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Öğe Association of serum calcitonin with coronary artery disease in individuals with and without chronic kidney disease(SPRINGER, 2012) Kanbay, Mehmet; Wolf, Myles; Selcoki, Yusuf; Solak, Yalcin; Ikizek, Mustafa; Uysal, Sema; Segall, LiviuCardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD). Recent data implicate disordered bone and mineral metabolism, including changes in serum levels of calcium, phosphate, parathyroid hormone (PTH), vitamin D, fibroblast growth factor-23 (FGF-23), and fetuin A, as novel risk factors for arterial calcification. The potential role of calcitonin, another hormonal regulator of mineral and bone metabolism, has not been studied in detail. We investigated the link between serum calcitonin and the total burden of coronary artery disease (CAD) using the validated Gensini score, in a cross-sectional study of 88 patients with estimated GFR (eGFR) between 46 and 87 ml/min/1.73 mA(2) who underwent coronary angiography. We evaluated the associations between serum calcitonin, minerals (calcium, phosphate), calcium x phosphate product, and other factors that regulate mineral metabolism (intact PTH, 25-OH-vitamin D, FGF-23, and fetuin A) and the severity of CAD. The mean serum calcitonin was 11.5 +/- A 7.8 pg/ml. In univariate analysis, the Gensini CAD severity score correlated significantly with male gender, eGFR, and serum levels of 25-OH-vitamin D, iPTH, FGF-23, fetuin A, and calcitonin (R = 0.474, P = 0.001 for the latter). In multivariate analysis adjusted for calcium, phosphate, 25-OH-vitamin D, iPTH, FGF 23, fetuin A, and calcitonin, only calcitonin (beta = 0.20; P = 0.03), FGF-23, fetuin A, and 25-OH-vitamin D emerged as independent predictors of Gensini score. In the second step, we adjusted for the presence of traditional risk factors, proteinuria, and GFR. After these adjustments, the FGF-23 and fetuin A remained statistically significant predictors of the Gensini score, while calcitonin did not. Our study suggests that, in addition to other well-known components of mineral metabolism, increased calcitonin levels are associated with greater severity of CAD. However, this relation was not independent of traditional and nontraditional cardiovascular risk factors. Longitudinal studies in larger populations including patients with more advanced CKD are needed.Öğe Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis(LIPPINCOTT WILLIAMS & WILKINS, 2013) Biyik, Murat; Ucar, Ramazan; Solak, Yalcin; Gungor, Gokhan; Polat, Ilker; Gaipov, Abduzhappar; Cakir, Ozlem O.Objectives Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis. Materials and methods This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality. Results There were 86 men and 59 women, mean age 58.9 +/- 13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n = 73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8 +/- 6.8 months, during which 40 patients died. The mean NLRs were 2.08 +/- 0.99 and 4.39 +/- 3.0 in surviving and nonsurviving patients, respectively (P < 0.001). Kaplan-Meier survival analysis was carried out according to the median NLR above and below 2.72. Patients with NLR of at least 2.72 had a significantly lower survival (log rank, P < 0.001). NLR was found to be an independent predictor of mortality in all Cox Regression models (odds ratio 1.2; 95% confidence interval 1.2-1.3; P < 0.001). Receiver operating characteristic analysis showed that cut-off values of 4.22, 3.07, and 2.96 for NLR predicted 12, 24, and 36-month mortality, respectively (AUC: 0.806, P = 0.0029; 0.841, P < 0.0001 and 0.783, P < 0.0001, respectively). Conclusion NLR is a predictor of mortality independent of CTP and MELD scores in patients with liver cirrhosis. NLR could predict mortality in the subgroup of patients with low MELD scores as well. Eur J Gastroenterol Hepatol 25:435-441 (C) 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2013, 25:435-441Öğe BRUCELLA PERITONITIS IN PERITONEAL DIALYSIS: A CASE REPORT AND REVIEW OF THE LITERATURE(MULTIMED INC, 2012) Solak, Yalcin; Biyik, Zeynep; Demircioglu, Sinan; Polat, Ilker; Genc, Nejdet; Turkmen, Kultigin; Turk, SuleymanBrucellosis is a zoonotic infection that humans contract usually by ingestion of unpasteurized milk and milk products or by direct contact with raw infected animal products. Infection is endemic in many countries, including Turkey. Being a systemic disease, brucellosis may affect almost any part of the body. The peritoneum is a site rarely involved in brucellosis. Most peritonitis episodes involving Brucella species have been spontaneous cases reported in cirrhotic patients with ascites. To our knowledge, the literature contains only 5 cases of Brucella peritonitis related to continuous ambulatory peritoneal dialysis. Here, we report Brucella peritonitis in a continuous ambulatory peritoneal dialysis patient, and we discuss the relevant literature.