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Ok E, Demirci C, Asci G, Yuksel K, Kircelli F, Koc SK, Erten S, Mahsereci E, Odabas AR, Stuard S, Maddux FW, Raimann JG, Kotanko P, Kerr PG, Chan CT. Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis. Kidney Int Rep 2023; 8:2603-2615. [PMID: 38106580 PMCID: PMC10719649 DOI: 10.1016/j.ekir.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up. Methods We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters. Results The mean duration of dialysis session was 418 ± 54 minutes in HHD and 242 ± 10 minutes in patients on ICHD. All-cause mortality rate was 3.76 and 6.27 per 100 patient-years in the HHD and the ICHD groups, respectively. In the intention-to-treat analysis, HHD was associated with a 40% lower risk for all-cause mortality than ICHD (hazard ratio [HR] = 0.60; 95% confidence interval [CI] 0.45 to 0.80; P < 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement. Conclusion These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD.
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Busink E, Kendzia D, Kircelli F, Boeger S, Petrovic J, Smethurst H, Mitchell S, Apel C. A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway. Eur J Health Econ 2023; 24:377-392. [PMID: 35716316 PMCID: PMC10060297 DOI: 10.1007/s10198-022-01478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients. METHODS A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]). RESULTS In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions. CONCLUSIONS Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances. Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.
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Affiliation(s)
- Ellen Busink
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany.
| | - Dana Kendzia
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | - Fatih Kircelli
- Global Medical Information & Education, Fresenius Medical Care, Bad Homburg, Germany
| | - Sophie Boeger
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | - Jovana Petrovic
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | | | | | - Christian Apel
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
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Zawada AM, Lang T, Ottillinger B, Kircelli F, Stauss-Grabo M, Kennedy JP. Impact of Hydrophilic Modification of Synthetic Dialysis Membranes on Hemocompatibility and Performance. Membranes (Basel) 2022; 12:932. [PMID: 36295691 PMCID: PMC9610916 DOI: 10.3390/membranes12100932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
The dialyzer is the core element in the hemodialysis treatment of patients with end-stage kidney disease (ESKD). During hemodialysis treatment, the dialyzer replaces the function of the kidney by removing small and middle-molecular weight uremic toxins, while retaining essential proteins. Meanwhile, a dialyzer should have the best possible hemocompatibility profile as the perpetuated contact of blood with artificial surfaces triggers complement activation, coagulation and immune cell activation, and even low-level activation repeated chronically over years may lead to undesired effects. During hemodialysis, the adsorption of plasma proteins to the dialyzer membrane leads to a formation of a secondary membrane, which can compromise both the uremic toxin removal and hemocompatibility of the dialyzer. Hydrophilic modifications of novel dialysis membranes have been shown to reduce protein adsorption, leading to better hemocompatibility profile and performance stability during dialysis treatments. This review article focuses on the importance of performance and hemocompatibility of dialysis membranes for the treatment of dialysis patients and summarizes recent studies on the impact of protein adsorption and hydrophilic modifications of membranes on these two core elements of a dialyzer.
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Affiliation(s)
- Adam M. Zawada
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany
| | - Thomas Lang
- Global Biomedical Evidence Generation, Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany
| | | | - Fatih Kircelli
- Medical Information and Education (EMEA), Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany
| | - Manuela Stauss-Grabo
- Global Biomedical Evidence Generation, Fresenius Medical Care Deutschland GmbH, 61352 Bad Homburg, Germany
| | - James P. Kennedy
- Product Development, Fresenius Medical Care Deutschland GmbH, 66606 Sankt Wendel, Germany
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Abstract
In haemodialysis (HD), unwanted substances (uraemic retention solutes or ‘uraemic toxins’) that accumulate in uraemia are removed from blood by transport across the semipermeable membrane. Like all membrane separation processes, the transport requires driving forces to facilitate the transfer of molecules across the membrane. The magnitude of the transport is quantified by the phenomenon of ‘flux’, a finite parameter defined as the volume of fluid (or permeate) transferred per unit area of membrane surface per unit time. In HD, as transmembrane pressure is applied to facilitate fluid flow or flux across the membrane to enhance solute removal, flux is defined by the ultrafiltration coefficient (KUF; mL/h/mmHg) reflecting the hydraulic permeability of the membrane. However, in HD, the designation of flux has come to be used in a much broader sense and the term is commonly used interchangeably and erroneously with other measures of membrane separation processes, resulting in considerable confusion. Increased flux is perceived to reflect more ‘porous’ membranes having ‘larger’ pores, even though other membrane and therapy attributes determine the magnitude of flux achieved during HD. Adjectival designations of flux (low-, mid-, high-, super-, ultra-) have found indiscriminate usage in the scientific literature to qualify a parameter that influences clinical decision making and prescription of therapy modalities (low-flux or high-flux HD). Over the years the concept and definition of flux has undergone arbitrary and periodic adjustment and redefinition by authors in publications, regulatory bodies (US Food and Drug Administration) and professional association guidelines (European Renal Association, Kidney Disease Outcomes Quality Initiative), with little consensus. Industry has stretched the boundaries of flux to derive marketing advantages, justify increased reimbursement or contrive new classes of therapy modalities when in fact flux is just one of several specifications that determine membrane or dialyser performance. Membranes considered as high-flux previously are today at the lower end of the flux spectrum. Further, additional parameters unrelated to the rate of diffusive or convective transport (flux) are used in conjunction with or in place of KUF to allude to flux: clearance (mL/min, e.g. of β2-microglobulin) or sieving coefficients (dimensionless). Considering that clinical trials in nephrology, designed to make therapy recommendations and guide policy with economic repercussions, are based on the parameter flux they merit clarification—by regulatory authorities and scientists alike—to avoid further misappropriation.
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Affiliation(s)
- Sudhir K Bowry
- Dialysis-at-Crossroads (D@X) Advisory, Bad Nauheim, Germany
| | - Fatih Kircelli
- Global Medical Information and Education, Fresenius Medical Care, Bad Homburg, Germany
| | - Madhukar Misra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, MO, USA
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Bowry SK, Kircelli F, Himmele R, Nigwekar SU. Blood-incompatibility in haemodialysis: alleviating inflammation and effects of coagulation. Clin Kidney J 2022; 14:i59-i71. [PMID: 34987786 PMCID: PMC8711760 DOI: 10.1093/ckj/sfab185] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 12/14/2022] Open
Abstract
Blood-incompatibility is an inevitability of all blood-contacting device applications and therapies, including haemodialysis (HD). Blood leaving the environment of blood vessels and the protection of the endothelium is confronted with several stimuli of the extracorporeal circuit (ECC), triggering the activation of blood cells and various biochemical pathways of plasma. Prevention of blood coagulation, a major obstacle that needed to be overcome to make HD possible, remains an issue to contend with. While anticoagulation (mainly with heparin) successfully prevents clotting within the ECC to allow removal of uraemic toxins across the dialysis membrane wall, it is far from ideal, triggering heparin-induced thrombocytopenia in some instances. Soluble fibrin can form even in the presence of heparin and depending on the constitution of the patient and activation of platelets, could result in physical clots within the ECC (e.g. bubble trap chamber) and, together with other plasma and coagulation proteins, result in increased adsorption of proteins on the membrane surface. The buildup of this secondary membrane layer impairs the transport properties of the membrane to reduce the clearance of uraemic toxins. Activation of complement system-dependent immune response pathways leads to leukopenia, formation of platelet–neutrophil complexes and expression of tissue factor contributing to thrombotic processes and a procoagulant state, respectively. Complement activation also promotes recruitment and activation of leukocytes resulting in oxidative burst and release of pro-inflammatory cytokines and chemokines, thereby worsening the elevated underlying inflammation and oxidative stress condition of chronic kidney disease patients. Restricting all forms of blood-incompatibility, including potential contamination of dialysis fluid with endotoxins leading to inflammation, during HD therapies is thus still a major target towards more blood-compatible and safer dialysis to improve patient outcomes. We describe the mechanisms of various activation pathways during the interaction between blood and components of the ECC and describe approaches to mitigate the effects of these adverse interactions. The opportunities to develop improved dialysis membranes as well as implementation strategies with less potential for undesired biological reactions are discussed.
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Affiliation(s)
- Sudhir K Bowry
- Dialysis-at-Crossroads (D@X) Advisory, Bad Nauheim, Germany
| | - Fatih Kircelli
- Global Medical Information and Education, Fresenius Medical Care, Bad Homburg, Germany
| | - Rainer Himmele
- Global Medical Information and Education, Fresenius Medical Care, Charlotte, NC, USA
| | - Sagar U Nigwekar
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Bowry SK, Kircelli F, Nandakumar M, Vachharajani TJ. Clinical relevance of abstruse transport phenomena in haemodialysis. Clin Kidney J 2021; 14:i85-i97. [PMID: 34987788 PMCID: PMC8711756 DOI: 10.1093/ckj/sfab183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
Haemodialysis (HD) utilizes the bidirectional properties of semipermeable membranes to remove uraemic toxins from blood while simultaneously replenishing electrolytes and buffers to correct metabolic acidosis. However, the nonspecific size-dependent transport across membranes also means that certain useful plasma constituents may be removed from the patient (together with uraemic toxins), or toxic compounds, e.g. endotoxin fragments, may accompany electrolytes and buffers of the dialysis fluids into blood and elicit severe biological reactions. We describe the mechanisms and implications of these undesirable transport processes that are inherent to all HD therapies and propose approaches to mitigate the effects of such transport. We focus particularly on two undesirable events that are considered to adversely affect HD therapy and possibly impact patient outcomes. Firstly, we describe how loss of albumin (and other essential substances) can occur while striving to eliminate larger uraemic toxins during HD and why hypoalbuminemia is a clinical condition to contend with. Secondly, we describe the origins and mode of transport of biologically active substances (from dialysis fluids with bacterial contamination) into the blood compartment and biological reactions they elicit. Endotoxin fragments activate various proinflammatory pathways to increase the underlying inflammation associated with chronic kidney disease. Both phenomena involve the physical as well as chemical properties of membranes that must be selected judiciously to balance the benefits with potential risks patients may encounter, in both the short and long term.
