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    The history of haemodialysis in Turkey
    (Athens Medical Soc, 2020) San, A.; Tonbul, H. Z.
    The review of the historical process of haemodialysis (HD) application in Turkey from the beginning to the present. It can easily be seen that the founders on Nephrology made great sacrifices that these days have not been easily reached. The establishment of dialysis centres was also time-consuming and difficult. The first application was made in 1962 at the Ankara University Faculty of Medicine. This was followed in 1965 by the Cerrahpasa Medical Faculty. Dialysis recording systems started in 1989. Today, there are about 884 HD centres in Turkey, two-thirds of which are private and one-third public. The fees of these patients are covered by the government and no extra payment is required. These centres are spread all over Turkey and there is no patient who has died due to lack of HD treatment. Patients are taken from and to their homes free and meals are provided by HD centres. Procedures and regulations related to HD are thoroughly arranged. All centres are supervised twice a year. A certificate program has been implemented since 2000 and authorised staff has been trained and given five-year certificates. Recent data shows that in Turkey there are about 63,349 patients and 17,322 devices. The annual mortality rate is 15%. The number of patients who use home HD has exceeded 800, placing Turkey in third position in Europe.
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    Peri-aortic fat tissue and malnutrition-inflammation-atherosclerosis/calcification syndrome in end-stage renal disease patients
    (Springer, 2013) Turkmen, K.; Tonbul, H. Z.; Erdur, F. M.; Guney, I.; Kayikcioglu, H.; Altintepe, L.; Ozbek, O.
    Thoracic peri-aortic fat tissue (PFT) is considered as a metabolically active organ in atherosclerosis. Malnutrition, inflammation and atherosclerosis/calcification (MIAC) are the most commonly encountered risk factors of cardiovascular disease in end-stage renal disease (ESRD) patients. Calcification of the aorta was found to be an important cardiovascular risk marker predicting future events, morbidity and mortality in this population. We aimed to investigate the relationship between PFT, MIAC syndrome and thoracic aortic calcification (TAC) in ESRD patients. Seventy-nine ESRD patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and 20 control subjects were enrolled in this cross-sectional study. PFT and TAC were assessed using a 64-MDCT scanner. Patients with serum albumin < 3.5 g/dL were defined as patients with malnutrition; those with serum C-reactive protein level > 10 mg/L had inflammation, and those with coronary artery calcification score (CACS) > 10 had atherosclerosis/calcification. TAC and PFT were significantly higher in ESRD patients compared with control subjects. There was a statistically significant relationship between PFT and TAC in ESRD patients (r = 0.458, p < 0.0001). PFT was found to be significantly increased when the MIAC components increased. PFT was positively associated with age, BMI, uric acid, hemoglobin and CAC. The multivariate analysis revealed that age and uric acid were independent predictors of increased PFT. Twenty-four (30.4 %) patients had none, 30 (37.9 %) had one component, 17 (21.5 %) had two components, and 8 (10.2 %) had all MIAC components. PFT was highest among patients having all three components (28.6 cm(3)) and lowest among those who do not have the MIAC syndrome (8.54 cm(3)). TAC was highest among patients having all three components (179.2 HU) and lowest among those who do not have the MIAC syndrome (0 HU). We found a relationship between PFT and MIAC syndrome in ESRD patients.