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Öğe THE ASSOCIATION BETWEEN HRQOL, OTHER FACTORS AND MORTALITY IN PD PATIENTS WHO WERE FOLLOWED FOR 7 YEARS(Oxford Univ Press, 2013) Guney, Ibrahim; Turkmen, Kultigin; Yazici, Raziye; Aslan, Sevket; Altintepe, Lutfullah; Yeksan, Mehdi[Abstract Not Availabe]Öğe Can Resistance Be Resolved with Lanthanum Carbonate in the Treatment of Hyperphosphatemia? A Multicenter Experience(Aves, 2023) Tonbul, Halil Zeki; Baloglu, Ismail; Ozer, Hakan; Oymak, Oktay; Altintepe, Lutfullah; Ersoy, Fettah FevziObjective: Kidney osteodystrophy is a condition that both reduces the quality of life and shortens the life span in patients with chronic kidney disease. Lanthanum carbonate is a phosphorus-binding agent that forms very tight complexes with phosphate ions, has low systemic absorption potential, and does not contain calcium and aluminum. The aim of this study was to evaluate the efficacy of lanthanum carbonate in patients with resistant hyperphosphatemia. Methods: One hundred four hemodialysis patients (44 females and 60 males; mean age: 59.5 +/- 4 years) whose serum phosphorus level was above 6 mg/dL despite the use of phosphorus-binding drugs (calcium acetate, calcium carbonate, and/or sevelamer) were included in this study. The patients were followed prospectively for 6 months. Results: Twenty (19.2%) patients included in the study could not use the drug regularly due to difficulties in using it and nausea, while 84 (28 females and 56 males) patients used the drug regularly for 6 months. Lanthanum carbonate was used at a dose of 3 x 750 mg in 37 patients and 3 1000 mg in 47 patients. While 72.6% of the patients used the drug by mixing it with food, the rest drank it with water. The most common side effects were nausea, constipation, and itching. Four different centers from 3 cities in Turkey participated in the study. When the patients who used it regularly were evaluated, after lanthanum carbonate use, the mean phosphorus level decreased from 6.9 +/- 0.7 mg/dL to 5.97 +/- 0.9 mg/dL (P =.02). The levels of calcium-phosphorus products were 62.12 +/- 9.89 before lanthanum carbonate treatment and 57.6 +/- 11.52 after treatment (P =.023).The levels of. It was observed that the mean parathormone levels decreased from 657 +/- 48 pg/mL to 521 +/- 36 pg/mL after treatment (P =.031). While none of the patients could take vitamin D due to hyperphosphatemia before the treatment, 52 patients could use vitamin D together with lanthanum carbonate. When 36 patients whose serum phosphorus level decreased with treatment but did not fall below 5.5 mg/dL were examined, it was observed that the mean parathyroid hormone level (708 +/- 27 vs. 558 +/- 30 pg/mL, P =.041) and the rate of patients using cinacalcet were higher in this group (41% vs. 8%). Conclusion: We found that serum phosphorus, calcium-phosphorus products, and parathyroid hormone levels decreased significantly with lanthanum carbonate treatment in patients with resistant hyperphosphatemia. As a result of our findings, we think that resistant hyperphosphatemia can be effectively treated with lanthanum carbonate in most hemodialysis patients without severe hyperparathyroidism.Öğe DETERMINATION OF RELIABILITY OF SOME TESTS IN EVALUATING AV FISTUL FLOW RATE IN HEMODIALYSIS PATIENTS(Oxford Univ Press, 2013) Yavuz, Yasemin Coskun; Selcuk, Nedim Yilmaz; Guney, Ibrahim; Altintepe, Lutfullah[Abstract Not Availabe]Öğe Does the serum uric acid level have any relation to arterial stiffness or blood pressure in adults with congenital renal agenesis and/or hypoplasia?