Son Dönem Böbrek Yetersizliğinde Ferritin ve Kardiyak Elektrofizyoloji: Kardiyo-Elektrofizyolojik Denge İndeksinin Etkisinin Değerlendirilmesi

Öz

Özet Amaç: Ferritin, demir depolanmasında anahtar bir protein olup, aynı zamanda kronik inflamasyon ve kardiyovasküler hastalıklarla ilişkili bir akut faz reaktanıdır. Hemodiyaliz uygulanan son dönem böbrek yetmezliği hastalarında artan ferritin seviyelerinin, proaritmik riski yansıtan kardiyo-elektrofizyolojik denge indeksi gibi elektrokardiyografik parametreleri etkileyebileceği düşünülmektedir. Bu çalışma, hemodiyaliz alan son dönem böbrek yetersizliği hastalarında ferritin seviyeleri ile kardiyo-elektrofizyolojik denge indeksi arasındaki ilişkiyi değerlendirmeyi amaçlamaktadır. Gereç ve Yöntem: Bu retrospektif, kesitsel çalışmada, hemodiyaliz uygulanan 438 son dönem böbrek yetersizliği hastası yer almıştır. Hastalar ferritin seviyelerine göre iki gruba ayrılmıştır: Grup 1 (≥1000 ng/mL, n=254) ve Grup 2 (≤200 ng/mL, n=184). Demografik, biyokimyasal ve elektrokardiyografik veriler (kardiyo-elektrofizyolojik denge indeksi dahil) analiz edilmiştir. Ferritin seviyeleri ile kardiyo-elektrofizyolojik denge indeksi arasındaki ilişki değerlendirilmiştir. Bulgular: Kardiyo-elektrofizyolojik denge indeksi Grup 1'de Grup 2'ye kıyasla anlamlı derecede yüksek saptandı (5.1'e karşı 4.9, p=0.003). Ferritin düzeyleri ile kardiyo-elektrofizyolojik denge indeksi arasında orta düzeyde pozitif bir korelasyon tespit edilmiştir (r=0.326, p<0.005). Gruplar arasında kalp hızı, QRS süresi ve PR aralıklarında anlamlı farklılıklar gözlenirken, Tp-e ve QT aralıkları gibi diğer elektrokardiyografik parametreler anlamlı farklılıklar göstermemiştir. Lojistik regresyon analizi, cinsiyet ve ferritin düzeylerini yüksek iCEBc (≥4,5) için anlamlı öngörücüler olarak tanımlamıştır (Ferritin odds ratio 1,08 (%95 CI: 1,03-1,12, p<0.005). Sonuç: Hemodiyaliz uygulanan son dönem böbrek yetersizliği hastalarında yüksek ferritin seviyeleri, proaritmik riski yansıtan kardiyo-elektrofizyolojik denge indeksi ile ilişkilendirilmiştir. Bu bulgular, ferritinin bu popülasyonda aritmi riski değerlendirmesinde potansiyel bir belirteç olarak önemini vurgulamaktadır. Çalışmamız ile demir metabolizmasının düzensizliği ile ilişkili kardiyovasküler riskleri azaltmaya yönelik stratejilerin araştırılması gerektiği sonucuna varılmıştır.

Anahtar Kelimeler

• Ferritin
• hemodiyaliz
• Kardiyo-Elektrofizyolojik Denge İndeksi
• Son dönem böbrek hastalığı.

Etik Beyan

Çalışma için 27/11/2024 tarihinde Ondokuz Mayıs Üniversitesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır. Karar no: 2024/511.

Teşekkür

Veri toplama aşamasındaki değerli katkılarından dolayı Ondokuz Mayıs Üniversitesi Kardiyoloji Anabilim Dalı asistanlarına en içten teşekkürlerimizi sunarız. Ayrıca, istatistiksel analizlerdeki uzman yardımı için Dr. Önder Aydemir'e teşekkür ederiz.

Ferritin and Cardiac Electrophysiology in End-Stage Renal Disease: Evaluating the Impact of Index of Cardio-Electrophysiological Balance

Öz

Objective: Ferritin is a critical protein involved in iron storage and functions as an acute-phase reactant, playing a significant role in chronic inflammation and the pathogenesis of cardiovascular diseases. Elevated ferritin levels in end-stage renal disease patients undergoing hemodialysis may influence cardiac electrophysiological parameters, such as the corrected index of cardio-electrophysiological balance, a marker of proarrhythmic risk. This study aimed to investigate the association between ferritin levels and the corrected index of cardio-electrophysiological balance in patients with end-stage renal disease undergoing hemodialysis. Material and Method: This retrospective cross-sectional study included 438 patients with end-stage renal disease undergoing hemodialysis, categorized into two groups according to their ferritin levels: Group 1 (≥1000 ng/mL, n=254) and Group 2 (≤200 ng/mL, n=184). Demographic, biochemical, and electrocardiographic data, including corrected index of cardio-electrophysiological balance, were analyzed. The correlation between ferritin levels and the corrected index of cardio-electrophysiological balance was assessed. Results: The index of cardio-electrophysiological balance was significantly higher in Group 1 compared to Group 2 (5.1 vs. 4.9, p=0.003). A moderate positive correlation between ferritin levels and the index of cardio-electrophysiological balance was identified (r=0.326, p<0.005). While significant differences were observed in heart rate, QRS duration, and PR intervals between the groups, other electrocardiographic parameters, such as Tp-e and QT intervals, did not show significant differences. The logistic regression analysis identified gender and ferritin levels as significant predictors of elevated iCEBc (≥4.5) (Ferritin odds ratio of 1.08 (95% CI: 1.03–1.12, p<0.005). Conclusion: Elevated ferritin levels in end-stage renal disease patients undergoing hemodialysis are associated with an increased corrected index of cardio-electrophysiological balance, reflecting heightened proarrhythmic risk. These findings underscore the importance of ferritin as a potential marker for arrhythmia risk assessment in this population. Further research is warranted to explore strategies for mitigating cardiovascular risks associated with iron metabolism dysregulation.

Anahtar Kelimeler

• End-stage renal disease
• ferritin
• hemodialysis
• Index of Cardio-Electrophysiological Balance

Etik Beyan

Approval for the study was obtained from Ondokuz Mayıs University Clinical Research Ethics Committee on 27/11/2024. Decision no: 2024/511.

Teşekkür

We extend our sincere gratitude to the assistant staff of the Cardiology Department at Ondokuz Mayıs University for their valuable contributions during the data collection phase. Additionally, we thank Dr. Önder Aydemir for his expert assistance with the statistical analysis.

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