Öğe A Case of Familial Mediterranean Fever After Renal Transplantation: From Phenotype II to I(TURKISH LEAGUE AGAINST RHEUMATISM, 2012) Solak, Yalcin; Atalay, Huseyin; Polat, Ilker; Biyik, Zeynep; Gaipov, Abduzhappar; Kucuk, Adem; Turk, SuleymanFamilial Mediterranean fever (FMF) is the prototype of autoinflammatory syndromes. Several factors may trigger the disease including physical and emotional stress, fat-rich diet, and menstruel cycle. Infections and some drugs such as cisplatin may result in a change in cytokine levels and may precipitate attacks. Most cases of FMF presents with typical self-limited attacks including fever and abdominal pain. However, a minority of patients, called as phenotype II, presents with amyloidosis AA-type and/or end-stage renal disease in the absence of clinically recognizable attacks. Immunosupression may precipitate a typical FMF attack, possibly through a change in cytokine balance. Initiation of colchicine treatment in these patients is of utmost importance to prevent amyloidosis involvement of the newly transplanted graft. In this article, we present a rare case of FMF who transformed from phenotype II to phenotype I after renal transplantation, most probably due to the effect of immunosuppressants.Öğe Coenzyme Q(10) and its Relation with Oxidant and Antioxidant System Markers in Patients with End-Stage Renal Disease(INFORMA HEALTHCARE, 2011) Gokbel, Hakki; Atalay, Huseyin; Okudan, Nilsel; Solak, Yalcin; Belviranli, Muaz; Turk, SuleymanRationale and objectives: Oxidative stress is increased in chronic kidney disease (CKD) patients and end-stage renal disease (ESRD) patients undergoing dialysis treatment. Coenzyme Q(10) (CoQ(10)) is a ubiquitous and strong antioxidant. Role of CoQ(10) is not fully evaluated in renal patients. We aimed to investigate the relationship of CoQ(10) with oxidant and antioxidant system markers in patients with renal disease. Material and methods: Forty patients with CKD (stages 3--5) who were managed conservatively without dialysis treatment, 40 hemodialysis, and 60 chronic ambulatory peritoneal dialysis (CAPD) patients were included in the study. Biochemical and whole blood analyses were done using hospital auto-analyzers from stored samples. Serum CoQ(10), malondialdehyde (MDA), superoxide dismutase (SOD), and antioxidant activity (AOA) levels were determined. Main findings: There was no difference among the groups in terms of serum CoQ(10) levels. However, other components of antioxidant system, namely, SOD and AOA were significantly higher in CAPD patients when compared to CKD patients. MDA levels were not significantly different among the groups. Principal conclusion(s): The results of this study showed no difference among CKD, CAPD, and hemodialysis patients in terms of serum CoQ(10) levels.Öğe Coenzyme Q10 supplementation and diastolic heart functions in hemodialysis patients: A randomized double-blind placebo-controlled trial(WILEY, 2013) Turk, Suleyman; Baki, Aysegul; Solak, Yalcin; Kayrak, Mehmet; Atalay, Huseyin; Gaipov, Abduzhappar; Aribas, AlpayCoenzyme Q10 (CoQ10) supplementation has been shown to improve diastolic heart function in various patient cohorts. Systolic and diastolic dysfunctions are common in patients with end-stage renal disease. Favorable effects of CoQ10 on cardiac functions are yet to be seen in hemodialysis patients. We aimed to evaluate effect of CoQ10 supplementation on diastolic function in a cohort of maintenance hemodialysis patients. This was a prospective, double-blind, placebo-controlled, crossover study in which all patients received placebo and oral CoQ10 200mg/d during the 8 weeks in each phase, with a 4-week washout period. Participants underwent conventional and tissue Doppler echocardiography before and after each study phase. Parameters characterizing left ventricle diastolic