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Arm circumference: its importance for dialysis patients in the obesity era
(Springer, 2013) Akpolat, Tekin; Kaya, Coskun; Utas, Cengiz; Arinsoy, Turgay; Taskapan, Hulya; Erdem, Emre; Yilmaz, M. Emin
The purposes of this study were to investigate the association between arm circumference and body mass index (BMI) and to discuss problems, mainly arm circumference and cuff size mismatch, that could affect the reliability of home blood pressure monitoring (HBPM) among peritoneal dialysis (PD) and hemodialysis (HD) patients. 525 PD and 502 HD patients from 16 centers were included in the study. A two-part questionnaire was used to gather information from the participants. Arm circumferences were categorized into four groups according to the British Hypertension Society cuff size recommendations. Mean BMI and arm circumference of all participants were 25.0 kg/m(2) and 27.6 cm, respectively. There was a significant correlation between BMI and arm circumference. The mean BMI and arm circumference values were higher in PD patients than in HD patients. Requirement of a large-sized adult cuff was more common among PD patients compared to HD patients (14 % vs 8 %, p = 0.002). Since HBPM is a useful tool for clinicians to improve BP control, nephrologists should be aware of the problems related to HBPM in dialysis patients and take an active role to increase the reliability of HBPM.
Carpal Tunnel Syndrome Based on Accumulation of ?2 Microglobulin With Vascular Steal Syndrome: A Case Report
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2006) Kadiroglu, Ali Kemal; Sit, Dede; Kayabasi, Hasan; Yilmaz, M. Emin; Isikoglu, Bunyamin
Rheumatologic and osteoarticular syndromes occur frequently in chronic haemodialysis patients. The number and severity of these complications increase with the time on hemodialysis (HD). Beta-2 microglobulin accumulates in the soft tissue in HD patients due to its low level of clearance. Carpal tunnel syndrome (CTS) is one of the clinical expressions of this accumulation. Early diagnosis and treatment of CTS is important, since being late may lead to permanent defect and/or resistant symptoms.
A Case With Pancytopenia Due to Hemodialysis Inadequacy (Case Report)
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2005) Sit, Dede; Kadiroglu, Ali Kemal; Yilmaz, M. Emin; Ayyildiz, M. Orhan; Isikoglu, Bunyamin
Hemodialysis inadequacy affects not only morbidity and mortality of the dialysis patients, but it can also reduce the effectivity of therapies such as rHuEPO. Hemodialysis inadequacy and erythropoietin ineffectivity are the essential problems of the physicians who deal with patients who have end stage renal failure, and they reduce treatment success. We report a rarely seen case who has pancytopenia because of hemodialysis inadequacy and/or rHuEPO ineffectivity.
Cefuroxime Axetil Related DRESS (drug reaction with eosinophilia and systemic symptoms) Syndrome
(Modestum Ltd, 2016) Yildirim, Yasar; Kara, A. Veysel; Yilmaz, Zulfikar; Yildirim, Resit; Yilmaz, Sureyya; Kadiroglu, A. Kemal; Yilmaz, M. Emin
DRESS (Drug reaction with eosinophilia and systemic symptoms) syndrome is a rare, potentially life-threatening, drug induced hypersensitivity reaction manifested by fever, rash, eosinophilia, lymphadenopathy, and organ involvement especially liver and kidney. The disease is characterized by a long latency period (at least two weeks) between the drug exposure and disease onset. The most commonly reported drugs associated with DRESS syndrome in the literature are allopurinol, and anticonvulsants. We describe a patient presented with eosinophilia, fever, diffuse maculopapular rash, hepatomegaly, and multiple intra-abdominal lymphadenopathies just ten days after initiation of cefuroxime axetil. In our case, we aim to announce the first case report of cefuroxime axetil related DRESS syndrome, and also speculate on the possible association between cephalosporin and DRESS syndrome.
