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Hemodiyaliz Hastalarında İskemik Kalp Hastalığının Tanı ve Tedavisi

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2004
Author Name
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Abstract (Original Language): 
Genel Bilgiler Kronik böbrek hastalığı olanlarda kardiyovas-ktiler sistem (KVS) hastalıklarından kaynaklanan morbid ite ve mortalite riski çok yüksektir (1). Bu risk klasik faktörlerden kısmen etkilenirken, özellikle renal yetmezlik ve hemodiyaliz (HD) işleminin kendisinden de oldukça etkilenmektedir (2). Diyaliz hastalarının yıllık mortalite oranının %24 okluğu ve bu ölümlerin %4'i'îinden KVS hastalıklarının sorumlu olduğu ifade edilmekledir (3). Diyaliz hastalarında nıiyokard enfarktüsü (MI) sonrası 1, 2 ve S yıllık mortalite oranlan sırasıyla %59, %73 ve U90 olarak bulunmuştur (4). Böbrek Hastasında Aterogenez Diyaliz hastalarmdaki akselere aterogenezden ilk kez 1970'lerde bahsedilmiştir (5). Kontrol vakalarına oranla, klinik ve subklinik ateromatöz hastalık prevalansı böbrek yetmezliğinde daha yüksek bulunmuştur. Aterojen faktörlerin başında dislipidemi, homosistein. lipoprotein (a) |lp(a)] ve fibrinojen düzeyleri gelmektedir (6,7). Üremide mikroenflanıatuar durum, malnütrisyon ve ate-roskleroz arasındaki ilişki dikkat çekicidir (8). Son yıllarda koroner arter hastalığı KAH için bağımsız prediktörler arasına enllamasyon marker-leri de girmiştir. Aterogenezden enfeksiyon ajanları da (Chlamydia pneumoniae, herpes simplex virüsü, Helicobacter pylori, sitomegalovirüs) sorumlu tutulmaktadır. Büyük ölçekli epidemiyolo-jik çalışmalar "highly sensitive" creak t if proein (CRP) plazma düzeylerinin MI, inme ve periferik arter hastalıkları için kuvvetli prediktör olduğunu ortaya koymuştur. Aterogenezde yer alan CRP, adezyon moleküllerinin ekspresyonunu tetikler. Bunun yanında fibrinojen, interlökinler (IL-6, IL-1), serum amiloid A (S AA) için de benzer sonuçlara ulaşılmıştır. Preterminal ve HD hastalarında proenflamatuar sitokinler (IL-6, ILI, CRP, TNF-Ct) artmıştır ve HD işlemi bunların düzeylerini daha da artırır (9).
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Official Journal of the Turkish Society of Nephrology I Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi
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, Diyaliz ve Transplantasyon Dergisi /Official Journal of the Turkish Society of Nephrology
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