HYPERURICEMIA IN DIALYSIS PATIENTS AND ITS ASSOCIATION WITH LEFT VENTRICULAR MASS INDEX

Öz

Objective: Hyperuricemia leads to endothelial dysfunction and vascular stiffness; however, there are not enough studies on the effect of uric acid levels on the myocardium in pediatric dialysis patients. In this study, we aimed to investigate the relationship between uric acid levels and ventricular hypertrophy in children undergoing dialysis. Material and Methods: This multicenter retrospective study was conducted among nine centers. We retrospectively reviewed the medical records of pediatric long-term dialysis patients. Results: One hundred and thirty-one patients were enrolled in this study. The mean age was 11.7±5.0 years (range 1-19.5) (M/F=68/63). One hundred and seven patients were undergoing peritoneal dialysis (PD) and 24 patients were on hemodialysis (HD). The mean left ventricular mass index (LVMI), and the percentage of patients with left ventricular hypertrophy (LVH) were significantly higher in the hyperuricemia group (56±24 vs 42±14 g/m , p=0.001; 63.3% vs 41.9 %, p<0.001 respectively) than the normal uric acid (UA) group. The mean potassium level was significantly higher (4.6±0.6 vs 4.3±0.6 mEq/L, p=0.004), and hemoglobin lower (10.2±1.3 vs 10.9±1.0 g/dl, p=0.001) in patients with left ventricular hypertrophy than without left ventricular hypertrophy. Seven patients (9.2%) died in the hyperuricemia group, and 1 (1.8%) in the latter group. The multivariate regression analysis showed that hyperkalemia was the only parameter associated with left ventricular hypertrophy (OR:0.931, CI: 95%, 0.886-7.269, p= 0.043). Conclusion: Hyperuricemia and hyperkalemia seemed to be associated with left ventricular hypertrophy. So uric acid and potassium lowering medical treatment and dietary interventions may be considered essential for decreasing cardiac morbidity in pediatric long-term dialysis patients.

Anahtar Kelimeler

• Dialysis
• hyperuricemia
• hyperkalemia
• left ventricular hypertrophy

Diyaliz Hastalarında Hiperürisemi ve Sol Ventrikül Kitle İndeksi ile İlişkisi

Öz

Amaç: Hiperüriseminin, endotel işlev bozukluğuna ve damar sertliğine yol açtığı bilinmektedir ancak çocukluk çağında diyaliz hastalarında kandaki ürik asit seviyelerinin miyokard üzerindeki etkisi konusunda yeterli çalışma bulunmamaktadır. Bu çalışmada, diyalize giren çocuk hastalardaki ürik asit düzeyinin ventriküler hipertrofi ile ilişkisini araştırmayı amaçladık. Gereç ve Yöntemler: Bu çalışma, 9 merkezin katıldığı çok merkezli bir retrospektif çalışma niteliği taşımaktadır. Bu merkezlerde takip edilen çocuk yaştaki diyaliz hastalarının tıbbi kayıtları retrospektif olarak incelendi. Bulgular: Bu çalışmaya 131 hasta dâhil edildi. Ortalama yaş 11,7±5,0 yıl (1-19,5 arası) olan hastaların (E/K=68/63). 107’si periton diyalizi, 24’ü ise hemodiyaliz programında idi. Hiperürisemi grubunda olan hastaların, ortalama sol ventrikül kütle indeksi ve sol ventrikül hipertrofisi olanların oranı normal ürik asit grubuna göre anlamlı olarak daha yüksekti (sırasıyla 56±24 vs 42±14 g/m , p=0,001; %63,3 vs %41,9, p<0,001). Sol ventrikül hipertrofisi olan hastalarda ortalama potasyum düzeyi, hipertrofisi olmayanlara göre olarak anlamlı şekilde daha yüksekti (4,6±0,6 vs 4,3±0,6 mEq/L, p=0,040). Ortalama hemoglobin düzeyi de hipertrofik grupta anlamlı olarak daha düşüktü (10,2±1,3 vs 10,9±1,0 g/dl, p=0,001). Hiperürisemi grubunda 7 hasta (%9,2) hayatını kaybederken, bu sayı normal ürik asit grubuna 1 (%1,8) idi. Çoklu regresyon analizi, hiperkaleminin sol ventrikül hipertrofisi ile ilişkili olan tek parametre olduğunu gösterdi (OR:0,931, CI: 95%, 0,886-7,269, p= 0,043). Sonuç: Sonuçlarımız, diyaliz hastalarında sol ventrikül hipertrofisi oluşum ve gelişmesinde, hiperürisemi ve hiperkaleminin rolü olabileceğini göstermektedir. Bu nedenle, bu hastalarda kardiyak morbiditenin azaltılması için hastalara ürik asit ve potasyum düşürücü tıbbi tedaviler verilerek beraberinde sıkı diyet kısıtlaması yapılmalıdır.

Anahtar Kelimeler

• Diyaliz
• hiperürisemi
• hiperkalemi
• sol ventrikül hipertrofisi

Kaynakça

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