Comparison of the effects of Losartan and Nebivolol on oxidative stress in patients with end stage renal disease
(Oxford Univ Press, 2007) Kayabasi, Hasan; Kadiroglu, Ali Kemal; Sit, Dede; Selek, Sahabettin; Yilmaz, M. Emin
[Abstract Not Available]
Delirium With a Single Dosage of Acyclovir in a Continuous Ambulatory Peritoneal Dialysis Patient: Case Report
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2007) Kayabasi, Hasan; Kadiroglu, Ali Kemal; Kara, Ismail Hamdi; Sit, Dede; Yilmaz, M. Emin
Valacyclovir is an effective oral agent for the treatment of herpes virus infection, however, the pharmacokinetics of the drug are altered in renal failure. It is increasingly recognized that dose adjustment of oral valacyclovir in renal failure is necessary to avoid neurotoxicity. We studied this drug in a continuous ambulatory peritoneal dialysis (CAPD) and immunocompromised patient. She developed neurotoxicity with an adjustment dosage of valacyclovir for a cutaneous zoster infection. The elimination half-time (15 h) was similar to that reported for end-stage renal disease patients, while the steady-state volume of distribution (85 l) and the area under the curve concentration (127 mg/l.h) were greater. The mean CAPD dialysance was only 5.27 ml/min with less than 1% of an administered dose being recovered in the 24-hour dialysate. 48 h after interrupting treatment, she recovered normal neurological status and 500 mg of valacyclovir every 2 days was effective and well tolerated.
Diagnosis and Treatment in Chronic Kidney Disease and Evalution of Cardiovascular Disease and Associated Risk Factors
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2008) Kadiroglu, Ali Kemal; Sit, Dede; Yilmaz, M. Emin
Today, chronic kidney disease (CKD) is a world-wide public health problem. Losing kidney function and occurance of cardiovascular disease (CVD) are inevitablely the main clinical outcomes. Increasing evidence suggested that the adverse outcomes of CKD can be prevented or delayed through early detection and treatment. CKD and hypertension are often present together and hypertension is both a cause and a complication of CKD and is a risk factor for progression of kidney disease and for CVD. The goals of antihypertensive therapy in CKD are to lower blood pressure, reduce the risk of CVD, slow progression of CKD and prevent the complications of decreased GFR. A clinical action plan should be developed for each patient, based on the stage of CKD and follow-up intervals for monitoring the patients should be determined by clinical condition.
The effect of venlafaxine HCl on painful peripheral diabetic neuropathy in patients with type 2 diabetes mellitus
(Elsevier Science Inc, 2008) Kadiroglu, Ali Kemal; Sit, Dede; Kayabasi, Hasan; Tuzcu, Alpaslan Kemal; Tasdemir, Nebahat; Yilmaz, M. Emin
Objective: The objective of this study was to evaluate the efficacy of venlafaxine HCl in the symptomatic treatment of painful peripheral diabetic neuropathy (PPDN) among patients with type 2 diabetes mellitus (DM). Design: This study was designed as a prospective, randomized, and controlled trial. Setting: This study was conducted at the Dicle University Medical Faculty (Diyarbakir, Turkey). Patients: Sixty type 2 DM outpatients (47 females and 13 males) with PPDN who had a minimum visual analog scale (VAS) score of 40 mm were enrolled in this study. Interventions: Patients randomized to the treatment group (n=30) received venlafaxine HCl, whereas those randomized to the control group (n=30) received a combination of vitamins B-1 and B-6 tablets. Measures: Severity of pain was measured by VAS, Short-Form McGill Pain Questionnaire, and numerical analog scale scores at admission and at the second, fourth, and eighth weeks of the study. Polyneuropathy was supported by electromyelography. Outcome: In the treatment group, severity of pain was measured as 70.0+/-13.0 in the VAS, as 24.9+/-6.2 in the Short-Form McGill Pain Questionnaire, and as 7.2+/-1.1 in the numerical analog scale. In the control group, it was measured as 73.0+/-8.0 in the VAS, as 26.8+/-6.2 in the Short-Form McGill Pain Questionnaire, and as 7.4+/-0.8 in the numerical analog scale (P>.05). Results: The most common form of PPDN was distal symmetrical sensorimotor polyneuropathy in both groups (46.8% vs. 50.0%). At the end of the study, there was a significant difference in severity of pain between the groups. In the treatment group, scores were 8.5+/-5.2 and 3.1+/-1.6 in the Short-Form McGill Pain Questionnaire and numerical analog scale, respectively; in the control group, these were 20.5+/-7.0 and 5.5+/-1.6, respectively (P<.001). Conclusions: Venlafaxine HCl is a safe and well-tolerable analgesic drug in the symptomatic treatment of PPDN; however, it has minimal adverse effects. It showed its efficacy markedly in the second week of therapy. (C) 2008 Elsevier Inc. All rights reserved.
