Objective: Hepatitis C virus (HCV) infection exerts diverse effects on atherogenesis. We investig... more Objective: Hepatitis C virus (HCV) infection exerts diverse effects on atherogenesis. We investigated whether malnutrition inflammation score (MIS) is associated with the presence of coronary artery disease (CAD) in anti-HCV-positive hemodialysis (HD) patients. Subjects/Methods: Twenty-two anti-HCV-positive HD patients with CAD and 61 anti-HCV-positive HD patients without CAD (as controls) were included. Data were obtained from hospital records, patients were evaluated for risk factors for CAD. The same physician performed MIS evaluation. Results: MIS of anti-HCV-positive HD patients with CAD were significantly higher than patients without CAD (8.874.0 vs 6.572.6, P ¼ 0.02). In patients with CAD, basal (P ¼ 0.002) and peak C-reactive protein (P ¼ 0.03) and serum ferritin (P ¼ 0.01) concentrations were higher, serum albumin concentrations (P ¼ 0.003) were lower than those patients without CAD. MIS was positively correlated with age (r ¼ þ 0.359, P ¼ 0.001) and viral load (r ¼ þ 0.629, Po0.0001). In univariate logistic regression analysis, advanced age (odds ratios (OR)
Keywords: ambulatory blood pressure monitoring; hypertension; renal transplant donors Background.... more Keywords: ambulatory blood pressure monitoring; hypertension; renal transplant donors Background. Hypertension is considered to be a contraindication in potential renal transplant donors. Ambulatory blood pressure monitoring (ABPM ) was developed as an alternative to in-office blood pressure Introduction measurement (OBPM ). The aim of this study was to determine the sensitivity of ABPM in revealing hyper-Much has been learned about ambulatory blood prestension in potential renal transplant donors, and to sure monitoring (ABPM ) over the past 15 years, and measure the correlation between ABPM results and several consensus groups have recommended that this target organ damage. method be used in caring for certain patients. Methods. The study included 126 potential living-re-Ambulatory (non-invasive) blood pressure monitors lated renal transplant donors. The potential donors' have helped in the diagnosis of mild and borderline blood pressures were measured during three separate hypertension, and in the identification of so-called clinic visits and then evaluated using 24-h ABPM. 'office' or 'white coat' hypertension [1][2][3]. Using this Cardiac and ophthalmological examinations were also method of monitoring, 'blood pressure (BP) load' is performed to investigate target organ damage in all of defined as the percentage of blood pressure readings the donors. that are elevated during the day and night, over a 24-h Results. According to the OBPM, 89 potential donors period. The thresholds used are 140/90 mmHg for day were normotensive and 37 had borderline or mild and 120/80 mmHg for night. Normotensive subjects hypertension. Of the normotensive group, six were reportedly have a BP load of <10% [1]. Whereas, diagnosed as hypertensive after 24-h ABPM, and these Heebels et al. [4] used the concept of 'whole-day BP subjects had target organ involvement. The status of load', defined as the percentage of BP readings the other 83 donors remained unchanged after ABPM >140/90 mmHg during a 24-h period, and a systolic and investigation for target organ damage. Thirteen of BP (SBP) load of >50% and/or a diastolic BP (DBP) the 37 subjects who had borderline or mildly elevated load in excess of 40% was defined as 'hypertensive BP pressures on OBPM were classified as normotensive load'. The target organ damage seen in essential hyperafter ABPM. These 13 individuals exhibited no hypertension is more closely associated with ambulatory tension-related target organ damage. The other 24 than with clinic blood pressure measurement [5-8]. patients who had been classified as borderline or mildly We also know that clinic blood pressure measurements hypertensive on OBPM fulfilled the criteria for hyperare related directly to mean levels and variability in tension after ABPM, and hypertensive changes were ambulatory blood pressure [9,10]. Because target found at target organ evaluation. Before donor nephorgan damage is a powerful predictor of morbidity rectomy, 94 subjects who were classified as normotensand mortality in cases of hypertension, ABPM might ive prior to transplantation underwent renal offer prognostic information superior to that provided angiography for routine pretransplant evaluation, and by clinic assessment [11,12]. none showed hypertensive or atherosclerotic changes. Hypertension is considered to be a contraindication Conclusion. In our study, ABPM was found to be for renal transplantation in potential donors [13]. With more sensitive than OBPM in terms of identifying the critical shortage of organ donors for renal transhypertension in potential renal transplant donors. plantation, it is imperative that we evaluate each candidate carefully for absolute and relative contraindications. In this study, we compared the accuracy of
The presence of Helicobacter pylori (HP) infection may adversely influence outcome in renal trans... more The presence of Helicobacter pylori (HP) infection may adversely influence outcome in renal transplant candidates because of its strong association with gastrointestinal disorders. We examined the association between HP infection and nutritional parameters in symptom-free hemodialysis patients and assessed prospectively the nutritional changes in patients who received therapy for the disease. The 163 study patients, including 114 men and 69
Arteriovenous fistulae (AVF) thrombosis is a common cause of morbidity in hemodialysis (HD) patie... more Arteriovenous fistulae (AVF) thrombosis is a common cause of morbidity in hemodialysis (HD) patients. Increased soluble endothelial protein C receptor (sEPCR) levels have been associated with increased risk of venous thrombosis. We aimed to investigate the possible effects of sEPCR levels on the development of AVF thrombosis in adult HD patients. 60 HD patients and 22 healthy controls were included. Patients were followed for 18 months and were divided into two groups according to AVF thrombosis development: group 1 (with thrombosis) and group 2 (without thrombosis). Also, patients classified into tertiles according to plasma sEPCR levels: lowest, intermediate, and highest. Groups were analyzed for any relationship between sEPCR levels and development of AVF thrombosis. Mean plasma sEPCR levels were significantly higher in HD patients than they were in controls. Group 1 patients had significantly higher sEPCR levels compared with group 2 patients. Patients' groups were similar r...
