Publications by authors named "Dede Sit"

34 Publications

The first kidney transplantation after recipient and living donor recovered from COVID-19.

North Clin Istanb 2021 17;8(2):187-189. Epub 2021 Feb 17.

Department of Nephrology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey.

SARS-CoV-2 is still a major threat to the world. In this pandemic, transplantation activities have largely been affected worldwide. We are still facing with this pandemic; however, after regulations, we have started our transplantation activities. We report the first kidney transplantation whose recipient and living donor recovered from COVID-19. A 31-year-old male with renal failure was admitted for transplantation with an ABO-compatible relative. The recipient and the donor were tested for COVID-19 before transplantation, and they were both positive with a polymerase chain reaction. The recipient had minor symptoms and received therapy; the living donor also received therapy. Thirty days after recovery, surgery was performed successfully. The recipient was discharged with mycophenolate mofetil (MMF), tacrolimus, and steroid 15 days after surgery. In the follow-up, they were both negative for COVID-19 45 days after surgery. Although there is missing literature regarding safety concerns and short-term follow-up, living-donor transplantation may be considered for patients, who recovered from COVID-19, after careful selection with paying attention to precautions.
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http://dx.doi.org/10.14744/nci.2021.70457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039110PMC
February 2021

A case of dasatinib-induced focal segmental glomerulosclerosis in a patient with Philadelphia chromosome positive chronic myeloid leukemia.

Nephrol Ther 2021 Feb 8;17(1):53-56. Epub 2021 Jan 8.

Health Sciences University, Umraniye training and research hospital clinic of Internal Medicine, Istanbul, Turkey.

Focal segmental glomerulosclerosis is a common glomerular histological lesion, which is usually characterised by non-nephrotic range proteinuria or nephrotic syndrome. It may be idiopathic or occurs secondarily to drugs, diabetes, obesity or HIV nephropathy and other infections. Dasatinib, a tyrosine kinase inhibitor that has been used for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia, has a few renal adverse effects. Exceptional cases with non-nephrotic range proteinuria have been reported in relation with dasatinib. In this case, we report a patient with symptoms of nephrotic syndrome and nephrotic range proteinuria, who was diagnosed as focal segmental glomerulosclerosis by kidney biopsy after treated with dasatinib.
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http://dx.doi.org/10.1016/j.nephro.2020.09.007DOI Listing
February 2021

Therapeutic effectiveness of rectally administered fish oil and mesalazine in trinitrobenzenesulfonic acid-induced colitis.

Biomed Pharmacother 2019 Oct 24;118:109247. Epub 2019 Jul 24.

Departments of Internal Medicine, Bağcılar Training and Research Hospital, Istanbul, Turkey.

Aim: Fish oil (FO) and mesalazine have well-known anti-inflammatory and antioxidant effects; on the other hand, information related to combined intrarectal administration of FO and mesalazine is limited. The present study was conducted to make comparison on therapeutic effectiveness of rectally administered FO and mesalazine in rats with trinitrobenzenesulfonic acid (TNBS)-induced colitis.

Methods: Wistar rats were randomly assigned to 5 groups as (1) Control, (2) Colitis, (3) Colitis + Mesalazine (Colitis + M), (4) Colitis + Fish Oil (Colitis + F), and (5) Colitis + Mesalazine + Fish Oil (Colitis + M + F). Intrarectally administered TNBS induced colitis. At the end of the trial, the rats' macroscopic and histopathologic lesions were rated and tumour necrosis factor (TNF)-α, Interleukin 6 (IL6), glutathione reductase (GR), glutathione peroxidase (GP), myeloperoxidase (MPO), malondialdehyde (MDA), Superoxide dismutase (SOD), Total nitrate and nitrite, and catalase (CAT) in serum and tissue were detected.

Results: As a result of macroscopic and microscopic examination, although separate administrations of FO and mesalazine partly decreased the damage, their combined administration decreased the damage scores significantly (p < 0.01). It was observed that separate and combined administrations of FO and mesalazine decreased the increase in the serum and tissue TNF-α and IL-6 levels caused by colitis (p < 0.05). It was observed that the serum MPO, serum GR, tissue SOD, tissue nitrite/nitrate values of both Colitis + M and Colitis + F groups were close to the control in terms of all the parameter values in Colitis + M + F group (p > 0.05). Also based on the histological results, the inflammation damage in the tissue caused by colitis in the Colitis + M + F group recovered significantly.

Conclusions: We found that microscopic and macroscopic damage, serum IL-6 level decreased and increased serum and tissue GP and tissue GR values in Colitis + M + F group compared to Colitis + M and Colitis + F groups. Combined intrarectal administration of FO and mesalazine may bring a new insight concerning the treatment of ulcerative colitis.
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http://dx.doi.org/10.1016/j.biopha.2019.109247DOI Listing
October 2019

Is FGF23 effective on insulin resistance in individuals with metabolic syndrome?

Horm Mol Biol Clin Investig 2018 Jul 12;35(2). Epub 2018 Jul 12.

University of Health Science, Bagcilar Training and Research Hospital, Department of Internal Medicine, Bagcilar, Istanbul, Turkey.

Purpose Metabolic syndrome (MetS) is a polymetabolic syndrome has high morbidity and mortality rates. Insulin resistance (IR) plays a key role in the increasing frequency of this situation and has been cited as being an important etiologic factor in MetS. In this study, the relationship between IR and fibroblast growth factor-23 (FGF23), was investigated in a population with MetS. Materials and methods Forty patients with diagnosis of MetS and 40 healthy volunteers with an equal number of males and females were included in the study and classified as patient group and control group. Blood samples were obtained after 12-h fasting period to study FGF23 and other parameters. MetS, defined according to the International Diabetes Federation (IDF) guidelines, FGF23 was studied by Enzyme-Linked ImmunoSorbent Assay (ELISA) method and IR was calculated using the homeostatic model assessment-insulin resistance (HOMA-IR) formula. Results There was a statistically significant difference in HOMA-IR between the patient and control group as expected, while levels of FGF23 were similar. According to gender, levels of FGF23 was statistically significantly higher in male patients compared with controls (p = 0.037). A relationship was not detected between HOMA-IR and FGF23 in the correlation analysis. Conclusion Although there are many studies suggesting the correlation between FGF23 and IR in different populations, we did not find any statistically significant relationship between IR and FGF23 levels in MetS in this study.
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http://dx.doi.org/10.1515/hmbci-2018-0018DOI Listing
July 2018

Burnout Syndrome Among Hemodialysis and Peritoneal Dialysis Nurses.

