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Amino asitli diyalizatların malnütrisyonlu SAPD hastalarında nütrisyonel ve diğer laboratuar parametreleri üzerine 1 yıllık dönemdeki etkileri
(2009) Güney, İbrahim; Altıntepe, Lütfullah; Okudan, Nilsel; Tonbul, H. Zeki; Türk, Süleyman; Yeksan, Mehdi
Amaç: Malnütrisyon periton diyaliz hastalarında ciddi bir problemdir ve morbitide-mortalitenin önemli nedenlerindendir. Amino asit içeren peritoneal diyaliz solüsyonları (nutrineal) ile diyaliz yapılan malnütrisyonlu hastalarda nutrisyonel durum ve diğer laboratuar parametrelerindeki değişiklikleri incelemeyi amaçladık. Yöntem: Serum albumin düzeyi 3.5 g/dl olan 19 SAPD hastası çalışmaya alındı. Hastaların bir yıllık takiplerinde; 5 hastanın exitus, 2 hastanın hemodiyalize ve bir hastanın ise APD’ye transfer olması, 2 hastada karın ağrısı, 1 hastada ise bulantı-kusma gelişmesi nedeni ile çalışmadan çıkarıldı. Çalışmayı tamamlayan 8 hastanın (6E/2K), yaş ortalaması 49.511.1 yıl idi. Başlangıç ve 1. yılda serum üre, kreatinin, total protein, albumin, ürik asid, fosfor, total kolesterol, trigliserid, hemoglobin düzeyleri, triseps deri kıvrım kalınlığı (TST), vücut yağ oranı ve vücut kitle indeksi (VKİ) belirlendi. Bulgular: Bir yıllık takip sonrasında ise başlangıç değerlerine göre serum albumin (p0.035), üre (p0.002) değerlerinde ve VKİ’de (p0.011) anlamlı artış saptanırken, ürik asit (p0.009) ve trigliserid (p0.004) değerlerinde anlamlı bir düşüş saptandı; diğer parametrelerde ise anlamlı bir fark saptanmadı. Sonuç: Amino asitli diyaliz solüsyonlarının malnütrisyonu bulunan SAPD hastalarında malnütrisyonu düzeltmek için kullanılabileceği kanaatindeyiz.
Association of fetuin-a levels with carotid ıntima media thickness and valvular calcification in hemodialysis and peritoneal dialysis patients
(2013) Solak, Yalçın; Atalay, Hüseyin; Bıyık, Zeynep; Türkmen, Kültigin; Yeksan, Mehdi; Türk, Süleyman; İnal, Ali
GİRİŞ: Fetuin A vasküler kalsifikasyonu önleyen bir negatif akut faz reaktanıdır. Koroner arter hastalığı (KAH) renal replasman tedavisi almakta olan hastalarda en önemli ölüm sebebidir. Diyalize giren son dönem böbrek yetmezliği hastalarında görülen kardiyovasküler hastalığın ana elementi hızlanmış kalsifik aterosklerozdur. Fetuin A seviyeleri açısından hemodiyaliz (HD) ve periton diyalizini(PD) karşılaştıran sınırlı sayıda çalışma mevcuttur. AMAÇ: HD ve PD hastalarında KAH prediktörleri ve valvüler kalsifikasyon ile serum fetuin A düzeyleri arasındaki ilişkiyi araştırmayı amaçladık. GEREÇ ve YÖNTEMLER: 39 HD (24 erkek, 15 kadın) ve 39 PD (25 erkek, 14 kadın) hastası çalışmaya alındı. Karotis intima media kalınlığı (KIMK) ultrason ile ölçüldü ve kalp kapağı kalsifikasyonları ekokardiyografi ile değerlendirildi. Ayrıca serum fetuin-A, CRP, ferritin, fibrinojen, ve albumin seviyeleri saptandı. Fetuin-A düzeylerine göre hastalar çeyreklere ayrıldı. Bulgular: Fetuin-A seviyesi HD hastalarında PD hastalarına göre daha düşüktü (hemodiyaliz 28,65,934 ng/ml, PD 324,8 ng/ml, p0,001). KIMK ile fetuin-A seviyesi arasında anlamlı negatif korelasyon vardı. KIMK, PD hastalarında HDe göre daha düşüktü. Fetuin-A seviyesi ile diyaliz
The Association of Glomerular Filtration Rate and Erectile Dysfunction with Severity of Coronary Artery Disease in Patients Presenting with Chest Pain
(SPRINGER, 2010) Solak, Yalçın; Akıllı, Hakan; Atalay, Hüseyin; Kayrak, Mehmet; Gök, Hasan; Türk, Süleyman