mm were critical parameters for stroke. Advanced age and second degree HTA were associated with h... more mm were critical parameters for stroke. Advanced age and second degree HTA were associated with higher risk for stroke. Those findings could help in more successful approach to stroke prevention.
... 4 EFFECT OF CHRONIC HEPATITIS C INFECTION ON LYMPHOCYTE SUBSETS IN RENAL TRANSPLANT PATIENTS ... more ... 4 EFFECT OF CHRONIC HEPATITIS C INFECTION ON LYMPHOCYTE SUBSETS IN RENAL TRANSPLANT PATIENTS B Akman, FN Özdemir ... MONONUCLEAR CELL INFILTRATION IN RENAL ALLOGRAFT BIOPSIES B Handan Özdemir, P Kaynak Aksoy, A Nihan Haberal, B ...
Posttransplantation erythrocytosis (PE) is a frequent problem in renal transplant patients. The p... more Posttransplantation erythrocytosis (PE) is a frequent problem in renal transplant patients. The pathogenesis and mechanisms of both the problem and therapy strategy are unknown. Since ACE and angiotensin 2 receptor inhibitors have been used to successfully manage PE, we speculated a relation between gene polymorphisms and this complication. Ninety-six ( 30 women, 66 men, age 34.4 ± 11.0 years) renal
Background: Some polymorphisms at the human vitamin D receptor (VDR) gene locus may influence cal... more Background: Some polymorphisms at the human vitamin D receptor (VDR) gene locus may influence calcium and bone metabolism. We investigated the roles of the BsmI and TaqI VDR gene polymorphisms in the development of hypercalcemia in Turkish peritoneal dialysis (PD) patients. ♦♦ ♦♦ ♦ Methods: We enrolled 132 PD patients treated with dialysate containing 1.75 mmol/L calcium. Serum levels of calcium, phosphorus, albumin, and intact parathyroid hormone (iPTH), and the cumulative doses of calcium-based phosphate binders and calcitriol were recorded every 3 months. The VDR BsmI and TaqI genotypes were determined by polymerase chain reaction. ♦♦ ♦♦ ♦ Results: When the patients were categorized according to these VDR genotypes, serum levels of phosphorus and iPTH and cumulative doses of calcium-based phosphate binders and calcitriol were similar across groups. The corrected serum calcium levels tended to increase in the patients with BsmI non-BB (Bb + bb) variants, but were significantly decreased in the BB variants (9.9 ± 0.7 vs 9.1 ± 0.6 mg/dL, p < 0.05). Hypercalcemia appeared in 21.2% of the patients during the follow-up period. The hypercalcemic patients had a significantly higher prevalence of the BsmI non-BB genotype than the normocalcemic patients (85.7% vs 59.6%, p < 0.007). On the contrary, the serum calcium levels were not affected by the TaqI VDR gene polymorphism (p > 0.05). ♦♦ ♦♦ ♦ Conclusions: These findings suggest that the non-BB variants of the BsmI VDR gene polymorphism are associated with increased risk of developing hypercalcemia in PD patients. Perit Dial Int 2005; 25(S3):S52-S55 www.PDIConnect.com
Twenty patients with end-stage renal failure who were on maintenance hemodialysis (HD) underwent ... more Twenty patients with end-stage renal failure who were on maintenance hemodialysis (HD) underwent pulmonary function testing (PFT) before and shortly after an HD session. On pre-HD PFT, the mean values of all parameters except residual volume (RV) were in the normal range. Mean RV was high (152.9%), and mean diffusing capacity of the lung for carbon monoxide (DLCO) was high-normal (110.4%). The pre-HD static inspiratory (PImax) and expiratory pressures (PEmax) were much lower than normal (67.4% and 36.3%, respectively). After the HD session, repeat PFT revealed a small increase in expiratory flow rates, and a significant drop in PImax. There was a strong correlation between PImax and PEmax (r=0.567, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) at the pre- and post-HD stages, indicating that common mechanism(s) are responsible for impairment of both inspiratory and expiratory muscle strength. The well-preserved DLCO was thought to be due to the use of biocompatible dialyzer membranes. Chronic vascular congestion might be the other explanation of high DLCO.