function and other standard echocardiographic measurements were recorded. Twenty-eight patients were randomized, but 22 patients completed study protocol. Intraventricular septum (IVS) thickness and left ventricle mass were significantly decreased in CoQ10 group (P=0.03 and P=0.01, respectively). Myocardial peak systolic and early diastolic velocities derived from IVS were significantly increased (P=0.048 and P=0.04, respectively). Isovolumetric relaxation time and E/Em ratio calculated for IVS also significantly reduced in CoQ10 group (p=0.02 and p=0.04, respectively). There was no significant difference in any of the studied echocardiographic parameters in placebo group. The results of this study showed that CoQ10 supplementation did not significantly improved diastolic heart functions compared with placebo in maintenance hemodialysis patients.Öğe Comparison of Adverse-Event Profiles of Intravenous Low-Molecular-Weight Iron Dextran and Iron Sucrose in Peritoneal Dialysis Patients(INFORMA HEALTHCARE, 2011) Solak, Yalcin; Atalay, Huseyin; Guney, Ibrahim; Turkmen, Kultigin; Kaya, Emine; Turk, SuleymanBackground: Both erythropoiesis-stimulating agents and iron treatments are underutilized in peritoneal dialysis (PD) patients. Studies to evaluate safety profiles of various intravenous iron preparations are limited in PD patients compared to hemodialysis. No study in the literature compared safety of low-molecular-weight iron dextran (LMW-ID) with that of iron sucrose in PD patients. We aimed to compare adverse-effect profiles of LMW-ID and iron sucrose with varying dosing schedules in PD patients with a hope to foster use of parenteral iron solutions in PD patients. Methods: We retrospectively reviewed patient charts and included patients who were administered iron sucrose or LMW-ID parenterally. Sociodemographic characteristics, clinical features, and pertinent laboratory data were collected. Adverse events which were deemed to be related to infusion of parenteral iron were recorded. We double-checked both physician records and nursing documents for observed adverse events. Results: A total of 167 chronic PD patients were included in the study, and 92 patients were administered LMW-ID, whereas 75 patients were administered iron sucrose. Only one adverse event occurred in a patient who was administered 500 mg iron sucrose in a single infusion. Conclusions: This study showed the comparable safety of LMW-ID in varying doses over that of iron sucrose in PD patients.Öğe Cross-Over, Open-Label Trial of the Effects of Gabapentin versus Pregabalin on Painful Peripheral Neuropathy and Health-Related Quality of Life in Haemodialysis Patients(ADIS INT LTD, 2013) Atalay, Huseyin; Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Guney, Figen; Turk, SuleymanPainful peripheral neuropathy (PPN) is common in haemodialysis patients and associated with impaired health-related quality of life (HR-QoL). Gabapentin and pregabalin have not been fully investigated in haemodialysis patients. Therefore, we compared the effects of gabapentin and pregabalin on intensity of pain and associated HR-QoL in haemodialysis patients with PPN. Gabapentin and pregabalin were administered after each haemodialysis session at doses of 300 and 75 mg, respectively. Patients were randomized into two groups; after 6 weeks patients underwent a 2-week washout and crossover and received another 6 weeks of treatment. All patients underwent electromyography at the outset. The short-form McGill pain questionnaire (SF-MPQ) for assessment of pain, and short-form medical outcomes study for assessment of HR-QoL at baseline and at the end of the study were applied. Forty patients completed the 14-week study period. Gabapentin and pregabalin significantly improved SF-MPQ total scores compared with pretreatment values (mean +/- A SD) [from 18.9 +/- A 4.3 to 9.3 +/- A 4.3 for gabapentin, p < 0.001, and from 18.5 +/- A 3.9 to 9.8 +/- A 3.6 for pregabalin, p < 0.001]. There was no significant difference between the study drugs in terms of efficacy against neuropathic pain (p > 0.05). Both gabapentin and pregabalin significantly improved HR-QoL at the end of the study compared with pretreatment scores (p < 0.001). Our results showed strong efficacy of gabapentin and pregabalin on pain intensity in the given doses. HR-QoL was also significantly improved by both drugs.