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Hemodiyaliz Hastalarında Diyalizatın Mikrobiyolojik Niteliğinin Enflamasyon Belirteçleri Üzerine Etkisi

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Inflammatory Markers in Hemodialysis Patients Effect of Dialysate Microbiological Properties

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Sayfa Aralığı:: 
162-169

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Abstract (Original Language): 
Hemodiyaliz tedavisi, son dönem böbrek yetmezlikli hastalarda uzun dönemde morbidite ve mortaliteye neden olan malnütrisyon, enflamasyon ve aterosklerozdan (MEA) oluşan geniş bir sendromun önemli bir parçası olan kronik enflamasyon ile birliktedir. MEA sendromunun etiyolojisinde birden çok sebep yer alsa da kullanılan diyalizat kökenli mikrobiyolojik bulaşmanın bu nedenler arasında önemli yer kapladığına inanılmaktadır. Bu inanış diyalizat içindeki bakteriyel ürünlerin diyalizör membranını kolayca geçip, bağışıklık sisteminde görev yapan hücreleri uyarıp, enflamatuvar araçların salınımına neden olduğu kanıtına dayanmaktadır. Birçok araştırmada bakteriyel ürünlerin hem düşük akımlı hem de yüksek akımlı diyalizörleri geçip mononükleer hücreleri uyararak, bu hücrelere TNF-α, IL-6 ve IL-1 gibi sitokinleri salgılattığı gösterilmiştir. Çalışmaya 21’i çalışma grubu, 21’i ise kontrol grubu oluşturmak üzere toplam 42 hemodiyaliz hastası alındı. Çalışma süresi 6 ay olarak belirlendi. Kronik enfeksiyon, enflamasyon ve malignansi durumları ile uzun süreli antibiyotik ve steroid kullanımı çalışma dışı bırakılma ölçütleri olarak kabul edildi. Daha önce geleneksel diyalizat kullanılan çalışma grubuna haftada 3 kez saf diyalizat ile düzenli hemodiyaliz tedavisi uygulandı. Kontrol grubundaki hastalar ise geleneksel diyalizatla aynı birimdeki diğer volüm kontrollü cihazlarla hemodiyalize devam ettiler. Çalışma sonunda, standart diyalizatla hemodiyalize giren kontrol grubu hastaların başlangıca göre hsCRP ve IL-6 düzeyleri arasında anlamlı fark yok iken, saf diyalizatla hemodiyalize giren çalışma grubunda hsCRP ve IL-6 düzeyleri anlamlı olarak azalmıştı (p<0.01). Sonuç olarak saf diyaliz, hemodiyaliz hastalarındaki enflamatuvar belirteçleri dolayısıyla kronik enflamatuvar durumu azaltmaktadır. Ancak bunun uzun dönem morbidite ve mortalite üzerine etkilerini görmek için daha uzun süreli ve daha fazla hasta sayılı çalışmalara gereksinim vardır.
Abstract (2. Language): 
Hemodialysis is associated with chronic inflammation, an important part of a wide syndrome spectrum consisting of malnutrition, inflammation and atherosclerosis (MIA) associated with increased longterm morbidity and mortality in end-stage renal failure. Although the etiology of the MIA syndrome is multifactorial, microbiological contamination of the dialysate is believed to be an important factor. It hs been demonstrated that bacterial products in the dialysate can easily pass through the dialyser membrane and cause the secretion of inflammatory mediators via the stimulation of the immune system. Bacterial products have been shown to pass both through low-flux and high-flux dialysers and cause the secretion of cytokines such as TNF-α, IL-6 and IL-1 by stimulating mononuclear cells. Forty-two patients (21 each in the study and patient groups) who were undergoing hemodialysis were included in this study. The study period was 6 months. Exclusion criteria were as follows; chronic infection, inflammation, malignancy and long-term antibiotic and steroid usage. Regular hemodialysis with ultrapure dialysate 3 times a week was performed in the study group, in whom a conventional dialysate was used previously. Hemodialysis with a conventional dialysate was continued in the control group patients, using other volumetric-controlled machines in the same unit. This study demonstrated that there was no significant difference between the beginning and end levels of hsCRP and IL-6 in the control group, in whom standard dialysate was used for hemodialysis. On the other hand, hsCRP and IL-6 levels were found to be significantly decreased in the study group who underwent hemodialysis with ultrapure dialysate (p<0.01). In conclusion; ultrapure dialysis decreases the inflammatory markers and consequently chronic inflammatory process in hemodialysis patients. Larger and long-term clinical studies are still needed to identify the long term effects of ultrapure dialysate on morbidity and mortality.

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DOI: 
DOI 10.5262/tndt.2010.1003.02

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Eyileten T ve ark: Hemodiyaliz Hastalarında Diyalizatın Mikrobiyolojik
Niteliğinin Enflamasyon Belirteçleri Üzerine Etkisi
Türk N efroloji D iyaliz ve Transplantasyon D ergisi
Turkish Nephrology, Dialysis and Transplantation Journal
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