Gülay Ulusal Okyay

Aims: The hemoglobin-albumin-lymphocyte-platelet (HALP) score is a composite biomarker reflecting systemic inflammation and nutritional status. However, its prognostic significance in immunoglobulin A nephropathy (IgAN) remains insufficiently explored. This study aimed to evaluate the renal prognostic value of inflammatory and nutritional indices, including the HALP score, measured at the time of kidney biopsy in patients with IgAN.Methods: The study cohort included 171 adult patients with biopsy-proven primary IgAN diagnosed between 1 January 2015 and 15 April 2025, with at least 12 months of follow-up unless the composite renal endpoint occurred earlier. Poor prognosis was defined as the occurrence of the primary composite endpoint: a ≥50% decline in estimated glomerular filtration rate from baseline or initiation of renal replacement therapy. Multivariable logistic regression, Kaplan-Meier survival, and receiver operating characteristic (ROC) curve analyses were performed to identify factors associated with poor renal prognosis. Results: During a median follow-up of 25.4 months, 45 patients (26.3%) reached the composite renal outcome. In the multivariable logistic regression analysis, each 10-unit increase in HALP was independently associated with lower odds of poor renal prognosis [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.62-0.99; p=0.040]. Kaplan-Meier survival analysis demonstrated significantly lower event-free survival in the low-HALP group (log-rank p

Background/aim: Posttransplant glomerulonephritis (GN) is an underrecognized but clinically important cause of allograft dysfunction. It remains uncertain whether GN detected in a clinically indicated kidney allograft biopsy provides prognostic information beyond graft function and chronic histological injury. The present study evaluates the association between biopsy-detected GN and death-censored graft loss. Materials and methods: Included in this retrospective single-center study were kidney transplant recipients (KTRs) who underwent clinically indicated allograft biopsy between May 2012 and October 2025. The primary outcome was death-censored graft loss, defined as a return to kidney replacement therapy. Postbiopsy graft survival was assessed using Kaplan–Meier analysis and sequential parsimonious Cox models. Results: Of the 120 KTRs in the study, 35 (29.2%) had biopsy-detected GN. Median death-censored graft survival was 2.19 years in the GN group and 7.71 years in the non-GN group (log-rank p = 0.005). GN was associated with graft loss in univariable analysis (HR, 2.04; 95% CI, 1.22–3.40; p = 0.006). In the main multivariable model adjusted for age, sex, biopsy estimated glomerular filtration rate, and interstitial fibrosis/tubular atrophy grade I–III, GN remained associated with graft loss (HR, 1.84; 95% CI, 1.06–3.18; p = 0.030). A multiple-imputation sensitivity analysis of the full cohort showed that additional adjustment for proteinuria attenuated the GN estimate (HR, 1.46; 95% CI, 0.84–2.54). The proportional hazards assumption was not satisfied for GN, and exploratory time-varying analysis suggested that the association may have varied over follow-up; however, later estimates were imprecise as few recipients with GN remained at risk. Conclusion: In this indication-biopsy cohort, biopsy-detected GN was associated with poorer death-censored graft survival after adjustment for graft function and chronic histological injury; however, this association was attenuated after additional adjustment for proteinuria. The magnitude and temporal pattern of the association require confirmation in larger cohorts.

Objective: Acute renal infarction (RI) is an uncommon condition with heterogeneous etiologies and potentially important renal sequelae. This study aimed to evaluate the clinical, laboratory, radiological, and treatment-related characteristics of patients with acute RI and to determine risk factors for acute kidney injury (AKI) at admission and chronic kidney disease (CKD) at 1 year.Materials and Methods: This retrospective observational study included patients with radiologically confirmed acute RI at two tertiary care centers in Ankara, Turkiye: Dışkapı Yıldırım Beyazıt Training and Research Hospital (1 January 2015 to 1 September 2022) and Ankara Etlik City Hospital (1 October 2022 to 28 February 2025). Multivariable logistic regression analysis was performed to identify predictors of AKI at admission. Firth penalized logistic regression was used to evaluate factors associated with CKD at 1 year because of the limited number of CKD events. Results: A total of 57 patients were enrolled; 56.1% were male and the mean age was 54.7 ± 13.8 years. AKI was present in 29 patients (50.9%), while CKD was observed in 13 patients (22.8%) at 1-year follow-up. In logistic regression analysis, older age was associated with AKI at admission (odds ratio [OR] = 1.058, 95% confidence interval [CI] 1.002-1.100; p=0.043), and AKI at admission remained associated with CKD at 1 year (penalized OR = 10.33, 95% CI 1.68–63.28; p=0.012).Conclusion: Patients with RI who had AKI at admission were at higher risk of developing CKD at 1 year. Older age was associated with AKI at admission. Post-discharge renal monitoring may be warranted, particularly for patients diagnosed with AKI.

