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Öğe Antifibrotic Effects of Aldosterone Receptor Blocker (Spironolactone) in Patients with Chronic Kidney Disease(TAYLOR & FRANCIS LTD, 2009) Guney, Ibrahim; Selcuk, N. Yilmaz; Altintepe, Lutfullah; Atalay, Huseyin; Basarali, M. Kemal; Buyukbas, SadikAims. Proteinuria and transforming growth factor beta (TGF-beta) are parameters that can lead to glomerulosclerosis and tubulointerstitial fibrosis. All components of the renin-angiotensin-aldosterone system (RAAS) activate the TGF-beta. Aldosterone may not be inhibited with angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) due to aldosterone escape. We aimed to evaluate the effect of spironolactone on parameters leading to fibrosis. Methods. This prospective study included 30 non-diabetic chronic kidney disease (CKD) patients treated with ACEIs and/or ARBs. The patients were divided into two groups that are similar in terms of demographic parameters. 25 mg of spironolactone was added to group 1 (n = 15) for six months, though it was not administered to group 2 (n = 15). Creatinine (U-Cr), protein (U-Prot), and TGF-beta 1 (U-TGF-beta 1) were measured in spot urine sample in the beginning of study and six months later. Results. Twenty-four patients completed the study. There were no significant changes in mean blood pressure, glomerular filtration rate, creatinine, albumin, and plasma aldosterone concentrations during the observation period in either group. U-Prot/U-Cr (mg/mg Cr) was reduced from 2.43 +/- 4.85 at baseline to 1.66 +/- 3.51 at sixth month (p = 0.003) in group 1. In addition, U-TGF-beta 1/U-Cr (ng/mg Cr) was also reduced from 22.50 +/- 6.65 at baseline to 17.78 +/- 10.94 at sixth month (p = 0.041) in the same group. U-TGF-beta 1/U-Cr and U-Prot/U-Cr ratios after the sixth month were not found significant compared with baseline values in group 2. Conclusion. Spironolactone reduced both proteinuria and urinary TGF-beta 1 excretion in CKD patients. We consider that spironolactone would be beneficial to prevent progression of renal fibrosis in CKD.Öğe The effect of vardenafil on erectile dysfunction, quality of life and depression in cases with renal failure(OXFORD UNIV PRESS, 2007) Turk, Suleyman; Kan, Seyfullah; Atalay, Huseyin; Guney, Ibrahim; Altintepe, Lutfullah; Kucur, Rahim; Kilic, Mehmet[Abstract not Available]Öğe Efficacy and Tolerability of Intravenous Paricalcitol in Calcitriol-Resistant Hemodialysis Patients with Secondary Hyperparathyroidism: 12-Month Prospective Study(TAYLOR & FRANCIS LTD, 2012) Tonbul, Halil Zeki; Solak, Yalcin; Atalay, Huseyin; Turkmen, Kultigin; Altintepe, LutfullahRationale/objectives: Data are limited regarding the use of paricalcitol in calcitriol-resistant patients with secondary hyperparathyroidism (SHPT). We aimed to evaluate the effects of paricalcitol in calcitriol-resistant hemodialysis patients with SHPT. Methods: This is a 12-month, open-label, prospective study. Forty patients with calcitriol-resistant and/or calcitriol-intolerant SHPT were included. After a washout period, all patients converted to paricalcitol with a 1: 3 conversion ratio. Serum calcium and phosphorus were monitored monthly, while serum intact parathyroid hormone (iPTH) once in every 3 months. Paricalcitol dose was reduced or discontinued in case of hypercalcemia and/or hyperphosphatemia. Pre- and posttreatment electrolyte and iPTH values were compared with Student's t-test and Wilcoxon signed-rank test, respectively. Main findings: Forty patients completed the study. Mean initiation dose of paricalcitol was 23 +/- 7 mu g/week. Mean serum calcium was 8.9 +/- 0.8 mg/dL at baseline and 9.4 +/- 0.7 mg/dL at study end (p = 0.07). Mean monthly serum phosphorus levels stayed stable. Paricalcitol was effective in reducing iPTH levels when compared with pretreatment values (747.9 +/- 497.2 pg/mL, 307.3 +/- 417.1 pg/mL, respectively; p < 0.001). Thirty-two patients had to discontinue intravenous (IV) paricalcitol at some time during their treatment. Main reasons for discontinuation were as follows: hyperphosphatemia (58%), hypercalcemia (25%), and iPTH < 150 pg/mL (17%). Principle conclusions: Paricalcitol was found to be effective in reducing iPTH levels in calcitriol-resistant patients with SHPT despite relatively frequent drug discontinuation rates.