Iran J Kidney Dis 2016 Nov;10(6):395-404

Nephrology Department, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.

Introduction: Burnout, a syndrome with 3 dimensions of emotional exhaustion, depersonalization, and reduction of personal accomplishment, is very common among hemodialysis nurses, while data are scarce regarding the prevalence of burnout syndrome (BS) among peritoneal dialysis (PD) nurses. This study aimed to assess and compare demographic and professional characteristics and burnout levels in hemodialysis and PD nurses, and to investigate factors that increase the level of burnout in dialysis nurses.

Materials And Methods: A total of 171 nurses from 44 dialysis centers in Turkey were included in a cross-sectional survey study. Data were collected using a questionnaire defining the social and demographic characteristics and working conditions of the nurses as well as the Maslach Burnout Inventory for assessment of burnout level.

Results: There was no significant difference in the level of burnout between the hemodialysis and PD nurses groups. Emotional exhaustion and depersonalization scores were higher among the shift workers, nurses who had problems in interactions with the other team members, and those who wanted to leave the unit, as well as the nurses who would not attend training programs. In addition, male sex, younger age, limited working experience, more than 50 hours of working per week, and working in dialysis not by choice were associated with higher depersonalization scores. Personal accomplishment score was lower among the younger nurses who had problems in their interactions with the doctors, who would not regularly attend training programs, and who felt being medically inadequate.

Conclusions: Improving working conditions and relations among colleagues, and also providing further dialysis education are necessary for minimizing burnout syndrome. Burnout reduction programs should mainly focus on younger professionals.
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November 2016

Response to: Comment on "The Effects of Hemodialysis on Tear Osmolarity".

J Ophthalmol 2016 23;2016:1925683. Epub 2016 Aug 23.

Bagcilar Training and Research Hospital, Nephrology Department, 34200 Istanbul, Turkey.

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http://dx.doi.org/10.1155/2016/1925683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011517PMC
September 2016

The Effects of Hemodialysis on Tear Osmolarity.

J Ophthalmol 2015 10;2015:170361. Epub 2015 Nov 10.

Nephrology Department, Bagcilar Training and Research Hospital, 34200 Istanbul, Turkey.

Aim. To determine the effects of hemodialysis (HD) on tear osmolarity and to define the blood biochemical tests correlating with tear osmolarity among patients with end stage renal disease (ESRD). Material-Method. Tear osmolarity of ESRD patients before and after the hemodialysis program was determined as well as the blood biochemical data including glucose, sodium, potassium, calcium, urea, and creatinine levels. Results. Totally 43 eyes of 43 patients (20 females and 23 males) with a mean age of 53.98 ± 18.06 years were included in the study. Tear osmolarity of patients was statistically significantly decreased after hemodialysis (314.06 ± 17.77 versus 301.88 ± 15.22 mOsm/L, p = 0.0001). In correlation analysis, pre-HD tear osmolarity was negatively correlated with pre-HD blood creatinine level (r = -0.366,  p = 0.016). Post-HD tear osmolarity was statistically significantly correlated with the post-HD glucose levels (r = 0.305  p = 0.047). Tear osmolarity alteration by HD was negatively correlated with creatinine alteration, body weight alteration, and ultrafiltration (r = -0.426,  p = 0.004; r = -0.365,  p = 0.016; and r = -0.320, p = 0.036, resp.). There was no correlation between tear osmolarity and Kt/V and URR values. Conclusion. HD effectively decreases tear osmolarity to normal values and corrects the volume and composition of the ocular fluid transiently. Tear osmolarity alteration induced by HD is correlated with body weight changes, creatinine alterations, and ultrafiltration.
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http://dx.doi.org/10.1155/2015/170361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657405PMC
December 2015

Relation of Complementary-Alternative Medicine use with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage.

Nephrology (Carlton) 2015 Oct;20(10):671-678

Division of Nephrology, Department of Internal Medicine, Bagcilar Education and Research Hospital, Istanbul, Turkey.

Aim: Complementary and alternative medicine is a broad field of health including all health care practices and methods, and their accompanying theories and beliefs. In the present study, we aimed to examine the frequency of complementary-alternative medicine use, and its relation with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage.

Methods: A total of 1053 predialysis patients; 518 female and 535 male, that were followed up with chronic kidney disease for at least 3 months were enrolled into the study. Demographic features, biochemical parameters and findings of physical examination were recorded. Their compliance to diet, and knowledge about disease were questioned. Beck depression inventory and questionnaire regarding complementary-alternative medicine use were performed.

Results: The overall frequency of complementary-alternative medicine use was 40.3% . Total ratio of herbal products was 46%. Complementary-alternative medicine use was significantly more frequent in female or single patients, and patients that informed about chronic kidney disease or under strict diet (P = 0.007, P = 0.016, P = 0.02, P = 0.016, respectively). When glomerular filtration rate of participants were considered, complementary-alternative medicine use was similar in different stages of kidney disease. Depression was observed in 41.9% of patients and significantly frequent in patients with alternative method use (P = 0.002). Depression score was higher as creatinine increases and glomerular filtration rate decreases (P = 0.002; r = 0.093).

Conclusion: We determined that complementary-alternative medicine use gradually increases at predialysis stage as glomerular filtration rate decreases and there is a strict relation between complementary-alternative medicine use and depression or female gender. Disorder related stressors may lead to seeking of alternative methods.
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http://dx.doi.org/10.1111/nep.12503DOI Listing
October 2015

The relation of mean platelet volume with microalbuminuria and glomerular filtration rate in obese individuals without other metabolic risk factors: the role of platelets on renal functions.

Clin Nephrol 2015 Jun;83(6):322-9

Introduction: Mean platelet volume (MPV) is an indirect indicator of platelet activity that plays a major role in the pathogenesis of endothelial injury. Obese individuals have higher microalbuminuria which is the initial step of renal endothelial injury. We aimed to analyze the relation of microalbuminuria and MPV in obese individuals without metabolic risk factors.

