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Öğe Diyabetik olmayan kronik böbrek yetmezliği hastalarında hemodiyalizin gözdeki etkileri(Turkiye Klinikleri, 2014) Ulaş, Fatih; Doğan, Ümit; Keleş, Asena; Ertilav, Muhittin; Tekçe, Hikmet; Çelebi, Serdal; Taslamacıoğlu, TubaObjective: To evaluate effects of hemodialysis on best-corrected visual acuity (BCVA), spherical equivalent, central corneal thickness (CCT), intraocular pressure (IOP), macular volume, and retinal nerve fiber layer (RNFL) thickness in non-diabetic chronic renal failure (CRF) patients. Material and Methods: Twenty-four eyes of 20 male and 4 female CRF patients aged between 46-78 years (mean 61.13±10.31 years) were included in this cross-sectional study. BCVA, spherical equivalent, CCT, IOP, macular volume and RNFLthickness measurements of the patients were recorded before and after hemodialysis. Statistical analysis of the data was carried out using paired sample t-test, Wilcoxon signed rank test and Pearson correlation analysis. Results: Hemodialysis significantly decreased plasma osmolality (p<0.001), increased plasma colloid oncotic pressure (p<0.001) and did not alter mean arterial pressure (p=0.139). There was no statistically significant difference in BCVA, spherical equivalent, CCT and all evaluated macular segment volumes (p values were >0.05). IOP decreased significantly after hemodialysis (p=0.007). There was statistically significant increase in all RNFLsegments (p values for global, superotemporal, superonasal, inferotemporal and inferonasal segments were 0.005, 0.002, 0.021, 0.041 and 0.024, respectively) except in nasal and temporal RNFLsegments. There was no significant correlation between all measured parameters (p values were >0.05) except for moderate significant correlation between plasma colloid osmotic pressure difference and CCT difference (r=-0.451, p=0.027), and plasma colloid osmotic pressure difference and IOP difference (r=-0.415, p=0.044). Conclusion: Hemodialysis did not alter BCVA, spheric equivalent, CCT and macular volume, but altered IOP and RNFLthickness significantly in nondiabetic CRF patients. Ophthalmologic examination of CRF patients treated with hemodialysis must be performed at the same time point based on the time of the hemodialysis sessions.Öğe Effect of serum parathormone level on retinal thickness and choroidal thickness in chronic renal disease(Gazi Eye Foundation, 2015) Ulaş, Fatih; Doäan, Ümit; Keleş, Asena; Ertilav, Muhittin; Tekçe, Hikmet; Çelebi, SerdalPurpose: To evaluate effects of serum parathormone level on retinal thickness and choroidal thickness in non-diabetic predialysis chronic renal disease (CRD) patients. Materials and Methods: Sixty-five eyes of 45 non-diabetic predialysis CHD patients and 20 healthy subjects were included in this cross-sectional study. Twenty-five CHD patients had high serum PTH levels and 20 CHD patients had PTH levels within normal limits. Spherical equivalent, central corneal thickness (CCT), intraocular pressure (IOP), retinal and choroidal thicknesses of CHD patients and healthy control subjects were measured. Serum creatinine, calcium, phosphor, C-reactive protein (CRP), vitamin D3 and PTH levels were recorded. Statistical analysis of data was carried out using independent samples t test, one-way analysis of variance and Pearson correlation analysis. Results: There was no statistically significant difference in serum calcium, phosphor, vitamin D3 and CRP levels (range of p values: 0.117-0.412) except for serum PTH levels (p<0.001). There was no statistically significant difference in age, spherical equivalent, CCT, and IOP measurements of groups (p values were ranging between 0.067-0.792). There was statistically significant difference in nasal and temporal retinal segment thicknesses between CHD patients and healthy control subjects (p values were 0.044 and 0.024, respectively). Patients with high serum PTH levels had thicker choroid than other 2 groups for all the measured segments, however this difference was not statistically significant (range of p values: 0.438-0.794). Conclusions: Retinal thickness decreased in non-diabetic predialysis CHD patients and high serum PTH levels might affect choroidal thickness in this group of CHD patients.