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Öğe Ambulatory Blood Pressure Monitoring in Haemodialysis and Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients(Nature Publishing Group, 2002) Tonbul, Zeki; Altıntepe, Lütfullah; Sözlü, C.; Yeksan, M.; Yıldız, A.; Türk, S.The aim of this study was to compare the results of the 44-h ambulatory blood pressure monitoring (ABPM) data between haemodialysis (HDp) and CAPD patients and to investigate the relation of circadian rhythm in blood pressure (BP) with development of left ventricular hypertrophy. Twenty-two HDp (11 male, 11 female, mean age: 50 +/- 17 years) and 24 CAPDp (11 male, 13 female, mean age: 47 +/- 15 years) were included. Echocardiographic measurements and ABPM were performed in all study groups. ABPM of the first and second days were analysed separately and compared with CAPDp. Left ventricular hypertrophy was detected in 17 of the 22 HDp (77%) and 17 of the 24 CAPDp (71%). There was no significant differences between HD and CAPDp in respect to 44-h, daytime and night-time systolic and diastolic BP values. Although the course of BP in CAPDp was stable during the 44-h period, systolic and diastolic BP levels on the second day were significantly higher than those of on the first day in HDp (P < 0.001 for both). Daytime systolic and diastolic BP levels on the first day in HD group were recorded lower than those of the CAPD group. On the second day, night-time BP readings (both systolic and diastolic BP) were measured significantly higher in the HD group compared with the CAPD group. Twenty-one of the 24 (88%) CAPD patients were dippers, whereas only four of the 22 (18%) HDp were dippers (P < 0.001). Dipper patients had significantly lower left ventricular mass index (LVMI) than nondipper patients (131 +/- 29 g/m(2) vs 153 +/- 40 g/m(2), P = 0.03). In 44-h ABPM, there were no differences in daytime and night-time systolic and diastolic blood pressures between HD and CAPD patients. Non-dipper patients had increased LVMI as compared with dipper patients. Abnormalities in circadian rhythm of the blood pressure might be one of the implicated factors for development of left ventricular hypertrophy.Öğe 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, SüleymanObjectives: 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.Öğe 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, MehdiBackground. 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.Öğe Is there any association between serum iron and copper levels in hemadialysis patients?(2009) Sivrikaya, Abdullah; Menevşe, Esma; Tiftik, Ali Muhtar; Tonbul, ZekiÇalışmanın amacı, hemodiyaliz hastalarında serum demir (Fe), bakır (Cu) ve ferritin düzeylerindeki değişiklikleri tespit etmek ve ferritin düzeyleri ile elementler arasında bir ilişkinin olup olmadığını belirtmekti. Çalışmaya 2-16 yıldır diyalize giren (yaş ortalaması 50.2616.36) 47 hemodiyaliz hastası (hemodiyaliz grubu) ve 23 sağlıklı kişi (yaş ortalaması 39.52ill.54) (kontrol grubu) dâhil edildi. Hemodiyaliz grubunda kan numuneleri diyaliz öncesi ve sonrası alındı. Veriler, gruplar arasında serum Fe düzeyleri bakımından önemli bir fark bulunmadığını gösterdi. Ancak, diyaliz öncesi Cu düzeyleri ve de diyaliz öncesi ve sonrası ferritin düzeyleri kontrol grubuna göre daha yüksekti (sırasıyla p0.05, p0.001). Diyaliz öncesi ferritin-Fe (r 0.373, p0.05) ve Fe-Cu (r 0.410, p0.01) düzeyleri arasında önemli pozitif korelasyon bulundu. Bu çalışmadan elde edilen bulgular, serum Cu düzeylerindeki değişikliklerin hemodiyaliz hastalarında önemli olabileceğini düşündürmektedir. Bununla birlikte, Cu ve Fe arasındaki korelasyon bu elementler arasında bir ilişkinin olduğunu göstermektedir. Fe ile Cu arasındaki ilişkinin aydınlanması için daha ileri çalışmalara ihtiyaç vardır.Öğe Oxidative Stress Markers in Hemodialysis and Peritoneal Dialysis Patients, Including Coenzyme Q10 and Ischemia-Modified Albumin(WICHTIG EDITORE, 2012) Mehmetoğlu, İdris; Yerlikaya, F. Hümeyra; Kurban, Sevil; Erdem, S. Sami; Tonbul, ZekiObjectives: Oxidative stress results from an imbalance between the production of free radicals and antioxidant activity. There is wide agreement that patients undergoing regular dialysis treatment experience increased oxidative stress. The aim of this study was to investigate serum total antioxidant status (TAS), total oxidant status (TOS), ischemia-modified albumin (IMA), and coenzyme Q(10)(CoQ(10)) levels in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, compared with controls. Methods: This study was performed on 41 (21 men, 20 women) CAPD patients, 38 (20 men, 18 women) HD patients, and 43 (23 men, 20 women) healthy control subjects. CoQ(10) levels were standardized using blood lipids. Results: Serum TAS levels and CoQ(10)/total cholesterol values of the HD and CAPD patients were significantly lower, whereas serum IMA and TOS levels were significantly higher, than those of controls. Furthermore, CoQ(10)/LDL, CoQ(10)/triglycerides, and CoQ(10)/total cholesterol + triglycerides values of the CAPD patients were significantly lower than those of controls. No differences were found between serum IMA, TAS, TOS, CoQ(10) levels, and adjusted CoQ(10) values of the CAPD and HD patients. Conclusions: Our results suggest that oxidative stress is increased in HD and CAPD patients compared with controls, as proven by decreased TAS and adjusted CoQ(10) levels and increased TOS and IMA levels. Therefore, an antioxidant supplementation to these patients may be suggested.Öğe Plasma Fatty Acid Composition in Continuous Ambulatory Peritoneal Dialysis Patients: An Increased Omega-6/Omega-3 Ratio and Deficiency of Essential Fatty Acids(TAYLOR & FRANCIS LTD, 2011) Yerlikaya, Fatma Humeyra; Mehmetoglu, Idris; Kurban, Sevil; Tonbul, ZekiPatients with end-stage renal disease, including those treated with peritoneal dialysis, have a high risk for death, particularly from cardiovascular causes. Plasma fatty acid (FA) composition is used as an indicator of disease risk, because its alteration has been related to metabolic disease and cardiovascular disease. For this purpose, we have measured plasma FA composition in continuous ambulatory peritoneal dialysis (CAPD) patients and compared them with those of healthy subjects. This study was performed on 51 (21 M, 30 F) CAPD patients at least 6 months under dialysis, aged 20-75 years (mean 47.81 +/- 11.8 years) and 45 (25 M, 20 F) healthy control subjects aged 20-60 years (mean 38.62 +/- 12.9 years). Plasma 10-cis-pentadecanoic acid, 10-cis-heptadecanoic acid, heneicosanoic acid, tricosanoic acid, nervonic acid, saturated fatty acid, and monounsaturated FA levels and delta 9 desaturase activity were significantly higher whereas linoleic acid, linolenic acid, 11,14-eicosedienoic acid, arachidonic acid, docosahexaenoic acid, and omega-3 FA levels were significantly lower in the CAPD group than those in the healthy group. Our results show that there are FA abnormalities and especially a depletion in essential FA levels and a high level of omega-6/omega-3 ratio in CAPD patients, the underlying mechanism of which is not known and needs to be investigated. Therefore, we believe that essential FA supplementation should be encouraged for CAPD patients.
