Periton diyaliz hastalarında kardiyovasküler risk faktörleri ile fetuin-a arasındaki ilişkinin değerlendirilmesi
Loading...
Date
2012
Authors
Çubukcuoğlu, Tarık
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Kronik böbrek yetmezliği (KBY) nedeniyle renal replasman tedavisi (RRT) gören hastalarda kardiyovasküler hastalıklar nedeniyle ortaya çıkan mortalite ve morbidite aynı yaş grubundaki sağlıklı kişilerden çok daha fazladır. Kronik inflamasyona bağlı gelişen vasküler kalsifikasyonun artmış kardiyovasküler mortalitenin başlıca sorumlusu olduğu düşünülmektedir. Kardiyovasküler riski belirlemek amacıyla kullanılan risk skorlamaları, bu hasta grubunda gerçek riski belirlemede yetersiz kalmaktadır. Bu nedenle farklı biyokimyasal parametreler, riski öngörebilmek amacıyla kullanılmakta ve yeni belirteçler üzerinde çalışılmaktadır. Son yıllarda bu konuda çalışmaların üzerine yoğunlaştığı fetuin-A, serumda major kalsifikasyon inhibitörü olarak görev yapan bir glikoproteindir.Bu çalışmamızda periton diyaliz (PD) hastaları ve sağlıklı kontrol grubunda serum fetuin-A düzeyi ile klinik ve biyokimyasal parametreler arasındaki ilişkiyi, ayrıca kardiyovasküler risk faktörleri ile olan korelasyonu incelemeyi hedefledik.Çalışmaya 48 hasta ve yaşı uygun sağlıklı 27 erişkin kontrol grubu olarak alındı. Hastalar ve kontrol grubunun serum fetuin- A düzeyleri ile kilo, boy, beden kitle indeksleri (BMI), kan basınçları, çeşitli inflamasyon belirteçleri ( ferritin, C-reaktif protein (CRP), sedimantasyon, fibrinojen, albumin ), lipid profilleri, PD hastalarında periton diyalizi yeterlilik kriterleri olan Kt/Vüre, nPCR, kreatin klirensi ölçülerek bunların fetuin- A düzeyi ile ilişkisi değerlendirildi. Çalışmaya katılan PD hasta grubunun yaş ortalaması 47,6±13.6, sağlıklı kontrollerin ise 37.7±1.9 yıl idi. Gruplar arasında cinsiyet dağılımı, yaş ortalaması, BMI, sigara kullanımı, ailede hipertansiyon (HT), diyabetes mellitus (DM), koroner arter hastalığı (KAH) ve obezite varlığı açısından anlamlı fark saptanmadı. CRP düzeyi PD grubunda, kontrol grubuna göre yüksek, fetuin-A düzeyi ise anlamlı düzeyde düşük saptandı. PD hasta grubu, rezidüel renal fonksiyonu (RRF) olanlar ve olmayanlar şeklinde iki alt gruba ayrılarak değerlendirildi. RRF olmayan grupta sedimantasyon, CRP, ferritin düzeyleri anlamlı düzeyde yüksekti. RRF'u olan grupta alkalen fosfataz (ALP) daha düşük bulundu. Bu iki grubun fetuin-A düzeyleri arasında fark saptanmadı. PD grubunda serum fetuin-A düzeyi ile CRP düzeyi arasında negatif korelasyon mevcuttu. Sağlıklı kontrollerde serum fetuin-A düzeyi ile yaş, açlık plazma glukozu ve (yüksek dansiteli lipoprotein) HDL düzeyi ilişkili bulundu.PD hastalarında kardiyovasküler nedenlere bağlı ölüm, enfeksiyöz nedenlerden sonra en sık karşımıza çıkan mortalite nedenidir. Geleneksel risk faktörlerinin bu hastalarda kardiyovasküler mortaliteyi tek başına açıklamaya yetmediği bilinmektedir. Bu hastalardaki subklinik inflamasyon ve ateroskleroz kardiyovasküler hastalık patogenezinde kilit rol oynamaktadır. Biz de çalışmamızda subklinik inflamasyon belirteçlerinin fetuin-A ile ilişkisini ortaya koymaya çalıştık. PD hastalarında kronik inflamasyon belirteçlerinin ve risk altındaki hasta grubunun daha erken saptanması yoluyla kardiyovasküler hastalık riski azaltılabilir ve erken evrede gerekli önlemler alınabilir.
