Hemodiyaliz hastalarında hipertansiyon: inflamatuar, hematolojik ve biyokimyasal değişiklikler ile MPV ve MPVLR’nin klinik önemi

Year 2025, Volume: 6 Issue: 5, 569 - 574, 24.10.2025

Funda Bulut Arıkan , Hakkı Öztürk

Abstract

Amaç: Hemodiyaliz, kalıcı inflamatuar yolakların aktivasyonu ile karakterizedir; bu durum immün disfonksiyon ve artmış kardiyovasküler morbidite ve mortaliteye yol açmaktadır. Hipertansiyon, bu hastalar arasında oldukça yaygındır ve giderek artan kanıtlar, sistemik inflamatuar ve immün mekanizmaların hipertansiyon gelişiminde rol oynadığını göstermektedir. Bu çalışma, hipertansiyonun hemodiyaliz hastalarında sistemik inflamatuar ve immün-inflamatuar indeksler ile hematolojik ve biyokimyasal parametreler üzerindeki etkisini değerlendirmeyi amaçlamıştır.
Yöntemler: Bu retrospektif çok merkezli çalışma, hemodiyaliz uygulanan 223 hasta ile gerçekleştirilmiştir. Hastalar hipertansif (n=90) ve normotansif (n=133) gruplar olarak sınıflandırılmıştır. SII, SIRI, PIV, NLR, LMR, PLR ve MPVLR dahil olmak üzere sistemik immün-inflamatuar indeksler hesaplanmıştır. Hematolojik ve biyokimyasal parametreler kapsamlı bir şekilde analiz edilmiştir. Biyobelirteçlerin tanısal performansı, alıcı işletim karakteristikleri (ROC) eğrisi analizi ile değerlendirilmiştir.
Bulgular: Hipertansif hemodiyaliz hastalarında, normotansif hastalara kıyasla MPVLR (p=0,033) ve MPV (p=0,039) anlamlı olarak yüksek bulunmuş; lenfosit sayısı (p=0,002), hematokrit (p=0,021) ve serum kalsiyum düzeyleri (p=0,021) ise düşük bulunmuştur. Cinsiyete göre yapılan analizlerde, kadınlarda SII, PIV, MPVLR ve lipid düzeyleri daha yüksek, sodyum ve ALT ise erkeklere göre daha düşük bulunmuştur (tüm p<0,05). ROC analizinde, hipertansif durumu ayırt etmede MPV yüksek özgüllük (%83,0), MPVLR ise yüksek duyarlılık (%78,9) göstermiştir. Korelasyon analizleri MPVLR’nin MPV, NLR ve PLR ile pozitif ilişkili olduğunu, SII’nin ise birçok inflamatuar belirteçle güçlü korelasyon gösterdiğini ortaya koymuştur.
Sonuç: Hemodiyaliz hastalarında hipertansiyon, MPV ve MPVLR’nin yükselmesi ile lenfosit sayısı, hematokrit ve kalsiyum düzeylerinin azalmasıyla ilişkilidir; bu durum trombosit aktivasyonu, immün disfonksiyon ve metabolik dengesizliği işaret etmektedir. Bu parametreler, hipertansiyonun tanı ve yönetiminde kullanılabilecek erişilebilir ve maliyeti düşük biyobelirteçler olarak hizmet edebilir. Önemli olarak, cinsiyete bağlı farklılıklar, kişiselleştirilmiş tedavi yaklaşımlarının önemini vurgulamaktadır.

Keywords

Hipertansiyon , Hemodiyaliz , immün-inflamatuar indeksler , Hematolojik belirteçler , Biyokimyasal belirteçler

Inflammatory indices in hypertensive hemodialysis patients: clinical implications of MPV and MPVLR

Abstract

Aims: Hemodialysis is marked by persistent activation of inflammatory pathways, leading to immune dysregulation and increased cardiovascular morbidity and mortality. Hypertension is highly prevalent among these patients, with growing evidence implicating systemic inflammation and immune mechanisms in its development. This study aimed to evaluate the influence of hypertension on systemic inflammatory and immune-inflammatory indices, as well as hematological and biochemical parameters, in hemodialysis.
Methods: This retrospective multicenter study was conducted with 223 patients receiving hemodialysis. Patients were divided into hypertensive (n=90) and normotensive (n=133) groups. Systemic immune-inflammatory indices, including SII, SIRI, PIV, NLR, LMR, PLR, and MPVLR, were calculated. Hematological and biochemical parameters were comprehensively analyzed. Diagnostic performance of biomarkers was assessed using receiver operating characteristic (ROC) curve analysis.
Results: Hypertensive hemodialysis patients showed significantly higher MPVLR (p=0.033) and MPV (p=0.039), along with reduced lymphocyte counts (p=0.002), hematocrit (p=0.021), and serum calcium levels (p=0.021) compared with normotensive patients. In sex-stratified analyses, females had higher SII, PIV, MPVLR, and lipid levels, while sodium and ALT were lower than in males (all p<0.05). ROC analysis demonstrated high specificity for MPV (83.0%) and high sensitivity for MPVLR (78.9%) in distinguishing hypertensive status. Correlation analysis revealed MPVLR was positively associated with MPV, NLR, and PLR, while SII strongly correlated with multiple inflammatory markers.
Conclusion: Hypertension in hemodialysis patients is implicated in elevated MPV and MPVLR, along with reduced lymphocyte counts, hematocrit, and calcium levels, which may indicate platelet activation, immune dysregulation, and metabolic imbalance. These parameters may provide adjunctive and cost-effective information for risk stratification and the follow-up of systemic inflammation in this vulnerable patient group. Importantly, sex based variations highlight the importance of personalized treatment approaches.

Keywords

Hypertension , hemodialysis , immune-inflammatory indices , hematological markers , biochemical marker

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