Study of Clinical Characteristics of Patients Initiating Hemodialysis as Initial Renal Replacement Therapy,
Abstract
Son dönem böbrek hastalığı (SDBH) görülme sıklığı giderek artmaktadır. Dünyada ve ülkemizde SDBH'ta en sık uygulanan renal replasman tedavisi (RRT) hemodiyaliz (HD)'dir. Ġlk RRT olarak HD'ye baĢlanılan hastalarda acil baĢlangıç artmaktadır. Buna paralel olarak arteriyovenöz fistül (AVF) kullanımı azalmakta, kateter kullanımı artmaktadır. Biz bu çalıĢmada ilk RRT olarak HD'ye baĢlanan hastaların klinik ve demografik özelliklerini değerlendirmeyi amaçladık. Ocak 2021-Aralık 2023 tarihleri arasında hastanemiz nefroloji kliniğinde yatan veya ayaktan baĢvuran ve ilk RRT olarak HD'ye baĢlanan SDBH olan 136 hasta dahil edildi. HD baĢlangıcındaki laboratuvar parametreleri (kreatinin, tahmini (estimating) glomerüler filtrasyon hızı (eGFR), hemoglobin (Hgb), pH, bikarbonat (HCO3), transferrin saturasyonu, ferritin, parathormon, albümin, ürik asit, potasyum, fosfor, kalsiyum, kolesterol) değerlendirildi. SDBH'nın etyolojisi, damar eriĢim yolu, HD baĢlangıcının nasıl olduğu (acil veya programlı), kullandığı ilaçlar, prediyaliz eritropoez stimüle edici ajan (ESA) ve demir tedavisi alıp almadığı değerlendirildi. Elde ettiğimiz veriler, Amerikan Böbrek Veri Sistemi (The United States Renal Data System (USRDS)) ve Türk Nefroloji Derneği (TND) registry verileri ile karĢılaĢtırıldı. Hastaların verileri hastane otomasyon sisteminden ve hasta dosyalarından elde edildi. eGFR CKD-EPI (2021) kreatinin denklemine göre hesaplandı. Hastaların ilk HD'ye alınma esnasındaki yaĢ ortalaması 59,6±15,7 idi. Hastaların %75,7'sinde HD'ye acil olarak baĢlandı. Damar eriĢim yolu olarak çoğunlukla (%78,7) tünelsiz santral venöz kateter (SVK) kullanıldı. HD baĢlangıcında Hgb <10 gr/dL olan hasta sayısı 90 (%66,2) idi. Prediyaliz ESA kullanımı %14 idi. SDBH'nın etyolojisinde ilk sırada %39 ile diyabetes mellitus (DM), 2. sırada %16,9 ile hipertansiyon (HT) gelmekteydi. Hastaların çoğunluğu HD'ye tünelsiz SVK ile acil baĢlangıç yaptı. Anemi sıklığına rağmen ESA kullanımı düĢüktü. HD'ye AVF ile programlı baĢlangıç yapılabilmesi ve SDBH'ya bağlı komplikasyonları yönetebilmek için prediyaliz dönemde yakın takip önemlidir. Hastanemizde nefroloji ve kalp damar cerrahisi branĢlarındaki uzman hekimlerin az sayıda olması, düĢük sosyo-ekonomik düzey, ileri yaĢ gibi faktörler merkezimizdeki acil baĢlangıçların diğer nedenleri arasında sayılabilir.
