Browsing by Author "Toraman, A"
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Item Relationship of insulin resistance in chronic haemodialysis patients with inflammatory indicators, malnutrition, echocardiographic parameters and 24 hour ambulatory blood pressure monitoringKursat, S; Colak, HB; Toraman, A; Tekçe, H; Ulman, C; Bayturan, OObjective. 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.Item Fragmented QRS as a predictor of subclinical cardiovascular disease in patients with chronic kidney diseaseToraman, A; Eren, B; Yilmaz, I; Duzgun, F; Taneli, F; Kursat, SBackground Fragmented QRS (fQRS) on surface electrocardiogram is correlated with increased cardiovascular risk and mortality in normal population. Aims To investigate the presence of fQRS and its association with subclinical atherosclerosis and vascular calcification in chronic kidney disease (CKD) patients without cardiovascular disease. Methods A total of 129 CKD (63 males and 66 females) patients was enrolled for the study. Carotid intima-media thickness (CIMT) measurement and coronary artery calcification score (CACS) were performed by the same radiologist. A 12-lead electrocardiogram recording was used to detect fQRS. Results The mean age was 55.1 +/- 15.1 years. fQRS was detected in 45% of patients. There was not any significant difference between patients with or without fQRS in terms of demographic parameters and comorbid diseases except for diabetes and hyperlipidaemia. The mean CIMT of CKD patients was 0.66 +/- 0.18 mm and it was significantly higher in fQRS(+) group compared to the fQRS(-) group. Similarly CACS values were higher in fQRS(+) group. In the logistic regression analysis, fQRS remained significantly associated with CIMT (beta = 0.220, t = 2.567, P = 0.011) (independent variables: CIMT, CACS, sodium and glomerular filtration rate (modification of diet in renal disease-glomerular filtration rate)). Conclusions This is the first study in the literature showing the relation of fQRS with CIMT and CACS in patients with CKD without known cardiovascular disease.Item Predictors of renal and patient outcomes in anti-neutrophil cytoplasmic antibody-associated vasculitis: Our single-center, tertiary care experienceToraman, A; Gündüz, ÖSObjectives: This study aims to assess the different predictors of renal and patient prognosis in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) patients with and without renal involvement. Patients and methods: A total of 79 patients (51 males, 28 females; mean age: 57.3 +/- 14.2 years; range, 18 to 71 years) with AAV between January 2006 and November 2019 were retrospectively analyzed. Demographic and laboratory data including the complement 3 (C3) serum levels and renal biopsy findings were extracted from the electronic and printed medical records of the hospital registry. Survival, renal survival, remission, and relapse outcomes were analyzed. Results: A total of 35% of the patients with renal involvement progressed to end-stage renal disease (ESRD). The dialysis requirement at the time of admission (hazard ratio [HR]: 21.95 [2.93-164.22]; p=0.003), estimated glomerular filtration rate (eGFR) (HR: 0.97 [0.94-0.99]; p=0.024) and Five-Factor Score (FFS) >= 2 at the time of diagnosis (HR: 3.59 [1.08-11.94]; p=0.037) were the predictors of ESRD. The five-year patient survival rate was 87.1%. The only predictor of mortality was age (HR: 1.07 [1.01-1.14]; p=0.024). The patients with hypocomplementemia (22%) had a lower remission rate (p=0.049), FFS >= 2 at the time of diagnosis (p=0.026), and higher levels of hematuria (p=0.004) and proteinuria (p=0.037). The FFS >= 2 at the time of diagnosis was an independent predictor of relapse (HR: 8.9 [1.02-77.36]; p=0.047). Conclusion: Our study suggests that the baseline renal function and FFS >= 2 at the time of diagnosis are the major prognostic factors for progression to ESRD in AAV patients. In addition, AAV patients with hypocomplementemia may have a lower remission rate.