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Öğe Carotid intima media thickness is independently associated with urinary sodium excretion in patients with chronic kidney disease(Taylor & Francis Ltd, 2015) Ustundag, Sedat; Yilmaz, Gulay; Sevinc, Can; Akpinar, Seval; Temizoz, Osman; Sut, Necdet; Ustundag, AytenAtherosclerosis-induced premature vascular diseases are the leading cause of mortality among patients with chronic kidney disease (CKD). The pathogenetic mechanism of atherosclerosis in patients with CKD has not been fully explained. Experimental studies have demonstrated that high dietary sodium intake not only increases circulatory volume and blood pressure, but also facilitates development of atherosclerosis by reducing production-bioavailability of nitric oxide due to oxidative stress and accordingly by enhancing endothelial and arterial stiffness. In this study, we investigated the relationship between sodium consumption and carotid artery intima-media thickness, which is the indicator of atherosclerosis, by determining daily urinary sodium excretion, which is a reliable indicator of sodium consumption, in our patient group. Our patient group included 193 patients with stage 2-4 non-diabetic CKD and without a history of atherosclerotic disease. We determined that 77% of our patients have been consuming more than 2 g of sodium per day, which is the upper limit of sodium consumption recommended for patients with CKD. We determined a positive linear correlation between carotid artery intima-media thickness and patient age (p < 0.001), C-reactive protein (p < 0.001), urinary sodium excretion (p < 0.001), body mass index (p = 0.002), systolic blood pressure (p = 0.002), hemoglobin (p = 0.030), triglycerides (p = 0.043), and diastolic blood pressure (p = 0.049). We also found a negative linear correlation between carotid artery intima-media thickness and glomerular filtration rate (p = 0.008). We found that urinary sodium excretion is the determinant of intima-media thickness even if all factors associated with intima-media thickness are adjusted, and that intima-media thickness increases by 0.031 (0.004-0.059) mm per 2 g increase in daily sodium excretion, independent from overall factors (p = 0.025). Our results reveal a relation between urinary sodium excretion and carotid artery intima-media thickness and suggest that excessive sodium consumption predisposes development of atherosclerosis in patients with CKD.Öğe Cognitive Dysfunction in Chronic Renal Disease: Impact of Dialysis Modality(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2015) Ak, Recep; Ustundag, Sedat; Ustundag, Ayten; Guldiken, Baburhan; Sut, NecdetOBJECTIVE: Cognitive dysfunction (CD) is common among patients with chronic kidney disease (CKD) and contributes to morbidity and mortality. We aimed to explore the factors involved in the development of CD in patients with CKD and to compare cognitive function between hemodialysis (HD) and peritoneal dialysis (PD) patients. MATERIAL and METHODS: We studied 122 patients with different stages of CKD, and divided them into two groups: Predialysis Group: included 60 CKD patients, (28 stage III and 34 stage IV); Dialysis Group: included 60 patients on dialysis therapy, (30 on HD and 30 on PD). Psychometric tests were done all patients. The results were compared with 41 healthy subjects. RESULTS: We found that the CD rate was higher in patients with CKD (24.6%) than controls (0%, p<0.001). The Mini Mental Test score was found to be correlated with age (r=-0.428), hemoglobin (r=0.336), CRP (r=-0.311), and albumin (r=0.336); the Calculation Test score was found to be correlated with LDL cholesterol (r=-0.336); the Praxis Test Score was found to be correlated with duration of CKD (r=-0.204), HDL (r=0.188); and the Visual Memory Test score was found to be correlated with parathormone levels (r=-0.270). We found the CD rate to be higher in patients on HD (50%) than on PD (23.3%, p=0.032). CONCLUSION: Our findings suggest that anemia, malnutrition and inflammation play an important role in the development of CD in our patients, and cognitive functions are better preserved in the PD group than the HD group.Öğe Effect of Six Months of Hemodialysis Treatment on Cognitive Function in Patients with End Stage Chronic Kidney Disease(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2018) Kilinc, Vildan Coban; Ustundag, Sedat; Ustundag, Ayten; Sut, NecdetOBJECTIVE: We aimed to investigate the prevalence of cognitive impairment (CI), its facilitating factors, and the effect of hemodialysis treatment on cognitive function (CF) in patients with stage V Chronic Kidney Disease (CKD). MATERIAL and METHODS: We investigated the prevalence of CI and its facilitating factors in 66 patients with CKD and analyzed the effect of hemodialysis on CF in 33 new hemodialysis patients. CF was evaluated in all patients by using the standardized mini mental test. RESULTS: CI was detected in 32% of our patients. We found a positive linear correlation between CI and lower educational status (p<0.001), elderly age (p=0.003), female gender (p<0.001), waist circumference (p=0.016), and urea levels (p=0.018). After 6 months of hemodialysis treatment, the CF score increased 0.5 points (p=0.092) and the rate of the patients with CI decreased to 27.3% from 39.4% (p=0.137). We observed that CI improves less with hemodialysis treatment in patients with high basal diastolic blood pressure (BP), (p=0.042). Although close to statistically significant, the improvement in CI was lower in patients with higher age (p=0.065), high basal mean BP (p=0.056) and basal systolic BP(r=0.269, p=0.135). CONCLUSION: Our findings suggest that evaluation of CI in CKD, elimination of its facilitating factors and not delaying hemodialysis when it is indicated decrease the morbidity and mortality due to CKD.Öğe The Effects of Spironolactone on Nephron Function in Patients with Diabetic Nephropathy(Taylor & Francis Ltd, 2008) Ustundag, Ayten; Tugrul, Armagan; Ustundag, Sedat; Sut, Necdet; Demirkan, BoraIncreasing evidence suggests that circulating aldosterone per se contributes directly to renal and cardiovascular diseases. We sought to evaluate the effects of a three-month treatment with 25 mg spironolactone, an aldosterone receptor antagonist, on nephron function in 20 type II diabetic patients with persistent microalbuminuria, despite at least six months' use of an ACEi or ARB (combination group), and in eleven type II diabetic patients with persistent microalbuminuria who have never used an ACEi or an ARB (spironolactone group). In the combination group, urinary protein excretion (UPE, p = 0.015), urinary albumin excretion (UAE, p = 0.010), and the urinary albumin to creatinine ratio (ACR, p = 0.007) decreased, and serum potassium (sK+, p = 0.004) was significantly elevated. ACR (p = 0.016) decreased significantly in the spironolactone group. In 31 patients given spironolactone (all patients group), UPE (p = 0.019), UAE (p = 0.002), and ACR (p = 0.011) decreased, and serum creatinine (sCr, p = 0.025) and sK+ (p = 0.002) were significantly elevated. Changes in albuminuria showed a positive correlation with changes in GFR (p = 0.002) and a negative correlation with changes in sCr (p = 0.007), and changes in ACR showed a negative correlation with changes in sCr (p = 0.004) in all patient groups. In our study, we observed that spironolactone, both alone and in combination with ACEi/ARB treatment, was well tolerated, and that it slowed down the progression of diabetic nephropathy with a marked antialbuminuric effect. Our results showed that the antialbuminuric effect developed by the decrease of intraglomerular pressure, particularly in patients with persistent microalbuminuria despite long-term ACEi/ARB treatment; adding aldosterone blockers to treatment was beneficial.
