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Öğe THE ASSOCIATION OF RELATIVE HYDRATION STATUS WITH NT-PROBNP, IVC INDEX AND BLOOD PRESSURE IN NEWLY DIAGNOSED STAGE 5 CHRONIC KIDNEY DISEASE(Carbone Editore, 2013) Yilmaz, Zulfukar; Yildirim, Yasar; Aydin, Fatma Yilmaz; Aydin, Emre; Kadiroglu, Ali Kemal; Yilmaz, Mehmet EminIntroduction: Accurate and sensitive methods are very important for the assessment of volume status in chronic kidney disease (CKD). Bioelectrical impedance analysis (BIA) is a simple, non-invasive and promising method to assess volume status in patients with CKD. Objective: The aim of this study was to evaluate the association between BIA derived relative hydration status (RHS) and clinical findings and other markers of volume status in patients who were newly diagnosed with stage 5 CKD. Patients and method: Totally 85 patients who were newly diagnosed with stage 5 CKD and have not received any renal replacement therapy were enrolled in this study. Hydration status was assessed by multi-frequency BIA device (Body Composition Monitor, Fresenius). Relative hydration status was defined as the overhydration (OH) to extracellular water (ECW) ratio and clinical overhydration was considered as an overhydration-to-extracellular water ratio of >% 15. The patient population was divided into 2 groups; group 1: RHS >% 15, group 2: RHS <= %15. Inferior vena cava (IVC) diameter was measured by echocardiography and indexed for body surface area as IVC index (mm/m2). NT-proBNP was measured by immunoassay. Results: Among subjects, 57.6% of the patients had RHS >% 15. Systolic blood pressure (SBP), diastolic blood pressure (DBP), proteinuria, OH. ECW, IVC index, and NT-proBNP were significantly higher, while serum albumin and residual urine were significantly lower in group I than group 2 (p<0.05). There was a significant positive correlation between RHS and SBP, DBP, proteinuria. OH, ECW, NT-proBNP and IVC index and a negative correlation with albumin and residual urine (p<0.05). Conclusions: RHS may be an important measuring parameter of volume overload in patients with CKD. RHS is correlated with NT-proBNP, blood pressure and IVC index.Öğe Bacteremia caused by Stenotrophomonas maltophilia in a dialysis patient with a long-term central venous catheter(Univ Chicago Press, 2006) Kara, Ismail Hamdi; Yilmaz, Mehmet Emin; Sit, Dede; Kadiroglu, Ali Kemal; Koekoglu, Oemer Faruk[Abstract Not Available]Öğe The effect of inflammatory reactions on antibody unresponsiveness to hepatitis B vaccine in hemodialysis patients(Briefland, 2007) Sit, Dede; Kadiroglu, Ali Kemal; Kayabasi, Hasan; Yilmaz, Zuelfuekar; Yilmaz, Mehmet EminBackground and Aims: In this study, the effect of infections and inflammation developed during hepatitis B vaccination program on antibody response in hemodialysis (HD) patients was evaluated. Methods: In total, 94 patients who had hepatitis B surface antigen (HBsAg) (-), antibody to hepatitis B surface (antiHBs) (-), antibody against hepatitis B core immunoglobulin G (antiHBclgG) (-) (Group A) and who were previously vaccinated but having antibody titer levels lower than 10 mIU/mL (Group B), on maintenance HD program were included in this study. In group A, 40 mu g intramuscular vaccine on 0, 1, 2 and 6 months and in group B, 40 mu g of intramuscular booster dose vaccine were administered. Antibody titer of 10 mIU/mL was considered as positive. Group A was then divided into two subgroups with respect to antibody response (Group A1 and Group A2). Results: Eighty-one patients completed the study (Group A; n=64, mean age=42.3 +/- 11.4 years; Group B: n=17, mean age=53.6 +/- 10.6 years). In Group A, antibody response was positive in 82.8% (Group A1), negative in 17.2% (Group A2) and it was positive in 100% of Group B. Inflammatory parameters, nutritional and demographic features were found similarly in all groups. Throughout the study, infections developed most frequently in Group A. Conclusions: We concluded that acute infections and inflammations developed in patients vaccinated according to vaccination schedule recommended for HBV prophylaxis during HD treatment does not affect antibody response and acute phase reactants are not indicators for negative antibody response.