Gulali Aktas

Serum Levels of Omentin in End-Stage Renal Disease Patients

Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis patients. Therefore, evaluation and prevention of cardiovascular diseases in end-stage renal disease (ESRD) patients are very important. The plasma level of omentin was found to be associated with different conditions such as insulin resistance. It is one of the novel adipokines synthesized mainly in the visceral adipose tissue. In this study, we aimed to investigate the level of omentin in patients with ESRD receiving hemodialysis. Methods: The study population consisted of 59 adult chronic hemodialysis patients (30 women and 29 men) and age-matched control subjects were selected from apparently healthy subjects (28 participants; 14 women and 14 men). Blood samples were obtained before the dialysis session. Omentin concentrations were determined by using enzyme-linked immunosorbent assay. Results: Plasma levels of omentin were found to be markedly higher in ESRD patients (606.6 ± 313.0 ng/ml) than in the control group (357.5 ± 147.4 ng/ml; p < 0.0001). Also, serum omentin levels were found to be correlated with creatinine (r = 0.333, p = 0.002). Conclusions: Omentin levels were found to be elevated in patients with ESRD receiving hemodialysis. To the best of our knowledge, this is the first clinical study that demonstrated the association between omentin and ESRD.

Does the kidney injury molecule-1 predict cisplatin-induced kidney injury in early stage?

Background It is not possible to diagnose acute kidney injury (AKI) in early stages with traditional biomarkers. Kidney injury molecule-1 (KIM-1) is a novel biomarker promising the diagnosis of AKI in early stages. We studied whether urinary and serum KIM-1 (KIM-1 U and KIM-1 S ) concentrations were useful in predicting cisplatin-induced AKI in early stages. Methods We prospectively analysed 22 patients on cisplatin treatment. KIM-1 S and KIM-1 U concentrations were assessed in the samples of the patients on four different time periods (before treatment [BT], first [AT1], third [AT3] and fifth [AT5] day after treatment). Results KIM-1 U concentrations on the first day after cisplatin treatment in patients with AKI were significantly increased compared to both KIM-1 U concentrations of the same patients BT (P = 0.009) and to AT1-KIM-1 U concentrations of the patients without AKI (P = 0.008). A receiver operating characteristic analysis revealed that AT1-KIM-1 U concentrations may predict AKI with an 87.5% sensitivity and 93.3% specificity (area under the curve = 0.94). KIM-1 S concentrations were not significantly changed between BT and AT periods. Conclusions KIM-1 U concentrations may predict cisplatin-induced AKI in early stages with high sensitivity and specificity.

Could red cell distribution width be a marker in Hashimoto's thyroiditis?

AIMS Hashimotos Thyroiditis (HT) is the most common autoimmune thyroiditis worldwide and characterized with lymphomonocytic inflammation of the thyroid gland. Red cell distribution width (RDW) reflects erythrocyte anisocytosis and besides it increases in iron deficiency anemia, recent studies reported that RDW was also associated with conditions characterized with overt or subclinical inflammation. We aimed to answer whether RDW increased in Hashimotos thyroiditis. METHODS Patients with HT admitted to outpatient clinic of our hospital were included to the study. Patients with anemia (especially iron deficiency), diabetes mellitus, chronic inflammatory disease and on medication that may affect hemogram results (e. g., aspirin) excluded from the study. Patient characteristics, thyroid stimulating hormone (TSH), Free T3 (FT3), Free T4 (FT4), Anti-thyroid peroxidase (Anti-TPO), Anti-Thyroglobulin (Anti-TG), leukocyte count (WBC), Hemoglobin (Hb), Hematocrit (Htc), mean corpuscular volume (MCV), RDW and platelet count (PLT) values of the study cohort were obtained from computerized database of our institution. RESULTS There was no significant difference between study and control groups in terms of WBC, Hb, Htc, MCV, PLT, PDW and FT3 levels. However, FT4 level was significantly lower and TSH was significantly higher in study group compared to controls. RDW was significantly increased in study group compared to control group. CONCLUSION We suggest that elevated RDW values in patients without iron deficiency anemia may require further evaluation for HT, especially in female population.

