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Öğe Could Low Altitude Predict the Use of Erythropoietin-Stimulating Agents in Hemodialysis Patients?(Wiley, 2025) Yasar, Emre; Azak, Alper; Girgin, Sinem; Okyay, Gulay Ulusal; Pembegul, IremIntroduction Altitude may influence the requirement for erythropoiesis-stimulating agent (ESA) therapy in patients undergoing hemodialysis (HD). This study aimed to compare anemia-related parameters, ESA utilization, and intravenous (IV) iron supplementation among HD patients residing at different altitudes. Methods This retrospective-multicenter study was conducted in three provinces of T & uuml;rkiye, each located at a distinct altitude: Balikesir (139 m; low-altitude-group [LA]), Malatya (964 m; moderate-altitude-group [MA]), and Hakkari (1728 m; high-altitude-group[HA]). Results Two hundred and twenty nine HD patients were included in the study: 99 in the LA group, 77 in the MA group, and 53 in the HA group. The mean age was 59 +/- 13 years. ESA use was observed in 92 (93%) patients in the LA group, 61 (73%) in the MA group, and 43 (81%) in the HA group (p = 0.021). Age (OR: 1.102, 95% CI: 1.035-1.174, p = 0.003), female gender (OR: 6.068, 95% CI: 1.080-34.111, p = 0.041), residing at LA (OR: 12.845, 95% CI: 1.833-90.118, p = 0.010), IV iron use (OR: 21.015, 95% CI: 3.397-130.009, p = 0.001), hematocrit (OR: 0.364, 95% CI: 0.229-0.578, p < 0.001), and ferritin (OR: 1.003, 95% CI: 1.001-1.005, p = 0.007) were identified as independent predictors of ESA use. Conclusion Residing at LA was associated with increased ESA requirements in HD patients, suggesting that altitude may be a relevant factor in anemia management.Öğe Effects of different measurements of foot angle on vital activities of hemodialysis patients(2023) Özbay, Zeynep; PEKMEZ, HIDIR; İnceoğlu, Feyza; Arpacı, Muhammed; aydın, merve; Pembegul, Irem; Aladag, MuratAim: Individuals who receive hemodialysis treatment due to chronic renal failure have limitations in their daily lives and a decrease in physical activity and walking speed. In this study, we have investigated the effectiveness of various measurements of ankle angles of hemodialysis performed on patients on balance, falling risk, and daily life activities. Materials and Methods: 114 volunteer hemodialysis patients with a mean age of 30-94 have measured at the position of plantar flexion, inversion, and eversion by a 1-degree sensitivity manual goniometer. The Time Up and Go test (TUG), Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale and Barthel Index (BI) were applied to the patients. Statistical analyses were made with the SPSS 25 program. Results: 55 male and 59 female participants were accompanied in the study. The average age was 62.8 ± 15.29, the average hemodialysis duration was 5.59 ± 3.92, the average body mass index was 5.08 ± 5.1 and he average number of falls was 5.59 ± 3.92. A low positive significant correlation was observed between plantar flexion and inversion foot angle measurements with The Lawton and Brody IADL scale (p<0,05). A low-level significant positive correlation was observed between the BI score and the plantar flexion angle measurements (p<0.05). A highly significant positive correlation was observed between plantar flexion angle measurement and inversion angle measurement. In contrast, a moderately significant positive correlation was observed between plantar flexion angle measurement and eversion angle measurement (p<0.05). Conclusion: We observed a decrease in daily life activities and a walking speed increase in falling risk in the diagnosis of chronic renal failure in hemodialysis patients.