Bennur Esen

Evaluation of relationship between sexual functions, depression and quality of life in patients with chronic kidney disease at predialysis stage

Abstract Aim: The relation of chronic kidney disease (CKD) with metabolic, psychiatric and endocrinologic disorder is well-known. Depressive mood and sexual dysfunction are frequently observed as renal functions deteriorate. We aimed to analyze the relationship of sexual dysfunction, depressive mood and life quality in patients with CKD at predialysis stage. Patients and methods: Fifty-three patients; 27 female and 26 male with CKD who had estimated glomerular filtration rate (eGFR) between 15 and 90 mL/min and followed up in the Nephrology Department, Bursa Sevket Yılmaz Education and Research Hospital, were enrolled. Age- and sex-matched 20 female and 20 male healthy control subjects were assigned to the control group. Detailed medical and sexual history was obtained by using Female Sexual Function Index (FSFI), Erectile Function International Evaluation Form (IEFF), Short form (SF) 36 Form and Beck Depression Questionnaire (BDI). Biochemical and hormonal parameters including urea, creatinine, uric acid, sedimentation rate, c-reactive protein, total testosterone, DHEA-S, FSH, LH, TSH, estradiol and prolactin were analyzed. Findings: Depression was observed in 12 male (46%) and 14 female (51%) patients. The frequency of depression among male patients and control subjects was similar, however, significantly higher in female patients than female controls (p = 0.036). Physical function score, physical role score and pain score in SF 36 of entire patients were significantly lower than controls (p = 0.0001, 0.0001, 0.001, respectively). The frequency of depression was similar between patients and controls (p > 0.05). When SF 36 tests of male and female patients were compared, general health status, vitality and mental health status were significantly better in male patients (p = 0.005, 0.016, 0.035, respectively). SF 36 scores of female patients were significantly lower than female controls (p = 0.0001). The frequency of erectile dysfunction (ED) was similar between male patients (84%) and controls (75%) (p = 0.62). On the other hand, sexual dysfunction was significantly higher in female patients when compared to female controls (92% vs. 30%; p = 0.0001). Conclusion: We showed that sexual dysfunction and depression are more frequent among female patients with CKD at predialysis stage; however, it does not have significant impact on life quality. When life quality of female and male patients was compared, general health status, vitality and mental health status of female patients were poorer. We failed to demonstrate a relationship between sexual dysfunction and sex hormone level.

Is hemodialysis a reason for unresponsiveness to hepatitis B vaccine? Hepatitis B virus and dialysis therapy.

Impaired renal function is associated with a high risk of chronicity of hepatitis B virus (HBV) infection. Patients on hemodialysis (HD) or peritoneal dialysis are at an increased risk of viral transmission due to frequent necessity of blood product transfer as well as use of contaminated dialysate or dialysis materials. Additionally, health professionals may cause viral spread via contaminated hands and carelessness against hygiene rules. The frequency of chronic HBV infection may be as high as 80% in patients on renal replacement therapies. This is because HBV vaccination is essential to eliminate chronic HBV infection. However, response rates of HD patients to HBV vaccination vary between 10%-50%. Dialysis adequacy and early vaccination before the onset of dialysis therapy seem to be major determinants of high seroconversion rates. Older age, male gender, duration of dialysis therapy and nutritional status are other well-known factors associated with seroconversion rate. There are controversial reports regarding the role of the presence of diabetes mellitus, HCV positivity, erythropoietin resistance, hyperparathyroidism, and vitamin D inadequacy. The role of genetic alteration in the functions or production of cytokines still needs to be elucidated.

The relation of mean platelet volume with microalbuminuria and glomerular filtration rate in obese individuals without other metabolic risk factors: the role of platelets on renal functions.

