| Abstract | Cilj istraživanja: Arterijska hipertenzija je učestala među bolesnicima s transplantiranim bubregom. Također nakon transplantacije bubrega dolazi do dramatičnog porasta apetita i tjelesne mase. Slijedom navedenoga, cilj ovog presječnog istraživanja bio je istražiti učestalost arterijske hipertenzije u bolesnika s transplantiranim bubregom koji se liječe pri Zavodu za nefrologiju i dijalizu, Kliničkog bolničkog centra Split te istražiti postoji li povezanost između pokazatelja nutritivnog statusa s vrijednostima arterijskog tlaka u ovoj populaciji bolesnika.
Materijali i metode: Ispitanici su bili svi bolesnici koji imaju funkcionalni transplantirani bubreg najmanje mjesec dana i kontroliraju se u Dnevnoj bolnici Zavoda za nefrologiju i dijalizu, Klinike za unutarnje bolesti, Kliničkog bolničkog centra Split. Za svakog ispitanika zabilježeni su: dob, spol, duljina liječenja metodom nadomještanja bubrežne funkcije (mjeseci), vrijeme proteklo od transplantacije bubrega (mjeseci), primarna bubrežna bolest, tjelesna masa (kg), tjelesna visina (cm), opseg struka (cm), opseg bokova (cm), opseg nadlaktice (cm). Također, za svakog ispitanika zabilježen je podatak o postojanju šećerne bolesti, o uzimanju antihipertenzivne terapije, o vrsti antihipertenzivne terapije, o broju antihipertenzivnih lijekova, o uzimanju statina te podatak o metodi nadomještanja bubrežne funkcije dijalizom. Nadalje, za svakog bolesnika zabilježe su vrijednosti SKT i DKT te serumske vrijednosti ureje, kreatinina, željeza (µmol/L), triglicerida, kolesterola-ukupnog, LDL (mmol/L), hemoglobina, albumina (g/L), CRP-a (mg/L), urata, glukoze, kalcija, fosfora (mmol/L), intaktnog paratireoidnog hormona (iPTH) (pmol/L), TIBC (eng. Total Iron Binding Capacity) ukupni kapacitet vezivanja željeza te je izračunat ITM (kg/m²) i TSAT.
Rezultati: U istraživanje je uključeno ukupno 198 ispitanika, 108 (58,7%) muškaraca i 90 (41,3%) žena, prosječne dobi 58,07±12,07 godina. Rezultati su pokazali kako je 100 (50,51 %) bolesnika uzimalo statine, 9 (4.55%) bolesnika nije uzimalo niti jedan antihipertenziv, dok je 189 (95,45%) bolesnika uzimalo antihipertenzivnu terapiju. Oni ispitanici koji su uzimali manje od tri antihipertenzivna lijeka imali su statistički značajno niže vrijednosti SKT (137,26 ± 18,72 vs.146,10 ± 18,18, p = 0,001) te ITM (25,42± 3,50 vs.26,92 ± 3,07, p = 0,005) nego li bolesnici koji su uzimali tri ili više antihipertenzivnih lijekova. Nadalje, oni bolesnici koji su uzimali tri ili više antihipertenzivnih lijekova imali su statistički značajno više vrijednosti ITM (26,92 ± 3,07 vs. 25,42 ± 3,50, p = 0,005), SAT (146,10 ± 18,18 vs. 137,26 ± 18,72, p = 0,001), iPTH (19,81 ± 14,08 vs. 11,65 ±8,46, p = 0,023) i albumina (42,86 ± 5,49 vs. 41,48 ± 4,72, p= 0,046) u usporedbi sa bolesnicima koji su uzimali manje od tri antihipertenzivna lijeka. Kada smo sve ispitanike podijelili u dvije skupine, ovisno o vrijednostima SKT (bolesnici sa vrijednostima SKT ≥ 140 mmHg te bolesnici sa SKT < 140 mmHg) rezultati su pokazali kako su oni bolesnici koji su imali SKT ≥ 140 mmHg bili su statistički značajno stariji (60,35 ± 10,54 vs. 54,02 ± 13,99, p <0,001), imali više vrijednosti DAT (84,88 ± 8,81 vs. 77,94 ± 7,66, p <0,001), urata (430,64 ± 87,99 vs. 404,16 ± 91,28, p = 0,031) i iPTH (18,96 ± 14,80 vs. 11,63 ± 5,34, p = 0,037). Dijabetičari su imali statistički značajno više vrijednosti DAT (83,02 ± 9,12 vs. 80,00 ± 8,67, p = 0,034) u usporedbi s bolesnicima koji nisu imali šećernu bolest.
