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Article Citation - WoS: 3Citation - Scopus: 4Assessment of Surrogate Markers for Cardiovascular Disease in Familial Mediterranean Fever-Related Amyloidosis Patients Homozygous for M694v Mutation in mefv Gene(Mdpi, 2022) Sahin, Sezgin; Romano, Micol; Guzel, Ferhat; Piskin, David; Poddighe, Dimitri; Sezer, Siren; Demirkaya, ErkanCardiovascular disease (CVD) remains underestimated in familial Mediterranean fever-associated AA amyloidosis (FMF-AA). We aimed to compare early markers of endothelial dysfunction and atherosclerosis in FMF-AA with a homozygous M694V mutation (Group 1 = 76 patients) in the Mediterranean fever (MEFV) gene and in patients with other genotypes (Group 2 = 93 patients). Measures of increased risk for future CVD events and endothelial dysfunction, including flow-mediated dilatation (FMD), pentraxin-3 (PTX3), and carotid intima-media thickness (cIMT), and fibroblast growth factor 23 (FGF23) as a marker of atherosclerotic vascular disease were compared between groups. The frequency of clinical FMF manifestations did not differ between the two groups apart from arthritis (76.3% in Group 1 and 59.1% in Group 2, p < 0.05). FMD was significantly lower in Group 1 when compared with Group 2 (MD [95% CI]: -0.6 [(-0.89)-(-0.31)]). cIMT, FGF23, and PTX3 levels were higher in Group 1 (cIMT MD [95% CI]: 0.12 [0.08-0.16]; FGF23 MD [95% CI]: 12.8 [5.9-19.6]; PTX3 MD [95% CI]: 13.3 [8.9-17.5]). In patients with FMF-AA, M694V homozygosity is associated with lower FMD values and higher cIMT, FGF23, and PTX3 levels, suggesting increased CVD risk profiles. These data suggest that a genotype-phenotype association exists in terms of endothelial dysfunction and atherosclerosis in patients with FMF-AA.Article Main Outcomes of the Diyal-Tr Study: Regional\rdifferences of Mortality and Morbidity in Chronic\rhemodialysis Patients(Aves, 2022) Kızılırmak, Pınar; Ecder, Süleyman Tevfik; Ateş, Kenan; Arıcı, Mustafa; Sezer, Siren; Kaptanoğulları, Hakan; Arınsoy, Selim Turgay; Ecder, Tevfik; Arinsoy, TurgayObjective: Variations in care at national or global level may have an impact on the prognosis of patients on chronic hemodialysis.\rWe aimed to describe regional differences in all-cause mortality or cardiovascular morbidity in chronic hemodialysis\rpatients in Turkey.\rMethods: We enrolled 2461 patients who were initiated chronic hemodialysis in 93 centers in Turkey between January 27,\r2017, and February 09, 2018. We included 2-year follow-up data of 1877 patients in this prospective study. The primary\routcome, the rate of composite endpoint of all-cause mortality or cardiovascular morbidity, was compared between geographical\rregions. Secondary outcomes were the rates of hospitalization and infections.\rResults: In total, 552 patients (29.4%) developed the primary outcome. The highest and lowest rates of primary outcome\roccurred in the Mediterranean (34.5%) and Southeastern (26.5%) & Central Anatolian regions (26.5%), respectively, with no\rsignificant differences across regions (P = .82). Hospitalization events were detected in 377 patients (20.1%). The highest\rrate of hospitalization was detected in the Black Sea region (33.8%), and the lowest (7.6%) in the Southeastern region. The\rregions did not differ in hospitalization rates (P = .88). Infections occurred in 11.3% (n = 212) of the patients. The highest and\rlowest rates of infections occurred in the Aegean (18.2%) and the Southeastern (2.9%) regions, respectively. We detected\rsignificant difference between geographic regions (P = .02).