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Öğe Are the Beck depression inventory score, SF 36 score and progression of the disease changing with education in chronic kidney disease patients(2018) Yavuz, Yasemin CoşkunAim: Patient education is important for patients with predialysis chronic renal disease (CKD)because it can delay the progression of the disease to end-stage renal failure.Anxiety and depression may also contribute to the progression of the disease in patients with CKD. We evaluated the influences of education on progression ofCKD, the Short Form 36 Health Survey (SF36), and the Beck Depression Inventory (BDI) in predialysis CKD patients.Material and Methods: 121 patients with nondialysis stage 2-5 CKD were involved in this study. At the start of the study, the SF36 and BDI scoring were performed in all patients and their creatinine clearances were calculated. 31 patients were given education on CKD by the dialysis specialist nurse once a month. At the end of the sixth month, SF36 and BDI were rescored, and their creatinine clearances were recalculated.Results: There were no significant differences between the two groups regarding age, gender, creatinine clearance, and duration of chronic kidney disease. At the end of the sixth month, when the educated and uneducated patients were compared, while the increase of the creatinine level was significant in the two groups, the SF36 and BDI scores were found to be improved significantly in the study group.Conclusion: The results of this study suggested that patient education may improve the SF36 and BDI scores, but it does not affect the progression of the disease for at least six months in duration.Öğe Association of depressive symptoms with 25(OH) vitamin D in hemodialysis patients and effect of gender(SPRINGER, 2020) Yavuz, Yasemin Coşkun; Bıyık, Zeynep; Özkul, Durmuş; Abuşoğlu, Sedat; Eryavuz, Duygu; Dağ, Mikail; Körez, Muslu Kazım; Güney, İbrahim; Altıntepe, LütfullahBackground Depression is common in chronic kidney disease ( CKD) patients and associated with significant increase in morbidity and mortality. In recent years, a relationship between vitamin D deficiency and depression has been shown. The aim of this study is to investigate the relationship between 25-hydroxy (OH) vitamin D and depression in hemodialysis patients. Methods A total of 140 patients were included in the study. Hamilton depression scale (HAM-D) was completed by all patients. 25(OH) vitamin D levels were compared between patients with and without depressive symptoms. Results Patients who had depressive symptoms had significantly lower 25(OH) vitamin D levels (13.70 [24.3-8.25] vs. 18.20 [29.2-11.7] ng/mL, p = 0.016). HAM-D score showed significant association with gender (p = 0.011) and 25(OH) vitamin D level (p = 0.011). Univariate logistic regression analysis showed that males had lower risk of depression by a ratio of 61.1% (OR 0.389, p = 0.012) and vitamin D-deficient patients had 2.88 times greater risk of depression compared to non-deficient patients (OR 2.885, p = 0.013). Multivariate logistic regression analysis showed that males had 53.7% less risk of depression (OR 0.463, p = 0.046) and vitamin D-deficient patients had 2.39 times greater risk of depression (OR 2.397, p = 0.047). When evaluated by gender, univariate logistic regression analysis showed that 25(OH) vitamin D and other variables were not associated with depression in females (p > 0.05), while only vitamin D level had a significant effect on depression in males (OR 8.207, p = 0.008). Conclusions We found a significant association between vitamin D level and depressive symptoms in hemodialysis patients. When analyzed according to gender, this association was found to stand independent of other variables only in males.Öğe Elevated Serum Uric Acid to HDL-Cholesterol Ratio is Related to Cardiovascular Risk in Patients Receiving Hemodialysis(Selçuk Üniversitesi, 2022) Göktepe, Mevlut Hakan; Çizmecioğlu, Ahmet; Bıyık, Zeynep; Altıntepe, Lütfullah; Yavuz, Yasemin Coşkun; Çizmecioğlu, Hilal AkayAim: Chronic kidney disease (CKD) is a progressive disease in which frequent cardiovascular (CV) comorbidities. High uric acid to HDL-cholesterol ratio (UHR) results were quite notable in patients receiving peritoneal dialysis. Thus, in this study, we aimed to evaluate the UHR results in dialysis patients. Materials and Methods: This retrospective, multicenter, cross-sectional study was conducted with CKD patients, and the control group consisted of hypertensive patients with a normal glomerular filtration rate (GFR). Patients’ laboratory, ambulatory blood pressure monitoring, and demographic records were obtained from the follow-up cases of two university hospitals’ internal medicine and nephrology departments. The patients’ group then were divided into five subsets according to GFR. Results: A total of 124 CKD patients and 127 control participated in this study. All CKD patients were also identified as pre-dialysis and dialysis. The cases of UHR, non-dipper blood pressure pattern, and nocturnal heart rate (HR) were increased in CKD compared to the control group. Per disease progression, the non-dipper HR and nocturnal HR were more significant in patients receiving dialysis with high UHR than in the pre-dialysis subset. In diabetic patients with an on-targeted HbA1c, those with high UHRs still had nocturnal diastolic BP elevations. Finally, there was not an exact stagespecific result for pulse wave velocity. Conclusions: Based on our results, dialysis patients with high UHRs have higher non-dipper pulse rate, nocturnal heart rate, and nocturnal diastole blood pressure, associated with CV risk. Despite well-managed diabetes, elevated UHR in dialysis patients may be associated with non-dipper hypertension.