67 research outputs found
Factors Related to Pulse Wave Velocity and Augmentation Index in Chronic Hemodialysis Patients
No full textBackground: Augmentation index (AIx) and pulse wave velocity (PWV) are early markers of atherosclerotic vascular changes and also have been shown to be predictive of cardiovascular disease and total mortality. The aim of our study was to evaluate the relationship between PWV and AIx-HR75, which is the corrected form of AIx according to a heart rate of 75 beats/min, echocardiographic parameters and biochemical parameters in chronic hemodialysis (HD) patients. Subjects and methods: AIx-HR75 and PWV were measured in 556 HD patients by applanation tonometry using the SphygmoCor device. Results: The mean PWV and AIx-HR75 values of the study group were 10.2 +/- 2.4 and 28.4 +/- 10.2 m/s. A positive correlation was found between PWV and AIx-HR75 (r = 0.214, p = 0.000). AIx-HR75 correlated with age (r = 0.093, p = 0.028), body surface area (BSA) (r = -0.194, p = 0.000), mean arterial pressure (MAP) (r = 0.335, p = 0.000), pulse pressure (PP) (r = 0.212, p = 0.000), cardiothoracic index (r = 0.155, p = 0.016), and presence of left ventricular hypertrophy (r = 0.152, p = 0.001). PWV correlated with MAP (r = 0.208, p = 0.000), PP (r = 0.098, r = 0.021), left ventricular mass (r = 0.105, p = 0.023), and predialysis sodium level (r = -0.105, p = 0.023). In the multivariate analyses, PWV was associated with MAP (t = 3.78, p = 0.000), presence of diabetes (t = 3.20, p = 0.001), and predialysis sodium level (t = -2.06, p = 0.040), and AIx-HR75 was associated with age (t = 2.48, p = 0.014), female sex (t = 3.98, p = 0.000), BSA (t = -2.15, p = 0.033), and MAP (t = 7.02, p = 0.000). Conclusion: There is a strong association between MAP and arterial stiffness parameters in HD patients. We feel that efficient control of blood pressure could lead to reduced arterial stiffness in HD patients
Increased arterial stiffness in patients with nephrotic syndrome
No full textIntroduction: Nephrotic syndrome (NS) and arterial stiffness (AS) have each been linked with increased risk for cardiovascular diseases. However, there is no data in the literature up-to-date on AS in adult patients with NS. Thus, in this study, we aimed to evaluate the potential associations between AS, volume and nutritional status in patients with NS in comparison to a healthy control group. Methods: 34 adult patients with newly diagnosed but untreated NS and 34 healthy controls were studied. AS was assessed by carotid-femoral PWV (cf-PWV) and body composition, nutritional status by multi-frequency bioelectric impedance analysis (BIA). Results: Mean age was 44.6 +/- 18.7 years (18 - 72). Mean cf-PWV was 8.3 +/- 2.5 m/s in patients with NS and 6.7 +/- 1.1 m/s in controls (p = 0.002). In univariate analysis, cf-PWV and positively correlated with age, systolic blood pressure, mean arterial pressure (MAP), pulse pressure, body mass index, body fat ratio, waisthip ratio, creatinine, uric acid and negatively with creatinine clearance. In linear regression analysis, only age and MAP predicted arterial stifffiess. Total body fluid, extracellular water (ECW), ECW/Height, ECW/body surface area and third space volumes were higher in patients with NS. Conclusion: Patients with NS have increased AS and are more hypervolemic compared to the healthy subjects
Comparison of dialysates with and without glucose in hemodialysis patients
No full text44th ERA-EDTA Congress -- JUN 22-24, 2007 -- Barcelona, SPAINERA-EDT
Statin use is associated with lower inflammation and erythropoietin responsiveness index in hemodialysis patients
No full textPatients with end-stage renal disease are prone to inflammation and inflammation is related to erythropoietin-stimulating agent hyporesponsiveness and mortality in this population. Statins have been demonstrated to reduce cardiovascular mortality in selected populations of end-stage renal disease patients. These drugs have pleiotrophic effects such as anti-inflammation. In this retrospective analysis, we determined whether the use of statins improves inflammation and inflammation-related anemia in a cohort of hemodialysis patients. Data were analyzed from Fresenius Medical Care Dialysis Clinics in Turkey between 2005 and 2007. Seventy prevalent hemodialysis patients who were on statins at the start of the study and have been on statins during follow-up (statin users) and 1293 patients who were not on statin at the start of the study and had never been prescribed any lipid-modifying drugs during follow-up (statin nonusers) were included in the study. High-sensitive C-reactive protein levels were significantly decreased in statin users (1.50 +/- 1.49 vs. 1.33 +/- 1.11 mg/L, P=0.05) compared with nonusers (1.93 +/- 3.22 vs. 2.05 +/- 2.77 mg/L). Hemoglobin levels and the rate of erythropoietin-stimulating agent users were similar. However, the prescribed erythropoietin-stimulating agent dose (31.6 +/- 27.5 vs. 47.3 +/- 45.2 U/kg/week, P < 0.05) and the erythropoietin response index (2.90 +/- 2.73 vs. 4.51 +/- 4.48 U/kg/week/Hb, P=0.001) were lower in statin users compared with statin nonusers. On stepwise multiple regression analysis, gender, high-sensitive C-reactive protein, duration of hemodialysis, serum ferritin, and statin use were independent determinants of the erythropoietin responsiveness index. Our results suggest that statin treatment leads to lower inflammation and improves hematopoiesis in hemodialysis patients
Can Subtypes of White Blood Cells Predict Mortality in Hemodialysis Patients?
