Person: BARUTÇU ATAŞ, DİLEK
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BARUTÇU ATAŞ
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DİLEK
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Publication Open Access Prediction of subclinical left ventricular dysfunction by speckle-tracking echocardiography in patients with anti-neutrophil cytoplasmic antibody--associated vasculitis(2021-12-24) İZGİ, TUBA NUR; ATAŞ, HALİL; VELİOĞLU, ARZU; BARUTÇU ATAŞ, DİLEK; ILGIN, CAN; ALİBAZ ÖNER, FATMA; DİRESKENELİ, RAFİ HANER; ARIKAN, İZZET HAKKI; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; Izgi T. N., Atas D., ATAŞ H., Akaslan D., Ilgin C., VELİOĞLU A., ARIKAN İ. H., Alibaz-Oner F., DİRESKENELİ R. H., TUĞLULAR Z. S., et al.Objectives: This study aims to evaluate left ventricular functions using speckle-tracking echocardiography (STE) in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Patients and methods: Between June 2018 and July 2019, a total of 31 AAV patients (17 males, 14 females; median age: 53 years; range, 47 to 62 years) and 21 healthy controls (11 males, 10 females; median age: 56 years; range, 46 to 60 years) were included in the study. Clinical and biochemical characteristics of all participants were recorded. All participants underwent conventional and two-dimensional STE. The receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value of serum N-terminal prohormone of brain natriuretic peptide (NT-pro-BNP) that predicted subclinical left ventricular dysfunction. The Spearman correlation analysis was used to determine the correlation between left ventricular global longitudinal strain (LV-GLS) and NT-pro-BNP. Results: The LV-GLS was lower in AAV patients (19.3% vs. 21.7%, respectively; p=0.014). NT-pro-BNP was negatively correlated with LV-GLS (p=0.005, r=0.401). Conclusion: Subclinical left ventricular dysfunction can be detected by STE in patients with AAV who have free of clinically overt cardiovascular disease. The LV-GLS is negatively correlated with serum NT-pro-BNP levels.Publication Open Access Etiology and the impact of refractory peritonitis on clinical outcomes of patients on peritoneal dialysis-12 years' single-center experience from Turkey(2022-05-01) TUĞCU, MURAT; BARUTÇU ATAŞ, DİLEK; ARIKAN, İZZET HAKKI; VELİOĞLU, ARZU; AŞICIOĞLU, EBRU; Mentese I. B., Atas D., Arikan I. H., Tugcu M., Velioglu A., Asicioglu E.BACKGROUND AND AIMS: The outcomes of refractory peritonitis in peritoneal dialysis (PD) patients have been reported to be inferior to those of solitary peritonitis. The current study aimed to examine the factors associated with treatment failure in PD patients experiencing refractory peritonitis. METHOD: This single-center retrospective study included all episodes of refractory peritonitis in adult PD patients in Marmara University Hospital, Turkey, between 2009 and 2020. Patient characteristics, microbiological data, outcomes and factors associated with refractory peritonitis were analysed. The primary outcome was peritonitis-related catheter loss. Secondary outcomes were hospitalization and peritonitis-related death. RESULTS: Overall, 236 episodes of refractory peritonitis occurring in 135 patients were included. Gram-positive, gram-negative and fungal infections accounted for 44.1%, 20.4% and 2.4% of all peritonitis episodes, respectively. Forty-seven patients (34.8%) needed catheter removal, 2 patients (1.5%) died due to peritonitis complications and 59 episodes (25%) needed hospitalization. Mean fifth day PD fluid cell count was significantly greater among patients who required PD catheter removal (3621.3 ± 3144.1 versus 1589.4 ± 2316.6 P < 0.001). Furthermore, patients with >1000/mm3 cell count on the fifth day had higher rate of catheter removal (72.3% versus 37.6%, P < 0.001) as compared to patients with cell count und 00/mm3. Treatment failure was more common in peritonitis episodes caused by gram (−) organisms (31.9% versus 14.8%, P:0.012). Pseudomonas and fungi-associated peritonitis were also significantly correlated with catheter loss (P:0.001 and P: <0.001) (Table 1). When peritonitis episodes with more and <1000 cells/mm3 on the fifth day were compared, there were more episodes with gram (−) bacteria (29.7% versus 12.9%, P:0.003) and hospitalization (41.9% versus 11.4%, P: <0.001) in the group with more than 1000 cells/mm3. In the multivariate analysis, factors associated with catheter loss were a cell count of >1000 on the fifth day and hospitalization, while presence of gram (+) bacteria related peritonitis was inversely correlated with catheter loss (Table 2). CONCLUSION: Our study shows that the PD cell count on the fifth day of peritonitis can be used as a prognostic tool to determine the prognosis of refractory peritonitis episodes. Although we were unable to show the adverse prognostic effect of gram (−) bacteria related peritonitis, gram (+) bacteria related peritonitis was associated with better outcome. Prospective studies are needed to assess the risk factors for adverse outcomes of patients with refractory peritonitis, as the evidence in this area is sparse.Publication Open Access Sarcopenia predicts mortality in renal transplant candidates(2022-05-01) BARUTÇU ATAŞ, DİLEK; ARIKAN, İZZET HAKKI; ÇOBAN, HARUN; AŞICIOĞLU, EBRU; ÇİMŞİT, CANAN; VELİOĞLU, ARZU; TUĞCU, MURAT; TUĞLULAR, ZÜBEYDE SERHAN; KURŞUN, MELTEM; ÇOBAN