Renal transplant hastalarında idrar sodyum atılımının metabolik sendrom, hipertansiyon ve greft fonksiyonu ile ilişkisinin değerlendirilmesi
Öz
Amaç: Renal transplant (RT) hastalarında idrar sodyum atılımı ile metabolik sendrom, hipertansiyon, greft fonksiyonu arasındaki ilişkinin değerlendirilmesidir.
Materyal-Metod: Nakil polikliniğinde düzenli takip edilen 152 RT alıcısı çalışmaya alındı. Hastaların demografik özellikleri, ofis kan basıncı değerleri, boy, kilo, vücut kitle indeksi, bel ve kalça ölçümleri, immunsüpresif ilaçlar, diğer ilaçlar ve biyokimyasal parametreleri kaydedildi. Tüm RT alıcılarında ilk sabah idrarında spot üriner sodyum ve spot üriner protein atılımları ölçüldü. Hastalar spot üriner sodyumdaki medyan değeri 57'ye göre düşük sodyum atılımı (≤57) ve yüksek sodyum atılımı (≥58) olarak gruplandırıldı.
Bulgular: Düşük sodyum grubunda; kadınlarda kreatinin değerleri anlamlı derecede düşük (p<0,001) ve eGFR yüksek saptandı (p=0,03). Yüksek sodyum grubunda; BUN ve kreatinin düzeyleri cinsiyete göre karşılaştırıldığında erkeklerde anlamlı derecede yüksek bulundu (sırasıyla p=0,04 ve p=0,02). EF ölçümü erkeklerde kadınlardan anlamlı derecede düşüktür (p=0,008). Metabolik sendromu olan ve olmayan hastaların spot idrar sodyum atılımları karşılaştırıldığında her iki grupta spot idrar sodyum atılım değerleri arasında fark saptanmadı (p=0,99).
Sonuç: Spot idrar sodyum atılımı, RT hastalarında sodyum alımını değerlendirmek için kullanılabilecek ucuz ve nispeten etkili bir tarama yöntemi olarak görülebilir. Özellikle erkek cinsiyet, böbrek fonksiyon bozukluğu ve yüksek tansiyonu olan RT alıcılarında daha değerli bir takip yöntemi olarak kabul edilebilir.
Anahtar Kelimeler
Böbrek nakli greft fonksiyonu hipertansiyon metabolik sendrom spot idrar sodyum
Kaynakça
- 1. Grundy, S.M., et al., Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation, 2005. 112(17): p. 2735-52.
- 2. Reaven, G.M., Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med, 1993. 44: p. 121-31.
- 3. Mancia, G., et al., 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens, 2013. 31(7): p. 1281-357.
- 4. Chobanian, A.V., et al., The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama, 2003. 289(19): p. 2560-72.
- 5. He, F.J. and G.A. MacGregor, Salt, blood pressure and cardiovascular disease. Curr Opin Cardiol, 2007. 22(4): p. 298-305.
- 6. Kaplan, N.M., Kaplan's clinical hypertension. 2010: Lippincott Williams & Wilkins.
- 7. Zipes DP, L.P., Bonow RO Braunwald E. Braunwald's Heart Disease A Textbook of Cardiovascular Medicine. Seventh Edition. Elsevier Saunders, 2005: p. 37-38.
- 8. McDonald, S.P., Australia and New Zealand Dialysis and Transplant Registry. Kidney Int Suppl (2011), 2015. 5(1): p. 39-44.
- 9. Collins, A.J., et al., United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease. Kidney Int Suppl (2011), 2015. 5(1): p. 2-7.
- 10. Baudrand, R., et al., High sodium intake is associated with increased glucocorticoid production, insulin resistance and metabolic syndrome. Clin Endocrinol (Oxf), 2014. 80(5): p. 677-84.
- 11. Hoffmann, I.S. and L.X. Cubeddu, Salt and the metabolic syndrome. Nutr Metab Cardiovasc Dis, 2009. 19(2): p. 123-8.
- 12. Teixeira, A.P., et al., Prevalence of metabolic syndrome and its associated factors in renal transplant recipients. J Bras Nefrol, 2012. 34(1): p. 16-21.
- 13. Fabbian, F., et al., Risk factors for metabolic syndrome in stable Italian renal transplant patients. Clinical and experimental nephrology, 2011. 15(4): p. 560-566.
