Periton Diyalizine Yeni Başlayan Hastaların Retrospektif Değerlendirmesi

Öz

Amaç:

Periton diyalizine 2016-2017 yılları arasında yeni başlayan hastaların periton diyalizine ilişkin durumlarının incelenmesidir.

Gereç ve Yöntemler:

Araştırmanın evrenini Amasya (n=12) ve Sivas (n=16)’ta yer alan periton diyaliz ünitesindeki hastalar, örneklemini ise 2016-2017 yılında PD’ye yeni başlayan hastalar (n=17) oluşturdu.  Veriler Türk Nefroloji, Diyaliz ve Transplantasyon Derneği Registry raporu rehber alınarak hazırlanan “PD hasta değerlendirme formu” aracılığıyla retrospektif olarak elde edildi.

Bulgular:

Son iki yılda PD tedavisine yeni başlayan merkezde 12 hasta, 20 yıldır PD uygulayan üniversitede ise 5 hastaya PD kateteri takılmıştır. Hastaların %41.1’inin etiyolojisinin diyabetik nefropati olduğu, %52.9’unun membran tipinin düşük-orta geçirgenlikte olduğu, %70.5’inin Kt/V üre değerinin 2’nin üstünde olduğu, %76.4’sinin serum albumin değerinin 3.5-4 aralığında olduğu, %41.1’inin tansiyonun normal sınırlarda olduğu, %52.9’unun kalsiyum kanal blokeri kullandığı, %70.5’inin Hb değeri 10.0-11.9gr/dl olduğu saptandı. Hastaların %94.1’inin demir ilacı kullanmadığı, %52.9’ünün eritropoetin kullandığı, %35.2’si ise halen kullanmakta idi.  %52.9’ünün serum fosforunun 4.5-5.49 mg/dl, %41.17’sinin PTH düzeyi 301-600 pg/ml arasında olduğu, hiçbir hastada kırık gelişmediği saptandı. Hastaların peritonit geçirmediği ve %47’inin ultrafiltrasyon sorunu yaşadığı,  %11.76’sının mekanik komplikasyon nedeniyle hemodiyalize transfer olduğu saptandı.  Hastaların kontrole geldiklerinde sıklıkla yakınmaları iştahsızlık, bulantı kusma, ödem ve halsizlikdi. Hemşireyi telefonla arama nedenlerinin sıklıkla drenaja yönelik problemler, oral ilaç kullanımı, PD makinası ve kateter ile ilgili sorunlardı.

Sonuç:PD hastalarında hipoalbunimeni, hiperfostatemi, anemi, bulaşıcı hastalık, kırık ve peritonit gibi ciddi komplikasyonlar gelişmediği saptandı.Bu durum periton diyaliz tedavisini avantajlı kılmaktadır.

Anahtar Kelimeler

• Periton diyalizi,Periyon diyaliz etiyolojisi

Kaynakça

1. Kaynaklar1. Lindsay H, Peritoneal dialysisParenteral nutrition and dialysis, Introduction to kidney disease and dialysis therapyChronic kidney diseasePharmaceutical Practice. In: Pharmaceutical Practice, Rees JA, Smith L, Watson J, Lamerton L. ed., Published January 1, 2014. Book Chapter Parenteral nutrition and dialysis 44, 423-4362014.https://www.clinicalkey.com/meded/content/book/3-s2.0-B9780702051432000441#section-hl0000650/Erişim Tarihi:13/04/2018
2. 2. Drake, RL., Vogl, AW Dialysis and peritoneal dialysisAbdomenRegional anatomyAbdominal visceraPeritoneal cavityIn the clinicGray's Anatomy for Students January , 2015. https://www.clinicalkey.com/meded/content/book/3-s2.0-9780702051319000043#section-hl0002518 Erişim Tarihi:13/04/2018
3. 3. Tokgoz B, Clinical advantages of peritoneal dialysis, Peritoneal Dialysis International,2009;29(2):59-61.
4. 4. Aguirre AR, Abensur H, Protective measures against ultrafiltration failure in peritoneal dialysis patients, Clinics (Sao Paulo), 2011; 66(12): 2151–2157.
5. 5. Kolesnyk I, Dekker FW, Boeschoten EW,. Krediet RT, Tıme-Dependent Reasons For Perıtoneal Dıalysıs Technıque Faılure And Mortalıty Peritoneal Dialysis International,2010;30: 170–177
6. 6. Lameire N, Peeters P, Vanholder R, Van Biessen W. Peritoneal dialysis in Europe: an analysis of its rise and fall. Blood Purification, 2006;24(1):107-14.
7. 7. Jain AK , Blake P , Cordy P , Garg AX , Global trends in rates of peritoneal dialysis, Journal of the American Society of Nephrology, 2012;23 (3): 533-44.
8. 8. Sarı F, Sarıkaya M, Çetinkaya R, Güneş AJ, Eren M, Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic, Türk Nefroloji Diyaliz ve Transplantasyon Dergisi, 2012; 21 (1): 34-38.