Methods: A total of 290 obese individuals (body mass index (BMI)>30 kg/m2) without an accompanying chronic disorder, and 204 nonobese healthy subjects were enrolled into the study. All participants underwent physical examination. Biochemical, hemogram, and hormonal parameters along with urine albumin analysis were performed. Glomerular filtration rate (GFR) was measured by Cockcroft-Gault (GFRC&G), modification of diet in renal disease (MDRD). The BMI was calculated as weight/height2 (kg/m2). Logistic regression analysis was used to analyze relation of variables.

Results: The patient group consisted of 171 (59%) female (mean age: 37.15±8.05 years) and 119 (41%) male (mean age 38.98±10.68 years) obese individuals. 130 (63.7%) age matched female (mean age 36.18±8.26 years) and 74 (36.3%) age matched male (mean age 36.49±10.25 years) controls were assigned to the control group. There was a significant difference between groups with regard to BMI, spot microalbuminuria, spot urine microalbuminuria/creatinine ratio but not with to MPV and spot urine creatinine (p: 0.01, 0.004, 0.002; respectively). GFR measured by MDRD and Cockcroft-Gault formula were significantly higher in the obese group (p<0.001 for both). Correlation analysis revealed a significant correlation between BMI and spot urine microalbuminuria, spot urine microalbuminuria/creatinine ratio, GFR (Cockcroft-Gault Formula), Homeostasis Model Assessment of Insulin resistance (HOMA-IR), insulin, C-peptide, diastolic blood pressure, glucose, uric acid, total cholesterol, low density lipoprotein (LDL)-cholesterol, c-reactive protein (CRP), thyroid stimulating hormone (TSH), leukocyte count, platelet count. MPV was inversely and significantly correlated with spot urine creatinine, systolic blood pressure, triglyceride, C-peptide, and platelet count. Mean urea, creatinine, uric acid, triglyceride, total cholesterol, LDL-cholesterol, insulin, C-peptide, HOMA-IR were significantly higher in obese male individuals while obese female individuals had higher levels of mean high density lipoprotein (HDL), CRP, TSH, platelet count, spot urine microalbumin/creatinine rate, and GFR measured by MDRD.

Conclusions: Obese individuals have higher microalbuminuria and nonsignificantly elevated MPV, however, urine albumin loss is independent of MPV.
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http://dx.doi.org/10.5414/CN108534DOI Listing
June 2015

Is hemodialysis a reason for unresponsiveness to hepatitis B vaccine? Hepatitis B virus and dialysis therapy.

World J Hepatol 2015 Apr;7(5):761-8

Dede Sit, Bennur Esen, Ahmet Engin Atay, Hasan Kayabaşı, Department of Internal Medicine and Nephrology, Bagcilar Education and Research Hospital, Istanbul 34200, Turkey.

Impaired renal function is associated with a high risk of chronicity of hepatitis B virus (HBV) infection. Patients on hemodialysis (HD) or peritoneal dialysis are at an increased risk of viral transmission due to frequent necessity of blood product transfer as well as use of contaminated dialysate or dialysis materials. Additionally, health professionals may cause viral spread via contaminated hands and carelessness against hygiene rules. The frequency of chronic HBV infection may be as high as 80% in patients on renal replacement therapies. This is because HBV vaccination is essential to eliminate chronic HBV infection. However, response rates of HD patients to HBV vaccination vary between 10%-50%. Dialysis adequacy and early vaccination before the onset of dialysis therapy seem to be major determinants of high seroconversion rates. Older age, male gender, duration of dialysis therapy and nutritional status are other well-known factors associated with seroconversion rate. There are controversial reports regarding the role of the presence of diabetes mellitus, HCV positivity, erythropoietin resistance, hyperparathyroidism, and vitamin D inadequacy. The role of genetic alteration in the functions or production of cytokines still needs to be elucidated.
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http://dx.doi.org/10.4254/wjh.v7.i5.761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404381PMC
April 2015

Evaluation of relationship between sexual functions, depression and quality of life in patients with chronic kidney disease at predialysis stage.

Ren Fail 2015 Mar 18;37(2):262-7. Epub 2014 Dec 18.

Division of Nephrology, Department of Internal Medicine, Bagcilar Research and Training Center , Istanbul , Turkey .

Aim: The relation of chronic kidney disease (CKD) with metabolic, psychiatric and endocrinologic disorder is well-known. Depressive mood and sexual dysfunction are frequently observed as renal functions deteriorate. We aimed to analyze the relationship of sexual dysfunction, depressive mood and life quality in patients with CKD at predialysis stage.

Patients And Methods: Fifty-three patients; 27 female and 26 male with CKD who had estimated glomerular filtration rate (eGFR) between 15 and 90 mL/min and followed up in the Nephrology Department, Bursa Sevket Yılmaz Education and Research Hospital, were enrolled. Age- and sex-matched 20 female and 20 male healthy control subjects were assigned to the control group. Detailed medical and sexual history was obtained by using Female Sexual Function Index (FSFI), Erectile Function International Evaluation Form (IEFF), Short form (SF) 36 Form and Beck Depression Questionnaire (BDI). Biochemical and hormonal parameters including urea, creatinine, uric acid, sedimentation rate, c-reactive protein, total testosterone, DHEA-S, FSH, LH, TSH, estradiol and prolactin were analyzed.

Findings: Depression was observed in 12 male (46%) and 14 female (51%) patients. The frequency of depression among male patients and control subjects was similar, however, significantly higher in female patients than female controls (p=0.036). Physical function score, physical role score and pain score in SF 36 of entire patients were significantly lower than controls (p=0.0001, 0.0001, 0.001, respectively). The frequency of depression was similar between patients and controls (p>0.05). When SF 36 tests of male and female patients were compared, general health status, vitality and mental health status were significantly better in male patients (p=0.005, 0.016, 0.035, respectively). SF 36 scores of female patients were significantly lower than female controls (p=0.0001). The frequency of erectile dysfunction (ED) was similar between male patients (84%) and controls (75%) (p=0.62). On the other hand, sexual dysfunction was significantly higher in female patients when compared to female controls (92% vs. 30%; p=0.0001).

