Nursing Care in Managing Risk Factors of Metabolic Syndrome After Kidney Transplant

Yıl 2019, Cilt: 28 Sayı: 1, 60 - 65, 31.03.2019

Dilek Soylu Özlem Ceyhan Pınar Tekinsoy Kartın

Öz

Metabolic Syndrome; Obesity, high blood pressure, low HDL cholesterol, dyslipidemia and hyperglycemia. Immunological risk factors for loss of graft function after renal transplantation may be acute and chronic rejection, infection, calcineurin inhibitor toxicity and metabolic complications. New-onset diabetes mellitus after transplantation and hypertension after kidney transplantation both reduce graft survival and increase mortality. Rejection after transplantation may also require patients to receive a new renal replacement therapy. Metabolic syndrome can be reduced by taking precautions such as increasing physical activity, prevention of weight gain and control of cardiovascular risk factors, and by well planning of immunosuppressive use. For this reason, the well-known risk factors associated with the metabolic syndrome and the metabolic syndrome are of great importance for the planning of nursing care, for the education and counselling of the patient and his / her family, in distinguishing high-risk patients and in identifying prevention / preventive approaches. In this review, nursing care in the prevention and control of metabolic syndrome risk factors, which we consider to be critical after kidney transplantation, will be summarized in the light of current knowledge.

Anahtar Kelimeler

Kidney Transplantation, Metabolic syndrome management, Nursing Care

Böbrek Nakli Sonrası Metabolik Sendrom Risk Faktörlerinin Yönetiminde Hemşirelik Bakımı

Öz

Metabolik Sendrom; obezite, yüksek tansiyon, düşük HDL kolestrol, dislipidemi ve hiperglisemi gibi sistemik bozuklukların bir arada bulunduğu bir durum olarak tanımlanmaktadır. Böbrek nakli sonrası gelişen greft fonksiyon kaybına immünolojik risk faktörleri, akut ve kronik rejeksiyon, enfeksiyon, kalsinorin inhibitör toksisitesi ve metabolik komplikasyonlar neden olabilmektedir. Böbrek naklinden sonra gelişen diyabet ve hipertansiyon hem greft sağkalımını azaltmakta hem de mortaliteyi arttırmaktadır. Nakil sonrasında gelişen rejeksiyon hastaların yeni bir renal replasman tedavisi almasını da gerektirebilmektedir. Metabolik sendrom, fiziksel aktivitenin artırılması, kilo alınımın önlenmesi ve kardiyovasküler risk faktörlerinin kontrolü gibi riski önleyici tedbirler alınarak ve immünsupresif kullanımının iyi planlanması ile azaltılabilmektedir. Bu nedenle, metabolik sendrom ve metabolik sendrom ile ilişkili risk faktörlerinin iyi bilinmesi, yüksek riskli hastaların ayırt edilmesinde ve önleme/koruyucu yaklaşımların belirlenmesinde hasta ve ailesinin eğitimi ve danışmanlığının yapılmasında hemşirelik bakımı büyük önem taşımaktadır. Bu derlemede, böbrek nakli sonrası kritik önem taşıdığını düşündüğümüz metabolik sendrom risk faktörlerini önleme ve kontrolünde hemşirelik bakımı güncel bilgiler ışığında özetlenecektir.

