Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri

Abstract

ÖZ

Amaç: Kronik böbrek yetmezliği (KBY) glomerüler filtrasyon hızında geri dönüşsüz azalma olarak tanımlanır. Kronik böbrek yetmezliğinde evre ilerledikçe anemi prevalansı %90’a kadar ulaşır. Aneminin rekombinan insan eritropoetini (rHuEPO) ile düzeltilemediği durumlarda, diyaliz yeterliliğinin, inflamasyonun, vitamin düzeylerinin, hiperparatiroidinin, kan kayıplarının, kullanılan ilaçların, serum aluminyum (Al) düzeyinin araştırılması gerekmektedir. Çalışmamızda pediatrik diyaliz hastalarında anemi nedenlerini araştırmayı hedefledik.

Araçlar ve Yöntem: Bu kesitsel prospektif çalışma periton diyalizi (PD) veya hemodiyaliz (HD) uygulanan çocuk hastalarda yapıldı

Bulgular: : Çalışmaya toplam 49 hasta (K/E=27/22) alındı. Hastaların yaş ortalaması 12.65 (0.16-20) yıl, ortalama diyaliz süresi 28 ay (1-108) idi. 35 hasta (%71.4) PD, 14 hasta (%28.6) HD programında idi. Hastaların 37’sinde (%75.5) anemi saptandı. Anemik hastaların ortalama Hemoglobin (Hb) 8.85±1.18 g/dl, Ortalama Eritrosit Volümü (OEV) 86.40 ±5.01 fl bulundu. Hemodiyaliz ve PD gruplarında sırasıyla ferritin ortalaması 831.35 (±545.05) ng/ml ve 450.05 (±313.15 ng/ml) bulundu (p=0.005). Hastaların 7’si (%14.3) intravenöz (iv) demir, 24’ü (%49) oral demir preparatı kullanmaktaydı. Parenteral demir kullanan hastalarda Hb ve ferritin düzeyleri istatistiksel olarak anlamlı yüksekti (p<0.05). Kırkdokuz hastanın 42’si EPO tedavisi kullanmaktaydı, EPO kullanma durumuna göre hastaların Hb düzeyleri arasında fark bulunmadı. Serum Al düzeyi 37 hastada bakıldı. Hastaların tamamının Al düzeyi güvenli sınırlar içindeydi.

Sonuç: Hastalarımızın %63’ü demir, %85.7’si EPO tedavisi kullanmalarına rağmen, %75 sıklıkta anemik olduklarını saptadık. Çalışmamızda, diyaliz hastalarımızın hiçbirinde Al birikimi olmadığını gördük. Çocuk diyaliz hastalarında tedaviye rağmen anemi sıklığının yüksek olmasının nedenlerine yönelik yapılacak daha kapsamlı prospektif çalışmalar, hastaların bireysel tedavilerinin planlanmasına yardımcı olacaktır.

Keywords

• Çocuk,Diyaliz,Aluminyum Düzeyleri,Anemi

Anemia and Aluminium Levels in Child Patients with Dialysis

Abstract

ABSTRACT

Purpose: Chronic renal failure (CRF) is defined as irreversible reduction in glomerular filtration rate. In chronic renal failure, the prevalence of anemia reaches up to 90% as the stage progresses. In cases where the anemia can not be corrected with recombinant human erythropoietin (rHuEPO), it is necessary to investigate the adequacy of dialysis, presence of inflammation, vitamin levels, hyperparathyroidism, blood loss, drugs used and serum aluminum (Al) level. The aim of the study was to investigate the reasons of anemia in pediatric patients with dialysis.

Materials and Methods: Our cross-sectional prospective study was performed in children with CRF undergoing peritoneal dialysis (PD) or hemodyalisis (HD).

Results: A total of 49 pediatric patients (F/M=27/22) were enrolled into the study. The mean age of patients was 12.65 (range 0.16-20) years, the mean duration of dialysis was 28 months (range 1-108), 35 patients (71.4%) were on PD and 14 patients (28.6%) were on HD program. Anemia was detected in 37 (75.5%) of the patients. The mean Hemoglobin (Hb) was 8.85±1.18 g /dl and mean corpuscular volume was (MCV) 86.40±5.01 fl in patients with anemia. The mean ferritin was 831.35 (±545.05) ng/ml and 450.05 (±313.15) ng/ml in the HD and PD groups, respectively (p=0.005). Seven patients (14.3%) were using iv iron and 24 (49%) were using oral iron preparations. Hb and ferritin levels were significantly higher in patients using parenteral iron (p <0.05). Forty-two patients (85.7%) were using rHuEPO, and there was no difference in the Hb levels of patients according to the use of rHuEPO. Serum Al levels were within safe limits in all of the 37 patients.

Conclusion: We found that 75% of our patients were anemic, despite the fact that 63% were using iron supplementation and 85.7% were using rHuEPO therapy. In our study, we found that none of our dialysis patients had Al accumulation. More extensive prospective studies are warranted to highlight the causes of high anemia frequency in childhood dialysis patients, which will help in planning of individual treatment of anemia.

Keywords

• Child,Dialysis,Aluminum,anemia

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