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    The relationship among asymmetric dimethylarginine (ADMA) levels, residual renal function, and left ventricular hypertrophy in continuous ambulatory peritoneal dialysis patients
    (Taylor & Francis Ltd, 2008) Ebinc, Fatma Ayerden; Erten, Yasemin; Ebinc, Haksun; Pasaoglu, Hatice; Demirtas, Canan; Tacoy, Guelten; Sindel, Suekrue
    Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial-based nitric oxide synthase. Its level is increased by end stage renal disease. However, most studies showing an increase in ADMA in dialysis patients have focused on hemodialysis. Results with peritoneal dialysis patients have been more inconclusive. Recent studies suggest that ADMA may be a new cardiovascular risk factor. The aim of the present study was to evaluate the relationship between ADMA levels, residual renal function, and left ventricular hypertrophy in peritoneal dialysis patients. Serum ADMA measurements and echocardiographic evaluations were performed in 54 peritoneal dialysis patients and 26 healthy volunteers. Residual renal function was measured in peritoneal dialysis patients by urea clearance from a urine collection. Thirty-two of the 54 peritoneal dialysis patients had residual renal function. ADMA levels of the peritoneal dialysis group were found to be significantly higher than those of healthy individuals (p = 0.03). Within the peritoneal dialysis group, ADMA levels of patients with residual renal function were significantly lower than those without residual renal function (p = 0.01), though they were still higher than the ADMA levels of the control group (p=0.04). Serum levels of ADMA were positively correlated with left ventricular mass index (r = 0.29, p = 0.01) and negatively correlated with early mitral inflow velocity (Em) (r = -0.28, p = 0.01), Em/Late mitral inflow velocity (Am) (r = -0,32, p = 0.00), and isovolumetric relaxation time (r = -0.30, p = 0.01). In conclusion, increased ADMA levels seem to be associated with left ventricular hypertrophy in peritoneal dialysis patients, and residual renal function may lead to a reduction of serum ADMA levels.
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    The relationship between vascular endothelial growth factor (VEGF) and microalbuminuria in patients with essential hypertension
    (Japan Soc Internal Medicine, 2008) Ebinç, Fatma Ayerden; Haksun, Ebinc; Ulver, Derici Boztepe; Koc, Eyuep; Erten, Yasemin; Altok, Kadriye Reis; Sindel, Şükrü
    Objective The existence of microalbuminuria (MAU) in patients with essential hypertension is a strong indicator of microvascular damage. Although endothelial dysfunction and increased vascular permeability both have a role in the development of MAU, its ethiopathogenesis in hypertensive patients is not yet clearly understood. Vascular endothelial growth factor (VEGF) is the most important regulator of pathological or physiological angiogenesis and it additionally leads to increased vascular permeability. This study aims to assess the relationship of serum VEGF levels to MAU in non-complicated, newly-diagnosed essential hypertensive patients (EHs). Methods This study included 30 newly-diagnosed EHs with MAU, 46 newly-diagnosed EHs without MAU and 46 healthy controls. None of the EHs had diabetes, renal impairment or atherosclerotic diseases. Serum VEGF levels were measured using the ELISA method. Results Serum levels of VEGF were significantly higher in EHs with MAU when compared with patients without MAU (225.15+/-109.34 pg/mL versus 166.78+/-114.35 pg/mL, p: 0.04) or controls (225.15+/-109.34 pg/mL versus 144.91+/-96.60 pg/mL, p: 0.007). On the other hand, no significant difference was observed between the non-MAU and control groups. In the univariate analysis, serum levels of VEGF, were positively correlated with systolic blood pressure (R: 0.253 p: 0.001), diastolic blood pressure (R: 0.162 p: 0.04), mean arterial pressure (R: 0.239 p: 0.002), creatinine clearance (R: 0.172 p: 0.04) and MAU (R: 0.338 p: 0.002). In the multiple linear regression analysis, VEGF levels were independently related to MAU (beta: 0.248, p: 0.02). Conclusion VEGF levels are higher in EHs in the presence of MAU. These high values may be important in the early diagnosis of vascular damage in EHs. Additionally, VEGF may increase glomerular permeability and lead to MAU in EHs.
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    The relationship of visfatin levels to inflammatory cytokines and left ventricular hypertrophy in hemodialysis and continuous ambulatory peritoneal dialysis patients
    (Taylor & Francis Ltd, 2008) Erten, Yasemin; Ebinc, Fatma Ayerden; Ebinc, Haksun; Pasaoglu, Hatice; Demirtas, Canan; Tacoy, Guelten; Sindel, Suekrue
    Visfatin was recently defined as an adipocytokine; however, the pathophysiological role of visfatin is not completely understood. A few studies suggest that visfatin may be a new proinflammatory adipocytokine. The aim of the present study was to compare serum visfatin levels between hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients and evaluate the relationship between visfatin levels to IL-6, TNF-alpha, and left ventricular hypertrophy. Serum visfatin, IL-6, and TNF-alpha levels were measured by using the ELISA method, and echocardiographic evaluations were performed in 31 hemodialysis patients, 30 CAPD patients, and 21 healthy volunteers. Serum visfatin levels were higher in the CAPD group (265.27 +/- 387.86 ng/mL) than hemodialysis (97.68 +/- 244.96 ng/mL,) and control (41.33 +/- 48.87 ng/mL) groups (p = 0.04, p = 0.01, respectively). No significant difference was observed between the hemodialysis and control groups. In univariate analysis, visfatin levels were positively correlated with IL-6 (r = 0.24, p = 0.03), TNF-alpha (r = 0.34, p = 0.002), and BMI (r = 0.26, p = 0.03) and negatively correlated with some left ventricular diastolic parameters [ Em and Em/Am (r =-0.305, p = 0.01), (r =-0.251, p = 0.03), respectively]. No relationship was found between visfatin and left ventricular mass index. In the linear regression analysis, visfatin levels independently related with TNF-((beta = 0.369, p = 0.001) and IL-6 (beta = 0.284, p = 0.015). This study has found significantly higher levels of serum visfatin in CAPD patients when compared to healthy individuals. Increased visfatin levels seem to associate with proinflammatory cytokines such as IL-6 or TNF-alpha. As for the effects of on left ventricular structure and functions, visfatin might have negative effects on left ventricular diastolic function parameters but have no effects on left ventricular mass index.