Öğe Ectopic, Polycystic and Stoned: Pelvic Kidney in a Patient With Autosomal Dominant Polycystic Kidney Disease(LIPPINCOTT WILLIAMS & WILKINS, 2012) Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Ozbek, Orhan; Tonbul, Halil Zeki[Abstract not Available]Öğe Effects of Coenzyme Q10 Supplementation on Exercise Performance and Markers of Oxidative Stress in Hemodialysis Patients: A Double-Blind Placebo-Controlled Crossover Trial(LIPPINCOTT WILLIAMS & WILKINS, 2016) Gokbel, Hakki; Turk, Suleyman; Okudan, Nilsel; Atalay, Huseyin; Belviranli, Muaz; Gaipov, Abduzhappar; Solak, YalcinCoenzyme Q10 (CoQ10) supplementation has been shown to decrease oxidative stress in a number of clinical settings. However, there are mixed results regarding the role of CoQ10 supplementation on exercise performance. Chronic kidney disease is recognized as an inflammatory state, and hemodialysis patients have low level of exercise performance. We aimed to evaluate the effect of CoQ10 supplementation on oxidative stress markers and exercise performance measures. This was a prospective, double-blind, placebo-controlled, crossover study in which all patients received placebo and oral CoQ10 200 mg/d. Participants underwent 6-minute walking test and cycle ergometer. Blood samples were drawn to determine malondialdehyde, oxidized low-density lipoprotein, superoxide dismutase, and glutathione peroxidase. Walking distance in 6-minute walking test and estimated maximal oxygen consumption (VO2max) were recorded. Twenty-eight patients were randomized, but 23 patients completed the study protocol. Serum CoQ10 level significantly increased with supplementation compared with basal values (P < 0.05). Neither walking distance nor estimated VO2max was different between the placebo and CoQ10 groups (P > 0.05). Serum malondialdehyde levels significantly increased in both groups compared with baseline values just after the exercise (P < 0.05). There was no difference in markers of oxidative stress and antioxidant system between placebo and CoQ10 supplementation with exercise (P > 0.05). The results of this study showed no significant effect of CoQ10 supplementation on exercise performance measures and oxidative system markers compared with placebo in maintenance hemodialysis patients.Öğe Effects of secondary amyloidosis on arteriovenous hemodialysis fistula outcomes and intradialytic hypotension: A case-control study(WILEY-BLACKWELL, 2012) Solak, Yalcin; Caymaz, Memduh; Tonbul, Halil Zeki; Ozbek, Orhan; Turkmen, Kultigin; Gormus, NiyaziAmyloid fibrils can affect vascular structure through deposition and by causing nitric oxide depletion and increase of asymmetric dimethyl arginine. Patients with amyloidosis are prone to development of hypotension. Hypotension may also affect the maturation of arteriovenous fistula (AVF) and may set the stage for formation of thrombosis and fistula failure. Thus, we aimed to evaluate effects of secondary amyloidosis on AVF outcomes and intradialytic hypotension. This is a case-control study which included 20 hemodialysis patients with amyloidosis and 20 hemodialysis patients without amyloidosis as control group. All patients underwent Doppler ultrasound of AVF. A thorough fistula history and baseline laboratory values along with episodes of intradialytic hypotension and blood pressure measurements were recorded. There was no difference between the groups regarding age, gender, body mass index, presence of comorbidities, hypertension, and drug use. Systolic and diastolic blood pressures were similar (119 +/- 28/75 +/- 17 and 120 +/- 14/75 +/- 10?mmHg for patients with and without amyloidosis, respectively). Intradialytic hypotension episodes were also similar. Patients with amyloidosis had significantly lower serum albumin and higher C-reactive protein values compared to control hemodialysis patients. AVF sites and total number of created fistulas were similar in both groups. Flow rates of current functional AVFs were not different between the groups (1084 +/- 875 and 845 +/- 466?mL/minute for patients with and without amyloidosis, respectively, p:0.67). Patency duration of first AVF was not different between the groups. Clinical fistula outcomes and rate of intradialytic hypotension episodes were not significantly different between patients with and without secondary systemic amyloidosis.