Krutost velikih arterija u terminalnoj fazi endemske nefropatije [Large-artery stiffness in end-stage Endemic nephropathy]

Premužić, Vedran (2016) Krutost velikih arterija u terminalnoj fazi endemske nefropatije [Large-artery stiffness in end-stage Endemic nephropathy]. PhD thesis, Sveučilište u Zagrebu.

PDF Download (2MB)

Abstract

Cardiovascular (CV) diseases are the most frequent cause of death in patients with end-stage-renal- disease (ESRD). Increased arteries stiffness (AS) was found to be independent risk factor. In general population AS is determined by age and blood pressure (BP). In patients with chronic renal disease (CKD) it is influenced additionaly with derangements in phosphate and calcium homeostasis. Endemic (Balkan) nephropathy (EN) is a chronic tubulointerstitial nephropathy characterized by normal BP values in early stages of CKD and hypertension (HT) appears in advanced CKD stages. Obviously, BP in EN has less impact on AS than in other CKD. The aim of this study was to analyze whether AS is lower in EN patients compared to patients with other ESRD undergoing chronic hemodialysis. In this study, 186 patients were included (90 EN, 96 non-EN) from three dialysis centers in Croatia and Bosnia and Herzegovina. After 25 months, control measurements were taken on 97 survived patients still treated with chronic hemodialysis. The obtained results confirmed the hypothesis that AS is lower in patients with EN. Prevalence of hypertension was lower in EN patients and they required less antihypertensives. Patients with EN had significantly lower serum phosphate levels, calcium x phosphate, and parathormone. All these factors were predictors of AS, but in three models of linear regression EN was the strongest negative predictor for AS. In logistic regression the ratio of AS was statistically significantly higher in patients without EN. The patients with EN were significantly older when they started their dialysis treatment, which indicates the slower progression of CKD. These patients had significantly lower CV mortality after 25 months of follow-up. Endemic nephropathy is an independent predictor of lower AS values. AS develops slower due to later onset of HT in predialytic course, lower BP values and milder HT and better control during dialysis treatment. In addition, they had better control of calcium and phosphates, which consequently causes slower progression of kidney disease and lower CV mortality.

Abstract in Croatian

Bolesnici s terminalnim bubrežnim zatajenjem najčešće umiru od kardiovaskularnih (KV) bolesti što je prema do sada objavljenim studijama velikim dijelom povezano s povećanom krutosti velikih arterija (KVA). Na KVA osim dobi najsnažnije utječe visina arterijskog tlaka (AT), a u bolesnika s kroničnom bubrežnom bolesti (KBB) bitan čimbenik je i regulacija homeostaze fosfata i kalcija. Endemska (Balkanska) nefropatija (EN) je kronična tubulointersticijska nefropatija čije obilježje su normalne vrijednosti AT u ranim stadijima KBB i pojava arterijske hipertenzije (AH) tek u završnim stadijima, pa se može pretpostaviti da je u tih bolesnika utjecaj AT na nastanak KVA manji nego u drugih KBB. Cilj ovog istraživanja bio je analizirati je li KVA manja u bolesnika s EN u usporedbi s drugim terminalnim KBB bolesnicima liječenih hemodijalizom, te koji čimbenici su pozitivni, a koji negativni prediktori za nastanak KVA. U istraživanje je uključeno 186 bolesnika (90 EN i 96 ne-EN) te je nakon 25 mjeseci učinjeno kontrolno mjerenje na 97 preživjelih ispitanika liječenih kroničnom hemodijalizom iz tri dijalitička centra u Hrvatskoj i Bosni i Hercegovini. Dobiveni rezultati potvrđuju hipotezu da je KVA manja u bolesnika s EN. U bolesnika s EN učestalost AH je bila manja i ti su bolesnici trebali manji broj antihipertenziva za postizanje kontrole AT. Bolesnici s EN imali su značajno niže vrijednosti serumskih fosfata, umnoška kalcija i fosfora, i parathormona. Svi ti čimbenici bili su prediktori KVA, ali u tri modela linearne regresije EN je bila najsnažniji i to negativni prediktor. U logističkoj regresiji omjer izgleda za nastanak KVA bio je statistički značajno veći za bolesnike bez EN. Bolesnici s EN bili su značajno stariji kada su počimali liječenjem dijalizom što ukazuje na sporiju progresiju KBB, a imali su značajno nižu ukupnu i KV smrtnost nakon 25 mjeseci praćenja. EN je nezavisni prediktor manje KVA koja se sporije razvija u ovih bolesnika zbog nižih vrijednosti AT i blaže AH već u preterminalnim stadijima te boljoj kontroli AH tijekom liječenja dijalizom, a dodatno u vrijeme hemodijalize i boljoj kontroli kalcija i fosfata što za posljedicu ima sporiju progresiju bubrežne bolesti i manji KV mortalitet.

Actions (login required)

View Item

Downloads