Aygül ÇELTİK, Zalal ALATAŞ, Mümtaz YILMAZ, Meltem SEZİŞ DEMİRCİ, Gülay AŞÇI, Hüseyin TÖZ, Mehmet ÖZKAHYA

Periton Diyalizi Hastalarında, Rezidüel Renal Fonksiyonların Kaybı Boylamsal Ürik Asit ve CRP Düzeyleri ile İlişkili midir?

Amaç: Periton diyalizi yapan hastalarda rezidüel renal fonksiyonların morbidite ve mortalite üzerinde olumlu etkileri vardır. Amacımız, periton diyalizi başlanmadan önceki bazal verilerin ve başlandıktan sonra ilk üç yıldaki boylamsal ürik asit ve C-reaktif protein (CRP) düzeyinin rezidüel renal fonksiyon kaybı üzerindeki etkilerinin araştırılmasıdır. Gereç ve Yöntem: Retrospektif kohort bir çalışmadır. Son dönem böbrek yetmezliği nedeni ile periton diyalizi başlanan 34 hasta çalışmaya dahil edildi. Primer sonlanım noktası rezidüel renal fonksiyon kaybıydı ve rezidüel idrar miktarının 200 mL/24 saatten az olması olarak tanımlandı. Hastalar, periton diyalizi başlandıktan sonra üç yıl boyunca veya RRF kaybı olana kadar takip edildi. Hastaların klinik ve laboratuvar verileri hasta dosyalarından kaydedildi. Bulgular: Takip süresi 32,7 (12,9-36) aydı. Periton diyalizi başlandıktan 22,1±9,8 ay sonra 10 hastada rezidüel renal fonksiyon kaybı oldu. Boylamsal ürik asit düzeyi 6,1±1,2 mg/dL ve boylamsal CRP düzeyi 0,5 (0,3-0,7) mg/dL idi. Rezidüel renal fonksiyon kaybı olan hastalarda, bazal sodyum, trigliserid düzeyleri daha düşük iken parathormon düzeyi daha yüksekti. Her iki grup arasında boylamsal ürik asit ve CRP düzeyi açısından fark yoktu. Periton diyalizi başlanmadan önceki parathormon [tehlike oranı (HR), 1.003; %95 güven aralığı (GA) 1.001-1.006; p=0,013], sodyum (HR 0,801; %95 GA 0,665-0,965; p=0,019) ve vücut kitle indeksi (HR 0,817; %95 GA 0,684-0,975; p=0,025) rezidüel renal fonksiyon kaybı için risk faktörüydü. Sonuç: Periton diyalizi hastalarında, bazal sodyum, trigliserid ve vücut kitle indeksi rezidüel renal fonksiyon kaybı için risk faktörü olarak bulunmuştur. Rezidüel renal fonksiyon kaybı ile boylamsal CRP ve ürik asit düzeyi arasında ilişki gösterilememiştir. İdeal ürik asit ve CRP düzeyinin belirlenmesi için prospektif çalışmalara ihtiyaç vardır.

Is Loss of Residual Renal Function Related to Longitudinal Uric Acid and CRP Levels in Peritoneal Dialysis Patients?

Aim: Residual renal functions have positive effects on morbidity and mortality among patients undergoing peritoneal dialysis. Our aim is to investigate the effects of baseline laboratory data and longitudinal uric acid and C-reactive protein (CRP) levels on loss of residual renal functions within the first three years of peritoneal dialysis. Materials and Methods: This is a retrospective cohort study. Thirty-four patients who started peritoneal dialysis due to end-stage renal disease were included. The primary endpoint was loss of residual renal function and was defined as residual urine volume of less than 200 mL/24 hours. Patients were followed for three years after the onset of peritoneal dialysis or until loss of residual renal functions. Demographic and clinical data were recorded retrospectively. Results: The follow-up period was 32.7 (12.9-36) months. Ten patients lost residual renal function 22.1±9.8 months after the initiation of peritoneal dialysis. Longitudinal uric acid level was 6.1±1.2 mg/dL and longitudinal CRP level was 0.5 (0.3-0.7) mg/dL. In patients with residual renal function loss, baseline sodium and triglyceride were lower, while parathormone were higher. There was no difference between the groups in terms of longitudinal uric acid and CRP levels. Baseline parathyroid hormone [hazard ratio (HR), 1,003; 95% confidence interval (CI) 1,001-1,006; p=0.013], body mass index (HR 0.817; 95% CI 0.684-0.975; p=0.025), and baseline sodium level (HR 0.801; 95% CI; 0.665- 0.965; p=0.019) were risk factors for residual renal function loss. Conclusion: In peritoneal dialysis patients, residual renal function loss were associated with baseline sodium, triglyceride, and body mass index. There was no correlation between residual renal function loss and longitudinal CRP and uric acid levels. Prospective studies are needed to determine the optimal uric acid and CRP levels.

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