Çocuk Diyaliz Hastalarında Anemi ve Aluminyum Düzeyleri

Year 2019, Volume: 3 Issue: 3, 79 - 84, 03.12.2019

Arzu Yazal Erdem , Nermin Uncu , Aysel Bulut Nilgün Çakar

Abstract

ÖZ

Amaç: Kronik böbrek
yetmezliği (KBY) glomerüler filtrasyon hızında geri dönüşsüz azalma olarak
tanımlanır. Kronik böbrek yetmezliğinde evre ilerledikçe anemi prevalansı %90’a
kadar ulaşır. Aneminin rekombinan insan eritropoetini (rHuEPO) ile
düzeltilemediği durumlarda, diyaliz yeterliliğinin, inflamasyonun, vitamin
düzeylerinin, hiperparatiroidinin, kan kayıplarının, kullanılan ilaçların,
serum aluminyum (Al) düzeyinin araştırılması gerekmektedir. Çalışmamızda
pediatrik diyaliz hastalarında anemi nedenlerini araştırmayı hedefledik.

Araçlar ve Yöntem: Bu kesitsel
prospektif çalışma periton diyalizi (PD) veya hemodiyaliz (HD) uygulanan çocuk
hastalarda yapıldı

Bulgular: : Çalışmaya toplam
49 hasta (K/E=27/22) alındı. Hastaların yaş ortalaması 12.65 (0.16-20) yıl,
ortalama diyaliz süresi 28 ay (1-108) idi. 35 hasta (%71.4) PD, 14 hasta
(%28.6) HD programında idi. Hastaların 37’sinde (%75.5) anemi saptandı. Anemik
hastaların ortalama Hemoglobin (Hb) 8.85±1.18 g/dl, Ortalama
Eritrosit Volümü (OEV) 86.40 ±5.01 fl bulundu.
Hemodiyaliz ve PD gruplarında sırasıyla ferritin ortalaması 831.35 (±545.05) ng/ml ve
450.05 (±313.15 ng/ml) bulundu (p=0.005).
Hastaların 7’si (%14.3) intravenöz (iv) demir, 24’ü (%49) oral demir preparatı
kullanmaktaydı. Parenteral demir kullanan hastalarda Hb ve ferritin düzeyleri
istatistiksel olarak anlamlı yüksekti (p<0.05). Kırkdokuz hastanın 42’si EPO
tedavisi kullanmaktaydı, EPO kullanma durumuna göre hastaların Hb düzeyleri
arasında fark bulunmadı. Serum Al düzeyi 37 hastada bakıldı. Hastaların
tamamının Al düzeyi güvenli sınırlar içindeydi.

Sonuç: Hastalarımızın
%63’ü demir, %85.7’si EPO tedavisi kullanmalarına rağmen, %75 sıklıkta anemik
olduklarını saptadık. Çalışmamızda, diyaliz hastalarımızın hiçbirinde Al
birikimi olmadığını gördük. Çocuk diyaliz hastalarında tedaviye rağmen anemi
sıklığının yüksek olmasının nedenlerine yönelik yapılacak daha kapsamlı
prospektif çalışmalar, hastaların bireysel tedavilerinin planlanmasına yardımcı
olacaktır.

Keywords

Çocuk, Diyaliz, Aluminyum Düzeyleri, Anemi

Anemia and Aluminium Levels in Child Patients with Dialysis

Abstract

ABSTRACT

Purpose: Chronic renal failure (CRF) is defined as
irreversible reduction in glomerular filtration rate. In chronic renal failure,
the prevalence of anemia reaches up to 90% as the stage progresses. In cases
where the anemia can not be corrected with recombinant human erythropoietin
(rHuEPO), it is necessary to investigate the adequacy of dialysis, presence of
inflammation, vitamin levels, hyperparathyroidism, blood loss, drugs used and
serum aluminum (Al) level. The aim of the study was to investigate the reasons
of anemia in pediatric patients with dialysis.

Materials and Methods: Our cross-sectional prospective study was
performed in children with CRF undergoing peritoneal dialysis (PD) or
hemodyalisis (HD).

Results: A total of 49 pediatric patients (F/M=27/22)
were enrolled into the study. The mean age of patients was 12.65 (range
0.16-20) years, the mean duration of dialysis was 28 months (range 1-108), 35
patients (71.4%) were on PD and 14 patients (28.6%) were on HD program. Anemia
was detected in 37 (75.5%) of the patients. The mean Hemoglobin (Hb) was
8.85±1.18 g /dl and mean corpuscular volume was (MCV) 86.40±5.01 fl in patients
with anemia. The mean ferritin was 831.35 (±545.05) ng/ml and 450.05 (±313.15)
ng/ml in the HD and PD groups, respectively (p=0.005). Seven patients (14.3%)
were using iv iron and 24 (49%) were using oral iron preparations. Hb and
ferritin levels were significantly higher in patients using parenteral iron (p
<0.05). Forty-two patients (85.7%) were using rHuEPO, and there was no
difference in the Hb levels of patients according to the use of rHuEPO. Serum
Al levels were within safe limits in all of the 37 patients.

Conclusion: We found that 75% of our patients were anemic,
despite the fact that 63% were using iron supplementation and 85.7% were using
rHuEPO therapy. In our study, we found that none of our dialysis patients had
Al accumulation. More extensive prospective studies are warranted to highlight
the causes of high anemia frequency in childhood dialysis patients, which will
help in planning of individual treatment of anemia.

Keywords

Child, Dialysis, Aluminum, anemia

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