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Affiliation(s)
- Sudhir K Bowry
- Dialysis-at-Crossroads (D@X) Advisory, Bad Nauheim, Germany
| | - Fatih Kircelli
- Global Medical Information and Education, Fresenius Medical Care, Bad Homburg, Germany
| | | | - Tushar J Vachharajani
- Department of Hypertension and Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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Gauly A, Fleck N, Kircelli F. Advanced hemodialysis equipment for more eco-friendly dialysis. Int Urol Nephrol 2021; 54:1059-1065. [PMID: 34480255 PMCID: PMC9005388 DOI: 10.1007/s11255-021-02981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/21/2021] [Indexed: 11/25/2022]
Abstract
Healthcare in general and dialysis care in particular are contributing to resource consumption and, thus, have a notable environmental footprint. Dialysis is a life-saving therapy but it entails the use of a broad range of consumables generating waste, and consumption of water and energy for the dialysis process. Various stakeholders in the healthcare sector are called upon to develop and to take measures to save resources and to make healthcare and dialysis more sustainable. Among these stakeholders are manufacturers of dialysis equipment and water purification systems. Dialysis equipment and consumables, together with care processes need to be advanced to reduce waste generation, enhance recyclability, optimize water purification efficiency and water use. Joint efforts should thus pave the way to enable delivering green dialysis and to contribute to environmentally sustainable health care.
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Affiliation(s)
- Adelheid Gauly
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Else-Kröner-Strasse 3, 61352, Bad Homburg, Germany.
| | - Nicole Fleck
- Fresenius Medical Care, Application Training and Clinical Support, Bad Homburg, Germany
| | - Fatih Kircelli
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Else-Kröner-Strasse 3, 61352, Bad Homburg, Germany
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Vernooij RWM, Law W, Peters SAE, Canaud B, Davenport A, Grooteman MPC, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ, Bots ML. The probability of receiving a kidney transplantation in end-stage kidney disease patients who are treated with haemodiafiltration or haemodialysis: a pooled individual participant data from four randomised controlled trials. BMC Nephrol 2021; 22:70. [PMID: 33632160 PMCID: PMC7905891 DOI: 10.1186/s12882-021-02265-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background Due to a critical shortage of available kidney grafts, most patients with Stage 5 Chronic Kidney Disease (CKD5) require bridging dialysis support. It remains unclear whether treatment by different dialysis modalities changes the selection and/or preparation of a potential transplant candidate. Therefore, we assessed whether the likelihood of receiving kidney transplant (both living or deceased kidney donors) differs between haemodialysis (HD) and online haemodiafiltration (HDF) in patients with CKD5D. Methods Individual participant data from four randomised controlled trials comparing online HDF with HD were used. Information on kidney transplant was obtained during follow-up. The likelihood of receiving a kidney transplant was compared between HD and HDF, and evaluated across different subgroups: age, sex, diabetes, history of cardiovascular disease, albumin, dialysis vintage, fistula, and level of convection volume standardized to body surface area. Hazard ratios (HRs), with corresponding 95% confidence intervals (95% CI), comparing the effect of online HDF versus HD on the likelihood of receiving a kidney transplant, were estimated using Cox proportional hazards models with a random effect for study. Results After a median follow-up of 2.5 years (Q1 to Q3: 1.9–3.0), 331 of the 1620 (20.4%) patients with CKD5D received a kidney transplant. This concerned 22% (n = 179) of patients who were treated with online HDF compared with 19% (n = 152) of patients who were treated with HD. No differences in the likelihood of undergoing a kidney transplant were found between the two dialysis modalities in both the crude analyse (HR: 1.07, 95% CI: 0.86–1.33) and adjusted analysis for age, sex, diabetes, cardiovascular history, albumin, and creatinine (HR: 1.15, 95%-CI: 0.92–1.44). There was no evidence for a differential effect across subgroups based on patient- and disease-characteristics nor in different categories of convection volumes. Conclusions Treatment with HD and HDF does not affect the selection and/or preparation of CKD5D patients for kidney transplant given that the likelihood of receiving a kidney transplant does not differ between the dialysis modalities. These finding persisted across a variety of subgroups differing in patient and disease characteristics and is not affected by the level of convection volume delivered during HDF treatment sessions.
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Affiliation(s)
- Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Way Law
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.,Wai-ping Law, Renal unit, Department of medicine, Queen Elizabeth Hospital, Hong Kong, PR China
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,The George Institute for Global Health, School of Public Health, Imperial College, London, UK.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bernard Canaud
- Global Medical Office, Fresenius Medical Care Deutschland, Bad Homburg, Germany.,Montpellier University, School of Medicine, Montpellier, France
| | - Andrew Davenport
- University College London, Centre for Nephrology, Royal Free Hospital, London, UK
| | - Muriel P C Grooteman
- Department of Nephrology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Fatih Kircelli
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Francesco Locatelli
- Department of Nephrology, Alessandro Manzoni Hospital, past director, Lecco, Italy
| | | | - Marion Morena
- PhyMedExp, University of Montpellier, INSERM, CNRS, Biochemistry/Hormonology department, University Hospital Center of Montpellier, Montpellier, France
| | - Menso J Nubé
- Department of Nephrology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Ercan Ok
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Ferran Torres
- Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Medical Statistics core facility, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College, London, UK.,The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Neri L, Bellocchio F, Kircelli F, Jirka T, Levannier M, Guillaume J, Attaf D, Barbieri C, Garbelli M, Stuard S, Canaud B, Chazot C. Long-term mortality risk associated with citric acid- and acetic acid-based bicarbonate haemodialysis: a historical cohort propensity score-matched study in a large, multicentre, population-based study. Nephrol Dial Transplant 2020; 35:1237-1244. [DOI: 10.1093/ndt/gfaa089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/27/2020] [Indexed: 01/02/2023] Open
Abstract
Abstract
Background
Citric acid-based bicarbonate dialysate (CiD) is increasingly used in haemodialysis (HD) to improve haemodynamic tolerance and haemocompatibility associated with acetic acid-based bicarbonate dialysate. Safety concerns over CiD have been raised recently after a French ecological study reported higher mortality hazard in HD clinics with high CiD consumption. Therefore, we evaluated the mortality risk associated with various acidifiers (AcD, CiD) of bicarbonate dialysate.
Methods
In this multicentre, historical cohort study, we included adult incident HD patients (European, Middle-East and Africa Fresenius Medical Care network; 1 January 2014 to 31 October 2018). We recorded acidifiers of bicarbonate dialysis and dialysate composition for each dialysis session. In the primary intention-to-treat analysis, patients were assigned to the exposed group if they received CiD in >70% of sessions during the first 3 months (CiD70%), whereas the non-exposed group received no CiD at all. In the secondary analysis, exposure was assessed on a monthly basis for the whole duration of the follow-up.
Results
We enrolled 10 121 incident patients during the study period. Of them, 371 met the criteria for inclusion in CiD70%. After propensity score matching, mortality was 11.43 [95% confidence interval (CI) 8.86–14.75] and 12.04 (95% CI 9.44–15.35) deaths/100 person-years in the CiD0% and CiD70% groups, respectively (P = 0.80). A similar association trend was observed in the secondary analysis.
Conclusions
We did not observe evidence of increased mortality among patients exposed to CiD in a large European cohort of dialysis patients despite the fact that physicians were more inclined to prescribe CiD to subjects with worse medical conditions.
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Affiliation(s)
- Luca Neri
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Francesco Bellocchio
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Fatih Kircelli
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Tomas Jirka
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | | | - Jean Guillaume
- Dialysis Unit of Tassin-Charcot, Nephrocare, Tassin-Charcot, France
| | - David Attaf
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Carlo Barbieri
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Mario Garbelli
- Clinical & Data Intelligence Systems, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco (CR), Italy
| | - Stefano Stuard
- Dialysis Unit of Tassin-Charcot, Nephrocare, Tassin-Charcot, France
| | | | - Charles Chazot
- Country Medical Director, NephroCare France, Fresnes, France
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Chazot C, Neri L, Bellocchio F, Jean G, Martial L, Attaf D, Jirka T, Kircelli F, Stuard S, Canaud B. Hémodialyse chronique avec concentré acide au citrate : absence d’impact négatif sur la mortalité. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Ertilav M, Levin WN, Celtik A, Kircelli F, Stuard S, Yuksel K, Ok E, Asci G. Impact of body mass index on short-term and long-term survival in prevalent hemodialysis patients. Hemodial Int 2019; 23:375-383. [PMID: 30860664 DOI: 10.1111/hdi.12746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/16/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Numerous studies showed that higher body mass index (BMI) is associated with better survival in hemodialysis (HD) patients. Most of them evaluated short-term mortality. It has been suggested that presence of inflammation may be a key modifier of relationship between BMI and mortality in incident HD patients. We examined whether presence of inflammation modifies the association between BMI and mortality in both short-term and long-term follow-up in a large group of prevalent HD patients. METHODS A total of 3.252 HD patients from 41 HD centers were enrolled; the patients were divided into quartiles based on time-averaged BMI (Q1 < 21.5, Q2 21.5 to <24.3, Q3 24.3 to <27.4, Q4 ≥ 27.4 kg/m2 ). Inflammation status was defined as present (inflamed) (C-reactive protein (CRP) ≥1.0 mg/dL and/or serum albumin ≤3.5 g/dL) or absent (noninflamed). FINDINGS During 7 years of follow-up 1386 patients (42.6%) died. Compared to noninflamed patients, inflamed patients in the lowest BMI quartile showed 5-fold increased risk for mortality in the short-term (95% confidence interval [CI] 2.82-9.22, P < 0.001) and 3-fold in the long-term (95%CI 2.42-4.27, P < 0.001) compared to the highest BMI quartile. Whereas, inflamed patients in the highest BMI quartile experienced 2-fold increased risk in short-term (95%CI 1.17-3.74, P = 0.01) and 1.68-fold increased risk in long-term (95%CI 1.30-2.18, P < 0.001) than in noninflamed patients. The protective effect of BMI for overall mortality was present in all age groups, in both genders, in patient with and without diabetes. BMI was not a mortality predictor in patients with HD duration more than 76 months at baseline. The protective effect of BMI was observed in all albumin tertiles. In patients in the lowest CRP tertile, BMI was not associated with mortality. DISCUSSION Higher BMI is associated with lower short-term and long-term mortality risk, especially in patients with inflammation in a prevalent HD population.