INTRODUCTION Mean platelet volume (MPV) is an indirect indicator of platelet activity that plays a major role in the pathogenesis of endothelial injury. Obese individuals have higher microalbuminuria which is the initial step of renal endothelial injury. We aimed to analyze the relation of microalbuminuria and MPV in obese individuals without metabolic risk factors. METHODS A total of 290 obese individuals (body mass index (BMI)>30 kg/m2) without an accompanying chronic disorder, and 204 nonobese healthy subjects were enrolled into the study. All participants underwent physical examination. Biochemical, hemogram, and hormonal parameters along with urine albumin analysis were performed. Glomerular filtration rate (GFR) was measured by Cockcroft-Gault (GFRC&G), modification of diet in renal disease (MDRD). The BMI was calculated as weight/height2 (kg/m2). Logistic regression analysis was used to analyze relation of variables. RESULTS The patient group consisted of 171 (59%) female (mean age: 37.15±8.05 years) and 119 (41%) male (mean age 38.98±10.68 years) obese individuals. 130 (63.7%) age matched female (mean age 36.18±8.26 years) and 74 (36.3%) age matched male (mean age 36.49±10.25 years) controls were assigned to the control group. There was a significant difference between groups with regard to BMI, spot microalbuminuria, spot urine microalbuminuria/creatinine ratio but not with to MPV and spot urine creatinine (p: 0.01, 0.004, 0.002; respectively). GFR measured by MDRD and Cockcroft-Gault formula were significantly higher in the obese group (p<0.001 for both). Correlation analysis revealed a significant correlation between BMI and spot urine microalbuminuria, spot urine microalbuminuria/creatinine ratio, GFR (Cockcroft-Gault Formula), Homeostasis Model Assessment of Insulin resistance (HOMA-IR), insulin, C-peptide, diastolic blood pressure, glucose, uric acid, total cholesterol, low density lipoprotein (LDL)-cholesterol, c-reactive protein (CRP), thyroid stimulating hormone (TSH), leukocyte count, platelet count. MPV was inversely and significantly correlated with spot urine creatinine, systolic blood pressure, triglyceride, C-peptide, and platelet count. Mean urea, creatinine, uric acid, triglyceride, total cholesterol, LDL-cholesterol, insulin, C-peptide, HOMA-IR were significantly higher in obese male individuals while obese female individuals had higher levels of mean high density lipoprotein (HDL), CRP, TSH, platelet count, spot urine microalbumin/creatinine rate, and GFR measured by MDRD. CONCLUSIONS Obese individuals have higher microalbuminuria and nonsignificantly elevated MPV, however, urine albumin loss is independent of MPV.

The association of endothelial nitric oxide synthase gene G894T polymorphism and serum nitric oxide concentration with microalbuminuria in patients with gestational diabetes.

AIM Gestational diabetes mellitus (GDM) is a glucose intolerant condition that affects 14% of all pregnancies. Diabetes mellitus (DM) occurs in 30 - 70% of patients with GDM after delivery. DM and GDM are associated with structural and functional deterioration of the renovascular system. Our aim is to investigate the association Glu- 298Asp polymorphism of the endothelial nitric oxide synthase (eNOS) gene with serum nitric oxide levels and microalbuminuria in patients with GDM and healthy pregnancies. MATERIAL AND METHODS Serum nitric oxide (NO) levels, urinary excretion of albumin and Glu298Asp polymorphism of the eNOS gene were analyzed in 68 patients with GDM and 73 healthy controls. High performance liquid chromatography (HPLC-Griess) method was used to analyze serum NO levels. Microalbuminuria was evaluated by rate nephelometry method. The Glu298Asp polymorphism of the eNOS gene was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). RESULTS Nitric oxide, glucose, creatinine, and microalbuminuria were significantly different between the patients and the control subjects (p = 0.001, p = 0.001, p = 0.002, and p = 0.005, respectively). There was a significant difference between groups in terms of the ratio of GG/GT+TT of eNOS gene Glu- 298Asp (p = 0.02). The patients with GT+TT genotype had significantly higher microalbuminuria levels and lower NO concentrations (22.16 vs. 9.51, p = 0.005, and 10.56 vs. 12.73, p = 0.021, respectively). The presence of T allele of eNOS gene is an independent predictor of microalbuminuria (OR: 2.346, 95% confidence interval: 1.247 - 5.238, p = 0.02) as well as serum glucose and NO concentration. CONCLUSION The G894T polymorphism of eNOS gene and decreased NO concentration seem to be independent predictors of increased urinary excretion of albumin in patients with GDM. Determining the frequency of eNOS gene G894T polymorphism may help to identify pregnancies at increased risk of microalbuminuria.