The effects of losartan on the oxidative stress index and thiols in patients undergoing dialysis treatment
(Oxford Univ Press, 2007) Kadiroglu, Ali Kemal; Kayabasi, Hasan; Sit, Dede; Kara, I. Hamdi; Yilmaz, M. Emin
[Abstract Not Available]
The effects of nebivolol on serum levels of malonyldialdehyde and paraoxonase in patients with end stage renal disease
(Oxford Univ Press, 2007) Sit, Dede; Kayabasi, Hasan; Kadiroglu, Ali Kemal; Yilmaz, Zulfikar; Yilmaz, M. Emin
[Abstract Not Available]
Eivaluation of the Nutritional Status and Anthropometric Measurements in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients According to the Anemia Status
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2007) Kadiroglu, Ali Kemal; Sit, Dede; Kayabasi, Hasan; Yilmaz, Zulfukar; Yilmaz, M. Emin
Nutritional biochemical markers such as serum albumin and anthropometric measurements such as BMI are valid and useful tools in assessing the nutritional status in dialysis. Forty-two patients on CAPD therapy were enrolled in the study. Anemic patients and patients who were al target hematocrit levels were evaluated by nutritional parameters and anthropometry. Gender, age, duration of CAPD, dialysis adequacy, educational and economic status had significant affect on BMI and serum albumin. There were positive significant correlations between hematocrit levels and BMI (r=0.331, p=0.0032), and FM (r=.0.383, p=0.012), and MAMC (r=0.365, p=0.017I and serum albumin levels (r=0.416. p=0.006). Achieving target hematocrit levels may improve BMI and MAMC, but not biochemical parameters.
The evaluation incidence and risk factors of mortality among patients with end stage renal disease in Southeast Turkey
(Taylor & Francis Ltd, 2008) Sit, Dede; Kadiroglu, Ali Kemal; Kayabasi, Hasan; Kara, Ismail Hamdi; Yilmaz, Zulfukar; Yilmaz, M. Emin
Aim. End stage renal disease (ESRD) presents with higher morbidity and mortality with respect to the general population. In recent study, the causes of mortality and associated risk factors in ESRD have been evaluated. Materials and Methods. In this study, 1538 patients diagnosed with ESRD in 10-year period were evaluated retrospectively. The patients were divided as dead (group 1) and alive (group 2). The patients' demographic features, causes of death, comorbidity at hospitalization, hematological and biochemical analyses, creatinine clearance at the beginning of hospitalization, daily urine volume, blood gas results, CRP value as inflammatory marker, ejection fraction, interventricular septum diameter, left ventricle posterior wall end-diastolic diameter, and left atrium diameter determined with echocardiography were recorded. Results. Mortality ratio of ESRD patients in a 10-year period was 14.1%. While the general mean age of all patients was 54.7 +/- 16.6 and male/female ratio was 781/757, these ratios were 66.3 +/- 21.8 and 114/103 in Group 1 and 52.8 +/- 21.7 and 667/654 in Group 2. One or more comorbid pathologies were present in 82.9% of Group 1. The most common cause of mortality was cardiovascular diseases (CVD), and the most common cause of comorbidity was infections. Older age, anemia, absence of residual renal function, hypoalbuminemia, inflammation, impaired Ca and P metabolism, and left ventricular hypertrophy were significantly higher in Group 1 than in Group 2. Conclusion. CVD are the most important preventable causes of morbidity and mortality in all stages of chronic kidney disease. Taking precaution against CVD and the associated complications will provide a positive contribution in reducing morbidity and mortality among ESRD patients.
The evaluation of effects of demographic features, biochemical parameters, and cytokines on clinical outcomes in patients with acute renal failure
(Taylor & Francis Ltd, 2007) Kadiroglu, Ali Kemal; Sit, Dede; Atay, A. Engin; Kayabasi, Hasan; Altintas, Abdullah; Yilmaz, M. Emin
Aim. To evaluate the effects of cytokines, biochemical parameters and demographic features on clinical outcomes of acute renal failure (ARF). Patients and Methods. 59 patients with acute renal failure (28 men, 31 women) were enrolled to the study. Cytokines, biochemical parameters, and complete blood count were measured. Patients were divided into two groups: as survivors (group 1, n = 46) and nonsurvivors (group 2, n = 13). Results. Mean age of patients were 52.3 +/- 17.9 years. 46 patients survived (77.9%) and 13 patients died (22. 1 %). There was a statistically significant relationship between IL-2R, IL-6, and TNF-oc levels and mortality rates (p = 0.004, p = 0.016, p = 0.020, respectively) and between TC levels and mortality rates (p = 0.041). In multivariable logistic regression analysis, the effects of proinflammatory cytokines (IL- I beta, IL-2R, IL-6, TNF alpha, CRP, and ESR) on the clinical outcomes in ARF was observed to be statistically significant (r = 0.341, p = 0.005). Conclusion. We realized that in totally demographic features (male gender, advanced age, poor nutritional status), biochemical parameters (TC, albumin, and hemoglobin) and cytokine levels (IL-2R, IL-6, TNF-oc), CRP and ESR may be predictive factors for mortality in patients with ARF.