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Affiliation(s)
- Muhittin Ertilav
- Division of Nephrology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey
| | - W Nathan Levin
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aygul Celtik
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Fatih Kircelli
- Medical Department, Fresenius Medical Care, Istanbul, Turkey
| | - Stefano Stuard
- Fresenius Medical Care Europe, Clinical and Therapeutical Governance, Bad Homburg v.d.H., Germany
| | - Kıvanc Yuksel
- Department of Data Management and Biostatistics, Ege University, ARGEFAR, Izmir, Turkey
| | - Ercan Ok
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Gulay Asci
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
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12
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Gozubatik‐Celik G, Uluduz D, Goksan B, Akkaya N, Sohtaoglu M, Uygunoglu U, Kircelli F, Sezen A, Saip S, Karaali Savrun F, Siva A. Hemodialysis‐related headache and how to prevent it. Eur J Neurol 2018; 26:100-105. [DOI: 10.1111/ene.13777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/02/2018] [Indexed: 01/03/2023]
Affiliation(s)
- G. Gozubatik‐Celik
- Department of Neurology Bakirkoy Research and Training Hospital for Neurologic and Psychiatric Diseases IstanbulTurkey
| | - D. Uluduz
- Department of Neurology Istanbul University Cerrahpasa School of Medicine IstanbulTurkey
| | - B. Goksan
- Department of Neurology Istanbul University Cerrahpasa School of Medicine IstanbulTurkey
| | - N. Akkaya
- Istanbul University Cerrahpasa School of Medicine IstanbulTurkey
| | - M. Sohtaoglu
- Department of Neurology Istanbul University Cerrahpasa School of Medicine IstanbulTurkey
| | - U. Uygunoglu
- Department of Neurology Istanbul University Cerrahpasa School of Medicine IstanbulTurkey
| | - F. Kircelli
- Fresenius Medical Care Dialysis Center IstanbulTurkey
| | - A. Sezen
- Dogan Dialysis Center Istanbul Turkey
| | - S. Saip
- Department of Neurology Istanbul University Cerrahpasa School of Medicine IstanbulTurkey
| | - F. Karaali Savrun
- Department of Neurology Istanbul University Cerrahpasa School of Medicine IstanbulTurkey
| | - A. Siva
- Department of Neurology Istanbul University Cerrahpasa School of Medicine IstanbulTurkey
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13
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Hazelbag CM, Peters SAE, Blankestijn PJ, Bots ML, Canaud B, Davenport A, Grooteman MPC, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Hoes AW, Groenwold RHH. The importance of considering competing treatment affecting prognosis in the evaluation of therapy in trials: the example of renal transplantation in hemodialysis trials. Nephrol Dial Transplant 2017; 32:ii31-ii39. [PMID: 28339826 DOI: 10.1093/ndt/gfw458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
Abstract
Background During the follow-up in a randomized controlled trial (RCT), participants may receive additional (non-randomly allocated) treatment that affects the outcome. Typically such additional treatment is not taken into account in evaluation of the results. Two pivotal trials of the effects of hemodiafiltration (HDF) versus hemodialysis (HD) on mortality in patients with end-stage renal disease reported differing results. We set out to evaluate to what extent methods to take other treatments (i.e. renal transplantation) into account may explain the difference in findings between RCTs. This is illustrated using a clinical example of two RCTs estimating the effect of HDF versus HD on mortality. Methods Using individual patient data from the Estudio de Supervivencia de Hemodiafiltración On-Line (ESHOL; n = 902) and The Dutch CONvective TRAnsport STudy (CONTRAST; n = 714) trials, five methods for estimating the effect of HDF versus HD on all-cause mortality were compared: intention-to-treat (ITT) analysis (i.e. not taking renal transplantation into account), per protocol exclusion (PP excl ; exclusion of patients who receive transplantation), PP cens (censoring patients at the time of transplantation), transplantation-adjusted (TA) analysis and an extension of the TA analysis (TA ext ) with additional adjustment for variables related to both the risk of receiving a transplant and the risk of an outcome (transplantation-outcome confounders). Cox proportional hazards models were applied. Results Unadjusted ITT analysis of all-cause mortality led to differing results between CONTRAST and ESHOL: hazard ratio (HR) 0.95 (95% CI 0.75-1.20) and HR 0.76 (95% CI 0.59-0.97), respectively; difference between 5 and 24% risk reductions. Similar differences between the two trials were observed for the other unadjusted analytical methods (PP cens, PP excl , TA) The HRs of HDF versus HD treatment became more similar after adding transplantation as a time-varying covariate and including transplantation-outcome confounders: HR 0.89 (95% CI 0.69-1.13) in CONTRAST and HR 0.80 (95% CI 0.62-1.02) in ESHOL. Conclusions The apparent differences in estimated treatment effects between two dialysis trials were to a large extent attributable to differences in applied methodology for taking renal transplantation into account in their final analyses. Our results exemplify the necessity of careful consideration of the treatment effect of interest when estimating the therapeutic effect in RCTs in which participants may receive additional treatments.
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Affiliation(s)
- C Marijn Hazelbag
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.,George Institute for Global Health, University of Oxford, Oxford, UK
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Bernard Canaud
- Nephrology, Dialysis and Intensive Care Unit, CHRU, Montpellier, France.,Dialysis Research and Training Institute, Montpellier, France
| | - Andrew Davenport
- University College London, Centre for Nephrology, Royal Free Hospital, London, UK
| | - Muriel P C Grooteman
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Fatih Kircelli
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | | | | | - Marion Morena
- Dialysis Research and Training Institute, Montpellier, France.,Biochemistry and Hormonology Department Laboratory, CHRU, Montpellier, France; PhyMedExp, University of Montpellier, ISERM U1046, CNRS UMR 9214, Montpellier, France
| | - Menso J Nubé
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ercan Ok
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Ferran Torres
- Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
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14
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Aydemir B, Gunes B, Mirza C, Gozkonan A, Papila R, Unal E, Kircelli F. SP613MANAGING ANEMIA VIA ADJUSTING RESTITUTION VOLUMES IS AN EFFECTIVE, SAFE AND ECONOMICAL WAY TO CONTROL ANEMIA. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx153.sp613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Artan AS, Kircelli F, Ok E, Yilmaz M, Asci G, Dogan C, Oto O, Gunestepe K, Basci A, Sever MS. Dialyzing women and men: does it matter? An observational study. Clin Kidney J 2016; 9:486-93. [PMID: 27274838 PMCID: PMC4886909 DOI: 10.1093/ckj/sfw013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/09/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Application and consequences of hemodialysis treatment may differ between genders; focusing on these differences may be useful to optimize outcomes. METHODS Data from 1 999 648 hemodialysis sessions performed in 10 984 (3316 incident and 7668 prevalent) patients, treated in 55 centers of the European Clinical Database (EuCliD)-Turkey, were analyzed, and various demographic, clinical, biochemical, therapeutic and prognostic parameters were compared. RESULTS There were 1905 male and 1411 female incident and 4339 male and 3329 female prevalent patients. For females, the mean age in incident (61.8 ± 14.9 years) and prevalent (58.3 ± 15.2 years) patients was higher than for males (60.2 ± 14.8 and 56.5 ± 14.9 years, respectively) (P < 0.001 for both analyses). Also, body mass index was higher, while the hemoglobin level, and the percentage of interdialytic weight gain and arteriovenous fistula were lower. Serum phosphorus was similar in both genders in incident cases, while it was lower in prevalent female patients. Serum parathyroid hormone levels were lower in incident, but higher in prevalent male cases. Erythropoiesis-stimulating agents and vitamin D preparations were more frequently used in female incident and prevalent patients. Hospitalization was more frequent in prevalent females, while it did not differ significantly in the incident cases. Overall, no significant difference was observed in survival rates at 3 years in both incident and prevalent male and female patients. CONCLUSIONS Many parameters differ significantly between female and male dialysis patients. Considering the effects of sex on several parameters may be a valuable approach for achieving better outcomes when formulating treatment strategies in this patient population.
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Affiliation(s)
- Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine , Istanbul Medical Faculty , Istanbul , Turkey
| | | | - Ercan Ok
- Ege Medical Faculty , Izmir , Turkey
| | - Murvet Yilmaz
- Bakirkoy Dr. Sadi Konuk Education and Research Hospital , Istanbul , Turkey
| | | | | | - Ozgur Oto
- Division of Nephrology, Department of Internal Medicine , Istanbul Medical Faculty , Istanbul , Turkey
| | | | - Ali Basci
- Ege Medical Faculty , Izmir , Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine , Istanbul Medical Faculty , Istanbul , Turkey
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16
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Yilmaz M, Kircelli F, Artan AS, Oto O, Asci G, Gunestepe K, Basci A, Ok E, Sever MS. Naturally nonanemic dialysis patients: Who are they? Hemodial Int 2016; 20:522-529. [PMID: 27147461 DOI: 10.1111/hdi.12425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Not only anemia, but also erythropoiesis stimulating agent (ESA)s for treating anemia may adversely affect prognosis of chronic hemodialysis patients. Various features of naturally (with no ESA usage) nonanemic patients may be useful for defining several factors in the pathogenesis of anemia. Methods Data, retrieved from the European Clinical Database (EuCliD)-Turkey on naturally nonanemic prevalent chronic hemodialysis patients (n: 201) were compared with their anemic (those who required ESA treatment) counterparts (n: 3948). Findings Mean hemoglobin values were 13.5 ± 0.8 and 11.5 ± 0.9 g/dL in nonanemic and anemic patients, respectively (P < 0.001). Nonanemia status was associated with younger age, male gender, longer dialysis vintage, nondiabetic status, more frequent hepatitis-C virus seropositivity and more frequent arteriovenous fistula usage. Serum ferritin and CRP levels and urea reduction ratio were higher in ESA-requiring patients. One (99%) and two (95.3%) years survival rates of the "naturally nonanemic" patients were superior as compared to anemics (91.0% and 82.6%, respectively), (P < 0.001). Discussion "Naturally nonanemic" status is associated with better survival in prevalent chronic hemodialysis patients; underlying mechanisms in this favorable outcome should be investigated by randomized controlled trials including large number of patients.
