Abstract
Objective: Frequency
and age-standardized mortality rate are increasing for asymptomatic and
ruptured abdominal aortic aneurysm (AAA). Because traditional risk factors and
chronic renal failure related risk factors in hemodialysis patients are
recognized as the main factors in AAA etiopathogenesis, in this study we aimed
to determine the frequency of AAA by
ultrasonography (USG).
Materials and Methods: A
total of 647 patients (341 men/306 women, 58.3±11.6 years of age) from 8
dialysis centers and 185 control subjects (102 men/83 women, 57.4±9.6 years of
age) were included in the study. Transverse diameter and anterior-posterior
diameter measurements of infrarenal aorta and suprarenal aorta were performed
with B-Mode gray scale ultrasound projection. The relationship between
demographic and biochemical parameters of patients and abdominal aortic
aneurysm was also evaluated.
Results: The frequency of AAA
was 8.2% in hemodialysis patients while 3.8% in control group (p<0.05). Men
displayed a higher risk of AAA than women (p<0.05). Univariate analysis of
hemodialysis patients and study parameters revealed a significant relation
between age, gender, hyperlipidemia and parathormone levels. However,
independent variables were determined as only age, male gender and diabetes
mellitus in multivariate analysis.
Conclusion: In our
study, the risk of AAA was found to increase in hemodialysis patients and
advanced age, male gender, and diabetes mellitus were determined as the
prominent factors . Our findings suggest that the patients having these risk
factors may have an improved life span with early detection and timely treatment
of abdominal aortic aneurysm cases by regular screening programs in
hemodialysis.
References
- Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC public health 2008; 8: 117.
- de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. Jama 2009; 302: 1782-1789.
- Ross L, Banerjee D. Cardiovascular complications of chronic kidney disease. Int J Clin Pract 2013; 67: 4-5.
- Leskinen Y, Salenius JP, Lehtimaki T, Huhtala H, Saha H. The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics. Am J Kidney Dis 2002; 40: 472-479.
- Lederle FA, Johnson GR, Wilson SE, Chute EP, Hye RJ, Makaroun MS, et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000; 160: 1425-1430.
- Gibbons RC, Russ JA. Aneurysm, Abdominal Aortic (AAA), Imaging. In: StatPearls. Treasure Island (FL): StatPearls Publishing.; 2017.
- Trenner M, Kuehnl A, Salvermoser M, Reutersberg B, Geisbuesch S, Schmid V, et al. High Annual Hospital Volume is Associated with Decreased in Hospital Mortality and Complication Rates Following Treatment of Abdominal Aortic Aneurysms: Secondary Data Analysis of the Nationwide German DRG Statistics from 2005 to 2013. Eur J Vasc Endovasc Surg 2017;S1078-5884.
- Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2005; 142: 203-211.
- Dabare D, Lo TT, McCormack DJ, Kung VW. What is the role of screening in the management of abdominal aortic aneurysms?Interact Cardiovasc Thorac Surg 2012; 14: 399-405.
- Metcalfe D, Holt PJ, Thompson MM. The management of abdominal aortic aneurysms. BMJ 2011; 342: d1384.
- Khan A, Khan AH, Adnan AS, Syed Sulaiman SA, Gan SH, Khan I. Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review. Biomed Res Int 2016; 2016: 9710965.
- Ultrasound Screening for Abdominal Aortic Aneurysms. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG) 2015.
- Takagi H, Umemoto T. Negative association of diabetes with rupture of abdominal aortic aneurysm. Diab Vasc Dis Res 2016; 13: 341-347.
- Wierzba W, Sliwczynski A, Pinkas J, Jawien A, Karnafel W. Diabetes mellitus increases the risk of ruptured abdominal aortic aneurysms. Diab Vasc Dis Res 2017; 14: 463-464.
- Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003; 63: 793-808.
Abstract
Amaç: Asemptomatik ve rüptüre
abdominal aort anevrizması (AAA) sıklığı ve yaş-standartize mortalitesi giderek
artmaktadır. Biz bu çalışmada
hemodiyaliz tedavisi alan hastalarda geleneksel risk faktörleri ve kronik
böbrek yetmezliği ile ilişkili risk faktörlerinin AAA etiopatogenezinde de
temel faktörler olması nedeniyle ultrasonografi (USG) ile AAA sıklığını
saptamayı amaçladık.
