| Abstract (croatian) | Cilj: Ispitati klinički značaj sindroma pothranjenosti, upale i ateroskleroze (PUA sindrom)
kao čimbenika srčanožilnog rizika u bolesnika na hemodijalizi. Bolesnici i metode: Istraživanjem
je obuhvaćeno 208 bolesnika liječenih redovitom hemodijalizom na Zavodu za nefrologiju
i dijalizu Kliničkog bolničkog centra Rijeka. Analizirano je 168 bolesnika, od toga 66 s
dijagnozom PUA sindroma, temeljenom na PUA zbroju dobivenom odgovarajućom bodovnom
ljestvicom. Praćeno je dvogodišnje preživljavanje i pobol bolesnika ovisno o nazočnosti PUA
sindroma. Bolesnici s PUA sindromom podijeljeni su u četiri skupine i liječeni atorvastatinom,
online hemodijafiltracijom (OL-HDF), Helixone® membranom ili dosadašnjim postupkom hemodijalize.
Analiziran je utjecaj liječenja na sastavnice PUA sindroma nakon 12 i 24 mjeseca
praćenja. Statistička analiza kliničkih i laboratorijskih varijabli vršena je primjenom odgovarajućih
testova u programskom paketu MedCalc 7,5 (MedCalc, Mariakerke, Belgium). Rezultati:
Prosječna dob bolesnika bila je 63 ± 13 godina, a spolna zastupljenost podjednaka. Najzastupljenija
osnovna bubrežna bolest bila je kronični glomerulonefritis (31,0 %). PUA sindrom bio
je nazočan u 39,3 % bolesnika. Smrtnost ovih bolesnika bila je značajno veća (36,4 % vs. 12,7 %,
P = 0,0006). Najčešći uzrok smrti bile su srčanožilne bolesti (62,2 %), među kojima najčešće infarkt
miokarda (24,3 %). Bolesnici liječeni atorvastatinom, OL-HDF, i Helixone® membranom
imali su značajno bolje preživljavanje od bolesnika liječenih standardnom hemodijalizom
(P = 0,0032). Nisu nađeni neovisni pretkazivači smrtnosti u bolesnika s PUA sindromom. Liječenje
atorvastatinom i OL-HDF nakon 12 i 24 mjeseca značajno je smanjilo serumske vrijednosti
C-reaktivnog proteina (P = 0,0161; P = 0,0425) i interleukina-6 (P = 0,0005; P = 0,021).
Zaključak: Atorvastatin, OL-HDF i primjena nove Helixone® membrane imaju povoljan učinak
u liječenju bolesnika s PUA sindromom. |
| Abstract (english) | Objectives. To evaluate the clinical significance of the Malnutrition-Inflammation-
Atherosclerosis (MIA) syndrome as a cardiovascular risk factor in the maintenance hemodialysis
patients. Patients and Methods. 208 maintenance hemodialysis patients were assessed
at the Nephrology and Dialysis Department of the University Clinical Hospital Rijeka.
A total of 168 patients were analyzed. The diagnosis of MIA syndrome was established using
the MIA score assessed with appropriate scale and it was present in 66 patients. Two-year
mortality and morbidity was followed according to presence of MIA syndrome. Patients
with MIA syndrome were randomized into 4 groups and treated with atorvastatin, online
hemodiafiltation (OL-HDF), Helixone® membrane, and standard hemodialysis. The MIA syndrome
parameters were evaluated after follow-uP of 12 and 24 months. A statistical analysis
was performed using the appropriate tests using the statistical software MedCalc 7.5 (Med-
Calc, Mariakerke, Belgium). Results. Mean patients age was 63±13 years with equal gender
distribution. The most common underlying renal disease was chronic glomerulonephritis (31.0 %). The MIA syndrome was present in 39.3 % of patients.
Their mortality was significantly higher (36.4 % vs.
12.7 %, P = 0.0006). Causes of death did not differ according
to the presence of MIA syndrome. The most common cause
of death was cardiovascular disease (62.2 %). The patients
treated with atorvastatin, OL-HDF and Helixone® membrane
had better survival than patients treated with standard hemodialysis
(P = 0.0032). Independent mortality predictors in
the patients with MIA syndrome were not found. Treatment
with atorvastatin and OL-HDF significantly reduced serum Creactive
protein levels (P = 0.0161; P = 0.0425) and serum
interleukin-6 levels (P = 0.0005; P = 0.021) after 12 and 24
months, respectively. Conclusion. Atorvastatin, OL-HDF and
use of the new Helixone® membrane was beneficial in the
treatment of patients with MIA syndrome. |
