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Öğe ASSOCIATION OF MULTIPLE PLASMA BIOMARKER LEVELS WITH KIDNEY DISEASE ACTIVITY IN FABRY DISEASE(Oxford Univ Press, 2023) Ozcan, Seyda Gul; Atli, Zeynep; Eren, Necmi; Dincer, Mevlut Tamer; Turkmen, Kultigin; Ozer, Hakan; Trabulus, Sinan[No abstract available]Öğe Coronary artery calcification progression and long-term cardiovascular outcomes in renal transplant recipients: an analysis by the joint model(Oxford Univ Press, 2022) Seyahi, Nurhan; Alagoz, Selma; Atli, Zeynep; Ozcan, Seyda Gul; Tripepi, Giovanni; Bakir, Alev; Trabulus, SinanBackground. Compared with the general population, the risk of death is substantially higher in renal transplant recipients than in age- and sex-matched individuals in the general population. In the general population, coronary artery calcification (CAC) predicts all-cause and cardiovascular mortality. In this study we aimed to analyse these relationships in renal transplant recipients. Methods. We examined 178 renal transplant patients in this prospective observational cohort study. We measured CAC with multidetector spiral computed tomography using the Agatston score at multiple time points. Overall, 411 scans were performed in 178 patients over an average 12.8 years follow-up. The clinical endpoint was a composite including all-cause death and non-fatal cardiovascular events. Data analysis was performed by the joint model. Results. During a follow-up of 12.862.4 years, coronary calcification progressed over time (P < 0.001) and the clinical endpoint occurred in 54 patients. In the analysis by the joint model, both the baseline CAC score and the CAC score progression were strongly associated with the incidence rate of the composite event [hazard ratio 1.261 (95% confidence interval 1.119-1.420), P = 0.0001]. [GRAPHICS] Conclusions. CAC at baseline and coronary calcification progression robustly predict the risk of death and cardiovascular events in renal transplant recipients. These findings support the hypothesis that the link between the calcifying arteriopathy of renal transplant patients and clinical end points in these patients is causal in nature.Öğe DEVELOPMENT AND VALIDATION OF THE THIRST DISTRESS SCALE FOR PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE(Oxford Univ Press, 2022) Ozcan, Seyda Gul; Bek, Sibel; Eren, Necmi; Atli, Zeynep; Yildiz, Abdulmecit; Kocyigit, Ismail; Cavdar, Caner[No abstract available]Öğe Effect of Tyrosine Kinase Inhibitor Therapy on Estimated Glomerular Filtration Rate in Patients with Chronic Myeloid Leukemia(Cig Media Group, Lp, 2024) Sonmez, Oezge; Yurttas, Nurguel Ozguer; Ihtiyaroglu, Ilker; Cakir, Halil Mete; Atli, Zeynep; Elverdi, Tugrul; Salihoglu, AyseIn this study, we evaluated the possible kidney toxicity of tyrosine kinase inhibitors (TKIs) in patients with chronic myeloid leukemia (CML). We examined 195 patients with CML and 138 patients with chronic kidney disease (CKD). We found a downward trend in the glomerular filtration rate under TKI treatment during follow up which was comparable to that of CKD patients. Introduction: The advent of tyrosine kinase inhibitors (TKIs) was revolutionary in the management of chronic myeloid leukemia (CML). Although TKIs were generally considered to be safe, they can be associated with renal injury. We evaluated the effect of TKIs on renal functions in a cohort of patients with long-term follow-up. Material and Methods: We retrospectively examined patients with chronic phase CML treated with TKIs. We analyzed the estimated glomerular filtration rate (eGFR) of patients from the initiation of TKI to the last follow-up. eGFR values of CML patients were compared to those of patients with stage 1 or 2 chronic kidney disease (CKD). Results: A total of 195 patients with CML and 138 patients with CKD were examined. eGFR decline was 1.556 ml/min/1.73m 2 /year for patients with CML ( P = .221). Patients receiving second-generation TKIs (2GTKI) were estimated to have 0.583 ml/min/1.73m 2 higher eGFR value than that of the imatinib group, but it was not significant ( P = .871). eGFR of patients who had used bosutinib had a downward trend. Duration of TKI therapy, age, and hypertension were found to be significant factors in eGFR decline for CML patients. Lower baseline GFR was associated with an increased risk of CKD development. Conclusion: Imatinib could result in a decline in eGFR which was clinically similar to early-stage CKD patients. We did not observe significant kidney function deterioration in patients receiving 2GTKIs including dasatinib and nilotinib. We recommend close renal function monitoring in patients receiving imatinib, especially for elderly patients with lower baseline eGFR and hypertension.