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Turkyilmaz S, Toz H, Turkyilmaz G, Kuserli Y, Kavala AA. Triglyceride-glucose index for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents. Eur Rev Med Pharmacol Sci 2024; 28:1015-1026. [PMID: 38375706 DOI: 10.26355/eurrev_202402_35337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate the triglyceride-glucose index (TyG index) for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents. PATIENTS AND METHODS Subjects with iliac artery stenosis, who underwent an iliac stent intervention and were followed up for at least 2 years were included in the study. Subjects were grouped according to TyG index (Group A, TyG index ≤8.848; Group B 8.849 ≤TyG index ≤9.382 and Group C TyG index ≥9.383). The subject's baseline characteristics, blood parameters, claudication distance, Transatlantic Intersociety Consensus classification, target lesion localization, stent direction, number of stents that were applied, and stent type were noted. Pre- and 1st and 2nd-year post-procedure Rutherford statuses, ankle-brachial index, and stenosis degree were recorded. To calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), Group B and Group C were combined and compared with Group A. RESULTS In total, 255 subjects were evaluated (female, n=77-30.2%, male, n=178-69.8%). The mean age of the subjects was 66.00±10.00 years (range from 39 to 90 years). The pre-procedure Rutherford measurements were significantly different among the groups (p=0.001). The rates of mild claudication and resting pain in Group A were higher than those in Groups B and C. The rate of moderate claudication in Group C was higher than that in Groups A and B. The rate of severe claudication in Group B was higher than that in Groups A and C. One year after the procedure, there were more asymptomatic cases in Group A than in Groups B and C (p=0.001). The rate of mild claudication in Group C was lower than that in Groups A and B. The rate of moderate claudication in Group C was higher than that in Group A. The rate of severe claudication in Group C was higher than that in Groups A and B. Two years after the procedure, the Rutherford measurements and the rates of mild claudication in Groups A and B were higher than those in Group C. The rate of severe claudication in Group C was higher than that in Groups A and B (p=0.001). One year after the procedure, the computed tomography angiography (CTA) measurements and the rate of full patency in Group A were higher than that in Groups B and C. The rate of 0-50% stenosis in Group B was higher than that in Groups A and C. The rate of 50-70% stenosis in Group C was higher than that in Group A. Two years after the procedure, the CTA measurements and the rates of 70-99% stenosis and 100% occlusion in Group C were higher than those in Groups A and B. The TyG index has high specificity and NPV. However, specificity and PPV levels were found to be quite low. CONCLUSIONS The TyG index was found to be an easy-to-use marker for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents.
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Affiliation(s)
- S Turkyilmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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Taner S, Goktepe B, Zaman EI, Asci G, Bulut IK, Toz H, Sarsik B, Firat O, Kizilkaya AE, Kabasakal C, Keskinoğlu A. Role of Systemic Inflammatory Markers in Pediatric Kidney Transplantation. Transplant Proc 2023:S0041-1345(23)00155-0. [PMID: 37062614 DOI: 10.1016/j.transproceed.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/06/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII = N × P/L), and neutrophil percentage-albumin ratio (NPAR) have become accepted markers of inflammation in recent years. These indices are used as indicators of disease activity, mortality, and morbidity in many diseases. This study evaluated the relationship between inflammatory indices and graft function in pediatric kidney transplant recipients. METHODS Medical records of pediatric patients who underwent kidney transplantation at Ege University between 1995 and 2020 were reviewed retrospectively. Demographic, clinical, and laboratory data were recorded during the third month, first year, and fifth year of transplantation and at the last visit. RESULTS The median age of the 119 patients (60 boys/59 girls) at the time of transplantation was 154 months, and the median follow-up period was 101 months. According to Spearman correlation analysis, patients' final creatinine levels were positively correlated with NLR (r = 0.319), PLR (r = 0.219), SII (r = 0.214), and NPAR (r = 0.347) of the last visit; final estimate glomerular filtration rate levels were negatively correlated with NLR (P = .010, r = -0.250) and NPAR (P = .004, r = -0.277). The median NPAR of the patients with chronic allograft dysfunction at the last visit was found to be statistically significantly higher than without (P = .032). CONCLUSION NLR, PLR, SII, and NPAR values are correlated with creatinine levels after 5 years of kidney transplantation. The NPAR and final creatinine levels had the highest correlation coefficient among these inflammatory markers. These results suggest that inflammatory markers, especially NPAR, may be a candidate to be an indicator of ongoing inflammation in the graft.
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Affiliation(s)
- Sevgin Taner
- Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Berk Goktepe
- General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ece Irem Zaman
- Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gulay Asci
- Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ipek Kaplan Bulut
- Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey.
| | - Huseyin Toz
- Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Banu Sarsik
- Pathology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ozgur Firat
- General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | | | - Caner Kabasakal
- Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Keskinoğlu
- Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
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Goktepe B, Celtik A, Kivratma G, Sezer TO, Asci G, Toz H. Is Serum Magnesium Level Associated With Serum Lipid Levels in Kidney Transplant Recipients? Transplant Proc 2023:S0041-1345(23)00161-6. [PMID: 37045703 DOI: 10.1016/j.transproceed.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/05/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Magnesium (Mg) is key in diabetes mellitus, hyperlipidemia, and cardiovascular disease. METHODS This is a retrospective cross-sectional study including 103 kidney transplant recipients. Patients aged under 18 years, patients treated with Mg supplementation, antihyperlipidemic agents, or diuretics, and patients with active infection or malignancy were not enrolled. Patients were divided into 2 groups according to median serum Mg level. The atherogenic index of plasma was calculated by a logarithmic transformation of the number acquired by dividing the molar concentrations of serum triglyceride by high-density lipoprotein value. RESULTS The mean serum Mg level was 1.91 ± 0.28 mg/dL. Six patients (5.8%) had hypomagnesemia (Mg <1.5 mg/dL), and 2 (1.9%) had hypermagnesemia (Mg >2.6 mg/dL). Serum Mg level was negatively correlated with body mass index, estimated glomerular filtration rate (eGFR), and tacrolimus trough level and positively correlated with levels of phosphorus, total cholesterol, and low-density lipoprotein (LDL-C). There was no correlation between serum Mg and triglyceride, high-density lipoprotein, atherogenic index of plasma, and cyclosporin A trough level. Patients with Mg >1.87 mg/dL had lower eGFR, tacrolimus, and cyclosporin A trough level and higher total cholesterol and LDL-C compared to those with Mg ≤1.87 mg/dL. In adjusted ordinal analysis, eGFR (hazard ratio (HR): 0.981, 95% CI 0.964-0.999, P = .036) and total cholesterol (HR: 1.015, 95% CI 1.004-1.027, P = .008) were independently associated with serum Mg. In multivariate linear regression analysis, serum Mg level was independently associated with LDL-C (β = .296, t = 3.079, P = .003) and total cholesterol (β = .295, t = 3.075, P = .003). CONCLUSION Serum Mg level may have an important impact on dyslipidemia in kidney transplant recipients.
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Affiliation(s)
- Berk Goktepe
- Ege University, School of Medicine, Department of General Surgery, Bornova, Izmir, Turkey
| | - Aygul Celtik
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Bornova, Izmir, Turkey.
| | - Goktug Kivratma
- Ege University, School of Medicine, Department of General Surgery, Bornova, Izmir, Turkey
| | - Taylan Ozgur Sezer
- Ege University, School of Medicine, Department of General Surgery, Bornova, Izmir, Turkey
| | - Gulay Asci
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Bornova, Izmir, Turkey
| | - Huseyin Toz
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Bornova, Izmir, Turkey
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Ozdek U, Toz H, Kömüroğlu AU, Mis L, Değer Y. The Impact of Chitosan on Oxidative Stress in Liver of Rats Loaded With Lead Acetate. J HELL VET MED SOC 2023. [DOI: 10.12681/jhvms.24541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study was conducted to determine the impact of chitosan on lead (Pb)-induced hepatotoxicity. Thus, lead acetate was administered intraperitoneally (50 mg/kg for 5 days) and chitosan was given as 200 mg/kg via oral gavage for 28 days. When the trial was terminated, it was determined that aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activities in serum as well as Pb, 8-hydroxy-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels and catalase (CAT) activity in liver tissue significantly increased, however reduced glutathione (GSH) and ceruloplasmin (Cp) levels in liver and high density lipoproteins (HDL) in serum had a significant decrease in the Pb group when compared to the control group. The administration of chitosan significantly prevented Pb-induced changes in serum liver enzyme activities, 8-OHdG and MDA levels. In addition, chitosan showed a statistically insignificant effect on reduced GSH, Cp, HDL levels and CAT activity. Accordingly, administration of chitosan can strengthen the antioxidant defence system of liver tissue and may decrease oxidative stress.
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Boenink R, Kramer A, Vanholder RC, Mahillo B, Massy ZA, Bušić M, Ortiz A, Stel VS, Jager KJ, Idrizi A, Watschinger B, Neuwirt H, Eller K, Kalachik O, Leschuk S, Petkevich O, Abramowicz D, Hellemans R, Wissing KM, Colenbie L, Trnacevic S, Rebic D, Resic H, Filipov J, Megerov P, Bušić M, Žunec R, Markić D, Soloukides A, Savva I, Toumasi E, Viklicky O, Reischig T, Krejčí K, Sørensen SS, Bistrup C, Skov K, Lilienthal K, Ots-Rosenberg M, Helanterä I, Koivusalo A, Hourmant M, Essig M, Frimat L, Tomadze G, Banas B, Boletis I, Sándor M, Pálsson R, Plant W, Conlon P, Cooney A, Biancone L, Cardillo M, Ziedina I, Jusinskis J, Vaiciuniene R, Dalinkeviciene E, Delicata L, Farrugia E, Radunović D, Prelević V, Tomović F, Hilbrands L, Bemelman FJ, Schaefer B, Resisæter AV, Lien B, Skauby M, Dębska-Ślizień A, Durlik M, Wiecek A, Sampaio S, Romãozinho C, Jorge C, Rambabova-Bushljetikj I, Nikolov IG, Trajceska L, Tacu D, Elec A, Covic A, Zakharova E, Naumovic R, Lausevic M, Baltesová T, Žilinská Z, Dedinská I, Ponikvar JB, Arnol M, Valentín MO, Domínguez-Gil B, Crespo M, Mazuecos A, Wallquist C, Lundgren T, Dickenmann M, Toz H, Aki T, Keven K, Ravanan R, Geddes C. Factors influencing kidney transplantation rates: a study from the ERA Registry. Nephrol Dial Transplant 2023; 38:1540-1551. [PMID: 36626928 DOI: 10.1093/ndt/gfad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor, and living donor KT rates over the last decade. METHODS KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle, and high KT rate countries based on the KT rate at the start of study period in 2010. RESULTS Experts from low KT rate countries reported more frequently to have taken measures regarding staff, equipment and facilities to increase total KT rate compared with middle and high KT rate countries. For donor type specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators, and (inter)national exchange of donor kidneys. Once a measure was taken, experts' opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients' lack of knowledge and distrust in the health care system. CONCLUSIONS In particular in low KT rate countries, KT rate might be stimulated by optimizing staff, equipment, and facilities. In addition, all countries may benefit from deceased and living donor specific measures.