\rConclusions: Our study showed that almost 3 in every 10 chronic hemodialysis patients reached the primary endpoint\rof all-cause mortality/cardiovascular morbidity during the 2 years of follow-up. The occurrence of this outcome does not\rseem to exhibit geographical variation across the country.Article Böbrek Naklinde de Novo Uzamış Salınımlı Takrolimus Kullanımı Sonuçları: Tek Merkez, 1 Yıllık Sonuçlar(2022) Sarıyıldız, Gülçin Türkmen; Demir, Mehmet Emin; Sezer, Siren; Sozener, Ulas; Ercan, Zafer; Gulen, Merter; Özşeker, Fatma Necla; Demir, Canan; Arslan, Aykut İlkerAmaç: Böbrek nakli alıcılarında günde tek doz uzamış salınımlı takrolimus (tac-ER) kullanımı, erken salınımlı takrolimus (tac-IR) kullanımına benzer etkinlik ve daha iyi ilaç uyumu sağlaması amacıyla geliştirilmiştir. Ancak uzamış salınımlı takrolimus ile ilgili deneyimler daha çok nakil sonrası dönemde yapılan “switch” protokollerine dayanmaktadır. Bu çalışmada böbrek alıcılarında de novo tac-ER kullanımı ile ilgili deneyimlerimizi ve 1 yıllık sonuçları sunmayı amaçladık. Gereç ve Yöntem: Bu tek merkezli retrospektif çalışmaya Ocak 2022-Ocak 2021 arasında yapılan 72 de novo böbrek nakli hastası dahil edilmiştir. Hastalar tac- ER ve tac-IR alan iki gruba ayrıldı. Bir yıllık allogreft fonksiyonları ve sağ kalımları, hastaların günlük ilaç dozları ve bunların akut rejeksiyon atakları ile ilişkileri karşılaştırıldı. Allogreft fonksiyonları ve akut rejeksiyon atakları üzerine etki eden faktörler incelendi. Bulgular: Toplam 69 hastanın (uzamış salınımlı grupta 30 hasta ve erken salınımlı grupta 39 hasta) verileri incelendi. Üç hasta posttransplant erken dönemde öldüğü için analize dahil edilmedi. Nakil sonrası 12 aylık izlem boyunca her iki grup arasında serum kreatinin ve takrolimus çukur değerler bencer bulundu (p>0,05). İlk 3 ay içinde hedef takrolimus değerlere ulaşmak için, tac-ER grubunda daha yüksek günlük dozlar (milligra/gün ve milligram/gün/kg) gerekti (p<0,05). Nakil sonrası ilk 12 ay içinde her iki grupta da rejeksiyon oranları benzerdi (p=0,281). Tek değişkenli analizde posttransplant 1. aydaki takrolimus dozu (milligram/kg/gün) takrolimus çukur değerinin aksine rejeksiyon gelişimi üzerinde etkili görüldü (p=0,02). Sonuç: Böbrek naklinde uzamış salınımlı takrolimusun (Advagraf®) de novo kullanımı, erken salınımlı takrolimus kullanımına benzer etkinlik, allogreft sağ kalımı ve fonksiyonu sağlar.Article Diabetes and Chronic Kidney Disease in Turkey (DIAKIT): A Cross-Sectional Cohort Study(BMC, 2025) Arici, Mustafa; Ates, Kenan; Yildiz, Alaattin; Odabas, Ali R.; Tokgoz, Bulent; Sezer, Siren; Altun, BulentBackground Chronic kidney disease (CKD) is a global public health problem with increasing disease burden affecting nearly 10% of adult population worldwide. We aimed to detect the prevalence of CKD, patients' distribution among CKD stages, and factors associated with having CKD in diabetic patients in Turkey. Methods This cross-sectional study, conducted in 2022, included 1591 patients with diabetes (mean age, 63 +/- 10 years; female: 65.5%) from the Cappadocia Cohort study. CKD was diagnosed by an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) or urinary albumin-to-creatinine ratio (UACR) >= 30 mg/g, which was measured in spot urine samples collected in the morning for three consecutive days. Results In this cohort of adult diabetic patients, the prevalence of CKD was 25.1%. More than half of the diabetic patients with CKD (53.8%) had albuminuria without a decrease in eGFR, 28.1% had decreased eGFR without albuminuria, and 18.2% had both albuminuria and decreased eGFR. While the percentage of CKD patients who are female vs. male was 60% vs. 40%, CKD prevalence was higher in males (29.2%) than in females (22.9%) (P = 0.007). Among patients with CKD, only 9.4% were aware that they had CKD. Age, male sex, HbA1c, triglyceride, uric acid, C-reactive protein, and hypertension Grade 1, 2 and 3 were associated with the presence of CKD, with uric acid showing the strongest association. Conclusions More than half of our patients with CKD would not have been diagnosed if urinary albumin excretion was not measured. Early detection of CKD by regular screening of diabetic patients using both UACR and eGFR measurements is essential for early diagnosis and prompt treatment to slow down disease progression.Article Citation - WoS: 2Citation - Scopus: 2Potential