Procena uticaja mikroinflamacije i sekundarnog hiperparatireoidizma na lečenje anemije kod bolesnika na hroničnom programu hemodijalize

Abstract

Anemija je česta komplikacija kod bolesnika na hemodijalizi. Na lečenje anemije utiču: nedostatak gvožđa, nedovoljna doza eritropoetina, mikroinflamacija, nedostatak vitamina D, povećana koncentracija iPTH i neadekvatna hemodijaliza. U ostale uzroke anemije kod ovih bolesnika spadaju: gubitak krvi (okultno gastrointestinalno krvarenje zbog uremijskog gastritisa, stvaranje krvnih ugrušaka u vantelesnoj cirkulaciji, česta uzorkovanja krvi za laboratorijske analize. Rad je imao za cilj da utvrdi prevalencu ciljne koncentracije hemoglobina u krvi bolesnika koji se leče redovnom hemodijalizom, utvrditi prevalencu „apsolutnog„ i „funkcionalnog“ nedostatka gvožđa kod bolesnika koji se leče redovnom hemodijalizom. Rad je imao za cilj da utvrdi prevalencu mikroinflamacije, kao i da ispita njen uticaj na koncentraciju hemoglobina u krvi, status gvožđa, vitamin D, adekvatnost hemodijalize i dozu eritropoetina kod bolesnika koji se leče redovnom hemodijalizom. Da utvrdi prevalencu nedostatka vitamina D, kao i da ispita njegov uticaj na koncentraciju hemoglobina u krvi, status gvožđa, mikroinflamaciju, malnutriciju, adekvatnost hemodijalize i dozu eritropoetina. Ispitivanje je uključilo 120 bolesnika koji se leče u Kliničkom centru u Kragujevcu. Na osnovu parametra inflamacije CRP bolesnici su podeljeni u dve grupe: CRP  5.0 mg/l, CRP  5.0 mg/l. Za statističku analizu korišćeni su: Kolmogorov Smirnov test, Student-ov T test, Mann-Whitney U test. Na osovu vrednosti vitamina D bolesnici su podeljeni u tri grupe: (25(OH)D10 ng/ml, (25(OH)Dod 10-20 ng/ml, (25(OH)D 20 ng/ml. Prevalenca mikroinflamacije kod bolesnika koji se leče redovnom hemodijalizom iznosi 50%. Bolesnici sa mikroinflamacijom (CRP  5.0 mg/l) imaju visoko statističi značajno (p  0.01) manju: koncentraciju hemoglobina u krvi, hematokrit, prosečnu količinu i srednju koncentraciju hemoglobina u eritrocitu, koncentraciju gvožđa u serumu i statistički značajno (p  0.05) manje zasićenje transferina gvožđem. Ovi bolesnici imaju i visoko statistički značajno (p  0.01) veću posečnu mesečnu dozu dugodelujućeg eritropoetina, indeks rezistencije dugodelujućeg eritropoetin, kao i staistički značajno (p  0.05) veću koncentraciju feritina u serumu i indeks rezistencije kratkodelujućeg eritropoetina, u odnosu na bolesnike bez mikroinflamacije (CRP  5.0 mg/l). Prevalenca smanjene (25(OH)D u serumu kod bolesnika koji se leče redovnom hemodijalizom iznosi 75.83%, a prevalenca teškog nedostatka vitamina D 24.17%. Bolesnici sa teškim deficitom vitamina D u serumu (25(OH)D10 ng/ml imaju statistički značajno manju koncentraciju hemoglobina u krvi, hematokrita, koncentraciju ukupnih proteina i albumina u serumu.

Anemia is a common complication on hemodialysispatients. Treatment of anemia is affected by iron deficiency, insufficient dose of erythropoietin, microinflamation, vitamin D deficiency, increased iPTH concentration and inadequate hemodialysis. Other common cause of anemia among these patients is a blood loss due to occult gastrointestinal hemorrhage related to uremic gastritis, extracorpuscular thrombosis, frequent blood sampling. The aim was to determine the prevalence of target concentracion of hemoglobin in the blood of patients who are tarted with regular hemodialysis, determine prevalence of „absolute“ and „functional“ iron deficiency in patients who are treted with regular hemodialysis. The aim was to determine the prevalence of microinflammation and to examine its effect on hemoglobin concentration in blood, iron status, vitamin D, hemodialysis adequacy, and erythropoietin dose in patients treated with regular hemodialysis. The aim of the study was to find out the prevalence of vitamin D deficiency and to reveal its impact on hemoglobin concentration, iron status, microinflamation, malnutrition, dialysis adequacy and erythropoietin dose. Study involved 120 patients who are treated at the Clinical Center in Kragujevac. Based on CRP concentration, Patients were divided into two groups: CRP ≤ 5.0 mg / l, CRP > 5.0 mg / l. The statistical analysis used: Kolmogorov Smirnov test, Student's T test, Mann-Whitney U test. Based on the value of vitamin D, patients were divided into three groups: (25(OH)D10 ng/ml, (25(OH)D 10-20 ng/ml, (25(OH)D20 ng/ml. The prevalence of microinflammation in patients treated with regular hemodialysis is 50%. Patients with microinflammation (CRP > 5.0 mg / l) have a high statistically significant (p < 0.01) lower hemoglobin concentration in blood, hematocrit, average amount and mean hemoglobin concentration in the erythrocyte, iron concentration in the serum, and a statistically significant (p < 0.05) lower saturation of transferrin with iron. These patients also have a high statistically significant (p < 0.01) higher average monthly dose of long-acting erythropoietin, a long-acting erythropoietin resistance index, and a statistically significant (p < 0.05) higher ferritin concentration in the serum and a short-acting erythropoietin resistance index compared to nonmicroinflammatory patients (CRP ≤ 5.0 mg /l). Hemodialysis patients with severe vitamin D deficiency have lower hemoglobin, lower dialysis adequacy, significant microinflamation, malnutrition, bone metabolism disorders and need higher dose of erythropoietin than patients whose vitamin D is higher tnan (25(OH)D10 ng/ml .Vitamin D is important risk factor for development of anemia in hemodialysis patients and important factor that can affect treatment of anemia in these patients.