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Affiliation(s)
- Rianne Boenink
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Anneke Kramer
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Raymond C Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,European Kidney Health Alliance, Brussels, Belgium
| | | | - Ziad A Massy
- Paris-Saclay University, UVSQ, Inserm, CESP, team 5, Clinical Epidemiology, Villejuif 94800, France.,Paris-Saclay University, AP-HP, Ambroise Paré Hospital, Nephrology department Boulogne-Billancourt 92100, France
| | | | - Alberto Ortiz
- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Vianda S Stel
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
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Koymen G, Celtik A, Cinkooglu A, Toz S, Asci G, Arda B, Toz H, Erdinc M. New-Onset Hypercalcemia After Renal Transplant: An Infectious Etiology Beyond Persistent Hyperparathyroidism. EXP CLIN TRANSPLANT 2021; 20:691-694. [PMID: 34142941 DOI: 10.6002/ect.2021.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pneumocystis jirovecii pneumonia is an opportunistic infection in kidney transplant recipients. It may be complicated by hypercalcemia. Here, we discuss a 59-year-old man who presented with respiratory symptoms and hypercalcemia. He had undergone a deceased donor kidney transplant 2 years previously. The patient had persistent hyperparathyroidism, but his serum calcium level was normal. At the time of admission, his serum calcium level had increased and his parathyroid hormone level was suppressed. He was diagnosed with Pneumocystis jirovecii pneumonia. Serum calcium and parathyroid hormone levels returned to baseline values after treatment. Pneumocystis jirovecii pneumonia is an important infection that can present with hypercalcemia among kidney transplant recipients.
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Affiliation(s)
- Gorkem Koymen
- From the Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey
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Celtik A, Sen S, Keklik F, Saydam G, Asci G, Sarsik B, Ozkahya M, Toz H. A histopathological scoring and grading system to predict outcome for patients with AA amyloidosis. Int Urol Nephrol 2020; 52:1297-1304. [PMID: 32529382 DOI: 10.1007/s11255-020-02505-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/11/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Renal involvement is associated with significant morbidity and mortality in AA amyloidosis. Extend of amyloid deposition in kidney biopsies may be predictive for clinical manifestations and outcomes. The aim of our study is to assess clinical features of patients with biopsy-proven renal AA amyloidosis and to evaluate the relationship between histopathological scoring and grading of renal amyloid deposition with clinical findings and outcomes. METHODS The study included 86 patients who were diagnosed with renal AA amyloidosis. The demographic and clinical features at the time of biopsy and follow-up data were retrospectively collected. Amyloid deposition in glomeruli, interstitium, vessels and tubulointerstitial findings were scored and renal amyloid prognostic score (RAPS) was assigned by adding all scores. RAPS was further divided into three grades (RAPS grade I, II, III). RESULTS Median age was 50 (36-59) years. Familial Mediterranean fever was the leading cause. RAPS grade and interstitial inflammatory infiltration were associated with baseline eGFR and glomerular amyloid deposition was associated with proteinuria. During the follow-up period (median 50 months), 39 patients developed ESRD. Extensive (involving > 50%) glomerular amyloid deposition, baseline eGFR and proteinuria were independent risk factors for progression to end stage renal disease. Death censored renal survival was significantly lower among patients with RAPS grade III compared to those with RAPS grade I and II. Patient survival rate was not different according to RAPS grade. CONCLUSIONS Degree of renal amyloid accumulation is associated with renal function and outcome. The scoring and grading system may be predictive in clinical outcome and contribute to understanding of disease mechanism.
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Affiliation(s)
- Aygul Celtik
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Bornova, 35100, Izmir, Turkey.
| | - Sait Sen
- Department of Pathology, School of Medicine, Ege University, Izmir, Turkey
| | - Fatma Keklik
- Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey
| | - Guray Saydam
- Division of Hematology, Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey
| | - Gulay Asci
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Bornova, 35100, Izmir, Turkey
| | - Banu Sarsik
- Department of Pathology, School of Medicine, Ege University, Izmir, Turkey
| | - Mehmet Ozkahya
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Bornova, 35100, Izmir, Turkey
| | - Huseyin Toz
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Bornova, 35100, Izmir, Turkey
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Aşci G, Özkahya M, Duman S, Toz H, Erten S, Ok E. Volume Control Associated with Better Cardiac Function in Long-Term Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080602600113] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundThis study was undertaken to investigate the effect of long-term blood pressure (BP) reduction, achieved with salt restriction and strict volume control, on frequency and regression of left ventricular hypertrophy (LVH) in long-term peritoneal dialysis (PD) patients.Methods56 patients who had been treated for more than 2 years under our care were enrolled. After echocardiographic (Echo) evaluation, 46 patients were included in the follow-up study. In our unit, we aim to keep patients’ BP below 130/85 mmHg and cardiothoracic index below 0.50. To reach these targets, moderate salt restriction is advised, and if necessary, hypertonic PD solutions are used. Echo was performed at the beginning of the study (after a mean period of 36 months on PD) and at the end of the prospective follow-up period (24 months later).ResultsAt the time of the first Echo, LVH was detected in only 8 (21%) patients. Residual urine volume was significantly decreased compared to data taken when they first started PD (658 ± 795 vs 236 ± 307 mL/day). Mean left ventricular mass index (LVMI) was 107 ± 26.5 g/m2. LVMI was significantly decreased at the end of the follow-up in patients who had LVH at baseline. No LVH developed in patients who had normal LVMI at baseline.ConclusionOur results indicate that control of hypertension is possible when extracellular fluid volume is kept under control using hypertonic PD solutions in case of recruitment in addition to salt restriction in long-term PD patients. Sustained normovolemia is associated with low incidence and regression of LVH.
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Affiliation(s)
- Gulay Aşci
- Department of Nephrology, Ege University Medical School, Izmir, Turkey
| | - Mehmet Özkahya
- Department of Nephrology, Ege University Medical School, Izmir, Turkey
| | - Soner Duman
- Department of Nephrology, Ege University Medical School, Izmir, Turkey
| | - Huseyin Toz
- Department of Nephrology, Ege University Medical School, Izmir, Turkey
| | - Sinan Erten
- Department of Nephrology, Ege University Medical School, Izmir, Turkey
| | - Ercan Ok
- Department of Nephrology, Ege University Medical School, Izmir, Turkey
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Gokalp C, Guner Oytun M, Gunay E, Dogdus M, Sezis Demirci M, Sen S, Tamsel S, Sezer TO, Toz H. Increase in interventricular septum thickness may be the first sign of cardiovascular change in kidney donors. Echocardiography 2020; 37:276-282. [PMID: 31955456 DOI: 10.1111/echo.14593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Because of the inadequate number of deceased kidney donors, living kidney donation remains an important issue for kidney transplantation. Previous studies have shown that living donation does not differ life expectancy and progression to end-stage renal disease compared with the normal population. In this study, we investigated short-term cardiovascular changes after donor nephrectomy. METHODS Thirty-four patients who underwent donor nephrectomy between January 2015 and July 2015 at Ege University Renal Transplantation Unit were included in the study. Arterial stiffness, multifrequency bioimpedance analysis, renal ARFI elastography, and echocardiography performed prior to the donor nephrectomy and 6 months after nephrectomy. RESULTS A total of 34 kidney donors were enrolled in this study. Twenty donors were female (59%) and 14 donors were male (41%). The pathological evaluation of donor kidneys using implantation renal biopsy sample revealed mean Karpinski Renal Score of 1.5 and the mean glomerulosclerosis ratio was 5% for all donated kidneys. Arterial stiffness, systolic and diastolic blood pressure measures, body fluid composition, and left atrial size did not change significantly during the follow-up. However, interventricular septum thickness of donors increased by 1 mm during a 6-month period (9.6 mm vs 10.6 mm, P = .002). CONCLUSION We observed an increase in interventricular septum thickness in kidney donors during a 6-month follow-up. In order to evaluate the net effect of this change on donor morbidity, prospective studies investigating an increased number of donors with long-term follow-up should be needed.
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Affiliation(s)
- Cenk Gokalp
- Department of Nephrology, School of Medicine, Ege University, Izmir, Turkey
| | - Merve Guner Oytun
- Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey
| | - Emrah Gunay
- Department of Nephrology, School of Medicine, Ege University, Izmir, Turkey
| | - Mustafa Dogdus
- Department of Cardiology, School of Medicine, Ege University, Izmir, Turkey
| | | | - Sait Sen
- Department of Pathology, School of Medicine, Ege University, Izmir, Turkey
| | - Sadik Tamsel
- Department of Radiology, School of Medicine, Ege University, Izmir, Turkey
| | - Taylan Ozgur Sezer
- Department of General Surgery, School of Medicine, Ege University, Izmir, Turkey
| | - Huseyin Toz
- Department of Nephrology, School of Medicine, Ege University, Izmir, Turkey
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Hortu I, Arı SA, Akdemir A, Koroglu OA, Yılmaz M, Toz H, Sagol S, Ergenoglu AM. Perinatal outcomes of renal transplant pregnancies: a 22-year experience at a single tertiary referral center. J Matern Fetal Neonatal Med 2019; 33:3028-3034. [PMID: 31288677 DOI: 10.1080/14767058.2019.1639664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Renal transplantation not only prolongs survival but also improves quality of life and fertility, particularly in patients with end-stage renal disease. The aim of this study was to evaluate the renal and perinatal outcomes of pregnancy after renal transplantation at a high volume academic tertiary hospital.Methods: Fifty-one renal transplant patients (RTPs) who experienced pregnancy after transplantation and received care at Ege University Hospital between January 1995 and December 2017 were retrospectively identified. Data on demographics, comorbidities, and clinical perinatal outcomes were analyzed.Results: The median age of expectant mothers with renal transplantation was 30.51 ± 5.28 years (range 23-41). The mean interval between discontinuing birth control methods and the last menstrual period was 22 months. Preeclampsia occurred in six pregnancies (11.5%), and 43 of 52 pregnancies resulted in live births (82.6%). The mean gestational age at birth was 36.35 ± 2.36 weeks (range: 26-38). A total of 15 births were preterm deliveries (28.8%). Intrauterine growth retardation (IUGR) was detected in four cases. The mean birth weight was 2664.58 ± 613.99 g (range: 600-3.800 g). Twelve newborns were hospitalized in the neonatal intensive care unit (23%). A significant inverse correlation between birth weight and preconception serum creatinine level was found (p < .001; r = -0.532). An inverse correlation between the interval between transplantation and pregnancy and low postpartum serum creatinine level was established significantly (p < .05; r = -0.331). In addition, an inverse correlation between preconceptional serum creatinine and postpartum serum creatinine in the first year was found statistically significant (p < .001, r = -0.681).Conclusion: Even though pregnancy does not seem to adversely affect renal graft function, risks of perinatal as well as obstetrical complications should not be ignored. Pregnancies in RTPs should be followed closely by a multidisciplinary team of experts to minimize perinatal complications before and during pregnancy.
