Bu çalışmaya 2009-2010 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Araştırma ve Uygulama Hastanesi Nefroloji, Endokrinoloji kliniklerinde tedavi gören veya Nefroloj

polikliniğine başvuran, rutin takip ve tedavileri yapılan evre 3-4 kronik böbrek hastalığı olan 90 hasta dahil edildi. Hastaların 51’i diyabetik, 39’u non diyabetik idi. Hastalardan biyokimyasal, hormonal, hematolojik parametreler için kan örnekleri alındı. Hastaların 24 saatlik idrarlarında protein ve kreatinin çalışıldı. Oksidatif stresi değerlendirmek amacıyla hastalarda ADMA, MDA, SOD, GSHpx, katalaz, vitamin C ve E, paroksanaz, aril esteraz çalışıldı. Elektrokardiyografileri çekildi, ekokardiyografileri yapıldı ve kan basınçları ölçüldü. Bütün hastalarda renal USG, sağ ve sol KİMK ölçümü bakıldı.

Bulgular

Diyabetik (n=51) ve non diyabetik (n=39) hastalarda evre 3 ile 4 arasında oksidatif stres durumu karşılaştırıldığında anlamlı fark izlenmedi. Diyabetik hasta grubunda CrCl ile SOD arasında negatif korelasyon (r= -0.322, p=0.024) , vitamin C ile CrCl arasında pozitif korelasyon (r=0.305, p=0.029) izlendi. CrCl ile diğer parametrelerde istatistiksel olarak anlamlı ilişki saptanmadı. Non diyabetik hasta grubunda CrCl ile prooksidan ve anti oksidan paramatreler arasında anlamlı ilişki saptanmadı. Diyabetik hasta grubunda CrCl ile LVDd (r= -0.305, p=0.030) ve LAD (r=0 -0.329, p=0.018) arasında negatif korelasyon saptandı. Diğer ekokardiyografik parametreler ile CrCl arasında anlamlı ilişki saptanmadı. Non diyabetik hasta grubunda CrCl ile ekokardiyografik bulgular arasında anlamlı ilişki izlenmedi. Diyabetik

hasta grubunda vitamin E ile LVDd arasında pozitif korelasyon((r=0.340, p=0.015), SOD ile LVDs arasında pozitif korelasyon (r=0.309, p=0.032) saptandı. Non diyabetik hasta grubunda vitamin C ile EF arasında pozitif korelasyon(r=0.389, p=0.015), vitamin C ile LVDd arasında negatif korelasyon (r= -0.401, p=0.036), MDA ile LVDs arasında pozitif korelasyon (r=0.401, p=0.011) saptandı. Diğer oksidatif stres parametreleri ile ekokardiyografik bulgular arasında anlamlı ilişki saptanmadı. . Çalışmamızda diyabetik hasta grubunda hsCRP ile BMI arasında pozitif korelasyon (r=0.500, p<0.001), IVSd ile arasında pozitif korelasyon (r=0.356, p=0.01), sağ KİMK ile arasında pozitif korelasyon(r=0.359, p=0.01) saptandı. Diyabetik evre 3- 4 böbrek hastalarında IVSd ile sağ KİMK (r=0.303, p=0.031) ve sol KİMK (r=0.363, p=0.009) arasında pozitif korelasyon izlendi. Non diyabetik hasta grubunda EF ile sağ KİMK (r= -0.468, p=0.003) ve sol KİMK (r= -0.416, p=0.002) arasında negatif korelasyon, sol KİMK ile IVSd arasında pozitif korelasyon (r=0.353, p=0.028), sol KİMK ile LAD arasında pozitif korelasyon (r=0.502, p=0.001) saptandı. Ayrıca vitamin E ile sağ KİMK arasında(r= -0.336, P=0.037) ve sol KİMK (r= -0.317, p=0.049) arasında negatif korelasyon izlendi.

Sonuç:

Diyabetik ve non diyabetik hastalarda evre 3 ile 4 arasında oksidatif stres durumu

karşılaştırıldığında anlamlı fark izlenmedi. Diyabetik hasta grubunda CrCl ile vitamin C arasında pozitif korelasyon saptandı. Diyabetik olmayan hasta grubumuzda ise CrCl ile oksidatif stres parametreleri arasında anlamlı ilişki izlenmedi. Diyabetik hasta grubunda CrCl ile LAD ve LVDd arasındaki negatif korelasyon bulundu. Diyabetik hasta grubumuzda inflamasyon belirteci olan hsCRP ile IVSd arasında pozitif korelasyon, sağ KİMK ile arasında pozitif korelasyon saptandı. Diyabetik hasta grubunda vitamin E ile LVDd arasında pozitif korelasyon, SOD ile LVDs arasında pozitif korelasyon görüldü. Non diyabetik hasta grubunda vitamin C ile EF arasında pozitif korelasyon, vitamin C ile LVDd arasında negatif korelasyon, MDA ile LVDs arasında pozitif korelasyon saptandı.

