Kronik böbrek hastalığı olan çocuklarda eritrosit uyarıcı ajan kullanımının ortalama trombosit hacmi, nötrofil/lenfosit oranı ve trombosit/lenfosit oranına etkisi

Yıl 2019, Cilt: 11 Sayı: 2, 193 - 199, 01.06.2019

Fatma Yazılıtaş , Evra Çelikkaya Fehime Kara Eroğlu , Gökçe Gür Can Evrim Kargın Çakıcı , Tülin Güngör Mehmet Bülbül

https://doi.org/10.21601/ortadogutipdergisi.417743

Öz

Amaç: Kronik böbrek hastalığı anemi, azalmış trombosit
üretimi, trombosit disfonksiyonu ve trombositoz gibi bazı hematolojik değişikliklerle
ilişkilidir. İnflamatuar belirteçler kronik böbrek hastalığı sürecinde
artmaktadır. Ortalama trombosit hacmi, nötrofil sayısının lenfosit sayısına oranı
ve trombosit sayısının lenfosit sayısına oranı enflamasyonun göstergesidir. Eritrosit
uyarıcı maddeler trombosit sayısını ve trombotik olayları arttırabilir. Bu çalışmada
Kronik böbrek hastalığı olan çocuklarda eritrosit uyarıcı ajan tedavisi sonrası
ortalama trombosit hacmi, nötrofil/lenfosit oranı ve trombosit/lenfosit oranı kullanımı
arasındaki ilişkiyi incelemeyi amaçladık.

Gereç ve Yöntem: Kronik böbrek hastalığı’ tanısı alan ve 2013-2018
yılları arasında eritrosit uyarıcı ajan ile tedavi edilen 30 hastanın dosyaları
retrospektif olarak incelendi.

Bulgular: Çalışmamıza 16 erkek ve 14 kız hasta dahil
edildi. Hastaların ortalama yaşı 10,6±5,4 yıl idi (ortanca 12; 1-17 yaş). Hastaların
12’si diyaliz öncesi, 9’u hemodiyaliz ve 9’u periton diyalizi grubundaydı. Hastaların
ortalama eritrosit uyarıcı ajan kullanım süresi ortanca 12,5 ay (aralık 1-127
ay) idi. Kronik böbrek hastalığı tanılı hastalarda eritrosit uyarıcı ajan ile tedavi
sonrası ortalama trombosit hacmi değerleri tüm gruplarda anlamlı olarak daha yüksek
saptandı. Eritrosit uyarıcı ajan ile tedavi sonrası trombosit/lenfosit oranlarında
anlamlı olarak farklılık gözlenmedi. Trombosit/lenfosit oranı, ortalama trombosit
hacmi, beyaz hücre sayısı ve monosit sayıları ile anlamlı ancak ters bir korelasyona
sahipti. Ortalama trombosit hacmi ve nötrofil/lenfosit oranı ölçümleri diyaliz modalitesinden
etkilenirken trombosit/lenfosit oranının etkilenmediği saptandı.

Sonuçlar: Bu çalışmada, sonuçlarımızdaki nedensellik
ve etki ilişkilerini raporlayamadık. Bununla birlikte, bu basit, ucuz, evrensel
yöntemler nefrologlar tarafından hastaların değerlendirilmesinde ilk adım olarak
kullanılabilir.

Anahtar Kelimeler

Kronik böbrek hastalığı, ortalama eritrosit hacmi, nötrofil/lenfosit oranı trombosit/lenfosit oranı, eritrosit uyarıcı ajan

The effect of erythrocyte stimulating agents on mean platelet volume, the platelet/lymphocyte ratio and the neutrophil/lymphocyte ratio in children with chronic kidney disease

Öz

Aim: Chronic kidney disease is associated with some hematologic changes
such as decreased platelet production, platelet dysfunction and thrombocytosis.
The inflammatory markers increase in chronic kidney disease. Mean platelet volume,
the ratio of neutrophil count to lymphocyte count, and the ratio of platelet count
to lymphocyte count are indicative of inflammation. Erythrocyte stimulating agents
can increase platelet count and thrombotic events. We aimed to determine the relationship
between the use of erythrocyte stimulating agents and mean platelet volume, the
neutrophil/lymphocyte ratio and the platelet/lymphocyte ratio in children with chronic
kidney disease in this study.

Material and Method: The files of 30 patients
diagnosed with chronic kidney disease and treated with erythrocyte stimulating agents
between 2013 and 2018 were reviewed retrospectively.

Results: The mean age of the patients (16 boys and 14 girls) was 10.6
± 5.4 years (median 12; 1-17 years). Twelve of them were in pre-dialysis, 9 in hemodialysis
and 9 in peritoneal dialysis group. The mean duration of use of erythrocyte stimulating
agents was 29.2 ± 34.8 months (median 12.5; 1-127 months). Mean platelet volume
values after treatment with erythrocyte stimulating agents
in chronic kidney disease patients were significantly higher in all groups.
The platelet/lymphocyte ratio values after treatment with erythrocyte stimulating
agents were not significant different in all groups. The platelet/lymphocyte ratio
had a significant but opposite correlation with mean platelet volume, white cell
count and monocyte counts. Mean platelet volume and the neutrophil/lymphocyte ratio
measurements were affected by dialysis modality. However the platelet/lymphocyte
ratio was not affected.