H., BARUTÇU ATAŞ D., KURŞUN M., TUĞCU M., AŞICIOĞLU E., ARIKAN İ. H., Cimsit C., TUĞLULAR Z. S., VELİOĞLU A.BACKGROUND AND AIMS: Sarcopenia is common in chronic kidney disease (CKD) and is associated with increased mortality and morbidity. Sarcopenia in CKD can be defined as a decreased muscle mass, mainly due to the catabolic state caused by the uremic environment. Malnutrition and inflammation are also common in sarcopenic patients. In this study, we aimed to investigate the prevalence of sarcopenia defined as low muscle mass determined by Psoas Muscle Index (PMI) in waitlisted end-stage renal disease (ESRD) patients and its association between ‘Prognostic Nutritional Index (PNI)’, ‘C-reactive protein (CRP) to Albumin Ratio (CAR)’ and mortality. METHOD: ESRD patients registered to national kidney transplant waiting list and had abdomen CT at admission were included in the study. Kidney donor candidates were constituted as healthy controls. PMI (cm2/m2) were calculated by proportioning the psoas muscle area detected in the abdomen CT with the square of the height. The PMI of the controls at the fifth percentile according to gender was accepted as the limit value for sarcopenia. PNI and CAR were calculated using albumin, CRP and absolute lymphocyte count. The associations between PMI, PNI, CAR and all-cause mortality were investigated. RESULTS: A total of 162 ESRD patients and 87 age matched healthy controls were included in the study. The mean age of the patients was 44.7 ± 14.2 years and followup time was 3.37 (0.35–9.60) years. The mean PMI were similar between the groups (5.24 ± 1.71 versus 5.48 ± 1.87 cm2/m2, P = 0.302). While prevalence of sarcopenia (16.7% versus 3.4%, P = 0.002) and CAR [1.47 (0.12–37.10) versus 0.74 (0.21–10.20), P < 0.001] was higher; PNI [40 (20.4–52.2) versus 44 (36.1–53.0), P < 0.001] was lower in ESRD patients than controls. When ESRD patients compared according to sarcopenia PMI [3.45 ± 0.9 versus 5.59 ± 1.6, P < 0.001] and PNI [39 (20.4–51) versus 41 (23–52.2), P = 0.005] was significantly lower and CAR [2.03 (0.28–34.65) versus 1.28 (0.12–37.1), P = 0.041] was higher in sarcopenic ESRD group than nonsarcopenic ESRD group (Table 1). In the correlation analysis, PMI was positively correlated with PNI (r = 0.246, P = 0.002), no correlated with CAR (r = −0.061, P = 0.445). In the follow-up, 67 waitlisted patients had been transplanted. In the five-year survival analysis, the non-sarcopenic transplant group [95% CI: 4.612–5.123 versus 95% CI: 2.721–5.413, P = 0.001] had better survival than sarcopenic transplant group (Figure 1). Mortality rates were similar in both sarcopenic transplant group and non-sarcopenic-non-transplant group. Multivariate regression analysis showed that sarcopenia (HR: 10.277, 95% CI: 3.912–27.000, P < 0.001), not having a transplant (HR: 3.949, 95% CI: 1.301–11.993, P = 0.015), low PNI (HR: 3.532, 95% CI: 1.303– 9.574, P = 0.013) and duration of renal replacement therapy (HR: 1.009, 95% CI: 1.002–1.015, P = 0.008) were independent risk factors for mortality in all ESRD group. CONCLUSION: In this study we observed that sarcopenia, as defined by low muscle mass, is almost seen five times more frequent in ESRD patients than controls and positively correlated witPublication Open Access Clinical outcomes in peritoneal dialysis with refractory peritonitis: significance of the day 5 cell count(2024-01-01) BERKE MENTEŞE, İLAY; BARUTÇU ATAŞ, DİLEK; TUĞCU, MURAT; ARIKAN, İZZET HAKKI; VELİOĞLU, ARZU; AŞICIOĞLU, EBRU; BERKE İ., BARUTÇU ATAŞ D., TUĞCU M., Arikan H., VELİOĞLU A., AŞICIOĞLU E.Background: Peritoneal dialysis-associated peritonitis is a common and severe complication of peritoneal dialysis, associated with high morbidity and mortality. However, there’s a lack of research on refractory peritonitis, which is difficult to manage and has a poor prognosis. Our study aimed to investigate factors affecting clinical outcomes in peritoneal dialysis patients with refractory peritonitis over a 12-year period at a medical faculty hospital in Turkey. Methods: We conducted a retrospective study at a single center from January 2009 to December 2020, involving 135 patients with 236 episodes of refractory peritonitis. The average age of the patient cohort was 53.0 ± 15.9 years, and 72 (53.4%) of the patients were male. The leading identified causes of end-stage kidney disease were glomerulonephritis, hypertensive glomerulosclerosis, and diabetic nephropathy. Data on microbiological etiology, dialysate white blood cell counts, and patient demographics were analyzed to identify catheter removal risk factors. Statistical significance was set at p ≤ 0.05. Results: Comparative analysis between patients with and without catheter loss revealed no significant differences in gender, age, presence of diabetes, prior hemodialysis, or duration of peritoneal dialysis. However, multivariate logistic regression analysis showed that a dialysate white blood cell count exceeding 1000/mm3 on day 5 and hospitalization had a positive association with catheter loss, while the presence of gram-positive bacterial growth had an inverse correlation. Conclusion: Our study shows that fifth-day dialysate white blood cell count predicts refractory peritonitis outcomes. Future research should focus on developing tools to manage catheter removal proactively and enhance patient prognosis.