Hemodiyaliz Hastalarında Hipervolemi ile Nabız Basıncı Arasındaki İlişki

Yıl 2021, , 380 - 385, 25.12.2021

Sami Evirgen , Alaattin Yıldız

https://doi.org/10.29058/mjwbs.951357

Öz

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 arasında
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.

Anahtar Kelimeler

Nabız Basıncı, Hipervolemi, Hemodiyaliz

The Relationship Between Pulse Pressure and Hypervolemia in Hemodialysis Patients

Öz

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.

Anahtar Kelimeler

Pulse Pressure, Hypervolemia, Hemodialysis

Kaynakça

• 1. Blacher J, Guerin AP, Pannier B, et al. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999; 99: 2434–9.
• 2. London GM, Gue ´rin AP, Marchais SJ, Me ´tivier F, Pannier B, Adda H : Arterial media calcification in end-stage renal disease:Impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003; 18: 1731–40.
• 3. London GM, Marchais SJ, Guerin AP: Arterial stiffness and function in end-stage renal disease. Adv Chronic Kidney Dis 2004;11: 202–9.
• 4. Amann K: Media calcification and intima calcification are distinct entities in chronic kidney disease. Clin J Am Soc Nephrol 2008;3: 1599–605.
• 5. Barenbrock M, Spieker C, Laske V, Heidenreich S, Hohage H, Bachmann J, Hoeks AP, Rahn KH: Studies of the vessel wall properties in hemodialysis patients. Kidney Int 1994; 45: 1397-400,
• 6. Charra B, Calemard E, Ruffet M. Survival as an index of adequacy of dialysis. Kidney Int 1992; 41:1286–91.
• 7. Tozawa M, Iseki K, Fukiyama K: Hypertension in dialysis patients: A cross-sectional analysis. Jpn J Nephrol 1997;3:129-35.
• 8. Salem MM: Hypertension in the hemodialysis population: A survey of 649 patients. Am J Kidney Dis 1995;.26:461-68.
• 9. Amar J, Vernier I, Rossignol E, Bongard V, Arnaud C, Conte JJ, Salvador M, Chamontin B: Nocturnal blood pressure and 24hour pulse pressure are potent indicators of mortality in hemodialysis patients. Kidney Int 2000; 57: 2485–91
• 10. Blacher J, Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM:Carotidarterial stiffnessasapredictorof cardiovascularand all-cause mortality in end-stage renal disease. Hypertension 1998;32: 570–74
• 11. Inrig JK, Patel UD, Toto RD, et al. Decreased pulse pressure during hemodialysis is associated with improved 6-month outcomes. Kidney Int 2009; 76: 1098–1107
• 12. Blumberg A, Nelp WB, Hegstrom RM et al. Extacellular volume in patients with chronic renal disease treated for hypertension by sodium restriction. The Lancet 1967; 2: 69–73
• 13. Rahman M, Fu P, Sehgal AR et al. Interdialytic weight gain, compliance with dialysis regimen, and age are independent predictors of blood pressure in hemodialysis patients. Am J Kidney Dis 2000; 35: 257–65
• 14. Charra B, Chazot C, Jean G, Laurent G. Long, slow dialysis. Miner Electrolyte Metab 1999; 25: 391–96
• 15. Katzarski KS, Charra B, Luik AJ et al. Fluid state and blood pressure control in patients treated with long and short hemodialysis. Nephrol Dial Transplant 1999; 14: 369–75
• 16. Chen YC, Chen HH, Yeh JC, Chen SY.Adjusting dry weight by extracellular volume and body composition in hemodialysis patients. Nephron. 2002 Sep;92(1):91-6
• 17. Guyton AC: Arterial Pressure and Hypertension. Philadelphia: WB Saunders, 1980
• 18. Kim KE, Onesti G, Swartz C: Hemodynamics of hypertension in chronic end-stage renal disease.Circulation 1972; 46: 456–61
• 19. Ahmad S, Kenny MA, Scribner BH: Hypertension and digoxin-like substance in the plasma of dialysis patients: possible marker of natriuretic hormone. Clin Phys Biochem 1986; 4: 210–16
• 20. Briganti M, Montanari A, Cocchi R, Bondi A, Fusaroli M. Longitudinal assessment of body composition in CAPD patients using bioelectric impedance analysis. A comparison with hemodialysis patients. ASAIO J 1995 Jul-Sep; 41(3): M725-7
• 21. Katzarski K, Charra B, Laurent G, Lopot F, Divino-Filho JC, Nisell J, Bergstrom J.Multifrequency bioimpedance in assessment of dry weight in haemodialysis. Nephrol Dial Transplant. 1996;11 Suppl 2:20-3