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Affiliation(s)
- Murvet Yilmaz
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Nephrology, Istanbul, Turkey.
| | - Fatih Kircelli
- Fresenius Medical Care, Department of Nephrology, Turkey
| | - Ayse Serra Artan
- Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Ozgur Oto
- Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Gulay Asci
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
| | | | - Ali Basci
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
| | - Ercan Ok
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
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17
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Marcelli D, Brand K, Kircelli F, Merello JI, Ponce P, Jirka T, Rosenberger J, Gurevich K, Marelli C, Imamovic G, Di Benedetto A, Grassmann A, Scatizzi L, Bayh I, Canaud B. TO006ANALYSIS OF CREATININE AND ALBUMIN CHANGE DYNAMICS DURING THE FIRST TWO YEARS ON EXTRACORPOREAL DIALYSIS THERAPY. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw143.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Turan MN, Kircelli F, Yaprak M, Sisman AR, Gungor O, Bayraktaroglu S, Ozkahya M, Asci G, Floege J, Ok E. FGF-23 levels are associated with vascular calcification, but not with atherosclerosis, in hemodialysis patients. Int Urol Nephrol 2016; 48:609-17. [DOI: 10.1007/s11255-016-1231-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
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19
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Affiliation(s)
- E Tatar
- Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Izmir
| | - C Karan
- Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Izmir
| | - F Kircelli
- Fresenius Medical Care, Istanbul, Turkey
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20
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Ok E, Asci G, Bayraktaroglu S, Toz H, Ozkahya M, Yilmaz M, Kircelli F, Sevinc Ok E, Ceylan N, Duman S, Cirit M, Monier-Faugere MC, Malluche HH. Reduction of Dialysate Calcium Level Reduces Progression of Coronary Artery Calcification and Improves Low Bone Turnover in Patients on Hemodialysis. J Am Soc Nephrol 2015; 27:2475-86. [PMID: 26701977 DOI: 10.1681/asn.2015030268] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 11/04/2015] [Indexed: 01/24/2023] Open
Abstract
Exposure to high Ca concentrations may influence the development of low-turnover bone disease and coronary artery calcification (CAC) in patients on hemodialysis (HD). In this randomized, controlled study, we investigated the effects of lowering dialysate Ca level on progression of CAC and histologic bone abnormalities in patients on HD. Patients on HD with intact parathyroid hormone levels ≤300 pg/ml receiving dialysate containing 1.75 or 1.50 mmol/L Ca (n=425) were randomized to the 1.25-mmol/L Ca (1.25 Ca; n=212) or the 1.75-mmol/L Ca (1.75 Ca; n=213) dialysate arm. Primary outcome was a change in CAC score measured by multislice computerized tomography; main secondary outcome was a change in bone histomorphometric parameters determined by analysis of bone biopsy specimens. CAC scores increased from 452±869 (mean±SD) in the 1.25 Ca group and 500±909 in the 1.75 Ca group (P=0.68) at baseline to 616±1086 and 803±1412, respectively, at 24 months (P=0.25). Progression rate was significantly lower in the 1.25 Ca group than in the 1.75 Ca group (P=0.03). The prevalence of histologically diagnosed low bone turnover decreased from 85.0% to 41.8% in the 1.25 Ca group (P=0.001) and did not change in the 1.75 Ca group. At 24 months, bone formation rate, trabecular thickness, and bone volume were higher in the 1.25 Ca group than in the 1.75 Ca group. Thus, lowering dialysate Ca levels slowed the progression of CAC and improved bone turnover in patients on HD with baseline intact parathyroid hormone levels ≤300 pg/ml.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Naim Ceylan
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | | | - Mustafa Cirit
- Division of Nephrology, Ataturk Training and Research Hospital, Izmir, Turkey; and
| | | | - Hartmut H Malluche
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky
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21
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Peters SAE, Bots ML, Canaud B, Davenport A, Grooteman MPC, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ. Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials. Nephrol Dial Transplant 2015; 31:978-84. [PMID: 26492924 DOI: 10.1093/ndt/gfv349] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/28/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mortality rates remain high for haemodialysis (HD) patients and simply increasing the HD dose to remove more small solutes does not improve survival. Online haemodiafiltration (HDF) provides additional clearance of larger toxins compared with standard HD. Randomized controlled trials (RCTs) comparing HDF with conventional HD on all-cause and cause-specific mortality in end-stage kidney disease (ESKD) patients reported inconsistent results and were at high risk of bias. We conducted a pooled individual participant data analysis of RCTs to provide the most reliable evidence to date on the effects of HDF on mortality outcomes in ESKD patients. METHODS Individual participant data were used from four trials that compared online HDF with HD and were designed to examine the effects of HDF on mortality endpoints. Bias by informative censoring of patients was resolved. Hazard ratios (HRs) and 95% confidence intervals (95% CI) comparing the effect of online HDF versus HD on all-cause and cause-specific mortality were calculated using the Cox proportional hazard regression models. The relationship between convection volume and the study outcomes was examined by delivered convection volume standardized to body surface area. RESULTS After a median follow-up of 2.5 years (Q1-Q3: 1.9-3.0), 769 of the 2793 participants had died (292 cardiovascular deaths). Online HDF reduced the risk of all-cause mortality by 14% (95% CI: 1%; 25%) and cardiovascular mortality by 23% (95% CI: 3%; 39%). There was no evidence for a differential effect in subgroups. The largest survival benefit was for patients receiving the highest delivered convection volume [>23 L per 1.73 m(2) body surface area (BSA) per session], with a multivariable-adjusted HR of 0.78 (95% CI: 0.62; 0.98) for all-cause mortality and 0.69 (95% CI: 0.47; 1.00) for cardiovascular disease mortality. CONCLUSIONS This pooled individual participant analysis on the effects of online HDF compared with conventional HD indicates that online HDF reduces the risk of mortality in ESKD patients. This effect holds across a variety of important clinical subgroups of patients and is most pronounced for those receiving a higher convection volume normalized to BSA.
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Affiliation(s)
- Sanne A E Peters
- The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bernard Canaud
- Nephrology, Dialysis and Intensive Care Unit, CHRU, Montpellier, France Dialysis Research and Training Institute, Montpellier, France
| | - Andrew Davenport
- University College London, Centre for Nephrology, Royal Free Hospital, London, UK
| | - Muriel P C Grooteman
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Fatih Kircelli
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | | | | | - Marion Morena
- Dialysis Research and Training Institute, Montpellier, France Biochemistry Laboratory, CHRU, Montpellier, France U1046 INSERM, University of Montpellier I, Montpellier, France
| | - Menso J Nubé
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ercan Ok
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Ferran Torres
- Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Mark Woodward
- The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Tatar E, Sen S, Harman M, Kircelli F, Gungor O, Sarsik B, Asci G, Hoscoskun C, Basci A, Toz H. The relationship between renal volume and histology in obese and nonobese kidney donors. Eur J Clin Invest 2015; 45:565-71. [PMID: 25845420 DOI: 10.1111/eci.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/28/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity and related kidney diseases have become a global epidemic problem. However, the underlying pathogenesis of obesity-related renal diseases has not been clearly understood. In this study, we explored the link between renal volume (RV) determined by computed tomography (CT) and renal histology together with functional parameters in an obese population. MATERIALS AND METHODS Eighty-two kidney donors who underwent CT for the measurement of kidney volume and zero-hour renal biopsy for renal histology were included in this cross-sectional study. Protein creatinine clearance and eGFR were evaluated in 24-h urine specimens as indicators of renal function. RESULTS Mean body mass index (BMI) was 28 ± 4.2 kg/m(2); 32.9% (n = 27) were obese. Mean RV was 196 ± 36 cm(3). RV was positively correlated with BMI, body surface area and creatinine clearance and negatively with HDL-cholesterol in the whole population. Renal function parameters of obese subjects were better, and their renal volumes were higher compared with the nonobese subjects. In obese subjects, corrected RV was positively correlated with glomerular filtration rate (r = 0.46, P = 0.01) and negatively with sclerotic glomeruli (r = -0.38, P = 0.04) and chronicity index (r = -0.43, P = 0.02). In adjusted ordinal logistic regression analysis, corrected RV was significantly associated with chronicity index (OR: 0.96; P = 0.01). CONCLUSIONS In obese cases, decreased RV determined by CT is associated with worse renal histology. In this population, kidney imaging techniques may provide important clues about renal survival.
