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Öğe 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, 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/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.Öğe Disability, depression and quality of life among elderly hemodialysis patients(OXFORD UNIV PRESS, 2005) Altıntepe, Lütfullah; Levendoğlu, F; Turk, S; Ugurlu, H; Guney, I; Atalay, H; Tonbul, Halil Zeki[Abstract not Available]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 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 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, Yalçın; Atalay, Hüseyin; Türkmen, Kültigin; Altıntepe, LütfullahRationale/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 Epicardial Adipose Tissue and Coronary Artery Calcification in Diabetic and Nondiabetic End-Stage Renal Disease Patients(TAYLOR & FRANCIS LTD, 2011) Tonbul, Halil Zeki; Turkmen, Kultigin; Kayikcioglu, Hatice; Ozbek, Orhan; Kayrak, Mehmet; Biyik, ZeynepBackground/aims: Atherosclerosis, coronary artery calcification, diabetes mellitus, inflammation, endothelial dysfunction, and left ventricular hypertrophy are the most commonly encountered risk factors in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease (CAD) and EAT was shown in healthy subjects and patients with high risk of CAD. To date, there is not enough data about EAT in diabetic and nondiabetic ESRD patients. Therefore, we aimed to investigate the EAT and coronary artery calcification score (CACS) in diabetic and nondiabetic ESRD patients and healthy subjects. Methods: Sixty ESRD patients (17 diabetic, 43 nondiabetic ESRD patients) and 20 healthy subjects were enrolled in the study. EAT and CACS were performed by a 64-slice multidetector computed tomography scanner. Results: There were no differences in age, gender, body mass index, pre-dialysis systolic and diastolic blood pressure levels, biochemical parameters including serum low-density lipoprotein and high-density lipoprotein cholesterol, triglycerides, and C-reactive protein between healthy subjects, diabetic, and nondiabetic ESRD patients. Total CACSs and EAT measurements were significantly higher in diabetic ESRD patients when compared with nondiabetic ESRD patients and healthy subjects. There was statistically significant relationship between EAT and CACS in ESRD patients (p < 0.0001, r = 0.48). Conclusion: In conclusion, we found a significant increase in terms of EAT and CACS in diabetic ESRD patients when compared with nondiabetic ESRD patients and healthy subjects.Öğe 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, MehdiBackground. 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.Öğe Female sexual dysfunction in end stage renal disease and relation with quality of life and depression(OXFORD UNIV PRESS, 2007) Yazıcı, Raziye; Altıntepe, Lütfullah; Güney, İbrahim; Yeksan, Mehdi; Atalay, Hüseyin; Türk, Süleyman; Tonbul, Halil Zeki[Abstract not Available]Öğe Female Sexual Dysfunction in Peritoneal Dialysis and Hemodialysis Patients(TAYLOR & FRANCIS LTD, 2009) Yazıcı, Raziye; Altıntepe, Lütfullah; Güney, İbrahim; Yeksan, Mehdi; Atalay, Hüseyin; Türk, Süleyman; Tonbul, Halil 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 Frequency and Outcome of Patients With Acute Renal Failure Have More Causes Than One in Etiology(2000) Selçuk, Nedim Yılmaz; Odabaş, Ali Rıza; Çetinkaya, Ramazan; Tonbul, Halil Zeki; Şan, AylaIn literature, there was little data about frequency and outcome of ARF with two or more causes in etiology. Therefore, the aim of this study was to search this issue. This series included 339 patients with ARF from Jan 1, 1987 to Jan 1,1999. Fourty-six (30 males) of all patients (13.5%) had two or more causes in etiology of ARF. Of these patients, causes were