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SON DÖNE M BÖBREK YETMEZLÎKLÎ HASTALARDA PLAZMA HOMOSÎSTEÎN DÜZEYLERİ ve rHuEPO KULLANIMININ PLAZMA HOMOSİSTEİN DÜZEYLERİ İLE İLİŞKİSİ

PLASMA HOMOCYSTEIN LEVELS IN PATIENTS WITH AND STAGE RENAL DISEASE AND RELATIONSHIP BETWEEN HOMOCYSTEIN LEVELS AND rHuEPO TREATMENT

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2002

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Hyperhomocysteinemia is accepted as an independent risk factor in the progression of atherosclerosis. This relationship is valid in end stage renal disease (ESRD) as it is valid in other medical conditions. Patients with chronic renal disease (CRD) carry the risk of hyperhomocycsteinemia before the hemodialysis (HD) treatment, during the HD treatment, when they are under CAPD treatment or after the renal transplantation. The mechanisms involved in the pathogenesis of hyperhomocysteinemia seem to be similar with the secondary effects of rhuEPO treatment, which is frequently administered to CRD patients. In our study, we aimed to compare the homocsytein levels and the effects of rhuEPO treatment on these levels in two different groups of patients with renal insufficiency. The study consisted of 2 groups; Group I consisted of 20 patients who did not take rhuEPO treatment, who never underwent HD treatment or in whom the HD treatment was recently started. Group II consisted of 20 patients who were under rhuEPO treatment and were included in a regular HDprogram. The exclusion criteria were; patients with Diabetes mellitus, patients who had blood transfusion in the last 3 months, patients who had additional diseases and/or who were under some medications that could affect the homocycstein and EPO levels. Venous plasma sampling was performed to all patients during fasting in order to study their hemoglobin, vitamin B12, folic acid, creatinine, albumin, and homocycstein levels. All patients were asked about their HD treatment periods and smoking states. The hyperhomocysteinemia rale is found to be 75% in Group I and 70% in Group II. This finding is in accordance with the literature. No relationship could be demonstrated in between the homocycstein levels and the folic acid, vitamin B12 and creatinine levels. This finding is not in accordance with the literature. However, the homocycstein levels are positively correlated with the albumin levels as in accordance with the literature. On the other hand, the homocystein levels were independent from the CRD etiology and the length of the HD treatment and this also is in accordance with the literature. Our other finding is that, we could not demonstrate any effect of rhuEPO treatment on homocystein levels. This finding is in accordance with the literature. However, his point needs to be illuminated with further prospective studies. y Hyperhomocysteinemia is a risk factor that could lead to mportant mortality and morbidity in all CRD patients starting from he pre-HD period. Quitting smoking, control of blood pressure, use of cheap and easily available folic acid and vitamin B preparations zan be helpful especially when they are started in the early period.
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Abstract (Original Language): 
Hiperhomosisteinemi, aterosklerozgelişiminde bağımsız bir risk faktörü olarak kabul edilmiştir. Bu ilişki, pekçok hastalık gibi KBYiçin de geçerlidir. Kronik böbrek yetmezliği hastaları diyaliz öncesi dönemde, diyaliz, CAPD, tedavisi altındayken veya renal transplantasyon uygulanmışken hiperhomosisteinemi açısından risk altındadır. Hiperhomosisteinemi patogenezinde yer alan mekanizmalar, KBY hastalarına sıkça uygulanan rhuEPO tedavisi ile gelişen sekonder etkilere benzerlik göstermektedir. Bizim çalışmamızda, farklı iki renal yetmezlik grubunda homosistein düzeylerini ve rhuEPO tedavisinin homosistein düzeylerine olan etkisini karşılaştırmayı amaçladık. Çalışma, rhuEPO tedavisi almayan diyaliz öncesi ve henüz diyalize başlanmış 20 hasta (Grup I) ile rhuEPO tedavisi verilen, düzenlihemodiyalizprogramında olan 20hastada (Grup II) gerçekleştirildi.Diabetes mellitusu olan ve son üç ay içinde kan transfüzyonu yapılan, homosistein ve EPO düzeylerini etkileyebilecek ek hastalık veya ilaç kullanımı olan hastalar çalışmaya alınmadı. Tüm gruplardaki hastalardan açken, hemoglobin, vitamin Bn, folik asit, kreatinin, albümin, homosistein düzeyleri çalışılmak üzere kan alındı. Hemodiyalize giriş süreleri ve sigara kullanımları sorgulandı. Hiperhomosisteinemi, Grup Ihastalarında %75, Grup II hastalarında %70 olarak tespit edildi. Bu sonuç literatürle uyumlu idi. Homosistein düzeyleri ile folik asit, vit Bu, kreatinin düzeyleri arasında ilişki tespit edilmedi. Bu sonuç literatürle uyumsuz bulundu. Ancak, homosistein düzeyi, literatürle uyumlu olarak albümin ile pozitif korelasyon gösterdi. Ayrıca homosistein düzeyi literatürde belirtildiği gibi KBY etyolojisinden ve hemodiyalize giriş süresinden etkilenmiyordu. Son olarak da, homosistein düzeyi üzerinde rhuEPO kullanımının herhangi bir etkisini tespit etmedik. Bu sonuç literatürle uyumludur. Ancak bu konuda daha geniş prospektif çalışmalara ihtiyaç vardır. Hiperhomosisteinemi, diyalt öncesi dönemde başlamak üzere tüm KBY hastalarında önemli mortalite ve morbiditeye neden olabilecek bir risk faktörüdür. Özellikle erken dönemlerden itibaren başlanarak sigaranın bırakılması, kan basıncı kontrolü ve ucuz, kolay ulaşılabilir folik asit, B vitamini preparatlarmın kullanımının yarar olabileceği öngörülebilir.
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