Alper SARI, Memnune Sena ULU, Sinan KAZAN, Onur TUNCA, Elif DİZEN KAZAN

Rutin Hemodiyaliz Ve Periton Diyalizi Hastalarında Monosit/HDL Kolesterol Oranının Karşılaştırılması

Amaç: Kronik böbrek hastalığı (KBH) inflamatuar bir süreçtir. KBH hastalarında serum proinflamatuar sitokinlerininin normal popülasyona göre on kat daha yüksek olduğu bilinmektedir. Monosit/HDL kolesterol oranının yeni bir inflamatuar belirteç olduğu gösterilmiştir ve KBH hastalarında kardiyovasküler olayları tahmin etmede kullanılabileceği iddiaa edilmiştir. Bu kesitsel çalışma ile, hemodiyaliz ve periton diyalizi ile tedavi alan hastalarda monosit/HDL kolesterol oranının karşılaştırılması amaçlamıştır. Yöntemler: Nefroloji kliniğimizde son dönem böbrek yetmezliği ile takip edilen ve periton diyalizi veya hemodiyaliz tedavisi alan hastaların dosyaları retrospektif olarak incelendi. Renal replasman tipine göre hastalar iki gruba ayrıldı. Gruplar arasında Monosit/HDL kolesterol oranı karşılaştırıldı. Verilerin analizi için IBM SPSS Statistics 22.0 (IBM Corp., NY, ABD) programı ile uygun istatistiksel yöntemler kullanıldı. Bulgular: Monosit/HDL kolesterol oranı HD ile tedavi alan hastalarda anlamlı şekilde yüksek bulundu (p=0.028). HDL kolesterol seviyeleri periton diyalizi grubunda anlamlı şekilde yüksekti (p=0.046). Total kolesterol, LDL kolesterol, trigliserid ve VLDL kolesterol hasta grupları arasında benzer olarak tespit edildi (p>0.05). Yüksek sensitiviteli CRP ve sedimentasyon düzeyleri gruplar arasında benzer bulundu (p>0.05). Sonuç: Literatür taramamıza göre bu çalışma renal replasman tedavi modaliteleri arasında monosit/HDL kolesterol oranını değerlendiren ilk çalışmadır. Bu çalışmada monosit/HDL kolesterol oranının hemodiyaliz alan hastalarda periton diyalizi ile takip olanlara göre anlamlı şekilde yüksek olduğu gösterilmiştir. Bu sonuçlara göre periton diyalizinin hemodiyalize göre daha az sistemik inflamasyon ile ilişkili olabileceği düşünülebilir.

Comparison Of Monocyte / HDL Ratio In Routine Hemodialysis And Peritoneal Dialysis Patients

Objective: Chronic kidney disease (CKD) is an inflammatory process. Serum proinflammatory cytokines are known to beten times higher in patients with CKD when compared to normal population. Monocyte/High density lipoprotein (HDL)cholesterol ratio (MHR) have been shown to be a new marker of inflammation and claimed that, it may be used to predictcardiovascular events in patients with CKD. This cross-sectional study aimed to compare monocyte / HDL cholesterolratio in patients treated with hemodialysis and peritoneal dialysis.Methods: Files of patients who have been followed up with end stage renal disease (ESRD) and have peritoneal dialysisor hemodialysis therapy in Nephrology Clinic of our hospital have been retrospectively examined. Patients were dividedinto two groups regarding renal replacement treatment type. Monocyte / HDL cholesterol ratio was compared betweengroups. IBM SPSS Statistics 22.0 (IBM Corp., NY, USA) packaged software and appropriate statistical methods were usedto analyse data.Results: Monocyte / HDL cholesterol ratio was significantly higher in patients treated with hemodialysis (p= 0.028). HDLcholesterol levels were significantly higher in peritoneal dialysis group (p= 0.046). Total cholesterol, LDL cholesterol,triglyceride and VLDL cholesterol have been ascertained to be similar in both patient groups (p> 0.05). The highsensitivity CRP and sedimentation levels have been detected to be similar within the groups (p> 0.05).Conclusion: This is the first study evaluating the monocyte/HDL cholesterol ratio among renal replacement therapymodalities in our literature review. In this study, it has been shown that; monocyte/HDL cholesterol ratio werestatistically higher in patients having hemodialysis than in the ones followed up with peritoneal dialysis. According tothese results, it may be considered that; peritoneal dialysis may be associated with less systemic inflammation thanhemodialysis.

