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TUĞLULAR, ZÜBEYDE SERHAN

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TUĞLULAR

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ZÜBEYDE SERHAN

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Now showing 1 - 4 of 4
  • Publication
    Elevated Plasma Levels of PAI-1 Predict Cardiovascular Events and Cardiovascular Mortality in Prevalent Peritoneal Dialysis Patients
    (TAYLOR & FRANCIS LTD, 2009) ARIKAN, İZZET HAKKI; Arikan, Hakki; Koc, Mehmet; Tuglular, Serhan; Ozener, Cetin; Akoglu, Emel
    Background. Elevated plasminogen activator inhibitor-1 (PAI-1) levels are associated with increased cardiovascular (CV) risk in the general population. It has been shown that peritoneal dialysis (PD) patients have increased plasma levels of PAI-1. The aim of this study was to investigate whether PAI-1 independently predicted CV outcome in PD patients. Material and Methods. Seventy-two PD patients (53% females, mean age 49.9 +/- 16.1 years) were studied. Twelve patients who underwent kidney transplantation and 14 patients who transferred to hemodialysis during follow-up were excluded from the analysis. The remaining 46 patients (54% female, mean age 54 +/- 16 years, dialytic age 42 +/- 30 months) were followed a mean time of 45.4 +/- 19.4 months (range 8-71 months). Baseline PAI-1, clinical, and laboratory parameters were assessed in all patients. Survival analyses were made with Kaplan-Meier and Cox regression analysis, with all-cause mortality and CV mortality and CV events (CVEs) as clinical end points. Results. During the follow-up, 29 patients died (17 from CV causes), and 28 fatal and non-fatal CVEs were recorded. The patients were divided according to plasma PAI-1 levels (i.e., <= or >41 ng/mL). The significant independent predictors of all-cause of mortality were age (>60 years; p = 0.018), CRP (>5 mg/L; p = 0.015), and serum albumin (<3.5 g/L; p = 0.011). Multivariable Cox regression analysis showed that plasma PAI-1 >41 ng/mL was independently predictive of higher CV mortality (p = 0.021) and CVEs (p = 0.001). The only other independent predictor of CV mortality was only CRP (>5 mg/L; p = 0.008). Conclusions. Plasma levels of PAI-1 >41 ng/mL is a significant predictor of CV mortality and CVEs in PD patients.
  • Publication
    Determinants of hemoglobin variability in stable peritoneal dialysis patients
    (SPRINGER, 2014) VELİOĞLU, ARZU; Arikan, Hakki; Asicioglu, Ebru; Velioglu, Arzu; Nalcaci, Serdar; Birdal, Gurdal; Guler, Derya; Koc, Mehmet; Tuglular, Serhan; Ozener, Cetin
    Significant within-patient hemoglobin (Hb) level variability is well recognized in particularly hemodialysis patients. Several factors such as hospitalizations, intercurrent diseases and IV iron therapy are found to be related to Hb variability (Hb-var). In this observational study, we aimed to identify predictors and outcome of Hb-var in peritoneal dialysis (PD) patients without hospitalization, intercurrent disease and IV iron therapy during the study period. All patients were in the maintenance phase of short-acting erythropoiesis-stimulating agents (ESAs) therapy. The target range of Hb was 11-12 g/dL according to KDOQI Guidelines in 2007. The desired range of Hb was 11-12.5 g/dL. Patients' demographic and laboratory data were collected at baseline. Atherosclerotic disease was assessed using carotid intima-media thickness (CIMT). We assessed Hb variability with various methods using SD Hb(mean), SD Hb(range) and the velocity of Hb change. Hb deflect(positive), Hb deflect(negative), Hb values and ESA dosing were recorded monthly for 6 months. This study included 50 prevalent PD patients (mean age 46.9 +/- A 13.7 years, 25 women). The mean velocity of Hb change was negatively correlated with age and positively correlated with frequent ESA dose changes. Higher albumin and residual renal function (RRF) were also positively correlated with Hb deflect(positive). Patients with CIMT a parts per thousand yen0.7 cm had lower SD Hb range compared to CIMT < 0.7 cm. Cumulative survival was better in patients with Hb levels consistently a parts per thousand yen10 g/dL compared to patients who had Hb < 10 g/dL for at least 1 month. However, Hb-var was not associated with mortality. In PD patients without hospitalization, intercurrent disease(s) or IV iron therapy, young age, higher albumin or RRF and lower CIMT were associated with greater oscillations in response to ESA therapy. Careful and appropriate ESA dose changes considering these parameters could minimize Hb variability in these patients.
