Hemodiyaliz Hastalarında Hipervolemi ile Nabız Basıncı Arasındaki İlişki

Amaç: Hipervolemi hemodiyaliz hastalarında yaygın bir problemdir. Çünkü optimal kuru ağırlığı belirlemek zordur. Kronik volüm yüklenmesi sol ventrikül hipertrofisine yol açar. Bu yüzden kardiyovasküler hastalık görülme oranı yüksektir. Yüksek nabız basıncı aortik sertleşmenin bir göstergesi ve kardiyovasküler mortalite için bağımsız bir risk faktörüdür. Hipertansif hemodiyaliz hastalarında nabız basıncı tek başına sistolik kan basıncına göre miyokard infarktüsü oluşum riski için daha güçlü bir risk faktörüdür. Bu çalışmanın amacı her ikisi de kardiyovasküler hastalık için risk faktörü olan hipervolemi ile nabız basıncı arasındaki ilişkiyi incelemektir. Gereç ve Yöntemler: Ortalama yaşları 48 ± 12 olan 70 (28 erkek (%40), 42 kadın (%60)) kronik hemodiyaliz hastası çalışmaya dahil edildi. Tüm hastalar haftada 3 gün hemodiyalize giriyordu. Vücut kompozisyonu monitörü (BCM) ile HD hastalarında sıvı durumu (Total Vücut Sıvısı, Ektrasellüler sıvı ve intrasellüler sıvı değerleri) iki kez (HD’nin başlangıcı ve bitişi) değerlendirildi ve aynı anda kan basınçları ölçüldü. Diyaliz öncesi ve sonrası kilo ölçümleri yapıldı ve kayıt edildi. Bulgular: Diyalizin girişindeki Ekstrasellüller Sıvı (ESS) / Vücut Ağırlığı (VA) (%) ile sırasıyla giriş sistolik kan basıncı ve nabız basıncı arasın- da anlamlı korelasyon bulundu (P=0.021,P=0.057 ). Diyastolik kan basıncı ile nabız basıncı ve hipervolemi arasında bir ilişki saptanmadı. Sonuç: İnterdiyalitik periyotta hastaların hipervolemik olması kardiyovasküler risk faktörlerine uzamış maruziyete neden olur. Çünkü hipervolemi ile nabız basıncı ve sistolik kan basıncı arasındaki ilişki bilinmektedir. Bu yüzden hastaların kuru ağırlığının doğru hesaplanması ile yeterli sıvının ultrafiltrasyonla çekilmesi sağlanabilir ve NB ile SKB’da orantılı azalmaya yol açarak kardiyovasküler olaylar azaltılabilir.

The Relationship Between Pulse Pressure and Hypervolemia in Hemodialysis Patients

Aim: Hypervolemia is a common problem in hemodialysis (HD) patients. Because reaching to optimal dry weight (DW) is difficult. Chronic volume overload causes left ventricular hypertrophy. Therefore, risk of cardiovascular events is very high. High pulse pressure is an indicator of aortic stiffness, an independent risk factor for cardiovascular mortality. Pulse pressure has a strong correlation with systolic blood pressure and thus with myocardial infarction in hypertensive HD patients. Aim of this study is to investigate the relationship between pulse pressure (PP) and hypervolemia. Material and Methods: Seventy (28 male (40%), 42 (60%) female) chronic HD patients with an average of age 48 ± 12 were enrolled. All patients underwent HD 3 times weekly were included. Fluid status [Total Body Water (TBW), ECW and Intracellular Water (ICW) values] was assessed twice (beginning and end of the HD) in HD patients with the body composition monitor (BCM). And blood pressure was measured simultaneously. Before and after hemodialysis, the weight of the patients was measured and recorded. Results: At the beginning of HD, Extracellular Water (ECW) / body weight (BW) (%) was associated systolic blood pressure (SBP) and PP measured simultaneously (P=0.021, P=0.057 respectively). There was no association between diastolic blood pressure with hypervolemia and PP. Conclusion: If patients have hypervolemia especially in the interdialitic period, they have prolonged exposition to cardiovascular risk factors, because hypervolemia is corralated with SBP and PP as well. Both of them are strongly associated with cardiovascular events. Removal of adequate fluid to obtain optimal dry weight causes decrease of systolic and pulse pressure proportionally.

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