SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ

Yıl 2019, Cilt: 20 Sayı: 1, 19 - 25, 25.02.2019

Harun Düğeroğlu Ümit Öztürk Mustafa Öztürk

https://doi.org/10.18229/kocatepetip.532110

Öz

AMAÇ: Çalışmanın amacı, son dönem kronik böbrek yet-mezliği olan hastalarda paratiroid bez boyutlarının hiper-paratiroidi ve kemik hastalığı ile ilişkisini belirlemek ve eritropoetin tedavisi ile ilişkisini ortaya koymaktır. GEREÇ VE YÖNTEM: Çalışmaya sürekli ayaktan periton diyalizi (SAPD) ünitesinde renal replasman tedavisi almakta olan 20 hasta, hemodiyaliz ünitesinden 40 hasta ve evre 4 prediyaliz (GFR 15-29 ml/dk) olan 20 hasta alındı. Hastalara paratiroid ultrasonografi, biyokimya - hematoloji tetkikleri ve kemik mineral dansitometri (KMD) ölçümleri yapıldı. BULGULAR: Prediyaliz hastaların parathormon (PTH) değerleri SAPD ve hemodiyaliz hastalarına göre daha düşük saptandı (sırasıyla p=0.002, p=0.001). Prediyaliz hastalarda adenom sayısı, periton diyalizi hastalarına göre düşük olduğu bulundu (p=0.015). Prediyaliz hastalarının paratiroid adenom volümü, hemodiyaliz hastalarına göre daha düşük saptandı (p=0.032). Son bir yılda kullanılan total eritropoetin (EPO) dozu; PTH düzeyi, adenom sayısı ve adenom volümünün yanı sıra, PTH’nın arttırdığı kemik yapım markerları olan alkalen fosfataz ve osteokalsin düzeyi ile de pozitif korelasyon göstermiştir (sırasıyla r=0.257 p=0.021, r=0.312 p=0.005). Ortalama PTH değerleri 496.5±439.7 pg/ml olarak bulundu ve adenom volümü ile PTH salgısı arasında pozitif korelasyon mevcuttu (p=0.001).

SONUÇ: PTH sekresyonunun en yüksek otonom değerlere sahip olan hastalar, en fazla eritropoetin kullanmış hastalardır. Bu bulgular, eritropoetinin paratiroid gland büyüklüğünü arttırmanın yanı sıra otonomitesini de arttırdığını göstermektedir.

Anahtar Kelimeler

Kronik böbrek yetmezliği, sekonder hiperparatiroidizm, eritropoetin, paratiroid bezler

THE RELATIONSHIP WITH CALCIUM METABOLISM AND BONE TURNOVER OF ULTRASONOGRAPHIC DIMENSIONS OF PARATHYROID GLANDS IN END-STAGE CHRONIC RENAL FAILURE AND THE ROLE OF ERYTHROPOETIN TREATMENT

Öz

OBJECTIVE: The aim of the study is to determine the association of parathyroid gland dimensions with hyperparathyroidism and bone disease in patients with end stage chronic renal failure and to demonstrate its association with erythropoietin treatment. MATERIAL AND METHODS: Twenty patients undergoing renal replacement therapy at the continuous ambulatory peritoneal dialysis (CAPD) unit, 40 patients from hemodialysis unit and 40 patients with stage 4 predialysis (GRF 15-29 ml / min) were included in the study. Patient parathyroid ultrasonography, biochemistry-hematology tests and bone mineral densitometry (BMD) measurements were performed. RESULTS: The PTH values of predialysis patients were lower than those of SAPD and hemodialysis patients (respectively p=0.002, p=0.001). Patients with predialysis had a lower number of adenomas than patients with peritoneal dialysis (p=0.015). The parathyroid adenoma volume of patients with predialysis was lower than that of hemodialysis patients (p=0.032). The total erythropoetin (EPO) dose used in the last year; showed positive correlation with PTH level, adenoma number, adenome volume, and bone building markers (osteocalcin and alkaline phosphatase) (respectively r=0.257 p=0.021, r=0.312 p=0.005). Mean PTH values were 496.5 ± 439.7 pg / ml and there was a positive correlation between adenoma volume and PTH secretion (p=0.001).

CONCLUSIONS: Patients with the highest autonomic levels of PTH secretion were the patients with the most erythropoetin use. These findings suggest that erythropoetin not only increases parathyroid gland size but also increases autonomy

Anahtar Kelimeler

Chronic renal failure, secondary hyperparathyroidism, erythropoetin, parathyroid gland

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