Uticaj sekundarnog hiperparatireodizma na lečenje anemije kod bolesnika na hroničnom programu hemodijalize

  • Nedim Hamzagić Medical Center Tutin, Center of Hemodialysis
  • Marija Andjelković Clinical Center Kragujevac, Center of Laboratory Diagnostics
  • Marijana Stanojević Pirković Clinical Center Kragujevac, Center of Laboratory Diagnostics
  • Petar Čanović University of Kragujevac, Faculty of Medical Sciences
  • Vesna Ignjatović University of Kragujevac, Faculty of Medical Sciences
  • Amra Ramović State University of Novi Pazar
  • Dejan Petrović Garnizonska ambulanta Kragujevac
DOI: https://doi.org/10.2298/VSP171219107H
Ključne reči: anemija;, eritropoetin;, hemodijaliza;, faktori rizika;, vitamin d

Sažetak


Uvod/Cilj. Anemija je česta komplikacija kod bolesnika na hemodijalizi. Na lečenje anemije utiču: nedostatak gvožđa, nedovoljna doza eritropoetina, mikroinflamacija, nedostatak vitamina D, povećana koncentracija intaktnog paratire­oidnog hormona i neadekvatna hemodijaliza. Cilj rada bio je da se utvrdi prevalenca nedostatka vitamina D, kao i njegov uticaj na koncentraciju hemoglobina u krvi, status gvožđa, mikroinflamaciju, malnutriciju, adekvatnost hemodijalize i dozu eritropoetina kod bolesnika na redovnoj hemodijalizi. Metoda. Ispitivanjem je bilo obuhvaćeno 120 bolesnika podeljenih u tri grupe: grupa sa teškim deficitom vitamina D – koncentracija 25-hidroksi vitmina D [25(OH)D] < 10 ng/mL; grupa sa deficitom vitmina D – koncentracija 25(OH)D 10–20 ng/mL; grupa sa nedovoljnim nivoom vitamina D – koncentracija 25(OH)D > 20 ng/mL. Za statističku analizu korišćeni su: Kolmogorov Smirnov test, jednofaktorska parametarska analiza varijanse-ANOVA i Kruskal-Wallis-ov test. Rezultati. Prevalenca snižene koncentracije 25(OH)D u serumu bolesnika koji su se lečili redovnom hemodijalizom iznosila je 75,83%, a prevalenca teškog nedostatka vitamina D 24,17%. Bolesnici sa teškim deficitom vitamina D u serumu imali su statistički značajno nižu koncentraciju hemoglobina u krvi, hematokrita, kon­centraciju ukupnih proteina i albumina u serumu i vrednosti parametara adekvatnosti hemodijalize. Koncentracija C-reaktivnog proteina u serumu bila je statistički značajno viša kod bolesnika sa teškim deficitom vitamina D u serumu, u odnosu na bolesnike sa koncentracijom 25(OH)D u serumu ≥ 10 ng/mL. Zaključak. Bolesnici sa teškim deficitom vi­tamina D u serumu imaju manju koncentraciju hemoglobina u krvi, manje adekvatnu hemodijalizu, značajnu mikro-inflamaciju, malnutriciju, poremećaj metabolizma koštanog tkiva i zahtevaju veću dozu eritropoetina u odnosu na bolesnike sa koncentracijom 25(OH)D ≥ 10 ng/mL. Vitamin D je značajan faktor rizika od razvoja i lečenja anemije kod bolesnika na redovnom programu hemodijalize.

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Objavljeno
2021/05/06
Broj časopisa
Vol. 77 Br. 5 (2020): Vojnosanit Pregl
Rubrika
Originalni članak