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    Subclinical Cardiovascular Risk Factors in Chronic Kidney Disease: Abnormal Heart Rate Recovery
    (2020) Turgut, Didem; Yenigün, Ezgi Coşkun; Kundi, Harun; Özyakar, Nihal; Dede, Fatih
    Objective: Chronic kidney disease (CKD) is associated with increased mortality and high cardiovascular (CV) risk. Slow heart rate recovery (HRR) is an index of cardiac autonomic dysfunction and also a prognostic tool for cardiac and all-cause mortality in high-risk groups. In this study, we aimed to investigate the subclinical CV risk factor in different stages of CKD. Materials and Methods: Fifty-one patients with stage 1–5 CKD (mean age, 42.5±8.1 years) and 42 healthy individuals (mean age, 36.0±7.9 years) were included in the study. The HRR was calculated by subtracting the heart rates in the 1st, 2nd, and 3rd minute of the recovery period from the maximum heart rate attained during the exercise stress test. Results: The HRR in the 1st minute was significantly slower in the CKD group compared with that in the control group (22.4±11.3 and 32.4±11.1, respectively; p<0.001). The HRR in the 2nd and 3rd minute was also slower in the patient group, but the difference was not statistically significant. Seventeen patients with the 1st minute HRR ?18 beats/min were mainly distributed in CKD stages 4 and 5. Conclusion: Patients with CKD with no known cardiac disease and no structural cardiac changes were at risk of CV events with a slow HRR in the exercise test. Clinicians should be careful not to underestimate CV events in this group of patients.
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    Urinay neutrophil gelatinase-associated lipocalin as a biomarker in different renal problems
    (Tubitak Scientific & Technical Research Council Turkey, 2020) Turgut, Didem; Piskinpasa, Serhan Vahit; Yenigun, Ezgi Coskun; Aydemir, Nihal; Dede, Fatih
    Background/aim: Neutrophil gelatinase-associated lipocalin (NGAL) is used previously to estimate the etiology, severity, and clinical outcomes of acute kidney injury (AKI). However, the role of urinary NGAL (uNGAL) in the postrenal setting is not clear. In our study, we aimed to discover the cut-off value of uNGAL that can be used in the differential diagnosis of underlying AKI etiologies. Materials and methods: In this prospective cross-sectional study, we examined 82 subjects in four groups: patients that had (1) postrenal AKI; (2) AKI other than postrenal etiologies; (3) stable chronic kidney disease; and (4) healthy subjects. A renal function assessment was carried out by measuring serum creatininc (sCr) and uNGAL at the time of diagnosis [0th min (T0)]. We followed the study group for three months. Results: At the time of diagnosis, sCr (T0) was highest in the postrenal AKI and AKI groups in contrast to stable chronic kidney disease patients and healthy subjects (P < 0.001), as expected. T0 median uNGAL was highest in the postrenal group (P < 0.001). Area under curve (AUC) of uNGAL to estimate postrenal AKI presence was 0.957 (95% CI, 0.897-1.000; P < 0.001). The cut-off point of uNGAL was 42.625 ng/mL for this estimation. Conclusion: Patients with AKI must be classified according to the underlying etiologies as soon as possible. uNGAL may be useful to estimate the etiologies, and whether the problem is acute or chronic in the course. In postrenal kidney problems, to plan the urgency of the urologic procedures, it is crucial.