- 14. Kim, B.K., et al., Relationship between sodium intake and blood pressure according to metabolic syndrome status in the Korean National Health and Nutrition Examination Survey. Blood pressure monitoring, 2012. 17(3): p. 120-127.
- 15. Unal, A., et al., The relationship between daily urinary sodium excretion and metabolic syndrome in patients with kidney transplantation. Annals of transplantation, 2014. 19: p. 397-402.
- 16. Donovan, D.S., et al., Effect of sodium intake on insulin sensitivity. Am J Physiol, 1993. 264(5 Pt 1): p. E730-4.
- 17. Verhave, J.C., et al., Sodium intake affects urinary albumin excretion especially in overweight subjects. Journal of internal medicine, 2004. 256(4): p. 324-330.
- 18. M, F., for the Transplant Therapy Outcomes Study Group. Study 1: long-term cardiovascular risk after kidney transplantation. Transplant Rev 4:s4 2003.
- 19. Opelz, G., T. Wujciak, and E. Ritz, Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study. Kidney Int, 1998. 53(1): p. 217-22.
- 20. Rodrigo, E., et al., Sodium Excretion Pattern at 1 Year After Kidney Transplantation and High Blood Pressure. Ann Transplant, 2015. 20: p. 569-75.
- 21. Ramesh Prasad, G.V., et al., The role of dietary cations in the blood pressure of renal transplant recipients. Clin Transplant, 2006. 20(1): p. 37-42.
- 22. Saint-Remy, A., et al., Urinary and dietary sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant recipients: an observational study. BMC Nephrology, 2012. 13(1): p. 121.
- 23. van den Berg, E., et al., Sodium intake and blood pressure in renal transplant recipients. Nephrol Dial Transplant, 2012. 27(8): p. 3352-9.
- 24. Mente, A., et al., Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med, 2014. 371(7): p. 601-11.
- 25. Umesawa, M., et al., The relationship between sodium concentrations in spot urine and blood pressure increases: a prospective study of Japanese general population: the Circulatory Risk in Communities Study (CIRCS). BMC Cardiovasc Disord, 2016. 16: p. 55.
- 26. Khaw, K.T., et al., Blood pressure and urinary sodium in men and women: the Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). Am J Clin Nutr, 2004. 80(5): p. 1397-403.
- 27. Takeda, Y., et al., Effects of an endothelin receptor antagonist in rats with cyclosporine-induced hypertension. Hypertension, 1995. 26(6): p. 932-936.
Evaluation of the relationship of urinary sodium excretion with metabolic syndrome, hypertension, and graft function in renal transplant patients
Öz
Aim: To evaluate the relationship between high sodium intake determined by spot urinary sodium excretion with metabolic syndrome, hypertension, and graft function in renal transplant (RT) recipients.
Materials and methods: 152 RT recipients were enrolled. The demographic characteristics, office blood pressure (BP) values, height, weight, body mass index, waist and hip measurements, immunesuppressive drugs, other medications and biochemical parameters of the patients were recorded. Spot urinary sodium and spot urinary protein excretions were measured in the first morning urine in all the RT recipients. The patients were grouped as low sodium excretion (≤57) and high sodium excretion (≥58) based on the median value of 57 in spot urinary sodium.
Results: In the low sodium group; creatinine values were found to be significantly lower (p<0.001) and eGFR was high in female patients (p=0.03). The mean protein in spot urine was found to be lower in women (p=0.03). In the high sodium group; BUN and creatinine levels were significantly higher in male patients than in female patients (p=0.04 and p=0.02, respectively). Ejection fraction was found to be significantly lower in male patients than in female patients (p=0.008). Spot urinary sodium excretion of patients with and without metabolic syndrome were compared and no difference was found between spot urinary sodium excretion values in both groups (p=0.99).
Conclusion: Spot urinary sodium excretion can be seen as an inexpensive and relatively effective screening method that can be used to evaluate sodium intake in RT patients. It can be considered as a more valuable follow-up method especially in RT recipients with male gender, kidney dysfunction and high BP.
Anahtar Kelimeler
Böbrek nakli greft fonksiyonu hipertansiyon metabolik sendrom spot idrar sodyum
Kaynakça
- 1. Grundy, S.M., et al., Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation, 2005. 112(17): p. 2735-52.
- 2. Reaven, G.M., Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med, 1993. 44: p. 121-31.
