Browsing by Author "Alici, T"

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    A case of rhabdomyolysis induced acute renal failure secondary to statin-fibrate-derivative combination and occult hypothyroidism
    Kursat, S; Alici, T; Colak, HB
    Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the systemic circulation. We hereby report a patient proved to be a case of unrecognized hypothyroidism presenting with rhabdomyolytic acute renal failure precipitated by the combined use of statin and fenofibrate. A 63-year-old woman was referred to our department because of fatigue, diffuse muscle pain and oliguria. On the basis of pathogenesis, clinical and laboratory examination the diagnoses of acute renal failure secondary to the statin-fibrate-derivative combination induced rhabdomyolysis and auto-immune thyroiditis induced hypothyroidism were made. Although saline, furosemide and sodium bicarbonate infusions enabled diuresis and have led to a rapid recovery of renal function and normalization of blood pressure in five days (creatinine level decreased from 4.5 mg/dl to 1.2 mg/dl), only thyroid replacement therapy (0, 1 mg thyroxine) that begun after the exclusion of adrenal insufficiency resulted in complete resolution of rhabdomyolysis. This prompted the diagnosis of background, clinically silent rhabdomyolysis aggrevated by the statin-fibrate-derivative combination. To our knowledge this case illustrates the first example of rhabdomyolytic acute renal failure induced by a statin-fibrate-derivative combination with underlying hypothyroidism which was responsible for the basal clinically unobservable rhabdomyolysis.
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    Effect of ultrafiltration on blood pressure variability in hemodialysis patients
    Kürsat, S; Özgür, B; Alici, T
    Aim: Increased blood pressure variability (BPV) in end-stage renal disease (ESRD) patients is proved to be a risk factor for cardiovascular disease [Tozawa et al. 1999]. The effect of ultrafiltration (UF) on BPV in hemodialysis (HD) patients has not been reported in the literature. This study was undertaken to define the effect of a single UF on BPV in HD patients. Methods: Prior and after HD with UF, 24-hour ambulatory BP monitoring (ABPM) was applied to each patient and then diurnal and nocturnal BP and BPV parameters (both before and after UF) were compared and correlated with UF values. Results: Increase in BPV after single UF in all groups was statistically significant (p < 0.05). Only the daytime systolic (DS) BPV increase (median 42.4%) was in positive correlation with Δ body weight (body wt) (median 3.07%) or UF amount (r = 0.649, p < 0.01). Conclusions: Large volume depletions and sympathetic hyperreactivity could explain the increase in BPV. Increased interdialytic weight gain requires more UF and subsequently BPV, morbidity and mortality also increase. Thus, considerable efforts must be made to prevent great interdialytic weight gain in HD patients.
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    Factors Affecting QT Dispersion During Hemodialysis in End-Stage Renal Disease Patients
    Alici, T; Tekçe, H; Degirmenci, M; Özgür, B; Kürsat, S
    Aim: To investigate the situation of the cardiac arrhythmia in the cases within the chronic haemodialysis program and its pathogenesis. Materials and Method: Sixty-four patients who admitted to the department of nephrology in our hospital with chronic renal failure requiring haemodialysis were taken into our study. In order to determine and asses the QT dispersion before and after haemodialysis, conventional ECG records with 12 derivations were taken. Results: Pre-haemodialysis QT and QTc dispersion were calculated as 49.6 +/- 24 msn and 57 +/- 29 msn; post-haemodialysis QT and QTc dispersion were calculated as 75 +/- 33 msn and 93 +/- 38 msn, reflecting significant changes (p<0.001). Of the electrolyte values taken before and after haemodialysis, K+ was shown to have a significant change (p<0.001). Positive correlation was observed between the decrease in K+ and the increase in QT dispersion (p<0.05). Negative correlation was observed between the QT dispersion increase and the amount of ultrafiltration (p<0.05). Discussion: QT and QTc dispersion increases were affected by the decrease in K+ value and the amount of ultrafiltration that occurred during haemodialysis. This indicates that the gradual reduction in K+ and optimization of ultrafiltration levels will increase the threshold of arrhythmia being one of the causes of cardiac mortality.