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Affiliation(s)
- Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Sabahattin Anıl Arı
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ozge Altun Koroglu
- Department of Pediatrics, Division of Neonatology, Ege University School of Medicine, Izmir, Turkey
| | - Mumtaz Yılmaz
- Department of Internal Medicine, Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Toz
- Department of Internal Medicine, Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Sermet Sagol
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - A Mete Ergenoglu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
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11
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Bulut IK, Taner S, Keskinoglu A, Toz H, Sarsik B, Sezer TO, Kabasakal C. Long-Term Follow-up Results of Renal Transplantation in Pediatric Patients With Focal Segmental Glomerulosclerosis: A Single-Center Experience. Transplant Proc 2019; 51:1064-1069. [PMID: 31101172 DOI: 10.1016/j.transproceed.2019.01.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND AIM Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease in children. We analyzed the long-term outcome of pediatric patients with FSGS undergoing renal transplantation. The objective of the study is to report the experience of a single center and determine the incidence of recurrence, rejection, graft loss, and related risk factors. MATERIALS AND METHOD This retrospective cohort study was performed between 1991 and 2018. Thirty patients with a pathologic diagnosis of primary FSGS were included in the study. The patients were diagnosed with FSGS according to histologic features in biopsies. RESULTS Twenty-one of the donors were deceased (70%) and 9 were alive (30%). FSGS recurred in only 2 patients. Graft loss occurred in 6 patients (20%). The causes of graft loss were chronic rejection in 4 patients and acute rejection in 2. Our graft survival rate was 100% at 1 year, 91% at 5 years, 80% at 10 years, 70% at 15 years, and 42% at 20 years. Five- and 10-year graft survival rates were 83% and 83% in living donors and 94% and 79% in deceased donors, respectively. According to Kaplan-Meier analysis, there was no statistically significant difference in terms of graft survival between living and deceased donors. CONCLUSION This study, with its contribution to literature in terms of long follow-up of FSGS patients from childhood to adulthood, is important. However, further studies are required.
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Affiliation(s)
- I K Bulut
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey.
| | - S Taner
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
| | - A Keskinoglu
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
| | - H Toz
- Department of Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
| | - B Sarsik
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Turkey
| | - T O Sezer
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - C Kabasakal
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey
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12
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Al-Daghri NM, Batzel JJ, Burgmann H, Carbone F, Charmandari E, Chrousos GP, Distelmaier K, Cvirn G, Dullaart RPF, Dumitrascu DL, Esteve-Pastor MA, Gervasini G, Goliasch G, Goswami N, Gruppen EG, Hernández-Mijares A, Kalantaridou SN, Krause R, Latini R, Makrigiannakis A, Marín F, Masson S, Montecucco F, Ndrepepa G, Nicolaides NC, Novelli D, Orasan OH, Qorbani M, Ratzinger F, Roessler A, Sabico S, Sciatti E, Stefanaki C, Stoner L, Tabatabaei-Malazy O, Tatar E, Toz H, Uslu A, Victor VM, Vizzardi E. Research update for articles published in EJCI in 2015. Eur J Clin Invest 2017; 47:775-788. [PMID: 28960328 DOI: 10.1111/eci.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Nasser M Al-Daghri
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Jerry J Batzel
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Heinz Burgmann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Federico Carbone
- First Clinical of Internal Medicine Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.,Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - George P Chrousos
- Choremeion Research Laboratory, 1st Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Klaus Distelmaier
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gerhard Cvirn
- Physiology, Medical University of Graz, Graz, Austria.,Institute of Physiological Chemistry, Medical University of Graz, Graz, Austria
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Dan L Dumitrascu
- 2nd Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - María A Esteve-Pastor
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
| | - Guillermo Gervasini
- Department of Medical and Surgical Therapeutics, Medical School, University of Extremadura, Badajoz, Spain
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Eke G Gruppen
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Antonio Hernández-Mijares
- Service of Endocrinology, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Sophia N Kalantaridou
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,CBmed GmbH - Center for Biomarker Research in Medicine, Graz, Austria
| | - Roberto Latini
- Department of Cardiovascular Research, IRCCS - Istituto Mario Negri, Milano, Italy
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
| | - Serge Masson
- Department of Cardiovascular Research, IRCCS - Istituto Mario Negri, Milano, Italy
| | - Fabrizio Montecucco
- First Clinical of Internal Medicine Department of Internal Medicine, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, Genova, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | | | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.,Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Deborah Novelli
- Department of Cardiovascular Research, IRCCS - Istituto Mario Negri, Milano, Italy
| | - Olga H Orasan
- 4th Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical sciences, Karaj, Iran.,Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran university of Medical sciences, Tehran, Iran
| | - Franz Ratzinger
- Division of Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Roessler
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Shaun Sabico
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Edoardo Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University and Spedali Civili of Brescia, Brescia, Italy
| | - Charikleia Stefanaki
- Choremeion Research Laboratory, 1st Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lee Stoner
- School of Sport and Exercise, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ozra Tabatabaei-Malazy
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran university of Medical sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical sciences, Tehran, Iran
| | - Erhan Tatar
- Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Huseyin Toz
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Adam Uslu
- Department of General Surgery and Transplantation, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Victor M Victor
- Service of Endocrinology, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Department of Physiology, University of Valencia, Valencia, Spain
| | - Enrico Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University and Spedali Civili of Brescia, Brescia, Italy
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13
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Ok E, Levin NW, Asci G, Chazot C, Toz H, Ozkahya M. Interplay of volume, blood pressure, organ ischemia, residual renal function, and diet: certainties and uncertainties with dialytic management. Semin Dial 2017; 30:420-429. [PMID: 28581677 DOI: 10.1111/sdi.12612] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume. These include intradialytic hypotension; ischemia of heart, brain, and gut; loss of residual renal function; and vascular access thrombosis. Comprehensibly, physicians are hesitant to follow strict volume control policy because of these safety concerns. Current data, however, suggest that a high ultrafiltration rate rather than the reduction in excess volume is related to these complications. Restriction of dietary salt intake, increased frequency, and/or duration of hemodialysis sessions or addition of temporary extra sessions during the process of gradually reducing postdialysis body weight in conventional hemodialysis and discontinuation of antihypertensive medications may prevent these complications. We believe that even if an unwanted effect occurs while gradually reaching euvolemia, this is likely to be counterbalanced by favorable cardiovascular outcomes such as regression of left ventricular hypertrophy, prevention of heart failure, and, ultimately, cardiovascular mortality as a result of the eventual achievement of normal extracellular fluid volume and blood pressure over the long term.