prerenal and renal in 26 (56%), prerenal, renal and postrenal in 12 (26%), renal and postrenal in 4 (9%), and prerenal and postrenal in 4 (9%). The most frequent cause is diarrhea and vomiting in prerenal, gentamycin usage in renal and prostat hypertrophy in postrenal. Of these patients, there was oliguria in 32 (70%), anuria in 8 (17%) and non-oliguria in 6 (13%). Treatment modalities of patients was only medical in 19 (41%), dialysis in addition to medical therapy in 27 (59%). In spite of treatment, 5 (10.8) of patients with two or more causes in etiology died. Causes of death were uremic coma in 2, cardiac disorders in 2 and septic shock in 1. Three (11.2%) of other patients with one cause died. Mortality rates were not different (?2: 0.0298, p > 0.5). Cortical necrosis was diagnosed in one patient with multiple etiology and 2 of other patients. Finally, frequency of ARF with two or more etiologic causes was 13.5%, and most frequent causes were hypovolemia and nephrotoxic drugs. Outcome of these patients was similar to other patients with one cause.Öğe Health-Related Guality of Life, Sleep Guality, and Depression in Peritoneal Dialysis and Hemodialysis Patients(Wiley-Blackwell, 2012) Türkmen, Kültigin; Yazıcı, Raziye; Solak, Yalçın; Güney, İbrahim; Altıntepe, Lutfullah; Yeksan, Mehdi; Tonbul, Halil ZekiHealth-related quality of life (HRQoL) and sleep quality (SQ) were impaired in patients with end-stage renal disease (ESRD). The impairment of both HRQoL and SQ and being in a depressive mood were found to be associated with increased morbidity and mortality in dialysis patients. We aimed to investigate the association between SQ, HRQoL, and depression, and to define independent predictors of SQ and depression in peritoneal dialysis (PD) and hemodialysis (HD) patients. Ninety HD patients (41 females, 49 males with mean age 50 +/- 15.7 years) and 64 PD patients (27 females, 37 males with mean age 52.4 +/- 15.3 years) receiving renal replacement therapy for at least 3 months were screened for the assessment of SQ, HRQoL, and depression in this cross-sectional study. A modified postsleep inventory, Short Form of Medical Outcomes Study (SF-36) and Beck depression inventory (BDI) were applied to all patients for evaluating SQ, HRQoL, and depression, respectively. HD and PD patients had similar total SQ scores. Physical and mental component scale of HRQoL were found to be significantly higher in HD patients (p?Öğe Kronik Böbrek Hastalığında Vasküler Kalsifikasyon(2010) Türkmen, Kültigin; Tonbul, Halil ZekiSon dönem böbrek yetersizliği gelişen hastalarda en sık ölüm nedeni kardiyovasküler hastalıklardır. Diyaliz hastalarında görülen vasküler kalsifikasyon (VK) kardiyovasküler hastalıklar için bir risk faktörüdür. İleri yaş, diyaliz yeterliliği, D-vitamin tedavisi ve kalsiyum içeren fosfat bağlayıcılar VK için ek klinik risk faktörleridir. Bununla birlikte VK dinamik ve programlanmış bir süreçtir ve sadece pasif kalsiyum-fosfat depolanması ile açıklanamaz. Osteoprotegerin, nükleer faktör kappa-B reseptör aktivatörü (RANK) ve bu molekülün reseptörü (RANKL), monosit stimule edici faktör (M-CSF) ve transkripsiyon factor bağlayıcı protein (Cbfa-1) ile birlikte VK olayında önemli rol oynamaktadır. Buna karşılık Fetuin-A, matriks Gla protein ve osteopontin VK inhibisyonunda rol almaktadır. Tanıda multi dedektör bilgisayarlı tomografi (MDCT) veya elektron beam bilgisayarlı tomografi (EBCT) kullanılmaktadır.