Evaluation of serum Spondin 2 levels in the different stages of Type 2 diabetic nephropathy

We aimed to determine whether serum SPON2 is a useful biomarker in the detection of Diabetic Nephropathy (DN) and to compare serum SPON2 levels with 24‐hour urinary albumin excretion rate (UAER) in patients with DN at different stages.

Evaluation of diabetes risk among Turkish nurses: The role of insulin resistance and life style on diabetes risk

Abstract Aims: The aim of this study was to investigate diabetes risk in healthy young nurses in a Training and Research Hospital in Turkey. Methods: The study was conducted in 338 nurses. Entire participants underwent laboratory examination including biochemical analysis and homoeostasis model assessment of insulin resistance. Risk of developing diabetes questionnaire (FINDRISK) was performed by interviewing with nurses. Pearsons simple linear regression analysis, Students t-test, chi-square and Fishers exact test were used for statistical analysis. Results: Insulin resistance (IR) and impaired fasting glucose were observed in 41.1% (n = 139) and 21.6% (n = 73), respectively. Only 42.6% of participants had normal body mass index whereas 34.6% were overweight and 22.8% were obese. The percentage of nurses under the age of 45 years was 83.4%, of this population, only 17.8% of them had a lower diabetes risk. Conclusions: Individuals with low diabetes risk may exhibit IR; however, IR is more frequent in individuals with high diabetes risk. Preventive measures and public awareness about these measures play a crucial role against diabetes risk.

Serum ICAM-1 level and ICAM-1 gene 1462A>G (K469E) polimorphism on microalbuminuria in nondiabetic, nonhypertensive and normolipidemic obese patients: Genetical background of microalbuminuria in obesity

BACKGROUND A growing body of evidence suggest that obese individuals are under risk of renal parenchymal disorders when compared to nonobese counterparts. Microalbuminuria is the early marker of renal involvement. Although most of obese patients carries multiple risk factors for microalbuminuria, some obese individuals without risk factor may progress to microalbuminuria. The present study was performed to examine the role of ICAM-1 gene 1462A>G (K469E) polymorphism on microalbuminuria in obese subjects without diabetes mellitus, hypertension, hiperlipidemia and older age. METHODS Ninety eight obese and 96 nonobese individuals without a comorbidity enrolled into the study. Serum ICAM-1 level was measured by enzyme linked immunoabsorbent assay (ELISA) method. ICAM-1 gene 1462A>G (K469E) polymorphism was examined by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR). Nepholometric method was used to examine urinary albumin loss, and microalbuminuria was measured by albumin to creatinine ratio. RESULTS Obese individuals had significantly higher microalbuminuria and proteinuria level compared to nonobese subjects (p: 0.043 and p: 0.011; respectively). GG genotype of ICAM-1 carriers have significantly higher microalbuminuria compared to individuals with AA or AG genotype carriers (p: 0.042). Serum ICAM-1 level was significantly correlated with creatinine and microalbuminuria (p: 0.002 and p: 0.03; respectively). Logistic regression analysis indicated a 7.39 fold increased risk of microalbuminuria in individuals with GG genotype of ICAM-1 gene 1462A>G (K469E) polymorphism. CONCLUSIONS GG genotype of ICAM-1 gene K469E polymorphism is associated with increased microalbuminuria in obese individuals without another metabolic risk factor.

