Hemodiyaliz hastalarında diyaliz sonu yorgunluk nedenleri.
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Dünya genelinde yapılan çok merkezli çalışma kayıtlarına göre hemodiyaliz tedavisi
alan hastalarda yorgunluk görülme oranı %60-97’dir. Bu nedenlerle hemodiyaliz sonrası
yorgunluğun belirlenmesi, en aza indirilmesi ve günlük yaşam aktivitelerinin planlanması
önemlidir. Bu çalışma ile hemodiyaliz sonu yorgun olan ve olmayan hastalarda yorgunluğa yol
açabilecek yaş, cinsiyet, anemi, nutrisyonel durum, kan basıncı, diyaliz süresi, ultrafiltrasyon
miktarı, diyaliz yeterliliği(Kt/V) ve orta molekül toksik maddelerin temizlenme ölçütü olan
beta-2 mikroglobulin kan düzeyi arasındaki ilişki araştırılacaktır.
Yöntem: Çalışmamıza 120 hemodiyaliz hastası dahil edildi. Hemodiyaliz tedavisi almakta olan
hastalarda yorgunluk varlığı Short Form-36 (SF-36) ve Fatigue Severity Scale (FSS) ile tespit
edildi. Çalışmaya 18 yaş üzeri ve 6 aydan uzun süredir hemodiyaliz tedavisi almakta olan
hastalar dahil edilmiş olup yorgunluk ve halsizlik yapabilecek hastalıkları (kalp yetmezliği,
karaciğer yetmezliği, malignite, aktif enfeksiyon) olanlar çalışmaya dahil edilmedi.
Hemodiyalize girilmeyen en uzun dönem sonunda diyaliz öncesi serum beta-2 mikroglobulin
düzeyleri ELISA yöntemi ile ölçüldü. Hemodiyaliz süreleri, hastaların yaşları, hastalık
özgeçmişleri ve diğer veriler dosya kayıtlarından elde edildi.
Veriler bilgisayar ortamında SPSS (Statistical Package for Social Sciences) 18.0 paket
programı ile analiz edildi. Tanımlayıcı analizlerde frekans verileri sayı (n) ve yüzde (%) olarak,
sayısal veriler ise Mean±SD (ortalama±standart sapma), median (ortanca (1-3. çeyrek)),
minimum-maximum, %95 güven aralığı kullanılarak gösterildi. Kategorik verilerin
karşılaştırılmasında Ki-kare (ꭕ
2
) testi ve Fisher’ın kesin ki-kare testi kullanıldı. Sayısal verilerin
normal dağılıma uygunluğu Kolmogorov-Smirnov ve Shapiro Wilk testleri ile incelendi.
Normal dağılan bağımsız iki gruptaki sayısal verilerin karşılaştırılması İndependent Samples T
testi ile değerlendirildi. Normal dağılmayan bağımsız iki gruptaki sayısal verilerin
karşılaştırılması Mann Whitney U testi kullanılarak incelendi. Normal dağılmayan ikiden fazla
bağımsız gruptaki sayısal değişkenlerin karşılaştırılması Kruskal Wallis testi kullanılarak
değerlendirildi. Sonuçlar %95’lik güven aralığında, anlamlılık p<0,05 düzeyinde
değerlendirildi.
Purpose: According to the records of multicenter studies conducted around the world, the rate of fatigue in patients receiving hemodialysis treatment is 60-97%. For these reasons, it is important to determine and minimize fatigue after hemodialysis and to plan daily living activities. In this study, age, gender, anemia, nutritional status, blood pressure, dialysis time, ultrafiltration amount, dialysis adequacy (Kt/V) and beta-2 microglobulin, which is a measure of clearance of medium molecule toxic substances that may cause fatigue in patients with or without fatigue at the end of hemodialysis, were investigated. The relationship between blood level will be investigated. Method: 120 hemodialysis patients were included in our study. The presence of fatigue in patients receiving hemodialysis treatment was determined with the Short Form-36 (SF-36) and Fatigue Severity Scale (FSS). Patients over the age of 18 and receiving hemodialysis treatment for more than 6 months were included in the study, and those with diseases that could cause fatigue and weakness (heart failure, liver failure, malignancy, active infection) were not included in the study. At the end of the longest period of non-hemodialysis, pre-dialysis serum beta-2 microglobulin levels were measured by ELISA method. Hemodialysis durations, patients' ages, medical history and other data were obtained from file records. Data were analyzed in computer environment with SPSS (Statistical Package for Social Sciences) 18.0 package program. In descriptive analyzes, frequency data were shown as numbers (n) and percent (%), and numerical data were shown using Mean±SD (mean±standard deviation), median (median (1-3rd quartile)), minimum-maximum, 95% confidence interval. . Chi-square (ꭕ2) test and Fisher's exact chi-square test were used to compare categorical data. Compliance of numerical data with normal distribution was examined by Kolmogorov-Smirnov and Shapiro Wilk tests. Comparison of numerical data in two normally distributed independent groups was evaluated with the Independent Samples T test. Comparison of numerical data in two independent groups that were not normally distributed was analyzed using the Mann Whitney U test. Comparison of numerical variables in more than two independent groups not normally distributed was evaluated using the Kruskal Wallis test. The results were evaluated at the 95% confidence interval, and the significance was at the p<0.05 level. vii Findings: In our study, fatigue was found to be statistically significantly higher in female patients, 86.2% of whom were tired compared to male patients (p=0.007). There was no statistically significant difference between fatigue status according to chronic diseases, blood pressure distribution and BMI groups (p>0.05). Age, dialysis time, Kt/v, CRP and beta-2 Microglobulin levels of patients who were tired were found to be statistically significantly higher than patients who were not tired (p values were respectively; p=0.011, p=0.001, p=0.029, p=0.018 p). =0.001). Other laboratory findings were measured similarly in the tired and non-tired groups (p>0.05). Beta-2 microglobulin levels of patients with diabetes mellitus were found to be statistically significantly lower than patients without diabetes mellitus (p=0.049). Beta-2 microglobulin level of patients with coronary artery disease was found to be statistically lower than patients without coronary artery disease (p=0.041). Beta-2 microglobulin levels were found to be higher in patients using low flux membranes compared to patients using high flux membranes (p=0.001). Beta-2 microglobulin levels of patients who were found to be tired with the Fatigue Severity Scale and SF-36 Score were statistically higher than the patients who were not tired (p=0.001). Results: In our study, we determined that female gender, low-flux membrane use, hemoglobin level, ultrafiltration amount and age, dialysis time, Kt/V, CRP, and serum beta-2 microglobulin levels can cause fatigue in hemodialysis patients.