Öğe Lower erythropoietin and iron supplementation are required in hemodialysis patients with hepatitis C virus infection(DUSTRI-VERLAG DR KARL FEISTLE, 2004) Altıntepe, Lütfullah; Kurtoğlu, E; Tonbul, Halil Zeki; Yeksan, M; Yildiz, A; Turk, SBackground: Chronic hepatitis C virus (HCV) infection is a common infectious agent in chronic hemodialysis (HD) patients. In this prospective case-control study, we aimed to investigate the influence of chronic HCV infection on erythropoietin (EPO) and iron requirement in HD patients. Patients and methods: 49 HD patients (24 male, 25 female, mean age 47 +/- 15 years) were included. The mean time spent on dialysis was 39 +/- 38 months, and follow-up time was 1 year for this study. Biochemical analyses and complete blood counts together with iron status of the patients (transferrin saturation and serum ferritin levels) were measured monthly. Highly sensitive C-reactive protein (hs-CRP) levels were measured within 3-month intervals. Endogenous EPO levels were measured by enzyme-linked immunoassay 2 weeks after cessation of EPO treatment. Results: Eleven of the HD patients (22%) were anti-HCV(+). There was no difference in age, sex, time on dialysis, distribution of primary renal diseases, predialytic BUN, Kt/V, albumin and i-PTH levels between HCV(+) and (-) patients. Anti-HCV-positive patients required significantly lower weekly doses of EPO (87 +/- 25 IU/kg vs 129 +/- 11 IU/kg, p = 0.042) and iron (16.8 +/- 12.2 mg vs 32.6 +/- 16.1 mg, p = 0.02) replacement than anti-HCV(-) group; hs-CRP levels were similar between study groups. Serum endogenous EPO levels were significantly higher in HCV(+) patients than HCV(-) HD patients (9.43 +/- 6.47 mU/ml vs 3.59 +/- 2.08 mU/ml, p = 0.008). Conclusion: Anti-HCV(+) HD patients had higher serum EPO levels and required less EPO and iron replacement as compared to anti-HCV(-) patients. Because of the changes in iron metabolism, iron treatment should be carefully administered in HD patients with HCV.Öğe Malnutrition-inflammation-atherosclerosis (MIA) syndrome components in hemodialysis and peritoneal dialysis patients(TAYLOR & FRANCIS LTD, 2006) Tonbul, Halil Zeki; Demir, Murat; Altıntepe, Lütfullah; Güney, İbrahim; Yeter, Ekrem; Türk, Süleyman; 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 Mantar zehirlenmesinde hemoperfüzyon ve plazmaferezin birlikte kullanımı (olgu sunumu)(2009) Atalay, Hüseyin; Güney, İbrahim; Altıntepe, Lütfullah; Çiftçi, Elif; Tonbul, Halil ZekiAmaç: Ülkemizde zehirli mantarların yenmesi sonucu ölüm oranı çok yüksektir. Tedavide hemoperfüzyon ve plazmaferezin birlikte kullanımı konusunda yeterli veri yoktur. Olgu sunumu: Yirmidört yaşında, geçmişinde her hangi bir rahatsızlığı olmayan ve ilaç kullanmayan hasta, yedi gün önce mantar yeme hikayesi ve bulantı, kusma, tüm vücutta ve gözlerinde sararma, bilinç bulanıklığı şikayetleriyle acil servisimize başvurdu. Hasta mantar zehirlenmesine bağlı akut böbrek yetmezliği ve karaciğer yetmezliği olarak değerlendirildi. Hastaya bir kez hemoperfüzyon ve beş kez plazmaferez, taze donmuş plazma desteği ile yapıldı. Sonuç: Mantar zehirlenmesi yüksek mortalitesinden dolayı, hemoperfüzyon ve plazmaferez tedavisi şansının, bu hastalar için göz ardı edilmemesi gerektiği düşüncesindeyiz.Öğe Paid living-unrelated renal transplantation abroad: Too much unknown(2012) Solak, Yalçın; Türkmen, Kültigin; Güney , İbrahim; Erikoğlu, Mehmet; Tonbul, Halil Zeki; Türk, SüleymanOBJECTIVE: Despite the unethical characteristic and unfavorable consequences, paid living-unrelated renal transplantation is still considered as an option for end-stage renal disease patients. This study aimed to compare the medical and surgical complications along with allograft functions of PLURT patients with age and gender matched transplant recipients who received a living or deceased donor kidney at our center. MATERIAL and METHODS: End-stage renal disease patients received PLURT (group 1) in a foreign country and age, and gender matched renal transplant recipients that received renal transplantation from living-related donors (LRT patients; group 2) and deceased donors (DDRT