Gultekin Genctoy

The prevalance, epidemiology and risk factors for onychomycosis in hemodialysis patients

BackgroundOnychomycosis has a high prevalance among immunocompromised patients such as diabetics and hemodialysis patients. In the present study, we aimed to investigate the prevalence of onychomycosis among hemodialysis patients with and without diabetes mellitus, and to find out the factors likely to be associated with the development of onychomycosis among hemodialysis patients.MethodsOne hundred and nine hemodialysis patients were enrolled. Fifty-seven of hemodialysis patients had the diagnosis of diabetes mellitus. Nail scrapings were obtained from 76 patients who had dystrophic nail changes. Samples were examined with 20% potassium hydroxide solution and all of the samples were inoculated on Saborauds dextrose agar, potateus dextrose agar and mycobiotic agar. Diagnosis of onychomycosis was based on the presence of both positive clinical signs and positive potassium hydroxide test.ResultsOnychomycosis was diagnosed in 26.6% of hemodialysis patients. Diabetes mellitus was present in 68.9% of patients with onychomycosis. Toenail scraping cultures were reported to be positive in 19.7% of patients with dystrophic nail changes. Logistic regression analysis revealed that the presence of diabetes mellitus and the mean duration of hemodialysis were the significant predictors associated with the development of onychomycosis.ConclusionThe prevalence of dystrophic nail changes and onychomycosis is increased among hemodialysis patients. The dialysis duration and the presence of diabetes mellitus are the independent risk factors associated with the development of onychomycosis in uraemic patients.

Pulmonary hypertension in hemodialysis patients without arteriovenous fistula: the effect of dialyzer composition

Pulmonary hypertension (PHT) increases mortality rate in hemodialysis (HD) patients. Numerous clinical, hemodynamic, and metabolic abnormalities have been suggested to be associated with the development of PHT in HD patients. We aimed to investigate the acute effects of two different dialyzer membranes on pulmonary arterial pressure (PAP) throughout a HD session in maintenance HD patients. Seventy-four HD patients dialyzed through permanent tunneled jugular central venous catheter were enrolled. A first-use cellulose acetate and high-flux polysulfone dialysis membrane were tested using a crossover design. For each membrane, pre- and post-dialysis pulmonary artery pressures were measured echocardiographically. Elevated pulmonary artery pressure was observed in 68.8% of patients (n = 51), whereas mild PHT was observed in 28.3% of patients (n = 21) and moderate PHT in 40.5% (n = 30). Decrease in pulmonary artery pressure following HD procedure performed using high-flux polysulfone membrane was significantly higher than the decrease observed following HD procedure performed using cellulose acetate membrane (p < 0.05). Significant decrease in pulmonary artery pressures was observed only after HD procedures performed using high-flux polysulfone membrane (p < 0.05). Ultrafiltered volume was only significantly correlated with the decrease in pulmonary artery pressure observed after HD procedure performed through high-flux polysulfone membrane (β = 0.411, p < 0.05). PHT seems to be prevalent among HD patients even in the absence of AV fistula and abnormal cardiac functions. Membrane composition seems to be important, which may overwhelm the improving effects of ultrafiltration.

Apolipoprotein E gene polymorphism in renal transplant recipients: effects on lipid metabolism, atherosclerosis and allograft function

Abstract:  Introduction:  Atherosclerosis is a serious complication and leading cause of mortality in renal transplant recipients (RTRs). Hyperlipidemia may be associated with progression of renal disease and chronic allograft dysfunction. Similarities in the pathogenesis of glomerulosclerosis and atherosclerosis have been proposed. Apolipoprotein (apo) E gene code forms three major isoforms (E2, E3, and E4) with variable effects on lipid metabolism.

The correlation of thrombolysis in myocardial infarction frame count with insulin resistance in patients with slow coronary flow

BackgroundIt has been reported that coronary endothelial dysfunction plays an important pathogenetic role in patients with slow coronary flow (SCF). Insulin resistance is defined as impairment of insulin-stimulated glucose and/or lipid metabolism, while endothelial dysfunction is defined as paradoxical or inadequate endothelial-mediated vasodilation. In this study, we aimed to evaluate insulin resistance in patients with SCF. MethodsThe study population included 25 patients with SCF and 28 healthy controls. Insulin resistance was estimated via homeostasis model assessment insulin resistance index (HOMA-IR). ResultsPatients with SCF had higher high-sensitive C-reactive protein (hs-CRP) and HOMA-IR scores (P<0.05) than controls. Mean thrombolysis in myocardial infarction frame count had significant correlation with hs-CRP, fasting plasma insulin levels and HOMA-IR score (r=0.566, P<0.05; r=0.883, P<0.05; r=0.884, P<0.05, respectively). ConclusionIn patients with SCF, thrombolysis in myocardial infarction frame counts and hs-CRP are correlated with increased insulin resistance and thus, it can be suggested that insulin resistance and inflammation may, in part, have a role in the pathogenesis of SCF.

