İnce, Hasan; Yılmaz, Zülfükar; Karabulut, Aziz; Aydın, Emre; Yıldırım, Yaşar; Kara, Ali Veysel; Kadiroğlu, Ali Kemal; Aydın, Fatma Yılmaz

Purpose: Chronic kidney disease (CKD) is a global public health issue, often associated with high mortality and morbidity, especially due to cardiovascular diseases. Epicardial adipose tissue (EAT), the visceral fat surrounding the heart, has been recognized as a significant factor in cardiovascular risk. This study aims to assess the relationship between EAT and body composition in patients with stage 4 and 5 CKD using bioelectrical impedance analysis (BIA). Methods: The study included 80 patients with stage 4 and 5 CKD who were not on dialysis. Body composition was measured using BIA, and EAT was assessed using transthoracic echocardiography(ECHO). Exclusion criteria included heart failure, morbid obesity, pregnancy, and pacemaker use, among others. Various demographic, clinical, and biochemical parameters were also recorded. Results: Patients with stage 5 CKD (6.7 ± 0.12) had significantly higher EAT compared to stage 4 CKD (5.9 ± 0.09) patients. EAT showed a positive correlation with age, BMI, blood pressure, C-reactive protein (CRP), and triglyceride levels, and a negative correlation with albumin and HDL levels. Multivariate analysis revealed that increased systolic blood pressure(SBP)(p:0.019),fat tissue mass (FTM)(p < 0.001), low HDL(p: 0.027), and low albumin(p < 0.001) were independent predictors of EAT. Conclusion: EAT is higher in advanced CKD patients and is associated with several cardiovascular risk factors. Measuring EAT in CKD patients using non-invasive methods like ECHO could be valuable in predicting cardiovascular risks. Addressing the factors that contribute to increased EAT may improve clinical outcomes for CKD patients.

Baloglu, Ismail; Turkmen, Kultigin; Kocyigit, Ismail; Altunoren, Orcun; Demirtas, Levent; Zararsız, Gokmen; Eroglu, Eray

Purpose: Because of the increase in globalization, clinicians all over the world are confronted the questions about safety of Ramadan fasting. However, there is no clear information about whether there is an obstacle for fasting patients with chronic disease. Hence, in the present study, we aimed to investigate the effects of Ramadan fasting on kidney and the factors affecting this relationship in patients with chronic kidney disease. Methods: This study involving 117 patients [36 females, 81 males; mean age, 60 (46.0–70.0) years] with stage 2–3 chronic kidney and fasting. Patients were evaluated every 10 days for acute kidney injury (AKI) in Ramadan month. And, patients with acute kidney injury and patients without AKI were grouped. Results: When the patients were evaluated for AKI, we observed that in 27 patients had acute kidney injury. While patients without AKI fasted for more days (p < 0.001), urea levels and frequency of hypertension were higher in the group with AKI (p = 0.019; p = 0.025 respectively). We also performed univariate and multiple binary logistic regression analysis to identify the risk factors of AKI. Hypertension and number of fasting day were found to be predictive of AKI (p = 0.02; p < 0.001 respectively). Conclusions: We found a significant relationship between hypertension, the number of fasting days and acute kidney injury. Patients with chronic kidney damage and hypertension should be evaluated more carefully, informed about the importance of hydration after fasting and should be followed frequently for AKI.

Kara, Ali Veysel; Soylu, Yasin Emrah

Purpose: The aim of this study was to investigate the relationship between vitamin D and novel inflammatory markers in hemodialysis patients. Methods: In total, 129 eligible maintenance hemodialysis patients were enrolled in this cross-sectional study. Patients were divided into two groups according to their serum vitamin D levels. A serum 25-hydroxyvitamin D (25(OH)D) level < 20 ng/ml was identified as vitamin D deficiency and a serum level ≥ 20 ng/ml was identified as normal. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated from the complete blood cell count. Spearman correlation analysis and both logistic and linear regression analyses were used to define the relationships between the study parameters. Results: The two groups showed statistically significant differences for gender and for C-reactive protein (CRP) and NLR values (p = 0.017, p = 0.010, and p = 0.013). Age and gender were independently associated with vitamin D deficiency (p = 0.003 and p = 0.030). Serum 25(OH)D levels showed significant but weak inverse correlations with CRP (r = − 0.205, p = 0.020) and with NLR (r = − 0.219, p = 0.013). Serum 25(OH)D levels also showed a significant but very weak correlation with PLR (r = − 0.182, p = 0.039). Serum 25(OH)D levels showed no correlation with mean platelet volume (p = 0.660). Gender was the only variable significantly associated with serum vitamin D levels, as determined by linear regression analysis (p = 0.003). Conclusion: CRP levels and NLR values were significantly higher in the vitamin D deficiency group. A significant inverse correlation was found between serum vitamin D levels and CRP levels, and NLR and PLR values.