Öğe Electrocardiographic P-wave characteristics in patients with end-stage renal disease: P-index and interatrial block(SPRINGER, 2013) Solak, Yalcin; Gul, Enes Elvin; Kayrak, Mehmet; Atalay, Huseyin; Abdulhalikov, Turyan; Turk, Suleyman; Covic, AdrianP-wave parameters including P-wave dispersion (P (d)) have been examined in general population to predict development of atrial fibrillation (AF). But data on end-stage renal disease (ESRD) population are limited. P index (Pi) and interatrial block (IAB) as novel parameters may more accurately predict AF and have not been previously investigated in ESRD patients. We aimed to evaluate these novel ECG parameters in ESRD patients. Eighty-six HD, 47 CAPD, and 43 age- and gender-matched control subjects were enrolled in the study. P-wave duration was measured in all 12-leads of the surface ECG. The standard deviation of the P-wave duration across the 12 ECG leads was accepted as a Pi. P-wave duration above and equal to 110 ms was defined as IAB. All P-wave parameters were evaluated digitally by two observers. Pi was found to be significantly different among the groups in ANOVA. In post hoc analysis, P (i) was increased in HD group compared with the control group (p = 0.01). Also, P (i) tended to increase in CAPD group compared with controls (p = 0.06). The effect of ESRD on P (i) was independent of age, gender, and systolic blood pressure in univariate covariant analysis. The prevalence of IAB was 61, 55, and 32 % in patients with HD, CAPD, and controls, respectively (p = 0.001). P (d) was significantly higher in HD group compared with healthy controls. However, Pd values of CAPD patients did not show significant difference compared with controls. The present study demonstrated that IAB frequency and Pi were increased in patients with ESRD.Öğe Evaluation of performance of quantiferon assay and tuberculin skin test in end stage renal disease patients receiving hemodialysis(EDIZIONI INT SRL, 2011) Maden, Emin; Bekci, T. Taha; Kesli, Recep; Atalay, Huseyin; Teke, Turgut; Solak, Yalcin; Turk, SuleymanPurpose: End stage renal disease (ESRD) cases are associated with increased risk of tuberculosis. There is no gold standard method for detecting latent tuberculosis infection (LTBI) in ESRD. The aim of the present study was to analyze the performance of the tuberculin skin test (TST) and QuantiFERON-TB Gold in tube (QFT-G) in cases receiving hemodialysis (HD). Methods: The TST and QFT-G were prospectively performed in 96 ESRD cases undergoing HD. The agreement of the QFT-G and TST was assessed in two TST cut off values (10 mm and 5 mm) in Bacille Calmette Guerin (BCG) vaccinated and non-vaccinated cases. Results: Of 96 cases 67 were BCG vaccinated and 29 were BCG non-vaccinated. QFT-G was positive in 39.6% cases and indeterminate in 3.1%. TST was positive in 43.8% of cases in cut off value of 10 mm and positive in 58.3% of cases in cut off value of 5 mm. Agreement between TST and QFT-G results was fair in both BCG vaccinated and non-vaccinated cases in either cut off values, except in cut off value of 10 mm in BCG vaccinated cases in which the agreement was moderate. Conclusion: The agreement between QFT-G and TST test is fair and there is no significant difference in both cut off values of TST in screening of LTBI in ESRD cases receiving HD.Öğe Gabapentin versus pregabalin in improving sleep quality and depression in hemodialysis patients with peripheral neuropathy: a randomized prospective crossover trial(SPRINGER, 2013) Biyik, Zeynep; Solak, Yalcin; Atalay, Huseyin; Gaipov, Abduzhappar; Guney, Figen; Turk, SuleymanIn dialysis patients, painful peripheral neuropathy (PPN) is associated with sleep disturbance and mood disorders. Our goal was to compare the effects of gabapentin and pregabalin on improving sleep quality and depression among hemodialysis patients with PPN. Fifty hemodialysis patients with PPN were randomized into 2 groups, to receive gabapentin and pregabalin, respectively. After 6 weeks of treatment, patients underwent a 2-week washout period, followed by crossover and another 6 weeks of treatment. All patients underwent electromyography (EMG) at the outset and completed the modified Short Form of McGill Pain Questionnaire (SF-MPQ), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality (PSQI) assessment at baseline and at the end of the study. Forty out of 50 patients completed the 14-week study period. Thirty-one out of 40 patients (77.5 %) had EMG-proven PPN. Both gabapentin and pregabalin significantly improved SF-MPQ, BDI and PSQI scores at the end of the study compared with pretreatment scores (p < 0.001). There was no significant difference between the two drugs in any studied parameter. Our results showed for the first time a good and similar efficacy of both drugs on pain intensity, quality of sleep and depression in hemodialysis patients with PPN.