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 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 Multimodal ocular evaluation in hemodialysis patientsMayali, H; Altinisik, M; Sarigul, C; Toraman, A; Turkoglu, MS; Kurt, EPurpose To evaluate choroidal thickness, intraocular pressure (IOP), axial length, central corneal thickness (CCT), lens thickness, anterior chamber depth, and ocular pulse amplitude (OPA) in hemodialysis patients. Materials and methods The patients with end-stage renal disease and undergoing hemodialysis were included in the study. Immediately before and 1 hour after hemodialysis, all patients underwent measurement of choroidal thickness with spectral domain optical coherence tomography (SD-OC, Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, CA), IOP and OPA with Pascal dynamic contour tonometry (Ziemer Ophthalmic Systems AG, Port, Switzerland), and anterior chamber depth, lens thickness, and axial length with optical biometry (LenStar LS900; Haag-Streit AG, Koeniz, Switzerland). Data from the patients' right eyes were included in the statistical analysis. Results The patient group included 8 (36.4%) males and 14 (63.6%) females with a mean age of 56, 14 +/- 9, 96 (40-70) years. The mean subfoveal choroidal thickness before and after hemodialysis was 255.21 +/- 6.15 (245-263) mu m and 234.95 +/- 7.89 (220-247) mu m, respectively (p < 0.001). Mean choroidal thickness at 1500 mu m and 3000 mu m nasal and temporal of the fovea also decreased significantly after hemodialysis (p < 0.001). Mean OPA values before and after hemodialysis were 2.14 +/- 1.07 (0.6-4) mmHg and 1.6 +/- 0.86 (0.5-3.2) mmHg, respectively (p < 0.001). There was a statistically significant correlation between OPA and choroidal thickness measurements (p < 0.001, R = 0.923). IOP increased from 15.11 +/- 2.58 (11-20) to 15.99 +/- 2.21 (13-20) mmHg, but the change did not reach statistical significance (p = 0.05). There was no statistically significant change in mean axial length, anterior chamber depth, lens thickness, or CCT after hemodialysis (p > 0.05 for all). Conclusion Although choroidal thickness and OPA may be decreased immediately after hemodialysis, there may be no significant changes in IOP or avascular ocular structures such as the lens and cornea.Item The relationship between depression-malnutrition and echocardiographic-blood pressure parameters in chronic hemodialysis patientsKursat, S; Colak, HB; Toraman, A; Ekmekci, C; Tekce, H; Alici, TAims 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.Item FRAILTY AND RELATED FACTORS IN ELDERLY PATIENTS WITH CHRONIC KIDNEY DISEASEAlp, A; Elbi, H; Toraman, AIntroduction: Chronic kidney disease and frailty are two crucial clinical conditions increasing in prevalence globally. Both lead to severe complications that increase mortality and morbidity in patients. Conditions that may potentiate frailty in chronic kidney disease patients may complicate the follow-up of chronic disease and complicate long-term survival in this patient group. In this study, we aimed to evaluate frailty and related factors in chronic kidney disease patients over 65 years of age who were on dialysis and who were not. Materials and Methods: This cross-sectional study was carried out in geriatric chronic kidney disease patients followed in nephrology outpatient clinics or undergoing routine hemodialysis. Frailty was assessed using a scoring scale. Laboratory findings and their relationship with demographic and epidemiological data were investigated. Results: One hundred eighty-eight patients aged 65 and over were included in our study. Of the patients, 92 were female, and 96 were male. The mean age was 72.86 years. We found frailty in 82 patients (43.6%). Female gender, over 75 years old, under dialysis treatment, low-income status, and low education level were parameters significantly associated with frailty. In the regression analysis, we found that economic status and dialysis were variables that independently affected frailty in chronic kidney disease patients. Conclusions: In our study, the frequency of frailty was found to be high. Practical management and early assessment of frailty seem rational with the basic nephrological approach in patients with chronic kidney disease. Considering the high mortality rate among frail patients, we think these patients should be followed up more closely.Item Exercise-induced acute renal failure with posterior reversible encephalopathy syndromeToraman, A; Kisabay, A; Eren, BG; Batum, M; Kursat, SPosterior reversible encephalopathy syndrome (PRES) is characterized by headache, mental changes, epileptic seizures. visual disttubances, and transient changes in the posterior circulation system of the brain. Rhabdomyolysis is a clinical condition characterized by muscle pain, weakness, dark-colored urine, and elevated creatine kinase levels. The common causes of rhabdomyolysis are trauma, excessive fatigue and intense exercise. A 23-year-old male soldier developed rhabdomyolysis-induced acute kidney injury after intense exercise and secondary PRES. The patient also had generalized convulsive seizures. There is no similar case of PRES from acute renal failure induced by muscle injury previously reported in the literature.