Mehmet Deniz Ayli

Ankara Atatürk Training and Research Hospital, Engüri, Ankara, Turkey

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Publications (13)18.81 Total impact

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    ABSTRACT: Atherosclerotic cardiovascular disease is an important cause of mortality and morbidity in hemodialysis patients. Iron accumulation in arterial wall macrophages is increased in atherosclerotic lesions. Hepcidin is a key hepatic hormone regulating iron balance. It inhibits iron release from macrophages and iron absorption from enterocytes by binding and inactivating the cellular iron exporter ferroportin. The aim of this study is to investigate the relation of hepcidin-25, iron parameters, and atherosclerosis measured by carotid intima media thickness (CIMT) in hemodialysis patients. Eighty-two hemodialysis patients were enrolled in this cross-sectional study. Predialysis blood samples were centrifuged at 1500 g and 4°C for 10 minutes and stored at −80°C for the measurement of hepcidin-25. DRG hepcidin enzyme-linked immunosorbent assay kit was used for the measurement of hepcidin-25. Ultrasonographical B-mode imaging of bilateral carotid arteries was performed with a high-resolution real-time ultrasonography (Mindray DC7). Mean age of the study population was 57.90 ± 16.08 years and 43.9% were men. Total study population was grouped into two according to median value of hepcidin-25. There was no difference between groups with respect to age, dialysis vintage, and C-reactive protein. CIMT was found to be statistically significantly higher in low hepcidin-25 group. In correlation analysis, CIMT was found to be correlated with age (P < 0.01, R = 0.33) and hepcidin-25 (P < 0.01, R = 0.46). In linear regression analysis, age (β = 0.31) and hepcidin-25 (β = 0.44) were found to be the determinants of CIMT in hemodialysis patients. Our results implicate that hepcidin may take part in pathophysiology of atherosclerosis and cardiovascular disease in hemodialysis patients.
    No preview · Article · Oct 2015 · Hemodialysis International
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    ABSTRACT: Background: Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone. In chronic kidney disease (CKD), circulating FGF-23 levels are markedly elevated and independently associated with mortality. Left ventricular hypertrophy (LVH) is a potent risk factor for mortality in CKD, and FGFs have been implicated in the pathogenesis of myocardial hypertrophy. In addition, the effect of anemia on CV disease and LVH is well known in CKD. A relation between iron and FGF-23 metabolism is mentioned in a few studies. The aim of this study was to test the association of FGF-23 levels with echocardiographic (ECHO) and iron parameters in peritoneal dialysis patients (PD). Methods: In this cross-sectional study, 61 subjects with PD (29 women and 32 men, mean age: 46.9±13.3 years, mean PD vintage: 69.5±39 months) underwent echocardiograms to assess left ventricular mass index (LVMI). Medical treatments and average values of the basic laboratory results of the last 6 months for all patients were recorded. Serum FGF-23 concentrations were measured using intact FGF-23 (iFGF-23) human enzyme-linked immunosorbent assay (ELİSA) kit. According to the median levels of serum FGF-23 the patients were grouped into two (FGF-23 high and low groups). Results: Significant positive correlation was recorded between serum FGF-23 levels and LVMI (P=0.023). There was also significant difference in terms of hemoglobin (12.1±2 versus 11.0±2, P=0.017), transferrin saturation (TSAT) (24.9±16.8 versus 19.5±10.8, P=0.042) between low and high FGF-23 group. Also in linear regression analysis the negative relation between FGF-23 and hemoglobin is persisted (r=0.199, P=0.045). Conclusions: FGF-23 is associated with LVMI, anemia and low TSAT in patients with PD. Whether increased FGF-23 is a marker or a potential mechanism of myocardial hypertrophy and anemia in patients with end-stage renal disease (ESRD) requires further study.
