[Show abstract][Hide abstract] ABSTRACT: Abstract Introduction: Long-term exposure to dialysis solutions is an important contributor to the ongoing inflammatory process in peritoneal dialysis (PD) patients. Some studies have shown amelioration of this adverse effect with biocompatible solutions. We aimed to compare the neutrophil-to-lymphocyte (N/L) ratio in PD patients using biocompatible and standard solutions and to find out the association between N/L ratio and peritonitis indices. Materials and methods: This was a cross-sectional, multicenter study involving 120 prevalent PD patients. Seventy-one patients (59%) were using biocompatible solutions and 49 patients (41%) were using standard solutions. From blood samples, N/L ratio and platelet-to-lymphocyte ratio were calculated and mean platelet volume, erythrocyte sedimentation rate and hs-CRP values were detected. Data regarding the peritonitis rate and time to first peritonitis episode were also recorded. Results: Biocompatible and standard groups were similar regarding age and gender. N/L ratio and hs-CRP levels have been found significantly higher in patients using biocompatible solutions (3.75 ± 1.50 vs. 3.27 ± 1.3, p = 0.04 and 3.2 ± 2.5 vs. 1.8 ± 2.0, p < 0.01, respectively). Peritonitis rates and time to the first peritonitis episode were found similar in patients using both types of solutions (0.23 ± 0.35 vs. 0.27 ± 0.32, p = 0.36 and 32.8 ± 35.8 vs. 21.5 ± 26.9 months, p = 0.16, respectively). Discussion: N/L ratio was significantly higher in biocompatible solution users in parallel to hs-CRP levels, so biocompatible solutions seem to be related with increased inflammation in PD patients. Although we cannot make a certain explanation, we assume that there may be an association between acidity of the peritoneal content and virulence of microorganisms.
[Show abstract][Hide abstract] ABSTRACT: Background: Chronic Heart Failure (CHF) is highly prevalent and is associated with high morbidity and mortality rates. It has been well established that excessive intake of sodium chloride (salt) induced hypertension in some populations. Although salt seems to induce cardiovascular diseases through elevation of blood pressure, it has also been indicated that salt can induce cardiovascular diseases independently from blood pressure elevation. Objectives: The present study aimed to evaluate the association between salt consumption and inflammation in CHF patients. Patients and Methods: This study was conducted on 86 patients between 18 and 65 years old who were diagnosed with New York Heart Association (NYHA) functional class I and II heart failure. Salt intake was calculated by using 24 hour urine sodium excretion. Besides, the association between inflammation and daily salt intake was evaluated regarding C -reactive protein (CPR), High sensitive CRP (HsCPR), Erythrocyte Sedimentation Rate (ESR), and ferritin and fibrinogen levels using Pearson correlation analysis. Results: Our results showed a statistically significant difference between the low (n = 41) and high (n = 45) salt intake groups in terms of serum HsCRP levels (5.21 ± 2.62 vs. 6.36 ± 2.64) (P < 0.048). Additionally, a significant correlation was observed between the amount of salt consumption and HsCRP levels. In this study, daily salt consumption of the enrolled patients was 8.53 gram/day. The medications and even the blood pressures were similar in the two groups, but daily pill count, prevalence of hypertension, and coronary heart disease were higher in the high salt intake group; however, the differences were not statistically significant (P = 0.065). Also, no significant difference was observed between the groups concerning the inflammation markers, such as CRP, ESR, ferritin, and fibrinogen. Conclusions: Neurohumoral and inflammatory factors are thought to contribute to high mortality and morbidity rates in CHF. Yet, inflammatory markers may early diagnose CHF and predict the prognosis. Excessive salt intake also worsens the inflammation as well as volume control. ►Implication for health policy/practice/research/medical education: Our work is about the association of inflammation and salt intake in chronic heart failure patients. Salt restriction is recommended to these patients. This approach may also contribute to lower the degree of inflammation besides volume and blood pressure control. Even there has been no intervention in our study, our results show the association between salt intake and inflammation in patients with heart failure.
International cardiovascular research journal. 05/2014; 8(3).
