Hemodiyalize Bağlı Gelişen Kardiyovasküler Disfonksiyona Yönelik Egzersiz Yaklaşımları

Yıl 2025, Cilt: 8 Sayı: 1, 25 - 37, 30.05.2025

Cansu Özdemir , Gülşah Barğı

https://doi.org/10.52538/iduhes.1587695

Öz

Hemodiyaliz, böbrek fonksiyonlarının yetersiz olduğu durumlarda, kanın yapay bir böbrek cihazı aracılığıyla temizlenmesini sağlayan bir tedavi yöntemidir. Bu süreçte, hastanın kanı vücut dışına alınarak diyaliz membranından geçirilir; bu sayede toksinler, fazla sıvı ve elektrolitler uzaklaştırılır. Hemodiyaliz kronik böbrek yetmezliği yaşayan hastalar için hayat kurtarıcı bir tedavi yöntemi olmasına rağmen, beraberinde kardiyovasküler disfonksiyon gibi sağlık sorunlarını da getirebilmektedir. Bu sebeple bu derlemede hemodiyalize bağlı olarak ortaya çıkan kardiyak disfonksiyon ve bu duruma yönelik uygulanan egzersiz yaklaşımlarını incelemeyi amaçladık. Eylül 2024 ve Kasım 2024 tarihleri arasında ‘‘böbrek diyalizi, böbrek yetmezliği, egzersiz, rehabilitasyon’’ anahtar kelimeleri kullanılarak PubMed, Google Akademik ve Scopus üzerinden elektronik veri tabanları tarandı. 2014-2024 yılları arasında toplamda 28 çalışmaya ulaşıldı. Konuyla ilgili 13 makale çalışmaya dahil edildi. Hemodiyaliz sırasında gelişen kardiyovasküler disfonksiyon, genellikle sıvı dengesizliği, elektrolit değişiklikleri ve oksidatif stres gibi faktörlerden kaynaklanmaktadır. Bu komplikasyonlar hastalarda kalp yetmezliği, aritmi ve koroner arter hastalığı gibi ciddi durumlara yol açarak yaşam kalitesini olumsuz etkilemektedir. Bu problemlerin yönetimi kapsamında çeşitli egzersiz yaklaşımları uygulanmaktadır. Bu egzersiz programları içerisinde aerobik egzersizler (bisiklet ergometresinde sürekli tipte), ev programları şeklinde uygulanan egzersizler ve hastanın durumuna göre de elastik bant veya ağırlık kaldırma şeklinde uygulanan dirençli egzersiz eğitimleri yer almaktadır. Literatürdeki çalışmalar, hemodiyalize giren bireylerde özellikle aerobik egzersizlerin kardiyovasküler komplikasyonları azaltmada etkili olduğunu göstermektedir. Egzersiz eğitimi sonrasında kalp atım hızı regüle olur, kan akışı iyileşir ve kardiyovasküler endurans artar. Böylece bu bireylerde kardiyovasküler disfonksiyon gelişme riski azalabilmektedir. Ayrıca, bireylerde elektrolit dengesizlikleri kontrol altına alınabilir, hipertansiyon yönetimi ve insülin duyarlılığı artar. Dolayısıyla bireylerin glisemik kontrolünün sağlanmasına da katkı sağlanabilir. Sonuç olarak, hemodiyaliz alınan günler dışında ve hemodiyaliz sırasında uygulanan egzersiz eğitimleri güvenlidir ve kardiyovasküler disfonksiyonun önlenmesinde faydalıdır. Bu nedenle hemodiyalize bağlanan bireylerin tedavisine düzenli uygulanan egzersiz programlarının entegrasyonuyla sağlıklarını desteklemek ve yaşam kalitelerini artırmak mümkündür.

Anahtar Kelimeler

Böbrek diyalizi , böbrek yetmezliği , egzersiz , rehabilitasyon

Exercise Approaches for Cardiovascular Dysfunction Due to Hemodialysis

Öz

Hemodialysis is a treatment method that cleanses the blood through an artificial kidney device when kidney function is insufficient. In this process, the patients blood is taken outside the body and passed through a dialysis membrane, which removes toxins, excess fluid and electrolytes. Although hemodialysis is a life-saving treatment for patients with chronic renal failure, it can also bring health problems such as cardiovascular dysfunction. Therefore, in this review, we aimed to examine cardiac dysfunction associated with hemodialysis and exercise approaches to address this condition. Between September 2024 and November 2024, electronic databases were scanned through PubMed, Google Scholar and Scopus using the keywords “exercise, rehabilitation, renal dialysis, renal insufficiency”. A total of 28 studies were found between 2014-2024. Related 13 articles were included in the study. Cardiovascular dysfunction during hemodialysis is usually caused by factors such as fluid imbalance, electrolyte changes and oxidative stress. These complications lead to serious conditions such as heart failure, arrhythmia and coronary artery disease in patients, negatively affecting quality of life. Various exercise approaches are applied in the management of these problems. These exercise programs include aerobic exercises (continuous type on bicycle ergometer), exercises applied in the form of home programs and resistance exercise training applied in the form of elastic band or weight lifting according to the patient's condition. Studies in the literature show that especially aerobic exercises are effective in reducing cardiovascular complications in individuals undergoing hemodialysis. After exercise training, heart rate is regulated, blood flow improves and cardiovascular endurance increases. Thus, the risk of developing cardiovascular dysfunction may be reduced in these individuals. In addition, electrolyte imbalances can be controlled, hypertension management and insulin sensitivity can be improved. Therefore, it may also contribute to the glycemic control of individuals. In conclusion, exercise training outside the days of hemodialysis and during hemodialysis is safe and beneficial in preventing cardiovascular dysfunction. Therefore, it is possible to support their health and improve their quality of life by integrating regular exercise programs into the treatment of individuals on hemodialysis.

Anahtar Kelimeler

Exercise , rehabilitation , renal dialysis , renal insufficiency

Kaynakça

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