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HEMODÎALÎZ HİPOTANSİYONU VE NİTRİK OKSİD OLUŞUMU: PARNAPARİN İLE HEPARİNİN KARŞILAŞTIRILMASI

THE ROLE OF NITRIC OXIDE GENERATION IN HEMODIALYSIS HYPOTENSION: COMPARISON OF HEPARIN WITH PARNAPARIN

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2000

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Background/Aims: Despite the increasing evidence for the role of nitric oxide (NO) in hemodialysis hypotension, the source of NO is still debated. Heparin stimulates NO production by the cultured human endothelial cells in vitro. The aim of this study is to compare the effects of unfractionated heparin and parnaparin, low molecular weight heparin, on the NO production and arterial pressure of hemodialysis patients during hypotensive episodes. Methods: Ten hemodialysis patients with hypotensive periods on maintenance hemodialysis therapy were involved in this study. Serum NO were obtained at the beginning of dialysis, during hypotensive episode and at the end of dialysis in the last hemodialysis session after 3 weeks of use of heparin and parnaparin for anticoagulation. Results: NO levels were 39.4±13.2 M at the beginning of hemodialysis, 92.4±31.4 M during hypotensive episode (p<0.05) and 43.1±25.1 M at the end of dialysis with heparin. In parnaparin period, NO levels were 47.2±22.7 M at the beginning, 80.7±46.5 M at the hypotensive episode (p<0.05) and 45.8*23.2 M at the end of session. Percent increase in NO levels during hypotensive period compared to the beginning of haemodialysis with heparin were significantly higher than parnaparin (140.2±50.4 <%> vs. 119.6±44.8 <%>, p<0,05). Percent decrease in mean arterial pressure with heparin was significantly higher than parnaparin (48.6±6.4 % vs. 39.6± 5.3 %, p<0,05). Conclusion: Decrease in mean arterial pressure and increase in NO production during hypotensive episodes were less prominent with parnaparin use compared to heparin and this difference might be related to their endothelial binding capacity, thrombin affinity and/or effects on platelet functions.
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Abstract (Original Language): 
Amaç: Hemodializ hipotansiyonunda, nitrik oksid (NO) 'in rolü konusunda artmakta olan kanıtlara rağmen, NO'nun kaynağı hala tartışılmaktadır. Heparin, in vitro olarak insan endotel hücre kültürlerinde NO oluşumunu uyarmaktadır. Bu çalışmanın amacı, hemodializ hastalarında hipotansif atak sırasında, unfraksiyone heparin ile düşük molekül ağırlıklı parnaparinin, NO üretimi üzerine etkilerini karşılaştırmaktır. Metod: Hemodializ tedavi programında olan ve hipotansif atakları olan 10 hemodializ hastası çalışmaya dahil edilmiştir. Antikoagülasyon ile üç haftalık heparin ve parnaparin kullanımı sonrası, son dializ seansında serum NO düzeylerine, dializ başında, hipotansif dönem sırasında ve dializ sonunda bakılmıştır. Bulgular: Heparin ile yapılan dializde NO düzeyi, dializ başında 39.4±13.2 M, hipotansif atak sırasında 92.4±31.4M(p<0.05) ve dializ sonunda 43.1±25JM idi. Parnaparin döneminde ise, dializ başında 47.2 22.7 M, hipotansif atak sırasında 80.7±46.5 M (p<0.05) ve dializ sonunda 45.8±23.2 M idi. NO düzeyindeki artış yüzdesi, hemodializin başına göre, hipotansif dönemde parnaparin ile karşılaştırıldığında, heparinli dializde anlamlı olarak artmıştı (140.2±50.4%'e karşı 119.6*44.8%, p < 0.05). Ortalama arteriyelbasınçtaki düşme yüzdesi parnaparin ile karşılaştırıldığında heparin ile anlamlı olarak yüksekti (48.6± 6.4%'e karşı 39.6±5.3%, p <0.05). Sonuç: Hipotansif atak sırasında ortalama arteriyel basıncındaki düşme ve NO oluşumundaki artış, heparin ile karşılaştırıldığında parnaparinde daha az belirgindi ve bu farklılık her iki ajanın endotele bağlanma kapasiteleri, trombine olan afiniteleri ve/veya trombosit fonksiyonu üzerine olan etkilerine bağlı olabilir.
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  • 2
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  • Turkish

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