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    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.
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    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.