- 3. Mancia, G., et al., 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens, 2013. 31(7): p. 1281-357.
- 4. Chobanian, A.V., et al., The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama, 2003. 289(19): p. 2560-72.
- 5. He, F.J. and G.A. MacGregor, Salt, blood pressure and cardiovascular disease. Curr Opin Cardiol, 2007. 22(4): p. 298-305.
- 6. Kaplan, N.M., Kaplan's clinical hypertension. 2010: Lippincott Williams & Wilkins.
- 7. Zipes DP, L.P., Bonow RO Braunwald E. Braunwald's Heart Disease A Textbook of Cardiovascular Medicine. Seventh Edition. Elsevier Saunders, 2005: p. 37-38.
- 8. McDonald, S.P., Australia and New Zealand Dialysis and Transplant Registry. Kidney Int Suppl (2011), 2015. 5(1): p. 39-44.
- 9. Collins, A.J., et al., United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease. Kidney Int Suppl (2011), 2015. 5(1): p. 2-7.
- 10. Baudrand, R., et al., High sodium intake is associated with increased glucocorticoid production, insulin resistance and metabolic syndrome. Clin Endocrinol (Oxf), 2014. 80(5): p. 677-84.
- 11. Hoffmann, I.S. and L.X. Cubeddu, Salt and the metabolic syndrome. Nutr Metab Cardiovasc Dis, 2009. 19(2): p. 123-8.
- 12. Teixeira, A.P., et al., Prevalence of metabolic syndrome and its associated factors in renal transplant recipients. J Bras Nefrol, 2012. 34(1): p. 16-21.
- 13. Fabbian, F., et al., Risk factors for metabolic syndrome in stable Italian renal transplant patients. Clinical and experimental nephrology, 2011. 15(4): p. 560-566.
- 14. Kim, B.K., et al., Relationship between sodium intake and blood pressure according to metabolic syndrome status in the Korean National Health and Nutrition Examination Survey. Blood pressure monitoring, 2012. 17(3): p. 120-127.
- 15. Unal, A., et al., The relationship between daily urinary sodium excretion and metabolic syndrome in patients with kidney transplantation. Annals of transplantation, 2014. 19: p. 397-402.
- 16. Donovan, D.S., et al., Effect of sodium intake on insulin sensitivity. Am J Physiol, 1993. 264(5 Pt 1): p. E730-4.
- 17. Verhave, J.C., et al., Sodium intake affects urinary albumin excretion especially in overweight subjects. Journal of internal medicine, 2004. 256(4): p. 324-330.
- 18. M, F., for the Transplant Therapy Outcomes Study Group. Study 1: long-term cardiovascular risk after kidney transplantation. Transplant Rev 4:s4 2003.
- 19. Opelz, G., T. Wujciak, and E. Ritz, Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study. Kidney Int, 1998. 53(1): p. 217-22.
- 20. Rodrigo, E., et al., Sodium Excretion Pattern at 1 Year After Kidney Transplantation and High Blood Pressure. Ann Transplant, 2015. 20: p. 569-75.
- 21. Ramesh Prasad, G.V., et al., The role of dietary cations in the blood pressure of renal transplant recipients. Clin Transplant, 2006. 20(1): p. 37-42.
- 22. Saint-Remy, A., et al., Urinary and dietary sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant recipients: an observational study. BMC Nephrology, 2012. 13(1): p. 121.
- 23. van den Berg, E., et al., Sodium intake and blood pressure in renal transplant recipients. Nephrol Dial Transplant, 2012. 27(8): p. 3352-9.
- 24. Mente, A., et al., Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med, 2014. 371(7): p. 601-11.
- 25. Umesawa, M., et al., The relationship between sodium concentrations in spot urine and blood pressure increases: a prospective study of Japanese general population: the Circulatory Risk in Communities Study (CIRCS). BMC Cardiovasc Disord, 2016. 16: p. 55.
- 26. Khaw, K.T., et al., Blood pressure and urinary sodium in men and women: the Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). Am J Clin Nutr, 2004. 80(5): p. 1397-403.
- 27. Takeda, Y., et al., Effects of an endothelin receptor antagonist in rats with cyclosporine-induced hypertension. Hypertension, 1995. 26(6): p. 932-936.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 14 Sayı: 1 |
Kaynak Göster
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