[Show abstract][Hide abstract] ABSTRACT: Abstract Background: Coagulation abnormalities have been reported in familial Mediterranean fever (FMF) patients with amyloidosis and nephrotic syndrome; but there is not enough data about the continuity of the thrombogenic activity in FMF patients in clinical remission. The purpose of this study was to assess thrombin activatable fibrinolysis inhibitor (TAFI) levels and its relationship with fibrinolytic activity and also evaluate relationships between mutations and clinical signs in attack-free patients without amyloidosis. Methods: Seventy-nine FMF patients and 40 healthy adults were included. The study group was divided into five groups as follows: first group, homozygote M694V; second group, homozygote M680I; third group, M694V in one allele, the other allele have other mutations or not; fourth group, other mutations; and fifth group, no mutation. Results: Serum TAFI levels were significantly increased in patients compared with healthy individuals (116.64 ± 21.8 vs. 78.48 ± 19.7 μg/mL, p < 0.001) and a positive correlation was detected between TAFI antigen level and erythrocyte sedimentation rate and C-reactive protein levels (r = 0.247, p = 0.029 and r = 0.252, p = 0.032, respectively). Mean fibrinogen and TAFI levels were significantly higher in Group 1 than the other groups (p = 0.04 and p = 0.001, respectively) and in Group 3 it was higher than Groups 2, 4 and 5 (p = 0.04 and p = 0.001, respectively). Conclusions: High level of TAFI antigen in attack-free period of FMF disease shows ongoing subclinical inflammation and hypercoagulability. Clinicians should be careful about thrombosis even in patients at clinical remission. Also, genetic tests must be considered to predict clinical outcome and to reduce complications of FMF disease.
[Show abstract][Hide abstract] ABSTRACT: Despite the developments in modern medicine, acute renal injury is still a challenging and common health problem. It is well known that ischaemia and reperfusion takes place in pathological mechanisms. Efforts to clarify the pathophysiology and interventions to improve outcomes are essential. Our study aimed to investigate whether the prophylactic use of paricalcitol is beneficial in renal ischaemia/reperfusion (I/R) injury.
Twenty-four Wistar albino rats were assigned randomly to four groups. Right nephrectomies were performed at the time of renal arterial clamping. Sham surgery was performed on the rats in group 1. For the rats in group 2, the left renal artery was clamped for 45 minutes. The rats in group 3 received paricalcitol for seven days (0.2μg/kg/day); following this, a right nephrectomy and left renal arterial clamping were not performed. The rats in group 4 received paricalcitol for seven days (0.2μg/kg/day); following this, a right nephrectomy and left renal arterial clamping for 45 minutes were performed. Tissue thiobarbituric acid reactive substances (TBARS), superoxide dismutase, sulfhydryl groups as well as nitric oxide metabolites, serum urea and creatinine levels were measured for all four groups.
In group 4, there were some improvements in terms of TBARS, nitrite, nitrate, superoxide dismutase and creatinine levels. In the histopathological evaluation, paricalcitol therapy improved tubular necrosis and medullar congestion but there was no significant difference in terms of tubular cell swelling, cellular vacuolisation or general damage. Immunohistopathological examination revealed lower scores for vascular endothelial growth factor in the group 4 rats than in group 2.
Paricalcitol therapy improved renal I/R injury in terms of serum and histopathological parameters. These potential beneficial effects need to be further investigated.
Annals of The Royal College of Surgeons of England 10/2013; 95(7):489-494. · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Aim: We aimed to investigate the QT dispersion and corrected QT (QTc) dispersion which are suggested as the signals of ventricular arrhythmias, in patients on maintenance CAPD and to evaluate the correlation between iron stores and these electrocardiographic parameters. Materials and method: Fifty-eight patients on maintenance CAPD and 19 healthy age- and sex-matched adults without cardiac disease were included. The PD patients were divided into two groups according to whether their computerized measurements of QTc dispersion were longer than 65 ms. Results: Although QT interval was statistically significantly shorter in control group (34 ± 28 vs. 43 ± 34 ms; p < 0.05), there was no significant difference in regards to the QTc, QT dispersion and QTc dispersion between two groups. PD patients with QTc dispersion longer than 65 ms had higher levels of serum ferritin (p = 0.038) and transferrin saturation (TSAT; p = 0.022) than the others. QTc dispersion were positively correlated with ferritin (r = 0.469, p < 0.01) and TSAT (r = 0.430, p < 0.01) in CAPD patients. Conclusion: Although prolonged QTc, QT dispersion and QTc dispersion were suggested as the markers of ventricular arrhythmias we did not find any significant difference in regards to these parameters between control patients and CAPD patients. But the high body iron stores in these patients increase the risk of increased QT dispersion. The concern over iron overload in dialysis patients is not only because of its oxidative toxicity, but also its precipitation of arrhythmias, which may be measured by the surrogate marker of QTc dispersion.
