Son dönem böbrek yetmezlikli hastalarda hipervoleminin adiponektin düzeyi üzerine etkisi
Küçük Resim Yok
Tarih
2012
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada, hemodiyaliz tedavisi alan son dönem böbrek hastalığı olan hipervolemik hastalarda, adiponektin düzeyi ile mevcut hipervolemi arasında anlamlı istatistiksel ilişkinin olup olmadığının tespit edilmesi amaçlanmıştır.Materyal ve MetodÇalışmamızda Abant İzzet Baysal Üniversitesi Tıp Fakültesi Hemodiyaliz Ünitesi, İzzet Baysal Devlet Hastanesi Hemodiyaliz ünitesi ve Bolu ilindeki özel diyaliz merkezlerinde diyalize giren hastalar cross-sectional olarak incelendi.123 HD hastasının fizik muayeneleri ayrıntılı olarak yapıldı. Hastaların rutin biyokimyasal parametreleri, ADPN değerleri çalışıldı. Ekokardiyografileri yapılarak LAD,IVS,PW ölçüldü, vena cava inferior kollaps indeksleri hesaplandı. Sonuçta çalışmaya 80 hasta dahil edildi,hastalar bulgularına göre 40 hipervolemik, 40 normovolemik olarak 2 gruba ayrıldı.BulgularÇalışmada 51 erkek (% 64) , 29 kadın (%36) olmak üzere toplam 80 hastanın sonuçları değerlendirildi. Olguların ortalama yaşları 53 ± 16 yıl, ortalama hemodiyalize giriş süreleri 6 ± 4 yıl olarak tespit edildi. Çalışma grubundaki hastaları etiyolojilerine göre sınıflandırdığımızda en büyük grubu hipertansif nefropatinin oluşturduğu görüldü. Grupların ekokardiyografik bulguları karşılatırıldığında normovolemik gruba göre hipervolemik grubun IVS, PW, LA düzeyi istatistiksel anlamlı olarak daha yüksekti. Hipervolemik ve normovolemik grup ADPN düzeyleri açısından karşılaştırıldığında ,hipervolemik grupta ADPN düzeyinin 2.5 kat daha yüksek olduğu görüldü. ADPN değerleri ile ekokardiyografik bulgular karşılaştırıldığında istatiksel anlamlı fark bulunmadı. Anti-HT ilaç kullanmayan gruba göre Anti-HT ilaç kullanan grupta adiponektin düzeyi istatistiksel anlamlı olarak daha yüksekti. Her 2 grupta ADPN düzeyi ile BMI-yaş-cinsiyet arasında anlamlı ilişki saptanmadı.artışmaHemodiyaliz hastalarında hipervoleminin doğru tespiti, kuru ağırlık kavramının ortaya çıkmasına neden olmuştur. Hemodiyaliz hastalarında kuru ağrılığın tespitine yönelik altın standart bir yöntem halen yoktur. Temel olarak anamnez, fizik muayene, telekardiyografide KTO, deneyimli kişilerce yapılan EKO'da IVS, PW ve LAD ve de vena kava inferior kollaps indexinin tespiti, biyoimpedans incelemeleri hemodiyaliz hastasının volüm durumunun belirlenmesinde birlikte değerlendirilmesi gereken verilerdir. Yapılan çalışmalarda ADPN düzeyleri ile böbrek yetmezliği arasındaki ilişkide volümün ADPN düzeylerini etkileyip etkilemediği araştırılmamıştır. Bu nedenle son dönem böbrek yetmezliğinde kuru ağırlığın daha kolay ve kısa yoldan doğru tespitinde, volüm durumuna dönük olarak yukarıdaki verilere paralel hassas yeni bir gösterge olabilmesi bakımından, çalışmamızda, ADPN düzeyleri değerlendirildi. Hipervolemik olan hastalarda anlamlı olarak yüksek bulunan ADPN'nin volüm durumunun tespitinde BNP, ANP gibi markerler yanısıra ADPN düzeylerinin de katkı sağlayabileceği kanısındayız.Anahtar kelimeler: Kronik Böbrek Yetmezliği, Kardiyovasküler Hastalıklar, Hipervolemi, Adiponektin
ObjectiveIn this study, the aim is to determine statistically significant relationship between adiponectin levels and the current hypervolemia in hypervolemic patients with end stage renal disease receiving hemodialysis.Materials and methodsIn our study, the dialysis patients were examined cross-sectional in Abant Izzet Baysal University Faculty of Medicine Hemodialysis Unit, Bolu Izzet Baysal State Hospital hemodialysis unit and dialysis centers. 123 HD patients were physically examined in detail. The routine biochemical parameters, ADPN levels evaluated. Echocardiography was performed in LAD, IVS, PW were measured, and the inferior vena cava collapse index was calculated. Eventually 80 patients were included in the study, according to the findings patients were divided into 2 groups; 40 hypervolemic and 40 normovolemic.ResultsIn this study, 51 male (64%), 29 female (36%) totally 80 patients were evaluated. The mean age of the patients was 53 ± 16 years, mean duration of hemodialysis entry was 6 ± 4 years. When we categorize patients according to their etiologies in the study group the largest group was hypertensive nephropathy. When we compare the echocardiographic findings between hypervolemic and normovolemic groups IVS, PW, LA was