Kronik böbrek yetmezlikli çocuklarda renal osteodistrofi sıklığı ve renal osteodistrofinin biyokimyasal parametrelerle ilişkisi
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Date
2010
Authors
Durmaz, Oğuzhan
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Publisher
Uludağ Üniversitesi
Abstract
Son dönem böbrek hastalığı ile böbrek yetmezliği gelişmiş hastalarda kemik hastalığı sık olarak karşımıza çıkmaktadır. Bu çalışmada kronik böbrek yetmezliği olan çocuklarda Dual Enerji X-Ray Absorbsiyometri (DEXA) kullanılarak osteopeni sıklığını saptamak ve çeşitli biyokimyasal belirleyicilerle DEXA bulguları arasındaki ilişkiyi göstermeyi planladık.Bu çalışmaya Uludağ Üniversitesi Tıp Fakultesi Pediatrik Nefroloji Bilim Dalı'nda Ağustos 1997 ile Ocak 2008 tarihleri arasında kronik böbrek yetmezliğine bağlı periton diyaliz tedavisi başlanılan ve 20 Ocak 2008 ile 10 Şubat 2008 tarihleri arasında düzenli poliklinik kontrolüne gelen 20 çocuk alındı Bu çocukların almakta olduğu tedaviler, kemik sağlıkları ve bunlara etkili olabilecek faktörler araştırıldı. Çalışmaya alınan tüm hastaların dosya kayıtlarından primer tanıları, tanı tarihleri, tanı yaşları, diyaliz süreleri, izlem süreleri ve çalışma anındaki ağırlık ve boy ölçümleri kaydedildi. Hastaların nefroloji poliklinik kontrolleri sırasında sabah açlık kanları alındı. Serum üre, kreatinin, Ca, P, ALP ve PTH değerleri çalışıldı, diyaliz etkinliğini değerlendirmek için Kt/V değerleri hesaplandı. Kemik mineral yoğunluğu, lomber bölgeden (L2-L4 arası vertebralardan), DEXA yöntemi ile ölçüldü.Çalışmaya alınan hastaların 9'u erkek (%45), 11 i kız (%55), ortalama periton diyaliz süreleri ise 3,54±2,2 yıl (6 ay-5,5 yıl) idi. Hastalarımızın kemik mineral yoğunluğu (KMY), kendi yaş grubu ve cinsiyetine göre sağlıklı çocukların değerleriyle karşılaştırıldığında 15 hastada (%75) düşük bulundu. Bu hastaların 9'unda (%45) osteopeni, 6'sında (%30) ise ağır osteopeni saptandı. KMY ortalaması 0,70±0,22 g/cm2 (0,31-1,21 g/cm2 arasında), Z skoru ortalaması -1,86±1,91 (-5,7-2,1 arasında) saptandı. İzlem süreleri ve cinsiyeti ile KMY ve Z skor sonuçları karşılaştırıldığında İstatistiksel farklılık saptanmadı. Z skoru ile biyokimyasal parametrelerinin ilişkisi incelendiğinde, Ca ve ALP değerleri ile Z skoru arasında istatistiksel anlamlılık saptanmazken, CaxP, PTH ve P değerleri ile Z skoru dağılımı istatistiksel olarak anlamlı bulundu. Kt/V değerleri 2.32±0.82 (0.79-4.63 arasında) arasında değişmekteydi. Onüç hastada (%65) Kt/V 2'nin üzerinde, 7 hastada (%35) ise 2'nin altında saptandı. Kt/V oranı 2'nin atında olan 7 hastanın 6'sında (% 85) DEXA skoru -1'in altında idi. Kt/V değeri 2'nin altında olan hastaların DEXA skoru anlamlı olarak düşük saptandı.Sonuç olarak, renal osteodistrofi (ROD) son dönem böbrek hastalığında (SDBH) sık karşılaşılan mortalite ve morbitideyi etkileyen önemli bir faktördür. Çalışmamızda CaxP değerinin 55, P'un 7 mg/dl, PTH'ın 200 pg/mL üzerinde olması ve Kt/V'nin 2'nin altında olmasının ROD gelişimi için birer risk faktörü olduğu görüldü. ROD'un önlenmesi ve erken dönemde saptanabilmesi için SDBH'nın Evre 3 aşamasından itibaren biyokimyasal parametrelerle birlikte DEXA'nın yapılmasının uygun olduğunu düşünmekteyiz.