Background/Objectives: Acute kidney injury (AKI) is a frequent complication following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). The association between preoperative inflammatory and immune-nutritional indices and postoperative AKI after CRS-HIPEC remains unclear. We aimed to investigate whether these prespecified candidate preoperative markers are associated with postoperative AKI in patients undergoing CRS-HIPEC. Methods: This retrospective single-center study included 87 patients who underwent CRS-HIPEC between October 2022 and April 2025. All received intraoperative cisplatin and mitomycin C. AKI was defined according to Kidney Disease: Improving Global Outcomes serum creatinine criteria. Preoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, pan-immune-inflammation value, systemic inflammation response index, and C-reactive protein–albumin–lymphocyte (CALLY) index were calculated from routine laboratory parameters. Each candidate marker was evaluated in a separate model adjusted for age and sex, and then in a second model additionally adjusted for baseline estimated glomerular filtration rate. Discriminatory performance was assessed using receiver operating characteristic analysis. The CALLY index was calculated using albumin in g/dL, lymphocyte count in ×10⁹/L, and C-reactive protein in mg/L. Results: AKI developed in 24 patients (27.6%). In-hospital mortality was higher in patients with AKI than in those without AKI (25.0% vs. 1.6%; p = 0.002). A higher log10-transformed CALLY index remained associated with lower odds of AKI after adjustment for age and sex (adjusted OR, 0.276; 95% CI, 0.113–0.673; p = 0.005). The CALLY index had the numerically highest AUC among the evaluated indices, with moderate discriminatory performance (AUC, 0.708; 95% CI, 0.579–0.836). A data-derived exploratory cutoff of ≤1.640 yielded 79.2% sensitivity and 63.5% specificity. Conclusions: In this selected retrospective cohort of patients without established chronic kidney disease, a lower preoperative CALLY index was associated with postoperative AKI and showed moderate discrimination as an individual marker. The data-derived threshold should be considered exploratory and requires independent validation before clinical application.

Introduction: Real-world epidemiological and longitudinal outcome data on autosomal dominant polycystic kidney disease (ADPKD) remain limited in underrepresented populations, including Türkiye. We aimed to characterize the epidemiology, regional distribution, and renal outcomes of ADPKD in a large multicenter national cohort. Methods: In this retrospective multicenter study, adult patients with ADPKD were identified across tertiary nephrology centers in six regions of Türkiye (2010–2025). Study-based prevalence was calculated using Turkish Statistical Institute population data. Longitudinal renal outcomes were evaluated using serial eGFR measurements and Cox regression models identified predictors of ≥ 40% eGFR decline. Results: A total of 2361 patients were included (mean age 38.6 ± 14 years; 51.8% female). Median province-level study-based prevalence was 3.86 per 100,000 population (IQR 2.92–5.49), with substantial regional variation, highest in the Black Sea region (13.46 per 100,000). Study-based prevalence increased significantly over time (annual percent change 14.4%; 95% CI 13.1–15.6; p < 0.001). During a median follow-up of 6 years, 23.9% experienced a ≥ 40% eGFR decline and 10.5% progressed to kidney failure (eGFR < 15 ml/min/1.73m2). Median annual eGFR decline was − 3.33 mL/min/1.73 m²/year. In multivariable analysis, age (adjusted HR 1.02; 95% CI 1.00–1.03; p = 0.010) and hypertension (adjusted HR 2.33; 95% CI 1.25–4.32; p = 0.007) were independently associated with renal progression, whereas tolvaptan use was associated with a lower risk of progression (adjusted HR 0.56; 95% CI 0.37–0.85; p = 0.004). The Mayo Imaging Classification remained independently predictive of renal outcomes (p = 0.027). Conclusions: This large real-world multicenter cohort highlights the geographically heterogeneous study-based burden of ADPKD across participating regions of Türkiye. Increasing prevalence over time likely reflects improved disease recognition, whereas the relatively low study-based prevalence suggests persistent under-recognition of ADPKD. These findings provide important longitudinal outcome data from an underrepresented population and support the need for earlier detection and improved risk stratification in ADPKD.

