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ULTRAFÎLTRASYONUN DÎGÎTAL BENZERÎ ÎMMÜNREAKTÎF MADDE (DLIS), ATRIAL NATRÎÜRETÎK PEPTÎD (ANP) VE EKOKARDÎYOGRAFÎK PARAMETRELER ÜZERÎNDEKÎ ETKÎSÎ

THE EFFECTS OF ULTRAFILTRATION ON DIGITALIS-LIKE IMMUNOREACTIVE SUBSTANCE (DLIS), ATRIAL NATRIURETIC PEPTIDE (ANP) AND ECHOCARDIOGRAPHY PARAMETERS

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Abstract (2. Language): 
Assessment of dry weight in hemodialysis patients is essential. Intravascular hypervolemia increases the levels of digitalis-like immunoreactive substance (DLIS), atrial natriuretic peptide (ANP) and it alters echocardiographic parameters. The basal levels of DLIS in forty-two hemodialysis patients were significantly higher when compared with control (n:20) (p< 0.05). Since endogenous DLIS gives cross-reaction to anti-digoxin antibodies, the levels of DLIS were determined by two seperate techniques, FPIA (fluorescence polarization enzyme immunoassay) and MEIA (microparticle enzyme immunoassay). The strong positive correlation between DLIS-FPIA andDLIS-MEIA (r:0.894, p<0.001) made us think that these two markers could be used interchangeably. Compared to the corresponding parameters of forty-two hemodialysis patients, DLIS and ANP levels and diameters ofright and left atria of eleven patients, selected as hypervolemic by conventional criteriae, were higher. After three months of ultrafiltration treatment, we determined that the levels of DLIS, ANP and diameters of both atria decreased significantly approaching control levels. We concluded that the tests of DLIS and ANP combined with atrial echocardiographic parameters were useful to determine the intravascular volume response to ultrafiltration treatment
Abstract (Original Language): 
Hemodiyaliz hastalarında kuru ağırlığın hatasız olarak ölçülmesi yaşamsal önem taşımaktadır. İntravasküler hipervolemi digital benzeri immünreaktif madde (digitalis¬like immunoreactive substance:DLIS) ve atriyal natriüretik peptid (ANP) düzeylerini arttırmakta ve ekokardiyograflk parametreleri etkilemektedir. İncelemeye alınan 42 hemodiyaliz hastasının bazal DLIS düzeyleri kontrol grubundan (n:20) daha yüksek bulunmuştur (p<0.05). Endojen DLLS'in anti-digoksin antikorları ile verdiği çapraz reaksiyon nedeniyle, DLIS düzeyleri FPIA (floresan polarizasyon enzim immünassay) ve MEIA (mikropartikül enzim immünassay) yöntemleriyle belirlenmiştir. DLIS-FPIA ve DLIS-MEIA arasındaki kuvvetli pozitif korelasyon (r:0.894,p<0.001), bu iki testin birbiri yerine kullanılabileceğini düşündürmüştür. Tüm hemodiyaliz hastaları içinden konvansiyonel kriterlere göre hipervolemik olduğu saptanan 11 hastanın DLIS ve ANP düzeyleri, sağ ve sol atrium çapları genel diyaliz populasyonunun benzer parametrelerinden daha yüksek bulunmuştur. Üç aylık ultrafıltrasyon işleminin sonunda DLIS,ANP düzeyleri ile sağ ve sol atriyum çapları anlamlı olarak gerilemiştir. DLIS ve ANP ölçümlerinin, atrial ekokardiyograflk parametreler ile birlikte , ultrafıltrasyona alınan yanıtın değerlendirilmesinde tanısal değere sahip olduğu sonucuna varılmıştır
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