Demirtas, Levent; Turkmen, Kultigin; Buyuklu, Mutlu; Kocyigit, Ismail; Orscelik, Ozcan

Introduction: Left atrium (LA) mechanical functions and atrial electromechanical delay (AEMD) times were considered independent predictors of cardiovascular morbidity in general population. Data are scant about these parameters in end-stage renal disease (ESRD) patients receiving hemodialysis (HD) and peritoneal dialysis (PD). We aimed to evaluate AEMD times and LA mechanical functions and associated risk factors in HD and PD patients. Methods: Forty-four healthy individuals, 62 HD and 50 PD patients were enrolled in the study. Echocardiography was performed before midweek dialysis session for HD patients and on admission for PD patients. Data were expressed as mean ± SD. Spearman’s test was used to assess linear associations. Predictors of left intra-atrial EMD time and LA active emptying volume (LAaeV) were assessed by regression analysis. Results: Left intra-atrial-AEMD times were significantly longer in HD patients compared to PD patients. LAaeV was positively correlated with inter-atrial time, left intra-atrial time, systolic and diastolic BP, calcium and neutrophil-to-lymphocyte ratio (NLR) (r 0.22, p 0.016; r 0.28, p 0.002; r 0.34, p < 0.001; r 0.35, p < 0.001; r 0.37, p < 0.001; r 0.46, p < 0.001, respectively) and negatively correlated with serum uric acid (r −0.31, p 0.013) in ESRD patients. We found positive correlations between left intra-atrial time and LAaeV, LAVmax, LAVp and NLR (r 0.28, p 0.002; r 0.27, p 0.003; r 0.27, p 0.003; r 0.22, p 0.03, respectively) and negative correlations with albumin, uric acid and potassium (r −0.24, p 0.008; r −0.19, p 0.04; r −0.26, p 0.037, respectively). Advanced age, decreased serum albumin and increased NLR were found to be independent predictors of LAaeV; however, only NLR was found to be an independent predictor of AEMD time in this population. Conclusions: Increased inflammation might be a risk factor of AEMD and LA mechanical dysfunction in ESRD patients.

Akin, Yigit; Yucel, Selcuk; Baykara, Mehmet

Behcet's disease (BD) is a rare chronic, relapsing, multisystemic disorder characterized by mucocutaneous, ocular, vascular and central nervous system manifestations. However, the etiopathogenesis of the disease remains unknown, and diagnosis is basically dependent on clinical manifestations. Sometimes BD may be diagnosed with rare clinical entities. Herein, we presented an extremely rare case of urethrovaginal fistula which has been diagnosed as manifestation of BD. After surgical treatment of fistula, there was no complication in 6 months following surgical repair and the follow-up period has been going on.

Akin, Yigit; Gulmez, Hakan; Ucar, Murat; Yucel, Selcuk

Purpose To investigate if effects of the first single dose of tamsulosin 0.4 mg on uroflowmetry parameters would predict treatment response at the third month. Methods Men over 40 years old with complaints of lower urinary tract symptoms associated with benign prostatic hyperplasia were studied with physical examination, urine and blood analysis, uroflowmetry (UFM), post-voiding residual urine volume (PVR), international prostate symptom score (IPSS), qualityof- life (QoL) index and transrectal prostate ultrasonography (TRUS), and patients with prostate cancer suspicion, past urinary surgery, urinary tract infection and neurologic diseases were excluded. UFM, PVR, IPSS, QoL were repeated at 6th hour of the first day, first month and third month of oral tamsulosin 0.4 mg treatment. All parameters were recorded as baseline, and changes in the UFM parameters, PVR, IPSS and QoL were evaluated in clinical visits. Results As a total, 48men (mean 60.17 ± 1.18 years) were recruited. There was a significant increase in maximumurine flow rate (Q max) and average urine flow rate (Qave) and decrease in PVR from baseline with the first dose of tamsulosin as well as first and third month of treatment (p<0.05). IPSS andQoL scores significantly improved at the first month in correlation with UFM parameters. Tamsulosin treatment was effective in 33 (68.7 %) patients at the first administration and 35 (72.9 %) at the third month. Positive predictive value and negative predictive value ofQmax change at first dose for the third month response rate were 90.9 and 66.6 %, respectively. Conclusions The mid-term effectiveness of tamsulosin may be predicted by changes in UFM parameters achieved with its first dose.