Browsing by Author "Tutal, Emre"

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Citation Count: 2
Effect of nutritional support on nutritional status and inflammation in malnourished patients undergoing maintenance hemodialysis
(Wiley, 2021) Demirci, Bahar Gurlek; Carrero, Juan Jesus; Tutal, Emre; Bal, Zeynep; Sezer, Siren
Introduction Protein energy wasting/malnutrition is a strong predictor of morbidity and mortality in patients on maintenance hemodialysis (MHD). We aimed to compare the effects of oral and/or intradialytic parenteral nutrition (IDPN) support on nutritional and inflammatory parameters in malnourished patients with MHD. Methods This is an observational study of 56 malnourished patients on MHD. We offered combined oral nutritional support (ONS) and IDPN for 12 months to all patients. Depending on patient choices for treatment, they were classified into four groups: group 1 (ONS only), group 2 (IDPN only), group 3 (both ONS and IDPN), and group 4 (patients who refused artificial nutrition support and only followed dietary advice). Normalized protein catabolic rate (nPCR), malnutrition inflammation score (MIS), and body composition (fat mass [FM], muscle mass [MM]) were assessed monthly. Findings The mean serum albumin levels of groups 2 and 3 significantly increased with the intervention, whereas that of group 4 significantly decreased. The mean nPCR levels of groups 2 and 3 significantly increased. Group 3 had the most significant positive change in serum albumin and nPCR levels. Mean serum C-reactive protein (CRP) levels of groups 1, 2, and 3 decreased, whereas those of group 4 increased. A increment in CRP was only identified in group 3. The MIS of groups 1, 2, and 3 significantly decreased whereas that of group 4 significantly increased. The increment % in FM was 1.1, 1.9, 9.1, and -2.9 for groups 1, 2, 3, and 4, respectively, and that in MM was -0.6, 4.4, 6.9, and -7.9 for groups 1, 2, 3, and 4, respectively. Discussion Compared to monotherapy or nutritional counseling, the choice of ONS plus IDPN is associated with improved nutritional status and decreased inflammation in malnourished patients on MHD. Nonetheless, interventional studies must be conducted to confirm these observations.
Citation Count: 0
Morning blood pressure surge in renal transplant recipients: Its relation to graft function and arterial stiffness
(Wiley, 2022) Demirci, Bahar Gurlek; Afsar, Baris; Tutal, Emre; Colak, Turan; Sezer, Siren
Background: When the blood pressure rises before awakening in the morning, it is called as morning blood pressure pulse (MBPS). MBPS is considered to be an independent risk factor for cardiovascular disease. The aim of this study was to investigate the associations between MBPS, graft function, arterial stiffness and echocardiographic indices in renal transplant recipients. Methods: Among 600 renal transplant recipients, 122 patients who had a history of hypertension and were taking at least one anti hypertensive medication were enrolled in the study. Arterial stiffness was measured by carotid-femoral pulse wave velocity (PWv), and echocardiographic indices were assessed. 24 h ambulatory blood pressure was monitored for all patients. MBPS was calculated by subtracting morning systolic blood pressure from minimal asleep systolic blood pressure. Results: Mean morning, day time and asleep systolic blood pressure values were 171.2 +/- 23.9, 137.9 +/- 18.1, and 131.7 +/- 18.9, respectively. Nondipper hypertension status was observed in 93 patients. Mean MBPS was 35.6 +/- 19.5 mm Hg, means PWv was 6.5 +/- 2.0 m/s. Patients with MBPS >= 35 mm Hg, had significantly lower eGFR and higher proteinuria, PWv. higher left atrium volume and LVMI. In regression analysis, day time systolic blood pressure, asleep systolic blood pressure, morning blood pressure surge, nondipper status and left ventricular mass index were detected as the predictors of graft function. Conclusions: Increased morning blood pressure surge is associated with graft dysfunction, increased arterial stiffness and LVMI that contribute to cardiovascular mortality and morbidity in renal transplant recipients.