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Öğe DETERMINATION OF VOLUME OVERLOAD BY BIOELECTRICAL IMPEDANCE ANALYSIS AND NT-PROBNP IN DIABETIC PRE-DIALYSIS PATIENTS(Editura Acad Romane, 2016) Yildirim, Y.; Kara, A. V.; Kilinc, F.; Aydin, F.; Aydin, E.; Yilmaz, Z.; Kadiroglu, A. K.Introduction. Diabetic chronic kidney disease has more fatal clinical progresses and this situation can be related to volume overload, which is seen more commonly in diabetic chronic kidney disease patients than in non-diabetic chronic kidney disease patients. Therefore, we examined the effect of diabetes mellitus on volume overload in newly diagnosed stage 5 chronic kidney disease patients whose volume overloads were not showing signs of improvement from renal replacement therapy. Method. One hundred and five patients (46 diabetic, 59 non-diabetic) with end-stage chronic kidney disease, who had glomerular filtration rate (GFR) under 15 mL/min for at least three months were enrolled in this prospective study. We determined the body volume overload and configuration using a bioimpedance device. NT-proBNP levels were recorded. Results. There was a statistically significant difference between diabetic and non-diabetic groups according to overhydration (OH, p=0.003), extracellular water (ECW, p=0.045), intracellular water (ICW, p<0.001) and OH/ECW (p=0.003). In addition, there was a statistically significant difference between groups in terms of N-terminal Pro-brain Natriuretic Peptide (NT-proBNP levels, p=0.008). Discussion. We compared diabetic and non diabetic end-stage chronic kidney disease patients who were not in renal replacement therapy yet. We found more volume overload and extracellular fluid volume in the diabetic group.Öğe Does the direction of arterial needle in AV fistula cannulation affect dialysis adequacy?(Dustri-Verlag Dr Karl Feistle, 2008) Ozmen, S.; Kadiroglu, A. K.; Ozmen, C. A.; Danis, R.; Sit, D.; Akin, D.; Yilmaz, M. E.Aim: The direction of arterial access needles in fistulas and grafts has been a subject of some controversy and there is no study comparing the results either direction of arterial needle placement in cannulation of arteriovenous fistula. We compared mean urea reduction rate (URR) and Kt/V in the same HD patients when dialyzed via antegrade or retrograde arterial needle cannulation. Materials and methods: This was a study involving 22 adults oil maintenance hemodialysis for more than 6 months. Doppler US examinations of arteriovenous fistula were performed in all Subjects. Pre-dialysis and post-dialysis blood samples were obtained at the patient's midweek HD treatment 4 times a month for each direction. Arterial needle was placed in retrograde direction for the first month. Oil the second month, the direction of arterial needle was converted to antegrade. Means were compared by paired t-test. Results: Mean URR and eKt/Vof retrograde cannulation were 74.2 +/- 7.2% and 1.57 +/- 0.33. The results were indifferent statistically from those of antegrade cannulation (73.0 +/- 8.7% and 1.57 +/- 0.35 (p = 0.123)). Mean fistula blood flow was 931 +/- 483 ml/min. No cannulation complication was observed during the study period for both directions. Conclusions: Both antegrade and retrograde arterial needle placement may be preferred according to center experience without concern of HD adequacy. Longterm outcomes of antegrade and retrograde arterial needle placement such as AVF failure, thrombosis, and stenosis warrant further studies.Öğe The effect of periodontal therapy on serum TNF-? and HbA1c levels in type 2 diabetic patients(Wiley, 2009) Dag, A.; Firat, E. T.; Arikan, S.; Kadiroglu, A. K.; Kaplan, A.Background: To determine the effect of non-surgical periodontal therapy on serum TNF-alpha and HbA1c levels in poorly and well-controlled type 2 diabetic patients. Methods: In total, 45 patients were enrolled in the study; 30 patients with type 2 diabetes mellitus with periodontitis (15 with poorly controlled diabetes, HbA1c >= 7%, group 1A and 15 with well-controlled diabetes, HbA1c < 7%, group 1B) and 15 patients that were systemically healthy with periodontitis (group 2). The plaque index, gingival index, probing depth, clinical attachment loss, gingival bleeding index, HbA1c value, and circulating TNF-alpha concentration were measured at baseline and three months after the non-surgical periodontal therapy. Results: All periodontal parameters and serum TNF-alpha levels were significantly decreased three months after the nonsurgical periodontal therapy compared to the baseline values in all groups. The HbA1c values were significantly decreased only in well-controlled diabetic patients. We found no significant differences in the periodontal parameters or TNF-alpha levels at baseline and after three months between the two groups. Conclusions: Although non-surgical periodontal therapy eliminates local/systemic infection and inflammation via decreases in TNF-alpha, it is insufficient for significantly reducing HbA1c levels without strict glycaemic control in poorly controlled diabetic patients in a short time period.