Person: TUĞLULAR, ZÜBEYDE SERHAN
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TUĞLULAR
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ZÜBEYDE SERHAN
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Publication Metadata only Waist circumference is associated with carotid intima media thickness in peritoneal dialysis patients(SPRINGER, 2013) VELİOĞLU, ARZU; Asicioglu, Ebru; Kahveci, Arzu; Arikan, Hakki; Koc, Mehmet; Tuglular, Serhan; Ozener, Cetin IshakAtherosclerosis is responsible for the high mortality rate in end-stage renal disease patients. Defining risk factors for atherosclerosis may lead to reduction in cardiovascular disease through modification of these factors. Peritoneal dialysis (PD) patients are subjected to high glucose loads on a daily basis, which results in considerable weight gain and an increase in waist circumference (WC). WC as an indicator of abdominal obesity is a risk factor for atherosclerosis in the general population. Carotid artery intima media thickness (CIMT) measurement is a reliable method for the detection of early atherosclerosis. The aim of this study was to investigate the relationship between WC and CIMT and to define risk factors associated with CIMT in PD patients. Fifty-five PD patients and 40 healthy controls were included. Atherosclerosis was assessed using measurement of CIMT. Fasting blood was collected for analysis. Anthropometric parameters (age, weight, BMI, and WC) were measured. Peritoneal dialysis patients had higher WC (93.9 +/- A 1.7 vs. 87.3 +/- A 1.2 cm, p < 0.05) and CIMT (0.70 +/- A 0.02 vs. 0.57 +/- A 0.01 mm, p < 0.01) than the control group. On univariate analysis, age, WC, plaque formation, and D/P creatinine were positively correlated with CIMT, whereas residual renal function, albumin, ultrafiltration volume, and D/D0 glucose were negatively correlated. On multivariate analysis, only age, WC, and plaque formation showed correlation (p < 0.001). Carotid artery intima media thickness is associated with age, plaque formation, and WC in PD patients. WC measurement is a simple, inexpensive, reproducible, and reliable method of evaluating atherosclerosis risk in PD patients and should be assessed at every visit. Appropriate counsel should be provided to patients with greater WC who are deemed to be at risk for atherosclerosis.Publication Open Access Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology(PUBLIC LIBRARY SCIENCE, 2021-08-10) ARIKAN, İZZET HAKKI; Arikan, Hakki; Ozturk, Savas; Tokgoz, Bulent; Dursun, Belda; Seyahi, Nurhan; Trabulus, Sinan; Islam, Mahmud; Ayar, Yavuz; Gorgulu, Numan; Karadag, Serhat; Gok, Mahmut; Akcali, Esra; Bora, Feyza; Aydin, Zeki; Altun, Eda; Ahbap, Elbis; Polat, Mehmet; Soypacaci, Zeki; Oguz, Ebru Gok; Koyuncu, Sumeyra; Colak, Hulya; Sahin, Idris; Dolarslan, Murside Esra; Helvaci, Ozant; Kurultak, Ilhan; Eren, Zehra; Dheir, Hamad; Ogutmen, Melike Betul; Taymez, Dilek Guven; Genek, Dilek Gibyeli; Ozkurt, Sultan; Bakir, Elif Ari; Yuksel, Enver; Sahutoglu, Tuncay; Oto, Ozgur Akin; Boz, Gulsah; Sengul, Erkan; Kara, Ekrem; Tuglular, SerhanBackground Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. Conclusions Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.Publication Open Access Recommendations for kidney patients in covid-19 era based on current evidence(2022-01-01) VELİOĞLU, ARZU; TUĞLULAR, ZÜBEYDE SERHAN; Ozturk S., VELİOĞLU A., TUĞLULAR Z. S.Patients with chronic kidney disease, patients on dialysis, and kidney transplant recipients are at high risk of mortality and morbidity due to coronavirus disease-19. Most patients with chronic kidney disease are elderly and have other comorbidities. In addition, some of these patients have been exposed to immunosuppressive drugs to treat their underlying primary disease or to prevent allograft rejection. This general profile of chronic kidney disease patients renders them susceptible to a more severe course of coronavirus disease-19 once they are infected with severe acute