Kolekalsiferol sonrası endotel disfonksiyonu ve damar sertliğinin diyaliz modalitesine göre değerlendirilmesi

Year 2023, , 198 - 205, 30.06.2023

Mehmet Baha Aytac , Merve Aktaş Özgür , Kenan Doğan , Murat Deveci , Özlem Kayabey , Kenan Bek

https://doi.org/10.53446/actamednicomedia.1192031

Abstract

Amaç: Özellikle serum 25-hidroksivitamin D (25OHD) seviyeleri düşük kronik böbrek hastalığı (KBH) olan çocuklarda kardiyovasküler hastalık(KVH) gelişme riski önemli ölçüde artmaktadır. Bu çalışmada; KBH olan ve hemodiyaliz(HD), periton diyalizi(PD) ve diyaliz dışı (ND) tedavi alan çocuklarda D vitamini eksikliğinin etkilerini ve kolekalsiferol tedavisinin endotel fonksiyonları ve damar sertliği üzerine olan etkilerini karşılaştırmayı amaçladık
Yöntem: 25OHD düzeyi düşük toplam 41 çocuktan oluşan 7HD, 7 PD ve 27 ND hasta grupları; 300.000 ünite tek doz oral kolekalsiferol öncesi ve sonrası biyokimyasal parametreler, akım aracılı dilatasyon (FMD) ve lokal arter sertliği açısından kendi aralarında karşılaştırıldı.
Bulgular: D vitamini takviyesi öncesi HD, PD ve ND hasta grupları arasında FMD ve lokal arteryel sertlik değerlerinde farklılık yoktu. Kolekalsiferol tedavisi sonrası tüm hasta gruplarında endotel bağımlı FMD ‘de önemli artış gözlendi; ancak endotel bağımsız FMD ve lokal arteryel sertlik ölçümlerinde iyileşme sadece PD ve ND hastalarında gösterildi. Diyaliz olan hastalarda (HD, PD) başlangıç parathormon düzeyi daha yüksekti; çalışma sonunda ise sadece diyalize girmeyen hasta grubunda anlamlı azalma olduğu tespit edildi.
Sonuç: KBH olan ve 25OHD düzeyi düşük çocuklarda hastalığın şiddetine bakılmaksızın endotel fonksiyon bozukluğu ve artmış damar sertliği saptanmıştır. Kolekalsiferol tedavisi ile gözlenen iyileşme, KVH gelişimini önlemek için D vitamini eksikliğinin KBH ‘nın erken evrelerinde bile düzeltilmesi gerektiğini ortaya koymuştur.

Keywords

Damar sertliği, endotel disfonksiyonu, kronik böbrek hastalığı, kolekalsiferol

Assessment of endothelial dysfunction and vascular stiffness after cholecalciferol according to dialysis modality

Abstract

ABSTRACT
Objective: The risk of developing cardiovascular disease (CVD) increases significantly in children with chronic kidney disease (CKD) especially with low serum 25- hydroxyvitamin D (25OHD) levels. Herein; we aimed to compare the effects of vitamin D deficiency and the impact of cholecalciferol treatment on endothelial functions and vascular stiffness in children with CKD receiving hemodialysis (HD), peritoneal dialysis (PD) and non- dialysis(ND).
Methods: 7 HD, 7 PD and 27 ND patient groups consisting of 41 children totally with low 25OHD levels were compared among each other in regards of biochemical parameters, flow-mediated dilatation(FMD) and local arterial stiffness before and after a single dose of 300.000 units of cholecalciferol treatment.
Results: There was no difference in FMD and local arterial stiffness values between HD, PD and ND patient groups before vitamin D supplementation. Significant increase in endothelium-dependent FMD was observed in all patient groups after intervention with cholecalciferol; however the improvement in endothelium-independent FMD and local arterial stiffness measurements was demonstrated in patients with PD and ND. Baseline parathormon level was higher in patients on dialysis; at the end of the study, significant decrease was detected only in patient group not receiving diaysis.
Conclusions: Endothelial dysfunction and impaired vascular stiffness were determined in children with CKD with low 25OHD levels regardless of the disease severity.. Recovery with cholecalciferol therapy revealed that vitamin D deficiency should be corrected even in early stages of CKD to prevent the development of CVD

Keywords

Vascular stiffness, endothelial dysfunction, chronic kidney disease, cholecalciferol

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