Turk Nefroloji, Diyaliz ve Transplantasyon Hemsireleri Dernegi, 2020
Çalışmada hemodiyaliz öncesi ve sonrası rutin pratikte ölçülen kan basıncı değerlerinin hemodiyal... more Çalışmada hemodiyaliz öncesi ve sonrası rutin pratikte ölçülen kan basıncı değerlerinin hemodiyaliz öncesi ve sonrası kılavuzların önerdiği şekilde standartlara uygun ölçülen kan basıncı değerlerinden ne kadar farklı olduğunu araştırdık. Gereç ve Yöntemler: Çalışma 76 hemodiyaliz hastası ile gerçekleştirildi. Hastalar hemodiyaliz merkezine geldikten sonra kılavuzların önerdiği şekilde standartlara uygun kan basıncı ölçümü yapıldı. Hastaların standart kan basıncı ölçüldükten sonra diyaliz öncesi rutin kan basınçları ölçüldü. Diyaliz tamamlandıktan sonra hastaların diyaliz sonrası rutin ve standartlara uygun kan basıncı ölçümleri yapıldı. Bulgular: Hastaların hemodiyaliz öncesi standartlara uygun ölçülen sistolik kan basıncı (SKB) ortalaması, rutin ölçülen SKB ortalamasından daha düşüktü (129 ± 25 vs.134 ± 25 mm Hg; p< 0.0001). Hemodiyaliz öncesi standart diyastolik kan basıncı (DKB) ortalaması da, rutin DKB ortalamasından daha düşüktü (74 ± 12 vs. 77 ± 14 mm Hg; p<0.0001). Hemodiyaliz sonrası ölçümlerde ise standart SKB ortalaması ile rutin SKB ortalaması arasında anlamlı fark yoktu (115 ± 24 vs 113 ± 26; p>0.05). Hemodiyaliz sonrası standart DKB ortalaması, rutin DKB ortalamasından daha yüksek idi (71 ± 12 vs. 68 ± 14 mm Hg; p=0.043). Sonuç: Hemodiyaliz öncesi standartlara uygun ölçülen SKB ve DKB, rutin ölçümlere göre sıklıkla daha düşüktür.
Turkiye Klinikleri Journal of Internal Medicine, 2020
Son dönem böbrek hastalığı (SDBH) nedeni ile kronik hemodiyaliz (HD) tedavisi görmekte olan hasta... more Son dönem böbrek hastalığı (SDBH) nedeni ile kronik hemodiyaliz (HD) tedavisi görmekte olan hasta popülasyonu, tüm dünyada olduğu gibi Türkiye'de de artmaktadır. Bu hastalara ait bilgilerin kaydedildiği veri tabanlarında yapılacak analizler, mevcut durum hakkında tespitler yapılmasını ve HD tedavisinde gelişme alanlarının belirlenmesini sağlayarak hastaların tedaviden daha fazla yarar görmelerine katkıda bulunabilir. Bu çalışmada, Türkiye'de kronik HD tedavisi görmekte olan hastaların demografik ve klinik özelliklerinin incelenmesi amaçlandı. Gereç ve Yöntemler: Bu tanımlayıcı çalışma için, Ocak 2017-Şubat 2018 tarihleri arasındaki bir yıllık zaman diliminde Türkiye'nin 7 bölgesindeki 93 merkezde SDBH nedeni ile kronik HD tedavisi görmekte olan hastalar elektronik ortamda kaydedildi. Hastaların bazı demografik özellikleri ile birlikte klinik özellikleri incelendi. Bulgular: Çalışmaya, kronik HD tedavisi görmekte olan 2.461 hasta dâhil edildi. Ortalama yaşı 56,7±14,3 yıl olan çalışma popülasyonunun %65,5'ini erkekler oluşturuyordu. Ortalama SDBH süresi 5,4±6,1 yıl idi. Çalışma popülasyonunun %92,8'i haftada üç kez HD tedavisi alıyordu. Hastaların %74,8'inde eşlik eden en az bir hastalık ve %9,1'inde hastaneye yatış öyküsü saptandı. Bu hastane yatışlarının %21,7'sinde kardiyak etiyoloji mevcuttu. Çalışma popülasyonunun %79,6'sında anemi bulundu. Eritropoez uyarıcı ajan alan hastalar, tüm popülasyonun %57,4'ünü oluşturuyordu. Hastaların %80,0'ında fosfat bağlayıcı ajan kullanımı tespit edildi. Statin kullanan hastaların oranı %8,9 idi. Sonuç: Çok-merkezli bu kayıt çalışması ile Türkiye'de kronik HD tedavisi görmekte olan hastaların klinik özellikleri geniş ölçekte ortaya kondu. Görece genç yaşlarda olan çalışma popülasyonunda azımsanamayacak sıklıkta saptanan komorbidite ve kardiyak hastane yatışı öyküsü, kısa ve uzun dönem izlemlerdeki klinik özellik değişim trendiyle birlikte öngördürücü ve prognostik faktörlerin ortaya çıkarılmasına ışık tutabilir. Anah tar Ke li me ler: Böbrek diyalizi; kronik böbrek yetmezliği; kayıt çalışması; anemi; kardiyovasküler hastalıklar ABS TRACT Objective: The number of patients who received chronic hemodialysis (HD) due to end-stage renal disease (ESRD) has increased both at global and national level. Analyses of disease registries in these patients could contribute to improved therapeutic benefits by addressing potential areas of development in HD therapy after determining current situation. This study aimed to investigate demographic and clinical characteristics of chronic HD patients in