Öğe Mean corpuscular volume is associated with endothelial dysfunction and predicts composite cardiovascular events in patients with chronic kidney disease(WILEY-BLACKWELL, 2013) Solak, Yalcin; Yilmaz, Mahmut Ilker; Saglam, Mutlu; Demirbas, Seref; Verim, Samet; Unal, Hilmi Umut; Gaipov, AbduzhapparAimMean corpuscular volume (MCV) is a measure of size of red blood cells. Recently a few studies showed an association of macrocytosis with all-cause mortality. We aimed to assess the relationship of MCV with cardiovascular (CV) morbidity and mortality in patients with chronic kidney disease (CKD), and the effect of MCV on endothelial function. MethodsThis is an observational cohort study with a prospectively maintained cohort of patients with stage 1-5 CKD. Estimated glomerular filtration rate (eGFR), flow mediated dilatation (FMD) and laboratory values were measured at baseline. Multivariate linear and Cox regression analyses were used to predict independent associations of FMD and composite CV events, respectively. ResultsA total of 309 patients were included in the study. In contrast to anaemia MCV did not show a significant change among CKD groups. MCV was an independent predictor of FMD in addition to serum haemoglobin, CRP, diabetes, systolic blood pressure (SBP) and eGFR. Median MCV value was 85fl. Kaplan-Meier analysis showed that at 38 months the survival rate was 97.6% in the group with MCV < 85 compared to 81.6% in the arm with MCV 85 (P<0.001, log-rank test). Cox regression analysis showed MCV as a predictor of composite CV events independent of major confounding factors. ConclusionThis is the first study in the literature showing an independent association of MCV and FMD. Our results also determined MCV as an independent predictor of composite CV events independent of anaemia, inflammation, diabetes and eGFR in patients with CKD.Öğe Mechanisms and consequences of salt sensitivity and dietary salt intake(LIPPINCOTT WILLIAMS & WILKINS, 2011) Kanbay, Mehmet; Chen, Yabing; Solak, Yalcin; Sanders, Paul W.Purpose of review Investigation into the underlying mechanisms of salt sensitivity has made important advances in recent years. This review examines in particular the effects of sodium and potassium on vascular function. Recent findings Sodium chloride (salt) intake promotes cutaneous lymphangiogenesis mediated through tissue macrophages and directly alters endothelial cell function, promoting increased production of transforming growth factor-beta (TGF-beta) and nitric oxide. In the setting of endothelial dysfunction, such as occurs with aging, diminished nitric oxide production exacerbates the vascular effects of TGF-beta, promoting decreased arterial compliance and hypertension. Dietary potassium intake may serve as an important countervailing influence on the effects of salt in the vasculature. Summary There is growing appreciation that, independently of alterations in blood pressure, dietary intake of sodium and potassium promotes functional changes in the vasculature and lymphatic system. These changes may protect against development of salt-sensitive hypertension. While salt sensitivity cannot be ascribed exclusively to these factors, perturbation of these processes promotes hypertension during high-salt intake. These studies add to the list of genetic and environmental factors that are associated with salt sensitivity, but in particular provide insight into adaptive mechanisms during high salt intake.