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1. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Clasification and Stratification. Am J Kidney Dis. 2002; Vol. 39: 1-266
2. Zyga S, Christopoulou G, Malliarou M. Malnutrition-inflammation-atherosclerosis syndrome in patients with end-stage renal disease. J Ren Care. 2011; 37: 12–5.
3. Tonbul HZ, Demir M, Altintepe L, et al. Malnutrition-Inflammation-Atherosclerosis syndrome componentsin hemodialysis and peritoneal dialysis patients. 2006; 24: 287-94.
4. Rao P, Reddy GC, Kanagasabapathy AS. Malnutrition-inflammation-atherosclerosis syndrome in Chronic Kidney disease. Indian J Clin Biochem. 2008; 23: 209–17.
5. Stenvinkel P. Inflammation in end-stage renal failure: could it be treated? Nephrol Dial Transpl. 2002; 17 Suppl 8: 33–8; discussion 40.
6. Daugirdas JT, Blake P, Ing TS, et al. Handbook of Dialysis, Fourth Edition. Dial Transplant. 2007; 36: 322.
7. Ancuta P, Wang J, Gabuzda D. CD16+ monocytes produce IL-6, CCL2, and matrix metalloproteinase-9 upon interaction with CX3CL1-expressing endothelial cells. J Leukoc Biol. 2006; 80: 1156–64.
8. Hessler JR, Robertson AL, Chisolm GM. LDLinduced cytotoxicity and its inhibition by HDL in human vascular smooth muscle and endothelial cells in culture. Atherosclerosis. 1979; 32: 213– 29.
9. Li XP, Zhao SP, Zhang XY, et al. Protective effect of high density lipoprotein on endothelium-dependent vasodilatation. Int J Cardiol. 2000; 73: 231–6.
10. Canpolat U, Çetin EH, Cetin S, et al. Association of Monocyte-to-HDL Cholesterol Ratio with Slow Coronary Flow is Linked to Systemic Inflammation. Clin Appl Thromb. 2016; 22: 476–82.
11. Canpolat U, Aytemir K, Yorgun H,et al. The role of preprocedural monocyte-to-highdensity lipoprotein ratio in prediction of atrial fibrillation recurrence after cryoballoon-based catheter ablation. Europace. 2015; 17: 1807–15.
12. Ulus T, Isgandarov K, Yilmaz AS, et al. Monocyte to High-Density Lipoprotein Ratio predicts Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome. Angiology 2018 Nov; 69: 909-16
13. Rogacev KS, Zawada AM, Emrich I, et al. Lower Apo A-1 and lower HDL-C levels are associated with higher intermediate CD14++CD16+ monocyte counts that predict cardiovascular events in chronic kidney disease. Arterioscler Thromb Vasc Biol. 2014; 34: 2120- 7.
14. Nahas M El. Chronic renal failure and uremic syndrome. Progression of chronic renal failure. In: Comprehensive Clinical Nephrology Masby (Elsevier Limited) 2nd edition Philadelphia, Pennsylvania, USA; 2003; p. 843–56.
15. Stenvinkel P, Alvestrand A. Inflammation in end-stage renal disease: Sources, consequences, and therapy. Vol. 15, Seminars in Dialysis 2002;p. 329–37.
16. Yong K, Ooi EM, Dogra G, et al. Elevated interleukin-12 and interleukin-18 in chronic kidney disease are not associated with arterial stiffness. Cytokine. 2013; 64: 39–42.
17. Johnsen SH, Fosse E, Joakimsen O, et al. Monocyte count is a predictor of novel plaque formation: A 7-year follow-up study of 2610 persons without carotid plaque at baseline the Troms?? study. Stroke. 2005; 36: 715–9.
18. National Cholesterol Education Program (NCEP) Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106: 3143– 421. ,
19. Efe TH, Arslan ED, Ertem AG, et al. Akut Pulmoner Emboli Hastalarında Monosit / HDL Oranının Kısa Dönem Mortaliteyi Ön Gördürmedeki Prognostik Değeri. 2016; 19: 149–53.
20. Ucar FM. A potential marker of bare metal stent restenosis: Monocyte count - to- HDL cholesterol ratio. BMC Cardiovasc Disord. 2016; 16: 1–7.
21. Koçak HE, Acipayam H, Elbistanli MS, et al. Is the monocyte/HDL ratio a prognostic marker of idiopathic sudden hearing loss? Otolaryngol Pol. 2016; 70: 6–10.
22. Kanbay M, Solak Y, Unal HU, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 2014; 46: 1619–25.
23. Katipoglu B, Ates I, Demir BF, et al. Relationship between monocyte/HDL cholesterol ratio and urinary protein excretion in patients with primary hypertension with reverse dipper pattern. Turk J Nephrol 2019; 28: 54-61.
24. Refaat H, Sany D, Mohab A, et al. Comparing Dialysis Modality and Cardiovascular Mortality in Patients on Hemodialysis and Peritoneal Dialysis. Adv Perit Dial. 2016; 32: 22-31.
25. Tokgoz B. Clinical advantages of peritoneal dialysis. Perit Dial Int. 2009 Feb; 29 Suppl 2: S59-61.