Turkey. Material and Methods: This descriptive study enrolled patients who were under chronic HD therapy due to ESRD in 93 centers of seven regions of Turkey between January, 2017 and February, 2018. Some demographic and clinical characteristics of the patients were examined. Results: A total of 2.461 chronic HD patients were included to the study. The mean age of the patients was 56.7±14.3 and men constituted 65.5% of the study population. The mean duration of ESRD was 5.4±6.1 years. Most of the patients (92.8%) were found to receive three sessions of HD per week. Near three-fourths (74.8%) of patients had at least one comorbidity and 9.1% had history of hospitalization, 21.7% of which featured cardiac origin. Anemia was found in 79.6% of the study population. Over half of patients (57.4%) were under erythropoiesis-stimulating agent therapy. Use of phosphate binders were recorded in 80.0% of patients. Statins were found to be used by 8.9% of the study population. Conclusion: This multi-center registry has comprehensively demonstrated clinical characteristics of patients who were under chronic HD therapy in Turkey. Substantial prevalence of comorbidity and cardiac hospitalization in such a comparably younger patient population may shed light on the identification of prognostic and predictive factors, with possible contribution by future trend analysis of other clinical characteristics in short-and long-term follow-up.
Clinical Journal of the American Society of Nephrology, 2017
Background and objectives Uremic pruritus in patients on hemodialysis is associated with depressi... more Background and objectives Uremic pruritus in patients on hemodialysis is associated with depression, lower quality of life, and mortality. We studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally. Design, setting, participants, & measurements Data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study were analyzed to describe pruritus prevalence from 1996 to 2015. Data from 6256 patients and 268 medical directors in 17 countries in 2012–2015 were analyzed to describe predictors, effects, medical directors’ awareness, and treatment of pruritus. Results Patients very much or extremely bothered by itching declined from 28% in 1996 to 18% in 2015. In 2012–2015, among patients nearly always or always bothered by itching, pruritus had a major effect on work and social life; 18% used no treatment for pruritus, and 17% did not report itching to ...
Background. Chronic kidney disease (CKD) is a growing health problem worldwide that leads to end-... more Background. Chronic kidney disease (CKD) is a growing health problem worldwide that leads to end-stage kidney failure and cardiovascular complications. We aimed to determine the prevalence of CKD in Turkey, and to evaluate relationships between CKD and cardiovascular risk factors in a population-based survey. Methods. Medical data were collected through home visits and interviews. Serum creatinine, blood glucose, total cholesterol, triglycerides, HDL, LDL and uric acid were determined from 12-h fasting blood samples, and spot urine tests were performed for subjects who gave consent to laboratory evaluation. Results. A total of 10 872 participants were included in the study. The final analysis was performed on 10 748 subjects (mean age 40.5 ± 16.3 years; 55.7% women) and excluded 124 pregnant women. A low glomerular filtration rate (GFR) (<60 mL/min/1.73 m 2) was present in 5.2% of the subjects who were evaluated for GFR, while microalbuminuria and macroalbuminuria were observed in 10.2% and 2% of the subjects, respectively. The presence of CKD was assessed in subjects who gave consent for urinary albumin excretion measurement (n = 8765). The overall prevalence of CKD was 15.7%; it was higher in women than men (18.4% vs. 12.8%, P < 0.001) and increased with increasing age of the subjects. The prevalence of hypertension (32.7% in the general population), diabetes (12.7%), dyslipidaemia (76.3%), obesity (20.1%) and metabolic syndrome (31.3%) was significantly higher in subjects with CKD than subjects without CKD (P < 0.001 for all). Conclusions. The prevalence of CKD in Turkey is 15.7%. Cardiovascular risk factors were significantly more prevalent in CKD patients.