Anahtar Kelimeler

Böbrek transplantasyonu, Metabolik sendrom yönetimi, Hemşirelik bakımı

Kaynakça

• Kaynaklar Akan N. Treatment and care of pregnancy after renal transplantation: A Case Report. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi. 2003;6(3):29-37.
• Tainio J, Qvist E, Höltta T, Pakarinen M, Jahnukainen T, Jalanko H. Metabolic risk factors and long-term graft function after paediatric renal transplantation. Transplant International. 2014;27(6): 583-592.
• Litwin M, Niemirska A. Metabolic Syndrome in Children With Chronic Kidney Disease and After Renal Transplantation. Pediatric Nephrology. 2014; 29(2):203–216.
• Houri I, Tzukert K, Mor‑Yosef Levi I, Aharon M, Bloch A, Gotsman O. Implementation of guidelines for metabolic syndrome control in kidney transplant recipients: Results at a Single Center. Diabetology and Metabolic Syndrome. 2015;7(90):2-9.
• Çoban Ş, Yıldız S, Bozkaya E, Derici ZS, Ünlü M, Çelik A, et al. Evaluation of morbidity and patient and graft survival in kidney transplant recipients: Experience of Dokuz Eylul University Hospital. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi. 2017; 26 (1): 41-47.
• Bozkurt B. New-Onset diabetes after renal transplantation. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi. 2015; 24 (2): 141-147.
• Sharif A. Metabolic syndrome and solid-organ transplantation. American Journal of Transplantation. 2010; 10(1): 12–17.
• Watt KDS, Charlton MR. Metabolic syndrome and liver transplantation: A Review and Guide To Management. Journal of Hepatology 2010;53(1):199-206.
• Wenrui X, Qiang Z, Yue X, Wei W, Xiaodong Z, Xiaopeng H. Effects of tacrolimus and cyclosporine treatment on metabolic syndrome and cardiovascular risk factors after renal transplantation: A Meta-Analysis. Chin Medical Journal. 2014;127(12): 2376-2381.
• Fabrizi F, Martin P, Dixit V, Bunnapradist S, Kanwal F, Dulai G. Post-transplant diabetes mellitus and HCV seropositive status after renal transplantation: Meta-analysis of Clinical Studies. Am J Transplant. 2005;5(10):2433-2440.
• Nafar M, Noori N, Jalali-Farahan S, Hosseinpanah F, Poorrezagholi F, Ahmadpoor P, et al. Mediterranean diets are associated with a lower incidence of metabolic syndrome one year following renal transplantation. Kidney International. 2009;76(11):1199–1206.
• Düring ME, Jenssen T, Bollerslev J, Asberg A. Visceral fat is better related to impaired glucose metabolism than body mass index after kidney transplantation. Transplant International. 2015;28(10): 1162–1171.
• Vicennati W, Pinna AD, Morelli MC, Pagotto U, Pasquali R. Prevalence of metabolic syndrome in organ transplantation: a review of the literature. Endocrinol Metab Synd. 2015; 4(1):2-14.
• Şahin H, Ok E, Mercangil SM. The risks of obesity in surgery. Ulusal Cerrahi Dergisi. 2008;24(4):208-214.
• Akbulut G, Rakıcıoğlu N. Recent Dietary Therapy Approaches in Obesity. Genel Tıp Dergisi. 2010;20(1):35-42.
• Karakan Ş, Sezer S, Acar Ö, Nurhan F. Factors affecting development of new diabetes mellitus after kidney transplantation; The Role of Obesity and Inflammation. Fırat Tıp Dergisi. 2013; 18(2): 122-125.
• Wissing KM, Pipeleers L. Obesity, metabolic syndrome and diabetes mellitus after renal transplantation: prevention and treatment. Elsevier Transplantation Reviews. 2014;28(2): 37–46.
• Hricik DE. Metabolic syndrome in kidney transplantation: management of risk factors. Clinical Journal of the American Society of Nephrology. 2011;6(7): 1781–1785.
• Alıcı M, Pınar R. Eveluatıon of the effectıveness of educatıon gıven to obese patıents. Hemşirelikte Araştırma Geliştirme Dergisi. 2008;2:32-4723.
• Cakir H, Pınar R. Randomized controlled trial of lifestyle modification in hypertensive patients]. Western Journal of Nursing Research. 2006;28:190-209. Redmon JB, Reck KP, Raatz SK, Swanson JE, Kwong CA, Ji H, et al. Two-year outcome of a combination of weight loss therapies for type 2 diabetes. Diabetes Care. 2005;28:1311-1315.
• Sertöz ÖÖ, Mete HE. Efficacy of cognitive behavioral group therapy on weight loss, quality of life and psychopathology in the treatment of obesity: Eight Week Follow-Up Study. Klinik Psikofarmakoloji Bülteni. 2005;15:119-126.
• Womble LG, Wadden T, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized controlled trial of commercial internet weight loss program. Obesity Research. 2004;12:1011-1018.
• Macdonald JM, Kirkman D, Jibani M. Kidney Transplantation: A Systematic Review of Interventional and Observational Studies of Physical Activity on Intermediate Outcomes. Advances in Chronic Kidney Disease. 2009;16(6):482-500.
• Weinstock RS, Trief PM, Cibula D, Morin PC, Delahanty LM. Weight Loss Success in Metabolic Syndrome by Telephone Interventions: Results from the SHINE Study. J Gen Intern Med. 2013;28(12):1620–1628.
• Karakoç Kumsar A, Taşkın F, Olgun N. Danger in health: obesity. Diyabet Obezite ve Hipertansiyonda Hemşirelik Forumu. 2009;1(1): 14–21.
• Ersoy C, Tuncel E, Özdemir B, Ertürk E, İmamoğlu Ş. Diabetes Education and Metabolic Control in Patients With Type 2 Diabetes Mellitus Under Insulin Treatment. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2006;32(2):43-47.
• Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Selfmanagement Education for Adults With Type 2 Diabetes: A Metaanalysis of the Effect on Glycemic Control. Diabetes Care 2002;25:1159-71.
• Özyardımcı Ersoy C, Ersoy A. Recent diagnostic and treatment approaches in dyslipidemia. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2013;39(3):205-209.
• Barnard A, Kohyn P, Saab S. Medical management of metabolic complications of liver transplant recipients. Gastroenterology and Hepatology. 2016;12(10):601-608.
• Ashton WD, Nanchahal K, Wood DA. Leisure-time physical activity and coronary risk factors in women. J Cardiovasc Risk. 2000;7(4):259-66.
• Slentz CA, Bateman LA, Willis LH, Shields AT, Tanner CJ, Piner LW, et al. Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and ınsulin resistance by homa in overweight adults from strrıde at/rt. Am J Physiol Endocrinol Metab. 2011;301(5):1033–1039.
• Karakoç Kumsar A, Taşkın F, Olgun N. Current approaches to obesity management. Diyabet, Obezite ve Hipertansiyonda Hemşirelik Forumu. 2011;3(11): 21–29.
• Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: A Meta-Analysis of Randomized, Controlled Trials. Ann Intern Med. 2002; 136: 493- 503.
• Saks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) Diet. The New England Journal of Medicine. 2001; 344(1): 3-10.
• Karakurt P, Kara M. Hypertension and in Home Care. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi.2007;10(1):97-104.