DÜZENL‹ HEMOD‹YAL‹Z TEDAV‹S‹ GÖREN KRON‹K RENAL YETMEZL‹KL‹ OLGULARDA HEMOSTAT‹K PARAMETRELERDEK‹ DE⁄‹fiMELER

Duzenli hemodiyaliz tedavisi goren kronik renal yetmezlikli (KRY) hastalarda, hemostatik parametrelerdeki deiflimleri ve hemodiyaliz tedavisinin bu parametreler uzerindeki etkilerini incelemek amac›yla, 20 sal›kl› olguda ve kuprofan (CP) membranlar›yla duzenli hemodiyaliz tedavisi goren 20 KRY'li olguda cal›fl›lm›flt›r. Hemodiyaliz tedavisinin etkilerinin gosterilebilmesi amac›yla da, cal›flma grubundaki hastalar hemodiyaliz seans› oncesi ve sonras›nda kan ornekleri al›narak incelenmifltir. Tum gruplarda trombosit say›s›, protrombin zaman› (PT), parsiyel tromboplastin zaman› (PTT), fibrinojen, fibrin-fibrinojen y›k›m urunleri (FDP), antitrombin III (AT III), D-dimer duzeyleri ve rutin parametreler tayin edilmifltir. Sal›kl› kontrol grubu ile diyaliz oncesindeki cal›flma grubu karfl›laflt›r›ld›¤›nda, KRY'li grupta trombosit say›s› kontrol grubuna gore anlaml› azalm›fl, PT anlaml› uzam›fl, fibrinojen duzeyleri anlaml› artm›fl, AT III aktivitesi anlaml› azalm›fl, D-Dimer duzeyleri kontrol grubuna gore anlaml› artm›fl olarak saptanm›flt›r. PTT her iki grupta da normal s›n›rlarda bulunmufltur. Diyaliz oncesi ve sonras›ndaki deerler incelendiinde, hemodiyaliz sonras›nda hemostatik parametrelerde anlaml› fark saptanmam›flt›r. Bu cal›flmada saptad›¤›m›z AT III aktivitesindeki azalma ve fibrinojen konsantrasyonlar›ndaki artma bu olgularda hiperkoagulasyon gelifltiini ve FDP-D-Dimer konsantrasyonlar›ndaki art›fl ise hiperkoagulasyona sekonder olarak fibrinolitik sistemin aktive olduunu ortaya koymufltur. AT III ve D-Dimer bir hemodiyaliz seans› ile deiflmediinden, bu parametrelerin uzun sureli hemodiyaliz tedavisi goren KRY'li hastalarda koagulasyon ve fibrinolitik sistemlerin aktivasyonlar›n›n izlenmesinde kullan›labilecei kan›s›na var›lm›flt›r. In order to investigate the changes of haemostatic parameters and the effects of regular hemodialysis in the patients with chronic renal failure (CRF) we studied in 20 healthy controls and in 20 patients with CRF undergoing regular hemodialysis with cuprophan (CP) membrane. To show the effects of hemodialysis we investigated blood samples of working group before and after hemodialysis. In all groups we determined AT III, D-dimer, platelets, fibrinogen, FDP, PT, PTT and routine parameters. In working group before dialysis platelets were lower than controls and fibrinogen levels were higher and AT III levels were lower and D-dimer levels were higher and PT was longer, PTT was found in the normal ranges in each group. There were no established differences between haemostatic parameters before and after dialysis. Decrease of AT III activity and increase of fibrinogen concentration in the patients with CRF undergoing regular hemodialysis treatment that we established in this study showed the developing of hypercoagulation in this cases, and increase of FDP-D-dimer concentrations showed the activation of fibrinolytic system secondary of hypercoagulation. Because of AT III and D-dimer don't change with one hemodialysis session we concluded that AT III and D-dimer might be used to observe the activations of coagulation and fibrinolytic system in the patients with CRF on long-term hemodialysis.