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Hemodiyaliz Hastalarında AV Fistül Yetersizliğinin Yol Açtığı Komorbid Sonuçların Fistül Kan Akım Hızı Üzerine Etkileri

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Effects of Comorbidities Due to AV Fistula Insufficiency on Fistula Blood Flow Rate in Hemodialysis Patients

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Sayfa Aralığı:: 
101-105

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Amaç: Arteriyovenöz (AV) fistüller kronik hemodiyaliz hastalarının en çok tercih edilen damar ulaşım yerleridir. Bu çalışmada 38 hastaya açılan A V fistülün yeterlilik durumları değerlendirilmiş, ihtiyaç duyulan 350 mL/dk kan akım hızına (KAH) ulaşılamayan sorunlu fistüller ile hastalara ait klinik ve laboratuvar değerler arasındaki ilişki araştırılmıştır. Yöntem-Gereçler: Çalışmaya 38 hemodiyaliz hastası (26 erkek, 12 kadın) alınmıştır. KAH'ı 350 mL/dk'nın altında olanlar " 1 . Grup", KAH'ı 350 mL/dk ve üzerinde diyaliz yapılanlar ise "2. Grup" olarak değerlendirilmiş, gruplar birbirleriyle demografik, klinik, biyokimyasal ve fistül lokalizasyon özelliklerine göre karşılaştırılmıştır. Bulgular: Yaş, cinsiyet, diyaliz süresi, vücut kitle indeksi (VKİ), sigara kullanım oranları, diyabet varlığı, hipertansiyon varlığı ve se¬ rum total kolesterol düzeyleri açısından gruplar arasında istatistik¬ sel olarak anlamlı bir farklılık saptanmamıştır. Düşük KAH ile diya¬ liz yapılan grubun hemoglobin ve serum albümin düzeyi, 2. gruba göre istatistiksel olarak ileri düzeyde anlamlı düşük bulunmuştur. Düşük KAH'lı grubun serum kalsiyum-fosfor çarpımı ve parathormon düzeyleri ise 2. gruptan istatistiksel olarak anlamlı düzeyde yüksek saptanmıştır. Düşük KAH'a hemoglobin, serum albümin, serum kalsiyum-fosfor çarpımı ve parathormon düzeyinin etkileri değerlendirilmiş, modelin ileri düzeyde anlamlı bulunduğu ve serum albümin düzeyi ile serum kalsiyum-fosfor çarpımının düşük kan akım hızına negatif yönlü bir etkisi olduğu görülmüştür. Sonuçlar: 350 mL/dk KAH'ın altında yapılan diyalizde, prognostik değeri kanıtlanmış olan serum albümin, hemoglobin, parathormon ve serum kalsiyum-fosfor çarpım düzeylerinin olumsuz etki¬ lendiği aşikârdır.
Abstract (2. Language): 
Introduction and Aims: Arteriovenous (AV) fistulas are the most frequently used blood vessel entrances in chronic hemodialysis patients. In this study the appropriateness of A V fistulas in 38 patients were evaluated and the association between the problematic fistulas which can not reach the required blood flow rate (BFR) of 350 mL/min, and the clinical and laboratory values of the patients were investigated. Methods: Thirty-eight hemodialysis patients (mean age 58 years [35-79 years], 26 males [%68.4], 12 females [% 31.6]) were included in the study. Patients were allocated according to their blood flow rate: Group 1 (<350 mL/min; n: 21) and Group 2 (>350 mL/min; n: 17). Groups were compared for their demographic, clinical and biochemical data, and localization of fistula. Results: No statistically significant difference was found between the groups by means of age, gender, the duration of dialysis, the body mass index (BMI), smoking, presence of diabetes and hypertension and serum total cholesterol levels. The level of serum albumin and hemoglobin of the dialysis patients with low BFR was highly statistically significantly low compared to the second group of dialysis patients with BFR of over 350 mL/min. The multiplicati¬ on of serum calcium and phosphorus and the level of parathormon of the l ow BFR group were found to be statistically significantly high compared to the second group. When we evaluated the ef¬ fects of parameters such as hemoglobin, serum albumin, multipli¬ cation of serum calcium-phosphorus and parathormon levels on low blood f l ow rate during hemodialysis; it was observed that the model was found highly significant and the level of serum albumin and the multiplication of serum calcium and phosphorus had a ne¬ gative effect on low blood f l ow rate. Conclusions: In dialysis performed with a rate of lower than 350 mL/min; serum albumin, hemoglobin, parathormon levels and the multiplication of serum calcium and phosphorus, which had approved prognostic value, were adversely affected.

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