Bone diseases are frequently seen in patients with end stage renal disease and renal failure. We planned to determine the frequency of osteopenia in children with chronic renal failure by using Dual Energy X-Ray Absorptiometry (DEXA) and to show the association between biochemical markers and DEXA findings.A total of 20 children who were started on peritoneal dialysis treatment due to chronic renal failure between August 1997 and January 2008 in Pediatric Nephrology Department of Uludag University and who were followed up at outpatient clinic between January 20, 2008 and February 10, 2008 were included to this study. The medications and bone health of these children and factors that may be associated were all investigated. The primary diagnoses, date of diagnosis, duration of dialysis, duration of follow-up and weight and height during the study period of these children were recorded. The fasting blood samples of the patients were obtained during outpatient visits. Serum urea, creatinine, Ca, P, ALP, and PTH levels were studied and Kt/V values were calculated for determination of the efficacy of dialysis. Bone mineral density was measured at lumbar spine (L2-L4) by DEXA.Nine (45%) of the children were male, 11 (55%) of them were female and the mean duration of peritoneal dialysis was 3.54±2.2 years (range, 6 months to 5.5 years). When bone mineral density (BMD) of our patients were compared with gender and age matched healthy children, BMD was found to be low in 15 patients (75%). Osteopenia and severe osteopenia was determined in 9 (45%) and 6 (30%) patients, respectively. The mean BMD was 0.70±0.22 g/cm2 (range, 0.31 and 1.21 g/cm2), the mean Z score was -1.86±1.91 (range, -5.7 and -2.1). When duration of follow-up and gender were compared with BMD and Z scores, no significant differences were determined. When the association between Z score and biochemical parameters were evaluated, no significant differences were found between Ca, ALP levels and Z score. In contrast, there was a significant correlation between CaxP, PTH and P levels and Z score. The mean Kt/V levels were 2.32±0.82 (range, 0.79 and 4.63). Kt/V were higher than 2 in 13 patients (65%) and lower than 2 in 7 patients (35%). DEXA score was lower than -1 (osteopenia and/or severe osteopenia) in 6 of the 7 patients (85%) with a Kt/V level lower than 2. DEXA scores were significantly lower in patients whose Kt/V levels were lower than 2.In conclusion, renal osteodystrophy (ROD) is a frequent and important factor affecting morbidity in end stage kidney disease (ESKD). In this study, biochemical parameters such as CaxP below 55, P above 7 mg/dl, PTH above 200 pg/mL and Kt/V below 2 was shown to be independent risk factors for development of ROD. We suggest that biochemical parameters and DEXA must be performed from the third stage of ESKD for the prevention and early determination of ROD.
Bone diseases are frequently seen in patients with end stage renal disease and renal failure. We planned to determine the frequency of osteopenia in children with chronic renal failure by using Dual Energy X-Ray Absorptiometry (DEXA) and to show the association between biochemical markers and DEXA findings.A total of 20 children who were started on peritoneal dialysis treatment due to chronic renal failure between August 1997 and January 2008 in Pediatric Nephrology Department of Uludag University and who were followed up at outpatient clinic between January 20, 2008 and February 10, 2008 were included to this study. The medications and bone health of these children and factors that may be associated were all investigated. The primary diagnoses, date of diagnosis, duration of dialysis, duration of follow-up and weight and height during the study period of these children were recorded. The fasting blood samples of the patients were obtained during outpatient visits. Serum urea, creatinine, Ca, P, ALP, and PTH levels were studied and Kt/V values were calculated for determination of the efficacy of dialysis. Bone mineral density was measured at lumbar spine (L2-L4) by DEXA.Nine (45%) of the children were male, 11 (55%) of them were female and the mean duration of peritoneal dialysis was 3.54±2.2 years (range, 6 months to 5.5 years). When bone mineral density (BMD) of our patients were compared with gender and age matched healthy children, BMD was found to be low in 15 patients (75%). Osteopenia and severe osteopenia was determined in 9 (45%) and 6 (30%) patients, respectively. The mean BMD was 0.70±0.22 g/cm2 (range, 0.31 and 1.21 g/cm2), the mean Z score was -1.86±1.91 (range, -5.7 and -2.1). When duration of follow-up and gender were compared with BMD and Z scores, no significant differences were determined. When the association between Z score and biochemical parameters were evaluated, no significant differences were found between Ca, ALP levels and Z score. In contrast, there was a significant correlation between CaxP, PTH and P levels and Z score. The mean Kt/V levels were 2.32±0.82 (range, 0.79 and 4.63). Kt/V were higher than 2 in 13 patients (65%) and lower than 2 in 7 patients (35%). DEXA score was lower than -1 (osteopenia and/or severe osteopenia) in 6 of the 7 patients (85%) with a Kt/V level lower than 2. DEXA scores were significantly lower in patients whose Kt/V levels were lower than 2.In conclusion, renal osteodystrophy (ROD) is a frequent and important factor affecting morbidity in end stage kidney disease (ESKD). In this study, biochemical parameters such as CaxP below 55, P above 7 mg/dl, PTH above 200 pg/mL and Kt/V below 2 was shown to be independent risk factors for development of ROD. We suggest that biochemical parameters and DEXA must be performed from the third stage of ESKD for the prevention and early determination of ROD.
Description
Keywords
Kronik böbrek yetmezliği, Periton diyalizi, Renal osteodistrofi, Osteopeni, Dual enerji X-ray absorbsiyometri, Chronic renal failure, Peritoneal dialysis, Renal osteodystrophy, Osteopenia, Dual energy X-ray absoprtiometry
Citation
Durmaz, O. (2010). Kronik böbrek yetmezlikli çocuklarda renal osteodistrofi sıklığı ve renal osteodistrofinin biyokimyasal parametrelerle ilişkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.