Öz
Amaç: Akut böbrek yetmezliği (ABY) yoğun bakım hastalarında mortaliteyi etkileyen en önemli faktörlerden biridir. Bu çalışmanın amacı, ürik asit düzeyleri ile akut böbrek hasarı (AKI) / ABY arasında bir ilişki olup olmadığını aydınlatmaktır.
Gereç ve Yöntem: Bu retrospektif çalışmamıza, önceden böbrek hastalığı olmayan ve glomerüler filtrasyon hızı (GFR) 80-120 ml/dakika olan hastanemiz yoğun bakım ünitesine kabul edilen toplam 1000 hasta dahil edildi. Yoğun bakım ünitesinde AKI gelişimi RIFLE kriterleri ile değerlendirildi. AKI gelişen hastalarda renal replasman tedavisi endikasyonu olup olmadığına bakıldı. Bilinci kapalı kişiler ve COVID-19 hastaları dahil yoğun bakım ünitesindeki tüm hastalar analize dahil edilmiştir.
Bulgular: Bireylerin %27,1’inde (n=271) AKI görüldü. AKI’lı hastaların %44.3’üne (n=120) hemodiyaliz uygulanmıştı. Hemodiyaliz nedenleri olguların %36’sında iskemi, %32’sinde sepsis ve multifaktöriyel nedenler idi. Potasyum dışındaki tüm parametrelerde (üre, kreatinin, ürik asit ve sodyumda) başlangıca göre artmıştı (p<0,001) ve başlangıç ölçümlerine göre istatistiksel olarak anlamlı bir fark bulundu. Tanı anında başlangıca göre tüm değerler artarken, GFR değerinde azalma gözlendi (p<0,001). Hemodiyalize giren hastaların ürik asit ölçümleri arasında istatistiksel olarak anlamlı fark vardı (p<0,05) ve ürik asit ölçümleri başlangıca göre arttı.
Sonuç: Bu çalışmanın sonuçlarına göre serum ürik asit düzeyinin azalmış böbrek fonksiyonu için bağımsız bir risk faktörü olduğu gösterilebilir. Ek olarak, yüksek ürik asit seviyeleri yoğun bakım ünitesinde hemodiyaliz, morbidite ve mortalitenin artmasına neden olur.
Anahtar Kelimeler
Hemodiyaliz akut böbrek yetmezliği hiperürisemi ürik asit yoğun bakım ünitesi
Destekleyen Kurum
yok
Proje Numarası
yok
Kaynakça
- Griffin BR, Liu KD, Teixeira JP. Critical care nephrology: core curriculum 2020. Am J Kidney Dis 2020; 75: 435-52
- Ostermann M, Zarbock A, Goldstein S, et al. Recommendations on acute kidney injury biomarkers from the acute disease quality initiative consensus conference: a consensus statement. JAMA Netw Open 2020; 3: e2019209.
- Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric asid metabolism and excreation. Int J Cardiol 2015;S0167-5273 0342-9.
- Chaudhary K, Malhotra K, Sowers J, Aroor A. Uric acid-key ingredient in the recipe for cardiorenal metabolic syndrome. Cardiorenal Med 2013; 3: 208-20.
- Yildirim A, Altinkaynak K, Aksoy H, Sahin YN, Akcay F. Plasma xantine oxidase, superoxide dismutase and glutathione peroxidase activities and uric acid levels in severe and mild pre-eclampsia. Cell Biochem Funct 2004; 22: 213-7.
- Nan H, Dong Y, Gao W, Tuomilehto J, Qiao Q. Diabetes associated with a low serum uric acid level in a general Chinese population. Diabetes Res Clin Pract 2007; 76: 68-74.
- Jhonson RJ, Perez-Pozo SE, Sautin YY, et al. Hypothesis: could excessive fructose intake and uric acid cause type 2 diabetes? Endocr Rev 2009; 30: 96-116.
- Şengül E, Binnetoğlu E, Yılmaz A. Kronik böbrek hastalarında serum ürik asit düzeyi ile glukoz, HbA1c, lipid profili, vücut kitle indeksi ve kan basıncı arasındaki ilişki. DEÜ Tıp Fakültesi Derg 2011; 25: 163-68.
- Nakagawa T, Kang DH, Feig D, et al. Unearthing uric acid: an ancient factor with recently found significance in renal and cardiovascular disease. Kidney Int 2006; 69: 1722-25.
- Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. Am J Physiol Cell Phsiol 2007; 293: 584-96.
- Chonchol M, Shlipak MG, Katz R, et al. Relationship of uric acid with progression of kidney disease. Am J Kidney Dis 2007; 50: 239-47.