Conclusion: We showed that sexual dysfunction and depression are more frequent among female patients with CKD at predialysis stage; however, it does not have significant impact on life quality. When life quality of female and male patients was compared, general health status, vitality and mental health status of female patients were poorer. We failed to demonstrate a relationship between sexual dysfunction and sex hormone level.
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http://dx.doi.org/10.3109/0886022X.2014.990348DOI Listing
March 2015

The association of endothelial nitric oxide synthase gene G894T polymorphism and serum nitric oxide concentration with microalbuminuria in patients with gestational diabetes.

Clin Nephrol 2014 Feb;81(2):105-11

Department of Internal Medicine, Bagcılar Education and Research Hospital, Istanbul, Department of Medical Biology, Medical School of Harran University, Sanlıurfa, Department of Physiology, Medical School of Mustafa Kemal University, Hatay, Department of Obstetrics and Gynecology, Suleymaniye Education and Research Hospital, Istanbul, Department of Obstetrics and Gynecology, Medical Faculty of Harran University, Sanlıurfa, and Department of Medical Biology and Genetics, Medical Faculty of Dicle University, Diyarbakir, Turkey.

Aim: Gestational diabetes mellitus (GDM) is a glucose intolerant condition that affects 14% of all pregnancies. Diabetes mellitus (DM) occurs in 30 - 70% of patients with GDM after delivery. DM and GDM are associated with structural and functional deterioration of the renovascular system. Our aim is to investigate the association Glu- 298Asp polymorphism of the endothelial nitric oxide synthase (eNOS) gene with serum nitric oxide levels and microalbuminuria in patients with GDM and healthy pregnancies.

Material And Methods: Serum nitric oxide (NO) levels, urinary excretion of albumin and Glu298Asp polymorphism of the eNOS gene were analyzed in 68 patients with GDM and 73 healthy controls. High performance liquid chromatography (HPLC-Griess) method was used to analyze serum NO levels. Microalbuminuria was evaluated by rate nephelometry method. The Glu298Asp polymorphism of the eNOS gene was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).

Results: Nitric oxide, glucose, creatinine, and microalbuminuria were significantly different between the patients and the control subjects (p = 0.001, p = 0.001, p = 0.002, and p = 0.005, respectively). There was a significant difference between groups in terms of the ratio of GG/GT+TT of eNOS gene Glu- 298Asp (p = 0.02). The patients with GT+TT genotype had significantly higher microalbuminuria levels and lower NO concentrations (22.16 vs. 9.51, p = 0.005, and 10.56 vs. 12.73, p = 0.021, respectively). The presence of T allele of eNOS gene is an independent predictor of microalbuminuria (OR: 2.346, 95% confidence interval: 1.247 - 5.238, p = 0.02) as well as serum glucose and NO concentration.

Conclusion: The G894T polymorphism of eNOS gene and decreased NO concentration seem to be independent predictors of increased urinary excretion of albumin in patients with GDM. Determining the frequency of eNOS gene G894T polymorphism may help to identify pregnancies at increased risk of microalbuminuria.
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http://dx.doi.org/10.5414/cn108138DOI Listing
February 2014

Evaluation of the serum cystatin C values in prediction of indications for hemodialysis in patients with chronic renal failure.

Int Urol Nephrol 2014 Jan 8;46(1):57-62. Epub 2013 Jun 8.

Clinic of Internal Medicine/Nephrology, Bagcilar Training and Research Hospital, 34200, Bagcılar, Istanbul, Turkey,

Background: Indications of dialysis treatment for patients with end-stage renal disease depend on various clinical and laboratory parameters. In this study, we aimed to determine whether standardized serum cystatin C (SCC) equation may be an applicability of marker for dialysis initiation and its relationship to other clearance values among patients with advanced chronic kidney disease.

Materials And Methods: A total of 84 patients (45 males, 39 females) aged 19-89 were evaluated in this study. Hemodialysis was indicated according to clinical and laboratory findings, and estimated glomerular filtration rate (eGFR) was according to four different formulas [MDRD, EpiCKD, Cockcroft Gault formula (CGF) and SCC equation].

Results: eGFR values of patients in the study were 7.23 ± 3.26, 7.86 ± 3.78, 15.09 ± 10.88 and 11.31 ± 4.54 according to MDRD, EpiCKD, SCC equation and CGF, respectively. There was a positive correlation between MDRD, EpiCKD and CGF, and between EpiCKD and CGF (p < 0.01). Also, statistically significant correlation was found between SCC equation and CGF (p < 0.05).

Conclusion: SCC equation was not seemed to be an appropriate marker for starting dialysis in patients with advanced CKD.
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http://dx.doi.org/10.1007/s11255-013-0481-4DOI Listing
January 2014

Do hemodialysis adequacy data reflect reality?

Artif Organs 2013 Feb 9;37(2):189-95. Epub 2012 Oct 9.

Department of Nephrology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

Hemodialysis (HD) adequacy requires monitoring in line with standards and at appropriate intervals. However, the use of inappropriate or incorrectly applied techniques in the determination of HD adequacy can lead to highly unfortunate results. This study was intended to identify the path to a solution by determining how far HD adequacy in HD centers in our region reflects reality. Three hundred and thirty HD patients from eight centers were included. On the first visit, predialysis and postdialysis blood collection with the centers' own methods being used were observed and errors were recorded. Kt/V1 was calculated from pre- and postdialysis blood specimens taken by the units themselves. On the second visit, one session later, pre- and postdialysis blood samples were collected in line with guidelines by ourselves, the authors, and Kt/V2 was calculated from these samples. The eight units' total Kt/V2 value was significantly lower compared with Kt/V1 (<0.0001). The level of patients in all centers with Kt/V1 <1.2 was 13.5%, and that of patients with Kt/V2 <1.2 was 22.1%. No center, apart from one unit, managed to complete the collection of blood specimens as recommended by the guidelines. With one exception, blood collection for HD adequacy was not performed using proper technique in any center. This simple but easily overlooked situation, HD being regarded as adequate though in fact it is not, may lead to patients not being treated effectively and accurately and to a rise in mortality and morbidity in the long term.
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http://dx.doi.org/10.1111/j.1525-1594.2012.01537.xDOI Listing
February 2013

Parameters of oxidative stress and echocardiographic indexes in patients on dialysis therapy.