Öğe Microvascular disease and its role in the brain and cardiovascular system: a potential role for uric acid as a cardiorenal toxin(OXFORD UNIV PRESS, 2011) Kanbay, Mehmet; Sanchez-Lozada, Laura-Gabriela; Franco, Martha; Madero, Magdalena; Solak, Yalcin; Rodriguez-Iturbe, Bernardo; Covic, AdrianArteriolosclerosis (microvascular disease) may have a key role not only in driving salt-sensitive hypertension but also in mediating the development of chronic kidney disease, vascular dementia, stroke and coronary heart disease. In this paper, we review the evidence that these latter conditions result from the altered autoregulation that occurs when arterioles become diseased. We also discuss the increasing evidence that dietary intake of sugars rich in fructose may be driving the development of microvascular disease as a consequence of raising intracellular uric acid. We hypothesize that the treatment of microvascular disease may require a multifaceted approach by utilizing agents which aim at blocking of the renin-angiotensin system, reducing oxidative stress, stimulating endothelial nitric oxide production and lowering uric acid levels. Paradoxically, agents that only stimulate nitric oxide, such as oestrogens, may increase the risk of poor outcomes if microvascular disease is not reversed.Öğe Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study(WILEY, 2014) Gungor, Gokhan; Ataseven, Huseyin; Demir, Ali; Solak, Yalcin; Gaipov, Abduzhappar; Biyik, Murat; Ozturk, BahadirBackground & AimsHepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival. Neutrophil gelatinase-associated lipocalin (NGAL) is a troponin-like biomarker for human acute kidney injury. We aimed to investigate levels of plasma and urine NGAL in HRS and predictive ability of these markers for all-cause mortality, in HRS, stable cirrhosis and control subjects. MethodsA total of 64 patients with cirrhosis (8 patients with type 1 HRS, 22 with type 2 HRS, and 34 without HRS) and 23 control subjects were included in the study. Blood and urine samples were measured with Human NGAL sandwich ELISA. Patients were followed up prospectively. ResultsPatients with type 1 and type 2 HRS had significantly higher plasma and urine NGAL levels compared with stable cirrhosis and control subjects. Cox regression analysis showed that plasma NGAL and MELD-Na scores were independent predictors of mortality. ROC-curve analysis showed that the plot of the plasma NGAL, urine NGAL, MELD-Na and Child-Turcot-Pugh score could predict all-cause mortality in cirrhotic patients' area under the curve (AUC 0.819, 0.686, 0.807 and 0.795 respectively). ConclusionsNGAL could predict mortality in patients with HRS independent of other commonly used risk factors.Öğe Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease(SPRINGER, 2013) Solak, Yalcin; Yilmaz, Mahmut Ilker; Sonmez, Alper; Saglam, Mutlu; Cakir, Erdinc; Unal, Hilmi Umut; Gok, MahmutIncreased inflammation is common in patients with chronic kidney disease (CKD) and is associated with increased adverse cardiovascular events (CVE). Neutrophil-to-lymphocyte ratio (NLR) was used to predict survival in patients with acute coronary syndrome. We aimed to evaluate predictive ability of NLR in CKD patients. 225 subjects with stage 3-5 CKD were followed for a mean of 39 months. Fatal and nonfatal CVE were recorded during this period. NLR at baseline was determined from complete blood count differential. Endothelial dysfunction (flow-mediated dilation, FMD), hsCRP and insulin resistance were determined. We investigated if NLR could predict development of fatal and nonfatal CVE. We also looked at how NLR and its individual components change across CKD stages and whether NLR is related to CRP, insulin resistance and endothelial dysfunction. There were 70, 74 and 81 patients in groups of CKD stage-3, stage-4 and stage-5, respectively. Median NLR was 2.81. NLR showed a significant increase from stage 3 to stage 5. NLR was inversely associated with FMD independent of hsCRP. 14 fatal and 52 nonfatal CVE occurred during follow-up period. NLR could predict composite CVE independent of insulin resistance and hsCRP. Increased NLR over 2.81 was related to a significantly decreased survival time (log-rank Chi-square = 14.833, P < 0.0001). A cutoff value for NLR a parts per thousand yen3.76 could predict development of composite CVE with 80.3 % sensitivity and 91.8 % specificity. NLR is independently related to endothelial dysfunction and could predict composite cardiovascular endpoints independent of traditional confounding factors in patients with moderate to severe CKD.Öğe Oxidative stress and Antioxidant Defense in Patients with Chronic Kidney Disease: Association with Plasma Coenzyme Q10 Levels(ELSEVIER SCIENCE INC, 2009) Gokbel, Hakki; Atalay, Hueseyin; Okudan, Nilsel; Solak, Yalcin; Belviranli, Muaz; Turk, Suleyman[Abstract not Available]
