Browsing by Author "Ozmen, S."

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Hyaluronic Acid as a New Biomarker To Differentiate Acute Kidney Injury From Chronic Kidney Disease
(Iranian Society of Nephrology, 2017) Akin, D.; Ozmen, S.; Yilmaz, M.E.
Introduction. It may be difficult to differentiate acute kidney injury from chronic kidney disease in patients with no past medical reports of kidney function. This study aimed to investigate the role of serum hyaluronic acid (HA), which is known as a marker of fibrosis, in differential diagnosis of kidney failure. Materials and Methods. A total of 90 patients (52 women and 38 mne) admitted to our renal unit with uremia for the first time were included. Serum HA level was measured. The diagnostic role of the test was investigated using the receiver operator curve curves. Results. The mean age of the patients was 54.6 ± 17.9 years. The diagnosis was chronic kidney disease (CKD) in 41.1%, acute kidney injury (AKI) in 48.9%, AKI on CKD in 6.7% (3 died without a diagnosis). The mean serum HA was significantly higher in the CKD group (146.1 ± 119.3 ng/mL) than the AKI group (68.9 ± 69.1 ng/ mL; P <.001). Serum HA significantly correlated with proteinuria (r = 0.717, P <.001) and serum albumin level (r = - 0.599, P <.001) in the CKD group only. Serum HA cutoff level of 61 ng/dL had a sensitivity of 82% and specificity of 67% for differential diagnosis of AKI and CKD. Conclusions. Serum HA level may be used as tool to differentiate AKI from CKD. Further larger studies are warranted to clarify the definite the role of this marker. © 2017, Iranian Society of Nephrology. All rights reserved.
A Novel Factor for Primary Arteriovenous Fistula Failure: Hyperinsulinism
(Taylor and Francis Ltd, 2016) Akin, D.; Ozmen, S.; Kaya, R.
Introduction: Dysfunction of vascular access is an important reason of morbidity for dialysis patients and it is a major factor affecting the economical burden of hemodialysis. The preferred type of vascular access is creation of an arteriovenous fistula (AVF). However, the problem of fistula maturation rate is still a challenge. Herein, we tried to search the role of hyperinsulinism and insulin resistance as a new predictor of primary AVF failure (pAVFF) that may be a cause of intimal damage. Methods: We included 119 patients (73 male and 46 female) with a diagnosis of end-stage renal disease (ESRD) who had undergone an AVF operation by a vascular surgeon. The AVF was examined for presence of thrill on the first postoperative day. A successful cannulation with two fistula needles with a blood flow of 250 mL/min for at least one complete dialysis session, after 4 weeks of AVF surgery was defined as functioning access. Insulin resistance in our patients was determined by the standard homeostasis model assessment (homa-IR). A logistic-regression analysis was performed to investigate the independent factors related with pAVFF. Findings: Detection of pAVFF occurred in 27 (22.7%) patients. The presence of thrill, amount of daily proteinuria, insulin levels, homa-IR, and serum albumin levels were found to be significantly different between patients with fistula failure and those without pAVFF. The logistic-regression analysis of preoperative factors revealed the following OR (odds ratio) and 95% CI values: homa-IR 1.205 (1.063–1.366) (p = 0.004), serum albumin 0.398 (0.178–0.892) (p = 0.025), and the amount of daily proteinuria 1.307 (1.012–1.688) (p = 0.041). Even after addition of the presence of postoperative thrill on AVF, which was a postoperative strong clinical factor to the analysis, mean homa-IR and mean serum albumin continued to be independent predictors of pAVFF. Discussion: Insulin resistance or hyperinsulinism may be a significant cause of pAVFF, which emphasizes the role of endothelium in fistula dysfunction. © 2016 Informa UK Limited, trading as Taylor & Francis Group.