    Preview · Article · Sep 2015 · Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
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    ABSTRACT: Atherosclerotic cardiovascular disease is one of the major causes of mortality and morbidity in peritoneal dialysis (PD) patients. S100A12 is an endogenous receptor ligand of advanced glycation end-products. It was shown to contribute to the development of atherosclerosis in animal models. The aim of this study was to evaluate the relationship between S100A12 levels and carotid atherosclerosis in PD patients. A cross-sectional study was performed in 56 PD patients and 20 control subjects. Plasma S100A12 levels were measured from all participants beside routine laboratory evaluation. All subjects underwent high-resolution B-mode ultrasonography to determine carotid intima media thickness (CIMT). S100A12 levels were compared between patient and control groups. Correlation analyses of S100A12 with other laboratory values and CIMT were also performed. Plasma S100A12 levels were higher in PD patients compared with control subjects (129.5 ± 167.2 ng/mL vs. 48.5 ± 30.3 ng/mL, respectively, p < 0.001). In the patient group, CIMT was found to be positively correlated with age (r = 0.354; p = 0.007), CRP level (r = 0.269; p = 0.045), and S100A12 (r = 0.293; p = 0.028) level while it was found to be negatively correlated with hemoglobin concentration (r = -0.264; p = 0.049). In the linear regression analysis, the model, including CRP, S100A12, age, and Hgb, was found to be significant (F: 4.177, p: 0.005). When the parameters are analyzed age and S100A12 were found to be independent determinants of CIMT (β = 0.308, p = 0.018 and β = 0.248, p = 0.049, respectively). This study suggests that an elevated plasma S100A12 level was closely associated with atherosclerosis. With aging elevated plasma S100A12 may show a powerful proatherogenic potential in patients undergoing PD.
    No preview · Article · May 2015 · Renal Failure
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    ABSTRACT: Background: Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in patients with end stage renal disease (ESRD). Apelin expressed in endothelial and other tissues including brain and kidney is an adipocytokine defined recently and is emerging an important mediator of cardiovascular homeostasis. The aim of this study was to test whether apelin levels might be associated with carotid artery atherosclerosis and left ventricular mass index (LVMI) in peritoneal dialysis patients. Patients and methods: Fifty peritoneal dialysis patients (25 female, mean age 41.4 ± 11.9 years, mean dialysis vintage 65.0 ± 35.4 months) and 18 healthy individuals (9 female, mean age 41.7 ± 6.8 years) were included in this cross-sectional study. Serum apelin 12 levels, echocardiographic findings and carotid intima media thickness (CIMT) were recorded as well as clinical and laboratory data. Results: There were no differences between the patient and the control groups with regard to demographic characteristics. In patient group, LVMI, CIMT, CRP and apelin levels were elevated compared to control group. However there was no association between apelin, LVMI and CIMT. There was a positive correlation between apelin and CRP, which was not statistically significant. When patients were divided into two groups according to the mean serum apelin levels, LVMI, CIMT and CRP were higher in the high apelin group but this difference did not reach statistical significance. Conclusion: We observed an increased inflammation and CVD risk in peritoneal dialysis patients. However, serum apelin levels seem not to be associated with cardiovascular risk in this group of patients.