The Evaluation of Red Cell Distribution Width in Chronic Hemodialysis Patients

Background. Red cell distribution width (RDW) has been used as a marker of iron deficiency; however, it is accepted as a marker of cardiovascular survival. We aimed to study RDW levels in hemodialysis (HD) patients and the association between RDW and inflammatory, nutritional, and volume markers. Methods. We included 296 HD patients with sufficient iron storage and without anemia or hypervolemia. We grouped patients into four groups according to clinical parameters, albumin, and C-reactive protein (CRP). Results. The lowest RDW levels were found in group 1 (13.2%). Although RDW of group 2 was higher than that of group 1, it was still in normal range (14.7% versus 13.2%, P = 0.028). RDW levels of groups 3 (17.8%) and 4 (18.5%) were significantly higher than those of groups 1 and 2 and above normal range. A positive correlation was detected between RDW and HD duration, interdialytic weight gain (IDWG), serum phosphate, and CRP levels and a negative correlation was detected with serum albumin. HD duration, CRP, IDWG, and serum albumin have been found as independent predictors of RDW elevation. Conclusions. Results of the present study reflect adverse effects of inflammation, malnutrition, and excess IDWG on RDW elevation in an HD study cohort with sufficient iron storage and without anemia and hypervolemia.

Red cell distribution width and mean platelet volume in patients with irritable bowel syndrome

Introduction Possible pathophysiological mechanisms of irritable bowel syndrome (IBS) are interactions between microbial flora of the gut and the mucosal/systemic immune system, post-infectious status and inflammation. Mean platelet volume (MPV) and red cell distribution width (RDW) have been reported as inflammatory markers in patients with inflammatory bowel disease, but they have not been studied in functional gastrointestinal disorders. Aim To investigate whether there was an association between haemogram parameters (RDW and MPV) and IBS. Material and methods Forty patients with IBS and 44 healthy controls were included to this retrospective study. Patients diagnosed with IBS according to Rome III criteria were included as the IBS group. They were all screened for psychiatric or organic bowel diseases for the sake of precise diagnosis. Results Both RDW (p < 0.001) and MPV (p = 0.046) were increased in patients with IBS compared to controls. This increase in RDW and MPV was independent of the type of IBS. Conclusions The RDW and MPV should be laboratory indicators of IBS. More prospective studies with larger cohorts are needed to confirm our results.

Serum omentin-1 levels in diabetic and nondiabetic patients with chronic kidney disease.

BACKGROUND Omentin-1, a novel adipokine identified in visceral adipose tissue, is negatively correlated with different conditions such as diabetes, obesity and inflammation. However, changes in serum Omentin levels associated with the degree of the renal dysfunction and metabolic risk factors in CKD patients has not yet been revealed. In the present study, we aimed to investigate the level of Omentin-1 and related para-meters in diabetic and non-diabetic CKD patients. METHODS 64 (30 diabetic, 34 non-diabetic) CKD patients and 27 healthy control subjects enrolled in this cross-sectional study. Anthropometric and laboratory assessment performed and malnutrition and inflammation components evaluated. Serum concentrations of Omentin-1 and insulin were measured by using ELISA. RESULTS Serum Omentin-1 levels in CKD patients were significantly lower compared to the healthy controls. Further analyze revealed that decreased omentin in CKD patients was due to the reduced omentin levels in the diabetic subgroup. An increase in inflammation and malnutrition components was correlated with a decrease in the serum level of Omentin. Omentin levels were lower in stage 2 and 3 CKD but not stage 4 CKD patients compared to control. CONCLUSIONS The results of the present study suggest that diabetes mellitus and inflammation should be associated with lower omentin levels in CKD population; however, this reduction resolves due to the failure of degradation and excretion of omentin when creatinine clearance falls below 30 ml/min (stage 4 CKD).

Association between omentin levels and insulin resistance in pregnancy.

AIMS Omentin is a new adipokine secreted mainly from visceral adipose tissue. Serum omentin is found to be reduced in patients with impaired glucose tolerance, type 2 diabetes mellitus, obesity and insulin resistant states. Despite the fact that pregnancy is also characterized with hyperinsulinemia, literature is lacking about data of omentin levels and its association with insulin resistance in pregnant women. We aimed to evaluate the association of omentin levels and insulin resistance in pregnant women and to compare these levels with those of non-pregnant, non-diabetic women. METHODS Uncomplicated pregnant women who admit to our outpatient clinics for routine follow-up were included in the study group. Non-pregnant women without diabetes mellitus were served as control group. Fasting glucose, insulin, omentin levels and HOMA IR were recorded. SPSS 15.0 for Windows was used for statistical analysis. RESULTS There were 36 pregnant women in the study group and 37 healthy, non-pregnant women in the control group. Serum omentin and fasting glucose levels were significantly decreased and fasting insulin was significantly increased in the study group compared to control group. CONCLUSION Omentin might be an indicator of insulin resistance in pregnant women. Larger prospective studies are needed to claim whether omentin can have a clinical use for diagnosis of gestational diabetes mellitus.