Öğe Hemodiyalizde arteriyovenöz fistül akım hızını değerlendiren bazı testlerin güvenilirliğinin tayini(Selçuk Üniversitesi Tıp Fakültesi, 2010) Yavuz, Yasemin Coşkun; Selçuk, N. YılmazHemodiyalize giren hastalarda vaskuler arteriovenöz fistül fonksiyonunu en doğru gösteren yöntemlerden birisi Doppler ultrason (USG) ile akım hızının ölçümüdür. Amacımız arteriyovenöz fistüllü hemodiyaliz hastalarında vasküler akses akımının ölçümünde Glukoz pompa infüzyon testinin doppler USG tekniği ile karşılaştırılması ve güvenilirliğininin tayin edilmesi, statik basınç ölçümleri ile birlikte değerlendirilmesidir. Gereç ve yöntem: Çalışmaya Konya il merkezinde AV fistülden hemodiyalize giren 93 hasta alındı. Fistül akım hızını ölçmek için hastanın hemodiyalize girmediği günlerden birinde Doppler USG çalışması ve GPT testi yapıldı. GPT testi farklı zamanlarda her hastada 3 kez hemodiyaliz başlamadan hemen önce yapıldı ve ortalamaları alındı. Tüm hastalarda vasküler akses takip metodlarından bir diğeri olan statik akses basınç ölçümleri de yapıldı. GPT ve Doppler USG ile ölçülen akses akımları karşılaştırıldı ve bu 2 yöntemin statik basınç ölçümleri ile ilişkisi değerlendirildi. Veriler SPSS 13.0 bilgisayar programına girildi. Normal dağılıma uyan verilerde Student-t testi kullanıldı. Normal dağılımauymayan verilerin analizinde Mann-Whitney U testi kullanıldı. Kategorik verilerin karşılaştırılmasında Ki-Kare testi kullanıldı. Veriler arası ilişkiler Pearson korelasyon analizi ile değerlendirildi. Bulgular: Vasküler akses akım ölçüm yöntemlerinden olan Doppler USG sonuçları ile Glukoz pompa testi bulguları karşılaştırıldı. Her iki yöntemle tespit edilen akses akım hızı ortalamaları farklı değildi (t: -0,257, p> 0,05). İki yöntemin birbiriyle korelasyonu da iyi idi (r: 0,49; p< 0,001). Güven aralığı (CI) 0,80- 4,45, odds ratio 1,89 idi. Vasküler giriş yolu akımı normal değeri 400- 1000 ml/dk alındığında sensitivitesi %62, spesifitesi %53 idi. Statik basınç oranları hastaların %78' inde vasküler stenozu gösteriyordu. Oysaki fizik muayene ve Doppler USG ilestenoz tespit edilmedi. Hastaların %87'sinde Kt/V? 1,2 idi. Ayrıca GPT ve doppler USG ile ölçülen akses akımları, hastaların cinsiyetlerinin, diyabetin, Kt/V' nin ve anevrizmanın etkilemediği tespit edildi (p> 0,05). Doppler USG ve Glukoz pompa testi ile ölçülen akses akım hızlarının statik basınç arteryel ve venöz oranları arasında iyi bir korelasyon yoktu. Statik basınç oranlarına göre stenozu olan hastalarda akses akımı anlamlı değişiklik göstermiyordu (p>0.05). Sonuç: Hemodiyalize giren hastalarda AV fistül fonksiyonu takip yöntemi olarak kullanılan doppler USG ile AV fistül akım hızı ölçümü yerine ucuz, kolay uygulanabilir, operatör bağımlı olmayan bir test olan Glukoz pompa infüzyon tekniğinin kullanılabileceği fakat statik basınç oranlarının AV fistül fonksiyonunu takipte başarıyla kullanılamayacağı sonucuna varılmıştır.Öğe Nondipping heart rate and associated factors in patients with chronic kidney disease(SPRINGER, 2019) Bıyık, Zeynep; Yavuz, Yasemin Coşkun; Altıntepe, Lütfullah; Çelik, Gülperi; Güney, İbrahim; Oktar, Sevil FişekciBackground Nondipping heart rate (NHR) is a condition reported to be associated with cardiovascular events and cardiovascular mortality recently. We aimed to search whether there is difference among hypertensive patients with and without chronic kidney disease (CKD) in terms of NHR pattern and the factors associated with NHR in patients with CKD. Methods The study included 133 hypertensive patients with normal kidney functions, 97 hypertensive patients with predialysis CKD, and 31 hypertensive hemodialysis patients. Heart rate, blood pressure and pulse wave velocity (PWV) were measured by 24-h ambulatory blood pressure monitorization. NHR was defined as a decrease of less than 10% at night mean heart rate when compared with daytime values. Results NHR pattern was established as 26.3% in non-CKD hypertensive group, 43.3% in predialysis group and 77.4% in dialysis group. Among patients with CKD, when NHR group was compared with dipper heart rate group, it was seen that they were at older age, there were higher prevalence of diabetes mellitus and more female sex, and while the value of urea, creatinine, phosphorus, intact parathyroid hormone, and PWV were significantly higher, the value of hemoglobin, albumin and calcium were significantly lower. By multivariate analysis, hemoglobin [odds ratio (OR) 0.661; 95% CI 0.541-0.806; p < 0.001] and PWV (OR 1.433; 95% CI 1.107-1.853; p = 0.006) were established as independent determinants of NHR pattern. Conclusions NHR pattern is significantly more frequently seen in hypertensive CKD patients than in hypertensive patients with non-CKD. Anemia and increased arterial stiffness are seen independently associated with NHR in CKD patients.