Background The most common cause of death in patients with chronic kidney disease is cardiovascular. Coexistence of reduced estimated glomerular filtration rate (eGFR) and erectile dysfunction (ED) may predate severe underlying coronary artery disease (CAD). The aim of this study was to evaluate the predictive value of presence and severity of ED and reduced estimated eGFR in the risk stratification of CAD in patients with chest pain. Methods Two hundred and sixty-five consecutive male patients with chest pain were included. All patients underwent exercise stress test (EST), of whom those with positive EST underwent coronary angiography. eGFR was calculated and sexual health inventory for men (SHIM) form was applied to evaluate ED. The relation between SHIM scores, eGFR and the number of arteries with significant lesions was evaluated. Results Of the 265 male patients, 105 had positive EST while the remaining 160 patients had negative EST. ED was present in 62 patients (38.8%) in the EST (-) group and in 64 patients (61%) in the EST (+) group (P = 0.000). In the EST (+) group, coronary angiography (CAG) revealed normal coronary anatomy or insignificant coronary lesions in 19 (18%), one-vessel disease in 45 (43%), two-vessel disease in 22 (21%) and three-vessel disease in 19 (18%) patients, respectively. The lowest ED prevalence (36.8%) was seen in patients who had normal coronary anatomy or insignificant coronary lesions while the highest prevalence was in those with three-vessel disease (89.5%). When eGFR were taken into account, there was a significant difference between the groups as well (107.2 +/- 19.2 ml/min in the EST (-) group versus 94.1 +/- 20.0 ml/min in the EST (+) group; P = 0.001). Conclusion The presence and severity of ED and reduced eGFR are associated with the severity of underlying CAD in patients presenting with chest pain, and they could be implemented in the risk stratification of these patients.
The Association of Peritoneal Transport Properties With 24-hour Blood Pressure Levels in Capd Patients
(Multimed Inc, 2003) Tonbul, Zeki; Altıntepe, Lütfullah ; Sözlü, Çetin; Yeksan, Mehdi; Yıldız, Alaattin; Türk, Süleyman
Objectives: We aimed to investigate the effects of peritoneal transport characteristics on blood pressure (BP) parameters, measured by 24-hour ambulatory blood pressure monitoring (ABPM), and on the development of left ventricular hypertrophy (LVH) in continuous ambulatory peritoneal dialysis (CAPD) patients. Design: Cross-sectional and prospective design. * Setting: Tertiary-care center. Patients: 25 CAPD patients (11 male, 14 female; mean age 47 +/- 14 years) were included. Mean time on CAPD was 22.9 +/- 18 months and all patients had been dialyzed for more than 6 months. The patients were divided into high, high-average, low-average, and low transport groups according to peritoneal equilibration test results. Main Outcome Measures: Daytime and nighttime systolic and diastolic BP and left ventricular mass index among the different peritoneal transport groups; changes in BP parameters before and after increase in ultrafiltration. Results: On 24-hour ABPM records, 13 patients (52%) were found to be hypertensive. Both mean systolic and diastolic BP were significantly increased in high-transporter groups compared to low transporters in both daytime and nighttime BP parameters. Left ventricular mass index was higher in high transporters compared to low transporters, without reaching statistical significance: 160 +/- 23 vs 119 +/- 41 g/m(2), p > 0.05. Following increase in ultrafiltration, mean systolic (145 +/- 13 vs 128 +/- 5 mmHg, p < 0.001) and diastolic (96 +/- 10 vs 81 +/- 3 mmHg, p < 0.001) BP decreased, and BP levels returned to normotensive levels in 6 (46%) of the 13 hypertensive patients, requiring discontinuation of anti hypertensive drugs. Conclusion: Improvement in volume status resulted in a decrease in both daytime and nighttime BR Differences in peritoneal transport properties were associated with the development of hypertension and LVH.
