Primena multimarker pristupa u proceni rizika kod pacijenata na dijalizi

Abstract

Introduction:The mortality rate of hemodialysis patients is very high, 10-20 times higer than in general population. Cardiovascular disease is reported to be major cause of death. By using this approach many different pathophysiological components will be covered. For validation one marker or combination of few markers as risk factors is needed to perform several statistical tests. Aim:The main goal of this thesis is to compare predictive values of ADMA as marker of endothelial dysfunction, CRP and SAA, as markers of inflammation and albumin as marker of malnutrition among patients on dyalisis,and in addition to create a common predictive value for patients with several risk factors. Methods:In this 3-years follow-up stady, plasma concentrations of ADMA and SDMA was measured by HPLC. CRP was measured using immunoturbidimetricassays; SAA was measured using immunonephalometric assays. Albumin level was obtained using standard clinical laboratory methods. Importance: The use of multimarker approach in evaluating markers of endothelial dysfunction, inflammation and malnutrion gives a new data related to risk stratification among patients on dialysis. This research shows that all markers are independent proctors of all-cause and cardiovascular cause of death. It is demonstrated that combined use of biomarkers increases the predictive power of prognostic model, whichwould improve risk stratification among patients on dyalisis.Best combination of markers for risk stratification is ADMA and albumin. Study of assessment of novel markers as risk factors contributes to better classification patients on dialysis in groups with different risk level. Therefore, management and treatment of patients on dialysis is adjusted by risk level.