Spremljanje serumskih koncentracij vitamina B12 in folatov pri bolnikih s kronično ledvično boleznijo na dializnem zdravljenju

Jenko, Vita (avtor), Jerin, Aleš (mentor), Vajdič Trampuž, Barbara (komentor)

Kronična ledvična bolezen (KLB) predstavlja pomemben izziv za zdravstveni sistem, saj gre za napredujočo in ireverzibilno bolezen, njeno obvladovanje pa zahteva redno spremljanje in dolgotrajno zdravljenje bolnikov. Ti so hkrati dovzetni za pojav neravnovesja v koncentracijah vitamina B12 in folatov, ki imata osrednjo vlogo v številnih fizioloških procesih. Znižane koncentracije vitaminov se pojavijo kot posledica prehranskih pomanjkljivosti, vpliva medsebojnega delovanja zdravil ter samega procesa dialize, med tem ko so povišane koncentracije najpogosteje posledica nadomeščanja teh dveh vitaminov. V magistrsko nalogo smo vključili 70 bolnikov, ki so pod rednim kliničnim spremljanjem, in jim v serumu izmerili koncentracijo vitamina B12 ter folatov z elektrokemiluminiscenčno imunsko metodo (ECLIA). Predpostavili smo, da so koncentracije teh dveh vitaminov pri dializnih bolnikih primerljive z vrednostmi v zdravi populaciji. V preiskovani skupini dializnih bolnikov je imelo 18,6 % posameznikov povišano koncentracijo vitamina B12, 20 % znižano koncentracijo folatov in 8,6 % povišano koncentracijo folatov. Delež dializnih bolnikov izven referenčnega območja pri obeh vitaminih presega 5 %, kar nakazuje, da njihove koncentracije niso primerljive z zdravimi osebami. Bolnike smo razdelili glede na spol, starost (< 45 let, 45–70 let, > 70 let; ter znotraj/izven starostnega razpona, na katerem temelji referenčno območje), čas na dializnem zdravljenju (< 5 let ali ≥ 5 let), pogostost dializ (2- ali 3-krat tedensko) ter čas odvzema krvi (januar, april; ter marec, julij, oktober, januar, april). Analiza je pokazala statistično značilno razliko v koncentracijah folatov med bolniki, starimi med 20–65 let, ki predstavljajo starostno skupino, na kateri temelji referenčno območje proizvajalca, in bolniki, starejšimi od 65 let (p = 0,0266). Primerjava koncentracij vitaminov znotraj enega leta je potrdila statistično značilne razlike med določenimi meseci. Najvišje koncentracije vitamina B12 so bile zabeležene v januarju, najnižje pa v aprilu. Koncentracije folatov so bile najvišje v poletnem oz. pozno poletnem času, najnižje pa pozimi. Rezultati, pridobljeni v sklopu magistrske naloge, podajajo boljši vpogled v stanje preskrbljenosti dializnih bolnikov z vitaminom B12 in folati. To je zelo heterogeno in ne povsem primerljivo s stanjem v zdravi populaciji.

• Jezik: Slovenski jezik
• Ključne besede: kronična ledvična bolezen, vitamin B12, folat, funkcionalno pomanjkanje, aktivna oblika
• Vrsta gradiva: Magistrsko delo/naloga
• Organizacija: FFA - Fakulteta za farmacijo
• Leto izida: 2025
• PID: 20.500.12556/RUL-173517
• Datum objave v RUL: 18.09.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Monitoring of serum vitamin B12 and folate concentrations in patients with chronic kidney disease undergoing dialysis treatment

Izvleček

Chronic kidney disease (CKD) poses a major burden on healthcare systems due to its progressive and irreversible nature, continuous monitoring and lifelong management of patients. Patients affected by this disease are also susceptible to imbalances in vitamin B12 and folate levels, both of which play a central role in many physiological processes. Deficiencies in these vitamins may arise from inadequate dietary intake, medication interactions or the dialysis procedure itself. Conversely, elevated levels are typically associated with supplementation. A total of 70 patients undergoing clinical follow-up were included in the analysis and serum levels of both vitamins were determined using electrochemiluminescence immunoassay (ECLIA). We assumed that vitamin B12 and folate concentrations in dialysis patients are comparable to the values in the healthy population. In the studied group, 18,6 % of patients had elevated vitamin B12 levels, 20 % decreased folate levels and 8,6 % elevated folate levels. The percentage of patients outside the reference range for either vitamin exceeded 5 %, indicating that their concentrations differ from those of healthy individuals. Patients were categorized by gender, age (< 45 years, 45–70 years, > 70 years; and within/outside the age range used to establish the reference range), duration of dialysis (< 5 years or ≥ 5 years), dialysis frequency (2 or 3 times per week) and the month of blood sampling (January, April; and March, July, October, January, April). A statistically significant difference in folate concentrations was found between two subgroups: one composed of patients within the age range used to establish the reference intervals (20–65 years), and the other consisting of patients outside the age range (older than 65 years) (p = 0,0266). Comparison of both vitamin concentrations throughout the year revealed statistically significant differences between certain months. Vitamin B12 levels were highest in January and lowest in April. Folate levels peaked in summer or late summer and were lowest during winter. The findings of this master's thesis provide a better insight into the state of vitamin B12 and folate status in dialysis patients, which is very heterogenous and not entirely comparable to the status in the healthy population.

• Ključne besede: chronic kidney disease, vitamin B12, folate, functional deficiency, active form