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Öğe Effect of the tunneled-cuffed central venous catheters on oxidative stress indices and inflammation in chronic hemodialysis patients(2021) Korucu, Berfu; Yeter, Hacı Hasan; Bali, Elif Burcu; Derici, Mehmet KürşatObjectives: The use of central venous catheters as hemodialysis (HD) vascular access is associated with worse\rmorbidity and mortality in HD patients. This occasion is often attributed to comorbidities of the patients with\rcentral venous catheters. Studies reveal that a biofilm layer occurs on most of the tunneled-cuffed central\rvenous catheters (TC-CVCs). This study aimed to determine the oxidative stress (OS) and systemic\rinflammation (SI) status in patients with TC-CVCs as HD vascular access without clinical signs and symptoms\rof infection.\rMethods: The study is composed of eighty-five patients with a minimum HD vintage of one year. Patients\rwith a history of infection or a cardiovascular event within six months, malignancy, systemic inflammatory\rdiseases, or malnutrition were excluded. OS indices and SI markers were studied and compared in patients\rwith arteriovenous fistula (AVF) and TC-CVCs.\rResults: Mean native thiol/total thiol (NT/TT) ratio was significantly higher and mean disulphide/total thiol\r(DT/TT) ratio was significantly lower in AVF group comparing TC-CVC group (0.46 ± 0.17 and 0.36 ± 0.17,\rp = 0.03 for NT/TT; 0.27 ± 0.08 and 0.31 ± 0.08, p = 0.04 for DS/TT; respectively). Mean OS index was\rsignificantly lower in the AVF group comparing TC-CVC group (0.15 ± 0.14 and 0.24 ± 0.23, p = 0.04;\rrespectively]. Median hs-CRP levels and median IL-6 levels were significantly lower in AVF group comparing\rTC-CVC group (5.8 [min: 3.0-max: 82.5] mg/L and 9.7 [min: 3.0-max: 45.4] mg/L, p = 0.004 for hs-CRP; 6.2\r[min: 2.0-max:159.0] pg/mL and 12.2 [min: 2.6-max: 41.3) pg/mL, p = 0.01 for IL-6; respectively).\rConclusions: TC-CVCs inversely affect OS and systemic inflammatory status in HD patients, presumably\rdue to foreign body reactions and biofilm layers.Öğe Effects of medium cut-off dialysis membranes on inflammation and oxidative stress in patients on maintenance hemodialysis(SPRINGER, 2020) Yeter, Hasan Haci; Korucu, Berfu; Akcay, Ömer Faruk; Derici, Kürşat; Derici, Ülver; Arinsoy, TurgayPurpose Medium cut-off membranes were developed for providing increased clearance of larger middle-molecule uremic toxins. We compared the effect of low-flux, medium cut-off, and high-flux membranes on chronic inflammation and oxidative stress in patients with maintenance hemodialysis. Methods A total of 42 patients were enrolled in this study. Total antioxidant status, total oxidant status, paraoxonase-1, ischemia-modified albumin, total Thiol, disulfide bond, and native Thiol were measured to determine oxidative stress. C-reactive protein was measured to define inflammation. Results 37% of the total patients were females, and the mean age was 52.9 +/- 16 years. Serum albumin and Kt/V were similar between groups during the study period. We did not find any significant difference at baseline in the 3rd and 6th months of the study when we compared the inflammatory marker and oxidative indicator levels between three hemodialysis membranes in the whole study group. In the subgroup analysis of 19 patients with a high C-reactive protein level, we found that the medium cut-off membrane significantly reduced serum C-reactive protein level, when compared to low-flux and high-flux membrane [2.8 mg/L vs. 13.7 mg/L and 6.1 mg/L, respectively,p = 0.05]. However, we did not find a significant change in oxidative stress indicators in patients with high C-reactive protein levels between the three dialysers. Conclusion The medium cut-off membrane has favorable effects on inflammation in patients with maintenance hemodialysis. However, this positive effect could not be demonstrated in oxidative stress.