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Article ; Online: Factors Influencing Hemoglobin Variability and Its Association with Mortality in Hemodialysis Patients.

Bal, Zeynep / Demirci, Bahar Gurlek / Karakose, Suleyman / Tutal, Emre / Erkmen Uyar, Mehtap / Acar, Nurhan Ozdemir / Sezer, Siren

TheScientificWorldJournal

2018 Volume 2018, Page(s) 8065691

Abstract: Purpose: We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients.: Methods: One hundred and sixty-nine patients ... ...

Abstract	Purpose: We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods: One hundred and sixty-nine patients during the entire 12 months were enrolled into the study. Fasting plasma glucose, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), C-reactive protein (CRP), serum iron, serum iron-binding capacity, and transferrin saturation were analyzed. We defined six groups: low, target range, high, low-amplitude fluctuation with low hemoglobin levels, low-amplitude fluctuation with high hemoglobin levels, and high-amplitude fluctuation. Body mass index (BMI), malnutrition-inflammation score (MIS), and Charlson Comorbidity Index were evaluated. Results: Hemoglobin variability was significantly correlated with age, platelet count, and number of hospitalization instances and inversely correlated with erythropoietin dose per body surface area. The coefficient of variation of hemoglobin showed a correlation with MIS and ferritin. The absolute level of hemoglobin showed a negative correlation between PTH, CRP, MIS, number of hospitalization instances and a positive correlation with albumin and BMI. High, low, and target-range groups showed survival advantage compared to the other three groups. In regression analysis, age, CRP levels, MIS, and BMI were the predictors of mortality. Conclusion: Inflammation and duration of anemia were the major predictors of hemoglobin variability. High-amplitude fluctuation predicts high mortality; on the contrary low-amplitude fluctuations is related to better survival. MIS was independently associated with mortality. This trial is registered with NCT03454906.
MeSH term(s)	Demography ; Female ; Hemoglobins/metabolism ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Renal Dialysis/mortality
Chemical Substances	Hemoglobins
Language	English
Publishing date	2018-04-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2075968-X
ISSN	1537-744X ; 1537-744X
ISSN (online)	1537-744X
ISSN	1537-744X
DOI	10.1155/2018/8065691
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Prolongation of Corrected QT Interval Is a Strong Predictor of Arterial Stiffness in Maintenance Hemodialysis Patients

Zeynep Bal / Ugur Bal / Suleyman Karakose / Emre Tutal / Mehtap Erkmen Uyar / Siren Sezer

International Cardiovascular Research Journal, Vol 11, Iss 1, Pp 1-

A Prospective Observational Study

2017 Volume 6

Abstract: Background: Rate of mortality due to cardiovascular diseases is high in Maintenance Hemodialysis (MHD) patients. Additionally, prolonged QT interval is reportedly associated with high-risk ventricular arrhythmia and sudden death. Vascular calcification ... ...

Abstract	Background: Rate of mortality due to cardiovascular diseases is high in Maintenance Hemodialysis (MHD) patients. Additionally, prolonged QT interval is reportedly associated with high-risk ventricular arrhythmia and sudden death. Vascular calcification may be related to QT dispersion interval in MHD patients because the extensive nature of the calcification process may involve the conducting system and myocardium. Objectives: This study aimed to evaluate the relationship between QT interval and Pulse Wave Velocity (PWV) as a sign of arterial stiffness associated with atherosclerosis in MHD patients. Patients and Methods: This prospective, observational study was conducted on 149 eligible MHD patients for 12 months. Patients using drugs known to affect QT interval were excluded. The patients were divided into four groups as follows: normal corrected QT (QTc) interval at the beginning and end of the study (n = 44, 29.5%), normal QTc interval at the beginning but prolonged QTc interval at the end of the study (n = 30, 20.1%), prolonged QTc interval at the beginning but normal QTc interval at the end of the study (n = 24, 16.1%), and prolonged QTc interval at the beginning and end of the study (n = 51, 34.2%). Demographic parameters, laboratory parameters, and PWV were assessed at the beginning and the 12th month of the study. Then, the data were analyzed using ANOVA or Pearson 2 test and P < 0.05 was considered to be statistically significant. Results: The study groups were similar with respect to age and comorbidities, including diabetes mellitus, hypertension, and dyslipidemia. In addition, there were no significant differences among the groups regarding the initial PWV (P = 0.412); however, the ending PWV showed significant differences (P = 0.029). The results of multivariate analysis showed that PWV was independently associated with change in the maximum QTc (confidence interval: 0.039 – 1.787, P = 0.031, β = 0.178). Conclusions: The results suggested inclusion of QTc interval prolongation, as a predictor of cardiovascular disease, either alone or in combination with PWV in such high-risk patients.
Keywords	Vascular Stiffness ; Chronic Kidney Disease ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2017-03-01T00:00:00Z
Publisher	Shiraz University of Medical Sciences
Document type	Article ; Online
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Article ; Online: Factors Influencing Hemoglobin Variability and Its Association with Mortality in Hemodialysis Patients

