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Hemodiyaliz ve Sürekli Ambulatuar Periton Diyalizi Hastalarının Kardiyovasküler Hastalık Risk Faktörleri Açısından Karşılaştırılması: 3 Yıllık İzlem

Comparison of Hemodialysis Patients With Continuous Ambulatory Peritoneal Dialysis Patients in Terms of Cardiovascular Disease Risk Factors: A Three-Year Follow-

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2005

Key Words:

Keywords (Original Language):

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Abstract (2. Language): 
End stage renal disease (ESRD) is known to be associated with well known risk factors of cardiovascular disease (CVD) like hypertension and dyslipidemia. The aim of this study is to compare 2 groups of ESRD patients, who are being followed by hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) for at least 3 years, in terms of CVD risk factors, retrospectively. Totally 133 ESRD patients (Group I: 65 CAPD patients, Group II: 68 HD patients) who were followed for at least 3 years under the initial dialysis modality were included. The predialysis 3 months' laboratory (Total cho¬lesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, LDL/HDL, albumin and C-reactive protein) and clinical findings (body weight, blood pressure, antihypertensive and antilipemic medication) of the patients were collected. The 1-12th and 25-36th months' laboratory and clinical findings were also recorded as the "first year" and "third year" follow-up results respectively. Groups were statistically comparable in terms of predialysis data. When the first year data of each group was compared according to the initial ones, total cholesterol significantly increased in Group I (p<0.01), albumin increased (p<0.0001), triglyceride increased (p<0.05) and HDL-cholesterol decreased (p<0.01) in Group II. Comparison of third year data of each group with initial ones revealed that HDL-cholesterol decreased in both groups (p<0.005, <0.0001 respectively) but also LDL-cholesterol decreased (p<0.01) in Group II. When the 1st year laboratory results of groups were compared, CAPD was found to be associated with relatively higher total cholesterol (p<0.01) and lower albumin (p<0.0001) levels. Blood pressure measurements were also higher in CAPD group (For both systolic and diastolic blood pressures p<0.001) in the 1st year. Third year data revealed that CAPD was associated with rela¬tively higher levels of LDL-cholesterol (p<0.05) and lower levels of albumin (p<0.01) but there was no other statistical difference between groups, in terms of other lipid parameters, CRP, blood pressure and medication rece¬ived. Conclusion: CAPD treatment is found to be associated with dyslipide-mia and hypertension when compared to HD, especially in the first year fol¬low-up period. This difference seems to continue in a lesser extend in the following years. CAPD patients are under persistent risk of hypoalbuminemia which may be secondary to hemodilution, peritoneal protein loss or protein malnutrition secondary to dextrose absorbtion from dialysis fluid.
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Abstract (Original Language): 
sküler hastalık (KVH) risk faktörleri ile ilişkisi bilinen bir send-romdur. Çalışmamızda, diyaliz tedavisinin başlangıcından itibaren en az 3 yıldır hemodiyaliz (HD) ya da sürekli ambulatuar periton diyalizi (SAPD) yöntemlerinden biriyle takip edilmekte olan 2 grup SDBY hastası, KVH risk faktörleri açısından retrospektif olarak karşılaştırılmıştır. Toplam 133 SDBY hastası (Grup I: 65 SAPD hastası, Grup II: 68 HD hastası) çalışmaya dahil edilmiştir. Diyaliz öncesi son 3 aylık laboratuvar (Total kolesterol, LDL-koles-terol, HDL-kolesterol, trigliserid, LDL/HDL, albümin ve C-reaktif protein) ve klinik bulgular (vücut ağırlığı, kan basıncı, antihipertensif ve antihiperlipide-mik tedavi) ile 1-12 ve 25-36 ay arası laboratuvar ve klinik bulgular "birinci yıl" ve "üçüncü yıl" verileri adıyla retrospektif olarak kaydedilmiştir. Gruplar diyaliz öncesi veriler göz önüne alındığında istatistiksel açıdan benzer bulunmuştur. Her grubun birinci yıl verileri ile diyaliz öncesi verilerinin karşılaştırılması sonucunda Grup I'de total kolesterol düzeylerinde anlamlı artış (p<0,01), Grup II'de albümin (p<0,0001) ve trigliseridde (p<0,05) artış ile HDL-kolesterol düzeylerinde düşüş (p<0,01), diyaliz öncesi verilerle üçüncü yıl verilerinin karşılaştırılmasında ise Grup I'de HDL kolesterol düzeylerinde düşüş (p<0,005), Grup II'de HDL (p<0,0001) ve LDL kolesterol (p<0,01) düzeylerinde düşüş olduğu görülmüştür. Grupların birinci yıl verilerinin birbiriyle karşılaştırılması sonucunda SAPD göreli olarak daha yüksek total kolesterol (p<0,01) ve daha düşük albümin (p<0,0001) düzeyleri ile ilişkili bulunmuştur. Aynı yıl içinde SAPD hastalarının sistolik ve diastolik kan basınç ortalaman da HD hastalarına göre daha yüksek seyretmiştir (p<0,001). Üçün¬cü yıl izleminde ise SAPD tedavisinin görece yüksek LDL-kolesterol (p<0,05) ve düşük albümin (p<0,01) ile ilişkili olduğu görülmüş, ancak bunlar dışında diğer olası aterosklerotik risk faktörleri (lipid parametreleri, CRP, kan basınç izlemleri) anlamlı bir fark saptanmamıştır. Sonuç: SAPD tedavisinin HD yön¬temine göre hipertansiyon ve dislipidemi gibi aterogenik risk faktörleri ile daha kuvvetli ilişki içinde olduğu görülmüştür. Bu ilişki, izleyen yıllarda azal¬arak devam etse de, kendisini en kuvvetli olarak birinci yılda göstermekte¬dir. SAPD hastaları sürekli olarak hipoalbüminemi riski altındadırlar. Bu du¬rum hemodilüsyon, peritoneal protein kaybı ya da diyalizattaki dekstrozun emilmesiyle gelişen protein malnütrisyonuna bağlı olabilir.
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Türk Nefroloji Diyaliz ve Transplantasyon Dergisi /Official Journal of the Turkish Society of Nephrology
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