Son dönem böbrek yetmezliğinde paratiroidektominin renal anemi üzerinde etkileri
Küçük Resim Yok
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET Son Dönem Böbrek Yetmezliğinde Paratiroidektominin Renal Anemi Üzerine Etkileri Amaç: Kronik böbrek yetmezliği (KBY) hastalarında anemi mortalitenin önemli nedenlerinden biridir. Renal aneminin pek çok nedeni gösterilmi? olsa da en sık sebebi eritropoetin (EPO) eksikliğidir. Ayrıca KBY?li hastalarda sekonder hiperparatiroidinin eritropoezi negatif yönde etkileyerek anemiye neden olduğunu gösterilmi?tir. Çalı?mamızda anemi nedeni ile eritropoez uyarıcı ajan (EUA) kullanan ve renal hiperparatiroidiye bağlı paratiroidektomi operasyonu geçirmi? son dönem böbrek yetmezliği (SDBY) hastalarında preoperatif ve postoperatif anemi paneli, trombosit sayıları ve EUA kullanım gereksinimlerini kar?ıla?tırarak paratiroidektominin etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalı?mamız ?nönü Üniversitesi Nefroloji Anabilim dalı ve Malatya Eğitim ve Ara?tırma Hastanesi Nefroloji Kliniği tarafından Ocak 2009 - Aralık 2018 tarihleri arasında SDBY tanısı almı? ve diyalize giren hastalar üzerinden yapıldı. Eritropoetin uyarıcı ajan kullanan, renal anemisi olan ve medikal tedaviye yanıt vermeyen hiperparatiroidi ve ili?kili bozukluklar nedeni ile paratiroidektomi yapılmı? hastalar çalı?maya alındı. Bu kriterlere uyan 8?i kadın, 14? ü erkek toplam 22 hasta çalı?maya dahil edildi. Hastaların preoperatif PTH, hgb, plt seviyeleri ve kullanılan EUA dozları, postoperatif 12.aya kadar olan değerlerle kar?ıla?tırıldı. Bulgular: Çalı?maya dahil edilen 22 hastadan dördünün postoperatif 1. ay PTH değerleri >300 pg/ml bulunduğundan hem 22 hasta üzerinden hem de 18 hasta üzerinden değerlendirme yapıldı. Hastaların ortalama hemoglobin değerleri preoperatif 9,3±1,5 g/dl ve postoperatif 12. ay 11,7±2 g/dl olarak bulundu. Preoperatif değerlerle kar?ıla?tırıldığında postoperatif 12. ayda hgb değerlerinde anlamlı artı? bulundu (p<0,01). Tüm hastaların ortalama EUA dozları preoperatif 22,5±13 U/ay ve postoperatif 12. ay 11,7±10,4 U/ay olarak bulundu. Preoperatif uygulanan dozlarla kar?ıla?tırıldığında postoperatif 12. ay dozlarında anlamlı azalma bulundu (p<0,001). 1.ay, 3.ay, 6. ay ve 12. aylardaki hemoglobin miktarlarındaki artı? ile kullanılan EUA dozlarındaki azalma arasında aylara göre sırasıyla orta düzeyde negatif (p<0,012), orta düzeyde negatif (p<0,01), yüksek düzeyde negatif (p<0,01), orta düzeyde negatif (p<0,044) anlamlı korelasyon bulundu. Ortalama trombosit değerleri preoperatif 206±15/mm3 ve postoperatif 12. Ay 249±22 /mm3 olarak bulundu. Preoperatif değerlerle postoperatif 12. Aya kadar olan trombosit değerleri arasında anlamlı fark bulunmadı (p>0.05). Onsekiz hasta üzerinden yapılan diğer değerlendirmede, hastaların ortalama hemoglobin değerleri preoperatif 9,4±1,4 g/dl ve postoperatif 12. ay 11,6±1,8 g/dl olarak bulundu. Preoperatif değerlerle kar?ıla?tırıldığında postoperatif 12. ayda hgb değerlerinde anlamlı artı? bulundu (p<0,001). Kullanılan EUA dozlarına bakıldığında, 18 hastanın ortalama EUA dozları preoperatif 21,6±12,8 U/ay ve postoperatif 12. ay 11,6±11 U/ay olarak bulundu. Preoperatif uygulanan dozlarla kar?ıla?tırıldığında postoperatif 12. ay dozlarında anlamlı azalma bulundu (p<0,003). 1.ay ve 12. ay hemoglobin miktarlarındaki artı? ile kullanılan EUA dozlarındaki azalma arasında anlamlı korelasyon yokken (p>0,05), 3.ay ve 6. aylarda sırasıyla orta düzeyde negatif (p<0.029) ve orta düzeyde negatif (p<0.014) anlamlı korelasyon bulundu. Onsekiz hastanın ortalama trombosit değerleri preoperatif 213±81/mm3 ve postoperatif 12. Ay 260±108 /mm3 olarak bulundu. Preoperatif trombosit değerlerlerinde postoperatif 12.ayda anlamlı artı? saptandı (p<0,035). Sonuç: KBY?li hastalarda medikal tedavilere yanıtsız hiperparatiroidi tedavisinde özellikle komplikasyonlarla ba?a çıkabilme açısından paratiroidektomi etkili bir seçenektir. KBY?li hastalarda anemi yönetiminde ise paratiroidektominin aneminin düzelmesinde pozitif yönde etkileri olacaktır. Ayrıca paratiroidektomi hastaların kullandığı EUA gereksiniminin zaman içerisinde azalmasına katkı sağlayabilecek ve maliyetleri azaltacaktır.