Zeynep Bal / Bahar Gurlek Demirci / Suleyman Karakose / Emre Tutal / Mehtap Erkmen Uyar / Nurhan Ozdemir Acar / Siren Sezer

The Scientific World Journal, Vol

2018 Volume 2018

Abstract: Purpose. We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods. One hundred and sixty-nine patients during ... ...

Abstract	Purpose. We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods. One hundred and sixty-nine patients during the entire 12 months were enrolled into the study. Fasting plasma glucose, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), C-reactive protein (CRP), serum iron, serum iron-binding capacity, and transferrin saturation were analyzed. We defined six groups: low, target range, high, low-amplitude fluctuation with low hemoglobin levels, low-amplitude fluctuation with high hemoglobin levels, and high-amplitude fluctuation. Body mass index (BMI), malnutrition-inflammation score (MIS), and Charlson Comorbidity Index were evaluated. Results. Hemoglobin variability was significantly correlated with age, platelet count, and number of hospitalization instances and inversely correlated with erythropoietin dose per body surface area. The coefficient of variation of hemoglobin showed a correlation with MIS and ferritin. The absolute level of hemoglobin showed a negative correlation between PTH, CRP, MIS, number of hospitalization instances and a positive correlation with albumin and BMI. High, low, and target-range groups showed survival advantage compared to the other three groups. In regression analysis, age, CRP levels, MIS, and BMI were the predictors of mortality. Conclusion. Inflammation and duration of anemia were the major predictors of hemoglobin variability. High-amplitude fluctuation predicts high mortality; on the contrary low-amplitude fluctuations is related to better survival. MIS was independently associated with mortality. This trial is registered with NCT03454906.
Keywords	Technology ; T ; Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2018-01-01T00:00:00Z
Publisher	Hindawi Limited
Document type	Article ; Online
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Article ; Online: Hypoalbuminemia, Poor Calcium-Phosphorus Control and High Transporter Peritoneal Characteristics – Three Important 10-Year Survival Predictors for Peritoneal Dialysis Patients

Emre TUTAL / Zeynep BAL / Siren SEZER / Mehtap ERKMEN UYAR

The Turkish Nephrology, Dialysis and Transplantation Journal, Vol 23, Iss 1, Pp 008-

2014 Volume 013

Abstract: OBJECTIVE: Peritoneal transport characteristic is a potential survival predictor. In this study we evaluated the effect of transport characteristics on 10 year patient survival and compared its’ impact with other possible survival predictors. MATERIAL ... ...

Abstract	OBJECTIVE: Peritoneal transport characteristic is a potential survival predictor. In this study we evaluated the effect of transport characteristics on 10 year patient survival and compared its’ impact with other possible survival predictors. MATERIAL and METHODS: We included 75 CAPD patients who were followed in our center for at least 10 years after initiation of PD. Based on the standard peritoneal equilibration test, PD patients were divided into two transporter groups: Low / Low average (n:27) and High / High Average (n:48). Clinical and demographic data were collected from patient charts and impact of transporter characteristics and some other well-known survival predictors were studied. RESULTS: 10 year PD survival rates were signifi cantly lower in H/HA group (p:0.001). Atherosclerosis-related mortality rate was signifi cantly higher in H/HA group (45.9% vs. 7.6%, p:0.043). Hypoalbuminemia, increased CaxP, chronic infl ammation, H/HA transport status were independent predictors of PD and patient survival. Further analysis revealed that hypoalbuminemia (p:0.0001) and increased CaxP levels (p:0.0001) were the main predictors. CONCLUSION: This study suggests that peritoneal transport status is an important survival predictor. However keeping the calcium and phosphorus levels in recommended ranges, and improving nutritional status still have more importance for lowering mortality rates of PD patients.
Keywords	Hypoalbuminemia ; Calcium-Phosphorus product ; High transporter peritoneum ; Survival predictors ; Peritoneal dialysis ; Diseases of the genitourinary system. Urology ; RC870-923 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Language	Turkish
Publishing date	2014-01-01T00:00:00Z
Publisher	Turkish Society of Nephrology
Document type	Article ; Online
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Article ; Online: Genitourinary Tuberculosis after Renal Transplantation

Zeynep BAL / Mehtap ERKMEN UYAR / Hamdi KARAKAYALI

The Turkish Nephrology, Dialysis and Transplantation Journal, Vol 20, Iss 3, Pp 299-

2011 Volume 300

Abstract: Tuberculosis (TB) is a major opportunistic infection after renal transplantation. The incidence of TB in the general population is high in developing countries including our country. The risk of TB in renal transplant recipients is reported to be 20–74 ... ...

