CLINICAL, LABORATORY AND ISTUMENTAL PARAMETERS ASSOCIATED WITH ARTERIAL PRESSURE AT PATIENTS’ ON PROGRAMMED HEMODIALYSIS
https://doi.org/10.24884/1561-6274-2011-15-2-49-56
Abstract
THE AIM. To study of the data of clinical, laboratory and instrumental parameters associated with arterial hypertension (AH) in the prevalent group of programmed hemodialysis (PHD) patients. PATIENTS AND METHOS. The medical examination was carried out in a prevalent group of patients (n=75) without of cardiovascular insufficiency and who had relatively compensated anemia. They received adequate standard PHD 3 times a week. Their mean arterial pressure (APm) measured 5 minutes before the beginning of a hemodialysis session was more than 107 mmHg. A clinical, laboratory and instrumental examination of the patients was conducted. RESULTS. Among the patients involved in the research 3% had «soft», 54% «moderate» and 43% «grave» AH. It has been ascertained that AH is associated with a shorter dialysis experience (r =-0.21), higher mass of a body index (IMB) (r =0.22), presence of pericardium friction noise (r =0.30), dullness of the percussion sound in iferolateral sections of lung fields (r =0.45), presence of moist rales (r =0.71), worse correction of anemia (r=-0.45), lesser iron reserves (r =-0.37) and lesser international normalized relation (INR) (r =0.37). A higher AP is associated with a higher content of C-reactive protein (CRP) (r =0.37), a atherogenic index (r =0.28), higher values of triglycerides (r =0.29), predialysis plasma sodium (r =0.34), potassium (r =0.43) and phosphorous (r =0.14). In addition to that, a high level of AP is associated with the presence of exudation in the pericardium (r =0.23), a higher left ventriculi mass index (LVMI) (r =0.17), a larger size of the right atrium (r =0.21), a higher pressure in the pulmonary artery ( r =0.34) and a lesser ejection fraction (r =0,32). CONCLUSION. Presented clinical, laboratory and instrumental parameters associated with AH may be of practical value for PHD patients' correction therapy.
About the Authors
O. A. LYASHENKO
Центральная городская клиническая больница г. Липецка
Russian Federation
Russian Federation
K. Ya. GUREVICH
Санкт-Петербургская медицинская академия последипломного образования,
Russian Federation
Russian Federation
A. M. KORNEEV
Липецкий государственный технический университет
Russian Federation
Russian Federation
References
1. Cohen E P. Hypertension in chronic hemodialysis: viewing a paradox, and some notes on therapy. Dialys and Transplant 2000; 29: 535-542
2. Mazzuchi N, Carbonell E, Fernandez-Cean J. Importance of blood pressure control in hemodialysis patient's survival. Kidney Int 2000; 58 (5): P 2147-2154
3. Horl M P, Horl WH. Hemodialysis-associated иhypertension: pathophysiology and therapy. Am J Kidney Dis 2002; 39: 227-244
4. Rocco MV, Yan G, Heyka RJ, Benz R et al.; HEMO Study Group. Risk factors for hypertension in chronic hemodialysis patients: Baseline data from the HEMO study. Am J Nephrol 2001; 21: 280-288
5. Goodkin DA, Bragg-Gresham JL, Koenig KG et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol 2003; 14: 3270-3277
6. Pеrez-Garcia R, Martin-Malo A, Fort J, Cuevas X et al. Baseline characteristics of an incident haemodialysis population in Spain: results from ANSWER-a multicentre, prospective, observational cohort study. Nephrol Dial Transplant 2009; 24 (2): 578-588
7. Бикбов Б Т, Томилина НА. Состояние заместительной почечной терапии больных с хронической почечной недостаточностью в Российской Федерации в 1998-2007 г г. (Аналитический отчёт по данным Российского регистра заместительной почечной терапии). Нефрология и диализ 2009; 11 (3): 144-233
8. Paoletti E, Specchia C, Di Maio G et al. The worsening of the left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10year survey. Nephrol Dial Transplant 2004; 19: 1829-1834
9. Laurent G, Charra B. The results of an 8 h thrice weekly haemodialysis schedule. Nephrol Dial Transplant 1998; 13 (6): 125-131
10. Добронравов ВА, Боровская ЕА, Владимирова ЮФ, Смирнов АВ. Динамика артериального давления и его суточного профиля у пациентов на стандартном программном гемодиализе: данные двухсуточного мониторирования. Нефрология 2009; 13 (2): 42-49
11. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Jf Hypertens 1999; 17: 151-185
12. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977; 55: 613-618
13. DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916;17:863-871
14. Levy D, Savage DD et al. Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987; 59: 956-960
15. Daugirdas J T. Simplified equations for monitoring KT/V, PCRn, eKT/V, and ePCRn. Adv Ren Replace Ther 1995; 2: 295-304.
16. European best practice guidelines for the management of anemia in patients with chronic renal failure. Nephrol Dial Transplant 1999; 14 [Suppl 5]: 50p.
