Turkiye Klinikleri Journal of Internal Medicine

.: ORIGINAL RESEARCH
Son Dönem Böbrek Yetersizliğinde Aterojenite ve Asimetrik Dimetilarjininin Yeri: Prospektif Gözlemsel Bir Çalışma
Atherogenicity in the End Stage Renal Disease and the Role of Asymetric Dimethylarginine: A Prospective Observational Study
Fatma KESKİN UZUNDEREa , Osman UZUNDEREb , Sedat ÜSTÜNDAĞc
aDiyarbakır Bismil Devlet Hastanesi, Dahiliye Kliniği, Diyarbakır, Türkiye
bSağlık Bilimleri Üniversitesi Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Bölümü, Diyarbakır, Türkiye
cTrakya Üniversitesi Tıp Fakültesi, Nefroloji BD, Edirne, Türkiye
Turkiye Klinikleri J Intern Med. 2023;8(2):58-67
doi: 10.5336/intermed.2022-93688
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmanın amacı, son dönem böbrek yetersizliği olan hastalarda asimetrik dimetilarjinin (ADMA) düzeyleri ile ateroskleroz gelişimi arasındaki ilişkinin incelenmesidir. Gereç ve Yöntemler: Prospektif, gözlemsel ve kohort bir araştırma olarak planlanan bu çalışmaya 31 hemodiyaliz (HD), 28 periton diyalizi (PD) tedavisi alan ve 25 prediyaliz hastası dâhil edilmiştir. Her üç grubun ADMA, karotis arter intima-media kalınlığı, interlökin-6 (IL-6), interselüler adezyon molekülü-1 ve vasküler adezyon molekülü-1 düzeyleri ölçüldü. Öncelikle henüz diyaliz tedavisi başlanmamış son dönem kronik böbrek hastalığı olan hasta grubu ile diyaliz tedavisi uygulanan hastalar ADMA düzeyleri ve ADMA ile ateroskleroz göstergeleri arasında ilişki açısından karşılaştırıldı. Sonra HD veya PD tedavisi gören hastalar da ADMA düzeyleri ve ateroskleroz göstergeleri açısından karşılaştırıldı. Bulgular: Renal replasman tedavisi almayan prediyaliz grubu hastalarına kıyasla renal replasman tedavisi alan hastalarda karotis arter intima-media kalınlığı (p=0,016) ve IL-6 (p=0,009) düzeylerinin anlamlı olarak daha yüksek olduğu saptandı. PD uygulanan hastaların ADMA düzeylerinin HD uygulanan hastalara göre 0,1 µmol/L düşük olduğu saptandı, ancak bu fark istatistiksel olarak anlamlı değildi (p>0,05). ADMA ile karotis arter intima-media kalınlığı (r=0,371; p=0,001) ve IL-6 düzeyleri (r=0,240; p=0,035) arasında pozitif yönlü korelasyon olduğu saptandı. Karotis intima media kalınlığı ile IL-6 (r=0,321; p=0,004) ve serum kreatinin (r=0,377; p=0,015) düzeyleri arasında pozitif yönlü korelasyon olduğu saptandı. Sonuç: Bu çalışmada, son dönem böbrek yetersizliği gelişmiş hastalarda ateroskleroz gelişiminde geleneksel ateroskleroz risk faktörlerinin yanı sıra artmış ADMA düzeyi ve inflamasyon artışı gibi yeni risk faktörlerinin etkili olduğu saptanmıştır.

Anahtar Kelimeler: Asimetrik dimetilarjinin; ateroskleroz; nitrik oksit; son dönem böbrek hastalığı
ABSTRACT
 Objective: The aim of this study is to investigate the relationship between asymmetric dimethylarginine (ADMA) levels and the development of atherosclerosis in patients with end-stage renal disease. Material and Methods: This study, which was planned as a prospective, observational and cohort study, included 31 hemodialysis (HD), 28 peritoneal dialysis (PD) and 25 predialysis patients. ADMA, carotid artery intima-media thickness, interleukin-6 (IL-6), intercellular adhesion molecule 1 and vascular cell adhesion molecule 1 levels were measured in all three groups. First of all, the patients with endstage chronic kidney disease who have not started dialysis treatment and the patients who received dialysis treatment were compared in terms of ADMA levels and the relationship between ADMA levels and atherosclerosis indicators. Then, patients receiving HD or PD were compared in terms of ADMA levels and atherosclerosis indicators. Results: Carotid artery intima-media thickness (p=0.016) and IL-6 (p=0.009) levels were found to be significantly higher in patients who received renal replacement therapy compared to patients in the predialysis group who did not receive renal replacement therapy. ADMA levels of the patients who underwent PD were found to be 0.1 µmol/L lower than the patients who underwent HD, but this difference was not statistically significant (p>0.05). A positive correlation was found between ADMA and carotid artery intima-media thickness (r=0.371; p=0.001) and IL-6 levels (r=0.240; p=0.035). A positive correlation was found between carotid intima-media thickness and IL-6 (r=0.321; p=0.004) and serum creatinine values (r=0.377; p=0.015). Conclusion: In this study, it was determined that in addition to traditional atherosclerosis risk factors, new risk factors such as increased ADMA level and increased inflammation were effective in the development of atherosclerosis in patients with end-stage renal disease.

Keywords: Asymmetric dimethylarginine; atherosclerosis; nitric oxide; end-stage renal disease
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