Kronik Hemodiyaliz Hastalarında Hafta Sonu Etkisinin Değerlendirilmesi: Tek Merkez Deneyimi

Year 2021, Volume: 74 Issue: 3, 332 - 336, 17.09.2021

Gizem Kumru

Abstract

Amaç: Pazartesi, Çarşamba ve Cuma (PÇC) hemodiyaliz programındaki hastalar ile Salı, Perşembe ve Cumartesi (SPCt) hemodiyaliz programındaki hastalar arasında diyaliz tedavi hedeflerine ulaşmada farklılık olup olmadığı bilinmemektedir. SPCt programındaki hastalarda, hemodiyalizin bir gününün hafta sonunda olması diğer hastalara göre daha kötü sonuçlara sahip olmalarına sebep olabilir. Bu çalışmada, bu iki farklı hemodiyaliz programındaki hastaların hemodiyaliz tedavi hedeflerine ulaşma durumları ve hasta sağ kalımları değerlendirilmiştir.

Gereç ve Yöntem: Merkezimizin hemodiyaliz ünitesinde 18 yaşından büyük, en az bir yıldır haftada üç gün hemodiyalize girmekte olan 62 kronik hemodiyaliz hastası değerlendirilmiştir. Hastaların demografik ve klinik özellikleri ile son bir yıldaki hemodiyaliz ilişkili laboratuvar verileri retrospektif olarak incelenerek, PÇC ile SPCt grupları arasında karşılaştırılmıştır.

Bulgular: Hastaların 29’u kadın (%46,8), ortalama yaşı 51,8±15,4 yıl ve ortanca hemodiyalize girme süresi 55,5 aydı. Otuz iki hasta (%51,6) PÇC ve 30 hasta (%48,4) SPCt hemodiyaliz programında takip edilmekteydi. Gruplar arası demografik özellikler, hemodiyaliz süresi ve arteriyovenöz fistül oranında farklılık saptanmadı. Hemodiyaliz hedef değerlerine ulaşma oranları gruplar arasında benzer iken; sadece serum potasyum hedefine ulaşma oranı SPCt grubunda daha yüksekti (p=0,002). Hasta mortalitesi SPCt grubunda PÇC grubuna göre daha fazla görüldü (sırasıyla %16,7 vs %3,1, p=0,099). Aterosklerotik hastalık varlığı mortalite için bağımsız risk faktörüydü (olasılık oranı=10.827, %95 güven aralığı: 1,127-104.046, p=0,039).

Sonuç: Bu çalışmada, hemodiyaliz tedavi hedeflerine ulaşma başarısı gruplar arasında benzer iken, tüm tedavisini hafta içi alan hasta grubunda hasta ölümlerinin daha az olma eğiliminde olduğu ve aterosklerotik hastalık varlığının mortalite için risk faktörü olduğu gösterilmiştir.

Keywords

Hafta Sonu Etkisi, Hemodiyaliz, Günlük Değişkenlik, Kalite Endeksleri

Ethical Statement

Etik Kurul Onayı: Çalışma için Sağlık Bilimleri Üniversitesi, Van Eğitim ve Araştırma Hastanesi Klinik Araştırmaları Etik Kurulu’ndan onay alındı (tarih: 11/03/2021, no: 2021/06). Hasta Onayı: Çalışma geriye dönük analiz olduğundan dolayı hasta onayı alınmamıştır.

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The Weekend Effect in Maintenance Hemodialysis Patients: A Single-center Experience Study

Abstract

Objectives: It is not known whether there are differences in achieving dialysis treatment goals between patients in the Monday, Wednesday, and Friday (PTC) hemodialysis program and those in the Tuesday, Thursday, and Saturday (SPCt) hemodialysis program. In this study, the achievement of hemodialysis treatment goals and mortality of patients on these two different hemodialysis programs were evaluated.

Materials and Methods: Sixty-two chronic hemodialysis patients, who were older than 18 years and under thrice weekly hemodialysis treatment for at least one year, were evaluated in our center. The demographic and clinical characteristics and hemodialysis-related laboratory data were retrospectively analyzed and compared between the MWF and TTS groups.

Results: Twenty-nine of the patients were female (46.8%), the mean age was 51.8±15.4 years, and median dialysis vintage was 55.5 months. Thirtytwopatients (51.6%) were on MWF program and 30 patients (48.4%) were on TTS program. There was no difference in demographic characteristics, dialysis vintage and arteriovenous fistula rate between the groups. While the rates of reaching the hemodialysis target values were similar between the groups, only serum potassium level was higher in the MWF group (p=0.002). Patient mortality was higher in the TTS group comparedto the MWF group (16.7% vs 3.1%, respectively, p=0.099). The presence of atherosclerotic disease was an independent risk factor for mortality (odds ratio=10,827, 95% confidence interval: 1.127-104,046, p=0.039).

Conclusion: In this study, it was shown that while the success of achieving hemodialysis treatment goals was similar between the groups, patient deaths tended to be less in the group of patients who received all treatment on weekdays. The presence of atherosclerotic disease was a risk factor for mortality.

Keywords

Weekend Effect, Hemodialysis, Daily Variation, Quality Indices

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