The association of peritoneal transport properties with 24-hour blood pressure levels in CARP patients
(2003) Tonbul, Halil Zeki; Altıntepe, Lütfullah; Sözlü, Çetin; Yeksan, Mehdi; Yıldız, Alaattin; Türk, Süleyman
Objectives: We aimed to investigate the effects of peritoneal transport characteristics on blood pressure (BP) parameters, measured by 24-hour ambulatory blood pressure monitoring (ABPM), and on the development of left ventricular hypertrophy (LVH) in continuous ambulatory peritoneal dialysis (CAPD) patients. Design: Cross-sectional and prospective design. Setting: Tertiary-care center. Patients: 25 CAPD patients (11 male, 14 female; mean age 47 ± 14 years) were included. Mean time on CAPD was 22.9 ± 18 months and all patients had been dialyzed for more than 6 months. The patients were divided into high, high-average, low-average, and low transport groups according to peritoneal equilibration test results. Main Outcome Measures: Daytime and nighttime systolic and diastolic BP and left ventricular mass index among the different peritoneal transport groups; changes in BP parameters before and after increase in ultrafiltration. Results: On 24-hour ABPM records, 13 patients (52%) were found to be hypertensive. Both mean systolic and diastolic BP were significantly increased in high-transporter groups compared to low transporters in both daytime and nighttime BP parameters. Left ventricular mass index was higher in high transporters compared to low transporters, without reaching statistical significance: 160 ± 23 vs 119 ± 41 g/m2, p > 0.05. Following increase in ultrafiltration, mean systolic (145 ± 13 vs 128 ± 5 mmHg, p < 0.001) and diastolic (96 ± 10 vs 81 ± 3 mmHg, p < 0.001) BP decreased, and BP levels returned to normotensive levels in 6 (46%) of the 13 hypertensive patients, requiring discontinuation of antihypertensive drugs. Conclusion: Improvement in volume status resulted in a decrease in both daytime and nighttime BP. Differences in peritoneal transport properties were associated with the development of hypertension and LVH.
Baking Soda Induced Severe Metabolic Alkalosis in a Haemodialysis Patient
(2009) Solak, Yalçın; Turkmen, Kültigin; Atalay, Hüseyin; Türk, Süleyman
Metabolic alkalosis is a rare occurence in hemodialysis population compared to metabolic acidosis unless some precipitating factors such as nasogastric suction, vomiting and alkali ingestion or infusion are present. When metabolic alkalosis develops, it may cause serious clinical consequences among them are sleep apnea, resistent hypertension, dysrhythmia and seizures. Here, we present a 54-year-old female hemodialysis patient who developed a severe metabolic alkalosis due to baking soda ingestion to relieve dyspepsia. She had sleep apnea, volume overload and uncontrolled hypertension due to metabolic alkalosis. Metabolic alkalosis was corrected and the patient's clinical condition was relieved with negative-bicarbonate hemodialysis.
Comparative Effect of Oral Pulse and Intravenous Calcitriol Treatment in Hemodialysis Patients: The Effect on Serum Il-1 and Il-6 Levels and Bone Mineral Density
(Karger, 2002) Türk, Süleyman; Akbulut, Mehmet; Yıldız, Alaattin; Gürbilek, Mehmet; Gönen, Said; Tombul, Zeki; Yeksan, Mehdi
Introduction: Increased serum levels of bone-resorptive cytokines such as interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) have been implicated for changes in bone remodeling in hemodialysis patients. In this prospective randomized study, we aimed to compare the effect of oral and intravenous (IV) pulse calcitriol on serum levels of IL-1beta and IL-6. Patients and Methods: Twenty-eight hemodialysis patients were included and consecutively randomized to receive either oral (n = 14, M/F = 7/7, mean age 42 +/- 15 years) or IV pulse (n = 14, M/F = 6/8, mean age 38 +/- 14 years) calcitriol treatment. No difference was found between groups for age, sex distribution, primary renal disease, mean time on hemodialysis and baseline biochemical parameters including serum levels of IL-1beta and IL-6. Results: The percent fall of intact parathyroid hormone iPTH) was significantly less with oral compared to IV calcitriol between 0 and the 3rd month (32 +/- 21 vs. 56 +/- 28%, p = 0.03). However, the percent fall in iPTH at the 6th month of the therapy was not different in the oral group compared to the IV group (57 +/- 22 vs. 73 +/- 24%, p = 0.12). The increase in bone mineral densities was higher in the IV group than the oral group. Oral and IV calcitriol caused a significant fall in IL-1beta (p =0.02 and p= 0.03, respectively) and IL-6 levels (p = 0.02 and p < 0.001, respectively) at the 6th month of treatment. The percent fall in serum IL-6 levels at the 6th month was significantly greater in the IV compared to the oral group (61 18 vs. 36 +/- 33%, p = 0.04), while the percent changes in serum IL-1beta levels were similar. Conclusion: IV calcitriol therapy has a greater suppression of PTH at the 3rd month of the therapy. Despite no difference in serum PTH levels at the 6th month, IV therapy has a greater increase in bone mineral densities and a greater decrease in serum IL-6 levels. These findings suggest IV calcitriol treatment has a superior effect on bone remodeling by influencing the levels of bone-resorptive cytokines as compared to the oral therapy group, beyond its suppressive effect on iPTH.