9. 9. Kurt M, Atmaca A, Gürlek A., Diyabetik nefropati, Hacettepe Tıp Dergisi 2004; 35(1):12-17.
10. 10. Süleymanlar G, Ateş K, Seyahi N, Türkiyede Nefroloji ve Diyaliz ve Transplantasyon, Regisrty 2016, Türk Nefroloji Derneği Yayınları, 2017,Ankara, p.11, p.34.
11. 11. Davies SJ, Phillips L, Naish PF, Russell GI, Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival Nephrology Dialysis Transplantation, 2002;17(6):1085-92.
12. 12. Chang JH, Sung JY, Ahn SY, Ko KP, Ro H. ve ark..Hemodialysis leads to better survival in patients with diabetes or high comorbidity, compared to peritoneal dialysis. The Tohoku Journal of Experimental Medicine 2013, 229(4):271-77.
13. 13. Peppelenbosch A, van Kuijk VHM, Bouvy ND, van der Sande FM,,JHM Tordior, Peritoneal dialysis catheter placement technique and complications,2008;1(4): 23–28.
14. 14. QuachT, Tregaskis P, Menahem S, Koukounaras J,Mott N ve ark.,Radiological insertion of Tenckhoff catheters for peritoneal dialysis: a 1-year single-centre experience. Clin Kidney J. 2014; 7(1): 23–26.
15. 15. Al-Hwiesh AK, Percutaneous versus laparoscopic placement of peritoneal dialysis catheters: simplicity and favorable outcome. 2014;25(6):1194-201.
16. 16. Li PKT, Stezo C, Piraino B, de Arteaga J, Fan S, Figueiredo AE, et al. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment, Peritoneal Dialysis International, 2016;36(5): 481–508.
17. 17. Davies SJ, Phillips L, Naish PF, Russell GI.Peritoneal glucose exposure and changes in membrane solute transport with time on peritoneal dialysis. Journal of the American Society of Nephrology,2001;2(5):1046-51.
18. 18. Wang L, Wang T.Adequacy of peritoneal dialysis: Kt/V revisitedEuropean Review for Medical and Pharmacological Sciences, 2015,;19(7):1272-75.
19. 19. Lo WK, Lui SL, Chan TM, Li FK, Lam MF ve ark.,Minimal and optimal peritoneal Kt/V targets: results of an anuric peritoneal dialysis patient's survival analysis. Kidney International,2005;67(5):2032-38.
20. 20. ErsoyFF, Periton Diyalizi Hastalarında Antihipertansif İlaçların Farmakokinetiği ve Kullanım İlkeleri,Turkiye Klinikleri Journal of Internal Medical Sciences,2005;1(38):120-122
21. 21. Türk Kardiyoloji Derneği Ulusal Hipertansiyon Tedavi ve Takip Kılavuzuhttps://www.tkd.org.tr/kilavuz/k03/4_18029.htm?wbnum=1106,Erişim Tarihi:09/04/2018
22. 22. Ertürk Ü, Hipertansiyon Tedavisinde Kalsiyum Kanal Blokerleri, Turkiye Klinikleri Journal of Cardiology Special Topics, 2000;13(5):368-70
23. 23. Zeidan A, Bhandari S, Anemia in Peritoneal Dialysis Patients; Iron Repletion, Current and Future Therapies. Peritoneal Dialysis International, 2017;37(1):6-13.
24. 24. Kazmi WH, Kausz AT, Khan S, Abichandani R, Ruthazer R, Obrador GT, Pereira BJ. Anemia: an early complication of chronic renal insufficiency, 2001;38(4):803-12.
25. 25. Spinowitz BS,Anemia Management In Patients On Peritoneal Dialysis: Efficacy And Safety of Epoetin, Haematologica,2008; 93(5): 761-764,
26. 26. Ficheux M, Cuny P, Lecouf A, Ryckelynck JP, Hurault de Ligny B, ve ark.,Traitement de la carence martiale par injection d’une dose totale de fer dextran en dialyse péritonéaleNéphrologie & Thérapeutique,2011;7(7): 558-561
27. 27. Lausević M, Nesić V, Jovanović N, Stojimirović B. Anemia in peritoneal dialysis patients, Srpski Arhiv Za Celokupno Lekarstvo, 2006;134(3-4):133-37.
28. 28. Coronel F, Herrero JA, Montenegro J, Fernandez C, Gandara A ve ark., Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis. Journal of Nephrology,2003;16(5):697-702