Renal dysfunction in allogeneic hematopoietic cell transplanthe late 1960s [1]. As the current in... more Renal dysfunction in allogeneic hematopoietic cell transplanthe late 1960s [1]. As the current indications for allogetation. neic HCT expand, the number of patients undergoing Background. Allogeneic hematopoietic cell transplantation this intensive treatment will continue to increase. Unfor-(HCT), formerly called bone marrow transplantation, can potunately, patients undergoing HCT still face multiple toxtentially cure various malignant and non-malignant diseases, icities, and a substantial mortality rate [2]. Acute renal but it is associated with a high risk of toxicity. We have previously shown an overall 21% incidence of severe acute renal failure is undoubtedly one of the major organ toxicities failure in patients undergoing autologous HCT. The present associated with this procedure. Zager demonstrated that study evaluated renal dysfunction in patients undergoing allo-53% of patients undergoing HCT had doubling of the geneic HCT. serum creatinine with almost half of those patients re-Methods. The clinical course of 88 adult patients who requiring dialysis [3]. The overall mortality of acute renal ceived allogeneic HCT at the University of Colorado Health Science Center was analyzed. Renal dysfunction was classified failure requiring dialysis with HCT has been reported to as follows: Grade 0 ϭ normal renal function; Grade 1 ϭ Ͼ25% range between 84 and 88% [2, 4]. While many potential decrement in GFR but Ͻtwofold rise in serum creatinine; etiologies (sepsis, hypotension, nephrotoxic antibiotics, Grade 2 ϭ Ͼtwofold increase in serum creatinine; Grade 3 ϭ chemoradiotherapy) may contribute to the occurrence of Ͼtwofold increase in serum creatinine and need for dialysis. renal dysfunction in autologous HCT, allogeneic HCT has Results. Of the 88 patients, 81 (92%) patients had some degree of renal dysfunction (Grade 1, 20 patients; Grade 2, 32
ObJective: End-stage renal disease (ESRD) patients are more prone to serious influenza virus infe... more ObJective: End-stage renal disease (ESRD) patients are more prone to serious influenza virus infection than healthy subjects. Selenium (Se) play an important role in cellular and humoral immunity and serum Se levels were lower in hemodialysis patients. Studies have demonstrated that Se deficiency results in less reboust immune responses to vaccination and infections. We aimed to investigate the effect of serum Se levels on immune parameters and antibody response to multivalent influenza vaccine (MIV) in HD patients. mateRiaL and metHODs: Twenty-six HD patients (Group 1) and 11 healthy subjects (Group 2) were vaccinated with a trivalent inactivated MIV. In both groups, serum Se levels, CD3, CD4, CD4/ CD8 ratio, CD3+HLA-DR+ cell percentages and antibody response to MIV were determined before and 1 month after the vaccination. RESultS: There were statistically significant differences between Group 1 and Group 2 in terms of baseline serum Se levels, CD8, CD4/CD8 ratio, and CD3+HLA-DR cell percentages. One month after the vaccination, no significant changes were observed in any of the parameters except antibody titers with to baseline levels. coNcluSıoNS: We did not observe any difference in terms of Se levels and the immune parameters mentioned above before and 1 month after MIV vaccination in HD patients. Further studies investigating the link between Se status and clinical outcomes are needed in dialysis patients.
The incidence of neoplasia is increased in end-stage renal disease (ESRD) patients. Zinc (Zn) def... more The incidence of neoplasia is increased in end-stage renal disease (ESRD) patients. Zinc (Zn) deficiency is associated with neoplasia and also commonly seen in ESRD patients. However, the data regarding the relationship between Zn levels and tumor markers is scant in this population. We aimed to investigate the relationship between Zn levels and tumor markers in hemodialysis patients. Twenty-six hemodialysis patients (11 male, 15 female, mean age 41.6±14.3 years) and 11 healthy subjects (6 male and 5 female, mean age 38.7±7.2 years) were included. Serum Alpha fetoprotein (AFP), carcinoembriyonic antigen (CEA), CA 19-9, CA 15-5, CA 125, beta subunit of human corionic gonadotrophin (β-HCG) and beta-2 microglobulin (β2M) and Zn levels were measured. Data were analysed by Student's t test. Serum Zinc levels were significantly lower in ESRD patients (group 1) compared to healthy subjects (group 2) (p<0.0001, for all). Serum CEA and β2M levels were also significantly higher in group 1 patients compared to group 2 subjects (p<0.005, p<0.0001, respectively). Serum Ca15-3 and CA-125 levels were found to be significantly lower in group 1 patients compared to group 2 subjects (p<0.005, p<0.001, respectively). There were no statistically significant difference in terms of serum CA 19-9, β-HCG and AFP between group 1 and group 2 patients. In group 1 patients, there was a negative correlation between serum Zn levels and AFP, while a positive correlation was obsorved between serum Zn levels and CA15-3. The measurement of AFP may be beneficial in HD patients. Further studies are needed.