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Affiliation(s)
- Erhan Tatar
- Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Sait Sen
- Department of Patology, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Fatih Kircelli
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Ozkan Gungor
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Banu Sarsik
- Department of Patology, Ege University School of Medicine, Izmir, Turkey
| | - Gulay Asci
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Cuneyt Hoscoskun
- Department of General Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Ali Basci
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Toz
- Department of Nephrology, Ege University School of Medicine, Izmir, Turkey
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23
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Peters S, Bots M, Canaud B, Davenport A, Grooteman M, Kircelli F, Locatelli F, Maduell F, Morena M, Nube M, Ok E, Torres F, Woodward M, Blankestijn P. FP690HAEMODIAFILTRATION AND MORTALITY IN END STAGE KIDNEY DISEASE PATIENTS AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv183.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Uludüz D, Göksan B, Çelik GG, Akkaya N, Sevindik MS, Uygunoglu U, Saip S, Kircelli F, Sezen A, Siva A. EHMTI-0235. Hemodialysis-related headache. J Headache Pain 2014. [PMCID: PMC4180252 DOI: 10.1186/1129-2377-15-s1-c58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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25
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Drueke T, Fernandez-Martin J, Locatelli F, London G, Gorriz J, Floege J, Ferreira A, Covic A, Memmos D, Bos WJ, Nagy J, Cannata-Andia J, Bhargava R, Ali F, Lear J, Bryan N, Law K, Brenchley P, Hutchison A, Turan MN, Yaprak M, Sisman AR, Yilmaz M, Kircelli F, Sevinc Ok E, Ozkahya M, Asci G, Ok E, Jean G, Chazot C, Lorriaux C, Deleaval P, Mayor B, Hurot JM. CKD-MBD - B. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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26
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Asci G, Tz H, Ozkahya M, Duman S, Demirci MS, Cirit M, Sipahi S, Dheir H, Bozkurt D, Kircelli F, Ok ES, Erten S, Ertilav M, Kose T, Basci A, Raimann JG, Levin NW, Ok E. The impact of membrane permeability and dialysate purity on cardiovascular outcomes. J Am Soc Nephrol 2013; 24:1014-23. [PMID: 23620396 DOI: 10.1681/asn.2012090908] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The effects of high-flux dialysis and ultrapure dialysate on survival of hemodialysis patients are incompletely understood. We conducted a randomized controlled trial to investigate the effects of both membrane permeability and dialysate purity on cardiovascular outcomes. We randomly assigned 704 patients on three times per week hemodialysis to either high- or low-flux dialyzers and either ultrapure or standard dialysate using a two-by-two factorial design. The primary outcome was a composite of fatal and nonfatal cardiovascular events during a minimum 3 years follow-up. We did not detect statistically significant differences in the primary outcome between high- and low-flux (HR=0.73, 95% CI=0.49 to 1.08, P=0.12) and between ultrapure and standard dialysate (HR=0.90, 95% CI=0.61 to 1.32, P=0.60). Posthoc analyses suggested that cardiovascular event-free survival was significantly better in the high-flux group compared with the low-flux group for the subgroup with arteriovenous fistulas, which constituted 82% of the study population (adjusted HR=0.61, 95% CI=0.38 to 0.97, P=0.03). Furthermore, high-flux dialysis associated with a lower risk for cardiovascular events among diabetic subjects (adjusted HR=0.49, 95% CI=0.25 to 0.94, P=0.03), and ultrapure dialysate associated with a lower risk for cardiovascular events among subjects with more than 3 years of dialysis (adjusted HR=0.55, 95% CI=0.31 to 0.97, P=0.04). In conclusion, this trial did not detect a difference in cardiovascular event-free survival between flux and dialysate groups. Posthoc analyses suggest that high-flux hemodialysis may benefit patients with an arteriovenous fistula and patients with diabetes and that ultrapure dialysate may benefit patients with longer dialysis vintage.
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Affiliation(s)
- Gulay Asci
- Department of Biostatistics, Ege University School of Medicine, Izmir, Turkey.
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Tattersall JE, Ward RA, Canaud B, Blankestijn PJ, Bots M, Covic A, Davenport A, Grooteman M, Gura V, Hegbrant J, Hoffmann J, Hothi D, Hutchison C, Kircelli F, Krieter D, Kuhlmann M, Ledebo I, Locatelli F, Maduell F, Martin-Malo A, Nicoud P, Nube M, Ok E, Pedrini L, Port F, Ragon A, Santoro A, Schindler R, Shroff R, Tattersall J, Vanholder R, Ward R. Online haemodiafiltration: definition, dose quantification and safety revisited. Nephrol Dial Transplant 2013; 28:542-50. [DOI: 10.1093/ndt/gfs530] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gungor O, Kircelli F, Voroneanu L, Covic A, Ok E. Hormones and Arterial Stiffness in Patients with Chronic Kidney Disease. J Atheroscler Thromb 2013; 20:698-707. [DOI: 10.5551/jat.18580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ok E, Asci G, Toz H, Ok ES, Kircelli F, Yilmaz M, Hur E, Demirci MS, Demirci C, Duman S, Basci A, Adam SM, Isik IO, Zengin M, Suleymanlar G, Yilmaz ME, Ozkahya M. Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study. Nephrol Dial Transplant 2012; 28:192-202. [DOI: 10.1093/ndt/gfs407] [Citation(s) in RCA: 315] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Turan MN, Gungor O, Asci G, Kircelli F, Acar T, Yaprak M, Ceylan N, Demirci MS, Bayraktaroglu S, Toz H, Ozkahya M, Ok E. Epicardial adipose tissue volume and cardiovascular disease in hemodialysis patients. Atherosclerosis 2012; 226:129-33. [PMID: 23159099 DOI: 10.1016/j.atherosclerosis.2012.10.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/18/2012] [Accepted: 10/25/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Epicardial adipose tissue (EAT) is proposed as a cardiovascular risk marker in non-uremic subjects. However, little is known about its role in patients with higher cardiovascular risk profile such as chronic kidney disease. The aim of this study was to investigate the relationship between EAT and several cardiovascular surrogate markers (coronary artery calcification (CAC), arterial stiffness and atherosclerosis) in patients on maintenance hemodialysis. METHODS A total of 191 prevalent hemodialysis patients were enrolled in this cross-sectional study. EAT and CAC scores (CACs) were determined by multi-slice computerized tomography, arterial stiffness by carotid-femoral pulse wave velocity (PWV), and carotid artery intima-media thickness (CA-IMT) by B-mode doppler ultrasonography. RESULTS Mean age was 59 ± 13 years and time on hemodialysis 75 ± 44 months. Twenty percent of the patients had diabetes. Mean EAT volume was 62.6 ± 26.8 cm(3)/m(2). Mean CA-IMT and PWV values increased across the EAT tertiles. EAT was correlated with age, female gender, body mass index, albumin and lipid parameters. Additionally, CA-IMT and PWV values were positively correlated with EAT. EAT volume was significantly higher in patients with CACs >10 compared to the patients with CACs ≤10. Despite the univariate associations between EAT and cardiovascular surrogate markers, only age, body mass index and total cholesterol levels were associated with EAT in adjusted models. CONCLUSIONS In prevalent hemodialysis patients, EAT is correlated with atherosclerosis, arterial stiffness and the presence of CAC. However, this correlation is not independent of other risk factors.
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Affiliation(s)
- Mehmet Nuri Turan
- Ege University, School of Medicine, Division of Nephrology, 35100 Bornova, Izmir, Turkey.
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Gungor O, Kismali E, Sisman AR, Kircelli F, Carrero JJ, Tatar E, Asci G, Toz H. The relationships between serum sTWEAK, FGF-23 levels, and carotid atherosclerosis in renal transplant patients. Ren Fail 2012; 35:77-81. [PMID: 23101788 DOI: 10.3109/0886022x.2012.734890] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the main cause of mortality after renal transplantation. Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and fibroblast growth factor-23 (FGF-23) are two novel molecules that have been associated with atherosclerosis in different populations. In this cross-sectional study, we investigated the associations between sTWEAK, FGF-23, and carotid artery intima-media thickness (CA-IMT) in renal transplant patients. METHODS A total of 117 renal transplant patients were studied. CA-IMT was determined by B-mode Doppler ultrasonography. Serum sTWEAK and FGF-23 were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). RESULTS Mean age was 39.6 ± 9.6 years and 51% of the patients were male. Mean sTWEAK level was 595 ± 225 pg/mL (158-1140), FGF-23 level was 92 ± 123 RU/mL (9.6-1006), and CA-IMT level was 0.62 ± 0.11 mm (0.40-0.98). sTWEAK level was positively correlated with CA-IMT. There was no association between sTWEAK and FGF-23 levels. FGF-23 was also associated with CA-IMT. In adjusted models using linear regression analysis, only age and serum TWEAK levels were predictors for CA-IMT. CONCLUSION There is a positive correlation between CA-IMT and sTWEAK, but not with FGF-23 levels in renal transplant patients.
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Affiliation(s)
- Ozkan Gungor
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.
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Tatar E, Kircelli F, Demirci MS, Turan MN, Gungor O, Asci G, Ozkahya M, Ok E, Hoscoskun C, Toz H. Pre-transplant HbA1c level as an early marker for new-onset diabetes after renal transplantation. Int Urol Nephrol 2012; 45:251-8. [PMID: 23054321 DOI: 10.1007/s11255-012-0304-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/17/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND New-onset diabetes after transplantation (NODAT) is a common complication in renal transplant (RT) patients. The clinical significance of pre-transplant HbA1c level remains unclear in RT patients. Thus, we investigated the predictive role of pre-transplant HbA1c levels for the NODAT diagnosed in 1 year after renal transplantation. METHODS Two hundred and four RT patients older than 18 years were analyzed. NODAT diagnosis during the 1-year follow-up after RT was based on the 2003 modified criteria of the ADA. HbA1c level was measured at pre-transplantation period and every 3 months after RT. RESULTS Mean age was 39.3 ± 10.7 (20-73) years and 36 % were female. Mean pre-transplant HbA1c level was 4.9 ± 0.5 % (4.0-6.4 %). Pre-transplant HbA1c level was positively correlated with age, pre-transplant body mass index (BMI) and cholesterol level. Fifty-four patients (25.9 %) developed NODAT and 33.8 % had impaired fasting blood glucose levels. Patients with NODAT were significantly older and had higher pre-transplant BMI and HbA1c than those without. Use of Tacrolimus was also higher in patients with NODAT. In stepwise logistic regression analysis, pre-transplant HbA1c level was an independent predictor for the development on NODAT (OR = 4.63, 95 % CI: 2.09-10.2, p < 0.001) together with age, Tacrolimus-based regimen and pre-transplant fasting blood glucose level. CONCLUSIONS Assessment of pre-transplant HbA1c levels may be a valuable tool for early diagnosis of NODAT in RT recipients.
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Affiliation(s)
- Erhan Tatar
- Division of Nephrology, Ege University School of Medicine, 35100, Bornova, Izmir, Turkey.
