Buradasınız

Anasayfa » Content

Diyaliz Öncesi Nefrolojik Takibin Hemodiyalize Başlayan Hastalarda Morbidite Açısından Yeri Ve Önemi

Importance of Nephrologic Care on Morbidity in Chronic Renal Failure Patients Before Hemodialysis

Journal Name:

  • Selçuk Tıp Dergisi

Publication Year:

  • 2010

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Despite advances in nephrology, morbidity and mortality of ESRD patients remain high on hemodialysis (HD). Pre-dialysis nephrologic care (PDNC) might be expected to result in decreased morbidity and better clinical outcome for the first year on HD. In study, CRF patients referred to nephrology clinic (PDNC group, n=28) and those urgently underwent HD (UHD group, n=27) were evaluated for the progress of clinical and biochemical parameters in the first year. At the enrollment, observed differences between groups were: lower Htc ratios (p<0,0001), higher diastolic BP (p=0,014) and higher serum creatinine levels (p=0,0001) in UHD. In the first year, EPO need was higher in UHD (p=0,0001). Higher hospitalization rates (p=0,001) and longer durations (p=0,037) were observed in UHD. IDWG measurements were higher in UHD (p=0,00001). At the end of first year and creatinine levels were higher in UHD (p=0,0001). CRP levels were improved in PDNC (p=0,01). Systolic BP was improved and normalized at 6th month (p=0,009) in PDNC. Ejection fraction was improved at the end of first year in PDNC (p=0,0001). These results impacts the importance of PDNC by reducing morbidity, correcting anemia and preserving cardiovascular status in ESRD patients
Bookmark/Search this post with
Abstract (Original Language): 
Nefrolojideki gelişmelere rağmen hemodiyalize başlayan SDBY hastalarında morbidite ve mortalite halen yüksektir. Diyaliz öncesi nefrolojik takibin (PDNT) erken ve düzenli olarak yapılmasının, KBY hastalarında ilk yıl içerisindeki morbiditeyi azaltabileceği ve iyi bir klinik seyir sağlayacağı düşünülmektedir. Çalışmamıza nefroloji kliniğinde takip edilen KBY hastaları (PDNT grup, n=28) ile, takip edilmeden acil olarak HD’e alınan hastalar (Acil-HD grup, n=27) alındı. Hastalar, ilk yıldaki klinik ve biyokimyasal parametrelerin seyri açısından retrospektif olarak karşılaştırıldı. Çalışma başlangıcında: düşük Htc değerleri (p<0,0001), yükselmiş diyastolik-KB değerleri (p=0,014) ve yüksek serum kreatinin değerlerinin (p=0,0001) acilHD grubunda anlamlı bir şekilde farklı olduğu saptandı. Bir yıldaki izlem sürecinde: Acil-HD grubunda eritropoietin (EPO) ihtiyacı tüm yıl boyunca yüksek idi (p=0,0001). Acil-HD grubunda hospitalizasyon sayısı (p=0,001), süresi (p=0,037) ile birlikte inter-diyalitik kilo alımı (IDWG) değerlerinin (p=0,00001) tüm yıl boyunca yüksek olduğu gözlendi. Acil-HD grubunda kreatinin seviyeleri hep yüksek seyrediyordu (p=0,0001). Serum CRP düzeyleri 1. yılın sonunda PDNT grubunda iyileşiyordu (p=0,01). PDNT grubunda sistolik KB değerlerinin 6. ayda normale döndüğü gözlendi (p=0,009). PDNT grubunda 1. yılın sonunda Ejeksiyon Fraksiyonu (EF) değerleri daha da iyileşiyordu (p=0,0001). Sonuçlarımız PDNT’in SDBY hastalarında anemiyi düzeltme, kardiyovasküler durumu ve morbiditeyi azaltma açısından önemini vurgulamaktadır.
FULL TEXT (PDF): 
PDF icon arastirmax-diyaliz-oncesi-nefrolojik-takibin-hemodiyalize-baslayan-hastalarda-morbidite-acisindan-yeri-onemi.pdf
  • 4
116-120
  • Turkish