Renal insufficiency is a common complication early after hematopoietic stem cell transplantation ... more Renal insufficiency is a common complication early after hematopoietic stem cell transplantation (HSCT). Renal function as measured by creatinine clearance (CrCl) was prospectively evaluated in 47 patients undergoing allogeneic (n ¼ 22) or autologous (n ¼ 25) HSCT during the first 100 days. Renal dysfunction was classified as follows: Grade 0 (o25% decline in CrCl), Grade 1 (X25% decline in CrCl but o2 Â increase in serum creatinine), Grade 2 (X2 Â rise in serum creatinine but no need for dialysis) and Grade 3 (X2 Â rise in serum creatinine and need for dialysis). Thirty-three patients (70%) had Grade 1-3 renal dysfunction. Renal dysfunction was more common after myeloablative allogeneic HSCT (91%) than autologous HSCT (52%) (P ¼ 0.004), and was associated with a high risk of mortality (P ¼ 0.039). Sepsis in autologous HSCT patients and cyclosporine toxicity in allogeneic HSCT patients were associated with renal dysfunction. We conclude that autologous and allogeneic HSCT differ in the likelihood and causes of renal dysfunction.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2019
P atients with chronic kidney disease (CKD) have an increased risk of cardiovascular morbidity an... more P atients with chronic kidney disease (CKD) have an increased risk of cardiovascular morbidity and mortality. [1,2] Traditional risk factors, such as diabetes mellitus, hypertension, and dyslipidemia are more common in patients with CKD than in the general population. [3-5] Non-traditional risk factors, such as malnutrition, inflammation, oxidative stress, hyperphosphatemia, anemia, and volume overload are common, and are associated with increased cardiovascular risk in CKD patients. [6] Moreover, this risk increases significantly as the patients approach end-stage renal disease (ESRD). [7] As a result, cardiovascular problems are a major cause of death in patients undergoing dialysis.
Turkish Journal of Nephrology (Turk J Nephrol) is a doubleblind peer-reviewed, open access, an in... more Turkish Journal of Nephrology (Turk J Nephrol) is a doubleblind peer-reviewed, open access, an international online-only publication of the Turkish Society of Nephrology. The journal is a quarterly publication, published in January, April, July and October. The publication language of the journal is English. Turkish Journal of Nephrology aims to contribute to the literature by publishing manuscripts at the highest scientific level in the fields of nephrology, dialysis and transplantation. The journal publishes original articles, rare case reports, reviews, and letters to the editor that are prepared in accordance with the ethical guidelines. The scope of the journal includes but not limited to; remarkable clinical and experimental investigations conducted in all fields of nephrology. The target audience of the journal includes specialists and professionals working and interested in all disciplines of nephrology and kidney care.
Journal of the American Society of Nephrology : JASN, Jan 25, 2018
Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardi... more Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardiovascular and all-cause mortality in the general population, but the benefits for patients on hemodialysis are uncertain. Mediterranean and DASH diet scores were derived from the GALEN Food Frequency Questionnaire within the DIET-HD Study, a multinational cohort study of 9757 adults on hemodialysis. We conducted adjusted Cox regression analyses clustered by country to evaluate the association between diet score tertiles and all-cause and cardiovascular mortality (the lowest tertile was the reference category). During the median 2.7-year follow-up, 2087 deaths (829 cardiovascular deaths) occurred. The adjusted hazard ratios (95% confidence intervals) for the middle and highest Mediterranean diet score tertiles were 1.20 (1.01 to 1.41) and 1.14 (0.90 to 1.43), respectively, for cardiovascular mortality and 1.10 (0.99 to 1.22) and 1.01 (0.88 to 1.17), respectively, for all-cause mortality. ...