Gingival health status in renal transplant recipients: relationship between systemic inflammation and atherosclerosis

Cardiovascular disease (CVD) is the leading cause of mortality in renal transplant recipients (RTR). Systemic and periodontal inflammation has been suggested to have a possible role in the development of atherosclerosis. In the present study, we aimed to investigate the relationship between gingival health status, inflammation and atherosclerosis in RTRs. Eighty‐three RTR (50 male, 33 female) were enrolled in the study. Routine biochemical analyses, serum lipoproteins, C‐reactive protein, fibrinogen, homocystein, parathyroid hormone (PTH) and cyclosporin A (CsA) trough levels were studied. All patients had 24‐h ambulatory blood pressure monitoring and B‐mode ultrasound of the common carotid arteries. Gingival status was evaluated by the Löe and Silness gingival index (GI). Mean GI value was 2.3 ± 0.5. Fifty patients (60.3%) had GI value ≥ 2.1 (severe gingivitis; group A). Thirty‐three patients (39.7%) had GI value < 2.1 (no or moderate gingivitis; group B). Age, carotid intima‐media thickness (CIMT) and mean time on dialysis before transplantation were significantly higher in group A than in B. Systemic inflammation markers were not different between group A and group B. Mean CIMT was positively correlated with GI (r = 0.425; p = 0.001) and negatively correlated with high‐density lipoprotein cholesterol (r = −0.256; p = 0.023). After the correction for confounding variables, mean CIMT was still significantly correlated with GI (r = 0.376, p = 0.02). In RTR, gingival inflammation seems to be associated with CIMT in the absence of systemic inflammation. Thus, gingivitis may, in part, play a role in the development of systemic atherosclerosis without causing any aggravation in systemic inflammatory response.

Impact of rHuEPO therapy initiation on soluble adhesion molecule levels in haemodialysis patients.

Background:  Increased levels of soluble adhesion molecules have been reported in haemodialysis (HD) patients. Recent studies have shown that recombinant human erythropoietin (rHuEPO) elicits proliferation and migration of endothelial cells and modifies endothelial function. The present study was design to explore the effects of rHuEPO on serum levels of soluble adhesion molecules in HD patients.

Efficacy and Safety of Intravenous Iron Therapy for HCV-Positive Haemodialysis Patients

Background: Iron supplementation is the cornerstone of anaemia management in haemodialysis (HD) patients. However, efficacy and safety of intravenous (IV) iron therapy in hepatitis C virus (HCV)-positive HD patients is yet to be elucidated. Methods: Sixty-six maintenance HD patients with suboptimal response to recombinant human erythropoietin (rh-EPO) were administered IV iron. Each patient received 100 mg/session IV iron sucrose for ten consecutive HD sessions and then the dose was decreased to 50–100 mg weekly or biweekly. Patients were followed for haemoglobin (Hb), ferritin, rh-EPO dose requirements, transaminase levels, and adverse drug reactions. Results: Baseline demographic and clinical characteristics, as well as Hb, ferritin, transaminase levels, rh-EPO and iron doses were similar between HCV-positive (n = 32) and HCV-negative patients (n = 29). After 5 months of follow-up, a significant increase in ferritin and Hb levels and decrease in rh-EPO doses were observed in both groups. The incidence of adverse drug reactions was not associated with HCV serology. Significant elevation in both alanine and aspartate aminotransferase levels were detected in HCV-positive patients. Conclusion: This study has shown that IV iron administration reverses suboptimal response to rh-EPO administration in HD patients regardless of HCV serology. There is however subtle increase of transaminase levels in HCV-positive patients. Further studies are warranted to reveal the impact of variation in serum transaminase levels during IV iron administration in HCV-positive HD patients.

