Yasin ŞAHİNTÜRK, Abdi Metin SARIKAYA, Ayça İNCİ, Üstün YILMAZ, Melahat COBAN, Semih GÜL, Doğan PAKALIN, Gökhan KÖKER, Asım Armağan AYDIN

Sürekli Ayaktan Periton Diyaliz Hastalarında Peritonit ile Diyaliz Yetersizliği ve Nutrisyonel Parametrelerin İlişkisi

Amaç: KBH hastalarında malnütrisyon mortalite artışının önemli bir nedenidir. Malnütrisyon gelişiminde ise en önemli neden diyaliz yetersizliğidir. SAPD Sürekli Ayaktan Periton Diyaliz hastalarında peritonit en önemli komplikasyon olmakla birlikte, diyaliz yetersizliği ve malnütrisyona neden olabileceği için önemi daha da artmaktadır. Malnütrisyon ve diyaliz yetersizliğinin erken tanınıp tedavi edilmesi mortaliteyi azaltacağı için peritonit sıklığı ile malnütrisyon ve diyaliz yetersizliği ilişkisinin araştırılması amaçlandı. Gereç ve Yöntemler: Çalışmaya 60 SAPD hastası alındı. Hastalar yıllık peritonit sıklığına göre iki gruba ayrıldı. Yılda iki veya daha fazla sayıda peritonit atağı geçiren hastalar yüksek peritonit indeksli HPI yılda bir veya hiç peritonit geçirmeyenler ise düşük peritonit indeksli LPI olarak gruplandırıldı. 34 %56,67 hasta LPI, 26 %43,33 hasta HPI grubuna dahil edildi. İki grup haftalık toplam KT/V üre, toplam kreatinin klirensi, rezidüel renal fonksiyon RRF , günlük protein alımı DPI , protein katabolizma hızı PCR , serum transferin ve albümin düzeyleri açısından karşılaştırıldı. Bulgular: Her iki grupta KT/V, klirensi, RRF, DPI, PCR ve serum transferin düzeylerinde anlamlı fark saptanmamıştır. Serum albümin düzeyinin HPI grubunda anlamlı düzeyde düşük olduğu saptanmıştır 3,84±0,52 ve 4,24±0,65, p:0,040 . HPI grubunda peritoneal albümin kaybı daha fazla olmasına rağmen istatistiksel anlam taşımamaktadır p:0,260 .Sonuç: Peritonit sıklığı önemli bir etken olsa da tek başına malnütrisyon ya da diyaliz yetersizliğini belirleyen bir faktör olmadığını, hastanın diyetle alım eksikliği, diyaliz süresi, kullanılan diyalizatın kronik peritoneal toksisitesi, diyabet gibi sistemik hastalıklarla birlikte değerlendirilmesi gerektiğini düşünmekteyiz

Anahtar Kelimeler:

SAPD, Peritonit, Malnütrisyon, Diyaliz yetersizliği

Relationship of Dialysis Failure and Nutritional Parameters with Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients

Objective: Malnutrition is an important risk for increased mortality rate in Chronic Renal Disease CRD patients. Dialysis failure is the leading cause of malnutrition. Peritonitis is the most important complication of CAPD Continuous Ambulatory Peritoneal Dialysis treatment and has become more important because of increasing risk of dialysis failure and malnutrition. Early detection and treatment of dialysis failure and malnutrition decrease mortality. We therefore aimed to search for the relationship between dialysis failure and nutritional parameters and the frequency of peritonitis.Material and Methods: A total of 60 CAPD patients were included in this study. The patients were divided into two groups according to their peritonitis frequency. Patients with two or more peritonitis attacks were grouped as High Peritonitis Index HPI and those with one or no peritonitis attacks as Low Peritonitis Index LPI . 34 56.67% patients were in the LPI and 26 43.33% in the HPI group. These two groups were compared according to their weekly KT/V, clearance, residual renal function RRF , daily protein intake DPI , protein catabolism rate PCR , and serum transferrin and albumin levels Results: There was no signifi cant difference for KT/V, clearance, RRF, DPI, PCR and serum transferrin levels. The serum albumin level was signifi cantly lower in the HPI group 3.84±0.52 vs. 4.24±0.65, p:0.04 . The total loss of albumin in the dialysate was higher in the HPI group but there was no statistical signifi cance p: 0.26 . Conclusion: Peritonitis frequency is an important factor but not a determinant for malnutrition and dialysis failure by itself. Our results show that patients' dietary intake defi ciency, duration of dialysis, chronic peritoneal toxicity of the used dialysate, or any systemic disease like diabetes should be evaluated together with the peritonitis frequency.

Keywords:

CAPD, Peritonitis, Dialysis failure, Malnutrition,

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