    No preview · Article · Jan 2015 · Renal Failure
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    Preview · Article · Sep 2014

  • No preview · Article · Jun 2014 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
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    ABSTRACT: Introduction and Aims: Premature cardiovascular disease limits the quality and length of life on long-term haemodialysis. The epidemiology of cardiovascular events in this context needs to be better defined and more effective management strategies developed. Adjudicated cardiovascular event data collected during the Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) Trial were used to define the frequency of fatal and non-fatal cardiovascular events attributable to atherosclerotic and non-atherosclerotic mechanisms. The risk factors for these events and the impact of assignment to treatment with cinacalcet or placebo were evaluated. Methods: A multicenter, global, randomized, double-blind, placebo-controlled clinical trial assessing mortality and non-fatal cardiovascular events in 3883 patients on haemodialysis with secondary hyperparathyroidism (median parathyroid hormone concentration 693 pg/mL (10%, 90% range 363 to 1694 pg/mL). The post hoc outcome measures were fatal and non-fatal cardiovascular events reflecting atherosclerosis and non-atherosclerotic cardiovascular diseases. Results: 1518 subjects experienced an adjudicated cardiovascular event, including 958 who experienced an event attributable to non-atherosclerotic disease. Of 1421 deaths during the trial, 768 (54%) were due to cardiovascular disease. Sudden death was the most frequent fatal cardiovascular event, accounting for 25% of overall mortality. Patients randomised to cinacalcet had a lower risk for time to first non-atherosclerotic cardiovascular event (hazard ratio 0.84, 95% CI 0.74, 0.96), whilst we were not able to able to detect a lower risk with cinacalcet treatment on time to atherosclerotic events (hazard ratio 0.88, 95% CI 0.76, 1.01). Conclusions: Accepting the limitations of post-hoc analysis, the benefit of cinacalcet on cardiovascular disease in the context of haemodialysis may mainly result from attenuation of non-atherosclerotic processes. ClinicalTrials.gov number: NCT00345839
    Full-text · Article · May 2014 · Nephrology Dialysis Transplantation

  • No preview · Article · Nov 2013 · Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia

  • No preview · Conference Paper · May 2013
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    ABSTRACT: Objective: It is the examination of whether there is a correlation between Cystatin C and creatinine clearance among glomerulonephritis patients with stage 1-4 chronic renal failure. The study researched early and severely decreased stage (1-4) patients with chronic renal failure. Primary glomerular patients were selected in order to see the result in isolation connected with glomerular exposure. Material and Method: From November 2009 to August 2010, patients referred to nephrology clinics, were enrolled in the study. During the patients' routine controls, their other data were obtained. Cystatin C level was studied in biochemistry laboratory of H. M. Dışkapı Yıldırım Beyazıt Training and Research Hospital. Patients who had histologic diagnosis were taken into the study. Resultant correlation between Cystatin C and creatinine clearance was analyzed. Whether there was a significant correlation between MDRD and Cystatin C was researched by Spearman's correlation test. Results: 26 subjects with the age of 18-72 were included in the research. It was seen that there was a significantly high level correlation between MDRD and Cystatin C measurements(r=0,884; p<0,001). When the cases were separated to two groups in regard to their MDRD and Cystatin C levels, it was seen that there was statistically significant but low concordance between two examinations (κ=0,308; p=0,002).Conclusion: In the end of the study, the significant correlation between Cystatin C and creatinine clearance was determined. Concordance level was found low by the subgroup analyses of the study. When it is taken with all the other studies, Cystatin C is seen like an appropriate method for measure the GFR. But, after all the positive and negative results were taken together, it is more appropriate to judge on these results. To get more clear information in this case, wider and detailed comparative studies are required.
    Full-text · Article · Jan 2013
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    ABSTRACT: Hyperkalemia is a life-threatening electrolyte disorder. Elderly patients are more prone to developing hyperkalemia due to age-related decline in glomerular fi ltration rate. An 81-year-old female patient previously diagnosed as having diabetes mellitus, hypertension and chronic kidney disease who was on amlodipine and basal insulin therapy, was administered primidone 31.25 mg/day orally for the treatment of essential tremor. After 2 days, serum potassium increased to 7.6 mEq/L from the baseline level of 5.3. Urinary potasium level was 11.4 mEq/L, and transtubular potasium gradient (TTKG) 2.1%. Since no predisposing factor for hyperkalemia could be detected, primidone was discontinued. After 7 days, the serum potassium level returned to normal. Irregular distribution of potassium between the intracellular and extracellular space and imbalance between intake and excretion are the main factors in hyperkalemia pathogenesis. A TTKG value <5% is highly suggestive of hypoaldosteronism. The relatively low TTKG in the present case suggests a mineralocorticoid insuffi ciency probably due to primidone usage . Recently administered drugs without a known hyperkalemia-inducing effect may be an etiologic factor in hyperkalemia in elderly patients who are at risk of developing hyperkalemia due to comorbid diseases or have potassium levels within upper range of normal.