Öğe Elevated Serum Uric Acid to HDL-Cholesterol Ratio is Related to Cardiovascular Risk in Patients Receiving Hemodialysis(Selçuk Üniversitesi, 2022) Goktepe, Mevlut Hakan; Cizmecioglu, Ahmet; Biyik, Zeynep; Altintepe, Lutfullah; Yavuz, Yasemin Coskun; Cizmecioglu, Hilal AkayAim: Chronic kidney disease (CKD) is a progressive disease in which frequent cardiovascular (CV) comorbidities. High uric acid to HDL-cholesterol ratio (UHR) results were quite notable in patients receiving peritoneal dialysis. Thus, in this study, we aimed to evaluate the UHR results in dialysis patients. Materials and Methods: This retrospective, multicenter, cross-sectional study was conducted with CKD patients, and the control group consisted of hypertensive patients with a normal glomerular filtration rate (GFR). Patients’ laboratory, ambulatory blood pressure monitoring, and demographic records were obtained from the follow-up cases of two university hospitals’ internal medicine and nephrology departments. The patients’ group then were divided into five subsets according to GFR. Results: A total of 124 CKD patients and 127 control participated in this study. All CKD patients were also identified as pre-dialysis and dialysis. The cases of UHR, non-dipper blood pressure pattern, and nocturnal heart rate (HR) were increased in CKD compared to the control group. Per disease progression, the non-dipper HR and nocturnal HR were more significant in patients receiving dialysis with high UHR than in the pre-dialysis subset. In diabetic patients with an on-targeted HbA1c, those with high UHRs still had nocturnal diastolic BP elevations. Finally, there was not an exact stagespecific result for pulse wave velocity. Conclusions: Based on our results, dialysis patients with high UHRs have higher non-dipper pulse rate, nocturnal heart rate, and nocturnal diastole blood pressure, associated with CV risk. Despite well-managed diabetes, elevated UHR in dialysis patients may be associated with non-dipper hypertension.Öğe Female sexual dysfunction in end stage renal disease and relation with quality of life and depression(OXFORD UNIV PRESS, 2007) Yazici, Raziye; Altintepe, Lutfullah; Guney, Ibrahim; Yeksan, Mehdi; Atalay, Huseyin; Turk, Suleyman; Tonbul, H. Zeki[Abstract not Available]Öğe Female Sexual Dysfunction in Peritoneal Dialysis and Hemodialysis Patients(TAYLOR & FRANCIS LTD, 2009) Yazici, Raziye; Altintepe, Lutfullah; Guney, Ibrahim; Yeksan, Mehdi; Atalay, Huseyin; Turk, Suleyman; Tonbul, H. ZekiBackground. Sexual dysfunction (SD) is a common problem in end-stage renal disease (ESRD). In contrast to basic and clinical research in the field of male SD, the sexual problems of women have received relatively little attention and are often under-treated. We evaluated sexual function in female ESRD patients using the validated Female Sexual Function Index (FSFI) and relation with QOL, depression, and some laboratory parameters. Methods. 117 ESRD patients (85 peritoneal dialysis [PD], 32 hemodialysis [HD], mean age 48.5 +/- 13.9 years) were enrolled. All patients had been dialyzed (PD or HD) for more than three months. In addition, an age-matched married control group of 48 subjects (mean age 47.1 +/- 12.7 years) were enrolled in the study. All patients were asked to complete three questionnaires of the FSFI, Beck Depression Index (BDI) and SF-36. Results. Female sexual dysfunction was found in 80 of the 85 peritoneal dialysis patients (94.1%) and all of the HD patients (100%), but in only 22 subjects of the control group (45.8%). A significant negative correlation was found between total FSFI score and age (r = -0.288, p = 0.002), BDI score (r = -0.471, p < 0.001), mental-physical component score of QOL (r = -0.463, p < 0.001 and r = -0.491, p < 0.001, respectively) in PD and HD patients. The rates of depression were 75.3, 43.8, and 4.2% in the PD and HD patients and control subjects, respectively. Conclusion. Female sexual dysfunction is common problem ESRD. This problem especially related with depression and QOL. Thus, sexual function should be evaluated in female subjects to determine its impact on quality of life.