Ali BORAZAN, İdris EMİR, Edip UÇAR, İsmail Zeki TEKİŞ

Hemodiyaliz hastalarında metabolik sendrom’un inflamasyonla ilişkisi

Amaç: Bu çalışmada hemodiyaliz hastalarında Uluslararası Diyabet Federasyonu (IDF) tarafından tanımlanan metabolik sendrom tanı kriterlerine göre metabolik sendrom tanısı olan ve olmayan hastalarda inflamasyon arasındaki ilişkiyi araştırmayı amaçladık. Materyal ve Metot: Bu çalışmaya hemodiyaliz tedavisi gören toplam 274 hasta alındı. Metabolik sendrom tanısı alan ve almayan hastalarda yaş, cinsiyet, ağırlık, bel çevresi, arteriyel kan basınçları, açlık kan şekeri, total kolesterol, LDL-kolesterol, HDL-kolesterol, trigliserid, Creaktif protein (CRP), albümin, ürik asit ve fibrinojen düzeyleri araştırıldı. Bulgular: Metabolik sendrom tanısı konulan 82 hasta ve metabolik sendrom tanısı konulmayan 192 hemodiyaliz hastası tespit edildi. Metabolik sendrom tanısı konulan gruptaki ortalama serum albümin düşüklüğü, CRP yüksekliği, fibrinojen yüksekliği metabolik sendrom tanısı konulmayan gruba göre istatistiksel olarak anlamlı bulundu (p

Relationship between metabolic syndrome and inflamation in hemodialysis Patients

Objective: In this study, we aimed to investigate the relationship between inflammation and metabolic syndrome as defined by the International Diabetes Federation (IDF) diagnostic criteria in hemodialysis patients. Material and Methods: Two hundred and seventy four patients treated with hemodialysis were included in the study. Patients’ age, sex, weight, waist circumference, arterial blood pressure, fasting blood glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, C-reactive protein, albumin, uric acid and fibrinogen levels were recorded. Results: Eighty two patients diagnosed with metabolic syndrome and 192 hemodialysis patients without metabolic syndrome were identified. In the Metabolic syndrome group mean decrease in serum albumin and mean increase in C-reactive protein and fibrinogen was significantly different from the other group (p<0.05, p<0.001, p<0.05, respectively). When gender, diabetes mellitus, and hypertension status was evaluated, there was a significant difference in terms of the proportion of women and diabetes mellitus (p<0,001), but the presence of hypertension and mean serum uric acide levels did not differ significantly. Conclusion: Hemodialysis patients with Metabolic syndrome should also be assessed for inflammation.

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1. Levey AS, Beto JA, Coronado BE, Eknoyan G, Foley RN, Kasiske BL, et. al. Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney FoundationTask Force on Cardiovascular Disease Am J Kidney Dis 1998:32;853–906.
2. Genestier S, Hedelin G, Schaffer P, Faller B. Prognostic factors in CAPD patients: A retrospective study of a 10-year period. Nephrol Dial Transplant 1995;10:1905–11.
3. Partfey PS. Cardiac disease in dialysis patients: diagnosis burden of disease, prognosis, risk factors and management. Nephrol dial transplant 2000;15:55-68.
4. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovas-cular disease in chronic renal disesase. J Am Soc Nephrol 1998;9: 16–23.
5. Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Bonadonna RC, et al. Bruneck Study. Metabolic syndrome: epidemiology and more extensive phenotypic description. Cross-sectional data from the Bruneck Study. Int J Obes Relat Metab Disord 2003;27(10):1283–9.
6. Nieuwdorp M, Stroes ES, Meijers JC, Buller H. Hypercoagulability in the metabolic syndrom. Current Opin Pharmacol 2005;5:155–9.
7. Speidl WS, Graf S, Hornykewycz S. High-Sensitivity C-Reactive Protein in the Prediction of Coronary Events in Patients with Prematüre Coranary Artery Disease. Am Heartn J 2002;144:449–55.
8. Owen WF, LOwrie EG. C-reactive protein as an outcome predictor for maintanence hemodialysis patients. Kidney Int 1998;54:627–36.
9. Kaysen GA, Stevenson FT, Depner TA. Determinants of albumin concentration in hemodialysis patients. Am J Kidney Dis 1997;29:658–68.
10. Gunnell J, Yeun JY, Depner TA, Kaysen GA. Acute-phase response predicts erythropoietin resistance in hemodialysis patients. Am J Kidney Dis 1999;33:63–72.
11. Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 2007;49:403–14.
12. Kuzuya M, Ando F, Iguchi A, Shimokata H. Age-specific change of prevalence of metabolic syndrome: longitudinal observation of large Japanese cohort. Atherosclerosis 2007;191:305–12.
13. Shinohara K, Shoji T, Emoto M, Tahara H, Koyama H, Ishimura E, et al. Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol 2002; 13:1894–900.
14. Honda H, Qureshi AR, Axelsson J, Heimbürger O, Suliman ME, Bárány P, et al. Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality. Am J Clin Nutr 2007;86:633–8.
15. Young DO, Lund RJ, Haynatzki G, Dunlay RW. Prevalence of the metabolic syndrome in an incident dialysis population. Hemodial Int 2007;11:86–95.
16. The IDF consensus worldwide definition of the metabolic syndrome. Vol 2005, International Diabetes Federation 2005.
17. Tsangalis G, Papaconstantinou S, Kosmadakis G, Valis D, Zerefos N. Prevalence of the metabolic syndrome in hemodialysis. Int J Artif Organs 2007;30:118–23.
18. Johnson DW, Armstrong K, Campbell SB, Mudge DW, Hawley CM, Coombes JS, et. al. Metabolic syndrome in severe chronic kidney disease: Prevalence, predictors, prognostic significance and effects of risk factor modification. Nephrology (Carlton) 2007;12:391–398.
19. Festa A, D’Agostino R Jr, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000;102:42–7.
20. Ridker PM, Stampfer MJ, Rifai N. Novel risk for systemic aterosclerosis. JAMA 2001;286:2401–2.
21. Fröhlich M, Imhof A, Berg G, Hutchinson WL, Pepys MB, Boeing H, et al. Association between C-reactive protein and features of the metabolic syndrome. Diabetes Care 2000;23:1835–9.
22. Garcia-Lorda P, Bullo M, Balanza R, Salas-Salvado J. C-reactive protein, adiposity and cardiovascular risk factors in a Mediterranean population. Int J Obes 2006;30:468–74.
23. Swales J, de Bono D. Cardiovascular risk factors. Gower Medical Publishing, London, New York, 1993.
24. Vuorinen-Markkola H, Yki-Jarvinen H. Hyperuricemia and insulin resistance. J Clin Endocrinol Metab 1994;78:25–9.
25. Numata T, Miyatake N, Wada J, Makino H. Comparison of serum uric acid levels between Japanese with and without metabolic syndrome. Diabetes Res and Clin Pract 2008;80:e1-5.
26. Sari I, Akar S, Pakoz B, Sisman AR, Gurler O, Birlik M, et al. Hyperuricemia and its related factors in an urban population, Izmir, Turkey. Rheumatol Int 2009;29:869–74.
27. Stenvinkel P, Heimbürger O, Paultre F, Diczfalusy U, Wang T, Berglund L. Strong Association between Malnutrition, Inflammation, and Atherosclerosis in Chronic Renal Failure. Kidney Int 1999;55:1899–911.
28. Kronenberg F. Homocysteine, lipoprotein (a) and fibrinogen: Metabolic risk factors for cardiovascular complications of chronic renal disease. Curr Opin Nephrol Hypertens 1998;7:271–8.