Comparison of Effects of Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis on Health-Related Quality of Life, Sleep Quality, and Depression
(Wiley-Blackwell, 2010) Güney, İbrahim; Solak, Yalçın; Atalay, Hüseyin; Yazıcı, Raziye; Altıntepe, Lütfullah; Kara, Fatih; Yeksan, Mehdi; Türk, Süleyman
Few studies investigating the effects of automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) on health-related quality of life (HRQoL), depression, and sleep quality exist in the literature. We aimed to determine differences between APD and CAPD modalities with respect to these parameters. Twenty APD and 48 CAPD patients were included in this crosssectional study. Biochemical values were measured at outpatient evaluation. A modified postsleep inventory was used to evaluate sleep quality. Health-related quality of life and depression were evaluated by the Short Form of Medical Outcomes Study and Beck Depression Inventory, respectively. Automated peritoneal dialysis and CAPD patients were compared in terms of sleep quality, HRQoL, and depression. Our results showed that there were no significant differences between APD and CAPD in any of the studied parameters. Moderate or severe sleep problems were found in 60% and 69% of the APD and CAPD patients, respectively. Mean HRQoL scores for any of the 8 Short Form of Medical Outcomes Study-36 domains were similar in the 2 groups. The mean physical component score was 51.1 +/- 21.2 and 48.9 +/- 18.2 in APD and CAPD patients, respectively (P=0.672). The mean mental component score was 47.5 +/- 20.1 in APD patients, whereas it was 42.4 +/- 19.5 in CAPD patients (P=0.291). Depression was detected in 70% of APD and 62.5% of the CAPD patients. The mean Beck Depression Inventory scores were also similar in the 2 groups. This study showed that HRQoL, sleep quality, and depression were similar in APD and CAPD patients.
Comparison of erythropoietin resistance in hemodialysis patients using calcitriol, cinacalcet, or paricalcitol
(WILEY-BLACKWELL, 2015) Afşar, Barış; Ağca, Erhan; Türk, Süleyman
The erythropoiesis-stimulating agent (ESA) hyporesponsiveness index (EHRI) calculated as the weekly dose of EPO divided by weight (kg) divided by hemoglobin level (g/dL) has been considered useful to assess ESA resistance. Recent evidence suggests that active vitamin D, cinacalcet, and paricalcitol use may be related with lower ESA resistance. We conducted this observational cross-sectional study to investigate ESA resistance calculated by the EHRI among patients using calcitriol, cinacalcet, and paricalcitol. Participants underwent a medical history taken, physical examination, measurement of biochemical analysis, calculation of dialysis adequacy, and EHRI. Sixty-five patients did not receive any treatment regarding vitamin D, paricalcitol, and cinacalcet (group 1), 41 were taking only vitamin D (group 2), 50 were taking only paricalcitol (group 3), 19 were taking only cinacalcet (group 4), and 21 were taking paricalcitol+cinacalcet (group 5). The EHRI values for groups 1, 2, 3, 4, and 5 were 11.36 +/- 8.72, 11.58 +/- 5.72, 8.29 +/- 5.54, 9.49 +/- 4.61, and 8.91 +/- 4.44 respectively (P=.034). Post hoc analysis showed that the EHRI differed between group 1 and group 3 (P=.017) and between group 2 and group 3 (P=.006). In linear regression analysis, use of paricalcitol was independently associated with EHRI. In conclusion, paricalcitol use was associated with lower EHRI levels as a measure of ESA resistance.
