Browsing by Author "Kürsat, S"
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Item Effect of ultrafiltration on blood pressure variability in hemodialysis patientsKürsat, S; Özgür, B; Alici, TAim: 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.Item Hand function assessment in patients receiving haemodialysisDuruöz, MT; Cerrahoglu, L; Dincer-Turan, Y; Kürsat, SObjective: To assess the usefulness of Duruozs Hand Index (DHI) in patients undergoing haemodialysis. Methods: Patients receiving haemodialysis for more than 2 months were recruited randomly. Demographic, clinical and functional characteristics of patients were evaluated. Functional assessment was performed with DHI, Hand Functional Index (HFI), Health Assessment Questionnaire (HAQ), Purdue Pegboard, grip strength and 3 kinds of pinch strengths. DHI was correlated (Spearman's) with the other functional parameters in assessing the convergent validity and with non-functional parameters in assessing the divergent validity Results: Sixty patients with a mean age of 50.05 were recruited. The average duration of haemodialysis was 55.02 months. DHI is significantly correlated with HAQ, HFI, Purdue Pegboard scores, grip strength and 3 types of pinch strengths while no significant correlation was found with non-functional parameters. Conclusions: DHI is a practical scale which is efficient in assessing accurately the functional disability of the hand in patients receiving haemodialysis.Item Factors Affecting QT Dispersion During Hemodialysis in End-Stage Renal Disease PatientsAlici, T; Tekçe, H; Degirmenci, M; Özgür, B; Kürsat, SAim: 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.Item VASCULAR CALCIFICATION AND GROWTH ARREST SPECIFIC PROTEIN 6 LEVELS IN CHRONIC RENAL DISEASEToraman, A; Cetintepe, L; Elbi, H; Taneli, F; Yildiz, R; Duzgun, F; Pabuscu, Y; Horasan, GD; Kürsat, SIntroduction: Cardiovascular disease is the main cause of mortality and morbidity in chronic renal failure. It's known that vascular calcification (VC) and carotid intima media thickness (CIMT) are strongly associated with cardiovascular diseases. Growth arrest specific protein 6 (Gas6) is a vitamin K-dependent protein and regulates various processes such as proliferation, cell survival, migration and inflammation. Gas6 is known to protect endothelial cells and vascular smooth muscle cells against apoptosis by inhibiting Bcl-2 induced Caspase 3 activation. The relationship between Gas6 and cardiovascular diseases has been demonstrated in many mouse models and cell cultures. However, there are conflicting reports whether Gas6 levels are increasing or decreasing in human studies of diabetic and/or chronic renal failure. In present study the aim was to examine plasma Gas6 levels and its relation with CIMT and coronary artery calcification score (CACS) in chronic kidney disease (CKD) patients. Methods: Total of 137 patients of which 32 chronic hemodialysis and 105 predialysis patients as well as 73 healthy controls were enrolled in the study. Human Gas6 levels in serum samples were studied by ELISA method. CIMT was measured by ultrasonography. CACS was measured by multislice computed tomography. Results: The mean age was 54.37 +/- 16.61 years in dialysis group, 55.20 +/- 14.80 years in predialysis group and 53.26 +/- 9.04 years in control group. Serum creatinine was 0.78 +/- 0.16 mg/dl in the control group and 1.96 +/- 1.64 mg/dl in the predialysis and 5.94 +/- 1.55 mg/dl in the dialysis group. 24 hours urine protein levels were significally higher in the dialysis group than the predialysis and the control group. CIMT values were similar in predialysis and dialysis groups. These values were significantly higher than control group. Although CACS was higher in dialysis group than predialysis and control group, the results were not statistically significant since the distribution range was very wide. Gas6 was 98.84 +/- 53.32 ng/mL in the control group and statistically higher than dialysis (63.85 +/- 38.92 ng/mL) and predialysis groups (54.96 +/- 38.49 ng/mL) (p=0.001). Gas6 levels were lower in diabetic patients than non-diabetics (53.69 +/- 35.26 ng/mL, 69.26 +/- 47.50 ng/mL, p=0.023, respectively). Negative correlation was detected between Gas6 and age, BMI, CACS, carotid IMT and proteinuria. In the logistic regression analysis, Gas6 remained significantly associated with BMI, CIMT and proteinuria. Conclusion: In our study, a negative correlation of Gas6 with BMI, CACS, CIMT and proteinuria and lower Gas6 levels in diabetic patients support that decreased Gas6 levels