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ABSTRACT: Background : In the Chronic REnal Disease In Turkey -CREDIT Study, a large populationbased study on 10,748 adults, the prevalence of chronic kidney disease (CKD) and relationship between CKD and other cardiovascular risk factors had been studied. Methods : This report presents the results of CREDIT study on the prevalence, awareness, treatment, and control of hypertension among CKD patients. Results : The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. Of the patients with hypertension, 31.5.% were under treatment, and 16.4% had hypertension under control. Prevalence of CKD was 25.3% in patients with hypertension. Among CKD patients (15.7% of the CREDIT study population), 56.3% had hypertension. The prevalence of hypertension was 34.8% at stage 1, 79.8% at stage 3, and 92.3% at stage 5 CKD. Only 13.4% of patients with CKD have optimal blood pressure. Among CKD patients, 61.9% were aware of hypertension, and 44.2% were under treatment. Overall control rate of hypertension in subjects with CKD was 16.3% with the lowest rate at stage 1 (12.3%) and highest rate at stage 4 (40%). The control rate increased to 28.8% for CKD patients under treatment for hypertension. Conclusion : As a conclusion, hypertension is highly prevalent in subjects with CKD in Turkey with suboptimal awareness, treatment, and control rates. Appropriate health strategies should be implicated to improve prevention, early diagnosis, and treatment of hypertension, which is one of the leading causes of CKD.
Kidney and Blood Pressure Research 07/2012; 36(1):36-46. · 1.46 Impact Factor
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ABSTRACT: National renal registry studies providing data for incidence, prevalence, and characteristics of end-stage renal disease and renal replacement therapy (RRT) serve as a basis to determine national strategies for the prevention and treatment of these diseases and identify new areas for special studies.
Since 1990, the Turkish Society of Nephrology has been coordinating a national renal registry that collects data on patients receiving RRT. This report focuses on data collected from 1996-2008.
Data were collected in dialysis centers for patients on RRT.
Year.
Point prevalence and incidence of RRT, RRT modalities, demographic and clinical characteristics of patients on RRT.
From 1996 to 2008, the number of centers (199 and 760) and response rates to the registry (76% and 99.4%) increased. In 2008, the point prevalence of RRT was 756 per million population (pmp) and incidence was 188 pmp, including pediatric patients. In prevalent patients, the most common RRT modality was hemodialysis (77.0% of patients), followed by peritoneal dialysis (10.1%) and transplant (12.9%). The age of hemodialysis and transplant patients increased, with a predominance of male patients. Percentages of diabetes mellitus and hypertension as causes of ESRD increased, whereas those of chronic glomerulonephritis and urologic disease decreased. Infection and crude death rates decreased in all treatment modalities.
The main study limitations were registry design and low number of kidney transplants.
With increasing numbers of dialysis centers and RRT patients during the last 12 years, the need for RRT in Turkey has been better met. The quality of RRT care has improved, especially regarding prevention and treatment of infections.
American Journal of Kidney Diseases 03/2011; 57(3):456-65. · 5.43 Impact Factor
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Gültekin Süleymanlar,
Cengiz Utaş,
Turgay Arinsoy,
Kenan Ateş,
Bülent Altun,
Mehmet Riza Altiparmak,
Tevfik Ecder,
Mehmet Emin Yilmaz,
Taner Çamsari,
Ali Başçi,
Ali Riza Odabas, Kamil Serdengeçti
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ABSTRACT: Chronic kidney disease (CKD) is a growing health problem worldwide that leads to end-stage kidney failure and cardiovascular complications. We aimed to determine the prevalence of CKD in Turkey, and to evaluate relationships between CKD and cardiovascular risk factors in a population-based survey.
Medical data were collected through home visits and interviews. Serum creatinine, blood glucose, total cholesterol, triglycerides, HDL, LDL and uric acid were determined from 12-h fasting blood samples, and spot urine tests were performed for subjects who gave consent to laboratory evaluation.
A total of 10 872 participants were included in the study. The final analysis was performed on 10 748 subjects (mean age 40.5 ± 16.3 years; 55.7% women) and excluded 124 pregnant women. A low glomerular filtration rate (GFR) (< 60 mL/min/1.73 m(2)) was present in 5.2% of the subjects who were evaluated for GFR, while microalbuminuria and macroalbuminuria were observed in 10.2% and 2% of the subjects, respectively. The presence of CKD was assessed in subjects who gave consent for urinary albumin excretion measurement (n = 8765). The overall prevalence of CKD was 15.7%; it was higher in women than men (18.4% vs. 12.8%, P < 0.001) and increased with increasing age of the subjects. The prevalence of hypertension (32.7% in the general population), diabetes (12.7%), dyslipidaemia (76.3%), obesity (20.1%) and metabolic syndrome (31.3%) was significantly higher in subjects with CKD than subjects without CKD (P < 0.001 for all).
