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    The Characteristics of Patients Returning to Hemodialysis due to Nonfunctioning Graft in Turkey
    (Wolters Kluwer Medknow Publications, 2019) Altun, Ilkem; Selcuk, N. Yilmaz; Baloglu, Ismail; Turkmen, Kultigin; Tonbul, H. Zeki
    Renal transplantation is the most effective treatment modality for end-stage renal failure. According to the Ministry of Health Organ Transplant Registration System, despite the presence of 14,936 renal transplant recipients in Turkey, there are not enough data about the prognosis of these patients. Therefore, we aimed to ascertain the rate of patients returning to hemodialysis (HD) due to nonfunctioning graft in our country. One thousand four hundred and ninety-eight (males: 826, females: 672) HD patients who undergo HD at 22 HD centers in total, from different geographical regions to represent our country were examined retrospectively. The informations were obtained from patient registry files and anamnesis which were in HD centers. The number of patients returning to HD due to the loss of graft function was 77 (males: 56, females: 21). Eleven of the patients had transplantation from cadavers (14%) and 66 from living donors (86%). Prevelance of patients, who return to HD after the failure of renal transplantation, between HD patients was 5.1. The mean duration of return to HD after renal transplantation was 6.7 +/- 5.9 years for all patients. There was no significant difference in the duration without HD after transplantation between two groups when cadaveric and living donor transplants were compared (P = 0.759). There was no statistically significant difference in duration without HD after transplantation between patients receiving HD treatment before transplantation and preemptive transplant (P = 0.212). The prevelance of patients, who return to HD due to nonfunctioning graft among HD patients was 5.1. The duration without HD were similar after transplantation from both cadavers and living donors. The duration without HD was found longer among those who were operated before 2000.
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    EVALUATION OF LONG TERM THIRST DUE TO RAMADAN FASTING IN TERMS OF ACUTE KIDNEY INJURY
    (Oxford Univ Press, 2017) Pektas, Fatih; Tonbul, H. Zeki; Baloglu, Ismail; Turkmen, Kultigin; Selcuk, N. Yilmaz; Erdur, F. Mehmet
    [Abstract Not Availabe]
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    FGF-23 AND KLOTHO LEVELS IN RENAL TRANSPLANT PATIENTS AND COMPARISON WITH HEMODIALYSIS PATIENTS
    (Oxford Univ Press, 2017) Baloglu, Ismail; Turkmen, Kultigin; Selcuk, N. Yilmaz; Tonbul, H. Zeki; Erdur, F. Mehmet
    [Abstract Not Availabe]
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    The relationship between coronary artery calcium scores and left atrium size in hemodialysis patients
    (Springer, 2017) Baloglu, Ismail; Turkmen, Kultigin; Tonbul, H. Zeki; Selcuk, N. Yilmaz
    Hemodialysis patients have extremely increased cardiovascular mortality. The coronary artery calcification score (CACS) in uremic patients receiving hemodialysis reflects the severity of atherosclerotic vascular disease and predicts the cardiovascular events. In cardiac conditions, left atrial (LA) size has a prognostic importance. In this study, relationship between coronary artery calcification and left atrial size was investigated. This was a cross-sectional study involving 32 hemodialysis patients (16 females, 16 males; mean age, 52.4 +/- 14.1 years) receiving HD for 6 months. Coronary artery calcium scoring was performed by a 16-MDCT scanner, and CACS was calculated by Agatston score. A calcification was defined as a minimum of two adjacent pixels (> 0.52 mm(2)) with a density over 130 Hounsfield units. Patients were divided into two subgroups (group 1: CACS 45.85, n = 16 and group 2: CACS > 45.85, n = 16) according to median CACS value. Mean CACS value of 32 hemodialysis patients was 245.57 +/- 373.91. LA size was significantly higher in patients with CACS > 45.85 (group 2) than in patients with CACS 45.85 (group 1). In the bivariate correlation analysis, total CACS was positively correlated with left atrium size (r = 0.47, p = 0.006). Total CACS was positively correlated with age (r = 0.43, p = 0.014). LA size was positively correlated with diastolic blood pressure (r = 0.42, p = 0.016) and negatively correlated with ejection fraction (r = -0.42, p = 0.016). The clinical parameters such as BMI, duration of dialysis, blood pressure, ejection fraction, serum levels of calcium, phosphorus, uric acid, albumin, CRP, triglyceride, cholesterol, hemoglobin and ferritin were not independently associated with total CACS. We found a positive relationship between the CACS and LA size measured by echocardiography in hemodialysis patients. Therefore; echocardiography, which is cheaper and non-invasive than tomographic examinations, might be considered for the risk stratification of coronary artery disease in hemodialysis patients.
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    THE RELATIONSHIP BETWEEN CORONARY ARTERY CALCIUM SCORES AND LEFT ATRIUM SIZE IN HEMODIALYSIS PATIENTS
    (Oxford Univ Press, 2017) Baloglu, Ismail; Turkmen, Kultigin; Tonbul, H. Zeki; Selcuk, N. Yilmaz
    [Abstract Not Availabe]
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    Relationship Between Erythropoiesis-Stimulating Agent Usage and Hemoglobin Variability in Hemodialysis Patients
    (Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2018) Tonbul, H. Zeki; Altintepe, Lutfullah; Baloglu, Ismail
    OBJECTIVE: 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.