in chronic renal failure may have a role in vascular calcification through altered glucose tolerance, chronic inflammation, endothelial dysfunction and increased apoptosis. Our study has an importance because it is the first study showing a relation between Gas6 and proteinuria, CACS and carotid IMT in patients with chronic renal failure.Item Effects of nutritional parameters on nocturnal blood pressure in patients undergoing hemodialysisTekçe, H; Kürsat, S; Çolak, HB; Aktas, GBackground: Malnutrition is a common problem in uremic patients. It is unclear whether there is an association between the degree of malnutrition and 24-h ambulatory blood pressure patterns in patients undergoing hemodialysis. In the present study, we observed the relationship between the degree of malnutrition and deterioration of the rhythm of diurnal blood pressure, which are both risk factors for cardiovascular morbidity-mortality and associated with hypervolemia. Method: We observed 148 patients undergoing hemodialysis in the Nephrology Department of Celal Bayar University Hospital. All cases were assessed for body weight alterations, dietary food intake, gastrointestinal symptoms, loss of subcutaneous fat and muscle tissue, presence and severity of comorbidities, functional capacity (subjective global assessment), and anthropometric indices. Ambulatory blood pressure measurements were performed for all cases on the day between the two hemodialysis sessions. Results: We found that the circadian blood pressure rhythm deteriorated in patients with a high-malnutrition score, and that malnutrition was more common and severe in those subjects with the non-dipper and reverse-dipper blood pressure patterns. Malnutrition score was positively correlated with the nighttime systolic and nighttime mean blood pressures and mean 24-h arterial blood pressure (all p <= 0.01). We identified a positive correlation between malnutrition score and the reduction in serum albumin and anthropometric indices. Conclusion: This is the first study to demonstrate an association between malnutrition and deterioration in the circadian blood pressure rhythm in a hemodialysis population. Nutritional disturbance is associated with an increase in night-time blood pressure. Low serum albumin levels and hypervolemia may contribute this situation.Item Relationship Between Angiotensin-converting Enzyme Gene Polymorphism and QT Dispersion in Hemodialysis PatientsToraman, A; Çolak, H; Tekçe, H; Cam, S; Kürsat, SIntroduction. The angiotensin-converting enzyme (ACE) gene insertion or deletion in long-term hemodialysis patients may be associated with corrected QT interval prolongation, leading to fatal arrhythmias. The ACE D allele is known to increase the risk of malignant ventricular arrhythmias and is also associated with increased QT dispersion after myocardial infarction and hypertension. This study aimed to evaluate the relationship between ACE gene polymorphism and QT dispersion in hemodialysis patients. Materials and Methods. In 70 hemodialysis patients, electrocardiography was performed and QT dispersion was calculated. Corrected QT interval was calculated using Bazett Formula. The ACE gene polymorphism was determined by polymerase chain reaction. Results. The mean age of the patients was 60 +/- 12 years. The mean QT dispersion and corrected QT dispersion were 61.71 +/- 21.99 and 73.18 +/- 25.51, respectively. QT dispersion inversely correlated with serum calcium and potassium levels and positively correlated with ACE gene polymorphism and residual urine. Calcium level was the predictor factor for QT dispersion. The ACE genotype correlated with QT dispersion, corrected QT dispersion, hemoglobin, and residual urine, and inversely correlated with serum potassium. Corrected QT dispersion correlated with ACE gene polymorphism and residual urine. The DD genotype of ACE had significally greater QT dispersion and corrected QT dispersion than the II and ID genotypes. Conclusions. Our study showed that the most important parameter affecting corrected QT dispersion was ACE gene polymorphism on the background of D allelle. Patients carrying this allelle need special attention regarding optimal suppression of renin-angiotensin-aldosteron system activity.Item Correlation Between Intestinal Colony Numbers and Inflammation Markers (TNF-Alpha, IL-6, High-Sensitive CRP) Following the Use of Sevelamer in Rats with Kidney FailureKürsat, S; Çolak, H; Yilmaz, O; Kolatan, E; Ulman, C; Kurutepe, S; Özyurt, BObjective: Our aim was to investigate anti-inflammatory effect of