Safa Ersen Ganidagli’s research while affiliated with Kahramanmaraş Sütçü İmam University and other places

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Publications (9)


Impaired cognition in hemodialysis patients: The Montreal Cognitive Assessment (MoCA) and important clues for testing
  • Article

January 2019

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93 Reads

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18 Citations

Clinical Nephrology

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BACKGROUND: Cognitive impairment is common among hemodialysis (HD) patients and is associated with poor treatment compliance and mortality. The aim of this study is to evaluate relatively young HD patients with less comorbidities using the Montreal Cognitive Assessment (MoCA) and identify clues for earlier detection of cognitive impairment with the help of cognitive subscale scores. MATERIALS AND METHODS: A total of 103 chronic HD patients (mean age 48.3 years) and 37 stage-3 to 5 chronic kidney disease (CKD) patients with similar demographics were included. Patients with cerebrovascular disease, dementia, depression, malignancy, and infections were excluded. All participants were tested with MoCA. Patients with an MoCA global score < 24/30 were considered cognitively impaired. Groups were compared for MoCA subscales and clinical features. RESULTS: 75 patients (72.8%) in the HD group and 19 in the CKD group (51.3%) had impaired cognition. The number of patients with cognitive impairment was significantly higher in the HD group compared with the CKD group (p = 0.024). The mean total MoCA score was lower in the HD group (p = 0.043). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain was significantly lower in the HD group (p = 0.001). CONCLUSION: In this study, we showed that cognitive impairment was more common in HD patients compared with predialytic CKD patients. This difference was predominantly related to the difference in executive scores. We may think that young HD patients with less comorbidities are also at risk for cognitive impairment. Noticing progressive declines in MoCA cognitive domains, before the development of global cognitive impairment, could be beneficial for HD patients. .


Schematic presentation of Hb variability and study group formation
Representation of CIMT of Hb variability groups with boxplot graphic (SPSS 16.0 was used for graphical demonstration)
The relation between hemoglobin variability and carotid intima-media thickness in chronic hemodialysis patients
  • Article
  • Full-text available

October 2017

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100 Reads

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6 Citations

International Urology and Nephrology

Purpose: Hemoglobin variability is a common problem among hemodialysis patients. We have previously demonstrated an association between Hb variability and left ventricular mass index. In this study, we investigated a possible relation between Hb variability and carotid intima-media thickness (CIMT). Methods: Twelve-month hemoglobin (Hb) values of 135 patients on maintenance hemodialysis were examined retrospectively. The range of 11-12 gr/dl was accepted as normal according to the KDOQI guidelines. Hemoglobin levels were classified as: Hb < 11 gr/dl:Low, Hb = 11-12 gr/dl:Normal and Hb > 12 gr/dl:High. According to 12-month Hb trajectory, the patients were divided into three groups: low-normal (LN), normal-high (NH) and low-high (LH). The CIMT measurements were taken on common carotid arteries bilaterally, and the average of these measurements were taken. The groups were compared in terms of CIMT measurements, demographic and laboratory features. Results: The LN, NH and LH groups were similar in terms of age, gender, incidence of diabetes mellitus, hypertension and cardiovascular diseases. Duration of hemodialysis, hemodialysis adequacy, serum lipids and CaxP products were also similar among the groups. The mean CIMT value was 0.601 ± 0.107, 0.744 ± 0.139 and 0.604 ± 0.134 mm in the LN, LH and NH groups, respectively (p < 0.001). CIMT was significantly higher in LH than in the other two groups. Conclusions: In our study, when the three groups with similar risk factors for atherosclerosis were examined, we found that the LH group with the highest hemoglobin variability has the highest CIMT. This study is the first study to demonstrate that Hb variability is associated with an increase in CIMT in HD patients.

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Evaluation the Iron Load in Chronic Hemodialysis Patients with Fibroscan: A Preliminary Study

January 2017

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115 Reads

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1 Citation

Turkish Nephrology Dialysis Transplantation

Objective: Iron preperations are frequently used in hemodalysis (HD) patients and iron may accumulate liver and other tissues. Noninvasively methods are needed to detect liver iron accumulation in HD patients. Hepatic iron accumulation with Fibroscan was shown in non-renal population. In this study, we aim to investigate whether or not the hepatic iron load can be determined with Fibroscan in hemodialysis patients. Material and Methods: 42 chronic HD patients included this study. Serum iron, iron binding capasity, ferritin and transferrin saturation were used to determine iron status. Liver stiffness was measured by an experienced gastroenterolog with Fibroscan device. Results: While mean Fibroscan value was 9,15 kPa, ferritin was 565,99 mg/dl. Fibroscan value were positive correlated with transferrin saturation and ferritin but negative correlated with albumin. In multiple regression analysis, it was observed that only ferritin and albumin levels related with Fibroscan value. Conclusion: This study showed that the stiffness of the liver increasing while the ferritin value increasing. This result might be due to iron accumulation in the liver.