Abstract	Tuberculosis (TB) is a major opportunistic infection after renal transplantation. The incidence of TB in the general population is high in developing countries including our country. The risk of TB in renal transplant recipients is reported to be 20–74 times higher than that in the general population. Genitourinary TB that occurs after renal transplantation is uncommon. An increased risk of graft rejection and graft loss has been reported. We present a case of genitourinary tuberculosis after renal transplantation, along with its clinical and laboratory properties.
Keywords	Genitourinary tuberculosis ; Renal transplant ; Diseases of the genitourinary system. Urology ; RC870-923 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Language	Turkish
Publishing date	2011-09-01T00:00:00Z
Publisher	Turkish Society of Nephrology
Document type	Article ; Online
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Article ; Online: New-onset diabetes and glucose regulation are significant determinants of left ventricular hypertrophy in renal transplant recipients.

Sezer, Siren / Erkmen Uyar, Mehtap / Tutal, Emre / Bal, Zeynep / Guliyev, Orhan / Colak, Turan / Hasdemir, Efe / Haberal, Mehmet

Journal of diabetes research

2015 Volume 2015, Page(s) 293896

Abstract: Background: New-onset diabetes after transplantation (NODAT) is associated with decreased graft survival and an increased risk for cardiovascular disease. The objective of this study was to evaluate the risk factors for development of NODAT and its' ... ...

Abstract	Background: New-onset diabetes after transplantation (NODAT) is associated with decreased graft survival and an increased risk for cardiovascular disease. The objective of this study was to evaluate the risk factors for development of NODAT and its' relationship with arterial stiffness and left ventricular mass index (LVMI) in kidney transplant recipients. Methods: 159 kidney transplant recipients were selected from our transplantation center who underwent renal transplantation between years 2007 and 2010. Results: Among 159 patients, 57 (32.2%) patients were with NODAT who were significantly older than patients without diabetes (P: 0.0001). Patients with NODAT had significantly higher pulse wave velocity (PWv) (P: 0.033) and left ventricular mass index LVMI (P: 0.001) compared to patients without NODAT. Further analysis was done according to LVMI as follows: LVMI > 130 g/m(2) (n: 57) and LVMI ≤ 130 g/m(2) (n: 102). We observed higher office systolic and diastolic BP, serum trygliceride, glucose, creatinine, age, and HbA1c (P: 0.0001) levels in patients with LVMI > 130 g/m(2). Linear regression analysis revealed that HbA1c was the major determinant of LVMI (P: 0.026, β: 0.361). Conclusions: HbA1c is the major determinant of LVMI, so strict control of serum glucose levels is essential for preventing cardiovascular disease in patients with NODAT.
MeSH term(s)	Adult ; Blood Glucose/metabolism ; Blood Pressure/physiology ; Diabetes Mellitus/blood ; Diabetes Mellitus/diagnosis ; Diabetes Mellitus/physiopathology ; Female ; Humans ; Hypertrophy, Left Ventricular/blood ; Hypertrophy, Left Ventricular/etiology ; Hypertrophy, Left Ventricular/physiopathology ; Kidney/physiopathology ; Kidney Transplantation ; Male ; Middle Aged ; Vascular Stiffness/physiology
Chemical Substances	Blood Glucose
Language	English
Publishing date	2015-04-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2711897-6
ISSN	2314-6753 ; 2314-6745
ISSN (online)	2314-6753
ISSN	2314-6745
DOI	10.1155/2015/293896
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Article ; Online: Iloprost as an acute kidney injury-triggering agent in severely atherosclerotic patients.

Uyar, Mehtap Erkmen / Yucel, Piril / Ilin, Sena / Bal, Zeynep / Yildirim, Saliha / Uyar, Ahmet Senol / Akay, Tankut / Tutal, Emre / Sezer, Siren

Cardiovascular journal of Africa

2016 Volume 27, Issue 3, Page(s) 128–133

Abstract: Background: Iloprost, a stable prostacyclin analog, is used as a rescue therapy for severe peripheral arterial disease (PAD). It has systemic vasodilatory and anti-aggregant effects, with severe vasodilatation potentially causing organ ischaemia when ... ...