No full textObjective: To investigate whether increased white blood cell count (WBC) is an independent risk factor for mortality in hemodialysis (HD) patients. There are limited number of studies that evaluate the WBC subtypes and mortality in HD patients. Material and Methods: In this 36 months long prospective study, predictive value of WBC subtypes for mortality was investigated in 910 HD patients (male 55%, diabetes 29.3%, age 59 +/- 14; HD duration 44 +/- 39 months). Results: There was significant correlation between high sensitive C-reactive protein and neutrophils (r= 0.43, p5.040/mm(3)), increased monocytes (>740/mm(3)) and decreased lymphocytes (<1.620/mm(3)) were correlated with poor survival. In Cox regression analysis, monocyte count over 1.267/mm(3) and lymphocyte count less than 461/mm(3) were found as independent factors for overall survival after correction for classical risk factors. However, neutrophil count was not correlated with mortality. Conclusion: Increased blood monocyte count and decreased lymphocyte count are independent risk factors for long-term mortality
Static and Dynamic Connectedness Between Green Bonds and Clean Energy Markets
No full textThe green bond market has become one of the most promising mech-anisms to raise financial sources for projects with environmental benefits that not only achieve carbon–neutral goals but also allow to diversify the risk and hedging. In this study, we examine the possible interdependence between the green bond market and seven energy markets, including Wilder Hill Clean Energy Index, S&P Global Clean Energy Index, Nasdaq Clean Edge Green Energy, Ardour Global Solar Energy Index, S&P Global Water Index, and MSCI Global Green Building Index using Diebold and Yilmaz’s (2012) spillover framework. Our findings show that movements in the clean energy market have a spillover effect in the green bond market. Additionally, the spread of risk is asymmetrical. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2024
The Impact of Membrane Permeability and Dialysate Purity on Cardiovascular Outcomes
No full textThe effects of high-flux dialysis and ultrapure dialysate on survival of hemodialysis patients are incompletely understood. We conducted a randomized controlled trial to investigate the effects of both membrane permeability and dialysate purity on cardiovascular outcomes. We randomly assigned 704 patients on three times per week hemodialysis to either high- or low-flux dialyzers and either ultrapure or standard dialysate using a two-by-two factorial design. The primary outcome was a composite of fatal and nonfatal cardiovascular events during a minimum 3 years follow-up. We did not detect statistically significant differences in the primary outcome between high- and low-flux (HR=0.73, 95% CI=0.49 to 1.08, P=0.12) and between ultrapure and standard dialysate (HR=0.90, 95% CI=0.61 to 1.32, P=0.60). Posthoc analyses suggested that cardiovascular event-free survival was significantly better in the high-flux group compared with the low-flux group for the subgroup with arteriovenous fistulas, which constituted 82% of the study population (adjusted HR=0.61, 95% CI=0.38 to 0.97, P=0.03). Furthermore, high-flux dialysis associated with a lower risk for cardiovascular events among diabetic subjects (adjusted HR=0.49, 95% CI=0.25 to 0.94, P=0.03), and ultrapure dialysate associated with a lower risk for cardiovascular events among subjects with more than 3 years of dialysis (adjusted H R=0.55, 95% CI=0.31 to 0.97, P=0.04). In conclusion, this trial did not detect a difference in cardiovascular event-free survival between flux and dialysate groups. Posthoc analyses suggest that high-flux hemodialysis may benefit patients with an arteriovenous fistula and patients with diabetes and that ultrapure dialysate may benefit patients with longer dialysis vintage.Fresenius Medical Care, TurkeyThe study was supported by Fresenius Medical Care, Turkey, with an unrestricted grant
Attention Deficit Hyperactivity Disorder Treatment Practice in Turkey
No full textObjective: To determine the factors associated with type of ADHD prescription and re-admission of the cases to the outpatient clinics between January-July 2013.
Method: The Ministry of Health prescription database, which included prescriber, region, age and gender data and contained almost 20% of IMS data.
Results: A total of 73,189 prescription were prescribed to a total of 41,341 (30,014 males; 72.7%) patients. 38645 (93.5%) of the patients were between 6 and 18 years of age. The most frequently prescribed drug was OROS methylphenidate (MPH, 59.7%) followed by IR MPH, atomoxetine and combination of drugs. There were several regional differences in prescription practice. Treatment choice changed significantly with age and gender. Rate of repeated prescription was highest among 6-18 year-old male subjects receiving combination treatment.
Conclusions: ADHD treatment choice seemed to be heavily influenced by official regulations. Age, gender and drug of choice were important factors associated with treatment adherenc
Effects of 2 different dialysates on intradialytic complications and various clinical and laboratory findings in chronic hemodialysis patients
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