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KOÇ, MEHMET

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Now showing 1 - 4 of 4
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    PublicationOpen Access
    Circulating endothelial cells are associated with future vascular events in hemodialysis patients
    (ELSEVIER SCIENCE INC, 2005-03) KOÇ, MEHMET; Koc, M; Richards, HB; Bihorac, A; Ross, EA; Schold, JD; Segal, MS
    Background. Endothelial dysfunction and injury are thought to have a key role in the pathogenesis of cardiovascular disease. We hypothesized that the presence of circulating endothelial cells, as a reflection of ongoing endothelial injury, might provide a novel means for predicting cardiovascular events in hemodialysis subjects who are known to be at marked increased risk for cardiovascular disease. Methods. Circulating endothelial cell number was determined in 29 hemodialysis patients who were then followed for vascular events for 470 172 days. In a second cohort of 44 hemodialysis patients, circulating endothelial cell number was correlated with markers of inflammation, namely high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-10, and monocyte chemoattractant protein-1 (MCP-1), and endothelial dysfunction, soluble vascular cellular adhesion molecule-1 (VCAM-1). Results. Seven of the 19 subjects with elevated circulating endothelial cells (defined as > 19 cells per mL) had cardiovascular (N = 5) or vascular (N = 5) events during follow-up, whereas no events occurred in subjects with a low number of circulating endothelial cells (less than or equal to19 CECs per mL) (P = 0.04 by Fisher Exact Test). In the second cohort, the number of circulating endothelial cells was independent of all markers of inflammation and endothelial dysfunction. Conclusion. In this hemodialysis population, an increase in circulating endothelial cells was found to predict the development of cardiovascular and vascular events, and to be independent of other known markers of inflammation or endothelial dysfunction. These studies suggest that circulating endothelial cells may be a novel way to assess endothelial health and cardiovascular risk. Further studies to investigate the utility of circulating endothelial cells in predicting cardiovascular risk are needed.
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    PublicationOpen Access
    Night-time blood pressure load is associated with higher left ventricular mass index in renal transplant recipients
    (NATURE PUBLISHING GROUP, 2003-04) KOÇ, MEHMET; Toprak, A; Koc, M; Tezcan, H; Ozener, IC; Oktay, A; Akoglu, E
    The absence of nocturnal fall in blood pressure (BP) is named as nondipper status, which has been shown to be an additional risk factor for the development of left ventricular hypertrophy and cardiovascular events in several high-risk groups. The aim of this study was to determine the influences of the nondipper status and nocturnal blood pressure loads on left ventricular mass index (LVMI) in renal transplant recipients. A total of 35 nondiabetic renal transplant recipients were included into the study. A 24-h ambulatory blood pressure monitoring (ABPM) was performed for all recipients. The nondipper status was defined as either an increase in night-time mean arterial pressure (MAP) or a decrease of no more than 10% of daytime MAP. LVMI was measured by using two-dimensional guided M-mode echocardiography. The night-time systolic blood pressure (SBP) load was defined as the percentage of the time, during which SBP exceeded 125 mmHg during night time. The nondipping was common among renal transplant recipients, of whom 60% were nondipper in our study. LVMI was significantly higher in the nondipper group vs the dipper group (133 +/- 35 g/m(2) VS 109 +/- 26 g/m(2), P= 0.04). A fall in MAP at night time was 14.5 +/- 4.3% in the dipper group, while it was 1.4 +/- 6.1% in the nondipper group (P< 0.001). On stepwise multiple regression analysis, night-time SBP load and haemoglobin were independent predictors of LVMI (R-2 = 0.53). In conclusion, nondipping is common after renal transplantation. Night-time SBP load and low haemoglobin are closely related to the increase in LVMI in renal transplant recipients. ABPM may be a more useful tool in optimizing treatment strategies to reduce cardiovascular events in renal transplant recipients.
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    PublicationOpen Access
    Inferior vena cava diameter determines left ventricular geometry in continuous ambulatory peritoneal dialysis patients: an echocardiographic study
    (OXFORD UNIV PRESS, 2003-10-01) KOÇ, MEHMET; Toprak, A; Koc, M; Tezcan, H; Ozener, IC; Akoglu, E; Oktay, A
    Background. Changes in left ventricular (LV) geometry are frequent in patients with continuous ambulatory peritoneal dialysis (CAPD). Geometric adaptation of LV to various stimuli was reported to have adverse prognosis. This study aimed to identify independent risk factors, which contribute to the development of LV geometric remodelling in CAPD patients. Methods. The left ventricles of 69 CAPD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. With respect to volume factor, we measured inferior vena cava (IVC) diameter and its decrease on deep inspiration [collapsibility index (CI)] by echocardiography. We modelled a stepwise multiple regression analysis to determine the predictors of LV geometry. Results. All four geometric models of LV were identified in our group of 69 CAPD patients. Eccentric left ventricular hypertrophy (eLVH) was observed in 32 (46%), concentric LVH (cLVH) in 19 (28%), normal geometry (NG) in 10 (14%) and concentric remodelling (CR) in eight (12%) CAPD patients. Mean IVC index of the eLVH group (10.72 +/- 2.19 mm/m(2)) was significantly higher than corresponding indexes of NG (7.90 +/- 1.54 mm/m(2)), CR (8.51 +/- 1.28 mm/m(2)) and cLVH (8.04 +/- 2.00mm/m(2)) groups (P < 0.001 for each comparisons). The eLVH group also had significantly lower mean CI value (0.48 +/- 0.11) than CR (0.58 +/- 0.09) and cLVH (0.57 +/- 0.07) groups (ANOVA P=0.008). Stepwise multiple regression analysis revealed that IVC index, CI and haemoglobin were the independent predictors of LV geometric stratification (R-2 =0.36, P < 0.001). Conclusion. Hypervolaemia, identified by IVC index and CI, and anaemia contribute independently to LV geometry in CAPD patients. Echocardiography as a non-invasive tool is not only useful to determine LV geometry, but also to assess the volume status of CAPD patients.
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    PublicationOpen Access
    Earthquakes and crush syndrome casualties: Lessons learned from the Kashmir disaster
    (ELSEVIER SCIENCE INC, 2007-01) KOÇ, MEHMET; Vanholder, R.; van der Tol, A.; De Smet, M.; Hoste, E.; Koc, M.; Hussain, A.; Khan, S.; Sever, M. S.
    Major earthquakes may provoke a substantial number of crush casualties complicated by acute kidney injury (AKI). After the 1988 Armenian earthquake, the International Society of Nephrology (ISN) established the Renal Disaster Relief Task Force (RDRTF) to organize renal care in large disasters