Aims: Heart rate variability (HRV), a marker of cardiac autonomic function, is suppressed in patients receiving maintenance hemodialysis (MHD) compared with the general population. However, data on modifiable dialysis-related factors influencing HRV remain limited. This study aimed to investigate the impact of different dialysate calcium concentrations on serum ionized calcium (iCa) levels and cardiac autonomic function, assessed by HRV, in MHD patients. Methods: This prospective observational study with repeated measures included patients receiving MHD. Baseline electrocardiography and transthoracic echocardiography were performed in all participants. Twenty-four–hour ambulatory electrocardiographic recordings were obtained using Holter monitors initiated immediately before the index hemodialysis (HD) session. The time domain measures of HRV were the standard deviation of all RR interval (SDNN), the mean of the standard deviation of all 5-minute RR intervals (SDNN index: SDNNI), the standard deviation of the average NN intervals over 5-minute segments (SDANN), and the square root of the mean difference between consecutive normal RR intervals (RMSSD). Serum iCa, magnesium, and potassium levels were measured at the beginning and at the end of the index HD session. Relative changes (Δ) in biochemical parameters were calculated as [(baseline value-4th hour value)]/baseline value. All clinical, biochemical, and HRV parameters were compared between groups stratified according to 1.25 mmol/L and 1.50 mmol/L calcium dialysate concentration. Results: A single 4-hour HD session using dialysate containing 1.25 mmol/L calcium was associated with a significant reduction in serum iCa levels and a greater relative change in iCa (∆iCa) compared with 1.50 mmol/L calcium dialysate. In the 1.25 mmol/L calcium dialysate group, all time-domain HRV parameters decreased, accompanied by greater relative changes. In contrast, treatment with 1.50 mmol/L calcium dialysate was related to increases in SDNNI, SDANN, and RMSSD values. After adjustment for potential confounders, multivariable regression analysis demonstrated that ∆iCa was independently associated with ∆SDANN. Conclusion: A single 4-hour HD session with 1.25 mmol/L calcium dialysate was associated with an acute decline in serum iCa levels and parallel changes in HRV indices, suggesting a potential link between dialysate calcium concentration and short-term autonomic modulation in MHD patients.

Microinflammation and functional iron deficiency are major contributors to anemia and treatment burden in maintenance hemodialysis (HD). Medium cutoff (MCO) membranes enhance the removal of middle‐ and large‐sized solutes implicated in these pathways, yet real‐world data using routinely measured inflammatory and iron‐related markers are scarce. This study examined the effects of MCO‐based expanded HD on inflammatory indices, iron metabolism, and anemia‐related treatment requirements. In this single‐center retrospective study, 22 maintenance HD patients (11 who continued on high‐flux dialyzers and 11 who were switched to MCO dialyzers) were followed for 24 weeks. Baseline and 24‐week assessments included C‐reactive protein (CRP), the CRP/albumin ratio, neutrophil count, and composite inflammatory indices, as well as serum iron, transferrin saturation (TSAT), total iron‐binding capacity (TIBC), and ferritin. Monthly intravenous iron supplementation and weekly erythropoiesis‐stimulating agent (ESA) doses were also documented. Baseline characteristics were comparable between groups. Over the 24‐week period, the MCO group showed a significant decline in neutrophil count ( p = 0.042) and downward trends in CRP and the CRP/albumin ratio, while both markers increased significantly in patients maintained on high‐flux dialyzers. Serum albumin remained stable in all participants. Parallel to the improvement in inflammation, the MCO group demonstrated significant enhancements in iron‐handling parameters, with higher serum iron ( p = 0.008) and TSAT ( p = 0.005), and lower TIBC ( p = 0.007), none of which were observed in the high‐flux group. Between‐group Δ‐differences were significant for CRP ( p = 0.010), CRP/albumin ratio ( p = 0.013), serum iron ( p = 0.040), TIBC ( p = 0.005), and TSAT ( p = 0.005). Hemoglobin levels remained stable in both groups, while intravenous iron and ESA requirements showed modest within‐group reductions in the MCO cohort. In this exploratory retrospective analysis, MCO membrane use was associated with favorable trends in inflammatory markers and iron‐handling parameters, alongside modest within‐group reductions in intravenous iron and ESA requirements, without compromising serum albumin. These findings suggest that MCO therapy may help mitigate microinflammation and support more efficient anemia management in real‐world HD practice.