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Affiliation(s)
- Ercan Ok
- Ege University Medical School, Izmir, Turkey
| | - Nathan W Levin
- Icahn School of Medicine at Mount Sinai Health System, New York, USA
| | - Gulay Asci
- Ege University Medical School, Izmir, Turkey
| | | | - Huseyin Toz
- Ege University Medical School, Izmir, Turkey
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14
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Ok E, Asci G, Bayraktaroglu S, Toz H, Ozkahya M, Yilmaz M, Kircelli F, Sevinc Ok E, Ceylan N, Duman S, Cirit M, Monier-Faugere MC, Malluche HH. Reduction of Dialysate Calcium Level Reduces Progression of Coronary Artery Calcification and Improves Low Bone Turnover in Patients on Hemodialysis. J Am Soc Nephrol 2015; 27:2475-86. [PMID: 26701977 DOI: 10.1681/asn.2015030268] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 11/04/2015] [Indexed: 01/24/2023] Open
Abstract
Exposure to high Ca concentrations may influence the development of low-turnover bone disease and coronary artery calcification (CAC) in patients on hemodialysis (HD). In this randomized, controlled study, we investigated the effects of lowering dialysate Ca level on progression of CAC and histologic bone abnormalities in patients on HD. Patients on HD with intact parathyroid hormone levels ≤300 pg/ml receiving dialysate containing 1.75 or 1.50 mmol/L Ca (n=425) were randomized to the 1.25-mmol/L Ca (1.25 Ca; n=212) or the 1.75-mmol/L Ca (1.75 Ca; n=213) dialysate arm. Primary outcome was a change in CAC score measured by multislice computerized tomography; main secondary outcome was a change in bone histomorphometric parameters determined by analysis of bone biopsy specimens. CAC scores increased from 452±869 (mean±SD) in the 1.25 Ca group and 500±909 in the 1.75 Ca group (P=0.68) at baseline to 616±1086 and 803±1412, respectively, at 24 months (P=0.25). Progression rate was significantly lower in the 1.25 Ca group than in the 1.75 Ca group (P=0.03). The prevalence of histologically diagnosed low bone turnover decreased from 85.0% to 41.8% in the 1.25 Ca group (P=0.001) and did not change in the 1.75 Ca group. At 24 months, bone formation rate, trabecular thickness, and bone volume were higher in the 1.25 Ca group than in the 1.75 Ca group. Thus, lowering dialysate Ca levels slowed the progression of CAC and improved bone turnover in patients on HD with baseline intact parathyroid hormone levels ≤300 pg/ml.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Naim Ceylan
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | | | - Mustafa Cirit
- Division of Nephrology, Ataturk Training and Research Hospital, Izmir, Turkey; and
| | | | - Hartmut H Malluche
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky
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15
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Uguz A, Unsal M, Unalp O, Sezer T, Celtik A, Sozbilen M, Toz H, Hoscoskun C. Is a High Body Mass Index Still a Risk Factor for Complications of Donor Nephrectomy? Transplant Proc 2015; 47:1291-3. [DOI: 10.1016/j.transproceed.2015.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Celebi Z, Akturk S, Erdogmus S, Kemaloglu B, Toz H, Polat K, Keven K. Urgency Priority in Kidney Transplantation: Experience in Turkey. Transplant Proc 2015; 47:1269-72. [DOI: 10.1016/j.transproceed.2015.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Alci E, Ustun M, Sezer T, Yilmaz M, Ozdemir M, Unsal M, Uguz A, Sozbilen M, Toz H, Hoscoskun C. Comparison of Patients in Whom Double-J Stent Had Been Placed or Not Placed After Renal Transplantation in a Single Center: A Follow-up Study. Transplant Proc 2015; 47:1433-6. [DOI: 10.1016/j.transproceed.2015.04.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Tatar E, Sen S, Harman M, Kircelli F, Gungor O, Sarsik B, Asci G, Hoscoskun C, Basci A, Toz H. The relationship between renal volume and histology in obese and nonobese kidney donors. Eur J Clin Invest 2015; 45:565-71. [PMID: 25845420 DOI: 10.1111/eci.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/28/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity and related kidney diseases have become a global epidemic problem. However, the underlying pathogenesis of obesity-related renal diseases has not been clearly understood. In this study, we explored the link between renal volume (RV) determined by computed tomography (CT) and renal histology together with functional parameters in an obese population. MATERIALS AND METHODS Eighty-two kidney donors who underwent CT for the measurement of kidney volume and zero-hour renal biopsy for renal histology were included in this cross-sectional study. Protein creatinine clearance and eGFR were evaluated in 24-h urine specimens as indicators of renal function. RESULTS Mean body mass index (BMI) was 28 ± 4.2 kg/m(2); 32.9% (n = 27) were obese. Mean RV was 196 ± 36 cm(3). RV was positively correlated with BMI, body surface area and creatinine clearance and negatively with HDL-cholesterol in the whole population. Renal function parameters of obese subjects were better, and their renal volumes were higher compared with the nonobese subjects. In obese subjects, corrected RV was positively correlated with glomerular filtration rate (r = 0.46, P = 0.01) and negatively with sclerotic glomeruli (r = -0.38, P = 0.04) and chronicity index (r = -0.43, P = 0.02). In adjusted ordinal logistic regression analysis, corrected RV was significantly associated with chronicity index (OR: 0.96; P = 0.01). CONCLUSIONS In obese cases, decreased RV determined by CT is associated with worse renal histology. In this population, kidney imaging techniques may provide important clues about renal survival.
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Affiliation(s)
- Erhan Tatar
- Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Sait Sen
- Department of Patology, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Fatih Kircelli
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Ozkan Gungor
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Banu Sarsik
- Department of Patology, Ege University School of Medicine, Izmir, Turkey
| | - Gulay Asci
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Cuneyt Hoscoskun
- Department of General Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Ali Basci
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Toz
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
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19
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Doganavsargil B, Buberal GE, Toz H, Sarsik B, Pehlivanoglu B, Sezak M, Sen S. Digitally reinforced hematoxylin-eosin polarization technique in diagnosis of rectal amyloidosis. World J Gastroenterol 2015; 21:1827-1837. [PMID: 25684948 PMCID: PMC4323459 DOI: 10.3748/wjg.v21.i6.1827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/28/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy of the digitally reinforced hematoxylin-eosin polarization (DRHEP) technique for detection of amyloidosis in rectal biopsies.
METHODS: One hundred hematoxylin-eosin (HE) stained rectal biopsies with Congo-red (CR)-positive amyloid depositions and 50 control cases with CR-negative amyloid-mimicking areas were scanned blinded to the CR results for amyloid depositions under both bright and polarized light, and digitally photographed using the DRHEP technique, to accentuate the faint birefringence observed in HE slides under polarization. The results of DRHEP and HE evaluation were statistically correlated with CR polarization results with respect to presence and localization of amyloid deposits as well as amyloid types.
RESULTS: Amyloid deposits showed yellowish-green birefringence by DRHEP, which allowed identification of amyloidosis in 41 HE-unsuspected cases (P = 0.016), 31 of which only had vascular deposits. True positivity was higher, and false negativity and positivity were lower by DRHEP, compared to evaluation by HE (69%, 31%, and 0.8% vs 33%, 67%, and 33%, respectively; P < 0.0001). The sensitivity, specificity, accuracy, and positive and negative predictive values for DRHEP were 69%, 98%, 78.6%, 98.5%, and 61.25%, respectively. Reasons for DRHEP false negativity were presence of extensive background birefringence in 12 cases, absence of CR birefringent vessel in 3 cases, and missing of the tiny deposits in 9 cases, which could be improved by experience, especially in the latter case. No correlation was found between age, gender, sites of deposits, or amyloid types.
CONCLUSION: The DRHEP technique improves diagnostic accuracy when used as an adjunct or a prior step to CR staining, especially for cases with limited tissues for further analysis.
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Sert I, Kurtulmus Y, Karaca C, Toz H, Kursat S, Colak H. The relation between serum testosterone levels and cardiovascular risk factors in patients with kidney transplantation. Saudi J Kidney Dis Transpl 2014; 25:951-9. [DOI: 10.4103/1319-2442.139862] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Sezer TO, Solak I, Sozbilen M, Firat O, Yilmaz M, Toz H, Sarsik B, Isayev C, Harman M, Hoscoskun C. A Horseshoe Kidney From a Live Donor as a Renal Transplant: Case Report. EXP CLIN TRANSPLANT 2013; 11:454-7. [DOI: 10.6002/ect.2012.0214] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Hur E, Usta M, Toz H, Asci G, Wabel P, Kahvecioglu S, Kayikcioglu M, Demirci MS, Ozkahya M, Duman S, Ok E. Effect of Fluid Management Guided by Bioimpedance Spectroscopy on Cardiovascular Parameters in Hemodialysis Patients: A Randomized Controlled Trial. Am J Kidney Dis 2013; 61:957-65. [DOI: 10.1053/j.ajkd.2012.12.017] [Citation(s) in RCA: 240] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 12/20/2012] [Indexed: 01/11/2023]
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23
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Celtik A, Alpay N, Celik A, Sezer TO, Turkmen A, Camsari T, Toz H, Sever MS, Hoscoskun C. Kidney transplant recipients with functioning grafts for more than 15 years. Transplant Proc 2013; 45:904-7. [PMID: 23622583 DOI: 10.1016/j.transproceed.2013.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Renal transplantation is the best renal replacement therapy because it significantly improves patient survival. The developments in transplantation and increasing number of patients with end-stage renal disease (ESRD) have unmasked long-term complications secondary to immunosuppressive drugs and chronic renal failure. METHODS AND RESULTS Eighty-six renal transplant recipients with grafts that have functioned more than 15 years were included in the study. This cross-sectional retrospective analysis of demographic, clinical, and laboratory findings was conducted in 3 Turkish transplantation centers. The mean age was 30.4 ± 10.2 years at the time of the transplantation. The mean time between the transplantation and the study was 19.1 ± 3.6 years. At the time of the study, mean creatinine level was 1.52 ± 0.60 mg/dL, 70.09% of the patients displayed glomerular filtration rates <60 mL/min/1.73 m(2). Urinary protein excretion was 0.57 ± 0.65 g/d. Hypertension and hyperlipidemia were the most common comorbid diseases. Twelve patients had diabetes and 9 cardiovascular disease. Seventeen patients had been diagnosed with skin and 5 with non-skin cancer. CONCLUSIONS As the number of recipients with long-term functioning grafts increases, long-term complications become evident, particularly chronic renal failure. Survivors should be evaluated regularly and treated early for risk factors and complications to improve long-term graft and patient survival.
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Affiliation(s)
- A Celtik
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey.
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24
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Tatar E, Gungor O, Celtik A, Sisman AR, Yaprak M, Asci G, Ozkahya M, Toz H. Correlation between serum YKL-40 (Chitinase-3-like protein 1) level and proteinuria in renal transplant recipients. Ann Transplant 2013; 18:95-100. [DOI: 10.12659/aot.883844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Erhan Tatar
- Bozyaka Training and Research Hospital, Division of Nephrology, Izmir, Turkey
| | - Ozkan Gungor
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Aygul Celtik
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Ali Rıza Sisman
- Dokuz Eylul University, School of Medicine, Department of Biochemistry, Izmir, Turkey
| | - Mustafa Yaprak
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Gulay Asci
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Mehmet Ozkahya
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Huseyin Toz
- Ege University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
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Tatar E, Sarsik B, Gungor O, Yaman B, Ozsan N, Cagirgan S, Sezis Demirci M, Ozgur Sezer T, Hoscoskun C, Toz H. Multiple unrelated malignancies following renal transplantation: an evaluation of four cases. Intern Med 2013; 52:673-7. [PMID: 23503409 DOI: 10.2169/internalmedicine.52.8591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The risk of de novo malignancy is significantly higher in patients who have undergone organ transplantation than in the general population. Long-term immunosuppressive treatment, in addition to age, genetic predisposition and infectious agents, plays a major role in the development of malignancy. Although skin and hemopoietic system cancers are common, atypical presentations of malignancies may occasionally be seen during long-term follow-up in patients with functioning allografts. In this report, four cases, each with more than one different primary malignancy (one patient with three malignancies and three patients with two malignancies), are presented.
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Affiliation(s)
- Erhan Tatar
- Division of Nephrology, Ege University School of Medicine, Turkey.
