The pathogenesis of hypertension in end stage renal disease; the importance of the sodium and volume control

Yıl 2012, Cilt: 1 Sayı: 3, 177 - 181, 01.09.2012

Hikmet Tekçe Gülali Aktaş Seyhun Kürşat

https://doi.org/10.5505/abantmedj.2012.36844

Öz

Hypertensions is a common clinical problem among patients with end stage renal failure. Because physiopathology of hypertension in these patients is multifactoriel, complicated and less understood, effective blood pressure control usually can not be achieved in this population. Major two risk factors in the pathogenesis of hypertension in patients receiving hemodialysis treatment are extracellular volume and dietary sodium intake. Therapeutic targets should be determined according to etiopathogenesis. There is increasing number of evidence indicating sodium intake in patients with end stage renal failure is related to volume overload and hypertension. Because sodium plays a key role in hypertension development among these population, salt restriction and additional ultrafiltration, if necessary, should be the mainstay of the antihypertensive treatment instead of antihypertensive drugs.

Anahtar Kelimeler

End stage renal disease, hypervolemia, sodium

Son dönem böbrek yetmezliğinde hipertansiyon ve patogenezi; sodyum ve volüm kontrolünün önemi

Öz

Hipertansiyon, son dönem böbrek yetmezliği SDBY hastalarında oldukça yaygın görülen bir klinik problemdir. Buna karşın bu hastaların etkin kan basıncı kontrolünden çoğu zaman uzak olmasının önemli bir sebebi, bu hasta grubunda hipertansiyon fizyopatolojisinin karmaşık, multifaktoriyel ve az anlaşılmış olmasından kaynaklanmaktadır. Hemodiyaliz hastalarındaki hipertansiyonun patogenezinde majör risk faktörlerinden ikisi, artmış ekstrasellüler volüm ve sodyum alımıdır. Buradan yola çıkarak terapödik hedefin anahatları da bu etyopatogenez çerçevesinde belirlenmelidir. Bulgular SDBY hastalarında sodyum yüklenmesinin, volüm yüklenmesi ve hipertansiyonla paralel seyrettiğini düşündürmektedir. Bu durum sodyumun, hipertansiyon için kilit bir rol oynadığını ve tedavinin yönetiminde esas uğraşı alanının antihipertansif ilaç desteği değil, tuz kısıtlaması ve gereğinde ek ultrafiltrasyon desteğinin olması yönündeki mücadelenin merkezi rolünü düşündürmektedir.

Anahtar Kelimeler

Son dönem böbrek yetmezliği, hipervolemi, sodyum

Kaynakça

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