Öğe Evaluation of post-earthquake late-term trauma levels in dialysis patients and healthcare professionals(2024) YAŞAR, Emre; Pembegul, IremAim: To determine and compare the post-earthquake trauma levels of hemodialysis (HD) patients, healthcare professionals working in the HD unit, and peritoneal dialysis (PD) patients in the 11th month of two earthquakes that occurred approximately nine hours apart on February 6, 2023, and affected the east and southeast regions of Turkey. Materials and Methods: The study included a total of 162 individuals, including 87 HD and 35 PD patients who had experienced both earthquakes, and 40 healthcare professionals working in the HD unit. The post-earthquake trauma levels of the participants were assessed using the Scale That Determines the Level of the Trauma After the Earthquake (SDLTAE), consisting of a total of 20 items, developed by Tanhan et al. after the 2011 Van earthquake. The individuals with an SDLTAE score of >52 were considered highly traumatized. Results: The mean age of the participants was 53±16 years, and 79 (49%) were women. The SDLTAE score of the HD patients was found to be higher than that of the PD patients (p=0.006). There were no significant differences between the SDLTAE scores of the healthcare professionals and the HD and PD patients (p=0.419 and p=0.089, respectively). Upon comparing patients with low and high total SDLTAE scores, we observed that the rate of female individuals was higher in all groups (p<0.001 for the HD and PD groups; p=0.017 for healthcare professionals). No correlation was found between the total SDLTAE score and age, dialysis duration, or laboratory parameters between the HD and PD patients (p>0.05). Conclusion: We found that HD patients had a higher level of trauma than PD patients. Our study showed that women were more traumatized than men in sensitive groups, such as those receiving dialysis and healthcare professionals. Regularly conducting psychological assessments for dialysis patients and healthcare professionals may increase the likelihood of early intervention.Öğe Geriatric Nutrition Risk and Creatinine Indexes in Estimating the Nourishment Situation of Elderly Hemodialysis Patients(Mattioli 1885, 2022) Yakaryilmaz, Funda Datli; Pembegul, Irem; Kara, MuratObjective: Malnutrition is a common complication in hemodialysis (HD) patients, although it cannot be evaluated adequately due to the limitations of available malnutrition screening tools. The aim of our study is to evaluate the relationship between Mini nutritional Assesment-Short Form (MNA-SF) and objective malnutrition tool Geriatric Nutritional Risk Index (GNRI) and Creatinine Index (CI) in HD patients. Methods: This is a cross-sectional study of 129 patients aged 65 years and older (female=61 (47.3%) and male=68 (52.7%), 68.88 ?? 7.24 years) receiving maintenance HD therapy. Malnutrition was diagnosed with MNA-SF. GNRI and CI were calculated using existing formulas. Results: Of the participants, 26 (20.15%) were diagnosed with severe malnutrition, 25 patients (19.4%) were at risk of malnutrition and 78 (60.45%) were diagnosed with normal nutritional status. The optimal cut-off value for GNRI <95 was determined in predicting malnutrition with GNRI, sensitivity and specificity 85.4% and 88.6%, respectively. CI (< 20) was not found effective in determining malnutrition patients due to its low sensitivity and specificity (sensitivity and specificity of 35.9% and 45.0%, respectively). GNRI (<95) is a better predictor of malnutrition screening than CI (<20). Conclusions: In the evaluation of undernourished elderly HD patients, GNRI was as effective as MNA-SF, but CI was insufficient in detecting malnutrition individuals.Öğe Hemodiyaliz Hastalarında Semptom Yükü Deprem Sonrasında Artar mı? Prospektif Bir Kohort Çalışması(2024) YAŞAR, Emre; Karaaslan, Tahsin; Pembegul, IremAmaç: Hemodiyalize (HD) giren hastalar, hastalığın kendisinden, tedavisinden veya komorbid durumlarından dolayı birçok semptomla karşılaşırlar. Bu çalışmanın amacı HD hastalarında semptom yükünün deprem öncesi ve deprem sonrası üçüncü ve altıncı aylarda prospektif olarak değerlendirilmesi ve karşılaştırılmasıdır. Gereç ve Yöntemler: 6 Şubat 2023 tarihli Kahramanmaraş depremleri öncesi diyaliz semptom indeksi (DSİ) değerlendirmesi yapılmış, depremlerden üç ve altı ay sonra HD tedavisine ünitemizde devam eden 75 birey dahil edildi. Semptom yükü 30 sorudan oluşan bir anket olan DSİ ile değerlendirildi. Deprem öncesi verileri Kasım-Aralık 2022, deprem sonrası üçüncü ay verileri Mayıs 2023 ve altıncı ay verileri Ağustos 2023’te toplandı. Bulgular: Yaş ortalaması 58±14 olan 75 bireyin 26‘sı(%33.8) kadındı. Bireylerin deprem öncesi ortanca 19[12-23] semptomu mevcutken, deprem sonrası üçüncü ayda ortanca 22[19-25] ve altıncı ayda ortanca 22[17-24] semptomu vardı(p<0.001). Semptom sayısı hem deprem sonrası üçüncü ayda