Person: TUĞCU, MURAT
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TUĞCU
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Publication Metadata only Sepsiste serum laktat yüksekliği-sidemi ilişkisinin böbrek fonksiyonları penceresinden incelenmesi(2022-12-08) TUĞCU, MURAT; AŞICIOĞLU, EBRU; ARIKAN, İZZET HAKKI; BARUTÇU ATAŞ, DİLEK; TUĞLULAR, ZÜBEYDE SERHAN; VELİOĞLU, ARZU; Karadağ H., Berke Menteşe İ., Barutçu Ataş D., Tuğcu M., Aşıcıoğlu E., Velioğlu A., Tuğlular Z. S. , Arıkan İ. H.Publication Open Access Low serum 25-OH vitamin D levels are associated with increased D/P creatinine ratio in peritoneal dialysis patients(2021-09-01) BARUTÇU ATAŞ, DİLEK; TUĞCU, MURAT; VELİOĞLU, ARZU; ARIKAN, İZZET HAKKI; AŞICIOĞLU, EBRU; BARUTÇU ATAŞ D., AYKENT M. B., ARIKAN İ. H., TUĞCU M., VELİOĞLU A., AŞICIOĞLU E.Low 25-OH vitamin D levels have been linked to peritonitis and cardiovascular mortality in peritoneal dialysis (PD) patients. In this study we aimed to investigate the association of 25-OH vitamin D levels with peritoneal membrane characteristics in chronic PD patients. Consecutive 103 PD patients were enrolled in this retrospective study. Peritoneal dialysate to plasma (D/P) creatinine increase more than 0.1 with time were accepted as significant according Roc curve analysis. Patients with and without an increase in the D/P creatinine ratio of 0.1 were classified as Group 1 and Group 2, respectively. The relationship between baseline 25-OH vitamin D and peritoneal membrane characteristics were investigated. Mean age of the patients was 53.4±14.9 years and duration of PD was 72.1±50.3 months. There were thirty (29.1%) patients in Group 1. The duration of PD [73.5 (52.3-133.8) vs 49.0 (33.5-94.0) months, p:0.008]; hemoglobin [11.4 (10.4-12.2) vs. 10.2 (9.4-11.0) g/dL, p:0.001]and PTH [500.5 (254.5-748.3) vs 329.0 (205.0-549.5)ng/mL, p:0.047] levels were significantly higher in Group 1, whereas 25-OH vitamin D levels [5.0 (3.0-9.3) vs 7.8 (4.5-11.1)μg/L, p:0.027] and CRP [4.0 (3.0-7.2) vs. 8.0 (3.0-13.5)mg/L, p:0.028] were significantly lower. Multivariate analysis revealed duration of PD [Exp(B):1.012 (95%CI:1.001-1.022), p:0.028]; hemoglobin [Exp(B):1.756 (95%CI:1.199-2.571), p:0.004]; C-reactive protein (CRP) [Exp(B):0.882 (95%CI:0.789-0.985), p:0.026] and 25-OH vitamin D [Exp(B):0.853 (95%CI:0.754-0.965), p:0.012] were independent predictors of an increase in D/P creatinine ratio in PD patients. Increased D/P creatinine ratio was negatively correlated with 25-OH vitamin D level (r: -0.217, p:0.028). Lower levels of initial 25-OH vitamin D were associated with an increase in D/P creatinine ratio over-time.Publication Metadata only Periton diyalizi hastalarında Covid-19 pandemi̇si’nin hijyen davranışları ve peritonit görülme sıklığı üzerine etkisi(2022-12-08) TUĞCU, MURAT; ARIKAN, İZZET HAKKI; AŞICIOĞLU, EBRU; BARUTÇU ATAŞ, DİLEK; VELİOĞLU, ARZU; Şimşek E., Barutçu Ataş D., Tuğcu M., Velioğlu A., Arıkan İ. H. , Aşıcıoğlu E.Publication Metadata only Primr FSGS ve ikinci FSGShastalarında karaciğer yağlanmasının karşılaştırılması(2019-10-16) ARIKAN, İZZET HAKKI; AKÇAY, SEÇKİN; TUĞCU, MURAT; VELİOĞLU, ARZU; KOÇ, MEHMET; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; Erbatur N. H., ARIKAN İ. H., AKÇAY S., TUĞCU M., VELİOĞLU A., AŞICIOĞLU E., KOÇ M., TUĞLULAR Z. S., ÖZENER İ. Ç.Giriş: Fokal segmental glomerüloskleroz (FSGS) çeşitli etiyolojiler sonrasında oluşan, podosit hasarı ve renal kitlede azalmadan kaynaklanan, glomerüllerin bir kısmında (fokal) ve etkilenen glomerülün bir bölümünde (segmental) skleroz ile karakterize histolojik bir lezyondur. FSGS genel olarak primer ve ikincil alt gruplarına ayrılır. Bu alt grupların bazı ortak klinik ve patolojik özellikleri olsa da tedavileri ve prognozları farklıdır ve bu nedenle ayrımları önemlidir. Bu ayrımda en önemli basamak olan elektron mikroskopunun ülkemizde rutin olarak uygulanmaması nedeni ile primer ve ikincil FSGS ayrımı güç olabilmektedir. Non-alkolik yağlı karaciğer hastalığı (NAFLD) ve kronik böbrek hastalığı (KBH) ilişkisi de göz önüne alındığında NAFLD’in ikincil FSGS etiyolojisinde rol oynayabileceği hipotezi kurulmuştur. Bizim çalışmamızın amacı primer ve ikincil FSGS ayrımın zor olduğu durumlarda ve hemodinamik FSGS’nin bilinen nedenlerinin (obezite, uyku apnesi) gösterilemediği durumlarda, tanıya yönlendirme amacı ile ikincil FSGS ile NAFLD arasındaki ilişkiyi araştırmaktır. Yöntem: Çalışmaya Marmara Üniversitesi Eğitim Araştırma Hastanesi’nde 2004 ile 2018 yılları arasında nefroloji bölümünden takipli ve böbrek biyopsisi ile FSGS tanısı alan 73 hasta dahil edildi. 