| Sažetak (hrvatski) | Anemija je dobro poznata posljedica kronične bubrežne bolesti, a učestalost joj raste s napredovanjem bubrežnog zatajenja, te se u završnom stadiju kronične bubrežne bolesti pojavljuje u čak do 95% bolesnika. Pripravci eritropoetina lijekovi su kojima se posljednjih godina postiže najveći napredak u liječenju bubrežne anemije. Cilj je istraživanja bio analizirati utječe li liječenje bubrežne anemije u bolesnika s kroničnom bubrežnom bolesti koji se još ne liječe dijalizom na ishode njihova liječenja, smanjuje li u učestalost srčanožilnih bolesti, odgađa li potrebu za liječenje dijalizom, smanjuje li pobol i smrtnost te smanjuje li učestalost neželjenih kardiovaskularnih događaja. Tijekom dvogodišnjeg razdoblja analizirali smo 62 bolesnika s kroničnom bubrežnom bolesti. Bolesnici su bili podijeljeni u dvije skupine. U prvoj su skupini (N=31) bolesnici u kojih je u liječenju bubrežne anemije primijenjen eritropoetin, a drugu skupinu (N=31) ine bolesnici u kojih su primijenjene druge mjere liječenja anemije kronične bubrežne bolesti, ali ne eritropoetin, zbog bilo kojeg razloga. Tijekom dvogodišnjega razdoblja u svakog su bolesnika u razmacima od najdulje 6 mjeseci praćeni laboratorijski parametri liječenja kronične bubrežne bolesti i bubrežne anemije. Evidentiran je broj hospitalizacija za svakog pojedinog ispitanika i uzet u obzir uzrok hospitalizacije te broj dana provedenih u bolnici. U dvogodišnjem razdoblju nije bilo statistički bitne razlike u promjenama biokemijskih pokazatelja (Fe, feritin, CRP, albumini, kalcij, fosfor), kao ni u vrijednostima glomerulske iltracije između ispitivanih skupina, ali je uočena tendencija sporije progresije bubrežnog zatajenja u bolesnika koji su primali eritropoetin u odnosu na bolesnike koji nisu primali taj pripravak. Uočeno je statistički bitno manje hospitalizacija zbog neželjenih kardiovaskularnih događaja u skupini bolesnika koja je primala eritropoetin. Zaključeno je da je bubrežna anemija povezana s povećanim morbiditetom i mortalitetom te sa smanjenom kvalitetom života bolesnika. Stoga je neophodno što ranije prepoznavanje i adekvatno liječenje tih bolesnika da bi im se produljio životni vijek i poboljšala kvaliteta života. |
| Sažetak (engleski) | Introduction: In the last ten years or so, there has been a steady increase in the number of patients with chronic kidney disease and those with end-stage renal failure who require some form of renal replacement therapy. Anemia is a well-known consequence of chronic kidney disease; its prevalence increases with the progression of renal failure and occurs in up to 95% of patients in the inal stages of chronic kidney disease. In recent years, the greatest advance in the treatment of renal anemia has been made by the introduction of erythropoietin preparations, the application of which has signiicantly improved the patients’ quality of life. The aim of this study was to analyze whether the treatment of renal anemia in chronic kidney disease patients not treated by dialysis affects the outcome of their treatment, reduces the incidence of cardiovascular diseases, delays the need of dialysis, reduces morbidity and mortality, and reduces the incidence of adverse cardiovascular events. Subjects and Methods: The study included patients with chronic kidney disease presenting for regular outpatient follow up at Department of Nephrology and Dialysis, Rijeka University Hospital Center. Patients were divided into two groups. Group 1 included patients whose renal anemia was treated with erythropoietin and group 2 patients whose anemia of chronic kidney disease
was treated in any other way, regardless of the reason for the exclusion of erythropoietin. Each group included 31 patients with chronic kidney disease. During two years, each patient’s laboratory parameters of chronic renal disease and renal anemia treatment were monitored at intervals not longer than six months. In addition, each patient’s number of hospitalizations was recorded, taking into account the cause of hospitalization and the number of days spent in hospital. Results: During the two-year period, 62 patients with chronic kidney disease were analyzed (31 patients in the groups receiving and not receiving erythropoietin each). The mean age was 66±13.5 in the group receiving erythropoietin and 68±13.6 in the group not receiving erythropoietin. There were 70% of men and 30% of women in the former group, and 53% of men and 47% of women in the latter group. Examination for comorbid conditions (diabetes, hypertension, hyperlipoproteinemia and previous stroke) revealed no statistically signiicant differences between the two groups of patients. There were no statistically signiicant differences in changes of biochemical parameters (Fe, ferritin, CRP, albumin, calcium, phosphorus) between the two groups of patients during the two-year period either. There was no statistically signiicant between group-difference in the glomerular iltration rate after two years, but a tendency of slower progression of renal failure was observed in patients having received erythropoietin as compared to those who did not receive erythropoietin. Moreover, the number of hospitalizations due to adverse cardiovascular events was statistically signiicantly lower in patients that received erythropoietin, while there was no statistically signiicant difference in the total number of hospitalizations, hospitalizations for other indications (infection, bleeding, and worsening of renal failure), or total number of days spent in hospital, regardless of indication. Conclusion: The number of patients with chronic kidney disease and those with end-stage renal failure requiring renal replacement therapy is increasing. Renal anemia, which occurs as a consequence of chronic kidney disease, is associated with increased morbidity and mortality, and with a reduced quality of life in these patients. Consequently, it is necessary to recognize this condition and apply appropriate treatment early in order to prolong life and improve the quality of life of patients with chronic kidney disease. |
