Browsing by Author "Tekçe, H"

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    Relationship of insulin resistance in chronic haemodialysis patients with inflammatory indicators, malnutrition, echocardiographic parameters and 24 hour ambulatory blood pressure monitoring
    Kursat, S; Colak, HB; Toraman, A; Tekçe, H; Ulman, C; Bayturan, O
    Objective. The relationship between malnutrition, echocardiographic parameters, 24 h ambulatory blood pressure (ABP) parameters and decreased insulin sensitivity index (ISI-S) in chronic haemodialysis patients was investigated. Material and methods. ISI-S and inflammatory indicators were measured. The nutritional state was assessed by malnutrition score. Echocardiography and 24 h ABP were performed 1 day before the second haemodialysis session of the week. Results. ISI-S was inversely correlated with the night-time mean blood pressure (BP)/day-time mean BP ratio (p = 0.021) and malnutrition score (p < 0.01). High-sensitivity C-reactive protein, night-time mean BP/day-time mean BP and vena cava collapse index were independent risk factors affecting ISI-S (p < 0.001; beta = 0.412, p= 0.025; beta = -0.204, p < 0.001; beta = -0.465). Conclusions. The decrease in ISI-S along with the hypervolaemia suggests that volume overload is a contributory factor in the pathogenesis of insulin resistance in patients with chronic renal failure. This study indicates that, in addition to the traditional cardiovascular risk factors in these patients, insulin resistance can be regarded as a risk factor, but not an independent one, mainly a reflection of the underlying culprit, hypervolaemia.
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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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    Effects of nutritional parameters on nocturnal blood pressure in patients undergoing hemodialysis
    Tekçe, H; Kürsat, S; Çolak, HB; Aktas, G
    Background: 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.
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    Relationship Between Angiotensin-converting Enzyme Gene Polymorphism and QT Dispersion in Hemodialysis Patients
    Toraman, A; Çolak, H; Tekçe, H; Cam, S; Kürsat, S
    Introduction. 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.
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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 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.