만성 신부전과 동반된 일차성 알도스테론증 1예

Abstract

Background : Early detection and treatment of chronic kidney disease (CKD) are important for inhibition of kidney disease progression and prevention of cardiovascular complications. Treatment of Anemia that is frequently accompanied with CKD, are important for prevention of cardiovascular complications. The lastest K/SOQI-CKD guideline targets early detection and treatment of kidney disease, and the study for these are necessary in Korea. In Korea, until mowadays, the study for prevalence, severity of anemia and influencing factors on anemia in CKD, were rare. Thus in our center, we classified patient for severity of CKD as K/DOQI-CKD guideline and studied prevalence, severity of anemia and influencing factors on anemia. Methods : According to K/DOQI-CKD guideline, patients were staged by GFR calculated by Adbbreviated MDRD Study Equation. Anemia was defined by Hb lessl than 10.0 g/dL below which hemodynamic change develops. We examined the frequency of anemia and independent factors that influences on anemia in study patients. Results : Mean creatinine levels for stage 1 to 5 were 0.87±0.15 (0.7-1.1) mg/dL; 1.04±0.18 (0.8-1.4) mg/dL; 1.69±0.36 (1.1-2.7) mg/dL; 2.90±0.66 (1.9-4.7) mg/dL; 5.01±1.28 (3.3-8.8) mg/dL. Mean Hb levels and percentage of anemic patients in each stages were 12.95±1.46 (10.5-15.4) g/dL, 0%; 13.31±2.20 (7.8-17.7) g/dL, 10.3%; 11.32±2.07 (7.4-16.6) g/dL, 25.5%; 10.10±1.71 (6.7-14.0) g/dL, 54.8%; 9.21±1.53 (6.2-12.2) g/dL, 76.9%. The frequency of anemia were high in Diabeltes Mellitus Mellitus (DM) compared to Non-Diabeltes (Non-DM) at stage 3, 4, 5 [36.7 vs 12.0% (p=0.06); 70.6 vs 35.7% (p=0.000); 100 vs 64.7% (p=0.06)]. Multivariate logistic regression analysis revealed that DM as etiology (OR 2.53, p=0.033 compared with Non-DM), Albumin level (OR of 5.38 p=0.001 for 3.0-1.4 compared with 4.0-5.3 g/dL) were independent factor determing anemia state in addition to K/DOQI guideline stage. GFR, sex, DM, Albumin level were independent factors associated with hemoglobin levels (R^2=0.571, p<0.001). Conclusion : Anemia in CKD was developed relatively early and frequently at stage 3 (Cr, 1.69±0.36 mg/dL, 25.5%) and more aggravated as decreasing renal function (stage 4, 5; 54.8%, 76.9%). DM as underlying disease, hypoalbuminemia were, independently influenced Anemia development.