Ren Fail 2010 Jan;32(3):328-34

Department of Nephrology, Faculty of Medicine, Dicle University, and Department of Internal Medicine, Silvan State Hospital, Diyarbakir, Turkey.

Aim: Quantity of oxidative stress (OS) is enhanced in every stage of chronic renal failure (CRF). OS and its effects on echocardiographic indexes in patients on hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) were evaluated.

Materials And Methods: Thirty-nine patients on CAPD, 32 patients on HD, and 30 healthy individuals with similar demographic features were included. Patients with diabetes mellitus and chronic inflammatory diseases were excluded. Blood samples were collected to examine hematological and biochemical parameters and levels of malonyldialdehyde (MDA), glutathione peroxidase (GSH-px), and superoxide dismutase (SOD) after a 12-hour fasting period in the middle of dialysis week. OS parameters were compared with ejection fraction (EF), interventricular septum diameter (IVSd), left ventricular posterior wall diameter (LVPWd), and left atrium diameter (LAd) determined in M-mod echocardiographic examination.

Results: No significant difference was observed between MDA and GSH-px levels of patients and control group; however, SOD levels of patients group were significantly lower (p<0.0001). SOD levels of patients on HD were lower than that of patients on CAPD (p=0.039). Negative correlation was detected between MDA and EF (r=-0.380, p=0.001); SOD has negative correlation with systolic blood pressure (r=-0.265, p=0.011), diastolic blood pressure (r=-0.230, p=0.028), phosphorus (r=-0.327, p=0.001), intact parathyroid hormone (iPTH) (r=-0.259, p=0.013), C-reactive protein (CRP) (r=-0.235, p=0.024), fibrinogen (r=-0.342, p=0.001), and total cholesterol (r=-0.249, p=0.017); and positive correlation with hemoglobin (r=0.414, p<0.001) and albumin (r=0.367, p<0.001). MDA was independently related with age (beta=-0.258, p=0.035), male gender (beta=-0.312, p=0.004), and EF (beta=-0.461, p<0.001). No correlation was determined between antioxidants and cardiac indexes.

Conclusion: SOD levels decreased significantly especially in patients on HD, and it was observed that lower levels of SOD would lead to OS in patients on HD and CAPD when compared to healthy individuals; MDA levels were independently influenced from EF.
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http://dx.doi.org/10.3109/08860221003606299DOI Listing
January 2010

An atypical localisation of tuberculosis infection in patients undergoing haemodialysis: a case report.

J Ren Care 2010 Mar;36(1):49-53

Assistant Professor, Department of Nephrology, Dicle University Medical Faculty, Diyarbakir, Turkey.

Spinal tuberculosis (TB) is a rare skeletal system localisation of TB in haemodialysis patients. In this paper, a case of Pott's disease with a psoas muscle abscess is reported. The patient had been on the dialysis programme for five years and was complaining of back pain, weight loss and weakness, which were investigated. A thoracolumbar magnetic resonance imaging showed multiple paravertebral abscesses invading the psoas muscle. TB diagnosis was made by microbiological analysis of specimen, which was obtained by fine needle aspiration under computerised tomography guidance.
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http://dx.doi.org/10.1111/j.1755-6686.2010.00137.xDOI Listing
March 2010

The prevalence and the characteristics of tuberculosis patients undergoing chronic dialysis treatment: experience of a dialysis center in southeast Turkey.

Ren Fail 2008 ;30(5):513-9

Clinics of Internal Medicine, Patnos State Hospital, Agri, Turkey.

Tuberculosis 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.
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http://dx.doi.org/10.1080/08860220802064721DOI Listing
October 2008

The association of demographic, clinical, and thrombophilic factors with the failure of arteriovenous fistula among hemodialysis patients.

Saudi Med J 2008 Jun;29(6):888-91

Department of Nephrology, Faculty of Medicine, Dicle University, 21280 Diyarbakir, Turkey.

Objective: To evaluate the association of demographic, clinical, and thrombophilic factors with the failure of arteriovenous fistula (AVF) among patients undergoing chronic hemodialysis.

Methods: Sixty-two (33 males, 29 females) patients undergoing chronic hemodialysis were included in the study in March 2005 at the Hemodialysis Center of the Medicine Faculty at Dicle University, Diyarbakir, Turkey. The patients were divided into 2 groups according to whether they needed (group II) or do not need (group I) more than one fistula placed.

Results: Female gender, longer vintage of hemodialysis, frequent intradialytic hypotensive episodes, elevated levels of phosporous, calcium-phosporous product (CaP), and intact parathormone (iPTH), and left ventricle hypertrophy were more likely in group 2.

Conclusion: Arteriovenous fistula loss, and recurrent requirement of AVF constitution increase with hemodialysis vintage. We believe that female gender, frequent intradialytic hypotensive episodes, elevated serum levels of phosporous, iPTH, and high CaP products are risk factors related to the failure of AVF among hemodialysis patients.
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June 2008

The effect of venlafaxine HCl on painful peripheral diabetic neuropathy in patients with type 2 diabetes mellitus.

J Diabetes Complications 2008 Jul-Aug;22(4):241-5. Epub 2008 Apr 16.

Department of Nephrology, Dicle University Medical Faculty, Diyarbakir, Turkey.

Objective: The objective of this study was to evaluate the efficacy of venlafaxine HCl in the symptomatic treatment of painful peripheral diabetic neuropathy (PPDN) among patients with type 2 diabetes mellitus (DM).

Design: This study was designed as a prospective, randomized, and controlled trial.

Setting: This study was conducted at the Dicle University Medical Faculty (Diyarbakir, Turkey).

Patients: Sixty type 2 DM outpatients (47 females and 13 males) with PPDN who had a minimum visual analog scale (VAS) score of 40 mm were enrolled in this study.

Interventions: Patients randomized to the treatment group (n=30) received venlafaxine HCl, whereas those randomized to the control group (n=30) received a combination of vitamins B(1)and B(6) tablets.