The Evaluation of the Association Between Serum Cholesterol Levels with Nutritional Parameters and Anthropometric Measures in Non-Diabetic Continuous Ambulatory Peritoneal Dialysis Patients
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2009) Sit, Dede; Kayabasi, Hasan; Kadiroglu, Ali Kemal; Yilmaz, M. Emin
We evaluated the association of serum cholesterol levels with nutritional parameters and anthropometric measurements in non-diabetic patients undergoing continuous ambulatory peritoneal dialysis (CAPD) treatment. Thirty-nine (21 males, 18 females) patients were enrolled into the study. The patients were divided into two groups as group 1 (n=20, serum cholesterol >= 200 mg/dl), and group 2 (n=19, serum cholesterol < 200 mg/dl.) according to serum cholesterol levels. A positive correlation was found between serum levels of cholesterol and prealbumin (r=0.428, p=0.007), transferrin (r=0.322, p=0.046), triglyceride (r=0.537, p=0.001), LDLC (r=0.739, p<0.001), and HDL-C (r=0.454, p=0.004), and between BMI and FM (r=0.851, p<0.001), FFM (r=0.503, p=0.001), TBW (r=0.522, p=0.001) and MAMC (r=0.849, p<0.001). BIA in group 1 was higher than group 2 (p = 0.007). No statistical relation was found between serum cholesterol, and the anthropometric measurements. In conclusion, we found a positive correlation between serum cholesterol levels and prealbumin and transferrin but not in anthropometric measurements in CAPD patients. Further, large scale studies are needed to conclude an absolute judgement.
The Frequency Of Metabolic Syndrome in Patients on Continuous Ambulatory Peritoneal Dialysis and the Association of Developing Metabolic Syndrome With Dialysis Duration
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2011) Kayabasi, Hasan; Yilmaz, Zulfukar; Yildirim, Idris; Yildirim, Yasar; Kadiroglu, Ali Kemal; Yilmaz, M. Emin
OBJECTIVE: To evaluate the characteristics of patients with metabolic syndrome, and the association of developing MS with peritoneal dialysis duration among patients undergoing continuous ambulatory peritoneal dialysis. MATERIAL and METHODS: Fifty-eight nondiabetic CAPD patients were evaluated. Biochemical parameters, blood pressure, length, weight, waist circumference, and body mass indexes were recorded. MS was determined using NCP-ATP III criteria. The patients were divided into 3 groups according to dialysis duration (Group 1: <= 60 months, Group 2: 61-120 months, Group 3: >= 121 months) and the frequency of MS was compared. RESULTS: Twenty-four of 58 patients were male, and MS was present in 22 (37.9%) patients. 14 (82.4%) of 22 patients with MS were female, (p=0.544). There was a statistically significant difference between patients with and without MS regarding age, BMI, waist circumference, PD duration, and triglyceride levels (p<0.05). 55% (n=32) of the patients were in group 1, 34.5% (n=20) in group 2, and 10.5% (n=6) in group 3 (p=0.092). The frequency of MS decreased with prolongation of dialysis duration (50% in group 1, 20% in group 2, and 33,3% in group 3) (p<0.001). CONCLUSION: The frequency of MS among our CAPD patients was 37.9% and it decreased with prolongation of dialysis duration. This result may suggest that alterations in metabolic state, and abandoning glucose-based PD solutions may improve MS criteria.