Impact of cytokine gene polymorphism on cardiovascular risk in renal transplant recipients

Cardiovascular events are the leading causes of morbidity and mortality in renal transplant recipients (RTR). Given the role of inflammation in atherosclerosis, the contribution of functional polymorphisms of cytokines to cardiovascular diseases (CVD) was assessed in RTR in this study. Polymorphisms of tumour necrosis factor alpha (TNF‐α) gene [−308 (G→A), −238 (G→A)], interleukin‐10 (IL‐10) gene [−1082(A→G), −819 (T→C), −592 (A→C)], transforming growth factor beta 1 (TGF‐β1) gene [codon 10 (T→C), codon 25 (G→C)], carotis intima media thickness (CIMT), left ventricular mass index (LVMI), 24‐h ambulatory blood pressure and serum lipoprotein homocysteine level, erythrocyte sedimentation rate, serum C‐reactive protein (CRP) and serum fibrinogen level of RTR were determined. Seventy‐two RTR (26 cadaveric allograft, 46 living‐related allograft, 43 male, 29 female) were included in this study. LVMI were similar in TNF‐α, IL‐10 and TGF‐β1 genotypes. Right and left CIMT were higher in TT genotype (n = 16) than CT (n = 46) and CC (n = 10) genotypes of TGF‐β1 codon 10 (T→C) gene polymorphism (RCIMT, 7.7 ± 2.2 mm vs. 7.0 ± 1.4 mm vs. 5.9 ± 1.4 mm, P = 0.025; LCIMT, 8.5 ± 2.5 mm vs. 7.0 ± 1.3 mm vs. 6.1 ± 1.2 mm, P = 0.002). Lipoprotein (a) level of TT genotype (35.5 ± 22.5 mg/dl) was higher than CC (4.1 ± 2.8 mg/dl) and CT (20.4 ± 11.2 mg/dl) genotypes of TGF‐β1 codon 10 (T→C) gene polymorphism (P = 0.037). High producers of cytokine IL‐10 −1082 [GG (n = 22) vs. AA + AG (n = 50)] and low producers of TGF‐β codon 25 [GC + CC (n = 17) vs. GG (n = 55)] had lower IMT of carotid artery but the difference did not reach statistical significance (P > 0.05). The CIMT of renal transplant patients was similar in IL‐10 (−819, −592) and TNF‐α (−308, −238) genotypes. No difference was observed in 24‐h ambulatory blood pressure levels, serum lipoproteins, plasma homocysteine level, erythrocyte sedimentation rate, serum CRP, serum fibrinogen level in IL‐10, TNF‐α and TGF‐β1 genotypes. Besides the well‐known factors, TGF‐β1 gene polymorphisms might play a role in CVD in RTR even at early stages of asymptomatic atherosclerosis.

Serum stem cell factor level in renal transplant recipients with posttransplant erythrocytosis.

The etiology of posttransplant erythrocytosis (PTE) remains unclear, and the most frequently suggested causative factors are still a matter of controversy. We aimed to investigate serum-soluble stem cell factor (sSCF) along with serum erythropoietin (EPO) levels in renal transplant recipients (RTRs) with PTE. Thirteen RTRs with PTE, 42 RTRs without PTE, and 42 healthy controls were included. Serum sSCF and EPO levels were determined using an enzyme-linked immunosorbent assay kit. Expected and observed/expected EPO levels were calculated. Serum sSCF levels and observed/expected EPO were significantly higher in RTRs with PTE than both RTRs without PTE and controls. In RTRs with PTE, sSCF level was significantly correlated with hematocrit and observed/expected EPO, respectively. Significant correlation was also observed between hematocrit level and observed/expected EPO in RTRs with PTE. Increased sSCF level and inadequate suppression of EPO production seem to have a role in the pathogenesis of PTE.

The interleukin‐10 promoter genotype predicts diastolic dysfunction in maintenance hemodialysis patients

Interleukin‐10 (IL‐10) predominantly acts as an anti‐inflammatory factor. Polymorphisms in the IL‐10 gene promoter determine quantitative cytokine production. Doppler echocardiography and tissue Doppler imaging (TDI) are superior to conventional echocardiography to evaluate diastolic dysfunction. The IL‐10 gene promoter polymorphism at position (−1082) was studied for its association with conventional and Doppler echocardiographic and TDI parameters in 112 hemodialysis (HD) patients. Blood pressure, serum C‐reactive protein (CRP), and albumin levels were also examined for the association study. The genetic association study showed that among the HD patients, there was no difference in the prevalence of systolic and diastolic dysfunction between genotypes on conventional echocardiography. However, using Doppler echocardiography and TDI, high producers for the IL‐10 −1082 promoter (−1082/GG) have higher E velocities, E/A values, lateral, and septal E′ velocities and a lower isovolumic ventricular relaxation time than low (−1082/AA) and intermediate producers (−1082/GA). Significantly higher levels of serum CRP levels and lower plasma albumin levels were found in low and intermediate producers for the IL‐10 −1082 promoter than high producers. The IL‐10 genotype may balance the effects of inflammatory cytokines on the myocardium and may be a determinant of LV function in HD patients.