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Diyaliz Öncesi Nefrolojik Takibin Hemodiyalize Başlayan Hastalarda Morbidite Açısından Yeri Ve Önemi

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Importance of Nephrologic Care on Morbidity in Chronic Renal Failure Patients Before Hemodialysis

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Sayfa Aralığı:: 
116-120

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Abstract (Original Language): 
Nefrolojideki gelişmelere rağmen hemodiyalize başlayan SDBY hastalarında morbidite ve mortalite halen yüksektir. Diyaliz öncesi nefrolojik takibin (PDNT) erken ve düzenli olarak yapılmasının, KBY hastalarında ilk yıl içerisindeki morbiditeyi azaltabileceği ve iyi bir klinik seyir sağlayacağı düşünülmektedir. Çalışmamıza nefroloji kliniğinde takip edilen KBY hastaları (PDNT grup, n=28) ile, takip edilmeden acil olarak HD’e alınan hastalar (Acil-HD grup, n=27) alındı. Hastalar, ilk yıldaki klinik ve biyokimyasal parametrelerin seyri açısından retrospektif olarak karşılaştırıldı. Çalışma başlangıcında: düşük Htc değerleri (p<0,0001), yükselmiş diyastolik-KB değerleri (p=0,014) ve yüksek serum kreatinin değerlerinin (p=0,0001) acilHD grubunda anlamlı bir şekilde farklı olduğu saptandı. Bir yıldaki izlem sürecinde: Acil-HD grubunda eritropoietin (EPO) ihtiyacı tüm yıl boyunca yüksek idi (p=0,0001). Acil-HD grubunda hospitalizasyon sayısı (p=0,001), süresi (p=0,037) ile birlikte inter-diyalitik kilo alımı (IDWG) değerlerinin (p=0,00001) tüm yıl boyunca yüksek olduğu gözlendi. Acil-HD grubunda kreatinin seviyeleri hep yüksek seyrediyordu (p=0,0001). Serum CRP düzeyleri 1. yılın sonunda PDNT grubunda iyileşiyordu (p=0,01). PDNT grubunda sistolik KB değerlerinin 6. ayda normale döndüğü gözlendi (p=0,009). PDNT grubunda 1. yılın sonunda Ejeksiyon Fraksiyonu (EF) değerleri daha da iyileşiyordu (p=0,0001). Sonuçlarımız PDNT’in SDBY hastalarında anemiyi düzeltme, kardiyovasküler durumu ve morbiditeyi azaltma açısından önemini vurgulamaktadır.
Abstract (2. Language): 
Despite advances in nephrology, morbidity and mortality of ESRD patients remain high on hemodialysis (HD). Pre-dialysis nephrologic care (PDNC) might be expected to result in decreased morbidity and better clinical outcome for the first year on HD. In study, CRF patients referred to nephrology clinic (PDNC group, n=28) and those urgently underwent HD (UHD group, n=27) were evaluated for the progress of clinical and biochemical parameters in the first year. At the enrollment, observed differences between groups were: lower Htc ratios (p<0,0001), higher diastolic BP (p=0,014) and higher serum creatinine levels (p=0,0001) in UHD. In the first year, EPO need was higher in UHD (p=0,0001). Higher hospitalization rates (p=0,001) and longer durations (p=0,037) were observed in UHD. IDWG measurements were higher in UHD (p=0,00001). At the end of first year and creatinine levels were higher in UHD (p=0,0001). CRP levels were improved in PDNC (p=0,01). Systolic BP was improved and normalized at 6th month (p=0,009) in PDNC. Ejection fraction was improved at the end of first year in PDNC (p=0,0001). These results impacts the importance of PDNC by reducing morbidity, correcting anemia and preserving cardiovascular status in ESRD patients

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