Parameters of oxidative stress and echocardiographic indexes in patients on dialysis therapy
(Taylor & Francis Ltd, 2010) Kayabasi, Hasan; Sit, Dede; Atay, A. Engin; Yilmaz, Zulfukar; Kadiroglu, Ali Kemal; Yilmaz, M. Emin
Aim: Quantity of oxidative stress (OS) is enhanced in every stage of chronic renal failure (CRF). OS and its effects on echocardiographic indexes in patients on hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) were evaluated. Materials and methods: Thirty-nine patients on CAPD, 32 patients on HD, and 30 healthy individuals with similar demographic features were included. Patients with diabetes mellitus and chronic inflammatory diseases were excluded. Blood samples were collected to examine hematological and biochemical parameters and levels of malonyldialdehyde (MDA), glutathione peroxidase (GSH-px), and superoxide dismutase (SOD) after a 12-hour fasting period in the middle of dialysis week. OS parameters were compared with ejection fraction (EF), interventricular septum diameter (IVSd), left ventricular posterior wall diameter (LVPWd), and left atrium diameter (LAd) determined in M-mod echocardiographic examination. Results: No significant difference was observed between MDA and GSH-px levels of patients and control group; however, SOD levels of patients group were significantly lower (p < 0.0001). SOD levels of patients on HD were lower than that of patients on CAPD (p = 0.039). Negative correlation was detected between MDA and EF (r = -0.380, p = 0.001); SOD has negative correlation with systolic blood pressure (r = -0.265, p = 0.011), diastolic blood pressure (r = -0.230, p = 0.028), phosphorus (r = -0.327, p = 0.001), intact parathyroid hormone (iPTH) (r = -0.259, p = 0.013), C-reactive protein (CRP) (r = -0.235, p = 0.024), fibrinogen (r = -0.342, p = 0.001), and total cholesterol (r = -0.249, p = 0.017); and positive correlation with hemoglobin (r = 0.414, p < 0.001) and albumin (r = 0.367, p < 0.001). MDA was independently related with age (beta = -0.258, p = 0.035), male gender (beta = -0.312, p = 0.004), and EF (beta = -0.461, p < 0.001). No correlation was determined between antioxidants and cardiac indexes. Conclusion: SOD levels decreased significantly especially in patients on HD, and it was observed that lower levels of SOD would lead to OS in patients on HD and CAPD when compared to healthy individuals; MDA levels were independently influenced from EF.
Periodontitis is an important and occult source of inflammation in hemodialysis patients
(Karger, 2006) Kadiroglu, Ali Kemal; Kadiroglu, Ela Tules; Sit, Dede; Dag, Ahmet; Yilmaz, M. Emin
Aim:To evaluate the association between C-reactive protein (CRP) levels and the periodontal status of hemodialysis (HID) patients. Methods: 41 HID patients on rHuEPO therapy were enrolled in the study. Hematologic and biochemical parameters and CRP levels were recorded. The plaque index, gingival index, probing pocket depth and periodontal disease index were used to identify periodontal disease. The patients were divided into 2 groups: group 1 (n = 21), high CRP, and group 2 (n = 20), normal CRP. Results: After periodontal therapy, while the mean CRP level and erythrocyte sedimentation rate declined from 30.46 to 10.36 (p = 0.001) and from 93.4 to 35.8 mg/l (p = 0.001), respectively, the hemoglobin level increased from 9.4 to 10.6 g/dl (p = 0.009) and hematocrit level from 28.2 to 32.0% (p = 0.008) in group 1. Conclusion: Periodontitis is an important and occult source of chronic inflammation and increases the CRP levels in HD patients. Periodontitis can cause hyporesponsiveness to rHuEPO treatment and decrease the hemoglobin levels. Copyright (c) 2006 S. Karger AG, Basel
Peritoneal Scintigraphy in Diagnosis of Peritoneal Leakage
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2008) Kadiroglu, A. Kemal; Kayabasi, Hasan; Altunci, Gulhan; Kaya, Halil; Yilmaz, M. Emin
Abdominal hernias and peritoneal leakage are mechanic complications of peritoneal dialysis. We want to present a nonobes type 2 diabetic female patient treated with continuous ambulatory peritoneal dialysis ( CAPD) who had left inguinal hernia due to peritoneal leakage detected by peritoneal scintigraphy. A 38-year-old female patient who has been on CAPD programme for 6 years was suffering from a swelling in her left inguinal region and a little decline in ultrafiltration rate in last two week. Fascial structure was intact by abdominopelvic ultrasound and computed tomography. In peritoneal scintigraphy; increased activity attachments were observed at the left inguinal side after first hour. The patient was transferred to the hemodialysis programme three times a week for 1 month temporarily. After 1 month, peritoneal leakage and fluid accumulation were not observed in the control peritoneal scintigraphy. The patient began to CAPD therapy again. In conclusion, peritoneal scintigraphy should be considered in detection of the dialysate leakage in patients on CAPD that failed to be diagnosed by abdominopelvic USG and computed tomography.