29. 29. Aygen B,Kronik Böbrek Hastalıklarında Aneminin Değerlendirilmesi ve Tedavisi, Medicine Science, 2015;4(3):2678-93
30. 30. Del Vecchio L, Cavalli A, Locatelli F.,Anemia management in patients on peritoneal dialysis. Contributions to Nephrology, 2012;178:89-94.
31. 31. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. American Journal of Kidney Diseases,2003;42(4 Suppl 3):S1–S201
32. 32. Billa V, Zhong A, Bargman J, Vas S, Wong PY ve ark.,High prevalence of hyperparathyroidism among peritoneal dialysis patients: a review of 176 patients. Peritoneal Dialysis International, 2000;20(3):315-21.
33. 33. Han DS, Lee SW, Kang SW, Choi KH, Lee HY, ve ark.,Factors affecting low values of serum albumin in CAPD patients. Advances Peritoneal Dialysis,1996;12:288-92.
34. 34. Mehrotra R, Duong U, Jiwakanon S, Kovesdy CP, Moran J, ve ark.Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis. American Journal of Kidney Diseases, 2011;58(3):418-28.
35. 35. John B, Tan BK, Dainty S, Spanel P, Smith D,ve ark.Plasma volume, albumin, and fluid status in peritoneal dialysis patients. 2010;5(8):1463-70.
36. 36. de Mutsert R, Grootendorst DC, Indemans F, Boeschoten EW, Krediet RT, ve ark, Netherlands Cooperative Study on the Adequacy of Dialysis-II Study Group.Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition. Journal of Renal Nutrition,2009; 19(2):127–135.
37. 37. Blake PG, Flowerdew G, Blake RM , Oreopoulos DG, Serum albumin in patients on continuous ambulatory peritoneal dialysis: predictors and correlations with outcomes,Journal of the American Society of Nephrology,1993;3(8):1501-1507
38. 38. Wu H, Huang R, Yi C, Wu J, Guo Q, Zhou Q, Yu X, Yang X. Risk Factors for Early-Onset Peritonitis in Southern Chinese Peritoneal Dialysis Patients.Peritoneal Dialysis International, 2016;36(6):640-646.
39. 39. Kofteridis DP, Valachis A, Perakis K, Maraki S, Daphnis E, Samonis G.Peritoneal dialysis-associated peritonitis: clinical features and predictors of outcome. International Journal of Infectious Diseases, 2010;14(6):489-93
40. 40. AkohJA,Peritoneal dialysis associated infections: An update on diagnosis and management,World Journal of Nephrology, 2012;1(4) :106–122
41. 41. Churchill DN, Thorpe KE, Nolph KD, Keshaviah PR, Oreopoulos DG ve ark., Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group.,Journal of the American Society of Nephrology,1998;9:1285-1292.
42. 42. Mujais S, Nolph K, Gokal R, Blake P, Burkart J ve ark., Evaluation and management of ultrafiltration problems in peritoneal dialysis. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Peritoneal Dialysis International, 2000;20(4):5-21.
43. 43. Lo WK, Bargman JM, Burkart J, Krediet RT, Pollock C ve ark. Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis.Peritoneal Dialysis International, 2006; 26(5):520–22.
44. 44. Dong R, GuoZY,Gastrointestinal symptoms in patients undergoing peritoneal dialysis: Multivariate analysis of correlated factors, World Journal of Gastroenterology , 2010;16(22): 2812–2817.
45. 45. Strid H, Simrén M, Johansson AC, Svedlund J, Samuelsson O ve ark, The prevalence of gastrointestinal symptoms in patients with chronic renal failure is increased and associated with impaired psychological general well-being,Nephrology Dialysis Transplantation,2002;17(8): 1434-1439
46. 46. Rodríguez CR , Quirós Ganga PL, Gil Cunquero JM , Ruiz SR , Fosalba NAve ark., Ten years of peritoneal dialysis in Andalusia (1999-2008): epidemiologic data, types of treatment, peritonitis, comorbidity and survival in patients, and technique, Nefrologia 2010;30(1):46-53