patients; group 3) followed between 2003-2010 at our transplantation center were included in the study. RESULTS: There were no significant differences between groups (Group 1&2 and group 1&3) regarding age, sex, urea, creatinine, creatinine clearance, and proteinuria. Data about patients that received renal transplantation from living-related and deceased-donors at our center were sufficient when compared with PLURT patients. PLURT has a negative impact on patients' survival because of surgical and medical problems. CONCLUSION: In the present study, PLURT, LRT and DDRT patients had early and late complications of renal transplantation which were similarly seen in recent studies. The main problem for unfavorable results of PLURT is the commercial aspect of renal transplantation without considering the risks for ESRD patients.Öğe PERI-AORTIC FAT TISSUE THICKNESS IN PERITONEAL DIALYSIS PATIENTS(MULTIMED INC, 2013) Turkmen, Kultigin; Ozbek, Orhan; Kayrak, Mehmet; Samur, Cigdem; Guler, Ibrahim; Tonbul, Halil ZekiBackground: Thoracic peri-aortic fat tissue (PFT) and epicardial adipose tissue (EAT) are metabolically active visceral fat deposits surrounding the thoracic aorta and the heart, respectively. Various studies have demonstrated a positive predictive value of both PFT and EAT for coronary artery disease in the general population. In the present study, we aimed to investigate PFT thickness and the independent predictors of PFT in peritoneal dialysis (PD) patients. Methods: Our cross-sectional study enrolled 35 PD patients (10 women, 25 men) and 30 age-and-sex-matched healthy subjects (15 women, 15 men). We measured PFT, thoracic artery calcification (TAC), EAT, and coronary artery calcification (CAC) by electrocardiogram-gated 64-multi-detector computed tomography. Results: The measured PFT, EAT, CAC, and TAC were significantly higher in the PD group than in the healthy subjects (p < 0.05 each). In the PD group, PFT and TAC were significantly correlated (r = 0.33, p = 0.007). Also, PFT measurements were positively correlated with EAT and total CAC in the PD and the control group alike (r = 0.58, p = 0.001 and r = 0.54, p = 0.01 respectively). A stepwise linear regression analysis revealed that age, duration of hypertension, and being a PD patient were independent predictors of PFT. Conclusions: Measured PFT was higher in PD patients than in healthy subjects and, in the PD population, was also shown to be related to calcification scores and EAT.Öğe Periton Diyaliz Hastalarında Kemik Mineral Dansitometresi ile Damar Kireçlenmesi (Vasküler Kalsifikasyon) Arasındaki İlişki(2012) Türkmen, Kültigin; Erdur, Fatih Mehmet; Özbek, Orhan; Kayıkçıoğlu, Hatice; Sağlam, Mustafa; Tonbul, Halil ZekiOBJECTIVE: Vascular calcifi cation (VC) and disturbed bone mineral metabolism (BMM) are commonly seen in patients with end-stage renal disease (ESRD). Fetuin-A has been found to be signifi cantly low in ESRD patients. The aim of our study was to investigate the relation between coronary artery calcifi cation, BMM and fetuin-A in peritoneal dialysis (PD) patients. MATERIAL and METHODS: 46 PD (M/F=28/18) patients were included in the study. Coronary artery calcifi cation scoring (CACS) was performed by multi slice computed tomography. The patients were divided into 4 groups according to their CACS values as Group 1 (CACS: 0), Group 2 (CACS:1- 99), Group 3 (CACS:100-399) and Group 4 (CACS: ?400). Serum levels of fetuin-A were measured. Bone mineral densitometry was measured by dual energy X-ray absorptiometer (DEXA). RESULTS: There was a statistically signifi cant difference difference between CACS and femur T scores in PD patients. Femur T scores were found to be decreased while CACS values are increased. We could not fi nd any differences in terms of CACS when we separated patients according to T scores greater or lower than -2. Osteopenic patients were found to be older and they also had low fetuin-A levels. CONCLUSION: We found an important relationship between CACS and bone mineralization in PD patients.