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    Bioimpedance and echocardiography used interchangeably in volume comparison of dialysis patients
    (Lithographia, 2012) Hur, E.; Yildiz, G.; Kose, Budak S.; Kokturk, F.; Musayev, O.; Gungor, O.; Magden, K.; Yildirim, I; Duman, S.; Ok, E.
    Background: Euvolemia is a major issue in chronic kidney disease. The present study compares cardiac condition and volume status in peritoneal dialysis (PD) and hemodialysis (HD) patients and points out importance of volume control. Methods: From a single-center center, 81 PD and 89 HD patients were enrolled. Echocardiography and body composition analysis using bioimpedance spectroscopy (BIS) technique were performed. Overhydration (OH) and extracellular water (ECW) in liters and OH/ECW % were used as volume indices. Results: Patients were younger (47.6 +/- 14. 5 and 53.1 +/- 11.8 years, p< 0.05), daily urine volume higher (1068 +/- 926 vs 290 +/- 444 ml, p <0.001) and dialysis vintage was shorter (30.1 +/- 18.6 vs 53.6 +/- 35.4 months, p<0.001), systolic blood pressure was lower (127.5 +/- 15.4 vs 140.3 +/- 18.9 mmHg, p<0.001) in PD than HD group respectively. Volume indices were (OH, OH/ECW %, ECW/height, ECW to Intracellular Water ratios (E/I) (p< 0.05)) significantly higher in HD patients compared to PD patients. Over all 66 of 170 patients (39%) had OH/ECW % <5 and OH/ECW % ratio was positively correlated with Left atrium index (R-2:0.105, p<0.05). Interventricular septum diameter and Left ventricular mass index (1.41 +/- 0.24 and 159.6 +/- 48.2 vs. 1.27 +/- 0.17 cm and 115.8 +/- 37 g/m(2), p<0.001) were increased in HD than in PD group. After multivariate adjustment OH/ECW increased with: HD and diabetic patients. LVH increased with: HD group, OH/ECW (%) and SBP significantly. Conclusion: Overhydration was more common among HD. Excess fluid may lead adverse effect in organ functions especially cardiac condition. This indicates that the current clinical and technical tools to achieve euvolemia are insufficient and that an additional tool, such as BIS, could be useful in the diagnosis of overhydration.
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    The effect of immunosuppressive treatment on arterial stiffness and matrix Gla protein levels in renal transplant recipients
    (Dustri-Verlag Dr Karl Feistle, 2011) Gungor, O.; Kircelli, F.; Carrero, J. J.; Hur, E.; Demirci, M. S.; Asci, G.; Toz, H.
    Introduction: Arterial stiffness is a risk marker for cardiovascular events. In this study we aimed to compare the effect on calcineurin inhibitors (CNI) and mammalian Target of Rapamycine inhibitors (mTORi) on arterial stiffness in renal transplant patients. Patients and methods: 81 renal transplant patients under CNI-based or mTORi-based protocol for at least 6 months were included in the study. Arterial stiffness was measured by using the SphygmoCor device (AtCor Medical, Sydney, Australia). Vitamin K-dependent, calcification inhibitor matrix Gla protein (MGP) concentrations were quantified by ELISA methods (Biomedica, Vienna, Austria). Results: 34 patients were on mTORi-based and 47 on CNI-based immunosuppression. Mean age was 37.9 +/- 10.8 (18 - 71) years and 45% were female. Age, gender, graft functions and follow-up period of the groups were similar. Augmentation index was 15.2 +/- 12.6% in CNI and 18.8 +/- 14.0% in mTORi groups (p > 0.05). There was no difference regarding carotid-femoral pulse wave velocity between groups. Arterial stiffness was positively correlated with age, total cholesterol, LDL cholesterol, mean arterial pressure (MAP) and proteinuria. MGP levels were higher in the mTORi group but were not predictors for carotid-femoral pulse wave velocity. Conclusion: Rather than specific immunosuppressive drug effects, conventional risk factors, blood pressure and proteinuria are the most important predictors for arterial stiffness in renal transplant patients.
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    Plasmapheresis Therapy in Renal Transplant Patients: Five-Year Experience
    (Elsevier Science Inc, 2011) Gungor, O.; Sen, S.; Kircelli, F.; Yilmaz, M.; Sarsik, B.; Ozkahya, M.; Hoscoskun, C.; Ok, E.; Toz, H.
    Introduction. Plasma exchange (PE) and double-filtration plasmapheresis (DFPP) have been used successfully in renal transplant patients as well as those with various other diseases over the last decade. In this retrospective study, we sought to explore the outcomes of plasmapheresis in renal transplant patients. Patients and methods. We investigated 58 patients who received PE or DFPP therapy between 2005 and 2010. PE was performed using a Fresenius AS.TEC 204 device and DFPP, by an INFOMED HF 440 device. Indications for therapy, biopsy findings, number of PE/DFPP sessions, laboratory data, medications, complications as well as graft and patient survivals were recorded. Results. Overall mean age of subjects was 34.1 +/- 8.8 years and 55% were female. Sixteen patients underwent 95 DFPP sessions and 42 underwent 215 PE sessions. Indications for therapy were acute humoral rejection (n = 39), recurrent focal segmental glomerulosclerosis (FSGS; n = 8), thrombotic microangiopathy (n = 6), and chronic humoral rejection (n = 5). Responses to therapy were 24/39 for acute humoral rejection, 1/5 for chronic rejection, 4/8 for FSGS, and 3/6 for thrombotic microangiography. No complication was observed in any patient. Conclusion. PE/DFPP is a safe and succesful method for treatment of acute humaral rejection as less so for recurrent FSGS and thrombotic microangiopathy. The outcomes among subjects with chronic humoral rejection were not satisfactory.
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    Trimethylaminuria (fish malodour syndrome) in chronic renal failure
    (Lithographia, 2012) Hur, E.; Gungor, O.; Bozkurt, D.; Bozgul, S. M. K.; Dusunur, F.; Caliskan, H.; Berdeli, A.; Akcicek, F.; Basci, A.; Duman, S.
    Trimethylaminuria (fish malodour syndrome) is a rare genetic metabolic disorder presented with a body odour which smells like a decaying fish. This odour is highly objectionable, that can be destructive for the social, and work life of the patient. Trimethylamine is derived from the intestinal bacterial degradation of foods that are rich of choline and carnitine. Trimethylamine is normally oxidised by the liver to odourless trimethylamine N-oxide which is excreted in the urine, so, uremia may worsen the condition. Uremia itself may cause more or less unpleasant odour. Poor uremic control may worsen the odour. We reported this case because Trimethylaminuria is not usually considered in the differential diagnosis of malodour in chronic renal failure and it is the first case that shown the association with Trimethylaminuria and chronic renal failure in the literature. Hippokratia. 2012; 16 (1): 83-85