Role of SGLT-2 Inhibitors in Improving Allograft Function and Reducing Rejection in Kidney Transplantation(Wiley, 2025) Demir, Mehmet Emin; Helvaci, Ozant; Yildirim, Tolga; Merhametsiz, Ozgur; Sezer, SirenSodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated renoprotective and cardioprotective benefits beyond their antiglycemic effects. Their potential utility in kidney transplant recipients (KTRs) for preserving graft function and reducing rejection risk is currently under active investigation. Preliminary studies indicate that SGLT-2i therapy stabilizes estimated glomerular filtration rate (eGFR), decreases glomerular hyperfiltration, and improves metabolic outcomes in KTRs. Emerging clinical evidence also suggests that SGLT-2i may be associated with reduced rates of acute rejection, although direct immunosuppressive actions remain unclear. Experimental findings further suggest that SGLT-2i modulates gene regulation pathways involved in inflammation, oxidative stress, and fibrosis, contributing to improved allograft outcomes. Current safety data in KTRs are reassuring, without significant increases in urinary tract infections or adverse graft events. Nevertheless, long-term prospective studies specific to transplant populations are lacking. This review summarizes available evidence regarding the mechanisms of action, clinical efficacy, and safety profile of SGLT-2i in kidney transplantation, emphasizing their metabolic, hemodynamic, inflammatory, and immunomodulatory effects.Other Current Induction Therapy Strategies and Anti-T Lymphocyte Globulin Usage in Kidney Transplantation: Consensus-Based Recommendations by a Turkish Expert Panel(Aves, 2024) Çakır, Ülkem; Dinçkan, Ayhan; Karadoğan, Nayim; Keven, Kenan; Koçak, Hüseyin; Koç, Serkan Kubilay; Yıldız, Alaattin; Turkmen, Aydin; Töz, Hüseyin; Sezer, SirenThis advisory committee convened to review national and global kidney transplantation dynamics and provide recom- mendations on the use of anti-T lymphocyte globulin (ATLG) for prevention and treatment of rejection after allogeneic kidney transplantation. A critical evaluation of 6 relevant articles released up to October 2022 was performed to reveal their importance in clinical practice. Additionally, 27 key questions on the indication, dosage of ATLG, and risk stratification were used for the Delphi technique with 8 members of the Turkish Society of Nephrology including 5 kidney transplanta- tion (KTx) subcommittee members and a surgeon experienced in solid organ transplantation. The committee declared that Türkiye had great potential in KTx; however, increase in transplantation would be possible in the case of raise in the deceased donor transplantation. As a consensus, ATLG was strongly recommended for induction and rejection treatment. Also, committee members recommended the safe dosage range in steroid resistant acute rejection as 2.5-3 mg/kg daily for 5-7 days, and the median of preferred dosage in induction sounded as 2-2.5 mg/kg daily for 3 days in intermediate risk state. Additionally, post-transplant infection and malignancy cases due to immunosuppression were much rarely encoun- tered than they were in the past.Article Hemodiyaliz Hastalarında Sevelamer Vasküler Sertliği Düzeltmekte ve Serum Ürik Asit Düzeyini Azaltmaktadır(2024) Demirci, Bahar Gürlek; Tutal, Emre; Bal, Zeynep; Erkmen, Mehtap; Sezer, Siren; Akdogan, MehtapAmaç: Sevelamer, pleotropik etkisi ile prebiyotik olarak etki gösterebilir. Bu çalışmanın amacı sevelamerin ürik asit, HbA1c, lipid profili ve arteryel sertlik progresyonu üzerine etkisinin gösterilmesidir. Gereç ve Yöntem: Hemodiyalize giren ve aynı fosfor bağlayıcıyı (FB) 3 yıl kullanan 151 hasta çalışmaya dahil edildi. Hastalar kullandıkları FB’ye göre sevelamer bazlı FB (grup 1) ve kalsiyum bazlı FB (grup 2) olarak 2 gruba ayrıldı. Üç yıllık takipte biyokimyasal parametreler kayıt edildi. Arteryel sertlik başlangıçta ve 3. yılın sonunda aortik nabız dalga hızı (PWv) ölçümü ile