Öğe Physical disability, psychological status, and health-related quality of life in older hemodialysis patients and age-matched controls(2006) Altıntepe, Lütfullah; Levendoğlu, Funda; Okudan, Nilsel; Güney, İbrahim; Çilli, Ali Savaş; Uğurlu, Hatice; Tonbul, Halil ZekiWe aimed at comparing the elderly adults and normal subjects with regard to their disability, psychological status, and quality of life (QOL). One hundred and twenty-five dialysis patients and 61 controls were recruited in the study. Depression and anxiety symptoms of the patients were evaluated with the Psychological Symptom Screening List (SCL 90-R). For evaluating the disability, the Rivermead mobility index (RMI) was utilized. For evaluating the QOL, we used the short form-36 (SF-36) scale. The Rivermead mobility index of the patients (9.6±3.4) was found. When compared with controls, dialysis patients had higher levels of disability (p=0.0001). Depression and anxiety symptom scores of these patients were also significantly higher than that of the controls (p<0.05). There was a correlation between the disability and depression symptom scores (r: 0.171, p=0.037). Both physical and mental capacity scores of the dialysis patients were lower than those of the controls (p<0.05 and p<0.05) QOL scores for elderly hemodialysis patients were found to be lower. Their disability was higher, making them dependable on others during their daily lives. Specific exercise programs should be developed for these patients. Even the smallest effort in this regard will result in improvements in physical functioning while bringing them significant benefits. © 2006 International Society for Hemodialysis.Öğe Quality of life in male hemodialysis patients - Role of erectile dysfunction(KARGER, 2004) Turk, S; Guney, I; Altıntepe, Lütfullah; Tonbul, Halil Zeki; Yildiz, A; Yeksan, MBackground: Health-related quality of life (QOL) is affected in hemodialysis patients (HD). A number of factors such as age, anemia, and comorbidity had been implicated in decreased QOL. Erectile dysfunction (ED) is a frequent and potentially treatable complication in HD patients. In this cross-sectional study, we aimed to evaluate the possible relation between the QOL and ED in HD patients. Patients and Methods: Among the 511 chronic HD patients dialyzed in 11 outpatient HD centers, 148 male patients (mean age: 46 +/- 9 years) were included. The mean time on dialysis was 41 +/- 35 months (range: 3-203 months). Biochemical parameters such as BUN, creatinine, hemoglobin, serum albumin and Kt/V were measured. The QOL of the patients were measured with the short form of Medical Outcomes Study (SF-36), physical component scores (PCS) and mental component scores (MCS) were calculated. The ED was evaluated by the International Index of Erectile Function (IIEF). Results: One hundred and four of the 148 patients (70%) had ED. Hemoglobin levels were correlated with PCS (r = 0.197, p = 0.02) and MCS (r = 0.20, p = 0.019). Patients with ED had lower scores in nearly all the components related to PCS and MCS as compared to patients without ED. IIEF score was correlated with PCS (r = 0.369, p < 0.001) and MCS (r = 0.308, p < 0.001). In linear regression analysis, IIEF score and hemoglobin levels were the independent variables that predicted both PCM and MCS. Conclusion: ED, a frequent complication in HD patients, was related to QOL together with anemia. Successful treatment of ED and anemia may lead to improvement in QOL in HD patients. Copyright (C) 2004 S. Karger AG, Basel.