hem de deprem sonrası altıncı ayda deprem öncesine göre anlamlı derecede arttı (ikisi için de p<0.001). Deprem sonrası altıncı ayda deprem sonrası üçüncü aya göre semptom sayısı anlamlı derecede azaldı (p=0.002). DSİ skoru; deprem öncesinde ortanca 51[29-71], deprem sonrası üçüncü ayda ortanca 71[51-82] ve deprem sonrası altıncı ayda ortanca 63[40-76] idi(p<0.001). DSİ skoru, hem deprem sonrası üçüncü ayda hem de deprem sonrası altıncı ayda deprem öncesine göre anlamlı derecede arttı(ikisi için de p<0.001). DSİ skoru, deprem sonrası altıncı ayda deprem sonrası üçüncü aya göre anlamlı derecede azaldı(p<0.001). Sonuç: HD hastalarında yüksek olan semptom yükünün deprem gibi büyük travmalar sonrası dönemde daha da arttığını gösterdik. Artmış semptom yükünün deprem sonrası farkında olmak ve takip etmek erken müdahale şansı sağlayabilir.Öğe Hemodiyaliz Hastalarında Umutsuzluk Düzeyi ile Günlük Yaşam Aktiviteleri Arasındaki İlişki(2022) YAKARYILMAZ, FUNDA DATLI; Pembegul, IremAmaç: Son dönem böbrek yetmezliği (SDBY) hastalarında, hastalık yükünün stres, psikososyal bozukluk ve günlük yaşamda bağımlılık riskini arttırdığı bildirilmektedir. Bu çalışmada hemodiyaliz (HD) tedavisi alan SDBY olan hastaların günlük yaşam aktivitelerini ve umutsuzluk düzeylerini saptamanın yanı sıra umutsuzluk üzerine etkili olan faktörleri değerlendirilmesi amaçlanmıştır. Materyal ve Metot: Bu kesitsel çalışmaya toplam 130 HD hastası (erkek / kadın: 72/58, ortalama yaş 59.48±14.58) alındı. Tüm katılımcılar Beck Umutsuzluk Ölçeği (BUÖ) ve Barthel Günlük Yaşam Aktivitesi (BGYA) Ölçeği ile değerlendirildi. Klinik verilere hastane kayıtlarından ulaşıldı. Sonuçlar: BGYA ölçeğine göre; hastaların %60.8'ü bağımlı olarak (%58.5’i orta / şiddetli derecede, %2.3 tam bağımlı) saptandı. BGYA skorları yaşlı grupta daha yüksek idi (p<0.001). Hastaların BUÖ skorları 6.78±4.84’idi, cinsiyet ve yaşa göre anlamlı farklılık saptanmadı (p=0.268, p=0.756, sırasıyla). BGYA ve BUÖ arasında negatif korelasyon mevcuttu (r=-0.216, p=0.014). Tartışma: Bu çalışmada HD hastalarında bağımlılık ve umutsuzluk düzeyinin yüksek olmasının yanı sıra her ikisinin birbiri ile ilişkili olduğunu saptadık. HD hastalarında genel iyilik halinin arttırılmasında ve bağımsızlığın korunmasında umudu arttırıcı müdahalelere ihtiyaç vardır.Öğe Lercanidipine-induced Chyloperitoneum in a Geriatric Patient with Peritoneal Dialysis(Galenos Publ House, 2023) Pembegul, Irem; Yakaryilmaz, Funda Datli; Balseven, OzgulPeritoneal dialysis is one of the renal replacement therapy modality for patients with end-stage renal disease. Hypertension is a common comorbidity in these patients and calcium channel blockers are the most commonly prescribed drugs. Chyloperitoneum is a non-infectious cause of cloudy peritoneal effluent. Lercanidipine is a lipophilic, third generation calcium channel blocker and a widely used antihypertensive agent. Herein, we presented a case of geriatric peritoneal dialysis patient admitted to hospital cloudy effluent after the use of lercanidipine for hypertension. The peritoneal effluent returned to normal after after the cessation of lercanidipine.Öğe Psychological effects of the COVID-19 pandemic on hemodialysis patients(2022) YAKARYILMAZ, FUNDA DATLI; Pembegul, IremDuring the unprecedented COVID-19 pandemic, there is insufficient information about the psychological effects and factors that will affect the mental health status of\rhemodialysis (HD) patients. We aimed to evaluate the psychological effects of the COVID-19 pandemic on HD patients. There is an observational study in secondary-level\rhealthcare services in eastern Turkey. There were a total of 176 respondents. Sociodemographic data of the participants were obtained from the files. All participants were\rmeasured with the Fear of COVID-19 Scale (FVC-19S) the depression anxiety and stress scale (DASS-21). There were significant differences between FVC-19S, depression, and anxiety in the age groups (p<0.001, p<0.001, p<0.001, respectively). While there was no difference in stress levels between age groups, stress levels were found\rto be significantly higher in males. (p<0.001). When important public health events such as pandemics break out, especially HD patients with advanced age and multiple\rcomorbid diseases should be evaluated carefully and psychologically, and early intervention should be provided.