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Renal Ünitelerce Bilinen Hastalar Kronik Hemodiyalize Nasıl Başlar?

How do Patients who are Known to the Renal Units Start Chronic Haemodialysis?

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2011
DOI: 
10.5262/tndt.2011.1003.04

Key Words:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
INTRODUCTION: A signifi cant number of known ESRD patients start dialysis as an emergency. Key factors that determine emergency dialysis initiation have not been well identifi ed. MATERIAL and METHODS: Ninety out of 159 patients studied were known for> 6 months and divided into Emergency dialysis (EmG n=46) and Elective dialysis (EG n=44) groups. RESULTS: Most diabetic patients started dialysis as an emergency (75% vs. 25% p=0.008). At the start, EmG had higher median urea (3.5 vs. 3.8 g/dl p=0.05), a lower bicarbonate (19 vs. 21.5 mEq/L, p=0.04) and haemoglobin (9.4 vs10.5 g/dl p=0.005). Three months pre-dialysis, EmG had a lower serum albumin (3.2 vs. 3.6 g/L, p=0.001) and haemoglobin (10.4 vs. 11, p=0.06), a higher CRP (21 vs. 5, p=0.08) and better preserved eGFR (11 vs. 9, p=0.001). In multivariate analysis, only a diagnosis of diabetes and a CRP >30 were independent risk factors for starting dialysis as an emergency. Having an albumin >3.5 was associated with a reduced risk of having an emergency start to dialysis. CONCLUSION: Apart from having diabetes, it seems diffi cult to predict emergency start of dialysis in known ESRD patients. Randomised controlled studies can further identify importance of high CRP and low serum albumin in relation to emergency initiation of dialysis.
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Abstract (Original Language): 
GİRİŞ: SDBY bulunduğu bilinen hastaların önemli bir kısmı diyalize acil şartlarda başlar. Diyalize acil şartlarda başlamayı belirleyen ana faktörler henüz tanımlanmamıştır. GEREÇ ve YÖNTEMLER: Çalışılan 159 hastanın 90’ı > 6 aydır bilinmekteydi ve Acil diyaliz (EmG n=46) ve Elektif diyaliz (EG n=44) gruplarına bölündü. BULGULAR: Çoğu diyabetik hasta diyalize acil şartlarda başladı (%75 ve %25, p=0,008). Başlangıçta EmG grubunda medyan üre (3,5 ve 3,8 g/dl, p=0,05) daha yüksekti, bikarbonat (19 ve 21,5 mEq/L, p=0,04) ve hemoglobin (9,4 ve 10,5 g/dl, p=0,005) ise daha düşüktü. Diyalizden 3 ay önce EmG grubunda serum albumin (3,2 ve 3,6 g/L, p=0,001) ve hemoglobin (10,4 ve 11, p=0,06) daha düşüktü, CRP (21 ve 5, p=0,08) daha yüksekti ve eGFR (11 ve 9, p=0,001) daha iyi korunmuştu. Multivaryant analizde sadece diyabet tanısı ve CRP >30 diyalize acil şartlarda başlamak açısından bağımsız risk faktörleriydi. Albumin düzeyinin >3,5 g/L olması diyalize acil şartlarda başlanması riskinde bir azalmayla ilişkiliydi. SONUÇ: Bilinen SDBY hastalarında diyabetli olmak dışında diyalize acil şartlarda başlanmasını öngörmek zor görünmektedir. Randomize kontrollü çalışmalar diyalize acil şartlarda başlanması açısından yüksek CRP ve düşük serum albumini bulunmasının önemini daha iyi tanımlayabilir.
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  • 3
227-234
  • Turkish

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