Aim: This study aimed to compare blood cadmium (Cd) levels between hemodialysis (HD) and peritoneal dialysis (PD) patients and healthy controls, and to evaluate the associations between Cd levels and inflammatory, oxidative, and nutritional markers. Material and Methods: Sixty-one dialysis patients (31 HD, 30 PD) and 15 healthy controls were included in this cross-sectional study. Whole-blood Cd was measured by atomic absorption spectrometry and corrected for hemoglobin (cCd). Serum interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), and advanced oxidation protein products (AOPP) were analyzed as indicators of inflammation and oxidative stress. Results: Both whole-blood Cd and cCd levels were significantly higher in both HD and PD patients compared with healthy controls (p=0.021 and p=0.001, respectively), while no statistically significant difference was observed between the two dialysis modalities. Correlation analyses demonstrated that Cd levels were positively correlated with inflammatory and oxidative stress markers, including IL-6 (rs=0.338, p=0.003), hs-CRP (rs=0.464, p=0.001), MDA (rs=0.464, p=0.001), and AOPP (rs=0.454, p<0.001). In contrast, cCd levels showed a significant negative correlation with serum albumin concentrations (rs=-0.454, p=0.001). Conclusion: Cd accumulation is markedly increased in dialysis patients regardless of treatment modality and is closely linked to systemic inflammation, oxidative damage, and reduced nutritional status. Environmental Cd exposure may represent an under-recognized contributor to adverse clinical outcomes in chronic kidney disease (CKD), and preventive strategies to minimize Cd burden may help improve prognosis in this population.

Introduction: 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 Türkiye, 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.

Background/aim: Acute methanol poisoning (MP) poses a significant public health challenge, with inflammation increasingly recognized as a key factor in its pathophysiology. Identifying accessible and reliable prognostic biomarkers could help enhance clinical outcomes. This study aimed to assess the prognostic value of the Systemic Immune-Inflammation Index (SII) and the Pan-Immune-Inflammation Value (PIV), measured upon emergency department admission, in predicting in-hospital mortality in patients with acute MP.Material and methods: This retrospective study included patients diagnosed with acute MP at two tertiary care centers in Ankara, Türkiye [University of Health Sciences Dışkapı Yıldırım Beyazıt Education and Research Hospital (January 1, 2015–October 1, 2022) and Etlik City Hospital (October 1, 2022–March 11, 2025)]. Demographic, clinical, and laboratory data, along with treatment details and outcomes (discharge or in-hospital death), were systematically recorded. Results: A total of 76 patients were included, of whom 92.1% were male, with a mean age of 49.0 ± 12.4 years. During hospitalization, 48.6% (n = 37) died. Both SII and PIV values at admission were significantly higher in non-survivors (p < 0.001 for SII; p = 0.031 for PIV). In multivariate Cox regression analysis, higher SII (HR: 2.44; 95% CI: 1.05–5.67; p = 0.034) and PIV (HR: 2.08; 95% CI: 1.05–4.13; p = 0.030) were independently associated with increased risk of mortality. Receiver Operating Characteristic (ROC) analysis showed an AUC of 0.750 (95% CI: 0.649–0.865) for SII, with an optimal cutoff of 665.6 (sensitivity: 50%, specificity: 46%), and an AUC of 0.640 (95% CI: 0.519–0.769) for PIV, with a cutoff of 512.5 (sensitivity: 53%, specificity: 47%). Conclusion: SII and PIV measured at hospital admission may serve as useful prognostic markers for predicting in-hospital mortality in patients with acute MP.