The prevalence of CKD in Turkey is 15.7%. Cardiovascular risk factors were significantly more prevalent in CKD patients.
Nephrology Dialysis Transplantation 11/2010; 26(6):1862-71. · 3.40 Impact Factor
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ABSTRACT: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterised by recurrent fever attacks and polyserositis which may lead to the development of AA amyloidosis and end-stage renal disease (ESRD). In this study, we aimed to evaluate the efficacy of continuous ambulatory peritoneal dialysis (CAPD) in FMF-amyloidosis patients with ESRD.
Forty age- and sex-matched patients undergoing CAPD at our centre between 1996 and 2002 were included in the study. Of these, 10 had FMF-amyloidosis, 10 had diabetes mellitus (DM), 10 had chronic glomerulonephritis (CGN) and 10 had chronic interstitial nephritis (CIN). Efficiency of CAPD, development of complications, presence of other diseases and survival were compared.
With the onset of ESRD, the frequency of FMF peritonitis attacks decreased, with less attacks occurring during CAPD in FMF-amyloidosis patients (p < 0.05). There was no significant difference between the FMF-amyloidosis group and other groups in terms of efficiency of CAPD, peritoneal function, complications and survival. DM patients had a shorter survival period compared with CGN and CIN patients (p < 0.05), but there was no survival difference between FMF-amyloidosis patients and other groups (p > 0.05).
We conclude that CAPD is an effective and safe renal replacement therapy for FMF-amyloidosis patients with ESRD.
Nephron Clinical Practice 01/2004; 98(4):c119-23. · 2.04 Impact Factor
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ABSTRACT: Patients with seminal vesicle and epididymal cysts are mostly asymptomatic. To date, only one patient presenting with bloody ejaculate and acute scrotum has been reported. Different extrarenal manifestations and the association of adult polycystic kidney disease (APKD) with some connective tissue diseases are known. We report on a 60-year-old male patient with bloody ejaculate and acute scrotum who had been diagnosed as having APKD 1 year earlier and whose past medical history revealed inflammatory low back pain, psoriasis, and the diagnosis of psoriatic arthritis. Cultures of urine and ejaculate were sterile, and the patient's renal functions were normal. Ultrasound showed epididymal and seminal vesicle cysts in addition to hepatic and renal cysts. Our case is the first in which psoriatic arthritis accompanied APKD, seminal vesicle cysts, and epididymal cysts. We also review other APKD cases that have accompanied seminal vesicle cysts.
European Journal of Internal Medicine 08/2003; 14(4):265-268. · 2.00 Impact Factor
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ABSTRACT: The establishment of the Turkish Society of Nephrology (TSN) in 1970 coincided with that of many western European nephrology societies. The TSN organized the 15th ERA-EDTA Congress in Istanbul in 1978, earlier than many European Countries, and currently has 286 active members. At present, Turkey has 161 nephrologists, which equals 2.5 nephrologists per million population (p.m.p.). The number of original articles submitted by Turkish authors to the journal Nephrology Dialysis Transplantation ranks 7th-8th amongst total submissions to the journal. Turkey also ranks 2nd-4th in the number of abstracts submitted to recent ERA-EDTA Congresses. With 18 063 patients undergoing intermittent haemodialysis treatment in 348 dialysis centres, Turkey has the 5th largest chronic haemodialysis patient population among European countries. In addition, 1903 patients are currently undergoing continuous ambulatory peritoneal dialysis. However, with a total of 4693 renal transplants since 1975, of which only 21.3% were of cadaveric origin, Turkey lags considerably behind other European countries in renal transplantation. In Turkey, the prevalence and incidence of renal replacement therapy (RRT) are at present 358 and 52 p.m.p. respectively, and the expansion rate of the RRT stock is 17% (HD 18.5%, CAPD 6%, and transplantation 1.7%). The yearly gross mortality rate of the total RRT population is 9.4%. The present priorities of the Turkish nephrological community include high-standard research activity and long-term, prospective clinical and epidemiological studies, an increase in the total number and percentage of cadaveric transplants, further improvement of the quality and cost-effectiveness of RRT, and finally the further development of scientific and educational collaboration with the world nephrological community.