Turk Nefroloji, Diyaliz ve Transplantasyon Hemsireleri Dernegi, 2020
Çalışmada hemodiyaliz öncesi ve sonrası rutin pratikte ölçülen kan basıncı değerlerinin hemodiyal... more Çalışmada hemodiyaliz öncesi ve sonrası rutin pratikte ölçülen kan basıncı değerlerinin hemodiyaliz öncesi ve sonrası kılavuzların önerdiği şekilde standartlara uygun ölçülen kan basıncı değerlerinden ne kadar farklı olduğunu araştırdık. Gereç ve Yöntemler: Çalışma 76 hemodiyaliz hastası ile gerçekleştirildi. Hastalar hemodiyaliz merkezine geldikten sonra kılavuzların önerdiği şekilde standartlara uygun kan basıncı ölçümü yapıldı. Hastaların standart kan basıncı ölçüldükten sonra diyaliz öncesi rutin kan basınçları ölçüldü. Diyaliz tamamlandıktan sonra hastaların diyaliz sonrası rutin ve standartlara uygun kan basıncı ölçümleri yapıldı. Bulgular: Hastaların hemodiyaliz öncesi standartlara uygun ölçülen sistolik kan basıncı (SKB) ortalaması, rutin ölçülen SKB ortalamasından daha düşüktü (129 ± 25 vs.134 ± 25 mm Hg; p< 0.0001). Hemodiyaliz öncesi standart diyastolik kan basıncı (DKB) ortalaması da, rutin DKB ortalamasından daha düşüktü (74 ± 12 vs. 77 ± 14 mm Hg; p<0.0001). Hemodiyaliz sonrası ölçümlerde ise standart SKB ortalaması ile rutin SKB ortalaması arasında anlamlı fark yoktu (115 ± 24 vs 113 ± 26; p>0.05). Hemodiyaliz sonrası standart DKB ortalaması, rutin DKB ortalamasından daha yüksek idi (71 ± 12 vs. 68 ± 14 mm Hg; p=0.043). Sonuç: Hemodiyaliz öncesi standartlara uygun ölçülen SKB ve DKB, rutin ölçümlere göre sıklıkla daha düşüktür.
Turkiye Klinikleri Journal of Internal Medicine, 2020
Son dönem böbrek hastalığı (SDBH) nedeni ile kronik hemodiyaliz (HD) tedavisi görmekte olan hasta... more Son dönem böbrek hastalığı (SDBH) nedeni ile kronik hemodiyaliz (HD) tedavisi görmekte olan hasta popülasyonu, tüm dünyada olduğu gibi Türkiye'de de artmaktadır. Bu hastalara ait bilgilerin kaydedildiği veri tabanlarında yapılacak analizler, mevcut durum hakkında tespitler yapılmasını ve HD tedavisinde gelişme alanlarının belirlenmesini sağlayarak hastaların tedaviden daha fazla yarar görmelerine katkıda bulunabilir. Bu çalışmada, Türkiye'de kronik HD tedavisi görmekte olan hastaların demografik ve klinik özelliklerinin incelenmesi amaçlandı. Gereç ve Yöntemler: Bu tanımlayıcı çalışma için, Ocak 2017-Şubat 2018 tarihleri arasındaki bir yıllık zaman diliminde Türkiye'nin 7 bölgesindeki 93 merkezde SDBH nedeni ile kronik HD tedavisi görmekte olan hastalar elektronik ortamda kaydedildi. Hastaların bazı demografik özellikleri ile birlikte klinik özellikleri incelendi. Bulgular: Çalışmaya, kronik HD tedavisi görmekte olan 2.461 hasta dâhil edildi. Ortalama yaşı 56,7±14,3 yıl olan çalışma popülasyonunun %65,5'ini erkekler oluşturuyordu. Ortalama SDBH süresi 5,4±6,1 yıl idi. Çalışma popülasyonunun %92,8'i haftada üç kez HD tedavisi alıyordu. Hastaların %74,8'inde eşlik eden en az bir hastalık ve %9,1'inde hastaneye yatış öyküsü saptandı. Bu hastane yatışlarının %21,7'sinde kardiyak etiyoloji mevcuttu. Çalışma popülasyonunun %79,6'sında anemi bulundu. Eritropoez uyarıcı ajan alan hastalar, tüm popülasyonun %57,4'ünü oluşturuyordu. Hastaların %80,0'ında fosfat bağlayıcı ajan kullanımı tespit edildi. Statin kullanan hastaların oranı %8,9 idi. Sonuç: Çok-merkezli bu kayıt çalışması ile Türkiye'de kronik HD tedavisi görmekte olan hastaların klinik özellikleri geniş ölçekte ortaya kondu. Görece genç yaşlarda olan çalışma popülasyonunda azımsanamayacak sıklıkta saptanan komorbidite ve kardiyak hastane yatışı öyküsü, kısa ve uzun dönem izlemlerdeki klinik özellik değişim trendiyle birlikte öngördürücü ve prognostik faktörlerin ortaya çıkarılmasına ışık tutabilir. Anah tar Ke li me ler: Böbrek diyalizi; kronik böbrek yetmezliği; kayıt çalışması; anemi; kardiyovasküler hastalıklar ABS TRACT Objective: The number of patients who received chronic hemodialysis (HD) due to end-stage renal disease (ESRD) has increased both at global and national level. Analyses of disease registries in these patients could contribute to improved therapeutic benefits by addressing potential areas of development in HD therapy after determining current situation. This study aimed to investigate demographic and clinical characteristics of chronic HD patients in