Öğe Relationship between symptom burden and dialysis adequacy in patients with chronic kidney disease undergoing hemodialysis(Kare Publ, 2023) Karaaslan, Tahsin; Pembegul, IremOBJECTIVE: The aim of this study was to reveal the relationship between hemodialysis (HD) adequacy and dialysis symptom index (DSI) in patients with end-stage kidney disease (ESKD).METHODS: This prospective study included 92 ESKD patients who underwent HD three times a week. Data including sex, age, education status, marital status, economic status, employment status, dependency status, type of vascular access, and duration of HD were recorded. Biochemical and hematological analyses were carried out. Dialysis adequacy was assessed based on clinical and biochemical analysis. The DSI was used to evaluate the emotional and physical symptoms of HD patients.RESULTS: Of the patients, 55 were males and 37 were females, with a mean age of 59.95 +/- 14.9 years. The median duration of HD was 60.0 months (interquartile range: 20.8-103.5). The mean DSI score was 54.35 +/- 26.0, with a significantly higher score in female patients (p<0.001). There was a significant correlation between DSI and increasing age (p<0.05). The single pool Kt/V (spKt/V) ratio of HD patients with AVF access was significantly higher, and the mean DSI was significantly lower than that of those receiving HD with a central venous catheter (p<0.001). The mean DSI score was significantly higher in patients with a spKt/V ratio of <1.2 than those with a spKt/V ratio of >= 1.2 (p<0.001). In multivariate regression analysis using biochemical parameters, the spKt/V ratio was a significant and independent predictor of DSI scores (R-2=0.64, p<0.001). In addition, a significant and independent relationship was found between DSI and gender, age, and economic status in the regression analysis (R-2=0.36, p<0.001).CONCLUSION: Dialysis adequacy is an independent predictor of DSI. If an adequate dialysis dose is ensured to be delivered, symptom burden may dramatically decrease.Öğe The relationship between dietary antioxidant capacity and serum oxidative stress index of hemodialysis patients(2023) ALATAŞ, HACER; Saka, Mendane; Arslan, Nurgül; YAPRAK, BÜLENT; Otlu, Önder; Pembegul, IremPurpose: Oxidative stress increases in uremic conditions such as kidney failure and during hemodialysis. In this study, it was aimed to examine the relationship between the total antioxidant capacity of the diet and the serum oxidative stress (sOSI) index in hemodialysis patients. Materials and Methods: In this study conducted with 82 individuals (41 patients and 41 controls). Demographic characteristics and anthropometric measurements of the individuals were taken by researchers. In order to determine the nutritional status of the individuals, 3-day food consumption records were taken and the total antioxidant capacity of the diet was calculated. Results: The mean age of the individuals participating in the study was found to be 54.01±2.24 years. Hemodialysis treatment mean for 4.8±3.12 years. While 41.46% of hemodialysis patients were moderately malnourished. Dietary Oxygen Radical Absorption Capacity (dORAC) (?mol) measurement result was found to be 2415.3±1073.45, 5468.4±2393.85 in the hemodialysis and control groups, respectively. In the multiple logistic regression analysis performed, the decrease in body mass index (OR 2.21 95% CI 1.050-2.317) and triceps skinfold thickness values (OR 3.22 95% CI 1.722-4.001) in hemodialysis patients led to an increase in the sOSI value. It has been observed that when dietary protein (OR 1.23 95% CI 1.003-3.189), vitamin C (OR 2.88 95% CI 1.004-3.106) and dTAC (OR 2.04 95% CI 1.967-2.001) increase, the sOSI value decreases in hemodialysis patients. Conclusion: There is a positive relationship between diet total antioxidant capacity and serum antioxidant level, and it was determined that the dietary antioxidant capacity of hemodialysis patients was significantly lower than that of healthy individuals. According to the results of the study, it is recommended to monitor the food consumption status of hemodialysis patients in order to increase the dietary antioxidant capacity.