belirlendi. Bulgular: Üç yıllık takipte ortalama ürik asid düzeyleri grup 1’de azalmışken grup 2’de stabil kaldı. Grup 1’deki hastaların %22,4’ünde ortalama ürik asid düzeylerinde 2 mg/dL’den fazla azalma saptandı. Diyabetik hastalarda HbA1c düzeyleri grup 1’de grup 2’ye göre daha düşüktü. PWv düzeyleri çalışmanın başında her 2 grup için de benzerdi. Ancak 3. yılın sonunda PWv düzeyleri grup 1’de grup 2’ye göre daha düşük saptandı. Sonuç: Sevelamer pleiotropik etki ile ürik asit düzeyini, düşük yoğunluklu lipoprotein-kolesterolü, HbA1c düzeyini azaltarak, fazla kalsiyum alımını engelleyerek kardiyovasküler riski azaltmaktadır. Hemodiyalize giren hastalarda sevelamer, kalsiyum bazlı fosfor bağlayıcılara göre arteryel sertlik progresyonunu da azaltarak kardiyovasküler risk profilini düzeltir.Editorial Citation - WoS: 1The Day the Earth Shook(Springer Heidelberg, 2023) Sezer, Siren; Tuglular, Serhan; Yildiz, Alaattin[No Abstract Available]Article Covid-19 Pandemic: Depression and Sleep Quality in Hemodialysis Patients(2022) Yavuz, Demet; Balakbabalar, Ayse Pinar Doğru; Demirağ, Mehmet Derya; Sezer, SirenIntroduction: Depression and sleep disturbance are prevalent comorbidities in hemodialysis patients. This study aimed to investigate the relationship between depressive mood, sleep disturbance, and the fear of COVID-19 Scale in hemodialysis patients during the pandemic process. Material and Method: 116 hemodialysis patients followed up in our clinic and volunteered were included in the study. The socio- demographic characteristics of the patients and the laboratory test results studied in their routine follow-ups were obtained from the file records. Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and the Fear of COVID-19 Scale (FCV-19S) were applied through face-to-face interviews. Results: 116 patients (70 males, 46 females) with a hemodialysis duration of 40 months (13-295) and age of 60.2±13.3 years were included in the study. The patients were divided into two groups according to their PSQI score as good sleeper (PSQI ≤ 5, n=66) and poor sleeper (PSQI >5, n=50). When evaluated by gender 28 (56%) female patients were in the poor sleeper group (p=0.002). Dialysis time was longer, BDI score and FCV-19 scale were higher in the poor sleeper group than the good sleeper group. PSQI score was positively correlated with dialysis time (r=0.259 p=0.005), BDI score (r=0.279 p=0.002), and FCV-19 scale (r=0.304 p=0.001). In the Multiple Logistic Regression analysis established to evaluate the risk factors affecting sleep quality, BDI was determined as an independent risk factor for poor sleep (OR: 1.084, 95%CI [1.021-1.152], p=0.008). Subjects were divided into two groups according to their BDI scores as those with depressive mood (BDI score ≥ 17, n=47) (40.5%) and those without (BDI score < 17, n=69) (59.5%). Thirty-two of the cases with depressive mood were women (68.1%) (p<0.001). There was a female predominance in the depressed patient group. The economic status was worse in the depressed group compared to the non-depressed group, and the PSQI score and FVC-19 scale were higher. In addition, BDI score was positively correlated with age (r=0.225 p =0.015), female gender (r=0.473 p=0.001), poor economic status (r=0.576 p =0.001), FVC-19 scale (r=0.330 p =0.001), while negatively correlated with serum albumin level (r=-0.279 p=0.003) and serum creatinine level (r=-0.2455 p =0.008). In the Multiple Logistic Regression model established, female gender (OR: 7.857, 95%CI [2.463-25.065], p<0.001) and poor economic status (OR: 7.569, 95%CI [2,300-24,908], p=0.001) were determined as independent risk factors for depressive mood. Conclusion: Nearly half of the patients had sleep disorders and depressive mood. Patients in the depressive mood and poor sleep group had a higher FVC-19 scale. We think it would be beneficial not to ignore the increased frequency of depressive mood and sleep disorders in hemodialysis patients during the COVID-19 pandemic.