Öğe Evaluation of choroidal and retinal thickness measurements using optical coherence tomography in non-diabetic haemodialysis patients(Springer, 2013) Ulaş, Fatih; Doğan, Ümit; Keleş, Asena; Ertilav, Muhittin; Tekçe, Hikmet; Çelebi, SerdalThe aim of this study is to evaluate the effects of haemodialysis with a high ultrafiltration rate on the choroidal and retinal thickness of non-diabetic end-stage chronic renal failure (CRF) patients using optical coherence tomography (OCT). Twenty-one eyes of 21 male CRF patients aged between 46 and 80 years were included in this prospective study. Retinal and choroidal thicknesses of the patients were measured using high-resolution OCT line scans with the activated enhanced depth imaging mode before and shortly after haemodialysis. Retinal and choroidal thickness measurements were taken at the fovea and at two points that were 1,500 mu m nasal and temporal to the fovea. The relationships between the haemodynamic changes, intraocular pressure (IOP) and central corneal thickness (CCT) were also evaluated. The mean choroidal thicknesses before haemodialysis at the subfoveal, temporal and nasal locations were 232.81 +/- A 71.92, 212.43 +/- A 70.50 and 182.14 +/- A 68.88 mu m, respectively. The mean choroidal thicknesses after haemodialysis at the subfoveal, temporal and nasal locations were 210.90 +/- A 65.53, 195.38 +/- A 66.48 and 165.19 +/- A 66.73 mu m, respectively. There were significant differences between the choroidal thicknesses before and after haemodialysis (p < 0.001 for all). The mean retinal thicknesses before haemodialysis at the foveal, temporal and nasal locations were 215.86 +/- A 41.06, 308.86 +/- A 37.73 and 338.00 +/- A 33.32 mu m, respectively. The mean retinal thicknesses after haemodialysis at the foveal, temporal and nasal locations were 216.90 +/- A 39.70, 313.86 +/- A 32.89 and 335.29 +/- A 36.85 mu m, respectively. There was no significant difference between the retinal thicknesses before and after haemodialysis (p > 0.05 for all). The mean CCT decreased insignificantly from 550.48 +/- A 17.46 to 548.10 +/- A 21.12 mu m (p = 0.411). The mean IOP decreased significantly from 14.09 +/- A 2.58 to 12.54 +/- A 2.23 mmHg (p = 0.003), which did not correlate with the CCT [r = (-)0.134, p = 0.562]. Haemodialysis with a high ultrafiltration volume did not alter the retinal thickness but caused a significant choroidal thinning and an IOP decrease in non-diabetic end-stage CRF patients.Öğe Impact of body mass index on short-term and long-term survival in prevalent hemodialysis patients(Wiley, 2019) Ertilav, Muhittin; Levin, W. Nathan; Çeltik, Aygül; Kırcelli, Fatih; Stuard, Stefano; Yüksel, KıvançIntroduction: Numerous studies showed that higher body mass index (BMI) is associated with better survival in hemodialysis (HD) patients. Most of them evaluated short-term mortality. It has been suggested that presence of inflammation may be a key modifier of relationship between BMI and mortality in incident HD patients. We examined whether presence of inflammation modifies the association between BMI and mortality in both short-term and long-term follow-up in a large group of prevalent HD patients. Methods: A total of 3.252 HD patients from 41 HD centers were enrolled; the patients were divided into quartiles based on time-averaged BMI (Q1 < 21.5, Q2 21.5 to <24.3, Q3 24.3 to <27.4, Q4 >= 27.4 kg/m(2)). Inflammation status was defined as present (inflamed) (C-reactive protein (CRP) >= 1.0 mg/dL and/or serum albumin <= 3.5 g/dL) or absent (noninflamed). Findings: During 7 years of follow-up 1386 patients (42.6%) died. Compared to noninflamed patients, inflamed patients in the lowest BMI quartile showed 5-fold increased risk for mortality in the short-term (95% confidence interval [CI] 2.82-9.22, P < 0.001) and 3-fold in the long-term (95%CI 2.42-4.27, P < 0.001) compared to the highest BMI quartile. Whereas, inflamed patients in the highest BMI quartile experienced 2-fold increased risk in short-term (95%CI 1.17-3.74, P = 0.01) and 1.68-fold increased risk in long-term (95%CI 1.30-2.18, P < 0.001) than in noninflamed patients. The protective effect of BMI for overall mortality was present in all age groups, in both genders, in patient with and without diabetes. BMI was not a mortality predictor in patients with HD duration more than 76 months at baseline. The protective effect of BMI was observed in all albumin tertiles. In patients in the lowest CRP tertile, BMI was not associated with mortality. Discussion: Higher BMI is associated with lower short-term and long-term mortality risk, especially in patients with inflammation in a prevalent HD population.