Concurrent Fungal Peritonitis in Two Sibling Peritoneal Dialysis Patients: Case Report

March 2016

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61 Reads

Turkish Nephrology Dialysis Transplantation

Fungal peritonitis is an important reason of catheter loss among peritoneal dialysis patients. The most frequently isolated agents are Candida species and some patients do not respond to the treatment and die. Two siblings who lived in the same house and followed-up at our center were admitted to the hospital for peritonitis and both were transferred to hemodialysis as fungal peritonitis was detected. The enabling factor was considered to be poor hygiene. Hygiene is important issue for peritoneal dialysis patients, especially those who live in the same house.


Infection-Associated Cutaneous Vasculitis in Hemodialysis Patients: Two Case Reports

March 2016

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125 Reads

Turkish Nephrology Dialysis Transplantation

Patients treated with hemodialysis are predisposed to infections. Catheter-related infections are the most common infections in patients who have a central venous hemodialysis catheter. These infections may lead to bacteremia or metastatic infection. Cutaneous vasculitis is a form of vasculitis characterized by purpuric eruption localized to the lower extremity. This entity may be related to drugs, infections or have an unknown etiology. Here we present two chronic hemodialysis patients who had fever and increased infection parameters such as leukocytosis and C-reactive protein (CRP). During follow-up, they developed purpuric eruptions on the legs. Infection-related cutaneous vasculitis was diagnosed in these patients and they were successfully treated with antimicrobial therapy.


Insulin oedema in newly diagnosed type 1 diabetes patient: a case report

May 2015

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7 Reads

Endocrine Abstracts

Aim: In this case report we present a newly diagnosed, underweight type 1 diabetes mellitus (DM) patient developed insulin oedema following high dose insulin therapy. Case: A 18-year-old male patient was admitted to the hospital with a 1-month history of excessive water consumption, pollakiuria, polyuria, and weight loss 6 kg. In laboratory examination, hyperglycaemia and ketonuria were detected; arterial blood pH was 7.38. Patient was hospitalised to the Endocrinology Clinic with a diagnosis of type 1 DM with ketosis. The patient was initially treated with an i.v. infusion of insulin and isotonic saline for hyperglisaemia and ketonuria. After clinical improvement basal-bolus therapy was started. At the follow-up visits, insulin requirement increased to ~2 U/kg per day. 15 days after discharge, the patient was again admitted to the clinic with a swelling in both legs. The patient had pitting pretibial and ankle oedema in both extremities. In laboratory examination, hyperglycaemia (fasting blood glucose 211 mg/dl), mild hypoalbuminaemia (3.5 g/dl) were detected. Other biochemical blood test results were normal. Patient was hospitalized again. No proteinuria was detected in his urine. Chest X-ray, echocardiography, abdominal and lower extremity Doppler ultrasonography results were also within normal limits. So as a result of these examinations, other factors that could cause oedema have been ruled out. Basal-bolus therapy was continued. At the follow-up visits, his insulin need was observed to decline (1.5 U/kg per day). With reduced insulin doses, oedema regressed spontaneously. Conclusion: Oedema formation is one of the rare complications of insulin therapy. The cause and incidence rate of insulin oedema are not clearly defined. The cause of this condition is not exactly known. In case of a catabolic state due to lack of insulin, intensive fluid therapy may lead to liquid extravasation in subcutaneous tissue and this may result in peripheral oedema. This condition can also worsen due to increased capillary permeability caused by chronic hyperglycaemia. In this case report we present a newly diagnosed, underweight type 1 DM patient developed insulin oedema following high dose insulin therapy.



