Krutost velikih arterija u terminalnoj fazi endemske nefropatije

doctoral thesis

• Title (english): Large-artery stiffness in end-stage Endemic nephropathy
• Author: Vedran Premužić
• Mentor: Bojan Jelaković (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2016-05-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Bolesnici s terminalnim bubrežnim zatajenjem najčešće umiru od kardiovaskularnih (KV) bolesti što je
prema do sada objavljenim studijama velikim dijelom povezano s povećanom krutosti velikih arterija
(KVA). Na KVA osim dobi najsnažnije utječe visina arterijskog tlaka (AT), a u bolesnika s kroničnom
bubrežnom bolesti (KBB) bitan čimbenik je i regulacija homeostaze fosfata i kalcija. Endemska
(Balkanska) nefropatija (EN) je kronična tubulointersticijska nefropatija čije obilježje su normalne
vrijednosti AT u ranim stadijima KBB i pojava arterijske hipertenzije (AH) tek u završnim stadijima, pa
se može pretpostaviti da je u tih bolesnika utjecaj AT na nastanak KVA manji nego u drugih KBB. Cilj
ovog istraživanja bio je analizirati je li KVA manja u bolesnika s EN u usporedbi s drugim terminalnim
KBB bolesnicima liječenih hemodijalizom, te koji čimbenici su pozitivni, a koji negativni prediktori za
nastanak KVA. U istraživanje je uključeno 186 bolesnika (90 EN i 96 ne-EN) te je nakon 25 mjeseci
učinjeno kontrolno mjerenje na 97 preživjelih ispitanika liječenih kroničnom hemodijalizom iz tri
dijalitička centra u Hrvatskoj i Bosni i Hercegovini. Dobiveni rezultati potvrđuju hipotezu da je KVA
manja u bolesnika s EN. U bolesnika s EN učestalost AH je bila manja i ti su bolesnici trebali manji broj
antihipertenziva za postizanje kontrole AT. Bolesnici s EN imali su značajno niže vrijednosti serumskih
fosfata, umnoška kalcija i fosfora, i parathormona. Svi ti čimbenici bili su prediktori KVA, ali u tri
modela linearne regresije EN je bila najsnažniji i to negativni prediktor. U logističkoj regresiji omjer
izgleda za nastanak KVA bio je statistički značajno veći za bolesnike bez EN. Bolesnici s EN bili su
značajno stariji kada su počimali liječenjem dijalizom što ukazuje na sporiju progresiju KBB, a imali su
značajno nižu ukupnu i KV smrtnost nakon 25 mjeseci praćenja.
EN je nezavisni prediktor manje KVA koja se sporije razvija u ovih bolesnika zbog nižih vrijednosti AT i
blaže AH već u preterminalnim stadijima te boljoj kontroli AH tijekom liječenja dijalizom, a dodatno u
vrijeme hemodijalize i boljoj kontroli kalcija i fosfata što za posljedicu ima sporiju progresiju bubrežne
bolesti i manji KV mortalitet.

Abstract (english)

Cardiovascular (CV) diseases are the most frequent cause of death in patients with end-stage-renal-
disease (ESRD). Increased arteries stiffness (AS) was found to be independent risk factor. In general
population AS is determined by age and blood pressure (BP). In patients with chronic renal disease
(CKD) it is influenced additionaly with derangements in phosphate and calcium homeostasis. Endemic
(Balkan) nephropathy (EN) is a chronic tubulointerstitial nephropathy characterized by normal BP values
in early stages of CKD and hypertension (HT) appears in advanced CKD stages. Obviously, BP in EN has
less impact on AS than in other CKD. The aim of this study was to analyze whether AS is lower in EN
patients compared to patients with other ESRD undergoing chronic hemodialysis. In this study, 186
patients were included (90 EN, 96 non-EN) from three dialysis centers in Croatia and Bosnia and
Herzegovina. After 25 months, control measurements were taken on 97 survived patients still treated with
chronic hemodialysis. The obtained results confirmed the hypothesis that AS is lower in patients with EN.
Prevalence of hypertension was lower in EN patients and they required less antihypertensives. Patients
with EN had significantly lower serum phosphate levels, calcium x phosphate, and parathormone. All
these factors were predictors of AS, but in three models of linear regression EN was the strongest negative
predictor for AS. In logistic regression the ratio of AS was statistically significantly higher in patients
without EN. The patients with EN were significantly older when they started their dialysis treatment,
which indicates the slower progression of CKD. These patients had significantly lower CV mortality after
25 months of follow-up. Endemic nephropathy is an independent predictor of lower AS values. AS
develops slower due to later onset of HT in predialytic course, lower BP values and milder HT and better
control during dialysis treatment. In addition, they had better control of calcium and phosphates, which
consequently causes slower progression of kidney disease and lower CV mortality.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:032685
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 97 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:07:07