Conclusions: In this small retrospective
study, we could not report causality and effect associations in our results. Nevertheless, these simple, cheap,
universal methods may be used as the first step in the evaluation of patients by
nephrologists.

Anahtar Kelimeler

Children, chronic kidney disease, mean platelet volume, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio

Kaynakça

• Suresh M, Mallikarjuna RN, Sharan SM, Hari KB, Shravya KG, Chandrasekhar M. Heamatological changes in chronic renal failure. Int J Sci R Pub 2012; 2: 9.
• Streja E, Kovesdy CP, Greenland S, ve ark. Erythropoietin, iron depletion, andrelative thrombocytosis: A possible explanation for hemoglobin-survival paradox in hemodialysis. Am J Kidney Dis 2008; 52: 727-36.
• Jagroop IA, Clatworthy I, Lewin J, Mikhailidis DP. Shape change on human platelet-measurements with a channelyzer and visualisation by electron microscopy. Platelets 2000; 11: 28–32.
• Bancroft AJ, Abel EW, Mclaren M, Belch JJ. Mean platelet volume is a useful parameter: a reproducible routine method using a modified Coulter thrombocytometer. Platelets 2000 Nov; 11: 379-87.
• Balta S, Celik T, Mikhailidis DP, ve ark. The relation between atherosclerosis and the neutrophillymphocyte ratio. Clin Appl Thromb Hemost 2016 Jul; 22: 405-11
• Templeton AJ, Ace O, McNamara MG, ve ark. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2014; 23: 1204-12.
• Turkmen K, Erdur FM, Ozcicek F, ve ark. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int 2013; 17: 391-6.
• Sharpe PC, Desai ZR, Morris TCM. Increase in mean platelet volume in patients with chronic renal failure treated with erythropoietin. J Clin Pathol 1994; 47: 159-61.
• Yilmaz G, Sevinc C, Ustundag S, ve ark. The relationship between mean platelet volume and neutrophil/lymphocyte ratio with inflammation and proteinuria in chronic kidney disease. Saudi J Kidney Dis Transpl. 2017 Jan-Feb; 28: 90-4.
• Erçoban HS. Kronik böbrek yetmezliğinde ortalama trombosit hacmini etkileyen faktörler ve klinik önemi. Yan Dal Uzmanlık Tezi. Başkent Üniversitesi Pediatrik Nefroloji Bilim Dalı, 2008.
• Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group, “KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease,” Kidney Int 2012; 3: 1-150.
• Ishibashi T, Kimura H, Uchida T, Kariyone S, Friese P, Burstein SA. Human interleukin 6 is a direct promoter of maturation of megakaryocytes in vitro. Proc Natl Acad Sci U S A. 1989 Aug; 86: 5953-7.
• Berridge MV, Fraser JK, Carter JM, Lin FK. Effects of recombinant human erythropoietin on megakaryocytes and on platelet production in the rat. Blood 1988; 72: 970-7.
• Sylvestre LC, Fonseca KP, Stinghen AE, Pereira AM, Meneses RP, Pecoits-Filho R. The malnutrition and inflammation axis in pediatric patients with chronic kidney disease. Pediatr Nephrol 2007; 22: 864-73.
• Harmon JP, Zimmerman DL, Zimmerman DL. Anticoagulant and antiplatelet therapy in patients with chronic kidney disease: risks versus benefits review. Curr Opin Nephrol Hypertens 2013; 22: 624-8.
• Özdemir K, Kara OD, Dinçel N, Bulut İK, Yılmaz E, Mir S. Effect of erythropoietin use on mean platelet volume in children undergoing chronic dialysis. Journal of Clinical and Experimental Investigations 2014; 5: 415-9
• Bilen Y, Cankaya E, Keles M, ve ark. Does decreased mean platelet volume predict inflammation in chronic renal failure, dialysis, and transplanted patients? Ren Fail. 2014 Feb; 36: 69-72. (doi: 10.3109/0886022X.2013.832310). Epub 2013 Sep 13.
• Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102: 5-14.
• Bakkaloğlu S, Tumer N, Ekim M, Yalçınkaya F. Anemi and ertyhropoıetın treatment ın chronıc renal failure. Türk Nefrol Diyal ve Transplant Derg /Office Journal of the Turkish Nephrology, Association 1998; 2: 54-8
• Imtiaz F, Shafique K, Mirza SS, ve ark. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012; 5: 2.
• Boccardo P, Remuzzi G, Galbusera M. Platelet dysfunction in renal failure. Semin Thromb Hemost 2004; 30: 579-89.
• Taylor JE, McLaren M, Henderson IS, ve ark. Prothrombotic effect of erythropoietin in dialysis patients. Nephrol Dial Transplant 1992; 7: 235–9.
• Carter JM, Lin FK. Effects of recombinant human erythropoietin on megakaryocytes and a platelet production in the rat. Blood 1988; 72: 970-7.
• Fabris F, Cordiano I, Randi ML, ve ark. Effect of human recombinant erythropoietin on bleeding time, platelet number and function in children with end-stage renal disease maintained by haemodialysis. Pediatr Nephrol 1991 Mar; 5: 225-8.
• McDonald TP, Clift RE, Cottrell MB. Large, chronic doses of erythropoietin cause thrombocytopenia in mice. Blood 1992 Jul 15; 80: 352-8.
• Ünal M, Küçük A, Ünal GÜ, ve ark. Mean platelet volume, neutrophil to lyphocyte ratio and platelet to lymphocyte ratio in psoriasis.