nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2005-9-1-34-38nefr-790Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSВОЗРАСТ И АРТЕРИАЛЬНОЕ ДАВЛЕНИЕ У БОЛЬНЫХ НА ГЕМОДИАЛИЗЕAGE AND ARTERIAL PRESSURE IN HEMODIALYSIS PATIENTSДобронравовВ. А.DobronravovV. A.

отделение гемодиализа

СмирновА. В.SmirnovA. V.

отделение гемодиализа

БабарыкинаЕ. В.BabarykinaE. V.

отделение гемодиализа

БоровскаяЕ. А.BorovskayaE. A.

отделение гемодиализа

ВладимироваЮ. В.VladimirovaYu. V.

отделение гемодиализа

КоношковаР. В.KonoshkovaR. V.

отделение гемодиализа

КузнецовА. А.KuznetsovA. A.

отделение гемодиализа

Научно-исследовательский институт нефрологии, Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова; Омская областная больницаРоссия200510012005913438Copyright © Добронравов В.А., Смирнов А.В., Бабарыкина Е.В., Боровская Е.А., Владимирова Ю.В., Коношкова Р.В., Кузнецов А.А., 20052005Добронравов В.А., Смирнов А.В., Бабарыкина Е.В., Боровская Е.А., Владимирова Ю.В., Коношкова Р.В., Кузнецов А.А.Dobronravov V.A., Smirnov A.V., Babarykina E.V., Borovskaya E.A., Vladimirova Y.V., Konoshkova R.V., Kuznetsov A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/790

ЦЕЛЬЮ ИССЛЕДОВАНИЯ была оценка влияния возраста на параметры системного АД в группе пациентов, получающих лечение гемодиализом (ГД). ПАЦИЕНТЫ И МЕТОДЫ. Обследовано 252 больных, получавших лечение хроническим ГД. Средняя длительность ГД составила 62±53 мес. Первичная почечная патология была представлена хроническим гломерулонефритом (68%), поликистозом почек (9%), аномалиями развития мочевых путей (7%), интерстициальными заболеваниями (16%). Средние значения возраста в обследованной группе составили 42,9+12,7 лет (1974 года, 95% доверительный интервал 41,444,5 года). РЕЗУЛЬТАТЫ. Сравнительный анализ средних значений систолического (САД), диастолического (ДАД), среднего (АДср) и пульсового АД (ПАД) позволил установить, что АД (за исключением ПАД) имеет более низкие значения в возрастной группе больных 60 74 лет, а наиболее высокие – среди лиц 1944 лет. Значения АД в группе больных 4559 лет имели промежуточные значения (все рANOVA<0,005). Выявлена отчетливая отрицательная зависимость между текущим возрастом больных на ГД и величинами САД, ДАД и АДср (все р<0,001). ПАД от возраста не зависело (r=0,107, p=0,09). По данным множественного регрессионного анализа возраст вошел в число независимых и достоверных предикторов уровня АДср (β =0,269, р=0,0003), наряду с длительностью диализной терапии (β =0,311,р= 0,000021), продолжительностью процедуры ГД (β =0,241,р=0,0007), диаметром аорты (β =0,176, р=0,0189) и кальцийфосфатным произведением (Са*Р) (β =0,154, р=0,0274). Тот же анализ, проведенный для САД и ДАД, даланалогичные результаты при сохраняющейся высокой достоверности окончательной регрессионной модели (R2 =0,324, р=0,0001 и R2 = 0,313, р=0,0001, соответственно). ПАД определялось длительностью лечения ГД (β=0,3, р=0,00002), средней продолжительностью процедуры ГД (β=0,19, р=0,008) и Са*Р (β=0,2, р=0,005). ЗАКЛЮЧЕНИЕ. Полученные данные требуют проведения дополнительных исследований для уточнения механизмов возрастных изменений АД и свидетельствуют о необходимости более осторожного подхода к его контролю у лиц среднего и пожилого возраста, включая фармакотерапию и выбор режима ГД.

THE AIM of the investigation was to assess the effects of age on the parameters of systemic arterial pressure (AP) in a group of patients treated by hemodialysis (HD). PATIENTS AND METHODS. Under examination there were 252 patients on chronic HD. The average duration of HD was 62±53 months. Primary renal pathology was presented by chronic glomerulonephritis (68%), polycystosis of the kidneys (9%), malformations of the urinary tracts (7%), interstitial diseases (16%). Mean values of the age in the group under examination were 42.9±12.7 years (1974 years, 95% confidence interval 41.444.5 years). RESULTS. A comparative analysis of mean values of systolic (SAP), diastolic (DAP), average (APaver) and pulse AP (PAP) has revealed that AD (PAP excluded) has lower values in the group of elderly patients of 6074 years of age, and the highest values  among the patients of 1944 years of age. The AP values in 4559 year old patients were intermediate (all Panova <0.005). A clear negative dependence was found between the current age of the HD patients and the values of SAP, DAP and APaver(all p<0.001). PAP did not depend on the age (r=0.107, p=0.09). By the data of multiple regressive analysis the age was included in the group of independent and reliable predictors of the APaver level (β=0.269, p=0.0003) along with the duration of the dialysis therapy (β=0.311, p=0.000021), duration of the HD procedure (β=0.241, p=0.0007), the aorta diameter (β=0.176, p=0.0189) and the calciumphosphate product (Ca* P) (β=0.154, p=0.0274). The same analysis used for SAP and DAP gave similar results with the retained high reliability of the final regression model (R2 =0.324, p=0.0001 and R2 =0.313, p=0.0001, respectively). PAP was determined by the duration of HD treatment (β=0.3, p=0.00002), average duration of the HD procedure (β=0.19, p=0.008) and Ca* P (β=0.2, p=0.005). CONCLUSION. The data obtained need additional investigations in order to specify the mechanisms of agedependent change of AP and show a more careful approach to be necessary to its control in patients of the middle and elderly age including pharmacotherapy and choice of the HD regimen.

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The authors declare that there are no conflicts of interest present.