Öğe Effects of Antithymocyte Globulin, Basiliximab, and Induction-Free Treatment in Living Donor Kidney Transplant Recipients on Tacrolimus-Based Immunosuppression(Baskent Univ, 2024) Sonmez, Ozge; Ozcan, Seyda Gul; Karaca, Cebrail; Atli, Zeynep; Dincer, Mevlut Tamer; Trabulus, Sinan; Seyahi, NurhanObjectives: Induction treatment in renal transplant is associated with better graft survival. However, intensified immunosuppression is known to cause unwanted side effects such as infection and malignancy. Furthermore, the effects of the routine use of immunosuppressants in low -risk kidney transplant recipients are still not clear. In this study, we assessed the first -year safety and efficacy of induction treatment. Materials and Methods: We examined first living donor kidney transplant patients who were on tacrolimusbased immunosuppression therapy. We formed 3 groups according to the induction status: antithymocyte globulin induction, basiliximab induction, and no induction. We collected outcome data on delayed graft function, graft loss, creatinine levels, estimated glomerular filtration rates, acute rejection episodes, hospitalization episodes, and infection episodes, including cytomegalovirus infection and bacterial infections. Results: We examined a total of 126 patients (age 35 +/- 12 years; 65% male). Of them, 25 received antithymocyte globulin, 52 received basiliximab, and 49 did not receive any induction treatment. We did not observe any statistically significant difference among the 3 groups in terms of acute rejection episodes, delayed graft function, and first -year graft loss. The estimated glomerular filtration rates were similar among the groups. Overall bacterial infectious complications and cytomegalovirus infection showed similar prevalence among all groups. Hospitalization was less common in the induction -free group. Conclusions: In low -risk patients, induction -free regimens could be associated with a better safety profile without compromising graft survival. Therefore, induction treatment may be disregarded in first living donor transplant patients who receive tacrolimusbased triple immunosuppression treatment.Öğe Estimation of the graft failure by current value joint model, and extension to alternative parameterization structures: Cohort study(Lippincott Williams & Wilkins, 2024) Bakir, Alev; Atli, Zeynep; Kaya, Eda; Pekmezci, Salih; Seyahi, NurhanIn clinical practice, individuals are followed up to predict the outcome event of interest, and their longitudinal measurements are collected on a regular or irregular basis. We aimed to examine the classical approach, joint model (JM), and alternative parameterization structures using data on the effect of time-varying longitudinal measurements on survival. The motivating cohort dataset included 158 consecutive kidney transplant recipients who had baseline and follow-up data. Although the longitudinal log-transformed estimated glomerular filtration rate (log[eGFR]) measurements and graft failure have an association clinically, the 2 processes are analyzed separately in the classical approach. In addition to the extended Cox model, the current value JM, the weighted cumulative effect JM, and dynamic predictions were performed in the study, by taking advantage of R codes. Of the 158 patients, 34.8% were males. The mean age was 29.8 +/- 10.9 years, and the median age was 26 years at the time of transplantation. The hazard ratio for graft failure was 8.80 for a 1-unit decrease in log(eGFR) in the extended Cox model, 10.58 in the current value JM, and 3.65 in the weighted cumulative effect JM. The presence of coronary heart disease was also found to be associated with log(eGFR): 0.199 (P = .03) for the current value JM and 0.197 (P = .03) for the weighted cumulative effect JM. The current value JM was identified as a better model than the extended Cox model and the weighted cumulative effect JM based on parameter and standard error comparison and goodness of fit criteria. JMs should be preferred, as they facilitate better clinical decisions by accounting for the varying slopes and longitudinal variation of estimated glomerular filtration rate among patients. Suitable types of models should be practiced depending on baseline biomarker levels, their trends over time, the distribution of the biomarkers, and the number of longitudinal biomarkers.