18 yaş altı, ailesel/genetik FSGS, Fabry hastalığı, Virüs ilişkili FSGS, ilaç ilişkili FSGS tanılı hastalar çalışmaya dahil edilmedi. Hastane arşivinden ve elektronik veri sisteminden hastaların demografik özellikleri ve laboratuvar verileri retrospektif olarak toplandı. Nefrotik sendromun tüm komponentlerinin olduğu ve bilinen ikincil bir neden olmayan hastalar primer FSGS, hipoalbüminemi ve ödemi olmayan diğer hastalar ikincil FSGS kabul edildi. Primer ve ikincil FSGS tanılı hastalar demografik, klinik, laboratuvar ve ultrason (USG) ile tanımlanan karaciğer yağlanması açısından karşılaştırıldı. Bulgular: Hastaların 46’sı (%63) erkek, 27’si (%37) kadındı. Hastaların 29’u (%39,7) primer FSGS, 44’ü (%60,3) ikincil FSGS olarak değerlendirildi. Primer FSGS tanılı 2 (%6,9) hastada hepatosteatoz saptandı, 27 hastada (%93,1) ise hepatosteatoz yoktu, ikincil FSGS tanılı 26 (%59,1) hastada hepatosteatoz saptandı, 18 hastada (%40,9) ise hepatosteatoz yoktu. İkincil FSGS tanılı hastalarda hepatosteatoz primer FSGS hastalarına göre daha sık olup anlamlı fark bulunmaktadır. (P<0,001) Sonuç: Çalışmamızda ikincil FSGS tanılı hastalarda karaciğer yağlanmasının, primer FSGS hastalarına göre daha sık görüldüğü bulunmuştur. Bu sonuç NAFLD KBH arasındaki ilişki de göze alındığında NAFLD’ın ikincil FSGS ile ilişkili olabileceğini desteklemektedir. Primer ve ikincil FSGS ayrımı hem elektron mikroskopuna ulaşım güçlüğü hem de bilinen bir biyomarker olmaması nedeni ile zorluğunu korumaktadır. Primer ve ikincil FSGS ayrımın zor olduğu durumlarda ve hemodinamik FSGS’nin bilinen nedenlerinin (obezite, uyku apnesi) gösterilemePublication Metadata only Kronik böbrek hastalığı olan yaşlı hastalarda mortalite belirteci: Prognostik beslenme indeksi(2021-09-22) TUĞCU, MURAT; VELİOĞLU, ARZU; ARIKAN, İZZET HAKKI; KOÇ, MEHMET; BARUTÇU ATAŞ, DİLEK; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; BARUTÇU ATAŞ D., TUĞCU M., AŞICIOĞLU E., VELİOĞLU A., ARIKAN İ. H., KOÇ M., TUĞLULAR Z. S.Publication Metadata only The relationship between perceived stress with anxiety, depression, sleep quality, insomnia and drug adherence in patients with systemic lupus erythematosus during the covid-19 pandemic(2022-05-01) DİRESKENELİ, RAFİ HANER; BARUTÇU ATAŞ, DİLEK; ARIKAN, İZZET HAKKI; GÖKMEN YILDIRIM, KARDELEN; VELİOĞLU, ARZU; ALİBAZ ÖNER, FATMA; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; TUĞCU, MURAT; GÖKMEN YILDIRIM K., BARUTÇU ATAŞ D., TUĞCU M., VELİOĞLU A., ARIKAN İ. H., ALİBAZ ÖNER F., DİRESKENELİ R. H., TUĞLULAR Z. S., AŞICIOĞLU E.AIMS: Sleep disorders, depression and anxiety are commonly reported in patients with systemic lupus erythematosus (SLE). Public health emergencies such as pandemics can also increase these psychosocial distresses. Early diagnosis and treatment of these disorders will substantially affect patients' quality of life and medication adherence. The aim of this study was to evaluate both medication non-adherence and the incidence of perceived stress, anxiety, depression, sleep quality and insomnia during the COVID pandemic in patients with SLE. METHOD: This was a cross-sectional, descriptive survey study. A total of 211 participants, including 160 SLE patients aged 18 years and older and 51 healthy volunteers who were similar in age and gender, were included. A questionnaire of socio-demographics and COVID-19 status, Medication Compliance Reporting Scale (MARS-5), Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HADA and HAD-D), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) scales was assessed. The participants were interviewed face to face, and the answers were recorded by the researcher. RESULTS: The mean age of the patients was 41.85 ± 12.97 years and 142 (88.7%) of the patients were female. There was no significant difference between the patient and