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Demirci C, Ozkahya M, Demirci MS, Asci G, Kose T, Colak T, Duman S, Toz H, Ergin P, Adam SM, Ok E. Effects of three times weekly eight-hour nocturnal hemodialysis on volume and nutritional status. Am J Nephrol 2013; 37:559-67. [PMID: 23735837 DOI: 10.1159/000351182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/01/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND This prospective cohort study compared the changes in body water composition and nutritional parameters measured with multifrequency bioimpedance analysis between 8-hour three times weekly nocturnal hemodialysis (NHD) and 4-hour conventional hemodialysis (CHD) patients. PATIENTS AND METHODS 55 patients on CHD and 57 patients on NHD were included in the study. Multifrequency bioimpedance analysis was performed at baseline and at the 12th month. The primary outcomes of the study were changes in extracellular water (ECW), fat mass, dry lean mass and phase angle. Secondary outcomes of the study included changes in blood pressure and biochemical parameters related to nutrition and inflammation. RESULTS ECW/height values decreased in the NHD group, while they increased in the CHD group. Fat mass, dry lean mass, and serum albumin increased and high sensitive CRP decreased in the NHD group but did not change in the CHD group. When changes in parameters from baseline to the 12th month between the groups were compared, NHD was associated with improvement in volume parameter including ECW/height (difference -0.44 l/m, p < 0.001). Change in blood pressure was not different between the groups, however requirement for antihypertensive medication decreased from 26.5 to 8.5% in the NHD group (p = 0.002). NHD was also associated with increases in fat mass (difference 1.8 kg, p < 0.001), dry lean mass (difference 0.6 kg, p = 0.006), serum albumin (difference 0.19 g/dl, p < 0.001) and cholesterol (difference 18.8 mg, p < 0.001). Phase angle values decreased in the CHD group but did not change in the NHD group (difference between the groups 0.37°, p = 0.04). CONCLUSION This study revealed that longer HD facilitates volume control and improves nutritional status.
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Affiliation(s)
- Cenk Demirci
- Division of Nephrology, Fresenius Medical Care Turkey Clinics, Izmir, Turkey.
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Ok E, Asci G, Toz H, Ok ES, Kircelli F, Yilmaz M, Hur E, Demirci MS, Demirci C, Duman S, Basci A, Adam SM, Isik IO, Zengin M, Suleymanlar G, Yilmaz ME, Ozkahya M. Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study. Nephrol Dial Transplant 2012; 28:192-202. [DOI: 10.1093/ndt/gfs407] [Citation(s) in RCA: 315] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sarsik B, Sen S, Kirdok FS, Akarca US, Toz H, Yilmaz F. Hepatic amyloidosis: Morphologic spectrum of histopathological changes in AA and nonAA amyloidosis. Pathol Res Pract 2012; 208:713-8. [DOI: 10.1016/j.prp.2012.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/19/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
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Turan MN, Gungor O, Asci G, Kircelli F, Acar T, Yaprak M, Ceylan N, Demirci MS, Bayraktaroglu S, Toz H, Ozkahya M, Ok E. Epicardial adipose tissue volume and cardiovascular disease in hemodialysis patients. Atherosclerosis 2012; 226:129-33. [PMID: 23159099 DOI: 10.1016/j.atherosclerosis.2012.10.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/18/2012] [Accepted: 10/25/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Epicardial adipose tissue (EAT) is proposed as a cardiovascular risk marker in non-uremic subjects. However, little is known about its role in patients with higher cardiovascular risk profile such as chronic kidney disease. The aim of this study was to investigate the relationship between EAT and several cardiovascular surrogate markers (coronary artery calcification (CAC), arterial stiffness and atherosclerosis) in patients on maintenance hemodialysis. METHODS A total of 191 prevalent hemodialysis patients were enrolled in this cross-sectional study. EAT and CAC scores (CACs) were determined by multi-slice computerized tomography, arterial stiffness by carotid-femoral pulse wave velocity (PWV), and carotid artery intima-media thickness (CA-IMT) by B-mode doppler ultrasonography. RESULTS Mean age was 59 ± 13 years and time on hemodialysis 75 ± 44 months. Twenty percent of the patients had diabetes. Mean EAT volume was 62.6 ± 26.8 cm(3)/m(2). Mean CA-IMT and PWV values increased across the EAT tertiles. EAT was correlated with age, female gender, body mass index, albumin and lipid parameters. Additionally, CA-IMT and PWV values were positively correlated with EAT. EAT volume was significantly higher in patients with CACs >10 compared to the patients with CACs ≤10. Despite the univariate associations between EAT and cardiovascular surrogate markers, only age, body mass index and total cholesterol levels were associated with EAT in adjusted models. CONCLUSIONS In prevalent hemodialysis patients, EAT is correlated with atherosclerosis, arterial stiffness and the presence of CAC. However, this correlation is not independent of other risk factors.
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Affiliation(s)
- Mehmet Nuri Turan
- Ege University, School of Medicine, Division of Nephrology, 35100 Bornova, Izmir, Turkey.
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Gungor O, Kismali E, Sisman AR, Kircelli F, Carrero JJ, Tatar E, Asci G, Toz H. The relationships between serum sTWEAK, FGF-23 levels, and carotid atherosclerosis in renal transplant patients. Ren Fail 2012; 35:77-81. [PMID: 23101788 DOI: 10.3109/0886022x.2012.734890] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the main cause of mortality after renal transplantation. Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and fibroblast growth factor-23 (FGF-23) are two novel molecules that have been associated with atherosclerosis in different populations. In this cross-sectional study, we investigated the associations between sTWEAK, FGF-23, and carotid artery intima-media thickness (CA-IMT) in renal transplant patients. METHODS A total of 117 renal transplant patients were studied. CA-IMT was determined by B-mode Doppler ultrasonography. Serum sTWEAK and FGF-23 were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). RESULTS Mean age was 39.6 ± 9.6 years and 51% of the patients were male. Mean sTWEAK level was 595 ± 225 pg/mL (158-1140), FGF-23 level was 92 ± 123 RU/mL (9.6-1006), and CA-IMT level was 0.62 ± 0.11 mm (0.40-0.98). sTWEAK level was positively correlated with CA-IMT. There was no association between sTWEAK and FGF-23 levels. FGF-23 was also associated with CA-IMT. In adjusted models using linear regression analysis, only age and serum TWEAK levels were predictors for CA-IMT. CONCLUSION There is a positive correlation between CA-IMT and sTWEAK, but not with FGF-23 levels in renal transplant patients.
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Affiliation(s)
- Ozkan Gungor
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.
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Tatar E, Kircelli F, Demirci MS, Turan MN, Gungor O, Asci G, Ozkahya M, Ok E, Hoscoskun C, Toz H. Pre-transplant HbA1c level as an early marker for new-onset diabetes after renal transplantation. Int Urol Nephrol 2012; 45:251-8. [PMID: 23054321 DOI: 10.1007/s11255-012-0304-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/17/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND New-onset diabetes after transplantation (NODAT) is a common complication in renal transplant (RT) patients. The clinical significance of pre-transplant HbA1c level remains unclear in RT patients. Thus, we investigated the predictive role of pre-transplant HbA1c levels for the NODAT diagnosed in 1 year after renal transplantation. METHODS Two hundred and four RT patients older than 18 years were analyzed. NODAT diagnosis during the 1-year follow-up after RT was based on the 2003 modified criteria of the ADA. HbA1c level was measured at pre-transplantation period and every 3 months after RT. RESULTS Mean age was 39.3 ± 10.7 (20-73) years and 36 % were female. Mean pre-transplant HbA1c level was 4.9 ± 0.5 % (4.0-6.4 %). Pre-transplant HbA1c level was positively correlated with age, pre-transplant body mass index (BMI) and cholesterol level. Fifty-four patients (25.9 %) developed NODAT and 33.8 % had impaired fasting blood glucose levels. Patients with NODAT were significantly older and had higher pre-transplant BMI and HbA1c than those without. Use of Tacrolimus was also higher in patients with NODAT. In stepwise logistic regression analysis, pre-transplant HbA1c level was an independent predictor for the development on NODAT (OR = 4.63, 95 % CI: 2.09-10.2, p < 0.001) together with age, Tacrolimus-based regimen and pre-transplant fasting blood glucose level. CONCLUSIONS Assessment of pre-transplant HbA1c levels may be a valuable tool for early diagnosis of NODAT in RT recipients.
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Affiliation(s)
- Erhan Tatar
- Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
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Solak I, Sezer TO, Toz H, Tatar E, Sozbilen M, Firat O, Hoscoskun C. What kind of changes occurred in clinical characteristics of deceased kidney donor recipients after national allocation system in Turkey? A single-center retrospective analysis. Transplant Proc 2012; 44:1598-600. [PMID: 22841223 DOI: 10.1016/j.transproceed.2012.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Clinical characteristics of recipients of deceased donor renal transplantations were evaluated in the period before versus after implementation of The National Allocation System (NAS). PATIENTS AND METHODS We evaluated retrospectively clinical profiles of the 42 after NAS (June 2008-December 2010) versus 42 consecutive deceased donor renal transplantation patients before NAS. Patient and graft survival rates were assessed using the Kaplan-Meier method; graft function was assessed based on creatinine clearance with the Cockcroft Gault equation. Patient and donor data were obtained from medical records. RESULTS Recipients were older in the pre-NAS group (39 ± 8 vs 33 ± 8 years, respectively; P = .001) and median duration of preoperative dialysis was longer in the post-NAS group (103 ± 61 months vs 50 ± 36 months, respectively; P = .000). The average number of human leukocyte antigen-mismatched antigens were pre-NAS 3.4 ± 1.0 versus post-NAS 3.9 ± 1.2 (P = .05). Considering the recipients serological status 9 were hepatitis C virus (HCV)(+) and 2 hepatitis B virus (HBV)(+) among the post-NAS versus no HBV(+) and only 1 HCV(+) patient pre-NAS. Kaplan-Meier analysis of graft survival rates showed 90% at 1 and 85% at 3 years pre-NAS. Similar to 95% at 1 and 86% at 3 years for the post-NAS group (P > .05). Likewise, patient survival rates for both groups at 1 and 3 years were 97%. The mean parameter of donor age, allograft loss, cold ischemia time, patient death, number of retransplantations, HBV(+) patients, and delayed graft function were similar between groups (P > .05). DISCUSSION After NAS the transplant recipients were older, had a longer duration of dialysis, greater number of HLA mismatched antigens and, more HCV(+). No differences were observed in short-term patient and graft survival rates.