Zaključak: Rezultati pokazuju kako je među bolesnicima s transplantiranim bubregom visoka prevalencije arterijske hipertenzije. Također razvidna je i povezanost nutritivnog statusa s vrijednostima arterijskog tlaka u ovoj populaciji bolesnika. Buduća, prospektivna, multicentrična istraživanja trebala bi dati odgovor na pitanje da li se intenzivnim praćenjem nutritivnog statusa i intervencijama prije transplantacije i nakon transplantacije bubrega može utjecati na učestalost arterijske hipertenzije nakon transplantacije bubrega. Također potrebno je pratiti nutritivni status nakon transplantacije bubrega i zbog rizika razvoja novonastale šećerne bolesti kako bi se pravovremenom detekcijom problema i intervencijama smanjio rizik nastanka šećerne bolesti, arterijske hipertenzije te ostalih neželjenih komplikacija nakon transplantacije bubrega koje utječu na morbiditet i mortalitet ove populacije bolesnika. |
| Abstract (english) | Objectives: Arterial hypertension is common amongst patients with transplanted kidney. Also, kidney transplantation often results in dramatic improvement of appetite and gain of body weight. Therefore, the aim of this cross-sectional study was to analyse the prevalence of arterial hypertension in patients with transplanted kidney who are being treated at the Department of Nephrology and Dialysis at the University Hospital of Split and to investigate whether there is a correlation between the nutritional status parameters and arterial blood pressure values in this study population.
Materials and methods: All of the participants in this study were patients with transplanted kidney that have had functional transplanted kidney for at least one month and who are regularly controlled in the Daily hospital of the Department of Nephrology and Dialysis at the University Hospital of Split. Patients age, gender, duration of the renal replacement therapy (months), time elapsed since the kidney transplantation (months), primary kidney disease, body weight (kg), body height (cm), waist circumference (cm), hip circumference (cm), and mid-upper arm circumference (cm) were recorded for each patient in this study. Also, for each patient history of diabetes, data about antihypertensive therapy, type of antihypertensive therapy, number of antihypertensive drugs taken, statin therapy and dialysis modality were recorded. Furthermore, values of systolic (SBP) and diastolic blood pressure (DBP) and serum values of urea, creatinine, iron (µmol/L), triglycerides, cholesterol levels, LDL (mmol/L), haemoglobin, albumin (g/L), C- reactive protein (mg/L), urate, glucose, calcium, phosphorus (mmol/L), intact parathyroid hormone (iPTH) (pmol/L), total iron binding capacity, body mass index (BMI) (kg/m²), and transferrin saturation were determined.
Results: Total of 198 patients were included in this study, 108 (58.7%) males and 90 (41.3%) females. The average age was 58.07 ± 12.07 years. The results showed that 100 (50.51%) of patients were taking statins, 9 (4.55%) patients were not taking any antihypertensive drugs, while 189 (95.45%) patients were taking antihypertensive therapy. Those patients who received less than three antihypertensive drugs as part of their antihypertensive therapy, had statistically significant lower values of SBP (137.26 ± 18.72 vs. 146.10 ± 18.18, p = 0.001) and BMI (25.42 ± 3.50 vs.26.92 ± 3.07, p = 0.005) than patients taking three or more antihypertensive drugs. Furthermore, those patients who had taken three or more antihypertensive drugs had significantly higher BMI (26.92 ± 3.07 vs. 25.42 ± 3.50, p = 0.005), higher SBP (146.10 ± 18, 18 vs. 137.26 ± 18.72, p = 0.001), iPTH (19.81 ± 14.08 vs. 11.65 ± 8.46, p = 0.023) and serum albumin (42.86 ± 5.49 vs. 41.48 ± 4.72, p = 0.046) compared to patients taking less than three antihypertensive drugs. When all study subjects were divided into two groups, depending on the values of SBP (patients with SBP values ≥ 140 mmHg and patients with SBP <140 mmHg) the results showed that those patients with SBP ≥ 140 mmHg were significantly older (60, P <0.001), had more DBP values (84.88 ± 8.81 vs. 77.94 ± 7.66, p <0.001), higher urates ( 430.64 ± 87.99 vs. 404.16 ± 91.28, p = 0.031) and iPTH (18.96 ± 14.80 vs. 11.63 ± 5.34, p = 0.037). Diabetics patients had significantly higher values of DBP (83.02 ± 9.12 vs. 80.00 ± 8.67, p = 0.034) compared topatients who did not have diabetes.
Conclusion: The results of this study have shown high prevalence of arterial hypertension in patients with transplanted kidney. The significant correlation of parameters of nutritional status and arterial pressure in this patient population were found. Future, prospective, multicentre studies should answer the question whether intensive monitoring of nutritional status and interventions prior to transplantation and after the kidney transplantation may affect the frequency of arterial hypertension after kidney transplantation. It is also necessary to monitor the nutritional status after kidney transplantation, because of the risk of developing diabetes so that we could detect the problem on time and intervene if necessary to reduce the risk of developing diabetes, arterial hypertension and other unwanted complications after kidney transplantation which could affect the morbidity and the mortality of this patient population. |