Gereç-Yöntemler: Toplam 8 diyaliz merkezinden 647 (341 erkek/306
kadın, 58.3±11.6 yıl ) hasta ve 185 (102 erkek/83 kadın, 57.4±9.6 yıl) kontrol
çalışmaya alındı. B-Mode gri skala Ultrasonografik projeksiyon ile infrarenal
aorta ve suprarenal aortanın transvers çap ve anterior-posterior çap ölçümleri
yapıldı. Ayrıca hastaların demografik ve biyokimyasal parametreleri ile
abdominal aort anevrizması arasındaki ilişki değerlendirildi.
Bulgular: Hemodiyaliz hastalarında abdominal aorta
anevrizması sıklığı %8.2 iken kontrol grubunda %3.8 idi (p<0.05). Cinsiyete
göre değerelendirildiğinde erkeklerde anevrizma riski daha yüksek saptandı
(p<0.05). Univariate analizde hemodiyaliz hastaları ve çalışma parametreleri
incelendiğinde yaş, cinsiyet, hiperlipidemi ve parathormon düzeyi arasında
anlamlı ilişki saptandı. Ancak multivariate analizde bağımsız değişkenler
yalnızca yaş, erkek cinsiyet ve diyabetes mellitus saptandı.
Sonuç: Çalışmamızda hemodiyaliz hastalarında abdominal
aort anevrizması riskinin arttığı ve risk artışında en temel faktörler olarak
ileri yaş, erkek cinsiyet ve diyabet mellitus varlığının ön planda çıktığını
saptadık. Bulgularımız, bu risk faktörlerine sahip hemodiyaliz hastalarında
düzenli tarama programları ile abdominal aort anevrizması olgularının
saptanarak gerekli girişimlerin yapılmasının yaşam sürelerine katkıda
bulunabileceğini düşündürmektedir.
References
- Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC public health 2008; 8: 117.
- de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. Jama 2009; 302: 1782-1789.
- Ross L, Banerjee D. Cardiovascular complications of chronic kidney disease. Int J Clin Pract 2013; 67: 4-5.
- Leskinen Y, Salenius JP, Lehtimaki T, Huhtala H, Saha H. The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics. Am J Kidney Dis 2002; 40: 472-479.
- Lederle FA, Johnson GR, Wilson SE, Chute EP, Hye RJ, Makaroun MS, et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000; 160: 1425-1430.
- Gibbons RC, Russ JA. Aneurysm, Abdominal Aortic (AAA), Imaging. In: StatPearls. Treasure Island (FL): StatPearls Publishing.; 2017.
- Trenner M, Kuehnl A, Salvermoser M, Reutersberg B, Geisbuesch S, Schmid V, et al. High Annual Hospital Volume is Associated with Decreased in Hospital Mortality and Complication Rates Following Treatment of Abdominal Aortic Aneurysms: Secondary Data Analysis of the Nationwide German DRG Statistics from 2005 to 2013. Eur J Vasc Endovasc Surg 2017;S1078-5884.
- Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2005; 142: 203-211.
- Dabare D, Lo TT, McCormack DJ, Kung VW. What is the role of screening in the management of abdominal aortic aneurysms?Interact Cardiovasc Thorac Surg 2012; 14: 399-405.
- Metcalfe D, Holt PJ, Thompson MM. The management of abdominal aortic aneurysms. BMJ 2011; 342: d1384.
- Khan A, Khan AH, Adnan AS, Syed Sulaiman SA, Gan SH, Khan I. Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review. Biomed Res Int 2016; 2016: 9710965.
- Ultrasound Screening for Abdominal Aortic Aneurysms. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG) 2015.
- Takagi H, Umemoto T. Negative association of diabetes with rupture of abdominal aortic aneurysm. Diab Vasc Dis Res 2016; 13: 341-347.
- Wierzba W, Sliwczynski A, Pinkas J, Jawien A, Karnafel W. Diabetes mellitus increases the risk of ruptured abdominal aortic aneurysms. Diab Vasc Dis Res 2017; 14: 463-464.
- Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003; 63: 793-808.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | March 26, 2018 |
| Submission Date | January 18, 2018 |
| Published in Issue | Year 2018 Volume: 8 Issue: 1 |
The published articles in SMJ are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.