Acute kidney injury (AKI), at least in critically ill patients, seldom occurs as isolated organ f... more Acute kidney injury (AKI), at least in critically ill patients, seldom occurs as isolated organ failure. Much more often it emerges as a component of the multiple organ failure syndrome, within the framework of the severe and prolonged catabolic phase determined by critical illness, and intensified by specific derangements in substrate utilization due to the acute loss of kidney function. On these bases, patients with AKI often have protein-energy wasting (preexisting and/or hospital acquired), which represents a major negative prognostic factor. Thus, nutritional support is frequently required, under the form of parenteral and/or enteral nutrition, even though no formal demonstration exists for its favorable effect on major outcomes. The primary goals of nutritional support in AKI are basically the same as those suggested for critically ill patients with normal renal function: i.e., to ensure the delivery of adequate amounts of nutrients, to prevent protein-energy wasting with the attendant metabolic complications, to promote wound healing and tissue reparation, to support immune system function and to reduce mortality. Patients with AKI on renal replacement therapy (RRT) should receive at least 1.5 g/kg per day of proteins, and no more than 30 kcal nonprotein calories or 1.3 x BEE (basal energy expenditure) calculated by the Harris-Benedict equation, with lipid supply representing about 30%-35% of energy. The enteral route should be the preferred route for nutrient delivery; however, parenteral nutrition is often required to target nutritional requirements. Due to the loss of the kidney&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s homeostatic function, and the frequent need of RRT, patients with AKI are especially prone to complications of nutritional support, such as hyperglycemia, hypertriglyceridemia, fluid retention, electrolyte and acid-base derangements. Since AKI comprises a highly heterogeneous group of subjects with nutrient needs widely varying even along the clinical course in the same patient, nutritional requirements should be frequently reassessed, individualized and carefully integrated with RRT.
This study was conducted to evaluate the efficacy and safety of once-monthly continuous erythropo... more 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. 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. A total of 173 patients were screened, 132 entered the DTP and 84 completed the study. Thirty-nine patients [46.4% (95% confidence interval...
Background. Clinical presentation and complications of end-stage renal disease patients are influ... more Background. Clinical presentation and complications of end-stage renal disease patients are influenced by many environmental and genetic factors. In this study we sought to define the frequencies of BsmI and TagI vitamin D receptor gene polymorphisms and their influences on clinical presentations in the Turkish end-stage renal disease population. Methodology and patients. Hemodialyzed patients (n ϭ 186; 111 male, 75 female) were genotyped for the insertion/deletion BsmI (B ¡ b, restriction site, exon VIII ¡ IX), TagI (T ¡ t, 352 exon IX) vitamin D receptor gene polymorphisms. The previous 12 months of laboratory values (C-reactive protein, intact parathyroid hormone, albumin, calcium, phosphorus, CaxP product) and clinical findings (vitamin D requirement, body weight) were analyzed retrospectively. Results. Mean age and follow-up periods were 42.1 Ϯ 12.6 years and 76.3 Ϯ 43.9 months, respectively. Polymorphism percentages were BsmI; BB/Bb/bb: 28.9/65.3/5.8% and TagI; TT/Tt/tt: 36.7/60.5/2.8%, respectively. Further analysis revealed that the TT variant of TagI was related to hyperparathyroidism (P Ͻ .05). Analysis of the data after regrouping patients according to iPTH levels (0 to 249; 250 to 499; Ն500 pg/mL) and hemodialysis duration (Ͻ60 versus Ն60 months) revealed an influence of TT variation on hyperparathyroidism as a function of increased hemodialysis duration and higher iPTH levels (P Ͻ .005). Conclusion. TT variants of the TagI vitamin D receptor gene influence the development of hyperparathyroidism in hemodialysis patients, an influence that becomes more evident in patients with longer hemodialysis duration.
Aims. We sought to evaluate influences of oxidative stress (OS) on rHuEPO requirements in hemodia... more Aims. We sought to evaluate influences of oxidative stress (OS) on rHuEPO requirements in hemodialysis patients without chronic inflammation. Methods. Sixty-eight hemodialysis patients and 46 healthy controls underwent measurements plasma levels of antioxidative agents, such as glutathione peroxidase (GPX), superoxide dismutase (SOD), and oxidative compounds including malonyldialdehyde (MDA). We retrospectively analyzed the last 3 months' rHuEPO requirements, iron indices, and CRP levels.
