METABOLIC DISORDERS IN RENAL TRANSPLANT RECIPIENTS

Tradicionalni čimbenici rizika za razvoj srčanožilnih bolesti (SŽB) kao što su to arterijska hipertenzija (AH), novonastala šećerna bolest (NDDM) i poremećaj metabolizma masnoća (HLP) i do pedeset su puta učestaliji u primatelja bubrežnog presatka nego u općoj populaciji. Cilj istraživanja bio je analizirati učestalost navedenih metaboličkih poremećaja u primatelja bubrežnog presatka, analizirati utjecaj primijenjene imunosupresivne terapije na pojavnost spomenutih metaboličkih poremećaja te analizirati broj i vrstu primijenjene antihipertenzivne terapije. Tijekom dvogodišnjeg razdoblja analizirali smo 53 bolesnika kojima je u KBCu Rijeka zbog završnog stadija kroni ne bubrežne bolesti transplantiran bubreg. Nakon transplantacije 92,5% bolesnika imalo je evidentiranu AH. Bolesnici koji su primali ciklosporin imali su statistički značajno veću incidenciju AH u odnosu na bolesnike koji su primali takrolimus (p=0,025). Devet bolesnika (17%) postiglo je ciljnu vrijednost arterijskog tlaka (<130/80 mm Hg). Osam bolesnika je u terapiji imalo jedan antihipertenziv, 24 bolesnika dva, 15 bolesnika tri, dva bolesnika su uzimala više od tri lijeka, dok četvoro bolesnika nije primalo antihipertenziv. Najčešće upotrijebljeni antihipertenziv bio je inhibitor kalcijskih kanala (40,4% bolesnika), potom slijede β blokatori (26,6% bolesnika) i inhibitori RAS sustava (ACE inhibitore primalo je 9,2% bolesnika, blokatore angiotenzinskih receptora 16,5% bolesnika). U šest (11,3%) bolesnika dijagnosticirana je NDDM, a u 21 (39,62%) dijagnosticirana je HLP. Zaključeno je da je potrebno provoditi redovitu i stalnu provjeru zdravstvenog stanja bolesnika s bubrežnim presatkom. Uz kontrolu laboratorijskih parametara funkcije presatka vrlo je važna kontrola krvnog tlaka, metabolizma glukoze i masnoća sa svrhom sprječavanja razvoja SŽB, poboljšanja funkcije presatka i kvalitete života te smanjenja mortaliteta primatelja bubrežnog presatka.Introduction: Advancements in immunosuppressive treatment of renal transplant recipients have signiicantly increased the graft and patient survival and signiicantly lowered the incidence of rejection crises. Efforts to increase long term patient and graft survival are directed to the prevention and treatment of cardiovascular diseases because they are the leading cause of mortality in these patients. Traditional risk factors for the development of cardiovascular diseases (e.g., arterial hypertension, posttransplant diabetes mellitus and metabolic lipid disorder) are up to ifty times more frequent among renal transplant recipients than in the general population. The goal of this study was to analyze the prevalence of the above mentioned metabolic disorders in renal transplant recipients, to analyze the impact of immunosuppressive therapy on the manifestation of these mentioned metabolic disorders, and to analyze the antihypertensive therapy applied. Subjects and Methods: We analyzed 53 patients that underwent renal transplantation at Rijeka University Hospital Center during a two-year follow-up. Glomerulonephritis was the primary kidney disease in 14 (29.6%), polycystic kidney disease in 10 (18.87%), interstitial nephritis in 7 (13.21%), nephroangiosclerosis in 5 (18.5%), diabetic nephropathy in 4 (7.55%) and other diseases in 13 (24.53%) patients. Results: The study included 53 patients (58.5% male), mean age 49.8±11.3 (range 27-72) years and mean dialysis treatment before transplantation 56.0±41.9 months. All patients received triple immunosuppressive therapy including a calcineurin inhibitor/ MMF/corticosteroids and induction with IL-2 receptor blocker (daclizumab or basiliximab). Thirty-three (62%) patients were treated with tacrolimus and 20 (38%) with cyclosporine. The mean creatinine value was 144.92±46.49. Eighteen (34%) patients had creatinine lower than 120 mmol/L and 35 (66%) patients had a level higher than 120 mmol/L. After transplantation, 49 (92.5%) patients were treated for arterial hypertension (arterial hypertension was deined as systolic blood pressure greater than 140 mm Hg and diastolic pressure greater than 90 mm Hg or the routine use of antihypertensive therapy). Patients receiving cyclosporine had a signiicantly higher incidence of arterial hypertension as compared with patients on tacrolimus (P=0.025). Among patients with serum creatinine level higher than 120 mmol/L, 32 (65.3%) patients had hypertension, 9 (17%) achieved target blood pressure (