Öğe Malnutrition-inflammation-atherosclerosis (MIA) syndrome components in hemodialysis and peritoneal dialysis patients(TAYLOR & FRANCIS LTD, 2006) Tonbul, H. Zeki; Demir, Murat; Altintepe, Lutfullah; Guney, Ibrahim; Yeter, Ekrem; Turk, Suleyman; Yeksan, MehdiBackground. Malnutrition, inflammation, and atherosclerosis (MIA syndrome) are common in end-stage renal disease (ESRD) patients. Each component of MIA syndrome is the predictor of outcomes in ESRD patients. In this cross-sectional study, we aimed to compare both dialysis modalities for MIA syndrome components. Material and Methods. Thirty hemodialysis (HD) (mean age 44 +/- 11 years, 14 male and 16 female, mean time on dialysis: 31.0 +/- 19.0 months) and 30 continuous ambulatory peritoneal dialysis (CAPD) patients (41 +/- 9 years, 12 male and 18 female, mean time on dialysis: 25.5 +/- 21.5 months) were included. In order to determine malnutrition in ESRD patients, serum albumin level and anthropometric measurements were used. For inflammation, serum C-reactive protein level, erythrocyte sedimentation rate, and fibrinogen levels were measured. Mean-carotid artery intima media thickness (m-CIMT), presence of carotid plaque and serum homocysteine level were used to determine atherosclerosis. Results. Five CAPD patients (16%) and one HD patient (3%) was hypoalbuminemic. HD and CAPD groups were similar for inflammation. Mean-CIMT and serum homocysteine level were higher in HD patients than CAPD patients. There was a positive correlation between homocysteine and m-CIMT. Conclusion. Before choosing renal replacement therapy, malnutrition, inflammation, and atherosclerosis parameters must be investigated in ESRD patients. Hemodialysis seems to be more advantageous for malnutrition components than CAPD. Both dialysis modalities seem to be similar for inflammation, and CAPD modality has superiority for atherosclerosis. Before choosing the type of renal replacement therapy, assessment of MIA syndrome components could be useful for individualization of the decision on which dialytic modality is appropriate in ESRD patients.Öğe Nondipping heart rate and associated factors in patients with chronic kidney disease(SPRINGER, 2019) Biyik, Zeynep; Yavuz, Yasemin Coskun; Altintepe, Lutfullah; Celik, Gulperi; Guney, Ibrahim; Oktar, Sevil FisekciBackground Nondipping heart rate (NHR) is a condition reported to be associated with cardiovascular events and cardiovascular mortality recently. We aimed to search whether there is difference among hypertensive patients with and without chronic kidney disease (CKD) in terms of NHR pattern and the factors associated with NHR in patients with CKD. Methods The study included 133 hypertensive patients with normal kidney functions, 97 hypertensive patients with predialysis CKD, and 31 hypertensive hemodialysis patients. Heart rate, blood pressure and pulse wave velocity (PWV) were measured by 24-h ambulatory blood pressure monitorization. NHR was defined as a decrease of less than 10% at night mean heart rate when compared with daytime values. Results NHR pattern was established as 26.3% in non-CKD hypertensive group, 43.3% in predialysis group and 77.4% in dialysis group. Among patients with CKD, when NHR group was compared with dipper heart rate group, it was seen that they were at older age, there were higher prevalence of diabetes mellitus and more female sex, and while the value of urea, creatinine, phosphorus, intact parathyroid hormone, and PWV were significantly higher, the value of hemoglobin, albumin and calcium were significantly lower. By multivariate analysis, hemoglobin [odds ratio (OR) 0.661; 95% CI 0.541-0.806; p < 0.001] and PWV (OR 1.433; 95% CI 1.107-1.853; p = 0.006) were established as independent determinants of NHR pattern. Conclusions NHR pattern is significantly more frequently seen in hypertensive CKD patients than in hypertensive patients with non-CKD. Anemia and increased arterial stiffness are seen independently associated with NHR in CKD patients.