Öğe Evaluation of kidney disease knowledge and its determinants among patients with chronic kidney disease(Dustri-Verlag Dr Karl Feistle, 2025) Gulcicek, Sibel; Atli, Zeynep; Erol, Ertugrul; Ikizler, Talat Alp; Seyahi, NurhanPurpose: Patient self-care and knowledge of chronic kidney disease (CKD) play a crucial role in treatment effectiveness at slowing disease progression and reducing complications. There is need for tools that can quantitatively assess patients' knowledge of CKD. We aimed to translate the Kidney Disease Knowledge Survey (KiKS) to Turkish, validate the questionnaire among CKD patients, and identify the determinants of CKD knowledge. Materials and methods: The 28-item KiKS was translated into Turkish and administered to 271 CKD patients not on dialysis. Reliability of survey questions was assessed using Cronbach's alpha coefficient. Hotelling's T-squared test was used to measure effectiveness and homogeneity of the scale. Univariate and multivariate regression analyses were performed to identify the determinants of CKD knowledge. Results: The mean age of participants was 56.7 +/- 13.0 years; 54.2% were male, and 68.3% had CKD stages 3 - 5. Cronbach's alpha value of scale for the 28-item KiKS was 0.804, confirming its reliability (p < 0.001). Multivariate linear regression analysis showed that CKD stage 3 patients were associated with lower KiKS scores compared to stage 1. Participants who were aware of their CKD diagnosis and used the internet to obtain information about kidney disease had higher scores.Conclusion: The Turkish version of KiKS is reliable and valid to assess the knowledge level of Turkish CKD patients. Advanced stages of CKD were associated with less knowledge about kidney disease in this population. Targeted educational interventions or longitudinal studies are needed to assess the impact of improved CKD knowledge on clinical outcomes.Öğe Higher antibody responses after mRNA-based vaccine compared to inactivated vaccine against SARS-CoV-2 in Behcet's syndrome(Springer Heidelberg, 2022) Ozdede, Ayse; Nohut, Okan Kadir; Atli, Zeynep; Tok, Yesim Tuyji; Guner, Sabriye; Yilmaz, Erkan; Ucar, DidarThere are limited data about humoral response to vaccine in Behcet's syndrome (BS). We compared SARS-CoV-2 antibody response after two doses of inactivated (Sinovac/CoronaVac) or mRNA (Pfizer/BioNTech) vaccines in patients with BS and healthy controls (HCs). We studied 166 (92M/74F) patients with BS (mean age: 42.9 +/- 9.6 years) and 165 (75M/90F) healthy controls (mean age: 42.4 +/- 10.4 years), in a single-center cross-sectional design between April 2021 and October 2021. A total of 80 patients with BS and 89 HCs received two doses of CoronaVac, while 86 patients with BS and 76 HCs were vaccinated with BioNTech. All study subjects had a negative history for COVID-19. Serum samples were collected at least 21 days after the second dose of the vaccine. Anti-spike IgG antibody titers were measured quantitatively using a commercially available immunoassay method. We found that the great majority in both patient and HC groups had detectable antibodies after either CoronaVac (96.3% vs 100%) or BioNTech (98.8% vs 100%). Among those vaccinated with CoronaVac, BS patients had significantly lower median (IQR) titers compared to HCs [36.5 (12.5-128.5) vs 102 (59-180), p < 0.001]. On the other hand, antibody titers did not differ among patients with BS and HCs who were vaccinated with BioNTech [1648.5 (527.0-3693.8) vs 1516.0 (836.3-2599.5), p = 0.512). Among different treatment regimen subgroups in both vaccine groups, those who were using anti-TNF-based treatment had the lowest antibody titers. However, the difference was statistically significant only among those vaccinated with CoronaVac. Among patients vaccinated with BioNTech, there was no statistically significant difference between different treatment regimen groups. Compared to inactivated COVID-19 vaccine, mRNA-based vaccine elicited higher antibody titers among BS patients. Only in the CoronaVac group, patients especially those using anti-TNF agents were found to have low titers compared to healthy subjects. BS patients vaccinated with BioNTech were found to have similar seroconversion rates and antibody levels compared to healthy controls. Further studies should assess whether the low antibody titers are associated with diminished protection against COVID-19 in both vaccine groups.