respiratory syndrome coronavirus 2. Many studies showed that impaired kidney function on admission is an independent risk factor for a more severe course of coronavirus disease-19 with significantly increased risk for hospital and intensive care unit admission, intubation, mechanical ventilation, and death. Coronavirus disease-19 vaccination is crucial to create immunity in the general community, but the evidence addressing this specific population is scarce. However, based on the current evidence, all patients with chronic kidney disease are strongly recommended to receive the available vaccine in their country against coronavirus disease-19, and booster doses will presumably prove necessary for this group of patients. Furthermore, vigilant use of protective measures is strongly recommended for this patient population. Current studies and recommendations from health authorities should be followed closely.Publication Metadata only 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, CetinSignificant 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 Metadata only Evaluation of Sepsis/Systemic Inflammatory Response Syndrome, Acute Kidney Injury, and RIFLE Criteria in Two Tertiary Hospital Intensive Care Units in Turkey(KARGER, 2010) TUĞLULAR, ZÜBEYDE SERHAN; Yegenaga, Itir; Tuglular, Serhan; Ari, Elif; Etiler, Nilay; Baykara, Nur; Torlak, Sinan; Acar, Sertan; Akbas, Turkay; Toker, Kamil; Solak, Zeynep MineSepsis is a common cause of acute renal failure in intensive care units (ICU) with mortality rates as high as 60%. In this study, the clinical and laboratory predictors of acute kidney injury (AKI) in critically ill Turkish patients with sepsis/systemic inflammatory response syndrome were identified. We studied 139 (67 females/72 males) patients admitted to our ICUs with sepsis/systemic inflammatory response syndrome without renal failure. The clinical and laboratory parameters and treatments were recorded. Patients were classified as those without AKI (n = 60; 43.20%) and those with AKI (n = 79; 56.80%) based on the RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) criteria. Those with AKI were further classified as: risk in 27 (19%), injury in 25 (17.9%), failure in 25 (17.9%), and loss in 2 (1.4%). We found that the mortality rate increased with the severity of renal involvement: 56% in risk, 68% in injury, 72% in failure, and 100% in loss categories. Patients with AKI had a more positive fluid balance, higher central venous pressure, more vasopressor use, and lower systolic blood pressure. In multivariate analysis, the sequential organ failure assessment score, blood pressure, serum creatinine, and fluid balance were risk factors for the development of AKI. In this population, the incidence of AKI was higher and contrary to previous knowledge. A positive fluid balance also carries a risk for AKI and mortality in septic ICU patients. The RIFLE criteria were found to be applicable to our ICU population. Copyright (C) 2010 S. Karger AG, BaselPublication Metadata only The prevalence of metabolic syndrome is increased in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis(SPRINGER, 2021) VELİOĞLU, ARZU; Atas, Dilek Barutcu; Atas, Halil; Izgi, Tuba Nur; Velioglu, Arzu; Arikan, Hakki; Oner, Fatma Alibaz; Direskeneli, Haner; Tuglular, Serhan; Asicioglu, EbruPurpose Cardiovascular disease is one of the major causes of mortality in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Metabolic syndrome (MetS) is associated with increased cardiovascular risk in the normal population. However, MetS in AAV has not been adequately investigated. We aimed to determine MetS prevalence and associated factors in AAV patients. Methods Thirty-seven AAV patients and 42 healthy controls were enrolled. MetS was determined by International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. The relationship between clinical features of AAV and MetS was also investigated. Results MetS was significantly higher in AAV patients than controls by