Diabetes mellitus appearing after kidney transplantation-posttransplant diabetes mellitus (PTDM)-... more Diabetes mellitus appearing after kidney transplantation-posttransplant diabetes mellitus (PTDM)-is a common complication associated with poor graft and patient survival. The purpose of the current study was to determine the risk factors for developing PTDM in 204 renal transplant recipients who had been followed for at least 30 months. Posttransplant diabetes mellitus was diagnosed according to the American Diabetic Association/WHO criteria, or a requirement for insulin, an oral hypoglycemic agent, or both. Analyses of possible risk factors for PTDM included demographic features, dialysis and posttransplantation duration, smoking, body mass index, medications, co-morbid diseases, HLA mismatches, as well as laboratory metrics of serum creatinine, albumin, calcium, phosphorus, C-reactive protein, parathyroid hormone, and lipid profiles. Twenty-six patients displayed PTDM. Univariate analysis showed that older age, greater body mass index, presence of hepatitis C virus (HCV) infection, and smoking at the time of renal transplantation were associated with PTDM development. In a multivariate analysis, HCV infection, smoking, and patient age at the time of transplantation were independent risk factors for PTDM. In conclusion, the presence of HCV infection or a smoking habit in addition to older age at the time of transplantation were the main predictors for developing PTDM. Patients should be closely followed regarding their smoking habit and weight gain as modifiable risk factors for PTDM.
The aim of this study was to reveal the pulmonary function status of renal transplant recipients ... more The aim of this study was to reveal the pulmonary function status of renal transplant recipients and chronic renal failure patients on hemodialysis or continuous ambulatory peritoneal dialysis. The study involved 73 subjects, including 49 patients who were either on peritoneal dialysis (n ϭ 22) or hemodialyis (n ϭ 27), and 24 renal transplant recipients. The spirometry results revealed significantly higher residual volume and total lung capacity in the hemodialysis and peritoneal dialysis groups than in the transplantation group. Forced expiratory flow between 25% and 75% of vital capacity was slightly below normal in the dialysis patients. Preservation of diffusion capacity of the lung for carbon monoxide was noted in the hemodialysis group (112.4%). Inspiratory and expiratory muscle strength was reduced in all groups. Only type of dialysis was correlated with this reduction. Inspiratory muscle strength in the peritoneal dialysis group (49.9%) was significantly lower than in the transplantation and hemodialysis groups (54.7% and 66.5%, respectively). The spirometry findings suggest that small-airway disease causes increased residual volume and total lung capacity (hyperinflation) in hemodialysis and peritoneal dialysis patients and that this airway obstruction subsides after renal transplantation. Preserved diffusion capacity in the hemodialysis group was attributed to the use of biocompatible dialyzer membranes. Renal failure complications may be the main explanation for global respiratory muscle weakness in dialysis patients, whereas corticosteroid therapy might be the primary cause in kidney graft recipients. Significantly lower inspiratory muscle strength in the peritoneal dialysis group suggests that presence of intra-abdominal dialysate might interfere with diaphragmatic contraction.
As a consequence of the expanded use of long-term hemodialysis and extended life spans, complicat... more As a consequence of the expanded use of long-term hemodialysis and extended life spans, complications of chronic renal failure are encountered with an increased frequency among uremic patients. Such patients may develop many thoracic and extrathoracic problemsmost frequently uremic pleuritis and pericarditis, uremic pneumonia, infection, and metastatic pulmonary calcification. We retrospectively analyzed the medical records of 257 patients who had received long-term hemodialysis between 1990 and 2006 to better understand the incidence, causes, and clinical features of pleural effusions in this population. The incidence of pleural effusion in hospitalized patients receiving long-term hemodialysis was 20.2% (n ϭ 52; mean age, 55.83 Ϯ 16.56 years; male-to-female ratio, approximately 3:2). Pleural effusion resulted from hypervolemia in 61.5% and was bilateral in 68.8% of patients. Unilateral effusion was present in 25 of 52 (48%) patients. The most frequent causes of unilateral effusion were hypervolemia (n ϭ 9) and parapneumonic effusion (n ϭ 5). Thoracenteses were performed in 14 of the 52 patients in the study group. Of thoracenteses performed, 64.3% of the patients had transudative pleural effusion and 35.7% had exudative effusion. Transudative pleural effusion resulted from hypervolemia in 66.7% and heart failure in 22.2%. Of the patients with transudative effusion, 85.7% were bilateral. The most frequent cause of exudative pleural effusion was uremic pleuritis, which occurred in 40% of the patients. The most common symptom was dyspnea, which occurred in 53.8% of patients. In conclusion, pleural effusions are common in patients receiving chronic hemodialysis. Thoracentesis may be performed in patients with unilateral pleural effusion. Since hypervolemia was the most common cause of pleural effusion, this complication should not be considered an obstacle in renal transplant recipients.