Öğe Safety of SARS-CoV-2 vaccination in patients with Behcet's syndrome and familial Mediterranean fever: a cross-sectional comparative study on the effects of M-RNA based and inactivated vaccine(Springer Heidelberg, 2022) Ozdede, Ayse; Guner, Sabriye; Ozcifci, Guzin; Yurttas, Berna; Dincer, Zeynep Toker; Atli, Zeynep; Uygunoglu, UgurMost of the published data relate to classical forms of rheumatic diseases (RD) and information on rare inflammatory disorders such as Behcet's syndrome (BS) and familial Mediterranean fever (FMF) is limited. We studied the frequency of side effects and disease flares after COVID-19 vaccination with either Pfizer/BioNTech or Sinovac/CoronaVac in 256 patients with BS, 247 with FMF, and 601 with RD. Telephone interviews were conducted using a questionnaire survey in a cross-sectional design in patients with BS, FMF, and RD followed by a single university hospital. Study participants were vaccinated either with CoronaVac (BS:109, FMF: 90, and RD: 343,) or BioNTech (BS: 147, FMF: 157 and RD: 258). The majority have received double dose (BS: 94.9%, FMF 92.3% and RD: 86.2%). BioNTech ensured a significantly better efficacy than CoronaVac against COVID-19 in all patient groups (BS: 1.4% vs 10.1%; FMF: 3.2% vs 12.2%, RD:2.7% vs 6.4%). Those with at least one adverse event (AE) were significantly more frequent among those vaccinated with BioNTech than those with CoronaVac (BS: 86.4% vs 45%; FMF: 83.4% vs 53.3%; and RD: 83.3% vs 45.5%). The majority of AEs were mild to moderate and transient and this was true for either vaccine. There were also AEs that required medical attention in all study groups following CoronaVac (BS: 5.5%, FMF: 3.3%, and RD:2.9%) or BioNTech (BS: 5.4%, FMF: 1.9%, and RD: 4.7%). The main causes for medical assistance were disease flare and cardiovascular events. Patients with BS (16.0%) and FMF (17.4%) were found to flare significantly more frequently when compared to those with RD (6.0%) (p < 0.001). This was true for either vaccine. BS patients reported mainly skin-mucosa lesions; there were however, 11 (4.3%) who developed major organ attack such as uveitis, thrombosis or stroke. Flare in FMF patients were associated mainly with acute serositis with or without fever. Arthralgia/arthritis or inflammatory back pain were observed mainly in the RD group. Our study demonstrates that BS and FMF patients vaccinated with either CoronaVac or BioNTech demonstrated similar AE profile and frequency compared to RD patients. AEs that required physician consultation or hospitalization occurred in all study groups after either CoronaVac or BioNTech. Increased frequency of flares in BS and FMF compared to that seen in RD might reflect defects in innate immunity and deserves further investigation. Caution should be required when monitoring these patients after vaccination.Öğe Sarcopenia, an overlooked diagnosis in kidney transplant recipients(Dustri-Verlag Dr Karl Feistle, 2024) Ozcan, Seyda Gul; Sonmez, Ozge; Atli, Zeynep; Karaca, Cebrail; Alagoz, Selma; Akman, Zafer; Koroglu, Ali EgemenMost studies of sarcopenia in renal transplant recipients (RTRs) have been hampered by a lack of standardization in the definitions of sarcopenia. In this study, we aimed to investigate the prevalence of sarcopenia and the associated factors in RTRs using the recently proposed criteria of the European Working Group on Sarcopenia in Older People 2018 (EWGSOP2), which included a standardized definition of sarcopenia. We examined 93 consecutive adult RTRs, 46 chronic kidney disease patients, and 46 healthy controls. We assessed the muscle strength with a hand grip test using a dynamometer and with a chair stand test. We used bioimpedance analysis to estimate appendicular