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Kemik Sağlığı ve Renal Replasman Tedavileri: En İyisi Hangisi?

Bone Health and Renal Replacement Therapies: Which are the Best?

Journal Name:

Publication Year:

DOI: 
10.17954/amj.2015.04
Abstract (2. Language): 
Objective: The aim of this study was to evaluate the efficacy and safety of renal replacement therapy modalities in terms of bone health for end-stage renal disease patients. Material and Methods: We included 27 hemodialysis (group 1), 51 chronic peritoneal dialysis (group 2), and 25 renal transplant patients (group 3) and 40 healthy subjects (control, group 4) in the study. Intact parathormone (iPTH), fibroblast growth factor 23 (FGF-23), osteoprotogerin (OPG), osteocalcin (OC), procollagen type-1 N terminal propeptide (PINP), beta- crosslaps (beta CTx), tartarate resistant acid phosphatase (TRAP5b), bone alkaline phosphatase (BAP), 1,25(OH)D3 and 25(OH)D3 levels were measured in the patients and the control group. The α-Klotho gen mutation (F352V) was evaluated by real-time PCR and the high-resolution melting method. Results: The α-Klotho gene polymorphism rates (wild/heterozygote/mutation: 22 (81.5%) / 0 (0%) / 5 (18.5%)) and FGF23 levels (G1-2-3-4 1252±310 / 872±526 / 34.6 (1.3-986) / 82 (23-991) respectively) were significantly higher in group 1. The 1.25(OH)D3 and 25(OH)D3 levels were lower in groups 1 and 2 but similar in group 3 and 4. The iPTH, FGF-23, OPG, OC and TRAP5b levels were significantly higher in Group 1 and 2. The PINP and beta CTx levels were highest in group 1. BMD level was lowest in group 1 and similar in groups 2-3, groups 2 and 4 and groups 3-4.Conclusion: This study showed that renal transplantation is the most effective and safe renal replacement therapy modality in terms of bone health (α-Klotho gene polymorphism, FGF-23 levels, indicators of bone metabolism and bone mineral density) for end-stage renal disease patients.
Abstract (Original Language): 
Amaç: Çalışmada, son dönem böbrek yetmezliği hastalarında renal replasman tedavilerinin kemik sağlığı açısından etkinlik ve güvenilirliklerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya 27 hemodiyaliz (HD, Grup 1), 51 periton diyalizi (PD, Grup 2), 25 böbrek nakli (Rtx, Grup 3) hastası ve 40 sağlıklı kontrol grubu (Grup 4) alındı. Hastalar ve kontrol grubunun intakt parathormon (iPTH), fibroblast growth faktor 23 (FGF-23), osteoprotogerin (OPG), osteokalsin (OK), prokollagen tip-1 N terminal propeptid (PINP), beta- crosslaps (beta CTx ), tartarat rezistan asid fosfataz (TRAF5b), kemik alkalen fosfataz (KAF), 1,25(OH)D3 ve 25(OH)D3 düzeyleri ölçüldü. α-Klotho gen mutasyonu (F352V) gerçek zaman PCR ve yüksek çözünürlüklü erime yöntemi kullanılarak değerlendirildi. Bulgular: α- klotho gen polimorfizmi (wild/heterezigot/mutasyon: 22(%81,5)/ 0(%0)/ 5(%18,5)) ve FGF23 düzeylerinin (G1-2-3-4 sırayla; 1252±310/ 872±526/ 34,6(1,3-986)/ 82(23-991)) HD hastalarında diğer tüm gruplardan anlamlı derecede daha yüksek olduğu görüldü. 1,25(OH)D3 ve 25(OH)D3 düzeylerinin HD ve PD hastalarında diğer gruplardan daha düşük, G3-G4 arasında benzer olduğu görüldü. iPTH, FGF-23, OPG, OC ve TRAP5b düzeylerinin G1 ve G2 hastalarında diğer gruplardan daha yüksek, PINP ve beta CTx düzeylerinin G1’de en yüksek, kemik mineral yoğunluğu (KMY) ise G1’de en düşük iken G2-G3, G2-G4 ve G3-G4 arasında benzer olduğu görüldü. Sonuç: Çalışmamızda böbrek naklinin; son dönem böbrek yetmezliği hastaları için kemik sağlığı (α- klotho gen polimorfizmi, FGF23 düzeyleri, kemik metabolizma markırları ve kemik mineral yoğunluğu) açısından en etkin ve güvenilir renal replasman tedavisi olduğu gösterilmiştir.
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