(Taylor & Francis Inc, 2017) Yazici, Raziye; Guney, Ibrahim; Altintepe, Lutfullah; Yazici, MehmetBackground: The relationship between serum uric acid and arterial stiffness or blood pressure is not clear. The serum uric acid level and its association with cardiovascular risk is not well known in patients with reduced renal mass. We aimed to investigate the relation between serum uric acid levels and arterial stiffness and also blood pressure in patients with congenital renal agenesis and/or hypoplasia. Material and Methods: In this single center, cross-sectional study, a total of 55 patients (39 (% 70.9) with unilateral small kidney and 16 (% 29.1) with renal agenesis) were included. The median age was 35 (21-50) years. The study population was divided into tertiles of serumuric acid (according to 2.40-3.96, 3.97-5.10, and 5.11-9.80mg/dl cut-off values of serum uric acid levels). Official and 24-h ambulatory non-invasive blood pressures of all patients were measured. The arterial stiffness was assessed by pulse wave velocity (PWV). Results: PWV values were increased from first to third tertile (5.5 +/- 0.6, 5.7 +/- 0.8, 6.1 +/- 0.7, respectively), but this gradual increase between tertiles did not reach significance. Linear regression analyses showed a positive correlation between serum uric acid levels and PWV (beta = 0.40, p = 0.010), but no correlation was found between uric acid and daytime systolic blood pressure (beta = 0.24, p = 0.345). Conclusion: In congenital renal agenesis/hypoplasia, the serumuric acid level was positively correlated with arterial stiffness, but there was no correlation with blood pressure.Öğe HEALTH RELATED QUALITY OF LIFE, SLEEP QUALITY AND DEPRESSION IN ELDERLY HEMODIALYSIS PATIENTS(Oxford Univ Press, 2012) Turkmen, Kultigin; Guney, Ibrahim; Turgut, Faruk; Altintepe, Lutfullah; Tonbul, Halil Zeki; Abdel-Rahman, Emaad[Abstract Not Availabe]Öğe Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center(Informa Healthcare, 2014) Turkmen, Kultigin; Guney, Ibrahim; Yazici, Raziye; Arslan, Sevket; Altintepe, Lutfullah; Yeksan, MehdiIntroduction: Impairment of health-related quality of life (HRQoL) and being in a depressive mood were found to be associated with increased mortality in peritoneal dialysis (PD) patients. We aimed to investigate the association between HRQoL, depression, other factors and mortality in PD patients. Materials and methods: Totally 171 PD patients were included and followed for 7 years in this prospective study. Results: Of 171 PD patients, 45 (26.3%) deceased, 18 (10.5%) maintained on PD, 87 (50.9%) shifted to hemodialysis (HD) and 21 (12.3%) underwent transplantation. The most common cause of death was cardiovascular disease (32, 71.1%) followed by infection (6, 13.3%), cerebrovascular accident (5, 11.2%). The etiology of patients who shifted to HD was PD failure (41, 47.1%), peritonitis (33, 37.9%), leakage (6, 6.9%), catheter dysfunction (3, 3.4%), self willingness (4, 4.6%). Non-survivors were older than survivors (56.6 +/- 15.0 vs. 43.6 +/- 14.6, p = 0.003). There were also statistically significant difference in terms of albumin, residual urine, presence of diabetes and co-morbidity. When the groups were compared regarding HRQoL scores, non-survivors had lower physical functioning (p<0.001), role-physical (p = 0.0045), general health (p = 0.004), role-emotional (p = 0.011), physical component scale (PCS) (p = 0.004), mental component scale (MCS) (p = 0.029). Age, presence of residual urine, diabetes, albumin, PCS and MCS were entered in regression analysis. Decrease of 1 g/dL of albumin and being diabetic were found to be the independent predictors of mortality. Conclusions: Diabetes and hypoalbuminemia but not HRQOL scores were associated with higher mortality in PD patients after 7 years of following period.