15 kg Atında Akut Diyaliz Yapılan Hastaların Uzun Dönem Renal Fonksiyonlarının Araştırılması

Gulcek, O.N. Investigation of long-term renal functions of patients under 15 kg who underwent acute dialysis, Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis in Pediatrics, Ankara, 2021. There are few studies on the prognosis of pediatric patients who have received renal replacement therapy (RRT), and how long-term renal outcomes of survivors are affected. This study aims to examine the clinical features of patients who have undergone acute RRT while weighing less than 15 kg, to investigate their renal functions during the dialysis period, and in the clinical follow-up after discharge, to examine their survival according to the RRT modalities, and the clinical characteristics of the patients, and to investigate renal functions of these patients in the long term. A total of 80 patients were included in the study. Hemodialysis (HD) was performed in 43 patients (53.8%), and peritoneal dialysis (PD) was performed in 37 patients (46.2%). The age, height, weight, and body surface area of HD patients were found to be significantly higher than those of PD patients (p<0.001). At the end of the dialysis process, 41 patients (51.3%) survived. The mortality rate was found to be higher in PD patients (45.9%) than HD patients (11.6%) (p<0.001). The only case of mortality associated with dialysis occurred in the PD group. It was determined that the height, weight, and body surface area values of the surviving patients at the beginning of dialysis were higher than those of the deceased patients (p<0.001). The use of vasopressor therapy, the rate of initiation of mechanical ventilation and sepsis were found to be significantly higher in patients who died. In multiple regression analysis, only low weight and vasopressor treatment were found to be negatively associated with survival. Dialysis modality did not affect survival. Non-nephrotic proteinuria was found in six (19.3%) of 31 patients (38.8%) at the last visit. Stage 2 chronic kidney disease (CKD) was diagnosed in three patients (9.6%), and proteinuria or hypertension was found in any of these patients. Office blood pressure measurement revealed hypertension in one patient. Masked hypertension was detected in one patient with ambulatory blood pressure monitoring. In conclusion, findings such as CKD, proteinuria, and hypertension may be observed in these group of patients, and they should be followed up regularly in the pediatric nephrology departments. Peritoneal dialysis and hemodialysis can be used safely, and effectively in patients weighing less than 15 kg. Key words: Acute kidney injury, catheter, hemodialysis, infant, peritoneal dialysisGülçek, Ö.N. 15 kg altında akut diyaliz yapılan hastaların uzun dönem renal fonksiyonlarının araştırılması, Hacettepe Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Uzmanlık Tezi, Ankara, 2021. Hayatının erken döneminde ve 15 kg altında iken, renal replasman tedavisi (RRT) uygulanmış olan hastaların prognozları ve sağ kalan hastaların uzun dönemde renal sonuçlarının nasıl olduğu konusunda yapılmış az sayıda çalışma bulunmaktadır. Bu çalışmanın amacı 15 kg’dan düşük akut RRT uygulanmış olan hastaların klinik özelliklerini incelemek, diyaliz sürecinde ve taburcu olduktan sonraki klinik izlemlerinde böbrek fonksiyonlarını araştırmak, uygulanan RRT modalitelerine ve hastaların klinik özelliklerine göre sağkalımlarını incelemek ve uzun dönemde bu hastaların renal fonksiyonlarını araştırmaktır. Çalışmamızda 80 hasta incelendi. Bu hastaların 43’üne (%53,8) hemodiyaliz (HD), 37’sine (%46,2) periton diyalizi (PD) uygulandı. Hemodiyaliz hastalarının diyaliz başı yaş, boy, vücut ağırlığı ve vücut yüzey alanlarının PD hastalarına göre daha yüksek olduğu tespit edildi (p<0,001). Diyaliz süreci sonunda 41 hasta (%51,3) sağ kaldı. Ölüm oranı PD uygulanmış hastalarda (%45,9), HD yapılanlara (%11,6) göre yüksek bulundu (p<0,001). Diyaliz ile ilişkilendirilmiş tek mortalite vakası PD grubunda yaşandı. Sağ kalan hastaların diyaliz başındaki boy, vücut ağırlığı ve vücut yüzey alanı değerlerinin ölmüş hastalara göre yüksek olduğu belirlendi (p