Culture-Negative Bilateral Emphysematous Pyelonephritis Presented as Acute Renal Failure and Managed Medically Only
(LIPPINCOTT WILLIAMS & WILKINS, 2010) Solak, Yalçın; Türkmen, Kültigin; Atalay, Hüseyin; Türk, Süleyman
Emphysematous pyelonephritis is a life-threatening infection especially seen in patients with poorly-controlled diabetes mellitus. Imaging modalities (preferably computed tomography) are required to establish the diagnosis. Treatment modalities include volume resuscitation, broad-spectrum antibiotics, percutaneous drainage, and, as a last resort, nephrectomy. We present a case of a 46-year-old female who had hypertension and type-2 diabetes mellitus and presented with complaints of dysuria, back pain, and decreased urine output. Renal ultrasound and abdominal computerized tomography (CT) revealed air-fluid levels at each perirenal region and collecting systems, consistent with emphysematous pyelonephritis. Her clinical situation improved with vigorous fluid resuscitation and broad-spectrum antibiotic treatment.
Depression and Quality of Life in Continuous Ambulatory Peritoneal Dialysis Patients
(Oxford Univ Press, 2006) Yeksan, Mehdi; Güney, İbrahim; Yazıcı, Raziye; Atalay, Hüseyin; Altıntepe, Lütfullah; Türk, Süleyman; Tonbul, H. Zeki
[Abstract not Available]
Early and intensive fluid replacement prevents acute renal failure in the crush cases associated with spontaneous collapse of an apartment in Konya
(TAYLOR & FRANCIS LTD, 2007) Altıntepe, Lütfullah; Güney, İbrahim; Tonbul, Zeki; Türk, Süleyman; Mazı, Mehmet; Ağca, Erhan; Yeksan, Mehdi
Background. Crush syndrome developing as a result of earthquake and other natural disasters has been investigated from many angles to date. Data are scarce, however, on cases associated with the spontaneous crash of buildings. This study presents the results on seven rhabdomyolysis patients treated in our clinics out of nine casualties who were rescued from the rubble of Zumrut apartment after the building collapsed suddenly and spontaneously. Methods. As a result of the sudden, spontaneous collapse of the 10-floor Zumrut apartment in Konya at 20:15 hours on February 2, 2004, 92 out of a total of 121 persons who were inside the building lost their lives, and 29 casualties were rescued from the rubble. Nine hospitalized patients had crush syndrome, and a prophylactic mannitol-bicarbonate cocktail was started in all at admission. Results. The time they remained entrapped under the rubble was 11.1 +/- 7.3 (5-24 hours) on average. The highest CPK level of the patients was 79049 +/- 75374 u/L (17478-223600 u/L), observed on the median day 1.7 +/- 1.1 (days 1-4) following the incident. ARF developed in only two cases (28.6%) owing to the prophylactic mannitol-bicarbonate cocktail administered to prevent ARF, and because of hyperpotassemia, hemodialysis (HD) treatment was administered to these patients. One patient required two sessions of HD, and another required four. In both patients who received HD treatment, the level of potassium was in excess of 7 mEq/L. A total of eight fasciotomies were performed on five (71.4%) of the seven patients with crush syndrome. Five of the fasciotomies (62.5%) were performed on two of our patients who required HD treatment. None of our patients with crush syndrome developed permanent kidney damage, and no mortality occurred. Conclusion. It was deduced that rapid fluid therapy accompanied by the prophylactic administration of mannitol-bicarbonate are largely effective in preventing the development of ARF in cases with crush syndrome resulting from disasters.
