Efekti pulsnog elektromagnetnog polja ekstremno niske frekvencije na gustinu kosti i incidenciju preloma kod bolesnika sa terminalnom bubrežnom slabošću na dijalizi: trogodišnja studija praćenja
Sažetak
Uvod/Cilj. Različite metode fizikalne terapije koriste se u lečenju mišićno-skeletnih oboljenja uključujući i ona koja se karakterišu sniženom mineralnom koštanom gustinom (BMD). Pulsno elektromagnetno polje ekstremno niske frekvencije (ELF-PEMF) stimuliše formiranje koštanog tkiva. Zbog poremećaja koštanog tkiva multifaktorijalne patogeneze bolesnici sa terminalnom bubrežnom slabošću (TBS) imaju visoku učestalost preloma. Vitamin D, suplementi kalcijuma, antiresorptivni i anabolički lekovi kod ovih bolesnika, zbog izmenjene farmakodinamike i farmakokinetike imaju minimalne ili ograničene efekte. Cilj ovog rada bio je da se ispitaju efekti dugotrajne primene ELF-PEMF u kombinaciji sa kineziterapijom na BMD, učestalost novih preloma kostiju i koncentraciju parathormona kod bolesnika sa TBS na programu hemodijalize. Metode. U 3-godišnjoj prospektivnoj kliničkoj studiji bolesnici, njih 151, sa TBS na programu hemodijalize na dobrovoljnoj bazi, svrstani su u dve grupe: studijska grupa (ELF-PEMF, 18 Hz, 2 mT, primenjivana tokom 40 min posle 10 uzastopnih procedura hemodijalize, četiri puta tokom jedne godine, ukupno 120 tretmana tokom tri godine uz kineziterapiju) i kontrolna grupa (samo kineziterapija). Rezultati. Ukupno 124 bolesni-ka je završilo ispitivanje. U studijskoj grupi (n = 54), nezavisno od pola, posle tri godine primene ELF-PEMF postignuto je značajno poboljšanje BMD, T-skora i Z-skora na lumbalnoj kičmi i vratu butne kosti. U kontrolnoj grupi (n = 70), primećeno je značajno smanjenje BMD, T-skora i Z-skora uz veću incidencu novih preloma kostiju. Zaključak. Tehnika ELF-PEMF mogla bi predstavljati korisnu i bezbednu nefarmakološku metodu u programu prevencije preloma kod bolesnika sa TBS.
Reference
Hug K, Röösli M. Therapeutic effects of whole-body devices applying pulsed electromagnetic fields (PEMF): A systematic literature review. Bioelectromagnetics 2012; 33(2): 95−105.
Le Vay D. Pulsed magnetic field therapy for tibial non-union. Lancet 1984; 2(8395): 171−2.
Bassett CA. Fundamental and practical aspects of therapeutic uses of pulsed electromagnetic fields (PEMFs). Crit Rev Bio-med Eng 1989; 17(5): 451−529.
Shupak NM, Prato FS, Thomas AW. Therapeutic uses of pulsed magnetic field exposure: a review. Radio Sci Bull 2003, 1(307): 9–32.
Bassett CAL, Pilla AA, Pawluk RJ. A non-operative salvage of surgically resistant pseudarthrosis and non-unions by pulsing electromagnetic fields. A preliminary report. Clin Orthop Relat Res 1977; 124: 128−43.
Pieber K, Herceg M, Paternostro-Sluga T. Electrotherapy for the treatment of painful diabetic peripheral neuropathy: A review. J Rehabil Med 2010; 42(4): 289−95.
Giannakopoulos XK, Giotis C, Karkabounas SC, Verginadis II, Si-mos YV, Peschos D, et al. Effects of pulsed electromagnetic fields on benign prostate hyperplasia. Int Urol Nephrol 2011; 43(4): 955−60.
West SL, Lok CE, Jamal SA. Fracture Risk Assessment in Chronic Kidney Disease, Prospective Testing Under Real World Environments (FRACTURE): A prospective study. BMC Nephrol 2010; 11: 17.
Jamal SA, West SL, Miller PD. Fracture risk assessment in pa-tients with chronic kidney disease. Osteoporos Int 2012; 23(4): 1191−8.
Salam SN, Eastell R, Khwaja A. Fragility fractures and osteoporosis in CKD: Pathophysiology and diagnostic methods. Am J Kidney Dis 2014; 63(6): 1049−59.
Chen YJ, Kung PT, Wang YH, Huang CC, Hsu SC, Tsai WC, et al. Greater risk of hip fracture in hemodialysis than in perito-neal dialysis. Osteoporosis Int 2014; 25(5): 1513−8.
Stevens PE, Levin A. Kidney Disease: Improving Global Out-comes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kid-ney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158(11): 825−30.
Rodrıguez-Garcıa M, Gomez-Alonso C, Naves-Dıaz M, Diaz-Lopez JB, Diaz-Corte C, Cannata-Andıa JB. Asturias Study Group. Vascular calcifications, vertebral fractures and mortality in haemodialysis patients. Nephrol Dial Transplant 2009; 24(1): 239−46.
