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Son Dönem Böbrek Hastalarında Kardiyovasküler Risk Faktörlerinin Ters Dönmesi (Ters ya da Reverz Epidemiyoloji)

Reversal of Cardiovascular Risk Factors in Patients with End-Stage-Renal-Disease

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DOI: 
DOI 10.5262/tndt.2012.1001.03

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Patients with end-stage-renal disease (ESRD) experience a high cardiovascular mortality and cardiovascular risk factors such as obesity, hyperlipidemia and hypertension are very common. Recent epidemiological research has revealed that the association between mortality and traditional cardiovascular risk factors has been altered and inverted in ESRD patients in a sense that a low bodymass- index, a low blood pressure or low plasma cholesterol concentrations are associated with an increased mortality. In addition, low plasma creatinine, homocysteine, uric acid, advanced glycation end products, leptin and adiponectin concentrations are indicators of a high mortality instead of the lower mortality seen in the normal population. These findings have been referred to as reverse epidemiology in the literature and the underlying causes are multifactorial comprising the malnutritioninflammation- syndrome, timing of competitive risk factors, altered pathophysiology and the impact of multiple selection biases of the studies. In the presence of reverse epidemiology, the approach to the patients and the definition of target values for therapy are difficult. In this article an attempt is made to enlighten the concept of reverse epidemiology and to review the current available literature.
Abstract (Original Language): 
Son dönem böbrek yetmezlikli (SDBY) hastalarda, kardiyovasküler mortalite son derece yüksek olup şişmanlık, hiperlipidemi ya da hipertansiyon gibi geleneksel kardiyovasküler risk faktörleri oldukça yaygındır. Son yıllardaki epidemiyolojik çalışmalar, SDBY hastalarda, geleneksel kardiyovasküler risk faktörlerin, mortalite ile tamamıyla değişmiş ve ters dönmüş bir ilişkide bulunduğunu ve özellikle düşük beden-kitle-indeksi, düşük tansiyon veya düşük plazma kolesterol düzeylerinin yüksek mortaliteyi beraberinde getirdiğini göstermiştir. Ayrıca düşük plazma kreatinin, homosistein, ürik asit, ileri glikasyon son ürünleri (AGE), serum leptin ve serum adiponektin düzeyleri normal toplumda gözlemlenilenin aksine artmış bir mortaliteye eşlik etmektedir. Bu olgu literatürde ters epidemiyoloji (reverse epidemiology) olarak adlandırılmıştır ve altında yatan unsurlar çok çeşitli olup başta diyaliz hastalarında rastlanan malnutrisyon-inflamasyon-sendromu, birbirine rakip risk faktörlerin zamanlama farkı, değişmiş fizyopatoloji ve çalışmaları etkileyen seçilim biyaslarını içermektedir. Ters epidemiyoloji olgusu hastaya yaklaşımı ve tedavide izlenecek hedef değerlerin belirlenmesini zorlaştırmaktadır. Bu yazı ters epidemiyolojinin altında yatan konseptin açığa kavuşturulmasını ve konuyla ilgili yayınlanan güncel klinik çalışmalarının derlenmesini amaçlamaktadır.
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