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Affiliation(s)
- I Solak
- Department of General Surgery, Ege University, School of Medicine, Izmir, Turkey
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Solak I, Sezer TO, Toz H, Tatar E, Isayev C, Firat O, Hoscoskun C. Spousal versus living unrelated renal transplantation: a retrospective analysis of allograft outcomes. Transplant Proc 2012; 44:1710-2. [PMID: 22841250 DOI: 10.1016/j.transproceed.2012.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the outcomes of spousal and living unrelated donor (LUD) allografts. PATIENTS AND METHODS The 378 ABO-compatible living and cadaveric kidney transplantations between February 2005 and August 2010 included 25 wife-to-husband (group 1), 15 husband-to-wife (group 2), and 20 LUD cases (group 3). Donor nephrectomy was performed by open surgery. Induction therapy with antithymocyte globulin or anti-interleukin-2 receptor antibody was followed by maintenance regimens using cyclosporine (CsA) or tacrolimus (Tac) plus mycophenolate mofetil (MMF) and corticosteroids. We compared spousal donor and LUDs in terms of clinical characteristics as well as graft and patient survival rates. RESULTS Fifty-six (93.3%) patients underwent induction therapy with either antithymocyte globulin (n = 30) or anti-interleukin-2 receptor antibody (n = 26). Maintenance immunosuppression was administered with Tac + MMF (n = 37; 61.6%) or CsA + MMF (n = 23; 38.4) with corticosteroids. Mean follow-up was 34 ± 16 months. There were four graft losses and five patient deaths. There were no significant differences between spousal and living unrelated transplants in terms of clinical characteristics or biopsy-proven acute rejection episodes. The Kaplan-Meier analysis showed 3-year patient survival rates of 94%, 100%, and 88% in group 1, group 2, and group 3, respectively (P > .05). Overall graft survival rates were 94%, 100%, and 77% in group 1, group 2, and group 3, respectively (P > .05). Graft and patient survival rates were similar at 3 years for wife-to-husband, husband-to-wife, or LUDs. CONCLUSION In conclusion, family members should be encouraged as LUD or spousal donors, based on similar patient and graft survival rates.
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Affiliation(s)
- I Solak
- Department of General Surgery, Ege University, School of Medicine, Izmir, Turkey.
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Sezer T, Solak I, Toz H, Kardaslar B, Er A, Hoscoskun C. Long-Term Outcomes of Kidney Transplants with Multiple Renal Arteries: A Retrospective Study. Transplant Proc 2012; 44:1697-9. [DOI: 10.1016/j.transproceed.2012.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gungor O, Tanrisev M, Kircelli F, Turan MN, Tugmen C, Tatar E, Toz H. The effects of mammalian target of rapamycin inhibitors on serum uric acid levels in renal transplant patients. Int Urol Nephrol 2012; 45:547-52. [PMID: 22752451 DOI: 10.1007/s11255-012-0214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 05/25/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS/AIMS Elevated uric acid (UA) levels are frequently observed after renal transplantation. We investigated the consequences of shifting from calcineurin inhibitors (CNI) to mammalian target of rapamycin inhibitors (mTORi) on UA levels and graft functions. METHODS Ninety-six patients were enrolled. Main points of interest were changes in UA and glomerular filtration rate (GFR). RESULTS Mean age of the whole population was 39 ± 11 years (18-73), and 64.2 % were male. Patients were stratified into two groups according to their CNI type prior to the switch as cyclosporin A (CsA) or tacrolimus (Tac). Patients that were switched from CsA had a mean GFR of 49 ± 18 ml/min and serum UA level of 7.4 ± 1.8 mg/dl at the pre-switch period. Mean GFR increased to 53 ± 22 ml/min (p = 0.03), and UA levels decreased to 6.2 ± 1.6 mg/dl at the final visit (p < 0.001). In the Tac group, pre-switch mean GFR was 59 ± 28 ml/min and serum UA level 6.6 ± 2.6 mg/dl. In this group, mean GFR increased to 63 ± 28 ml/min (p = 0.03) and UA levels decreased to 6.2 ± 2.1 at the last visit (p < 0.001). CONCLUSION Switch from CNI to mTORi-based regimen provides better control of UA levels and improves renal functions.
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Affiliation(s)
- Ozkan Gungor
- Division of Nephrology, Ege University, School of Medicine, 35100 Bornova, Izmir, Turkey.
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Gungor O, Kircelli F, Turan MN, Cetin O, Elbi H, Tatar E, Sertoz OO, Toz H. Irritable bowel syndrome in renal transplant patients: prevalence, link with quality of life, anxiety, and depression. Ren Fail 2012; 34:876-9. [PMID: 22680982 DOI: 10.3109/0886022x.2012.690805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gastrointestinal complications are common in renal transplant recipients and may arise from any part of the gastrointestinal tract. Irritable bowel syndrome (IBS) is highly common in the general population, but the status is not known in renal transplant patients. In this study, we evaluated the prevalence of IBS and its association with health-related quality of life (HRQOL), anxiety, and depression in renal transplant patients. METHODS One hundred and ninety-eight patients were enrolled in this study. Sociodemographic and laboratory variables were recorded. Severity of depressive and anxiety symptoms and HRQOL were assessed by the Beck Depression Inventory, State-Trait Anxiety Inventory, and Short Form 36 (SF-36), respectively. Diagnosis of IBS was based on Rome III criteria. RESULTS The mean age was 38 ± 10 years and 61% were male. The mean transplant duration was 62 ± 54 months. Among 198 patients, 55 (27%) had IBS. Patients with IBS had lower SF-36 scores and had higher depressive and anxiety symptoms than patients without IBS. CONCLUSIONS IBS is highly prevalent in renal transplant patients. The presence of IBS is closely related with HRQOL anxiety and depression.
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Affiliation(s)
- Ozkan Gungor
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.
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Susla O, Shin HS, Jung YS, Rim H, Speer T, Owala FO, Razawi M, Holy E, Ferdinand B, Danilo F, Luscher TF, Tanner FC, Markaki A, Kyriazis J, Petrakis I, Mavroeidi V, Perakis K, Fragkiadakis GA, Venyhaki M, Tzanakakis M, Vardaki E, Maraki K, Doskas T, Daphnis E, Bregman R, Vale B, Lemos C, Kawakami L, Silva MI, Zhu F, Kaysen G, Kotanko P, Abbas SR, Dou Y, Heymsfield S, Levin NW, Turkmen K, Kayikcioglu H, Guney I, Altintepe L, Ozbek O, Tonbul HZ, Kaysen GA, Kaysen GA, Usvyat LA, Thijssen S, Levin NW, Kotanko P, Mutluay R, Konca Degertekin C, Derici U, Yilmaz MI, Akkiyal F, Gultekin S, Gonen S, Deger SM, Arinsoy T, Sindel S, Hueso M, Torras J, Carrera M, Vidal A, Navarro E, Rivas I, Rama I, Bolanos N, Varela C, Martinez-Castelao A, Grinyo JM, Harving F, Svensson M, Schmidt EB, Jorgensen KA, Christensen JH, Park JH, Koo EH, Kim HK, Kim MS, Cho AJ, Lee JE, Jang HR, Huh W, Kim DJ, Kim YG, Oh HY, Zawiasa A, Nowak D, Nowicki M, Nathalie N, Griet G, Eva S, Raymond V, Ng KP, Stringer S, Jesky M, Dutton M, Ferro C, Cockwell P, Jia T, Gama Axelsson T, Lindholm B, Heimburger O, Barany P, Stenvinkel P, Qureshi AR, Quiroga B, Goicoechea M, Garcia de Vinuesa S, Verdalles U, Reque J, Panizo N, Arroyo D, Santos A, Macias N, Luno J, Honda H, Hirano T, Ueda M, Kojima S, Mashiba S, Hayase Y, Michihata T, Akizawa T, Gungor O, Sezis Demirci M, Kircelli F, Tatar E, Hur E, Sen S, Toz H, Basci A, Ok E, Sepe V, Albrizio P, Gnecchi M, Cervio E, Esposito P, Rampino T, Libetta C, Dal Canton A, Faria MS, Faria MS, Ribeiro S, Silva G, Nascimento H, Rocha-Pereira P, Miranda V, Vieira E, Santos R, Mendonca D, Quintanilha A, Costa E, Belo L, Santos-Silva A, Pruijm M, Pruijm M, Hofmann L, Heuvelin E, Forni V, Coristine A, Stuber M, Vogt B, Burnier M, Chiappini MG, Ammann T, Muzzi L, Grosso A, Sabry A, Bansal V, Hoppensteadt D, Jeske W, Fareed J. Nutrition, inflammation and oxidative stress - CKD 1-5. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Riegersperger M, Plischke M, Steiner-Boker S, Seidinger D, Winkelmayer W, Sunder-Plassmann G, Vlahovic P, Vlahovic P, Cvetkovic T, Djordjevic V, Velickovic-Radovanovic R, Stefanovic N, Ignjatovic A, Sladojevic N, Cademartori V, Massarino F, Parodi EL, Russo R, Sofia A, Fontana I, Viviani GL, Garibotto G, Mai M, Mai W, Taner B, Wadei H, Prendergast M, Gonwa T, Martin J, Martin J, Aurore S, Aline CS, Nicolas M, Manolie M, Catherine S, Eric A, Christophe M, Brakemeier S, Liefeldt L, Glander P, Waiser J, Lachmann N, Schonemann C, Zukunft B, Illigens P, Schmidt D, Wu K, Rudolph B, Neumayer HH, Budde K, Pallardo Mateu L, Gavela Martinez E, Sancho Calabuig A, Crespo Albiach J, Beltran Catalan S, Gavela Martinez E, Kanter Berga J, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Hujiwara T, Nukui A, Yashi M, Duraes J, Malheiro J, Fonseca I, Rocha A, Martins LS, Almeida M, Dias L, Castro-Henriques A, Cabrita A, Mai M, Mai W, Wadei H, Prendergast M, Gonwa T, Volpe A, Quaglia M, Menegotto A, Fenoglio R, Izzo C, Airoldi A, Terrone C, Stratta P, Ahmed B, Mireille K, Nilufer B, Annick M, Karl Martin W, Anh-Dung H, Dimitri M, Philippe M, Judith R, Daniel A, Liefeldt L, Glander P, Glander P, Lan Y, Schmidt D, Heine C, Budde K, Neumayer HH, Schmidt D, Glander P, Glander P, Budde K, Neumayer HH, Liefeldt L, Quaglia M, Quaglia M, Capone V, Izzo C, Menegotto A, Fenoglio R, Airoldi A, Stratta P, Grace B, Clayton P, Cass A, Mcdonald S, Yagisawa T, Yagisawa T, Yashi M, Kimura T, Nukui A, Fujiwara T, Sakuma Y, Ishikawa N, Iwabuchi T, Muraishi O, Torregrosa V, Barros X, Martinez de Osaba MJ, Paschoalin R, Campistol JM, Hassan R, El-Hefnawy A, Soliman S, Shokeir A, Cobanoglu Kudu A, Gungor O, Kircelli F, Altinel E, Asci G, Ozbek SS, Toz H, Ok E, Sandrini S, Setti G, Valerio F, Possenti S, Torrisi I, Polanco N, Garcia-Puente L, Gonzalez Monte E, Morales E, Gutierrez E, Bengoa I, Hernandez A, Caballero J, Morales JM, Andres A, Sgarlato V, Sgarlato V, Comai G, La Manna G, Moretti I, Grandinetti V, Martelli D, Scolari MP, Stefoni S, Valentini C, Valentini C, Persici E, La Manna G, Cappuccilli ML, Sgarlato V, Liviano D'arcangelo G, Fabbrizio B, Carretta E, Mosconi G, Scolari MP, Feliciangeli G, Grigioni FW, Stefoni S, Apicella L, Guida B, Vitale S, Garofalo G, Russo L, Maresca I, Rossano R, Memoli B, Carrano R, Federico S, Sabbatini M, Carta P, Zanazzi M, DI Maria L, Caroti L, Miejshtri A, Tsalouchos A, Bertoni E, Sezer S, Erkmen Uyar M, Colak T, Bal Z, Tutal E, Kalaci G, Ozdemir Acar FN, Jacquelinet C, Bayat S, Pernin V, Portales P, Szwarc I, Garrigue V, Vetromile F, Delmas S, Eliaou JF, Mourad G, Huber L, Huber L, Slowinski T, Naik M, Glander P, Liefeldt L, Schmidt D, Neumayer HH, Budde K, Nakai K, Fujii H, Kono K, Goto S, Ishimura T, Takeda M, Fujisawa M, Nishi S, Pereira Paschoalin R, Paschoalin R, Torregrosa JV, Barros Freiria X, Duran Rebolledo CE, Sanchez Escuredo A, Sole M, Campistol JM, Youssouf S, Tabbasm F, Bell R, Al-Jayyousi R, Warwick G, Grall A, Treguer L, Essig M, Lecaque C, Noel N, Buchler M, Bertrand D, Rivalan J, Braun L, Villemain F, Hurault de Ligny B, Totet A, Pestourie N, Toubas D, Nevez G, Le Meur Y, Nour el Houda B, Mustapha H, Wafaa F, Inass L, Rambabova Bushljetikj I, Rambabova Bushljetikj I, Masin-Spasovska J, Spasovski G, Popov Z, Sikole A, Ivanovski N, Raimundo M, Guerra J, Teixeira C, Santana A, Silva S, Mil Homens C, Gomes Da Costa A, Loredo D, Cleres M, Gondolesi G, Gutierrez LM, Fortunato RM, Descalzi V, Raffaele P. Transplantation - clinical II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sevinc Ok E, Kircelli F, Asci G, Altunel E, Ertilav M, Sipahi S, Bozkurt D, Duman S, Ozkahya M, Toz H, Ok E. Neither oxidized nor anti-oxidized low-density lipoprotein level is associated with atherosclerosis or mortality in hemodialysis patients. Hemodial Int 2012; 16:334-41. [PMID: 22497657 DOI: 10.1111/j.1542-4758.2012.00683.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is anticipated that oxidized low-density lipoprotein (oxLDL) and anti-oxLDL are associated with atherosclerosis and mortality. However, data on this issue are controversial and limited. We aimed to investigate the effect of these two markers on the extent and progression of atherosclerosis and mortality in a group of hemodialysis patients. In this prospective observational study with a follow-up of 36 months, 124 hemodialysis patients were studied. Ninety-five patients underwent carotid intima media thickness (CA-IMT) measurement by B-Mode ultrasonography both at baseline and at the end of the study. oxLDL and anti-oxLDL were measured by enzyme-linked immunosorbent assay. The extent and progression of CA-IMT, along with overall and cardiovascular mortality, were assessed. The mean age at baseline was 54.0 ± 14.8 years, 57.3% male and 20% diabetic. The mean oxLDL and anti-oxLDL levels were 8.11 ± 3.16 mU/L and 1.30 ± 0.31, respectively. Baseline mean CA-IMT was 0.82 ± 0.20 mm. Fifteen patients died during a follow-up period of 28.5 ± 6.6 months, 11 from cardiovascular causes. Only oxLDL, not anti-oxLDL, was correlated with the extent of atherosclerosis at baseline. However, both had no role in the progression of atherosclerosis. Also, in unadjusted and adjusted models, both parameters were not associated with overall or cardiovascular mortality. Neither oxLDL nor anti-oxLDL level is associated with the progression of atherosclerosis or mortality in hemodialysis patients.
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Affiliation(s)
- Ebru Sevinc Ok
- Division of Nephrology, School of Medicine, Ege University, Izmir, Turkey.
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Gungor O, Kircelli F, Kitis O, Asci G, Toz H, Ok E. Can strict volume control be the key for treatment and prevention of posterior reversible encephalopathy syndrome in hemodialysis patients? Hemodial Int 2012; 17:107-10. [DOI: 10.1111/j.1542-4758.2012.00672.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ozkan Gungor
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Fatih Kircelli
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Omer Kitis
- Division of Radiology; Ege University School of Medicine; Izmir; Turkey
| | - Gulay Asci
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Huseyin Toz
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Ercan Ok
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
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Toz H, Sen S, Celik HA, Yilmaz M, Hur E, Hoscoskun C, Ozkahya M, Aydin HH. Calcineurin inhibitor-based and free regimens have distinct gene expression patterns in subclinical graft fibrosis. Ann Transplant 2011; 16:76-87. [PMID: 21716190 DOI: 10.12659/aot.881869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Chronic nephrotoxic effects of calcineurin inhibitors may be responsible for late allograft dysfunction and reduced allograft half-life. Mammalian target of rapamycin inhibitors (mTOR-i's), a newer class of immunosuppressant, do not have the chronic nephrotoxic effects shown with calcineurin inhibitors (CNI). Whether these drug classes have distinct features at the molecular level is not clear. MATERIAL/METHODS Difference in gene expression profiles of kidney graft protocol biopsies from patients treated with CNI or mTOR-i's were investigated. Biopsies from patients using CNI (n=4) and mTOR-i-based treatments (n=4) were analyzed. The control group consisted of 5 biopsies obtained at the time of implantation (zero hour). Microarray hybridization was performed using the Affymetrix® GeneChip U133 plus 2.0 Array. RESULTS In the CNI and mTOR-i groups, 64 up-regulated and 119 down-regulated genes were found compared to control subjects. A total of 29 genes in the CNI group and 101 genes in the mTOR-i group were up-regulated compared to each other. CONCLUSIONS Despite similar clinical courses and histopathological appearances, different treatment strategies cause different gene expression profiles in kidney transplantation.
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Affiliation(s)
- Huseyin Toz
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.
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Tatar E, Gungor O, Firat O, Kircelli F, Arda B, Harman M, Toz H, Hoscoskun C. Differential Diagnosis of an Unusual Pelvic Mass in a Renal Transplant Recipient: Multidrug-Resistant Abdominopelvic Tuberculosis. Ren Fail 2011; 33:1040-2. [DOI: 10.3109/0886022x.2011.618921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Celik G, Demirci MS, Tumuklu M, Ascı G, Sipahi S, Toz H, Bascı A, Ok E. Factors related to pulse wave velocity and augmentation index in chronic hemodialysis patients. Ren Fail 2011; 33:957-63. [PMID: 21902600 DOI: 10.3109/0886022x.2011.615967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Augmentation index (AIx) and pulse wave velocity (PWV) are early markers of atherosclerotic vascular changes and also have been shown to be predictive of cardiovascular disease and total mortality. The aim of our study was to evaluate the relationship between PWV and AIx-HR75, which is the corrected form of AIx according to a heart rate of 75 beats/min, echocardiographic parameters and biochemical parameters in chronic hemodialysis (HD) patients. SUBJECTS AND METHODS AIx-HR75 and PWV were measured in 556 HD patients by applanation tonometry using the SphygmoCor device. RESULTS The mean PWV and AIx-HR75 values of the study group were 10.2 ± 2.4 and 28.4 ± 10.2 m/s. A positive correlation was found between PWV and AIx-HR75 (r = 0.214, p = 0.000). AIx-HR75 correlated with age (r = 0.093, p = 0.028), body surface area (BSA) (r = -0.194, p = 0.000), mean arterial pressure (MAP) (r = 0.335, p = 0.000), pulse pressure (PP) (r = 0.212, p = 0.000), cardiothoracic index (r = 0.155, p = 0.016), and presence of left ventricular hypertrophy (r = 0.152, p = 0.001). PWV correlated with MAP (r = 0.208, p = 0.000), PP (r = 0.098, r = 0.021), left ventricular mass (r = 0.105, p = 0.023), and predialysis sodium level (r = -0.105, p = 0.023). In the multivariate analyses, PWV was associated with MAP (t = 3.78, p = 0.000), presence of diabetes (t = 3.20, p = 0.001), and predialysis sodium level (t = -2.06, p = 0.040), and AIx-HR75 was associated with age (t = 2.48, p = 0.014), female sex (t = 3.98, p = 0.000), BSA (t = -2.15, p = 0.033), and MAP (t = 7.02, p = 0.000). CONCLUSION There is a strong association between MAP and arterial stiffness parameters in HD patients. We feel that efficient control of blood pressure could lead to reduced arterial stiffness in HD patients.
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Affiliation(s)
- Gülperi Celik
- Department of Internal Medicine, Division of Nephrology, Selçuklu School of Medicine, Seluk University, Konya, Turkey.