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    Relationship between the degree of malnutrition and echocardiographic parameters in hemodialysis patients
    Tekce, H; Colak, HB; Ekmekci, C; Alici, T; Akcicek, F; Kursat, S
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    Relationship between the degree of malnutrition and echocardiographic parameters in hemodialysis patients
    Kürsat, S; Tekçe, H; Ekmekçi, C; Çolak, HB; Alici, T
    Background: The aim of this study is to investigate the relationship between the degree of malnutrition and inadequate volume control evidenced by echocardiography. Methods: In this study 72 chronic hemodialysis patients were investigated in a cross-sectional manner. The malnutrition score was calculated using Subjective Global Assessment. M-mode echocardiography was performed in all patients. Results: The highest malnutrition score (23.2 +/- 1.5 points) and lowest vena cava inferior collapse index (35 +/- 2%) were observed in the eccentric left ventricular hypertrophy group. The malnutrition index was found to be in positive relationship with the left atrium diameter and index, left ventricular mass and index, and left ventricular end-diastolic diameter. On the other hand, a negative correlation was detected with the vena cava inferior collapse index. When all parameters that were found to be related to malnutrition were assessed by multivariate analyses, a statistically significant relation was found between the left ventricular end-diastolic diameter and the malnutrition index. Conclusion: The results of our study show that the progressive worsening of the nutritional status follows a parallel course along with the deterioration in the echocardiographic parameters concerning hypervolemia. This in turn suggests that increasing degrees of malnutrition are associated with more profound derangements in the volume status. Volume excess might be a mechanism explaning the increased mortality and morbidity caused by malnutrition in hemodialysis patients. Owing to its cross-sectional design, this study cannot provide unequivocal evidence regarding the cause and effect relationship between volume overload and malnutrition in hemodialysis patients. Copyright (c) 2007 S. Karger AG, Basel.
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    The relationship between depression-malnutrition and echocardiographic-blood pressure parameters in chronic hemodialysis patients
    Kursat, S; Colak, HB; Toraman, A; Ekmekci, C; Tekce, H; Alici, T
    Aims The aim is to research the relationship between the degree of depression-malnutrition and inadequate volume control. Methods The mean age of the 52 patients was 55 +/- 14.6 years. Malnutrition score [subjective global assessment (SGA)] and depression score [Taiwanese Depression Questionnaire (TDQ)] of each chronic hemodialysis (CHD) patient were calculated. Then an echocardiographic assessment was carried out with the same device 1 day before the second HD session of the week. The 24 h blood pressure monitoring was performed 1 day before the second HD session of the week. Results TDQ scores (TDQS) were >= 19 in 41 and < 19 in 11 patients. TDQS was found to be significantly high in women (p = 0.01) who were older than 40 years (p = 0.03) and who have low family income (p = 0.03). TDQS was found to be significantly correlated with HD duration (p = 0.034), vena cava inferior collapse index (p = 0.02), malnutrition score (p = 0.011), residual renal function (ml/day) (p = 0.03), level of albumin (p = 0.0009), and iron (p = 0.015). A positive correlation was detected between TDQS and the ratio of mean nighttime blood pressure/mean daytime blood pressure (p = 0.005, r = 0.394). Depression score was found to be significantly different between normal geometry and left ventricular hypertrophy (eLVH), concentric remodeling and eLVH, and concentric LVH and eLVH. Conclusions The results show that lesser degrees of nocturnal dip and eLVH are associated with increased degrees of depression, implying that hypervolemia is strongly associated with depression and might be a component of strong relationships involving malnutrition, inflammation, and atherosclerosis in CHD patients.