Öğe Kronik böbrek hastalığında serum parathormon seviyesinin retina ve koroid kalınlığı üzerine etkisi(2015) Ulaş, Fatih; Doğan, Ümit; Keleş, Asena; Ertilav, Muhittin; Tekçe, Hikmet; Çelebi, SerdalAmaç: Hemodiyaliz tedavisi almayan, diyabetik olmayan kronik böbrek hastalığı (KBH) olgularında serum parathormon (PTH) seviyesinin retina ve koroid kalınlığı üzerindeki etkilerinin değerlendirilmesi.Gereç ve Yöntem: Bu kesitsel çalışmaya, diyabetik olmayan ve hemodiyaliz tedavisi başlanmamış 45 KBH hastası ve 20 sağlıklı olgunun 65 gözü dahil edildi. KBH hastalarının 25'inin serum PTH seviyesi yüksek ve 20'sinin ise normal sınırlardaydı. KBH hastalarının ve sağlıklı kontrol olguların sferik ekivalan, merkezi kornea kalınlığı (MKK), göz içi basıncı (GİB), retina ve koroid kalınlığı ölçümleri yapıldı. Olguların serum kreatinin, kalsiyum, fosfor, C-reaktif protein (CRP), vitamin D3 ve PTH seviyeleri kaydedildi. Verilerin istatistiksel değerlendirmesi bağımsız örneklem t testi, tek yönlü varyans analizi ve Pearson korelasyon analizi ile yapıldı.Bulgular: Olguların serum kalsiyum, fosfor, vitamin D3 ve CRP seviyeleri arasında anlamlı fark saptanmazken (p değerleri 0.117-0.412 aralığında), serum PTH seviyeleri arasında anlamlı fark saptandı (p<0.001). Olguların yaş, sferik ekivalan, MKK, GİB ölçümleri değerlendirildiğinde gruplar arasında istatistiksel olarak anlamlı fark gözlenmedi (p değerleri 0.067-0.792 aralığında). KBH olguları ve sağlam gruplar arasında nazal ve temporal retina kalınlık değerleri KBH hastalarında sağlam kontrollere göre istatistiksel olarak anlamlı derecede daha inceydi (p değerleri sırasıyla 0.044 ve 0.024). KBH ve sağlam gruplar arasında koroidal kalınlık ölçümleri arasında ölçülen tüm segmentlerde istatiksel olarak anlamlı fark olmamakla birlikte PTH seviyesi yüksek olan grupta diğer iki gruba göre koroid tabakası daha kalındı (p değerleri 0.438-0.794 aralığında).Sonuç: Hemodiyaliz tedavisi almayan ve diyabetik olmayan KBH olgularında retinal kalınlığı incelmektedir ve bu grup KBH olgularında yüksek serum PTH seviyesinin koroid tabakası kalınlığı üzerine etkisi olabilir.Öğe Long-term outcome of kidney transplantation from elderly living and expanded criteria deceased donors(Taylor & Francis Ltd, 2015) Tanrısev, Mehmet; Hoşcoşkun, Cüneyt; Aşçı, Gülay; Sözbilen, Murat; Fırat, Özgür; Ertilav, MuhittinThe imbalance between organ demand and supply causes the increasing use of suboptimal donors. The aim of this study is to investigate the survival and allograft function of kidney transplantation from standard (SLD) and elderly living (ELD), standard criteria (SCDD) and expanded criteria deceased (ECDD) donors. All patients transplanted from 1997 to 2005 were investigated according to the donor characteristics. Data were collected retrospectively during the 83.4 +/- 43.1 months of follow-up period. ELD was defined as donor age >= 60 years. ECDD was defined as UNOS criteria. A total of 458 patients were divided into four groups: SLD (n:191), ELD (n:67), SCDD (n:154), and ECDD (n:46). Seven-year death-censored graft survival in SLD, ELD, SCDD, and ECDD were 81.6%, 64.8%, 84.7%, and 68.3%, respectively (p = 0.003). The death-censored graft survival in ELD group was lower than in SLD (p = 0.007) and SCDD (p = 0.007) groups, while in ECDD group it was lower than in SCDD group (p = 0.026). Patient survival was similar. In ECDD group, 83% of total deaths occurred within the first 3 years, mainly due to infections (66.6%) (p < 0.05). Estimated glomerular filtration rate (eGFR) was lower in ELD (compared with SLD and SCDD); and ECDD (compared with SCDD) at last visit. In multivariate analysis, ELD, experience of an acute rejection episode and presence of delayed graft function were the independent predictors for death censored graft loss. Transplantation of a suboptimal kidney provides inferior graft survival and function. A higher number of deaths due to infection in the early post-transplant period in the ECDD group are noteworthy.