Öğe Evaluation of fluid status related parameters in hemodialysis and peritoneal dialysis patients: Clinical usefulness of bioimpedance analysis(Elsevier Urban & Partner Sp. Z O O, 2014) Yilmaz, Zulfukar; Yildirim, Yasar; Aydin, Fatma Yilmaz; Aydin, Emre; Kadiroglu, Ali Kemal; Yilmaz, Mehmet Emin; Acet, HalitBackground and objective: Fluid overload is a common and serious problem that leads to severe complications in dialysis patients. We aimed to compare hydration status as measured with bioimpedance analysis (BIA) method in hemodialysis (HD) and peritoneal dialysis (PD) patients, as well as investigating the association between blood pressure, left ventricular mass index (LVMI) and hydration status. Materials and methods: We examined 43 HD and 33 PD patients. Blood pressure was recorded. In each group, echocardiographic examinations were performed on all patients. Hydration status was assessed using multifrequency bioelectrical impedance analysis. Overhydration was defined as an overhydration (OH)/extracellular water (ECW) ratio of >0.15. Results: The OH/ECW ratio was significantly higher in PD patients compared to post-HD patients. Overhydration was statistically more frequent in PD than in post-HD patients (30.3% vs. 11.6%, P = 0.043). Systolic blood pressure (SBP) in both post-HD and PD groups, and LVMI in the PD group were found to be significantly higher in overhydrated patients than non-overhydrated patients. In multiple linear regression analyses, increased OH/ECW ratio was independently associated with higher SBP and LVMI. Conclusions: Fluid overload may be an even more prevalent and serious problem in PD patients. Overhydration is closely associated with increased blood pressure and LVMI. OH/ECW ratio, a derived parameter of fluid load measured by BIA, was a significant and independent determinant of SBP and LVMI. (C) 2014 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.Öğe EVALUATION OF THE ANTIOXIDANT AND RENOPROTECTIVE EFFECTS OF ELLAGIC ACID ON ISCHEMIA/REPERFUSION INDUCED NEPHROPATHY IN RATS(Oxford Univ Press, 2014) Yildirim, Yas Ar; Aba, Ozlem; Yilmaz, Zulfukar; Kadiroglu, Ali Kemal; Yilmaz, Mehmet Emin; Gul, Mesut; Ketani, Aydin[Abstract Not Available]Öğe EVALUATION OF THE ANTIOXIDANT AND RENOPROTECTIVE EFFECTS OF ELLAGIC ACID ON ISCHEMIA/REPERFUSION INDUCED NEPHROPATHY IN RATS(Carbone Editore, 2014) Yildirimi, Yasar; Adiyaman, Ozlem Aba; Yilmaz, Zulfukar; Kadiroglu, Al Kemal; Yilmaz, Mehmet Emin; Gul, Mesut; Ketani, AydinAims: Renal ischemia-reperfusion (I/R) injury is one of the important cause of acute kidney injury (AKI). Reactive oxygen species and inflammatory cytokines play major role in the pathogenesis of IR injury. Ellagic acid (EA), a phenolic compound, have shown to exert antioxidants, anti-inflammatory, anticarcinogenic, antihyperlipidemic effects. We aim to evaluate, the effect of EA on renal I/R induced nephropathy in rats. Materials and methods: Twenty-eight male Sprague-Dawley rats were divided into four groups; control, control + EA, I/R, and EA+I/R. EA (85 mg/kg, perorally) was administered 30 min prior to the ischemia. Rats were unilaterally nephrectomized and subjected to 45 min of renal pedicle occlusion followed by 60 min of reperfusion. Both groups were subsequently studied by renal function tests, oxidant and antioxidant parameters, and kidney histology. Results: Serum/kidney TAC, NO and paraoxonase levels were significantly higher, while serum urea and creatinine, serum/kidney MDA and TOS were significantly lower in EA+I/R group compared to I/R group (p<0.05). Histopathologic examination revealed that the severity of damage was significantly lower in the EA+I/R group compared to the I/R alone group. Conclusion: Administration of EA appears to have beneficial effects on I/R induced renal injury by reducing oxidative stress, thus preventing histological injuries and bringing about an improvement in renal function.