Effect of Anti-Hcv Positivity on Response to Hepatitis B Virus Vaccine in Haemodialysis Patients
(1998) Koşar, Ali; Dalmaz, Mahmut; Sağmanlıgil, Şerife; Yeksan, Mehdi; Türk, Süleyman
There are different factors that affect the response of recombinant hepatitis B vaccine in hemodialysis patients. A total of 36 patients on a hemodialysis program (HD) were included in this study; 17 of patients were anti-HCV-positive and 19 were anti-HCV-negative. All serological markers of anti-HBs, HBs, anti-HBc IgM and anti-HBc total were negative in all patients. A 20 g dose of vaccine (Genhevac B Pasteur Merieux, France) was given intramuscularly at 0, 1 and 6 months. Anti-HBs levels were measured at 1, 2, 7 and 16 months and an anti-HBs titer>10 IU/mL was accepted as a protective level against hepatitis B virus infection. At 1, 2 and 7 months there was no statistically significant difference between these groups according to anti- HBs levels. However, anti-HBs levels were lower in anti-HCV-positive group at the 16th month (p<0.05). Anti-HCV positivity in HD patients has a negative effect on the antibody response to hepatitis B virus vaccine. This can be a result of the hepatitis or of the effect on the immune system which is caused by HCV. This negative effect could not be explained in this study and we believe more studies should be carried out in selected patients and larger series.
Effect of Recombinant Human Erythropoietin (R-HuEPO) Therapy on Plasma FT3, FT4, TSH, FSH, LH, Free Testosterone and Prolactin Levels in Hemodialysis Patients
(1992) Yeksan, M.; Tamer, Nour; Cirit, Mustafa; Türk, Süleyman; Akhan, Galip; Akkuş, İdris; Erkul, I.
The aim of this study was to evaluate the effect of r-HuEPO treatment on free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), free testosterone and prolactin levels in uremic hemodialysis patients. Twenty-four uremic hemodialysis patients were given r-HuEPO with a dose 60 U/kg as intravenous bolus injection at the end of each dialysis session. Once the hematocrit value of the patient had reached a range of 30-35%, the dose was adjusted so as to keep the hematocrit levels constant. Twenty uremic dialysis patients were taken as control group. The above-mentioned hormone levels of patients and control group were determined before and 4 months after r-HuEPO treatment. After the treatment, serum prolactin levels significantly decreased in both sexes (36.8 ± 7.8 vs 22.9 ± 6.3 ng/ml and 78.3 ± 13.3 vs 37.4 ± 10.4 ng/ml male and female, respectively). FT3 and FT4 significantly increased (1.17 vs 1.67 pg/ml, p < 0.05, and 0.64 vs 0.084 ng/dl, p < 0.05, respectively). TSH levels increased but those changes were not significant. There was no change in the level of any hormone in the control group. Also, the sexual functions of eight male patients treated with r-HuEPO improved and menstruation started again in four female patients. We concluded that r-HuEPO treatment especially decreases prolactin level in uremic hemodialysis patients. It is conceivable that correction of elevated prolactin levels could improve sexual disorders in these patients.
Effect of Recombinant-Human-Erythropoietin (Rhuepo) Therapy on Plasma FT(3), FT(4), TSH, FSH, LH, Free Testesterone and Prolactin Levels in Hemodialysis-Patients
(WICHTIG EDITORE, 1992) Yeksan, M.; Tamer, Nour; Cirit, Mustafa; Türk, Süleyman; Akhan, Galip; Akkuş, İdris; Erkul, I.
The aim of this study was to evaluate the effect of r-HuEPO treatment on free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), free testosterone and prolactin levels in uremic hemodialysis patients. Twenty-four uremic hemodialysis patients were given r-HuEPO with a dose 60 U/kg as intravenous bolus injection at the end of each dialysis session. Once the hematocrit value of the patient had reached a range of 30-35%, the dose was adjusted so as to keep the hematocrit levels constant. Twenty uremic dialysis patients were taken as control group. The above-mentioned hormone levels of patients and control group were determined before and 4 months after r-HuEPO treatment. After the treatment, serum prolactin levels significantly decreased in both sexes (36.8 +/- 7.8 vs 22.9 +/- 6.3 ng/ml and 78.3 +/-13.3 vs 37.4 +/- 10.4 ng/ml male and female, respectively). FT3 and FT4 significantly increased (1.17 vs 1.67 pg/ml, p<0.05, and 0.64 vs 0.084 ng/dl, p<0.05, respectively). TSH levels increased but those changes were not significant. There was no change in the level of any hormone in the control group. Also, the sexual functions of eight male patients treated with r-HuEPO improved and menstruation started again in four female patients. We concluded that r-HuEPO treatment especially decreases prolactin level in uremic hemodialysis patients. It is conceivable that correction of elevated prolactin levels could improve sexual disorders in these patients.