  • Publication
    Fibroblast Growth Factor-23 Levels Are Associated With Uric Acid But Not Carotid Intima Media Thickness in Renal Transplant Recipients
    (ELSEVIER SCIENCE INC, 2014) VELİOĞLU, ARZU; Asicioglu, E.; Kahveci, A.; Arikan, H.; Koc, M.; Tuglular, S.; Ozener, C.
    Introduction. Cardiovascular disease (CVD) is the leading cause of mortality in chronic kidney disease (CKD) patients. Fibroblast growth factor-23 (FGF-23) is associated with atherosclerosis and cardiovascular mortality in CKD patients and healthy subjects. However, data in renal transplant recipients (RTR) are scarce. We aimed to determine factors associated with FGF-23 and to explore its relationship to atherosclerosis. Methods. Forty-six patients and 44 controls were included. FGF-23 was measured from plasma. Carotid intima media thickness (CIMT) was evaluated ultrasonographically. Results. Patients had higher waist circumference (WC; 92.2 +/- 14.9 vs 85.3 +/- 11.0 cm; P < .05), glucose (99.8 +/- 17.2 vs 90.3 +/- 6.5 mg/dL; P < .01), creatinine (1.43 +/- 0.6 vs 0.86 +/- 0.1 mg/dL; P < .01), triglyceride (160.4 +/- 58.9 vs 135.6 +/- 59.8 mg/dL; P < .05), white blood cells (WBC; 7938.6 +/- 2105.2 vs 6715.7 +/- 1807.5 WBC/mm(3); P < .01), ferritin (217.0 +/- 255.8 vs 108.3 +/- 142.4 ng/mL; P < .05), uric acid (6.5 +/- 1.6 vs 4.7 +/- 1.3 mg/dL; P < .01), C-reactive protein (CRP; 8.2 +/- 18.2 vs 5.3 +/- 7.9 mg/L; P < .01), parathyroid hormone (PTH; 89.7 +/- 59.2 vs 44.1 +/- 16.7 pg/mL; P < .01), and alkaline phosphatase (ALP; 162.5 +/- 86.6 vs 74.2 +/- 21.9 U/L; P < .01). FGF-23 was higher in patients (11.7 +/- 7.2 vs 9.6 +/- 6.8 pg/mL; P < .05). CIMT was similar (0.58 +/- 0.09 vs 0.57 +/- 0.1 mm; P > .05). WC, creatinine, and uric acid were positively correlated with FGF-23, whereas albumin showed negative correlation. On multivariate analysis only creatinine and uric acid were determinants of FGF-23. Conclusion. FGF-23 levels are associated with uric acid in RTR. Larger studies are needed to confirm this finding.
  • Publication
    Associations between apolipoprotein E gene polymorphism and plasminogen activator inhibitor-1 and atherogenic lipid profile in dialysis patients
    (TAYLOR & FRANCIS LTD, 2007) ARIKAN, İZZET HAKKI; Arikan, Hakki; Koc, Mehmet; Sari, Hakan; Tuglular, Serhan; Ozener, Cetin; Akoglu, Emel
    Background. Apolipoprotein-E (ApoE) gene polymorphism has an important role in lipoprotein metabolism and could participate in the development of cardiovascular diseases (CVD). Plasminogen activator inhibitor-1 (PAI-1) is also regarded as a risk factor for CVD. The aim of the present study is to further investigate the possible link(s) between ApoE gene polymorphism and plasma PAI-1 antigen and serum lipid profile in peritoneal dialysis (PD) and hemodialysis (HD) patients. Material and Methods. We studied 72 PD patients (38 female, mean age 49.9 +/- 16.1 years), 72 HD patients (22 female, mean age 57.4 +/- 14.6 years), and 42 healthy subjects (21 female, mean age 50.1 +/- 18.6 years). Serum lipid parameters, plasma PAI-1 levels, and ApoE genotypes were determined in all subjects. Results. The distribution of ApoE genotypes and alleles frequencies was similar in dialysis patients and healthy controls. In PD patients, total cholesterol (TC), low-density lipoprotein (LDL)-C, and ApoB levels were significantly higher than that of HD patients. HD patients with E3/4 genotype had elevated TC, LDL-C and ApoB levels compared with E3/3 genotype. TC and triglyceride levels were also higher in E3/4 genotype than that of E2/3 genotype. PD and HD patients showed a significantly increased PAI-1 level s compared with controls, whereas PAI-1 levels were highest in HD patients. There was no significant relation between ApoE genotypes and PAI-1 levels. Conclusions. The present study suggests that ApoE polymorphism significantly affects serum lipid profile in HD patients and epsilon 4 allele carriers are more susceptible to have atherogenic lipid profile.