sevelamer in experimentally induced renal failure (RF) and whether this effect was related to a decrease in Escherichia coli colony counts in feces. Material and Methods: Eighteen female Wistar albino rats weighted 200-250 g were divided into three groups. RF was induced by 5/6 nephrectomy. Group 1 was the control group. Group 2 rats were those with induced RF receiving a high phosphate diet. Group 3 contained rats with induced RF receiving a high phosphate diet + sevelamer. E.coli count in feces, plasma creatinine, high-sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) concentrations were determined at the beginning and at the end of 1st, 3rd and 6th weeks in all rats. Results: In Group 2 and 3, creatinine concentrations were found to be increased (p=0.03, p=0.02) in the 1st week. In Group 2, there was an increase in number of E. coli colony count in the 3rd week (p=0.05). In group 3, E. coli colony count and levels of inflammatory markers (IL-6, CRP, TNF-alfa) significantly were increased in comparison to the basal :+alues (p=0.042, p=0.021, p=0.042, respectively) in the 1st week. In group 3, in the sixth week, E. coli colony count (p=0.02) and levels of inflammatory markers (IL-6, hsCRP, TNFalpha) (p<0.05) were found to be significantly decreased in comparison to the 1st week levels. Conclusion: Anti-inflammatory effects of sevelamer might be explained by its effects on the bacterial colonization in colon.Item Relationship between the degree of malnutrition and echocardiographic parameters in hemodialysis patientsKürsat, S; Tekçe, H; Ekmekçi, C; Çolak, HB; Alici, TBackground: 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.Item The hand function assessment with Duruoz's hand index (DHI)* in patients receiving haemodialysisDuruöz, T; Cerrahoglu, L; Dincer-Turan, Y; Kürsat, SItem Increased incidence of tuberculosis in chronic hemodialysis patientsKürsat, S; Özgür, BWe encountered 9 cases of tuberculosis out of our 157 chronic HD patients in 36 months. Four pulmonary, 4 lymph nodal and one isolated dermal involvement were detected. Therapy was commenced without waiting for absolute cultural or pathologic diagnosis because of the high index of clinical suspicion. All cases except one recovered completely. Among associated conditions, peptic ulcer disease, anti-HCV positivity, and diabetes mellitus were noted, though the last two did not reach statistical significance. Prompt institution of the specific therapy and close supervision of the cases during treatment enabled us to obtain a cure in all cases except one and to discern adverse drug effects immediately and to make appropriate changes in the therapy. Thus, no morbidity due to the disease itself or drugs was observed. Copyright (C) 2001 S. Karger AG, Basel.Item Association between neutrophil-lymphocyte & platelet lymphocyte ratios with prognosis & mortality in rapidly progressive glomerulonephritisToraman, A; Nese, N; Özyurt, BC; Kürsat, SBackground & objectives: Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome manifested by features of nephritic syndrome and progressive loss of renal function over a short time. The objective of this study was to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and prognostic factors and pathological findings of renal biopsy in RPGN. Methods: Consecutive newly diagnosed RPGN patients who had follow up for at least six months were retrospectively analyzed. The estimated glomerular filtration rate (eGFR) was calculated. Albumin, C-reactive protein (CRP) levels and CRP/albumin ratio were also calculated. Results: Fifty four patients were included in the study. The mean age was 48.92 +/- 20.12 years. Clinicopathological diagnosis was pauci-immune glomerulonephritis (GN) in 40 while two had postinfectious GN, six systemic lupus erythematosus, three IgA nephropathy, two Henoch-Schonlein purpura and one membranoproliferative GN. The mean NLR was 7.02 +/- 6.34 and mean PLR was 273.90 +/- 39.15. Positive correlations between NLR and CRP levels (P=0.009, r=0.511) and CRP/albumin ratios (P=0.005, r=0.542) were observed. PLR and CRP/albumin ratios (P=0.041, r=0.412) were correlated positively. The percent of fibrocellular crescents was negatively correlated with NLR (P=0.019, r=-0.291), and positively correlated with the lymphocyte count (P=0.05, r=0.256). In secondary crescentic subgroup, the per cent of fibrinoid necrosis had a positive correlation with PLR (P=0.013, r=0.642). Both NLR (P=0.036) and PLR (P=0.051) detected at the first month of the treatment period, were observed to be significantly