Kemik Sağlığı ve Renal Replasman Tedavileri: En İyisi Hangisi?

Yıl 2015, Cilt: 1 Sayı: 1, 25 - 42, 01.01.2015

Vural Taner Yılmaz Sebahat Özdem Levent Dönmez Ramazan Çetinkaya Gültekin Süleymanlar F. Fevzi Ersoy

Öz

Amaç: Çalışmada, son dönem böbrek yetmezliği hastalarında renal replasman tedavilerinin kemik sağlığı açısından etkinlik ve güvenilirliklerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya 27 hemodiyaliz HD, Grup 1 , 51 periton diyalizi PD, Grup 2 , 25 böbrek nakli Rtx, Grup 3 hastası ve 40 sağlıklı kontrol grubu Grup 4 alındı. Hastalar ve kontrol grubunun intakt parathormon iPTH , fibroblast growth faktor 23 FGF-23 , osteoprotogerin OPG , osteokalsin OK , prokollagen tip-1 N terminal propeptid PINP , beta- crosslaps beta CTx , tartarat rezistan asid fosfataz TRAF5b , kemik alkalen fosfataz KAF , 1,25 OH D3 ve 25 OH D3 düzeyleri ölçüldü. α-Klotho gen mutasyonu F352V gerçek zaman PCR ve yüksek çözünürlüklü erime yöntemi kullanılarak değerlendirildi. Bulgular: α- klotho gen polimorfizmi wild/heterezigot/mutasyon: 22 %81,5 / 0 %0 / 5 %18,5 ve FGF23 düzeylerinin G1-2-3-4 sırayla; 1252±310/ 872±526/ 34,6 1,3-986 / 82 23-991 HD hastalarında diğer tüm gruplardan anlamlı derecede daha yüksek olduğu görüldü. 1,25 OH D3 ve 25 OH D3 düzeylerinin HD ve PD hastalarında diğer gruplardan daha düşük, G3-G4 arasında benzer olduğu görüldü. iPTH, FGF-23, OPG, OC ve TRAP5b düzeylerinin G1 ve G2 hastalarında diğer gruplardan daha yüksek, PINP ve beta CTx düzeylerinin G1’de en yüksek, kemik mineral yoğunluğu KMY ise G1’de en düşük iken G2-G3, G2-G4 ve G3-G4 arasında benzer olduğu görüldü. Sonuç: Çalışmamızda böbrek naklinin; son dönem böbrek yetmezliği hastaları için kemik sağlığı αklotho gen polimorfizmi, FGF23 düzeyleri, kemik metabolizma markırları ve kemik mineral yoğunluğu açısından en etkin ve güvenilir renal replasman tedavisi olduğu gösterilmiştir

Anahtar Kelimeler

Periton diyalizi, Hemodiyaliz, Böbrek nakli, FGF-23, α- klotho gen polimorfizmi, Kemik mineral yoğunluğu

Bone Health and Renal Replacement Therapies: Which are the Best?

Öz

Objective: The aim of this study was to evaluate the efficacy and safety of renal replacement therapy modalities in terms of bone health for end-stage renal disease patients.Material and Methods: We included 27 hemodialysis group 1 , 51 chronic peritoneal dialysis group 2 , and 25 renal transplant patients group 3 and 40 healthy subjects control, group 4 in the study. Intact parathormone iPTH , fibroblast growth factor 23 FGF-23 , osteoprotogerin OPG , osteocalcin OC , procollagen type-1 N terminal propeptide PINP , beta- crosslaps beta CTx , tartarate resistant acid phosphatase TRAP5b , bone alkaline phosphatase BAP , 1,25 OH D3 and 25 OH D3 levels were measured in the patients and the control group. The α-Klotho gen mutation F352V was evaluated by real-time PCR and the high-resolution melting method.results: The α-Klotho gene polymorphism rates wild/heterozygote/mutation: 22 81.5% / 0 0% / 5 18.5% and FGF23 levels G1-2-3-4 1252±310 / 872±526 / 34.6 / 82 respectively were significantly higher in group 1. The 1.25 OH D3 and 25 OH D3 levels were lower in groups 1 and 2 but similar in group 3 and 4. The iPTH, FGF-23, OPG, OC and TRAP5b levels were significantly higher in Group 1 and 2. The PINP and beta CTx levels were highest in group 1. BMD level was lowest in group 1 and similar in groups 2-3, groups 2 and 4 and groups 3-4. conclusion: This study showed that renal transplantation is the most effective and safe renal replacement therapy modality in terms of bone health α-Klotho gene polymorphism, FGF-23 levels, indicators of bone metabolism and bone mineral density for end-stage renal disease patients

Anahtar Kelimeler

Peritoneal dialysis, Hemodialysis, Renal transplantation, FGF-23, α-Klotho gene polymorphism, Bone mineral density

Kaynakça

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