Čimbenici rizika za razvoj eritricitoze nakon transplantacije bubrega [Risk factors for development of erythrocytosis after kidney transplantation]

Mustapić, Željka (2013) Čimbenici rizika za razvoj eritricitoze nakon transplantacije bubrega [Risk factors for development of erythrocytosis after kidney transplantation]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Introduction: Posttransplant erythrocytosis (PTE) is a persistently elevated hematocrit level greater than 51% that occurs in 10% to 15% of graft recipients, usually within 24 months from engraftment. Spontaneous remission of PTE is observed in 25% of patients. Excess erythropoietin (EPO) production, usually from native kidneys may play an important role in etiolgy, but the most important factor in developing PTE include renin-angiotensin system (RAS). Other predisposing factors are male gender, smoking and rejection-free course. Inactivation of the RAS represents the most effective therapeutic modality in 90% of patients. Patients and methods: We enroled 30 patients with PTE, 30 patients with posttransplant anemia (PTA) and 30 patients with normal RBC after kidney transplantation at Department of nephrology, arterial hypertension, dialysis and transplantation, UHC Zagreb. PTA was defined as hemoglobin (Hb) <135 g/L in male and Hb<120 g/L in female recipients. We evaluated EPO, parathyroid hormone (IPTH), interleukin-3 (IL-3) and routine biochemical and clinical findings at regular outpatient control. Results: 90% of patients with PTE were male, with median age of 51 years (37.0-56.0). Median time for PTE development was 9.55 months after engrafment (7.47-22.0). Hypercalcemia (p=0.039) and hypophosphatemia (p=0.015) were more frequent in PTE group than in PTA group. IPTH and alkaline phosphatase (ALP) were significantly more elevated in PTE group than in PTA group (p=0.001, p=0.0001) and in normal RBC group (p=0.04, p=0.023). Serum IL-3 levels were increased in PTA group compared to others. Baseline serum EPO levels were similar for all patients. Systolic BP in PTE and normal RBC group was higher than in PTA group (p=0.025). Patients with PTE had more frequent statins in therapy than PTA patients (p=0.0006), while antihypertensive therapy showed no differencies between groups. 86.7% patients in PTA group, 96.7% in PTE and all patients with normal RBC had antihypertensive therapy. Conclusion: Our results identified iPTH and ALP as risk factors for development of erythrocytosis after kidney transplantation, and sistolic BP, EPO, IL-3, BUN, HDL-cholesterol and statin therapy as factors significantly influencing hematocrit level.

Abstract in Croatian

Uvod: Posttransplantacijska eritrocitoza (PTE) definira se kao povećanje vrijednosti hematokrita primatelja iznad 51%. Javlja se u 8-15% bolesnika, najčešće unutar 2 godine od transplantacije. Kod 25% bolesnika dolazi do spontane remisije bolesti. Etiologija PTE je multifaktorska. Smatra se da je u brojnim slučajevima eritrocitoza uvjetovana hipersekrecijolm eritropoetina (EPO) najčešće iz nativnih bubrega. Poremećaj renin-angiotenzin sustava (RAS) smatra se najvažnijim čimbenikom rizika. Ostali poznati čimbenici su muški spol, pušenje te vrijeme bez odbacivanja grafta. Liječenje PTE inhibicijom RAS sustava uspješno je u 90% bolesnika. Ispitanici i metode: U istraživanje je uključeno 90 bolesnika nakon transplantacije bubrega koji se liječe i prate u Zavodu za nefrologiju, arterijsku hipertenziju, dijalizu i transplantaciju, Klinike za unutrašnje bolesti, KBC Zagreb. Bolesnici su podijeljeni u tri grupe: bolesnike koji su razvili PTE, bolesnike koji su razvili posttransplantacijsku anemiju (PTA, Hb <135 g/L u muškaraca, Hb < 120 g/L u žena), te bolesnike s urednim nalazima crvene krvne slike (CKS). Istraživana je razlika u koncentraciji eritropoetina, paratireoidnog hormona, IL-3, biokemijskih i kliničkih parametara koji se analiziraju na redovitim kontrolama. Rezultati: 90% bolesnika s PTE bili su muškarci, središnje dobi 51 godinu. Središnje razdoblje razvoja PTE je 9.55 mjeseci (7.47-22.0) od transplantacije. Hiperkalcemija (p=0.039) i hipofosfatemija (p=0.015) su značajno češće u bolesnika s PTE nego u bolesnika s PTA. Intaktni paratireoidni hormon (iPTH) i ukuona alkalna fosfataza (ALP) značajno su viši u PTE grupi u odnosu na bolesnike s PTA (p=0.001, p=0.0001) te bolesnike s urednom CKS (p=0.04, p=0.023). Značajno je viša koncentracija IL-3 u grupi s PTA u odnosu na bolesnike s PTE. Nismo našli razlike u vrijednostima EPO između grupa. Sistolički arterijski tlak bio je značajno viši u grupi bolesnika s PTE i normalnom CKS u odnosu na bolesnike s PTA (p=0.025). Značajno je češća upotreba antilipemika u grupi s PTE nego u grupi s PTA (p=0.0006), dok nema značajne razlike u upotrebi antihipertenziva koja se kreće od 86.7% u grupi s PTE do 100% u grupi s normalnom CKS. Zaključak: Naše istraživanje je izdvojilo iPTH i ALP kao čimbenike rizika za razvoj PTE, dok eritropoetin, sistolički arterijski tlak, ureja, IL-3, HDL-kolesterol te terapija antilipemicima pokazuju značajan utjecaj na vrijednost hematokrita.

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