Hipervolemik ve ultrafiltrasyon yetmezliği olan periton diyalizi hastalarında çift doz icodextrinin etkinliği

Abstract

ÖZETAmaç: Bu çalisma hipervolemik ve ultrafiltrasyon yetmezligi olan peritondiyalizi hastalarinda çift doz kullanilan icodextrinin olasi klinik ve laboratuaretkilerini göstermek amaciyla yapildi.Hastalar ve Metod: Otuz dört PD hastasi iki gruba ayrildi. Birinci gruptaki17 hasta çift doz icodextrin, ikinci gruptaki diger 17 hasta ise tek doz icodextrinkullandi. Bu solüsyonlar diger dializ solüsyonlariyla kombine edildi. Tüm hastalar üçay takip edildi. Peritoneal esitlenme testi %2.27 glikoz içeren solüsyonla yapildi.Kt/V ve haftalik kreatinin klirensi hesaplandi. Idrar ve ultrafiltrasyon volümleri,vücut kitle indeksi, serum ozmolaritesi ve biyokimyasal parametreler degerlendirildi.Sol ventrikül kitlesini (LVM) ölçmek amaciyla ekokardiyografi yapildi.Yirmi dörtsaatlik kan basinci ölçümleri gerçeklestirildi. Tüm testler üçüncü aydan sonratekrarlandi.Bulgular: Her bir grupta üçüncü ay sonunda haftalik kreatinin klirensi, Kt/V,serum ozmolaritesi ve idrar volümleri açisindan istatistiksel olarak fark yoktu(p>0.05). Çift doz icodextrin kullanimi ile ultrafiltrasyon miktarinda artis gözlendi(p<0.05). Üçüncü ay sonunda LVM, total protein ve albümin, serum total kolesterolve HDL, sistolik ve diyastolik kan basinçlarinda çift doz icodextrin kullanan gruptaazalma izlendi (p<0.05). Tek doz icodextrin kullanan grupta da LVM, serum HDL vetrigliserit düzeyleri azaldi (p<0.05). Ancak günlük ultrafiltrasyon miktari, kanbasinci, vücut kitle indeksi, BUN ve kreatinin, serum total protein ve albümindüzeylerinde anlamli degisiklik olmadi (p>0.05).vSonuç: Çift doz icodexrin kullanimi kan basinci regülasyonu, LVM ve serumkolesterol düzeylerini azaltmada tek doz icodextrine göre daha etkilidir. Tek dozicodextrin kullanimi sol ventrikül kitlesini azaltir ancak bu durum ultrafiltrasyonvolümü ve kan basinci ile iliskili bulunmamistir.Anahtar kelimeler: Kan basinci, hipervolemi, icodextrin, sol ventrikülkitlesi, periton diyalizi, ultrafiltrasyon yetmezligi

EFFECT OF THE DOUBLE DOSE ICODEXTRIN USEON HYPERVOLEMIC PERITONEAL DIALYSISPATIENTS WITH ULTRAFILTRATION FAILUREABSTRACTAim: This study was performed to reveal the possible clinical and laboratoryeffects of double icodextrin administration on hypervolemic peritoneal dialysispatients with ultrafiltration failure.Patients and Method: Thirty four PD patients were randomized into twogroups. In the first group 17 patients were treated with double dose icodextrin and,in the second group the other 17 patients were treated with one dose icodextrincombined with varying doses of other peritoneal dialysis solutions. All patients had afollow-up period of three months. The peritoneal equilibration test is performed witha 2.27% glucose solution. Kt/V and weekly creatinine clearence were calculated.Urine and ultrafiltration volumes, body mass index, serum osmolarity andbiochemical parameters were evaluated. Echocardiography was performed forinterpretation of the left ventricular mass (LVM). Blood pressure measurements wereassessed with 24 hour-ambulatory monitoring. All tests were repeated after the thirdmonth.Results: Weekly creatinine clearence, Kt/V, serum osmolarity and urinevolumes were not statistically different after the third month in each group (p>0.05).The daily ultrafiltration volume increased as a result of doubling the icodextrin doseviiin daily PD scheme (p<0.05). LVM, total protein and albumin, serum totalcholesterol and high density lipoproteins (HDL), systolic and diastolic bloodpressures were decreased significantly in the double icodextrin using group afterthree months (p<0.05). In the single icodextrin group; LVM, serum HDL andtriglyceride levels decreased significantly (p<0.05). But daily ultrafiltration volume,blood pressure, body mass index, BUN and creatinine, serum total protein andalbumin levels did not changed significantly (p>0.05).Conclusion: We concluded that double icodextrin administartion is moreeffective for blood pressure regulation, to reduce LVM and serum cholesterol levelswhen compared with the single icodextrin use. The use of single icodextrin resultedin a significant reduction in LVM but LVM was not found to be related to theultrafiltration volume and blood pressure.Key words: Blood pressure, hypervolemia, icodextrin, left ventricular mass,peritoneal dialysis, ultrafiltration failure