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Tatar E, Kircelli F, Asci G, Carrero JJ, Gungor O, Demirci MS, Ozbek SS, Ceylan N, Ozkahya M, Toz H, Ok E. Associations of triiodothyronine levels with carotid atherosclerosis and arterial stiffness in hemodialysis patients. Clin J Am Soc Nephrol 2011; 6:2240-6. [PMID: 21836150 DOI: 10.2215/cjn.02540311] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES End-stage renal disease is linked to alterations in thyroid hormone levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low triiodothyronine (T3) levels. These alterations are involved in endothelial damage, cardiac abnormalities, and inflammation, but the exact mechanisms are unclear. In this study, we investigated the relationship between serum free-T3 (fT3) and carotid artery atherosclerosis, arterial stiffness, and vascular calcification in prevalent patients on conventional hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS 137 patients were included. Thyroid-hormone levels were determined by chemiluminescent immunoassay, carotid artery-intima media thickness (CA-IMT) by Doppler ultrasonography, carotid-femoral pulse wave velocity (c-f PWV), and augmentation index by Sphygmocor device, and coronary artery calcification (CAC) scores by multi-slice computerized tomography. RESULTS Mean fT3 level was 3.70 ± 1.23 pmol/L. Across decreasing fT3 tertiles, c-f PWV and CA-IMT values were incrementally higher, whereas CACs were not different. In adjusted ordinal logistic regression analysis, fT3 level (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97), age, and interdialytic weight gain were significantly associated with CA-IMT. fT3 level was associated with c-f PWV in nondiabetics but not in diabetics. In nondiabetics (n = 113), c-f PWV was positively associated with age and systolic BP but negatively with fT3 levels (odds ratio = 0.57, 95% confidence interval 0.39 to 0.83). CONCLUSIONS fT3 levels are inversely associated with carotid atherosclerosis but not with CAC in hemodialysis patients. Also, fT3 levels are inversely associated with surrogates of arterial stiffness in nondiabetics.
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Affiliation(s)
- Erhan Tatar
- Ege University School of Medicine, Division of Nephrology, 35100, Bornova, Izmir, Turkey.
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Gungor O, Kircelli F, Tatar E, Toz H. Icodextrin-associated hepatotoxicity. Clin Kidney J 2011; 4:278. [PMID: 25949504 PMCID: PMC4421436 DOI: 10.1093/ndtplus/sfr065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ozkan Gungor
- Division on Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Fatih Kircelli
- Division on Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Erhan Tatar
- Division on Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Toz
- Division on Nephrology, Ege University School of Medicine, Izmir, Turkey
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Gungor O, Kircelli F, Demirci MS, Tuncel P, Sisman AR, Tatar E, Hur E, Asci G, Ok E, Toz H. Serum paraoxonase 1 activity predicts arterial stiffness in renal transplant recipients. J Atheroscler Thromb 2011; 18:901-5. [PMID: 21737961 DOI: 10.5551/jat.9175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins. Its activity decreases in dialysis patients but is restored after transplantation. Whether it affects arterial stiffness is unclear. In this study we aimed to investigate the effects of PON 1 on arterial stiffness in renal transplant patients. METHODS Seventy renal transplant recipients were enrolled. Arterial stiffness was measured using a Syphmocor device. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. RESULTS Mean age was 39.0 ± 9.6 years and 5.7% of the patients were diabetic. Post-transplant follow-up time was 46.7 ± 37.9 months. Eighty-five percent received anti-hypertensive and 12.9% anti-hyperlipidemic medication. Mean PON1 activity was 75.9 ± 52.4 U/L. PON1 activity was negatively correlated with systolic and diastolic blood pressure, mean arterial pressure, LDL-cholesterol and carotid-femoral pulse wave velocity (cf-PWV). Mean c-f PWV was 8.10 ± 1.39 m/s. Cf-PWV was positively correlated with age, systolic and diastolic blood pressure, mean arterial pressure, proteinuria and negatively correlated with PON1, PON1/HDL ratio and creatinine clearance. In linear regression analysis, PON1 was a predictor of cf-PWV in a model that included age, gender, diabetes, mean arterial pressure, urine protein level, creatinine clearance and PON 1. CONCLUSIONS Reduced PON1 activity is significantly associated with increased arterial stiffness. The results of this study show the possible role of PON1 for arterial stiffening in renal transplant recipients.
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Affiliation(s)
- Ozkan Gungor
- Ege University School of Medicine, Division of Nephrology, Izmir, Turkey.
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Gungor O, Kircelli F, Carrero JJ, Hur E, Demirci MS, Asci G, Toz H. The effect of immunosuppressive treatment on arterial stiffness and matrix Gla protein levels in renal transplant recipients. Clin Nephrol 2011; 75:491-6. [PMID: 21612751 DOI: 10.5414/cnp75491] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
INTRODUCTION Arterial stiffness is a risk marker for cardiovascular events. In this study we aimed to compare the effect on calcineurin inhibitors (CNI) and mammalian Target of Rapamycine inhibitors (mTORi) on arterial stiffness in renal transplant patients. PATIENTS AND METHODS 81 renal transplant patients under CNI-based or mTORi-based protocol for at least 6 months were included in the study. Arterial stiffness was measured by using the SphygmoCor device (AtCor Medical, Sydney, Australia). Vitamin K-dependent, calcification inhibitor matrix Gla protein (MGP) concentrations were quantified by ELISA methods (Biomedica, Vienna, Austria). RESULTS 34 patients were on mTORi-based and 47 on CNI-based immunosuppression. Mean age was 37.9 ± 10.8 (18 - 71) years and 45% were female. Age, gender, graft functions and follow-up period of the groups were similar. Augmentation index was 15.2 ± 12.6% in CNI and 18.8 ± 14.0% in mTORi groups (p > 0.05). There was no difference regarding carotid-femoral pulse wave velocity between groups. Arterial stiffness was positively correlated with age, total cholesterol, LDL cholesterol, mean arterial pressure (MAP) and proteinuria. MGP levels were higher in the mTORi group but were not predictors for carotid-femoral pulse wave velocity. CONCLUSION Rather than specific immunosuppressive drug effects, conventional risk factors, blood pressure and proteinuria are the most important predictors for arterial stiffness in renal transplant patients.
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Affiliation(s)
- O Gungor
- Ege University School of Medicine, Division of Nephrology, Izmir, Turkey.
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Kallenberg CGM, Specks U, Stone JH, Ok E, Asci G, Sevinc Ok E, Kircelli F, Yilmaz M, Hur E, Demirci MS, Ozdogan O, Demirci C, Sertoz OO, Duman S, Ozkahya M, Kayikcioglu M, Elbi H, Basci A, Toz H, Grooteman M, van den Dorpel R, Bots M, Penne L, van der Weerd N, Mazairac A, den Hoedt C, van der Tweel I, Levesque R, Nube M, ter Wee P, Blankestijn P, Pergola PE, Raskin P, Toto RD, Meyer CJ, Grossman EB, Krauth M, Ruiz S, Audhya P, Christ-Schmidt H, Wittes J, Warnock DG. Late breaking clinical trials 1. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kuo KL, Hung SC, Tarng DC, Selim G, Stojceva-Taneva O, Tozija L, Gelev S, Stojcev N, Dzekova P, Trajcevska L, Severova G, Pavleska S, Sikole A, Combe C, Thumma J, Gillespie B, De Sequera P, Yamamoto H, Robinson B, Matsushita Y, Tasaki H, Tohara Y, Yamauchi E, Matsuoka K, Arizono K, Bellasi A, Ferramosca E, Ratti C, Block G, Raggi P, Drozdz M, Krasniak A, Chmiel G, Podolec P, Pasowicz M, Tracz W, Kowalczyk-Michalek M, Sulowicz W, Kalantzi K, Korantzopoulos P, Bechlioulis A, Vlachopanou A, Foulidis V, Pagiati E, Nikolopoulos P, Gouva C, Arroyave I, Rodelo J, Cardona M, Garcia A, Henao J, Mejia G, Rico J, Arbelaez M, Fujimori A, Okada S, Yamamoto K, Okamoto S, Kamiura N, Sakai M, Tanikake M, Kutlay S, Sengul S, Keven K, Nergizoglu G, Erturk S, Ates K, Duman N, Karatan O, Erbay B, Sameiro-Faria M, Costa E, Rocha-Pereira P, Borges A, Nascimento H, Mendonca D, Amado L, Reis F, Miranda V, Quintanilha A, Belo L, Santos-Silva A, Oh JS, Kim SM, Sin YH, Kim JK, Ishihara M, Otsubo S, Kimata N, Akiba T, Nitta K, Kim KM, Baek CH, Kim SB, Testa A, Sanguedolce MC, Spoto B, Mallamaci F, Malatino L, Tripepi G, Zoccali C, Lee JE, Moon SJ, Kim JK, An HR, Ha SK, Pakr HC, Bahlmann FH, Becker E, Sperber V, Triem S, Noll C, Zewinger S, Fliser D, Laufs U, Thijssen S, Usvyat LA, Raimann JG, Balter P, Kotanko P, Levin NW, Hornum M, Bay JT, Clausen P, Melchior Hansen J, Mathiesen ER, Feldt-Rasmussen B, Garred P, Sural S, Panja CS, Bhattacharya SK, Cernaro V, Lacquaniti A, Lorenzano G, Romeo A, Donato V, Buemi M, Raimann JG, Usvyat L, Thijssen S, Rogus J, Lacson E, Kotanko P, Levin NW, Robinson BM, Karaboyas A, Sen A, Hecking M, Mendelssohn D, Jadoul M, Kawanishi H, Saran R, Kolarz M, Undas A, Wyroslak J, Malyszko J, Klejna K, Naumnik B, Koc-Zurawska E, Mysliwiec M, Piecha G, Kuczera P, Adamczak M, Fedorova OV, Bagrov AY, Wiecek A, Gungor O, Kircelli F, Asci G, Carrero JJ, Tatar E, Demirci M, Toz H, Ozkahya M, Ok E, Bansal V, Shareain K, Hoppensteadt D, Litinas E, Fareed J, Kim MJ, Lee SW, Song JH, Kweon J, Kim WH, Sasaki K, Yasuda K, Hatanaka M, Hayashi T, Katsipi I, Tatsiopoulos A, Papanikolaou P, Doulgerakis C, Kollia K, Kardouli E, Asmanis E, Gennadiou M, Kyriazis J, Panizo S, Barrio-Vazquez S, Carrillo-Lopez N, Fernandez-Vazquez A, Braga S, Rodriguez-Rebollar A, Naves-Diaz M, Cannata-Andia JB, Nikodimopoulou M, Liakos S, Kapoulas S. Cardiovascular complications in CKD 5D (1). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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