Measures: Severity of pain was measured by VAS, Short-Form McGill Pain Questionnaire, and numerical analog scale scores at admission and at the second, fourth, and eighth weeks of the study. Polyneuropathy was supported by electromyelography.

Outcome: In the treatment group, severity of pain was measured as 70.0+/-13.0 in the VAS, as 24.9+/-6.2 in the Short-Form McGill Pain Questionnaire, and as 7.2+/-1.1 in the numerical analog scale. In the control group, it was measured as 73.0+/-8.0 in the VAS, as 26.8+/-6.2 in the Short-Form McGill Pain Questionnaire, and as 7.4+/-0.8 in the numerical analog scale (P>.05).

Results: The most common form of PPDN was distal symmetrical sensorimotor polyneuropathy in both groups (46.8% vs. 50.0%). At the end of the study, there was a significant difference in severity of pain between the groups. In the treatment group, scores were 8.5+/-5.2 and 3.1+/-1.6 in the Short-Form McGill Pain Questionnaire and numerical analog scale, respectively; in the control group, these were 20.5+/-7.0 and 5.5+/-1.6, respectively (P<.001).

Conclusions: Venlafaxine HCl is a safe and well-tolerable analgesic drug in the symptomatic treatment of PPDN; however, it has minimal adverse effects. It showed its efficacy markedly in the second week of therapy.
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http://dx.doi.org/10.1016/j.jdiacomp.2007.03.010DOI Listing
August 2008

The evaluation incidence and risk factors of mortality among patients with end stage renal disease in southeast Turkey.

Ren Fail 2008 ;30(1):37-44

Department of Nephrology, Medicine Faculty in Dicle University, Diyarbakir, Turkey.

Aim: End stage renal disease (ESRD) presents with higher morbidity and mortality with respect to the general population. In recent study, the causes of mortality and associated risk factors in ESRD have been evaluated.

Materials And Methods: In this study, 1538 patients diagnosed with ESRD in 10-year period were evaluated retrospectively. The patients were divided as dead (group 1) and alive (group 2). The patients' demographic features, causes of death, comorbidity at hospitalization, hematological and biochemical analyses, creatinine clearance at the beginning of hospitalization, daily urine volume, blood gas results, CRP value as inflammatory marker, ejection fraction, interventricular septum diameter, left ventricle posterior wall end-diastolic diameter, and left atrium diameter determined with echocardiography were recorded.

Results: Mortality ratio of ESRD patients in a 10-year period was 14.1%. While the general mean age of all patients was 54.7 +/- 16.6 and male/female ratio was 781/757, these ratios were 66.3 +/- 21.8 and 114/103 in Group 1 and 52.8 +/- 21.7 and 667/654 in Group 2. One or more comorbid pathologies were present in 82.9% of Group 1. The most common cause of mortality was cardiovascular diseases (CVD), and the most common cause of comorbidity was infections. Older age, anemia, absence of residual renal function, hypoalbuminemia, inflammation, impaired Ca and P metabolism, and left ventricular hypertrophy were significantly higher in Group 1 than in Group 2.

Conclusion: CVD are the most important preventable causes of morbidity and mortality in all stages of chronic kidney disease. Taking precaution against CVD and the associated complications will provide a positive contribution in reducing morbidity and mortality among ESRD patients.
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http://dx.doi.org/10.1080/08860220701741965DOI Listing
May 2008

Relationship between bone mineral density and biochemical markers of bone turnover in hemodialysis patients.

Adv Ther 2007 Sep-Oct;24(5):987-95

Department of Nephrology, Dicle University Medical Faculty, Diyarbakir, Turkey.

End-stage renal disease is closely associated with changes in bone and mineral metabolism. In recent times, osteoporosis has become important among hemodialysis (HD) patients. In this study, the investigators sought to evaluate the relationship between bone mineral density (BMD) and biochemical markers of bone turnover among HD patients. A total of 70 uremic patients on a maintenance HD program for at least 1 y were enrolled in the study. All patients were treated with conventional bicarbonated HD for 5 h through the use of low-flux hollow-fiber dialyzers. Bone densitometry was measured by dual energy x-ray absorptiometry in the lumbar spine (LS) and the femoral neck (FN). BMD was classified according to World Health Organization criteria on the basis of BMD T scores. Biochemical bone turnover markers such as calcium, phosphorus, ionized calcium, intact parathyroid hormone, alkaline phosphatase, plasma bicarbonate, blood pH, serum albumin, and hematocrit levels were measured before the HD session in the morning. Male patients (n=37; 52.9%; mean age, 46.2+/-17.0 y) were assigned to a single study group, and female patients (n=33; 47.1%; mean age, 44.0+/-13.1 y) to another. Mean duration of HD treatment was 33.7+/-28.5 mo in females and 33.0+/-26.0 mo in males. Among all patients, BMD T scores in the osteopenia/osteoporosis range were observed at the LS in 58 patients (82.8%) and at the FN in 45 patients (64.3%). According to BMD measurements in FN T score, 10% of patients (n=7) were osteoporotic, 54.3% (n=38), osteopenic, and 35.7% (n=25), normal. On the other hand, in LS T score, the results were 47.1% (n=33) osteoporotic, 35.7% (n=25), osteopenic, and 17.1% (n=12), normal. No statistically significant association was found in osteopenia/osteoporosis between sexes according to FN and LS T score (P=.542, P=.267, respectively). No significant relationship was noted between BMD and biochemical markers of bone turnover. A positive correlation was found between FN T scores of BMD and age (r=.413, P=.000). BMD T scores within the range of scores for osteopenia/osteoporosis were observed in 78.5% of patients at the LS and in 58.5% of patients at the FN. The investigators concluded that no correlation could be found between markers of bone turnover and bone mass measurements in both skeletal regions. LS T score results were worse than FN T score results. Elevated alkaline phosphastase levels combined with high intact parathyroid hormone levels are predictive of renal osteodystrophy but not of adynamic bone disease/osteoporosis.
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http://dx.doi.org/10.1007/BF02877703DOI Listing
January 2008

Evaluation of CA 72-4 as a new tumor marker in patients with gastric cancer.