The effect of vardenafil on erectile dysfunction, quality of life and depression in cases with renal failure
(OXFORD UNIV PRESS, 2007) Türk, Süleyman; Kan, Seyfullah; Atalay, Hüseyin; Güney, İbrahim; Altıntepe, Lütfullah; Küçür, Rahim; Kılıç, Mehmet
[Abstract not Available]
Effects of Serum Selenium Level on Cell-Mediated Immunity and on Antibody Response to Multivalent Influenza Vaccine in Hemodialysis Patients
(2012) Türkmen, Kültigin; Ecder, Tevfik; Türk, Süleyman
OBJECTIVE: End-stage renal disease (ESRD) patients are more prone to serious influenza virus infection than healthy subjects. Selenium (Se) play an important role in cellular and humoral immunity and serum Se levels were lower in hemodialysis patients. Studies have demonstrated that Se deficiency results in less reboust immune responses to vaccination and infections. We aimed to investigate the effect of serum Se levels on immune parameters and antibody response to multivalent influenza vaccine (MIV) in HD patients. MATERIAL and METHODS: Twenty-six HD patients (Group 1) and 11 healthy subjects (Group 2) were vaccinated with a trivalent inactivated MIV. In both groups, serum Se levels, CD3, CD4, CD4/CD8 ratio, CD3+HLA-DR+ cell percentages and antibody response to MIV were determined before and 1 month after the vaccination. RESULTS: There were statistically significant differences between Group 1 and Group 2 in terms of baseline serum Se levels, CD8, CD4/CD8 ratio, and CD3+HLA-DR cell percentages. One month after the vaccination, no significant changes were observed in any of the parameters except antibody titers with to baseline levels. CONCLUSIONS: We did not observe any difference in terms of Se levels and the immune parameters mentioned above before and 1 month after MIV vaccination in HD patients. Further studies investigating the link between Se status and clinical outcomes are needed in dialysis patients.
Effects of serum selenium level on cell-mediated ımmunity and on antibody response to multivalent ınfluenza vaccine in hemodialysis patients
(2012) Türkmen, Kültigin; Ecder, Tevfik; Türk, Süleyman
AMAÇ: Son dönem böbrek yetmezliği (SDBY) olan hastalar sağlıklı bireylere oranla ciddi influenza virüs enfeksiyonuna daha yatkındırlar. Selenyum (Se) hücresel ve hümoral bağışıklıkta önemli bir rol oynamaktadır ve hemodiyaliz hastalarında serum Se düzeyleri düşüktür. Yapılan çalışmalarda Se eksikliği olanlarda aşılara ve enfeksiyon hastalıklarına yeterli bağışıklık yanıtının oluşmadığı gösterilmiştir. Çalışmamızda SDBY hastalarında serum Se düzeyinin bağışıklık göstergeleri ve çok değerlikli influenza aşısına (MIV) antikor yanıtı üzerine etkisini göstermeyi hedefledik. GEREÇ ve YÖNTEMLER: 26 hemodiyaliz hastası (grup 1) ve 11 sağlıklı kontrol (grup 2) trivalan MIV ile aşılandı. Aşı öncesi ve 1 ay sonrasında serum Se, CD3, CD4, CD4/ CD8 oranı, CD3HLADR hücre oranları değerlendirildi. BULGULAR: Grup 1'deki hastaların grup 2'deki hastalara göre bazal serum Se düzeyleri, CD4/CD8 oranı düşük, CD8 ve CD3HLA-DR hücre yüzdeleri ise yüksek bulundu. Her iki grubta MIV aşılanma sonrasında antikor düzeyleri dışında Se düzeyleri, CD8, CD4/CD8 oranı ve CD3HLA-DR hücre yüzdelerinde anlamlı bir fark bulunmadı. SONUÇ: Hemodiyaliz hastalarında, MIV aşısı öncesi ve 1 ay sonrasında serum Se ve bağışıklık göstergeleri üzerinde herhangi bir fark saptamadık. Hemodiyaliz hasta grubunda Se düzeyi ile klinik sonuçları değerlendiren çalışmalara gereksinim vardır.