Objective: Hepatitis C virus (HCV) infection exerts diverse effects on atherogenesis. We investig... more Objective: Hepatitis C virus (HCV) infection exerts diverse effects on atherogenesis. We investigated whether malnutrition inflammation score (MIS) is associated with the presence of coronary artery disease (CAD) in anti-HCV-positive hemodialysis (HD) patients. Subjects/Methods: Twenty-two anti-HCV-positive HD patients with CAD and 61 anti-HCV-positive HD patients without CAD (as controls) were included. Data were obtained from hospital records, patients were evaluated for risk factors for CAD. The same physician performed MIS evaluation. Results: MIS of anti-HCV-positive HD patients with CAD were significantly higher than patients without CAD (8.874.0 vs 6.572.6, P ¼ 0.02). In patients with CAD, basal (P ¼ 0.002) and peak C-reactive protein (P ¼ 0.03) and serum ferritin (P ¼ 0.01) concentrations were higher, serum albumin concentrations (P ¼ 0.003) were lower than those patients without CAD. MIS was positively correlated with age (r ¼ þ 0.359, P ¼ 0.001) and viral load (r ¼ þ 0.629, Po0.0001). In univariate logistic regression analysis, advanced age (odds ratios (OR)
Keywords: ambulatory blood pressure monitoring; hypertension; renal transplant donors Background.... more Keywords: ambulatory blood pressure monitoring; hypertension; renal transplant donors Background. Hypertension is considered to be a contraindication in potential renal transplant donors. Ambulatory blood pressure monitoring (ABPM ) was developed as an alternative to in-office blood pressure Introduction measurement (OBPM ). The aim of this study was to determine the sensitivity of ABPM in revealing hyper-Much has been learned about ambulatory blood prestension in potential renal transplant donors, and to sure monitoring (ABPM ) over the past 15 years, and measure the correlation between ABPM results and several consensus groups have recommended that this target organ damage. method be used in caring for certain patients. Methods. The study included 126 potential living-re-Ambulatory (non-invasive) blood pressure monitors lated renal transplant donors. The potential donors' have helped in the diagnosis of mild and borderline blood pressures were measured during three separate hypertension, and in the identification of so-called clinic visits and then evaluated using 24-h ABPM. 'office' or 'white coat' hypertension [1][2][3]. Using this Cardiac and ophthalmological examinations were also method of monitoring, 'blood pressure (BP) load' is performed to investigate target organ damage in all of defined as the percentage of blood pressure readings the donors. that are elevated during the day and night, over a 24-h Results. According to the OBPM, 89 potential donors period. The thresholds used are 140/90 mmHg for day were normotensive and 37 had borderline or mild and 120/80 mmHg for night. Normotensive subjects hypertension. Of the normotensive group, six were reportedly have a BP load of <10% [1]. Whereas, diagnosed as hypertensive after 24-h ABPM, and these Heebels et al. [4] used the concept of 'whole-day BP subjects had target organ involvement. The status of load', defined as the percentage of BP readings the other 83 donors remained unchanged after ABPM >140/90 mmHg during a 24-h period, and a systolic and investigation for target organ damage. Thirteen of BP (SBP) load of >50% and/or a diastolic BP (DBP) the 37 subjects who had borderline or mildly elevated load in excess of 40% was defined as 'hypertensive BP pressures on OBPM were classified as normotensive load'. The target organ damage seen in essential hyperafter ABPM. These 13 individuals exhibited no hypertension is more closely associated with ambulatory tension-related target organ damage. The other 24 than with clinic blood pressure measurement [5-8]. patients who had been classified as borderline or mildly We also know that clinic blood pressure measurements hypertensive on OBPM fulfilled the criteria for hyperare related directly to mean levels and variability in tension after ABPM, and hypertensive changes were ambulatory blood pressure [9,10]. Because target found at target organ evaluation. Before donor nephorgan damage is a powerful predictor of morbidity rectomy, 94 subjects who were classified as normotensand mortality in cases of hypertension, ABPM might ive prior to transplantation underwent renal offer prognostic information superior to that provided angiography for routine pretransplant evaluation, and by clinic assessment [11,12]. none showed hypertensive or atherosclerotic changes. Hypertension is considered to be a contraindication Conclusion. In our study, ABPM was found to be for renal transplantation in potential donors [13]. With more sensitive than OBPM in terms of identifying the critical shortage of organ donors for renal transhypertension in potential renal transplant donors. plantation, it is imperative that we evaluate each candidate carefully for absolute and relative contraindications. In this study, we compared the accuracy of
The presence of Helicobacter pylori (HP) infection may adversely influence outcome in renal trans... more The presence of Helicobacter pylori (HP) infection may adversely influence outcome in renal transplant candidates because of its strong association with gastrointestinal disorders. We examined the association between HP infection and nutritional parameters in symptom-free hemodialysis patients and assessed prospectively the nutritional changes in patients who received therapy for the disease. The 163 study patients, including 114 men and 69
Arteriovenous fistulae (AVF) thrombosis is a common cause of morbidity in hemodialysis (HD) patie... more Arteriovenous fistulae (AVF) thrombosis is a common cause of morbidity in hemodialysis (HD) patients. Increased soluble endothelial protein C receptor (sEPCR) levels have been associated with increased risk of venous thrombosis. We aimed to investigate the possible effects of sEPCR levels on the development of AVF thrombosis in adult HD patients. 60 HD patients and 22 healthy controls were included. Patients were followed for 18 months and were divided into two groups according to AVF thrombosis development: group 1 (with thrombosis) and group 2 (without thrombosis). Also, patients classified into tertiles according to plasma sEPCR levels: lowest, intermediate, and highest. Groups were analyzed for any relationship between sEPCR levels and development of AVF thrombosis. Mean plasma sEPCR levels were significantly higher in HD patients than they were in controls. Group 1 patients had significantly higher sEPCR levels compared with group 2 patients. Patients' groups were similar r...