Hepatogastroenterology 2007 Jun;54(76):1272-5

Department of Gastroenterology, Dicle University School of Medicine, Diyarbakir, Turkey.

Background/aims: The place of CA 72-4, a new tumor marker in the prognosis of stomach cancer were studied,

Methodology: Endoscopically and histologically diagnosed 47 gastric patients were studied. CEA, CA 19-9, CA 125, CA 15-3, CA 72-4 levels were measured.

Results: We determined that serum CA 72-4 level in the group with cancer was significantly elevated. In patients particularly having liver metastases, CA 72-4 level was found to be greater.

Conclusions: We are of the opinion that serum CA 72-4 level is a valuable parameter in the prognosis of stomach cancer.
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June 2007

Plasma cytokine levels in ulcerative colitis.

Hepatogastroenterology 2007 Jun;54(76):1130-3

Department of Gastroenterology, Dicle University School of Medicine, Diyarbakir, Turkey.

Background/aims: Some immunological factors are responsible in the pathogenesis of ulcerative colitis. There is a relationship between cytokines and ulcerative colitis.

Methodology: In this study 20 ulcerative colitis patients (mean age 36.2 years old, 9 women, 11 men) and 20 healthy control groups (mean age 27.2 years old, 11 women, 9 men) were involved in the study.

Results: We established that IL-2Rsp, IL-6, IL-8 and IL-10 levels were different at the patients and control groups (p < 0.005). TNF-alpha and IL-1 beta were similar at the both groups.

Conclusions: According to these results, IL-2Rsp, IL-6, 11-8 and IL-10 play an important role in the pathogenesis of ulcerative colitis. We consider that these cytokines are beneficial parameters in the diagnosis, treatment and prognosis of ulcerative colitis.
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June 2007

Prophylactic intranasal mupirocin ointment in the treatment of peritonitis in continuous ambulatory peritoneal dialysis patients.

Adv Ther 2007 Mar-Apr;24(2):387-93

Department of Nephrology, Dicle University Medical Faculty, Diyarbakir, Turkey.

This study was undertaken to evaluate the effectiveness of prophylactic intranasal mupirocin for peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). A total of 49 patients undergoing CAPD for at least 6 mo were followed for 1 year. A nasal smear was obtained from each patient at the beginning and end of the study. Intranasal mupirocin ointment was administered to the nares twice daily for 5 d every 4 wk in the mupirocin group. The frequency of Staphylococcus aureus nasal carriage was similar in both groups at the beginning, and S aureus was eradicated in 56.5% of patients in the mupirocin group; 29% of patients in the control group had negative nasal smear culture findings at the end of the study. Peritonitis episodes occurred at rates of 4.3% in the mupirocin group and 4.1% in the control group (P>.05). Prophylactic administration of intranasal mupirocin ointment was ineffective in reducing episodes of peritonitis.
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http://dx.doi.org/10.1007/BF02849908DOI Listing
July 2007

The evaluation of effects of demographic features, biochemical parameters, and cytokines on clinical outcomes in patients with acute renal failure.

Ren Fail 2007 ;29(4):503-8

Department of Internal Medicine, Medicine Faculty of Dicle University, Diyarbakir, Turkey.

Aim: To evaluate the effects of cytokines, biochemical parameters and demographic features on clinical outcomes of acute renal failure (ARF).

Patients And Methods: 59 patients with acute renal failure (28 men, 31 women) were enrolled to the study. Cytokines, biochemical parameters, and complete blood count were measured. Patients were divided into two groups: as survivors (group 1, n = 46) and nonsurvivors (group 2, n = 13).

Results: Mean age of patients were 52.3 +/- 17.9 years. 46 patients survived (77.9%) and 13 patients died (22.1%). There was a statistically significant relationship between IL-2R, IL-6, and TNF-alpha levels and mortality rates (p = 0.004, p = 0.016, p = 0.020, respectively) and between TC levels and mortality rates (p = 0.041). In multivariable logistic regression analysis, the effects of proinflammatory cytokines (IL-1beta, IL-2R, IL-6, TNFalpha, CRP, and ESR) on the clinical outcomes in ARF was observed to be statistically significant (r = 0.341, p = 0.005).

Conclusion: We realized that in totally demographic features (male gender, advanced age, poor nutritional status), biochemical parameters (TC, albumin, and hemoglobin) and cytokine levels (IL-2R, IL-6, TNF-alpha), CRP and ESR may be predictive factors for mortality in patients with ARF.
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http://dx.doi.org/10.1080/08860220701274991DOI Listing
August 2007

Myocardial infarction and venous thrombosis in a 42-year old woman with heterozygous methylenetetrahydrofolate reductase (MTHRF) gene mutation, hyperhomocysteinemia, and protein C deficiency.

Int J Cardiol 2007 May 13;117(3):e98-100. Epub 2007 Mar 13.

Objective: Hyperhomocysteinemia and protein C deficiency have synergistic effect on the onset of thrombotic disease.

Methods: We report a 42-year old woman with myocardial infarction and venous thrombosis in whom recognition of heterozygous MTHRF gene mutation, hyperhomocysteinemia, and protein C deficiency.

Results: The patient was treated successfully with coronary artery bypass graft surgery and systemic anticoagulation.

Conclusions: Our report emphasize that a combined hyperhomocysteinemia, and protein C deficiency may be a high risk factor for arterial and venous thromboembolic events in young adults. These patients might be candidates for indefinite anticoagulation.
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http://dx.doi.org/10.1016/j.ijcard.2006.11.204DOI Listing
May 2007

The prevalence of insulin resistance in nondiabetic nonobese patients with chronic kidney disease.

Adv Ther 2006 Nov-Dec;23(6):988-98

Department of Nephrology, Dicle University Medical Faculty, Diyarbakir, Turkey.

