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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 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.Article 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, SirenBackground: 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.