[Show abstract][Hide abstract] ABSTRACT: Patients diagnosed with chronic kidney disease (CKD) have a greater rate of cardiovascular mortality compared with the general population. The soluble form of TNF-like weak inducer of apoptosis (TWEAK) plays a role in cellular proliferation, migration, and apoptosis. The current study aimed to analyze whether soluble TWEAK levels are associated with the severity of coronary arterial disease (CAD) in CKD patients.
Ninety-seven patients diagnosed with CKD stages 2-3 according to their estimated glomerular filtration rate and the presence of kidney injury were included in the study. Plasma sTWEAK concentrations were determined using commercially available ELISA kits. Coronary angiographies were performed through femoral artery access using the Judkins technique.
Correlation analysis of sTWEAK and Gensini scores showed significant association (p < 0.01, r (2) = 0.287). When patients were divided into two groups with a limit of 17 according to their Gensini score, sTWEAK levels indicated a statistically significant difference (p < 0.01).
Our results indicate a relationship between sTWEAK levels and CAD in CKD stages 2-3 patients.
International Urology and Nephrology 09/2013; · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Introduction: Chronic kidney disease (CKD) is an important health care problem with increasing incidence. Early diagnosis, recognition and interventions to avoid the disease progression have great value. Even some risk factors for disease progression have been described; there are still some dark spots. Transforming growth factors (TGFs), particularly bone morphogenetic protein-7 (BMP7) take place in renal fibrosis. Our study aimed to evaluate the association between serum BMP7 levels and the progression of CKD. Materials and methods: Our study has been conducted between January 2008 and December 2010. Decrease in GFR by 10%, doubling of serum creatinine and need for renal replacement therapy have been set as progression end-points. Totally 93 patients (48 female, 45 male) have been included. Baseline and end of follow-up BMP7 levels have been measured. Results: At the end of the follow-up, 46 of 93 patients have been considered as having progressive CKD. Higher levels of serum BMP7 levels have been found to be associated in progressive kidney disease. Discussion: Our results showed that BMP7 levels were higher in patients with progressive CKD, and also BMP7 to be associated with CKD progression. But this relationship was not statistically significant. In patients with progressive CKD, higher levels of proteinuria and blood pressure have been previously described. The effect of BMP7 on kidneys is not still clear, it is hypothesized that TGF-beta1 inhibition may alter renal fibrosis.
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective: Although colchicine is effective on prevention and regression of amyloidosis in many cases, rate of unresponsiveness to colchicine therapy is not too low. However, there is no sufficient data about which factors effect to response of colchicine therapy on regression of amyloidosis. Materials and methods: 24 patients with renal amyloidosis were enrolled into the study. The patients were divided in two groups according to urinary protein excretions: non-nephrotic stage (14/24) and nephrotic stage (10/24). The patients were also categorized according to the etiology of amyloidosis; familial Mediterranean fever (FMF)-associated amyloidosis (15/24) versus rheumatoid disorders (RD)-associated amyloidosis (9/24). The changes of amount of proteinuria and estimated glomerular filtration rates were investigated after colchicine treatment started in these groups. Results: The mean follow-up period was 27.7 ± 19.2 months. After initiating colchicine therapy, the degree of proteinuria was decreased higher than 50% in 11/14 (78%) of non-nephrotic patients and elevated only in three (22%) patients. In nephrotic group, proteinuria was increased in 5/10 (50%) of patients. Glomerular filtration rates were stable in nephrotic and non-nephrotic groups. Presenting with nephrotic syndrome was higher in RD-associated amyloidosis (RD_A) group (5/9) than FMF-associated amyloidosis (FMF_A) group (5/15) without statistical significance (p > 0.05). After colchicine treatment, proteinuria was decreased in 12/15 patients in FMF_A group, however, the significant decreasing of proteinuria was not observed in RD_A group (p = 0.05 vs. p > 0.05). Conclusion: Colchicine therapy was found more effective in low proteinuric stage of amyloidosis. The beneficial effect of colchicine therapy was not observed in patients with RD- associated amyloidosis.