correlated with mortality. Interpretation & conclusions: This study showed that NLR could predict mortality in patients with RPGN; correlated with systemic inflammation; showed a negative correlation with the per cent of fibrocellular crescents and could be regarded as a measure of glomerular inflammatory state. Moreover, PLR may be considered to be an indicator of disease severity in acute phase of crescentic GN.Item Recurrent Renal Cell Carcinoma in a Pregnant Hemodialysis PatientÇolak, HB; Inci, A; Kutsal, DA; Gök, F; Baytur, YB; Lekili, M; Kürsat, SRenal cell carcinoma is the most common renal neoplasm reported in pregnancy. A successful pregnancy outcome is very important in women with serious chronic renal failure. Our case was a pregnant women diagnosed with renal failure due to a renal mass in the second trimester of her pregnancy. A healthy baby was delivered following intensified hemodialysis sessions.Item The Relationship between Malnutrition Subgroups and Volume Parameters in Pre-Dialysis PatientsKutsal, DA; Kürsat, S; Inci, A; Ulman, C; Ütük, IOThere are two types of malnutrition in patients with chronic renal failure (CRF); type 1 and type 2. The aim of this study was to investigate the relationship between malnutrition and inflammation and also the relationship between malnutrition and volume status. Ninety-four pre-dialysis CRF patients were included in the study. Nutritional status of the patients was calculated using the subjective global assessment. Scores of 1-5 were given according to the severity of the symptoms and physical examination findings. Serum inflammation markers [high-sensitive C-reactive protein (hs-CRP), interleukin-1 beta, interleukin-6 and tumor necrosis factoralfa] and nutrition parameters (albumin, pre-albumin, transferrin, fetuin-A, insulin like growth factor-1 and insulin-like growth factor-binding protein-3)] were measured in all the patients. Serum N-terminal pro-brain natriuretic peptide levels and echocardiography were performed to evaluate the volume status of the patients. The mean age of the patients was 59.6 +/- 13.3 years, the mean malnutrition score was 17.2 +/- 6.01, the mean and the median of hs-CRP levels were 18.5 +/- 40.7 and 5.6 mg/L, respectively, the mean albumin level was 3.46 +/- 0.48 and the mean creatinine clearance was 23.7 +/- 13.5 mL/min. A positive correlation between malnutrition scores with inflammation and volume parameters was found in the bivariate and multivariate analysis. In the multiple regression analysis, volume parameters proved to be the most important factors influencing malnutrition scores. Thus, the elimination of volume excess would ameliorate both inflammation and malnutrition. This hypothesis needs to be supported or proved with prospective studies.Item Functional bowel disorders and associated risk factors in hemodialysis patients in TurkeyGök, EG; Inci, A; Çoban, M; Kutsal, DA; Kürsat, SBackground/Aims: Functional bowel disorders (FBDs) impair the quality of life in patients with end-stage renal disease (ESRD). The aim of our study was to determine the prevalence and distribution of the subtypes of FBDs in hemodialysis (HD) patients. Materials and Methods: This prospective, cross-sectional study included 80 patients who received HD for more than 3 months (patient group) and 80 healthy controls (control group). FBDs were diagnosed according to the Rome II diagnostic criteria by excluding organic pathologies. Results: Forty-six (57.5%) patients were males, and their average age was 62.13 +/- 12.92 (23-90) years. The mean duration of dialysis was 57.48 +/- 59.23 (3-312) months, and the mean Kt/V (K: dialyzer clearance of urea, t: dialysis time, V: volume of distrubition of urea) value was 1.53 +/- 0.31. The rate of FBDs was significantly higher in the patient group than in the control group (p=0.01). In total, 7.5% of the patients had irritable bowel syndrome, 3.8% had functional bloating, and 16.3% had functional constipation. FBDs were significantly higher in women (p=0.004). While there was no statistically significant difference between patients with and those without FBDs in terms of the presence of additional diseases, smoking, alcohol use, educational level, marital status, and residential areas (p>0.05), serum phosphorus (P) levels were significantly higher in the patients with FBDs (p=0.03). Conclusion: FBDs and their functional constipation subtype are more common in HD patients than in the healthy population in Turkey. FBDs are most frequently observed in females and housewives with high serum P levels.