significantly higher in hypervolemics. When we compare ADPN levels between hypervolemic patients and normovolemic patients, ADPN levels was found to be 2.5 times higher in hypervolemic patients. There was no statistically significant difference between ADPN levels and echocardiographic findings. The ADPN level was significantly higher in the group who uses Anti-HT medication than who do not uses. There was no significant association between age-sex-BMI and ADPN level.DiscussionThe correct identification of hypervolemia in hemodialysis patients, has led to the emergence of the notion of dry weight. There is still no gold standart method to determine the dry weight in hemodialysis patients. Basically, history, physical examination, Chest-X CTO, IVS, PW and collapse index of the inferior vena cava in the LAD determination in echocardigraphy done by skilled people, bioimpedance studies should be evaluated in hemodialysis patients to determine the status of the volume data. The studies between ADPN levels and renal dysfunctions has not been investigated the effectiveness of volume on ADPN level. For this reason ADPN levels evaluated to be a new and sensitive marker to determine dry weight in ESRD patients more easier practical and properly. We believe that the ADPN levels which was found to be significantly higher in hypervolemic patients will contribute to the determination of volume status as well as markers such as BNP and ANP.Keywords : CVD, ESRD , hypervolemia , adiponectin
ObjectiveIn this study, the aim is to determine statistically significant relationship between adiponectin levels and the current hypervolemia in hypervolemic patients with end stage renal disease receiving hemodialysis.Materials and methodsIn our study, the dialysis patients were examined cross-sectional in Abant Izzet Baysal University Faculty of Medicine Hemodialysis Unit, Bolu Izzet Baysal State Hospital hemodialysis unit and dialysis centers. 123 HD patients were physically examined in detail. The routine biochemical parameters, ADPN levels evaluated. Echocardiography was performed in LAD, IVS, PW were measured, and the inferior vena cava collapse index was calculated. Eventually 80 patients were included in the study, according to the findings patients were divided into 2 groups; 40 hypervolemic and 40 normovolemic.ResultsIn this study, 51 male (64%), 29 female (36%) totally 80 patients were evaluated. The mean age of the patients was 53 ± 16 years, mean duration of hemodialysis entry was 6 ± 4 years. When we categorize patients according to their etiologies in the study group the largest group was hypertensive nephropathy. When we compare the echocardiographic findings between hypervolemic and normovolemic groups IVS, PW, LA was significantly higher in hypervolemics. When we compare ADPN levels between hypervolemic patients and normovolemic patients, ADPN levels was found to be 2.5 times higher in hypervolemic patients. There was no statistically significant difference between ADPN levels and echocardiographic findings. The ADPN level was significantly higher in the group who uses Anti-HT medication than who do not uses. There was no significant association between age-sex-BMI and ADPN level.DiscussionThe correct identification of hypervolemia in hemodialysis patients, has led to the emergence of the notion of dry weight. There is still no gold standart method to determine the dry weight in hemodialysis patients. Basically, history, physical examination, Chest-X CTO, IVS, PW and collapse index of the inferior vena cava in the LAD determination in echocardigraphy done by skilled people, bioimpedance studies should be evaluated in hemodialysis patients to determine the status of the volume data. The studies between ADPN levels and renal dysfunctions has not been investigated the effectiveness of volume on ADPN level. For this reason ADPN levels evaluated to be a new and sensitive marker to determine dry weight in ESRD patients more easier practical and properly. We believe that the ADPN levels which was found to be significantly higher in hypervolemic patients will contribute to the determination of volume status as well as markers such as BNP and ANP.Keywords : CVD, ESRD , hypervolemia , adiponectin
Açıklama
Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Endokrinoloji ve Metabolizma Hastalıkları, Endocrinology and Metabolic Diseases ; Kardiyoloji