Abstract	Background: Iloprost, a stable prostacyclin analog, is used as a rescue therapy for severe peripheral arterial disease (PAD). It has systemic vasodilatory and anti-aggregant effects, with severe vasodilatation potentially causing organ ischaemia when severe atherosclerosis is the underlying cause. In this study, we retrospectively analysed renal outcomes after iloprost infusion therapy in 86 patients. Methods: Eighty-six patients with PAD who received iloprost infusion therapy were retrospectively analysed. Clinical and biochemical parameters were recorded before (initial, Cr1), during (third day, Cr2), and after (14th day following the termination of infusion therapy, Cr3) treatment. Acute kidney injury (AKI) was defined according to KDIGO guidelines as a ≥ 0.3 mg/dl (26.52 µmol/l) increase in creatinine levels from baseline within 48 hours. Results: Cr2 (1.46 ± 0.1 mg/dl) (129.06 ± 8.84 µmol/l) and Cr3 (1.53 ± 0.12 mg/dl) (135.25 ± 10.61 µmol/l) creatinine levels were significantly higher compared to the initial value (1.15 ± 0.6 mg/dl) (101.66 ± 53.04 µmol/l). AKI was observed in 36 patients (41.86%) on the third day of iloprost infusion. Logistic regression analysis revealed smoking and not using acetylsalicylic acid as primary predictors (p = 0.02 and p = 0.008, respectively) of AKI during iloprost treatment. On the third infusion day, patients' urinary output significantly increased (1813.30 ± 1123.46 vs 1545.17 ± 873.00 cm Conclusion: While iloprost treatment is effective in patients with PAD who are not suitable for surgery, severe systemic vasodilatation can cause renal ischaemia, resulting in nonoliguric AKI. Smoking, no acetylsalicylic acid use, and lower diastolic blood pressure are the clinical risk factors for AKI during iloprost treatment.
MeSH term(s)	Acute Kidney Injury/blood ; Acute Kidney Injury/chemically induced ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/mortality ; Aged ; Aged, 80 and over ; Arterial Pressure ; Aspirin/therapeutic use ; Atherosclerosis/diagnostic imaging ; Atherosclerosis/drug therapy ; Atherosclerosis/mortality ; Atherosclerosis/physiopathology ; Biomarkers/blood ; Chi-Square Distribution ; Creatinine/blood ; Female ; Humans ; Iloprost/administration & dosage ; Iloprost/adverse effects ; Infusions, Intravenous ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/administration & dosage ; Platelet Aggregation Inhibitors/adverse effects ; Protective Factors ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Smoking/adverse effects ; Time Factors ; Treatment Outcome ; Up-Regulation ; Vasodilator Agents/administration & dosage ; Vasodilator Agents/adverse effects
Chemical Substances	Biomarkers ; Platelet Aggregation Inhibitors ; Vasodilator Agents ; Creatinine (AYI8EX34EU) ; Iloprost (JED5K35YGL) ; Aspirin (R16CO5Y76E)
Language	English
Publishing date	2016-05
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2383233-2
ISSN	1680-0745 ; 1996-3467 ; 1015-9657 ; 1995-1892
ISSN (online)	1680-0745 ; 1996-3467
ISSN	1015-9657 ; 1995-1892
DOI	10.5830/CVJA-2015-051
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Zs.A 4813: Show issues

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Article ; Online: Long-term oral nutrition supplementation improves outcomes in malnourished patients with chronic kidney disease on hemodialysis.

Sezer, Siren / Bal, Zeynep / Tutal, Emre / Uyar, Mehtap Erkmen / Acar, Nurhan Ozdemir

JPEN. Journal of parenteral and enteral nutrition

2014 Volume 38, Issue 8, Page(s) 960–965

Abstract: Background: There is no consensus on the type, time of initiation, or duration of use of enteral nutrition in patients with chronic kidney disease (CKD). This study aimed to compare the effects of a renal-specific oral nutrition supplement (RS-ONS) and ... ...