NCEP-ATPIII (51.4% vs. 26.2%, p 0.022) and IDF (62.2% vs. 35.7%, p 0.020). When AAV patients with MetS were compared to those without, there were significant differences in age, CRP, GFR and NT-pro-BNP. Age [58 (13) vs. 50 (8) years p: 0.028], CRP [4.0 (3.6) vs. 3.2 (1.0) mg/l, p 0.021] and NT-pro-BNP [173.5 (343.7) vs. 106.0 (103.0) pg/ml, p 0.013] were significantly higher in AAV patients with MetS than those without; GFR was significantly lower [38 (46) vs. 83 (51) ml/min/1.73 m(2), p 0.004]. ROC curve analysis showed NT-pro-BNP > 58.0 ng/ml predicted MetS with 87.1% sensitivity and 46.7% specificity (Area under curve: 0.71, CI 0.536-0.902, p 0.041). Multivariate analysis revealed age [OR (95% CI): 1.180 (1.010-1.370), p 0.039] and NT-pro-BNP > 58 pg/ml [OR (95% CI): 5.5 (1.02-30.1) p 0.047] were independent predictors of MetS in AAV patients. Conclusion MetS is significantly higher in AAV patients than controls and is associated with age and NT-pro-BNP. Screening and treating MetS may improve prognosis in AAV patients.Publication Metadata only 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 Open Access Humoral response to BNT162b2 and coronaVac in patients undergoing maintenance hemodialysis: A multicenter prospective cohort study(2023-01-01) TUĞCU, MURAT; TUĞLULAR, ZÜBEYDE SERHAN; MİRİOĞLU Ş., KAZANCIOĞLU R., Cebeci E., EREN N., Sakaci T., Alagoz S., Tugcu M., TUĞLULAR Z. S., SÜMBÜL B., Seyahi N., et al.Introduction: Data regarding inactivated vaccines for SARS-CoV-2 in patients undergoing maintenance hemodialysis (MHD) are limited. We aimed to investigate humoral responses induced by CoronaVac compared to BNT162b2 in this population. Methods: In this multicenter prospective cohort study, adult patients undergoing MHD who lacked a history of COVID-19 and decided to get vaccinated with BNT162b2 or CoronaVac were enrolled. Participants provided serum samples before, 1 and 3 months after 2 doses. Anti-SARS-CoV-2 IgG antibodies against receptor-binding domain of the virus were measured, and levels >= 50 AU/mL were considered as positive. Breakthrough infections and adverse events were recorded. Results: Ninety-two patients were included, 68 (73.9%) of whom were seronegative at baseline. BNT162b2 and CoronaVac were administered in 38 (55.9%) and 30 (44.1%) patients. At 1 month, seropositivity was 93.1% in BNT162b2 and 88% in CoronaVac groups (p = 0.519). Quantitative antibody levels were significantly higher in BNT162b2 (p < 0.001). At 3 months, both seropositivity (96.4% and 78.3%, p = 0.045) and antibody levels (p = 0.001) remained higher in BNT162b2 compared to CoronaVac. Five patients (7.4%) experienced breakthrough COVID-19. Adverse events were more frequent with BNT162b2, although all of them were mild. Multiple linear regression model showed that only vaccine choice (BNT162b2) was related to the humoral response (beta = 0.272, p = 0.038). Seropositive patients at baseline (n = 24) had higher antibody levels at any time point. Conclusions: BNT162b2 and CoronaVac induced humoral responses in naive patients undergoing MHD, which were more robust and durable for 3 months after BNT162b2. Both vaccines created high antibody levels in patients who were seropositive at baseline.Publication Open Access Characteristics and outcomes of hospitalised older patients with chronic kidney disease and COVID-19: A multicenter nationwide controlled study(WILEY, 2021-09) TUĞLULAR, ZÜBEYDE SERHAN; Ozturk, Savas; Turgutalp, Kenan; Arici, Mustafa; Gok, Mahmut; Islam, Mahmud; Altiparmak, Mehmet Riza; Aydin, Zeki; Doner, Baris; Eren, Necmi; Sengul, Erkan; Karadag, Serhat; Ozler, Tuba Elif; Dheir, Hamad; Pembegul, Irem; Taymez, Dilek Guven; Sahin, Garip; Bakirdogen, Serkan; Dolarslan, Murside Esra; Soypacaci, Zeki; Hur, Ender; Kara, Ekrem; Basturk, Taner; Ogutmen, Melike Betul; Gorgulu, Numan; Sahin, Idris; Ayli, Mehmet Deniz; Tuglular, Zubeyde Serhan; Sahin, Gulizar; Tokgoz, Bulent; Tonbul, Halil Zeki; Yildiz, Alaattin; Sezer, Siren; Odabas, Ali