The effect of inflammation and blood pressure measurement on health related quality of life in patients of chronic renal replacement therapy

Introduction and Purpose: Patients diagnosed with end stage renal disease (ESRD) are icnreas, ng in our country as well as all over the world with each passing day. There is close relationship between hemodialysis (HD) and peritoneal dialysis (PD), and kidney transplant (RTX)-treated patients' morbidity and quality of life. Determining The factors that are influencing the mortality and quaility of life of the HD, Pd and Rtx patients' will increase the quality of life. We aimed to determine the relationship between the modality of renal replacement therapy, the inflamation indicators and controlling blood pressure with health related quality of life in ESRD patients whom treated with different renal replacement therapies. Materials and Methods: In this study, 16 hemodialysis, 17 peritoneal dialysis and 27 renal transplant treated patients e who were admitted Cukurova University Faculty of Medicine, Nephrology Clinic, were included. The control group is consisted of 29 people who were admitted to Nephrology Clinic with diagnosis of Hypertension. The age, gender, educational status, renal failure caused by the dialysis treatment (HD, PD), dialysis duration of treatment, kidney transplant period, used drugs [antihypertensives (ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, alpha blockers, diuretics), immunosuppressive and others], and physical examination findings were recorded. To evaluate the quality of life for all patients, the ABPM day short form (SF-36) form was filled by all patients. ABPM was performed with oscillometric type, model and number spacelabshealtcar 2010 ref 90207-1Q, SN 207-063257 brands. Moduls were stuied with DPP machine, CRP was studied by immunoturbimetric method with Dode Behring II" type machine, ferritin was studied by immunoturbimetric method with Roche Moduler system type machine. Full blood count was stuied by Beckman type coulter machine. Il-6 and Il-8 measurement is studied by ELISA method. (DIAsource, Belgium) Findings: When PD and HD patients' subunit of quality of life points were compared, in HD patients all of the subunit points were higher except physical fucntion points. In a comparison of HD patients and Rtx patients, all subgroups of QOL scores were significantly higher in patients with Rtx, and pain, mental health, social function, physical function was statistically significant in sub-units. (p <0.05) When RTX patients and PD patients' quality of life scale scores were analyzed it was higher in Rtx patients and general health, mental health, emotional role limitations due to the difference in the sub-unit, was found to be statistically significant. (p <0.05) With the control group Rtx patients were compared, general health, social functioning subscale of the control group scores were higher but pain, mental health, energy, physical function, role emotional distress scores were higher in Rtx patients. The difference with pain, social functioning scales, was statistically significant. (p <0.05) When HD and PD patients compared, ABPM measurements are showed no statistically significant differences. (p> 0.05) When looking at HD and Rtx patients, no significant differences in the measurement of DBP and DBP load while there was a statistical difference in other measurements. (p <0.05 ). When PV and Rtx patients compared with blood pressure measurement in the PD patients was observed to be significantly higher. (p <0.05) Rtx patients with patients in the control group were compared, the load of SBP and DBP load was significantly higher statistically in Rtxhasta. (p <0.05) When RTX and control patients were compared with PD and HD patients, the sedimentation rate and CRP levels were significantly higher in dialysis patientsSF-36 quality of life scale scores, IL-6, erythrocyte sedimentation rate, ferritin level and presence of concomitant disease of was significantly correlated, but there was no relationship between blood pressure monitoring with the SF-36 quality of life scale scores. All three in patients receiving RRT, nocturnal blood pressure load was increased. Interestingly, daytime blood pressure follow up, which is lower than Rtx follow-up of patients with dialysis patients, night-time blood pressure monitoring and blood pressure calculated load was higher in the control group of patients. Interestingly, in daytime blood pressure follow up, Rtx patients were lower than dialysis patients but with night time follow up of blood pressure, calculated load was higher than the control group of patients. Results: There is relationship found between SF-36 quality scores andI l-6, erythrocyte sedimentation rate, ferritin level and presence of concomitant disease but there is no relationship between detected blood pressure monitoring with the SF-36 quality of life scale scores. All three in patients receiving RRT, nocturnal blood pressure load was increased. Interestingly, in daytime blood pressure follow up, Rtx patients were lower than dialysis patients but with night time follow up of blood pressure, calculated load was higher than the control group of patients. With RRT, llifetime is important as well as the to the quality of life and it can be said that kidney transplant provides better quality of life to the patients. Although there was good control of blood pressure during the day, even in these patients, nocturnal blood pressure and high blood pressure loads due to continue, it is recommended to evaluate patients with ABPM. Although there was good control of blood pressure during the day, even in these patients, due to continue of nocturnal blood pressure and high blood pressure loads, it is recommended to evaluate patients with ABPM.