Procena uticaja mikroinflamacije i sekundarnog hiperparatireoidizma na lečenje anemije kod bolesnika na hroničnom programu hemodijalize
Evaluating the influence of microinflamation and secondary hyperparathyroidism in curing anemia in patients on chronich hemodialysis program
Doktorand
Hamzagić, NedimMentor
Petrović, DejanČlanovi komisije
Đukić, SvetlanaFolić, Marko
Mijušković, Mirjana
Metapodaci
Prikaz svih podataka o disertacijiSažetak
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 nedo...statka 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)D10 ng/ml, (25(OH)Dod 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)D10 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 pre...valence 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)D10
ng/ml, (25(OH)D 10-20 ng/ml, (25(OH)D20 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)D10 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.