Kronik Böbrek Hastalarında Hemodiyalizin Kalp Fonksiyonları Üzerine Etkisi

Abstract

Amaç: Diyaliz, kronik böbrek hastalarında çığır açan bir tedavi yöntemidir. Kronik böbrek hastalarında kardiyak patolojilere bağlı morbidite ve mortalite yaygındır. Diyalize bağlı gelişen kardiyak değişikliklerinin erken tanı ve tedavisi sürveyi uzatır. Bu çalışmanın amacı hemodiyaliz hastaları ile glomerüler Filtrasyon Hızı (eGFR) <30 ml/dk olan ve diyaliz almayan hastalar arasındaki kardiyak farklılıkları saptamaktır. Gereç ve Yöntem: Bu çalışmaya 50 hemodiyaliz hastası ve 50 eGFR<30 ml/dk olan ve diyaliz almayan hasta dahil edildi. Gruplar arasında demografik özellikler, ekokardiyografik bulgular, hematolojik ve biyokimyasal parametreler karşılaştırıldı. Bulgular: Gruplar arasında cinsiyet ve yaş yönünden fark yoktu. Diyaliz hastaları 69,3±10,5 yaşında ve %50'si erkek, eGFR<30 ml/dk olan ve diyaliz almayan hastalar ise 72±10 yaşında ve %40'ı erkekti. (sırasıyla p=0.150, p=0.211). Hipertansiyon [36(%72) karşı 33(%66), p=0.333], diyabet [23(%46) karşı 22(%44), p=0.500] ve koroner arter hastalığı [26(%52) karşı 23(%46), p=0.345] gruplar arasında benzerdi. Sol ventrikül hipertrofisi [43(%86) karşı 33(%66), p=0.035] ve triküspit yetersizliği [43(%86) karşı 32(%64), p=0.010) diyaliz hastalarında daha sıktı. Pulmoner arter sistolik basıncı (mmHg) diyaliz hastalarında daha yüksekti [33(25-40) karşı 25(20-35), p=0.018]. Ayrıca hemoglobin (g/dl) [10.8±1.5 karşı 11.6±1.7, p=0.020], hematokrit (%) [33.2±4.6 karşı 35.6±5.9, p=0.032] düzeyleri daha düşük ve anemi [45(90%) karşı 37(%74), p=0.033] hemodiyaliz hastalarında daha sık saptandı. Sonuç: Hemodiyaliz hastalarının, eGFR<30 ml/dk olan ve diyaliz almayan hastalar ile karşılaştırıldığında, sol ventrikül hipertrofisi, triküspit yetersizliği daha sık ve pulmoner arter sistolik basınçları daha yüksekti. Ayrıca diyaliz hastalarında hemoglobin seviyeleri daha düşüktü. Bu çalışma, hemodiyaliz hastalarında kardiyak patolojilerin erken tanısı ve tedavisi için düzenli ekokardiyografik değerlendirmenin önemini vurgulamaktadır

Keywords

• Kronik Böbrek Hastalığı
• Ekokardiyografi
• Hemodiyaliz.

Effect of Hemodialysis on Cardiac Structures and Functions in Chronic Renal Disease Patients

Abstract

Objective: Although dialysis is a revolutionary treatment for chronic kidney disease, cardiac pathologies continue to be a major cause of morbidity and mortality. Early diagnosis of dialysis related cardiac changes prolongs survival. The aim of our study was to assess the cardiac differences between hemodialysis patients and patients not receiving dialysis with estimated glomerular filtration rate (eGFR) <30 ml/dk. Materials and Methods: A total of 50 hemodialysis patients and 50 patients not receiving dialysis with eGFR<30 ml/dk were included in this study. Baseline characteristics, echocardiographic findings, hematological and biochemical parameters were compared between groups. Results: Age and gender were similar between groups. Dialysis patients were 69.3±10.5 years of age and 50% were male, patients not receiving dialysis with eGFR<30 ml/dk were 72±10 years of age and 40 % were male. (p=0.150, p=0.211, respectively). Also, hypertension [36(72%) vs 33(66%), p=0.333], diabetes mellitus [23(46%) vs 22(44%), p=0.500] and coronary artery disease [26(52%) vs 23(46%), p=0.345] were similar between groups. Left ventricular hypertrophy [43(86%) vs 33(66%), p=0.035] and tricuspid regurgitation [43(86%) vs 32(64%), p=0.010] were more common in dialysis patients. Pulmonary artery systolic pressure (mmHg) was higher in dialysis patients [33(25-40) vs 25(20-35), p=0.018]. Also, hemoglobin (g/dl) [10.8±1.5 vs 11.6±1.7, p=0.020], hematocrit (%) [33.2±4.6 vs 35.6±5.9, p=0.032] levels were lower and anemia [45(90%) vs 37 (74%), p=0.033] was more frequent in hemodialysis patients. Conclusion: Left ventricular hypertrophy, tricuspid regurgitation were more common and pulmonary artery systolic pressure levels were higher in dialysis patients compared to the patients not receiving dialysis with eGFR<30 ml/dk. Also, hemoglobin levels were lower in dialysis patients. This study emphasizes the importance of regular echocardiographic assessment for early diagnosis and management cardiac patologies in dialysis patients.

Keywords

• Chronic Kidney Disease
• Echocardiography
• Hemodialysis.

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