The prevalence of end-stage renal disease (ESRD) is increasing. Hemodialysis (HD) is the most commonly applied renal replacement therapy (RRT) in ESRD worldwide and in our country. There is an increasing trend in urgent initiation in patients starting HD as the initial RRT. Parallel to this, the use of arteriovenous fistula (AVF) is decreasing, and catheter use is increasing. In this study, we aimed to evaluate the clinical and demographic characteristics of patients initiating HD as the initial RRT. A total of 136 patients with ESRD who were hospitalized or referred to our nephrology clinic between January 2021 and December 2023 and initiated HD as the initial RRT were included. Laboratory parameters at the initiation of HD (creatinine, estimated glomerular filtration rate (eGFR), hemoglobin (Hgb), pH, bicarbonate (HCO3), transferrin saturation, ferritin, parathyroid hormone, albumin, uric acid, potassium, phosphorus, calcium, cholesterol) were evaluated. The etiology of ESRD, vascular access route, how HD initiation occurred (urgent or scheduled), medications used, and whether they received predialysis erythropoiesis-stimulating agents (ESA) and iron therapy were evaluated. The data obtained were compared with the United States Renal Data System (USRDS) and Turkish Society of Nephrology registry data. Patients' data were obtained from the hospital automation system and patient records. eGFR was calculated according to the CKD-EPI (2021) creatinine equation. The mean age of patients at the initiation of HD was 59,6±15,7 years. HD was initiated urgently in 75,7% of patients. Non-tunnelled central venous catheter was predominantly used as the vascular access route (78,7%). The number of patients with Hgb <10 g/dL at the initiation of HD was 90 (66,2%). The use of predialysis ESA was 14%. Diabetes mellitus (DM) was the leading cause of ESRD at 39%, followed by hypertension (HT) at 16,9%. The majority of patients initiated HD urgently with non-tunnelled central venous catheter. Despite the frequency of anemia, ESA utilization was low. Close monitoring during the predialysis period is important for the initiation of HD with AVF and the management of complications associated with ESRD. The limited number of expert physicians in the nephrology and cardiovascular surgery departments in our hospital, low socioeconomic status, and advanced age can be considered among the other causes of urgent initiation in our center.
The prevalence of end-stage renal disease (ESRD) is increasing. Hemodialysis (HD) is the most commonly applied renal replacement therapy (RRT) in ESRD worldwide and in our country. There is an increasing trend in urgent initiation in patients starting HD as the initial RRT. Parallel to this, the use of arteriovenous fistula (AVF) is decreasing, and catheter use is increasing. In this study, we aimed to evaluate the clinical and demographic characteristics of patients initiating HD as the initial RRT. A total of 136 patients with ESRD who were hospitalized or referred to our nephrology clinic between January 2021 and December 2023 and initiated HD as the initial RRT were included. Laboratory parameters at the initiation of HD (creatinine, estimated glomerular filtration rate (eGFR), hemoglobin (Hgb), pH, bicarbonate (HCO3), transferrin saturation, ferritin, parathyroid hormone, albumin, uric acid, potassium, phosphorus, calcium, cholesterol) were evaluated. The etiology of ESRD, vascular access route, how HD initiation occurred (urgent or scheduled), medications used, and whether they received predialysis erythropoiesis-stimulating agents (ESA) and iron therapy were evaluated. The data obtained were compared with the United States Renal Data System (USRDS) and Turkish Society of Nephrology registry data. Patients' data were obtained from the hospital automation system and patient records. eGFR was calculated according to the CKD-EPI (2021) creatinine equation. The mean age of patients at the initiation of HD was 59,6±15,7 years. HD was initiated urgently in 75,7% of patients. Non-tunnelled central venous catheter was predominantly used as the vascular access route (78,7%). The number of patients with Hgb <10 g/dL at the initiation of HD was 90 (66,2%). The use of predialysis ESA was 14%. Diabetes mellitus (DM) was the leading cause of ESRD at 39%, followed by hypertension (HT) at 16,9%. The majority of patients initiated HD urgently with non-tunnelled central venous catheter. Despite the frequency of anemia, ESA utilization was low. Close monitoring during the predialysis period is important for the initiation of HD with AVF and the management of complications associated with ESRD. The limited number of expert physicians in the nephrology and cardiovascular surgery departments in our hospital, low socioeconomic status, and advanced age can be considered among the other causes of urgent initiation in our center.
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İç Hastalıkları, Internal diseases
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