Öğe Impact of medium cut-off membranes on S100A12 and soluble receptor for advanced glycation end products(Wiley, 2023) Korucu, Berfu; Yeter, Hasan; Gonen, Sevim; Derici, Mehmet Kursat; Ronco, Claudio; Derici, UlverIntroduction Of the most remarkable molecules associated with atherosclerosis and the cardiovascular outcome are S100A12 (10,379.5 Da) and soluble receptor for advanced glycation end products (sRAGE-42,803 Da) in the hemodialysis (HD) population. We designed a study investigating the effects of the medium cut-off (MCO) dialyzers focusing on S100A12 and sRAGE in HD patients compared with low-flux and high-flux dialyzers. Methods This single-site, prospective, observational study comprises age and sex-matched HD groups (low-flux, high-flux, and MCO). Blood samples were drawn at baseline (predialysis and postdialysis) and the sixth month (predialysis). Results Groups had similar demographic features and laboratory parameters. Baseline S100A12 levels of the groups were similar [34.3 (+/- 66.5), 30.9 (+/- 42.7), and 40.6 (+/- 29.6); p = 0.13]. Compared to their baseline, the sixth-month S100A12 levels were constant in low-flux and high-flux group and significantly lower in MCO group (p = 0.16, p = 0.33, and p = 0.004). Baseline sRAGE levels of the groups were similar at baseline [2.8 (+/- 0.8), 2.7 (+/- 0.6), and 2.6 (+/- 0.7); p = 0.65], and the sixth-month [2.9 (+/- 0.5), 2.4 (+/- 0.7), and 2.4 (+/- 0.8); p = 0.24]. sRAGE levels remained constant in all groups [p = 0.84, p = 0.13, and p = 0.39]. S100A12/sRAGE ratio at baseline and sixth month was constant in low-flux [22.3 (+/- 63.7) and 18.1 (+/- 24.8); p = 0.17] and high-flux groups [11.9 (+/- 15.3) and 13.1 (+/- 5.8); p = 0.26], the ratio decreased significantly in MCO group [16.5 (+/- 11.6) to 7.8 (+/- 5.5); p = 0.03]. Conclusion Our study suggests that prolonged use of MCO dialyzers is associated with better S100A12 and sRAGE levels. Long-term studies with larger samples are needed to understand the effects of a better S100A12-sRAGE profile provided by MCO dialyzers on HD patients' cardiovascular outcomes.Öğe Relationship between Serum Adipocyte Fatty Acid-Binding Protein Levels and Systemic Inflammation in Hemodialysis Patients(AVES, 2020) Korucu, Berfu; Derici, Mehmet Kursat; Deger, Serpil Muge; Cokay, Abdurrahman; Helvaci, Ozant; Elbeg, Sehri; Derici, UlverObjective: Adipocyte fatty acid-binding protein (A-FABP) is expressed in adipose tissue and macrophages. It regulates cholesterol trafficking and is involved in atherosclerosis formation. A-FABP levels are associated with cardiovascular diseases (CVDs) in patients with or without chronic kidney disease. In this study, we evaluated A-FABP levels in healthy controls and hemodialysis (HD) patients and compared the results with C-reactive protein (CRP) and interleukin-6 (IL-6) levels to determine their relationship with systemic inflammation. Materials and Methods: The study comprised 23 healthy controls and 70 HD patients, excluding individuals with an active infection, malignancy, anorexia, obesity, and hypo- or hyperthyroidism. Demographic features, laboratory findings, A-FABP levels, and levels of inflammatory markers were evaluated between and within the groups. Results: Levels of A-FABP and inflammatory markers were significantly higher in HD patients. In the HD group, 20% of the patients had documented CVD. Levels of A-FABP and inflammatory markers were similar in nondiabetic and diabetic HD patients. Age was negatively correlated with A-FABP levels. Presence of diabetes was not correlated with A-FABP. Serum CRP and IL-6 levels were significantly correlated with A-FABP levels (r=0.354, p=0.003 and r=0.393, p=0.001, respectively). Conclusion: A-FABP levels are elevated in HD patients. Systemic inflammation is significantly related to A-FABP levels in both nondiabetic and diabetic HD patients and decreases with age. Findings of this study support the adverse cardiovascular effects of systemic inflammation in HD patients.
