Selim, GJulshen
Preferred name
Selim, GJulshen
Official Name
Selim, GJulshen
Alternative Name
Selim Gjulsen
Selim Gulsen
Selim G
Gjulshen Selim
Main Affiliation
Email
gjulshen.selim@medf.ukim.edu.mk
56 results
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Item type:Publication, Effect of nephrology referral on the initiation of haemodyalisis and mortality in ESRD patients(Macedonian Academy of Sciences and Arts, 2007-12); ; ; Gelev, SLate nephrology referral of patients with chronic kidney disease (CKD) has been suggested as increasing mortality after the initiation of dialysis. The aim of this study was to assess the impact of nephrology referral on the initiation of haemodyalisis (HD) and mortality during HD treatment in end-stage renal disease (ESRD) patients who have died in our institution over a five-year period. We studied data from all 117 patients on HD treatment in our institution who died (after 90 days of HD treatment) in the period between 01.01. 2002 and 31.12. 2006. Early (ER) and late referral (LR) were defined by the time of follow-up by a nephrologist greater than or less than 6 months, respectively, before the initiation of haemodialysis. Out of a total of 117 patients, 37.6% (44 patients) started HD in the ER group and 62.4% (73 patients) in the LR group. At the start of HD, LR patients were older, had a higher proportion of temporary catheters and had a significantly lower levels of haemoglobin and diuresis. Creatinine clearance was less in the LR (7.67 +/- 3.86 ml/min/1.73 m2) vs. the ER group (8.70 +/- 3.62 ml/min/1.73 m2), but not significantly different. Cardiovascular disease (CVD), defined by a history of myocardial infarction, cerebral vascular disease, peripheral arteriopathy, and/or heart failure, was also significantly more common among LR patients compared to ER (56%; 27%, p = 0.002). During the haemodyalisis treatment, the LR group had significantly lower levels of haemoglobin and haematocrit. CVD accounted for about 64% of deaths observed in the LR group. According to echocardiography data, there were no significant differences in the left ventricular mass index (LVMI) between the LR and ER groups at the time of dialysis initiation, but during haemodialysis treatment the LR group had significantly greater LVMI than the ER group (232,96 +/- 92,48 g/m2 vs.184,09 +/- 51,74 g/m2; p = 0,031). The time until death in months during dialysis treatment was significantly different between the LR and ER group, (69.51 +/- 64.03 vs.113.27 +/- 89.03, p = 0.0025). LR patients experienced a greater degree of anaemia and a high prevalence of CVD at the time of dialysis initiation. Our data suggest that the anaemia, CV damage and progression of left ventricular hypertrophy (LVH) in the LR patients during haemodialysis treatment are associated with poor survival on haemodialysis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, LOWER SERUM POTASSIUM LEVEL IS ASSOCIATED WITH MORTALITY AS CONFOUNDING EFFECT OF MALNUTRITION IN DIALYSIS PATIENTS(Macedonian Association of Anatomists and Physiologists, 2019); ; ; Introduction: Obtaining normal serum potassium level is an important goal in maintenance hemodialysis patients. Hyperkalemia is known to be associated with mortality. In this study we aimed to assess the relationship between pre-dialysis potassium level, nutritional status and survival in dialysis patients. Materials and methods: This study used annual cohorts of hemodialysis patients with 36 months of follow-up. To determine the impact of potassium level on mortality, patients were followed from the first potassium measurement until death or a censoring event; hypokalemia was defined by potassium levels below median level - 5.5 mmol/l and albumin level below 35g/l was considered as an index for undernourished. Time-dependent Cox proportional hazards modeling was used to estimate the association between potassium level and mortality. Results: A total of 199 patients were included in the study. Mean age was approximately 56 years, about 59% were men and 23% had end-stage renal disease caused by diabetes. Albumin below 35 g/l was observed in 26 (13%) patients. In the follow-up period 53 (26%) patients died, consisting of 31 (31%) of the 101 hypokalemic and 22 (22%) of 98 hyperkalemic patients. The Kaplan-Meier survival rate was significantly better in the hyperkalemic population (34.300.71 vs. 31.061.16, p=0.051). Hypokalemia, when defined as serum potassium 5.5 mmol/l, was associated with all-cause mortality (hazards ratio (HR) 1.857, 95% CI 0.986-3.496, p = 0.051). The significance was lost in the model after adjustment for albumin level. Only albumin level determined mortality (p=0.03). Conclusion: Lower potassium level was associated with all-cause mortality, but only as a confounding effect of malnutrition in dialysis patients - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Active Smoking is Associated with Lower Dialysis Adequacy in Prevalent Dialysis Patients(Scientific Foundation Spiroski (publications), 2019-11-15); ; ; ; Mladenovska, DanielaDialysis adequacy measured by single pool Kt/V (spKt/V) lower than 1.2 or urea reduction rate (URR) lower than 65% is associated with a significant increase in patient mortality rate. Patients' adherence to the medical treatment is crucial to achieve recommended targets for spKt/V. Smoking is a recognized factor of non-adherence. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Impact of preoperative arterial and venous diameter on achievement of the adequate blood flow in arteriovenous fistula for hemodialysis(Wiley, 2020-06); ; ; ; An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of the study was to determine the factors associated with the achievement of adequate blood flow (BF) of AVFs at the 4th week after creation. Created AVFs in 63 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on hemodialysis (CKD5D) were analyzed in a prospective study. Doppler ultrasound (DUS) was used for measuring the diameter of the radial artery, the brachial artery and the cephalic vein before AVF creation. The BF of AVF was calculated by DUS at the 4th week after creation and adequate BF was defined as ≥ 600 mL/min. The average age of patients was 61.31 ± 12.9 years. An adequate BF of AVF at the 4th week after creation was achieved in 43.54% of patients. The BF of AVF measured in male patients was significantly higher compared to the BF of AVF obtained in females (576.03 mL/min vs 375.12 mL/min, P = 0.004). The diameter of the blood vessels with achieved adequate BF was significantly larger compared to the diameter of the blood vessels without adequate BF (radial artery: 2.45 mm vs 2.03 mm, P = 0.000; brachial artery: 4.78 mm vs 4.06 mm, P = 0.001 and cephalic vein: 3.12 mm vs 2.83 mm P = 0.018). The gender and the diameter of the blood vessels before AVF creation were significantly associated with achievement of adequate BF of AVF at the 4th week of creation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Hypomagnesemia and cause-specific mortality in hemodialysis patients: 5-year follow-up analysis(SAGE Publications, 2017-10-13); ; ; The aim of this prospective study was to evaluate the association between serum magnesium (Mg) and mortality, in particular the cause-specific mortality of Mg and other risk factors in hemodialysis (HD) patients. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Improvement of bone and mineral parameters related to adynamic bone disease by diminishing dialysate calcium(Elsevier BV, 2007-10); ; The existence of adynamic bone disease (ABD) as most prevalent form of renal osteodystrophy in recent years and its reduced ability to handle an exogenous calcium load has implied a higher risk for vascular and soft-tissue calcifications. The effect of low dialysate calcium (LCD) on parathyroid hormone (PTH) secretion in ABD patients has not yet sufficiently been clarified. This randomized, prospective study aimed to compare the effects of LCD and high calcium dialysate (HCD) on the evolution of bone and mineral parameters related to ABD in dialysis patients. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Effect of Treatment on Short-Term Outcomes in Elderly Patients with Acute Kidney Injury(Scientific Foundation SPIROSKI, 2017-08-15); ; ; ; Elderly population (≥ 65) are more prone to develop acute kidney injury (AKI) compared to younger, also elderly with AKI have an increased requirement for dialysis treatment and an elevated risk of short-term and long-term mortality. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MALNUTRITION-INFLAMMATION SCORE PREDICTS SURVIVAL IN HEMODIALYSIS PATIENTS(Macedonian Association of Anatomists, 2019); ; ; Canevska AleksandraThe short life span of dialysis patients is induced by traditional cardiovascular and non-traditional dialysis related factors such as inflammation, oxidative stress, protein energy malnutrition. Malnutrition-Inflammation Score (MIS) has been proposed as a new quantitative system for assessment of malnutrition and inflammation. In this study we sought to investigate the association of MIS and five-year-mortality in dialysis patients. In a prospective study were included 131 prevalent dialysis patients. Kalantar-Zadeh method (7) was used to calculate the malnutrition score. Patients were followed for five years. Kaplan-Meier survival and Cox-proportional mortality analysis were performed according to higher and lower malnutrition inflammation score, by cut-off value of 7. The mean age of study participants was 55.45 years and mean dialysis vintage was 111.04 months. After follow-up of 60 months 55 (42%) patients died from all-cause mortality and out of those 65% (36) were cardiovascular deaths. In comparative analysis among the survived and died patients, none of the inflammatory or nutritional variables such as CRP, albumin, creatinine, BMI or SGA significantly differed. There was a significantly longer survival among patients with lower MIS in respect of all-cause and cardiovascular mortality 49.28 1.88 vs. 39.29 3.53 months, p=0.011, 52.20 1.7 vs. 45.07 3.41, p=0.045, respectively. MIS emerged as a powerful predictor of all-cause and cardiovascular mortality through Cox regression analysis: HR 1.97 95%CI: (1.15 – 3.38), p=0.013; HR 1.063 95%CI-0.952-1.186, p=0.055), respectively. The malnutrition-inflammation score is a useful tool to predict outcomes. The key to improving survival and quality of life in dialysis patients could be gained by understanding of the malnutrition-inflammation complex syndrome and its interactions with cardiovascular disease and outcome. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, FAMILY SUPPORT IS CRUCIAL FOR DIALYSIS PATIENTS COMPLIANCE TO TREATMENT AND QUALITY OF LIFE(Macedonian Association of Anatomists, 2020); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The blood flow rate on the first day after arteriovenous fistula creation is a predictor of successful fistula maturation(Wiley, 2022-12-02); ; ; The determination of blood flow rate (BFR) is a useful tool for assessing the function of arteriovenous fistula (AVF).