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    Chylous ascites and chylothorax due to membranous nephropathy
    Colak, HB; Alici, T; Tekce, H; Öz, D; Erol, A; Aras, F; Kursat, S
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    The Results of the 24-Hour Ambulatory Blood Pressure Monitoring of the Essential Hypertension Patients Using Diuretic or Not
    Çolak, HL; Alici, T; Tekçe, H; Kursat, S
    Researchers have discovered that blood pressure (BP) varies in a diurnal manner throughout a 24-hour period, being higher during the day and lower at night. Most people have a dipping BP pattern characterized by a nighttime BP that is 10-20% lower than their daytime BP. First time treated essential hypertensive non-diabetic patients in Hypertension and Nephrology Outpatient Clinic were randomly allocated to two different groups according to their hydrochlorothiazide usage status in addition to other antihypertensive drugs. Age, gender, body mass index (BM)), duration of hypertension and initial fasting blood sugar, total cholesterol, HDL-cholesterol, LDL-cholesterol, uric acid. BUN, creatinine, Na, K, calcium levels were not different betwe en the groups. During their follow-up, the attainment of 140(90 mmHg or less blood pressure levels for three consecutive monthly controls prompted the implementation of 24-hour ambulatory blood pressure monitoring (ABPM). The interval between the first office visit and the last control was also comparable between the groups. At the last clinic visit, the groups were again compared for BMI. and the same biochemical parameters. There was not any statistically significant difference between the subgroups. Twenty-four-hour ABPM results were also comparable. These findings suggest that the same blood pressure target can be achieved in essential hypertensives with the combinalion therapy regardless of die use of hydrochlorothiazide.
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    Blood pressure and ejection fraction changes due to ultrafiltration in hemodialysis
    Kursat, S; Aysel, S; Alici, T; Tezcan, UK
    Background: Nocturnal hypertension (NH) is an unsolved problem in hemodialysis (HD) patients. The effect of ultrafiltration (UF) on NH and myocardial performance has not been systematically investigated in HD patients. Methods: Seventeen reverse-dipper (RD) HD patients were subjected to intensified UF. Before and after UF, echocardiographic and blood pressure (BP) measurements were taken. Results: Excluding daytime diastolic BP, all BP parameters (mmHg), namely daytime systolic BP (138.1 +/- 15.1; 131.1 +/- 12.5), night-time systolic BP (150.4 +/- 17.6; 125.3 +/- 16.5), night-time diastolic BP (87.3 +/- 10.3; 76.5 +/- 11.6), daytime pulse pressure (56.1 +/- 7.6; 50.5 +/- 5), night-time pulse pressure (63.3 +/- 9.4; 48.7 +/- 7), significantly decreased (p<0.001 for all comparisons). Thirteen patients converted to non-dipper and two patients converted to dippers, whereas two patients remained on RD. Unit for measurement of diameters was mm. Ejection fractions (EF) increased (51.23 +/- 9.01; 64.05 +/- 7.23, p<0.001), left atrial diameters (LAD) decreased (35 +/- 8.29; 32.05 +/- 7.12, p<0.001), the vena cava inferior collapse index increased (VCICI) [24.82 +/- 8.20 (%); 51.76 +/- 9.65 (%), p<0.001], left ventricular end-systolic (LVES) and diastolic diameters (LVED) decreased (3.19 +/- 0.60; 2.77 +/- 0.51, p<0.001; 4.39 +/- 0.65; 4.18 +/- 0.56, p=0.002, respectively). Percentage reduction in night-time diastolic BP correlated with the percentage reduction in LA-D (p=0.038). Percentage reduction in night-time pulse pressure correlated with the percentage increase in EF (p<0.013). Similarly, percentage reductions in night-time systolic BP, night-time diastolic BP and night-time mean BP correlated with the percentage reduction in LVESD (p=0.014, p<0.001 and p=0.001, respectively). Conclusions: NH in HD patients is a volume dependent phenomenon. Improved night-time BP parameters have a more profound effect on myocardial function than daytime BP parameters.