Effects of Parathyroidectomy on Renal Anemia in End Stage Renal Disease Patients Objective: Anemia is one of the major causes of mortality in patients with chronic renal failure (CRF). Although many causes of renal anemia have been shown, the most common cause is erythropoietin (EPO) deficiency. In addition, secondary hyperparathyroidism in CRF patients has been shown to cause anemia by negatively affecting erythropoiesis. In our study, we aimed to evaluate the effectiveness of parathyroidectomy by comparing the preoperative and postoperative anemia panel, platelet counts and erythropoiesis stimulating agent (ESA) usage requirements in end stage renal disease (ESRD) patients using ESA who were undergone parathyroidectomy due to renal hyperparathyroidism. Materials and Methods: Our study was carried out at the Department of Nephrology of ?nönü University and Malatya Training and Research Hospital Nephrology Clinic between January 2009 and December 2018, in patients who were diagnosed with ESRD and who undergone dialysis. Patients with renal anemia that using ESA and who undergone parathyroidectomy due to hyperparathyroidism and related disorders that resistant to medical treatments were included in the study. A total of 22 patients (8 female, 14 male) were included in the study. Preoperative PTH, hgb, plt levels and ESA doses of the patients were compared with the values up to the postoperative 12th month. Results: Evaluation was made on both 22 patients and 18 patients due to PTH values of 4 of 22 patients were higher than 300 pg/ml at postoperative first month. The mean hemoglobin values of the patients were found to be 9.3 ± 1.5 g / dl preoperatively and 11.7 ± 2 g / dl at the postoperative 12th month. When compared with preoperative values, hgb values were significantly increased at 12th month postoperatively (p <0.01). The mean ESA doses of all patients were 22.5 ± 13 U / month preoperatively and 11.7 ± 10.4 U / month for the postoperative 12th month. There was a significant decrease in the postoperative 12th month compared to the preoperative doses (p <0.001). Between the postoperative hemoglobin levels and ESA doses for 1st month, 3rd month, 6th month and 12th month a moderately negative (p<0,012), a moderately negative (p<0,01), a highly negative (p<0,01), a moderately negative (p<0,044) significant association was found respectively. Mean platelet values were 206 ± 15 / mm3 preoperative and 249 ± X 22 / mm3 postoperative 12th month. There was no significant difference between the preoperative platelet values and the values up to 12th month postoperatively (p> 0.05). In the evaluation of 18 patients, the mean hemoglobin values of the patients were found to be 9,4±1,4 g / dl preoperatively and 11,6±1,8 g / dl at the postoperative 12th month. When compared with preoperative values, hgb values were significantly increased at 12th month postoperatively (p <0.001). The mean ESA doses of 18 patients were 21,6±12,8 U / month preoperatively and 11,6±11 U / month for the postoperative 12th month. There was a significant decrease in the postoperative 12th month compared to the preoperative doses (p<0,003). Between the postoperative hemoglobin levels and ESA doses for 3rd month and 6th month a moderately negative (p<0.029) and a moderately negative (p<0.014) significant association was found respectively. However no significant relationship was found at 1st and 12th months postoperatively. Mean platelet values were 213±81 / mm3 preoperatively and 260±108 / mm3 postoperatively. When compared with preoperative values, platelet values were significantly increased at 12th month postoperatively (p<0,035). Conclusion: Parathyroidectomy is an effective option in the treatment of hyperparathyroidism and especially in terms of coping with complications in patients with CRF who do not respond to medical treatments. In anemia management in patients with CRF, parathyroidectomy will have positive effects on the recovery of anemia. In addition, parathyroidectomy will contribute to the reduction of the ESA requirements and decrease the costs.