Nephrology Dialysis Transplantation 01/2003; 17(12):2087-93. · 3.40 Impact Factor
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ABSTRACT: Drug-induced ototoxicity might sometimes be a problem in end-stage renal failure (ESRF) patients. However, ototoxicity secondary to isoniazid intake has not been reported in ESRF until now. During the last decade, ototoxicity was diagnosed in 16.6% (7/42) of our ESRF patients undergoing hemodialysis (HD) who also used antituberculosis therapy. Streptomycin was not included in any of these regimens, isoniazid was used by all 7 patients with ototoxicity and there was reversal of hearing loss in 2 of these patients after discontinuation of isoniazid. In our ESRF-HD patients who developed ototoxicity during the course of antituberculosis therapy, isoniazid was probably the responsible agent either alone or it added to the side effects of other drugs.
Nephron 11/2002; 92(2):478-80. · 13.26 Impact Factor
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ABSTRACT: In this study, we retrospectively evaluated all attacks of diarrhoea in our renal transplant recipients that came to our medical attention between 1985 and 2000. Also, the clinical features of patients with diarrhoea were compared with the features of recipients without diarrhoea. We diagnosed 41 attacks of diarrhoea in 39 (12.6%) of 308 renal transplant recipients during this time period. An aetiology was detected in 33 (80.5%) of all diarrhoeal episodes and in seven (17.1%) of those the specific agent was diagnosed with the help of stool microscopy. The most frequent causes of diarrhoeal attacks were infectious agents (41.5%) and drugs (34%). Six (14.6%) episodes of diarrhoea were chronic and six were nosocomial. About two-thirds of diarrhoea developed within the late post-transplant period (>6 months). When recipients with diarrhoea were compared with those without diarrhoea, it was seen that diarrhoeal patients had significantly higher creatinine and significantly lower albumin levels when compared with the latter group (p < 0.05). Also, the frequency of antibiotic usage was significantly higher in diarrhoeal patients than in the control group (p < 0.05). Four (10.2%) patients with diarrhoea died despite institution of the appropriate therapy. Two of these deaths were primarily related to diarrhoea and the aetiological agent was Clostridium difficile in both these cases. During the 15-yr study period, 3.6% of all deaths and 5.1% of infection-related deaths in transplant recipients were secondary to diarrhoea. As a result, we observed that infections and drugs were the most frequent causes for diarrhoea in our series of renal transplant recipients. Also, diarrhoea was an important cause of mortality in this patient population.
Clinical Transplantation 07/2002; 16(3):212-6. · 1.67 Impact Factor
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ABSTRACT: In this study, we retrospectively evaluated all attacks of diarrhoea in our renal transplant recipients that came to our medical attention between 1985 and 2000. Also, the clinical features of patients with diarrhoea were compared with the features of recipients without diarrhoea. We diagnosed 41 attacks of diarrhoea in 39 (12.6%) of 308 renal transplant recipients during this time period. An aetiology was detected in 33 (80.5%) of all diarrhoeal episodes and in seven (17.1%) of those the specific agent was diagnosed with the help of stool microscopy. The most frequent causes of diarrhoeal attacks were infectious agents (41.5%) and drugs (34%). Six (14.6%) episodes of diarrhoea were chronic and six were nosocomial. About two-thirds of diarrhoea developed within the late post-transplant period (>6 months). When recipients with diarrhoea were compared with those without diarrhoea, it was seen that diarrhoeal patients had significantly higher creatinine and significantly lower albumin levels when compared with the latter group (p < 0.05). Also, the frequency of antibiotic usage was significantly higher in diarrhoeal patients than in the control group (p < 0.05). Four (10.2%) patients with diarrhoea died despite institution of the appropriate therapy. Two of these deaths were primarily related to diarrhoea and the aetiological agent was Clostridium difficile in both these cases. During the 15-yr study period, 3.6% of all deaths and 5.1% of infection-related deaths in transplant recipients were secondary to diarrhoea. As a result, we observed that infections and drugs were the most frequent causes for diarrhoea in our series of renal transplant recipients. Also, diarrhoea was an important cause of mortality in this patient population.
Clinical Transplantation 05/2002; 16(3):212 - 216. · 1.67 Impact Factor
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ABSTRACT: A 58-year-old female patient diagnosed as having sarcoidosis 23 years ago developed nephrotic syndrome. No pathology was found which could explain this, so it was attributed to her sarcoidosis. Renal biopsy showed global and segmental sclerosis. The occurrence of focal segmentary glomerulosclerosis in a case of sarcoidosis is rare. In systemic sarcoidosis it is thought that T-cell dysfunction may play a role in the pathogenesis of glomerulonephritis. When treatment is considered, corticosteroid therapy may be used according to the clinical status at diagnosis as well as on follow-up of the patient.