- Wu XH, Zhang J, Wang VC, et al. Two steroidal glycosides from Smilax riparia, resist to hyperuricemia based on URAT1 in hyperuricemic mice. Phytomedicine 2014; 21: 1196-201.
- Moore PK, Hsu RK, Liu KD. Management of acute kidney injury: core curriculum 2018. Am J Kidney Dis 2018; 72: 136-48.
- Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. The Madrid Acute Renal Failure Study Group. Kidney Int 1996; 334: 1448-60.
- Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units-causes, outcome, and prognostic factors of hospital mortality; a prospective , multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 1996; 24: 192-8.
- Silveira Santos CGD, Romani RF, Benvenutti R, et al. Acute Kidney Injury in Elderly Population: A Prospective Observational Study. Nephron 2018; 138: 104-12.
- Wu B, Li L, Cheng X, et al. Propensity-score-matched evaluation of under-recognition of acute kidney injury and short-term outcomes. Sci Rep 2018 11; 8: 15171.
- Conlon P, Stafford-Smith M, White WD, et al. Acute renal failure following cardiac surgery. Nephrol Dialys Transplant 1999; 14: 1158-62.
- Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of Postoperative Acute Kidney Injury.Crit Care 2009; 13: R79.
- Singh A, Hussain S, Kher V, Palmer AJ, Jose M, Antony B. A systematic review of cost-effectiveness analyses of continuous versus intermittent renal replacement therapy in acute kidney injury. Expert Rev Pharmacoecon Outcomes Res 2022; 22: 27-35.
- Herget-Rosenthal S, Marggraf G, Husing J, et al. Early detection of acute renal failure by serum cystatin C. Kidney Int 2004; 66: 1115-22.
- Waheed Y, Yang F, Sun D. Role of asymptomatic hyperuricemia in the progression of chronic kidney disease and cardiovascular disease. Korean J Intern Med 2021; 36: 1281-93.
- Kang DH. Hyperuricemia and progression of chronic kidney disease: role of phenotype transition of renal tubular and endothelial cells. Contrib Nephrol 2018; 192: 48-55.
- Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930-6.
- Medve L, Antek C, Paloczi B, et al. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study. BMC Nephrology 2011; 12: 3-7.
- Liano F, Pascual I. Epidemiology of acute renal failure: A prospective, multicenter communitybased study. Kidney Int 1996; 50: 811-8.
- Barrantes F, Feng Y, Ivanov O, et al. Acute kidney injury predicts outcomes of non-critically ill patients. Mayo Clin Proc 2009; 84: 410-16.
- Koçyiğit İ, Ünal A, Sipahioğlu MH, et al. Trends in Acute Renal Failure in Central Anatolia. Turk Neph Dial Transpl 2013; 22: 251-57.
Öz
Objective: Acute renal failure is one of the most important factors affecting mortality in intensive care patients. The aim of this study was to elucidate whether there was a relationship between uric acid levels and/or acute kidney imjury/failıre (AKI).
Material and Method: A total of 1000 individuals who were admitted to intensive care unit (ICU) of our institution without any prior renal disease and glomerular filtration rate (GFR) of 80-120 ml/minutes, have been enrolled in this retrospective analysis. The development of AKI in the ICU were evaluated via RIFLE criteria. In patients who developed AKI, it was checked whether there was an indication for renal replacement therapy (RRT). All patients in the ICU including the unconscious indivuduals and COVID-19 patients have been included in the analysis.
Results: Acute renal failure (ARF) was observed in 27.1% (n=271) of the individuals. Hemodialysis had been administered in 44.3% (n=120) of patients with ARF. The reasons for hemodialysis were ischemia in 36%, sepsis and multifactorial reasons in 32% of the subjects. A statistically significant difference was found compared to the initial measurements in urea, creatinine, uric acid and sodium (Na) increased compared to baseline (p<0.001) as all parameters except potassium (K). All values from baseline increased at the time of diagnosis, while a decrease was observed in the GFR value (p<0.001). There was a statistically significant difference between the uric acid measurements of the patients undergoing hemodialysis (p<0.05) and uric acid measurements were increased compared to baseline.
Conclusion: Regarding the results of this study one can conclude that serum uric acid level has been shown to be an independent risk factor for decreased renal function. Additionally, elevated uric acid levels lead to increased hemodialysis, morbidity and mortality in the ICU.
Anahtar Kelimeler
Acute renal failure hemodialysis hyperuricemia uric acid intensive care unit
Proje Numarası
yok
Kaynakça
- Griffin BR, Liu KD, Teixeira JP. Critical care nephrology: core curriculum 2020. Am J Kidney Dis 2020; 75: 435-52
- Ostermann M, Zarbock A, Goldstein S, et al. Recommendations on acute kidney injury biomarkers from the acute disease quality initiative consensus conference: a consensus statement. JAMA Netw Open 2020; 3: e2019209.
- Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric asid metabolism and excreation. Int J Cardiol 2015;S0167-5273 0342-9.
- Chaudhary K, Malhotra K, Sowers J, Aroor A. Uric acid-key ingredient in the recipe for cardiorenal metabolic syndrome. Cardiorenal Med 2013; 3: 208-20.
- Yildirim A, Altinkaynak K, Aksoy H, Sahin YN, Akcay F. Plasma xantine oxidase, superoxide dismutase and glutathione peroxidase activities and uric acid levels in severe and mild pre-eclampsia. Cell Biochem Funct 2004; 22: 213-7.
- Nan H, Dong Y, Gao W, Tuomilehto J, Qiao Q. Diabetes associated with a low serum uric acid level in a general Chinese population. Diabetes Res Clin Pract 2007; 76: 68-74.
- Jhonson RJ, Perez-Pozo SE, Sautin YY, et al. Hypothesis: could excessive fructose intake and uric acid cause type 2 diabetes? Endocr Rev 2009; 30: 96-116.
- Şengül E, Binnetoğlu E, Yılmaz A. Kronik böbrek hastalarında serum ürik asit düzeyi ile glukoz, HbA1c, lipid profili, vücut kitle indeksi ve kan basıncı arasındaki ilişki. DEÜ Tıp Fakültesi Derg 2011; 25: 163-68.
- Nakagawa T, Kang DH, Feig D, et al. Unearthing uric acid: an ancient factor with recently found significance in renal and cardiovascular disease. Kidney Int 2006; 69: 1722-25.
- Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. Am J Physiol Cell Phsiol 2007; 293: 584-96.
- Chonchol M, Shlipak MG, Katz R, et al. Relationship of uric acid with progression of kidney disease. Am J Kidney Dis 2007; 50: 239-47.
- Wu XH, Zhang J, Wang VC, et al. Two steroidal glycosides from Smilax riparia, resist to hyperuricemia based on URAT1 in hyperuricemic mice. Phytomedicine 2014; 21: 1196-201.
- Moore PK, Hsu RK, Liu KD. Management of acute kidney injury: core curriculum 2018. Am J Kidney Dis 2018; 72: 136-48.
- Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. The Madrid Acute Renal Failure Study Group. Kidney Int 1996; 334: 1448-60.
- Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units-causes, outcome, and prognostic factors of hospital mortality; a prospective , multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 1996; 24: 192-8.
- Silveira Santos CGD, Romani RF, Benvenutti R, et al. Acute Kidney Injury in Elderly Population: A Prospective Observational Study. Nephron 2018; 138: 104-12.
- Wu B, Li L, Cheng X, et al. Propensity-score-matched evaluation of under-recognition of acute kidney injury and short-term outcomes. Sci Rep 2018 11; 8: 15171.
- Conlon P, Stafford-Smith M, White WD, et al. Acute renal failure following cardiac surgery. Nephrol Dialys Transplant 1999; 14: 1158-62.
- Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of Postoperative Acute Kidney Injury.Crit Care 2009; 13: R79.
- Singh A, Hussain S, Kher V, Palmer AJ, Jose M, Antony B. A systematic review of cost-effectiveness analyses of continuous versus intermittent renal replacement therapy in acute kidney injury. Expert Rev Pharmacoecon Outcomes Res 2022; 22: 27-35.
- Herget-Rosenthal S, Marggraf G, Husing J, et al. Early detection of acute renal failure by serum cystatin C. Kidney Int 2004; 66: 1115-22.
- Waheed Y, Yang F, Sun D. Role of asymptomatic hyperuricemia in the progression of chronic kidney disease and cardiovascular disease. Korean J Intern Med 2021; 36: 1281-93.
- Kang DH. Hyperuricemia and progression of chronic kidney disease: role of phenotype transition of renal tubular and endothelial cells. Contrib Nephrol 2018; 192: 48-55.
- Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930-6.
- Medve L, Antek C, Paloczi B, et al. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study. BMC Nephrology 2011; 12: 3-7.
- Liano F, Pascual I. Epidemiology of acute renal failure: A prospective, multicenter communitybased study. Kidney Int 1996; 50: 811-8.
- Barrantes F, Feng Y, Ivanov O, et al. Acute kidney injury predicts outcomes of non-critically ill patients. Mayo Clin Proc 2009; 84: 410-16.
- Koçyiğit İ, Ünal A, Sipahioğlu MH, et al. Trends in Acute Renal Failure in Central Anatolia. Turk Neph Dial Transpl 2013; 22: 251-57.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Research Articles [en] Araştırma Makaleleri [tr] |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 26 Eylül 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 3 Sayı: 3 |
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