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Gungor O, Tanrisev M, Kircelli F, Turan MN, Tugmen C, Tatar E, Toz H. The effects of mammalian target of rapamycin inhibitors on serum uric acid levels in renal transplant patients. Int Urol Nephrol 2012; 45:547-52. [PMID: 22752451 DOI: 10.1007/s11255-012-0214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 05/25/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS/AIMS Elevated uric acid (UA) levels are frequently observed after renal transplantation. We investigated the consequences of shifting from calcineurin inhibitors (CNI) to mammalian target of rapamycin inhibitors (mTORi) on UA levels and graft functions. METHODS Ninety-six patients were enrolled. Main points of interest were changes in UA and glomerular filtration rate (GFR). RESULTS Mean age of the whole population was 39 ± 11 years (18-73), and 64.2 % were male. Patients were stratified into two groups according to their CNI type prior to the switch as cyclosporin A (CsA) or tacrolimus (Tac). Patients that were switched from CsA had a mean GFR of 49 ± 18 ml/min and serum UA level of 7.4 ± 1.8 mg/dl at the pre-switch period. Mean GFR increased to 53 ± 22 ml/min (p = 0.03), and UA levels decreased to 6.2 ± 1.6 mg/dl at the final visit (p < 0.001). In the Tac group, pre-switch mean GFR was 59 ± 28 ml/min and serum UA level 6.6 ± 2.6 mg/dl. In this group, mean GFR increased to 63 ± 28 ml/min (p = 0.03) and UA levels decreased to 6.2 ± 2.1 at the last visit (p < 0.001). CONCLUSION Switch from CNI to mTORi-based regimen provides better control of UA levels and improves renal functions.
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Affiliation(s)
- Ozkan Gungor
- Division of Nephrology, Ege University, School of Medicine, 35100 Bornova, Izmir, Turkey.
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Gungor O, Kircelli F, Turan MN, Cetin O, Elbi H, Tatar E, Sertoz OO, Toz H. Irritable bowel syndrome in renal transplant patients: prevalence, link with quality of life, anxiety, and depression. Ren Fail 2012; 34:876-9. [PMID: 22680982 DOI: 10.3109/0886022x.2012.690805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gastrointestinal complications are common in renal transplant recipients and may arise from any part of the gastrointestinal tract. Irritable bowel syndrome (IBS) is highly common in the general population, but the status is not known in renal transplant patients. In this study, we evaluated the prevalence of IBS and its association with health-related quality of life (HRQOL), anxiety, and depression in renal transplant patients. METHODS One hundred and ninety-eight patients were enrolled in this study. Sociodemographic and laboratory variables were recorded. Severity of depressive and anxiety symptoms and HRQOL were assessed by the Beck Depression Inventory, State-Trait Anxiety Inventory, and Short Form 36 (SF-36), respectively. Diagnosis of IBS was based on Rome III criteria. RESULTS The mean age was 38 ± 10 years and 61% were male. The mean transplant duration was 62 ± 54 months. Among 198 patients, 55 (27%) had IBS. Patients with IBS had lower SF-36 scores and had higher depressive and anxiety symptoms than patients without IBS. CONCLUSIONS IBS is highly prevalent in renal transplant patients. The presence of IBS is closely related with HRQOL anxiety and depression.
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Affiliation(s)
- Ozkan Gungor
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.
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Susla O, Shin HS, Jung YS, Rim H, Speer T, Owala FO, Razawi M, Holy E, Ferdinand B, Danilo F, Luscher TF, Tanner FC, Markaki A, Kyriazis J, Petrakis I, Mavroeidi V, Perakis K, Fragkiadakis GA, Venyhaki M, Tzanakakis M, Vardaki E, Maraki K, Doskas T, Daphnis E, Bregman R, Vale B, Lemos C, Kawakami L, Silva MI, Zhu F, Kaysen G, Kotanko P, Abbas SR, Dou Y, Heymsfield S, Levin NW, Turkmen K, Kayikcioglu H, Guney I, Altintepe L, Ozbek O, Tonbul HZ, Kaysen GA, Kaysen GA, Usvyat LA, Thijssen S, Levin NW, Kotanko P, Mutluay R, Konca Degertekin C, Derici U, Yilmaz MI, Akkiyal F, Gultekin S, Gonen S, Deger SM, Arinsoy T, Sindel S, Hueso M, Torras J, Carrera M, Vidal A, Navarro E, Rivas I, Rama I, Bolanos N, Varela C, Martinez-Castelao A, Grinyo JM, Harving F, Svensson M, Schmidt EB, Jorgensen KA, Christensen JH, Park JH, Koo EH, Kim HK, Kim MS, Cho AJ, Lee JE, Jang HR, Huh W, Kim DJ, Kim YG, Oh HY, Zawiasa A, Nowak D, Nowicki M, Nathalie N, Griet G, Eva S, Raymond V, Ng KP, Stringer S, Jesky M, Dutton M, Ferro C, Cockwell P, Jia T, Gama Axelsson T, Lindholm B, Heimburger O, Barany P, Stenvinkel P, Qureshi AR, Quiroga B, Goicoechea M, Garcia de Vinuesa S, Verdalles U, Reque J, Panizo N, Arroyo D, Santos A, Macias N, Luno J, Honda H, Hirano T, Ueda M, Kojima S, Mashiba S, Hayase Y, Michihata T, Akizawa T, Gungor O, Sezis Demirci M, Kircelli F, Tatar E, Hur E, Sen S, Toz H, Basci A, Ok E, Sepe V, Albrizio P, Gnecchi M, Cervio E, Esposito P, Rampino T, Libetta C, Dal Canton A, Faria MS, Faria MS, Ribeiro S, Silva G, Nascimento H, Rocha-Pereira P, Miranda V, Vieira E, Santos R, Mendonca D, Quintanilha A, Costa E, Belo L, Santos-Silva A, Pruijm M, Pruijm M, Hofmann L, Heuvelin E, Forni V, Coristine A, Stuber M, Vogt B, Burnier M, Chiappini MG, Ammann T, Muzzi L, Grosso A, Sabry A, Bansal V, Hoppensteadt D, Jeske W, Fareed J. Nutrition, inflammation and oxidative stress - CKD 1-5. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Riegersperger M, Plischke M, Steiner-Boker S, Seidinger D, Winkelmayer W, Sunder-Plassmann G, Vlahovic P, Vlahovic P, Cvetkovic T, Djordjevic V, Velickovic-Radovanovic R, Stefanovic N, Ignjatovic A, Sladojevic N, Cademartori V, Massarino F, Parodi EL, Russo R, Sofia A, Fontana I, Viviani GL, Garibotto G, Mai M, Mai W, Taner B, Wadei H, Prendergast M, Gonwa T, Martin J, Martin J, Aurore S, Aline CS, Nicolas M, Manolie M, Catherine S, Eric A, Christophe M, Brakemeier S, Liefeldt L, Glander P, Waiser J, Lachmann N, Schonemann C, Zukunft B, Illigens P, Schmidt D, Wu K, Rudolph B, Neumayer HH, Budde K, Pallardo Mateu L, Gavela Martinez E, Sancho Calabuig A, Crespo Albiach J, Beltran Catalan S, Gavela Martinez E, Kanter Berga J, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Hujiwara T, Nukui A, Yashi M, Duraes J, Malheiro J, Fonseca I, Rocha A, Martins LS, Almeida M, Dias L, Castro-Henriques A, Cabrita A, Mai M, Mai W, Wadei H, Prendergast M, Gonwa T, Volpe A, Quaglia M, Menegotto A, Fenoglio R, Izzo C, Airoldi A, Terrone C, Stratta P, Ahmed B, Mireille K, Nilufer B, Annick M, Karl Martin W, Anh-Dung H, Dimitri M, Philippe M, Judith R, Daniel A, Liefeldt L, Glander P, Glander P, Lan Y, Schmidt D, Heine C, Budde K, Neumayer HH, Schmidt D, Glander P, Glander P, Budde K, Neumayer HH, Liefeldt L, Quaglia M, Quaglia M, Capone V, Izzo C, Menegotto A, Fenoglio R, Airoldi A, Stratta P, Grace B, Clayton P, Cass A, Mcdonald S, Yagisawa T, Yagisawa T, Yashi M, Kimura T, Nukui A, Fujiwara T, Sakuma Y, Ishikawa N, Iwabuchi T, Muraishi O, Torregrosa V, Barros X, Martinez de Osaba MJ, Paschoalin R, Campistol JM, Hassan R, El-Hefnawy A, Soliman S, Shokeir A, Cobanoglu Kudu A, Gungor O, Kircelli F, Altinel E, Asci G, Ozbek SS, Toz H, Ok E, Sandrini S, Setti G, Valerio F, Possenti S, Torrisi I, Polanco N, Garcia-Puente L, Gonzalez Monte E, Morales E, Gutierrez E, Bengoa I, Hernandez A, Caballero J, Morales JM, Andres A, Sgarlato V, Sgarlato V, Comai G, La Manna G, Moretti I, Grandinetti V, Martelli D, Scolari MP, Stefoni S, Valentini C, Valentini C, Persici E, La Manna G, Cappuccilli ML, Sgarlato V, Liviano D'arcangelo G, Fabbrizio B, Carretta E, Mosconi G, Scolari MP, Feliciangeli G, Grigioni FW, Stefoni S, Apicella L, Guida B, Vitale S, Garofalo G, Russo L, Maresca I, Rossano R, Memoli B, Carrano R, Federico S, Sabbatini M, Carta P, Zanazzi M, DI Maria L, Caroti L, Miejshtri A, Tsalouchos A, Bertoni E, Sezer S, Erkmen Uyar M, Colak T, Bal Z, Tutal E, Kalaci G, Ozdemir Acar FN, Jacquelinet C, Bayat S, Pernin V, Portales P, Szwarc I, Garrigue V, Vetromile F, Delmas S, Eliaou JF, Mourad G, Huber L, Huber L, Slowinski T, Naik M, Glander P, Liefeldt L, Schmidt D, Neumayer HH, Budde K, Nakai K, Fujii H, Kono K, Goto S, Ishimura T, Takeda M, Fujisawa M, Nishi S, Pereira Paschoalin R, Paschoalin R, Torregrosa JV, Barros Freiria X, Duran Rebolledo CE, Sanchez Escuredo A, Sole M, Campistol JM, Youssouf S, Tabbasm F, Bell R, Al-Jayyousi R, Warwick G, Grall A, Treguer L, Essig M, Lecaque C, Noel N, Buchler M, Bertrand D, Rivalan J, Braun L, Villemain F, Hurault de Ligny B, Totet A, Pestourie N, Toubas D, Nevez G, Le Meur Y, Nour el Houda B, Mustapha H, Wafaa F, Inass L, Rambabova Bushljetikj I, Rambabova Bushljetikj I, Masin-Spasovska J, Spasovski G, Popov Z, Sikole A, Ivanovski N, Raimundo M, Guerra J, Teixeira C, Santana A, Silva S, Mil Homens C, Gomes Da Costa A, Loredo D, Cleres M, Gondolesi G, Gutierrez LM, Fortunato RM, Descalzi V, Raffaele P. Transplantation - clinical II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sahin OZ, Asci G, Kircelli F, Yilmaz M, Duman S, Ozkahya M, Dogan C, Odabas AR, Cirit M, Ok E. The impact of low serum sodium level on mortality depends on glycemic control. Eur J Clin Invest 2012; 42:534-40. [PMID: 22049913 DOI: 10.1111/j.1365-2362.2011.02613.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low serum sodium levels have been associated with mortality both in patients with and without chronic kidney disease. In this study, we investigated this association in relation to glycemic control in hemodialysis (HD) patients. MATERIALS AND METHODS Between March and September 2005, 697 prevalent HD patients were enrolled in this prospective observational study and followed up for all-cause and cardiovascular mortality. The associations of serum sodium concentration with both overall and cardiovascular survival rates were studied. RESULTS At baseline, mean predialysis serum sodium concentration was 138.4 ± 2.3 mEq/L (range: 130-145 mEq/L). Mild hyponatremia (< 135 mEq/L) was present in only 41 subjects (5.9%), and no patient had serum sodium level < 130 mEq/L. During 20.2 ± 6.2 months of follow-up, 119 patients (15.9%) died, 68 from CV causes. In adjusted Cox regression analysis, lowest sodium quartile was associated with 2.13-fold increased risk of overall mortality (95% confidence interval (CI) 1.14-3.98, P = 0.01, model chi-square 114.6, P < 0.001). As a continuous variable, each 1 mEq/L increase in predialysis sodium concentration was associated with a hazard ratio (HR) of 0.87 for overall mortality (95% CI 0.81-0.95, P = 0.002) and 0.86 for cardiovascular mortality (95% CI 0.78-0.96, P = 0.007). The predictivity of low serum sodium was prominent in diabetic subjects but not in nondiabetics. However, relationship between serum sodium and patient survival in diabetics was lost after adjustment for the HbA1c level: HR 0.91 (95% CI 0.78-1.05, P = 0.20). CONCLUSIONS Low serum sodium concentration is associated with mortality only in those with diabetes. Furthermore, the impact of serum sodium on survival in these patients seems to be derived from poor glucose control.