Turkey. Material and Methods: This descriptive study enrolled patients who were under chronic HD therapy due to ESRD in 93 centers of seven regions of Turkey between January, 2017 and February, 2018. Some demographic and clinical characteristics of the patients were examined. Results: A total of 2.461 chronic HD patients were included to the study. The mean age of the patients was 56.7±14.3 and men constituted 65.5% of the study population. The mean duration of ESRD was 5.4±6.1 years. Most of the patients (92.8%) were found to receive three sessions of HD per week. Near three-fourths (74.8%) of patients had at least one comorbidity and 9.1% had history of hospitalization, 21.7% of which featured cardiac origin. Anemia was found in 79.6% of the study population. Over half of patients (57.4%) were under erythropoiesis-stimulating agent therapy. Use of phosphate binders were recorded in 80.0% of patients. Statins were found to be used by 8.9% of the study population. Conclusion: This multi-center registry has comprehensively demonstrated clinical characteristics of patients who were under chronic HD therapy in Turkey. Substantial prevalence of comorbidity and cardiac hospitalization in such a comparably younger patient population may shed light on the identification of prognostic and predictive factors, with possible contribution by future trend analysis of other clinical characteristics in short-and long-term follow-up.
Clinical Journal of the American Society of Nephrology, 2017
Background and objectives Uremic pruritus in patients on hemodialysis is associated with depressi... more Background and objectives Uremic pruritus in patients on hemodialysis is associated with depression, lower quality of life, and mortality. We studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally. Design, setting, participants, & measurements Data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study were analyzed to describe pruritus prevalence from 1996 to 2015. Data from 6256 patients and 268 medical directors in 17 countries in 2012–2015 were analyzed to describe predictors, effects, medical directors’ awareness, and treatment of pruritus. Results Patients very much or extremely bothered by itching declined from 28% in 1996 to 18% in 2015. In 2012–2015, among patients nearly always or always bothered by itching, pruritus had a major effect on work and social life; 18% used no treatment for pruritus, and 17% did not report itching to ...
Background. Chronic kidney disease (CKD) is a growing health problem worldwide that leads to end-... more Background. Chronic kidney disease (CKD) is a growing health problem worldwide that leads to end-stage kidney failure and cardiovascular complications. We aimed to determine the prevalence of CKD in Turkey, and to evaluate relationships between CKD and cardiovascular risk factors in a population-based survey. Methods. Medical data were collected through home visits and interviews. Serum creatinine, blood glucose, total cholesterol, triglycerides, HDL, LDL and uric acid were determined from 12-h fasting blood samples, and spot urine tests were performed for subjects who gave consent to laboratory evaluation. Results. A total of 10 872 participants were included in the study. The final analysis was performed on 10 748 subjects (mean age 40.5 ± 16.3 years; 55.7% women) and excluded 124 pregnant women. A low glomerular filtration rate (GFR) (<60 mL/min/1.73 m 2) was present in 5.2% of the subjects who were evaluated for GFR, while microalbuminuria and macroalbuminuria were observed in 10.2% and 2% of the subjects, respectively. The presence of CKD was assessed in subjects who gave consent for urinary albumin excretion measurement (n = 8765). The overall prevalence of CKD was 15.7%; it was higher in women than men (18.4% vs. 12.8%, P < 0.001) and increased with increasing age of the subjects. The prevalence of hypertension (32.7% in the general population), diabetes (12.7%), dyslipidaemia (76.3%), obesity (20.1%) and metabolic syndrome (31.3%) was significantly higher in subjects with CKD than subjects without CKD (P < 0.001 for all). Conclusions. The prevalence of CKD in Turkey is 15.7%. Cardiovascular risk factors were significantly more prevalent in CKD patients.
