Alev Arslan, Osman Küçükosmanoğlu, Zekiye Aytül Noyan, Nazan Özbarlas

Kronik böbrek yetersizliği olan çocuklarda hemodiyalizin kardiyak etkileri

Amaç: Çalışmamızda kronik böbrek yetersizliği nedeniyle hemodiyaliz yapılan hastalarda hemodiyaliz öncesi ve sonrası kardiyak fonksiyonların değerlendirilmesi planlanmıştır. Gereç ve Yöntem: Çalışmaya altı aydan daha uzun süredir düzenli hemodiyaliz yapılan 24 hasta dahil edildi. Diyaliz öncesi ve sonrası konvansiyonel ve doku Doppler ekokardiyografi uygulandı, NT-proBNP düzeyleri kontrol edildi. Ekokardiyografi sonuçları, vücut komposizyon monitörü ile ölçülen hidrasyon durumuna gore ve diyaliz sırasında hipotansiyon gelişmesine gore karşılaştırıldı.Bulgular:. Doku Doppler ekokardiyografi ile hesaplanan miyokardiyal performans indeksi 22 hastada normalden yüksekti. Mitral E/A oranları hemodiyalizden sonra istatistiksel olarak daha düşüktü. NT-proBNP düzeyleri normalden yüksekti ancak diyaliz öncesi ve sonrası düzeyleri arasında fark bulunmadı. Dokuz hastada diyaliz sırasında hipotansiyon gelişti. Hipotansiyon gelişen hastaların ekokardiyografik bulguları ve NT-proBNP düzeyleri arasında, hipotansiyon gelişmeyen hastaların sonuçları ile karşılaştırıldığında anlamlı fark saptanmadı. Sonuç: Kronik böbrek yetersizliğinde kalpte diyastolik disfonksiyon sıktır. Hidrasyon durumundan daha az etkilendikleri doku Doppler ekokardiyografi ve miyokardiyal performans indeks ölçümleri ile bütünsel ve bölgesel kalp fonksiyonları daha doğru değerlendirilir. Kronik böbrek yetersizliğinde NT-proBNP ile kalpteki fonksiyon bozukluğu takip edilebilir. Çocuklarda ultrafiltrasyon sıvı hacmini belirlemek için vücut kompozisyon monitörü kullanılabilir.

Anahtar Kelimeler:

Vücut kompozisyon monitörü, kronik böbrek yetersizliği, miyokardiyal performans indeksi

Cardiac effects of hemodialysis in children with chronic kidney disease

Purpose: The aim of the study was to evaluate cardiac functions before and after hemodialysis in children with chronical renal failure.Materials and Methods: The study comprised 24 children undergoing hemodialysis more then six months. Conventional and tissue Doppler echocardiography was performed, NT-proBNP levels were measured before and after hemodialysis. Echocardiographic results were compared regard to hydration status which measured with body composition monitor and hypotension event during dialysis. Results: Myocardial performance indices which gained with tissue Doppler echo were high in 22 patient. Mitral E/A ratio significantly decreased after hemodialysis. NT-proBNP levels were high but no difference was determined after dialysis. Nine patient experienced hypotension but nonsignificant difference was detected regarding echocardiographic findings and NT-proBNP levels. Conclusion: Diastolic dysfunction is frequent in chronical renal failure. Tissue Doppler echocardiography and myocardial performance index supply a more proper evaluation of global and regional cardiac function in chronical renal failure due to less hydration affectability. NT-proBNP should be monitored for cardiac dysfunction in chronical renal failure. Body composition monitor should be used in children for setting the ultrafiltration volume.

Keywords:

Body composition monitor, chronic kidney disease, myocardial performance index,

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