Effects of Parathyroidectomy on Renal Anemia in End Stage Renal Disease Patients Objective: Anemia is one of the major causes of mortality in patients with chronic renal failure (CRF). Although many causes of renal anemia have been shown, the most common cause is erythropoietin (EPO) deficiency. In addition, secondary hyperparathyroidism in CRF patients has been shown to cause anemia by negatively affecting erythropoiesis. In our study, we aimed to evaluate the effectiveness of parathyroidectomy by comparing the preoperative and postoperative anemia panel, platelet counts and erythropoiesis stimulating agent (ESA) usage requirements in end stage renal disease (ESRD) patients using ESA who were undergone parathyroidectomy due to renal hyperparathyroidism. Materials and Methods: Our study was carried out at the Department of Nephrology of ?nönü University and Malatya Training and Research Hospital Nephrology Clinic between January 2009 and December 2018, in patients who were diagnosed with ESRD and who undergone dialysis. Patients with renal anemia that using ESA and who undergone parathyroidectomy due to hyperparathyroidism and related disorders that resistant to medical treatments were included in the study. A total of 22 patients (8 female, 14 male) were included in the study. Preoperative PTH, hgb, plt levels and ESA doses of the patients were compared with the values up to the postoperative 12th month. Results: Evaluation was made on both 22 patients and 18 patients due to PTH values of 4 of 22 patients were higher than 300 pg/ml at postoperative first month. The mean hemoglobin values of the patients were found to be 9.3 ± 1.5 g / dl preoperatively and 11.7 ± 2 g / dl at the postoperative 12th month. When compared with preoperative values, hgb values were significantly increased at 12th month postoperatively (p <0.01). The mean ESA doses of all patients were 22.5 ± 13 U / month preoperatively and 11.7 ± 10.4 U / month for the postoperative 12th month. There was a significant decrease in the postoperative 12th month compared to the preoperative doses (p <0.001). Between the postoperative hemoglobin levels and ESA doses for 1st month, 3rd month, 6th month and 12th month a moderately negative (p<0,012), a moderately negative (p<0,01), a highly negative (p<0,01), a moderately negative (p<0,044) significant association was found respectively. Mean platelet values were 206 ± 15 / mm3 preoperative and 249 ± X 22 / mm3 postoperative 12th month. There was no significant difference between the preoperative platelet values and the values up to 12th month postoperatively (p> 0.05). In the evaluation of 18 patients, the mean hemoglobin values of the patients were found to be 9,4±1,4 g / dl preoperatively and 11,6±1,8 g / dl at the postoperative 12th month. When compared with preoperative values, hgb values were significantly increased at 12th month postoperatively (p <0.001). The mean ESA doses of 18 patients were 21,6±12,8 U / month preoperatively and 11,6±11 U / month for the postoperative 12th month. There was a significant decrease in the postoperative 12th month compared to the preoperative doses (p<0,003). Between the postoperative hemoglobin levels and ESA doses for 3rd month and 6th month a moderately negative (p<0.029) and a moderately negative (p<0.014) significant association was found respectively. However no significant relationship was found at 1st and 12th months postoperatively. Mean platelet values were 213±81 / mm3 preoperatively and 260±108 / mm3 postoperatively. When compared with preoperative values, platelet values were significantly increased at 12th month postoperatively (p<0,035). Conclusion: Parathyroidectomy is an effective option in the treatment of hyperparathyroidism and especially in terms of coping with complications in patients with CRF who do not respond to medical treatments. In anemia management in patients with CRF, parathyroidectomy will have positive effects on the recovery of anemia. In addition, parathyroidectomy will contribute to the reduction of the ESA requirements and decrease the costs.
Açıklama
Anahtar Kelimeler
Nefroloji, Nephrology