[Show abstract][Hide abstract] ABSTRACT: Abstract Introduction: Fas/FasL system plays an important role in the regulation of cell life and death, and circulating levels of sFasL have been shown to increase in some inflammatory conditions. However, there is no sufficient information about the levels of sFasL in patients with FMF. This study was designed to evaluate the serum sFasL levels in patients with FMF during attack and attack-free periods. Methods: Twenty-five FMF patients in attack and forty-four in free-attack period, and 20 age-, sex-, and BMI-matched healthy controls were included in this study. Participants with any chronic diseases were excluded. Blood samples were obtained within the first 24 h of the attack period and between febrile attacks, and levels of WBC, ESR, Fibrinogen, hsCRP and sFasL were determined. Results: The levels of traditional acute phase reactants during the attack were significantly higher than the attack-free and controls (p < 0.05). The serum sFasL levels in the FMF study groups did not differ from the control group (0.70 ± 0.08 vs. 0.73 ± 0.12; 0.70 ± 0.08 vs. 0.83 ± 0.14; 0.73 ± 0.12 vs. 0.83 ± 0.14, respectively, p > 0.05). Moreover, the sFasL levels during the attack were not significantly different from those in attack-free patients (0.70 ± 0.08 vs. 0.83 ± 0.14, p > 0.05). Conclusion: In this study, we demonstrated that serum sFasL levels were not markedly affected in FMF and cannot be used as a supportive marker to differentiate attacks from attack-free periods. However, further studies are needed to determine its usefulness as a marker in clinical practice.
[Show abstract][Hide abstract] ABSTRACT: The first influenza pandemic of this century happened through a rapid spread of a novel swine-derived H1N1 influenza virus. Vaccines are produced in order to avoid the infection. Children and other high risk groups are highly recommended for vaccination due to the high probability of contracting the virus. Chronic kidney disease patients were also accepted as a risk group and vaccination of all patients undergoing hemodialysis or peritoneal dialysis was recommended. The results of H1N1 influenza virus vaccine on patients receiving hemodialysis and peritoneal dialysis are analyzed. Antibody titers of both hemodialysis and peritoneal dialysis patients were elevated after vaccination. Peritoneal dialysis patients responded better.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 02/2013; 17(1):55-9. · 1.53 Impact Factor
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 02/2013; 17(1):117-9. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Many studies have investigated preexistent renal disease during pregnancy. However, insufficient data regarding the new onset of glomerulonephritis in the course of gestation, especially in patients with preeclampsia, exist. The aim of this study was to investigate underlying renal disease in preeclamptic Turkish women with persistent proteinuria after delivery. METHODS: Between 2005 and 2010, 463 patients with preeclampsia were admitted to our hospital. The symptoms of proteinuria persisted in 34 women (0.7 %). Thirteen of these patients refused a kidney biopsy. Seven of these patients had a history of documented kidney disease. Kidney biopsies were performed on 14 women who were diagnosed with persistent proteinuria in the postpartum period and the specimens were examined by light and immunofluorescence microscopy. RESULTS: Ten of 14 patients (71 %) were diagnosed with underlying renal disease. Four patients were diagnosed with idiopathic preeclampsia (29 %). Histopathological findings existed for ten patients with underlying renal disease; four patients (29 %) were diagnosed with membranoproliferative glomerulonephritis (MPGN), four patients (29 %) were diagnosed with IgA nephropathy (IgAN), one patient (7 %) was diagnosed with focal segmental glomerulosclerosis (FSGS), and one patient (7 %) was diagnosed with amyloidosis. Hematuria was detected in eight patients (57 %), and high serum creatinin levels were observed in five (36 %). CONCLUSIONS: Persistent proteinuria is the most important predictor of underlying renal disease after delivery. All patients with preeclampsia should be evaluated with respect to continuing proteinuria, persistent hematuria, or impaired renal functions after postpartum period and a percutaneous renal biopsy should be performed in those patients who have positive signs of underlying renal disease.