mm were critical parameters for stroke. Advanced age and second degree HTA were associated with h... more mm were critical parameters for stroke. Advanced age and second degree HTA were associated with higher risk for stroke. Those findings could help in more successful approach to stroke prevention.
... 4 EFFECT OF CHRONIC HEPATITIS C INFECTION ON LYMPHOCYTE SUBSETS IN RENAL TRANSPLANT PATIENTS ... more ... 4 EFFECT OF CHRONIC HEPATITIS C INFECTION ON LYMPHOCYTE SUBSETS IN RENAL TRANSPLANT PATIENTS B Akman, FN Özdemir ... MONONUCLEAR CELL INFILTRATION IN RENAL ALLOGRAFT BIOPSIES B Handan Özdemir, P Kaynak Aksoy, A Nihan Haberal, B ...
Posttransplantation erythrocytosis (PE) is a frequent problem in renal transplant patients. The p... more Posttransplantation erythrocytosis (PE) is a frequent problem in renal transplant patients. The pathogenesis and mechanisms of both the problem and therapy strategy are unknown. Since ACE and angiotensin 2 receptor inhibitors have been used to successfully manage PE, we speculated a relation between gene polymorphisms and this complication. Ninety-six ( 30 women, 66 men, age 34.4 ± 11.0 years) renal
Background: Some polymorphisms at the human vitamin D receptor (VDR) gene locus may influence cal... more Background: Some polymorphisms at the human vitamin D receptor (VDR) gene locus may influence calcium and bone metabolism. We investigated the roles of the BsmI and TaqI VDR gene polymorphisms in the development of hypercalcemia in Turkish peritoneal dialysis (PD) patients. ♦♦ ♦♦ ♦ Methods: We enrolled 132 PD patients treated with dialysate containing 1.75 mmol/L calcium. Serum levels of calcium, phosphorus, albumin, and intact parathyroid hormone (iPTH), and the cumulative doses of calcium-based phosphate binders and calcitriol were recorded every 3 months. The VDR BsmI and TaqI genotypes were determined by polymerase chain reaction. ♦♦ ♦♦ ♦ Results: When the patients were categorized according to these VDR genotypes, serum levels of phosphorus and iPTH and cumulative doses of calcium-based phosphate binders and calcitriol were similar across groups. The corrected serum calcium levels tended to increase in the patients with BsmI non-BB (Bb + bb) variants, but were significantly decreased in the BB variants (9.9 ± 0.7 vs 9.1 ± 0.6 mg/dL, p < 0.05). Hypercalcemia appeared in 21.2% of the patients during the follow-up period. The hypercalcemic patients had a significantly higher prevalence of the BsmI non-BB genotype than the normocalcemic patients (85.7% vs 59.6%, p < 0.007). On the contrary, the serum calcium levels were not affected by the TaqI VDR gene polymorphism (p > 0.05). ♦♦ ♦♦ ♦ Conclusions: These findings suggest that the non-BB variants of the BsmI VDR gene polymorphism are associated with increased risk of developing hypercalcemia in PD patients. Perit Dial Int 2005; 25(S3):S52-S55 www.PDIConnect.com
Twenty patients with end-stage renal failure who were on maintenance hemodialysis (HD) underwent ... more Twenty patients with end-stage renal failure who were on maintenance hemodialysis (HD) underwent pulmonary function testing (PFT) before and shortly after an HD session. On pre-HD PFT, the mean values of all parameters except residual volume (RV) were in the normal range. Mean RV was high (152.9%), and mean diffusing capacity of the lung for carbon monoxide (DLCO) was high-normal (110.4%). The pre-HD static inspiratory (PImax) and expiratory pressures (PEmax) were much lower than normal (67.4% and 36.3%, respectively). After the HD session, repeat PFT revealed a small increase in expiratory flow rates, and a significant drop in PImax. There was a strong correlation between PImax and PEmax (r=0.567, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) at the pre- and post-HD stages, indicating that common mechanism(s) are responsible for impairment of both inspiratory and expiratory muscle strength. The well-preserved DLCO was thought to be due to the use of biocompatible dialyzer membranes. Chronic vascular congestion might be the other explanation of high DLCO.
