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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 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 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]