• 22. Alvarez-Lara MA, Martin-Malo A, Espinosa M, Rodriguez-Benot A, Aljama P.Blood pressure and body water distribution in chronic renal failure patients. Nephrol Dial Transplant. 2001;16 Suppl 1:94-7
• 23. Chertow GM, Lazarus JM, Lew NL, Ma L, Lowrie EG. Bioimpedance norms for the hemodialysis population. Kidney Int. 1997 Dec;52(6):1617-21
• 24. Dumler F, Kilates C.Body composition analysis by bioelectrical impedance in chronic maintenance dialysis patients: comparisons to the National Health and Nutrition Examination Survey III. J Ren Nutr. 2003 Apr;13(2):166-72
• 25. Dumler F.Best method for estimating urea volume of distribution: comparison of single pool variable volume kinetic modeling measurements with bioimpedance and anthropometric methods. ASAIO J. 2004 May-Jun;50(3):237-41
• 26. Zaluska WT, Schneditz D, Swatowski A, Jaroszynski AJ, Ksiazek A.Comparison of prescribed and delivered doses of dialysis using anthropometrically and bioelectrically measured patient volumes. Med Sci Monit. 2003 Sep;9(9):CR405-10
• 27. Cavalcanti S, Cavani S, Santoro A. Role of short-term regulatory mechanism on pressure response to hemodialysis induced hypovelemia. Kidney Int 2002; 61: 228–38.
• 28. Spiegel DM, Bashir K, Fisch B. Bioimpedance resistance ratios for the evaluation of dry weight in hemodialysis. Clin Nephrol 2000; 53: 108–14
• 29. .Jaeger JQ, Mehta RL. Assessment of dry weight in hemodialysis: an overview. J Am Soc Nephrol 1999; 10: 392–403
• 30. Fagugli MR, Pasini P, Quintaliani G et al. Association between extracellular water, left ventricular mass and hypertension in haemodialysis patients Nephrol Dial Transplant. 2003; 18: 2332–38
• 31. Wizemann V, Moissl U  Differences in hydration status between healthy, pre-ESRD, dialysis, transplante subgroups can be distinguished clearly with Bioimpedance spectroscopy
• 32. Blacher J, Staessen JA et al. Pulse Pressure Not Mean Pressure Determines Cardiovascular Risk in Older Hypertensive Patients. Arch İntern Med. 2000; 160 : 1085-89
• 33. Cin SD, Braga M, Molinari M, Cristallo M, Di Carlo V. Role of bioelectrical impedance analysis in acutely dehydrated subjects Clin Nutr 1992; 11: 128-33
• 34. Foley NR, Charles A et al. Blood pressure and long-time mortality in United States hemodialysis patients. Kidney int. 2002;62:1784-90
• 35. Klassen PS, Lowrie EG et al. Association between pulse pressure and mortality in patients undergoing maintenance hemodialysis. JAMA.2002;287:1548-55
• 36. Kalainy S, Reid R, Jindal K, Pannu N, Braam B. Fluid volume expansion and depletion in hemodialysis patients lack association with clinical parameters. Can J Kidney Health Dis. 2015 Dec 22;2:54
• 37. Hur E, Usta M, Toz H, et al. Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: a randomized controlled trial. Am J Kidney Dis 2013; 61: 957-65
• 38. Seibert E, Müller SG, Fries P et al. Calf Bioimpedance Spectroscopy for Determination of Dry Weight in Hemodialysis Patients: Effects on Hypertension and Left Ventricular Hypertrophy. Kidney Blood Press Res 2013;37:58-67
• 39. Onofriescu M, Siriopol D, Voroneanu L, Hogas S, Nistor I, Apetrii M, Florea L, Veisa G, Mititiuc I, Kanbay M, Sascau R, Covic A. Overhydration, Cardiac Function and Survival in Hemodialysis Patients. PLoS One. 2015 Aug 14;10(8)
• 40. Moissl U, Arias-Guillen M, Wabel P, et al. Bioimpedance-guided fluid management in hemodialysis patients. Clin J Am Soc Nephrol 2013;8:1575-82
• 41. O’Lone EL, Visser A, Finney H, Fan SL. Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients: independent predictor of patient survival. Nephrol Dial Transplant 2014;29:1430-37
• 42. Lertdumrongluk P, Streja E, Rhee CM, et al. Changes in pulse pressure during hemodialysis treatment and survival in maintenance dialysis patients. Clin J Am Soc Nephrol 2015; 10(7): 1179–91
• 43. Hong YA, Yoon HE, Choi BS, Shin SJ, Kim YS, Lee SY, Lee SH, Kim SH, Lee EY, Shin SK, Kwon YJ, Kim JH, Chang YK, Kim SY, Kim JE, Ahn SY, Ko GJ. The Effect of Strict Volume Control Assessed by Repeated Bioimpedance Spectroscopy on Cardiac Function in Peritoneal Dialysis Patients. Sci Rep. 2019 Nov 27;9(1):176-79