Ureña P, Bernard-Poenaru O, Ostertag A, Baudoin C, Cohen-Solal M, Cantor T, et al. Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 2003; 18(11): 2325−31.
Disthabanchong S, Jongjirasiri S, Adirekkiat S, Sumethkul V, Ingsa-thit A, Domrongkitchaiporn S, et al. Low hip bone mineral den-sity predicts mortality in maintenance hemodialysis patients: A five-year follow-up study. Blood Purif 2014; 37(1): 33−8.
Panaput T, Thinkhamrop B, Domrongkitchaiporn S, Sirivongs D, Praderm L, Anukulanantachai J. Dialysis Dose and Risk Factors for Death Among ESRD Patients Treated with Twice-Weekly Hemodialysis: A Prospective Cohort Study. Blood Purif 2014; 38(3−4): 253−62.
von der Recke P, Hansen MA, Hassager C. The association be-tween low bone mass at the menopause and cardiovascular mortality. Am J Med 1999; 106(3): 273−8.
Kohno K, Inaba M, Okuno S, Maeno Y, Maekawa K, Yamakawa T, et al. Association of reduction in bone mineral density with mortality in male hemodialysis patients. Calcif Tissue Int 2009; 84(3): 180−5.
Matsubara K, Suliman ME, Qureshi AR, Axelsson J, Martola L, Heimbürger O, et al. Bone mineral density in end-stage renal disease patients: Association with wasting, cardiovascular dis-ease and mortality. Blood Purif 2008; 26(3): 284−90.
Park SH, Jia T, Qureshi AR, Bárány P, Heimbürger O, Larsson TE, et al. Determinants and survival implications of low bone mineral density in end-stage renal disease patients. J Nephrol 2013; 26(3): 485−94.
Beaubrun AC, Kilpatrick RD, Freburger JK, Bradbury BD, Wang L, Brookhart MA. Temporal trends in fracture rates and postdischarge outcomes among hemodialysis patients. J Am Soc Nephrol 2013; 24(9): 1461−9.
Iimori S, Mori Y, Akita W, Kuyama T, Takada S, Asai T, et al. Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients-a single-center cohort study. Nephrol Dial Trans-plant 2012; 27(1): 345−51.
Wagner J, Jhaveri KD, Rosen L, Sunday S, Mathew AT, Fishbane S. Increased bone fractures among elderly United States hemodialysis patients. Nephrol Dial Transplant 2014; 29(1): 146−51.
Rajabi AH, Jaffe M, Arinzeh TL. Piezoelectric materials for tis-sue regeneration: A review. Acta Biomater 2015; 24: 12−23.
Schnoke M, Midura RJ. Pulsed electromagnetic fields rapidly modulate intracellular signaling events in osteoblastic cells: Comparison to parathyroid hormone and insulin. J Orthop Res 2007; 25(7): 933−40.
Vincenzi F, Targa M, Corciulo C, Gessi S, Merighi S, Setti S, et al. Pulsed electromagnetic fields increased the anti-inflammatory effect of A2A and A3 adenosine receptors in human T/C-28a2 chondrocytes and hFOB 1.19 osteoblasts.. 19 osteoblasts. PLoS One 2013; 8(5): e65561.
Jing D, Cai J, Wu Y, Shen G, Li F, Xu Q, et al. Pulsed electro-magnetic fields partially preserve bone mass, microarchitec-ture, and strength by promoting bone formation in hindlimb-suspended rats. J Bone Miner Res 2014; 29(10): 2250−61.
Jing D, Li F, Jiang M, Cai J, Wu Y, Xie K, et al. Pulsed electro-magnetic fields improve bone microstructure and strength in ovariectomized rats through a Wnt/Lrp5/β-catenin signaling-associated mechanism. PLoS One 2013; 8(11): e79377.
Luo F, Hou T, Zhang Z, Xie Z, Wu X, Xu J. Effects of pulsed electromagnetic field frequencies on the osteogenic differentiation of human mesenchymal stem cells. Orthopedics 2012; 35(4): e526−1.
Goto T, Fujioka M, Ishida M, Kuribayashi M, Ueshima K, Kubo T. Noninvasive up-regulation of angiopoietin-2 and fibroblast growth factor-2 in bone marrow by pulsed electromagnetic field therapy. J Orthop Sci 2010; 15(5): 661−5.
Shen WW, Zhao JH. Pulsed electromagnetic fields stimulation affects BMD and local factor production of rats with disuse osteoporosis. Bioelectromagnetics 2010; 31(2): 113−9.
Bragin DE, Statom GL, Hagberg S, Nemoto EM. Increases in mi-crovascular perfusion and tissue oxygenation via pulsed elec-tromagnetic fields in the healthy
Wang Q, Wu W, Han X, Zheng A, Lei S, Wu J, et al. Osteogenic differentiation of amniotic epithelial cells: Syner-gism of pulsed electromagnetic field and biochemical stimuli. BMC Musculoskelet Disord 2014; 15: 271.