Öğe Evaluation of the Frequency of QTc Dispersion and Its Relationship with Clinical and Laboratory Parameters in Dialysis Patients(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2013) Yilmaz, Zulfukar; Yildirim, Yasar; Yilmaz Aydin, Fatma; Aydin, Emre; Kadiroglu, Ali Kemal; Yilmaz, Mehmet Emin; Kayabasi, HasanOBJECTIVE: QTc dispersion is defined as the difference between the maximal and minimal correct QT interval on standard 12-lead ECG. Increased QTc dispersion has been reported in ESRD patients. In our study, we aimed to evaluate the frequency of QTc dispersion and its relationship between clinical and laboratory parameters in patients on regular dialysis programme. MATERIAL and METHODS: Sixty patients underwent dialysis ( 30 HD, 30 CAPD) and another 30 healthy subjects were enrolled into the study. The standard 12 lead ECGs were performed and QTcd was measured from all dialysis patients and control subjects. Blood samples were collected for the measurement of laboratory parameters. RESULTS: Dialysis patients showed significantly higher QTcd than control subjects (55.75 +/- 36.48 versus 28.73 +/- 28.27; p=0.001). Patients with QTcd > 50 ms had significantly higher SBP, urea and ferritin levels, but significantly lower iron binding capacity and calcium levels compared those with QTcd <= 50 ms(p<0.05). Positive correlations were found between QTcd and urea, ferritin and SBP levels, and inverse correlations with iron binding capacity level (p<0.05). CONCLUSION: The frequency of QTc dispersion was 40% among the dialysis patients. Although serum calcium was significantly lower in patients who had QTcd > 50 ms than QTcd <= 50 ms (p<0.05), there was no significant correlation between QTcd and calcium.Öğe Evaluation of volume overload by bioelectrical impedance analysis, NT-proBNP and inferior vena cava diameter in patients with stage 3&4 and 5 chronic kidney disease(Taylor & Francis Ltd, 2014) Yilmaz, Zulfukar; Yildirim, Yasar; Oto, Ferhat; Aydin, Fatma Yilmaz; Aydin, Emre; Kadiroglu, Ali Kemal; Yilmaz, Mehmet EminBackground: Determination of fluid overload is important in chronic kidney disease. Early diagnosis and treatment of volume overload may decrease morbidity and mortality. We aimed to determine body composition by using bioelectrical impedance analysis, and studying other clinical characteristics, inferior vena cava diameter, and N-terminal pro-B natriuretic peptide associated with hydration status in chronic kidney disease Stages 3&4 and 5 in patients not undergoing dialysis. Method: We examined 62 patients with Stages 3&4 and 68 patients with Stage 5 chronic kidney disease. Plasma NT-proBNP was measured and analyzed after log transformation. Inferior vena cave diameter was measured with echocardiography and indexed for body surface area. Hydration status was assessed using multi-frequency bioelectrical impedance analysis. Overhydration was defined as overhydration/extracellular water >0.15. Results: Overhydration was more frequent in Stage 5 than in Stages 3&4 patients. Systolic and diastolic blood pressure, inferior vena cava index, and log NT-proBNP were higher in overhydrated compared to non-overhydrated patients. A significant positive correlation existed between overhydration/extracellular water and log NT-proBNP, systolic and diastolic blood pressures, and inferior vena cava index. In multiple linear regression analysis, the variables associated with hydration status were male sex, extracellular water/total body water, and extracellular water/intracellular water (greater overhydration), while serum albumin levels had a negative association with overhydration. Conclusion: Overhydration is more prevalent in Stage 5 chronic kidney disease patients than in Stages 3&4 patients. Bioelectrical impedance analysis, inferior vena cava diameter, and NT-proBNP analysis in chronic kidney disease are useful methods to determine the volume overload.