Chronic renal failure in grades 3-4, secondary hyperparatiroid, carotis intima media thicknes related risk faktors

Background: In patients with CRF (Chronic Renal Failure), secondary hyperparatiroid (SHPT) is a leading cause of morbidity and mortality due to its clinical outcome. Furthermore, hyperphosphotemy associated with SHPT and abnormal mineral metabolizm involving increased Ca×P outcome contributes to cardiovascular mortality. It has also been shown that Intima-Media Thickness increase of carotis arteries (CIMT) is a reliable indicator of ateroschlerosis. Our aim in this study is to determine CIMT and SHPT as well as the related risk factors in predialitic patients with CRF in grades 3-4.Material and Method: A total of 84 cases, 62 patients with CRF in grades 3-4 and 22 healthy subjects, were included into the study. There was not any difference between both groups in terms of age and sex (p>0.05). Serum glucose, urea, creatinin, sodium, potassium, calcium, phosphore, ALT, AST, LDH, total protein, albumin, uric acid, total cholesterol, LDL, HDL, trigliserid, iron, iron binding capasity, parathormon, insulin levels, hemogram values and CIMT of all the cases included into the study were also determined. In patient group, furthermore, 1.25(OH)2 D3 level and M mod echocardiographies were taken.Results: Between the patient group and controls, a significant difference was found in terms of CIMT, glucose, urea, creatinin, Na, K, Ca, P, Ca×P, t. protein, albumin, uric acid, iron, hemoglobin, hematocrit, MCV, WBC, neutrophil and parathormon (p<0.05). In PTH values, numerically, a remarkable difference was noted as 139.02±86.48 pg/ml in grade 3, 209.93±183.25 pg/ml in grade 4 (p=0.168). While there was a negative correlation between PTH and Ca (r=-0.345, p=0.001) and albumin (r=-0.244, p=0.025), the correlation was positive between PTH and other risk factors such as urea (r=0.577, p<0.001), creatinin (r=0.671, p<0.001), HOMA-IR (r=0.280, p=0.010), P (r=0.462, p<0.001) and Ca×P (r=0.294, p=0.007). In the study, a significant difference was determined between controls (0.65±0.09 mm) and patient group (0.82±0.14 mm) for CIMT (p<0.001); In addition, there was a significant difference between grade 3 (0.75±0.13 mm) and grade 4 (0.84±0.14 mm) (p=0.030). In the patient group, there was a negative correlation between CIMT and Ca (r=-0.345, p=0.001) and albumin (r=-0.324, p=0.003), whereas the correlation was found to be positive between CIMT and other risk factors such as PTH (r=0.362, p=0.001), urea (r=0.489, p<0.001), creatinin (r=0.345, p=0.001), age (r=0.563, p<0.001), glucose (r=0.221, p=0.043), P (r=0.460, p<0.001) and Ca×P (r=0.373, p<0.001)Conclusion: As CRF grades progress SHPT frequensy and CIMT also increase. The correlation between CIMT and urea, creatinin, age, glucose, P, Ca×P and PTH was found to be positive, while it was negative betveen CIMT and Ca and albumin. A positive correlation was determined between PTH and P, age, creatinin and HOMA-IR, whereas it was negative between PTH and Ca and albumin.Key words: Creatinin clearance, CRF, Carotis Intima-Media Thickness, parathormon, secondary hyperparatiroidy.