Renal dysfunction in allogeneic hematopoietic cell transplanthe late 1960s [1]. As the current in... more Renal dysfunction in allogeneic hematopoietic cell transplanthe late 1960s [1]. As the current indications for allogetation. neic HCT expand, the number of patients undergoing Background. Allogeneic hematopoietic cell transplantation this intensive treatment will continue to increase. Unfor-(HCT), formerly called bone marrow transplantation, can potunately, patients undergoing HCT still face multiple toxtentially cure various malignant and non-malignant diseases, icities, and a substantial mortality rate [2]. Acute renal but it is associated with a high risk of toxicity. We have previously shown an overall 21% incidence of severe acute renal failure is undoubtedly one of the major organ toxicities failure in patients undergoing autologous HCT. The present associated with this procedure. Zager demonstrated that study evaluated renal dysfunction in patients undergoing allo-53% of patients undergoing HCT had doubling of the geneic HCT. serum creatinine with almost half of those patients re-Methods. The clinical course of 88 adult patients who requiring dialysis [3]. The overall mortality of acute renal ceived allogeneic HCT at the University of Colorado Health Science Center was analyzed. Renal dysfunction was classified failure requiring dialysis with HCT has been reported to as follows: Grade 0 ϭ normal renal function; Grade 1 ϭ Ͼ25% range between 84 and 88% [2, 4]. While many potential decrement in GFR but Ͻtwofold rise in serum creatinine; etiologies (sepsis, hypotension, nephrotoxic antibiotics, Grade 2 ϭ Ͼtwofold increase in serum creatinine; Grade 3 ϭ chemoradiotherapy) may contribute to the occurrence of Ͼtwofold increase in serum creatinine and need for dialysis. renal dysfunction in autologous HCT, allogeneic HCT has Results. Of the 88 patients, 81 (92%) patients had some degree of renal dysfunction (Grade 1, 20 patients; Grade 2, 32
ObJective: End-stage renal disease (ESRD) patients are more prone to serious influenza virus infe... more ObJective: End-stage renal disease (ESRD) patients are more prone to serious influenza virus infection than healthy subjects. Selenium (Se) play an important role in cellular and humoral immunity and serum Se levels were lower in hemodialysis patients. Studies have demonstrated that Se deficiency results in less reboust immune responses to vaccination and infections. We aimed to investigate the effect of serum Se levels on immune parameters and antibody response to multivalent influenza vaccine (MIV) in HD patients. mateRiaL and metHODs: Twenty-six HD patients (Group 1) and 11 healthy subjects (Group 2) were vaccinated with a trivalent inactivated MIV. In both groups, serum Se levels, CD3, CD4, CD4/ CD8 ratio, CD3+HLA-DR+ cell percentages and antibody response to MIV were determined before and 1 month after the vaccination. RESultS: There were statistically significant differences between Group 1 and Group 2 in terms of baseline serum Se levels, CD8, CD4/CD8 ratio, and CD3+HLA-DR cell percentages. One month after the vaccination, no significant changes were observed in any of the parameters except antibody titers with to baseline levels. coNcluSıoNS: We did not observe any difference in terms of Se levels and the immune parameters mentioned above before and 1 month after MIV vaccination in HD patients. Further studies investigating the link between Se status and clinical outcomes are needed in dialysis patients.
The incidence of neoplasia is increased in end-stage renal disease (ESRD) patients. Zinc (Zn) def... more The incidence of neoplasia is increased in end-stage renal disease (ESRD) patients. Zinc (Zn) deficiency is associated with neoplasia and also commonly seen in ESRD patients. However, the data regarding the relationship between Zn levels and tumor markers is scant in this population. We aimed to investigate the relationship between Zn levels and tumor markers in hemodialysis patients. Twenty-six hemodialysis patients (11 male, 15 female, mean age 41.6±14.3 years) and 11 healthy subjects (6 male and 5 female, mean age 38.7±7.2 years) were included. Serum Alpha fetoprotein (AFP), carcinoembriyonic antigen (CEA), CA 19-9, CA 15-5, CA 125, beta subunit of human corionic gonadotrophin (β-HCG) and beta-2 microglobulin (β2M) and Zn levels were measured. Data were analysed by Student's t test. Serum Zinc levels were significantly lower in ESRD patients (group 1) compared to healthy subjects (group 2) (p<0.0001, for all). Serum CEA and β2M levels were also significantly higher in group 1 patients compared to group 2 subjects (p<0.005, p<0.0001, respectively). Serum Ca15-3 and CA-125 levels were found to be significantly lower in group 1 patients compared to group 2 subjects (p<0.005, p<0.001, respectively). There were no statistically significant difference in terms of serum CA 19-9, β-HCG and AFP between group 1 and group 2 patients. In group 1 patients, there was a negative correlation between serum Zn levels and AFP, while a positive correlation was obsorved between serum Zn levels and CA15-3. The measurement of AFP may be beneficial in HD patients. Further studies are needed.