Öğe Hyaluronic Acid as a New Biomarker to Differentiate Acute Kidney Injury From Chronic Kidney Disease(Iranian Soc Nephrolgy, 2017) Akin, Davut; Ozmen, Sehmus; Yilmaz, Mehmet EminIntroduction. It may be difficult to differentiate acute kidney injury from chronic kidney disease in patients with no past medical reports of kidney function. This study aimed to investigate the role of serum hyaluronic acid (HA), which is known as a marker of fibrosis, in differential diagnosis of kidney failure. Materials and Methods. A total of 90 patients (52 women and 38 mne) admitted to our renal unit with uremia for the first time were included. Serum HA level was measured. The diagnostic role of the test was investigated using the receiver operator curve curves. Results. The mean age of the patients was 54.6 +/- 17.9 years. The diagnosis was chronic kidney disease (CKD) in 41.1%, acute kidney injury (AKI) in 48.9%, AKI on CKD in 6.7% (3 died without a diagnosis). The mean serum HA was significantly higher in the CKD group (146.1 +/- 119.3 ng/mL) than the AKI group (68.9 +/- 69.1 ng/mL; P < .001). Serum HA significantly correlated with proteinuria (r = 0.717, P < .001) and serum albumin level (r = -0.599, P < .001) in the CKD group only. Serum HA cutoff level of 61 ng/dL had a sensitivity of 82% and specificity of 67% for differential diagnosis of AKI and CKD. Conclusions. Serum HA level may be used as tool to differentiate AKI from CKD. Further larger studies are warranted to clarify the definite the role of this marker.Öğe Once-monthly continuous erythropoietin receptor activator (CERA) for haemoglobin maintenance in haemodialysis patients with chronic renal anaemia(Oxford Univ Press, 2014) Duman, Neval; Uyanik, Abdullah; Unsal, Abdulkadir; Sezer, Siren; Camsari, Taner; Cirit, Mustafa; Yilmaz, Mehmet EminBackground. This study was conducted to evaluate the efficacy and safety of once-monthly continuous erythropoietin receptor activator (CERA) for maintenance of stable haemoglobin (Hb) levels in adult chronic renal anaemia patients on dialysis according to local clinical judgment in Turkey. Methods. This was a prospective, open-label, single-arm, multi-centre study conducted in 20 centres in Turkey. After a 4-week screening period, eligible patients receiving conventional erythropoiesis-stimulating agents were converted to monthly intravenous CERA and entered a 16-week CERA dose-titration period (DTP) followed by an 8-week efficacy evaluation period (EEP) and a 4-week safety follow-up. The primary endpoint was the proportion of patients whose Hb concentration remained stable within +/- 1.0 g/dL of their reference Hb and within the range of 10.0-12.0 g/dL during the EEP. Results. A total of 173 patients were screened, 132 entered the DTP and 84 completed the study. Thirty-nine patients [46.4%(95% confidence interval: 35.5-57.7%)] maintained stable target Hb concentrations. The mean change in time-adjusted average Hb concentration was 0.29 +/- 1.08 g/dL between baseline and the EEP. The mean CERA monthly dose was 112.4 +/- 76.78 mu g during the EEP, and the CERA dose was adjusted in 39 patients (36.4%). Eleven patients (8.4%) reported 13 treatment-related adverse events, the most frequent adverse events being infections and infestations, gastrointestinal and vascular disorders. Conclusions. Once-monthly CERA maintains stable Hb concentrations in chronic renal anaemia patients on dialysis in Turkey. The study results confirm the known efficacy and safety profile of CERA.