17. Leypoldt JK, Cheung AK, Delmez JA et al. Relationship between volume status and blood pressure during chronic hemodialysis. Kidney Int 2002; 61: 266-275
18. Luik AJ, van Kuijk WHM, Spek J et al. Effects of hypervolemia on interdialytic hemodynamics and blood pressure control in hemodialysis patients. Am J Kidney Dis 1997; 30: 466-474
19. Ventura JE, Sposito M. Volume sensitivity of blood pressure in end-stage renal disease. Nephrol Dial Transplant 1997; 12: 485-491
20. Wabel P, Moissl U, Chamney PC et al. Towards improved cardiovascular management: the necessity of comorbining blood pressure and fluid overload. Nephrol Dial Transplant 2008; 23: 2957-2964
21. Charra B, Bergstrom J, Scribner BH. Blood pressure control in dialysis patients: importance of the lag phenomenon. Am J Kidney Dis 1998; 32 (5): 720-724
22. Ozkahya M, Ok E, Toz H et al. Long-term survival rates in haemodialysis patients treated with strict volume control Nephrol Dial Transplant 2006; 21 (12): 3506-3511
23. Agarwal R, Alborzi P, Satyan S et al. Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP). Hypertension 2009; 53: 500
24. Дудко МЮ, Шутов ЕВ, Капитанов ЕН, Ермоленко ВМ. Влияние нарушений водного баланса на состояние сердечно-сосудистой системы у больных на заместительной почечной терапии. Нефрология и диализ 2006; 8 (3): 244-249
25. Ibrahim S, Taweel A. Influence of plasma volume status on blood pressure in patients on maintenance hemodialysis. Dialysis and Transplant 2007; 36 (1): 13-24
26. Волгина ГВ. Клиническая эпидемиология кардиоваскулярных нарушений при хронической почечной недостаточности (обзор литературы). Нефрология и диализ 2000; 2 (1-2): 25-32
27. Волгина ГВ, Перепеченых ЮВ, Бибков БТ и соавт. Факторы риска кардиоваскулярных заболеваний у больных с хронической почечной недостаточностью. Нефрология и диализ 2000; 2 (4): 252-258
28. Basile C, Lomonte C., Vernaglione L. et al. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant 2008; 23: 282-287
29. London GM, Guerin A P, Marchais SJ. Hemodynamic overload in the end-stage renal disease patients. Semin Dial 1999; 12: 77-83
30. Kooman J P, Van Der Sande FM, Leunissen KM. Role of sodium and volume in the pathogenesis of hypertension in dialysis patients. Reflections on pathophysiological mechanisms. Blood Purif 2004; 22: 55-59
31. Santos S F, Peixoto AJ. Hypertension in dialysis. Curr Opin Nephrol Hypertens 2005; 14: 111-118
32. Agarwal R. Management of hypertension in hemodialysis patients. Hemodial Int 2006; 10: 241-248
33. Tomson ChRV, Shresha SM. The pivotal role of sodium balance in control of blood pressure in dialysis patients. Hemodialysis International 2007; 11 [Suppl 2]: S21 -S26
34. Kooman J P, Van Der Sande FM, Leunissen KM. Sodium, blood pressure and cardiovascular pathology: is it all volaemia? Nephrol Dial Transplant 2004; 19: 1049-1049
35. de Wardener HE, He FJ, MacGregor GA. Plasma sodium and hypertension. Kidney Int 2004; 66: 2454-2466
36. He FJ, Markandu ND, Sagnella GA et al. Plasma sodium: ignored and underestimated. Hypertension 2005; 45: 98-102
37. Ермоленко ВМ. Хроническая почечная недостаточность. В: Тареева ИЕ, ред. Нефрология. Руководство для врачей. Медицина, М., 2000; 596 -644
38. Block GA, Hulbert-Shearon TE, Levin NW. et al. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998; 31: 607-617
39. Huang CX, Plantinga LC, Fink NE et al. Phosphate levels and blood pressure in incident hemodialysis patients: a longitudinal study. Adv Chronic Kidney Dis 2008; 15 (3): 321-331.
40. Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999; 340: 115-126
41. Triperi G, Mallamaci F, Zoccali C. Inflammantion markers, adhesion molecules, and all-cause and cardiovascular mortality in patients with ESRD: searching for the best risk marker by multivariate modeling. J Am Soc Nephrol 2005; 16 [Suppl 1]: 83-88
42. Wanner C, Zimmermann J, Schwelder S. et al. Inflammantion and cardiovascular risk in dialysis patients. Kidney Int 2002; S80: 99-102
43. Honda H, Qureshi A, Heimburger O. et al. Serum albumin, C-reative protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis 2006; 47: 139-148
44. London GM. Pathophysisology of cardiovascular damage in the early renal population. Nephrol Dial Transplant 2001; 16 (2): 3-6
45. Cooke J P. Does ADMA cause endothelial dysfunction? Arterioscler Thromb Vasc Biol 2000; 20: 2032-2037
46. U.S. Renal Data System, USRDS 2003 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diadetes and Digestive and Kidney Diseases, Bethesda, MD, 2003: 560
47. Harrison DG. Cellular and molecular mechanisms of endothelial dysfunction? J Clin Invest 1997; 100: 2153-2157
Review
For citations:
LYASHENKO O.A., GUREVICH K.Ya., KORNEEV A.M. CLINICAL, LABORATORY AND ISTUMENTAL PARAMETERS ASSOCIATED WITH ARTERIAL PRESSURE AT PATIENTS’ ON PROGRAMMED HEMODIALYSIS. Nephrology (Saint-Petersburg). 2011;15(2):49-56. (In Russ.) https://doi.org/10.24884/1561-6274-2011-15-2-49-56
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