Purpose: According to the records of multicenter studies conducted around the world, the rate of fatigue in patients receiving hemodialysis treatment is 60-97%. For these reasons, it is important to determine and minimize fatigue after hemodialysis and to plan daily living activities. In this study, age, gender, anemia, nutritional status, blood pressure, dialysis time, ultrafiltration amount, dialysis adequacy (Kt/V) and beta-2 microglobulin, which is a measure of clearance of medium molecule toxic substances that may cause fatigue in patients with or without fatigue at the end of hemodialysis, were investigated. The relationship between blood level will be investigated. Method: 120 hemodialysis patients were included in our study. The presence of fatigue in patients receiving hemodialysis treatment was determined with the Short Form-36 (SF-36) and Fatigue Severity Scale (FSS). Patients over the age of 18 and receiving hemodialysis treatment for more than 6 months were included in the study, and those with diseases that could cause fatigue and weakness (heart failure, liver failure, malignancy, active infection) were not included in the study. At the end of the longest period of non-hemodialysis, pre-dialysis serum beta-2 microglobulin levels were measured by ELISA method. Hemodialysis durations, patients' ages, medical history and other data were obtained from file records. Data were analyzed in computer environment with SPSS (Statistical Package for Social Sciences) 18.0 package program. In descriptive analyzes, frequency data were shown as numbers (n) and percent (%), and numerical data were shown using Mean±SD (mean±standard deviation), median (median (1-3rd quartile)), minimum-maximum, 95% confidence interval. . Chi-square (ꭕ2) test and Fisher's exact chi-square test were used to compare categorical data. Compliance of numerical data with normal distribution was examined by Kolmogorov-Smirnov and Shapiro Wilk tests. Comparison of numerical data in two normally distributed independent groups was evaluated with the Independent Samples T test. Comparison of numerical data in two independent groups that were not normally distributed was analyzed using the Mann Whitney U test. Comparison of numerical variables in more than two independent groups not normally distributed was evaluated using the Kruskal Wallis test. The results were evaluated at the 95% confidence interval, and the significance was at the p<0.05 level. vii Findings: In our study, fatigue was found to be statistically significantly higher in female patients, 86.2% of whom were tired compared to male patients (p=0.007). There was no statistically significant difference between fatigue status according to chronic diseases, blood pressure distribution and BMI groups (p>0.05). Age, dialysis time, Kt/v, CRP and beta-2 Microglobulin levels of patients who were tired were found to be statistically significantly higher than patients who were not tired (p values were respectively; p=0.011, p=0.001, p=0.029, p=0.018 p). =0.001). Other laboratory findings were measured similarly in the tired and non-tired groups (p>0.05). Beta-2 microglobulin levels of patients with diabetes mellitus were found to be statistically significantly lower than patients without diabetes mellitus (p=0.049). Beta-2 microglobulin level of patients with coronary artery disease was found to be statistically lower than patients without coronary artery disease (p=0.041). Beta-2 microglobulin levels were found to be higher in patients using low flux membranes compared to patients using high flux membranes (p=0.001). Beta-2 microglobulin levels of patients who were found to be tired with the Fatigue Severity Scale and SF-36 Score were statistically higher than the patients who were not tired (p=0.001). Results: In our study, we determined that female gender, low-flux membrane use, hemoglobin level, ultrafiltration amount and age, dialysis time, Kt/V, CRP, and serum beta-2 microglobulin levels can cause fatigue in hemodialysis patients.
Açıklama
Anahtar Kelimeler
Kronik böbrek Hastalığı, Beta-2 mikroglobulin, Üre temizlenme oranı(Kt/V), Chronic kidney disease, Beta-2 microglobulin, Urea clearance rate(Kt/V)
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Canseven, M. (2021). Hemodiyaliz hastalarında diyaliz sonu yorgunluk nedenleri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