Öğe The prevalence and the characteristics of tuberculosis patients undergoing chronic dialysis treatment: Experience of a dialysis center in southeast Turkey(Taylor & Francis Ltd, 2008) Kayabasi, Hasan; Sit, Dede; Kadiroglu, Ali Kemal; Kara, Ismail Hamdi; Yilmaz, Mehmet EminTuberculosis remains a significant health problem for patients receiving chronic dialysis. The purpose of this study was to evaluate the prevalence, clinical characteristics, and outcomes of tuberculosis among patients with end-stage renal failure (ESRF) undergoing chronic hemodialysis and continuous ambulatory peritoneal dialysis. Between 1999 and 2006, we diagnosed 21 active tuberculosis patients among a total of 674-dialysis patient in our dialysis center (582 patients on hemodialysis and 92 patients on continuous ambulatory peritoneal dialysis program). Fourteen patients developed extrapulmonary tuberculosis (generally tuberculous lymphadenitis, n = 8) and seven patients developed pulmonary tuberculosis. All patients who developed tuberculosis after starting dialysis had low creatinine clearances and, in general, anemia and hypoalbuminemia. Three of patients greater than 40 years died. In conclusion, tuberculous lymphadenitis was the most frequent form of extrapulmonary tuberculosis in our dialysis population. If no cause is found despite extensive investigations in an end stage renal failure case with fever, loss of weight, and/or atypical lymphadenopathy, the physician should consider the possibility of tuberculosis. Finally, it was considered that ESRF is associated with depressed immune system and elevated risk of tuberculosis; thus, in this population, clinicians must evaluate patients carefully.Öğe QUS measurements in dialysis patients(Medi+World Int, 2005) Kara, Ismail Hamdi; Yilmaz, Mehmet Emin; Turgutalp, Kenan; Tuzcu, Alparslan; Kadiroglu, Ali KemalBackground: It was aimed to evaluate the bone measurements by quantitative heel ultrasound (QUS) in patients undergoing chronic haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), and healthy controls. It was also aimed to investigate the relationship between weight, body mass index (BMI), smoking and parathyroid hormone (PTH) with QUS parameters. Method: Present study included 25 patients on chronic HD (Group 1), 16 patients treated by CAPD (Group 2) and 32 controls (Group 3). QUS (Hologic, Sahara bone sonometer) measured broadband ultrasound attenuation (BUA; dB/Mhz), quantitative ultrasound index (QUI; g/cm(2)), speed of sound (SOS; m/s). The WHO (1997) classification of BMI was used for weight classification. The smoking criterion was defined as smoker and non-smoker. Results: Mean age of cases was 40.2 +/- 15.5, 36.0 +/- 9.9 and 36.6 +/- 12.4 years, in groups 1, 2 and 3 (p>0.05), and mean dialysis duration time was 31.8 +/- 12.6 and 42.8 +/- 12.8 months, in groups 1 and 2 (p=0.015). Depending on the QUS parameters, both osteoporosis and osteop zenia were diagnosed in five (56%) of women and in 11 (69%) of men in HD vs in two (33%) of women and in four (40%) of men in CAPD, respectively (p=0.584). QUS measurements were not correlated with serum PTH and BMI in both HD and CAPD groups, respectively. In HD group, we found SOS to be lower ( 1526 +/- 27 vs. 1548 +/- 19 m/s, p=0.016) in smokers compared to non- smokers. There were negative correlations between smoking and QUS parameters ( r=-0.34; p=0.044). Conclusion: Our findings suggest that there is an unfavorable influence of HD and smoking on bone mineralization compared to CAPD.Öğe Vascular access practice in a large cohort of chronic hemodialysis patients(Oxford Univ Press, 2007) Sever, Mehmet Sukru; Dogan, Cengiz; Yildiz, Alaattin; Yilmaz, Mehmet Emin; Suleymanlar, Gultekin; Arinsoy, Turgay; Ok, Ercan[Abstract Not Available]