Oxidative Stress and Gastrointestinal System Cancers

Abstract During cellular processes, free radicals are produced and removed which have potential to cause cellular damage via different pathways. Oxidative stress (OS) is a result of imbalance between free radical production and elimination, which the accumulation of free radicals may cause group disorders including atherosclerotic vascular disorders and cancer. Carcinogenesis is a multistep process including metaplasia to overt cancer that has significantly related to internal and external oxidative agents. Gastrointestinal tract is the susceptible area to dietary oxidants and microbial agents. Lack of available data exists with regard to exact relation of OS and common gastrointestinal system cancers. In this chapter, complex interaction of OS and five most common gastrointestinal system cancers were summarized.

The relation of anthropometric measurements and insulin resistance in patients with polycystic kidney disease

Abstract Objective To examine the frequency of insulin resistance (IR) and its relation with anthropometric measurements in patients with autosomal dominant polycystic kidney disease (ADPKD). Material and Methods Nonobese 82 patients with ADPKD and 58 age matched healthy controls were enrolled into the study. None of participants were diabetic or receiving renal replacement therapies (RRT). IR was determined by homeostasis model assessment of insulin resistance (HOMA-IR) formula. Tanita body composition analyzer was used for anthropometric measurements. Creatinine clearance of participant were assessed by the modification of diet in renal diseases (MDRD). Results Patients with ADPKD had significantly higher level of urea and creatinine, microalbuminuria, and lower level of MDRD. Body fat distribution and HOMA-IR in both the groups were similar. Systolic and diastolic blood pressure of patients were higher than those of controls. Conclusion We failed to determine a higher frequency of IR among patients with ADPKD.

The Relation of Serum 25-Hydroxy Vitamin D3 with Inflammation and Indirect Markers of Thrombotic Activity in Patients with End Stage Renal Disease

Background: Patients with end stage renal disease (ESRD) have increased inflammatory and thrombotic activity. Lacks of available data exist on pro-inflammatory and prothrombotic properties of low serum 25-OH-D3 level. We aimed to analyse the association of 25-OH vitamin D with indirect markers of inflammatory and thrombotic activity in patients on haemodialysis (HD) or peritoneal dialysis (PD). Methods: A total of 104 patients with ESRD receivin g renal replacement therapy (RRT) were enrolled into this prospective study. Seventy patients on HD and 34 age matched patients on PD with similar duration of ESRD and RRT were from same geographical area and had similar sunlight exposure. The mean age of patients on HD and PD were 56.59 ± 18.19 years and 53.26 ± 10.6 years; respectively. Fasting blood samples were obtained before dialysis session to analyse serum creatinine, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocyte count, platelet count, platecrit (PCT), haemoglobin, haematocrit and 25-OH-D3. Results: There was no significant difference between patients on PD and HD in terms of serum calcium, phosphorus, parathormon, CRP, ESR, ferritin and bicarbonate levels. Patients on PD had significantly lower level of 25-OH-D3 (9.35 ± 7.69 vs 4.71 ± 3.01, p: 0.0001). Leukocyte count, platelet count, haemoglobin, haematocrit, RDW, neutrophil ratio, monocyte ratio, neutrophil count and PCT were significantly higher in PD patients (p: 0.001, p<0.001, p<0.001, p: 0.002, p: 0.020, p: 0.034, p: 0.009, p: 0.001, p: 0.001; respectively). There was a significant association between 25 hydroxy vitamin D3 with, CRP, ESR and haematocrit in PD group but not in HD group (p:0.019, p:0.002, p:0.025 respectively). Female patients in both groups had lower 25-OH-D3 level than male dialysis patients (p: 0.0001). Multiple regression analysis revealed out a significant effect of CRP, sedimentation, haematocrit, platelet count and PCT on D vitamin level (p: 0.022). Conclusion: Low serum 25-OH-D3 level reflects increased inflammatory and platelet activity in PD patients.