The relation between strict volume control and inlamatory markers in hemodialysis patients

2-ABSTRACTThe Relation Between Strict Volume Control and Inlamatory Markers inHemodialysis PatientsC ardiovascular deaths are m ore frequ ent in ürem ic patients than gen eralpopulation. Left ventricular hypertrophy (LVH) is an important risk factor formortality in hemodialysis patient like others. Hypertension, hypervolemia andürem ic tox ins in chronic renal failure cause endothelial disfun ction andaccelerated atherosclerosis by inflamation and oxidative stress. Hypertension andhypervolemia are seen in 80-90% of treated chronic renal failure patients andaccepted as two important mortality risk factors. Because of the ongoinghypervolemia, anti-hypertensive treatment are not succesfull in m ost centers. İnthis study we aimed to evaluate the strict volume control on inflamatory andoxidative stress markers.The study population was composed of patients with strict volume controlwith hemodialysis (n=20), normotensive hemodialysis patients with anti-hypertensive medications (n=20) and healthy volunteers (n=20). The study wasstarted at the end of 6 months follow up period when the patients blood pressurewere came to aceptable levels. Echocardiographic examination of the patientswere done at short inter-dialytic day. Routine biochemical parameters, MDA,SOD, GSH-Px, ok-LDL, NO, CRP, TNF-α , IL -1, IL-6, PAI-1 and adiponectinvolues were examined in all groups.Blood pressure was in acceptable levels in anti-hypertensive taking group.LVMI and LVEDDI were significantly lower in strict volume control group thenanti-hypertensive group (p< 0,05). Oxidative stress and inflamatory markers werealso significantly lower in strict volume control group than anti-hypertensive drugusing group. Antioxidant system was protected better in strict volume controlgroup (p<0.001).Nitric oxide levels were similar in both groups. Adiponectin andPAI-1 levels were significantly betterin strict volume control group (p<0.05).The treatment of hypervolemic hypertension by anti-hypertensive drugs indialiysis patients was not reverse the endothelial dysfunction. On the other hand,better blood pressure control and endothelial dysfunction protection were achived3by strict volume control. The preference of strict volume control over anti-hypertensive therapy protected cardiac function better and patients were faced tolower oxidative stress and inflamation, in hemodialysis patients.Key words: Chronic renal failure, Hemodialysis, Strict volume control,Oxidative stress, Inflammation.4