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Affiliation(s)
- Osman Z Sahin
- Division of Nephrology, Ataturk Traning and Research Hospital, Izmir, Turkey.
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Sevinc Ok E, Kircelli F, Asci G, Altunel E, Ertilav M, Sipahi S, Bozkurt D, Duman S, Ozkahya M, Toz H, Ok E. Neither oxidized nor anti-oxidized low-density lipoprotein level is associated with atherosclerosis or mortality in hemodialysis patients. Hemodial Int 2012; 16:334-41. [PMID: 22497657 DOI: 10.1111/j.1542-4758.2012.00683.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is anticipated that oxidized low-density lipoprotein (oxLDL) and anti-oxLDL are associated with atherosclerosis and mortality. However, data on this issue are controversial and limited. We aimed to investigate the effect of these two markers on the extent and progression of atherosclerosis and mortality in a group of hemodialysis patients. In this prospective observational study with a follow-up of 36 months, 124 hemodialysis patients were studied. Ninety-five patients underwent carotid intima media thickness (CA-IMT) measurement by B-Mode ultrasonography both at baseline and at the end of the study. oxLDL and anti-oxLDL were measured by enzyme-linked immunosorbent assay. The extent and progression of CA-IMT, along with overall and cardiovascular mortality, were assessed. The mean age at baseline was 54.0 ± 14.8 years, 57.3% male and 20% diabetic. The mean oxLDL and anti-oxLDL levels were 8.11 ± 3.16 mU/L and 1.30 ± 0.31, respectively. Baseline mean CA-IMT was 0.82 ± 0.20 mm. Fifteen patients died during a follow-up period of 28.5 ± 6.6 months, 11 from cardiovascular causes. Only oxLDL, not anti-oxLDL, was correlated with the extent of atherosclerosis at baseline. However, both had no role in the progression of atherosclerosis. Also, in unadjusted and adjusted models, both parameters were not associated with overall or cardiovascular mortality. Neither oxLDL nor anti-oxLDL level is associated with the progression of atherosclerosis or mortality in hemodialysis patients.
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Affiliation(s)
- Ebru Sevinc Ok
- Division of Nephrology, School of Medicine, Ege University, Izmir, Turkey.
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Sipahi S, Kircelli F, Aydin P, Ulker E, Sarioglu M, Tamer A. Treatment by Functional Electrical Therapy of an Unresolved Peritoneal Leakage in a Peritoneal Dialysis Patient. Perit Dial Int 2012; 32:216-8. [DOI: 10.3747/pdi.2011.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Sipahi
- Division of Nephrology Sakarya Education and Research Hospital Sakarya, Turkey
| | - F. Kircelli
- Division of Nephrology Yozgat State Hospital Yozgat, Turkey
| | - P. Aydin
- Division of Nephrology Sakarya Education and Research Hospital Sakarya, Turkey
| | - E.A. Ulker
- Division of Nephrology Sakarya Education and Research Hospital Sakarya, Turkey
| | - M. Sarioglu
- Division of Physical Therapy and Rehabilitation, Turkey
| | - A. Tamer
- Division of Internal Medicine Sakarya Education and Research Hospital Sakarya, Turkey
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Gungor O, Kircelli F, Kitis O, Asci G, Toz H, Ok E. Can strict volume control be the key for treatment and prevention of posterior reversible encephalopathy syndrome in hemodialysis patients? Hemodial Int 2012; 17:107-10. [DOI: 10.1111/j.1542-4758.2012.00672.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ozkan Gungor
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Fatih Kircelli
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Omer Kitis
- Division of Radiology; Ege University School of Medicine; Izmir; Turkey
| | - Gulay Asci
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Huseyin Toz
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Ercan Ok
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
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Gunduz M, Gunduz E, Kircelli F, Okur N, Ozkaya M. Role of surrogate markers of atherosclerosis in clinical and subclinical thyroidism. Int J Endocrinol 2012; 2012:109797. [PMID: 22505888 PMCID: PMC3296143 DOI: 10.1155/2012/109797] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 11/30/2011] [Indexed: 11/17/2022] Open
Abstract
Background. Data on the relationship between homocysteine, plasminogen activator inhibitor 1, hs-CRP, fibrinogen, and carotid intima media thickness (CA-IMT) is plenty but contradicting and the majority of the studies investigated this issue in only specific thyroidism groups. The aim of this paper was to investigate these relations in patients with subclinical and clinical hypo- and hyperthyroidism. Methods. In this cross-sectional study, 16 patients from each thyroidism group and 20 healthy cases were enrolled. Fibrinogen levels and plasminogen activator inhibitor 1 (PAI-1) activity were assessed. CA-IMT was determined by gray-scale high-resolution color Doppler ultrasound. Results. Serum homocysteine levels were higher in hypothyroidic patients compared to the control (P = 0.003). Fibrinogen levels were higher in patients with subclinical hypothyroidism compared to other groups (P < 0.05). There was no difference between groups regarding PAI-1. Whereas total cholesterol, homocysteine, and LDL were correlated with CAIMT, hs-CRP, PAI-1, and fibrinogen were not. In the clinical hypothyroidism group, the correlation of homocysteine with CA-IMT was derived from the correlation between CA-IMT and homocysteine. Conclusions. Homocysteine and fibrinogen levels are higher in patients with clinical and subclinical hypothyroidism, respectively. Homocysteine level is associated with CA-IMTonly in patients with clinical hypothyroidism.
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Affiliation(s)
- Mehmet Gunduz
- Department of Internal Medicine, Kahramanmaras University, 46000 Kahramanmaras, Turkey
- *Mehmet Gunduz:
| | - Ercan Gunduz
- Department of Internal Medicine, Malatya Hekimhan State Hospital, 44400 Malatya, Turkey
| | - Fatih Kircelli
- Division of Nephrology, Yozgat State Hospital, 66000 Yozgat, Turkey
| | - Nazan Okur
- Department of Radiology, Kahramanmaras University, 46000 Kahramanmaras, Turkey
| | - Mesut Ozkaya
- Department of Radiology, Kahramanmaras University, 46000 Kahramanmaras, Turkey
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Kircelli F, Gunduz M, Gungor O, Ok E. Excess epicardial fat mass misrepresented as cardiomegaly in dry-weight assessment of a dialysis patient. Hemodial Int 2011; 16:435-7. [DOI: 10.1111/j.1542-4758.2011.00636.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fatih Kircelli
- Division of Nephrology; Yozgat State Hospital; Yozgat; Turkey
| | - Mehmet Gunduz
- Department of Internal Medicine; Yozgat State Hospital; Yozgat; Turkey
| | - Ozkan Gungor
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
| | - Ercan Ok
- Division of Nephrology; Ege University School of Medicine; Izmir; Turkey
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Tatar E, Gungor O, Firat O, Kircelli F, Arda B, Harman M, Toz H, Hoscoskun C. Differential Diagnosis of an Unusual Pelvic Mass in a Renal Transplant Recipient: Multidrug-Resistant Abdominopelvic Tuberculosis. Ren Fail 2011; 33:1040-2. [DOI: 10.3109/0886022x.2011.618921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tatar E, Kircelli F, Asci G, Carrero JJ, Gungor O, Demirci MS, Ozbek SS, Ceylan N, Ozkahya M, Toz H, Ok E. Associations of triiodothyronine levels with carotid atherosclerosis and arterial stiffness in hemodialysis patients. Clin J Am Soc Nephrol 2011; 6:2240-6. [PMID: 21836150 DOI: 10.2215/cjn.02540311] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES End-stage renal disease is linked to alterations in thyroid hormone levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low triiodothyronine (T3) levels. These alterations are involved in endothelial damage, cardiac abnormalities, and inflammation, but the exact mechanisms are unclear. In this study, we investigated the relationship between serum free-T3 (fT3) and carotid artery atherosclerosis, arterial stiffness, and vascular calcification in prevalent patients on conventional hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS 137 patients were included. Thyroid-hormone levels were determined by chemiluminescent immunoassay, carotid artery-intima media thickness (CA-IMT) by Doppler ultrasonography, carotid-femoral pulse wave velocity (c-f PWV), and augmentation index by Sphygmocor device, and coronary artery calcification (CAC) scores by multi-slice computerized tomography. RESULTS Mean fT3 level was 3.70 ± 1.23 pmol/L. Across decreasing fT3 tertiles, c-f PWV and CA-IMT values were incrementally higher, whereas CACs were not different. In adjusted ordinal logistic regression analysis, fT3 level (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97), age, and interdialytic weight gain were significantly associated with CA-IMT. fT3 level was associated with c-f PWV in nondiabetics but not in diabetics. In nondiabetics (n = 113), c-f PWV was positively associated with age and systolic BP but negatively with fT3 levels (odds ratio = 0.57, 95% confidence interval 0.39 to 0.83). CONCLUSIONS fT3 levels are inversely associated with carotid atherosclerosis but not with CAC in hemodialysis patients. Also, fT3 levels are inversely associated with surrogates of arterial stiffness in nondiabetics.