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 Severe hyponatremia and rhabdomyolysis associated with hypothyroidismToraman, A; Dursun, B; Batmazoglu, Mhypothyroidism and usually occurs in elderly patients. In this report we presented a young patient with hypothyroidism induced severe hyponatremia and rhabdomyolysis. A nineteen-year-old woman was brought to the hospital with confusion. Because of acute hyponatremia with confusion, she was treated with hypertonic saline. The neurological examination returned to normal after treatment and fluid restriction, then serum sodium level increased to normal. Because of recurrent hyponatremia futher investigations were held. She was diagnosed as Hashimoto's thyroiditis. Hyponatremia improved with levothyroxine therapy and serum sodium level remained normal range. The elevated parameters of rhabdomyolysis decreased with levothyroxine therapy. Hypothyroidism should be considered in patients presenting with hyponatremia and rhabdomyolysis.Item IS THERE A RELATIONSHIP BETWEEN PARATHYROID HORMONE AND NEUTROPHIL LYMPHOCYTE RATIO OR PLATELET LYMPHOCYTE RATIO?Toraman, A; Aras, F; Hekimsoy, Z; Kursat, SContext. Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are recent prognostic markers associated with inflammation in many diseases such as chronic kidney disease (CKD), malignancies, myocardial infarction. Objective. In this study, we investigated the relationship between NLR-PLR and parathyroid hormone (PTH) and vitamin D in patients with high PTH levels. Design. The patients with high PTH levels in Nephrology and Endocrinolgy Outpatient clinics were evaluated retrospectively. Subjects and methods. The medical records of the patients were examined and clinical data, including demographic details, clinical and laboratory findings, treatment and follow-up data were obtained. NLR and PLR were calculated. Serum creatinine, calcium, phosphorus, magnesium, lipid levels, calcium phosphorus product, PTH and vitamin D values were investigated. The relationship between NLR-PLR and laboratory parameters, GFR (MDRD-GFR), PTH and vitamin D were investigated. Results. 48 male and 253 female patients were enrolled in this study. The mean age was 57.57 +/- 13.28. NLR correlated negatively with albumin, hemoglobin, vitamin D, calcium and cholesterol and it positively correlated with creatinine and PTH. Multiple regression analysis showed that main determinants of NLR were PTH, albumin, LDL-cholesterol, hemoglobin and gender. Conclusions. In this study NLR and PLR correlated negatively with hemoglobin and cholesterol. Positive correlation between NLR and creatinine could be explained by increased degrees of inflammation associated with more pronounced degrees of renal dysfunction. The impact of PTH on NLR was independent of GFR. In multiple regression model this suggests that PTH could be a pro-inflammatory parameter independent of the degree of renal dysfunction.Item An evaluation of both serum Klotho/FGF-23 and apelin-13 for detection of diabetic nephropathyOzdemir, N; Toraman, A; Taneli, F; Yurekli, BS; Hekimsoy, ZPurposeThe aim of our study is to evaluate whether serum Klotho/FGF-23 and apelin-13 can be used as new biomarkers for detection of development of nephropathy.MethodsIn this cross-sectional study, 88 type 2 diabetes mellitus (T2DM) patients and 38 healthy controls were included. The mean duration of T2DM was 11.4 & PLUSMN; 9.7 years. T2DM individuals were categorized into two groups as group 1 with e-GFR < 60 mL/min/1.73 m(2) and group 2 with e-GFR > 60 mL/min/1.73 m(2). They were also divided into two groups according to their 24 h urine albumin levels, classifying them as follows: normoalbuminuria if less than 30 mg/day and albuminuria if more than 30 mg/day.ResultsMean serum Klotho levels in the T2DM group were observed to be significantly higher than in the control group. Serum apelin-13 levels were observed to be significantly lower in the T2DM group compared to the control group (p < 0.001). In the diabetic group, apelin-13 levels were positively correlated with age, waist circumference, and albuminuria while they were negatively correlated with e-GFR. Apelin-13 levels were seen to be significantly higher in group 1 (p < 0.001).ConclusionApelin-13 levels were found to be significantly higher in individuals with diabetic nephropathy than in those without diabetic nephropathy. In the diabetic group, a significant relationship was detected between apelin-13 levels and albumin excretion. Based on these findings, we consider that serum Klotho and apelin-13 levels may have a protective effect on diabetic nephropathy and can additionally be used as a biomarker to predict diabetic nephropathy.