Hemodiyaliz Hastalarında Sevelamer Vasküler Sertliği Düzeltmekte ve Serum Ürik Asit Düzeyini Azaltmaktadır

Abstract

Amaç: Sevelamer, pleotropik etkisi ile prebiyotik olarak etki gösterebilir. Bu çalışmanın amacı sevelamerin ürik asit, HbA1c, lipid profili ve arteryel sertlik progresyonu üzerine etkisinin gösterilmesidir. Gereç ve Yöntem: Hemodiyalize giren ve aynı fosfor bağlayıcıyı (FB) 3 yıl kullanan 151 hasta çalışmaya dahil edildi. Hastalar kullandıkları FB’ye göre sevelamer bazlı FB (grup 1) ve kalsiyum bazlı FB (grup 2) olarak 2 gruba ayrıldı. Üç yıllık takipte biyokimyasal parametreler kayıt edildi. Arteryel sertlik başlangıçta ve 3. yılın sonunda aortik nabız dalga hızı (PWv) ölçümü ile belirlendi. Bulgular: Üç yıllık takipte ortalama ürik asid düzeyleri grup 1’de azalmışken grup 2’de stabil kaldı. Grup 1’deki hastaların %22,4’ünde ortalama ürik asid düzeylerinde 2 mg/dL’den fazla azalma saptandı. Diyabetik hastalarda HbA1c düzeyleri grup 1’de grup 2’ye göre daha düşüktü. PWv düzeyleri çalışmanın başında her 2 grup için de benzerdi. Ancak 3. yılın sonunda PWv düzeyleri grup 1’de grup 2’ye göre daha düşük saptandı. Sonuç: Sevelamer pleiotropik etki ile ürik asit düzeyini, düşük yoğunluklu lipoprotein-kolesterolü, HbA1c düzeyini azaltarak, fazla kalsiyum alımını engelleyerek kardiyovasküler riski azaltmaktadır. Hemodiyalize giren hastalarda sevelamer, kalsiyum bazlı fosfor bağlayıcılara göre arteryel sertlik progresyonunu da azaltarak kardiyovasküler risk profilini düzeltir.

Keywords

• Sevelamer
• hemodiyaliz
• ürik asit
• vasküler sertlik

References

1. 1. Askar AM. Hyperphosphatemia. The hidden killer in chronic kidney disease. Saudi Med J. 2015;36:13-19.
2. 2. Savica V, Santoro D, Monardo P et al. Sevelamer carbonate in thetreatment of hyperphosphatemia in patients with chronic kidney disease on hemodialysis. Ther Clin Risk Manag. 2008;4:821-826
3. 3. Rastogi A. Sevelamer revisited: pleiotropic effects on endothelial and cardiovascular risk factors in chronic kidney disease and end-stage renal disease. Ther Adv Cardiovasc Dis. 2013;7:322-342.
4. 4. Gouri A, Dekaken A, Bentorki A, et al. Serum uric acid level and cardiovascular risks in hemodialysis patients: an Algerian cohort study. Clin Lab. 2014;60:751-758.
5. 5. Lee HY, Oh BH. Aging and arterial stiffness. Circ J. 2010;74:2257-2262
6. 6. Frazão JM, Adragão T. Treatment of hyperphosphatemia with sevelamer hydrochloride in dialysis patients: effects on vascular calcification, bone and a close look into the survival data. Kidney Int Suppl. 2008;111:38-43.
7. 7. Chertow GM, Burke SK, Raggi P, et al. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002;62:245-252.
8. 8. Alayoud A, Montassir D, Hamzi A, et al. The Kt/V by ionic dialysance: Interpretation limits. Indian J Nephrol. 2012;22:333-339.

9. 9. Verbeke F, Marechal C, Laecke SV, et al. Aortic Stiffness and Central Wave Reflections Predict Outcome in Renal Transplant Recipients. Hypertension. 2011;58:833-838.
10. 10. Cozzolino M, Mangano M, Stucchi A, et al. Cardvascular disease in dialysis patients. Nephrol Dial Transplant. 2018;33(Suppl 3):28-34.
11. 11. Mitchell GF, Hwang SH, Vasan RS, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation. 2010;121:505-511.
12. 12. Kerr DN. Hypercalcemia and metastatic calcification. Cardiovasc Res. 1997;36:293-297.
13. 13. Qunibi WY, Hootkins RE, McDowell LL, et al. Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study). Kidney Int. 2004;65:1914-1926.
14. 14. Suki WN, Zabaneh R, Cangiano JL, et al. Effects of sevelamer and calciumbased phosphate binders on mortality in hemodialysis patients. Kidney Int. 2007;72:1130-1137.
15. 15. Chue CD ,Townend JN, Steeds RP, et al. Evaluating the effects of sevelamer carbonate on cardiovascular structure and function in chronic renal impairment in Birmingham: the CRIB-PHOS randomised controlled trial. Trials. 2011;12:30.
16. 16. Grassi D, Ferri L, Desideri G, et al. Chronic hyperuricemia, uric acid deposit and cardiovascular risk. Curr Pharm Des. 2013;19:2432-2438.
17. 17. Zanoli L, Lentini P, Briet M, et al. Arterial Stiffness in the Heart Disease of CKD. J Am Soc Nephrol. 2019;30:918-928.
18. 18. Ramirez-Sandoval JC, Sanchez-Lozada LG, Madero M. Uric Acid, Vascular Stiffness, and Chronic Kidney Disease: Is There a Link? Blood Purif. 2017;43:189-195.
19. 19. Soltani Z, Rasheed K, Kapusta DR, et al. Potential Role of Uric Acid in Metabolic Syndrome, Hypertension, Kidney Injury, and Cardiovascular Diseases: Is It Time for Reappraisal? Curr Hypertens Rep. 2013;15:175-181.
20. 20. Özalp Kızılay D, Şen S, Ersoy B. Associations Between Serum Uric Acid Concentrations and Cardiometabolic Risk and Renal Injury in Obese and Overweight Children. J Clin Res Pediatr Endocrinol. 2019;11:262-269.
21. 21. Sun PP, Perianayagam MC, Jaber BL. Endotoxin-binding affinity of sevelamer: a potential novel anti-inflammatory mechanism. Kidney Int Suppl. 2009;114:20-25.
22. 22. Stinghen AE, Gonçalves SM, Bucharles S, et al. Sevelamer decreases systemic inflammation in parallel to a reduction in endotoxemia. Blood Purif 2010;29:352-356.
23. 23. Ikeda F, Doi Y, Ninomiya T, et al. Haemoglobin A1c even within nondiabetic level is a predictor of cardiovascular disease in a general Japanese population: the Hisayama Study. Cardiovasc Diabetol. 2013;12:164.
24. 24. Vlassara H, Uribarri J, Cai W, et al.. Effects of Sevelamer on HbA1c, Inflammation, and Advanced Glycation End Products in Diabetic Kidney Disease. Clin J Am Soc Nephrol. 2012;7:934-942.
25. 25. Shantouf R, Budoff MJ, Ahmadi N, et al. Effects of Sevelamer and Calcium-Based Phosphate Binders on Lipid and Inflammatory Markers in Hemodialysis Patients. Am J Nephrol. 2008;28:275-279.
26. 26. Chertow GM, Burke SK, Dillon MA, et al. Long-term effects of sevelamer hydrochloride on the calcium-phosphate product and lipid profile of haemodialysis patients. Nephrol Dial Transplant. 1999;14:2907-2914.