Öğe PERI-AORTIC FAT TISSUE AND MALNUTRITION-INFLAMMATION-ATHEROSCLEROSIS/CALCIFICATION SYNDROME IN END-STAGE RENAL DISEASE PATIENTS(Oxford Univ Press, 2012) Turkmen, Kultigin; Kayikcioglu, Hatice; Guney, Ibrahim; Altintepe, Lutfullah; Ozbek, Orhan; Tonbul, Halil Zeki[Abstract Not Availabe]Öğe Relationship Between Erythropoiesis-Stimulating Agent Usage and Hemoglobin Variability in Hemodialysis Patients(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2018) Tonbul, H. Zeki; Altintepe, Lutfullah; Baloglu, IsmailOBJECTIVE: Anemia is a common problem in chronic renal failure. Recent studies have shown that there is a close relationship between fluctuations in hemoglobin values and increased mortality. Therefore, treatment of anemia and providing stable hemoglobin (Hb) levels with erythropoiesis-stimulating agent (ESA) is important in the management of chronic renal failure. Hence, ESA usage and relationship between ESA type and Hb variability were investigated in hemodialysis patients. MATERIAL and METHODS: 130 patients treated at a hemodialysis center were monitored monthly for one year. The mean age was 60 +/- 7 years, mean weight was 72 +/- 13 kg, and mean dialysis duration was 5 +/- 2 years (F/M: 64/66). Hb stability was defined as continuous ESA usage at maintenance dosage and Hb levels being at the target level (Hb >= 11g/dl) for last 12 months. Hb variability and ESA dose change was accepted as decrease of Hb levels under 11 g/dl during maintenance dosage use and increasing ESA to starting dosage. In our study, annual mean values of monthly prescribed ESA rates, types of ESA and weekly dosages, and changes in ESA dosages due to monthly changes in hemoglobin (Hb) levels were examined. The relation between ESA type and Hb variability was investigated. RESULTS: During a one-year period, the number of patients who did not use ESA (Hb levels always > 12 g/dl) was 5 (% 3.8) and the number of patients who used ESA for different periods was 125 (% 96.2). The mean number of patients using ESA monthly was 71 (57%). 32 (45%) patients used short acting, 31 (44%) used medium acting (darbepoetin) and 8 (11%) used long acting ESA (methoxy polyethylene glycol-epoetin beta). 26 patients (21%) used ESA at the starting dose and 45 (36%) at the maintenance dose. One third of the 71 patients (36.6%) were using ESA at the starting dose and two thirds (63.4%) were on the maintenance dose. Mean weekly short acting ESA dose was 9666 +/- 2376 IU in the starting dose group and 5400 +/- 1142 IU in the maintenance group. Mean weekly darbepoetin dose was 46.6 +/- 10,3 mcg in the starting dose group and 26.4 +/- 4,9 mcg in the maintenance group. There were no Hb changes in 33 patients (26.4%) but 92 (73.6%) had Hb variability during one year. During one year, the Hb level dropped under 11 g/dl once in 32 patients (35%), twice in 39 patients (42%), three times in 16 patients (17%) and four times in 5 (6%) patients and the ESA dose was increased to the starting dose. Number of monthly Hb changes was higher in the short acting ESA than the medium and long acting ESA groups. CONCLUSION: Our results revealed that monthly ESA usage rate and weekly ESA dosage were lower than in western countries. During the one year period, there was Hb variability in three in four of the patients and ESA dosages were changed. The number of monthly Hb variability cases was found to be lower in the medium and long acting ESA groups. The most important reason of Hb variability was monthly dose change or discontinuation of ESA, due to the limits in the application of ESA.Öğe TECHNICAL SURVIVAL IN PERITONEAL DIALYSIS PATIENTS: QUALITY OF LIFE AND OTHER RELATED FACTORS(Oxford Univ Press, 2013) Guney, Ibrahim; Turkmen, Kultigin; Yazici, Raziye; Arslan, Sevket; Altintepe, Lutfullah; Yeksan, Mehdi[Abstract Not Availabe]
