Cardiovasculary effects of renal osteodystrophy in patients with stage 3-4 chronic kidney disease

Umut TÜRKMEN, Cardiovasculary Effects of Renal Osteodystrophy in Patients with Stage 3-4 Chronic Kidney Disease, Zonguldak Bülent Ecevit University, Faculty of Medicine, Department of Internal Medicine Thesis, Zonguldak, 2018. Introduction: Microvascular and macrovascular complications can be seen in chronic kidney disease and patients can also have calcium metabolism disorders. More than half of the deaths in chronic kidney disease is caused by cardiac pathologies. Renal osteodystrophy is thought to affect cardiac function in patients with chronic kidney disease, so this study was planned to investigate this condition. Materials and Methods: 300 patients were admitted to study who applied Zonguldak Bülent Ecevit University, Faculty of Medicine in 2011-2017 years with stage 3-4 chronic kidney disease, over 18 years old and had an echocardiography. Patients who didn't have required laboratory parameters, who were pregnant and who had chronic liver disease were excluded. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula was used to determine eGFR value. Patients were evaluated for serum parameters and echocardiography findings. Achieved data were analyzed with SPSS 19.0 Software Package and p values under 0,05 were considered statistically significant in statistical analysis. Results: In the study, patients were divided into 2 groups for osteodystrophy condition and they were compared for echocardiographic findings. The group with osteodystrophy had higher pulmonary artery pressure (p=0,016) and aorta velocity (p<0,001). In laboratory findings and other variables, urea (p=0,011) and uric acid (p=0,016) were higher in the group with osteodystrophy whereas eGFR was lower (p=0,026). Parathormone had statistically significant difference for ejection fraction (p=0,005) and patients with higher PTH levels had lower ejection fraction. Patients with higher parathormone levels also had higher aorta velocity (p=0,001). When calcium levels and aorta velocity were compared, they had statistically significant difference (p=0,041). Phophorus value had statistically significant difference for ejection fraction (p=0,027), Aorta annulus diameter (p=0,012) and ascending aorta diameter (p=0,003). Aorta annulus diameter (p=0,012) and ascending aorta diameter (p=0,003) had significant difference for calcium-phosphorus product. Uric acid (p=0,025), creatinine (p=0,006) and ferritin value (p=0,017) had statistically significant difference with ejection fraction. Patients who had higher values of these had lower ejection fraction. Patients with higher albumin value (p=0,001) had higher ejection fraction. Conclusion: As a result of the study, renal osteodystrophy was found to have relationship with aorta pathologies and pulmonary artery pressure. For this reason, annual echocardiography is recommended by us for patients with renal osteodystrophy in stage 3-4 chronic kidney disease.