Acute kidney injury (AKI), at least in critically ill patients, seldom occurs as isolated organ f... more Acute kidney injury (AKI), at least in critically ill patients, seldom occurs as isolated organ failure. Much more often it emerges as a component of the multiple organ failure syndrome, within the framework of the severe and prolonged catabolic phase determined by critical illness, and intensified by specific derangements in substrate utilization due to the acute loss of kidney function. On these bases, patients with AKI often have protein-energy wasting (preexisting and/or hospital acquired), which represents a major negative prognostic factor. Thus, nutritional support is frequently required, under the form of parenteral and/or enteral nutrition, even though no formal demonstration exists for its favorable effect on major outcomes. The primary goals of nutritional support in AKI are basically the same as those suggested for critically ill patients with normal renal function: i.e., to ensure the delivery of adequate amounts of nutrients, to prevent protein-energy wasting with the attendant metabolic complications, to promote wound healing and tissue reparation, to support immune system function and to reduce mortality. Patients with AKI on renal replacement therapy (RRT) should receive at least 1.5 g/kg per day of proteins, and no more than 30 kcal nonprotein calories or 1.3 x BEE (basal energy expenditure) calculated by the Harris-Benedict equation, with lipid supply representing about 30%-35% of energy. The enteral route should be the preferred route for nutrient delivery; however, parenteral nutrition is often required to target nutritional requirements. Due to the loss of the kidney&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s homeostatic function, and the frequent need of RRT, patients with AKI are especially prone to complications of nutritional support, such as hyperglycemia, hypertriglyceridemia, fluid retention, electrolyte and acid-base derangements. Since AKI comprises a highly heterogeneous group of subjects with nutrient needs widely varying even along the clinical course in the same patient, nutritional requirements should be frequently reassessed, individualized and carefully integrated with RRT.
This study was conducted to evaluate the efficacy and safety of once-monthly continuous erythropo... more 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. 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. A total of 173 patients were screened, 132 entered the DTP and 84 completed the study. Thirty-nine patients [46.4% (95% confidence interval...
Background. Clinical presentation and complications of end-stage renal disease patients are influ... more Background. Clinical presentation and complications of end-stage renal disease patients are influenced by many environmental and genetic factors. In this study we sought to define the frequencies of BsmI and TagI vitamin D receptor gene polymorphisms and their influences on clinical presentations in the Turkish end-stage renal disease population. Methodology and patients. Hemodialyzed patients (n ϭ 186; 111 male, 75 female) were genotyped for the insertion/deletion BsmI (B ¡ b, restriction site, exon VIII ¡ IX), TagI (T ¡ t, 352 exon IX) vitamin D receptor gene polymorphisms. The previous 12 months of laboratory values (C-reactive protein, intact parathyroid hormone, albumin, calcium, phosphorus, CaxP product) and clinical findings (vitamin D requirement, body weight) were analyzed retrospectively. Results. Mean age and follow-up periods were 42.1 Ϯ 12.6 years and 76.3 Ϯ 43.9 months, respectively. Polymorphism percentages were BsmI; BB/Bb/bb: 28.9/65.3/5.8% and TagI; TT/Tt/tt: 36.7/60.5/2.8%, respectively. Further analysis revealed that the TT variant of TagI was related to hyperparathyroidism (P Ͻ .05). Analysis of the data after regrouping patients according to iPTH levels (0 to 249; 250 to 499; Ն500 pg/mL) and hemodialysis duration (Ͻ60 versus Ն60 months) revealed an influence of TT variation on hyperparathyroidism as a function of increased hemodialysis duration and higher iPTH levels (P Ͻ .005). Conclusion. TT variants of the TagI vitamin D receptor gene influence the development of hyperparathyroidism in hemodialysis patients, an influence that becomes more evident in patients with longer hemodialysis duration.
Aims. We sought to evaluate influences of oxidative stress (OS) on rHuEPO requirements in hemodia... more Aims. We sought to evaluate influences of oxidative stress (OS) on rHuEPO requirements in hemodialysis patients without chronic inflammation. Methods. Sixty-eight hemodialysis patients and 46 healthy controls underwent measurements plasma levels of antioxidative agents, such as glutathione peroxidase (GPX), superoxide dismutase (SOD), and oxidative compounds including malonyldialdehyde (MDA). We retrospectively analyzed the last 3 months' rHuEPO requirements, iron indices, and CRP levels.