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Affiliation(s)
- Erhan Tatar
- Ege University School of Medicine, Division of Nephrology, 35100, Bornova, Izmir, Turkey.
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Gungor O, Kircelli F, Tatar E, Toz H. Icodextrin-associated hepatotoxicity. Clin Kidney J 2011; 4:278. [PMID: 25949504 PMCID: PMC4421436 DOI: 10.1093/ndtplus/sfr065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ozkan Gungor
- Division on Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Fatih Kircelli
- Division on Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Erhan Tatar
- Division on Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Toz
- Division on Nephrology, Ege University School of Medicine, Izmir, Turkey
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Tatar E, Sezis Demirci M, Kircelli F, Gungor O, Yaprak M, Asci G, Basci A, Ozkahya M, Ok E. The association between thyroid hormones and arterial stiffness in peritoneal dialysis patients. Int Urol Nephrol 2011; 44:601-6. [PMID: 21779917 DOI: 10.1007/s11255-011-0034-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 07/01/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND/AIMS The association between thyroid hormones and arterial stiffness is unclear. In this study, we investigated, for the first time in a large cohort of euthyroid peritoneal dialysis patients, the relationship between thyroid hormone levels and arterial stiffness. METHODS Fifty-seven patients were enrolled. Serum TSH, free T3 and free T4 levels were measured by chemiluminescence immunoassay method. Pulse wave analysis [augmentation index (AIx) and subendocardial viability ratio (SEVR)] were measured to assess arterial stiffness. RESULTS Mean age was 49 ± 12.3 years, and 56.1% were female. Mean TSH, fT3 and fT4 levels were 1.97 ± 0.99 mIU/ml, 2.80 ± 0.42 pg/ml and 1.22 ± 0.16 ng/dl, respectively. Mean AIx and SEVR were 22.3 ± 11.3 and 136 ± 21%, respectively. AIx was negatively correlated with residual urine volume (r = -0.372, P: 0.03) and fT3 levels (r = -0.382, P: 0.005). SEVR was correlated only with TSH level (r = -0.394, P: 0.003). In linear regression analysis adjusted for age, gender, history of diabetes and cardiovascular disease and residual diuresis, fT3 level (t = -3.949, P < 0.001) remained associated with AIx. Only TSH level (t = -2.409, P: 0.02) was related to SEVR. CONCLUSION Low serum fT3 level is associated with arterial stiffness, and high TSH level within the normal range is related to lower SEVR in euthyroid PD patients.
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Affiliation(s)
- Erhan Tatar
- Division of Nephrology, Ege University School of Medicine, 35100 Bornova, Izmir, Turkey.
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Kircelli F, Peter ME, Sevinc Ok E, Celenk FG, Yilmaz M, Steppan S, Asci G, Ok E, Passlick-Deetjen J. Magnesium reduces calcification in bovine vascular smooth muscle cells in a dose-dependent manner. Nephrol Dial Transplant 2011; 27:514-21. [PMID: 21750166 PMCID: PMC3275783 DOI: 10.1093/ndt/gfr321] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background. Vascular calcification (VC), mainly due to elevated phosphate levels, is one major problem in patients suffering from chronic kidney disease. In clinical studies, an inverse relationship between serum magnesium and VC has been reported. However, there is only few information about the influence of magnesium on calcification on a cellular level available. Therefore, we investigated the effect of magnesium on calcification induced by β-glycerophosphate (BGP) in bovine vascular smooth muscle cells (BVSMCs). Methods. BVSMCs were incubated with calcification media for 14 days while simultaneously increasing the magnesium concentration. Calcium deposition, transdifferentiation of cells and apoptosis were measured applying quantification of calcium, von Kossa and Alizarin red staining, real-time reverse transcription–polymerase chain reaction and annexin V staining, respectively. Results. Calcium deposition in the cells dramatically increased with addition of BGP and could be mostly prevented by co-incubation with magnesium. Higher magnesium levels led to inhibition of BGP-induced alkaline phosphatase activity as well as to a decreased expression of genes associated with the process of transdifferentiation of BVSMCs into osteoblast-like cells. Furthermore, estimated calcium entry into the cells decreased with increasing magnesium concentrations in the media. In addition, higher magnesium concentrations prevented cell damage (apoptosis) induced by BGP as well as progression of already established calcification. Conclusions. Higher magnesium levels prevented BVSMC calcification, inhibited expression of osteogenic proteins, apoptosis and further progression of already established calcification. Thus, magnesium is influencing molecular processes associated with VC and may have the potential to play a role for VC also in clinical situations.
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Affiliation(s)
- Fatih Kircelli
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.
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Gungor O, Kircelli F, Demirci MS, Tuncel P, Sisman AR, Tatar E, Hur E, Asci G, Ok E, Toz H. Serum paraoxonase 1 activity predicts arterial stiffness in renal transplant recipients. J Atheroscler Thromb 2011; 18:901-5. [PMID: 21737961 DOI: 10.5551/jat.9175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins. Its activity decreases in dialysis patients but is restored after transplantation. Whether it affects arterial stiffness is unclear. In this study we aimed to investigate the effects of PON 1 on arterial stiffness in renal transplant patients. METHODS Seventy renal transplant recipients were enrolled. Arterial stiffness was measured using a Syphmocor device. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. RESULTS Mean age was 39.0 ± 9.6 years and 5.7% of the patients were diabetic. Post-transplant follow-up time was 46.7 ± 37.9 months. Eighty-five percent received anti-hypertensive and 12.9% anti-hyperlipidemic medication. Mean PON1 activity was 75.9 ± 52.4 U/L. PON1 activity was negatively correlated with systolic and diastolic blood pressure, mean arterial pressure, LDL-cholesterol and carotid-femoral pulse wave velocity (cf-PWV). Mean c-f PWV was 8.10 ± 1.39 m/s. Cf-PWV was positively correlated with age, systolic and diastolic blood pressure, mean arterial pressure, proteinuria and negatively correlated with PON1, PON1/HDL ratio and creatinine clearance. In linear regression analysis, PON1 was a predictor of cf-PWV in a model that included age, gender, diabetes, mean arterial pressure, urine protein level, creatinine clearance and PON 1. CONCLUSIONS Reduced PON1 activity is significantly associated with increased arterial stiffness. The results of this study show the possible role of PON1 for arterial stiffening in renal transplant recipients.
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Affiliation(s)
- Ozkan Gungor
- Ege University School of Medicine, Division of Nephrology, Izmir, Turkey.
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Gungor O, Kircelli F, Carrero JJ, Hur E, Demirci MS, Asci G, Toz H. The effect of immunosuppressive treatment on arterial stiffness and matrix Gla protein levels in renal transplant recipients. Clin Nephrol 2011; 75:491-6. [PMID: 21612751 DOI: 10.5414/cnp75491] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
INTRODUCTION Arterial stiffness is a risk marker for cardiovascular events. In this study we aimed to compare the effect on calcineurin inhibitors (CNI) and mammalian Target of Rapamycine inhibitors (mTORi) on arterial stiffness in renal transplant patients. PATIENTS AND METHODS 81 renal transplant patients under CNI-based or mTORi-based protocol for at least 6 months were included in the study. Arterial stiffness was measured by using the SphygmoCor device (AtCor Medical, Sydney, Australia). Vitamin K-dependent, calcification inhibitor matrix Gla protein (MGP) concentrations were quantified by ELISA methods (Biomedica, Vienna, Austria). RESULTS 34 patients were on mTORi-based and 47 on CNI-based immunosuppression. Mean age was 37.9 ± 10.8 (18 - 71) years and 45% were female. Age, gender, graft functions and follow-up period of the groups were similar. Augmentation index was 15.2 ± 12.6% in CNI and 18.8 ± 14.0% in mTORi groups (p > 0.05). There was no difference regarding carotid-femoral pulse wave velocity between groups. Arterial stiffness was positively correlated with age, total cholesterol, LDL cholesterol, mean arterial pressure (MAP) and proteinuria. MGP levels were higher in the mTORi group but were not predictors for carotid-femoral pulse wave velocity. CONCLUSION Rather than specific immunosuppressive drug effects, conventional risk factors, blood pressure and proteinuria are the most important predictors for arterial stiffness in renal transplant patients.
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Affiliation(s)
- O Gungor
- Ege University School of Medicine, Division of Nephrology, Izmir, Turkey.
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50
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Kallenberg CGM, Specks U, Stone JH, Ok E, Asci G, Sevinc Ok E, Kircelli F, Yilmaz M, Hur E, Demirci MS, Ozdogan O, Demirci C, Sertoz OO, Duman S, Ozkahya M, Kayikcioglu M, Elbi H, Basci A, Toz H, Grooteman M, van den Dorpel R, Bots M, Penne L, van der Weerd N, Mazairac A, den Hoedt C, van der Tweel I, Levesque R, Nube M, ter Wee P, Blankestijn P, Pergola PE, Raskin P, Toto RD, Meyer CJ, Grossman EB, Krauth M, Ruiz S, Audhya P, Christ-Schmidt H, Wittes J, Warnock DG. Late breaking clinical trials 1. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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