Öğe The effects of Losartan on oxidative stress and inflammation in non-diabetic patients undergoing chronic hemodialysis(Verduci Publisher, 2013) Kayabasi, H.; Yilmaz, Z.; Sit, D.; Kadiroglu, A. K.; Yilmaz, E.INTRODUCTION: We aimed to evaluate the effects of Losartan, an angiotensin receptor blocker, on serum inflammatory markers, plasma thiol groups, and oxidative stres indexes among patients undergoing hemodialysis (HD) treatment. PATIENTS AND METHODS: Fiftytwo end-stage renal disease (ESRD) patients undergoing chronic HD programme for at least 12 months, and thirty age and gender matched healthy volunteers were enrolled into this prospective clinical trial. Plasma levels of thiol groups (SH), total antioxidant capacitiy (TAC), and total oxidant status (TOS) were studied. Oxidative stress index (OSI) was calculated by TOS/TAC. Firstly results of patients were compared with healthy subjects and then patients were treated by Losartan 50-100 mg and followed up for three months. RESULTS: Among patients, SH Groups, TAC, TOS, and OSI were statistically higher than controls. Also the inflammatory markers were significantly higher in patients than controls and albumin was lower among patients. At the end of the 3 months among all patients the mean value of TAC was increased to 1.7 +/- 0.4 micromol Trolox Eqv./L. from 1.4 +/- 0.2, and SH groups to 0.33 +/- 0.02 mmol/L from 0.22 +/- 0.01, (p < 0.001) while TOS decreased to 7.2 +/- 1.1 micromol H2O2 Eqv./L from 9.5 +/- 4.5, and OSI decreased to 5.0 +/- 0.8 from 7.1 +/- 3.2 (p < 0.001). CONCLUSIONS: Losartan was effective in controlling blood pressure, and decreasing OSI, a marker of elevated oxidative stress, and increasing plasma levels of SH groups, an antioxidant, in ESRD patients undergoing hemodialysis. So, it may not be only a hypotensive drug, but also improves OS, particularly in patients with ESRD.Öğe Significance of elevated gingival crevicular fluid tumor necrosis factor-? and interleukin-8 levels in chronic hemodialysis patients with periodontal disease(Wiley, 2010) Dag, A.; Firat, E. T.; Kadiroglu, A. K.; Kale, E.; Yilmaz, M. E.Background and Objective: The prevalence of chronic renal disease in industrialized countries is increasing, and chronic renal disease and periodontitis can have significant, reciprocal effects. The aim of this study was to evaluate the associations between specific clinical parameters and the levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) in the gingival crevicular fluid of hemodialysis (HD) patients with periodontal disease. Material and Methods: Forty-three HD patients and 43 systemically healthy subjects were enrolled in this study. Plaque index (PI), gingival index (GI) and pocket depth were used to determine periodontal status. Venous blood samples were obtained from each patient in the morning before the dialysis session and analyzed to determine the levels of inflammatory, biochemical and hematological parameters. Gingival crevicular fluid was collected from all subjects, and the levels of TNF-alpha and IL-8 were determined in the gingival crevicular fluid samples. Results: The following results were obtained from HD patients and controls: TNF-alpha (pg/mL), 31.40 +/- 1.46 and 3.06 +/- 0.15 (p < 0.001); IL-8 (pg/mL), 90.98 +/- 94.03 and 35.05 +/- 16.86 (p < 0.001); PI, 1.69 +/- 1.02 and 0.04 +/- 0.02 (p < 0.001); GI, 0.82 +/- 0.06 and 0.04 +/- 0.02 (p < 0.001); and pocket depth, 2.23 +/- 0.63 and 1.51 +/- 0.05 (p < 0.001), respectively. In addition, there were positive correlations between TNF-alpha and PI (r = 0.642, p < 0.001), between TNF-alpha and GI (r = 0.565, p < 0.001), between TNF-alpha and pocket depth (r = 0.522, p < 0.001), between IL-8 and PI (r = 0.402, p = 0.002), between IL-8 and GI (r = 0.396, p = 0.002), and between IL-8 and pocket depth (r = 0.326, p = 0.012). There were negative correlations between albumin and PI (r = -0.491, p < 0.001), albumin and GI (r = -0.406, p < 0.001), albumin and pocket depth (r = -0.464, p < 0.001) and albumin and CRP (r = -0.467, p = 0.002) and between the gingival crevicular fluid levels of TNF-alpha and IL-8, TNF-alpha and hemoglobin (r = -0.745, p < 0.001; r = -0.285, p < 0.05) (respectively). Conclusion: The levels of TNF-alpha and IL-8 in gingival crevicular fluid were significantly higher in HD patients than in controls. There were strong, positive correlations between clinical periodontal parameters and the levels of inflammatory cytokines in gingival crevicular fluid from the HD patients.