Diabetes mellitus appearing after kidney transplantation-posttransplant diabetes mellitus (PTDM)-... more Diabetes mellitus appearing after kidney transplantation-posttransplant diabetes mellitus (PTDM)-is a common complication associated with poor graft and patient survival. The purpose of the current study was to determine the risk factors for developing PTDM in 204 renal transplant recipients who had been followed for at least 30 months. Posttransplant diabetes mellitus was diagnosed according to the American Diabetic Association/WHO criteria, or a requirement for insulin, an oral hypoglycemic agent, or both. Analyses of possible risk factors for PTDM included demographic features, dialysis and posttransplantation duration, smoking, body mass index, medications, co-morbid diseases, HLA mismatches, as well as laboratory metrics of serum creatinine, albumin, calcium, phosphorus, C-reactive protein, parathyroid hormone, and lipid profiles. Twenty-six patients displayed PTDM. Univariate analysis showed that older age, greater body mass index, presence of hepatitis C virus (HCV) infection, and smoking at the time of renal transplantation were associated with PTDM development. In a multivariate analysis, HCV infection, smoking, and patient age at the time of transplantation were independent risk factors for PTDM. In conclusion, the presence of HCV infection or a smoking habit in addition to older age at the time of transplantation were the main predictors for developing PTDM. Patients should be closely followed regarding their smoking habit and weight gain as modifiable risk factors for PTDM.
The aim of this study was to reveal the pulmonary function status of renal transplant recipients ... more The aim of this study was to reveal the pulmonary function status of renal transplant recipients and chronic renal failure patients on hemodialysis or continuous ambulatory peritoneal dialysis. The study involved 73 subjects, including 49 patients who were either on peritoneal dialysis (n ϭ 22) or hemodialyis (n ϭ 27), and 24 renal transplant recipients. The spirometry results revealed significantly higher residual volume and total lung capacity in the hemodialysis and peritoneal dialysis groups than in the transplantation group. Forced expiratory flow between 25% and 75% of vital capacity was slightly below normal in the dialysis patients. Preservation of diffusion capacity of the lung for carbon monoxide was noted in the hemodialysis group (112.4%). Inspiratory and expiratory muscle strength was reduced in all groups. Only type of dialysis was correlated with this reduction. Inspiratory muscle strength in the peritoneal dialysis group (49.9%) was significantly lower than in the transplantation and hemodialysis groups (54.7% and 66.5%, respectively). The spirometry findings suggest that small-airway disease causes increased residual volume and total lung capacity (hyperinflation) in hemodialysis and peritoneal dialysis patients and that this airway obstruction subsides after renal transplantation. Preserved diffusion capacity in the hemodialysis group was attributed to the use of biocompatible dialyzer membranes. Renal failure complications may be the main explanation for global respiratory muscle weakness in dialysis patients, whereas corticosteroid therapy might be the primary cause in kidney graft recipients. Significantly lower inspiratory muscle strength in the peritoneal dialysis group suggests that presence of intra-abdominal dialysate might interfere with diaphragmatic contraction.
As a consequence of the expanded use of long-term hemodialysis and extended life spans, complicat... more As a consequence of the expanded use of long-term hemodialysis and extended life spans, complications of chronic renal failure are encountered with an increased frequency among uremic patients. Such patients may develop many thoracic and extrathoracic problemsmost frequently uremic pleuritis and pericarditis, uremic pneumonia, infection, and metastatic pulmonary calcification. We retrospectively analyzed the medical records of 257 patients who had received long-term hemodialysis between 1990 and 2006 to better understand the incidence, causes, and clinical features of pleural effusions in this population. The incidence of pleural effusion in hospitalized patients receiving long-term hemodialysis was 20.2% (n ϭ 52; mean age, 55.83 Ϯ 16.56 years; male-to-female ratio, approximately 3:2). Pleural effusion resulted from hypervolemia in 61.5% and was bilateral in 68.8% of patients. Unilateral effusion was present in 25 of 52 (48%) patients. The most frequent causes of unilateral effusion were hypervolemia (n ϭ 9) and parapneumonic effusion (n ϭ 5). Thoracenteses were performed in 14 of the 52 patients in the study group. Of thoracenteses performed, 64.3% of the patients had transudative pleural effusion and 35.7% had exudative effusion. Transudative pleural effusion resulted from hypervolemia in 66.7% and heart failure in 22.2%. Of the patients with transudative effusion, 85.7% were bilateral. The most frequent cause of exudative pleural effusion was uremic pleuritis, which occurred in 40% of the patients. The most common symptom was dyspnea, which occurred in 53.8% of patients. In conclusion, pleural effusions are common in patients receiving chronic hemodialysis. Thoracentesis may be performed in patients with unilateral pleural effusion. Since hypervolemia was the most common cause of pleural effusion, this complication should not be considered an obstacle in renal transplant recipients.
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