Süleyman KARAKÖSE, Zeynep BAL, Burak SAYIN, Emre TUTAL, Mehtap Erkmen AKDOĞAN, Siren SEZER, Dilek GÖkÜSTÜN

KRONİK HEMODİYALİZ HASTALARINDA ARTERİYEL SERTLİK İLE 25- (OH) VİTAMİN D, FGF 23 ARASINDAKİ İLİŞKİ

AMAÇ: Vasküler kalsifikasyon (VK) kronik hemodiyaliz hastalarında (KHH) oldukça yaygındır ve artan kanıtlar, mineral metabolizmasındaki anormalliklerin VK ve artmış mortalite ile yakından ilişkili olduğunu göstermektedir. Çalışmamızda yüksek Fibroblast growth factor-23 (FGF-23) ve düşük 25(OH) Vitamin D düzeylerinin yüksek kalsiyum yükünün bir sonucu olup olmadığını ve KHH’da 25(OH) Vitamin D düzeyleri ile arteriyel sertlik arasında bir ilişki olup olmadığını incelemeyi amaçladık. GEREÇ VE YÖNTEMLER: En az 24 aydır haftada 3 kez olmak üzere kronik hemodiyaliz programında olan yüz on yedi hasta seçildi ve 12 ay boyunca takip edildi. Laboratuar sonuçları hasta dosyalarından kaydedildi. Bir yıllık kümülatif kalsiyum (Ca) ve terapötik D vitamini (parikalsitol ve kalsitriol) alımının ve serum FGF-23 seviyesinin 25(OH) Vitamin D seviyeleri üzerindeki etkisini ve bu parametrelerin yıllık pulse wave velocity (PWV) ölçüm sonuçlarındaki değişim üzerindeki etkilerini analiz ettik. BULGULAR: Bazal kalsiyum dozu D vitamini yetersiz olan grupta kontrol grubuna göre anlamlı olarak yüksek bulundu (P=0,014). FGF-23'ün serum seviyesi hemodiyaliz süresi (P=0,001), ortalama paratiroid hormon (PTH) (P=0,001), ortalama fosfor (P) (P=0,009) ve ortalama CaXP (P=0,006) ile pozitif korelasyon gösterdi. Başlangıçtaki PWV ölçümü iki grup arasında benzerdi, ancak yetersizlik grubundaki hastalarda kontrol grubuna göre 12. aydaki PWV ölçümleri daha yüksekti (P=0,034). SONUÇ: Kalsiyum, serum fosfor seviyesinden bağımsız olarak belirsiz mekanizmalar ile serum FGF23 seviyelerini artırabilir. Ek olarak, yüksek FGF-23 düzeylerinin vitamin D seviyelerinde düşüşe neden olarak VK'na ve arterlerin sertleşmesine yol açarak daha yüksek PWV ölçümlerine neden olabileceği bulunmuştur.

THE RELATIONSHIP BETWEEN ARTERIAL STIFFNESS AND 25-(OH) VITAMIN D, FGF 23 IN MAINTENANCE HEMODIALYSIS PATIENTS

AIM: Vascular calcification (VC) is highly prevalent in maintenance hemodialysis (MHD) population and increasing evidence indicates that abnormalities in mineral metabolism are closely associated with VC and increased mortality in chronic kidney disease (CKD) patients. In our study, we aimed to determine whether high Fibroblast growth factor-23 (FGF-23) and low 25 (OH) Vitamin D levels are a result of high calcium load and whether there is a relationship between 25 (OH) Vitamin D levels and arterial stiffness in CKD patients. MATERIAL AND METHODS: One hundred and seventeen patients who were receiving MHD 3 times a week for at least 24 months were selected and followed up for 12 months and laboratory results were recorded from patient files. We analyzed the influence of a yearlong cumulative calcium and therapeutic vitamin D (paricalcitol and calcitriol) intake and serum FGF-23 level on endogenous 25(OH)D levels and the impacts of these parameters on the change in annual pulse wave velocity (PWV) measurement results in MHD patients. RESULTS: Elementary calcium dose was significantly higher in vitamin D insufficiency group than control group (P=0.014). Serum levels of FGF-23 were positively correlated with duration of HD (P=0.001), mean parathyroid hormone (PTH) (P=0.001), mean phosphorus (P) (P=0.009) and mean CaXP (P=0.006). Baseline PWV measurement were similar between two groups, however patients in insufficiency group had higher 12th month PWV measurements compared to control group (P=0.034). CONCLUSION: Calcium could increase serum FGF23 levels by indeterminate mechanisms independently of serum phosphorus level. Additionally, elevated FGF-23 level was found to be insulting a decline in vitamin D levels which may cause VC and stiffening of the arteries and resulting higher PWV measurements.

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