Murat ŞAHİN, Orçun ALTUNÖREN, Hayriye SAYARLİOGLU

İnterdiyalitik Kilo Alımının Kardiyovasküler Mortalite ve Morbidite Üzerine Etkisi

Amaç: Kronik böbrek hastalığı (KBH) bulunanlarda morbidite ve mortalite oranları genel popülasyonla karşılaştırıldığında yüksektir. Kardiyovasküler hastalıklar KBH popülasyonunda oldukça sıktır ve mortalitenin en sık sebebidir. KBH bulunan hastalarda kardiyovasküler mortaliteyi etkileyen önemli faktörlerden birisi sıvı ve elektrolit dengesidir. Çalışmamızda hemodiyaliz hastalarında interdiyalitik kilo alımı (IDWG)’nın kardiyovasküler (KV) morbiditeye ve mortalite olan etkilerini saptamayı ve nutrisyonel parametrelerle olan ilişkisini incelemeyi amaçladık. Gereç ve Yöntemler: Hemodiyaliz merkezlerinde diyalize giren 111 hasta retrospektif olarak tarandı. Çalışmaya en az 6 ay boyunca haftada 3 defa hemodiyaliz olan hastalar dahil edildi. Hastaların kuru ağırlığı klinik bulgulara göre hesaplandı. Kuru ağırlık değerlendirilirken sıvı yüklenmesi durumunu gösteren ödem, kan basıncı yüksekliği, akciğer grafisinde kardiyotorasik indeks incelendi. Hastaların normotansif kaldığı diyaliz sonrası ağırlık, kuru ağırlık olarak kabul edildi. İnterdiyalitik kilo alımı diyaliz öncesindeki kilo ile sonrasında kuru ağırlığına eriştiği kilo arasındaki fark olarak hesaplandı. IDWG’nin diyaliz sonrası vücut ağırlığına bölünmesiyle IDWG’nin vücut ağırlığına oranı hesaplandı. Hastaların 0-6-12-18. ve 24. aylardaki IDWG değerleri kaydedildi. Hastaların dosyalarından aynı kişi tarafından yapılan ekokardiyografi değerlendirmeleri alındı. Bulgular: İki yıllık takipte 17 hastada mortalite gelişmişti Mortalite gelişen ve gelişmeyen hastalarda IDWG miktarı sırasıyla vücut ağırlığının %3.84 ve %3.67’si olarak bulundu(p=0.64). Çalışmamızda IDGW yüksek (diyaliz çıkış ağırlığının %4.8’inden fazla) olanlarda mortalite (5/18) %27, IDWG düşük olanlarda (12/93) %12 olarak saptandı (p=0.11). Mortalite grubunda sistolik ve diyastolik kan basınç ortalamaları sırasıyla 125 mmHg ve 75.8 mmHg iken (sistolik kan basıncı için p=0.96; diyastolik kan basıncı için p=0.82), mortalite gelişmeyen grupta ise sistolik ve diyastolik sırasıyla 125 mmHg ve 79 mmHg olarak saptandı. Sonuç: Çalışmamızda mortaliteyi etkileyen faktörler diyabet varlığı, Ejeksiyon Fraksiyonu (EF) ve ileri yaş olarak bulunmuştur. Hemodiyaliz hastaları yaş, hastalık, ve mortalite açısından değerlendirildiğinde iyi takip ve uygun tedavi hemodiyaliz hastalarının sonuçlarını iyi yönde etkilemektedir.

Anahtar Kelimeler:

İnterdiyalitik kilo alımı, Diyaliz, Mortalite

Effect of Interdialytic Weight Gain on Cardiovascular Mortality and Morbidity

Objective: Compared to the general population, chronic kidney disease (CKD) is associated with high mortality and morbidity. Cardiovascular diseases (CVD) are prevalent among CKD patients and are the most common cause of mortality. One of the most critical factors affecting CKD patients’ mortality is fluid and electrolyte balance. Our study aimed to determine the effects of interdialytic weight gain (IDWG) on cardiovascular (CV) mortality and morbidity in hemodialysis patients and examine its relationship with nutritional parameters. Material and Methods: We retrospectively analyzed the hospital records of 111 hemodialysis patients. Mortality developed in 17 patients during the 2-year follow-up. The dry weight of the patients was calculated according to clinical findings. While evaluating dry weight, edema indicating fluid overload, high blood pressure, and cardiothoracic index on chest X-ray were examined. Post-dialysis weight, in which patients remained normotensive, was considered dry weight. Interdialytic weight gain was calculated as the difference between pre-dialysis and post-dialysis dry weights. IDWG values of the patients at 0-6-12-18 and 24 months were recorded. Echocardiographic evaluations made by the same person were obtained from the files of the patients. Results: Mortality developed in 17 patients at two-year follow-up. IDWG rates between mortality and non-mortality group were %3.84 and %3.67 respectively (p=0.644). In our study mortality rate in the higher IDWG group was %27 (5/18) and %12 (12/93) in the lower IDWG group. In the mortality group, mean systolic and diastolic blood pressures were 125 mmHg and 75,8 mmHg, respectively. In the non-mortality group, mean systolic and diastolic blood pressures were 125 mmHg and 79 mmHg, respectively (systolic blood pressure p=0.961, diastolic blood pressure p=0.825). Conclusion: In our study, the factors that affect mortality were diabetes mellitus, Ejection fraction (EF), and advanced age. When hemodialysis patients are evaluated regarding age, comorbidity, and mortality, follow-up and appropriate treatment may cause beneficial outcomes.

Keywords:

Dialysis, Interdialytic weight gain, Mortality,

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