The mortality and morbidity rates due to cardiovascular diseases among adults with chronic renal failure are disproportionally elevated when compared to their healthy counterparts. Vascular calcifications (VC) caused by chronic inflammation could be the reason of the decreased life span and prevalent morbidity in these patients. Scoring systems used to determine the chance of cardiovascular (CV) risk frequently fail to identify the risk in these patients. Traditional CV risk factors are not sufficient to explain cardiovascular mortality in Peritoneal Dialysis (PD) patients. New markers to predict the risk of CV disease continues to be investigated. The most studied marker in recent years is fetuin-A, which is major calcification inhibitor in serum and one of the decisive risk factors of VC. In our study, we compared traditional and non-traditional CV risk factors and correlation of serum fetuin-A levels with CV risk factors between PD patients and healthy volunteers.Forty eight PD patients and 27 healthy volunteers were included in the study Fetuin-A levels, body weight, body mass index, blood pressure, markers of inflammation (sedimentation, C-reactive protein, ferritin) lipid profile and dialysis adequacy tests were performed. The relationship between these parameters was compared with fetuin-A. Mean age in PD patients and healthy volunteers was 47,6 ± 13,6, 37.7 ± 1.9 years respectively. Sex distribution, mean age, smoking history, family history of hypertension (HT), diabetes (DM), coronary artery disease (CAD) and obesity were similar. CRP and sedimentation levels were significantly higher in the group of PD patients. Fetuin-A levels were significantly lower in PD patients than control group. The PD group was then separated into two groups according to the residual renal function (RRF). Sedimentation, CRP and ferritin levels were found higher in RRF negative group. Alkaline phosphates levels were higher in RRF positive group and there was no significant difference for fetuin-A between two groups.There was a negative correlation between serum fetuin-A and CRP levels (p<0,05 r=-0,4). In healthy volunteers, there was a positive correlation between serum fetuin-A levels and age, fasting blood glucose, HDL levels.Cardiovascular death is the most frequent cause of death in patients on peritoneal dialysis. Traditional risk factors may explain some, but probably not all of the increased atherosclerotic cardiovascular disease (ASCVD). Subclinical inflammation and atherosclerosis play a key role in pathogenesis of cardiovascular disease. We aimed to study the relation between fetuin-A subclinical inflammation and cardiovascular risk factors. In the early stages of the renal failure by using markers of subclinical chronic inflammation, cardiovascular disease risk can be reduced and necessary measures can be taken.
The mortality and morbidity rates due to cardiovascular diseases among adults with chronic renal failure are disproportionally elevated when compared to their healthy counterparts. Vascular calcifications (VC) caused by chronic inflammation could be the reason of the decreased life span and prevalent morbidity in these patients. Scoring systems used to determine the chance of cardiovascular (CV) risk frequently fail to identify the risk in these patients. Traditional CV risk factors are not sufficient to explain cardiovascular mortality in Peritoneal Dialysis (PD) patients. New markers to predict the risk of CV disease continues to be investigated. The most studied marker in recent years is fetuin-A, which is major calcification inhibitor in serum and one of the decisive risk factors of VC. In our study, we compared traditional and non-traditional CV risk factors and correlation of serum fetuin-A levels with CV risk factors between PD patients and healthy volunteers.Forty eight PD patients and 27 healthy volunteers were included in the study Fetuin-A levels, body weight, body mass index, blood pressure, markers of inflammation (sedimentation, C-reactive protein, ferritin) lipid profile and dialysis adequacy tests were performed. The relationship between these parameters was compared with fetuin-A. Mean age in PD patients and healthy volunteers was 47,6 ± 13,6, 37.7 ± 1.9 years respectively. Sex distribution, mean age, smoking history, family history of hypertension (HT), diabetes (DM), coronary artery disease (CAD) and obesity were similar. CRP and sedimentation levels were significantly higher in the group of PD patients. Fetuin-A levels were significantly lower in PD patients than control group. The PD group was then separated into two groups according to the residual renal function (RRF). Sedimentation, CRP and ferritin levels were found higher in RRF negative group. Alkaline phosphates levels were higher in RRF positive group and there was no significant difference for fetuin-A between two groups.There was a negative correlation between serum fetuin-A and CRP levels (p<0,05 r=-0,4). In healthy volunteers, there was a positive correlation between serum fetuin-A levels and age, fasting blood glucose, HDL levels.Cardiovascular death is the most frequent cause of death in patients on peritoneal dialysis. Traditional risk factors may explain some, but probably not all of the increased atherosclerotic cardiovascular disease (ASCVD). Subclinical inflammation and atherosclerosis play a key role in pathogenesis of cardiovascular disease. We aimed to study the relation between fetuin-A subclinical inflammation and cardiovascular risk factors. In the early stages of the renal failure by using markers of subclinical chronic inflammation, cardiovascular disease risk can be reduced and necessary measures can be taken.
Description
Keywords
Periton diyalizi, Kardiyovasküler risk faktörleri, Fetuin-A, İnflamasyon, Vasküler kalsifikasyon, Peritoneal dialysis, Cardiovascular risk factors, Inflammation, Vascular calcification
Citation
Çubukcuoğlu, T. (2012). Periton diyaliz hastalarında kardiyovasküler risk faktörleri ile fetuin-a arasındaki ilişkinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.