This study was undertaken to evaluate the prevalence of insulin resistance (IR) and associated factors in nondiabetic, nonobese patients with chronic kidney disease (CKD) who had not yet received dialysis therapy. A group of 89 consecutive patients (42 male, 47 female) who were hospitalized in the Nephrology Clinic at Dicle University, had recently been diagnosed with CKD, and had not yet been treated with dialysis were enrolled in the study, as was a control group of 30 healthy volunteers. Diabetic and obese patients were excluded. IR was determined by the homeostasis model assessment of IR (HOMA-IR) formula. Blood samples were taken after an overnight fasting period to establish serum glucose, insulin, C-peptide, albumin, lipid profile, hematocrit, bicarbonate, and intact parathormone (iPTH) levels. The mean age of patients was 48.7+/-19.7 y (men, 49.5+/-21.5 y; women, 48.1+/-18.0 y); other mean values were as follows: glucose, 98.4+/-20.6 mg/dL; insulin, 16.7+/-16.2 microU/mL; HOMA-IR, 5.46+/-1.14; hemoglobin (Hgb), 8.7+/-1.6 g/dL; calcium-phosphorus product (Ca x P), 52.2+/-16.2 mg2/dL2; iPTH, 377.7+/-258.1 pg/mL, and bicarbonate (HCO3), 16.6+/-5.3 mEq/L. HOMA-IR was significantly higher in patients with stage 4 CKD than in controls (P<.001); serum levels of urea, creatinine clearance (CrCl), C-reactive protein (CRP), albumin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), Hgb, HCO3, Ca x P, and iPTH were found to be associated with HOMA-IR when a comparison was made with the control group. According to correlation analyses of possible risk factors in patients with IR, positive correlations with age, body mass index, CRP, Ca x P product, and iPTH, and negative correlations with albumin, CrCl, Hgb, and HDL-C were found. A high percentage of IR was found, and this percentage increased as glomerular filtration rate decreased in patients with stage 4 CKD. In addition, a correlation was found between IR and parameters such as age, body mass index, CRP, Ca x P, iPTH, albumin, CrCl, Hgb, and HDL-C.
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http://dx.doi.org/10.1007/BF02850219DOI Listing
March 2007

Seroprevalence of hepatitis B and C viruses in patients with chronic kidney disease in the predialysis stage at a university hospital in Turkey.

Intervirology 2007 22;50(2):133-7. Epub 2006 Dec 22.

Department of Nephrology, Medical Faculty of Dicle University, Diyarbakir, Turkey.

Background: Hepatitis B (HBV) and C (HCV) viruses are the most common viruses that cause viral infections among the hemodialysis patients.

Objectives: To assess the prevalence of HBV and HCV in predialytic chronic kidney disease (CKD) patients.

Design: A cross-sectional study.

Subjects: 171 consecutive predialytic CKD patients.

Measurements: Third-generation micro-ELISA assay was used for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core (anti-HBc) and surface antibody (anti-HBs), secretory form of hepatitis B envelop antigen (HBeAg), antibody to secretory form of hepatitis B envelop antigen (anti-HBe), and ELISA for antibody to hepatitis C virus (anti-HCV).

Results: The main causes of CKD were 29.8% diabetic nephropathy, 19.9% chronic glomerulonephritis, 16.3% hypertensive nephrosclerosis, 14.0% unknown, 5.3% amyloidosis, 4.7% autosomal-dominant polycystic kidney disease, 4.1% chronic tubuluointerstitial nephritis, 3.5% malignancies, 1.7% benign prostatic hypertrophy, 0.6% Alport syndrome. The seroprevalence of hepatitis was: HBsAg 10.5%, anti-HBc 36.8%, anti-HBs 28.7%, HBeAg 5.3%, anti-HBe 32.7%, anti-HCV 7% and HBsAg+anti-HCV 0.6%.

Conclusions: The seroprevalence of HBsAg and anti-HCV among predialytic CKD patients was similar to our patients in hemodialysis program.
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http://dx.doi.org/10.1159/000098239DOI Listing
July 2007

[Retrospective evaluation of brucellosis cases inhabiting in Mus province].

Mikrobiyol Bul 2006 Jul;40(3):289-90

The aim of this study was to evaluate the brucellosis patients inhabiting in Mus province, in Eastern Anatolia of Turkey, retrospectively. The mean age of the patients (n: 87) was 38.1 +/- 12.4 years, and 45% of them were female. The transmission route was the consumption of unpasteurized fresh cheese (in 85%), and unboiled milk (in 45%). The most common symptoms were recorded as chills (89%), fever (87%), and arthralgia (81%). Splenomegaly (71%) and hepatomegaly (63%) were the predominant physical examination signs. Diagnosis was made based on the clinical features and positive Rose-Bengal test result (93%), however, blood cultures could not be performed due to insufficient laboratory equipment. In 92% of the patients at least one complication has been detected indicating delayed admission to the hospital, while the most common complications were sacroileitis (79%) and spondylitis (44%). Streptomycin+doxycyclin, streptomycin+doxycyclin+ ciprofloxacin, and streptomycin+doxycyclin+ rifampicin combination therapies were used in 62%, 24% and 14% of the patients, respectively, for six weeks, resulting with complete cure.
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July 2006

Periodontitis is an important and occult source of inflammation in hemodialysis patients.

Blood Purif 2006 1;24(4):400-4. Epub 2006 Jun 1.

Department of Nephrology, Medical Faculty, University of Dicle, Diyarbakir, Turkey.

Aim: To evaluate the association between C-reactive protein (CRP) levels and the periodontal status of hemodialysis (HD) patients.

Methods: 41 HD patients on rHuEPO therapy were enrolled in the study. Hematologic and biochemical parameters and CRP levels were recorded. The plaque index, gingival index, probing pocket depth and periodontal disease index were used to identify periodontal disease. The patients were divided into 2 groups: group 1 (n = 21), high CRP, and group 2 (n = 20), normal CRP.

Results: After periodontal therapy, while the mean CRP level and erythrocyte sedimentation rate declined from 30.46 to 10.36 (p = 0.001) and from 93.4 to 35.8 mg/l (p = 0.001), respectively, the hemoglobin level increased from 9.4 to 10.6 g/dl (p = 0.009) and hematocrit level from 28.2 to 32.0% (p = 0.008) in group 1.

Conclusion: Periodontitis is an important and occult source of chronic inflammation and increases the CRP levels in HD patients. Periodontitis can cause hyporesponsiveness to rHuEPO treatment and decrease the hemoglobin levels.
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http://dx.doi.org/10.1159/000093683DOI Listing
November 2006
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