Relationship between epicardial adipose tissue, inflammation and volume markers in hemodialysis and transplant patients.

Cardiovascular (CV) diseases are still the most important cause of morbidity and mortality in both patients receiving hemodialysis (HD) treatment and individuals with renal transplantation (Rtx). Measurement of epicardial adipose tissue (EAT) thickness is an easily applied, cheap, and useful recent method predicting increased CV risk. We aimed to compare EAT changes in HD and Rtx patients and the association between EAT and inflammatory and CV volume markers in both groups. A total of 124 patients: 45 Rtx, 43 HD patients and 36 healthy controls were enrolled in the study. Laboratory parameters and inflammatory markers (interleukin‐6 [IL‐6] and high sensitive C‐reactive protein [Hs‐CRP]) were evaluated from venous blood samples after an overnight fast. EAT thickness was measured with transthoracic echocardiography. The levels of Hs‐CRP, IL‐6, systolic and diastolic blood pressures, left atrial (LA) diameter, left atrial index (LAI), left ventricular mass (LVM) and LVM index (LVMI) were significantly higher in the HD patients than in the other groups. EAT was positively correlated with age, body mass index (BMI), time on dialysis, serum creatinine, total cholesterol, Low density lipoprotein‐cholesterol, and LVM in Rtx group and positively correlated with age, BMI, duration of dialysis, Hs‐CRP, IL‐6, LAI and LVMI and inversely correlated with inferior vena cava collapse index (IVC‐CI) in HD group. EAT thickness of RTx patients (whose previous HD duration was similar to those in HD group) are similar to the healthy population and significantly thinner than patients on HD.

Platelet Parameters in Hepatic Hydatid Cysts

Background. Hepatic hydatid cyst infection is caused by microorganisms named Echinococcus which belong to family Taeniidae. Platelets are considered as a mediator in inflammation and infectious diseases because of the various proinflammatory substances that they contain. Design and Methods. Thirty-three patients who were admitted to Doğubayazıt State Hospitals General Surgery Clinic with a diagnosis of hepatic cyst hydatid were enrolled in this retrospective study. Laboratory data of the patients in pre- and postoperative periods were obtained from computerized medical records database of the hospital. Results. Preoperative mean platelet volume (MPV) of the patients was significantly increased compared to postoperative MPV values. Conclusion. We claim that MPV is a useful follow-up marker after surgery in patients with hydatid cyst.

Effects of nutritional parameters on nocturnal blood pressure in patients undergoing hemodialysis

Abstract Background: Malnutrition is a common problem in uremic patients. It is unclear whether there is an association between the degree of malnutrition and 24-h ambulatory blood pressure patterns in patients undergoing hemodialysis. In the present study, we observed the relationship between the degree of malnutrition and deterioration of the rhythm of diurnal blood pressure, which are both risk factors for cardiovascular morbidity--mortality and associated with hypervolemia. Method: We observed 148 patients undergoing hemodialysis in the Nephrology Department of Celal Bayar University Hospital. All cases were assessed for body weight alterations, dietary food intake, gastrointestinal symptoms, loss of subcutaneous fat and muscle tissue, presence and severity of comorbidities, functional capacity (subjective global assessment), and anthropometric indices. Ambulatory blood pressure measurements were performed for all cases on the day between the two hemodialysis sessions. Results: We found that the circadian blood pressure rhythm deteriorated in patients with a high-malnutrition score, and that malnutrition was more common and severe in those subjects with the non-dipper and reverse-dipper blood pressure patterns. Malnutrition score was positively correlated with the nighttime systolic and nighttime mean blood pressures and mean 24-h arterial blood pressure (all p ≤ 0.01). We identified a positive correlation between malnutrition score and the reduction in serum albumin and anthropometric indices. Conclusion: This is the first study to demonstrate an association between malnutrition and deterioration in the circadian blood pressure rhythm in a hemodialysis population. Nutritional disturbance is associated with an increase in night-time blood pressure. Low serum albumin levels and hypervolemia may contribute this situation.