Nephron 03/2002; 90(2):211-2. · 13.26 Impact Factor
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ABSTRACT: In patients with chronic renal failure, mechanical and hemodynamic changes could occur in the lungs without obvious pulmonary symptoms and findings and their effects could pave the way to pulmonary functional disorders. In this study, pulmonary functional disorders and especially alveolocapillary defects, which are frequently seen in uremia, were determined in renal transplanted patients. Pulmonary functions and diffusion capacity were assessed in uremic patients (n = 20) and in successfully transplanted patients (n = 20) without any lung disease or pulmonary edema symptoms and findings. Patients were selected randomly among outpatients who were followed up in a Nephrology and Transplantation Unit. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF25-75) were measured. Single breath carbon monoxide diffusion test and diffusion lung capacity adjusted for hemoglobin concentration (DLAdj) were done. The means of the spirometric values such as FVC, FEV1 and FEV1/FVC were normal in the nondialyzed uremic group, but the PEF25-75 value (68.7%) and diffusion capacity (DLAdj 72.7%) were found to be slightly low. There were 2 patients with normal values and 18 patients with some functional abnormalities in this nondialyzed uremic group. The means of all spirometric parameters and diffusion capacities were found to be normal in the transplanted group. There were 7 patients with normal function and 13 patients with some functional abnormalities in this transplanted group. When the nondialyzed uremic group and the transplanted group were compared statistically, significant differences were found between their spirometric values (except for FVC) and their diffusion capacities. Even though the uremic patients did not show any symptoms, their pulmonary function tests, especially diffusion capacity, were found to be disturbed. Although the transplanted patients as a group had normal mean spirometric values and diffusion capacity there were nevertheless many individual transplanted patients with defective diffusion capacity and abnormal spirometric values.
Nephron 02/2002; 90(1):72-7. · 13.26 Impact Factor
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ABSTRACT: On August 17, 1999 a major earthquake hit the most densely populated area at the eastern end of the Marmara Sea in northwestern Turkey. The number of documented cases of acute renal failure (ARF) following this event exceeded all similar cases previously reported for any single earthquake. The aim of this report was to provide an overview of the morbidity and mortality of all documented patients with ARF, due to crush injury, that were treated in hospitals with dialysis units following the Marmara earthquake.
Special questionnaires were sent out to all hospitals with dialysis units known to have admitted earthquake victims with ARF and related crush injuries. Responses to questionnaires from the Turkish Society of Nephrology (TSN) Task Force were collected from 35 hospitals in October 1999. We retrospectively evaluated patients, clinic and laboratory findings, surgical interventions, and frequency and duration of dialysis. Patients who died before or on admission and those with prior chronic renal disease were excluded from the study.
A total of 639 patients (291 female and 348 male) with ARF due to crush injury were hospitalized in 35 hospitals. The mean age was 31.6+/-14.7 years and 71.1% were young adults within the range of 16-45 years. 477 patients (74.6%) received one or more dialysis treatments, 162 patients were not dialysed, 15 patients died before dialysis could be instituted, and 147 patients recovered without dialysis treatment. 340 patients were oliguric on admission. The most important abnormalities related to ARF as a result of crush injury morbidity, were oliguria (53.2%), uraemia (94%), high creatinine levels (87%), hyperkalaemia (42%), hyperphosphataemia (63%), hypocalcaemia (83%), and high creatinine phosphokinase levels (73 %). 512 patients had a total of 790 extremity injuries. Eighty-three patients (12.9%) had fractures of the extremities and non-extremity fractures were observed in 59 (9.2%) patients. 323 fasciotomies were performed. Thoracic and abdominal trauma was observed in 110 patients (17.2%). Infection and sepsis were observed in 223 (34.9%) and 121 (18.9%) patients, respectively. Haematologic abnormalities were observed in 197 patients (33%) including 116 with Htc < or =30%. There were pulmonary problems in 96 patients (15%), cardiovascular problems in 198 patients (30.9%), gastrointestinal problems in 23 (3.16%), neurologic problems in 43 (6.7%), and psychiatric problems in 7 (1%) patients. Ninety-seven of the 639 patients with ARF as a result of crush injury died (15.2%), and mortality rates were 17.2 and 9.3% in dialysed and non-dialysed patients, respectively. Findings significantly associated with mortality were sepsis, thrombocytopenia, disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and abdominal and thoracic traumas.
We conclude that in cases of severe disasters such as major earthquakes, patients should be rapidly transferred to undamaged peripheral general hospitals. When proper dialysis and intensive care facilities together with around the clock dedicated human effort are available, crush injury-related ARF patients have a lower mortality. Mortality, when it occurs, is mainly associated with thoracic and abdominal trauma and medical problems such as DIC and/or ARDS/respiratory failure, often in conjunction with sepsis.
Nephrology Dialysis Transplantation 01/2002; 17(1):33-40. · 3.40 Impact Factor