control groups in terms of the history of COVID-19 infection, symptoms and hospitalization. Fifty-nine (36.9%) patients had high perceived stress, 16 (10.0%) had anxiety, 45 (28.1%) had depression, 77 (48.1%) had poor sleep quality and 62 (38.8%) patients had insomnia. PSS (23.64 ± 7.86 versus 19.73 ± 4.80, P = .001), HAD-D (5.60 ± 3.40 versus 4.08 ± 2.21, P = .003), PSQI (6.31 ± 3.62 versus 4.43 ± 2.20, P = .001) and ISI (6.81 ± 4.98 versus 4.53 ± 2.83, P = .002) scores were significantly higher in the patient group than controls. Patients with PSS score ≥ 25 were categorized as patients with a high PSS score. Presence of anxiety, depression, poor sleep quality and insomnia were significantly higher in patients with a high PSS score. Medication non-adherence was detected in 79 (49.4%) of the patients. Interestingly, there was no difference in MARS-5 scores between high and low PSS groups. Comparison of baseline characteristics and clinical data of the patients according to PSS score is shown in Table 1. The high PSS score was positively correlated with HAD-A, HAD-D, PSQI and ISI scores. Regression analysis revealed that high perceived stress is an independent predictor of depression [Exp(β) 95% CI 1.488 (1.245-1.779), P < .001], and anxiety [Exp(β) 95% CI 1.235 (1.026-1.487), P = .026]. CONCLUSION: SLE patients demonstrated increased levels of perceived stress, depression, poor sleep quality and insomnia compared to the healthy population during the COVID-19 pandemic. SLE patients with high perceived stress had more depression, anxiety, poor sleep quality and insomnia than those without. It needs to be determined whether these findings will have an impact on patient outcomes during long-term follow-up. Palavras-chave adult; anxiety; conference abstract; controlled study; coronavirus disease 2019; depression; female; follow up; gender; Hospital Anxiety and Depression Scale; hospitalization; human; incidence; insomnia; Insomnia Severity Index; major clinical study; male; medication compliance; outcome assessment; pandemic; Perceived Stress Scale; physiological stress; Pittsburgh Sleep Quality Index; questionnaire; sleep quality; sociodemographics; systemic lupus erythematosus; young adultPublication Open Access Prevalence and predictors of 25-OH vitamin D deficiency in peritoneal dialysis patients: A single center study(2021-09-01) VELİOĞLU, ARZU; TUĞCU, MURAT; AŞICIOĞLU, EBRU; BARUTÇU ATAŞ, DİLEK; ARIKAN, İZZET HAKKI; BARUTÇU ATAŞ D., VELİOĞLU A., TUĞCU M., ARIKAN İ. H., AŞICIOĞLU E.Vitamin D has a critical role in bone-mineral disorders in chronic kidney disease (CKD) and its deficiency is further associated with increased cardiovascular morbidity and mortality among CKD patients. We aimed to evaluate prevalence of vitamin D deficiency and investigate the laboratory and clinical parameters associated with 25- OH vitamin D deficiency in peritoneal dialysis (PD) patients. Sixty-four (33M/31F) peritoneal dialysis patients were enrolled in this retrospective single center study. Clinical and laboratory data were obtained from patient charts. Prevalence of 25-OH vitamin D deficiency and its associations were analyzed. The patients’ mean age was 49.7±13.3 years and the mean duration of PD was 61.0±55.0 months. The mean 25-OH vitamin D level was 8.9±2.4 ng/ml and none of the patients were on 25-OH vitamin D therapy. All of the patients had lower than normal 25-OH vitamin D levels according to KDOQI guidelines. Levels of 25-OH vitamin D were deficient and insufficient in 84.4% (57.8% mild; 26.6% severe) and 15.6% of the patients, respectively. There was no association between 25-OH vitamin D levels and sex, age, BMI, duration of PD and cause of ESRD. There was a negative correlation between 25-OH vitamin D levels and uric acid and parathyroid hormone. Uric acid was an independent predictor of 25-OH vitamin D deficiency in the logistic regression analysis [OR (95%CI): 0.139 (0.029-0.667), p: 0.014]. We conclude that 25-OH vitamin D deficiency is very common in PD patients. Serum uric acid is an independent predictor of 25-OH vitamin D deficiency which should further be investigated in larger studies.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.