted by dog faeces, is a par... more Hydatid cyst (CH), which is quite common in the world, mostly transmitted by dog faeces, is a parasitic disease caused by Echinococcus granulosus. CH often infects the liver and lungs. During the clinical course, renal involvement is rarely seen. In this article; due to liver hydatid disease, mezengioproliferatif glomerulonephritis case is presented.
Background: Hyponatremia is classified according to volume status with the help of physical exami... more Background: Hyponatremia is classified according to volume status with the help of physical examination, biochemical measures, urine and serum osmolalities, and echocardiography. Bioimpedance spectroscopy (BIS) has been getting popularity for revealing tissue compositions of various patient groups. The aim of this observational study was to investigate the role of BIS for the differential diagnosis of hyponatremia (ClinicalTrials.gov Identifier: NCT01838759). Patients and methods: Personal characteristics of age, sex, weight, height, and blood pressure were recorded. Body composition monitor (BCM) was used for hydration status for each individual. Primary outcome was investigated by the accuracy of volume status measured by BIS. Statistics: Kappa statistic (K) is a measure of agreement between two sources, which is measured on a binary scale (i.e., condition present/absent). K statistic can take values between 0
Acute kidney injury (AKI) may result in complete recovery in some of the patients and partial rec... more Acute kidney injury (AKI) may result in complete recovery in some of the patients and partial recovery in others. AKI episodes may accelerate the progression to chronic kidney disease and end-stage renal failure, while risk for morbidity and mortality is high following AKI. Discharge of patients from the hospital, independently from dialysis is a crucial outcome. Many patients without a need for dialysis, require follow-up for various durations and different treatments. The objective of this study was to compare mean recovery time of the patients followed-up due to prerenal, renal and postrenal AKIs. In this prospective observational study, a total of 159 patients hospitalized in Bulent Ecevit Hospital, clinic of nephrology or monitored in the other wards and intensive care unit due to AKI, between June 2011 and January 2012, were enrolled. The cases were divided into three groups as prerenal, renal and postrenal, and monitored with the daily visits and renal function testing. Prere...
In this study, we compared estimated glomerular filtration rate (eGFR) calculated with the formul... more In this study, we compared estimated glomerular filtration rate (eGFR) calculated with the formulas of Cockcroft-Gault (C&G), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Mayo Clinic Quadratic (Mayo Q) and, GFR (mGFR) that was scintigraphically measured with creatinine clearance (CrCl) and technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA). Objective of this study was to define the correlations between the formulas, provide a reliable method for measurement and estimation of GFR in daily clinical practice and demonstrate the potential errors. C&G, CKD-EPI, Mayo Q and MDRD eGFR of 84(37 males, 47 females) patients diagnosed with chronic kidney disease were calculated. Values of 99mTc-DTPA based on mGFR were compared with eGFR values of the formulas. Significant correlations were found with the values of 99mTc-DTPA mGFR, CrCl, MDRD, CKD-EPI, Mayo Q and C&G eGFR. The highest correlation was found between LB...
Chronic kidney disease(CKD) and hemodialysis (HD) are associated with increased oxidative stress.... more Chronic kidney disease(CKD) and hemodialysis (HD) are associated with increased oxidative stress. Cardiovascular diseases (CVD) are the most important cause of mortality in these patients. Increased cardiovascular risk is associated with oxidative stress. The aim of this study was to evaluate whether the duration of single session hemodialysis may affect oxidative stress parameters on the patients with end-stage renal disease (ESRD). Total oxidant status (TOS) and oxidative stress index (OSI) as oxidative markers and total antioxidant status (TAOS), paraoxonase1 (PON1) and arylesterase (ARES) as antioxidant markers were compared hemodialysis therapy before and after the treatment. TOS levels before hemodialysis were found as 4.4±2.4 μmol H2O2 Equiv/L, TAOS 2.1±0.3 µmol trolox Equiv./L, OSI 0.2±0.1%, PON1 levels 58.5±35.6 U/L and ARES levels 22±0.2 U/L while after the HD the respective values were 1.4±1.2 μmol H2O2 Equiv/L, 1.4±0.5 µmol trolox Equiv./L, 0.1±0.1%, 54.3±31.3 U/L, 21.8±...
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