REFERENCES

References: 

1. Levey AS, Eknoyan G, Cardiovascular disease in chronic renal disease.
Nephrol Dial Transplant 1999; 14: 828-33.
2. Obrador GT, Pereira BJG. Early referral to the nephrologist and timely
initiation of renal replacement therapy: A paradigm shift in the management
of patients with chronic renal failure. Am J Kidney Dis 1998; 31: 398-417.
3. Massy ZA. Importance of homocysteine, lipoprotein(a) and non-classical
cardiovascular risk factors (fibrinogen and advanced glycation endproducts) for atherogenesis in uraemic patients. Nephrol Dial Transplant
2000; 15 (suppl 5): 81-91.
4. Hood SA, Sondheimer JH. Impact of pre-ESRD management on dialysis
outcomes: a review. Semin Dial 1998; 11: 175-80.
5. Pereira BJG. Optimization of pre-ESRD care: The key to improved dialysis
outcomes. Kideney Int 2000; 57: 351-65.
6. Jungers P, Zingraff J, Albouse G et al. Late referral to maintenance dialysis:
detrimental consequences. Nephrol Dial Transplant 1993; 8: 1089-93.
7. Eadington DW. Delayed referral for dialysis. Nephrol Dial Transplant 1996;
11: 2124- 6.
8. Daugirdas JT. Simplified equations for monitoring Kt/V, PCRn, eKt/V, and
ePCRn. Adv Ren Replace Ther 1995; 2(4): 295-304.
9. Khan IH, Catto GRF, Neil E, Macleod AM. Death during the first 90 days of
dialysis: A case sontrol study. Am J Kidney Dis 1995; 25: 276- 80.
10. Prichard SS. Comorbidities and their impact on outcome in patients with
end- stage renal disease. Kidney Int, 2000; 57 (Suppl 74): S100-4.
11. Foley RN, Herzog CA, Collins AJ. Blod pressure and long-term mortality in
United States hemodialysis patients: USRDS Waves 3 and 4 Study. Kidney
Int, 2002; 62: 1784-90.
12. Jungers P, Massy ZA, Khoa TN, et al. Longer duration of predialysis
nephrological care is associated with improved long-term survival of
dialysis patients. Nephrol Dial Transplant 2001; 16: 2357-64.
13- Saran R, Bragg-Gresham JL, Rayner HC, et al. Nonadherence In
Hemodialysis: Associations With Mortality, Hospitalization, and Practice
Patterns In The DOPPS. Kidney International, 2003; 64: 254-62.
14. Foley RN, Parfrey PS, Harnett JD, et al. Impact of hypertension on
cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney
Int, 1996; 49: 1379-85.
15. Hashimoto H, Kitagawa K, Hougaku H, et al: C-Reactive protein is an
independent predictor of the rate of increase in early atherosclerosis.
Circulation, 2001; 104: 63-7.
16. Owen WF, Lowrie EG: C-reactive protein as an outcome predictor for
maintenance hemodialysis patients. Kidney Int, 1998; 54: 627-36.
17. Zimmermann J, Herrlinger S, Pruy A, et al: Inflammation enhances
cardiovascular risk and mortality in hemodialysis patients.Kidney Int, 1999;
55: 648-55.
18. MacDougall IC, Cooper AC: Erythropoietin resistance: the role of
inflammation and pro-inflammatory cytokines. Nephrol Dial Transplant,
2002; 17 [Suppl 11]: 39-43.
19. Mann JF, Gerstein HC, Pogue J, et al: Renal insufficiency as a predictor of
cardiovascular outcomes and the impact of ramipril: The HOPE randomized
trial. Ann Intern Med 2001; 134: 629-36.
20. Ruilope LM, Salvetti A, Jamerson K, et al: Renal function and intensive
lowering of blood pressure in hypertensive participants of the hypertension
optimal treatment (HOT) study. J Am Soc Nephrol 2001; 12: 218-25.

Thank you for copying data from http://www.arastirmax.com