Riza; Ates, KenanObjective Older adults with co-morbidities have been reported to be at higher risk for adverse outcomes of coronavirus disease 2019 (COVID-19). The characteristics of COVID-19 in older patients and its clinical outcomes in different kidney disease groups are not well known. Methods Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between 17 April 2020 and 31 December 2020. Hospitalised patients aged 18 years or older with confirmed COVID-19 diagnosis suffering from stage 3-5 chronic kidney disease (CKD) or on maintenance haemodialysis (HD) treatment were included in the database. Non-uraemic hospitalised patients with COVID-19 were also included as the control group. Results We included 879 patients [388 (44.1%) female, median age: 63 (IQR: 50-73) years]. The percentage of older patients in the CKD group was 68.8% (n = 188/273), in the HD group was 49.0% (n = 150/306) and in the control group was 30.4% (n = 70/300). Co-morbidities were higher in the CKD and HD groups. The rate of presentation with severe-critical disease was higher in the older CKD and HD groups (43.6%, 55.3% and 16.1%, respectively). Among older patients, the intensive care unit (ICU) admission rate was significantly higher in the CKD and HD groups than in the control group (38.8%, 37.3% and 15.7%, respectively). In-hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD groups (26.7% and 30.1%) compared with the control group (8.6% and 17.1%). In the multivariate analysis, in-hospital mortality rates in CKD and HD groups were higher than control group [hazard ratio (HR): 4.33 (95% confidence interval [CI]: 1.53-12.26) and HR: 3.09 (95% CI: 1.04-9.17), respectively]. Conclusion Among older COVID-19 patients, in-hospital mortality is significantly higher in those with stage 3-5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, co-morbidities, clinical and laboratory data on admission.Publication Metadata only Strategies to prevent SARS-CoV-2 transmission in hemodialysis centres across Europe-lessons for the future(2023-03-01) TUĞLULAR, ZÜBEYDE SERHAN; Noordzij M., Meijers B., Gansevoort R. T., Covic A., Duivenvoorden R., Hilbrands L. B., Hemmelder M. H., Jager K. J., Mjoen G., Nistor I., et al.Background Early reports on the pandemic nature of coronavirus disease 2019 (COVID-19) directed the nephrology community to develop infection prevention and control (IPC) guidance. We aimed to make an inventory of strategies that dialysis centres followed to prevent infection with COVID-19 in the first pandemic wave. Methods We analyzed IPC measures taken by hemodialysis centres treating patients presenting with COVID-19 between 1 March 2020 and 31 July 2020 and that completed the European Renal Association COVID-19 Database centre questionnaire. Additionally, we made an inventory of guidelines published in European countries to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in dialysis centres. Results Data from 73 dialysis units located in and bordering Europe were analyzed. All participating centres implemented IPC measures to mitigate the impact of SARS-CoV-2 during the first pandemic wave. Measures mentioned most often included triage with questions before entering the dialysis ward, measuring body temperature, hand disinfection, masking for all patients and staff, and personal protective equipment for staff members. These measures were also recommended in most of the 14 guidelines that were identified in the inventory of national guidelines and were also scored as being among the most important measures by the authors of this paper. Heterogeneity existed between centres and national guidelines regarding the minimal distance between dialysis chairs and recommendations regarding isolation and cohorting. Conclusions Although variation existed, measures to prevent transmission of SARS-CoV-2 were relatively similar across centres and national guidelines. Further research is needed to assess causal relationships between measures taken and spread of SARS-CoV-2.