Prevalance of ACE Gene Polymorphism in Patients with End Stage Kidney Disease in Southeastern Turkey
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2007) Zerman, Avar; Sit, Dede; Kadiroglu, Ali Kemal; Kayabasi, Hasan; Budak, Metin; Yilmaz, Zi. Ilflikar; Yilmaz, M. Emin
Aim: To evaluate the frequency of angiotensin converting enzyme gene polymorphism from renin angiotensin aidosterone system in patients undergoing chronic dialysis. Materials and Methods: Eighty-seven patients undergoing di;. alysis treatment and 38 healthy volunteers were enrolled in the study. Demographic features, arterial blood pressure, body mass index (BMI, hematological and biochemical parameters were recorded. ACE gene polymorphism was studied using sterile polymerase chain reaction (PCM method from blood samples taken into tubes containing EDTA. Results: Of the 87 patients, 49 were undergoing hemodialysis and 38 were on peritoneal dialysis programme. In the patient group male/female ratio was 48139 and the mean age was 41.11 +/- 13.6 years; in controls male/female ratio was 14,24 and the mean age was 38.0 +/- 1.41 years. Diabetes mellitus, hypertension, chronic glomerulonephritis were the first three causes of ESRD with percentages of 28, 24, and 23% respectively. Systolic and diastolic blood pressures were higher in patients than controls. ACE gene (I/D) polymorphism prevalence was found as 0.9%, 44.8%, 45.9% among patients. and 31.5%, 39.4%, 28.9% among controls for 11/D/DD respectively, and statistical significance was found (p=0.006). ACE D allele frequency was 68.4% among patients, and 48.7% among controls (p=0.001). Conclusion: We found difference in dispersion of ACE genotype and frequency of D allele between patients and controls.
The prevalence of insulin resistance in nondiabetic nonobese patients with chronic kidney disease
(Springer, 2006) Sit, Dede; Kadiroglu, Ali Kemal; Kayabasi, Hasan; Yilmaz, M. Emin
This study was undertaken to evaluate the prevalence of insulin resistance (IR) and associated factors in nondiabetic, nonobese patients with chronic kidney disease (CKD) who had not yet received dialysis therapy. A group of 89 consecutive patients (42 male, 47 female) who were hospitalized in the Nephrology Clinic at Dicle University, had recently been diagnosed with CKD, and had not yet been treated with dialysis were enrolled in the study, as was a control group of 30 healthy volunteers. Diabetic and obese patients were excluded. IR was determined by the homeostasis model assessment of IR (HOMA-IR) formula. Blood samples were taken after an overnight fasting period to establish serum glucose, insulin, C-peptide, albumin, lipid profile, hematocrit, bicarbonate, and intact parathormone (iPTH) levels. The mean age of patients was 48.7 +/- 19.7 y (men, 49.5 +/- 21.5 y; women, 48.1 +/- 18.0 y); other mean values were as follows: glucose, 98.4 +/- 20.6 mg/dL; insulin, 16.7 +/- 16.2 mu U/mL; HOMA-IR, 5.46 +/- 1.14; hemoglobin (Hgb), 8.7 +/- 1.6 g/dL; calcium-phosphorus product (Ca x P), 52.2 +/- 16.2 mg2/dL(2); WTH, 377.7 +/- 258.1 pg/mL, and bicarbonate (HCO3), 16.6 +/- 5.3 mEq/L. HOMA-IR was significantly higher in patients with stage 4 CKD than in controls (P <.001); serum levels of urea, creatinine clearance (CrCl), C-reactive protein (CRP), albumin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), Hgb, HCO3, Ca x P, and WTH were found to be associated with HOMA-IR when a comparison was made with the control group. According to correlation analyses of possible risk factors in patients with IR, positive correlations with age, body mass index, CRP, Ca x P product, and WTH, and negative correlations with albumin, CrCl, Hgb, and HDL-C were found. A high percentage of IR was found, and this percentage increased as glomerular filtration rate decreased in patients with stage 4 CKD. In addition, a correlation was found between IR and parameters such as age, body mass index, CRP, Ca x P, iPTH, albumin, CrCl, Hgb, and HDL-C.

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