Abstract	Background: There is no consensus on the type, time of initiation, or duration of use of enteral nutrition in patients with chronic kidney disease (CKD). This study aimed to compare the effects of a renal-specific oral nutrition supplement (RS-ONS) and a standard recommended nutrition regime on biochemical and nutrition markers in malnourished patients with CKD on hemodialysis. Methods: Sixty-two malnourished patients with CKD, divided into experimental (RS-ONS; n = 32; mean [SD] age, 62.0 [11.3] years; 55.2% female) and control (CON; n = 30; mean [SD] age, 57.2 [12.3] years; 31% female) groups, were evaluated for anthropometric, biochemical, and inflammatory parameters. Results: Mean (SD) serum albumin levels were significantly increased in the RS-ONS group from 3.5 (0.3) g/dL at baseline to 3.7 (0.2) g/dL at 6 months (P = .028). Significantly fewer patients had serum albumin levels of <3.5 g/dL after month 6. Dry weight of patients significantly increased in the RS-ONS but decreased in the CON groups (P < .001 for each). Percent change from baseline revealed negative results for bioelectrical impedance analysis (P < .001) in the CON group. Malnutrition inflammation score at 6 months (P = .006) and erythropoietin (EPO) dose requirements were higher in the CON group (P = .012). Conclusions: Our findings indicate that consuming RS-ONS improves serum albumin and anthropometric measures, as well as reduces EPO dose, in patients with CKD.
MeSH term(s)	Administration, Oral ; Aged ; Body Weight ; Dietary Supplements ; Electric Impedance ; Erythropoietin/administration & dosage ; Female ; Humans ; Male ; Malnutrition/blood ; Malnutrition/diet therapy ; Malnutrition/etiology ; Middle Aged ; Nutritional Status ; Renal Dialysis/adverse effects ; Renal Insufficiency, Chronic/blood ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/therapy ; Serum Albumin/metabolism
Chemical Substances	Serum Albumin ; Erythropoietin (11096-26-7)
Language	English
Publishing date	2014-01-16
Publishing country	United States
Document type	Controlled Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	800861-9
ISSN	1941-2444 ; 0148-6071
ISSN (online)	1941-2444
ISSN	0148-6071
DOI	10.1177/0148607113517266
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Article: Combined Brucella melitensis and Staphylococcus aureus endocarditis in a patient with a prosthetic aortic valve with fatal outcome.

Karahocagil, Mustafa / Karanfil, Aydin / Uyar, Mehtap Erkmen

European journal of internal medicine

2005 Volume 16, Issue 7, Page(s) 534

Language	English
Publishing date	2005-11
Publishing country	Netherlands
Document type	Letter
ZDB-ID	1038679-8
ISSN	0953-6205
ISSN	0953-6205
DOI	10.1016/j.ejim.2005.05.003
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Article: The influence of socioeconomic factors on depression in maintenance hemodialysis patients and their caregivers.

Sezer, Siren / Uyar, Mehtap Erkmen / Bal, Zeynep / Tutal, Emre / Ozdemir Acar, F Nurhan

Clinical nephrology

2013 Volume 80, Issue 5, Page(s) 342–348

Abstract: Aim: A Depression has a strong impact on the quality of life of patients receiving maintenance hemodialysis (MHD). The objective of this study was to analyze the factors influencing the depression scores of MHD patients and their primary caregivers.: ... ...

Abstract	Aim: A Depression has a strong impact on the quality of life of patients receiving maintenance hemodialysis (MHD). The objective of this study was to analyze the factors influencing the depression scores of MHD patients and their primary caregivers. Methods: 141 patients (54 female, aged 53.6 ± 14.2 years) who had been on MHD for at least 3 months were included. Age, gender, etiology of renal disease, duration of dialysis, marital and employment status, and income and living status of patients were recorded from patient charts and through face-to-face interviews. Disability was assessed by a selfadministered questionnaire. Additionally, 40 of the 141 patients (28%) primary caregivers were interviewed face-to-face. All patients and 40 primary caregivers were evaluated for the presence of depressive symptoms by Beck Depression Inventory (BDI). Results: Moderate to severe depressive symptoms were found in 36.2% of the study group. Divorced patients were significantly more depressed (p < 0.02) than married or single patients. Patients living with and being cared for by their nuclear family (father, mother, and/or children) were less depressed than patients being cared for by other relatives (p < 0.009). Monthly income was negatively correlated with both patients' and primary caregivers' BDI score (p < 0.005). Patients with high disability scores were more depressed than nondisabled patients (p < 0.08). Primary caregivers' BDI scores were positively correlated with the patients' BDI scores (p < 0.0001). Binary logistic regression analysis revealed that higher depression scores were significantly associated with more than 3 children under guardianship (p < 0.01) and higher disability scores (p < 0.023). Conclusion: In this present study, we observed that economically, socially, and physically self-sufficient MHD patients had lower depression rates. The treatment of depression and social and psychological support for both the patient and the family members are essential for better medical status among MHD patients.
MeSH term(s)	Adult ; Aged ; Caregivers/psychology ; Depression/etiology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Quality of Life ; Renal Dialysis/psychology ; Socioeconomic Factors
Language	English
Publishing date	2013-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	185101-9
ISSN	0301-0430
ISSN	0301-0430
DOI	10.5414/CN107742
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