Turkiye Klinikleri Journal of Internal Medicine

.: ORIGINAL RESEARCH
Diyal-TR Kayıt Çalışmasındaki Hastaların Bir Yıllık Takibindeki Kardiyovasküler Olaylar: İnterim Analiz Bulguları
Cardiovascular Events in One-Year Follow-Up of the Patients in the Diyal-TR Registry: Interim Results
Pınar KIZILIRMAKa, Tevfik ECDERb, Kenan ATEŞc, Mustafa ARICId, Siren SEZERe, Hakan KAPTANOĞULLARIf, Turgay ARINSOYg
aAmgen Inc. İstanbul, TÜRKİYE
bDemiroğlu Bilim Üniversitesi Tıp Fakültesi, Nefroloji BD, İstanbul, TÜRKİYE
cAnkara Üniversitesi Tıp Fakültesi, Nefroloji BD, Ankara, TÜRKİYE
dHacettepe Üniversitesi Tıp Fakültesi, Nefroloji BD, Ankara, TÜRKİYE
eAtılım Üniversitesi Tıp Fakültesi, Nefroloji BD, Ankara, TÜRKİYE
fBiruni Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Diyaliz Bölümü, İstanbul, TÜRKİYE
gGazi Üniversitesi Tıp Fakültesi, Nefroloji BD, Ankara, TÜRKİYE
Turkiye Klinikleri J Intern Med. 2020;5(3):105-11
doi: 10.5336/intermed.2020-75401
Article Language: TR
Full Text
ÖZET
 Amaç: Kronik hemodiyaliz (HD) tedavisi uygulanan hastalar, başta kardiyak ve enfeksiyöz nedenler olmak üzere morbidite ve mortalitenin yüksek seyrettiği bir grubu temsil etmektedir. Bu ara analizde, Diyal-TR kayıt çalışmasındaki kronik HD tedavisi uygulanan hastalarda, 1 yıllık izlemde gözlenen kardiyovasküler (KV) olayların incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu prospektif çalışmaya, 27 Ocak 2017-8 Şubat 2018 tarihleri arasında Türkiye'deki 93 merkezde son dönem böbrek hastalığı nedeni ile kronik HD tedavisine başlanan hastalar dâhil edilmiştir (n=2.461). Hastaların, 1 yıl süre ile 3 ay arayla yapılan vizitlerindeki klinik özellikleri incelenmiştir. KV ölüm, KV nedenle hastaneye yatış ve KV olaydan oluşan bileşik sonlanım noktası; yaş grubu, beden kitle indeksi (BKİ) (BKİ <23 kg/m2 veya ≥23 kg/m2), albümin düzeyi (<3,5 g/dL veya ≥3,5 g/dL) ve anemi durumuna göre karşılaştırılmıştır. Bulgular: Toplam 123 (%5,0) hastada, bileşik sonlanım noktasına ulaşılmıştır. Tüm nedenlere bağlı ölüm 80 (%3,3) hastada bulunmuştur. Bileşik sonlanım noktası ≥65 yaş hastalarda (%7,0), genç hastalara (%4,2) kıyasla anlamlı olarak daha fazla gerçekleşmiştir (p<0,01). BKİ'nin düşük olduğu hastalarda, yüksek olanlara kıyasla bileşik sonlanım noktası (%7,1'e karşı %4,5; p=0,02) ve KV ölüm (%2,1'e karşı %0,8; p=0,02) daha fazla gözlenmiştir. Hemoglobin düzeyi <10 g/dL olan hastalarda KV ölüm oranının (%2,2), hemoglobin düzeyi >12 g/dL olanlardakine (%0,6) kıyasla anlamlı olarak daha yüksek olduğu belirlenmiştir (p=0,03). Sonuç: Kronik HD tedavisi alan hastaların, 1 yıllık takibine ilişkin bu ara analizde, KV olayların başlangıçta ileri yaş, anemi ve düşük BKİ ile daha fazla görüldüğü ortaya konmuştur. Anemisi ve düşük BKİ olan kişilerde, KV ölümün de daha yüksek oranda gözlenmesi, kronik HD hastalarında anemiyi ve kısmen malnütrisyonu gidermeye yönelik stratejilerin gerekliliğine işaret etmektedir.

Anahtar Kelimeler: Böbrek diyalizi; kronik böbrek hastalığı; kayıt çalışması; anemi; malnütrisyon; kardiyovasküler olaylar
ABSTRACT
 Objective: Patients on chronic hemodialysis (HD) treatment represent a population with high morbidity and mortality, especially of cardiac and infectious origin. This interim analysis aimed to examine cardiovascular (CV) events observed during the one-year follow-up of patients on chronic HD treatment in Diyal-TR registry. Material and Methods: This prospective analysis included patients (n=2461) who were initiated chronic HD treatment due to end-stage renal disease in 93 centers across Turkey between 27 January 2017 and 8 February 2018. Data on patients' clinical characteristics were collected at every 3 months during their routine visits for one year. The composite endpoint of CV death, CV hospitalization, or CV event was compared by the age group, body mass index (BMI) (BMI <23 kg/m2 vs ≥23 kg/m2), albumin (<3.5 g/dL vs ≥3.5 g/dL), and anemia status of the patients. Results: The composite endpoint occurred in 123 (5.0%) patients. All-cause death was seen in 80 (3.3%) patients. The composite endpoint was significantly higher in ≥65-year-old patients (7.0%) than that in their younger counterparts (4.2%, p<0.01). Compared to those with high BMI, patients with low BMI had significantly higher rate of the composite endpoint (4.5% vs. 7.1%, p=0.02) and of CV death (0.8% vs. 2.1%, p=0.02).Patients with hemoglobin level of <10 g/dL had significantly higher CV death rate (2.2%) compared to that in those with hemoglobin level of >12 g/dL (0.6%, p=0.03). Conclusion: This interim analysis of patients on chronic HD treatment after oneyear follow-up showed higher rate of CV events with baseline advanced age, anemia, and low BMI. Increased rate of CV death in patients with anemia or low BMI seems to indicate the need for strategies that would reverse anemia nd -to some extent- malnutrition in patients receiving chronic HD treatment.

Keywords: Renal dialysis; chronic kidney disease; registries; anemia; malnutrition; cardiovascular events
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