Renal insufficiency is a common complication early after hematopoietic stem cell transplantation ... more Renal insufficiency is a common complication early after hematopoietic stem cell transplantation (HSCT). Renal function as measured by creatinine clearance (CrCl) was prospectively evaluated in 47 patients undergoing allogeneic (n ¼ 22) or autologous (n ¼ 25) HSCT during the first 100 days. Renal dysfunction was classified as follows: Grade 0 (o25% decline in CrCl), Grade 1 (X25% decline in CrCl but o2 Â increase in serum creatinine), Grade 2 (X2 Â rise in serum creatinine but no need for dialysis) and Grade 3 (X2 Â rise in serum creatinine and need for dialysis). Thirty-three patients (70%) had Grade 1-3 renal dysfunction. Renal dysfunction was more common after myeloablative allogeneic HSCT (91%) than autologous HSCT (52%) (P ¼ 0.004), and was associated with a high risk of mortality (P ¼ 0.039). Sepsis in autologous HSCT patients and cyclosporine toxicity in allogeneic HSCT patients were associated with renal dysfunction. We conclude that autologous and allogeneic HSCT differ in the likelihood and causes of renal dysfunction.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2019
P atients with chronic kidney disease (CKD) have an increased risk of cardiovascular morbidity an... more P atients with chronic kidney disease (CKD) have an increased risk of cardiovascular morbidity and mortality. [1,2] Traditional risk factors, such as diabetes mellitus, hypertension, and dyslipidemia are more common in patients with CKD than in the general population. [3-5] Non-traditional risk factors, such as malnutrition, inflammation, oxidative stress, hyperphosphatemia, anemia, and volume overload are common, and are associated with increased cardiovascular risk in CKD patients. [6] Moreover, this risk increases significantly as the patients approach end-stage renal disease (ESRD). [7] As a result, cardiovascular problems are a major cause of death in patients undergoing dialysis.
Turkish Journal of Nephrology (Turk J Nephrol) is a doubleblind peer-reviewed, open access, an in... more Turkish Journal of Nephrology (Turk J Nephrol) is a doubleblind peer-reviewed, open access, an international online-only publication of the Turkish Society of Nephrology. The journal is a quarterly publication, published in January, April, July and October. The publication language of the journal is English. Turkish Journal of Nephrology aims to contribute to the literature by publishing manuscripts at the highest scientific level in the fields of nephrology, dialysis and transplantation. The journal publishes original articles, rare case reports, reviews, and letters to the editor that are prepared in accordance with the ethical guidelines. The scope of the journal includes but not limited to; remarkable clinical and experimental investigations conducted in all fields of nephrology. The target audience of the journal includes specialists and professionals working and interested in all disciplines of nephrology and kidney care.
Journal of the American Society of Nephrology : JASN, Jan 25, 2018
Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardi... more Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardiovascular and all-cause mortality in the general population, but the benefits for patients on hemodialysis are uncertain. Mediterranean and DASH diet scores were derived from the GALEN Food Frequency Questionnaire within the DIET-HD Study, a multinational cohort study of 9757 adults on hemodialysis. We conducted adjusted Cox regression analyses clustered by country to evaluate the association between diet score tertiles and all-cause and cardiovascular mortality (the lowest tertile was the reference category). During the median 2.7-year follow-up, 2087 deaths (829 cardiovascular deaths) occurred. The adjusted hazard ratios (95% confidence intervals) for the middle and highest Mediterranean diet score tertiles were 1.20 (1.01 to 1.41) and 1.14 (0.90 to 1.43), respectively, for cardiovascular mortality and 1.10 (0.99 to 1.22) and 1.01 (0.88 to 1.17), respectively, for all-cause mortality. ...
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Papers by Tevfik Ecder