    No preview · Article · Sep 2012 · Turkish Nephrology
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    ABSTRACT: The demand for kidney transplantation due to improved recipient outcomes has stimulated surgeons to expand the criteria for usable donors, but still the use of organs from deceased donors with terminal acute renal failure is uncommon. We report 2 kidney transplant recipients from a cadaveric donor who was not accepted by other centers because of acute renal failure. The donor, a 24-year-old man with an intracerebral hemorrhage, displayed a serum creatinine (SCr) value of 0.6 mg/dL on hospital admission, which increased to 7.3 mg/dL on the fourth hospital day. After the diagnosis of brain death and refusal of the kidneys by other regional centers, we decided to transplant the 2 kidneys. Recipient 1, a 31-year-old man on an 11-year dialysis program, discontinued hemodialysis after 7 days of delayed graft function. The SCr level decreased gradually and was stable at 1.08 mg/dL on postoperative day (POD) 45. The contralateral graft was transplanted into a 30-year-old man (recipient 2) undergoing dialysis treatment for 7 years. After 10 days of delayed graft function, the SCr decreased gradually with continued hemodialysis until POD 24. The SCr level has been stable at 1.34 mg/dL on POD 52. At the end of the third month the SCr levels in recipients 1 and 2 were 1.1 mg/dL and 1.4 mg/dL, respectively. In conclusion, one may safely expand the donor pool with kidneys from deceased donors with acute renal failure (ARF) with good short-term outcomes.
    No preview · Article · Jul 2012 · Transplantation Proceedings
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    ABSTRACT: Fibroblast growth factor-23 (FGF-23) is a phosphorus-regulating substance. Circulating FGF-23 levels increase markedly in dialysis patients and are independently associated with increased risk of mortality. Given the fact that cardiovascular disease is the leading cause of death in dialysis patients, the aim of this study was to test if elevated FGF-23 levels might be associated with left ventricular mass index (LVMI) and left ventricular index of myocardial performance (MPI) in maintenance haemodialysis patients. In this cross-sectional study, plasma FGF-23 concentrations were measured using a C-terminal human enzyme-linked immunosorbent assay kit, and echocardiography was performed in 128 maintenance haemodialysis patients (65 women and 63 men, mean age: 55.5 ± 13 years, mean haemodialysis vintage: 52 ± 10 months, all patients are on haemodialysis thrice a week) and 40 control subjects (21 women and 19 men; mean age: 54 ± 11 years) with normal kidney function (eGFR > 90 mL/min/1.73 m(2)). Serum FGF-23 levels were elevated when compared with age- and gender-matched controls with preserved kidney function [(median 958 RU/mL; interquartile range 106-1894 RU/mL) vs (median 27 RU/mL; interquartile range 11-35), P < 0.0001]. Patients with a history of coronary artery disease and aortic valve calcifications had higher levels of log FGF-23 than those without (3.00 ± 0.22 vs 2.82 ± 0.26, P = 0.002; and 3.06 ± 0.19 vs 2.83 ± 0.26, P = 0.0001, respectively). Patients with MPI > 0.47 had higher serum FGF-23 levels than those with MPI < 0.47 [(median 1156 RU/mL; interquartile range 396-1894 RU/mL) vs (median 657 RU/mL; interquartile range 106-1102 RU/mL), P = 0.0001]. Significant correlations were recorded between log FGF-23 levels and LVMI (r = 0.281, P = 0,007) and MPI (r = 0.555, P = 0.0001). Multivariable-adjusted regression analyses revealed that increased log FGF-23 concentrations were independently associated with increased left ventricular mass index (30% increase per 1-SD increase in log FGF-23 concentration, P = 0.002) and increased MPI (28.5% increase per 1-SD increase in log FGF-23 concentration, P = 0.001). Plasma FGF-23 concentration is independently associated with LVMI and MPI in maintenance haemodialysis patients. Further prospective studies are needed to clarify whether increased serum FGF-23 level is a marker or a potential mechanism for left ventricular involvement in patients with end-stage renal disease.
    Full-text · Article · Apr 2011 · Nephrology Dialysis Transplantation