Effects of Sildenafil and Vardenafil on Erectile Dysfunction and Health-Related Quality of Life in Haemodialysis Patients: A Prospective Randomized Crossover Study
(Oxford Univ Press, 2010) Türk, Süleyman; Solak, Yalçın; Kan, Seyfullah; Atalay, Hüseyin; Kılınç, Mehmet; Ağca, Erhan; Bodur, Said
Background. Erectile dysfunction (ED) is prevalent in end-stage renal disease (ESRD) and has been associated with impaired health-related quality of life (HRQoL). HRQoL, in turn, is related to morbidity and mortality in ESRD patients. Previous studies have shown improved HRQoL with ED treatment using sildenafil and vardenafil. However, no study has examined the effects of sildenafil or vardenafil on HRQoL in impotent ESRD patients. Furthermore, vardenafil has never been tested and its safety profile has not been determined in ESRD patients. The aim of this randomized crossover study was to compare the effects of sildenafil and vardenafil on measures of HRQoL and on ED scores as well as to determine the safety profile of vardenafil in ESRD patients. Methods. In 32 haemodialysis patients with impotence, ED and HRQoL were evaluated by the International Index of Erectile Function (IIEF-5) and the 36-item Short-Form Health (SF-36) surveys, respectively. Patients were randomized into sildenafil and vardenafil groups. After a 4-week treatment and 2-week washout periods, crossover was performed and an additional 4-week treatment was administered. IIEF-5 and SF-36 surveys were given before and after each treatment period. Adverse effects were evaluated by interview. Friedman tests and Bonferroni-adjusted Wilcoxon signed-rank tests were used to compare groups and for post hoc analysis, respectively. Results. IIEF-5 and SF-36 scores were significantly improved by both sildenafil and vardenafil compared to pretreatment values. There were no differences between sildenafil and vardenafil with respect to the studied parameters. Adverse effect profiles were also similar. No patient dropped out because of side effects. Conclusions. Sildenafil and vardenafil caused similar improvements in ED and HRQoL in haemodialysis patients. Vardenafil was well tolerated in our patient population.
Erectile Dysfunction and the Effects of Sildenafil Treatment in Patients on Haemodialysis and Continuous Ambulatory Peritoneal Dialysis
(Oxford Univ Press, 2001) Türk, Süleyman; Karalezli, Giray; Tonbul, Halil Zeki; Yıldız, Mustafa; Altıntepe, Lütfullah; Yıldız, Alaattin; Yeksan, Mehdi
Background. Sexual dysfunction, including erectile dysfunction, is common in patients with uraemia. Despite successful treatment of male sexual dysfunction with sildenafil in non-uraemic population, its efficacy in dialysis patients is unknown. Patients and methods. In this study, 35 male HD patients (mean age 48 +/- 12 years) and 15 male CAPD patients (mean age 44 +/- 12 years) were included. In the baseline period, haemoglobin, serum urea, and albumin, Kt/V, several hormonal parameters, Beck depression scale, and penile Doppler blood flow, (peak systolic velocity after intracavernous papaverine administration) were measured. The international index of erectile function (IIEF) form was used to evaluate erectile dysfunction. Sildenafil was given to patients with erectile dysfunction at a dose of 50-100 mg/day twice a week. Results. The percentage of erectile dysfunction was similar between patients on HD (71%) and those on CAPD (80%). Patients with erectile dysfunction were significantly older and had lower free-testosterone serum levels and penile blood flow than those without. In linear regression analysis for baseline IIEF score, penile blood flow was the only independent variable associated with erectile dysfunction. IIEF score increased to a similar extent after sildenafil treatment in both HD patients (from 8.10 +/-5.54 to 21.70 +/-9.61, P <0.001) and CAPD patients (from 9.90 +/-3.87 to 21.60 +/- 10.18, P=0.011). Changes in IIEF scores after sildenafil treatment were associated with baseline penile blood flow as an independent variable by linear regression analysis. Adverse events observed during sildenafil treatment were dyspepsia in two patients and headache in one patient. Conclusion. The rate of erectile dysfunction is high in dialysis patients. Penile blood flow is the most important factor for predicting both the development of erectile dysfunction and the response to sildenafil therapy in such patients. Oral sildenafil is an effective, reliable, well-tolerated treatment for uraemic patients with erectile dysfunction.

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