Anahtar kelimeler: Kronik böbrek hastalığı, oksidatif stres, ekokardiyografik parametreler,

7. ABSTRACT Introduction

Risk of CVD has increased in CKD patients. Besides, there has been increased oxidative stress in these patients. In our study, we aimed to investigate oxidative stress state, atherosclerosis development , risk of cardiovascular disease and the relation with oxidative stress parameters and their echocardiographic findings in diabetic and nondiabetic CKD patients of 3-4 phase.

Material – Method

90 patients with chronic kidney disease of phase 3-4 applying to Nephrology polyclinic, having routine follow-up and treatment or having medical treatment in Dicle University Faculty of Medicine Research and Application Hospital Nephrology, Endocrinology Clinics between 2009 – 2010 years were included to this study. 51 were diabetic and 39 were nondiabetic patients. Blood samples of patients were collected for biochemical, hormonal, hematological parameters. Protein and creatinine were measured in the patient’s 24 hour urine. ADMA, MDA, SOD, GSHpx, catalase, vitamin C and E, Paraoxonase and aryl esterase were examined in patients in order to evaluate the oxidative stress. Electrocardiography and echocardiography were applied and blood pressures were measured. Renal USG, right and left CIMT measured in all patients.

Results

In terms of oxidative stress state, no significant difference between phase 3 and 4 was observed in diabetic (n=51) and nondiabetic (n=39) patients. In diabetic patient group, between CrCl and SOD negative correlation (r= -0.322, p=0.024), between vitamin C and CrCl positive correlation (r=0.305, p=0.029) was observed. No statistically significant relation was observed in CrCl and other parameters. In nondiabetic patient group, no significant relation was observed between CrCl and oxidative stress parameters. In diabetic patient group, CrCl was negatively correlated with LVDd (r= -0.305, p=0.030) and LAD (r=0 -0.329, p=0.018). There is no significant relation between CrCl and other

echocardiographic findings. In non diabetic patient group no significant relation was observed between CrCl and echocardiographic findings. In diabetic patient group vitamin E was positively correlated with LVDd (r=0.340, p=0.015) and SOD was positively correlated with LVDs (r=0.309, p=0.032). In nondiabetic patient group, between vitamin C and EF positive correlation (r=0.389, p=0.015), between vitamin C and LVDd negative correlation (r= -0.401, p=0.036), between MDA and LVDs positive correlation (r=0.401, p=0.011) was determined. No significant relation was determined between other oxidative stress parameters and echocardiographic findings. In our study, in diabetic patient group hsCRP was positively correlated with BMI (r=0.500, p<0.001), IVSd (r=0.356, p=0.01), and right CIMT (r=0.359, p=0.01). In diabetic phase 3- 4 CKD patients, IVSd was positively correlated with right CIMT (r=0.303, p=0.031) and left CIMT (r=0.363, p=0.009). In non diabetic patient group EF was negatively correlated with right CIMT (r= -0.468, p=0.003) and left CIMT (r= -0.416, p=0.002). Between left CIMT and IVSd positive correlation (r=0.353, p=0.028), between left CIMT and LAD positive correlation (r=0.502, p=0.001) was determined. Furthermore, between vitamin E and right CIMT (r= -0.336, P=0.037) and left CIMT (r= -0.317, p=0.049) negative correlation was observed.

Conclusion

In terms of oxidative stress state, no significant difference between phase 3 and 4 was observed in diabetic and nondiabetic patients. Positive correlation between CrCl and Vitamin C was determined in diabetic patients. In our nondiabetic patient group, no significant relation was determined between CrCl and oxidative stress parameters. In diabetic patient group, negative correlation between CrCl with LAD and LVDd was found. In our diabetic patient group, the inflammation marker hsCRP was positively correlated with IVSd and right CIMT . In diabetic patient group positive correlation was determined between vitamin E and LVDd; and between SOD and LVDs. In nondiabetic patient group between vitamin C and EF positive correlation; between vitamin C and LVDd negative correlation, between MDA and LVDs positive correlation was determined.

Keywords: Chronic kidney disease, oxidative stress, echocardiographic parameters,

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Belgede Evre 3-4 kronik böbrek hastalarında prooksidan ve antioksidan parametrelerin ateroskleroz belirteçleri ve ekokardiyografik bulgularla ilişkisinin değerlendirilmesi (sayfa 70-75)