skeletal mass using the Sergi formula. Finally, we conducted a 2-minute walking test to assess endurance. Sarcopenia and probable sarcopenia were determined according to the revised criteria of the EWGSOP2. Probable sarcopenia was found in 29 RTR patients (31.2%), of them 14 (15.1%) were diagnosed with sarcopenia. Multivariate logistic regression analysis showed that presence of diabetes mellitus, increased uric acid level, and statin use were risk factors for probable sarcopenia. On the other hand, longer dialysis vintage was a risk factor for sarcopenia in RTRs. We found that probable sarcopenia and sarcopenia were highly prevalent in our relatively young RTRs. We recommend active screening for the presence of sarcopenia in RTRs, especially in the cadaveric ones. Furthermore, caution seems warranted regarding the myopathic side effects in RTRs who use statins.Öğe SARCOPENIA: AN OVERLOOKED DIAGNOSIS IN KIDNEY TRANSPLANT RECIPIENTS(Oxford Univ Press, 2022) Ozcan, Seyda Gul; Sonmez, Ozge; Akman, Zafer; Karaca, Cebrail; Atli, Zeynep; Trabulus, Sinan; Seyahi, Nurhan[No abstract available]Öğe The incidence, clinical characteristics, and outcome of COVID-19 in a prospectively followed cohort of patients with Behcet's syndrome(Springer Heidelberg, 2022) Ozcifci, Guzin; Aydin, Tahacan; Atli, Zeynep; Balkan, Ilker Inanc; Tabak, Fehmi; Oztas, Mert; Ozguler, YesimInitial case series of small number of patients at the beginning of the pandemic reported a rather guarded prognosis for Behcet's syndrome (BS) patients infected with SARS-CoV-2. In this prospective study, we describe the incidence, clinical characteristics, disease course, management, and outcome in a large cohort of BS patients with laboratory-confirmed infection of SARS-CoV-2. We defined a cohort of 1047 registered BS patients who were aged between 16 and 60 years and seen routinely before the pandemic at the multidisciplinary outpatient clinic. We followed prospectively this cohort from beginning of April 2020 until the end of April 2021. During 13 months of follow-up, of the 1047 (599 M/448 F) patients, 592 (56.5%) were tested for SARS-CoV-2 PCR at least once and 215 (20.5%; 95% CI 0.18-0.23) were tested positive. We observed 2 peaks which took place in December 2020 and April 2021. Of the 215 PCR positive patients, complete information was available in 214. Of these 214, 14 (6.5%) were asymptomatic for COVID-19. In the remaining, the most common symptoms were anosmia, fatigue, fever, arthralgia, and headache. A total of 40 (18.7%) had lung involvement, 25 (11.7%) were hospitalized, 1 was admitted to the intensive care unit while none died. Favipiravir was the most prescribed drug (74.3%), followed by colchicine (40.2%), and hydroxychloroquine (20.1%) in the treatment of COVID-19. After COVID-19, 5 patients (2.3%) were given supplemental O-2 and 31 (14.5%) antiaggregant or anticoagulants. During COVID-19, of the 214 PCR positive patients, 116 (54.2%) decreased the dose of their immunosuppressives or stopped taking completely; 36 (16.8%) experienced a BS flare which was mostly oral ulcers (10.3%). None of the patients reported a thrombotic event. A total of 93 (43.5%) patients reported BS flares after a median 45 days of COVID-19 infection and this was found to be significantly associated with immunosuppressive drug discontinuation. Multiple regression analysis adjusted for age and gender indicated that smoking and using interferon-alpha decreased the likelihood of getting COVID-19. The incidence and severity of COVID-19 did not differ between those who were using colchicine or not. The cumulative incidence of COVID-19 in this prospectively followed cohort of BS patients was almost two folds of that estimated for the general population living in Istanbul, Turkey, however, the clinical outcome of COVID-19 was not severe and there was no mortality. The protective effect of smoking and interferon deserves further investigation. On the other hand, colchicine did not have any positive or negative effect against COVID-19. Significant number of patients flared after COVID-19, however, this was significantly associated with immunosuppressive discontinuation during the infection. Contrary to our previous observations, COVID-19 did not seem to exacerbate thrombotic events during or after the infection.