Wiener klinische Wochenschrift 01/2013; · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cardiovascular diseases are the leading causes of mortality in hemodialysis patients. Uremia induced hypertriglyceridemia; increased levels of lipoprotein remnants and low high-density lipoprotein are the main features of cardiovascular risk factors. Also, elevated oxidative stress and inflammation are the main contributors of endothelial dysfunction. Even statin based interventional trials failed to improve mortality in dialysis patients, and different treatment options have been proved to be useful. We aimed to evaluate the effect of dialyzer type on uremia-associated dyslipidemia and endothelial dysfunction. In total 312 patients were enrolled. The initial and 6(th) month blood samples were obtained from the non-arteriovenous fistula arm on the day before the first hemodialysis session of the week. Flow mediated dilatation of the patients was measured from the same arm before obtaining the blood samples. Patients were on hemodialysis therapy for 76.43 ± 52.7 months. According to their dialyzer type, there has been a statistically significant improvement noted in terms of total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and triglyceride levels. The flow mediated dilatation of the patients are measured as 4.3 ± 0.5 and 4.4 ± 0.4 in baseline measurements of the low flux and high flux groups, respectively. Sixth month values of the patients were measured as 4.34 ± 0.4 and 4.62 ± 0.6. The improvement in low flux groups was not statistically significant but in the high flux group the endothelial dysfunction was significantly improved. Our results show that high-flux dialyzers improved dyslipidemia and endothelial dysfunction in hemodialysis patients. These findings provide a new insight on the selection of high efflux in hemodialysis.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 12/2012; 16(6):595-9. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Metabolic syndrome represents a collection of abnormalities that includes fatty liver, and currently affects one third of the United States population and has become a major health concern worldwide. Fructose intake, primarily from added sugars in soft drinks, can induce fatty liver in animals and is epidemiologically associated with nonalcoholic fatty liver disease in humans. Fructose is considered lipogenic due to its ability to generate triglycerides as a direct consequence of the metabolism of the fructose molecule. Here we show that fructose also stimulates triglyceride synthesis via a purine-degrading pathway that it is triggered from the rapid phosphorylation of fructose by fructokinase. Generated AMP enters into the purine-degradation pathway through the activation of AMP deaminase resulting in uric acid production and the generation of mitochondrial oxidants. Mitochondrial oxidative stress results in the inhibition of aconitase in the Krebs cycle, resulting in the accumulation of citrate and the stimulation of ATP citrate lyase and fatty acid synthase leading to de novo lipogeneis. These studies provide new insights into the pathogenesis of hepatic fat accumulation under normal and diseased states.
Journal of Biological Chemistry 10/2012; · 4.65 Impact Factor
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 10/2012; 16(5):479-80. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Immunosuppressive and anti-inflammatory agents have recently become increasingly popular in the treatment of encapsulating peritoneal sclerosis (EPS). The aim of our study was to investigate the effects of sirolimus on EPS in a rat model.
We separated 32 non-uremic rats into four groups: 1 control group, 2 ml isotonic saline injected IP daily for 3 weeks; 2 chlorhexidine gluconate (CG) group, 2 ml 0,1 % CG and 15 % ethanol dissolved in saline injected IP daily for 3 weeks; 3 resting group, CG (weeks 0-3) plus peritoneal rest (weeks 3-6); 4 sirolimus group, CG (weeks 0-3), plus 0.2 ml (1 mg/ml) sirolimus (weeks 3-6). Pathological samples were examined by using hematoxylin eosin (HE) and Masson's trichrome stains. Peritoneal thickness, fibrosis, vascular changes, and inflammation were evaluated by light microscopy. Finally, tissue metalloproteinase (MMP)-2 levels were measured by enzyme-linked immunoassay.
In the CG group, there was a significant increase in peritoneal thickness, inflammatory activity, and fibrosis score compared to the control group (p < 0.05). We also observed a lower fibrosis score and less peritoneal thickening in the sirolimus group compared to the resting and CG groups (p < 0.05). There was no difference in histopathologic findings, except for the inflammatory activity in the sirolimus group, compared to the control group. Although the CG group had higher tissue MMP-2 levels than the control group, the tissue MMP-2 levels were not significantly different from the other groups.
Sirolimus has a beneficial effect on peritoneal fibrosis induced by CG. This suggests that sirolimus may have therapeutic value in the management of EPS.
International Urology and Nephrology 04/2012; 44(3):977-82. · 1.33 Impact Factor