Gastrointestinal stromal tumour in a patient with multiple endocrine neoplasia type 1

May 2015

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17 Reads

Endocrine Abstracts

Introduction: Multiple endocrine neoplasia type-1 (MEN-1) is an autosomal dominant disorder MEN-1 diagnosis is established as the occurrence of two or more MEN-1 associated tumour or one MEN-1 associated tumour in a patient that have 1 MEN-1 family member or positive MEN-1 genetic mutation. MEN-1 associated tumours usually involve the parathyroid glands, anterior pituitary and enteropancreatic cells but many other tumours may be seen. In this report, we presented a gastrointestinal stromal tumour (GIST) in a patient with MEN-1. Case: A first degree relative of a patient that has MEN-1 was hospitalised to our clinic for screening MEN-1 related tumours. The patient has stomach ache for 6 months and a history of gastric surgery for perforation 9 years ago. In his family history one brother was diagnosed as MEN-1 (parathyroid adenoma, Cushing’s disease, gastric neuroendocrine tumour, pancreatic mass and positive MEN gene mutation) and other siblings are under evaluation for MEN-1 associated tumours. In physical examination palpation of abdomen revealed a mass in epigastrium and other findings were normal. Laboratory results were as follow; calcium 10.8 mg/dl (8.4–10.2), phosphor 1.7 mg/dl (2.4–5.4), cortisol 23.88 μg/dl (5–23), prolactine 19.7 ng/ml (3–23), IGF1 152 ng/dl (11–836), TSH 1.57 μIU/ml (0.4–4.2), fT4 0.91 ng/dl (0.8–2.7), gastrin 57.2 pmol/l (6.2–54.8), insulin 6.92 μIU/ml (6–27) and cortisol after low dose dexamethasone suppression test 1.45 μg/dl. Parathyroid ultrasound showed a hypoechoic solid mass in posterior of the left thyroid lobe, suggestive for parathyroid adenoma. Abdomen CT showed a 112×73 mm solid mass. General surgery performed a biopsy and pathologic examination revealed a GIST. Conclusion: GISTs are neoplasms arising from connective tissue located in the gastrointestinal wall. GISTs are uncommon neoplasms for MEN-1 syndrome and only a few cases are reported. It is not clear whether GISTs are coincidental or there is a role of MEN-1 gene mutation in these tumours.


Orofacial digital syndrome type 1: An underlying cause of chronic renal failure

April 2014

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31 Reads

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1 Citation

Abstract Orofacial digital syndrome type 1 is condition which is characterized with, in addition to oral-facial and digital congenital anomalies, polycystic renal disease in most patient, and the prognosis is dependent on renal involvement in such patients. Our case was a 22-year-old patient who was presented with clinical picture of chronic renal failure, was started on hemodialysis and had took our attention due to oral, facial and digital anomalies in addition to polycystic renal disease.

Citations (3)


... End-stage renal disease (ESRD) is the most advanced stage of chronic kidney disease where kidney function is irreversibly lost, necessitating dialysis or transplantation [1,2]. Cognitive impairments (CIs) are common in ESRD patients receiving haemodialysis (HD) treatment, with more than 70% exhibiting at least mild impairments in one or more domains such as attention, memory, and executive function [3][4][5][6]. "Brain fog" has been a common complaint among dialysis patients [7] and a popular topic of discussion in online patient forums [8]. CIs in ESRD are associated with adverse health outcomes including dialysis withdrawal, hospitalisation, and mortality [3, [9][10][11]. ...

Reference:

Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients
Impaired cognition in hemodialysis patients: The Montreal Cognitive Assessment (MoCA) and important clues for testing
  • Citing Article
  • January 2019

Clinical Nephrology

... Management of KF is done mainly through kidney replacement therapy (KRT) of which haemodialysis (HD) is the main modality worldwide [1]. Patients on maintenance haemodialysis (MHD) experience numerous complications, including anaemia and chronic kidney disease-mineral and bone disorders (CKD-MBD) [4] [5] [6]. These complications are the cause of more than half of deaths among patients with KF due to the cardiovascular changes they bring about such as: cardiac hypertrophy, increased vascular thickness and accelerated arteriosclerosis [4] [5] [6]. ...

The relation between hemoglobin variability and carotid intima-media thickness in chronic hemodialysis patients

International Urology and Nephrology

... Renal insufficiency has been reported in OFDS primarily due to polycystic kidney disease. Renal insufficiency usually presents after 18 years of age (11). In one study ESRD in two patients with 28 and 35 years of age was regarded as early ESRD and authors recommended monitoring of renal function in OFDS patients (12). ...

Orofacial digital syndrome type 1: An underlying cause of chronic renal failure
  • Citing Article
  • April 2014